RESUMO
The aim of this study was to investigate cardiac abnormalities in Kuwaiti sickle cell disease [SCD] patients using markers such as tricuspid regurgitant jet velocity [TRJV], pulmonary artery systolic pressure [PASP], and the 6-minute walk [6MW] test and correlate these findings with clinical, hematological, and biochemical parameters. Seventy-three patients with SCD and 70 matched controls were studied. The cardiac status was investigated using transthoracic echocardiography in 57 patients; the 6MW test was carried out in patients and controls. Complete blood counts and hemolytic parameters were assessed. Reticulocytes, bilirubin, and lactate dehydrogenase were significantly higher [p < 0.0001] in patients, while hemoglobin [Hb] and haptoglobin were lower [p < 0.0001] than in controls. The mean fetal Hb among patients was 15.85 +/- 8.7%. Of the 57 patients, 14 [24.5%] and 15 [26%] had mild tricuspid and mitral regurgitation, respectively. The mean ejection fraction, TRJV, and PASP were 63.9 +/- 6.3%, 1.7 +/- 0.5 m/s, and 23.0 +/- 7.3 mm Hg, respectively. Three [5.2%] patients had mildly raised TRJV [2.6-2.97 m/s, normal range <2.5 m/s] while 8 [14%] had high PASP [mean 35.3 +/- 5.1 mm Hg, normal range <30 mm Hg]. Hb, hematocrit, and reticulocytes were different [p = 0.010, p = 0.006, and p = 0.011, respectively] between patients with normal and high PASP. All 3 patients who had a high TRJV had a high PASP, and 2 of these patients died during follow-up. The systolic and diastolic blood pressure, oxygen saturation before and after the 6MW test, and distance walked were lower [p = 0.006, p = 0.000, p = 0.002, p = 0.000, and p = 0.000, respectively] in patients compared to controls. Raised PASP was common in Kuwaiti SCD patients while raised TRJV was not
RESUMO
Over the past two decades, there has been considerable progress in the treatment of acute myocardial infarction [AMI] that led to substantially lower mortality and morbidity. Therefore, we carried out this study to evaluate the changes in our practice as related to AMI treatment over a five year period. This is a retrospective analysis that included all patients with a diagnosis of AMI, admitted to the coronary care unit between the first of January 1998 and the end of December 2002. The total number of patients with AMI was 2,280. Comparing the first year to the last year of the study, the use of medications at discharge increased significantly for beta-blockers [76 vs 88, p < 0.0001]; for angiotensin converting enzyme inhibitors [ACEI] [40 vs 45%, p = 0.02] and for lipid lowering drugs [25 vs 66%, p < 0.0001]. Similarly, the use of thrombolytic dru g s increased significantly [60 vs 66%, p < 0.001]. The time to administration of thrombolytic treatment shortened significantly [104 vs 70 minutes, p < 0.001]. The use of inhospital cardiac catheterization increased as well [7 vs 14%; p = 0.006]. Our study showed significant changes in the practice of AMI treatment over the five year study period. The use of therapies with proven benefit such as beta- blockers, ACEI, lipid lowering drugs, thrombolysis and in-hospital cardiac catheterization has increased. Although the time to thrombolytic treatment did shorten, it needs to be shortened further to obtain the maximum benefit from such therapy