Cardiovascular Disease and Stroke Risk Among Egyptian Resident Physicians: A Cross-Sectional Multicenter Study.

BACKGROUND: Cardiovascular diseases (CVDs) are the leading cause of death worldwide and are considered silent killers that threaten different age groups. The stressful lifestyle of resident physicians might make them vulnerable to CVDs. Since 2021, Egypt has recently reported more frequent sudden deaths of junior physicians after long shifts. Many factors can be associated with this prevalence, such as diabetes mellitus, increased blood pressure, or a sedentary lifestyle. Therefore, this study aimed to estimate the risk of developing heart attack and stroke within 10 years among resident physicians in Egypt with the goal of informing health policymakers to improve the healthcare systems for Egyptian physicians. METHODS: This cross-sectional study was conducted at six university teaching hospitals around Egypt: Cairo, Al-Azhar, Zagazig, Menoufia, South Valley, and Sohag. Data were collected on the ground using a questionnaire developed from a validated tool, the QRISK3 calculator, developed by the National Health Service, and used to measure the development of CVDs and stroke over the next 10 years. RESULTS: Four hundred twenty-eight resident physicians filled out the study questionnaire, including 224 (52.3%) females. The mean age of the participants was 28.22 years (±2.54). The study revealed that 258 (60.3%), with a median (IQR) = 0.2% (0.1%-0.5%), of the resident physicians are at high risk of having a heart attack or stroke within 10 years. Migraine symptoms (n=65, 15.2%) and angina or heart attack in a first-degree relative (n=26, 6.1%) were the most reported risk factors. The risk was variable among the six university hospitals, with a significant P-value <0.001, where Menoufia University hospitals ranked first, followed by Zagazig University hospitals. However, the percentage of each specialty differs from others. The highest risk was among anesthesiology and ICU residents (n=18, 78.3%), followed by surgery residents (n=44, 62.9%). CONCLUSION: About 258 (60.3%) of the resident physicians are at risk of having a heart attack or stroke within 10 years. There is an urgent need to increase resident physicians' awareness about their heart attack and stroke risks and for health policymakers to ensure a better lifestyle and friendly training environment for resident physicians in Egypt.

Short and Long-Term Clinical Outcomes in Octogenarian Patients With Non-ST-Elevation Myocardial Infarction: A Comparative Analysis of Revascularization Strategies Versus Medical Management.

INTRODUCTION: As the primary cause of morbidity and mortality among older individuals, cardiovascular disease remains a major concern. Choosing between revascularization and medical management of elderly patients remains controversial. This study aims to evaluate the clinical implications of these treatment approaches in the context of non-ST-elevation myocardial infarction (NSTEMI) in octogenarian patients. METHODS: This observational cohort study involved 41 octogenarian patients who were diagnosed with NSTEMI from 2019 to 2021 and were managed by revascularization (with either percutaneous coronary intervention, coronary artery bypass graft surgery, or both) or conservative medical therapy. All NSTEMI patients were diagnosed based on symptoms, electrocardiographic changes, and cardiac biomarkers. The study compared the short- and long-term outcomes of 13 patients in the revascularization group and 28 in the medical therapy group. RESULTS: Overall, the mean patient age was 84.63 years. Eighteen patients were men (43.9%), and 23 were women (56.1%). The most prevalent disease among the sample was hypertension (34 patients, 82.9%), followed by diabetes mellitus (27 patients, 65.9%) and prior ischemic heart disease (21 patients, 51.2%). Almost all patients in the revascularization-treated group developed complications after the procedure (84.6%), while 46.4% of the patients in the medication-only group developed a complication later on. The revascularization-treated group showed higher mortality rates in both the short- and long-term (23.1% and 38.5%, respectively) compared to the medication-only group, which showed better survival rates numerically in both the short- and long-term (14.3% and 32.1%, respectively). This was not statistically significant. CONCLUSION: Revascularization treatment in elderly patients with NSTEMI was associated with a higher risk of complications and a higher mortality rate compared with conservative medical management. Patients managed with only medications had a better survival rate in both the short- and long-term.

Epidemiology of pediatric trauma in Makkah, Kingdom of Saudi Arabia: An observational cohort study.

OBJECTIVES: To explore the epidemiology and patterns of pediatric trauma in addition to length of hospital stay and outcome. METHODS: A single-center retrospective study of 605 patients aged 14 years and younger was carried out from January to December 2022. The study included all patients who experienced intentional or unintentional trauma aged 14 years or below in 2022 and excluded trauma that did not prompt an emergency room visit. RESULTS: Most pediatric trauma cases involved boys (69.1%, n=418), and girls comprised only 30.9% (n=187). Trauma was most common in children one to 5 years old (41.5%, n=251). Falling from a height was the most common mode of injury in both girls and boys (n=253, 41.8%). The most common body parts involved were the extremities (n=357, 59%), followed by the head (n=210, 34.7%). Most children were transferred to hospital via emergency medical services (n=234, 38.7%). In most cases, the child was admitted to the surgical ward (n=458, 75.7%), while others were managed in the emergency department without admission (n=93, 15.4%). Most patients were stable after receiving standard care (n=558, 92.2%). CONCLUSION: To reduce health care expenses and improve public health outcomes, prioritizing preventive measures is crucial. This includes increasing public awareness, implementing safety protocols, and enacting government regulations to prevent avoidable injuries.

Regional Myopericarditis Mimicking Inferior Myocardial Infarction Following COVID-19 Vaccination: A Rare Adverse Event.

We present the case of a 41-year-old man who developed myopericarditis after receiving the Pfizer COVID-19 vaccine. The patient experienced a sudden onset of chest and abdominal pain 16 days after vaccination. Electrocardiogram findings revealed deep T-wave inversion and minimal ST-segment elevation. Further investigation through coronary artery angiography and computed tomography identified an anomalous left main coronary artery. Magnetic resonance imaging confirmed the diagnosis of myopericarditis. This case highlights the importance of considering myopericarditis as a potential cause of chest pain and elevated cardiac biomarkers following COVID-19 vaccination, particularly in young individuals. Clinicians should be aware of this adverse event and include it in the differential diagnosis for patients presenting with similar symptoms after vaccination.

A Challenging Case of Heart Displacement by a Large Mediastinal Germ Cell Tumor.

Mediastinal germ cell tumors (GCTs) are rare and aggressive cancers originating from the germ cells in the mediastinum. Early detection and treatment are vital due to their high potential for metastasis and recurrence. We present a case of a 28-year-old man who exhibited a cough and shortness of breath. Laboratory tests revealed elevated tumor markers, alpha-fetoprotein, and beta-human chorionic gonadotropin. Imaging studies displayed a large mediastinal mass, causing the right displacement of the mediastinum and cardiac tamponade. The biopsy confirmed a non-seminomatous GCT, specifically a yolk sac tumor. The patient experienced pericardial effusion and cardiac tamponade after receiving two cycles of etoposide and cisplatin chemotherapy. To relieve the tamponade, an emergency pericardiocentesis was performed malignant GCTs necessitate prompt diagnosis and treatment and utilizing multimodal therapy such as chemotherapy to achieve tumor control. Due to the high risk of metastasis, vigilant surveillance for recurrence is essential, emphasizing the need for specific criteria for accurate early detection.

Correction: A Cross-Sectional Study of the Knowledge, Attitude, and Practice of Self-Medication Among the General Population in the Western Region of Saudi Arabia.

[This corrects the article DOI: 10.7759/cureus.29944.].

A Cross-Sectional Study of the Knowledge, Attitude, and Practice of Self-Medication Among the General Population in the Western Region of Saudi Arabia.

Introduction Self-medication (SM) is defined as consuming pharmaceutical drugs without the advice of a physician for either diagnosis or treatment. Reliance on self-medication has become a more common worldwide issue and now plays a major role in self-care. However, the practice is linked to many risks for patients and the whole community. This study assesses knowledge, attitudes, and practices associated with self-medication in the western region of Saudi Arabia. Methods This is an observational questionnaire-based cross-sectional study conducted over two months, between January and March 2022. The survey comprised 29 questions adapted from similar studies and was translated into Arabic to fit the study population. All residents of the three major cities, Makkah, Jeddah, and Taif, were included; the population under 18 years of age and health workers were excluded. We used OpenEpi version 3.0 (www.OpenEpi.com) for sample size calculation and Statistical Package for Social Sciences (IBM Corp, Armonk, USA) was used for data analysis. Results Most of the participants (67.7%) declared that they practiced self-medication: (28.6%) men and (39.1%) women. Self-medicating for different indications showed differences between men and women but without statistical significance. Major indications for self-medicating were headache (45.3%), cough, cold/flu (42.7%), and fever (34.0%). The primary reasons participants gave for choosing to self-medicate were easy availability of the medicines (41.4%) and that they were treating a minor illness (40.8%). Many types of medicines were used, most commonly analgesics (44.0%) and antipyretics (43.6%). Conclusion The practice of self-medication is high among the population in Makkah, Jeddah, and Taif. Educating the public on the consequences and adverse effects is necessary.

A Cross-Sectional Study of Tuberculosis Knowledge, Attitude, and Practice Among the General Population in the Western Region of Saudi Arabia.

Background Religious gatherings like the Hajj, an Islamic pilgrimage, attract millions of people to one place during the same time frame. Due to crowding, infectious diseases, specifically tuberculosis (TB), are very common during such events. This study investigates the knowledge, attitudes, and practices of the public in the western region of Saudi Arabia related to TB to better understand the situation. Methodology An observational, questionnaire-based, cross-sectional study was conducted over two months between January and March 2022. A survey of 29 questions was used to collect data from the general population. The study included any person who was a resident of Makkah. Individuals under 18 years of age and health workers were excluded. We used OpenEpi, version 3.0, for sample size calculation, which gave a result of 604 participants, and SPSS version 25.0 (IBM Corp., Armonk, NY, USA) was used for data analysis. Results A total of 604 participants were included in this study; 64.7% of respondents showed poor overall knowledge, and 14.1% had good knowledge of TB. Concerning attitude, 89.9% of the respondents showed poor attitude, and only 2.3% had a good attitude. As for practice, 59.4% of respondents had poor knowledge of proper practices, and only 10.4% knew the right practices regarding TB. Upon further analysis of our results, women exhibited better knowledge of TB than men (0.62, 95% confidence interval (CI), 0.44-0.87). Participants over 50 years old had the lowest knowledge about TB compared with participants aged 18 to 28 years old (7.61, 95% CI, 4.35-13.32). Non-Saudi residents had less knowledge compared with Saudi residents (45.849, 95% CI, 18.475-113.78). Level of education also played a substantial role; university graduates had the most knowledge about TB compared with participants with below university or no formal education (0.052, 95% CI, 0.01-0.40). Conclusions Participants with lower educational backgrounds were the most lacking in knowledge, attitude, and practice regarding TB. This lack of knowledge was more common among non-Saudi men over 50 years old. Information campaigns are needed to help reduce the prevalence of TB.

Patent Foramen Ovale-Induced Platypnea-Orthodeoxia Syndrome: A Case Report and Literature Review.

Platypnea-orthodeoxia syndrome (POS) is a rare condition characterized by dyspnea and hypoxia worsening in the upright position and relieved in the recumbent position. POS can result from anatomical or functional conditions that cause interatrial communication or deformity of the atrial septum. Investigations with imaging and cardiac catheterization can aid in the evaluation. In cases where POS is caused by intracardiac shunting without pulmonary hypertension, closure of the intracardiac shunt can be curative. We report a case of POS in a 54-year-old male who was treated successfully with percutaneous closure of a patent foramen ovale (PFO).