Basic life support awareness among medical undergraduate students in Syria, Iraq, and Jordan: a multicenter cross-sectional study.

BACKGROUND AND AIMS: Basic life support (BLS) training rates vary widely worldwide, and there is a general scarcity of surveys that assess students' knowledge and awareness of BLS in middle eastern nations. This study aims to evaluate medical students' knowledge and awareness towards basic life support. METHODS: A cross-sectional study, using an online web-based questionnaire, assessing BLS awareness and knowledge, was conducted from 3 to 30 November 2021. The study included 2114 medical students from Syria, Iraq, and Jordan. The questionnaire consisted of three sections: demographic baseline characteristics, knowledge about BLS, and ability to apply basic life support. A binominal logistic regression was done between the total score and other demographic characteristics to determine if we could predict the research sample's appropriate knowledge of BLS level. RESULTS: There was a moderate knowledge of BLS and cardiopulmonary resuscitation (CPR) skills among participating students with an average score of 19.67 (0-34). Seventy-eight of the participants (1656) stated that they have not attended a basic life support course. There was a significant difference between the participants from different countries, where the mean score in Syria, Jordan, and Iraq was 18.3, 24.3, and 18.8, respectively (p < 0.05). Considering the level of knowledge, 18.3%, 72.8%, and 8.9% of the participants had a high, intermediate, and low level, respectively. Furthermore, students who took a BLS course had a higher level of knowledge than those who did not, with an odds ratio of 5.168 (p value < 0.0001). CONCLUSION: The overall knowledge of medical students' basic life support knowledge is insufficient and need to be greatly improved. According to this study, previous participation in basic life support training had a positive effect on knowledge level. As a result, universities must establish basic life support programs as quickly as possible.

Determinants of COVID-19 vaccine acceptance in the Arab world: a cross-sectional study.

BACKGROUND: The Arab region is highly affected by the COVID-19 pandemic. Local governments have already started to act against the disease. However, only a few countries provided COVID-19 vaccination. Compliance with vaccination is a major topic affecting proper coverage. Thus, we aim to explore vaccine acceptance among Arab populations, and compare it with the global numbers. METHODS: An internet-based survey using social media platforms was conducted, targeting adults who were able to read and understand Arabic, had access to the internet, and from all 22 Arab league countries. Due to the response rate variation between participants, the countries were grouped into four categories based on their income: Low income, Lower-middle income, Upper-middle income, and High-income economies. Data about demographics, previous COVID-19 infection, and vaccine acceptance tendency were collected and analyzed using Chi-squared (χ2) test and Logistic regression. RESULTS: A total of 870 participants completed the survey. 59.3% of the participants were male, 53.3% were between 25 and 44 years, and 69.9% were Arabs who live inside of their home country. The COVID-19 vaccine acceptance rate was 62.4%. A significant higher tendency toward vaccination was identified in males (65.4%, P = 0.04) and people living outside their home countries (67.9%, P = 0.02). However, age group, level of education, and previous COVID-19 infection were all factors with insignificant effect. Citizens of High-income countries were more likely to accept the vaccine (70.2%). CONCLUSIONS: Less than two-thirds of Arabs are compliant with COVID-19 vaccination. This proportion is relatively lower than the global rate. It is important to develop strategies to promote vaccine acceptance and reach the ideal coverage needed to achieve efficient immunization.

One Health Education for Future Physicians: A Case Report of Cat-Transmitted Sporotrichosis.

A healthy 35-year-old Brazilian woman presented with persistent redness, swelling, and multiple wounds on the hand 2 weeks after a cat bite in her home country. She was treated twice with amoxicillin-clavulanate but failed to demonstrate improvement. She then presented to our institution with a newly developed abscess on the right hand. Incision and drainage were performed and she was admitted to the hospital. She was subsequently treated with broad-spectrum antibiotics. Her symptoms improved but did not resolve. Four days after hospital discharge, a wound culture resulted as positive for Sporothrix schenchii. The patient was treated with itraconazole. Sporotrichosis is endemic in many countries including Brazil and is known to be transmitted by cat bites. Sporotrichosis should be considered in the differential diagnosis for patients who have symptoms of cellulitis after cat bites in an endemic area.

Safety and In-Hospital Outcomes of Transvenous Lead Extraction for Cardiac Implantable Device-Related Infections: Analysis of 13 Years of Inpatient Data in the United States.

OBJECTIVES: The aim of this study was to investigate the safety and in-hospital outcomes of transcutaneous lead extraction (TLE) associated with device-related infection (DRI) in the United States from 2003 to 2015. BACKGROUND: DRI remains the most serious complication and the most common indication for lead extraction in patients with cardiac implantable electronic devices. The rates of DRI and associated lead extraction have been growing in line with the increasing number of cardiac implantable electronic device implantations worldwide. METHODS: Data for this study were drawn from the National (Nationwide) Inpatient Sample. The International Classification of Diseases-9th Revision-Clinical Modification coding system was used to identify hospitalizations with TLE for DRI and to investigate the rates of major adverse events. RESULTS: From a total of approximately 100 million unweighted hospitalizations over the 13-year study period, 12,257 unweighted observations were identified. This represents 59,082 (95% confidence interval [CI]: 58,982 to 59,182) patients who underwent TLE for DRI during the study period. A large majority of patients (75%) were older than 60 years. Patients were predominantly male (70%) and Caucasian (76%), and 80% had at least 1 comorbidity. The median length of stay was 8 days (interquartile range 5 to 14 days). At least 1 major adverse event occurred in 10.42% of procedures. The all-cause in-hospital mortality rate was 4.11%. Independent predictors of mortality were weight loss (adjusted odds ratio [aOR]: 4.02; 95% CI: 3.13 to 5.17), congestive heart failure (aOR: 3.28; 95% CI: 2.48 to 4.34), chronic kidney disease (aOR: 2.09; 95% CI: 1.70 to 2.56), pericardial complications (aOR: 2.87; 95% CI: 1.79 to 4.61), and procedure-related pulmonary injury (aOR: 2.06; 95% CI: 1.25 to 3.40). CONCLUSIONS: These results reflect the high rate of complications and mortality for TLE due to DRI in real-world experience, highlighting the importance of comorbidities, especially congestive heart failure and chronic kidney disease, as significant predictors of mortality in these patients.

Risk Factors, Imaging Findings, and Sex Differences in Spontaneous Coronary Artery Dissection.

Spontaneous coronary artery dissection (SCAD) is increasingly being recognized. However, data supporting diagnosis and management are scarce. We analyze a contemporary and comprehensive SCAD registry to advance the understanding of SCAD risk factors, angiographic appearance, and gender differences. This is a retrospective analysis of a prospectively populated database of SCAD patients seen at the Massachusetts General Hospital (MGH) between June 2013 and October 2017. Core laboratory analysis of both coronary angiograms and computerized tomographic (CT) angiography of the extracoronary vessels was performed. Of the 113 patients, 87% were female and mean age was 47 ± 10 years. Traditional cardiovascular risk factors including hypertension, hyperlipidemia, and smoking were present in 27%, 14%, and 22% of patients. Among females, 14%, 8%, and 9% had a history of gestational hypertension, pre-eclampsia, and gestational diabetes, respectively. Fifteen percent had used fertility treatment and 47% of postmenopausal women had used hormone replacement therapy. Angiography showed multivessel SCAD in 42%, severe coronary artery tortuosity in 59%, and extracoronary vascular abnormalities in 100% of patients with complete CT angiographic imaging. Gender differences revealed a self-reported depression and anxiety prevalence of 20% and 32%, respectively, in women compared with 0% in men. Type 1 SCAD was more commonly diagnosed in men than women (71% vs 29%, p <0.01). In conclusion, we highlight under-recognized features of SCAD including (1) relation with pregnancy complications and exposure to hormonal therapy; (2) diffuse, multivessel process in tortuous coronaries on a background of extracoronary arterial abnormalities; and (3) gender differences highlighting the role of mental health as well as potential underdiagnoses in men.

Emergency Department Visits for Atrial Fibrillation in the United States: Trends in Admission Rates and Economic Burden From 2007 to 2014.

BACKGROUND: Atrial fibrillation (AF) is an increasingly prevalent public health problem and one of the most common causes of emergency department (ED) visits. We aimed to investigate the trends in ED visits and hospital admissions for AF. METHODS AND RESULTS: This is a repeated cross-sectional analysis of ED visit-level data from the Nationwide Emergency Department Sample for 2007 to 2014. We identified adults who visited EDs in the United States, with a principal diagnosis of AF. A sample of 864 759 ED visits for AF, representing a weighted total of 3 886 520 ED visits, were analyzed. The annual ED visits for AF increased by 30.7% from 411 406 in 2007 (95% confidence interval, 389 819-432 993) to 537 801 (95% confidence interval, 506 747-568 855) in 2014. Patient demographics remained consistent, with an average age of 69 to 70 years and slight female predominance (51%-53%) throughout the study period. Hospital admission rates were stable at ≈70% between 2007 and 2010, after which they gradually declined to 62% in 2014 (Ptrend=0.017). Despite the decline in hospital admission rates, AF hospitalizations increased from 288 225 in 2007 to 333 570 in 2014 because of the increase in total annual ED visits during the study. The adjusted annual charges for admitted AF patients increased by 37% from $7.39 billion in 2007 to $10.1 billion in 2014. CONCLUSIONS: Annual ED visits and hospital admissions for AF increased significantly between 2007 and 2014, despite a reduction in admission rates. These data emphasize the need for widespread implementation of effective strategies aimed at improving the management of patients with AF to reduce hospital admissions and the economic burden of AF.

Prospective Cardiovascular Genetics Evaluation in Spontaneous Coronary Artery Dissection.

BACKGROUND: Previous studies describing genetics evaluation in spontaneous coronary artery dissection (SCAD) have been retrospective in nature or presented as single case reports. As part of a dedicated clinical program, we evaluated patients in cardiovascular genetics clinic to determine the role of genetically triggered vascular disease and genetic testing in SCAD. METHODS AND RESULTS: Patient data were entered prospectively into the Massachusetts General Hospital SCAD registry database from July 2013 to September 2017. Clinically indicated genetic testing was conducted based on patient imaging, family history, physical examination, and patient preference. Of the 107 patients enrolled in the registry, 73 underwent cardiovascular genetics evaluation at our center (average age, 45.3±9.4 years; 85.3% female), and genetic testing was performed for 44 patients. A family history of aneurysm or dissection was not a prevalent feature in the study population, and only 1 patient had a family history of SCAD. Six patients (8.2%) had identifiable genetically triggered vascular disease: 3 with vascular Ehlers-Danlos syndrome (COL3A1), 1 with Nail-patella syndrome (LMX1B), 1 with autosomal dominant polycystic kidney disease (PKD1), and 1 with Loeys-Dietz syndrome (SMAD3). None of these 6 had radiographic evidence of fibromuscular dysplasia. CONCLUSIONS: In this series, 8.2% of the SCAD patients evaluated had a molecularly identifiable disorder associated with vascular disease. The most common diagnosis was vascular Ehlers-Danlos syndrome. Patients with positive gene testing were significantly younger at the time of their first SCAD event. A low threshold for genetic testing should be considered in patients with SCAD.

Diagnostic Accuracy of a Novel Mobile Phone Application for the Detection and Monitoring of Atrial Fibrillation.

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in adults, associated with significant morbidity, increased mortality, and rising health-care costs. Simple and available tools for the accurate detection of arrhythmia recurrence in patients after electrical cardioversion (CV) or ablation procedures for AF can help to guide therapeutic decisions. We conducted a prospective, single-center study to evaluate the accuracy of Cardiio Rhythm Mobile Application (CRMA) for AF detection. Patients >18 years of age who were scheduled for elective CV for AF were enrolled in the study. CRMA finger pulse recordings, utilizing an iPhone camera, were obtained before (pre-CV) and after (post-CV) the CV. The findings were validated against surface electrocardiograms. Ninety-eight patients (75.5% men), mean age of 67.7 ± 10.5 years, were enrolled. No electrocardiogram for validation was available in 1 case. Pre-CV CRMA readings were analyzed in 97 of the 98 patients. Post-CV CRMA readings were analyzed for 92 of 93 patients who underwent CV. One patient left before the recording was obtained. The Cardiio Rhythm Mobile Application correctly identified 94 of 101 AF recordings (93.1%) as AF and 80 of 88 non-AF recordings (90.1%) as non-AF. The sensitivity was 93.1% (95% confidence interval [CI] = 86.9% to 97.2%) and the specificity was 90.9% (95% CI = 82.9% to 96.0%). The positive predictive value was 92.2% (95% CI = 85.8% to 95.8%) and the negative predictive value was 92.0% (95% CI = 94.8% to 95.9%). In conclusion, the CRMA demonstrates promising potential in accurate detection and discrimination of AF from normal sinus rhythm in patients with a history of AF.

The Management of the Khan Al-Assal Chemical Attack in Aleppo University Hospital (AUH).

On March 19, 2013, Khan al-Assal was attacked with chemical weapons. In total, 20 people were killed and an additional 124 were injured; 63 people were cared for at Aleppo University Hospital on that day, where 14 died, all of them were civilians; 7 men, 6 women, and 1 child. This is a brief first hand report, for what has now become a more frequent, more deadly and horrific event in the lives of many Syrians. (Disaster Med Public Health Preparedness. 2018;12:663-665).

Management of post-stroke depression in the Middle East and North Africa: Too little is known.

Stroke is among the most common disabilities among adults and most stroke victims live in developing countries. However, little is known about services delivered in these countries for post-stroke depression, a common comorbidity that influences functional outcomes of stroke. In this paper, a physician from Syria reviews the literature on post-stroke depression among patients living in countries of the Middle East and North Africa region in order to examine whether current practices can be improved. Studies of prevalence were found in six of the region's countries and only four studies described interventions for stroke patients with clinical depression. The limited studies on prevalence confirmed that stroke incidence and post-stroke depression are common although diagnosed depression appears to vary depending on the economic environment of the country. Hence, additional interventions in MENA countries may be warranted to increase recognition of depression in stroke patients and to ensure health professionals are prepared to deliver appropriate services to stroke patients and their family-caregivers for depression when it occurs.

Catheter Ablation for Cardiac Arrhythmias: Utilization and In-Hospital Complications, 2000 to 2013.

OBJECTIVES: This study sought to investigate the utilization of and in-hospital complications in patients undergoing catheter ablation in the United States from 2000 to 2013 by using the National Inpatient Sample and Nationwide Inpatient Sample. BACKGROUND: Catheter ablation has become a mainstay in the treatment of a wide range of cardiac arrhythmias. METHODS: This study identified patients 18 years of age and older who underwent inpatient catheter ablation from 2000 to 2013 and had 1 primary diagnosis of any of the following arrhythmias: atrial fibrillation, atrial flutter, supraventricular tachycardia, or ventricular tachycardia. RESULTS: An estimated total of 519,951 (95% confidence interval: 475,702 to 564,200) inpatient ablations were performed in the United States between 2000 and 2013. The median age was 62 years (interquartile range: 51 to 72 years), and 59.3% of the patients were male. The following parameters showed increasing trends during the study period: annual volume of ablations, number of hospitals performing ablations, mean age and comorbidity index of patients, rate of ≥1 complication, and length of stay (p < 0.001 for each). Substantial proportions (27.5%) of inpatient ablation procedures were performed in low-volume hospitals and were associated with an increased risk for complications (odds ratio: 1.26; 95% confidence interval: 1.12 to 1.42; p < 0.001). Older age, greater numbers of comorbidities, and complex ablations for atrial fibrillation and ventricular tachycardia were independent predictors of in-hospital complications and in-hospital mortality. In addition, female sex and lower hospital volumes were independent predictors of complications. CONCLUSIONS: From 2000 to 2013, there was a substantial increase in the annual number of in-hospital catheter ablation procedures, as well as the rate of periprocedural complications nationwide. Low-volume centers had a significantly higher rate of complications.

Illness recognition and disruptiveness in psychotic illness.

A case control investigation was performed to examine the relatively high rate of unrecognized psychotic illness within an extended family with a high-density of psychotic illness and identify factors related to nonrecognition. The study was conducted within the catchment area of a Regional Mental Health Center in central Israel. Subjects were recruited using clinic records indicating multiple family members with mental illness. Additional subjects were recruited in the homes of the subjects through family members. A total of 247 subjects were recruited, 111 of whom were determined to suffer from a psychotic disorder based on criteria in standard use. Sixty-six subjects were members of a single extended family (clan) and 181 subjects were members of nonrelated families residing in the same geographic area. While the rate of unrecognized psychotic illness was insignificant among the members of the families not related to the clan, among clan members the rate of unrecognized psychotic illness was 45%. Among this clan, recognition of psychotic illness appeared to be directly related to disruptive behavior. Additionally, it was found that, overall, subjects were more likely to recognized by the mental health system if they had fewer ill family members and more education. We conclude that although nonrecognition of mental illness does not appear to be a problem among the families in the area who are not related to the particular clan, within the clan a particular subculture appears to have developed in which perceived need for psychiatric services is related to disruptive behavior. A high density of psychotic illness within a family and less education may create a family environment that becomes tolerant of psychotic symptoms that are not disruptive to others, resulting in nonrecognition of nondisruptive illness by the mental health system.

Genome scan of Arab Israeli families maps a schizophrenia susceptibility gene to chromosome 6q23 and supports a locus at chromosome 10q24.

Schizophrenia is a complex neuropsychiatric disorder to which an as-yet-unknown number of genes contribute, interacting with each other and the environment. Linkage analyses have implicated several chromosomal regions as harboring schizophrenia susceptibility loci although rarely at levels commensurate with proposed thresholds for genome-wide significance. We systematically recruited Arab Israeli families multiply affected with schizophrenia from the catchment area of a Regional Mental Health Center. Clinical diagnoses were established by semistructured interviews and all other available sources of information under narrow, core and broad categories. Using 350 microsatellite markers, spaced at an average of 10.3 cM, we performed an autosomal scan in 155 subjects from 21 families. Linkage analysis employed affects only, multipoint, nonparametric (model-free) and also parametric (dominant and recessive) approaches. We detected significant evidence for a schizophrenia susceptibility gene at chromosome 6q23 with a nonparametric LOD score (NPL) of 4.60 (P=0.000004) under the broad diagnostic category and a parametric LOD score of 3.33 (dominant model). Under the core diagnostic category the NPL was 4.29 (P=0.00001) and the LOD score 4.16 (dominant model). We also detected suggestive evidence for linkage at chromosome 10q24 under the broad diagnostic category (NPL 3.24, P=0.0008; heterogeneity LOD score, dominant model 2.65, alpha=0.82). Additionally, NPL scores >2.0 were observed at chromosome 2q37, 4p15-16, 7p22, 9q21-22 and 14q11.1-11.2. The linkage we detected at chromosome 6q23 fulfills the criteria for genome-wide significance and is located approximately midway between loci suggested by a previous significant report at chromosome 6q25 and findings located more centromerically at 6q21-22.

Tolerance to the mydriatic effect of buprenorphine, butorphanol, nalbuphine, and cyclorphan, and cross-tolerance to morphine in mice.

An increase in the use of opioid derivatives in the treatment of pain syndrome in clinical practice, and especially in the treatment of cancer, has added impetus to the search for an agent which does not induce tolerance and cross-tolerance to other opiodis. The mydriatic effect of opioids in mice, the correlation between analgesia and mydriasis, and tolerance to the analgesic effect of morphine in mice were evaluated previously. In the present work, tolerance to the mydriatic effect of four agonist-antagonists and cross-tolerance to morphine were examined. Measurement of the pupillary diameter was performed using a binocular operating microscope. Tolerance and cross-tolerance to morphine were developed following a chronic use of buprenorphine, nalbuphine, and cyclorphan. After chronic injection of butorphanol, no tolerance or cross-tolerance to morphine was observed.

Cervical epidural steroid injection for cervicobrachialgia.

Fifty patients with chronic resistant cervicobrachialgia were randomly divided into two groups. Twenty-five patients (group A) were treated with cervical epidural steroid/lidocaine injections and 17 patients (group B) were treated with steroid/lidocaine injections into the posterior neck muscles. Another eight patients from group B were excluded from the study because they had started the process of litigation of insurance claims and their subjective analysis of pain relief might therefore not be trustworthy. One to three injections were administered at 2-week intervals according to the clinical response. All patients continued their various pre-study treatments: non-steroidal anti-inflammatory drugs, non-opioid analgesics and physiotherapy. Pain relief was evaluated by the visual analogue scale 1 week after the last injection and then 1 year later. One week after the last injection we rated pain relief as very good and good in 76% of the patients in group A, as compared to 35.5% of the patients in group B. One year after the treatment 68% of the group A patients still had very good and good pain relief, whereas only 11.8% of group B patients reported this degree of pain relief. These differences were statistically significant. We failed to achieve significant improvement of tendon reflexes or of sensory loss in both groups, but the increase in the range of motion, the fraction of patients who were able to decrease their daily dose of analgesics, and recovery of the capacity for work were significantly better in group A. We encountered no complications in either group of patients.(ABSTRACT TRUNCATED AT 250 WORDS)