RESUMO
Studies primarily outside the United States have reported that SMuRF-less STEMI patients are surprisingly common (14-27%) and have a worse in-hospital/short-term prognosis. Given potential demographic and management differences over time and in the US, we aimed to identify the proportion and outcomes of SMuRF-less STEMI patients in a large US healthcare population. Patients with a first STEMI presenting to Intermountain Healthcare catheterization laboratories between 2001-2021 were included. SMuRF included a clinical diagnosis of, or treatment for, hypertension, hyperlipidemia, diabetes, and smoking. Follow-up MACE were defined as death, MI, and heart failure hospitalization (HFH) by 60 days and long-term. Qualifying STEMI patients totaled 3510, 26.2% (919) with no SMuRF. SMuRF-less patients were younger, more frequently male, and had fewer comorbidities. Neither total MACE (adj HR 0.95, p = 0.72) nor death (adj HR 1.06, p = 0.69) differed by SMuRF status at 60 days. Long-term outcomes were more frequent in SMuRF patients, which remained significant for total MACE (adj HR 0.83, p = 0.02) and HFH (HR 0.36, p = 0.0005) after adjustment for baseline differences other than SMuRF. Results were consistent through subgroup and sensitivity analyses. In this moderately large US healthcare population, SMuRF-less STEMI presentation was confirmed to be common (26.2%). However, unlike earlier, mostly non-US reports, adjusted short-term outcomes were similar, and long-term outcomes were more favorable. Further studies to increase understanding, recognition, and treatment of risk factors in SMuRF-less subjects and to optimize STEMI management are indicated.
RESUMO
BACKGROUND: Alternative medicine is defined as medical therapies that are not regarded as orthodox by the medical profession. The teaching of complementary and alternative medicine (CAM) in medical schools is becoming prevalent worldwide. Only a few studies have been done to assess medical students' attitude toward CAM and the need for CAM courses. MATERIALS AND METHODS: An observational, descriptive, cross-sectional study was conducted on medical students in two universities, King Saud (KSU) and Majmaah (MU) medical colleges, between February and April 2015. A survey was developed and validated by a pilot study. Data were gathered from both colleges by means of hard and soft copy surveys. Medical students of both genders from the 1st year to the 5th year from both universities were targeted in this study. Fifth-year students from Majmaah and students from the preparatory year were excluded from the study. KSU students comprised 1433, while MU students comprised only 180. The sample size was 384. Data were analyzed using SPSS software. RESULTS: The study included 399 medical students. Bloodletting is the most known modality (80.7%), while homeopathy is the least known with a percentage of 7.47%. The overall assessment of the attitude toward CAM was neutral, with a mean of 3.1. Students who had taken a CAM course previously were more satisfied with their knowledge than those who had not, showing a statistical significance of P = 0.0001. CONCLUSION: This study showed a lack of knowledge of CAM among medical students. There was an association between taking a CAM course and students' satisfaction with their knowledge. Most of the students agreed with the inclusion of CAM courses in the medical curriculum.
