Day 1 :
- Coronary Heart Diseases
Lewis Yacoub Alsharkawy
Ibrahim Bin Hamad Obaidullah Hospital, UAE
Title: Impact of COVID -19 pandemic on Acute Coronary Syndrome /NSTEMI admission rates and quality of service in Ibrahim Bin Hamad Obid Alla Hospital – Ras Alkhimah ,UAE (IBHOH-RAK)
Mourad Alsharkawy Graduated from Cairo University 1982 .Finished residency program 1987.Postgraduate in internal medicine followed by cardiovascular medicine 1990.Worked in KSA from 1991 to 1997 .Joint fellowship cardiology program and worked in National Heart Institute (Cairo ) up to 2005 dealing with skilled invasive and non invasive cardiovascular diagnostic and therapeutic procedures .Consultant cardiology in Ministery of Health Egypt to 2008 . Joint Oman and worked as head of Cardiology unit ( Nizwa Hospital ) up to 2014 . Currently working in IBHOH-RAK which is JCI accreditation hospital. He has built this model after years of experience in research, evaluation.
Study the impact of COVID -19 pandemic on the numbers of patients attended & admitted with ACS/NSTEMI and quality of service comparing the non COVID -19 and COVID -19 era ( for the same period of the year)
We collected data retrospectively of the patients were admitted and diagnosed with ACS/NSTEMI according to the Clinical practice guide line (CPD ) and hospital policy during April 2020 to September 2020 ( COVID -19 era ) and during the same period during 2019 ( non-COVID -19 era ) comparison the admission rate & Key performance indicator (KPI) for both group .
- The total numbers of patient admitted and diagnosed as ACS/NSTEMI in 6 months period (COVID -19 era) was 66 patients , all received for example the standard care including Beta blocker & ACEi/ARBs and high statin statin if no contraindication , they evaluated by Echocardiography before discharge , all cases reached above our target benchmark except for BB in month of August 2020 .
- The total Numbers of patients admitted and diagnosed as ACS/NSTEMI during the same period of the previous year 2019 ( non COVID-19 era ) was 66 patients all received for example the standard care including Beta blocker & ACEi/ARBs and high statin statin if no contraindication , they evaluated by Echocardiography before discharge ,all cases reached above our target benchmark.
- The Number of patients admitted are the same during the same period irrespective to COVID and non COVID period.
- No significant changes in the quality of care comparing both groups.
Despite the challenges facing the provision of distinguished medical services during COVID 19 pandemic ,the rate of admissions and the provision of medical services appropriately during the evaluated period were not affected in comparison with the same period of the previous year in IBHOH with no changes in the number of cases was admit and the quality of services ,and this reflect the efficiency of the system in dealing and absorbing disaster conditions.
- Interventional Cardiology and Heart Surgery
Dr Ram Manohar Lohia Hospital, India
Title: Intermediate-term outcome following plain balloon angioplasty of discrete near-total or total occlusion of aortic coarctation
Dr Ranjeet Nath has completed his DM Cardiology rom AIIMS Hospital, New Delhi. He is the Professor and Head of the Department of Cardiology of Dr Ram Manohar Lohia Hospital New Delhi. He has published more than 20 papers in reputed journals and has been serving as an editorial board member of some journal as well.
Background and Objective: Surgical repair or stenting has been the standard treatment for patients with discrete near-total or total occlusion of aortic coarctation (CoA) in both adolescents and adults. The role of plain balloon angioplasty (BA) as definitive therapy has not been well established in these patients due to the reported higher rates of complication and re-coarctation. The purpose was to evaluate intermediate-term outcome following BA of such patients by using different techniques in those patients where surgery or stenting was not possible.
Materials and Methods: The data of 9 patients of such CoA treated with BA from January 2014 to December 2018 was analyzed. The approach for BA was retrograde in 4 patients and antegrade in 5 patients. Different stiff coronary hardware was used in some cases to cross the occluded segments and make the procedure successful. They were evaluated at a mean interval of 43 months (range 14-72 months). The assessment included clinical examination, echocardiography and cardiac catheterization as and when required.
Results: The mean age of studied patients was 27.88 year (range 14–52 years). Immediate success was obtained in all patients with no early mortality or major complications. Peak systolic pressure gradient reduced from 79.11 ±19mmHg to 10.89 ±7.11mmHg immediately. On follow-up, out of the 5 patients who had Doppler peak gradient of more than 20 mmHg, none had significant peak systolic gradient on catheterization. There was no mortality or serious complications on follow-up. Hypertension was completely relieved in 45% (4/9) and improved in 55% (5/9) patients.
Conclusion: Balloon angioplasty of discrete near-total or total occlusion of native CoA by different method is safe and effective on the intermediate follow-up and can be considered in patients who are not candidates for surgery or stenting.
Keywords: Coarctation of Aorta, Balloon angioplasty
Azerbaijan Medical University, Azerbaijan
Title: Drug and Cost Compere Analysis for treatment of Chronic Heart Failure
Eyubova Ulviyya Aladdin has represented at four International Conferences and several presentation are scheduled for the upcoming months. 5 articles have been published and some are awaiting publication. Currently working as a researcher at the Azerbaijan Medical University in the Republic of Azerbaijan. Eyubova Ulviyya Aladdin is editorial board two journal (1. CPQ Medicine 2. Journal of Chronic Diseases and Therapeutics).
Background: Currently, the use of many new medications and device treatments has been started to treat patients with chronic heart failure. Modern principles of current treatment techniques are based on the pathogenic concept that develops as a result of the long-term activation of the CHF neurohormonal system. At present, the inhibitor of neprilysin is widely used in the treatment of CHF in the world practice.
In addition to the medical treatment of CHF, device treatments have also developed significantly in modern times. Being one of them, in recent years the resynchronous therapy of the heart is one of the most widely used treatments over the world.
Purpose: Our study has been conducted in the form of 2 groups. The first group consists of the patients treated with complex medical therapy including sacubitril / valsartan. And the second group consists of the patients implanted a device for resynchronous therapy of the heart. Our aim is to assess the changes in the clinical indicators in both groups after 6 months.
Methods: The results of 64 male and female with CHF were researched. Patients were over 38 years of age. Eligibility criteria included a history of chronic heart failure, circulatory failure (functional class II-IV, NHYA) and a left ventricular ejection fraction of less than 40%. Exclusion criteria included acute myocardial infarction, hypertrophic cardiomyopathy, congenital heart defects, patients under 25 years of age, heart failure in oncological patients.
Results: At the time of re-examination after 6 months, there is a high positive change in the clinical indicators of patients, functional classes and ejection fraction of left ventricul in first group than second group.
Conclusion: The results of both treatments have been compared both medically and economically. In results, full patogenetic treatment (including sacubitril/valsartan) gave better results.
Richard Stephen Tayon
Coral Gables Hospital, United States
Title: When 80 mg a day of Warfarin is Not Enough: A Case for a Warfarin Resistant Dosing Algorithm
A case is presented of a patient with lupus anticoagulant disorder that experiences treatment failure due to marked resistance to warfarin following standard algorithmic dosing. It is the opinion of the researcher that this patient may possess a genetic variation in the protein target for warfarin as is noted with VKORC1 D36 enzyme mutations. However, due to high cost and difficulty in obtaining genetic testing, this was not determined definitively. This case demonstrates the necessity for a standardized algorithm for dosing patients with severe warfarin resistance in situations where genetic testing is not afforded. Data was collected from 10/31/13 to 1/1/20 utilizing retrospective analysis. Data collected included: PTT, PT, INR, hemoglobin, hematocrit, and platelet results. Adverse treatment outcomes such as incidence of bleeding and thromboembolic events were examined. Through the course of 14 admissions and 266 hospital days, the daily warfarin dose ranged from 10 mg to 80 mg. Although the corresponding average INR was sub therapeutic (1.28 +0.17), the average hemoglobin (11.78 g/dL + 0.61), hematocrit (37.64% + 1.85), and platelet count (186.89 x 109/L + 22.12) results were all within normal limits. No adverse treatment outcomes were noted. In patients with sub therapeutic INR levels despite supra high dosages of warfarin, standard algorithmic dosing should be abandoned in favor of an individualized patient approach whereby employing clinical and demographic factors to predict a stable warfarin dose. Further research is needed into developing a predictive algorithm for dosing patients with severe warfarin resistance.
Haniye Ghasemof Juyomi
Shiraz University of Medical Sciences, Iran
Title: The Effects of Combine Oral Contraceptive Pills on Cardiovascular Risk Factors: A Systematic Review on Clinical Trials
Ghasemof Juyomi is a midwife, graduated from Shiraz University of Medical Sciences, Shiraz, Iran; that participated in international conferences related to women health and cardiometabolic risk fatcors. She is interested in the fields of Neonatal and Maternal complication, and disorders and side effects of medications that taken before, during and after pregnancy.
Background: The combine contraceptive pills (COCPs), included a combination of esterogen and progesterone, are an accepted therapeutic for pregnancy prevention. Several studies indicated that COCP intake might have some side effects, such as cardiovascular diseases (CVD). Therefore this study aimed to investigate the effects of COCP on CVD risk factors.
Methods: Google Scholar, PubMed and Magiran Library databases were systematically searched to find relevant clinical trials investigating the effects of COCPs on CVD from inception up to June 2020.
Results: Included articles (n = 10) assessed several risk factors such as blood pressure, serum levels of total cholesterol, triglyceride, low-density lipoprotein (LDL) and high-density lipoprotein (HDL). A total of the articles indicated the increament of blood pressure, serum levels of cholesterol, triglyceride, LDL and reduction in HDL following COCPs intake.
Conclusions: The results of studies showed that COCP intake for long time is related to the increase of the CVD risk factors and most probably they have an adverse effects on cardiovascular disease.
Keyword: Contraceptive Pills, Cardiovascular Disease, Lipid profile