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We report a 31-year-old patient with acute fulminant myocarditis, resulting in cardiogenic shock that necessitated mechanical circulatory support, who improved dramatically after treatment with intravenous (IV) pulse steroids. A coordinated multidisciplinary team was the key secret in the cure of this critical patient. In this case study, we focus on the role of IV pulse steroids in the treatment of fulminant lymphocytic myocarditis.

Introduction: Heart failure with reduced ejection fraction (HFrEF) in Qatar has not been well characterized in the outpatient setting. Objective: To describe the characteristics of patients with HFrEF who had improvement in their left ventricular ejection fraction (LVEF) and independent predictors of improvement. Methods: This retrospective cohort study conducted at the advanced heart failure (HF) clinic in Qatar recruited patients who visited the clinic between January 2017 and December 2018. Adult patients were eligible if they were diagnosed with HFrEF (LVEF < 40%) and had two echocardiograms separated by at least 6 months. Results: Of 582 eligible patients, 161 (27.7%) had improved LVEF. They were younger (53.4 vs. 57.3 years, P = 0.002) and had shorter duration of HF diagnosis (4.3 vs. 5.6 years, P = 0.001). They experienced lower rates of all-cause hospitalization (20.5% vs. 38.0%, P = 0.001) and emergency department visits (25.5% vs. 35.9%, P = 0.001), without a difference in hospital mortality rate, than those without LVEF improvement. Decreased odds ratio of improved LVEF was associated with per year increase in age (adjusted odds ratio [aOR]: 0.98, 95% confidence interval [CI]: 0.97–0.99, P = 0.03), presence of left bundle branch block (aOR: 0.40, 95% CI: 0.20–0.80, P = 0.001), duration of HF diagnosis (aOR: 0.85, 95% CI: 0.78–0.94, P = 0.001), and ischemic HF etiology (aOR: 0.50, 95% CI: 0.30–0.77, P = 0.001; compared with dilated etiology). Beta-blocker therapy was associated with higher odds of LVEF improvement (aOR: 2.65, 95% CI: 1.02–6.88, P = 0.001). Conclusion: Patients with HFrEF with improved LVEF were younger, had a nonischemic cardiomyopathy, and had significantly fewer hospitalizations and emergency department visits.

BackgroundAcute coronary syndrome (ACS) remains a risk factor for heart failure (HF). Therefore, we aimed to assess the cardioprotective role of sodium–glucose cotransporter-2 (SGLT2) inhibitors post-ACS in patients with acute HF (AHF) and diabetes.MethodsWe conducted a retrospective observational cohort study employing propensity score matching. This study involved patients with diabetes admitted with ACS complicated by AHF, defined as either new clinical HF requiring diuretics during the index admission or having an ejection fraction (EF) of

Patients at each shock stage may behave and present differently with a spectrum of shock severity and adverse outcomes. Shock severity, shock aetiology, and several factors should be integrated in management decision-making. Although the contemporary shock stages classification provided a standardized shock severity assessment, individual agents or management strategy has not yet been studied in the context of each shock stage. The pre-shock state may comprise a wide range of presentations. Nitrate therapy has potential benefit in myocardial infarction and acute heart failure. Herein, this review aims to discuss the potential use of nitrate therapy in the context of the pre-shock state or stage B of the contemporary shock classification given its various presentations.

We report the case of acute lymphoblastic leukemia (ALL) in a 29-year-old male with no past medical history who presented with symptoms and signs of heart failure due to possible infiltrative cardiomyopathy as suggested by echocardiography. Workup including different imaging modalities confirmed the diagnosis of ALL. The patient completed his treatment course with a resolution of heart failure symptoms and normalization of cardiac function which was confirmed by different imaging modalities.

Background: Out-of-hospital cardiac arrest (OHCA) is a leading cause of death worldwide. However, there is limited information on the outcome of the OHCA in the Middle East population, and limited studies have been carried out in the Arab Gulf countries. Hence, we aim to study the incidence and rate of survival in the OHCA setting and to assess the impact of gender on the clinical outcome following OHCA. Methods: Retrospective analysis of a prospective registry of all eligible, consecutive, and nontraumatic adult patients who successfully resuscitated (return of spontaneous circulation) from “Cardiac Arrest” occurring outside the hospital, Hospitalized in Doha, Qatar from January 1991 to June 2010. Results: A total of 41,453 consecutive patients were admitted during the study, of whom 987 (2.4%) had a diagnosis of OHCA. Among them, 269 (27.3%) were women and 718 (72.7%) were men. Although the mortality rate was higher in females than in males (65.4% vs. 57.7%, P = 0.03), the logistic regression analysis did not show gender as an independent predictor of death in this clinical setting. Conclusion: In this sample of the state population, women who have OHCAs had a lower rate of survival, but gender was not an independent predictor of mortality following OHCA.

Background: Worldwide, limited data are available about young patients (≤40 years) who present with out-of-hospital cardiac arrest (OHCA). We compared demographic characteristics, clinical presentation, and outcome in younger patients (≤40 years) versus older patients (>40 years) with OHCA. Materials and Methods: This was a retrospective analysis of a registry of patients hospitalized with OHCA over a 23-year period (1991–2013) in Hamad Medical Corporation, Doha, Qatar. Results: Of 1146 patients admitted to our institution with OHCA, 159 patients (13.9%) were 40 years of age or younger. Compared to the older group (>40 years), younger group patients were more likely to be males (84.9% vs. 71.5%; P= 0.001) and to be smokers (27.7% vs. 19.7%; P= 0.012). They are less likely to have diabetes (6.3% vs. 49.2%; P= 0.001), hypertension (8.3% vs. 49.9%; P= 0.001), prior myocardial infarction (3.1% vs. 23.4%; P= 0.001), or chronic renal disease (0% vs. 8.5%; P= 0.001). There was no significant difference in ejection fraction, ST-elevation myocardial infarction (13.2% vs. 15.7%; P= 0.41), utilization of inotropes (36.5% vs. 44%; P= 0.08), or utilization of reperfusion therapy (thrombolytic: 16.4% vs. 12.2%, P= 0.14, and percutaneous intervention: 6.3% vs. 5.3%, P= 0.60, for the younger and older groups, respectively); on the other hand, younger patients were more likely to receive antiarrhythmic medications (33.3% vs. 21.2%; P= 0.001). Inhospital mortality was lower in the younger group (52.1% vs. 68.3%; P= 0.001) even after adjustment for baseline variables. Conclusion: In the Middle East it is not uncommon to present with OHCA in young age. These patients are predominantly males, more likely to present with arrhythmia and they have a better survival rate.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is the cause of COVID-19, was first reported in Wuhan, China. SARS-CoV-2 especially involves alveolar epithelial cells, which results in respiratory symptoms more severe in patients with cardiovascular disease (CVD) probably linked with increased secretion of angiotensin-converting enzyme 2 in these patients compared with healthy individuals. Cardiac manifestations may contribute to overall mortality and even be the primary cause of death in many of these patients. A higher prevalence of hypertension (HTN) followed by diabetes mellitus and CVD was observed in COVID-19 patients. A higher case-fatality rate was seen among patients with pre-existing comorbid conditions, such as diabetes, chronic respiratory disease, HTN, and cancer, compared to a lesser rate in the entire population. Cardiovascular (CV) manifestations of COVID-19 encompass a wide spectrum, including myocardial injury, infarction, myocarditis-simulating ST-segment elevation myocardial infarction, nonischemic cardiomyopathy, coronary vasospasm, pericarditis, or stress (takotsubo) cardiomyopathy. This review is intended to summarize our current understanding of the CV manifestations of COVID-19 and also to study the relationship between SARS-CoV-2 and CVDs and discuss possible mechanisms of action behind SARS-CoV-2 infection-induced damage to the CV system.

Background Central venous catheterisation is commonly used in critical patients in intensive care units (ICU). It may cause complications and attribute to increase mortality and morbidity. At coronary ICU (CICU) of cardiac hospital, central line-associated bloodstream infection (CLABSI) rate was 2.82/1000 central line days in 2015 and 3.11/1000 central line days in 2016. Working in collaboration with Institute for Healthcare Improvement (IHI), we implemented evidence-based practices in the form of bundles in with the aim of eliminating CLABSI in CICU.Methods In collaboration with IHI, we worked on this initiative as multidisciplinary team and tested several changes. CLABSI prevention bundles were tested and implemented, single kit for line insertion, simulation-based training for line insertions, standardised and real-time bundle monitoring by direct observations are key interventions tested. We used model for improvement and changes were tested using small Plan-Do-Study-Act cycles. Surveillance methods and CLABSI definition used according to National Healthcare Safety Network.Results The CLABSI rate per 1000 patient-days dropped from 3.1 per 1000 device-days to 0.4 per 1000 device-days. We achieved 757 days free of CLABSI in the unit till December 2018 when a single case happened. After that we achieved 602 free days till July 2020 and still counting.Conclusions Implementation of evidence-based CLABSI prevention bundle and process monitoring by direct observation led to significant and subsequently sustained improvement in reducing CLABSI rate in adult CICU.

Uncontrolled hyperthyroidism has been associated with significant changes in cardiovascular hemodynamics. We report a case of a 39-year-old male who has been recently diagnosed with severe hyperthyroidism. He was undergoing dobutamine stress echocardiography (DSE) for evaluation of symptoms suggestive of stable angina. The exam was complicated by ST-segment elevation myocardial infarction- (STEMI-) required coronary angiography that showed mild coronary artery disease.

Cognitive radio sensor networks (CRSNs) is the state-of-the-art communication paradigm for power constrained short range data communication. It is one of the potential technologies adopted for Internet of Things (IoT) and other futuristic machine-to-machine-based applications. Many of these applications are power constrained and delay sensitive. Therefore, CRSN architecture must be coupled with different adaptive and robust communication schemes to take care of the delay and energy efficiency at the same time. Considering the tradeoff that exists in terms of energy efficiency and overhead delay for a given data packet length, it is proposed to transmit the physical layer payload with an optimal packet size (OPS) depending on the network condition. Furthermore, due to the cognitive feature of CRSN architecture overhead energy consumption due to channel sensing and channel handoff plays a critical role. Based on the above premises, in this paper, we propose a heuristic exhaustive search-based Algorithm-1 and a computationally efficient suboptimal low complexity Karuh-Kuhn-Tucker (KKT) condition-based Algorithm-2 to determine the OPS in CRSN architecture using variable rate m-QAM modulation. The proposed algorithms are implemented along with two main cognitive radio assisted channel access strategies based on distributed time slotted-cognitive medium access control (DTS-CMAC) and centralized common control channel-based cognitive medium access control (CC-CMAC) and their performances are compared. The simulation results reveal that proposed Algorithm-2 outperforms Algorithm-1 by a significant margin in terms of its implementation time. For the exhaustive search-based Algorithm-1 the average time consumed to determine OPS for a given number of cognitive users is 1.2 s, while for KKT-based Algorithm-2, it is of the order of 5-10 ms. CC-CMAC with OPS is most efficient in terms of overall energy consumption but incurs more delay as compared to DTS-CMAC with OPS scheme.

The determination of optimal packet size (OPS) for a cognitive radio-assisted sensor networks (CRSNs) architecture is non-trivial. State of the art in this area describes various complex techniques to determine OPS for CRSNs. However, it is observed that under high interference from the surrounding users, it is not possible to determine a feasible OPS of data transmission under the simple point-to-point CRSN topology. This is contributed primarily to the peak transmit power constraint of the cognitive nodes. To address this specific challenge, this paper proposes a multiple-input multiple output-based CRSNs (MIMO-CRSNs) architecture for futuristic technologies, such as Internet of Things and machine-to-machine communications. A joint optimization problem is formulated, considering network constraints, such as the overall end-to-end latency, interference duration caused to the non-cognitive users, average BER, and transmit power. We propose our Algorithm 1 based on the generic exhaustive search technique to solve the optimization problem. Furthermore, a low complexity suboptimal Algorithm 2 based on solving classical Karush-Kuhn-Tucker conditions is proposed. These algorithms for MIMO-CRSNs are implemented in conjunction with two different channel access schemes. These channel access schemes are time-slotted distributed cognitive medium access control denoted as MIMO-DTS-CMAC and CSMA/CA-assisted centralized common control channel-based cognitive medium access control denoted as MIMO-CC-CMAC. Simulations reveal that the proposed MIMO-CRSN outperforms the conventional point-to-point CRSN in terms of overall energy consumption. Moreover, the proposed Algorithm 1 and Algorithm 2 show a perfect match, and the implementation complexity of Algorithm 2 is less than Algorithm 1. Algorithm 1 takes almost 680 ms to execute and provides OPS value for a given number of users, whereas Algorithm 2 takes 4-5 ms on average to find the OPS for the proposed MIMO-CRSN framework.

Patient: Female, 75 FINAL DIAGNOSIS: Hypertensive crisis with multi organ failure Symptoms: Anemia • general weakness • hypokalemia • nausea • tachycardia, Medication: - Clinical Procedure: - Specialty: Cardiology., Objective: Unexpected drug reaction., Background: Skin reactions are common adverse drug reactions and may include angioedema, erythroderma, Stevens-Johnson syndrome, and toxic epidermal necrolysis (TEN). TEN is a rare but serious reaction characterized by widespread erythema, necrosis, and bullous detachment of the epidermis and mucous membranes., Case Report: An elderly woman presented with generalized weakness and nausea, associated with a hypertensive crisis. Following the initiation of hydralazine, well-demarcated erythematous maculopapular rashes appeared on her right forearm and left leg, which transformed into a bullous rash. Subsequently, a similar patch appeared on her left forearm, with a similar progression and associated with generalized edema of the extremities. A clinical diagnosis of drug-induced toxic epidermal necrolysis was made and hydralazine was discontinued. Following this, the skin lesions improved, with complete subsequent resolution. Skin biopsy was not performed due to the rapid resolution of the lesions. A negative screen for autoantibodies ruled out systemic lupus erythematosus, scleroderma, and other undifferentiated connective tissue disorders. After re-administration of hydralazine, the same lesions appeared again, which again resolved after its discontinuation, thus confirming our initial clinical suspicion. Treatment is immediate discontinuation of the offending drug and supportive care., Conclusions: Clinical awareness with close monitoring is important for the identification of a rare adverse drug reaction, which can be fatal if not diagnosed and treated promptly.