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Background: Peripartum cardiomyopathy (PPCM) is idiopathic cardiomyopathy that presents during the last trimester or the first several months after delivery and it is a serious complication of pregnancy. Objectives: The aim was to assess the most common risk factors seen among pregnant women leading to PPCM and factors that are associated with better outcomes after therapy. Materials and Methods: A total of 20 patients who presented to the outpatient cardiology clinic and fulfilled the diagnostic criteria of the European Society of Cardiology were recruited to participate in the study. A detailed history was obtained and left ventricular measurements were evaluated using M-mode, 2-dimentional, and Simpson methods to estimate the ejection fraction. Data were analyzed using the Statistical Package for the Social Sciences. Results: Mean age at diagnosis was 34.7 ± 5.2 years. Multiparous women constituted 60% of the study sample. Gestational age at presentation ranged between 28 and 38 weeks, with a mean of 32.9 ± 2.6. Being overweight was a common feature as 60% of patients had above-normal body mass index. Family history was reported in 50% of patients, followed by passive smoking (35%), hypertension (25%), thyroid disorders (30%), and type II diabetes mellitus (20%). The mean left ventricular ejection fraction at the time of diagnosis was 32.3% ± 6.7% with an increase to 44.2% ± 8.9% at follow-up. Younger patients were more likely to regain normal left ventricular function following diagnosis (P = 0.005). Conclusion: These preliminary results strongly demonstrate that advanced maternal age, anemia, multiparity, and family history were the most common risk factors seen among our population.

Background: Coronary artery disease (CAD) is the leading cause of morbidity and mortality worldwide despite current advances in primary preventive and state-of-the art interventional strategies for effective CAD treatment. The major manifestation of CAD is the acute myocardial infarction (AMI). Vitamin D deficiency is associated with an increased risk of coronary atherosclerosis and AMI. Objectives: The major aim of this study was to determine the association of Vitamin D deficiency with AMI in Iraqi patients living in this region. Materials and Methods: Vitamin D level status was determined in 148 patients presented with AMI and 148 of healthy controls. Measurement of serum 25-hydroxyvitamin D (25(OH) D) levels was performed using enzymatic immunoassay method. Normal serum 25(OH) D level is = 30 ng/ml, while patients with level of 20–30 ng/ml was classified as insufficient, and those with level 10–20 ng/ml as deficient. The severe Vitamin D deficiency in patients was defined when serum 25(OH) D level was = 10 ng/ml. Results: The mean of 25(OH) D level was significantly lower in patients with AMI (8.73 ng/ml) as compared to healthy controls (13.60 ng/ml). Notably, the prevalence of severe deficiency of 25(OH) D level (

Background: Coronary artery disease (CAD) and its major manifestation of acute myocardial infarction (AMI) are the most common causes of mortality and disability worldwide. Objectives: The major aim of this study was to assess the prevalence of the most frequent risk factors for AMI in Iraqi patients, including hypertension, hyperlipidemia, diabetes mellitus, smoking, family history, insufficient physical activity, obesity, and abnormal coronary artery characteristics. Materials and Methods: In this study, 74 patients presented with AMI (51 males and 23 female) were enrolled. Laboratory investigations were carried out using enzymatic immunoassay technique. Results: The mean age was 55.5 ± 12.47 years, with an age range of 20–90 years. The incidence of AMI in male patients was significantly higher than that in female patients. Major findings showed that 85.1% of AMI patients were insufficiently physically active and 74.3% were hypertensive. High level of low-density lipoprotein was seen in 50% of patients, high triglycerides in 41.9%, low high-density lipoprotein in 39.2%, and high total cholesterol in 34%. Nearly 39.2% were smokers, 35.1% were obese, and 29.7% were diabetic. Interestingly, 51.4% of the AMI patients had a positive family history of CAD. The left anterior descending artery was the most common vessel involved during AMI. Conclusions: The findings of this study conclude that AMI occurs in older age and in male gender among Iraqi population, and ST-elevation MI is the main presentation. Hypertension, hyperlipidemia, and smoking are the major risk factors. This study shed light on the primary prevention and control of these cardiovascular risk factors for CAD through healthy lifestyle, increased physical activity, and healthy dietary choices, which can reduce the prevalence of CAD.

Background: Ramadan fasting is a common religious tradition practiced by several prominent faiths in the world. It is also currently regaining interest as a medical practice, both as preventive and as therapy and/or simple choice of lifestyle. Fasting brings about some changes in life style, diet, and sleeping patterns, which raises major concerns for cardiac patients. Thus, the role of Ramadan fasting in acute coronary events could be pivotal for cardiac patients. The association of fasting with acute myocardial infarction (AMI) remains to be further clarified. Objectives: The major aim of this study was to determine the prevalence of AMI and its associated risk factors among Iraqi patients during Ramadan (DR) and non-Ramadan months. Materials and Methods: A total of 154 AMI patients admitted to the Surgical Specialty Hospital–Cardiac Center, Erbil city were enrolled a month before Ramadan and DR in 2019. The serum levels of lipid profile parameters were analysed using enzymatic immunoassay analyzer. The HbA1c was measured using a fully automated glycohemoglobin analyzer. Results: The incidence of AMI was statistically significantly lower among fasted patients (29%) as compared to non-fasting patients (71%) (P < 0.05). Low-density lipoprotein-cholesterol and triglycerides statistically significantly decreased in fasted AMI patients (15.6% and 22.2%,P < 0.05) compared to nonfasting patients (31.2% and 58.7%), but not with high-density lipoprotein-cholesterol and total cholesterol. No statistically significant changes were found in hypertension and diabetes between fasted and nonfasted patients with AMI (P > 0.05). Conclusion: Ramadan fasting has a preventive effect, and it does not increase the risks of acute coronary events in Iraqi patients.

Scientific knowledge has advanced to enable the development of inhaled insulin. It is a form of diabetes medication administered via the pulmonary system that studies have shown to be efficacious in the treatment of both type 1 and type 2 diabetes. Inhaled insulin is a new, safe means to deliver insulin that may increase patient compliance with insulin therapy, helping them to achieve optimal glycemic control and possibly reducing their risk of developing cardiovascular complications. However, diabetes is a chronic illness requiring lifetime intervention. Empowering patients with the knowledge of the diabetes disease process may give them the confidence to be more autonomous in managing their diabetes. HIIP gives nurse practitioners a new option that may improve their patients’ acceptance of insulin therapy, and improve glycemic control.

Background: Invasive ventilation is a common practice in intensive care units (ICUs). Once a patient is intubated, maintenance of the endotracheal tube placement is essential. When the ETT is not secured effectively, even basic nursing management can cause tube slippage which is a major factor in causing airway trauma. Aim of the study: This study was aimed at comparing the effectiveness of three endotracheal tube securement techniques (Twill, Adhesive and Simple bow) on endotracheal tube slippage, external jugular venous pressure measurement, oral mucosa and facial skin integrity, pain intensity and on patient satisfaction after the fixation method. Subjects and methods: A randomized clinical trial was conducted at the intensive care units in Ain Shams University Specialized Hospital. It included a sample of 90 patients, randomly allocated to the three equal groups: Twill, Adhesive and Simple bow groups, 30 subjects for each. The tools used for data collection included demographic and clinical data sheet, the time profile of ETT fixation method sheet and scales for endotracheal tube (ETT) slippage, external jugular venous pressure (EJVP) measurement, oral assessment guide (OAG) for oral mucosa, Facial Skin Integrity, pain intensity and patient satisfaction procedure scale. The study maneuvers were applied according to the group. Results: Both ETT slippage and EJVP were measured at 15, 30, 60 and 120 min post fixation method. At 120 min, 73% of patients in the Twill group had no slippage compared to Simple bow (50%) and (36%) in Adhesive groups. However, at 30 min post fixation method 90% of patients in the Twill group had normal EJVP measurement compared to Simple bow and Adhesive groups (70% and 57%, respectively), with a statistically significant difference between the three groups. At 60 min, only 10% of patients in the Twill group had high EJVP compared to Simple bow (37%) and Adhesive groups (47%) with a statistically significant difference among them. As well, at 120 min post fixation method, most patients in the Twill group (97%) had normal EJVP measurement, compared to the Adhesive (60%) and Simple bow (57%) groups. Oral mucosa and facial skin integrity assessment was done for all patients in the three study groups at 2, 6, 12, and at 24 h post fixation method. For oral mucosa at 24 h post fixation method, 80% of patients in the Twill group had healthy oral mucosa compared to Simple bow and Adhesive groups (47% and 37%, respectively), with a statistically significant difference between the three groups (P = 0.07). For facial skin integrity, at 6 h, no one of patients in the Twill and Simple bow groups had severe facial skin reaction compared to patients in the Adhesive group (7%) and the difference was statistically significant, (P = 0.01). As well, a statistically significant difference was revealed among the three groups, at 12 and 24 h post fixation method, (P = 0.04 and 0.02, respectively). The Twill technique had the shortest time taken for application and removal of securement method than other groups. Additionally, the Twill group had the lowest scores of pain at all three assessment times (5, 10 and 20 min), whereas those in the Adhesive group had the highest scores. All these differences were statistically significant, (P