Search

Introduction: Extracorporeal membrane oxygenation (ECMO) is being increasingly used for acute support in patients with cardiogenic shock (CS). Data regarding the indications, outcomes, and readmissions in these patients from a nationally representative sample is lacking. Methods: A secondary analysis of the Nationwide Readmission Database for years 2016-2017 was performed. Patients who were admitted with a primary diagnosis of CS were identified using ICD-10, Clinical Modification codes and were sub-grouped into those with acute coronary syndrome (ACS) and without ACS (non-ACS). Any readmission within 30 days of discharge was considered for analysis. Results: A total of 6,126 patients with CS received ECMO support, among which 35% had concurrent acute coronary syndrome (ACS). Patients on ECMO who had ACS were significantly older (60.5±11 vs 45.1±11 years, p Conclusions: Only 1 in every 2 patients with CS on ECMO survives to discharge. Survival to discharge in these patients differs significantly according to the presence or absence of ACS. Among the patients who survive to discharge, 18% of patients are readmitted within 30 days.

Background: Stresses associated with medical school expose students to psychological distress that can have negative consequences. The purpose of this study was to screen for psychological distress among medical students, identify stressors, and examine the correlation between these stressors and students’ academic performance. Methods: This cross-sectional study was conducted with 219 medical students at the basic science and clinical clerkship training levels at Umm Al-Qura University in Makkah, Saudi Arabia, in 2014. The Mental Health Inventory (MHI-38) was used to assess students’ psychological well-being and distress in terms of anxiety, depression, and life satisfaction. A questionnaire was also used to assess common stressors and collect demographic information and students’ grade point average (GPA). Results: Male students had higher levels of depression, anxiety, and loss of control than female students did. The mean MHI-38 anxiety, depression, and life satisfaction scores were 34.69 (SD = 7.14), 15.11 (SD = 3.82), and 3.12 (SD = 1.01) respectively, indicating the sample was slightly anxious, somewhat depressed, and somewhat satisfied with life. MHI-38 depression scores significantly (p Conclusions: Results showed that psychological distress is common among the sample but is most prominent among males. Less depressed students had a higher GPA, and academic-related stressors were most frequently reported by students. These findings highlight the need for addressing mental health issues and eliminating the risk factors.

The Meeting-to-Meeting Model is designed to provide a medical educator with an easy-to-use guide to conduct efficient bedside teaching sessions in inpatient settings. Here, we summarize some of the strategies described in the literature, which we have modified in order to make the model more practical. The model comprises five main steps: Meeting I, corridor I, patient encounter, corridor II, and meeting II. We also briefly describe adult learning theory in relation to BST. Further research is needed to assess the generalizability of the model and to evaluate its effect on educational outcomes.

Precise diagnosis and troubleshooting of LVAD complications require thorough and careful evaluation of imaging, lab testing and LVAD parameters. A 60 yo man with NICM and HM3 implant presented with dizziness and low flow alarms. ECG showed VT at 160 bpm. Labs showed AKI, normal plasma free

Iatrogenic coronary artery dissection is a potentially life-threatening complication of cardiovascular interventions. The optimal management of iatrogenic coronary artery dissection is not clear; however, both conservative management and percutaneous or surgical revascularization have been performed depending on the patient’s clinical status and the extent of dissection. We present the first reported case of right coronary artery dissection after Bentall procedure performed for ascending aortic aneurysm. Urgent percutaneous intervention using adjunctive coronary imaging was performed with excellent clinical recovery. In this article, we highlight coronary artery dissection after Bentall procedure as a possible complication, provide an insight into various options in its management, and review published data on iatrogenic coronary artery dissection. We also discuss the challenges in percutaneous treatment of coronary artery dissection with special focus on intracoronary imaging for accurate diagnosis and guidance in the management of this complex lesion.

Depression commonly overlaps with uremic symptoms, but anxiety is less commonly studied among renal patients. The symptoms of medical illness, along with the psychological and social stresses that often accompany a debilitating chronic disease, are thought to produce deleterious psychological consequences. We sought to determine the prevalence and predictors of anxiety and depression among Saudi dialysis patients in Makkah. A cross-sectional study of anxiety and depression among end-stage renal disease (ESRD) patients in Makkah was conducted in November 2011. The Hospital Anxiety and Depression Scale (HADS) was used to screen for anxiety and depression. Participants' demographic data, possible stressors and past psychiatric history were obtained. All participants were Saudi ESRD patients on maintenance hemodialysis. According to HADS, 57 (21.1%) patients were probable cases of anxiety and 63 (23.3%) were probable cases of depression. Only 32 (11.3%) were diagnosed with depression or anxiety before ESRD onset. Age was a significant predictor of anxiety and depression diagnoses. Major family problems (p = 0.001) were also a significant predictor of anxiety. Anxiety and depressive symptoms are prevalent among ESRD patients in Makkah, and anxiety can be predicted by family factors. Early detection, management and family support might improve clinical outcomes.

We present a patient with Crohn’s disease under treatment with adalimumab who developed acute myeloid leukaemia (AML) with core-binding factor beta gene rearrangement. This case report emphasises the importance of long-term close follow-up of patients receiving adalimumab because of the increased risk of developing AML and other malignancies.

Among all cardiac diseases, congestive heart failure (CHF) is the leading cause of patient rehospitalization. Fluid overload and lung congestion are the major reasons for these recurrent admissions. This disease can be associated with worsening renal function, a phenomenon called cardiorenal syndrome (CRS), which is challenging to manage. Conventional diuretic therapy of both CRS and diuretic resistance has offered limited efficacy. Compared with conventional therapy, hemodiafiltration (HDF) has shown promising results for fluid removal in some clinical trials, with inconclusive effects on all-cause mortality and rehospitalizations. Nonetheless, the results are inconsistent because of the high heterogeneity among these studies. In this chapter, we shed light on the role of different methods of ultrafiltration, including peritoneal ultrafiltration, sustained slow efficiency dialysis, and HDF, in the management of CHF, and review the current literature.

Bedside teaching (BST) is a fundamental component of clinical training and an essential tool in the creation of a competent physician.1-15 Sir William Osler (1849-1919), one of Canada’s most renowned physicians, was the first to introduce BST to medical education in 1892. He described modern medical education as something that needed to be taught at the bedside: “Medicine is learned by the bedside and not in the classroom.”9 BST allows the physician and patient to interact at the bedside; through this physician-patient interaction process, medical students and residents are simultaneously afforded the opportunity to learn clinical skills, clinical reasoning, physician-patient communication, empathy, and professionalism.6,12,15 In real practice, comprehensive history taking can help the physician diagnose up to 56% of patient problems, which may rise to 73% if a physical examination is added.8 Much information can be gained and a proper diagnosis reached by obtaining a good medical history and performing an efficient clinical examination.8 Clinical teaching in which the patient is involved is enriched by these visual, auditory, and tactile experiences. Senior medical students and medical residents believe that BST is a valuable but underutilized tool.15 Time spent on BST has been on the decline since 1978, as highlighted by Ahmed, who reported that the proportion of teaching time taken up by BST had declined from 75% 30 years ago to only 16% today.8 The learning triad The BST learning triad comprises patients, students, and tutors.6 All three must be present for BST to occur and it must occur within a clinical environment. Each individual member brings his or her own value to the learning triad. For example, the student brings medical knowledge and the eagerness to learn; the tutor brings depth of knowledge, mentorship, and willingness to help the student learn and make connections; and finally, the patient brings relevant clinical issues to the forefront that allow the student to learn. An effective learning environment requires all three groups to work together in the learning triad.6 The obstacles that may reduce the effectiveness of BST can be categorized by each group in the learning triad.

A 56-year-old man with diabetes and a history of triple coronary artery bypass graft surgery (left internal mammary artery [LIMA] to left anterior descending [LAD] artery, saphenous vein grafts to posterior descending artery and obtuse marginal artery) underwent coronary catheterization for

A woman aged 67 years with a history of multiple myeloma who was receiving chemotherapy was admitted to the medical intensive care unit with massive gastrointestinal bleeding. She denied having any family history of bleeding diathesis. Her laboratory studies showed a normal platelet count and coagulation profile, whereas her serum-free lambda light chain level was elevated at 183.25 mg/dL (reference: 0.57–2.63). She underwent gastric endoscopy …

Preterm Premature Rupture Of Membranes (PPROM) is directly linked to prematurity associated with severe neonatal morbidity and mortality. Randomized clinical trials have shown that weekly injections of 17-alpha-hydroxyprogesterone (17P) or daily vaginal progesterone application decreases the number of preterm deliveries, particularly for women with a history of preterm delivery or those with a shortened cervix. However, no studies have yet been conducted to prove or disprove the effect of rectal progesterone on latency period. To address this issue, we will conduct a multicenter randomized triple-blind controlled trial of 216 participants (108 in each group) from January 1, 2016 to August 31, 2016. Inclusion criteria, exclusion criteria, data collection procedure, data analysis, and assessment of safety procedures are explained in the study protocol. The primary objective will be to determine the effect of rectal progesterone on the latency period in PPROM. The secondary objective will be to study the effect of rectal progesterone on maternal outcomes of hospitalization, intensive care unit admission, chorioamnionitis, post-partum hemorrhage, post-partum pyrexia, endometritis, and maternal death. In addition, we will evaluate prenatal birth weight, Apgar score, neonatal morbidity, duration of neonatal intensive care unit stay, intrauterine fetal death, and neonatal death associated with PPROM.