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Mediworld 07th MAR-APR Final Draft for Print REVISE COPY

News & Updates Heart

News & Updates Heart attack protocol can improve outcomes - research Cleveland Clinic, OH, USA Researchers in the United States have found that implementing a four-step protocol for the most severe type of heart attack not only improved outcomes and reduced mortality in both men and women, but eliminated or reduced the gender disparities in care and outcomes typically seen in this type of event. The research by a Cleveland Clinic team was presented this month at the American College of Cardiology's 67th Annual Scientific Session and published in the Journal of the American College of Cardiology. Cardiovascular disease is the leading cause of death in women, and STEMI (ST elevation myocardial infarction), caused by an abrupt and prolonged blockage of the blood supply to the heart, impacts about one million women each year. Previous studies have shown that women with STEMI have worse clinical outcomes, including higher mortality and higher rates of in-hospital adverse events. Studies have shown women also typically have higher door-to-balloon times (time from when they arrive at the hospital to when they receive a coronary intervention such as angioplasty or stenting). They receive lower rates of guideline-directed medical therapy: for example, they are treated with lower rates of aspirin within 24 hours. Previous studies have attributed the differences in care and outcomes in women with STEMI to their being older and higher risk patients than men, suggesting that these disparities may be inevitable. In this study, Cleveland Clinic researchers put in place a comprehensive four-step protocol for STEMI patients, designed to minimize variability in care. It included: (1) standardized emergency department (ED) cardiac catheterization lab activation criteria, (2) a STEMI Safe Handoff Checklist, (3) immediate transfer to an available catheterization lab, and (4) using the radial artery in the wrist as the first option for percutaneous (under the skin) coronary intervention, such as stenting. This approach has been shown to have fewer bleeding complications and improved survival when compared to using the femoral artery. The results of the study showed improvements in both genders after implementation of the protocol, and substantial reductions in care differences between men and women. Prior to the protocol, women had significantly higher 30-day mortality than men (10.7 percent vs 4.6 percent) prior to the protocol. Providers were able to lower the overall mortality rates for both men and women, and the difference between the genders was no longer statistically significant (6.5 percent vs. 3.3 percent). In-hospital deaths of women with STEMI were reduced by about 50 percent. In addition, there was also no difference in rates of major adverse events such as in-hospital stroke, bleeding, vascular complication, and transfusions af ter implementation. Prior to the protocol, mean door-toballoon time for women was an average of 20 minutes longer compared to men, but afterwards, the times were equal between men and women. The system also resulted in equal rates of guideline-directed medical therapy in women. 26

News & Updates Risk of maternal death doubled in pregnant women with anaemia Pregnant women with anaemia are twice as likely to die during or shortly after pregnancy compared to those without the condition, according to a major international study led by Queen Mary University of London of over 300,000 women across 29 countries. The research, published in the journal The Lancet Global Health and financed by healthcare innovation funder Barts Charity, suggests that prevention and treatment of maternal anaemia must remain a global public health and research priority. Anaemia, which is characterized by a lack of healthy red blood cells, affects 32 million pregnant women worldwide, and up to half of all pregnant women in low and middle-income countries (LMICs). Women in LMICs are at increased risk of anaemia due to higher rates of dietary iron deficiency, inherited blood disorders, nutrient deficiencies and infections such as malaria, HIV and hookworm. Lead author Dr Jahnavi Daru from Queen Mary University of London said: “Anaemia in pregnancy is one of the most common medical problems pregnant women encounter both in low and high income countries. We've now shown that if a woman develops severe anaemia at any point in her pregnancy or in the seven days after delivery, she is at a higher risk of dying, making urgent treatment even more important. “Anaemia is a readily treatable condition but the existing approaches so far have not been able to tackle the problem. Clinicians, policy makers and healthcare professionals should now focus their attention on preventing anaemia, using a multifaceted approach, not just hoping that iron tablets will solve the problem.” The study looked at data on 312,281 pregnancies in 29 countries across Latin America, Africa, Western Pacific, Eastern Mediterranean and South East Asia. Of these, 4,189 women had severe anaemia (a blood count of less than 70 grams per litre of blood) and were matched with 8,218 women without severe anaemia. This analysis is the first to take into account factors that influence the development of anaemia in pregnancy (e.g. blood loss or malaria infection) which may have been skewing the results of previous studies. The study results showed that, when all known contributing factors are controlled for, the odds of maternal death are doubled in mothers with severe anaemia. Strategies for the prevention and treatment of maternal anaemia include providing oral iron tablets for pregnant women, food fortification with iron, improving access to antenatal care in remote a r e a s , h o o k w o r m t r e a t m e n t a n d a c c e s s t o transfusion services. UAE climate leading to high incidence of skin condition Dr Uttam Kumar Have you ever suffered from itchy dry skin and feel like there is no cure? Then you are not alone. It could be that you are suffering from eczema, a skin condition that it is very common around the globe. The hot and dry conditions of the UAE mean that symptoms can be exacerbated. In general, terms “eczema” and “dermatitis” are used interchangeably. Eczema is a recurring, non-infectious, inflammatory skin condition and is most common in people with a family history of allergic disorders such as asthma, rhinitis or hay fever, since these conditions are based on genetics. In eczema, skin becomes red, dry, itchy and scaly, and in severe cases, may weep, bleed, or crust over – causing extreme discomfort. In more severe cases, the skin may become infected, suddenly flare up then subside for no apparent reason. Atopic eczema is the most common type and generally when discussing eczema, it is this type that is being referred to. Worldwide, the prevalence is 15-20 per cent, with more than 30 per cent in developed countries. Cold winters in some regions of the world can lead skin to become excessively dry and, if not treated properly, can cause irritation and eczema to flare. Extremely hot weather, of the kind experienced commonly in the UAE, can also increase itchiness, with sweat irritating the affected skin. Dr Uttam Kumar, specialist in dermatology at Burjeel Hospital explains that eczema is amongst the most common problems he sees in the clinic, along with allergies and urticaria (hives) and psoriasis. Many of these patients suffer in silence for longer than necessary. Burjeel Hospital's team of dermatology experts are well equipped to treat most cases and help their patients alleviate any discomfort or stress they may feel from this skin condition. Steroids are often prescribed but are not a long term solution for treating eczema. They are only used to treat the initial inflammation. Eczema flare-ups can be avoided in many ways, for example, the skin should be kept moist by using bland emollients (moisturizers) which are allergen-free and fragrancefree. Other ways to prevent an outbreak can include: wearing 100 per cent cotton or soft fabrics, using a mild soap-free cleanser or hypo-allergenic bath oil in lukewarm water, avoiding heavy sweating, changing bed linen regularly as well as avoiding any exposure to dust mites (ventilating regularly). Because of the genetic, and recurring, nature of the condition, eczema often cannot be fully cured but can be contained and symptoms lessened. Using emollient moisturizer will keep the dry skin hydrated and avoid any irritants you can identify, which might be in scents, fabrics and clothing or food. 27