Biomedical subjects

Lukman Thalib

Publications and source records attributed to Lukman Thalib.

At least 19 recordsLinked to original sources

PubMed2006

The prevalence and predictors of erectile dysfunction in men with newly diagnosed with type 2 diabetes mellitus.

OBJECTIVE: To determine the prevalence of and risk factors for erectile dysfunction (ED) in men newly diagnosed with type 2 diabetes mellitus (DM). PATIENTS AND METHODS: All consecutive samples of men newly diagnosed with type 2 DM attending the diabetes centre in the capital of Kuwait were included in the study. Face-to-face interviews with the men were conducted using the International Index of Erectile Function (IIEF)-5 questionnaire. A threshold IIEF-5 score of <21 was used to identify men with ED. Pertinent clinical and laboratory characteristics were collected. RESULTS: Of 323 men with newly diagnosed type 2 DM, 31% had ED; comparing potent men and men with ED, there were statistically significant differences for smoking, duration of smoking, hypertension, education level, body mass index and serum glycosylated haemoglobin level. Among these, age was the most important risk factor identified by multivariate logistic regression. CONCLUSION: About a third of men with newly diagnosed type 2 DM had ED; this was associated with many variables, but most notably with age at presentation.

Adult↗

PubMed2006

Sex of first child and breast cancer survival: a population-based study.

Previous reports on the influence of the sex of a child and prognosis of a subsequent breast cancer have been conflicting. We took advantage of a number of large and good quality, nationwide Registries in Sweden to evaluate the prognostic value of the sex of the first child in breast cancer. A population-based cohort of 32,003 women born after 1935 and diagnosed with primary breast cancer between 1958 and 1997 was generated by linking a number of Swedish registries including Swedish Cancer Registry, Cause of Death Registry, Swedish Generation Registry and the Registry of Population and Population changes. Of these, 4,251 were nulliparous, 2,732 had only a boy and 2,497 had only a girl prior to diagnosis. We used this subpopulation to quantify the association between the sex of the first child and breast cancer-specific mortality, using the Cox proportional hazards. Sex of the child did not significantly influence the prognosis of breast cancer. Stratifying by age and adjusting for age at diagnosis, calendar period, time since last birth and age at first child did not alter the results. Our study, the largest up to date, failed to identify evidence to support the proposed association between the sex of the first child and breast cancer survival. Given the previous reports that advocated taking sex of the first child into consideration in making decisions related to breast cancer therapy, our findings are reassuring and clinically important.

Adult↗

PubMed2006

Incidence of acute myocardial infarction during Islamic holiday seasons.

Some weather and holiday seasons are associated with increased incidence of acute myocardial infarction (AMI). We studied the influence of one such season, Islamic holiday season of "Eid Al-Fitr", on the incidence of AMI in a Muslim country. This was carried out by examining the admissions to the coronary care unit of a large hospital over six consecutive years (from 1997 to 2003), encompassing six consecutive holiday seasons in Kuwait. We compared the admission rates during three time intervals in each of those 6 years; the Eid holiday season, the 2 months before and the 2 months after. A total of 964 AMI admissions occurred, with a mean age of 55 years. When the admission rates were compared, the Islamic holiday seasons were associated with a significant increase in AMI admission rate (45 cases vs. 31 cases, p < 0.01). This increase occurred mainly on the second day of the 4-day holiday season. This finding was confirmed using Locally Weighted Smooth Regression (LOESS) regression models with different smoothing levels. Our finding might have potential implications for preventive health campaigns in Muslim countries.

Adult↗

PubMed2006

Prediction of mandibular third-molar impaction in adolescent orthodontic patients.

INTRODUCTION: The purpose of this study was to identify risk factors for mandibular third-molar impaction in adolescent orthodontic patients. METHODS: Radiographs made before (T1) and after (T2) treatment and at least 10 years postretention (T3) of 134 patients that allowed accurate diagnosis of impaction vs eruption of at least 1 mandibular third molar were evaluated. RESULTS: Univariate logistic regression analyses at T1 showed that the decision to extract premolars (P <.05), an increase of 1 mm in mesial molar movement (P <.05), and an increase of 1 mm in eruption space measured from second molar to Xi point (centroid of the ramus) (P <.01) reduced the risk of impaction by 63%, 22%, and 30%, respectively. An increase of 1 degrees in mandibular third-molar angulation relative to the occlusal plane increased the risk of impaction by 11% (P <.01). Multivariate logistic regression analyses at T1 showed that reduced eruption space (P <.01), signs of forward mandibular growth rotation (P <.01), and female sex (P <.05) increased the risk of impaction. However, association tests documented increased frequencies of extractions and more mesial molar movement in female patients with erupted third molars. Univariate logistic regression analyses at T2 showed that every millimeter of increase in eruption space measured from the second molar to the anterior border of the ramus and to Xi point reduced the risk of impaction by 29% and 22%, respectively (P <.01), whereas every degree of increase in the angle between the occlusal surface and the occlusal plane increased the risk of impaction by 11% (P <.01). Multivariate logistic regression analyses at T2 showed that increased eruption space reduced the risk of impaction (P <.05), whereas increased mesial angulation of the third-molar bud (P <.01) and signs of forward growth rotation (P <.05) increased the risk of impaction.

Adolescent↗

PubMed2006

Body mass index of Kuwaiti children aged 3-9 years: reference percentiles and curves.

AIM: The suitability of using the standards for body mass index (BMI), produced in the U.S. by the National Center for Health Statistics, for assessing overweight and obesity among children in Kuwait and other Arabian Gulf countries has not been examined. These standards were obtained from better-nourished and genetically different populations to those found in Kuwait and in other Gulf region countries. The purpose of this study was to develop BMI reference percentiles and curves appropriate for children aged 3-9 in these countries. METHOD: Attempts were made to include all healthy Kuwaiti kindergarten and elementary education children in this study The total sample was 113,013, comprising 55,053 males and 57,960 females. The children were measured for weight and height from which the BMI was calculated. Appropriate polynomial regression smoothing techniques were used to obtain the best-fitting percentile curves. RESULTS: At percentiles < or =25th, the BMI of boys exceeded that of girls. At the 50th percentile, boys' BMI was mostly higher than or equal to that of the girls except at age nine where it was lower At the 75th percentile, the BMI of both genders was similar, with exceptions at age six and nine years. At the 85th and 95th percentiles, girls' BMI was consistently higher than males. At the lowest percentile, the BMI of US children was higher than Kuwaiti, Saudi (starting at six) and Iranian children. The BMI of Kuwaiti children at higher percentiles was higher than that of Saudi, Iranian (except at age < four years) and US children. CONCLUSION: BMI curves for Kuwaiti children follow almost the same pattern as their US counterparts but with noticeable variations especially at the lower and higher percentiles. This study may reflect that western standards may not be directly applicable to assess the level of BMI in Kuwait and possibly in the neighbouring Gulf countries, since they may overestimate the levels of overweight, obesity and underweight.

Body Mass Index↗

PubMed2006

Could missile attacks trigger acute myocardial infarction?

OBJECTIVE: During the Gulf war in 2003, Kuwait was targeted with missile attacks for 10 consecutive days. Our objective is to evaluate the influence of missile attacks on the incidence of acute myocardial infarction (AMI). METHODS AND RESULTS: We retrospectively compared the number of admissions for AMI presenting to a major general hospital during missile attacks period (MAP) in 2003 with four control periods. MAP and each control period consisted of the same number of days (10 days). The four control periods were the 10 days immediately before and after MAP; and the same time period as MAP for the years 2001 and 2002. The number of admissions for AMI was highest during MAP, 21 cases compared to 14-16 cases in the four control periods, with a trend towards increase during MAP (incidence rate ratio = 1.59; 95% CI 0.95 to 2.66, p < 0.07). The number of admissions for AMI during the first 5 days of MAP was significantly higher compared to the first 5 days of the four control periods (incidence rate ratio = 2.43; 95% CI 1.23 to 4.26, p < 0.01). The observed AMI admission rate during the first 5 days of MAP was significantly higher than expected for a 5-day period in the years 2001, 2002 and 2003. This increase was specific to AMI and did not affect other acute cardiac conditions. CONCLUSIONS: Missile attacks were associated with an increase in the incidence of AMI. This increase was specific to AMI and did not influence acute cardiac conditions.

Acute Disease↗

PubMed2006

Troponin estimation identifies myocardial infarction patients with different characteristics.

OBJECTIVE: To investigate the impact of new myocardial infarction definition based on troponin, the rate of myocardial infarction diagnosis, patients characteristics, and short-term prognosis. METHODS: We enrolled 1,255 consecutive myocardial infarction patients from the Kuwait Registry of Acute Coronary Syndromes from December 2003 to May 2004. Two patient groups were identified, those diagnosed with elevated creatine kinase-MB (CK group) and those diagnosed with elevated troponin with normal CK-MB (Troponin group). RESULTS: The use of troponin have increased the number of myocardial infarctions by 49%. Compared with the CK group, the Troponin group were older [age 60.3 +/- 12.5 years versus 53.7 +/- 12.2 years, p<0.001], more likely to have diabetes (59% versus 41%, p<0.001), hypertension (59% versus 36%, p<0.001), and hypercholesterolemia (37% versus 24%, p<0.001). The Troponin group were more likely to suffer heart failure at presentation than the CK group (32% versus 14%, p<0.001) and, subsequently, increase incidence of heart failure during their hospital stay (17% versus 8%, p<0.001). CONCLUSION: A substantial increase in the rate of myocardial infarction occurred with the adoption of the new diagnostic criteria. The clinical outcome for the additional patients diagnosed was not better than that of patients diagnosed by the old criteria.

Biomarkers↗

PubMed2006

Mechanical thromboprophylaxis in critically ill patients: a systematic review and meta-analysis.

OBJECTIVE: To systematically review the randomized trials, observational studies, and survey evidence on compression and pneumatic devices for thromboprophylaxis in intensive care patients. METHODS: Published studies on the use of compression and pneumatic devices in intensive care patients were assessed. A meta-analysis was conducted by using the randomized controlled trials. RESULTS: A total of 21 relevant studies (5 randomized controlled trials, 13 observational studies, and 3 surveys) were found. A total of 811 patients were randomized in the 5 randomized controlled trials; 3421 patients participated in the observational studies. Trauma patients only were enrolled in 4 randomized controlled trials and 4 observational studies. Meta-analysis of 2 randomized controlled trials with similar populations and outcomes revealed that use of compression and pneumatic devices did not reduce the incidence of venous thromboembolism. The pooled risk ratio was 2.37, indicative of favoring the control over the intervention in reducing the deep venous thrombosis; however, the 95% CI of 0.57 to 9.90 indicated no significant differences between the intervention and the control. A range of methodological issues, including bias and confounding variables, make meaningful interpretation of the observational studies difficult. CONCLUSIONS: The limited evidence suggests that use of compressive and pneumatic devices yields results not significantly different from results obtained with no treatment or use of low-molecular-weight heparin. Until large randomized controlled trials are conducted, the role of mechanical approaches to thromboprophylaxis for intensive care patients remains uncertain.

Adolescent↗

PubMed2005

Self-medication with antibiotics and antimalarials in the community of Khartoum State, Sudan.

PURPOSE: To estimate the prevalence of self medication with antibiotics and antimalarials in Khartoum State, Sudan and evaluate factors associated with self medication. METHODS: A pre-tested questionnaire was used to collect data from a sample of 600 households, (1750 adult persons), selected from three cities in Khartoum State, Sudan, using a multistage stratified clustered sampling. RESULTS: One thousand two hundred and ninety three (73.9%) of the study population had used antibiotics or antimalarials without a prescription within one month prior to the study. Eight hundred and forty one (48.1%) of the respondents agreed that they have used antibiotics, 43.4% used antimalarials, while 17.5% used both. Self medication with either antibiotics/ antimalarials was found to be significantly associated with age, income, gender and level of education. Overall, self medication with any antibiotics or antimalarials was least common among the > or = 60 years compared to youngest age group (OR: 0.07; 0.04 -0.11) and most common among the female gender (OR: 1.8; 1.4 -2.4), the middle income group (OR: 3.7; 2.6-5.3) and the university graduates. Self medication with antibiotic was found to be significantly higher among females (OR: 1.5; 1.16-1.87), middle aged respondents aged 40-59 (OR: 2.1; 1.5-3.0) compared to younger respondents. Lower income and higher level of education was also found to be significantly associated with the increase risk of self medicating with antibiotic. Increase risk for self medication with antimalarials were, however, found to be significantly associated with male gender and younger age group of < 40 years and middle income earners and less educated respondents. The main reason that was indicated for the self-medication was financial constraints. The main source of medicines was the private pharmacies, which were regarded as a cheaper alternative to other primary healthcare sources. CONCLUSION: The prevalence of self-medication with antibiotics/antimalarials in Khartoum State, Sudan is alarmingly high. Self medication behaviour varies significantly with a number of socio-economic characteristics. Given the growing global resistance for antibiotic and documented health issues related to inappropriate use of such drugs, our findings has major public health policy implications for countries like Sudan.

Adult↗

PubMed2005

Third molar angulation during and after treatment of adolescent orthodontic patients.

The purpose of this study was to analyse the effect of premolar extraction therapy on third molar angulation during active treatment, and to test the significance of such changes on subsequent impaction of the third molars. Lateral cephalograms made before (T1) and after (T2) treatment and at long-term follow-up (T3) of 157 patients treated non-extraction (non-ex) or with extraction of four premolars (ex), all accurately diagnosed for impaction versus eruption of at least one third molar at T3, were evaluated. Linear regression models demonstrated that the maxillary third molars uprighted more from T1 to T2 (P < 0.05) and were less distally angulated at T2 (P < 0.01) in the ex than in the non-ex patients. No such differences were detected in the mandible (P > 0.05). The regression models also showed similar uprighting of the maxillary and mandibular third molars from T1 to T2 and similar angulation of the maxillary third molars at T2 in those patients with subsequent eruption and impaction (P > 0.05), but more mesially angulated mandibular third molars at T2 in the impaction patients (P < 0.01). Chi square testing demonstrated a higher frequency of distal tipping of the maxillary third molars from T1 to T2 in the impaction patients (P < 0.01), while mesial tipping from T1 to T2 of the mandibular third molars occurred with similar frequency in the two patient groups (P > 0.05). Chi square analysis also showed a higher frequency of greater than 30 degree distal angulation as well as an amount mesial angulation of the maxillary third molars at T2 (P < 0.01), and a higher frequency of greater than 40 degree mesial angulation of the mandibular third molars at T2 (P < 0.01) in patients with impaction than in those with eruption.

Adolescent↗

PubMed2005

Multiple births and breast cancer prognosis: a population based study.

Survival in relation to endocrine or reproductive factors has rarely been studied since the focus of most studies has been on the risk of breast cancer. In this study we analysed the effect of multiple birth compared to single births on breast cancer survival. A population based cohort of 30619 women born after 1935 and diagnosed with primary breast cancer, between 1958 and 1998, was generated by linking a number of Swedish registries including Swedish Cancer Registry, Cause of Death Registry, Swedish Generation Registry and the Registry of Population and Population changes. Then we quantified the association between singleton and multiple births to breast cancer specific fatality using the Cox proportional hazards model. We found the singleton and multiple births were associated with increased fatality if breast cancer was diagnosed within 5 years of childbirth, this effect dying out to nil at 5 years after childbirth. Thereafter there was a protective effect on survival with time. Although childbirth is known to decrease breast cancer risk, this study demonstrates that a survival disadvantage exists for breast cancer diagnosed within the first 5 years of singleton and multiple births. It is concluded that breast cancer diagnosed within 5 years of childbirth, particularly if this or prior pregnancies have been multiple, should be regarded as a negative prognostic factor and considered in counselling and treatment of these patients.

Adult↗

PubMed2005

Prediction of maxillary third molar impaction in adolescent orthodontic patients.

The purpose of this study was to identify risk factors for maxillary third molar impaction in adolescent orthodontic patients. Radiographs made before treatment (T1) and after treatment (T2) and at a minimum of 10 years postretention (T3) of 132 patients that allowed accurate diagnosis of impaction vs eruption of one or both maxillary third molars were evaluated. Although univariate logistic regression revealed that the decision to extract premolars reduced the risk of impaction by 76% (P < .01), this parameter was not included in the final prediction model at T1. Multiple logistic regression analyses revealed that third molar impaction could be predicted at T1 according to the size of the retromolar space and the amount of mesial molar movement that will occur during active appliance therapy, reducing the risk of impaction by 22% and 34% for every millimeter increase in distance, respectively (P < .01). At T2, multiple logistic regression revealed that the odds of impaction were more than 60 times higher (P < .01) if the third molar was angulated mesially as compared with less than 30 degrees distally relative to the occlusal plane and almost five times (P < .05) higher if the third molar was angulated more than 30 degrees distally as compared with less than 30 degrees distally. Similar analyses at T2 showed 29% reduced risk of impaction for every millimeter increase in retromolar space and 18% reduced risk for every degree increase in angle MP/SN (P < .01).

Adolescent↗

PubMed2005

Vitamin D status of mothers and their neonates in Kuwait.

BACKGROUND: There has been a resurgence of nutritional rickets in children in many developing countries and some of the developed countries. Children between 6 and 18 months old are commonly affected. In order to find out the association between vitamin D and rickets we studied the vitamin D status of the neonates and their mothers in Kuwait. METHODS: Two hundred and fourteen full-term pregnant mothers and their neonates were selected from two hospitals in Kuwait. All mothers had normal vaginal delivery. On the day of delivery 2.5 mL of maternal blood and 2.5 mL of cord blood samples were withdrawn. Serum 25-hydroxyvitamin D (25OHD) was determined in duplicate by radioimmunoassay using an Incstar kit. Quality control analyses were done using several between and within run experiments. RESULTS: A total of 128 mother-neonate pairs were selected from the Al-Adan hospital and 86 from the Maternity Hospital. The mean age and parity of the mothers were similar in both hospitals. The mean (+/- SD) 25OHD levels of the mothers and the neonates in the Adan hospital were 13.3 (6.5) ng/mL and 8.2 (6.5) ng/mL, respectively. The corresponding values in the Maternity Hospital were 17.6 (12.4) and 8.1 (7.3) ng/mL for the mothers and the neonate, respectively. Serum 25OHD of the mothers and their newborn infants were highly correlated (r = 0.790, P < 0.001). CONCLUSIONS: Results demonstrate that 40% of the mothers and 60% of the neonates are vitamin D deficient on the day of delivery. The vitamin D of the mothers and neonates are highly correlated (r = 0.790, P < 0.001).

Adult↗

PubMed2004

Childbirth and breast cancer prognosis.

Although certain risk factors for breast cancer incidence may also effect survival, findings have been inconsistent and the long-term role of childbirth is unknown. We studied the influence of number and timing of births on breast cancer prognosis prospectively. From 1958 to 1997, altogether 32,003 women, born 1932 or later, were notified to the Swedish Cancer Registry due to a primary invasive breast cancer. We obtained information on dates of all childbirths and achieved complete follow-up through 1997 by means of linkage to other nation-wide databases. Proportional hazards analyses were used to compute crude and multivariate hazard ratios (HR) with 95% confidence intervals (CI) of dying from breast cancer. We found a successively worse prognosis for women with a shorter delay between their last birth and breast cancer diagnosis (p for trend <0.0001). Compared to women with their last birth more than 10 years before diagnosis, the multivariate HR of breast cancer death was 1.39 (95% CI 1.17-1.67) for those with breast cancer diagnosis in the 3rd year after last birth and 1.72 (CI 95% 1.42-2.09) for those with diagnosis within 1 year after last birth. This adverse effect on prognosis of childbirth persisted beyond 10 years among women with a first birth before the age of 20 years. A pregnancy has marked adverse effects on the prognosis of a breast cancer diagnosed within 10 years after delivery. These findings suggest that pregnancy influences tumor biology.

Adult↗

PubMed2004

CLIP score as a prognostic indicator for hepatocellular carcinoma: experience with patients in the Middle East.

OBJECTIVE: To assess the prognostic ability of the Cancer of the Liver Italian Programme (CLIP) score and compare it with the Okuda system in patients with hepatocellular carcinoma from the Middle East, where the majority (70%) present with intermediate or advanced stages of the disease and do not receive any tumour-specific treatment. METHODS: The medical records of 145 patients (113 males; mean age, 58.8 +/- 12.2 years) diagnosed with hepatocellular carcinoma over a 6-year period were reviewed and the disease was staged according to the CLIP and Okuda systems. The survival was compared by Kaplan-Meier curves and Cox regression analysis. RESULTS: The overall median survival of patients with hepatocellular carcinoma was 8.3 months (95% confidence interval, 6.6-9.4). The median survivals for CLIP score 0, 1, 2, 3 and 4-6 were 35, 29, 9, 6, and 2 months, respectively; for Okuda stages I, II and III, they were 24, 9 and 4 months, respectively. The CLIP system was judged to be statistically more efficient and consistent than the Okuda in predicting survival in the Cox proportional hazard model. CONCLUSIONS: These data from patients with hepatocellular carcinoma in the Middle East suggest that the CLIP score is more reliable than the Okuda system in predicting survival and can be used efficiently to determine prognosis in patients who present with intermediate or late stage of the disease.

Adult↗

PubMed2004

Differences in the etiology of mandibular fractures in Kuwait, Canada, and Finland.

We studied causes of mandibular fractures treated in oral and maxillofacial units in three countries in years 1990-2000 in Kuwait (n=596), 1995-2000 in Canada (n=228), and 1990-99 in Finland (n=268). Of the Finnish patients, 27% were women. Corresponding percentages in Kuwait and Canada were 13 and 17%, respectively. Traffic crashes were the cause of injury in 55% of the cases in Kuwait and 33% in Oulu, but only 7% in Toronto. In Kuwait, the victims were often young people, which is why more traffic education, more control of speed, and more control of the use of safety belts should be implemented. Assault was the cause in 54% in Toronto, 12% in Kuwait, and 37% in Oulu. Falling was the cause in 22% of the cases in Kuwait. Alcohol was implicated in 21% of cases in Canada and 15% in Finland.

Accidental Falls↗

PubMed2004

Diabetes mellitus as a contributor to the in-hospital mortality after acute myocardial infarction in Kuwait.

OBJECTIVES: First, to compare the in-hospital mortality after acute myocardial infarction (AMI) among diabetic versus non-diabetic patients. Secondly, to evaluate if this association remains the same across gender and ethnic groups. METHODS AND RESULTS: We used a 1:2 individually matched retrospective case-control study. All patients admitted to Mubarak Al-Kabeer hospital in Kuwait, with a confirmed diagnosis of AMI during August 1997 and July 2002 made up the study population. All 149 patients who died during this period made up the cases. Two control subjects to match each case were randomly chosen from survivors, after hospitalization with AMI. Cases and controls were individually matched by age, sex and ethnicity. History of diabetes mellitus (DM) was found to be significantly associated with in-hospital mortality after AMI (odds ratio: 1.9, 95% CI: 1.2-3.0). None of the other cardiovascular related histories were associated with mortality. Further analyses on the type of diabetes showed that the NIDDM (non-insulin dependent diabetes mellitus) risk of mortality was significantly raised after AMI. Also among women (odds ratio: 2.7, 95% CI: 1.2-5.9), and non-Kuwaiti population (odds ratio: 3.4, 95% CI: 1.1-9.9) the risk was significantly elevated. CONCLUSIONS: Risk of in-hospital mortality after AMI is almost doubled among diabetic patients. This association was found to be significantly higher among NIDDM, women and non-Kuwaiti population.

Acute Disease↗

PubMed2004

A registry of acute myocardial infarction in Kuwait: Patient characteristics and practice patterns.

BACKGROUND: Coronary artery disease is the leading cause of death in Kuwait, yet data about patient characteristics and practice patterns are lacking. OBJECTIVES: To establish a registry of all acute myocardial infarction (AMI) cases admitted to the general hospitals in Kuwait, so that the characteristics and management patterns of patients with AMI could be accurately determined. METHODS: For six consecutive months, all patients with AMI admitted to the coronary care units of the five participating hospitals were prospectively included in the registry. RESULTS: Of the 662 patients, 87% were men. The mean age was 55 years. A history of diabetes, hypertension and current smoking was found in 41%, 35% and 49% of patients, respectively. A history of hypercholesterolemia or a fasting cholesterol of 5.2 mmol/L or greater was found in 56% of patients. Eighty per cent suffered ST-segment elevation AMI. Four hundred seventy-six patients who were eligible for thrombolytic therapy were identified, 12 (3%) of whom did not receive it. The median time from diagnostic electrocardiogram to thrombolytic therapy was 45 min. The rate of prescribing acetylsalicylic acid, beta-blockers, angiotensin-converting enzyme inhibitors and statins at discharge among survivors was 98%, 86%, 51% and 50%, respectively. The in-hospital mortality rate was 6.2%. CONCLUSIONS: The Kuwaiti AMI population is young, with high rates of diabetes, smoking and hypercholesterolemia. The majority of patients have ST-segment elevation AMI. Thrombolytic therapy is appropriately used, but measures need to be introduced to decrease the time to treatment. The rate of use of acetylsalicylic acid and beta-blockers was appropriate, while that of angiotensin-converting enzyme inhibitors and statins needs to be improved.

Cardiovascular Agents↗