Biomedical subjects

Mohammad Zubaid

Publications and source records attributed to Mohammad Zubaid.

12 recordsLinked to original sources

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

Determinants of plasma homocysteine in relation to hematological and biochemical variables in patients with acute myocardial infarction.

BACKGROUND: Elevated plasma total homocysteine (tHcy) is a risk factor for coronary artery disease (CAD), but the mechanism is not known. This study evaluates the determinants and associations of tHcy in patients presenting with acute myocardial infarction (AMI). METHODS: Plasma concentration of tHcy, protein C, protein S, and antithrombin were measured in 210 (177 males and 33 females) patients with first AMI and 167 (87 males and 80 females) controls. Serum vitamin B12, folate, creatinine, lipid profile, fasting glucose, full blood count and red cell folate were determined. Creatinine clearance was calculated using the modification of diet in renal disease formula. Univariate and multivariate analyses were used to determine the associations of tHcy. RESULTS: Mean tHcy was higher in male than female patients. On logistic regression analysis, the most important determinants oftHcy in the patients were age, creatinine, creatinine clearance, vitamin B12 and red cell folate. When study patients were compared with the controls, tHcy, fasting glucose and serum creatinine were significantly higher, while creatinine clearance and HDL cholesterol were significantly lower in the study patients. Logistic regression analysis showed significant association of tHcy with AMI, odds ratio = 1.39, in the presence of other confounding factors. CONCLUSIONS: Our results show that tHcy is a significant risk factor for CAD in our patient population. The determinants in the patients are age, glomerular filtration rate and the status of vitamins B12 and folate. The above determinants should be kept in mind when using tHcy as a risk factor for CAD.

Adult↗

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↗

PubMed2005

Impact of fasting in Ramadan in patients with cardiac disease.

OBJECTIVES: To investigate whether Ramadan fasting has any effect on patients with heart disease. METHODS: We prospectively studied 465 outpatients with heart disease who were fasting during the month of Ramadan from October 24 to November 24, 2003. These studied subjects were from various medical centers in the Gulf region; State of Qatar, Kuwait, United Arab Emirates, and Bahrain. We performed detailed clinical assessments one month before Ramadan, during Ramadan and one month after Ramadan and analyzed predictors of outcome. RESULTS: Overall, the mean age was 55.9+/-11.3 years (age range 32-72). Of the 465 patients treated, 363 (78.1%) were males and 102 (21.9%) females. Among them, 119 (25.6%) patients had congestive heart failure, 288 (62%) patients with angina, 22 (4.7%) patients with atrial fibrillation and 11 (2.4%) patients with prosthetic metallic valves. Three hundred and seventy (79%) had prior myocardial infarction (MI), 195 (17.2%) had prior coronary artery bypass surgery (CABG), and 177 (38%) had prior percutaneous coronary interventions (PCI). At the time of follow-up, we found that 91.2% could fast and only 6.7% felt worse while fasting in Ramadan. Of the studied subjects, 82.8% were compliant with cardiac medications and 68.8% were compliant with dietary instructions. We hospitalized 19 patients during Ramadan for cardiac reasons (unstable angina, worsening heart failure, MI, uncontrolled hypertension, subtherapeutic anticoagulation or arrhythmias) CONCLUSION: The effects of fasting during Ramadan on stable patients with cardiac disease are minimal. Most patients with stable cardiac disease can fast.

Adult↗

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↗

PubMed2002

Normal angiographic tapering of the coronary arteries.

OBJECTIVE: Although the size of normal coronary arteries has been reported, the expected magnitude of angiographic tapering has not. Accordingly, the coronary angiograms of 13 men and 13 women with normal and right dominant coronary arteries were analyzed in detail to calculate the normal tapering of angiographic segments. BACKGROUND: Coronary artery disease is a diffuse process that can lead to the underestimation of the extent of lumen narrowing by angiographic analysis. Knowledge about the expected size of the angiographic lumen may help to overcome this problem in quantitative angiographic studies. Similarly, the expected magnitude of tapering is potentially useful to identify segments with nonapparent disease if the propensity of atheroma to build up distally and at branch points induces greater than expected tapering. METHODS: Lumen diameter was measured in 13 main segments. Two tapering indexes (T1 and T2) were defined. T1 was the difference between the proximal and distal segment diameter, divided by the proximal segment diameter, expressed as a percentage. T2 was the difference between the mean diameter of the proximal half of a segment and the distal diameter, divided by the mean of the proximal half of the segment, expressed as a percentage. RESULTS: In women, for the proximal and distal left anterior descending artery, T1 was 18 14% and 29 9%, respectively, while T2 was 14 11% and 21 9%, respectively. The right coronary artery (RCA) demonstrated a lesser magnitude of T1 and T2 tapering. In women, T1 was 9 12% and 7 8% for the proximal and the distal RCA, respectively, while T2 was 4 10% and 2 9% for the proximal and the distal RCA, respectively. Similar tapering results were obtained in men. CONCLUSIONS: The estimation of an expected magnitude of tapering of coronary arteries may identify diseased segments that are not angiographically stenotic.

Coronary Angiography↗

PubMedDate not supplied

Association of psychosocial risk factors with risk of acute myocardial infarction in 11119 cases and 13648 controls from 52 countries (the INTERHEART study): case-control study.

BACKGROUND: Psychosocial factors have been reported to be independently associated with coronary heart disease. However, previous studies have been in mainly North American or European populations. The aim of the present analysis was to investigate the relation of psychosocial factors to risk of myocardial infarction in 24767 people from 52 countries. METHODS: We used a case-control design with 11119 patients with a first myocardial infarction and 13648 age-matched (up to 5 years older or younger) and sex-matched controls from 262 centres in Asia, Europe, the Middle East, Africa, Australia, and North and South America. Data for demographic factors, education, income, and cardiovascular risk factors were obtained by standardised approaches. Psychosocial stress was assessed by four simple questions about stress at work and at home, financial stress, and major life events in the past year. Additional questions assessed locus of control and presence of depression. FINDINGS: People with myocardial infarction (cases) reported higher prevalence of all four stress factors (p<0.0001). Of those cases still working, 23.0% (n=1249) experienced several periods of work stress compared with 17.9% (1324) of controls, and 10.0% (540) experienced permanent work stress during the previous year versus 5.0% (372) of controls. Odds ratios were 1.38 (99% CI 1.19-1.61) for several periods of work stress and 2.14 (1.73-2.64) for permanent stress at work, adjusted for age, sex, geographic region, and smoking. 11.6% (1288) of cases had several periods of stress at home compared with 8.6% (1179) of controls (odds ratio 1.52 [99% CI 1.34-1.72]), and 3.5% (384) of cases reported permanent stress at home versus 1.9% (253) of controls (2.12 [1.68-2.65]). General stress (work, home, or both) was associated with an odds ratio of 1.45 (99% CI 1.30-1.61) for several periods and 2.17 (1.84-2.55) for permanent stress. Severe financial stress was more typical in cases than controls (14.6% [1622] vs 12.2% [1659]; odds ratio 1.33 [99% CI 1.19-1.48]). Stressful life events in the past year were also more frequent in cases than controls (16.1% [1790] vs 13.0% [1771]; 1.48 [1.33-1.64]), as was depression (24.0% [2673] vs 17.6% [2404]; odds ratio 1.55 [1.42-1.69]). These differences were consistent across regions, in different ethnic groups, and in men and women. INTERPRETATION: Presence of psychosocial stressors is associated with increased risk of acute myocardial infarction, suggesting that approaches aimed at modifying these factors should be developed.

Case-Control Studies↗

PubMedDate not supplied

Establishing a gradient of risk in patients with acute coronary syndromes using troponin I measurements.

OBJECTIVE: To evaluate the role of serum troponin I (Tnl) estimations in the early risk stratification of patients with acute coronary syndromes (ACS) subsequently diagnosed as acute myocardial infarction (AMI) or unstable angina (UA). SUBJECTS AND METHODS: Blood samples were collected from 86 patients admitted to the Coronary Care Unit of the Mubarak Al-Kabeer Hospital, Kuwait, with a diagnosis of ACS on admission (Tnl-1) and after 8 h (Tnl-2) and 16 h (Tnl-3). Blood was also collected from 38 age-matched healthy controls for comparison. Serum Tnl was measured by paramagnetic particle chemiluminescent immunoassay. RESULTS: Serum Tnl of < 0.05 ng/ml, corresponding to the 99th percentile, was established for healthy subjects. Patients diagnosed as UA had a 99th percentile Tnl-1 value of about 0.30 ng/ml. The best specificity and sensitivity for ACS was obtained for Tnl-2; indeed, Tnl-2 > 0.3 ng/ml gave a > 80% certainty of diagnosis of AMI. Also, Tnl-2 < 0.3 ng/ml in ACS patients was approximately 80% sensitive for the diagnosis of UA but relatively nonspecific (approximately 40%). Specificity for Tnl-2 for the diagnosis of UA improved to about 90% by narrowing the diagnostic range to 0.05-0.3 ng/ml. Tnl values in UA increased by < 100% at 8 h, while in AMI, this increase was up to 1,000%. CONCLUSION: In the evaluation of ACS, admission and 8-hour serum Tnl < 0.05 ng/ml is probably not cardiac in origin; serum Tnl > 0.3 ng/ml on admission and increasing rapidly by 8 h is likely AMI, and serum Tnl > 0.05 and < 0.3 ng/ml on admission with a mild increase by 8 h is likely due to UA.

Adult↗

PubMedDate not supplied

Patient characteristics and practice patterns in the treatment of acute myocardial infarction in Kuwait: a pilot study.

OBJECTIVES: To determine the characteristics, management and outcomes of patients with acute myocardial infarction (AMI) admitted to the general hospitals and to assess the feasibility of establishing a registry for AMI in Kuwait. SUBJECTS AND METHODS: We prospectively included 111 consecutive patients (94 males and 17 females, mean age 55 years) admitted to the coronary care units of the five participating hospitals during May 2000. The subjects all had a final diagnosis of AMI. A structured data collection form that included biochemical measurements was filled out for each patient. RESULTS: The prevalence of hypercholesterolemia, diabetes, hypertension and current smoking was 46, 45, 30 and 49%, respectively. Fifty-four of 57 patients who were eligible for thrombolytic therapy received treatment. The median time from symptom onset to thrombolytic therapy was 180 min. At discharge 93% were prescribed aspirin, 81% beta-blockers, 40% angiotensin-converting enzyme inhibitors, and 32% lipid-lowering drugs. The in-hospital mortality was 10%. CONCLUSIONS: The incidence of smoking, diabetes and hypercholesterolemia is high among our patients. Thrombolytic therapy is used regularly but insufficiently early. Based on this pilot study, it is feasible to establish an AMI registry in Kuwait.

Adrenergic beta-Antagonists↗

PubMedDate not supplied

Racial variation in risk factors and occurrence of acute myocardial infarction: comparison between Arab and South Asian men in Kuwait.

BACKGROUND: There are little data available on the rates of occurrence, risk factors and mortality due to acute myocardial infarction among the various ethnic groups living in Middle-East countries. Therefore, we did a study to compare Arabs and South Asians living in Kuwait. METHODS AND RESULTS: The data for this retrospective study were collected from the computerized database of the Coronary Care Unit at the Mubarak Al-Kabeer Hospital (a 476-bed teaching hospital) and the 1997-2000 Census data for the State of Kuwait. Arab and South Asian men above 25 years admitted between September 1997 and August 2000 with a diagnosis of acute myocardial infarction were included in the study A total of 866 Arabs and 277 South Asian men were admitted. The rate of admission for the entire patient population was two-fold higher among Arabs as compared with South Asians (6.7/1000 population and 3.3/1,000, respectively). Diabetes mellitus was present in 453 Arabs (52.3%) and 109 South Asians (39.4%) (p< or = 0.001) of those >25 years of age. Hypertension was recorded in 247 Arabs (28.5%) and 57 South Asians (20.6%) (p < or = 0.01). Among patients <55 years of age (454 Arabs and 226 South Asians); the rate of admission was 4.0/1,000 in Arabs and 3.5/1,000 in South Asians (not significant). Hypertension was present in 97 Arabs (21.3%) and 43 South Asians (19%) (not significant). Diabetes mellitus was present in 202 Arabs (44.5%) and 80 South Asians (35.4%) (p < or = 0.05). Smoking was recorded in 353 Arabs (77.8%) and 160 South Asians (70.8%) (notsignificant). Hypercholesterolemia was presentin 182 (40.1%) and 88 (39%), respectively (not significant). While in hospital, 11 Arabs and 9 South Asians died (not significant). CONCLUSIONS: Among men >55 and <75 years of age, Arabs had a higher rate of admission with acute myocardial infarction compared with men of South Asian origin. The incidence of diabetes and hypertension was significantly higher among Arabs in this age group. In younger patients (<55 years), the rate of acute myocardial infarction was not different between the two groups; however, diabetes was present more often among Arabs. The smoking rate is very high in both groups and is an important risk factor for both Arab and South Asian men living in the Middle East.

Adult↗