Hypertension is one of the most important modifiable risk factors for cardiovascular disease and death even in high-income countries. According to the PURE Study, globally only half of hypertensives are aware and less than a fifth controlled. May Measurement Month (MMM) is a global campaign to raise awareness and screen for high blood pressure (BP) in lieu of formal screening. United Arab Emirates (UAE) has taken part in MMM since its inception and here data from MMM18 are reported. Trained volunteers from 54 sites screened 31 316 individuals from all the Emirates of UAE using convenience sampling. Blood pressure measurement, the definition of hypertension, and statistical analysis followed the standard MMM protocol. The mean age was 36.8 ± 11.4 years and 18 411(59%) were male. Participants of Arab descent were 11 829 (38%) and 11 569 (37%) were South Asian. Mean body mass index was 26.8 ± 5.29 kg/m2. Of those screened, 7 917 (25%) had never had a BP recorded, while 16 892 (54%) had recorded BP in the previous year. After imputation, 6 243 (20%) had hypertension. Of those participants, only 2 540 (41%) were aware and 2 331 (37%) were on antihypertensive medication, of which 61% were controlled. Of all hypertensives, only 23% were controlled. May Measurement Month in UAE expanded significantly compared to 2017. A quarter had never had BP measured and awareness of hypertension low (41%). This opportunistic screening method found a substantial number of adults with untreated or inadequately treated hypertension.
Elevated blood pressure (BP) is a growing burden worldwide, leading to over 10 million deaths each year. May Measurement Month (MMM) is a global initiative aimed at raising awareness of high BP and to act as a temporary solution to the lack of screening programmes worldwide. United Arab Emirates has a young population, but cardiovascular disease (CVD) is the commonest cause of death (40%). Myocardial infarction and stroke occurs at least a decade earlier than in western countries. Previous screening in our young population showed that 85% of the population had at least one CVD risk factor and about 62% of them were unaware of it. An opportunistic cross-sectional survey of volunteers aged ≥18 was carried out in May 2017. Blood pressure measurement, the definition of hypertension and statistical analysis followed the standard MMM protocol. Screening was held in 23 sites such as mosques, sports, and men’s/ladies’ clubs, airports, parks, shopping malls, work places as well as their residences, and in the public areas of hospitals or outpatient clinics. A total of 6193 individuals were screened during MMM17. The mean age was 39.2 ± 13.1 years. After multiple imputation, 1867 (30.2%) had hypertension. Of individuals not receiving anti-hypertensive medication, 813 (15.8%) were hypertensive. Of 1054 individuals receiving anti-hypertensive medication, 427 (40.6%) had uncontrolled BP. MMM17 was a useful screening model as it makes BP measurement easily accessible. Eight hundred and thirteen (16%) possibly new hypertensives were uncovered and 427(40.6%) of those on treatment for hypertension were found to be uncontrolled. These results suggest that opportunistic screening can identify significant numbers with raised BP.
Stress cardiomyopathy (also called apical ballooning syndrome, takotsubo cardiomyopathy, broken heart syndrome, and stress-induced cardiomyopathy) is a syndrome characterized by transient regional systolic dysfunction, principally, of the left ventricle (LV), mimicking myocardial infarction (MI), but in the absence of angiographic evidence of obstructive coronary artery disease or acute plaque rupture. In most cases of stress cardiomyopathy, the regional wall motion abnormality extends beyond the territory perfused by a single epicardial coronary artery. The term takotsubo is taken from the Japanese name for an octopus trap, which has a shape that is similar to the systolic apical ballooning appearance of the LV in the most common and typical form of this disorde mid and apical segments of the LV are hypokinetic/akinetic, and there is hyperkinesis of the basal walls.
Anti- phospholipid syndrome (APS) is an autoimmune prothrombotic disease characterized by persistently elevated antiphospholipid antibodies, resulting in recurrent arterial and venous thromboembolic events. The deep veins of the lower limbs and the cerebral arterial circulation are the most common sites of venous and arterial thrombosis, respectively [1] The other major clinical manifestations of the antiphospholipid syndrome are obstetrical. They include the unexplained death of one or more morphologically normal fetuses at or beyond the 10th week of gestation, the premature birth of one or more morphologically normal neonates before the 34th week of gestation because of either eclampsia or severe preeclampsia, and three or more unexplained, consecutive spontaneous abortions before the 10th week of gestation [2] Thrombotic events post COVID 19 infection has been described since the beginning of pandemic in 2019[3]. Autopsy reports have shown that most thromboses are located in the lung, although they have also been observed in other organs such as the skin and kidneys. SARS-CoV2 infection induces a generalized prothrombotic state, which is attributed to a combination of factors such as hypoxia, excess cellular apoptosis, and mainly to overactivation of the immune system [4]. Considering the high rate of mortality due to coagulation abnormalities and thrombosis among coronavirus disease 2019 patients, it is important to pay attention to the differential diagnoses of coronavirus disease 2019 and other diseases following thrombotic events [5].
Fish bone as a foreign body in the throat is common and frequently seen in emergency departments. In most cases, the bone is stuck in the tonsils or oropharynx, some go further to the laryngopharynx, and in rare cases they may go furthest. The authors report a rare case of a fish bone that migrated to the thyroid gland [1, 13&14] Fish bones as swallowed foreign bodies can be managed by direct removal using headlight or require an endoscopic approach. Some even need open surgery. Some bones may penetrate the mucosa of the upper aerodigestive tract and migrate to neck soft tissues and organs. In such cases, patient complaints are of unusual presentation for swallowed foreign bodies, and patients may suffer different complications that require a more aggressive management [2].
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