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Background: Cardiovascular diseases are the number one cause of death globally. Cardiovascular diseases have emerged as a major health burden in developing countries. Myocardial infarction (MI) is defined by the demonstration of myocardial cell necrosis due to significant and sustained ischaemia. Author attempted to study the risk factors and clinical profile of patients with MI admitted in Cardiology Department of tertiary care center, Chitwan, Nepal.Methods: This descriptive retrospective study was conducted in College of Medical Sciences Teaching Hospital (CMS-TH), Chitwan, Nepal, from January 2016 to November 2017. Demographic features, cardiovascular risk factors, clinical presentation, Electrocardiogram (ECG) findings, regions of infarction and rhythm disturbances were studied and documented.Results: A total of 132 patients diagnosed with MI were studied. Most of the patients (90.15%) had ST-elevation MI (STEMI). The patients were predominantly male (87%). The majority of patients lied in the age group of 61-70 yrs (29.54%). The most common presenting symptom was chest pain (86.36%) followed by shortness of breath (42.42%) and vomiting (12.87%). Tobacco smoking/chewing (62.87%) was the major risk factor followed by hypertension (43.18%) and diabetes (34.09%). Majority of infarction occurred on anterior wall (52.94%). Most of the patients (90.90%) had normal sinus rhythm on ECG. On arrival to emergency department eight (6.06%) patients had cardiogenic shock and only one had congestive cardiac failure.Conclusions: STEMI was most common type of MI presenting to CMS-TH. Most of the patients were male and the most common risk factor contributing to MI was cigarette smoking. Most of the patients arrived more than 24 hours after onset of symptom.
Social stigma and neglect post-coronavirus disease 2019 (COVID-19) and self-quarantine can be associated with a brief psychotic disorder (BPD). A 53-year-old African-American man with no significant past medical and psychiatric history was brought to the emergency department (ED) with symptoms of persecutory delusions post COVID-19 and self-quarantine. His symptoms included false beliefs that people were plotting to kill him which made him combative at work and home. As his symptoms worsened, his wife brought him to the hospital. He was given intramuscular haloperidol 5 mg one dose in the ED. The Clinical Health Psychology and Psychiatry team diagnosed the patient with BPD as per the Diagnostic and Statistical Method of Mental Disorder Fifth Edition (DSM-5). Over the next few days, his symptoms slowly improved. At follow-up visit in the outpatient clinic in a week, we found him back to his baseline without any delusional thoughts. Increased stressors post COVID-19, neglect at home, and social stigmata at work associated with COVID-19 along with his individual vulnerability appeared to be the cause of his delusions but various other mechanisms may exist. Our case raises the question: does social stigma and neglect post-COVID-19 and self-quarantine matter?
The importance of this review lies in its study of the risk of sudden cardiac death (SCD) and sudden cardiac arrest (SCA) in people living with the human immunodeficiency virus (PLWH). To the best of our knowledge, this is the first review investigating the effect of the human immunodeficiency virus (HIV) on SCD and SCA. The review's objective was to determine the risk of SCD and SCA in PLWH. To do this, the electronic databases Ovid MEDLINE, EMBASE, Cochrane Central, Scopus, and Google Scholar were systematically searched to identify eligible studies published before January 31, 2021. Reference lists of the included studies were searched for further identification of relevant studies. The search terms included: "Sudden Cardiac Death," "Sudden Cardiac Arrest," "Human Immunodeficiency virus," "HIV," "Acquired immunodeficiency syndrome," and "AIDS." Only observational studies that assessed the association between SCD and SCA in PWLH were selected. Data were extracted by two independent authors who screened titles, abstracts, and articles to meet the inclusion criterion. Quality assessment was done by using modified Downs and Black checklist. A total of seven studies were included in this review. Five studies revealed a higher incidence of SCD in PLWH, two of which focused on patients with HIV and low left ventricular ejection fraction (LVEF). The other two studies were about the association of HIV and SCA. Studies reported that PLWH had a three-to five-fold higher incidence of SCD as compared to non-HIV patients. HIV patients with low LVEF had a higher incidence of SCD than HIV patients with normal LVEF. PLWH had a higher incidence of SCA and less successful cardiopulmonary resuscitation (CPR) as compared to patients without HIV. After adjusting for various confounders in multiple studies, all the studies reported a higher incidence of SCD in PLWH. To conclude, PLWH is at an increased risk of SCD and SCA. Some risk factors for this include LVEF, viral load (VL), and the cluster of differentiation 4 (CD4) count. There is a paucity of data on the mechanisms involved, although a higher prevalence of cardiac fibrosis and interstitial fibrosis in PLWH may play a role. Because of the general suboptimal quality of the heterogeneous nature of the current evidence, further, rigorous studies are needed to determine the association of increased risk of SCD and SCA in PLWH.
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