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Obesity is associated with an increased risk of new-onset AF in susceptible individuals. This effect appears to be consistent in both genders. Further studies are warranted to examine the impact of weight loss interventions on the risk of developing AF.

Kratom mainly grows in Southeast Asia. It is widely used for pain management and opioid withdrawal, which is available online for cheaper prices. Alkaloids extracted from kratom such as mitragynine and 7-hydroxy mitragynine exhibit analgesic properties by acting through µ receptors. Commonly reported side effects of kratom include hypertension, tachycardia, agitation, dry mouth, hallucinations, cognitive and behavioral impairment, cardiotoxicity, renal failure, cholestasis, seizures, respiratory depression, coma, and sudden cardiac death from cardiac arrest. Rhabdomyolysis is a less commonly reported lethal effect of kratom. Limited information is available in the literature. In this article, we present a case of a 45-year-old female who is overdosed with kratom and presented with lethargy, confusion, transient hearing loss, and right lower extremity swelling and pain associated with weakness who was found to have elevated creatinine phosphokinase. She was diagnosed with rhabdomyolysis, compartment syndrome, multiorgan dysfunction including acute kidney injury, liver dysfunction, and cardiomyopathy. She underwent emergent fasciotomy and required hemodialysis. Her renal and liver function subsequently improved. We described the case and discussed pharmacology and adverse effects of kratom toxicity with a proposed mechanism and management. We conclude that it is essential for emergency physicians, internists, intensivists, cardiologists, and nephrologists to be aware of these rare manifestations of kratom and consider a multidisciplinary approach.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first described in patients in Wuhan, China, who presented with flu-like symptoms. Since then, it has spread all over the world and in March 2020 it was labeled as a pandemic by the World Health Organization. Most common presentations include respiratory symptoms that vary from mild cough and shortness of breath to severe acute respiratory distress syndrome. Gastrointestinal symptoms like nausea, vomiting and diarrhea are also common. However, cardiovascular complications have not been reported widely. Patients can present with cardiac complications that include chest pain, heart failure and fulminant myocarditis, which is one of the most serious cardiac manifestations. Primary means of diagnosis are echocardiogram and cardiac magnetic imaging. Treatment is mostly supportive in case of cardiogenic shock and includes ionotropic support with or without mechanical circulatory support and mechanical ventilation. A strong suspicion is required for early diagnosis and aggressive treatment in order to reduce mortality and morbidity.

Background: The utilization of guideline-directed medical therapy (GDMT) significantly reduces morbidity and mortality in patients with heart failure with reduced ejection fraction (HFrEF). Previous studies have documented the underutilization of GDMT in HFrEF. The present study aimed to determine reasons for underutilization and achievement of target doses of GDMT in patients with de novo diagnosis of HFrEF. Methods: Patients presenting with de novo HFrEF at the Veterans Affairs Medical Center were included. Baseline demographic, clinical, and echocardiographic data were collected. The utilization of target doses of GDMT was assessed at the time of discharge and 1-, 3-, 6-, and 12-month follow-up. Results: Of the 95 patients who met the criteria for de novo HFrEF, 48 were included in the final analysis. Dose titration of either beta-blocker or angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEi/ARB) was attempted in 20 patients (42%) at 1 month, 21 patients (44%) at 3 months, 13 patients (27%) at 6 months, and 14 patients (29%) at 12 months. Nine (19%) patients were on a target dose of beta-blockers and three (6%) patients were on a target dose of an ACEi/ARB at 12 months. The most common reasons for underutilization were patient-level factors, such as hypotension, acute kidney injury/hyperkalemia, and patient noncompliance. Conclusions: Utilization and achievement of target doses of GDMT were suboptimal among patients discharged with de novo HFrEF during a 1-year follow-up. Although patient factors may limit the up-titration of therapies, concerted efforts are needed to support primary care physicians in improving adherence to target doses of GDMT in patients with HFrEF.

Introduction:The link between demographic, clinical variables and health-related quality of life (HRQoL) in hypertrophic cardiomyopathy patients (HCM) is not well established. Hypothesis: Specific predictors of decreased HRQoL in HCM can be identified. Methods: The Hypertrophic Cardiomyopathy Association contacted members diagnosed with HCM by e-mail to complete an online (N = 712, completion rate 51.78%). They were given 2 weeks to complete the questionnaire and were sent 5 e-mail reminders. Demographic variables included sex, race, age, age of HCM onset. Medical variables include total number of types of heart surgeries, if a medical device had been implanted, total number of cardiomopathy (CM) medications being used, total number of distinct activities (ACT) that cause HCM symptoms, and total number of distinct CM symptoms (CMSx) experienced such as palpitations. HRQoL was measured using the total Peds-Ql score, which assesses function in 4 domains (physical, emotional, social, school/work). The total score (range 0-100; higher scored indicating greater HRQoL) was the dependent variable. A linear regression was modeled using Mplus 7.1. Results: The majority of respondents were Caucasian (N = 658, 93%), middle aged (M = 52.10, SD = 1.40), and composed of almost equal numbers of men and women (male = 347, 49%). The significant predictors (all P < .00) of the PedsQL was sex (Β = −.16), age (Β = −.13), total number of medications (Β = −.15), ACT (Β = −.32,), and CMSx (Β=-0.26,). The R 2 = .36 and the effect size was 0.55. History of surgical procedures and/or the presence of a defibrillator were not significant predictors of decreased HRQoL. Conclusions: Our findings suggest that predictors of impaired HRQoL such as number of medications and symptoms related to activity and CM can be identified in HCM. Management strategies such as surgery or defibrillator implantation do not impact HRQoL. Assessment of these factors may offer providers an opportunity to identify areas of concern and implement management strategies to improve HRQoL in patients with HCM.

Background:Hemovigilance is an adverse reaction monitoring system to improve the safety and quality of blood transfusion. Identification of the adverse reactions and their risk factors would help in taking appropriate steps to reduce their incidence.Aims:To identify the transfusion related adverse events and their rates for benchmarking purposes in Fayoum University Hospitals (FUH) for implementation of the hemovigilance system.Methods:The study was conducted in FUH, from May 2016 to April 2017. All patients receiving transfusion therapy and all blood donors were included. All the adverse events related to transfusion of blood and blood products were recorded.Results:A total of 8687 blood components were issued to 3292 recipients from 8300 donors. Ninety Nine donor reactions were reported, with a rate of (1.19%), vasovagal attacks being the most common complication (91.8 %). Thirty Six (1.09 %) recipients adverse reactions were reported to the blood bank. The most common reaction observed in recipients was allergic reaction (47.2%) followed by febrile non‐ hemolytic transfusion reaction (36.1%).Summary/Conclusion:Data related to adverse transfusion reactions in developing countries for benchmarking purposes are rare in literature. The use of transfusion related adverse reactions to build the hemovigilance system facilitates its development and allows areas requiring improvement to be tracked and identified.