The coronavirus disease-19 (COVID-19) pandemic has forced hospitals to prioritize COVID-19 patients, restrict resources, and cancel all non-urgent elective cardiac procedures. Clinical visits have only been facilitated for emergency purposes. Fewer patients have been admitted to the hospital for both ST-segment elevation myocardial infarctions (STEMI) and non-ST segment elevation myocardial infarctions (NSTEMI) and a profound decrease in heart failure services has been reported. A similar reduction in the patient presentation is seen for ischemic heart disease, decompensated heart failure, and endocarditis. Cardiovascular services, including catheterization, primary percutaneous coronary intervention (PPCI), cardiac investigations such as electrocardiograms (ECGs), exercise tolerance test (ETT), dobutamine stress test, computed tomography (CT) angiography, transesophageal echocardiography (TOE) have been reported to have declined and performed on a priority basis. The long-term implications of this decline have been discussed with major concerns of severe cardiac complications and vulnerabilities in cardiac patients. The pandemic has also had psychological impacts on patients causing them to avoid seeking medical help. This review discusses the e fects of the COVID-19 pandemic on the provision of various cardiology services and aims to provide strategies to restore cardiovascular services including structural changes in the hospital to make up for the reduced sta f personnel, the use of personal protective equipment in healthcare workers, and provides alternatives for high-risk cardiac imaging, cardiac interventions, and procedures. Implementation of the triage system, risk assessment scores, and telemedicine services in patients and their adaptation to the cardiovascular department have been discussed.
Colchicine, extracted from the colchicum autumnale plant, used by the ancient Greeks more than 20 centuries ago, is one of the most ancient drugs still prescribed even today. The major mechanism of action is binding to microtubules thereby interfering with mitosis and subsequent modulation of polymorphonuclear leukocyte function. Colchicine has long been of interest in the treatment of cardiovascular disease; however, its efficacy and safety profile for specific conditions have been variably established in the literature. In the subset of pericardial diseases, colchicine has been shown to be effective in recurrent pericarditis and post-pericardiotomy syndrome (PPS). The future course of treatment and management will therefore highly depend on the results of the ongoing large randomized placebo-controlled clinical trial to evaluate the efficacy and safety of colchicine for the primary prevention of several postoperative complications and in the perioperative period. Also, given the positive preliminary outcomes of colchicine usage in pericardial effusions, the future therapeutical use of colchicine looks promising. Further study is needed to clarify its role in these disease states, as well as explore other its role in other cardiovascular conditions.
Background: Aspirin non-adherence or discontinuation is associated with an almost three-fold increase in risk of major adverse cardiac events. Compliance, commonly known as adherence, has been a major health care issue. Some studies have reported non-adherence rates to aspirin as high as fifty percent. The main objective of this study was to determine the frequency and predictors of non-compliance to aspirin in post myocardial infarction patients.Methods: This cross sectional study was conducted over a period of 3 months from May 2015 to July 2015 at Civil Hospital, Karachi. All patients visiting Cardiology out-patient department (OPD) with previously diagnosed myocardial infarction were included in the study. Patients who were not prescribed aspirin or those with contraindication to aspirin therapy such as hemophiliacs and peptic ulcer disease patients, and those with memory problems were excluded from the study. A pre-coded questionnaire was presented to the selected sample of 456 patients. Compliance was assessed through self-report. Chi square test was used as the primary statistical test. Results:Out of 456 patients, 39% (n=178) were non-compliant to aspirin therapy. The most common reported cause for non-compliance was the failure to remember taking the drug reported by 40.7% (n=72) of the people. The second most common cause was the lack of awareness of the importance of the drug and the possible side effects of not taking it 31.4% (n =56). Conclusion:It can be concluded that non-compliance to aspirin is a major problem present in Pakistan. With the number of cardiovascular deaths increasing around the globe and in Pakistan, it is vital that non-compliance to aspirin should be taken as a serious issue.
Introduction:The most substantial method of control for the spread of DM, is the spreading of knowledge and information regarding DM and its complications. Therefore, the objective of this study was to investigate and evaluate the level of knowledge, awareness and management practices among people suffering from DM in the rural areas of Sindh. Methodology:A descriptive cross sectional survey was performed on 400 Diabetes Mellitus (DM) Type 2 patients from March 2015 to June 2015, dwelling in rural areas of Sindh province, South Pakistan. A paper based questionnaire was used to determine sociodemographic features, knowledge and awareness with regards to DM and its complications and last part evaluated management practices to manage diabetes.Results: Only 50% participants knew that DM is a condition of high blood glucose and only 39% considered it as a preventable disease. With regards to management practices, only 65.0% had a home glucometer and 48% regularly checked their blood sugar levels. Family history of DM, BMI, education level, monthly household income, marital status and age were important predictors of knowledge among rural dwellers. Conclusion:Our study has revealed lack of knowledge and inadequate management practices among diabetic patients of rural areas of Sindh, especially in patients attending primary healthcare setups. Management techniques and knowhow of this silent and deadly pathological condition should be spread to rural populace through seminars and media, which would eventually mold their life in a better condition.
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