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Background: The ability to interpret electrocardiograms (ECG) is crucial for accurate diagnosis and treatment of the most relevant cardiac abnormalities. This study aims to assess the electrocardiographic interpretation abilities of resident doctors at internal medicine and emergency medicine departments in eight Arabic countries, emphasizing the most relevant cardiac abnormalities. Methods: An online cross-sectional study was conducted between 7 th October 2022 and 21 st October 2022 in 8 Arabic countries (Syria, Jordan, Iraq, Qatar, Yemen, Egypt, Sudan, and Algeria) to evaluate the ECG interpretation skills of resident doctors at internal medicine and emergency medicine departments. The questionnaire consisted of two main sections; the first section included sociodemographic information, while the second section contained twelve clinical case questions of the most severe cardiac abnormalities with their ECG recordings. We used the STATA and Excel Microsoft programs to conduct the analysis. Results: Out of 2509 responses, 630 were eligible for the data analysis (Response rate=25.1%). The average age was 26.85±1.7, and more than half of the participants were males (52.4 %). Internal medicine residents were (n=530, 84.1%), whereas emergency medicine residents were (n=100, 15.9%). Almost participants were in their first and second years of residency (79.8%). Only 36.2% of the inquired resident doctors have attended an ECG course. The majority of participants 85.6% recognized the ECG waves order correctly. 50.5% of the participants scored above 7.5/10 on the ECG interpretation scale. The proportions of participants who properly diagnosed atrial fibrillation, third-degree heart block, and atrial tachycardia were 71.1%, 76.7%, and 56.6%, respectively. No statistically significant difference was defined between the internal and emergency medicine residents regarding of knowledge toward ECG interpretation (P value=0.42). However, there was a significant correlation between ECG interpretation and medical residency year (P value Conclusion: According to the findings of our research, resident doctors in departments of internal medicine and emergency medicine in Arabic nations have adequate ECG interpretation abilities; nevertheless, additional development is required to avoid misconceptions about critical cardiac conditions.

INTRODUCTION We aimed to evaluate the clinical benefits of a de-escalation strategy from prasugrel or ticagrelor to clopidogrel versus continuation of prasugrel or ticagrelor along with aspirin in both strategies for patients presenting with acute coronary syndrome (ACS) and treated with percutaneous coronary intervention (PCI), and to analyze the effect of the recently published randomized clinical trial (RCT) by Park et al., which included the largest sample size ever and the largest switched number of patients, on current guidelines and practices. DATA SOURCES The PubMed, EMBASE, Scopus, Web of Science, Cochrane Central, and Google Scholar databases were searched systematically from inception to May 2021 by using the search terms ('de-escalation' OR 'switching') AND ('antiplatelet' OR 'clopidogrel' OR 'ticagrelor' OR 'prasugrel') AND ('percutaneous coronary intervention' OR 'PCI'' OR 'Acute coronary syndrome' OR 'ACS'). STUDY SELECTION AND DATA EXTRACTION We included RCTs that reported the primary outcomes, i.e. net clinical benefits and Bleeding Academic Research Consortium (BARC) type 2 or higher bleeding. A combination of both ischemic and bleeding events was defined as a net clinical benefit. DATA SYNTHESIS A total of four RCTs were included, with 5952 patients. A random-effects meta-analysis revealed that a de-escalation strategy was associated with lower ischemic and bleeding events (net clinical benefits; risk ratio [RR] 0.63, 95% confidence interval [CI] 0.47-0.85; p = 0.003), and lower BARC type 2 or higher bleeding (RR 0.51, 95% CI 0.29-0.91; p = 0.02) when compared with a continuation strategy. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE The current guidelines recommend potent P2Y12 prasugrel or ticagrelor for 12 months despite their association with a high risk of bleeding. Our meta-analysis updates cardiologists, providing them with the best available evidence in managing patients with ACS who underwent PCI. CONCLUSION Among patients with ACS treated with PCI, a de-escalation strategy (prasugrel or ticagrelor to clopidogrel) is associated with lower ischemic and bleeding events (net clinical benefits) and lower BARC type 2 or higher bleeding; however, due to the limited number of included studies, further high-quality studies are needed to establish the clinical efficacy of the de-escalation strategy.

Arrhythmias in COVID-19 patients are associated with hypoxia, myocardial ischemia, cytokines, inflammation, electrolyte abnormalities, pro-arrhythmic or QT-prolonging medications, and underlying heart conditions such as severe congestive heart failure, inherited arrhythmia syndromes, or congenital heart conditions. In the pediatric population, multisystem inflammatory syndrome can lead to cardiac injury and arrhythmias. In addition, arrhythmias and cardiac arrests are most prevalent in the critically ill intensive care unit COVID-19 patient population. This review presents an overview of the association between COVID-19 and arrhythmias by detailing possible pathophysiological mechanisms, existing knowledge of pro-arrhythmic factors, and results from studies in adult and pediatric COVID-19 populations, and the clinical implications., Graphical abstract Image, graphical abstract