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Background: Diabetes mellitus (DM) in a setting of acute myocardial infarction (AMI) is associated with significant metabolic changes and worse outcomes. Objective: To evaluate the prevalence and the prognostic significance of electrolyte/metabolite disturbances among AMI patients with vs. without DM. Methods: Patients admitted to a tertiary medical center with AMI throughout 2002–2012 were screened. Exclusion criteria were: dialysis, mechanical ventilation, and in-hospital coronary artery bypass graft (CABG) surgery. All the results of the following analyses were obtained: Glucose, Uric Acid, (UA) Calcium, Magnesium, Albumin, Potassium, and Sodium. The primary outcome was in-hospital all-cause mortality. Results: A total of 14,364 AMI patient admissions was evaluated, mean age 68.1 ± 14.4 years, 65.5% males, and 41.2% with DM. Following an adjustment to potential confounders, DM patients had increased risk for significant hyperglycemia, hyperuricemia, hypercalcemia, hypomagnesemia, hyperkalemia, and hyponatremia as well as significantly decreased risk for hypoglycemia, hypermagnesemia, and hypokalemia compared with nondiabetics. Overall, 681 (4.7%) patients died throughout the index admission. Deceased had an increased incidence of electrolyte/metabolite abnormalities versus hospital survivors. The prognostic significance of the different categories of the investigated variables is very similar among diabetics and nondiabetics, except increased and decreased uric acid levels [<4.5 (men); <4.0 (women) and ≥9.0 (men); ≥9.4 (women)] which are associated with worse outcomes among diabetics while hyperglycemia (Glucose ≥213 mg/dL) and increased Potassium levels (Potassium ≥4.4mEq/L) which comprise significantly worse prognosis among nondiabetics. Conclusions: Patients with DM admitted with AMI are at greater risk for electrolyte/metabolite abnormalities which are associated with increased risk for in-hospital mortality. The latter association is similar among patients with and without DM except for hyperglycemia and increased potassium levels (stronger among nondiabetics). [ABSTRACT FROM AUTHOR]

Abstract Background The Dead Sea region, the lowest in the world at 410 meters below sea level, is considered a potent climatotherapy center for the treatment of different chronic diseases. Objective To assess the prevalence of chronic diseases and the quality of life of residents of the Dead Sea region compared with residents of the Ramat Negev region, which has a similar climate, but is situated 600 meters above sea level. Methods An observational study based on a self-administered questionnaire. Data were collected from kibbutz (communal settlement) members in both regions. Residents of the Dead Sea were the study group and of Ramat Negev were the control group. We compared demographic characteristics, the prevalence of different chronic diseases and health-related quality of life (HRQOL) using the SF-36 questionnaire. Results There was a higher prevalence of skin nevi and non-inflammatory rheumatic diseases (NIRD) among Dead Sea residents, but they had significantly higher HRQOL mean scores in general health (68.7 ± 21 vs. 64.4 ± 22, p = 0.023) and vitality (64.7 ± 17.9 vs. 59.6 ± 17.3, p = 0.001), as well as significantly higher summary scores: physical component score (80.7 ± 18.2 vs. 78 ± 18.6, p = 0.042), and mental component score (79 ± 16.4 vs. 77.2 ± 15, p = 0.02). These results did not change after adjusting for social-demographic characteristics, health-related habits, and chronic diseases. Conclusions No significant difference between the groups was found in the prevalence of most chronic diseases, except for higher rates of skin nevi and NIRD among Dead Sea residents. HRQOL was significantly higher among Dead Sea residents, both healthy or with chronic disease.

Cardiovascular (CV) patients are becoming older with a greater number of CV risk factors (CVRFs). The Framingham risk score (FRS) includes the major CVRFs and is used for CV risk stratification. We investigated temporal trends in burden of CVRFs among patients with acute myocardial infarction (AMI) throughout a decade. Patients with AMI hospitalized through 2002 to 2012 were studied. The baseline characteristics included age, sex, ethnicity, type of AMI (ST-segment elevation [STEMI] vs non-STEMI [NSTEMI]), coronary artery disease (CAD), diabetes mellitus (DM), dyslipidemia, hypertension, obesity, smoking, and blood lipid profile. The FRS was calculated for each patient. A total of 14 698 AMI admissions were included (age 66.9 ± 13.6 years, 68% males, 47.6% STEMI). Half of admitted cases had ≥4 CVRFs. The mean FRS was 17.1 ± 4.1. Throughout the study period, patients with AMI became older with increased burden of CVRFs. The mean FRS increased from 16.8 ± 4.0 (2002) to 17.3 ± 4.1 (2012; P <.001). Multivariate analysis demonstrated a significant increase in FRS among patients with NSTEMI and significant decrease for patients with STEMI. Conclusions: The last decade, patients with AMI became older with increased burden of CVRFs. Framingham risk score increased among patients with NSTEMI and decreased in patients with STEMI. These trends impact on risk stratification and secondary prevention programs. [ABSTRACT FROM AUTHOR]

Objective: Acute myocardial infarction (AMI) is associated with significant risk for long-term morbidity and healthcare expenditure. We investigated healthcare utilization and direct costs throughout 10 years following AMI. Methods: A retrospective study included AMI patients hospitalized in a tertiary medical center throughout 2002-2012. Data was obtained from computerized medical records. Hospitalizations, emergency department (ED), primary care and outpatient consulting clinic visits and other ambulatory services, following the AMI and their costs, were compared with the year preceding the AMI. Results: Overall 9548 patients were analyzed (age 66.6 ± 13.9 years, 67.8% men, 48.1% ST-elevation AMI). A significant increase in the utilization of all the evaluated services was observed in the first year following the AMI compared with the preceding year (p < .001 for each) and followed by a decline thereafter (p-for trend < .001 for each) except increased number of ED visits (p-for trend = .014). Annual per-patient costs throughout the first year following AMI (5592€) were significantly greater compared with the preceding year (3120€) and declined subsequently to 3216€ and 2760€ for years 2-5 and 6-10, respectively. Multivariate analysis showed that throughout the first half of the follow-up total costs were slightly higher and in the second half similar to the year preceding the AMI. Analysis of the relative costs showed that ambulatory services make up most of the expenditure. Conclusions: Healthcare utilization and economic expenditure peak throughout the first year and decline afterwards. For several services it remains higher for up to 10 years compared with the year preceding the AMI. [ABSTRACT FROM AUTHOR]

Potassium levels (K, mEq/L) fluctuate in patients with acute myocardial infarction (AMI). Potassium was reported to be associated with prognosis in patients with AMI; however, studies evaluating the prognostic value of K fluctuations in this setting are scarce. We retrospectively analyzed patients with AMI hospitalized in a tertiary medical center, through 2002 to 2012. Patients on chronic dialysis or mechanical ventilation were excluded. Based on all K values during hospitalization, minimal, maximal, and fluctuation (gap between 2 consecutive K) were recorded. Primary outcome was inhospital all-cause mortality. Overall, 10 032 patients were studied (age 68.1+14.3 years, 65.4% males, 44.2% ST-segment elevation MI), of which 507 (3.7%) died in hospital. Potassium decreased during the first 2 to 3 days (P for trend <.001), followed by stabilization (P for trend = .807). Potassium in the extreme categories (<3.8 and >4.7) and absolute fluctuations >0.1 mEq/L were more common among nonsurvivors than survivors (P < .001 each). In a multivariate analysis, combinations of minimal K <3.8 with maximal K > 4.7 (odds ratio [OR] = 18.1), K > 4.4 with fluctuation >0.1 (OR = 1.74), or <0.1 (OR = 2.6) and minimal K after the first 2 admission days (OR = 2.07) were associated with increased risk of mortality (P < .001 each). Potassium fluctuations, peak and nadir K, and its timing independently predict inhospital mortality in patients with AMI. [ABSTRACT FROM AUTHOR]

The author reflects on location of body potassium (K) in intracellular space with regulation of extracellular potassium by intracellular shifts and renal excretion. Topics discussed include modifications in electrophysiological property of resting membrane is done through changes in extracellular K levels, less occurrence of hypokalemia in isolated rabbit hearts than threshold of fibrillation and connection between hypokalemia and risk of ventricular arrhythmias in patients.

Frequent fluctuations of hemoglobin A1c (HbA1C) values predict patient outcomes. However, data regarding prognoses depending on the long-term changes in HbA1C among patients after acute myocardial infarction (AMI) are scarce. We evaluated the prognostic significance of HbA1C levels and changes among diabetic patients (n = 4066) after non-fatal AMI. All the results of HbA1C tests up to the 10-year follow-up were obtained. The changes (∆) of HbA1C were calculated in each patient. The time intervals of ∆HbA1C values were classified as rapid (

In this article, the authors talks about the European Society of Cardiology guidelines which includes new-onset atrial fibrillation (NOAF); and potentially important parameters to be obtained, analyzed as potential predictors and compared between the 2 subgroups of NOAF.

Aims: We examined whether thickness of the basal muscular interventricular septum (IVS), as measured by pre-procedural computed tomography (CT), could be used to identify the risk of conduction disturbances following transcatheter aortic valve replacement (TAVR). The IVS is a pivotal region of the electrical conduction system of the heart where the atrioventricular conduction axis is located., Methods and Results: Included were 78 patients with severe aortic stenosis who underwent CT imaging prior to TAVR. The thickness of muscular IVS was measured in the coronal view, in systolic phases, at 1, 2, 5, and 10 mm below the membranous septum (MS). The primary endpoint was a composite of conduction disturbance following TAVR. Conduction disturbances occurred in 24 out of 78 patients (30.8%). Those with conduction disturbances were significantly more likely to have a thinner IVS than those without conduction disturbances at every measured IVS level (2.98 ± 0.52 mm vs. 3.38 ± 0.52 mm, 4.10 ± 1.02 mm vs. 4.65 ± 0.78 mm, 6.11 ± 1.12 mm vs. 6.88 ± 1.03 mm, and 9.72 ± 1.95 mm vs. 10.70 ± 1.55 mm for 1, 2, 5 and 10 mm below MS, respectively, P < 0.05 for all). Multivariable logistic regression analysis showed that pre-procedural IVS thickness (<4 mm at 2 mm below the MS) was a significant independent predictor of post-procedural conduction disturbance (adjOR 7.387, 95% CI: 2.003-27.244, P = 0.003)., Conclusion: Pre-procedural CT assessment of basal IVS thickness is a novel predictive marker for the risk of conduction disturbances following TAVR. The IVS thickness potentially acts as an anatomical barrier protecting the underlying conduction system from mechanical compression during TAVR., Competing Interests: Conflict of interest: none declared., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Surgical site infections (SSIs) are uniformly defined for adults and children as infections that develop within 30 days after an operation and are classified as being either incisional or organ/space in the operated area. SSI rates among children are similar to adults, but are higher among neonates. SSIs represent a significant burden in terms of patient morbidity and mortality, length of hospitalization and cost to the health services. The difficulty in treatment and prevention of SSIs usually results from the variety of pathogens causing the infection. There are a multitude of risk factors influencing the development of SSIs that may be related to patient characteristics, such as younger age, and/or the surgical procedure, such as duration of surgery, wound class, and surgical technique. The prognostic scores which, to the best of our knowledge, have been developed and validated for adults, are yet to be adopted for children. Prevention of SSIs requires addressing the causes at each phase of patient treatment, uniformly for both adults and children. Guidelines for the prevention of SSIs have been developed; however, they are not specifically related to the pediatric patients and are not fully supported by evidence. For instance, management of prophylactic antibiotics is a standard for adults, but there is no clear agreement for children, and use of antibiotic prophylactics varies between medical centers. In summary, a systematic registry of SSIs among children in Israel is required along side of rigorous investigation of the risk factors and prevention program development.

Background: During military escalations emergency departments provide treatment both to victims of conflict-related injuries and to routine admissions. This requires special deployment by the hospitals to optimize utilization of resources., Objectives: To evaluate routine visits to the ED during Operation Cast Lead in Israel in 2008-2009., Methods: We obtained data regarding routine visits to the ED at Soroka University Medical Center throughout OCL. The visits one month before and after OCL and the corresponding periods one year previous served as controls., Results: The mean number of daily visits throughout the study period (126 days) was 506 +/- 80.9, which was significantly lower during OCL (443.5 +/- 82) compared with the reference periods (P < 0.001). Compared to the reference periods, during OCL the rates were higher among Bedouins, visitors from the region closest to the Gaza Strip (< 30 km), patients transported to the ED by ambulance and patients of employment age; the rates were lower among children. No difference in the different periods was found in the rate of women patients, the rate of patients referred to the ED by a community physician, and hour of arrival. The overall in-hospital admission rate increased during OCL, mainly in the internal medicine and the obstetric departments. There was no change in the number of in-hospital births during OCL; however, the rate of preterm labors (32-36 weeks) decreased by 41% (P = 0.013)., Conclusions: Throughout OCLthe number of routine ED visits decreased significantly compared to the control periods. This finding could help to optimize the utilization of hospital resources during similar periods.

Background and Objectives: Sexual concerns are prevalent among ICD recipients. Our goal was to evaluate the prevalence of sexual dysfunction (SD), depression, and quality of life (QOL) in male recipients of ICD with and without shock delivery., Patients and Methods: ICD implanted males were asked to fill-out 3 self-administered questionnaires: Florida Patient Acceptance Survey (FPAS), Centre for Epidemiologic Studies Depression Scale (CES-D), and Arizona Sexual Experiences Scale (ASES). All patients were offered a referral to a sex clinic., Results: A total of 47/72 patients (65%), agreed to participate. Patients were classified into no-shock [NS] (66%) and at least one shock [S] (34%) groups. SD defined as worse than median ASES male score was found in 42.6% of the patients, 52% and 25% in NS/S groups, respectively (p = 0.08). ICD related deterioration in sexual function (SF) was reported by 71% vs. 44% of NS/S groups, respectively (p = 0.069), and by 85% of the patients with SD vs. 44.4% of the better SF group (p = 0.005). Twenty three (49%) patients were referred to a sex clinic. Depression (CES-D score= 16) was found in 36% of the study group. CES-D score mean ranks were 21 vs. 30 in the NS/S groups respectively, (p = 0.049). QOL was similar in NS/S groups. No correlation was found between SD and depression or QOL, however, depression correlates with low QOL (Pearson correlation = 0.416, p = 0.04)., Conclusions: ICD implantation seems to impair male SF. Receiving a shock might be associated with a protective effect on SF. ICD implanted males are at risk for depression S > NS. QOL was similar in NS/S groups. ICD implanted males should be screened and treated for SD and depression.