Suchergebnisse

Background: Cardiogenic shock (CS) is still the leading cause of in-hospital mortality in patients presenting with acute myocardial infarction (AMI). Aim: To investigate the epidemiological and clinical characteristics of a series of patients hospitalized for AMI complicated by CS and to determine the in-hospital mortality. Methods: We retrospectively analysed 70 patients affected by AMI complicated by CS admitted to cardiology department of the military hospital between October 2005 and April 2015. Results: A total of 70 patients were included in the study, 56 (80%) patients were male. The mean age was 63±10 years. Diabetes mellitus (62%) and hypertension (50%) were the predominant risk factors. On admission, 41% of patients were in left ventricular failure and 59% in shock. The mean LVEF was 49±14.4%. Thrombolysis was performed in 51% of patients. Seventy-two (72%) of patients underwent angiography and 56.6% had percutaneous coronary intervention (PCI). Of these, 27% were taken for primary PCI and 73% had rescue PCI. Revascularization was complete in 37% of cases. The success rate of PCI was 85%. The average of hospital stay was 7±8 days. Patients revealed a mortality rate of 47%, occurring on average in the 6th day of hospitalization. We found that renal failure (p=0.014), late onset of shock (p=0.031), hyperglycemia (p=0.014), leukocytosis (p=0.02), use of vasopressors (p=0.003), and the anterior territory of MI (p=0.003) were significantly predictive of hospital mortality. Conclusion: Despite significant advances in the treatment of myocardial infarction, the in-hospital mortality of patients in CS complicating MI remains high. Renal failure, late onset of shock, hyperglycemia and the anterior territory of MI were the major predictive of hospital mortality. A multidisciplinary approach including medical actors and pre-hospital centers specialized in the treatment of this condition is actually necessary.

BACKGROUND: This paper examines one EC-funded multinational project (RESCAP-MED), with a focus on research capacity building (RCB) concerning non-communicable diseases (NCDs) in the Mediterranean Middle East and North Africa. By the project's end (2015), the entire region was engulfed in crisis. OBJECTIVE: Designed before this crisis developed in 2011, the primary purpose of RESCAP-MED was to foster methodological skills needed to conduct multi-disciplinary research on NCDs and their social determinants. RESCAP-MED also sought to consolidate regional networks for future collaboration, and to boost existing regional policy engagement in the region on the NCD challenge. This analysis examines the scope and sustainability of RCB conducted in a context of intensifying political turmoil. METHODS: RESCAP-MED linked two sets of activities. The first was a framework for training early- and mid-career researchers through discipline-based and writing workshops, plus short fellowships for sustained mentoring. The second integrated public-facing activities designed to raise the profile of the NCD burden in the region, and its implications for policymakers at national level. Key to this were two conferences to showcase regional research on NCDs, and the development of an e-learning resource (NETPH). RESULTS: Seven discipline-based workshops (with 113 participants) and 6 workshops to develop writing skills (84 participants) were held, with 18 fellowship visits. The 2 symposia in Istanbul and Beirut attracted 280 participants. Yet the developing political crisis tagged each activity with a series of logistical challenges, none of which was initially envisaged. The immediacy of the crisis inevitably deflected from policy attention to the challenges of NCDs. CONCLUSIONS: This programme to strengthen research capacity for one priority area of global public health took place as a narrow window of political opportunity was closing. The key lessons concern issues of sustainability and the paramount importance of responsively shaping ...