Managing critical care during COVID-19 pandemic: The experience of an ICU of a tertiary care hospital.

Background: The COVID-19 pandemic has strained ICUs worldwide. To learn from our experience, we described the critical care response to the outbreak.

Methods: This is a case study of the response of the Intensive Care Department (75-bed capacity) at a tertiary-care hospital to COVID-19 pandemic, which resulted in a high number of critically ill patients.

Prevalence and clinical correlates of ambulatory blood pressure phenotypes in a Saudi hypertensive population.

International Guidelines recommend ambulatory blood pressure monitoring (ABPM) for the management of hypertension. ABPM phenotypes predict outcomes independent of office blood pressure (BP). The authors explored the prevalence and clinical correlates of ABPM phenotypes and relationship with office BP in Saudi patients (n = 428, mean age 53.

Antimicrobial consumption in five adult intensive care units: a 33-month surveillance study.

Background: Estimating the baseline antimicrobial consumption is extremely important to monitor the impact of antimicrobial stewardship activities that aim to reduce the burden and cost of antimicrobial consumption.

Objectives: To quantify service-specific antimicrobial consumption using different metrics.

Methods: A surveillance study was conducted at King Abdulaziz Medical City, Riyadh, Saudi Arabia, between October 2012 and June 2015 in five adult intensive care units (ICUs).

Prevalence of anginal symptoms and myocardial ischemia and their effect on clinical outcomes in outpatients with stable coronary artery disease: data from the International Observational CLARIFY Registry.

Importance: In the era of widespread revascularization and effective antianginals, the prevalence and prognostic effect of anginal symptoms and myocardial ischemia among patients with stable coronary artery disease (CAD) are unknown.

Objective: To describe the current clinical patterns among patients with stable CAD and the association of anginal symptoms or myocardial ischemia with clinical outcomes.

Design, Setting, And Participants: The Prospective Observational Longitudinal Registry of Patients With Stable Coronary Artery Disease (CLARIFY) registry enrolled outpatients in 45 countries with stable CAD in 2009 to 2010 with 2-year follow-up (median, 24.

Correlation between transient ischemic dilatation (TID) and coronary artery disease in Saudi male patients.

Objective: A high transient ischemic dilatation ratio (TID) for the left ventricle (LV) from a gated myocardial perfusion imaging (G-MPI) study is widely believed to be associated with significant coronary artery disease (CAD). We have investigated the relationship between TID and CAD for our male Saudi Arabian patient population.

Methods: In this retrospective study, all male Saudi Arabian patients who underwent a two-day G-MPI study using Tc99m MIBI during the year 2011 having a TID ⩾ 1.

Rosuvastatin versus atorvastatin in achieving lipid goals in patients at high risk for cardiovascular disease in clinical practice: A randomized, open-label, parallel-group, multicenter study (DISCOVERY Alpha study).

Background: The majority of clinical trials investigating the clinical benefits of lipid-lowering therapies (LLTs) have focused on North American or western and nothern European populations. Therefore, it is timely to confirm the efficacy of these agents in other patient populations in routine clinical practice.

Objective: The aim of the Direct Statin COmparison of low-density lipoprotein cholesterol (LDL-C) Values: an Evaluation of Rosuvastatin therapY (DISCOVERY) Alpha study was to compare the effects of rosuvastatin 10 mg with those of atorvastatin 10 mg in achieving LDL-C goals in the Third Joint Task Force of European and Other Societies on Cardiovascular Disease Prevention in Clinical Practice guidelines.

Cardiac echinococcosis causing acute dissection of the left ventricular free wall.

Cardiac echinococcosis is a rare condition, and its manifestations are protean depending upon its site of infestation. We report a case of hydatid heart disease presenting like an acute cardiac ischemic episode associated with a rise in serum cardiac enzymes secondary to left ventricular free wall dissection caused by ruptured intramyocardial echinococcal cyst. The resultant complex cardiac anatomy was characterized fully by echocardiographic examination.

Mixed aneurysmal and obstructive coronary artery disease causing acute myocardial infarction in a young woman with Takayasu's arteritis.

Takayasu's disease is a chronic inflammatory pathology of the aorta and its main branches. The present report describes a rare presentation of the disease in a young woman who presented with anterior myocardial infarction, and was subsequently found to have mixed aneurysmal and obstructive coronary artery disease involving the left anterior descending artery and its diagonal branches. Issues surrounding the management of coronary artery disease in this patient are discussed.

Long-term clinical results after stent implantation in old obstructed saphenous vein grafts.

Study Objective: To assess the long-term clinical outcome of treating patients with coronary artery disease and obstructed saphenous vein grafts (SVGs) with stents deployed by oversized balloon catheters.

Design: The study included 89 of 92 consecutive patients who had 121 SVG stent implants (average, 1.4 stents per patient).

Immediate and long-term results comparing coronary versus biliary tubular-slotted stents to treat old obstructed saphenous vein grafts.

Stenting of old obstructed saphenous vein grafts improves immediate angiographic results and long-term clinical outcome compared to standard balloon angioplasty. Comparison of results and long-term clinical outcome between different types of stents in the treatment of vein graft disease is scarce. The authors studied two matched groups of 33 patients each, receiving either coronary or biliary tubular-slotted stents in old vein graft lesions to compare immediate results and long-term clinical outcome.

Results of saphenous vein graft stent implantation: single center results from use of oversized balloon catheters.

The results and complications of a single-center experience of stent implantation in old saphenous vein grafts (SVGs) need to be defined. The authors studied their initial consecutive 92 patients (125 stents, 1.4 stents/per patient) with a mean age of 67+/-9 years.

Pulmonary artery pressure and pulmonary vascular resistance before and after mitral balloon valvotomy in 100 patients with severe mitral valve stenosis.

We studied the pulmonary vascular hemodynamics before and after mitral balloon valvotomy in 100 patients with severe mitral valve stenosis. Before balloon valvotomy 23 patients had a pulmonary artery systolic pressure of < 31 mm Hg (group 1), 54 patients had a pulmonary artery systolic pressure between 31 and 50 mm Hg (group 2), and 23 patients had a pulmonary artery systolic pressure of > 50 mm Hg (group 3). After balloon valvotomy the mean systolic pulmonary artery pressure in group 1 decreased from 28 +/- 3 to 26 +/- 5 mm Hg (p = NS).

Comparison between single (Inoue) and double balloon mitral valvuloplasty: immediate and short-term results.

This study compared the results in 60 consecutive patients with severe rheumatic mitral stenosis, who underwent percutaneous double-balloon mitral valvuloplasty by means of a combination of 20 mm + 20 mm diameter balloon catheters (group A), with a similar group of 60 consecutive patients who underwent single (Inoue) balloon mitral valvuloplasty (group B). After balloon mitral valvuloplasty the hemodynamic measurements showed significant improvement in both groups: in groups A and B, respectively, mitral valve area calculated with the Gorlin formula increased from 0.9 +/- 0.

Percutaneous double balloon tricuspid valvotomy for severe tricuspid stenosis: 3-year follow-up study.

We performed percutaneous double balloon tricuspid valvotomy in four patients (36 +/- 12 years of age), with severe symptomatic rheumatic tricuspid stenosis and mild mitral valve disease. Two 9F Meditech balloon catheters, 15-20 mm diameter, were positioned simultaneously across the tricuspid valve and inflated up to five atmospheres pressure achieving valvotomy. After balloon valvotomy there was symptomatic improvement, and the Doppler tricuspid valve area was increased from a mean of 1 +/- 0.

Beta-adrenergic receptor blockade in the management of pregnant women with mitral stenosis.

Twenty-five pregnant women with symptomatic mitral valve stenosis (mean valve area, 1.1 +/- 0.25 cm2) were managed by initiation or modification of beta-adrenergic receptor blockade with the use of either propranolol or atenolol.

Left atrial systolic antegrade flow in patients with mitral regurgitation: a pulsed Doppler sign displayed by color flow imaging.

Twenty-two patients with severe mitral regurgitation were observed to have turbulent systolic antegrade flow on pulsed Doppler mapping of the left atrium. All were studied by color flow imaging to delineate the mechanism of this peculiar flow. Pulsed Doppler findings of an eccentric regurgitant flow in one side, an antegrade systolic flow with slightly delayed onset in the other side, and a low velocity flow near the posterior wall, were consistant with the theory of a large eccentric regurgitant jet swirling in the left atrium.

The value and extent of valve area increase by balloon dilatation of the stenosed bioprosthesis: in vitro studies.

The value and extent in which balloon dilatation increases the valve area in severe bioprosthesis stenosis has not been defined. In-vitro double balloon dilatation, using 15 to 20 mm diameter Meditech balloon catheters, simultaneously inflated to 5 atmospheres, was attempted in 10 intact, stenosed, surgically excised bioprosthetic valves, 7 mitral and 3 aortic, size 21 to 35 mm. Radiological studies and calculation of the valve area, using a conical sizer, were performed both before and after balloon dilatation.

Double balloon aortic valvotomy for rheumatic aortic stenosis; in vivo studies.

The manner in which aortic valve area increases after in vitro double balloon aortic valvotomy for severe rheumatic aortic stenosis has not been defined. We selected ten intact aortic valves excised at cardiac surgery from patients (mean age 45 +/- 10 years) with severe rheumatic aortic stenosis, with a valve area less than or equal to 1 cm2. In vitro double balloon aortic valvotomy was attempted on each valve using two Meditech 15 mm diameter balloon catheters.

A prospective study comparing the haemodynamic with the cross-sectional echocardiographic diagnosis of rheumatic tricuspid stenosis.

The value of cross-sectional echocardiography in the diagnosis of tricuspid valve stenosis is not clearly established. We prospectively studied by cardiac catheterization 42 consecutive patients, with a mean age of 29 +/- 11 years, who exhibited the cross-sectional echocardiographic features of tricuspid valve stenosis, defined as: diastolic doming of all three tricuspid leaflets and leaflet thickening with restrictive motion. To expose occult and amplify borderline tricuspid diastolic gradients, simultaneous right atrial and right ventricular pressures were recorded in the basal state, after incremental infusions of normal saline to 200, 400, 500, 700 or 1000 ml until a mean right atrial pressure of 12 mmHg was achieved, and finally after intravenous administration of 0.