Fares, Munes

Background There is no consensus on the most effective and best tolerated first‐line antiarrhythmic treatment for fetal tachyarrhythmia. The purpose of this systematic review and meta‐analysis was to compare the efficacy, safety, and fetal–maternal tolerance of first‐line monotherapies for fetal supraventricular tachycardia and atrial flutter. Methods and Results A comprehensive search of several databases was conducted through January 2017. Only studies that made a direct comparison between first‐line treatments of fetal tachyarrhythmia were included. Outcomes of interest were termination of fetal tachyarrhythmia, fetal demise, and maternal complications. Ten studies met inclusion criteria, with 537 patients. Overall, 291 patients were treated with digoxin, 137 with flecainide, 102 with sotalol, and 7 with amiodarone. Digoxin achieved a lower rate of supraventricular tachycardia termination compared with flecainide (odds ratio [ OR ]: 0.773; 95% confidence interval [ CI ], 0.605–0.987; I 2 =34%). In fetuses with hydrops fetalis, digoxin had lower rates of tachycardia termination compared with flecainide ( OR : 0.412; 95% CI , 0.268–0.632; I 2 =0%). There was no significant difference in the incidence of maternal side effects between digoxin and flecainide groups ( OR : 1.134; 95% CI , 0.129–9.935; I 2 =80.79%). The incidence of maternal side effects was higher in patients treated with digoxin compared with sotalol ( OR : 3.148; 95% CI , 1.468–6.751; I 2 =0%). There was no difference in fetal demise between flecainide and digoxin ( OR : 0.767; 95% CI , 0.140–4.197; I 2 =44%). Conclusions Flecainide may be more effective treatment than digoxin as a first‐line treatment for fetal supraventricular tachycardia.

Abstract Background: Palestinian refugees have been a displaced group of people since 1948, many of whom are living in refugee camps in the Middle East. They are entitled to free health care from the United Nations Relief and Work Agency (UNRWA). They show a higher prevalence of diabetes than the population in their host countries in the Middle East. This study examined the realities of care for diabetic patients in UNRWA health clinics in Damascus, Syria. The aim was three‑fold: To investigate the level of diabetes care, to probe patients′ level of general understanding of their disease and its management, and to search for areas of potential improvement. Methods: Data on patient education and care was gathered over a 1 month period from August 4, 2008 to September 4, 2008 using questionnaires and direct observation of the workflow at the clinics. Clinic‑led care was observed by the study team using checklists during patient visits. All of the clinic staff and sampled patients were interviewed. The main areas of care assessed were: Patient follow‑up; examination of eyes and feet; availability of medications; and patient education. A total of 154 people with diabetes were sampled from three refugee camps situated around Damascus. Results: A total of 154 patients, three doctors and seven nurses composed the sample of the study. Foot examinations were almost always neglected by health staff and eye examinations were not offered by the UNRWA clinics. Interviews with patients showed that: 67% (95% confidence intervals [CI]: 0.59‑0.70) had to buy their medication at their own expense at least once due to medication shortage in the UNRWA clinics, 48% (95% CI: 0.40‑0.55) displayed poor knowledge regarding the cause and exacerbating factors of diabetes, 65% (95% CI: 0.56‑0.72) had not heard of insulin, and 43% (95% CI: 0.35‑0.51) did not know for how long they needed to take their medications.