سال:1391 | دوره: | شماره: |تعداد مقالات:7

Introduction: EAT is an independent factor in coronary artery disease (CAD). The objectiveof the current study was to define an echocardiographic cut-off point for EAT and to determine its diagnostic value in predicting the increase in CAD risk.Methods: Two hundred patients underwent coronary artery angiography for diagnosis of CAD and transthoracic echocardiography for measurement of EAT on the right ventricle (RV), RV apex and RV outlet tract. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the EAT cut-off points in the three above-mentioned areas for predicting the severity of CAD were measured. The relation between the EAT and CAD risk factors was evaluated as well.Results: EAT was independent from gender, height, hypertension, diabetes, HDL, total cholesterol, ejection fraction, acute coronary syndrome, and the location of the coronary artery stenosis in the coronary artery in all three anatomical areas. EAT on RV and RV apex had a significant relation with CAD (P£0.05). Overall, RV EAT³10 mm and RV apex EAT³8 mm had sensitivity and PPV of more than 70% in predicting coronary stenosis ³50% and acute coronary syndrome (ACS) and RVOT EAT ³13 mm is of PPV=83.5% for predicting coronary stenosis ³50%.Conclusion: EAT thickness has an acceptable diagnostic value for predicting severe coronary artery stenosis and ACS. Therefore, non-invasive EAT thickness measurement could be of great assistance to clinicians for detecting the patients at risk and helping them to undergo supplementary evaluations with invasive approaches.

Introduction: Hypertension is an important global health concern claiming 7.1 million lives annually. Literacy, as an essential element of the health education, and its relationship with health has previously been studied. However, few studies have been conducted on the association between literacy and health outcomes. To assess the association between educational level and hypertension, awareness and hypertension control in the north of Iran were the main objectives of this study.Methods: The present study was a population-based cross-sectional study carried out on 3497 subjects aged 15-65 years using stratified and cluster sampling. Interviewers recorded the data using a multidimensional questionnaire, including blood pressure level. Blood pressure was measured three times with 5-minute intervals and defined based on JNC-7.Results: Totally, 21.2% (741 cases) of our patients suffered from hypertension and illiterate people were significantly more aware of their disease (P=0.011). Among the aware group, at least 89.6% (435 cases) used one method to control their disease; this however was not statistically significant among the educational levels. Control of hypertension was significantly greater in college educated group than in illiterate group (32.4% vs. 68.8%; P=0.001). Logistic regression analysis revealed that illiteracy is a risk factor for hypertension (P<0.001).Conclusion: In spite of the fact that awareness in illiterate people was high, the rate of hypertension control was low in this group. Prevention, detection, treatment, and control of hypertension especially in illiterate people should receive high priority.

Introduction: Low Cardiac Output Syndrome (LCOS) contributes to postoperative morbidity and mortality. This article tries to find a predictive factor to interpret outcome after cardiac operation.Methods: In a cross-sectional study, 100 children with congenital heart disease undergoing cardiovascular surgery with cardiopulmonary bypass (CPB) without significant left-to-right shunt were selected. Arterial and central venous oxygen saturation values were measured via blood samples simultaneously obtained in 6-hr intervals for a total of 24-hr during postoperative period at hours 0, 6, 12, 18, and 24. Postoperative ventilation support (intubation period) and cardiovascular support were also obtained from the hospital records. Statistical analysis was later performed comparing the arterial-mixed venous oxygen saturation differences and durations of required ventilatory and cardiovascular support, both for the complicated and non-complicated patient groups. The data was processed with correlation Pearson and Mann-Whitney U tests in SPSS 15 software, P less than 0.05 was significant.Results: Mortality following cardiac operation is 6% and complications may happen in 45% of the cases. The highest Arterial-mixed venous oxygen saturation difference occurred immediately post operation (up to 57%). These measures were high up to 18 hours in complicated and non-complicated groups (36% vs.31%) (P<0.05). This factor cannot predict prolongation of intubation period in patients (P>0.05).Conclusion: Arterial-mixed venous oxygen saturation difference may be high as much as 57% or as low as 23%.These different measures, being higher up to 18 hours in complicated to non-complicated groups after 18 hours, can be related to tissue ischemia during surgery and cannot be discriminative.

Introduction: Acute surgical abdomen is one of the most common emergency surgical causes all over the world and also one of the most important abdominal pain causes which is sometimes intolerable for the patients referring to the emergency departments. Diagnosis and planning for operation in these cases is based on time-demanding serial examinations and results of paraclinical data. In this waiting period, patients have to tolerate pain. Therefore, we aimed to study the hypothesis that relieving pain has no influence on valuable findings in physical examination.Methods: This double blind randomized clinical trial was carried out on 120 patients above 12 years old referred to an emergency department of a referral hospital with acute abdomen. Patients were divided into two groups of receiving intravenous placebo and Morphine randomly. Pain score, change in tenderness as well as change in rebound tenderness before and after receiving morphine or placebo were measured based on Numeric Pain Assessment Scale.Results: Statistically significant difference was observed between both groups regarding the mean pain score. Prevalence of tenderness and rebound tenderness after medication administration revealed a significant difference between two groups. Furthermore, pain and tenderness showed a significant decrease in patients receiving morphine also a significant difference occurred in rebound tenderness between two groups.Conclusion: Despite the fact that opioid analgesics decrease pain in patients with acute surgical abdomen, they do not tend to eliminate required diagnostic data being obtained from physical examination like tenderness and rebound tenderness. Surprisingly, all the acute abdomen cases had rebound tenderness after morphine administration. Therefore, this research advises a cautious usage of morphine in patients with acute abdomen.

Introduction: Cardiac catheterization is a common procedure which needs a careful coagulation monitoring. In our study, we aimed tofind factors influencing active clotting time (ACT) following heparin therapy.Methods: ACT of 71 patients who were scheduled to undergo transcutaneous diagnostic catheterization and angiography were measured at baseline, 2 and 60 minutes after 50 IU/kg heparin loading. ACT in two groups of patients (cyanotic and non-cyanotic) was compared. All data were analyzed with Wilcoxon, Mann-Whitney test and Pearson in SPSS 16, P value less than 0.05 was considered significant.Results: ACT following heparin at 2nd and 60th minutes was not significantly different in cyanotic and non-cyanotic groups. At 60th minute following heparin administration, ACT decreased more dramatically in older children.Conclusion: Cyanosis does not affect ACT measures following heparin treatment. Moreover, after 60 minutes, heparin efficacy (ACT values) decreased more with increase in patients’ age.

Introduction: Hypertension is the most common medical problem affecting pregnant women during pregnancy contributing to one third of substantial maternal mortality and varieties of fetal and neonatal health problems, while representing health status of a society. This study aimed to investigate the links between a healthy life style and developing hypertension during pregnancy in order to improve healthier behaviors.Methods: In a case-control study from October 2009 to April 2010, physical activity and nutritional practices of two groups of pregnant women (220 in each group) with gestational age of 20 weeks or more, single pregnancy, without any previous medical disorders were compared. Samples in case group had pregnancy induced hypertension. Data were collected using a two-part questionnaire after obtaining informed written consents from mothers before enrollment; later the data were analyzed using the SPSS 13 and Stata software.Results: Women in two groups did not differ regarding their socioeconomic characteristics. There were no significant differences in nutritional practices and level of physical activity in pregnant women of study groups; mean score of physical activity was 54.6114.8 in test and 57.3115.0 in control group (P=0.06) and it was 72.9110.3 and 73.719.5 about nutritional habits in test and control group respectively. Mean pre-pregnancy BMI was higher in case group (P=0.02); these women also had a higher percentage of previous prenatal mortality and history of hypertension.Conclusion: Results state that health during pregnancy is relevant to healthy life style especially preconceptional period; therefore employing proper strategies to improve women knowledge and attitude of the important dimensions of healthy life considering good and healthy diet and active life seem to solve the problem; this needs to unite all health workers to set proper educational programs and courses and support of health policy makers.

We introduce a 28-year-old woman with Thalassemia major whose clinical assessment, including two-dimensional Doppler echocardiography demonstrated severe left ventricular hypertrophy with severe biventricular enlargement and systolic dysfunction as well as severe diastolic dysfunction. We hereby address these issues from an echocardiographic point of view.