RESUMO
BACKGROUND: Rheumatic heart disease (RHD) is still a concerning issue in developing countries. Among delayed RHD presentations, rheumatic mitral valve stenosis (MS) remains a prevalent finding. Percutaneous transvenous mitral commissurotomy (PTMC) is the intervention of choice for severe mitral stenosis (MS). We aimed to assess the mid-term outcome of PTMC in patients with immediate success. METHODS: In this retrospective cohort study, out of 220 patients who had undergone successful PTMC between 2006 and 2018, the clinical course of 186 patients could be successfully followed. Cardiac-related death, undergoing a second PTMC or mitral valve replacement (MVR) were considered adverse cardiac events for the purpose of this study. In order to find significant factors related to adverse cardiac outcomes, peri-procedural data for the studied patients were collected.The patients were also contacted to find out their current clinical status and whether they had continued secondary antibiotic prophylaxis regimen or not. Those who had not suffered from the adverse cardiac events were additionally asked to undergo echocardiographic imaging, in order to assess the prevalence of mitral valve restenosis, defined as mitral valve area (MVA) < 1.5 cm2 and loss of ≥ 50% of initial area gain. RESULTS: During the mean follow-up time of 5.69 ± 3.24 years, 31 patients (16.6% of patients) had suffered from adverse cardiac events. Atrial fibrillation rhythm (p = 0.003, HR = 3.659), Wilkins echocardiographic score > 8 (p = 0.028, HR = 2.320) and higher pre-procedural systolic pulmonary arterial pressure (p = 0.021, HR = 1.031) were three independent predictors of adverse events and immediate post-PTMC mitral valve area (IMVA) ≥ 2 cm2 (p < 0.001, HR = 0.06) was the significant predictor of event-free outcome. Additionally, follow-up echocardiographic imaging detected mitral restenosis in 44 patients (23.6% of all patients). The only statistically significant protective factor against restenosis was again IMVA ≥ 2 cm2 (p = 0.001, OR = 0.240). CONCLUSION: The mid-term results of PTMC are multifactorial and may be influenced by heterogeneous peri-procedural determinants. IMVA had a great impact on the long-term success of this procedure. Continuing secondary antibiotic prophylaxis was not a protective factor against adverse cardiac events in this study. (clinicaltrial.gov registration: NCT04112108).
Assuntos
Valvuloplastia com Balão , Cateterismo Cardíaco , Ecocardiografia Doppler em Cores , Ecocardiografia Transesofagiana , Estenose da Valva Mitral/terapia , Valva Mitral/diagnóstico por imagem , Cardiopatia Reumática/terapia , Adulto , Valvuloplastia com Balão/efeitos adversos , Cateterismo Cardíaco/efeitos adversos , Feminino , Humanos , Irã (Geográfico) , Masculino , Pessoa de Meia-Idade , Valva Mitral/fisiopatologia , Estenose da Valva Mitral/diagnóstico por imagem , Estenose da Valva Mitral/fisiopatologia , Valor Preditivo dos Testes , Intervalo Livre de Progressão , Recuperação de Função Fisiológica , Recidiva , Estudos Retrospectivos , Cardiopatia Reumática/diagnóstico por imagem , Cardiopatia Reumática/fisiopatologia , Índice de Gravidade de Doença , Fatores de TempoRESUMO
Heracleum persicum Desf. Ex Fischer (Apiaceae) is a native medicinal plant in the Iranian traditional medicine and also a safe and common dietary spice. The present pilot study aimed to investigate the impact of supplementation with H. persicum fruits on serum lipid concentrations in a group of patients with minimal coronary artery disease. Subjects who were diagnosed with <50% luminal narrowing in any of the major coronary arteries in coronary angiography were recruited for this trial and were randomized to receive either H. persicum hydroalcoholic fruit extract (n=15; 300 mg/day) or placebo (n=12) for a period of 6 months. Serum concentrations of total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides were measured at baseline and at the end of study. No significant difference in concentrations of total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol was observed between H. persicum extract and placebo groups (p>0.05). However, serum triglycerides levels were reduced after H. persicum extract supplementation in a borderline significant manner (p=0.063). Short-term supplementation with H. persicum fruit extract might be used as an adjunctive treatment for patients with hypertriglyceridemia.
Assuntos
Angiografia Coronária , Doença da Artéria Coronariana/sangue , Suplementos Nutricionais , Heracleum/química , Extratos Vegetais/farmacologia , Adulto , Idoso , Colesterol/sangue , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Dieta , Método Duplo-Cego , Feminino , Frutas/química , Humanos , Hipertrigliceridemia/tratamento farmacológico , Lipídeos/sangue , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Triglicerídeos/sangueRESUMO
BACKGROUND: Chronic pruritic skin lesions are among the common late complications of sulfur mustard intoxication. In the present randomized double-blind clinical trial, therapeutic efficacy of Aloe vera/olive oil combination cream in the alleviation of these lesions was evaluated and compared to that of betamethasone 0.1% cream. METHODS: Sixty-seven Iranian chemical warfare-injured veterans were randomized to apply A. vera/olive oil (n=34, completers=31) or betamethasone 0.1% (n=33, completers=32) cream twice daily for 6 weeks. Evaluation of pruritus severity was performed using a pruritic score questionnaire and visual analogue scale (VAS). RESULTS: Both treatments were associated with significant reductions in the frequency of pruritus (p<0.05), burning sensation (p<0.01 and p<0.001 in A. vera/olive oil and betamethasone group, respectively), scaling (p<0.01 and p<0.05) and dry skin (p<0.001) at the end of trial. Fissure and excoriation were only reduced in the A. vera group (p<0.05). The change in the frequency of hyper- and hypopigmentation lesions, blisters, erythema and lichenification did not reach statistical significance in any of the groups (p>0.05). Mean pruritus (p<0.05) and VAS scores (p<0.01 and p<0.05) were significantly decreased by the end of trial in both groups. The rate of improvement in the pruritus severity [defined as being classified in a less severe category (mild, moderate and severe)] was found to be comparable between the groups (p>0.05). CONCLUSION: A. vera/olive oil cream was at least as effective as betamethasone 0.1% in the treatment of sulfur mustard-induced chronic skin complications and might serve as a promising therapeutic option for the alleviation of symptoms in mustard gas-exposed patients.
Assuntos
Aloe , Betametasona/uso terapêutico , Glucocorticoides/uso terapêutico , Gás de Mostarda/toxicidade , Óleos de Plantas/uso terapêutico , Dermatopatias/tratamento farmacológico , Adulto , Anti-Inflamatórios/uso terapêutico , Substâncias para a Guerra Química/toxicidade , Método Duplo-Cego , Emolientes/uso terapêutico , Humanos , Irã (Geográfico) , Masculino , Pessoa de Meia-Idade , Azeite de Oliva , Prurido/induzido quimicamente , Prurido/tratamento farmacológico , Dermatopatias/induzido quimicamente , Resultado do Tratamento , VeteranosRESUMO
BACKGROUND: Eyes are the most sensitive organs to sulfur mustard (SM). Late ocular complications have been reported even 15-20 years post-exposure. To date, no study has investigated the composition of tear proteins in tear samples of SM-intoxicated patients. METHODS: Total protein content as well as concentrations of vascular endothelial growth factor (VEGF), calcitonin gene related peptide (CGRP) and substance P were measured in unstimulated tears of chemically-injured patients who suffer from late ocular complications of SM. These levels were compared to corresponding values obtained from tears of healthy control subjects. The concentration of total proteins was measured using the Bradford method and those of VEGF, CGRP and substance P by ELISA. RESULTS: Total protein concentration was significantly lower in tears of the SM compared to control group (p<0.01). In contrast, tear samples of the SM group had significantly higher VEGF and VEGF/total protein compared to control group (p<0.01). Tear CGRP concentration was found to be lower in the SM vs. control group (p<0.05) but no significant difference in CGRP/total protein was observed (p>0.05). Finally, tear substance P concentrations were not found to be significantly different between the two groups (p>0.05). CONCLUSION: The results of this investigation indicated decreased total protein and CGRP, and elevated VEGF concentration in tears of SM-intoxicated patients who suffer from chronic ocular complications.
Assuntos
Substâncias para a Guerra Química/toxicidade , Oftalmopatias/metabolismo , Proteínas do Olho/análise , Gás de Mostarda/toxicidade , Lágrimas/química , Adulto , Peptídeo Relacionado com Gene de Calcitonina/análise , Estudos Transversais , Oftalmopatias/induzido quimicamente , Humanos , Irã (Geográfico) , Masculino , Pessoa de Meia-Idade , Substância P/análise , Fator A de Crescimento do Endotélio Vascular/análiseRESUMO
Different symptoms in Climacteric period, includes hot flash. Hormone replacement therapy (HRT) is common therapy for relief of menopausal symptoms but has possible contraindications and side effects. Recently Piascledine (combination of Avocado oil with Soybean oil) showed effects in reducing hot flash severity. Present study designed to compare the effects of HRT with Piascledine in treatment of hot flash. The cases of this study were sixty-six women at the age range of 40 to 70 years and complaints of menopause-induced hot flashing, whose last menstruation dated at least 6 months prior to the beginning of the study. The patients in this open label clinical trial, randomized to receive Piascledine capsule 1 mg or HRT (0.625 mg oral daily Conjugated Estrogen tablets, plus 2.5 mg continuous oral daily Medroxyprogesterone Acetate tablets) for 2 month. Hot flash property and severity was assessed via a daily check list and Visual analog scale. Climacteric symptom was measured before and after intervention using Greene Climacteric Scale (GCS) and Blatt-kupperman Menopausal Index (BKMI). Thirty-three eligible patients were allocated in each group. From the Piascledine group, one patient and from the HRT group, 16 patients weren>t willing to attend the study; therefore, 32 and 17 woman received treatment in Piascledine and HRT groups. 4 patients were withdrawn for vaginal bleeding and one for breast tenderness from HTR group. Hot flash severity in both groups decreased during the time similarly. With regard to GCS (p = 0.571) and BMKI (p = 0.891), the outcome was similar among the two groups. Due to low HRT compliance and its possible risks in long period of time and considering the same activity of soybean supplement and HRT in relieving the hot flash as menopausal symptoms in women, it seems that soybean supplements can be an alternative therapy to hormone.