Left main and three vessels spontaneous coronary artery dissection as an incidental finding in young man with history of Hodgkin's lymphoma-a case report.

BACKGROUND: Spontaneous coronary artery dissection is a rare and important cause of myocardial infarction, especially in young women without other coronary artery disease. This arterial dissection can occur within or between any of the 3 layers. Its predisposing factors include connective tissue diseases (Marfone syndrome, Ehlers-Danlos syndrome), vasculitis (polyarteritis nodosa, systemic lupus erythematosus, and Kawasaki disease), atherosclerosis and fibromuscular dysplasia. Clinical presentations of spontaneous coronary artery dissection are wide spectrum from asymptomatic to acute coronary disease, sustained ventricular arrhythmia and sudden cardiac death. CASE PRESENTATION: We describe A 33-year-old man with history of Hodgkin's lymphoma five years earlier that became a candidate for Patent foramen ovale closure due to recurrent embolic cerebrovascular accident. Before the intervention, coronary angiography incidentally showed dissection in the left main and all major coronary arteries. CONCLUSIONS: Based on our hypothesis, chemoradiotherapy-induced arteriopathies could be consider as a predisposing factor for spontaneous coronary artery dissection.

Assessing the Stress Echocardiography in Women With Breast Arterial Calcification.

Objective: breast arterial calcification (BAC) is one of the most prevalent mammographic findings and has been debated as a marker of cardiovascular disease (CVDs). The present study aimed to assess the findings of stress echo in women with BAC. Materials and methods: This cross-sectional study was conducted on women who undergo mammography for routine breast cancer screening at Imam Reza hospital, western Iran from March 2018 to July 2018. The patients underwent stress echocardiography to evaluate the probability of myocardial ischemia (MI). Chi-square and independent t-tests were used to assess the differences between subgroups. Results: BAC was present in 61 (15.2%) women. The mean age of the patients with BAC was significantly higher than the patients without BAC (58.59± 7.82 vs. 55.32±6.57, p =0.003). Prevalence rates of the menopause (88.5% vs. 71.1%, p=0.009), hypertension (29.5% vs. 17.7%, p=0.032), and hypercholesterolemia (24.6% vs. 13.0, p=0.018) were significantly higher in the patients with BAC compared to the patients without BAC. The prevalence rate of MI symptoms in the patients with BAC was equal to 24.6%. Significantly, more women with BAC were positive for myocardial ischemia compared to the women without BAC (24.6% vs. 8.5%, p<0.001). The prevalence rates of the diabetes mellitus, hypertension, hypercholesterolemia, and history of CVDs were significantly higher in the patients who were positive for MI. Conclusion: It was found that BACs are correlated with an increased occurrence rate of CVDs. Our results illustrated that the patients who were positive for MI were more plausible to be diabetic, hyperlipidemic, hypertensive, and having a history of CVDs.

Acute myocardial infarction: Circadian, daily, monthly and seasonal patterns of occurrence in diabetics.

BACKGROUND: Illustrating the temporal pattern of acute myocardial infarction (AMI), as a major cause of mortality, may help with disease prevention and better treatment. Therefore, the aim of our study was to investigate the circadian, daily, monthly and seasonal patterns of AMI occurrence in patients with diabetes mellitus, and other likely associated factors. METHODS: This cross-sectional study was performed on 142 diabetic patients admitted to the Imam Ali cardiovascular hospital, Kermanshah, Iran with a diagnosis of ST-segment elevation myocardial infarction (STEMI) from March 2018 to February 2019. Data were collected using a checklist developed based on the study goals. One-way Analysis of Variance (ANOVA) and Chi-Square test (or Fishers҆ Exact test) were used to assess the differences between subgroups. Multiple logistic regression model was constructed to evaluate independent predictors of the AMI occurrence. RESULT: Out of the 142 diabetic patients, 90 (63.4%) were male. The mean age of the patients was (mean ± SD) 62.81 ± 10.21 years. Occurrence of STEMI was the most common during winter (p = 0.001). Prior angina, prior congestive heart failure (CHF), prior stroke, High-density lipoprotein (HDL), and Creatine Phosphokinase (CPK) were significantly associated with seasonal pattern of STEMI (p-value < 0.05). Angiotensin receptor blockers (ARBs) use was associated with an increased odds of the AMI occurrence in winter (OR = 8.32; P = 0.027). CONCLUSION: The present study of Iranian patients with diabetes revealed that AMI occurred more frequently during the winter compared to the other seasons. ARBs use was associated with an increased odd of the AMI occurrence in winter. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40200-021-00813-3.

Comparison of renal function after Endovascular Aneurysm Repair and Open Aneurysm Repair in patients treated with abdominal aortic aneurysm below the renal artery.

INTRODUCTION: In addition to open endoaneurysmorrhaphy (EA) for treating the abdominal aortic aneurysm (AAA), other approaches such as endovascular aneurysm repair (EVAR) is gaining attention. Renal dysfunction could be a complication of these surgical techniques. We decided to compare renal function in EVAR vs. EA in patients operated for infrarenal AAAs. METHODS: Two groups of patients with AAA were included in this retrospective study. The first group (28 cases) consisted of patients who underwent AAA repair by EA technique and the second group included 12 patients who underwent EVAR for AAA repair. Serum creatinine levels measured one week, one month, three months, six months, and one year after the surgeries were documented. Through calculating the glomerular filtration rate (GFR) and scoring by the RIFLE criteria (Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease), the patients' renal function was evaluated. RESULTS: Of 40 patients included, three cases had diabetes mellitus (7.5%), 16 cases had hypertension (40%), 16 were smokers (40%), and 12 cases had a ruptured AAA (30%). The mean time of onset or increase of renal dysfunction compared to baseline in both groups was 6.45 days. The lowest time for patients with renal dysfunction (GFR less than 60) was from the onset and the highest time was 90 days after surgery. GFR of patients before surgery (76.9 in the EVAR group, vs. 56.2 in the EA group; P = 0.015) and one year after the surgery (84.1 in the EVAR group, vs. 57.7 in the EA group; P = 0.027) was differed significantly. The RIFLE criterion also was significantly different at the end of the first year in the two groups (P = 0.042). CONCLUSION: Based on the results, we concluded that the changes in renal function in EA group were more than EVAR group during one year. It may be necessary to follow patients undergoing these surgeries for a longer period to understand the prognosis of these patients better.

Lack of Association between Interarm Systolic Blood Pressure Difference and Coronary Artery Disease in Patients Undergoing Elective Coronary Angiography.

AIM: Peripheral vascular disease (PVD) and coronary artery disease (CAD) are, in many cases, asymptomatic and not usually diagnosed. The timely diagnosis of peripheral vascular diseases can act as an indicator or practical evidence of CAD. Therefore, this study was conducted to determine the relationship between interarm systolic blood pressure difference (IASBPD) and severity and number of coronary artery stenosis. METHODS: The samples in this cross-sectional study consisted of 578 patients who were candidates for coronary angiography, with an average age of 57.5 ± 10.5 years. Patients were classified according to CAD and number and severity of coronary artery stenosis. The relationship between IASBPD and presence or lack of CAD as well as the number and severity of coronary artery stenosis was studied. The sensitivity, specificity, and positive predictive value of IASBPD index were calculated for the detection of CAD using the Kappa coefficient. RESULTS: There was no statistically significant relationship between IASBPD, CAD, and severity and number of coronary artery stenosis. This index had low sensitivity and predictive value in the diagnosis of CAD and stenosis in coronary arteries in comparison with angiography. CONCLUSION: The results showed that the IASBPD index cannot be a valid criterion for the diagnosis of CAD as well as the number and severity of coronary artery stenosis. More studies with larger sample sizes and different designs are needed in this regard to achieve more conclusive results.

Prevalence and predictors of slow coronary flow phenomenon in Kermanshah province.

Introduction: This study was conducted to investigate prevalence and predictors of slow coronary flow phenomenon (SCF) phenomenon. Methods: This cross-sectional study was performed at Imam Ali Cardiovascular Hospital affiliated with the Kermanshah University of Medical Sciences (KUMS), Kermanshah province, Iran. From March 2017 to March 2019, all the patients who underwent coronary angiography were enrolled in this study. Data were obtained using a checklist developed based on the study's aims. Independent samples t tests and chi- square test (or Fisher exact test) were used to assess the differences between subgroups. Multiple logistic regression model was applied to evaluate independent predictors of SCF phenomenon. Results: In this study, 172 (1.43%) patients with SCF phenomenon were identified. Patients with SCF were more likely to be obese (27.58±3.28 vs. 24.12±3.26, P <0.001), hyperlipidemic (44.2 vs. 31.7, P <0.001), hypertensive (53.5 vs. 39.1, P <0.001), and smoker (37.2 vs. 27.2, P =0.006). Mean ejection fraction (EF) (51.91±6.33 vs. 55.15±9.64, P <0.001) was significantly lower in the patients with SCF compared to the healthy controls with normal epicardial coronary arteries. Mean level of serum triglycerides (162.26±45.94 vs. 145.29±35.62, P <0.001) was significantly higher in the patients with SCF. Left anterior descending artery was the most common involved coronary artery (n = 159, 92.4%), followed by left circumflex artery (n = 50, 29.1%) and right coronary artery (n = 47, 27.4%). Body mass index (BMI) (OR 1.78, 95% CI 1.04-2.15, P <0.001) and hypertension (OR 1.59, CI 1.30-5.67, P =0.003) were independent predictors of SCF phenomenon. Conclusion: The prevalence of SCF in our study was not different from the most other previous reports. BMI and hypertension independently predicted the presence of SCF phenomenon.

Assessing the adherence to treatment among patients with cardiovascular diseases in Kermanshah, Iran.

Background: The present study aimed to investigate the psychological determinants of adherence to treatment among patients with cardiovascular diseases (CVDs) referring to Imam Ali Hospital in Kermanshah, Iran. Methods: This cross-sectional study was conducted on 227 patients (mean age=58.10, SD = 13.44) with CVDs, randomly selected amongst those admitted to Imam Ali cardiovascular center of Kermanshah in 2018. Data were collected through Meaning in Life Questionnaire (MLQ), the Jefferson Scale of Patient's Perceptions of Physician Empathy (JSPPPE), the Illness Perception Questionnaire (IPQ), and Adherence to Treatment Questionnaire. The relationships between the criterion and predictor variables were assessed using Pearson correlation coefficient and linear regression (stepwise method) in IBM SPSS Statistics-23. Results: The adherence to treatment was associated with meaning in life (r=0.367), patients' perceptions of physician empathy (r=0.218), and illness perception (r=-0.238), at the 0.01 level. Meaning in life, patient's perceptions of physician empathy, and illness perception explained 18.6% of the variance in adherence to treatment. Meaning in life (beta=0.367 and P≤0.001) was the most influential predictor of adherence to treatment. Additionally, there was a significant difference in the score of adherence to treatment by gender (23.46±4.42 for female vs. 24.77±3.53 for male, P = 0.030). Conclusion: The patients' perceptions of physician empathy, meaning in life, and illness perception were important factors to predict adherence to treatment in patients with CVDs. Gender was a significant predictor of the adherence to treatment.

Investigation of anemia risk factors and its related outcomes in patients with ST-elevation myocardial infarction.

Background: Anemia is one of the symptoms of hospital patients suffering from ST-elevation myocardial infarction (STEMI), which may have a predictive role in short- or long-term complications. This study aimed to identify anemia risk factors and related short- or long-term outcomes in STEMI patients. Methods: This was a prospective study of patients older than 18 years diagnosed with STEMI who admitted to Imam Ali hospital from 2014 to 2015. To collect demographic and clinical information related to anemia, a questionnaire compiled by researchers was administered. The collected data were analyzed by SPSS (version 20); also, independent t test and multiple logistic regression analyses were applied to find related risk factors of anemia in STEMI patients. Significance level was set at p < 0.05 for all statistical tests. Results: In total, 49 (11.7%) out of 423 patients suffered from anemia. STEMI patients with anemia were more likely to be female (OR = 2.92; CI 95% = 1.58-5. 38), diabetic (OR = 2.5; CI 95% = 1.32- 4.74), ≥ 60 years old (OR = 2.42; CI 95% = 1.24-4.73), nonsmokers (OR = 2.18; CI 95% = 1.07- 4.4), and susceptible to require in-hospital cardiopulmonary resuscitation (CPR), (OR = 3.12; CI 95% = 1.35- 7.1). In the final analysis, using the Forward Wald model in logistic regression, anemia remained significantly related to female gender (OR = 2.76; CI 95% = 1.42-5.36), diabetes mellitus (OR = 2.38; CI 95% = 1.2-4. 74), and a history of MI (OR = 2.5; CI 95% = 1.04-6.11). Conclusion: STEMI patients with anemia are more susceptible to have in-hospital outcomes. Furthermore, female gender, hyperglycemia, and history of MI were factors related to anemia that might have major role in the complications of STEMI.

Circadian pattern of symptom onset in patients with ST-segment elevation myocardial infarction in western Iran.

BACKGROUND: Circadian variation is known as an important factor in acute myocardial infarction (AMI). Moreover, the circadian pattern may help in disease prevention and better medication prescription. Therefore, the aim of our study was to investigate the circadian pattern of symptom onset in patients with ST-segment elevation myocardial infarction (STEMI). METHODS: This cross-sectional study was conducted on 777 patients admitted to the Imam Ali Cardiovascular Center, Kermanshah, Iran, with a diagnosis of STEMI from March 2018 to February 2019. Data were collected using a checklist developed based on the study's objectives. Differences between subgroups were assessed using one-way analysis of variance (ANOVA) with post-hoc testing and chi-square test (or Fisher's exact test). RESULTS: Out of the 777 patients, 616 (79.3%) were men. The mean and standard deviation (SD) of age of the patients was 60.93 ± 12.86 years. 380 patients (48.9%) were current smoker, 40.3% were hypertensive, 21.1% had hypercholesterolemia, 18.3% had diabetes mellitus (DM), 25.2% had history of angina, and about 15.0% had history of myocardial infarction (MI). The occurrence of STEMI was most common during hours between 06:01-12:00 (27.7%), followed by 12:01-18:00 (27.3%), 00:00-06:00 (24.3%), and 18:01-24:00 (20.7%), respectively. Gender was significantly associated with circadian pattern of STEMI. Women showed a double peak of symptom onset in 06:01-12:00 and 12:01-18:00. CONCLUSION: The present study of Iranian patients displayed circadian pattern of STEMI with 2 peaks in the morning and afternoon, and the both peaks were dominated by women.

Comparison of foam sclerotherapy versus radiofrequency ablation in the treatment of primary varicose veins due to incompetent great saphenous vein: Randomized clinical trial.

BACKGROUND AND OBJECTIVE: Minimally invasive procedures such as foam sclerotherapy and radiofrequency ablation (RFA) have gained attention for treatment of incompetent great saphenous vein (GSV). The objective of this study was to compare recurrence rate and quality of life between foam sclerotherapy and RFA in patients with incompetent GSV varicose veins. METHODS: In this parallel single-blinded randomized clinical trial, 60 adult patients with primary varicose veins due to incompetent GSV (CEAP classes C2-4EPAsPr) were included and randomly divided to receive RFA or foam sclerotherapy. Health-related quality of life (HRQOL) was assessed by the Short Form 36, and the Aberdeen Varicose Vein Questionnaire (AVVQ) was applied to assess the impact of varicose veins on quality of life of the patients. In addition, pain severity after the procedures was investigated by a visual analog scale (VAS) (range, 0 to 10). The patients were followed at 1 week, 1 month, 3 months, and 6 months postoperation. GSV reflux and recurrence was assessed by color Doppler ultrasound examination after 6 months. RESULTS: Twenty-eight patients in RFA and 27 patients in foam sclerotherapy remained for the final analyses. The time interval from the procedure and recovery to daily normal activities was 1 day in both groups. Mean (±SD) pain VAS score in RFA group decreased from preintervention score of 7.35 (±3.28) to 1.21 (±0.68); P < .0001. Likewise, this score decreased from 6.64 (±2.04) to 1.29 (±0.91) in foam sclerotherapy group. HRQOL scores increased gradually at 1, 3, and 6 months after the intervention. AVVQ scores decreased significantly 1 week postintervention in both groups. After 6 months, 17.9% (5 patients) in RFA group and 14.8% (4 patients) in foam sclerotherapy group had recurrence of GSV reflux (P = .52). CONCLUSION: Both foam sclerotherapy and RFA were effective in treatment of GSV reflux. Comparable findings were observed between the 2 groups regarding postoperative pain, recovery time, HRQOL, and AVVQ scores.

Association of Helicobacter pylori and Coronary heart disease in Iran: A meta-analysis.

Background: Several studies in the recent decade have supported a relationship between different types of infections and CHD (Coronary Heart Disease); however, such a relationship is not definitely proven. Helicobacter pylori is one of the most common infections in human. The role of inflammation in the pathogens of CAD (Coronary Artery Disease) has been widely discussed; although, the mechanism is not clearly known yet. Methods: In this systematic review and meta-analysis all case-control articles on the relationship between Helicobacter pylori and CHD published from 31st June 2000 to 31st June 2016 indexed in Scopus, PubMed, Google Scholar, Science Direct, and Iranian databases Magiran, Iran Medex, Irandoc, and SID were included. The articles were searched using the following keywords in Farsi and English. The extracted data was imported into Microsoft Excel and analyzed in Stata 12. Results: Thirty case-control studies conducted in different regions of Iran (15 provinces) have been published from 2001 to 2015 included in this study. A general estimate of OR (Odds Ratio) for the association of Helicobacter pylori and heart diseases in Iran was 2.351 (95 CI: (1.715, 3.221)). Conclusion: According to the observed association between Helicobacter pylori and heart diseases in the resent study, most of the hosts of the bacterium are afflicted with the infection in their childhood. Therefore, personal hygiene promotion and preventive programs for Iranian children may have a considerable role in reducing the risk of the infection and cardiovascular diseases, consequently.

Association of Helicobacter Pylori with Presence of Myocardial Infarction in Iran: A Systematic Review and Meta-Analysis.

BACKGROUND: Over the past decade, cardiovascular diseases have been recognized as the leading cause of mortality worldwide. Myocardial infarction (MI) is one of the most prevalent types of cardiovascular diseases that is caused by the closure of coronary arteries and ischemic heart muscle. Numerous studies have analyzed the role of H. pylori as a possible risk factor for coronary artery diseases, in most of which the role of infection in coronary artery disease is not statistically significant. METHODS: These contradictory findings made us conduct a systematic review to analyze all relevant studies in Iran through a meta-analysis and report a comprehensive and integrated result. All published studies from September 2000 until September 2016 were considered. Using reliable Latin databases like PubMed, Google Scholar, Google search, Scopus, Science Direct and Persian databases like SID, Irandoc, Iran Mede and Magiran. After quality control, these studies were entered into a meta-analysis by using the random effects model. After evaluating the studies, 11 papers were finally selected and assessed. RESULTS: A total of 2517 participants had been evaluated in these studies, including 1253 cases and 1264 controls. Based on the results of meta-analysis and using random effects model, an overall estimate of OR Helicobacter Pylori with Presence of Myocardial Infarction in Iran was OR=2.53 (CI=1.37-4.67). CONCLUSIONS: The results of this review study show that H. pylori are associated with the incidence of MI so that the odds ratio of MI in the patients with helicobacter pylori is twice greater than that of the people without H. pylori. Future studies are recommended to evaluate the mechanisms associated with relation of H. pylori with MI as well as its association with time.

Efficacy of Polyunsaturated Fatty Acids (PUFA) in the Treatment of Attention Deficit Hyperactivity Disorder.

OBJECTIVE: We aimed to investigate the efficacy of polyunsaturated fatty acids (PUFAs) as an adjuvant treatment in patients with ADHD receiving methylphenidate as well as its side effects. METHOD: This randomized clinical trial was conducted on 40 ADHD patients aged between 6 and 12 years. Both treatment and placebo groups received methylphenidate. Treatment arm also received omega-6 once daily. The Parent ADHD Rating Scale was used to evaluate disease improvement. RESULTS: The Parent ADHD Rating Scale scores of the two groups were similar at baseline. Although total score and scores of three categories decreased significantly in both groups, total score and scores of inattention, hyperactivity, and impulsivity were not significantly different between the groups. CONCLUSION: The results did not support the efficacy of PUFA in the treatment of ADHD, and adding PUFAs to the therapeutic regimen of ADHD is not recommended at the moment.

Study of Echocardiographic Changes After Kidney Transplantation in End-stage Renal Disease Patients.

BACKGROUND: Cardiovascular complications are the leading cause of mortality in end-stage renal disease (ESRD) patients. This study aimed to evaluate the efficacy of kidney transplantation on the cardiovascular status in ESRD patients. METHODS: During 2012 to 2014 and in a cross-sectional study, 181 patients were randomly selected for this study. All patients were followed for periods of 6 and 12 months after kidney transplantation. The patients with ESRD and kidney transplant recipients; the patients with left ventricle ejection fraction<50%, left ventricular hypertrophy, mitral valve regurgitation and tricuspid valve regurgitation were included to study and the patients with kidney transplant rejection, myocardial infarction, high blood pressure with treatment-resistant, high blood pressure and addicted patients were censored. RESULTS: one hundred and eighty-one patients had the mean age of 38.52 (range, 16-69 years) that 54.7% were men and the mean duration of dialysis was 3.74 years. There were significant differences after 6 and 12 months compared with before and also 6 months compared with 12 months from kidney transplantation for all echocardiographic findings. The echocardiographic findings improved after 12 months compared with 6 months and also these times compared with before kidney transplantation. CONCLUSIONS: The results of this study appeared that kidney transplantation had a positive effect on the cardiovascular status of patients with ESRD and improved the cardiac function of these patients.

Adherence to Antihypertensive Medications in Iranian Patients.

Introduction. Appropriate adherence to medication is still a challenging issue for hypertensive patients. We determined adherence to antihypertensive(s) and its associated factors among 280 Iranian patients. Methods. They were recruited consecutively from private and university health centers and pharmacies in four cities. The validated Persian version of the 8-item Morisky Medication Adherence Scale (MMAS-8) was administered to measure adherence. Results. Mean (±SD) overall MMAS-8 score was 5.75 (±1.88). About half of the sample (139 cases, 49.6%) showed low adherence (MMAS-8 score < 6). There was a negative linear association between the MMAS-8 score and systolic BP (r = -0.231, P < 0.001) as well as diastolic BP (r = -0.280, P < 0.001). In linear regression model, overweight/obesity (B = -0.52, P = 0.02), previous history of admission to emergency services due to hypertensive crisis (B = -0.79, P = 0.001), and getting medication directly from drugstore without refill prescription in hand (B = -0.51, P = 0.04) were factors recognized to have statistically significant association with the MMAS-8 score. Conclusion. Antihypertensive adherence was unsatisfactory. We suggest that health care providers pay special attention and make use of the aforementioned findings in their routine visits of hypertensive patients to recognize those who are vulnerable to poor adherence.

Effect of Percutaneous Coronary Intervention on Left Ventricular Diastolic Function in Patients With Coronary Artery Disease.

BACKGROUND: There is considerable disagreement over the effects of percutaneous coronary intervention (PCI) on left ventricular diastolic function that has necessitated the investigation of diastolic indices. The present study was conducted to evaluate left ventricular diastolic function and its indices, three months after performing the PCI procedure in patients with coronary artery disease (CAD). METHODS: In a quasi-experimental clinical trial study (before and after), 51 patients with CAD scheduled for elective PCI were investigated provided that their Ejection Fraction (EF) was > 30%. Before and three months after PCI, echocardiography was carried out to evaluate left ventricular diastolic indices including the E/Ea as the most important criteria for diagnosis of diastolic heart failure (DHF). RESULTS: Based on the E/Ea indices and after PCI, the number of patients with DHF decreased significantly: 40 patients (78.4%) before PCI versus 28 patients (54.9%) after PCI (p<0.05). The Mean and Standard error of deceleration time (DT), isovolumic relaxation time (IVRT), early diastolic mitral annulus velocity; Ea (E'), E/Ea and left ventricular ejection function (LVEF) indices underwent significant changes. In addition, MVA dur/PVA dur, PVs/PVd, and E/Ea indices had changed significantly after PCI in both genders. However, no significant difference was reported for the other indices. CONCLUSION: The E/Ea ratio as an important criterion for diagnosis of DHF was improved after PCI. Improvement of several other diastolic indices was observed after the PCI procedure. It can be concluded that PCI can be an effective treatment modality in patients with left ventricular diastolic indices.

Validation of the Persian Version of the 8-Item Morisky Medication Adherence Scale (MMAS-8) in Iranian Hypertensive Patients.

The reliability and validity of the 8-item Morisky Medication Adherence Scale (MMAS-8) was assessed in a sample of Iranian hypertensive patients. In this multi-center study which lasted from August to October 2014, a total of 200 patients who were suffering from hypertension (HTN) and were taking anti-hypertensive medication(s) were included. The cases were accessed through private and university health centers in the cities of Tehran, Karaj, Kermanshah, and Bafgh in Iran and were interviewed face-to-face by the research team. The validated Persian translation of the MMAS-8 was provided by the owner of this scale. This scale contains 7 questions with "Yes" or "No" response choices and an additional Likert-type question (totally 8 questions). The total score ranges from 0 to 8 with higher scores reflecting better medication adherence. Mean (±SD) overall MMAS-8 score was 5.57 (±1.86). There were 108 (54%), 62 (31%), and 30 (15%) patients in the low, moderate, and high adherence groups. Internal consistency was acceptable with an overall Cronbach's ? coefficient of 0.697 and test-retest reliability showed good reproducibility (r= 0.940); P< 0.001. Overall score of the MMAS-8 was significantly correlated with systolic BP (r= - 0.306) and diastolic BP (r= - 0.279) with P< 0.001 for both BP measurements. The Chi-square test showed a significant relationship between adherence level and BP control (P= 0.016). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the scale were 92.8%, 22.3%, 52.9%, and 76.7%, respectively. The Persian version of the MMAS had acceptable reliability and validity in Iranian hypertensive patients. This scale can be used as a standard and reliable tool in future studies to determine medication adherence of Persian-speaking patients with chronic conditions.

The Value of Pre- and Post-Stenting Fractional Flow Reserve for Predicting Mid-Term Stent Restenosis Following Percutaneous Coronary Intervention (PCI).

Measuring fractional flow reserve (FFR) in percutaneous coronary intervention (PCI) has predictive value for PCI outcome. We decided to examine the utility of pre- and post-stenting FFR as a predictor of 6-month stent restenosis as well as MACE (major adverse cardiac events). Pre- and post-stenting FFR values were measured for 60 PCI patients. Within 6 months after stenting, all patients were followed for assessment of cardiac MACE including myocardial infarction, unstable angina, or positive exercise test. Stent restenosis was also assessed. Cut-off values for pre- and post-stenting FFR measurements were considered respectively as 0.65 and 0.92.Stent restenosis was detected in 4 patients (6.6%). All 4 patients (100%) with restenosis had pre-stenting FFR of < 0.65, while only 26 of 56 patients without restenosis (46.4%) had pre-stenting FFR value of < 0.65 (P= 0.039). Mean pre-stenting FFR in patients with restenosis was significantly lower than in those without restenosis (0.25 ± 0.01 vs. 0.53 ± 0.03, P= 0.022). Although stent restenosis was higher in patients with post-stenting FFR of < 0.92 (2 cases, 9.5%) than in those with FFR value of ≥ 0.92 (2 cases, 5.1%), the difference was not statistically (P= 0.510). Pre-stenting FFR, the use of longer stents, and history of diabetes mellitus can predict stent restenosis, but the value of post-stenting FFR for predicting restenosis was not explicit.

Relationship between family functioning and mental health considering the mediating role of resiliency in type 2 diabetes mellitus patients.

This study was aimed at describing the mediating role of resiliency in the relationship between family functioning and mental health in patients with type 2 diabetes mellitus. This descriptive research was a correlational study. A total of 225 individuals were chosen by simple random sampling technique from type 2 diabetic patients presented to diabetes care centers in Kermanshah in 2014 in Iran. The 12-item General Health Questionnaire (GHQ-12), the Family Assessment Device (FAD) and the Resilience Scale (CD-RISC) were used to collect the required data. The collected data were analyzed using the Pearson's correlation test and To study the mediating role of resiliency in family functioning and mental health interaction, the path analysis method was applied. The results showed that there is a relationship between family functioning, resilience and mental health. Resilience plays a mediating role between family functioning and mental health. Therefore, paying attention to resilience in patients may lead to improving mental health in diabetic patients.