Pubertal status of children with congenital heart disease.

BACKGROUND: CHD influences many aspects of life in affected individuals. Puberty, a major aspect of development, is a concern for patients and families. OBJECTIVES: We investigated pubertal status in children and adolescents with CHD. METHODS: Patients with CHD aged 6-18 were enrolled. Cardiac diagnoses were confirmed using history, examination, and paraclinical tools including echocardiography. An endocrinologist determined pubertal stages, and the second Tanner stages for pubarche (P2), thelarche (B2), and gonadarche (G2) were considered as the pubertal onset. A study with a large sample size on pubertal onset in a normal population was used for comparison. RESULTS: Totally, 451 patients (228 girls and 223 boys) at a median (10th-90th percentile) age of 10.79 (8.02-14.28) years for the girls and 10.72 (8.05-14.03) years for the boys were enrolled. The median (10th-90th percentile) ages at B2 and P2 in the girls with CHD were 10.77 (9.55-12.68) and 10.53 (9.39-12.28) years, respectively, which were higher than the median ages of 9.74 (8.23-11.94) and 10.49 (8.86-12.17) years in the normal girls.The median (10th-90th percentile) ages at G2 and P2 in the boys with CHD were 11.04 (8.85-13.23) and 11.88 (9.78-13.46) years, correspondingly, which were higher than the median ages of 9.01 (6.00-11.84) and 10.34 (6.84-13.10) years in the normal boys. CONCLUSIONS: Pubertal onset could be delayed in children with CHD when compared with the normal population.

Children's behavioral pain reactions during local anesthetic injection using cotton-roll vibration method compared with routine topical anesthesia: A randomized controlled trial.

BACKGROUND: Topical anesthesia has been widely advocated as an important component of atraumatic administration of intraoral local anesthesia. The aim of this study was to use direct observation of children's behavioral pain reactions during local anesthetic injection using cotton-roll vibration method compared with routine topical anesthesia. MATERIALS AND METHODS: Forty-eight children participated in this randomized controlled clinical trial. They received two separate inferior alveolar nerve block or primary maxillary molar infiltration injections on contralateral sides of the jaws by both cotton-roll vibration (a combination of topical anesthesia gel, cotton roll, and vibration for physical distraction) and control (routine topical anesthesia) methods. Behavioral pain reactions of children were measured according to the author-developed face, head, foot, hand, trunk, and cry (FHFHTC) scale, resulting in total scores between 0 and 18. RESULTS: The total scores on the FHFHTC scale ranged between 0-5 and 0-10 in the cotton-roll vibration and control methods, respectively. The mean ± standard deviation values of total scores on FHFHTC scale were lower in the cotton-roll vibration method (1.21 ± 1.38) than in control method (2.44 ± 2.18), and this was statistically significant (P < 0.001). CONCLUSION: It may be concluded that the cotton-roll vibration method can be more helpful than the routine topical anesthesia in reducing behavioral pain reactions in children during local anesthesia administration.

Discriminative Power of EuroSCORE in Predicting Morbidity and Prolonged Hospital Stay in an Iranian Sample Population.

BACKGROUND: The EuroSCORE is a simple and rigorous risk stratification model and is, thus, commonly used in predicting the early and late outcomes of cardiac surgery across the world. We aimed to assess the discriminative power of the EuroSCORE model to predict postoperative morbidity and total prolonged length of stay in hospital (LOS) and Intensive Care Unit (ICU) stay in an Iranian group of cardiac surgical population. METHODS: In a prospective study, the additive EuroSCORE model was applied to 570 patients undergoing isolated coronary artery bypass grafting (CABG) at Tehran Heart Center. The discrimination power of the EuroSCORE model was tested by the area under the receiver operating characteristic (ROC) curve and the calibration by comparing the observed and predicted outcomes across the risk spectrum assessed using the Hosmer-Lemeshow goodness-of-fit test. RESULTS: The mean age was 59.03 ± 0.73 years and 429 out of the 570 (75.3%) patients were men. The overall morbidity rate was 47.5%. The observed morbidity in the high-risk patients (EuroSCORE > 6) was significantly greater than that in the low-risk patients (EuroSCORE ≤ 6). Furthermore, 51.2% of the patients had LOS beyond 14 days. Both prolonged LOS (> 14 days) and prolonged ICU stay (> 72 hours) were more prevalent in the high-risk group than in the low-risk group. The discriminative power of the EuroSCORE in predicting morbidity, prolonged LOS, and ICU stay was poor with an area under the ROC curve of 0.617, 0.598, and 0.581, respectively. However, this risk score showed good calibrations for morbidity (p value = 0.119), prolonged LOS (p value = 0.958), and prolonged ICU stay (p value = 0.620). CONCLUSION: The EuroSCORE provided inappropriate discrimination in predicting early morbidity and prolonged LOS and ICU stay in our study population. Creating a revised model may enable us to accurately predict outcomes in Iranian CABG patients.

Normal values for longitudinal tissue velocity and strain rate imaging in individual segments of the left and right ventricles of healthy adult hearts.

OBJECTIVES: To quantify the normal peak mean systolic velocities and strain rate parameters in the left ventricle (LV) and right ventricle (RV) and define their regional differences in normal adult hearts. METHODS: Sixty-nine healthy volunteers (42% male; mean age ± SD, 30.03 ± 5.35 years) underwent color tissue Doppler and strain rate imaging. The first and second peak mean systolic velocities, peak strain, and strain rate in the systolic ejection phase were determined for 16 LV segments, the apex (17th segment), and 3 RV free wall segments. RESULTS: The first peak mean systolic velocity was measurable in less than 50% of segments in the inferior and septal (-posterior) walls and RV free wall and in greater than 70% of segments of the other LV walls. The first and second peak mean systolic velocities of all LV walls and the RV free wall decreased significantly from the basal to apical region (P < .001).The strain and strain rate in the lateral and anterior walls decreased significantly from base to apex, whereas the anteroseptal and posterior walls were homogeneous. The strain rate in the inferior wall increased remarkably from base to apex, whereas it decreased significantly from the mid level to the apex. The strain in the RV was homogeneous, whereas the strain rate decreased significantly from the mid level to the apex. The apex (17th segment) showed the lowest value for each of the study parameters. CONCLUSIONS: Longitudinal velocities decreased from base to apex, whereas deformation measurements did not show uniform patterns in LV walls and the RV free wall. In most cases, there are 1 peak systolic velocity in the inferior and septal (-posterior) walls and 2 peak systolic velocities in the other 4 LV walls.

Microbial microleakage assessment of a new hydrophilic fissure sealant: a laboratory study.

PURPOSE: The purpose of this study was to compare microbial leakage of a new hydrophilic sealant with that of a conventional hydrophobic resin-based sealant. METHODS: One hundred extracted, caries-free, human maxillary premolars were randomly divided into five groups. Those in Groups 1, 2, and 3 had dry, wet, and artificial saliva-contaminated occlusal surfaces, respectively, and were sealed with a hydrophilic sealant, while those in Groups 4 and 5 had dry and wet occlusal surfaces, respectively, and were sealed with a hydrophobic sealant. A newly designed microbial penetration method utilizing Streptococcus mutans as an indicator was tested for leakage assessment. Data were analyzed using SPSS 15.0 software, and the significance level was set at α=0.05. RESULTS: The log rank test indicated a statistically significant difference in leakage rates among the five groups. Mantel-Cox log-rank test findings showed that Group 3 had the highest leakage rate, with Groups 2 and 4 having the lowest. There was no statistically significant difference in leakage rate between Groups 2 and 4. CONCLUSIONS: With respect to the limitations of an in vitro study, our findings suggest that hydrophilic sealants are an acceptable alternative to hydrophobic sealants.

On-label and off-label use of drug-eluting stents: comparison of short- and long-term outcomes.

In this retrospective study, we compared the in-hospital and long-term outcomes of the on-label and off-label uses of drug-eluting stents.From April 2003 through June 2007, 1,538 patients underwent percutaneous coronary intervention with a drug-eluting stent (sirolimus or paclitaxel) at Tehran Heart Center. Off-label implantation of the drug-eluting stent was as implemented on the basis of specific clinical and procedural characteristics set forth in our text. There were 708 patients in the on-label group and 830 in the off-label group.Baseline characteristics were not significantly different between the groups. Histories of non-ST-segment-elevation myocardial infarction, percutaneous coronary intervention, and coronary artery bypass grafting were more prevalent in the off-label group. Both groups had similar procedural and in-hospital complications. The follow-up rate at 1 year was 93.1% in the on-label group and 93.3% in the off-label group. During that period, the occurrence of major adverse cardiac events was not significantly different between the groups. After 1 year between the respective on- and off-label uses of the sirolimus-eluting and paclitaxel-eluting stents, and after adjustment for diabetes mellitus, myocardial infarction, percutaneous coronary intervention, and coronary artery bypass grafting, there was no remarkable difference in the occurrence of major adverse cardiac events (hazard ratio, 0.688; 95% confidence interval, 0.365-1.295; P=0.2463) or target-vessel revascularization (hazard ratio, 0.69; 95% confidence interval, 0.291-1.636; P=0.3993).We found that off-label use of drug-eluting stents was safe after 1 year and that such use was not associated with increased in-hospital myocardial infarction or death.

Family history of the cancer on the survival of the patients with gastrointestinal cancer in northern Iran, using frailty models.

BACKGROUND: Gastrointestinal (GI) tract cancer is one of the common causes of the mortality due to cancer in most developing countries such as Iran. The digestive tract is the major organ involved in the cancer. The northern part of the country, surrounded the Caspian Sea coast, is well known and the region with highest regional incidence of the GI tract cancer. In this paper our aim is to study the most common risk factors affecting the survival of the patients suffering from GI tract cancer using parametric models with frailty. METHODS: This research was a prospective study. Information of 484 cases with GI cancer was collected from Babol Cancer Registration Center during 1990-1991. The risk factors we studied are age, sex, family history of cancer, marital status, smoking status, occupation, race, medication status, education, residence (urban, rural), type of cancer, migration status (indigenous, non-native). The studied cases were followed up until 2006 for 15 years. Hazard ratio was used to interpret the death risk. The effect of the factors in the study on the patients survival are studied under a family of parametric models including Weibull, Exponential, Log-normal, and the Log-logistic model. The models are fitted using with and without frailty. The Akaike information criterion (AIC) was considered to compare between competing models. RESULTS: Out of 484 patients in the study, 321 (66.3%) were males and 163 (33.7%) were females. The average age of the patient at the time of the diagnosis was 59 yr and 55 yr for the males and females respectively. Furthermore, 359 (74.2%) patients suffered from esophageal, 110 (22.7%) patients recognized with gastric, and 15 (3.1%) patients with colon cancer. Survival rates after 1, 3, and 5 years of the diagnosis were 24%, 16%, and 15%, respectively. We found that the family history of the cancer is a significant factor on the death risk under all statistical models in the study. The comparison of AIC using the Cox and parametric models showed that the overall fitting was improved under parametric models (with and without frailty). Among parametric models, we found better performance for the log-logistic model with gamma frailty than the others. Using this model, gender and the family history of the cancer were found as significant predictors. CONCLUSIONS: Results suggested that the early preventative care for patients with family history of the cancer may decrease the risk of the death in the patients with GI cancer. The gender appeared to be an important factor as well so that men experiencing lower risk of death than the women in the study. Since the proportionality assumption of the Cox model was not held (p = 0.0014), the Cox regression model was not an appropriate choice for analysing our data.

Recuperação anestésica e efeitos hemodinâmicos da infusão contínua de tiopental versus halotano na manutenção da anestesia em pacientes submetidos à cirurgia ocular / Anesthetic recovery and hemodynamic effects of continuous thiopental infusion versus halothane for maintenance anesthesia in patients undergoing ocular surgery

PURPOSE: To investigate anesthesia recovery and hemodynamic status in patients under thiopental infusion or halothane maintenance anesthesia undergoing ocular surgery. METHODS: Fifty-nine voluntary patients undergoing ocular surgery in Farabi hospital were allocated to one of two maintenance anesthesia groups: inhaled halothane, 0.8 to 1 per cent, (group I, n=37) and thiopental infusion, 10 to 12 mg/kg/hour, (group II, n=22). Hemodynamic parameters were recorded at the time of patient entrance to the operation room and at the 1, 2, 5, 10, 15, 20, 25, 30, 35, and 40 minutes following anesthesia. Anesthesia recovery variables were also compared between the two groups. RESULTS: In group I, arterial blood pressure at 10 to 40 min and heart rate at 1 and 25 min after the administration of anesthetics were significantly lower when compared with group II (W ²= 25.10, p= 0.005). Arterial oxygen saturation was similar in the two groups over the whole points of time. The time intervals between the end of surgery and beginning of the first body movements and respiratory efforts were significantly longer in group received halothane (p<0.001). CONCLUSION: Continuous infusion of thiopental can be applied effectively and safely for maintenance of anesthesia. In comparison with halothane, it is associated with lower changes of intraoperative hemodynamics and faster anesthesia recovery.

OBJETIVO: Investigar a recuperação anestésica e as condições hemodinâmicas em pacientes submetidos a infusão de tiopental ou hatotano na manutenção da anestesia na cirurgia ocular. MÉTODOS: Cinquenta e nove voluntários submetidos a cirurgia ocular no Hospital Farabi foram distribuídos em dois grupos de manutenção anestésica: Grupo I (n=37) inalação halotano, 0,8 a 1 por cento e Grupo II (n=22) infusão de tiopental, 10 a 12 mg/kg/hora. Foram registrados parâmetros hemodinâmicos da entrada dos pacientes na sala operatória até 1, 2, 5, 10, 15, 20, 25, 30, 35 e 40 minutos durante a anestesia. Variáveis de recuperação anestésica foram também comparados entre ambos os grupos. RESULTADOS: No Grupo I a pressão arterial nos 10 a 40 minutos e avaliação cardíaca em um e 25 minutos após a administração dos anestésicos foram significantes mais baixos comparados com o Grupo II (W²=25.10, p=0.005). A saturação de oxigênio foi similar nos dois grupos durante todos procedimentos. Os intervalos de tempo entre o final da cirurgia e início dos primeiros movimentos e a respiração foram significativamente mais prolongados no grupo que recebeu halotoano (p<0.001). CONCLUSÃO: A infusão continua de tiopental pode ser aplicado efetivamente e com segurança na manutenção da anestesia. Em comparação com halotano as mudanças hemodinâmicas foram menores e a recuperação anestésica mais rápida.

Anesthetic recovery and hemodynamic effects of continuous thiopental infusion versus halothane for maintenance anesthesia in patients undergoing ocular surgery.

PURPOSE: To investigate anesthesia recovery and hemodynamic status in patients under thiopental infusion or halothane maintenance anesthesia undergoing ocular surgery. METHODS: Fifty-nine voluntary patients undergoing ocular surgery in Farabi hospital were allocated to one of two maintenance anesthesia groups: inhaled halothane, 0.8 to 1 per cent, (group I, n=37) and thiopental infusion, 10 to 12 mg/kg/hour, (group II, n=22). Hemodynamic parameters were recorded at the time of patient entrance to the operation room and at the 1, 2, 5, 10, 15, 20, 25, 30, 35, and 40 minutes following anesthesia. Anesthesia recovery variables were also compared between the two groups. RESULTS: In group I, arterial blood pressure at 10 to 40 min and heart rate at 1 and 25 min after the administration of anesthetics were significantly lower when compared with group II (W ²= 25.10, p= 0.005). Arterial oxygen saturation was similar in the two groups over the whole points of time. The time intervals between the end of surgery and beginning of the first body movements and respiratory efforts were significantly longer in group received halothane (p<0.001). CONCLUSION: Continuous infusion of thiopental can be applied effectively and safely for maintenance of anesthesia. In comparison with halothane, it is associated with lower changes of intraoperative hemodynamics and faster anesthesia recovery.

Success rate, procedural complications and clinical outcomes of coronary interventions in octogenarians: a case-control study.

BACKGROUND: Clinical trials of revascularization have routinely under-enrolled elderly subjects. Thus, symptom relief and improved survival might not apply to elderly patients, in whom the risk of mortality and disability from revascularization procedures seems to be high and co-morbidity is more prevalent. The present case control study was performed to draw a comparison in terms of the procedural success, procedural and in-hospital complications, and major adverse cardiac events (MACE) in a one-year follow-up of octogenarians (age ≥ 80 years) with a selected matched younger control group in the Tehran Heart Center Angioplasty Registry. METHODS: According to the Tehran Heart Center Interventional Registry of 9, 250 patients with a minimum follow-up period of one year between April 1993 and February 2010, 157 percutaneous coronary intervention (PCI) procedures were performed in 112 octogenarians. Additionally, 336 younger patients (459 PCI procedures) were selected from the database as the propensity-score matched controls. RESULTS: There were 147 (93.6%) and 441 (96.1%) successful PCI procedures in the elderly group and control group, respectively (p value = 0.204). Procedural complications were seen in 5 (3.2%) of the elderly group and 16 (3.5%) of the control group (p value = 0.858). Totally, 7 (6.3%) in-hospital complications occurred in the elderly group and 22 (6.8%) in the control group (p value = 0.866). One-year MACE was seen in 9 (9.1%) of the elderly and 18 (5.8%) of the control group (p value = 0.26). CONCLUSION: Procedural success and complications, in-hospital complications, and one-year MACE were not significantly different between our two study groups. Therefore, age alone should not be used as the sole criterion when considering revascularization procedures. Furthermore, PCI should not be refused in octogenarians if indicated.

Determinants of social activity and work status after coronary bypass surgery.

Despite the occurrence of adverse events after coronary artery bypass, the degree of social integration can be increased following this operation. This study addresses the predictive power of risk factors as well as clinical status in determining long-term social functioning and rate of return to work following isolated bypass surgery. A prospective cohort study was conducted in 178 patients who underwent isolated bypass surgery between 2004 and 2007. Information on work status and social relationships was obtained 1-2 days before surgery and during a mean follow-up of 29.4 ± 1.1 months. The proportion of patients who engaged in social activities at 2, 3, and 4 years of follow-up was 0.3, 0.6, and just over 0.8, respectively, and the proportion who had returned to work at these time points was 0.2, 0.45, and 0.63, respectively. Social activity after surgery was less in patients with left ventricular dysfunction, cerebrovascular disease, and higher New York Heart Association functional class. The rate of return to work was lower for men and for patients with left ventricular dysfunction, diabetes, cerebrovascular disease, and those who were hospitalized for more than 14 days.

Role of surgeon in length of stay in ICU after cardiac bypass surgery.

BACKGROUND: We presumed that the surgeon himself has an impact on the results after coronary artery bypass grafting (CABG) as there is no unique protocol for the discharge of post-operative cardiac patients at our institution. Therefore, we examined whether the surgeon himself has an impact on the intensive care unit (ICU) stay of isolated CABG patients. METHODS: We prospectively studied a total of 570 consecutive patients undergoing elective CABG. Length of stay in the ICU was defined as the number of days in the ICU unit post-operatively. Seven operating surgeons were classified in 3 categories on the basis of the mean hospital stay of their patients (1, 2 and 3 if the mean total patients' stay in hospital was <8 days, between 8 to 10 days, and longer than 10 days; respectively). Using a multivariable regression model, we determined the independent predictors of length of stay in the ICU (> 48 hours) and examined the role of surgeon in this regard. RESULTS: Incidence of post-operative arrhythmia and length of ICU stay were higher in the patients of surgeon category 3 than those of surgeon categories 1 and 2. Surgeon category 3 also operated on patients with higher EuroSCOREs than did surgeon categories 1 and 2. With the aid of a multivariable stepwise analysis, three variables were identified as independent predictors significantly associated with ICU length of stay: age, history of cerebrovascular accident, and surgeon category. CONCLUSION: Surgeon category may independently predict a prolonged length of stay in the ICU. We suggest that a unique discharge protocol for post-CABG patients be considered to restrict the role of surgeon in the ICU stay of these patients.

Measurement of Atrial Septal Defect Size: A Comparative Study between Transesophageal Echocardiography and Balloon Occlusive Diameter Method.

BACKGROUND: Transcatheter closure of atrial septal defect secundum (ASD-II) has become an alternative method for surgery. We sought to compare the two-dimensional transesophageal echocardiography (TEE) method for measuring atrial septal defect with balloon occlusive diameter (BOD) in transcatheter ASD-II closure. METHODS: A total of 39 patients (71.1% female, mean age: 35.31 ± 15.37 years) who underwent successful transcatheter closure of ASD-II between November 2005 and July 2008 were enrolled in this study. Transthoracic echocardiography (TTE) and TEE were performed to select suitable cases for device closure and measure the defect size before the procedure, and BOD measurement was performed during catheterization via TEE. The final size of the selected device was usually either equal to or 1 - 2 mm larger than the BOD of the defect. RESULTS: The mean defect size obtained by TEE and BOD was 18.50 ± 5.08 mm and 22.86 ± 4.76 mm, respectively. The mean difference between the values of ASD size obtained by TEE and BOD was 4.36 ± 2.93 mm. In comparison with BOD, TEE underestimated the defect size in 94.9%, but TEE value being equal to BOD was observed in 5.1%. There was a good linear correlation between the two measurements: BOD = 0.773 × ASD size by TEE+8.562; r2 = 67.9.1%. A negative correlation was found between TEE sizing and the difference between BOD and TEE values (r = -0.394, p value = 0.013). CONCLUSION: In this study, BOD was larger than ASD size obtained by two-dimensional TEE. However, TEE maximal defect sizing correlates with BOD and may provide credible information in device size selection for transcatheter ASD closure.

Tricuspid regurgitation improvement in relation to the amount of pulmonary artery pressure reduction.

BACKGROUND: Given the common concomitance of tricuspid regurgitation (TR) with significant mitral stenosis, we aimed at exploring the relation between TR severity and pulmonary artery hypertension (PAH) in patients who underwent mitral balloon valvotomy (MBV). METHODS: We analyzed the echocardiography data of 133 consecutive patients (82.0% female, mean age 44.68 ± 12.56 years) with different degrees of TR severity that underwent MBV between April 2006 and March 2008. The pulmonary artery systolic pressure (PAPs) > 35 mmHg was considered as PAH. RESULTS: Before MBV, 36.20% of the patients had moderate to severe TR, 92.5% PAH, and 18.0% right ventricular (RV) dilation (RV dimension ≥ 33 mm). After MBV, TR severity improved in 41.4%, worsened in 8.3%, and did not change in 50.4%. Before and after MBV, PAPs was significantly correlated with TR severity, and the mean PAPs change in patients with improved TR was significantly more than that of patients without TR improvement (p value = 0.042). Tricuspid regurgitation severity and mean PAPs (from 52.83 ± 18.82 to 35.89 ± 9.39 mmHg) decreased significantly after MBV (both p values < 0.001); this reduction was significantly correlated to the amount of PAPs decrease. A cut-off point of ≥ 19 mmHg reduction in PAPs had a specificity of 71.79% and sensitivity of 52.73% to show TR severity improvement (by Receiver-Operative-Characteristics analysis). The mean of RV dimension decreased from 28.94 ± 5.43 to 27.95 ± 4.67 mm (p value < 0.001). In contrast to patients with RV dilation, TR reduced significantly in patients without RV dilation (p value < 0.001). CONCLUSION: Improvement in TR severity was directly correlated with the amount of PAPs reduction after MBV. More studies are needed to better define a cut-off value for PAPs reduction related to TR severity improvement.

Effect of gender and type 2 diabetes mellitus on heart rate recovery in patients with coronary artery disease after cardiac rehabilitation.

INTRODUCTION: The purpose of this study was to clarify whether type 2 diabetic patients with coronary disease are subject to similar benefits in heart rate recovery (HRR) as non-diabetic counterpatrs after cardiac rehabilitation, assessing men and women subjects separately. MATERIAL AND METHODS: The data used for this analysis were from an eight-week, phase-II cardiac rehabilitation including 284 patients with ischaemic heart disease who were managed at Tehran Heart Centre between July 2004 and January 2006. The heart rate parameters were compared between diabetic and non-diabetic patients before and after cardiac rehabilitation. Diabetic and non-diabetic patients had similar age and left ventricular ejection fraction. RESULTS: Among men, the non-diabetic patients achieved a greater improvement in peak heart rate and heart rate recovery (HRR). Additionally, lower resting heart rate was found in nondiabetic men after rehabilitation. In the women >or= 50 years old, there was no significant difference between diabetic and non-diabetic. The non-diabetic women < 50 years old showed significantly higher peak heart rate and HRR compared with diabetic women. CONCLUSIONS: These results indicate that the benefit of cardiac rehabilitation in HRR is significantly lower in type 2 diabetic men. Improvement of HRR is not associated with diabetic status in women >/= 50 years old. The response to cardiac rehabilitation in women may appear to be influenced more by age at menopause rather than diabetes mellitus.

Potential link of microalbuminuria with metabolic syndrome in patients undergoing coronary angiography.

BACKGROUND AND AIMS: Microalbuminuria and metabolic syndrome (MetS) are both risk factors for cardiovascular disease.We sought to examine the relationship between microalbuminuria and MetS in patients undergoing coronary angiography. METHODS: From August 2007 to March 2008, we studied 531 patients (354 men, 66.7%) undergoing elective coronary angiography due to symptoms related to coronary artery disease. MetS was defined based on the adapted Adult Treatment Panel III (ATP-III A) proposed by the American Heart Association/National Heart, Lung, and Blood Institute, and microalbuminuria was defined as urinary albumin-to-creatinine ratio (ACR) between 30 mg/g and 300 mg/g. RESULTS: MetS was detected in 39.7% of participants, 62.1% of women and 28.5% of men. Microalbuminuria was detected in 109 (20.5%) of participants, in 41 (12.8%) of non-MetS individuals, and in 68 (32.2%) of the MetS individuals. There was a significant positive association between the number of components of MetS and the corresponding prevalence of microalbuminuria (p<0.001). In patients with MetS compared to those without any component of MetS, multivariable-adjusted OR (95% CI) of microalbuminuria was 2.71 (1.71-4.29). Multiple logistic regression analyses revealed higher fasting blood glucose and lower HDL-cholesterol are independently associated with microalbuminuria. CONCLUSIONS: Our study demonstrated that microalbuminuria is strongly associated with MetS and that among the components of MetS high fasting blood glucose had the largest power to determine the risk of microalbuminuria in Iranian patients undergoing coronary angiography.

Effect of opium on glucose metabolism and lipid profiles in rats with streptozotocin-induced diabetes.

BACKGROUND: This experimental study was performed to determine the impact of opium use on serum lipid profile and glucose metabolism in rats with streptozotocin-induced diabetes. MATERIAL AND METHODS: To determine the effect of opium, 20 male rats were divided into control (n = 10) and opium-treated (n = 10) groups. After diabetes induction, the animals were investigated for daily glucose measurements for 35 days. Serum lipid profile and haemoglobin A1c (HbA(1c)) were assayed at the baseline (before induction of diabetes) and at 35-day follow-up. RESULTS: The glycaemia levels in the rats treated with opium were similar to the levels measured in the control rats (544.8 +/- 62.2 mg/dl v. 524.6 +/- 50.0 mg/dl, P = 0.434). In addition, there was no difference between the opium-treated rats and control rats in HbA(1c) (6.5 +/- 0.5% v. 6.6 +/- 0.2%, P = 0.714). Compared to the control rats, the serum total cholesterol, high density lipoprotein (HDL), triglyceride and lipoprotein (a) in the test animals were similar. CONCLUSION: Opium use has no significant effect on glucose metabolism and serum lipid profile in rats with induced diabetes.

Evaluation of longitudinal tissue velocity and deformation imaging in akinetic nonviable inferobasal segments of left ventricular myocardium by dobutamine stress echocardiography.

AIM: To study tissue velocity imaging (TVI) and strain rate imaging (SRI) indices in akinetic nonviable and normal left ventricular (LV) inferobasal segment and effect of dobutamine infusion on these indices in nonviable segments. METHODS: The study population consisted of two groups: 25 patients (mean age 60.75 +/- 8.69 years) with left ventricular akinetic inferobasal nonviable segment determined by dobutamine stress echocardiography (DSE) and 14 normal coronaries (mean age 56.67 +/- 11.90 years) with normal echocardiography as control group. The following TVI and SRI parameters were measured in patient and control group: ejection phase velocity (Sm [cm/sec]), peak systolic strain (ST [%]), and strain rate (SR [per second])). RESULTS: Ejection fraction was significantly lower in patient group (29.40%+/- 5.46% vs. 55.00%+/- 3.39%; P < 0.001). Several differences were observed in patients with nonviable inferobasal segments compared to control group: Sm was reduced (3.58 +/- 1.08 cm/sec vs. 5.56 +/- 1.28 cm/sec; P < 0.001); SR and ST were significantly decreased (-0.39 +/- 0.20/second vs. -1.44 +/- 0.64/second, and -3.86%+/- 4.12% vs. -17.64%+/- 7.44%, respectively; P < 0.001 in both). The range of SR for nonviable segments (-0.04 to -0.77/second) did not overlap with that of the normal segments (-0.80 to -3.0/second). This range for Sm and ST overlapped with those of the normal segments. CONCLUSION: All TVI and SRI parameters are reduced in akinetic nonviable inferobasal compared with normal segments. According to findings of this study, resting strain rate has a potential to discriminate nonviable inferobasal from normal segments.

Relationship between myocardial viability and coronary run-off in jeopardized myocardium.

OBJECTIVE: The aim of this study was to evaluate the relationship between coronary run-off and myocardial viability in jeopardized regions. METHOD: We studied 50 patients (40 male, mean age: 55.63 +/- 10.54 years) with coronary artery stenosis >70% and ejection fraction <40% referred for viability study via dobutamine stress echocardiography. The relationship between coronary run-off and viability was evaluated. Good run-off demonstrates good or moderate and no run-off means poor or no run-off. RESULTS: In the apical region, 33% of the segments with good antegrade run-off were viable and 67% nonviable. Also, 72% of the segments with no run-off were nonviable and 28% viable. In the midportion region, 70% of the segments with good antegrade run-off were viable and 30% nonviable; 50% of the segments with no run-off were nonviable and 50% viable. In the basal region, 85% of the segments with good antegrade run-off were viable and 15% nonviable; 19% of the segments with no run-off were nonviable and 81% viable. The proportion of the nonviable segments increased significantly from the basal to apical regions either with good (p < 0.001) or no run-off (p = 0.004). From 239 viable segments, 58.6% had antegrade, 15.4% retrograde, and 25.5% no run-off. Of 181 nonviable segments, 44% had antegrade, 34% retrograde, and 34.8% no run-off. CONCLUSION: There was more susceptibility to nonviability in the apical regions despite good run-off, while the basal segments showed more viability in spite of having no run-off. The findings may be helpful for selecting patients with coronary artery disease and left ventricular systolic dysfunction that benefit from revascularization.

Reliability of World Health Organization's Quality of Life-BREF versus Short Form 36 Health Survey questionnaires for assessment of quality of life in patients with coronary artery disease.

OBJECTIVE: The objective of this study was to ascertain the reliability and predictive power of the World Health Organization's Quality of Life Questionnaire (WHOQOL-BREF) and Short Form 36 Health Survey questionnaire (SF-36) in coronary artery disease patients. METHODS: Between May and September 2006, patients with coronary artery disease hospitalized in Tehran Heart Center were divided randomly into two groups of 268 patients (for assessment of QOL with the SF-36 questionnaire) and 275 patients (for assessment of QOL with the WHOQOL-BREF questionnaire). Cronbach's alpha coefficient was used to test reliability of the two questionnaires and a value of 0.7 or higher was considered satisfactory. RESULTS: For the SF-36 and the WHOQOL-BREF questionnaires, Cronbach's alpha was 0.825 and 0.701, respectively, both of which exceeded 0.7. In SF-36 questionnaire, with the deletion of four items in the scales of mental health (1), role limitation - physical (16), and bodily pain (19), Cronbach's alpha was significantly increased. Also, in the BREF questionnaire, deletion of each of items 3, 4, 8, 9, 22, and/or 26 led to an increase in Cronbach's alpha. CONCLUSION: Although the WHOQOL-BREF questionnaire is a reliable tool for the evaluation of QOL in coronary artery disease patients, its reliability was significantly lower than that of the SF-36 questionnaire and thus it can be less applicable than SF-36 for this purpose.