Correlation of polypill and blood pressure level: A systematic review of clinical trials.

BACKGROUND: High blood pressure (BP) is considered as the most important risk factor for cardiovascular disease (CVD). The main aim of this study was to investigate the effect of polypill on BP by reviewing clinical trial studies. MATERIALS AND METHODS: In this systematic review study, online databases such as PubMed, Scopus, and Web of Science databases with no limited time were systematically searched until July 10, 2020. Clinical trial studies published in English that examined the effect of polypill on BP were included. BP was the main outcome investigated. RESULTS: Eleven original articles with a population of 17,042 people were reviewed. The polypill drugs studied in this study had different compounds. Compared to conventional care, treatment with polypill compounds has a positive and significant effect on lowering BP (P < 0.05). CONCLUSION: Our finding confirmed that polypills could reduce BP in patients. It seems that changing routine care and replacing it with a polypill strategy could facilitate the achievement of BP control goals.

The impact of physical activity and group discussion on happiness in postmenopausal women: A randomized trial.

Menopause is a physiological phenomenon, which in some cases may lead to physical and psychological complications. These complications degrade happiness and quality of life. The authors conducted the current study to determine the impact of physical activity (PA) and group discussion (GD) on happiness in postmenopausal women. For this clinical trial with a factorial design, 160 eligible menopausal women in the 45-55 age range were randomly assigned to four groups of PA, GD and GD+PA), and control group. The four groups completed the Oxford Happiness Questionnaire. The happiness score in the PA, GD and GD+PA groups was significantly higher immediately and two months after the intervention than that of the control group. PA and GD can increase happiness in postmenopausal women who reside in Kermanshah-Iran. Using PA and GD in postmenopausal women care programs is recommended.

Which symptoms are the psychopathological core affecting the manifestation of pseudo-cardiac symptoms and poor sleep quality in young adults? Symptoms of personality disorders versus clinical disorders.

Background: Diagnosing and identifying the psychological origin of pseudo-cardiac symptoms and comorbid conditions such as poor sleep quality is very difficult due to its extensive and complex nature. The present study was conducted to determine the contribution of symptoms of personality disorders (PDs) and clinical disorders (CDs; i.e., psychological symptoms measured using the Symptom Checklist-90) to the manifestation of pseudo-cardiac symptoms and poor sleep quality. Methods: Subjects in this cross-sectional study were 953 (64.3% female; 28.8 ± 6.2 years) community samples in the west of Iran who were selected by convenience sampling. After applying the inclusion criteria, data were collected using the Symptom Checklist-90 (SCL-90-R), the Personality Diagnostic Questionnaire (PDQ-4), and the Scale for Pseudo-Cardiac Symptoms and Poor Sleep Quality (SPSQ). Pearson correlations, factor analytical techniques, and hierarchical regression models were used to examine associations between symptoms of PDs/CDs and outcome factors. Results: Factor analytical techniques confirmed both the integrated structure of symptoms of PDs and CDs. Both pseudo-cardiac symptoms and poor sleep quality were more strongly associated with symptoms of CDs than PDs. The results of the hierarchical analysis show that the CDs factor alone could explain the total variance of both pseudo-cardiac symptoms (change in R2 = 0.215 vs. 0.009; p < 0.001) and poor sleep quality (change in R2 = 0.221 vs. 0.001; p < 0.001). Conclusion: The different capabilities of two unique factors for the symptoms of PDs and CDs were confirmed by factor analytical methods and regression analysis techniques. Although each of the symptoms of PDs and CDs independently contributes to the manifestation of pseudo-cardiac symptoms and poor sleep quality, the CDs factor is the psychopathological core.

Evaluation of Crocin Effect on Contrast-Induced Nephropathy Following Coronary Angiography or Angioplasty: A Randomized Controlled Trial.

Contrast-induced nephropathy (CIN) is the third cause of hospital-acquired acute kidney injury. The CIN prophylactic strategies adopted to date, although not highly efficient, are mostly based on antioxidant activity and hydration therapy. This study was designed and conducted to evaluate crocin's efficacy in the prevention of CIN in chronic kidney disease (CKD) patients undergoing coronary angiography/angioplasty. In this randomized clinical trial, a total of 110 eligible CKD stage 3 patients requiring contrast agent administration for coronary angiography/angioplasty were enrolled and randomly assigned to either crocin (n = 57) or control (n = 53) group. The patients in both groups received standard hydration therapy; nevertheless, in the crocin group, the patients were also orally administered three consecutive oral doses of 30 mg crocin tablets 1 day before up to 1 day after contrast media (CM) exposure. The primary endpoint was CIN incidence defined as an increase in serum creatinine (SrCr) level by ≥ 0.3 mg/dL or any change in urinary neutrophil gelatinase-associated lipocalin (NGAL) from the baseline within 48 hours of CM exposure. During 4 months, 130 patients were recruited. The mean age of the patients was 65.62 ± 9.05 years, and the majority of them were male (64.54%). The SrCr in the crocin group did not significantly increase within 48 hours of angiography/angioplasty. The changes in the urinary NGAL level were not significant in both groups. The CIN incidence was significantly lower in the crocin group than in the control group (1.75% and 13.2%; P = 0.028). Crocin administration plays an important nephron-protective role in the prevention of CIN.

Reperfusion Therapy and Predictors of 30-Day Mortality after ST-Segment Elevation Myocardial Infarction in a University Medical Center in Western Iran.

BACKGROUND: Considerable variability in survival rate after ST-segment elevation myocardial infarction (STEMI) is present and outcomes remain suboptimal, especially in low- and middle-income contraries. This study aimed to investigate predictors of 30- day mortality after STEMI, including reperfusion therapy, in a tertiary hospital in western Iran. METHODS: In this registry-based cohort study (2016-2019), we investigated reperfusion therapies - primary percutaneous coronary intervention (PPCI), pharmaco-invasive (thrombolysis followed by angiography/percutaneous coronary intervention), and thrombolysis alone - used in Imam-Ali hospital, the only hospital with a PPCI capability in the Kermanshah Province. We estimated hazard ratios (HRs) and 95% confidence intervals (CIs), using Cox proportional-hazard models, to investigate the potential predictors of 30-day mortality including reperfusion therapy, admission types (direct admission/referral from non-PPCI-capable hospitals), demographic variables, coronary risk factors, vital signs on admission, medical history, and laboratory tests. RESULTS: Data of 2428 STEMI patients (mean age: 60.73; 22.9% female) were available. Reperfusion therapy was performed in 84% of patients (58% PPCI, 10% pharmaco-invasive, 16% thrombolysis alone). Only 17% of the referred patients had received thrombolysis at non-PPCI-capable hospitals. Among patients with thrombolysis, only 38.2% underwent coronary angiography/ percutaneous coronary intervention. The independent predictors of mortality were: no reperfusion therapy (HR: 2.01, 95% CI: 1.36-2.97), referral from non-PPCI-capable hospitals (1.73, 1.22-2.46), age (1.03, 1.01-1.04), glomerular filtration rate (0.97, 0.96-0.97), heart rate>100 bpm (1.94, 1.22-3.08), and systolic blood pressure<100 mm Hg (4.92, 3.43-7.04). Mortality was lower with the pharmaco-invasive approach, although statistically non-significant, than other reperfusion therapies. CONCLUSION: Reperfusion therapy, admission types, age, glomerular filtration rate, heart rate, and blood pressure were independently associated with 30-day mortality. Using a comprehensive STEMI network to increase reperfusion therapy, especially pharmaco-invasive therapy, is recommended.

Hypertension and coronary artery ectasia: a systematic review and meta-analysis study.

BACKGROUND: Coronary artery ectasia (CAE) is characterized by the enlargement of a coronary artery to 1.5 times or more than other non-ectasia parts of the vessel. It is important to investigate the association of different factors and CAE because there are controversial results between available studies. We perform this systematic review and meta-analysis to evaluate the effects of hypertension (HTN) on CAE. METHODS: To find the potentially relevant records, the electronic databases, including Scopus, PubMed, and Science Direct were searched on 25 July 2019 by two of the authors independently. In the present study, the pooled odds ratio (OR) accompanied by 95 % confidence intervals (CIs) were calculated by a random-effects model. Heterogeneity presented with the I2 index. Subgroup analysis and sensitivity analysis by the Jackknife approach was performed. RESULTS: Forty studies with 3,263 cases and 7,784 controls that investigated the association between HTN and CAE were included. The pooled unadjusted OR of CAE in subjects with HTN in comparison by subjects without HTN was estimated 1.44 (95 % CI, 1.24 to 1.68) with moderate heterogeneity (I2 = 41 %, Cochran's Q P = 0.004). There was no evidence of publication bias in the analysis of HTN and CAE with Egger's test (P = 0.171), Begg's test (P = 0.179). Nine articles reported the adjusted effect of HTN on CAE by 624 cases and 628 controls. The findings indicated the overall adjusted OR was 1.03 (95 % CI, 0.80 to 1.25) with high heterogeneity (I2 = 58.5 %, Cochran's Q P = 0.013). CONCLUSIONS: We found that when the vessel was in normal condition, HTN was not very effective in increasing the chance of CAE and only increased the CAE chance by 3 %. This is an important issue and a warning to people who have multiple risk factors together. More studies need to be performed to further establish these associations by reported adjusted effects.

An investigation of pain intensity patterns and psychosomatic symptoms among the cardiac patients admitted to an Iranian hospital.

BACKGROUND: Heart diseases are the main reasons of death in the developed countries. This study was conducted with the aim of investigating the patterns of pain intensity and psychosomatic symptoms among cardiac patients. METHODS: This is a descriptive study and the statistical population included all the cardiac patients who were admitted to an Iranian Hospital (Kermanshah-Imam Ali Hospital) during 2018 (From July to November) 250 people were selected out of the population using convenience sampling and 180 patients answered pain intensity assessment tools, the patient health questionnaire (PHQ-15) and the patient demographic information form. RESULTS: The results of this study indicated moderate (52.2%), low (36.1%) and high (11.7%) levels of pain intensity plus mild (4.4%), moderate (28.3%) and severe (67.2%) psychosomatic symptoms with the most common psychosomatic symptoms being chest pain (52.8%), fatigue (52.8%), shortness of breath (49.4%), heart palpitation (47.8%).The results of chi-square test showed a no significant relationship between psychosomatic symptoms and variables of age, marital status, drug abuse and pain intensity (p> 0.05), however, significant relationship was found between psychosomatic symptoms and gender (p< 0.001). Moreover, there was no significant relationship between pain intensity and age, gender, marital status and drug abuse at the level of (p>0.05). CONCLUSION: Psychosomatic symptoms and pain intensity are associated with certain functional disorders and health care, therefore, identifying psychosomatic symptoms and pain intensity is very useful in assessing the effectiveness of clinical approaches on cardiac patients.

Comparison of the effect of manual compression and closure pad on postangiography complications: A randomized controlled trial.

BACKGROUND: Different methods are available for the closure of the femoral artery after catheterization. The present study aimed at comparing the effect of manual compression (MC) and closure pad (CP) on vascular complications (hematoma and bleeding) of coronary angiography. METHODS: In the current clinical trial, a total of 238 patients who were candidates for angiography were randomly assigned to the MC and CP groups. In the MC group, after removal of the arterial sheath, the arterial puncture site was manually compressed for 5-10 minutes and hemostasis was achieved. In the CP group, after removal of the arterial sheath, the arterial puncture site was first manually compressed for 5-10 minutes and initial coagulation was achieved. Then, to continue the coagulation process, a CP was attached to the artery puncture site. Postangiography complications including bleeding and hematoma were monitored in both groups immediately and up to 24 hours after hemostasis. Data were analyzed by SPSS-18 software. RESULTS: After angiography, 7 (9.5%) and 5 (2.4%) patients had hematoma in the MC and CP groups, respectively; however, no significant difference was found between the groups. Rebleeding after hemostasis was observed in 2 (7.1%) patients in the MC group, but none of the subjects in the CP group had rebleeding. There was no significant difference in bleeding volume between the groups. CONCLUSION: The results indicated the same efficacy of MC and CP methods in the prevention of postangiography vascular complications. Given the advantages of CP such as the possibility of changing the position in bed and increased physical comfort in the patient, this method is recommended for angiography and catheterization.

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.

Protection from Reperfusion Injury with Intracoronary N-Acetylcysteine in Patients with STEMI Undergoing Primary Percutaneous Coronary Intervention in a Cardiac Tertiary Center.

BACKGROUND: Evidence suggests that oxidative stress plays a principal role in myocardial damage following ischemia/reperfusion events. Recent studies have shown that the antioxidant properties of N-acetylcysteine (NAC) may have cardioprotective effects in high doses, but-to the best of our knowledge-few studies have assessed this. OBJECTIVES: Our objective was to investigate the impact of high-dose NAC on ischemia/reperfusion injury. METHODS: We conducted a randomized double-blind placebo-controlled trial in which 100 consecutive patients with ST-elevation myocardial infarction undergoing percutaneous coronary intervention (PCI) were randomly assigned to the case group (high-dose NAC 100 mg/kg bolus followed by intracoronary NAC 480 mg during PCI then intravenous NAC 10 mg/kg for 12 h) or the control group (5% dextrose). We measured differences in peak creatine kinase-myocardial band (CK-MB) concentration, highly sensitive troponin T (hs-TnT), thrombolysis in myocardial infarction (TIMI) flow, myocardial blush grade (MBG), and corrected thrombolysis in myocardial infarction frame count (cTFC). RESULTS: The peak CK-MB level was comparable between the two groups (P = 0.327), but patients receiving high-dose NAC demonstrated a significantly larger reduction in hs-TnT (P = 0.02). In total, 94% of the NAC group achieved TIMI flow grade 3 versus 80% of the control group (P = 0.03). No significant differences were observed between the two groups in terms of changes in the cTFC and MBG. CONCLUSIONS: In this study, NAC improved myocardial reperfusion markers and coronary blood flow, as revealed by differences in peak hs-TnT and TIMI flow grade 3 levels, respectively. Further studies with large samples are warranted to elucidate the role of NAC in this population. ClinicalTrials.gov identifier: NCT01741207, and the Iranian Registry of Clinical Trials (IRCT; http://irct.ir ) registration number: IRCT201301048698N8.

Evaluating the Effect of Intracoronary N-Acetylcysteine on Platelet Activation Markers After Primary Percutaneous Coronary Intervention in Patients With ST-Elevation Myocardial Infarction.

During percutaneous coronary intervention (PCI), trauma occurs in the arterial endothelium, resulting in platelet activation and aggregation. As platelet aggregation may lead to coronary thrombosis, antiplatelet agents are essential adjunctive therapies in patients undergoing PCI. The aim of this study was to determine the effect of the intracoronary administration of high-dose N-acetylcysteine (NAC) for the evaluation of its antiplatelet effects in human subjects. In this triple-blind trial, 147 patients undergoing primary PCI were enrolled. Finally, 100 patients were randomized to receive high-dose intracoronary NAC (100 mg/kg bolus, followed by 10 mg·kg⁻¹·h⁻¹ intracoronary continued intravenously for 12 hours) (n = 50) or dextrose solution (n = 50). Platelet activation biomarkers were measured before and 24 hours after the procedure. Secondary end points, comprising all-cause death, reinfarction, and target-vessel revascularization, were assessed at 30 days and 2 years. In comparison with the placebo, NAC could not reduce the level of platelet activation biomarkers within a 24-hour period after its prescription. Major adverse clinical events at 30 days and 2 years were infrequent and not statistically different between the 2 groups. Our results revealed that NAC, compared with the placebo, did not provide an additional clinical benefit as an effective antiplatelet agent after PCI.

Adherence to Antihypertensives in Patients With Comorbid Condition.

BACKGROUND: Comorbidity has been noted as a potential barrier to proper adherence to antihypertensive medications. OBJECTIVES: We decided to investigate whether comorbidity could significantly affect adherence of Iranian patients with hypertension to their medication regimen. PATIENTS AND METHODS: Two hundred and eighty consecutive hypertensive patients were interviewed in 4 cities of Iran. The 8-item Morisky medication adherence scale (MMAS-8) (validated in Persian) was used to assess medication adherence. This scale determines adherence by scores as lower than 6 (low adherence), 6 or 7 (moderate adherence), and 8 (high adherence). Comorbidity was considered as any concomitant medical condition, which necessitates the patient to take medicine for a minimum of 6 months prior to the interviews. RESULTS: The most common comorbid conditions were ischemic heart disease (65 patients, 23.2%), diabetes mellitus (55 patients, 19.6%), and dyslipidemia (51 patients, 18.2%). Mean (± SD) MMAS-8 score in comorbid group was 5.68 (± 1.85) and in non-comorbid hypertensive patients, it was 5.83 (± 1.91) (P = 0.631). Mean (± SD) number of comorbidities was 1.53 (± 0.75) in low adherence group compared to 1.54 (± 0.77) in moderate/high adherers (P = 0.98). With increasing the number of comorbid diseases, the proportion of patients with high adherence decreased successively from 20% in those with no comorbid disease to 14.1% in those with one or two comorbid conditions, and finally 11.1% in those with 3 to 5 comorbid conditions. CONCLUSIONS: With increasing the number of comorbid conditions, the proportion of patients with high adherence decreases. In our opinion, this finding is a useful clinical note for healthcare providers when managing patients with hypertension who have other medical problems at the same time.

Emotion Risk-Factor in Patients with Cardiac Diseases: The Role of Cognitive Emotion Regulation Strategies, Positive Affect and Negative Affect (A Case-Control Study).

Application of psychological interventions is essential in classic treatments for patient with cardiac diseases. The present study compared cognitive emotion regulation strategies, positive affect, and negative affect for cardiac patients with healthy subjects. This study was a case-control study. Fifty subjects were selected using convenient sampling method from cardiac (coronary artery disease) patients presenting in Imam Ali medical center of Kermanshah, Iran in the spring 2013. Fifty subjects accompanied the patients to the medical center, selected as control group, did not have any history of cardiac diseases. For collecting data, the cognitive emotion regulation questionnaire and positive and negative affect scales were used. For data analysis, multivariate analysis of variance (MANOVA) Was applied using the SPSS statistical software (ver. 19.0). In all cognitive emotion regulation strategies, there was a significant difference between the two groups. A significant difference was also detected regarding positive affect between the two groups, but no significant difference was found regarding negative affect. We found as a result that, having poor emotion regulation strategies is a risk factor for developing heart diseases.

Non-Coronary Patients with Severe Chest Pain Show More Irrational Beliefs Compared to Patients with Mild Pain.

BACKGROUND: Despite providing insufficient medical evidence of the existence of a real cardiac condition, patients with non-coronary chest pain still interpret their pain incorrectly. The present study, therefore, sought to compare the irrational beliefs in non-coronary patients with mild chest pain against those with severe chest pain. METHODS: A cross-sectional design was used. The statistical population comprised non-coronary patients who presented to the Heart Emergency Center of Kermanshah city, Iran. Using a matching method, 96 participants were selected and studied in two groups of 48. The instruments used were the Comorbidity Index, Brief Pain Index, and the Jones Irrational Beliefs Test (short-form). The multivariate analysis of variance, chi-square test, and t-test were used for data analysis. RESULTS: Controlling for the effects of age and comorbid conditions, the severity of three types of irrational beliefs, including emotional irresponsibility (P<0.001), hopelessness changes (P<0.001), and problem avoiding (P=0.002) was higher among patients with severe chest pain (according to effect level). However, in terms of demand for approval, no difference was seen between the two groups (P=0.180). CONCLUSION: Non-coronary patients with severe chest pain showed a greater number of irrational beliefs in comparison to patients with mild pain. Irrational beliefs are common mental occurrences in patients with non-coronary chest pain, and they should be attended to by health professionals, especially in severe non-coronary chest pain. Further investigation to determine the association between irrational beliefs and non-coronary chest pain is necessary.

Reducing Irrational Beliefs and Pain Severity in Patients Suffering from Non-Cardiac Chest Pain (NCCP): A Comparison of Relaxation Training and Metaphor Therapy.

BACKGROUND: Patients suffering from non-cardiac chest pain (NCCP) can interpret their chest pain wrongly despite having received a correct diagnosis. The objective of this study was to compare the efficacy of the relaxation method with metaphor therapy for reducing irrational beliefs and pain severity in patients with NCCP. METHODS: Using a randomized controlled trial, 33 participants were randomly divided into a relaxation training group (n= 13), a metaphor therapy group (n = 10), and a control group (n = 10), and were studied for 4 weeks. The two tools used in this research were the Brief Pain Inventory (BPI) index for determining the degree of pain and the short version of the Jones Irrational Belief Test. Metaphor therapy and a relaxation technique based on Öst's treatment were used as the interventions. The collected data were analyzed with a multivariate analysis of covariance (MANCOVA), a Chi-square test, and the Bonferroni procedure of post-hoc analysis. RESULTS: The relaxation training method was significantly more effective than both metaphor therapy and the lack of treatment in reducing the patients' beliefs of hopelessness in the face of changes and emotional irresponsibility, as well as the pain severity. Metaphor therapy was not effective on any of these factors. In fact, the results did not support the effectiveness of metaphor therapy. CONCLUSIONS: Regarding the effectiveness of the relaxation method as compared with metaphor therapy and the lack of treatment in the control group, this study suggests that relaxation should be paid greater attention as a method for improving the status of patients. In addition, more studies are needed to determine the effectiveness of metaphor therapy in this area.

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.

Study of the possible medical and medication explanatory factors of angiographic outcomes in patients with acute ST elevation myocardial infarction undergoing primary percutaneous intervention.

BACKGROUND: Myocardial blush grade (MBG), thrombolysis in myocardial infarction (TIMI) and corrected TIMI frame count (cTFC) are indices of successful angiographic reperfusion. This study sought to determine the predictors of angiographically successful reperfusion including demographic, clinical and angiographic factors in patients with ST elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI). MATERIALS AND METHODS: A cross-sectional study of patients with a confirmed diagnosis of STEMI undergoing pPCI was designed. Eligible patients referring to a university heart center were enrolled in the study from March 2012 to December 2012. Successful epicardial reperfusion was defned as TIMI flow grade 3 or cTFC<= 28 frames and successful myocardial reperfusion as MBG 2 or 3. RESULTS: The study population consisted of 100 patients, including 74 males and 26 females, with mean ± standard deviation age of 58.27 ± 11.60 years. Achieving open microvasculature (MBG 2/3) was positively associated with a history of nitrate intake (P = 0.03) and history of calcium channel blocker (CCB) intake (P = 0.005). Hyperglycemia was inversely associated with achieving a final cTFC ≤ 28 frames (r = -0.32, P = 0.001). CONCLUSIONS: Our findings suggest that patients with a history of nitrate and CCB intake had a higher likelihood of successful PCI. In addition, patients with a higher blood glucose level on admission may have a reduced rate of reperfusion success. Future studies with a larger sample size are recommended to investigate the significant relationships observed in this study.

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.