The Risk of Venous Thromboembolism Associated with Oral Contraceptive; the Search Is Still On

<img src="/public/site/images/yousefifard/ABDOLVAND.jpg" alt="" /

Intravenous caffeine versus intravenous ketorolac for the management of moderate to severe migraine headache

The aim of this study was to determine if intravenous caffeine is as effective as intravenous ketorolac for the treatment of moderate to severe migraine headaches. Eligible patients randomly received 60 mg caffeine citrate or 60 mg ketorolac infused intravenously. Their pain score were measured at baseline, one hour and two hours after infusion. Therapeutic success was defined as decreasing of at least 3 points on the pain score. In total 110 patients were enrolled (75.5% women). Therapeutic success after 60 min was achieved by 63.6% of patients in the caffeine and 70.1% of patients in the ketorolac group (p = 0.23). After 120 min, 87.3% of the caffeine group and 83.6% of the ketorolac group achieved therapeutic success (p = 0.49). In this multi-center, randomized double blind study, intravenous caffeine was as effective as intravenous ketorolac for first line abortive management of acute migraine.

Troponin utilization in patients presenting with atrial fibrillation/flutter to the emergency department: retrospective chart review

Abstract Background There are few recommendations about the use of cardiac markers in the investigation and management of atrial fibrillation/flutter. Currently, it is unknown how many patients with atrial fibrillation/flutter undergo troponin testing, and how positive troponin results are managed in the emergency department. We sought to look at the emergency department troponin utilization patterns. Methods We performed a retrospective chart review of patients with atrial fibrillation/flutter presenting to the emergency department at three centers. Outcome measures included the rates of troponins ordered by emergency doctors, number of positive troponins, and those with positive troponins treated as acute coronary syndrome (ACS) by consulting services. Results Four hundred fifty-one charts were reviewed. A total of 388 (86%) of the patients had troponins ordered, 13.7% had positive results, and 4.9% were treated for ACS. Conclusions Troponin tests are ordered in a high percentage of patients with atrial fibrillation/flutter presenting to emergency departments. Five percent of our total patient cohort was diagnosed as having acute coronary syndrome by consulting services

TRANSIENT CORTICAL BLINDNESS: A MUST KNOW COMPLICATION OF CORONARY ANGIOGRAPHY

Abstract &nbsp;&nbsp; INTRODUCTION: This is a case of transient visual loss following trans-femoral coronary angiography in a 44 year- old man, which lasted for 2 days. &nbsp;&nbsp; CASE REPORT: Ophthalmologic, neurological and radiological studies using physical exam and brain MRI showed no pathological finding. &nbsp;&nbsp; CONCLUSION: Visual loss resolved completely without any sequel in 2 days. The leakage of contrast agent into occipital area of the brain could possibly be the cause. &nbsp; &nbsp;&nbsp; Keywords: Complication of coronary angiography, Transient Cortical Blindness &nbsp;</p

Effects of Telestroke on Thrombolysis Times and Outcomes: A Meta-analysis

<p><b>Objective</b>: Telestroke systems are tools, used to provide an advanced stroke care in regions without sufficient neurologic services. We performed this meta-analysis to assess the effects of telemedicine on treatment times and clinical outcomes of acute stroke care. <b>Methods:</b> A literature search of PubMed, SCOPUS, and Cochrane CENTRAL was conducted for original studies investigating telemedicine applications in acute stroke care. Dichotomous data on treatment outcomes were pooled as odds ratios (ORs), while continuous data on thrombolysis times were pooled as mean differences (MDs) with 95% confidence interval (CI), using RevMan software (version 5.3). <b>Results</b>: Pooling data from 26 studies (6605 thrombolysed patients) showed no significant differences between the telestroke and control groups in terms of in-hospital mortality (OR = 1.21, 95% CI [0.98, 1.49]), 90-day mortality (OR = 1.08, 95% CI [0.85, 1.37]), symptomatic intracranial hemorrhage (sICH) (OR = 1.10, 95% CI [0.79, 1.53]), and favorable clinical outcome at discharge (OR = 1.03, 95% CI [0.69, 1.53]) and 90 days later (OR = 0.99, 95% CI [0.82, 1.18]). The onset-to-door (OTD) duration (MD = −10.4 minutes, 95% CI [−14.79, −.01]) and length of hospital stay (MD = −0.55 days, 95% CI [−1.02, −0.07]) were significantly shorter in the telestroke group, compared to the control group. Although the overall effect estimate (under the fixed-effect model) showed a significant decrease in the onset-to-treatment (OTT) duration in the telestroke group (MD = −5.83 minutes, 95% CI [−8.57, −3.09]), employing the random-effects model for between-study heterogeneity abolished this significance (MD = −5.90 minutes, 95% CI [−13.23, 1.42]). <b>Conclusion</b>: Telestroke significantly reduced OTD and hospital stay durations in stroke patients without increasing the risk of mortality or sICH. Therefore, telemedicine can improve stroke care in regional areas with minor experience in thrombolysis. Further randomized controlled trials are needed to assess the benefits of telestroke systems, especially in terms of cost-effectiveness and quality of life outcomes.</p

Socioeconomic determinants and metabolic syndrome : Results from the Isfahan Healthy Heart Program

Introduction: The prevalence of metabolic syndrome (MetS) is increasing in Iran. We assessed the relationship between socioeconomic status (SES) and Mets components in the Iranian population. Materi- als and Methods: The sample for this study comprised a random cross-section of men and women from two province districts who participated in the Isfahan Healthy Heart Program (IHHP) in 2007. Each participant completed a questionnaire, underwent anthropometric testing and blood pressure measurements, and pro- vided a blood sample. Mets was defined based on ATPIII criteria. Several SES dimensions, such as education, occupation, and number of children, as well as home, car, and personal computer ownership, were assessed to determine the participant’s SES. Results: A higher-than-average income, car ownership, owning or renting a private home, and having a computer are increasing towards increment in SES. All MetS components were more prevalent in participants defined as having a lower SES, while low HDL levels were more common in participants having an SES II (P>0.001). A multivariate analysis showed that having the lowest SES (I) increased the risk of MetS by 1.72 [1.44-2.07], whereas subjects having an SES III had a 1.23 [1.04-1.47] lower risk for MetS. Conclusions: The relationship between SES and Mets is due largely to behavioural factors, such as practicing unhealthy eating habits. Given the high prevalence of Mets in Iran, we propose that regular health check-ups may be useful in the early detection of the syndrome and, consequently, in the prevention of its effects. In addition, the early detection of MetS may result in the early diagnosis and prevention of car- diovascular diseases. (www.actabiomedica.it

The effect of hypoxia-induced intrauterine growth restriction on renal artery function

The risk of developing cardiovascular diseases is known to begin before birth and the impact of the intrauterine environment on subsequent adult health is currently being investigated from many quarters. Following our studies demonstrating the impact of hypoxia in utero and consequent intrauterine growth restriction (IUGR) on the rat cardiovascular system, we hypothesized that changes extend throughout the vasculature and alter function of the renal artery. In addition, we hypothesized that hypoxia induces renal senescence as a potential mediator of altered vascular function. We demonstrated that IUGR females had decreased responses to the adrenergic agonist phenylephrine (PE; pEC50 6.50 ± 0.05 control v. 6.17 ± 0.09 IUGR, P < 0.05) and the endothelium-dependent vasodilator methylcholine (MCh; E max 89.8 ± 7.0% control v. 41.0 ± 6.5% IUGR, P < 0.001). In IUGR females, this was characterised by increased basal nitric oxide (NO) modulation of vasoconstriction (PE pEC50 6.17 ± 0.09 IUGR v. 6.42 ± 0.08 in the presence of the NO synthase inhibitor N-nitro-l-arginine methyl ester hydrochloride (l-NAME; P < 0.01) but decreased activated NO modulation (no change in MCh responses in the presence of l-NAME), respectively. In contrast, IUGR males had no changes in PE or MCh responses but demonstrated increased basal NO (PE pEC50 6.29 ± 0.06 IUGR v. 6.42 ± 0.12 plus l-NAME, P < 0.01) and activated NO (E max 37.8 ± 9.4% control v. -0.8 ± 13.0% plus l-NAME, P < 0.05) modulation. No significant changes were found in gross kidney morphology, proteinuria or markers of cellular senescence in either sex. In summary, renal vascular function was altered by hypoxia in utero in a sex-dependent manner but was unlikely to be mediated by premature renal senescence