Intravenous Amiodarone versus Digoxin in Atrial Fibrillation Rate Control; a Clinical Trial

Introduction: Treatment of rapid ventricular response arterial fibrillation (rapid AF) varies depending on the decision of the in-charge physician, condition of the patient, availability of the drug, and the treatment protocol of the hospital. The present study was designed aiming to compare IV digoxin and amiodarone in controlling the heart rate of patients presenting to emergency department with rapid AF and relative contraindication for first line drug in this regard.Method: In the present clinical trial, patients presented to the ED with rapid AF and relative contraindication for calcium channel blockers and beta-blockers were treated with either IV amiodarone or IV digoxin and compared regarding success rate and complication using SPSS version 22. P < 0.05 was considered as statistically significant.Results: 84 patients were randomly allocated to either amiodarone or digoxin treatment groups of 42 (53.6% male). The mean age of the studied patients was 61.8 ± 11.14 years (38 - 79). No significant difference was present regarding baseline characteristics. The rate of treatment failure was 21.4% (9 cases) in amiodarone and 59.5% (25 cases) in digoxin groups (p < 0.001). The mean onset of action was 56.66 ± 39.52 minutes (10 - 180) in amiodarone receivers and 135.38 ± 110.41 minutes (25 - 540) in digoxin group (p < 0.001). None of the patients showed any adverse outcomes of hypotension, bradycardia, and rhythm control.Conclusion: Based on the findings of the present study, rapid AF patients with relative contraindication for calcium channel blockers or beta-blockers who had received amiodarone experienced both higher (about 2 times) treatment success and a more rapid (about 2.5 times) response compared to those who received IV digoxin

Early vs Late Coronary Angiography and Intervention Following Thrombolytic Therapy; a Cohort Study

Introduction: The precise time of using percutaneous coronary intervention (PCI) after fibrinolytic therapy for maximum efficiency and minimum side effects is still undetermined. Therefore, the present study was designed to compare the outcome of myocardial infarction (MI) patients who underwent surgical intervention (angiography and PCI) within 48 hours of thrombolytic therapy or after that.Methods: The present study is a prospective cohort study aiming to compare the occurrence of no-reflow phenomenon, unstable angina, bleeding during intervention, and one month major adverse cardiac outcomes (recurrent MI, need for repeating surgical intervention, and mortality) between MI patents undergoing surgical intervention within the first 48 hours of or after 48 hours of thrombolytic therapy.Results: 90 patients with the mean age of 54.97 ± 10.54 were studied (86.67% male). 50 (56%) patients underwent surgical intervention within 48 hours and 40 (44%) after that. The 2 groups were not significantly different regarding baseline characteristics. No-reflow phenomenon in the < 48 hours group was about twice the > 48 hours group (OR = 0.35; 95% confidence interval: 0.14 – 0.92; p = 0.03), other outcomes were not significantly different. No case of mortality was seen in the 1 month follow up.Conclusion: Based on the results of the present study, it seems that no-reflow phenomenon rate is significantly lower in patients undergoing surgical intervention after 48 hours of fibrinolytic therapy. The difference between the two groups regarding prevalence of major adverse cardiac outcomes was not statistically significant

The prevalence of current water pipe use among Iranian male population: a systematic review and meta-analysis

Introduction: Waterpipe as a traditional method of tobacco consumption is a public health challenge. Considering the growing trend of waterpipe (hookah) use in Iran, this systematic review aimed to measure the pooled prevalence of waterpipe current use among Iranian men. Materials and Methods: The present systematic review was conducted on the published cross-sectional studies during 2009-2019 aiming at estimating the prevalence of waterpipe current use among Iranian men. Current use of waterpipe was defined as using waterpipe within the preceding 30 days. Random Effect model was used to estimate the pooled prevalence by STATA v.14. Results: Ten cross-sectional epidemiologic studies with a total sample size of of 6,263 were included in the meta-analysis. The pooled prevalence of waterpipe current use among Iranian men was estimated at 25% (95% Confidence Interval: 30-20%).  Conclusions: There are a variety of definitions for current use of waterpipe across studies. The results of this study suggest a high prevalence of current use of waterpipe among Iranian men during 2009-2019. Increased use of waterpipe in communities should be considered as a public health concern and a matter of priority by health policymakers. Preventive programs should take into account the acceptability and appealing nature of waterpipe among Iranian population and consider them as important modifiable factors