Incidence Rate and Risk Factors of Radial Artery Spasm during Transradial Coronary Angiography

Background: Radial artery spasm (RAS) is one of the most common complications of radial coronary angiography. Several demographic and clinical factors increase the risk of RAS in this procedure. We aimed to evaluate the effect of various risk factors on the incidence and severity of RAS in radial coronary angiography.  Methods: This cross-sectional study was performed on 120 patients who were randomly selected from candidates referred to Shahid Modarres Educational Medical Center for coronary angiography by the radial method. After angiography, radial arteriography was performed to diagnose spasms. The association of some demographic and clinical factors with the incidence and severity of RAS was evaluated. Results: 35 of the 120 patients (29.16%) developed RAS during angiography. Shorter height, shorter radius bone length, less radial artery diameter, longer procedure length, diabetes mellitus, more catheters used, and female sex were significantly associated with higher incidence. The predictive power of these factors for the occurrence of spasms was very good with AUC=0.88. Age, shorter height, higher body mass index, smaller radial artery diameter, longer procedure time, diabetes mellitus, failure of initial effort for puncture, number of catheters used, and female sex were significantly associated with the severity of spasms. Conclusions: The incidence or severity of spasms during the procedure can be reduced by examining the available risk factors for every patient before deciding to perform angiography

A rare case report of complete transposition of the femoral artery and vein

In the inguinal region at normal anatomical situation the artery is positioned lateral to vein and by this figure artery and vein get out under inguinal ligament and entrance to this region. Every surgeon (general surgeon, vascular surgeon or orthopaedic) that works at this region should know anatomical anomaly and variation of these vessels in inguinal region. Dissection at this region without knowing these variations could damage the vessels especially femoral artery. Some times this variations could induce compression on the vein and induce deep vein thrombosis. In this case while exploring femoral artery for transfemoral thrombectomy, femoral vein was found in the arteries anatomical position and complete transposition of artery and vein was founded. In conclusion, knowing normal variations and anomalies while dissecting this area helps us for lowering iatrogenic vascular trauma and complications.     &nbsp

The Relationship of ST Segment Changes in Lead aVR with Outcomes after Myocardial Infarction; a Cross Sectional Study

Introduction: Among the 12 leads studied in electrocardiography (ECG), lead aVR can be considered as the most forgotten part of it since no attention is paid to it as the mirror image of other leads. Therefore, the present study has been designed with the aim of evaluating the prevalence of ST segment changes in lead aVR and its relationship with the outcome of these patients.Methods: In this retrospective cross sectional study medical profiles of patients who had presented to emergency department with the final diagnosis of myocardial infarction (MI) in a 4-year period were evaluated regarding changes of ST segment in lead aVR and its relationship with in-hospital mortality, the number of vessels involved, infarct location and cardiac ejection fraction.Results: 288 patients with the mean age of 59.00 ± 13.14 (18 – 91) were evaluated (79.2% male). 168 (58.3%) patients had the mentioned changes (79.2% male). There was no significant relationship between presence of ST changes in lead aVR with infarct location (p = 0.976), number of vessels involved (p = 0.269) and ejection fraction on admission (p = 0.801). However, ST elevation ≥ 1 mv in lead aVR had a significant relationship with mortality (Odds = 7.72, 95% CI: 3.07 – 19.42, p < 0.001). Sensitivity, specificity, positive and negative predictive values and positive and negative likelihood ratios of ST elevation ≥ 1 for prediction of in-hospital mortality were 41.66 (95% CI: 22.79 – 63.05), 91.53 (95% CI: 87.29 – 94.50), 31.25 (95% CI: 16.74 – 50.13), 94.44 (95% CI: 90.65 – 96.81), 0.45 (95% CI: 0.25 – 0.79), and 0.05 (95% CI: 0.03 – 0.09), respectively.Conclusion: Based on the results of the present study, the prevalence of ST segment changes in lead aVR was estimated to be 58.3%. There was no significant relationship between these changes and the number of vessels involved in angiography, infarct location and cardiac ejection fraction. However, presence of ST elevation ≥ 1 in lead aVR was associated with 8 times increase in in-hospital mortality risk

Paradoxical Embolism in a Patient with Patent Foramen Ovale; a Case Report

Patent foramen ovale (PFO) is usually asymptomatic; however, it could be quite dangerous for patients with right side clot in which thrombus can transmit the PFO and paradoxically emboli to systemic circulation. Here we present a patient with ankle fracture and paradoxical embolus to the brain, who was successfully treated with emergent thrombectomy, inferior vena cava (IVC) filter placement and anticoagulation therapy. Despite the high rate of mortality in these patients, fortunately our patient survived with surgical treatment

Effect of Nocturnal Oxygen Therapy on Electrocardiographic Changes Among Patients with Congestive Heart Failure

Introduction: Nocturnal hypoxia is an important factor in increasing the risk of mortality in patients with chronic heart failure and is associated with atrial and ventricular arrhythmias. In addition, QT dispersion (QTd) is used as a prognostic sign in determining future malignant arrhythmias and sudden cardiac death. In the current study, we investigated the effect of nocturnal oxygen therapy (NOT) on electrocardiographic changes among patients with chronic heart failure.Methods: In this study, a consecutive of 154 patients (87 males and 67 females) known with chronic heart failure (EF ≤ 40%) were enrolled. The patients were administered NOT (oxygen flow of 2 L/min for 8 hours during sleeping). Electrocardiography was takenbefore and after the NOT, and RR interval, PR interval and QTd were measured each time.Results: The mean age of the participants was 61.3 ± 11.4 years. Our results revealed significant reduction in QTd (55.8 ± 7.5 vs. 61.4± 9.1 msec, P = 0.001) and heart rate (79.6 ± 4.7 vs. 76.8 ± 4.3, P = 0.001) in a patient’s electrocardiogram after NOT.Conclusions: In this study, NOT decreased heart rate and QTd in patients with chronic heart failure, but not PR interval, which could consequently decrease the risk of malignant arrhythmias and sudden cardiac death

The Evaluation of the Effect of Hypothyroidism Treatment on Non-Alcoholic Fatty Liver Disease

Introduction: There is still controversy over the existence of a relation between hypothyroidism and fatty liver disease. The scale by which hypothyroidism can affect fatty liver disease progression is also to be determined. Therefore, our study aims to contribute in the determination of this relation. Materials and methods: This observational analytical-before and after study with 53 patients was conducted. The subjects were categorized as having either primary or subclinical hypothyroidism. The serum levels of thyroid stimulation hormone (TSH), free T3 (FT3), free T4 (FT4), alanine transaminase (ALT), aspartate aminotransferase (AST) and alkaline phosphatase (ALP) were measured and liver ultrasound was done to screen nonalcoholic fatty liver disease (NAFLD). Results: The study consisted of 41 women and 12 men with the mean age of 48.3 years. The mean TSH levels decreased after hypothyroidism treatment in patients. The mean levels of FT4 did not have a significant increase after treatment, although in patients with subclinical hypothyroidism this increase was significant. T3 levels increased significantly after treatment. Statistical studies showed that there was a significant change in the degree of fatty liver before and after hypothyroidism treatment. Conclusion: There was an explicit relation between hypothyroidism and non-alcoholic fatty liver disease as Hypothyroidism treatment can prevent non-alcoholic fatty liver disease progression

The Effect of Thyroid Hormone Replacement on the Metabolic Control and Insulin Resistance in Patients with Subclinical Hypothyroidism

Introduction: Studying the treatment effect of subclinical hypothyroidism in decreasing metabolic syndrome risk factors and cardiovascular diseases is necessary and can be helpful to control future disorders. In spite of various studies, the relationship between subclinical hypothyroidism and cardiovascular diseases remain controversial. Studies which consider the effects of subclinical hypothyroidism treatment on metabolic control and insulin resistance have not been done in the Islamic Republic of Iran yet. Materials and methods: In this interventional study, 153 patients with subclinical hypothyroidism (thyroid stimulation hormone (TSH) >5, normal T3 and T4 at least 2 times) were selected from Labbafinejad endocrine clinic. Laboratory tests were performed at 8 a.m. after 12-14 hours fasting. Patients were then treated with levothyroxine (25-50 µg daily). To adjust the dose, thyroid function tests (TFT) were checked every 2 months for 6 months. Collected data was used for analysis by spss18 software. Results: After 6 months treatment of subclinical hypothyroidism mean values improved in factors such as insulin resistance profile (fasting blood sugar (FBS), 2 hours post prandial (2hPP), fasting insulin and homeostasis model assessment estimated insulin resistance (HOMA-IR index), lipid profile (total cholesterol, low density lipoprotein (LDL) and high density lipoprotein (HDL), decreased c-reactive protein (CRP) and weight (all had P value<0.05). Treatment did not have significant effect on triglycerides (TG), waist circumference, body mass index (BMI), uric acid ad systolic/diastolic blood pressure (p values>0.05). But the number of cases with high systolic/diastolic blood pressure decreased significantly after 6 months treatment (P values=0.007 and 0.01). Conclusion: Subclinical hypothyroidism treatment is suggested according to mentioned effects, especially in cases with insulin resistance, lipid profile disturbance, obesity, and high blood pressure

Evaluation of type 2 Diabetes Mellitus Risk in Patients with post Trauma Splenectomy

Introduction: Recent studies suggest that the spleen has an important role as a source of multipotent stem cells and precursors of beta cells of pancreas islets. In addition, increased risk of developing hyperglycemia was reported in patients who underwent splenectomy due to trauma in long-term follow up. Therefore, there might be an association between splenectomy and an increased risk of type 2 diabetes mellitus. In this study, we evaluated the risk of type 2 diabetes and its risk factors including hyperglycemia, dyslipidemia, obesity and hypertension in trauma patients with splenectomy. Materials and methods: In this study, 221 patients who underwent splenectomy surgery due to trauma in the surgical ward of Imam Hossein Hospital 5 to 10 years ago were selected. Those with a history of diabetes, cancer, hyperthyroidism, Cushing's syndrome, pancreatitis, renal failure, and cirrhosis were excluded from the study. Then fasting plasma glucose, hemoglobin A1c (HbA1c), triglyceride, cholesterol and high density lipoprotein (HDL), body mass index and blood pressure have been evaluated in 90 patients who had had a history of splenectomy due to trauma from 2007, July 23 to 2012, July 22. Results: The results indicate that none of these patients has diabetes, 14.4 percent are in pre-diabetic stage, 56.6 percent has dyslipidemia, 57.7 percent has obesity and 20 percent has hypertension. Conclusion: The results of this study suggest that splenectomy does not increase the risk of type 2 diabetes. Prevalence of diabetes risk factors was approximately the same with those of Tehran population

Effect of Proton Pump Inhibitor Administration on Glycemic Parameters in Patients with Type 2 Diabetes Mellitus

Introduction: Proton pump inhibitors can influence glucose-insulin homeostasis by elevating plasma gastrin. Considering the few clinical trials and contradictory results of previous studies, we aimed to evaluate the effect of omeprazole, a proton pump inhibitor, on glucose-insulin homeostasis in patients with type 2 diabetes mellitus (T2DM). Materials and Methods: In this before-after clinical trial, 40 patients with T2DM received omeprazole treatment for 12 weeks. Patients were asked to continue their diet, lifestyle, and physical activity throughout the study period. Glycosylated hemoglobin (HbA1c), fasting plasma sugar (FBS), insulin level, C-peptide and 2 hours post prandial blood sugar (2hppBS) were measured at baseline and after 12 weeks. Homeostatic model assessment of Insulin resistance (HOMA-IR) and homeostatic model assessment of β-cell dysfunction (HOMA-B) indices were also calculated at baseline and after 12 weeks of omeprazole administration. Results: After 12 weeks of omeprazole administration, there was a clear decrease in the mean HbA1C before (8.11±0.96) and after (7.13±0.68) the treatment (P<0.001). Similarly, a decrease in mean FBS and 2HPPBS before and after treatment was observed, which was statistically significant for FBS (P=0.01) but not for 2HPPBS (P=0.1). There was a clear increase in the level of Insulin (P=0.001) and C-peptide (P=0.003). The mean activity index of HOMA-B before and after receiving omeprazole was 54.41 27.06 and 79.24 45.32, respectively (P=0.007). Also, HOMA-IR index was 5 before, and 6 after receiving omeprazole (P=0.001). Conclusion: Administration of omeprazole, increases insulin levels and decreases the levels of HbA1c, FBS, thus improving glycemic status and can be combined with other drugs used to manage DM, especially in patients with gastrointestinal problems; but more studies are needed

Effect of Vitamin D Administration on Glycemic Control in Patients with Type II Diabetes Mellitus and Vitamin D Deficiency

Introduction: The prevalence of diabetes mellitus (DM) and its morbidity and mortality are prominent all over the world. Observational data suggest that vitamin D deficiency is associated with insulin resistance. In this study, we aimed to assess this association. Methods:  This study was a clinical trial consisting of 42 patients with type 2 DM who had vitamin D deficiency. The patients underwent vitamin D replacement with vitamin D pearls (50,000 iu) weekly for 10 weeks. The level of low-density lipoprotein (LDL), high-density lipoprotein (HDL), cholesterol (Chol), triglycerides (TG), hemoglobin A1c (HbA1C), 2 hour post prandial (2HPP), fasting blood sugar (FBS), body mass index (BMI), blood pressure (BP), and 25oHVitD3 were measured before and after the treatment in all patients. Data were analyzed with paired t test. Results:  100% of patients reached acceptable vitamin D level (above 30 mg/dl). No toxicity was reported. Changes in FBS, 2Hpp, HbA1C, Chol, SBP were significant and there was no significant change in LDL, HDL, and DBP. Conclusion:  Screening for vitamin D deficiency and its replacement may have a beneficial effect on type 2 DM management and its associated risk factors. More studies with larger sample size and use of placebo are recommended