Psychometric evaluation of the health-seeking behavior scale based on Kroeger’s model for elective cardiac interventions

Background: Coronary artery bypass graft surgery (CABG) is one of the two most commonly used interventions for Myocardial Reperfusion. Studies suggest that the existence and direction of the effect of the factors affecting health-seeking behavior depend on the context of each society. Thus, this study aimed to introduce and validate a tool for investigating the factors affecting the health-seeking behavior of patients requiring a cardiovascular intervention as a prerequisite for planning and policymaking.   Methods: By reviewing the literature and questionnaires previously used in the field of health-seeking behavior and the patient's decision-making process, a set of related questions was collected based on Kroeger’s model variables. Ten content experts were requested to evaluate each item and then content validity ratio (CVR) and content validity index (CVI) were calculated and used for instrument modification. Participants were included through a convenience sampling procedure. Exploratory factor analysis (EFA) and Confirmatory factor analysis (CFA) was used to assess construct validity. Cronbach's alpha coefficient was used to measure instrument reliability.   Results: Of the 142 participants, 79 (55.5%) were male. Through the validation process, a hierarchical model with four factors and 20 items with three error covariance (accounting for 63.06 present of outcome variable variation) was confirmed. Also, an examination of the four constructs obtained with Cronbach's alpha coefficient was more than 0.8 indicating acceptable reliability.   Conclusion: Findings suggest that the designed scale of health-seeking behavior based on Kroeger’s model is a reliable and valid scale among the Iranian population

Comparison of 180° and 360° Arc Data Acquisition to Measure Scintigraphic Parameters from Gated Single Photon Emission Computed Tomography Myocardial Perfusion Imaging: Is There Any Difference?

Objective: The aim of the current study was to compare 180° and 360° data collection modes to measure end diastolic volume (EDV), end systolic volume (ESV) and ejection fraction (EF) values of the cardiac system by gated myocardial perfusion tomography. Methods: Thirty-three patients underwent gated myocardial perfusion tomography. Single photon emission computed tomography data of patients’ heart were acquired by 180°, 45° left posterior oblique to 45° right anterior oblique, and 360° to obtain EDV, ESV, EF and cardiac volume changes (V1, V2, V3, V4, V5, V6, V7 and V8) throughout each cardiac cycle. Results: Results of the current study indicated that there were no significant differences between 180° and 360° angular sampling in terms of measuring EDV, ESV and EF in myocardial perfusion imaging. Cardiac volume change patterns during a cardiac cycle were also similar in 360° and 180° scans. We also observed that there was no difference in EDV, ESV and EF values between the group with stress induced by exercise and the group with stress imposed by dipyridamole. Conclusion: As there is no difference between 180°and 360° cardiac scanning in terms of EDV, ESV and EF, half-orbit scan is recommended to study these cardiac system parameters because it offers more comfort to patients and a shorter scanning time. Keywords: 180° data collection, 360° data collection, ejection fraction, end diastolic volume, end systolic volume, gated myocardial perfusio

Bushehr Elderly Health (BEH) Programme, phase I (cardiovascular system)

Purpose: The main objective of the Bushehr Elderly Health Programme, in its first phase, is to investigate the prevalence of cardiovascular risk factors and their association with major adverse cardiovascular events. Participants: Between March 2013 and October 2014, a total of 3000 men and women aged ≥60 years, residing in Bushehr, Iran, participated in this prospective cohort study ( participation rate=90.2%). Findings to date: Baseline data on risk factors, including demographic and socioeconomic status, smoking and medical history, were collected through a modified WHO MONICA questionnaire. Vital signs and anthropometric measures, including systolic and diastolic blood pressure, weight, height, and waist and hip circumference, were also measured. 12-lead electrocardiography and echocardiography were conducted on all participants, and total of 10 cc venous blood was taken, and sera was separated and stored at –80°C for possible future use. Preliminary data analyses showed a noticeably higher prevalence of risk factors among older women compared to that in men. Future plans: Risk factor assessments will be repeated every 5 years, and the participantswill be followed during the study to measure the occurrence of major adverse cardiac events. Moreover, the second phase, which includes investigation of bone health and cognition in the elderly, was started in September 2015. Data are available at the Persian Gulf Biomedical Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran, for any collaboratio

Single Coronary Artery with Anomalous Origin of the Right Coronary Artery from the Distal Portion of Left Circumflex Artery: A Very Rare Case

Congenital anomalies of coronary arteries, albeit rare, may be significant contributors to angina pectoris, hemodynamic abnormalities, and sudden cardiac death. A 47-year-old man referred to us with atypical chest pain. Electrocardiography demonstrated no significant ischemic changes, but cardiac troponin I test was positive. The patient underwent coronary angiography, which revealed a single coronary artery from the left Valsalva sinus. In addition, the left anterior descending (LAD) and the left circumflex (LCx) arteries were in normal position with significant stenosis in the mid-portion of the LAD and the distal portion of the LCx. A large branch originated from the distal portion of the LCx and tapered toward the proximal portion as the right coronary artery (RCA). This is a rare coronary anomaly that has no ischemic result. Coronary lesions were the cause of the patient’s angina pectoris. Angioplasty and stenting of the LAD and LCx was done, and medical therapy (Clopidogrel, Aspirin, Atorvastatin, and Metoprolol) was continued. The patient was asymptomatic at 8 months’ follow-up

The association between MDA-oxidised LDL, antibodies against oxidised LDL and ischemic heart disease in postmenopausal women: a population-based study

Background: Although the association between oxidized LDL particles and cardiovascular diseases has been shown in different studies, the role of oxidized LDL for cardiovascular diseases in menopause is very limited. The main aim of the current study was to investigate the relationship between MDA-oxidised LDL, antibodies against oxidized LDL and ischemic heart disease or myocardial infarction among postmenopausal women. Materials and methods: A total of 378 healthy, postmenopausal women were randomly selected from 13 clusters in the port city of Bushehr, Iran. Serum oxidized LDL and MDA-oxidised LDL levels were measured using enzyme-linked immunosorbent assay methods.&nbsp;&nbsp; The prevalence of ischemic heart disease (IHD) was assessed using the Minnesota Code with a 12-lead resting electrocardiogram (EKG). The National Cholesterol Education Program (NCEP), Adult Treatment Panel III was used to assign the subjects to different levels of cardiovascular risk for lipid profile. Results: There was a significant difference for circulating oxidized LDL between subjects who had high LDL-cholesterol or high total cholesterol levels with normal postmenopausal women (P<0.05). However, no significant difference was found for oxidized LDL and anti oxidized LDL levels among subjects with the other cardiovascular risk factors.&nbsp; EKG with evidence of IHD (IHD EKG) was not associated with oxidized LDL and anti oxidized LDL levels. But a significant association was found between myocardial infarction and circulating oxidized LDL even after adjustments were made for age, body mass index, smoking and serum cholesterol levels in multiple logistic regression analyses (OR:3.11, CI=1.24-7.80, p=0.016). Conclusion: Although no relationship was found between IHD EKG and oxidized LDL, the significant association between myocardial infarction and circulating oxidized LDL may suggest a potential pathogenesis role for oxidized LDL in the development of vulnerable atherosclerotic plaques

Mixed Medullary-Follicular Carcinoma of the Thyroid

Introduction. Mixed medullary-follicular thyroid carcinoma is an uncommon tumor that consists of both follicular and parafollicular cells. Case. We report a 43-year-old woman with a palpable mass in the right side of the neck. Fine needle aspiration suggested a diagnosis of high grade anaplastic carcinoma that has been associated with papillary features. Total thyroidectomy was done in which histopathological examination showed diagnosis of medullary carcinoma. Immunohistochemical staining was positive for chromogranin, calcitonin, and thyroglobulin in tumoral cells. Conclusion. Mixed medullary-follicular thyroid carcinoma is a rare tumor. Diagnosis of these tumors with fine needle aspiration is very difficult and may lead to misdiagnosis. It is necessary to correlate the cytological finding with serum calcitonin and thyroglobulin. Also immunostaining for calcitonin and thyroglobulin confirms diagnosis

The correlation between insulin-like growth factor 1 (IGF-1) and high sensitivity C-reactive protein (hs-CRP) in postmenopausal women

Background: Low circulating IGF-1 and high hs-CRP may be associated with cardiovascular diseases. Hence, it is an important question that is there any correlation between these important biomarkers? Since the correlation between IGF-1 and hs-CRP has not been adequately investigated, the main aim of this study was to evaluate the association between these biomarkers among postmenopausal women. Materials and Methods: A total of 361 healthy Iranian postmenopausal women were randomly selected in a population-based study. The metabolic syndrome was defined according to NCEP, ATPIII criteria. Circulating hs-CRP and IGF-1 levels were measured by highly specific enzyme-linked immunosorbent assay method. Results: Women with higher than median hs-CRP levels had lower IGF-1 levels, in comparison to women with lower than median hs-CRP levels (p<0.0001). In multiple regression analysis, after adjustment for age and the metabolic syndrome, IGF-1 levels had a significant inverse correlation with circulating hs-CRP levels (&beta;=-0.139, p<0.007). After adjustment for age, body mass index and type 2 diabetes mellitus, IGF-1 levels also showed an inverse correlation with hs-CRP levels (&beta;=-0.130, p<0.014). Conclusion: There is a significant inverse correlation between serum IGF-1 and hs-CRP levels in postmenopausal women. This finding provides evidence of the potential cardioprotective effect of IGF-1 via anti-inflammatory mechanisms

The Correlation of Adiponectin, and Visfatin Serum Levels With Ischemic Heart Disease in Postmenopausal women: A population-Based Study

Background: There is a controversial evidence about adiponectin role in cardiovascular diseases and visfatin role has been suggested in pathogenesis of coronary artery disease. Material and Methods: A total of 378 postmenopausal women were randomly selected from 13 clusters in Bushehr Port. The prevalence of ischemic heart disease was assessed by using the Minnesota Code with a 12-lead resting electrocardiogram (EKG). Serum adiponectin and visfatin levels were measured by using enzyme-linked immunosorbent assay methods Results: A total of 159 patients (41.8 percent) were suffering from ischemic heart disease. There was no significant difference between women with ischemic heart disease and healthy postmenopausal women in adiponectin serum level. However, diabetic women with ischemic heart disease, compared with healthy postmenopausal women had a higher level of visfatin (Geometric Mean: 3.05&plusmn;1.84 ng/ml versus 2.52&plusmn;1.90 ng/ml, respectively; p=0.023). Multiple logistic regression analysis indicated that higher serum levels of visfatin were significantly associated with a higher prevalence of ischemic heart disease after adjusting for potential confounders, including classical cardiovascular risk factors and circulating hs-CRP levels [odds ratio=3.26, confidence interval (1.14-9.68), p=0.027]. Conclusion: Adiponectin was not correlated with ischemic heart disease among postmenopausal women. But visfatin serum level correlated with ischemic heart disease in postmenopausal non-diabetic women independently from cardiovascular risk factors

The role of gated myocardial perfusion scintigraphy (GMPS) in myocarditis: a case report and review of the literature Correspondence to:

Acute myocarditis is one of the most challenging diagnoses and treatments in cardiology. The acute viral myocarditis diagnosis is usually based on high suspicion, history taking, and physical examination. Likewise, the use of chest radiography, electrocardiography (ECG), and echocardiography is helpful in making a final diagnosis, but all are non-specific. In addition, in imaging query, magnetic resonance imaging (MRI) depicts some degree of cardiac inflammation in the course of myocarditis. Myocardial perfusion imaging (MPI) has also been shown to be useful in diagnosis, and this noninvasive technique diminishes the need for myocardial biopsy. The current study presents the diagnostic and prognostic role of MPI in a 25-year-old patient with suspected myocarditis. The patient underwent gated-technetium- 99m-lablled, methoxyisobutyl isonitrile, single photon emission computed tomography (Gated 99mTc-MIBI SPECT) that showed nonheterogeneous absorption with remarkable decreased radiotracer uptake in the myocardium in both stress and rest phases. In addition, the gated mode demonstrated decreased wall motion and thickening of the myocardium with a sum motion score (SMS) of 28, a sum thickening score (STS) of 15, and a measured LVEF of 34%. The study concludes that 99mTC-MIBI SPECT imaging is a useful modality in the preparation of supplementary diagnostic and prognostic information in viral myocarditis

One year follow up effect of renal sympathetic denervation in patients with ‎resistant hypertension

BACKGROUND: Resistant hypertension is a common clinical problem of blood pressure that is not controlled despite the simultaneous application of multiple antihypertensive agents. Ablation of renal afferent nerves has been applied and proved to decrease hypertension and injuries produced by severe sympathetic hyperactivity. The main objective of this study was to investigate the long-term effect of renal artery sympathetic ablation and its complications in patients with treatment-resistant hypertension. METHODS: In this prospective study which done between March 2012 and November 2013, 30 patients with resistant arterial hypertension despite treatment with &ge;3 antihypertensive drugs-were randomly enrolled in this self-control clinical study in Isfahan, Iran. The patients were treated with the renal denervation procedure; the femoral artery was accessed with the standard endovascular technique and the Symplicity catheter was advanced into the renal artery and connected to a radiofrequency generator. Before and 12 months after renal denervation procedure waist, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), metabolic syndrome, fasting blood sugar (FBS), high-density lipoprotein (HDL), and triglyceride were measured in all patients. RESULTS: Both mean SBP and DBP were significantly decreased, 12 months after renal denervation (P &lt; 0.001). The frequency of metabolic syndrome was not significantly different after renal denervation in compare to baseline (P = 0.174). Furthermore, a significant decreased in FBS and triglyceride was observed in compare to baseline (P = 0.001). CONCLUSION: This study highlighted the role of renal sympathetic denervation as a modern and secure catheter-based method for sustained reduction hypertension in treatment-resistant cases.</p