Right coronary artery-to-pulmonary artery fistula, the role of echocardiography

Coronary artery fistula is an uncommon but hemodynamically significant anomaly of the coronary arteries, occurring as an incidental finding in 0.1% to 0.2% of coronary angiograms. Although half of the patients with a coronary artery fistula remain asymptomatic, the other half develops CHF, infective endocarditis, myocardial ischemia, or rupture of an aneurysm. This report is illustrative of the right coronary artery fistula to the right pulmonary artery in a 57-year-old male. The definitive diagnosis was made during transesophageal echocardiography and confirmed at operation

Comparison of N-acetylcysteine and angiotensin converting enzyme inhibitors in blood pressure regulation in hypertensive patients

BACKGROUND: Hypertension (HTN) is the most prevalent non-infectious disease worldwide and can lead to mortality. This trial aimed to compare the effect of N-acetylcysteine (NAC) and angiotensin-converting enzyme inhibitors (ACEIs) on controlling blood pressure in hypertensive patients. METHODS: This cross-sectional clinical trial was conducted in Hajar Hospital, Shahrekord, Iran, in 2009. A sample of 126 patients with HTN was selected and randomly divided into 2 groups (group A and group B). First, group A was treated with ACEI alone and group B with ACEI + NAC for 2 months. Blood pressure of all patients was evaluated each week. After a 2 week period of washout, the drugs were changed. In the second period of the trial, group A was treated with ACEI + NAC and group B with NAC alone and their blood pressure was evaluated in the same manner as the previous period. The data were analyzed using SPSS. RESULTS: A significant reduction was observed in systolic and diastolic blood pressure of patients (P < 0.050). However, during both periods of the trial, the group receiving NAC + ACEI experienced a more significant reduction in blood pressure compared with the ACEI group (P < 0.050). CONCLUSION: NAC accompanied with ACEI decreased the patients' systolic and diastolic blood pressure significantly; however, ACEI alone did not have any significant effects on blood pressure. Systolic blood pressure decreased 7 mmHg on average and fluctuated during the trial

The Necessities and Requirements of the Pediatric Angiography Ward from the Perspective of the Healthcare Team: A Qualitative Study

Background & Aims: Pediatric angiography has been widely used for the diagnosis and treatment of congenital heart disorders in children over the past two decades. The work environment of the nurses of pediatric intensive care units is highly stressful due to various technical and medical equipment and patients with life-threatening diseases. In order to improve special pediatric care environments, attention must be paid to the experiences and opinions of the nurses employed in these units. To this end, the prioritization of the health of workplace and applying multidimensional approaches to the health promotion of the workplace are paramount. Considering the teamwork involved in patient care and treatment and increased number of beds in intensive care units, it is critical to evaluate the perceptions of physicians and nurses regarding the aspects of care in intensive care units. The improvement of the performance of pediatric critical care nurses and attention to their experiences and viewpoints are also essential in this regard. To this end, the prioritization of the health of workplace and applying multidimensional approaches to the health promotion of the workplace are paramount. The use of pediatric angiography has increased in the past two decades. In addition, the differences in the culture, environment, and education of nurses in pediatric intensive care units, along with the differences in the hospitalized patients further emphasize on the necessity of qualitative research. However, most of the studies in this regard have been performed with a quantitative approach, while only qualitative research could determine the dimensions of the perceptions of the healthcare team. To date, no qualitative studies have assessed the experiences of the healthcare team in the pediatric angiography ward. The present study aimed to elaborate on the necessities and requirements of the pediatric angiography ward from the perspective of the healthcare team. Materials & Methods: This study was conducted using the qualitative content analysis approach in 2018. The sample population included 20 subjects, including nine nurses, four radiologists, and seven cardiologists, who were selected via purposeful sampling from the angiography unit of Hajar Hospital in Shahrekord, Iran. The inclusion criteria were the nurses and physicians with one year of work experience in the angiography or cardiology ward and willingness to participate in the study, and the exclusion criterion was unwillingness to participate. The duration of the interviews was 35-60 minutes, and the recordings were performed in accordance with ethical principles. Data collection and interviews continued until reaching data saturation. Data collection and analysis continued for four months. The semi-structured, individual interviews were initiated with the nurses and physicians with an open question ("Please explain your experiences of working in the pediatric angioplasty ward."/"What challenges have you faced in performing pediatric angiography?") The interviews continued with probing questions ("Please explain further."/"Please set an example.") The obtained data were analyzed using the qualitative content analysis method. After the researcher listened to the recorded interviews several times, he was immersed in the data to obtain an overview of the interviews. All the interviews were transcribed word-for-word, so that the words containing the key concepts would be highlighted and the codes would be extracted. After extracting the concepts and codes from important sentences and paragraphs, they were classified into categories based on the similarities and differences, and the categories were reduced to a smaller number of categories based on their correlations. In order to maximize the diversity of the participants, the research units were selected from the nurses, physicians (pediatric cardiologists), and radiologists engaged in the angiography ward. To ensure the accuracy and reliability of the research findings, the four criteria of credibility, dependability, transferability, and conformability were considered. To observed ethical considerations, a letter of recommendation was obtained from the Vice-Chancellor of Research of Shahrekord University of Medical Sciences. In addition, written informed consent and permission to record the interviews were obtained from the subjects prior to participation. Results: The mean age of the nurses was 34 years, and the mean work experience in the angiography ward was five years. The mean age of the radiologists was 31.5 years, and the mean work experience in the angiography ward was three years. The mean age of the pediatric cardiologists was 45 years, and the mean work experience in the angiography ward was five years. Data analysis yielded the three categories of the sensitivity of the ward, the necessity of the proper use of specialized equipment, and the need for education and skills training. The category of the sensitivity of the ward had three subcategories of the special conditions of the patients, sterilization of the angiography environment, and the need to become familiarized with the ward. The category of the proper use of specialized equipment had two subcategories of expensive equipment and management regulations of the maintenance of specialized equipment. The category of the need for education and skills training had two subcategories of the need for knowledge skills and the need for communication skills. Conclusion: The three most important findings of this study were the need for familiarity and proper use of specialized equipment and the necessity of education and skills training, which are like a golden treasure, the key to which is in the hands of hospital managers and officials. The training of the healthcare team in the angiography ward is a gradual and continuous process. Among the required skills for practice in the angiography ward are having adequate knowledge and the ability to properly communicate with the patients and their companions and the ability to use the specialized equipment correctly and appropriately, which could be achieved through the implementation of communication and counseling training courses, training on the use of specialized equipment, and the necessary preparations for the personnel of this ward. Considering the sensitivity of the angiography ward, the criticality of the applied procedures in the ward, and important issues such as clinical governance and accreditation, special attention should be paid to educational need assessment in order to implement proper interventions by hospital managers and health planners in terms of the training and skills of the personnel. Keywords: Angiography Ward, Children, Healthcare Tea

Relationship between risk factors and in-hospital mortality due to myocardial infarction by educational level: a national prospective study in Iran

Introduction: Since no hospital-based, nationwide study has been yet conducted on the association between risk factors and in-hospital mortality due to myocardial infarction (MI) by educational level in Iran, the present study was conducted to investigate relationship between risk factors and in-hospital mortality due to MI by educational level. Methods: In this nationwide hospital-based, prospective analysis, follow-up duration was from definite diagnosis of MI to death. The cohort of the patients was defined in view of the date at diagnosis, hospitalization and the date at discharge (recovery or in-hospital death due to MI). 20750 patients hospitalized for newly diagnosed MI between April, 2012 and March, 2013 comprised sample size. Totally, 2511 deaths due to MI were obtained. The data on education level (four-level) were collected based on years of schooling. To determine in-hospital mortality rate and the associated factors with mortality, seven statistical models were developed using Cox proportional hazards models. Results: Of the studied patients, 9611 (6.1%) had no education. in-hospital mortality rate was 8.36 (95% CI: 7.81-8.9) in women and 6.12 (95% CI: 5.83-6.43) in men per 100 person-years. This rate was 5.56 in under 65-year-old patients and 8.37 in over 65-year-old patients. This rate in the patients with no, primary, high school, and academic education was respectively 8.11, 6.11, 4.85 and 5.81 per 100 person-years. Being woman, chest pain prior to arriving in hospital, lack of thrombolytic therapy, right bundle branch block, ventricular tachycardia, smoking and ST-segment elevation myocardial infarction were significantly associated with increased hazard ratio (HR) of death. The adjusted HR of mortality was 1.27 (95% CI: 1.06-1.52), 0.93 (95% CI: 0.77-1.13), 0.72 (95% CI: 0.57-0.91) and 0.82 (95% CI: 0.66-1.01) in the patients with respectively illiterate, primary, secondary and high school education compared to academic education. Conclusion: A disparity was noted in post-MI mortality incidence in different educational levels in Iran. HR of death was higher in illiterate patients than in the patients with academic education. Identifying disparities per educational level could contribute to detecting the individuals at high risk, health promotion and care improvement by relevant planning and interventions in clinics and communities

ASSESSMENT OF THE EFFICACY OF PROPRANOLOL AND DILTIAZEM ON THE INTENSITY, DURATION AND PERIODS OF PAIN IN THE ANGINA PATIENTS REFERRED TO THE HEART CLINIC OF THE SHAHREKORED UNIVERSITY OF MEDICAL SCIENCES

ASSESSMENT OF THE EFFICACY OF PROPRANOLOL AND DILTIAZEM ON THE INTENSITY, DURATION AND PERIODS OF PAIN IN THE ANGINA PATIENTS REFERRED TO THE HEART CLINIC OF THE SHAHREKORED UNIVERSITY OF MEDICAL SCIENCES KHaledi A1, Elahei N2,Moradi M3, Salehi SH4* Received: 7 Sep , 2013 Accepted: 16 Nov , 2013 Abstract Background & Aims: Ischemic heart disease is one of the most common, chronic and deadly diseases in the world. Ischemic heart disease treatment consists of ensuring the patient, its identification, eliminating risk factors, lifestyle changes and drug therapy. The study tries to compare the efficacy of propranolol and diltiazem on the intensity, duration and periods of pain in the angina patients referred to the heart clinic of Shahrekored University of Medical Sciences. Materials & Methods: In a cross sectional study 60 patients with stable angina were selected with convenience sampling. Initially after receiving exercise testing, and completing the questionnaire to determine angina class, the patients were randomly divided into A and B groups by using the questionnaire and related chart recording of physiological variables. Demographic characteristics, types of drugs, the number of angina attacks and the results of the stress test were registered. The patients were treated with 20 mg propranolol every 8 hours daily, and with 30 mg diltiazem for 6 weeks, and they were considered as Group A, and Group B respectively. The patients were examined by a cardiologist for 6 weeks. Inclusion criteria to the survey were typical angina pain, positive exercise test, patient satisfaction, and dwelling in the provincial capital. Exclusion criteria were negative exercise test, treated with cardiac drugs, drug complications, diabetes, severe ischemic attacks, and cutting off medication. Hospitalization data were recorded by a questionnaire, and the collected papers were analyzed by using SPSS statistical software. Results: The results showed that from the 60 stable angina patients in both groups of A, and B, 68.3 % were male, and 31.7 % were females. The most abundant minor pain, was angina pain, with 50% , and the least pain, was terrified angina pain with 10%. The most abundant Angina class was class 2 with 80%, and lowest was class 3 with 8.3%. There was a significant differences between the two groups of treatment concerning the drug’s effectiveness, number of attacks of pain, and the effect of pain. Fisher's exact test indicated that there was a significant difference between negative exercise test in the two groups. Conclusion: Although both Ayndral and diltiazem had an effective role on the quality of pain, number of attacks, period of pain in patients with stable angina, but this effect was more effective in diltiazem group. More investigations with bigger sample size are needed

Heart Failure, the Outcomes, Predictive and Related Factors in Iran

Background and purpose: Heart failure (HF) is a serious issue concerning public health in all countries. Assessment and monitoring of mortality and influencing factors are of great importance in HF treatment programs. This study was conducted to determine the incidence of HF and the associated factors in Iran. Materials and methods: In this study, we did two main, independent analyses. One was a cohort analysis and the other a nested case-control. The study population included 1691 patients with HF (case group) and 6464 individuals without HF (control group). They were recruited from a hospital-based cohort in cardiology wards of hospitals across Iran in 2012. Results: The incidence rate and the 95 confidence interval of HF was 8.1: 95CI: 7.7-8.5 in study population (per 100 person-year). HF Incidence was higher in women than that of the men (95 8.6: 7.9-9.4 and 95 CI: 7.9: 7.5-8.3, respectively). The highest incidence of HF was observed in Khouzestan and Guilan provinces (9.05 and 7.51, per 100 person-year, respectively) while the lowest incidence was found in Zanjan and Kohgiluyeh and Boyer Ahmad (0.47 per 100 person-year). We found atrial fibrillation (AF), coronary artery bypass grafting, and ventricular tachycardia with highest contribution to mortality in patients with HF. Cerebral vascular attack, diabetes type II, hypertension, and the occurrence of disease in cold seasons were among the main determinants for HF incidence. Conclusion: This study showed different distribution of HF in different parts of Iran. The study suggests that identifying the risk factors predicting the incidence of HF could play a major role in developing efficient programs to reduce the rate of mortality due to HF. © 2014, Mazandaran University of Medical Sciences. All rights reserved

The effect of recommended recitals on the severity of perceived pain in hospitalized patients undergoing surgery: a randomized clinical trial

زمینه و هدف: جراحی یک تجربه استرس زا است که با درجاتی از درد همراه است. دعا و ذکر، قبل از عمل جراحی در جهت کاهش درد تأثیر بسزایی دارد. این مطالعه با هدف بررسی تأثیر اذکار مستحبی بر سطح درد درک شده بیماران بعد از عمل جراحی انجام شده است. روش بررسی: در این مطالعه کارآزمایی بالینی، 108 نفر از بیماران کاندید عمل جراحی مراجعه کننده به بیمارستان آیت اله کاشانی شهرکرد انتخاب و به صورت تصادفی در دو گروه آزمون (54 نفر) و شاهد (54 نفر) قرار گرفتند. شاخص های فیزیولوژیکی در هر دو گروه قبل از مداخله کنترل شد. در گروه آزمون در خصوص تکرار اذکار مستحبی مشخص شده، آموزش لازم داده شد. با استفاده از ابزار دیداری درد (Visual Analogue Scale= VAS) در ساعت 3،12 و 24 بعد از عمل، شدت درد درک شده در دو گروه ارزیابی شد. یافته ها: تمامی بیماران مطالعه را به پایان رساندند. آزمون کای دو نشان داد که در بین دو گروه از نظر نوع عمل جراحی، جنس و سطح تحصیلات تفاوت آماری معنی داری وجود ندارد (05/0P). نتیجه گیری: ذکر و دعا منجر به افزایش آستانه درد، ارتقاء سطح سازگاری، کاهش درد در بیماران شده است؛ همچنین هیچگونه عارضه ای در این خصوص مشاهده نگردید. لذا توصیه می شود که قبل از عمل جراحی برای بیماران امکانات لازم برای انجام ذکر خدا و فریضه عبادی فراهم گردد

Epidemiological pattern of myocardial infarction and modelling risk factors relevant to in-hospital mortality: the first results from the Iranian Myocardial Infarction Registry

Background: Myocardial infarction (MI) care and treatment contribute greatly to the patients' fatality and mortality. Assessing and monitoring mortalities and the effective factors are necessary in MI care and treatment programs. No comprehensive and population-based study has yet been conducted in Iran to determine the epidemiological pattern of MI, and particularly in-hospital mortality rate and the effective factors. Aim: To determine the epidemiological pattern of MI based on person-, time-, place-, and mortality-associated risk factors. Methods: This was a prospective, population-based cohort study, which analysed the data of 20,750 MI patients in Iran in 2012. MI was diagnosed based on ICD-10: codes I21 and I22. The cohort of the patients was defined in terms of the date at diagnosis, hospitalisation, and the date at discharge (recovery or death due to MI). The in-hospital mortality rate was calculated by Cox regression. Univariate analysis and multiple logistic regression were used to determine the effective factors on the patients' mortality. The odds ratio (95% confidence interval CI]) was reported using Stata software. Results: The relative frequency of in-hospital mortality was 12.1%. The in-hospital mortality rate was higher in women than in men, and 6.74 (95% CI 6.4-7.0) per 100 person-years were at risk of death. The highest relative mortality (13.2%) was obtained in January (11 Dey to 11 Bahman in the Persian calendar) and the lowest (5.9%) in May (11 Ordibehest to 10 Khordad in the Persian calendar). Age of over 84 years, female gender, educational level, smoking, lack of thrombolytic therapy, type 2 diabetes, chest pain prior to arriving in hospital, right bundle branch block, ventricular tachycardia, percutaneous coronary intervention, lateral MIs, and ST segment elevation myocardial infarction (STEMI) were determinants of in-hospital mortality in the patients. The relative frequency of mortality was higher from STEMI (83.7% of deaths in registry) vs. non-STEMI (16.3% of deaths in registry). Conclusions: STEMI, lack of thrombolytic therapy, age of over 84 years, and ventricular tachycardia have the greatest effect on in-hospital mortality in MI patients. The results of this study are helpful in planning for monitoring and promotion of healthcare of the patients

Association between dietary salt intake and reservation of renal function in patients with mild hypertension

BACKGROUND: It is now hypothesized whether restricted salt intake can be a potential precursor to renal dysfunction in mild hypertension state. We aimed to study the association between salt intake and renal function in patients with mild hypertension. METHODS: One hundred consecutive hypertensive Iranian patients (with systolic blood pressure 140-160 mmHg and/or diastolic 90-100 mmHg) who were referred to the hypertension research center, Isfahan, Iran, between 2011 and 2014 for screening of hypertension were assessed. Renal function was assessed by measuring serum creatinine (Cr) and creatinine clearance (CrCl). Daily salt intake was assessed on the basis of 24 h urinary sodium excretion. RESULTS: There was no association between the amounts of sodium intake and serum Cr concentration (r = 0.138, P = 0.174), however, an association was revealed between sodium intake and value of CrCl (r = 0.303, P = 0.003). Multivariable linear regression model showed that sodium intake could effectively predict renal function assessed by CrCl (Beta = 0.070, P = 0.016). CONCLUSION: There is an association between sodium intake and reservation of renal function in mild hypertension state and thus by restriction of dietary salt intake, reserving renal function, and preventing appearance and progression of renal insufficiency in higher degrees of hypertension can be facilitated

Effect of hand and foot surface stroke massage on anxiety and vital signs in patients with acute coronary syndrome: A randomized clinical trial

Background and objectives: Anxiety affects various body systems, which leads to an increase in respiratory rate, heart rate, blood pressure, and myocardial oxygen demand. The aim of this study was to investigate the effect of hand and foot surface stroke massage on the level of anxiety and vital signs in patients with acute coronary syndrome (ACS). Materials and methods: The single-blind clinical trial was performed on 70 patients with ACS. The patients were randomly assigned to the case and control groups. Anxiety levels were controlled 30 min before and 15 min after the intervention. The vital signs were checked in the two groups before, immediately after, 60 min, and 90 min after the intervention. The data were analyzed using SPSS software, descriptive statistics (mean ± standard deviation), independent t-test, paired t-test, and chi-square test. Results: No significant difference was observed in the patients' levels of anxiety, systolic blood pressure, diastolic blood pressure, respiratory rate, and pulse rate before the intervention. However, after the intervention, the mean changes in the levels of anxiety, blood pressure, heart rate, and respiratory rate were significant. Conclusion: Hand and foot massage can be a useful nursing intervention in attenuating anxiety levels and improving the vital signs in patients. © 201