Design of a generally applicable abdominal shield for reducing fetal dose during radiotherapy of common malignancies in pregnant patients

Background: In most cancer cases, the treatment choice for a pregnant patient is radiotherapy. In these patients, the abdomen is usually not exposed; therefore fetus exposure is due to peripheral dose (PD). The purpose of this study was to estimate the fetal dose (the maximum PD in each pregnancy stage) for modalities available and to fabricate and evaluate a generally applicable fetal shield. Materials and Methods: PD values were measured for brain, breast and mediastinum irradiation in a whole body anthropomorphic phantom using a NE 2571 ionization chamber. An external shield was then designed to reduce the fetal dose to the standard dose limit, 5 mSv. Results: The range of PD values as a function of distance from the field’s edge were as follows 1) 9.4-259 cGy for Mantel field; 2) 6.5-95 cGy for chest wall irradiation with 10 MeV electrons, 3) 8.5- 52.5 cGy for tangential field with Co-60 and 4) 4.8-7.8 cGy for brain radiotherapy with 9 MV photon. PD values for the same setups using the fetal shield were as follows: 1) 1.4-22 cGy, 2) 0.5-4 cGy, 3) 1.5-5 cGy and 4) under 1 cGy. Conclusions: The measured PD data sets can be used to estimate fetal dose for specific treatment setups and pregnancy stages. The use of external shield designed in this research reduced the fetal dose effectively to under the threshold (a 70-90% reduction), except for the final stages of pregnancy in Hodgkin’s patients

Prognostic Factors for Survival at 6-Month Follow-up of Hospitalized Patients with Decompensated Congestive Heart Failure

Abstract:BACKGROUND: The prevalence of Congestive Heart Failure (CHF) is increasing in recent years. Factors associated with mortality in CHF patients are important to be determined in order to select therapeutic modality by physicians. The purpose of the current study was to declare predictors of 6-months survival in patients hospitalized for decompensated CHF in Isfahan.METHODS: A cohort of 301 hospitalized patients with decompensated CHF were recruited in this study. The diagnosis of CHF was based on previous hospitalizations and Framingham criteria for heart failure (HF). Information regarding past history, accompanying diseases such as cerebrovascular accidents (CVA), chronic obstructive pulmonary diseases (COPD), clinical data, medications and echocardiography were obtained by a cardiologist. Patients were followed for their survival for 6 months by telephone calls. Kaplan-Meier method was used for uni variate survival analysis and Cox proportional hazard model was used for multivariate analysis.RESULTS: Mean age of patients was 71.9 &plusmn; 12.2 years and 59.8% was male. During 6-months follow-up 138 (45.8%) patients died. Mean survival was 119.2 &plusmn; 4.4 days (Mean &plusmn; SEM). Significant prognostic factors for 6 months survival were high education level (HR = 0.74, CI 95% 0.59&mdash;0.93), COPD (HR = 1.91, CI 95% 1.2&mdash;3.04), CVA (HR = 1.69, CI 95% 1.03&mdash;2.78), Angiotensin Converting enzyme (ACE) inhibitors use (HR = 0.44, CI 95% 0.3&mdash;0.66) and Diuretics (HR = 0.63, CI 95% 0.41-0.96).CONCLUSION: Six-month survival of hospitalized decompensated CHF patients in Iran is not favorable. Many factors particularly accompanying diseases and medications affected the patient&rsquo;s 6-months survival.Keywords: Heart failure, Survival,&nbsp; Mortality.</p

Dietary sodium and potassium intake and their association with blood pressure in a non-hypertensive Iranian adult population: Isfahan salt study

Aim: The association of sodium (Na) and potassium (K) intake with blood pressure (BP) is an ongoing debate, especially in central Iran. We aimed to examine the mean Na and K intake, major sources of Na and the relationship between BP and dietary and urinary Na and K. Methods: This cross-sectional study was performed in central Iran in 2013-2014. A total of 796 non-hypertensive adults aged >18years were randomly recruited. The semi-quantitative food frequency questionnaire was used to assess dietary Na and K intake. Moreover, 24-hour urine samples were collected to measure 24-hour urinary Na (UNa) and K (UK) as biomarkers. BP was measured twice on each arm using a standard protocol. Results: The mean Na and K intake were 4309.6±1344.4 and 2732.7±1050.5mg/day, respectively. Table and cooking salt were the main sources of Na. Odds ratio (OR) (95% confidence interval (CI)) of the crude model in the highest quartile of UNa indicated a significant association with the higher risk of prehypertension (OR (95% CI): 2.09 (1.09-4.05); P for trend=0.007). After adjustment for potential confounders, prehypertension was significantly associated with increasing dietary Na/K ratio (OR (95% CI): 1.28 (1.01-1.57); P for trend=0.046) and UNa/UK ratio (OR (95% CI): 2.15(1.08-4.55); P for trend=0.029). Conclusions: Increasing dietary and urinary Na/K ratios and UNa were associated with elevated BP and prehypertension occurrence. These findings support the necessity of developing a salt reduction programme in our country. © 2016 Dietitians Association of Australia

Efficacy of Glucose-Insulin-Potassium Infusion on Left Ventricular Performance in Type II Diabetic Patients Undergoing Elective Coronary Artery Bypass Graft.Dy

BACKGROUND: Glucose-insulin-potassium (GIK) may improve cardiovascular performance after coronary artery bypass graft surgery (CABG). Our study investigated whether an infusion of GIK during elective CABG surgery in type II diabetic patient improved left ventricular performance. &nbsp;&nbsp; METHODS: We measured left ventricular ejection fraction and troponin (Tn), a myofibrillar structural protein. In this research, after ethics committee approval, 50 patients with type 2 diabetes mellitus (DM) were enrolled into a randomized simple sampling, prospective, double-blind clinical trial study. In the case group, 500 cc dextrose water 5% plus 80 IU regular insulin and 40 mEq KCL were infused at the rate of 30 cc/hr. Patients in control group received 5% dextrose solution at the rate of 30cc/hr. Venous blood samples were taken before induction of anesthesia, after removal of the aortic clamp and before discharging from hospital. The Mann-Whitney-test was used to test for differences in Tn concentration between the groups. Fisher&rsquo;s exact test was used to determine whether there was a difference in the proportion of patients with a low ejection fraction (&lt;45%) in the case group compared with that in the control group. Changes in potassium and glucose concentrations over time within the groups were examined by ANOVA and paired t-tests. P&lt;0.05 was regarded as significant level for all tests. &nbsp;&nbsp; RESULTS: In this study, 50 patients with type 2 DM were evaluated in case and control groups. The mean age &plusmn; SD in the case group was 57.7 &plusmn;9.9 years and in the other group was 61.2 &plusmn; 8.4 years. The groups were well-matched for age, sex and number of bypass grafts. Randomization did not give an equal distribution of male and female patients. There wasn&rsquo;t any significant difference in ejection fraction between the case and control groups before and after CABG (P&gt;0.05). Tn concentration in the case group was 3.3 &plusmn; 5.0 and in the control group was 3.9 &plusmn; 5.1. There was no significant difference in Tn between the two groups before and after CABG (P&gt;0.05). There was not any significant difference in hospitalization time between the two groups.&nbsp; &nbsp;&nbsp; CONCLUSION: The results suggested that GIK can&rsquo;t improve left ventricular performance in routine CABG surgery. &nbsp; &nbsp;&nbsp; Keywords: Cardiovascular surgery, Glucose-Insulin-Potassium, Cardiac troponin

Effect of Applying Chemical Fertilizers on Concentration of Cd, Pb and Zn in Agricultural Soils

Background &Objective: &nbsp;Nowadays uncontrolled uses of chemical fertilizers which have many heavy metals such as Cadmium, Lead and Zinc in addition have economic problems, cause to serious damages in the environment. Therefore uncontrolled application of fertilizers can cause accumulation contaminants in soil, water sources and increasing in plants and human & animals&rsquo; food chain. The main objective of this research was to investigate the effects of chemical fertilizers application to increase heavy metals in agricultural soils at directions to prevent contamination in water sources, agricultural products and the best uses of chemical fertilizers. Methods: In this study, 20 soil samples and 5 useful chemical fertilizer samples were collected and investigated. After fertilizer and soil samples were prepared, digested and filtered, heavy metals were determined with using atomic absorption. Results: The results of this study showed that, Cd in Diammonum phosphate&nbsp; fertilizer 1.25 times, Super phosphate triple 1.7 times and in Macro granular fertilizer 1.5 times were as much as maximum acceptable concentration in chemical fertilizers. Cadmium concentration in all of the Jarghoye (Isfahan) agricultural soil samples 3 to 7 times and in the Mobarake village (Najaf abad) agricultural soil samples 10 to 35 times were as much as maximum acceptable concentration in agricultural soils. But Pb and Zn concentration in all of the agricultural soil samples was less than the amount of maximum acceptable concentration. Conclusion: Phosphate chemical fertilizers were positive effects to increase concentration of Pb and Zn in agricultural soils. Therefore, application of the fertilizer must be more attention because of increasing heavy metals in the agriculture soils and probably increasing heavy metals in food chain.&nbsp;&nbsp

Immediate outcomes of eptifibatide therapy during intracoronary stent implantation

Background: The objective of the present study was to assess the major immediate outcomes of eptifibatide therapy during intracoronary stent implantation. Materials and Methods: In an interventional study, patients undergoing percutaneous coronary intervention (PCI) were randomized into either the eptifibatide (n = 100) or the control (n = 107) group. In each group, demographic and clinical characteristics such as cardiac death, stent thrombosis (ST), myocardial infarction (MI), rates of target lesion and vessel revascularization, cerebral vascular accident (CVA), and emergency coronary artery bypass grafting (CABG) were recorded. Results: The overall rates of major adverse events such as mortality, Stent thrombosis (ST), Myocardial Infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), CVA, and emergency CABG within 24 h after stent implantation were low and comparable between the two groups; P > 0.05 considered significant for all comparisons. Conclusion: There were no statistical differences between the clinical outcomes of groups administered with single-dose intracoronary eptifibatide and control groups among patients undergoing PCI during stent implantation

A prospective double-blind randomized placebo-controlled clinical trial to evaluate the safety and efficacy of spironolactone in patients with advanced congestive heart failure on continuous ambulatory peritoneal dialysis

Congestive heart failure (CHF) is frequent in patients with chronic renal failure, and may contribute to high cardiovascular morbidity and mortality. There is little data in the literature about the safety and efficacy of use of spironolactone in patients with end-stage renal disease with heart failure. In this study, we evaluated the safety and efficacy of spironolactone in patients on continuous ambulatory peritoneal dialysis (CAPD) with CHF. This randomized pros-pective double-blind placebo-controlled clinical trial was performed at the St. Al-Zahra peritoneal dialysis center. Eighteen CAPD patients with New York Heart Association (NYHA) class III or IV heart failure, ejection fraction (EF) ≤45%, serum potassium level ≤5.5 mEq/L and who were eligible, were randomly assigned to taking either spironolactone (25 mg every other day) or placebo for six months. The serum potassium was measured monthly and echocardiography was repeated at the end of the study period. The serum potassium levels rose in both groups, and there was no statistically significant difference intragroup and between the groups during the study period. Only in one patient in the spironolactone group did the serum potassium level reach above the critical level (5.70 mEq/L) at the end of the second month of study, necessitating patient exclu-sion. The EF did not change significantly in the placebo group (33.3 ± 11.7 vs. 34.2 ± 11.6, F = 1, P = 0.363), but in the spironolactone group the EF rose significantly (25.7 ± 7.3 vs. 33.3 ± 7.8, F = 27.45, P = 0.002). Our study suggests that spironolactone could be used in CHF patients on CAPD to improve their cardiac function, but close monitoring of their serum potassium level is required

Blood group types and clinical, procedural, and adverse outcomes in ST-elevated myocardial infarction patients: A 3-year cohort in Iran

Background: The objectives of this study were to assess the relation of blood groups and the rate of successful angioplasty in patients with ST-elevated myocardial infarction (STEMI) and also to investigate long-term adverse outcomes follow-up. Materials and Methods: In this study, 500 eligible patients with definitive diagnosis of STEMI who underwent primary percutaneous coronary intervention (PCI) were followed up for 3 years. The patient's angiography images were examined and thrombolysis in myocardial infarction (TIMI) flow rate and coronary artery patency rate were evaluated in different ABO blood groups. All patients were followed up after 3 years based on major adverse cardiovascular events. Results: There was no significant difference in coronary artery patency rate between the patients of the different blood types with respect to TIMI flow before (P = 0.19) and after revascularization (P = 0.69). The incidence of atrial fibrillation (AF) in blood Group A was the highest. Death in the blood Groups AB and O was significantly higher than the other groups. No significant differences were seen in different blood groups in the frequency of mortality (P = 0.13), myocardial infarction (P = 0.46), heart failure (P = 0.83), re-hospitalization, angiography (P = 0.90), PCI (P = 0.94), coronary artery bypass graft (P = 0.26), implantable cardioverter defibrillator (ICD) implantation (P = 0.26), and mitral regurgitation (P = 0.88). Conclusion: The incidence of AF in blood Group A and inhospital mortality in blood Groups AB and O were the highest. The blood group may be considered in assessment of clinical risk in STEMI patients