[Effect of a cardiac rehabilitation program on clinical and paraclinical findings of patients with ischemic heart disease]

Ischemic heart disease [IHD] is predicted to be the most common cause of death worldwide by 2020. Cardiac rehabilitation [CR] as a secondary preventive measure can reduce the cardiac risk factors, mortality and morbidity, and improve the quality of life in such patients. This study aimed to investigate the effect of an 8-week CR program on clinical and paraclinical findings of patients with IHD. This clinical trial was performed on IHD patients referred to Kashan Shahid Beheshti hospital. Patients were allocated the two groups [rehabilitation and control]. The rehabilitation group received an 8-week rehabilitation program; the clinical and paraclinical evaluations were performed before and after the program. This study showed that body weight, BMI, HDL, TG, FBS, resting heart rate and the systolic and diastolic blood pressure, quality of life, exercise capacity, maximal oxygen uptake during exercise and the numbers of recurrent hospitalization were significantly improved in the rehabilitation group [P<0.001]. The rehabilitation program had no effect on the platelet count, frequency and duration of chest pain, total cholesterol, and LDL. Using an 8-week cardiac rehabilitation program can be beneficial in the management of IHD patients and ultimately can reduce the risk factors of the heart diseases, improve the quality of life and reduce the risk of disease exacerbation

[Serum digoxin level among patients referred to Kashan cardiovascular clinic during 2009-10]

Considering that the Digoxin's therapeutic level is very close to its toxic level, it is important to determine the digoxin dose. Digoxin serum level is affected by multiple pharmacokinetic factors. Therefore, this study aimed to evaluate the serum digoxin level and its relation with the initial dose and other related factors in patients referred to Kashan cardiovascular clinic. This cross-sectional study was carried out on 125 patients for whom digoxin was prescribed for at least one month. The patients were excluded in the case of having simultaneous history of thyroid disease and other antiarrhythmic drugs. Serum digoxin, creatinine and potassium level and also the demographic characteristics of the patients for the first time were checked out. The mean age of patients was 63.7 +/- 13.42 years. Sixty-six [52.8%] cases were male. The most common reason for drug implication was systolic dysfunction [63.2%] and the most common cause of systolic dysfunction the coronary artery disease [56.61%]. Most patients [70.4%] had a glomerular filtration rate [GFR] between 30-90 ml/min. Moreover, Fifty-nine patients [47.2%] with the highest frequency in treatment group were treated with 3.5 tablets per week. Serum digoxin level was significantly associated with the age and GFR [P=0.001 and P=0.008, respectively], but not with gender, potassium level and the reason for drug use and left ventricular ejection fraction. The main factor in determining the digoxin dose is the patient's GFR that includes all pharmacokinetic variables of drug plasma level

[Assessing the effective dose of warfarin in treatment course of the patients referring to Kashan heart clinic]

The major problem in prescribing the therapeutic dose of warfarin, the most clinically used anticoagulant, is achieving its optimal International Normalized Ratio [INR]. This study was designed to determine the mean dose of warfarin among the patients admitted to Kashan Heart Clinic in 2008. In this cross-sectional study, the medical documents of all patients receiving warfarin in any medical indications were studied for demographic specification, INR results, smoking, other used drugs and the underlying diseases. The warfarin dose attained [INR equal to 2.4-2.6 for 3 consecutive test results] was regarded as the optimal dose. All unqualified cases in terms of INR criteria were excluded. Statistical analysis was done using ANOVA, Pearson, Spearman and t-tests. Seventy one out of 86 patients were included in the study. The mean daily dose of warfarin was 3.97 +/- 1.38 mg. Fourty six, 13, 11 and one patient[s] received warfarin for atrial fibrillation, prosthetic valve, congestive heart failure and embolic cerebrovascular accident, respectively. While warfarin dose had an inverse relation to age [P=0.01], it had no significant relation with sex [P=0.7], underlying diseases [P>0.07], smoking [P=0.2], other used drugs [P=0.07] and the patient weight [P=0.1]. The results showed that warfarin dose was higher among the patients with prosthetic valve [P=0.008]. The obtained effective daily and weekly dose of warfarin i.e. 3.97 +/- 1.38 and 27.83 +/- 9.77 mg, respectively could be used as a therapeutic clue for prescribing the appropriate dose and optimum INR

Comparison of Perkins, Tono-Pen and Schiotz tonometers in paediatric patients under general anaesthesia

This cross-sectional study aimed to investigate if the Tono-Pen, Schiotz and Perkins tonometers could be used interchangeably in general practice for measuring elevated intraocular pressure. A total of 74 eyes of 37 paediatric patients under general anaesthesia were checked with all 3 tonometers. All of the tonometers gave significantly different measurements from each other. However, with a mean difference of 1.4 mmHg and 95% limits of agreement of -5.7 to +8.6, the greatest agreement was between the Perkins and Tono-Pen tonometers. The Perkins tonometer is a hand-held variant of the Goldmann tonometer [the gold standard for intraocular pressure measures]. Therefore the Tono-Pen with its ease of use and safety could be a reliable device for use in general practice