[Epidemiological study of suicide attempt among urban community of Ilam]

Background: suicide is considered as one of the most important health issues in Ilam province especially after the postwar era. At present, Ilam province has the highest incidence rate of suicide in Iran, and has gained the attention of researchers and regional and national health authorities

Methods: the statistical population included all registered suicide and attempted suicide cases that referred to Shahid Mostafa Khomeini Hospital, Ilam during 2016. The total number of registered cases that were evaluated was 582

Results: results of the study showed a female predominance with highest rate for those aged 15-24 years. Based on educational history, individuals with high school diploma demonstrated the highest suicide rate, while most attempted suicides were observed among housewives. 3Iosr suicides took place at home and tablets were the mean b: which most of the suicides were made. In most of the cases the reason behind the suicide was unknown. The highest rate of attempted suicide \\%-as seen in individuals with a negative medical history and absence of any previous suicidal intentions

Conclusion: according to the results of this study, it is possible to reduce suicide among individuals b: t various means such as teaching life skills, identifying cases with family violence, providing strategies for solving the family problems, introducing supportive organization to the clients, and referral of the cases to related supportive organizations

Hemi-fontan or bidirectional cavopulmonary shunt for right ventricular failure after mitral valve replacement and acute ascending aortic dissection: report of two cases

Right ventricular failure due to right coronary artery disease, right ventricular hypertrophy, stunning, abnormal septal motion, myocardial infarction, or non-homogeneous distribution of cardioplegia is an uncommon but serious complication of open heart surgery. We report a patient with severe right ventricular hypertrophy secondary to severe mitral valve stenosis and another patient with detachment of the right coronary artery due to the dissection of the ascending aorta. The patients developed right ventricular failure, which persisted after surgery and rendered weaning from cardiopulmonary bypass unsuccessful. Through a hemi-Fontan, or bidirectional cavopulmonary shunt, and an intra-aortic balloon pump, the patients were successfully weaned from cardiopulmonary bypass. This shunt may be an alternative to a right ventricular assist device in some patients with right ventricular failure. The long-term outcome and the indication of bi-directional cavopulmonary shunt has not been confirmed, although it is believed to be effective for saving the life of patients with low cardiac output and acute right ventricular failure. In our cases, six months following the operation, there was some degree of recovery of the right ventricular function. In long-term follow-up, however, it would be interesting for the authors to know if the improved right ventricular function, with better antegrade pulsatile flow in the pulmonary artery, in any way interferes with the functioning of the bidirectional cavopulmonary shunt

Congenital saccular aneurysm of coarctation of aorta: a case report

True saccular aneurysm is exceptional in coarctation of aorta in children. A 6-year-old girl with headache and systemic arterial hypertension referred to our center for cardiovascular evaluation. Physical examination revealed high blood pressure and weak lower extremity pulses. Two-dimensional and Doppler echocardiography and angiography demonstrated a saccular aneurysm of the descending aorta, 5×4 cm in size, associated with aortic coarctation. Aneurysmectomy was performed without cardiopulmonary bypass. The section of the aorta containing the coarctation and the aneurysm was resected and replaced with a 15 mm woven polyester graft. Histological examination revealed a thin walled aneurysm with hyalinosis changes and decreased elastic fibers. One-year echocardiographic follow-up revealed no gradient across of Dacron tube and hypertension decreased to normal level

Myoclonus, seizure, and ventricular fibrillation after intrathecal injection of tranexamic acid

Tranexamic acid is generally used in the treatment of disorders that predispose one to bleeding. It is a synthetic lysine analog that has strong antifibrinolytic activity. Plasminogen binds to fibrin to form plasmin, which in turn degrades fibrin into fibrin degradation products. Tranexamic acid blocks the lysine binding site on plasminogen and prevents interaction with fibrin. Tranexamic acid reduces blood loss in open heart surgery, hip replacement, and gynecology procedures. In this first case of inadvertent intrathecal injection of Tranexamic acid in a pregnant woman, we found that a massive intrathecal injection of Tranexamic acid triggered refractory ventricular fibrillation and cardiovascular collapse, which did not respond to full resuscitation