[ efficacy of biomarkers indexes in comparison with echocardiography in assessment of antracycline induced cardiotoxicity in cancer patients]

Anthracyclines are the most frequent cause of treatment-induced cardiotoxicity and can cause severe morbidity and mortality during the life. The aim of the present study was to assess the validity and efficacy of cardiac biomarkers such as serum troponin I and creatine phosphokinase MB versus the standard echocardiography for early diagnosis of anthracycline-induced cardiotoxicity. This was an analytical study in which 46 cancer patients who received anthracyclines-containing chemotherapy were investigated during 2007 to 2008.patients were selected based on obtaining a convenience sample using a consecutive sampling method. The serum levels of CKMB and cTnI were measured before treatment, after the third cycle of therapy, and following the completion of chemotherapy. Echocardiography was performed a year later for monitoring the cardiac function. Data were analyzed using chi square, Fisher's Exact and ANOVA tests. Our results showed that among three diagnostic methods [serum cTnI, CKMB measurements, and echocardiography] to diagnose anthracycline-induced cardiotoxicity, the echocardiography was found to be of higher value compared to other two laboratory tests measured [p<0.000]. Considering the high diagnostic value of echocardiography in monitoring the cardiac function during anthracycline containing chemotherapy and also high cost of laboratory testing of CKMB, cTnI, it recommended that the ECG to remain as a valuable and cost-effective technique in monitoring the cardiac function

[Risk factors of breast cancer in Ramsar and Tonekabon]

Breast cancer is the most common cancer and the leading cause of death in women between 40-45 years old. Recognition of highly significant risk factors of breast cancer is of vital importance in preventing the incidence of this type of malignancy. The objective of this study was to determine the risk factors of breast cancer. This was a descriptive-analytical case-control study. The study population consisted of patients with and without breast cancer living in two cities of Ramsar and Tonekabon who visited the hematology and oncology clinic during 2004-2007. A total of 120 individuals were selected based on pairs sampling method. The study tool was a researcher-designed questionnaire which could evaluate a number of variables. Data were analyzed using statistical tests including chi-square test, paired t-test, and logistic regression. Findings: There was a significant relationship between the breast cancer and the duration of breast feeding [p<0.02], family history of breast cancer [p<0.01], history of using oral contraceptive pill [p<0.000], condition of menopause [p<0.000], and history of abortion [p<0.001]. Considering our data, periodic screening of women with one or more risk factors of breast cancer is recommended

Evaluating correlation between neutrophil and congestive heart failure

Acute myocardial infarction [MI] with inflammatory response is a result of tissue necrosis due to leukocytosis and increased number of peripheral blood neutrophils. To investigate the relationship between neutrophils and congestive heart failure [CHF]. This cohort study was performed on 100 patients affected by acute MI who had two points out of three standard criteria [physical examination, enzyme and EKG findings] during the last 6 months of 2002 in Yahyanezhad hospital, Babol, Iran. CHF was detected through physical examinations, medical history, chest X-ray, and echocardiography using a CFG 750 VinG Med Instrument at the fourth day of admission. Ejection fraction 0.05] when the age of patients taken into account. Our data show that the neutrophilia of admission time correlates significantly with heart failure as an early onset of acute MI. This could be useful both in detection of high-risk people and also diagnostic and therapeutic measures

[Peripartum cardiomyopathy: a case report]

Peripartum cardiomyopathy is a rare but sometimes fatal form of heart failure during the period of 1 month antepartum to 5 months postpartum. The aim of this report is to assess the clinical presentation, management and crucial role of echocardiography in women with peripartum cardiomyopathy. A 22 year-old woman, with previously healthy primipara, was admitted to the emergency ward with sever dyspnea, cough, and bloody hemoptesis and a preliminary diagnosis of pulmonary embolism [PE] two weeks after cesarean section. Neither perfusion scintigaphy nor Doppler sonography test of lower extremities and pelvis showed any evidence of PE or deep venous thrombosis. Echocardiography revealed features of left ventricular failure. A diagnosis of peripartum cardiomyopathy was made, appropriate treatment was administered and the patient improved. It is possible to misdiagnose peripartum cardiomyopathy with PE. Echocardiography is a valuable tool in the differential diagnosis. As a noninvasive procedure, it should be performed at the bedside as soon as possible to introduce proper treatment and to avoid potentially fatal errors

[Evaluation of platelet indices and count in patients with ischemic heart disease compared to normal population]

Atherosclerosis and its complications are a major cause of ischemic heart diseases. Platelets play an important role in initiation of atherosclerosis and coronary thrombus formation. Large platelets are shown to be hemostatically more active. Evaluation of platelet volume parameters could be useful and significant in prediction and differentiation of coronary events. In this study, 100 patients with chest pain were divided into 3 groups according to clinical manifestation and standard diagnostic criteria. 25 patients were with unstable angina, 25 patients with chronic stable angina and 50 patients with non-cardiac chest pain as normal population. Platelet indices and count were assayed within 1 to 3 hours, after sampling from venous blood and collection in K3 EDTA, by a Sysmex KX21 analyzer. Data were provided for each group and surveyed by ANOVA and Tukey tests with Pearson correlation and P-value less than 0.05. Patients with unstable angina had a significant higher MPV [Mean platelet volume] [10.7 +/- 0.23 fl], PDW [Platelet distribution width] and PLCR [Platelet-lerge cell ratio] than those in chronic stable angina and normal group [P<0.05]. MPV in chronic stable angina patients [10.1 +/- 0.2 fl] was higher than normal population [9.5 +/- 0.1 fl] but platelet count and other indices were not statistically significant difference. There were no sex or age differences in MPV amounts in population group. Platelet volume indices are increased in unstable angina probably because of platelet activation and a compensatory volume enhancement. Platelets count reduction in this condition results from platelet consumption. These changes in platelet count and volume could differentiate unstable angina patients from chronic stable patients and normal individuals

Factors influencing the length of hospital stay of patients with heart failure

We evaluated the factors [demographic, clinical, procedural and hospital-related factors] influencing length of hospital stay [LOS] of patients with Congestive Heart Failure [CHF]. Congestive heart failure is an imbalance in pump function in which the heart fails to maintain the circulation of blood adequately. CHF is a major medical problem with significant hospital costs in adults. There are growing numbers of CHF diagnosed each year. Consequently, providers are constantly challenged to find more cost effective ways to care for CHF patients without compromising quality of care. We used univariate and multivariate models to evaluate which demographic, clinical and administrative factors influenced length of stay in 100 patients with CHF admitted to Yahyanejad general hospitals between 2001 and 2003. One hundred patients were included in this study. Mean age 61 years, mean left ventricular ejection fraction 37%. Median length of hospital stay was 6 days [IQR 4, 9]. Longer than average length of stay, defined as >6 days, was associated with the presence of peripheral congestion, duration of treatment with intravenous diuretic, the development of renal impairment, other acute medical problems at admission, iatrogenic complications during hospital stay. Conclusions: Peripheral congestion, concomitant acute medical problems requiring specific treatment, were related to a longer than average length of hospital stay. Multivariate models only partly explained variance in hospital stay, suggesting the importance of pre and post-discharge factors, including the healthcare environment, the availability of primary and secondary care resources, and the threshold for hospital admission

[Multiple brain infarctions and aneurysm of interatrial septum: case report]

Background and Objective: Previous reports have described an association between atrial septal aneurysm and cerebral embolic events. We report this patient for clinical presentation of multi-infarction and role of transesophageal echocardiography in diagnosis of this condition

Case: A 40-year-old man was admitted in hospital because of sudden right hemiparesis, which repeated after three weeks with Wernicke dysphasia and after that degrees of apathy. Brain CT scan revealed some hypodense areas. Ultrasound study failed detect any thrombosis or stenosis in carotid, vertebral and basilar arteries. MRI was in favor of vascular events. No arrhythmia was found in holter ECG. Transthoracic and transesophageal echocardiography were in favor of atrial septal aneurysm without patent foramen ovale or any thrombus. Warfarin was started and there was no recurrence during follow up

Conclusion: Inter-atrial septal aneurysm is probably an important factor for stroke. Embolic event is due to migration of in situ thrombosis or transition through it. Marked mobility and thickness of aneurysm may also increase the risk of embolization. Transesophageal echocardiography is a helpful tool in the diagnosis and management of patients with stroke and this anomaly