[Clinical and paraclinical characteristics of hospitalized pa talents with congestive heart failure in Yazd [a survey of 258 patients]]

The Clinical and Paraclinical Characteristics of patients with congestive heart failure [CUF] have been described by a number of previous studies, but very little information is available on this issue in Iran. This study aimed to delineate the clinical and paraclinical characteristics of Iranian patients hospitalized with CHF. During an observational, analytical, descriptive, cross-sectional study, 258 consecutive patients were interviewed and examined at S hospitals in Yazd, Iran from January to December 1999.Questionnaire comprised of information regarding etiology, signs, symptoms, paraclinical data, etc. Results were analyzed by SPSS9.01 and EP16 programs using ANOVA, Chi-Square and f-TEST and reported as Mean +/- SD. The study population had a high mean age [67.59 +/- 0.73], 0.8% were less than 35 years old and 70.80% were older than 65 years. Mortality rate due to heart failure was 7.5%. Major causes of CHF were ischemia [65.1%]. valvular lesions [5.8%], cardiomyopathy [5%] and hypertensive heart diseases [4.6%]. Mean number of hospitalizations per year was 2.2 +/- 0.1, while mean hospitalization time was 7.25 +/- 3.8 days and mean cost was 1122439 +/- 89874.8 rials. Even though many background and aggravating factors of heart failure are preventable, this disease incurs a lot of expenditure on our country's health system. Therefore, there is a requirement for programming and research in the fields of education, treatment and prevention of this disease for all members of the community

[Relation between admission blood glucose levels and in-hospital and one year mortality in non-diabetic acute myocardial infarction patients]

Several studies have evaluated the association of admission blood glucose levels and short and long term mortality after myocardial infarction and have had different results. The aim of this study was evaluation of association between admission blood glucose levels and in-hospital and one year mortality in non-diabetic patients with AMI. In this study, demographic, clinical and Para clinical data of 120 non-diabetic patients with AMI on admission was collected and analyzed. The patients were followed for one year. Blood glucose level >/= 140 mg/dl was defined as hyperglycemia. 78% of patients were men. The mean age and admission blood glucose level was 63 +/- 13 years and 146 +/- 76mg/dl, respectively. Death due to cardio vascular causes was seen in 20% of patients in hospital and 9.8% during the one year follow up. The mean admission blood glucose level in patients who died in hospital was significantly more than live patients and also had an influence on the in-hospital outcome. Every 100mg/dl increase in blood glucose level was associated with 11% increase in in-hospital mortality risk in non-diabetic patients. Our results demonstrate that admission blood glucose level is a good marker for diagnosing patients with worse prognosis after AMI. We suggest that later studies should focus on optimal control of hyperglycemia with insulin in patients with AMI

[Diagnosis and treatment of penetrating cardiac injury one year after thoracic stab wound]

In any patient with a history of penetrating thoracic trauma, cardiac injury must be kept in mind. Here, we describe a 36 years-old female referred to this hospital with severe chest pain and hypotension. After primary evaluation and suggestion of AMI, streptokinase was started for the patient and because of deterioration of vital signs, cardiac surgery consultation was requested. After performing urgent echocardiography, massive pericardial tamponade was detected. Visualization of a knife blade on C.X.R and past medical history of thoracic stab injury led to a diagnosis of delayed cardiac tamponade and urgent sternotomy was performed. The blade that had penetrated the right ventricular chamber was extracted. Six days after operation, patient was discharged without any problem. This case study suggests the importance of high suspicion to cardiac injury in any patient with chest pain and a history of chest trauma

Early outcome of acute myocardial infarction

Introduction: Previos studies indicated that generally after acute myocardial infarction women have a poorer outcome thane men. Further studies with complete adjustements for coexisting condition are needed to determin whether the older age of the women who studied or the presence of other unfavorable prognostic factors or both explains this difference

Material and Method: We studied 817 consecutive patients [556 men and 261 women] hospitalized in all CCUs in city of Yazd due to acute myocardial infarction from May 2000 to October 2001

Results: In this survey, women were older than men [67.50 +/- 11 Vs 60 +/- 13] and had higher prevalence of hypertension, diabetes, dyslipidemia and in-hospital mortalities. The unadjusted odds ratio for death among women compared to men was 2.7[95 percent confidence interval, 1.79 to 4.28]. After adjustment for age the odd ratio reduced to 2.03 [95 percent confidence interval, 1.3 to 3.1]. Adjustmen for other differences in the base line characteristics reduced the odds ratio to 1.91 [95 percent confidece interval, 1.03 to 3.5]. These differences were significat, but after adjustment for treatment the odds ratio reduced to 1.51 [95 percent confidence interval, 0.6 to 3.7], and it wasn't Statistically significant

Conclusin: Women have worse prognosis after acute myocardial infarction and on the treatment may be contributing to this, and for correct judgement the difference of mortality after acute myocardial infarction, both sexes should under go the same approach for treatment