[Call-to-needle times for thrombolysis in acute myocardial infarction in emergency ward of Ghaem hospital]

Thrombolytic therapy is a standard treatment for patients presenting with acute myocardial infarction. Early administration of these agents is crucial for outcome of management. This audit was conducted to evaluate the time between prsenting the patient for his or her discomfort and the administration of thrombolysis [call-to-needle times], and to identify factors that contribute to this time interval. 100 patients with confirmed diagnosis of acute myocardial infarction, who received thrombolysis therapy, were interviewed within 72 hours of admission. We analyzed call to needle times with respect to the factors: age, gender, diabetes, history of ischemic hear disease [IHD] and transport. 100 patients who received thrombolysis were evaluated. Mean age was 54 years. 78% of patients were male, 34% were diabetic and 52% had history of IHD. The time interval between feeling symptoms and seeking medical attention was 3 minutes. Average time for transportation to hospital took 52 minutes by ambulance and 97 minutes by relatives. Call-to-needle time was 38 minutes. Male and diabetic patients seek medical attention with more delay [Pvalue< 0.05]. The biggest delay was between the onset of symptom and the patient decision for calling help. Most of delay was caused by patients' decision. This problem can be overcome by giving better education to people and shortening the time before thrombolysis

Cross-sectional study of periodontal status in healthy persons and those with coronary artery disease

Infections and among them extravascular infection may cause atherosclerosis and provoke their complication. Some evidence suggests that dental infections and periodontal disease are involved in pathogenesis of coronary artery disease. Patients were chosen from private cardiology clinic. In this double blind controlled cross-sectional study, patients were in two groups. Those who had CAD* by given criteria, and those in non-CAD group. Periodontal examinations were performed by periodontologist in a blind manner. Of 250 subjects screened and examined by cardiologist, 39 agreed and presented for dental examinations, of whom 10 were edentulous, and 29 were dentate. Of dentate subjects 11 had CAD and 18 were free of CAD. For all periodontal parameters, greater values were recorded for CAD group, indicating a more severe periodontal disease among CAD subjects as compared to non-CAD group. CAD subjects showed a significantly greater level of dental plaque accumulation as compared to non-CAD group [P=0.004]. Percentage of edentulous subjects was greater among CAD subjects than non-CAD subjects. All periodontal parameters were not significantly greater, among CAD patients than non-CAD control subjects, suggesting no association between poor periodontal status and coronary artery disease. Further studies are needed

Maternal and Fetal outcomes following open heart surgery during pregnancy

This study is aimed at evaluation fetal and maternal outcome in pregnant women with heart disease candidate for open heart surgery. In this study we evaluated adverse complications in 14 pregnant women underwent open heart surgery during three years period. Variable parameters were: age, parity; gestational age, history of cardiac surgery and medications, cardiac complications during pregnancy surgical indications of cardiac disease, fetal and maternal mortality and related complications. Mean age and gestational age were 38.4 years and 17.28 weeks respectively. Most of the patients were multiparous [71.42%] and in functional NYHA class III or IV [85.70%]. During pregnancy 71.43 percent of patients showed signs and symptoms of CHF and 64.28 percent of them had atrial fibrillation. All patients underwent emergent open heart surgery. Maternal and fetal mortality following surgery were 35.71 and 78/57 percent respectively. Cardiac Surgery during pregnancy were accompanied with high fetal and maternal mortality. Such pregnancies need to be managed by a team including obstetrician, cardiologist, anesthetist and cardiac surgeon. For best result, it is better to postpone surgery whenever possible and surgery is performed only when it was indicated. The present study demonstrates that emergency surgery, poor NYHA class, Atrial Fibrilation, unstable heart disease, poor economical cultural conditions will result in adverse outcome in mother and fetus following cardiac surgery

Evaluation of new coronary events in diabetic IHD patients in two controlled and uncontrolled diabetic groups by measurement of HbAlC

Introduction: The role of glycemia control in reduction of coronary events in diabetic patients with IHD is unknown

Material and Methods: In this study 204 patients with diabetes type 2 and IHD were followed up for 1 year. They were visited every 3 months observations were obtained and patients were studied, new coronary events assessed and recorded on the base of history, physical exams, ECG, echocardiography and other tests. FBS and HbAlc also were measured each time

Results: We studied 204 patients of whom 85 pts. were in group of controlled diabetes [HbAlc < 7] and 119 pts. in group of uncontrolled diabetes

The age and sex distributions were relatively equivalent in both groups

The mean age was 60.4 years. Most of patients used oral hypoglycemic agents in both groups. There were no significant differences in other major risk factors in our studied groups

103 pts. [51%] experienced at least one coronary event, 71 pts. [35%] had recurrent ischemia. Nonfatal MI and mortality occurred in 28 pts [14%] and 4 pts [2%] respectively

Glycemia control caused 7% reduction in recurrent ischemia, 3% reduction in cardiac mortality and 1% reduction in nonfatal ML but they weren't significant statiscally

Conclusion: In this study glycemic control reduced the rate of new coronary events in diabetics with IHD, but this reduction wasn't significant statiscally