effect of amlodipine and sildenafil on the NT-ProBNP level of patients with COPD-induced pulmonary hypertension

Pulmonary hypertension [PH] is an important cause of heart failure in chronic obstructive pulmonary disease [COPD]. The pro brain natriuretic peptide N-terminal [NT-proBNP] has been suggested as a noninvasive marker to evaluate ventricular function. However, there is no evidence to support the use of NT-proBNP in monitoring the benefits of vasodilators in COPD induced PH. Thus, we used NT-proBNP as a biomarker to evaluate the effect of oral vasodilators on cardiac function in COPD-induced PH. Forty clinically-stable PH patients were enrolled with history of COPD, normal left ventricular ejection-fraction [LVEF], right ventricular systolic pressure [RVSP] > 45 mmHg and baseline blood NT-proBNP levels >100 pg/mL. Patients were randomized into two groups, one group received sildenafil and second group were given amlodipine for two weeks. NT- proBNP and systolic pulmonary arterial pressure [systolic PA-pressure] were measured at the beginning and the end of study. Mean NT-proBNP level in the first group was 1297 +/- 912 pg/mL before therapy and 554 +/- 5 pg/mL after two weeks drug therapy, respectively. Similarly, in second group NT- proBNP level was 1657 +/- 989 pg/mL and 646 +/- 5 pg/mL before and after treatment. Amlodipine or sildenafil significantly reduced NT-proBNP levels in COPD-induced PH patients [p < 0.05]. Our study shows that amlodipine and sildenafil have a similar effect on NT-proBNP levels. In both groups NT- proBNP levels were significantly reduced after treatment. Therefore, our findings support the potential benefits of treatment with vasodilators in COPD induced PH

Changing pattern of infective endocarditis in Iran: a 16 years survey

To investigate the changes in characteristics of patients with infective endocarditis in Iran and comparing the results with the changing profiles of Infection Endocarditis [IE] in other countries. We studied all patients with definite or possible IE seen at four referral teaching hospitals in Iran from Jan. 1995 to Dec. 2010. The data was analyzed both collectively and separately in two consecutive eight-year periods, i.e. 1995-2003 and 2004-2010. A total of 286 episodes of IE, 172 males and 114 females, were reviewed from which 162 ones were in the first eight-year time period and 124 episodes in the second one. Mean age of the patients was significantly increased in the second eight-year period [24.2 +/- 11 vs 39.4 +/- 15 years old, p value = 0.01]. Increase in the episodes caused by Staphylococcus aureus was significant [40.7% vs 22.8%, p value = 0.01]. The mean size of the vegetation was noticeably higher among IDUs than non-IDUs [1.53 +/- 0.1cm vs 0.76 +/- 0.2cm, p value < 0.001]. As well as extra cardiac complications, mortality rate was noticeably higher among the patients with vegetation size >/= 1cm [34.4% vs 16.3%, p value = 0.003]. There was not a significant difference regarding the mortality rate between the conservatively and surgically treated patients [20.7% vs 22.9%, p value = 0.07]. The most important changing characteristic of IE which influences the outcome of the disease seems to be vegetation size which can account for as the outcome predictor

[ correlation of diastolic dysfunction with TIMI frame count in patients with chronic stable angina pectoris]

Evaluation of diastolic dysfunction and its relationship with TIMI frame count in patients with stable coronary artery disease referred to Ayatollah Taleghani Hospital in Tehran in the years 2010-2011 is the purpose of this study. Patients were divided into two groups: case and control. Both groups had chronic angina. Patient information on check list has been studies based on data provided by angiography and echocardiography methods. Cases had significantly higher values of corrected TIMI frame count [TFC] for the left anterior desending artery [LAD], TFC for Circumflex artery [Cx] and Right coronary artery [RCA], [mean TFC P<0.001]. Conventional echocardiography showed significantly lower maximal peak systolic velocity [sm] [cm/s], Correlation of early diastolic velocity at myocardial segments [Em] and peak systolic velocity at myocardial segments [Sm] with mean TFC in all 3 vessels were significant [P=0/0001]. Ratio of maximal early to late diastolic filling [E/A], in patient with TFC >/= 21 was 0/7 and in patients with TFC/= 21. Correlation between mean of angiography and diastolic disfunction was significant. According to this study diastolic dysfunction which estimated by echocardiography showed significant correlation with TIMI frame count in chronic stable angina patients. Due to simplicity, low cost, quality and reproducibility of this method, this will be helpful.

Disseminated Mycobacterium kansasii in an HIV-negative patient

Disseminated Mycobacterium kansasii infection is a rare infection in non-HIV patients. This research has uncovered a very rare manifestation of disseminated M. kansasii infection in a non-HIV patient with lung and pericardial involvement

Mulibrey nanism in a 35 year-old iranian female with constrictive pericarditis

Mulibrey nanism is a rare autosomal recessive disorder characterized by severe growth retardation and pericardial constriction associated with muscle, liver, brain, and eye abnormalities. More than 80% of previously reported cases are Finnish. We report a 35-year-old Iranian female who presented with classic phenotypic features of Mulibrey nanism with symptomatic constrictive pericarditis and underwent pericardiectomy .Our case is one of the rare examples of Mulibrey nanism outside Finland that has been reported so far

Correlation between the pulmonary artery pressure measured in echocardiography and pulmonary artery diameter in the ct-scan of patients suffering from interstitial lung disease

Pulmonary hypertension [PH] is a significant cause of morbidity and mortality in patients suffering from pulmonary parenchymal diseases. Diagnosis of PH has always been a major clinical dilemma due to its non-specific clinical manifestations. However, diagnosing PH and determining its severity are essential for the prognosis and treatment planning in PH patients. This study aimed at evaluating the correlation between the pulmonary artery diameter [PAD] in the CT-scan and pulmonary artery pressure [PAP] in echocardiography of patients. PAD was evaluated in the CT-scan of 117 patients suffering from interstitial lung disease [ILD] and the correlation between PAD and PAP was studied. A receiver operating characteristic curve [ROC curve] which is indicative of the precision of the diagnostic test was drawn to find the cut off point for the MPAD representing PH. The area under the curve was also calculated in order to define the discriminative power of the test. PAP higher than 25 mmHg was considered as PH. PAD over 29 mm reported in the CT-scan for the diagnosis of PH in ILD patients had sensitivity of 63% and specificity of 41.5%. No significant linear correlation was found between PAD and PAP [P-value=0.17, r=0.15]. The area under the ROC curve was calculated to be 0.49 in the cutoff point of 29 mm for determining PH [CI 95%=0.38-0.60, P=0.89]. ROC curve showed a weak discriminative power. PAD had low sensitivity and specificity in the CT-scan for the diagnosis of PH. Therefore, we conclude that CT-scan alone is not helpful in finding PH cases and further examinations are required

Unusual presentation of ruptured sinus of valsalva aneurysm

Sinus of Valsalva Aneurysm [SVA] is caused by dilation, usually of a single sinus of Valsalva, from a separation between the aortic media and the annulus fibrosus. Indeed, a deficiency of normal elastic tissues and abnormal development of the bulbus cordis have been associated with the development of SVA. We report a 31-year-old man with unusual presentation of ruptured sinus of valsalva aneurysm

Severity of nicotine withdrawal symptoms after smoking cessation

Smoking is among the most common preventable causes of early death in the world. Implementation of smoking cessation programs is among the effective strategies of tobacco control. More than half the smokers experience nicotine withdrawal syndrome after quitting and this could be one of the main reasons of unsuccessful smoking cessation. This study evaluated the severity of nicotine withdrawal symptoms 14 days after quitting [the last visit of smokers to the smoking cessation clinic]. This was a cross sectional study conducted on volunteers for smoking cessation from Nov. 2006 to Nov. 2007. During a one month course, volunteers attended 4 sessions of treatment and training [1 session per week]. Since the 2[nd] session, they stopped smoking with the aid of nicotine gum and behavioral therapy under the supervision of a physician. Fourteen days after quitting [4[th] session], the severity of nicotine withdrawal symptoms was evaluated using the Minnesota test and was compared between males and females using the Chi square test. A total of 197 participants were studied, 65% of which were males, 76.6% were married, 49.2% successfully quit smoking during the study period, 12.2% cut down smoking, and 38.6% did not finish the course. The mean score for increase in appetite, irritability and depression was 4.6 +/- 3.4, 4.3 +/- 3.4 and 3.6 +/- 3.3, respectively. The mean score for severity of depression was 4.5 +/- 3.4 in women and 3.19 +/- 3.2 in men [p=0.03]. The mean score for severity of anxiety was 4.6 +/- 3.6 in women and 2.6 +/- 2.9 in men [p=0.004]. Also, the mean score for severity of irritability was 5.7 +/- 3.3 and 3.6 +/- 3.3 in women and men, respectively [p=0.002]. The severity of symptoms related to nicotine withdrawal syndrome was considerably low 14 days following abstinence. However, the severity of nicotine craving was significantly higher compared to other symptoms. Severity of more than half the symptoms was significantly higher in women but further investigations are required in this regard

Tobacco smoking pattern: cigarette vs. hookah

Smoking causes 5.2 million deaths annually in the world of which 70% occur in developing countries. Hookah smoking is increasing around the world especially in the Eastern Mediterranean Region including Iran. This study was carried out to evaluate the pattern of tobacco smoking in both forms of cigarette and hookah smoking. A cross- sectional study was conducted among a random population in the main squares of Tehran in 2006. The sample size consisted of 2053 people in the age range of 10 to 80 years. Non-Probability Sampling method was used. Questionnaires designed and adapted according to WHO and IUATLD questionnaires given to these people. Forty-six percent of the sample had experienced hookah smoking. The prevalence of occasional hookah smoking in the previous year was 45%, while 10% of the participants used hookah at least once a week, 17.9% at least once a month and 17.1% at least once a year;47.2% of participants had experienced cigarette smoking. Prevalence of daily cigarette smoking was 22.7%; 22.7% of current smokers and 25.01% of non-smokers consumed hookah at least once a week. Prevalence of hookah smoking is very similar among cigarette smokers and non-smokers. In this study the prevalence of cigarette smokers was more than national data and the rate of cigarette and hookah smoking among women was higher than that of other studies in this realm. These issues need to be further investigated and more serious studies are required in this regard

Public awareness about framework convention on tobacco control [FCTC] in Tehran

The global tobacco epidemic is currently responsible for 5.2 million morbidity and mortality per year seventy percent of which occur in developing countries. Framework Convention on Tobacco Control [FCTC] is the first international public health treaty ratified by all countries in order to encounter the ever-growing tobacco epidemic. This study was designed to evaluate the public awareness of Tehran residents about FCTC. This was a cross-sectional study and sampling was performed in main city centers during the years 2007-2008 by using non-probability sampling method. The questionnaires were designed according to the World Health Organization [WHO] and IUATLD standard questionnaires and a total of 2053 individuals were questioned. Of the participants, 47.2% had experienced smoking [55.5% of men and 28.8% of women]. The frequency of daily cigarette consumption was 22/7% [29/7% of men and 7% of women] [P<0.001]. Forty-six percent of the participants had experienced hookah [50% of men and 36/8% of women] [P=0.0000]. A total of 184 individuals [9%] were aware of FCTC among which, 35 individuals [19%] who comprised 1/7% of the total understudy population claimed to have a complete knowledge regarding some details. Awareness about FCTC was 5.1% among those with an educational level equal or below high school diploma. This rate was 14.9% in those with a bachelor's degree and 33.3% [more than twice the rate] in those with higher educational levels [P<0.001]. Prevalence of smoking was found to be higher in our study compared to similar studies. Higher level of education was significantly associated with greater awareness regarding FCTC. The overall public awareness was low and implementation of public awareness programs regarding FCTC is necessary

Assessment of wells criteria in patients with pulmonary embolism

Pulmonary embolism [PE] is one of the most important emergencies in internal medicine. Wells criteria are used to predict the presence of pulmonary embolism on the basis of clinical manifestations. The aim of this study was to assess Wells criteria in patients with pulmonary embolism. Materials and Ninety-nine patients with the diagnosis of PE underwent anticoagulant therapy during 2002-2006. Data were collected using a questionnaire and then analyzed by using SPSS software. The most common symptoms were dyspnea [70.7%] and chest pain [60.6%]. Wells criteria included "an alternative diagnosis less likely than PE" [84%], hemoptysis [34%], leg pain or swelling [30%], tachycardia [29%], recent surgery or immobilization [27%], previous deep vein thrombosis [22%] and malignancy [2%]. Eight percent, 69% and 23% of patients had Wells scores less than 2 points, 2-6 and >6 points, respectively. Among the patient group with modified Wells criteria, 36 patients [36.4%] had scores <4 points and 63 [63.6%] had scores greater than 4 points. The majority of patients with PE had Wells score of 2-6 points and those patients with Wells score less than 4 had a positive CT-angiogram

Evaluation of age and smoking habit by verbal autopsy

Cigarette smoking is the first preventable cause of morbidity and mortality in the world and can result in various diseases, disability and death. International studies have reported that about half of the smoking-related deaths occur in the middle ages. We decided to assess the age of death among smokers and non-smokers in this study. This descriptive cross-sectional study was conducted at Tehran Behesht-e-Zahra Cemetery between September 2005 and March 2006. To estimate the sample size, a pilot study was performed on 112 deaths in March 2005 and based on the results; the sample size was estimated to be 2500. Five days of each month were selected randomly. On these days a physician [co-author] visited the Cemetery office and collected the data with the help of office operator. Information was obtained from first-degree relatives of the deceased after obtaining consent. The under-study variables were age at the time of death and cigarette use. Data were analyzed by SPSS software version 11 and using ANOVA test. A total of 7858 cases were studied out of which 57.3% were males. There were 63.1% [4960] non-smokers, 25.1% [1971] smokers and 11.8% [927] ex-smokers. The mean age of death among total under-study population was 56.8 yrs [55.1 yrs in males and 57.6 yrs in females]. The mean age of death was 57.9 yrs among non-smokers, 50.1 yrs among smokers and 56.8 yrs among ex-smokers [p=0.00]. Results showed that age of death was lower among smokers but we could not determine a direct correlation between cigarette smoking and death in these patients

Myocardial infarction after blunt chest trauma in two young men

Traumatic myocardial injury occurs in up to 55% of patients sustaining blunt chest trauma. We report two cases of myocardial infarction following blunt chest trauma in two young men due to a car accident. They were both suffering multiple trauma and were hospitalized in ICU. Diagnostic and therapeutic procedures performed for these patients are presented in this article

Tobacco dependency evaluation with fagerstrom test among the entrants of smoking cessation clinic

Smoking is considered the first preventable cause of mortality worldwide. There are many predictive factors on smoking cessation including social, family and individual issues. High nicotine dependency is one of the factors that make the cessation harder for the smoker. There are several methods for estimating the nicotine dependency rate in practice among which Fagerstrom test is one of the most suitable and non-invasive ones. This was a cross-sectional study. Data were collected from all smokers who had participated in the group therapy smoking cessation courses in Tehran smoking cessation clinic. The questionnaires were designed based on these data and nicotine dependency rate was evaluated via Fagerstrom test [FT]. The smokers declared that they had quit smoking since the third session of the cessation course; this claim was confirmed by testing the expiratory carbon-monoxide rate. Finally, data were analyzed by using t-test and Chi-square test via SPSS software version 12. There were 986 cases in this study including 786 [79.7%] males. Evaluation of the nicotine dependency rate showed that more than half of the smokers [n= 544, 55.2%] had high dependency, 330 [33.5%] had moderate dependency and 112 [11.3%] had low dependency. At the end of the course, 642 subjects quit smoking successfully. The maximum rate of success in cessation was among the smokers with low nicotine dependency [79 cases, 70.5%] and the minimum rate of success was among the smokers with high nicotine dependency [323 cases, 59.4%] [P=0.00]. According to the results of this study smokers with high nicotine dependency had a low chance to quit successfully. Therefore, it is recommended to follow them up for a longer period of time and use combination therapy for them

Evaluation of patients with infective endocarditis in a pulmonary referral centre

Despite the decreased incidence of rheumatic fever and use of prophylactic antibiotic the incidence rate of infective endocarditis has not declined. In this research, we have studied the clinical feature and therapeutic response of patients with infective endocarditis presenting with pulmonary manifestations to a pulmonary referral center. All patients with diagnosis of endocarditis that had pulmonary manifestations [based on Duke Criteria] as their primary clinical presentation were entered in this study. Data in regard to individual information, clinical features, laboratory finding and therapeutic responses were noted. All data were analysed using SPSS software [version 11.5]. A total number of twenty patients here entered the study. Mean age was 34.8 +/- 11.6 yr. The commonest clinical features included: fever [95%], cough [65%] and dyspnea [65%]. Also the commonest signs were cardiac murmurs [65%], hepatomegaly [35%] and splenomegaly [35%]. Clubbing was seen in 10%. Sixty percent of the cases were intravenous drug users and 25% were infected with HIV. Also 50% of the patients did not have any background of valvular diseases. However, there was vegetations on one valve in 75% and multiple valves were involved in 25%. The commonest valves affected were trocuspid [50%], mitral [30%] and pulmonic valve [10%]. Staphylococcus aureus [47.3%] and Streptococcus viridans [27.3%] were the commonest microorganisms detected. Pericardial effusion was present in 30% which was higher in IV drug users [p. value=0.042]. Total mortality rate in hospital was 5%. Infective endocarditis should be considered in the list of differential diagnosis in patients suffering from pulmonary symptoms especially in IV drug users

Effect of major lung resection on pulmonary artery pressure

Background: Major lung resection is one of the surgical procedures which its significant physiologic and hemodynamic effects on the right heart have been recently studied. This study has been implemented to review the effects of this surgery on the most important echocardiographic index of the right heart that is pulmonary artery pressure [PAP]

Materials and Methods: 29 patients were consecutively studied during 2 years. Each patient underwent a single transthoracic echocardiography before the operation and another echo study within one week after the operation. Background variables [age and sex] and echocardiographic indices [EF for global left heart function and PAP] were recorded. Analysis of data after review of distribution was done by paired-t-test and Wilcoxon signed rank test

Results: In this study 18 men and 11 women with mean +/- SD age of 52 +/- 21 were included. Mean +/- SD of EF and PAP before the operation were 57.1 +/- 3.9 and 26.8 +/- 9.9 respectively. After the operation no significant changes in EF [p?1] was observed while PAP changed to 29.7 +/- 11.3 [p <0.086]

Conclusion: The results showed that reduced pulmonary vascular bed after lobectomy and pneumonectomy did not affect left sided EF, while right sided index [PAP] was slightly elevated although not statistically significant. We can deduce that major lung resection does not affect cardiac outcome and PAP significantly; future studies with more patients and longer follow-ups will clarify this issue