Fibrinolytic therapy in CCU instead of emergency ward: how it affects door to needle time?

The door-to-needle-time [DNT] is considered a standard time for scheduling thrombolysis for acute ST-segment elevation of myocardial infarction and this time can be reduced by minimizing the delay in starting thrombolytic treatment once the patient has reached to the hospital. This study was carried out on a sample of Iranian patients with acute myocardial infarction to determine the DNT in those after changing schedule of thrombolysis during 8 years from emergency to coronary care unit [CCU]. A descriptive cross-sectional study was carried out on all consecutive patients with a confirmed diagnosis of acute myocardial infarction admitted to the emergency ward of Ekbatan Hospital in Hamadan, Iran, within 2011 and had an indication of fibrinolytic therapy, which 47 patients were finally indicated to receive streptokinase in the part of CCU. The mean time interval between arrival at the hospital and electrocardiogram [ECG] assessment was 6.30 min, taking ECG and patient's admission was 21.6 min and transferring the patient from admission to CCU ward was 31.9. The time between transferring the patients to CCU ward and fibrinolytic administration order and the time between its ordering and infusion was 31.2 min and 14.0 min respectively. In sum, the DNT was estimated 84.48 +/- 53.00 min ranged 30-325 min that was significantly more than standard DNT [P<0.01]. Furthermore, DNT mean in this study is significantly more than a study conducted 8 years ago in the same hospital [P<0.01]. The DNT is higher than the standard level and higher than the estimated level in the past. This shows that DNT was longer after transferring to CCU

Effect of vitamin C administration on leukocyte vitamin C level and severity of bronchial asthma

Oxidative stress mediated by reactive oxygen species is known to contribute to the inflammatory process of bronchial asthma. Reactive oxygen species are released into the bronchial tree by activated inflammatory cells. In this study, we aimed to determine the effect of vitamin C administration on leukocyte vitamin C level as well as severity of asthma. In this double blind clinical trial study we evaluated 60 patients with chronic stable asthma. The patients were divided into two groups [A and B] including 30 patients in each group. Patients in these groups were matched according to their age, weight, height, gender, BMI and drug consumption. In addition to standard asthma treatment [according to stepwise therapy in 4[th] step of bronchial asthma] in which the patients were controlled appropriately, group A received 1000 mg vitamin C daily and group B received placebo. At the baseline and after one month treatment, non-fasting blood samples were drawn for laboratory evaluations. Asthmatic patient's clinical condition was evaluated through standard pulmonary function test [PFT]. The mean [ +/- SD] leukocyte vitamin C level in group A at the baseline and after one month treatment with 1000 mg/day vitamin C, were 0.0903 [ +/- 0.0787] microg/10[8] leukocytes and 0.1400 [ +/- 0.0953] microg/10[8] leukocytes respectively [P<0.05]. The mean [ +/- SD] leukocyte vitamin C level in group B at the baseline and after one month administration of placebo, were 0.0867 [ +/- 0.0629] microg/10[8] leukocytes and 0.0805[ +/- 0.0736] microg/10[8] leukocytes respectively. The leukocyte vitamin C level in group A was higher than those of group B after one month treatment with vitamin C and placebo and the difference was statistically significant [P<0.05]. Comparing PFT [FEV[1], FVC and FEV1/FVC] in group B during the study period showed a significant increase in FEV[1] [P<0.05], while the other two parameters remained unchanged. In group A, who received 1000 mg/day vitamin C, none of the spirometry parameters changed after one month treatment, indicating no effect of vitamin C treatment in the spirometry parameters

E-selectin S128R polymorphism leads to severe asthma

The E-selectin mediates the interaction of activated endothelial cells with leukocytes and plays a fundamental role in the pathogenesis of asthma. It has been suggested that an S/R [Serine128 Arginine] polymorphism of E-selectin alters ligand binding function. Our purpose in this study was to determine whether this Serine128 Arginine polymorphism influences the risk of asthma and also to analyze the possible correlation of disease severity in Iranian patients with polymorphism of E-selectin. We studied human E-selectin gene polymorphism in 172 asthmatic patients and 173 healthy volunteers by polymerase chain reaction-restriction fragment length polymorphism [PCR-RFLP]. To determine the severity of the asthma's situation, a questionnaire was prepared requesting the following information: age, sex, clinical signs and symptoms and past medical history. After the participants filled in the questionnaire, all active or ex-smoker patients were excluded. A trained observer assessed airway reversibility, peak flowmetry and spirometry in asthmatic patients. We found increased serum levels of soluble E-selectin [sE-selectin] in asthmatic patients compared with healthy subjects [P <0.0001]. Frequencies of the SS, SR, and RR genotypes were found as 66.3%, 31.4%, and 2.3% in the patients and 91.9%, 8.1%, and 0.0% in control subjects, respectively. The 128 Arg allele was more prevalent in patients than controls [OR 5.78; 95% CI, 3.07-10.86, P<0.0001]. However, in this study the polymorphism was not associated with circulating sE-selectin levels. We found a direct correlation between the level of sE-selectin and the severity of asthma [P=0.001]. On the other hand, there was a close relation between 128 Arginine carriage and disease severity [P<0.0001]. These results suggest that the Ser 128 Arg polymorphism of the E-selectin gene is a genetic factor that may be associated with the severity of asthma