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OBJECTIVES@#Cigarette smoking is an established, strong, and modifiable risk factor for coronary heart disease (CHD). However, little research has investigated CHD risk in former smokers who continue to be exposed to others’ cigarette smoke (former & secondhand smokers). @*METHODS@#In the Tehran Lipid and Glucose Study, a prospective population-based cohort (n=20,069) was followed up for a median period of 14.6 years. A subset of 8,050 participants of 30 years of age and older was analyzed, with first CHD events as the study outcome. Participants were categorized as never, former, current, secondhand, and former & secondhand smokers. Data on smoking intensity (cigarette/d) were also collected. A Cox proportional hazards regression model was applied to estimate the risk of CHD, taking into account the main potential confounders. @*RESULTS@#The mean age of participants was 46.10 ±11.38 years, and they experienced 1,118 first CHD events (with most CHD cases in former smokers) during the follow-up period. The risk of CHD was highest in current smokers, followed in order by former & secondhand, former, and secondhand smokers (hazard ratio [HR], 1.99; 95% confidence interval [CI], 1.65 to 2.39; HR, 1.55; 95% CI, 1.15 to 2.08; HR, 1.39; 95% CI, 1.12 to 1.72; HR, 1.27; 95% CI, 1.07 to 1.51, respectively), compared to never smokers. The risk of CHD increased with smoking intensity, which has been proposed as a preferable measure of smoking, indicating a dose-response pattern. @*CONCLUSIONS@#The elevated risk of CHD in former & secondhand smokers was a noteworthy finding, with possible implications for health policy; however, further research is needed.
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OBJECTIVES@#Cigarette smoking is an established, strong, and modifiable risk factor for coronary heart disease (CHD). However, little research has investigated CHD risk in former smokers who continue to be exposed to others’ cigarette smoke (former & secondhand smokers). @*METHODS@#In the Tehran Lipid and Glucose Study, a prospective population-based cohort (n=20,069) was followed up for a median period of 14.6 years. A subset of 8,050 participants of 30 years of age and older was analyzed, with first CHD events as the study outcome. Participants were categorized as never, former, current, secondhand, and former & secondhand smokers. Data on smoking intensity (cigarette/d) were also collected. A Cox proportional hazards regression model was applied to estimate the risk of CHD, taking into account the main potential confounders. @*RESULTS@#The mean age of participants was 46.10 ±11.38 years, and they experienced 1,118 first CHD events (with most CHD cases in former smokers) during the follow-up period. The risk of CHD was highest in current smokers, followed in order by former & secondhand, former, and secondhand smokers (hazard ratio [HR], 1.99; 95% confidence interval [CI], 1.65 to 2.39; HR, 1.55; 95% CI, 1.15 to 2.08; HR, 1.39; 95% CI, 1.12 to 1.72; HR, 1.27; 95% CI, 1.07 to 1.51, respectively), compared to never smokers. The risk of CHD increased with smoking intensity, which has been proposed as a preferable measure of smoking, indicating a dose-response pattern. @*CONCLUSIONS@#The elevated risk of CHD in former & secondhand smokers was a noteworthy finding, with possible implications for health policy; however, further research is needed.
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Purpose: to assess the relationship between the severity of coronary arteries involvement and the extent and pattern of myocardial scars in Cardiac Magnetic Resonance of patients with history of remote myocardial infarction
Materials and Methods: the Cardiac Magnetic Resonance images of sixty patients with history of remote ST segment or non-ST segment elevation myocardial infarction were reviewed. The patients were candidates for selective coronary angiography and referred for Cardiac Magnetic Resonance imaging in order to evaluate the myocardial viability
Results: the age of patients with history of old myocardial infarction [n = 60], among whom 78.3% were male, averaged 61.2 [SD = 11.5]. There was no association between the severity of coronary artery stenosis in each territory and the presence of myocardial scar detected by late Gadolinium enhancement of Cardiac Magnetic Resonance [for all three vessel territories P = .05]. However, there was a significant association between the coronary artery runoff and the presence of late Gadolinium enhancement in Cardiac Magnetic Resonance [P value for left anterior descending coronary artery [LAD], left circumflex [LCX] and right coronary artery [RCA] was = .002, = .001 and = .001, respectively]. A significant relationship was found between the pattern of scar in terms of being transmural or non-transmural and the severity of coronary artery stenosis [P = .001], while the pattern of scar was not associated with the coronary artery runoff [P = .2]
Conclusion: the results of this study support the hypothesis contending that the time window for revascularization will increase in the presence of antegrade coronary flow in the jeopardized myocardium, which causes a limitation in the infarct progression and subsequent lesser extent of myocardial scar
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This retrospective study was undertaken to compare the outcomes of staged bilateral total hip arthroplasty (THA) by the conventional approach with those of two-incision minimally invasive (MIS-2) THA in terms of clinical and radiological results, complications, and patient preferences. Twenty-two patients aged 30 to 80 years underwent staged bilateral THA. The conventional posterolateral approach was used on the first hips treated and a modified MIS-2 approach on the second hips. The mean time between the first and second procedures was 73.8 months, and the patients were followed up for at least 12 months after both procedures. At the last follow-up visits, THA via the MIS-2 approach was found to provide significantly earlier partial-weight-bearing ambulation, better postoperative Harris hip scores, and better ability to sit cross-legged and was found to be more preferred by patients than conventional THA. There were no significant differences in the complication rates for the two approaches. The present results show that MIS-2 THA is as safe as the conventional posterolateral approach in experienced hands and presents no additional complication risks.
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Humanos , Artroplastia , Artroplastia de Quadril , Seguimentos , Mãos , Quadril , Preferência do Paciente , Estudos Retrospectivos , CaminhadaRESUMO
One of the primary factors in managing patients with retinoblastoma is early diagnosis. The main idea of this study was to recognize the consequences of delay in diagnosis on therapy of the disease. A retrospective review of all children with proven retinoblastoma, who had presented to MAHAK hospital in Tehran, from April 2007 to Dec 2011, was performed. Grouping of intraocular tumors was applied as A to E according to International Classification of Retinoblastoma. There were 157 [91 boys] children eligible for study. The mean age was 1.21 +/- 0.11 years with average delay in diagnosis of 3.4 +/- 0.53 months. Classification of D group in both unilateral [93 patients] and bilateral tumors was the largest category. A significant relation [P=0.05] between delayed diagnosis time and tumor grouping was evident. The most frequent symptoms were leukocoria and strabismus. Age was significantly lower in the subgroup of bilateral tumors than in unilateral retinoblastomas [0.6 +/- 0.12 year vs 1.6 +/- 0.15 years]. The diagnosis was delayed in subgroup of extra ocular retinoblastoma more than in intraocular tumors [8.7 +/- 2.9 months vs 2.9 +/- 0.52 months]. The authors recommend early referring of suspected cases to ophthalmologists and pediatric oncologists and to organize educational programs to publisize signs and symptoms of the disease such as leukocoria, strabismus and ocular inflammatory disorders through national media. In conclusion, early diagnosis of retinoblastoma can be the primary factor in managing the patients as the delay in diagnosis accounts for highly advanced disease and poor prognosis
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This retrospective study was undertaken to compare the outcomes of staged bilateral total hip arthroplasty (THA) by the conventional approach with those of two-incision minimally invasive (MIS-2) THA in terms of clinical and radiological results, complications, and patient preferences. Twenty-two patients aged 30 to 80 years underwent staged bilateral THA. The conventional posterolateral approach was used on the first hips treated and a modified MIS-2 approach on the second hips. The mean time between the first and second procedures was 73.8 months, and the patients were followed up for at least 12 months after both procedures. At the last follow-up visits, THA via the MIS-2 approach was found to provide significantly earlier partial-weight-bearing ambulation, better postoperative Harris hip scores, and better ability to sit cross-legged and was found to be more preferred by patients than conventional THA. There were no significant differences in the complication rates for the two approaches. The present results show that MIS-2 THA is as safe as the conventional posterolateral approach in experienced hands and presents no additional complication risks.
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Humanos , Artroplastia , Artroplastia de Quadril , Seguimentos , Mãos , Quadril , Preferência do Paciente , Estudos Retrospectivos , CaminhadaRESUMO
Osteoporosis and related fractures due to discomfort, disability, decreased quality of life and death is a major health problem in the world, According to the importance of recording and reporting Osteoporosis, lifestyle in growth duration, during teenage, is the most risk factor that determines Osteoporosis in adolescents and the elderly. The aim of this study was assessing adolescence lifestyle and its relation with osteoporosis among adolescents in Qazvin, Iran. In this descriptive-analytical study, 300 teenagers were selected by stratified cluster sampling. The scale for data collection was a self-administered questionnaire containing 15 items related to life style. Using SPSS 16, the data were analyzed by Chi-square and Fisher's exact tests. The results showed that the majority of teenagers [71.3%] don't regularly have physical activity. There were significant differences between physical activity patterns of male and female teenagers [P=0.001]. It was shown that female teenagers [66.7%] use more foods containing vitamin D, cola-type beverages and caffeine than male teenagers [34.7%].Only, 26.9% the female teenagers and 33.5% of the male teenagers drink one cup of milk daily. The results showed that 29.3% of male teenagers and 24.3% of female teenagers haven't used any method for facilitating calcium absorption in the body. The findings of this study showed that Iranian teenagers had several known risk factors and unfavorable behaviors. Therefore, modifying teenagers' lifestyle by preventive educational strategies on osteoporosis can help to prevent osteoporosis in adolescents
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Procedural sedation in children continues to be a problem in the emergency department [ED]. Midazolam is the first water-soluble benzodiazepine and it has been widely used for procedural sedation in pediatric patients. The aim of this study was evaluation of clinical safety and effectiveness of intramuscular Midazolam for pediatric sedation in the ED setting. We performed a self-controlled clinical trial on 30 children who referred to the Baqiyatallah Hospital ED between 2009 and 2010. They received intramuscular Midazolam 0.3 mg/kg for procedural sedation and then they were folio wed for sedative effectiveness and safety. Vital signs and O2 saturation were also observed. The findings were I compared using SPSS ver. 16 software. I The mean age was 5.50 +/- 2.70 years, the mean weight was 19.50 +/- 6.63 kilograms and 16 patients [53.3%] were females. The most common adverse effect was euphoria [66.66%] and vertigo [6.7%]; 27.7% did not show any side effects. There was an overall complication rate of 72.3%. The vital signs including heart rate, respiratory rate, systolic and diastolic blood pressure and O2 saturation decreased significantly during sedation [P value < 0.05]. Midazolam is an effective and relatively safe sedative for pediatric patients in the ED. The patient should be observed closely and monitored for psychological and hemo-dynamic side effects
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Low birth weight [LBW] is one of the main factors for neonatal mortality and morbidity. Many factors are related with low birth weight. The present study was conducted to identify the prevalence and related factors of LBW at Mashhad, in northeast of Iran. This cross-sectional study was performed in all medical health centers of Mashhad during the first six months of 2010. Data collection was performed by scale, meter, and a questionnaire including two sections of neonatal factors and maternal factors. The questionnaire was completed by measuring neonate's height and weight, interviewing with mother, and investigating mother's and neonate's health files. Data was analyzed by descriptive statistics, chi-square, Fisher, independent T, and Man-witney tests by SPSS [11.5]. Among 2674 alive births, 297 neonates had the weight <2500 gr. Therefore the prevalence of LBW was 11.1%. The factors related to LBW were maternal age <18 yrs [P=0.019], gestational age <37 weeks [P=0.000], multi-pregnancy [P=0.000], first delivery [P=0.029], addiction to narcotics [P=0.001], smoking during pregnancy [P=0.007], history of LBW neonate [P=0.000], irregular visits during pregnancy [P=0.02], Using drugs during pregnancy [P=0.029], psychological disorders of mother [P=0.024], PROM [P=0.000] anomalies of placenta [P=0.01], oligohydramnios [P=0.01], bleeding during pregnancy [P=0.000], and preeclampsia [P=0.001]. The prevalence of LBW in our study suggests a greater emphasis should be placed on related factors of LBW for the early detection and prevention of them
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Initial studies have shown that low-energy ultrasound stimulates living tissue cells to reduce regeneration or speed up their recovery. The purpose of this study was to examine the effects of various ultrasound parameters on the speed of recovery in injured sciatic nerves. NMRI mice [n = 200] with injured left paw, caused by crushing their sciatic nerves, were randomly selected. The animals were exposed to ultrasound radiation with various frequencies, intensities, and exposure time. They were allocated into 20 groups [19 treatment and 1 control groups]. Sciatic functional index [SFI] test was used to evaluate the difference between the groups with respect to functional efficiency of the sciatic nerve and its recovery. The results of SFI test obtained from the 14th day showed a significant difference among the groups [P<0.05]. On the 14th day after treatment, one of the groups [US11] recovered up to 90%. Altered ultrasound exposure parameters had more favorable outcomes compared with our previous work
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Animais de Laboratório , Terapia por Ultrassom , Ondas Ultrassônicas , Recuperação de Função Fisiológica , Camundongos , Regeneração NervosaRESUMO
Various radiometal complexes have been developed for tumor imaging, especially Ga-68 tracer. In the present study, the development of a radiogallium bis-thiosemicarbazone complex has been reported. [[67]Ga] acetylacetonate bis[thiosemicarbazone] complex [[[67]Ga] AATS] was prepared starting [[67]Ga]Gallium acetate and freshly prepared acetylacetonate bis [thiosemicarbazone] [AATS] in 30 min at 90°C. The partition co-efficient and the stability of the tracer were determined in final solution [25°C] and the presence of human serum [37°C] up to 24 h. The biodistribution of the labeled compound in wild-type and fibrosarcoma-bearing rodents were determined up to 72 h. The radiolabled Ga complex was prepared in high radiochemical purity [> 97%, HPLC] followed by initial biodistribution data with the significant tumor accumulation of the tracer in 2 h which is far higher than free Ga-67 cation while the compound wash-out is significantly faster. Above-mentioned pharmacokinetic properties suggest an interesting radiogallium complex while prepared by the PET Ga radioisotope, 68Ga, in accordance with the physical half life, for use in fibrosarcoma tumors, and possibly other malignancies
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Crocin, as an active constituent of saffron, has many biological functions including antioxidant and anti-inflammatory activities. The present study was aimed to investigate the effects of crocin and chlorpheniramine on local edema induced by histamine. Local edema was induced by subcutaneous injection of histamine [100 micro l, 0.1%] in ventral surface of right hind paw. The thickness of paw was measured at 1 h before and 1, 2, 3 h after injection of histamine, using a fine caliper. The number of neutrophils in paw tissue sections was counted 3 h after intraplantar injection of histamine. Intraperitoneal injection of crocin at doses of 100 and 200 mg/kg and chlorpheniramine at a dose of 10 mg/kg significantly [p<0.05] decreased both paw thickness and infiltration of neutrophils in paw tissues. In a combined treatment, intraperitoneal injection of an effective dose of crocin [100 mg/kg] with an ineffective dose of chlorpheniramine [2.5 mg/kg] produced a more documented response in comparison with crocin [100 mg/kg] and chlorpheniramine [2.5 mg/kg] used alone. The results suggested that both crocin and chlorpheniramine suppressed histamineinduced local paw edema. Moreover, histamine H1 receptors function may be affected by crocin
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Background: The purpose of this study is to evaluate the validity and reliability of a Persian translation of the Modifiable Activity Questionnaire [MAQ] in a sample of adults from Tehran, Iran
Methods: There were 48 adults [53.1% males] enrolled to test the physical activity questionnaire. A sub-sample included 33 participants [45.5% males] who assessed the reliability of the physical activity questionnaire. The validity was tested in 25 individuals [48.0% males]. The reliability of two MAQs was calculated by intraclass correlation coefficients. The validation study was evaluated with the Spearman correlation coefficients to compare data between the means of 2 MAQs and the means of 4 physical activity records
Results: Intraclass correlation coefficients between 2 MAQs for the previous year's leisure time was 0.94; for occupational, it was 0.98; and for total [leisure and occupational combined] physical activity, it was 0.97. The Spearman correlation coefficients between the means of the 2 MAQs and means of the 4 physical activity records was 0.39 [P=0.05] for leisure time, 0.36 [P=0.07] for occupational, and 0.47 [P=0.01] for total [leisure and occupational combined] physical activities
Conclusions: High reliability and relatively moderate validity were found for the Persian translated MAQ in adults from Tehran. However, further studies with larger sample sizes are suggested to more precisely assess the validity of the MAQ
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Humanos , Feminino , Masculino , Adulto , Pessoa de Meia-Idade , Inquéritos e Questionários , Reprodutibilidade dos Testes , População Urbana , AdultoRESUMO
Acute lymphoblastic leukemia is one the most common malignancies in children and adolescents. L-asparginase [L-ASP] is one of the leading medications in treatment of ALL. L.ASP interferes with the synthesis of some coagulation proteins and therefore causing disturbance in normal coagulation. In this study, the effects of L-ASP on anticoagulant proteins [protein C, protein S, and antithrombin III] and platelet function were assessed. This was a before-after study on 41 patients with ALL who refered to Mahak hospital [Tehran, Iran]. Before and after the injection of L.ASP, a bleeding time test was performed based on Ivy method. Protein C and protein S performance was assessed by turbidometry and antithrombin III performance was evaluated by chromogenic method. 48.8% of patients were female. Mean [ +/- SD] of age was 4.0 +/- 7.2. A significant reduction in the mean amount of protein C, antithrombin III and bleeding time was recorded. However, the reduction in protein S was not significant. No patient showed the symptoms of thrombosis. The results of this study showed that L. ASP drug reduced coagulation proteins [except the protein S]. This decrease along with other concomitant genetic factors can lead to thrombosis in some patients with ALL during induction therapy
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Humanos , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Coagulação Sanguínea/efeitos dos fármacos , Plaquetas/efeitos dos fármacos , Proteína C/efeitos dos fármacos , Proteína S/efeitos dos fármacos , Tempo de SangramentoRESUMO
The intra-plantar injection of carrageenan elicited an inflammatory response characterized by increase of the paw thickness and infiltration of neutrophils in paw tissues. Histidine, n-acetylcysteine and diclofenac decreased paw thickness, and neutrophil infiltration in the paw tissues. The anti-inflammatory effect induced by co-administration of histidine and n-acetylcysteine with diclofenac, was more than that obtained from histidine and n-acetylcysteine administered alone. The results suggested that histidine, n-acetylcysteine and diclofenac produced anti-inflammatory activities by reducing paw edema and neutrophil infiltrationin induced by carrageenan. Inhibition of cyclooxygenase products such as prostaglandins may be involved in the anti-inflammatory effects induced by histidine and n-acetylcysteine.
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Patients with peripartum cardiomyopathy may require analgesia/ anesthesia for delivery or cesarean section. Many different methods of anesthesia has been used for this purpose. Remifentanil was used safely in peripartum cardiomyopathic patients, but there is not any report about etomidate usage in such patients. We report on a 19 years old patient, at 32 weeks of gestation, with severe peripartum cardiomyopathy, in uncompensated heart failure and pulmonary edema. She was scheduled for emergency cesarean section because of threatening mother's life and fetal distress. General anesthesia was induced with etomidate and maintained with remifentanil infusion safely, without any adverse outcome on mother or newborn
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Humanos , Feminino , Período Pós-Parto , Complicações Cardiovasculares na Gravidez , Cesárea , Anestesia Obstétrica , Etomidato , Piperidinas , Insuficiência CardíacaRESUMO
Tracheobronchial foreign body [TFB] aspiration is a common cause of mortality and morbidity in early childhood. The aim of this study was to evaluate the diagnostic value of chest x-ray in tracheobronchial foreign body aspiration among a group of Iranian children. We evaluated 32 children who underwent bronchoscopy for suspected airway foreign bodies. We reviewed the patients' age, symptoms, duration of symptoms, prebronchoscopy posterior-anterior x-rays, type of foreign body, and anatomic location of foreign body. Sensitivity, specificity, negative predictive value [NPV], positive predictive value [PPV], and accuracy indices of chest x-ray for the diagnosis of TFB aspiration were measured in this study. The mean age of patients was 30 months [range 6-54 months], and 19[59.4%] were males. Among 32 patients who underwent bronchoscopy, foreign body was found and removed in 26 [81.2%] of them. Foreign bodies observed were the hull of nuts in 10 [38.5%], pomegranate seeds in 6 [23%], beans in 4 [15.4%], and some food products such as meat in two [7.7%] children. Chest x-ray was normal in 12 patients [37.5%]. The most common symptom was cough in 80% of patients; followed by wheezing in 60%, tachypnea in 40%, dyspnea in 20%, and stridor in 5%. The sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV], and accuracy of expiratory chest radiography in this study were 65%, 50%, 85%, 25%, and 62.5%, respectively. Chest x-ray is not specific for diagnosis of foreign body aspiration, and a normal chest x-ray does not always rule out the diagnosis of foreign body aspiration in patients with a history suggestive of foreign body aspiration and positive physical examinations
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Humanos , Masculino , Feminino , Traqueia , Brônquios , Criança , Broncoscopia , Radiografia Torácica , Corpos Estranhos/diagnóstico por imagem , Estudos RetrospectivosRESUMO
About 8% of patients experience prolonged mechanical ventilation after cardiac surgery. Development of criteria for successful liberation of a patient from mechanical ventilation and extubation may be highly dependent on the clinical situation. Different criteria were used for ventilator weaning. We designed a clinical trial to determine the usefulness of rapid shallow breathing index [RSBI] as a predictor for successful weaning from mechanical ventilation. In a prospective observational study, 52 patients who had prolonged mechanical ventilation [> 72 h] after open cardiac surgery were studied. Patients had 60 - min spontaneous breathing trials and satisfied at least 5 weaning predictors and fulfilled the criteria for discontinuing mechanical ventilation. Traditional weaning criteria and RSBI were determined. According to the outcome assessment of weaning, patients were divided into failure or success groups. The mean RSBI values were significantly different between the failure [103.5 +/- 21.9 breath/min/L] and success groups [80.4 +/- 15.3 breath/min/L, p=0.0001]. There was no significant difference regarding the values of other prediction criteria between the two groups. Using RSBI < 105 [breath/min/L] as the threshold value for predicting successful weaning, sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV], and diagnostic accuracy were 92.5%, 70%, 92.5%, 70% and 88% respectively. Although a small number of patients require prolonged ventilatory support after open cardiothoracic surgeries, growing experience in critical care settings and mechanical ventilation cause favorable outcomes. Ventilator weaning is more likely to be successful if RSBI is less than 105 [breath/min/L]. This index is a more valuable and accurate predictor of weaning than other weaning predictors
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Humanos , Pessoa de Meia-Idade , Idoso , Respiração Artificial , Sensibilidade e Especificidade , Valor Preditivo dos Testes , Avaliação de Resultados em Cuidados de Saúde , Estudos Prospectivos , Ensaios Clínicos como Assunto , Procedimentos Cirúrgicos Cardíacos , Mecânica RespiratóriaRESUMO
The effect of Odonthobuthos doriae [O.d] scorpion venom at 0/3, 1 and 3, 10 microg/ml concentrations were investigated on nerve-muscle transmission, using the Twitch tension technique. A concentration of 0.3 microg/ml caused a small change in the twitch height in response to indirect muscle stimulation, but higher concentrations [1, 3, 10 microg/ml] caused a transient augmentation in twitch response followed by a large contracture in the chick biventer cervices [CBC] preparation. This effect could be defined as a complex action of the venom, predominately presynaptic, in which its' effects on postjunctional synapses is also maintained. In order to find out which bioactive fraction could explain the venom effects, the soluble crude venom was partially separated by the gel filtration method, using a Sephadex G50 column, and four fractions were separated. Two of the four purified fractions [O.d F[3], O.d F[4]] were characterized as toxic and their LD[50] values were lower than the crude venom. Unlike the O.d Fj and O.d F[2] fractions, O.d F[3] and O.d F[4] fractions caused a significant block in the twitch and contracture, in comparison to the control sample. in conclusion, fractions O.d F[3] and O.d F[4] are supposed to be as the biological active components of the O.d. venom