[Information needs of patients with cardiovascular disease in health information seeking process: a qualitative study]

Introduction: Seeking health information is of salient importance in management of cardiovascular diseases [CVDs]. The present study aimed to explore and reveal the information needs of patients with cardiovascular diseases when seeking healthcare information. Our data sources were patients', family caregivers' and healthcare providers' experiences

Method: In a qualitative research approach, content analysis method was used. There were 31 participants comprising 16 cardiovascular patients, 5 family caregivers, and 10 healthcare providers. Required data were gathered through semi-structured interviews and purposeful sampling, and continued until data saturation. Analysis of data was performed concurrently with data collection and through a comparative method

Results: Four central themes including disease-related, healthcare-related, health system-related and life-related information needs emerged out of content analysis

Conclusion: The results showed that information seeking in patients with cardiovascular diseases is holistic and is beyond physical health and the disease. Some of the important findings of this study are seeking information about prognosis, role playing, mental and sexual health, healthcare system performance, modern medicine, Islamic and traditional medicine. Therefore, providing information through various modes of communication for meeting patient needs, having their participation in decisions for treatment, and optimal management of life is necessary

[Effect of patient education and telephone follow up by the nurse on the level of hope in patients suffering from heart failure]

This study was conducted to investigate the effect of patient education and telephone follow up by the nurse on the level of hope in patients suffering from heart failure. In this study, 189 patients suffering from heart failure were chosen using the convenient sampling method and randomly were assigned into two experiment and one control groups. The control group received only usual care. The first intervention group received one hour education and also one educational booklet at the time of discharge. The second intervention group received telephone followed up by the nurse three months after discharge and also one hour education and educational booklet at the time of discharge. Data was collected using miller hope and demographic data questionnaires. Data was analyzed using descriptive and inferential statistics. There was no significant difference between the mean of hope in the groups [P=0.354]. After the intervention, a significant difference was reported between the mean of hope in the groups [P=0.004]. Patient educations at discharge and telephone follow up after discharge as a cost-effective method by the nurse significantly increase hope in patients suffering from heart failure

[Results and outcomes of band ligation among 95 cases with esophageal varices in Taleghani Hospital between 2002 and 2007]

Endoscopic Variceal Ligation [EVL] is considered the selective method of therapy for patients who suffer from esophageal varices. In this article we evaluated the results and outcomes of patients who underwent EVL with multiband ligators due to their esophageal varices. We studied 95 cases of esophageal varices who underwent EVL at Taleghani Hospital between 2002 and 2007. EVL was applied because of active bleeding, primary or secondary prophylaxis for esophageal varice of grade 2 or above. The process was repeated every 3-4 weeks until the varices were occluded or become to grade 1 varices or small thrombosed ones. Their demographaic data were gathered and analyzed as well as all the 1 informations about their recent procedure. Our studied subjects had the mean age of 51.53 +/- 15.31 [ranged from 15 to 81]. The average number of sessions for performing EVL were 1.81 +/- 1.07 [ranged between 1 and 8 times]. The mostprevalent cause for applying EVL was active bleeding. Complications were significantly more in patients whom were candidated for EVL by reason of active bleeding, compared to those who underwent EVL for either primary or secondary prophylactic reasons [P=0.02]. Among cases who had developed any complications, the numbers of ligation sessions were significantly more than other patients [2.58 +/- 1.25 vs 1.40 +/- 0.66, P<0.001]. There was no case of death due to this mode of therapy. EVL as a selective mode of therapy for treatment of esophageal varices possesses a few cosequential complications and its application, therfore, is reasonable

Role of Genetic Factors in Inflammatory Bowel Disease

According to the remarks of gastroenterologists, prevalence of inflammatory bowel disease is increasing in our country. Since these diseases are the cause of multiple complications and low quality of life in patients, it mandates more considerations. On the other hand the pathogenesis of inflammatory bowel disease remained unclear and majority of researchers confirm the interaction of genetics, immunologic and environmental factors in its pathogenesis. Considering these factors separately is an important point in understanding the pathogenesis of the disease. This article evaluates the role of genetic factors in inflammatory bowel disease and different studies, in this field. Since discovery of the first inflammatory bowel disease related chromosomal locus in 1996, 10 related chromosomal loci have been recognized. The majority of studies have been performed on CARD15/NOD2 gene [IBD1 locus] and its polymorphisms. Since understanding of exact pathogenesis of inflammatory bowel disease is important in promoting newer and more effective therapeutic modalities, this goal would be accessible with extension of such clarifying studies

[Liver steatosis and chronic hepatitis-B infection: viral and host risk factors]

Liver steatosis and chronic hepatitis B infection are the most common causes of chronic liver diseases in Iran. There have been a limited number of studies throughout the world, evaluating the association of hepatitis B infection and steatosis. We studied the association between some of viral and host factors and the presence of steatosis among patients with chronic hepatitis B infection. In this analytical cross-sectional study, 71 patients with chronic hepatitis B infection were preliminarily assessed by liver biopsy. The patients were divided into two groups based on either presence or absence of steatosis in liver tissue. These two groups were compared in terms of different host and viral factors along with their stage of fibrosis. Of 71 patients, 30 [42.3%] had significant steatosis [in >5% of hepatocytes, according to Brunt classification]. Sex and gender were not significantly different in 2 groups. The mean BMI, serum levels of FBS, cholesterol, TG, GGT, were significantly higher in steatosis group compared to those of non-steatosis one [P<0.05]. In contrast, the mean levels of AST, ALT, ALK-P were not significantly different in these groups. The frequency of HBeAg positivity and the mean level of viral load of two groups had no significant difference. There was also no significant difference in the mean stages of fibrosis between two groups. It seems that certain metabolic hosts factors such as BMI, FBS, cholesterol, TG, GGT are associated with steatosis in patients with chronic hepatitis B infection while such an association was not found with the evaluated viral factors. We suggest further investigations to evaluate the role of other factors [such as HBV genotype] in the future

[ frequency of C3435T MDR1 gene polymorphism in Iranian patients with ulcerative colitis]

P-glycoprotein, the product of MDR1 [multi drug resistance] gene, is a trans membrane efflux pump, transferring drugs and toxins from intracellular to extracellular domains. It acts as a protective barrier to keep toxins out of the body by excreting them into the bile, urine and intestinal lumen. In the human gastrointestinal tract, P-glycoprotein is found in high concentrations on the epithelial cells of colon and small intestine. MDR1 gene polymorphism such as C3435T is associated with lower Pglycoprotein expression, thus it is suggested to have an association with ulcerative colitis. We tried to determine the frequency of C3435T polymorphism of MDR1 gene in Iranian patients with ulcerative colitis and compare it with healthy control population. In this case-control designed study, we assessed the C3435T polymorphism of MDR1 gene, in 150 ulcerative colitis patients and 150 sex- and ethnicity-matched healthy controls, who were visited at a teaching hospital during a one year period.[2002-2003]. The extracted leukocyte DNA was amplified by polymerase chain reaction [PCR] with specific primers, and C3435T polymorphism was detected by RFLP method. The mean age of patients was 40.1+/-13.9 years [14-74] and of controls was 40.7+/-14.0 years [16-79]. The frequency of C3435T allele was significantly higher in ulcerative colitis patients compared with controls [OR=1.58, 95% CI= 1.13 - 2.22, p<0.008]. The frequency of C/T genotype was also significantly higher in patients with ulcerative colitis [OR=1.67, 95% CI=1.06-2.64, p<0.028]. This study suggests that the higher frequency of 3435T allele has an association with ulcerative colitis in Iranian population as previously reported in western countries

[Association of the vitamin D receptor gene polymorphisms with inflammatory bowel disease in Iran]

Different genes such as vitamin D receptor [VDR] gene have some roles in IBD susceptibility. Some studies have recognized the relation of VDR gene polymorphisms with inflammatory and autoimmune disorders. Determining the frequency of these polymorphisms and their possible relation with IBD can improve understandings about genetic background of these diseases. The objective of this study was to assess the association of VDR gene polymorphisms [Apa I, Taq I, Bsm I, Fok I] with IBD in Iran. In this case-control designed study 100 UC, 50 CD patients and 150 sex and age matched healthy controls, hospital base, were selected. These patients were referred to [Taleghani Hospital] during a one year period [2004-2005]. Assessment of VDR gene polymorphisms was performed by PCR-RFLP method. Only the frequency of the Fok I polymorphism was significantly higher in UC and CD groups. The frequency of the polymorphic allele f was higher in UC and CD groups comparing with controls [p=0.019, OR=1.581 and p<0.001, OR=2.642, respectively]. The f/f genotype was significantly more frequent in UC and CD patients comparing with controls [p=0.010, OR=2.774 and p<0.001, OR = 5.947, respectively]. There were no significant differences between frequencies in patients and controls in other polymorphisms. There is a relation between Fok I polymorphism in VDR receptor gene and IBD in Iran but no association was observed with other 3 polymorphisms

frequency of three common mutations of CARD15/NOD2 gene in Iranian IBD patients

CARD15/NOD2 gene, located on the pericentromeric region of chromosome 16 [IBD1] has been reported to have an association with IBD, especially Crohn's disease [CD]. Many independent studies have shown a variable association between three common mutations of CARD 15, with Crohn's disease in different ethnic groups. Thus, raising the hypothesis that genetic and / or allelic heterogeneity may influence the relationship between CARD 15 and Crohn's disease. In the present study, we have investigated the frequency of three main mutations of CARD 15 gene [Arg 702 Trp, Gly 908 Arg and Leu 1007 fsinsC] in Iranian IBD patients and compared it with healthy control population. For this case-control study, 100 ulcerative colitis [UC], 40 Crohn's disease patients and 100 sex- age- and ethnicity-matched controls were enrolled from a teaching hospital during a one year period [2003-2004]. All three mutations were assessed on DNA of leukocyte cells, by PCR [Polymerase Chain Reaction] and RFLP [Restriction Fragment Length Polymorphism] methods. The mean age of UC, CD and healthy controls were 38.6 +/- 14.3, 36.6 +/- 14.1, and 38.6 +/- 14.2 years. Among the three evaluated CARD 15 gene mutations, the frequency of Arg702Trp mutation was significantly higher in Iranian patients with Crohn's disease [OR19.2; 95%CI:4.2-87.3, p<0.001]. None of these mutations were associated with ulcerative colitis. This study showed that Arg702Trp mutation of CARD 15 gene is probably associated with Crohn's disease in Iranian population; indicating that genetic polymorphisms may differ between populations

[Left ventricular systolic dysfunction among nocturnal myocardial infarctions]

Background and Objective: Diurnal variation in the onset of acute myocardial infarction with a peak in the morning has been demonstrated. Few data are available concerning about the left ventricular systolic dysfunction according to the infarct time. Regarding importance of onset of heart failure following acute myocardial infarction, this study was done to survey the effect of the time of acute myocardial infarction on left ventricular systolic dysfunction

Methods: This prospective study was performed on 100 patients with acute myocardial infarction [AMI]. Left ventricular systolic dysfunction [LVSD] was defined by echocardiography when ejection fraction [EF] was less than 55%

Findings: Of these patients, 72 had EF<55% and 37% of them experienced myocardial infarction between 6 am and 5:59 pm [Group 1] and 63 experienced their AMI between 6 pm and 5:59 am [Group 2]. Left ventricular EF less than 55% occurred in 22 [59.5%] patients of group 1 compared with 50 [79.4%] in group 2 [P=0.04]. Mild, moderate and severe LVSD were also more frequent in group 2 patients [P=0.01]

Conclusion: The risk of mild, moderate and severe left ventricular systolic dysfunction after AMI is higher among infarctions that begin at night

[Enrichment of intact peripheral blood dendritic cells by immunomagnetic depletion]

Introduction: Enrichment of intact peripheral blood dendritic cells [DCs] has been done using rosette and immunomagnetic depletion techniques

Material and Methods: Peripheral blood mononuclear cells were separated using ficoll density gradient centrifugation and T lymphocytes were depleted through reaction with AET- treated sheep red blood cells. The remaining cells were depleted from lineage marker positive cells using monoclonal antibodies against CD3, CD11b, CD14, CD16, CD19, CD56 and anti- mouse IgG magnetic beads. Flowcytometric analysis was used to determine the purity of the obtained DCs through HLA-DR expression and lack of lineage markers

Results: The obtained results showed that a significant population of isolated cells [58.5% +/- 4.5, n=5] fail to react with anti-lineage marker monoclonal antibodies but express the HLA-DR antigen

Conclusion Immunomagnetic depletion is a new method for DCs separation that unlike classic methods, can isolate DCs in intact form. According to our information, this is the first report of DCs separation in Iran and purity of the obtained DCs is comparable with similar studies in other countries. Significant enrichment of intact DCs could facilitate the study of DCs natural functions in different fields such as autoimmunity, cancers and infectious diseases