Is there any difference in rate of acute complications-especially stent thrombosis-between bare metal and drug eluting stents?

Although bare metal stents [BMS] resolved abrupt closure which was the most important complication of percutaneous coronary balloon angioplasty, and then drug-eluting stents [DES] significantly reduced the rate of restenosis that was seen in around 30% to 40% at mid-term of post-percutaneous coronary intervention [PCI], but stent thrombosis is still a major problem which occurs in different phases. This study was conducted to evaluate the rate of acute complications, especially acute stent thrombosis [in the first 24 hours] in patients who received either BMS or DES. This retrospective study was performed on 1674 patients [640 women and 1034 men] who underwent PCI with at least one stent [from 2002 until 2006]. 2404 stents were deployed, 975 BMS [40%] and 1429 DES [60%], [820 Cypher, 570 Taxus and 39 other kinds]. 705 stents [35%] were deployed directly and 1699 stents [65%] followed pre-dilatation. In 35 cases [2%], the procedure was not completed because of several reasons [failure of guiding catheter engagement, failure to cross the lesions by guidewires or balloon catheters]. Fourteen patients [0.8%] suffered acute stent thrombosis [eight in the DES and six in the BMS groups], one of whom was referred for emergency coronary bypass surgery [CABG] and twelve patients treated by re-PCI. One patient was complicated by embolic occlusion of a dominant LCX during manipulation of the guiding catheter that was referred to emergency CABG. Two patients suffered left main [LM] dissection, one of whom was treated by prompt stenting and the other after stabilizing by LM stenting, was referred for urgent CABG. Fifteen cases [0.8%] developed slow or no-reflow phenomenon [six cases in the BMS and nine cases in the DES groups] who were managed by medical and mechanical intervention. Twenty five cases [1.5%] had mild CPK-MB rising [ten patients in the BMS and fifteen patients in the DES groups]. Totally 0.3% of cases were referred for emergency or urgent and [1.7%] for elective CABG. Fortunately there was no in-hospital death. This study showed a low and similar incidence of acute complications, especially acute stent thrombosis, in PCI in both BMS and DES groups

Successful percutaneous transcatheter closure of coronary artery fistulas [CAFs]

Coronary artery fistulas [CAFs] are vascular anomalies which in rare cases can cause hemodynamic problems with indication for intervention. Cogenital CAFs is a very rare malformation that may involve any or all coronary artery branches and any cardiac chamber. Elective closure of coronary artery fistulas by percutaneous transcatheter techniques is generally accepted in the presence of symptoms, but controversies exist in the management of asymptomatic patients. We described two patients: A 49 years old female developed episodes of increasing exertional chest pain and dyspenea over 3 years, another 32 years old was referred for coronary angiograph because of dyspenea on exertion with-increasing its severity since one year age. Although non invasive imaging may be helpful, we demonstrated that cardiac catheterization and coronary angiography is necessary for the precise delineation of coronary anatomy and CAF. Mentioned above treatment is advocated for symptomatic patients and for those asymptomatic patients who are at risk for future complication. Form available data and our results Transcatheter closure [TCC] of coronary artery fistula [CAF] is an acceptable alternative to surgery in most patients

[Social skills: the role of this skills in prevention of adolescents abuse]

Child abuse is one of the social problems. The control of which requires good and appropriate planning in order to prevent and reduce the related problems. The present study describes the relationship between social skills of adolescents with their abuse at 17 district[th] in Tehran. The purpose of this research was to study the relationship between social skills of adolescents with their Maltreatment in the 17 district[th] in Tehran. This is a descriptive correlational study conducted through multistage sampling. Sample size included 144 students selected from four girl and boy secondary schools in 17 district[th] of Tehran city. Matson evaluation of social skills and Child Abuse Self Report Scale were used for measuring social skills and child abuse. For analyzing the data Pearson correlation test and multiple regression analysis were used. The findings demonstrated a significant relationship between adolescents' social skills and maltreatment with them. The results indicated that adolescents' aggressiveness is the most significant predictor in maltreating them. Overall it is concluded that deficits in social skills particularly aggressiveness, non-social behaviors, and lack of observing appropriate social skills at children interacting with adults increases the likelihood of children's abuse. So it is necessary to improve social skills of teenagers and students by authorities and practitioners

comparison of outcomes of routine early angiography versus delayed ischemia-guided angiography after thrombolytic therapy in ST segment-elevation myocardial infarction

Thrombolytic therapy continues to be the common treatment in acute ST elevation myocardial infarction in the majority of heart centers worldwide. However, thrombolytic therapy is associated with high re-occlusion and re-infarction rates. So, most patients now undergo early diagnostic angiography and possibly angioplasty of the culprit artery but the controversy about the timing of angiography after thrombolysis continues to remain unresolved. In this prospective cohort study, we compared the outcome of early invasive strategy versus delayed invasive approach in ST-elevation MI patients who had received successful thrombolytic therapy. Primary endpoint of the study was Major Adverse Cardiovascular Events or MACE [the combined rate of death, re-infarction, major bleeding and cerebrovasular events. Secondary endpoints were re-infarction and re-hospitalization rate. The study comprised 142 patients of which 87 had a routine angiography in less than 10 days of acute event and 55 underwent ischemia-guided angiography after 10 days of index event. Stenting of the culprit vessel was done in 60% of the routine angiography group and 63% of the ischemia-guided group. The patients were followed for 8.8 +/- 2.8 months after the index event. The primary endpoint occurred in 6.9% of routine angiography patients and 10.9% of the control group [P= 0.4]. The rate of re-infarction was significantly higher in the delayed invasive arm than routine early invasive arm [10.9% vs. 1.1, P:0.01],and mostly occurring before angiography. Routine angiography as soon as possible after thrombolysis can reduce re-infarction and was not associated with any increased risk of adverse events in our study

[Relationship between cognitive emotion regulation styles and general health among university students]

This research is about the relationship between Cognitive Emotion Regulation Styles and General Health in C.A students of Tabriz University. The subjects of this research are 300 students of Tabriz University that were selected through simple random sampling. Then they were administered cognitive emotion regulation correlational coefficient, stepwise regression analysis, independent t test, and one-way analysis of variance. The results indicated significant relation between cognitive emotion regulation styles and psychological health. Catastrophising and blaming others styles, belonged to maladaptive cognitive emotion regulation and positive refocusing, and positive reappraisal styles belonged to adaptive cognitive emotion regulation were significant predictors of psychological health. The catastrophising style did have more roles in predicting the psychological health. Also it is revealed that boys more than girls' use self blame style but they have more psychological health than girls as well. Cognitive emotion regulation styles are useful for behavioral interventions

In-hospital course of early invasive strategy in acute coronary syndromes

Unstable angina is emerging as a major public health problem worldwide. Two approaches - an early invasive strategy or a conservative strategy - are used of the management of non-ST elevation acute coronary syndrome [MSTE-ACS]. An early invasive strategy involves the use of early coronary angiography and revascularization with percutaneous coronary intervention [PCI] or coronary artery bypass graft surgery [CABG]. A conservative strategy involves initial treatment with aggressive pharmacologic treatment, and coronary angiography with revascularization is used if there is evidence of spontaneous or provoked ischemia within the hospital stay. Two hundred sixty-one patients coronary syndrome were enrolled in this study for early invasive strategy. Patients received aspirin, heparin, clopidogrel, and lipid-lowering therapy. The primary endpoint was a composite of death, non-fatal myocardial infarction, cerebrivascular accident, and recurrent chest pain. Angiograms were assessed qualitatively by two expert invasive cardiologists. Sixty-seven percent of the patients underwent percutaneous [33%] or surgical [34%] revascularization. The overall death rate was 1.1%. In-hospital major adverse cardiac event [MACE] rate was 3.2% in the revascularization groups. According to the favorable in-hospital course in patients referred for PCI or CABG, it seems that accurate selection of patients who may be candidates for early invasive strategies is of paramount importance. We found that diabetes, cardiac enzyme elevations [Troponin T], ST/T changes, and the presence of two or more risk factors besides diabetes are powerful predictors of the patients who will undergo revascularization. Proper selection of patients admitted with ACS for invasive strategy is warranted. Positive cardiac enzymes [Troponin T], diabetes mellitus, and presence of two or more major CAD risk factors are helpful for patient selection

Frequent oversizing during Amplatzer device deployment for percutaneous PDA closures

Transcatheter closure of small to moderate patent ductus arteriosus [PDA] has been well established during this last decade. The Amplatzer device occluder [ADO] is self-expandable device with ease of delivery and a rapid learning curve. The aim of the study was to access the optimum sizing of ADO in regard to maximum efficacy with respect to shunt occlusion without oversizing and reducing bulk and potential protrusions. From April 2007 to July 2008, a total of twenty-four adult PDA closures were reviewed. Occlusion was achieved via antegrade venous approach. Our primary objective was an evaluating of optimum ADO sizing for PDA closures. We retrospectively compared the patients with a theoretical optimum size as regards complications and residual shunts. PDA size determination was based on the smallest diameter at pulmonary artery [PA] side. Based on specific criteria, undersizing was not observed in our cases, while oversizing was noted in 42% of cases. Oversizing did not lead to a decrease in residual shunts [37.5% vs. 36%, p=NS]. Although no short-term complications were observed in the oversized group, oversizing resulted in a characteristic mushroom deformity due to unnecessary tension applied to our device. The Chinese device also performed well in terms of deployment and short-term complications with no significant difference in comparison to its American counterpart [p=NS]. An acceptable rate of acute complications was obtained; nonetheless, we were frequently oversizing, leading to mild device deformation and protrusion. Although not previously described in the literature, the terminal ballooning of the ADO should alert us of such a complication

Platelet GP IIb/IIIa receptor inhibition by eptifibatide in non ST-elevation MI-acute coronary syndrome

Recent trials of platelet glycoprotein IIb/IIIa receptor inhibitors have improved our understanding to best use these powerful antiplatelet drugs in acute coronary syndrome. We tested the hypothesis that inhibition of GPIIb/IIIa platelet receptor with Eptifibatide is effective as an empiric therapy in patients with acute coronary syndrome who do not necessarily undergo immediate revascularization. Since Feb 2006 one hundred and ninety-six patients who had presented with non ST-elevation acute coronary syndrome [NSTE-ACS] were randomly assigned to receive Eptifibatide in addition to standard therapy, for up to 72 hours or routine standard therapy. The primary end point was composite of death and non-fatal myocardial infarction [MI] or urgent target vessel revascularization [TVR] in 30 days. The incidence of composite end point of death, non fatal MI and urgent TVR was significantly lower in Eptifibatide group than standard group [16% vs. 0% - P value <0.01],particularly in troponin positive subgroup of patients [27.8% vs. 0% - P value <0.01]. Any major adverse reaction such as major bleeding, stroke, or thrombocytopenia was not seen. Early administration of GP IIb/IIIa receptor inhibitor is recommended in patients with high-risk acute coronary syndrome

Role of personality structure and sense of identity in mental health and appropriate efficiency in qom city hall employees

Hardiness is one of the most important personality traits in structuring personality stricture which can cause resistance to psychological traumas. In the present study the relationships between hardiness as a personality structure with automatic thoughts as a mental dysfunction and inferiority as a sense of identity was investigated. In this study, by Applying cluster sampling method, 406 male employees of Qom city hall were selected. Aghayousefi questionnaire of Aghayousefi automatic thoughts and inferiority and Ahvaz hardiness inventory [AHI] was used. Descriptive and inferential indexes such as correlation and multiple-linear regression were utilized in statistical analysis with SPSS 15. revealed that inferiority and automatic thoughts variables are predictor of hardiness. This means that

influence of age at the time of cochlear implantation on hearing threshold in prelingually deaf children

There always has been a question about the best age for cochlear implantation [CI] in prelingual deaf children. The age factor in the outcome of cochlear implantation in prelingual deaf children has been the subject of many studies. The aim of the present study was to find the effect of age at the time of implantation on hearing threshold of these children. One hundred and nine prelingual deaf children who had undergone CI were enrolled. The mean hearing threshold [HT] at octave intervals from 125 to 8000 Hz at different periods from the operation time were compared between those patients whose age at the time of implantation were less than 24 months and those whose age were equal or greater than 24 months. The mean age of patients at the time of implantation was 38.9 months and a half of them had less than 28 months. There was no difference in mean HT between the two age groups across different measurement periods. A multiple regression model showed that device type was the sole significant predictor of mean HT at the first and third months after implantation, where age replaced it at the sixth month. These results suggest that what had been found in other studies as a favorable effect of younger age at the time of implantation on speech perception cannot be explained by a better hearing, and there are other important factors including rehabilitation programs beginning at a younger age that may explain those findings

Suppression of tinnitus in patients undergoing cochlear implantation

Tinnitus is a frequent complaint in patients with sensorineural deafness. Different reports suggest that electrical stimulation caused by cochlear implant devices supresses tinnitus to a considerable degree. In a longitudinal study we have evaluated the severity and duration of tinnitus in both ears of 17 cochlear implant patients before and after operation. Severity of tinnitus was reduced in both implanted and not implanted ears after the implantation [P = 0.003 and P = 0.004 respectively]. Duration of tinnitus, however, was not affected significantly. No significant difference in tinnitus suppression was observed between the implanted and not implanted ears. This might be attributed to both the electrical stimulation caused by the device and the psychogenic stability provided by return to the world of sound