Effects of a Cardiac Rehabilitation Program Versus Usual Care on Cardiopulmonary Function in Patients With Cardiac Syndrome X.

PURPOSE: Because of uncertainty in the pathophysiological process, the treatment of cardiac syndrome X (CSX) is still under study. Addressing the effects of cardiac rehabilitation (CR) can help promote the prescription of this modality as an adjuvant therapy for these patients. METHODS: This study was performed on 30 patients with effort-induced angina pectoris using a positive exercise test and/or myocardial perfusion scan in the absence of obvious stenosis or a stenosis of <50% on coronary angiography. The patients were divided into the CR and usual care (UC) groups and underwent cardiopulmonary exercise testing with gas exchange analysis before and after the study. The Duke Treadmill Score was used to compare prognosis and survival estimates of patients. RESULTS: An increase in peak oxygen uptake ((Equation is included in full-text article.)O2) was significantly higher in the CR group than in the control group (P = .017). Resting (Equation is included in full-text article.)O2 was also increased in the CR group, but its difference with the UC group was not statistically significant. Resting O2 pulse was increased in the CR group, which significantly differed between groups (P = .041). Exercise test duration and the Duke Treadmill Score significantly increased in the CR group as compared with the UC group (P = .003 and P = .002, respectively). Also, recovery heart rate in the first minute was significantly improved in CR group. CONCLUSION: Adding a 4-wk course of CR to UC for patients with CSX not only increased the Duke Treadmill Score and exercise test duration but also improved the resting O2 pulse, peak (Equation is included in full-text article.)O2, and first-minute recovery heart rate.

Characteristics of drug demand reduction structures in Britain and Iran.

Administrative structure of drug demand reduction and the way in which involved organizations interact with each other has been neglected by researchers, policy makers, and administrators at the national level and even in international institutions in this field. Studying such structures in different countries can reveal their attributes and features. In this study, key experts from the addictive behavior department of St George's University of London and a group of Iranian specialists in the field of drug demand reduction first wrote on a sheet the name of organizations that are in charge of drug demand reduction. Then, via teamwork, they drew the connections between the organizations and compared the two charts to assess the relations between the member organizations. In total, 17 features of efficient structure were obtained as follow: multi-institutional nature, collaborative inter-institutional activities, clear and relevant inter-institutional and intra-institutional job description, the ability to share the experiences, virtual institutions activity, community-based associations activity, mutual relationships, the existence of feedback sys-tems, evaluation, changeability, the ability to collect data rapidly, being rooted in community, flexibility at the local and regional levels, connection with research centers, updated policymaking, empowering the local level, and seeking the maximum benefit and the minimum resources. Recognizing the characteristics of substance related organizations in various countries could help policy makers to improve drug demand reduction structures and to manage the wide-spread use of psychoactive substances more effectively.

Risk factors of suicidal ideation and attempt in women with drug user spouses.

BACKGROUND: Despite ample evidence of the presence of mental and psychological disorders observed in the family members of drug users, few studies have attempted to focus on suicidal behavior in women whose spouses are drug users. METHODS: This cross-sectional study focused on 131 women who had a drug user spouse. They had all been married for >2 years, with no mental or psychological disorders and no history of drug use prior to marriage. Drug use history after marriage, the extent and nature of physical and non-physical wife abuse, and any history of suicidal ideation and attempt in the past year were collected, in addition to data about anxiety and depression. RESULTS: Our study showed that women who identified with a history of suicidal ideation and attempt were younger, had a shorter marital duration, had a more extensive history of drug use, were more likely to be abused by their spouse, and had higher anxiety and depression scores than their counterparts. Suicidal ideation predictors included a personal history of drug use [odds ratio (OR) = 9.217, 95% confidence interval (CI) = 1.727-49.180, p = 0.009] and anxiety and depression (OR = 1.080, 95% CI = 1.022-1.141, p = 0.004), whereas suicidal attempt predictors included a personal history of drug use (OR = 7.236, 95% CI = 1.671-31.326, p = 0.010), exposure to physical abuse by spouse (OR = 4.005, 95% CI = 1.393-11.523, p = 0.008), and anxiety and depression (OR = 1.092, 95% CI = 1.015-1.175, p = 0.018). CONCLUSION: The findings of this study showed that a personal history of drug use, an elevated anxiety score, and depression and exposure to physical abuse by their spouse may act as predictors of suicidal ideation or attempt in women with a drug user spouse. These findings may serve to benefit and support healthcare systems, associated with ongoing efforts to develop preventive programs for suicidal behavior in this population.

Initiation to the first drug use among substance-dependent persons in Iran.

In the present study, we report the initiation to the first drug in a representative sample of drug dependents in Iran. This is a cross-sectional study with a sample size of 7,743. The participants were characterized as drug dependents according to the Diagnostic and Statistical Manual-Fourth Edition and were sampled from the medical centers, prisons, and streets of the capitals of 29 provinces in the Islamic Republic of Iran. The mean age at first drug use in the sample was 21.1 (6.5), which differed for various first drugs of abuse. Opium was the first drug of use among 46.4% of the sample, and cannabis was the first drug only among 23.5%. The most frequent place of initiation was at a friend's house (n = 2,476, 33.2%). The same-gender friend out of school (the highest rate) was the most frequent person who suggested the first use. A total of 43.5% of the participants started drug use with friends and 18.8% at a friend's party. Policymakers may benefit from considering the information provided here in designing programs with the purpose of prevention.

Prophylactic ophthalmic bethametazone for sulfur mustard-induced ocular injury.

BACKGROUND: The present study sought to evaluate the prophylactic effect of bethametazone on sulfur mustard (SM)-induced ocular morphometric damage in the rabbit eye. METHODS: Twenty five healthy New Zealand white rabbits were divided into 4 groups of normal (not exposed to SM or solution), solution (exposed to solution), SM (exposed to SM), and prophylactic bethametazone (received eye solution of bethametazone then exposed to SM solution; then treated for 2 weeks). On the day 14 after exposure, five-micron sections were stained with haematoxylin and eosin for light microscopy evaluation. The ocular morphometric characteristics in the study groups were compared to determine the prophylactic effects of the bethametazone. RESULTS: Bethamethazone could protect eyes from SM effect by means of decrease in changes in number of Keratocyte in 10000 µm(2), thickness of cornea (µm), thickness of corneal epithelium (µm), number of meibomian gland's cells in 2500 µm(2), thickness of palpebral conjuctival epithelium (µm), thickness of epithelial of palpebral skin (µm), number of epithelial layers of palpebral skin, and number of goblet cells in conjunctival sac in 1000 µm. CONCLUSIONS: Bethametazone may have a prophylactic effect on the early lesions of the eye of the rabbit due to SM exposure.

Survival of rehospitalized kidney allograft recipients.

INTRODUCTION: Undergoing transplantation is extremely stressful, and a recipient is likely leave the hospital burdened with fears of an uncertain future. A paucity of knowledge on the long-term survival of rehospitalized kidney transplant recipients is the likely the reason that physicians fail to provide this group of patients with promising information and reassurance about their future. We sought to describe the long-term patient and graft survival after nonfatal rehospitalization in kidney recipients with a normal graft function after discharge. MATERIALS AND METHODS: We reviewed the follow-up data (from the time of discharge after first rehospitalization) of 253 kidney transplant recipients who had been discharged from rehospitalization with a normal kidney function (serum creatinine less than 1.6 mg/dL). Patient and graft survival rates 6 months and 1, 2, and 5 years after discharge were determined. RESULTS: The mean duration of follow-up (from the time of discharge after the first rehospitalization) was 38.9 +/- 11.2 months (range, 6 to 84 months). The overall patient survival rates were 98%, 97%, 95%, and 93% at 6 months, 1 year, 2 years, and 5 years, respectively. Graft survival rates at these times were 88%, 82%, 77%, and 63%, respectively. After the first posttransplant rehospitalization, 54 patients (21.9%) experienced more hospitalization episodes (mean, 2.6+/- 2.0 times), while 193 (78.1%) had no further hospitalizations during the follow-up period. Conclusion. Kidney transplant recipients who are rehospitalized should be reassured about favorable chances of survival if discharged with a normal graft function.

Mucormycosis after kidney transplantations: report of seven cases.

This is a report of 7 cases of mucormycosis infections in patients who had undergone transplantation and been admitted in the kidney transplant centre of Baqiyatallah Hospital in Tehran, Iran, from 2002 to 2005. We retrospectively reviewed the hospital records for demographic data, symptoms, diagnostic techniques and outcomes. Five patients were male and 2 female. The mean age of patients was 49.5 y. The time interval between transplantation and disease onset varied greatly (range: 1 month to 4 y). Patients' symptoms were fever (7 cases), respiratory distress (4 cases) and severe headache (3 cases). Suspected patients were evaluated by CT scan, BAL and biopsy and diagnosis confirmed by culture. The final diagnosis was pulmonary mucormycosis in 4 cases, rhino-cerebral mucormycosis in 2 cases and disseminated mucormycosis in 1 case. Despite early and intensive treatment with amphotericin B in all patients and extensive debridement in 3 cases, only 2 patients survived the disease. Mucormycosis is a potentially lethal complication after kidney transplantation. It could occur very early on or very late into the post-transplant period. Despite the results of other studies, the most frequent site of infection in our patients was the lungs.