Service quality from the perspective of myocardial infarction patients.

OBJECTIVE: Service quality (SQ) generally refers to the nonclinical aspects of health services and primarily focuses on the relationship between the care provider and the customers, and the environment in which care services are delivered. The aim of this study was to assess the SQ provided for myocardial infarction (MI) from the patients' perspective. METHODS: A cross-sectional study was conducted with 164 patients with MI at the Tabriz Shahid Madani cardiology clinic. Study participants were selected using convenience sampling. SQ was measured using a validated Comprehensive Quality Measurement in Healthcare SQ questionnaire. The reliability was confirmed based on Cronbach's alpha coefficient (α=0.81). SQ was calculated using the formula SQ=10- (importance × performance), based on the importance and performance of non-health-related aspects from the customers' perspective. Importance scores ranged from 1 to 10 and performance was scored between 0 and 1. RESULTS: Of 164 participants, about 75% were men and almost 44% were between 51 and 65 years of age. From the customers' perspective, the total SQ score was 6.80 (0-10 scale), and the individual scores for all SQ aspects were below an acceptable level. Confidentiality, dignity and continuity were given the highest scores, while availability of support groups had the lowest score. CONCLUSION: The study findings revealed an opportunity to improve SQ. Patient and provider participation in quality improvement activities could be an effective strategy to improve the aspects of health care quality that were most important to the customers and those with low scores, such as availability of support groups.

Marrubiin-loaded solid lipid nanoparticles' impact on TNF-α treated umbilical vein endothelial cells: A study for cardioprotective effect.

Oxidative stress possesses a key role in the onset and development of cardiovascular diseases (CVDs), thus it can be an efficient target to tackle such ailment. Marrubiin, a bioactive diterpene, is a potent antioxidant against oxidative stress. Herein, we aimed to formulate marrubiin loaded solid lipid nanoparticles (SLNs) to improve its pharmacokinetics and bioavailability and also to investigate free drug and formulation's protective impact against intracellular reactive oxygen species (ROS) generation in HUVECs. Marrubiin-SLNs were formulated using hot homogenization/solidification method and then were subjected to physicochemical characterizations, i.e. size, zeta potential, morphology, polydispersity index (PDI), encapsulation efficiency (% EE), drug loading/content and physical stability assessments. MTT assay was performed to study the cytotoxicity of the intact and SLN incorporated marrubiin on HUVECs. Further, the antioxidant property of marrubiin and formulations was evaluated using DPPH radical scavenging assay and their protective effect against TNF-α induced oxidative stress was assessed by the means of intracellular ROS assessment, and also apoptosis/necrosis, cell cycle, and DNA fragmentation assays. Electron microscopy analysis showed spherical monodispersed SLNs with the size less than 100 nm, particle/zeta size analyses also approved the size of particles with a zeta potential of -1.28 ±â€¯0.17 mV. Results also showed high EE (98%), drug loading (31.74 mg/g) with 3.15% drug content. In vitro release studies revealed about 90% of marrubiin cumulative release during 24 h. The stability of marrubiin-SLNs in terms of size, zeta potential, polydispersity index, EE and drug leakage was approved. Marrubiin antioxidant stability after formulation was approved by DPPH analysis. MTT cell survival assay showed no significant cytotoxicity after 24 h and 48 h. Intracellular ROS detection assay revealed that marrubiin and marrubiin-SLNs, play protective effect against TNF-α induced oxidative stress in HUVECs which was further approved by apoptosis assessment. Conclusively, based on our findings, marrubiin nanoparticles are proposed as a preventive/therapeutic remedy against disorders elicited by increased levels of intracellular ROS in CVDs.

The effects of percutaneous mitral balloon valvuloplasty on the left atrial appendage function in patients with sinus rhythm and atrial fibrillation.

INTRODUCTION: Mitral stenosis (MS) causes structural and functional abnormalities of the left atrium (LA) and left atrial appendage (LAA), and studies show that LAA performance improves within a short time after percutaneous transvenous mitral commissurotomy (PTMC). This study aimed to investigate the effects of PTMC on left atrial function by transesophageal echocardiography (TEE). METHODS: We enrolled 56 patients with severe mitral stenosis (valve area less than 1.5 CM(2)). All participants underwent mitral valvuloplasty; they also underwent transesophageal echocardiography before and at least one month after PTMC. RESULTS: Underlying heart rhythm was sinus rhythm (SR) in 28 patients and atrial fibrillation (AF) in remainder 28 cases. There was no significant change in the left ventricular ejection fraction (LVEF), left ventricular end diastolic dimension (LVEDD), or the left ventricular end systolic dimension (LVESD) before and after PTMC in both groups. However, both groups showed a significant decrease in the left atrial volume index (LAVI) following PTMC (P=0.032 in SR and P=0.015 in AF group). LAA ejection fraction (LAAEF) and the LAA emptying velocity (LAAEV) were improved significantly after PTMC in both groups with SR and AF (P<0.001 for both). CONCLUSION: Percutaneous transvenous mitral commissurotomy improves left atrial appendage function in patients with mitral stenosis irrespective of the underlying heart rhythm.

Protective effect of carvedilol in cardiomyopathy caused by anthracyclines in patients suffering from breast cancer and lymphoma.

OBJECTIVE: Anthracyclines can damage the left ventricle, causing cardiomyopathy. This study evaluated the protective effect of carvedilol in cardiomyopathy caused by anthracyclines in patients suffering from breast cancer and lymphoma. METHODS: In this clinical trial, patients undergoing chemotherapy were randomly divided into three groups. The first group received placebo and the second and third groups received, respectively, 12.5mg and 25mg of apo-carvedilol 24 hours before starting the study. The patients underwent echocardiography and tissue Doppler to look for cardiomyopathy. After four months the efficacy of carvedilol was evaluated. RESULTS: Sixty-six patients were evaluated. No meaningful difference was observed among the groups in terms of mortality, age, gender, type of malignancy, chemotherapy regimen, and cumulative dose of doxorubicin and epirubicin. No statistically significant differences were observed between control and case groups considering the frequency of systolic cardiomyopathy (p=0.284) or the frequency of diastolic cardiomyopathy (p=0.284). CONCLUSION: Carvedilol at a daily dose of 12.5mg has a protective effect against diastolic disorder and at a daily dose of 25mg has a protective effect against both systolic and diastolic disorders.