فهرست مطالب behzad rahimi

Premature coronary artery disease (CAD) is common in men and women under 45 and 55 years, respectively. It has been demonstrated that R202Q mutation of MEFV gene may increase the risk of cardiovascular disease in individuals with metabolic syndrome. The goal of the present investigation was to evaluate the frequency of MEFV gene mutation R202Q in exon 2 in Iranian patients with premature CAD (West Azerbaijan province of Iran).

A total of 100 patients with premature CAD and 100 healthy individuals participated in this hospital-based study. Cases and controls were selected based on strict criteria, including a minimum of one documented angiography with at least 50% stenosis of the coronary artery. PvuII based PCR-RFLP technique was used for the detection of R202Q mutation in the tested samples.

R202Q mutation was not found in any of the healthy controls; whereas 12 out of 100 patients with premature CAD were heterozygote for R202Q mutation (12%) (12% vs. 0%). Considering the heterozygosity of the R202Q mutation in the patients, the allele frequency was 0.06 (12 out of 200 chromosomes).

Our results indicate that the R202Q mutation in the MEFV gene is frequent in patients with premature CAD. Further studies are necessary to analyze more details regarding variable expressivity or incomplete penetrance of R202Q mutation in the tested population.

Background &

Raynaud's is a common phenomenon that is also seen in connective tissue diseases such as polymyositis, lupus and mixed connective tissue diseases. However, its occurrence is more pronounced in systemic sclerosis. This phenomenon can be so severe that it leads to cyanosis and gangrene of the fingertips in the final stages. In Raynaud's phenomenon, finger discoloration occurs during contact with cold weather during various stages. First, the skin turns white, then cyanotic and blue, and then changes color to red. The primary pathology in Raynaud's phenomenon is spasm of the end vessels of the limbs and involvement in it from the distal part of the limb and fingers to the proximal, which gradually causes skin atrophy. Capillaroscopy is a method used to diagnose Raynaud's phenomenon and can be used to evaluate the functional and morphological changes of microcirculation in connective tissue diseases (CTDs). Examination of nail capillaries can reveal the nature and extent of microvascular pathology in patients Show CTD. This method can clearly show the main capillary changes of the nail, including megcapillary, capillary bleeding and reduced capillary distribution, in diseases such as systemic sclerosis. The aim of this study was to determine the capillaroscopy findings in CTD patients. After the study, data on Raynaud's patients were compared with other patients. In other words, the aim of this study was to determine the microvascular structure, capillary density, loop diameter, microhemorrhage and angiogenesis in patients and non-patients with Raynaud's syndrome.

The case control study was performed on patients who referred to the rheumatology clinic of Rasoul Akram hospital in Tehran from 2017 to 2019. According to ACR criteria, rheumatoid arthritis, systemic lupus erythematosus, scleroderma, dermatomyositis, polymyositis, Sjogren and mixed connective tissue disease were included in the study. Patients were divided into two groups according to Raynaud's disease and the findings of capillaroscopy were compared. Written consent was obtained from all patients stating their consent to enter the project. Information obtained from patients was considered confidential. The results of the study were performed without publishing the names of the patients.

Finally, 96 people (22 male / 74 female) participated in the final analysis after completing the required data. The mean age of patients was 46.22 ± 14.02 years (18-84 years). In total, out of 96 cases, 30 (31.3%) had normal, 17 (17.7%) had nonspecific morphological abnormality (NSMA) and 49 (51%) had Scleroderma Pattern. There was no statistically significant difference in capillaroscopy findings according to gender and age groups. Abnormalities of microvascular structures and capillary density as well as loop diameters were significantly higher in the scleroderma group than in the other groups. In terms of micro hemorrhage and angiogenesis, most of the positive cases were in the scleroderma. Abnormalities of microvascular structures and loop diameters were significantly higher in the Raynaud than in the non-Raynaud patients.

There was a statistically significant difference between the Capillaroscopy results. This difference in microvascular structures and loop diameters was significant between Raynaud's patients and other patients, so that Raynaud's patients had a higher relative frequency of abnormal microvascular structures and abnormal loop diameters. According to some studies, the trend of capillary changes can be highly related to the progression of the disease to diseases of the scleroderma spectrum. Therefore, it seems that the sequence of using Capillaroscopy can be helpful in diagnosing these changes.

The present study investigates the effect of job security and employee well-being in providing services to customers: a study in the branches of the National Bank of East Azarbaijan province. This study is applied in nature and descriptive-causal in terms of implementation method. The statistical population of the research consists of all the employees of the National Bank of East Azarbaijan Province, who were selected as a statistical sample of 313 people using Cochran's formula and available-judgmental sampling method. And to collect primary data, a questionnaire tool was used, which is a job security questionnaire with 3 questions and following Sharma et al. (2016) and an 18-year employee welfare questionnaire and following Haag et al. (2000), as well as a customer service questionnaire. 30 questions are based on Saqaian (2013). Structural equation method and PLS3 software were used for data analysis. The findings of the research showed that job security and employee well-being have a significant direct impact on providing services to customers in the branches of the National Bank of East Azarbaijan province.

Target: 

Bendopnea, defined as dyspnea while bending, can be observed in patients with heart failure (HF). In this study, we investigated the frequency of this symptom in patients with systolic HF and its association with echocardiographic parameters.

In this study, patients with left ventricular ejection fraction (LVEF) ≤45% and decompensated HF referred to our clinics were prospectively recruited. All patients were examined by cardiologists for collecting data on the presence of bendopnea and baseline characteristics. They also underwent electrocardiographic and echocardiographic examinations. All findings compared between patients with or without bendopnea.

A total of 120 patients with a mean age of 65.19 ± 12.62 years were evaluated, and 74.8% were men. Bendopnea was observed in 44.2% of the patients. The etiology of HF was ischemic in most patients (81.9%), and the functional class of most patients (85.9%) was III or IV. The mortality rate at 6 months follow-up was comparable between patients with or without bendopnea (6% vs. 9.5%, p=0.507). The waist circumference (odds ratio [OR] 1.037, 95% confidence interval [CI] 1.005 – 1.070, p = 0.023), paroxysmal nocturnal dyspnea (OR 0.338, 95% CI 0.132 – 0.866, p = 0.024), and right atrium size (OR 1.084, 95% CI 1.002 – 1.172, p = 0.044) were associated with bendopnea.

Bendopnea can be frequently found among patients with systolic HF. This phenomenon is associated with obesity and baseline symptoms of patients and right atrium size upon echocardiographic examinations. It can help clinicians with the risk stratification of HF patients.

In this paper, an analytical method for evaluating single piles under lateral loading by stiffness matrix method has been developed in which nonlinear behavior for soil stiffness and flexural stiffness of piles. In this method, the implicit limit state functions are used and the analysis is based on the reliability method. Two types of failures have been investigated in this study, which include lateral displacement of the pile head as well as the maximum bending moment along the pile. The reliability index is evaluated using an algorithm for the first-order reliability method (FORM) and based on the elliptical method using random variables. In this study, spatial variability of soil characteristics is also considered using spatial autocorrelation method. In this research, validation of the results using numerical derivation and comparison with Monte Carlo simulations based on important sampling was done and also sensitivity analysis was conducted too.

Peripheral Blood Platelet to Lymphocyte Ratio (PLR) has been recently suggested as a prognostic determinant in cardiac ischemic events, followed by mortality. The present study aimed to evaluate the predictive power of PLR in predicting the severity of coronary artery involvement in patients presented with the acute coronary syndrome.

This cross-sectional study included 520 patients who were referred to Taleghani Hospital, Urmia, Iran, with the acute coronary syndrome and underwent coronary angiography. The information of patients’ coronary angiography was investigated; moreover, the severity and extent of coronary artery involvement were determined based on GENSINI criteria. Finally, the data were analyzed in SPSS software (version 21).

There was a significant and positive correlation between PLR and coronary artery involvement based on the GENSINI criteria (P=0.005). Furthermore, according to the multivariate linear regression model, PLR was an independent predictor of the severity and coronary artery involvement according to GENSINI criteria among the patients with the acute coronary syndrome (P=0.049).

The PLR seems to be an independent predictor of the severity of coronary artery involvement in patients admitted with acute coronary artery disease.

 The assessment of potential benefits and harms of a medical procedure is essential for both physicians and patients to make an informed choice among treatment options. There is a paucity of studies on the role of creatine kinase-MB  (CKMB) in the prediction of patient outcome after elective percutaneous intervention

 The current study aimed to assess the association of CKMB level with demographic characteristics and major adverse cardiac events (MACES) after percutaneous coronary intervention (PCI) with drug-eluting stent implantation.

 The study was conducted based on the data concerning the consecutive patients hospitalized for PCI and followed for 12 months. We examined the association between CKMB levels at 12 h post-PCI in patients with drug-eluting stent implantation and demographic characteristics. MACEs were defined as death, myocardial infarction, the need for re-revascularization in the first 48 h after the procedure and during a 1-year follow-up in 2898 patients who underwent PCI in Tehran Heart Center within 2015-2016.

 In multivariate logistic regression, after adjustment for differences, no relationship was observed between CKMB level at 12 h post-PCI and 12-month MACEs; nonetheless, in-hospital MACEs were higher in patients who had CKMB> 3 times the upper limit of normal. Furthermore, thrombus, angulated segment, and coronary perforation during the procedure were more prevalent in patients with higher CKMB levels.

 The obtained results demonstrated that in patients with elective drug-eluting stent implantation, the moderate elevation of post-procedural CKMB>3 times was associated with in-hospital MACEs. Moreover, no association was found between 1-year adverse events and >3 times the elevation of CKMB.

Hypertension is one of the most serious global concerns since it has affected over 1.2 billion people.

The present study aimed to determine the effect of vitamin D supplementation on blood pressure, fasting blood sugar, and lipid profile in hypertensive patients with vitamin D deficiency.

In this double-blinded randomized placebo-controlled clinical trial study, 116 hypertensive patients (intervention and placebo groups, 58 each) with vitamin D deficiency (< 30 ng/mL with ECL) for 14 weeks, started from the beginning of autumn 2019 in Seyed-al-Shohada Educational Hospital in Urmia City. Fifty-five patients (49%) were male with the mean vitamin D 15.89 ± 5.09 ng/mL and 57 females with 17.29 ± 6.31 ng/mL. In a stratified blocked randomization scheme, the patients were randomly allocated into similar sized intervention and control groups based on body mass index (BMI), then the randomization with four block size was performed in each of strata by random allocation software. The intervention group received six doses of 50,000 IU vitamin D supplements for 6 weeks, then two supplements for two following months (one capsule per month). Blood pressure (24/h blood pressure measured by an ambulatory blood pressure monitoring device), vitamin D, FBS, and lipid profile (HDL, LDL, CL, and TG) were all measured at baseline and end of the study. Physical activity (measured by short IPAQ questionnaire), sun exposure using a questionnaire, dietary intake of vitamin D using three 24-hour recalls during the intervention, and anthropometric indices were measured at baseline, middle, and end of the study. Fifty-six patients in each group completed the study. The study was approved by the Ethics Committee of the Urmia University of Medical Sciences (ethics code: IR.UMSU.REC.1398.192).

The office blood pressure, 24-h systolic blood pressure (SBP) and diastolic blood pressure (DBP), nighttime SBP and DBP were significantly reduced in the intervention group compared to the control group, whereas the reduction of daytime SBP and DBP was not statistically significant. Vitamin D supplementation significantly decreased serum triglyceride, cholesterol, and LDL levels.

Vitamin D supplementation had positive effects on blood pressure, triglyceride, cholesterol, and LDL levels in patients with low serum vitamin D.

 Over 5.5 trillion cigarettes are produced annually. Based on the observations, 76% of these consumed cigarettes are littered in public areas instead of discarding in suitable bins. Rainwater drain system carries the water and other wastes such as cigarette butts from the ground and transfers them to the bigger aquatic media without any treatment in which hundreds of chemicals leach into animal's habitats and our water supply origin. The key purpose of this article was to measure the concentration of Arsenic (As) released into water from cigarette butts and to compare their levels among the different brands. 

 Ten cigarette butts (comprising cigarette filter and remaining tobacco) of five cigarette brands named Winston, Bahman, Kent, Montana, and Magna were soaked into individual 100 ml of distilled water for 10 days. Five solutions were prepared for each brand, as was detected in all leachate of brands but with different quantities. 

 Arsenic levels were 53.51, 32.78, 55.33, 42.4, and 59.24 μg/l for Kent, Winston, Montana, Bahman, and Magna, respectively. 

 As concentrations were placed in the following order: Winston < Bahman < Kent, Montana, Magna. Based on the present study, cigarette butt plays an important role in environmental pollution and its importance should not be ignored in terms of arsenic potential.

Epicardial fat thickness (EFT) can reflect risk of cardiovascular disease particularly coronary artery disease (CAD). The aim of this study was to investigate the association of EFT assessed by echocardiography and presence as well as severity of CAD.

Two hundred and twenty consecutive patients who candidate for coronary angiography because of possible CAD were studied. EFT was evaluated in standard parasternal long axis (PlAX) and parasternal short axis (PSAX) view from 3 cardiac cycles at the end of systole and diastole. The severity of CAD was defined in two ways: (1) SYNTAX score, (2) number of vessels with significant lesion.

PLAX (EFTS ) (EFT in systole) and PLAX (EFTd ) (EFT in diastole) were significantly higher in patients with CAD in comparison with patients without CAD (P = 0.046, P = 0.041 respectively). There was a significant correlation between PLAX (EFTS ) (P = 0.05), PLAX (EFTd ) (P = 0.04) and SYNTAX score. There was no statistically significant relationship between EFT and number of diseased vessel (P > 0.05). Multivariate analysis was done for adjusting the effects of confounding factors and it showed that EFT (OR: 10.53, P = 0.004) was significantly correlated severe CAD as assessed by the SYNTAX score.

EFT assessed by transthoracic echocardiography was higher significantly in patients with CAD than in normal patients. EFT as an easily available and cost-effective echocardiographic feature might be useful to predict complexity of CAD.

Coronary artery ectasia is known as the cause of chest pain and dyspnea. Because of its variable presentations according to the genetic and environmental differences, we studied patients with pure coronary artery ectasia in north-west of Iran.

Exclusion criteria were established ectasia in one or more coronary arteries without any significant coronary artery stenosis defined as stenosis > 70%. Coronary artery angiography and demographic data of patients were evaluated.

The mean age of patients according to the type of ectasia were 54.57±8.65 in type 1, 59.95±9.62 in type 2, 58.91±12.33 in type 3, and 57.46±10.74 in type 4. Type 3 ectasia was the most common type of ectasia (30.7%). Type 1 ectasia was more common in men and type 3 ectasia was more common in women (p=0.04). There wasn’t any significant association between the type of ectasia and the prevalence of dyspnea or chest pain. Coronary artery ectasia was frequently observed in the left anterior descending artery (LAD).

The prevalence of coronary ectasia according to its types is different between men and women. There was no association between the extent of ectasia according to Markis classification and the prevalence of dyspnea and chest pain.

Although the myocardial bridge is considered as a benign congenital anomaly, atherosclerotic stenosis of coronary artery segments adjacent to muscle bridge has made some concerns about its direct role in triggering atherosclerosis. This study tries to investigate the role of the conventional risk factors of atherosclerosis in this phenomenon.

Between June 2011 and July 2018, a total of 342 patients with coronary artery Muscle Bridge in coronary artery angiography were investigated for concomitant coronary artery stenosis and the presence of conventional risk factors of atherosclerosis.

86 (25.1%) patients had coronary artery stenosis adjacent to muscle bridge. The mean age of patients was 56±11.76 and 49.2±11.34 years in coronary artery stenosis and normal coronary groups, respectively. (p- value= 0.001) Multivariate regression analysis showed that male gender (OR=2.8), diabetes mellitus (OR=2.3), and hypertension (OR=2.0) were independent predictors of coronary artery stenosis adjacent to muscle bridge.

Our study showed that conventional risk factors of coronary artery disease play an important role in atherosclerotic stenosis adjacent to muscle bridge.

CAE characterized as diffuse dilatation of epicardial coronary arteries has been shown to have association with risks of death and myocardial infarction. Neutrophil count and neutrophil to lymphocyte ratio (NLR) are cost effective, available and rapidly measureable inflammatory marker. In this study we decided to investigate the association between these factors as inflammatory markers and CAE severity.

In this cross sectional study 577 patients who underwent coronary angiography between September 2016 and September 2017 were evaluated. According to angiography findings patients were divided into four groups: 1-normal coronary artery, 2-coronary artery diseased group, 3-low risk coronary artery ectasia (CAE) and 4-high risk CAE.

In CAE group 61 patients (52.1%) had one vessel involvement and defined as low risk and 56 patients (47.9%) had two or more vessel involvement and grouped as high risk CAE. NLR was non-significantly higher in CAD group following high risk CAE group. (2.61±0.51 and 2.33±0.11 respectively) absolute neutrophil count was significantly higher in CAD and high risk CAE groups.

Neutrophil count is an inflammatory marker with good association with coronary artery ectasia and coronary artery disease.

Recent studies have shown that some of the MEFV gene mutations are common in patients with coronary artery disease. The present study was designed to investigate the presence or absence of E148Q mutation in exon 2 of MEFV gene in patients with premature coronary artery disease. In this study, 90 patients with coronary artery disease were voluntarily selected for molecular analysis of the E148Q mutation in the exon 2 of the MEFV gene. 2-3 ml of peripheral blood was collected in tubes containing EDTA. Genomic DNA was extracted using "salting out" method. RFLP-PCR was used to determine the E148Q mutation. Of 90 patients studied, 7 (7.8%) patients were heterozygous for the E148Q mutation. In other words, of 180 chromosomes examined, 7 chromosomes (3.9%) had a mutated allele regarding E148Q mutation. In this study, the E148Q mutation was not found to be homozygote in tested samples. It can be concluded that E148Q mutation is not a risk factor for coronary artery disease in the tested group.

Premature coronary heart disease (PCHD) affects public health and leads to death. PCHD has several genetic and environmental risk factors. The aim of this study was to analysis of the mutations in exon 10 of MEFV gene in patients with PCHD in West Azerbaijan province of Iran.
Totally 41 PCHD patients who were admitted to the cardiology unit of Sayedoshohada hospital (Urmia, Iran) enrolled in the study. Selection of the patients was done based on the strict criteria, that is, who had a minimum of one angiographically documented coronary artery with the stenosis of 50%. Mutations in exon 10 of MEFV gene were found by direct sequencing.
V726A, M680I, K695R, and A744S mutations with 2.44%, 1.22%, 1.22%, and 1.22%, allelic frequency were found, respectively. Five patients (12.2%) with PCHD carried at least one mutated MEFV allele. Heterozygote V726A was the most frequent mutation among tested cases (4.88%), followed by heterozygote M680I, heterozygote K695R, and heterozygote A744S.
The results of the present study imply that the frequency of the MEFV gene exon 10 is significantly high in PCHD patients. This is the first report in its own kind in clinically diagnosed PCHD pa­tients of Iranian Azeri Turkish population.

QT dispersion (QTd) is equal to longer QTc minus shorter QTc measured by 12-lead electrocardiogram (ECG). QTd reflects inhomogeneity in repolarization of ventricular myocardium and because of easy and fast measurement of QTd, it can be used to predict high-risk patients for dysrhythmia after Acute Myocardial Infarction (AMI).. This study aimed to assess the effect of thrombolytic therapy on QTd before and 1 hour and 4 days after beginning of thrombolytic therapy..Patients and The patients with chest pain and ST Elevated Myocardial Infarction (STEMI) that underwent thrombolytic therapy were enrolled into this study. Streptokinase was the thrombolytic agent in all the patients. Standard 12-lead (ECG) was evaluated before beginning of thrombolytic therapy (QTd 1) and 1 hour (QTd2) and 4 days (QTd3) after thrombolytic therapy. First, ECG was magnified × 10 for exact calculation of QT and QTd. After all, the variables were compared using one–way analysis of variance (ANOVA). Besides, P ≤ 0.05 was considered as statistically significant.. This study was conducted on 160 patients. The results revealed no significant differences among QTd 1, QTd 2, and QTd 3 (P > 0.05). At inferior AMI, however, a significant difference was observed among QTd1, QTd2, and QTd3 (P = 0.031).. Thrombolytic therapy had no significant effects on QTd. Thus, thrombolytic therapy does not increase the risk of arrhythmia..