فهرست مطالب manizheh danesh

Plaque instability is a leading cause of morbidity and mortality in coronary artery disease (CAD) patients. Numerous efforts have been made to figure out and manage unstable plaques prior to major cardiovascular events incidence. The current study aims to assess the values of the atherogenic index of plasma (AIP) to detect unstable plaques.

The current case?control study was conducted on 435 patients who underwent percutaneous coronary intervention due to chronic stable angina (stable plaques, n = 145) or acute coronary syndrome (unstable plaques, n = 290). The demographic, comorbidities, chronic  edications, biochemical and hematological characteristics of the patients were entered into the study checklist. The baseline AIP was measuredaccording to the formula of triglycerides/high?density lipoprotein logarithm. Binary logistic regression was applied to investigate the standalone association of AIP with plaque instability. Receiver operating curve (ROC) was depicted to determine a cut?off, specificity, and sensitivity of AIP in unstable plaques diagnosis.

AIP was an independent predictor for atherogenic plaque unstability in both crude (odds ratio [OR]: 3.677, 95% confidence interval [CI]: 1.521–8.890; P = 0.004) and full?adjusted models (OR: 15, 95% CI:2.77–81.157; P = 0.002). According to ROC curve, at cut?point level of 0.62, AIP had sensitivity and specificity of 89.70% and 34% to detect unstable plaques, respectively (area under the curve: 0.648, 95% CI: 0.601–0.692, P < 0.001).

According to this study, at the threshold of 0.62, AIP as an independent biomarker associated with plaque instability can be considered a screening tool for patients at increased risk for adverse events due to unstable atherosclerotic plaques.

Atrial fibrillation (AF) is the most common cardiac arrhythmia, with a significant rise in prevalence during recent decades. Considering its remarkable morbidity and mortality rates, AF has become a significant concern worldwide. To our knowledge, this is the first study to assess the prevalence of AF in Iran.
The current cross-sectional study is a part of the Isfahan Cohort Study (ICS), which has evaluated 6504 adults aged over 35 years and followed them up since 2001. An echocardiogram was taken from all the participants and interpreted by 2 skilled residents of cardiology. AF diagnosis was made based on the ICD-10-CM codes (I480-I484, I489), and its prevalence was determined.
Thirteen out of 6504 study participants (prevalence=0.19%) at a mean age of 61.8± 9.5 years were diagnosed with AF. AF was slightly predominant among males (53.8% vs 46.2%). Diabetes mellitus, ischemic heart disease, and peripheral vascular disease were present in 1 (7.7%), 2 (15.4%), and 1 (7.7%) cases with AF, respectively.
The remarkably low rate of AF in this study compared with other investigations may be due to the lower age of the assessed population, less alcohol consumption in Iranian society, and failure to find cases with paroxysmal and transient AF. (Iranian Heart Journal 2022; 23(2): 53-60)

Many studies who evaluated the outcome of the congenital hypothyroidism (CH) screening reported some intellectual and behavioral deficit despite early diagnose and treatment. The aim of the present study was to compare the intellectual and behavioral adjustment of CH children with controls.

This study was conducted among a group of 135 children aged 8‑‑12 years in Isfahan, including transient and permanent congenital hypothyroidism (TCH and PCH) and a matched group of their classmate. Demographic characteristics collected using a designed data collecting form completed by parents. Intellectual quotient (IQ) was evaluated using Wechsler Intelligence Scale for Children aged 6‑‑16 years (WISC‑III). Depression and anxiety were evaluated using The Children’s Depression Inventory (CDI) and the Multidimensional Anxiety Scale for Children (MASC), respectively. The SPSS software version 20.0 was used for data analysis. Nonparametric tests (Mann‑‑Whitney) were used to investigate the association between variables. A significant level of less than 0.05 was considered in all analyzes.

There was no significant difference in the IQ scores between PCH and TCH groups (P = NS). However, neither of them had intellectual disability (defined as IQ <70). IQ scores were significantly lower in PCH comparing to controls (P < 0.001). Total IQ and verbal IQ were significantly differenct between TCH and control group (P = 0.007 and P = 0.001). No significant difference was found in anxiety and depression scores between CH children and controls.

There is no significant difference in anxiety and depression scores between congenital hypothyroidism children and controls, although IQ scores in children with congenital hypothyroidism is lower than controls.

Transulnar approach (TUA) has been classified as an appropriate surrogate for the transradial approach (TRA), but the safety of TUA in the presence of ipsilateral radial artery occlusion (RAO) is not well studied. In this article, we aimed to assess the feasibility and occurrence of complications of this approach in Iranian individuals with ipsilateral RAO.

In this prospective double-center study, a total number of 70 participants from July 2017 to November 2018 with coexisting ipsilateral RAO due to prior RA angiography, severe arterial spasm, prominent vascular anomalies, or arterial harvesting for hemodialysis or graft procedures were enrolled and underwent TUA. Incidence of probable complications including pain, hematoma, arteriovenous fistula (AVF), pseudoaneurysm formation, any adverse events requiring immediate vascular surgery, life-threatening hand ischemia, infection, ulnar nerve palsy, major adverse cardiac events (MACE) including death, myocardial infarction (MI), or stroke plus ulnar artery (UA) obstruction and narrowing was evaluated both before discharge time and one month afterward.

The mean age of the study population was 68.2 ± 12.8 years [men number: 41 (58.5%)]. Our success rate was 98.6% and 37.1% of subjects underwent further coronary intervention. No aforementioned adverse outcomes were reported in any individual except for pain (11.4%) and minor hematoma (grade I) (5.7%) as well as MACE (1.4%). Follow-up assessment revealed asymptomatic UA occlusion (UAO) and severe narrowing in 2.8% and 1.4% of participants, respectively.

Our outcomes suggested that due to high safety and low complication rates, TUA could be tried safely in patients with concurrent ipsilateral RAO. Other appropriate cohort studies are required for assessing the incidence of TUA complications.

Irritable bowel syndrome (IBS) is one of the most common functional gastrointestinal disorders with signifcant impact on quality of life (QOL). Considering the role of stress in the clinical course of IBS, we investigated associations between stress coping skills and symptoms and QOL in IBS patient. A cross‑sectional study was conducted on 95 IBS patients referring to tertiary care centers. Coping skills (Jalowiec coping scale), IBS symptom severity scale, disease‑specifc QOL (IBS‑QOL), and symptoms of depression and anxiety (Hospital Anxiety and Depression Scale [HADS]) were evaluated by questionnaires. Bivariate and multivariate analyses were performed to investigate association among these parameters. Disease severity was positively correlated with emotive (r = 0.30) and fatalistic (r = 0.41) and negatively correlated with optimistic (r = -0.25) and confrontive (r = -0.24) coping strategies. Psychological dysfunction (total HADS score, B [95% (confdence interval) CI] = 2.61 [0.001–5.21]) and fatalistic coping (B [95% CI] = 35.27 [0.42–70.13]) were signifcant predictors of IBS severity. However, IBS patients involved in this study utilized adaptive coping strategies more frequently. Our study showed that use of maladaptive coping strategies had positive correlation with symptom severity and degree of anxiety and depression among patients, while implementation of optimistic strategies were found to be negatively correlated to severity of symptoms and also utilization of adaptive coping styles was associated with lesser degree of anxiety and depression.

Rupture of an atherosclerotic plaque or endothelial erosion with superimposed thrombosis in coronary arteries are primary causes of acute coronary syndromes. This study aimed to evaluate the anatomic distribution of culprit lesions by coronary territories, also to find any association between long-term outcomes and culprit lesion location in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS).
Patients presented at the emergency room of a tertiary cardiac center with symptoms suggestive of ACS, possible candidates for elective coronary angiography (CAG), were enrolled and followed up every year for five years for major adverse cardiac events (MACEs).
Findings: The subjects had a mean age of 60.6 ± 11.3 years, whom 74.4% were men. CAG revealed that among 98 lesions in coronary arteries, the left anterior descending (LAD) artery was the most common accused artery with frequency of 46%. Five-year follow-up results showed that 32.2% of patients experienced MACE which developed more in the LAD (38%) and then the right coronary artery (RCA) territories (27.6%) with no significant differences between other territories.
Although we found no significant differences between MACEs scores in different groups of coronary territories, but cardiologists may be able to plan follow-ups by the primary lesion. According to our study, the most frequent MACE was repeated percutaneous coronary intervention (PCI), which showed the importance of intervention in early diagnose, follow-up and treatment. Further studies with higher sample sizes are needed to show the prognostic value of culprit lesion territory in patients with ACS.

 Inflammatory bowel diseases (IBD) are chronic diseases with significant impact on patients' well-being. The aim of this study was to determine stress coping strategies in IBD patients and their association with disease activity, psychological health, and quality of life (QOL).

 This cross-sectional study was conducted on IBD patients referred to a gastroenterology clinic in Isfahan city (Iran). Disease activity, severity of anxiety and depression symptoms, stress coping strategies, and QOL were assessed using self-administered questionnaires. Coping strategies in IBD patients were compared to an unaffected control group.

 In the present study, 80 patients with mean age of 52.9 years (57.5% female) and mean disease duration of 6.5 years were studied. Compared to the controls, IBD patients had higher scores in the maladaptive coping styles (evasive and palliative) (P < 0.05). Association between coping strategies and disease activity was not significant. Severity of anxiety and depression was directly correlated with the maladaptive strategies (fatalistic and emotional) (r = 0.283 to 0.468) and inversely correlated with the adaptive strategies (confrontive, optimistic, and self-reliant) (r = -0.320 to -0.534). In addition, QOL was inversely correlated with the maladaptive strategies (fatalistic and emotional) (r = -0.278 to -0.327) and directly correlated with the adaptive strategies (confrontive and optimistic) (r = 0.262 to 0.355).

 Patients with IBD use more maladaptive and less adaptive stress coping strategies which are associated with their psychological health and QOL. Larger and prospective studies on the dynamic and interactive network of biopsychosocial factors in IBD patients are required.
 

Extraintestinal symptoms are common in patients with irritable bowel syndrome (IBS). In the present study, we determined the relationship between psychological disorders and extraintestinal symptoms in patients with IBS.

Adult patients with IBS referred to 4 gastroenterology clinics in Isfahan, Iran, completed the irritable bowel severity scoring system (IBSSS), extraintestinal symptoms scale, Hospital Anxiety and Depression Scale, and Irritable Bowel SyndromeQuality of Life (IBS-QOL) Questionnaire. Univariate and multivariate analyses were conducted.

The patients included 113 females and 45 males with mean age of 34.8 ± 11.1 years. Cumulative frequency of extraintestinal symptoms was 3.3 ± 2.4 (0 to 10). Anxiety and depression were present in 79.7% and 54.4% of the patients, respectively. Frequency of extraintestinal symptoms was correlated with anxiety and depression (r = 0.289 to 0.531), IBS severity (r = 0.373 to 0.505), and quality of life (r = -0.317 to -0.398). Severity of IBS was independently associated with extraintestinal digestive symptoms’ frequency (A = 0.248). Female gender, education level, and anxiety were independently associated with extraintestinal non-digestive symptoms’ frequency (A = -0.225 to 0.260). Severity of IBS and frequency of non-digestive symptoms were independent predictors of quality of life (A = -0.494 and -0.218). After controlling for psychological factors, IBS severity and depression were independent predictors of quality of life (A = -0.435 and -0.318).

Extraintestinal symptoms and psychological disorders are common in patients with IBS and impact their quality of life. Psychological disorders are associated with extraintestinal symptoms, especially non-digestive symptoms. These results highlight the need for an integrated biopsychosocial approach to the management of IBS patients with physical and mental comorbidities.