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OBJECTIVE: Trans-palmar access is a novel, safe, and feasible technique for coronary artery angiography wherein its appropriate anesthetic methods is still concerned. In this study, we aimed to evaluate the pain severity, satisfaction, and possible complications with local ulnar nerve anesthesia through both distal and proximal forearm in patients undergoing trans-palmar coronary angiography. METHODS: This was a randomized clinical trial performed on 60 patients who were candidates for trans-palmar coronary angiography. The patients were randomized into 2 equal groups as proximal and distal approaches (those who received the same dose of subcutaneous lidocaine (2%) in the proximal and distal of forearm, respectively). Pain intensity at different times, duration of anesthesia, patient satisfaction, and occurrence of complications were evaluated. RESULTS: The mean age of the patients was 59.45±7.09 years, and, of them, 34 (61.8%) were men. Pain severity with the proximal anesthesia approach was significantly higher than that in the distal group at the time of puncture (5.39±0.73 vs. 2.30±0.60, p=0.001). Over time and immediately after the procedure and at discharge, the mean pain severity in the proximal group was significantly less than in the distal group (p0.050). CONCLUSION: Using the proximal ulnar nerve anesthesia approach was associated with a delayed onset and longer anesthesia than the distal method.

Aims The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) Chronic Ischaemic Cardiovascular Disease Long Term (CICD LT) registry aims to study the clinical profile, treatment modalities, and outcomes of patients diagnosed with CICD in a contemporary environment in order to assess whether these patients at high cardiovascular (CV) risk are treated according to ESC guidelines on prevention or on stable coronary disease and to determine mid- and long-term outcomes and their determinants in this population. Methods and results Nine thousand one hundred and seventy-four patients over 18 years with documented CICD defined by a history acute coronary syndrome with/without ST elevation, previous coronary revascularization, or stable coronary artery disease were enrolled between 1 May 2015 and 31 July 2018. Individual patient data on clinical profile, biology, and treatment modalities were collected across 154 centres from 20 ESC countries. Two years of follow-up is scheduled in order to determine the following clinical outcomes: all-cause and CV death, all-cause and CV hospitalizations, changes in medications, and quality of life using the EuroQol5D-5L score. Conclusion The CICD LT is an international registry of care and outcomes of patients hospitalized with CICD which will provide insights into the contemporary profile and management of patients with this common disease.

BACKGROUND The feasibility and safety of coronary angiography (CAG) and angioplasty via trans-snuffbox approach (TSA) is still concerned; therefore, in this study, we aimed to assess possible complications occurring after TSA versus trans-radial approach (TRA). METHODS This prospective observational study was undertaken from June 2017 till March 2018. Individuals aged at least 18 years who were admitted for CAG through upper extremity were eligible and categorized to TSA (n = 70) and TRA (n = 56) groups. Occurrence of complications including hematoma, pain or paresthesia, pseudoaneurysm formation, arterial obstruction, limb ischemia, and major adverse cardiovascular events (MACE) including death, myocardial infarction (MI), stroke, and emergency vessel revascularization was assessed after the procedure and in two separate visits three and six months afterwards. RESULTS The mean age of participants in TSA and TRA groups was 55.1 ± 9.7 and 56.5 ± 9.6 years, respectively (P = 0.415). Men were the dominant group in both approaches [TSA: 44 (62.8%), TRA: 36 (64.3%), P = 0.868]. Success rates in TSA and TRA were 88.6% and 94.6%, respectively (P = 0.230). Radial artery occlusion (RAO) was reported in two (3.2%) and one (1.8%) case in TRA and TSA, respectively (P = 0.653). MACE incidence was not significantly different in TSA compared with TRA group (1.8% vs. 4.8%, respectively, P = 0.389). There was no major procedural complication, neither in TSA nor in TRA category. CONCLUSION Our results revealed that TSA could be classified as an alternative modality to other common CAG and angioplasty methods due to its high safety rate and lower complications. Several comprehensive population-based studies are necessary for confirming these findings.

Background With the onset and spread of the COVID‐19 pandemic, the hospitalization and treatment of noncovid patients were dramatically affected. The aim of this study is to evaluate the electrophysiology (EP) lab activity in a referral center in Iran during the COVID‐19 era. Methods A cross‐sectional descriptive survey was conducted on EP lab activity in Shahid Chamran Heart Center, Isfahan, Iran. Two periods of COVID‐19 occurrence peaks in Iran were compared with same date in 2019. Information was collected on number of diagnostic and therapeutic electrophysiology studies (EPSs) and implantation of intracardiac devices such as permanent pacemaker (PPM), implantable cardioverter defibrillator (ICD), and cardiac resynchronization therapy (CRT). Results In the first peak of COVID‐19 pandemic, both of EPSs and intracardiac device implantations decreased by 80% compared to the same period in 2019. The most common type of device implanted during this period was PPM (70%); however, at the time of control, the ICD (73%) was the most common. Paroxysmal supraventricular tachyarrhythmia (PSVT) was the best indication for diagnostic and therapeutic EPSs in covid and control periods. In the second peak of prevalence of COVID‐19 virus infection in Iran, 6% and 36% decreases in device implantations and EPSs were seen, respectively. During this period, the number of procedures increased, although it was still lower than in 2019. Conclusion A significant reduction in the EP lab activity has been observed during both the COVID‐19 pandemic peaks., This study is a cross‐sectional descriptive survey conducted on EP lab activity in Shahid Chamran Heart Center, Isfahan, Iran (as largest Heart Center in center of Iran), regarding number of EPS and intracardiac device implantations during the two peaks of COVID‐19 pandemics in Iran. The same date in 2019 was considered as control time. In conclusion, our EP lab activity decreased significantly during the COVID‐19 era.

As the COVID-19 pandemic continues, more information on the non-respiratory effects of the coronavirus is obtained. Cardiovascular complications, especially acute coronary syndromes, are rare. However, they prove to be effective factors in the mortality rate of COVID-19 subjects. Acute ST-elevation myocardial infarction with a special angiographic pattern in the form of extensive and multi-vessel thrombosis, regardless of atherosclerotic plaques, has posed a new therapeutic challenge. This has been associated with an increase in the incidence of stent thrombosis. Hypercoagulation, due to severe inflammation, is the main pathology of this phenomenon. Technically, percutaneous coronary intervention with aspiration thrombectomy and injectable antiplatelet are the mainstay of treatment for these patients. In addition, it is vital that appropriate antiplatelet and ischemia treatment after the intervention be taken into account.

As has been well established, the resting Electrocardiogram (ECG) findings provide valuable diagnostic and prognostic information for the occurrence of Cardiovascular Events...

With the onset of the coronavirus disease-2019 (COVID-19) pandemic, hospitalization and treatment of non-covid patients decreased worldwide. The aim of this study is to evaluate the admission and treatment of patients with coronary artery diseases (CADs) by examining coronary Cath labs activities in some centers of Iran during the COVID-19 period.A retrospective, multi-center survey was conducted in four cites in Iran which participated in National Persian Registry Of CardioVascular diseasE (N-PROVE). Two periods of COVID-19 occurrence peak in Iran were compared with the same date in 2019. Information was collected on the number of diagnostic and therapeutic coronary catheterizations in both stable ischemic heart diseases (SIHDs) and acute coronary syndrome (ACS) settings.In the first peak of COVID-19 pandemic, coronary angiographies and angioplasties decreased by 37 and 38% compared to the same period in 2019, respectively. The most common indication for coronary angiography during this period was ACS [especially ST-Segment Elevation Myocardial Infarction (STEMI)]; however, at the time of peak decrease, the SIHDs were the most. In the second peak of COVID-19 pandemic in Iran, 34% and 27% decrease in diagnostic and therapeutic coronary procedures were seen, respectively. During this period, the number of elective admissions increased, although it was still lower than that in 2019. The tendency to rescue percutaneous coronary intervention increased in most centers during the COVID-19 era, especially in the second peak.A significant reduction in the coronary Cath lab activity has been observed during the COVID-19 pandemic that can indicate an increased risk of cardiovascular mortality and morbidity.

BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSION 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.

OBJECTIVE: Distal radial artery access or trans-snuffbox access (TSA) is a novel, safe, and feasible technique for coronary artery interventions wherein its vascular hemostasis is still concerned. So, this study aimed to compare two homeostasis methods comprising manual and mechanical compression approaches in patients undergoing coronary angiography (CAG) via TSA. METHODS: In a prospective nonrandomized clinical trial, a total of 80 patients undergoing diagnostic CAG by TSA were divided into two equal groups: manual compression and mechanical compression (using radial TR band), the main end point of which was primary hemostasis time. Other variables were patient satisfaction, puncture site pain severity, hospitalization time, and local neurovascular complication during the 30-day follow-up. RESULTS: The mean age of the patients was 57.1±8.0 years, with 40 of them (54.1%) being male. The primary hemostasis time was significantly shorter in the manual compression approach [15.0±5.9 minutes with median 15 (9–20)] than in the TR band group [25.7±4.9 minutes with median 25 (20–30)] (p0.050). The neurovascular complication, including hematoma, numbness, and dRA occlusion, rates had also no significant difference between the two groups (p>0.050). CONCLUSION: The manual compression approach on the puncture site reduces hemostasis time in patients undergoing CAG via TSA when compared with the mechanical compression method.

With the outbreak of the second peak of COVID-19 in many countries of the world, the symptoms and complications of this disease has received a great deal of attention. One of the most important known complications of severe acute respiratory syndrome coronavirus 2 is the occurrence of venous thromboembolic events, especially in critically ill patients who are hospitalized in the intensive care unit. The pathology of this event is complex and multifactorial, but the main problem now is the timely diagnosis of these phenomena, which can reduce the mortality and morbidity of patients. Deterioration of clinical condition in patients with severe acute respiratory syndrome coronavirus 2 infection along with increased coagulation markers can increase clinical suspicion of venous thromboembolic events. Imaging techniques, especially computed tomography pulmonary angiography, can well solve this puzzle and lead to timely treatment of these patients.

Objective The aim of study was to evaluate the impact of health-related quality of life (QoL) on the occurrence of ischaemic heart disease (IHD) and stroke using a validated questionnaire.Methods W...

The aim of study was to evaluate the impact of health-related quality of life (QoL) on the occurrence of ischaemic heart disease (IHD) and stroke using a validated questionnaire.We followed the 3,283 subjects, aged ≥ 35 years and without history of cardiovascular events (CVE) over four years from 2007 to 2011 from the Isfahan cohort study. The World Health Organization QoL questionnaire (WHOQOL-BREF), which contains four separate domains, was used to assess QoL. Incidence rates of IHD and stroke were recorded during follow-up. Socioeconomic demographic data including marital state, educational level, occupation, income and place of living and metabolic risk factors such as diabetes mellitus (DM), hypertension (HTN), dyslipidaemia, body mass index and smoking were also recorded.More IHD (42%) and stroke (57%) patients were illiterate; while the educational status was significantly different only in the IHD group (P = 0.000). Differences in income and occupation were notable in patients with stroke and IHD, respectively, compared to subjects without them (P0.050). DM and HTN were significantly higher in IHD and stroke patients in comparison with subjects without CVE (P = 0.000). Two-way multivariate analyses of covariance test after age, educational status and metabolic risk factors adjustment showed that subjects with stroke had a significantly higher score in all QoL domains in comparison with individuals without stroke (P0.050). There was no significant association between QoL domains and IHD incidence (P0.050).This study indicates that there is no association between QoL and IHD incidence although there was a significant relationship between higher QoL and incidence of stroke.

To determine the effects of transdermal fentanyl patches (TFPs) for postoperative analgesia in patients undergoing total knee arthroplasty (TKA) surgery. A randomized, double-blind, controlled trial study of 40 ASA I–III patients undergoing TKA surgery was performed under general anaesthesia. Patients were randomly divided into two groups. Group I (n = 20) received two 25 μg TFPs placed on the laterals of chest wall approximately 12 h before induction of general anaesthesia. Group II, the control group (n = 20), received placebo patches of identical size. Postoperative pain at rest was assessed with visual analogue scale (VAS) at 0, 30 min and 2, 4, 6, 12, 24, 48 and 72 h. Total rescue consumption of morphine was estimated with patient control analgesia during the first 72 h after operation. The degree of active knee flexion and incidence of side effects were also evaluated. The VAS scores at 2, 4, 6, 12, 24, 48 and 72 h were significantly less in the group I compared to the group II (p

The subacromial syndrome is the most common source of shoulder pain. The mainstays of conservative treatment are non-steroidal anti-inflammatory drugs and exercise therapy. Recently, low-level laser therapy (LLLT) has been popularized in the treatment of various musculoskeletal disorders. The aim of this study is to evaluate the additive effects of LLLT with exercise in comparison with exercise therapy alone in treatment of the subacromial syndrome. We conducted a randomised clinical study of 80 patients who presented to clinic with subacromial syndrome (rotator cuff and biceps tendinitis). Patients were randomly allocated into two groups. In group I (n = 40), patients were given laser treatment (pulsed infrared laser) and exercise therapy for ten sessions during a period of 2 weeks. In group II (n = 40), placebo laser and the same exercise therapy were given for the same period. Patients were evaluated for the pain with visual analogue scale (VAS) and shoulder range of motion (ROM) in an active and passive movement of flexion, abduction and external rotation before and after treatment. In both groups, significant post-treatment improvements were achieved in all parameters (P = 0.00). In comparison between the two groups, a significant improvement was noted in all movements in group I (P = 0.00). Also, there was a substantial difference between the groups in VAS scores (P = 0.00) which showed significant pain reduction in group I. This study indicates that LLLT combined exercise is more effective than exercise therapy alone in relieving pain and in improving the shoulder ROM in patients with subacromial syndrome.

Objective Acrylamide is a chemically reactive substance used in various industries. Recently, the discovery of acrylamide in a variety of human foods including heat-processed starchy foods such as potato chips and bread has been reported. Acrylamide is also known as a carcinogen and cytotoxic material. The aim of this study was to evaluate the detrimental effects of acrylamide on membrane integrity and sperm parameters in mice. Study design This experimental study was conducted on thirty male NMRI mice, aged 8–10 weeks and weighing 25–30g. They were randomly allotted into three equal groups. Group I (low dose) and group II (high dose) were fed on water solutions containing acrylamide 5 and 10mg/kg/day, respectively, for 2 months, while the third group received fresh water as the control group. Sperm analysis was done for parameters as well as evaluation of membrane integrity by Hypoosmotic Swelling Test (HOS-test) for sperm tails and Eosin-Y staining for sperm heads. Results Total sperm motility and progressive motility (fast and slow) in both groups, I and II, decreased significantly ( P =0.00), but no significant change was observed in non-progressive motility ( P >0.05). The total motile sperm percentage decreased significantly only in group II ( P =0.01). Sperm morphology did not significantly change in the experimental groups compared to the controls ( P >0.05). In sperm membrane integrity evaluation, functional intact membrane of sperm tail in both groups I and II had a significant decrease ( P =0.00), but membrane integrity of the sperm head decreased significantly only in group II ( P =0.00). Conclusion These results indicate that acrylamide, through effects on membrane integrity, decreased sperm vitality as well as causing abnormal sperm parameters in progressive motility and total motility.

To compare intraarticular morphine–bupivacaine and tramadol–bupivacaine as postoperative analgesics in patients undergoing arthroscopic anterior cruciate ligament (ACL) reconstruction. A randomized, double blind, controlled trial study of 60 ASA I–II patients undergoing arthroscopic ACL reconstruction was performed under general anesthesia. Patients were randomly allocated into three groups. The MB group (n = 20) received 10 mg morphine and 0.5% bupivacaine; the TB group (n = 20) received 100 mg tramadol and 0.5% bupivacaine; and the control group (n = 20) received isotonic saline intraarticularly in a total volume of 20 ml after the operation. Postoperative pain was assessed with visual analogue scale (VAS) at 0, 30, 60, 90 min and 2, 4, 6, 12, 24 h being at rest. Analgesic duration as defined was the time of first request for analgesics, the first 24 h analgesic consumption, time to unassisted ambulation, discharge time and incidence of side effects were also evaluated. The VAS scores at 30, 60, 90 min and 2, 4, 12, 24 h were significantly less in the MB and TB groups in comparison with the control group (P

Background: Undescended testis (UDT) is the most common endocrine disorder in male children. Delayed diagnosis and treatment of UDT lead to complications such as infertility, malignancy and testis rotation. Objective: The aim of this study was to evaluate the causes of delay in proper treatment of patients with undescended testis in our population. Materials and Methods: An observational, descriptive, cross sectional study of 143 male patients, who applied to Shahid Sadoughi University Hospitals for orchiopexy operation was performed. The maximum recommended age for orchiopexy was 18 months. Results: The mean age at referral was 5.34 years. Only 44 (30.8%) cases were operated on before the age of 18 months. The most common reasons of delay in treatment were absence of early diagnose (42.5%), parent's unawareness of surgery necessity and its complications associated (33.7%) and parent's disregard (23.5%). Only 19.6% of patients were diagnosed at born in the hospital. 49% of parents had the correct information for proper operation age and 40.6% of them had enough information about necessity of surgery and side effects of disease. Parent’s literacy, place of living and type of cryptorchidism had no significant relation with delay diagnosis (p> 0.05). Conclusion: These results revealed that late diagnosis by physician and lack of insight of parents are the main reasons in delayed diagnosis and treatment of UDT. Therefore, education of parents and careful physical examination of the babies at birth and regular follow-up until 18 months can prevent the delay in diagnosis.

BACKGROUND: Obstructive sleep apnea syndrome (OSAS) is a highly prevalent sleep-related disorder that is associated with increased risk of hypertension (HTN) and coronary heart disease. This study aimed to evaluate the correlation between the OSAS and coronary artery disease (CAD) severity. METHODS: The cross-sectional study was conducted from September 2012 to December 2013. We enrolled 127 patients with chronic stable angina who were referred for coronary angiographic studies in Shahid Chamran and Nour Hospitals in Isfahan, Iran. The Berlin questionnaire (BQ) was used for estimate the probability of OSAS in patients as a low or high probability. Demographic characteristics and metabolic risk factors including diabetes mellitus, HTN, obesity, and smoking also were recorded. The severity of CAD was assessed and compared based on the Gensini score with Mann–Whitney U statistical test. Independent t-test for continuous variables and chi-square test for categorical variables were used. RESULTS: Totally, 65.4% of subjects were considered as high and 34.6% as low probability for OSAS, which 81.1% of them had CAD. There was a significant difference between body mass index, systolic blood pressure, diastolic blood pressure, and ischemic heart disease drug consumption with OSAS probability (P < 0.0500). CAD was accompanied by OSAS significantly (P = 0.0260). The Gensini score was significantly higher in patients with high OSAS probability (100.4 ± 69.1 vs. 65.3 ± 68.9; P = 0.0030). OSAS also increase odds of CAD based on regression analysis (odds ratio, 95% confidence interval = 2.7). CONCLUSION: This study indicates that more severe CAD is associated with high OSAS probability identified by BQ. &nbsp