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The World Health Organization has recommended the integration of Complementary and Alternative Medicine (CAM) with modern medicine, as part of the global "health for all" approach. Herbal treatments are the most common and known methods of CAM. Based on the critical role of physicians in true and safe application of these products, this research evaluated knowledge, attitude, and practice (KAP) of physicians in Rasht towards herbal remedies. This was a cross sectional study, performed between April 2017 and May 2019 on all physicians, who worked in Rasht city, northern Iran. A researcher-made questionnaire with 2 main parts, including a demographics section and research questions was used. A total of 142 (38%) individuals responded to the questionnaires. Mean KAP scores were 6.47 ± 6.17, 27.80 ± 3.26, and 5.02 ± 5.54, respectively. In none of these fields, significant differences were seen in participants regarding demographic variables, experience, work place, academic relevance, and field of work (P .05). Physicians of Rasht city, with different work environments and regardless of demographic characteristics, had a positive view towards herbal remedies, without enough knowledge to consult their patients.

Introduction The study of polymorphisms and their relationship with diseases is very important for risk assessment. The aim of this study was to determine the relationship between early risk of coronary artery disease(CAD) with renin-angiotensin(RAS) genes and endothelial nitric oxide synthase(eNOS) in a sample of the Iranian population. Methods & materials In this cross-sectional study, 63 patients with premature CAD and 72 healthy samples were enrolled. Polymorphism of the promotor region of eNOS- and ACE-I/D (Angiotensin Converting Enzyme-I/D) polymorphism was evaluated. Polymerase chain reaction (PCR) test and PCR-RFLP (Restriction Fragment Length Polymorphism) was performed for ACE and eNOS-786 gene, respectively. Results The frequency of deletion(D) for the ACE gene was significantly higher in patients(96% versus 61%; P 0.9). Conclusion ACE polymorphism seems to be an independent risk factor for premature CAD.

Introduction: Pulmonary arterial stiffness (PAS) has been shown to be related to pulmonary artery pressure (PAP) in patients with pulmonary artery hypertension (PAH). The aim of this study was to determine the correlation between functional capacity and echocardiographic indices of PAS in patients with PAH. Materials and methods This cross sectional study was performed on patients with PAH were confirmed by right heart catheterization who referred to Imam Reza PAH clinic for routine follow up between November 2019 and January 2020. All patients underwent echocardiography and the maximum Doppler frequency shift, pulmonary acceleration time, peak velocity of the pulmonary flow and velocity time integral, as well as PAS were measured. All patients performed 6-minute walk test. Results Fifty patients with the mean age of 41.90 ± 14.73 years old participated in this study. Majority of the patients were female (74%). The most common cause of PAH was idiopathic (74%). There was a significant correlation between PAS and PASP (r = 0.302, P = 0.041), V2 (r=-0.461, P = 0.003), T2/V1 (r=-0.311, P = 0.037) and Z3 ratio (r=-0.346, P = 0.023). There was no significant correlation between PAS and 6MWT, PVR and TAPSE (P > 0.05). There was a significant correlation between V2 and PVR (r = 0.359, P = 0.049). Conclusions PAS and V1 are simple, non-invasive, available tools for evaluation of pulmonary vascular bed and early diagnosis of pre-symptomatic clinical status in patients with PAH.

Coronavirus disease 2019 (COVID19) is spreading rapidly and there is now much concern regarding different aspects of public health. Underlying disorders like cardiovascular diseases can increase the mortality rate. Understanding cardiovascular complications, manifestations and management in COVID19 is a necessary need. In this comprehensive review, we evaluated different aspects of cardiovascular disorders or complications related to COVID19 infection.

Background: The rate of heart transplantation is increasing worldwide. Due to the drawbacks of endomyocardial biopsy (EMB), various non-invasive methods have been suggested to assess rejection. Therefore, the aim of this study was to evaluate the predictive value of echocardiographic parameters to determine heart transplant rejection in a sample of Iranian patients. Methods: This was a cross-sectional study on heart transplant patients with available EMB results. All patients underwent echocardiography at the same day of EMB and prior to biopsy. The association between echocardiographic parameters and rejection was assessed using binary logistic regression. Results: A total of 67 patients (50, 74.6% male and 17, 25.4% female) with the mean age of 39.20 ± 11.39 years entered this study. Heart transplant rejection was observed in 22 (32.8%) patients. There was only a significant difference in mitral inflow early diastolic flow (E) and septal time to peak systolic velocity in ejection phase (septal Ts) between rejection and non-rejection groups. Logistic regression revealed a significant association between rejection and septal Ts (p=0.048, OR=0.931) and E velocity (p=0.022, OR=78.069). Based on ROC curve, the area under the curve for septal Ts and E were 81.9% and 68.6%. Moreover, the sensitivity and specificity for septal Ts and E in detection of rejection were 75%, 69% and 68%, 61%, respectively. Conclusion: Septal Ts could be used as a good echocardiographic parameter for predicting rejection in heart recipient patients.

Background: Partial anomalous pulmonary venous connection (PAPVC) is a rare congenital anomaly in which one or more pulmonary veins are connected to the venous circulation leading to left to right heart shunt. Although correction of anomalous pulmonary venous connection is achieved through surgery, there are rare instances where the abnormal pulmonary vein has dual connection to both left atrium and the major systemic veins. Under these circumstances catheter-based treatment might become a feasible option. Case presentation: We report a case of atrial septal defect (ASD) and dual drainage of left upper pulmonary vein, which were successfully addressed by occluder devices and followed carefully while detecting early clot formation behind the implanted device in the vertical vein.Conclusion: For comprehensive evaluation of patients with ASD, assessment of pulmonic veins is crucial and in the presence of a vertical vein, the dual drainage of pulmonic veins should be considered.

Background: There are still many gaps in our knowledge regarding the direct cardiovascular injuries due to COVID-19 infection. In this study, we tried to find out the effect of SARS-CoV-2 infection on cardiac function in patients without any history of structural heart disease by electrocardiographic and echocardiographic evaluations. Methods: This was a cross-sectional study on patients with COVID-19 infection admitted to Imam Reza hospital, Mashhad, Iran between 14 April and 21 September 2020. COVID-19 infection was verified by a positive reverse-transcriptase polymerase chain reaction (PCR) assay for SARS-CoV-2 using nasopharyngeal/oropharyngeal samples. We enrolled all patients over 18 years old with definite diagnosis of COVID-19 infection. At admission, demographic data, comorbid conditions, physical examination, Lung CT scan and laboratory findings were recorded. All patients underwent a comprehensive transthoracic echocardiography at the first week of admission. Clinical and imaging data were collected prospectively. Findings: In total, 142 patients were enrolled in this study. The mean age of participants was 60.69± 15.70 years (range: 30-90 years). Most patients were male (82, 57.7%). The most common findings were left axis deviation (15.5%) in ECG and Right ventricle (RV) dysfunction (34.5%) in echocardiography. Multivariate analysis showed that O2 saturation at admission was independently a predictor of re-hospitalization (P

Heparin-induced thrombocytopenia (HIT) is an immunogenic disorder. It can lead to thrombocytopenia and a hypercoagulated state with an increased risk for new thrombosis. We here reported a 49-year-old man with previous cardiac surgery and heparin administration, treated by new oral anticoagulant agent, Rivaroxaban.

Unroofed Coronary Sinus (UCS) is an uncommon congenital heart anomaly and the most unusual type of Atrial Septal Defect.This report presents a-71-year-old female with palpitation and dyspnea following an emotional stress, who was referred for ablation of typical atrial flutter.Finally diagnosed with a partially UCS causing a bidirectional shunt.

Introduction Nasal polyposis (NP) is a frequent problem during adulthood. Treatment of NP is primarily based on drugs, such as oral or topical steroids and in some types, by surgery. Despite of available therapeutic options for NP, recurrence after polypectomy is found. Vascular endothelial growth factor (VEGF) is a known factor involved in NP. Bevacizumab is a monoclonal antibody, which acts against VEGF. Aim Regarding the availability of bevacizumab and its use in ophthalmic off-label application, in this study, we hypothesized that it could be a choice of non-invasive treatment. The researchers aimed at evaluating the use of bevacizumab in vitro on the growth of NP. Materials and methods In this experimental study, the researchers used eight non-allergic NP tissues from patients admitted for polypectomy clinic of Imam Reza Hospital, Mashhad. Tissues were cultured in DMEM medium based on standard protocols in the presence or absence of bevacizumab (10 to 250 μM) then incubated. The mean of the responses was reported. The level of VEGF and MTT test for NP epithelial cell viability were determined for each group. Data were analyzed using the SPSS software. Results The researchers demonstrated that bevacizumab leads to a decrease in the level of VEGF (the most common cause of angiogenesis in NP) in media culture of NP, dose-dependently (P

Partial anomalous pulmonary venous connection is a rare congenital anomaly in which one or more pulmonary veins are connected to the venous circulation leading to left to right heart shunt. Although correction of anomalous pulmonary venous connection is achieved through surgery, there are rare instances where the abnormal pulmonary vein has dual connection to both left atrium and the major systemic veins. Under these circumstances, catheter-based treatment might become a feasible option.A 22-year-old female presented with exertional dyspnea, holo-systolic murmur in left sternal border, and fixed splitting of S2 in examination.The patient was diagnosed with secundum type atrial septal defect (ASD) and dual drainage of left upper pulmonary vein.The patient was candidate for device closure. Under TEE guidance, occluder devices were deployed in the upper part of vertical vein and subsequently in place of ASD.Echocardiogram in the next day showed complete occlusion of flow through the vertical vein and ASD. Dual antiplatelet was prescribed on discharge. Follow-up echocardiography after 3 months showed obvious improvement in RV size. Due to suspicion for clot formation, TEE was done and thrombosis with approximate length of extension of 15 mm was detected back to the device. The patient is following for 5 years. Repeated TEE after 2 years did not show any change in the burden of clot.For comprehensive evaluation of patients with ASD, assessment of pulmonic veins is crucial and in the presence of a vertical vein, the dual drainage of pulmonic veins should be considered.

Aims: Natural products still serves as a hope for some illnesses which modern medicine fails to cure. Many people, either knowing their effects or not, are using these herbal products. Treatment of chronic heart failure (CHF) is yet a complicated clinical challenge and there is need to improve or make new therapeutic targets. Finding new agents for CHF is an important subject in cardiovascular drug research. In this study, we evaluated the effects of ten herbals on treatment of CHF on isoproterenol-induced model. Methods and results: Ninety-six male Wistar rats (16 weeks old) were used in 12 groups. Transthoracic echocardiography was performed on the rats for confirmation of CHF model by decreasing ejection fraction. After 4 weeks’ treatment, hearts were removed and blood samples were collected in tubes to measure plasma levels of laboratory findings. Our results showed that the mean of ejection fraction in model rats was 51.82 ± 3.49 percent and all of our used natural products could significantly increase the ejection fraction (P < 0.01). The most effective herbals in improving the ejection fraction were Allium sativum (30.69 %), Peganum harmala (26.08 %) and Apium graveolens (24.09 %). The best results in decreasing NT-ProBNP, was obtained from Allium sativum, Peganum harmala and Berberis vulgaris respectively. Our results showed that none of natural products had toxic effect on renal and liver tissues. Conclusion: Our results showed that Allium sativum, Peganum harmala and Berberis vulgaris could significantly improve cardiac function by improvement of left ventricular remodeling, lowering hs-CRP and NT-ProBNP and echocardiographic indexes without liver or renal side effects.

Pulmonary prosthetic valve thrombosis is a serious and rare complication with high mortality. Using reteplase for treatment of prosthesis thrombosis is rarely reported. We report the first case in Iran of a thrombosed pulmonary valve in a patient who had undergone repair of tetralogy of Fallot, which was successfully treated twice with intravenous thrombolytic therapy with reteplase.

SummaryIntroduction Considering the high prevalence of glucose-6-phosphate dehydrogenase (G6PD) deficiency among newborns, different screening methods have been established in various countries. In this study, we aimed to assess the prevalence of G6PD deficiency among newborns in Rasht, Iran, and compare G6PD activity in cord blood samples, using quantitative and qualitative tests. Methods This cross-sectional, prospective study was performed at five largest hospitals in Rasht, Guilan Province, Iran. The screening tests were performed for all the newborns, referred to these hospitals. Specimens were characterized in terms of G6PD activity under ultraviolet light, using the kinetic method and the qualitative fluorescent spot test (FST). We also determined the sensitivity, specificity, negative predictive value, and positive predictive value of the qualitative assay. Results Blood samples were collected from 1474 newborns. Overall, 757 (51.4%) subjects were male. As the findings revealed, 1376 (93.4%) newborns showed normal G6PD activity, while 98 (6.6%) had G6PD deficiency. There was a significant difference in the mean G6PD level between males and females (P = 0.0001). Also, a significant relationship was detected between FST results and the mean values obtained in the quantitative test (P < 0.0001). Conclusion According to the present study, FST showed acceptable sensitivity and specificity for G6PD activity, although it appeared inefficient for diagnostic purposes in some cases.

Background: Patients with Contrast-Induced-Nephropathy (CIN) are at a greater risk of in-hospital complications, longer hospitalization, and long-term mortality in comparison with those without CIN. Despite many studies on the helpful effects of statins in preventing contrast-nephropathy, there is not enough evidence comparing different statins in inhibiting CIN. So, we planned this study to compare the efficacy of rosuvastatin and atorvastatin in prevention of contrast-induced nephropathy. Methods: This was a randomized clinical trial. The efficacy of two known statins, atorvastatin and rosuvastatin were compared in prevention of CIN in patients with ST-Elevation Myocardial Infarction (STEMI) who underwent Primary Percutaneous Intervention (PPCI) between May 2015 and April 2016 in Qaem and Imam Reza hospital, Mashhad, Iran. Subjects were divided randomly to 80-mg atorvastatin or 40-mg rosuvastatin group before PPCI. Participants’ characteristics including echocardiographic, laboratory and demographic data were recorded and incidence of CIN was assessed. Results: Two hundred cases with STEMI undergoing PPCI were recruited in the study and randomized to 80-mg atorvastatin (n = 98) or 40-mg rosuvastatin (n = 102) group before PPCI. The incidence of CIN was 5.67% (n = 13) in all participants; 6.3% (n = 7) in the rosuvastatin group and 5.1% (n = 6) in the atorvastatin group. There was a significant difference between creatinine and Glomerular Filtration Rate (GFR) after 48 hours of PPCI. Creatinine was lower and GFR was higher in the rosuvastatin group (P = 0.029, P = 0.005). Conclusion: There was a little trend for prevention of CIN in patients after PPCI in rosuvastatin group compared to atorvastatin group, in full dose. However, this preference was not clinically relevant.

Ectopic increase of adrenocorticotropic hormone (ACTH) or ectopic Cushing syndrome is a rare initial presentation of small cell carcinoma and carcinoid tumor of the lung. Here, we reported a 36-year-old male with atypical symptoms of Cushing syndrome managed by Etomidate that had a central pulmonary nodule, and pathologic evaluation of pulmonary lobectomy revealed the diagnosis of well-differentiated, low-grade typical carcinoids of lung. © 2019Tehran University of Medical Sciences. All rights reserved. Acta MedIran 2019;57(7):464-467.

Fatemeh Keihanian,1 Amin Saeidinia,1,2 Keivan Abbasi,1 Faeze Keihanian2–5 1Faculty of Medicine, Guilan University of Medical Sciences, Rasht, Iran; 2Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; 3Cardiology Department, Imam Reza Hospital, Mashhad, Iran; 4Cardiology Department, Ghaem International Hospital, Rasht, Iran; 5Pharmaceutical Research Division, Booali Research Center, Mashhad University of Medical Sciences, Mashhad, Iran Introduction: Septicemia is an emergency in medicine due to various dangers and lethality. In patients with septicemia, blood culture and other cultures should be done before antibiotic therapy. Determination of each isolated bacterium from blood culture and pattern of antibiotic sensitivity have an important role epidemiologically in a region and can assist physicians in the determination of primary antimicrobial agents. In this study, the researchers evaluated the schema of resistance of antibiotics in blood culture during the years 2014–2015 at eight educational hospitals in Rasht, North of Iran.Materials and methods: This was a descriptive cross-sectional study. The researchers evaluated all blood cultures performed at four educational hospitals in Rasht. Demographic data were completed by a checklist, and antibiotic sensitivity antibiogram for all blood culture samples was done by diffusion agar (Kirby–Bauer method). Data were entered and analyzed in the SPSS software version 16, and the pattern of resistance, sensitivity, and intermediate antibiogram results was classified.Results: From 3,283 cases, 225 subjects were positive (6.85%). Sixty-two percent of patients were male and others were female. The most common agent in the samples were Pseudomonas aeruginosa (66, 29.3%), coagulase-negative Staphylococcus (including Staphylococcus epidermidis and Staphylococcus saprophyticus; 50, 22.2%), coagulase-positive Staphylococcus aureus (29, 12.9%), and Escherichia coli (28, 12.4%). The most resistant antibiotic was ceftriaxone (44%), and the most sensitive antibiotic was ciprofloxacin (54%).Conclusion: According to significant changes of microorganisms that cause sepsis and meaningful alterations of antibiogram findings, the current findings showed that choosing the best choice for empiric therapy should be corrected. The rate of positive samples in the current study was higher than the normal range. Consulting with a pharmacist for antibiotic prescription in hospitals and participation of physicians in antibiotic administration workshops could help decrease resistance. Keywords: antibiotic resistance, blood culture, pattern of antibiograms, empiric therapy

Mostafa Ahmadi,1 Ramin Khameneh Bagheri,1 Faeze Keihanian,2,3 Amin Saeidinia4 1Atherosclerosis Prevention Research Center, Imam Reza Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; 2Pharmaceutical Research Division, Booali Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; 3Cardiology Department, Imam Reza and Qaem Hospitals, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; 4Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Background: Although there is ongoing progress in coronary artery-bypass graft (CABG) surgery and percutaneous coronary intervention techniques and supplies, the risk of cardiac complications remains high compared with the normal population. Aim: In this study, our aim was to compare fluoroscopy times in engagement of three different catheters in saphenous vein grafts (SVGs) in post-CABG patients undergoing angiography. Methods: This was a single-center, cross-sectional, comparative study. We evaluated patients with previous CABG referred for invasive coronary diagnostic angiography. Patients having had SVG–obtuse marginal artery, SVG–diagonal, and SVG–posterior descending artery CABG were included. All patients underwent diagnostic angiography by each of a right diagnostic Judkins catheter, right modified Amplatz catheter, and right guiding Judkins catheter. Demographics and clinical history of patients and fluoroscopy time in different groups were evaluated. Results: A total of 61 patients were evaluated. The distribution of baseline characteristics in the three groups of our study was normal. Mean fluoroscopy time in SVG–obtuse marginal artery was 25.70±6.70 seconds in group A, 22.23±6.51 seconds in group B, and 17.35±7.82 seconds in group C. Mean total fluoroscopy time was 86.35±16.28 seconds in group A, 73.80±10.00 seconds in group B, and 51.90±10.22 seconds in group C, which was significant (P

Most adverse events following total hip arthroplasty (THA) are uncommon and preventable or treated easily as expected. Adverse effects related to any major surgical procedure, including anesthesia, performing with other medical problems, drugs, and allergic reactions, might also occur. Potential cardiovascular complications are known to occur during or following THA and will be reviewed here. Complications can be categorized as myocardial infarction, cardiac arrest, thromboembolism, and so on. Special considerations in cardiovascular procedures are also reviewed in this paper.

Heart failure is a major public health concern and one of the most common reasons for a cardiac hospital admission. Heart failure may be classified as having a reduced or preserved ejection fraction and its severity is based on the symptom score. Given the aging population, it is predicted that admissions with heart failure will increase. Whilst pharmacological therapy has improved the associated morbidity and mortality, there is a need for additional therapies to improve the clinical outcome as the death rate remains high. Curcumin is a natural product derived from turmeric that appears to have cardiovascular benefit through a number of mechanisms. In this review, we have assessed the mechanisms by which curcumin may exert its effects in different models of heart failure and show that it has promise as a complementary treatment in heart failure.

Atherothrombotic cardiovascular disease is a major cause of mortality throughout the world. Platelet activation and aggregation play a central role in hemostasis and thrombosis. Herbal medicines have been traditionally used in the management of cardiovascular disease and can help in modifying its progression, particularly in hemostasis and the coagulation process, as well as altering platelet function tests and some coagulation parameters. Curcumin is a polyphenol derived from the Curcuma longa plant and has been used extensively in complementary and alternative medicine, as it is nontoxic and safe with various therapeutic properties. Modern scientific research has demonstrated its anti-inflammatory, antioxidant, anti-carcinogenic, antithrombotic, and cardiovascular protective effects. The present study reviewed previous studies in the literature, which support the positive activity of curcumin in hemostasis, anticoagulation, and fibrinolysis. We also presented molecular mechanisms associated with the antiplatelet and anticoagulant activities of curcumin and potential implications for the treatment of cardiovascular disease.

Introduction: Irregular wide antibiotic administration by physicians and over the counter use of them had led to inappropriate or non-essential choice of antibiotic. If blood related diseases like sepsis and bacteremia, have not been diagnosed and treated as soon as possible, they can make high complications and mortalities. This study was conducted to survey of epidemiological changes about frequency of micro-organisms in blood cultures in Razi laboratory of Rasht during 2006 to 2011. Material & Methods: This is a descriptive retrospective study performed by information database of Razi laboratory. For all of positive samples addressed for blood culture, anti-biograms had been done by method of Kirby & Bauer and agar diffusion. Last, formation or deformation of growth zone was evaluated and on the basis of standard table, results were classified to three categories of sensitive, intermediate and resistance. All of common standard antibiotic disks had been used in this survey. Results: In all cases which addressed for culture (466 cases) 43 subjects (9.22%) were positive and one of them was contaminated. The most frequent bacteria separated from the blood cultures were respectively: coagulase negative Staphylococcus, Escherichia coli, Pseudomonas aeruginosa, Klebsiella and coagulase positive Staphylococcus. Relation between type of bacteria and gender of patients was significant (P = 0.001) in which in female cases it was the most frequent. The most resistance in all of applied antibiotics in coagulase negative Staphylococcus group was 60.2%, in gram negative non non-fermentative bacillus group was 43.16% and in gram negative intestinal bacteria group was 39.25%. Discussion & Conclusion: Although there are similar results in the pattern of resistance in comparison of other studies, pattern of this study is unique and exclussive for Rasht city and it is based on hygienic condition of Guilan province. Because of being respective and variables were not considerd by opinions of researchers of this study, it is necessary to conduct a prospective and continous study in this wide level.

Background: Burns are common event and associated with a high incidence of death, disability, and high costs. Centella asiatica (L.) is a medicinal herb, commonly growing in humid areas in several tropical countries that improve wound healing. On the basis of previous studies, we compared the efficacy of Centiderm versus silver sulfadiazine (SSD) in partial thickness burning patients. Methods: Study population comprised burn victims referred to Velayat Burning Hospital at Rasht, Iran. The intervention group received Centiderm and control group SSD cream. Burn wounds were treated once daily at home. All of the wounds were evaluated till complete healing occurred and at the admission, days 3, 7, 14 objective signs; visual acuity score (VAS) and subjective signs were recorded. Re-epithelialization time and complete healing days were recorded. We used random fixed block for randomization. The randomization sequence was created using the computer. Patients and burning specialist physician were blinded. Results: Seventy-five patients randomized into 2 groups; (40 patients: Centiderm group; 35 patients: SSD group). The mean age of them was 30.67 ± 9.91 years and 19 of them were male (31.7%). Thirty patients in Centiderm and 30 patients in SSD group were analyzed. All of objective and subjective signs and mean of re-epithelialization and complete healing were significantly better in Centiderm group rather than SSD group (P