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Opium has been used traditionally for lowering blood lipids, diabetes, cancer, and postpone of cardiac diseases. The coronary angiography patients were divided to opium user and control group. SYNT...

BACKGROUND: In 2013, there was an estimation of greater than 4.5 million Afghan refugees who had migrated to the least developed countries. Over one million are legally registered in Iran. We assessed the heart health status as described by the American Heart Association (AHA) in the Afghan refugee populace. METHODS: This cross-sectional survey was carried out on 1,634 Afghan refugees, including 746 males (45.7%) and 888 females (54.3%), selected through a convenience sampling method in 2016. The American Heart Association's seven cardiovascular health metrics were evaluated to specify the status of heart health in Afghan refugees. Differences with age and sex were analyzed using the χ(2) test. RESULTS: Only one (0.1%) participant met the ideal for all seven cardiovascular health metrics. No significant differences were found between women and men in meeting the ideal criteria for more than five cardiovascular health metrics. As age increased, the proportion of refugees who met the ideal for more than five cardiovascular health metrics declined. CONCLUSIONS: Refugees were not meeting the ideal cardiovascular health for some of the assessed metrics. Intervention to improve and monitor heart health in Afghan refugees is needed.

In recent years, non-communicable diseases (NCDs) have accounted for about 70% of the world's deaths. The most common NCDs are cardiovascular disease, cancer, diabetes mellitus, and chronic respiratory diseases. These diseases have four common risk factors, including inadequate physical activity, unhealthy diet, smoking, and excessive alcohol consumption. Cardiovascular diseases, despite their high prevalence, are the most preventable chronic diseases. The most common risk factor for cardiovascular disease is high blood pressure, which can be prevented if it is diagnosed and controlled carefully. Recent guidelines have changed the methods of blood pressure measurement, definition, and treatments. Recently, more emphasis has been placed on Out-of-Office Blood Pressure Measurement. Therefore, it is necessary to consider the methods of measuring blood pressure at home and 24-hour Holter blood pressure monitoring, as well as understanding its standards. The use of automatic arm sphygmomanometers to measure blood pressure is more acceptable than manual ones (mercury or Aneroid). The most accepted definitions of hypertension are BP≥140/90 mm Hg in the clinic, the average blood pressure at home≥135/85 mm Hg, and the average blood pressure in 24-hour Holter monitoring≥130/80 mm Hg. Proper treatment of hypertension by changing lifestyle and proper medication therapy can control blood pressure and prevent serious complications. Today, the use of combination drugs, especially a single pill in a single dose, has been emphasized. This study aimed to review the most recent hypertension treatment protocols based on the guidelines of the American Heart Association (AHA 2017), the European Society of Cardiology (ESC 2018), the British Heart Association (NICE 2019), and the International Society of Hypertension (ISH 2020). Furthermore, this study attempted to assess the symptoms, complications, methods of diagnosing, definitions, as well as pharmacological and non-pharmacological treatments of hypertension.

Neutrophil-lymphocyte (NLR), platelet-lymphocyte (PLR), eosinophil-lymphocyte (ELR), and monocyte-lymphocyte (MLR) ratios are systemic inflammatory markers related to myocardial infarction. The aim of this study is to investigate the association of Src homology 2-B adapter protein 3 (SH2B3) C784 T and methylenetetrahydrofolate reductase (MTHFR) C677 T polymorphisms (SNP) with systemic inflammatory markers and the severity of coronary artery disease (CAD) in 150 ST-elevation myocardial infarction (STEMI) patients. Single nucleotide polymorphisms were genotyped using the tetra-primer amplification refractory mutation system-polymerase chain reaction (T-ARMS-PCR) method. The inflammatory markers were calculated. An interventional cardiologist blinded to other data assessed the SYNTAX (SX) Score. Eosinophil and platelet counts were significantly higher in SH2B3 variants than in the wild type. Additionally, SH2B3 variants had significantly higher ELR than the wild type (.12 ± .19 vs .25 ± .34, p = .018). NLR, PLR, ELR, and MLR were considerably higher in MTHFR variants than in the wild type ( p < .05). The SX score was significantly higher in both SH2B3 C784 T (21.24 ± 8.90 vs 15.29 ± 9.40, p = .00) and MTHFR C677 T (20.34 ± 10.21 vs 16.08 ± 8.39, p = .00) variants when compared with wild type. In conclusion, these polymorphisms are associated with several markers of systemic inflammation as well as the severity of CAD.

Some plants that were frequently grown in public city areas showed cardiotoxicity effects. The data of this review article were obtained from MEDLINE/PubMed, Scopus and Google Scholar until Decembe...

Aims Tuberculous pericarditis is present in only one to two percent of the tuberculosis cases, i.e. considered rare. The disease is responsible for 4% and 7% of acute pericarditis and cardiac tamponade cases, respectively. Moreover, these conditions are associated with hazardous side effects. Thus, timely and precise diagnosis of the disease could prevent such complications. Case report We reported an 85-year-old male case who was referred with clinical signs of breath shortness, cardiac murmur, and swollen jugular veins. Besides, the relevant laboratory findings indicated elevated white blood cell counts (11.6). In addition, other diagnostic measures, such as thoracic radiography and echocardiography were performed on the patient. Then, the diagnosis indicated a 28mm diameter of pericardial fluid; accordingly, the patient was selected as a candidate for emergency pericardiotomy. The fluid was drained, and therapeutic medication, as well as antibiotics were administered for the patient. Finally, the patient was discharged with an appropriate general condition. Conclusion A sample of pericardial fluid was tested using polymerase chain reaction)method for the diagnosis of tuberculosis, which provided a positive result. Considering the dangerous complications of this disease, it is recommended for all patients who could suction severe pericardial effusion to be tested for this disease.

The Venous thromboembolism (VTE), including venous thrombosis (DVT) and pulmonary embolism(PE) and one of the causes of death during the pregnancy. During the pregnancy, Multiple changes to the mother's coagulation system lead to high coagulation. The results have shown that approximately 1 in every 200-500 women during the pregnancy with venous thromboembolism and 30% in those with pulmonary embolism. During the third trimester of pregnancy, and especially during the first two weeks after childbirth, the risk of (VTE) increases in women. The risk of VTE after pregnancy is 5 times higher than that of the during pregnancy. Also, Pregnancy alone is a risk factor for VTE, And, besides, some women have a high risk of developing the VTE. The most important risk factors for VTE during pregnancy include the previous history of VTE, acquired thrombophilia, history of previous VTE due to major surgery, Medical problems (including cancer, heart disease, etc.), hereditary thrombophilia are high risk (Table 1). Due to numerous clinical conditions and also the risks of an embryo and mother seeking anticoagulant therapy, management during pregnancy should be taken into consideration. Therefore, according to the latest instructions from the Ministry of Health and Medical Education, it was decided to design the software in order to prevent the occurrence of VTE.

Adverse consequences of the coronavirus disease 2019 (COVID-19) vaccination which have been reported in scientific papers are varied. One possible but rare consequence is myocarditis, which may have a diversity of clinical manifestations. We report a case of a 70-year-old man who presented to the hospital for some syncope, 3 days after his first COVID-19 AstraZeneca Vaccination. Initial electrocardiogram (ECG) showed a long QT interval (QTc = 600 milliseconds). Laboratory tests revealed elevated troponin and lack of evidence of viral infection. Further investigations revealed the vaccine-induced myocarditis and arrhythmias linked to it. Within one week of magnesium treatment, the QT interval was completely corrected, and the patient discharged with no typical syncope attacks. This case like the previous reported one confirms that myocarditis is a complication of COVID-19 vaccine, but implies its clinical manifestations may be varied and even may happen after the single dose of vaccination.

BACKGROUND Premature coronary artery disease (CAD) is still prevalent worldwide and may differ in various ethnicities. Due to the presence of different ethnicities in Iran, the Iran-premature coronary artery disease (I-PAD) study aimed to determine the frequency of premature CAD and related risk factors based on each ethnicity. METHODS In this multi-center case-control study, 4000 patients with premature CAD from ten different ethnicities who lived in different cities of Iran and underwent coronary angiography were enrolled (women aged ≤ 70 and men ≤ 60 years). Patients with CAD defined as obstruction equal or above 75% in at least a single coronary artery or left main ≥ 50% were included in the case group, while patients with normal coronary arteries were included in the control group. Lifestyle behaviors, cardiometabolic risk factors, anthropometric measurements, and other variables were collected. Serum, whole blood, buffy coat, plasma, urine, stool, and saliva samples were stored. RESULTS The number of patients enrolled until April 2020 was 2071. The mean age of patients was 53.51 ± 7.52 and 934 (45.09%) of patients were women. To date, about 39.6% of the patients were normal. Also, about 26.0% were with one-vessel disease (1VD), 15.0% with two-vessel disease (2VD), and 15.2% with three-vessel disease (3VD). More than 30000 patients' biosamples from across the country have been stored. CONCLUSION Knowing the frequency of premature CAD according to different ethnicities with major differences in their lifestyle behaviors and risk factors can assist health decision-makers. In addition, I-PAD biosamples will be an invaluable source.

Chest pain is a clinical symptom for immediate consultation, and electrocardiogram (ECG) is a valuable diagnostic tool for use in the emergency room. Although the ST- elevation myocardial infarction (STEMI) requires urgent management, there are other ECG high-risk findings which are associated with adverse outcomes or imminent acute myocardial infarction (AMI). This is a case of STEMI equivalent pattern such as de Winter. As this ECG pattern is uncommon, it may be misinterpreted in the emergency department. We report a misinterpretation of de Winter´s pattern (dWp) in a young woman referred to the emergency department for chest pain, feeling of suffocation and hemodynamic instability who undergone reteplase treatment with the suspicion of acute massive pulmonary embolism but developed cardiogenic shock as a result of extensive myocardial infarction due to spontaneous dissection of the left anterior descending coronary artery. A prompt diagnosis of de Winter´s pattern and early angiography to detect the underlying cause of clinical manifestation can be lifesaving.

The mortality rate from aluminum phosphide (AlP) poisoning is as high as 70–100%, with refractory hypotension and severe metabolic acidosis being the two most common presentations in this poisoning. As this poisoning has no specific antidote, treatments revolve around supportive care. Cardiogenic shock created by toxic myocarditis is considered the main cause of mortality in these patients. Meanwhile, the intra-aortic balloon pump (IABP) has been suggested for the treatment of cardiogenic shock. This article reports the successful treatment of cardiogenic shock caused by AlP poisoning in a 17-year-old man and a 21-year-old woman using the IABP procedure.

Coronary artery disease (CAD) is the leading cause of death worldwide. Atherosclerosis as the main underlying mechanism of CAD is associated with inflammation and adipose tissue dysfunction. C1q/TNF-related protein12 (CTRP12) is a newly discovered adipokine which is a paralog of adiponectin. CTRP12 has anti-inflammatory and insulin sensitizing effects. Circulating levels of this adipokine have been reported to be lower in patients with type 2 diabetes and women with polycystic ovarian syndrome. The present study was undertaken for the first time to evaluate serum levels of CTRP12 in CAD patients and its association with anthropometric and biochemical parameters. Serum levels of CTRP12 were measured using ELISA kit in 188 CAD patients (angiography confirmed) and 70 controls. The serum levels of adiponectin, TNF-α and IL-6 were measured using ELISA kits. Serum levels of CTRP12 were found to be lower in CAD patients (585.48 ± 201.67 pg/mL) than in the controls (814.86 ± 247.85 pg/mL; p 0.001). CTRP12 also showed an independent association with the risk of CAD (OR [CI] = 0.998 [0.996-0.999]; p = 0.019). Moreover, it showed an inverse correlation with HOMA-IR (r = -0.298; p = 0.012) and TNF-α (r = -0.269; p = 0.023) and a positive correlation with adiponectin (r = 0.344; p = 0.003) in the controls. In CAD patients, CTRP12 was inversely correlated with BMI (r = -0.181, p = 0.013), HOMA-IR (r = -0.199; p = 0.006), TNF-α (r = -0.259; p 0.001) and IL-6 (r = -320; p 0.001) and a positive correlation with high density lipoprotein-cholesterol(r = 0.342; p 0.001) and adiponectin (r = 0.398; p 0.001). The present study showed for the first time that serum levels of CTRP12 are independently associated with CAD and that CTRP12 is associated with several CAD risk factors. The results suggest a possible link between CTRP12 and pathogenic mechanisms of atherosclerosis, such as inflammation and high density lipoprotein-cholesterol metabolism; however, more study is required in this regard.

Background: Cardiovascular Disease (CVD) is one of the most important causes of mortality and morbidity in developed and developing countries. Objectives: This study aimed to evaluate the risk factors associated with the extent of coronary vessel involvement across the spectrum of Coronary Artery Disease (CAD) in patients referring to the Cardiac Ward of Vali-Asr Hospital of Birjand, Iran. Methods: A cross-sectional study was conducted on 3,394 patients undergoing coronary angiography at the Cardiac Ward of Vali-Asr Hospital of Birjand, Iran, in 2011-2015. Subjects were assigned to four groups in terms of the extent of coronary vessel involvement: Normal CAD, non-significant CAD, CAD, and non-obstructive CAD. Adjusted odds ratios and 95% confident intervals were calculated by including all variables with P values < 0.05 into the multivariate model to control for confounding factors. Data were analyzed using SPSS version 22. Results: Among male and female patients, those aged 45-65 years needed angiography more than other groups. Multiple logistic regression analysis showed that diabetes, male gender, FBS, and history of hypertension significantly increased the likelihood of coronary vessel involvement (P ≤ 0.05). Conclusions: The findings of the present study imply that age, male gender, FBS, and history of hypertension are the independent risk factors for the extent of coronary vessel involvement in CAD and non-significant CAD groups. To reduce the rates and consequences of CAD, it is paramount to control cardiovascular risk factors, screen susceptible populations at risk, and improve coronary interventional services.

Objectives: This study aimed to evaluate the incidence of coronary artery ectasia (CAE) and its associated factors in the East of Iran. Methods: A cross-sectional study was conducted on 2,795 patients undergoing coronary angiography between 2011 and 2017. Patients were categorized into three groups: Coronary artery ectasia, normal coronary artery, and coronary artery stenosis. Patients' demographic data, cardiac risk factors, and angiographic results were extracted from medical records. Then, information on CAE patients was evaluated. Data were analyzed by the independent t-test, Mann-Whitney test, and chi-square test. Statistical significance was defined by a P-value ≤ 0.05. Results: The prevalence of CAE was 3.04%. The mean age of CAE patients (59.44 ± 10.15) was significantly higher than that of normal coronary artery patients (53.98 ± 9.97). The proportion of men was significantly lower in the CAE group (48.2%) than in the CAS group (62.1%) but higher than in the normal group (32.3). Body mass index (BMI) and low HDL (high-density lipoprotein) were higher in the CAE group, but diabetes mellitus was lower than in the CAS group. Conclusions: The prevalence of CAE was low in our study. Old age, male sex, obesity, and low HDL were CAE risk factors, but diabetes mellitus was a preventing factor in our study.

Objective: This study was conducted to investigate the effect of contrast agent used in angiography on sensorineural hearing loss . Methodology: This Quasi experimental study was conducted at Valiasr hospital, Birjand, Iran on 157 coronary artery disease patients hospitalized for angiography. The hearing level of the right and left ears was measured individually before and after the angiography. Then, to calculate the mean auditory threshold of the patients, the hearing level was averaged at three different frequencies of 500, 1000, and 2000 Hz. After data collection and introducing them into SPSS 22, descriptive statistics (frequency percentage distribution, mean and standard deviation) were used along with Mann-Whitney and Kruskal-Wallis tests at the significance level of 0.05. Results: Out of the 157 patients studied, 79 (50.3%) were male. The mean age of the subjects was 57.62±10.17 years (29-85 years), which was 57.67±9.31 in women and 56.85±11 in men. The hearing level of the right ear before and after injection of the radiocontrast agent was 23.69±13.18 and 23.33±13.30 db, respectively, while in the left ear, the values were 25.14±15.01 and 25.02±15.16, respectively, where this difference was not significant (p>0.05). Conclusion: There is no appreciable effect of radiocontrast agent on neurosensory auditory disorder of patients undergoing angiography of coronary artery disease Keywords: Contrast agent, hearing loss, Angiography.

Background. Diabetes mellitus is recognized as one of the most common, serious, and costly chronic diseases. Opium addiction is also a common health problem in Iran. Given the high prevalence of opium use in South Khorasan Province and the increasing prevalence of opioid abuse in the community, this study was performed to investigate the effect of opioid abuse on the extent of disease in diabetic patients undergoing coronary angiography in the cardiology department of Vali-e-Asr Hospital in Birjand city, South Khorasan Province, Iran. Methods. This study recruited a total of 1051 diabetic patients who underwent coronary angiography in the cardiology department of Vali-e-Asr Hospital of Birjand city from 2011 to 2015. The collected data were analyzed using SPSS version 22.0 with the chi-square test and univariate regression analysis. P value Results. Among opiate-addicted diabetics, the risk of coronary artery disease was 0.44 times higher than among nonaddicted diabetics (range 0.24–0.77, P=0.004). The extent of coronary vessel involvement, when present, was not different between the two groups. Conclusion. Opiate-addicted diabetics appear to be more susceptible to CAD than their nonaddicted counterparts. The determinants and correlates of this interaction must be the subject of further study.

The article's abstract is no available.

Tricyclic antidepressants are used to treat a variety of mental disorders, and are considered a common cause of fatal drug poisoning. This study reports a young woman with no history of cardiac diseases who presented to the emergency department with heart palpitation, weakness, and lethargy. After a short period of time, she became unconscious and experienced hypotension and refractory arrhythmia, finally being diagnosed with imipramine poisoning. Accurate history taking and the possible causes of these complications including cardio-toxic drug poisoning should be considered in such patients.

Introduction: Inflammation plays an important role in the pathogenesis of cardiovascular diseases in patients receiving hemodialysis. Objectives: To compare serum levels of quantitative as high-sensitive C-reactive protein (hsCRP), erythrocyte sedimentation rate (ESR), and cancer antigen 125 (CA-125) among three groups including hemodialysis with heart failure (HF), hemodialysis without HF and healthy controls. Patients and Methods: Seventy patients with chronic kidney disease (CKD) receiving hemodialysis were included. Thirty-five healthy subjects were in the control group. Inflammatory markers were measured. All subjects underwent 2D transthoracic echocardiography. HF was defined as LVEF (left ventricular ejection fraction)

Back pain is among the most common complaints of patients during the first hours after coronary angiography (CA), i.e. when they are restricted to complete bed rest. This study aimed to evaluate the effects of foot reflexology on back pain after CA.This randomized controlled trial was conducted in 2018-2019 on patients hospitalized in the post-angiography unit of Razi hospital, Birjand, Iran. Through convenience sampling, 120 patients were recruited and their demographic characteristics and baseline back pain intensity were assessed immediately after angiography using a demographic questionnaire and a visual analogue scale, respectively. Then, patients were randomly allocated to a control (n = 60) and a reflexology (n = 60) group through block randomization. Patients in the reflexology group received 8-min foot reflexology for each foot (16 min for both feet) while their counterparts in the control group solely received routine post-angiography care services. Back pain assessment was repeated for all participants immediately, two, four, and 6 h after the intervention. Data were analyzed using the SPSS software (v. 16.0).Back pain intensity significantly increased after angiography in both groups (P 0.05). Yet, pain intensity in the reflexology group at all post-intervention measurement time points was significantly less than the control group (P 0.001).Foot reflexology is effective in significantly reducing back pain after CA.

Introduction: High prevalence of pulmonary hypertension has been reported in patients with chronic renal failure, especially those undergoing hemodialysis. Objectives: Considering the high prevalence of pulmonary hypertension in hemodialysis patients and uncertainty about the causes, the present study planned to investigate the role of parathyroid hormone (PTH) and cardiac ejection fraction (EF %) in development of pulmonary hypertension. Patients and Methods: By simple census sampling, all patients on hemodialysis in the hemodialysis center of Birjand University of Medical Sciences were enrolled. After obtaining written consent, the EF% and systolic pulmonary artery pressure (sPAP) were determined using echocardiography (MEDISON V10 model, Korea). The cut-point of less than 35 mm Hg was considered for normal sPAP. The blood sample was prepared to assay PTH using COBAS411 and ROCH kit. Independent t test or Man-Whitney test were used to compare means. P value Results: A totsl of 114 patients were enrolled in the study. Finally 89 patients, including 49 (55.1%) male and 40 (44.9%) female completed the study. The mean age and mean sPAP of the studied patients were 55.14 ± 15.68 years and 30.65 ± 12.10 mm Hg respectively. Among the studied patients, normal and high sPAP were reported in 60 (67.4%) and 29 (32.6%) cases respectively. Cardiac EF% in patients with normal and high sPAP was 59.08 ± 2.83 versus 56.37 ± 4.79 respectively (P = 0.01). PTH was determined 275.12 ± 218.44 versus 395.67 ± 332.05(pg/mL) (P = 0.03), in patients with normal and high sPAP respectively. Conclusion: The prevalence of pulmonary hypertension in the studied patients was 32.6%. Patients in the pulmonary hypertension group had higher levels of PTH and lower cardiac EF%.

Information on incidence and risk factors of cardiovascular disease (CVD) is rare in the Middle East. This study aims to compare Iranian candidates for coronary artery bypass graft (CABG) surgery and healthy controls in terms of lipid profile, atherogenic index of plasma (AIP), and atherosclerosis index (ASTI). The individuals recruited in this study were 135 CVD patients before CABG surgery and 135 healthy subjects matching in age with the cases. Lipid profiles of the two groups were analyzed with a commercial kit. The AIP and ASTI indexes were calculated with related formula. The TC, TG, LDL-C and HDL-c parameters were dramatically changed (p0.01) between study groups. AIP and ASTI indexes were significantly higher in patients than in healthy people (p=0.001). In individuals with CVD, it is suggested to measure these indexes in order for effective diagnosis before CABG surgery.

Introduction: Opiate dependence is among the main contributors to diseases worldwide, imposing heavy costs on the healthcare system. As an established approach, substitution therapy by methadone has been long considered as the most effective therapeutic method. Case Presentation: Herein, we present the case of a 40-year-old man, who was referred to the hospital with complaints of sudden and transient loss of consciousness and a history of opiate dependence under methadone therapy, showing recurrent ventricular tachycardia and resistant torsade de pointes. Conclusions: Poisoning is among the major adverse effects of methadone use, which involves different systems of the body, including the cardiovascular and respiratory systems. Furthermore, effective drugs on QT interval show interferences. Therefore, it is suggested to incorporate relevant recommendations in the new version of the national opiate-dependence therapy protocol.

Sulfur mustard (SM) has been used as a chemical weapon in some conflicts, and many veterans and civilians have been injured thereby. Pulmonary, cutaneous, and ocular effects of SM have been frequently reported, although it seems that other organs such as the cardiovascular system are probably also affected. There are a number of studies evaluating the cardiovascular impacts of SM. However, these are dispersed and unfocused. In this paper, these studies have been reviewed to draw conclusions about the cardiovascular effects of SM. It seems that there is a probable relationship between SM exposure and cardiovascular toxicity in the long term. It appears that coronary artery diseases especially coronary ectasia and diastolic dysfunction are among the significant cardiovascular abnormalities frequently seen in these patients. Abnormal coronary arteries may occur due to direct endothelial injury by SM, sustained inflammatory status in patients with chronic lung disease, and abnormal mediators of tissue injury and repair or oxidative stressors.

Background: Hypertension (HTN) is a major cause of noncommunicable diseases. In this study, we report the prevalence rate of HTN in Birjand population. Methods: This cross-sectional study was conducted on 1286 individuals in Birjand in 2014. Individuals with systolic blood pressure (SBP) ≥140 mmHg and/or diastolic blood pressure (DBP) ≥90 mmHg were considered as hypertensive. Data were analyzed using Chi-square test, independent t-test, and one-way ANOVA. P < 0.05 was considered as statistically significant. Results: Among the 1286 participants, 659 were women (51.2%). Prevalence of HTN was 20.1% (10.3% systolic HTN and 6.9% diastolic HTN). Prevalence self-reported HTN was 12.3%. SBP and DBP means were higher in men (P < 0.001). Mean scores of SBP and DBP increased by aging and body mass index (P < 0.001). Diabetic individuals had higher SBP scores (P < 0.001). Dyslipidemic patients had greater SBP and DBP (P < 0.001). Conclusions: Prevalence of HTN in our study is high. About one-fifth of the participants had HTN. In addition, BP is higher in men, elderly, and diabetic individual. Therefore, it is necessary to control BP regularly in different groups in society.