مجله دانشکده پزشکی اصفهان
پیاپی 209 (هفته سوم آذر 1391)

Compared to men, women suffer from acute myocardial infarction (AMI) at higher age. In addition, hypertension, dyslipidemia, diabetes mellitus, and in-hospital mortality are more frequent in women. This study aimed to determine gender-based differences in predictive factors of short-term survival in patients with acute myocardial infarction. In a cohort study based on hospital records during 1999-2008, all patients with AMI admitted to all public and private hospitals in Isfahan and Najaf Abad (center of Iran) were investigated. To determine predictive factors of short-term (28-day) survival, univariate and multivariate Cox regression analyses were used. Survival rate of patients was calculated using Kaplan-Meier and log rank tests. Overall, 12815 patients with AMI were included (72.6% male). The adjusted relative risk (RR) of death increased with age. In patients over 80 years of age, RR was 12.7 [95% confidence interval (CI): 5.1-31.3] in men and 8.8 (95% CI: 1.2-63.1) in women. In both genders, RR of anterior wall infarction was greater than inferior wall infarction [3.0 (95% CI: 1.8-5.1) vs. 1.7 (95% CI: 1.0-3.0) in men and 2.2 (95% CI: 1.2-4.0) vs. 1.6 (95% CI: 0.8-2.9) in women]. While survival rate increased in both genders during the study period, this improvement was more apparent in women. Increasing trend of survival rate following an AMI in both genders warrants continuous medical care and public health promotion activities. Physicians will therefore be encouraged to provide more efficient care for patients who are at higher risk of mortality.

The relation between angiotensin converting enzyme (ACE) insertion/deletion (I/D) polymorphism and cardiovascular diseases was reported previously but the role of this polymorphism and the occlusion of vein grafts in long-term post coronary artery bypass graft (CABG) surgery still has remained controversial. The aim of the present study was to investigate any probable relationship between ACE I/D polymorphism and the atherosclerotic occlusion of vein grafts.

Patients who undergone CABG surgery more than five years ago, participated in this cross-sectional study. Occlusion of vein graft was determined by angiography. The ACE I/D polymorphism was detected by polymerase chain reaction (PCR) based restriction analysis.

A total of 102 patients (84 males) were enrolled to the study. The frequency distribution of DD, ID, and II polymorphisms were 23.6%, 62.7%, and 13.7%, respectively. There were no differences among genotypic groups regarding the number of occluded, diseased, and atherosclerosis-free vein grafts (P = 0.6, 0.7, and 0.18, respectively). Patients with II genotype had the same number of completely occluded vein grafts in a marginally significant shorter time after CABG (P = 0.06) compared with the other groups.

Although the results of our study indicated no association of ACE I/D polymorphisms and the occlusion of vein grafts long-term post-CABG, ACE II genotype may accelerate the rate of occlusion in vein grafts.

Etomidate and ketamine are commonly used to induce sedation in cataract surgery due to their favorable hemodynamic side-effect profile. This study was performed to compare the efficacy and safety of etomidate/fentanyl with ketamine/midazolam combinations for inducing sedation in cataract surgery with phacoemulsification technique. This study was a double-blind active-control clinical trial. 94 patients scheduled for cataract surgery under sedation, were randomly assigned to receive either etomidate/fentanyl or ketamine/midazolam. Participants’ blood pressure, heart rate, nausea and vomiting frequency, decreased arterial O2 saturation episodes, and recovery duration as well as the patients and surgeon satisfaction were recorded during the study period. No statistically significant differences were observed in systolic and diastolic blood pressure and heart rate between groups. Mean systolic blood pressure was 148.5 ± 25.1 in etomidate/fentanyl and 149.3 ± 22.0 in ketamin/midazolam groups (P = 0.87). Similarly, the patients of both groups reported the same levels of pain and nausea, but not vomiting episodes which have only happened in etomidate/fentanyl group. In contrast, patient satisfaction was significantly higher in ketamine/midazolam group (P = 0.001), although surgeon satisfaction were comparable with both combinations (P = 0.07). The members of both groups reached a desired level of sedation in 30 minutes and the between-group differences of sedation scores remained non-significant. However, myoclonus was only experienced by the etomidate/fentanyl group patients. Overall, this study demonstrated that the combination of etomidate/fentanyl is as efficient and safe as ketamine/midazolam in cataract surgery, without any significant side effects.

Postoperative shivering is very common and could be followed by many problems such as increasing in oxygen consumption, blood pressure, intracranial and intraocular pressure, and postoperative pain. Therefore, the prevention of shivering is important especially in the elderly and ischemic heart disease patients. The goal of this study was to compare the efficacy of pethidine (meperidine), dexamethasone, and placebo in the prevention of postoperative shivering. This double-blind placebo-controlled clinical trial was carried out on 120 patients who were candidates for surgery under general anesthesia. The patients were randomly divided into three groups including those who received placebo (a), dexamethasone (b), and pethidine (c). Induction and maintenance of anesthesia for all patients were similar. Central and peripheral temperatures of patients were measured every 5-minute. After induction, normal saline, dexamethasone, and pethidine were injected to groups a, b, and c, respectively. In recovery phase, all patients were monitored for visible shivering. There was no significant difference between the three groups regarding gender, age, duration of surgery, and recovery time. Nineteen cases (47.5%) in group (a) had postoperative shivering compared with the 4 cases (10%) in group (b) and the difference between 2 groups was significant (P = 0.001). Similarly, in group (c), 15 cases (37.5%) had shivering that was significantly lower than the placebo group (P = 0.08). The present study showed that pethidine and dexamethasone are effective in preventing postoperative shivering in elective surgeries under general anesthesia. Moreover, dexamethasone is markedly more effective than pethidine. Dexamethasone can be administered after induction of anesthesia as an alternative to pethidine particularly in patients with hemodynamic instability.

Family physician program and referral system is being performed from 2005 in rural areas of Iran. Family physicians are mandated to screen high risk population for high-priority diseases. The aim of the present study is to evaluate the family physicians’ performance in screening of hypertension (HTN) and diabetes mellitus (DM) 5 years after the introduction of family physician program.

In a cross-sectional study in 2011 in rural health centers of Isfahan County, we collected the data from health dossier of all hypertensive and diabetic mellitus patients who were cared in these centers. Demographic data, the date of definite diagnosis, the last fasting blood sugar test and blood pressure were registered in a checklist.

Family physician teams diagnosed 3209 hypertensive and 1684 diabetic mellitus patients. Based on the prevalence of hypertension and diabetes mellitus in the studied areas, family physicians diagnosed 31.5% of hypertensive patients and 55% of diabetic mellitus patients.

In rural areas which family physician program has been introduced, HTN and DM screening were improved.

Vaginal candidiasis is the second cause of vaginal infections and almost 75% of healthy females get infected by these yeasts at least once during their reproductive age. The present study aimed to isolate and identify Candida species from the patients with vaginal candidiasis and healthy individuals. The study was cross-sectional and conducted on patients with suspected vaginal candidiasis referred to the private clinics of Shiraz, Iran and healthy individuals. Following the clinical examination, samples were taken from the vaginal discharges for culturing, gram staining, and determining the pH. Afterwards, the species were differentiated by CHROMagar Candida medium and the formation of chlamydospore. In the present study, the culture of the specimens of 42 patients (35%) yielded positive results. Vaginal discharge was the most prevalent clinical symptom of candida vaginitis with a rate of 78.6% followed by itching (57.1%), burning sensation (47.6%), and lower abdominal pain (45.2%). The most frequently identified species was Candida albicans (57.1%), followed by Candida parapsilosis (14.3%), Candida glabrata (11.9%), and Candida krusei (9.5%). Mixed colonization with two yeast species was observed in 7.1% (n=3) of the cases. Of the 21 healthy controls, the culture of the vaginal swabs yielded yeast colonies identified to be Candida albicans in 5 individuals (23.8%). Since only one third of the suspected patients were diagnosed as vaginal candidiasis through laboratory tests and also due to the lack of specificity of the symptoms, performing laboratory tests for definite diagnosis of this infection is recommended.

Leishmaniasis is a parasitic infectious disease with a wide spectrum in tropical and subtropical areas. Antimoniates are compounds of choice to treat cutaneous leishmaniasis in Iran and many other countries of the world. There are many fluctuations in response to leishmanicidal agents according to type of the disease, involved species of the parasite, and drug regimen.

This study was conducted in the Skin Disease and Leishmaniasis Research Center, Isfahan, Iran. Novy-MacNeal-Nicolle (NNN) and Roswell Park Memorial Institute (RPMI) 1640 media were used to isolate parasites from skin lesions of patients. Deoxyribonucleic acid (DNA) extraction of Leishmania isolates was performed and strain identification was determined using specific internal transcribed spacers-1 (ITS-1) primers. After amplification, the resulted products were analyzed using polymerase chain reaction- restriction fragment length polymorphism (PCR-RFLP). Patients were under traditional glucantime therapy and were followed up for 14 weeks to detect their treatment courses.

PCR-RELP showed that all etiologic agents of cutaneous leishmaniasis (CL) among referral patients in Isfahan were L. major. The mean duration of ulcer recovery of cases with CL was 58 days.

The mean recovery period of patients with zoonotic CL was noticeably shorter than cases with anthroponotic CL.