hamid khederlou

Clopidogrel, a selective thienopyridine, is used for secondary prevention of major adverse cardiovascular events. Some studies have reported inflammatory arthritis as a rare adverse effect of Clopidogrel. A 47-year-old male underwent percutaneous coronary intervention and was subsequently prescribed a 600 mg loading dose of Clopidogrel, followed by a daily dose of 75 mg. After six days of taking Clopidogrel, the patient presented to the emergency department with right knee pain. The knee joint exhibited swelling, warmth, and tenderness, although there was no redness or crusting. After two and six days of hospitalization, despite receiving antibiotics and Indomethacin, he developed arthritis of the metacarpophalangeal and metatarsophalangeal joints, respectively. According to the laboratory investigation, cultures, synovial fluid analysis, and imaging, infectious, rheumatologic, and crystallopathy diseases were ruled out for the patient. Clopidogrel was discontinued, and the patient was switched to ticagrelor 90 mg twice daily. All symptoms and signs of joint inflammation had improved within five days of stopping the Clopidogrel. After one week and one and six months of follow-up, there has been no recurrence of symptoms.

Fractional flow reserve (FFR) is crucial to evaluating coronary artery stenosis in patients diagnosed with chronic coronary syndrome (CCS). By assessing the severity of stenosis, FFR assists in determining whether percutaneous coronary intervention (PCI) is necessary.

Conducted at Tehran Heart Center from 2013 through 2017, this cohort study involved 52,248 CCS patients who underwent coronary angiography. Among them, 598 symptomatic individuals, despite receiving comprehensive medical treatment, underwent FFR assessment. Subsequently, 225 patients with positive FFR (≤0.80) underwent PCI, while 373 patients received solely medical treatment. The patients were monitored for 3 years to evaluate primary and secondary endpoints.

After 3 years, the PCI group demonstrated a lower incidence of the primary composite endpoint, consisting of all-cause mortality, nonfatal myocardial infarction, repeat target vessel/lesion revascularization (TVR/TLR), and coronary artery bypass graft surgery, than the medical treatment group (HR, 0.85; 95% CI, 0.74 to 0.98; P=0.012). Additionally, urgent TVR/TLR significantly decreased in the PCI group (HR, 0.56; 95% CI, 0.42 to 0.74; P<0.001).

FFR-guided PCI demonstrated effectiveness in reducing long-term major adverse cardiac events, primarily by lowering the incidence of TVR/TLR. The results emphasize the significance of FFR-guided PCI in addressing stenosis rather than alleviating ischemia.

Obesity is considered a widespread concern internationally. Few studies have investigated the relationships between dairy consumption and hypertension and obesity. Therefore, this study examined the above concern in students.

This cross-sectional study was conducted on 292 male students (18–30 y) living in the dormitories of Tabriz University of Medical Sciences. Students were selected via the multistage stratified random sampling method. Demographic information, anthropometric measurements, blood pressure (BP) readings, and a semi-quantitative validated questionnaire assessing dairy consumption (including a 24-hour dietary record covering 2 typical days and a holiday) were collected. After all the questionnaires were reviewed, they were coded and analyzed with Nutritionist IV software.

The average age of the subjects was 22.36 years. The mean±SD values of body mass index (BMI), waist circumference, waist-to-hip ratio, and waist circumference-to-standing height ratio were 22.68±2.58 kg/m², 80.95±7.81 cm, 0.85±0.04, and 0.46±0.04 among the studied population, respectively. The mean±SD values of systolic and diastolic blood pressure were 111.84±10 mm Hg and 70.99±8 mm Hg, respectively. Milk consumption was associated with a low waist circumference (95% credible interval, 1.005 to 4.580; P=0.046). The odds of hypertension (defined as BP>120/90 mm Hg) were 2.686 times higher in the overweight and obese group than in the normal BMI group. The risk of hypertension was 1.045 times higher for individuals with abdominal obesity than for those who did not consume dairy products.

Milk consumption was associated with a low waist circumference. The correlations between systolic blood pressure and anthropometric factors were statistically significant. BMI, waist circumference, and waist-to-hip ratio were positively associated with systolic blood pressure.

 Acute aortic dissection type A is a life-threatening cardiovascular emergency necessitating rapid diagnosis and treatment. We sought a new prognostic tool with cardiac biomarkers and simple inflammatory factors.

 from 2003 to 2014, 50 patients with documented acute aortic dissection type A were entered to this study. These patients were followed up until December 2020; within median follow up of 93.6 months. The patients were evaluated on the association of the baseline characteristics, first laboratory investigation, echocardiographic findings, surgical approach, and long-term mortality.

 Total number of mortality during the follow up was 29 (58%) patients, which was significantly higher in medical group (89.4% vs 38.7%, P value=0.001). Multivariable analysis showed only an increase in hs-cTnT levels was suggested as a predictor of mortality (95% CI: 1.06–1.38; HR=1.21; P=0.005), so that for every 100 units increase, patients were 21% more likely to have mortality in long term. Also, performing surgical treatment for aortic dissection was determined as the independent predictor of surviving, so that death was 74.6% less than those who received medical treatment (95% CI: 0.13–0.58; HR=0.27; P=0.001).

 hs-cTnT is a potential predictor of mortality in patients with acute aortic dissection type A.

Ventricular arrhythmias (VAs), which result from acute myocardial infarction and revascularization, are preventable causes of sudden cardiac death. This study aimed to determine the incidence, types, and risk factors of VAs in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention (PCI).

This cross-sectional study was conducted at the cardiology department of a tertiary care cardiac center in Zanjan, Iran. All the patients were monitored during hospitalization, and the incidence of cardiac arrhythmias and the outcomes were recorded.

Among 315 patients, the mean age was 62.14±10.11 years, and 76.2% were male. Male gender was significantly associated with VA occurrence (P=0.038). Among the patients, 50.5% had VAs, of which 26.4% were sustained ventricular tachycardia (sustained VT) and ventricular fibrillation (VF). Sustained VT and VF, but not total arrhythmias, were more common in anterior infarctions. Most arrhythmias occurred during the first 12 hours, and frequent premature ventricular contractions (43.3%) and idioventricular rhythm (20.1%) were the most common. A history of PCI and coronary artery bypass grafting (CABG) was associated with substantially reduced arrhythmias (P=0.017 and P=0.013, respectively). However, cardiovascular risk factors exerted no statistically significant effects on the VA type.

Approximately half of our patients experienced reperfusion-induced VAs. Overall, gender and a history of PCI and CABG were significantly associated with VA occurrence. Therefore, males and patients without a positive history of PCI and CABG should receive antiarrhythmic drugs as a precaution.

Myocardial perfusion imaging (MPI) is a noninvasive method with acceptable sensitivity and specificity in diagnosing coronary artery disease (CAD) in moderate-risk patients, including those with CAD risk factors.

The present cross-sectional, prospective study was conducted on 4886 patients from April 2020 through March 2023 at Chamran and Tehran Heart Center hospitals. A questionnaire regarding anthropometric variables, demographic characteristics, CAD risk factors, and MPI findings was designed.

Totally, 2179 patients (44.6%) had abnormal MPI. Patients with abnormal MPI were significantly older than those with normal MPI. Older age (OR, 1.64; 95% CI, 1.2 to 1.72; P<0.001), diabetes mellitus (DM) (OR, 1.36; 95% CI, 1.1 to 1.48; P=0.012), hypertension (OR, 1.24; 95% CI, 1.04 to 1.37; P=0.032), and dyslipidemia (OR, 1.54; 95% CI, 1.25 to 1.8; P<0.001) were associated with abnormal MPI independently. Patients with more CAD risk factors were more likely to have abnormal MPI. Thus, in patients without or at most with 1 risk factor and those with 8 CAD risk factors, the likelihood of abnormal MPI was 3.7% and 76.2%, respectively. The frequency of left ventricular dilation and right ventricular prominence was significantly higher in patients with older age (P<0.001 and P=0.043, respectively), dyslipidemia (P<0.001 and P=0.007, respectively), DM (P<0.001 and P<0.001, respectively), and hypertension (P=0.048 and P=0.057, respectively).

Individuals with CAD risk factors, especially those with older age, DM, hypertension, or dyslipidemia, require meticulous attention during CAD evaluation, particularly via MPI.

Due to the increasing prevalence of COVID-19 and its effects on the sense of taste and smell, we analyzed Blood electrolyte levels and biomarkers in COVID-19 patients who have a sign of anosmia and ageusia in Zanjan, Iran, and its relationship with biochemical blood indicators.

The retrospective study included all hospitalized patients with confirmed COVID-19. We registered laboratory parameters. A questionnaire that validity and reliability have already been confirmed was used to assess anosmia and ageusia. Statistical analysis was evaluated using a bivariate Bayesian logistic regression in the binomial distribution.

A total of 450 COVID-19 patients completed the study (221 females). The mean age of the patients was 56.36±17.34 years. 31.8% and 24.9% of patients reported anosmia and ageusia. There was no significant relationship between anosmia and ageusia with age, gender, place of hospitalization, marriage status, duration of hospitalization, and CT scan (p<0.05). The Male’s platelet was 18.72 lower than the female’s (p=0.002). Male’s C-reactive protein was 4.96 units higher than female (p=0.002). In hospitalized persons for less than four days and people under 39 years of age, CRP levels were lower (P=0.001, P=0.019 respectively). The Levels of lactate dehydrogenase in patients with anosmia were 51.72 units less than in patients without anosmia (p=0.010).

These results suggest that anosmia and ageusia are prevalent symptoms in Iranian COVID-19 patients. More information on serum biomarkers would help us to establish a greater degree of accuracy on this matter.

The coronavirus disease 2019 (COVID-19) global pandemic is a life-threatening condition with high morbidity and mortality rate in Iran. Based on several studies, COVID-19 clinical outcomes are associated with co-morbidities, such as Cardiovascular Diseases (CVD). It appears that there is a relationship between the COVID-19 prognosis and the existence of CVD-related risk factors, for instance hypertension, obesity, diabetes, etc. 

A descriptive-analytical cross-sectional study was designed to investigate the relationship between CVD risk factors and COVID-19 with a total of 100 participants in Imam Khomeini hospital, Tehran, Iran. A checklist of anthropometric and prognostic information was filled for each patient and finally the data were analyzed. 

There was a statistically significant dependence between hospitalization in ICU, reservoir bag-mask, intubation, life-threatening complications, and the final outcome (p<0.01). However, there was no significant correlation between CVD risk factors and prognostic parameters like length of Intensive Care Unit (ICU) hospitalization, the requirement to reserve bag-mask oxygenation, etc. 

In this investigation, no significant association was observed between CVD-related risk factors and COVID-19 prognosis among Iranian adult COVID-19 cases.

Due to its non-specific symptoms, pulmonary arterial hypertension (PAH) is difficult to diagnose via non-invasive methods. Various diagnostic tests are required to evaluate PAH patients. The increased diameter of the main pulmonary artery in computed tomography (CT) imaging represents a high probability of PAH. Moreover, N-terminal pro B-type natriuretic peptide (NT-proBNP) and pro B-type natriuretic peptide (proBNP) can be considered as prognostic predictors in patients with PAH.

This study aimed to evaluate the correlation of CT-based main pulmonary artery diameter (MPAD) and the serum level of NT-proBNP (as a strong pro-inflammatory factor) with the severity of PAH in echocardiography among patients with PAH.

In this cross-sectional study, a total of 63 hospitalized patients with PAH due to chronic obstructive pulmonary disease were recruited from 2019 to 2020 after initial evaluations and collection of serum NT-proBNP measurements and echocardiographic findings. On the chest CT scans, the largest diameter of the pulmonary artery trunk was determined, and then, correlation of CT-based MPAD with both PAH severity on echocardiography and NT-proBNP level in patients with PAH were evaluated.

The results of the present study on 63 patients (70% male; mean age, 67.02 years) showed a significant positive correlation between the MPAD and NT-proBNP level (r = 0.444, P < 0.001). Moreover, a significant positive relationship was observed between the pulmonary artery pressure (PAP) and NT-proBNP (r = 0.353, P = 0.005) and also between MPAD and PAP (r = 0.306, P = 0.015). In PAH patients, the mean values of MPAD, PAP, and NT-proBNP were 32.58 mm, 47.9 mmHg, and 6563 pg/mL, respectively.

Considering the significant positive correlation between PAP, MPAD, and NT-proBNP level in subgroup comparisons based on MPAD and PAP, if the MPAD is abnormal on CT scan, additional echocardiographic assessments and serum NT-proBNP measurements can be helpful.

The most common tachyarrhythmias in fetal cases is supraventricular tachycardia (SVT); atrioventricular nodal re-entrant tachycardia (AVNRT) type. Premature delivery, neonatal complications, and mortality following fetal SVT are high, and therefore, require proper management. Hereby, we introduce an AVNRT that was diagnosed in the fetus and adenosine infusion, and propranolol tablets were initially administered, but arrhythmia was not controlled; eventually, the tachycardia was controlled with flecainide tablets. She was discharged with the prescription of propranolol and flecainide tablets. She is currently 18 months old and under follow-up.

Since mid-December of 2019, an outbreak of pneumonia has been spread from Wuhan City, Hubei province, China, as a viralpneumonia. After virus identification and isolation, the pathogen for this pneumonia was originally called 2019 novelcoronavirus (2019-nCoV). 2019-nCoV has been associated with progressive cytokine storm leading to a hyper-inflammatorystate that this state associated with respiratory failure. We hereby reported a known case of Rheumatoid arthritis, Hypertensionand Coronary artery bypass graft that confirmed 2019-nCoV and he was associated with progressive cytokine storm leading torespiratory failure. After corticosteroid administration, respiratory failure and extremely high levels of IL6 respondeddramatically to pulse-doses of Methylprednisolone. We concluded that pulse-doses of Corticosteroids can be effective incontrolling and relieving cytokine storms and related respiratory failure.

Fabry disease is an X-linked disorder due to deficiency of the lysosomal hydrolaseagalactosidase A and the resultant accumulation of glycosphingolipids throughout the body, such as in the heart. Cardiac manifestations in Fabry disease are due to glycosphingolipid deposition in the myocardium, valves, and conduction system. Fabry cardiomyopathy, characterized by progressive severe concentric left ventricular hypertrophy. We, as a result of this, have reported a case of Fabry disease with left ventricular hypertrophy. He was admitted with dyspnea and also dizziness, general weakness, and acroparesthesias. Physical examination showed Angiokeratoma on the skin. The electrocardiography revealed ST-segment depression in leads V3–V6, and changes related to left ventricular hypertrophy. Echocardiography showed concentric left ventricular hypertrophy.

Heart Failure is a pathophysiologic state in which the cardiac output is not able to supply the body with enough oxygen and nutrients. The prevalence of heart failure has increased dramatically over the last decades. Vitamin D levels in patients with chronic heart failure are lower than healthy controls, and vitamin D deficiency has a direct relationship with mortality.

This study aimed to evaluate the effect of vitamin D on the improvement of left ventricular ejection fraction in patients with systolic heart failure.

In this case-control clinical trial, 142 patients with chronic systolic heart failure were identified. Based on the inclusion and exclusion criteria, 114 patients were enrolled in the study and randomly divided into two groups. One group (n = 58) received 50,000 units of vitamin D capsules weekly for eight weeks, and the patients in the other group (n = 56) received a placebo. After excluding 15 patients from the placebo group and 17 patients from the intervention group during the study, according to the exclusion criteria, 41 patients were evaluated in both groups for ejection fraction changes after two months.

According to the results of this research, there were no statistically significant differences in the baseline parameters between the two studied groups. The intervention group consisted of 18 female and 23 male patients with a mean age of 61.68 ± 19.8 years. Moreover, the placebo group included 21 female and 20 male patients with a mean age of 62.12 ± 18.2 years. After a 2-month follow-up, the intervention group showed statistically significant changes in ejection fraction, end-diastolic volume, and heart failure class compared to the placebo group. Also, the serum level of albumin and vitamin D in the intervention group was significantly higher than the placebo group.

The results of this study show that vitamin D treatment can improve the ejection fraction and functional ability of patients with vitamin D deficiency. If more comprehensive studies support this hypothesis, vitamin D deficiency assessment and correction in patients with chronic heart failure may be recommended.

Myocardial infarction (MI) is the most frequent cause of ischemic heart death. MI is generally assumed to be due to arterial thrombosis superimposed on an atherosclerotic plaque in an epicardial coronary artery. Total occlusion of an epicardial coronary artery leads to ST elevation, while non-occlusive lesion leads to ST depression. We hereby have reported a case of ST-segment elevation myocardial infarction with normal coronary arteries angiography. A 35-year-old man presented with typical chest pain, nausea, vomiting and cold sweating. ECG obtained at admission and 30 minutes later revealed sinus tachycardia with ST-segment elevations (> 2 mm) in leads V2-V5. Cardiac biomarkers including creatine phosphokinase (CPK), creatine kinase muscle-brain (CK.MB) and troponin high sensitive were elevated. The standard treatment for MI including pain relief, aspirin, thrombolysis if indicated and beta blockade were begun for the patient. STEMI was confirmed and thus, angiography was performed. Coronary angiography revealed normal coronary arteries without any angiographic evidence of stenosis, coronary artery dissection, embolism, plaque rupture or vasospasm.

Coronary artery disease is the main cause of death in most societies, which is fatal symbol of acute myocardial infarction. Early diagnosis and treatment of this disease is the greatest impact on survival. But the diagnosis of acute myocardial infarction has always been a challenge, particularly in elderly patients due to atypical manifestation. Since a large proportion of deaths is due to unawareness of the symptoms and delay in diagnosis Therefore, this study have been done to determine the clinical manifestation of acute myocardial infarction in elderly and non-elderly patients. In this cross-sectional study of 65 elderly patients and 65 non-elderly patients were studied who had been hospitalized in the coronary care unit Ayatollah Mousavi Hospital of Zanjan after acute myocardial infarction. Checklist includes demographic, anthropometric and clinical symptoms were completed. The data were analyzed using the software SPSS23. In elderly patient, the frequency of atypical chest pain is 39.3% and absence of pain is 14.3%. This results for non-elderly patient is 15.6% and 6.3%, respectively (P-value=0.02). The frequency of atypical pain in elderly women is more than elderly men, significantly (P-value=0.057). The frequency of atypical pain in the diabetic elderly and non-elderly patients is more than non-diabetic patients. The prevalence of atypical pain or absence of chest pain is more in women than in men, the elderly compared to non-elderly and in patients with diabetes than in non-diabetic patients.

Sleep behaviors have a significant impact on a child's quality of life; thus, sleep disorders are a major concern for parents. These disorders show the highest prevalence amongst pre-school children which can lead to mood disorders and the disruption of cognitive and emotional abilities. These side effects can subsequently cause failure in school, family problems and psychiatric disorders. Primarily, a list of kindergartens located in Zanjan city were selected with the help of the State Welfare Organization of Iran. The cluster sampling method was used and 345 samples were randomly entered to the study. Parents were asked to respond to the researcher’s questions based on BEARS questionnaire. Finally, the data were analyzed using SPSS software. 304 out of 345 children participating in the study (88%) had sleep disorders. Fear of sleeping alone was the most reported sleep disorders (59.4%). Our study showed that the use of mass media reduced sleep-related problems (P=0.027). There was a significant relationship between maternal education and sleep disorders, and the lowest prevalence of sleep disorders was observed amongst children whose mothers held a bachelor's degree (P=0.008). The high prevalence of sleep disorders in this study suggests that such psychological problems require special attention on the part of pediatricians, pediatric psychiatrists and general health professionals with an orientation towards teamwork.

Coronary artery disease is one of the most common causes of mortality around the world. The association between vitamin D deficiency and the incidence of diseases, such as hypertension, diabetes, and metabolic syndrome, has been demonstrated previously. There have been studies concerning the relationship between vitamin D deficiency and cardiovascular diseases, which have shown different results. Therefore, this study aimed at determining the association between serum levels of vitamin D and acute coronary syndrome.
In this case-control study, serum levels of vitamin D were compared between 50 patients with acute coronary syndrome and 50 individuals without this syndrome. A checklist, including demographic data of patients, comorbidities, vitamin D levels, lipid profiles, Electrocardiogram (ECG) changes and echocardiography results, was completed during hospitalization.
Mean age in the case and control group was 63.26 ± 10.76 and 61.22 ± 10.71 years, respectively. The prevalence of diabetes and high blood pressure in the case group was 32% and 54% versus 10% and 8% in the control group, respectively. Overall, 70% and 18% of subjects were smokers in the control and case groups, respectively. Mean concentration of vitamin D in serum was 20.63 ± 13.90 ng/mL, which was significantly lower than the control group with a mean concentration of 29.54 ± 16.8 ng/mL (P-Value = 0.002). Finally, it was shown that for every one unit increase in vitamin D levels, the risk of acute coronary syndrome was reduced by 7% (P-Value = 0.005).
The results of this study showed that the serum levels of vitamin D were significantly lower in patients with acute coronary syndrome compared to those without this disease.

Knee joint as the largest synovial joint in the body, consists of the lateral collateral ligament, cruciate ligament, and medial and lateral meniscus. For proper management, identification of damage to any structures of the knee is necessary. In this study, snsitivity, specificity, and diagnostic accuracy of high resolution CT scan in meniscal lesions, were assessed.
In this test accuracy assessment study, 57 patients with a history of positive meniscus lesion, who referred to Ayatollah Mousavi Hospital of Zanjan city from 2015 to 2016, were investigated by magnetic resonance imaging, high resolution computed tomography, and arthroscopy. Magnetic resonance imaging and high resolution computed tomography data, were compared to knee arthroscopy as the diagnosis gold standard. Kappa (κ) correlation coefficient was used to calculate the consistency of the tests.
Out of the 57 patients presented with meniscal lesion, 52 patients (91.2%) were male and 5 patients (8.8%) were female. The highest incidence of meniscal lesions was in ages from 21 to 30 years. Among the causes of meniscal lesions, exercise with prevalence of 47.9%, was the most prevalent cause of injury. In comparison with arthroscopy, the sensitivity, specificity, and accuracy of high resolution computed tomography were determined to be 64.7%, 55%, and 60%, respectively, and for magnetic resonance imaging were 85.2%, 50%, and 77.5%, respectively.
According to the results of the present study, specificity, sensitivity, and accuracy of high resolution computed tomography in the diagnosis of meniscal lesions, was lower than the previous studies.

Lead is an element, which can cross the placenta and enter the fetus during pregnancy if present in the blood of the expectant mother. Therefore, in this study, the level of lead in maternal and umbilical cord blood of neonates was determined, and its relationship with weight at birth, gestational age, height, and head circumference was investigated.
In this cross sectional study, a total of 70 pregnant women and their newborns were selected at Mousavi Hospital of Zanjan, Iran, based on the inclusion criteria. The level of lead in the umbilical cord blood of newborns and mothers was evaluated, and its correlation with birth weight, gestational age, height, and head circumference was assessed.
The average level of lead in the maternal and cord blood was 11.01 μg/dL and 9.54 μg/dL, respectively, which indicates a significant difference (P In this study, the average lead level of pregnant women was 11.01 μg/dL in Zanjan, which is higher than the global standard (10 μg/dL). The birth weight of newborns, whose mothers had higher blood lead levels, was lower than that of other neonates. Therefore, more attention should be paid to the level of lead by the healthcare system in order to take effective measures and reduce lead pollution.

Behcet’s disease is a multisystemic, inflammatory and chronic disorder characterized by recurrent oral aphthous ulcers and genital ulcers, uveitis and other manifestations, including systemic organ involvement. Cardiac involvement in Behcet’s disease is rarely however, it plays an important role in prognosis and increases mortality. We hereby have reported a case of Behcet's disease with dilated cardiomyopathy. He was presented with constitutional symptoms and also oral and genital aphthous ulcers, pseudofolliculitis, tachycardia, arthritis, splenomegaly, ESR (erythrocyte sedimentation rate) and CRP (C-reactive protein) elevation and LV systolic dysfunction with LVEF=45% were found in evaluation. He was started on Azathioprine and Prednisolone.