javad azimivaghar

Coronary artery disease (CAD) is one of the leading causes of death worldwide. Early identification of factors associated with this disease can play a significant role in its prevention and management. Platelet indices have proposed as potential markers in predicting and assessing CAD. This study aimed to investigate the relationship between these indices and CAD in patients visiting Imam Ali (AS) Hospital in Kermanshah. This cross-sectional study conducted on patients with coronary artery disease (CAD) visiting Imam Ali (AS) Hospital in Kermanshah. Patients categorized into the intervention group, while healthy individuals placed in the control group. Demographic information, clinical findings, laboratory results, and platelet indices collected using a checklist. Data were analyzed using SPSS version 26, with independent t-tests and one-way ANOVA used to compare the groups. The mean age of patients with CAD was 61.24±11.13 years, while the mean age of healthy individuals was 56.36 ± 18.86 years. The percentage of males in the patient group was 79.33%, and in the healthy group, it was 56%. The gender distribution between the two groups was statistically significant (P-value=0.001). The mean platelet distribution width (PDW) was significantly higher in healthy individuals compared to CAD patients (P=0.001), while no significant differences were found in mean platelet volume (MPV) and platelet large cell ratio (P-LCR) between the groups. Logistic regression analysis showed that with each one-unit increase in PDW, the likelihood of having CAD decreased (OR=0.30, P=0.001). The findings of this study suggest that the mean PDW in healthy individuals is significantly higher than in patients with CAD, to further assess this relationship, conducting prospective studies with larger sample sizes recommended

The Worldwide incidence and mortality rate of head and neck squamous cell carcinoma (HNSCC) are increasing. This study was conducted with the aim to analyse the survival rate and identifying factors that influence survival outcomes in HNSCC patients.  

We carried out a retrospective cohort study on patients with HNSCC presented to teaching hospitals for 5-year period. Clinical and Pathological characteristics of patients were collected. We assessed the overall survival rates and their relationship with treatment, demographic and pathological factors affecting patients’ survival.  

Seventy eight patients included in our study. The majority of participants were male (88.5%) and 9 (11.5%) were female, with median age of 62.85±14.97 years. The larynx was the most common primary tumor site. 28 patients (35.89%) passed away. The overall 2 -year and 5-year survival rates were 87.2% and 67.4%, respectively. The mortality rate was slightly increased in patients older than 60 years, female, smokers, invasive tumor stage, positive LMP and poorly differentiated tumours, though it was not significant. The lower risk of death in treated patients who revealed 3+ positive EGFR expression was meaningful (HR=0.56, P=0.015). The survival rate in p16-positive individuals was higher over time, although it was insignificant.  

This retrospective cohort study identified that anti-EGFR agent therapy of HNSCC patients was the most important factor affecting survival. The highest risk factors for death for the elderly were poor tumor differentiation, smoking, and vascular invasion. The results emphasized that timely diagnosis, targeted therapy and reduction of smoking would improve the survival rate and patient care. In the current article, we  spotlight future perspectives for benefit of anti-EGFR in the era of immunotherapy.

Breast cancer is one of the most common cancers and the fifth leading cause of cancer deaths in Iran. The present study aimed to investigate the absorbed dose received by the heart and its relationship with cardiac complications in radiotherapy of patients with left breast cancer using a three-dimensional conformal radiotherapy technique.

A total of 181 women with left breast cancer who received radiotherapy after surgery were included in the study. Dosimetric parameters were obtained using dose-volume histograms for the heart, whole lung, left lung, and clinical target volume. Electrocardiography tests were performed for all patients before and one year after the radiotherapy.

The mean doses of heart, left lung, whole lung, and clinical target volume were 6.3±3.1, 13.3±4.5, 6.9±3.7, and 47.3±6.4 Gray (Gy), respectively. A significant reduction in T-wave amplitude was observed in 57% of patients three months after radiotherapy. T-wave amplitude decreased from 3.03±0.92 mm to 1.56±0.83 mm. The reduction in the T-wave amplitude displayed a significant relationship with the mean dose of the heart (β = 2.653; P= 0.019).

In women with left-sided breast cancer, cardiac complications are frequent, for which electrocardiographic tests can be used for cardiac evaluation after radiotherapy. Based on the obtained results, the most frequent side effect caused by radiotherapy in these patients was an abnormality in T-wave

Obesity is strongly associated with increased cardiovascular diseases (CVD) and cardiovascular risk factors, such as diabetes mellitus, hypertension, and dyslipidemia. However, numerous studies have suggested the existence of an “obesity paradox” in which overweight and mildly obese patients often exhibit a better outcome than their leaner counterparts. Therefore, this study aimed to characterize the association between BMI and in-hospital and one-year outcomes. This hospital-based research was conducted as a part of the Kermanshah STEMI Registry. Following the application of inclusion criteria, a total of 2,397 STEMI patients were evaluated. The data were collected using a standardized case report developed by the European Observational Registry Program (EORP). Body mass index (BMI) (kg/m2) was classified into underweight (<18.5), normal weight (18.5–24.9), overweight (25–29.9), class I/mild obese (30–34.9), and class II/extreme obese (≥35) categories. The independent predictors of the in-hospital and one-year outcomes were assessed using multivariable logistic regression models.  Out of the 2397 patients, 43 (1.79%) were underweight, 934 (38.97%) were normal, 1038 (43.30%) were overweight, 322 (13.43%) were class I obese, and 60 (2.50%) were class II obese. The results of the crude analysis showed that class I obesity was protective against CV death (OR 0.50; 95% CI 0.30-0.84), MACE3 (MI, stroke, and death) (OR 0.47; 95% CI 0.29-0.76), and MACE5 (MACE3 plus unstable angina and heart failure) (OR 0.59; 95% CI 0.44-0.79).  Multivariate adjustment eliminated the protective effect of class I obesity against death and MACE events. Therefore, it is possible that this protective effect does not exist and instead reflects the impact of confounding variables such as age.

Acute Myocardial Infarction (AMI) is the leading cause of global mortality. Moreover, Left Ventricular Ejection Fraction (LVEF) is the most important predictor of post-AMI mortality. Thus, the present study aimed to investigate the relationship between smoking cessation and LVEF following one year from the STEMI.

CASE REPORT: 

The present study was a part of the Kermanshah STEMI Registry and included 825 smokers admitted to Imam Ali Hospital, Kermanshah, Iran, with AMI during a 2-year study period. Data collection was performed using the standardized case report form by the European Observational Registry Program (EORP). Moreover, multiple logistic regression was used to compare LVEF between the patients who had quit smoking post-AMI and those who were still smokers after one year. Also, one-to-one Propensity Score Matching (PSM) was used to reduce the assessment error and selection bias, increase the result accuracy, and minimize the effects of confounders on the LVEF-smoking relationship.

Following one year after AMI, 219 (26.55%) patients had quit smoking, while 606 (73.45%) still smoked. Using the PSM, a total of 168 ex-smokers were matched to 168 current smokers. Moreover, it was shown that LVEF was higher in current smokers compared to ex-smokers. However, the difference was not significant. Also, multiple logistic regression showed that the Odds Ratio (OR) of LVEF reduction was insignificantly higher in ex-smokers (OR=1.13; 95% CI: 0.98-1.29) compared to current smokers. Multivariate regression analysis found similar results even after the application of PSM (OR 1.02; 95% CI: 0.82-1.22).

Given the low rate of smoking cessation after MI, physicians are recommended to ask about the smoking status of MI patients at each office visit or re-admission and strongly recommend quitting smoking.

The cost of hospital services has increased sharply, so we must pay attention to the proper management of costs in hospitals and the need to make optimal use of available facilities and resources by using economic analysis. This study aimed to investigate the types of efficiency of hospitals in Sabzevar University of Medical Sciences before and after establishing the Health System Reform.

This descriptive-analytical study was conducted to measure hospitals' technical, scale, and managerial efficiency under the auspices of Sabzevar University of Medical Sciences using the comprehensive data analysis model and Pabon Lasso model in 2014 and 2018.

Hospitals' average technical efficiency and scale had increased from 0.945 in 2014 to 0.924 in 2018. Also, the average change in total productivity was equal to 0.978, which indicates an improvement in the productivity situation during the study period.

One of the reasons for the increase in the number of hospitals with technical efficiency and scale 1 is the start of Heshmatieh Hospital and the optimal use of resources by the above hospital. In this study, the Malmquist index and Pabon Lasso model show that hospitals' performance has improved after establishing the Health Reform Plan. Still, the values of various types of performance calculated through data envelopment analysis show a slight decrease in performance. Sabzevar hospitals are after the implementation of the Reform plan. Therefore, the correct distribution of resources effectively improves the hospital's function.

Our study aimed to compare the 1-year therapeutic outcome between coronary artery bypass graft surgery (CABG) and percutaneous coronary intervention (PCI) in patients with multivessel coronary artery disease (CAD).  This retrospective cohort study was conducted on 150 patients with multivessel CAD who underwent CABG or PCI in Imam Ali Cardiovascular Center, Kermanshah, Iran, between March 2017 and March 2019. Data were collected using a checklist developed based on the study objectives. Differences between subgroups were assessed by using the independent t test and the χ2 test (or the Fisher exact test). A multivariate binary logistic regression model was used to determine factors associated with referral to CABG or PCI.  The mean age was 63.48 (SD=9.73) years in the PCI group and 60.54 (SD=10.85) years in the CABG group (P=0.741). The CABG group was more likely to have left main disease (16.6% vs 0%; P<0.001). The PCI group was more likely to take an antiplatelet (viz, clopidogrel) and nitrates, whereas the CABG group was more likely to take antihypertensives (angiotensin receptor blockers) and anticoagulants (viz, rivaroxaban and warfarin) (P<0.05). The CABG had significantly higher rates of major bleeding (P=0.003) and arrhythmia (P=0.045) than the PCI group. There was a significant difference in the mortality between the 2 treatment groups (9.3% of the CABG group vs 1.3% of the PCI group; P=0.029). Left main disease was associated with an increased odds of referral to CABG (OR=0.02; P=0.015).  PCI was associated with a lower adverse clinical outcome than CABG in patients with multivessel CAD. (Iranian Heart Journal 2022; 23(1): 25-33)

Circadian variation is known as an important factor in acute myocardial infarction (AMI). Moreover, the circadian pattern may help in disease prevention and better medication prescription. Therefore, the aim of our study was to investigate the circadian pattern of symptom onset in patients with ST-segment elevation myocardial infarction (STEMI).

This cross-sectional study was conducted on 777 patients admitted to the Imam Ali Cardiovascular Center, Kermanshah, Iran, with a diagnosis of STEMI from March 2018 to February 2019. Data were collected using a checklist developed based on the study's objectives. Differences between subgroups were assessed using one-way analysis of variance (ANOVA) with post-hoc testing and chi-square test (or Fisher’s exact test).

Out of the 777 patients, 616 (79.3%) were men. The mean and standard deviation (SD) of age of the patients was 60.93 ± 12.86 years. 380 patients (48.9%) were current smoker, 40.3% were hypertensive, 21.1% had hypercholesterolemia, 18.3% had diabetes mellitus (DM), 25.2% had history of angina, and about 15.0% had history of myocardial infarction (MI). The occurrence of STEMI was most common during hours between 06:01-12:00 (27.7%), followed by 12:01-18:00 (27.3%), 00:00-06:00 (24.3%), and 18:01-24:00 (20.7%), respectively. Gender was significantly associated with circadian pattern of STEMI. Women showed a double peak of symptom onset in 06:01-12:00 and 12:01-18:00.

The present study of Iranian patients displayed circadian pattern of STEMI with 2 peaks in the morning and afternoon, and the both peaks were dominated by women.

Coronary artery disease (CAD) is a costly problem and its presentations and risk factors may differ by sex. 

This study aimed to evaluate the risk factors profile and angiographic pattern of the patients undergoing coronary angiography, according to their gender.

This cross-sectional study was conducted on 741 patients who were referred for coronary angiography from March to August 2018 at Imam Ali cardiovascular center, western Iran. Using a checklist, we collected the demographic, clinical, biochemical, and lab parameters and angiographic findings in these patients. Also, differences between groups were compared using Chi-square and independent t-tests. 

Women were different from men in terms of the prevalence of hypertension (71.7% vs. 45.3%), diabetes mellitus (34.9% vs. 17.8%), and hypercholesterolemia (26.4% vs. 17.1%). Whereas, men were more likely to be smoker (28.7% vs. 0%) and obese (42.09±16.68 vs. 29.12±4.72). Total Cholesterol and Triglycerides were higher in women compared to men, which were statistically significant. Glucose plasma was significantly higher in women compared to men (p=0.01).  Both atherogenic (low-density lipoprotein (LDL)) and protective (high-density lipoprotein (HDL)) cholesterol were higher in women than men. Women were more likely to take antiplatelet (i.e. Aspirin) and antihypertensive therapies (i.e. beta-Blocker, angiotensin receptor blockers (ARBs), and angiotensin converting enzyme (ACE) inhibitors) than men. Also, it was shown that, Men were more likely to have two-vessel disease (p=0.041) and three-vessel disease (P=0.013) compared to women. Disease in the right coronary artery (RCA) (28.9% vs. 14.4%), circumflex (LCx) (26.0% vs. 15.3%), and left anterior descending (LAD) (37.8% vs. 26.4%) was more plausible to occur in men compared to women (p≤0.05). 

Access and use of health care programs are needed to control CAD risk factors. The findings of the current study showed the significance of gender in the extent of coronary artery blockages.

Treatment of myocardial infarction (MI) has been successfully developed, especially after introducing primary percutaneous coronary intervention (PPCI) as it nowadays is the recommended treatment for ST-segment elevation myocardial infarction (STEMI). 

This study aimed to evaluate the in-hospital mortality of STEMI patients treated with PPCI according to gender and other likely risk factors. 

This cross-sectional study presents a part of the results of a single-center registry in Imam Ali cardiovascular center affiliated to Kermanshah University of medical science (KUMS). From June 2016 to December 2017, 731 consecutive patients undergoing PPCI registered. Data were collected using a case report form developed by European Observational Registry Program (EORP). The relationship between in-hospital mortality and predicting variables was assessed using the Chi-square test, t-test, and univariate and multivariate logistic regression models (Forward LR). 

Totally, 155 patients (approximately 21%) were female. The mean age of women and men was 65.2 and 57.5, respectively (p=0.001). There were differences between women and men in hypertension (58.1% vs. 30.4%, respectively, p=0.001), diabetes mellitus (26.5% vs. 14.9%; p=0.001), hypercholesterolemia (37.4% vs. 18.6%; p=0.001), and history of prior congestive heart failure (5.2% vs. 2.0%; p=0.016). Although more men were current smokers (58.7% (men) vs. 15.5% (women); p=0.001). Women had a significantly greater incidence of multi-vessel disease, thrombolysis in myocardial infarction (TIMI) flow grade of 0/1 before PPCI, and longer symptom-to-balloon time. In-hospital mortality was higher in women than in men (5.2% vs. 1.9%; p=0.024). Multivariate analysis identified age ≥ 60 years, Killip class≥ II, and post-procedural TIMI flow grade < 3, but not female sex, as independent predictors of in-hospital mortality. 

In-hospital mortality after PPCI in women was higher than men, though this difference was likely due to the severe clinical profile in women. Also, female gender was not identified as an independent predictor of death.

Primary Mucinous eccrine carcinoma (PMEC) is a quite rare malignant tumor that typically involves the head and neck region in approximately 75% of patients and the periorbital area is the most common area.

 A 57-year-old man was seen with a  painless red mass involving the left lower eyelid for the past 7 months. Examination revealed a small mass measuring 0.6 cm with shiny red smooth appearance of the skin. H&E stained examination revealed a tumor mass was composed of polygonal cells in nests, lobules and islands separated by  large amount of mucin. The neoplastic cells showed eosinophilic cytoplasm and round nuclei with mild pleomorphism. There was no necrosis, no atypical mitosis, no lymphovascular and perineural invasion. Rare mitotic figures were found. Tumoral nests present on all surgical margins.

 Primary MEC is a slow-growing neoplasm that may recur after incomplete surgical excision.This tumor is often clinically mistaken for other cutaneous tumors due to its variable appearance.Recurrent tumor tends to be locally invasive with a rare metastatic rate of 9.6%.  As a result of the recurrence risk, patients should  be followed up regularly. Thus, our patient was recommended regular follow-up every six months.

In patients with uncomplicated primary hypertension (HTN), angiotensin converting enzyme inhibitors (ACEIs) are considered as monotherapy. In some studies, cough was not related to age, sex, underlying disease, or drug dosage. However, in previous studies, the incidence of cough was greater in females than males. The aim of this study is to determine the incidence of captopril-induced cough in patients with HTN and to evaluate some associated parameters such as sex and age. In this cross-sectional epidemiologic study, 877 patients with new onset HTN, referring to our outpatient clinic, were assessed and underwent treatment by captopril as first-line medical treatment. All patients were enrolled in four different age groups (<35, 36-45, 46-55 and >55 years old) and comparison was made between the groups. The overall incidence of captopril-induced cough was 15.5%, with a significant difference between females and males and obviously a higher rate in females (P=0.017). In addition, cough was significantly more common in females than males in 36- to 45-year-old group (46.42% vs. 24.71%). The incidence of cough after treatment with captopril decreased by increasing age of patients and this reduction in both male and female patients was statistically significant (P<0.001). A persistent, dry cough in a hypertensive patient, treated by captopril, should be considered as an adverse effect of ACE inhibitor therapy. Our study demonstrated the higher incidence of cough in female patients, receiving captopril. Thus, identification of this adverse effect may prevent unnecessary treatment of patients using captopril.