pouya ebrahimi

Prehospital factors are critical contributors to delays in managing patients with ST elevation myocardial infarction (STEMI), potentially leading to increased mortality and morbidity. Identifying and addressing these obstacles could significantly reduce the mortality and morbidity of these patients and enhance healthcare performance.

This study aims to evaluate the prehospital factors associated with delays in primary percutaneous coronary intervention (PPCI) among patients with STEMI.

In this prospective study, 394 STEMI patients treated with PPCI were evaluated, with the interval between symptom onset and the start of the procedure being measured and recorded. Patients were categorized into two groups based on this interval: Appropriate and delayed (< 90 minutes vs. ≥ 90 minutes). The potential predictors of delay were identified and assessed.

In this study, 394 STEMI patients were evaluated and categorized into 192 patients with delayed PPCI and 202 patients with on-time PPCI. Multivariate analysis revealed that being female (OR: 1.59, 95% CI: 1.08 - 2.01, P-value: < 0.01), having no past medical history of cardiovascular disease (CVD) (OR: 1.49, 95% CI: 1.09 - 1.90, P-value: < 0.01), no family history of CVD (OR: 1.28, 95% CI: 1.04 - 1.53, P-value: 0.03), a lower education level than academic (OR: 1.44, 95% CI: 1.05 - 1.84, P-value: < 0.01), symptom onset between 18:00 and 06:00 (OR: 1.58, 95% CI: 1.10 - 2.06, P-value: 0.01), and transport by ambulance versus private vehicle (OR: 1.57, 95% CI: 1.07 - 2.08, P-value: < 0.01) were significantly associated with a higher risk of delayed PCI. Conversely, higher socioeconomic status (OR: 0.68, 95% CI: 0.51 - 0.86, P-value: 0.02) and having a caregiver at home (OR: 0.52, 95% CI: 0.32 - 0.72, P-value: < 0.01) were significantly associated with a lower risk of delayed PPCI.

Reducing factors that contribute to delays in PPCI can lead to improved public health outcomes and greater health opportunities for the population. Delays in STEMI patients were significantly associated with living in rural areas, lower education levels, and female gender. Conversely, using private vehicles for transport, having a caregiver present, and higher socioeconomic status may reduce the risk of delayed PPCI.

In recent years, alarming trends in non-communicable diseases (NCDs) have grown into some of the most important health concerns worldwide. The present research attempts to address the controversial approaches to the practical function of medical ethics while critically reviewing the main concepts of ethical considerations in NCD prevention literature. After refining the searched documents, we integrated related concepts and research, particularly emphasizing ethical considerations in NCD management. All four functional areas of NCD prevention (general health policymaking, social interventional, primary prevention, and secondary prevention) are affected by parallel associated factors of health determinants: environmental modification, lifestyle improvement and physiological characteristics, respectively. In addition to the practical aspects of implementing a response to NCDs, a variety of ethical considerations should be taken into account. For instance general policies, equity in care, interventional programs, and clinical/research data protection. A comprehensive, holistic approach considering all the involved parties can accommodate the wide spectrum of needs and continuum of management for NCDs.Creating an ethical procedure structure in public health systems can provide insight into managing the challenges posed by NCDs to health systems and assist in systematically confronting ethical problems in the management of NCDs.

Penetrating cardiac trauma is a fatal condition and can result in the injury of various parts of the heart. Ventricular Septal Defect (VSD) following these traumas occurs only in 1-5% of cases. The patients' conditions depend on location, size, and concomitant injuries. One of the uncommon coincidences with the VSD is Mitral Regurgitation (MR) due to injury to sub-valvular structures. In this study, we report a case of concomitant traumatic-induced VSD and MR in a 14-year-old boy following a stab wound to his chest. The patient was a teenage boy coming to the Rajaei Cardiology Hospital emergency room following a stab wound to the anterior and left part of his chest. Despite primary urgent surgery, his breathlessness had continued for three more months. Evaluations with Transthoracic Echocardiography (TTE) revealed VSD with concomitant MR, but there was no papillary muscle rupture. Cardiac Magnetic Resonance Imaging (MRI) and angiographic evaluation confirmed the provisional diagnosis. The Amplatzer VSD occluder repaired the VSD, and the patient was discharged following the resolution of his symptoms. Although the MR has been present in the follow-up echocardiography, the patient has been asymptomatic. Since the initial presenting symptoms and signs of VSD and MR might be subtle or delayed, imaging modalities such as TTE and Transesophageal Echocardiogram (TEE) are beneficial in determining the diagnosis and the optimal treatment.

 Cirrhosis is one of the most critical health problems with a great economic burden on the health system.

 This study evaluated cirrhosis predictors in patients with hepatitis C virus (HCV).

 A total of 608 patients with HCV were included in the present study within 2011 and 2017 and divided into two groups based on the presence and absence of cirrhosis. Demographic and laboratory data (e.g., blood group, aspartate transaminase (AST), alanine transaminase (ALT), prothrombin time (PT), platelet count, anti-HCV antibodies, and virus level count) were collected by referring to patients’ files and compared between the two groups. Predictive factors were determined using the regression model.

 In this study, 85 patients (13.9%) had liver cirrhosis. Univariate analysis showed that hepatic enzymes AST, ALT, platelet count, PT, partial thromboplastin time, international normalized ratio, and HCV ribonucleic acid levels in cirrhosis patients were significantly higher than in non-cirrhosis patients (P < 0.05). Adjusted logistic regression analysis showed age < 45 years (adjusted odds ratio (ORAdj): 1.11, P = 0.028), male gender (ORAdj: 2.08, P = 0.023), co-infection with hepatitis B virus (HBV) infection (ORAdj: 2.58, P = 0.001), and alcohol consumption (ORAdj: 1.87, P = 0.001) were predictive factors for cirrhosis in patients with HCV

 This study showed that in patients with hepatitis C, age > 45 years, male gender, alcohol consumption, and co-infection with HBV significantly increased the risk of liver cirrhosis.

The present study aimed to determine the effects of iron nanoparticles (Fe-NPS) on growth performance, survival rate, liver histopathology and some blood and immune parameters of stellate sturgeon (Acipenser stellatus) juvenile. A total of 144 fish (175-195 g) were fed diets containing graded levels of Fe-NPs (0, 25, 50 and 100 mg kg -1 diet) for 8 weeks. Based on results, no significant differences were observed in body weight increases, specific growth rate (SGR), feed conversion ratio (FCR), mean cell volume (MCV), mean cell hemoglobin (MCH), mean cell hemoglobin concentration (MCHC), eosinophils, monocytes, albumin, alanine aminotransferase (ALT), aspartate aminotransferase (AST) and lysozyme activity between treatments (P>0.05). Fish fed 50 mg Kg -1 Fe-NPs showed a significant difference in the red and white blood cells, neutrophils, total protein, respiratory burst activity, and total immunoglobulin level (P<0.05) with no negative effect on the fish liver. After 8 weeks, survival rates of 86.11%, 94.4%, and 97.22% were recorded in groups that received 25, 50 and 100 mg Kg -1 Fe-NPS, respectively. Survival rate in control group was 94.44%. These results indicated that Fe-NPS at level 50 mg Kg -1 improved the welfare and survival rate of stellate sturgeon juvenile and had no negative effect on the fish liver.

Diabetes mellitus is one of the common chronic diseases in societies that has been associated with many psychological disorders. In this study, we aimed to investigate the frequency of psychological disorders in middle-aged women with and without diabetes mellitus in Isfahan City, Iran, during the years 2015-2016.

In this cross-sectional study, 246 women with diabetes mellitus and 246 healthy women were randomly selected from patients referring to comprehensive urban and rural health centers. Psychological evaluation, mental illness, epilepsy, and suicidal thoughts were assessed based on Iranian Woman Health Form.

The frequency of psychological disorders such as anxiety, restlessness, frustration, sadness, and being motiveless for doing daily tasks, as well as overall frequency of psychological disorders, and the frequency of suicidal ideation, epilepsy, and history of mental illnesses was significantly higher in those with diabetes mellitus compared with healthy subjects (P < 0.001). Based on the multiple logistic regression model, patients with psychiatric disorders were 5.32 times more likely to develop diabetes than healthy controls [odds ratio (OR) = 5.32; 95% confidence interval (Cl) = 3.30-8.62).

There is a positive correlation between psychiatric disorders and diabetes mellitus; so people with psychological illnesses should be screened for diabetes.