مجله دانشکده پزشکی اصفهان
پیاپی 444 (هفته چهارم مهر 1396)

Rupture of an atherosclerotic plaque or endothelial erosion with superimposed thrombosis in coronary arteries are primary causes of acute coronary syndromes. This study aimed to evaluate the anatomic distribution of culprit lesions by coronary territories, also to find any association between long-term outcomes and culprit lesion location in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS).
Patients presented at the emergency room of a tertiary cardiac center with symptoms suggestive of ACS, possible candidates for elective coronary angiography (CAG), were enrolled and followed up every year for five years for major adverse cardiac events (MACEs).
Findings: The subjects had a mean age of 60.6 ± 11.3 years, whom 74.4% were men. CAG revealed that among 98 lesions in coronary arteries, the left anterior descending (LAD) artery was the most common accused artery with frequency of 46%. Five-year follow-up results showed that 32.2% of patients experienced MACE which developed more in the LAD (38%) and then the right coronary artery (RCA) territories (27.6%) with no significant differences between other territories.
Although we found no significant differences between MACEs scores in different groups of coronary territories, but cardiologists may be able to plan follow-ups by the primary lesion. According to our study, the most frequent MACE was repeated percutaneous coronary intervention (PCI), which showed the importance of intervention in early diagnose, follow-up and treatment. Further studies with higher sample sizes are needed to show the prognostic value of culprit lesion territory in patients with ACS.

Violence against women as domestic violence is a mental health problem in women, present in all countries. Overlooking this problem could entail irremediable harms to mother and child health.
This cross-sectional study was conducted on 385 married women from Karchagan-Lenjan, Iran, during 2015-2016. Needed information were gathered via using two questionnaires involving violence dimension and measurements on knowledge, attitude, and action of women toward domestic violence and their communication skills, as well.
Findings: Mean score (SD) of women’s knowledge toward domestic violence was 7.62 ± 2.90 and was higher than average. No significant difference was seen between mean extent of violence in couples with equal level of education and couples with different levels of education (P = 0.500). Total violence and its components had reverse significant association with total communication skills and verbal skills (P Using communication skills could lower couple contention or, at least, defer it to a better time. Obviously, verbal skill is the most important and effective way in establishing and management of relations. Our findings show that improving the communication skills in women could reduce the violence, especially physical violence, against them.

Electrolytes imbalance is one of the most prevalent complications among the patients hospitalized in intensive care unit (ICU) and for early detection of it, concentrations of blood gases are measured. But, phlebotomy is related to secondary complications such as infection in these patients. This study aimed to determine the relationship between the concentrations of blood gases and saliva gases in patients hospitalized in internal care units.
This was a cross-sectional study in internal care units of Alzahra hospital, Isfahan, Iran during 2015-2016. 120 patients admitted in internal care unit were selected and amounts of blood gases including pH, partial pressure of carbon dioxide (PCO2), bicarbonate (HCO3), and partial pressure of oxygen (PO2) were measured in blood and saliva and compared between the two samples.
Findings: There were statistically significant direct correlation between the amounts of pH, PCO2, HCO3, and PO2 in blood and saliva (Pearson correlation coefficient of 0.25, 0.74, 0.72, and 0.58, respectively) (P The direct correlation between the concentration of blood and saliva gases suggests that water-electrolyte imbalance probably can be predicted via measuring gases concentration in saliva. This can decrease interventional procedures and finally decrease secondary complications due to repeated phlebotomy in patients hospitalized in intensive care units. More studies are recommended.

Vascular diseases and cognitive impairment are prevalent in elder people. Association between cardiovascular diseases and cognitive dysfunction is reported in previous studies and there are limited studies followed patients with cardiovascular diseases for cognitive functions. This study aimed to evaluate patients with coronary artery diseases and over 65 years of age for cognitive function.
This was a prospective cohort study on patients undergoing coronary artery angiography in Sina and Chamran hospitals, Isfahan City, Iran, during 2015-2016. At first, Neuropsychiatry Unit Cognitive Assessment Tool (NUCog), Tower of London (TOL) test, Color Trail Test (CTT) and Mini-Mental Status Exam (MMSE) were done for all participants and after one year, these patients were again evaluated for cognitive function.
Findings: 85 patients with mean age of 65.78 ± 5.30 years were evaluated; of them, 85.9% were men. The mean score of NUCog test was not statistically different between the beginning and end of the study (P = 0.670). The mean scores of MMSE and TOL tests and also the mean time of TOL test were statistically different between the first and second evaluation (P = 0.030, P = 0.020, and P Generally, presence of cardiovascular disease especially coronary artery disease can deteriorate cognitive function in elder patients over times.

Sleep disorder is a usual complaint of general population. Sleep disorders can affect college students’ educational functioning, mood, cognition, and self-esteem negatively. Different studies have various opinions about the effects of exercise and physical activity on sleep quality. The aim of the current study was to assess sleep status in non-medical students.
This was an analytic cross-sectional study conducted on 250 non-medical students in Yazd University, Iran, during 2016-17. 25 students were chosen randomly of each of 10 different non-medical majors and filled the Iranian version of International Physical Activity Questionnaire (IPAQ) and Pittsburgh Sleep Quality Index (PSQI) questionnaire.
Findings: Participants had mean age of 19.95 ± 1.65 years. 129 cases (51.6%) were boys and 121 cases (48.4%) were girls. There was no significant association between sleep disorders and body activity in studied population (P = 0.250). Girls’ Body activity was significantly less than boys’ (P Results of current study show that the rate of sleep disorder does not have significant association with physical activity. In addition, the rate of sleep disorders is not significantly different between boys and girls. Rate of physical activity and sleep disorder severity were significantly different among various non-medical majors.

Cleft lip is one of the most common congenital anomalies in the world. There has been recently a considerable increase in use of local methods. In this regard, opioids are the common adjuvants but their safety and efficacy have not been studied extensively in children undergoing cleft lip repair. Therefore, we aimed to investigate the efficacy of local pethidine in comparison with intravenous pethidine in patients undergoing bilateral infraorbital nerve block.
In this prospective, randomized, double-blind study, 40 children undergoing cleft lip repair allocated randomly to two groups. Group 1 received infraorbital injection of Marcaine and pethidine; and group 2 received infraorbital injection of Marcaine and intravenous pethidine. Statistical analysis was performed using SPSS software.
Findings: The mean pain score was 5.15 ± 1.87 and 5.85 ± 2.10 in groups 1 and 2, respectively (P = 0.21). There was no significant difference in postoperative analgesic requirements between the groups (P > 0.05). There were no major complications in both groups.
There was no significant differences between addition of pethidine to Marcaine and intravenous injection of pethidine in terms of postoperative pain score, duration of hospitalization, and postoperative analgesic requirements. Although no major complications were found, intravenous injection of pethidine is not suggested for cleft lip repair in children.

One of the most common infections in patients with high mortality rate is ventilator-dependent pneumonia. This study aimed to determine the frequency of extended spectrum beta-lactamase (ESBL) in Klebsiella pneumonia isolated from patients with ventilator-associated pneumonia in Kermanshah City, Iran.
This study performed on tracheal tube samples of patients admitted to the intensive care units. After collecting specimens, 57 Klebsiella pneumonia isolates were confirmed via standard bacteriological and biochemical tests. After antibiotic susceptibility testing by using disk diffusion method, the presence of ESBL phenotype was determined via combined disk test. The frequency of ESBL genes was determined by using their specific primers and polymerase chain reaction (PCR) method.
Findings: From 57 isolates of Klebsiella pneumonia, 22 (38.6%) were positive for ESBL, phenotypically. The highest genotype frequency was shv gene (31.6%) determined via PCR test. The highest resistance was to ceftriaxone and co-trimoxazole (78.9%), and the lowest resistance was to colistin (3.5%).
Considering the high resistance of Klebsiella isolated from samples of patients with ventilator- associated pneumonia against third-generation cephalosporin and the prevalence of ESBL-producing strains among these patients, identification of isolates with ESBL and suitable antibiotic selection for the treatment of this patients seem to be necessary.