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Background: Implantable Cardioverter Defibrillator (ICD) is an acceptable treatment method in patients suffering from life-threatening ventricular dysrhythmias. In spite of many advantages, ICD can lead to many challenges in living for these patients. Therefore, understanding these experiences can lead to improvement of holistic care and treatment of these patients. Objectives: This study aimed to identify and describe the patients' experiences of living with ICD. Materials and Methods: This qualitative study was conducted using interpretative phenomenological approach. The participants who were selected through purposive sampling included 4 women and 6 men (mean age: 43.1 ± 1.6 years). The data were gathered through semi-structured interviews and field notes from November 2013 to December 2014. The data were also analyzed simultaneously using Van Manen's proposed stages. Results: Analysis of the data resulted in emergence of 4 themes and 11 subthemes representing the dimensions of the patients' lived experiences with ICD. These themes included "compromised self-identity", "crossing the border of the unknown", "fluctuation in the adjustment path", and "surrounded by changes". Compromised self-identity was manifested through "loss of prestige", "changes in body image", and "being hurt by the battery label". "Unpredictable situation", "rise and fall", and "internal turmoil" were the main axes of crossing the border of the unknown. In addition, fluctuation in the adjustment path included "wandering to cope with ICD" and "institutionalization of ICD in life". Considering the patients' descriptions of surrounded by changes, "family changes", "social role changes", and "change in manifestation of routines" were of great importance. Conclusions: This study allowed in-depth identification of aspects of living with ICD. The results also promoted the ability of nurses to understand and interpret the views of patients about living with ICD. In this way, the quality of patient care becomes more favorable, resulting in improvement of the patients' satisfaction. It can also provide a basis to conduct further researches on different aspects of prevention, care, treatment, and rehabilitation of these patients, leading to strengthening of the nursing research body. [ABSTRACT FROM AUTHOR]

Background: This study aimed to investigate the interaction between gender and other socio-economic characteristics on sleep quality of the patients with Coronary Artery Disease (CAD). Methods: This cross sectional study was conducted on 717 patients with CAD. The socio-economic status (education level, income, marital status, and place of residence) was considered as the independent variable. Besides, the study outcome was the quality of sleep which was measured using Pittsburgh Sleep Quality Index (PSQI). Gender was considered as a possible effect modifier. Two-way ANOVA was used to evaluate the interaction between gender and socio-economic factors on sleep quality. As defined by Baron and Kenny, moderator was defined as a variable that affected the direction or magnitude of the association of interest. Results: Female gender, low education level, and low income were predictive of poor sleep quality. Among female (10.0 ± 4.3 vs. 7.6 ± 5.0, P < 0.05), but not male patients (6.7 ± 4.2 vs. 7.0 ± 4.2, P > 0.05), low education was associated with poor sleep quality. Also, among female (10.0 ± 4.3 vs. 5.7 ± 2.5, P < 0.05), but not male patients (7.0 ± 4.2 vs. 6.0 ± 3.8, P > 0.05), low income was predictive of poor sleep quality. Gender did not modify the effect of other socio-economic factors on sleep quality. Conclusions: Among female but not male patients with CAD, low education and income were associated with poor sleep quality. This information helps us better understand the mechanisms behind the poor sleep quality of the female patients with CAD. This is important because poor sleep is a prognostic factor among the CAD patients. [ABSTRACT FROM AUTHOR]

Background: This study was performed to determine the changes in corrected QT (QTc) and QT dispersion and their relationship with end-stage liver disease score in the children undergoing orthotopic liver transplantation. Methods: This case-control study was performed in a 2-year period from February 2009 to March 2011 in Department of Organ Transplantation of Nemazee Hospital. We consecutively included all the 22 pediatric patients undergoing orthotopic liver transplantation and 22 healthy age- and sex-matched controls. Electrocardiogram (ECG) was performed for all the patients and controls before and 6 months after the transplantation and the QTc was calculated according to Bazett's formula in lead I, aVF, and V1. Besides, QT dispersion was calculated by the difference between maximum and minimum QTc in the three leads. The data were statistically analyzed using independent sample t-test, chi-square test, paired t-test, and Pearson correlation analysis. In addition, P value < 0.05 was considered as statistically significant. Results: The patients with end-stage liver disease had significantly longer QTc dispersion (P = 0.002) compared to the controls. The post-transplantation QTc dispersion (P = 0.003) was also significantly longer compared to the healthy controls. Moreover, pretransplant QTc dispersion was negatively correlated with weight (r = -0.589, P = 0.004) and Child-Pugh score (r = -0.549, P = 0.008). Conclusions: The patients with ESLD awaiting liver transplantation suffer from prolonged QTc interval predisposing them to ventricular tachycardia. The QTc prolongation in these patients does not response to liver transplantation. This study revealed a fine negative correlation between the Child-Pugh score and QTc. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the study was: Is primary Arterio-venous fistula the vascular access of choice for adequate dialysis and better patient outcome in end stage renal disease. Materials and Methods: "The present study was done in the department of cardiovascular and thoracic surgery at Sber-i-Kashmir institute of medical sciences, Soura, Srinagar Kashmir. Native Arterio-Venous (AV) fistulas were made in the patients with end stage renal disease for performing hemodialysis. They were followed for patency and adequacy of blood flow during hemodialysis. All the patients were operated under local anesthesia. Results: The results showed that 77% of the AV fistulas based on radial artery with side-to-side anastomosis and 80% of those with end-to-side anastomosis were functionally patent after one year. After two years, the patency rate in side-to-side and end-to-side anastomosis was 50% and 55%, respectively. In addition, the patency rate was 90% in brachial artery based AV fistula with end-to-side anastomosis, whether done primarily or secondarily, at the end of one year. However, a rapid decline was observed in the patency rate during the third year in both radial artery based and brachial artery based AV fistulas. Conclusions: We concluded that Arterialised arm superficial veins after primary AV fistula was the optimal and rational vascular access for hemodialysis providing adequate blood flow during this process. Besides, failure of primary AV fistula should be replaced by secondary AV fistula preferably based on brachial artery. [ABSTRACT FROM AUTHOR]

Background: Traditional cardiovascular risk factors are strong predictors of an increased likelihood for premature CHD. Considering the benefits of risk factors" management, it is imperative to find and treat them before looking for more unknown and weak risk factors. Objectives: Limited information is available about the demographic and historical characteristics of the patients with premature Coronary Heart Disease (CHD) in IR Iran. The main objective of this study was to determine the prevalence of the traditional risk factors in these patients. Also, the researchers hypothesized that there are insufficient risk assessment and preventive intervention methods for the asymptomatic adult population. Methods: This study was conducted on 125 patients with premature CHD (age<50 years) who were admitted in two academic hospitals with acute coronary syndromes. The patients were accepted since they had a definite CHD on the basis of acute myocardial infarction (elevated cardiac enzymes) or documented CAD in coronary angiography. Results: The mean age of the study population was 42.50+5.65 (26 to 49 years). Among the patients,92 (73.6%) were male, 113 (90.4%) were married, 58 (46.4%) were smokers,19 (15.2%) were opium users, 97 (77.6%) had dyslipidemia, 44 (35.2%) had hypertension, and 33 (26.4%) had diabetes mellitus. In addition, family history was presented in 54 patients (43.2%). Among the study population, 120 patients (96%) had at least one of the traditional risk factors, including dyslipidemia, hypertension, diabetes mellitus, cigarette smoking, and family history of CHD. However, none of the dyslipidemic patients had controlled total cholesterol, LDL, HDL, and triglyceride. Also, none of the diabetic patients had hemoglobin A1C<7%. Among the 44 hypertensive patients, blood pressure of 15 ones (34%) was within the normal range. Besides, only 3 patients (2.4%) had regular physical activity (at least 30 minutes, three times a week). Conclusions: Premature Coronary Heart Disease is a public health problem. However, there is lack of effective and intensive treatments of well-defined traditional risk factors and prevention methods for the majority of the patients experiencing premature CHD. In sum, there is still plenty of room for improvement of risk management in IR Iran. [ABSTRACT FROM AUTHOR]

Background: This study aimed to evaluate the renal tubular function in the patients with congenital heart disease using β²-microglobulin. Methods: In this case-control study, based on oxymetry, the patients with congenital heart disease were divided into two groups of cyanotic (n=20) and acyanotic (n=20). Congenital heart disease was diagnosed by echocardiography. Healthy individuals within the same age and sex groups were used as controls. Na+, β²-micro globulin, creatinine (Cr), and β²-microglobulin/Cr ratio were measured in random urine samples and the results were compared to the same parameters in the control group using Tukey, One-Way ANOVA, and X² tests. Results: Based on the study results, urine sodium in the patients with cyanotic heart disease was significantly different from that of the controls (P=0.023). The results also revealed a significant difference between the two groups with congenital heart disease regarding urine β²-microglobulin (P=0.045). In addition, the patients with cyanotic heart disease were significantly different from those with acyanotic heart disease and the controls regarding urine β²-micro globulin/Cr ratio (P=0.012 and P=0.026, respectively). Conclusions: The results of this study demonstrated that renal tubular dysfunction began in the patients with congenital heart disease, especially in those with cyanotic congenital heart disease. Besides, early diagnosis before cardiac surgery leads to better control of renal tubular disease. [ABSTRACT FROM AUTHOR]

Background: Diabetes mellitus is a life threatening disease accompanied by several micro- and macro vascular complications. Several modalities are available for interventional revascularization of coronary artery lesions, but their efficacy in diabetic patients is studied only in few patients. Materials and Method: This study evaluated major in- hospital complications and clinical outcome after one year in 200 consecutive patients who underwent percutaneous Coronary Intervention from 2007 to 2009. Results: Our findings showed comparable single and 2 vessel stenting, regarding major adverse cardiovascular event in diabetic and nondiabetic patients. In connection with long term and in hospital outcome, no statistically significant difference was found between one and two vessel stenting when drug eluting stent was used in diabetic patients. Conclusion: The use of drug eluting stent in single or two vessel disease of diabetic patients is technically satisfactory and clinically safe and can substitute for coronary artery bypass grafting. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present investigation was to explore probable association of renal artery stenosis (RAS) with coronary artery disease (CAD) and the prevalence of renal artery stenosis (RAS) in patients with CAD. Patients and methods: This study comprised 165 consecutive patients with CAD, including 52.7% males and 47.2% females with respective mean ages of 60.3 ±8.9 and 59.5±10.1. The patients underwent simultaneous coronary and renal angiographies, and the lumen reduction of 50% or more was considered as significant stenosis. Indeed, stenosis of more than 70% of the arterial lumen was regarded as severe. Results: According to our findings, the prevalence of renal artery stenosis in our hypertensive and normotensive patients were 46.2% and 19.5% respectively (p=0.002). Renal artery angiography revealed that 64 (38.8%) of the patients had simultaneous renal artery stenosis. RAS is more common in females than males (p=0.031). Multivariate analysis revealed that among all examined factors, hypertension and serum creatinine were associated with RAS. There was no correlations found between gensini score and RAS (p=0.63). Conclusion: We found a relatively high prevalence of RAS including 46.2% in hypertensive and 19.5% in normotensive patients in our patients with CAD. [ABSTRACT FROM AUTHOR]

Background: The effect of opium on glycemic control in diabetics is a controversial issue, as some studies have shown glucose lowering effect of opium in diabetes while the results of other studies do not support this idea. The possible role of opioid peptides in the regulation of food intake has been previously investigated. However, there is no data available about relationship between opium using and dietary pattern. Objectives: The aim of the present study was to determine the daily intake of different nutrients in opium addict with diabetes diagnosed with coronary artery disease (CAD). Methods: This study comprised 232 consecutive diabetic patients with CAD, and candidates for isolated coronary artery bypass surgery in Tehran Heart Center. Of these, 26 patients were opium addicts. Nutritional assessment was obtained by a validated semi- quantitative food frequency questionnaire (FFQ). Results: In opium addicts compared to non-addicts, consumption of carbohydrates (360.0±120.9 versus 447.8±249.8 Gr/day, P=0.016) and vitamin A (1170.4±570.2 versus 1496.3±889.6 µg/d as Retinol Activity Equivalent (RAE), P=0.040) was lower than non-addicts and intake of other nutrients were similar across two group of patients. Conclusions: Opium addiction in diabetic patients may lead to decrease of vitamin A and carbohydrate intake. This study showed that carbohydrate intake in addicted diabetic patients is lower than their non-addict counterpart. Thus, the so called lowering effect of opium on blood sugar may be due to nutritional habit of addicted patients. [ABSTRACT FROM AUTHOR]

We reported a young male with knife assault to his chest. He was transferred to the hospital without manipulating the knife. He was completely conscious and had sinus tachycardia and regular breathing. Emergency thoracotomy was performed and the knife was removed. No organ was damaged. This case presentation showed that in this kind of trauma, it is mandatory not to manipulate the penetrating foreign body during the transfer to the hospital. [ABSTRACT FROM AUTHOR]

A letter is presented about a study on patients undergoing coronary artery bypass graft (CABG) which showed that opium use is a predictor of postoperative atrial fibrillation (AF) in these patients. AF occurs in about 20 to 30 percent of patients after CABG surgery in over 50 percent of patients after valve surgery. The need of anesthesiologists and cardiac surgeons to provide better measures when planning surgery in opium addict patients is cited.