Prevalence and predictors of slow coronary flow phenomenon in Kermanshah province

Predictors and clinical outcomes of slow flow phenomenon in diabetic patients with chronic coronary syndrome

BACKGROUND

Coronary slow flow (CSF) is characterized by late distal coronary perfusion of coronary arteries at the time of angiography despite the vessels appearing normal. The importance of CSF is still debatable. Therefore, this study aimed to investigate CSF's predictors and clinical outcomes in diabetic patients with chronic coronary syndrome (CCS).

PATIENT AND METHODS

This retrospective study included 250 diabetic patients diagnosed with chronic stable angina and referred for coronary angiography (CAG), showing normal coronaries with CSF (Group I) and 240 diabetic patients with normal coronaries and normal flow (Group II). The patients in both groups were followed up for one year to evaluate clinical outcomes.

RESULTS

The incidence of major adverse cardiac events (MACE) was higher in Group I than in Group II, but the difference was not statistically significant except when the composite endpoints of STEMI, NSTEMI, and unstable angina were combined under the term ACS. The independent predictors of CSF, as detected by multivariate regression analysis, were body mass index (BMI) (OR = 0.694, 95% CI = 0.295-0.842, P = 0.010), blood glucose during catheterization (OR = 0.647, 95% CI = 0.298-0.874, P = 0.008), serum triglycerides (OR = 0.574, 95% CI = 0.289-0.746, P = 0.010), and the neutrophil/lymphocyte ratio (NLR) (OR = 0.618, 95% CI = 0.479-0.892, P = 0.001).

CONCLUSION

Serum triglyceride levels, BMI, NLR, and high blood glucose levels at the time of catheterization were independent predictors of CSF in diabetic patients. MACE levels were higher in diabetic patients with CSF.

Relationship between quantitative epicardial adipose tissue based on coronary computed tomography angiography and coronary slow flow

BACKGROUND

The purpose of this study was to explore the relationship between quantitative epicardial adipose tissue (EAT) based on coronary computed tomography angiography (CCTA) and coronary slow flow (CSF).

METHODS

A total of 85 patients with < 40% coronary stenosis on diagnostic coronary angiography were included in this retrospective study between January 2020 and December 2021. A semi-automatic method was developed for EAT quantification on CCTA images. According to the thrombolysis in myocardial infarction flow grade, the patients were divided into CSF group (n = 39) and normal coronary flow group (n = 46). Multivariate logistic regression was used to explore the relationship between EAT and CSF. Receiver operating characteristic (ROC) curve was plotted to evaluate the diagnostic value of EAT in CSF.

RESULTS

EAT volume in the CSF group was significantly higher than that of the normal coronary flow group (128.83± 21.59 mL vs. 101.87± 18.56 mL, P < 0.001). There was no significant difference in epicardial fat attenuation index between the two groups (P > 0.05). Multivariate logistic regression analysis showed that EAT volume was independently related to CSF [odds ratio (OR) = 4.82, 95% confidence interval (CI): 3.06-7.27, P < 0.001]. The area under ROC curve for EAT volume in identifying CSF was 0.86 (95% CI: 0.77-0.95). The optimal cutoff value of 118.46 mL yielded a sensitivity of 0.80 and a specificity of 0.94.

CONCLUSIONS

Increased EAT volume based on CCTA is strongly associated with CSF. This preliminary finding paves the way for future and larger studies aimed to definitively recognize the diagnostic value of EAT in CSF.

The expression levels of PPAR-α/γ and UCP1/2 on the slow coronary flow phenomenon; results from a case-control study

PURPOSE

The slow coronary flow (SCF) phenomenon is considered a coronary artery disorder. Because of the critical function of peroxisome proliferator-activated receptors (PPARs) in regulating the oxidative stress and inflammatory reactions in cardiovascular disease, The aim of the current study was to investigate the expression of the genes for uncoupling proteins 1 and 2 (UCP1 and UCP2), peroxisome proliferator-activated receptors and (PPAR- PPAR-), and PPAR- in SCF patients.

METHODS

In this case-control study, coronary angiography examination was used to analyze 35 individuals with SCF and 35 subjects with normal coronary flow (NCF). SCF was diagnosed using the TIMI (thrombolysis in myocardial infarction frame count) method. The SCF phenomenon is thought to be the TIMI > 27. In the peripheral blood mononuclear cells (PBMCs), the messenger ribonucleic acid (mRNA) expression levels of the PPAR-, PPAR-, UCP1, and UCP2 genes were evaluated.

RESULTS

UCP1 and UCP2 expression levels were significantly higher in the SCF group compared to the NCF group (P = 0.034 and P0.001, respectively). The PPAR- and PPAR- levels were found to be significantly lower in the SCF group compared to the NCF group (P = 0.015, P0.001, respectively). According to the results of the logistic regression analysis, high UCP1 and UCP2 levels and low PPAR- and PPAR- levels are each independent predictors of the SCF phenomenon.

CONCLUSION

This research provided evidence about the potential role of PPAR-α, PPAR-γ, UCP1, and UCP2 as biomarkers in SCF. More investigations are suggested to assess the functions of these factors in SCF patients mechanistically.

Lived sexual experience of health workers on the Iranian frontline of the fight against the COVID-19 pandemic: A qualitative content analysis

BACKGROUND

Lifestyle changes due to the COVID-19 pandemic may affect individuals' sexual lives and probably their sexual function. The present study aimed to explain the sexual lived experiences of health workers on the Iranian frontlines of the fight against the COVID-19 pandemic.

MATERIALS AND METHODS

The present study was qualitative research using the conventional qualitative content analysis method. It was conducted in the city of Ramsar, Iran, in 2022. The data were collected using 12 in-depth personal interviews and a purposive sampling method. Lundman and Granheim's method was used to analyse the data.

RESULTS

The analysis of the data in the first phase of the research led to 60 initial codes, 7 subcategories, 3 main categories (concerns about health risks, sexual dissatisfaction, and sexual facilitators and barriers), and one theme (unhealthy lifestyle due to sexual dissatisfaction).

CONCLUSION

The present study revealed new and different dimensions of the sexual experiences of health workers on the frontlines of the fight against the COVID-19 pandemic [concerns about health risks, sexual dissatisfaction, sexual facilitators, and sexual inhibitors]; these dimensions are based on the Iranian context and culture that can be considered to enhance sexual pleasure and the physical and mental health of health professionals that have an impact on improving patients' and people's health status in society.

Effect of short-term dynamic psychotherapy on sexual function and marital satisfaction in women with depression: Clinical trial study

Background and Aims

This study aimed to look at the influence of short-term dynamic psychotherapy on sexual function and marital satisfaction in women with depression.

Methods

Through a clinical trial study using a pretest-posttest design and a control group, this study enlisted the participation of 60 women diagnosed with depression. The patients were interviewed before being randomly assigned to experimental or control groups. Data were obtained through the Beck Depression Inventory, the Enrique Marital Satisfaction Questionnaire, and the Female Sexual Function Questionnaire. The experimental group received intense short-term dynamic psychotherapy intervention, while the control group was on a 2-month waiting list. The SPSS 24 program utilized an analysis of variance to analyze the data.

Results

The pre- and posttest study results revealed a significant difference in marital satisfaction, sexual function, and depression between the experimental and control groups (p < 0.01).

Conclusion

During the posttest phase, a short-term intensive dynamic psychotherapy intervention helped the experimental group feel better about their marriage and improve their sexual function. It also helped them feel less depressed.

Evaluation of clinical ethics in Iranian hospitals: Employing a 360° approach-A cross-sectional study

Background and Aims

Clinical ethics is defined as recognizing and resolving value conflicts that arise from providing care in medical centers. This study aimed to evaluate the practice of clinical ethics in Iranian hospitals with a 360° approach.

Methods

The study was conducted by employing a descriptive-analytical method in 2019. The statistical population included staff, patients, and managers of public, private, and insurance hospitals in Mazandaran province. The sample size for each group was 317, 729, and 36, respectively. The data collection tool was a researcher-made questionnaire. The appearance and content validity of the questionnaire were confirmed by expert opinion and construct validity was confirmed by confirmatory factor analysis. The reliability was confirmed by Cronbach's alpha coefficient. Data were analyzed by one-way analysis of variance and Tukey's post-hoc test. We used SPSS software version 21 to analyse the data.

Results

The obtained mean score of clinical ethics from the perspective of service providers (0.56 ± 4.45) was higher than the perspective of service presenters (4.35 ± 0.65) and service recipients (0.79 ± 4.22), which was statistically significant (p < 0.05). Among the eight dimensions of clinical ethics, respect for the patient's right (0.68 ± 4.09) illustrated the highest score and medical error management (0.63 ± 4.33) presented the lowest score.

Conclusion

Based on the findings of the study, the level of clinical ethics in the hospitals of Mazandaran province is favorable, and among the dimensions of clinical ethics, respect for patient rights gained the lowest score and communication with other colleagues gained the highest score. Therefore, informing and teaching medical professionals in the field of clinical ethics, formulating binding laws, and paying serious attention to this issue in ranking and accrediting hospitals are recommended.

Investigating the predictors of perceived social support to control COVID-19: A qualitative study

Background

Considering the adverse effects of COVID-19 pandemic, the present study aimed to explore the barriers and facilitators of perceived social support to prevent the further spread of the disease.

Methods

In the present qualitative study, a content analysis was done. To this aim, 37 Iranian subjects who had active accounts on Instagram were initially invited to participate in the study. The data were collected through face-to-face (n = 25) and telephone conversations (n = 12). A purposive sampling was used and the data collection continued until data saturation. Finally, 41 interviews were held which took 17-48 min.

Results

The data analysis led to the extraction of two main categories, the barriers and facilitators of perceived social support, as well as 12 subcategories. Economic issues, familial factors, socio-cultural factors, personal and psychological factors, ineffective quarantine rules, and poor management were the main barriers to perceived social support. The facilitators were divided into six categories, including familial influences, personal factors, government support, and improved occupational, social, spiritual, and emotional condition.

Conclusion

The findings showed that a combination of environmental and social variables might influence the COVID-19 disease, either decreasing or increasing its spread. A sound knowledge of these variables, influenced by the social context and real-life experiences during the pandemic, allows to take the right measures and enrich training programs. The prevalence of the disease can be controlled by increasing environmental and social facilitators and decreasing the influence of barriers.

Slow Coronary Blood Flow: Pathogenesis and Clinical Implications

Coronary slow flow (CSF) phenomenon, also known as cardiac syndrome Y, is defined as the delayed opacification of the coronary vasculature at the distal level. Different hypotheses and theories have been postulated about its substrate and mechanism, such as microvascular and endothelial dysfunction. Several studies have confirmed that CSF is a cause of ischaemia detected by non-invasive testing. Clinically, it can present as angina pectoris, acute coronary syndrome and sudden cardiac death. It has an incidence of 1–5% in patients undergoing coronary angiography and has been most frequently found in young men who are smokers with metabolic syndrome. There are no established treatments for CSF and further studies are still necessary.