Seyed Ali Hosseini

Background and Aims: Coronary artery disease (CAD) is often treated with percutaneous coronary intervention (PCI). Various stent types are used during PCI, potentially resulting in different outcomes. Here, we compared major adverse cardiovascular events (MACE) across different stents over a 5‐year follow‐up post‐PCI. Methods: This retrospective cohort study analyzed individuals receiving PCI from Iranian databases. Inclusion criteria encompassed drug‐eluting stent recipients, excluding emergency surgical cases. Demographics, medical history, angiography, PCI details, and follow‐up on MACE were collected and analyzed using Cox regression analyses. Results: Out of 4159 recruited patients, MACE were observed in 10.2% of individuals over 5 years. Factors significantly associated with MACE included a history of heart failure (HR: 2.58, 95% CI: 1.92–3.47), hypertension (HR: 1.87, 95% CI: 1.52–2.30), and lower baseline ejection fraction (HR: 0.975, 95% CI: 0.952–0.997). Procedural elements like the number of stents used (HR: 1.008, 95% CI: 1.005–1.012) and their total length (HR: 1.008, 95% CI: 1.005–1.012) were also significant predictors. No significant relationship was found between the types of drug‐eluting stents and MACE. Conclusion: In a 5‐year study of post‐PCI patients, MACE rates were higher in those with lower ejection fractions and those with more stented vessels and longer stents but similar across different drug‐eluting stents.

Background: The best method for accurately assessing the right ventricle (RV) after coronary artery bypass grafting (CABG) remains controversial. In this study, we aimed to investigate several echocardiographic RV function indices to determine which are most effective in evaluating RV function post-CABG. Objectives: Here, we aimed to assess RV functional parameters after CABG using echocardiography. Methods: This prospective before-after study was conducted on 60 patients scheduled for CABG. The patients were assessed before and six weeks after CABG using standard echocardiography and Speckle-Tracking Echocardiography (STE). The significance of changes in study parameters was evaluated using the paired t-test or the non-parametric Wilcoxon test. Two-sided P-values ≤ 0.05 were considered statistically significant. Statistical analysis was performed using SPSS software, version 16.0. Results: Six weeks after CABG, we found significant changes in two parameters: Tricuspid annular plane systolic excursion (TAPSE) and S’ tissue Doppler imaging (20.82 ± 2.53 vs. 14.60 ± 1.84, P = 0.01; 11.79 ± 1.99 vs. 8.80 ± 0.88, P = 0.01, respectively). However, no significant changes occurred in the right ventricular global 2D longitudinal strain or free wall longitudinal strain (-18.83 ± 2.88 vs. -18.79 ± 2.66, P = 0.88; -21.29 ± 3.36 vs. -20.86 ± 3.17, P = 0.12, respectively). Conclusions: Tricuspid annular plane systolic excursion and S’ tissue Doppler imaging indices change following CABG and cannot be considered standard echocardiographic parameters for assessing RV function after the procedure. However, the two major parameters for right ventricular functional assessment, global 2D longitudinal strain and free wall longitudinal strain, may be less affected by CABG and thus could be more reliable as standard parameters.

Introduction. Takotsubo cardiomyopathy (TCM) features transient left ventricular apical dysfunction or ballooning. The underlying mechanism remains elusive; however, evidence suggests the role of different physical and psychological stressors. We systematically reviewed patients presenting with TCM and autoimmunity to explore the link between the two conditions. Methods. We applied the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) to report this review. Using keywords related to autoimmune/immune-mediated diseases and TCM, we searched PubMed, Scopus, and WOS in March 2022. The final results were added to a data extraction sheet. Data were analyzed by SPSS version 26.0. Results. Our search yielded 121 studies, including 155 patients. Females were considerably predominant. Most patients had a history of autoimmune disease, and almost a third had a history of cardiovascular disease. Dyspnea and chest pain were the most common chief complaints. More than 70 of patients had experienced physical stress. Myasthenia gravis, systemic lupus erythematosus, and multiple sclerosis were the most frequently reported autoimmune diseases. Conclusion. There were similarities in age and sex compared to classic TCM. TCM should be considered as a differential diagnosis for ACS, especially in patients with a positive background of autoimmunity. A precise reporting system is required for further studies.

Background: The social stigma associated with a disease represents an important issue for health policymakers at the local, national, and international levels. This study aimed to survay and analyze the experience of stigma among patients with coronavirus disease 2019 (COVID-19) in Iran. Methods and Materials: This qualitative study was conducted from September to December 2020 in the Fars, Khorasan, and Yazd provinces of Iran. Sampling was done via the snowball method; based on data saturation criteria, 24 adults over 18 years of age who had experienced affliction with COVID-19 were recruited. Semi-structured telephone interviews were conducted with each patient. Data were analyzed following the conventional content analysis method described by Erlingsson and Brysiewicz. Results: The results showed that during their affliction with COVID-19, the participants experienced difficult, anxious times, with rejection and alienation from their first-degree relatives taking them by surprise. The three main themes extracted from this study were (i) fear and rejection, (ii) discrimination, and (iii) loneliness. These experiences have changed the attitudes of the participants toward life and themselves. Conclusion: Based on our results, it can be said that paying attention to social stigma among patients during pandemics is an important social necessity and health policy. It is recommended to have psychological counseling sessions for those afflicted and to provide education and training to the public regarding the proper treatment of patients with COVID-19. Quantitative studies in this field are highly recommended.

Background. The erector spinae plane (ESP) block is a novel approach to minimizing postoperative pain. We investigated the efficacy and side effects of the ultrasonography-guided bilateral ESP block in reducing pain in the first 24 hours after lumbar laminectomy. Materials and Methods. We conducted a single-blind (statistical analyst and those responsible for recording patient information postoperation were unaware of the study groups) randomized clinical trial on 50 patients aged 18 to 65 with American Society of Anesthesiology (ASA) class I or II physical status scheduled for lumbar laminectomy surgery at Shahid Chamran Hospital, Shiraz, Iran. Patients were randomly allocated to the ESP block (26 participants) or control (24 participants) group. A bilateral ESP block was administered to patients in the first group before general anesthesia, which was provided identically to both groups. The postoperative time to the first request of analgesia, pain score, total opioid use, side effects, and patient satisfaction were compared between the groups. Results. Compared with the control group, patients in the ESP block group had significantly more postoperative pain relief in the first hour and until 24 hours . The total opioid consumption was lower in the ESP block group . However, the ESP block led to a higher rate of urinary retention . Conclusion. The bilateral ESP block effectively reduces postoperative pain following lumbar laminectomy, minimizing the need for narcotics. Further research is needed to delineate ways to reduce urinary retention as its main complication. This trial is registered with IRCT20100127003213N6.

Background. Dual antiplatelet therapy with a P2Y12 inhibitor (e.g., clopidogrel and ticagrelor) and aspirin is recommended for at least one year after percutaneous coronary intervention (PCI) to prevent further myocardial infarction and stent thrombosis as the major adverse effects of PCI. Methods. This randomized clinical trial was conducted from October 2022 to March 2023. Patients who had undergone elective PCI were included in the study. Patients were randomized into two different groups. One group took ASA 80 mg and clopidogrel 75 mg once daily, while the other took ASA 80 mg once daily and ticagrelor 90 mg twice daily. After six months of close follow-up, patients were asked to score their dyspnea on a 10-point Likert scale. They were also asked about dyspnea on exertion, paroxysmal nocturnal dyspnea (PND), bleeding, and the occurrence of major adverse cardiovascular events (MACEs). Results. 223 patients were allocated to the clopidogrel group and 214 to the ticagrelor group. In the ticagrelor group, 95 patients (44.3%) reported dyspnea at rest, compared with only 44 patients (19.7%) in the clopidogrel group ( < 0.001). MACEs occurred in 7 patients (2.8%) in the ticagrelor group, compared with 16 (7.6%) in the clopidogrel group ( = 0.031). Eight patients (3.8%) reported bleeding with ticagrelor, as did seven (3.2%) with clopidogrel ( = 0.799). Conclusions. New-onset dyspnea was recorded more frequently with ticagrelor than clopidogrel, yet fewer MACEs occurred with ticagrelor (ClinicalTrials.gov number: NCT05858918).

Introduction: Palmar hyperhidrosis or excessive palmar sweating can reduce one's quality of life as it is associated with significant physical and occupational disabilities. We compared the gel and nanoemulgel of oxybutynin in treating these patients.Materials and Methods: This pilot study was performed as a double‐blind controlled randomized clinical trial at Shahid Faghihi Hospital, Shiraz, Iran. In two randomly allocated groups of 15, patients diagnosed with primary palmar hyperhidrosis by an attending dermatologist applied half a fingertip (roughly 0.25 g) of 1% oxybutynin topical gel or 1% oxybutynin nanoemulgel to both palms every 12 h for one month. The Hyperhidrosis Disease Severity Scale (HDSS), Visual Analog Scale (VAS), and Dermatology Life Quality Index (DLQI) were used to assess the patients at the beginning and end of the study. Statistical analysis was performed using SPSS version 25.Results: The groups were similar in terms of age (p = 0.800), sex (p = 0.096), and baseline HDSS, VAS, and DLQI scores. The mean HDSS scores decreased significantly (p = 0.001) over time in patients receiving the gel (3.00 ± 1.00 vs. 2.33 ± 0.61) or nanoemulgel (2.92 ± 0.82 vs. 2.14 ± 0.53), without a significant difference between the groups. The same was true for the VAS and DLQI scores. Three patients in each group experienced transient, self‐limited anticholinergic side effects (p = 0.983).Conclusion: Oxybutynin gel and nanoemulgel offer equal safety and similar efficacy in reducing the disease severity and increasing the quality of life of patients with palmar hyperhidrosis.

Background: Although statins decrease mortality in coronary artery disease, the effect of high-dose statins and duration of therapy post-percutaneous coronary intervention (PCI) is not well addressed. Aim: To determine the effective dose of statin to prevent major adverse cardiovascular events (MACEs), such as acute coronary syndrome, stroke, myocardial infarction, revascularisation and cardiac death, after PCI in patients with chronic coronary syndrome. Methods: In this randomised, double-blind clinical trial, all chronic coronary syndrome patients with a recent history of PCI were randomly divided into two groups after 1 month of high-dose rosuvastatin therapy. Over the next year, the first group received rosuvastatin 5 mg daily (moderate intensity), while the second received rosuvastatin 40 mg daily (high intensity). Participants were evaluated in terms of high-sensitivity C-reactive protein and MACEs. Results: The 582 eligible patients were divided into group 1 (n=295) and group 2 (n=287). There was no significant difference between the two groups in terms of sex, age, hypertension, diabetes, smoking, previous history of PCI or history of coronary artery bypass grafting (p>0.05). There were no statistically significant differences in MACE and high-sensitivity C-reactive protein after 1 year between the two groups (p=0.66). Conclusion: The high-dose group had lower LDL levels. However, given the lack of association between high-intensity statins and MACEs in the first year after PCI among chronic coronary syndrome patients, the use of moderate-intensity statins may be as effective as high-intensity statins, and treatment based on LDL targets may suffice.