Yafteh

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Introduction: Coronary artery disease (CAD) is among the most common, serious, chronic and life- threatening illnesses in the world. CAD represents a spectrum of conditions, with acute myocardial infarction at one end of it and silent ischemia at the other. There is growing evidence on importance of prognosis of C- reactive protein (CPR) in unstable angina and this protein is a maker of an adverse prognosis. Materials and Methods: In this cross- sectional research. We study all of the patients that admitted in the coronary care unit of the Shahid Rahimi hospital with unstable angina (n=32) and acute myocardial infarction (n=32), but exclude the patients with exclusion criteria. Complete clinical data and blood samples for laboratory measurements were collected on admission. A baseline ECG were obtained at entry and 12 hours later. A CFM echocardiogram was performed within initial 24 hours. Serum CPR levels were measured on admission and at time of hospital discharge. All patients were followed up for 14 days after discharge. Findings: Patients with MI showed a striking higher CPR during the duty period than with UA. The occurrence of cardiac events at 14 day follow up was related to CPR level at 48 hours and hospital discharge (p=0.02). CPR levels correlated inversely with ejection fraction (r=-0.44). Conclusion: Our data demonstrated that the CPR were significantly higher in patients with acute myocardial infraction than patients with unstable angina. Elevated levels of CPR were associated with cardiac events out of hospital during a 14- day follow up.

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Background: Coronary artery disease (CAD) is one of the most important and lethal diseases in the world. CAD represents a board spectrum of disease from silent ischemia at one end to sudden cardiac death at the other end. The middle of this spectrum consists of acute myocardial infarction (AMI) and unstable angina pectoris (UA). Recent data show that the inflammatory process plays a major role in the pathogenesis of acute coronary syndrome. In this study we evaluated the difference in complement factors C3 and C4 between AMI and UA, and the relation between early completions of AMI and UA and the amount of C3 and C4. Materials and methods: In this cross – sectional analytic study, 30 patients with AMI and 30 patients with UA were compared with healthy subjects. Clinical and laboratory data were collected. Blood samples were obtained on arrival and at 12.24 and 48 hours. electrocardiography and echocardiography were performed. All patients were monitored for 14 days after discharging from hospital. For all patients ECG was take on arrival and then daily bat. Findings: Complement activation occurred in patients with AMI and UA. In AMI activation of complement factors was significantly higher than in UA (p<0.01). In Qwave MI and congestive heart failure, this elevation of activity was prominent (p<0.01). In AMI a positive relation was found between complement factors and Cratin phospho kinas level (r=0.71). There was a positive relation between complement and mortality, and an inverse relation with ejection fraction (r=0.71). There was significant difference among complement factors in the UA, AMI, and control group (p<0.01). Conclusions: Elevated levels of complement factors in AMI were related to the degree of left ventricular ejection fraction (LVEF). Q-wave MI, and mortality. However, in UA, elevated levels of complement factors were unrelated, with the exception of the serum C3 level, which was related to LVEF.

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Background: Kawasaki disease (KD) is an acute febrile vasculitis of childhood occurs worldwide, with Asians at highest risk. Approximately 20% of untreated patients develop coronary artery abnormalities including aneurysms, myocardial infarction and sudden death. KD is the common cause of acquired heart disease in children in the United States and Japan. The aim of this study was to determine the severity of kawasaki disease based on laboratory and echocardiographic findings. Materials and Methods: In this cross-sectional research, we studied records of all patients (n=61) admitted to Mofid Children’s hospital with Kawasaki disease from December 21, 2004 to January 21, 2008. Patients with exclusion criteria were omitted (n=11) and other 50 patients were entered the study. At least three CFM echocardiograms were performed for all of these children with Kawasaki disease: at diagnosis, after 2-3 wk and 6-8 wk after onset of illness. These CFM echocardiograms was performed only by one Paediatric cardiologist (he didn’t have any information about severity and other characteristics of the disease in these patients). All patients were followed up for 12 weeks after discharge. Results: There were 32(64%) boys and 18(36%) girls in this study (total number: 50). The male to female ratio was 1. 8: 1. 100% of the patients had fever, 82% changes in oral cavity & lips, 78% bilateral bulbar conjunctival injection, 64% changes of the peripheral extremities, 58% polymorphous rash and 40% cervical adenopathy. Coronary artery aneurysm was seen in 2% of the patients. No recurrence of KD was observed among these children. Based on laboratory and echocardiographic findings, the patients divided into two groups: severe (n=24) and non-severe (n=26). Mean age of the children, mean duration of hospitalization and rash were significantly higher in the severe group. There was no significant difference between number of patients with K<3. 4mEq/L in two groups. Number of patients with Na<135mEq/L was significantly higher in the severe group (p=0. 01). Mitral regurgitation and 2-times receiving IVIG were significantly higher in the severe group (p=0. 02 and p=0. 008, respectively). Conclusion: Our data demonstrated that sooner performance of CFM echocardiogram and ESR, CRP, Platelet count and Na levels can help us to detect severe Kawasaki disease easer & faster.

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Kawasaki disease (KD, also called mucocutaneous lymph node syndrome) is one of the most common childhood vasculitis. Although the etiology of the disease is unknown infectious, genetic and immunologic factors have been supposed to be responsible for KD occurrence. Complications such as coronary artery aneurysm, cardiomyopathy and heart failure, may occur, which can cause significant morbidity and mortality in children. KD is the common cause of acquired heart disease in children in the United States and Japan. Materials and Methods: 61 patients with approved KD admitted in the Mofid Children’s Hospital (from December 2004 to January 2008) and their parents were studied in this cross-sectional survey. 11 patients were omitted according to exclusion criteria, 50 patients were divided into two groups: Mild (n=26) and severe (n=24). Data was analyzed via Fisher’s exact test and student’s t-test using SPSS software, V. 11,5. p<0.05was taken into account significant. Results: 50 patients (32 males, 18 females) with mean age of 43 months were concluded in this survey. All of the patients had fever (100%), coronary artery aneurism was seen in 2% of the patients. No recurrence of KD was seen among these children and there was no history of KD in their parents and siblings. Mitral valve prolaps in mothers and ischemic heart disease in fathers among sever group were significantly higher than mild group (p=0.03 and p=0.001, respectively). Mitral regurgitation and 2-times receiving IVIG was significantly higher in severe group (p=0.02 and p=0.008, respectively). Conclusion: This study showed that mitral valve prolaps in mothers and ischemic heart disease in fathers had significant relation with Kawasaki disease in their children. Also, CRP, ESR, Na, LFT and echocardiography are useful to detect and manage severe Kawasaki disease. To provide more accurate conclusions, prospective and multicentric studies with larger sample sizes are necessary.

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Background: Congenital heart disease is the most common congenital malformations in newborns. The aim of this study was to determine the prevalence and types of congenital heart disease in babies born in the city of Khorramabad. Materials and Methods: The present study was a descriptive cross-sectional. Sampling method was census. All babies born in the city of Khorramabad from 2007 to 2011, whom their first echocardiogram was diagnosed with congenital heart disease, were studied. The studied variables included sex, premature birth, cyanosis, anomalies of other organs, maternal age over 40 years, consanguineous parents, drug use during pregnancy, maternal medical history, a history of congenital heart disease in the mother and types of heart abnormality. Data collected through questionnaire and statistically analyzed by SPSS software. Results: Of 43195 newborns177 cases had congenital heart disease. The incidence of congenital heart disease per 1,000 live births in the study was 4.2. In this study ventricular septal defect (44%) and atrial septal defect (21 %) were the most common congenital malformations of the heart. 63.8% of neonates with congenital heart disease were male(p=0.005), 80.4 % term infants(p<0.001) , 93.5 % of them had no cyanosis, consanguineous parents 28%,congenital heart diseases in parents 10.3 %, history of diabetes in 9.3 % of mothers and 5.6% of newborns had other anomalies such as cleft lip and palate. Conclusion: In this study, ventricular septal defect and atrial septal defect were the most common congenital malformations of the heart and frequency of boys was approximately twice of girl.

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Background : Helicobacter pylori is a microorganism which results in gastritis, peptic ulcer and is associated with GI malignancies. This bacteria has an important role in GI disease .There is not enough data about prevalence of H.P infection among children (1-14 years old) in Lorestan province, so this study performed to determine the sero-prevalence of H.P among children referred to Shahid Madani children's hospital of Khorramabad and risk factors related to it were studied too. Materials and Methods: This analytical epidemiologic study was carried out during 2011-2012. At first children’s parents were interviewed and after filling a questionnaire and an informed consent. Blood samples were obtained from the children in order to determine serum level of H.P IgG using ELIZA method. Demographic data such as age, gender, mother’s education, father’s job, were recorded in the questionnaire .Then statistical analysis was performed using SPSS software. Results: In this research 200 children (1-14 years old) were studied to determine H.Pylori antibody prevalence. The average age of the children was 5.1 ± 2.9. 61% of them were male and 39% were female. Based on age, H.Pylori was most common among children aged 10-14 years old (57.9%) and the least prevalence among children under 1 year old was (16.7%), and according to Fisher exact test this difference was significant (p=0.032). Statistical analysis indicated that H.pylori infection prevalence was significantly higher (54.2%) among low income families (income <2500000 Rials) and this was important (p=0.006). The prevalence was not significant among children living in cities with those living in villages (p=0.83). Conclusion: Based on serum levels of antibody of H pilory antibody there is a linear relationship between the prevalence of this infection and age ،height and the present weight of the child (p<0.05).It means that with age, height and weight, the amount of serum antibody of H.pylori increases significantly. H.pylori infection prevalence was significantly higher among low income families (income <2500000 Rials).