Effects of citalopram on blood pressure control in depressive patients with hypertension: A randomized clinical trial

Introduction

Since there is a bi-directional interaction between hypertension and depression, we aimed to evaluate the effects of citalopram administration in the management of hypertension.

Methods

A randomized clinical trial was conducted on 72 patients with concomitant depression and hypertension. The intervention group (n=41) received citalopram 20 mg daily plus anti-hypertensive standard treatment, while the control group (n=31) received only the standard treatment. The study's primary endpoint was in-office blood pressure (BP) measurement at baseline and home BP monitoring in the first and second months after entering the study.

Results

There were no significant differences in baseline systolic BP (163.3±19.6 vs.164.2±20.3 mm Hg; P=0.910) and diastolic BP (94.5±13.8 vs. 88.2±14.4; P=0.071). After one month, diastolic BP (82.7±11.7 vs. 77.09±12.2; P=0.023) was significantly higher in the control group compared to the intervention group. Two months after the intervention, systolic BP (133.8±16.5 vs. 124.5±12.4; P=0.009) and diastolic BP (80.7±10.3 vs. 73.7±9.7; P=0.002) were significantly decreased in the intervention group compared to the control group.

Conclusion

This study supported the beneficial effects of citalopram in lowering BP in patients with concomitant depression and hypertension.

Empagliflozin and colchicine in patients with reduced left ventricular ejection fraction following ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention: a study protocol for a randomized, double-blinded, three-arm parallel-group, controlled trial

BACKGROUND

Patients with acute myocardial infarction are at greater risk for chronic heart failure and mortality. Currently, there is limited evidence supporting the beneficial effects of sodium-glucose cotransporter-2 inhibitors on cardiovascular outcomes in non-diabetic patients with reduced left ventricular ejection fraction following acute myocardial infarction. Furthermore, the clinical effects of the combination of standard-dose sodium-glucose cotransporter-2 inhibitors with colchicine and high-dose sodium-glucose cotransporter-2 inhibitors in this setting have not been evaluated yet.

METHODS

A prospective, double-blinded, parallel-group, placebo control randomized trial will be carried out at Shahid Madani Heart Center, the largest teaching referral hospital for cardiovascular diseases, affiliated with Tabriz University of Medical Sciences. A total of 105 patients with reduced left ventricular ejection fraction (≤ 40%) following the first episode of ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention with stent insertion will be randomized 1:1:1 to receive empagliflozin 10 mg daily, a combination of empagliflozin 10 mg daily and colchicine 0.5 mg twice daily, or empagliflozin 25 mg daily for 12 weeks. The primary outcomes are changes in the New York Heart Association functional classification and high-sensitivity C-reactive protein from the randomization through week 4 and week 12.

DISCUSSION

The present study will be the first trial to evaluate the efficacy and safety of early treatment with the combination of standard-dose empagliflozin and colchicine as well as high-dose empagliflozin in non-diabetic patients with reduced left ventricular ejection fraction following ST-elevation myocardial infarction. The results of this research will represent a significant step forward in the treatment of patients with acute myocardial infarction.

TRIAL REGISTRATION

Clinical trial ID: IRCT20111206008307N39. Registration date: 27 October 2022.

Reactive airway dysfunction syndrome caused by chlorine gas from the point of view of Persian Medicine: A review article

Introduction: Chlorine gas inhalation is a toxic respiratory irritant associated with high lung complications. Despite its wide industrial and domestic applications such as bleaching detergents, there is no specific treatment for chlorine gas poisoning yet and common standard treatments are mostly supportive. In this regard, this study aimed to find a new treatment for this pathogenesis from the perspective of Persian medicine (PM). Materials and methods: In this review study, at first, we searched the etiologies and clinical symptoms associated with chlorine gas poisoning in modern medicine and then compared them with similar etiologies and symptoms in valuable Persian medical manuscripts. Then we reviewed the proposed treatments for similar illnesses from the point of view of PM. Results: The pathology of lung damage caused by inhalation of chlorine gas is reactive airway dysfunction syndrome (RADS), which leads to dyspnea, hypoxemia, respiratory tract obstruction, pneumonia, pulmonary edema, and finally acute respiratory distress syndrome (ARDS). In a comparative study, it seems that this pathology has the closest similarity with the Persian term“Varme-e-harr riye”. The treatment strategy for this syndrome in PM is bloodletting at the first and then the application of cold-temperament foods and medications to improve the lungs. Conclusion: According to the compatibility of acute pulmonary edema caused by chlorine inhalation and “varam-e-harr riye” in PM, it seems that wet cupping can be considered as a suggested primary and emergency treatment for this pathology in future clinical studies.

Medicinal Plants in the Treatment of Hypertension: A Review

Traditional medicine is a comprehensive term for ancient, culture-bound health care practices that existed before the use of science in health matters and has been used for centuries. Medicinal plants are used to treat patients with cardiovascular diseases, which may occur due to ailments of the heart and blood vessels and comprise heart attacks, cerebrovascular diseases, hypertension, and heart failure. Hypertension causes difficulty in the functioning of the heart and is involved in atherosclerosis, raising the risk of heart attack and stroke. Many drugs are available for managing these diseases, though common antihypertensive drugs are generally accompanied by many side effects. Medicinal herbs have several active substances with pharmacological and prophylactic properties that can be used in the treatment of hypertension. This review presents an overview of some medicinal plants that have been shown to have hypotensive or antihypertensive properties.

Pharmaceutical properties of sour tea (Hibiscus sabdariffa), Toward an ideal treatment for Hypertension

High blood pressure is the main risk factor for cardiovascular disease and should be controlled primarily by changes in lifestyle, such as regular exercise, a low-salt diet, and weight loss in overweight or obesity. If lifestyle changes are not enough, many types of medications can be used to control high blood pressure; however, side effects constitute one of the most critical limitations of conventional medicines associated with high blood pressure. For this reason, the use of traditional and herbal medicines has been welcomed by the public for many years. Sour tea (Hibiscus sabdariffa) is one of the most suitable herbal medicines for hypertension. According to research results, sour tea has the same effect as conventional medicines without serious side effects. The present study introduces sour tea as a suitable herbal medicine for high blood pressure to provide readers of this article with a comprehensive understanding of the medicinal properties of sour tea for the treatment of hypertension and its effects on several other common diseases, including cancer.

Effects of Adding Pentoxifylline to Captopril on Primary Hypertension: A Pilot Randomized Clinical Trial

Because of the key role blood viscosity plays in the regulation of blood pressure (BP) and the hemorheological effects of pentoxifylline (PTX), this study was conducted to evaluate whether PTX can reduce BP when added to captopril in patients with stage 1 hypertension. In this randomized clinical trial 62 patients with stage 1 hypertension were entered. The intervention group (n = 30) received 1200 mg PTX in 3 divided doses plus 25 mg captopril 3 times a day, whereas the control group (n = 32) received only 75 mg captopril in 3 divided doses. Measurements of BP were done at baseline and in the first and second months after entering the study. Major adverse cardiac events during this period were recorded. When the systolic BP levels in the intervention and the control groups were compared, no significant differences at baseline (150.4 ± 6.03 versus 150.4 ± 6.2, P = .98) or first (138.4 ± 9.4 versus 142.3 ± 5.6, P = .08) or second (134.6  ± 8.9 versus 137.4 ± 6.0, P = .20) month of the study were noted. Similarly no significant difference was observed in the diastolic BP at baseline (91.7 ± 3.9 versus 92.0 ± 3.7, P = .84) or first (85.5 ± 5.1 versus 86.9  ± 3.8, P = .27) or second (82.6  ± 5.7 versus 84.0  ± 3.5, P = .31) month. Based on the results of present study, adding PTX as a hemorheological agent to captopril could not significantly reduce blood pressure in the patients with stage 1 hypertension.

ST-segment depression in left precordial leads in electrocardiogram of patients with acute inferior myocardial infarction undergoing primary percutaneous coronary intervention

BACKGROUND

The early identification of patients with acute inferior ST-segment elevation myocardial infarction (STEMI) with high risk features is particularly important. Acute inferior STEMI may be associated with ST-segment depression in the left precordial leads (V4-V6). This study assessed prognostic value of ST-segment depression in these left precordial leads during the admission of patients with acute inferior STEMI treated with primary percutaneous coronary intervention.

METHODS

This retrospective study enrolled 1,374 patients with acute inferior STEMI who underwent primary percutaneous coronary angioplasty between March 2011 and June 2014. The patients were divided into two groups: one group (n = 687) with left precordial ST-segment depression and the other (n = 687) without such ST-segment changes.

RESULTS

The patients with left precordial ST-segment depression were older and had higher incidence of hypertension, diabetes mellitus, and higher levels of troponin. In-hospital mortality was higher in patients with left precordial ST-segment depression. Advanced coronary artery disease was more observed in these patients.

CONCLUSION

In patients with acute inferior STEMI treated with primary coronary intervention, left precordial ST-segment depression during admission of ECG is associated with more advanced coronary artery disease, and worse in-hospital clinical outcomes.

Effect of Pentoxifylline in Ameliorating Myocardial Injury in Patients With Myocardial Infarction Undergoing Thrombolytic Therapy: A Pilot Randomized Clinical Trial

Cell death following acute myocardial infarction (MI) is the hallmark pathology of cardiovascular disease, leading to considerable mortality and morbidity. Platelet and neutrophil activation and inflammatory cytokines, prominently TNF-α, play an important role in the development of cell death. Because pentoxifylline inhibits platelet and neutrophil activation and reduces TNF-α, this study was performed to assess the potential benefit of pentoxifylline in the reduction of myocardial injury following acute MI. In this randomized clinical trial, 98 patients with acute MI were randomly divided into 2 groups. The intervention group received an oral dose of 1200 mg of pentoxifylline immediately before thrombolytic therapy (TLT). All patients received the same standard protocol for treatment of MI. Cardiac enzymes were checked over 48 hours. ST resolution was measured over 90 minutes. Then all patients were followed up for a 1-month period to assess major adverse cardiac effects (MACEs). There were no significant differences in peak levels of CPK (P = .18) and CK-MB (P = .33) between the 2 groups, whereas peak level of troponin I was significantly lower in the pentoxifylline group (16.8 ± 10.4 vs 21.3 ± 11.6; P = .048). No significant change between the groups was observed in biomarkers levels, ST segment resolution, cardiac ejection fraction, and MACEs. The results showed that pentoxifylline significantly reduced the peak value of troponin I in patients with acute MI receiving TLT. No significant change was observed in the other studied parameters. Further outcome-based studies are needed to show the clinical relevance of differences between the groups in troponin peak.

The pattern and risk factors associated with adverse drug reactions induced by Reteplase in patients with acute ST-elevation myocardial infarction: The first report from Iranian population

Objective:

Acute myocardial infarction (AMI) is one of the main leading causes of mortality and morbidity. Reteplase is a fibrin-specific thrombolytic which is used in the treatment of AMI. There is a limited number of studies reporting the postmarketing adverse drug reactions (ADRs) induced by reteplase. This study was aimed to examine the reteplase pattern of ADR and its associated risk factors in patients with acute ST-elevation myocardial infarction.

Methods:

A cross-sectional, prospective study in an 8-month period was done at the University affiliated referral cardiovascular center. The Naranjo probability scale and World Health Organization criteria for severity of ADRs were used for assessing the ADRs. The linear regression and logistic regression tests were used to evaluate the correlation between ADRs and risk factors.

Findings:

The all 20 patients who received reteplase during the study period were entered. The majority of patients (n = 17) experienced at least one ADR. The results showed that the incidence of ADRs was mainly associated with gender and age, and the number of ADRs was associated with the history of diabetes and taking anti-diabetic agents. The gender was the main predictor in the occurrence of ADRs (odds ratio: 32, 95% confidence interval: 1.38–737.45; P = 0.030).

Conclusion:

The results showed that gender, age, diabetes mellitus, and using of anti-diabetes medications are the risk factors associated with the incidence of ADRs by reteplase.

Echocardiographic Evaluation of the Relationship Between inflammatory factors (IL6, TNFα, hs-CRP) and Secondary Pulmonary Hypertension in patients with COPD. A Cross sectional study

BACKGROUND

Inflammatory mechanism appears to play a major role in the pathogenesis of various types of human pulmonary hypertension such as idiopathic PAH (IPAH) and PAH associated" with connective tissue disease. Although we know that inflammatory factors such as IL6 and TNFα have an important role in IPAH, there is limited information about the relationship between acute phase reactants and pulmonary hypertension occurring secondary to pulmonary diseases such as chronic obstructive pulmonary diseases (COPD).

METHODS

This cross-sectional study was carried out on 94 patients who had COPD. Patients with a recent history of systemic steroid and acetylsalicylic acid (ASA) use, infection, trauma or surgery, gastrointestinal bleeding, coronary artery disease (CAD) and Hypertension were excluded. Body plethysmography and transthoracic echocardiography were done. Blood samples for each patient included were drawn for complete blood count (CBC), IL6, TNFα and highly sensitive C reactive protein (hs-CRP).

RESULTS

Twenty patients (28.6%) had pulmonary hypertension. The difference between the mean IL6 and hs-CRP in patients with and without pulmonary hypertension was significant (7 pg/ml vs. 4.4 pg/ml and 13.04 pg/ml vs. 3.31 pg/ml) (p=0.006 and p=0.000). There was a correlation between IL6 and mean pulmonary arterial pressure (r=0.35, p=0.003). After adjustment forage, sex, serum Hemoglobin, Hematocrit, O2Sat, FEV1, FVC the relationship between the IL6, hs-CRP and the presence of pulmonary hypertension remained significant (p=0.022, p=0.026).

CONCLUSION

Inflammatory factors such as IL6 and hs-CRP are independent risk factors for pulmonary hypertension in COPD patients.

Relationship Between Prohormone Brain Natriuretic Peptide (NT-proBNP) Level and Severity of Pulmonary Dysfunction in Patients With Chronic Congestive Heart Failure

Introduction: Congestive heart failure (CHF) is a common disease and its prevalence is increasing in industrialized countries. NT-proBNP measurement is an established diagnostic test for diagnosis of CHF in patients who present to emergency room with acute dyspnea. The primary object of this study was to determine the relationship between levels of brain natriuretic peptide precursor and severity of lung function impairment in patients with chronic CHF.

Methods: This cross-sectional and analytical study that performed in Tuberculosis and Lung Disease Research Center of Tabriz University of Medical Sciences on 95 patients with chronic heart failure, and relation between NT-proBNP levels and pulmonary function parameters were examined.

Results: Sixty-four patients were male and 31 were female. The average age of male and females was 62.90 ± 11.54 and 61.61 ± 11.98 years, respectively. A significant inverse linear correlation was found between NT-proBNP and FEV1 (P < 0.001, r = -0.367), FVC (P < 0.001, r = -0.444), TLC (P = 0.022, r = -0.238), maximal midexpiratory flow (MMEF) (P = 0.047, r = -0.207) and left ventricular ejection fraction (LVEF) (P < 0.001, r = -0.461). A significant positive linear correlation was found between NT-proBNP and FEV1/FVC (P = 0.013, r = 0.257), RV/TLC (P = 0.003, r=0.303) and 5 Hz Raw (r = 0.231, P = 0.024).

Conclusion: This study showed that, both restrictive and obstructive ventilator impairments can occur in chronic CHF and as NT-proBNP increases appropriate to hemodynamic deterioration, pulmonary dysfunction increases.

Effects of music on cardiovascular responses in men with essential hypertension compared with healthy men based on introversion and extraversion

Introduction: The present research investigated the effects of two different types of music on cardiovascular responses in essential hypertensive men in comparison with healthy men based on introversion and extraversion.

Methods: One hundred and thirteen hypertensive men referred to Madani Heart Hospital in Tabriz completed the NEO-FFI Questionnaire and after obtaining acceptable scores were classified in four groups: introvert patients, extravert patients, introvert healthy subjects, and extravert healthy subjects (each group with 25 samples with age range 31-50). Baseline blood pressure and heart rate of each subject was recorded without any stimulus. Then subjects were exposed to slow-beat music and blood pressure and heart rate were recorded. After15 minute break, and a little cognitive task for distraction, subjects were exposed to fast-beat music and blood pressure and heart rate were recorded again.

Results: Multivariate analysis of covariance (MANCOVA) test showed that extravert patient subjects obtained greater reduction in systolic blood pressure and heart rate after presenting slow-beat music compared with introvert patients (P= 0.035, and P= 0.033 respectively). And extravert healthy subjects obtained greater reduction in heart rate after presenting slow-beat music compared with introvert healthy subjects (P= 0.036). However, there are no significant differences between introvert and extravert groups in systolic and diastolic blood pressure and heart rate after presenting fast-beat music.

Conclusion: Based on our results, introvert subjects experience negative emotions more than extravert subjects and negative emotions cause less change in blood pressure in these subjects compared with extravert subjects.

Diagnostic Values of Plasma, Fresh and Frozen Urine NT-proBNP in Heart Failure Patients

INTRODUCTION

The plasma N-terminal probrain natriuretic peptide (NT-proBNP) level is an important diagnostic and prognostic marker of heart failure. Recent studies have suggested urinary NT-proBNP as a new and simple test for diagnosis of heart failure. We aim to compare diagnostic value of plasma, fresh and frozen urine levels of N-terminal probrain natriuretic peptide (NT-proBNP) for detecting heart failure.

METHODS

Between January 2010 and January 2012, we measured urine and plasma levels of NTproBNP in 98 patients with chronic heart failure (CHF) and 29 age- and sex-matched healthy control subjects.

RESULTS

There were significant correlations between plasma NT-proBNP and fresh (r=0.45, p<0.001) and frozen (r=0.42, p<0.001) urine NT-proBNP concentrations in CHF patients. Due to receiver operating curve analysis, fresh and frozen urine NT-proBNP could diagnose HF with are aunder curve (AUC) of 0.73±0.04 (p<0.001) and 0.65±0.05 (p=0.01) with sensitivity and specificity of 73.97%, 58.62%, and 65.31%, 62.07%, for a cut-off of 94.2 and 96 pg/mL, respectively. Plasma NT-proBNP had greater AUC (0.94±0.02, p<0.001) and better sensitivity and specificity (94.9%, 89.66% for cut-off of 414.5 pg/mL). There was no significant correlation between LVEF and plasma, fresh and frozen urine NT-proBNP levels in CHF patients.

CONCLUSION

Plasma NT-proBNP is still the best diagnostic marker with high sensitivity and specificity; however, urinary especially fresh urine NT-proBNP may be a surrogate to plasma NTproBNP for diagnosing HF with acceptable accuracy.

Effects of emotional stimuli on cardiovascular responses in patients with essential hypertension based on brain/behavioral systems

INTRODUCTION

Effects of emotional stimuli on hemodynamics in patients with essential hypertension based on brain/behavioral systems have not been studied broadly.

METHODS

Eighty five essential hypertensive male patients who had completed Carver-White BIS/BAS scale were enrolled to the study. Later, 25 BIS and 25 BAS patients were selected and their blood pressure and heart rate were recorded prior to stimuli induction. Participants were then exposed to stressor pictures. After that, 15 minutes of relaxation and cognitive tasks were performed. Finally, the participants were exposed to pleasant pictures. The blood pressure and heart rate were recorded after presenting of 2 stimuli.

RESULTS

Our study showed that BIS patients achieved higher scores in diastolic blood pressure and heart rate in comparison with BAS patients after presenting stressful stimuli. Also, BAS patients achieved lower scores in systolic blood pressure and heart rate in comparison with BIS patients after presenting pleasant stimuli.

CONCLUSION

In summary, BIS patients experience negative emotions more than BAS patients. Therefore, the role of induced mood states is important in relation to physical health.

Simultaneous operation of hydatid cyst of the heart and liver: a case report

Primary echinococcosis of the heart is exceptionally uncommon and is reported 0.5% to 2% of all hydatid cyst sites in comparison with liver (70%) or lung (20%) involvement. Hydatid disease of the heart is caused by the cestode tapeworm echinococcosis granulosis or alveolaris. We present a 29-year-old female with hydatid disease of the liver and heart. She only complained of abdominal pain and palpitation. Echocardiography and multi-slice computed tomography (MSCT) showed a 120×101 mm cyst in the liver and 64 mm in the right ventricular free wall. Both cysts were excised within one procedure successfully.

Self-Care Behaviors among Patients with Heart Failure in Iran

INTRODUCTION

Recovery from heart failure and dealing with its effects is significantly influenced by patient's self-care. In order to maximize the effects of behavioral interventions and for educational planning, it is essential to know how much experience and information do patients with heart failure have about their disease and self-care behaviors. The present study aimed to identify self-care behaviors in patients with heart failure.

METHODS

Eighty heart failure patients hospitalized in Shahid Madani Training Center in Tabriz, Iran, participated in this study. Data collection was done through Self-Care of Heart Failure Index (SCHFI) that contained 22 questions in three sections including self-care behaviors, self-care management and confidence in performing self-care behaviors.

RESULTS

The patient's self-care behaviors in three behavioral sub categories of maintaining, managing and confidence were low. The most repeated self-care behavior in the participating patients was taking medication and visiting the doctor.

CONCLUSION

The results of the study showed low levels of self-care behaviors in patients with heart failure, which notes the need for patient empowerment. It is necessary to develop appropriate strategies in this regard by the authorities.

Quality of nursing care in psychiatric wards of university hospitals in northwest of iran from the perceptions of nurses

INTRODUCTION

Nursing care is considered as an essential component of health services. Patients' health improvement depends upon the quality of nursing care. As an important principle, perceptions of nurses as well as their active participation in decision-makings has an important role in the quality of services. This study aimed to determine the percep-tion of nurses toward the quality of nursing care in psychiatric wards.

METHODS

In this descriptive study, we used census sampling. Seventy-six nurses employed at psychiatric wards of university hospitals in Northwest of Iran participated in this study. Quality Patient Care Scale (QUALPAC) was used to collect data. The score of each aspect and total scores were categorized as desirable, partly desirable and undesirable. The collected data were analyzed using descriptive statistics.

RESULTS

Findings showed that 60.5% of nurses perceived the quality of nursing care as desirable, while 65.8% and 53.9% reported the quality of physical and communicational aspects of care as desirable. Moreover, 51.3% of nurses considered the quality of care in psychosocial aspect as partly desirable.

CONCLUSION

Although research findings indicated the desirability of care quality from the perceptions of most nurses, designing and applying educational programs and continuous evaluation are necessary to improve nursing care quality especially in psychosocial aspects in these centers.

Mental illness stigma among nurses in psychiatric wards of teaching hospitals in the north-west of Iran

BACKGROUND

Stigma is one of the obstacles in the treatment and regaining the mental health of people with mental illness. The aim was determination of mental illness stigma among nurses in psychiatric wards. This study was conducted in psychiatric wards of teaching hospitals in Tabriz, Urmia, and Ardabil in the north-west of Iran.

MATERIALS AND METHODS

This research is a descriptive analysis study in which 80 nurses participated. A researcher-made questionnaire was used, which measured demographic characteristics and mental illness stigma in the three components of cognitive, emotional, and behavioral. All data were analyzed using SPSS13 software and descriptive and analytical statistics.

RESULTS

Majority of nurses (72.5%) had medium level of stigma toward people with mental illness. About half of them (48.8%) had great inclination toward the social isolation of patients. The majority of them (62.5%) had positive emotional responses and 27.5% had stereotypical views. There was a significant correlation between experience of living with and kinship of nurses to person with mental illness, with prejudice toward and discrimination of patients. There was also a significant correlation between interest in the continuation of work in the psychiatric ward and prejudice, and also between educational degree and stereotypical views.

CONCLUSIONS

The data suggest there is a close correlation between the personal experience of nurses and existence of mental illness stigma among them. Therefore, the implementation of constant educational programs on mental illness for nurses and opportunities for them to have direct contact with treated patients is suggested.

Multiple etiologies of axonal sensory motor polyneuropathy in a renal transplant recipient: a case report

INTRODUCTION

Neurological complications leading to morbidity and mortality are not frequent in renal transplant recipients. Here, we report a renal transplant recipient who presented with diminished strength in his limbs probably due to multiple etiologies of axonal sensorimotor polyneuropathy, which resolved with intravenous immunoglobulin.

CASE PRESENTATION

A 49-year-old Iranian male renal transplant recipient with previous history of autosomal dominant polycystic kidney disease presented with diminished strength in his limbs one month after surgery. Our patient was on cyclosporine A, mycophenolate mofetil and prednisone. Although a detected hypophosphatemia was corrected with supplemental phosphate, the loss of strength was still slowly progressive and diffuse muscular atrophy was remarkable in his trunk, upper limb and pelvic girdle. Meanwhile, his cranial nerves were intact. Post-transplant diabetes mellitus was diagnosed and insulin therapy was initiated. In addition, as a high serum cyclosporine level was detected, the dose of cyclosporine was reduced. Our patient was also put on intravenous ganciclovir due to positive serum cytomegalovirus immunoglobulin M antibody. Despite the reduction of oral cyclosporine dose along with medical therapy for the cytomegalovirus infection and diabetes mellitus, his muscular weakness and atrophy did not improve. One week after administration of intravenous immunoglobulin, a significant improvement was noted in his muscular weakness.

CONCLUSION

A remarkable response to intravenous immunoglobulin is compatible with an immunological basis for the present condition (post-transplant polyneuropathy). In cases of post-transplant polyneuropathy with a high clinical suspicion of immunological origin, administration of intravenous immunoglobulin may be recommended.

Prevalence of significant carotid artery stenosis in Iranian patients with peripheral arterial disease

BACKGROUND

Generalized screening for carotid artery stenosis with carotid duplex ultrasonography in patients with peripheral arterial disease is controversial.

OBJECTIVES

The aim of the present study was to determine the prevalence of significant internal carotid artery (ICA) stenosis in a group of Iranian patients with peripheral arterial disease.

METHODS

We prospectively screened 120 patients with a known diagnosis of peripheral vascular disease for carotid artery stenosis. Based on the angiographic assessment of abdominal aorta and arteries of the lower extremities, patients with stenosis greater than 70% in the lower extremity arteries were included. A group of healthy individuals aged ≥ 50 years was recruited as a control. Risk factors for atherosclerosis including smoking, diabetes mellitus, hyperlipidemia, ischemic heart disease, and cerebrovascular disease were recorded. Common carotid arteries (CCAs) and the origins of the internal and external arteries were scanned with B-mode ultrasonography. Significant ICA stenosis, > 70% ICA stenosis but less than near occlusion of the ICA, was diagnosed when the ICA/CCA peak systolic velocity ratio was ≥ 3.5.

RESULTS

Ninety-five patients, with a mean age of 58.52 ± 11.04 years, were studied. Twenty-five patients had a history of smoking, six patients had a history of coronary artery disease, six patients had hypertension, and ten patients had diabetes mellitus. Significant ICA stenosis was present in four patients (4.2%) with peripheral arterial disease in one healthy individual (1%) of the control group (P > 0.05). In terms of the risk factors for atherosclerosis, no statistically significant relationship was found between individual atherosclerotic risk factors and significant ICA stenosis (P > 0.05).

CONCLUSION

The prevalence of significant ICA stenosis in Iranian patients with peripheral arterial disease is low. In addition, there is no relationship between individual atherosclerotic risk factors and significant ICA stenosis.