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1.  What's the role of perceived social support and coping styles in depression and anxiety? 
Due to the excessive and pathologic effects of depression and anxiety, it is important to identify the role of protective factors, such as effective coping and social support. This study examined the associations between perceived social support and coping styles with depression and anxiety levels.
Materials and Methods:
This cross sectional study was part of the Study on the Epidemiology of Psychological, Alimentary Health and Nutrition project. A total 4658 individuals aged ≥20 years was selected by cluster random sampling. Subjects completed questionnaires, which were used to describe perceived social support, coping styles, depression and anxiety. t-test, Chi-square test, pearson's correlation and Logistic regression analysis were used in data analyses.
The results of Logistic regression analysis showed after adjusting demographic characteristics for odd ratio of anxiety, active copings such as positive re-interpretation and growth with odds ratios; 95% confidence interval: 0.82 (0.76, 0.89), problem engagement (0.92 [0.87, 0.97]), acceptance (0.82 [0.74, 0.92]) and also among perceived social supports, family (0.77 [0.71, 0.84]) and others (0.84 [0.76, 0.91]) were protective. In addition to, for odd ratio of depression, active copings such as positive re-interpretation and growth (0.74 [0.69, 0.79]), problem engagement (0.89 [0.86, 0.93]), and support seeking (0.96 [0.93, 0.99]) and all of social support types (family [0.75 (0.70, 0.80)], friends [0.90 (0.85, 0.95)] and others [0.80 (0.75, 0.86)]) were protective. Avoidance was risk factor for both of anxiety (1.19 [1.12, 1.27]) and depression (1.22 [1.16, 1.29]).
This study shows active coping styles and perceived social supports particularly positive re-interpretation and family social support are protective factors for depression and anxiety.
PMCID: PMC4274570  PMID: 25538777
Anxiety; coping styles; depression; perceived social support
2.  Topiramate augmentation in refractory obsessive-compulsive disorder: A randomized, double-blind, placebo-controlled trial 
This study aimed to assess the efficacy of topiramate, a glutamate-modulating agent, in patients with treatment-resistant obsessive-compulsive disorder (OCD) as an adjunct to serotonin reuptake inhibitors (SRIs).
Materials and Methods:
Thirty-eight patients with refractory OCD, were randomly assigned to receive topiramate or placebo. This study was designed as a 12 weeks, double-blind, placebo-controlled trial. Primary outcome measures were the change in Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score and the rate of treatment response in each group at the study end point. Treatment response was considered as 25% or more reduction in Y-BOCS score.
A total of 13 patients in the topiramate group and 14 ones in the placebo group completed the trial. Topiramate-assigned patients showed significantly improved mean Y-BOCS score over time (P < 0.001). Although differences between two groups were significant in the Y-BOCS score at the first 2 months (P = 0.01), this was not significant at the end of the study (P = 0.10). Changes of Clinical Global Impression (CGI)-Severity of Illness Scale score and CGI-Improvement Scale score were not significantly different between two groups (P > 0.05). Treatment response was almost significantly different in the topiramate group comparing placebo group (P = 0.054). Mean topiramate dosage was 137.5 mg/day (range, 100-200).
This study didn’t show efficacy of topiramate as an agent to augment SRIs in treatment-resistant OCD patients.
PMCID: PMC4274576  PMID: 25538783
Clinical global impression scale; obsessive-compulsive disorder; randomized controlled trials; topiramate; Yale-Brown obsessive-compulsive scale
3.  The effect of stress management training on stress and depression in women with depression disorders: Using cognitive-behavioral techniques 
The present study aimed to investigate the effect of stress management training through cognitive-behavioral techniques on stress, social adaptability and depression in women with depression disorders.
Materials and Methods:
In this study, 40 patients diagnosed with depression who had referred to psychiatry and consultation clinics of Isfahan were randomly selected and assigned to intervention and control groups (20 patients in each group). The intervention group received eight 90-min sessions of stress training through cognitive–behavioral techniques. Data collection tools included Cooper's stress questionnaire, Bell's social adaptability questionnaire and Hamilton's depression scale questionnaire. The participants completed the questionnaires before the intervention and 1 month after the same. Data analysis was performed using covariance analysis.
Based on the results, considering variables of stress, social adaptability and depression, the equal variance hypothesis was confirmed. The relationship between pre- and post-test scores on stress, social adaptability and depression was statistically significant (P < 0.001). The modified mean difference was F = 12.45, P < 0.001 on stress; F = 6.88, P < 0.01 on social adaptability; and F = 5.36, P < 0.02 on depression, all of which were significant.
Stress management training through cognitive behavioral techniques can play a main role in depression reduction and development of social adaptability through modifying inappropriate social information-processing patterns.
PMCID: PMC4113980  PMID: 25077163
Cognitive-behavioral techniques; depression; stress management; stress
4.  The relation between occupational exposure to lead and blood pressure among employed normotensive men 
Lead is a pollutant with numerous adverse effects on health. Since it can affect blood pressure, peripheral blood vessels, and the heart, the present study aimed to evaluate the relation between occupational exposure to lead and blood pressure.
Materials and Methods:
This cross-sectional study included male individuals working in battery firms in Isfahan. A questionnaire covering demographic characteristics and the history of different diseases and occupational exposure to lead was completed. Each participant's blood pressure was also measured and recorded. After obtaining blood samples and determining lead levels, mean and frequency analyses were performed. In addition, Pearson's correlation test and linear regression were used to assess the relation between blood lead levels (BLLs) and systolic and diastolic blood pressure. All analyses were performed in SPSS.19
The mean age of the 182 studied workers was 42.85 ± 13.65 years. They had worked in battery firms for a mean period of 23.67 ± 14.72 years. Moreover, the mean value of BLLs among the participants was 7.92 ± 3.44 μg/dL. Correlation between BLL and systolic and diastolic blood pressure was not significant. The effects of lead on systolic and diastolic blood pressure after stepwise regression were B = –0.327 [confidence interval (CI) 95%: –0.877 to 0.223] and B = –0.094 (CI 95%: –0.495 to 0.307), respectively.
This study revealed that BLLs in battery firm workers to be normal. Additionally, BLLs were not significantly related with either systolic or diastolic blood pressure which might have been the result of normal BLLs.
PMCID: PMC4155701  PMID: 25197288
Hypertension; lead; occupational exposure
5.  Memantine add on to citalopram in elderly patients with depression: A double-blind placebo-controlled study 
Proper management of depression in elderly population would improve the outcome of the disease and reduce its related disability and mortality. Use of memantine with minimal side effects and drug interaction seems reasonable in the elderly but its antidepressant activity is controversial. The aim of the current research is to investigate the effects of add-on memantine during citalopram therapy in elderly patients with depression, in Isfahan.
Materials and Methods:
In this double-blind, placebo controlled trial study; elderly patients aged more than 60 years who were recently diagnosed with depression, were enrolled. The selected patients were randomlysplit into two groups, viz. intervention and placebo groups. The intervention was memantine (20 mg daily) or identical placebo plus citalopram for 8 weeks. The severity of depression and quality of life was evaluated using Geriatric Depression Scale (GDS-15), Hamilton Rating Scale for depression (HRSD) and World Health Organization Quality of Life WHOQOL-BREF respectively. The mentioned scores were evaluated at baseline, 4 weeks and 8 weeks, after initiating the trial in two studied groups and compared with each other.
28 and 29 patients were studied in the intervention and placebo groups, respectively. Score of GDS-15, HRSD and WHO-QOL-BREF scales at baseline, 4 weeks and 8 weeks, after initiating trial did not change significantly after use of memantine (P > 0.05). There was no significant difference in mean +/- SD of GDS-15, HRSD and WHO-QOL-BREF scales among intervention and placebo groups (P > 0.05).
The outcome of this clinical trial did not support the antidepressant effect of add-on memantine in elderly patients with depression receiving citalopram. It is recommended to design further studies considering the limitations of the current study mentioned herein and the effect of memantine with other anti-depressant agents.
PMCID: PMC4155707  PMID: 25197294
Depression; geriatric; memantine; quality of life
6.  Sexual dysfunction in women with multiple sclerosis: Dimensions and contributory factors 
Sexual dysfunction (SD) is a common reported problem in patients with multiple sclerosis (MS).
to examine frequency and distribution of SD dimensions and to determine whether SD is related to various clinical and demographic variables in female patients.
Materials and Methods:
A total of 271 MS women (age: 19-50 years) participated in this cross-sectional study. We used a structured demographic and clinical interview and Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19). Disability was rated by Expanded Disability Status Score (EDSS).
63.5% (n = 173) of women had SD included 142 (52.4%) women with primary SD, 102 (37.5%) women with secondary SD and 120 (41%) women with tertiary SD. The most common SD-related complaint was orgasmic problem (41.2%). Women with primary SD were significantly older and had higher EDSS score. No significant relationship was found between primary SD and disease duration. Fatigue (OR = 2.69, 95% CI: 1.352-5.385, P = 0.005), memory and concentration complaints (OR = 1.915, 95% CI: 1.034-3.546, P = 0.039) and some of urinary symptoms such as frequency (OR = 2.108, 95% CI: 1.015-4.375, P = 0.045) were seem to be the significant predictors. Fatigue was also found to be the most powerful predicting factor for tertiary SD (OR = 2.793, 95% CI: 1.358-5.744 P = 0.005).
SD, a common multifactorial problem among MS women, can arise at any time during the disease and with any level of disability. However, we found relationships between SD and some of clinical variables and symptoms. Understanding these relationships would help us to develop practical approach and treatment for SD.
PMCID: PMC4061644  PMID: 24949030
Female sexual dysfunction; MSISQ-19; multiple sclerosis
7.  Validity, reliability, and factor analysis of Persian version of quality of life questionnaire for irritable bowel syndrome (IBS-QOL-34) 
Quality of life (QOL) improvement is the main objective of treating patients with irritable bowel syndrome (IBS). This study aimed to assess the validity, reliability, and factor analysis of IBS-QOL-34 questionnaire as a common transcultural instrument for Iranian IBS patients.
Materials and Methods:
Two hundred and forty patients with IBS (based on gastroenterologists’ diagnosis according to ROM III criteria) were referred to Digestive Health Clinic in Psychosomatic Research Center have been selected in this study. Aside with IBS-QOL-34, MOS 36-item short-form health survey (SF-36) and IBS severity index (IBSSI) questionnaires were completed by the cases for determination of correlation coefficients; the data were analyzed using descriptive statistics, factor analysis, Cronbach's alpha, Pearson correlation coefficient by Statistical Package for Social Sciences (SPSS) software, version 18.
Total reliability of the questionnaire was reported by using Cronbach's alpha as 0.95, ranging from 0.65 to 0.90. Correlation coefficients of concurrent implementation of IBS-QOL with SF-36 and IBSSI resulted in −0.61 and 0.64, respectively. Exploratory factor analysis using varimax rotation identified eight principle components, which will determine QOL at 67% variance.
According to the results, IBS-QOL-34 questionnaire has good psychometric properties in the research community and can be safely used as a valid tool to assess QOL of patients with IBS for healthcare and therapeutic purposes.
PMCID: PMC3818619  PMID: 24250698
Factor analysis; irritable bowel syndrome; quality of life questionnaire; reliability; validity
8.  Lipid profile in antipsychotic drug users: A comparative study 
ARYA Atherosclerosis  2013;9(3):198-202.
Schizophrenic patients who receive antipsychotic drugs may be highly prone to metabolic disorders such as weight gain, dyslipidemia, and insulin resistance. The objective of the present study was to compare the effect of atypical and conventional antipsychotics on lipid profile.
128 schizophrenic patients were enrolled into the study. Patients were divided into two groups. One group had received one type of atypical antipsychotic drug, and, the other, one type of conventional antipsychotic drug. They were considered as atypical and conventional groups. Moreover, both groups had not used any other antipsychotic drugs during the past year. Demographic data and food frequency questionnaire were completed by the participants. Serum triglyceride, total cholesterol (TC), high-density lipoprotein and low-density lipoprotein (LDL) cholesterols, and apolipoprotein A and B (Apo B) were tested by blood sample drawing after 12 hours of fasting through the antecubital vein. Student’s t-test was used to compare atypical and conventional groups.
There was no significant difference in age, gender, duration of illness, period of drug consumption, and age at onset of illness in the two groups. Patients in the atypical group used clozapine and risperidone (46.9%) more than olanzapine. In the conventional group 81.3% of patients used phenothiazines. Comparison between lipid profile in the conventional and atypical groups showed a significantly higher mean in TC (P = 0.01), LDL (P = 0.03), and Apo B (P = 0.01) in conventional group than the atypical group.
In schizophrenic patients, the level of lipid profile had been increased in both atypical and conventional antipsychotic users, especially conventional users, so the effect of antipsychotic drugs should be investigated periodically.
PMCID: PMC3681276  PMID: 23766777
Atypical Antipsychotic; Conventional Antipsychotic; Lipid Profile
9.  Comparing the effectiveness of acceptance-based behavior therapy and applied relaxation on acceptance of internal experiences, engagement in valued actions and quality of life in generalized anxiety disorder 
Acceptance-based behavior therapy (ABBT) was developed based on the theory that generalized anxiety disorder (GAD) is maintained through a reactive and fused relationship with internal experiences and a tendency toward experiential avoidance and behavioral restriction. ABBT specifically targets these elements. Here, we aimed to compare ABBT to the applied relaxation (AR), which is the most utilized psychological therapy for GAD.
Materials and Methods:
This study was a randomized clinical trial study. The sample included 18 GAD patients who were referred by an expert psychiatrist to Psychosomatic Research Center of Isfahan University of Medical Sciences. Patients were assigned into two groups (ABBT and AR group). Both groups received routine drug therapies by psychiatrists. The ABBT and AR were applied in 12 weekly sessions. The instruments used in the study included Valued Living Questionnaire, Action, and Acceptance Questionnaire, and Short-Form Health Survey-12 revised Version (SF-12V2). The data were analyzed using the multivariate analysis of variance.
No significant differences were found between ABBT and AR groups in their acceptance of internal experiences, engagement in meaningful activities and quality of life (P > 0.05).
The current study compared ABBT to the most utilized psychological therapy for GAD; i.e., AR. ABBT and AR have similar efficacy on acceptance of internal experiences, valued actions and quality of life.
PMCID: PMC3724371  PMID: 23914213
Anxiety disorder; behavior therapy; quality of life; relaxation
10.  Effect of Acceptance-Based Behavior Therapy on Severity of Symptoms, Worry and Quality of Life in Women With Generalized Anxiety Disorder 
Objective: Acceptance-based behavior therapy (ABBT) is a new psychotherapy for generalized anxiety disorder (GAD). The current study intended to compare severity of symptoms, worry and quality of life of GAD female patients between ABBT and control.
Methods: This study was a randomized clinical trial. The sample included 18 women with GAD referred to psychiatrists in Isfahan, Iran. Patients were assigned in 2 groups randomly (ABBT and control group without any psychotherapy). Both groups received medication. The intervention in ABBT group was conducted based on Roemer & Orsillo's manual for Acceptance-based Behavior Therapy for GAD. 12 therapeutic sessions administered in Shariati psychiatric clinic of Isfahan. The instruments included the GAD-7 Inventory, Penn State Worry Questionnaire (PSWQ) and Short Form Health Survey -12 revised Version (SF-12V2). The data were analyzed using the Multivariate Analysis of Variance (MANCOVA).
Results: Overall, clients receiving ABBT compared to control group reported a significantly decrease in severity of GAD symptoms, and improve in quality of life at post- treatment state. They reported decrease in severity of worry but it was not statistically significant compared to control group.
Conclusion : ABBT was effective in alleviating symptoms of GAD.
PMCID: PMC3940006  PMID: 24644479
Acceptance-Based Behavior Therapy; Generalized Anxiety Disorder; Worry; Quality of Life
11.  Is there any difference between non-obese male and female in response to cardiac rehabilitation programs? 
Coronary artery disease (CAD) is the leading cause of death and disability all over the world. A sedentary lifestyle and dyslipidemia are known to be the major risk factors, which play an important role in the progression of coronary artery disease. Regarding gender differences, the risk of developing coronary heart disease is recognized as being different between non-obese males and non-obese females. Hence, the aim of this study is to assess the benefits of a comprehensive cardiac rehabilitation program (CRP) on the functional capacity and lipid profiles, such as, total cholesterol, triglycerides, low density lipoprotein cholesterol, and high density lipoprotein cholesterol in non-obese males and non-obese females with coronary artery disease, and comparing these groups.
Materials and Methods:
We evaluated 585 non-obese males and females with coronary artery disease. All the participants completed the cardiac rehabilitation program for two months, which included 24 exercise training sessions, medical evaluation, and consultation. For investigation of the effects of the cardiac rehabilitation program on the functional capacity and lipid profiles, exercise tests were carried out by each patient, and also, their blood samples were taken on entrance and at the end of this period.
The findings, following 24 sessions in the cardiac rehabilitation program, showed that the functional capacity (P = 0.00) and all lipid profiles had significantly improved in both the groups, except that the high density lipoprotein cholesterol did not show a significant difference in non-obese females. In addition, comparing the two groups did not show any significant differences in lipid profiles, but the changes in functional capacity were significant (P = 0.00) between the two groups, following the cardiac rehabilitation program.
The CRP, which was performed by the patients under supervision of a physician and an exercise physiologist, plays a key role in improving the functional capacity (FC) and all lipid profiles in non-obese males and females with coronary artery disease, without any attention to gender differences.
PMCID: PMC3687888  PMID: 23798948
Cardiac rehabilitation program; coronary artery disease; gender; risk factor
12.  Type D personality is associated with hyperlipidemia in patients with myocardial infarction 
There are many studies indicating the role of psychological factors in the pathogenesis of cardiovascular disorders. Type D as a new personality construct has been proposed by Denollet, characterized by the joint global traits including negative affectivity and social inhibition. The purpose of this study was to examine the link between type D personality and hyperlipidemia in patients with myocardial infarction (MI).
Materials and Methods:
One hundred and seventy-six consecutive patients admitted to the cardiac care unit (CCU) wards of nine hospitals in Isfahan, Iran, following MI, were selected based on the inclusive and exclusive criteria. The patients completed demographic questionnaire and Type D Personality Scale (DS14). Their medical data were obtained from medical records. Chi-squared test, Student's t-test, and multivariate logistic regression were used to analyze the data.
Of the 176 subjects, 63 patients (35.8%) were type D. In univariate analysis, hyperlipidemia was the only significant variable (56% vs. 40%, P = 0.041) found to be associated with type D. Also, by multivariable logistic regression analysis, hyperlipidemia [Odds Ratio (OR) 0.374; 95% confidence interval (CI) 0.175–0.796] was the only independently significant variable found to be linked with type D personality. No other statistically significant differences were found between the two groups on demographic and medical factors characteristics.
The type D personality was associated with hyperlipidemia. Thus, personality factors may make people vulnerable to metabolic syndromes.
PMCID: PMC3634292  PMID: 23626631
Hyperlipidemia; negative affectivity; psychological factors; social inhibition; type D personality
13.  Attitude scale and general health questionnaire subscales predict depression? 
According to Beck theory, dysfunctional attitude has a central role in emergence of depression. The aim of this study was to determine contributions of dysfunctional attitude and general health index to depression.
In this case-control study, two groups of subjects participated. The first group consisted of 65 patients with major depression and dysthymic disorder, who were recruited from Noor and Navab Safavi Psychiatry Clinics in Isfahan. The control group was consisted of 65 non-patient individuals who were accompanied or relatives of the patients and was matched with them based on age, sex and education. Both groups completed 26-item Dysfunctional Attitude Scale (DAS-26) and 28-item General Health Questionnaire (GHQ-28). Logistic regression and correlation methods were applied for statistical analysis.
Logistic regression analysis showed that by an increase of one level in categorized DAS-26 scores and one score in the physical symptoms, anxiety, social dysfunction and depression subscales of GHQ-28 the risk of depression increase by 6.8, 1.6, 1.9, 3.7, 4.78 times, respectively.
Capability of dysfunctional attitude and general health subscales to predict depression supports the Beck's cognitive diathesis stress theory of depression that dysfunctional attitude may be a predisposing risk factor for depression.
PMCID: PMC3523436  PMID: 23248655
Depression; Beliefs; Cognition; Dysfunctional Attitude; General Health
14.  Type D personality and quality of life in patients with irritable bowel syndrome* 
Some studies indicate that psychological factors and extra-intestinal symptoms affect health related quality of life (HRQoL) in patients with irritable bowel syndrome (IBS) more than what bowel symptoms themselves. Type D personality characterized by global traits including negative affectivity and social inhibition has been proposed to be related to HRQoL. The aim of this study was to determine the association between type D personality and HRQoL inpatients with IBS.
In a cross-sectional study, 194 consecutive patients with IBS referred to two referral gastrointestinal clinics affiliated with Isfahan University of Medical Sciences were selected in respect of inclusion and exclusion criteria. The patients completed type D personality (DS-14), IBS quality of life and the IB severity scoring (IBS-SSS) scales. The patients were divided into two groups with and without type D personality using DS-14. The data was analyzed using ANCOVA and multiple regression.
The findings indicated that 40.7% of the patients had type D personality. The results of ANCOVA with controlling for the influence of severity of IBS and treatment duration showed significant difference between the two groups in health related quality of life (F = 11.89, p < 0.01). Multiple regression analysis indicated negative affectivity (ß =-0.283, p < 0.01), severity of symptoms (ß = 0.279, p = 0.000) and duration of treatment (ß =-0.189, p < 0.05) as the significant predictors for HRQoL in patients with IBS.
Type D personality may be an important determinant of individual differences in HRQoL among IBS patients. Negative affectivity as one of type D dimensions may have an adverse effect on HRQoL in patient with IBS. Therefore, additional attention is needed in IBS patients with type D personality.
PMCID: PMC3263093  PMID: 22279472
Type D Personality; Negative Affectivity; Social Inhibition; Irritable Bowel Syndrome; Quality of Life; Psychosomatic Disorders
15.  Relationship between depression and apolipoproteins A and B: a case–control study 
Clinics  2011;66(1):113-117.
To investigate the relation between major depressive disorder and metabolic risk factors of coronary heart disease.
Little evidence is available indicating a relationship between major depressive disorder and metabolic risk factors of coronary heart disease such as lipoprotein and apolipoprotein.
This case–control study included 153 patients with major depressive disorder who fulfilled the criteria of the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM‐IV), and 147 healthy individuals. All participants completed a demographic questionnaire and Hamilton rating scale for depression. Anthropometric characteristics were recorded. Blood samples were taken and total cholesterol, high‐ and low‐density lipoproteins and apolipoproteins A and B were measured. To analyze the data, t‐test, χ2 test, Pearson correlation test and linear regression were applied.
Depression was a negative predictor of apolipoprotein A (β = −0.328, p<0.01) and positive predictor of apolipoprotein B (β = 0.290, p<0.05). Apolipoprotein A was inversely predicted by total cholesterol (β = −0.269, p<0.05) and positively predicted by high‐density lipoprotein (β = 0.401, p<0.01). Also, low‐density lipoprotein was a predictor of apolipoprotein B (β = 0.340, p<0.01). The severity of depression was correlated with the increment in serum apolipoprotein B levels and the decrement in serum apolipoprotein A level.
In view of the relationship between apolipoproteins A and B and depression, it would seem that screening of these metabolic risk factors besides psychological interventions is necessary in depressed patients.
PMCID: PMC3044579  PMID: 21437446
Coronary risk factors; Coronary heart disease; Major depression
16.  Positive and negative perfectionism and their relationship with anxiety and depression in Iranian school students 
Although many studies have investigated the relationship between perfectionism, anxiety, and depression among the adults, little is known about the manifestations of perfectionism among schoolage youths. This study has investigated this relationship in an Iranian sample.
Using multistage cluster random sampling, 793 Iranian school students in 2007 were studied. Data of demographic characteristics, children's depression inventory, revised children's manifest anxiety scale, and the positive and negative perfectionism scales were obtained using questionnaires.
The results indicated that both aspects of perfectionism are associated with depression and anxiety. Negative and positive perfectionism have positive and negative associations, respectively, with depression and anxiety. The interaction of anxiety and depression with perfectionism reveals that depression is in association with lower scores of positive perfectionism, whereas in students with higher scores of negative perfectionism, the anxiety scores are also higher. Moreover, the accompaniment of anxiety with depression is in association with relatively lower levels of negative perfectionism.
It was concluded that negative perfectionism is a risk factor for both depression and anxiety, while positive perfectionism is a protective factor. However, the interventions which encourage the positive aspects of perfectionism and decrease its negative aspects may be able to diminish psychopathological subsequence.
PMCID: PMC3063422  PMID: 21448388
Depressions; Anxiety
17.  Levofloxacin-Induced Torsades de Pointes 
Texas Heart Institute Journal  2010;37(2):216-217.
A 91-year-old woman, presenting with flu-like symptoms, developed a brief episode of polymorphic ventricular tachycardia in the emergency department. The arrhythmia resolved spontaneously, and a subsequent electrocardiogram revealed Q waves and ST-segment elevation in the anterior precordial leads, along with a prolonged QT interval. The presumed diagnosis was ST-segment–elevation myocardial infarction with ischemia-induced ventricular tachycardia. Emergent coronary artery angiography revealed only minimal luminal irregularities. It was discovered that the patient had been taking levofloxacin and, apparently as a result, developed drug-induced torsades de pointes. The case of this patient is an example of the difficulties that are occasionally encountered in differentiating ST-segment–elevation myocardial infarction from nonischemic ST elevation.
PMCID: PMC2851437  PMID: 20401298
Aged, 80 and over; antibacterial agents/adverse effects; arrhythmias, cardiac/chemically induced; electrocardiography; fluoroquinolones/adverse effects; myocardial infarction/diagnosis; torsades de pointes/chemically induced/etiology
18.  Sinus Arrest during Radiofrequency Ablation of the Atrioventricular-Node Slow Pathway 
Texas Heart Institute Journal  2009;36(5):477-479.
Radiofrequency ablation has been associated with changes in autonomic function. In this case, a 52-year-old woman was referred for electrophysiologic study of recurrent supraventricular tachycardia. Typical slow/fast atrioventricular node re-entry tachycardia was induced and confirmed during the study. Radiofrequency ablation of the slow pathway of the atrioventricular node led to sinus arrest, which resolved once ablation was stopped. Given the distance of the ablation site from the sinus node, we inferred that mechanisms other than direct injury to the sinus node were involved. To our knowledge, this is only the 2nd reported finding of sinus arrest during slow-pathway ablation of the atrioventricular node. This case highlights the complex interaction between the autonomic nervous system and the cardiac conduction system. Possible mechanisms include a Bezold-Jarisch reflex and modification of the intrinsic autonomic nervous system.
PMCID: PMC2763469  PMID: 19876434
Afferent pathways; autonomic nervous system diseases; catheter ablation/adverse effects; electrophysiology; heart conduction system; parasympathetic nervous system; radiofrequency ablation; tachycardia, supraventricular/therapy
19.  Prevalence of diabetes and other cardiovascular risk factors in an Iranian population with acute coronary syndrome 
Coronary artery disease is the leading cause of death in industrialized countries and most patients with diabetes die from complications of atherosclerosis. The objective of this study was to determine the presence of diabetes mellitus and other conventional coronary heart disease risk factors (cigarette smoking, hypertension and hyperlipidemia) in patients with acute coronary events in an Iranian population.
The study included 514 patients with unstable angina or myocardial infarction (MI) out of 720 patients admitted to CCU ward of a general hospital from March 2003 to March 2005. History of diabetes, hypertension and cigarette smoking, demographic indices, coronary heart disease and diabetes mellitus treatment, myocardial enzymes, serum triglycerides (TG) and cholesterol and fasting and non fasting blood glucose levels and HbA1C of diabetics were recorded of admission sheets. The data were structured to appropriate one way ANOVA, T tests, and chi square test with SPSS 13 product for windows.
Out of all patients 35.8% were female, 30% were diabetics (Duration 13.4 ± 8.7 years), 42% were smoker and 91% were hypertensive. Twenty four percent had MI and 76% had unstable angina. MI was significantly higher in diabetic patients (36.4% vs. 19.2%, P < 0.001). Location and extension of MI and myocardial enzymes did not differ between diabetics and non-diabetic patients. Diabetic patients were older than non diabetics (65 ± 11.6 vs. 59.7 ± 12.5 years, p < 0.05). Five (66.7%) out of 9 patients with fatal MI were diabetics (Odds Ratio = 2.98). Age, duration of diabetes and HbA1c levels, did not differ between diabetic patients with or without MI. Hypertension and current smoking was significantly higher in patients with MI compared to patients with unstable angina (p < 0.05). Serum TG, HDL-C, LDL-C and total cholesterol level did not differ between patients with MI and unstable angina. Diabetic patients compare to non diabetic patients were more hypertensive (96% vs. 88.7%, p < 0.005) and had higher serum triglyceride (TG over 200 mg/dl, 35.1% vs. 26.4, p <0.05). Diabetes was more frequent among women than men (36.4% vs. 26.4%, p < 0.05). Women were older than men (65 ± 11.6 vs. 59.2 ± 13 years, p < 0.005) and had higher total serum cholesterol (200 ± 41.8 vs. 192 ± 42.5 mg/dl, p < 0.05) and HDL-C levels (49.7 ± 22 vs. 40 ± 13 mg/dl, p < 0.005). Ninety seven percent of all patients had at least one of cardiovascular risk factors (hypertension, smoking, diabetes, high cholesterol and low HDL-cholesterol levels).
In this study 19 out of 20 patients with acute coronary event have at least one of conventional cardiac risk factors. Diabetes and hypertension are leading risk factors, which may directly or indirectly interfere and predict more serious complications of coronary heart disease.
PMCID: PMC1550715  PMID: 16842631
20.  Cryoablation of Incessant Ventricular Tachycardia: Case Report and Long-Term Follow-Up 
Texas Heart Institute Journal  2000;27(1):52-54.
We report the case of a 52-year-old man who had incessant ventricular tachycardia despite treatment with antiarrhythmic agents. Placement of an implantable cardioverter/defibrillator, radiofrequency ablation, and antitachycardia pacing were ineffective. He underwent intraoperative arrhythmia mapping and cryoablation at our institution. Eighteen months later, he remained free of arrhythmia. He was in New York Heart Association functional class II with an ejection fraction of 30%.
PMCID: PMC101020  PMID: 10830630
Anti-arrhythmia agents/therapeutic use; cardiac pacing, artificial; catheter ablation/methods; cryosurgery/methods; defibrillators, implantable; myocardial infarction/complications; tachycardia, ventricular/etiology; tachycardia, ventricular/surgery;; tachycardia,ventricular/therapy

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