Background: THROMBOLYTIC THERAPY in patients with sub-massive pulmonary embolism (SMPTE) needs further assessment. Objectives: The current study aimed to assess a potential benefit of THROMBOLYTIC and non-THROMBOLYTIC THERAPY in patients with SMPTE. Patients and Methods: One hundred-nineteen patients were enrolled with SMPTE from 2006 to 2010 in the tertiary care center of Rajaie medical and research center. The patientswhohad pulmonary thromboemboli (PTE) and received THROMBOLYTIC plus heparin THERAPY and or non-THROMBOLYTIC (unfractionated heparin alone) were evaluated for hemodynamic changes (blood pressure, pulse rate, pulmonary artery systolic pressure, right ventricular failure and right ventricle enlargement), before and after 48 hours of treatment. The mortality rate was also assessed. Results: Forty-five percent of the patients with SMPTE received THROMBOLYTIC THERAPY (streptokinase) and 55% of SMPTE patients received non-THROMBOLYTIC THERAPY (unfractionated heparin). Pulse rate, pulmonary arterial pressure and tricuspid regurgitation gradient in patients receiving THROMBOLYTIC THERAPY reduced significantly (P = 0. 001, P = 0. 01 and P = 0. 001, respectively). There was no significant difference before and after treatment regarding systolic blood pressure (P = 0. 4), diastolic blood pressure (DBP) (P = 0. 5), systolic arterial pressure (SPAP) (P = 0. 1), Right ventricular (RV) function (P = 0. 1) and RV size (P = 0. 1). In patients who received a non-THROMBOLYTIC THERAPY, there were no significant differences between the groups regarding SBP (P = 0. 2), DBP ( P= 0. 4) and PR (P = 0. 1), SPAP (P = 0. 6), TRG (P = 0. 4), RV function (P = 0. 4) and RV size (P = 0. 2) before and after treatment. There were no significant differences between the groups according to mortality rate. Conclusions: THROMBOLYTIC THERAPY lead to earlier relief of hemodynamic condition in comparison to non-THROMBOLYTIC THERAPY but no changes were observed in mortality rate.

The important role of reperfusion therapies in the treatment of acute myocardial infarction is well documented. However, reperfusion therapies can initiate inflammatory response and may damage the myocardium. The purpose of current study was to compare the effects of percutaneous coronary intervention and THROMBOLYTIC THERAPY on inflammatory markers in the setting of ST elevation myocardial infarction (STEMI). Eighty three patients with STEMI were enrolled in this study. 40 patients underwent percutaneous coronary intervention (PCI), and 43 patients received streptokinase (1. 5 million IU) as a main medical reperfusion THERAPY. Monocyte expression of Toll-like receptor 4 (TLR4), serum levels of TNF-α and IL-1β , red cell distribution width (RDW) and C-reactive protein (CRP) were compared between groups at admission time, two hours and four hours after termination of treatment. p<0. 05 was considered as statistically significant for all tests. Compared to baseline, both treatments increased monocyte expression of TLR4, serum levels of cytokines and CRP. Compared to PCI, medical reperfusion THERAPY significantly raised both monocyte expression of TLR4 (39. 8± 4. 7 % vs 49. 1± 3. 6 %, p<0. 01), and serum levels of TNF-α (13. 2± 3. 7 pg/ml vs 25. 1± 2. 6 pg/ml p<0. 05). No effect was seen on RDW levels. Moreover, medical reperfusion THERAPY caused significant rise in CRP levels (p<0. 01). The present study demonstrates that THROMBOLYTIC THERAPY is associated with higher inflammatory responses compared to PCI. Our findings suggest that THROMBOLYTIC THERAPY may increase the likelihood of detrimental effects of reperfusion THERAPY on the myocardium.

Background: Acute ischemic stroke (AIS) is a leading cause of mortality and long-term disability worldwide. In Iran, AIS tends to occur nearly a decade earlier than in developed nations, presenting unique challenges. Intravenous recombinant tissue plasminogen activator (IV-rtPA) is an effective THROMBOLYTIC THERAPY for AIS, but various factors limit its utilization.Objectives: This study aimed to identify the barriers to the administration of IV-rtPA in AIS patients at Shahid Beheshti Hospital in Qom, Iran. Methods: A cross-sectional descriptive-analytical study was conducted on AIS patients admitted between November 2021 and September 2022. A total of 322 patients were screened, and 178 met the inclusion criteria. Data on demographic characteristics, stroke severity (NIHSS score), comorbidities, onset-to-door time, and reasons for not receiving IV-rtPA were analyzed using SPSS version 22. Results: Of the 178 patients, 87 (48.9%) received IV-rtPA, while 91 (51.1%) did not. The primary reasons for withholding thrombolysis were clinical improvement (37.4%), late hospital arrival beyond 4.5 hours (24.2%), lack of consent (20.9%), the physician's conservative approach (11%), and mild progression of stroke symptoms (6.6%). A significant correlation was found between NIHSS score and reasons for non-receipt of THERAPY (P < 0.001). Patients with a prior stroke history were more likely to experience delays due to a physician’s conservative approach (28.6% vs. 5.7%, P < 0.01). Barriers to thrombolysis were also associated with lower education levels and a lack of public awareness about stroke symptoms. Conclusions: Delayed hospital admission and lack of consent were the leading barriers to IV-rtPA administration. Public awareness campaigns emphasizing the urgency of recognizing stroke symptoms and seeking timely medical care are crucial to improving thrombolysis rates and reducing AIS-related disabilities in Iran.

Background: Stroke is a major health concern worldwide, and timely intervention is crucial for improving outcomes in ischemic stroke patients. Emergency specialists play a critical role in managing these patients, yet gaps in their knowledge of stroke symptoms, risk factors, and THROMBOLYTIC THERAPY can cause delays in treatment, ultimately impacting patient outcomes. Objectives: This study aimed to evaluate the knowledge of emergency medicine specialists in Tabriz, Iran, regarding stroke symptoms, risk factors, and therapeutic interventions, with a specific focus on THROMBOLYTIC THERAPY. Methods: A survey study was conducted with 30 emergency medicine specialists from hospitals in Tabriz, using a structured questionnaire for data collection. Participants were selected through simple random sampling. The questionnaire assessed knowledge of common stroke symptoms, risk factors, and management protocols, including the use of tissue plasminogen activator (tPA). The validity and reliability of the tool were established through expert review and a pilot study. Data were analyzed using descriptive statistics and Pearson correlation, with a significance level set at P < 0.05. Results: The study revealed that participants had limited knowledge of stroke symptoms, with most identifying only 4 out of 10 common symptoms. While high blood pressure and heart disease were widely recognized as risk factors (100%), less common factors, such as stress and heredity, were poorly identified. Regarding management, 97% of participants were aware of tPA, but none correctly identified all three treatment strategies (tPA, aspirin, and surgery). Additionally, fewer than 60% of participants prioritized calling emergency medical services (EMS) as the first step in stroke management. Conclusions: The findings underscore significant gaps in emergency specialists' knowledge of stroke symptoms, risk factors, and management strategies, particularly concerning THROMBOLYTIC THERAPY. Targeted educational interventions are essential to enhance emergency medicine specialists' understanding of stroke care and improve patient outcomes.

Background: Metabolic syndrome (MetS) comprises a group of conditions that happen together and increase the risk of heart disorders. MetS has known characteristic diagnostic criteria and is diagnosed through physical examination and blood tests. This syndrome is extremely prevalent in patients with acute myocardial infarction. We aimed to determine the prevalence of MetS and its relationship with myocardial infarction and response to treatment in patients suffering from acute myocardial infarction under fibrinolytic treatment. Methods: In this cross-sectional study, 145 patients with acute ST-elevation myocardial infarction (STEMI) were enrolled. They were referred to Bu-Ali Sina Hospital in Qazvin, Iran, between January 2018 and January 2019 and were candidates for THROMBOLYTIC THERAPY. The patients were divided into two groups with and without MetS according to the NCEP ATP III definition (the National Cholesterol Education Program-Adult Treatment Panel III). In each group, the ST resolution of more than 50% in electrocardiogram was evaluated 90 minutes after THROMBOLYTIC administration. In addition, angiographic information and left ventricular ejection fraction (LVEF) were compared between the two groups. Results: Overall, the prevalence of MetS was 57. 2% in the study population. After treatment, ST-segment resolution of more than 50%, the number of involved coronary vessels, the thrombolysis in myocardial infarction flow grade, mean LVEF, and type of myocardial infarction were similar in both study groups. Conclusion: Our study indicates that MetS does not affect the response rate to THROMBOLYTIC treatment.