Pedunculated focal nodular hyperplasia of the liver in a healthy child born following in vitro fertilization: a case report and review of the literature

BACKGROUND

Focal nodular hyperplasia is a common nonmalignant liver mass. This nonvascular lesion is an uncommon mass in children, especially those with no predisposing factors, namely radiation, chemotherapy, and hematopoietic stem cell therapy. Exophytic growth of the lesion further than the liver margins is not common and can complicate the diagnosis of the lesion. This report observes a focal nodular hyperplasia as a pedunculated lesion in a healthy child.

CASE PRESENTATION

We describe a 9-year-old healthy Persian child who was born following in vitro fertilization complaining of abdominal pain lasting for months and palpitation. Employing ultrasound and computed tomography, a mass was detected in the right upper quadrant compatible with focal nodular hyperplasia imaging features. The child underwent surgery and the mass was resected.

CONCLUSION

Diagnosing focal nodular hyperplasia, especially pedunculated form can be challenging, although magnetic resonance imaging with scintigraphy is nearly 100% sensitive and specific. Thus, a biopsy may be needed to rule out malignancies in some cases. Deterministic treatment in patients with suspicious mass, remarkable growth of lesion in serial examination, and persistent symptoms, such as pain, is resection, which can be done open or laparoscopic.

The role of diabetic foot treatment in improving left ventricular function: Insights from global longitudinal strain echocardiography

We decided to evaluate the effect of treatment of diabetic foot ulcers in improving heart function by strain echocardiography than conventional transthoracic echocardiography. This prospective cross-sectional study included patients with diabetic foot ulcer (DFU). Conventional and two-dimensional strain echocardiography performed before and after three months diabetic foot treatment. Then, we compared the echocardiographic parameters including left ventricular ejection fraction (LV-EF), left ventricular global longitudinal strain (LV-GLS). Multivariate and univariate logistic regression analysis were performed to find which variable was mainly associated with LV-GLS changes. 62 patients with DFU were conducted. After echocardiography, all patients underwent surgical or non-surgical treatments. Three months after the treatment, LV-EF was not significantly different with its' primary values (P = 0.250), but LV-GLS became significantly different (P<0.05). In the multivariate logistic regression analysis, with the increase in the grade of ulcer, LV-GLS improved by 6.3 times. Not only the treatment of DFU helps to control adverse outcomes like infection, limb loss and morbidity but also it enhances cardiac function. Of note, strain echocardiography found to be a better indicator of myocardial dysfunction than LV-EF. These findings make a strong reason for the routine assessment of cardiac function in patients with DFU.

A case report of QTc prolongation: Drug induced or myocarditis in Severe Acute Respiratory Syndrome Coronavirus 2

Remdesivir is a nucleotide prodrug of an adenosine analog. It binds to the viral Ribonucleic Acid (RNA)-dependent RNA polymerase and inhibits viral replication by terminating RNA transcription prematurely. Remdesivir has demonstrated in vitro and in vivo activity against Severe Acute Respiratory Syndrome Coronavirus 2; it also acts in vitro neutralization activity against the Omicron variant and its subvariants. We reported a 54-years-old woman admitted with Coronavirus disease 2019. Considering to require a high fraction of inspired oxygen therapy (⩾0.6) and based on lung high resolution computed tomography, Remdesivir therapy was ordered for 5 days. She experienced palpitations and dizziness 2 days after starting Remdesivir therapy. Her QTc interval was prolonged on the electrocardiogram without any significant electrolyte abnormalities or concomitant use of medications. Although the cardiac side effects of Remdesivir therapy have been well documented, in a few cases reported the association between Remdesivir therapy and QTc interval prolongation. Since, QTc interval prolongation has the potential risk of sudden cardiac death, the clinicians should be aware of mentioned association and check electrocardiogram daily, as well as other laboratory exams.

Combined tracheoesophageal transection following a life-threatening clothesline-type blunt neck trauma: A case report

INTRODUCTION

Blunt neck trauma is an uncommon, life-threatening injury that may result in tracheoesophageal transection. The manifestations of these traumas are rather vague and nonspecific; therefore, the injury may be missed, if a careful attention is not paid.

CASE PRESENTATION

A 23-year-old young man presented with complete transection of the trachea and concurrent esophageal injury, caused by clothesline-type blunt neck trauma, while riding a motorcycle. On early examination, the patient was hemodynamically stable; however, after a few minutes, he manifested respiratory distress and progressive subcutaneous emphysema. The airway immediately was secured by inserting an endotracheal tube in distal part of the transected trachea. Afterward, the patient underwent primary repair of transected trachea and esophagus, and tracheostomy. The post-operative period was uneventful.

DISCUSSION

The blunt traumas to neck, which lead to complete transection of the trachea and the esophagus, are rare injuries. Clothesline-type injuries are the principal reasons for cricotracheal separation and further esophageal injuries. In most cases, subcutaneous emphysema is a sign of significant trauma to the aerodigestive tract. After securing the patient's airway, early surgical repair of the transected trachea and esophagus reduces the risk of further complications.

CONCLUSION

This report discusses a rare, life-threatening presentation of blunt neck trauma called clothesline-type injury, that led to complete transection of the trachea and concurrent esophageal rupture. Establishing a secure airway for those patients with tracheal injuries is required. Repairing the injured trachea and esophagus primarily at the earliest possible time can improve the patient prognosis and prevent further complications.

The effect of physical activity level on the severity of diastolic dysfunction

BACKGROUND

Diastolic dysfunction (DD) is a risk factor for cardiovascular events in patients undergoing non-cardiac surgeries. Investigators aimed to assess the effect of physical activity level on the diastolic function of the left ventricle (LV) in patients attending the preoperative visit.

METHODS

This analytic cross-sectional study was conducted on 228 patients referred to Poursina hospital from November 2021 to March 2022. To define the physical activity level, we used the short form of the International Physical Activity Questionnaire (IPAQ). We categorized patients into inactive, minimally active, and health-enhancing physical activity groups. We also divided participants into three groups based on their daily sitting time. Also, echocardiographic parameters were calculated. The diastolic function of LV was evaluated, and its grading was defined from mild (grade1) to severe (grade 3).

RESULTS

Results showed that patients with DD had significantly higher age and lower levels of education (P < 0.001 and P = 0.005, respectively). After assessing echocardiographic parameters, we found that E/e', TR Velocity, left atrial volume index, and pulmonary artery pressure had a statistically significant inverse relationship with physical activity level (P < 0.001 for all). Comparing physical activity level of subgroups showed that in HEPA (health-enhancing physical activity), the chance of developing grade 2 or 3 DD was reduced by 97% compared to the inactive group (OR = 0.03, P < 0.001). Still, there was no significant difference between the inactive and minimally active groups (P = 0.223).

CONCLUSIONS

This study showed an inverse relationship between physical activity level and DD of the LV in a sample of 228 individuals attending the Anesthesia Clinic, independent of potentially confounding variables.Therefore, due to lower rate of DD in patients who are physically active, we can expect lower occurrence rate of cardiovascular events during surgery.

Ethnic differences in the lifestyle behaviors and premature coronary artery disease: a multi-center study

BACKGROUND

Diverse ethnic groups that exist in Iran may differ regarding the risk factors such as hypertension, hyperlipidemia, dyslipidemia, diabetes mellitus, and family history of non-communicable disease. Premature Coronary Artery Disease (PCAD) is more endemic in Iran than before. This study sought to assess the association between ethnicity and lifestyle behaviors in eight major Iranian ethnic groups with PCAD.

METHODS

In this study, 2863 patients aged ≤ 70 for women and ≤ 60 for men who underwent coronary angiography were recruited in a multi-center framework. All the patients' demographic, laboratory, clinical, and risk factor data were retrieved. Eight large ethnicities in Iran, including the Farses, the Kurds, the Turks, the Gilaks, the Arabs, the Lors, the Qashqai, and the Bakhtiari were evaluated for PCAD. Different lifestyle components and having PCAD were compared among the ethnical groups using multivariable modeling.

RESULTS

The mean age of the 2863 patients participated was 55.66 ± 7.70 years. The Fars ethnicity with 1654 people, was the most subject in this study. Family history of more than three chronic diseases (1279 (44.7%) was the most common risk factor. The Turk ethnic group had the highest prevalence of ≥ 3 simultaneous lifestyle-related risk factors (24.3%), and the Bakhtiari ethnic group had the highest prevalence of no lifestyle-related risk factors (20.9%). Adjusted models showed that having all three abnormal lifestyle components increased the risk of PCAD (OR = 2.28, 95% CI: 1.04-1.06). The Arabs had the most chance of getting PCAD among other ethnicities (OR = 2.26, 95%CI: 1.40-3.65). While, the Kurds with a healthy lifestyle showed the lowest chance of getting PCAD (OR = 1.96, 95%CI: 1.05-3.67)).

CONCLUSIONS

This study found there was heterogeneity in having PACD and a diverse distribution in its well-known traditional lifestyle-related risk factors among major Iranian ethnic groups.

Ethnicity based differences in statin use and hypercholesterolemia control among patients with premature coronary artery disease-results of I-PAD study

Background

Statins use is the most important treatment for high LDL cholesterol in patients with premature coronary artery disease (CAD). Previous reports have shown racial and gender differences in statin use in the general population, but this wasn't studied in premature CAD based on different ethnicities.

Methods and results

Our study includes 1917 men and women with confirmed diagnosis of premature CAD. Logistic regression model was used to evaluate the high LDL cholesterol control in the groups and the OR with 95% confidence interval (CI) was reported as the effect size. After adjustment for confounders, the odds of controlling LDL in women taking Lovastatin, Rosuvastatin, and Simvastatin were 0.27 (0.03, 0.45) lower in comparison with men. Also, in participant who took 3 types of statins, the odds of controlling LDL were significantly different between Lor and Arab compared with Fars ethnicity. After adjustment to all confounders (full model), the odds of controlling LDL were lower for Gilak in Lovastatin, Rosuvastatin, and Simvastatin by 0.64 (0.47, 0.75); 0.61 (0.43, 0.73); 0.63 (0.46, 0.74) respectively and higher for Arab in Lovastatin, Rosuvastatin, and Simvastatin by 4.63 (18.28, 0.73); 4.67 (17.47, 0.74); 4.55 (17.03, 0.71) respectively compared to Fars.

Conclusions

Major differences in different gender and ethnicities may have had led to disparities in statin use and LDL control. Awareness of the statins impact on high LDL cholesterol based on different ethnicities can help health decision-makers to close the observed gaps in statin use and control LDL to prevent CAD problems.

Relationship Between Duke Treadmill Score and Severity of CAD in Suspected Patients

Nowadays, cardiovascular disease, including coronary artery disease, is the leading cause of death around the world. Duke Treadmill Score (DTS) is used as a prognostic score for patients suspected of coronary artery disease. Investigating the Relationship between DTS and syntax score (SxScore) as an indicator of complexity and severity of coronary artery disease in patients with intermediate and high Duke Score. This cross-sectional study was conducted at the exercise test unit of Heshmat Hospital in Rasht from September 2017 to December 2018. Among 1033 patients that passed exercise cardiac stress testing (EST), 118 patients who had positive exercise testing for CAD were enrolled. Coronary angiography was performed, and SxScore, a marker of CAD complexity, was determined. The relationship between DTS and SxScore was then evaluated. The data were analyzed by SPSS version 21. The risk of positive EST raised age more than 61 years (OR=1.072; 95%; CI=1.046-1.099), Hypertension (OR=3.235; 95%; CI=2.097-4.992), Hyperlipidemia (OR=2.109; 95%; CI=1.371-3.242) and Diabetes Mellitus (OR=2.15; CI=1.22-3.14). The presence of the following factors reduced positive EST: female (OR=0.377;95%; CI=0.133-1.068), retired (OR=0.128;95%; CI=0.045-0.361). The results of the present study showed that there was no significant difference between the degree of coronary artery involvement based on syntax with Duke scores (P=0.328). Although both DTS and Syntax scores are useful in evaluating coronary artery disease, there isn't a significant relationship between these scores, and they don't coincide. In other words, we cannot use DTS to predict the Syntax score.

Intraoperative Awareness in Patients Undergoing Cardiac Surgery in an Academic Center in the North of Iran

Background

Coronary artery bypass grafting (CABG) has distinctive characteristics that may increase the risk of awareness during general anesthesia (AGA).

Objectives

This study was conducted to assess the incidence of AGA in cardiac surgery in an academic hospital in Guilan, Iran.

Methods

This descriptive cross-sectional study was performed in Dr. Heshmat Hospital in Rasht, Iran. Eligible patients candidates for CABG were enrolled in the survey in 2022. After surgery, when the patient was cooperative enough, a questionnaire including demographic data and specialized questions related to different stages of anesthesia was completed via face-to-face interviews. The data were analyzed using IBM SPSS Statistics 21 with chi-square, Fisher's exact, and t-test.

Results

The data from 322 patients were analyzed, of whom 14 (4.3%) experienced AGA. Among them, the "feeling of fear and anxiety" reported by 9 (39.1%) cases was the most common awareness state. "Dreaming during surgery and anesthesia" and "feeling unable to move during anesthesia,", each reported by 6 (26.1%) cases, were the other common types of awareness state. None of the demographic data had a significant association with the occurrence of AGA.

Conclusions

The incidence of AGA during CABG was almost acceptable according to the credible evidence.

Evaluation of cardiometabolic risk markers linked to reduced left ventricular ejection fraction (LVEF) in patients with ST-elevation myocardial infarction (STEMI)

Background

It is well established that left ventricular systolic dysfunction (LVSD), as marked by reduced left ventricular ejection fraction (LVEF), notably worsens the prognosis of ST-elevation myocardial infarction (STEMI). However, the link between cardiometabolic risk markers and LVSD seems unclear. This study aimed to investigate the differences in variables affecting reduced LVEF in STEMI patients.

Methods

In the current retrospective study, 200 consecutive STEMI patients were enrolled between April 2016 to January 2017. Analysis of serum parameters, anthropometric evaluation, and echocardiography was performed after admission. The participants were categorized according to LVEF levels as follows: group1 (normal: 50–70%, n = 35), group2 (mildly reduced: 40–49%, n = 48); group3 (moderately reduced: 30–39%, n = 94) and group4 (severely reduced: < 30%, n = 23). Between-group comparisons were made using the Kruskal–Wallis test.

Results

Overall, of 200 STEMI patients with a mean age of 62 years, 27%(n = 54) were females. The median of BMI of patients in group4 (31.07 kg/m²) was significantly higher than group3 (26.35 kg/m²), group2 (25.91 kg/m²), and group1 (24.98 kg/m²; P value < 0.0001). Group4 patients showed significantly increased fasting blood sugar (FBS) than groups 1 (212.00, vs. 139.00 mg/dl; P value = 0.040). Patients in groups 1 and 2 exerted significantly elevated triglyceride levels than those in group4 (142.00, 142.50, and 95.00 mg/dl; P value = 0.001). WBC count, neutrophil%, and neutrophil to lymphocyte ratio among those in group1 (10,200/m³, 70.00%, and 2.92, respectively) were significantly lower than group4 (12,900/m³, 83.00%, and 5.47, respectively; P value < 0.05).

Conclusion

These findings highlight higher BMI, FBS, and leucocyte count linked to LVSD, probably through increasing the inflammation and reducing LVEF levels. More extensive studies are needed to clarify the clinical relevance of these results.

Melissa officinalis tea favourably affects the frequency of premature ventricular beats and cardiometabolic profile among patients with premature ventricular contraction: A randomised open-label controlled trial

BACKGROUND AND AIMS

Premature ventricular contraction (PVC) as one of the most common arrhythmias could worsen the morbidity of cardiovascular events, particularly concurrent with other risk factors. Considering the probable side effects of antiarrhythmic drugs chronic use, prescribing herbal medicines for such conditions is on the rise. Melissa officinalis (MO) is widely identified as an antiarrhythmic and cardioprotective agent but there is limited evidence for its clinical use. This research, thus, aimed to investigate the effects of MO tea among patients with PVCs.

METHODS

The present 12-week randomised controlled trial enrolled 60 patients with confirmed diagnosis of moderate to low-grade PVCs. The patients in intervention group received MO teabags (containing 2-g dried leaves/250 mL in hot water) two times/day in addition to lifestyle modification recommendations, while control group only received lifestyle modification recommendations. After collecting the data, blood samples were gathered to explore serum concentrations of glucose and lipid markers. The number of premature ventricular beats and heart rates was determined by 24-hour rhythm Holter monitoring.

RESULTS

On average, the patients aged 47 years and approximately 67.8% (n = 40) were women. The ANCOVA adjusted for baseline values and confounders revealed that patients in the MO tea group had significantly lower concentrations of triglyceride (adjusted mean (AM) = 144.75 mg/dL), total cholesterol (AM = 155.35 mg/dL), and fasting blood sugar (AM = 90.85 mg/dL), compared with the controls (AM = 174.27, 171.99, 99.84 mg/dL, respectively (P-value ≤.042). However, the intervention failed to affect LDL-C and HDL-C levels significantly. Significantly reduced frequency of 24-hour premature ventricular beats in the MO tea group (AM = 2142.39) was also noted compared with the controls (AM = 3126.05); (P-value = .017). The 24-hour heartbeats showed only a significant decrease within the intervention group (P-value < .01).

CONCLUSION

Together, these results seem to support the higher cardioprotective effects of MO as a medicinal plant than lifestyle modifications alone. Nevertheless, further exploration of this hypothesis is warranted using large-scaled clinical trials.

The effects of rice bran oil on left ventricular systolic function, cardiometabolic risk factors and inflammatory mediators in men with coronary artery disease: a randomized clinical trial

BACKGROUND/OBJECTIVE

In the current study, we aimed to explore the effects of rice bran oil (RBO) in adjunct to conventional medical therapy on left ventricular ejection fraction (LVEF), cardiometabolic risk factors, and inflammatory mediators in male patients with coronary artery disease (CAD).

SUBJECTS/METHODS

The present randomized controlled trial included 40 men diagnosed with CAD (mean age = 55.76 years) who were randomly allocated into two groups to receive either 30 grams per day of RBO (intervention group) or sunflower oil (control group) plus a standard diet for eight weeks. At the initial visit, demographic and anthropometric data and blood samples were collected. LVEF levels and serum concentrations of lipid profile, glucose, uric acid, hs-CRP, and TNF-α were investigated.

RESULTS

A total of 37 participants completed the study (n = 18 in the intervention group, n = 19 in the control group). Analysis of covariance (ANCOVA) adjusted for baseline values, age and body mass index revealed that RBO significantly improved LVEF (51.34%) and reduced triglyceride (125.01 mg dl^-1), blood sugar (110.4 mg dl^-1), total cholesterol (123.01 mg dl^-1) and low density lipoprotein (56.88 mg dl^-1) levels compared to sunflower oil ((45.56%), (155.93 mg dl^-1), (128.94 mg dl^-1), (163.93 mg dl^-1) and (83.79 mg dl^-1), respectively) following a 8-week trial (P-values < 0.05). Additionally, the test demonstrated that RBO consuming patients had significantly lower levels of serum uric acid (4.60 mg dl^-1), TNF-α (6.99 ng L^-1) and hs-CRP (2.11 mg L^-1) compared to the control group ((5.92 mg dl^-1), (15.23 ng L^-1), (4.47 mg L^-1), respectively) (P-value < 0.05). However, no significant changes were found regarding weight, blood pressure or serum HDL levels throughout the trial.

CONCLUSION

Consumption of 30 grams per day RBO within a standard diet could be considered an effective non-pharmacological approach in improving LVEF, cardiometabolic risk factors, and inflammatory state in CAD. However, future trials are recommended for more clarification.

Investigating shift work disorder among workers of Hamadan Glass Factory in 2017

Introduction: Shift work is an occupational stressor that influences some workforce. The present study examined shift work disorders among people who work in Hamadan Glass Factory. Materials and Methods: Participants included 210 workers (130 shift workers and 80 day-workers) of Hamadan Glass Factory. The survey of shift workers (SOS) was used to collect information on respondents’ demographic background, gastrointestinal, cardiovascular, psychological disorders, sleep-related problems, musculoskeletal disorders, and adverse effects of shift work on individual, family, and social life. Other information was obtained by studying participating workers’ medical records in the same year. Data were analyzed using SPSS 16. Results: The results indicated significant relationships between shift work and variables such as sleeplessness, sleep quality and quantity, stomachache, and diet. Concerning background variables (age, work experience, and marital status), the results of the Kruskal-Wallis test showed a significant relationship between age and musculoskeletal, cardiovascular, and gastrointestinal disorders. Moreover, the results of the Fisher test demonstrated a significant association between work experience and social problems; but none of these background variables were connected with sleep disorders. Considering the effect of shift work (morning, evening, and night) on personal, family, social life, and alertness, chi-square results revealed significance among the three shift-work types. Incidence was higher in night shifts than in morning and evening shifts. Conclusion: The findings showed that shift work is more likely to lead to sleep disorders and gastrointestinal diseases, risk of diabetes, infectious diseases, musculoskeletal and cardiovascular disorders than day-work. Shift workers encounter more social problems than novice shift workers. 

Relationship between Pulmonary Function Tests and Severity of Coronary Artery Disease in Patients with Chronic Obstructive Pulmonary Disease

BACKGROUND

The aim of this study was to examine relationship between the parameters of pulmonary function and the severity of coronary artery disease (CAD) in chronic obstructive lung disease patients.

MATERIALS AND METHODS

Four hundred and twenty four patients with ischemic heart diseases who underwent coronary angiography were studied. The demographic characteristics and medical history of the patients were obtained from their medical records.The severity of COPD was determined according to the Global Initiative for Chronic Obstructive Lung Disease. In addition, the severity of CAD was quantified by SYNTAX scoring.

RESULTS

Eighty-eight (21.2%), 270 (65.1%), 52 (12.5%), and 5 (1.2%) of the patients had the grade 1, 2, 3, or 4 COPD, respectively. In addition, 46 (11.1%), 319 (76.9%), and 50 (12.0%) of them had low, intermediate, and high CAD, respectively. A statistically significant relationship was observed between the severity of COPD and the severity of CAD. Significant relationships were found between age, sex, BMI, LDL, EF, and systolic pressure of pulmonary artery with the severity of COPD. The odds of higher CAD in females were 1.849 times higher than male patients. In addition, the odds of high CAD in the patients with grade 1 or 2 COPD were 0.006 and 0.068 times of the patients with grades 3 and 4 COPD, respectively.

CONCLUSIONS

The findings of the present study indicate that the parameters of pulmonary function and the severity of CAD are associated with the severity of COPD.

Serum parameters and severity of coronary artery disease in patients with acute coronary syndrome

Introduction: Coronary artery disease (CAD) is one of the most common causes of morbidity and mortality in developed countries. SYNTAX (SX) score is a useful index that scores lesion severity during coronary angiography (CA) and can predict the patient’s outcome. Recent studies have associated a number of serum parameters with SX score, including platelet volume, and platelet-to-lymphocyte ratio (PLR). Objectives: We aimed to study the SX score in association with various serum parameters to find a valuable parameter for prediction of CAD severity. Patients and Methods: This study consisted of 363 patients referred to Heshmat hospital (Rasht) from March 2016 to October 2016 with acute coronary syndrome (ACS). Serum laboratory parameters were measured after 12 hours of fasting. Severity of CAD was evaluated during CA by SX score. The associations were analyzed using multinomial logistic regression model. Results: The mean age of patients was 63.68±11.03 years; since 26.2% of cases had severe, 43% had moderate, and 30.8% had mild CAD. Comparing to mild CAD, the multivariate adjusted model showed higher significant odds of severe CAD for one elevation of platelets (odds ratio [OR] =2.18 (95% CI: 1.35-3.50), white blood cells (WBCs) (OR=1.66, 95% CI: 1.17-2.35) RDW (red cell distribution width), (OR=1.59, 95% CI: 1.08-2.35) and serum creatinine (OR=1.75, 95% CI: 1.16-2.63). Conclusion: Plasma platelets, WBC and RDW and also serum creatinine were all independently correlated with severity of CAD.

The Association between Dyslipidemia and Preterm Birth: A Prospective Cohort Study in The North of Iran

BACKGROUND

Dyslipidemia is recognized as an important factor in the incidence of Preterm Birth (PTB). The early diagnosis of factors affecting PTB is important in the reduction of maternalneonatal complications; therefore, we aimed to evaluate the association between dyslipidemia and PTB in women from the Guilan province of Iran.

METHODS

The current investigation was a prospective cohort study on 378 pregnant women in Rasht city (Guilan province), during 2018-2019. Samples were randomly selected among pregnant women who referred to Al-Zahra hospital. Association of the lipid profiles: Total Cholesterol (TC), High- Density Lipoprotein (HDLC), Low-Density Lipoprotein (LDLC), and Triglycerides (TG) with PTB was assessed using the Chi-square, Fisher tests and logistic regression analysis.

RESULTS

Our findings showed that of the evaluated lipid profiles, TG and TC had the highest predictive power with AUC =0.833 (95٪, CI: 0.736-0.930) and 0.772 (95%, CI: 0.676-0.867), respectively; also, their sensitivity and specificity were 83.3%, 70.2% and 83.3%, 66.1%, respectively. Moreover, abnormal LDL concentrations increase the risk of PTB by two folds (P < 0.05).

CONCLUSION

It seems that by controlling the lipid profiles of pregnant women, the risk of PTB could be reduced.

National Study of Opium and Cancer in Iran (IROPICAN): Study Protocol and Results of the Pilot Phase

Background: Several epidemiologic studies have reported that opium consumption is associated with higher risk of cancer and may indeed cause cancer. However, most of these studies were not primarily designed to study the effect of opium on cancer. Therefore, control selection and data collections methods were not optimized for this purpose. Aim: We designed a large multicenter case-control study to specifically investigate the association between opium use and risk of 4 cancer types (i.e., lung, bladder, head and neck and colorectal cancers). We will recruit 800 cases and 800 controls for each cancer in this project. Methods: So far we have collected 70% of the cases and controls. We report here the study protocol and results of the pilot phase. Results: During the pilot phase, we determined that hospital visitors are the most appropriate type of controls; 185 cases and 176 controls were enrolled. Controls are matched to cases for sex, age and place of residence. Collection of data using a comprehensive questionnaire, focused on measuring use of opium and its derivatives, was feasible. Underreporting of opium was estimated to be 30% among controls. Collection of other data, including data tobacco and alcohol use, and nutritional data using a food frequency questionnaire, was feasible. Biologic samples including blood and saliva sample were collected from cancer cases and controls. Results of the pilot phase and validation study were used to optimize the full study protocol and questionnaires. Conclusion: The pilot phase of the study showed that the study is feasible, the best method of control selection is from hospital visitors, and both questionnaire and biologic samples can be collected. In addition of the results from pilot phase, preliminary results from the main phase of this study will be presented.

CHA2DS2-VASc Score Predict No-Reflow Phenomenon in Primary Percutaneous Coronary Intervention in Primary Percutaneous Coronary Intervention

Introduction: No-reflow is one of the major complications of primary PCI in patients with acute ST elevation myocardial infarction. This phenomenon is associated with adverse outcomes in these patients. In the current study, we evaluated the effectiveness of CHA2DS2-VASc score in predicting no-reflow phenomenon. CHA2DS2-VASc score is a risk stratification method to estimate the risk of thromboembolism in patients with atrial fibrillation. Methods: In total, 396 patients with ST elevation myocardial infarction who had undergone primary PCI were evaluated in our study. Based on post interventional TIMI flow rate results, the patients were divided into two groups: control group (294 patients) and no-reflow group (102 patients). The CHA2DS2-VASc score was calculated for each participant. Multivariate regression analysis was performed to determine the predictive value of this score. Results: Our findings showed that CHA2DS2-VASc score can predict no-reflow independently (odds ratio: 3.06, 95%, confidence interval: 2.23-4.21, P <0 .001). Moreover, lower systolic blood pressure, higher diastolic blood pressure, grade 0 initial TIMI flow rate and smaller stent size were other independent predictors of the no-reflow in our study. We also defined a cut off value of ≥ 2 for the CHA2DS2-VASc score in predicting the no-reflow with a sensitivity of 88% and specificity of 67%, area under curve: 0.83 with 95% CI (0.79-0.88). Conclusion: The CHA2DS2-VASc score could be used as a simple applicable tool in the prediction of no-reflow before primary PCI in the acute ST elevation myocardial infarction patients.

Prevalence of diabetes mellitus after extra corporeal shock wave lithotripsy in 15 years follow-up

Objective:

To investigate the hypothesis that extracorporeal shock wave lithotripsy (ESWL) increases the risk of new onset diabetes mellitus (DM) or significant changes in fasting blood sugar (FBS).

Materials and Methods:

A total number of 307 patients enrolled in this study. All of them had undergone ESWL for kidney stone from 1991 to 1994. In 2009, after 15-19 years, we invited patients to check their blood sugar.

Results:

There were 307 patients, 19.8% females, and 80.1% males. The mean age of the patients was 44 for females and 42 years for males. 47.5% had kidney stone in the left side, 42.9% in the right side and 9.4% bilateral. The mean FBS increasing was 11.86 g/dl. It was 14.54 g/dl for the right side, 8.57 g/dl for left and 16.24 g/dl for bilateral ESWL.

Discussions:

The increasing of FBS is more significant in shock wave intensities higher than 15.5 KV. And there wasn't any significant relationship between age, sex, body mass index (BMI) and total number of shock waves with increasing of FBS. ESWL treatment might associate with increasing FBS without any relation to age, sex and BMI.

Nutritional intake, depressive symptoms and vitamin D status in hypertensive patients in the north of Iran: A case-control study

OBJECTIVE

We investigated vitamin D status, body size, nutritional intake and depression status in hypertensive patients in the north of Iran that have special dietary habit and lifestyle according to their culture and geographical situation.

MATERIALS AND METHODS

This study was conducted on 127 patients with newly recognized hypertension and the 120 normal participants, in the north of Iran. Anthropometric data was measured and demographic characteristics, dietary intake, depression and medical status were collected by valid questionnaires. Blood samples were measured for 25-hydroxyvitamin D.

RESULTS

Hypertensive patients had significantly lower serum 25-hydroxyvitamin D than control group (16±8.7ng/mL vs. 19.8±8.4ng/mL; P=0.04). In adjusted model, serum 25-hydroxyvitamin D of less than 30ng/mL was associated with an almost 4-fold odds of hypertension. The odds of hypertension in depressed patients was 1.2 times higher than in those without depression (p=0.002). After adjusted logistic regression analysis for energy intake, significant association was observed between hypertension and some dietary nutrients, including cholesterol, fiber and vitamin D intake. There was no significant association between hypertension and body weight, waist circumference as well as BMI.

CONCLUSION

The vitamin D status was lower in the most individuals and it causes a considerable increase in the risk of hypertension. Undesirable intake of some nutrients and depression also increase the risk of developing hypertension. Health training about suitable dietary habits, easier access to vitamin D supplementation and screening for depression in patients with hypertension are cost-effective tools to improve outcomes in Iran.

The association between various indices of obesity and severity of atherosclerosis in adults in the north of Iran

Recent observational studies have reported controversial results for the association between different anthropometric indices of obesity and severity of atherosclerosis. The aim of the current study is to determine the associations between anthropometric indices with severity of atherosclerosis in adult population in north of Iran.The cross-sectional study was performed on 610 participants, who were admitted to a hospital for elective angiographyin Rasht, Iran, Anthropometric indices, including waist circumference (WC), waist-to-height ratio (WHtR), conicity index (CI), body mass index (BMI), and hematological factors, were measured using the standard methods. According to angiography reports, severity of atherosclerosis was determined.Sixty-two percent of participants had moderate to severe atherosclerosis. According to BMI, 44% were overweight and 25.8% were obese. Based on WHtR and WC, 90%, and 57% were obese, respectively. The prevalence of moderate to severe atherosclerosis in centrally obese women was significantly higher than in centrally nonobese women (52% vs 28% P = 0.02). According to multivariate adjustment analysis, age, sex, systolic blood pressure, hemoglobin A1c, uric acid, and triglyceride were independently associated with severity of atherosclerosis. BMI, WC, CI, and WHtR had no significant association with severity of atherosclerosis.Our findings showed that anthropometric indices reflective of general and abdominal obesity were not independently related to the severity of atherosclerosis in adults, in northern Iran.