Endoplasmic reticulum as a target in cardiovascular diseases: Is there a role for flavonoids?

Flavonoids are found in natural health products and plant-based foods. The flavonoid molecules contain a 15-carbon skeleton with the particular structural construction of subclasses. The most flavonoid's critical subclasses with improved health properties are the catechins or flavonols (e.g., epigallocatechin 3-gallate from green tea), the flavones (e.g., apigenin from celery), the flavanones (e.g., naringenin from citrus), the flavanols (e.g., quercetin glycosides from berries, onion, and apples), the isoflavones (e.g., genistein from soya beans) and the anthocyanins (e.g., cyanidin-3-O-glucoside from berries). Scientific data conclusively demonstrates that frequent intake of efficient amounts of dietary flavonoids decreases chronic inflammation and the chance of oxidative stress expressing the pathogenesis of human diseases like cardiovascular diseases (CVDs). The endoplasmic reticulum (ER) is a critical organelle that plays a role in protein folding, post-transcriptional conversion, and transportation, which plays a critical part in maintaining cell homeostasis. Various stimuli can lead to the creation of unfolded or misfolded proteins in the endoplasmic reticulum and then arise in endoplasmic reticulum stress. Constant endoplasmic reticulum stress triggers unfolded protein response (UPR), which ultimately causes apoptosis. Research has shown that endoplasmic reticulum stress plays a critical part in the pathogenesis of several cardiovascular diseases, including diabetic cardiomyopathy, ischemic heart disease, heart failure, aortic aneurysm, and hypertension. Endoplasmic reticulum stress could be one of the crucial points in treating multiple cardiovascular diseases. In this review, we summarized findings on flavonoids' effects on the endoplasmic reticulum and their role in the prevention and treatment of cardiovascular diseases.

Cultural barriers in the education of cardiovascular disease patients in Iran

BACKGROUND

Cardiovascular diseases are responsible for the highest mortality rate in Iran; however, there is a lack of evidence for cultural factors influencing patient education. Such information is important for the provision of effective patient care.

AIM

To identify key issues relating to cultural factors influencing education of cardiovascular disease patients in Iran.

METHODS

The qualitative research approach was used in this study, with open-ended interviews used to gather data. Eighteen nurses, four cardiovascular specialists, nine patients with cardiovascular disease and four family members were interviewed at two educational hospitals in Tehran. Interviews were taped, transcribed and analysed using constant comparative analysis.

FINDINGS

Participants expressed a range of cultural factors influencing patient education. Five themes emerged from the analysis: (a) patients' lifestyle, (b) beliefs about disease and treatment, (c) concealment of true diagnosis, (d) different opinions regarding the preferred instructor, and (e) ineffective communication.

CONCLUSION

Findings show that cultural beliefs may act as risk factors for, or serve to intensify, cardiovascular disease. Consideration of these factors is essential for the success of patient education programmes.

Marital adjustment in patients on long-term hemodialysis: a case-control study

INTRODUCTION

This study was conducted to compare marital adjustment between patients on long-term hemodialysis and healthy controls and to determine whether the psychological symptoms correlate with marital adjustment in these patients.

MATERIALS AND METHODS

In a case-control study, 40 patients on long-term hemodialysis and 40 healthy participants were compared for the quality of marital relationship. The Revised Dyadic Adjustment Scale was used for interviews of marital relationship, which includes total marital adjustment and its subscales of marital consensus, affection expression, marital satisfaction, and marital cohesion. Symptoms of anxiety and depression and the Ifudu comorbidity scale were also assessed in the patients group.

RESULTS

Marital consensus, affection expression, marital satisfaction, marital cohesion, and the overall marital relationship were significantly poorer in the patients on hemodialysis than in the controls. Also, symptoms of anxiety were more severe among the patients on hemodialysis in comparison with that in the controls. However, this was not the case for symptoms of depression. In the patients on hemodialysis, the severity of anxiety slightly correlated reversely with the total marital relationship score and marital satisfaction subscale. Depression correlated reversely with total marital adjustment, affection expression, marital satisfaction, and marital cohesion. Finally, some marital relationship subscales showed poorer results in men on dialysis, younger patients, and those with higher educational levels.

CONCLUSIONS

Marital adjustment in patients on hemodialysis, which is linked with depressive symptoms and anxiety, is poorer compared to the healthy controls. This finding shows the necessity of an appropriate family approach for patients on long-term dialysis.

Costs and length of hospitalizations following kidney transplantation

INTRODUCTION

We assessed the costs of hospital admissions and length of hospital stay in kidney allograft recipients admitted to our center, in order to rank hospitalization causes in terms of costly and prolonged admissions, to bring to light the respective correlates of costly and prolonged admissions, and to investigate the relationship between costs and length of rehospitalizations.

MATERIALS AND METHODS

In a retrospective study at Baqyiatallah Hospital, in Tehran, records of 358 posttransplant hospitalizations were reviewed for the costs and duration of hospital stay. The causes of rehospitalizations, relative frequency of prolonged stays in costly rehospitalizations, and also relative frequency of costly admissions in short and prolonged stays were evaluated.

RESULTS

Among rehospitalizations, 83.3% of those due to cerebrovascular accident were costly and 51% of those with graft rejection resulted in prolonged hospital stays. Costly admissions had a high regularity in cases of patients older than 60 years, end-stage renal disease due to diabetes mellitus, graft loss, intensive care unit admission, and hospitalizations accompanied by in death. Prolonged stays were more common in those who were admitted to intensive care unit and those who ultimately died. The Costs showed a significant correlation with the length of rehospitalization (r = 0.626, P = .001).

CONCLUSIONS

The strong correlation between the length of hospitalization and posttransplant hospitalization costs means that the former should be curtailed by focusing on such correlates of high-cost admissions as high age and diabetes mellitus as the cause of kidney failure.

Additional burden of intensive care to rehospitalizations following kidney transplantation: a study of rate, causes, and risk factors

INTRODUCTION

Little information exists on the burden of intensive care unit (ICU) to the posttransplant rehospitalizations of kidney allograft recipients. We do not clearly know the extent of the need for ICU during rehospitalizations and causes of readmissions. In this study, we aimed to assess ICU admissions of kidney transplant recipients, to determine the risk factors of ICU admissions in rehospitalized patients, and to evaluate the additional burden of ICU admission.

MATERIALS AND METHODS

A total of 581 posttransplant rehospitalizations of kidney transplant recipients were assessed for ICU admission. Clinical characteristics of the patients and the length of hospital stay, transplantation-admission interval, hospitalization costs, and mortality rate were reviewed.

RESULTS

Twenty-five rehospitalized kidney transplant recipients (4.3%) had been admitted to ICU with kidney dysfunction (36.0%), cerebrovascular accident (24.0%), sepsis (16.0%), brain tumor (8.0%), brain abscess (4.0%), diabetic ketoacidosis (4.0%), trauma (4.0%), and hemodynamic shock (4.0%). The risk factors of referral to ICU were higher age (P = .001) and hospitalization for cerebrovascular accident (P = .001) and malignancy (P = .004). Additional burdens were 1.8, 3.3, and 11.4 times as high as the rehospitalization burden for the length of hospital stay, hospitalization costs, and mortality rate, respectively.

CONCLUSIONS

Age and some special causes of hospitalizations are risk factors of ICU admission of kidney transplant recipients, and this occurs in about 5% of rehospitalizations. Admission to ICU adds considerably to the burden of rehospitalizations, warranting measures to prevent conditions that lead to the need for intensive care in these patients.

Survival of rehospitalized kidney allograft recipients

INTRODUCTION

Undergoing transplantation is extremely stressful, and a recipient is likely leave the hospital burdened with fears of an uncertain future. A paucity of knowledge on the long-term survival of rehospitalized kidney transplant recipients is the likely the reason that physicians fail to provide this group of patients with promising information and reassurance about their future. We sought to describe the long-term patient and graft survival after nonfatal rehospitalization in kidney recipients with a normal graft function after discharge.

MATERIALS AND METHODS

We reviewed the follow-up data (from the time of discharge after first rehospitalization) of 253 kidney transplant recipients who had been discharged from rehospitalization with a normal kidney function (serum creatinine less than 1.6 mg/dL). Patient and graft survival rates 6 months and 1, 2, and 5 years after discharge were determined.

RESULTS

The mean duration of follow-up (from the time of discharge after the first rehospitalization) was 38.9 +/- 11.2 months (range, 6 to 84 months). The overall patient survival rates were 98%, 97%, 95%, and 93% at 6 months, 1 year, 2 years, and 5 years, respectively. Graft survival rates at these times were 88%, 82%, 77%, and 63%, respectively. After the first posttransplant rehospitalization, 54 patients (21.9%) experienced more hospitalization episodes (mean, 2.6+/- 2.0 times), while 193 (78.1%) had no further hospitalizations during the follow-up period. Conclusion. Kidney transplant recipients who are rehospitalized should be reassured about favorable chances of survival if discharged with a normal graft function.

Satisfactory outcome despite low 2-hour postdose cyclosporine level in Iranian kidney recipients

INTRODUCTION

Cyclosporine has a narrow therapeutic serum level in kidney transplantation. Achieving the recommended therapeutic levels is necessary, but in different ethnic groups, the impact of the cyclosporine level on patient and graft survival has not been fully addressed yet. We investigated this issue by studying the 2-hour postdose serum concentration of cyclosporine (C2) and the long-term graft and patient survival in Iranian transplant recipients.

MATERIALS AND METHODS

A total of 397 kidney recipients were evaluated for the C2 serum levels. All patients were under treatment with prednisolone, mycophenolate mofetil, and cyclosporine (Neoral). Measurements C2 were considered at different time intervals: the first 2 months, 2 to 6 months, and after 6 months posttransplantation. The mean of C2 levels at specified intervals were evaluated and compared with the recommended optimal ranges. Patient and graft survival rate were also calculated.

RESULTS

In the studied patients, C2 levels were lower than the upper recommended range in 96.9%, 83.6% and 64.5% in the first 2 months, between 2 and 6 months, and after 6 months posttransplantation, respectively. The overall 5-year patient and graft survival rates were 95% and 85%, respectively.

CONCLUSIONS

Despite the fact that the majority of the patients had C2 levels lower than the recommended values, we observed good patient and graft survival rates. Our data suggests that different populations may need different target levels definition.