Correlations between Cardiovascular Risk Factors and Ventricular Arrhythmias Following Primary Percutaneous Coronary Intervention in Patients with ST-Elevation Myocardial Infarction

Background

Ventricular arrhythmias (VAs), which result from acute myocardial infarction and revascularization, are preventable causes of sudden cardiac death. This study aimed to determine the incidence, types, and risk factors of VAs in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention (PCI).

Methods

This cross-sectional study was conducted at the cardiology department of a tertiary care cardiac center in Zanjan, Iran. All the patients were monitored during hospitalization, and the incidence of cardiac arrhythmias and the outcomes were recorded.

Results

Among 315 patients, the mean age was 62.14±10.11 years, and 76.2% were male. Male gender was significantly associated with VA occurrence (P=0.038). Among the patients, 50.5% had VAs, of which 26.4% were sustained ventricular tachycardia (sustained VT) and ventricular fibrillation (VF). Sustained VT and VF, but not total arrhythmias, were more common in anterior infarctions. Most arrhythmias occurred during the first 12 hours, and frequent premature ventricular contractions (43.3%) and idioventricular rhythm (20.1%) were the most common. A history of PCI and coronary artery bypass grafting (CABG) was associated with substantially reduced arrhythmias (P=0.017 and P=0.013, respectively). However, cardiovascular risk factors exerted no statistically significant effects on the VA type.

Conclusion

Approximately half of our patients experienced reperfusion-induced VAs. Overall, gender and a history of PCI and CABG were significantly associated with VA occurrence. Therefore, males and patients without a positive history of PCI and CABG should receive antiarrhythmic drugs as a precaution.

The Relationship Between Prostate Cancer and Metformin Consumption: A Systematic Review and Meta-analysis Study

INTRODUCTION

Prostate cancer is the most common malignant cancer in men worldwide and after lung cancer, it is the second leading cause of cancer mortality in men. The purpose of this study was to investigate the relationship between prostate cancer and metformin consumption in men.

METHODS

The current study is a systematic and meta-analysis review based on the PRISMA statement. To access the studies of domestic and foreign databases, Iran Medex, SID, Magiran, Iran Doc, Medlib, ProQuest, Science Direct, PubMed, Scopus, Web of Science and the Google Scholar search engine were searched during the 2009- 2018 period for related keywords. In order to evaluate the heterogeneity of the studies, Q test and I2 indicator were used. The data were analyzed using the STATA 15.1 software.

RESULTS

In 11 studies with a sample size of 877058, the odds ratio of metformin consumption for reducing prostate cancer was estimated at 0.89 (95%CI: 0.67-1.17). Meta-regression also showed there was no significant relationship between the odds ratio and the publication year of the study. However, there was a significant relationship between the odds ratio and the number of research samples.

CONCLUSION

Using metformin in men reduces the risk of prostate cancer but it is not statistically significant.

Surveying the relationship between Gly1057Asp polymorphism of IRS-2 gene and susceptibility to type 2 diabetes; a systematic review and meta-analysis study

Type 2 diabetes mellitus (T2DM) is a multi-factorial disease in which influenced by several genetic and environmental factors. Insulin receptor substrate 2 (IRS 2) is the main mediator of insulin in the liver which controls insulin sensitivity. Gly1057Asp polymorphism is one of the candidates to increase risk of T2DM. The present study is an attempt to study the relationship of Gly1057Asp polymorphism of IRS-2 and T2DM by a meta-analysis. A systemic search was conducted in English and Persian databases such as Scopus, PubMed, Google Scholar, SID, and other academic databases for studies that have investigated the relationship of Gly1057Asp polymorphism of IRS-2 and T2DM. This association was determined using odds ratios (ORs) with a confidence interval of 95% (CIs). Heterogeneity of the studies was examined by I2 index. Funnel plots and Egger tests were used to determine bias or publication bias. The collected data was analyzed in STATA through meta-analysis. Nine articles were selected as eligible for further analysis, which represented 3,196 patients with T2DM and 3409 controls subjects without T2DM. The present meta-analysis showed a significant relationship between GA genotype of Gly1057Asp polymorphism and T2DM (OR=0.88; 95% confidence interval, 0.79-0.98), whereas no significant relationship between GG and AA genotype with T2DM was seen; OR for GG and AA genotypes were 1.10 (95% CI, 0.99 -1.22) and 1.13 (95% CI, 0.95- 1.33), respectively. The results of our study show that genotype GA of Gly1057Asp polymorphism of IRS-2 gene plays a protective role and may decrease the risk of T2DM, whereas GG and AA genotypes are considered as a risk factor and related to development of T2DM to some extents.

The relationship between body mass index and preeclampsia: A systematic review and meta-analysis

Background

One of the causes of maternal and fetal mortality and morbidity is pregnancy-induced hypertension, the most common form of which is preeclampsia that causes many complications for mother and fetus.

Objective

The aim of this systematic review and meta-analysis was to determine the relationship between body mass index (BMI) and preeclampsia in Iran.

Materials and Methods

Using valid keywords in the SID database, PubMed, Scopus, data obtained from all the articles, which were reviewed in Iran between 2000 and 2016, were combined using the meta-analysis method (random-effects model) and analyzed using STATA version 11.1.

Results

A total number of 5,946 samples were enrolled in 16 studies with the mean BMI values of 25.13, 27.42, and 26.33 kg /m2 in the healthy, mild, and severe preeclamptic groups, respectively.

Conclusion

The results of this study revealed that there is a significant relationship between BMI and the risk of preeclampsia, so it can be said that BMI may be one of the ways to diagnose preeclampsia.

Prevalence of Hypertension in Renal Diseases in Iran: Systematic Review and Meta-Analysis

BACKGROUND

Hypertension is a risk factor for renal disease. Therefore, this study was aimed at estimating the prevalence of hypertension in renal patients in Iran through meta-analysis.

METHODS

The search was carried out using authentic Persian and English keywords in national and international databases including IranMedex, SID, Magiran, IranDoc, Medlib, ScienceDirect, Pubmed, Scopus, Cochrane, Embase, Web of Science, Medline, and Google Scholar search engine without any time limitation until 2017. Heterogeneity of studies was assessed using the I 2 index. Data were analyzed using STATA ver 11.

RESULTS

In 35 reviewed studies with a sample of 39,621 subjects, the prevalence of hypertension in renal patients was 35% (95% CI: 29%-41%) (25% in women and 18% in men). The prevalence of systolic hypertension in renal patients was 5%, diastolic hypertension 26%, and diabetes 23%. The prevalence of hypertension in hemodialysis patients was 34%, 27% in peritoneal dialysis, 43% in kidney transplantation, and 26% in chronic renal failure. In addition, meta-regression showed that the prevalence of hypertension in renal patients did not significantly decrease during the years 1988-2017.

CONCLUSIONS

More than a third of kidney patients in Iran suffer from high blood pressure. The diastolic blood pressure of these patients is about five times higher than their systolic blood pressure. Moreover, the age group under 30 is a high-risk group. The prevalence of hypertension in women with kidney disease is higher than in men. In addition, patients who have kidney transplants are more likely to have high blood pressure than other kidney patients.

An Investigation of the Prevalence and Causes of Malnutrition in Iran: a Review Article and Meta-analysis

Malnutrition is one of the most important health issues in developing countries, which might have adverse effects on the physical and intellectual health of children. The search process was started to find Persian and English articles published until September 2017 regarding the prevalence of malnutrition in children under the age of six in Iran using national and international databases including SID, Magiran, Irandoc, IranMedex, PubMed, Medline, Scopus, and ISI Web of Science. The data were analyzed using meta-analysis methods and the random effects model. The heterogeneity of studies was analyzed using the I² index. The data were analyzed using R and STATA software (ver. 11.2). Twenty seven articles conducted from 2002 to 2016 were collected to be included in the meta-analysis process. The total sample size was 161,941 patients in an age range of 0-6 years. The final estimate of the prevalence of different forms of malnutrition through meta-analysis of data extracted from studies in Iran was as follows: severe underweight (1%; 95% confidence interval [CI], 1–1), moderate underweight (6%; 95% CI, 5–7), mild underweight (25%; 95% CI, 21–28), severe short stature (3%; 95% CI, 2–3), moderate short stature (8%; 95% CI, 6–9), mild short stature (21%; 95% CI, 17–24), severe slimness (1%; 95% CI, 1–1), moderate slimness (5%; 95% CI, 4–5) and mild slimness (20%; 95% CI, 17–24). Considering that the prevalence of malnutrition is relatively high in Iran, health authorities should plan to improve the nutritional status of children.

Evaluating the effect of magnesium supplementation and cardiac arrhythmias after acute coronary syndrome: a systematic review and meta-analysis

BACKGROUND

Atrial and ventricular cardiac arrhythmias are one of the most common early complications after cardiac surgery and these serve as a major cause of mortality and morbidity after cardiac revascularization. We want to evaluate the effect of magnesium sulfate administration on the incidence of cardiac arrhythmias after cardiac revascularization by doing this systematic review and meta-analysis.

METHODS

The search performed in several databases (SID, Magiran, IranDoc, IranMedex, MedLib, PubMed, EmBase, Web of Science, Scopus, the Cochrane Library and Google Scholar) for published Randomized controlled trials before December 2017 that have reported the association between Magnesium consumption and the incidence of cardiac arrhythmias. This relationship measured using odds ratios (ORs) with a confidence interval of 95% (CIs). Funnel plots and Egger test used to examine publication bias. STATA (version 11.1) used for all analyses.

RESULTS

Twenty-two studies selected as eligible for this research and included in the final analysis. The total rate of ventricular arrhythmia was lower in the group receiving magnesium sulfate than placebo (11.88% versus 24.24%). The same trend obtained for the total incidence of supraventricular arrhythmia (10.36% in the magnesium versus 23.91% in the placebo group). In general the present meta-analysis showed that magnesium could decrease ventricular and supraventricular arrhythmias compared with placebo (OR = 0.32, 95% CI 0.16-0.49; p < 0.001 and OR = 0.42, 95% CI 0.22-0.65; p < 0.001, respectively). Subgroup analysis showed that the effect of magnesium on the incidence of cardiac arrhythmias was not affected by clinical settings and dosage of magnesium. Meta-regression analysis also showed that there was no significant association between the reduction of ventricular arrhythmias and sample size.

CONCLUSION

The results of this meta-analysis study suggest that magnesium sulfate can be used safely and effectively and is a cost-effective way in the prevention of many of ventricular and supraventricular arrhythmias.

Type 2 diabetes mellitus and non-alcoholic fatty liver disease: a systematic review and meta-analysis

AIM

The aim of this study was the evaluation of the prevalence of NAFLD in patients with type 2 diabetes mellitus.

BACKGROUND

Non-alcoholic fatty liver disease (NAFLD) is an emerging disease with high prevalence in patients with type 2 diabetes mellitus (T2DM). Many studies have reported the prevalence of NAFLD in type 2 diabetes mellitus patients. However, these results are inconsistent.

METHODS

A Literature search was conducted in PubMed, Scopus, web of science and Science Direct from 2005 to August 2017. The necessary information was extracted. Heterogeneity was evaluated using I² statistic. Meta-regression analyses were performed to the estimation of the relationship between the year of study and sample size with the prevalence of NAFLD. Publication bias was assessed by both Begg rank correlation and Egger tests. Subgroup analysis was performed for identification of sources heterogeneity.

RESULTS

Seventeen studies involving 10897 type 2 diabetes mellitus patients with NAFLD were included in this meta-analysis. The overall prevalence of NAFLD in type 2 diabetes mellitus patients by random effects models was 54% (95% CI, 45%- 64%). There is a significant heterogeneity across studies with (I²= 99%, p> 0.01). The funnel plot as graphically and Begg and Egger as statistically showed no publication bias among studies. Subgroup analysis indicated that the prevalence of NAFLD in type 2 diabetes mellitus patients differed in predictive factors such as lipid profile, BMI, HbA1c, AST, and ALT. This finding in spite of heterogeneity of documents is corresponding to the positive correlation between NAFLD and type 2 diabetes mellitus.

CONCLUSION

The findings indicated that the overall prevalence of NAFLD among type 2 diabetes mellitus patients is significantly higher. It can be concluded that type 2 diabetes mellitus patients should be managed to prevent NAFLD.