Comparison of risk assessment tools for cardiovascular diseases: results of an Iranian cohort study

OBJECTIVES

Several popular cardiovascular risk assessment tools have been developed in Western countries; however, the predictive abilities of these tools have not been evaluated in Middle Eastern countries. The present study aimed to determine the abilities of cardiovascular risk assessment tools in a population-based study in Northern Iran.

STUDY DESIGN

Population-based cohort study in Northern Iran.

METHODS

In total, 2883 individuals (1629 men and 1254 women), aged 40-74 years, were included in the study. We determined the predictive abilities of the American College of Cardiology/American Heart Association (ACC/AHA) risk prediction tool, the Framingham general cardiovascular risk profile in primary care settings, and the Systematic Coronary Risk Evaluation (SCORE) equations for low- and high-risk European countries. Receiver operating characteristic (ROC) analysis was used to determine the predictive abilities of these four risk assessment tools.

RESULTS

Based on areas under curve (AUC) values and related 95% confidence intervals (95% CIs), the discriminative abilities of the ACC/AHA tool, the Framingham approach, and the SCORE for low- and high-risk European countries to estimate non-fatal cardiovascular disease (CVD) events were 0.6625, 0.6517, 0.6476 and 0.6458, respectively, in men, and 0.7722, 0.7525, 0.7330 and 0.7331, respectively, in women. Moreover, the abilities of these four tools to estimate fatal CVD events were found to be 0.8614, 0.8329, 0.7996 and 0.7988 in men, and 0.8779, 0.8372, 0.8535 and 0.8518 in women, respectively.

CONCLUSIONS

The cardiovascular risk assessment tools investigated in this study showed acceptable predictive abilities in women. The ACC/AHA approach showed slightly better performance compared with the SCORE tool; however, the SCORE tool benefited from the lowest cost compared with all the other tools.

HLA-DRB1*01:01, but not HLA-DRB1:1503 or HLA-DRB1*11, is associated with decreased inhibitor risk in Iranian hemophilia A patients

BACKGROUND/OBJECTIVE

Hemophilia A is a genetic disorder through which patients suffer from recurrent bleeding. This can be caused by a defect in human plasma coagulation factor VIII. High incidence of FVIII inhibitors in some severe hemophilia A patients after FVIII therapy is a considerable complication. Determination of good predictive factors can improve the safety of this treatment. HLA-II have been shown as a predictive element for inhibitor development. The goal of this study is to determine the association between HLA-DRB1*15:03, HLA-DRB1*11 and HLA-DRB1*01:01 alleles and FVIII inhibitors in severe hemophilia A patients in Iran.

MATERIALS/METHODS

HLA-DRB1 genotyping was performed using Multiplex sequences Specific Primers (PCR-SSP) in two groups of severe hemophilia A patients comprising 51 and 50 individuals with and without FVIII inhibitors respectively. The levels of inhibitor were determined through Nijmegen-modified Bethesda assay. HLA-DRB1 allele frequencies were compared between groups by using multiple logistic regression models.

RESULTS

HLA-DRB1*01:01 allele frequency was significantly higher in patients without inhibitor OR_adj: 2.7 (95%CI: 1.08, 6.97; P = 0.034). There wasn't any statistically significant difference in HLA-DRB1*11 allele frequency between groups OR_adj: 0.7 (95%CI: 0.27, 1.82; P = 0.47). There was no connection between HLA-DRB1*15:03 and inhibitor development OR_adj: 0.94 (95%CI: 0.38, 2.35; P = 0.94).

CONCLUSION

An association between HLA-DRB1*01:01 and paucity of FVIII inhibitor showed that this allele has probably a protective effect in severe hemophilia A patients in Iran. Determination of the predictive and protective alleles are beneficial in pre-treatment activities and decrease the risk of unsuccessful therapy with FVIII in each population.

New Indications for Dabigatran: A Suggestion from a Drug Use Evaluation Study

Objective:

Dabigatran etexilate is a novel oral anticoagulant with several advantages over warfarin such as no need for routine monitoring and fewer drug interactions. This drug was added to our hospital's formulary in 2012. The objective of this study was to assess the rational drug use of dabigatran at a large teaching hospital.

Methods:

A prospective cross-sectional study was performed from November to June 2015 at Alzahra teaching hospital, Isfahan, Iran. All patients who received at least one dose of dabigatran were eligible for inclusion. Data were collected on patient demographics, indication, dosing regimen, adverse events, concurrent anticoagulant therapy, and laboratory data (including renal function).

Findings:

A total of sixty patients were included in our study. The majority of patients (n = 40, 66.7%) was prescribed dabigatran for deep vein thrombosis prophylaxis. Only one patient received dabigatran with appropriate indication, dose, and duration. Thirty-six (60%) of our patients had thrombocytopenia at the time of dabigatran initiation. We also detected that ten patients (16.7%) received this drug for heparin-induced thrombocytopenia (HIT). In 32 patients, platelet levels increased after dabigatran initiation. Only seven patients received the appropriate dose of dabigatran (regarding both indication and renal function).

Conclusion:

Unlabeled use and incorrect dosing of dabigatran in this study emphasize the need to develop a hospital protocol for dabigatran use within our facility. We suggest proper education of clinicians about novel drugs, pharmacist interventions, and further studies about the safety and efficacy of dabigatran for the new indication (such as HIT).

Sleep disturbances in patients with rheumatoid arthritis

BACKGROUND

Sleep problems are frequent in chronic diseases like rheumatoid arthritis (RA). The present study was conducted to determine frequency of sleep disturbances and their relations with disease severity.

METHODS

The present case-control study was performed on 100 rheumatoid patients who were referred to the rheumatology clinic at the Avicenna hospital. A hundred age- and sex-matched healthy individuals were recruited in the study as a control group. Pittsburgh Sleep, 1Quality questionnaire, Insomnia Severity Index questionnaire and Epworth Sleepiness Scale were used. The disease activity was caIculated with the disease activity score 28. The collected data were analyzed using SPSS version 19.

RESULTS

Mean scores of the sleep quality were 6.2 +/- 4.3 in patients and 4.6 +/- 2.5 in control group. 28% of the patients had good sleep quality whereas 72% had poor sleep quality. Daytime sleepiness was present in 24.8% of the patients and 15% of the control group. Multiple logistic regressions showed that insomnia, pain and disease intensity were the most important factors that determine patients' sleep quality.

CONCLUSION

The present study showed that sleep disturbances are frequent in patients with RA and may contribute to disease severity. It is recommended that rheumatoid patients be evaluated for sleep disturbances during routine examinations.

Anti-inflammatory and analgesic effects of egg yolk: a comparison between organic and machine made

OBJECTIVES

Yolk composition may be influenced by the bird's dietary intake. Quality of egg yolk from different sources is also varied. Especially egg yolk from organic sources, those prepared by the hen and duck were naturally fed. Traditional medicine users in north of Iran believe the oil extracted by direct heat from egg yolk has analgesic activity. In this work anti-inflammatory and antinociceptive activities of organic and machine made hen yolk and duck yolk were evaluated.

MATERIALS AND METHODS

Three various sources of egg yolk (organic hens, duck and machine made) were chosen. Each yolk was extracted by two methods, solvent extraction (hexane) and direct heating. In order to investigate the analgesic and anti-inflammatory activity, carageenan, hot plate and writhing tests were carried out.

RESULTS

The organic hen and duck oil extracted by direct heat method showed the highest activity compared to other types. Organic sources may contain some special components which are not existed in machine made eggs. Oil samples obtained by direct heat from three different kinds of egg yolk showed significant anti-inflammatory activity at 100-300 mg/kg compared to controls (p < 0.001). All samples indicated analgesic properties at all doses in writhing test. The highest activity was seen at 300 mg/kg of organic hen egg yolk oil prepared by heat (HO) and hexane extract of duck egg yolk (ED) which was similar to 5 mg/kg morphine (p > 0.001). In hot plate test all of the oil samples did not show significant difference with controls. Hexane extract of organic egg yolk (EO) (300 mg/kg) and ED (200 and 300 mg/kg) showed significant analgesic activity in hot plate test.

CONCLUSIONS

This study confirms anti-inflammatory and analgesic scheme of yolk. We can also claim environmental and dietary condition is very important in yolk contents. In order to improve life quality of human beings and better efficiency for egg yolk components we suggest considering the way of feeding for poultry. We can propose organic yolk oil prepared by direct heat as an alternative remedy for inflammatory joint conditions.