Risk stratification of coronary heart disease in UK South Asians

It is clear that South Asians living in the West have substantially greater relative (coronary heart disease) CHD mortality and morbidity than the general population. Despite this current risk functions based on classical risk factors alone underestimate risk in non-diabetic South Asians. After reviewing the available literature for longitudinal studies exploring the relationship between South Asian ethnicity, as an independent factor, and CHD an adjustment factor suitable for use with the paper- based risk prediction functions was derived. The exploration of possible explanations for the excess risk identified dysglycaemia as one possible explain. Adding 10 years to age, although crude and based on the single prospective study, provides adequate sensitivity and specificity to take into account an "ethnicity factor" accounting for average excess risk in individual UK South Asians. Using this adjustment it was shown that more South Asian men and women, living in the UK, are candidates to receive lipid-lowering therapy for primary and secondary prevention than their Caucasian counterparts. Although the evidence base for a CVD risk estimation procedure in South Asians is slight it is better that they have their risk estimated, albeit with less precision, than be excluded. The present work provides a properly researched evidence base. Moreover, it provides its own very simple, but 1. practice acceptable, adjustment for currently used paper risk estimation tools. Acceptance of ant1hypertensives as a primary prevention treatment was looked at in the South Asians community. South Asians are at least equally accepting of treatment as Caucasians when given information about the personal impact of CVD and the effect and tolerability of antihypertensive treatment. With South Asians having a greater need and at least equal acceptance of preventive therapy, they should receive more such treatment. Current evidence suggests that this is not the case and targeted intervention may be needed. Further research is still required in many areas such as risk factors, risk estimation and recalibration, lifestyle intervention, and efficacy of preventive drug therapy in ethnic minorities. Because this population is at high risk, the benefits of appropriate research will also be high

Communication Patterns and Related Factors among Iranian Couples: A Cross-sectional Study

Background: Given the effect of various factors on the use of communication patterns by couples, this study aimed to determine the most common communication pattern among couples and related factors in Sari, northern Iran. Methods: This cross-sectional study was performed on 520 people (260 couples) in Sari. Data were collected using a demographic–fertility factors questionnaire, Enrich couple scale, communication patterns questionnaire, general health questionnaire (GHQ-28), and NEO personality inventory. Data analysis was performed in SPSS version 25 using descriptive and inferential statistics (multiple regression model). Results: While the mean (standard deviation) age of women included in the study was 34.08 (7.71) years, the mean age of men was 39.13 (9.18) years. The most common communication patterns in both women and men was the mutual constructive communication, whereas the lowest frequent communication pattern was the demand/withdraw communication in both men and women. Marital satisfaction had a significant positive correlation with mutual constructive communication pattern in women and men (P = 0.001). In addition, a significant inverse correlation was observed between the number of marriage to date, women’s age, and spouses' demand/withdraw communication pattern with mutual constructive communication pattern in women. Also, a significant inverse correlation was observed between flexibility (P = 0.047), number of marriages (P = 0.013), and the wives' age (P = 0.005) with mutual constructive communication pattern in men. Conclusion: According to the results of the study, it is necessary to recognize the factors related to couples’ communication patterns in order to improve the communication patterns so that marital conflicts could be avoided while a more effective communication is established.  Keywords: communication patterns, couples, personality characteristics, marital satisfaction, public healt

Determination of celiac disease frequency in type 1 diabetes mellitus children in the Pediatric Endocrinology Clinic of Sari, Mazandaran

Background: Diabetes mellitus, type 1 (T1DM) and celiac disease (CD) are both immune-mediated. The mean rate of clinical overlap is 8%. The aim of this study was to discover the frequency of CD in children with type 1 diabetes in Mazandaran province. Methods: This retrospective descriptive study was performed in the pediatric endocrinology referral center, in Sari from 2012 to 2014. We screened all individuals aged between six months and 18 years with diabetes diagnosis after ketoacidosis, positive anti-GAD 65 antibodies, and insulin therapy. Patients with a positive tissue Transglutaminase Immunoglobulin A (tTG-IgA) antibodies test underwent endoscopic biopsy. Categorical data were tested using chi-square and quantitative data with independent sample T-test in SPSS. Date reported with 95% confidence interval. P<0.05 was considered statically significant. Results: Of the 119 children enrolled, six cases (5%) were positive for tTG-IgA antibodies and all of them were boys (P=0.013). Histopathologically, CD was confirmed in 5 persons (4.2%). The mean age of seropositive patients was 10.3±3.3 years. History of DKA was mostly negative (83.3%) in them. The mean breastfeeding duration was 21±3.2 months, and only one had started formula after 12 months of birth. Conclusions: The results of the current study showed that the frequency of CD in T1DM children in north of Iran was similar to that other countries but lower than that in previous reports of Iran. The periodic screening test for CD in this high-risk group is necessary to diagnose the asymptomatic disease and prevent its complications

Comparison of Dabigatran vs. Warfarin in Acute Vnous Thromboemboly: Systematic Review

Abstract Acute Venous Thromboembolism (VTE) is a common disease associated with the significant morbidity and mortality. We reviewed clinical outcomes systematically with Dabigatran as a direct oral anticoagulants (DOAC) for treatment of acute VTE. We used Ovide, PubMed, Cochrane (CENTRAL), EMBASE, Scopus, Science Direct, LILAC(for article written not English) and also Iranian database; Magiran, Isc, Iran Medex, Iran DOC, Doaj up to May 2014 to identify randomized clinical trials of Dabigatran compared with conventional treatment for VTE. Two investigators extracted data independently. Number of 5107 patients including two trails were selected. The risk of recurrent VTE was similar with the Dabigatran and standard treatment (Hazard Ratio, 95% confidence interval 1.09 (0.76-1.57). Dabigatran reduced the risk of minor bleeding in comparison with standard treatment; Warfarin (0.62) (0.50-0.76). Finally-in minor bleeding-the Dabigatran seemed as effective as, and probably safer than standard treatment of acute VTE. But in some aspects such as adherence to treatment, pregnant patient, impact on quality of life, new researches are needed to be clarified

The Effect of Preoperative Oral Melatonin on Postoperative Pain after Lumbar Disc Surgery: A Double-Blinded Randomized Clinical Trial

BACKGROUND: Despite advances in surgical and anesthesiology techniques, many patients continue to experience postoperative pain after lumbar disc surgeries. The aim of this study was to investigate the effect of preoperative oral melatonin on the severity of postoperative pain after lumbar laminectomy/discectomy. METHODS: In this double blinded randomized controlled clinical trial 80 patients undergoing an elective mini-open microdiscectomy surgery at Imam Khomeini educational hospital in Sari, Iran, were selected and randomly assigned into one of four groups. Patients in group A, B, C, and D received 3, 5 and 10 mg melatonin or placebo tablets one hour before surgery, respectively. Using the visual analogue scale (VAS) the severity of pain, nausea and vomiting, pruritus, and use of narcotics were assessed immediately after surgery and before leaving the post-anesthesia care unit, 6, 12 and 24 hours postoperatively. RESULTS: In all three groups receiving melatonin at all three different doses, postoperative pain was significantly less than the placebo group (P&lt;0.01). There were no statistically significant differences in postoperative pain level between the three groups receiving melatonin (P&gt;0.05). The amount of opioid received by the patients within 24 hours after surgery had statistically significant differences within the groups (P=0.043, F=2.58). The results of post hoc analysis in terms of postoperative pain intensity showed statistically significant differences between the two groups receiving melatonin at a dose of 5 mg and the placebo group (P= 0.04). No serious side effects reported in four groups. CONCLUSION: The use of oral melatonin with a dose of 5 mg, 1 hour before the surgery as an inexpensive method can effectively reduce pain intensity as well as the amount opioid use after lumbar laminectomy and discectomy

A 33-day-old Infant with the Transposition of the Great Arteries; A Rare Case Report

Dextro-transposition of the great arteries (d-TGA) is the one most common cyanotic congenital heart disease in neonates. The discordant ventriculoarterial arrangement results in parallel circulation, it so is vital to understand the management. We report a rare interesting but critical case of 33-day-old boy who developed cyanosis and had transposition of great arteries combined with interrupted aortic arch (IAA), diagnosed as d-TGA, and describe the entire interventional management. The patient underwent surgical correction of the transfection and defects

A Different Olfactory Perception in Anosmic Patients: Evidence from Functional MRI

Olfactory system is a vital sensory system in mammals, giving them the ability to connect with their environment. Anosmia, or the complete loss of olfaction ability, which could be caused by injuries, is an interesting topic for inspectors with the aim of diagnosing patients. Sniffing test is currently utilized to examine if an individual is suffering from anosmia; however, functional Magnetic Resonance Imaging (fMRI) provides unique information about the structure and function of the different areas of the human brain, and therefore this noninvasive method could be used as a tool to locate the olfactory-related regions of the brain. In this study, by recruiting 31 healthy and anosmic individuals, we investigated the neural BOLD responses in the olfactory cortices following two odor stimuli, rose and eucalyptus, by using a 3T MR scanner. Comparing the two groups, we observed a network of brain areas being more active in the normal individuals when smelling the odors. In addition, a number of brain areas also showed an activation decline during the odor stimuli, which is hypothesized as a resource allocation deactivation. This study illustrated alterations in the brain activity between the normal individuals and anosmic patients when smelling odors, and could potentially help for a better anosmia diagnosis in the future

Does high-dose metformin cause lactic acidosis in type 2 diabetic patients after CABG surgery? A double blind randomized clinical trial

Metformin is a dimethyl biguanide oral anti-hyperglycemic agent. Lactic acidosis due to metformin is a fatal metabolic condition that limits its use in patients in poor clinical condition, consequently reducing the number of patients who benefit from this medication. In a double blind randomized clinical trial, we investigated 200 type 2 diabetic patients after coronary artery bypass surgery in the open heart ICU of the Mazandaran Heart Center, and randomly assigned them to equal intervention and control groups. The intervention group received regular insulin infusion along with 2 metformin 500 mg tablets every twelve hours, while the control group received only intravenous insulin with 2 placebo tablets every twelve hours. Lactate level, pH, base excess, blood glucose and serum creatinine were measured over five 12 h periods, with data averaged for each period. The primary outcome in this study was high lactate levels. Comparison between the 2 groups was made by independent Student’s t-test. To compare changes in multiple measures in each group and analysis of group interaction, a repeated measurement ANOVA test was used

The prevalence of pediatric asthma in the Islamic Republic of Iran: A review and meta-analysis

The prevalence of asthma is inconsistent in different countries and even in regions of a country. Awareness of this prevalence has favorable impacts on health care system planning. The aim of this literature review and meta-analysis was to estimate the prevalence of pediatric asthma in the Islamic Republic of Iran during two recent decades. A search was done in national (SID, Magiran, Irandoc, Iranmedex) and international databases (PubMed and Google Scholar) to find articles which evaluated asthma prevalence in pediatrics and adolescences, using the international study of asthma and allergies in children written questionnaire. Twenty eight articles between 1992 and 2012 with a total of 96822 participants were found. ‘Asthma ever’ prevalence was 2.7% (95% CI:1.9 to 3.6) and 3.5% (95% CI: 2.6 to 4.6) in children aged 6-7 and 13-14 years, respectively. ‘Wheezing in the past 12 months’ were 7.6% (5.6 to 9.8) and 10.7% (95%CI: 8.9 to 12.7) in children aged 6-7 and 13-14 years, respectively. The prevalence of asthma had an increasing trend during the last two decades, therefore, the health care system should be alarmed for more meticulous planning and evaluation to control and prevent asthm