Association between dietary salt intake and reservation of renal function in patients with mild hypertension

BACKGROUND: It is now hypothesized whether restricted salt intake can be a potential precursor to renal dysfunction in mild hypertension state. We aimed to study the association between salt intake and renal function in patients with mild hypertension. METHODS: One hundred consecutive hypertensive Iranian patients (with systolic blood pressure 140-160 mmHg and/or diastolic 90-100 mmHg) who were referred to the hypertension research center, Isfahan, Iran, between 2011 and 2014 for screening of hypertension were assessed. Renal function was assessed by measuring serum creatinine (Cr) and creatinine clearance (CrCl). Daily salt intake was assessed on the basis of 24 h urinary sodium excretion. RESULTS: There was no association between the amounts of sodium intake and serum Cr concentration (r = 0.138, P = 0.174), however, an association was revealed between sodium intake and value of CrCl (r = 0.303, P = 0.003). Multivariable linear regression model showed that sodium intake could effectively predict renal function assessed by CrCl (Beta = 0.070, P = 0.016). CONCLUSION: There is an association between sodium intake and reservation of renal function in mild hypertension state and thus by restriction of dietary salt intake, reserving renal function, and preventing appearance and progression of renal insufficiency in higher degrees of hypertension can be facilitated

Prevalence of Athero sclerosis risk factors in hypertensive smokers, non-smokers and passive smokers .

یکی از مهمترین علل کاهش سن مرگ و میر ناشی از بیماریهای قلبی عروقی، افزایش شیوع پرفشاری خون و آترواسکلروزیس ناشی از آن در کشورهای در حال توسعه آسیایی و غرب آسیا نسبت به دیگر کشورهای توسعه یافته می‌باشد. امروزه مطالعات نشان داده‌اند که استعمال سیگار در کشورهای آسیایی نسبت به سایر کشورهای جهان روند رو به افزایش داشته است. هدف از این مطالعه بررسی تأثیر دود سیگار در عوارض قلبی عروقی و ریسک فاکتورهای آترواسکلروزیس در بیماران مبتلا به پرفشاری خون می‌باشد. این مطالعه یک پژوهش گذشته‌نگر بر روی 6123 نفر جمعیت مردان دارای فشارخون و افراد سالم ساکن مناطق مرکزی ایران (استان اصفهان و استان مرکزی) می‌باشد که بصورت خوشه‌ای- تصادفی از مطالعه ملی Isfahan Healthy Heart project IHHP) ( نمونه‌گیری شده‌اند. کلیه افراد از نظر سوابق بیماری قلبی عروقی، دموگرافیک، سیگاری بودن و معاینات فیزیکی فشارخون، ریت قلبی، ریت تنفسی، وزن، قد، دور شکم و آزمایشات پاراکلینیکی LDL، HDL، Col-T، TG، 2hhp و FBS مورد بررسی قرار گرفتند که اطلاعات خام بعد از جمع‌آوری در نرم‌افزار آماری SPSS 10 مورد تجزیه و تحلیل Chi-square و one-way ANOVA قرار گرفت. از 6111 نفر جمعیت مردان تحت مطالعه ساکن نواحی مرکزی 893 نفر مبتلا به پرفشاری خون و 5230 نفر سالم بودند. شیوع پرفشاری خون در منطقه شهری 5/2 برابر منطقه روستایی بود که این نسبت با اضافه شدن عامل سیگاری بودن به 5/3 برابر افزایش داشت که تفاوت معنی‌دار بود. شیوع عوامل خطرساز آترواسکلروزیس و نیز عوارض قلبی عروقی بر اساس شاخصهای موردنظر در مطالعه در مبتلایان به پرفشاری خون بطور معنی‌داری بیشتر از افراد سالم بود که این میزان در مبتلایان فشارخونی سیگاری و یا در معرض دود سیگار نسبت به غیرسیگاریها از شیوع بالاتری برخوردار بود. مقایسه گروههای سیگاری در مبتلایان به پرفشاری خون و افراد سالم نشانگر اثر مؤثر و مستقیم سیگار و دود سیگار در افزایش شیوع عوامل خطرساز آترواسکلروزیس جهت ابتلا به بیماریهای قلبی عروقی در مبتلایان به پرفشاری خون نسبت به افراد غیرسیگاری می باشد

Association of Socioeconomic Status and Life-style Factors with Coping Strategies in Isfahan Healthy Heart Program, Iran

Aim To investigate the association between life-style and socioeconomic factors and coping strategies in a community sample in Iran. Method As part of a community-based study called Isfahan Healthy Heart Program, we studied 17 593 individuals older than 19 living in the central part of Iran. Demographic and socioeconomic factors (age, sex, occupation status, marital status, and educational level) and lifestyle variables (smoking status, leisure time physical activity, and psychological distress), and coping strategy were recorded. Data were analyzed by Pearson correlation and multiple linear regression. Results Not smoking (women β = -11.293, P < 0.001; men β = -3.418, P = 0.007), having leisure time physical activity (women β = 0.017, P = 0.046; men β = 0.005, P = 0.043), and higher educational level (women β = 0.344, P = 0.015; men β = 0.406, P = 0.008) were predictors of adaptive coping strategies, while smoking (women β = 11.849, P < 0.001; men β = 9.336, P < 0.001), high stress level (women β = 1.588, P = 0.000; men β = 1.358, P < 0.001), and lower educational level (women β = -0.443, P = 0.013; men β = - 0.427, P = 0.013) were predictors of maladaptive coping strategies in both sexes. Non-manual work was a positive predictor of adaptive (β = 4.983, P < 0.001) and negative predictor of maladaptive (β = -3.355, P = 0.023) coping skills in men. Conclusion Coping strategies of the population in central Iran were highly influenced by socioeconomic status and life-style factors. Programs aimed at improving healthy life-styles and increasing the socioeconomic status could increase adaptive coping skills and decrease maladaptive ones and consequently lead to a more healthy society

Radiologic features of radiolucent foreign bodies ingestion in common mynah (Acridotheres tristis).

BACKGROUND In mynahs with foreign body ingestion, delayed diagnosis increases the risk of poor outcomes. OBJECTIVE The aim of this study was to evaluate various radiologic features on plain and contrast radiographs in mynahs for assessing the presence of ingested foreign bodies. METHODS In our cross-sectional study, a total of 41 mynahs were included. The diagnosis was made by history, surgery, excision by forceps or excretion in the faeces. Overall, 21 mynahs were considered not to have a foreign body in their gastrointestinal tract. Plain and post-contrast [oral administration of barium sulphate colloidal suspension of 25% weight/volume (20 mg/kg)] lateral and ventrodorsal radiographs from the cervical and coelomic cavity were taken. Different parameters including oesophageal, proventricular, and small intestinal diameters and opacities were assessed. Image evaluation was performed by two national board-certified radiologists blinded to the final diagnoses. RESULTS The inter- and intra-observer reliabilities of the diagnostic features were significant (p < 0.001). The diagnosis of the foreign body was highly accurate [90.2% (95% CI: 76.9%, 92.3%)] with the sensitivity, specificity, and area under the representative characteristic curve of 90.0%, 90.5%, and 0.93%, respectively for plain radiographs. The size and opacity of the oesophagus, proventriculus, and intestinal loops as well as serosal details were significantly different between mynahs with and without foreign body intake (p < 0.05). CONCLUSIONS Lateral and ventrodorsal plain radiographs are highly reliable for diagnosing the presence of non-opaque obstructing objects in the gastrointestinal tract of mynahs. Attention should be paid to the size and opacity of the oesophagus, extension, and opacity of the proventriculus, segmental opacity of intestinal loops, and decrease in serosal details

Effect of Hydrogenated, Liquid and Ghee Oils on Serum Lipids Profile

BACKGROUND: Trans fatty acids are known as the most harmful type of dietary fats, so this study was done to compare the effects of hydrogenated, liquid and ghee oils on serum lipids profile of healthy adults. &nbsp;&nbsp; METHODS: This study was a randomized clinical trial conducted on 129 healthy participants aged from 20 to 60 years old who were beneficiaries of Imam-e-Zaman charitable organization. Subjects were randomly divided into 3 groups and each group was treated with a diet containing cooking and frying liquid, ghee, or hydrogenated for 40 days. Fasting serum lipids, including total cholesterol (TC), triglyceride (TG), LDL-cholesterol (LDL-C), HDL-cholesterol (HDL-C), apoprotein A (Apo A), and apoprotein B (Apo B) were measured before and after the study. &nbsp;&nbsp; RESULTS: TC, TG and Apo B had a significant reduction in the liquid oil group compared to the hydrogenated oil group. In the ghee group TG declined and Apo A increased significantly (p &lt; 0.01). Liquid oil group had a significant reduction in HDL-C, compared to the ghee oil group (P &lt; 0.05).&nbsp; &nbsp;&nbsp; CONCLUSION: It was concluded that consuming liquid oil along with frying oil caused to reduce all serum lipid levels. However, ghee oil only reduced TG and increased HDL-C levels. &nbsp; &nbsp;&nbsp; Keywords: Serum lipids, Apoproteins, Liquid oil, Hydrogenated oil, Ghee, Clinical tria

Secular trend changes in mean age of morbidity and mortality from an acute myocardial infarction during a 10-year period of time in Isfahan and Najaf Abad

زمینه و هدف: با توجه به گزارشات متفاوت در مورد خصوصیات دموگرافیک بیماران مبتلا به انفارکتوس قلبی حاد در ایران، این مطالعه جهت تعیین میانگین سن رخداد و مرگ و میر از بیماری و تغییرات آن در طول زمان انجام گردید. روش بررسی: در این مطالعه همگروهی گذشته نگر مبتنی بر بیمارستان، 12815 بیمار مبتلا به انفارکتوس قلبی حاد بستری شده در بیمارستان های شهر اصفهان و نجف آباد در طی سال های 87-1378 بررسی شدند. بعد از جمع آوری اطلاعات اولیه بیماران، آنها به مدت 28 روز جهت بررسی پیامدهای بیماری پیگیری شدند. اطلاعات در مورد پیامدهای بیماری از طریق تماس تلفنی یا مراجعه به درب منزل بیماران جمع آوری شد. یافته ها: میانگین سن رخداد بیماری برای مردان 54/12 ± 60 و برای زنان 34/11 ± 72/66 بود (001/0

Late clinical events of drug eluting versus bare metal stenting; OPCES' ancillary study

Objective: To compare one year clinical outcomes of patients with chronic stable angina who underwent implantation of bare metal stent (BMS) or drug eluting stent (DES). Methodology: Four hundred forty two (442) participants of OPCES study (Osvix versus Plavix in Cardiovascular Events after Stenting) were included in this sub-study. After evaluation of exclusion criteria (combined DES and BMS stenting (n=31) and incomplete data (n=48) patients were divided in two groups according to selected stent(DES or BMS). Follow-up was conducted by a structured telephone interview after 6 and 12 months. The patients' documents were reviewed by the Study Event Committee in the Isfahan Cardiovascular Research Center to evaluate the occurrence of study endpoints which consisted of clinical success rate and major adverse cardiac events (Major Adverse Cardiac Events (MACE), cardiac death, non-fatal MI, target vessel revascularization and stroke) in hospital, after 6 and 12 months. Results: One hundred sixty six (45.7%) patients were in the DES and 197(54.3%) were in the BMS group. Procedural complications were seen more frequently in the DES group (1.0% vs. 4.8%, P=0.027), the prevalence of the in-hospital MACE, angiographic and clinical success rate were the same between both the groups. There was no significant difference regarding 6 and 12 months MACE rate in patients treated by BMS or DES (6 months: 1.1% vs. 0.6%, p>0.999 12 month: 3.4% vs 2.6%, P = 0.755). Conclusion: Considering the same clinical outcome and the economical parameters, use of the BMS after proper patient selection are recommended

Availability and affordability of blood pressure-lowering medicines and the effect on blood pressure control in high-income, middle-income, and low-income countries: an analysis of the PURE study data.

BACKGROUND: Hypertension is considered the most important risk factor for cardiovascular diseases, but its control is poor worldwide. We aimed to assess the availability and affordability of blood pressure-lowering medicines, and the association with use of these medicines and blood pressure control in countries at varying levels of economic development. METHODS: We analysed the availability, costs, and affordability of blood pressure-lowering medicines with data recorded from 626 communities in 20 countries participating in the Prospective Urban Rural Epidemiological (PURE) study. Medicines were considered available if they were present in the local pharmacy when surveyed, and affordable if their combined cost was less than 20% of the households' capacity to pay. We related information about availability and affordability to use of these medicines and blood pressure control with multilevel mixed-effects logistic regression models, and compared results for high-income, upper-middle-income, lower-middle-income, and low-income countries. Data for India are presented separately because it has a large generic pharmaceutical industry and a higher availability of medicines than other countries at the same economic level. FINDINGS: The availability of two or more classes of blood pressure-lowering drugs was lower in low-income and middle-income countries (except for India) than in high-income countries. The proportion of communities with four drug classes available was 94% in high-income countries (108 of 115 communities), 76% in India (68 of 90), 71% in upper-middle-income countries (90 of 126), 47% in lower-middle-income countries (107 of 227), and 13% in low-income countries (nine of 68). The proportion of households unable to afford two blood pressure-lowering medicines was 31% in low-income countries (1069 of 3479 households), 9% in middle-income countries (5602 of 65 471), and less than 1% in high-income countries (44 of 10 880). Participants with known hypertension in communities that had all four drug classes available were more likely to use at least one blood pressure-lowering medicine (adjusted odds ratio [OR] 2·23, 95% CI 1·59-3·12); p<0·0001), combination therapy (1·53, 1·13-2·07; p=0·054), and have their blood pressure controlled (2·06, 1·69-2·50; p<0·0001) than were those in communities where blood pressure-lowering medicines were not available. Participants with known hypertension from households able to afford four blood pressure-lowering drug classes were more likely to use at least one blood pressure-lowering medicine (adjusted OR 1·42, 95% CI 1·25-1·62; p<0·0001), combination therapy (1·26, 1·08-1·47; p=0·0038), and have their blood pressure controlled (1·13, 1·00-1·28; p=0·0562) than were those unable to afford the medicines. INTERPRETATION: A large proportion of communities in low-income and middle-income countries do not have access to more than one blood pressure-lowering medicine and, when available, they are often not affordable. These factors are associated with poor blood pressure control. Ensuring access to affordable blood pressure-lowering medicines is essential for control of hypertension in low-income and middle-income countries. FUNDING: Population Health Research Institute, the Canadian Institutes of Health Research, Heart and Stroke Foundation of Ontario, Canadian Institutes of Health Research Strategy for Patient Oriented Research through the Ontario SPOR Support Unit, the Ontario Ministry of Health and Long-Term Care, pharmaceutical companies (with major contributions from AstraZeneca [Canada], Sanofi Aventis [France and Canada], Boehringer Ingelheim [Germany amd Canada], Servier, and GlaxoSmithKline), Novartis and King Pharma, and national or local organisations in participating countries

Prevalence of a healthy lifestyle among individuals with cardiovascular disease in high-, middle- and low-income countries: The Prospective Urban Rural Epidemiology (PURE) study

Importance: Little is known about adoption of healthy lifestyle behaviors among individuals with a coronary heart disease (CHD) or stroke event in communities across a range of countries worldwide. Objective: To examine the prevalence of avoidance or cessation of smoking, eating a healthy diet, and undertaking regular physical activities by individuals with a CHD or stroke event. Design, Setting, and Participants Prospective Urban Rural Epidemiology (PURE) was a large, prospective cohort study that used an epidemiological survey of 153 996 adults, aged 35 to 70 years, from 628 urban and rural communities in 3 high-income countries (HIC), 7 upper-middle-income countries (UMIC), 3 lower-middle-income countries (LMIC), and 4 low-income countries (LIC), who were enrolled between January 2003 and December 2009. Main Outcome: Measures smoking status (current, former, never), level of exercise (low, 600 metabolic equivalent task [MET]-min/wk; moderate, 600-3000 MET-min/wk; high, 3000 MET-min/wk), and diet (classified by the Food Frequency Questionnaire and defined using the Alternative Healthy Eating Index). Results: Among 7519 individuals with self-reported CHD (past event: median, 5.0 [interquartile range {IQR}, 2.0-10.0] years ago) or stroke (past event: median, 4.0 [IQR, 2.0-8.0] years ago), 18.5% (95% CI, 17.6%-19.4%) continued to smoke; only 35.1% (95% CI, 29.6%-41.0%) undertook high levels of work- or leisure related physical activity, and 39.0% (95% CI, 30.0%-48.7%) had healthy diets; 14.3% (95% CI, 11.7%-17.3%) did not undertake any of the 3 healthy lifestyle behaviors and 4.3% (95% CI, 3.1%-5.8%) had all 3. Overall, 52.5% (95% CI, 50.7%-54.3%) quit smoking (by income country classification: 74.9% [95% CI, 71.1%-78.6%] in HIC; 56.5% [95% CI, 53.4%-58.6%] in UMIC; 42.6% [95% CI, 39.6%-45.6%] in LMIC; and 38.1% [95% CI, 33.1%-43.2%] in LIC). Levels of physical activity increased with increasing country income but this trend was not statistically significant. The lowest prevalence of eating healthy diets was in LIC (25.8%; 95% CI, 13.0%-44.8%) compared with LMIC (43.2%; 95% CI, 30.0%- 57.4%), UMIC (45.1%, 95% CI, 30.9%-60.1%), and HIC (43.4%, 95% CI, 21.0%- 68.7%). Conclusion and Relevance: Among a sample of patients with a CHD or stroke event from countries with varying income levels, the prevalence of healthy lifestyle behaviors was low, with even lower levels in poorer countries.IS

Gender Differences in Obesogenic Behaviour, Socioeconomic and Metabolic Factors in a Population-based Sample of Iranians: The IHHP Study

This study investigated the gender differences in association of some behavioural and socioeconomic factors with obesity indices in a population-based sample of 12,514 Iranian adults. The mean body mass index (BMI), waist circumference (WC), and the waist-to-hip ratio (WHR) were significantly higher in women than in men. Current and passive smoking had an inverse association with BMI among males whereas current smoking, transportation by a private car, and longer duration of watching television (TV) had a positive association with BMI among females. Current and passive smoking, cycling, and Global Dietary Index (GDI) had an inverse association with WC among males. Higher consumption of fruits and vegetables, current and passive smoking, duration of daily sleep, and GDI had an inverse association with WC among females. Using a private car for transportation had a significant positive association with WHR among both males and females. Living in an urban area, being married, and having a higher education level increased the odds ratio of obesity among both the genders. Non-manual work also increased this risk among males whereas watching TV and current smoking increased this risk among females. Such gender differences should be considered for culturally-appropriate interventional strategies to be implemented at the population level for tackling obesity and associated cardiometabolic risk factors