Study of age at first myocardial infarction in patients in Iran: A national study

Background and Objectives: Determining and monitoring the age at myocardial infarction (MI) and its comparison in various regions is one of the vital and basic principles for the management of MI. This study was conducted to determine the age at the first MI in Iran. Methods: In this cross-sectional, analytical study at a national level, the data of 20750 new MI patients registered in 2012 in 31 provinces of Iran according to the cardiologist’s diagnosis, World Health Organization criteria, and the codes ICD10: 121-122 were used. The calculations were done using the Stata 12 software. Results: The mean±SD of age at the first MI was 61.2±13.4 years in all patients in Iran. Moreover, 15033 (72.4%) patients were male with a mean age of 59.6±13.3 years. The mean age at MI in men was lower than women (65.4±12.6 years), showing a statistical significance (P<0.001).The mean age at MI was different among Iran provinces, with a statistical significance (P<0.001). The lowest mean age at the first MI was seen in the patients living in Semnan (59.1±12.9 years), followed by Tehran (60.4±13.5 years), Sistan va Balouchestan (60.3±13.9 years), and Lorestan (60.1±14.5 years), with a significant difference from the mean age of the patients in Ardabil (63.2±15.1 years) and Zanjan (64.4±112.8 years) (P<0.019). Conclusion: Our study demonstrated that the age at MI was approximately five years younger in men than women. This studyprovided the ground for monitoring the age at MI, and more effective management of cardiovascular diseases in Iran

Heart Failure, the Outcomes, Predictive and Related Factors in Iran

Background and purpose: Heart failure (HF) is a serious issue concerning public health in all countries. Assessment and monitoring of mortality and influencing factors are of great importance in HF treatment programs. This study was conducted to determine the incidence of HF and the associated factors in Iran. Materials and methods: In this study, we did two main, independent analyses. One was a cohort analysis and the other a nested case-control. The study population included 1691 patients with HF (case group) and 6464 individuals without HF (control group). They were recruited from a hospital-based cohort in cardiology wards of hospitals across Iran in 2012. Results: The incidence rate and the 95 confidence interval of HF was 8.1: 95CI: 7.7-8.5 in study population (per 100 person-year). HF Incidence was higher in women than that of the men (95 8.6: 7.9-9.4 and 95 CI: 7.9: 7.5-8.3, respectively). The highest incidence of HF was observed in Khouzestan and Guilan provinces (9.05 and 7.51, per 100 person-year, respectively) while the lowest incidence was found in Zanjan and Kohgiluyeh and Boyer Ahmad (0.47 per 100 person-year). We found atrial fibrillation (AF), coronary artery bypass grafting, and ventricular tachycardia with highest contribution to mortality in patients with HF. Cerebral vascular attack, diabetes type II, hypertension, and the occurrence of disease in cold seasons were among the main determinants for HF incidence. Conclusion: This study showed different distribution of HF in different parts of Iran. The study suggests that identifying the risk factors predicting the incidence of HF could play a major role in developing efficient programs to reduce the rate of mortality due to HF. © 2014, Mazandaran University of Medical Sciences. All rights reserved

Geographical pattern of in-hospital mortality due to myocardial infarction in Iran

Background and purpose: So far, no spatial analysis of in-hospital mortality due to myocardial infarction (MI) has been conducted in Iran. The present study was performed to determine the geographical pattern of mortality due to myocardial infarction in Iran. Materials and methods: In a prospective hospital-based study, we used the data of cases with MI registered by Myocardial Infarction Registry of Iran, 2012. For spatial analysis, LISA, Global Moran’s I, and Getis-Ord’s statistics were used. Data was analyzed using Stata software and ArcGIS 9.3 Results: A total of 20,750 patients was admitted to hospital due to MI and 2511 (12.1%) deaths occurred (median age at death: 65.2 ± 15.2). The incidence of death from MI did not follow a particular pattern (Moran's Index: 0.141, P-value = 0.126). The highest standardized incidence rates of in-hospital mortality from MI in 100,000 population were observed in Ardebil (31), North Khorasan (23.7), Yazd (20.2), West Azerbaijan (19.1) and Khuzestan (18.4). The lowest incidence rates were found in Sistan-Baluchestan and Khorasan provinces. Conclusion: This study supports the hypothesis of random pattern of mortality due to myocardial infarction in Iran

Epidemiological pattern of myocardial infarction and modelling risk factors relevant to in-hospital mortality: the first results from the Iranian Myocardial Infarction Registry

Background: Myocardial infarction (MI) care and treatment contribute greatly to the patients' fatality and mortality. Assessing and monitoring mortalities and the effective factors are necessary in MI care and treatment programs. No comprehensive and population-based study has yet been conducted in Iran to determine the epidemiological pattern of MI, and particularly in-hospital mortality rate and the effective factors. Aim: To determine the epidemiological pattern of MI based on person-, time-, place-, and mortality-associated risk factors. Methods: This was a prospective, population-based cohort study, which analysed the data of 20,750 MI patients in Iran in 2012. MI was diagnosed based on ICD-10: codes I21 and I22. The cohort of the patients was defined in terms of the date at diagnosis, hospitalisation, and the date at discharge (recovery or death due to MI). The in-hospital mortality rate was calculated by Cox regression. Univariate analysis and multiple logistic regression were used to determine the effective factors on the patients' mortality. The odds ratio (95% confidence interval CI]) was reported using Stata software. Results: The relative frequency of in-hospital mortality was 12.1%. The in-hospital mortality rate was higher in women than in men, and 6.74 (95% CI 6.4-7.0) per 100 person-years were at risk of death. The highest relative mortality (13.2%) was obtained in January (11 Dey to 11 Bahman in the Persian calendar) and the lowest (5.9%) in May (11 Ordibehest to 10 Khordad in the Persian calendar). Age of over 84 years, female gender, educational level, smoking, lack of thrombolytic therapy, type 2 diabetes, chest pain prior to arriving in hospital, right bundle branch block, ventricular tachycardia, percutaneous coronary intervention, lateral MIs, and ST segment elevation myocardial infarction (STEMI) were determinants of in-hospital mortality in the patients. The relative frequency of mortality was higher from STEMI (83.7% of deaths in registry) vs. non-STEMI (16.3% of deaths in registry). Conclusions: STEMI, lack of thrombolytic therapy, age of over 84 years, and ventricular tachycardia have the greatest effect on in-hospital mortality in MI patients. The results of this study are helpful in planning for monitoring and promotion of healthcare of the patients

Incidence of acute myocardial infarction in Islamic Republic of Iran: a study using national registry data in 2012

Population-based data on Myocardial infarction rates in the Islamic Republic of Iran have not been reported on a national or provincial scale. In a cross-sectional study, data were collected on 20 760 new cases Of myocardial infarction (ICD10 codes 121-22) admitted to hospitals and registered by the Iranian Myocardial Infarction Registry in 2012 The crude and age adjusted incidence for the 31 provinces and the whole country were directly calculated per 100 000 people using the WHO standard population. Overall males comprised 72.4% of cases and had a significantly lower Mean age at incidence than women 59.6 (SD 13.3) years versus 65.4 (SD 12.6) years]. The male:female incidence ratio was 2.63. The age-standardized Myocardial infarction incidence rate was 73.3 per 100 000 in country (95% Cl: 72.3%-74.3%) and varied Signifitantly from 24.5 to 152.5 per 100 000 across the I.ji provirites. The Study provides baseline data for monitoring and managing cardiovascular diseases in the country

The Survey of Malnutrition Prevalence in Patients With Parkinson Disease In Tehran, Iran

Background: Parkinson disease (PD) introduced as the second most prevalent neurodegenerative disease following Alzheimer disease. A patient’s nutritional status may be compromising in PD. This study aimed to describe the outpatient nutritional status in patients with PD at a third-level hospital in Iran.Methods: The validated Persian version of the Mini-Nutritional Assessment (MNA) questionnaire was used to evaluate the nutritional status of 158 Iranian PD patients (age, 35-85 years). The exclusion criteria were as follows: chronic comorbidities affecting the nutritional status (e.g., diabetes and hypertension); adherence to special diets; and cognitive disorders. Based on the MNA questionnaire, a total score below 17 represented malnutrition, while scores 17-24 indicated a risk of malnutrition.Results: Based on the findings, 26% of the participants had low weight, 67% of whom were over 65 years. According to the MNA questionnaire, 14.3% of the participants showed malnutrition and 26.2% were at risk of malnutrition.Conclusion: Based on our findings, PD can contribute to reduced nutritional status. More than one-fourth of the PD population was at risk of malnutrition, which highlights the need for more attention towards nutritional assessment. Nutritional assessment is essential for the development of nutritional interventions and early detection of PD patients who are at risk of malnutrition

Use of Fentanyl Patch and Intravenous Morphine for Treatment of Leg Bone Fracture: Treatment Profile, and Clinical Effectiveness

BACKGROUND: Severe pain is one of the major problems in patients with leg bone fracture. Various methods have been proposed to relieve pain. Opioids are one of the most important available medications to control these types of pain. Among the opioids available, fentanyl can be applied for its unique properties as transdermal patches. AIM: Therefore, the current study aimed to investigate the effect of intravenous morphine and fentanyl skin patch in patients with a lower leg fracture. METHODS: We entered 60 patients in this randomised, one-blind randomised clinical trial among patients referring to the emergency department of Vali-e-Asr Hospital in Arak with a fracture of the leg. Demographic and clinical data were recorded for patients. The case group (n = 30) received the fentanyl patch in the same area. Patients in the control group (30) received 0.1mcg/kg of morphine intravenously. In both groups, the severity of pain was measured every 20 minutes within two hours after onset of treatment based on VAS criteria and subsequently recorded in the checklist. Data were analysed by SPSS v.22 software package. RESULTS: The results of the present study demonstrated that the mean visual analogue scale (VAS) pain score at minutes 20, 40, 60 and 80 were statistically lower in intervention group when compared with the control group (p = 0.000). CONCLUSION: Our results indicated a considerable risk-benefit profile for the treatment of pain in patients suffering from dysphagia, nausea and vomiting, or resistance to other opioids. The use of fentanyl patch is also suitable for patients who are not able to take their medication at their scheduled time

Prognostic investigations of B7-H1 and B7-H4 expression levels as independent predictor markers of renal cell carcinoma.

In order to evaluate the correlation of B7-H4 and B7-H1 with renal cell carcinoma (RCC), we analyzed B7-H1 and B7-H4 expressions and their clinical significance by immunohistochemical method. Our result indicated that B7-H4-positive staining was detected in 58.13 % of RCC tissues (25 tissues tumors), and there were 18 tissues of patients without detectable B7-H4. Furthermore, 21 cases (48.83 %) were B7-H1-positive. Positive tumor expressions of B7-H4 and B7-H1 were markedly related to advanced TNM stage (P = 0.001; P = 0.014), high grade (P = 0.001; P = 002), and larger tumor size (P = 0.002; P = 024) in RCC tissues than patients with B7-H4-negative and B7-H1-negative in RCC tissues. The patients with B7-H1 and B7-H4-positive expressions were found to be markedly correlated with the overall survival of the patients (P < 0.05) and tended to have an increased risk of death when compared with negative expression groups. Univariate analysis showed that B7-H4 and B7-H1 expressions, TNM stage, high grade, and tumor size were significantly related to the prognosis of RCC. Furthermore, multivariate analysis showed that B7-H4 and B7-H1 expressions decreased overall survival. The adjusted HR for B7-H1 was 2.83 (95 % CI 1.210-2.971; P = 0.031) and also was 2.918 (95 % CI 1.243-3.102; P = 0.006) for B7-H4 that showed these markers were independent prognostic factors in RCC patients. The expressions of B7-H1 and B7-H4 in RCC patients indicate that these markers may be as a predictor of tumor development and death risk. Further investigations can be helpful to confirm B7-H1 and B7-H4 roles as an independent predictor of clinical RCC outcome

The Effects of Filgrastim on Complications of Patients with Cerebral Hemorrhage Due To Head Trauma

BACKGROUND: Filgrastim, a neopogen brand, is a blood-forming agent and a natural protein in the body that plays a role in stimulating the growth of white blood cells and protecting them against infectious agents. To the best of knowledge, human and animal specimens have shown the effect of Filgrastim on treating brain injuries regarding bone marrow transfusion into the blood, neuroprotection, stimulation of neurons for forming new neural networks and reducing the risk of bacterial infections. AIM: This study aimed to investigate the effect of Filgrastim on the prognosis of a cerebral haemorrhage in patients with traumatic brain injury. METHODS: This study was conducted as a clinical trial, in which the initial diagnosis of patients with cerebral haemorrhage due to head trauma was performed with a clinical examination and CT scan. After the patient arrives at the emergency room, the patient's initial examination is performed, and blood tests are taken from the patient. Moreover, CBC values (Hb, Platelet, Hematocrit) were checked and recorded in the checklist. The intervention group received 150 mcg/day Filgrastim injected subcutaneously for 4 days. Furthermore, patients in the control group received the same amount of sterile water. At the end of the treatment period, blood tests were performed again in all patients, and their results were then recorded. All data were analysed by SPSS v.21 software package. RESULTS: Our findings revealed that the mean volume of bleeding in the intervention group based on CT scan was significantly reduced after four days as compared to the control group. Moreover, the mean score of consciousness and muscular strength of patients in the intervention group was significantly higher than the control group. Also, WBCs in the intervention group exhibited a significant increase after four days of intervention, while platelet and hematocrit levels in the intervention group decreased significantly compared to the control group. CONCLUSION: Regarding the results, the therapeutic application of filtration is considered to be effective. Given the lack of serious complications of the proposed dosages, the use of this drug can be suggested

Adenomyoma of the Small Intestine in a Child, A Case Report

Adenomyoma is a tumor including components derived from glands and muscle. The main position of Adeomyoma occurrence is the stomach and the second most frequent location is the small bowel, usually in the periampullary area. and its occurrence in the small intestine distal to the duodenum is very rare. A 9 years old male patients admitted to the hospital with abdominal pain, nausea, and vomiting. The patient underwent surgery with acute appendicitis diagnosis. In addition to the inflammation of the appendix, a 3 cm nodule within 150 cm of ileocecal valve without any adhesion to the surrounding tissues was observed during the surgery. Our histopathological findings of this patients did not show goblet cells in all part of lesion. Adenomyom of ileum is rare disorder and the location of this lesion was not reported before