Empowerment in the self-management of hypertension: challenges from the perspective of Iranian elderly patients

Uncontrolled hypertension in the elderly causes various diseases and disability. This study was aimed to explore the challenges in self-management empowerment from the perspective of Iranian elderly patients with hypertension. Using exploratory descriptive approach, on 30 hypertension patients in Bushehr by purposive and convenience sampling method. First, qualitative data were collected through interviews with the elderly , and the quantitative data were then collected using a researcher-made questionnaire in three dimensions of knowledge, attitude and performance. Qualitative data was directed with the content analysis approach, and quantitative data were analyzed with SPSS. In the qualitative phase, coding and summarizing of the data obtained from deep semi-structured interviews with the elderly led to five areas of awareness of changes, autonomy, satisfaction with performance, coping and sense of control. 7 men and 23 women participated in the qualitative phase, in which the average age of participants was 66.17% and 63% were married. Data analysis showed that the mean score of the elderly was equal to 10.17 and 58.26 for the dimensions of knowledge and performance respectively, which were at a weak level; and the mean attitude score was 9.96, which was at a moderate level. Given the challenges in empowering the management of hypertension in elderly, the planned training is recommended to be developed for the elderly and health care staff to achieve the main objective, i.e. the empowerment of the elderly through the self-management of hypertension

Bushehr Elderly Health (BEH) Programme, phase I (cardiovascular system)

Purpose: The main objective of the Bushehr Elderly Health Programme, in its first phase, is to investigate the prevalence of cardiovascular risk factors and their association with major adverse cardiovascular events. Participants: Between March 2013 and October 2014, a total of 3000 men and women aged ≥60 years, residing in Bushehr, Iran, participated in this prospective cohort study ( participation rate=90.2%). Findings to date: Baseline data on risk factors, including demographic and socioeconomic status, smoking and medical history, were collected through a modified WHO MONICA questionnaire. Vital signs and anthropometric measures, including systolic and diastolic blood pressure, weight, height, and waist and hip circumference, were also measured. 12-lead electrocardiography and echocardiography were conducted on all participants, and total of 10 cc venous blood was taken, and sera was separated and stored at –80°C for possible future use. Preliminary data analyses showed a noticeably higher prevalence of risk factors among older women compared to that in men. Future plans: Risk factor assessments will be repeated every 5 years, and the participants will be followed during the study to measure the occurrence of major adverse cardiac events. Moreover, the second phase, which includes investigation of bone health and cognition in the elderly, was started in September 2015. Data are available at the Persian Gulf Biomedical Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran, for any collaboration

State-of-the-art modalities in cardio-oncology: insight from a nuclear medicine approach

Cancer and cardiovascular disease are the most significant causes of morbidity and mortality worldwide. Although the cancer survival rate has increased due to improved treatment approaches, especially targeted therapy, some side effects such as cardiotoxicity decrease the efficiency of the clinical outcome. Radiation therapy and chemotherapy have a long-established history of potential cardiotoxic effects. A new multi-disciplinary and translational field known as cardio-oncology has been developed for the identification, prevention, and treatment of cardiovascular dysfunctions associated with cancer treatment approaches. One of the important tools for detecting and monitoring cardiotoxic effects is non-invasive nuclear cardiac imaging techniques. Cardiac nuclear imaging modalities especially recent findings positron emission tomography (PET) tracers have a quintessential role in the early detection of cardiovascular disorders. Moreover, comprehensive studies are required to investigate novel nuclear medicine treatment approaches such as peptide receptor radionuclide therapy (PRRT), fibroblast activation protein (FAP), and chemokine receptor (CXCR) targeting probes for possible cardiac side effects that play important roles in the treatment of malignancies

Review on Kidney-Liver Crosstalk: Pathophysiology of Their Disorders

Kidney-liver crosstalk plays a crucial role in normal and certain pathological conditions. In pathologic states, bothrenal-induced liver damage and liver-induced kidney diseases may happen through these kidney-liver interactions.This bidirectional crosstalk takes place through the systemic conditions that mutually influence both the liver andkidneys. Ischemia and reperfusion, cytokine release and pro-inflammatory signaling pathways, metabolic acidosis,oxidative stress, and altered enzyme activity and metabolic pathways establish the base of this interaction betweenthe kidneys and liver. In these concomitant kidney-liver diseases, the survival rates strongly correlate with earlyintervention and treatment of organ dysfunction. Proper care of a nephrologist and hepatologist and the identificationof pathological conditions using biomarkers at early stages are necessary to prevent the complications induced by thiscomplex and potentially vicious cycle. Therefore, understanding the characteristics of this crosstalk is essential forbetter management. In this review, we discussed the available literature concerning the detrimental effects of kidneyfailure on liver functions and liver-induced kidney diseases

Bushehr Elderly Health (BEH) Programme, phase I (cardiovascular system)

Purpose: The main objective of the Bushehr Elderly Health Programme, in its first phase, is to investigate the prevalence of cardiovascular risk factors and their association with major adverse cardiovascular events. Participants: Between March 2013 and October 2014, a total of 3000 men and women aged ≥60 years, residing in Bushehr, Iran, participated in this prospective cohort study ( participation rate=90.2%). Findings to date: Baseline data on risk factors, including demographic and socioeconomic status, smoking and medical history, were collected through a modified WHO MONICA questionnaire. Vital signs and anthropometric measures, including systolic and diastolic blood pressure, weight, height, and waist and hip circumference, were also measured. 12-lead electrocardiography and echocardiography were conducted on all participants, and total of 10 cc venous blood was taken, and sera was separated and stored at –80°C for possible future use. Preliminary data analyses showed a noticeably higher prevalence of risk factors among older women compared to that in men. Future plans: Risk factor assessments will be repeated every 5 years, and the participantswill be followed during the study to measure the occurrence of major adverse cardiac events. Moreover, the second phase, which includes investigation of bone health and cognition in the elderly, was started in September 2015. Data are available at the Persian Gulf Biomedical Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran, for any collaboratio

Examining the Validity and Reliability of the Cardiovascular Disease Questionnaire in Measuring the Empowerment of Elderly Patients to Receive Social Support

Objectives: Increased problems associated with aging and cardiovascular disorders can negatively influence the elderly empowerment in lifestyle management. Cardiovascular diseases impose economic, social, and psychological burdens in the form of direct and indirect health costs, which results in the loss of empowerment and quality of life in the elderly population. Therefore, it is important to develop a valid and reliable instrument that can effectively measure the empowerment of elderly patients with cardiovascular disease to receive social support.  Methods & Materials: In this descriptive study, the psychometric design of the questionnaire was developed and evaluated based on the following four steps: 1) the concept of empowering the elderly patients with cardiovascular disease in receiving social support was clearly defined after reviewing certain related books and articles; 2) the questionnaire items were designed using resources in Iran and elsewhere; 3) the psychometrics, content validity, and face validity of the questionnaire were examined by ten experts from different universities; and 4) internal consistency of the questionnaire was checked by determining the Cronbach's alpha coefficient, and external reliability was checked by conducting test-retest.  Results: The empowerment of elderly patients’ in receiving social support was determined in seven domains including awareness of personal changes, role playing, adaptation, independence, perceived satisfaction, being in control, and self-management. The primary version of the questionnaire was designed taking into account 35 items during the first and second stages. In the third and fourth stages of psychometric validity and reliability, four items were deleted from the questionnaire and the final version of the questionnaire consisted of 31 items. The content validity index and content validity ratio was reported to be 0.94 and 0.96, respectively. The internal and external reliability of the questionnaire was calculated as (r=0.90) and (r=0.83), respectively. Conclusion: The final questionnaire had appropriate psychometric properties. The need for further studies is suggested to measure the other types of validity, such as structure validity of the questionnaire

Effects of resistant starch on glycemic control, serum lipoproteins and systemic inflammation in patients with metabolic syndrome and related disorders: A systematic review and meta-analysis of randomized controlled clinical trials

The aim of this systematic review and meta-analysis was to evaluate the effects of resistant starch (RS) on glycemic status, serum lipoproteins and inflammatory markers in patients with metabolic syndrome (MetS) and related disorders. Two independent authors systematically searched online database including EMBASE, Scopus, PubMed, Cochrane Library, and Web of Science from inception until 30 April 2019. Cochrane Collaboration risk of bias tool was applied to assess the methodological quality of included trials. The heterogeneity among the included studies was assessed using Cochrane’s Q test and I-square (I2 ) statistic. Data were pooled using a random-effects model and weighted mean difference (WMD) was considered as the overall effect size. Nineteen trials were included in this meta-analysis. Administration of RS resulted in significant reduction in fasting plasma glucose (FPG) (14 studies) (WMD: �4.28; 95% CI: �7.01, �1.55), insulin (12 studies) (WMD: �1.95; 95% CI: �3.22, �0.68), and HbA1C (8 studies) (WMD: �0.60; 95% CI: �0.95, �0.24). When pooling data from 13 studies, a significant reduction in total cholesterol levels (WMD: �8.19; 95% CI: �15.38, �1.00) and LDL-cholesterol (WMD: �8.57; 95% CI: �13.48, �3.66) were found as well. Finally, RS administration was associated with a significant decrease in tumor necrosis factor alpha (TNF-a) (WMD: �2.02; 95% CI: �3.14, �0.90). This meta-analysis showed beneficial effects of RS on improving FPG, insulin, HbA1c, total cholesterol, LDL-cholesterol and TNF-a levels in patients with MetS and related disorders, but it did not affect HOMA-IR, triglycerides, HDL-cholesterol, CRP and IL-6 levels

Factors that impact evaluation of left ventricular systolic parameters in myocardial perfusion gated SPECT with 16 frame and 8 frame acquisition models | [16 ve 8 frame görüntüleme modelli miyokard perfüzyon gated SPECT çalışmasında sol ventrikül sistolik parametrelerinin değerlendirilmesini etkileyen faktörler

Objective: Evaluating the effects of heart cavity volume, presence and absence of perfusion defect, gender and type of study (stress and rest) on the difference of systolic parameters of myocardial perfusion scan in 16 and 8 framing gated SPECT imaging. Methods: Cardiac gated SPECT in both 16 and 8 framing simultaneously and both stress and rest phases at one-day protocol was performed for 50 patients. Data have been reconstructed by filter back projection (FBP) method and left ventricular (LV) systolic parameters were calculated by using QGS software. The effect of some factors such as LV cavity volume, presence and absence of perfusion defect, gender and type of study on data difference between 8 and 16 frames were evaluated. Results: The differences in ejection fraction (EF), end-diastolic volume (EDV) and end-systolic volume (ESV) in both stress and rest were statistically significant. Difference in both framing was more in stress for EF and ESV, and was more in rest for EDV. Study type had a significant effect on differences in systolic parameters while gender had a significant effect on differences in EF and ESV in rest between both framings. Conclusion: In conclusion, results of this study revealed that difference of both 16 and 8 frames data in systolic phase were statistically significant and it seems that because of better efficiency of 16 frames, it cannot be replaced by 8 frames. Further well-designed studies are required to verify these finding

A Novel Missense Variant in Actin Binding Domain of MYH7 Is Associated With Left Ventricular Noncompaction

Cardiomyopathies are a group of common heart disorders that affect numerous people worldwide. Left ventricular non-compaction (LVNC) is a structural disorder of the ventricular wall, categorized as a type of cardiomyopathy that mostly caused by genetic disorders. Genetic variations are underlying causes of developmental deformation of the heart wall and the resultant contractile insufficiency. Here, we investigated a family with several affected members exhibiting LVNC phenotype. By whole-exome sequencing (WES) of three affected members, we identified a novel heterozygous missense variant (c.1963C>A:p.Leu655Met) in the gene encoding myosin heavy chain 7 (MYH7). This gene is evolutionary conserved among different organisms. We identified MYH7 as a highly enriched myosin, compared to other types of myosin heavy chains, in skeletal and cardiac muscles. Furthermore, MYH7 was among a few classes of MYH in mouse heart that highly expresses from early embryonic to adult stages. In silico predictions showed an altered actin-myosin binding, resulting in weaker binding energy that can cause LVNC. Moreover, CRISPR/Cas9 mediated MYH7 knockout in zebrafish caused impaired cardiovascular development. Altogether, these findings provide the first evidence for involvement of p.Leu655Met missense variant in the incidence of LVNC, most probably through actin-myosin binding defects during ventricular wall morphogenesis