Demographic and Technical Risk Factors of 30-Day Stroke, Myocardial Infarction, and/or Death in Standard- and High-Risk Patients Who Underwent Carotid Angioplasty and Stenting

Background: Carotid angioplasty and stenting (CAS) is an accepted treatment to prevent stroke in patients with carotid artery stenosis. The purpose of this study is to identify risk factors for major complications after CAS. Materials and Methods: This is a prospective study that was conducted at Shiraz University of Medical Sciences in southern Iran from March 2011 to June 2014. Consecutive patients undergoing CAS were enrolled. Both standard- and high-risk patients for endarterectomy were enrolled. Demographic data, athero- Published online: June 9, 2015 Afshin Borhani Haghighi, MD Department of Neurology Nemazee Hospital Shiraz 71345 (Iran) E-Mail neuro.ab @ gmail.com www.karger.com/ine DOI: 10.1159/000430923 This work was done as the thesis project for the medical degree by Ms. Samaneh Yousefi

Evaluation of Asymptomatic Cardiac Disease in Patients with Ocular Pseudoexfoliation

Purpose: To evaluate asymptomatic cardiac disease in patients with ocular pseudoexfoliation.Patients and Method: Forty-two patients with ocular pseudoexfoliation (with or without glaucoma) and 40 patients without pseudoexfoliation, who had no positive signs or symptoms of cardiac ­­­­­­diseases, were enrolled in this study. For each participant a standard treadmill exercise test, as a noninvasive and reliable method for detecting ischemic heart disease, was performed under supervision of a cardiologist. The prevalence of ischemic heart disease was compared in the case and control groups.Results: The mean age of participants was 68.38 ± 8.10 years in the case and 62.45 ± 8.40 years in the control group. There was no statistically significant difference between the two groups in terms of diabetes mellitus, hyperlipidemia, smoking, and family history of ischemic heart disease. Twenty patients (47.6 %) with pseudoexfoliation and 9 participants (22.5 %) without pseudoexfoliation had hypertension (P = 0.02). There were 10 (23.8 %) positive exercise tests in the pseudoexfoliation group and 8 (20 %) positive exercise tests in participants without pseudoexfoliation (P = 0.78). Conclusion: Based on our findings ocular pseudoexfoliation was not associated with increased risk of asymptomatic ischemic heart disease as evaluated by a treadmill exercise test. Keywords: Pseudoexfoliation syndrome; Exercise test; Myocardial ischemia; Iran

ACE genetic variability and response to fluoxetine: lack of association in depressed patients

Evidences suggest that besides the neurotransmitters contributing to the development of depression, renin-angiotensin system (RAS) may also have a substantial role. Certain polymorphisms of RAS are associated with over activity of RAS &amp; depression. Considering that antidepressants reduce the actions of angiotensin II, the main product of RAS, this may come into mind that genetic polymorphisms of the mentioned system may affect the outcome of therapy in depressed patients.In the present study, 100 newly diagnosed depressed patients, according to DSM-IV criteria, were treated with 20 mg of fluoxetine for 8-12 weeks. Patients were categorized into responsive and non-responsive groups according to 50% reduction in symptoms. Genotype frequencies of angiotensin-converting enzyme (ACE) gene [ACE (I/D, A-240T and A2350G)] were then determined in DNAs extracted from venous blood of the patients using polymerase chain reaction–restriction fragment length polymorphism (PCR– RFLP) and PCR.Results indicate that polymorphisms studied and their haplotypes were not associated with better response to fluoxetine. However, a strong association between age and treatment in depressed Iranian patients was observed (P=0.001).In conclusion, unlike previous reports, this study does not support the hypothesis of special genotypes of RAS contributing to a better response to antidepressants in depressed patients.</p

Dietary inflammatory index and metabolic syndrome in Iranian population (Fasa Persian Cohort Study)

Metabolic syndrome (MetS) is one of the risk factors for all causes of mortality. Inflammation is an important risk factor for MetS. The present cross-sectional study aimed to investigate the relationship between MetS and pro-inflammatory diet by using the food inflammation index (DII). This study consists of 10,017 participants with an age range of 35 to 70 years. The Fasa Cohort Study (FACS) population (Fars Province, Iran) was used to collect data. The DII was estimated according to Shivappa et al. method using a validated 125-item FFQ. To determine the association between MetS components and DII Logistic regression was used (P>0.05). The overall mean of DII was-0.89 +/- 1.74. However, adjusted multinomial logistic regression indicates each unit increase in waist circumference (WC) (OR 0.98, 95% CI 0.96-0.99) and HDL-C (OR 0.99, 95% CI 0.98-0.99) was associated with significantly decreased odds of being in the 4th DII quartile in men and all participations respectively, there is no statistically significant relationship between MetS and DII. Overall, although people in the highest quartile of inflammatory food consumption had more likely to develop MetS, this relationship was not statistically significant among males and females. Plus:CARDIOVASCULAR RISK; ASSOCIATION; PATTERNS; DISEASE; OBESITY; HEALTH; STRATEGIES; MORTALITY; CANCE

Prevalence, awareness, treatment, and control of hypertension based on ACC/AHA versus JNC7 guidelines in the PERSIAN cohort study

In this cross-sectional population-based study, we used the baseline data of the Prospective Epidemiologic Research Studies in IrAN cohort study collected in Iran from 2014 to 2020. The main outcomes were the prevalence of hypertension and proportion of awareness, treatment, and control based on the 2017 ACC/AHA guideline compared to the seventh report of the Joint National Committee (JNC7). Of the total of 163,770 participants, aged 35–70 years, 55.2% were female. The sex-age standardized prevalence of hypertension was 22.3% (95% CI 20.6, 24.1) based on the JNC7 guideline and 36.5% (31.1, 41.8) based on the ACC/AHA guideline. A total of 24,312 participants [14.1% (10.1, 18.1)] were newly diagnosed based on the ACC/AHA guideline. Compared to adults diagnosed with hypertension based on the JNC7 guideline, the newly diagnosed participants were mainly young literate males who had low levels of risk factors and were free from conventional comorbidities of hypertension. About 30.7% (25.9, 35.4) of them (4.3% of the entire population) were eligible for pharmacologic intervention based on the ACC/AHA guideline. Implementation of the new guideline may impose additional burden on health systems. However, early detection and management of elevated blood pressure may reduce the ultimate burden of hypertension in Iran

The Level of Satisfaction of Family Physician Program in Urban Population of Fasa from 2014 to 2015

Background & Objective: Patient satisfaction is an indicator of the health services that is increasingly important in today's competitive world and perhaps the simplest method for evaluation of family physician program. This study aimed to determine the level of satisfaction of service recipients in urban areas in Fasa, Iran, with implementation of the Family Physician Program. Materials & Methods: This descriptive cross-sectional study was carried on the 411 patients for whom family physician program was implemented in 2014. Data were collected by a valid and reliable demographic and satisfaction questionnaire in 6 dimensions (care and reverence, trust and belief in his performance, waiting time, availability and timely access to a doctor in time, usefulness of actions, payment costs and paramedical unit performance and on time accessibility, professional services and emergency). Data were analyzed using SPSS software version 18 using independent-samples t-test, chi square test, and ANOVA. Results: Only 1.7% of people had little satisfaction. However, the majority of people expressed consent in all aspects of the Satisfaction of the Family Physician Project. The highest levels of satisfaction were observed in care, respect, trust and belief and the emergency services were observed in the lowest level of satisfaction. Conclusion: Good satisfaction after implementing the family physician program shows the successfulness of the program. Therefore, implementation of family physician program will be a significant milestone for other cities but in order to increase the satisfaction of the emergency services and relevant programs, revision seems necessary in order to improve some of the indices of people satisfaction. &nbsp; &nbsp; &nbsp

Caregivers Awareness about the rules of Family Physician Program in Fasa in the Year 2014

Background & Objective: Caregivers awareness about family physician program is necessary to achieve its success and goals. This study was conducted to determine the caregivers&rsquo; awareness about family physician in urban areas of Fasa. Materials & Methods: This cross-sectional study was carried out on 411 patients referring to family physician clinics affiliated to Fasa University of Medical Sciences in winter 2014. The data were collected by a valid and reliable two-part questionnaire including demographic characteristics and 10 questions on people&rsquo;s awareness about family physician program. The data were analyzed by using SPSS software version 19 by independent t-test, one-way ANOVA test, and chi square test. P-value less than 0.05 was considered significant. Results: 17.3%, 61.5%, and 21.2% of people reported appropriate intermediate, and poor awareness about the program, respectively. The mean awareness score&nbsp; was 58/7 &plusmn; 14.5 (based on the score&nbsp; 100). But the mean score of the awareness about the rules and the referral system were higher compared to the awareness of how to get services in non-working hours from doctor, emergency services, hospitalization, and laboratory (9/15 &plusmn; 3/67 against 9/16 &plusmn; 2/50). Conclusion: The majority of participants in Fasa family physician program reported average knowledge about this program; therefore, it is essential to improve people knowledge in order to succeed in this program

Investigating the Consistancy Rate of Hypertension Treatment through Guide Line JNC-7, in Patients Who Were Referred to Health Centers and Health Houses of Fasa University of Medical Sciences 2012

&nbsp;Background & Objective:&nbsp;Choosing antihypertensive as a drug for treating hypertension is the most important part of its treatment.&nbsp;The present study was done in investigating the&nbsp;consistancy rate of&nbsp;hypertension treatment through Guide Line JNC-7 in patients who were referred to health centers and health houses of Fasa University of Medical Sciences in 2012.&nbsp;&nbsp;&nbsp;Materials & Methods: In this cross- sectional study, the non-random sample of population was consisted of 200 patients who were suffering from hypertension. The questionnaire contained both demographic information and the use of anti-hypertension medication based on guide line (JNC-7 (. After the confirmation approval of content validity and reliability of the questionnaire, the data and the descriptive statistics were analyzed through SPSS-15 software. &nbsp;&nbsp;Results: 60 ٪ of the patients were in the first stage of hypertension and 40 percent of them were in the second one. Beta blockers were the most common prescribed drugs which were used among the first stage patients. However, ACEI and Diuretics (Thiazides) were the commonly prescribed drugs for the second stage hypertension patients.&nbsp;Patients who had diabetes and heart failure were used Beta- blocker drugs which was not in line with the Guide line JNC-7.&nbsp;&nbsp;Conclusions: The treatment of hypertension in patients was not in consistence with guideline JNC-7. It is recommended to organize training classes for doctors to inform patients about the better way of treating this problem. &nbsp;&nbsp;&nbsp;&nbsp

Metabolic Syndrome as a Risk Factor for Osteoarthritis

Metabolic syndrome refers to a set of conditions that include high blood pressure, increased insulin level in the blood, the accumulation of the excess fat around the abdomen, and increased blood lipids. In metabolic syndrome, the vast majority of these conditions are simultaneously present, and the risk of developing heart disease, stroke, and diabetes rises. Besides, osteoarthritis or degenerative joint disease is the most common joint disease in humans and is also the main cause of pain and disability in the elderly. The end result of this process is pain and reduced range of motion, and in advanced cases joint inflammation, cartilage destruction, and disability are clinical symptoms of osteoarthritis. Considering the high prevalence of these two disorders in the country and many common pathologic aspects of these two diseases such as obesity and elderly, we decided to review their relationship

Serum hs-CRP Levels Do Not Correlate With Carotid Intima-Media Thickness in Knee Osteoarthritis

Knee osteoarthritis (KOA) is prevalent morbidity which is associated with increased cardiovascular (CV) mortality. Any means to add to the risk stratification strategies especially prior to the total arthroplasty operations is of great applicability in terms of patient safety and cost reduction. We investigated the correlation between serum high sensitivity C-reactive protein (hs-CRP) levels, as a measure of CV risk, and common carotid intima-media thickness (IMT), as the cursor of underlying atherosclerosis. In a cross-sectional study, serum hs-CRP levels and common carotid IMT were determined in 68 patients with KOA. The mean serum hs-CRP level was 1.85±1.98 mg/L, and the mean carotid IMT was 0.67±0.16 centimeters with a Pearson’s R=0.016 (P=0.898). Using linear regression models, no correlation was found between hs-CRP and IMT. Findings indicate the poor ability of hs-CRP to predict underlying atherosclerosis in patients with KOA. Although hs-CRP has been shown to be a powerful prognostic tool in general and is associated with increased mortality in patients with KOA, its applicability to predict the atherosclerosis risk especially prior to operation is limited. Further investigation to find the best cost-effective non-invasive indicator of CV risk in patients with KOA is mandatory