Effectiveness of polypill for primary and secondary prevention of cardiovascular diseases (PolyIran):a pragmatic, cluster-randomised trial

Background: A fixed-dose combination therapy (polypill strategy) has been proposed as an approach to reduce the burden of cardiovascular disease, especially in low-income and middle-income countries (LMICs). The PolyIran study aimed to assess the effectiveness and safety of a four-component polypill including aspirin, atorvastatin, hydrochlorothiazide, and either enalapril or valsartan for primary and secondary prevention of cardiovascular disease. Methods: The PolyIran study was a two-group, pragmatic, cluster-randomised trial nested within the Golestan Cohort Study (GCS), a cohort study with 50 045 participants aged 40�75 years from the Golestan province in Iran. Clusters (villages) were randomly allocated (1:1) to either a package of non-pharmacological preventive interventions alone (minimal care group) or together with a once-daily polypill tablet (polypill group). Randomisation was stratified by three districts (Gonbad, Aq-Qala, and Kalaleh), with the village as the unit of randomisation. We used a balanced randomisation algorithm, considering block sizes of 20 and balancing for cluster size or natural log of the cluster size (depending on the skewness within strata). Randomisation was done at a fixed point in time (Jan 18, 2011) by statisticians at the University of Birmingham (Birmingham, UK), independent of the local study team. The non-pharmacological preventive interventions (including educational training about healthy lifestyle�eg, healthy diet with low salt, sugar, and fat content, exercise, weight control, and abstinence from smoking and opium) were delivered by the PolyIran field visit team at months 3 and 6, and then every 6 months thereafter. Two formulations of polypill tablet were used in this study. Participants were first prescribed polypill one (hydrochlorothiazide 12·5 mg, aspirin 81 mg, atorvastatin 20 mg, and enalapril 5 mg). Participants who developed cough during follow-up were switched by a trained study physician to polypill two, which included valsartan 40 mg instead of enalapril 5 mg. Participants were followed up for 60 months. The primary outcome�occurrence of major cardiovascular events (including hospitalisation for acute coronary syndrome, fatal myocardial infarction, sudden death, heart failure, coronary artery revascularisation procedures, and non-fatal and fatal stroke)�was centrally assessed by the GCS follow-up team, who were masked to allocation status. We did intention-to-treat analyses by including all participants who met eligibility criteria in the two study groups. The trial was registered with ClinicalTrials.gov, number NCT01271985. Findings: Between Feb 22, 2011, and April 15, 2013, we enrolled 6838 individuals into the study�3417 (in 116 clusters) in the minimal care group and 3421 (in 120 clusters) in the polypill group. 1761 (51·5) of 3421 participants in the polypill group were women, as were 1679 (49·1) of 3417 participants in the minimal care group. Median adherence to polypill tablets was 80·5 (IQR 48·5�92·2). During follow-up, 301 (8·8) of 3417 participants in the minimal care group had major cardiovascular events compared with 202 (5·9) of 3421 participants in the polypill group (adjusted hazard ratio HR 0·66, 95% CI 0·55�0·80). We found no statistically significant interaction with the presence (HR 0·61, 95% CI 0·49�0·75) or absence of pre-existing cardiovascular disease (0·80; 0·51�1·12; pinteraction=0·19). When restricted to participants in the polypill group with high adherence, the reduction in the risk of major cardiovascular events was even greater compared with the minimal care group (adjusted HR 0·43, 95% CI 0·33�0·55). The frequency of adverse events was similar between the two study groups. 21 intracranial haemorrhages were reported during the 5 years of follow-up�ten participants in the polypill group and 11 participants in the minimal care group. There were 13 physician-confirmed diagnoses of upper gastrointestinal bleeding in the polypill group and nine in the minimal care group. Interpretation: Use of polypill was effective in preventing major cardiovascular events. Medication adherence was high and adverse event numbers were low. The polypill strategy could be considered as an additional effective component in controlling cardiovascular diseases, especially in LMICs. Funding: Tehran University of Medical Sciences, Barakat Foundation, and Alborz Darou. © 2019 World Health Organization. Published by Elsevier Ltd/Inc/BV. All rights reserved

Direct Poly Azo Dye Decolorization Using Nanophotocatalytic UV/NiO Process

In this study, efficiency of UV/NiO system as a forms of Advanced Oxidation Processes (AOP) to remove red poly azo was investigated. This study was conducted as a pilot scale and batch mode. Ultraviolet was achieved by 11 W low pressure lamp. Effects of various factors such as pH, different times of irradiation, different concentration of nickel oxide, primary concentration of colors were evaluated. The test results of UV/NiO system showed that no effects were observed with UV alone in photocatalysis process for removal of dye DR 80. Nickel oxide is an effective catalyst in removal of dye by the nanophotocatalytic process. The results represent that the color removal efficiency increase with pH reduction and optimum pH was found 4. Fainally, the highest removal efficiency for DR 80 dye with concenteration of 25 mg/L and 50 mg/L was obtained about 94.29% and 82.22% by the process of UV/NiO respectively. Reaction kinetic in the UV/NiO process follows pseudo secondry-order reactions. Totally UV/NiO process is an effective methode for DR 80 poly azo dye removal in aqueous solutions

Study on the simultaneity of the substance abuse with psychiatric disorder in referred outpatients to psychiatryclinic of zare hospital for period of one year

(Received 17 Mar, 2008; Accepted 15 Mar, 2008) Abstract Background and purpose: One of the important problems in diagnosis and treatment of psychiatric disorders is its accompaniment with substance abuse.In addition to substance abuse symptoms which are present in all addicts, in psychiatric patients it cause special problems in main diagnosis , slow reaction to therapy and even non effectiveness of the therapy and also poor prognosis.Considering its different prevalence in studies and also considering the point that a similar work has never been done in Iran, this study is designed to find out the abundancy of disorders and pattern and type of substances used by the referred patients to psychiatric clinic of zare hospital.Materials and methods: In this descriptive research study , 782 referrals to psychiatric clinic of zare hospital in a period of one year were evaluated D. S.M. IV interview.The self made Questionnaire which is filed by a psychologist and then referred to a psychiatric for the diagnosis of the disease, includes the time of Commencement, amount and type of substance used.Results: The results obtained, showed that 79.1% were men , 20.9% were women, 54.4% were urban and 45.5% were from rural areas. 4.8% were referred for substance – withdrawal and 95.2% for psychiatry problems. and also the 28% were smokers, 68.4% never smoked and 3.8% were smokers in the past. 12.7% were substance abuse at persent 3.3% had a history if substance abuse in the past and 84% had no history of substance abuse ever. Substance dependency and nondependency were 8.6% and 91.4% respectively. The percentages for the first consumed substance were as follow:60.8 opium, 6.4 alcohal, 26.4 hashish, 4 heroin and 2.4 other substances. From psychiatry diagnostic point of view 28.7% suffered from schizophrenia , 41% had mood disorders, 14% had personality disorders and 4% suffered from anxiety. There has been a statistically significant relationship between the variables such as sex , residential areas , occupation, education, marital status, history of cigarette smoking and age of commence ment of smoking with substance dependency (p<0.05).Conclusion: Considering the high prevalence of Substance usage by the patients referred to psychiatric clinics, the Concurrency of substance usage and psychiatry problems are important in history taking and treatment of the patients. On the other hand to have a high success Coefficient, a simultaneous psychiatric diagnosis for the patients referred for withdrawal , should be kept in mind.J Mazand Univ Med Sci 2008; 18(67): 67-74 (Persian