Applying decision tree for detection of a low risk population for type 2 diabetes: A population based study

Introduction: The aim of current study was to create a prediction model using data mining approach, decision tree technique, to identify low risk individuals for incidence of Type 2 diabetes (T2DM), using the Mashhad Stroke and Heart Atherosclerotic Disorders (MASHAD) Study program. Methods: a prediction model was developed using classification by the decision tree method on 9528 subjects recruited from MASHAD database. Moreover, the receiver operating characteristic (ROC) curve was applied. Results: The prevalence rate of T2DM was ~14% in our population. For decision tree model, the accuracy, sensitivity, and specificity value for identifying the related factors with T2DM were 78.7%, 47.8% and 83%, respectively. In addition, the area under the ROC curve (AUC) value for recognizing the risk factors associated with T2DM was 0.64. Moreover, we found that subjects with family history of T2DM, age>=48, SBP>=130, DBP>=81, HDL>=29, LDL>=148 and occupation=other have more than 59% chance of this disorder, while the chance of T2DM in subjects without history with TG>=184, age>=48 and hs-CRP>=2.2, have approximately 51% chance. Conclusion: Our findings demonstrated that decision tree analysis, using routine demographic, clinical, anthropometric and biochemical measurements, which combined with other risk score models, could create a simple strategy to predict individuals at low risk for type 2 diabetes in order to decrease substantially the number of subjects needing for screening and recognition of subject at high risk

The Effect of nipple soreness treatment with Purslane Cream and Lanolin on Frequency and duration of Breastfeeding in nursing mothers: A Randomized Clinical Trial

Background & aim: Despite the global efforts to promote breastfeeding, women report some problems leading to stop breastfeeding in the early postpartum. Nipple soreness is considered as one of the main causes of early breastfeeding discontinuation. Treatment of this problem could keep breastfeeding for a prolonged period of time. Therefore, the present study aimed to investigate the effect of nipple pain treatment with lanolin and purslane cream on frequency and duration of breastfeeding. Methods: This double-blinded, randomized clinical trial was conducted on 86 breastfeeding women with nipple soreness who attended healthcare clinics in Mashhad, Iran, in 2016. The participants were randomly allocated to two equally sized group (43 in each), receiving purslane cream and lanolin for eight days. The correct method of breastfeeding and using the cream were trained to both groups. The nipple pain score was measured before intervention and on the third and eighth days post-intervention using a numeric pain rating scale. The subjects were also trained to record the duration and frequency of breastfeeding during the study period. Data were analyzed by SPSS version 22 using t-test, Fisher's exact test, Chi-square, and Wilcoxon tests. Results: Two study groups were identical in terms of the pain intensity before intervention. There was a significant difference concerning the pain intensity between the two groups on days 3 and 8.  The pain intensity in the purslane cream group was significantly lower than the lanolin group (

A variant in CYP2R1 predicts circulating vitamin D levels after supplementation with high-dose of vitamin D in healthy adolescent girls

Aim The determinants of serum vitamin D seems to be the environmental factors (dietary and supplementary intake and exposure to ultraviolet light) and genetic factors. We aimed to study the relationship between a vitamin D‐associated genetic polymorphism and serum 25(OH)D concentrations in healthy adolescent girls in Iran, and its effects on a high‐dose supplement of vitamin D. Material and method A total of 616 healthy adolescent girls with mean age 15 received 50,000 IU of vitamin D3 weekly over 9 weeks. Serum vitamin D levels and other metabolic factors were measured at baseline and after the intervention. The genotyping of the CYP2R1 variant (rs10741657) was performed by TaqMan genotyping assays. Results Regardless of the genetic background, at baseline, 87% of adolescent girls were vitamin D deficient (serum 25(OH)D level < 50 nmol/l). High‐dose supplementation with VitD reduced the proportion of girls who were deficient substantially to about 24%. The genetic analysis revealed that although at baseline there was not a gene‐vitamin D association ( p trend = 0.1), the response to supplementation appeared to be modulated by this variant ( p trend < 0.001). However, other anthropometric and biochemical measures were not affected by this intervention, over this short period. Serum 25(OH)D was increased in all participants although the carriers of the minor A allele seemed to be better responders so that the percentages of the change serum vitamin D in the holder of AA and AG genotypes were 539.4 ± 443.1 and 443.7 ± 384.6, respectively, compared with those with common GG genotype (363.3 ± 354.0). Our regression analysis revealed that the probability of an increase in serum 25(OH)D in a participant with AA genotype was 2.5‐fold greater than those with a GG genotype (OR = 2.5 (1.4–4.4); p value = 0.002). Conclusion Based on our findings, it appears that the rs10741657 variant of the CYP2R1 gene modulates the response to high‐dose of vitamin D supplementation

A genetic variant in proline and serine rich coiled-coil 1 gene is associated with the risk of cardiovascular disease

Background: Cardiovascular disease is one of the most common causes of morbidity and mortality worldwide. The Proline and Serine Rich Coiled-Coil 1 gene in 1p13.3 locus has been reported to be associated with low density lipoprotein cholesterol (LDL-C) and coronary artery disease (CAD). The objective of this study was to investigate the association between the rs599839 polymorphism of the Proline and Serine Rich Coiled-Coil 1 (PSRC1) gene with CVD outcomes in a population sample recruited as part of the Mashhad-Stroke and Heart-Atherosclerotic-Disorders (MASHAD) cohort. Methods: Five hundred and nine individuals who had an average follow-up period of 10 years were enrolled as part of the MASHAD cohort. DNA was extracted and genotyped using the TaqMan-real-time-PCR based method. Results: The study found individuals with GA/GG genotypes were at a higher risk of CVDs (OR= 4.7; 95% CI, 2.5-8.7; p< 0.001) in comparison to those with AA genotype; however, the result was not significant for GG genotype data. Conclusions: The results suggest that the GA/GG genotypes of the PSRC1gene locus were at increased risk of CVD in a representative population-based cohort, demonstrating further functional analysis to discover the value of emerging marker as a risk stratification biomarker to recognize high risk cases

Comparing Diagnostic Accuracy of Purple line with Transvers Diagonal of Michaelis Sacral to Predict labor Progress

Background and Aim: One of the key aspects of maternal care is observing the progress of labor. Careful assessment of labor progress could provide mothers to be referred on time and could decrease the maternal and neonatal morbidity. This study aimed to compare diagnostic accuracy of purple line with transvers diagonal of Michaelis sacral rhomboid to predict labor progress in nulliparous and multiparous women. Methods: In this double-blind diagnostic accuracy study, 350 nulliparous and multiparous womenwith a single pregnancy in vertex presentation and gestational age of 38-42 week, who admitted in Om-ol-Banin Hospital, Mashhad, Iran, from April to August 2012, were selected using convenience sampling. At first, the transvers diagonal of the Michaelis sacral rhomboid area was measured in cervical dilatation of ≤ 3 centimeters. Then, labor progress and presence or absence of purple lines between the buttocks in the lateral position was hourly controlled in the active phase of labor. Data were analyzed by SPSS Version 16 using Mann-Whitney and Chi-square test. Results: The mean age of the women was 25/22 (±5) years. Out of the 350 women enrolled, 61/2% were primigravidas and 38/8% were multigravidas. The presence of purple line was accompanied with normal labor progress with 68.57% sensitivity, 42.66% specificity, and 80.57% validity. The transverse diagonal of the Michaelis sacral cut-off point was ≥98.5 millimeter with 86.5% sensitivity, 59.45% specificity and 79.65% validity, which was also accompanied with normal progress of labor. Conclusion: Considering the diagnostic accuracy of transverse diagonal of the Michaelis sacral and purple line, thetransvers diagonal of Michaelis Sacral is more accurate predictor of labor progress

Health providers’ communication skills training affects hypertension outcomes

<p><b>Objective:</b> Hypertension is a common cardiovascular risk factor within the Iranian population, and this may be improved through changes in lifestyle. We aimed at improving hypertension outcomes and health literacy skills among hypertensive patients through communication skills training targeting health providers.</p> <p><b>Methods:</b> A randomized controlled trial method was used to enroll 35 health providers and 240 hypertensive patients attending community-based healthcare practices in the Mashhad, Iran. We evaluated the effects of a communication skills intervention for primary care providers compared to usual care controls, on the hypertension outcomes, patient medication adherence, and self-efficacy, assessed at baseline and post-intervention. Bivariate analysis and the regression model were used to assess whether the health provider training improved outcomes.</p> <p><b>Results:</b> Majority of participating patients were female (77.3%), less than high school education (80.3%), married (82.3%), and low income (82.3%), with mean age of 37 years. Following the educational intervention, there was a significant improvement (<i>p</i> < 0.05) in patient communication skills, self-efficacy, adherence to medication, and hypertension outcomes in the intervention compared to the control group.</p> <p><b>Conclusions:</b> The brief communication skills training for health care providers appear to be an efficient way to improve patient–provider communication skills and hypertension outcome among patients with uncontrolled BP.</p

hs-CRP is strongly associated with coronary heart disease (CHD): A data mining approach using decision tree algorithm

BACKGROUND AND AIMS: Coronary heart disease (CHD) is an important public health problem globally. Algorithms incorporating the assessment of clinical biomarkers together with several established traditional risk factors can help clinicians to predict CHD and support clinical decision making with respect to interventions. Decision tree (DT) is a data mining model for extracting hidden knowledge from large databases. We aimed to establish a predictive model for coronary heart disease using a decision tree algorithm. METHODS: Here we used a dataset of 2346 individuals including 1159 healthy participants and 1187 participant who had undergone coronary angiography (405 participants with negative angiography and 782 participants with positive angiography). We entered 10 variables of a total 12 variables into the DT algorithm (including age, sex, FBG, TG, hs-CRP, TC, HDL, LDL, SBP and DBP). RESULTS: Our model could identify the associated risk factors of CHD with sensitivity, specificity, accuracy of 96%, 87%, 94% and respectively. Serum hs-CRP levels was at top of the tree in our model, following by FBG, gender and age. CONCLUSION: Our model appears to be an accurate, specific and sensitive model for identifying the presence of CHD, but will require validation in prospective studies

Serum inflammatory cytokines and depression in coronary artery disease

Background: Severe depression may be accompanied by immune dysregulation and is also associated with increased risk of coronary artery disease (CAD). Objectives: We investigated serum levels of 10 cytokines and their relationship with depression in patients with cardiovascular diseases as well as healthy subjects in northeast of Iran. Patients and Methods: The study was carried out on 462 subjects (120 healthy subjects and 342 candidates undergoing angiography). The healthy subjects were referred for routine annual checkups or pre-employment examinations; they did not have clinically evident CAD. A questionnaire was used to obtain demographic data and the Beck depression inventory (BDI) was applied to assess depression. The Evidence Investigator® platform was used for cytokines assays for IL-1α, IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, TNF-α, MCP-1 and IFN-γ, using sandwich chemiluminescent method. The statistical analysis was performed using SPSS version 11.5. Results: The mean age was 53.3 ± 11.5, 54.8 ± 11.3, and 59.5 ± 11.3 in healthy, angiography (-), and angiography (+) subjects, respectively (P < 0.05). There were significant differences in serum levels of IL-4, IL-6, IL-10, and MCP-1 cytokines, comparing subjects with CAD and healthy persons (P < 0.05). When all subjects were divided to with and without depression regardless of their cardiovascular status, there was a significant difference in serum levels of IL-8 and IL-6 between the groups (P < 0.05). When the subgroup with features of CAD was selected and divided to those with and without depression, there was also a significant difference in serum levels of IL-8 and TNF-α (P < 0.05). Conclusions: The positive interaction between depression and CAD was probably mediated by inflammatory mechanisms