Factors Associated with The Incidence of Coronary Heart Disease in The Mashad: A Cohort Study

Coronary heart disease (CHD) is the leading cause of morbidity and mortality globally, and specifically in Iran. Accurate assessments of Coronary heart disease (CHD) incidence is very necessary for public health. In current study we aimed to investigate the incidence of CHD and importance of several classical, modifiable and un-modifiable risk factors for CHD among an urban population in eastern Iran after 6 years of follow-up. Methods The population of MASHAD cohort study were followed up for 6 years, every 3 years in two step by phone and who reported symptoms of CVD were asked to attend for a cardiac examination, to estimate the incidence of CHD with 95% confidence interval (95% CI) as well multiple logistic regression analysis was performed to assess the association of several baseline characteristics with incidence of CHD event. Evaluation of goodness-of-fit was done using ROC analysis. CHD cases divided into four different classes which include: stable angina, unstable angina pectoris, myocardial infarction and sudden cardiac death. Results In the six years\u27 follow-up of Mashhad study, the incidence rate of all CHD event in men and women in 100,000 people-years with 95% confidence intervals were 1920 (810-3030) and 1160 (730-1590), respectively. The areas under ROC curve (AUC), based on multivariate predictors of CHD outcome, was 0.7825. Conclusion Our findings indicated that the incidence rate of coronary heart diseases in MASHAD cohort study increases with age as well as our final model designed, was able to predict approximately 78% of CHD events in Iranian population

INCIDENCE AND ETIOLOGY OF PEDIATRIC STROKE IN SOUTHERN KHORASAN

&nbsp; Abstract INTRODUCTION: Ischemic stroke is rarely seen in childhood. The pediatric causes of stroke are very different from adult causes. methods: This population-based study was conducted to determine the incidence, clinical manifestations and etiology of pediatric ischemic stroke in Southern Khorasan, Iran, during 2002-2007. In this province, every child with possible diagnosis of stroke is referred to a stroke neurologist and routinely admitted to the Pediatric Division of Vali-e-Asr tertiary care hospital. The diagnosis of ischemic stroke was made based on the clinical presentation and brain imagery. All of the patients underwent a standard battery of diagnostic investigations. results: Seventeen children with ischemic stroke (7 girls, 10 boys) were evaluated. The incidence of pediatric ischemic stroke in Khorasan province is 1.8 cases per 100,000 children population per year. Meningoencephalitis-induced vasculopathy constituted 23.5% of the etiology followed by Fallot tetralogy, head trauma, dehydration, migraine, and hypercoagulable state. 23.5% of our patients had uncertain causes of stroke. In-hospital mortality of our pediatric ischemic stroke patients was 11.7%. CONCLUSIONS: The incidence and clinical characteristics of pediatric brain infarction in Iran are the same as in other studies. Meningoencephalitis-induced vasculopathy is the most common determined etiology of pediatric ischemic stroke in Southern Khorasan. &nbsp; &nbsp; Keywords: Child, stroke, incidence, etiology.</div

ATHEROSCLEROSIS RISK FACTORS AND ETIOLOGIC MECHANISMS OF LACUNAR STROKE

&nbsp; Abstract INTRODUCTION: It is thought that lacunae occur in patients with hypertension or diabetes mellitus as small-vessel involvement. The frequency of other stroke mechanisms in patients with lacunae was evaluated in this study. methods: Consecutive stroke patients admitted to Valie-Asr Hospital, Khorasan in 2006 were enrolled in a prospective study. Diagnosis of stroke and its risk factors was made by a stroke neurologist. All of the stroke patients underwent a standard battery of diagnostic investigations. Brain infarction was categorized as lacunae and large-vessel territory infarction (LVTI). Chi-square test and odds ratios were used for statistical analysis. results: Ninety-six patients with lacunae and 252 patients with LVTI were studied. The frequency of diabetes and hypercholesterolemia was significantly higher in patients with lacunar stroke than in those with LVTI (P=0.034 and P&lt;0.001, respectively). The frequency of hypertension, smoking, transient ischemic attacks (TIA) and ipsilateral carotid stenosis was not significantly different between the two groups (P=0.94, P=0.59, P=0.37 and P=0.13, respectively). Atrial fibrillation was significantly more frequent in patients with LVTI (P&lt;0.001). The frequency of various etiologic mechanisms was not significantly different in lacunar stroke and LVTI patients (df=4, P=0.164). CONCLUSIONS: Hypertension in patients with lacunar stroke is not more frequent than in other stroke patients. Cardioembolism and artery-to-artery embolism are important but less common mechanisms of lacunae. &nbsp; &nbsp; Keywords: Atherosclerosis, lacune, stroke.</div

CARDIAC SOURCES OF EMBOLISM IN IRANIAN STROKE PATIENTS

AbstractINTRODUCTION: Rheumatic valvular disease is a common complication of rheumaticfever in children in developing countries. Later in life, rheumatic valvular diseasebecomes an important modifiable risk factor of stroke. The incidence of rheumaticvalvular disease and its complications are unknown in Iran.METHODS: This is a prospective study of 302 consecutive patients admitted to atertiary care hospital in Iran, with a diagnosis of non-hemorrhagic stroke between June2005 and June 2006. All patients underwent diagnostic workup to determine strokeetiology according to clinical indications. Diagnosis and classification of stroke was madebased on the PIC criteria.RESULTS: In 302 patients with stroke (mean age: 66.78&plusmn;14.36 years), 60 patients(20%) (mean age: 65.61&plusmn;17.48 years) had cardiac sources of embolism (CSE). Rheumaticmitral stenosis was present in 28 (46.6%) of these patients. Atrial fibrillation wasdocumented in 19 patients (67.8%) with rheumatic valvular disease. The remaining 32patients (53.3%) had other CSE. In the latter group, 8 patients (25%) had non-valvularatrial fibrillation. In the entire group with CSE, a total of 30 patients were candidates foranticoagulation; among them, 14 (46.6%) were anticoagulated, but only 6 (20%) werewithin therapeutic range at the time of their stroke.CONCLUSIONS: Rheumatic valvular disease seems to be the most common CSE in Iran.Many patients with rheumatic or non-rheumatic CSE are not adequately managed forsecondary prevention of cardioembolic stroke.Key Words: Cardioembolic, stroke, rheumatic

Twin Pregnancy with Hydatidiform Mole and Coexisting Fetus: Report of Three Cases and Review of Literature

A twin pregnancy with a coexisting complete hydatidiform mole and a healthy fetus (CMCF) is rare. Here we report three cases of CMCF with different clinical courses but similar outcome without a surviving neonate. Two women required uterine evacuation before 20 weeks of gestational age because of vaginal bleeding and medical complications and the other patient underwent termination of her pregnancy at 24 weeks of gestation due to severe pre-eclampsia. The pathologic diagnosis of complete hydatidiform mole was confirmed in each case and the chromosome complement was 46XX in two molar gestations and 46XY in one gestation. One of the three women required chemotherapy for treatment of low-risk gestational trophoblastic disease. The hCG level was normalized after 4 cycles and the patient was free of disease at 1 year follow-up. Review of the literature discussing the diagnostic tools, clinical features, management and outcome of pregnancies with CMCF are presented