Short and one-year outcome of endovascular aortic repair (EVAR) for abdominal aortic aneurysms (AAAs)

BACKGROUND: Endovascular aortic repair (EVAR) of abdominal aortic aneurysms (AAAs) has been marked as standard practice during the past decades. We aimed to investigate the shortand long-term outcomes of EVAR in patients with AAAs in Isfahan, Iran. .METHODS: This retrospective study conducted on 50 patients with AAAs who have undergone EVAR procedure consequently in four different hospitals (Chamran hospital, Asgarieh hospital, Sepahan hospital and Saadi hospital) in Isfahan, Iran, between 2017 to 2020. We followed patients for one year and recorded short-term and one-year outcome include Endoleak, Aorta-iliac expansion, and mortality in hospital records during one year and telephone follow up. Data was entered in SPSS (ver.25) and analyzed with Univariate Linear Regression and Chi-Square Test.RESULTS: The mean age of participants was 66.6±11.7 years old, in which 88%(n=44) of them were male. Elective EVAR was performed in 88% of patients. Regarding the complications one year after EVAR, endoleak and CIN (contrast-induced nephropathy) were occurred in 6%(n=3) and 6%(n=3) of patients, respectively. We also reported the rate of in-hospital mortality and one-year mortality as 2%(n=1) and 8%(n=4), respectively. Univariate regression analysis revealed no significant difference regarding one-year mortality in patients who underwent EVAR. In patients who underwent spinal anesthesia in comparison with general and regional anesthesia before EVAR, there were lower rate of vascular complications [0% (n=0) versus 23.5% (n=4) and 20.0% (n=2), P=0.053], level of blood urea nitrogen (BUN) [9.8 ± 13.9 versus 17.0 ± 13.1 and 14 ± 6.2, P=0.031] and creatinine (Cr) [0.6±1.1 versus 1.1±0.6 and 1.3±0.5, P=0.005], respectively.CONCLUSION: Desirable short- and long-term outcomes as expected, combined with a reduction in hospital length of stay and mortality and one-year mortality allowed EVAR to become the favorable therapeutic strategy for AAAs in Iran especially in high-risk patients. Lower rate of vascular complications, ICU length of stay and lower level of BUN and Cr were observed using spinal anesthesia in patients who underwent EVAR in our centers

Obstructive sleep apnea, diagnosed by the Berlin questionnaire and association with coronary artery disease severity

BACKGROUND: Obstructive sleep apnea syndrome (OSAS) is a highly prevalent sleep-related disorder that is associated with increased risk of hypertension (HTN) and coronary heart disease. This study aimed to evaluate the correlation between the OSAS and coronary artery disease (CAD) severity. METHODS: The cross-sectional study was conducted from September 2012 to December 2013. We enrolled 127 patients with chronic stable angina who were referred for coronary angiographic studies in Shahid Chamran and Nour Hospitals in Isfahan, Iran. The Berlin questionnaire (BQ) was used for estimate the probability of OSAS in patients as a low or high probability. Demographic characteristics and metabolic risk factors including diabetes mellitus, HTN, obesity, and smoking also were recorded. The severity of CAD was assessed and compared based on the Gensini score with Mann&ndash;Whitney U statistical test. Independent t-test for continuous variables and chi-square test for categorical variables were used. RESULTS: Totally, 65.4% of subjects were considered as high and 34.6% as low probability for OSAS, which 81.1% of them had CAD. There was a significant difference between body mass index, systolic blood pressure, diastolic blood pressure, and ischemic heart disease drug consumption with OSAS probability (P &lt; 0.0500). CAD was accompanied by OSAS significantly (P = 0.0260). The Gensini score was significantly higher in patients with high OSAS probability (100.4 &plusmn; 69.1 vs. 65.3 &plusmn; 68.9; P = 0.0030). OSAS also increase odds of CAD based on regression analysis (odds ratio, 95% confidence interval = 2.7). CONCLUSION: This study indicates that more severe CAD is associated with high OSAS probability identified by BQ. &nbsp;&nbsp;</p

A systematic review on post-discharge venous thromboembolism prophylaxis in patients with COVID-19

Abstract Background Coronavirus disease of 2019 (COVID-19) is associated with venous thromboembolism (VTE), not only during hospitalization but also after discharge, raising concerns about anticoagulant (AC) use for post-discharge COVID-19 patients. We aimed to systematically review the current literature on the possible benefits or risks regarding extended thromboprophylaxis. Main body We searched related databases from December 1, 2019, to October 6, 2022, including studies on the necessity, duration, and selection of the ideal AC regarding extended thromboprophylaxis for post-discharge COVID-19 patients. The screening of the selected databases led to 18 studies and 19 reviews and guidelines. Studies included 52,927 hospitalized COVID-19 patients, with 19.25% receiving extended thromboprophylaxis. VTE events ranging from 0 to 8.19% (median of 0.7%) occurred in a median follow-up of 49.5 days. All included studies and guidelines, except four studies, recommended post-discharge prophylaxis after an individual risk assessment indicating high thrombotic and low bleeding risk. Studies used risk assessment models (RAMs), clinical evaluation, and laboratory data to identify COVID-19 patients with a high risk of VTE. IMPROVE-DD was the most recommended RAM. Direct oral anticoagulants (DOACs) and low molecular weight heparins (LMWHs) were the most used AC classes. Conclusions Post-discharge prophylaxis for COVID-19 patients is recommended after an individual assessment. The IMPROVE-DD model can help predict VTE risk. After distinguishing patients who need post-discharge AC therapy, DOACs for 30–35 days and LMWHs for 40–45 days can be the drug of choice. Further studies, particularly the results of the ongoing randomized controlled trials (RCTs), are required. Also, to properly handle such patients, every physician should consider lifestyle modification in addition to pharmacological treatment for post-discharge VTE prophylaxis

Occupational categories and cardiovascular diseases incidences; A cohort study in Iranian population: Different Occupational Categories and Cardiovascular disease

Introduction: In spite of traditional cardiovascular risk factor, the different occupations can play an important role in cardiovascular disease (CVDs) incidence. We aimed to assess the correlation between the occupational classes, based on the International Standard Classification of Occupation (ISCO), and CVDs in Iran as a developing country. Methods: We followed the 2440 men, aged 35-65 years and without history of CVDs over fourteen years; 2001 to 2015 during the Isfahan Cohort Study. ISCO was used to classify occupations into 10 categories. Incidence rates of ischemic heart diseases and stroke were recorded. Socioeconomic demographic data including marital state, income and place of living and metabolic risk factors were also recorded. Results: The mean age was 46.97±8.31 years old. 257 cardiovascular events (CVEs) were recorded that unstable angina was the highest recorded with 52% prevalence and the fatal stroke had the lowest outbreak (1%). The unemployed/jobless group and elementary occupations (9th ISCO category) had higher and lower relative frequency in CVEs respectively. There was non-significant decrease in CVEs in all of categories except of 4th (cleri­cal support workers) and 10th (armed forces) groups in comparison to unemployed/jobless subjects (P&gt;0.05). After considering of the group 7 as a reference group (most absolute CVEs frequency), in fully adjustment analysis group 4 had significant risk for CVEs (P=0.04). Conclusion: This study indicates that working as cleri­cal support workers (4th ISCO category) is associated with higher significant risk for IHD and stroke incidence in comparison to craft and related trades workers (7th group of ISCO)

Causes of delay in proper treatment of patients with undescended testis

Background: Undescended testis (UDT) is the most common endocrine disorder in male children. Delayed diagnosis and treatment of UDT lead to complications such as infertility, malignancy and testis rotation. Objective: The aim of this study was to evaluate the causes of delay in proper treatment of patients with undescended testis in our population. Materials and Methods: An observational, descriptive, cross sectional study of 143 male patients, who applied to Shahid Sadoughi University Hospitals for orchiopexy operation was performed. The maximum recommended age for orchiopexy was 18 months. Results: The mean age at referral was 5.34 years. Only 44 (30.8%) cases were operated on before the age of 18 months. The most common reasons of delay in treatment were absence of early diagnose (42.5%), parent's unawareness of surgery necessity and its complications associated (33.7%) and parent's disregard (23.5%). Only 19.6% of patients were diagnosed at born in the hospital. 49% of parents had the correct information for proper operation age and 40.6% of them had enough information about necessity of surgery and side effects of disease. Parent’s literacy, place of living and type of cryptorchidism had no significant relation with delay diagnosis (p> 0.05). Conclusion: These results revealed that late diagnosis by physician and lack of insight of parents are the main reasons in delayed diagnosis and treatment of UDT. Therefore, education of parents and careful physical examination of the babies at birth and regular follow-up until 18 months can prevent the delay in diagnosis

The effect of pioglitazone on circulating interleukin-10 and tumor necrosis factor-alpha levels in a patient with metabolic syndrome: A randomized, double-blind controlled trial

BACKGROUND: This study aimed to evaluate the effect of pioglitazone as an insulin sensitizer on circulating interleukin-10 (IL-10) as an anti-inflammatory factor and tumor necrosis factor-alpha (TNF-&alpha;) as main proinflammatory factor in non-diabetic metabolic syndrome (MetS) patients in Caucasians race of Middle East area in Iran. METHODS: We conducted a randomized double-blind controlled study of 68 non-diabetic patients with MetS. Patients were randomly divided into two groups including intervention group received pioglitazone 30 mg daily for 24 weeks, and the control group received placebo pills for the same duration. Circulating levels of TNF-&alpha; and IL-10 were assessed as a primary goal. Lipid profile, liver enzymes, blood pressure (BP), waist circumference, and body mass index (BMI) also were measured. RESULTS: Lipid profile and fasting blood sugar had non-significant changes after treatment by pioglitazone, but BMI was increased significantly (P = 0.002). BP and waist circumference had a significant decrease in both groups (P &lt; 0.050). Aspartate transaminase and alanine transaminase were decreased significantly in the pioglitazone group (P = 0.002). TNF-&alpha; decreased non-significantly in both groups (P &gt; 0.050). IL-10 increased in intervention group non-significantly (P = 0.971); whereas in placebo group decreased to a little extent (P = 0.401). C-reactive protein was also decreased insignificant after receive pioglitazone (P = 0.333). There was no significant difference in all variables between the two groups (P &gt; 0.050) except liver enzymes (P &lt; 0.050). CONCLUSION: This study indicates that the pioglitazone has no positive effect on improving inflammatory status in the non-diabetes patients with MetS. &nbsp;&nbsp;</div