Clinical characteristics, management and 1-year outcomes of patients with acute coronary syndrome in Iran: The Iranian Project for Assessment of Coronary Events 2 (IPACE2)

Objectives: To assess contemporary data on characteristics, management and 1-year postdischarge outcomes in Iranian patients hospitalised with acute coronary syndrome (ACS). Setting: 11 tertiary care hospitals in 5 major cities in the Islamic Republic of Iran. Participants: Patients aged �20 and �80 years discharged alive with confirmed diagnosis of ACS including ST-segment elevation myocardial infarction (STEMI), non-STEMI (NSTEMI) and high-risk unstable angina (HR-UA). Primary and secondary outcome measures: Patients were followed up regarding the use of medications and the end points of the study at 1 month and 1 year after discharge. The primary end point of the study was 1-year postdischarge major adverse cardiac and cerebrovascular events (MACCEs), defined as mortality (cardiac and non-cardiac), ACS and cerebrovascular attack (stroke and/or transient ischaemic attack). The secondary end points were hospital admission because of congestive heart failure, revascularisation by coronary artery bypass grafting surgery or percutaneous coronary intervention (PCI), and major and minor bleeds. Results: A total of 1799 patients (25.7 STEMI and 74.3 HR-UA/NSTEMI) discharged alive with confirmed diagnosis of ACS were included in the final analysis. During hospitalisation, the majority of the patients received aspirin (98.6), clopidogrel (91.8), anticoagulants (93.4), statins (94.3) and β-blockers (89.3). Reperfusion therapy was performed in 62.6 of patients with STEMI (46.3 thrombolytic therapy and 17.3 primary PCI). The mean door-to-balloon and door-to-needle times were 82.9 and 45.6 min, respectively. In our study, 64.7 and 79.5 of the patients in HR-UA/NSTEMI and STEMI groups, respectively, underwent coronary angiography. During the 12 months after discharge, MACCEs occurred in 15.0 of all patients. Conclusions: Our study showed that the composition of Iranian patients with ACS regarding the type of ACS is similar to that in developed European countries and is unlike that in developing countries of the Middle East and Africa. We found that our patients with ACS are treated with high levels of adherence to guideline-recommended in-hospital medications

Impaired IL-23-dependent induction of IFN-gamma underlies mycobacterial disease in patients with inherited TYK2 deficiency

Human cells homozygous for rare loss-of-expression (LOE) TYK2 alleles have impaired, but not abolished, cellular responses to IFN-alpha/beta (underlying viral diseases in the patients) and to IL-12 and IL-23 (underlying mycobacterial diseases). Cells homozygous for the common P1104A TYK2 allele have selectively impaired responses to IL-23 (underlying isolated mycobacterial disease). We report three new forms of TYK2 deficiency in six patients from five families homozygous for rare TYK2 alleles (R864C, G996R, G634E, or G1010D) or compound heterozygous for P1104A and a rare allele (A928V). All these missense alleles encode detectable proteins. The R864C and G1010D alleles are hypomorphic and loss-of-function (LOF), respectively, across signaling pathways. By contrast, hypomorphic G996R, G634E, and A928V mutations selectively impair responses to IL-23, like P1104A. Impairment of the IL-23-dependent induction of IFN-gamma is the only mechanism of mycobacterial disease common to patients with complete TYK2 deficiency with or without TYK2 expression, partial TYK2 deficiency across signaling pathways, or rare or common partial TYK2 deficiency specific for IL-23 signaling.ANRS Nord-Sud ; CIBSS ; CODI ; Comité para el Desarrollo de la Investigación ; Fulbright Future Scholarshi

OBESITY AND ITS ASSOCIATION WITH OTHER CARDIOVASCULAR RISK FACTORS IN WOMEN IN CENTRAL IRAN - WOMEN'S HEALTHY HEART PROJECT

Abstract&nbsp; INTRODUCTION: Cardiovascular diseases (CVD) are considered the most important cause of death worldwide. Obesity is a major CVD risk factor. This study was conducted to evaluate the prevalence of obesity and its association with other CVD risk factors in Iranian women. methods: This cross-sectional study was conducted in 2001 as part of Isfahan Healthy Heart Program (IHHP) in three Central Iranian cities of Isfahan, Najaf-Abad and Arak. Being over 19 years of age, absence of pregnancy, absence of mental retardation and Iranian nationality were the criteria for inclusion in the study. A questionnaire on demographics characteristics, drug consumption, smoking status, and physical activity were filled out for every subject. Height, weight and blood pressure of all subjects were measured and fasting blood samples were taken to measure blood glucose and lipids. The data were analyzed with T-test, &chi;2 and multiple linear regression, using SPSS11. results: Of 6391 women aged 38.8&plusmn;14.5 years participating in the study, 79% lived in the urban areas and 21% in the rural areas. The prevalence of a higher BMI was greater in urban areas in all ages. Hypertension, diabetes, total cholesterol-triglyceride and LDL-C disorders and inadequate physical activity were more prevalent in obese women than normal ones, but no significant difference was seen in HDL-C disorder and smoking between the two groups (P&lt;0.05). There was a significant positive relationship between BMI and age, blood glucose and urban residence, and a negative relationship was observed between BMI and inadequate physical activity (P&lt;0.05). Discussion: The high prevalence of obesity and the major risk factors of cardiovascular diseases in urban areas is testament to unhealthy lifestyle and insufficient physical activity of women in areas studied.Keywords . Women . Obesity . Residence . Risk factor</p