Determination of the incidence of cardiovascular composite events in Patients with Obstructive Sleep Apnea: A 3-year follow-up

Background: The occurrence of obstructive sleep apnea (OSA) and its health-related issues, especially cardiovascular diseases (CVD), are increasing in developing countries. With a 3-year follow-up study, the present study aimed to determine the incidence of cardiovascular events in patients with OSA in an Iranian population.Methods: In this prospective cohort study, 415 adults (300 patients with OSA and 115 patients without OSA) with a history of snoring and/or witnessed apneas or other suspected sleep breathing disorders were consecutively enrolled and followed up for three successive years to evaluate the development of cardiovascular events including acute coronary syndrome, cerebrovascular accidents (including ischemic or hemorrhagic strokes or transient ischemic attacks), death due to cardiac causes and all-cause mortality. Results: 415 patients were studied with a mean age of 56.2 ±15.7 years, 211 (50.8) of whom were male. Cardiovascular events developed in 15 participants (5%) of the OSA group, and 3 participants (2.6 %) of the OSA negative group. No significant differences were observed between the two groups in terms of the incidence of any of these events (P-value> 0.05). Using multiple logistic regression model (with P-value <0.2 as the significance level), age, OSA, and history of CVD remained as significant predictors for the development of cardiac composite events (incidence of CVD, CVA, death due to cardiac causes, and all-cause mortality) with the odds ratios of (95% confidence interval) 1.03 (1.01, 1.06), 2.41 (1.02, 5.76), and 7.40 (2.91, 18.67), respectively.Conclusions: The present study showed that OSA is associated with a more than twofold increased risk of cardiovascular events. Thus, obstructive sleep apnea should be considered an independent cardiovascular risk factor

Association of BRAFV600E Mutation and MicroRNA Expression with Central Lymph Node Metastases in Papillary Thyroid Cancer: A Prospective Study from Four Endocrine Surgery Centers

Background: Studies have demonstrated an association of the BRAFV600E mutation and microRNA (miR) expression with aggressive clinicopathologic features in papillary thyroid cancer (PTC). Analysis of BRAFV600E mutations with miR expression data may improve perioperative decision making for patients with PTC, specifically in identifying patients harboring central lymph node metastases (CLNM). Methods: Between January 2012 and June 2013, 237 consecutive patients underwent total thyroidectomy and prophylactic central lymph node dissection (CLND) at four endocrine surgery centers. All tumors were tested for the presence of the BRAFV600E mutation and miR-21, miR-146b-3p, miR-146b-5p, miR-204, miR-221, miR-222, and miR-375 expression. Bivariate and multivariable analyses were performed to examine associations between molecular markers and aggressive clinicopathologic features of PTC. Results: Multivariable logistic regression analysis of all clinicopathologic features found miR-146b-3p and miR-146b-5p to be independent predictors of CLNM, while the presence of BRAFV600E almost reached significance. Multivariable logistic regression analysis limited to only predictors available preoperatively (molecular markers, age, sex, and tumor size) found miR-146b-3p, miR-146b-5p, miR-222, and BRAFV600E mutation to predict CLNM independently. While BRAFV600E was found to be associated with CLNM (48% mutated in node-positive cases vs. 28% mutated in node-negative cases), its positive and negative predictive values (48% and 72%, respectively) limit its clinical utility as a stand-alone marker. In the subgroup analysis focusing on only classical variant of PTC cases (CVPTC), undergoing prophylactic lymph node dissection, multivariable logistic regression analysis found only miR-146b-5p and miR-222 to be independent predictors of CLNM, while BRAFV600E was not significantly associated with CLNM. Conclusion: In the patients undergoing prophylactic CLNDs, miR-146b-3p, miR-146b-5p, and miR-222 were found to be predictive of CLNM preoperatively. However, there was significant overlap in expression of these miRs in the two outcome groups. The BRAFV600E mutation, while being a marker of CLNM when considering only preoperative variables among all histological subtypes, is likely not a useful stand-alone marker clinically because the difference between node-positive and node-negative cases was small. Furthermore, it lost significance when examining only CVPTC. Overall, our results speak to the concept and interpretation of statistical significance versus actual applicability of molecular markers, raising questions about their clinical usefulness as individual prognostic markers.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140269/1/thy.2015.0378.pd

A randomized controlled study for evaluation of psyllium effects on kinetics of carbohydrate absorption

&lt;p&gt;&lt;strong&gt;BACKGROUND&lt;/strong&gt;: This study was performed to evaluate the effects of psyllium on kinetics of alimentary carbohydrate absorption in diet-treated type 2 diabetic patients.&lt;br /&gt;&lt;strong&gt;METHODS&lt;/strong&gt;: This was a double blind, prospective, controlled clinical trial. Twelve patients (6 in each group) participated in the present study. After an overnight fast, a standard 435 kcal breakfast was given to participants. Fasting, 1- and 2- hour postprandial plasma glucose was measured in the case and control groups. Cow&amp;rsquo;s milk containing 5 grams of psyllium granules for the case and without psyllium for the control groups was also delivered.&lt;br /&gt;&lt;strong&gt;RESULTS&lt;/strong&gt;: Plasma glucose changes in the first hour were significantly different between control and case groups (53.8 versus 17.8 respectively, P = 0.037). Also, mean 2-hour postprandial plasma glucose was 167.67 and 117.67 mg/dl for control and case groups, respectively (P = 0.05).&lt;br /&gt;&lt;strong&gt;CONCLUSIONS&lt;/strong&gt;: This pilot study revealed that psyllium may effectively reduce postprandial plasma glucose possibly by retarding GI carbohydrate absorption. Larger studies are needed to confirm the results of this study and define its role compared to acarbose or meglitinides.&lt;br /&gt;&lt;strong&gt;KEYWORDS&lt;/strong&gt;: Psyllium, postprandial hyperglycemia, type 2 diabetes mellitus.&lt;/p&gt

Capparis spinosa (Capparaceae); A Survey on Morpho-ecologic Variation for Different Populations of Iran

Capparis spinosa grows naturally from the Atlantic coast of the Canary Islands and Morocco to the Black Sea, in Crimea and Armenia, and to the east side of the Caspian Sea in Iran. Capparis species are valuable as a resource for medicine, food, improving soil fertility, stabilizing dunes, fuel, timber, and livestock feed. In this research, sixteen populations of Capparis spinosa were collected from different locations in Iran and quantitative and qualitative data of morphological characters were revised. A multivariable statistical analysis was performed for the morphological characters of Capparis populations. The populations were classified into two main groups using a Ward's hierarchical clustering method. We showed some of the climatic conditions correlate with morphological characters. Data obtained were standardized (Mean= 0, variance= 1) and used to estimate Euclidean distance for clustering and ordination analyses. PCA (Principal components analysis) was used to identify the most variable morphological characters among the studied populations. The Redundancy Analysis (RDA) was applied to the dataset of nine explanatory environmental variables (annual precipitation and temperature, number of frost days, relative humidity, potential evapotranspiration, minimum and maximum absolute temperatures, minimum temperature of the coldest month of the year, and maximum temperature of the warmest month). In the Flora of Iran and Flora Iranica C. spinosa and C. sicula are considered as synonyms, which are improved by this study

ANTHROPOMETRIC INDICES IN ASSOCIATION WITH CARDIOMETABOLIC RISK FACTORS: FINDINGS OF THE ISFAHAN HEALTHY HEART PROGRAM

Abstract &nbsp;&nbsp; BACKGROUND: Obesity is increasing worldwide, but the debate about the most valid index associated with its health hazards remains unresolved. This study aimed to compare four main anthropometric indices by gender, to determine the best index in predicting cardiometabolic risk factors and to find their cutoff values in the population studied. &nbsp;&nbsp; METHODS: This study was a cross-sectional community-based study performed on a representative sample of 12,514 adults (aged &ge;19 years) selected via 2-stage random cluster sampling from 3 cities in Iran. Partial correlation and ROC curve analyzes were used to determine the best anthropometric indices and their cutoff values. &nbsp;&nbsp; RESULTS: The study population comprised 6123 males and 6391 females. In both genders, waist circumference (WC) had the highest correlation with cardiometabolic risk factors (6 of 8 risk factors in men and 7 of 8 risk factors in women). ROC analyses showed that in males, the largest area under curve (AUC) was obtained for waist-to-stature ration (WSR) in most risk factors (6 of the 10) followed by body mass index (BMI) and waist-to-height ratio (WHR) with largest AUC (3 of the 10). The corresponding figure for females was obtained for WSR (9 of the 10) followed by BMI and WHR (1 of 10). Optimal cutoff values computed for combination of 3 major risk factors (including diabetes mellitus, hypertension and dyslipidemia) revealed that in males and females, respectively, the cutoff values were 21.9 and 23.5 kg/m2 for BMI, 80.70 and 84.70 cm for WC, 0.85 and 0.86 for WHR and 0.47 and 0.53 for WSR. &nbsp;&nbsp; CONCLUSION: WSR could be a valid anthropometric index for predicting cardiometabolic risk factors, and it has less variation than other indices among populations with ethnic differences in body size and fat distribution. &nbsp; &nbsp;&nbsp; Keywords: Anthropometry, Cardiovascular Risk Factors, Iran, Obesity.</p

In vitro adherence of Lactobacillus strains isolated from the vaginas of healthy Iranian women

Background: The lactobacilli are a part of the bacterial flora of the human vagina. Detection of normal Lactobacillus species in the vaginas of healthy women in different geographical locations, and evaluation of their specific properties, can aid in the selection of the best species for preventing sexually transmitted diseases in the future. This study was performed to isolate and identify the Lactobacillus species in the vaginas of healthy women and to evaluate the adherence of these lactobacilli to Vero and HeLa cell lines. Methods: The study included 100 women. Bacteria were isolated from healthy women and purified. Phenotypic and biochemical tests were performed to identify the lactobacilli. The Lactobacillus species were detected by molecular methods using polymerase chain reaction amplification of the full length of the 16S rDNA of the isolated bacteria. Several isolates of each species were then selected to study their adherence to Vero and HeLa cell lines. Results: Among the 50 samples taken from healthy women meeting the inclusion criteria, Lactobacillus species were identified in 33 (66%) samples. Of these lactobacilli, 14 isolates were Lactobacillus crispatus, six (18.2%) were Lactobacillus gasseri, nine (27%) were Lactobacillus rhamnosus, and the rest were either Lactobacillus salivarius (6%) or Lactobacillus plantarum (6%). L. rhamnosus showed the greatest adhesion to the cells when compared to the other tested species. All the lactobacilli isolated in this study showed a smaller capacity for cell adherence when compared with control species. Conclusion: L. crispatus, L. rhamnosus, and L. gasseri were the dominant Lactobacillus species in the vaginas of healthy women in Iran. L. rhamnosus attached more readily to the cells than did the other species; therefore, this isolate is a good candidate for further studies on the potential health benefits and application of lactobacilli as probiotics

Ehlers-Danlos syndrome: prevalence and outcomes in gender affirming surgery - a single institution experience

Aim: Patients with Ehlers-Danlos Syndrome (EDS) are considered to have an increased risk for wound healing complications. Surgeons may therefore be hesitant to offer elective surgeries, including gender-affirming surgeries (GAS), to EDS patients. At our center, we frequently encountered patients presenting for GAS evaluation with the co-existing diagnosis of EDS. This study aims to establish the prevalence of EDS diagnosis in our GAS patients and compare their post-operative complications to patients without EDS diagnosis.Methods: This is a single-institution retrospective case-control study on all patients who underwent GAS from 2016-2020. Data include EDS diagnosis, demographics, operation, and complications (including minor wound healing issues).Results: Of 1363 patients presenting for GAS, 36 (2.6%) had EDS diagnoses and were matched with 108 control patients. Major complications requiring surgical intervention in the OR occurred in 6 patients (4.2%), (2.8% EDS vs. 5.4% controls; P = 0.63), while 8.3% of EDS and 14% of controls required minor interventions (P = 0.38). The rate of wound healing issues of any severity was 28% in EDS vs. 47% in control groups (P = 0.04).Conclusion: The prevalence of EDS diagnosis in our patient population is 132 times the highest reported prevalence in the general population. Wound healing issues and the need for additional post-operative interventions in the group with EDS diagnosis were not significantly different from the control group. Our findings suggest that patients with a diagnosis of EDS undergoing GAS have comparable outcomes to patients without EDS. Concerns for post-operative complications should not be a barrier to offering GAS to patients presenting with an EDS diagnosis

Thirty-day readmission after lower extremity bypass in diabetic patients

Background: Lower extremity bypass (LEB) for peripheral vascular disease is a common procedure in diabetics and is associated with readmission. Thus, we hypothesized that diabetes might be a predictor of 30-d unplanned readmission after LEB.Methods: Patients undergoing infrainguinal LEB in the 2011-12 American College of Surgeons National Surgery Quality Improvement Program database were divided into nondiabetics mellitus (NDM), non-insulin-dependent diabetics mellitus (NIDDM), and insulin-dependent diabetic mellitus (IDDM). Univariate and multivariate analyses were used to evaluate the influence of diabetes on 30-d readmission.Results: A total of 9207 patients (5155 [56%] NDM, 1690 (18%) NIDDM, and 2362 (26%) IDDM) underwent LEB. Unplanned readmission was observed in 1448 patients (16%). IDDM had significantly higher crude postoperative complication (43% versus 30% NDM, 36% NIDDM; P \u3c 0.001) and unplanned readmission rates (20% versus 14% NDM, 16% NIDDM; P \u3c 0.001). Concomitant cardiac disease significantly modified the association between diabetes and unplanned readmission. On multivariable analysis, IDDM was an independent predictor of unplanned readmission in the absence of cardiac disease (odds ratio [OR] = 1.23; 95% confidence interval [CI], 1.03-1.47; P = 0.01). However, this association did not remain significant in the presence of cardiac disease (OR = 0.70; 95% CI, 0.48-1.01; P = 0.56). On subgroup analysis of those without cardiac disease, cardiac complications were a significant risk factor for readmission in IDDM (OR = 2.00; 95% CI, 1.12-3.57; P = 0.02) but not NDM (P = 0.31) or NIDDM (P = 0.10).Conclusions: Although post-LEB unplanned readmission was more common among diabetics, IDDM was independently associated with unplanned readmission only in those without cardiac disease. This was driven, in part, by increased cardiac complications. Therefore, a more stringent preoperative cardiac workup in this group should be considered before LEB

Familial Hypercholesterolemia (FH) in Iran: Findings from the Four-Year FH Registry

Background. Familial hypercholesterolemia (FH) is a common autosomal dominant disease. Its diagnosis in Iran was uncommon. Iran registry of FH (IRFH) has been started from 2017 from Isfahan. In this study, we report the four-year FH registry. Methods. The Iran FH registry is an ongoing study which is followed by a dynamic cohort. It has been started from 2017. The patients are selected from laboratories due to high cholesterol level and who have history of premature cardiovascular disease. The Dutch Lipid Clinic Network (DLCN) criteria are used for the detection of FH. Cascade screening is performed for detection of first-degree relative of patients. Results. Among the 997 individuals included in this registry, they were 522 (mean age 51.41±12.91 year), 141 (mean age 51.66±8.3 year), and 129 (mean age 41±16.5 year) patients from laboratories, premature cardiovascular disease, and relatives, respectively. In total, 263 patients were diagnosed with probable or definite FH, and others were in the possible group. Low-density lipoprotein cholesterol (LDL) level was 141.42±45.27 mg/dl in the laboratory group and 54.9% of patients were on LLT treatment. In patients with premature cardiovascular disease and FH, the LDL level was 91.93±32.58 and was on LLT treatment. The LDL concentration in the first relative of FH patients was 152.88±70.77 and 45.7% of them are on LLT therapy. Conclusions. Most of FH patients were underdiagnosed and undertreated before their inclusion in the IRFH. Cascade screening helps in the improvement of diagnosis