Brain, heart, and sudden death

During the past 30 years, rate of coronary artery disease (CAD), as the main cause of sudden death (SD), has decreased more than rate of SD. Likewise, cause of SD remains elusive in not a trivial portion of its victims. One possible reason is attention to only one organ, the heart, as the cause of SD. In fact, SD literature focuses more on the heart, less on the brain, and seldom on both. A change is required. In this paper, we first review the pathological findings seen in heart autopsies of SD victims after psychological stressors such as physical assault victims without internal injuries. Then, we summarize new studies investigating brain areas, like the insula, whose malfunctions and injuries are related to SD. Next, we review prototypes of neurological diseases and psychological stressors associated with SD and look at heart failure (HF)-related SD providing evidence for the brain-heart connection. Finally, we propose a new look at SD risk factors considering both brain and heart in their association with SD, and review strategies for prevention of SD from this perspective

PARS risk charts: A 10-year study of risk assessment for cardiovascular diseases in Eastern Mediterranean Region

This study was designed to develop a risk assessment chart for the clinical management and prevention of the risk of cardiovascular disease (CVD) in Iranian population, which is vital for developing national prevention programs. The Isfahan Cohort Study (ICS) is a popu- lation-based prospective study of 6504 Iranian adults 35 years old, followed-up for ten years, from 2001 to 2010. Behavioral and cardiometabolic risk factors were examined every five years, while biennial follow-ups for the occurrence of the events was performed by phone calls or by verbal autopsy. Among these participants, 5432 (2784 women, 51.3%) were CVD free at baseline examination and had at least one follow-up. Cox proportional hazard regression was used to predict the risk of ischemic CVD events, including sudden cardiac death due to unstable angina, myocardial infarction, and stroke. The model fit statis- tics such as area under the receiver-operating characteristic (AUROC), calibration chi- square and the overall bias were used to assess the model performance. We also tested the Framingham model for comparison. Seven hundred and five CVD events occurred during 49452.8 person-years of follow-up. The event probabilities were calculated and presented color-coded on each gender-specific PARS chart. The AUROC and Harrell’s C indices were 0.74 (95% CI, 0.72–0.76) and 0.73, respectively. In the calibration, the Nam-D’Ago stino ¿ 2 was 10.82 (p = 0.29). The overall bias of the proposed model was 95.60%. PARS model was also internally validated using cross-validation. The Android app and the Web-based risk assessment tool were also developed as to have an impact on public health. In compari- son, the refitted and recalibrated Framingham models, estimated the CVD incidence with the overall bias of 149.60% and 128.23% for men, and 222.70% and 176.07% for women, respectively. In conclusion, the PARS risk assessment chart is a simple, accurate, and well- calibrated tool for predicting a 10-year risk of CVD occurrence in Iranian population and can be used in an attempt to develop national guidelines for the CVD management .Peer ReviewedPostprint (published version

Alcohol intake as a risk factor for acute stroke: the INTERSTROKE Study

Background and Objectives: There is uncertainty about the association between alcohol consumption and stroke, particularly for low-moderate intake. We explored these associations in a large international study. Methods: INTERSTROKE, a case-control study, is the largest international study of risk factors for acute stroke. Alcohol consumption was self-reported and categorised by drinks/week as low (1-7), moderate (7-14 for females, 7-21 for males) or high (>14 for females, >21 for males). Heavy episodic drinking (HED) was defined as >5 drinks on ≥1 day per month. Multivariable conditional logistic regression was used to determine associations. Results: We included 12,913 cases and 12,935 controls; 25.0% (n=6,449) were current drinkers, 16.7% (n=4,318) former and 58.3% (n=15,076) never drinkers. Current drinkers were younger, male, smokers, active and with higher-paid occupations. Current drinking was associated with all stroke (OR 1.14; 95% CI 1.04-1.26) and intracerebral hemorrhage (ICH) (OR 1.50, 95% CI 1.21-1.84) but not ischaemic stroke (OR 1.06; 95% CI 0.95-1.19). HED pattern was associated with all stroke (OR 1.39; 95% CI 1.21-1.59), ischaemic stroke (OR 1.29; 95% CI 1.10-1.51) and ICH (OR 1.76; 95% CI 1.31-2.36). High level of alcohol intake was consistently associated with all stroke, ischaemic stroke and ICH. Moderate intake was associated with all stroke and ICH, but not ischaemic stroke. Low alcohol intake was not associated with stroke overall but there were regional differences; low intake was associated with reduced odds of stroke in Western Europe/North America (OR 0.66; 95%CI 0.45-0.96) and increased odds in India (OR 2.18; 95%CI 1.42-3.36)(p-interaction 0.037). Wine consumption was associated with reduced odds of all stroke and ischaemic stroke but not ICH. The magnitudes of association were greatest in those without hypertension and current smokers. Discussion: High and moderate intake were associated with increased odds of stroke, while low intake was not associated with stroke. However, there were important regional variations, which may relate to differences in population characteristics of alcohol consumers, types or patterns of consumption

Academic Achievement of Talented Students at Isfahan University of Medical Sciences

Abstract. Background. The necessity of identifying talented students to develop appropriate programs to educate them is well recognized. Special programs for talented students were started in Isfahan University of Medical Sciences in year 2000. This study analyses academic achievement of talented students before attending these programs, and compares them to those who are not considered as talented . Methods. Through a retrospective cohort study students admitted in the university in either 1997 or 1998 were categorized as”talented” and "non-talented" based on the criteria employed by National Organization for Educational Measurement. The two groups were matched according to their courses of study, number of passed units, and the semesters passing the corresponding units. From each student’s file, the total average, average of each semester, and the courses of study were extracted. Results. There were 73 talented (36 female and 37 male) and 401 non-talented students. Of talented students, 50 were studying medicine and 23 were studying dentistry. With increment of passed semesters, term averages were decreased. The slope of average decrements among talented students were not significantly different from that of "non-talented" ones. Conclusion. Although term average is not the only criterion for assessment of academic achievement, it seems that current University programs were not effective to improve academic achievement of talented students ,or at least , maintain their status

An abridged guideline for Acute Stroke Management

Stroke is one of the most prevalent and disabling disease in human being. Approximately 700000 strokes occur each year in the United States, leaving 500 000 stroke survivors with disability, and economic loss resulting from stroke approaches an estimated $51.2 billion annually 1. What comes below is stroke management guideline used at Massachusetts General Hospital (at Harvard medical school) in year 2005 2. This presentation is an abridged form of the proposed guideline. At the end, some comments and recommendations are presented regarding acute stroke management in Iran. &nbsp;</p

ACUTE MYOCARDIAL INFARCTION IN ISFAHAN, IRAN: HOSPITALIZATION AND 28TH DAY CASE-FATALITY RATE

Abstract &nbsp;&nbsp; BACKGROUND: This study aimed to investigate 28-day case fatality rate due to acute myocardial infarction (MI) in Isfahan using a standardized surveillance system. &nbsp;&nbsp; METHODS: A prospective longitudinal study was performed on hospitalized myocardial infarction patients in Isfahan, Iran from 2000 to 2004. All hospitalizations due to myocardial infarction (MI) events were recorded via a system adopted from &ldquo;World Health Organization Monitoring Trends and Determinants in Cardiovascular Disease&rdquo; (MONICA) project, with ignoring MONICA age limitation. Patients were followed and their families enquired about their patients survival status at 28th day with phone calls and if not available at home visits. &nbsp;&nbsp; RESULTS: Age-adjusted hospital admission rate showed an increase during the study period, rising from 131.67 to 209.27 per 100000, but slowed toward the end of the study. Patients&rsquo; mean age was 62.35&plusmn;12.64, with one third of events documented among female patients. Young patients (&lt; 45 years old) comprised 8.6% of hospitalizations which remained nearly constant through the study. The corresponding figure was about 28% for patients aged less than 55 years. The 28-day case fatality rate was 23.1% for women and 13.2% for men. For individuals aged 35-64 years, the fatality rate was 13.0% for women and 7.7% for men.&nbsp; &nbsp;&nbsp; CONCLUSION: This study showed an increase in myocardial infarction hospital admission rate in Isfahan but the rate of increase is decreasing. A multi-centric community-based myocardial infarction incidence study is needed to elucidate myocardial infarction epidemiology in Iran. &nbsp; &nbsp;&nbsp; Keywords: Myocardial Infarction (MI), Epidemiology, Prevention and control, Cardiovascular diseases, Iran, Fatality rate. &nbsp;</p