Contributions of mean and shape of blood pressure distribution to worldwide trends and variations in raised blood pressure: A pooled analysis of 1018 population-based measurement studies with 88.6 million participants

© The Author(s) 2018. Background: Change in the prevalence of raised blood pressure could be due to both shifts in the entire distribution of blood pressure (representing the combined effects of public health interventions and secular trends) and changes in its high-blood-pressure tail (representing successful clinical interventions to control blood pressure in the hypertensive population). Our aim was to quantify the contributions of these two phenomena to the worldwide trends in the prevalence of raised blood pressure. Methods: We pooled 1018 population-based studies with blood pressure measurements on 88.6 million participants from 1985 to 2016. We first calculated mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP) and prevalence of raised blood pressure by sex and 10-year age group from 20-29 years to 70-79 years in each study, taking into account complex survey design and survey sample weights, where relevant. We used a linear mixed effect model to quantify the association between (probittransformed) prevalence of raised blood pressure and age-group- and sex-specific mean blood pressure. We calculated the contributions of change in mean SBP and DBP, and of change in the prevalence-mean association, to the change in prevalence of raised blood pressure. Results: In 2005-16, at the same level of population mean SBP and DBP, men and women in South Asia and in Central Asia, the Middle East and North Africa would have the highest prevalence of raised blood pressure, and men and women in the highincome Asia Pacific and high-income Western regions would have the lowest. In most region-sex-age groups where the prevalence of raised blood pressure declined, one half or more of the decline was due to the decline in mean blood pressure. Where prevalence of raised blood pressure has increased, the change was entirely driven by increasing mean blood pressure, offset partly by the change in the prevalence-mean association. Conclusions: Change in mean blood pressure is the main driver of the worldwide change in the prevalence of raised blood pressure, but change in the high-blood-pressure tail of the distribution has also contributed to the change in prevalence, especially in older age groups

Rising rural body-mass index is the main driver of the global obesity epidemic in adults

Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities(.)(1,2) This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity(3-6). Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017-and more than 80% in some low- and middle-income regions-was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing-and in some countries reversal-of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.Peer reviewe

IFI27 transcription is an early predictor for COVID-19 outcomes, a multi-cohort observational study

PurposeRobust biomarkers that predict disease outcomes amongst COVID-19 patients are necessary for both patient triage and resource prioritisation. Numerous candidate biomarkers have been proposed for COVID-19. However, at present, there is no consensus on the best diagnostic approach to predict outcomes in infected patients. Moreover, it is not clear whether such tools would apply to other potentially pandemic pathogens and therefore of use as stockpile for future pandemic preparedness.MethodsWe conducted a multi-cohort observational study to investigate the biology and the prognostic role of interferon alpha-inducible protein 27 (IFI27) in COVID-19 patients.ResultsWe show that IFI27 is expressed in the respiratory tract of COVID-19 patients and elevated IFI27 expression in the lower respiratory tract is associated with the presence of a high viral load. We further demonstrate that the systemic host response, as measured by blood IFI27 expression, is associated with COVID-19 infection. For clinical outcome prediction (e.g., respiratory failure), IFI27 expression displays a high sensitivity (0.95) and specificity (0.83), outperforming other known predictors of COVID-19 outcomes. Furthermore, IFI27 is upregulated in the blood of infected patients in response to other respiratory viruses. For example, in the pandemic H1N1/09 influenza virus infection, IFI27-like genes were highly upregulated in the blood samples of severely infected patients.ConclusionThese data suggest that prognostic biomarkers targeting the family of IFI27 genes could potentially supplement conventional diagnostic tools in future virus pandemics, independent of whether such pandemics are caused by a coronavirus, an influenza virus or another as yet-to-be discovered respiratory virus

Adult Onset Still's Disease With Different Antibodies: A Case Report and Review of Literature

Adult-onset Still’s disease (AOSD) is a rare systemic inflammatory disorder of unknown etiology. There is not currently any specific serological markers for AOSD , and  diagnosis still relying on the exclusion of other likely diagnoses. Yamaguchi’s criteria are used as a diagnostic criterion which contains negative serologic markers for other collagen vascular diseases including systemic lupus erythematosus and rheumatoid arthritis. Here we report a 28-year-old woman with arthralgia, fever, rash, leukocytosis, lymphadenopathy, sore throat, abnormal liver function and negative rheumatoid factor and ANA but  seropositive for anti-CCP, anti-dsDNA, and C-ANCA. It seems that despite AOSD is considered as a seronegativedisorder; it should be remembered in patients with compatible findings who are seropositive

Epidemiological Study of Influenza Among Cardiovascular Diseases Patients Hospitalized in Mazandaran Heart Center

Background and purpose: Influenza virus is scattered around the world and causes epidemics of varying severity annually. Mortality caused by influenza is more common in cardiovascular patients than in other chronic diseases. Paying attention to this is very important in preventing the disease and its complications in children and adults with cardiovascular diseases. Therefore, this study was conducted with the aim of epidemiological investigation of hospitalized cases caused by influenza in cardiovascular patients and its effect on the health of these patients in Mazandaran Heart Center. Materials and methods: The present study is a cross-sectional descriptive study that was conducted on patients who were admitted to the Mazandaran Heart Center between 2016 and 2018. All patients who were hospitalized with the initial and final diagnosis of influenza and were treated with all flu medicine were included in the study. Since the PCR test was not available for all these patients, as the value of clinical diagnosis was based on symptoms and initial laboratory findings during the epidemic, in addition to PCR-positive cases, cases with clinical diagnosis were also included in the study. All data analysis with SPSS version 16 software was used. Results: In this study, 113 patients with an average age and standard deviation of 63.3+15 years were included. Among these patients, the highest frequency of history of heart disease was related to congestive heart failure (35.4%) and angioplasty (292%), and the lowest frequency was related to valve replacement 8.0%. Among other underlying diseases, the highest frequency was related to hypertension (65.5%), diabetes mellitus (41.6%), and hyperlipidemia (31.0%), and the lowest frequency was related to thyroid disorders (2.7%). Also, 31.9% of patients had diabetes and hypertension and 16.8% had diabetes and hyperlipidemia. Examining the signs and symptoms of influenza among the patients also showed that the highest frequency related to fever (76.1%), sputum (66.4%), cough (64.6%), shortness of breath (611%) and myalgia (548%) and the lowest frequency was related to diarrhea (5.3%). Only 7% of patients had a recent history of flu vaccination. In the chest radiography report, 25.7% of the patients had increased bronchial marking and 17.7% had evidence of pneumonia. Finally, 82.3% of patients were discharged after complete recovery. Also, only 12 cases (10.6%) of the patients died. Heart failure was the most common underlying disease among deceased patients. Conclusion: The results of this study revealed that the symptoms of influenza in heart patients are similar to other patients and the type of underlying disease has no effect on the disease presentation and its initial manifestations, but persisting of the symptoms and progression towards severe disease were more common. Most of the deaths were due to heart failure, and this issue highlights the importance of these patients' adherence to the flu vaccine. Unfortunately, the results of the study indicated that this high-risk population had little adherence to influenza and pneumococcal vaccinations

Study of the Resistance of Escherichia Coli Which Creates Community-Acquired Urinary Tract Infections to Ciprofloxacin and Co-Trimoxazole Antibiotics in Sari Hospitals, Iran

Objective: Escherichia coli is the most important etiologic factor in urinary tract infection (UTI), which is becoming resistant to the common antibiotics. The aim of this study was to evaluate the resistance of this bacterium to the antibiotics that are commonly used. Materials and Methods: A descriptive study conducted in patients with uncomplicated UTI referring to Sari hospitals during 2013-2014. For this purpose, samples that had positive urine culture were selected and evaluated with antibiogram. In addition, E-Test MIC method was used for antibiotics ciprofloxacin and co-trimoxazole. SPSS software was used for data analysis. Results: Of the 101 patients studied, 83 (82.2%) were females and 18 (17.8%) were male. The mean age of patients was 40.32 ± 3.22 years. The most sensitivity was seen to nitrofurantoin (92.07%), gentamicin (76.23%). Most resistance was also seen to the antibiotics amoxicillin (74.25%), co-trimoxazole (64.35%) and ciprofloxacin (36.63%). In E-Test MIC method, 23.7% were resistant to the ciprofloxacin and 43.5% to co-trimoxazole. Conclusion: Due to the high antibiotic resistance that was observed to ciprofloxacin and co-trimoxazole in this study, it seems a better alternative antibiotic such as nitrofurantoin should be used for the empirical treatment of patients with UTIs

Clinical Manifestations and usual and unusual CXR manifestation of smear positive Pulumonary tuberculosis; in Sari, Qaemshahr and Neka

, , , (Received 7 June, 2009; Accepted 22 July, 2009)AbstractBackground and purpose: Clinical and radiological manifestations of Pulumonary tuberculosis are well known. However, it appears there is an increasing rate of unusual radiological patterns in immuno-competent adults, with smear positive pulmonary tuberculosis (based on our experience). The aim of this study was to analyze chest X-ray (CXR) findings and clinical patterns among immuno-competent men and women with smear positive pulmonary tuberculosis (TB) in Sari, Qaemshahr and Neka, during March 2006 to March of 2007.Materials and methods: All new cases of pulmonary TB diagnosed during 12 months in 3 districts in Northern Iran, (Mazandaran Province) were included in a cross-sectional study. Inclusion criteria's were: positive smear of sputum and absence of any immuno-suppressive state. 65 cases fulfilled the inclusion criteria. Descriptive methods were used for data analysis.Results: The common presenting symptoms were: coughing at 83%, hemoptysis at 24.6%, night sweating at 55%, anorexia at 60%, weight loss at 73.8 %, and fever at 60%. Usual radiological patterns was found in 70.8% of patients (upper lobe lesion with or without the remaining part) and incidence of an unusual radiographic pattern was 29.2%(middle and lower lob infiltration without upper lob lesion, milliary pattern, hilar lymphadenopathy and normal CXR).Conclusion: This study showed that TB with atypical radiographic manifestations is more common than reported previously.These varieties of radiologic manifestations can mimic other disease entities. Therefore, recognition and understanding of radiologic manifestations and complication of tuberculosis are important to facilitate a diagnosis.Key words: J Mazand Univ Med Sci 2009; 19(70): 61-66 (Persian