Dissimilarity in the Frequency of Venous Thromboembolism Risk Factors among Studies, a Commentary

Venous Thromboembolism (VTE) is the 3rd most prevalent vascular disease behind myocardial infarction and cerebrovascular ischemic attack. This disorder has received attention from health policy makers because of its major complications including recurrent VTE, post thrombotic syndrome, sudden cardiac death and high mortality rate. In the United States, VTE was reported in approximately 201000 cases annually, 25% of which expired within 7 days after diagnosis and 22% of mortalities did not have a definitive diagnosis. Despite the progression in diagnosis and treatment of VTE since 1979, its incidence did not decrease dramatically.This gap declares that VTE risk factors, especially transient ones, have not been detected completely. Obesity, history of VTE, family history of VTE, recent surgery,malignancy, myeloproliferative disorders, trauma, pregnancy, post-menopausal hormone therapy, hereditary syndromes like anti phospholipid syndrome (APS), chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD), blood transfusion and older age are determined as major risk factors. These factors can be categorized into two major subgroups as intrinsic and predisposing. Recent investigations focused on predisposing ones, which can be justified. Designing a cross sectional study in Imam Hossein Hospital, Tehran, Iran, from 2016 to 2017, we found that inactivity due to disability (30.9%), smoking (29.3%), and active malignancy (18.1%), were the most prevalent transient risks factor of VTE in our sample, respectively. Similar to our results, Kesieme et al. and Cushman et al. declared that VTE is more diagnosed in the elderly. Park MS et al. introduced recent surgery, trauma (73%), and disability to walk (62%) as major independent risk factors of VTE. Fuji T et al. introduced malignancy, recent infectious disease, and obesity as the factors predisposing patients who were admitted for orthopedic surgery to VTE. As can be seen, despite the risk factors of VTE being the same in various studies, their frequency varied between the studies. Population and cultural characteristics and various habits may have an effect in this regard. Therefore, it is suggested to performa multi-center, comprehensive study considering all the racial and ethnic in order to have a correct pattern of the frequency of predisposing factors of this disease in the Iranian population for health and prevention programs

Prevalence of anemia and new onset atrial fibrillation in patient come to imam hossein hospital emergency department

Background: Recognition of association between anemia and new onset atrial fibrillation would result in better therapeutic approaches and better prognosis. Hence, the purpose was to determine the prevalence of anemia and new onset atrial fibrillation (AF) in patient come to Imam Hossein hospital emergency department.Materials and Methods: In the observational study that performed as a case-control survey, 150 consecutive addicted patients in imam hossein hospital emergency department in 2018 were enrolled including those with and without AF in electrocardiogram (EKG) and the frequency rate of anemia among groups was determined and compared.Results: The results in this study demonstrated that 43 patients (27.8%) had anemia that was seen in 36% and 21.3% in case and control groups, respectively with statistically significant difference (p=0.047).Conclusion: Totally, according to the obtained results there was significant association between anemia and new onset atrial fibrillation

Nutrition and osteoporosis prevention and treatment

Introduction: Osteoporosis falls among the major general health issues, specifically in the elderly, and is a widespread disease these days. According to various studies, good nutrition plays a significant role in osteoporosis prevention and treatment. The aim of this study was to conduct an extensive literature review on the effects of different nutrients to understand how macronutrients, micronutrients, and non-nutritive substances affect bone health. Methodology: To find relevant studies, the main keyword "osteoporosis" was searched in combination with "zinc," "vitamin K," "phosphorus," "vitamin D," "calcium," "lipid," "protein," and "phytoestrogens" in PubMed (MEDLINE), Web of Science, SID, and Iran Medex databases. Findings: The most important element for bone health is calcium, which has a direct link to the bone mass density (BMD). In the case of calcium deficiency, high phosphorus content can damage bone tissue. The acceptable ratio of phosphorus to calcium is 0.5-1.5:1. Vitamin D is another important nutrient for bones; serum levels of vitamin D less than 20 ng/ml reduce bone density and increase the risk of fracture. High protein intake results in calcium excretion and loss of bone mass. In addition, calcium deficiency increases the risk of osteoporosis, specifically in the elderly. According to the literature, there is an inverse correlation between saturated fats and BMD. Vitamin K and magnesium deficiencies are correlated with BMD reduction and increased risk of osteoporosis. Copper and zinc are used as co-factors in the formation of collagen and elastin, and in mineralization of bone. As a result, deficiency of these elements may disrupt the process of incorporating minerals into the bone matrix. Conclusion: Good nutrition may play a significant role in osteoporosis prevention and treatment. Indeed, a healthy diet containing calcium (1,200 mg/day); vitamin D (600 IU); and certain amounts of protein, magnesium, and vitamin K can contribute greatly to bone health

Prevalence, Risk Factors and Outcomes Associated with Acute Kidney Injury in Patients Hospitalized for COVID-19: A Comparative Study between Diabetic and Nondiabetic Patients

Background. The risk factors for acute kidney injury (AKI) development in patients with diabetes hospitalized for COVID-19 have not been fully studied yet. In this study, we aimed to estimate the rate of AKI among the hospitalized population with COVID-19 and to identify the risk factors associated with AKI among patients with diabetes. Material and Methods. This retrospective cohort study included 254 patients (127 with diabetes and 127 without diabetes) who were admitted for COVID-19 to a tertiary hospital in Tehran, Iran, between February and May 2020. Clinical characteristics and outcomes, radiological findings, and laboratory data, including data on AKI, hematuria, and proteinuria were recorded and analyzed. Results. Of 254 patients, 142 (55.9%) were male and the mean (± SD) age was 65.7 years (±12.5). In total, 58 patients (22.8%) developed AKI during hospitalization, of whom 36 patients had diabetes (p=0.04); most patients (74.1%) had stage 1 or 2 AKI. Also, 8 patients (13.8%) required renal replacement therapy (RRT) after developing AKI. Regardless of diabetes status, patients who developed AKI had significantly higher mortality rates compared with patients who did not develop AKI (p=0.02). Hematuria and proteinuria were observed in 38.1% and 55% of patients, respectively. Multivariate analysis showed that invasive mechanical ventilation, proteinuria, HBA1c level, history of cardiovascular disease, and use of statins were independent risk factors for AKI development in patients with diabetes. Conclusion. Results of this study showed that AKI develops in a considerable percentage of patients with COVID-19, especially in those with diabetes, and is significantly associated with mortality

Comparative Evaluation of Therapeutic Approaches to Central Sleep Apnea

BACKGROUND: To date, there is no standard approach to manage and to improve central sleep apnea (CSA). The most applicable therapeutic approaches are positive airway pressure therapy (PAP), bi-level PAP therapy (BIPAP), supplemental O2 and servo ventilation, or a combination of two approaches. Given the high prevalence of heart disease (HF) and/or concomitants of other diseases and opioid use worldwide; it seemingly requires evaluation of patients' conditions in response to each abovementioned approach to select the most effective approach. MATERIALS AND METHODS: This longitudinal cross-sectional study included 64 CSA patients who had undergone continuous PAP (CPAP), CPAP + O2, and BiPAP. Hence, if a patient was nonresponsive to a treatment, the next was applied. If the patient was nonresponsive to all approaches, oxygen alone was administered. The collected data were analyzed with SPSS. RESULTS: The study of 64 CSA patients showed that frequencies of response to CPAP, CPAP + O2, and BiPAP were 42.2%, 20.3%, and 28.1%, respectively. While 9.4% of patients with histories of congestive heart failure (CHF) and ischemic heart disease (IHD) who were older than others and with the highest apnea-hypopnea index, were nonresponsive to all approaches. CPAP therapy showed more appropriate results in patients with CHF and IHD. Furthermore, patients with the history of opioid use showed the most positive results in response to CPAP and BIPAP. CONCLUSION: The results suggest that CPAP and BIPAP are, respectively, the most effective therapeutic approaches to CSA in patients with the histories of HF and opioid use, but CPAP + O2 could be reliable in some conditions as well. Therefore, it may require further studies to be clarified. KEYWORDS: Bi-level positive airway pressure; central sleep apnea; continuous positive airway pressure; supplemental O

Baseline and postoperative levels of C-reactive protein and interleukins as inflammatory predictors of atrial fibrillation following cardiac surgery: a systematic review and meta-analysis

Background: Postoperative atrial fibrillation (POAF) is a leading arrhythmia with high incidence and serious clinical implications after cardiac surgery. Cardiac surgery is associated with systemic inflammatory response including increase in cytokines and activation of endothelial and leukocyte responses. Aim This systematic review and meta-analysis aimed to determine the strength of evidence for evaluating the association of inflammatory markers, such as C-reactive protein (CRP) and interleukins (IL), with POAF following isolated coronary artery bypass grafting (CABG), isolated valvular surgery, or a combination of these procedures. Methods: We conducted a meta-analysis of studies evaluating measured baseline (from one week before surgical procedures) and postoperative levels (until one week after surgical procedures) of inflammatory markers in patients with POAF. A comprehensive search was performed in electronic medical databases (Medline/PubMed, Web of Science, Embase, Science Direct, and Google Scholar) from their inception through May 2017 to identify relevant studies. A comprehensive subgroup analysis was performed to explore potential sources of heterogeneity. Results: A literature search of all major databases retrieved 1014 studies. After screening, 42 studies were analysed including a total of 8398 patients. Pooled analysis showed baseline levels of CRP (standard mean difference [SMD] 0.457 mg/L, p < 0.001), baseline levels of IL-6 (SMD 0.398 pg/mL, p < 0.001), postoperative levels of CRP (SMD 0.576 mg/L, p < 0.001), postoperative levels of IL-6 (SMD 1.66 pg/mL, p < 0.001), postoperative levels of IL-8 (SMD 0.839 pg/mL, p < 0.001), and postoperative levels of IL-10 (SMD 0.590 pg/mL, p < 0.001) to be relevant inflammatory parameters significantly associated with POAF. Conclusions: Perioperative inflammation is proposed to be involved in the pathogenesis of POAF. Therefore, perioperative assessment of CRP, IL-6, IL-8, and IL-10 can help clinicians in terms of predicting and monitoring for POAF