Sex differences in conventional and some behavioral cardiovascular risk factors, Analysis of the prevention clinic database

Background: An increase in Cardiovascular Disease (CVD) frequency was observed over the past three decades in low- and middle income countries, especially in Iran. The purpose of the present study was to review and compare the frequencies of conventional and some non-conventional CVD risk factors between men and women in a tertiary level referral cardiovascular teaching hospital in a six month period in the North of Iran.  Methods: A descriptive cross-sectional study was conducted using medical databases including conventional risk factors: opium consumption, physical inactivity, high salt diet, and serum vitamin D level. The chi-square and independent t tests were used to assess the differences between groups.  Results: A total of 740 (55% women) who had available full medical history data were recruited in the study. Approximately 62% of the participants were older than 45 years with the mean age of 54 (14.2) years old. Percentages of hypertension, diabetes, dyslipidemia, and obesity in women were significantly higher than those of men (P<0.05). A total of 50% of all the participants were physically inactive. Men had higher frequency of opium and saltshaker use than women (P<0.05).  Conclusion: The current study indicated that despite the importance of conventional CVD risk factors like diabetes, hypertension, dyslipidemia, and obesity, educational programs should be considered to improve physical activity and reducing salt consumption and awareness about opium use complications

Frequency of using complementary herbal medicines among Helicobacter pylori-infected patients in the North of Iran

Helicobacter pylori is a prevalent infection and one of the most critical factors that result in gastric cancer. Besides antibiotic therapy, some plants are suitable as an alternative treatment against H. pylori infection due to their role in protecting the gastric mucosa. This study investigated the frequency of using complementary herbal medicines among H. pylori-infected patients in the North of Iran. This cross-sectional study was conducted on 390 patients with H. pylori infection undergoing treatment in Rasht, Iran, 2022. The demographic data, clinical characteristics, and consumption of complementary herbals were recorded. The mean age of the patients was 40 years, and 63.6% were female. The majority of the patients were educated. About 55.9% of patients consumed at least one herbal product, and the most consumed herbal product was mint extract. Most patients purchased herbal products from the grocery (93.1%); none referred to the pharmacy. About 89.2% of the patients recovered completely, and 10.8% had a disease recurrence. No particular complications were observed in most patients (97.7%). However, no significant association between the consumption of herbal products and patients' recovery was reported (P0.05). According to our results, consuming herbal products results in no specific improvement in patients with H. pylori infection

Efficacy and tolerability of fourteen-day sequential quadruple regimen

The optimal pharmacological regimen for eradication of Helicobacter pylori (H. pylori) has been investigated for many years. This study aimed to evaluate the efficacy and tolerability of bismuth-based quadruple therapy (B-QT) and a modified sequential therapy (ST) regimens in eradication of H. pylori. A randomized, double-blind trial was conducted on 344 patients. Patients with H. pylori infection and without a history of previous treatment were randomized to receive 14-day B-QT (bismuth subcitrate 240 mg, pantoprazole 40 mg, amoxicillin 1000 mg, and clarithromycin 500 mg twice daily) or 14-day ST (bismuth subcitrate 240 mg, pantoprazole 40 mg, amoxicillin 1000 mg, and metronidazole 500 mg twice a day for seven days followed by bismuth subcitrate 240 mg, pantoprazole 40 mg, amoxicillin 1000 mg, and furazolidone 100 mg twice a day for additional seven days). Drug adverse effects were assessed during the study. H. pylori eradication was determined eight weeks after the end of treatment using 14C-urea breath test. Based on per-protocol and intention-to-treat, the eradication rate was significantly higher (p<0.05) in the B-QT regimen 91.9 % (95 % CI; 88.1-94.0) and 90.2 % (95 % CI; 86.3-92.9), respectively compared to the ST regimen 80.8 % (95 % CI; 76.6-84.9) and 78.1 % (95 % CI; 73.7-82.4), respectively. The severity of vomiting and loss of appetite were significantly higher in ST regimen (p<0.05). The B-QT regimen was more effective and safer than the ST regimen. Conclusively, it is suggested to assess the efficacy and safety of this regimen in longer studies, larger population, and in other communities

Outcomes of Phaco-viscocanalostomy in Primary Open Angle Glaucoma versus Pseudoexfoliation Glaucoma

Purpose: Viscocanalostomy represents an alternative to standard penetrating glaucoma surgery. The aim of this study is to compare the outcomes of combined phacoemulsification and viscocanalostomy in eyes with primary open-angle glaucoma (POAG) versus eyes with pseudoexfoliation glaucoma (PEXG). Methods: In this prospective non-randomized comparative study, eyes with cataract and POAG or PEXG were enrolled. Pre- and postoperative data including best corrected visual acuity (BCVA), intraocular pressure (IOP), and the number of antiglaucoma medications administered were recorded at each visit. All patients underwent phacoviscocanalostomy. Complete success was defined as the IOP of 21 mmHg or less without the administration of medication while a qualified success reported the same IOP parameters either with or without the administration of medication. Results: Fifty-four eyes with POAG and fifty-four with PEXG underwent phacoviscocanalostomy. The mean follow-up time was 23.36 ± 8.8 months (range, 6–40 months). The mean postoperative IOP reduced significantly in both groups, although the mean IOP reduction was significantly greater in PEXG eyes (14.7 ± 8.9 vs 10.1 ± 7.7 mmHg) (P = 0.05). At the final follow-up visit, the mean postoperative IOP was 14.1 ± 2.1 and 16.6 ± 3.5 mmHg in the PEXG and POAG eyes, respectively (P = 0.001). A complete success rate of 88.9% and 75.9% was achieved in PEXG and POAG eyes, respectively (P = 0.07). The qualified success rate was 100% in the PEXG and 85.2% in POAG groups (P = 0.03). Conclusion: Phacoviscocanalostomy achieved significant IOP reduction and visual improvement in both POAG and PEXG patients. Our results indicated that in terms of IOP reduction, this procedure was more effective in treating PEXG

The family medicine specialty, learning from experience

Family medicine has been accepted as a model for Iranian health-care reform, but many debates have been raised since its establishment. Despite many successes achieved, this area of medicine is very challengeable. Family practice as a specialty is an innovation that has been introduced by the ministry of health and medical education in Iran. Although this approach seems sophisticated, learning from experience is the first step to avoid difficulties that may occur from this selection. Our goal is to declare strengths, weaknesses, opportunities, and threats of family medicine specialty

Acupuncture for chronic nonpulsatile tinnitus: A randomized clinical trial

Background: There is challenge to find an effective treatment for tinnitus. Few studies were done on the effects of acupuncture on tinnitus. This study evaluated the effect of acupuncture on chronic non-pulsatile tinnitus. Methods: This randomized double-blind clinical trial was conducted from December 2014 to September 2015. Patients suffering from chronic non-pulsatile tinnitus were randomly allocated into two groups: acupuncture vs. placebo. They were treated in 15 sessions and at the end of the fifteenth sessions and 3 weeks after completion of the treatment, visual analog scale (VAS) for tinnitus loudness and tinnitus severity index (TSI) questionnaires were completed. Results: The case group included 26 males and 18 females, and in the control group there were 27 males and 17 females: with mean age of 49.11±1.07 and 55.20±8.33 years, respectively (p=0.005). TSI and VAS before treatment were 43.84±2.81 and 9.56±0.43 in cases and 43.52±2.94 and 9.54±0.45 in controls, respectively. Both measures improved after 15 sessions in cases to 24.82±1.04 and 2.88±0.33, and to 33.16±1.24 and 7.86±0.23 in controls. The changes of TSI and VAS were significant in all groups (p<0.001). TSI and VAS in acupuncture group were lower than placebo group in each session (p<0.001), except TSI in the tenth session (p=0.392). Conclusions: Acupuncture is effective in reducing the loudness and severity of tinnitus and can be a useful treatment for nonpulsatile chronic tinnitus

Association between Metabolic syndrome and Subjective social status in coronary artery disease patients, a cross sectional study: Metabolic syndrome and Subjective social status

Aims: The&nbsp; purpose&nbsp; of&nbsp; this&nbsp; study&nbsp; was&nbsp; to&nbsp; examine&nbsp; the&nbsp; association&nbsp; of&nbsp; metabolic&nbsp; syndrome (MetS)&nbsp; with&nbsp; subjective&nbsp; social&nbsp; status (SSS)&nbsp; and&nbsp;&nbsp; depression&nbsp; symptoms&nbsp; among&nbsp; coronary artery disease patients (CAD). Materials and methods: in&nbsp; a&nbsp; cross&nbsp; sectional&nbsp; study&nbsp; during&nbsp;&nbsp; 2019- 2020,&nbsp; patients&nbsp; with&nbsp; CAD&nbsp;&nbsp;&nbsp; older&nbsp; than&nbsp; 30&nbsp; through&nbsp; simple&nbsp; sampling&nbsp; method&nbsp; were&nbsp; selected. SSS&nbsp; and&nbsp; depression&nbsp; were&nbsp; assessed&nbsp; using&nbsp; MacArthur&nbsp; scale&nbsp; and&nbsp; Persian&nbsp; version&nbsp; of&nbsp; the 13&nbsp; items&nbsp; beck&nbsp; depression&nbsp; scale,&nbsp; respectively.&nbsp; The components &nbsp;of&nbsp; Metabolic&nbsp; syndrome,&nbsp; ,&nbsp; and&nbsp; demographic&nbsp; factors&nbsp; were&nbsp; collected&nbsp; based&nbsp; on&nbsp; patients&nbsp; medical&nbsp; records. result: data&nbsp; related&nbsp; to&nbsp; 500&nbsp; CAD&nbsp; patients&nbsp; aged&nbsp; 61.81&nbsp; ±&nbsp; 12.25&nbsp; years&nbsp; were&nbsp; assessed. prevalence of&nbsp; MetS&nbsp; was&nbsp; 57 % . Almost&nbsp; 75%&nbsp; of&nbsp; study&nbsp; subjects&nbsp; were&nbsp; in&nbsp; low&nbsp; category&nbsp; of&nbsp; SSS.&nbsp; Univariate&nbsp; logistic&nbsp; regression&nbsp; analysis&nbsp; showed&nbsp; the&nbsp; odds&nbsp; of&nbsp; MetS&nbsp;&nbsp; in&nbsp; patients&nbsp; with&nbsp; higher&nbsp; SSS&nbsp; was&nbsp; 21%&nbsp; less&nbsp; than&nbsp; patients&nbsp; with&nbsp; lower&nbsp; SSS&nbsp; (OR=0.79, 95% CI=0.53-1.19, P=0.274). The&nbsp; odds&nbsp; of&nbsp; MetS&nbsp; was&nbsp; higher&nbsp; in&nbsp; women [OR=1.67(1.16-2.42)] , married&nbsp; subjects[OR=1.55(0.74-3.26)] , in&nbsp; rural&nbsp; area [OR=1.30(0.88-1.91)] ,&nbsp; those&nbsp; without&nbsp; job [OR=0.83(0.58-1.19)]&nbsp; and&nbsp; literacy[OR= 0.83(0.58-1.19)] . There&nbsp; was&nbsp; no&nbsp; significant&nbsp; association&nbsp; between&nbsp; depression&nbsp; and&nbsp; the&nbsp; odds&nbsp; of&nbsp; metabolic&nbsp; syndrome (OR=0.98,&nbsp; 95%&nbsp; CI= 0.63-1.52, P= 0.950). In&nbsp; multivariate&nbsp; logistic&nbsp; regression&nbsp; analysis&nbsp; ,&nbsp; the&nbsp; inverse&nbsp; association&nbsp; between&nbsp; SSS&nbsp; and&nbsp; MetS&nbsp; was&nbsp; still&nbsp; remained&nbsp; (OR= 0.74, 95% CI=0.49-1.12, P=0.163). Conclusions: MetS&nbsp; was&nbsp; more&nbsp; prevalent&nbsp; in&nbsp; lower&nbsp; even&nbsp; considering&nbsp; demographic&nbsp; factors&nbsp; and&nbsp; depression&nbsp; symptoms. More&nbsp; researches&nbsp; need&nbsp; to&nbsp; assess&nbsp; the&nbsp; effect&nbsp; of&nbsp; perceived&nbsp; social&nbsp; standing&nbsp; on&nbsp; cardiometabolic&nbsp;&nbsp; risk&nbsp; factors

The Relative Frequency of Allergic Fungal Rhinosinusitis in Patients with Nasal Polyposis in Rasht City, Iran

Background and Objectives: Allergic fungal rhinosinusitis (AFRS) is a relatively new and known disease with effective treatment, which belongs to the group of nasal polyposis diseases. According to high prevalence of AFRS in regions with warm and humid climate, the aim of this study was to detect the frequency of AFRS in patients with chronic rhinosinusitis (CRS) and nasal polyposis in Amir-al-momenin Hospital in Rasht city. Methods: During functional endoscopic sinus surgery, the samples were collected from 55 patients with CRS along with nasal polyposis and were examined in terms of histopathology, mycology, culture and total serum IgE level. Data were analyzed using chi-square and exact Fisher&rsquo;s tests. Results: In this study, 17 (30.9%) female and 38 (69.1%) male patients with the mean age of 38.34&plusmn;12.67 years, were participated. History of Atopia was seen in 54.5% of the patients, asthma in 25.5%, and blood eosinophilia (>6%) in 26.9%. Total serum IgE level was reported higher than natural value in 48.9% of the patients. Based on Kuhn and Benet criteria, the relative frequency of AFRS was 5.5% (3 patients) and nonfungal eosinophilic mucin rhinosinusitis (NF-EMRS) was 16.4% (9 patients). In AFRS patients, 3 cases had atopy, 3 were eosinophilic mucin positive, 2 cases had asthma, 1 direct smear-positive, 3 positive PAS staining, and 1 positive (Aspergillus fumigatus) culture. Conclusion: In sinus samples of the studied patients, the frequency of eosinophilic mucin was much higher compared to other reports. Although, the frequency of positive smear and fungal culture is lower than other similar studies

Atracurium as an Alternative to Succinylcholine in Electroconvulsive Therapy: A Randomized Clinical Trial

Background: Electroconvulsive Therapy (ECT) is a successful treatment option for various psychiatric disorders. It is performed under general anesthesia where succinylcholine is the preferred muscle relaxant in this process. However its several contraindications and potential adverse effects, and the fact that it is not always available should be considered. Therefore, finding an effective and safe alternative is crucial. Objectives: This study aims to assess the safety and efficacy of atracurium in ECT. Materials & Methods: This single-blind clinical trial was conducted at Shafa hospital affiliated to Guilan University of Medical Sciences from November 2020 to April 2021. Participants were 67 eligible patients with ECT, randomly assigned into two groups receiving succinylcholine (0.5 mg/ kg), and atracurium (0.2 mg/kg). Seizure duration, hemodynamic parameters, the time to return to spontaneous breathing, and recovery time were assessed and compared between the two groups. Results: Seizure duration was longer in the succinylcholine group (P=0.071), while the time to return to spontaneous breathing (P=0.0001) and the recovery time (P=0.0001) were significantly longer in  the atracurium group. The trend of changes in the Mean Arterial Pressure (MAP) and Heart Rate (HR) were significant over time; however, the difference between the two groups was significant only in HR one minute after the seizure induction (P=0.001). None of patients was reported serious adverse effects. Conclusion: When succinylcholine can't be used, atracurium can be a safe alternative in the ECT process