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Abstract Background Diabetic cardiomyopathy (DbCM) is a form of Stage B heart failure (HF) at high risk for progression to overt disease. Using baseline characteristics of study participants from the Aldose Reductase Inhibition for Stabilization of Exercise Capacity in Heart Failure (ARISE-HF) Trial we sought to characterize clinical characteristics of individuals with findings consistent with DbCM. Methods Among study participants meeting inclusion criteria, clinical characteristics, laboratory testing, imaging, Kansas City Cardiomyopathy Questionnaire (KCCQ), Physical Activity Scale of the Elderly (PASE) and cardiopulmonary exercise testing (CPET) results were tabulated. Cluster phenogroups were identified. Results Among 691 study participants (mean age 67.4 years; 50% were female), mean duration of type 2 diabetes mellitus (T2DM) was 14.5 years. The median (Q1, Q3) N-terminal pro-B type natriuretic peptide and high sensitivity cardiac troponin T were 71 (35, 135) ng/L and 9 [6, 12] ng/L. The most common echocardiographic abnormalities were reduced global longitudinal strain in 25.3% and impaired diastolic relaxation in 17.7%. Despite rather well-preserved KCCQ scores the average PASE score was markedly impaired at 155 accompanied by an average maximal oxygen consumption of 15.7 mL/Kg/minute on CPET. In K-means clustering, 4 phenogroups were identified including a higher-risk group with more advanced age, greater elevation of cardiac biomarkers, and more prevalent evidence for diastolic dysfunction and left ventricular hypertrophy. Conclusions Baseline data from the ARISE-HF Trial provide clinical characterization of individuals with T2DM and features of stage B HF, and may help clarify the diagnosis of DbCM. Trial Registration ARISE-HF, NCT04083339.

Abstract Aims Serial assessment of natriuretic peptides is widely utilized in heart failure clinics. Uncertainty exists regarding the value of multiple natriuretic peptide measurements and how they might be best interpreted. Methods and results Six hundred thirty‐two patients with heart failure with reduced ejection fraction ( 0.1). However, among those with higher baseline NT‐proBNP, those with lower subsequent AUC had a greater improvement in cardiac remodelling indices (P‐value

Abstract Background The insulin-like growth factors (IGF) play a crucial role in regulating cellular proliferation, apoptosis, and key metabolic pathways. The ratio of IGF-1 to IGF binding protein-3 (IGFBP-3) is an important factor in determining IGF-1 bioactivity. We sought to investigate the association of IGF-1 and IGFBP-3 with cardio-renal outcomes among persons with type 2 diabetes. Methods Samples were available from 2627 individuals with type 2 diabetes and chronic kidney disease that were randomized to receive canagliflozin or placebo and were followed up for incident cardio-renal events. Primary outcome was defined as a composite of end-stage kidney disease, doubling of the serum creatinine level, or renal/cardiovascular death. IGF-1 and IGFBP-3 were measured at baseline, Year-1 and Year-3. Elevated IGF-1 level was defined according to age-specific cutoffs. Cox proportional hazard regression was used to investigate the association between IGF-1 level, IGFBP-3, and the ratio of IGF-1/IGFBP-3 with clinical outcomes. Results Elevated IGF-1 was associated with lower glomerular filtration rate at baseline. Treatment with canagliflozin did not significantly change IGF-1 and IGFBP-3 concentrations by 3 years (p-value > 0.05). In multivariable models, elevated IGF-1 (above vs below age-specific cutoffs) was associated with the primary composite outcome (incidence rate:17.8% vs. 12.7% with a hazard ratio [HR]: 1.52; 95% confidence interval CI 1.09–2.13;P: 0.01), renal composite outcome (HR: 1.65; 95% CI 1.14–2.41; P: 0.01), and all-cause mortality (HR: 1.52; 95% CI 1.00–2.32; P; 0.05). Elevations in log IGFBP-3 did not associate with any clinical outcomes. Increase in log IGF-1/IGFBP-3 ratio was also associated with a higher risk of the primary composite outcome (HR per unit increase: 1.57; 95% CI 1.09–2.26; P; 0.01). Conclusions These results further suggest potential importance of IGF biology in the risk for cardio-renal outcomes in type 2 diabetes. SGLT2 inhibition has no impact on the biology of IGF despite its significant influence on outcomes. Trial registration: CREDENCE; ClinicalTrials.gov Identifier: NCT02065791.

Abstract Aim The Universal Definition of Heart Failure (UDHF) provides a framework for staging risk for HF events. It is not clear whether prognostic biomarkers have different meaning across UDHF stages. We sought to evaluate performance of biomarkers to predict HF events among high‐risk patients undergoing coronary and/or peripheral angiography categorized into UDHF stages. Methods One thousand two hundred thirty‐five individuals underwent coronary and/or peripheral angiography were enrolled. Study participants were categorized into UDHF Stage A (at risk), Stage B (pre‐HF), and Stage C or D (HF, including end stage) and grouped into Stage A/B and C/D. Biomarkers and clinical variables were used to develop prognostic models. Other measures examined included total HF hospitalizations. Results Over a median of 3.67 years of follow‐up, 155 cardiovascular (CV) deaths occurred, and 299 patients were hospitalized with acute HF. In patients with Stage A/B, galectin‐3 (HR = 1.52, P = 0.03), endothelin‐1 (HR = 2.16, P = 0.001), and N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP; HR = 1.43, P

Background The 2020 Acute Disease Quality Initiative Consensus provided recommendations on novel acute kidney injury biomarkers. In this study, we sought to assess the added value of novel kidney biomarkers to a clinical score in the CASABLANCA (Catheter Sampled Blood Archive in Cardiovascular Diseases) study. Methods and Results We evaluated individuals undergoing coronary and/or peripheral angiography and added 4 candidate biomarkers for acute kidney injury (kidney injury molecule‐1, interleukin‐18, osteopontin, and cystatin C) to a previously described contrast‐associated acute kidney injury (CA‐AKI) risk score. Participants were categorized into integer score groups based on the risk assigned by the biomarker‐enhanced CA‐AKI model. Risk for incident cardiorenal outcomes during a median 3.7 years of follow‐up was assessed. Of 1114 participants studied, 55 (4.94%) developed CA‐AKI. In adjusted models, neither kidney injury molecule‐1 nor interleukin‐18 improved discrimination for CA‐AKI; addition of osteopontin and cystatin C to the CA‐AKI clinical model significantly increased the c‐statistic from 0.69 to 0.73 (P for change

In this review, we discuss clinical evidence-based data regarding the potential benefit of statin therapy in the perioperative period of non-cardiac surgery. Results from meta-analyses of prospective observational studies have provided conflicting evidence. Moreover, comparison among studies is complicated by varying data sources, outcome definitions, types of surgery, and preoperative versus perioperative statin therapy. However, results of two recent large prospective cohort studies showed that statin use on the day of or the day after non-cardiac surgery (or both) is associated with lower 30-day all-cause mortality and reduction in a variety of postoperative complications, predominantly cardiac, compared with non-use during this period. There is a paucity of data from randomized controlled trials assessing the benefit of statin therapy in non-cardiac surgery. No randomized controlled trials have shown that initiating a statin in statin-naïve patients may reduce the risk of cardiovascular complications in non-cardiac surgeries. One randomized clinical trial demonstrated that the use of a preoperative statin in patients with stable coronary heart disease treated with long-term statin therapy had a significant reduction in the incidence of myocardial necrosis and major adverse cardiovascular events after non-cardiac surgery. In conclusion, it is important that all health-care professionals involved in the care of the surgical patient emphasize the need to resume statin therapy, particularly in patients with established atherosclerotic cardiovascular disease. However, initiating a statin in statin-naïve patients undergoing non-cardiac surgery needs more evidence-based data.

BACKGROUND AND OBJECTIVES: To improve cardiovascular (CV) health of American population, the American Heart Association (AHA) developed definitions of ideal, intermediate, and poor CV health based on 7 accessible health metrics. The applicability of this construct and the distribution of its components in the community-based populations in the Middle East region have not been reported. DESIGN AND SETTINGS: A prospective population-based cohort study conducted from 1999 to 2011. METHODS: We used data from phase 4 of Tehran Lipid and Glucose Study (2009-2011) (2861 women and 2004 men, aged ≥ 20 years) to estimate the frequency of CV health levels (ideal, intermediate, and poor) in adults of both genders, and the frequency of each metric at each level of CV health. The median or mean of each CV health metric was also estimated in the whole spectrum of CV health in all subgroups. RESULTS: Only 1 adult participant met all 7 ideal CV health metrics; 25.01% of women and 26% of men had intermediate CV health; 74.8% of women and 74% of men exhibited poor CV health. Only 19.7% of women and 10.3% of men had 5 or more ideal CV health metrics. Nonsmoking was the most frequent ideal health behavior. A total of 89.6% of participants had 1 or 2 ideal CV health behaviors. Ideal smoking and fasting plasma glucose had the highest frequency of CV health factors among others. CONCLUSION: The frequency of ideal CV health was extremely low in this cohort of adults. The frequency of intermediate CV health was also low, and it may be significantly lower in the general population.

To determine, the predictors of incident metabolic syndrome (MetS) in a community-based cohort of West Asians, during a mean follow-up of 9.3 years, a sample of 2858 non-MetS Iranian adults aged ≥ 20 years were examined at baseline and followed at three year intervals during three consecutive phases. The MetS was defined using the joint interim statement. Cox proportional hazard regression was used to determine the independent variables associated with incident MetS. Overall, 1117 new cases MetS were identified resulting in an incidence rate of 550.9/10000 person years (95% CI: 519.5-584.2). The corresponding incidence rates among women and men were 433.5/10000 person years (95% CI: 398.8-471.2) and 749.2/10000 person years (95% CI: 689.9-813.5), respectively. Baseline-adjusted predictors of developing MetS included all of the MetS components, being overweight or obese in both gender, and family history of diabetes and age only in women. There were significant effect modifications of gender on age (P

Objectives. The current study was conducted to determine the relationship between the presences of significant multidrug resistance in Pseudomonas aeruginosa (P. aeruginosa) having intact mexR genes (nalC) to different antibiotics. Methods. In order to identify nalC, fifty strains of P. aeruginosa were obtained. All isolates were found in urinary tract infections. They were evaluated against different antibiotics. The nalC mutant was identified by PCR. Results. The 50 clinical isolates of P. aeruginosa originated from two hospitals in Iran, in which 32 isolates were found in Milad hospital, and 18 isolates were collected in the Ilam Hospital. The results in Milad hospital of nalC revealed that all P. aeruginosa resistant to oxacillin showed the presence of nalC. In Ilam hospital only three (16.6%) isolates were resistant to oxacilin and aztreonam, and among these three isolates only one isolate revealed resistance to ceftazidime and amikacin. The resistant isolates showed the presence of both OXA-10 and nalC. Conclusion. Our results showed that the presence of nalC was observed among P. aeruginosa resistance to oxacilin. Thus, the finding suggested relationship between oxacilin resistance and presence of nalC and consequently overproduction of the MexABOprM efflux system.

To examine, the predictors of incident chronic kidney disease (CKD) in a community-based cohort of Middle East population, during a mean follow-up of 9.9 years. In a sample of 3313 non-CKD Iranian adults ≥20 years the estimated glomerular filtration rate (eGFR) was calculated at baseline and at three year intervals during three consecutive phases. The eGFR 2% of individuals develops CKD each year. Our findings confirmed that sex- specific risk predictors should be considered in primary prevention for incident CKD.

Rock typing has been utilized in numerous studies where it has been proven to be a powerful tool for determining rock properties and estimating unknown parameters such as permeability. It can be performed based on routine core analysis (RCAL) or special core analysis (SCAL) data, and the accuracy of results could be different. Because of the high cost and time-consuming process of special core analysis, SCAL data are not available in all wells of a reservoir. Hence, in this study, a practical workflow is carried out using RCAL data. For this purpose, the data of four wells in a reservoir have been used. After utilizing three HFU (Hydraulic Flow Units), Winland r35 and lithology methods, the results showed that the best and the most accurate rock typing method is Winland r35 method. In the next step, several approaches were used to estimate permeability, and it was observed that the combination of the multi-resolution graph-based clustering (MRGC) method in GEOLOG software and Winland r35 method in this carbonate reservoir is the best estimation approach. The correlation coefficient (R2), between measured and estimated permeability was approximately 0.96. Eventually, when the only available data are the RCAL data, the presented algorithm yields a high degree of accuracy.

It is difficult to identify the carbonate reservoirs by using conventional seismic reflection data, especially in cases where the reflection coefficient of the gas-bearing zone is close to that of the carbonate background. In such cases, the extended elastic impedance (EEI) as a seismic reconnaissance attribute with the ability to predict fluids and lithology can be used. It allows for a better distinction between seismic anomaly caused by lithology and the one caused by the fluid content. The EEI attribute extends the available reflection angles and applies different weights to the intercept and gradient values so as to extract the petrophysical properties of the rock at a specific incident angle. Using the EEI attribute, we can estimate the elastic parameters such as shear impedance; the ratio of the compressional velocity to shear velocity; Poisson’s ratio; and bulk, Lame, and shear moduli, and petrophysical properties, including porosity, clay content, and water saturation. The known reservoirs in the study area are three oil-bearing formations namely, Surmeh (Arab), Gadvan (Buwaib), and Dariyan (Shuaiba), and three gas-bearing formations, including Kangan, Dalan, and Faraghan. The Dehram group is composed of Kangan (Triassic), Dalan, and Faraghan (Permian) formations. Permian carbonates of Kangan–Dalan and its equivalent Khuff have regionally been developed as a thick carbonate sequence in the southern Persian Gulf region. In this paper, parameters 𝜆𝑝 and 𝜇𝜌 extracted from the EEI method are used to characterize a carbonate reservoir. Our results show that the EEI can highlight the difference between the reservoir and non-reservoir formation to identify the gas-bearing areas.

Intelligent reservoir characterization using seismic attributes and hydraulic flow units has a vital role in the description of oil and gas traps. The predicted model allows an accurate understanding of the reservoir quality, especially at the un-cored well location. This study was conducted in two major steps. In the first step, the survey compared different intelligent techniques to discover an optimum relationship between well logs and seismic data. For this purpose, three intelligent systems, including probabilistic neural network (PNN),fuzzy logic (FL), and adaptive neuro-fuzzy inference systems (ANFIS)were usedto predict flow zone index (FZI). Well derived FZI logs from three wells were employed to estimate intelligent models in the Arab (Surmeh) reservoir. The validation of the produced models was examined by another well. Optimal seismic attributes for the estimation of FZI include acoustic impedance, integrated absolute amplitude, and average frequency. The results revealed that the ANFIS method performed better than the other systems and showed a remarkable reduction in the measured errors. In the second part of the study, the FZI 3D model was created by using the ANFIS system.The integrated approach introduced in the current survey illustrated that the extracted flow units from intelligent models compromise well with well-logs. Based on the results obtained, the intelligent systems are powerful techniques to predict flow units from seismic data (seismic attributes) for distant well location. Finally, it was shown that ANFIS method was efficient in highlighting high and low-quality flow units in the Arab (Surmeh) reservoir, the Iranian offshore gas field.

ABSTRACT An alarmingly increasing number of outbreaks caused by contaminated gastrointestinal (GI) endoscopes are being reported as a particularly concerning issue. This study is the first large-scale multicenter survey to evaluate the contamination of GI endoscopes in Tehran, Iran. This multicenter study was conducted among 15 tertiary referral and specialized gastrointestinal settings. Reprocessed GI endoscopes were sampled by the sequence of the flush-brush-flush method. Bacterial and viral contamination, as well as antimicrobial resistance, were explored by culture and molecular assays. A total of 133 reprocessed and ready-to-use GI endoscopes were investigated. In phase I and phase II, 47% and 32%, respectively, of the GI endoscopes were determined to be contaminated. GI flora was the most prevalent contaminant isolated from GI endoscopes, in which the most predominant bacteria were Pseudomonas aeruginosa, Escherichia coli, and Klebsiella pneumoniae, in both phase I and II evaluations. The majority of the isolated bacteria in the current study were considered multidrug-resistant organisms (MDROs). More importantly, we recovered carbapenem-resistant nonfermentative Gram-negative bacilli (CRNFGNB), carbapenem-resistant Enterobacterales (CRE), extended-spectrum β-lactamase (ESBL)-producing Enterobacterales (ESBL-E), multidrug-resistant Clostridioides difficile, vancomycin-resistant Enterococcus (VRE), and drug-resistant Candida spp. Disconcertingly, our molecular assays revealed contamination of some reprocessed GI endoscopes with hepatitis B virus (HBV), hepatitis C virus (HCV), and even HIV. This multicenter study indicates a higher-than-expected contamination rate among reprocessed and ready-for-patient-use GI endoscopes, which suggests a higher-than-expected endoscopy-associated infection (EAI) risk, and potentially, morbidity and mortality rate, associated with endoscopy procedures in Tehran, Iran. IMPORTANCE In the light of severe outbreaks caused by multidrug-resistant microorganisms due to contaminated GI endoscopes, understanding to what extent GI endoscopes are inadequately reprocessed is crucial. Several studies assessed contamination of GI endoscopes with various outcomes across the world; however, the prevalence and risk factors of contaminated GI endoscopes and potential subsequent nosocomial spread are still unknown in Iran. The present study is the first large-scale multicenter survey to evaluate the microbial contamination of repossessed and ready-to-use GI endoscopes in Tehran, Iran. Our study showed a higher-than-expected contamination rate among reprocessed GI endoscopes, which suggests potential seeding of deadly but preventable outbreaks associated with endoscopy procedures in Iran. These results suggest that the current reprocessing and process control guidelines do not suffice in Iran. The current study is of particular importance and could provide insights into unrecognized and unidentified endoscopy-associated outbreaks in Iran.

Background: Infection is a serious problem in medicine and appropriate antibiotic therapy is very important. Because of broad spectrum activity and low toxicity of β-lactam antibiotics, they are the most commonly used drugs. But, bacterial resistance to β-lactam antibiotics, has been considered as the global healthcare concern. The aim of study was to evaluate the antimicrobial resistance pattern and molecular characterization among ESBL-producing Escherichia coli isolated from patients with diarrhea admitted to a hospital in Ilam, Iran. Methods: Totally, fifty E. coli isolates were investigated. Confirmatory tests for phenotypic detection of ESBLs were performed. Molecular identification of the blaTEM and blaSHV genes was carried out by PCR method. To identify genetic relatedness among isolates, Randomly Amplified Polymorphic DNA (RAPD) analysis was performed. Results: The antibiotic susceptibility results showed that the most effective antibiotic was imipenem and minimum effect was related to gentamicin. Thirty-one isolates (62%) were ESBL-producing organisms according to phenotypic method. The distribution of blaTEM and blaSHV genes among ESBL-producing isolates were 20 (64.5%) and 6 (19.3%), respectively. RAPD-PCR typing among isolates gave us eight different types. Twelve isolates were clustered in genotype A and all of them were ESBL-producer. Conclusion: The present study showed noticeable incidence of ESBL-producing E. coli isolated from outpatients and hospitalized patients with diarrhea. Therefore, it seems that constant supervision is crucial to monitor the ESBL-producing microorganisms in hospitals and community.

Startup is one of the most important stages in the operation of a wastewater treatment plant (WWTP). In this paper, a novel method is presented for the startup of Arak Activated Sludge WWTP, which is shown to contain more advantages than other common methods. In this method, a portion of the inflow is initially allowed to enter gradually into an aeration basin prior to seeding. Under these conditions, less seeding is required due to the low flow of the influent and the low volume of the aeration basin. Once MLSS in the basin reaches the desired level, the rest of the system comes into operation and the sludge developed in the system is used for further seeding. In the case of the WWPT in Arak, it took about 2 months for the total MLSS to be developed and wasting the sludge to start because of the cold weather conditions in the region. The wasted sludge was controlled by the F/M ratio at a constant sludge age. During the start-up, the MLSS increase exhibited a linear trend and the low loading allowed for the variation in influent contaminants to be controlled. The effluent contaminants were below the standard levels recommended by the Environment Protection Organization. BOD5 and COD removals increased from 40% and 60% to 90% and TSS removal increased from 70% to 96%. Lower loading levels, better process control, and lower sludge processing costs are the benefits of this system

Introduction & Objective: Adiponectin exerts anti-tumor effect through connection to its receptor. Some studies have shown that polymorphism in Adipor1 results in insulin resistance, diabetic type 2 and colorectal cancer (CRC). The purpose of this study is to investigate the incidence mutant allele of adiponectin receptor 1 polymorphism rs2275738 and to examine the association of genetic variant in ADIPOR1 rs 2275738 with the risk of colorectal cancer. Materials & Methods: This study was a case-control type. Genotyping of adiponectin receptor 1 gene was determined in series of 106 colorectal cancer patients and 106 controls by the use of polymerase chain reaction and restriction fragment length polymorphism genotyping assay (PCR-RFLP). We calculated odd ratio and confidence interval (CI) of ADIPOR1 genotypes by SPSS 16 and χ2 to examine if this polymorphism is associated with colorectal cancer. Results: The frequency of TT,CT,CC genotype for adiponectin receptor polymorphism rs2275738 in the patients was 27.4, 50, 22.6 percents, respectively. Frequency of TT,CT,CC genotype in the controls was 40.6,22.6,36.8, respectively. Allele frequency of T,C was 41 and 59 percents in the controls respectively and 52.4 and 47.6 in the patients. Incidence of mutant allele among the patients and the controls shows significant differences (OR=1.57 CI=1.07-2.31 P=0.01). Conclusion: These findings suggest that polymorphism Adipor1 rs 2275738 is associated with increased risk of CRC.

Introduction & Objective: One candidate gene for colorectal cancer susceptibility is exonuclease1 (EXO1) .It is a member of RAD2 nuclease family. It plays a main role in mismatch repair. EXO1 acts also in DNA replication and recombination. Single nucleotide polymorphisms (SNPs) are shown to be related with cancer incidence. The aim of the present study was to examine the association between P757L polymorphism at exon 13 of the EXO1 gene and the risk of colorectal cancer in an Iranian population. Materials & Methods: In this case-control study, 81cases and 86 healthy controls were selected from among individuals who were referred toTehran Taleghani hospital during 2008-2009. The individuals were divided into two groups, case and control, based on their colonoscopy and pathology results. Genotype analysis was performed using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method and MNII restriction enzyme. Totally 167 samples were analyzed. Results: Based on our findings when Pro/Pro genotype was reference for the Leu/Leu (TT) genotype (OR=0.168, 95%CI 0.034-0.816), it showed a reverse association with colorectal cancer. While Pro/Leu (CT) genotype did not revealed a significant association with colorectal cancer at the same status. (OR=0.663, 95%CI 0.340-1.294). Conclusion: The results of this study were compatible with other investigations which convey Leu/Leu (TT) genotype of EXO1 has reverse association with colorectal cancer. Therefore TT genotype has a protective effect against colorectal cancer.