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BACKGROUND: Diurnal variation of natriuretic peptide (NP) levels and its relationship with 24-h blood pressure (BP) rhythm has not been established. Obese individuals have a relative NP deficiency and disturbed BP rhythmicity. OBJECTIVES: This clinical trial evaluated the diurnal rhythmicity of NPs (B-type natriuretic peptide [BNP], mid-regional pro-atrial natriuretic peptide [MR-proANP], N-terminal pro–B-type natriuretic peptide [NT-proBNP]) and the relationship of NP rhythm with 24-h BP rhythm in healthy lean and obese individuals. METHODS: On the background of a standardized diet, healthy, normotensive, lean (body mass index 18.5 to 25 kg/m(2)) and obese (body mass index 30 to 45 kg/m(2)) individuals, age 18 to 40 years, underwent 24-h inpatient protocol involving ambulatory BP monitoring starting 24 h prior to the visit, controlled light intensity, and repeated blood draws for assessment of analytes. Cosinor analysis of normalized NP levels (normalized to 24-h mean value) was conducted to assess the diurnal NP rhythm and its relationship with systolic BP. RESULTS: Among 52 participants screened, 40 participants (18 lean, 22 obese; 50% women; 65% Black) completed the study. The median range spread (percentage difference between the minimum and maximum values) over 24 h for MR-proANP, BNP, and NT-proBNP levels was 72.0% (interquartile range [IQR]: 50.9% to 119.6%), 75.5% (IQR: 50.7% to 106.8%), and 135.0% (IQR: 66.3% to 270.4%), respectively. A cosine wave-shaped 24-h oscillation of normalized NP levels (BNP, MR-proANP, and NT-proBNP) was noted both in lean and obese individuals (p(rhythmicity) < 0.05 for all). A larger phase difference between MR-proANP BP rhythm (−4.9 h vs. −0.7 h) and BNP BP rhythm (−3.3 h vs. −0.9 h) was seen in obese compared with lean individuals. CONCLUSIONS: This human physiological trial elucidates evidence of diurnal NP rhythmicity and the presence of an NP-BP rhythm axis. There exists a misalignment of the NP-BP diurnal rhythm in the obese, which may contribute to the disturbed diurnal BP pattern observed among obese individuals. (The Diurnal Rhythm in Natriuretic Peptide Levels; NCT03834168)

Patients with type 2 diabetes mellitus (T2D) are at increased risk of cardiovascular (CV) disease. Sodium glucose cotransporter 2 (SGLT2) inhibitors, also known as gliflozins, are a class of medications used to treat T2D by preventing the reabsorption of glucose filtered through the kidney and thereby facilitating glucose excretion in the urine. Over the past 5 years, many cardiovascular outcome trials (CVOTs) have evaluated the safety and efficacy of SGLT2 inhibitors in preventing CV events. The results of 7 CVOTs have provided solid evidence that the use of SGLT2 in patients with T2D and at high CV risk significantly reduced the risk of death from CV causes. Moreover, in patient with heart failure with reduced ejection fraction, regardless of the presence or absence of T2D, SGLT2 inhibitors use significantly reduced the risk of worsening heart failure and death from CV causes. Although the exact mechanism of the cardiorenal benefit of SGLT2 inhibitors is still unknown, studies have shown that the beneficial effect of these drugs cannot be exclusively explained by their glucose lowering effect, and several possible mechanisms have been proposed. This review will explore the changing role of SGLT2 inhibitors from a diabetes drug to clinical practice guideline-supported therapy for the prevention and treatment of CV diseases, including heart failure.

Background: Symptom-to-balloon time (SBT) and door-to-balloon time (DBT) are both considered important metrics in patients undergoing primary percutaneous coronary intervention (pPCI) for ST-segment–elevation myocardial infarction (STEMI). We sought to assess the relationship of SBT and DBT with infarct size and microvascular obstruction (MVO) after pPCI. Methods: Individual patient data for 3115 ST-segment–elevation myocardial infarction patients undergoing pPCI in 10 randomized trials were pooled. Infarct size (% left ventricular mass) was assessed within 1 month after randomization by technetium-99 m sestamibi single-photon emission computerized tomography (3 studies) or cardiac magnetic resonance imaging (7 studies). MVO was assessed by cardiac magnetic resonance. Patients were stratified by short (≤2 hours), intermediate (2–4 hours), or long (>4 hours) SBTs, and by short (≤45 minutes), intermediate (45–90 minutes), or long (>90 minutes) DBTs. Results: Median [interquartile range] SBT and DBT were 185 [130–269] and 46 [28–83] minutes, respectively. Median [interquartile range] time to infarct size assessment after pPCI was 5 [3–12] days. There was a stepwise increase in infarct size according to SBT category (adjusted difference, 2.0% [95% CI, 0.4–3.5] for intermediate versus short SBT and 4.4% [95% CI, 2.7–6.1] for long versus short SBT) but not according to DBT category (adjusted difference, 0.4% [95% CI, −1.2 to 1.9] for intermediate versus short DBT and −0.1% [95% CI, −1.0 to 3.0] for long versus short SBT). MVO was greater in patients with long versus short SBT (adjusted difference, 0.9% [95% CI, 0.3–1.4]) but was not different between patients with intermediate versus short SBT (adjusted difference, 0.1 [95% CI, −0.4 to 0.6]). There was no difference in MVO according to DBT. Results were similar in multivariable analysis with SBT and DBT included as continuous variables. Conclusions: Among 3115 patients with ST-segment–elevation myocardial infarction undergoing infarct size assessment after pPCI, SBT was more strongly correlated with infarct size and MVO than DBT.

Epicardial adipose tissue (EAT) plays a role in the development and outcomes of coronary artery disease and atrial fibrillation. However, the role of EAT in heart failure (HF) remains obscure. The aim of this study was to determine whether EAT predicts outcomes in HF patients Cardiac magnetic

Objective To evaluate the effect of different fat distribution measures on the risk of all-cause mortality events among chronic kidney disease (CKD) patients, which has not been previously evaluated. Methods The present study consisted of 1,860 individuals with CKD, aged ≥30 years who participated in Tehran Lipid and Glucose Study. The estimated glomerular filtration rate was estimated using the abbreviated prediction equation, provided by the Modification of Diet in Renal Disease formula, and CKD was defined as estimated glomerular filtration rate 2 . Cox proportional hazard regression was implemented to estimate the hazard ratios (HRs) of different anthropometric measures for predicting mortality events. Results During 10.1 years of follow-up, 221 cases of all-cause mortality events occurred. In confounder-adjusted model (age, sex, creatinine, the history of cardiovascular disease, and smoking), none of the HRs of different anthropometric measures reached the significant level; however, when we also considered mediator variables (hypertension, diabetes, and hypercholesterolemia) in the model, there was significant interaction between sex and waist circumference for the risk prediction of mortality events. Among men, the HRs of mortality for 1 standard deviation increase in anthropometric measures were 0.73 (0.57–0.92) for weight, 0.67 (0.54–0.83) for waist circumference, 0.75 (0.58–0.97) for body mass index, and 0.71 (0.52–0.96) for hip circumference. However among women, none of the measures were associated with increased risk of all-cause mortality events. Conclusion Among men with CKD, regardless of fat distribution in hip, waist, or in whole body, having more fat mass results in better survival.

There is a paucity of data about the impact of changes in anthropometric measurements on the risk of mortality events, especially in men.The study sample consists of 1805 Iranian men, aged ⩾ 30 years, free from cardiovascular disease at baseline; they had undergone health examinations in both phases I (1999-2001) and II (2001-2003) and were followed up until March 2010. Participants were categorized by changes in anthropometric measurements into four groups: Group 1, change percentage-5%; Group 2, -5% ⩽ change percentages+5%; Group 3, 5% ⩽ change percentage10%; and Group 4, change percentage ⩾ 10%. Cox proportional hazard regression was performed to assess the hazard ratios (HRs) of the anthropometric changes for all-cause mortality, given group 2 as the reference.During 6.6 years of follow-up, 88 cases of mortality events occurred. The confounder-adjusted multivariate HRs for the first, third and fourth groups of hip circumference (HC) changes were 3.13(1.28-7.64), 0.75(0.43-1.31) and 0.82(0.23-2.99); the corresponding values for waist to hip ratio (WHR) change were 1.80(0.75-4.33), 1.21(0.70-2.1) and 2.32(1.25-4.3). After further adjustment for mediator covariates, results did not change. The equivalent values for body mass index and waist circumference did not reach statistical significance.In Middle Eastern Caucasian men, increase in WHR was associated with incident mortality, which was more prominent in those with ⩾ 10% increase in the ratio. Moreover, decrease in HC was highly associated with excess risk of mortality.

Background: Helicobacter pylori is the most common cause of chronic infection in the human stomach. The infection has universe prevalence in all age groups. Probably, this bacterium is the cause of most common chronic bacterial infection in human beings and infects approximately half of the world population. H. pylori produces urease, an enzyme that degrades the urea in the stomach’s mucous to ammonia resulting in biochemical reaction that leads to increase in pH of the stomach lumen. This allows pathogenic intestinal protozoa to take the opportunity to cross through stomach’s increased pH and cause disease. The aim of this study was to evaluate the relationship between H. pylori infection and prevalence of parasitic infection in patients in Ilam. Materials and Methods: Following stool samples collection during 2013 in patients with abdominal pain in Ilam, Iran. H. pylori infection was investigated based on stool antigen analysis (HPSA) by enzyme-linked immunosorbent assay (ELISA) method in patients who had recurrent abdominal pain. Stool specimens were examined using the direct examination and the spontaneous sedimentation method for detecting the trophozoite and cyst of parasites. Results: In this study, we found 65 patients with H. pylori infection. Out of these 65 patients, the percentage of patients with positive results for Giardia lamblia was 30.7% and for Entamoebahistolytica/dispar was 12.3%. Conclusion: The results of this study suggest that H. pylori infection may provide favorable conditions for giardiasis infection; however, this presumption needs further studies with larger sample size.

Background: Revascularization appears to be beneficial only in patients with high levels of ischemia. This study examined the utility of gas analysis during the recovery phase of cardiopulmonary exercise testing (CPET) in predicting coronary artery disease (CAD) severity and prognosis. Methods: 40 Caucasian patients (21.2% females), mean age 63.5 +/- 7.6 with significant coronary artery lesions (>= 50%) were studied. Within two months of coronary angiography, CPET on a treadmill (TM) and recumbent ergometer (RE) were performed on two visits 2-4 days apart; subjects were subsequently followed 32 +/- 10 months. Myocardial wall motion was recorded by echocardiography at rest and peak exercise. Ischemia was quantified by the wall motion score index (WMSI). Results: Mean ejection fraction was 56.7 +/- 9.6%. Patients with 1-2 stenotic coronary arteries (SCA) showed a poorer CPET response during the recovery phase than patients with 3-SCA. ROC analysis revealed the change of carbon-dioxide output (Delta VCO2) recovery/peak (area under ROC curve 0.77, p = 0.02, Sn = 87.5%, Sp = 70.4%) and oxygen uptake (Delta VO2) recovery/peak during TM CPET (area under ROC curve 0.76, p = 0.03, Sn 75.0%, Sp 77.8%) were significant in distinguishing between 1-2-SCA and 3-SCA. The same variables predicted.WMSI peak/rest on univariate analysis (p lt 0.05). Multivariate Cox analysis revealed a high predictive value of Delta VO2 recovery/peak obtained during TM CPET for composite endpoint of cumulative cardiac events (HR = 1.27, CI = 1.07-1.51, p = 0.008). Conclusions: The current study suggests CPET parameters in recovery hold predictive value for CAD severity and prognosis. TM testing seems to be a better approach in the assessment of CAD severity and prognosis.

Objective To assess the effects of lipid component total cholesterol (TC), triglycerides (TG), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C) and non-HDL-C on risk of stroke events versus coronary heart disease (CHD). Methods The study was conducted on 2620 Iranians, aged ≥ 50 years, free from cardiovascular events at baseline (1999–2001). The multivariable hazard ratios (HRs) for stroke/CHD were calculated for 1 mmol/L change in lipid components, using Cox proportional hazard regression. Results During 9.1 years of follow-up, 73 and 358 cases of stroke and CHD occurred. We found significant interactions between TC and non-HDL-C with gender in risk prediction of stroke. Among women, multivariate adjusted HRs of ischemic stroke were 1.40 (1.08–1.82), 1.66 (0.71–3.86), 2.27 (0.58–8.91), 1.51 (1.06–2.15) and 1.36 (1.024–1.78) for TC, Ln TG, HDL-C, LDL-C and non-HDL-C respectively, while corresponding HRs of ischemic stroke for men were 0.78 (0.55–1.11), 0.71 (0.33–1.51), 1.04 (0.24–4.47), 0.82 (0.56–1.22), 0.78 (0.55–1.11), respectively. We found no interaction between gender and any of the lipids in risk prediction of incident CHD (p > 0.3). All lipid components were independently associated with CHD in whole population. Conclusion The associations of lipid components on ischemic stroke were modified by gender. Only among female population, TC, LDL-C and non-HDL-C were independently associated with increased risk of ischemic stroke. Regarding CHD events, all lipid components were significant predictors.

To determine the extent to which burden of cardiovascular disease (CVD) outcomes among diabetic population is attributable to hypertension. Nine-year follow-up data were secured for 7068 participants aged ≥ 20 years old, free from CVD at baseline. Cox proportional hazards regression was implemented to estimate hazard ratios (HRs) of hypertension. Population-attributable hazard fraction (PAHF) was used to assess proportion of diabetic population hazard of CVD events and mortality attributable to hypertension. In the whole population, irrespective of diabetes or hypertension status, incidence rate (95% CI) of CVD, coronary heart disease (CHD), as well as CVD and all-cause mortality per 1000 person-year were 8.3 (7.6-9.0), 7.1 (6.5-7.8), 1.8 (1.5-2.1) and 3.9 (3.5-4.5), respectively. Among diabetes participants, hypertension was a risk factor for CHD (HR = 1.63, 95% CI 1.15-2.03), CVD (HR = 1.74, 95% CI 1.50-2.41), CVD mortality (HR = 1.65, 95% CI 0.87-3.12) and all-cause mortality (HR = 1.53, 95% CI 0.97-2.42). HRs, however, were not statistically significant for all-cause or CVD mortality. PAHFs (%) of hypertension was 27.5 (95% CI 8.3-42.6) for CHD, 29.6 (95% CI 10.6-44.4) for CVD, 27.9 (95% CI - 17.2 to 55.7) for CVD mortality and 22.6 (95% CI - 5.9 to 43.4) for all-cause mortality. Our study shows that there is an excess risk of CVD in hypertensive patients with diabetes related to inadequate control of blood pressure.

Background and Purpose— The purpose of this study was to examine whether metabolic syndrome (MetS), applying different definitions, predicts incident coronary heart disease (CHD) and cerebrovascular events (CVAs) independent of its components. Methods— Among 2548, aged ≥50 years, World Health Organization, International Diabetes Federation, and Joint Interim Statement criteria were used to define MetS. Cox proportional hazards regression was implemented to estimate hazard ratios of incident CVA and CHD. Results— During 9.3 years of follow-up, 72 and 343 cases of CVA and CHD events occurred. The multivariate hazard ratios (95% CI) of incident CVA and CHD were 2.71 (1.57–4.68) and 2.07 (1.63–2.64) for MetS as defined by the Joint Interim Statement, respectively. There was no difference among the 3 definitions of MetS regarding the prediction of the CVA incidence. However, MetS as defined by the Joint Interim Statement predicted CHD better than the International Diabetes Federation definition. After adjustment for components, MetS lost its association with CHD and CVA; in this model, the elevated blood pressure and high fasting plasma glucose (International Diabetes Federation definition) showed significant risk for CVA events; regarding CHD events, the elevated blood pressure, high fasting plasma glucose, and, for World Health Organization definition, obesity and dyslipidemia remained as predictors. Conclusions— All definitions of MetS were associated with CVA and CHD events. After adjusting its components, MetS lost its association with incident CVA and CHD; however, elevated blood pressure for both CVA and CHD events and high fasting plasma glucose for CHD events remained as independent predictors in all definitions.

Recently, Joint National Committee has changed the optimal therapeutic goal of systolic blood pressure (SBP) up to 150 mm Hg for elderly population. We aimed to investigate impact of different blood pressure (BP) categories on risk of developing cardiovascular disease (CVD) and mortality among elderly. The present study included 1845 participants, aged ≥60 years (mean age = 65 years), free of CVD at baseline, who had undergone health examinations between January 1999 and 2001, and were followed up until March 2010. Cox proportional hazard regression was performed to assess the hazard ratios (HRs) of BP categories for CVD and mortality events, considering those with optimal BP (SBP120 mm Hg and diastolic BP [DBP]80 mm Hg) as reference. During a median of 10 years follow-up, 380 cases of first CVD and 260 cases of mortality events occurred. In multivariable adjusted model, prehypertensive group (SBP between 120-129 mm Hg or DBP between 80-85 mm Hg) could not predict CVD (HR, 0.87 [0.61-1.24]) nor mortality events (HR, 0.86 [0.58-1.34]). Those with SBP between 140 mm Hg and 150 mm Hg (group 3) were at higher risk for developing CVD (HR, 1.79 [1.17-2.74]), but there were no significant risk for total mortality (HR, 1.13 [0.65-1.97]). Hypertensive group (SBP ≥150 mm Hg or DBP ≥90 mm Hg or taking antihypertensive drugs) was associated with increased risk of both CVD (HR, 1.73 [1.24-2.42]) and mortality events (HR, 1.49 [1.00-2.23]).However, Joint National Committee 8 suggested no more benefit with lowering SBP150 mm Hg, but the results of this study imply that those with SBP between 150 mm Hg and 140 mm Hg are still at elevated risk for CVD/coronary heart disease events.

Background: Helicobacter pylori is a common cause of chronic infection in human beings. The infection has universal prevalence and contracts all age groups. Probably, these bacteria are the cause of the most common chronic bacterial infection in man and have infected approximately half of the world population. The urease of these bacteria degrades the urea in stomach's mucosa to ammoniac which results pH increment of the stomach lumen. This may allow the pathogenic intestinal protozoa to take the opportunity to cross through stomach's decreased pH situation and cause the disease. Objectives: The current study aimed to evaluate the prevalence of parasitic infections (such as giardiasis) in children with Helicobacter pylori infection in Ilam city. Patients and Methods: Following the sample collection during 12 months from children in Ilam (Ilam, Iran), Helicobacter pylori infection was determined based on stool antigen analysis (HPSA) by enzyme-linked immunosorbent assay (ELISA) method in children who had recurrent abdominal pain. Stool specimens were examined by the direct examination and spontaneous sedimentation method to detect both trophozoite and cyst of parasites. Results: In this study 37 children with H. pylori infection were evaluated, and the patients with positive results for Giardia lamblia, and Entamoebahistolytica/dispar were found 29.7%, and 10.8% respectively. Conclusions: The results of the current study suggest that H. pylori infection may provide favorable conditions for Giardiasis infection, but this presumption needs to be investigated further with more samples.

Data on the impact of changes in lipid measures on subsequent coronary heart disease (CHD) outcomes are not consistent.Study was conducted in 4459 adults, aged ≥30 years, free of cardiovascular disease at baseline who attended two consecutive examinations first in 1999-2001 and second in 2001-2003, and were followed up until March 31, 2010. Multivariate Cox proportional hazard regression adjusted for baseline lipid measures and other risk factors was calculated for a 1 standard deviation (SD) change in total cholesterol (TC), log-transformed triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C) (calculated using modified Friedewald formula), non-HDL-C, TC/HDL-C and log-transformed TG/HDL-C. Effect of change in dyslipidemia (TC ≥6.21 mmol/L or TG ≥2.26 mmol/L or HDL-C1.03 mmol/L or non-HDL-C ≥4.91 mmol/L) on incident CHD was examined, considering those with no dyslipidemia at baseline and follow-up as the reference group.During a mean follow-up of 9.5 years, 303 cases of CHD occurred. A 1-SD increase in TC, TG, non-HDL-C, TC/HDL-C and TG/HDL-C was associated with 14, 20, 19, 16 and 14% increase in risk of CHD event, respectively (all p values0.05); the corresponding risk for LDL-C was [1.12 (0.99-1.27), P=0.07]. Participants with maintained dyslipidemia during follow-up had a significant risk for incident CHD [HR: 1.67(1.21-2.49)] compared to those with no dyslipidemia at baseline or follow-up.Changes in TC, TG, and non-HDL-C, TC/HDL-C, TG/HDL-C were independent predictors of CHD events. Furthermore, maintained dyslipidemia was a strong predictor for CHD events.

Aims To examine the nature of the association between 25-hydroxyvitamin D [25(OH)D] and newly diagnosed type 2 diabetes. Methods Serum 25(OH)D concentrations were measured for 761 participants (aged 20–83 years) in the Tehran Lipid and Glucose Study, selected for a 1-to-3 nested case–control study. Cases were 191 cases of Type 2 diabetes diagnosed during a median follow-up of 3.6 years. A total of 570 participants were matched with these cases with regard to age, sex, BMI, and month of entering the study. Diabetes was defined according to the American Diabetes Association criteria, 2003. Serum 25(OH)D was measured using the enzyme immunoassay method. Odds ratios for Type 2 diabetes were obtained from conditional logistic regression models for tertiles of serum 25(OH)D concentrations [tertile-1: 2.82–11.02 (reference), tertile-2: 11.03–21.80, and tertile-3: ≥ 21.82 ng/ml]. The multivariate model was adjusted for age, sex, family history of diabetes, systolic blood pressure, triglyceride-to- HDL cholesterol ratio, waist-to-height ratio, lifestyle modification intervention, leisure time physical activity, and fasting plasma glucose at baseline. Non-linearity in the associations between baseline 25(OH)D and Type 2 diabetes, was examined by using restricted cubic splines. Results Unadjusted odds ratios (95% confidence intervals) of diabetes were 0.73 (0.74–1.13), 0.54 (0.34–0.85) for the second and third tertiles, respectively. Multivariate adjusted odds ratios were 0.47 (0.25–0.90) and 0.43 (0.23–0.82), respectively. Below the cutoff of ~ 10 ng/ml the risk of newly diagnosed Type 2 diabetes increased dramatically. Discussion It was found that 25(OH)D concentrations contributed to the Type 2 diabetes incidence rate in a non-linear fashion, with the risk beginning to increase sharply for values

Objective: To assess the impact of short-term changes in body mass index (BMI), waist circumference (WC), hip circumference (HC), and waist-to-hip ratio on the risk of future coronary heart disease (CHD) among women. Participants and Methods: The study sample consisted of 2468 women aged 30 years or older without cardiovascular disease at baseline who underwent 2 consecutive examinations, the first between January 31, 1999, and August 21, 2001, and second between October 20, 2001, and September 22, 2005, and were followed up until March 31, 2010. Cox proportional hazard regression was performed to estimate the hazard ratios (HRs) of the anthropometric measures for CHD events. Results: During a mean follow-up of 6.6 years, CHD occurred in 127 of the study participants (5.1%). There were significant interactions between a BMI of 30 kg/m 2 or greater and anthropometric changes in prediction of CHD events (all P

Background Data about the risk factors of stroke are sparse in the Middle East populations. We aimed to determine the potential risk factors and their population attributable fraction (PAF) for stroke in an Iranian population. Methods A cohort Study consisted of 1089 men and 1289 women, with mean (SD) ages of 61.1(7.6) and 59.0(6.7) years, respectively. Cox regression was implemented to estimate the hazard ratio (HR) of each risk factor for stroke events in a stepwise method. We calculated a multivariate adjusted population attributable fraction (PAF) for any risk factors remained in the model. Results During 9.3 years of follow-up, 69 events of stroke occurred with incidence rates of 4.5 (95% CI: 3.3-6.0) and 2.5 (1.7-3.6) in 1000 person-years for men and women respectively. Among potential risk factors, only age ≥ 65 years (HR: 2.03, CI: 1.24-3.31), male gender (HR: 2.00, CI: 1.16-3.43), hypertension (HR: 3.03, CI: 1.76-5.22), diabetes mellitus (HR: 2.18, CI: 1.34-3.56), and chronic kidney disease (CKD) (HR: 2.01, CI: 1.22-3.33), were independently associated with increased risk of stroke events in the total population. A paired homogeneity test showed that the hazard ratio of CKD did not differ from other independent risk factors. The PAFs were 29.7% and 25% for male gender and age ≥ 65 as non-modifiable and 48.6%, 29.1% and 22.0% for hypertension, CKD and diabetes as modifiable risk factors respectively. Conclusion Following this population based study of Iranians, we demonstrated that among modifiable risk factors, CKD as well as hypertension and diabetes are the strongest independent predictors of stroke.

We assessed the clinical outcomes of symptomatic and asymptomatic coronary heart disease (CHD) with type 2 diabetic patients.Population-based cohort study.The study sample consisted of 380 men and 546 women, aged ≥30 years. Silent CHD was defined using Minnesota coding criteria on baseline electrocardiogram (ECG), in the absence of a history of CHD and symptoms of angina. Participants were categorized into four groups: group 1, participants with no CHD symptoms and with normal ECG; group 2, silent CHD; group 3, participants with symptomatic CHD but with normal ECG; group 4, participants with symptomatic CHD and ECG-determined CHD. Cox regression analysis was used to estimate the hazard ratios (HRs) of cardiovascular disease (CVD) and CHD events for these groups, with group 1 as the reference.During median follow up of 9.2 years, we ascertained 226 CVD events (202 CHD). In the multivariable-adjusted model, among men, HRs (95% CI) of CVD events were 2.32 (1.29-4.16), 2.56 (1.47-4.46), and 3.97 (2.24-7.02) for groups 2, 3, and 4, respectively; the corresponding figures among women were 1.19 (0.65-2.18), 1.90 (1.24-2.92), and 1.92 (1.02-3.62) respectively. Similar results were achieved for CHD events.In both sexes, symptomatic CHD was an independent predictor of recurrent CVD/CHD, regardless of ECG results. In diabetic men with asymptomatic CHD, ECG could be of prognostic value for incident CVD/CHD. The present study provides evidence-based support only in men for the ADA recommendation of 'further cardiac testing for diabetic patients with an abnormal resting ECG'.

Background Gastroenteritis is a remarkable hygiene problem worldwide. Bacteria and parasites can cause gastroenteritis-associated disorders. Objectives The aims of study were to survey the most common cause of gastroenteritis in patients referred to Imam Khomeini Hospital of Ilam, Iran. Patients and Methods This descriptive-analytical study was performed during 2012 to 2013. After collecting 2376 stool samples, standard biochemical and microbiological tests were performed. Susceptibility was tested by disc diffusion method agreeing with clinical and laboratory standards institute (CLSI) guidelines. The protozoa were detected by sediment wet-mount method. Results Of 2376 patients, 466 (19.6%) were contaminated with pathogenic bacteria or protozoa.The frequency of microorganisms isolated from the patients were 10.3%, 2.5%, 2.5%, 2.1%, 46.4%, 30.9%, 2.5% and 2.5% for enteropathogenic Escherichia coli (EPEC), Shigella dysenteriae, Klebsiella pneumonia, Yersinia enterocolitica, Entamoeba histolytica, Giardia lamblia, E. coli and Candida spp., respectively. Sensitivities to ciprofloxacin in E. coli and S. dysenteriae strains were 100% and 91.66%, respectively. Conclusions The results showed that some patients were probably contaminated with nonbacterial and nonparasitic agents. All the parasitic isolates were resistant to most antibiotics. Therefore determination of microbial isolates and antibiotic susceptibility is necessary before treatment procedures.

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

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.

Vitiligo is an acquired cutaneous disorder of pigmentation, with an incidence of 0.5% to 2% worldwide. There are three major hypotheses for the pathogenesis of vitiligo that are not exclusive of each other: biochemical/cytotoxic, neural and autoimmune. Recent data provide strong evidence supporting an autoimmune pathogenesis of vitiligo. As vitiligo can have a major effect on quality of life, treatment can be considered and should preferably begin early when then disease is active. Current treatment modalities are directed towards stopping progression of the disease and achieving repigmentation. Therapies include corticosteroids, topical immunomodulators, photo(chemo)therapy, surgery, combination therapies and depigmentation of normally pigmented skin. It seems that traditional Chinese medicine could be more effective than the current treatment for vitligo.

BackgroundTo compare the predictive ability of adolescent lipoprotein classification using the National Examination Survey (NHANES) cut points and those of the National Cholesterol Education Program (NCEP) for predicting abnormal levels in adulthood.MethodFrom 1032 adolescents, aged 14–19 years, participants of the Tehran Lipid and Glucose Study, all lipid measures were determined at baseline and again after 6 years. Multivariable Odds Ratios (ORs) were calculated for borderline and high categories of lipids to predict dyslipidemia in adulthood, considering the normal level as a reference. Area under the receiving characteristics curve (AUC) was used to assess the predictive ability of each adolescent lipid classification.ResultApplying the NCEP classification, the prevalences of high total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), triglycerides and low high density lipoprotein cholesterol (HDL-C) in males were 12.1%, 12.9%, 26.1% and 34.2% respectively; in females the corresponding prevalences were 15.4%, 17.9%, 21.4% and 25.0%, respectively. Using NHANES cut points, the prevalence of high TC, LDL-C and triglycerides were lower, than those defined by NCEP; the ORs of high categories of lipids (defined by NHANES) were higher than ORs based on the NECP classification, except for HDL-C. For all lipid measures, both classifications had similar predictive abilities, except for TC/HDL-C, which had higher predictive power applying the NHANES classification rather than the NCEP one (AUC 71% vs. 68%, respectively).ConclusionNo differences were found between NCEP and NHANES classifications for prediction of adult dyslipidemia, except for TC/HDL-C. Because of their simple application, NCEP cut points can be used in clinical settings.