Current practice of percutaneous coronary intervention on patients with acute coronary syndrome in Iran: A prospective observational study.

Background: Frequent Percutaneous Coronary Intervention (PCI) procedures are being performed on a daily basis in Iran. However, no study has been reported on the current PCI practice in patients with acute coronary syndrome (ACS) in Iran. We aimed to describe the clinical characteristics and treatment patterns in Iranian ACS patients treated with PCI. Methods: Between February 2017 and July 2017, ACS patients presented to 5 referral hospitals in two major cities of Iran (Tehran and Shiraz) were included in this observational study if aged > 18 years and underwent PCI for ACS during hospitalization; and their clinical and procedural characteristics were collected. All data were entered into SPSS v.21 and descriptive statistics were performed. Results: Of a total of 314 patients, 228 (73%) were males, 162 (52%) were diagnosed with ST-elevation myocardial infarction and 152 (48%) with Unstable angina/ Non-ST elevation myocardial infarction. Trans-femoral approach was more often (64%) used for PCI procedures. Stent placement was the most frequent (98%) treatment strategy on PCI, with drug-eluting stent selected in the majority of subjects (98%). The overall rate of PCI success was 95%, with 4.1% PCI-related complications, and 1.6% post-PCI bleeding events. The vast majority of the study patients (99%) were discharged with dual anti-platelet therapy. Conclusion: In this study, we observed a high level of adherence to the currently accepted guidelines in the current PCI practice on ACS patients in Iran. Also we found our practice is highly in line with the global reduction trend in the PCI-related complications.

National and sub-national exposure to ambient fine particulate matter (PM2.5) and its attributable burden of disease in Iran from 1990 to 2016.

Ambient particulate matter is a public health concern. We aimed (1) to estimate national and provincial long-term exposure of Iranians to ambient particulate matter (PM) < 2.5 µm (PM2.5) from 1990 to 2016, and (2) to estimate the national and provincial burden of disease attributable to PM2.5 in Iran. We used all available ground measurements of PM < 10 µm (PM10) (used to estimate PM2.5) from 91 monitoring stations. We estimated the annual mean exposure to PM2.5 for all Iranian population from 1990 to 2016 through a multi-stage modeling process. By applying comparative risk assessment methodology and using life table for years of life lost (YLL), we estimated the mortality and YLL attributable to PM2.5 for five outcomes. The predicted provincial annual mean PM2.5 concentrations range was between 21.7 µg/m3 (UI: 19.03-24.9) and 35.4 µg/m3 (UI: 31.4-39.4) from 1990 to 2016. We estimated in 2016, about 41,000 deaths (95% uncertainty interval [UI] 35634, 47014) and about 3,000,000 YLL (95% UI: 2632101, 3389342) attributable to the long-term exposure to PM2.5 in Iran. Ischemic heart disease was the leading cause of mortality by 31,363 deaths (95% UI: 27520, 35258), followed by stroke (7012 (5999, 8062) deaths), lower respiratory infection (1210 (912, 1519) deaths), chronic obstructive pulmonary disease (1019 (715, 1328) deaths), and lung cancer (668 (489, 848) deaths). In 2016, about 43% of all PM2.5 related mortality in Iran was, respectively, in the following provinces: Tehran (12.6%), Isfahan (9.3%), Khorasan Razavi (8.0%), Fars (6.5%), and Khozestan (6.4%). In summary, we found that the majority of Iranians were exposed to the levels of ambient particulate matter exceeding the WHO guidelines from 1990 to 2016. Further, we found that there was an increasing trend of total mortality attributed to PM2.5 in Iran from 1990 to 2016 where the slope was higher in western provinces.

Comparative Effectiveness Study in Multiple Sclerosis Patients Using Instrumental Variable Analysis.

Randomized clinical trials are considered the ideal source for generation of robust evidence for clinical and public health decision making. Estimation of treatment effect in observational studies is always subject to varying degrees of bias due to lack of random allocation, blindness, precise definition of intervention, as well as the existence of potential unknown and unmeasured confounding variables. Unlike other conventional methods, instrumental variable analysis (IVA), as a method for controlling confounding bias in non-randomized studies, attempts to estimate the treatment effect with the least bias even without knowing and measuring the potential confounders in the causal pathway. In this paper, after understanding the main concepts of this approach, it has been attempted to provide a method for analyzing and reporting the IVA for clinical researchers through a simplified example. The data used in this paper is derived from the clinical data of the follow-up of multiple sclerosis (MS) patients treated with two class of interferon.

Comparison of linoleic acid-containing water-in-oil emulsion with urea-containing water-in-oil emulsion in the treatment of atopic dermatitis: a randomized clinical trial.

BACKGROUND: Application of topical moisturizers is an essential part of the management of atopic dermatitis (AD). Linoleic acid (LA), the most abundant fatty acid in the epidermis, and its derivatives have an essential role in the structure and function of the epidermal barrier, and their defects are prominent in AD. The aim of this study was to compare the efficacy and safety of two cosmetic products containing either LA or urea in patients with AD. PATIENTS AND METHODS: A total of 20 patients with AD who met the eligibility criteria and provided written informed consents were enrolled in this randomized, intra-individual split-body, single-center trial. Symmetrical lesions of patients were randomized for treatment with LA- or urea-containing water-in-oil (w/o) emulsions applied two to three times daily for 4 weeks. The efficacy of the two products was evaluated by local Scoring Atopic Dermatitis (SCORAD) of both lesions and also patient (or guardian) satisfaction. In addition, trans-epidermal water loss (TEWL), stratum corneum (SC) hydration, pH, sebum, temperature, erythema, melanin content, and ultrasonographic thickness and echo density of epidermis and dermis were measured before, and 2 and 4 weeks after, treatment. RESULTS: Four weeks of treatment with the LA-containing product resulted in a significant decrease in local SCORAD, TEWL, erythema, and echo density of dermis, as well as an increase in SC hydration compared to baseline. The urea-containing product also reduced the local SCO-RAD and echo density of dermis and increased SC hydration. In contrast to the LA-containing product, changes in TEWL and erythema were not significant. Moreover, the reduction of erythema was significantly higher in the LA-containing product-treated side compared to the urea-containing product-treated side (p = 0.006). CONCLUSION: Both LA- or urea-containing w/o emulsions can significantly improve barrier dysfunction and clinical severity of AD. In agreement with literature, it was confirmed that an LA-containing w/o emulsion exhibited erythema-reducing effects. Since emollients should be used on a regular basis, patients should choose a product by individual preference following recommendation by their dermatologists.

No relationship between most polymorphisms of steroidogenic acute regulatory (StAR) gene with polycystic ovarian syndrome.

BACKGROUND: Polycystic ovary syndrome (PCOS) is one of the most common endocrine women's disorders in reproductive age. Hyperandrogenism has a critical role in the etiology of PCOS and it can cause fault in Steroidogenesis process. During steroidogenesis, steroidogenic acute regulatory protein (StAR) seems to increase the delivery of cholesterol through mitochondrial membrane. Therefore, polymorphisms of StAR might effect on this protein and play a role in the etiology of PCOS. OBJECTIVE: The aim of this study was to investigate the association between StAR SNPs with PCOS. Thus, seven polymorphisms in this gene: rs104894086, rs104894089, rs104894090, rs137852689, rs10489487, rs104894085 were detected. MATERIALS AND METHODS: In this case control study, 45 PCOS women, 40 male factor/unexplained infertile women, and 40 fertile women as two control groups were participated from 2008-2012. Polymorphisms were detected using restriction fragment length polymorphism (PCR-RFLP) method. RESULTS: Heterozygote genotyping for rs137852689 SNP (amino acid 218 C > T) was only seen in seven PCOS patients, one in normal ovulatory women, and five in male factor/unexplained infertile women (15.5%, 2.5%, 12.5%, respectively) (p= 0.12). While, it has shown no association between other SNPS with PCOs. CONCLUSION: The RFLP results for seven chosen SNPs, which located in exon 5 and 7 showed normal status in three groups, it means no heterozygous or homozygous forms of selected SNPs were observed. So, it seems evaluation of the active amino acid sites should be investigated and also the study population should be increased.

Estimating the prevalence of illicit drug use among students using the crosswise model.

OBJECTIVE: The aim of our study is to compare the prevalence of illicit drug use estimated through a technique referred to as the "crosswise model" (CM) with the results from conventional direct questioning (DQ). METHOD: About 1,500 students from Tehran University of Medical Sciences 2009-2010 were first interviewed by DQ and, then three months later, by the CM. RESULT: The CM yielded significantly higher estimates than DQ for lifetime prevalence of use of any illicit drug (CM = 20.2%,DQ = 3.0%, p < .001) and for lifetime prevalence of use of opium or its residue (CM = 13.6%, DQ = 1.0%, p < .001). Also, for use of any illicit drug in the last month and use of opium or its residue in the last month, the CM yielded higher point estimates than DQ, although these differences were not significant (any drug: CM = 1.5%, DQ = 0.2%, p = .66; opium: CM = 3.8%, DQ = 0.0%, p = .21). CONCLUSION: Our findings suggest that the CM is a fruitful data collection method for sensitive topics such as substance abuse.

Survival analysis of Iranian patients undergoing continuous ambulatory peritoneal dialysis using cure model.

BACKGROUND: Peritoneal dialysis is one of the most prevalent types of dialysis prescribed to the patients suffering from renal failure. Studies on the factors affecting the survival of these patients have mainly used log-rank test and Cox analysis. The present study aimed to investigate the risk factors affecting short- and long term survival of patients on continuous ambulatory peritoneal dialysis (CAPD) using cure model. METHODS: The data obtained retrospectively from 20 medical centers in Iran, between 1996 and 2009. All patients with renal failure who had been treated by CAPD and followed at least 3 months were included in the study. The STATA (11.0) software and CUREREGR module were used for survival analysis using cure model. RESULTS: Totally 2006 patients were included in this study. The major reasons for renal failure were hypertension (35.4%) and diabetes (33.6%). The median of survival time was 4.8 years with a 95% confidence interval of 4.3 to 5.6 years. The percentage of long-lived patients surviving was 40% (95% CI: 32%, 47%). The analysis showed that the effect of diabetes, serum albumin level, age, diastolic blood pressure, and medical center was significant on the long-term survival of the patients. In addition, in short-term survival the effects of age, albumin, and medical center were significant. CONCLUSIONS: By improving the quality of medical care in centers, nutritional status, controlling co-morbidities can help the patients on CAPD with better health and increase their short and long term survival.

Relationship of leptin administration with production of reactive oxygen species, sperm DNA fragmentation, sperm parameters and hormone profile in the adult rat.

PURPOSE: Leptin, an adipose tissue-derived hormone, plays an important role in energy homeostasis and metabolism, and in the neuroendocrine and reproductive systems. The function of leptin in male reproduction is unclear; however, it is known to affect sex hormones, sperm motility and its parameters. Leptin induces mitochondrial superoxide production in aortic endothelia and may increase oxidative stress and abnormal sperm production in leptin-treated rats. This study aims to evaluate whether exogenous leptin affects sperm parameters, hormone profiles, and the production of reactive oxygen species (ROS) in adult rats. METHODS: A total of 65 Sprague-Dawley rats were divided into three treated groups and a control group. Treated rats received daily intraperitoneal injections of 5, 10 and 30 µg/kg of leptin administered for a duration of 7, 15, and 42 days. Control rats were given 0.1 mL of 0.9 % normal saline for the same period. One day after final drug administration, we evaluated serum specimens for follicle-stimulating hormone (FSH), leutinizing hormone (LH), free testosterone (FT), and total testosterone (TT) levels. Samples from the rat epididymis were also evaluated for sperm parameters and motility characteristics by a Computer-Aided Semen Analysis (CASA) system. Samples were treated with 2',7'-dichlorofluorescein-diacetate (DCFH-DA) and analyzed using flow cytometry and TUNEL to determine the impact of leptin administration on sperm DNA fragmentation. RESULTS: According to CASA, significant differences in all sperm parameters in leptin-treated rats and their age-matched controls were detected, except for TM, ALH and BCF. Serum FSH and LH levels were significantly higher in rats that received 10 and 30 µg/kg of leptin compared to those treated with 5 µg/kg of leptin in the same group and control rats (P < 0.05). ROS and sperm DNA fragmentation was significantly higher in rats injected with 10 and 30 µg/kg of leptin for 7 and 15 days compared with rats treated with 5 µg/kg of leptin and the control group (P < 0.05) for the same time period. However, at day 42 of treatment, ROS and sperm DNA fragmentation levels significantly decreased in all groups (P < 0.05). CONCLUSION: According to these results, leptin can possibly affect male infertility by ROS induction or hormone profile modulation.

Health impact assessment of air pollution in Shiraz, Iran: a two-part study.

We aimed to assess health-impacts of short-term exposure to the air pollutants including PM10, SO2, and NO2 in Shiraz, Iran in a two-part study from 2008 to 2010. In part I, local relative risks (RRs) and baseline incidences (BIs) were calculate using generalized additive models. In part II, we estimated the number of excess hospitalizations (NEHs) due to cardiovascular diseases (CDs), respiratory diseases (RDs), respiratory diseases in elderly group (RDsE-people older than 65 years old), and chronic obstructive pulmonary diseases (COPDs) as a result of exposure to air pollutants using AirQ model, which is proposed approach for air pollution health impact assessment by World Health Organization. In part I, exposure to increase in daily mean concentration of PM10 was associated with hospitalizations due to RDs with a RR of 1.0049 [95% confidence interval (CI), 1.0004 to 1.0110]. In addition, exposure to increase in daily mean concentration of SO2 and NO2 were associated with hospitalizations due to RDsE and COPDs with RRs of 1.0540 [95% CI, 1.0050 to 1.1200], 1.0950 [95% CI, 1.0700 to 1.1100], 1.0280 [95% CI, 1.0110 to 1.0450] and 1.0360 [95% CI, 1.0210 to 1.0510] per 10 µg/m3 rise of these pollutants, respectively. In part II, the maximum NEHs due to CDs because of exposure to PM10 were in 2009-1489 excess cases (ECs). The maximum NEHs due to RDs because of exposure to PM10 were in 2009-1163 ECs. Meanwhile, the maximum NEHs due to RDsE and COPDs because of exposure to SO2 were in 2008, which are 520 and 900 ECs, respectively. In conclusion, elevated morbidity risks were found from acute exposure to air pollutants.

Enzymatic digestion improves testicular sperm retrieval in non-obstructive azoospermic patients.

BACKGROUND: In patients with non-obstructive azoospermia (NOA), vital spermatozoa from the tissue is obtained from testes by enzymatic treatment besides the mechanical treatment. OBJECTIVE: To increase the sperm recovery success of testicular sperm extraction (TESE), with enzymatic digestion if no sperm is obtained from testis tissue by mechanical method. MATERIALS AND METHODS: Tissue samples were collected from 150 men who presented with clinical and laboratory data indicating NOA by means of TESE and micro dissection TESE methods. Initially, mature spermatozoa were examined for by mechanical extraction technique shredding the biopsy fractions. In cases whom no spermatozoa was observed after maximum 30 min of initial searching under the inverted microscope, the procedure was followed by enzymatic digestion using DNaseI and collagenase type IV. Surgery type, pathology, AZF, karyotype, hormones and testis size were compared in patients. RESULTS: Of 150 cases with NOA, conventional mincing method extended with enzymatic treatment yielded successful sperm recovery in 13 (about 9%) patients. Comparison of parameters revealed that level of FSH and LH were significantly different (p=0.04 and 0.08 respectively) between two groups that response negative and positive to enzymatic digestion. CONCLUSION: The combination of conventional TESE and enzymatic digestion is an effective method to recover spermatozoa. The benefit of the mincing combined with enzyme to sperm retrieval for NOA firstly shorten the mechanical searching time, leading to minimizing further cellular damage as well as exposure to external conditions, and secondly reduce the number of cases with sperm recovery failures. Also, the serum level of FSH and LH are factors that influence the chance of sperm retrieval.