Regular physical activity postpones age of occurrence of first-ever stroke and improves long-term outcomes.

OBJECTIVE: Few data are available on the associations between the level of pre-stroke physical activity and long-term outcomes in patients with stroke. This study is designed to assess the associations between pre-stroke physical activity and age of first-ever stroke occurrence and long-term outcomes. METHODS: Six hundred twenty-four cases with first-ever stroke were recruited from the Mashhad Stroke Incidence Study a prospective population-based cohort in Iran. Data on Physical Activity Level (PAL) were collected retrospectively and were available in 395 cases. According to the PAL values, subjects were classified as inactive (PAL < 1.70) and active (PAL ≥ 1.70). Age at onset of stroke was compared between active and inactive groups. Using logistic model, we assessed association between pre-stroke physical activity and long-term (5-year) mortality, recurrence, disability, and functional dependency rates. We used multiple imputation to analyze missing data. RESULTS: Inactive patients (PAL < 1.70) were more than 6 years younger at their age of first-ever-stroke occurrence (60.7 ± 15.5) than active patients (67.0 ± 13.2; p < 0.001). Patients with PAL< 1.7 also had a greater risk of mortality at 1 year [adjusted odds ratio (aOR) = 2.31; 95%CI: 1.14-4.67, p = 0.02] and 5 years after stroke (aOR = 1.81; 95%CI: 1.05-3.14, p = 0.03) than patients who were more physically active. Recurrence rate, disability, and functional dependency were not statistically different between two groups. Missing data analysis also showed a higher odds of death at one and 5 years for inactive patients. CONCLUSIONS: In our cohort, we observed a younger age of stroke and a higher odds of 1- and 5-year mortality among those with less physical activity. This is an important health promotion strategy to encourage people to remain physically active.

Obese subjects have significantly higher serum prooxidantantioxidant balance values compared to normal-weight subjects.

BACKGROUND: It has been reported that obesity is associated with higher levels of oxidative stress. We aimed to evaluate the hypothesis that pro-oxidant antioxidant balance (PAB) values could be affected by adiposity and to assess the association between PAB levels and indices of obesity. METHODS: Subjects (n = 733) were recruited and tlen were divided into 3 groups of normal-weight (BMI < 25, n = 207), overweight (25 < BMI < 30, n = 375), and obese (BMI > 30, n = 151). PAB values were measured in all participants. RESULTS: There was a significant association between PAB values and weight when the correlation was determined for all subjects (p < 0.05). Obese subject had significantly higher levels of PAB values [40.8 (34.3 - 51.1) HK unit] compared with overweight [37.5 (29.7 - 47.3) HK unit] and normal-weight subjects [37.2 (29.6 - 45.2) HK unit] (p < 0.05 in each case). However, there was no significant difference in PAB values between normal and over-weight subjects (p > 0.05). On performing the analysis of covariance, low-density lipoprotein-cholesterol (LDL-C) was found to have a significant independent association with PAB values (j = 0.046, p = 0.04). CONCLUSIONS: The high levels of PAB values in obese subjects without overt signs/symptoms of cardiovascular disease may be related to a heightened state of oxidative stress associated with obesity.

Down syndrome and consanguinity.

BACKGROUND: Among the genetics disorders, Down syndrome (DS) is the major cause of mental retardation, congenital heart and intestinal disease. So far, no certain therapeutic method has been suggested for the treatment of this syndrome. The aim of the current survey was to investigate the frequency of parental consanguinity, maternal age in the patients with DS. MATERIALS AND METHODS: This study was conducted on 38 consecutive patients with clinically and laboratory confirmed DS who referred to the genetic lab of a referral University Hospital. The G-banding method for karyotyping was employed. RESULTS: The patients were 21 males and 17 females within the age of 16 days to 28 years old. Free trisomy (92.1%, n = 35) was the most common chromosomal abnormality. The frequency of DS was higher among the non-consanguine marriages (71.1%) in comparison with the consanguine marriages (28.9%). Mean age of the mothers in the consanguine marriages (mean = 27.1 ± 6.3) was lower than in the non-consanguine marriages (mean = 31.1 ± 7.7). CONCLUSION: Higher frequency of DS among the non-consanguine marriages in comparison with the consanguine marriages, may suggest that DS diagnostic tests might be done on all embryos regardless of the parents' familial relationship.

Dobutamine stress-induced ischemic right ventricular dysfunction in patients with three-vessel coronary artery disease.

BACKGROUND: Dobutamine stress echocardiography (DSE) is a non-invasive technique to detect coronary artery diseases (CAD). There are limited studies on evaluation of the right ventricular function by stress echocardiography. The appropriate evaluation of RV function and early diagnosis of its failure can help to improve outcomes for the patients undergoing cardiac surgery. OBJECTIVE: To determine right ventricular dysfunction in patients with three-vessel CAD by using DSE. METHODS: This cross-sectional study was among 13 patients who were candidates for coronary artery bypass grafting (CABG) referred to Ghaem Hospital, Mashhad, Iran; from September 2015 to May 2016. After a physical examination and initial measures, DSE was performed and echocardiographic parameters were recorded by a cardiologist. Paired-samples t-test was performed using SPSS Software v.16.0 for data analysis. RESULTS: The study included 13 patients (9 males) with a mean age of 65.4±7.6 years. The mean of TAPS was 16.9±4.5 mm and 15.7±2.9 mm before and after stress echocardiography, respectively (p=0.69). Systolic right ventricular (SRV) peak increased from before DSE compared with after DSE (8.0±2.2 vs. 13.7±4.2 mm/s, p<0.001). In addition, after dobutamine injection, right ventricular (RV) cardiac output decreased in 7 patients and one patient was affected by post-ejection shortening. CONCLUSION: It seems that TAPS and RV cardiac output after injection of dobutamine, can be used as markers for the recognition of ischemic RV dysfunction.

Mashhad stroke and heart atherosclerotic disorder (MASHAD) study: design, baseline characteristics and 10-year cardiovascular risk estimation.

OBJECTIVE: The Mashhad stroke and heart atherosclerotic disorder (MASHAD) study is a 10-year cohort study that aims to evaluate the impact of various genetic, environmental, nutritional and psychosocial risk factors on the incidence of cardiovascular events among an urban population in eastern Iran. METHODS: The MASHAD study comprises a cohort of 9704 individuals aged 35-65 years using a stratified cluster random sampling design. This cohort will be followed up until 2020, with follow-up examinations being undertaken every 3 years. Ten-year cardiovascular disease (CVD) risk estimation was determined using NCEP ATP III criteria. RESULTS: Overall, 88.4 % of women and 79.2 % of men (P < 0.001) had at least one lipid abnormality. The 10-year risk for CVD of <10, 10-20 and >20 % were observed to be 86.6, 11 and 2.5 %, respectively. Predicted risk of CVD > 10 % using the Framingham algorithm was considerably higher in men compared to women. Overall, 9.5 % [95 % confidence interval (CI) 8.9-10.1 %] of our subjects had prevalent CAD. CONCLUSION: The prevalence of CVD risk factors within our population is high compared to Western countries, indicating the necessity for interventional risk modifications.