Distribution of HPV genotypes in Mashhad, Iran: insights from a 2022-2023 study.

BACKGROUND: Human papillomavirus (HPV), is one of the main causes of cervical cancer and also one of the most common sexually transmitted infections (STIs). HPV is responsible for almost all cases of cervical cancer and plays a principal role in causing other cancers including oropharynx, penis, larynx, oral cavity, anus, vulva, and vagina. The study aims to investigate the prevalence and distribution of HPV genotypes among patients referred to private laboratories in Mashhad, located in the northeast of Iran. METHODS AND MATERIALS: 428 samples including 382 females (89.3%) and 46 males (10.7%) between January 10, 2022, and February 11, 2023, in Mashhad, Iran were evaluated to detect HPV and determine its genotypes. Cervical swabs and urine samples were collected from females and males, respectively. Viral DNA was extracted by using a CedExtra purification kit (cedbio, Iran) and viral genotypes were identified with a High + Low Papillomastrip kit (Operon, Spain). Mann Whitney U test and Chi-square test were accomplished for statistical analysis. RESULT: From the total of 428 participants analyzed, the HPV test result was positive for 129 patients (30.1%) and negative for 299 people (69.9%). Among the participants, 115 female (30.1%) and 14 male (30.4%) were positive for HPV infection. The prevalence of HPV infection among the referring people was about 30%. The most common genotype identified was HPV-6 (10.3%), followed by HPV-16 (8.7%) and HPV-51 (7.7%), the second and third most common genotypes, respectively. Additionally, HPV-39 was detected at a frequency of 6.70%. HPV-11, HPV-61, HPV-91, and HPV-44 with a frequency of 1% were among the least genotypes identified among the patients. CONCLUSION: In line with the results of this study, the prevalence of HPV genotypes in both genders is 30%. The results likely reflect differences in the prevalence of high-risk HPV genotypes, that are less common. Also, HPV-6 and HPV-16 genotypes that are covered by the vaccine had a significant prevalence. On the other hand, with the prevalence of HPV-51 and HPV-39 genotypes in infected people who are not covered by the Gardasil (quadrivalent) vaccine, there is a risk of related cancers in the future.

Zika virus tropism and pathogenesis: understanding clinical impacts and transmission dynamics.

The Zika virus (ZIKV) is classified within the Flavivirus genus of the Flaviviridae family and is categorized as an arbovirus. The virus was initially identified in a rhesus monkey in Uganda in 1947 and later in a human in Nigeria in 1952. Since 2007, the prevalence of the virus has been on the rise, culminating in a major outbreak in the United States (US) in 2015. During this outbreak, the adult population was severely impacted, experiencing a range of symptoms, including organ failure, microcephaly, fetal death, and Guillain-Barré syndrome (GBS). Additionally, skin rash, limb swelling, fever, headache, and heightened sensitivity are found in most adults with Zika syndrome. Although the virus can be transmitted through blood, vertical transmission from mother to child, and sexual contact, the primary way of transmission of the virus is through the Aedes mosquito. Cells such as neurons, macrophages, peripheral dendritic cells, and placental cells are among the target cells that the virus can infect. The TAM AXL receptor plays a crucial role in infection. After the virus enters the body through the bloodstream, it spreads in the body with a latent period of 3 to 12 days. Currently, there is no specific treatment or publicly available vaccine for the ZIKV. Limited laboratory testing has been conducted, and existing drugs originally designed for other pathogens have been repurposed for treatment. Given the Aedes mosquito's role as a vector and the wide geographical impact of the virus, this study aims to comprehensively investigate Zika's pathogenesis and clinical symptoms based on existing knowledge and research. By doing so, we seek to enhance our understanding of the virus and inform future prevention and treatment strategies.

From discovery to treatment: tracing the path of hepatitis E virus.

The hepatitis E virus (HEV) is a major cause of acute viral hepatitis worldwide. HEV is classified into eight genotypes, labeled HEV-1 through HEV-8. Genotypes 1 and 2 exclusively infect humans, while genotypes 3, 4, and 7 can infect both humans and animals. In contrast, genotypes 5, 6, and 8 are restricted to infecting animals. While most individuals with a strong immune system experience a self-limiting infection, those who are immunosuppressed may develop chronic hepatitis. Pregnant women are particularly vulnerable to severe illness and mortality due to HEV infection. In addition to liver-related complications, HEV can also cause extrahepatic manifestations, including neurological disorders. The immune response is vital in determining the outcome of HEV infection. Deficiencies in T cells, NK cells, and antibody responses are linked to poor prognosis. Interestingly, HEV itself contains microRNAs that regulate its replication and modify the host's antiviral response. Diagnosis of HEV infection involves the detection of HEV RNA and anti-HEV IgM/IgG antibodies. Supportive care is the mainstay of treatment for acute infection, while chronic HEV infection may be cleared with the use of ribavirin and pegylated interferon. Prevention remains the best approach against HEV, focusing on sanitation infrastructure improvements and vaccination, with one vaccine already licensed in China. This comprehensive review provides insights into the spread, genotypes, prevalence, and clinical effects of HEV. Furthermore, it emphasizes the need for further research and attention to HEV, particularly in cases of acute hepatitis, especially among solid-organ transplant recipients.

Uncommon high distribution of HPV-16, HPV-54, and HPV-56 in female referred to a laboratory in Karaj, Iran: indications of a paradigm shift in HPV genotypes?

BACKGROUND: Human papillomavirus (HPV) is among the leading cause of sexually transmitted infections, particularly prevalent among sexually active individuals. While many HPV infections clear up over time, some may progress to various cancers such as anal cancer, cervical cancer and, vaginal cancer. This study examines the prevalence of different HPV genotypes, classified as high-risk (HR) and low-risk (LR), among females of various age groups who visited the laboratory in Karaj. MATERIAL AND METHODS: Genital specimens were gathered from the individuals involved in the study and subjected to DNA extraction (DNA/RNA extraction AmpliSense, Moscow, Russia) followed by amplification using Real-Time PCR. HR- and LR-HPV genotypes were identified using the GenoFlow HPV Array test kit (GenoFlow; DiagCor Bioscience, Hong Kong) and homemade HPV genotyping kit. Demographic information such as age, was examined alongside statistical virological data. RESULTS: Overall, 367 (17%) out of the 2109 (100%) female cases tested positive for HPV. Among these, 219 (46.2%) were classified as low-risk, 44 (9.3%) as potentially high-risk, and 211 (44.5%) as high-risk. The highest percentage of positive test results was detected in individuals under 30 years old (35%) and those aged 40-50 (18%). Individuals in the < 30 age group were primarily infected with HR genotypes. The most commonly identified genotypes overall were HPV-16 (11.7%), HPV-54 (10.3%), HPV-56 (8.4%), HPV-40 (8.1%). The lowest frequency was observed for HPV-70, HPV-71, HPV-82, and HPV-90, each recorded in only a single case. CONCLUSION: Our results highlight the notable occurrence of HPV among females who visited the laboratory in Karaj, especially in the < 30 age group. Identifying HPV-16 as the most prevalent genotype in our examination highlights the necessity of tailored interventions for specific age ranges. While HPV-16 is covered by vaccination programs, HPV-54 and HPV-56 are not, emphasizing the need for effective screening and preventive plans to manage the consequences of HPV-related diseases in future.

High prevalence of HPV-56 and HPV-39 in Sari, Iran: an analysis of genotype distribution.

BACKGROUND: Human papillomavirus (HPV) is responsible for the most common sexually transmitted infection, particularly among sexually active individuals. Understanding the geographical distribution and epidemiology of the most prevalent HPV genotypes is essential for developing effective prevention strategies. Consequently, this study aimed to examine the distribution of HPV genotypes among HPV-positive women and men in Sari, the capital city of Mazandaran province in northern Iran. MATERIALS AND METHODS: HPV DNA was extracted (PZP Company, Molecular IVD, Iran) from genital and cervical samples of the study participants. Genotyping was conducted for 90 cases utilizing the High + Low Papilloma Strip test (Operon Company, Spain). Demographic data were statistically analyzed in correlation with the virological data (STATA version 17). RESULTS: Overall, 67.7% (61 out of 90) of the cases tested positive for HPV, with 75% of those being classified as high-risk. The participant group consisted of 92% females (83) and 8% males (7). The highest HPV prevalence, 75% (36), was observed in females and males aged under 31, with the majority of positive cases belonging to high-risk genotypes. The most frequently identified genotypes were HPV-11 (23%), HPV-6 (21%), HPV-56 (18%), HPV-39 (16%), HPV-16, HPV-91, and HPV-66 each comprising (14%). HPV-56 was the most common high-risk genotype, accounting for 11 cases (18%), followed by HPV-39, which was present in 10 cases (16%). CONCLUSION: The prevalence of HPV infection was particularly high among individuals under the age of 31 for both genders, with men exhibiting a 100% infection rate. These findings emphasize the urgent need for targeted education aimed at the younger population and the implementation of infection control measures. Specifically, widespread HPV vaccination targeting HPV-6, HPV-11, HPV-39, and HPV-56 should be prioritized for the general population.

Experiences of patient education among people affected by cardiovascular disease: a qualitative study based on Andragogy model.

BACKGROUND: Patient education is a key component of patient care, positively affecting health promotion and self-care ability. In this regard, an extensive body of research supports the use of the andragogy model in patient education. The study aimed to explore the experiences of people with cardiovascular disease in patient education. METHODS: This qualitative study involved 30 adult patients with cardiovascular disease who were hospitalized or had a history of hospitalization. They were purposively recruited with maximum variation from two large hospitals in Tehran, Iran. Data were gathered by conducting semi-structured interviews. Data collection was done by conducting semi-structured interviews. Then, the data were analyzed using directed content analysis and a preliminary framework based on six constructs of the andragogy model. RESULTS: Data analysis resulted in the development of 850 primary codes, which were reduced to 660 during data reduction. These codes were grouped into nineteen subcategories under the six primary constructs of the andragogy model, i.e., need-to-know, self-concept, prior experience, readiness for learning, orientation to learning, and motivation for learning. The most common problems in patient education were associated with self-concept, previous experience, and readiness for learning components. CONCLUSION: This study provides valuable information about the problems of patient education for adults with cardiovascular disease. Correction of the issues identified can improve care quality and patient outcomes.

WHO implementation workshop on guidelines on procedures and data requirements for changes to approved biotherapeutic products, Seoul, Republic of Korea, 25-26 June 2019.

The first global workshop on implementation of the WHO guidelines on procedures and data requirements for changes to approved biotherapeutic products adopted by the WHO Expert Committee in 2018 was held in June 2019. The workshop participants recognized that the principles based on sound science and the potential for risk, as described in the WHO Guidelines on post-approval changes, which constitute the global standard for product life-cycle management are providing clarity and helping national regulatory authorities in establishing guidance while improving time-lines for an efficient regulation of products. Consequently, the regulatory situation for post-approval changes and guideline implementation is changing but there is a disparity between different countries. While the guidelines are gradually being implemented in some countries and also being considered in other countries, the need for regional workshops and further training on post-approval changes was a common theme reiterated by many participants. Given the complexities relating to post-approval changes in different regions/countries, there was a clear understanding among all participants that an efficient approach for product life-cycle management at a national level is needed to ensure faster availability of high standard, safe and efficacious medicines to patients as per the World Health Assembly Resolution 67.21.

Measuring Empathy in Iranian Pharmacy Students Using the Jefferson Scale of Empathy-Health Profession Student Version.

Objective. To assess validity of the Farsi-translated version of the Jefferson Scale of Empathy-Health Profession Student version (JSE-HPS) and measure empathy scores of Iranian pharmacy students.Methods. The JSE-HPS questionnaire was administered to 504 Iranian pharmacy students in 2019. Confirmatory factor analysis and exploratory factor analysis were used to explore the underlying components and construct validity. Group comparisons of the empathy scores and the underlying components were conducted using statistical tests.Results. Based on 496 useable survey questionnaires, three domains of empathy among Iranian pharmacy students were confirmed by confirmatory factor analysis: compassionate care, perspective taking, and standing in a patient's shoes. Two items in the JSE-HPS were removed, as their factor loadings were under the permissible limits in exploratory factor analysis. Empathy scores were significantly higher among female pharmacy students.Conclusion. These findings support the validity and reliability of the Farsi version of the JSE-HPS among Iranian pharmacy students.

Sinus node dysfunction and related permanent pacemaker implantation after major cardiac surgeries, systematic review, and meta-analysis.

Background: There is no concise evidence or clinical guidelines regarding the incidence of sinus node dysfunction (SND) and permanent pacemaker (PPM) implantation following cardiac surgeries and their management approaches. Objective: We aim to systematically review current evidence on the prevalence of SND, PPM implantation concerning it, and its risk factors in patients undergoing cardiac surgery. Method: Four electronic databases (Cochrane Library, Medline, SCOPUS, and Web of Science) were systematically searched for articles regarding SND after cardiovascular surgeries and reviewed by two independent researchers, and a third review in case of discrepancies. Using the random-effects model, a proportion meta-analysis was performed on data regarding PPM implantation. Subgroup analysis was performed for different interventions, and the possible effect of different covariates was evaluated using meta-regression. Results: From the initial 2012 unique records, 87 were included in the study, and results were extracted. Pooled data from 38,519 patients indicated that the overall prevalence of PPM implantation due to SND after cardiac surgery was 2.87% (95% CI [2.09; 3.76]). The incidence of PPM implantation in the first post-surgical month was 2.707% (95% CI [1.657; 3.952]). Among the four main intervention groups, including valve, maze, valve-maze, and combined surgeries, maze surgery was associated with the highest prevalence (4.93%; CI [3.24; 6.92]). The pooled prevalence of SND among studies was 13.71% (95% CI [8.13; 20.33]). No significant relationship was observed between PPM implantation and age, gender, cardiopulmonary bypass time, or aortic cross-clamp time. Conclusion: Based on the present report, patients undergoing the maze and maze-valve procedures are at higher risk of post-op SND, whereas lone valve surgery had the lowest prevalence of PPM implantation. Systematic Review Registration: PROSPERO (CRD42022341896).

Concordance of the cardiovascular patient education with the principles of Andragogy model.

BACKGROUND: Patient education is a critical aspect of patient care and is considered a vital part of self-care (especially in patients with cardiovascular disease (CVD)) and health promotion. The literature supports incorporating the principles of the andragogy model (adult learning) into patient education. This study aimed to determine the concordance of the CVD patient education with the principles of the andragogy model. METHODS: This cross-sectional survey was conducted on 384 adult CVD patients from 2 selected hospitals of Tehran. The sampling method was convenient, and the data collection tool was a researcher-made questionnaire based on the principles of the andragogy model. Data were analyzed using SPSS16 statistical software. RESULTS: The mean age of the patients was 55.69 ± 13.01 years old. Frequency of distribution of the patients who, in total, selected the items of 4 or 5 for respecting the principles of andragogy model was as follows: 68.16% for the motivation, 66.29% for the need, 66.03% for the orientation, 54.16% for the experiences, 51.55% for the self-concept, and 44.65% for the readiness principle. Also, three principles of motivation (77.37) need (74.97), and orientation (74.78) had the highest mean, respectively, in terms of adhering to this model. But the most common problems in patient education were related to the principles of readiness (64.35), self-concept (68.19), and experiences (77.71) with the lowest mean. CONCLUSIONS: The findings of this study provided valuable information on the flaws in patient education, including ignoring and disrespecting the principles of adult education. Correcting these detected defects and providing feedback to health professionals can improve the quality of patient education programs and patient satisfaction. Also, it empowers healthcare providers, patients, and families through effective education strategies.

Efficacy of Date Palm Pollen in the Male Sexual Dysfunction after Coronary Artery Bypass Graft: A Randomized, Double-Blind, Clinical Trial.

Background: Bypass graft surgery of the coronary artery has a significant effect on the creation and development of sexual dysfunction among male patients. The previous studies have demonstrated that date palm pollen (DPP) increases the count and quality of sperm. Additionally, it has been shown that DPP has a protective effect against myocardial infarction and cardiac remodeling. Therefore, this is the first study investigating the impact of DPP (Phoenix dactylifera L.) on managing male sexual dysfunction after coronary artery bypass graft. Methods: This randomized, double-blind, placebo-controlled clinical trial was conducted on 60 patients (DPP group n = 30, control group n = 30) of Iranian men after coronary artery bypass graft. Two parallel groups were randomly generated from the study participants. The intervention group was prescribed 3 grams of the powder of DPP twice a day (9 AM and 9 PM) for two months, while the control group received the same prescription of the placebo powder. Results: The DPP consumption significantly increased the International Index of Erectile Function (IIEF) (from 23.21 to 46.57) and the Hurlbert Index of Sexual Desire (HISD) (from 59.39 to 64.45) scores over time in the intervention group. However, there were no significant changes in the control group. Conclusion: Daily intake of 6 g DPP for two months exhibited beneficial effects on the symptoms of male sexual dysfunction in patients who have undergone coronary artery bypass graft (CABG).

Perioperative Cardiac Troponin T and Risk of Postoperative Atrial Fibrillation in Coronary Artery Bypass Graft Surgery.

BACKGROUND: Postoperative atrial fibrillation (AF) is a common complication after cardiac surgery. We investigated whether perioperative cardiac troponin T (cTnT) is associated with the risk of AF after coronary artery bypass grafting (CABG). METHODS: Two thousand four hundred twenty-one patients with isolated CABG were studied. High sensitivity cTnT (hs-cTnT) was assessed before and then at 80 hour and 24 hour after the operation. Logistic regression models were applied to investigate the association of perioperative hs-cTnT with postoperative AF. The ROC curve analysis was applied to determine the optimal cutoff values. RESULTS: Postoperative AF was occurred in 356 (14.7%) patients. Age (adjusted odds ratio [ORs] 1.087-1.090), male gender (OR 1.390), left atrium size (ORs 1.055-1.111), on-pump coronary bypass (OR 1.561), and application of intra-aortic balloon pump (ORs 2.890-2.966) were independently associated with AF. Preoperative hs-cTnT was associated with AF in patients with off-pump coronary bypass (ORs 1.997-2.375). However, the area under the curve for preoperative hs-cTnT was 0.625 in this group. On-pump coronary bypass had major influence on postoperative hs-cTnT levels regardless of the occurrence of AF. CONCLUSIONS: Preoperative hs-cTnT level is associated with the risk of AF after isolated CABG in patients undergoing off-pump coronary bypass, but the accuracy of this biomarker is yet inadequate. Postoperative levels of hs-cTnT have no predictive value considering large influence by the surgical technique and the cardiac surgery itself. Therefore, perioperative hs-cTnT is not a clinically useful biomarker for predicting AF following CABG.

Determining the Entrepreneurial and Intrapreneurial Intentions of Student Pharmacists in Iran.

Objective. To identify factors and entrepreneurial characteristics associated with entrepreneurial and intrapreneurial intentions among Doctor of Pharmacy (PharmD) students in Iran.Methods. First, the Entrepreneurial-Intrapreneurial Pharmacist Questionnaire (EIPQ), which was developed in the United States, was translated from English to Persian. The paper-based Persian-EIPQ questionnaire was then tested in a convenience sample of student pharmacists enrolled in pharmacy schools in Iran. The entrepreneurial characteristics questionnaire was evaluated using exploratory factor analysis with varimax rotation. Internal consistency was examined using Cronbach alpha. The association of demographics and educational variables and entrepreneurial characteristics with entrepreneurial and intrapreneurial intentions was determined using a multiple linear regression model.Results. A total of 504 surveys, 98.6% of the completed questionnaires received, were analyzed. A majority of the participants were female (75.8%) and from 18 to 25 years old (92.2%). Entrepreneurial intention had a positive and significant association with risk-taking propensity, leadership self-efficacy, autonomy, achievement motivation, and having an entrepreneur in the family. Intrapreneurial intention had a positive and significant association with risk-taking propensity, leadership self-efficacy, achievement motivation, people liking, attending a private school, and having an entrepreneur in the family.Conclusion. Based on the findings, student pharmacists with higher levels of risk-taking propensity, achievement motivation, leadership self-efficacy, autonomy, and people liking may be more likely to have greater levels of entrepreneurial and/or intrapreneurial intention.

Comparison of heart rate variability and cardiac arrhythmias in polluted and clean air episodes in healthy individuals.

OBJECTIVE: Pathophysiological mechanisms and pathways linking cardiovascular mortality and morbidity with air pollution were recently hypothesized. The present study evaluated association between air pollution and changes in heart rate variability as a marker of cardiac autonomic function in healthy individuals, and also determined the frequency of cardiac arrhythmias and QT interval changes on polluted compared to unpolluted days. METHODS: Continuous Holter electrocardiography (ECG) monitoring was conducted on 21 young healthy individuals in the two episodes of clean air and elevated air pollution in Tehran. All subjects underwent a medical history review, a physical examination and echocardiography in order to rule out structural heart diseases. Measured pollutants and parameters included NO(2), CO(2), O(3), SO(2), and PM10, which all showed significantly higher concentrations on polluted days. Holter parameters were measured for 24-h time segments and compared. RESULTS: Maximum heart rate was significantly lower in polluted air conditions in comparison with clean air conditions (115.1 ± 32.2 vs. 128.9 ± 17.7), and the square root of the mean of squared differences between adjacent NN intervals (r-MSSD) was higher in polluted air compared to clean air (99.0 ± 58.2 vs. 58.5 ± 26.4). Also, the occurrence of nonsustained supraventricular tachycardia was reported in 42.9% of participants in air pollution episodes, whereas this arrhythmia was not seen in clear air conditions (p = 0.001). CONCLUSION: Changes in air pollution indices may lead to the occurrence of nonsustained supraventricular tachycardia, a slight reduction in maximum heart rate, and an increase in r-MSSD in healthy individuals. Air quality monitoring in cities associated with a high exposure to air pollutants is recommended in order to prevent such events.

Characterization of suitability of coronary venous anatomy for targeting left ventricular lead placement in patients undergoing cardiac resynchronization therapy.

BACKGROUND: Differences in the quantity and distribution of coronary veins between patients with ischemic and nonischemic cardiomyopathy might affect the potential for the left ventricular (LV) lead targeting in patients undergoing cardiac resynchronization therapy (CRT). In the current study, we assessed and compared the suitability of the coronary venous system for the LV lead placement in ischemic and dilated cardiomyopathy. METHODS: This single-centre study, performed at our hospital, retrospectively studied 173 patients with the New York Heart Association class III or IV who underwent CRT. The study population was comprised of 74 patients with an ischemic underlying etiology and 99 patients with a non-ischemic etiology. The distribution of the veins as well as the final lead positions was recorded. RESULTS: There was no significant difference between the two groups in terms of the position of the available suitable vein with the exception of the posterior position, where the ischemic group had slightly more suitable veins than did the dilated group (48.4% versus 32.1%, p value = 0.049). There was also no significant difference with respect to the final vein, through which the LV lead was inserted. Comparative analysis showed that the patients with previous coronary artery bypass grafting surgery (CABG) had significantly fewer suitable veins in the posterolateral position than did the non-CABG group (16.3% versus 38.7%, p value = 0.029). There was, however, no significant difference between the two subgroups regarding the final vein position in which the leads were inserted. CONCLUSION: The final coronary vein position suitable and selected for the LV lead insertion was not different between the cases with cardiomyopathy with different etiologies, and nor was it different between the ischemic cases with and without a history of CABG. Patients with a history of procedures around the coronary vessel may have an intact or recovered venous system and may, therefore, benefit from transvenous LV lead placement for CRT.

Reform in medical ethics curriculum: a step by step approach based on available resources.

In this project, we aimed to revise the medical ethics curriculum at the School of Medicine, Tehran University of Medical Sciences, in order to promote the level of students' ethical awareness and enable them to make ethical decisions. Ideal and long term educational objectives were set to determine directions for future reforms and to provide a baseline for future evaluation of the project. However, based on limited available recourses, the first stage of the reform was planned and implemented with a 3 years scope. In revising the curriculum, which was done according to the Harden's ten questions, we focused on moral attitude and ethical reasoning skill in addition to academic knowledge base by using methods such as case discussions, portfolio, and clinical ethics rounds. The revised curriculum was implemented during the first semester of the 2006-2007 academic year for the first time. The student feedback indicated that the new curriculum was successful in increasing the students' awareness of ethical issues and enabled them to understand and accept their professional obligations. Revising the curriculum and its evaluation should be considered as an ongoing process. The present project was a successful experience that motivated faculty members to pursue the next steps of improving the curriculum on medical ethics and proved to be convincing for the authorities and policy makers to support it.

Pre-participation Cardiovascular Screening of Elderly Wrestlers.

PURPOSE: Sudden death of a competitive athlete is a tragedy that is usually caused by a previously unsuspected cardiovascular disease. The aim of this study was to clarify the role of noninvasive testing in pre-participation cardiovascular evaluation of elderly wrestlers. METHODS: We included 63 Iranian elderly wrestlers who participated in Tehran international elderly wrestlers' preparation camping by census method. A questionnaire including past medical and family history as well as coronary risk factors was filled out and then a complete physical examination of the cardiovascular system was done by an internist for all wrestlers. Electrocardiogram (ECG), complete echocardiographic examination and then symptom limited exercise test were performed and reported by the cardiologists who did not know the other examinations results. RESULTS: Exertional dyspnea and typical chest pain (FC=I or II) were present in 5% and 1.7% of the examinees, respectively. There were one or more risk factors in 64.5% of the cases. Cardiovascular examination revealed abnormal heart sounds in 27.1%. ECG showed ischemic changes in 13.6% and premature atrial contractions and premature ventricular contractions in 11.4%. Echocardiography showed mild left ventricular systolic dysfunction in 3.4%, regional wall motion abnormality in 8.5%, valvular disease in 32.3%, diastolic dysfunction in 45.7%, and left ventricular hypertrophy in 16.9% of the cases. Exercise test results were negative, equivocal, positive and highly positive in 70.4%, 15.8%, 5.2%, and 8.6% of cases, respectively. CONCLUSION: Beside physical examination, pre-participation screening of elderly wrestling athletes with ECG and exercise testing is feasible and recommended in the presence of coronary risk factors or cardiac symptoms. Echocardiography can also be recommended to detect other relevant abnormalities when there is a clue in the standard history, physical examination or ECG.

The effects of a 10-week water aerobic exercise on the resting blood pressure in patients with essential hypertension.

PURPOSE: To investigate the effects of a 10-week water aerobic exercise on the resting blood pressure in patients with stage 1 or 2 hypertension referring to Tehran University Clinics. METHODS: Forty men with stage 1 or 2 essential hypertension were assigned to two groups of intervention [n = 12; aged 48.33±10.74 years (mean±SD)] and control [n = 28; aged 46.96±11.58 years (mean±SD)]. Subjects in the intervention group participated in a supervised 10-week water aerobic training program of 55 min sessions, 3 days per week on alternate days, while those in the control group were not involved in any regular training program during this period. Blood pressure of the participants was recorded and compared at the beginning and at the end of the study (48 hours after the last training session). RESULTS: Exercise lowered systolic blood pressure and mean arterial pressure by 11.71 (95% confidence interval: 5.07 to 18.35) and 5.90 (95% confidence interval: 1.17 to 10.63) mm Hg respectively. The lowering effect of exercise on diastolic blood pressure was neither statistically significant nor clinically important (0.55 mm Hg; P. value = 0.8). There was no significant effect of age, baseline body mass index and stage of hypertension on the exercise-induced changes in blood pressure. CONCLUSION: A 10-week course of water aerobic exercise markedly reduced the systolic and mean arterial blood pressure of patients with essential hypertension and is especially recommended for the obese and the elderly who have orthopedic problems or bronchospasm.

Radiofrequency Catheter Ablation of Atrioventricular Nodal Reentrant Tachycardia: Success Rates and Complications during 14 Years of Experience.

BACKGROUND: Radiofrequency catheter ablation (RFCA) has been introduced as the treatment of choice for supraventricular tachycardia. The aim of this study was to evaluate the success rate as well as procedural and in-hospital complications of RFCA for the treatment of atrioventricular nodal reentrant tachycardia (AVNRT). METHODS: Between March 1995 and February 2009, 544 patients (75.9% female, age: 48.89 ± 13.19 years) underwent 548 RFCAs for AVNRT in two large university hospitals. Echocardiography was performed for all the patients before and after the procedure. Electrocardiograms were recorded on digital multichannel systems (EP-Med) or Bard EP system. Anticoagulation was initiated during the procedure. RESULTS: From the 548 patients, 36 had associated arrhythmias, atrial flutter (4%), atrial fibrillation (0.7%), concurrent atrial fibrillation and atrial flutter (0.7%), and concealed atrioventricular pathway (0.4%). The overall success rate was 99.6%. There were 21 (3.9%) transient III-degree AV blocks (up to a few seconds) and 4 (0.7%) prolonged II- or III-degree AV blocks, 2 (0.25%) of which required permanent pacemaker insertion, 3(0.5%) deep vein thrombosis, and one (0.2%) arteriovenous fistula following the procedure. No difference was observed in the echocardiography parameters before and after the ablation. CONCLUSION: RFCA had a high success rate. The complication rate was generally low and in the above-mentioned centers it was similar to those in other large centers worldwide. Echocardiography showed no difference before and after the ablation. The results from this study showed that the risk of permanent II or III-degree AV block in patients undergoing RFCA was low and deep vein thrombosis was the second important complication. There was no risk of life-threatening complications.