Clinical Characteristics and Outcomes of COVID-19 in 1294 New Cancer Patients: Single-Center, Prospective Cohort Study from Iran.

OBJECTIVE: To determine the clinical characteristics and outcomes of COVID-19 in a large cohort of new cancer patients referred to an oncology clinic in the north of Iran. METHODS: During the 20-month COVID-19 pandemic, new cancer patients were followed-up. Demographic, pathologic, and clinical variables were collected for each patient. COVID-19 was confirmed based on a positive polymerase chain reaction test. Analyses were performed using the STATA version 14.0 at a significance level of 0.05. RESULTS: In this study, 1294 new cancer patients were followed for 24 months (mean age: 58.7 years [range 10-95]). During the study period, COVID-19 was diagnosed in 9.4% of the patients with hospitalization rate of 3.4%, an ICU admission rate of 0.7%, and COVID-19 mortality rate of 4.9%. Hematological malignancies (ORU= 2.6, CI95% 1.28-5.34), receiving palliative treatments (ORA=3.03, CI95% 1.6-5.45) and receiving radiotherapy (ORA=2.07, 1.17-3.65) were the most common predictive factors of COVID infection in cancer patients. Also, the COVID mortality was higher in brain cancer patients (p = 0.07), metastatic disease (p = 0.01) and patients receiving palliative treatments (p = 0.02). CONCLUSION: In patients suffering from cancer, COVID-19 infection can be predicted by cancer type, palliative care, and radiotherapy in cancer patients. Furthermore, brain cancers, metastasis, and palliative care were all associated with COVID-19-related mortality.

No evidence of a causal association of type 2 diabetes and glucose metabolism with atrial fibrillation.

AIMS/HYPOTHESIS: Several epidemiological studies have shown an increased risk of atrial fibrillation in individuals with type 2 diabetes or milder forms of dysglycaemia. We aimed to assess whether this relation is causal using a Mendelian randomisation approach. METHODS: Two-sample Mendelian randomisation was used to obtain estimates of the influence of type 2 diabetes, fasting blood glucose (FBG), and HbA1c on the risk of atrial fibrillation. Instrumental variables were constructed using available summary statistics from meta-analyses of genome-wide association studies (GWAS) for type 2 diabetes and associated phenotypes. Pleiotropic SNPs were excluded from the analyses. The most recent GWAS meta-analysis summary statistics for atrial fibrillation, which included over 1 million individuals (approximately 60,000 individuals with atrial fibrillation) was used for outcome analysis. RESULTS: Neither type 2 diabetes (OR 1.01 [95% CI 0.98, 1.03]; p = 0.37), nor FBG (OR 0.95 [95% CI 0.82, 1.09] per mmol/l; p = 0.49) or HbA1c (OR 1.01 [95% CI, 0.85, 1.17] per mmol/mol [%]; p = 0.88) were associated with atrial fibrillation in Mendelian randomisation analyses. We had >80% statistical power to detect ORs of 1.08, 1.06 and 1.09 or larger for type 2 diabetes, FBG and HbA1c, respectively, for associations with atrial fibrillation. CONCLUSIONS/INTERPRETATION: This Mendelian randomisation analysis does not support a causal role of clinical significance between genetically programmed type 2 diabetes, FBG or HbA1c and development of atrial fibrillation. These data suggest that drug treatment to reduce dysglycaemia is unlikely to be an effective strategy for atrial fibrillation prevention. DATA AVAILABILITY: The datasets analysed during the current study are available from the following repository: Nielsen JB, Thorolfsdottir RB, Fritsche LG, et al (2018) GWAS summary statistics for AF (N=60,620 AF cases and 970,216 controls). Center for Statistical Genetics: http://csg.sph.umich.edu/willer/public/afib2018/nielsen-thorolfsdottir-willer-NG2018-AFib-gwas-summary-statistics.tbl.gz.

GABRIC Diabetes School: an innovative education centre for people with diabetes.

Diabetes prevalence and deaths attributable to diabetes continue to rise across globally. Diabetes Self-Management Education and Support (DSME/S) is a critical resource designed to help people with diabetes (PWD) successfully selfmanage their disease; however, its utilization is too low. In the Islamic Republic of Iran, there are currently limited structured educational programmes and no national standards for DSME/S protocol. In response to this, the GABRIC Diabetes Education Association (GDEA) has been developed as a school for diabetics, which has a comprehensive DSME/S programme for PWD with 18 distinct courses on 5 levels for 8 target groups. In addition, GABRIC has developed a database registry with more than 100 000 members throughout the country, of whom 95% are diabetic with a proportion of 82% Type 2 diabetes and 13% Type 1 diabetes. The success of the GABRIC school model results is yet to be investigated through study trials, and offers a fruitful line of research.

Acute Cholestatic Liver Injury From Hydralazine Intake.

Hydralazine is a commonly used oral antihypertensive agent. We report a rare case of hydralazine-induced hepatotoxicity in the form of subacute hepatic necrosis. A 75-year-old African American woman presented with jaundice of 7-day duration. She was started on hydralazine 100 mg 3 times a day 10 weeks before presentation. On physical examination, scleral icterus was noted. Workup revealed elevated liver transaminases, alkaline phosphatase, and conjugated bilirubin. She had no history of liver disease, and liver function tests had been normal before starting hydralazine. Other etiologies, including viruses, common toxins, drugs, autoimmune, and copper-induced hepatitis, were excluded. Abdominal imaging studies did not show any evidence of intrahepatic or extrahepatic biliary ductal dilatation, and no pathologies were seen in the liver and pancreas. The patient's liver biopsy revealed extensive lobular hepatitis, significant necrosis, mixed inflammatory infiltrate, and no significant fibrosis, supporting a diagnosis of drug-induced liver injury. Hydralazine was immediately discontinued. She showed improvement of clinical and laboratory abnormalities within 5 days after discontinuation of hydralazine. To establish the diagnosis of hydralazine-induced liver injury, we used assessment tool outlined by the Council for International Organization of Medical Sciences (CIOMS) scale that led to "high probable" relationship. Although rare, clinically significant, and potentially life-threatening liver injury can result from use of hydralazine. Both clinical and histological presentations in our patient suggest acute liver injury. The hydralazine-induced hepatitis seems to be reversible as discontinuation of the drug improves clinical outcomes. We highly recommend monitoring of the liver function during hydralazine treatment.

COVID-19 Vaccination in Patients With Malignancy; A Systematic Review and Meta-Analysis of the Efficacy and Safety.

Background: Data on the efficacy and safety of COVID-19 vaccines in patients with malignancy are immature. In this paper, we assessed the literature involving the use of COVID-19 vaccines in cancer patients and reported the seroconversion rates as the main outcome and severity of COVID-19 infection and side effects following COVID-19 vaccination as the secondary outcomes. Methods: A systematic review with meta-analysis was performed. Searches were conducted in electronic websites, databases, and journals, including Scopus, PubMed, Embase, and Web of Science from January 01, 2019, to November 30, 2021. Studies reporting data on the safety and efficacy of COVID vaccine in cancer patients using any human samples were included. The risk of bias was assessed using the NEWCASTLE-OTTAWA scale in the included studies. Results: A total of 724 articles were identified from databases, out of which 201 articles were duplicates and were discarded. Subsequently, 454 articles were excluded through initial screening of the titles and abstracts. Moreover, 41 studies did not report the precise seroconversion rate either based on the type of cancer or after injection of a second dose of COVID vaccine. Finally, 28 articles met all the inclusion criteria and were included in this systematic review. The overall seroconversion rates after receiving a second dose of COVID-19 vaccine, based on type of cancer were 88% (95% CI, 81%-92%) and 70% (95% CI, 60%-79%) in patients with solid tumors and hematologic malignancies, respectively. Conclusion: Overall, we conclude that vaccination against COVID-19 in patients with active malignancies using activated and inactivated vaccines is a safe and tolerable procedure that is also accompanied by a high efficacy.

A simple risk score effectively predicted type 2 diabetes in Iranian adult population: population-based cohort study.

BACKGROUND: Although several strategies to predict the development of diabetes have been developed the question is whether better scores can be developed without sacrificing simplicity. METHODS: Data on 3242 participants of Tehran Lipid and Glucose Study aged ≥20 years, without diabetes at the baseline that completed a ~6-year follow-up were used to develop prediction models by running a series of logistic regression model. A simple score system was then developed based on the most important variables selected with forward stepwise approach. RESULTS: During follow-up, 231 individuals developed diabetes. The area under the receiver operating characteristic curve for the score system based on the model including systolic blood pressure (SBP), family history of diabetes, waist-to-height ratio (WHtR), triglyceride-to-high-density lipoprotein cholesterol ratio (TG/HDL-C) ≥3.5 and fasting plasma glucose (FPG) levels ≥5 mmol l(-1) was 0.83 (95% CI 0.80-0.86); the model discriminated subjects with substantial risk for diabetes, appreciably better than 2-h post-challenge plasma glucose (2h-PCPG) alone (0.78; 95% CI 0.75-0.82) (P < 0.001). Scoring ≥25 yielded a positive likelihood ratio of 3.27. FPG levels even in the presence of 2h-PCPG predicted incident diabetes. CONCLUSION: We presented a simple model based on SBP, family history of diabetes, WHtR, TG/HDL-C and FPG; concluding that this approach is superior to relying exclusively on the 2h-PCPG for identifying individuals at high risk for developing diabetes in a Middle Eastern adult population.

Lipid measures for prediction of incident cardiovascular disease in diabetic and non-diabetic adults: results of the 8.6 years follow-up of a population based cohort study.

BACKGROUND: Diabetes is a strong risk factor for cardiovascular disease (CVD).The relative role of various lipid measures in determining CVD risk in diabetic patients is still a subject of debate. We aimed to compare performance of different lipid measures as predictors of CVD using discrimination and fitting characteristics in individuals with and without diabetes mellitus from a Middle East Caucasian population. METHODS: The study population consisted of 1021 diabetic (men = 413, women = 608) and 5310 non-diabetic (men = 2317, women = 2993) subjects, aged > or = 30 years, free of CVD at baseline. The adjusted hazard ratios (HRs) for CVD were 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), non-HDL-C, TC/HDL-C and log-transformed TG/HDL-C using Cox proportional regression analysis. Incident CVD was ascertained over a median of 8.6 years of follow-up. RESULTS: A total of 189 (men = 91, women = 98) and 263(men = 169, women = 94) CVD events occurred, in diabetic and non-diabetic population, respectively. The risk factor adjusted HRs to predict CVD, except for HDL-C, TG and TG/HDL-C, were significant for all lipid measures in diabetic males and were 1.39, 1.45, 1.36 and 1.16 for TC, LDL-C, non- HDL-C and TC/HDL-C respectively. In diabetic women, using multivariate analysis, only TC/HDL-C had significant risk [adjusted HR1.31(1.10-1.57)].Among non-diabetic men, all lipid measures, except for TG, were independent predictors for CVD however; a 1 SD increase in HDL-C significantly decreased the risk of CVD [adjusted HR 0.83(0.70-0.97)].In non-diabetic women, TC, LDL-C, non-HDL-C and TG were independent predictors.There was no difference in the discriminatory power of different lipid measures to predict incident CVD in the risk factor adjusted models, in either sex of diabetic and non-diabetic population. CONCLUSION: Our data according to important test performance characteristics provided evidence based support for WHO recommendation that along with other CVD risk factors serum TC vs. LDL-C, non-HDL-C and TC/HDL-C is a reasonable lipid measure to predict incident CVD among diabetic men. Importantly, HDL-C did not have a protective effect for incident CVD among diabetic population; given that the HDL-C had a protective effect only among non- diabetic men.

Population-based incidence of Type 2 diabetes and its associated risk factors: results from a six-year cohort study in Iran.

BACKGROUND: The Middle East is estimated to have the largest increase in prevalence of diabetes by 2030; yet there is lack of published data on the incidence of Type 2 diabetes in this region. This study aimed to estimate Type 2 diabetes incidence and its associated risk factors in an Iranian urban population. METHODS: Among 3307 non-diabetics >or= 20 years (mean age 42 +/- 13 years, 42% males), glucose tolerance test was performed at baseline in 1999-2001 and at two consecutive phases in 2001-2005 and 2005-2008. Diabetes and glucose tolerance status were defined according to the ADA 1997 criteria. Logistic regression was used to determine the independent variables associated with incident diabetes and their odds ratios (OR). RESULTS: After median follow-up of 6 years, 237 new cases of diabetes were ascertained corresponding to an age and sex standardized cumulative incidence of 6.4% (95%CI: 5.6-7.2) and incidence rate of 10.6 (9.2-12.1) per 1000 person years. Besides classical diabetes risk factors, female sex and low education level significantly increased risk of diabetes in age adjusted models. In full model, the independent predictors were age [OR, 95%CI: 1.2 (1.1-1.3)], family history of diabetes [1.8 (1.3-2.5)], body mass index >or= 30 kg/m2 [2.3 (1.5-3.6)], abdominal obesity [1.9 (1.4-2.6)], high triglyceride [1.4 (1.1-1.9)], Isolated impaired fasting glucose (IFG) [7.4 (3.6-15.0)], Isolated impaired glucose tolerance (IGT) [5.9 (4.2-8.4)] and combined IFG and IGT [42.2 (23.8-74.9)]. CONCLUSION: More than 1% of the Iranian urban population older than 20 years develops Type 2 diabetes each year. Combination of IFG and IGT was the strongest predictor of incident diabetes among the modifiable risk factors.

Association of liver enzymes with incident type 2 diabetes: A nested case control study in an Iranian population.

BACKGROUND: To investigate the association of Aspartate aminotransferase (AST), Alanin aminotranferase (ALT) and Gamma glutamyl transferase (GGT) with incident type 2 diabetes. METHODS: In a nested case-control study, AST, ALT, GGT as well as classic diabetes risk factors, insulin and C-reactive protein (CRP) were measured in 133 non-diabetic subjects at baseline of which 68 were cases and 65 were controls. Incident diabetes was defined by the WHO 1999 criteria. Conditional logistic regression was used to calculate the odds ratio (OR) of incident diabetes associated with different hepatic markers. We used factor analysis for clustering of classic diabetes risk factors. RESULTS: In Univariate analysis both ALT and GGT were associated with diabetes with ORs of 3.07(1.21-7.79) and 2.91(1.29-6.53) respectively. After adjustment for CRP and insulin, ALT and GGT were still predictive of incident diabetes. When the model was further adjusted for anthropometric, blood pressure and metabolic factors, only ALT was independently associated with diabetes [OR = 3.18 (1.02-9.86)]. No difference was found between the area under the receiver operating characteristic curves of the models with and without ALT (0.820 and 0.802 respectively, P = 0.4) CONCLUSION: ALT is associated with incident type 2 diabetes independent of classic risk factors. However, its addition to the classic risk factors does not improve the prediction of diabetes.

High prevalence of undiagnosed diabetes and abnormal glucose tolerance in the Iranian urban population: Tehran Lipid and Glucose Study.

BACKGROUND: To estimate the prevalence of diagnosed and undiagnosed diabetes mellitus, impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and combined IFG/IGT in a large urban Iranian population aged > or = 20 years. METHODS: The study population included 9,489 participants of the Tehran Lipid and Glucose Study with full relevant clinical data. Age-standardized prevalence of diabetes and glucose intolerance categories were reported according to the 2003 American Diabetes Association definitions. Age-adjusted logistic regression models were used to estimate the numbers needed to screen (NNTS) to find one person with undiagnosed diabetes. RESULTS: The prevalence of diagnosed and undiagnosed diabetes, isolated IFG, isolated IGT, and combined IFG/IGT were 8.1%, 5.1%, 8.7%, 5.4% and 4.0% in men and 10%, 4.7%, 6.3%, 7.6%, and 4.5% in women respectively. Participants with undiagnosed diabetes had higher age, body mass index (BMI), waist circumference, systolic and diastolic blood pressures, triglycerides (all p values <0.001) and lower HDL-cholesterol (only in women, p < 0.01) compared to normoglycemic subjects. Undiagnosed diabetes was associated with family history of diabetes, increased BMI (> or = 25 kg/m2), abdominal obesity, hypertriglyceridemia, hypertension and low HDL-cholesterol levels. Among men, a combination of increased BMI, hypertension, and family history of diabetes led to a NNTS of 1.6 (95% CI: 1.57-1.71) and among women a combination of family history of diabetes and abdominal obesity, yielded a NNTS of 2.2 (95% CI: 2.1-2.4). CONCLUSION: In conclusion, about one third of Tehranian adults had disturbed glucose tolerance or diabetes. One- third of total cases with diabetes were undiagnosed. Screening individuals with BMI > or = 25 kg/m2 (men), hypertension (men), abdominal obesity (women) and family history of diabetes may be more efficient.

Hypothyroidism and Hypoparathyroidism in Thalassemia Major Patients: A Study in Sistan and Baluchestan Province, Iran.

BACKGROUND: Hypothyroidism (HT) and hypoparathyroidism (HPT) are common endocrine complications in thalassemia major (TM) patients. OBJECTIVES: In the present study, we assessed the frequency of HT and HPT in a population of TM patients in Southeast of Iran. METHODS: This cross sectional study was performed on 194 TM patients in Zabol, Sistan and Baluchestan Province, Iran, during February - July 2016. The demographic, clinical, and laboratory data were collected via interviews and history - taking. For hormone measurements, specific ELISA kits were used. Statistical analysis was performed in SPSS version 16. RESULTS: A total of 103 (53.1%) and 91 (46.9%) females and males were recruited in this study, respectively. The mean age of the patients was 15 ± 7.5 years. HT and HPT showed overall frequencies of 8.2% (18/194) and 18% (35/194), respectively. Subclinical and overt HT were observed in 13 (6.7%) and 5 (2.6%) patients, respectively. There was no significant association between HT and age, while patients with HPT were significantly older than those without HPT (20.1 ± 5.8 vs. 13.9 ± 6.2 years; P < 0.001). HPT was significantly associated with the mean received blood per transfusion (P = 0.009), total transfused blood per year (P = 0.01), splenomegaly (P < 0.001), splenectomy (P < 0.001), hepatomegaly (P = 0.01), and chelation regimen (P < 0.001). The ferritin level was correlated with neither HT nor HPT. Also, no significant difference was observed between patients with or without HT or HPT regarding the cooccurrence of either diabetes or hepatitis C virus (HCV) infection. In the multivariate analysis, splenectomy remained an independent risk factor for HPT after correction for potential covariates (OR, 6.5; 95% CI, 1 - 39.2; P = 0.04). CONCLUSIONS: In patients with TM, HT was a complication with a relatively low frequency, while HPT was more common. Based on the findings, HPT was more frequent in older patients receiving regular blood transfusions, thereby necessitating close monitoring of these patients.

Diabetes Mellitus: Findings from 20 Years of the Tehran Lipid and Glucose Study.

CONTEXT: We summarized findings from Tehran lipid and glucose study (TLGS) about different aspects of type 2 diabetes (T2D) over the span of nearly 2 decades. EVIDENCE ACQUISITION: A review was undertaken to retrieve papers related to all aspects of T2D from the earliest date available up to January 30, 2018. RESULTS: An annual crude incidence rate of 10 per 1000 person-years of follow-up was found for T2D in adult participants. Overall incidence rate of pre-diabetes/T2D was 36.3 per 1000 person-years or about 1% each year among youth. Diabetes was associated with increased risk of CVD [hazard ratio (HR): 1.86, 95% confidence interval (95% CI): 1.57 - 2.27] and mortality [HR: 2.56; 95% CI: 2.08 - 3.16] in the total population. Compared with non-diabetic men and women, their diabetic counterparts survived 1.4 and 0.7 years shorter, respectively, during 15 years of follow-up. Wrist circumference, hyperinsulinaemia, 25-hydroxy vitamin D and increase in alanin aminotranferase provided incremental prognostic information beyond the traditional risk factors for incident T2D in adults. Using decision tree algorithms, a number of high risk groups were found for incident T2D. A probability of 84% was found for incidence of T2D among a group of men with fasting plasma glucose (FPG) > 5.3 mmol/L and waist to height ratio (WHtR) > 0.56, and women with FPG > 5.2 mmol/L and WHtR > 0.56. CONCLUSIONS: Original TLGS studies have contributed greatly to clarify important evidence regarding the epidemiology and risk factors for T2D among Iranian population.

The prospective association of general and central obesity variables with incident type 2 diabetes in adults, Tehran lipid and glucose study.

OBJECTIVE: To investigate which anthropometric index is the best predictor of diabetes in relation to age. METHODS: In this longitudinal study 4479 non-diabetic men and women aged > or =20 years were followed for 3.6 years. Diabetes with its risk factors and obesity were defined according to the ADA and the WHO criteria, respectively. Logistic regression analysis was used to estimate the odds ratio (OR) of developing diabetes in model 1 including only the anthropometric measure and in model 2 adjusted for common diabetes risk factors and in model 3 adjusted for other anthropometric indices plus all the variables in model 2. RESULTS: A total of 166 new cases of type 2 diabetes were diagnosed. In subjects aged <60 years general obesity and high waist-to-hip ratio (WHR) predicted diabetes in all three models with OR of 2.4 and 2.6 in model 3, respectively, while high waist circumference (WC) lost it association with diabetes in the full model. In subjects aged > or =60 years, however, high WC was the only independent predictor of diabetes in model 3 with OR of 3.8 while high WHR and general obesity predicted diabetes in models 1 and 2, respectively. CONCLUSION: General obesity and high WHR in Iranian subjects aged <60 years and high WC in older ones are the important predictors of type 2 diabetes.

Metabolic syndrome in normal-weight Iranian adults.

BACKGROUND: This study provides the first reported estimates of the prevalence of the metabolic syndrome in a normal-weight Iranian population. SUBJECTS AND METHODS: In this population-based cross-sectional study, the study population consisted of a representative sample of 1737 males and 1707 females aged > or = 20 years with normal body mass index (BMI) (18.5-24.9 kg/m2 for both genders). The metabolic syndrome was defined according to the Adult Treatment Panel III guidelines. We present means and proportions, and multivariate odds ratios that quantify the association between metabolic syndrome and normal BMI quartiles, controlling for age, physical activity, smoking and education. RESULTS: The overall prevalence of the metabolic syndrome in normal-weight men and women were 9.9% and 11.0% (P=0.2) respectively. Men had a lower BMI than women, while their waist circumference (WC) was higher. The prevalence of high WC and low high-density lipoprotein cholesterol (HDL-C) was higher in women, while high blood pressure, high triglyceride levels and having at least one metabolic risk factor were more prevalent in men. Individuals in the highest category of normal BMI had significantly higher odds for being at risk for metabolic syndrome compared to those in the first category (OR: 5.21 for men and 2.15 for women). There was an increasing trend in odds for having all the metabolic syndrome components except for high fasting blood sugar (FBS) and high WC in men. Women showed a similar increasing trend except for high FBS across normal BMI quartiles. CONCLUSION: The prevalence of the metabolic syndrome in normal-weight Iranian adults is relatively high. Therefore, interventions for prevention of cardiovascular disease could be considered in this population.

Prevalence of gestational diabetes mellitus in southern Iran (Bandar Abbas City).

OBJECTIVE: To estimate and report the prevalence of gestational diabetes mellitus (GDM) in pregnant women of Bandar Abbas, a city in southern Iran. METHODS: From March 2002 to March 2004, 800 pregnant women underwent assessment for GDM in obstetrics clinics in Bandar Abbas. The medical history and risk factors for GDM were recorded, and the weight, height, and blood pressure were measured. All the women were screened for GDM by a 1-hour, 50-g oral glucose tolerance test (OGTT), with a cutoff point of 130 mg/dL. All patients with a "positive" screening test result underwent a 3-hour OGTT with 100 g of glucose. RESULTS: The prevalence rate of GDM in our study was 6.3% (95% confidence interval, 4.7% to 8.4%) and 8.9% (95% confidence interval, 6.9% to 11.3%) with use of the National Diabetes Data Group and the Carpenter and Coustan criteria, respectively. The patients with GDM were significantly older than the normal group of pregnant women (28.2 +/- 5.6 years versus 24.6 +/- 5.2 years, respectively) (P<0.001). The mean number of pregnancies, systolic blood pressure, and body mass index (BMI) were significantly higher in the GDM group than in the normal pregnant women (P<0.05). Among the recorded risk factors, only age (3)25 years, history of macrosomia in previous newborns, and BMI (3)25 kg/m2 were significantly more prevalent in the GDM group than in the normal group (P<0.05). If selective screening criteria for GDM had been applied, 11.3% of patients with GDM would have been missed. CONCLUSION: This study showed a higher prevalence of GDM in Bandar Abbas in comparison with other parts of Iran. Screening for GDM in all pregnant women in Bandar Abbas seems necessary, regardless of the presence of risk factors for GDM.

Evaluating the incidence of cognitive disorder following off-pump coronary artery bypasses surgery and its predisposing factors.

BACKGROUND: Cognitive disorder is a fluctuating cognitive destruction and a common problem for hospitalized patients, which leads to loss of consciousness. It is usually accompanied with increased mortality, prolonged hospital stay, and decreased rehabilitation. OBJECTIVES: The purpose of this study was to determine risk factors associated with cognitive disorder after open-heart surgery. PATIENTS AND METHODS: In total, 171 patients who had undergone off-pump open-heart surgery and lacked any history of psychiatric disorders were enrolled. Samples were selected according to a purposive sampling method. The Mini-Mental State Examination questionnaire was used for these patients to assess the incidence of cognitive disorder 24 hours after the operation in ICU and to compare creatinine level, ESR, extubation time and patients' age in the two groups, one with postoperative cognitive disorder and the other without it. Independent T-test was used to compare the two groups regarding any history of diseases such as diabetes, hypertension and hyperlipidemia, Chi square test was used. RESULTS: In total, 75% of patients had postoperative cognitive disorder. There was a significant association between the history of high blood pressure, C-reactive protein and preoperative creatinine levels in both cognitive disorder and control groups. CONCLUSIONS: Given the significant prevalence of postoperative cognitive disorder and significant associatio n between the history of high blood pressure, C-reactive protein and preoperative creatinine and cognitive disorder, detection of patient's clinical symptoms may improve diagnosis, treatment and prevention of this disorder.

Role of prostaglandin D2 and the autonomic nervous system in niacin-induced flushing.

BACKGROUND: Although niacin often has beneficial effects on the lipoprotein profile, flushing is an untoward effect associated with its use. Aspirin can only reduce the flushing response by 30-40%. Thus, the aim of the present study was to investigate the mechanisms of niacin-induced flushing, with and without aspirin, in normal, healthy individuals. METHODS: Niacin-induced flushing was evaluated in 30 healthy individuals after oral administration of 1000 mg niacin alone or with 325 mg aspirin. Neurological, autonomic nervous system, and skin blood flow measurements (using laser Doppler on the glabrous and hairy skin of each participant) were made at various times after drug administration. In addition, the systemic release of 9α,11ß-prostaglandin (PG) F(2) was determined. Flushing symptoms of redness, warmth, tingling, itching, and intensity were recorded using the modified Flushing ASsessment Tool (FAST). RESULTS: After aspirin, the mean flushing scores for all symptoms decreased significantly; however, 36-53% of participants still had some degree of symptoms, even though aspirin completely blocked 11ß-PGF(2) synthesis. Maximum skin blood flow (MaxSkBF) in both the glabrous and hairy forearm increased significantly after niacin, but decreased significantly after aspirin only in hairy skin. Regression analysis showed that, in glabrous skin, both PGF(2) and parasympathetic activity were significant predictors of MaxSkBF after niacin, contributing 26% and 14%, respectively (total R(2) = 40%). CONCLUSIONS: The present study indicates, for the first time, that the parasympathetic nervous system, in addition to PGD(2) , may play an important role in niacin-induced flushing. Changing the sympathetic/parasympathetic balance in favor of parasympathetic activation may be a good therapeutic target to reduce niacin-induced flushing.

Reduction in incidence of type 2 diabetes by lifestyle intervention in a middle eastern community.

BACKGROUND: Very few studies have used community-based interventions for primary prevention of Type 2 diabetes, and the direct effect of such interventions on diabetes incidence is relatively unknown. PURPOSE: This study aims to assess the effect of lifestyle modification on risk factors for noncommunicable diseases (NCDs) and the development of Type 2 diabetes at the community level. DESIGN: A cluster-controlled trial was conducted. SETTING/PARTICIPANTS: In all, 3098 and 5114 individuals in intervention and control groups, respectively (mean age=43 years), recruited from District 13 of Tehran, Iran, participated in the baseline examination in 1999-2001. Among these individuals, a total of 1754 and 2993 individuals in the intervention and control groups, respectively (58%), completed a follow-up examination in 2002-2005. INTERVENTION: The study intervention involved improvement in diet, increase in the level of physical activity, and reduction in cigarette smoking through educational interviews, lectures, and publications. MAIN OUTCOME MEASURES: Incident Type 2 diabetes was measured by fasting plasma glucose (FPG) and 2-hour plasma glucose (2hPG) and change in NCD risk factors. RESULTS: The mean follow-up time was 3.6 years. The incidence of diabetes in the control and intervention groups was 12.2 and 8.2 per 1000 person-years, respectively, with a relative risk reduction of 65% (95% CI=30%, 83%, p<0.003). The adjusted difference in mean change of risk factors between the intervention and control groups was significant for weight (-0.5 kg in men); BMI (-0.18 kg/m(2) in men); waist circumference (-1.0 cm in women); systolic and diastolic blood pressure (-1.1 and -0.6 mmHg, respectively, in women); FPG (-2.1 and -2.3 mg/dL in men and women); 2hPG (-4.6 mg/dL in women); total cholesterol (-2.8 mg/dL in women); triglycerides (-7.6 and -5.2 mg/dL in men and women); and high-density lipoprotein cholesterol (1.1 mg/dL in women; all p<0.05). CONCLUSIONS: Lifestyle intervention resulted in a significant decrease in the incidence of Type 2 diabetes and better control of NCD risk factors in a population-based setting. ISRCTN TRIAL REGISTRATION #: ISRCTN52588395.

Impaired fasting glucose cutoff value of 5.6 mmol/l combined with other cardiovascular risk markers is a better predictor for incident Type 2 diabetes than the 6.1 mmol/l value: Tehran lipid and glucose study.

OBJECTIVE: To investigate whether cutoff value of 5.6 mmol/l for impaired fasting glucose (IFG) improves the prediction of Type 2 diabetes mellitus (T2DM) in comparison to the 6.1 mmol/l value. RESEARCH DESIGN AND METHODS: A total of 5794 non-diabetic subjects aged 42+/-13 years were followed for 6.5 years. T2DM was defined based on the WHO 1999 criteria. Cox regression analysis was used to calculate the relative risk (RR) of developing T2DM. Model discrimination was assessed by calculating the area under the receiver operating characteristic curve (AUC). RESULTS: During the follow-up, there were 351 incident T2DM. The RR (95% CI) of the 6.1 and 5.6 mmol/l cutoffs were comparable in both univariate and multivariate analysis [9.6 (7.5-12.3) vs. 8.4 (6.4-10.0), respectively in univariate and 2.4 (1.8-3.2) vs. 3.3 (2.6-4.2), respectively in multivariate models]. Using the 5.6 mmol/l cutoff value in the multivariate model significantly improved its discrimination in comparison to the 6.1 mmol/l value [AUC (95% CI): 0.78 (0.74-0.83) vs. 0.74 (0.70-0.79), P<0.01]. Models with impaired glucose tolerance and fasting glucose had the highest AUC of 0.81(95% CI: 0.78-0.85). CONCLUSIONS: The 5.6 mmol/l cutoff value of IFG combined with other diabetes risk factors performs significantly better than the 6.1 mmol/l value for prediction of future T2DM.