Association between plasma leptin/adiponectin ratios with the extent and severity of coronary artery disease.

BACKGROUND: Leptin can have a direct effect on endothelial and vascular smooth muscle cells and high level of leptin is involved in the pathogenesis of atherosclerosis. This study aimed to determine the relationship between leptin/adiponectin (L/A) ratio and the extent and severity of coronary artery disease (CAD). METHODS: This case-control study was conducted in an educational hospital in Ilam, Iran from June 2014 to September 2015. Totally 300 participants including 150 patients with CAD (case group) and 150 healthy individuals (control group) were selected and their plasma leptin, adiponectin and leptin/adiponectin ratio was measured. The extent and severity of coronary artery disease were assayed based on the number of involved vessels and Gensini score (GS) and the relation between scores and L/A findings were compared between cases and controls. RESULTS: Totally, 300 participants including 150 (42.7% male), mean age 59.5 ± 11.4 years as cases and 150 (50.7% male), mean age 59.8 ± 10.7 as controls were analyzed. Plasma level of leptin and L/A ratio were higher in cases compared to controls, but level of adiponectin was significantly lower in CAD patients than the control group. More number of involved coronary vessels was significantly correlated to higher level of plasma leptin, L/A ratio and lower level of adiponectin among case group. Moreover, adiponectin was negatively and leptin or L/A ratio were positively correlated with number of involved vessels. 7.3% of cases had only one involved vessel, 42.7% had two involved vessels, and 50% of total patients had involved vessels and the mean ± SD of GS in the case group was 23.6 ± 6.9. CONCLUSIONS: Plasma levels of leptin, and adiponectin can indicate the extent of coronary artery diseases but leptin may be a better marker of extent of CAD than either L/A ratio or adiponectin separately.

Association between the increased level of high-sensitive CRP (hs CRP) and non-arrhythmic ECG changes and echocardiographic abnormalities in patients with acute coronary syndrome.

Background: Abnormality in the cardiovascular system such as left ventricular dysfunction caused increased serum CRP and change in electrocardiography pattern. The present study aimed to understand the association between increased levels of highly sensitive CRP (hs-CRP) and non-arrhythmic ECG changes and electrocardiographic abnormalities in patients with the acute coronary syndrome. Methods: This study was done on 120 patients diagnosed with acute coronary syndrome and hospitalized at CCU. The patients were classified into two groups, one group with an increased level of hs-CRP and another with a normal hs-CRP level. Results: The patients with an increased level of hs-CRP showed a significantly higher level of cardiac enzymes also ST-segment elevation myocardial infarction (STEMI) was seen in the group with an increased level of hs-CRP than those with normal serum hs-CRP level, but another diagnosis including unstable angina, non-STEMI, heart failure, and emergency hypertension was similarly observed in both groups. Two groups were assessed in terms of left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVeDD) the prevalence of valvular heart disease, and wall motion abnormality, also showed that groups with increased hs-CRP level, ST-segment elevation leads more significant differences than a normal group (P=0.001). Conclusion: Patients with an increased level of hs-CRP can be diagnosed as STEMI but not valuable to suppose as echocardiographic abnormalities such as left ventricular dysfunction or hypertrophy.

Early repolarization and the severity of coronary artery disease: A case-control study.

BACKGROUND: Early repolarization (ER) is a common finding of the routine electrocardiogram (ECG). The ER usually considered a benign ECG finding, nevertheless a controversy. This study was conducted to investigate the relationship between early repolarization (ER) and the severity of coronary artery disease in patients with a diagnostic coronary angiography. METHODS: This case-control study included ninety patients (45 patients and 45 control groups) with a diagnostic angiography and was conducted in 2015. After obtaining informed consent, patients with angiography for ER were considered as cases and those for other purposes were as controls. Data were analyzed using SPSS software Version 16. A p-value lesser than 0.05 was significant. RESULTS: The frequency of ER was higher in men (75.6%), and there was a significant relationship between sex and ER (P=0.003). The mean age of the patients in the ER group was lower than that of non-ER patients, but not statistically significant (P=0.1). Abnormal angiography was more prevalent in patients with ER than non-ER patients (59.6% vs. 40.4%). ER morphology showed a significant correlation to abnormal angiography and also stenosis severity (P=0.035). CONCLUSION: ER was higher in men than in women. There was a significant correlation between the existence of ER morphology and atherosclerosis severity. Screening programs for ER detection may reduce the risk of arrhythmias and prevent related complications.

A comparison of the effect of two methods of positioning the hands during basic and advanced cardiovascular life support on the chest compression depth in adults.

Introduction: There is no agreement on how the hands are positioned in cardiopulmonary resuscitation (CPR). In this study, the effects of two methods of positioning the hands during basic and advanced cardiovascular life support on the chest compression depth are compared. Methods: In this observational simulation, the samples included 62 nursing students and emergency medicine students trained in CPR. Each student performed two interventions in both basic and advanced situations on manikins and two positions of dominant hand on non-dominant hand, and vice versa, within four weeks. At each compression, the chest compression depth was numerically expressed in centimeter. Each student was assessed individually and without feedback. Results: The highest mean chest compression depth was related to Basic Cardiovascular Life Support (BCLS) and the position of the dominant hand on non-dominant hand (5.50 ± 0.6) and (P = 0.04). There was no statistically significant difference in the basic and advanced regression variables in men and women except in the case of Advanced Cardiovascular Life Support (ACLS) with dominant hand on non-dominant hand (P = 0.018). There was no significant difference in mean chest compression during basic and advanced cardiovascular life support in left- and right-handed individuals (P = 0.09). Conclusion: When the dominant hand is on the non-dominant hand, more pressure with greater depth is applied.

Fatal Suicide and Modelling its Risk Factors in a Prevalent Area of Iran.

BACKGROUND AND OBJECTIVES: This paper aimed to study the epidemiology of suicide and causes related to fatal suicide in Ilam province, west of Iran. METHODS: All data related to attempted suicide and fatal suicide during 2011-2012 were extracted from the suicide registry of authorized directorates in Ilam Province, Iran. Risk factors for fatal suicide were evaluated using logistic regression modeling and discrimination of model assessed using ROC curve. RESULTS: A total of 1537 registered cases were analyzed, among which 130 were recorded as fatal suicides (1227 attempted suicides). Overall, 805 (52.4%) cases were female, 9.2% had a history of suicide, 59.3% were married and 63.3% of cases were aged under 24 years. The most common suicide method was overdose of medications (75.5%). In multivariable analysis, male gender (OR: 0.50; CI 95% 0.25 to 0.99) and higher education (OR: 0.36; CI 95% 0.20 to 0.65) were protective factors and application of physical methods (OR: 11.61; 95% CI 5.40 to 24.95) was a risk factor for fatal suicide. CONCLUSIONS: Female gender, low education level and use of physical methods of suicide were revealed as risk factors of fatal suicide. We suggest population based case-control studies based on the suicide registry data for further assessing the risk factors of suicide in Ilam.

A Cost-Benefit and Accurate Method for Assessing Microalbuminuria: Single versus Frequent Urine Analysis.

Background. The purpose of this study was to answer the question whether a single testing for microalbuminuria results in a reliable conclusion leading costs saving. Methods. This current cross-sectional study included a total of 126 consecutive persons. Microalbuminuria was assessed by collection of two fasting random urine specimens on arrival to the clinic as well as one week later in the morning. Results. In overall, 17 out of 126 participants suffered from microalbuminuria that, among them, 12 subjects were also diagnosed as microalbuminuria once assessing this factor with a sensitivity of 70.6%, a specificity of 100%, a PPV of 100%, a NPV of 95.6%, and an accuracy of 96.0%. The measured sensitivity, specificity, PVV, NPV, and accuracy in hypertensive patients were 73.3%, 100%, 100%, 94.8%, and 95.5%, respectively. Also, these rates in nonhypertensive groups were 50.0%, 100%, 100%, 97.3%, and 97.4%, respectively. According to the ROC curve analysis, a single measurement of UACR had a high value for discriminating defected from normal renal function state (c = 0.989). Urinary albumin concentration in a single measurement had also high discriminative value for diagnosis of damaged kidney (c = 0.995). Conclusion. The single testing of both UACR and urine albumin level rather frequent testing leads to high diagnostic sensitivity, specificity, and accuracy as well as high predictive values in total population and also in hypertensive subgroups.