Association of obesity and the clinical course of hospitalised COVID-19 survivors.

Obesity is a risk factor for chronic inflammation and severe pulmonary infections. This study aimed to assess the association between obesity and the clinical courses of hospitalised COVID-19 survivors. This cross-sectional study used the Isfahan COVID Cohort (ICC) baseline data. The ICC is an ongoing, 5-year prospective, longitudinal cohort study conducted on hospitalised COVID-19 survivors in affiliated hospitals of the Medical University of Isfahan (MUI), Iran. Patients aged 19 and over throughout Isfahan County were recruited using a consecutive sampling method 1 month after discharge. Demographic and basic characteristics, symptoms and clinical features of these patients were collected and analysed. A total of 3843 hospitalised patients with COVID-19 were included in this study. Regarding the body mass index classification in the general obesity group, the patients with overweight and obesity had more extended hospitalisation and a higher frequency of low O2 saturation compared to the normal weight patients, and the highest frequency of low O2 saturation and more extended hospitalisation was observed in patients with obesity (5.9 ± 3.8 vs. 6.8 ± 5.4 vs. 7.1 ± 5.3, respectively; p = .001 and 59% vs. 64.5% vs. 65.5%; p < .001). Furthermore, individuals with abdominal obesity had a significantly longer duration of hospitalisation compared to the non-abdominal obesity group (6.3 ± 4.6 vs. 7.0 ± 5.3; p < .001). In the fully adjusted model, a significant association was observed between abdominal obesity and an increased occurrence of low oxygen saturation compared to general obesity (odds ratio: 1.25, 95% confidence interval: 1.03-1.44). Obesity was associated with more extended hospitalisation and hypoxia in patients with COVID-19. However, no significant relationship was found between obesity and other clinical courses.

Association of the triglyceride glucose index with all-cause and cardiovascular mortality in a general population of Iranian adults.

BACKGROUND: The triglyceride glucose (TyG) index is a new and low-cost marker to determine insulin resistant which may be a predictor of cardiovascular disease (CVD). Although available evidence showed that its association with CVD mortality (CVM) and all-cause mortality (ACM) may differ in different populations, scarce data are available in this regard specially in low and middle-income countries. PURPOSE: To examine the association between TyG index and risk of CVM and ACM in Iranians. METHODS: This prospective cohort study included 5432 adults (age ≥ 35 years) with no history of CVD events. Fasting glucose and triglyceride were measured at baseline in all participants and TyG index was calculated. Cox frailty model was used to calculate hazard ratios (HRs) for CVM and ACM across the tertiles of TyG index. RESULTS: After a median follow-up of 11.25 years, a total number of 191 cardiovascular deaths, and 487 all-cause mortality was recorded. The risk of both CVM and ACM increased across the tertiles of TyG index. In the adjusted model for lifestyle and metabolic variables, the risks of ACM and CVM increased by 41% (95% CI 1.11, 1.81; P for trend = 0.005) and 64% (95% CI 1.07, 2.50; P for trend = 0.024), respectively. However, adjustment for diabetes mellitus disappeared the significance for both ACM and CVM. These associations may vary by sex. TyG was not related to the risk of non-CVD mortality. CONCLUSION: The predicting value of TyG index for ACM and CVM might be mediated by diabetes status. Further studies are required to confirm these findings.

Prediction of blood pressure based on anthropometric measurements in adolescents.

BACKGROUND: Recently, an important health issue in children is obesity, leading to hypertension. The aim of this study was to determine association of blood pressure with anthropometric variables in adolescents. METHODS: In this study, 1992 adolescents aged 11-18 years old between 2000 and 2007 were included. Cut point of anthropometric indices of waist circumference (WC), waist-to-stature ratio (WSR) and body mass index (BMI) was identified using Youden's index. RESULTS: Cut point of BMI for identification of hypertension was 19.69, 25.5, 20.65 and 24.13 for boys at middle and high school, girls at middle and high school, respectively. This measure for WSR was 0.44, 0.50, 0.45 and 0.517 for boys at middle and high school, girls at middle and high school, respectively. Regarding WC, it was 69.50, 96.5, 65.5 and 77.5 for boys at middle and high school, girls at middle and high school, respectively. CONCLUSIONS: In middle school boys, WSR, WC and BMI are associated with DBP but by increasing age, only BMI and weight are associated with DBP. BMI is the consistent anthropometric determinant of DBP. We also observed the relationship between WSR and SBP in boys, which could be applied as a predictive measure.

Invasion of HeLa Cells by Shigella Species Clinical Isolates Recovered from Pediatric Diarrhea.

Shigella is considered a major public health concern, especially for children younger than 5 years of age in developing countries. The pathogenicity of Shigella is a complex process that involves the interplay of multiple genes located on a large, unstable virulence plasmid as well as chromosomal pathogenicity islands. Since various factors (including virulence and antibiotic resistance genes) are associated with the severity and duration of shigellosis, in this article, we aim to evaluate whether the invasion of HeLa cells is affected by Shigella spp. isolates with different characteristics (including serogroups, virulence gene profiles, and antibiotic resistance patterns) recovered from pediatric patients in Tehran, Iran. Cell invasion ability of 10 Shigella isolates with different serogroups (Shigella flexneri and Shigella sonnei), gene profiling (virA, sen, ipgD, ipaD, ipaC, ipaB, and ipaH), and antibiotic resistance phenotyping (ampicillin, azithromycin, ciprofloxacin, nalidixic acid, trimethoprim-sulfamethoxazole, cefixime, cefotaxime, minocycline, and levofloxacin) were measured by plaque-forming assay in HeLa cell lines. The results show that all the selected Shigella spp. isolates recovered from pediatric patients were able to invade HeLa cells, but the total number and average size of plaques were different between the isolates. The higher invasion ability of S. flexneri isolates in HeLa cells compared to S. sonnei isolates was attributed to the presence of particular virulence genes; however, the role of each of these virulence factors remains to be determined.

Corrigendum to "Hematological Inflammatory Markers in Patients with Clinically Confirmed Familial Hypercholesterolemia".

[This corrects the article DOI: 10.1155/2022/5051434.].

Effects of sulfur dioxide and particulate matter pollution on hospital admissions for hypertensive cardiovascular disease: A time series analysis.

Background and aims: Air pollution is a major environmental risk factor and the leading cause of disease burden with detrimental effects on cardiovascular systems. Cardiovascular diseases are predisposed by various risk factors, including hypertension, as the most important modifiable risk factor. However, there is a lack of sufficient data concerning the impact of air pollution on hypertension. We sought to study the associations of short-term exposure to Sulfur dioxide (SO2) and particulate matter (PM10) with the number of daily hospital admissions of hypertensive cardiovascular diseases (HCD). Methods: All hospitalized patients between March 2010 to March 2012 were recruited with the final diagnosis of HCD based on the International Classification of Diseases 10 (codes: I10-I15) from 15 hospitals in Isfahan, one of the most polluted cities in Iran. The 24-hour average concentrations of pollutants were obtained from 4 monitoring stations. In addition to single- and two-pollutant models, we used Negative Binomial and Poisson models with covariates of holidays, dew point, temperature, wind speed, and extracted latent factors of other pollutants controlling for multi-collinearity to examine the risk for hospital admissions for HCD affected by SO2 and PM10 exposures in the multi-pollutant model. Results: A total of 3132 hospitalized patients (63% female) with a mean (standard deviation) age of 64.96 (13.81) were incorporated in the study. The mean concentrations of SO2 and PM10 were 37.64 µg/m3 and 139.08 µg/m3, respectively. Our findings showed that a significantly increased risk of HCD-induced hospital admission was detected for a 10 µg/m3 increase in the 6-day and 3-day moving average of SO2 and PM10 concentrations in the multi-pollutant model with a percent change of 2.11% (95% confidence interval: 0.61 to 3.63%) and 1.19% (0.33 to 2.05%), respectively. This finding was robust in all models and did not vary by gender (for SO2 and PM10) and season (for SO2). However, people aged 35-64 and 18-34 years were vulnerable to SO2 and PM10 exposure-triggered HCD risk, respectively. Conclusions: This study supports the hypothesis of the association between short-term exposure to ambient SO2 and PM10 and the number of hospital admissions due to HCD.

Ambient carbon monoxide and cardiovascular-related hospital admissions: A time-series analysis.

Background and aims: Although several studies have investigated the association between air pollutants and cardiovascular diseases (CVDs) in recent years, a lack of evidence exists regarding carbon monoxide (CO) exposure, especially in the Eastern Mediterranean's polluted regions. In this study, we aimed to evaluate the short-term effect of CO exposure on daily CVD hospital admissions in Isfahan, a major city in Iran. Methods: Data were extracted from the CAPACITY study on daily CVD hospital admissions in Isfahan from March 2010 to March 2012. The 24-h mean CO concentrations were obtained from four local monitoring stations. In a time-series framework, the association between CO and daily hospitalizations for total and cause-specific CVDs in adults (ischemic heart disease (IHD), heart failure (HF), and cerebrovascular disease) was conducted using Poisson's (or negative binomial) regression, after adjusting for holidays, temperature, dew point, and wind speed, considering different lags and mean lags of CO. The robustness of the results was examined via two- and multiple-pollutant models. Stratified analysis was also conducted for age groups (18-64 and ≥65 years), sex, and seasons (cold and warm). Results: The current study incorporated a total of 24,335 hospitalized patients, (51.6%) male with a mean age of 61.9 ± 16.4 years. The mean CO concentration was 4.5 ± 2.3 mg/m³. For a 1 mg/m3 increase in CO, we found a significant association with the number of CVD hospitalizations. The largest adjusted percent change in HF cases was seen in lag0, 4.61% (2.23, 7.05), while that for total CVDs, IHD, and cerebrovascular diseases occurred in mean lag2-5, 2.31% (1.42, 3.22), 2.23% (1.04, 3.43), and 5.70% (3.59, 7.85), respectively. Results were found to be robust in two- and multiple-pollutant models. Although the associations changed for sex, age groups, and seasons, they remained significant for IHD and total CVD, except for the warm season, and for HF, except for the younger age group and cold seasons. Additionally, the exposure-response relationship curve of the CO concentrations with total and cause-specific CVD admissions showed non-linear relationships for IHD and total CVDs. Conclusions: Our results showed that exposure to CO contributed to an increase in the number of CVD hospitalizations. The associations were not independent of age groups, season, and sex.

"Incidence, characteristics and prognosis of cervical artery dissection-induced ischemic stroke in central Iran".

OBJECTIVES: Ischemic stroke is the most common presentation of cervical artery dissection (CAD). Information regarding CAD-induced stroke is scarce, especially in the Middle East. Here we investigated the incidence of CAD-induced stroke, its characteristics, and the clinical course in central Iran. METHODS: This is an observational study conducted in the city of Isfahan, Iran. We recruited patients with ischemic stroke during 2017-2019. We analyzed characteristics of the CAD-induced stroke patients with regards to the involved vessel (internal carotid artery dissection (ICAD) or vertebral artery dissection (VAD)). We assessed functional outcome (modified Rankin Scale [mRS]) and recanalization status after 1 year of follow-up. RESULTS: Among 3630 ischemic stroke patients, 51(1.4%) had CAD-induced stroke (mean age: 41.8 ± 12.6; 40.4% female; 28 and 19 ICAD and VAD cases, respectively). The crude incidence rate of CAD-induced stroke was 1.20/100,000/year (0.66/100,000/year and 0.45/100,000/year for strokes due to ICAD and VAD, respectively). mRS ≤ 2 was present in 63.8% of the patients after 1 year of follow-up. History of exercise during the last days before stroke occurrence was associated with a better follow-up mRS (ß = -3.1, p-value: 0.037). Administration of anticoagulant or double-antiplatelets was related neither to mRS nor recanalization results. Trauma (27.7%), smoking (21.3%), and headache disorders/migraine (21.3%) were the most common reported factors. CONCLUSION: We found a crude incidence rate of 1.20/100,000/year for CAD-induced stroke. Trauma, smoking, and headache disorders were the most common reported factors among our patients. CAD-induced stroke had a favorable long-term prognosis regardless of the type of the involved vessel or the used medication.

Comparison of Equations for the Calculation of LDL-Cholesterol in Familial Hypercholesterolemia: Data from Iranian Registry.

OBJECTIVE: Low-density lipoprotein cholesterol is the mainstay of diagnosis, treatment, and follow-up of patients with familial hypercholesterolemia, the most prevalent autosomal domi- nant disorder among humans. Since the reference measurement method (ultracentrifugation) is time-consuming and expensive, many formulas emerged to calculate low-density lipopro- tein cholesterol levels and are commonly used in laboratories. METHODS: To compare the performance of 3 low-density lipoprotein cholesterol calcula- tion equations with a direct method (enzymatic photometric assay), the lipid profiles of 1148 patients of the registry of familial hypercholesterolemia in Iran were analyzed retrospec- tively, 270 of which had a possible or definite familial hypercholesterolemia diagnosis according to Dutch criteria. While measured using the direct method, we calculated the low-density lipoprotein cholesterol levels using the Friedewald, Chen, and Anandaraja formulas. RESULTS: Our results showed that all 3 formulas are highly correlated with the direct method, and the Chen formula showed the highest intra-class correlation coefficient among all (0.954 among all patients with hypercholesterolemia and 0.947 among the familial hyper- cholesterolemia population). In addition, the Chen formula was the most sensitive, and the Friedewald formula was the most specific formula using a low-density lipoprotein cholesterol cut-off of 100 in familial hypercholesterolemia patients. CONCLUSION: Our findings encourage applying the Chen formula in addition to the Friedewald formula to make better clinical decisions for familial hypercholesterolemia patients.

Egg consumption and risk of cardiovascular events among Iranians: results from Isfahan Cohort Study (ICS).

PURPOSE: The association between egg consumption and cardiovascular events remains controversial. This study aims to evaluate this association in cardiovascular events including myocardial infarction (MI), ischemic coronary heart disease (ICHD), stroke, cardiovascular disease (CVD), and CVD mortality in an Iranian population. METHODS: This prospective cohort study included 6504 adults (age ≥ 35 years) with no history of CVD event at baseline. The frequency of egg consumption was assessed using a validated food frequency questionnaire. Participants were followed for 12 years and incidence of new CVD cases were determined through active examinations and linkages to multiple registries. Cox frailty models were conducted to calculate adjusted hazard ratios (HR)s for cardiovascular events associated with egg consumption. RESULTS: Over a median follow-up of 12 years, fully adjusted model [adjusted for age, sex, education, residency, smoking, daily physical activity, family history of CVD, metabolic syndrome, aspirin, body mass index and Global Dietary Index] revealed a null association between egg and cardiovascular events. Compared with non-consumers (&lt;1 time/week), higher egg consumption (≥3 time/week) was not associated with incident MI (HR = 1.44, 95% CI: 0.86, 2.41; P = 0.48), ICHD (HR = 1.26, 95% CI: 0.80, 1.99; P = 0.41), stroke (HR = 0.79, 95% CI: 0.46, 1.38; P = 0.71) and CVD (HR = 1.05, 95% CI: 0.79, 1.40; P = 0.93). CONCLUSION: These findings suggest that higher egg consumption is not associated with increased risk of MI, ICHD, stroke, and CVD among Iranians. Larger studies with longer duration of follow-up are warranted to explore these associations in populations with higher egg consumption.

Hematological Inflammatory Markers in Patients with Clinically Confirmed Familial Hypercholesterolemia.

BACKGROUND AND AIMS: Familial hypercholesterolemia (FH) is an autosomal dominant genetic disorder of lipid metabolism which leads to premature cardiovascular diseases. In patients with FH, blood inflammatory markers may be disrupted; however, its extent is unclear. In this study, we aimed to evaluate the NLR (neutrophil to lymphocyte ratio), PLR (platelet count to lymphocyte count ratio), MPV (mean platelet volume), RPR (red blood cell distribution width to platelet count ratio), WBC (white blood cell), and PDW (platelet distribution width and platelet count). METHODS: The patients were selected from laboratories due to high cholesterol level and who had history of premature cardiovascular disease. The Dutch Lipid Clinic Network (DLCN) criteria are used for the detection of FH. Controls had a history of hyperlipidemia, and both groups could be on pharmacotherapy or not. All the biochemical markers were evaluated using appreciate methods. Statistical analysis was done using STATA 14. RESULTS: The study group consisted of 1074 patients with FH and 473 control cases. Of the CBC inflammatory markers, only PLR was significantly (p value = 0.003) higher in FH patients (7.96 ± 10.08) compared to non-FH (6.45 ± 2.44). In FH patients, the PLR was significantly higher in probable/definite FH group (9.70 ± 14.06) compared to possible FH (7.36 ± 8.23) (p value < 0.001). Linear regression analysis showed that only RLR was independently associated with total cholesterol (b = 0.000, p = 0.13). CONCLUSIONS: Our results may show the importance of high cholesterol on platelet activity and highlight the use of lipid lowering drugs in patients with hyperlipidemia.

Longitudinal association of dietary carbohydrate and the risk cardiovascular disease: a dose-response meta-analysis.

Previous findings on the association of dietary carbohydrate with cardiovascular disease (CVD) events and mortality are inconsistent. We aimed to assess the relationship between dietary carbohydrate and the incidence of cardiovascular events and mortality. A comprehensive literature search of MEDLINE (PubMed), Scopus, ISI Web of Science, and EMBASE, was performed up to June 2019. Prospective cohort studies which examined dietary carbohydrate in relation to fatal and non-fatal myocardial infarction, fatal and non-fatal stroke, heart failure, and sudden cardiac death were included in our study. Summary HRs and 95% CIs were estimated using a random-effects model. A total of 19 cohort studies including 15,663,111 participants were identified. Combining 27 effect sizes with 1,577,225 CVD cases led to a significant association between dietary carbohydrate and total CVD events (HR= 1.05, 95% CI: 1.00, 1.10; I2 = 38.5%), but no association was observed between dietary carbohydrate and CVD mortality (HR = 1.02; 95% CI: 0.91, 1.14; I2=27.1%, derived from 8 effect sizes with 106,412 events), and CHD events (HR = 1.03, 95% CI: 0.98, 1.09; I2 = 46.6%, derived from 18 effect sizes with 1,549,281 events). Moreover, using 8 effect sizes with 6,829 cases, higher carbohydrate intake was associated with increased risk of stroke (HR = 1.13; 95% CI: 1.01, 1.27; I2= 0.0%). In subgroup analysis by sex, higher carbohydrate intake increased the risk of total CVD events (HR: 1.10; 95% CI: 1.03, 1.17; I2 = 0.0%), and CHD (HR: 1.10; 95% CI: 1.01, 1.20; I2= 15.0%), but not stroke and CVD mortality in women. No significant association was found in men. Low- to very-low-certainty evidence suggests that higher carbohydrate intake is directly but slightly associated with CVD and stroke risk, while no association was found for CHD and CVD mortality. We also found sex-specific associations.

Association of adherence to the dietary approach to stop hypertension and Mediterranean diets with blood pressure in a non-hypertensive population: Results from Isfahan Salt Study (ISS).

BACKGROUND AND AIMS: Hypertension is among the major risk factors for cardiovascular events in the Iranian population. This cross-sectional study was designed to examine the association of adherence to the dietary approaches to stop hypertension (DASH) and Mediterranean (MED) dietary patterns with the distribution of blood pressure and pre-hypertension prevalence. METHODS AND RESULTS: This cross-sectional study was carried out in 1363 non-hypertensive adults. Adherence to the DASH and MED diets was calculated using a semi-quantitative food frequency questionnaire (FFQ). Hypertension was measured by the standard method. Multiple logistic regression was applied to obtain the odds ratio of pre-hypertension in the tertiles of MED and DASH dietary patterns. Compared to the lowest, participants with the highest adherence to the DASH dietary pattern had significantly lower systolic blood pressure (SBP) (111.3 ± 11.8 vs. 112.8 ± 12.5; P = 0.010) and diastolic blood pressure (DBP) (70.7 ± 9.2 vs. 71.8 ± 9.8; 0.042). There was no significant difference in the mean SBP and DBP among the participants across tertiles of MED or diet adherence. Higher scores of the DASH and MED diets were inversely associated with lower SBP after adjustment for all potential confounders (OR = -0.04, 95% CI = -0.29, -0.01, P = 0.039) and (OR = -0.04, 95% CI = -0.72, -0.02, P = 0.044), respectively. Also, DASH and MED dietary patterns was associated with reduced OR of pre-hypertension occurrence by 13% (OR: 0.87; 95% CI: 0.70-0.98; P for trend = 0.042) and 16% ([OR: 0.84; 95% CI: 0.69-0.97; P trend = 0.035), respectively. CONCLUSION: Adherence to the DASH and MED diets was inversely associated with the odds for pre-hypertension and SBP.

Evaluation of correlation between digital vs. mercury sphygmomanometer in a middle-income country: The role of socio-economic situation.

BACKGROUND: Using manometer sphygmomanometers as standard measurement tool, there are controversial data regarding accuracy and validity of digital manometers for measurement of systolic (SBP) and diastolic blood pressure (DBP). Thus, we aimed to compare the accuracy of readings of digital sphygmomanometer in reference to mercury sphygmomanometer in a large population of healthy adults. METHODS AND MATERIALS: This cross-sectional study was performed on 1119 healthy adults. We measured participant's blood pressure once with mercury sphygmomanometer, as gold standard and again with digital mercury sphygmomanometer. Blood pressure was measured in sitting position after 5 min of rest and preferentially from right arm unless deformed. RESULTS: The mean ± standard deviation of age of participants was 37.25 ± 10.45 years. Majority of participants were male 588 (52.5%). The right/left SBP measured by digital sphygmomanometer were significantly higher compared with those measured by mercury sphygmomanometer: 115.37 ± 12.33 vs 110.95 ± 10.06/113.69 ± 11.77 vs 110.23 ± 10.34, respectively (P < .001), while an opposite result was observed about right/left DBP: 68.60 ± 8.55 vs 70.60 ± 8.31/69.39 ± 8.31 vs 70.75 ± 8.41, respectively (P < .001). In subgroup analysis in terms of marital status, education, and income, we observed similar findings. CONCLUSION: According to the results of our data analysis, it was shown that the digital device measurements had significant incompatibility with the mercury sphygmomanometers and it seems that digital devices still cannot be used as the gold standard in blood pressure measurement.

One-year survival and prognostic factors for survival among stroke patients: The PROVE-stroke study.

Background: Survival and prognostic factors following stroke occurrence differ between world regions. Studies investigating stroke features in the Middle-east region are scarce. We aimed to investigate 1-year survival and related prognostic factors of stroke patients in Central Iran. Materials and Methods: It is an observational analytical study conducted on patients registered in the Persian Registry of Cardiovascular Disease-Stroke (PROVE-Stroke) database. Records of 1703 patients admitted during 2015-2016 with the primary diagnosis of stroke in all hospitals of Isfahan, Iran were reviewed. Information regarding sociodemographic characteristics, clinical presentations, medications, and comorbidities were recorded. The living status of patients after 1 year from stroke was considered as 1-year survival. Results: Among 1345 patients with the final diagnosis of stroke, 970 (72.1%) were alive at the 1 year follow-up and the mean survival time based on Kaplan-Meier procedure was estimated 277.33 days. The hemorrhagic and ischemic types of stroke were reported in 201 (15.0%) and 1141 (84.8%) patients, respectively. Age (hazard ratio [HR] = 1.07, 95% confidence interval [CI] = 1.05-1.09), diabetes (HR = 1.49, 95% CI = 1.07-2.06), history of stroke or transient ischemic attack (HR = 1.81, 95% CI = 1.30-2.52), history of warfarin usage (HR = 1.73, 95% CI = 1.11-2.71), hospital complications of hemorrhage (HR = 3.89, 95% CI = 2.07-7.31), sepsis (HR = 1.78, 95% CI = 1.18-2.68), and hydrocephalus (HR = 3.43, 95% CI = 1.34-8.79), and modified Rankin Scale (mRS) ≥3 at the time of hospital dicharge (HR = 1.98, 95% CI = 1.27-3.07), were predictors of 1-year survival. Conclusion: Predictors of 1-year survival can be categorized into unchangeable ones, such as age, diabetes, previous stroke, and mRS. The changeable factors, such as hospital complications of infection and hemorrhage, guide physicians to pay greater attention to reduce the risk of mortality following stroke.

Long-term exposure to PM2.5 and cardiovascular disease incidence and mortality in an Eastern Mediterranean country: findings based on a 15-year cohort study.

BACKGROUND: Evidence concerning the impact of long-term exposure to fine Particulate Matter ≤2.5 µm (PM2.5) on Cardio-Vascular Diseases (CVDs) for those people subject to ambient air pollution in developing countries remains relatively scant. This study assessed the relationship of 15-year PM2.5 exposure with cardiovascular incidence and mortality rate in Isfahan province, Iran. METHODS: The cohort comprised 3081 participants over 35 years old who were free of CVDs. They were selected through multi-stage cluster sampling in Isfahan, Iran. PM2.5 exposure was determined separately for each individual via satellite-based spatiotemporal estimates according to their residential addresses. In this context, CVD is defined as either fatal and non-fatal Acute Myocardial Infarctions (AMI) or stroke and sudden cardiac death. The incidence risk for CVD and the ensuing mortality was calculated based on the average PM2.5 exposure within a study period of 15 years using the Cox proportional hazards frailty model upon adjusting individual risk factors. The mean annual rate of PM2.5 and the follow-up data of each residential area were combined. RESULTS: Mean three-year PM2·5 exposure for the cohort was measured at 45.28 µg/m3, ranging from 20.01 to 69.80 µg/m3. The median time period for conducting necessary follow-ups was 12.3 years for the whole population. Notably, 105 cardiovascular and 241 all-cause deaths occurred among 393,786 person-months (27 and 61 per 100,000 person-months, respectively). In well-adjusted models, 10 µg/m3 increase in PM2.5 corresponded to a 3% increase in the incidence rate of CVDs [0.95 CI = 1.016, 1.036] (in case of p = 0.000001 per 10 µg/m3 increase in PM2.5, the Hazard Ratio (HR) for AMI and Ischemic Heart Disease (IHD) was 1.031 [0.95 CI = 1.005, 1.057] and 1.028 [0.95 CI = 1.017, 1.039]), respectively. No consistent association was observed between PM2.5 concentration and fatal CVD (fatal AMI, fatal stroke, SCD (Sudden Cardiac Death)) and all-cause mortality. CONCLUSIONS: Results from analyses suggest that the effect of PM2.5 on cardiovascular disease occurrence was stronger in the case of older people, smokers, and those with high blood pressure and diabetes. The final results revealed that long-term exposure to ambient PM2.5 with high concentrations positively correlated with IHD incidence and its major subtypes, except for mortality. The outcome accentuates the need for better air quality in many countries.

Familial Hypercholesterolemia (FH) in Iran: Findings from the Four-Year FH Registry.

BACKGROUND: Familial hypercholesterolemia (FH) is a common autosomal dominant disease. Its diagnosis in Iran was uncommon. Iran registry of FH (IRFH) has been started from 2017 from Isfahan. In this study, we report the four-year FH registry. METHODS: The Iran FH registry is an ongoing study which is followed by a dynamic cohort. It has been started from 2017. The patients are selected from laboratories due to high cholesterol level and who have history of premature cardiovascular disease. The Dutch Lipid Clinic Network (DLCN) criteria are used for the detection of FH. Cascade screening is performed for detection of first-degree relative of patients. RESULTS: Among the 997 individuals included in this registry, they were 522 (mean age 51.41 ± 12.91 year), 141 (mean age 51.66 ± 8.3 year), and 129 (mean age 41 ± 16.5 year) patients from laboratories, premature cardiovascular disease, and relatives, respectively. In total, 263 patients were diagnosed with probable or definite FH, and others were in the possible group. Low-density lipoprotein cholesterol (LDL) level was 141.42 ± 45.27 mg/dl in the laboratory group and 54.9% of patients were on LLT treatment. In patients with premature cardiovascular disease and FH, the LDL level was 91.93 ± 32.58 and was on LLT treatment. The LDL concentration in the first relative of FH patients was 152.88 ± 70.77 and 45.7% of them are on LLT therapy. CONCLUSIONS: Most of FH patients were underdiagnosed and undertreated before their inclusion in the IRFH. Cascade screening helps in the improvement of diagnosis.

A comparison of the efficiency of molecular and conventional methods in the diagnosis of cutaneous leishmaniosis.

Leishmaniosis is one of the most important vector borne diseases. Among different forms of the disease, cutaneous leishmaniosis (CL) is the most common. Determining the method of definitive diagnosis for the disease has been the aim of various studies. Therefore this study afforded an opportunity to investigate this subject. To diagnose CL in 150 suspected patients referred to Mehran and Dehloran health centers during June 2018 to November 2019, two polymerase chain reaction (PCR) methods were performed and compared with the in vitro culture and microscopic evaluation of stained slides. The smears were stained with Giemsa for microscopy and cultured in Novy-Nicolle-McNeal (NNN) blood agar for promastigote growth. For semi-nested PCR and PCR-RFLP, the tissue and serosity from the lesions were used for DNA extraction. The semi-nested PCR technique using minicircle kDNA gene showed the highest positivity rates among all diagnostic assays with 114/150 (76%) of the samples and was used as reference standard, followed by the PCR-RFLP test using ITS1 gene with 112/150, (74.7%) positivity rates, microscopy with 101/150 (67.3%) and then culture 72/150 (48%). microscopy and culture methods together improved overall positivity rates to 68.7% (103/150). The all positive samples using molecular technique were identified as Leishmania major. The highest sensitivity (98.3%), specificity (100%), accuracy (98.8%), negative predictive value (94.7%) and κ coefficient (0.96=almost perfect) was observed by comparing PCR-RFLP and semi-nested PCR. kDNA-semi-nested PCR and ITS1-PCR-RFLP presented an interesting alternative to conventional methods for the identification of CL and improved its diagnostic value significantly in suspected patients with negative direct smears.

Rationale and Design of the Persian CardioVascular Disease Registry (PCVDR): Scale-Up of Persian Registry Of CardioVascular DiseasE (PROVE).

We aimed to present the methodology of a national registry entitled "Persian CardioVascular Disease Registry (PCVDR)." Persian Registry Of cardioVascular diseasE (PROVE) was a demonstration registry conducted in Isfahan since 2014 to test the feasibility and practicality of PCVDR in Iran. Built on that experience, the first phase of PCVDR that consist of angiography and percutaneous coronary intervention (PCI) registry at national level started in March 2017. Currently, PCVDR is in place in 19 hospitals, located in 7 provinces. Five questionnaires including basic information, angiography, and PCI techniques, discharge and follow-up were completed for registered patients. Since beginning until October 7th, 2019, the number of angiography and PCI cases registered in all provinces were 37,120 and 16,277, respectively. Of all PCI cases registered, 11,846 patients (72.8%) were followed up until 12 months. We expect that this registry be expanded to cover most hospitals and centers with cardiology departments in the country.

Acute Cardiac Injury in COVID-19: A Systematic Review and Meta-analysis.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has been widespread since late December 2019, with several symptoms related to the upper and lower respiratory system. However, its cardiac manifestations are less frequently studied. We aimed to analyze the available COVID-19 data on acute cardiac injury, using troponin and brain natriuretic peptide (BNP) levels. METHODS: We performed a systematic review on Medline/PubMed, Scopus, and Google Scholar databases until March 25, 2020. Relevant records reporting the incidence of acute cardiac injury as well as troponin and BNP levels were collected from published peer-reviewed articles with further analysis according to the clinical status of the patients (severe, non-severe, and death). RESULTS: Eleven records of 1394 individuals were included. The mean age of patients with acute cardiac injury was 56.6 ± 33.4 years (males: 54.3%). The incidence of acute cardiac injury was 15% (95% CI: 11, 20%). Further analysis revealed that dead or severe patients had significantly higher percentages of myocardial injury, compared to non-severe ones (peer-reviewed: 44%, 95% CI: 16, 74% vs. 24%, 95% CI: 15, 34% vs. 5%, 95% CI: 1, 12%, respectively). Mean total troponin was 10.23 pg/mL (95% CI: 5.98, 14.47), while 13% (95% CI: 8%, 18%) of patients had elevated levels. Mean BNP was 216.74 pg/mL (95% CI: 3.27, 430.20). CONCLUSION: Acute cardiac injury in COVID-19 patients is more frequent than what was expected at the beginning of the outbreak. Meanwhile, further studies are needed to investigate the utility of cardiac biomarkers as diagnostic and prognostic tools for long-term cardiac complications of this infection.