Comparison between myocardial infarction with non-obstructive coronaries (MINOCA) and myocardial infarct patients with coronary artery disease (MI-CAD): A single-center retrospective cohort study.

Background: The coronary angiography results in a group of patients with myocardial infarction (MI) are normal or near-normal; which is diagnosed as myocardial infarction with non-obstructive coronary arteries (MINOCA). This study aimed to compare the mortality rate and risk factors between MINOCA and myocardial infarction with obstructive coronary artery (MI-CAD). Methods: This retrospective cohort study was conducted from January 1, 2018, to December 31, 2019. A total of 679 patients admitted to Afshar Hospital in Yazd with a diagnosis of ST-elevation myocardial infarction (STEMI) from 2018-2019 who underwent primary Percutaneous Coronary Intervention (PCI) were enrolled in the study. Demographic, and clinical variables, ECG finding and one-year mortality, were extracted using MI registry data from the Yazd Cardiac Research Center. Results: The estimated frequency of MINOCA was 4.6%. Patients with MINOCA (47.14±6.2) were younger than patients with MI-CAD (57.61±9.1) (P <0.0001). MINOCA patients (47.4±9.47) had a considerably greater left ventricular ejection fraction (LVEF) than MI-CAD patients (43.5±6.8) (P =0.018). The majority site of MI in MINOCA patients was located in the non-anterior wall (p <0.0001). A comparison of MINOCA and MI-CAD patients' one-year mortality revealed no significant difference (P =0.07). Conclusion: The prevalence of patients with MINOCA in Yazd was similar to other communities. Although these patients probably do not have a better prognosis, despite being younger and having better LV systolic function and lower CAD risk factors.

Coronary artery disease incidence, risk factors, awareness, and medication utilization in a 10-year cohort study.

BACKGROUND: There is a substantial disparity in coronary artery disease (CAD) burden between Iran and other nations that place a strong emphasis on the assessment of CAD risk factors and individuals' awareness and ability to control them. METHODS: Two thousand participants of a community-based Iranian population aged 20-74 years were investigated with a mean follow-up of 9.9 years (range: 7.6 to 12.2). An analysis of Cox regression was conducted to determine the association between CAD development and classic risk factors such as age, sex, smoking, physical activity, education, obesity, dyslipidemia, hypertension, and diabetes mellitus. Furthermore, we computed the population attributable fraction for these risk factors. RESULTS: After a follow-up period of nearly 10 years, 225 CAD events were reported, constituting 14.5% of the overall incidence. Nighty three percent of participants had more than one risk factor. Age was the most predictive risk factor, with a hazard ratio (HR) and confidence interval (CI) of 5.56 (3.87-7.97, p < 0.001) in men older than 45 and females older than 55 compared to lower ages. In comparison to females, males had an HR of 1.45 (CI: 1.11-1.90, p value = 0.006) for developing CAD. Nearly 80% of the patients had dyslipidemia, with a hazard ratio of 2.19 (CI: 1.40-3.44, p = 0.01). Among the participants, 28.9% had hypertension, and 52% had prehypertension, which had HRs of 4.1 (2.4-7.2, p < 0.001) and 2.4 (1.4-4.2, p < 0.001), respectively. Diabetes, with a prevalence of 17%, had an HR of 2.63 (CI: 2 -3.47, p < 0.001), but prediabetes was not significantly associated with CAD. Awareness of diabetes, dyslipidemia, and hypertension was 81%, 27.9%, and 48.1%, respectively. Regarding medication usage, the corresponding percentages were 51% for diabetes, 13.2% for dyslipidemia, and 41% for hypertension. CONCLUSIONS: Compared to previous studies in Iran and neighboring countries, the current study found a higher incidence of CAD, more prevalent risk factors, and a lower awareness and ability to control these risk factors. Thus, an effective preventive strategy is needed to reduce the CAD burden in Iran.

The impact of long COVID on health-related quality of life in patients 6 months after discharge with severe COVID-19.

This study investigates the relationship between long COVID and health-related quality of life (HRQOL) in patients discharged for 6 months. It included 192 patients with a history of severe COVID-19 and 192 patients with a history of non-severe COVID-19 patients that were selected through quota sampling methods from the Medical Care Monitoring Center (MCMC) of hospitals in Shiraz, Iran, in 2020. Phone-based interviews were conducted to collect data using the short form of the 12-item health-related quality of life (SF-12) questionnaire. Descriptive statistics, including mean (standard deviation) and frequency (percentage), were utilized. Statistical tests, such as the chi-squared test, independent samples t-test, Fisher's exact test, and multiple linear regression models were performed. Statistical analysis was performed using SPSS software version 24, with a significance level of 0.05. Among 384 patients, 79.95% were married, with a mean age of 53.95 years. The majority of patients in both groups were male (57.81% in the severe group and 51.04% in the non-severe group). Patients with severe COVID-19 had significantly lower quality of life scores compared to those with non-severe COVID-19 (p < 0.001, 34.45 [SD = 6.59] versus 39.64 [SD = 5.07]). Furthermore, multiple linear regression analysis indicated that severe COVID-19 inducts a significant negative effect on HRQOL in patients after adjustment of confounders (p < 0.001, B = - 4.84). Patients with severe COVID-19 had lower HRQOL compared to those with a non-severe level. It is necessary to consider implementing policies aimed at providing social, psychological, or medical support to improve the HRQOL of patients with a history of severe COVID-19.

The relationship between nut consumption and premature coronary artery disease in a representative sample of Iranians: Iran-premature coronary artery disease (IPAD) study.

OBJECTIVE: The cardioprotective effects of nuts are well established. However, the positive impacts of nuts in preventing CVD at a younger age, a condition known as premature coronary artery disease (PCAD), is still debated. Therefore, we aim to determine the association between nuts and PCAD occurrence and its severity in different Iranian ethnicities. DESIGN: This case-control study was conducted within the framework of the Iran-premature coronary artery disease (I-PAD) study, an ongoing multi-centric study on Iranian patients of different ethnicities. SETTING: This multi-centric case-control study was conducted in among 3253 persons under the age of 70 years in women and 60 years in men from different ethnicities in Iran. PARTICIPANTS: Information on nut consumption was collected using a validated FFQ. Subjects were selected from among the candidates for angiography. Cases were those whose coronary angiography showed stenosis of more than 75 % in at least one vessel or more than 50 % of the left main artery, while the control group participants had normal angiography results. RESULTS: In the crude model, compared to the first quartile, the highest quartile of nut consumption was significantly associated with a lower risk of PCAD (OR = 0·26, 95 % CI (0·21, 0·32); Pfor trend = 0·001). In the top quartile of nut intake, a substantial decrease in PCAD was observed after controlling for putative confounders (OR = 0·32; 95 % CI (0·24, 0·43); Pfor trend = 0·001). Additionally, a 75 % decrease in the risk of severe PCAD was observed in the participants in the highest quartile of nut intake. CONCLUSION: A significant inverse association was observed between nut intake and the risk and severity of PCAD in the Iranian population. Large-scale clinical trials are required to confirm these findings.

Comparing the effectiveness of metformin with lifestyle modification for the primary prevention of type II diabetes: a systematic review and meta-analysis.

BACKGROUND: Concerning ascending trend in the prevalence of chronic type II diabetes, prevention and the development of an effective approach after the recognition of at-risk individuals is crucial. This study aims to investigate comparing the influence of lifestyle modification and metformin interventions in the prevention of type II diabetes developments. METHOD: The search was conducted using PubMed, Google Scholar, Scopus and Web of Science databases. The inclusion criteria include randomized controlled trials (RCT) which studied both lifestyle modification and metformin interventions in the population above 18 years old without a history of any type of diabetes. After excluding studies with intervention time of fewer than 6 months, a systematic review and meta-analysis were performed to evaluate relative risk (RR) with a confidence interval (CI) of 95% of type II diabetes development. RESULTS: Data from 5 studies were included in the meta-analysis. The population also consists of individuals with a mean age of 50 years old with BMI and FBS of 35.5 and 104.7 mg/dl respectively. Participants range of prevention years was between 2-3 years with a mean of 2.8 years. Lifestyle modification decreases the probability of the incidence of type II diabetes by 25.3% (RR: 0.747, 95% CI, 0.6-0.92) compared to the metformin intervention (p-value = 0.007). Our results indicate that long-term lifestyle modifications can prevent diabetes type II and decrease diabetes mellitus incidence down to one-quarter in comparison to metformin. CONCLUSION: Lifestyle modification can be more efficacious than metformin in diminishing the incidence of type II diabetes. Therefore, lifestyle modification can be a therapeutic strategy for controlling type II diabetes incidence, especially in high-risk individuals.

Ethnicity based differences in statin use and hypercholesterolemia control among patients with premature coronary artery disease-results of I-PAD study.

Background: Statins use is the most important treatment for high LDL cholesterol in patients with premature coronary artery disease (CAD). Previous reports have shown racial and gender differences in statin use in the general population, but this wasn't studied in premature CAD based on different ethnicities. Methods and results: Our study includes 1917 men and women with confirmed diagnosis of premature CAD. Logistic regression model was used to evaluate the high LDL cholesterol control in the groups and the OR with 95% confidence interval (CI) was reported as the effect size. After adjustment for confounders, the odds of controlling LDL in women taking Lovastatin, Rosuvastatin, and Simvastatin were 0.27 (0.03, 0.45) lower in comparison with men. Also, in participant who took 3 types of statins, the odds of controlling LDL were significantly different between Lor and Arab compared with Fars ethnicity. After adjustment to all confounders (full model), the odds of controlling LDL were lower for Gilak in Lovastatin, Rosuvastatin, and Simvastatin by 0.64 (0.47, 0.75); 0.61 (0.43, 0.73); 0.63 (0.46, 0.74) respectively and higher for Arab in Lovastatin, Rosuvastatin, and Simvastatin by 4.63 (18.28, 0.73); 4.67 (17.47, 0.74); 4.55 (17.03, 0.71) respectively compared to Fars. Conclusions: Major differences in different gender and ethnicities may have had led to disparities in statin use and LDL control. Awareness of the statins impact on high LDL cholesterol based on different ethnicities can help health decision-makers to close the observed gaps in statin use and control LDL to prevent CAD problems.

Ethnic differences in the lifestyle behaviors and premature coronary artery disease: a multi-center study.

BACKGROUND: Diverse ethnic groups that exist in Iran may differ regarding the risk factors such as hypertension, hyperlipidemia, dyslipidemia, diabetes mellitus, and family history of non-communicable disease. Premature Coronary Artery Disease (PCAD) is more endemic in Iran than before. This study sought to assess the association between ethnicity and lifestyle behaviors in eight major Iranian ethnic groups with PCAD. METHODS: In this study, 2863 patients aged ≤ 70 for women and ≤ 60 for men who underwent coronary angiography were recruited in a multi-center framework. All the patients' demographic, laboratory, clinical, and risk factor data were retrieved. Eight large ethnicities in Iran, including the Farses, the Kurds, the Turks, the Gilaks, the Arabs, the Lors, the Qashqai, and the Bakhtiari were evaluated for PCAD. Different lifestyle components and having PCAD were compared among the ethnical groups using multivariable modeling. RESULTS: The mean age of the 2863 patients participated was 55.66 ± 7.70 years. The Fars ethnicity with 1654 people, was the most subject in this study. Family history of more than three chronic diseases (1279 (44.7%) was the most common risk factor. The Turk ethnic group had the highest prevalence of ≥ 3 simultaneous lifestyle-related risk factors (24.3%), and the Bakhtiari ethnic group had the highest prevalence of no lifestyle-related risk factors (20.9%). Adjusted models showed that having all three abnormal lifestyle components increased the risk of PCAD (OR = 2.28, 95% CI: 1.04-1.06). The Arabs had the most chance of getting PCAD among other ethnicities (OR = 2.26, 95%CI: 1.40-3.65). While, the Kurds with a healthy lifestyle showed the lowest chance of getting PCAD (OR = 1.96, 95%CI: 1.05-3.67)). CONCLUSIONS: This study found there was heterogeneity in having PACD and a diverse distribution in its well-known traditional lifestyle-related risk factors among major Iranian ethnic groups.

National and sub-national trends of salt intake in Iranians from 2000 to 2016: a systematic analysis.

BACKGROUND: One fifth of the global burden of cardiovascular diseases (CVDs) in 2017 was attributable to excessive salt intake. As a member of the World Health Organization (WHO), Iran has committed itself to a 30% reduction in salt intake by 2025. Evidence on the amount and trend of salt intake among the Iranian population at national and sub-national levels is scarce. This study aimed to estimate the Iranian population's salt intake during 2000-2016 at the national and sub-national levels, by sex and age groups. METHODS: Data on national and sub-national mean salt intake was obtained through systematically searching the literature and contacting the research studies' principal investigators. Data collected through various methods were harmonized using the cross-walk method. Bayesian hierarchical and spatio-temporal-age regression models and simulation analysis were used to estimate the mean salt intake and its uncertainty interval across sex, age, year, and province. RESULTS: National age-sex standardized mean salt intake decreased from 10·53 g/day (95% uncertainty interval [UI]: 10·2 to 10·9) in 2000 to 9·41 (9·2 to 10·6) in 2016 (percent change: - 9·8% [- 21·1-3·1]). The age-standardized mean salt intake in women had decreased from 9·8 g/day (95% UI: 9·0-10·6) in 2000 to 9·1 g/day (8·6-9·7) in 2016 (percent change: - 6·6% [- 19·0-7·9]). The same measure in men was 11·1 g/day in 2000 (95% UI: 10·3-11·8) and 9·7 g/day (9·1-10·2) in 2016 (percent change: - 12·7% [- 23·0 - -0·9]). Age-sex standardized mean salt intake at the sub-national level in 2016 varied from 8·0 (95% UI: 7·0-9·0) to 10·5 (10·0-11·1). The difference between the provinces with the highest and the lowest levels of salt intake in 2016 was 31·3%. CONCLUSION: Salt intake decreased in Iran from 2000 to 2016, while persistently exceeding the recommended values. This declining trend was more pronounced between 2010 and 2016, which might be attributed to Iran's compliance to WHO's Action Plan for reducing NCDs.

Cut-off values of obesity indices to predict coronary heart disease incidence by time-dependent receiver operating characteristic curve analysis in 10-year follow-up in study of Yazd Healthy Heart Cohort, Iran.

BACKGROUND: The current study aimed to determine the optimal cut-off of obesity indices for detecting coronary heart disease (CHD) in 10-year study of Yazd Healthy Heart Cohort (YHHC) in Iran. METHODS: A total of 2000 individuals aged 20-74 years were enrolled. All participants without cardiovascular disease (CVD) had a full medical check-up at the start of the study. At the start of the study, a variety of obesity indices were assessed and calculated, including body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHpR), waist-to-height ratio (WHtR), A Body Shape Index (ABSI), abdominal volume index (AVI), body adiposity index (BAI), and body roundness index (BRI). Coronary artery bypass graft (CABG), percutaneous coronary intervention (PCI), myocardial infarction (MI), Rose Angina Questionnaire (RAQ) (chest pain) greater than 3, and electrocardiographic (ECG) changes in favour of the coronary artery disease (CAD) were considered as the CVD risks. A time-dependent receiver operating characteristic (ROC) curve with right-censored data and naive estimator was used to estimate the time-dependent sensitivity and specificity and the best cut-off of the anthropometric indices for CHD risk. RESULTS: Overall, 1623 participants (818 men and 805 women) with mean and standard deviation (SD) of weight of 71.21 ± 12.94 kg were included. In a 10-year follow-up, 101 [59 (58.42%) men and 42 (41.58%) women] developed CVD event. WHpR demonstrated the largest area under the time-dependent ROC curve (AUC) of 0.65 and 0.63 as well as 95% confidence interval (CI) of 58.64-72.66 and 50.74-75.55 for men and women, respectively, in predicting CVD. Optimal WHpR cut-off was 0.93 and 0.92, respectively, for men and women. CONCLUSION: WHpR index was superior to other obesity indices in predicting CHD.

Worldwide incidence and mortality of ovarian cancer and Human Development Index (HDI): GLOBOCAN sources and methods 2018.

OBJECTIVE: Ovarian cancer is known as the seventh most common cancer among women, accounting for about 4% of all cancers associated with the females. METHOD: This is a descriptive cross-sectional study based on cancer incidence data and cancer mortality rates from the Global Cancer Data in 2018. The incidence and mortality rates were estimated and ovarian cancer distribution maps for world countries were drawn. To analyze data, correlation and regression tests were used to evaluate association between its incidence and mortality with human development index (HDI). RESULTS: Results revealed a direct and significant correlation between ovarian cancer incidence (R = 0.409, P < 0.0001) and mortality (R = 0.193, P < 0.05) with HDI. It also projected a direct and significant correlation between incidence with Gross National Income per 1,000 capita (GNI), mean years of schooling (MYS), life expectancy at birth (LEB) and expected years of schooling (EYS) (P < 0.0001). The findings also demonstrated a direct and significant correlation between mortality and GNI, MYS, LEB as well as EYS (P < 0.05). The linear regression model showed that a higher MYS [B = 0.2, CI 95%: (-0.03, 0.5)] can significantly augment the incidence of ovarian cancer while an increased MYS [B = 0.2, CI 95% (0.03, 0.4)] can induce mortality. CONCLUSIONS: Given the direct and significant correlation between ovarian cancer incidence and mortality with HDI, attention to risk factors in these countries can be effective in curbing its incidence and mortality.

Incentives to Reduce Salt Intake Resulting From Women's Experiences: A Qualitative Study.

INTRODUCTION: Over consumption of salt adversely affects health and is associated with some diseases. Salt over consumption has been reported to be higher in Asian countries including Iran. This research aimed to identify the facilitative factors of reduced salt consumption among 20-65 year-old women to develop effective educational interventions. Methods: This research used qualitative content analysis. We included 42 (31 women aged 20-65 years residing in Hamidia, Yazd and 11 healthcare providers) using Purposeful sampling method. Data were collected through focal group discussions (three groups of 6) and in-depth semi-structured individual interviews with 24 Participants. Data analysis was done using Graneheim and Lundman's approach. Results: Motivators and facilitators were extracted. The former consisted of sub-categories: physical fitness and healthcare, obtaining others' approval, family cooperation and support, internal motivators, contextual motivators and healthcare staff support. Sub-categories of the latter were gaining more information from different instructions, willingness to acquire self-protection skills and nutritional advice. These factors affected to reduce the salt intake among women. Conclusion: In the light of the qualitative results of motivating and facilitating factors, it is essential to enhance internal motivators and increase access to information via different communicative channels in community including schools, medical care providers and public associations. It is also necessary to pave the way for more family and medical staff support, provide appropriate educational and advertising programs, raise women's awareness and change their attitude and behavior with this concern.

Short and long-term outcomes of patients with coronary artery bypass surgery.

BACKGROUND: Coronary artery disease (CAD) is a major problem in Iran as well as throughout the globe, and coronary artery bypass grafting (CABG) surgery is an appropriate option for many patients with symptomatic and severe CAD. The main purpose of this study was assessment of the short and long-term outcomes of patients undergoing CABG in Yazd Province, Iran. METHODS: This historical cohort study examined the mortality rates of patients who had undergone CABG in Afshar Hospital in Yazd from 2011 to 2013. During this period, 2510 patients undergoing CABG were entered into the study and then followed for in-hospital and long-term mortality. RESULTS: Mean age of the patients was 61.37 ± 10.50 years and 34.1% were women. In-hospital mortality turned out to be 3.7% and age over 70, left ventricular (LV) dysfunction, female gender, and left main (LM) involvement induced significant higher in-hospital mortality. Of all the patients, 84.1% were followed for a period of 41 ± 20 months. The survival rate proved to be 92.4% in one year and 82.9% in five years. The patients with age over 70, diabetes mellitus (DM), and LV systolic dysfunction (LVSD) showed significant lower survival rate, whereas the patients with utilization of left internal mammary artery (LIMA) demonstrated significant higher survival rate. CONCLUSION: In-hospital and long-term mortality rate of patients undergoing CABG surgery is acceptable in comparison with other studies and more effort is needed into making this event a success.

Population Attributable Risk of Hyperuricemia in Hypertension Incidence in 20-74-Year-Old Population during a 10-Year Longitudinal Cohort: Yazd Healthy Heart Cohort.

BACKGROUND: The population attributable risk (PAR) percent has used widely in public health policy. We aimed to calculate the attribute risk of hypertension due to hyperuricemia by Levin's formulas compare to direct PAR calculation method. METHODS: This was a sub-study of Yazd Healthy Heart Cohort (YHHC). Overall, 1256 normotensive individuals were enrolled through multistage randomized cluster sampling and followed up for mean 9.8 years, from 2005-2015. The threshold cutoff point of the hyperuricemia was considered equal and more than 75th percentile that equal to 5.5 mg/dl for men and 4.3mg/dl for women. To calculate the attributable risk of hyperuricemia in developing hypertension, two methods were applied. Levin's formulas and direct PAR estimation by population risk calculation via exposure prevalence weighted formula. Multiple logistic regression was used for estimate of odds ratio (OR) of hyperuricemia in developing hypertension. We calculated Relative Risk (RR) from OR. The data were analyzed using SPSS software version 16. A significant level of 0.05 was considered. RESULTS: Hypertension developed in 44.7% of individuals with uric acid level ≥ 75th percentile vs. 35.6% of other individuals (P=0.024). Attributable risk (AR) of hyperuricemia in hypertension incidence was 9.1%. PAR of hyperuricemia for hypertension incidence by using two methods mentioned before was 6%, 5.8% respectively. CONCLUSION: The results of the study confirmed the noticeable contribution of hyperuricemia as an independent other risk factor for the occurrence of hypertension. PAR of hyperuricemia for hypertension incidence by using two methods almost near was 6%, 5.8% respectively.

Pulmonary arterial pressure in at-term in vitro fertilization neonates: A cross-sectional study.

OBJECTIVE: Hormones consumption in women who conceive through in vitro fertilization (IVF) as well as embryonic manipulations have raised concerns regarding the neonates' health, including the possibility of pulmonary hypertension. This study, therefore, aimed to assess the pulmonary arterial pressure in at-term IVF neonates. MATERIALS AND METHODS: This prospective cross-sectional study was conducted between March 2013 and October 2017 and compares 160 IVF neonates (group 1) with 160 naturally conceived neonates (group 2). The neonates in both groups were cesarean newborns, matched in terms of gestational and neonatal age. The neonates were three-seven days old, had a full-term gestational age of 37-39 weeks and 6 days, and a normal birth weight of 2500-4000 gr. The systolic pulmonary artery pressure (SPAP) was estimated using real-time echocardiography on the basis of peak flow velocity of tricuspid regurgitation jet. RESULTS: A significant difference was observed in the mean SPAPs between the two groups (p<0.001). Although, the effect of gestational age on reducing SPAP was greater and statistically significant in group 1, the gradual decrease in the PAP after birth appeared to be slower in this group. Moreover, in both groups, the effect of gestational age on reducing SPAP was more convincing than that of the neonatal age. Further, in both groups, a significant reverse correlation was observed between the SPAP and the neonatal weight; however, it appeared to be markedly higher in group 1. CONCLUSION: Our study renders IVF as being culpable in the incidence of pulmonary hypertension among neonates. Hence, to detect the likelihood of pulmonary arterial hypertension in IVF neonates, it is recommended to monitor their PAP during the neonatal period, and thereby facilitate them with the required treatment.

Dietary habits and the 10-year risk of overweight and obesity in urban adult population: A cohort study predicated on Yazd Healthy Heart Project.

BACKGROUND AND OBJECTIVE: Overweight and obesity are thought to be associated with increased risk of chronic disease in the Middle East. The present study aimed to determine the association between dietary habits and the incidence of overweight and obesity in urban adult population in the central part of Iran after a 10-year follow-up. METHODS: This cohort study was initiated with 2000 participation aged 20-74 years from Yazd city in Iran based on Yazd Healthy Heart Project (YHHP). The participants without overweight and obesity at the baseline of the study were followed up to 10 years. Demographic data, anthropometric measurements, behavioral and metabolic risk factors of cardiovascular diseases and dietary habits were assessed at baseline and phase II. RESULTS: After a 10-year follow up, 516 non-overweight and 1068 non-obese participants were included for the final analysis. Once adjustments were made for all potential confounders including age, sex, smoking, economic status, physical activity and education, it was identified that lack of weight control increased the risk of obesity (hazard ratio; 95% CI) in total population (1.9; 1.06, 3.4), as well as the risk of overweight (2.39; 1.07, 5.27) and obesity (2.65; 1.13, 6.25) in men. Moreover, consumption of mayonnaise increased the 10-year risk of overweight in women (6.09; 1.2, 30.99). CONCLUSIONS: As revealed by the present study, unhealthy dietary habits can increase the incidence of overweight and obesity in central part of Iran. Therefore, changing the lifestyle appears to be urgent in reducing the risk of overweight and obesity.

Toward an Alum Free Mono-Component Monovalent Pertussis Vaccine: A Cytokine Response Assay.

BACKGROUND: Current evidence indicates the resurgence of whooping cough despite high coverage of whole-cell (wP) and acellular (aP) pertussis vaccines. OBJECTIVE: To investigate the cytokine response to a genetically inactivated protein containing the S1 subunit of pertussis toxin (PTS1) with and without the Listeriolysin O (LLO-PTS1), in comparison with current wP and aP vaccines in the mice model. METHODS: Thirty-six female NMRI mice aged 8 to 12 weeks (25 ± 5 g) were divided into six groups, including control (n=6) and five treated groups (n=6/each). Treated groups received intraperitoneal injection of recombinant PTS1, recombinant fusion LLO-PTS1, aP, wP, and sham (phosphate-buffered saline), whereas the control group did not receive anything. After 60 days, the serum levels of IFN-γ, IL-4, and IL-17 cytokines were evaluated by ELISA method. RESULTS: Our findings showed LLO-PTS1 significantly increased IL-17 and IL-4 cytokines compared with wP and aP vaccines. IFN-γ failed to increase substantially in the LLO-PTS1 group compared to others, but it was non-inferior to standard vaccines. CONCLUSION: Our alum free mono-component monovalent recombinant fusion protein (LLO-PTS1) could bear the capacity to stimulate the release of IFN-γ similar to wP and aP vaccines in the mouse model. Besides, it showed better results in stimulating the release of IL-17 and IL-4 response. This study can be regarded as a platform for further probes in booster pertussis vaccine development.

Prevention of adhesive capsulitis following pacemaker implantation: A randomized controlled study.

INTRODUCTION: Gradual painful loss of active and passive range of motion in shoulder joint was introduced as adhesive capsulitis (AC). Disabilities in patients with AC are absenteeism from work, loss to leisure time, and recurrent seeking to health care services. The aim of this study was to evaluate the incidence of AC following pacemaker implementation. The effect of physical therapy and exercise education was also evaluated to prevent AC following pacemaker implementation. METHODS: This study is a randomized clinical controlled trial. It was conducted on 62 pacemaker candidates. Patients with no shoulder pain and without any motion limits were enrolled in the study consecutively. The patients randomly were divided into two groups after pacemaker implementation. One group was treated with physical therapy (group A, n = 28) and the other group did not (group B, n = 34). The incidence of AC was assessed in both groups after 4 months. RESULTS: A total of 62 patients were enrolled in the study. The mean age was 63.2 ± 12.1 years in the group A and 67.1 ± 17.6 years in the group B. Age was not significantly different between groups. A total of 11 patients (17.7%) had AC 16 weeks after the initial visit (two patients in group A and nine patients in group B; P = .004). CONCLUSIONS: Incidence of AC is 17.7% following device implantation. Exercise education and physical therapy significantly reduces AC incidence following pacemaker implantation.

GLOBAL Leukemia in Children 0-14 Statistics 2018, Incidence and Mortality and Human Development Index (HDI): GLOBOCAN Sources and Methods.

OBJECTIVE: Cancer is the second leading cause of death in children under 15 and leukemia is the most common type of cancer in this age group.  The aim of the present study is to investigate the incidence and mortality of leukemia in children aged 0-14 years and its relationship with Human Development Index (HDI in different countries of the world.  Methods: Incidence and mortality rates were obtained from GLOBOCAN and Country's income from World Bank. The data analysis was conducted using correlation analysis. The association of incidence and mortality rates with HDI was investigated using linear regression models. RESULTS: The results revealed a significant positive correlation between the incidence rate and Gross National Income per capita (r = 0.464, P <0.0001), mean years of schooling (r = 0.566, P <0.0001), life expectancy at birth (r = 0.712, P <0.0001) and expected years of schooling (r = 0.604, P <0.0001). The results also demonstrated a positive and significant correlation between mortality rate and life expectancy at birth (r = 0.199, P <0.0001). An improvement in HDI [Beta = 7.7, CI95% (0.1, 15.3)] and life Expectancy at birth [Beta = 0.1, CI95% (0.03, 0.1)] caused a significantly rise in the incidence of leukemia. Moreover, the improved HDI [Beta = 6.2, CI95% (1.9, 10.5)] was associated with increased mean years of schooling [Beta = -0.1, CI95% (-0.2, -0.01)] and expected years of schooling [Beta = -0.1, CI95% (-0.3, -0.08). CONCLUSION: As the HDI increases, incidence and mortality from of leukemia increases indicating a change in factors that affects leukemia incidences.

The Most Important Predictors of Metabolic Syndrome Persistence after 10-year Follow-Up: YHHP Study.

BACKGROUND: Metabolic syndrome (MetS) is one of the world's largest health epidemics, and its management is a major challenge worldwide. The aim of this 10-year follow-up study was to assess the most important predictors of MetS persistence among an Iranian adult population. METHODS: In this cohort study, 887 out of 2000 participants with MetS aged 20-74 years in the central part of Iran were followed-up for about 10 years from 2005-2006 to 2015-2016. MetS was defined based on the criteria of NCEP-ATP III adopted for the Iranian population. Cox proportional hazards regression was conducted to evaluate the predictors of MetS persistence in crude- and multivariate-adjusted models. RESULTS: Our analyses showed that 648 out of 887 participants (73%) completed the follow-up and 565 (87.2%) of them had persistence of MetS after 10-year follow-up. There was a significant association between age, weight, body mass index, triglyceride, and waist circumference in participants who had MetS compared to those without MetS after 10-year follow-up (P < 0.05). There was a direct association between increases in the mean changes of systolic/diastolic blood pressure, waist circumference, and low HDL-C and risk of MetS persistence after adjusting the model for sex and age in the total population (P trend < 0.05). The trends were the same for women except in diastolic blood pressure. After adjustment for potential confounders, the risk of MetS persistence in men was significantly higher than women (HR = 1.98, 95% CI: 1.38-2.85, Ptrend = 0.001). CONCLUSIONS: Most of the risk factors of MetS were positively associated with persistence of MetS. Therefore, modification of lifestyle is recommended to reduce MetS.