Prevalence of anemia and its associated factors among patients with type 2 diabetes mellitus in a referral diabetic clinic in the north of Iran.

BACKGROUND: PURPOSE: This study intended to investigate the prevalence of anemia and its associated factors among patients with type 2 diabetes mellitus (T2DM) in Gorgan, Iran. METHODS: This cross-sectional study was conducted on 415 (109 men) patients with T2DM referred to the referral diabetes clinic of Sayad Shirazi Hospital in Gorgan in 2021. Demographic information, anthropometric indices, past medical history,  and some laboratory data on cell counts, serum blood glucose, HbA1c, creatinine, lipid/iron profiles, and urinary albumin were collected. The univariable and multivariable logistic regression analysis was applied to compute odds ratios (ORs) and 95% confidence intervals (CI) for potential associated factors, using SPSS version 21. The multivariable Model was adjusted for obesity, Hb A1c, T2DM duration, using glucose-lowering drugs (GLDs), chronic kidney disease (CKD), albuminuria, hypertriglyceridemia, and hypercholesterolemia.  RESULTS: The prevalence of anemia was 21.5% [95%CI: 17.6-25.7] among our total participants. The corresponding values for men and women were 20.2 (13.1-29.0) and 21.9 (17.4-27.0), respectively.The adjusted model revealed that obesity (OR, 1.94 [95% CI, 1.17-3.23]), T2DM duration for more than five years (OR, 3.12 [1.78-5.47]), albuminuria (OR, 6.37 [3.13-10.91]), chronic kidney disease (OR, 4.30 [ 2.83-7.29]) and hypertriglyceridemia (OR, 1.72 [ 1.21-2.77]) were significantly associated with prevalent anemia among patients with T2DM. Moreover, using insulin separately or in combination with oral GLDs associated positively with the prevalence of anemia with ORs of 2.60 [1.42-6.42] and 1.87 [1.30-4.37] , respectively. CONCLUSION: Anemia had a high prevalence among patients with T2DM in the north of Iran (about 22%), which is associated with obesity, hypertriglyceridemia, duration of T2DM, and diabetic kidney disease.

White blood cell count and clustered components of metabolic syndrome: A study in western Iran.

BACKGROUND: White blood cell count (WBC) is one of the objective parameters of systemic inflammation. The aim of present study was to evaluate the relationship between WBC count and metabolic syndrome. METHODS: In this study on Lor population in Borujerd province (West of Iran), from 2011 to 2013, 800 persons were enrolled. MetS was defined based on ATP III criteria. Differences among the quartiles of WBC were examined by one-way analysis of variance. RESULTS: Only 14.7% did not have any of the five components and 43% of all subjects had metabolic syndrome. The means of WBC count in MetS group were significantly higher than the control group (p<0.0001). In subjects without any MetS components, the means of WBC was 5.321 /µL, and it was 5.664, 5.714, 5.961, 6.302, and 6.572 /µL in subjects with 1, 2, 3, 4, and 5 components, respectively. These differences show a significant increasing trend (p<0.0001). CONCLUSION: WBC count was associated with clustered components of metabolic syndrome. It seems that WBC counts could be considered as a predictive factor for metabolic syndrome in preventive medicine.

Blunted Overnight Blood Pressure Dipping in Second Trimester; A Strong Predictor of Gestational Hypertension and Preeclampsia.

BACKGROUND: Preeclampsia is a global burden with 10 million incidences annually and 210 daily deaths worldwide. Diagnosis is mainly based on the features following full presentation. OBJECTIVE: This study explored whether early pregnancy circadian changes of ambulatory blood pressure monitoring (ABPM) could predict preeclampsia and hypertension. METHODS: In a prospective study, 294 pregnant women who were referred to Sarem Women's Hospital, Iran were recruited. Systolic, diastolic and mean arterial pressures (MAP) were recorded (diurnally and nocturnally) in each trimester. Dipping was defined as a minimum 10% decrease in blood pressure. RESULTS: Of the 251 women who completed the study, 25 percent (n=63) experienced blunted MAP dipping during sleep phases in the second trimester. Eighty-nine percent (n=56) experienced hypertensive disorder in the third trimester, one-third of which experienced preeclampsia. Of the women with normal MAP dipping (n=188), 5 percent (n=10) had gestational hypertension and 1 percent (n=2) became preeclamptic. (P<0.0001). CONCLUSION: This study clearly demonstrated blunted blood pressure dipping overnight during the second trimester which is a strong predictor of forthcoming pregnancy-induced hypertension and preeclampsia. A scoring system was developed to predict hypertensive disorder and it was significantly correlated with preeclampsia occurrence.

Aspirin Resistance in Different Doses by Bleeding Time and Urinary 11-dehydro-thromboxane B2.

The aim of the present study was the evaluation bleeding time (BT) in comparison to Urinary 11-dehydro thromboxane B2 (TXB2) regarding different ASA frequent dosages used in Borujerd city. This is a double blind randomized clinical trial on 370 subjects aged 35 years and older, referred to clinical offices in Borujerd. All ischemic heart disease's patients were randomly assigned to 4 ASA dose groups (80 mg, 81 mg, 100 mg and 325 mg) and one group-matched control group without any IHD. BT was measured by Ivy method; TXB2 was measured in a urine sample, both at least 5 days after ASA consumption. Probale AR was indicated if TXB2 was normal or higher than normal higher limit values, or BT was normal or lower than normal higher values. (IRCT201202026958N3) Probale AR was present in 37.6% and 64% resistance by BT and TXB2, respectively. All 4 treated groups had higher TXB2 levels than the control group/normal values (p>0.05). Also, urinary TXB2 level correlated positively with BT. Given the simplicity and low costs of its performance it might be of some potential use in developing countries. However, due to IVY method limitations it cannot be perceived as a tool to assess such specific aspects of platlat function or aspirin resistance.

The Association Between Primary Open Angle Glaucoma and Clustered Components of Metabolic Syndrome.

PURPOSE: There is conflicting evidence whether components of metabolic syndrome (MetS) increase or decrease the risk of primary open-angle glaucoma (POAG). The aim of the present study was to determine the association between metabolic syndrome and primary open-angle glaucoma. METHODS: A total of 200 participants comprising 100 controls and 100 patients with POAG documented by clinical tests and examined by an experienced ophthalmologist using standard ophthalmologic equipment were included in the study. MetS was defined and based on ATP III criteria and POAG was defined by the criteria of the International Society of Geographic and Epidemiological Ophthalmology (ISGEO). The data were entered into the SPSS software and analyzed. RESULTS: The prevalence of MetS in the glaucoma group was 53% in comparison to 38% in the control group (p=0.037). MetS was associated with an increased odds ratio for an IOP higher than 21 mmHg (OR: 1.72; 95% CI 1.03-2.79; p=0.034). The mean IOP was 24.91±4.29 mmHg in the patients without MetS, and 27.23±4.81 mmHg in those with MetS (p=0.027). The mean values of CCT were 603.64±63.16 µm in MetS patients and 579.27±72.87 µm in controls (p=0.018). CONCLUSION: Data showed an increased prevalence of components of metabolic syndrome in patients with glaucoma. The mechanisms underlying these associations need to be established in future studies. Our results support the recommendation that patients with metabolic syndrome undergo regular ophthalmological exams to monitor for the onset or progression of glaucoma.

Metabolic syndrome and its components associated with chronic kidney disease.

BACKGROUND: There is limited information on the relationship between metabolic syndrome (MetS) and chronic kidney disease (CKD) in the Iranian population, a group that has a high prevalence of CKD and obesity. The aim of present study was to determine the relationship between MetS and CKD in West of Iran. MATERIALS AND METHODS: A total of 800 subjects aged more than 35 years admitted from 2011 to 2013 were enrolled in the study. MetS was defined based on the Adult Treatment Panel III criteria, and CKD was defined from the Kidney Disease Outcomes Quality Initiative practice guidelines. Waist circumference and body mass index were calculated, as well, blood samples were taken and lipid profile, plasma glucose levels, and serum creatinine were measured. Data were analyzed with SPSS version 17 (SPSS Inc., Chicago, IL, USA). RESULTS: CKD was seen in 14.8% patients with MetS and 8.3% individuals without MetS. MetS was associated with an increased odds ratio (OR) for a glomerular filtration rate <60 ml/min/1.73 m(2) (OR: 1.91; 95% confidence interval [CI]: 1.22-2.99; P = 0.004). Individuals with 2, 3, 4, and 5 components of the MetS had an increased OR for CKD: 2.19 (95% CI: 0.95-3.62), 2.65 (95% CI: 1.03-4.71), 2.86 (95% CI: 1.08-5.53), and 5.03 (95% CI: 1.80-8.57), respectively, compared with individuals with none of the components. CONCLUSION: We found a high prevalence of CKD in patients with MetS compared with the subject without MetS. Our observations raised major clinical and public health concerns in Iran, where both the MetS and kidney diseases are becoming common.

Normal range of bleeding time in urban and rural areas of Borujerd, west of Iran.

BACKGROUND: Bleeding time (BT) is the oldest and simplest test for assessing the platelets (Plts) function. BT can affect by several factors such as race and diet, which has a wide reference range. The aim of this project is to determine the normal range of BT in Borujerd, Iran. Determining the normal range of BT can help us to modify the definition of bleeding disorder and aspirin resistance. METHODS: This was cross-sectional study carried out in 2011-2012. Subjects with a history of coagulation disorders or a positive family history of coagulation disorders, consumption of anti-Plts, anti-histamines, and phenothiazine in the previous month and subject with Plt less than 150,000 were excluded. The samples were 505 volunteers who were referred from 16 urban and 9 rural clusters to research center. BT of the samples was determined according to Ivy simplate method considering national standard protocol in the selected persons. Normal range was calculated as mean ± 2 standard deviation. RESULTS: Of 505 volunteers, 50.4% were female. The range of BT was 2.8-2.95 min with mean of 2.79 ± 0.78 min. Range and mean of BT in women was 2.83-3.06 min and 2.88 ± 0.87 min, and range and mean of BT in men was 2.7-2.9 min and 2.69 ± 0.67 min; this difference was significant (P = 0.012). BT in urban and rural participants was 2.78 ± 0.79 and 2.77 ± 0.73 min. There was no significant difference between BT in urban and rural participants. CONCLUSION: The normal range of BT in Boroujerd was in the lower limit of the normal universal range. In this study, BT was significantly different in both genders, but its correlation with age, blood group, and place of residency was not significant.

Metabolic syndrome and inflammatory biomarkers in adults: a population-based survey in Western region of iran.

BACKGROUND: There is evidence that inflammation may be involved in pathogenesis of MetS. Inflammatory biomarkers are moving to the forefront as the potent predictors of MetS. OBJECTIVES: The present study aimed to evaluate the association between MetS and some inflammatory biomarkers. PATIENTS AND METHODS: This community-based cross-sectional study was conducted on 800 subjects aged above 35 years selected through random sampling in Borujerd (west of Iran) from 2011 to 2013. MetS was defined based on ATP III criteria and the subjects were divided into two groups (MetS and non-MetS groups). Waist circumference and Body Mass Index (BMI) were calculated. In addition, blood samples were taken and C-Reactive Protein (CRP), lipid profile, Fasting Blood Sugar (FBS), and Bleeding Time (BT) were measured. Then, the correlations between MetS and the above-mentioned variables were estimated. After all, the data were entered into the SPSS statistical software (v. 17) and analyzed using T-test, chi-square, median test, and spearman's rank correlation. RESULTS: In this study, 344 subjects (43%) met the ATP III criteria. The results showed a significant difference between MetS and non-MetS groups regarding BMI, white blood cell, total cholesterol, LDL, platelet, and high-sensitivity CPR (hs-CRP) (P < 0.0001, P = 0.040, P < 0.0001, P < 0.0001, and P = 0.045, respectively). Besides, waist circumference, Triglyceride (TG), FBS, and systolic and diastolic blood pressure were significantly higher, while HDL was significantly lower in the MetS group (P < 0.0001). CONCLUSIONS: The incidence rate of MetS in our survey was higher compared to the previous reports. In addition, this incidence rate was higher in females in comparison to males. The results also showed a significant correlation between inflammatory biomarkers and MetS and that the higher levels of hs-CRP were associated with higher rate of MetS.

Large Left Atrial Myxoma Causing Mitral Valve Obstruction: A Rare Cause of Syncope.

Cardiac myxoma is the most frequent benign tumors of heart. A 37-year-old woman dropped during the second prostration in prayer and decreased his mental state, with no prior history of syncope. On cardiac examination, there was an early diastolic sound that was compatible with a tumor plop. A transthoracic echocardiogram was performed which showed the presence of a pediculated mass in the left atrium, with an appearance suggestive of atrial myxoma. Atrial Myxoma can appear with non-specific symptoms. The best diagnostic method for myxoma is echocardiography that has a high sensitivity.

The impact of alendronate on bone mineral density of osteoporotic patients.

The present study assessed the real life therapeutic effects of weekly doses of alendronate in treating a group of osteoporotic patients in Iran. The present historical cohort was conducted on patients who had undergone two or more bone mineral densitometry within an interval of 1.5-2 years in Shariati Hospital bone mineral density department between 2002 and 2010.patients were asked by phone about consumption of alendronate. The mean increase in the BMD values at different sites was calculated. There was a significant increase in the body mass index (BMI) values of both the individuals taking alendronate and the control group (P<0.001). Taking the weekly dosage of the drug was associated with a 7.67% increase in the BMD values at the femoral neck, 8.68% at the total hip, and 3.17% at the lumbar spine. Moreover, our results showed a significant difference between the height decline in the two groups (alendronate taking: 0.7±2.4 vs. control: -0.7±2.6, P<0.001). Comparing the results of the present study with that of previous ones revealed the drug is beneficial in improving bone mineral density in Iranians; as well alendronate is more effective in Iranian postmenopausal women when compared with the Americans.

Evaluation of fibrinolytic medical therapy for patients with acute myocardial infarction.

BACKGROUND: Fibrinolytic therapy is the standard therapeutic method for patients with acute myocardial infarction (AMI). This study endeavored to assess the delay in arrival to the emergency department and door to needle time for thrombolytic therapy. METHODS: This study was conducted on 80 patients with AMI whom referred to our clinic from January 2009 to January 2010. We measured time of arrival, needle time and door to needle time for all patients. Moreover, the relations of these times to some variables such as age, gender and the referred shift of emergency department personnel were calculated. RESULTS: A total of 80 patients, 62 (77.5%) male and 18 (22.5%) female were evaluated for thrombolytic therapy. The arrival time of overnight shifts was 14.59 ± 1.23 minutes shorter than other shifts. The median door to needle time was 46.56 minutes and the mean time of the onset of chest pain to arrival at the emergency department was 19.44 minutes. Seventy-two patients (90%) received fibrinolytic therapy within the first 30 minutes of arrival. The needle time was significantly longer in the night shift (P < 0.05) (between 8 to 14 minutes), while the time of receiving Streptokinase therapy in the other shifts was not meaningfully different. Finally there was a statistically significant difference between the referred shifts and needle time (P < 0.05). CONCLUSION: Despite our good results for door to needle time, to improve and attain the gold standard's limits in administering fibrinolytic therapy, improvement of policies like training the personnel to shorten this time is recommend.

The effect of inhaled corticosteroids on hypothalamic-pituitary-adrenal axis.

OBJECTIVES: The aim of this study was to compare systemic effects of high-dose fluticasone propionate (FP) and beclomethasone dipropionate (BDP) via pressurized metered dose inhaler on adrenal and pulmonary function tests. MATERIALS AND METHODS: A total of 66 patients with newly diagnosed moderate persistent asthma without previous use of asthma medications participated in this single blind, randomized, parallel design study. FP or BDP increased to 1 500 µg/d in 62 patients who had not received oral or IV corticosteroids in the previous six months. Possible effects of BDP and FP on adrenal function were evaluated by free cortisol level at baseline and after Synacthen test (250 µg). Fasting plasma glucose and pulmonary function tests were also assessed. Similar tests were repeated 3 weeks after increasing dose of inhaled corticosteroids to 1 500 µg/d. RESULTS: No statistically significant suppression was found in geometric means of cortisol level post treatment in both groups. After treatment in FP group, mean forced expiratory volume in one second (FEV1) and mean forced vital capacity (FVC) values improved by 0.17 l (5.66% ± 13.91, P=0.031) and 0.18 l (5.09% ± 10.29, P=0.010), respectively. Although FEV1 and FVC improved in BDP group but was not statistically significant. Oral candidiasis and hoarseness were observed in 6.5% patients receiving BDP, but hoarseness was found in 3.2% patients in FP group (P=0.288). CONCLUSIONS: The results indicate that safety profiles of high doses of BDP and FP with respect to adrenal function are similar, but FP is more efficacious than that of BDP in improving pulmonary function test.

Determination of normal range of bleeding time in rural and urban residents of Borujerd, Iran: A pilot study.

BACKGROUND: Bleeding time test is used to assess the function of platelets in human body. The aim of this project was thus to estimate the sample size required to determine the normal range of bleeding time (BT) in Borujerd (a city in Iran). A pilot study was designed to determine the range of normal BT in a small group of normal people. The total sample size for the next study was then calculated according to the results. METHODS: In order to determine the sample size, a total of 33 volunteers participated in this study. The normal range of BT was determined by Ivy method. Written informed consents were obtained from all participants and their clinical history was recorded. The sampling was performed once for each participant. However, the results were interpreted by two observers. The study protocol was approved by the Ethics Committee of the research center at Lorestan University of Medical Sciences (Iran). RESULTS: In this study, 33 normal participants (20 women and 13 men) were divided into four age groups of 35-44, 45-54, 55-64 and over 64 years old. Maximum and minimum BTs in men were 209 (in the age group of 35-44 years) and 150 seconds (in the age group of over 64 years), respectively. On the other hand, the corresponding values in women were 194 (in 55-64 year-old subjects) and 145 seconds (in women over 64 years of age). Considering the aforementioned results, the total sample size for the next study was determined to be 580 normal subjects by two-sample t-test power analysis at a power of 0.91816. CONCLUSION: There was a significant difference between the normal range of BT in participants of Borujerd and previously recorded range in other studies. Moreover, normal BT in men decreased by aging. This study did not show any special order in increasing or decreasing BT in women.