Comparison of risk assessment tools for cardiovascular diseases: results of an Iranian cohort study.

OBJECTIVES: Several popular cardiovascular risk assessment tools have been developed in Western countries; however, the predictive abilities of these tools have not been evaluated in Middle Eastern countries. The present study aimed to determine the abilities of cardiovascular risk assessment tools in a population-based study in Northern Iran. STUDY DESIGN: Population-based cohort study in Northern Iran. METHODS: In total, 2883 individuals (1629 men and 1254 women), aged 40-74 years, were included in the study. We determined the predictive abilities of the American College of Cardiology/American Heart Association (ACC/AHA) risk prediction tool, the Framingham general cardiovascular risk profile in primary care settings, and the Systematic Coronary Risk Evaluation (SCORE) equations for low- and high-risk European countries. Receiver operating characteristic (ROC) analysis was used to determine the predictive abilities of these four risk assessment tools. RESULTS: Based on areas under curve (AUC) values and related 95% confidence intervals (95% CIs), the discriminative abilities of the ACC/AHA tool, the Framingham approach, and the SCORE for low- and high-risk European countries to estimate non-fatal cardiovascular disease (CVD) events were 0.6625, 0.6517, 0.6476 and 0.6458, respectively, in men, and 0.7722, 0.7525, 0.7330 and 0.7331, respectively, in women. Moreover, the abilities of these four tools to estimate fatal CVD events were found to be 0.8614, 0.8329, 0.7996 and 0.7988 in men, and 0.8779, 0.8372, 0.8535 and 0.8518 in women, respectively. CONCLUSIONS: The cardiovascular risk assessment tools investigated in this study showed acceptable predictive abilities in women. The ACC/AHA approach showed slightly better performance compared with the SCORE tool; however, the SCORE tool benefited from the lowest cost compared with all the other tools.

Atypical and novel presentations of Coronavirus Disease 2019: a case series of three children.

Typical presentations of Coronavirus Disease 2019 (Covid-19) including respiratory symptoms (cough, respiratory distress and hypoxia), fever and dyspnoea are considered main symptoms in adults, but atypical presentation in children could be a diagnostic challenge. We report three children whose initial presentation was gastrointestinal, and in whom Covid-19 infection was found, concluding that cases of acute appendicitis, mesenteric adenitis and flank tenderness may mask an infection with this virus, and should therefore be investigated.

Fermi Volume Evolution and Crystal-Field Excitations in Heavy-Fermion Compounds Probed by Time-Domain Terahertz Spectroscopy.

We measure the quasiparticle weight in the heavy-fermion compound CeCu_{6-x}Au_{x} (x=0, 0.1) by time-resolved terahertz spectroscopy for temperatures from 2 up to 300 K. This method distinguishes contributions from the heavy Kondo band and from the crystal-electric-field satellite bands by different terahertz response delay times. We find that the formation of heavy bands is controlled by an exponentially enhanced, high-energy Kondo scale once the crystal-electric-field states become thermally occupied. We corroborate these observations by temperature-dependent dynamical mean-field calculations for the multiorbital Anderson lattice model and discuss consequences for quantum-critical scenarios.

Discriminatory Ability of Visceral Adiposity Index (VAI) in Diagnosis of Metabolic Syndrome: A Population Based Study.

Background Visceral adiposity index (VAI) has been suggested as an index of visceral adiposity. This study was conducted to determine the discriminatory ability of VAI in diagnosis of metabolic syndrome (MetS). Methods and materials We used the data of 5 312 subjects aged 18-74 years of a cohort study conducted among 6 140 individuals aged 10-90 years in Amol, northern Iran. The city population was divided into 16 strata based on gender and age groups in 10-year intervals. The subjects were randomly selected from each stratum. MetS was defined based on National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATPIII), American Heart Association/National Heart, Lung and Blood Institute (AHA/NHLBI) update of Adult Treatment Panel III (ATPIII), International Diabetes Federation (IDF) and joint interim statement (JIS) definitions. The discriminatory ability of VAI and other obesity measures were evaluated using receiver operating characteristic (ROC) curves. Results While waist circumference (WC) showed the highest discriminatory ability for MetS in IDF definition in men (AUC=0.899 [CI=0.888-0.910]), VAI had the greatest discriminatory ability according to other definitions in men and women. The related AUCs of VAI were 0.866 (95%CI: 0.850-0.881), 0.829 (95%CI: 0.813-0.846), 0.859 (95%CI: 0.844-0.873) and 0.876 (95%CI: 0.863-0.889) based on NCEP/ATPIII, AHA/NHLBI update of ATPIII, IDF and JIS definition in men, and also 0.888 (95%CI: 0.875-0.902), 0.894 (95%CI: 0.881-0.907), 0.883 (95%CI: 0.869-0.897) and 0.879 (95%CI: 0.864-0.894) in women, respectively. Conclusion VAI showed an excellent discriminatory ability in diagnosis of MetS. Considering its relatively simple calculation, this index could be suggested as a reliable tool in medical practice.

Lipid accumulation product and metabolic syndrome: a population-based study in northern Iran, Amol.

PURPOSE: Lipid accumulation product (LAP) demonstrated a strong predictive accuracy for metabolic syndrome (MetS) in previous studies. This study was conducted to determine the predictive performance of LAP compared to obesity indexes. Moreover, the optimal cutoff point of LAP based on the study population waist circumference threshold was estimated in both men and women. METHODS: 5797 subjects with an average age of 44.77 ± 16.77 years for men and 43.78 ± 15.43 years for women were included in the present study. The ROC analysis was performed to assess the predictive accuracy of LAP in the diagnosis of MetS. The optimal cutoff point of LAP was determined according to maximal Youden index in both men and women. RESULTS: The optimal cutoff points determined for LAP were 49.71 (sensitivity = 85.2 %, specificity = 82.3 %) for women and 39.89 (sensitivity = 86 %, specificity = 79.6 %) for men. Based on the assigned cutoff points, the prevalence of high LAP was obtained 44.1 % in men and 45.1 % in women. LAP also showed a significantly higher predictive performance for MetS compared to obesity measures and also TG. CONCLUSION: LAP has a strong and reliable diagnostic accuracy for MetS in Iranian population in the north of Iran. LAP showed a better predictability than other obesity indexes assessed in the present study.

Silver- and fluoride-containing mesoporous bioactive glasses versus commonly used antibiotics: Activity against multidrug-resistant bacterial strains isolated from patients with burns.

The wound healing process is frequently associated with a number of major clinical challenges, due to the failure of commonly used antibiotics as a remedy for wounds. There have always been fascinating questions about the novel applications of bioactive glasses (BGs) and it is expected that in the next few years these types of materials may play an important role in many aspects of soft tissue regeneration. This research focuses on the feasibility of using silver- and fluoride-containing BGs against multidrug-resistant bacterial strains isolated from patients with burns. According to the results obtained, fluoride did not exhibit antibacterial activity against the tested bacteria, while both 1% and 2% silver-containing BGs inhibited the bacterial growth. It is an important finding that 1% silver-containing BGs showed a potential antibacterial activity without any toxicity against fibroblasts, suggesting that this class of BGs could play a key role in the prevention of infection, reduction of pain, and removal of excessive exudates.

Steady-State Dynamics and Effective Temperature for a Model of Quantum Criticality in an Open System.

We study the thermal and nonthermal steady-state scaling functions and the steady-state dynamics of a model of local quantum criticality. The model we consider, i.e., the pseudogap Kondo model, allows us to study the concept of effective temperatures near fully interacting as well as weak-coupling fixed points. In the vicinity of each fixed point we establish the existence of an effective temperature-different at each fixed point-such that the equilibrium fluctuation-dissipation theorem is recovered. Most notably, steady-state scaling functions in terms of the effective temperatures coincide with the equilibrium scaling functions. This result extends to higher correlation functions as is explicitly demonstrated for the Kondo singlet strength. The nonlinear charge transport is also studied and analyzed in terms of the effective temperature.

Promotion of spinal cord axon regeneration by 3D nanofibrous core-sheath scaffolds.

Since spinal cord injury is a complicated problem, neural tissue repair, and regeneration strategies have received a great deal of attention. In this study, a three-dimensional (3D) nanofibrous core-sheath scaffold with nanorough sheath and aligned core were fabricated by a combined electrospinning method with water vortex and two-nozzle system. In vitro and in vivo biological tests were carried out on the poly(lactic-co-glycolic acid) (PLGA) scaffolds. The cell morphology and proliferation evaluation of nerve cells on 3D PLGA scaffolds were studied. Cells were properly orientated along the aligned fiber direction of the scaffold. In animal studies, adult rats received a complete lateral hemisection at the T9-T10 level. Scaffolds were engrafted to bridge 3 mm defects of 10 adult rat spinal cords; 10 rats were used as controls. For 8 weeks, motor and sensory recovery by open field locomotor scale, narrow beam and tail flick tests were assessed. Locomotor and sensory scores of grafted animals were significantly better than the control group. Histological findings demonstrated that the scaffold supports the axonal regeneration of injured spinal cords and regenerating axons were seen to enter the graft and extend along its length.

Neuroprotective effect of olive oil in the hippocampus CA1 neurons following ischemia: Reperfusion in mice.

INTRODUCTION: Transient global ischemia induces selective, delayed neuronal death of pyramidal neurons in the hippocampal CA1. Oxidative Stress is considered to be involved in a number of human diseases including ischemia. Preliminary studies confirmed reduction of cell death in brain following treatment with antioxidants. AIM: According to this finding, we study the relationship between consumption of olive oil on cell death and memory disorder in brain ischemia. We studied the protective effect of olive oil against ischemia-reperfusion. MATERIAL AND METHODS: EXPERIMENTAL DESIGN INCLUDES THREE GROUPS: Intact (n = 8), ischemic control (n = 8) and treatment groups with olive oil (n = 8). The mice treated with olive oil as pre-treatment for a week. Then, ischemia induced by common carotid artery ligation and following the reduction of inflammation [a week after ischemia], the mice post-treated with olive oil. Nissl staining applied for counting necrotic cells in hippocampus CA1. Tunnel kit was used to quantify apoptotic cell death while to short term memory scale, we apply y-maze and shuttle box tests and for detection the rate of apoptotic and treated cell, we used western blotting test for bax and bcl2 proteins. RESULTS: High rate of apoptosis was seen in ischemic group that significantly associated with short-term memory loss. Cell death was significantly lower when mice treated with olive oil. The memory test results were adjusted with cell death results and bax and bcl2 expression in all groups' comparison. Ischemia for 15 min induced cell death in hippocampus with more potent effect on CA1. CONCLUSION: Olive oil intake significantly reduced cell death and decreased memory loss.

Adult-onset familial mediterranean Fever in northwestern iran; clinical feature and treatment outcome.

BACKGROUND Familial Mediterranean fever (FMF) is an autosomal recessive disorder characterized by sporadic, paroxysmal attacks of fever and serosal inflammation. Although the disease usually begins before the age of 20 years, we aimed to evaluate the demography, clinical features and treatment outcome of familial Mediterranean fever in Iranian adult patients above 20 years old. METHODS In this cross-sectional study, adult patients (first attack at the age of >20 years) with a diagnosis of FMF who referred to the gastroenterology and rheumatology Clinics of Ardebil University of Medical Science (situated in north west of Iran) over the period of 2004-2009 were enrolled. FMF diagnosis was based on clinical criteria. RESULTS Forty four FMF patients (30 male and 14 female) with the mean [± Standard Deviation (SD)] age of first attack of 29 ± 7.8 years were enrolled. Abdominal pain (95.5%) and fever (91%) were the most common clinical findings. All of the patients had satisfactorily responded to therapy. Response was complete in 76.7% and partial in 23.3% of the patients. There was no clinical or laboratory evidence of amyloidosis at the time of diagnosis or during follow-up. CONCLUSION Our findings demonstrated that adult-onset FMF in Iran has different characteristics (more common in males, lesser prevalence of arthritis and erysipelas-like erythema, less delay in diagnosis) and treatment outcome (favorable response even to low-dose colchicine) in comparison with the previous data on early onset patients.

Histopathological Study of Chronic Hepatitis B: A Comparative Study of Ishak and METAVIR Scoring Systems.

BACKGROUND: Ishak and METAVIR scoring systems are among the most commonly used histopathological systems to evaluate chronic hepatitis. OBJECTIVE: To assess the level of agreement between these two scoring systems in patients with chronic hepatitis B. METHODS: Liver biopsy samples taken from 92 patients with chronic hepatitis B were considered as the training set; 57 more biopsy specimens were used as the validation set. In the training set, grade of necroinflammation and stage of fibrosis for each liver biopsy specimen were determined by two expert liver pathologists using both Ishak and METAVIR systems. Inter-observer variability between the two pathologists was evaluated. Biopsy specimens of the validation set were seen and scored by a third expert pathologist. In the training set, criteria were developed to categorize Ishak grading and staging systems separately to best fit with the METAVIR scoring system. The criteria found in the training set, was then tested in the validation set. The level of agreement between the two scoring systems was assessed by weighted kappa statistics. RESULTS: For the training set, agreement between the two pathologists was excellent. Using our proposed criteria in the training set, there was excellent level of agreement in grading (κ = 0.89) and staging (κ = 0.99) between Ishak and METAVIR systems. In the validation set, the criteria led to substantial correlation (κ = 0.61) in grading, and excellent correlation (κ = 0.94) in staging between the two systems. CONCLUSION: Using our proposed criteria, excellent or at least substantial concordance between Ishak and METAVIR scoring systems can be achieved for the degree of both necro-inflammatory changes and fibrosis.

[Modified set back tongue flap: an alternative surgical approach in the reconstruction of defects of the base of the tongue]. / Der modifizierte Set-back-Zungenlappen. Eine Alternative in der Rekonstruktion von Zungengrunddefekten.

The base of the tongue after tumor resection can be reconstructed in several ways. In addition to direct suturing of small defects, a variety of local or microvascularly anastomosed flaps have been described. The present paper is aimed at introducing a local tongue flap for the reconstruction of medium-sized defects. Six patients were treated at the hospital between 1999 and 2002 with the above technique to cover defects affecting one-half to three-fourths of the base of the tongue. One patient had secondary bleeding and the other one experienced no complications. Nutrition could be started after 7.5 days (4-12) postoperatively on average. The tracheostomy was closed at 16.2 days (12-22) on average after the initial operation. The hospitalization of the patients was 20.3 days (15-27) on average. The modified set back tongue flap is an alternative in the reconstruction of subtotal defects of the base of the tongue. Easy handling, good functional outcome in swallowing, and the low complication rate were advantageous in the present series.

Differences between trunk sway characteristics on a foam support surface and on the Equitest ankle-sway-referenced support surface.

Clinicians have sought ways to increase trunk sway so that it is easily observed and a balance deficit more easily identified. One technique often used for this purpose is to reduce the efficacy of ankle proprioceptive inputs on sway. To achieve this reduction either a foam mat is used as an unstable support surface or the subject stands on a surface made unstable with servo-driven ankle-sway-referencing. The purpose of the current study was to investigate differences in trunk pitch and roll sway characteristics using these techniques. Trunk sway while standing quietly on two legs was measured in 25 normal subjects in the age range 20-35 years for three support-surface conditions. Each condition was tested twice for 20 s, once with eyes open and once with eyes closed. The three conditions were standing on a foam support surface, standing on a support surface with pitch (fore-aft) ankle-sway-referencing as used for the standard Sensory Organization Test (SOT) of the Neurocom Equitest System (SOT 4 and 5), and standing with roll (lateral) ankle-sway-referencing. The latter was achieved by having the subjects stand turned 90 degrees to the standard SOT position. Two angular velocity sensors mounted on a belt measured trunk sway in the pitch and roll directions. Trunk roll angle and angular velocity amplitudes for pitch sway-referencing were reduced compared to either the foam or roll sway-referencing conditions, but trunk pitch angle and angular velocities amplitudes were greater. For roll sway-referencing, the trunk roll angle was greater than for the other stimulus conditions. Analyses of the trunk sway velocity in the frequency domain indicated that ankle-sway-referencing in the pitch direction increased trunk pitch sway at 1 Hz and decreased trunk roll sway between 2 and 5 Hz compared to foam support frequency spectra. Roll ankle-sway-referencing decreased trunk roll between 2 and 4 Hz only. These results indicate that using a foam support surface provides multidirectional trunk sway with velocity content across all frequencies in the range 0.8-5.2 Hz. Roll ankle-sway-referencing, but not pitch ankle-sway-referencing, yields trunk sway with similar characteristics to those with foam. Pitch ankle-sway-referencing forces pitch trunk resonance to be around 1 Hz and yields very different trunk sway from that obtained with a foam support surface. Roll sway-referencing is an alternative means to test multidirectional control of sway. Clinically though, foam is simpler to use and provides a more difficult balance task for the patient.

Ribosomal RNA gene organization in Cryptosporidium parvum.

The cytoplasmic ribosomal RNA (rRNA) genes of the Apicomplexan protozoan parasite Cryptosporidium parvum have been analyzed with respect to size, copy number, organization and structure. The small and large subunit rRNAs are 1.7 and 3.6 kb, respectively. A 151 bp putative 5.8S rRNA gene was identified. The rDNA unit is 5' small subunit rRNA internal transcribed spacer 1-5.8S rRNA-internal transcribed spacer 2-large subunit rRNA 3'. There are five copies of the rDNA unit per haploid genome and they are not organized in a conventional head to tail tandem array with a conserved external transcribed spacer. The rDNA units are dispersed through the genome to at least three chromosomes. At least two of the rDNA units are single unlinked copies on different chromosomes. There are two structurally distinct types of rDNA unit, Type A and B, with marked differences in the internal transcribed spacer regions. There are four copies of the Type A rDNA unit and one copy of the Type B rDNA unit.