Survival and causes of death in systemic sclerosis patients: a single center registry report from Iran.

The aims of the study were to determine prognostic factors for survival and causes of death in a cohort of patients with systemic sclerosis (SSc). This was a cohort study of SSc patients in single rheumatologic center from January 1998 to August 2012. They fulfilled the American College of Rheumatology classification criteria for SSc or had calcinosis Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, telangiectasia or sine sclerosis. Causes of death were classified as SSc related and non-SSc related. Kaplan-Meier and Cox proportional hazard regression models were used in univariate and multivariate analysis to analyse survival in subgroups and determine prognostic factors of survival. The study includes 220 patients (192 female, 28 male). Out of thirty-two (14.5 %) who died, seventeen (53.1 %) deaths were SSc related and in nine (28.1 %) non-SSc-related causes, and in six (18.8 %) of patients causes of death were not defined. Overall survival rate was 92.6 % (95 % CI 87.5-95.7 %) after 5 years and 82.3 % (95 % CI 73.4-88.4 %) after 10 years. Pulmonary involvement was a major SSc-related cause of death, occurred in seven (41.1 %) patients. Cardiovascular events were leading cause of in overall death (11) 34.3 % and 6 in non-SSc-related death. Independent risk factors for mortality were age >50 at diagnosis (HR 5.10) advance pulmonary fibrosis (HR 11.5), tendon friction rub at entry (HR 6.39), arthritis (HR 3.56). In this first Middle Eastern series of SSc registry, pulmonary and cardiac involvements were the leading cause of SSc-related death.

Psychological state in patients undergoing coronary artery bypass grafting surgery or percutaneous coronary intervention and their spouses.

Percutaneous coronary intervention (PCI) and the coronary artery bypass grafting surgery (CABG) are well accepted treatments for coronary artery disease. Many patients and their spouses experience increased level of stress, anxiety and depression before and after going under the procedure. One hundred and ninety-six cardiac patients who were candidate for CABG or PCI procedures and their spouses were asked to complete Hospital Anxiety and Depression Scale and General Health Questionnaire-12 before and 1 month after procedures. Anxiety, depression and stress level in patients and their spouses going under the procedures significantly reduced over time. Scores of anxiety, depression and stress in patients and their spouses were correlated. There was no difference in the level of anxiety, depression and stress between CABG and PCI groups before to after procedures. We suggest providing information about the procedures to both patients and their spouses to deal better with their own psychological state.

Systemic sclerosis: comparison of efficacy of oral cyclophosphamide and azathioprine on skin score and pulmonary involvement-a retrospective study.

The aim of this study was to evaluate efficacy of azathioprine (AZA) and cyclophosphamide (CYC) as a therapeutic regimen for interstitial lung disease associated with systemic sclerosis (SSc). Thirty-six selected patients included in this retrospective cohort and received one of the two drugs; the first group consists of 15 patients who were treated with AZA (1.5-2 mg/kg/day) and the second group with 21 patients received oral CYC (up to 2 mg/kg/day). Both groups received additional low dose of prednisolone (≤10 mg) for 6 months. Forced vital capacity (FVC), diffusion lung capacity for carbon monoxide (DLCO) and skin score were assessed as outcome measures. Modified Rodnan skin score (mRSS), pulmonary function test and DLCO were evaluated at entry and at the end of study after 12 months. The mean (SD) FVC percentages obtained at baseline and post-treatment in AZA-treated patients were 62.8 ± 9.8 and 71.1 ± 20.9 with mean difference of FVC% +7.6 ± 13.1, p = 0.05, and in CYC-treated patients 59.5 ± 10.7, 63.1 ± 16.2 and +2.9 ± 11.5, respectively, p = 0.19. Baseline and post-treatment DLCO% in AZA-treated patients were 61.4 ± 25.8 and 76.7 ± 24.0 with mean difference of +15.0 ± 14.5, respectively, p = 0.01. In CYC-treated patients, those measures were 67.7 ± 27.5 and 60.0 ± 22.9 with mean difference of -8.0 ± 23.7 (p = 0.12). Following 12 months of treatment in AZA-treated patients, mean difference of changes in mRSS was -2.9 ± 3.7 and -1.4 ± 4.5 in CYC-treated patients. Our results indicated that AZA can be effective in ameliorating or stabilizing lung function in selected SSc patient groups.

Systemic sclerosis: demographic, clinical and serological features in 100 Iranian patients.

To evaluate demographic, clinical and laboratory features associated with scleroderma-specific auto-antibodies. Sera of 100 patients with systemic sclerosis (SSc) were analyzed by an indirect immunofluorescence technique with HEp-2 cells as a substrate. Specific ANA such as anti-centromere antibodies (ACA), anti-topoisomerase (TOPO), anti-RNA polymerase III (Pol 3), anti-U3-RNP (U3-RNP), anti-Th/To (Th/To) and anti-PM/Scl (PM/Scl) were detected by line immunoassay and anti-U1-RNP (U1-RNP) by ELISA. Frequency of clinical features associated with a specific antibody group was reported cumulatively over the follow-up period. Frequency of specific clinical features was compared across the two disease subtype including limited cutaneous (lcSSc) or diffuse cutaneous (dcSSc) as well as the auto-antibody groups. Ninety-four percent of patients were ANA positive with significant higher skin score, Raynauds and digital ulcer/gangrene. Anti-TOPO was detected in 71% of all patients, in 90.5% of dcSSC and in 65.8% of lcSSc. Anti-TOPO was significantly associated with dcSSc, higher skin score, digital ulcer/gangrene, pulmonary fibrosis, DLCO <70%. U1-RNP antibody was associated with lower fibrosis in lung. ACA was positive in 7% of patients and exclusively in those with lcSSc. We did not find association between gender and presence of auto-antibodies. Anti-TOPO antibody had a high prevalence in contrast to low prevalence of ACA antibody. There were no differences in clinical subtypes of the disease in patients with positive anti-TOPO and positive ACA. Differences in prevalence of auto-antibodies are suggestive of further genetic study.

Prevalence & Impact of COVID-19 in Systemic Sclerosis Patients and Assessment of the Demographic & Clinical Features in Cases Associated with Worse Prognosis: Results of a Single Centre Registry.

Background: Our knowledge of the COVID-19 infection impact on systemic sclerosis (SSc) is scarce. This study aimed to assess the prevalence of COVID-19 infection and to determine the predictive factors of worse outcomes and death in SSc patients. Methods: In this cohort study all patients who attended our clinic between 20th February 2020 and 20th May 2021 were followed, and those with a history of COVID-19 infection completed the questionnaire. Results of para-clinical tests were extracted from the SSc database. The outcomes were classified as: alive vs. deceased and, mild vs. worse outcomes. Descriptive statistics and binary logistic regression models were applied. Results: Of the total 192 SSc patients studied, COVID-19 affected 12.5%; 6% experienced mild disease, 7% were hospitalized and 3% died. The worse outcome was associated with: older age [95%CI: 1.00-1.08], smoking [95%CI: 2.632-33.094], diabetes [95%CI: 1.462-29.654], digital pitting scars (DPS) [95%CI: 1.589-21.409], diffusing capacity of the lungs for carbon monoxide [DLCO<70 [95%CI: 1.078-11.496], left ventricular ejection fraction (LVEF)<50% [95%CI: 1.080-38.651], systolic pulmonary artery pressure (sPAP)>40 mmHg [95%CI: 1.332-17.434], pericardial effusion (PE) [95%CI: 1.778-39.206], and tendon friction rub [95%CI: 1.091-9.387]. Death was associated with male gender [95%CI: 1.54-88.04], hypertension [95%CI: 1.093-2.155], digital ulcers (DU) [95%CI: 0.976-18.34], low forced vital capacity (FVC) [95%CI: 0.03-0.81], and joint flexion contracture (JFC) [95%CI: 1.226-84.402]. Conclusion: Risk factors for the worse outcome in COVID-19 infected SSc patients included, older age, smoking, diabetes, DPS, DLCO<70, LVEF<50%, sPAP>40 mmHg, PE, and TFR. Death was associated with the male gender, hypertension, DU, low FVC, and JFC.

Evidence-Based Design in the Hospital Environment: A Staff's Burnout Study in the COVID-19 Era.

OBJECTIVE: This study aimed to evaluate the evidence-based design of the hospital physical space effect on the burnout of nurses and physicians during COVID-19. The research question was to identify the connection between daylight, nature-view windows, and hospital staff burnout during Covid-19. BACKGROUND: The evidence-based design in the hospital environment affects the health of the medical staff. The promotion of the hospital environment has a significant effect on healthcare system improvement. METHODS: This cross-sectional study was performed on 406 nurses and physician's burnout in Guilan province in 2020. Three questionnaires were used: demographic, physical space of the hospital, daylight, nature-view windows, and Maslach Burnout Inventory. Logistic regression (LR) analysis was used to determine the association between burnout and the hospital environment. The significance level was considered with p < .05. RESULTS: The results showed statistically significant correlations between patient units and the environmental characteristics of the hospitals with staff's burnout (p < .001). Of note, 62.9% of physicians and 71.9% of nurses had moderate work-related burnout. The highest burnout score was seen among staffs of emergency departments adjusted multivariate LR model revealed that 27.1% of work-related burnout in nurses and physicians was predictable with age, light, marital status, and hospitals. Our results showed that accessing more daylight could reduce burnout (p = .018, odds ratio [OR] = 0.910). CONCLUSION: Based on the result, the daylight impact on burnout reduction is more significant than other factors. It is suggested that adequate lighting, proper environmental design, and nature-view windows could create appropriate space for enhancing medical staff satisfaction and reducing burnout.

Biomechanical Properties of Heel Pad, Metatarsal Head Soft-Tissue and Foot Ulcers in Patients with Systemic Sclerosis: A Case Control Study.

Background: Systemic sclerosis is a chronic disease of connective tissue accompanied by fibrosis of the skin and inner organs and an increased risk of foot ulcers. Biomechanical indices such as soft-tissue thickness and compressibility may correlate with the risk of this phenomenon. Objective: The aim of this study was to assess heel pad and first metatarsal head (MTH) soft-tissue thickness and compressibility index (CI) in scleroderma patients compared to matched healthy individuals. Not all patients had foot ulcers. Methods: Heel pad thickness in standing (loaded) and lying (unloaded) positions were measured in 40 scleroderma patients by means of a lateral foot radiograph. CI was measured as the ratio of loaded to unloaded thickness. The Soft-tissue thickness of the first MTH was measured by ultrasound. Results were compared with 40 healthy controls of matched age and body mass index. All patients' diagnoses were made based on the American College of Rheumatology classification criteria. Results: Forty scleroderma patients (36 females, 4 males) with the following demographics were studied; mean age (SD) 45(12), mean body mass index 25.5 (4), and mean disease duration=10(9.6) years; only 8 (20%) had digital ulcers. Patients' heel pad thickness and CI in the dominant side and MTH soft-tissue thickness on both sides were significantly different compared to the control group. Comparison of results in patients with and without foot ulcers also showed a significant difference in soft-tissue thickness. Thickness was negatively associated with disease duration, but the CI did not change over time. Conclusion: Soft-tissue thickness of the foot decreases in scleroderma patients and is associated with foot ulcers and digital ulcers in the hands.

Design of vestibules as transitional spaces in infection control: Necessity of working space changes to cope with communicable infections.

BACKGROUND: After the spread of infectious diseases, people stay at home as a shelter space to be safe and sound. Current homes and work spaces have shown not to be a good environment for health and hygiene. During different crises of infectious diseases, architects and designers analyze the needs for change and evolve of environments to achieve a suitable design that prevents the spread of pathogens. OBJECTIVES: This proper design should help improve people's living standards and mental health in terms of functionality and environmental psychology. METHODS: In the traditional architecture of some countries, such as Canada, Japan, and Iran, the vestibule has provided some possibility of separating the external and internal space. The design of the intermediate space with the appropriate scale of today's buildings at the entrance can create a filter between the indoor and outdoor environments by dividing these spaces. RESULTS: The use of intermediate space by modern technology can prevent the transfer of viral infection into the interior of the building. This can be done by removing the virus from clothes, changing or covering shoes, disinfecting equipment, separating infected items, and creating proper ventilation in the intermediate space so that microorganisms cannot be transferred into the safe environment. CONCLUSIONS: In this paper, we looked at the architectural design in a new light to have a healthier life and more security, by inspiration of the patterns in traditional architecture and the human body.

The Effectiveness of the Anteroom (Vestibule) Area on Hospital Infection Control and Health Staff Safety: A Systematic Review.

The emergence of SARS-CoV2 in 2019 showed again that the world's healthcare system is not fully equipped and well-designed for preventing the transmission of nosocomial respiratory infections. One of the great tools for preventing the spread of infectious organisms in hospitals is the anteroom. Several articles have investigated the role of the anteroom in disease control but the lack of a comprehensive study in this field prompted us to provide more in-depth information to fill this gap. Also, this study aimed to assess the necessity to construct an anteroom area for hospital staff members at the entrance of each ward of the hospital, and specify the equipment and facilities which make the anteroom more efficient. Articles were identified through searches of Scopus, Web of Sciences, PubMed, and Embase for studies published in English until May 2020 reporting data on the effect of the anteroom (vestibule) area in controlling hospital infections. Data from eligible articles were extracted and presented according to PRISMA's evidence-based data evaluation search strategy. Also, details around the review aims and methods were registered with the PROSPERO. From the database, 209 articles were identified, of which 25 studies met the study criteria. Most studies demonstrated that an anteroom significantly enhances practical system efficiency. The results showed that the equipment such as ventilation system, high-efficiency particulate absorption filter, hand dispensers, alcohol-based disinfection, sink, mirror, transparent panel, UVC disinfection, and zone for PPE change, and parameters like temperature, door type, pressure, and size of the anteroom are factors that are effective on the safety of the hospital environment. Studies demonstrated that providing an anteroom for changing clothing and storing equipment may be useful in reducing the transmission of airborne infections in hospitals. Since the transmission route of SARS-CoV2 is common with other respiratory infectious agents, it can be concluded that a well-designed anteroom could potentially decrease the risk of SARS-CoV2 transmission during hospitalization as well.

Association of Musculoskeletal and Radiological Features with Clinical and Serological Findings in Systemic Sclerosis: A Single-Centre Registry Study.

AIM: Systemic sclerosis (SSc) is a chronic connective tissue disease with the clinical hallmark of skin thickening and tethering. Correlation of musculoskeletal features with other parameters should be considered in SSc patients. METHODS: We reviewed the records of all patients who had more than one visit and standard anteroposterior radiography of hand. We used univariate analysis, and factors with p<0.05 were included in logistic regression to find out dependent factors. RESULTS: Overall, 180 SSc patients were enrolled in our study, 161 (89.4%) of whom were women. Median age (IQR) was 47.0 years (16), and 52% had diffuse subtype of the disease. In multivariate analysis, tendon friction rubs (TFRs) was associated with the presence of calcinosis, muscle tenderness, and flexion contracture (FC) on physical examination (p<0.05). Arthritis showed no differences in the two subtypes of the disease (p=0.98), and in multivariate analysis, there were no correlations between radiographic arthritis and serological and clinical features. The radiographic results indicated that disease duration correlated with joint erosion, acro-osteolysis, resorption of distal ulna, calcinosis and radiologic FC (p< 0.05). Acro-osteolysis was more frequent in the dcSSc subtype, TFRs, and anti-TOPO I antibody. Radiologic FC showed association with skin score, calcinosis and haematocrit <30% (p<0.05). Joint flexion on radiography was associated with disease duration, modified Rodnan skin score, calcinosis, and low haematocrit (P<0.01). CONCLUSION: Disease duration was a main dependent factor for developing joint erosion, acro-osteolysis, bone resorption, calcinosis, and flexion contracture on hand radiography. Acro-osteolysis presented in the severe form of the disease. Acro-osteolysis was the only dependent variable associated with bone demineralization.

Pulmonary Thromboembolism Presenting with Recurrent Bradycardia and Hypotension.

Recurrent short episodes of bradycardia and hypotension are rarely reported as clinical manifestations of pulmonary thromboembolism (PTE). We report a case of acute massive PTE presenting with dyspnea, burning chest pain with physical activity, and recurrent transient bradycardia and hypotension at rest. Echocardiography showed a left ventricular ejection fraction of 45% with global hypokinesia. Computed tomography angiography showed a large pulmonary thromboembolism. Lytic therapy improved the right ventricular function, and the pulmonary artery pressure decreased to 38 mmHg. Recurrent bradycardia and transient hypotension at rest with syncope on activity and recovery without treatment are not common and may suggest a vasovagal mechanism. Evaluation of patients with these clinical findings could enable early diagnosis and treatment of acute PTE, with decreased morbidity and mortality.

Persian Registry Of cardioVascular diseasE (PROVE): Design and methodology.

BACKGROUND: Our aim was to create and establish a database called "Persian Registry Of cardioVascular diseasE (PROVE)" in order to be used for future research and in addition, as a tool to develop national guidelines for diagnosis, treatment, and prevention of cardiovascular disease (CVD). In this paper, the design and methodology of the PROVE pilot study will be discussed, launched in Isfahan, Iran, in 2015-2016. METHODS: Through establishing PROVE, patients' data were collected from hospitals and outpatient clinics prospectively or retrospectively and followed up for a maximum of three years based on the type of CVDs. The inclusion criteria were as patients with acute coronary syndrome (ACS), ST elevation myocardial infarction (STEMI), stroke, atrial fibrillation (AF), heart failure (HF), congenital heart disease (CHD), percutaneous coronary intervention (PCI), and chronic ischemic cardiovascular disease (CICD). Specific protocols, questionnaires, and glossaries were developed for each registry. In order to ensure the validation of the protocols, questionnaires, data collection, management, and analysis, a well-established quality control (QC) protocol was developed and implemented. Data confidentiality was considered. RESULTS: In order to register patients with ACS, STEMI, stroke, HF, PCI, and CICD, the hospital recorded data were used, whereas, in case of AF and CHD registries, the data were collected from hospitals and outpatient clinics. During the pilot phase of the study in Isfahan, from March 2015 to September 2016, 9427 patients were registered as ACS including 809 as STEMI, 1195 patients with HF, 363 with AF, 761 with stroke, 1136 with CHD, 1200 with PCI, and 9 with CICD. Data collection and management were performed under the supervision of the QC group. CONCLUSION: PROVE was developed and implemented in Isfahan as a pilot study, in order to be implemented at national level in future. It provides a valuable source of valid data that could be used for future research, re-evaluation of current CVD management and more specifically, gap analysis and as a tool for assessment of the type of CVDs, prevention, treatment, and control by health care decision makers.

Effect of age on the phenotype of metabolic syndrome in developing country.

BACKGROUND: This study aimed to determine how age groups effect on the phenotype of metabolic syndrome (MetS) among Iranian population. MATERIALS AND METHODS: This cross-sectional study was conducted as part of Isfahan Healthy Heart Program. Height, weight, waist circumference, and blood pressure were measured by trained health-care professionals. MetS was defined as having three or more of the National Cholesterol Education Program III criteria. The relation between different age groups and different phenotypes of MetS was examined using the multinomial logistic regression. RESULTS: We found low high-density lipoprotein-cholesterol (HDL-c) was the most common feature, followed by hypertriglyceridemia (HTG), abdominal obesity (ABO), hypertension (HTN), and high fasting blood glucose in decreasing order of prevalence. The most prevalent combination of MetS components was hypertrigeceridemia, low HDL-c and ABO (50.7%) in all subjects and especially in younger age group (63.2%). In elder age group, the most prevalent three components combination was HTG, Low HDL-c and HTN (43.9%). Logistic regression analysis demonstrated that elder subjects were at approximately 12 times higher risk of having the combination HTG, ABO, low HDL-c, and HTN (P < 0.001) compared to the middle age subjects who had a lower risk for the same combination; (2 [1.49-3.49]) (P < 0.001). CONCLUSION: This study provides a nationally representative estimate of the prevalence of different phenotypes of MetS across different age groups. Regarding different phenotypes of MetS in various age groups need to have important implications in the clinical management of these patients and the implementation of public health.

Smoking motivators are different among cigarette and waterpipe smokers: The results of ITUPP.

The present study explores different drivers of cigarette and water pipe smoking among middle and high school students in Isfahan province. A questionnaire-based cross-sectional study was conducted. Trained staff collected questionnaires and saliva samples for response accuracy evaluation. Prevalence by demographic, parental and educational factors was calculated. Logistic regression was applied to compare behavior drivers of those who purely smoked cigarettes or a waterpipe. Waterpipe smokers were considered as the reference category. This study reported ORs along 95% confidence intervals; 5408 questionnaires were returned. The sample age was 15.37±01.70 on average. The self-reported prevalence of cigarette and waterpipe experimentation was 11.60% (n=624) and 20.70% (n=1,109), respectively; and 5.08% (n=311), 11.06% (n=619) for smokers, and 13.30% (n=711) for the whole sample. Psychological factors were the most important driver for cigarette smoking; bad event happening with odds of 2.38 (95% CI: 1.29-4.39); angriness 2.58 times (95% CI: 1.51-4.43); and distress by 2.49 times (95% CI: 1.42-4.40). Habitual situations were strong predictors of cigarette smoking, but not a predictor of waterpipe smoking, such as smoking after a meal (OR=3.11, 95% CI: 1.67-5.77); and smoking after waking up (OR=2.56, 95% CI: 1.42-4.40). Comprehensive and multifaceted preventive programs must tailor identified factors and increase family's awareness.

Advanced method used for hypertension's risk factors stratification: support vector machines and gravitational search algorithm.

BACKGROUND: The aim of this study is to present an objective method based on support vector machines (SVMs) and gravitational search algorithm (GSA) which is initially utilized for recognition the pattern among risk factors and hypertension (HTN) to stratify and analysis HTN's risk factors in an Iranian urban population. METHODS: This community-based and cross-sectional research has been designed based on the probabilistic sample of residents of Isfahan, Iran, aged 19 years or over from 2001 to 2007. One of the household members was randomly selected from different age groups. Selected individuals were invited to a predefined health center to be educated on how to collect 24-hour urine sample as well as learning about topographic parameters and blood pressure measurement. The data from both the estimated and measured blood pressure [for both systolic blood pressure (SBP) and diastolic blood pressure (DBP)] demonstrated that optimized SVMs have a highest estimation potential. RESULTS: This result was particularly more evident when SVMs performance is evaluated with regression and generalized linear modeling (GLM) as common methods. Blood pressure risk factors impact analysis shows that age has the highest impact level on SBP while it falls second on the impact level ranking on DBP. The results also showed that body mass index (BMI) falls first on the impact level ranking on DBP while have a lower impact on SBP. CONCLUSION: Our analysis suggests that salt intake could efficiently influence both DBP and SBP with greater impact level on SBP. Therefore, controlling salt intake may lead to not only control of HTN but also its prevention.

Validation of the revised stressful life event questionnaire using a hybrid model of genetic algorithm and artificial neural networks.

OBJECTIVES: Stressors have a serious role in precipitating mental and somatic disorders and are an interesting subject for many clinical and community-based studies. Hence, the proper and accurate measurement of them is very important. We revised the stressful life event (SLE) questionnaire by adding weights to the events in order to measure and determine a cut point. METHODS: A total of 4569 adults aged between 18 and 85 years completed the SLE questionnaire and the general health questionnaire-12 (GHQ-12). A hybrid model of genetic algorithm (GA) and artificial neural networks (ANNs) was applied to extract the relation between the stressful life events (evaluated by a 6-point Likert scale) and the GHQ score as a response variable. In this model, GA is used in order to set some parameter of ANN for achieving more accurate results. RESULTS: For each stressful life event, the number is defined as weight. Among all stressful life events, death of parents, spouse, or siblings is the most important and impactful stressor in the studied population. Sensitivity of 83% and specificity of 81% were obtained for the cut point 100. CONCLUSION: The SLE-revised (SLE-R) questionnaire despite simplicity is a high-performance screening tool for investigating the stress level of life events and its management in both community and primary care settings. The SLE-R questionnaire is user-friendly and easy to be self-administered. This questionnaire allows the individuals to be aware of their own health status.

Predictors of metabolic syndrome in the Iranian population: waist circumference, body mass index, or waist to hip ratio?

This study aimed to investigate whether body mass index (BMI), waist circumference (WC), or waist to hip ratio (WHR) could be a better predictor of metabolic syndrome and, if so, what would be the cutoff points for these surrogates to appropriately differentiate metabolic syndrome in different age and sex subgroups. Methods. The present cross-sectional study was conducted on a sample of Isfahan Cohort Study (ICS). In total, 468 individuals (194 with and 274 subjects without metabolic syndrome) according to the National Cholesterol Education Program's Adult Treatment Panel III (ATP-III) criteria were selected. Anthropometric indices were measured and plotted using receiver-operating characteristic (ROC) curves. Results. According to ROC curve analysis, WC and WHR parameters were better indicators of metabolic syndrome compared to BMI in women, whereas in men WHR had a lower discriminating value compared to the other two parameters. Among these three anthropometric parameters, BMI had a lower sensitivity and WC and WHR both had a higher sensitivity for predicting metabolic syndrome in women compared with in men. The cut points for WC were nearly equal in men and women, 90.3 versus 90.0, respectively. Women had higher cut points for BMI (28.5 kg/m(2)) compared to men (26.0 kg/m(2)). Our results showed the highest sensitivity and specificity for WC cut points specially in women. To predict metabolic syndrome, we looked into optimal age-specific cut points for BMI, WC, and WHR. The results indicated that WC had the highest discriminating value compared to other indicators in the different age subgroups. The optimal cut points for all three parameters gradually increased with age. Conclusion. Our results demonstrated that regardless of gender and age variables, WC could be a preferred parameter for predicting metabolic syndrome compared to BMI and WHR in Iranian population.

The first Iranian recommendations on prevention, evaluation and management of high blood pressure.

This paper presents the complete report of the first Iranian Recommendations on Prevention, Evaluation and Management of High Blood Pressure. The purpose is to provide an evidence-based approach to the prevention, management and control of hypertension (HTN) by adapting the most internationally known and used guidelines to the local health care status with consideration of the currently available data and based on the locally conducted researches on HTN as well as social and health care requirements. A working group of national and international experts participated in discussions and collaborated in decision-making, writing and reviewing the whole report. Multiple subcommittees worked together to review the recent national and international literature on HTN in different areas. We used the evaluation tool that is called "AGREE" and considered a score of > 60% as a high score. We adapted the Canadian Hypertension Education Program (CHEP), the United Kingdom's National Institute for Health and Clinical Excellence (NICE) and the US-based joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC7). The key topics that are highlighted in this report include: The importance of ambulatory and self-measurement of blood pressure, evaluation of cardiovascular risk in HTN patients, the role of lifestyle modification in the prevention of HTN and its control with more emphasis on salt intake reduction and weight control, introducing pharmacotherapy suitable for uncomplicated HTN or specific situations and the available drugs in Iran, highlighting the importance of angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers and calcium channel blockers as the first line therapy in many situations, the non-use of beta blockers as the first time treatment except in specific conditions, treating HTN in women, children, obese and elderly patients, the patient compliance to improve HTN control, practical guidelines to improve the patient's information on knowing their risk and self-care as well as a quick reference guide that can serve as simplified guidelines for physicians. The working team decided to update these recommendations every two years.