Glycosylated haemoglobin and coronary atherosclerosis in non-diabetic patients: is it a prognostic factor?

BACKGROUND: Some studies aimed to evaluate the relationship between HbA1c and coronary artery disease (CAD). However, it is well known that long-term glycometabolic disorders put the heart at risk for CAD. Considering the inconsistencies between previous studies, this study aimed to investigate the relationship between HbA1c and coronary artery atherosclerosis. METHODS: A cross-sectional study was conducted on 411 non-diabetic patients who underwent their first coronary angiography between November 2013 and December 2014 in Baqiyatallah Hospital. Blood samples were taken before angiography. Coronary angiograms were reported and reviewed by two cardiologists according to the Gensini score. They were not aware about the patients' HbA1c level. Severity of CAD was determined through ascertaining the prevalence of multi-vessel disease, extent of CAD (single-, two- or three-vessel disease or left main stem stenosis (>50%)). Data analysis was performed by using SPSS software. RESULTS: A total of 411 patients (252 men and 159 women) were evaluated. Angiography was normal in 67 patients (16.3%), 30.7% had single-vessel disease (SVD), and 29.1%, 20.7% and 3.2% had two-, three- and multivessel disease, respectively. Based on the ROC curve, the HbA1c was able to differentiate between patients with and without coronary atherosclerosis (p < .001, cut-off point = 5.45). The cut-off points for differentiation of severe CAD and patients with 75-100% stenosis of coronary artery were 5.55 (p < .001) and 5.65 (p < .001), respectively. CONCLUSIONS: The present study demonstrated that HbA1c might be an independent diagnostic factor in non-diabetic patients with severe coronary atherosclerosis.

Effect of Statins on Patients and Graft Survival in Kidney Transplant Recipients: a Survival Meta-analysis.

INTRODUCTION: Modifying cardiovascular risk factors is very important for the patients after kidney transplantation. Statins are a potentially beneficial intervention for kidney transplant patients, and the effect of statins on cardiovascular outcomes in patients with chronic kidney disease varies according to the stages. This systematic review summarizes the potential beneficial effects of statins on kidney allograft outcome. MATERIALS AND METHODS: A systematic review and meta-analysis was conducted by literature search using the PubMed, Science Direct, Scopus, ISI Web of Knowledge, and Google Scholar. Articles published after 2000 reporting hazard ratios (HRs) for the effect of statins on patient and graft survival of kidney transplant patients were included. RESULTS: Seven articles were included in the systematic review, involving 1870 kidney transplant patients that received statins and 3339 kidney transplant patients as the control group. Statins has no protective effect on transplant rejection, graft survival or patient survival after kidney transplantation. The effect of statins on graft survival, however, was significant when adjusted for factors such as age, sex, and serum creatinine level (HR, 0.80; 95% CI, 0.69 to 0.92; P = .003). Similarly, patient survival was significantly better with statin use (adjusted HR, 0.75; 95% CI, 0.63 to 0.88; P = .003). CONCLUSIONS: The present study may provide valuable information on the potential beneficial effects of statins in kidney allograft recipients. Meta-analysis showed that the use of statins correlated independently with improved patient and graft survival after kidney transplantation.

Long-term Video-EEG Monitoring Findings in Children and Adolescents with Intractable Epilepsy.

OBJECTIVE: Long Term Video-EEG Monitoring (LTM) may give us important information in the preoperative assessment of these patients. We performed this study for the first time in pediatric age group in Iran. MATERIALS AND METHODS: In this cross-sectional study, 43 children between 4 to 18 yr, with intractable epilepsy referred to Shefa Neuroscience Research Center, Tehran, Iranfrom2007-2012, were enrolled to study in order to evaluate their long-term video EEG findings. RESULTS: The patients mean age was10.07 yr, from which 24(65.9%) were boys.Seven patients with definite epileptogenic zone were advised to perform lesionectomy surgery.In two patients, there was not any seizure onset focus but corpus callosotomy was advised to control their frequent falling.Eight cases were recommended to perform electrocorticography or invasive EEG monitoring and26 cases to adjust medical treatment. In three cases, there was not any electrical seizure activity during clinical attacks, so discontinuing anti-epileptic drugs were recommended fordiagnosis of conditions that mimic epilepsy. CONCLUSION: It is necessary to perform LTM in patients with refractory epilepsy in order to determine their treatment strategy. If there is any doubt about pseudoseizureLTM can help to differentiate epilepsy from conditions that mimic epilepsy.