BACKGROUND:

This study aimed to compare Iranian elderly with the middle-aged population in terms of the prevalence of metabolic syndrome and its components.

METHODS:

This cross-sectional study was conducted using the data from the third phase of the Isfahan Healthy Heart Program. Male and female residents of Isfahan over 19 years of age were selected by multistage cluster random sampling. A questionnaire including demographic characteristics, health status, medical history, medications used, as well as waist circumference, weight, height, and systolic and diastolic blood pressures was completed for all participants. Fasting blood samples were obtained from all subjects and examined for fasting blood sugar and lipid profile. T-test and Mann-Whitney test were used for quantitative data and chi-square test was performed for qualitative data.

RESULTS:

The prevalence of metabolic syndrome in individuals aged over 60 years was significantly higher than those under 60 (49.5% vs. 17.5%, respectively; P < 0.001). Metabolic syndrome was also more prevalent among elderly females than in males (59.2% vs. 39.8%, respectively; P < 0.005). Some anthropometric measures such as height, body mass index, abdominal circumference, waist-hip ratio, and waist-to-height ratio were significantly different in men and women below 60 years in comparison with those over 60 years (P < 0.05). Moreover, there were significant differences in most studied parameters between the elderly and non-elderly women (P < 0.001).

CONCLUSION:

This study showed that metabolic syndrome has a relatively high prevalence in Iranian elderly people, especially in elderly women. Therefore, early diagnosis and management of the complication are recommended among this high-risk group to avoid the subsequent complications.

BACKGROUND:

Myocardial infarction (MI) is an irreversible cardiomyocytes injury which begins after 15–20 minutes of coronary artery occlusion. The extent of infarction is modulated by a number of factors including collateral blood supplies, medications, and ischemic preconditioning. Although angioplasty and thrombolytic agents can relieve the cause of the infarction, the time from the occlusion onset to reperfusion determines the degree of irreversible myocardial injury. Experimental studies suggested that stem cells and progenitor cells derived from bone marrow can be used in the repair of cardiac tissue after acute MI. This study was designed to investigate the feasibility, safety and initial clinical outcome of intracoronary infusion of autologous progenitor cells in patients with acute MI.

METHODS:

Patients with a history of anterior MI and a left ventricular ejection fraction (LVEF) less than 35 % who were candidates for coronary angioplasty were randomly allocated in a 1:1 ratio to either control or bone marrow cell groups (each including 16 patients). Thallium scan and 17-segment echocardiography analysis for regional wall motion abnormality were performed before and 1 and 6 months after intracoronary infusion of bone marrow cells. The same tests were also conducted for the control group at identical time intervals. Quantitative variables were compared by independent t-test and paired t-test. Statistical significance was assumed at a value of P < 0.05.

RESULTS:

LVEF in the case and control groups increased to 39.37 ± 2.47% and 31.00 ± 1.87%, respectively (P = 0.069 and 0.1, respectively). Wall motion abnormality index (WMAI) decreased insignificantly in both groups. Perfusion defect scores (PDSs) decreased significantly in the case group.

CONCLUSION:

In this study, autologous mesenchymal stem cell transplantation by intracoronary catheter during angioplasty in patients with a history of severe LV dysfunction caused mild increases in LVEF.

BACKGROUND:

Hypertension prevention and control are among the most important public health priorities. We evaluated the impacts of a workplace intervention project “Stop Hypertension in Mobarakeh Steel Company” (SHIMSCO) on controlling hypertension in industrial workers.

METHODS:

The study was carried out in Mobarakeh Steel Company in Isfahan among 7286 male workers and employees. All individuals were evaluated for the presence of hypertension (HTN). According to examinations, 500 subjects with systolic blood pressure (SBP) ≥ 140 mmHg, and/or diastolic blood pressure (DBP) ≥ 90 mmHg, and/or those using antihypertensive medications were confirmed to have HTN and thus included in this study. They were questioned for sociodemographic characteristics, past medical history and medication use. They received an educational program including healthy lifestyle and self-care recommendations of HTN management and control as well as training for accurate blood pressure measurement and home monitoring for two years. SBP, DBP, weight, height and routine lab tests were measured for all hypertensive subjects before and after the interventions. Paired t-test, generalized estimation equation (GEE) and ordinary linear regression (OLR) were used for statistical analysis in SPSS.

RESULTS:

The comparison of SBP and DBP before and after the educational program showed significant reductions in both parameters (−7.97 ± 14.72 and −2.66 ± 9.96 mmHg, respectively). However, a greater decrease was detected in case of DBP. GEE showed SBP and DBP to decrease about −0.115 and −0.054 mmHg/month. OLR also revealed reductions of 4.88 and 2.57 mmHg respectively in SBP and DBP upon adding each antihypertensive drug.

CONCLUSION:

SHIMSCO, a 3-year interventional project in workplaces, was effective in reducing SBP and DBP among hypertensive employees and workers. We conclude that implementing simple educational programs in worksites can improve the management and control of hypertension and perhaps other chronic diseases.

BACKGROUND

A common problem in cardiac surgery patients is decreased central venous pressure (CVP) and systemic blood pressure during transfer from operation room to intensive care unit (ICU). Since these reductions may lead to dangerous complications, this study aimed to evaluate the effects of vasopressors and isotonic fluids on hemodynamic status of cardiac surgery patients during their transfer to ICU.

METHODS

This randomized single-blind clinical trial was conducted in Chamran Hospital (Isfahan, Iran). A total number of 75 consecutive patients undergoing planned first-time coronary artery bypass grafting entered our study. Systolic blood pressure (SBP), diastolic blood pressure (DBP), CVP, and pulse rate (PR) were recorded at 5 to 10 minutes before leaving operating room and immediately after hospitalization in the ICU. Subjects in the first group received 7 cc/kg intravenous normal saline (as an isotonic fluid) within 5-10 minutes. The second group received 10 mg ephedrine before being transferred to the ICU.

RESULTS

The mean age of participants was 61.0 ± 3.6 years. No significant change in PR was detected in normal saline group (P > 0.05). No significant differences were found in two groups in SBP before and after hospitalization in the ICU (P > 0.05). DBP and CVP had statistically significant reductions in both groups after hospitalization in the ICU (P < 0.001). The mean CVP was also reduced significantly (10.7 ± 2.9 vs. 8.2 ± 3.4; P < 0.001).

CONCLUSION

Significant reductions in mean values of DBP and CVP occur during cardiac surgery and after arrival to the ICU. These reductions cannot be prevented by administration of vasopressors, such as ephedrine, or infusion of isotonic fluids, such as normal saline. Further studies are required to assess whether more fluids, other types of fluids, or other drugs can stop this phenomenon.

BACKGROUND

Atrial fibrillation (AF) is the most common complication of cardiac surgery. Although it is managed easily, it can cause critical hemodynamic instabilities for intensive care patients. This observational study investigated the predictive power of P-wave dispersion (PWD) for the incidence of post cardiac surgery AF.

METHODS

Among patients undergoing isolated coronary artery bypass grafting surgery (CABG), 52 patients were selected randomly. Before the operation, ejection fraction, regional wall motion abnormality, and mitral regurgitation were determined by echocardiography. Angiographic data provided information about stenosed vessels. PWD was measured before and after CABG. The incidence of post-CABG AF was determined by rhythm monitoring.

RESULTS

There were no significant differences in age, sex, stenosed vessels, maximum P-wave duration, the prevalence of hypertension, smoking, mitral regurgitation, and regional wall motion abnormality between post-CABG AF and non-AF groups (P > 0.05). The mean prevalence of diabetes mellitus in post-CABG AF group was more than non-AF group (P = 0.036). The mean ejection fraction in post-CABG AF group was lower than non-AF group (P < 0.005). The mean PWD in AF group vs. non-AF group before CABG was 47.5 vs. 23.7 ms. The mean values of post-surgical PWD in AF and non-AF groups were 48.10 and 24.4 ms, respectively. Before CABG, the mean ejection fraction value and minimum P-wave duration in AF group were lower than non-AF group (P < 0.005). A reverse relation was present between minimum P wave duration and PWD (P < 0.001). There was a negative association between high ejection fraction values and decreased PWD (P = 0.002).

CONCLUSION

Our data suggested minimum P wave duration, PWD, and low ejection fraction are as good predictors of AF in patients undergoing isolated CABG. The absence of differences in age, sex, smoking, hypertension, mitral regurgitation, and regional wall motion abnormality in our study was in contrast with other reports. On the other hand, increased rate of post-CABG AF in our diabetic patients with lower ejection fraction supports other studies. Overall, minimum P wave duration, PWD, and low ejection fraction can be used for patient risk stratification of AF after CABG.

BACKGROUND

Renal artery stenosis is one of the important causes of hypertension and end stage renal failure. Magnetic resonance angiography (MRA) and Doppler ultrasonography are non-invasive and safe diagnostic techniques that have also high sensitivity and specificity. Since the accuracy and reliability of these techniques depend upon technicians and softwares, we decided to evaluate and compare the sensitivity and specificity of these techniques in Isfahan.

METHODS

Our study included all the patients (37 patients) who underwent renal artery angiography during 2 years from May 2003 to May 2005 and up to six months after that had underwent MRA (21 patients) and Doppler sonography (16 patients) in Isfahan. Renal artery angiography was considered as the gold standard.

RESULTS

Sensitivity, specificity, positive and negative predictive values of 100%, 25%, 25%, and 100% were obtained for MRA respectively. Specificity and positive predictive values (PPV) of Doppler sonography were 67%. Its sensitivity and negative predictive values (NPV) were 57%.

CONCLUSION

Although it seems that technician dependency, technical and software problems were the reasons of low specificity of gadolinium-enhanced MRA in our study, further studies with larger sample sizes are recommended.