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Introduction: So far, there is no evidence available to demonstrate the relationship between five subgroups of total cholesterol/high density lipoprotein cholesterol (TC/HDL-C) ratio with premature myocardial infarction (MI). Objective: We conducted a case control study to probe more features of the relation between TC/HDL-C ratio and the five subgroups of the ratio with myocardial infarction under 55 years and above it. Method: A hospital based case control study with incident cases was designed. Cases and controls were comprised of 523 under 55-year and 699 above 55-year documented newly diagnosed MI cases, respectively. Standardized clinical and para clinical method were used to ascertain disease and risk factors. Independent sample t-test, Pearson chi square test, Odds ratios and Mantel-Haenszel test and logistic regression analysis conducted to evaluate relationships. Results: This study enrolled 1222 MI cases. Patients with very low risk category of TC/HDL-C ratio estimated OR=0.18 with 95% confidence interval (CI) (0.04–0.72) for developing MI under 55 years. Patients who had low risk category of TC/HDL-C ratio having OR=0.26 95% CI (0.07–0.89). Low risk and very low risk categories of the TC/HDL-C ratio compare to high risk subgroup of the ratio demonstrate decreased risk of developing MI under 55 years p

Pace of medical research development heralded an escalation in recent years. Groundbreaking evidences have been provided for managing dyslipidemia in 2017. Beside statins, alternatives of Anti PCSK-9 monoclonal antibodies in human and AT04A anti PCSK-9 vaccine in mice have shown to significant decrease in total cholesterol level. Wonderful! Apart from this, dual pathway inhibition by using aspirin with very low dose Rivaroxaban has been shown to be more effective in mitigating ischemic event rate than aspirin alone in patients with stable coronary artery disease or peripheral artery disease. Furthermore, patients with atrial fibrillation undergo percutaneous coronary intervention will benefit more from double antithrombotic therapy than triple one. Besides, a novel risk score of PRECISE-DAPT has determine the optimal duration of antiplatelet therapy in patients implanting coronary stents; and many other medical research advances which grabs our attention on 2018. In order to translate recent advances in medical research into clinical practice we need to design, conduct and apply high quality research in different medical subspecialties. The emergency medicine (EM) environment defined as overburdened with inability to afford more than a few minutes per patients. Where, time for research might be considered as a potential risk of interruption in clinical practice. EM is a broad field involving multiple disciplines and crosscutting themes with the unique features in research including urgency and location of the treatment. Art of research in EM comprises hybridization of clinical research, basic science and health services research. Accordingly, research priority setting should be put forwarded based on these three areas, examining existing gaps in EM knowledge, system design issues, educational predicament and disparities between diagnostic skills and clinical decisions. Where the most appropriate research questions arise? Definitely, it comes from critical thinking in patient care setting, regular reading habit, teaching, journal clubs, collaborations and society. To alleviate the issue of immense question and limited time in EM field which tangles decision makers mind we recommend to prioritize questions in line with; patients well- being, learners need, feasibility to answer, inquiries that most likely to recur in your practice and most interesting foreground research query. A research need has been defined as a gap in existing knowledge on practice, learner‚s education, patient values and societal demands. To examine the gaps in EM research knowledge we can provide research time and facilities, training new investigators, develop multicenter research networks, improve research coordination and involving funding agencies to make practical attempts for filling pre specified gaps. In conclusion, since patient oriented outcome research will provide us with the most important endpoints for clinical policy making and patient care standard setting, I totally agree with the advocates of involving stakeholders including clinicians, society and patients in EM research process to mitigate the existence knowledge gaps for dedicating high quality EM care

Dear Editor, The current scientific literature states that Intralipid 10% emulsion has a higher ratio of phospholipids to triglycerides, and contains more lypozomal phospholipids as compared to Intralipid 20% and Intralipid 30%, so it causes higher plasma concentrations of triglycerides, cholesterol and phospholipids (1, 2). It should be noted that serum triglycerides concentration is used as a marker for lipid tolerance and predicting the probability of complications involved with the administration of Intralipid 10%. In view of the fact that Intralipid 10% emulsion is the only currently available Intralipid in Iran, and also used for years, is known to have no significant side effects, we conducted a before and after descriptive, observational study on 20 newborns (10 females and 10 males) hospitalized in NICU of Valiasr hospital, Tehran University of Medical Sciences, that required total intravenous nutrition, and evaluated the effects of Intralipid 10% on neonates’ total plasma triglycerides before TPN and once the dose of Intralipid reached 2.5 g/kg/day. In the first step total plasma triglycerides level was measured. Then continuous daily infusion of Intralipid 10% with 0.5 g/kg/day dose was started increasing daily 0.5 g/kg until enteral nutrition was able to provide approximately 100 to 110 kcal for kg body weight. The outcome was total plasma triglycerides levels higher than 200 mg/dL in newborns receiving intravenous Intralipid 10% nutrition. Heparin was administered routinely with parenteral nutrition; heparin can theoretically release lipase lipoprotein from endothelial cells that may accelerate clearance of lipids from plasma. Total plasma triglycerides was monitored weekly when the Intralipid 10% dosage reached 2.5 g/kg/day and was continued to the end of TPN therapy, or until it reached the maximum level of 150-200 mg/dL, defined in scientific references as the indication for termination of intravenous Intralipid administration. There were no significant differences observed between total plasma triglycerides level before intravenous feeding (62.95 ± 10.46 mg/dL) and after Intralipid terminating dose of 2.5 gr/kg/day (63.15 ± 12.98 mg/dL) (P = 0.9). Also no correlation was observed between birth weight, duration of intravenous feeding and plasma triglycerides level difference (P > 0.005). Viewing the results of this study which has been referred to in detail, we intend to indicate that no significant difference between total plasma triglyceride levels before intravenous feeding and total plasma triglyceride levels after Intralipid 10% dosage has reached 2.5 g/kg/day, was seen (P = 0.9). This study in accordance with previously published studies (3-6) showed that Intralipid 10% is well tolerated by patients and levels of plasma triglycerides did not increase, VLDL and HDL remained in normal range and no significant complication was observed. The last noteworthy point is that the length of infusion can also be an important parameter in modulating possible listed side effects of Intralipid 10% mentioned in other sources. In conclusion, this study showed that in the absence of Intralipid 20% or 30%, the use of Intralipid 10% has not led to high levels of triglycerides in our neonates.

A Systematic Review of Lipid Measures and Lipid Ratios of Five Continents Populations, Estimation of Ratios and Standard Lipid Indices for Atherosclerosis: Persian Study There have been no studies combining the results of published evidences of lipid measures and lipid ratios to produce international comparisons of lipid measures among different populations. To provide a valid report of lipid measures around the globe for developing risk assessment instrument and guidelines for coronary artery disease (CAD). A systematic review of observational studies was designed. Search strategy consisted of following electronic data bases: MEDLINE (Ovid), Cochrane library, evidence based medicine (EBM) reviews, and Pub Med. Time period of the study was 1999 to 26 January 2014. Quality assessment of the assembled studies was conducted by using standard check lists and blinding the review authors. We identified 815 articles using the pre-specified keywords and the search strategy. Thirty-four articles met our criteria of relevance and appropriateness. Mean level of low density lipoprotein cholesterol (LDL-C) was statistically significant and higher in men than in women and the ratio of LDL-C/high density lipoprotein cholesterol (HDL-C) was higher among women of the universe. Multivariate adjusted measures and relationships demonstrated that distribution of lipid measures was globally different. Results of polynomial regression revealed that lipid measures for Mexican Americans, Koreans, Europeans and Iranians were different from other countries.