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ABSTRACT Objective We examined the accuracy of novel anthropometric indices in predicting the progression of prediabetes to diabetes. Subjects and methods This study was performed on the pre-diabetic sub-population from Isfahan Cohort Study (ICS). Participants were followed up from 2001 to 2013. During every 5-year follow-up survey, patients’ data regarding the incidence and time of incidence of diabetes were recorded. We evaluated the association between the risk of developing diabetes and novel anthropometric indices including: visceral adiposity index (VAI), lipid accumulation products (LAP), deep abdominal adipose tissue (DAAT), abdominal volume index (AVI), A body shape index (ABSI), body roundness index (BRI) and weight-adjusted waist index (WWI). We categorized the indices into two groups according to the median value of each index in the population. We used Cox regression analysis to obtain hazard ratios (HR) using the first group as the reference category and used receiver operating characteristics (ROC) curve analysis for comparing the predictive performance of the indices. Results From 215 included subjects, 79 developed diabetes during the 13-year follow-up. AVI, LAP, BRI, and VAI indicated statistically significant HR in crude and adjusted regression models. LAP had the greatest association with the development of diabetes HR = 2.18 (1.36-3.50) in multivariable analysis. ROC curve analysis indicated that LAP has the greatest predictive performance among indices (area under the curve = 0.627). Conclusion Regardless of baseline confounding variables, prediabetic patients with a higher LAP index may be at significantly higher risk for developing diabetes.

Due to the increasing occurrence of natural disasters, it is essential to prioritize the improvement of health literacy during emergencies, particularly for individuals with chronic illnesses like diabetes who are especially vulnerable in the medical sector. The primary objective of this study was to identify the key themes within an emerging framework for disaster health literacy specifically tailored for diabetics. A scoping review design was selected based on the Arksey and O’Malley framework. The published articles indexed in PubMed, Embase, Scopus, and Web of Science databases were retrieved up to April 2023, applying related keywords. There restrictions were placed in the English language and the study design. Textual analysis method to identify themes in the articles. The research team conducted multiple collaborative sessions to identify the themes related to health literacy during disasters based on a comprehensive review of existing literature. Three challenges were identified during the analysis process. These challenges include the difficulties encountered by diabetic patients in the early stages of disasters, the physical side effects they experience, and the major recommendations for preparedness and initial response. Subsequently, a framework was developed based on the extracted main challenges and the established logical connections between the conceptual codes, achieved through consensus among the research team. The study emphasized the importance of integrating health literacy assessment and training initiatives throughout all stages of the disaster cycle, with a specific emphasis on individuals with diabetes. By implementing such programs, it is anticipated that the overall health literacy of diabetic patients during disasters can be enhanced.

Abstract Background The role of hemoglobin (Hb) level in the short-term prognosis of patients with acute decompensated heart failure (ADHF) remains a matter of debate. We aimed to declare the prevalence of, association with, severity of, and prognostic role of SHL with ADHF. Methods Using the data from the Persian Registry Of Cardiovascular Disease/ Heart Failure (PROVE-HF) study, we assessed the association between anemia and polycythemia (Hb 16.5 g/dLit in males and 16 g/dLit in females, respectively) and short-term mortality using Cox proportional hazard modeling, with adjustment of clinically relevant variables. Results Of 3652 ADHF patients, anemia was seen in 1673 patients (48.40%). The prevalence of mild, moderate, and severe anemia was 42.33% (n = 1546), 3.23% (n = 118), and 0.24% (n = 9), respectively. Also, 422 patients (11.55%) had polycythemia. Compared to non-anemic patients, anemic patients were mainly male, older, and were more likely to have diabetes mellitus (DM), renal dysfunction, hypertension (HTN), and thyroid disease. Significant predictors of short-term mortality were lower systolic and diastolic blood pressure, lower Hb level, and higher blood urea nitrogen (BUN). Anemic patients had higher all-cause mortality [adjusted hazard ratio (aHR) 1.213, 95% confidence interval [CI] 1.054–1.396]. Moderate anemia increased mortality by approximately 80% in males (aHR 1.793, 95% CI 1.308–2.458) and females (aHR 1.790, 95% CI 1.312–2.442), respectively. Polycythemia had no association with short-term mortality in both genders (P-value > 0.05). Conclusions This study revealed that anemia is an adverse prognostic factor for short-term mortality in ADHF patients, with higher mortality in moderately anemic patients.

Abstract Background /Aims: Visceral adiposity index (VAI) and lipid accumulation product (LAP) are novel anthropometric indices that have shown an association with metabolic syndrome; however, limited data are available regarding the predictive performance of these indices for the incidence of cardiovascular diseases (CVD) and mortality. Methods This study was performed on the data retrieved from Isfahan Cohort Study (ICS). ICS is an ongoing population‐based cohort study conducted in 3 counties in central Iran. Pearson correlation analysis was performed between LAP, VAI, and metabolic parameters. Cox regression analysis and receiver operative characteristics (ROC) curve analysis were performed in order to evaluate the ability of VAI and LAP for the incidence of CVD, CVD‐associated mortality, and all‐cause mortality. We further compared the predictive performance of VAI and LAP with body mass index (BMI). Results LAP and VAI were significantly correlated with all metabolic variables, including blood pressure, fasting blood glucose, and lipid profile components. Univariate regression analysis indicated a significant association between LAP and VAI and CVD incidence. In multivariate analysis, only VAI was significantly associated with CVD incidence. Regarding CVD mortality, only VAI in the multivariate analysis revealed a significant association. Interestingly, Both VAI and LAP were negatively associated with all‐cause mortality. ROC curve analysis indicated the superior performance of LAP and VAI for predicting CVD incidence compared to BMI; however, BMI was better in predicting all‐cause mortality. Conclusion Compared to BMI, LAP and VAI have better predictive performance for the incidence of CVD. In contrast, BMI was superior to VAI and LAP in the prediction of all‐cause mortality.

Background. Metformin is commonly prescribed to treat polycystic ovary syndrome (PCOS) patients, but in some cases, it may not be effective even at high doses or may cause intolerable side effects. Therefore, recent studies have examined the impact of combining metformin with other antidiabetic medications. Methods. A systematic search was performed in Scopus, PubMed, Web of Science, and Embase up to 30 June 2023. All interventional studies that assessed the efficacy of different antidiabetic agents were included. Results. Among the 3488 records found in the primary search, 16 papers were included. Our study showed that dipeptidyl peptidase-4 inhibitors (DPP4i) had the most significant impact on glycemic profile, while thiazolidinediones (TZDs) had the most influence on lipid levels. However, it was observed that patients taking only metformin experienced a greater increase in high-density lipoprotein cholesterol (HDL-C) levels. Glucagon-like peptide-1 receptor agonists (GLP1RAs) effectively modified various anthropometric measurements, such as weight, body mass index, waist circumference, and waist-to-hip ratio. The effects of different antidiabetic drugs on hormone levels were inconclusive, although testosterone levels were more affected by GLP1RA, sodium-glucose cotransporter-2 inhibitors (SGLT2i), and TZDs. None of the combined therapies showed a significant change in blood pressure. Conclusion. Since PCOS is a metabolic disorder, choosing the best combination of antidiabetic drugs in the clinical course of PCOS patients will be very important. Today, it seems that we need a new metabolic approach for better treatment of the metabolic aspects of these patients.

Background. Primary adrenal insufficiency is an uncommon condition that manifests as nonspecific symptoms such as fatigue, weight loss, salt craving, and hyperpigmentation. Common cardiovascular presentations of AI are hypotension, arrhythmias, and syncope. However, acute heart failure is an uncommon presentation. Case Presentation. Here, a 26-year-old man was hospitalized with vasopressor-resistant cardiogenic shock, which was finally attributed to an adrenal crisis. His past medical history was notable for Hashimoto’s disease, controlled with oral levothyroxine. Conclusion. AI should be considered among patients with cardiogenic shock who are unresponsive to conventional inotropes. Additionally, a history of autoimmune diseases may increase the suspicion of AI. Although the presentation of cardiogenic shock in a patient with undiagnosed AI is considered a rarity, delay in prompt treatment can lead to life-threatening conditions.

Background: Frailty is a common problem in elderly individuals. However, this issue is not well investigated among heart failure (HF) patients with appropriate scales. We aimed to translate and evaluate Edmonton frailty scale (EFS) validity and reliability in Iranian HF adults. Methods: We implemented this methodological study on stable HF patients referred to an outpatient heart clinic in Isfahan, Iran. The translation was done using the forward-backward method. Ten individuals were asked to comment about all items in terms of understandability and simplicity. Fifteen experts were invited, and their ratings on each item were collected to measure the content validity index (CVI) and content validity ratio (CVR). Cronbach’s alpha was used for the assessment of internal consistency. After completing the scale for the second time with a two-week interval, test-retest reliability with intraclass correlation coefficient (ICC) measurement was done. Results: The translation process was performed uneventfully. All items were reported to be simple and meaningful. CVI of items ranged from the minimum of 0.80 to a maximum of 1.00 plus an acceptable CVR of at least 0.60. Fifty HF patients (age: 67.2±14.1 years, males: 56%) completed the questionnaire twice without missing data. Cronbach’s alpha was first to be 0.550. After omitting three items about social support, drug usage, and nutrition, the value was raised to 0.711. Test-retest reliability showed a good index of consistency (ICC: 0.693, 95% confidence interval: 0.527-0.810). Conclusion: Modified Persian EFS is a simple and meaningful tool with high validity and acceptable reliability for assessing frailty in HF individuals irrespective of age.

BACKGROUND: Garlic may have anti-oxidanmayti-hypertensive and anti-hyperlipidemic properties. However, the effects of its administration on cardiac function in heart failure (HF) patients impact require further investigation. We aimed to evaluate garlic prescription effects on cardiac outcomes and quality of life scores in Iranian HF patients.METHODS: From August to December 2020, a randomized, double-blind clinical trial was conducted. Individuals with heart failure (New York heart association (NYHA) functional class of II and III) referred to private clinics in Isfahan, Iran, were randomly assigned to intervention (n=80) and control (n=80) groups. They have received 500 mg of odorless garlic tablets or the same shape and dosage of placebo twice daily for three months. Laboratory data, cardiac outcomes (end-diastolic diameter, ventricular septal thickness, NYHA functional class, left ventricular ejection fraction), quality of life score (Minnesota living with HF questionnaire), and the Modified Borg Scale (MBS) were all evaluated at the baseline and the end of the trial.RESULTS: The population’s mean age was 58.1±13.5 years (55% males). Patients who consumed garlic had remarkably improved functional class compared to placebo takers and their baseline (NYHA practical class of II, 79.4% vs. 50.6%, P

Background and Aim. Regarding patients admitted with acute decompensated heart failure (ADHF), there are inconsistent reports surrounding the association between length of stay (LOS) and mortality or rehospitalization following discharge. This study evaluates the association between LOS and 30-day outcomes after discharge in patients admitted with ADHF. Method. This study is performed in the context of the Persian Registry of Cardiovascular Disease/Heart Failure (PROVE/HF). We included all patients admitted with ADHF regardless of the etiology of heart failure (HF). LOS was classified in tertiles (4 and 6 days). Our outcomes were 30-day all-cause mortality and rehospitalization. Baseline characteristics and outcomes are reported according to the tertiles of LOS. A binary logistic regression and cox regression analysis were performed to evaluate the association between LOS and rehospitalization and death, respectively. Results. Between April 2019 and March 2020, 385 patients with ADHF were registered in our study. The mean length of hospitalization was 6.35 ± 5.46 days, varying from a minimum of 0 days to a maximum of 47 days. One hundred patients had a hospital stay lower than 4 days; 151 individuals had an intermediate LOS (4–6 days); and 134 were hospitalized for more than 6 days. Our analysis indicated no association between LOS and 30-day rehospitalization and death in multivariable or univariable models. Conclusion. This study found no association between LOS and rehospitalization or death in patients admitted with ADHF; however, further investigations are warranted.

Chronic inflammatory demyelinating polyneuropathy (CIDP) is a rarely reported disease. The association between diabetes mellitus (DM) and CIDP has been a matter of controversy. Here we presented a 59-year old male patient with uncontrolled type 2 DM presented with simultaneous type B insulin resistance (TBIRS) and CIDP. Both blood glucose and neurological manifestations responded well to corticosteroid therapies. Although the pathogenesis of CIDP remains to be elucidated, the role of antibodies in the pathogenesis of TBIRS and CIDP might be a promising platform for further studies to provide additional insights into the origin of these 2 rare complications.

Background. Primary adrenal insufficiency is an uncommon condition that manifests as nonspecific symptoms such as fatigue, weight loss, salt craving, and hyperpigmentation. Common cardiovascular presentations of AI are hypotension, arrhythmias, and syncope. However, acute heart failure is an uncommon presentation. Case Presentation. Here, a 26‐year‐old man was hospitalized with vasopressor‐resistant cardiogenic shock, which was finally attributed to an adrenal crisis. His past medical history was notable for Hashimoto's disease, controlled with oral levothyroxine. Conclusion. AI should be considered among patients with cardiogenic shock who are unresponsive to conventional inotropes. Additionally, a history of autoimmune diseases may increase the suspicion of AI. Although the presentation of cardiogenic shock in a patient with undiagnosed AI is considered a rarity, delay in prompt treatment can lead to life‐threatening conditions. [ABSTRACT FROM AUTHOR]

Purpose: Subacute thyroiditis (SAT) is a transient inflammatory disorder of the thyroid gland with a possible viral etiology. We conducted this study to estimate the pooled prevalence of thyroid autoantibodies in SAT patients. This question arose due to the varying reports on the positivity rates of thyroid autoantibodies among SAT patients. Methods: We searched PubMed, Embase, Scopus, and Web of Science from their inception until March 25th, 2023. Observational studies reporting the positivity rate of thyroid autoantibodies for more than ten patients were included. We used the Joanna Briggs Institute's (JBI) critical appraisal checklist to assess the quality of the included studies. Pooled prevalence estimates with 95% confidence intervals were calculated using the random effects model. Subgroup analyses were performed to find sources of heterogeneity. Results: Out of 1373 identified records, 32 studies involving 2348 SAT patients were included in our study. Thyroglobulin antibody (TgAb) and thyroid peroxidase antibody (TPOAb) were positive in 22.8% and 12.2% of patients, respectively. The Study design, mean erythrocyte sedimentation rate and mean thyroid-stimulating hormone of patients were identified as sources of heterogeneity. As our secondary objectives, we found a recurrence rate of 14.7% and permanent hypothyroidism in 11.6% of patients. Conclusion: The results of our study revealed a low TPOAb positivity rate in SAT patients, consistent with its non-autoimmune etiology. The TgAb positivity rate in SAT patients was higher than that of the general population, possibly explained by the transient release of thyroglobulin into the bloodstream during the thyrotoxic phase, leading to subsequent TgAb production. Furthermore, our findings demonstrate a notable recurrence rate and permanent hypothyroidism among SAT patients, highlighting the importance of ongoing follow-up care. [ABSTRACT FROM AUTHOR]

Background. Metformin is commonly prescribed to treat polycystic ovary syndrome (PCOS) patients, but in some cases, it may not be effective even at high doses or may cause intolerable side effects. Therefore, recent studies have examined the impact of combining metformin with other antidiabetic medications. Methods. A systematic search was performed in Scopus, PubMed, Web of Science, and Embase up to 30 June 2023. All interventional studies that assessed the efficacy of different antidiabetic agents were included. Results. Among the 3488 records found in the primary search, 16 papers were included. Our study showed that dipeptidyl peptidase-4 inhibitors (DPP4i) had the most significant impact on glycemic profile, while thiazolidinediones (TZDs) had the most influence on lipid levels. However, it was observed that patients taking only metformin experienced a greater increase in high-density lipoprotein cholesterol (HDL-C) levels. Glucagon-like peptide-1 receptor agonists (GLP1RAs) effectively modified various anthropometric measurements, such as weight, body mass index, waist circumference, and waist-to-hip ratio. The effects of different antidiabetic drugs on hormone levels were inconclusive, although testosterone levels were more affected by GLP1RA, sodium-glucose cotransporter-2 inhibitors (SGLT2i), and TZDs. None of the combined therapies showed a significant change in blood pressure. Conclusion. Since PCOS is a metabolic disorder, choosing the best combination of antidiabetic drugs in the clinical course of PCOS patients will be very important. Today, it seems that we need a new metabolic approach for better treatment of the metabolic aspects of these patients. [ABSTRACT FROM AUTHOR]

Background: /Aims: Visceral adiposity index (VAI) and lipid accumulation product (LAP) are novel anthropometric indices that have shown an association with metabolic syndrome; however, limited data are available regarding the predictive performance of these indices for the incidence of cardiovascular diseases (CVD) and mortality. Methods: This study was performed on the data retrieved from Isfahan Cohort Study (ICS). ICS is an ongoing population‐based cohort study conducted in 3 counties in central Iran. Pearson correlation analysis was performed between LAP, VAI, and metabolic parameters. Cox regression analysis and receiver operative characteristics (ROC) curve analysis were performed in order to evaluate the ability of VAI and LAP for the incidence of CVD, CVD‐associated mortality, and all‐cause mortality. We further compared the predictive performance of VAI and LAP with body mass index (BMI). Results: LAP and VAI were significantly correlated with all metabolic variables, including blood pressure, fasting blood glucose, and lipid profile components. Univariate regression analysis indicated a significant association between LAP and VAI and CVD incidence. In multivariate analysis, only VAI was significantly associated with CVD incidence. Regarding CVD mortality, only VAI in the multivariate analysis revealed a significant association. Interestingly, Both VAI and LAP were negatively associated with all‐cause mortality. ROC curve analysis indicated the superior performance of LAP and VAI for predicting CVD incidence compared to BMI; however, BMI was better in predicting all‐cause mortality. Conclusion: Compared to BMI, LAP and VAI have better predictive performance for the incidence of CVD. In contrast, BMI was superior to VAI and LAP in the prediction of all‐cause mortality. [ABSTRACT FROM AUTHOR]

Background: The role of hemoglobin (Hb) level in the short-term prognosis of patients with acute decompensated heart failure (ADHF) remains a matter of debate. We aimed to declare the prevalence of, association with, severity of, and prognostic role of SHL with ADHF. Methods: Using the data from the Persian Registry Of Cardiovascular Disease/ Heart Failure (PROVE-HF) study, we assessed the association between anemia and polycythemia (Hb < 13 g/dLit, > 16.5 g/dLit in males and < 12 g/dLit, and > 16 g/dLit in females, respectively) and short-term mortality using Cox proportional hazard modeling, with adjustment of clinically relevant variables. Results: Of 3652 ADHF patients, anemia was seen in 1673 patients (48.40%). The prevalence of mild, moderate, and severe anemia was 42.33% (n = 1546), 3.23% (n = 118), and 0.24% (n = 9), respectively. Also, 422 patients (11.55%) had polycythemia. Compared to non-anemic patients, anemic patients were mainly male, older, and were more likely to have diabetes mellitus (DM), renal dysfunction, hypertension (HTN), and thyroid disease. Significant predictors of short-term mortality were lower systolic and diastolic blood pressure, lower Hb level, and higher blood urea nitrogen (BUN). Anemic patients had higher all-cause mortality [adjusted hazard ratio (aHR) 1.213, 95% confidence interval [CI] 1.054–1.396]. Moderate anemia increased mortality by approximately 80% in males (aHR 1.793, 95% CI 1.308–2.458) and females (aHR 1.790, 95% CI 1.312–2.442), respectively. Polycythemia had no association with short-term mortality in both genders (P-value > 0.05). Conclusions: This study revealed that anemia is an adverse prognostic factor for short-term mortality in ADHF patients, with higher mortality in moderately anemic patients. [ABSTRACT FROM AUTHOR]

Backgrounds: To determine the average cutoff values of serum-free and total testosterone (FT, TT) and dehydroepiandrosterone sulfate (DHEAS) among healthy premenopausal women. Materials and Methods: Participants were women aged 18-55 years without signs and symptoms of hyperandrogenism (n = 489). Participants if Ferriman-Gallwey (FG) scores between 6 and 8 were considered a group located in the upper spectrum related to the normal hirsutism score (n = 30). DHEAS, TT, and FT levels were compared between different populations. Upper limits of 97.5 and 95 and lower limits of 5 and 2.5 percentiles were calculated to provide the reference intervals for DHEA, TT, and FT in the total sample and in the population with FG 6-8. Results: In the total population, the mean ± standard deviation (SD) serum FT, TT, and DHEAS levels were 1.40 ± 0.63 pg/mL, 0.42 ± 0.17 ng/mL, and 1.5 ± 0.97 µg/ml, respectively. The cutoff values of FT at 1.35 and TT at 0.49 were obtained for differentiating the patients with FG 6-8 scores from the normal population, with the corresponding specificity of 0.60, the sensitivity of 0.67, and area under the ROC curve (AUC) (confidence interval 95%) of 0.63 (0.52-0.73), P = 0.01 and 0.68 (0.58-0.78) P = 0.001, respectively. Conclusions: In our study, the mean ± SD serum FT level was 1.40 ± 0.63 pg/mL, the TT level was 0.42 ± 0.17 ng/mL, and the DHEAS level was 1.5 ± 0.97 µg/ml, in premenopausal women between 18 and 49 years of age. Furthermore, in a population with FG 6-8 score, a cutoff value of FT at 1.35 and TT at 0.49 was obtained. Although the irregular menstrual cycle did not change the reference range when compared with the normal group. [ABSTRACT FROM AUTHOR]

Previous studies reported a relationship between thyroid-stimulating hormone (TSH) and low-density lipoprotein cholesterol (LDL-C) levels. In this study, we aim to evaluate the impact of TSH levels on lipid profile in patients with familial hypercholesterolemia (FH) and euthyroid state. Patients were selected from the Isfahan FH registry. The Dutch Lipid Clinic Network (DLCN) criteria are used to detect FH. Patients were classified into no FH, possible FH, probable FH, and definite FH groups based on the DLCN scores. Patients with any cause of secondary hyperlipidemia, including hypothyroidism, were excluded from this study. The study group consisted of 103 patients with possible FH, 25 patients with definite FH, and 63 individuals with no FH. The mean TSH and LDL-C levels among participants were 2.10 ± 1.22 mU/l and 142.17 ± 62.56 mg/dl, respectively. No positive or negative correlation was found between serum TSH and total cholesterol (P value = 0.438), high-density lipoprotein cholesterol (P = 0.225), triglycerides (P value = 0.863), and LDL-C (P value = 0.203). We found no correlation between serum TSH levels and lipid profiles in euthyroid patients with FH. [ABSTRACT FROM AUTHOR]

Shock index (SI) and modified SI (MSI) are used for prognosis in patients with cardiovascular diseases (CVDs), especially myocardial infarction. However, the utility of these indices in heart failure(HF) is less frequently investigated. We aimed to evaluate the long-term prognostic capability of SI and MSI among Iranian HF patients. This retrospective cohort study was implemented in the context of the Persian Registry Of cardioVascular diseasE/HF (PROVE/HF). A total of 3896 acute decompensated HF (ADHF) patients were enrolled from March 2016 to March 2020. SI and MSI were assessed at admission. Receiver operating characteristic (ROC) and Kaplan–Meier curves were used to define optimum SI and MSI cut-off points and depict mortality during follow-up, respectively. The association of CVD death according to different SI and MSI cut-off points and quartiles was assessed through univariate and multivariate regression hazard models. Mean age of participants was 70.22 ± 12.65 years (males: 62.1%). We found 0.66 (sensitivity:62%, specificity: 51%) and 0.87 (sensitivity: 61%, specificity: 51%) as optimised cut-off points for SI and MSI, respectively. Mean follow-up was 10.26 ± 7.5 months and 1110 (28.5%) deaths occurred during this time. Multivariate adjusted models revealed patients had SI ≥ 0.66 or within the third and fourth quartiles had higher likelihood of mortality compared to reference group (hazard ratio(HR): 1.58, 95%CI: 1.39–1.80, p < 0.001, HR: 1.38,95%CI:1.14–1.66, p = 0.001 and HR:2.00,95%CI:1.68–2.38, p < 0.001, respectively). MSI outcomes were similar (MSI ≥ 0.87: HR: 1.52,95%CI: 1.34–1.72, p < 0.001, third quartile (0.89 ≤ MSI < 1.00):HR:1.23,95%CI:1.009–1.50, p = 0.041, fourth quartile (MSI ≥ 1.00): HR: 1.80,95%CI: 1.53–2.13, p < 0.001). Kaplan–Meier curves showed patients with higher SI and MSI cut-off values and quartiles had lower survival rates. Higher SI and MSI values were associated with increased mortality risk, and these two bedside indices could be appropriately considered for long-term prognosis in ADHF patients. [ABSTRACT FROM AUTHOR]

Background and Aim. Regarding patients admitted with acute decompensated heart failure (ADHF), there are inconsistent reports surrounding the association between length of stay (LOS) and mortality or rehospitalization following discharge. This study evaluates the association between LOS and 30-day outcomes after discharge in patients admitted with ADHF. Method. This study is performed in the context of the Persian Registry of Cardiovascular Disease/Heart Failure (PROVE/HF). We included all patients admitted with ADHF regardless of the etiology of heart failure (HF). LOS was classified in tertiles (<4 days, >4 and <6 days, and >6 days). Our outcomes were 30-day all-cause mortality and rehospitalization. Baseline characteristics and outcomes are reported according to the tertiles of LOS. A binary logistic regression and cox regression analysis were performed to evaluate the association between LOS and rehospitalization and death, respectively. Results. Between April 2019 and March 2020, 385 patients with ADHF were registered in our study. The mean length of hospitalization was 6.35 ± 5.46 days, varying from a minimum of 0 days to a maximum of 47 days. One hundred patients had a hospital stay lower than 4 days; 151 individuals had an intermediate LOS (4–6 days); and 134 were hospitalized for more than 6 days. Our analysis indicated no association between LOS and 30-day rehospitalization and death in multivariable or univariable models. Conclusion. This study found no association between LOS and rehospitalization or death in patients admitted with ADHF; however, further investigations are warranted. [ABSTRACT FROM AUTHOR]

Aim: Recent studies have indicated that Sodium–GLucose co-Transporter 2 Inhibitors (SGLT2Is) may increase insulin sensitivity (IS); however, these results are heterogeneous and need to be systematically assessed. Method: We searched MEDLINE/PubMed, Embase, Web of Science, Scopus, Cochrane Library, Ovid, and ProQuest using a predefined search query. Randomized clinical trials on SGLT2Is with a passive control group or metformin controlled group were included. Risk of bias assessment was performed using the Cochrane risk of bias assessment tool. Meta-analysis was performed separately on studies with type 2 diabetes mellitus (T2DM) population and studies with non-T2DM population and also for passive- and active-controlled studies using standardized mean difference (SMD) as the measure of the effect size. Subgroup analysis was performed according to different types of SGLT2Is. Meta-regression analysis was performed according to the dose and duration of intervention. Results: Twenty-two studies (6 on non-T2DM population) with a total of 1421 (243 non-T2DM) patients were included. Six studies (3 on T2DM and 3 on non-T2DM) were controlled by metformin, and others were passively controlled. SGLT2Is could significantly increase IS in T2DM patients (SMD = 0.72 [0.32–1.12]). SGLT2Is could reduce insulin resistance in non-T2DM population, but this was not significant. SGLT2Is were not inferior to metformin in reducing insulin resistance. Subgroup analysis indicated that dapagliflozin could significantly increase IS, but empagliflozin was not associated with significant improvement in IS. Meta-regression analysis indicated no effect for dose but duration of SGLT2I administration on IS. Conclusion: SGLT2Is, particularly dapagliflozin, could increase IS. These results need to be consolidated by further studies. [ABSTRACT FROM AUTHOR]

Background: Frailty is a common problem in elderly individuals. However, this issue is not well investigated among heart failure (HF) patients with appropriate scales. We aimed to translate and evaluate Edmonton frailty scale (EFS) validity and reliability in Iranian HF adults. Methods: We implemented this methodological study on stable HF patients referred to an outpatient heart clinic in Isfahan, Iran. The translation was done using the forward-backward method. Ten individuals were asked to comment about all items in terms of understandability and simplicity. Fifteen experts were invited, and their ratings on each item were collected to measure the content validity index (CVI) and content validity ratio (CVR). Cronbach’s alpha was used for the assessment of internal consistency. After completing the scale for the second time with a two-week interval, test-retest reliability with intraclass correlation coefficient (ICC) measurement was done. Results: The translation process was performed uneventfully. All items were reported to be simple and meaningful. CVI of items ranged from the minimum of 0.80 to a maximum of 1.00 plus an acceptable CVR of at least 0.60. Fifty HF patients (age: 67.2±14.1 years, males: 56%) completed the questionnaire twice without missing data. Cronbach’s alpha was first to be 0.550. After omitting three items about social support, drug usage, and nutrition, the value was raised to 0.711. Test-retest reliability showed a good index of consistency (ICC: 0.693, 95% confidence interval: 0.527-0.810). Conclusion: Modified Persian EFS is a simple and meaningful tool with high validity and acceptable reliability for assessing frailty in HF individuals irrespective of age. [ABSTRACT FROM AUTHOR]

Chronic inflammatory demyelinating polyneuropathy (CIDP) is a rarely reported disease. The association between diabetes mellitus (DM) and CIDP has been a matter of controversy. Here we presented a 59-year old male patient with uncontrolled type 2 DM presented with simultaneous type B insulin resistance (TBIRS) and CIDP. Both blood glucose and neurological manifestations responded well to corticosteroid therapies. Although the pathogenesis of CIDP remains to be elucidated, the role of antibodies in the pathogenesis of TBIRS and CIDP might be a promising platform for further studies to provide additional insights into the origin of these 2 rare complications. [ABSTRACT FROM AUTHOR]

BACKGROUND: Garlic may have anti-oxidanmayti-hypertensive and anti-hyperlipidemic properties. However, the effects of its administration on cardiac function in heart failure (HF) patients impact require further investigation. We aimed to evaluate garlic prescription effects on cardiac outcomes and quality of life scores in Iranian HF patients. METHODS: From August to December 2020, a randomized, double-blind clinical trial was conducted. Individuals with heart failure (New York heart association (NYHA) functional class of II and III) referred to private clinics in Isfahan, Iran, were randomly assigned to intervention (n=80) and control (n=80) groups. They have received 500 mg of odorless garlic tablets or the same shape and dosage of placebo twice daily for three months. Laboratory data, cardiac outcomes (end-diastolic diameter, ventricular septal thickness, NYHA functional class, left ventricular ejection fraction), quality of life score (Minnesota living with HF questionnaire), and the Modified Borg Scale (MBS) were all evaluated at the baseline and the end of the trial. RESULTS: The population's mean age was 58.1±13.5 years (55% males). Patients who consumed garlic had remarkably improved functional class compared to placebo takers and their baseline (NYHA practical class of II, 79.4% vs. 50.6%, P<0.001 and 79.4% vs. 54%, P=0.006, respectively). MBS levels were significantly lower among garlic consumers (baseline: 2.52±0.5, after three months: 2.2±1.06, P= 0.040). CONCLUSIONS: Garlic administration may improve cardiac function and breathe in HF patients. Complementary research is necessary to confirm our findings. [ABSTRACT FROM AUTHOR]

Coronavirus disease 2019 (COVID-19) has various manifestations on different body organs, including the lungs, heart, kidneys, and central nervous system. However, the frequency of electrolyte abnormalities, especially hypophosphatemia, is still debated in this pandemic. Our main aim in this review is to evaluate the frequency and complications of hypophosphatemia in COVID-19-infected individuals. A systematic literature review was performed in Web of Science, Scopus, PubMed, EMBASE, and Cochrane electronic databases with the combination of different keywords till October 2021. We recruited all relevant published records (including cross-sectional and case-control studies as well as editorials and brief reports) assessing hypophosphatemia among patients with COVID-19 infection. After assessing all 928 recruited records and discarding duplicates, 4 records met the inclusion criteria. Three articles were further included during a manual search of the literature. Overall, the included studies reported 1757 subjects (males: 51.3%), with the mean age ranging from 37.2 ± 13.6 years to 65.9 ± 13.9 years. Hypophosphatemia prevalence has been reported from 7.6% to 19.5%. Patients with the severe status of COVID-19 had a higher prevalence of low serum phosphate levels than those with moderate infection. This review indicates that hypophosphatemia might be categorized as a complication in clinical settings during the COVID-19 pandemic, requiring a high clinical suspicion to implement appropriate diagnostic and therapeutic interventions to prevent life-threatening outcomes. However, it needs to be more elucidated by further studies whether hypophosphatemia in severe COVID-19 is directly related to COVID-19 or is just a complication of severe illness. [ABSTRACT FROM AUTHOR]

Background. Most of the patients with hypertension (HTN) who undergo medical therapy unaccompanied by psychological and behavioral interventions may not achieve their goal in HTN treatment. Self-care is a key factor in controlling HTN. Given that depression, stress, and anxiety are the most psychological disorders in chronic illnesses. Their impact on self-care, quality of life, and HTN control must be studied more. Methods. We analyzed the difference in medication adherence in 252 patients with low vs. high psychological distress. Also, patients with controlled and uncontrolled HTN were compared according to their psychological distress scores. We further assessed the relation of psychological distress, self-care, and medication adherence with patients' demographic characteristics. Results. 61.3% of our participants were female with a mean age of 60.6 ± 11.35 and male participants had a mean age of 60.5 ± 11.55. The psychological distress score was significantly higher in women with uncontrolled HTN (p value = 0.044). Also, individuals with controlled HTN tend to have a higher medication adherence score (p value = 0.01) and higher self-care score (p value = 0.033). Hypertensive females had a higher psychological distress score (3.35 ± 2.05) and a lower self-care score (64.05 ± 8.16). There was a positive relationship between age and drug adherence. The self-care score was higher (65.95 ± 7.88) in patients having lower psychological distress levels. Conclusion. A lower psychological distress score can result in better self-care, enhancing the probability of better HTN control; thus, psychological interventions may be necessary for the treatment of HTN. However, more studies are needed to assess the effectiveness of this intervention. [ABSTRACT FROM AUTHOR]

Background. Polycythemia vera (PV) is a myeloproliferative disorder presented with different manifestations. However, bilateral adrenal hemorrhage (BAH) and adrenal insufficiency (AI) are rare manifestations. Herein, we described a patient who suffered from BAH and AI in the context of PV. Case Presentation. A 60-year-old man with an underlying history of PV was admitted with severe abdominal pain, nausea, and loss of consciousness. Primitive computed tomography (CT) scan findings revealed bilateral adrenal masses (right: 40 ∗ 23 mm, left: 60 ∗ 35 mm) with the second scan showing quite similar results (right adrenal: 40 ∗ 29 mm, left adrenal: 48 ∗ 26 mm) suggesting BAH. The further adrenal assessment proved concurrent AI. Both adrenal masses resolved completely after 15 months. However, the patient still suffered from AI. Conclusion. BAH and AI in patients with PV should be considered rare complications requiring high clinical suspicion for early diagnosis and treatment to avoid life-threatening outcomes. [ABSTRACT FROM AUTHOR]