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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

AIM: Risk stratification in patients with angiographically confirmed coronary artery disease (CAD) could be made more precise. Since it is very difficult to determine which risk factors best predict clinical endpoints, a gentle design of risk stratification model with multiple risk factors may develop prognosis in CAD patients. There is no study with a high level of evidence including multiple risk factors to evaluate the prognostic role of different factors in acute coronary syndrome. This study aimed at determining the importance of different prognostic factors for clinical endpoints in CAD patients METHODS: A prospective concurrent inception cohort study consisting of 521documented CAD patients 184 of whom were exposed participants who were angiographically documented CAD patients with ABI

Background: The direct and indirect negative impacts of hypertension on mortality and morbidity and the deficiencies in physicians’ knowledge on its management prompted us to search for new methods of training this item. Objectives: In this study, 2 methods of teaching—planned lecture and cooperation—were compared in instructing hypertension to medical students. Materials and Methods: This study was designed to be a prospective analysis of the efficacy of 2 models of cooperation and planned lecture teaching of hypertension. The medical students, in the second term of the 2010 academic year who were introduced to the nephrology ward for their internal medicine course, were randomly assigned to 2 groups to be taught hypertension by 2 models of cooperation and planned lecture to compare their advantages and disadvantages. In their final exam 2 questions concerning the management of hypertension were asked with regard to evaluating the long-term impact of the models on learning. Data were analyzed by paired t-test to compare pre- and post-test in each group, and independent t-test was used to compare the average and standard deviation scores between groups. Results: Fifty-one students participated in the study. The total number of students in the lecture (group 1) and cooperation (group 2) methods was 28 and 23, respectively. By independent t-test, differences in test scores indicated a similar achievement of the 2 methods for the endpoint of basic knowledge (P = 0.253). But, the cooperation method was more successful in transferring abilities, primarily in the areas of workup and treatment (P < 0.05). Conclusions: The study findings show that both methods can set in the optimal training for hypertension to students but that the cooperative method is more effective for deduction analysis.

Psychosocial factors such as depression, hostility, social isolation are associated with increased risk of coronary heart disease. We aimed to determine the association of psychiatric symptoms and psychosocial factors with myocardial infarction (MI). We performed a secondary analysis of data from a population-based survey of Iranians aged 18-65 years using standardized psychosocial instruments. Of the 2158 participants, 51 had suffered an MI. In univariate analysis: number of stressful life events, stressfulness, somatization, depression, anxiety, phobic anxiety and psychoticism were significantly associated with MI ( P < 0.05). In multivariate logistic regression, interpersonal sensitivity (P = 0.047), phobic anxiety (P = 0.016), number of stressful life events (P = 0.054), stressfulness (P = 0.057) and age (P = 0.001) remained at significantly associated with MI.

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.

Giant cell tumour (GCT) is a benign, but aggressive, primary tumour of the bone. The recurrence rate after surgical treatment has been reported to be as high as 50%. Many surgical techniques have been employed in the treatment of this tumour. More aggressive interventions, such as en bloc resection and bulk allograft or prosthetic reconstruction, are generally understood to be associated with lower rates of local recurrence. However, because of lessened morbidity, intralesional techniques have come to be favoured for this condition. In addition to curettage, various adjuvant procedures and packing materials have been advocated in order to control and reconstruct long bone defects secondary to this neoplasm. We report our experience with 40 long bone GCT patients treated with curettage, burring, bone grafting and no adjuvants between 1997 and 2002. There was a local recurrence rate of 32.5%, with most recurrences noted within the first 30 months after surgery. Minor complications were found in 18% of patients. The risk of local recurrence in this study is acceptable (within the range that has been historically reported for curettage and bone grafting). In cases where more resources are available, the addition of adjuvant therapies, as noted in the recent literature, may be beneficial. The results of this study should be considered when designing multicenteric studies in the future.

Summary Background: Studies investigating possible correlations between plasma lithium concentration, lithium treatment duration, and frequency of lithium administration, and lithium nephrotoxicity have yielded conflicting results. Objectives: Our main objective was to investigate whether there was any relationship between erythrocyte lithium concentration (ELC) and renal side effects. Another objective of our study was to identify a parameter, which could be estimated inexpensively, for assessing possible renal side-effects of lithium. Method: Seventy Iranian inpatients with bipolar disorder entered this case–control study. Medications taken concurrently by the patients were recorded. A direct method of measuring ELC was used in this study. The cases were patients on lithium who had urine specific gravity (SG) of 1·006 or less after 8–10 h water deprivation at night and the controls consisted of patients on lithium with urine SG of 1·011 or more after this period. Blood urea nitrogen, serum creatinine, sodium and potassium and urine SG, sodium, and potassium were measured in all patients during this time. Renal indices were compared by using independent sample t-test at a significance level of a P-value of 0·05 or less. Non-parametric Spearman's rank correlation test was used to investigate the relationship between clinical variables and the indices of renal function. Results: Results revealed that in case group mean serum sodium concentrations were significantly higher (P = 0·008) and mean urine sodium and potassium were significantly lower than those of controls (P = 0·004 and 0·007 respectively). We found no statistically difference in lithium ratios between the two groups. However, ELCs were significantly higher in the cases (P = 0·026). There were no significant correlation between concomitant use of neuroleptics, benzodiazepines or carbamazepine and ELC or lithium renal side-effects. Conclusion: This study showed that ELC may reflect lithium renal side-effects better than plasma lithium level.

Background: Given the lack of consistency in the literature regarding the reliability of the ankle-brachial index (ABI) as a valid screening tool and an independent risk indicator of cardiovascular events and mortality, we compared it with angiography as a reference standard test. Methods: This case-control study, conducted between 2010 and 2011 in Tehran Heart Center, recruited 362 angiographically confirmed cases of coronary artery disease (CAD) and 337 controls. A standard protocol was used to measure the ABI and different CAD risk factors. Results: A low ABI had specificity of 99.7%, positive predictive value of 95.8%, negative predictive value of 49.8%, sensitivity of 64%, likelihood ratio of 24.07, and odds ratio (OR) of 22.79 (95%CI: 3.06–69.76). The role of the associated risk factors was evaluated with OR (95%CI), with the variables including gender 3.15 (2.30–4.30), cigarette smoking 2.72 (1.86–3.99), family history 1.72 (1.17–2.51), diabetes 1.66 (1.15–2.4), and dyslipidemia 1.38 (1.02–1.88). In a multivariate model, the following variables remained statistically significantly correlated with CAD [OR (95%CI)]: ABI 13.86 (1.78–17.62); gender 3.69 (2.43–5.58); family history of CAD 2.18 (1.41–3.37); smoking 1.69 (1.08–2.64); age 1.04 (1.02–1.06). Conclusions: A low ABI had specificity of 99.7%; however, because of its low sensitivity (64%), we should consider CAD risk factors associated with a low ABI in order to use it as a first-line screening test.

Among the various methods of clinical teaching, rounds and grand rounds are considered as the gold standards. Clinical round includes some standard components and it plays an effective role in student's learning process. The aim of this study was to evaluate the content of teaching rounds in 40 clinical wards in 4 medical teaching hospitals affiliated to Tehran University of Medical Sciences in Tehran, Iran, and also to assess the learners benefit rate from these programs and determine the factors affecting those. This is a cross sectional, descriptive and analytical study conducted on 318 medical learners in different grades, about the content of clinical rounds. The data collection tool was a questionnaire made by researchers. The validity of the questionnaire according to experts opinions and the reliability with a pilot study conducted on 30 cases were confirmed (α=0.826). Data entered into the SPSS software and for analysis Chi-square, Student's t-test, ANOVA and linear regression analysis tests were used. In this study 20 subjects related to clinical rounds content were assessed. The highest score was related to the subject of diagnosis and the lowest one was related to legal issues. Overall, the mean score of the learner's benefit rate to this method was 3.52 out of five. The level of learner's benefit rate was above the average and the benefit rates according to educational grade, number of the students and faculties were significantly different (P0.05). Average of the benefit rate among residents were significantly higher than the other medical trainees (P0.05). In conclusion, in understudied clinical rounds, there has been more emphasized on history taking, clinical examinations and diagnosis subjects, and Issues like: accountability, health economy, patient's nutrition, non-drug treatments and medical legal issues are less considered in the studied rounds.

Background Many countries have started screening and prevention programs for chronic kidney disease (CKD). However, one of the main concerns of health authorities is whether management strategies for diagnosed CKD patients can decrease mortality or morbidity. This study aimed to investigate the effect of two competing clinical strategies of treatments under nephrologists’ supervision compared with no treatment on the frequency of the need to start renal replacement therapy (RRT) and mortality in CKD patients. Methods Our cohort comprised consecutive newly diagnosed patients with CKD in an outpatient clinic in Tehran between October 2002 and October 2011. CKD Patient enrollment occurred if two criteria of high plasma creatinine level and chronicity of renal disease by at least 3 months of clinical history or small sized kidneys in ultrasound findings were met. Demographic data and time of RRT or mortality in patients who had been followed up regularly were compared with those in the control group. The control group included those patients who did not attend a nephrology clinic to receive CKD management package for at least 1 year during the study period. Results The cohort included 76 patients in the control group and 389 patients in the supervised group. The mean age of the patients was 61.33±14.9 years (16–95 years). The ratio of males/females was 1.47 (277/188). The mean follow-up in the control and supervised groups was 33.29±20.50 (7–111) and 36.03±25.24 (6–124) months , respectively, and the total patient years of follow-up was 1382.3. A substantial number of patients survived without RRT until the first year of follow up (96%) in both groups, but afterward, those in the control group had more deaths or need to start RRT in comparison with those who received medical advice (20 vs. 67 months; p= 0.029). This cohort also showed a higher survival and a longer time to show a GFR of less than 15 cc/min (84 vs 34 months, p Conclusions Active follow-up of CKD patients appears to significantly decrease the risk of death or progression to end-stage renal disease and the requirement to start renal replacement therapy.

Developing current evidence in order to better assess the rates and pattern of the CAD risk factors among populations is pivotal in CAD risk stratification.A large scale population based survey involving 31,999 healthy people was designed. Risk factors information was provided from medical history, physical examination and laboratory assessments.Increasing linear trend was observed for: cigarette smoking (CS) (P=0.001), systolic blood pressure (SBP)140 mmHg (P=0.001), diastolic blood pressure (DBP)90 mmHg (P=0.001), SBP120 mmHg (P=0.001), DBP80 mmHg (P=0.001), fasting blood glucose (FBS)126 Mg/dl (P=0.001), total cholesterol (TC)200Mg/dl (P=0.001), triglyceride200 Mg/dl (P=0.001), TC170 Mg/dl (P=0.001), and LDL-c130 Mg/dl (P=0.001). Multivariable adjusted magnitudes of associations for risk factors across age groups were statistically different, thus in an age group of 30-40 years: cigarette smoking, high DBP, increased body mass index (BMI), high level of FBS and lower level of education demonstrated strongest associations. In an age group of 40-50 years: CS, high level of DBP, increased BMI, FBS126 Mg/dl, and SBP120 mmHg, in an age group of 50-60 years: SBP120 mmHg, CS, higher level of DBP, and FBS126 Mg/dl, and in above 60 years: SBP120 mmHg, HDL-c45 Mg/dl, C/S and FBS have demonstrated the strongest associations.Trends of increment in the mean levels of SBP, DBP, TC, LDL-c and FBS are statistically significant across age decades. Multivariate strength of associations for CAD risk factors demonstrates significant differences across age groups.

The drug ecstasy has been increasingly used for recreational purposes, especially among students. Teachers play an important role in altering student attitudes toward ecstasy. OBJECTIVE: The aim of this study was to access teacher knowledge and attitude toward ecstasy and its side effects. METHODS: In a cross-sectional study, 460 teachers from 20 public and 10 private schools were randomly invited to participate in the study between April 2005 and April 2006 and their knowledge and attitudes toward ecstasy were collected on the basis of a designed questionnaire. RESULTS: No significant correlation was found between knowledge about ecstasy and gender, whereas, there was a positive relation between knowledge and education level of the teachers (P = .033). Attitude was higher in female participants (P = .012), but was not related to the age of the teachers. We found no relation between attitude toward ecstasy and the teachers' education levels. CONCLUSION: Knowledge about ecstasy and its side effects was dependant on the teachers' education level, whereas their attitude toward ecstasy was dependent on the teachers' gender. Language: en

Background: Coronary artery bypass grafting (CABG) has become a safer procedure in recent years. Aims : We aimed to compare complications and early outcome of CABG in patients without history of general risk factors with those in patients with at least one general risk factor for coronary artery disease (CAD). Settings and Design : Cross-sectional study. Materials and Methods : Postoperative in-hospital complications, 30-day mortality rate and length of stay in hospital of 708 patients without preoperative general risk factors undergoing CABG in three university hospitals were assessed and compared with 10,844 patients undergoing CABG with at least one general risk factor as controls. In addition, the association of the studied variables with patients' early outcome was evaluated. Statistical Analysis : SPSS software with Pearson's χ 2 test; independent sample t test, Mann-Whitney test and univariate analysis were used. Results : All studied in-hospital complications were similar between the two groups. Thirty days mortality rate (0.7% in study group and 1.4% in control group) was similar between groups, whereas prolonged length of stay (>12 days) was more frequent in control group (61.33% vs. 71.36%, P Conclusion : Most aspects of early complications after CABG, as well as 30-day mortality rate, were similar between patients with and without general risk factors for coronary artery disease undergoing CABG.

Obesity is a significant health crisis around the world. Of great concern are the data pointing to the recent increase in the prevalence of obesity irregardless of age group and country. Overweight and obesity in adolescence are markers of overweight and obesity in adults, respectively. Very little data are currently available on the prevalence of childhood obesity in Iran, and more research on the risk factors is required before preventive public health programs can be formulated and put into practice.The objective of this study was to quantify the prevalence of overweight and obesity and their associated factors in adolescent children living in Tehran.During a multistage stratified cluster sampling, 2900 students (1200 males and 1700 females) aged 11-17 years were selected from 20 secondary schools in the school year of 2004-2005. A questionnaire was filled, and weight and height were measured.The body mass index (BMI) was calculated and adjusted for age and sex. Prevalences of overweight and obesity were 17.9 and 7.1%, respectively. BMI increased with age, and it was higher in those who had lower levels of physical activity. Age at menarche was negatively associated with BMI. There was no relationship between macro- and micronutrient intake and overweight and obesity. This study highlights the high prevalence of overweight and obesity in adolescent children in Tehran.

Aim To study the effect of acetazolamide on cystoid macular oedema (CMO) in patients with Behcet's disease. Patients and methods A total of 67 eyes of 35 Behcet's patients with chronic, but well-controlled uveitis, and CMO were randomised into a double-masked, crossover trial comparing the effect of acetazolamide vsplacebo. The patients received an initial 4-week course of either 250 mg acetazolamide twice daily (b.i.d.) or placebo, followed by a 4-week washout period. They then received a 4-week course of the reverse study medication. An improvement in visual acuity and fundus fluorescein angiographic findings was assessed. Results In total, 29 patients (55 eyes) completed the trial and were available for analysis. Of the 29, 16 men and 13 were women. The age range was 13–50 years (mean 33.6 years). Patients on acetazolamide showed a slightly better improvement of angiographic signs (at least by one grade improvement) over that of placebo (12 vsfive eyes). They also had less deterioration of angiographic signs over that of placebo (three vsseven eyes). However, these findings were not statistically significant (P=0.99). Acetazolamide had no statistically significant effect (P=0.53) on the improvement of visual acuity of patients over that of placebo (13 vseight eyes), nor on the deterioration of visual acuity (three vs11 eyes). Conclusion Despite seemingly favourable results, the 4-week course of acetazolamide (250 mg b.i.d.) has no statistically significant effect on the improvement of the visual acuity and the fluorescein angiographic findings in Behcet's patients with CMO.

Background Coronary artery disease (CAD) is a leading cause of mortality, morbidity, and disability with high health care cost in Iran. It accounts for nearly 50 percent of all deaths per year. Yet little is known about CAD and CAD risk factors in the Iranian population. We aimed to assess the prevalence of different CAD risk factors in an Iranian population. Methods A descriptive cross sectional survey was conducted involving 3000 healthy adults at 18 years of age or above who were recruited with cluster random sampling. Demographic data and risk factors were determined by taking history, physical examination and laboratory tests. Results The average age was 36.23 ± 15.26. There was 1381 female (46%) and 1619 male (54%) out of which 6.3% were diabetic, 21.6% were smoker, and 15% had positive familial heart disease history. 61% had total cholesterol level > 200 mg/dL, 32% triglyceride > 200 mg/dl, 47.5% LDL-c > 130 mg/dl, 5.4% HDL-c < 35 mg/dl, 13.7% systolic blood pressure > 140 mmHg, 9.1% diastolic blood pressure > 90 mmHg and 87% of them were physically inactive. Conclusion Clinical and Para-clinical data indicated that Iranian adult population are of a high level of CAD risk factors, which may require urgent decision making to address national control measures regarding CAD.