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Background On the one hand, the primary coronary slow flow phenomenon (CSFP) can cause recurrence of chest pain, prompting medical examinations and further healthcare costs, while on the other hand, it can lead to myocardial infarction, ventricular arrhythmia and sudden cardiac death. Nevertheless, there is not any agreement on the optimal treatment for primary CSFP, so we decided to examine the effectiveness of sildenafil in this context.Methods This pilot study is a 12-week, triple-blind, randomised, placebo-controlled trial for receiving either 50 mg daily oral sildenafil or placebo. Twenty eligible patients aged 30–70 years from a tertiary hospital in Yazd were randomly allocated in a 1:1 ratio to two groups. The primary outcomes were the alterations in functional capacity (metabolic equivalents, METs), Duke treadmill score (DTS) and angina severity (Canadian Cardiovascular Society (CCS) class). The study protocol registration code is IRCT20220223054103N1.Results The angina severity in the Sildenafil group improved, with all receivers achieving a state of being asymptomatic during regular physical activity (CCS I). Whereas just 40% of the recipients in the placebo group achieved the same level of improvement (p=0.011). Mean METs at baseline were 9.9 (SD: 3.1) and at week 12 were 13.1 (SD: 3.3) for sildenafil and 9.56 (SD: 2.1) and 9.63 (SD: 2.4) for placebo (difference favouring sildenafil with a median increase of 3.1 (IQR: 1.1 to 4.1, p=0.008)). Median DTS scores at baseline were 3 (IQR: 0 to 9) and at week 12 were 9.5 (IQR: 7.75 to 15) for sildenafil and 7 (IQR: −1.5 to 9.25) and 8 (IQR: 1.5 to 11.25) for placebo (difference favouring sildenafil with a median increase of 5.5 (IQR: 1 to 9.2, p=0.01)).Conclusions We suggest that a daily low dose of sildenafil could be a valuable therapeutic option for primary CSFP.Trial registration number IRCT20220223054103N1.

Abstract Background There is a substantial disparity in coronary artery disease (CAD) burden between Iran and other nations that place a strong emphasis on the assessment of CAD risk factors and individuals’ awareness and ability to control them. Methods Two thousand participants of a community-based Iranian population aged 20–74 years were investigated with a mean follow-up of 9.9 years (range: 7.6 to 12.2). An analysis of Cox regression was conducted to determine the association between CAD development and classic risk factors such as age, sex, smoking, physical activity, education, obesity, dyslipidemia, hypertension, and diabetes mellitus. Furthermore, we computed the population attributable fraction for these risk factors. Results After a follow-up period of nearly 10 years, 225 CAD events were reported, constituting 14.5% of the overall incidence. Nighty three percent of participants had more than one risk factor. Age was the most predictive risk factor, with a hazard ratio (HR) and confidence interval (CI) of 5.56 (3.87–7.97, p

Background: The coronary angiography results in a group of patients with myocardial infarction (MI) are normal or near-normal; which is diagnosed as myocardial infarction with non-obstructive coronary arteries (MINOCA). This study aimed to compare the mortality rate and risk factors between MINOCA and myocardial infarction with obstructive coronary artery (MI-CAD). Methods: This retrospective cohort study was conducted from January 1, 2018, to December 31, 2019. A total of 679 patients admitted to Afshar Hospital in Yazd with a diagnosis of ST-elevation myocardial infarction (STEMI) from 2018-2019 who underwent primary Percutaneous Coronary Intervention (PCI) were enrolled in the study. Demographic, and clinical variables, ECG finding and one-year mortality, were extracted using MI registry data from the Yazd Cardiac Research Center. Results: The estimated frequency of MINOCA was 4.6%. Patients with MINOCA ( 47.14±6.2) were younger than patients with MI-CAD (57.61±9.1) (P

Abstract Objective: The cardioprotective effects of nuts are well established. However, the positive impacts of nuts in preventing CVD at a younger age, a condition known as premature coronary artery disease (PCAD), is still debated. Therefore, we aim to determine the association between nuts and PCAD occurrence and its severity in different Iranian ethnicities. Design: This case–control study was conducted within the framework of the Iran-premature coronary artery disease (I-PAD) study, an ongoing multi-centric study on Iranian patients of different ethnicities. Setting: This multi-centric case–control study was conducted in among 3253 persons under the age of 70 years in women and 60 years in men from different ethnicities in Iran. Participants: Information on nut consumption was collected using a validated FFQ. Subjects were selected from among the candidates for angiography. Cases were those whose coronary angiography showed stenosis of more than 75 % in at least one vessel or more than 50 % of the left main artery, while the control group participants had normal angiography results. Results: In the crude model, compared to the first quartile, the highest quartile of nut consumption was significantly associated with a lower risk of PCAD (OR = 0·26, 95 % CI (0·21, 0·32); P for trend = 0·001). In the top quartile of nut intake, a substantial decrease in PCAD was observed after controlling for putative confounders (OR = 0·32; 95 % CI (0·24, 0·43); P for trend = 0·001). Additionally, a 75 % decrease in the risk of severe PCAD was observed in the participants in the highest quartile of nut intake. Conclusion: A significant inverse association was observed between nut intake and the risk and severity of PCAD in the Iranian population. Large-scale clinical trials are required to confirm these findings.

Abstract Background Concerning ascending trend in the prevalence of chronic type II diabetes, prevention and the development of an effective approach after the recognition of at-risk individuals is crucial. This study aims to investigate comparing the influence of lifestyle modification and metformin interventions in the prevention of type II diabetes developments. Method The search was conducted using PubMed, Google Scholar, Scopus and Web of Science databases. The inclusion criteria include randomized controlled trials (RCT) which studied both lifestyle modification and metformin interventions in the population above 18 years old without a history of any type of diabetes. After excluding studies with intervention time of fewer than 6 months, a systematic review and meta-analysis were performed to evaluate relative risk (RR) with a confidence interval (CI) of 95% of type II diabetes development. Results Data from 5 studies were included in the meta-analysis. The population also consists of individuals with a mean age of 50 years old with BMI and FBS of 35.5 and 104.7 mg/dl respectively. Participants range of prevention years was between 2–3 years with a mean of 2.8 years. Lifestyle modification decreases the probability of the incidence of type II diabetes by 25.3% (RR: 0.747, 95% CI, 0.6—0.92) compared to the metformin intervention (p-value = 0.007). Our results indicate that long-term lifestyle modifications can prevent diabetes type II and decrease diabetes mellitus incidence down to one-quarter in comparison to metformin. Conclusion Lifestyle modification can be more efficacious than metformin in diminishing the incidence of type II diabetes. Therefore, lifestyle modification can be a therapeutic strategy for controlling type II diabetes incidence, especially in high-risk individuals.

Abstract Background Diverse ethnic groups that exist in Iran may differ regarding the risk factors such as hypertension, hyperlipidemia, dyslipidemia, diabetes mellitus, and family history of non-communicable disease. Premature Coronary Artery Disease (PCAD) is more endemic in Iran than before. This study sought to assess the association between ethnicity and lifestyle behaviors in eight major Iranian ethnic groups with PCAD. Methods In this study, 2863 patients aged ≤ 70 for women and ≤ 60 for men who underwent coronary angiography were recruited in a multi-center framework. All the patients’ demographic, laboratory, clinical, and risk factor data were retrieved. Eight large ethnicities in Iran, including the Farses, the Kurds, the Turks, the Gilaks, the Arabs, the Lors, the Qashqai, and the Bakhtiari were evaluated for PCAD. Different lifestyle components and having PCAD were compared among the ethnical groups using multivariable modeling. Results The mean age of the 2863 patients participated was 55.66 ± 7.70 years. The Fars ethnicity with 1654 people, was the most subject in this study. Family history of more than three chronic diseases (1279 (44.7%) was the most common risk factor. The Turk ethnic group had the highest prevalence of ≥ 3 simultaneous lifestyle-related risk factors (24.3%), and the Bakhtiari ethnic group had the highest prevalence of no lifestyle-related risk factors (20.9%). Adjusted models showed that having all three abnormal lifestyle components increased the risk of PCAD (OR = 2.28, 95% CI: 1.04–1.06). The Arabs had the most chance of getting PCAD among other ethnicities (OR = 2.26, 95%CI: 1.40–3.65). While, the Kurds with a healthy lifestyle showed the lowest chance of getting PCAD (OR = 1.96, 95%CI: 1.05–3.67)). Conclusions This study found there was heterogeneity in having PACD and a diverse distribution in its well-known traditional lifestyle-related risk factors among major Iranian ethnic groups.

Introduction: Oxidative stress is involved in the pathogenesis of many diseases, including atherosclerosis. Lipid profile conditions, oxidative stress and antioxidant imbalances play a major role in the development of the disease. The purpose of this study was to compare the different time course of concurrent training on lipid profile and total antioxidant capacity of cardiac patients. Methods: The present study was a quasi-experimental study. Twenty male patients, mean age 56 ± 9.75, were voluntarily divided into the control and combination training groups The concurrent training group performed aerobic and resistance training for eight and three days a week. Aerobic exercise was performed for 15-20 minutes at 50-80% of maximal heart rate and resistance training program consisted of three upper extremity movements and two lower extremity movements with three sets and 10 repetitions. Blood samples were taken before and after four and eight weeks, and lipid profile and total antioxidant capacity were measured. Data were analyzed by repeated measures ANOVA using SPSS version 16 software. Results: Concurrent training has reduced the significant levels in LDL, cholesterol and triglycerides after four and eight weeks, and has also reduced a significant increase level in HDL. Concurrent exercise had a significantly effect on the amount of total antioxidant after eight weeks (P

Background: Obesity and overweight are important public health problems which are rapidly growing throughout the world. This study aims to provide 10-year incidence estimates of obesity and overweight in adults along with their risk factors in an Iranian adult population. Methods: This cohort study was conducted within the framework of the Yazd Healthy Heart Project (YHHP) throughout phases from 2005-2006 to 2015-2016 among urban adult population. The participants comprised of 1000 males and 1000 females aged 20-74 years from urban areas of Yazd. Cox proportional hazards model was used to examine the potential risk factors for obesity and overweight. Results: A total of 2000 participants aged 47.09 ± 16.97 years and body mass index (BMI) of 21.99 ± 2.21 kg/m2 were entered in this study at baseline. After 10 years of follow-up, the cumulative incidence of overweight for the entire population was 38.6% (41.6% in women and 36.8% in men). Furthermore, the 10-year cumulative incidence of obesity was 14.8% in the population (20.8% for women and 10.5% for men). Female participants showed a significantly higher incidence rate compared to males either for obesity or overweight. Regarding risk factors, there was a significant association between non-smoking (HR= 1.54, 95% CI: 1.06-2.25), socio-economic status (HR= 1.82, 95% CI: 1.13-2.94), and education (HR= 1.56, 95% CI: 1.14-2.13) with overweight (P < 0.05). Conclusion: This study revealed the incidence rate of obesity and overweight is significantly high in adult population of Yazd, Iran especially in women. The most important predictors of overweight seem to be smoking, lower socio-economic status, and education.

Abstract Background: Congenital cardiovascular malformation is the most common group of birth defects. Fetal echocardiography is highly sensitive and specific in the diagnosis of congenital heart disease in low- and high-risk populations. Objective: This study aimed to assess abnormal findings in fetal echocardiography and maternal disease. Materials and Methods: This cross-sectional study was performed on 114 pregnant women referred to Afshar hospital, Yazd, Iran from October 2016 to March 2017. All pregnant women underwent fetal echocardiography through fetal heart screening protocol, which is administered by the international society of ultrasound in obstetrics and gynecology guidelines. Data collected included referral cause, gestational age, maternal age, gravida, and final diagnosis after an accurate fetal echocardiography. Results: The mean gestational age was 20 wk. The most common referral cause of pregnant women included diabetes (36.8%), fetal arrhythmia (14%), high maternal age (7%), and echogenic focus on ultrasound (6.1%). The most common postpartum findings were normal (68.4%), cardiac abnormalities (17.6%), and arrhythmias (14%). In postnatal echocardiography, the results were consistent with fetal echocardiography except in 2 women. Conclusion: This study showed that fetal echocardiography can be used in the early diagnosis and treatment of congenital heart diseases.

Abstract Background One fifth of the global burden of cardiovascular diseases (CVDs) in 2017 was attributable to excessive salt intake. As a member of the World Health Organization (WHO), Iran has committed itself to a 30% reduction in salt intake by 2025. Evidence on the amount and trend of salt intake among the Iranian population at national and sub-national levels is scarce. This study aimed to estimate the Iranian population’s salt intake during 2000–2016 at the national and sub-national levels, by sex and age groups. Methods Data on national and sub-national mean salt intake was obtained through systematically searching the literature and contacting the research studies’ principal investigators. Data collected through various methods were harmonized using the cross-walk method. Bayesian hierarchical and spatio-temporal-age regression models and simulation analysis were used to estimate the mean salt intake and its uncertainty interval across sex, age, year, and province. Results National age-sex standardized mean salt intake decreased from 10·53 g/day (95% uncertainty interval [UI]: 10·2 to 10·9) in 2000 to 9·41 (9·2 to 10·6) in 2016 (percent change: − 9·8% [− 21·1–3·1]). The age-standardized mean salt intake in women had decreased from 9·8 g/day (95% UI: 9·0–10·6) in 2000 to 9·1 g/day (8·6–9·7) in 2016 (percent change: − 6·6% [− 19·0–7·9]). The same measure in men was 11·1 g/day in 2000 (95% UI: 10·3–11·8) and 9·7 g/day (9·1–10·2) in 2016 (percent change: − 12·7% [− 23·0 – -0·9]). Age-sex standardized mean salt intake at the sub-national level in 2016 varied from 8·0 (95% UI: 7·0–9·0) to 10·5 (10·0–11·1). The difference between the provinces with the highest and the lowest levels of salt intake in 2016 was 31·3%. Conclusion Salt intake decreased in Iran from 2000 to 2016, while persistently exceeding the recommended values. This declining trend was more pronounced between 2010 and 2016, which might be attributed to Iran’s compliance to WHO’s Action Plan for reducing NCDs.

Background: Statins use is the most important treatment for high LDL cholesterol in patients with premature coronary artery disease (CAD). Previous reports have shown racial and gender differences in statin use in the general population, but this wasn't studied in premature CAD based on different ethnicities. Methods and results: Our study includes 1917 men and women with confirmed diagnosis of premature CAD. Logistic regression model was used to evaluate the high LDL cholesterol control in the groups and the OR with 95% confidence interval (CI) was reported as the effect size. After adjustment for confounders, the odds of controlling LDL in women taking Lovastatin, Rosuvastatin, and Simvastatin were 0.27 (0.03, 0.45) lower in comparison with men. Also, in participant who took 3 types of statins, the odds of controlling LDL were significantly different between Lor and Arab compared with Fars ethnicity. After adjustment to all confounders (full model), the odds of controlling LDL were lower for Gilak in Lovastatin, Rosuvastatin, and Simvastatin by 0.64 (0.47, 0.75); 0.61 (0.43, 0.73); 0.63 (0.46, 0.74) respectively and higher for Arab in Lovastatin, Rosuvastatin, and Simvastatin by 4.63 (18.28, 0.73); 4.67 (17.47, 0.74); 4.55 (17.03, 0.71) respectively compared to Fars. Conclusions: Major differences in different gender and ethnicities may have had led to disparities in statin use and LDL control. Awareness of the statins impact on high LDL cholesterol based on different ethnicities can help health decision-makers to close the observed gaps in statin use and control LDL to prevent CAD problems.

Background: Breast cancer is an uncontrolled and unnatural proliferation of cells in different breast tissues. The first measure to diagnose breast cancer is an examination by a surgeon followed by mammography, sonography, sampling, and other diagnosing methods. Given that there are several methods to diagnose breast cancer, and most of them are quite expensive, the present systematic review compares the expenses and effectiveness of different methods to diagnose breast cancer. Methods: The study was carried out as a systematic review through searching databases, i.e., PubMed, Web of Science, Magiran, Scopus, and Embase for articles published from March 1999 to May 31, 2017. The research articles regarding health technology assessment and economic assessment (n = 8) were examined. Results: Generally, conducting MRI screening and digital mammography every six months after the age of 30 are proved to be the most efficient and economical methods to screen carriers of BRCA (BReast CAncer) mutated genes. Besides, implementing both the techniques simultaneously was more cost-efficient with BRCA1 compared to BRCA2. Some studies have revealed that genetic tests and Oncotype tests, in particular, were the most cost-efficient methods to diagnose the disease, especially in its early stages. Conclusion: Consequently, indexing gene expression in individuals with BRCA gene mutation is revealed to more cost-efficient.

Introduction: Congenital heart disease is the most common congenital anomaly. About 50% of Neonates with congenital heart disease are asymptomatic in the first few days of life and are not diagnosed on initial examination. Pulse oximetry is a non-invasive method that can show the percentage of oxygen saturation in the blood and congenital heart disease. Methods: This was a descriptive cross-sectional study and the sampling method was census. Echocardiography was performed for all neonates with spo2 less than 95% and also neonates who were diagnosed with a problem by a cardiologist. After collecting the samples, the results obtained from pulse oximetry, physical examination and echocardiography were analyzed using SPSS software version 16 and statistical tests of Kolmogorov-Smirnov normality and Spearman correlation. Was investigated. Results: In pulse oximetry evaluation, 1.9% of neonates had spo2 (arterial oxygen saturation) less than 95%. 1.7% of neonates had heart problems in physical examination and 2.12% of neonates had heart problems in echocardiography. The highest correlation between pulse oximetry and echocardiography was 0.917. Conclusion: Considering the diagnostic importance of congenital heart diseases and their impact on a personchr('39')s life, it is recommended that pulse oximetry be added to physical examinations at birth as a screening method for heart disease.

Introduction: SARS-COV 19 is a new coronavirus that was reported first time in 30 December 2019 in Wuhan, China. The first case of coronary heart disease in Iran was reported with a definitive test on February 18 in Qom province and the first case in Yazd province on 24 February. The World Health Organization (WHO) declared a Covid infection on March 11 a pandemic. The aim of this study was to investigate the seroepidemiology of COVID 19 in Yazd province. Methods: The present study was a cross-sectional population-based study of seroepidemiological type that was conducted to investigate the serological prevalence of Covid-19 in the period of 3 to 20 May 2020 in Yazd Province. Sampling was clustered and it was without age and sex restrictions. Information was collected including demographic information, adherence to health protocols, and history of clinical symptoms of COVID 19. "Pishtaz ELISA Kit" was used to evaluate the IgG and IgM antibody titers against Covid 19. Chi-square, analysis of variance and T tests were used via SPSS.version.16 software Results: Mean age of the participants was 34.3± 17.5. Among the study participants, 507 (54.5%) were women. The serological prevalence of definite cases was 14.91% (95% CI: 12.91-16.91%) and suspicious cases were 2.85% (95% CI:1.85-3.85%). Ardakan City with 32% had the highest and Taft, Mehriz, Khatam with 7% had the lowest prevalence of COVID 19 (P

Vitamin D is a fat soluble vitamin with a well-known general metabolism and actions in bone structure and immune system regulation. Vitamin D exhibits direct antimicrobial activities against a spectrum of microbes, including Gram-positive and Gram-negative bacteria, enveloped and non-enveloped viruses, as well as fungi. An observational study showed that concentrations of 38 ng/ml or more were associated with a significant more than twofold reduction in the risk of developing acute respiratory syndrome (17% vs. 45%). Some clinical trials on vitamin D showed a decrease in incidence and severity of the Coronavirus Disease 2019 (COVID-19). To achieve the optimum vitamin D3 levels, approximately half of the population should take at least 2000–5000 iu/d of vitamin D3. Various loading doses were proposed for achieving a 25(OH)D concentration of 30 ng/ml. A study reported that to achieve the concentration of 40–60 ng/ml a weekly or fort nightly dose totaling 100,000–200,000 iu over 8 weeks (1800 or 3600 iu/d) as loading should be prescribed. Approximately about half the people, using 5000 iu/d of vitamin D3 or 30,000–35,000 iu/wk would increase 25(OH)D concentration to 40 ng/ml and 6235–7248 iu/d can ensure that 97.5% of the people have concentrations > 20 ng/ml. Well-designed human clinical studies over the dosage and combination of micronutrients such as vitamin C and D and Zinc in different populations are required to substantiate the benefits of micronutrient supplementation against infection.

Background Pediatric hypertension is the main cause of morbidity and mortality in pediatric populations. Purpose To examine pediatric hypertension in a clinical setting, we used the percentile rank approach and defined hypertension as that above the 95th percentile. Methods The present study was linked to the a national analytical cross-sectional community-based Iranian Children and Adolescents’ Psychiatric Disorders (IRCAP) survey. The survey was nationwide and funded by the National Institute of Medical Research Development. The IRCAP survey included 31,000 children and adolescents aged 6–18 years in all 31 Iran provinces. The current study included 1,035 children and adolescents and linked the data of the risk factors of cardiovascular disease only in Yazd province via random cluster sampling. Results Of the total participants, 456 (44.1%) were male and 579 (55.9%) were female. The mean age was 11.2±3.8 years (11.7±3.7 years for males, 11.0±3.6 years for females), while mean height was 146±20.0 cm overall, 147.2±22.0 cm for males, and 144.6±17.0 cm for females (P=0.009). The blood pressure distributions and percentiles were evaluated. Conclusion Here we determined age- and height-specific 50th, 90th, 95th, and 99th percentiles of systolic and diastolic blood pressures in Yazd boys and girls using 10-cm height intervals.

Background: The response to ovarian stimulation is different among women referring for assisted reproductive techniques. This difference could be due to different genotypes in genes related to reproduction such as estrogen receptor beta (ER β or ESR2) gene. Objective: In the present study, we explored the rate of ESR2 gene polymorphism in infertile women undergoing IVF treatment with different ovarian response to ovulation induction. Materials and Methods: A cross-sectional study was performed among 91 infertile women. The relationship between genotype distribution of the +1730 G/A polymorphism in the ESR2 gene (rs4986938) and the mean number of follicles and oocytes, their mean ratio, mean number of embryos, mean size of the follicles and pregnancy rates were measured. The ESR2 gene +1730 G/A polymorphism were identified by the amplification-refractory mutation system-polymerase chain reaction. Results: Genotypes GG, GA, and AA of the ESR2 gene presented frequencies of 27.5%, 67%, and 5.5%, respectively, in the infertile women. The results of the study showed that the mean number of follicles and oocytes, their mean ratio, mean number of embryos, mean size of the follicles, and pregnancy rates are not related to different genotypes. Conclusion: According to the endocrine and paracrine factors which are involved in the ovulation induction and maturation of oocytes, more studies with higher number of participants are required to confirm the results of the present study; in addition, further studies are required to find out other gene polymorphisms affecting estrogen receptor efficacy in the infertile women.

Background: Currently evidence indicates the resurgence of whooping cough despite high coverage of whole-cell (wP) and acellular (aP) pertussis vaccines. Objective: In this study, we investigated the cell-mediated immune response of a genetically inactivated protein containing the S1 subunit of pertussis toxin (PTS1) without and with the Listeriolysin O (LLO-PTS1), developed by the researchers (the authors of this study), in comparison with current wP and aP vaccines in the mice model. Methods: Thirty-six female NMRI mice aged 8 to 12 weeks (25 ± 5 g) were divided into six groups including control (n=6), and five treated groups (n=6/each). Treated groups comprising recombinant PTS1, recombinant fusion LLO-PTS1, aP, wP, and sham (phosphate-buffered saline) were injected intraperitoneally whereas the control group did not receive anything. After 60 days, the serum levels of IFN-γ, IL-4, and IL-17 cytokines (as the T-helper 1, 2, and 17 responses, respectively) were evaluated by mouse ELISA Kit. Results: Our findings showed LLO-PTS1 significantly increased IL-17 and IL-4 cytokines compared with wP and aP vaccines (superiority). IFN-γ failed to significantly increase in the LLO-PTS1 group compared to others but it was non-inferior to standard vaccines (non-inferiority). Conclusion: Our alum free mono-component monovalent recombinant fusion protein (LLO-PTS1), registered as a patent in the www.iripo.ssaa.ir, could bear the capacity to stimulate the Th-1 response similar to wP and aP vaccines (non-inferiority) in the mice model. In addition, it showed better results in Th-17 and Th-2 response (superiority). This study can be regarded as a springboard for further probes in booster pertussis vaccine development.

Introduction: Health care providers play a central role as the main members of the health care service providers team for the elderly and their knowledge and attitudes towards the aging phenomenon can play an important role in the quality of health care services provision for the elderly. Therefore, the present study aims to comparatively investigate knowledge and attitude of health care providers about the aging phenomenon in comprehensive health centers of Yazd and Hamadan, Iran. Methods: The cross-sectional study conducted on 220 health care providers who were enrolled in the study from comprehensive health centers in Yazd and Hamadan by cluster sampling. The data were collected by a questionnaire including demographic information, Kogan's attitude towards old people scale, and Palmore Facts on Aging Quiz .Data were analyzed by SPSS using descriptive statistics, independent t-test, ANOVA, and Pearson correlation coefficient. Results: Mean score of knowledge about aging (range: 0-25) was 12.24 ± 2.43 in Yazd and 12.17 ± 2.51 in Hamadan. Mean score of attitude towards aging (range: 34-204) was 121.49 ± 10.53 in Yazd and 119.40 ± 11.21 in Hamadan. There was no statistically significant difference in knowledge (p = 0.828) and its three dimensions (misconceptions about aging, psychosocial status and physical condition), and attitude (p = 0.152) and its three levels (negative, neutral and positive attitude) between health care providers in Yazd and Hamadan. There was a significant, positive correlation between knowledge and attitude in both Yazd (p < 0.01, r = 0.656) and Hamadan (p < 0.01, r = 0.718). Conclusion: The knowledge of health care providers in both cities was moderate and had positive attitude towards aging. Considering the moderate knowledge of health care providers about the aging, effective steps can be taken to promote knowledge and improve the attitudes of health care providers by providing educational curricula on physical, psychological, social and spiritual health of the elderly people and holding in-service training programs.

Background: The population attributable risk (PAR) percent has used widely in public health policy. We aimed to calculate the attribute risk of hypertension due to hyperuricemia by Levin's formulas compare to direct PAR calculation method. Methods: This was a sub-study of Yazd Healthy Heart Cohort (YHHC). Overall, 1256 normotensive individuals were enrolled through multistage randomized cluster sampling and followed up for mean 9.8 years, from 2005-2015. The threshold cutoff point of the hyperuricemia was considered equal and more than 75th percentile that equal to 5.5 mg/dl for men and 4.3mg/dl for women. To calculate the attributable risk of hyperuricemia in developing hypertension, two methods were applied. Levin's formulas and direct PAR estimation by population risk calculation via exposure prevalence weighted formula. Multiple logistic regression was used for estimate of odds ratio (OR) of hyperuricemia in developing hypertension. We calculated Relative Risk (RR) from OR. The data were analyzed using SPSS software version 16. A significant level of 0.05 was considered. Results: Hypertension developed in 44.7% of individuals with uric acid level ≥ 75th percentile vs. 35.6% of other individuals (P=0.024). Attributable risk (AR) of hyperuricemia in hypertension incidence was 9.1%. PAR of hyperuricemia for hypertension incidence by using two methods mentioned before was 6%, 5.8% respectively. Conclusion: The results of the study confirmed the noticeable contribution of hyperuricemia as an independent other risk factor for the occurrence of hypertension. PAR of hyperuricemia for hypertension incidence by using two methods almost near was 6%, 5.8% respectively.

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The aim of this study was investigated the effects of fennel supplementation with energy-restricted diets on body fat and muscle percentage and insulin resistance in women with PCOS. Sixty-four overweight/obese women with PCOS were randomly allocated to 4 groups for 12 weeks as follows: (1) standard diet + fennel (SDF), (2) high-protein, low-carbohydrate diet supplemented with fennel (HPF), (3) standard diet + placebo (SDP), and (4) high-protein, low-carbohydrate diet + placebo (HPP). After 12 weeks of intervention, there were significant changes in the percentage of body fat and muscle in all groups. Decreasing in fasting insulin was −4.12 micIU/ml (P = 0.01) for HPF and −4.5 micIU/ml (P = 0.03) for SDP groups. In addition, HOMA-IR significantly decreased in HPF (P = 0.02) and SDP (P = 0.02) groups. Energy-restricted diets independent of dietary composition improved the body fat and muscle percentage and insulin resistance indices in women with PCOS. High-protein diet and fennel compared with standard diet and placebo had no significant effect on insulin resistance, body fat and muscle.

Background: Cardiovascular diseases (CVDs) are the leading cause of premature death in the 21st century. Dietary factors, such as high salt intake, are related to increased risk of CVDs{Akpolat, 2009 #21}. One of the main sources of dietary salt is bread. On the other hand, salt content is a quality indicator of bread. Therefore, this study was conducted to evaluate the salt content in a variety of consumed breads in Yazd city, Iran. Methods: This study was a cross sectional research conducted in Yazd. The list of the bakeries obtained from their industry office. Ten percent of about 600 bakeries in Yazd (62 bakeries; 2 samples in each bakery) were selected using simple random sampling based on sample frame of ID number of each bakery. Finally, 9 types of bread included in this study. Sodium content was measured using flame photometer method. Salt content in breads was reported in each 100 g bread. Results: It was found that Nan-Taftoon Tanuri is the most popular bread among traditional breads in Yazd (45.2%). It had significantly more salt than Nan-Fantezi and Nan-Sangak (P < 0.02). Also, Nan-Sangak had the least salt among traditional breads. However, the mean salt of traditional breads was more than the standard level (1g salt/100g bread (P < 0.0001). Conclusion: The current study showed that the mean salt content of traditional breads was significantly more than the standard level. Furthermore, Nan-TaftoonTanuri had significantly more salt than others, such as Nan-Fantezi and Nan-Sangak

Introduction: Taking into consideration the high impact of Diabetes Mellitus type II (DM II) on human's health, identification of risk factors to prevent its development seems essential. Further studies are needed to ensure the positive role of uric acid in the onset of diabetes. This study targeted at investigating the attributed risk of hyperuricemia for the onset of DM II. Methods: In the present study, 1641 non-diabetic people, selected through multi-stage random cluster sampling, were followed up for 10 years (2006 - 2016). During the study, data on the variables of the study were collected and entered in SPSS 16 which was used to analyze the data. To calculate the attributions of hyperuricemia in the risk of developing diabetes, Levin's formulas and attributable risk related to the prevalence of exposure during these ten years were used. Results: Findings showed that 54.8% of people with hyperuricemia suffered from DM II., whereas 28.2% of people with normal uric acid level developed diabetes. The Attributable Risk (AR) of hyperuricemia and 75th percentile of serum uric acid for DM II were calculated by the weighted attributable risk formula which was 3.6 % and 24.2 %, respectively. With the treatment of high uric acid, the probability of the incidence of diabetes in hyperuricemia patients was reduced to 24.2% over a 10-year period. Conclusion: In this study, there was a significant correlation between high uric acid level and the risk of diabetes. Therefore, necessary measurements should be taken to treat the hyperuricemia patients in order to prevent the incidence of diabetes caused by high blood acid uric.

Introduction: Rapid changes in lifestyle, especially in nutritional aspects of the elderly, have led to many chronic diseases. Therefore, attention to nutritional needs of the elderly is an essential issue. The purpose of this study was to determine the predictors of healthy nutrition behaviors based on health belief model (HBM) in the elderlies of Kalat city, Razavi Khorasan Province, Iran.. Methods: The cross-sectional study was carried out on 200 elderlies aged 60 years and older who were covered by comprehensive health services centers in the city of Kalat. The participants were selected by multistage random sampling. The data collection tools included a researcher-made questionnaire for measuring HBM constructs regarding healthy nutrition and also a Food Frequency Questionnaire for measuring Healthy nutrition behaviors. Data were analyzed by SPSS software using descriptive statistics, t-test, one-way ANOVA, Pearson correlation coefficient and linear regression. Results: The mean score of nutritional knowledge of the elderlies was 7.75 ± 2.14 (possible score 0-15) and the mean score of healthy nutrition behaviors was 1.62 ± 1. 23 (possible score 0-5). Healthy nutrition behaviors were significantly correlated with perceived benefits (r = 0.254), self-efficacy (r = 0.244) and cues to action (r = 0.334) (p < 0.05). Linear regression showed that cues to action (β = 0.353), perceived benefits (β = 0.199) and self-efficacy (β = 0.181) were significant predictors of healthy nutrition behaviors. Conclusion: The level of healthy nutrition behaviors in the elderlies is not desirable, and cues to action, perceived benefits and self-efficacy are the most important predictors of these behaviors. Paying attention to these factors helps educators and other health professionals in designing appropriate intervention programs.

Broad-range bacterial rDNA polymerase chain reaction (PCR) followed by sequencing may be identified as the etiology of infective endocarditis (IE) from surgically removed valve tissue; therefore, we reviewed the value of molecular testing in identifying organisms' DNA in the studies conducted until 2016. We searched Google Scholar, Scopus, ScienceDirect, Cochrane, PubMed, and Medline electronic databases without any time limitations up to December 2016 for English studies reporting microorganisms involved in infective endocarditis microbiology using PCR and real-time PCR. Most studies were prospective. Eleven out of 12 studies used valve tissue samples and blood cultures while only 1 study used whole blood. Also, 10 studies used the molecular method of PCR while 2 studies used real-time PCR. Most studies used 16S rDNA gene as the target gene. The bacteria were identified as the most common microorganisms involved in infective endocarditis. Streptococcus spp. and Staphylococcus spp. were, by far, the most predominant bacteria detected. In all studies, PCR and real-time PCR identified more pathogens than blood and tissue cultures; moreover, the sensitivity and specificity of PCR and real-time PCR were more than cultures in most of the studies. The highest sensitivity and specificity were 96% and 100%, respectively. The gram positive bacteria were the most frequent cause of infective endocarditis. The molecular methods enjoy a greater sensitivity compared to the conventional blood culture methods; yet, they are applicable only to the valve tissue of the patients undergoing cardiac valve surgery.

BACKGROUND: Coronary artery disease (CAD) is a major problem in Iran as well as throughout the globe, and coronary artery bypass grafting (CABG) surgery is an appropriate option for many patients with symptomatic and severe CAD. The main purpose of this study was assessment of the short and long-term outcomes of patients undergoing CABG in Yazd Province, Iran.METHODS: This historical cohort study examined the mortality rates of patients who had undergone CABG in Afshar Hospital in Yazd from 2011 to 2013. During this period, 2510 patients undergoing CABG were entered into the study and then followed for in-hospital and long-term mortality.RESULTS: Mean age of the patients was 61.37 ± 10.50 years and 34.1% were women. In-hospital mortality turned out to be 3.7% and age over 70, left ventricular (LV) dysfunction, female gender, and left main (LM) involvement induced significant higher in-hospital mortality. Of all the patients, 84.1% were followed for a period of 41 ± 20 months. The survival rate proved to be 92.4% in one year and 82.9% in five years. The patients with age over 70, diabetes mellitus (DM), and LV systolic dysfunction (LVSD) showed significant lower survival rate, whereas the patients with utilization of left internal mammary artery (LIMA) demonstrated significant higher survival rate.CONCLUSION: In-hospital and long-term mortality rate of patients undergoing CABG surgery is acceptable in comparison with other studies and more effort is needed into making this event a success.

Introduction: Obesity as one of the most important public health problems is growing worldwide and it is associated with many non-communicable diseases. The aim of this study was investigating the prevalence of general obesity and central obesity and their related factors. Methods: The data of this research were extracted from a population health survey of Yazd province, Iran (YaHS), which was conducted on 9911 adults aged 20-70 years in 2014-2015. Body Mass Index (BMI) < 18.5 was considered underweight, in the range of 18.5 -24.9 healthy, from 25 to 29.9 overweight, and ≥30 was interpreted as obese. Central obesity was defined as the waist circumference (WC) of ≥ 102 cm for men and ≥ 88 cm for women as well as waist to hip ratio (WHO) ≥ 0.90 for men and ≥0.85 for women. Chi-square and one-way ANOVA tests were used for univariate analysis. Results: The prevalence of underweight, overweight, and obesity in both genders were 3.7 % (4.0% in men and 3.4% in women), 37.7% (39.9% in men and 35.6% in women), and 27 % (19.3% in men and 34.7% in women), respectively. The prevalence of abdominal obesity based on WC and WHR were 44.8 (23.9% in males and 65.4% in females) and 69.8% (69.4% in males and 70.2% in females), respectively. Gender (female), old age, being married for both genders, and low education in women were associated with an increase in both types of obesity. Conclusion: Overweight and obesity have affected more than half of the population (64%) and abdominal obesity has high prevalence in Yazd

Introduction: Considering the effects of skin diseases on health, activities, and quality of life of older adults, the study was conducted with the aim of determining knowledge, attitude, and practice status in older adults of Sarakhs city about skin care and prevalence of some skin problems among them. Methods: Totally 400 older adults aged 60 years and above (60-99 years) in a cross-sectional study were selected through cluster random sampling from urban and rural older adults in Sarakhs city, Razavi Khorasan Province, Iran. Data was collected through skin examination and a researcher-made questionnaire, which included four parts of demographic questions, attitude to, knowledge, and practice of skin care. Descriptive statistics, t-tests, analysis of variance, and Pearson correlation coefficient were used to analyze the data. Results: The most commonly detected skin problem was dryness (30.25%) followed by pruritus (5.9%) and flaking of the skin (8.25%). Average knowledge score was 18.15 ± 7.59 (possible score range of 0-56), average attitude score was 27.13 ± 3.17 (possible score range of 12 to 36), and average practice score was 33.9± 8.30 (possible score range of 13-67). There was a positive significant correlation between scores of knowledge and attitude (r = 0.283, p < 0.001), knowledge and practice (r = 0.222, p < 0.001), as well as attitude and practice (r = 0.298, p < 0.001). Conclusion: The commonest skin problems among older adults was skin dryness, pruritis and flaking. Knowledge and practice of skin care is at low level. An accurate and comprehensive training plan seems necessary to promote the level of these people’s knowledge and practices.

Dear Editor, According to the International Agency for Research on Cancer (IARC), Asia has the highest death rates and incidence of breast cancer; 27% of all cancers that occur among women in Iran are attributed to breast cancer. The role of obesity in breast cancer development has been known for decades. S strong evidence exists on the idea that obesity and weight gain during adulthood are associated with increased risk of postmenopausal breast cancer. Furthermore, growing evidence is available on the association of obesity with breast cancer and overall mortality rate in women’s premenopausal and postmenopausal periods (1). Evaluation of the breast cancer risk helps identification of the women with the high risk of developing breast cancer in the future. Some strategies to reduce this risk involve adopting a healthier lifestyle as well as involving diet and exercise in everyday life (2). Obesity and overweight are defined by Body Mass Index (BMI). The effect of high BMI on breast cancer was assessed in selected studies using the odds ratio (OR). The results of the data analysis using the random effects method showed that the risk of breast cancer was higher among the people with obesity (BMI ≥ 30): Pooled OR = 1.81, 95% CI = 1.24 - 2.64 and for overweight (30 > BMI ≥ 25): Pooled OR = 1.46, 95% CI = 1.13 - 1.89(3). According to the care plan for risk factors in non-communicable diseases (Steps 2016), the prevalence rates of obesity and overweight were 29.77% and 34.96% among Iranian women, respectively. Furthermore, population-attributable fractions of these diseases were 13.32% and 11.01%, respectively, which indicates that by eliminating obesity and overweight factors, we can expect 24.33% reduction in the population’s breast cancer. For instance, a well-designed randomized controlled trial in children with a particular disease found that 20% of the control group developed bad outcomes compared with only 12% of the individuals who received treatment. Absolute risk reduction (ARR) – also called risk difference (RD) – is the most useful way of presenting research results to help your decision-making. In this example, the ARR is 8% (20% - 12% = 8%), which means that, if 100 children were treated, 8 would be prevented from developing bad outcomes. Another way of expressing this is the number needed to treat (NNT); that is the number of people who must be treated to benefit one person. It is the inverse of absolute risk reduction. If 8 children out of 100 benefit from a treatment, the NNT for one child to benefit is about 13 (100 ÷ 8 = 12.5)(4). A randomized, controlled, primary prevention trial was conducted in 40 US clinical centers from 1993 to 2005. In this study, a total of 48,835 postmenopausal women, aged 50 to 79 years, without prior breast cancer were enrolled. Women were randomly assigned into the dietary modification intervention group (40% [n = 19,541]) and the control group (60% [n = 29,294]) (5). The baseline characteristics of BMI and breast cancer incidence indicated that overweight ARR rate equals 0.0025 that is 0.25% (NNT: 400), obesity ARR equals 0.0012 i.e., 0.12% (NNT: 833.33) and obesity grade 2 and more equals 0.0033 that is 0.33% (NNT: 303.03). In other words, by treating 400 patients suffering from overweight and 833.33 patients suffering from obesity, we can prevent one case of breast cancer. Overweight, obesity, and abdominal fat are associated with the risk of developing breast cancer in women during the premenopausal and postmenopausal periods. Therefore, in order to prevent breast cancer and its complications, an intervention program should be implemented to control obesity and a breast cancer screening program should be conducted among the obese and overweight women (6). Governments are responsible for maintaining, restoring, and promoting health in the community. In order to make the right decisions and direct resources of the health sector, the most common cancer in women should be investigated as a priority for the health system. Therefore, a special study of breast cancer is necessary considering the mortality rate and disability. In this regard, we decided to investigate the most relevant risk factor and evaluate the risk associated with breast cancer by reviewing articles related to breast cancer. Later, we examined the most effective interventional strategies in this area. Consequently, given high prevalence of the overweight and obesity, intervention plans should be implemented to reduce the risk factors of the breast cancer.

Background: Metabolic syndrome (MetS) is one of the world's largest health epidemics, and its management is a major challenge worldwide. The aim of this 10-year follow-up study was to assess the most important predictors of MetS persistence among an Iranian adult population. Methods: In this cohort study, 887 out of 2000 participants with MetS aged 20–74 years in the central part of Iran were followed-up for about 10 years from 2005–2006 to 2015–2016. MetS was defined based on the criteria of NCEP-ATP III adopted for the Iranian population. Cox proportional hazards regression was conducted to evaluate the predictors of MetS persistence in crude- and multivariate-adjusted models. Results: Our analyses showed that 648 out of 887 participants (73%) completed the follow-up and 565 (87.2%) of them had persistence of MetS after 10-year follow-up. There was a significant association between age, weight, body mass index, triglyceride, and waist circumference in participants who had MetS compared to those without MetS after 10-year follow-up (P < 0.05). There was a direct association between increases in the mean changes of systolic/diastolic blood pressure, waist circumference, and low HDL-C and risk of MetS persistence after adjusting the model for sex and age in the total population (Ptrend< 0.05). The trends were the same for women except in diastolic blood pressure. After adjustment for potential confounders, the risk of MetS persistence in men was significantly higher than women (HR = 1.98, 95% CI: 1.38–2.85, Ptrend= 0.001). Conclusions: Most of the risk factors of MetS were positively associated with persistence of MetS. Therefore, modification of lifestyle is recommended to reduce MetS.

Background: The study on natural substances especially, dietary components such as liquid oils affecting cholesterol can be important for therapeutic propose. Sesame seeds with various biomedical actions can be control the hypercholesterolemia. On the other hand, olive oil has a wide range of therapeutic effect on lipid profile in human. The aim of this study is to evaluate and compare lipid profile changes after olive and sesame oils consumption in hypercholesterolemia. Methods: This study was a clinical randomized trial that was performed via parallel design on 48 patients. The patients were randomly allocated in to two groups: A: olive oil and B: sesame oil. After 1 month prescription of Step I National Cholesterol Education Program diet, patients consumed 4 table spoons aprox. 60 g) of refined olive or sesame oil daily as an exchange of other oils, for 1 month. Lipid profiles The P < 0.05 was considered as significant difference. Results: Out of 48 patients, 24 (50%) were men. The mean age was 41.7 ± 8.3 years. The mean of total cholesterol, triglyceride (TG), low density lipoprotein (LDL), cholesterol, and high density lipoprotein (HDL) cholesterol, before oil consumption was 224.5 ± 22, 256 ± 132, 132.6 ± 9, and 44.5 ± 11 mg/dl. After olive oil consumption cholesterol, TG, LDL-C, weight, waist and BMI were decreased and HDL-C was increased. After sesame oil consumption cholesterol, TG, LDL-C were significantly decreased. Weight, waist were decreased and HDL-C was increased (P > 0.05). Conclusions: Sesame oil had equivalent effect on lipid profile in comparison olive oil and lipid profile improvement was better in sesame oil in LDL-C and TG.

Background: Atherosclerosis of the peripheral arteries occurs in 12% of individuals at 65 years of age or older. At least 28% of these patients suffer from coronary heart diseases and 10% of them are afflicted with cerebrovascular diseases. To calculate the agreement between two diagnostic tests for peripheral arterial disease (PAD), namely ankle brachial index (ABI) and ultrasound duplex scanning (USD). Methods: Forty symptomatic PAD patients were enrolled in this study, and their demographic characteristics, risk factors, and symptoms as well as their ABI and USD measurements were recorded. On the basis of the symptoms and ABI and USD findings, the patients were divided into four groups and comparisons were made between them so that the associations between the findings could be analyzed. Results: The study population included 32 (80%) men at a mean age of 62.9+12.8 years (26-90). Smoking (75%) and hypertension (100%) were the most common risk factors in the men and women, respectively, followed by diabetes in both genders. Whereas the agreement between ABI and USD findings in the men was significant (Kappa=0.28, P=0.02), it was not significant (Kappa=-0.91, P=0.68) in the women. Additionally, there was a significant correlation between symptoms and ABI findings (Kappa=0.21, P=0.04), while that between symptoms and USD measurements was not significant (Kappa=0.09, P=0.3) Conclusion: The correlation between ABI findings and symptoms, especially in the men, was better than that between ABI findings and USD measurements. ABI could, therefore, be considered an appropriate tool for the initial screening of arterial stenosis and lower extremity circulation.

Background: Atherosclerosis of the peripheral arteries occurs in 12% of individuals at 65 years of age or older. At least 28% of these patients suffer from coronary heart diseases and 10% of them are afflicted with cerebrovascular diseases. To calculate the agreement between two diagnostic tests for peripheral arterial disease (PAD), namely ankle brachial index (ABI) and ultrasound duplex scanning (USD). Methods: Forty symptomatic PAD patients were enrolled in this study, and their demographic characteristics, risk factors, and symptoms as well as their ABI and USD measurements were recorded. On the basis of the symptoms and ABI and USD findings, the patients were divided into four groups and comparisons were made between them so that the associations between the findings could be analyzed. Results: The study population included 32 (80%) men at a mean age of 62.9+12.8 years (26-90). Smoking (75%) and hypertension (100%) were the most common risk factors in the men and women, respectively, followed by diabetes in both genders. Whereas the agreement between ABI and USD findings in the men was significant (Kappa=0.28, P=0.02), it was not significant (Kappa=-0.91, P=0.68) in the women. Additionally, there was a significant correlation between symptoms and ABI findings (Kappa=0.21, P=0.04), while that between symptoms and USD measurements was not significant (Kappa=0.09, P=0.3) Conclusion: The correlation between ABI findings and symptoms, especially in the men, was better than that between ABI findings and USD measurements. ABI could, therefore, be considered an appropriate tool for the initial screening of arterial stenosis and lower extremity circulation.

Background: Congenital heart disease (CHD) is a major health problem and its prevalence is different around the world. The aim of study was determination of the epidemiological aspects of CHD in central and southern district of Iran. Materials and Methods: In this descriptive and analytical study, 3714 medical records were evaluated from March 21, 2001 to December 18, 2011. Medical records of inpatients from angiography and outpatients in the Heart Clinic of Afshar hospital (a referral hospital in center and south of Iran) were the source of information. Types of CHD and demographic data including age, sex and residential location are collected. The data were analyzed by SPSS (version 17) software. Chi-square and Fisher′s exact tests were used to compare variables between groups. Results: At the study, the mean age of the patients at diagnosis time was 8.8 ± 11.6 year (at the range of one day to 76 years with median of 4 years). The percentage of females and males was 54.2 (n: 2014) and 43.8 (n: 1627), respectively. The chi-square test showed that there was significant difference in frequency of CHDs between females and males (P value < 0.0001). Ventricular septal defect (VSD) was found to be the most frequent of CHDs (27%). Patent ductus arteriosus (PDA) (16.8%), atrial septal defect (ASD) (15.8%), pulmonary stenosis (PS) (11%) and Tetralogy of Fallot (TOF) (8.9%) were more prevalent in CHDs after VSD. Conclusions: The frequency of CHDs in female was more than male and VSD, PDA, ASD, PS, and TOF were most common in CHDs, respectively.