Can CRP/melatonin ratio measurement be used as a predictor of multiple sclerosis?

@#Background & Objective: This study aimed to find a biomarker to predict the development of multiple sclerosis (MS). Serum levels of vitamin D3, C-reactive protein (CRP) and melatonin and their ratio were evaluated to find the valuable cut-off point. Methods: Serum levels of vitamin D3, CRP and melatonin were evaluated using commercial ELISA kit in newly diagnosed MS patients and compared with healthy controls. Results: Serum CRP level significantly increased and serum melatonin level significantly decreased in MS patients in comparison to controls. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy for the cut-off point of CRP/melatonin ratio ≥ 78.29087 were 80%. Conclusion: CRP/melatonin ratio ≥ 78.29087 may be used for prediction of MS in an at risk population

Surgical procedures of morbid obesity

Surgical intervention has been recently advocated in the treatment of morbid obesity. The objective of this study was to review surgery as an alternative in the treatment of morbidly obese adolescents. This research was conducted by searching English websites such as PubMed, Up to Date, and Google Scholar, as well as some Persian websites including SID, Iranmedex, and Magiran. Articles published from 2000 to 2010 on interventional and clinical trials were reviewed for treatment of morbid obesity in adolescents. Keywords used in internet searches include obesity; adolescence; and surgery. The results obtained from the studies indicated that 4% of American adolescents suffer from morbid obesity. So far, pharmacological treatment and other approaches toward this type of obesity have been inefficient. Hence, surgery was employed as one of the new approaches to the treatment of this disorder. According to the National Health Institute criteria, in the treatment of adolescent candidates for surgery, anthropometric measurements are performed together with the measurement of other co-morbidities of obesity. Adolescents whose percentiles are >/=99 are considered as morbidly obese patients. The results of the studies suggested that for the extremely obese adolescents, who do not respond to other types of medical interventions within 6 months, surgery can be performed. Adolescents with BMI of >/=40 kg/m[2] and skeletal maturity, or those with co morbidities of obesity, or 13-year-old girls and boys >/=15 years of age can be candidates for surgery. However, the side effects of obesity should not be neglected. Therefore, before the adolescent obesity become morbid obesity, preventive measures should be taken through changes in lifestyle

Angiotensin- converting enzyme insertion/deletion polymorphism and its association with coronary artery disease in an Iranian population

The study of the association between genotype and phenotype is of great importance for the prediction of many diseases and pathophysiological conditions. The relationship between angiotensin-converting enzyme [ACE] gene insertion/ deletion [I/D] polymorphism and pathological processes such as coronary artery disease [CAD] has been investigated previously with discordant results. This study was designed to determine the association between ACE gene I/D polymorphism and CAD in an Iranian population. A total of 1050 individuals who were referred to Tehran Heart Center for coronary angiography were recruited. Six hundred seventy-six CAD-positive patients [documented by coronary angiography and Gensini scores higher than 6] and 374 CAD-negative patients were evaluated for ACE gene I/D polymorphism via the Polymerase Chain Reaction Amplification method. The patients' age, sex, smoking status and its duration as well as familial history of CAD, hypertension, and diabetes mellitus were recorded. Five hundred four [74.6%] of the CAD-positive patients were male, and the mean age of this group was 60 [60 +/- 10]. In the CAD-negative individuals, the mean age was 56 [56 +/- 10] and 196 of them were male [52.4%]. After the analysis of all the groups and gender subgroups, neither genotype nor allele frequency was significantly different between the CAD-positive and CAD-negative groups [p values for genotypes and allele frequencies were 0.494 and 0.397, respectively]. ACE gene I/D polymorphism was not associated with an increased risk of CAD in an Iranian population

Impact of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers on mortality of coronary artery bypass grafting

There is controversy over the potential benefits/harms of the usage of angiotensin-converting enzyme inhibitors [ACEIs] or angiotensin receptor blockers [ARBs] as regards the postoperative mortality of coronary artery bypass grafting [CABG]. This study investigates the correlation between the in-hospital mortality of CABG and the preoperative administration of ACEI/ARB. Out of 10055 consecutive patients with isolated CABG from 2006 to 2009, 4664 [46.38%] patients received preoperative ACEI/ARB. Data were gathered from the Cardiac Surgery Registry of Tehran Heart Center. In-hospital mortality was defined as death within the same admission for surgery. Adjusted for confounders, multivariable logistic regression models were used to evaluate the impact of preoperative ACEI/ARB therapy on in-hospital death. The mean age of the patients was 60.04 +/- 9.51 years and 7364 [73.23%] were male. Eighty-seven [0.86%] patients expired within 30 days. Multivariate analysis revealed that the administration of ACEI/ARB significantly protected against in-hospital deaths in as much as there were 33 [0.70%] vs. 54 [1.0%] deaths in the ACEI/ARB positive and negative groups, respectively [OR: 0.628; p value = 0.09]. Patients without ACEI/ARB were more likely to have a higher global ejection fraction. Preoperative ACEI usage in patients undergoing CABG can be associated with decreased in-hospital mortality. Large-scale randomized clinical trials are suggested

new method for extubation: comparison between conventional and new methods

Extubation is associated with the risk of complications such as accumulated secretion above the endotracheal tube cuff, eventual atelectasia following a reduction in pulmonary volumes because of a lack of physiological positive end expiratory pressure, and intra-tracheal suction. In order to reduce these complications, and, based on basic physiological principles, a new practical extubation method is presented in this article. The study was designed as a six-month prospective cross-sectional clinical trial. Two hundred fifty-seven patients undergoing coronary artery bypass grafting [CABG] were divided into two groups based on their scheduled surgery time. The first group underwent the conventional extubation method, while the other group was extubated according to a new described method. Arterial blood gas [ABG] analysis results before and after extubation were compared between the two groups to find the effect of the extubation method on the ABG parameters and the oxygenation profile. In all time intervals, the partial pressure of oxygen in arterial blood / fraction of inspired oxygen [PaO[2] / FiO[2]] ratio in the new method group patients was improved compared to that in the conventional method; some differences, like PaO[2] / FiO[2] four hours after extubation, were statistically significant, however [p value = 0.0063]. The new extubation method improved some respiratory parameters and thus attenuated oxygenation complications and amplified oxygenation after extubation.

Discharge against medical advice among inpatients with heart disease in Iran

Discharge against medical advice [DAMA] is a relatively common problem worldwide. We sought to determine the prevalence of and reasons for DAMA among inpatients of our cardiac center. From a total of 20289 discharges from our cardiac teaching hospital, 992 [4.9%] patients at a minimum age of 18 years were cases of DAMA. After excluding 49 cases due to missing data, we retrospectively analyzed our prospectively collected data from 943 patients, who were DAMA cases. Patients' characteristics, including demographic details, reason for discharge, insurance status, and length of stay before discharge, were examined. The mean age of the study patients was 60.7 +/- 13.0 [range, 18-94 years] with a male-to-female ratio of 2.1/1. Lack of consent to surgery or other invasive procedures was the reason cited for DAMA in 31% of the patients, followed by personal or family issues [17%]. No reason for DAMA was reported in 26 [2.8%] of the patients. Women compared to men were more likely to cite "lack of consent to surgery or invasive procedures" as the reason for DAMA [p value = 0.005], whereas men more prevalently stated "personal or family issues" as the reason for DAMA [18.7% vs. 12.7%, p value = 0.022]. The most frequent self-reported reason for DAMA in our cardiac patients was lack of consent to surgery or invasive procedures. This may be because of fear of undergoing invasive procedures such as revascularization. Explaining the stages of a given invasive procedure to patients and comparing its risks versus benefits may lessen impulsive decision-making and DAMA

Assessment of left ventricular dyssynchrony in heart failure patients regarding underlying etiology and QRS duration

Left ventricular [LV] dyssynchrony is a prevalent feature in heart failure [HF] patients. The current study aimed to evaluate the prevalence of inter and intraventricular dyssynchrony in HF patients with regard to the QRS duration and etiology. The available data on the tissue Doppler imaging [TDI] of 230 patients with refractory HF were analyzed. The patients were divided into three groups according to the QRS duration: QRS duration < 120 ms; 120-150 ms; and >/= 150 ms and the patients were re-categorized into two subgroups depending on the underlying etiology: ischemic cardiomyopathy [ICM] or dilated cardiomyopathy [DCM]. The time-to-peak myocardial sustained systolic velocity [Ts] in six basal and six middle segments of the LV was measured manually using the velocity curves from TDI. LV dyssynchrony was defined as interventricular mechanical delay >/= 40 ms and tissue Doppler velocity all segments delay >/= 105 ms; standard deviation [SD] of all segments >/= 34.4 ms; basal segments delay >/= 78 ms; SD of basal segments >/= 34.5 ms; and opposing wall delay >/= 65 ms. After adjustment for the possible confounders, interventricular dyssynchrony was more prevalent in the patients with QRS duration >/= 150 ms than in those with QRS duration 120-150 ms and < 120 ms. The patients with DCM also had a higher percentage of interventricular dyssynchrony than those with ICM in the wide QRS groups. Turning to the intraventricular dyssynchrony indices, the patients with QRS duration >/= 150 ms and 120-150 ms revealed a significantly greater delay between Ts at the basal and all segments than did those with QRS duration < 120 ms, while etiology did not influence the frequency of these indices in each QRS group. The prevalence of both inter and intraventricular dyssynchrony indices was greater in the patients with wide QRS than in those with narrow QRS duration. The underlying etiology may affect the frequency of interventricular but not intraventricular dyssynchrony indices

Using workload to predict left main coronary artery stenosis in candidates for coronary angiography

Coronary angiography, albeit a safe procedure, may cause serious complications especially in patients with left main stenosis [LMS].This study was designed to investigate the efficacy of workload achieved by exercise tolerance test [ETT] in predicting LMS in candidates for coronary angiography. A total of 743 patients with a positive ETT who subsequently underwent cardiac catheterization were retrospectively studied. Different risk factors were compared among the patients with and without LMS. A multivariate forward stepwise logistic regression analysis was used to identify the main predictors of LMS. Among our 743 patients, 72% were male and 41 [5.5%] had LMS >/= 50%. Patients with LMS, by comparison with those without LMS, were older and were more likely to be male and had higher percentages of ejection fraction less than 35% [EF 7, LMS was found in 8.3% and 3.6%, respectively [P=0.006]. The risk of having LMS in the men with METs 7 [OR=3, P=0.003, 95% CI=1.50-6.00]. Among the patients with LMS, stenosis >/= 70% was found in 44% in METs 7. Lower METs correlated with an increased likelihood of significant LMS in the patients, especially if they were male, who had a positive exercise test and were suspected of coronary artery disease. It is, therefore, advisable that patients with METs

Comparison between transepicardial cell transplantations: Autologus undifferentiated versus differentiated marrow mesenchymal stem cells

Marrow-derived mesenchymal stem cells [MSCs] have been heralded as a source of great promise for the regeneration of the infarcted heart. There are no clear data as to whether or not in vitro differentiation of MSCs into major myocardial cells can increase the beneficial effects of MSCs. The aim of this study was to address this issue. To induce MSCs to transdifferentiate into cardiomyocytes and endothelial cells, 5-Azacytidine and vascular endothelial growth factor [VEGF] were used, respectively. Myocardial infarction in rabbits was generated by ligating the left anterior descending coronary artery. The animals were divided into three experimental groups: I] control group, II] undifferentiated mesenchymal stem cell transplantation group, and III] differentiated mesenchymal stem cell transplantation group. The three groups received peri-infarct injections of culture media, autologous undifferentiated MSCs, and autologous differentiated MSCs, respectively. Echocardiography and pathology were performed in order to search for improvement in the cardiac function and reduction in the infarct size. Improvements in the left ventricular function and reductions in the infarcted area were observed in both cell transplanted groups [Groups II and III] to the same degree. There is no need for prior differentiation induction of marrow-derived MSCs before transplantation, and peri-infarct implantation of MSCs can effectively reduce the size of the infarct and improve the cardiac function