Ankle-brachial index as a prognostic factor and screening tool in coronary artery disease: does it work?

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. 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. 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]. 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

Medical student's benefit rates from the clinical teaching rounds and its associated factors in Tehran university of medical sciences in the year 2010

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 [alpha = 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 [P<0.05]. Average of the benefit rate among residents were significantly higher than the other medical trainees [P<0.05]. 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

Comparison of two methods of teaching hypertension in under graduate medical students: [planned lecture] versus [cooperative learning]

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. In this study, 2 methods of teaching-planned lecture and cooperation were compared in instructing hypertension to medical students. 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 ad-; vantages 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. 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]. 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

Pattern of coronary artery disease risk factors in population younger than 55 years and above 55 years: a population study of 31999 healthy individuals

More than eighty percent of patients with coronary heart diseases [CHD] have conventional risk factors. Prevalence of well known risk factors seems to show a different pattern in younger patients and individual above 55 years. To evaluate the pattern of conventional CHD risk factors in healthy individuals in two different age groups. A large scale population based survey of 31999 individuals from ten medical centers was designed. Screening of risk factors was performed upon these protocols: taking medical history, physical examination and blood tests of complete blood cell counts, fasting blood sugar, lipid profile, urinalysis and creatinine. Prevalence of the risk factors in healthy people aged above 55 years were: 8.1% for systolic blood pressure [SBP]>140 mmHg, 3.8% for diastolic blood pressure [DBP]>90mmHg, 13.9% for fasting blood glucose [FBS] >/= 126 Mg/dl, 36.9% for total cholesterol>200 Mg/dl, 19.2% for triglyceride [TG]>200 Mg/dl, 67.8% for HDL-c<40 Mg/dl, 27.2% for LDL-c>130 Mg/dl, 4.72 for TC/HDL-c ratio, 2.88 for LDL-c/HDL/c ratio and 4.24 for TG/HDL-c ratio. Prevalence of risk factors in individuals younger than 55 years were: 1.7% for SBP>140 mmHg, 1.2% for DBP>90 mmHg, 5.2% for FBS >/= 126 Mg/dl, 31.3% for TC>200 Mg/dl, 21.5% for TG>200 Mg/dl, 69.4% for HDL-c<40 Mg/dl, 23.2% for LDL-c>130 Mg/dl, 4.7 for TC/HDL-c ratio, 2.83 for LDL-c/HDL-c ratio and 4.43 for TG/HDL-c ratio. In univariate model of analysis: prevalence of the risk factors were significantly higher in age above 55 years than in people younger than 55 years except for hypertriglyceridemia and HDL-c<40 Mg/dl. In a multivariate model of logistic regression, pattern of following CHD risk factors remained to demonstrate a statistically significance difference between two age groups: FBS >/= 126 Mg/dl P=0.006, TG>200 Mg/dl P=0.002, HDL-c<40 Mg/dl P=0.019, education status P=0.001, sex P=0.012, and SBP>140 mmHg P=0.001. Pattern of such a CHD risk factors of FBS >/= 126 Mg/dl, TG>200 Mg/dl, HDL-c<40 Mg/dl, education status, sex and SBP>140 mmHg demonstrated a statistically significant difference in the age above 55 years to the healthy people younger than 55 years. These results cab be implicated to set up prediction models for stratifying individuals at higher risk of CHD

Relationship between the pattern of coronary artery disease risk factors and lipid ratios with five groups of body mass index in 28566 healthy adults

Pattern of the coronary artery disease [CAD] risk factors across body mass index [BMI] categories remains uncertain. There is a different threshold of obesity for increasing cardiovascular hazard across populations, accordingly recognition and management of obesity and overweight can guide better control of CAD epidemic in the national level. To determine the discrepancy in the prevalence of CAD risk factors across five BMI categories. A population based survey of 28566 participants recruited to medical screening of taxi drivres in Tehran [MSTDT] was designed. According to a standardized protocol data on CAD risk factors were obtained by taking medical history, examination and laboratory tests. After adjustment for age, sex, literacy, smoking, systolic blood pressure [SBP], fasting blood sugar [FBS], and LDL-C/HDL-C ratio, these CAD risk factors of diastolic blood pressure [DBP]>90 mmHg, hypertriglyceridemia, high triglyceride/HDL-C ratio, hypercholesterolemia, and high cholesterol/HDL-C ratio were increased significantly across five incremental categories of BMI. Prevalence of DBP>90 mmHg, hypertriglyceridemia, hyper cholesterolemia and ratios of cholesterol/HDL-C and TG/HDL-C increased considerably across five groups of BMI. This pattern is different from previous research and our results endorsed more features of pattern of CAD risk factors across BMI categories

[ clinical outcome of patients with acute coronary syndrome without critical stenosis in angiography: a prospective cohort study]

Previous studies were suggestive of a good prognosis in patients with acute coronary syndrome [ACS] and absence of any critical stenosis in coronary angiography but recent limited reports have revealed that patients with non-obstructive acute coronary syndrome are at a higher risk of future clinical coronary events. A concurrent prospective cohort study was designed and 146 male patients with ACS and non-obstructive coronary artery disease were regarded as the unexposed group, while 191 female patients with non-obstructive coronary artery disease were regarded as the exposed group. Coronary events were recorded within one year of follow-up. Prognostic factors were evaluated at baseline by using a standardized protocol. Of the 337 patients with ACS, 191 [56.6%] were female. Coronary events in female patients after one year of follow-up were: ST EMI 3 [1.6%], unstable angina pectoris 22 [11.5%], Q-wave MI 1 [0.5%] and no syncope. In male patients the outcomes were: ST EMI 4 [2.7%], unstable angina pectoris 29 [19.9%], Q-wave MI 1 [0.7%], and syncope 1 [0.7%]. Multivariate adjusted relationships revealed that physical inactivity [P=0.035], dyslipidemia [P=0.001], low ankle brachial index [P=0.024] and age between 40-50 years [P=0.004] were significantly associated with coronary events in women. In male patients, body mass index of 30-39.99 [P=0.011] was associated with a higher rate of ST-segment elevated MI. Prognostically, coronary events and clinical endpoints were significantly different between men and women with acute coronary syndrome. Persistence of symptoms over one year seems to relate to the development and progression of coronary atherosclerosis