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

Attitudes, concerns, perceived impact and coping strategies for avian influenza among the first year medical students and interns in Tehran university of medical sciences

To study and compare the attitudes, concerns, perceived impact and coping strategies for avian influenza [AI] among the first year medical students [FYMS] and interns in Tehran University of Medical Sciences. This was a cross sectional study carried out on FYMS [n=158] and interns [n=158] in 2008. The data collection tool was a questionnaire containing 37 questions in five parts. The three choices including "agree, disagree and unsure" were considered for all questions. We used Chi-square and Fisher's exact tests for analysis. Most of FYMS and interns [78.2%] believed their health would be depended on the care of their selves. Most of them [95.3%] believed that if they knew avian flu better, they could be more prepared for it. The majority were concerned about risk to their health from their work [62.7%]. Most [67.7%] accepted the risk and only 5 [1.6%] would consider stopping work. For non-work concerns, 70.9% were concerned about their spouses/sexual partners and 65.8% about their children. For perceived impact, most [66.5%] believed that they would feel stressed at work and the majority [74.4%] expected an increased workload. FYMS and interns have positive attitudes but major concerns about contracting AI and its relation to medical practice.

Health-related quality of life in Iranian women with different levels of physical activity

One of the most significant current discussions is the effect of different levels of physical activity on health-related quality of life [HRQOL], but there have been no studies in Iran which investigate this issue. The aim of this study was to investigate the relationship between the level of physical activity and HRQOL in Iranian women. This was an analytical cross-sectional study conducted from October 2010 to January 2011 in Karaj's gymnasiums. We selected gymnasiums using simple randomized sampling. The validated Persian short form 36-item HRQOL questionnaire version 2.0 [SF-36 v2] and the short form of the International Physical Activity Questionnaire were used for data collection. Based on IPAQ, participants were classified into two groups: one with a high level of physical activity [N=240] and another with a moderate level [N = 120]. The group with a high level of physical activity had significantly higher vitality scores [P=0.01] and lower role limitation-physical scores [P= 0.02] than the group with a moderate level. The high level of physical activity was associated with considerably higher scores in general health [73.94 +/- 0.99 vs.70.82 +/- 1.33] [P=0.06] and mental well-being [73.94 +/- 1.18 vs.70.88 +/- 1.82] [P =0.1] domains than moderate level. It seems that the high level of physical activity, compared with the moderate level, tends to have positive association with more domains of SF- 36 v2

Relationship between maternal nutrition status and infants birth weight

The present study was performed to determine relationship between maternal nutrition status and infants' birth weight. Maternal nutrition status was assessed by pre-pregnancy body mass index [BMI], weight gain, intake of iron and folic acid supplements during pregnancy. This case-control study was included 46 cases [women who had delivered low birth weight infants] and 92 controls [women who had delivered infants with more than 2500 gr]. They were selected from population who received prenatal cares from health care centers in south of Tehran. Data were collected from present documents in the centers and completed by telephone interviewing. Then data were analyzed in spss!3 by t-test or chi[2]. Crude odd ratios and 95% confidence intervals were calculated. There was no difference between maternal jobs, age, parity, birth interval, and delivery type in case and control groups. Weight gain [P<0.001] and intake of iron supplement [P<0.05] were less in cases as compared with control group. Weight gain during pregnancy was found to reduce risk factors for delivery LBW infants [OR-3.77,%95 CI: 1.7-8.1]. Suitable weigh gain and intake of iron supplement decrease the risk of low birth weight infants

[ comparison between lateral spinal anesthesia and sitting positions in lower limb vascular surgery]

Patients who require surgery on the lower extremities are considered to be a high risk group from the point of anesthesia. This study was performed to compare sitting and lateral positions in spinal anesthesia method with hyperbaric bupivacaine 0.5% for hemodynamic status and analgesic period in patients under vascular surgery of the lower limbs in Imam-Khomeini Hospital Complex affiliated to Tehran University of Medical Sciences in 2009. In this study 40 patients were divided into two groups of 20 to undergo spinal anesthesia with 3 ml of hyperbaric bupivacaine 0.5% injected into the subarachnoid space in sitting or lateral positions. The anesthesia was performed at T10 level and the hemodynamic status and analgesic periods were compared in the two groups. The changes in mean arterial blood pressure and systolic and diastolic blood pressures were different between the two groups [P<0.05]. Except in the first and thirtieth minutes, the changes in heart rate [HR] were significantly different throughout the study between the two groups [P<0.04] and they were higher in sitting position. The duration of analgesia was significantly longer in lateral position [P<0.04] and the use of fluid was significantly larger in the sitting group [P<0.05]. According to the obtained results, the changes in hemodynamic variables were significantly lower in the group in lateral versus sitting position in patients undergoing spinal anesthesia with bupivacaine for vascular surgery of the lower limb

echocardiographic study of heart in a group of male adult elite athletes

Severe and prolonged physical training is associated with morphological and physiological cardiac changes, often termed as the "athlete's heart". Echocardiographic features peculiar to elite Iranian athletes have not been previously described. The aim was to examine the echocardiographic characteristics of highly trained Iranian athletes involved in three different sports. We studied cardiac morphology and function as assessed by rest echocardiography in 50 elite adult male athletes referring to a university hospital in Tehran between February 2001 and March 2006. Resting ejection fraction, interventricular septal wall thickness [IVSWT], left ventricular posterior wall thickness [LVPWT], left ventricular internal end diastolic dimension [LVEdD], left ventricular internal systolic dimension [LVIsD], left ventricular [LV] mass, and relative wall thickness [RWT] were measured. The control group consisted of 50 age- and weight-matched normal healthy men. Of the athletes, 38 were engaged in predominantly dynamic [running and soccer] and 12 in predominantly static [weightlifting] sports. The overall mean LVEdD [51.06 +/- 5.49mm] and IVSWT [10.24 +/- 1.43mm] were higher in the athletes than those in the normal subjects. The mean of IVSWT in the 38 endurance-trained athletes was significantly more than that of the 12 strength-trained athletes [11.1 mm vs. 10.3 mm, P < 0.05]. LVEdD was also greater in the endurance-trained athletes, but the difference was not statistically significant [51.2 mm vs. 50.6 mm]. Our results of higher LVEdD and IVSWT in Iranian male athletes are in line with previous reports. To generalize the results, we require more studies with larger sample sizes [with female athletes included]