Interactive Effect of Probiotics Supplementation and Weight Loss Diet on Metabolic Syndrome Features in Patients With Coronary Artery Diseases: A Double-Blind, Placebo-Controlled, Randomized Clinical Trial.

Background. Nutrition and probiotics supplementation are considered as nondrug strategies for the control of coronary artery disease (CAD). The aim of the present study was to investigate the interactive effects of probiotic supplementation and weight loss program on anthropometric and metabolic syndrome (MetS) indices in patients with CAD. Methods. A randomized, double-blind, placebo-controlled trial was performed in 44 overweight CAD patients. All the patients received weight loss program (5% to 10% of initial body weight) throughout the study course. The subjects were randomly assigned into intervention or placebo groups (n = 22, each) and received a probiotic or maltodextrin capsule/day, respectively, for 12 consecutive weeks. Anthropometric and MetS indices were assessed. Results. There was a significant decrease in total cholesterol (-30.7 ± 49.83 vs -5.9 ± 65 mmol/L, P = .043) and low-density lipoprotein cholesterol (-25.64 ± 51.7 vs -5.44 ± 70.1 mg/dL, P = .049) in the probiotic group compared to the placebo group. Other MetS feature indices and blood pressure did not differ significantly within or between groups. Conclusion. Probiotics supplementation improved total cholesterol and low-density lipoprotein cholesterol but had no effect on other lipid profile parameters and anthropometric indices. The weight loss diet plus probiotics supplementations resulted in more favorable decrease of cardiovascular risk factors compared to a weight loss program alone.

Effect of physician prescribed information on hospital readmission and death after discharge among patients with health failure: A randomized controlled trial.

In order to understand if a physician prescribed medical information changes, the number of hospital readmission, and death among the heart failure patients. A 12-month randomized controlled trial was conducted (December 2013-2014). Totally, 120 patients were randomly allocated into two groups of intervention (n = 60) and control (n = 60). Accordingly, the control group was given the routine oral information by the nurse or physician, and the intervention group received the Information Prescription (IP) prescribed by the physician as well as the routine oral information. The data was collected via telephone interviews with the follow-up intervals of 6 and 12 months, and also for 1 year after the discharge. The patients with the median age of (IQR) 69.5 years old (19.8) death upon adjusting a Cox survival model, [RR = 0.67, 95%CI: 0.46-0.97]. Few patients died during 1 year in the intervention group compared to the controls (7 vs 15) [RR = 0.47, 95%CI: 0.20-1.06]. During a period of 6-month follow-up there was not statistically significant on death and readmission between two groups. Physician prescribed information was clinically and statistically effective on the reduction of death and hospital readmission rates among the HF patients in long term follow-up.

Role of circulatory leukocyte based indices in short-term mortality of patients with heart failure with reduced ejection fraction.

BACKGROUND: Pro-inflammatory signaling is mediated by a variety of inflammatory mediators which can cause myocardial apoptosis, hypertrophia, and fibrosis, and also ultimately lead to adverse cardiac remodeling. This study aimed to assess the role of circulating leukocyte-based indices in predicting the short-term mortality in patients with heart failure with reduced ejection fraction (HFrEF). METHODS: In a retrospective study, patients with HFrEF admitted to a tertiary referral center between January 2016 and January 2017 were recruited to this study. The association between neutrophil to lymphocyte ratio (NLR), derived neutrophil to lymphocyte ratio (dLNR = neutrophils/(leukocytes-neutrophils)), monocyte/granulocyte to lymphocyte ratio (MGLR = (white cell count-lymphocyte count) to lymphocyte count), platelet to lymphocyte ratio (PLR) and six-months mortality of patients were assessed. RESULTS: A total of 197 patients with HFrEF were enrolled in the study. NLR (P<0.001), dNLR (P<0.001), MGLR (P<0.001), PLR (P=0.006) and LVEF (P=0.042) showed significant difference between survived and died patients. In the Cox multivariate analysis we did not find NLR, dLNR, MGLR or PLR as an independent predictor of short-term mortality in HFrEF patients. CONCLUSIONS: Although High NLR, PLR, MGLR and dNLR was associated with short-term mortality, it failed to independently predict the prognosis of HFrEF patients.

Effect of flaxseed oil supplementation on the erythrocyte membrane fatty acid composition and endocannabinoid system modulation in patients with coronary artery disease: a double-blind randomized controlled trial.

BACKGROUND: The endocannabinoid system (ECS) overactivation, associated with increased inflammatory process, may act as a risk factor for coronary artery disease (CAD). Dietary fat may influence the ECS tone. The aim of the present study was to investigate the effect of flaxseed oil on the erythrocyte membrane fatty acid profile and ECS activity by the measurement of serum N-arachydonoil ethanolamine (AEA) and cannabinoid receptor type-1 (CB1), cannabinoid receptor type-2 (CB2), and fatty acid amide hydrolase (FAAH) mRNA expression. METHODS: This clinical trial was performed on 44 patients with CAD. The intervention group received 1.5% fat milk supplemented with flaxseed oil (containing 2.5 g α-linolenic acid or ALA), while the placebo group received 1.5% fat milk for 10 weeks. The fatty acid profile of erythrocyte membrane phospholipids was measured by gas chromatography. The AEA level was determined using an ELISA kit, and real-time PCR was performed to measure CB1, CB2, and FAAH mRNA expression pre- and post-intervention. RESULTS: Flaxseed oil supplementation resulted in a significant increase in the ALA content and a significant reduction in linoleic acid (LA) content of membrane phospholipids, compared to the placebo group (MD = - 0.35 and 2.89, respectively; P < 0.05). The within group analysis showed that flaxseed oil supplementation caused a significant reduction in both LA and arachidonic acid (MD = - 4.84 and - 4.03, respectively; P < 0.05) and an elevation in the ALA (MD = 0.37, P < 0.001) content of membrane phospholipids compared with the baseline. In the intervention group, a marked reduction was observed in the serum AEA level after 10 weeks of intervention, compared with the placebo group (MD = 0.64, P = 0.016). Changes in CB2 mRNA expression in the flaxseed oil group were significant (fold change = 1.30, P = 0.003), compared with the placebo group. CONCLUSION: Flaxseed oil supplementation could attenuate the ECS tone by decreasing the AEA level and increasing CB2 mRNA expression. Therefore, flaxseed oil may be considered a promising agent with cardioprotective properties.

Effect of flaxseed oil supplementation on anthropometric and metabolic indices in patients with coronary artery disease: A double-blinded randomized controlled trial.

Introduction: It has been established that omega 3 fatty acids have cardio-protective effects through modulation of cardiometabolic risk factors via multiple mechanisms. The aim of this study was to investigate the effects of flaxseed oil on anthropometric indices and lipid profile in patients with coronary artery disease (CAD). Methods: A randomized, double-blind, placebo-controlled trial was performed in 44 patients with CAD. The subjects were randomly assigned to receive either 200 ml of 1.5% fat milk supplemented by 5 g of flaxseed oil (containing 2.5 g α-Linolenic acid) as intervention or 200 ml of 1.5% fat milk as placebo group for 10 consecutive weeks. Anthropometric indices and lipid profile were assessed at baseline and post-intervention. Results: The results indicated that supplementation with flaxseed oil had no impact on anthropometric indices. Weight, body mass index, waist circumference and hip circumference decreased statistically significant within groups, but not between groups. At the end of the intervention, diastolic blood pressure (DBP) decreased significantly (P = 0.022) in the intervention group. Moreover, the triglyceride (TG) level decreased significantly in the intervention group from 173.45 (49.09) to 139.33 (34.26) (P < 0.001). Other lipid profile indices including total cholesterol, low density lipoprotein and high density lipoprotein did not differ significantly within and between groups. Conclusion: We observed that supplementation of flaxseed oil improved TG and DBP but had no effect on other lipid profiles and anthropometric indices in patients with CAD.

The efficacy and safety of probiotics intervention in attenuating cardiac remodeling following myocardial infraction: Literature review and study protocol for a randomized, double-blinded, placebo controlled trial.

INTRODUCTION: Structural and functional changes that occur post myocardial infraction (MI) lead to the syndrome of heart failure (HF). However, their pathogenesis is poorly understood. Recently, alteration of the intestinal microbiota (dysbiosis) has emerged as a new candidate that may be correlated with risk of HF development. We hypothesized that selective gut modulation by probiotic administration may improve metabolic dysfunction and attenuate cardiac remodeling (CR) in MI subjects. METHODS: /Design: This article is presented in two sections: First, we provided a review of recent findings related to gut microbiota and CR and their association with probiotic supplementation. Secondly, we will conduct a randomized double-blinded controlled clinical trial in 46 Iranian patients with MI after successful percutaneous coronary intervention (PCI). The participants (age: ≥ 30 years; ejection fraction (EF) greater than 30) will be selected by a simple random sampling method and will be assigned to 3 months of 1.6* 109 CFU probiotic (Lactobacillus rhamnosus), or placebo groups (maltodextrin). The primary outcome is development of CR. The secondary outcomes measures include gut microbiota profile, biochemical variables and the safety of the probiotics supplementation. Also, echocardiography will be measured at baseline and following treatment. The data will be compared within and between groups using appropriate statistical methods. DISCUSSION: The results of this trial will provide evidence about the efficacy and safety of gut microbiota manipulation by probiotics in post-MI cardiac remodeling prevention. ETHICAL ISSUES: Present study protocol was approved by the regional committee of ethics in international branch of Tabriz University of Medical sciences (TBZMED) as a thesis proposal for PhD degree in Nutrition Sciences (IR.TBZMED.REC.1397.184).Trial registration The Clinical trial was registered in the Iranian Registry of Clinical Trials (IRCT20121028011288N15).

Effect of remote ischemic post-conditioning on oxidative stress in blood of STEMI patients treated with primary angioplasty.

Introduction: This study designed to use remote ischemic post conditioning (RIPC) as a protective strategy during percutaneous coronary intervention (PCI) in patients with ST segment elevation myocardial infarction (STEMI) to reduce myocardial cells damage due to reperfusion injury. Methods: Sixty-one patients were divided into test group (32 patients) receiving RIPC and control group (29 patients). Patients were included with first MI who had 20-80 years old. The RIPC protocol was applied on patients arm in three successive episodes during the opening of infarct-related artery (IRA). Whole blood sample were taken from patients after the first episode before IRA opening and after the third episode after IRA opening. The serums were extracted and stored in the freezer -70˚C to determine the levels of glutathione peroxidase (GPX), superoxide dismutase (SOD), total antioxidant capacity (TAC) and malondialdehyde (MDA). Results: The levels of GPX and SOD after the first episode of RIPC were significantly higher in test group than control group (P < 0.001). Similar alterations of these enzymes were obtained after IRA opening (after third episode). In addition, the levels of TAC remained unchanged in control patients but it was significantly increased after the third episode of RIPC in test patients (P < 0.001). Finally, the MDA level was increased in control group in comparison with test group, and administration of RIPC in test group prevented the enhancement of MDA levels significantly (P < 0.001). Conclusion: The results indicated that RIPC protocol has protective properties in patients with STEMI through enhancing the antioxidant potentials and decreasing lipid peroxidation.

The Efficacy of Written Information Intervention in Reduction of Hospital Re-admission Cost in Patients With Heart Failure; A Systematic Review and Meta-Analysis.

OBJECTIVE: To assess the efficacy of written information versus non written information intervention in reducing hospital readmission cost, if prescribed or presented to the patients with HF. METHODS: The study was a systematic review and meta-analysis. We searched Medline (Ovid) and Cochrane library during the past 20 years from 1993 to 2013. We also conducted a manual search through Google Scholar and a direct search in the group of related journals in Black Well and Science Direct trough their websites. Two reviewers appraised the identified studies, and meta-analysis was done to estimate the mean saving cost of patient readmission. All the included studies must have been done by randomization to be eligible for study. RESULT: We assessed the full-texts 3 out of 65 studies with 754 patients and average age of 74.33. The mean of estimated saving readmission cost in intervention group versus control group was US $2751 (95% CI: 2708 - 2794) and the mean of total saving cost in intervention group versus control group was US $2047 (base year 2010) with (95% CI: 2004 - 2089). No publication bias was found by testing the heterogeneity of studies. CONCLUSION: One of the effective factors in minimizing the healthcare cost and preventing from hospital re-admission is providing the patients with information prescription in a written format. It is suggested that hospital management, Medicare organizations, policy makers and individual physicians consider the prescription of appropriate medical information as the indispensable part of patient's care process.

Dispersive liquid-liquid microextraction based on solidification of floating organic droplet followed by spectrofluorimetry for determination of carvedilol in human plasma.

BACKGROUND: Simple, chip and rapid analytical methods are required in biomedical analysis laboratories to support therapeutic drug monitoring units in hospitals. The present work aimed to provide such a method for quantitative determination of carvedilol in plasma samples. RESULTS: A new, simple, precise and efficient method was developed for the determination of carvedilol in human plasma using a dispersive liquid-liquid microextraction based on solidification of floating organic droplet, followed by spectrofluorimetry method. Some important parameters such as types and volumes of extraction and disperser solvents, pH, salt effect and sample volume were optimized. Under the optimized experimental conditions, the method provided a linear range of 40 to 300 ng ml(-1), with a correlation coefficient of 0.996. The limit of detection, lower limit of quantification and upper limit of quantification were 18, 40 and 300 ng ml(-1), respectively. The found recovery was from 98.2 to 102.2%, the mean intra- and inter-day precisions were 8.3 and 6.4%, respectively. The relative error for accuracy varied from 0.4 to 2.2%. The short-term temperature and freeze-thaw stability studies showed that carvedilol in human plasma was stable for sample preparation and analysis after storage. CONCLUSION: The proposed method provided reasonable acceptable results and could be used for therapeutic monitoring of carvedilol.

Repeat percutaneous balloon mitral valvotomy vs. mitral valve replacement in patients with restenosis after previous balloon mitral valvotomy and unfavorable valve characteristics.

BACKGROUND: Symptomatic mitral restenosis develops in up to 21% of patients after percutaneous balloon mitral valvotomy (PBMV), and most of these patients undergo mitral valve replacement (MVR). HYPOTHESIS: Repeating PBMV (re-PBMV) might be an effective and less-invasive treatment for these patients. METHODS: Forty-seven patients with post-PBMV mitral restenosis and unfavorable valve characteristics were assigned either to re-PBMV (25 cases; mean age 40.7 ± 11 y, 76% female) or MVR (22 cases; mean age 47 ± 10 y, 69% female) at 51 ± 33 months after the prior PBMV. The mean follow-up was 41 ± 32 months and 63 ± 30 months for the re-PBMV and MVR groups, respectively. RESULTS: The 2 groups were homogenous in preoperative variables such as gender, echocardiographic findings, and valve characteristics. Patients in the MVR group were older, with a higher mean New York Heart Association functional class, mean mitral valve area, mitral regurgitation grade, and right ventricular systolic pressure (P = 0.03), and more commonly were in AF. There were 3 in-hospital deaths (all in the MVR group) and 4 during follow-up (3 in the MVR group and 1 in the re-PBMV group). Ten-year survival was significantly higher in re-PBMV vs MVR (96% vs. 72.7%, P<0.05), but event-free survival was similar (52% vs. 50%, P = 1.0) due to high reintervention in the re-PBMV group (48% vs. 18.1%, P = 0.02). CONCLUSIONS: In a population with predominantly unfavorable characteristics for PBMV, short- and long-term outcomes are both reasonable after re-PBMV with less mortality but requiring more reinterventions compared with MVR.