Serum Vitamin D Status in Older Adults: A Cohort Study.

Background: Vitamin D is best known as a key regulator of bone metabolism and calcium and phosphate homeostasis. This study aimed to assess the effect of different factors on the five-year changes in serum vitamin D concentration among older adults. Methods: This cohort study was conducted on adults aged ≥60 years living in Amirkola, in the North of Iran, from 2012 to 2017. Serum 25-hydroxyvitamin D (25-OH vitamin D) concentrations of <20, 20-29.99, and ≥30 ng/mL, respectively, were used to designate vitamin D deficiency, insufficiency, and sufficiency. Any variation between the second and baseline values of the 25-OH vitamin D concentration was reported as a five-year difference. Data were analyzed using SPSS version 17.0, and Chi square, t test, one-way ANOVA, and Tukey HSD post hoc tests were employed. P values less than 0.05 were considered statistically significant. Results: The mean serum concentration of 25-OH vitamin D at baseline and follow-up examination in 1011 individuals was 34.68±33.18 and 23.88±14.91, respectively (P<0.001). Following a five-year follow-up, vitamin D deficiency, insufficiency, and sufficiency were found in 452 (44.7%), 334 (33.0%), and 225 (22.3%) cases, respectively. The reduction in serum 25-OH vitamin D concentration after five years was significantly influenced by the administration of vitamin D (P=0.013) and calcium (P=0.007) supplements, serum profile of parathyroid hormone (PTH) (P=0.010), calcium (P=0.021), and phosphorous (P=0.021). However, age, sex, body mass index, metabolic syndrome, and physical activity had no significant impact (P>0.05). Conclusion: Regardless of age, sex, body mass index, metabolic syndrome, or physical activity, the mean serum concentration of vitamin D decreased over a five-year follow-up.

Correlation of plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) with radiographic features of congestion in chest CT scan of patients with COVID-19.

BACKGROUND: Given the importance of chest computed tomography (CT) to differentiate congestion from COVID-19 pneumonia, and considering the association of chest CT findings with cardiac biomarkers in patients with concomitant COVID-19 and heart failure, this study was conducted to identify the correlation between plasma NT-proBNP level and radiographic features of congestion in patients with COVID-19. This retrospective cohort research was carried out on adult hospitalized patients with COVID-19 and the plasma concentration of NT-proBNP was measured. The most important findings in chest CT have been considered to differentiate COVID-19 pneumonia from congestion. The study population was divided into two groups based on the presence of these imaging characteristics. RESULTS: Totally, 180 patients with a mean age of 59.6 ± 14.6 years were included in the research. The radiographic findings related to congestion have been found in chest CT of 107 (59.4%) patients. Mean plasma concentration of NT-proBNP in patients with and without radiographic features of congestion was 9886.5 ± 12,676 and 2079.9 ± 4209.3 pg/mL, respectively (p < 0.001). The area under the curve of plasma levels of NT-proBNP for identification of patients with COVID-19 who had pulmonary vein enlargement in chest CT was 0.765 (95% CI 0.688-0.842) and 0.731 (95% CI 0.648-0.813) for the individuals who had interlobar fissure thickening (p < 0.001). CONCLUSIONS: The diagnostic accuracy of plasma NT-proBNP and its positive correlation with radiographic features of congestion in chest CT scan of patients with COVID-19 can be helpful for administering appropriate medications to prevent blood volume overload.

Living Arrangement of Older Adults and its Effect on Five-Year Survival.

INTRODUCTION: Given the impact of living alone on health outcomes, this study was conducted to assess the living arrangement of senior adults and its effect on the mortality. MATERIAL AND METHODS: This cohort study carried out on elderly people aged 60 years and over. Demographic characteristics, the number of comorbid disorders and living condition-as being alone or living with other people-were collected. The mini-mental state examination questionnaire, the geriatric depression scale, the Katz index of activities of daily living, the Lawton instrumental activities of daily living scale, and a modified version of Duke social support index were used for data collection. The participants were followed for five years, and their survival was assessed. RESULTS: Out of the 500 examined individuals, 100 (20.0%) were living alone. During 5 years of follow-up, sixteen (19.8%) of the people who died were living alone. The adjusted effect of age (P<0.001), male gender (P=0.004), the number of comorbidities (P=0.031), the person's social support (P=0.028) and dependence to others to do complex daily activities (P=0.020) on the mortality of the participants was significant, however, other factors including living alone, illiteracy, cognitive impairment and depression did not show such a statistically significant effect (P>0.05). CONCLUSION: Living arrangement, itself, did not show a significant effect on the mortality of older adults.

Chest computed tomography findings in more than 4,000 non-hospitalized suspected COVID-19 patients.

Background: When the first wave of COVID-19 outbreak occurred, the infrastructure for definitive detection of the disease through real-time polymerase chain reaction (RT-PCR) was not yet available in many regions, and a large proportion of suspected patients were inevitably referred to radiology centers to provide a chest CT scan. This research was conducted to describe chest CT characteristics in patients who underwent chest CT during the first weeks of COVID-19 outbreak in Babol, Iran. Methods: All non-hospitalized suspected COVID-19 patients referred to the state radiologic clinic to perform chest CT from March 8, 2020 to March 28, 2020 have been enrolled in this observational study. All CT scans were reviewed by a faculty member radiologist with approximately 20 years of experience. Results: Totally, 2,207 (52.3%) men and 2016 (47.7%) women have been examined. Imaging characteristics in 2292 (54.3%) individuals illustrated a highly suggestive sign of COVID-19 infection while 1869 (44.3%) had a normal chest CT scan. 1813 cases (77.00%) had bilateral involvement and 541 cases (23.00%) were infected unilaterally; Also, 1727 (73.36%) patients had left-sided involvement. Lung field involvement in 2036 (86.49%) patients was less than 20%. Ground glass opacity had a sensitivity, specificity, PPV, NPV, LR+ and LR- of 99%, 96%, 96%, 98%, 22 and 0.01, respectively, for categorization of a patient as a COVID-19 case. These values were 99%, 73%, 70%, 99%, 3.72% and 0.01%, respectively for consolidations. Conclusion: Although, RT-PCR is still introduced as the gold standard method for definite diagnosis, diagnostic accuracy of chest CT in COVID-19 detection is considerable.

Ten-year data analysis of digestive system malignancies in Babol, North of Iran: 2008-2017.

BACKGROUND: Unlike some regions of the world where digestive system cancers are not considered as important health problems, these neoplasms are among the most common malignancies in the northern region of Iran. METHODS: This observational analytical study was carried out based on data collected by the Cancer Registration Center affiliated to the Vice Chancellery for Health of Babol University of Medical Sciences, North of Iran, during 2008-2017. Crude incidence rate (CR), and age-standardized incidence rate (ASR) have been calculated for different GI cancers, based on the primary involved site; and have been compared in different years, patients' age, gender and place of residence. RESULTS: Totally, 4332 records were related to digestive system cancers. Mean age of patients was 63.48±14.73 years; men (2743; 63.3%) were more affected than women (1589; 36.7%) (p<0.001). The most incident malignancies of digestive system were from stomach, colorectal and esophagus in men; and colorectal, stomach and esophagus in women, respectively. These three cancers accounted for 3725 (85.98%) of total GI malignancies. The mean age of patients in various types of GI cancers was statistically different (p<0.001). Age- standardized incidence rate showed different values in different years; from 521.40 (95% CI: 462.79-580.00) in year 2016 to 1834.33 (95% CI: 1637.36-2031.29) in year 2008. CONCLUSION: Gastric, esophageal and colorectal cancers were the most prevalent digestive system malignancies in Babol, North of Iran, and accounted for about 86% of all GI tract cancers. A considerable variation has been found in incident gastrointestinal cancers in different years.

Comparison of anthropometric indices for predicting the risk of metabolic syndrome in older adults.

Background. The prevalence of obesity and metabolic syndrome (MetS) is increasing, worldwide. Using a simple, efficient and reliable tool for predicting MetS is an essential approach in preventive health programs. The aim of this study was to compare the different anthropometric indices in predicting metabolic syndrome in older adults.Methods. This cross-sectional study is a part of the Amirkola Health and Ageing cohort Project (2011-2016). Of total, 1,488 older people aged 60-92 years were entered to the study. Medical and personal information of participants were collected by a questionnaire. After measuring the height, weight, waist circumference, hip circumference and neck circumference, body mass index, waist to hip ratio, waist to height ratio, abdominal volume index and conicity index were calculated. Independent t-test, chi-square and ROC curve were used to analyze the data.Results. Based on ATPIII-2005 diagnostic criteria, the prevalence of metabolic syndrome was 71.57%.The prevalence in female was higher than male. All of examined anthropometric indices, except neck circumference (p = 0.10), showed a significant difference in people with MetS compared to the individuals without metabolic syndrome (p<0.001). Waist to height ratio showed the largest area under the curve for predicting MetS (0.786; 95% CI: 0.76-0.81) followed by BMI (0.746; 95% CI: 0.71-0.77), AVI (0.745; 95% CI: 0.71-0.77), and waist circumference (0.743; 95% CI: 0.71-0.77).Conclusion. Waist to height ratio was the best predictor of MetS in older adults.

Effectiveness of extracorporeal blood purification (hemoadsorption) in patients with severe coronavirus disease 2019 (COVID-19).

BACKGROUND: Extracorporeal blood purification has been proposed as one of the therapeutic approaches in patients with coronavirus infection, because of its beneficial impact on elimination of inflammatory cytokines. METHODS: This controlled trial has been conducted on critically ill COVID-19 patients admitted in the state hospital affiliated to Babol University of Medical Sciences, Iran who received different antiviral and antibacterial drugs, and different modalities of respiratory treatments and did not have positive clinical improvement. No randomization and blindness was considered. All of the participants underwent three sessions of resin-directed hemoperfusion using continuous renal replacement therapy with a mode of continuous venovenous hemofiltration (CVVH). RESULTS: Five men and five women with a mean age of 57.30 ± 18.07 years have been enrolled in the study; and six of them have improved after the intervention. Peripheral capillary oxygen saturation (SpO2) changed after each session. Mean SpO2 before the three sessions of hemoperfusion was 89.60% ± 3.94% and increased to 92.13% ± 3.28% after them (p < 0.001). Serum IL-6 showed a reduction from 139.70 ± 105.62 to 72.06 ± 65.87 pg/mL (p = 0.073); and c-reactive protein decreased from 136.25 ± 84.39 to 78.25 ± 38.67 mg/L (P = 0.016). CONCLUSIONS: Extracorporeal hemoadsorption could improve the general condition in most of recruited patients with severe coronavirus disease; however, large prospective multicenter trials in carefully selected patients are needed to definitely evaluate the efficacy of hemoperfusion in COVID-19 patients. TRIAL REGISTRATION: The research protocol has been registered in the website of Iranian Registry of Clinical Trials with the reference number IRCT20150704023055N2 .

Association of Metabolic Syndrome and Its Components with Survival of Older Adults.

BACKGROUND: Metabolic syndrome (MetS) as an important risk factor arising from insulin resistance accompanying abnormal adipose deposition and function has become a major challenge to public health around the world. OBJECTIVES: This research was conducted to evaluate the association of MetS and its components with survival of older adults. METHODS: This prospective study is a part of the Amirkola Health and Ageing Cohort Project (2011 - 2017) conducted among 1562 older adults (aged 60 years and over) living in Amirkola, north of Iran. MetS was defined according to four sets of definition: Iranian definition, International Diabetes Federation (IDF) definition, 2001 Adult Treatment Panel (ATP) III and 2005 Adult Treatment Panel (ATP) III. RESULTS: Eight hundred sixty-three (55.2%) males and 699 (44.8%) females with a mean age of 69.3 ± 7.4 years were included in the research. The results showed that 71.9%, 74.3%, 68.8% and 66.7% of older adults had MetS based on 2005 ATP III, Iranian, IDF and 2001 ATP III diagnostic criteria, respectively. Only raised fasting plasma glucose (FPG) had a significant association with a five-year survival rate of older adults (FPG ≥ 110mg/dL: adjusted HR: 2.05; 95% CI: 1.51 - 2.78; P < 0.001). Other MetS components did not show any significant associations with survival (P > 0.05). Nevertheless, MetS itself significantly decreased the survival rate of older adults after adjusting age, gender and number of chronic diseases (HR = 1.67; 95% CI: 1.16 - 2.41; P = 0.006). CONCLUSIONS: MetS and one of its components, high FPG, have significant associations with survival of older adults.

Epidemiologic comparison of the first and second waves of coronavirus disease in Babol, North of Iran.

BACKGROUND: A few studies compared the epidemiologic features of the first and second waves of coronavirus disease 2019 (COVID-19) outbreak. This research was carried out to compare the 1st and the 2nd waves of the epidemics in the northern Iran. METHODS: In this observational research, demographic, clinical and laboratory characteristics of the patients with COVID-19, admitted to four government hospitals affiliated to Babol University of Medical Sciences during the 1st and the 2nd waves of COVID-19 epidemics have been compared. The period from May 21, 2020 to September 21, 2020 was considered as the second wave of the epidemics while from February 19, 2020 to May 20, 2020, as the first wave of the outbreak in this region. RESULTS: Out of 6691 total hospitalized cases, 4374 (65.37%), including 1532 (49.6%) people in the first wave and 2842 (78.9%) in the second wave had RT-PCR test for disease confirmation. Among those who were examined with RT-PCR test, 2322 patients (53.1%) including 728 (31.4%) persons in the first wave and 1594 (68.6%) in the second wave were positive for SARS-CoV-2 RNA. 414 (56.9%) of the confirmed cases in the first wave and 767 (48.1%) in the second wave were males (p<0.001). Gastrointestinal symptoms were more incidental in the second wave of the disease. However, severe respiratory conditions were more common during the first wave (p<0.001). Crude mortality rate was lower in the second wave of the outbreak (p<0.001). CONCLUSION: Different epidemiologic characteristics were found in the second wave of COVID-19 outbreak in comparison with the first wave of the epidemics in northerrn Iran.

Sinus venosus atrial septal defect presenting with brain abscess in a 33-year-old man.

This study aimed to present a case of 33-year old man who was admitted with a history of one week headache and acute diplopia. No important finding was reported in his past medical history. Brain CT-scan revealed a large mass lesion in left parieto-occipital area with prominent vasogenic edema and midline shift. Brain magnetic resonance imaging (MRI) showed a mass with size of 5*4*5 centimeter with ring enhancement. After cranial surgery and removing the mass, transthoracic and transesophageal echocardiography (TEE) were conducted to find the source of brain abscess. Right ventricular (RV) and right atrial (RA) enlargement, significant left to right shunt, normal left ventricular (LV) and RV function, bidirectional shunt in addition to moderate size superior sinus venosus type atrial septal defect (ASD) were detected. Considering that most of brain abscesses have hematogenous source, a complete cardiac evaluation including TEE with contrast study is suggested for evaluation of patients with brain abscess.

Lifestyle Interventions to Promote Healthy Nutrition and Physical Activity in Middle-Age (40-60 Years) Adults: A Randomized Controlled Trial in the North of Iran.

BACKGROUND: This study was conducted to evaluate the effectiveness of short-term structured interventions on healthy lifestyle behaviors, dietary intake, anthropometric measures, blood pressure, fasting blood glucose, and serum lipid profile of middle-aged adults. STUDY DESIGN: Randomized controlled trial study. METHODS: Overall, 300 individuals out of apparently healthy (non-patient) adults aged 40-60 yr living in Amirkola, Babol the north of Iran were enrolled in 2016-2017. The Persian translation of the Health Promoting Lifestyle Profile II (HPLP-II) and two days 24-h food recall questionnaires were used for data collection. Eligible participants were allocated randomly in three groups (high-intensive, low-intensive and the control). The follow-up examination has been conducted after 16 wk of intervention. RESULTS: The three study groups had no significant difference in age (P=0.888), sex (P=0.395), BMI (P=0.969), healthy lifestyle score (P=0.675) and total daily energy intake (P=0.612). After intervention, the mean scores of all the six subdomains of HPLP-II questionnaire had significant improvement (P<0.001). Mean weight loss was 1.5, 1.0 and 0.3 kg, in high-intensive, low-intensive and control groups, respectively. BMI although reduced, was still in the overweight range in two sexes. Mean of neck, arm, waist and buttock size, diastolic blood pressure, serum triglyceride, total cholesterol, and HDL levels have been changed to a better condition in comparison with the baseline values (P<0.001). Dietary intake had good changes in total daily energy (P<0.001), daily intake of carbohydrate, protein, and fat (P<0.001), and proportion of energy from carbohydrate (P=0.007) and fat (P=0.022) after the intervention. CONCLUSION: Our intervention program could have positive impact on healthy lifestyle behaviors, dietary intake and weight in addition to some other anthropometric variables and serum lipid profile of middle-aged adults.

New modalities for non-invasive positive pressure ventilation: A review article.

Efficiency of non-invasive positive pressure ventilation in the treatment of respiratory failure has been shown in many published studies. In this review article, we introduced new modalities of non-invasive ventilation (NIV), clinical settings in which NIV can be used and a practical summary of the latest official guidelines published by the European Respiratory Clinical Practice. Clinical trials and review articles in four databases up to 25 February 2018 about new modalities of non-invasive positive pressure ventilation were reviewed. Commonly used modalities for treatment of respiratory failure include: CPAP (continuous positive airway pressure) and BiPAP (bilevel positive airway pressure) or NIPSV (noninvasive pressure support ventilation). The limitations of the BiPAP method are the trigger and cycle asynchrony, inadequate volume delivery and increased respiratory rate. Newer methods, such as adaptive servo-ventilation, have been developed to treat central and complex sleep apnea and the NAVA (neutrally adjusted ventilatory assist) to improve the trigger and cycle asynchrony. In the proportional assist ventilation, unlike the pressure support ventilation, with increased patient effort (flow) the tidal volume increases and it prevents the increase in the respiratory rate and respiratory distress. High-flow nasal cannula is a non-invasive technique that does not provide respiratory support, but provides a mixture of oxygen to the patient. The use of non-invasive pursed-lip breathing ventilation in chronic obstructive pulmonary disease (COPD) patients reduces dyspnea (decreases respiratory rate) and increases blood oxygen saturation. New modalities of NIV improve patient comfort and patient-ventilator interactions, and are recommended in patients with respiratory failure.

Physiological risk factors for cardiovascular disease in middle-aged (40-60 year) adults and their association with dietary intake, Northern Iran.

BACKGROUND: Considering the importance of healthy diet in the protection of cardiovascular diseases (CVD), this research aimed to assess the physiological risk factors for CVD in middle-aged adults and their association with dietary intake in the north of Iran. METHODS: In this cross-sectional study conducted in the years 2016-2017 among the adults aged 40-60 years living in Amirkola, Babol, the participants´ physical activity, dietary intake, body mass index, fat mass, blood pressure, fasting blood glucose and serum lipid profile were reported. The International Physical Activity Questionnaire was used to assess physical activity and a structured 24-hour food-recall questionnaire was used to assess the participants´ dietary intake. Consumed foods and beverages on two separate days were analyzed and transcribed in 10 food groups (gram). RESULTS: Two hundred and ninety-one persons (96.7%) had complete participation, 96.2% with at least one CVD risk factor and 75.9% had overweight or obesity; 33% with hypertension; 6.2% had high fasting blood glucose; 64.6% with hypercholesterolemia, 47.8% had hypertriglyceridemia, and 8.9% with low HDL. Mean daily intake values of carbohydrate, protein and fat were all higher than dietary reference intakes for adults. Physical activity less than 1500 MET-minutes per week was significantly associated with having three or more physiological risk factors for CVD [adjusted odds ratio: 2.04 (1.08-3.85)] (P=0.029). CONCLUSION: Most of the middle-aged adults in this region had at least one of the physiological risk factors for CVD and daily intakes of carbohydrate and protein were higher than dietary reference intakes (DRIs) for adults.

The First Step of Health Policy-Making for Lifestyle Modifications at Middle Age: Problem Identification in 40- to 60-Year-Old Population, Northern Iran.

Background: The purpose of this study was to determine the current situation of lifestyle behaviors and related outcomes, as the first step to make proper local health policies for improvement of health lifestyle behaviors. Materials and Methods: This analytic research has been conducted as a cross-sectional study on the middle-aged (40-60 years old) population of Amirkola, Northern Iran. The Persian translation of the Health-Promoting Lifestyle Profile II questionnaire and the International Physical Activity Questionnaire were used for data collection. Also, anthropometric variables, blood pressure, fasting blood sugar, and serum lipids profile were examined. Results: Three hundred one individuals have been enrolled in the study. Results showed that 10.6% of the participants had unhealthy lifestyle behaviors in the subdomain of spiritual growth; 46.8% in the subdomain of health responsibility; and 48.2% in the subdomains of stress management, physical activity, and nutrition; men had more physical activity than women (p < 0.001). Totally, 189 persons (63.9%) had serum cholesterol greater than or equal to 200 mg/dL; seventy-five individuals (25%) had high blood pressure. One hundred twenty-six persons (81.8%) of women and 103 (70.1%) of men were overweight or obese. Conclusions: Health lifestyle behaviors in 40- to 60-year-old population need a proper intervention to improve the current situation.

Hyponatremia, bone mineral density and falls in the elderly; Results from AHAP study.

BACKGROUND: Hyponatremia (HN) can be associated with osteoporosis, falls and bone fractures in the elderly. Recent researches demonstrated different results about the correlation of HN with bone mineral density and bone fractures. METHODS: This analytic research came from the AHAP project in northern IRAN. All people aged 60 years and over were included in the study. Individuals with severe comorbidities and then who had concurrent conditions which could have impact on bone mineral densities (BMD) such as long-term use of steroids, calcium and/or vitamin D supplements, bisphosphonates, calcitonin, thiazides and hormonal medications were excluded. RESULTS: One thousand and one hundred and thirteen older persons entered in the study. More than 10 percent of the participants had HN (serum Na+ level ≤ 137mEq/L). No significant difference has been observed between hyponatremic and nonhyponatremic individuals about their balance abilities; bone mineral density; incidence of falls and/or bone fracture during the previous 6 months; dependency in activities of daily living; and osteoporosis. CONCLUSION: HN was not a prevalent problem in older adults who met the inclusion criteria of this research. No significant difference has been observed between HN and bone mineral density and falls in the elderly.

Gender differences in the health status of elderly living alone compared to those who are not alone: Evidence of the AHAP study, North of Iran.

BACKGROUND: One of the factors that have impact on the health status of elderly people is living alone. This study was conducted to examine the living condition of elderly population in Babol and probable differences which this condition induced on the health disorders of elderly people. METHODS: This cross-sectional study was performed on 1544 elderly people aged 60 and over in Amirkola, Babol. Demographic characteristics, the incidence of falls, chronic diseases, polypharmacy, headache with uncertain cause, chronic pains and back pain were collected by the study questionnaire; social support, physical activity, depression and cognitive disorders were assessed with standard questionnaires. RESULTS: 6.8% of elderly people were living alone. Lack of social support, cognitive disorders, depression, multiple chronic diseases, occurrence of falls and headache with uncertain cause were significantly higher among those elderly who live alone (p<0.05). Regardless of age and educational level, headache and depressive symptoms in male individuals living alone, and falls occurrence in female individuals were significantly more than those who did not live alone (p<0.05). Also, in female elderly subjects, the effect of the marital status factor on health-related disorders was more than the effect of living alone factor. CONCLUSION: Many disorders and disabilities are higher in the elderly people who live alone; also there is a difference in the health status of elderly people who live alone, according to their gender.