Metolazone Add-On Therapy in Heart Failure: A Cohort Study from Persian Registry of Cardiovascular Disease/Heart Failure (PROVE/HF).

BACKGROUND: One of the strategies for overcoming diuretic resistance among heart failure (HF) patients is adding thiazide-type diuretics. The main aim of this article is to compare the adverse clinical outcomes, including death and re-hospitalization, among individuals suffering from severe acute decompensated HF (ADHF) that consumed furosemide or furosemide plus metolazone. METHODS: This retrospective cohort study was done in the context of the Persian registry of cardiovascular disease (PROVE) from September 2017 to September 2018. One thousand and four hundred thirty-eight individuals (furosemide: 972 and furosemide plus metolazone: 466) with the final diagnosis of severe ADHF (left ventricular ejection fraction < 30%) were selected and followed for 10.3 ± 7.8 months. The association between two groups, as mentioned above, with the incidence of death and re-admission, was evaluated with different models. RESULTS: The mean age of the study population was 68.19 ± 12.98 years. There was no significant relation in terms of death or re-hospitalization between patients with different diuretic regimens. After adjustment of potential confounders, we found that adding metolazone as an adjuvant HF therapy was not independently associated with death or re-hospitalization (hazard ratio (HR): 0.78,95% confidence interval (CI) = 0.59-1.03, P = 0.085, and odds ratio (OR): 0.80, 95% CI: 0.60-1.07, P = 0.135, respectively). CONCLUSION: Our findings revealed that adding metolazone in patients with furosemide resistance is not associated with higher morbidity and mortality. Therefore, usage of these two therapeutic agents could be a helpful strategy for severe HF patients.

First Serological & Molecular Study of Coxiella burnetii in Stray, Domestic Cats, and Their Owners in Iran.

Coxiella burnetii, the agent of Q fever, is recognized as a worldwide zoonosis a wide host and potentially complex reservoir systems. Infected ruminants are the main source of infection for humans, but cats also represent a potential source of infection. The prevalence of C burnetii in cats in Iran is unknown and the risks of transmission to humans are undetermined. This study aimed to determine the prevalence of C burnetii in domestic cats and their owners. An Enzyme-linked immunosorbent assay was used for detection of anti-C burnetii antibodies in both cats and humans. Cats serum samples and humans serum samples (n = 85) were tested with indirect ELISA. C burnetii was diagnosed using real time- polymerase chain reaction. Antibodies were detected in 19 sera of 85 (22.35%) samples in stray cats, 9 sera of 78 (11.53%) samples of domestic cats and 4 sera of 78 (5.12%) samples of their owners. This first study of C burnetii prevalence in cats in Iran has indicated that positive samples can be found throughout the country and these results confirm that Iranian cats have been exposed to C burnetii. Moreover, this study demonstrates that cat owners, breeders and veterinary personnel might be at higher risk of exposure of C burnetii.

Community-based newborn hearing screening programme for early detection of permanent hearing loss in Iran: an eight-year cross-sectional study from 2005 to 2012.

OBJECTIVES: We here present the results of the first eight years of the newborn hearing screening programme in Iran, with a view to establishing the prevalence of hearing impairment among infants, and the efficacy of the programme. METHODS: A total of 3,350,995 infants were screened using the series method of transient evoked otoacoustic emissions (TEOAEs)/automated auditory brainstem responses (AABRs), between 2005 and 2012. The infants were first tested for TEOAEs (three times). Based on the results of this test, the positive cases were referred to the next stage, where they were tested for AABRs. If they also tested positive on AABRs, they were referred to the diagnostic and rehabilitation stages. RESULTS: Results of this study indicated an infant hearing impairment prevalence of 3 per 1000. Although this rate was as high as 5 per 1000 in the early years of the programme, it decreased to 2.6 per 1000 in the last year. The absolute referral rate was 14.5% in the first stage, which decreased to 0.9% and 0.2% in the second and the third stages, respectively. The follow-up rate was 70% in the first stage, which increased up to 73% and 85% in the second and the third stages, respectively. CONCLUSION: The study results suggest that the prevalence of hearing impairment in infants in Iran is comparable with that in developed and developing countries, and that the series TEOAEs/AABRs method used in the screening programme in Iran is efficient.

Prognostic validity of dichotic multiple frequencies auditory steady-state responses versus distortion product otoacoustic emissions in hearing screening of high risk neonates.

OBJECTIVE: To determine the validity of dichotic multiple frequencies auditory steady-state responses (ASSR) as a hearing screening technique versus using distortion product otoacoustic emissions (DPOAEs) among high-risk neonates. METHODS: A cross sectional study was performed on 118 high-risk neonates by means of dichotic multiple frequencies ASSR and DPOAE for hearing screening. DPOAE results were used as the standard for hearing screening in parallel with ASSR. Dichotic multiple frequencies ASSR results were analyzed by means of F-value of less or greater than 0.05 criteria as a pass-fail for the responses. Dichotic multiple ASSR hearing screening technique was considered in two intensity levels at 40 and 70 dB HL. The ASSRs thresholds were measured in high risk neonates with and without hearing deficits as determined by DPOAES. The results of ASSR and DPOAE were compared to be gathered by contingency table in order to obtain sensitivity, specificity and other different statistical values. Average performing times for the tests were analyzed. RESULTS: The specificity of dichotic multiple ASSR was 92.6%, 93.8% and the sensitivity was 71.6%, 62.2% at the 70 and 40 dB hearing levels, respectively. Mean ASSR thresholds for normal-hearing infants at an average corrected age of 6 days were 32.2 ± 12.2, 29.8 ± 10.2, 26.2 ± 11.4 and 30.4 ± 10.8 dB HL for 0.5, 1, 2 and 4 kHz, respectively. The average times for performing the tests were 18.7 and 32.9 min respectively. CONCLUSIONS: ASSR with this special paradigm is a fairly desirable method for hearing screening of high-risk neonates. There is good concordance between ASSRs and DOPAEs results among high risk neonates referred for hearing screening. The sensitivity and specificity of this test is sufficient for hearing screening in high risk neonates. This test could be valuable for rapid confirmation of normal thresholds. As long as further research have not been conducted on ASSR, great caution should be made to interpret the results of ASSR as a hearing screening technique in young infants and also additional techniques such as the tone-evoked ABRs should be used to cross-check results. It's still too soon to recommend ASSRs as a standalone electrophysiologic measure of hearing thresholds in infants.

Persian language version of the "Tinnitus Handicap Inventory": translation, standardization, validity and reliability.

UNLABELLED: Tinnitus is a debilitating condition that is widespread yet difficult to successfully diagnose and treat. This symptom can seriously affect the individual's life quality. OBJECTIVES: The aim of current study was to compose and validate a Persian version of the Tinnitus Handicap Inventory (THI-P). MATERIALS AND METHODS: The linguistic validation of the original version of THI into Persian version (THI-P) included translation, back translation and data gathering. The THI-P was administered to 112 tinnitus subjects. Age, gender, medical history and tinnitus characteristics were recorded as baseline information. All participants complained of chronic unilateral or bilateral subjective idiopathic tinnitus lasting for at least 6 months before consulting about their tinnitus. RESULTS: There was no significant difference between gender, age, hearing impairment and total score and subscales of THI-P. Pearson product-moment correlations revealed adequate test-retest reliability for the THI-P (r = 0.96). Cronbach's-alpha coefficient indicated adequate internal stability of the THI-P (r= 0.943), with a total item correction varying between r=0.939 and r=0.944, indicating its reproducibility. CONCLUSION: The present study proved the internal consistency/ coherency of the Persian version of THI (THI-P). This provides satisfactory application in clinical/research environments.