Exertional abdominal pain as a symptom of secondary pulmonary hypertension in mitral stenosis.

We report a rare presentation of mitral stenosis (MS). MS is a common valvular disease, the first manifestation of which is usually easy fatigability and exertional dyspnea. As the disease progresses in severity, other signs and symptoms appear, such as orthopnea, hemoptysis, and peripheral edema. This is the first report of a case of mitral stenosis presenting with exertional abdominal pain as the first manifestation. This case report describes the clinical characteristics of a 55-year-old woman with mitral stenosis and severe pulmonary hypertension, whose first symptom was exertional abdominal pain.

Socioeconomic disparities and smoking habits in metabolic syndrome: evidence from isfahan healthy heart program.

BACKGROUND: The metabolic syndrome (Mets) consists of major clustering of cardiovascular disease (CVD) risk factors. This study determines the association of socioeconomic determinants and smoking behavior in a population-based sample of Iranians with Mets. METHODS: This cross-sectional survey comprised 12600 randomly selected men and women aged ≥ 19 years living in three counties in central part of Iran. They participated in the baseline survey of a community-based program for CVD prevention entitled" Isfahan Healthy Heart Program" in 2000-2001. Subjects with Mets were selected based on NCEP- ATPIII criteria. Demographic data, medical history, lifestyle, smoking habits, physical examination, blood pressure, obesity indices and serum lipids were determined. RESULTS: The mean age of subjects with Mets was significantly higher. The mean age of smokers in both groups was higher than non-smokers but with lower WC and WHR. Marital status, age and residency were not significantly different in smokers with Mets and non-smokers with Mets. Smoking was more common in the middle educational group in the income category of Quartile 1-3. Mets was significantly related to age, sex and education. Middle-aged and elderly smokers were at approximately 4-5 times higher risk among Mets subjects. Low education decreased the risk of Mets by 0.48; similarly in non-smokers, 6-12 years of education decreased the risk of Mets by 0.72. CONCLUSION: More educated persons had a better awareness and behavior related to their health and role of smoking. In the lower social strata of the Iranian population, more efforts are needed against smoking habits.

Topiramate add-on treatment in schizophrenia: a randomised, double-blind, placebo-controlled clinical trial.

Glutamate antagonists such as topiramate have been proposed based on the glutamate hypothesis of schizophrenia because its properties encourage its exploration and possible development as a medication for the treatment of schizophrenia. A randomised, double-blind, placebo-controlled clinical trial was performed on 18- to 45-year-old patients with schizophrenia. Baseline information including vital signs, height, weight, smoking status, demographic characteristics, (past) psychiatric history, medication history and medication-related adverse effects were collected. Patients were randomly assigned to a topiramate or placebo group. Efficacy of medication was measured by administering Positive and Negative Syndrome Scale (PANSS), and tolerability of treatment was recorded on day 0 (baseline), day 28 and day 56. PANSS values (95% confidence interval) at baseline, day 28 and day 56 in the topiramate group were 96.87 (85.37-108.37), 85.68 (74.67-96.70) and 76.87 (66.06-87.69), respectively; compared with 101.87 (90.37-113.37), 100.31 (89.29-111.32) and 100.56 (89.74-111.37) in the placebo group. General linear model for repeated measures analysis showed that topiramate has lowered PANSS values significantly compared with the placebo group. Similar significant decline patterns were found in all three subscales (negative, positive and psychopathology sign). Clinical response (more than 20% reduction in PANSS) was significantly higher in topiramate-treated subjects than controls (50% vs 12.5%). Topiramate can be an effective medication in controlling schizophrenic symptoms, considering its effect on negative symptoms and controlling antipsychotic-associated weight gain.