Archives of Iranian Medicine
Volume:21 Issue: 3, Mar 2018

Little is known about secondary prevention of cardiovascular diseases, using cardio-protective drugs, in the community-level, especially in low- and middle-income countries. We aimed to assess main drug use and its predictors in Northeast of Iran.
This is a cross-sectional analysis on the Golestan Cohort Study data (2004–2008) with 50 045 participants. We assessed drug use in those with a history of ischemic heart disease (IHD) or stroke, recorded by face-to-face interviews. We explored drug use predictors (i.e., age, gender, wealth, education, residency, smoking, body mass index, physical activity, hypertension, and diabetes) through multivariable logistic regression.
A total of 3371 (6.7%) participants (56.7 ± 9.0 years, 58.1% female) reported a history of IHD, stroke or both. Median duration since diagnosis was 3.14 years (IQR: 1.25-6.30). Rates of using anti-platelets, statins, angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers, and beta-blockers were 28.8% (95% CI: 27.3–30.3), 5.4 (4.7–6.2), 15.7 (14.5–17.0), and 40.6 (38.9–42.3), respectively. About 43% (41 – 45) of patients did not use any protective drugs. Use of ≥ three drugs was only 7.3% (6.6–8.2). Indicators of ≥1 drug use were: older age (OR for ≥60 vs. Drug use after IHD or stroke is low in Northeast of Iran. Comprehensive efforts to promote secondary prevention are urgently needed.

This study aimed to investigate the association between epicardial adipose tissue (EAT) and coronary artery disease (CAD) as well as cardiovascular risk factors.
Complete medical records of subjects were reviewed and cardiovascular risk factors were recorded. Epicardial fat volume (EFV) and epicardial fat thickness (EFT) were measured using digital volumetry of acquired images using a 256-slice CTscanner. Calcium score was measured using Agatston method in non-contrast images. After contrast administration, bolus-tract images were obtained. Coronary arteries were assessed using reconstructed images in arterial phase of contrast-enhanced images. EFV and EFT measurements were compared to computed tomography angiography (CTA) findings of coronary arteries.
A total of 269 patients (Mean age: 55.5 ± 12.1, 44% female) were included. Higher means of EFT and EFV were associated with coronary artery stenosis. However, the correlation coefficients of the arterial stenosis with EFT and EFV were weak. EFV and EFT had a significant association with age (P Increased EFV and EFT are associated with CAD, age, BMI and hypertension. However, no remarkable association was found between them and calcium score, hyperlipidemia or DM. These variables could weakly predict CAD in univariate models but they are not independent predictive factors for CAD in multivariate models consisting of other CAD risk factors. Hence, EFT and EFV are not independent predictors for CADs when they are considered simultaneously with other CAD risk factors.

This study aimed to evaluate Rabies virus vaccine strains. The obtained results may be helpful for vaccine producers and researchers to compare the strains with wild type and other vaccine strains and select the correct strain to challenge their products.
Fourteen rabies virus vaccine strains were compared with each other. The full genomes of the selected strains were taken from the GenBank and the N, P and G genes were labeled. The major and minor antigenic sites of these sequences were identified and contrasted with each other. The identity matrix was designed for rabies virus full genome, N and G genes. In addition, the phylogenetic tree was drawn based on rabies virus N gene for deep analysis.
Although there were no significant differences between antigenic sites in N, P, and G genes, there were noticeable differences for full genome identity matrix and this significant difference can also be observed in N and G identity matrix. In the phylogenetic tree, the Iranian sequences were distant from currently applied vaccine strains.
It is necessary to pay attention to the results shown in phylogenetic tree because they warn us about distance between the Iranian sequences and current strains used in applied vaccines. In addition, the obtained results help vaccine producers to choose a correct strain to challenge their product and evaluate their vaccine potency.

Eating disorders are a common health problem among adolescents, and females are especially vulnerable to them. There is lack of information on the prevalence of eating disorders in Saudi Arabia. The current study aimed to investigate the prevalence of eating disorders among female undergraduate university students in Taif city, Saudi Arabia.
The study was undertaken in the female section at Taif university from November 1, 2016 to March 30, 2017. Eating Attitudes Test (EAT-26) was used to determine the prevalence of eating disorders. The questionnaire was distributed among undergraduate students and their anthropometric measurements were assessed after obtaining their consent. The sample included 1200 university students with a median age of 21 years (range 17–33). Nonparametric tests were used to assess relationship between variables. Chi-squared test was used to compare items of the disordered eating attitudes and behaviors between positive and negative EAT respondents.
Using the cutoff score of 20 on EAT-26 test, 35.4% of the students were classified at risk for eating disorders. Medical and obese students achieved the highest significant EAT scores.
A high prevalence of eating disorders was found among females at Taif university, Kingdom of Saudi Arabia. Our findings call for prevention of these disorders and we recommend establishing a national screening program among Saudi university female students for early detection and management of these problems.

Peripheral arterial occlusive disease (PAD) includes acute and chronic disorders of the blood supply as a result of obstruction of blood flow in the arteries of the limb. Treatment of PAD can be conservative, surgical and endovascular. Percutaneous transluminal angioplasty with or without stenting has become a recognized method, which is increasingly used in treatment of arterial occlusive disease. This study aimed to determine early results of endovascular treatment of critical limb ischemia (CLI) patients with infrapopliteal lesions.
The study included 69 patients (46 men; mean age 65 years, range 38–84) with CLI (class 4 to 6 according to Rutherford). The primary study endpoints were absence of major amputation of the target limb at 6 months and occurance of local and systemic complications specifically related to use of endovascular treatment.
Major amputation was avoided in 61 patients. Through 6 months, 6 patients underwent additional revascularization. One local complication (clinicaly significant dissection of popliteal artery) occurred, and it was resolved by stent implantation. There were no cases of systemic complications and death during the follow-up period. Rates of major amputation were 12.3% for diabetics versus 8.3% for non-diabetics.
Our data showed that endovascular treatment of infrapopliteal disease is an effective and safe treatment in patients experiencing CLI, provides high limb preservation and low complication rates. Study outcomes support endovascular treatment as a primary option for patients experiencing CLI due to below the knee (BTK) occlusive disease.

Dietary salt consumption is an important factor for mortality from cardiovascular diseases (CVDs). Therefore, the aim of this study is to measure the levels of salt consumption and then estimate the effects of current levels of salt consumption on mortality from CVDs at national and subnational levels from 1990 to 2016 in Iran.
In this study, we will use national and subnational studies with data on salt consumption, including self-report or lab tests for sodium measurement and all available published data about salt and sodium (with conduct a systematic review) to estimate salt exposure levels. We will also use data from death registration system (DRS) to estimate CVDs mortality attributable to salt consumption. We will use mixed-effects model to explore the effects of some covariates on salt consumption and then spatialtemporal model will be used to take into account how the values of salt consumption in each point vary further across time, space, and age. We will compute the proportional reduction in CVD deaths that will occur if salt consumption reduces to an alternative level (5 g/d), using comparative risk assessment (CRA). The simulation analysis will be used to estimate the uncertainty of the number of deaths attributable to salt consumption. All analyses will be performed separately by sex and age groups, province and year in STATA and R software packages.
The findings of this study seem to be helpful for providing good information about the salt consumption and CVDs mortality attributable to it for policymakers in directing future policy decisions and planning cost-effective strategies in Iran.

Pilonidal sinus, including one or more sinus canals and hairs, is a disease with a chronic course showing acute attacks which is often encountered in the general population, usually affecting young adults, at a rate in males twice that of females. Pilonidal sinus on the penis is so rare that very few cases have been reported in literature. A 20-year-old male presented to the urology outpatient clinic with the complaint of a suppurative lesion with discharge on the skin of the penis which had been ongoing for approximately three months. Clinical examination revealed an indurated, erythematous, ulcerative lesion, 3 cm x 2 cm in size, in the middle of the ventral aspect of the penile shaft. We present the first case in literature of recurrent pilonidal sinus related to Actinomyces israelii, located on the penis.