فهرست مطالب سید محمود صدربافقی

Due to significant social, economic, cultural, and lifestyle changes in Iran during past decades and the relationship among the unstable social and economic status and mental complications the study of psychiatric disorders has become important and necessary, the aim of this study was epidemiology of psychiatric disorders in children and adolescents.

A total of 1035 children aged 6-18 years from Yazd Province, Iran were enrolled in this cross-sectional study in 2017 using a multistage cluster sampling method. Data were collected using the following inventories for school-age children (6-18 years): Kiddie-SADS-Present and Lifetime Version (K-SAD-SPL). Logistic regression and SPSS version 16 software were used for data analysis.

44.1% of participants were boys and 55.9% were girls. The mean age of the participants was 11.3±3.9 years. The prevalence of psychiatric disorders in children and adolescents was 35.5%. Meanwhile, anxiety disorders had the highest prevalence rate (22.2%) and among anxiety disorders, separation anxiety disorder (8.7%) and generalized anxiety (8.6%) were the most prevalent. There was a significant difference in all psychiatric disorders based on gender, more evident in the high rate of obsessive-compulsive disorder, enuresis, tic, attention deficit hyperactivity disorder, hyperactivity, oppositional defiant disorder, conduct disorder, smoking disorder, and epilepsy were more evident in boys (P-value < 0.05).

The prevalence rate of psychiatric disorders in young population of Yazd Province is relatively high and because of its impact on individuals' social and personal function, it could have substantial implications for mental health services.

  Taking into consideration the high impact of Diabetes Mellitus type II (DM II) on human's health, identification of risk factors to prevent its development seems essential. Further studies are needed to ensure the positive role of uric acid in the onset of diabetes. This study targeted at investigating the attributed risk of hyperuricemia for the onset of DM II. In the present study, 1641 non-diabetic people, selected through multi-stage random cluster sampling, were followed up for 10 years (2006 - 2016). During the study, data on the variables of the study were collected and entered in SPSS 16 which was used to analyze the data. To calculate the attributions of hyperuricemia in the risk of developing diabetes, Levin's formulas and attributable risk related to the prevalence of exposure during these ten years were used. Findings showed that 54.8% of people with hyperuricemia suffered from DM II., whereas 28.2% of people with normal uric acid level developed diabetes. The Attributable Risk (AR) of hyperuricemia and 75th percentile of serum uric acid for DM II were calculated by the weighted attributable risk formula which was 3.6 % and 24.2 %, respectively. With the treatment of high uric acid, the probability of the incidence of diabetes in hyperuricemia patients was reduced to 24.2% over a 10-year period. In this study, there was a significant correlation between high uric acid level and the risk of diabetes. Therefore, necessary measurements should be taken to treat the hyperuricemia patients in order to prevent the incidence of diabetes caused by high blood acid uric.

Since thrombolytic drugs such as streptokinase could cause reocculsion, anticoagulants like heparin are utilized afterwards. Several nomograms have been recommended due to unpredictable pharmacokinetics of heparin. Therefore, this study aimed to compare two prevalent nomograms of heparin used in patients suffering from acute myocardial infarction (AMI) after recieving streptokinase. In this single-blind randomized clinical trial, 113 patients with AMI were randomly assigned to one of the two nomogram groups four hours after receiving streptokinase. Patients in the group1(n=50), received an initial infusion with rate of 17 U/Kg/hr and a bolus of 80 U/Kg. In Group 2(n=35), the initial rate of heparin (n= 53) was 12 U/Kg/hr with a maximum 900U/hr after a bolus of 60 U/Kg with a maximum of 4000 U. Activated Partial Thromboplastin Time (aPTT) was measured every 6 hours for at least 48 hours and infusion rate was adjusted based on each nomogram in order to maintain aPTT in the therapeutic level of 46-70 s. Patients in the two groups were homogenized in regard with their demographic characteristics. The time needed for aPTT to pass the infusion threshold for groups 1 and 2 were 8.00±3.81 hr and 11.12±5.55 hr, respectively (p=0.00). In the first 12 hours, percentages of patients, whose aPTT was reported in an apporpriate therapeutic range were 56.0% and 30.19% for the two groups, respectively (p=0.00). Moreover, period of time that subjects in group 1 were in the therapeutic range in the first 24 and 48 hours was 14.40 ± 6.42 hrs and 27.48 ± 9.90 hrs, respectively. While these numbers for group 2 were 9.74±3.08 hrs and 21.06 ± 9.42 hrs, respectively (P=0.00, P=0.00). The changes in the heparin rate was reported significantly lower in group 1 compared to group 2. The study findings revealed that nomogram 1 is preferred to nomogram 2, since patients in nomogram 1 reached the therapeutic range faster, stayed in this range for a longer period of time, and needed less change in the heparin rate

Dental pulp calcification may have the same pathogenesis as vascular calcifications. Pulp stones are calcified mass, which are commonly observed in usual dental radiographs. The purpose of this study was to evaluate the relationship between pulp stones and ischemic CVD. This was a cross-sectional descriptive-analytic study on 20-25-year-old patients who had at least 8 intact teeth and were referred to Afshar hospital for cardiovascular examinations. Relationship between vascular stenosis and dental pulp stone was explored. Sixty one patients who had undergone angiography were studied. They included 32 male (52.5%) and 29 female (47.5%). 38 patients had at least one stenotic vessel (from one to three vessels) and the others (37.7%) showed normal angiographic findings. 73.8% (31 cases) of the patients with dental pulp stones suffered from coronary narrowing where as only 36.8% (7 cases) of the patients without dental pulp stones showed coronary vessels narrowing. Pulp stones were mostly seen in first and second Molar teeth. According to the results, we can state that oral and maxillofacial radiology is helpful in screening of cardiovascular diseases.

Atherosclerosis and the side effects thereof are a major cause of mortality and morbidity in diabetic patients. Diabetic dyslipidemia is defined by a decrease in blood levels of HDL cholesterol and increases in triglycerides and LDL cholesterol. Diabetic dyslipidemia is atherogenic, inducing cardiovascular disease in diabetic patients at a frequency that is two to three times greater than that of nondiabetics. This study analyzes the data from the first phase of the Yazd Healthy Heart Program, a community intervention project focused on the prevention of cardiovascular disease. Using the cluster sampling method, we analyzed data from 2000 subjects from Yazd, Iran, ranging in age from 20 to 74 years.

Pervious studies suggested that obesity is correlated with dyslipidemia, hypertension and diabetes mellitus and it has been known as a main cardiovascular diseases risk factor. Obesity can be defined with Body Mass Index (BMI), Waist-to-Hip Ratio (WHR) and Waist Circumference (WC). The present study shows the prevalence of obesity and abdominal obesity and also their contemporaneity with other risk factors in Yazd 20 – 74 years old citizens.This descriptive study was performed in the year 2005 at Cardiology Reserch Center, Yazd on 2000, 20-74 years old Yazd urban population (phase I Yazd healthy heart project) by cluster sampling. Weight, height, WC and hip circumference (HC) measured by trained health providers and also BMI (weight / height2) and WHR (waist / hip) computed. WC was defined as the distance around the smallest area below the rib cage and above the umbilicus. WHR was achieved by dividing WC to greatest hip circumflex. In this study the prevalence of overweight (BMI: 25- 29/9 kg / m2) and obesity (BMI >= 30 kg / m2) was 35.7%, 16.3%, respectively. The results showed a significant relationship between BMI and mean total cholesterol, TG, LDL-C (p= 0.00). Also hyperlipidemia, HTN and diabetes mellitus were significantly more prevalent in obese cases and subjects with abdominal obesity (p= 0.00). On the other hand inverse relationship was seen between obesity and abdominal obesity with smoking level of education. Also BMI increased with aging except in ages over 65 that obesity prevalence decreased.The prevalence of obesity and its association with other CVD risk factors in Yazd urban population were significant. So interventional programs for lifestyle changes and control of obesity should be the major hygienic priorities in Yazd.

Several studies have evaluated the association of admission blood glucose levels and short and long term mortality after myocardial infarction and have had different results. The aim of this study was evaluation of association between admission blood glucose levels and in-hospital and one year mortality in non-diabetic patients with AMI.

In this study, demographic, clinical and Para clinical data of 120 non-diabetic patients with AMI on admission was collected and analyzed. The patients were followed for one year. Blood glucose level ≥ 140 mg/dl was defined as hyperglycemia.

78% of patients were men. The mean age and admission blood glucose level was 63+13 years and 146+76mg/dl, respectively. Death due to cardio vascular causes was seen in 20% of patients in hospital and 9.8% during the one year follow up. The mean admission blood glucose level in patients who died in hospital was significantly more than live patients and also had an influence on the in-hospital outcome. Every 100mg/dl increase in blood glucose level was associated with 11% increase in in-hospital mortality risk in non-diabetic patients.

Our results demonstrate that admission blood glucose level is a good marker for diagnosing patients with worse prognosis after AMI. We suggest that later studies should focus on optimal control of hyperglycemia with insulin in patients with AMI.

Previous studies have shown that various factors such as emotional stress can trigger of MI in susceptible persons. More studies are needed to evaluate the characteristics of patients regarding to emotional stress, heavy work, routine activity, infection or rest before occurrence of MI.

We studied 608 consecutive hospitalized in CCUs from May 2000 to October 2001. For patients, questionnaires including demographic, clinical and paraclinical characteristics were completed and data analyzed.

In this study rest (33.4%) and ordinary activity (32.4%) were more prevalent among the MI situations and infection had the lowest prevalence (0.7%). In patients higher than 45 years we had similar results, but in age group younger than 45 year ordinary activity (30.6%) and after heavy work (20.8%) had the highest prevalence before occurring of MI. In Diabetic patients, MI developed in sleep situation more frequently.(17.8%),(P=0.03) 52.5% of MI mortality occurred in rest situation.(P=0.009)

Rest had the highest prevalence of MI compared to other situations but in age group younger than 45 years MI after heavy work had the highest prevalence. Autonomic neuropathy may be one of the reason of higher prevalence of MI in sleep situation.

Everyday, millions of people around the world go through phlebotomy, either to donate blood or for therapeutic intention. The most important worrisome adverse effects are hemodynamic alterations. In this study, hemodynamic changes following blood donation were assessed. Methods & Materials: Three hundred laborers who donated blood voluntarily were enrolled in this study. Blood pressure (BP) and pulse rate were measured before the procedure, ten minutes afterwards, and one week following phlebotomy. Hemoglobin (Hgb) and hematocrit (Hct) were also determined prior to and one week after phlebotomy. Finally, results before and after donation were compared with each other.

242 volunteers had normal BP and 58 were hypertensive. The mean systolic blood pressures (SBP) before phlebotomy, ten minutes after the procedure, and one week later were 120, 117, and 122 mmHg, respectively. During the same periods of time, the mean of diastolic blood pressures (DBP) were 77 , 78 and 78 mmHg , in order , while pulse rates on average were 80 , 82 and 76 beats/minute . None of the aforementioned changes were clinically significant. After one week, Hgb decreased by about 0.3 g/dl (P<0.001) and Hct declined on average of 1.7 (P<0.001). Forty six individuals had high DBP and one week after donation, their DBP was reduced by 7 mmHg. Age, body mass index and smoking did not have any significant effect on hemodynamic status.

Hemodynamic changes in healthy blood donors were not clinically significant. It seems that DBP drops desirably in hypertensive individuals. This needs to be evaluated more carefully in future studies.

Unstable angina (UA) is situated in a spectrum with myocardial infarction (MI) at one end of it and stable angina at the other end. To determine the clinical and paraclinical characteristics of unstable angina this study was designed. Two hundred patients with definite UA who were hospitalized at cardiac care units (CCU) in Yazd were enrolled in this cross- sectional study. Clinical and para-clinical characteristics including class of severity of angina, clinical circumstances, drugs, risk factors, changes in ECG, and patient's condition at the time of leaving hospital were evaluated.Results& The average of age of patients was 61.85 years and 57% of them were female and 43% were male. The most prevalent risk factor among men was smoking (48.8%) and among women was hypertension (62.8%). According to Braunwald suggestion, patients were divided into 3 classes based on the severity of their diseases. Frequency distribution of patients in classes I,H and III were 24.5%, 4% and 71.5%, respectively. Normal ECG, was observed in 24.5% of subjects at the time of hospitalization and in 67% of patients when leaving hospitals. Frequency distribution based on the risk stratification was 22.5%, 58.5% and 19% in the low, medium and high risk groups, respectively. During hospitalization, acute myocardial infarction (AMI) was seen in 3.5% of individuals that majority of them belonged to class III of angina.