فهرست مطالب morteza motedayen

Ventricular arrhythmias (VAs), which result from acute myocardial infarction and revascularization, are preventable causes of sudden cardiac death. This study aimed to determine the incidence, types, and risk factors of VAs in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention (PCI).

This cross-sectional study was conducted at the cardiology department of a tertiary care cardiac center in Zanjan, Iran. All the patients were monitored during hospitalization, and the incidence of cardiac arrhythmias and the outcomes were recorded.

Among 315 patients, the mean age was 62.14±10.11 years, and 76.2% were male. Male gender was significantly associated with VA occurrence (P=0.038). Among the patients, 50.5% had VAs, of which 26.4% were sustained ventricular tachycardia (sustained VT) and ventricular fibrillation (VF). Sustained VT and VF, but not total arrhythmias, were more common in anterior infarctions. Most arrhythmias occurred during the first 12 hours, and frequent premature ventricular contractions (43.3%) and idioventricular rhythm (20.1%) were the most common. A history of PCI and coronary artery bypass grafting (CABG) was associated with substantially reduced arrhythmias (P=0.017 and P=0.013, respectively). However, cardiovascular risk factors exerted no statistically significant effects on the VA type.

Approximately half of our patients experienced reperfusion-induced VAs. Overall, gender and a history of PCI and CABG were significantly associated with VA occurrence. Therefore, males and patients without a positive history of PCI and CABG should receive antiarrhythmic drugs as a precaution.

 Acute myocardial infarction (MI) is caused due to coronary artery occlusion and divided into two forms of ST-elevation (STEMI) and non-ST-elevation (NSTEMI) myocardial infarction. This study aimed to determine the success rate of treatment with primary PCI (percutaneous coronary intervention) versus thrombolysis in the establishment of perfusion and to evaluate the short-term complications caused by each method.

 In this prospective cohort study, 90 patients were selected for primary PCI treatment and 90 patients for thrombolytic treatment. Clinical data and basic demographic characteristics of the patients and cardiovascular risk factors were recorded. The success rate of coronary reperfusion by primary PCI and thrombolytic therapy was then determined by angiography and 90-minute ECG with resolution or improvement of chest pain. All patients were examined for any serious complications such as cerebrovascular accidents, shock, and heart failure for 30 days after treatment. Data were analyzed using SPSS ver. 20.

 In the primary PCI group, 75.6% of the patients were males, and 24.4% were females, but in the thrombolytic group, 76.6% and 23.3% of the cases were males and females, respectively. The mean door-to-balloon time for PCI was 63.60 ± 23.92 and was 53.70 ±21.52 min in the thrombolytic group. Thrombolysis in myocardial infarction (TIMI) flow grade III and TIMI-II were the most frequent in primary PCI and thrombolytic groups, respectively. The odds ratio (OD) of mechanical MI and major arrhythmia in patients received the primary PCI compared to those received thrombolytic therapy was 0.24 and 0.66, respectively. Also, the OD of mortality in the primary PCI group was 2.12.

 Our findings suggest that in STEMI patients, the chances of short-term complications such as post-MI mechanical complications, major arrhythmia, and bleeding requiring blood transfusion were lower in patients who were treated with primary PCI than those who received thrombolytic treatment. Also, the average hospitalization in CCU and hospital in the primary PCI group was lower than the thrombolytic group.

Thanks for your observations and giving us a chance to reply to the letter you received about our paper entitled: “The relationship between body mass index and preeclampsia: A systematic review and meta-analysis”. In the following, the authors have tried to answer the issues raised as much as possible:The quality assessment was done by the Newcastle-Ottawa Scale, 27 articles with a quality score of < 3 were excluded from the study, and 16 high-quality studies were analyzed (Figure 1). The article was written according to PRISMA guidelines (1). According to this guidelines reporting the quality assessment details is not obligatory in all meta-analysis, in meta-analysis conducted on randomized clinical trials and Cochrane articles, this section is usually reported in analytically in most articles. But only 30% of meta-analysis report quality assessment in the results of articles (Page 9, Table II, Item 22) (2). Many statistical tests, such as Begg and Mazumdar (1994), can be used to check publication bias. In this article, we report the p-value and a plot in the results section, which seems to be sufficient (Page 469, Table II (p = 0.584), Figure 5). Egger et al. proposed a test for the asymmetry of the funnel plot. The power of this method to detect bias will be low with small numbers of studies. Begg and Mazumdar  proposed testing the interdependence of variance and effect size using Kendall's method. This bias indicator makes fewer assumptions than that of Egger et al. (3, 4). Pubmed and Scopus databases for English and SID for Persian articles had good coverage for our search, no search results for additional article were found on Web of Sciences. Using the Web of Sciences is not obligatory in search of all meta-analysis studies. In our investigation, there were neither any articles in the Web of Sciences nor in PubMed and Scopus databases. Subgroup analysis were done according to mild and severe preeclampsia (Figure 3, 4). To pool the results of articles, there were alternative, fixed effect models, (when heterogeneity is not significant) and random effect models (when heterogeneity is significant) (5). Effect size was defined by the researcher as mean BMI with a 95% confidence interval (CI), when we use CI there is the sample size in its formula (mean ±zơ/ ).  Effect size can be defined as mean difference, or SMD, WMD, OR, RR, if we use SMD it would lead to an increase in missing values, SMD is computed when mean, SD, and sample size are avaliable in both cases and control groups, but when we define mean BMI as effect size, it is not necessary we have mean, SD, and sample size in both groups. Consequently, the results of this article, according to pooled results of 16 high-quality articles, are valid to cite.

Myocardial infarction (MI) is the most frequent cause of ischemic heart death. MI is generally assumed to be due to arterial thrombosis superimposed on an atherosclerotic plaque in an epicardial coronary artery. Total occlusion of an epicardial coronary artery leads to ST elevation, while non-occlusive lesion leads to ST depression. We hereby have reported a case of ST-segment elevation myocardial infarction with normal coronary arteries angiography. A 35-year-old man presented with typical chest pain, nausea, vomiting and cold sweating. ECG obtained at admission and 30 minutes later revealed sinus tachycardia with ST-segment elevations (> 2 mm) in leads V2-V5. Cardiac biomarkers including creatine phosphokinase (CPK), creatine kinase muscle-brain (CK.MB) and troponin high sensitive were elevated. The standard treatment for MI including pain relief, aspirin, thrombolysis if indicated and beta blockade were begun for the patient. STEMI was confirmed and thus, angiography was performed. Coronary angiography revealed normal coronary arteries without any angiographic evidence of stenosis, coronary artery dissection, embolism, plaque rupture or vasospasm.

Hypertension is a risk factor for renal disease. Therefore, this study was aimed at estimating the prevalence of hypertension in renal patients in Iran through meta‑analysis.

The search was carried out using authentic Persian and English keywords in national and international databases including IranMedex, SID, Magiran, IranDoc, Medlib, ScienceDirect, Pubmed, Scopus, Cochrane, Embase, Web of Science, Medline, and Google Scholar search engine without any time limitation until 2017. Heterogeneity of studies was assessed using the I2 index. Data were analyzed using STATA ver 11.

In 35 reviewed studies with a sample of 39,621 subjects, the prevalence of hypertension in renal patients was 35% (95% CI: 29%–41%) (25% in women and 18% in men). The prevalence of systolic hypertension in renal patients was 5%, diastolic hypertension 26%, and diabetes 23%. The prevalence of hypertension in hemodialysis patients was 34%, 27% in peritoneal dialysis, 43% in kidney transplantation, and 26% in chronic renal failure. In addition, meta‑regression showed that the prevalence of hypertension in renal patients did not significantly decrease during the years 1988–2017.

More than a third of kidney patients in Iran suffer from high blood pressure. The diastolic blood pressure of these patients is about five times higher than their systolic blood pressure. Moreover, the age group under 30 is a high‑risk group. The prevalence of hypertension in women with kidney disease is higher than in men. In addition, patients who have kidney transplants are more likely to have high blood pressure than other kidney patients.

One of the causes of maternal and fetal mortality and morbidity is pregnancy-induced hypertension, the most common form of which is preeclampsia that causes many complications for mother and fetus.

The aim of this systematic review and meta-analysis was to determine the relationship between body mass index (BMI) and preeclampsia in Iran.

Using valid keywords in the SID database, PubMed, Scopus,data obtained from all the articles, which were reviewed in Iran between 2000 and 2016, were combined using the meta-analysis method (random-effects model) and analyzed using STATA version 11.1.

A total number of 5,946 samples were enrolled in 16 studies with the mean BMI values of 25.13, 27.42, and 26.33 kg /m2 in the healthy, mild, and severe preeclamptic groups, respectively.

The results of this study revealed that there is a significant relationship between BMI and the risk of preeclampsia, so it can be said that BMI may be one of the ways to diagnose preeclampsia.

 Hormone replacement therapy (HRT) is widely used to control postmenopausal symptoms. This therapy is also used to prevent diseases such as osteoporosis and dementia. However, clinical trials suggest some negative effects regarding postmenopausal HRT. This study evaluates the effects of HRT on postmenopausal cardiovascular events. We collected data from 32 articles by using valid keywords and searching databases of PubMed, Medlib, ScienceDirect, EmBase, Scopus, Index Copernicus, SID, and Iranmedex. Analysis was performed by comparing three groups of postmenopausal women: combined hormone therapy (estrogen + progesterone), estrogen alone treated group, and placebo-receiving group (control group). Data were analyzed using the random effect model meta-analysis by using R software and Stata software Version 11.2. Of the collected 32 studies between 1998 and 2016, there were 1277686 subjects with an average age of 60.6 years. The prevalence of myocardial infarction were (2.64%), coronary heart disease (1.7%), stroke (254%), cardiovascular death (1.54%), revascularization (3.26 %), and cerebrovascular disease (CVD) (2.78%) in the combined hormone therapy group. Also, in the estrogen-treated group were 2.95%, 3.41%, 2.49%, 2.8%, - , 3.14%, respectively. In the placebo-receiving group these events were 2.09%, 2.73%, 2.9%, 2.25%, 4.96%, and 11.92, respectively. The results showed that estrogen therapy could increase the incidence of stroke. Moreover, HRT could have positive effects on the serum lipid profile in postmenopausal women. Postmenopausal HRT appears to be non-effective on coronary artery disease, revascularization, myocardial infarction, and cardiac-related deaths; however, it could play a role in increasing the stroke rate.

Context: Hypertension is one of the most important issues in advanced and developing countries and is prevalent in diabetic patients. The present study was aimed at estimating the prevalence of hypertension in diabetic patients in Iran through meta-analysis.
Evidence Acquisitions: The search was carried out using authentic Persian and English keywords in national and international databases including IranMedex, SID, Magiran, IranDoc, Medlib, ScienceDirect, PubMed, Scopus, Cochrane, Embase, Web of Science, Medline and Google Scholar search engine without any time limitation until 2017. Heterogeneity of studies was assessed using I2 indexes. Data were analyzed using STATA software version 11.1.
In 32 reviewed studies with a sample of 34714 subjects, the prevalence of hypertension in Iranian diabetic patients was 51% (95% CI, 43%-60%). The prevalence of hypertension was 55% in type I diabetics and 53% in type II diabetic patients. Metaregression showed that there was no significant relationship between the prevalence of hypertension in diabetic patients with the sample size and year of study.
About half of the diabetic patients in Iran suffer from hypertension. Patients with type 1 diabetes suffer from hypertension 2% more than type 2 diabetes patients. The prevalence of hypertension in diabetic patients in Iran has not significantly decreased over the past years and diabetic patients in northern Iran are more likely to have hypertension than other parts of the country

Aim: The aim of this study was the evaluation of the prevalence of NAFLD in patients with type 2 diabetes mellitus.
Non-alcoholic fatty liver disease (NAFLD) is an emerging disease with high prevalence in patients with type 2 diabetes mellitus (T2DM). Many studies have reported the prevalence of NAFLD in type 2 diabetes mellitus patients. However, these results are inconsistent.
A Literature search was conducted in PubMed, Scopus, web of science and Science Direct from 2005 to August 2017. The necessary information was extracted. Heterogeneity was evaluated using I2 statistic. Meta-regression analyses were performed to the estimation of the relationship between the year of study and sample size with the prevalence of NAFLD. Publication bias was assessed by both Begg rank correlation and Egger tests. Subgroup analysis was performed for identification of sources heterogeneity.
Seventeen studies involving 10897 type 2 diabetes mellitus patients with NAFLD were included in this meta-analysis. The overall prevalence of NAFLD in type 2 diabetes mellitus patients by random effects models was 54% (95% CI, 45%- 64%). There is a significant heterogeneity across studies with (I2= 99%, p> 0.01). The funnel plot as graphically and Begg and Egger as statistically showed no publication bias among studies. Subgroup analysis indicated that the prevalence of NAFLD in type 2 diabetes mellitus patients differed in predictive factors such as lipid profile, BMI, HbA1c, AST, and ALT. This finding in spite of heterogeneity of documents is corresponding to the positive correlation between NAFLD and type 2 diabetes mellitus.
The findings indicated that the overall prevalence of NAFLD among type 2 diabetes mellitus patients is significantly higher. It can be concluded that type 2 diabetes mellitus patients should be managed to prevent NAFLD.

Based on the serious complications which are followed, hypertension is a common and asymptomatic health problem. This study aims to present a general statistics of the rate of the prevalence of systolic and diastolic hypertension in Iranian men and women based on the age range through the systematic review and meta-analysis method.

In this study of systematic review and meta-analysis, some databases such as Google Scholar, Scope.com, Magiran, Iran Medex, Medlib, Sid, and Pubmed were searched by using keywords such as hypertension, men and women, Iran, and prevalence. The first and the last published articles in this field were in 1999 and 2012, respectively. Data were combined by random effects meta-analysis model and they were analyzed by STATA11.

From 100 articles which were found in the searched references, 22 of them were finally analyzed. Among the selected final articles from 1999 to 2012, 96689 subjects were used in this study. The mean prevalence of hypertension was 17% (confidence coefficient of 95%, 17-17%). The prevalence rate of hypertension among the people above 20 was between 10-32% and its mean was 24% (confidence coefficient of 95%, 23-24%). The mean prevalence of hypertension among the people below 20 was 5% (confidence coefficient of 95%, 4-5%).

In the studies done in Iran, the prevalence rate of hypertension was high. Noticing that hypertension is an important and dangerous factor for cardiovascular diseases, it is a worrying issue in Iran and it is necessary to be programmed in order to control and prevent this disease.

Background and Coronary heart disease is one of the most common reasons for mortality in many countries. High lipid levels such as high total cholesterol are recognized as the risk factors for cardiovascular diseases. Various studies investigated the prevalence of dyslipidemia in Iran, so, in current study we performed a systematic review and meta-analysis of all studies assessing the prevalence of dyslipidemia in Iran. The search was conducted using different databases such as Pubmed, SID, Magiran, Iranmedex, Irandoc, Medlib, and Google Scholar. The search keywords and terms included total cholesterol, prevalence, meta-analysis, and Iran. Finally 41 articles that were published during 1998-2011 were selected. Assigning weights to the studies was done based on number of samples and the prevalence was investigated using binomial distribution. Data was analyzed applying random effects model in STATA (version 10) and R software. Also, publication bias was assessed by funnel plot. Total number of samples in selected articles were 205913. Prevalence of total cholesterol &ge 200 mg/dl was 38% (CI95% = 30-46) which was 41% in male and 43% in female. The prevalence of cholesterol &ge 240 mg/dl (CI95%) was 17% (15-19) 15% in male and 18% in female. This prevalence was seen in both urban (18%) and rural (23%) areas. Precise information and knowledge on prevalence of lipid profile disorders could help clinicians and policy makers to plan for suitable interventional programs that decrease the prevalence of cardiovascular diseases.