BACKGROUND: Acute coronary syndrome (ACS), a clinical manifestation of chronic coronary artery disease, is often associated with multiple complications, recurrent hospitalizations, and diminished quality of life. Evaluating quality of life is a key outcome for determining the effectiveness of clinical and educational interventions. This study examined the impact of a care program grounded in the Roy Adaptation Model (RAM) on the quality of life of patients with ACS. METHODS: In this randomized controlled trial, 76 patients with ACS were randomly assigned to either the intervention or control group. Data collection took place from July to December 2024. Participants in the intervention arm received a two-week educational care program grounded in the Roy Adaptation Model, delivered through in-person sessions and supplemented with an instructional booklet. Data were gathered using a demographic survey, the SF-36 quality-of-life instrument, and the Roy Adaptation Model assessment form, which were administered at baseline and at one and three months following the intervention. RESULTS: Independent t-tests revealed no significant pre-intervention differences in physical, mental, or overall quality-of-life scores between the groups. Following the intervention, the intervention group demonstrated significant improvements. Repeated-measures ANOVA confirmed significant main effects of time and time-by-group interaction. Subscale analysis demonstrated significant improvements in seven of the eight SF-36 domains in the intervention group. In contrast, the control group exhibited a significant improvement only in general health. CONCLUSION: The Roy Adaptation Model provides an effective framework for fostering adaptation and enhancing quality of life in cardiac patients.
BACKGROUND:The expression of metabolic genes can be changed by the simultaneous effect of endurance exercise and nutrition. The aim of this study was to verify the effects of endurance exercise and whey protein consumption on the expression of Fibronectin type III domain-containing protein 5 (FNDC5), Paraoxonase-1 (PON1), and proliferator-activated receptor alpha (PPARα) genes in muscle. METHODS:A total of twenty BalB/C male mice were accidentally selected and subsequently divided into four groups, with each group consisting of five mice. The groups were as follows: placebo, exercised, whey-supplemented, and exercise plus whey-supplemented. In the groups involving exercise, the animals underwent treadmill exercise three times per week. The expression of FNDC5, PON1, and PPARα genes was analyzed by reverse transcription-quantitative polymerase chain reaction (RT-qPCR). Finally, GraphPad Prism 9.0 software was used to statistically evaluate changes in gene expression, and one-way analysis of variance (ANOVA) at the p<0.05 level and Tukey's multiple comparison test. RESULTS:FNDC5 gene expression in muscle increased in the groups that were supplemented with whey or exercised, compared to the placebo group. Investigations did not show a significant difference in FNDC5 expression in the liver between the whey-supplemented, exercise plus whey-supplemented, and placebo groups. In both liver and muscle tissue, whey protein increased the expression of PON1 (P = 0.001) regardless of exercise. PPARα expression also increased in muscle tissue. Additionally, the expression of PON1 in muscle was higher in the whey-supplemented group compared to the exercise and placebo groups. CONCLUSION:The consumption of whey protein and its interaction with exercise can significantly contribute to the modification of energy and lipid metabolism, muscle function, and oxidative stress through increased metabolic gene transcription.
BACKGROUND:Coarctation of the aorta (CoA) in infants and young children is typically treated with high-risk open-heart surgery. Endovascular stenting provides a less invasive alternative; however, its safety and efficacy remain underexplored. This study aimed to evaluate procedural success, complications, and four-year outcomes of stenting for CoA. METHODS:A retrospective review included 30 infants and young children (28 days to 3 years of age, weight >2.5 kg) with CoA who underwent endovascular stenting in Kerman and Sistan-Baluchestan, Iran, from 2024 to 2025. Patients with complex heart defects requiring immediate surgery or weighing <2.5 kg were excluded. Diagnostics utilized echocardiography, femoral angiography (for gradient assessment), and CT angiography. Outcomes included reduction in gradient, minor complications (hematoma, transient arrhythmia, localized bleeding, and bruising), major complications (stent thrombosis, vascular rupture, stent migration, vascular injury, sepsis, and mortality), and stent patency. RESULTS:Procedural success was achieved in 27 out of 30 patients (90%, 95% CI: 73.5-97.9%). The mean gradient was reduced by 89% (from 45 ± 10 mmHg to 5 ± 3 mmHg, p<0.001). Minor complications occurred in 3 of 30 patients (10%; 95% CI: 2.1-26.5%), including 2 hematomas and 1 transient arrhythmia; no major complications or mortality were reported. Four-year stent patency was 90% (95% CI: 73.5-97.9%); 3 out of 30 patients (10%) required re-dilation at 2.5 years due to growth. Cox regression analysis found no predictors for re-intervention (p>0.05). CONCLUSION:Endovascular stenting seems to be a safe and effective alternative for CoA in infants and young children. Larger prospective studies are necessary.
BACKGROUND: Diabetic patients face an elevated cardiovascular disease burden, often requiring coronary artery bypass grafting (CABG). However, evidence regarding post-CABG outcomes in diabetic versus non-diabetic patients is inconsistent, and data from the Iranian population are particularly scarce. This study was conducted to clarify this ambiguity by comparing short-term post-CABG complications between these groups.. METHODS: A retrospective cohort study analyzed data from the Yazd Cardiovascular Disease Registry (YCDR) for all CABG patients (2017-2018) at Afshar Hospital. Patients were stratified into diabetic (n=592) and non-diabetic (n=694) groups. We collected standardized data on demographics, comorbidities (including diabetes), and in-hospital major postoperative complications following CABG, such as reoperation, mortality, infections, renal complications, neurological complications (including TIA, stroke, and seizure), and pulmonary complications. RESULTS: The frequency distribution of female sex (36.66% vs. 21.90%), hypertension (65.03% vs. 44.52%), and hyperlipidemia (39.02% vs. 23.20%) in diabetic patients was significantly higher than in non-diabetic patients (p<0.001). No statistically significant differences were observed between diabetic and non-diabetic groups in the incidence of major complications, including reoperation (2.1% vs. 2.3%), mortality (3.2% vs. 2.4%), and other major events (all p>0.05). However, seizure occurred exclusively in the diabetic group (1.1% vs. 0%; p=0.049). Logistic regression analysis demonstrated that diabetes mellitus was not an independent predictor of overall postoperative complications. CONCLUSION: In this cohort, diabetes was not an independent risk factor for most shortterm post-CABG complications. The exception was a higher seizure incidence in diabetic patients, warranting further mechanistic investigation. Larger prospective studies are needed to confirm these findings.
BACKGROUND:Given the importance of diabetes mellitus (DM) and its role in the development of aortic valve stenosis (AVS), as well as its association with adverse outcomes after aortic valve replacement (AVR), the present meta analysis aimed to provide a comprehensive review of previous studies in this field. METHODS:To achieve this objective, a thorough literature search was conducted in PUBMED/MEDLINE, ScienceDirect, CINAHL, EMBASE/SCOPUS, PsycINFO, ClinicalKey, the Cochrane Central Register of Controlled Trials (CENTRAL), ProQuest, Web of Science, and Persian databases such as SID and Magiran. The number of patients, gender ratio, mean age, prevalence of T2DM, AVS, and treatment outcomes after TAVI, TAVR, and SAVR (stroke, early and late mortality) were recorded. RESULTS:This metaanalysis comprised 22 studies involving a total of 760,287 patients with AVS. The pooled prevalence of DM was approximately 31% (95% CI: 26-36%). DM was associated with a significantly higher risk of early mortality, including both inhospital mortality (OR: 2.399) and 30day mortality (OR: 1.45), compared with nonDM patients (p<0.05). However, the increase in late mortality (one year or longer) among DM patients was not statistically significant. Additionally, DM patients showed a significantly elevated risk of stroke compared with nonDM patients (OR: 1.15; 95% CI: 1.03-1.28; p=0.009). CONCLUSION:Overall, DM appears to play a significant role in the development of AVS and is associated with adverse outcomes including mortality and stroke after AVR.
Across the world the incidence of cancer is predicted to increase by 47% over the next 20 years. Increasingly, cardiologists will be faced with patients presenting with acute coronary syndromes, who are receiving active treatment for cancer. On the other hand, metastasis of malignant tumors to the heart is not usual but can present with various clinical features such as pericardial effusion, heart failure, arrhythmia, and myocardial infarction. Rarely, they may cause characteristic electrocardiographic changes, resembling ST-segment elevated myocardial infarction (STEMI). Decision making in this scenario is complex and requires detailed knowledge of the patient's cancer stage, response to cancer treatment, and overall prognosis. Proper diagnosis is critical in these patients to prevent unnecessary or even harmful interventions such as fibrinolytic therapy. We reported a 45-year-old woman with a history of ovarian carcinoma, who presented with atypical chest pain and ECG findings suggestive myocardial infarction. But after full investigation we realized these ECG changes were due to the myocardial invasion of the tumor not coronary atherosclerosis and obstruction.
BACKGROUND:The incidence of coronary artery disease (CAD) is influenced by several risk factors, including hypertension. Although the association between hypertension and CAD has been investigated in Western countries, limited research has been conducted in Asia and the Middle East. We investigated the association between hypertension and the 10year risk of CAD in the adult population. METHODS:In this cohort study, 2,000 participants aged 20 to 74 years in the Yazd Healthy Heart Project were enrolled in 2005-2006 and followed up to 2015-2016. Participants with a history of CAD were excluded. At baseline, data on demographic characteristics, anthropometric measurements, biochemical blood tests, and lifestyle factors were collected. The association between hypertension and approximately 10year CAD risk was assessed using the Cox regression model. RESULTS:The baseline prevalence of hypertension among adults was 36.1%. During the tenyear followup, CAD incidence was 16.8% in men, 12.0% in women, and 14.5% in the total population. After adjusting for potential confounders, hypertension increased the risk of CAD in men (HR = 1.64; 95% CI: 1.09-2.46), women (HR = 2.16; 95% CI: 1.15-4.05), and the whole sample (HR = 1.73; 95% CI: 1.23-2.43). This association was similar in men and women (p for interaction ≥0.05). CONCLUSION:This study demonstrated a significant association between hypertension and CAD risk, highlighting the need for targeted interventions in populations with hypertension to reduce CAD risk.
BACKGROUND:Familial hypercholesterolemia (FH) is the most common monogenic disorder in humans. There is a lack of data on the clinical characteristics and natural history of FH patients in Iran, which necessitates performing a longitudinal study. METHODS:In this five-year prospective longitudinal cohort study, we enrolled patients with high LDL cholesterol who were registered in the Iranian Registry of Hypercholesterolemia (IFHR), diagnosed as definite and probable FH cases based on the Dutch Lipid Clinic Network Score (DLCN ≥6). General characteristics, lipid profiles, and cardiovascular disease assessments were evaluated in the baseline phase, and whole blood samples were stored for future genetic and epigenetic studies. This study will evaluate the incidence and recurrence rates of cardiovascular disease (CVD) and mortality as the main outcomes during five years of follow-up. RESULTS:During the initial year, we successfully identified and enrolled patients with FH. We are reporting the whole methodology and the results of the first 50 who were followed up. At the study's outset, the patients exhibited a mean age of 50.27±12.06 years, with 64% being men and 36% women. The mean LDL level recorded was 312.8 ±106.3 mg/dL, with the highest LDL concentration observed at 623.5 mg/dL. A total of 62.0% of patients were on lipid-lowering treatment mostly of the PCAD group. CONCLUSION:In this paper, we present the design and methodology of the Isfahan Familial Hypercholesterolemia Cohort (IFHC) study in detail with the aim of helping future research generate evidence from comprehensive IFHC data sources.
BACKGROUND: The hypertriglyceridemic waist phenotype (HTGW), a surrogate indicator of visceral adiposity, has been proposed as a simple screening tool for cardiometabolic risk. Limited information is available on the influence of HTGW and its temporal variations on the development of hypertension. This study examined the association between HTGW and decade-long hypertension incidence in an urban population of Iranian adults. METHODS: Data were obtained from the Yazd Healthy Heart Project (YHHP). In its initial phase (2005-2006), 2,000 participants aged 20-74 years were enrolled. At baseline, demographic characteristics, blood pressure, anthropometric data, and biochemical tests were evaluated and reassessed in 2015-2016. After excluding individuals with hypertension at baseline, 1,269 normotensive participants were followed for approximately 10 years to assess incident hypertension, using multivariable logistic regression analyses in SPSS. RESULTS: In this study, after excluding participants lost to follow-up, 786 participants were selected for the final analysis. The cumulative incidence of hypertension was 40.3% (317 out of 786). After adjustment for potential confounders, the risk of HTN was significantly higher among participants with hypertriglyceridemia (OR=2.38, 95% CI: 1.21-4.67) and those with HTGW (OR=1.88, 95% CI: 1.12-3.13) compared to those with normal waist and normal triglycerides (NWNT) in the total population. In men, there was a significant positive association between hypertriglyceridemia (OR=2.71, 95% CI: 1.22-6.02) and HTGW (OR=2.35, 95% CI: 1.23-4.47) and the 10-year incidence of HTN after multivariate adjustment. CONCLUSION: Our findings showed that hypertriglyceridemia and HTGW are independent predictors of 10-year hypertension incidence, particularly among men, in an Iranian urban adult population.
BACKGROUND: Morbidity and mortality rates in patients with peripheral arterial disease range from 30% to 70% during the 5- to 15-year period after diagnosis. The objective of the present study was to evaluate the mortality rate after emergency leg amputation and analyze the cause of death. METHODS: In this case series study, the incidence and cause of mortality, level of amputation, presence of chronic arterial disease, diabetes mellitus, smoking, and arterial hypertension were evaluated in 100 consecutive patient records. RESULTS: Sixty-one male and 39 female patients with a mean age of 66 years were studied. Amputation was indicated urgently in 86% of patients. Most (60%) suffered supra-genicular amputation, with 11 (18.33%) deaths, and 40% infra-genicular amputation, with seven (17.5%) deaths. The total death rate was 18%. CONCLUSION: Mortality in the perioperative period of emergency major lower limb amputation remains high, with infection being the leading cause.
BACKGROUND: Cardiovascular diseases (CVDs) are the most important cause of mortality and disability worldwide, causing substantial personal, social, and economic problems. This study determined the use and Cost of inpatient diagnostic and therapeutic CVD procedures in Isfahan from 2019 to 2021. METHODS: This descriptive study covered a three-year period (2019-2021). Data were gathered from the Health Information System of two public hospitals that carried out these procedures (Chamran and Khorshid hospitals) in Isfahan, Iran. A list of procedures was carefully chosen according to experts' opinions, for which the use and cost of these procedures were extracted. RESULTS: Coronary angiography demonstrated the highest annual average use (47.65%), while mitral valve repair showed the lowest (0.06%). The highest annual average total cost was seen in angioplasty (617,425,750,917 IRR), while the lowest was seen in mitral valve repair (2,375,305,232 IRR). Regarding cost per procedure, VSD surgery (409,107,479 IRR) had the highest annual average cost, while the lowest was seen in coronary angiography (56,340,938 IRR). A consistent upward trend in cost per procedure (in IRR) was observed across all procedures during the study period. CONCLUSION: The majority of cardiovascular procedure costs are attributable to diagnosing and treating ischemic heart disease (IHD). Consequently, the increasing prevalence of CVDs particularly IHD coupled with the use of advanced technologies, imposes a significant financial burden on the healthcare system. This underscores the critical need for policy actions focused on lifestyle modification and primary prevention. Such measures are essential to curb rising costs and ensure healthcare system sustainability.
BACKGROUND:The present study aimed to determine the predictive model of health-promoting lifestyle in cardiovascular patients based on intimate relationships and distress tolerance, mediated by cognitive flexibility. METHODS:The research design was a cross-sectional correlational study using structural equation modeling. The statistical population included cardiovascular patients in 2025 who referred to three specialized cardiology clinics for outpatient examination. A total of 265 individuals were selected as the sample using convenience sampling. Standard questionnaires for health-promoting behaviors (Walker et al.), social intimacy (Miller and Lefcourt), distress tolerance (Simons and Gaher), and cognitive flexibility (Dennis and Vander Wal) were used. Statistical data analysis was performed using the Pearson correlation coefficient and path analysis with bootstrap testing, employing AMOS 24 and SPSS 26 software. RESULTS:The results of path analysis and bootstrap testing showed that the proposed model had a good statistical fit (χ²/df = 2.94, RMSEA = 0.071, CFI = 0.939, GFI = 0.990). The indirect effect of intimate relationships on health-promoting lifestyle through cognitive flexibility (β = 0.1148, p = 0.001) and the indirect effect of distress tolerance on health-promoting lifestyle through cognitive flexibility (β = 0.0924, p = 0.001) were confirmed. CONCLUSION:The structural model, with good fit, explained the mediating role of cognitive flexibility in the relationship between intimate relationships and distress tolerance with health-promoting lifestyle in cardiovascular patients. These findings provide an operational framework for psychotherapy interventions based on strengthening distress tolerance and interpersonal relationships to improve cardiovascular health.
BACKGROUND:Primary percutaneous coronary intervention (PPCI) is considered the gold standard for ST-elevation myocardial infarction (STEMI) treatment. While door-to-device (DTD) time critically influences outcomes, its combined impact with baseline characteristics requires further investigation. METHODS:In this descriptive cross-sectional analytical study, 163 patients with STEMI undergoing PPCI were recruited through convenience sampling at two hospitals affiliated with Ahvaz Jundishapur University of Medical Sciences between November 2024 and May 2025. Data were collected via hospital records and a researcher-designed checklist covering demographic and clinical variables. Statistical analyses were performed using SPSS version 26. RESULTS:The mean age of participants was 57.55 ± 13.19 years, and 85.9% were male. The mean DTD time was 108.08 minutes. Longer DTD time was significantly associated with prolonged CCU stay (r = 0.335, p < 0.001) and lower left ventricular ejection fraction (LVEF) (r = -0.232, p = 0.003). Although DTD time did not differ significantly between survivors and non-survivors (p = 0.573), it varied significantly across different degrees of myocardial injury (p = 0.027). Multivariate regression analysis showed that male gender (β = -8.007, p = 0.002), increased DTD time (β = -0.043, p = 0.005), and myocardial injury (β = -14.904, p = 0.016) were significantly associated with reduced LVEF. Increased DTD time (β = 0.014, p < 0.001) and decreased LVEF (β = -0.061, p = 0.003) were significantly associated with longer CCU stays. CONCLUSION:While baseline characteristics showed minimal impact, DTD time significantly predicted worse outcomes, including prolonged CCU stays, reduced LVEF, and myocardial injury. These findings emphasize the critical importance of reducing DTD time (<60 minutes) through optimized emergency protocols to improve STEMI management outcomes.
BACKGROUND:This study aimed to evaluate the association between the bifurcation angle and the angle of the origin of the left anterior descending (LAD) coronary artery with the degree of proximal LAD (pLAD) stenosis. METHODS:This study was cross-sectional and addressed 578 patients suspected of coronary artery disease (CAD) who underwent coronary computed tomography angiography (CCTA) because of angina pectoris symptoms at Shahid Chamran Hospital, Isfahan. PLAD stenosis as well as the left main (LM)-LAD and the LAD-left circumflex artery (LCX) (bifurcation) angles were assessed and recorded on CCTA images. Then, one-way analysis of variance (ANOVA) or chi-squared tests were used. ROC analysis was used to evaluate the diagnostic value of each of the two angles in identifying pLAD stenosis. RESULTS:Using a cut-off value of 23º for the LM-LAD angle, the sensitivity and specificity for predicting pLAD stenosis <50% were 63.70% and 47.67%, respectively. In addition, using a cut-off value of 30º for the LM-LAD angle, the sensitivity and specificity for predicting pLAD stenosis ≥50% were 52.24% and 68.77%, respectively (P value<0.05). Moreover, for predicting pLAD stenosis <50%, a 49º cut-off for the LAD-LCX angle demonstrated a sensitivity and specificity of 61.64% and 56.99%, respectively. Furthermore, for predicting pLAD stenosis ≥50%, a 50º cut-off for the LAD-LCX angle yielded a sensitivity and specificity of 70.15% and 58.63%, respectively (P value<0.05). CONCLUSION:The findings of this study showed that the LAD-LCX and LM-LAD angles had a direct and significant association with the severity of pLAD stenosis, such that wider angles were associated with greater pLAD stenosis.
BACKGROUND: Due to high burnout and intense emotional investment in patient outcomes, nurses may inadvertently become trapped in dysfunctional interpersonal dynamics at work, resembling Stockholm syndrome. Understanding and managing this phenomenon requires field research. This study explores intervention strategies to address organizational Stockholm syndrome among nursing staff in cardiac care hospitals in Isfahan. METHODS: This sequential exploratory mixed-methods study comprised qualitative and quantitative phases. In Phase I, 21 cardiac nursing specialists were purposively recruited and interviewed using semi-structured, in-depth interviews. Data were analyzed using Braun and Clarke's thematic analysis, and trustworthiness was ensured according to Lincoln and Guba's criteria. In Phase II, the qualitative findings informed the development of a structured survey administered to 276 staff working in cardiovascular wards in Isfahan. Participants rated eight qualitatively derived strategic domains using a 5-point Likert scale. A hierarchical model was tested in AMOS 22 to examine the higher-order organization and conceptual coherence of the proposed framework. RESULTS: The findings support a hierarchical framework for addressing organizational Stockholm syndrome among cardiac nurses, highlighting coordinated strategies across individual, interpersonal, and organizational domains. The three higher-order dimensions were Individual Empowerment (positive affect, psychological development, and self-belief), Interpersonal Development (social capital and communication climate), and Improving Organizational Climate (social hope and morale). The quantitative findings indicated acceptable hierarchical coherence among the domains, providing preliminary structural support for the proposed framework. CONCLUSION: The proposed tri-level framework offers a practical approach for hospital management to address organizational Stockholm syndrome by supporting empowerment initiatives, strengthening organizational voice, and enhancing transparency. Integrating these strategies may improve psychological safety, promote staff well-being, and ultimately contribute to better quality of patient care.
BACKGROUND:Cardiac rehabilitation (CR) is a critical intervention for reducing complications after cardiovascular procedures such as percutaneous coronary intervention (PCI). One of the key outcomes used to evaluate the effectiveness of CR programs is improvement in patients' work ability. This study aimed to assess the impact of a structured CR program on work ability in patients undergoing PCI. METHODS:A retrospective study was conducted, comparing 36 patients who participated in a structured CR program following PCI with 36 patients who did not receive rehabilitation. The CR program included educational and exercise components, delivered over four weeks with three sessions per week. Work ability was evaluated three months post-intervention using a standardized questionnaire. Statistical analyses, including independent t-tests and correlation assessments, were performed to examine the relationship between CR participation and work ability. RESULTS:The two groups were comparable in terms of age, gender, and underlying medical conditions (p > 0.05). Notably, 80% of patients in the CR group demonstrated good to excellent work ability, compared with only 25% in the control group (p < 0.001). The mean work ability score was significantly higher in the CR group than in the control group (mean difference = 7.55, p < 0.001). CONCLUSION:Participation in a cardiac rehabilitation program significantly improves work ability in patients following PCI. These findings highlight the importance of integrating CR into post-PCI care. Future research should focus on randomized clinical trials incorporating diverse rehabilitation protocols and extended follow-up periods to further validate these results.
BACKGROUND:Despite controversial findings regarding the association between thyroid hormones and heart failure with preserved ejection fraction (HFpEF), thyroid dysfunction is widely assumed to be independently associated with this condition. Herein, we sought to systematically review the existing literature and estimate the prevalence of thyroid dysfunction in patients with HFpEF. METHODS:We conducted a comprehensive search in PubMed, Scopus, Web of Science, Embase, and ProQuest up to the end of November 2024. Observational studies assessing thyroid dysfunction prevalence in patients with HFpEF were included in this study. The prevalence of overt thyroid dysfunction, low T3 syndrome, and subclinical hypothyroidism (SCH) was pooled using a random-effects model. Duval and Tweedie's Trim and Fill test, funnel plot, and Egger's test were utilized for publication bias assessment. All analyses were conducted with R Version 4.5.1 and Comprehensive Meta-Analysis Version 3 software. RESULTS:Fourteen studies involving 3,931 subjects with HFpEF were included in this analysis. The pooled prevalence of overt thyroid dysfunction, based on six studies, was 15% (95% CI: 7%-29%). The pooled prevalence of low T3 syndrome was 22% (95% CI: 20%-25%), and for SCH, it was 15% (95% CI: 1%-68%). CONCLUSION:Despite heterogeneity among the included studies, our findings suggest that thyroid dysfunction is relatively common in patients with HFpEF and may be associated with more severe symptoms and worse outcomes.
BACKGROUND:Breast cancer is the most common malignancy in women, with 15-20% being HER2-positive, an aggressive subtype treated with Trastuzumab. Despite its survival benefits, Trastuzumab may cause cardiotoxicity, typically monitored by left ventricular ejection fraction (LVEF). This study assessed Trastuzumab's impact on LVEF and related factors among women with breast cancer in Baghdad. METHODS:This retrospective observational cohort study included 60 women with stage I-III HER2-positive breast cancer treated at Al-Amal National Oncology Hospital between January 2023 and May 2024. Baseline demographic, clinical, and echocardiographic parameters were collected, with follow-up assessments every three weeks during therapy and after the final cycle. Data were analyzed using SPSS version 27. RESULTS:A P-value <0.05 was considered statistically significant. Mean LVEF declined significantly from 64.98% ± 5.50 to 62.02% ± 6.91 post-treatment (P < 0.001). The proportion of patients with impaired left ventricular diastolic function increased from 11.7% to 26.7% (P = 0.003). An LVEF decline of ≥10% was considered clinically meaningful. Traditional risk factors were not associated with LVEF decline, whereas baseline LVDF (OR 10.80; 95% CI: 2.21-17.42; P = 0.007) and post-treatment LVDF (OR 8.20; 95% CI: 1.74-13.58; P = 0.008) were significantly linked to LVEF decline. CONCLUSION:Trastuzumab can cause early cardiac function decline, which is not always detected by LVEF alone. Assessment of left ventricular diastolic function at baseline and during therapy can identify high-risk patients, enabling timely monitoring and management to balance anticancer benefits with cardiotoxic risk.
BACKGROUND:The burden of stroke can be reduced by controlling its mortality risk factors. We aimed to identify the predictors of mortality within six months after ischemic stroke. METHODS:This prospective cohort study was performed on 703 ischemic stroke patients in Tehran, Iran, during 2018-2019. Data on demographic and clinical characteristics were collected through interviews and hospital records. The patients' survival status was followed up by telephone interviews at 28 days, 3 months, and 6 months after stroke. Cox proportional hazard model and extended Cox model were used to determine the predictors of mortality after stroke. RESULTS:The 6-month mortality rate was 19.50% (95% CI: 16.70-22.67). Age (HR=1.01; 95% CI: 1.001-1.03), higher educational levels (HR=1.05; 95% CI: 1.01-1.10), and blood sugar levels on admission (HR=1.04; 95% CI: 1.01-1.08) were significantly associated with an increase in 6-month mortality. However, alcohol consumption (HR=0.09; 95% CI: 0.02-0.38), alteplase administration (HR=0.65; 95% CI: 0.43-0.98), and higher hemoglobin values (HR=0.80; 95% CI: 0.72-0.88) were associated with a decrease in 6-month mortality. The hazard ratio of death for diastolic blood pressure, socioeconomic status, cholesterol levels, and stroke severity varied over time. CONCLUSION:Some characteristics significantly increased or decreased the risk of mortality after stroke. Additionally, the effect of some variables changed over time, suggesting that stroke prognosis may be associated with dynamic risk factors. Identifying and addressing these factors can inform targeted strategies to improve post-stroke survival outcomes.
BACKGROUND:Diet is an important risk factor for ischemic heart disease (IHD), but its effects on IHD and trends in the North Africa and Middle East (NAME) region are unknown. We aimed to evaluate the burden of different dietary risk factors on mortality and disability-adjusted life-years (DALYs) attributable to IHD in the NAME region from 1990 to 2019. METHODS:The data and estimations were extracted from the Global Burden of Disease (GBD) 2019 Global Health Data Exchange. The proportion of IHD burden due to dietary risks was estimated through a comparative risk assessment approach. We calculated the mortality and DALYs rate attributable to diet for IHD using disease-specific population attributable fractions. RESULTS:The age-standardized rate of IHD mortality and DALYs attributed to dietary risk in the NAME region were 102.1 (95% uncertainty interval (UI): 81.0-121.1) and 2060.6 (95% UI: 1630.7-2471.2), respectively. These rates were higher than the global estimates for mortality (62.4 [95% UI: 51.0-73.6]) and DALYs (1271.3 [95% UI: 1061.3-1473.8]) and were greater in men than in women. Suboptimal diet contributed to 46.6% of IHD mortality and 49.5% of related DALYs. Low whole-grain intake was the leading dietary risk across all countries and years, responsible for 44.5 [95% UI: 18.6-57.1] IHD mortalities and 912.8 [95% UI: 369.7-1177.8] DALYs per 100,000. CONCLUSION:Despite a decline in the burden of IHD attributable to diet in the NAME region, it remains substantially high. There exists considerable potential for enhancing dietary quality, particularly through the increased incorporation of whole grains.
