Beneficial Effects of Pentoxifylline Plus Losartan Dual Therapy in Type 2 Diabetes with Nephropathy

Background

This study was designed to comparatively assess the effects of add-on pentoxifylline to losartan versus increasing the dose of losartan on serum N-terminal pro-brain natriuretic peptide (NT-proBNP), serum highly sensitive C-reactive protein (hsCRP) and the urinary albumin excretion (UAE) rate in patients with type 2 diabetes and nephropathy.

Third national surveillance of risk factors of non-communicable diseases (SuRFNCD-2007) in Iran: methods and results on prevalence of diabetes, hypertension, obesity, central obesity, and dyslipidemia

Background  

The burden of non-communicable diseases is rising globally. This trend seems to be faster in developing countries of the Middle East. In this study, we presented the latest prevalence rates of a number of important non-communicable diseases and their risk factors in the Iranian population.     

The economic costs of diabetes: a population-based study in Tehran, Iran

Aim/hypothesis  The aim of the study was to determine the annual healthcare expenditures of an individual with diabetes in Tehran, between March 2004 and March 2005. Methods  This prevalence-based ‘cost-of-illness’ study was conducted in two phases. In the first phase, 23,707 randomly selected individuals were interviewed to gather a cohort of participants with diabetes. In the second phase, 710 diabetic patients and 904 age- and sex-matched controls were followed up for 1 year at intervals of 3 months and the direct (physician services, medications and devices, hospitalisation, laboratory, paraclinical and transport) and indirect (loss of productivity) expenditures were recorded. The excess costs of a person with diabetes were estimated through comparison with matched controls. The estimates were also extrapolated to the total population of Tehran and Iran. The costs were converted from the Iranian rial to the US dollar (exchange rate September 2004). Results  Total annual direct costs of diabetic and control participants were $152.3 ± 14.5 and $52.0 ± 5.8, respectively, which is indicative of 2.92 times higher costs in diabetic patients. The most expensive components of direct costs were medications and devices, and hospitalisation in diabetic patients (28.7% and 28.6%, respectively). Total indirect costs were $39.6 ± 2.4 and $16.7 ± 1.1 in diabetic and non-diabetic individuals. The aggregate annual direct costs of diabetes were estimated to be $112.424 ± 10.732 million and $590.676 ± 65.985 million in Tehran and Iran, respectively. Diabetes complications contributed 53% of the aggregate excess direct costs of diabetes. Conclusions/interpretation  Diabetes is an expensive medical problem in Iran and planning of national programmes for its control and prevention is necessary.     

Association of CTLA-4 gene polymorphism with Graves' disease and ophthalmopathy in Iranian patients

BackgroundThe cytotoxic T lymphocyte associated antigen-4 (CTLA-4) gene, is one of the candidate genes for susceptibility to Graves' disease. This study aimed to investigate the association of Graves' disease and Graves' ophthalmopathy with polymorphisms at position + 49 in exon 1 and positions ? 318 and ? 1147 in the promoter region of CTLA-4 gene in Iranian patients.MethodsA total of 205 unrelated Iranian patients with Graves' disease who were referred to the outpatient endocrine clinic of a large university general hospital and 103 sex-matched healthy controls were included in this study. Venous blood was obtained, genomic DNA was extracted by a salting out method, and the polymorphisms at positions + 49, ? 318 and ? 1147 of the CTLA-4 gene were determined using the PCR-restriction fragment length polymorphism method (PCR-RFLP). Genotype and allele frequencies were determined.ResultsThe frequency of the G allele at position + 49 was significantly higher in patients with Graves' disease than in the control group (27.1% vs. 15.1%, OR = 2.096, 95%CI = 1.350–3.253 and p < 0.01). Significant trends were not seen for the other two polymorphisms studied. In patients with ophthalmopathy, the frequency of the G allele at position + 49 was higher than in those without ophthalmopathy (33.8% vs. 20.0%, OR = 2.043, 95%CI = 1.304–3.202 and p < 0.01).ConclusionThe results of this study suggest that the G allele at position + 49 in exon1 of the CTLA-4 gene is associated with Graves' disease and Graves' ophthalmopathy in Iranian patients.     

Inadvertent rubella vaccination of pregnant women: evaluation of possible transplacental infection with rubella vaccine

During mass campaign for measles/rubella vaccination on December 2003 in Iran, many pregnant women have vaccinated mistakenly. These women were grouped to susceptible and immune against rubella before vaccination by the status of IgG avidity response to rubella vaccine, then susceptible women were followed up to delivery time and their neonates were followed up to one year. In five neonates that were born from susceptible women, rubella-specific IgM has detected in cord blood sera, but they have not shown signs compatible to congenital rubella syndrome.     

Trends in the prevalence of diabetes and impaired fasting glucose in association with obesity in Iran: 2005–2011

Aims

To estimate the prevalence and trends of diabetes mellitus (DM) and impaired fasting glucose (IFG), 2005–2011, and to determine the contribution of obesity to DM prevalence.

Patients and methods

Data from Surveillance of Risk Factors of Non-communicable Diseases (SuRFNCD) conducted in 2005, 2007, and 2011 were gathered. DM was defined as presence of self-reported previous diagnosis or a fasting plasma glucose (FPG) ≥ 7 mmol/L. IFG was diagnosed with FPG levels between 5.6 and 6.9 mmol/L. Prevalence rates for 2011 and trends for 2005–2011 were determined by extrapolating survey results to Iran's adult population. Population attributable fraction (PAF) of obesity was also calculated.

Results

In 2011, IFG and total DM prevalence rates were 14.60% (95%CI: 12.41–16.78) and 11.37% (95%CI: 9.86–12.89) among 25–70 years, respectively. DM was more common in older age (p < 0.0001), in women (p = 0.0216), and in urban-dwellers (p = 0.0001).In 2005–2011, trend analysis revealed a 35.1% increase in DM prevalence (OR: 1.04, 95%CI: 1.01–1.07, p = 0.011); albeit, IFG prevalence remained relatively unchanged (OR: 0.98, 95%CI: 0.95–1.00, p = 0.167). In this period, DM awareness improved; undiagnosed DM prevalence decreased from 45.7% to 24.7% (p < 0.001). PAF analysis demonstrated that 33.78%, 10.25%, and 30.56% of the prevalent DM can be attributed to overweight (BMI ≥ 25 kg/m²), general obesity (BMI ≥ 30 kg/m²), and central obesity (waist circumference ≥ 90 cm), respectively. Additionally, the DM increase rate in 2005–2011, was 20 times higher in morbidly obese compared with lean individuals.

Conclusion

More than four million Iranian adults have DM which has increased by 35% over the past seven years, owing in large part, to expanding obesity epidemic.     

Gender-specific changes in physical activity pattern in Iran: national surveillance of risk factors of non-communicable diseases (2007–2011)

Objectives

This study describes the gender-specific pattern of physical activity (PA) in Iran 2011. The 4-year changes in PA levels (domains) are also determined according to the Iran’s national surveys conducted on 2007 and 2011.

Methods

Physical activity assessed based on the global physical activity questionnaire. In all, 4,121 (2007), and 7,436 (2011) adults were analyzed.

Results

Based on 2011 survey, 56.4 %, 39.2 %, and 74.4 % of participants were physically inactive at work, commuting and recreation, respectively. In all domains of PA, males showed a higher degree of activity (min/day) than females (P value <0.001). The overall prevalence of physical inactivity was increased from 15 % (2007) to 21.5 % (2011) (P value <0.001). Over the 4 years, a significant decline in total physical activity (MET × min/week) and the duration of commuting activity were noted in both genders. Work-related activity was dramatically decreased in females. However, the time spent in recreational activity remained relatively constant.

Conclusions

This report indicating that the Iranian population, particularly females, have become less active during the survey period. Physical inactivity should receive more attention as a public health issue.     

Manual or Automated Sphygmomanometer? A Historical Cohort to Quantify Measurement Bias in Blood Pressure Recording

The authors aimed to quantify end‐digit and threshold biases in blood pressure (BP) measurement with manual and digital sphygmomanometers. In a 3‐year follow‐up, end‐digit and threshold biases were investigated and a new index, called the deviation index, was used to quantify measurement bias. The distribution of systolic and diastolic BPs became close to normal after implementation of digital sphygmomanometers. The appearance of zero end digits decreased from 97% to 30% (P<.0001). The deviation index decreased from 97% to 20% (P<.0001). Mean systolic and diastolic BPs increased immediately after implementation of automated sphygmomanometers (124.22±0.83 vs 132.90±0.78 and 74.38±0.50 vs 80.43±0.51, respectively; P<.0001 for both) but showed a linear decreasing trend during follow‐up (systolic −3.59 mm Hg per year; 95% confidence interval, −5.57 to −1.61 [P<.0001]; diastolic: −2.52 mm Hg per year; 95% confidence interval, −3.78 to −1.26 [P<.0001]). Threshold bias decreased from 12.94% to 6.68% (P<.0001). Replacing manual sphygmomanometers with digital devices decreased end‐digit and threshold biases in BP measurement. The deviation index can be used to quantify the magnitude of measurement bias.

Blood pressure (BP) is recorded in nearly each medical visit. Various kinds of error could arise in this process, originating from uncalibrated devices, improper technique, or examiner error.¹, ² Rounding BP values to the nearest 10 mm Hg is a known source of bias in recording BP in the clinical setting.³, ⁴, ⁵ This is called end‐digit bias and leads to the appearance of zeros as end digits more frequently than would be expected by chance alone. Another kind of bias is threshold bias, defined as selection of particular values near treatment cut‐offs.⁶ Introduction of automated digital sphygmomanometers have made a difference in proper BP measurement and may help decrease both end‐digit and threshold biases.⁷ While monitoring for quality assurance is not routine in general practice, several studies have focused on how and when a flawed BP recording system should be suspected in the clinical setting.From a statistical perspective, we propose a simple index to assess the validity of BP measurement systems. In this study, we investigated a quantitative method by which one could examine the degree of deviation of recorded BP measurements from expected values. We then compared manual and automated sphygmomanometers in terms of end‐digit and threshold biases in a real clinical setting and applied our index to quantify the magnitude of end‐digit bias in this context.