Publications by authors named "Arash Rashidi"

27 Publications

  • Page 1 of 1

Thrombosis, Bleeding, and the Observational Effect of Early Therapeutic Anticoagulation on Survival in Critically Ill Patients With COVID-19.

Ann Intern Med 2021 01 26. Epub 2021 Jan 26.

Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (S.G., D.E.L.).

Background: Hypercoagulability may be a key mechanism of death in patients with coronavirus disease 2019 (COVID-19).

Objective: To evaluate the incidence of venous thromboembolism (VTE) and major bleeding in critically ill patients with COVID-19 and examine the observational effect of early therapeutic anticoagulation on survival.

Design: In a multicenter cohort study of 3239 critically ill adults with COVID-19, the incidence of VTE and major bleeding within 14 days after intensive care unit (ICU) admission was evaluated. A target trial emulation in which patients were categorized according to receipt or no receipt of therapeutic anticoagulation in the first 2 days of ICU admission was done to examine the observational effect of early therapeutic anticoagulation on survival. A Cox model with inverse probability weighting to adjust for confounding was used.

Setting: 67 hospitals in the United States.

Participants: Adults with COVID-19 admitted to a participating ICU.

Measurements: Time to death, censored at hospital discharge, or date of last follow-up.

Results: Among the 3239 patients included, the median age was 61 years (interquartile range, 53 to 71 years), and 2088 (64.5%) were men. A total of 204 patients (6.3%) developed VTE, and 90 patients (2.8%) developed a major bleeding event. Independent predictors of VTE were male sex and higher D-dimer level on ICU admission. Among the 2809 patients included in the target trial emulation, 384 (11.9%) received early therapeutic anticoagulation. In the primary analysis, during a median follow-up of 27 days, patients who received early therapeutic anticoagulation had a similar risk for death as those who did not (hazard ratio, 1.12 [95% CI, 0.92 to 1.35]).

Limitation: Observational design.

Conclusion: Among critically ill adults with COVID-19, early therapeutic anticoagulation did not affect survival in the target trial emulation.

Primary Funding Source: None.
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http://dx.doi.org/10.7326/M20-6739DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7863679PMC
January 2021

Incidence of symptomatic venous thromboembolism following hospitalization for coronavirus disease 2019: Prospective results from a multi-center study.

Thromb Res 2021 02 11;198:135-138. Epub 2020 Dec 11.

Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.

Background: Thrombosis and pulmonary embolism appear to be major causes of mortality in hospitalized coronavirus disease 2019 (COVID-19) patients. However, few studies have focused on the incidence of venous thromboembolism (VTE) after hospitalization for COVID-19.

Methods: In this multi-center study, we followed 1529 COVID-19 patients for at least 45 days after hospital discharge, who underwent routine telephone follow-up. In case of signs or symptoms of pulmonary embolism (PE) or deep vein thrombosis (DVT), they were invited for an in-hospital visit with a pulmonologist. The primary outcome was symptomatic VTE within 45 days of hospital discharge.

Results: Of 1529 COVID-19 patients discharged from hospital, a total of 228 (14.9%) reported potential signs or symptoms of PE or DVT and were seen for an in-hospital visit. Of these, 13 and 12 received Doppler ultrasounds or pulmonary CT angiography, respectively, of whom only one patient was diagnosed with symptomatic PE. Of 51 (3.3%) patients who died after discharge, two deaths were attributed to VTE corresponding to a 45-day cumulative rate of symptomatic VTE of 0.2% (95%CI 0.1%-0.6%; n = 3). There was no evidence of acute respiratory distress syndrome (ARDS) in these patients. Other deaths after hospital discharge included myocardial infarction (n = 13), heart failure (n = 9), and stroke (n = 9).

Conclusions: We did not observe a high rate of symptomatic VTE in COVID-19 patients after hospital discharge. Routine extended thromboprophylaxis after hospitalization for COVID-19 may not have a net clinical benefit. Randomized trials may be warranted.
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http://dx.doi.org/10.1016/j.thromres.2020.12.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7836837PMC
February 2021

AKI Treated with Renal Replacement Therapy in Critically Ill Patients with COVID-19.

J Am Soc Nephrol 2021 Jan 16;32(1):161-176. Epub 2020 Oct 16.

Division of Renal Medicine, Brigham and Women's Hospital, Boston, Massachusetts

Background: AKI is a common sequela of coronavirus disease 2019 (COVID-19). However, few studies have focused on AKI treated with RRT (AKI-RRT).

Methods: We conducted a multicenter cohort study of 3099 critically ill adults with COVID-19 admitted to intensive care units (ICUs) at 67 hospitals across the United States. We used multivariable logistic regression to identify patient-and hospital-level risk factors for AKI-RRT and to examine risk factors for 28-day mortality among such patients.

Results: A total of 637 of 3099 patients (20.6%) developed AKI-RRT within 14 days of ICU admission, 350 of whom (54.9%) died within 28 days of ICU admission. Patient-level risk factors for AKI-RRT included CKD, men, non-White race, hypertension, diabetes mellitus, higher body mass index, higher d-dimer, and greater severity of hypoxemia on ICU admission. Predictors of 28-day mortality in patients with AKI-RRT were older age, severe oliguria, and admission to a hospital with fewer ICU beds or one with greater regional density of COVID-19. At the end of a median follow-up of 17 days (range, 1-123 days), 403 of the 637 patients (63.3%) with AKI-RRT had died, 216 (33.9%) were discharged, and 18 (2.8%) remained hospitalized. Of the 216 patients discharged, 73 (33.8%) remained RRT dependent at discharge, and 39 (18.1%) remained RRT dependent 60 days after ICU admission.

Conclusions: AKI-RRT is common among critically ill patients with COVID-19 and is associated with a hospital mortality rate of >60%. Among those who survive to discharge, one in three still depends on RRT at discharge, and one in six remains RRT dependent 60 days after ICU admission.
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http://dx.doi.org/10.1681/ASN.2020060897DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7894677PMC
January 2021

Characteristics and Outcomes of Individuals With Pre-existing Kidney Disease and COVID-19 Admitted to Intensive Care Units in the United States.

Am J Kidney Dis 2021 02 19;77(2):190-203.e1. Epub 2020 Sep 19.

Division of Renal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA.

Rationale & Objective: Underlying kidney disease is an emerging risk factor for more severe coronavirus disease 2019 (COVID-19) illness. We examined the clinical courses of critically ill COVID-19 patients with and without pre-existing chronic kidney disease (CKD) and investigated the association between the degree of underlying kidney disease and in-hospital outcomes.

Study Design: Retrospective cohort study.

Settings & Participants: 4,264 critically ill patients with COVID-19 (143 patients with pre-existing kidney failure receiving maintenance dialysis; 521 patients with pre-existing non-dialysis-dependent CKD; and 3,600 patients without pre-existing CKD) admitted to intensive care units (ICUs) at 68 hospitals across the United States.

Predictor(s): Presence (vs absence) of pre-existing kidney disease.

Outcome(s): In-hospital mortality (primary); respiratory failure, shock, ventricular arrhythmia/cardiac arrest, thromboembolic events, major bleeds, and acute liver injury (secondary).

Analytical Approach: We used standardized differences to compare patient characteristics (values>0.10 indicate a meaningful difference between groups) and multivariable-adjusted Fine and Gray survival models to examine outcome associations.

Results: Dialysis patients had a shorter time from symptom onset to ICU admission compared to other groups (median of 4 [IQR, 2-9] days for maintenance dialysis patients; 7 [IQR, 3-10] days for non-dialysis-dependent CKD patients; and 7 [IQR, 4-10] days for patients without pre-existing CKD). More dialysis patients (25%) reported altered mental status than those with non-dialysis-dependent CKD (20%; standardized difference=0.12) and those without pre-existing CKD (12%; standardized difference=0.36). Half of dialysis and non-dialysis-dependent CKD patients died within 28 days of ICU admission versus 35% of patients without pre-existing CKD. Compared to patients without pre-existing CKD, dialysis patients had higher risk for 28-day in-hospital death (adjusted HR, 1.41 [95% CI, 1.09-1.81]), while patients with non-dialysis-dependent CKD had an intermediate risk (adjusted HR, 1.25 [95% CI, 1.08-1.44]).

Limitations: Potential residual confounding.

Conclusions: Findings highlight the high mortality of individuals with underlying kidney disease and severe COVID-19, underscoring the importance of identifying safe and effective COVID-19 therapies in this vulnerable population.
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http://dx.doi.org/10.1053/j.ajkd.2020.09.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7501875PMC
February 2021

Serum electrolyte dynamics in multiple myeloma patients undergoing autologous haematopoietic stem cell transplantation.

Nephrology (Carlton) 2020 Jun 23;25(6):450-456. Epub 2020 Mar 23.

Adult Hematologic Malignancies & Stem Cell Transplant Section, University Hospitals Seidman Cancer Center, Cleveland, Ohio, USA.

Aim: High-dose melphalan followed by autologous haematopoietic cell transplantation remains the standard-of-care therapy for multiple myeloma (MM). Gastrointestinal toxicity concomitant with electrolyte derangement is a primary cause of morbidity from transplant. Here, we assessed the dynamics of electrolyte imbalances and its role in hematologic counts and engraftment. Ω Patients and Methods One hundred and eighteen MM patients that received transplant were studied.

Results: Engraftment speed (ES) was calculated as the period between the first rise in the absolute neutrophil count (ANC) and full engraftment defined as the first of three consecutive days with ANC > 500 × 10 /L. The defined median ES was 2 days (range 0-5 days) and 40 patients had ES ≤2 days. Engraftment occurred at a median of 10 days. The median time-to-nadir for phosphorus and potassium was 10 and 4.28 days, respectively. The drop in phosphorus and potassium serum level was statistically greater in patients with an ES ≤2 days compared to patients with ES ≥2 days. Magnesium level were not significantly affected and there was no significant difference between the drop in serum phosphorus and potassium based on severity of nausea or oral mucositis.

Conclusion: Our results indicate that there is a significant correlation between the magnitude of drop in potassium and phosphorous levels and a steep rise in neutrophil counts around the engraftment period following stem cell transplant. These events indicate a "genesis syndrome" characterized by a rapid, massive transfer of electrolytes into proliferating cells as has been previously described after HCT for certain high-grade lymphomas and leukemias.
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http://dx.doi.org/10.1111/nep.13712DOI Listing
June 2020

Serum amyloid A-type amyloidosis of the kidney and immune complex-mediated glomerulopathy in the setting of hyperimmunoglobulin E (Job's) syndrome.

Clin Kidney J 2021 Jan 31;14(1):432-434. Epub 2019 Dec 31.

Department of Internal Medicine, Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA.

Hyperimmunoglobulin E syndrome (HIES) is a rare immunodeficiency syndrome with characteristic features of pulmonary infections, eczema, recurrent skin abscesses and elevated serum IgE. We present a case of an HIES patient referred for nephrology consultation with elevated serum creatinine and nephrotic-range proteinuria. The subsequent kidney biopsy revealed AA-type amyloidosis and a separate and distinct inactive immune complex-mediated glomerulopathy with frequent glomerular capillary wall and mesangial polyclonal deposits. Potential kidney pathology in the setting of HIES has not been well described previously, and this case provides insight into associated renal comorbidities faced by patients with this rare syndrome.
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http://dx.doi.org/10.1093/ckj/sfz185DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7857815PMC
January 2021

Nutrition Leadership Development: Capacity-Building Initiatives in Iran and the Middle-East Region Since 2009.

Front Public Health 2015 27;3:184. Epub 2015 Jul 27.

The Leadership Group , Bloemendaal , Netherlands.

Personal and organizational performance is determined by commitment and both technical and general competencies, including leadership skills. Academia, however, mainly targets technical aspects in its curricular programs. On the other hand, the inter-disciplinary and multi-sector nature of Nutrition necessitates high levels of collaboration between stakeholders. Leadership development is therefore required in Nutrition. This paper describes the endeavor made in Iran and the Middle-East region, aiming at building leadership capacity among nutrition professionals. The empowered human resource is expected to facilitate nutrition security at the national and regional levels. Since 2007, the development process of the initiative has begun through research, bench marking, and consultation. The "learning organizations," "leadership from inside-out," and "transformational leadership" frameworks have been employed as underpinning theories. Main topics have been self-awareness, effective communication, shared visioning, trust building, creativity, and motivating. Outbound team-building activities and coaching have also been included. The first workshop of the Iranian Food and Nutrition Leadership Program was held in 2009 in Tehran. The experience expanded to the region as the Middle-East Nutrition Leadership Program (MENLP). The Ph.D. Nutrition programs (at four leading Universities) and Iranian Nutrition Society have been taken as other opportunity windows to develop leadership competencies. Biannual Iranian nutrition congresses have been used as the main media for advocacy purposes. High-satisfaction rates obtained following each training activity. In short, the initiative on "nutrition leadership development" has received growing investment and positive feedback in Iran. Continuous improvement of the initiative, establishment of active alumni networks, building MENLP regional platform, and integrating a monitoring and evaluation system are required to increase the investment returns.
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http://dx.doi.org/10.3389/fpubh.2015.00184DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4515594PMC
August 2015

Topiramate and nephrolithiasis: a comment.

Headache 2015 May 15;55(5):700-1. Epub 2015 Apr 15.

University Hospitals, Case Medical Center - Nephrology, Cleveland, Ohio, USA.

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http://dx.doi.org/10.1111/head.12558DOI Listing
May 2015

Tailorable optical scattering properties of V-shaped plasmonic nanoantennas: a computationally efficient and fast analysis.

J Opt Soc Am A Opt Image Sci Vis 2014 Oct;31(10):2256-62

In this work, we introduce an efficient computational scheme, based on the macro basis function method, to analyze the scattering of a plane wave by V-shaped plasmonic optical nanoantennas. The polarization currents and scattered fields for the both symmetric and antisymmetric excitations are investigated. We investigate how the resonant frequency of the plasmonic V-shaped nanoantenna is tailored by engineering the geometrical parameters and by changing the polarization state of the incident plane wave. The computational model presented herein is faster by many orders of magnitude than commercially available finite methods, and is capable of characterizing all nanoantennas comprised of junctions and bends of nanorods.
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http://dx.doi.org/10.1364/JOSAA.31.002256DOI Listing
October 2014

The effect of iron-vitamin C co-supplementation on biomarkers of oxidative stress in iron-deficient female youth.

Biol Trace Elem Res 2013 Jun 21;153(1-3):171-7. Epub 2013 May 21.

National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

There is no study that assessed the effect of co-supplementation of iron and vitamin C on biomarkers of oxidative stress in non-anemic iron-deficient females. We investigated the effects of iron vs. iron + vitamin C co-supplementation on biomarkers of oxidative stress in iron-deficient girls. In a double-blind randomized controlled clinical trial, performed among 60 non-anemic iron-deficient girls, participants were randomly assigned to receive either 50 mg/day elemental iron supplements or 50 mg/day elemental iron + 500 mg/day ascorbic acid for 12 weeks. Fasting blood samples were taken at baseline, weeks 6 and 12 for assessment of biomarkers of oxidative stress. Compared with the baseline levels, both iron and iron + vitamin C supplementation resulted in a significant reduction in serum malondialdehyde (MDA) levels (P time < 0.001) and remarkable elevation in serum total antioxidant capacity (TAC; P time < 0.001) and vitamin C levels (P time = 0.001); however, comparing the two groups we failed to find an additional effect of iron + vitamin C supplementation to that of iron alone on serum TAC and MDA levels (P group was not statistically significant). Iron + vitamin C supplementation influenced serum vitamin C levels much more than that by iron alone (P group < 0.01). We also found a significant interaction term between time and group about serum vitamin C levels while this interaction was not significant about serum TAC and MDA levels. In conclusion, we found that iron supplementation with/without vitamin C improve biomarkers of oxidative stress among non-anemic iron-deficient females and may strengthen the antioxidant defense system by decreasing reactive oxygen species. Co-supplementation of iron + vitamin C has no further effect on oxidative stress compared with iron alone.
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http://dx.doi.org/10.1007/s12011-013-9695-7DOI Listing
June 2013

Immunoglobulin A nephropathy associated with mesothelioma.

WMJ 2012 Feb;111(1):29-32

Department of Internal Medicine, Cleveland Clinic Health System, Fairview Hospital, 18101 Lorain Ave, Cleveland, OH 44111, USA.

Immunoglobulin A nephropathy (IgAN) has been identified in patients with various malignancies. Although membranous glomerulonephritis and minimal change disease have been described in patients with mesothelioma, to our knowledge IgAN associated with mesothelioma has not been reported. We present a case of IgAN, characterized by progressive deterioration of renal function from normal and confirmed by kidney biopsy. Despite improvement of renal function following treatment with cyclophosphamide and prednisone, the patient succumbed to acute respiratory failure 8 months later. We conclude that IgAN may be a potential complication of mesothelioma.
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February 2012

Electrocardiogram abnormalities and cardiovascular mortality in elderly patients with CKD.

Clin J Am Soc Nephrol 2012 Jun 29;7(6):949-56. Epub 2012 Mar 29.

Division of Nephrology and Hypertension, Case Western Reserve University, Cleveland, Ohio, USA.

Background And Objectives: Cardiovascular disease is the most common cause of death in CKD. This study evaluated whether electrocardiogram (ECG) abnormalities are predictors of cardiovascular death in CKD.

Design, Setting, Participants, & Measurements: The Cardiovascular Health Study limited database (1989-2005) was used to identify a cohort with CKD at baseline (estimated GFR < 60 mL/min per 1.73 m(2)). The patients were categorized as having major, minor, or no ECG abnormalities. Rates of adjudicated cardiovascular events and mortality were compared among the groups using proportional hazards regression models.

Results: A total of 1192 participants had CKD at baseline; mean age ± SD was 74.7±6.2 years. Of these patients, 452 (38.8%) had major, 346 (29.7%) had minor, and 367 (31.5%) had no ECG abnormalities. Participants with estimated GFR < 60 mL/min per 1.73 m(2) were more likely to have ECG abnormalities at baseline (adjusted prevalence odds ratio, 1.23 [95% confidence interval (CI), 1.06-1.43]) than those with GFR ≥ 60 mL/min per 1.73 m(2). During mean follow-up of 10.3±3.8 years, 814 (68.3%) participants died. Compared with participants without ECG abnormalities, participants with major abnormalities had the highest risk for cardiovascular events and death; adjusted hazard ratios were 2.15 (95% CI, 1.56-2.98) and 2.27 (95% CI, 1.56-3.30), respectively. For minor ECG abnormalities, hazard ratios were 1.24 (95% CI, 0.91-1.70) and 1.48 (95% CI, 1.00-2.18), respectively.

Conclusions: In patients with CKD, major ECG abnormalities are frequently present and predict a significantly higher risk for death and adverse cardiovascular outcomes.
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http://dx.doi.org/10.2215/CJN.07440711DOI Listing
June 2012

Drug treatment of hypertension in older hypertensives.

Clin Geriatr Med 2009 May;25(2):235-44

Department of Medicine, Case Western Reserve University, 29325 Health Campus Drive, Suit#3, Westlake, Ohio 44145, USA.

There is strong evidence supporting the benefit of antihypertensive treatment in older patients. Blood pressure goal and drug selection in the elderly is similar to that in younger populations, but there are a few special considerations in these patients. A number of studies have been conducted to determine the drugs or drug classes most effective for reducing cardiovascular complications in older patients with hypertension. This article reviews the evidence for drug treatment in this population.
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http://dx.doi.org/10.1016/j.cger.2009.03.001DOI Listing
May 2009

In-school snacking, breakfast consumption, and sleeping patterns of normal and overweight Iranian high school girls: a study in urban and rural areas in Guilan, Iran.

J Nutr Educ Behav 2009 Jan-Feb;41(1):27-31

Department of Human Nutrition, School of Public Health, Guilan University of Medical Sciences and Health Services, Rasht, IR Iran.

Objective: To investigate the relationship of snacking during school hours, sleep time, and breakfast consumption by weight status of Iranian high school girls in urban and rural areas in Guilan Province, Iran.

Design: Data were collected by self-administered questionnaire and measure of body weight and height.

Setting: High schools in urban and rural areas in Guilan Province, northern Iran.

Participants: Representative sample of 2302 school girls (1106 in Rasht City and 1196 in rural areas) selected by multistage cluster sampling.

Main Outcome Measures: Breakfast skipping, snacking habits at school, sleep habits, body weight, and height.

Analysis: Differences in the frequency of the measured variables between the urban and rural girls and overweight and normal weight girls were tested using the chi-square test, P < .05.

Results: Prevalence of obesity was significantly (P < .05) lower in urban areas (4.1%) than in rural areas (5.2%). Prevalence of overweight was significantly higher in those who usually skipped breakfast (P < .001). Consumption of food items of low nutrient density as snacks during the school day was common in this population, especially in rural areas.

Conclusion And Implications: The school environment may contribute to the high prevalence of overweight/obesity observed among Iranian adolescent females. Students should be encouraged to eat breakfast and choose nutritious snacks during the school day.
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http://dx.doi.org/10.1016/j.jneb.2008.03.115DOI Listing
April 2009

The case for chronic kidney disease, diabetes mellitus, and myocardial infarction being equivalent risk factors for cardiovascular mortality in patients older than 65 years.

Am J Cardiol 2008 Dec 23;102(12):1668-73. Epub 2008 Oct 23.

Division of Nephrology and Hypertension, Metro Health Medical Center, Cleveland, Ohio, USA.

The objective of the study was to determine whether chronic kidney disease (CKD) is as important a risk as either diabetes mellitus (DM) or previous myocardial infarction (MI). CKD and DM are important coronary artery disease risk factors. We hypothesized that the risk of cardiovascular mortality in elderly patients with CKD is equivalent to that for patients with either DM or previous MI. The CHS limited-access database was used to identify a cohort of patients with a baseline history of MI, DM, or CKD (estimated glomerular filtration rate <60 ml/min). Subjects were categorized in 1 of 3 groups as group 1, patients with DM (no CKD or MI); group 2, patients with previous MI (no DM or CKD); and group 3, patients with CKD (no DM or MI). Patients were followed up for a mean of 8.6 years, and rates of cardiovascular mortality were compared using proportional hazards regression. There were 789, 443, and 667 people in the MI, DM, and CKD groups, respectively. During follow-up, 124 patients (15.7%) died of cardiovascular causes in the MI group, and 69 (15.8%) and 87 (13%), in the DM and CKD groups, respectively. After adjusting for age, race, gender, smoking, hypertension, and total, high-density lipoprotein, and low-density lipoprotein cholesterol, the hazard ratio (HR) for cardiovascular mortality was similar between the DM (HR 1.0, 95% confidence interval 0.8 to 1.4)) and CKD cohorts (HR 0.8, 95% confidence interval 0.6 to 1.1) compared with the MI group. In conclusion, the risk of cardiovascular mortality in patients with moderate CKD was as high as that in patients with a history of MI or DM. Designation of CKD as a cardiovascular risk equivalent in patients >65 years of age appears justified.
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http://dx.doi.org/10.1016/j.amjcard.2008.07.060DOI Listing
December 2008

Does absolute neutrophilia predict early congestive heart failure after acute myocardial infarction? A cross-sectional study.

South Med J 2008 Jan;101(1):19-23

Zanjan University of Medical Sciences, Zanjan, Iran.

Background: Acute myocardial infarction (AMI) is usually associated with increased neutrophil count. However, it has not clearly been defined whether neutrophilia can cause myocardial injury. In this study, we hypothesized that absolute neutrophilia can predict the occurrence of congestive heart failure (CHF) after AMI.

Methods: A cross-sectional study was carried out on 312 patients with a diagnosis of AMI. Patients with a history of chest pain for more than 12 hours before admission, heart failure with Killip class III and IV, history of recent gastrointestinal bleeding, major trauma, infection, malignancy, renal failure and corticosteroid consumption were excluded. A blood sample was drawn for leukocyte count and an echocardiogram was obtained 4 days after admission. Congestive heart failure was defined as an ejection fraction less than 40% on echocardiogram or clinical heart failure according to the Framingham's criteria for diagnosis of heart failure.

Results: After excluding 19 patients, data for 293 patients were analyzed. Among them, 152 (51.9%) patients developed new onset CHF. Two hundred and two patients (68.9%) had neutrophilia (neutrophil count >7500/mic/lit). The risk of developing heart failure was higher in patients with neutrophilia (OR = 2.32; 95% CI = 1.33-4.03, P = 0.000). There was a negative correlation between ejection fraction and neutrophil count (r = -0.191, P = 0.000). After adjustment for age, sex, serum creatinine level, peak enzyme CK-MB level and MI location, the relationship between the absolute neutrophil count and the presence of congestive heart failure remained significant (OR = 2.14; 95% CI = 1.19-3.84, P = 0.011).

Conclusions: The study shows that the presence of absolute neutrophilia during the first 12 hours after AMI can predict the occurrence of CHF. This association may help identify high-risk individuals, who might benefit from more aggressive interventions.
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http://dx.doi.org/10.1097/SMJ.0b013e31815d3e11DOI Listing
January 2008

Are patients who have metabolic syndrome without diabetes at risk for developing chronic kidney disease? Evidence based on data from a large cohort screening population.

Clin J Am Soc Nephrol 2007 Sep 8;2(5):976-83. Epub 2007 Aug 8.

University Hospitals Case Medical Center, Division of Nephrology, Lakeside Building Room 8124-C, 11100 Euclid Avenue, Cleveland, OH 44106-5048, USA.

Background And Objectives: Recently, metabolic syndrome (MS) was suggested to be an independent risk factor for chronic kidney disease (CKD). This study explored the relationship between MS and risk for development of CKD that is independent of diabetes.

Design, Setting, Participants, & Measurements: The study population consisted of 4607 adult (age >18 yr) individuals who did not have diabetes or CKD at baseline and were successfully followed for 3 yr in the Tehran Lipid and Glucose Study, a prospective, population-based study of risk factors for atherosclerosis and diabetes. Individuals with and without MS at baseline were compared regarding development of new CKD.

Results: A total of 1010 (21.9%) individuals met criteria for MS at baseline. During the follow-up, 38 (3.4%) individuals in MS group and 73 individuals (2.0%) of 3590 people in non-MS group developed CKD (OR = 1.88, 95% CI; 1.26-2.8). After exclusion of individuals with hypertension at baseline (n = 798), 406 people (10.7%) were defined as having MS. After follow-up, 62 (1.82%) people in the MS group and eight (1.98%) people in non-MS group developed CKD (OR = 0.925, 95% CI; 0.446-1.917; P = 0.844).

Conclusions: The results of this study suggest that MS is a cluster of multiple risk factors, and, as a cluster, it is a significant risk for CKD. The risk of MS for developing CKD is highly affected by the presence of diabetes and hypertension, and it seems that clustering of individual risk factors is more plausibly associated with risk for developing CKD than a unique biologic phenomenon.
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http://dx.doi.org/10.2215/CJN.01020207DOI Listing
September 2007

Is chronic kidney disease comparable to diabetes as a coronary artery disease risk factor?

South Med J 2007 Jan;100(1):20-6

Division of Nephrology, University Hospitals of Cleveland, Lakeside Bldg Rm 8124-C, 11100 Euclid Ave, Cleveland, Ohio 44106-5048, USA.

Background: Chronic kidney disease (CKD) is one of the known risk factors for coronary heart disease (CHD). Though electrocardiograms (ECGs) have limited accuracy in determining the true prevalence of CHD, we wondered whether CKD and diabetes mellitus (DM) controlled for hypertension (HTN), had similar prevalences of ECG abnormalities that could reflect underlying coronary heart disease.

Method: Data were collected for 5,942 men and women aged 30 to 69 years in the Tehran Lipid and Glucose Study (TLGS), a crosssectional phase of a large epidemiologic study first initiated in 1999. ECG findings of all subjects were coded according to Minnesota ECG coding criteria. The Whitehall criteria for abnormal ECG findings that could represent ischemia were utilized. Creatinine clearance (Crcl) was estimated using the Cockroft-Gault equation and diabetes was defined according to the American Diabetic Association (ADA) criteria. Subjects with moderate CKD and without DM were compared with the patients with DM without CKD. HTN prevalence was similar. The analysis was performed for all Whitehall ECG ischemia abnormalities combined, and separately for pathologic Q waves.

Results: In spite of an overall similar prevalence of smoking, and a lower incidence of dyslipidemia and HTN, moderate CKD patients had a higher prevalence of Whitehall criteria abnormal ECG findings compared with the patients with DM. Over 19% of patients with CKD had abnormal ECG findings while 14.7% of diabetic patients had abnormal ECGs (P = 0.02). The prevalence of Q waves was 11.5% in patients with CKD and 10.8% in patients with DM. In an age-matched subgroup of patients with DM and no CKD, the prevalence of ECG abnormalities was 19.3%, similar to the patients with moderate CKD and no DM (19.7%) (P = 0.9). The prevalence of pathologic Q waves in an age-matched group was 11.45%, compared with 11.5%, respectively.

Conclusion: Moderate CKD is a major risk factor for the development of the Whitehall ECG criteria which have been associated with ischemic heart disease. The importance of CKD as a risk factor for ECG abnormalities is comparable with DM. Patients with moderate CKD probably are candidates for aggressive CHD risk modification.
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http://dx.doi.org/10.1097/01.smj.0000235482.22558.a5DOI Listing
January 2007

Height and weight of urban preschool children in relation to their mothers' educational levels and employment status in Rasht City, northern Iran.

Matern Child Nutr 2007 Jan;3(1):52-7

Department of Human Nutrition, School of Public Health, Guilan University of Medical Sciences and Health services, Rasht, Iran.

This study determined the relationship between anthropometric status of 3-5-year-old urban children and theirs mothers' educational levels and employment status in Rasht City, northern Iran. A total of 1319 children (638 girls and 681 boys) at the ages of 3 and 6 years in all day-care centres in Rasht City were studied, using a cross-sectional design. Height and weight of the children were measured, and data on mothers' educational levels, employment status and duration of any breastfeeding were collected. Height for age, weight for age and weight for height of the children were compared with the National Center for Health Statistics (NCHS) reference population of the United States, and z-values 12 years of schooling, OR = 1.87; 95% CI: 1.08-2.4) had higher relative risk for underweight than children of mothers with an intermediate level of education (5-12 years of schooling). Children of mothers with college education were also more at risk for development of stunting (OR = 1.41; 95% CI: 1.14-4.22). In addition, children of employed mothers were more likely to be underweight (OR = 1.52; 95% CI: 1.05-2.31), stunted (OR = 2.42; 95% CI: 1.21-6.35) and wasted (OR = 3.35; 95% CI: 1.21-5.58) than children of non-employed mothers. The relative risk for undernutrition was higher in the children of both less and highly educated mothers compared with children of mothers with an intermediate level of education. Mothers' employment was also negatively related to nutritional status of these children in day-care centres in Rasht City.
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http://dx.doi.org/10.1111/j.1740-8709.2007.00065.xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6860702PMC
January 2007

Risk of diabetes in patients taking thiazide diuretics.

Authors:
Arash Rashidi

Mayo Clin Proc 2006 Dec;81(12):1637-8; author reply 1638

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http://dx.doi.org/10.4065/81.12.1637DOI Listing
December 2006

Which drug should be used to treat patients with uncomplicated essential hypertension?

Curr Opin Nephrol Hypertens 2006 May;15(3):303-8

Division of Nephrology and Hypertension, University Hospitals of Cleveland, Louis Stokes Cleveland VA Medical Center, Case Western Reserve University, Cleveland, OH 44106-5401, USA.

Purpose Of Review: To review recent data and guidelines on selecting the initial antihypertensive drug.

Recent Findings: The main driver of benefit from blood pressure-lowering therapy is blood pressure reduction, and there is little evidence supporting additional drug class-specific benefits in primary prevention of major cardiovascular outcomes. The results also confirm that in the patient with uncomplicated hypertension as well as in those patients with diabetes without nephropathy, initial therapy with 'newer therapies' (i.e. angiotensin-converting enzyme inhibitors, calcium channel blockers, and angiotensin receptor blockers) are effective, but not more effective than thiazide diuretics, at reducing stroke, coronary heart disease, morbidity or mortality, or all-cause mortality.

Summary: While compelling indications may exist for specific drug classes in those with specific target organ damage (i.e. heart failure, renal insufficiency, and coronary artery disease), thiazide diuretics remain unsurpassed in lowering blood pressure and in preventing hypertension-related clinical outcomes. Despite a more favorable metabolic profile, alpha-blockers are less effective in preventing cardiovascular disease, especially heart failure and stroke. Calcium channel blockers produce a similar reduction in blood pressure and cardiovascular disease outcomes compared with thiazide-type diuretics, although they are consistently less effective in preventing heart failure. In the absence of heart failure or renal disease, angiotensin-converting enzyme inhibitors have shown little advantage in clinical trials over diuretics in preventing cardiovascular disease and are not indicated as an initial therapy in Blacks.
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http://dx.doi.org/10.1097/01.mnh.0000222699.37830.c7DOI Listing
May 2006

Is it time to prescribe statins to patients with calcified aortic stenosis?

Am Heart J 2005 Jul;150(1):41-5

Fairview Hospital, Cleveland Clinic Health System, Cleveland, Ohio 44111, USA.

Aortic stenosis (AS) is a common disease especially in the older population. It is associated with high mortality and morbidity. Recent data suggest that coronary artery disease and AS share common risk factors. Retrospective studies suggest that statins might slow the progression of AS but there are no randomized clinical trial data available. It would seem that statins can be considered for medical treatment of AS; however, this needs to be investigated in future randomized clinical trials.
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http://dx.doi.org/10.1016/j.ahj.2005.01.021DOI Listing
July 2005

Blood pressure measures and electrocardiogram-defined myocardial infarction in an Iranian population: Tehran Lipid and Glucose study.

J Clin Hypertens (Greenwich) 2004 Feb;6(2):71-5

Endocrine and Metabolism Research Center, Shaheed Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran.

The purpose of this study was to describe blood pressure values in Iranian adults with electrocardiogram (ECG) evidence of a myocardial infarction (MI). High blood pressure is a risk factor, and an ECG can be diagnostic of coronary artery disease. In recent studies the role of pulse pressure in predicting coronary artery disease has been suggested to be more important than that of blood pressure. From among participants of the Tehran Lipid and Glucose study, data for 2479 men and 3060 women aged > or =30 years not currently using any antihypertensive medication were collected. The study used the mean of two separate blood pressure measurements for each individual. ECG findings of all subjects were coded according to Minnesota ECG coding criteria, and they were categorized into probable/possible MI or no MI. ECG evidence of probable or possible MI was found in 1.2% of subjects (1.8% in men vs. 0.8% in women, p<0.001). Prevalence of ECG-defined MI in hypertensive persons was two-fold higher than in normotensives. Adjusted for age, sex, and body mass index, mean diastolic blood pressure was significantly lower in cases with ECG-defined MI than in subjects without MI (p<0.03). There was a strong positive correlation between pulse pressure and systolic blood pressure in both hypertensive/normotensive and MI/no MI groups at the p<0.001 level. There was a weak inverse correlation between diastolic blood pressure and pulse pressure in hypertensive/normotensive/no MI groups (-0.32 and -0.14, both p<0.001). Diastolic blood pressure was not correlated with pulse pressure in cases with MI. Prevalence of ECG-defined MI in hypertensive cases was higher than in normotensives. Systolic blood pressure is a better predictor for pulse pressure than diastolic blood pressure in both normotensive and hypertensive populations with or without ECG-defined MI.
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http://dx.doi.org/10.1111/j.1524-6175.2004.02984.xDOI Listing
February 2004