Background: Cardiovascular disease (CVD) is the most common cause of death among patients with end-stage renal disease especially whom under hemodialysis (HD). Stromal cell-derived factor-1 (SDF-1) and its receptor CXC chemokine receptor type-4 (CXCR4) could contribute to CVD. The main aim of this study was to evaluate the association between SDF-1 and CXCR4 with CVD and its related risk factors in patients under HD. Methods: Sixty patients under HD and 29 healthy subjects were recruited in the study. The serum levels and relative messenger RNA (mRNA) expressions of SDF-1 and CXCR4 were measured using enzyme-linked immunosorbent assay and real-time polymerase chain reaction in patients and controls, respectively. CVD history of the patients was obtained. Results: Twenty patients (33.3%) had a history of CVD. The mean levels of serum and relative mRNA expressions of SDF-1 and CXCR4 were higher in patients than controls and also in patients with a history of CVD than patients without it. The serum levels and relative expressions of SDF-1 and CXCR4 were positively correlated with blood urea nitrogen, parathyroid hormone, and high-sensitivity C-reactive protein and inversely correlated with hemoglobin. The history of CVD was the independent predictor of serum levels of SDF-1 and CXCR4 and also relative mRNA expression of CXCR4. Conclusions: The higher levels of serum and relative mRNA expressions of SDF-1 and CXCR4 were associated with CVD in patients under HD. Furthermore, SDF-1 and CXCR4 were associated with several traditional and uremia-related CVD risk factors in such patients.

Background: Hyperlipidemia and hypertension are the most important causes of ischemic heart disease. There is evidence that flaxseed powder can improve lipid profile and blood pressure. In this study, we want to investigate the effects of flaxseed powder consumption on patients with hyperlipidemia and hypertension. Methods: This randomized double-blind placebo-controlled clinical trial was performed on 80 hyperlipidemic and hypertensive patients (men and women between 20 and 60 years old). In this study, participants were recruited from Imam Khomeini hospital clinics of Shiraz University of Medical Sciences in 2017 randomly allocated to flaxseed powder group and placebo group. The intervention group received 36 g of flaxseed sachet (n = 40), and control group received 12 g placebo sachet (n = 40) for 8 weeks. Serum lipid profiles, blood pressure, fasting blood sugar, and anthropometric indices were measured. Data were analyzed by using SPSS. Results: We found significant reduction (P < 0.001) in anthropometric indices (waist circumference and waist-to-hip ratio) and lipid profiles (triglycerides [P = 0.015], total cholesterol [P = 0.018], and low-density lipoprotein [P < 0.001]) within flaxseed group in comparison with placebo group. Conclusions: Based on beneficial effects of flaxseed on cardiovascular risk factors, it seems that flaxseed consumption can be considered as a useful therapeutic approach for reducing lipid profile and anthropometric indices.

Background: Although there is a critical need for information on economic performance of Iranian general practitioners (GPs) in health policymaking, there is not any scientific evidence in this area. Therefore, in the present report, the characteristics of economic behaviors of Iranian GPs were described. Methods: This was a cross-sectional study in 2015, in which the data were collected from 666 GPs. The variables including monthly gross income, hours of work, and patient visits were studied as the measures of economic behavior of GPs. Descriptive statistics, t-test, and Analysis of Variance were used for analyzing the data. The statistical analysis was performed by STATA12. Results: The annual income of the GPs understudy was 26,000 US dollar (USD) (82,680 purchasing power parity [PPP]). The ratio of this value to gross domestic product per capita and minimum wage of Iran in 2015 was 4.8 and 9.2, respectively. On average, every GP in Iran has an income of 2188.1 USD (6958.16 PPP), works 142 h, and visits an average of 494 patients/month. The results showed that the economic behavior of Iranian GPs has a significant difference in terms of gender, age, marital status, practice experience, practice location, type of practice, being a family physicians, and working in different settings (P < 0.05). Conclusions: The Iranian GPs understudy work less than their counterparts in other (compared) countries. The studied GPs had a higher income (adjusted by hours of work and countries' per capita income) than their counterparts in other (studied) countries. Moreover, there are inequalities between GPs in terms of income, the volume of services provided and the work hours.

Background: Recent therapeutic advances in cardiovascular disease, thanks to the discovery of endothelial progenitor cells (EPCs). Stromal cell-derived factor-1α (SDF-1α), platelet-derived growth factor (PDGF), basic fibroblast growth factor (bFGF), and nitric oxide (NO) play a role in migration, homing, and differentiation of EPCs into mature endothelial cells. The incidence of cardiovascular disease is higher in men than in women. This fact suggests the influence of sex hormones on incidence of cardiovascular disease. Methods: Twenty-four female wistar rats weighing 160–180 g were randomly divided into four groups (N = 6): 1. sham-treated by sesame oil, 2. ovariectomized (OVX)-treated by sesame oil, 3. OVX-treated by 10 μg/kg/day testosterone, and 4. OVX-treated by 100 μg/kg/day testosterone. After 21 days, the animals were euthanized and blood samples were saved for determination of EPC count and serum levels of SDF-1α, PDGF, bFGF, and NO production. Results: High-dose testosterone induced significant increase in EPC count in OVX rats (P < 0.05). Also 100 μg/kg/day testosterone increased serum level of SDF-1α more than OVX-treated by 10 μg/kg/day testosterone (P < 0.05). But 10 μg/kg/day testosterone increased significantly the serum level of PDGF >100 μg/kg/day testosterone-treated group (P < 0.05). The serum level of bFGF in sham-treated by sesame oil was equal with its concentration in OVX-treated by 100 μg/kg/day testosterone. And the serum concentration of NO production in testosterone-treated groups were significantly less than other groups (P < 0.05). Conclusions: This study suggests that testosterone might be effective on cardiovascular disease in females by increasing EPC count through SDF-1α and PDGF mechanisms which are some of the vascular healing factors.

Background: Inflammation is defined as body tissues response to harmful stimuli. Obesity-related inflammation leads to increased risk chronic diseases including diabetic polyneuropathy (DPN). The present study was performed to determine association between body mass index (BMI) and inflammatory markers including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) in DPN patients. Methods: In this cross-sectional study, 200 DPN patients with a mean (SD) of age 58.76 (9.53) years were selected. All patients completed the questionnaire including demographic data and chronic disease history. In addition, anthropometric measures and clinical laboratory tests were taken. Multivariate linear regression was used to detect the association between BMI, CRP, and ESR levels. Results: BMI was associated with increase in ESR and CRP levels (β-ESR = 4.67, P < 0.001 and β-CRP = 0.71, P < 0.001). Also, this association remained after adjustment for other different variables. Conclusions: These findings indicate that higher BMI is related to increase inflammatory markers including CRP and ESR in DPN patients. Therapies for DPN and reducing inflammation should target the weight loss among obese patients.

Context: Mitoxantrone (MTX) is an antracyclin drug that is used for treatment of patients with chronic refractory multiple sclerosis (MS). Congestive heart failure (CHF) is a rare complication of this drug that may occur early, during therapy, or late, months or years after termination of therapy. Aims: The aim of this study is to evaluate the long-term adverse effect of MTX on cardiac function. Methods: The study involved 49 MS patients on MTX therapy because of their disease was refractory to other treatments (18 men and 31 women). They were treated in two canters related to Esfahan University of Medical Sciences. The mean age was 34.65 ± 9.56 years. Systolic and diastolic left ventricular (LV) functions were measured by echocardiography. The baseline echocardiographic data were collected from patients' file. Echocardiography was repeated by a single cardiologist in 2016. Results: After MTX therapy, one patient's ejection fraction (EF) reduced below 50% (2%). In spite of their normal diastolic function before therapy, two patients developed diastolic dysfunction (4%). Nonparametric binominal analysis reveals that MTX therapy increased the probability of developing systolic dysfunction, early or late P < 001. Conclusions: MS patients treated with MTX are at increased risk of developing early and late-LV dysfunction, so all patients on MTX therapy must be periodically evaluated for these late complications.

Background: Despite many attempts to discover pathophysiologic mechanisms to explain chronic heart failure (CHF), no conceptual paradigms have been proved yet. Various studies have shown the role of trace elements on heart failure (HF). Among all trace elements, selenium deficiency is regarded as important risk factors for HF. Considering selenium deficiency in our society and high prevalence of HF, we compared selenium level in patients with HF with healthy individuals. Methods: In all, 32 hospitalized patients with HF and 32 healthy controls were enrolled in a case–control study. Demographic characteristics as well as functional class and risk factors were recorded for all two groups. Echocardiography was conducted for patients and all provided data were registered. Then serum selenium levels were compared in case and control groups. Results: The mean (±standard deviation) serum selenium was 92.5 ± 22.44 mg/dL in patients with HF and 109.3 ± 29.62 mg/dL in controls. The level of selenium was significantly lower and the frequency of risk factors was significantly higher in case group. Selenium level did not differ significantly in patients with different HF causes. There were a nonsignificant relationship between selenium level and left ventricular ejection fraction and a significant reverse relationship between selenium level and left ventricular volume and pulmonary artery pressure. Conclusions: Our results showed statistically significant lower level of serum selenium in patients with CHF in comparison to normal individuals. Moreover, selenium level had significant reverse relationship with left ventricular volume and pulmonary artery pressure.

Background: Body of evidence is increasing about the importance of Vitamin D (VD) for normal development of the fetus and for maternal health. As limited data are available regarding the association between maternal VD level and pregnancy-related complications and neonatal anthropometric measures, the present study aimed to evaluate the neonatal anthropometric measures including weight, high, and head circumference and pregnancy-related complications such as preeclampsia, blood pressure, gestational diabetes mellitus, and nausea and vomiting in pregnancy with 25(OH)VD level. Methods: The current prospective observational study was conducted among 812 Iranian pregnant women during the first trimester in Isfahan, Iran. Needed data were collected using validated questionnaires and biochemical examinations. Results: Overall, this study demonstrated an inverse significant association between VD level and chance of having low-weight infant in the adjusted model (odds ratio [OR]: 0.03, 95% confidence interval [CI]: 0.004–0.26, P < 0.001) in the first VD assessment. The same results were obtained in the second VD assessment (OR: 0.08, 95% CI: 0.01–0.40, P < 0.01). However, such associations were not seen about other neonatal measures and pregnancy-related complications. Conclusions: We found that low maternal VD level might be associated with risk of low-weight infant. Such findings could be considered to implement informative interventional programs to control newborn adverse outcomes. Further studies are required to confirm these findings.

Background: Formula milk is prepared as a nutritional substitution for human breast milk, but because of biologic and constituent differences, it might cause obesity and growth disorders in infants. In this study, we compared the growth pattern of formula-fed and breastfed infants living in Yasuj, southwest of Iran. Methods: Infants 7–14 months of age in southwest of Iran were classified as exclusively breastfed (n = 200) and formula-fed (n = 200) in their first 6 months of life. Growth velocity and Z-scores of weight for age, length for age, weight for length, and head circumference were estimated using WHO Anthro Plus software (2010) and SPSS Version 19 (SPSS Inc., Chicago, IL, USA) using World Health Organization reference for growth data. Results: The study showed that Z-score of length for age and head circumference for age at the birth were significantly lower in formula-fed group than exclusively breastfed group (P < 0.05), but the Z-score of weight for length did not differ significantly. At the sixth month of age, Z-score of weight for length was significantly higher in formula-fed group (P < 0.05), but Z-score of length for age had no significant difference and Z-score of head circumference was higher in exclusively breastfed group yet (P < 0.05). Growth velocity, prevalence of obesity, wasting, underweight, and stunting did not differ between two groups. Conclusions: Our findings suggest that formula feeding can lead to greater weight gain and may help the catch up of length, but evidences are not convincing enough to suggest the formula as an obesogenic feeding in the studied area. To make a conclusion, we suggest comparing the privileged and unprivileged areas and controlling for confounding variables including family hygiene and infant feeding practices between formula-fed and breastfed infants.

Background: Antiretroviral therapy (ART) significantly delays the progression from HIV to AIDS. Adherence to ART is the second strongest predictor of progression to AIDS and death, after CD4 count. A very high level of adherence (≥95%) is required for ART to be effective on a long term and to prevent the emergence of resistant viral strains and prevent comorbidities. Methods: A case series study was undertaken at an ART center for a period of 6 months. Non-probability purposive sampling was adapted to select HIV-positive subjects aged >15 years on ART for more than 6 months. A predesigned semi-structured questionnaire was used to obtain the data. Treatment compliance was assessed by self-reported 1-week recall method. Results: A total of 536 HIV-positive people were interviewed, among which 315 (58.8%) of them were males and 214 (39.9%) were females. Nearly two third of the participants (359, 67.0%) reported ≥95% adherence to treatment. Personal commitments (51, 28.8%) and working time inconvenience (42, 23.7%) were the common reasons for less adherence. On bivariate analysis, married people (OR: 1.586, CI: 1.097-2.292), participants residing in rural area (OR: 1.628, CI: 1.130-2.345), participants not having side effects of drugs (OR: 5.324, CI: 3.491-8.181), participants equipped with better knowledge about ART (OR: 2.019, CI: 1.377-2.961), and participants having support of friends and family members (OR: 1.612, CI: 1.019-2.540) showed a higher level of adherence to ART. Conclusions: Demographic factors such as marital status, residing in rural area, and other personal factors like having good knowledge about ART, without side effects to drugs, and having support of friends and family members were found to show a high level of adherence to ART.