Cardiometabolic outcomes with dapagliflozin after myocardial infarction by baseline ejection fraction: DAPA-MI

\ua9 2025 The Author(s). ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology. Aims: In the randomized DAPA-MI clinical trial, 10 mg of dapagliflozin once daily improved cardiometabolic outcomes versus placebo after acute myocardial infarction (MI) in patients without established diabetes or heart failure (HF). We assessed associations between baseline left ventricular ejection fraction (LVEF) and cardiometabolic outcomes in DAPA-MI. Methods: The primary outcome, assessed using the win ratio method, was the hierarchical composite of death, hospitalization for HF, non-fatal MI, atrial fibrillation/flutter, Type 2 diabetes, New York Heart Association classification at last visit and body weight decrease of ≥5% from baseline to last visit. For the present analysis, patients were categorized using LVEF at randomization (<50% or ≥50%). Results: Of the DAPA-MI participants with available LVEF data who received ≥1 dose of study drug (n = 3751), 2913 (77.7%) had LVEF <50% and 838 (22.3%) had LVEF ≥50%. The primary hierarchical composite outcome resulted in a win ratio favouring dapagliflozin of 1.38 (95% CI: 1.21, 1.57; P < 0.001) in patients with LVEF <50% and 1.32 (1.00, 1.73; P = 0.048) in patients with LVEF ≥ 50% (P interaction = 0.76). In a sensitivity analysis excluding patients with LVEF <30%, the primary hierarchical composite outcome resulted in a win ratio favouring dapagliflozin of 1.40 (95% CI: 1.22, 1.61; P < 0.001). There were no significant interactions between baseline LVEF and any secondary outcomes. Conclusions: Regardless of baseline LVEF, dapagliflozin resulted in significant cardiometabolic benefits versus placebo, although there was no impact on the composite of cardiovascular death or hospitalization for HF

Diabetic retinopathy clinical practice guidelines: Customized for Iranian population

Purpose: To customize clinical practice guidelines (CPGs) for management of diabetic retinopathy (DR) in the Iranian population. Methods: Three DR CPGs (The Royal College of Ophthalmologists 2013, American Academy of Ophthalmology Preferred Practice Pattern 2012, and Australian Diabetes Society 2008) were selected from the literature using the AGREE tool. Clinical questions were designed and summarized into four tables by the customization team. The components of the clinical questions along with pertinent recommendations extracted from the above-mentioned CPGs; details of the supporting articles and their levels of evidence; clinical recommendations considering clinical benefts, cost and side effects; and revised recommendations based on customization capability (applicability, acceptability, external validity) were recorded in 4 tables, respectively. Customized recommendations were sent to the faculty members of all universities across the country to score the recommendations from 1 to 9. Results: Agreed recommendations were accepted as the fnal recommendations while the non-agreed ones were approved after revision. Eventually, 29 customized recommendations under three major categories consisting of screening, diagnosis and treatment of DR were developed along with their sources and levels of evidence. Conclusion: This customized CPGs for management of DR can be used to standardize the referral pathway, diagnosis and treatment of patients with diabetic retinopathy. © 2016 Journal of Ophthalmic and Vision Research

Intravitreal injection of anti-vascular endothelial growth factor agents for ocular vascular diseases: Clinical practice guideline

Purpose: To provide the clinical recommendations for the administration of intravitreal anti-vascular endothelial growth factor (VEGF) drugs especially bavacizumab for ocular vascular diseases including diabetic macular edema, neovascular age-related macular degeneration, myopic choroidal neovascularization, retinal vein occlusion and central serous chorioretinopathy. Methods: Twenty clinical questions were developed by the guideline technical committee. Relevant websites and databases were searched to find out the pertinent clinical practice guidelines to answer the questions. The technical committee provided possible answers (scenarios) according to the available evidences for each question. All scenarios along with their levels of evidence and the supported articles were sent to the experts for external review. If the experts did not agree on any of the scenarios for one particular clinical question, the technical committee reviewed all scenarios and their pertinent evidences and made the necessary decision. After that, the experts were asked to score them again. All confirmed scenarios were gathered as the final recommendations. Results: All the experts agreed on at least one of the scenarios. The technical committee extracted the agreed scenario for each clinical question as the final recommendation. Finally, 56 recommendations were developed for the procedure of intravitreal anti-VEGF injection and their applications in the management of ocular vascular diseases. Conclusion: The implementation of this guideline can standardize the management of the common ocular vascular diseases by intravitreal injection of anti-VEGF agents. It can lead to better policy-making and evidence-based clinical decision by ophthalmologists and optimal evidence based eye care for patients. © 2018 Journal of Ophthalmic and Vision Research

Intravitreal injection of anti-vascular endothelial growth factor agents for ocular vascular diseases: Clinical practice guideline

Purpose: To provide the clinical recommendations for the administration of intravitreal anti-vascular endothelial growth factor (VEGF) drugs especially bavacizumab for ocular vascular diseases including diabetic macular edema, neovascular age-related macular degeneration, myopic choroidal neovascularization, retinal vein occlusion and central serous chorioretinopathy. Methods: Twenty clinical questions were developed by the guideline technical committee. Relevant websites and databases were searched to find out the pertinent clinical practice guidelines to answer the questions. The technical committee provided possible answers (scenarios) according to the available evidences for each question. All scenarios along with their levels of evidence and the supported articles were sent to the experts for external review. If the experts did not agree on any of the scenarios for one particular clinical question, the technical committee reviewed all scenarios and their pertinent evidences and made the necessary decision. After that, the experts were asked to score them again. All confirmed scenarios were gathered as the final recommendations. Results: All the experts agreed on at least one of the scenarios. The technical committee extracted the agreed scenario for each clinical question as the final recommendation. Finally, 56 recommendations were developed for the procedure of intravitreal anti-VEGF injection and their applications in the management of ocular vascular diseases. Conclusion: The implementation of this guideline can standardize the management of the common ocular vascular diseases by intravitreal injection of anti-VEGF agents. It can lead to better policy-making and evidence-based clinical decision by ophthalmologists and optimal evidence based eye care for patients. © 2018 Journal of Ophthalmic and Vision Research

The Frequency of Mental Disorders among Kerman Residents above 15 Years of Age

Abstract: Background & Aims: In developed countries mental disorders are recognized by screening questionnaires and clinical interviews. Since there is a limited number of epidemiological studies about mental disorders in Iranian population, the present study was performed to find the prevalence and type of mental disorders among Kerman residents older than 15 years old. Method: At the first step, GHQ – 28 was completed door – side for 1527 residents selected through stratified cluster sampling. The cut off point of 6 was considered as disorder presence. At the second step, 490 ones who had obtained the cut off point participated in DSM – IV clinical interview. Results: In whole, 32.1% (34.5% female and 27.1% male) were diagnosed as psychiatrically ill. The frequency of mental disorders was 35.1% among those over 65 years, 35.3% among 45 – 64 years subjects, 100% in divorced, 45.8% in widows, 40.2% in illiterates, 36.9% in students, 34.7% in housewives and 34.8% in low socioeconomic class. Major depressive and panic disorders were the most frequent disorders (6.8% and 4.3% respectively). The frequency of generalized anxiety disorder was 2.8%, schizophrenia was 0.9% and Bipolar disorder was 0.3%. Conclusion: The frequencies of major depressive and generalized anxiety disorder were higher than other studies in Iran and similar to some studies from other countries. Different cultures and screening questionnaires maybe some reasons for these incompatibilities. The results of this study my help mental health providers to improve their programs. Keywords: Epidemiology, Mental disorders, Adult, Adult childre

Comparison of the Outcomes of Three Detoxification Methods (Clonidin, Methadon, Rapid) in Opioid-dependents Referred to Kerman Shaheed Beheshti Hospital in a 6 -month Follow- up

Abstract: Background & Aims: In this study the efficacy of traditional method, methadone tapering method and rapid method as three opiate detoxification treatments was compared based on demographic features and naltrexone consumption in a 6- month follow up. Method: This Cohort prospective study was performed on 140 opioid addict men referred to opiate detoxification center of Shahid Beheshti Hospital, Kerman/ Iran from 2005-2007. They were divided into three groups of traditional method (n= 61), methadone tapering (n= 34) and rapid treatment (n= 45) and followed up for 6 months in order to evaluate the results of detoxification treatments. Results: At the end of the first month, the rate of abstinence in whole was 80.7%, and this rate was 83.6% in traditional treatment group, 82.4% in methadone group and 75.6% in rapid treatment group that shows no significant difference. After the 6th month the rate of abstinence was 12.8% in whole, 16.7% in traditional treatment group, 16.7% in methadone group and 6.3% in rapid treatment group. These rates, too, show no significant difference among three groups. The rate of naltrexone consumption at the end of the 1st month was 75.7% in whole, 52.5% in traditional group, 47.1% in methadone group and 97.8% in rapid treatment group that shows significant difference among three groups (P<0.05). There was no case of naltrexone consumption at the end of the 6th month. Conclusion: Since the rate of relapse and results of three detoxification methods have been the same the best detoxification method for each patient should be selected based on the physical condition of the patient, available facilities, probable expenses and physician's clinical judgment. Keywords: Opiate substitution treatment, Naltrexone, Methadone, Relaps

The effect of methadone maintenance therapy on harm minimization between opiate dependents in socio behavioral consulting centers

IntroductionSocio behavioral consulting centers offer Methadone maintenance therapy which is a very useful method for drug dependents. These centers offer a wide range of services like education, consulting, prevention, take care of patient, and treatment for high risk groups like patients infected with AIDS. MMT is helpful in harm minimization and increases quality of drug dependent’s life, so as a result reduces infection in HIV patients.AimsThis study intends to investigate importance of MMT on harm minimization between opioid dependents in Kerman.MethodsThe study was cross sectional and descriptive and it was done on 110 patients referred to sociobehavioral consulting centers no.1 and no.2 in Kerman city in 2005 and 2006. Data was gathered by questionnaires once on the beginning of the treatment and once 6 months after. Then data was analyzed by SPSS13 and chi square test.FindingsMMT results in a reduction of 97.3% of common injections and 96.4% of police arresting to imprisonment and 80% in family problems and 68.2% drug abuse and negative morphine test in these centers. Also after 6 months of treatment, drug consumption expenses were lowered.ConclusionThis study showed that the treatment with MMT in social behavioral consulting centers reduced dangerous behaviors and increased quality of life and controlled the transmission of Dangerous Diseases such as AIDS, Hepatitis and etc in the community.</jats:sec

The prevalence of hypertension among 7-12 year old schoolchildren in Kerman, Iran: A population-based study

Background: The aim of this study was to find the prevalence of chronic hypertension and prehypertension conditions among children. Methods: In this cross-sectional study, a total of 1017 students in Kerman schools were examined during a period from 2013 to 2014. The weight, height, body mass index (BMI), systolic and diastolic blood pressure and family history of high blood pressure were obtained. Pediatric Hypertension was defined as a mean systolic or diastolic reading (or both) � 95th percentile and prehypertension was defined as the blood pressure reading between the 90th and 95th percentiles of the predicted values based on gender, age and height. Results: According to the results, the prevalence of prehypertension and hypertension in schoolchildren was 1.9 and 3, respectively. According to BMI, 13.7 of children were overweight and 14.3 were obese. There was a positive association between BMI and the development of hypertension. Conclusion: Our findings demonstrated that approximately 3 of schoolchildren were afflicted with hypertension. Hypertension showed a positive association with overweight and obesity. © 2020, Kerman University of Medical Sciences. All rights reserved