Faculty Bibliography

BACKGROUND AND PURPOSE: Cerebral venous sinuses thrombosis (CVST) is an uncommon type of stroke with an incidence of 3-4 cases per million. There have been reports of higher incidence of this disease in Iran. Our objective is to describe the incidence, clinical presentation, predisposing factors, and outcomes of CVST at Sina Hospital in Hamadan, west of Iran. METHODS: This is a prospective, single-center, longitudinal study of all patients referred to Sina Hospital in Hamadan, west of Iran, between May 2009 to May 2015 who were diagnosed with CVST. RESULTS: In this study, 151 patients were included. There were 118 women and 33 men. The mean age was 37.48 years. The mean incidence rate of CVST in the duration of our study was 13.49 per 1 million. Oral contraceptives, the most common risk factor, were used by 55.1% of women and half of these patients had fasting simultaneously. Fifty-eight patients had more than 1 risk factor. After 12 months' follow-up, 73.1% of the patients were functionally independent (mRS score 0-1). Ten percent were dependent. The overall mortality was 16.9%. CONCLUSIONS: The incidence of CVST in Hamadan is higher than the world's average, and overall outcome is worse. It seems that fasting and subsequent dehydration in women with recent use of oral contraceptives make them more susceptible to CVST.

The correlates and consequences of pulmonary hypertension (PH) associated with obstructive sleep apnea (OSA) are poorly understood. Patients undergoing pulmonary artery catheterization within 6 months of an overnight polysomnography showing OSA were included in the present analysis. A total of 83 patients with complete data were analyzed (no PH, n = 25 [30%]; PH, 58 [70%]; of these, 18 had a pulmonary capillary wedge pressure of <15 mm Hg). No significant differences were observed between the PH and no PH groups regarding age or apnea-hypopnea index. The correlates of PH were elevated right ventricular systolic pressure (p <0.001), body mass index (p = 0.026), female gender (p = 0.01), nocturnal desaturation (82% vs 18%), and forced vital capacity <70% (p = 0.04) on univariate analysis and female gender (p = 0.03), age <49 years (p = 0.02), body mass index of > or =26 kg/m(2) (p = 0.08), and right ventricular systolic pressure of > or =30 mm Hg (p <0.001) on multivariate analysis. Patients with PH had a lower 6-minute walk distance (285.5 +/- 122 m vs 343 +/- 213 m, p = 0.4). The survival rate at 1, 4, and 8 years for patients with PH was 93%, 75%, and 43% compared to 100%, 90%, and 76% for patients without PH, respectively. Patients with severe PH (n = 27; 33%) had more nocturnal desaturation (p = 0.045), worse pulmonary hemodynamics, and greater mortality (37%) than the groups with mild or moderate PH (16%) or no PH (16%). In conclusion, our results have shown that, although generally mild to moderate, severe PH can occur in patients with OSA. Female gender, younger age, obesity, and nocturnal desaturation were associated with PH. PH can cause functional limitations and increased mortality in patients with OSA.

BACKGROUND: Although a short-term effect of neighborhood characteristics on individual alcohol abuse has been demonstrated by a quasi-experimental residential mobility study, the obversed effect of alcohol problem involvement on place of residence and residential character has not been studied. We test the alcoholism effect on place of residence, and we also attempt to replicate the neighborhood-to-alcoholism effect. METHODS: A sample of 206 Caucasian men (average age was 33) who were systematically recruited for alcoholism through a court record search of drunk driving offenses and door-to-door canvassing, in a 4-county-wide area were followed up at 3-year intervals in a prospective study of the course and outcomes of alcoholism. Participants' alcoholism diagnoses were made by semistructured diagnostic interviews. Residential addresses at baseline and at 12-year follow-up were geocoded. Corresponding census tract variables were used as indicators of neighborhood residential character. RESULTS: The regression analysis shows that, the more alcohol problems a man has, the more likely he is going to remain in, or migrate into, a disadvantaged neighborhood. This effect is only evident when a number of relevant confounding variables, including initial level of socioeconomic status, age, antisocial symptomatology, and spousal alcohol-use disorder status at baseline are controlled. Alcoholics in remission tended to live in neighborhoods whose residential characteristics were not distinguishable from those of nonalcoholics. Unremitted alcoholics, however, tended to stay in or migrate into more disadvantaged neighborhoods. CONCLUSION: Alcoholic involvement has long-term negative effects on place of residence; involving an elevated likelihood of moving into or remaining in a disadvantaged neighborhood. Recovery from alcoholism is protective against downward social drift on the one hand, and is favorable to improvement in social conditions on the other.