Effects of virgin coconut oil consumption on serum brain-derived neurotrophic factor levels and oxidative stress biomarkers in adults with metabolic syndrome: a randomized clinical trial

BACKGROUND AND AIM

Metabolic syndrome is associated with health conditions and neurological disorders. Brain-derived neurotrophic factor (BDNF) plays a protective role on the nervous system. Decreased levels of BDNF have been shown in MetS and neurodegenerative diseases. There is promising evidence regarding the anti-inflammatory antioxidant, and neuroprotective properties of virgin coconut oil (VCO). The aim of this study was to evaluate the effects of VCO consumption on serum BDNF levels, oxidative stress status, and insulin resistance in adults with MetS.

METHODS

This randomized controlled clinical trial was conducted on 48 adults with MetS aged 20-50 years. The intervention group received 30 ml of VCO daily to substitute the same amounts of oil in their usual diet. The control group continued their usual diet. Serum BDNF levels, total antioxidant capacity (TAC), malondialdehyde (MDA) as well as HOMA-IR and QUICKI index were measured after four weeks of intervention.

RESULTS

VCO consumption significantly reduced serum levels of MDA (p = .01), fasting insulin (p < .01) and HOMA-IR index (p < .01) and increased serum TAC (p < .01) and QUICKI index (p = .01) compared to the control group. Serum BDNF levels increased significantly in VCO group compared to the baseline (p = .02); however, this change was not significant when compared to the control group (p = .07).

CONCLUSION

VCO consumption improved oxidative stress status and insulin resistance and had a promising effect on BDNF levels in adults with MetS. Further studies are needed to understand the long-term effects of VCO consumption.

Efficacy of a self-monitoring traffic light diary on outcomes of patients with heart failure: A randomized controlled trial

BACKGROUND AND OBJECTIVE

Patients with heart failure experience high hospitalization. However, patients cannot recognize symptoms according to current approaches, which needs to be improved by new self-monitoring instruments and strategies. Thus, we aimed to assess a self-monitoring traffic light diary on outcomes of patients with heart failure.

METHODS

This was a single-blind, two-arm parallel group randomized controlled trial at the heart failure clinic of Tehran Heart Center (Tehran, Iran). Adult patients with a definitive diagnosis of heart failure with reduced ejection fraction (i.e., ejection fraction of less than 40 %), and New York Heart Association functional classes II-IV were included. A block-balanced randomization method was used to assign eligible subjects to the intervention or control group. Baseline data were collected before random allocation. Participants in the intervention group received a comprehensive intervention consisting of (1) self-care education by an Australian Heart Foundation booklet on heart failure, (2) regular self-monitoring of weight and shortness of breath at home, and (3) scheduled call follow-ups for three months. Patients in the control group received usual care. The primary outcome was heart failure self-care; the secondary outcomes were heart failure quality of life, knowledge, and all-cause hospitalization.

RESULTS

From June to August 2017, 68 patients were included in the study. The overall age of participants was 55 (13.6) years old, and 71 % of patients were male. A significant association between the intervention and self-care maintenance (β 5.1; 95 % CI 2.50 to 7.70, P < 0.001), self-care management (β 10.6; 95 % CI 6.50 to 14.8, P < 0.001), self-care confidence (β 8.0; 95 % CI 5.0 to 11.0, P < 0.001) and heart failure knowledge (β 1.7; 95 % CI 1.30, 2.04; P < 0.001) was found. However, there was no association between the intervention and quality of life (β 2.5; 95 % CI -0.79, 5.88, P 0.135) and hospitalization-free survival of the two groups (Log-Rank P 0.540).

CONCLUSION

A self-monitoring traffic light diary can improve self-care behaviors and heart failure knowledge in patients with heart failure with reduced ejection fraction.

RCT APPROVAL ID

Iranian Registry of Clinical Trials IRCT2017021032476N1.

STUDY PROTOCOL

PMCID: PMC6262204.

The effect of thyme essential oil and endothelial progenitor stem cells on lipopolysaccharide-induced sepsis in C57BL/6 mice

Sepsis is a potentially fatal syndrome related to severe systemic inflammation developed by infection. Despite different antimicrobial therapies, morbidity and mortality rates remain high. Herbs along with cell therapy have been introduced as a promising option to improve the symptoms of sepsis. The present study aimed to evaluate the therapeutic effect of simultaneous administration of thyme essential oil (TEO) and endothelial progenitor stem cells (EPCs) on lipopolysaccharide (LPS)-induced sepsis in C57BL/6 mice. Sepsis was induced in C57Bl/6J mice by intraperitoneal injection of LPS, followed 2 h later by an intravenous injection of EPCs or oral administration of TEO or simultaneous administration of TEO and EPCs. After 10 days, the complete blood cell, renal and liver factors, serum levels of inflammatory cytokines, and angiogenic factors were measured. Simultaneous treatment with EPCs and TEO significantly increased the survival of mice with sepsis and modulated the inflammatory response by reducing the serum levels of pro-inflammatory cytokines. Moreover, this treatment significantly reduced the level of white blood cells and neutrophils and increased the number of red blood cells, the percentage of hematocrit, and hemoglobin. The combination of TEO with EPCs decreased organ injuries and was assessed by lower levels of the liver enzymes alanine aminotransferase and aspartate aminotransferase compared to the sepsis group. Administration of EPCs and TEO also significantly improved angiogenic factors, lung function, and toll-like receptor 4 expression. EPCs in combination with TEO increase survival in the LPS-induced sepsis mice model by acting on several targets. Thus, the combination of TEO with EPCs can be a feasible approach for the future clinical treatment and control of sepsis.

Assessing health determinants worldwide: Econometric analysis of the Global Burden of Diseases Study 2000-18 - Highlighting impactful factors on DALY, YLL, and YLD indicators

Background

As the health status of a population is influenced by a variety of health determinants, we sought to assess their impact on health outcomes, both at the global and regional levels.

Methods

This ecological study encompassed all 194 member countries of the World Health Organization (WHO) from 2000 to 2018. We first identified all health determinants and then retrieved the related data from various global databases. We additionally considered three indicators - disability-adjusted life years (DALYs), years of life lost (YLL), and years lived with disability (YLD) - in evaluating health outcomes; we extracted their data from the Global Burden of Disease (GBD) 2019 study. We then applied econometric analyses using a multilevel mixed-effects linear regression model.

Results

The analysis using the DALY indicator showed that the variables of sexually transmitted infections, injuries prevalence, and urbanisation had the highest effect size or regression coefficients (β) for health outcomes. The variables of sexually transmitted infection (β = 0.75, P < 0.001) in the African region; drinking water (β = -0.60, P < 0.001), alcohol use (β = 0.20, P < 0.001), and drug use (β = 0.05, P = 0.036) in the Americas region; urbanisation (β = -0.34, P < 0.001) in the Eastern Mediterranean region; current health expenditure (β = -0.21, P < 0.001) in the Europe region; injuries (β = 0.65, P < 0.001), air pollution (β = 0.29, P < 0.001), and obesity (β = 0.92, P < 0.001) in the South-East Asia region; and gross domestic product (β = -0.25, P < 0.001), education (β = -0.90, P < 0.001), and smoking (β = 0.28, P < 0.001) in the Western Pacific region had the most significant role in explaining global health outcomes. Except for the drug use variable in regional findings, the role of other variables in explaining the YLL indicator was greater than that of the YLD indicator.

Conclusions

To address global health disparities and optimise resource allocation, global and interregional policymakers should focus on determinants that had the highest β with health outcomes in each region compared to other regions. These determinants likely have a higher marginal health product, and investing in them is likely to be more cost-effective.

Effects of hydrolyzed collagen alone or in combination with fish oil on the gut microbiome in patients with major burns

Burns are associated with gut dysbiosis. Collagen peptides and omega-3 fatty acids (FAs) are suggested to improve wound healing and the inflammatory response. These are also correlated with microbiome colonization. Therefore, the present study aimed to investigate the effect of hydrolyzed collagen alone or in combination with fish oil on specific species of the gut microbiome in patients with major burns. In this randomized double-blind clinical trial, 57 adults (aged 18-60 years) with 20-45% total body surface area burns were randomised into three groups to receive either 40 gr hydrolyzed collagen +10 ml sunflower oil, 40 g hydrolyzed collagen +10 ml fish oil or placebo, divided into two daily drinks, for two weeks. Gut bacteria were measured using the real-time quantitative polymerase chain reaction (qPCR) method. The mean concentration of Bifidobacterium was significantly reduced in the control (P = 0.002) and collagen (P = 0.005) groups compared with the baseline values, whereas no significant change was observed in the collagen omega-3 group. The Firmicutes to Bacteroidetes ratio decreased significantly in the collagen group (p = 0.002) after supplementation compared to baseline . No significant changes in concentration of Lactobacillus, Enterobacteriaceae, and F.prausnitzii were observed between or within the study groups. Two weeks of supplementation with collagen and omega-3 FAs in patients with major burns did not result in a significant difference in the concentration of bacteria measured between the study groups. However, the addition of omega-3 FAs prevented a significant reduction in gut Bifidobacterium. Future studies are suggested to investigate the potential efficacy of these nutrients in improving the gut microbiota and clinical outcomes in major burns. REGISTRATION NUMBER: IRCT20131125015536N9.

Prevalence of refractive errors in population aged 50 years and over: The Gilan eye study

PURPOSE

To describe the prevalence of refractive error (RE) and its association with other environmental and health factors among population aged ≥50 years who lived in Gilan, Iran in 2014.

METHODS

In this population-based cross-sectional study, 3281 individuals aged ≥50 years living in Gilan for at least 6 months were enrolled. The prevalence of different types of REs including myopia (spherical equivalent (SE)≤-0.50D), high myopia (SE ≤ -6.00D), hyperopia (SE≥ + 0.50D), high hyperopia (SE≥ + 3.00D), astigmatism (cylinder < -0.50D) and high astigmatism (cylinder < -2.25D) were determined. Anisometropia was defined as the SE difference of ≥1.00D between the two eyes. Associated factors including age, body mass index (BMI) and education were also studied.

RESULTS

2587 eligible individuals (58% female subjects) with the mean age of 62.6 ± 8.8 years participated (87.6% response rate). The prevalence of myopia, hyperopia and astigmatism was 19.2%, 48.6% and 57.4%, respectively. 3.6% high hyperopia, 0.5% high myopia and 4.5% high astigmatism were identified. The positive simultaneous effects3 of older age (Odds Ratio (OR) = 3.14), nuclear (OR = 1.71) and posterior subcapsular (OR = 1.61) cataracts as well as the negative effects of higher levels of education (OR = 0.28) were obtained on myopia. Higher BMI was found as a risk factor for hyperopia (OR = 1.67), while older patients were less likely to be hyperopic (OR = 0.31).

CONCLUSION

Higher incidence of myopia and astigmatism was found in patients aged over 70 years. It was also found that patients at older ages who suffered with cataracts were at a higher risk of myopia, while elderly people with greater BMI were at a higher risk of hyperopia.

Uveal melanoma in the Iranian population: two decades of patient management in a tertiary eye center

BACKGROUND

To assess the characteristics and outcomes of uveal melanoma management at a tertiary center in the Middle East.

METHODS

A study on 164 patients with uveal melanoma was conducted by reviewing the available medical records, ultrasound, and pathology report results. Age at diagnosis, tumor location and size, treatment mode, visual outcome, metastasis, mortality, and survival were studied.

RESULTS

The mean age of patients was 52.0 ± 15.0 years, and 52.5% were male. Choroidal melanoma was the most common uveal melanoma, followed by the ciliary body and iris melanoma. The mean thickness of tumors was 8.29 ± 3.29. The majority of patients (n = 111, 67.9%) were managed by brachytherapy with ruthenium-106 plaques. Enucleation was performed primarily in 46 (28%) patients and secondarily in nine (5.5%) patients. The sexual disparity was detected as the proximity of uveal melanoma to the fovea in males. For a 61-month mean follow-up period, mortality occurred in eight of our cases, six of which were due to metastasis. The most common site for distance metastasis was the liver (5/6), followed by the lung (1/6). The five-year and eight-year overall survival (OS) rate was 0.947%± 0.019. The 5-year survival rate reached zero in metastatic patients. OS was not statistically different depending on the age, tumor diameters, the primary treatment received, or the histopathologic findings (p > 0.50 for all).

CONCLUSION

In this study, individuals diagnosed with UM exhibited an OS rate of around 94% at the five-year mark, which remained consistent up to eight years. Notably, the presence of distance metastasis emerged as the sole statistically significant factor influencing overall survival.

Non-COVID-19 hospitalization and mortality during the COVID-19 pandemic in Iran: a longitudinal assessment of 41 million people in 2019-2022

BACKGROUND

During a COVID-19 pandemic, it is imperative to investigate the outcomes of all non-COVID-19 diseases. This study determines hospital admissions and mortality rates related to non-COVID-19 diseases during the COVID-19 pandemic among 41 million Iranians.

METHOD

This nationwide retrospective study used data from the Iran Health Insurance Organization. From September 23, 2019, to Feb 19, 2022, there were four study periods: pre-pandemic (Sept 23-Feb 19, 2020), first peak (Mar 20-Apr 19, 2020), first year (Feb 20, 2020-Feb 18, 2021), and the second year (Feb 19, 2021-Feb 19, 2022) following the pandemic. Cause-specific hospital admission and in-hospital mortality are the main outcomes analyzed based on age and sex. Negative binomial regression was used to estimate the monthly adjusted Incidence Rate Ratio (IRR) to compare hospital admission rates in aggregated data. A logistic regression was used to estimate the monthly adjusted in-hospital mortality Odds Ratio (OR) for different pandemic periods.

RESULTS

During the study there were 6,522,114 non-COVID-19 hospital admissions and 139,679 deaths. Prior to the COVID-19 outbreak, the standardized hospital admission rate per million person-month was 7115.19, which decreased to 2856.35 during the first peak (IRR 0.40, [0.25-0.64]). In-hospital mortality also increased from 20.20 to 31.99 (OR 2.05, [1.97-2.13]). All age and sex groups had decreased admission rates, except for females at productive ages. Two years after the COVID-19 outbreak, the non-COVID-19 hospital admission rate (IRR 1.25, [1.13-1.40]) and mortality rate (OR 1.05, [1.04-1.07]) increased compared to the rates before the pandemic. The respiratory disease admission rate decreased in the first (IRR 0.23, [0.17-0.31]) and second years (IRR 0.35, [0.26-0.47] compared to the rate before the pandemic. There was a significant reduction in hospitalizations for pneumonia (IRR 0.30, [0.21-0.42]), influenza (IRR 0.04, [0.03-0.06]) and COPD (IRR 0.39, [0.23-0.65]) during the second year. There was a significant and continuous rise in the hematological admission rate during the study, reaching 186.99 per million person-month in the second year, reflecting an IRR of 2.84 [2.42-3.33] compared to the pre-pandemic period. The mortality rates of mental disorders (OR 2.15, [1.65-2.78]) and musculoskeletal (OR 1.48, [1.20-1.82), nervous system (OR 1.42, [1.26-1.60]), metabolic (OR 1.99, [1.80-2.19]) and circulatory diseases (OR 1.35, [1.31-1.39]) increased in the second year compare to pre-pandemic. Myocardial infarction (OR 1.33, [1.19-1.49]), heart failure (OR 1.59, [1.35-1.87]) and stroke (OR 1.35, [1.24-1.47]) showed an increase in mortality rates without changes in hospitalization.

CONCLUSIONS

In the era of COVID-19, the changes seem to have had a long-term effect on non-COVID-19 diseases. Countries should prepare for similar crises in the future to ensure medical services are not suspended.

Changes in emergency department visits and mortality during the COVID-19 pandemic: a retrospective analysis of 956 hospitals

BACKGROUND

During the COVID-19 pandemic, many non-COVID-19 emergency department (ED) visits were indirectly affected. ED visits and mortality were assessed during different pandemic time periods compared with pre-pandemic.

METHODS

The study used data from 41 million Iran Health Insurance Organization members. The outcomes were non-COVID-19 ED visits and associated mortality in 956 hospitals. An analysis of ED visits was conducted both for all-cause and cause-specific conditions: cardiovascular diseases (CVD), mental and substance use disorders, unintentional injuries, and self-harm. In addition, total in-hospital ED mortality was analyzed. A negative binomial regression and a Poisson regression with a log link were used to estimate the incidence rate ratio (IRR) of visits and mortality relative risk (RR).

RESULTS

1,789,831 ED visits and 12,377 deaths were reported during the study. Pre-pandemic (Sep 2019 to Feb 2020), there were 2,767 non-COVID-19 visits rate per million person-month, which decreased to 1,884 during the first COVID-19 wave with a national lockdown from Feb 20 to Apr 19, 2020 (IRR 0.68, [0.56-0.84]). The non-COVID-19 ED mortality risk was 8.17 per 1,000 visit-month during the pre-pandemic period, rising to 12.80 during the first wave of COVID-19 (RR 1.57, [1.49-165]). Non-COVID-19 ED visit rates decreased during the first pandemic year from Sep 2020 to Feb 2021 (IRR 0.73, [0.63-0.86]), but increased after COVID-19 vaccination two years later from Sep 2021 to Feb 2022 (IRR 1.11, [0.96-0.17]). The total ED mortality risk for non-COVID-19 was significantly higher after the COVID-19 outbreak in the first (RR 1.66, [1.59-1.72]) and second years (RR 1.27, [1.22-1.32]) of the pandemic. The visit incidence rate for mental health and substance use disorders declined from 8.18 per million person-month to 4.57 (IRR 0.53, [0.32 to 0.90]) in the first wave. In the second year, unintentional injury visits increased significantly compared with pre-pandemic (IRR 1.63, [1.30-2.03]). As compared to before the pandemic, there was no significant change in CVD and self-harm visit rates during the pandemic. Cardiac arrest was the leading cause of death in Iran hospitals' EDs.

CONCLUSION

In the first year of the COVID-19 pandemic, non-COVID-19 hospital ED visits declined and mortality risk increased. Despite two years since the COVID-19 outbreak, non-COVID-19 ED mortality risk remains high.

Short-Term Effects of Adding Topical Ketorolac to Intravitreal Bevacizumab in Diabetic Macular Edema: A Crossover Randomized Clinical Trial

Purpose

To evaluate the short-term additive effects of topical ketorolac to intravitreal bevacizumab (IVB) in the management of center-involved diabetic macular edema (CI-DME).

Methods

In a randomized double-masked placebo-controlled crossover clinical trial, eyes with CI-DME and the best-corrected visual acuity (BCVA) between (20/40) and (20/400) were included. These eyes should have had at least one intravitreal anti-VEGF injection in the preceding two months. They were randomized into two groups; while both groups received two IVB injections with a six-week interval, one group received topical ketorolac every 6 hr in the first interval and artificial tears every 6 hr as a placebo in the second interval and the other group received the same medications using a crossover method. The main outcome measures were changes in BCVA and central macular thickness (CMT).

Results

Fifty-seven eyes of 35 patients with CI-DME were included in the study. The mean BCVA improvement was -0.09 ± 0.47 logMAR in the periods of receiving ketorolac and -0.03 ± 0.12 logMAR in the periods of placebo treatment, respectively (P = 0.99). Corresponding changes in CMT were -13.1 ± 170.1 and +11.7 ± 157.7 µm in the ketorolac and placebo periods, respectively (P = 0.322). The treatment effect was not statistically significant regarding both BCVA and CMT changes. Statistical analysis also disclosed that the carryover effect was insignificant for BCVA and CMT. Although the period effect was not significant for BCVA, it was at a meaningful level for CMT changes (P = 0.012).

Conclusion

This crossover clinical trial demonstrated that in the course of DME treatment with IVB injections, topical ketorolac did not have any additive beneficial effect at least during a six-week period.

Choosing the Best Instrument for Measuring Health Spillover Effect in Caregivers of Patients With Multiple Sclerosis

OBJECTIVES

To measure the health spillover effect in caregivers of patients with multiple sclerosis (MS), we aimed to select the best instrument from 2 common health-related quality of life (QoL) instruments, the 3-level EQ-5D (EQ-5D-3L) and the Health Utilities Index Mark 3 (HUI-3), by assessing them.

METHODS

Using consecutive sampling, 452 primary caregivers of patients with MS were asked to fill out a Care-related QoL instrument (CarerQol-7D), EQ-5D-3L, HUI-3, and the Center for Epidemiologic Studies Depression Scale between October 2019 and May 2020. Convergent and clinical validity were assessed to measure spillover effect in caregivers of patients with MS.

RESULTS

A strong correlation of health-utility scores between EQ-5D-3L and HUI-3 (r = 0.914, P < .01) was observed. The 95% limit of agreement (LoA) for CarerQol-7D and HUI-3 (-10.6 to 8.2) was narrower than the LoA for CarerQol-7D and EQ-5D-3L (-15.1 to 17.1). Both EQ-5D-3L and HUI-3 proved clinical validity for the QoL of caregivers. The CarerQoL-7D score was significantly lower in female (P < .001), single (P < .014), lower-educated (P < .001), parent's relatives (P < .001), and unemployed (P < .001) caregivers.

CONCLUSIONS

We found that both, EQ-5D-3L and HUI-3, were appropriate for measuring caregivers' QoL, although HUI-3 was a better choice because of its narrower LoA. Our findings suggest researchers should use HUI-3 to measure the quality-adjusted life-year of caregivers to aggregate with the QoL of patients in the denominator of an economic evaluation equation, such as the cost-effective ratio.

Sector area index: a novel supporting marker for blepharoptosis screening and grading

PURPOSE

To introduce a new supporting marker for discriminating different grades of ptosis called Sector Area Index (SAI) and a semi-automated technique to calculate it.

METHODS

In this cross-sectional comparative case series, a circle enclosing the intercanthal distance was automatically drawn after choosing two points as the medial and lateral canthus and manually selecting the palpebral fissure region. Finally, 15-degree apart sectors are applied to the enclosed circle. SAI was measured automatically by dividing the area of each 15-degree sector marked with the upper eyelid contour by the total area of the sector marked with the edge of the surrounding circle. SAI values and inter-eye SAI differences were compared between patients with different grades of ptosis as well as normal patients.

RESULTS

In the current study, 106 eyes were recruited (30, 25, 27, and 24 in the control, mild, moderate, and severe ptosis groups, respectively). Mean values of SAI in all sectors showed a decreasing trend from normal individuals toward patients with severe ptosis. The mean difference values of SAI between study eyes and fellow eyes in all four groups of patients showed a statistically significant difference (p < 0.05). In a pairwise comparison between groups, mean values of SAI in all nasal sectors from 15° to 60° showed a statistically significant difference between all groups (p < 0.05).

CONCLUSION

The mean difference of SAI between study eyes and fellow eyes, including eyelid curvature, especially in 15°-60° and 120°-165° sectors, can demonstrate differentiating performance for detecting and discriminating varying grades of ptosis.

Prevalence of cataract and its contributing factors in Iranian elderly population: the Gilan eye study

PURPOSE

To report the prevalence and the associated factors leading to cataract among the Iranian population living in Gilan Province, Iran.

METHODS

This population-based cross-sectional study was performed from June to November 2014 on 2,975 residents aged ≥ 50 years old living in urban and rural regions of the Gilan Province in Iran. A representative sample of residents in the province was recruited into the study through door-to-door visiting, and baseline data were collected by questionnaire. All participants were referred to the medical center for comprehensive ophthalmic examination, laboratory tests, and blood pressure measurement.

RESULTS

Among the population, 2,588 (86.99%) subjects were eligible to be included in this study, categorized either into the cataract or the non-cataract group. The mean age of participants was 62.59 ± 8.92 years, and 57.5% were female. Higher prevalence of cataract was found in individuals of older ages (odds ratio (OR) = 1.13; 95% confidence interval (CI) = 1.10 to 1.16; P < 0.001) and a history of previous ocular surgery (OR = 5.78; 95% CI = 2.28 to 14.63; P < 0.001). At the same time, a lower prevalence of cataract was seen in patients exposed to sunlight for more than 4 h per day (OR = 0.49; 95% CI = 0.32 to 0.73; P = 0.001).

CONCLUSION

Cataract affects 50.50% of the study population, especially those over 80. The mildest form of cataract, grade zero, is the most common. Surgery for cataract has good outcomes. The risk of cataract is higher for those older or who have had eye surgeries. People not affected by cataract tend to be exposed to more sunlight.

A Stepped-Wedge Cluster-Randomized Controlled Trial of Multi-interventional Approach for Fall Prevention

BACKGROUND AND OBJECTIVES

Falls are one of the most common adverse events at hospitals that may result in injury and even death. They are also associated with raised length of stay (LOS) and hospitalization costs. This experiment aimed to examine the effectiveness of multiple interventions in reducing inpatient fall rates and the consequent injuries.

METHODS

The present study was a stepped-wedge cluster-randomized controlled trial. It was done in 18 units in a public university hospital over 36 weeks. Patients included in this research were at risk of falls. Overall, 33 856 patients were admitted, of whom 4766 were considered high-risk patients. During the intervention phases, a series of preventive and control measures were considered, namely staff training; patient education; placement of nursing call bells; adequate lighting; supervision of high-risk patients during transmission and handovers; mobility device allocation; placement of call bell and safe guard in bathrooms; placing "fall alert" signs above patients' beds; nurses informing physicians timely about complications such as delirium and hypoxia; encouraging appropriate use of eyeglasses, hearing aids and footwear; keeping side rails up; and reassessing patients after each fall. The primary outcome was participant falls per 1000 patient-days. Secondary outcomes were fall-related injuries and LOS.

RESULTS

The results revealed a decrease in fall rate (n = 4 per 1000 patient-days vs 1.34 per 1000 patient-days, incidence rate ratio (IRR) = 0.19 [95% confidence interval (CI), 0.14-0.26]; P = .001) and injuries (n = 2.4 per 1000 patient-days vs 0.79 per 1000 patient-days, IRR = 0.22 [95% CI, 0.15-0.32]; P = .001) in exposed compared with unexposed phases. There was not a significant difference in LOS (exposed mean 10.63 days [95% CI, 10.26-10.97], unexposed mean 10.84 days [95% CI, 10.59-11.09], mean difference = -0.13 [95% CI, -0.53 to 0.27], P = .52).

CONCLUSIONS

This multi-interventional trial showed a reduction in falls and fall rates with injury but without an overall effect on LOS. Further research is needed to understand the sustainability of multiple fall prevention strategies in hospitals and their long-term impacts.

Validity of the models predicting 10-year risk of cardiovascular diseases in Asia: A systematic review and prediction model meta-analysis

We aimed to review the validity of existing prediction models for cardiovascular diseases (CVDs) in Asia. In this systematic review and meta-analysis, we included studies that validated prediction models for CVD risk in the general population in Asia. Various databases, including PubMed, Web of Science conference proceedings citation index, Scopus, Global Index Medicus of the World Health Organization (WHO), and Open Access Thesis and Dissertations (OATD), were searched up to November 2022. Additional studies were identified through reference lists and related reviews. The risk of bias was assessed using the PROBAST prediction model risk of bias assessment tool. Meta-analyses were performed using the random effects model, focusing on the C-statistic as a discrimination index and the observed-to-expected ratio (OE) as a calibration index. Out of 1315 initial records, 16 studies were included, with 21 external validations of six models in Asia. The validated models consisted of Framingham models, pooled cohort equations (PCEs), SCORE, Globorisk, and WHO models, combined with the results of the first four models. The pooled C-statistic for men ranged from 0.72 (95% CI 0.70 to 0.75; PCEs) to 0.76 (95% CI 0.74 to 0.78; Framingham general CVD). In women, it varied from 0.74 (95% CI 0.22 to 0.97; SCORE) to 0.79 (95% CI 0.74 to 0.83; Framingham general CVD). The pooled OE ratio for men ranged from 0.21 (95% CI 0.018 to 2.49; Framingham CHD) to 1.11 (95%CI 0.65 to 1.89; PCEs). In women, it varied from 0.28 (95%CI 0.33 to 2.33; Framingham CHD) to 1.81 (95% CI 0.90 to 3.64; PCEs). The Framingham, PCEs, and SCORE models exhibited acceptable discrimination but poor calibration in predicting the 10-year risk of CVDs in Asia. Recalibration and updates are necessary before implementing these models in the region.

Zero-Inflated Count Regression Models in Solving Challenges Posed by Outlier-Prone Data; an Application to Length of Hospital Stay

Introduction

Ignoring outliers in data may lead to misleading results. Length of stay (LOS) is often considered a count variable with a high frequency of outliers. This study exemplifies the potential of robust methodologies in enhancing the accuracy and reliability of analyses conducted on skewed and outlier-prone count data of LOS.

Methods

The application of Zero-Inflated Poisson (ZIP) and robust Zero-Inflated Poisson (RZIP) models in solving challenges posed by outlier LOS data were evaluated. The ZIP model incorporates two components, tackling excess zeros with a zero-inflation component and modeling positive counts with a Poisson component. The RZIP model introduces the Robust Expectation-Solution (RES) algorithm to enhance parameter estimation and address the impact of outliers on the model's performance.

Results

Data from 254 intensive care unit patients were analyzed (62.2% male). Patients aged 65 or older accounted for 58.3% of the sample. Notably, 38.6% of patients exhibited zero LOS. The overall mean LOS was 5.89 (± 9.81) days, and 9.45% of cases displayed outliers. Our analysis using the RZIP model revealed significant predictors of LOS, including age, underlying comorbidities (p<0.001), and insurance status (p=0.013). Model comparison demonstrated the RZIP model's superiority over ZIP, as evidenced by lower Akaike information criteria (AIC) and Bayesians information criteria (BIC) values.

Conclusions

The application of the RZIP model allowed us to uncover meaningful insights into the factors influencing LOS, paving the way for more informed decision-making in hospital management.

Effect of diet low in advanced glycation end products on appetite, body composition, and brown adipose tissue markers in patients with coronary artery disease treated with angioplasty: A randomized controlled trial

Background

Recent changes in dietary habits have resulted in increased intake of advanced glycation end products (AGEs), which are known to have a predominant contribution to the pathogenesis and complications of coronary artery disease (CAD). AGEs are also thought to induce weight gain by affecting appetite, energy expenditure, and brown adipose tissue (BAT). Here, we investigated whether the restriction of dietary AGEs could affect appetite, body composition, anthropometric indices, and BAT-derived markers in CAD patients treated with angioplasty.

Materials and Methods

Forty-two stented CAD patients were randomly allocated into two groups that received either a low-AGEs or a control diet for 12 weeks. At baseline and postintervention, fasting blood samples were analyzed for total AGEs, nesfatin-1, and BAT-derived markers (fibroblast growth factor 21 and neuregulin 4). Subjective appetite ratings and body composition were evaluated using the Visual Analog Scale (VAS) and bioelectric impedance analysis. Anthropometric indices, including fat mass index (FMI), abdominal volume index (AVI), and body adiposity index (BAI), were calculated through the relevant formula.

Results

Restricting dietary AGEs for 12 weeks could cause a significant reduction in weight, FMI, AVI, and BAI (P < 0.05) compared to the comparison group. In addition, VAS data analyses indicated a significant decrease in the sense of hunger and prospective food intake (P < 0.05) in the intervention group compared to the comparison group. No significant difference was seen in the measured biochemical markers between the two groups.

Conclusion

This study indicated that the low-AGEs diet could decrease appetite, weight, and anthropometric indices in stented CAD patients.

Covariates of a healthy diet and physical activity self-management one year after Bariatric surgery: A cross-sectional study

BACKGROUND

Healthy diet and physical activity self-management is important in maintaining weight loss and preventing weight regain after bariatric surgery. We aimed at evaluating covariates of healthy diet and physical activity self-management among patients undergone bariatric surgery using Health Action Process Approach (HAPA) model.

METHOD

In this cross-sectional study, 272 patients with a history of bariatric surgery were selected from the data registry of Tehran Obesity Treatment Study (TOTS). Data were collected using bariatric surgery self-management standard questionnaire (BSSQ), and items based on HAPA model for healthy diet and physical activity self-management. Data were analyzed using Path analysis and AMOS version 24.

RESULTS

The mean score of self-management was (32 ± 10SD). Coping planning construct (β = 0.22; p<0.001) and risk perception (β = 0.02; p<0.01) in dietary self-management and action planning (β = 0.16; p = 0.001) and risk perception (β = 0.001; p = 0.17) in physical activity self-management had the highest and lowest effect powers, respectively. Coping planning (β = 0.22; p<0.001) and action planning (β = 0.17; p<0.03) in diet, and action planning (β = 0.16; p = 0.010) in physical activity were significantly related to self-management. Also, task-coping self-efficacy (β = 0.28; and p<0.001), outcome expectancies (β = 0.37; p<0.001), risk perception (β = 0.13; p = 0.015) in diet and coping self-efficacy (β = 0.50; p<0.001), outcome expectancies (β = 0.12; p = 0.021) in physical activity were significantly related to behavioral intention. The values of CFI = 0.939 and RMSEA = 0.052 for diet and CFI = 0.948 and RMSEA = 0.048 for physical activity indicated adequate fit.

CONCLUSION

HAPA was applicable as a framework for interventions promoting healthy diet and physical activity self-management in patients who have undergone bariatric surgery.

The relationship of circulating neuregulin 4 and irisin, and traditional and novel cardiometabolic risk factors with the risk and severity of coronary artery disease

BACKGROUND AND AIMS

Neuregulin 4 (NRG4) and irisin are adipokines that have been suggested to be associated with cardiometabolic risk factors and coronary artery disease (CAD), but the data are inconclusive. This study aimed to investigate the relationship between circulating NRG4 and irisin and cardiometabolic risk factors with CAD risk and severity.

METHODS AND RESULTS

In this cross-sectional study, the presence of CAD and the severity of stenosis (gensini score) were documented based on coronary angiography in 166 adults. Circulating NRG4 and irisin, glucose homeostasis markers, hs-CRP, lipid profiles, blood pressure, and anthropometric measurements were assessed as well. Age (p = 0.005), sex (p = 0.008), SBP (p = 0.033), DBP (p = 0.04), MAP (p = 0.018), FBG (p = 0.012), insulin (p = 0.039) and HOMA-IR (p = 0.01) were significantly associated with odds of having CAD. The final logistic regression model showed that age, sex, HOMA-IR, and MAP were the most important determinants of having CAD. There were no significant associations between circulating irisin and NRG4 with odds of having CAD. The final general linear model showed that being men (β = 17.303, 95% CI: 7.086-27.52, P = 0.001), age (Aβ = 0.712, 95% CI: 0.21-1.214, P = 0.006), HOMA-IR (Aβ = 2.168, 95% CI: 0.256 to 4.079, P = 0.027), and NRG4 level (β = 1.836, 95% CI: 0.119-3.553, P = 0.036) were directly associated with higher gensini score. Participants with the three-vessel disease had a mean increase of about 5 units in circulating irisin compared to those with no clinical CAD (β = 5.221, 95% CI: 0.454-9.987, p = 0.032).

CONCLUSIONS

This study showed that the adipokines NRG4 and Irisin might be associated with the severity of coronary stenosis.

Diagnostic accuracy of confocal scan in detecting acanthamoeba keratitis and fungal keratitis: a systematic review and meta-analysis

PURPOSE

Acanthamoeba keratitis (AK) and fungal keratitis (FK) are two microbial keratitis that cause serious damage and, without early accurate diagnosis and treatment, may lead to blindness. In vivo corneal confocal scan, as an emerging ocular diagnostic method in comparison with microbiological smears and cultures as the gold standard, may assist in accelerating appropriate diagnosis.

OBJECTIVE

To determine the diagnostic accuracy of confocal scan for the diagnosis of AK and FK.

METHODS

Data were collected via a comprehensive literature search of PubMed, Web of Science, Cochrane Library, Embase and Scopus using keywords related to diagnostic accuracy of confocal scan in AK and FK up to October 2022. Pooled data underwent meta-analysis in terms of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall diagnostic odds ratio (DOR) of confocal scan for the diagnosis of AK and FK.

RESULTS

The final 14 relevant studies were identified, including 1950 eyes. Meta-analysis in AK group revealed 94% sensitivity, 87% specificity, 89% PPV, 92% NPV, and DOR of 143.32, and in FK group disclosed 88% sensitivity, 85% specificity, 85% PPV, 88% NPV, and DOR of 75.98.

CONCLUSION

The accuracy of confocal scan for the diagnosis of AK was significantly more than that for detecting FK; despite the limitations such as limited numbers of available retrospective studies for the detection of FK, confocal scan had an acceptable performance in detecting FK eyes. The overall performance of NCS was similar with that of HRT-RCM for the detection of both types of keratitis.

The effect of topical ketorolac tromethamine on macular thickening after phacoemulsification in diabetic patients

BACKGROUND

To determine the effect of ketorolac tromethamine 0.5% in preventing post-phacoemulsification macular thickening. This randomized clinical trial. patients randomized 1:1 to receive either topical ketorolac three times a day or a placebo.

METHODS

A total of 101 eyes of 101 diabetic patients who were scheduled for phacoemulsification and had normal macular contour and thickness enrolled consecutively. The topical ketorolac and placebo were prescribed on the day before surgery and continued up to 4 weeks after surgery. Patients with proliferative diabetic retinopathy, a history of intravitreal injection in less than three months, a history of macular photocoagulation in less than 6 months, and any other concomitant ocular pathologies were excluded. Central macular thickness (CMT) and best corrected visual acuity (BCVA) was recorded in the follow-ups of 6, 12, and 24 weeks after the surgery and compared with the controls.

RESULTS

49 eyes in the case group and 52 eyes in the control group were analyzed. Mean BCVA was significantly improved in both groups at all follow-ups (P < 0.001 for all). There was no statistically significant difference regarding the BCVA in different time points except week 12 (P = 0.028) among the study group. In the case and control groups, CMT was increased at all follow-ups (P < 0.05). There was no statistically significant difference when comparing the two groups regarding the mean of CMT at any time point postoperatively (P > 0.05 for all).

CONCLUSION

Based on our findings, topical ketorolac tromethamine 0.5% is not effective in the prevention of post-phacoemulsification macular thickening in diabetic patients.

TRAIL REGISTRATION

The study protocol was registered into www.

CLINICALTRIAL

gov with the RCT registration number NCT03551808. (2018/06/11 ) CLINICAL TRIAL REGISTRATION NUMBER: NCT03551808.

Implications of the Serum Concentrations of Neuregulin-4 (Nrg4) in Patients with Coronary Artery Disease: A Case-Control Study

Background

Neuregulin-4 (Nrg4), a novel brown fat-enriched factor, has been reported to play a crucial role in developing metabolic disorders. The current case-control study aimed to investigate the association between serum Nrg4 and coronary artery disease (CAD).

Methods

This study enrolled 43 patients with CAD and 43 subjects with normal coronary arteries diagnosed by coronary angiography. Anthropometric and biochemical parameters were measured and recorded. The serum Nrg4 level was determined using the enzyme-linked immunosorbent assay. The relationships between circulating Nrg4 and CAD and other clinical parameters were analyzed. A receiver operating characteristic analysis was applied to assess the utility of Nrg4 in identifying CAD.

Results

The study population comprised 86 patients, including 64 men (74.4%), at a mean age of 57.83±6.01 years. Patients with CAD had significantly lower serum Nrg4 than the control group (P<0.001). The serum Nrg4 level was negatively correlated with anthropometric variables, including the body mass index, waist circumference, and the waist-to-hip ratio, fasting blood glucose, and the triglyceride-glucose index (P<0.05). In multivariable-adjusted regression analysis, the odds of CAD decreased by 46% per 1 SD elevation in the serum Nrg4 level (OR, 0.54; 95% CI, 0.40 to 0.73; P<0.001) after controlling for potential confounders. Nrg4 showed a significantly high area under the curve value (AUC, 0.85; 95% CI, 0.75 to 0.94) with 81.4% sensitivity and 95.3% specificity to identify CAD.

Conclusion

Generally, the serum level of Nrg4 declines in patients with CAD, which might be an independent risk factor for CAD.

The causal effect of family physician program on the prevalence, screening, awareness, treatment, and control of hypertension and diabetes mellitus in an Eastern Mediterranean Region: a causal difference-in-differences analysis

BACKGROUND

Hypertension (HTN) and diabetes mellitus (DM) as part of non-communicable diseases are among the most common causes of death worldwide, especially in the WHO's Eastern Mediterranean Region (EMR). The family physician program (FPP) proposed by WHO is a health strategy to provide primary health care and improve the community's awareness of non-communicable diseases. Since there was no clear focus on the causal effect of FPP on the prevalence, screening, and awareness of HTN and DM, the primary objective of this study is to determine the causal effect of FPP on these factors in Iran, which is an EMR country.

METHODS

We conducted a repeated cross-sectional design based on two independent surveys of 42,776 adult participants in 2011 and 2016, of which 2301 individuals were selected from two regions where the family physician program was implemented (FPP) and where it wasn't (non-FPP). We used an Inverse Probability Weighting difference-in-differences and Targeted Maximum Likelihood Estimation analysis to estimate the average treatment effects on treated (ATT) using R version 4.1.1.

RESULTS

The FPP implementation increased the screening (ATT = 36%, 95% CI: (27%, 45%), P-value < 0.001) and the control of hypertension (ATT = 26%, 95% CI: (1%, 52%), P-value = 0.03) based on 2017 ACC/AHA guidelines that these results were in keeping with JNC7. There was no causal effect in other indexes, such as prevalence, awareness, and treatment. The DM screening (ATT = 20%, 95% CI: (6%, 34%), P-value = 0.004) and awareness (ATT = 14%, 95% CI: (1%, 27%), P-value = 0.042) were significantly increased among FPP administered region. However, the treatment of HTN decreased (ATT = -32%, 95% CI: (-59%, -5%), P-value = 0.012).

CONCLUSION

This study has identified some limitations related to the FPP in managing HTN and DM, and presented solutions to solve them in two general categories. Thus, we recommend that the FPP be revised before the generalization of the program to other parts of Iran.

Polycyclic aromatic hydrocarbons (PAHs) in meat, poultry, fish and related product samples of Iran: a risk assessment study

Meat, poultry, and seafood such as fish are a valuable source of protein, vitamins and minerals. Considering their high consumption in the human diet, it is necessary to study pollutants (such as PAHs) in them. This present study has focused on the PAHs level and probabilistic risk of health in meat, poultry, fish and related product samples by MSPE-GC/MS technique (magnetic solid-phase extraction with gas chromatography-mass spectrometry). The maximum mean of 16 PAH was detected in smoked fish samples (222.7 ± 13.2 μg/kg) and the minimum mean of 16 PAH was detected in chicken (juje) kebab (112.9 ± 7.2 µg/kg μg/kg). The maximum mean of 4PAHs was detected in tuna fish (23.7 ± 2.4 µg/kg) and the minimum mean of 4PAHs was seen in grilled chicken and sausage samples (non-detected). Our results showed the 4PAHs and B[a]P were lower than the EU (European Union) standard levels (these standard levels were 30 and 5 μg/kg, respectively). Furthermore, the correlation among the type and concentrations of PAHs congeners was investigated through cluster analysis by heat map and principal component analysis. The 90th percentile ILCR (incremental lifetime cancer risk) of PAH compounds in fish, poultry, meat and related products samples was 3.39E-06, which was lower than the maximum acceptable level of risk (10-4). Finally, the highest ILCR was related to hamburger (4.45E-06). Therefore, there is no risk in consuming these foods in Iran, but it is necessary to monitor PAHs concentration in different types of foods.

Larvicidal Effects of Metabolites Extracted from Nocardia and Streptomyces Species against the Forth Larval Stage of Anopheles stephensi (Diptera: Culicidae)

Background

Larvicidal agents can be produced using microbial resources, which are environmentally friendly, biodegradable, and economical. The study's goal was to evaluate the larvicidal activity of metabolites isolated from Nocardia (N. fluminea, N. soli and N. pseudobrasiliensis) and Streptomyces (S. alboflavus) bacterial species against Anopheles stephensi.

Methods

Four metabolites isolated from Nocardia and Streptomyces strains were exanimated for larvicidal activity. The experiments were performed for 24, 48, and 72 hours. 300, 350, 400, 450, 500, 550, and 600 μl of Actinobacteria metabolites were added to 100 cc of dechlorinated water. Fourth-stage larvae were placed in dechlorinated water as a control. LC50 and LC90 were calculated using toxicity data and analyzed.

Results

All metabolites had a statistically significant influence on mosquito larvae (P< 0.05). At 24, 48, and 72 hours, the LC50 for N2 (N. fluminea) was 417, 386, and 370 ppm, respectively, and the LC90 was 650, 595, and 561 ppm. Moreover, LC50 for N4 (N. soli) was 389, 376, and 347 and LC90 were 591, 565, and 533 and LC50 for N5 (N. pseudobrasiliensis) was 390, 357, and 341 ppm and LC90 were 589, 532 ppm. In addition, LC50 for S921 (S. alboflavus) was 484, 416, and 382 ppm, and LC90 was 701, 612, and 574 ppm.

Conclusion

The four bacterial metabolites tested in our study were found to have a notable effect on the mortality rate of Anopheles stephensi larvae, indicating their potential as natural larvicides. This is an effective technique for controlling Anopheles stephensi that has no detrimental environmental impact.

Mycobacterium tuberculosis genotypes in an ethnically diverse area with millions of pilgrims and thousands of immigrants

BACKGROUND

Immigration is considered as a risk factor of tuberculosis (TB). Qom province receives millions of pilgrims and significant numbers of immigrants each year. Most of the immigrants to Qom, arrive from neighboring TB-endemic countries. This study aimed to identify the current circulating Mycobacterium tuberculosis genotypes in Qom province using 24-locus MIRU-VNTR genotyping.

METHODS

Eighty six M. tuberculosis isolates were collected during 2018-2022 from patients referring to Qom TB reference laboratory. The DNA of isolates was extracted and followed by 24 loci MIRU-VNTR genotyping which performed using the web tools available on MIRU-VNTRplus.

RESULTS

Of 86 isolates, 39 (45.3%) were of Delhi/CAS genotype, 24 (27.9%) of NEW-1, 6 (7%) of LAM, 6 (7%) of Beijing, 2 (2.3%) of UgandaII, 2 (2.3%) of EAI, 1 of S (1.2%) and 6 (7%) did not match with profiles present in MIRUVNTRplus database.

CONCLUSIONS

About half of the isolates belong to Afghan immigrants; which warns health policy makers about the future situation of TB in Qom. Also, the similarity of Afghan and Iranian genotypes provides evidence that immigrants partake in the circulation of M. tuberculosis. This study underpin the studies about the circulating M. tuberculosis genotypes, their geographical distribution, the association of TB risk factors with these genotypes and the impact of immigration on the situation of TB in Qom province.

Diverse Expression Patterns of EBV Oncogenes (LMP2A, EBV-Encoded microRNA, and EBV-encoded dUTPase) in EBV Associated Gastric Carcinoma and their Association with Viral Loads

The chromogenic in situ hybridization (CISH) test is the gold standard for detecting Epstein-Barr virus (EBV)-associated gastric carcinoma (GC). Real-time (RT) PCR method is also a sensitive test that can detect the viral load in samples. As such, three EBV oncogenes were investigated in this study. RNA extraction and cDNA synthesis were performed on GC tissues of nine patients, who were previously confirmed to have EBVGC subtype. In addition, 44 patients that had positive RT-PCR but negative CISH results were also included as the control group. TaqMan RT-PCR analysis was performed to determine the expression of EBV-encoded microRNAs, and the expression of EBV-encoded dUTPase, as well as LMP2A, was analyzed by SYBR Green RT-PCR. EBV-encoded microRNAs and LMP2A were identified in 2 out of 9 (22%) EBVGC subtypes. In addition, EBV-encoded dUTPase was detected in 4 out of 9 (44.5%) EBVGC subtypes. EBV-encoded dUTPase was also expressed in a sample of the control group. The expression of LMP2A, EBV-encoded microRNAs, and EBV-encoded dUTPase viral oncogenes in patients with high EBV viral loads indicates that these expressions correlate with viral loads. Our findings indicate that the EBV-encoded dUTPase gene may have a role in EBVGC patients' non-response to treatment and might be considered a Biomarker-targeted therapy.

Choroidal structure investigated by choroidal vascularity index in patients with inherited retinal diseases

PURPOSE

To evaluate the choroidal structure in patients with inherited retinal diseases (IRDs) by investigating the choroidal vascularity index (CVI).

METHODS

The present study was conducted on 113 IRD patients and 113 sex- and age-matched healthy individuals. Patients' data was extracted from the Iranian National Registry for IRDs (IRDReg®). Total choroidal area (TCA) was determined between retinal pigment epithelium and choroid-scleral junction,1500 microns on either side of the fovea. Luminal area (LA) was considered as the black area corresponding to the choroidal vascular spaces, following Niblack binarization. CVI was calculated as the ratio of the LA to the TCA. CVI and other parameters were compared among different types of IRD and the control group.

RESULTS

The IRD diagnosis included retinitis pigmentosa (n = 69), cone-rod dystrophy (n = 15), Usher syndrome (n = 15), Leber congenital amaurosis (n = 9), and Stargardt disease (n = 5). Sixty-one (54.0%) individuals of each of the study and control groups were male. The average CVI was 0.65 ± 0.06 in the IRD patients and 0.70 ± 0.06 in the control group (P < 0.001). Accordingly, the average of TCA and LA were 2.32 ± 0.63 and 1.52 ± 0.44 mm [1] in patients with IRDs, respectively. The measurements for the TCA and the LA were significantly lower in all subtypes of IRD (P-values < 0.05).

CONCLUSION

CVI is significantly lower in patients with IRD than in healthy age-matched individuals. Choroidal changes in IRDs may be related to the changes in the lumen of the choroidal vessels rather than the stromal changes.

Application of Frailty Quantile Regression Model to Investigate of Factors Survival Time in Breast Cancer: A Multi-Center Study

Background

The prognostic factors of survival can be accurately identified using data from different health centers, but the structure of multi-center data is heterogeneous due to the treatment of patients in different centers or similar reasons. In survival analysis, the shared frailty model is a common way to analyze multi-center data that assumes all covariates have homogenous effects. We used a censored quantile regression model for clustered survival data to study the impact of prognostic factors on survival time.

Methods

This multi-center historical cohort study included 1785 participants with breast cancer from four different medical centers. A censored quantile regression model with a gamma distribution for the frailty term was used, and p-value less than 0.05 considered significant.

Results

The 10^th and 50^th percentiles (95% confidence interval) of survival time were 26.22 (23–28.77) and 235.07 (130–236.55) months, respectively. The effect of metastasis on the 10^th and 50^th percentiles of survival time was 20.67 and 69.73 months, respectively (all p-value < 0.05). In the examination of the tumor grade, the effect of grades 2 and 3 tumors compare with the grade 1 tumor on the 50^th percentile of survival time were 22.84 and 35.89 months, respectively (all p-value < 0.05). The frailty variance was significant, which confirmed that, there was significant variability between the centers.

Conclusions

This study confirmed the usefulness of a censored quantile regression model for cluster data in studying the impact of prognostic factors on survival time and the control effect of heterogeneity due to the treatment of patients in different centers.

Effect of a collagen-enriched beverage with or without omega-3 fatty acids on wound healing, metabolic biomarkers, and adipokines in patients with major burns

BACKGROUND & AIMS

This study investigated the effects of collagen hydrolysate and omega-3 fatty acids (FAs) on the rate and quality of wound healing, metabolic disorders, and adipose-derived peptides in patients with major burns.

METHODS

In this randomized clinical trial, 66 patients with 20-45% deep partial or full-thickness burns were randomly assigned to three groups to receive either a beverage containing collagen (40 gr/d), collagen (40 gr/d) plus 3 gr/d omega-3 (ω-3) FAs, or placebo for four weeks. Wound healing rate, Vancouver scar scale (VSS), as well as baseline, weeks two and three serum concentrations of adiponectin, fibroblast growth factor 21 (FGF21), neuregulin 4 (NRG4), transforming growth factor (TGF)-β1, and pre-albumin/hs-CRP ratio were assessed.

RESULTS

The wound healing rate during the weeks post-burn (p = 0.006 and p = 0.01), and days of 95% (21.3 ± 6.8 and 22.9 ± 8.7 vs. 34.3 ± 14.8 days, p = 0.003 and p = 0.03) and complete (26 ± 7.7 and 27.4 ± 9.4 vs. 41.1 ± 16.6 days, p = 0.003 and p = 0.01) wound healing were significantly better with Collagen and Collagen. ω-3 compared to the placebo group. The VSS was significantly lower, indicated better scar status, in the both intervention groups compared to the placebo (p = 0.02 and p = 0.01). Wound healing outcomes were not statistically different between the Collagen and Collagen. ω-3 groups. Hs-CRP/pre-albumin ratio was significantly lower in the Collagen. ω-3 than the placebo group at week three (1.2 ± 1.9 vs. 4.8 ± 7.7 dl/l, p = 0.03). The significant decrease in serum adiponectin seen during the trial course within the placebo (10 ± 8.8 to 5.8 ± 4.9 mg/l, p = 0.03) and Collagen (11.8 ± 14 to 8.6 ± 11.7 mg/l, p = 0.03) groups was prevented in the Collagen. ω-3 group (p = 0.4). Circulating FGF21 decreased significantly within the Collagen (p = 0.005) and Collagen. ω-3 (p = 0.02) groups at the end of week three compared to the baseline.

CONCLUSIONS

Adding collagen hydrolysate as part of adjunctive therapy improved wound healing rate and quality. These findings as well as the efficacy of omega-3 FAs need to be further confirmed in larger populations. This study was registered with the Iranian Registry of Clinical Trials (IRCT20090901002394N42).

Translation and validation of the Persian version of the scleroderma health assessment questionnaire (SHAQ)

The present study aimed to translate and validate the Scleroderma Health Assessment Questionnaire (SHAQ) for Persian-speaking patients (SHAQ-P), using a cross-sectional study. This cross-sectional study included SSc patients with 2013 ACR/EULAR criteria. The SHAQ was translated using a "forward-backward" method. HAQ-DI and SSc-HAQ scores were calculated from the patient-answered questionnaires. Rheumatology experts assessed the face and content validities of the SHAQ-P. Psychometric properties of the SHAQ-P were then assessed: Structural validity was analyzed using principal component factor analysis. Discriminant and convergent validities were measured on subgroups of the initial patient population. Test-retest reliability was measured on patients who filled the SHAQ-P again after 1 month. The Scale-CVI-average (S-CVI/Ave) score for content validity was 88.7%. Face validity was measured to be 68.17% using the QQ10 questionnaire. Factor analysis revealed a two-factor structure with 20 out of 26 questions loading on the first factor (N = 285). One-way ANOVA showed that patients with a higher number of involved organs had higher average HAQ-DI and SSc-HAQ-scores (N = 60, P = 0.019 and 0.023, respectively). HAQ-DI and SSc-HAQ-scores were significantly correlated with the physical component score of SF36 (N = 31, correlation coefficient =  - 0.65 and  - 0.72, respectively). Reliability testing after one month demonstrated that HAQ-DI and SSc-HAQ-scores were significantly correlated with their initial (N = 40, correlation coefficient = 0.86 and 0.84, respectively), proving that the Persian SHAQ was a valid and reliable questionnaire to evaluate scleroderma patients' quality of life.

Prevalence of Hypertension among Children Based on the New American Academy of Pediatrics Clinical Practice Guidelines

Background

In 2017, the American Academy of Pediatrics (AAP) updated clinical practice guidelines for the diagnosis and management of hypertension in children. The present study aimed to assess the prevalence of hypertension in Iranian children based on the latest guidelines.

Methods

Data on 7301 student participants (3589 boys and 3712 girls) aged between 7-12 yr were assessed. The data were extracted from the fifth Childhood and Adolescence Surveillance and Prevention of Adult Non-communicable Disease (CASPIAN V) school-based study conducted in the 30 provinces of Iran in 2015. Blood pressure (BP) was classified as normal, elevated BP, and stage 1 and 2 hypertension using weighted analysis and the 2017 AAP guidelines. All analyses were performed in STATA 14.0 statistical software, with findings presented in terms of prevalence.

Results

The overall prevalence of high BP in Iranian children was 14.7%. In addition, 15.1% of boys had high BP, with 9.4% and 1.7% of them with stage 1 and 2 hypertension, respectively. Moreover, 14.3% of girls had high BP, of which 10% had stage 1 and 1.3% with stage 2 hypertension. For elevated hypertension, it was observed in 4% of boys and 3% of girls.

Conclusion

Using the 2017 AAP guidelines demonstrated a higher prevalence of hypertension in children (14.7%) in Iran. The prevalence of hypertension in boys was slightly higher compared to girls.

Impact of Dietary Advanced Glycation End-Product Restriction on Insulin Resistance and Anthropometric Indices in Coronary Artery Patients Treated with Percutaneous Coronary Intervention: A Randomized Controlled Trial

Background

Insulin resistance (IR), even in its subclinical state, is a significant risk factor for the onset and progression of coronary artery disease (CAD). IR is a multifactorial condition, and dietary composition is a factor associated with its development. Elevated advanced glycation end products (AGEs) in the body, secondary to highly processed food consumption, can impair glucose metabolism. The present study investigated whether a restricted AGE diet could affect insulin sensitivity and anthropometric indices reflecting visceral adipose tissue in nondiabetic CAD patients.

Methods

This trial randomly allocated 42 angioplasty-treated patients to follow either low-AGE or control diets based on the AHA/NCEP guidelines for 12 weeks. Serum levels of total AGEs, insulin, HbA1c, and fasting blood sugar, as well as anthropometric measurements, were evaluated before and after the intervention. The Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) and anthropometric indices were calculated according to the proposed formula. The patients' health status was assessed using the Seattle Angina Questionnaire (SAQ) at baseline and after the intervention.

Results

Our study showed a significant reduction in anthropometric indices in the low-AGE group after 12 weeks. Insulin levels and IR decreased during the low-AGE diet. No significant changes were observed in the other serum biochemical markers. All SAQ domains significantly decreased in both groups, except for Treatment Satisfaction.

Conclusion

A low-AGE diet for 12 weeks had beneficial effects on HOMA-IR and insulin levels in patients with CAD. Regarding the fundamental role of AGE in IR development and body fat distribution, AGE restriction may positively affect these patients.

Cost-Benefit Analysis of Human Papillomavirus Vaccine in Iran

Despite increasing global attention to the national human papillomavirus (HPV) immunization program, this program is controversial in Iran. Evidence indicates that HPV vaccination is not cost-effective in Iran. Using cost-effectiveness analysis for decision-making about public health interventions such as vaccination is controversial because its potential benefits may not fit this framework. This study aimed to evaluate the economic effects of the HPV vaccination by cost-benefit analysis (CBA) using bivalent and quadrivalent in Iran in 2020. We performed a CBA from a societal perspective. We used two approaches of the vaccine's economic benefits: willingness to pay by discrete choice experiment and cost of illness. Costs only included the vaccine cost. The cost of two doses of bivalent and quadrivalent vaccines were US $29 and the US $151, respectively (US $1 = IRR 42,000). The benefits of bivalent and quadrivalent vaccines were US $ - 432, US $380 per person using the willingness to pay approach, and they were US $7375 and US $6590 thorough cost-of-illness approach. The cost-benefit ratio (CBR) of bivalent and quadrivalent vaccines was - 15.11 and 2.51 by the willingness to pay approach, and 258.12 and 43.51 by the cost of illness approach. This study confirms the benefits of the national bivalent and quadrivalent vaccination programs and provides reliable evidence for policy-makers programming HPV vaccination.

The relationship between low-carbohydrate diet score, dietary insulin index and load with obesity in healthy adults

PURPOSE

Carbohydrate intake and insulinemic potential of diet are suggested to be correlated with the development of different chronic diseases. Considering the limited research on obesity, this study aimed to investigate the association of dietary insulin index (DII), dietary insulin load (DIL), and low-carbohydrate diet score (LCDS) with body weight and obesity in healthy adults.

METHODS

In this cross-sectional study, DII, DIL, and LCDS were calculated using relevant formulas based on dietary intakes obtained by a valid 168-item food frequency questionnaire, in 393 otherwise healthy adults of either normal-weight, overweight, or obese.

RESULTS

Individuals in the highest tertile of DIL and DII had respectively 73% (OR: 0.27, 95% CI 0.08-0.94, p = 0.049) and 50% (OR: 0.5, 95% CI 0.26-0.96, p = 0.038) lower odds of being overweight compared to the lowest tertile, after adjusting the effects of age, sex, and dietary energy intake. Participants in the highest tertile of DIL had 92% greater odds of being obese compared to the lowest tertile, but this association did not remain significant after adjusting the effect of energy intake. Individuals in the highest tertile of LCDS had about 2 times odds of being overweight compared with those in the lowest tertile (OR: 2.04, 95% CI 1.04-4.01, p = 0.049). There was no relationship between being obese and tertiles of LCDS.

CONCLUSION

Higher dietary carbohydrate intake and insulinemic potential of diet could not be considered independent dietary risk factors for overweight or obesity.

LEVEL OF EVIDENCE

Level III: evidence obtained from an observational study.

Job Satisfaction among Ophthalmologists in Iran

Purpose

To estimate the level of job satisfaction among ophthalmologists in Iran and determine the associated factors that may impact their overall job satisfaction.

Methods

In this cross-sectional study, 181 ophthalmologists (79.0% male) were interviewed by the Warr-Cook-Wall questionnaire with 7-point-Likert scale, which transformed responses from a 0 (most dissatisfied) to 100 (most satisfied). Questionnaires were randomly distributed among registered ophthalmologists at the 29 t h Annual Congress of the Iranian Society of Ophthalmology in November 2019. Satisfaction under each scale was considered as a score of > 60% of the total score.

Results

A total of 181 ophthalmologists with a mean age of 47.8 ± 12.1 years and 16 ± 12 years of practice participated in the present study. They were mostly satisfied with their job as a whole (88.1%, mean score: 60.6 ± 20.7) and dissatisfied with their income (55.9%, mean score: 47.6 ± 20.3). High levels of job satisfaction was found among ophthalmologists with longer duration of practice (P < 0.001) while lower levels of satisfaction were identified among those who worked in academic centers (P = 0.004).

Conclusion

In this study,high levels of job satisfaction were found among ophthalmologists with longer duration of practice while low levels of satisfaction were identified among ophthalmologists who worked in academic centers. The factors of salary and working hours accounted for the least levels of job satisfaction.

Factors affecting nonadherence to treatment among type 2 diabetic patients with limited health literacy: Perspectives of patients, their families, and healthcare providers

BACKGROUND

Treatment adherence is one of the behaviors associated with type 2 diabetes that predicts whether it will be successfully treated or develop complications and become uncontrolled. This study aimed to determine factors affecting nonadherence to treatment among diabetic patients with limited health literacy from the perspectives of patients, their families, and healthcare providers.

MATERIALS AND METHODS

This qualitative study with a content analysis approach was conducted on 84 eligible type 2 diabetes patients with limited health literacy and poor adherence to treatment, as well as their families and healthcare providers using a purposive sampling method, in Kerman city in 2021. Interviews were conducted using a semistructured interview guide with a broad, open-ended question to provide a general history of the disease separately. The interviewer asked participants to identify the perceived barriers to treatment nonadherence. Each interview lasted 45-60 min. MAXQDA version 20 and inductive content analysis were used to code and analyze extracted data.

RESULTS

Four major themes emerged from the patients' perspectives as "financial problems," "individual factors," "problems related to medication availability," and "healthcare providers' poor practices." Two major themes were classified from the perspective of patients' families as "financial problems" and "Individual factors," and four major themes were identified from the viewpoint of healthcare providers including "financial problems," "individual factors," "scarcity and medication availability," and "poor practice of the healthcare provider." These mentioned barriers were confirmed regarding treatment nonadherence among study participants.

CONCLUSION

Study findings revealed different factors of treatment nonadherence among diabetic patients with limited health literacy. Therefore, these factors should be considered in tailoring promotive educational and supportive interventions. Considering the importance of adherence to treatment patients, planning empowerment family-based interventions focusing on health literacy improvement seems necessary.

Public preferences regarding the priority setting criteria of health interventions for budget allocation: results of a survey of Iranian adults

Objectives

Priority setting in health directly impacts the general public as payers and final consumers, so the public preferences must be considered. The present study aimed to provide public preferences about health intervention allocation criteria for the optimal allocation of public health budget in Iran.

Methods

A choice-based survey method was used to assess the general public’s preferences regarding 8 critical criteria with a societal aspect. One thousand sixty-four adult citizens of Tehran, Iran, participated in the study. Participants were asked to allocate a hypothetical budget between the two groups with differences in allocation criteria. Public preferences were inferred from absolute majority responses i.e., more than 50% of participants’ allocation for a criterion. The Logistic Regression Model was used to investigate the factors affecting the preferences regarding the importance of allocation criteria.

Results

Based on expressed participants’ preferences, criteria of disease severity, age, daily care needs, Number of alternative interventions, individual’s economic status, and diseases with absence from work were important. Thus, 77, 69, 61, 57, 54, and 51% of participants preferred to allocate the hypothetical budget to the treatment of patients with poor economic status, treatment of patients with diseases leading to absence from work, treating patients with severe diseases, treatment of diseases in need of daily care and treatment of children’s diseases, respectively. Findings from the factors affecting participants’ preferences regarding allocation criteria also showed that people with different characteristics had different preferences.

Conclusions

Iranian general public pays special attention to the criteria of equitable allocation, including patients’ economic status, criteria with societal aspects such as absenteeism from work and the need for daily care, as well as criteria with medical aspects such as disease severity and access to alternative interventions which may sometimes be less considered in decision making.

Factors associated with treatment adherence to treatment among in patients with type 2 diabetes in Iran: A cross-sectional study

Introduction

Diabetes is a chronic metabolic disorder that affects millions of people worldwide. Adherence to treatment is a key determinant to proper management. This study aimed to assess the factors associated treatment adherence in patients with type 2 diabetes.

Materials and methods

We conducted this cross-sectional study on 704 patients with type 2 diabetes referred to three diabetes clinics in Kerman, Iran. We used treatment adherence questionnaire and functional communicative critical health literacy (FCCHL) to collect data and descriptive statistics, as well as Pearson correlation coefficient and multivariate regression analysis to analyze data. Significance level was <0.05.

Results

The study results showed that health literacy, HbA1c, and income were main predictors of diabetes treatment adherence. The patients' adherence increased as their health literacy increased. The patients' HbA1c decreases as their adherence increased. We found a 2.54-point increase in the treatment adherence score for those with sufficient income and a 0.76-point increase in the treatment adherence score for those with relatively sufficient income compared with those with insufficient income.

Conclusion

We found several factors affecting diabetes treatment adherence. Planning theory-based interventions can be helpful to improve the determinants.

Intervention to Improve Menstrual Health Among Adolescent Girls Based on the Theory of Planned Behavior in Iran: A Cluster-randomized Controlled Trial

OBJECTIVES

Poor menstrual health may lead to school absenteeism and adverse health outcomes for adolescents. The purpose of this study was to determine the effect of pubertal and menstrual health education on health and preventive behaviors among Iranian secondary school girls.

METHODS

A quasi-experimental study was conducted to evaluate the effectiveness of a health intervention program. A total of 578 students (including intervention and control participants) in 12 schools in Tehran Province, Iran were included by multistage random sampling. The program comprised seven 2-hour educational sessions. After confirming the reliability and validity of a researcher-made questionnaire, that questionnaire was used to collect the required data, and the groups were followed up with after 6 months.

RESULTS

After the educational intervention, the mean scores of menstrual health-related knowledge and constructs of the theory of planned behavior were significantly higher in the intervention group than in the control group (p&lt;0.001 for all dimensions).

CONCLUSIONS

The results of this study emphasize the effectiveness of menstrual health interventions in schools. These findings should also encourage health policy-makers to take committed action to improve performance in schools.

Impact of Coronavirus Disease 2019 Pandemic on the Epidemiology of Intravitreal Injections

Purpose

To evaluate the epidemiologic pattern of intravitreal injections (IVIs) during Coronavirus Disease 2019 (COVID-19) pandemic.

Methods

The records of patients receiving IVIs in two 12-month periods immediately before and after the beginning of the COVID-19 epidemic were included. Age, province of residency, indication, number of injections, and number of operating room (OR) visits were analyzed.

Results

Compared to pre-COVID period, a 37.6% decrease in the number of patients receiving IVI in COVID period was seen (10518 vs. 6569). There was a parallel decrease in the number of OR visits (25590 vs. 15010: 41.4%) and injections (34508 vs. 19879: 42.4%). Regarding IVI indication, age-related macular degeneration (AMD) showed the highest decrease in IVI rate (46.3%) which was significantly higher than decrease in other indications (P < 0.001). Retinopathy of prematurity (ROP) patients showed no change after epidemic. Mean overall age in AMD group was the highest (67.7 ± 13.2 years) compared to other indication groups (excluding ROP) (P < 0.001); while the mean age of the other indications was not significantly different from each other (excluding ROP).

Conclusions

COVID pandemic decreased the number of IVIs significantly. While previous studies suggested that the AMD patients had the highest risk of visual loss due to failure to receive IVIs in a timely manner, this very same group showed the highest decrease in the IVI number after pandemic. The health systems should devise strategies to protect this most vulnerable group of patients in future similar crises.

Are levels of adipokines and micronutrients different in male adult smokers and non-smokers? A case-control study

OBJECTIVE

Smoking is a common public problem leading to increases in oxidative stress and decreases in the levels of some micronutrients, finally affecting adipokine levels. The aim of this study was to compare the serum levels of omentin (intelectin-1), chemerin, TNF-α, and some micronutrient intakes in male smokers and non-smokers.

METHODS

40 male smokers and 40 male non-smokers with a mean age of 38.6±14.1 years were included in this study. Serum levels of omentin, chemerin, and TNF-α were measured. To calculate the daily intake of energy, carbohydrate, protein, fat, and some of the micronutrients, the 24-h recall and semi-quantitative food frequency questionnaire (FFQ) was used.

RESULTS

Omentin, chemerin, and TNF-α levels in male smokers were lower than non-smokers, but these differences were not statistically significant. However, after adjustment for total and saturated fat intakes and age, omentin (β=138.4, p=0.027) and TNF-α (β=144.5, p=0.015) revealed significant differences.

CONCLUSION

The serum levels of omentin, chemerin, TNF-α, and some micronutrient intakes were not significantly different between smokers and non-smokers. Further population studies are needed to clarify this subject.

Comparison of associated factors of domestic violence against women by their husbands based on demographic characteristics and life skills in Iran

BACKGROUND

In recent decades, the prevention of domestic violence against women (DVAW) has been considered a priority for women's health in many countries. Identifying factors related to DVAW by their husbands or intimate partner can promise prevention and decrease in prevalence. The objective of this study was to examine and compare associated factors of domestic violence based on demographic characteristics and some life skills.

MATERIALS AND METHODS

This cross-sectional study was conducted in Abadan, Iran. 640 couples completed questionnaires including demographic characteristics, communication skills, anger management, and problem-solving skill. In addition, women completed the questionnaire on domestic violence. Data were analyzed using descriptive statistics (t-test and one-way analysis of variance) and multiple linear regression.

RESULTS

Approximately 57% of the women in this study have been subjected to psychological violence in their lifetime by their husbands. The result of multiple regression indicated that demographic characteristics had a very small contribution to explaining domestic violence (R ²= 0.03) and only the education level of women was identified as a key predictor of domestic violence. The result of multiple regression based on life skills among couples demonstrated that communication skills and anger management of couples were inversely and significantly associated with domestic violence and these variables explained 51% of the variance in domestic violence.

CONCLUSIONS

Empowering couples with anger management and communication skills can play an important role in decreasing domestic violence. Therefore, developing and planning educational interventions by policymakers and health care providers seems necessary for couples.

Mini vitrectomy as an alternative technique for intraocular pressure adjustment in non-drainage scleral buckling

Purpose In non-drainage scleral buckling, anterior chamber paracentesis is usually carried out to decrease intraocular pressure. When the buckling is extensive however, this technique may be inefficient and time consuming. In this study, we tried to determine if a mini 25-gauge pars plana vitrectomy could be used as an efficient and safe alternative procedure to anterior chamber paracentesis for adjusting intraocular pressure during a non-drainage scleral buckling. Methods In this case series, 44 patients with rhegmatogenous retinal detachment (proliferative vitreoretinopathy stage < C) were included. In all cases, a mini 25-gauge pars plana vitrectomy was performed before buckle fixation and repeated if necessary. Complete retinal attachment was defined as the anatomical success. Results Forty-four eyes of 44 patients with mean age of 48.1 ± 18.2 years were included. Silicon buckle nº 276, sponge 505, and sponge 507 were utilized for 7, 34, and 3 eyes, respectively. Intravitreal injection of SF6 gas was performed for 54.5% of the eyes. Mean total time of the operation was 61 ± 16 min and the mean time for vitrectomy was 87 ± 31 s. Complete retinal attachment in 37 and incomplete attachment in 4 eyes were achieved after single operation that was a success rate of 93.2%. One had more than usual vitreous leak at the site of scleretomy and one developed a tiny vitreous hemorrhage at the sclerotomy site. Three sclerotomy sites needed suturing. Conclusion The anatomical outcome and the safety observed in this study were comparable to the current methods reported in the literature. Therefore, if anterior chamber paracentesis fails to adjust intraocular pressure during a non-drainage scleral buckling, performing a small gauge mini vitrectomy is safe and helpful.

Evaluation of the recovery after heart surgery following preoperative supplementation with a combination of beta-hydroxy-beta-methylbutyrate, L-arginine, and L-glutamine: a double-blind randomized placebo-controlled clinical trial

BACKGROUND

The preoperative period is a good time to improve nutrition status, compensate for nutrient deficiencies, and optimize immune function in patients' underlying surgery. In some medical conditions, supplementation with a combination of L-glutamine (Gln), β-hydroxy-β-methylbutyrate (HMB), and L-arginine (Arg) had promising effects on improving recovery. The present study aimed to evaluate the effect of supplementation with Gln/Arg/HMB in patients undergoing heart surgery.

METHODS

This randomized clinical trial was conducted on 70 patients undergoing cardiac surgery. Participants were requested to consume 2 sachets of a combination of 7 g L-arginine, 7 g L-glutamine, and 1.5 g daily HMB or placebo 30 days before operation. At the baseline and end of the study, left ventricular ejection fraction and the serum levels of troponin, creatine phosphokinase (CPK), CPK-MB, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and bilirubin were measured. Also, the Sequential Organ Failure Assessment (SOFA) score, time of stay in hospital and intensive care unit (ICU), and postoperative complications were recorded after surgery.

RESULTS

In total, 60 preoperative patients (30 in each group) with a mean age of 53.13 ± 14.35 years completed the study (attrition rate = 85.7%). Subjects in the Gln/Arg/HMB group had lower serum levels of CPK-MB (median [IQR] = 49 [39.75] vs. 83 [64.55]; P = 0.011), troponin (median [IQR] = 2.13 [1.89] vs. 4.34 [1.99]; P < 0.001), bilirubin (median [IQR] = 0.50 [0.20] vs. 0.40 [0.22]; P < 0.001), and SOFA score (median [IQR] = 2 [2] vs. 5 [2]; P < 0.001) at end of the study compared to the placebo. Also, the time of stay in the hospital (median [IQR] = 5 [1] vs. 6 [3]; P < 0.001) and ICU (median [IQR] = 2.50 [1.00] vs. 3.50 [1.50]; P = 0.002) was lower in the Gln/Arg/HMB group.

CONCLUSION

The present study showed that perioperative supplementation with a combination of Gln, Arg, and HMB enhances the recovery, reduces myocardial injury, and decreases the time of hospital and ICU stay in cardiac surgery patients. These results need to be confirmed in a larger trial.

TRIAL REGISTRATION

IRCT.ir IRCT20120913010826N31. Registered on 13 October 2020.

Stigma Experience in Patients With Vitiligo: A Comprehensive Study in a Skin Hospital

Vitiligo is the most common cause of skin depigmentation, which relates to a wide range of psychological disorders. Stigma is defined as a negative attitude towards oneself that results from one's perception of being different from the general population. In this study, we have evaluated the quality of life and stigmatization degree among vitiligo patients. In this cross-sectional study, 323 patients with vitiligo referred to Razi Hospital, Tehran, Iran, were evaluated. All patients were asked to fill out a questionnaire containing age, gender, marital status, educational level, employment status, duration of vitiligo, location of lesions, history of underlying diseases, history of previous treatments, as well as history of depression or suicide. Quality of life and stigmatization among patients were assessed by DLQI (dermatology life quality index) and FSQ (feeling stigmatization questionnaire) questionnaires. The prevalence of moderate and severe stigmatization were 49.8 % and 13.3%, respectively. Women were significantly more stigmatized than men. The presence of vitiligo lesions on the face, hands, or forearms, previous topical and oral treatments, and prior depressive disorders were significantly associated with an increased sense of stigma. Patients with thigh or trunk lesions faced less stigmatization. Additionally, stigmatization was meaningfully related to the level of quality of life impairment. In the present study, 63% of patients with vitiligo experienced moderate to severe stigmatization levels related to gender, lesion site, history of prior treatments, and depression. Moreover, there was a significant correlation between the level of stigma sensation and the life quality disturbance.

Alteration of the Inflammatory and Anti-Inflammatory Cytokine Profiles of Peripheral Blood Mononuclear Cell in Crohn’s Disease Patients after Following up

Background:

Crohn’s disease (CD) has a chronic course, which its recurrence varies widely among different patients. In this study we prospectively analyzed blood samples of 19 CD patients. Alteration in transcription of inflammatory and anti-inflammatory cytokines was analyzed compared with household members after three month follow up.

Methods:

CD patients were diagnosed based on clinical symptoms, endoscopic and histopathologic characteristics. Nineteen CD patients and their households were evaluated from Jun 2019 to Feb 2021 at Tehran university hospitals. CD activity score, biological, clinical and demographic data of the patients were recorded at two time point intervals. Bacteriological tests were done using aerobic and anaerobic blood cultures. To investigate transcriptional alterations, peripheral blood mononuclear cells (PBMCs) were isolated using Ficol centrifugation method and relative quantitative real-time PCR was done to determine the expression level of IFN-γ, TNF-α, IL10, and FOXP3 cytokines.

Results:

Our results showed a correlation between fecal calprotectin level (709.8 ± 554.6), C-reactive protein concentration (18.1 ± 15.9), and erythrocyte sedimentation rate (30.4 ± 17.9) with disease activity (Flare/remission). IL10 and Foxp3 anti-inflammatory gene’s expression were significantly (P = 0.003 for IL10 and P = 0.008 Foxp3) higher during the flare and remission in patients with active disease respectively. Bacteriological examination showed infection with Streptococcus spp. and Clostridium spp. in two CD patients during flares, which was correlated with upregulation and down-regulation of IL10, TNF-α, IFN-γ and FOXP3 proteins, respectively.

Conclusion:

Occurrence of bacteremia, and higher amount of CAP, CRP and ESR are correlated with higher level of transcription for inflammatory cytokines, which could effectively reflect the disease activity. Raise in FoxP3 transcription proposed change in Treg sub-population in PBMC or its activity during the CD remission phase.