Search

To determine the 3-year changes in anterior and posterior values of corneal asphericity (Q) in 6- to 12-year-old children.The first and second phases of the study were conducted in 2015 and 2018, respectively. The target population in the first phase was 6- to 12-year-old students in Shahroud, Iran. Multistage cluster sampling was performed on urban students. Additionally, all rural students in Shahroud county were invited to participate. Corneal imaging and ocular biometry were performed using the Pentacam-HR and Allegro Biograph, respectively.A total of 4961 right eyes were analysed in this report. The mean (95% confidence interval) anterior and posterior Q values for an 8-mm chord diameter were -0.38 ± 0.11 (-0.39 to -0.38) and -0.32 ± 0.12 (-0.33 to -0.32) in the first phase of the study, respectively. The mean 3-year changes in anterior and posterior Q values were 0.00 ± 0.08 (95% CI: 0.00-0.00) and -0.01 ± 0.06 (95% CI: -0.01 to -0.01), respectively. Based on a multiple regression model, advancing age (β = -0.002; [-0.003 to -0.001]), 3-year increase in mean keratometry (β = -0.04; [-0.06 to -0.02]), central corneal thickness (β = -0.001; [-0.001 to -0.000]), lens thickness (-0.05; [-0.11 to -0.003]) and anterior chamber depth (-0.09; [-0.15 to -0.03]) showed a statistically significant association with increased anterior Q prolation. Increased axial length was associated with a decrease in Q (β = 0.02; [0.004 to 0.03]). In addition, female gender (β = -0.004; [-0.007 to -0.001]) was significantly associated with a more prolate posterior Q value, while rural residence (β = 0.005; [0.002 to 0.009]) was significantly associated with a more oblate posterior Q value.Three-year changes in anterior and posterior Q values were very small. The cornea tends to become more prolate with increasing age.

To determine spherical equivalent (SE) progression among children in the Shahroud School Children Eye Cohort Study.A prospective cohort study recruited children aged 6 to 12 years in 2015 (baseline) with a follow-up in 2018. Cycloplegic autorefraction and axial length (AL) measurements were included. SE progression over 3 years was analysed in non-myopic (SE ≥ + 0.76 D), pre-myopic (PM; SE between +0.75 D and -0.49 D), low myopic (LM; SE between -0.5 D and -5.99 D), and high myopic (HM; SE ≤ - 6 D) eyes. Age, sex, near work, outdoor time, living place, parental myopia, mother's education, and baseline SE were evaluated as risk factors for SE progression (≤ -0.50 D).Data were available for 3989 children (7945 eyes). At baseline, 40.3% (n = 3205), 3.4% (n = 274) and 0.1% (n = 7) eyes had PM, LM and HM, respectively. At the 3-year follow-up, 40.5% (n = 3216), 7.5% (n = 599) and 0.2% (n = 15) eyes had PM, LM, and HM, respectively. SE progression in eyes with LM and HM was -1.08 ± 0.76 D and -1.60 ± 1.19 D, respectively. SE progression was associated with age at baseline (Odds Ratio [OR] = 1.14; 95% confidence interval [CI], 1.08-1.21), female sex (OR = 1.80; 95% CI: 1.48-2.18), near work (OR = 1.08; 95% CI: 1.02-1.14), parental myopia (OR = 1.20; 95% CI: 1.01-1.42) and baseline SE (OR = 2.28; 95% CI: 1.88-2.78).A myopic shift was associated with older age, female sex, near work, parental myopia and greater myopic baseline SE. These results help identifying children at risk of progression that may benefit from treatment and lifestyle counselling.

To determine the distribution of macular and cube thickness and their normal range in the students aged 9 years to 15 years and to investigate their associated demographic and biometric factors.This study was based on the data of the second phase of the Shahroud School Children Eye Cohort Study, conducted in 2018. After measurements of visual acuity, biometry, and subjective and cycloplegic refraction, retinal examination was performed using the Zeiss Cirrus HD 4000 optical coherence tomography.The data of 5,043 right eyes were analyzed after applying the exclusion criteria. The central macular thickness was 239 ± 19.35 μ m. The mean cube volume and cube thickness were 9.94 ± 0.44 and 278 ± 12.20, respectively. According to multiple linear regression analysis, the central macular thickness was significantly lower in girls (coefficient [β]: -9.18; P0.001) and rural students (β: 3.86; P0.001) and had a direct association with axial length (β: 5.19; P0.001), lens thickness (β: 5.33; P = 0.003), and mean keratometry (β: 2.41; P0.001). The cube volume was lower in girls (β: -0.13; P0.001) and higher in rural students (β: 0.05; P0.001).Macular thickness was slightly higher in Iranian children. Sex, living place, axial length, lens thickness, and mean keratometry were the main associated factors with macular thickness.

To determine the prevalence of myopia and hyperopia in Shahroud schoolchildren and their risk factors.Optometric examinations including the measurement of uncorrected and corrected visual acuity as well as non-cycloplegic and cycloplegic refraction using retinoscopy were done for students. Generalized Structural Equation Modeling (GSEM) was used to determine direct and indirect effects of independent variables on myopia and hyperopia.The data of 5581 students with a mean age of 9.24 ± 1.7 years were used in this study. The prevalence of myopia was 5.0% (95%CI: 4.3-5.7) and the prevalence of hyperopia was 4.8% (95%CI: 4.0 - 5.5) in all schoolchildren. According to the GSEM results, the odds of myopia in rural areas were 0.55 compared to urban areas. A one-unit increase in the ocular AL increased the odds of myopia by 4.91 times. The interaction of sex and age on myopia was significant such that in girls, the odds of myopia increased by 20% for every one-year increase in age while no significant change was seen in boys. A one-unit increase in the ocular AL decreased the odds of hyperopia by 0.49 times. Moreover, the interaction of outdoor activity hours and sex on the prevalence of hyperopia was significant such that increased outdoor activity reduced the odds of hyperopia in girls while no significant correlation was found in boys.Myopia and hyperopia had moderate prevalence. Axial Length had the largest direct association on myopia and hyperopia. Age and outdoor activity had weak associations on refractive errors.

Purpose To compare the effect of duration of fluorometholone 0.1% treatment on corneal haze after photorefractive keratectomy (PRK) with mitomycin C (MMC) 0.02%. Design Prospective, randomized, double-blind, clinical trial. Methods Setting: Single center clinical trial. Study Population: A total of 252 myopic PRK candidates (252 eyes) aged 21 to 40 years with a mean spherical equivalent (SE) of ≤ 6 diopters (D) were randomized to receive one of the three corticosteroid regimens after PRK (group A = 1 month followed by 2-month placebo, group B = 2 months followed by 1-month placebo and group C = 3 months). Main Outcome Measures: Corneal haze incidence, subjective SE, uncorrected distance visual acuity (UDVA), and corneal densitometry. Results The corneal haze incidence (grade ≥ 1) at 12 months was 1.35% (1/74 eyes) in group A and 0% in the other two groups. The mean anterior corneal densitometry (grayscale unit) was 21.19 ± 2.07, 21.09 ± 2.19, and 21.31 ± 2.21 in group A, B and C, respectively. The mean SE was 0 ± 0.09, 0 ± 0.11, and 0 ± 0.10 and UDVA (decimal) was 1 ± 0, 1 ± 0.01, and 1 ± 0 in group A, B and C, respectively. During 1-year follow-up, no statistically significant difference was observed in mean SE (p = 0.158), UDVA (p = 0.343) and anterior corneal densitometry (p = 0.109) at any stage between the study groups. Conclusions Long-term topical corticosteroids are not necessary following PRK with MMC for moderate myopia.

CLINICAL RELEVANCE Posterior corneal astigmatism has an important role in diagnosis and treatment of astigmatism, but it is usually overlooked. BACKGROUND This cross-sectional study aimed to investigate the distribution of posterior corneal astigmatism (PCA) and its associated factors in a middle-aged population that participated in the Shahroud Eye Cohort Study (ShECS) phase II. METHODS Anterior corneal astigmatism (ACA) and PCA values were measured using rotating Scheimpflug System (Pentacam HR, Oculus). With-the-rule (WTR) astigmatism was considered when the steepest corneal meridian was aligned within 90° ± 30°, and against-the-rule (ATR) astigmatism when the steepest meridian was 0 ± 30°. All the remaining values were considered as oblique astigmatism. Logistic regression models were used for evaluating the association of PCA magnitudes with other factors. RESULTS The current study consisted of 3871 eyes with available Pentacam data. Mean age of participants was 55.4 ± 6.1 years and 1557 (40.2%) subjects were male. Means of ACA and PCA were 0.77 ± 0.67 and -0.24 ± 0.15 D, respectively. The majority of PCA consisted of WTR astigmatism (82.43%), while ACA mostly showed ATR astigmatism (55.46%). PCA > 0.3 D was associated with male sex (OR = 1.16, P-value = 0.028) and spherical equivalent (OR = 0.93, P-value = 0.011) in the adjusted model, while PCA > 0.5 dioptre was strongly associated with myopia (OR = 4.6, P-value

The purpose of this study was to investigate 3-year changes in keratoconus (KC) indices to determine the indicators of KC progression compared with age-related changes in children aged 6 to 12 years.In this report of the Shahroud Schoolchildren Eye Cohort Study, KC was diagnosed based on vision, refraction, tomography, and slitlamp examination findings. KC progression was defined as changes in refractive astigmatism or zonal maximum keratometry (Zonal Kmax-3 mm). Then, 3-year changes (Δ) in vision, refraction, and tomographic indices were compared between progressive KC and normal eyes. The best set of ∆parameters for distinguishing KC progression from age-related changes were determined using the area under curve (AUC).Eighteen KC eyes and 10,422 normal eyes were analyzed. All KC cases showed progression after 3 years. Δindices were statistically different between the 2 groups except corrected distance visual acuity, anterior radius of curvature, irregularity index, and KC percentage index. The best Δindices, in descending order of AUC value, were index of height decentration, Zonal Kmax-3 mm, refractive astigmatism, single point Kmax, and index of vertical asymmetry (all AUC0.9), followed by inferior-superior asymmetry, index of surface variance, minimum corneal thickness, index of height asymmetry, KC index, posterior radius of curvature, and Belin/Ambrósio total Deviation (AUC = 0.8-0.9).According to our findings, changes in index of height decentration, Zonal Kmax-3 mm, refractive astigmatism, single point Kmax, and index of vertical asymmetry are the best indices for detecting KC progression in children younger than 12 years.

Background: High-risk behaviors in people with severe mental illnesses, such drug injection by shared equipment and unprotected sex, expose them to the risk of blood-borne infections such as hepatitis B virus (HBV) and hepatitis C virus (HCV) infections. Objectives: This study aimed to determine the prevalence of HBV and HCV serum markers in people with severe mental illnesses in Tehran, Iran. Methods: In this cross-sectional study, people with mental illnesses, such as schizophrenia, bipolar disorder, and depression, were studied. The participants were recruited using a non-random convenience sampling method from Roozbeh and Razi hospitals in Tehran between December 2019 and March 2020. Blood samples were evaluated for HCV-Ab, HBs Ag, HBs Ab, and HBc Ab using an enzyme immunoassay technique. Results: A total of 257 participants were recruited for this study; their mean age was 35.77 years, and 70.0% of whom were male. Bipolar disorder (40.5%) and schizophrenia (35.8%) were the most frequent severe mental disorders in the participants. The prevalence of HBV and HCV seromarkers was as follows: HBs Ag: 0.3% (95% CI: 0.0 - 2.0%), HBc Ab: 7.3% (95% CI: 4.6 - 11.3%), HBs Ab: 18.7% (95% CI: 14.1 - 24.0%), and HCV Ab: 3.1% (95% CI: 1.3 - 6.9%). In logistic regression analysis, tattooing (OR = 4.94, 95% CI: 1.73 - 14.13) and age (OR= 1.06, 95% CI: 1.01 - 1.11) were associated with HBV infection (HBc Ab positivity), and only tattooing (OR= 6.33, 95% CI: 1.19 - 33.80) was significantly associated with exposure to HCV. Conclusions: The results of this study showed that the prevalence of HBsAg positivity in people with severe mental illness was not higher than that in the general population of Iran; however, HCV Ab positivity was more prevalent in people with severe mental illness than in the general population of Iran. Preventive, diagnostic, and therapeutic interventions for HCV infection are needed in this population in Iran.

Despite the widespread literate on health inequalities and their determinants, changes in health inequalities over time have not received enough attention.To measure and decompose the over-time changes in economic inequality in presenting visual acuity measured using Logarithm of the Minimum Angle of Resolution.We analysed 4706 participants who had complete data on presenting visual acuity and economic status in 2009 and 2014 in the Shahroud Eye Cohort Study. We measured changes in presenting visual acuity concentration indices and decomposed them the using a longitudinal approach.Both the presenting visual acuity and economic status deteriorated between 2009 and 2014. The mean (standard deviation) for presenting visual acuity and economic status scores in 2009 versus 2014 were 0.090 (0.2) versus 0.103 (0.2) and 0.01 (1.0) versus 0.0005 (1.07), respectively. Presenting visual acuity concentration index (95% confidence interval) in the first versus second phases of the study were -0.245 (-0.212 to -0.278) versus -0.195 (-0.165 to -0.225), respectively. Longitudinal decomposition of this change in concentration indices during the 5-year period indicated that the most important contributor to reduction in economic inequality of presenting visual acuity was deterioration of presenting visual acuity among people with higher economic status due to their ageing.Unexpectedly, reduction in economic inequality in presenting visual acuity was due to presenting visual acuity deterioration among the higher economic status group rather than its amelioration among the lower economic status group. Therefore, the needs of all socioeconomic groups should be considered separately to modify presenting visual acuity in each group and, consequently, reduce the economic inequality in presenting visual acuity.التغير التَّناقُضِّ في التفاوت الاقتصادي في تصحيح الانكسار البصري بين عامي 2009 و 2014 : انخفاض غير مفيد.آسیه منصوري، محمد حسن إماميان، حجت زراعتی، حسن هاشمي، أكبر فتوحي.رغم انتشار الوعي بعدم المساواة الصحية ومُدِّداتها، لم تحظَ التغيرات في عدم المساواة الصحية على مر الزمن بالاهتمام الكافي.هدفت هذه الدراسة إلى قياس التغيرات على مر الزمن في التفاوت الاقتصادي في حدة البصر المُسْتَعْلِنة المقاسة باستخدام لوغاريتم زاوية الوضوح الصغرى، وتحليلها.أجرينا تحليلاً على 4706 مشاركاً كانت لديهم بيانات كاملة عن "حدة البصر المُسْتَعْلِنة" والنقاط الاقتصادية في عامي 2009 و2014 في دراسة شهرود الأترابية للعيون. وقسنا التغيرات في مؤشرات تركيز حدة البصر المُسْتَعْلِنة، وحللناها باستخدام نهج طولي.تدهور كل من "حدة البصر المُسْتَعْلِنة" والحالة الاقتصادية بين عامي 2009 و2014. وكان متوسط (الانحراف المعياري) نقاط حدة البصر المُسْتَعْلِنة والنقاط الاقتصادية في عام 2009 مقارنة بعام 2014 هو 0.090 (0.2) مقابل 0.103 (0.2)، و0.01 (1.0) مقابل 0.0005 (1.07) على التوالي. وبلغ مؤشر تركيز حدة البصر المُسْتَعْلِنة (فاصل الثقة 95٪) في المرحلة الأولى مقابل المرحلة الثانية من الدراسة –0.245 (–0.212 إلى –0.278) مقابل -0.195 (-0.165 إلى -0.225) على التوالي. ويشير التحليل الطولي لهذا التغير في مؤشرات التركيز خلال فترة 5 سنوات إلى أنَّ أهم عامل مساهم في الحدّ من التفاوت الاقتصادي "لحدة البصر المُسْتَعْلِنة" هو تدهور "حدة البصر المُسْتَعْلِنة" بين الأشخاص ذوي النقاط الاقتصادية الأعلى نظرًا لتقدمهم في السن.على غير متوقع، كان الانخفاض في التفاوت الاقتصادي في "حدة البصر المُسْتَعْلِنة" ناجمًا عن تدهور "حدة البصر المُسْتَعْلِنة" بين الفئة ذات النقاط الاقتصادية الأعلى وليس تحسنها بين الفئة ذات النقاط الاقتصادية الأدنى. ولذلك، ينبغي النظر في احتياجات جميع الفئات الاجتماعية الاقتصادية على نحو منفصل، لتعديل "حدة البصر المُسْتَعْلِنة" في كل فئة، ومن ثمَّ الحدّ من التفاوت الاقتصادي في "حدة البصر المُسْتَعْلِنة".Changement paradoxal dans l'inégalité économique en matière de correction des vices de réfraction entre 2009 et 2014 : une baisse non significative.Malgré l'importance de la littérature, les inégalités en matière de santé et leurs déterminants, les changements observés dans ce domaine au fil du temps n'ont pas fait l'objet de suffisamment d'attention.Mesurer et décomposer les changements survenus au fil du temps en matière d'inégalités économiques dans l'acuité visuelle à l'examen mesurée à l'aide du logarithme de l'angle minimal de résolution.Nous avons analysé 4706 participants qui disposaient de données complètes sur l'acuité visuelle à l'examen et le statut économique en 2009 et 2014 dans l'étude de cohorte oculaire de Shahroud. Nous avons mesuré les changements dans les indices de concentration pour l'acuité visuelle à l'examen et les avons décomposés en utilisant une approche longitudinale.L'acuité visuelle à l'examen et le statut économique se sont tous deux détériorés entre 2009 et 2014. Les scores moyens (écart-type) pour l'acuité visuelle à l'examen et le statut économique présentés en 2009 par rapport à 2014 étaient de 0,090 (0,2) contre 0,103 (0,2) et de 0,01 (1,0) contre 0,0005 (1,07), respectivement. L'indice de concentration pour l'acuité visuelle à l'examen (intervalle de confiance à 95 %) dans la première et la deuxième phase de l'étude était de −0,245 (−0,212 à −0,278) contre −0,195 (−0,165 à −0,225), respectivement. La décomposition longitudinale de ce changement dans les indices de concentration au cours de la période de cinq ans a indiqué que l'élément le plus important contribuant à la réduction de l'inégalité économique de l'acuité visuelle à l'examen était la détérioration de celle-ci chez les personnes ayant un statut économique plus élevé à cause de leur vieillissement.De manière inattendue, la réduction de l'inégalité économique dans l'acuité visuelle à l'examen était due à la détérioration de cette dernière dans le groupe de statut économique supérieur plutôt qu'à son amélioration dans le groupe de statut économique inférieur. Les besoins de tous les groupes socio-économiques doivent donc être considérés séparément pour modifier l'acuité visuelle à l'examen dans chaque groupe et, par conséquent, réduire l'inégalité économique.

Background Isolated systolic hypertension (ISH), is the most common form of hypertension in older adults. However, the ISH prevalence is not well known in many developing countries such as Iran. This study was conducted to determine the ISH prevalence and its related risk factors in an Iranian population. Methods Data were obtained from the second phase of the Shahroud eye cohort study (ShECS) in 2014. ShECS is a longitudinal population-based study which the first phase had been conducted in 2009 using the stratified multistage cluster sampling design on 5190 people aged 40 to 70 years. The ISH prevalence was determined based on the eighth Joint National Commission guidelines for different demographic variables. The associated risk factors were estimated by multiple logistic regression and a two-tailed p-value less than 0.05 was considered significant. Results The ISH prevalence was 15.89% (95% CI: 14.88–16.96). It was 15.68% (14.12–17.39) and 15.87% (14.54–17.29) for men and women, respectively. The prevalence of ISH increased significantly with increasing age. The 65–70 compared to 45–69 year age group (OR = 4.21), body mass index (OR = 1.03), diabetes (OR = 1.64), retirement, compared to practitioner job (OR = 1.53), and waist to hip ratio (WHR) (OR = 9.81) were significantly associated with ISH prevalence. Conclusions ISH is highly prevalent among the older adult population in Iran. Given the risk of cardiovascular disease associated with ISH, it is recommended to conduct education and public health interventions to improve the detection, prevention, and treatment of ISH.

Aim To determine the prevalence of ocular trauma in Iranian children aged 6–12 years. Methods This population-based cross-sectional study, comprised the first phase of the Shahroud Schoolchildren Eye Cohort Study on primary school children using cluster sampling in urban areas and census in rural areas. The students underwent the measurement of uncorrected and corrected visual acuity as well as non-cycloplegic, cycloplegic, and subjective refraction. The history of trauma, hospitalization, and surgery due to trauma was collected from parents using a questionnaire. Results The data of the trauma history was recorded for 5267 out of 5620 students. The mean age of the students was 9.7 ± 1.7 years (range: 6–12 years), 53.7% of them were boys, and 79.3% were from urban areas. A positive history of ocular trauma was found in 285 participants, and the lifetime prevalence of ocular injury (95% CI) was 5.2% (4.6–5.9). Blunt trauma was the most common ocular injury with a prevalence of 66.2%. There was a significant positive assocation between ocular trauma and living in rural areas (OR: 1.49, p: 0.012), older age (OR: 1.17, p Conclusion This study found a marked prevalence of ocular trauma compared to previous studies. Male sex, older age, and living in rural areas were associated with ocular trauma, which could be due to differences in lifestyle preference, outdoor exposure, and dangerous situations. Educational programs and safety instructions should be encouraged.

PURPOSE To examine the association between near work, screen time including TV and outdoor time with myopia in children from the Sunflower Myopia Asian Eye Epidemiology Consortium (AEEC). METHODS We analysed AEEC cross-sectional data (12 241 children) on risk factors (near work, screen time including TV and outdoor time) and myopia of six population-based studies (China, Hong Kong and Singapore). Cycloplegic refraction and axial length (AL) measurements were included. Risk factors were determined using questionnaires. Data were pooled from each study, and multivariable regression analysis was performed to evaluate the associations between risks factors and myopia, spherical equivalent (SE) and AL. RESULTS Among the included children, 52.1% were boys, 98.1% were Chinese and 69.7% lived in urban areas. Mean±standard deviation (SD) for age was 8.8 ± 2.9 years, for SE was -0.14 ± 1.8 D and for AL was 23.3 ± 1.1 mm. Myopia prevalence was 30.6%. In multivariate analysis, more reading and writing (OR = 1.17; 95% CI, 1.11-1.24), more total near work (OR = 1.05; 95% CI, 1.02-1.09) and less outdoor time (OR = 0.82, 95% CI, 0.75-0.88) were associated with myopia (p's

Assessment of the risk of cardiovascular disease is essential for disease prevention in every region.This study aimed to investigate the 10-year risk of cardiovascular disease and its determinants in an adult population in Shahroud, Islamic Republic of Iran.A total of 4737 people aged 45-69 years were evaluated. The 10-year risk of cardiovascular disease was calculated using the Framingham risk scoring method. Cardiovascular disease risk is reported as per cent risk and 95% confidence intervals (CI). Factors affecting the risk of cardiovascular disease were assessed using multiple beta regression analysis.The mean age of the participants was 55.9 years; 41% were males. The mean 10-year risk of developing cardiovascular disease was 16.4% (95% CI: 16.0-16.8%); 28.3% of the participants had a risk of more than 20% (47.8% of the men and 14.9% of the women). Age, diabetes, smoking (only in men), high blood pressure, triglycerides (only in women), waist circumference, total cholesterol and high-density lipoprotein cholesterol were significantly associated with cardiovascular disease risk. In men, there was a non-significant increase in risk with higher body mass index up to body mass index 39.9 kg/mThe cardiovascular disease risk was very high, especially in men. Effective interventions should be implemented to reduce risk factors for cardiovascular disease. Longitudinal studies are recommended to investigate the effect of body mass index on the risk of cardiovascular disease.توقُّع خطر الإصابة بأمراض القلب والأوعية الدموية لمدة 10 سنوات في شاهرود بجمهورية إيران الإسلامية ومتناقضة منسب كتلة الجسم.محمدحسن امامیان، حسن هاشمي، أكبر فتوحي.يُعد تق ييم خطر الإصابة بأمراض القلب والأوعية الدموية أمراً ضرورياً للوقاية من الأمراض في جميع المناطق.هدفت هذه الدراسة إلى تقصِّ خطر الإصابة بأمراض القلب والأوعية الدموية لمدة 10 سنوات ومُدِّداتها لدى السكان البالغين في مدينة شاهرود بجمهورية إيران الإسلامية.تم تق ييم ما مجموعه 4737 شخصاً تتراوح أعمارهم بين 45 و 69 عاماً. واحتُسِب خطر الإصابة بأمراض القلب والأوعية الدموية لمدة 10 سنوات باستخدام طريقة درجات مخاطر فرامنجهام. وتم الإبلاغ بمخاطر الإصابة بأمراض القلب والأوعية الدموية كنسبة خطر مئوية، وكانت فواصل الثقة بنسبة ٪95. وقُيِّمت العوامل التي تؤثّر في خطر الإصابة بأمراض القلب والأوعية الدموية باستخدام تحليل انحدار بيتا المتعدد.بلغ متوسط عمر المشاركين 55.9 عاماً، وكان ٪41 منهم من الذكور. وبلغ متوسط خطر الإصابة بأمراض القلب والأوعية الدموية لمدة 10 سنوات ٪16.4 (فاصل الثقة ٪95: 16.0–16.8 ٪)، وتعرَّض ٪28.3 من المشاركين لمخاطر أكثر من ٪20(٪47.8 من الرجال و ٪14.9 من النساء). وارتبط العمر والسُّكَّري والتدخين (لدى الرجال فقط) وارتفاع ضغط الدم وثلاثي جليسيريد الدم (لدى النساء فقط) ومحيط الخصر والكوليسترول الكُلِّ وكوليسترول البروتين الشحمي مرتفع الكثافة بمخاطر الإصابة بأمراض القلب والأوعية الدموية بصورةٍ كبيرة. وحدثت زيادة غير كبيرة في تعرُّض الرجال للخطر مع ارتفاع منسب كتلة الجسم إلى 39.9 كجم/مإن خطر الإصابة بأمراض القلب والأوعية الدموية مرتفع جداً، خاصةً لدى الرجال. وينبغي تنفيذ تدخلات فعّالة للحد من عوامل خطر الإصابة بأمراض القلب والأوعية الدموية. ويوصَ بإجراء دراسات طولية لاستقصاء تأثير منسب كتلة الجسم على خطر الإصابة بأمراض القلب والأوعية الدموية.Prédiction du risque de maladie cardio-vasculaire sur une période de 10 ans en République islamique d'Iran, et paradoxe de l'indice de masse corporelle.L'évaluation du risque de maladie cardio-vasculaire est essentielle pour la prévention des maladies dans chaque région.La présente étude visait à étudier le risque de maladie cardio-vasculaire sur 10 ans et ses déterminants dans une population adulte à Shahroud, en République islamique d'Iran.Au total, 4737 personnes âgées de 45 à 69 ans ont été évaluées. Le risque de maladie cardio-vasculaire sur 10 ans a été calculé à l'aide de la méthode de notation du risque de Framingham. Le risque de maladie cardio-vasculaire est indiqué en pourcentage du risque et en intervalles de confiance (IC) à 95 %. Les facteurs affectant le risque de maladie cardio-vasculaire ont été évalués au moyen d'une analyse de régression multiple bêta.L'âge moyen des participants était de 55,9 ans ; 41 % étaient des hommes. Le risque moyen de développer une maladie cardio-vasculaire sur 10 ans était de 16,4 % (IC à 95 % : 16,0-16,8 %) ; 28,3 % des participants avaient un risque de plus de 20 % (47,8 % des hommes et 14,9 % des femmes). L'âge, le diabète, le tabagisme (uniquement chez les hommes), l'hypertension artérielle, les triglycérides (uniquement chez les femmes), le tour de taille, le cholestérol total et le cholestérol des lipoprotéines de haute densité étaient associés de manière significative au risque de maladie cardio-vasculaire. Chez les hommes, on a constaté une augmentation non significative du risque avec un indice de masse corporelle plus élevé pouvant atteindre 39,9 kg/mLe risque de maladie cardio-vasculaire était très élevé, surtout chez les hommes. Des interventions efficaces devraient être mises en œuvre pour réduire les facteurs de risque des maladies cardio-vasculaires. Des études longitudinales sont recommandées pour étudier l'effet de l'indice de masse corporelle sur le risque de maladie cardio-vasculaire.

Impaired stereoacuity is seen in some children without amblyopia, strabismus, and clinically significant refractive errors. Therefore, there are probably other factors affecting stereoacuity.The aim of this work was to investigate the longitudinal changes of local stereoacuity and associated factors in schoolchildren.The present report is a part of the Shahroud Schoolchildren Eye Cohort Study. The target population was children aged 6 to 12 years in Shahroud, Iran. The second phase of the study was conducted in 2018 by re-inviting all participants in the first phase (2015). After an initial interview, study participants underwent optometric examination and ocular biometry. Stereoacuity was evaluated using Stereo Fly Test. Exclusion criteria were functional amblyopia, strabismus, significant refractive errors, probable ocular pathology/organic amblyopia in either of the two study phases, a history of intraocular surgery or ocular trauma, and incomplete data.The data of 4666 children were analysed for this report, of which 53.7% were male. The mean age of the studied participants in the second phase was 12.37 ± 1.71 years. The mean stereoacuity was 42.31 (95% CI: 42.05 - 42.57) seconds of arc in the first phase, which reduced to 51.72 (95% CI: 50.79-52.65) seconds of arc in the second phase (P 0.001). The prevalence of poor stereoacuity was 0.17% (95% CI: 0.06-0.29) in the first phase, which increased to 3.94% (95% CI: 3.34-4.54) in the second phase (P 0.001). According to the multiple linear regression, older age in the first study phase (β = 0.011, P 0.001), urban residence (β = -0.019, P = 0.006), increased spherical anisometropia (0.038, P = 0.013), and increased axial length (β = 0.062, P = 0.003) were significantly associated with reduction of stereoacuity (in log scale) after three years.In addition to the known risk factors of amblyopia, strabismus, and significant refractive errors, other factors are also associated with stereoacuity changes in children.

providOBJECTIVES:This study compared the vaccination coverage rate (VCR) in children under 5 years old in Nasiriyah, Iraq before and during the coronavirus disease 2019 (COVID-19) pandemic.METHODS: This cross-sectional study was conducted in the city of Nasiriyah in southeastern Iraq, with data collected from 79 primary healthcare facilities. This study evaluated the VCR in 3 periods (2018, 2019, and 2020) using multi-level random sampling. Pertinent data were extracted from the vaccination records of 598 children for Bacillus Calmette-Guérin (BCG); pentavalent 1, 2, and 3; measles; and activated oral poliovirus vaccine 1 and 2. Missing data were completed by telephone calls to participants’ parents. Logistic regression was applied to compare and estimate the odds ratios (ORs) with 95% confidence intervals (CIs) for the association between VCR and related factors.RESULTS: The data showed the greatest decline in the studied vaccines in 2020. Among the vaccines studied, BCG had the highest rate in all 3 periods (100% VCR) and measles had the lowest rate (83.7%), reaching 63.6% in 2020 (p

Purpose To compare the agreement between artificial intelligence (AI)-based classifiers and clinical experts in categorizing normal cornea from ectatic conditions. Methods Prospective diagnostic test study at Noor Eye Hospital. Two hundred twelve eyes of 212 patients were categorized into three groups of 92 normal, 52 subclinical keratoconus (SKCN), and 68 KCN eyes based on clinical findings by 3 independent expert examiners. All cases were then categorized using four different classifiers: Pentacam Belin/Ambrosio enhanced ectasia total deviation value (BADD) and Topographic Keratoconus Classification (TKC), Sirius Phoenix, and OPD-Scan III Corneal Navigator. The performance of classifiers and their agreement with expert opinion were investigated using the sensitivity, specificity, and Kappa index (κ). Results For detecting SKCN, Phoenix had the highest agreement with the clinical diagnosis (sensitivity, specificity, and κ of 84.62%, 90.0%, and 0.70, respectively) followed by BADD (55.56%, 86.08%, 0.42), TKC (26.92%, 97.50%, 0.30), and Corneal Navigator (30.77%, 93.75%, 0.29). For KCN diagnosis, the highest agreement with expert opinion was seen for Phoenix (80.02%, 96.60%, 0.79), BADD (95.59%, 85.42%, 0.75), TKC (95.59%, 84.03%, 0.73), and Corneal Navigator (67.65%, 96.45%, 0.68). Analysis of different classifiers showed that Phoenix had the highest accuracy for differentiating KCN (91.24%) and SKCN (88.68%) compared to other classifiers. Conclusions Although AI-based classifiers, especially Sirius Phoenix, can be very helpful in detecting early keratoconus, they cannot replace clinical experts’ opinions, particularly for decision-making before refractive surgery. Albeit, there may be concerns about the accuracy of clinical experts as well.

PURPOSE To describe the normative data of corneal densitometry in photorefractive Keratectomy (PRK) candidates by using a Scheimpflug camera. METHODS Five hundred twenty-two eyes of 261 PRK candidates that underwent comprehensive optometric and ophthalmic examinations were enrolled in this study. Corneal densitometry values were obtained using a Scheimpflug camera (Pentacam HR; Oculus Optikgerate GmbH, Wetzlar, Germany) and displayed in grayscale units (GSU). RESULTS Of 261 participants, 187 (71.6%) were women. The mean age of the participants was 28.79 ± 5.02 years (range: 21-40 years). The mean entire corneal densitometry was 14.86 ± 2.37 GSU. According to corneal depth, maximum and minimum densitometry values were seen in the anterior (30.28 ± 7.42 GSU) and posterior (9.86 ± 2.08 GSU) layers, respectively (P < 0.001). Based on the annulus over the cornea, the highest and lowest densitometry values were seen in the 10- to 12-mm (21.31 ± 4.26 GSU) and 2- to 6-mm zones (13.26 ± 2.34 GSU), respectively. However, this difference was not seen after 35 years of age. Individuals aged 30 to 35 years showed higher corneal densitometry values compared with subjects aged 20 to 25 years old (P < 0.001). In generalized linear models, the corneal thickness was associated with the densitometry value in the central and posterior corneal layers. There were no significant differences in sex and refractive errors among participants. CONCLUSIONS This study provided normal corneal densitometry data in PRK candidates. Corneal densitometry increased with age until 35 years of age and then decreased thereafter. This finding should be considered in patient selection for PRK and their postoperative examinations.

Central corneal thickness (CCT) is a key indicator of the corneal health status and is therefore of clinical importance. The aim of the present study was to determine the agreement between Scheimpflug photography (SP) and optical low-coherence reflectometry (OLCR) systems in measuring the CCT in children.In this cross-sectional study, the samples were selected from Shahroud schoolchildren using cluster sampling. The samples then underwent optometric examinations, including the measurement of visual acuity and refraction. CCT measurements were done by the SP and OLCR systems between 8 am and 4 pm. To evaluate the agreement between these devices, 95% limits of agreement (LoA) and interclass correlation coefficient (ICC) were reported.After applying the exclusion criteria, 4890 right eyes (53.2% male) were analyzed. The mean age of the students was 9.22 ± 1.72 years (range: 6-12 years). The mean CCT by the SP and OLCR systems was 555.30 ± 34.15 and 550.23 ± 35.11 µm, respectively. The 95% LoA between the two devices was -19.81 to 9.66 µm, and the ICC was 0.983. The CCT difference between the SP and OLCR systems was 5.61 µm in boys and 3.36 µm in girls. The CCT difference between the two devices was 6.41 µm in 6-year-old and 3.54 µm in 12-year-old children. The 95% LoA was -17.96 to 9.58 µm and -18.89 to 8.47 µm and the ICC was 0.987 and 0.984 in myopic and hyperopic subjects, respectively.The results of this study showed a high agreement between OLCR and SP measurements of CCT in children.

Objectives To determine the distribution of keratoconus indices in normal children 6 to 12 years of age. Methods This cross-sectional study was conducted in children living in urban and rural areas of Shahroud, northeast Iran in 2015. After careful optometric examinations, the Pentacam was used for corneal imaging and measurement of keratoconus indices. Results Of 5,620 students who participated in the study, the data of the right eye of 4,947 children were analyzed after applying the exclusion criteria. The mean age of all children was 9.23±1.71 years (range: 6-12 years). The mean and 95% confidence intervals (in the parentheses) of index of surface variance (ISV), index of vertical asymmetry, keratoconus index (KI), central keratoconus index (CKI), index of height asymmetry, index of height decentration (IHD), and average pachymetric progression index (PPIAve) was 17.770 (17.610-17.930), 0.137 (0.135-0.139), 1.022 (1.022-1.023), 1.010 (1.010-1.010), 3.299 (3.230-3.368), 0.007 (0.007-0.008), and 0.948 (0.943-0.952), respectively. The results of multilevel mixed-effects linear regression analysis showed that ISV, KI, CKI, IHD, and PPIAve were significantly higher in girls. Index of surface variance and CKI were higher in urban students, and PPIAve was higher in rural students. Except for PPIAve, which was increased with increasing age, the mean values of other keratoconus indices were significantly lower in 12-year-old students compared with 6-year-old ones. Conclusion The results provide valuable information about normal distribution of keratoconus indices in children aged 6 to 12 years. These findings can be used in future research and detection of abnormal cases in the clinical setting.

To compare the accuracy of three devices (Pentacam, Sirius and OPD-Scan III) to differentiate subclinical keratoconus from normal corneas by wavefront parameters. Two hundred and seventeen patients were enrolled in three groups [68 normal, 79 subclinical keratoconus (SKCN) and 70 KCN eyes] in this prospective diagnostic test study. Wavefront indices were evaluated between the groups using Pentacam, Sirius and OPD-Scan III. The accuracy of the parameters was determined by measuring the area under the receiver operating characteristic curve (AUC) for each group. Front Baiocchi-Calossi-Versaci (BCV) index with Sirius (sensitivity = 87.7%, specificity = 83%, AUC = 0.887), front Vertical Coma (Z3−1) with Pentacam (sensitivity = 75%, specificity = 100%, AUC = 0.857) and Corneal Z3−1 with OPD-Scan III (sensitivity = 100%, specificity = 78.6%, AUC = 0.857) had the highest AUC values for the diagnosis of subclinical KCN. In the KCN group, the highest AUC values were obtained for front higher-order aberration (HOA), front/back Z3−1 and front Secondary Vertical Coma (Z5−1) with Pentacam (sensitivity = 100%, specificity = 100%, AUC = 1.00 for all three), front root mean square values per unit area (RMS/A), HOA, Residual HOA, BCV, RMS Trefoil and RMS Coma with Sirius (sensitivity = 100%, specificity = 100%, AUC = 1.00 for all) and Corneal HOA, RMS total Coma and Z3−1 with OPD-Scan III (sensitivity = 100%, specificity = 93%, AUC = 0.96 for all three). Corneal wavefront indices generated from different devices have acceptable validity for differentiating normal cornea from the early form of KCN, and this can be very useful for preoperative screening before refractive surgery. The front BCV with Sirius was the most accurate parameter for diagnosis of SKCN followed by Z3−1 with Pentacam and OPD-Scan III.

Purpose: To determine the distribution of ocular biometric components, including axial length, lens thickness, and vitreous chamber depth, their relationship with personal characteristics, and spherical equivalent refraction after adjusting axial length and vitreous chamber depth for personal characteristics. Methods: Among 6- to 12-year-old children, urban subjects were selected using random cluster sampling, and in rural areas, all eligible subjects were considered for enrollment. Ocular biometrics were measured using BioGraph. Data were summarized as mean and 95% confidence intervals. Linear regression was used to investigate the relationships between the study variables. Results: Data from 4938 children were analyzed. Mean axial length, lens thickness, and vitreous chamber depth were 23.02 (95% confidence interval: 22.97–23.07) mm, 3.48 (95% confidence interval: 3.47–3.49) mm, and 20.63 (95% confidence interval: 20.59–20.66) mm, respectively. According to the multiple linear regression model, axial length and vitreous chamber depth associated positively with height (β = 0.020, P Conclusion: This cross-sectional study showed a general pattern of ocular biometric components. The axial length value was almost similar to European countries, but less than that in the Eastern and Southeast Asian populations. By increasing age, axial length and vitreous chamber depth increased while lens thickness and spherical equivalent decreased. Among all ocular biometric components, axial length was strongest determinant for spherical equivalent.

To determine 5-year changes in keratoconus indices and corrected distance visual acuity in 40–64-year-old keratoconus compared with normal subjects. In this prospective population-based cohort study, 5-year changes in Belin grading system indices including the average radii of curvature in the 3 mm zone surrounding the thinnest point in the anterior (ARC-3 mm) and posterior (PRC-3 mm) cornea, corrected distance visual acuity, minimum corneal thickness, maximum Ambrosio’s relational thickness (ART-max), and maximum anterior keratometry indices centered on steepest point in the central 3 mm (Kmax-3 mm), 4 mm (Kmax-4 mm), and 5 mm (Kmax-5 mm) zones were compared between keratoconus and normal participants. In the analysis, comparisons were made between all keratoconus eyes and the right eyes of normal participants. The mean age in the keratoconus (n = 16 eyes) and normal (n = 1986 eyes) groups (48.31 ± 4.78, 49.37 ± 5.79 years, respectively) was not statistically different (P = 0.327). The two groups differed in terms of changes in PRC-3 mm (− 0.07 ± 0.15 vs. + 0.001 ± 0.14 mm, respectively, P = 0.042) and ART-max (− 6.28 ± 25.19 vs. + 15.8 ± 72.7 μm, respectively, P = 0.003). There were significant correlations between the reduction in PRC-3 mm and its baseline value (β = − 0.20, P

Purpose: To determine the total corneal refractive power in 1–8 mm corneal zones and the 8 mm Q-value in non-keratoconic patients with Down syndrome and normal subjects aged 10–30 years. Methods: Right eye data from 203 Down syndrome patients (mean ± standard deviation age: 17.0 ± 4.7 years) and 189 age- and gender-matched normal subjects (17.1 ± 4.5 years) were compared. Main extracted Pentacam indices were total corneal refractive power in steep and flat axes, and mean and difference (corneal astigmatism) total corneal refractive power in 1–8 mm zones. Results: Mean total corneal refractive power in 1–8 mm zones was 45.17–45.74 D and 42.91–43.52 D in Down and normal group, respectively (all p 0.05). The prevalence of against the rule and oblique astigmatism in all zones were higher in the Down syndrome group (all p Conclusion: Adolescent and young non-keratoconic patients with Down syndrome have a more prolate cornea and a homogeneous keratometry distribution. In this population, females have a steeper cornea.

ISSUES This systematic review aimed to provide an updated estimate on the prevalence of human immunodeficiency virus (HIV) infection among non-injecting people who use drugs (PWUD) and the various subgroups and the odds of HIV infection in the injecting compared to non-injecting PWUD. APPROACH A comprehensive search of international, regional and national databases was performed from January 2005 to May 2020. We conducted backward citation tracking of the included studies and contacted experts for unpublished studies. Studies providing HIV prevalence among non-injecting PWUD were included. Data were also drawn from a previous systematic review, covering 10 years from 1998 to 2007, and was added to the new database. The HIV prevalence was pooled for non-injecting PWUD and other subgroups using the random-effects model. KEY FINDINGS Seventeen studies with a total sample of 9912 non-injecting PWUD were found. The prevalence of HIV infection was 1.9% (95% confidence interval 0.9, 3.1) for 2007 and afterward (nine studies). It was not significantly different from the estimate for the years before 2007 (0.5%; 95% confidence interval 0.0, 2.0; eight studies). No significant difference was found among gender subgroups. The overall estimate of odds of HIV infection among injecting PWUD was 5.7 (95% confidence interval 3.2, 10.0) times higher than non-injecting PWUD. IMPLICATIONS AND CONCLUSIONS The HIV prevalence among the non-injecting PWUD was higher than the general population in Iran. Targeting non-injection PWUD by preventive measures such as harm reduction, drug and psychoeducation, and surveillance seem to be crucial in reducing HIV prevalence in this group.

To determine the distribution of peripapillary retinal nerve fiber layer (RNFL) thickness and its association with different demographic and ocular parameters in adolescents.The present study is part of the second phase of the Shahroud Schoolchildren Eye cohort study, which was conducted in 2018 by reinviting the participants in the first phase. First, preliminary ocular examinations were performed, including measurement of uncorrected and best-corrected visual acuity, autorefraction, and subjective refraction.All study participants underwent corneal imaging using Pentacam to measure central corneal thickness and corneal radius of curvature (keratometry), ocular biometry using Allegro Biograph to measure anterior chamber depth, crystalline lens thickness, and axial length (AL), and finally optical coherence tomography imaging to measure RNFL thickness as well as macular thickness and volume.The data of 4963 right eyes were analyzed after applying the exclusion criteria. The mean age of the study participants was 12.41±1.72 (9 to 15) years. The mean total, superior, inferior, temporal, and nasal RNFL thicknesses were 98.93 [95% confidence interval (CI): 98.61-99.25], 122.84 (95% CI: 122.31-123.37), 129.17 (95% CI: 128.63-129.7), 68.02 (95% CI: 67.65-68.38), and 75.69 (95% CI: 75.3-76.07), respectively. According to the results of the multivariable regression model, macular volume (β=9.81, P =0.001) had a significant direct association, and macular thickness (β=-0.01, P =0.046) had a significant inverse association with the average RNFL thickness. In addition, AL (β=-3.14, P0.001), mean keratometry (β=-1.38, P0.001), and central corneal thickness (β=-0.01, P =0.011) were significantly inversely related to the average RNFL thickness.We report the distribution of peripapillary RNFL thickness using spectral-domain optical coherence tomography and identify macular volume, AL, and mean keratometry as significantly associated factors in children. Our findings may serve as a database to interpret RNFL thickness results in children aged 9 to 15 years with suspected ocular disease.

Background Metabolic syndrome is a combination of metabolic risk factors causing a pathological condition that increases the risk of non-communicable diseases, such as diabetes and cardiovascular diseases. A variety of dietary approaches have been examined to halt this rapid trend; however, the effects of modified-Paleo diet and medium-carbohydrate diet on inflammation, adipokines, hepatokines, and the profile of endothelial microparticles in individuals with metabolic syndrome have not been investigated in detail. The present study is designed to examine the effect of modified-Paleo and moderate-carbohydrate diet with two delivery modes: “fixed diet plan” vs “calorie counting” on weight, body composition, serum levels of some hepatokines and adipocytokines, and flow cytometric analysis of endothelial microparticles in adults with metabolic syndrome. Methods Eighty metabolic syndrome patients will be recruited in this study. They will be randomly allocated to one of the following 4 groups: (1) receiving a modified-Paleo diet with calorie counting, (2) receiving a modified-Paleo diet with a fixed diet plan, (3) receiving a medium-carbohydrate diet with calorie counting, and (4) receiving a medium-carbohydrate diet with a fixed diet plan for 10 weeks. Weight, height, waist circumference, and body composition will be assessed at the study baseline and at the end of the trial. Serum insulin, asprosin, chemerin, FGF-21, CTRP-1, PYY, ghrelin, plasma EMPs (CD31+/CD42b− and CD144+/CD42b−), lipid profile, glycemic indices, hs-CRP, leptin, vitamin C, creatinine and satiety, hunger, fullness, and desire to eat (via visual analog scales) will be measured at the study baseline and at the end of the trial. Insulin resistance and insulin sensitivity will be determined using the HOMA-IR and QUICKI equations. Discussion To the best of our knowledge, this is the first randomized controlled trial that will determine the effect of modified-Paleo and moderate-carbohydrate diet on weight, body composition, serum levels of some hepatokines and adipocytokines, and the profile of EMPs in adults with metabolic syndrome. Moreover, the effects of different diet delivery modes, including “fixed diet plan” and “calorie counting” will also be analyzed. The results of this trial can provide clinical witnesses on the effectiveness of carbohydrate-restricted diets in ameliorating metabolic status and prevent the development of chronic diseases. Trial registration Iranian Registry of Clinical Trials IRCT2016121925267N4. Registered on 26 July 2017

CLINICAL RELEVANCE Accurate measurement of the anterior chamber depth is very important. There is no report regarding the agreement between rotating Scheimpflug imaging (Pentacam HR) and biograph (Lenstar LS 900) in children. This study therefore explores the agreement between Pentacam and Biograph in measuring anterior chamber depth in children. BACKGROUND This study aims to determine the agreement between Pentacam and Biograph in measuring anterior chamber depth in children. METHODS The participants were students living in urban and rural areas of Shahroud, Iran, selected through cluster sampling. The students were transported to the examination site to undergo imaging and optometric tests. Pentacam imaging was then conducted, and biograph was used to measure biometric components. In this report, the anterior chamber depth was calculated from the corneal endothelium. RESULTS Of 6624 students selected randomly, 5620 participated in the study. After applying the exclusion criteria, 4882 eyes were included in the final analysis. The mean anterior chamber depth measured by the Pentacam (3.09 ± 0.26 mm) was higher than that of biograph (3.04 ± 0.24 mm) (p

Objective: Prediction models for cardiovascular disease (CVD) mortality come from high-income countries, comprising laboratory measurements, not suitable for resource-limited countries. This study aims to develop and validate a non-laboratory model to predict CVD mortality in a middle-income setting. Study design and setting: We used data of population aged 40-80 years from three cohort studies: Tehran Lipid and Glucose Study (n = 5160), Isfahan Cohort Study (n = 4350), and Golestan Cohort Study (n = 45,500). Using Cox proportional hazard models, we developed prediction models for men and women, separately. Cross-validation and bootstrapping procedures were applied. The models' discrimination and calibration were assessed by concordance statistic (C-index) and calibration plot, respectively. We calculated the models' sensitivity, specificity and net benefit fraction in a threshold probability of 5%. Results: The 10-year CVD mortality risks were 5.1% (95%CI: 4.8-5.5) in men and 3.1% (95%CI: 2.9%-3.3%) in women. The optimism-corrected performance of the model was c = 0.774 in men and c = 0.798 in women. The models showed good calibration in both sexes, with a predicted-to-observed ratio of 1.07 in men and 1.09 in women. The sensitivity was 0.76 in men and 0.66 in women. The net benefit fraction was higher in men compared to women (0.46 vs. 0.35). Conclusion: A low-cost model can discriminate well between low-and high-risk individuals, and can be used for screening in low-middle income countries. (C)& nbsp;2021 Elsevier Inc. All rights reserved.

Several recent studies have been undertaken into carbohydrate-restricted diets. it has not been clearly demonstrated whether diets with different proportions of energy from carbohydrate exert distinct effects on metabolism and inflammation or not. The current randomized clinical trial (RCT) has been conducted to further elucidate the effects of severe and mild carbohydrate restriction on inflammation and cardiometabolic status in adults with metabolic syndrome (MetS).Eighty adults with metabolic syndrome were randomized to one of the four carbohydrate restricted diets: Paleolithic-based low-carbohydrate diet with calorie-counting method (PLCD-CC) (n = 20), Paleolithic-based low-carbohydrate diet with portion-control method (PLCD-PC) (n = 20), moderate-carbohydrate diet with calorie-counting method (MCD-CC) (n = 20) and moderate-carbohydrate diet with portion-control method (MCD-PC) (n = 20) for 10 weeks. PLCD is defined as a diet consisting of 25-30% of energy from carbohydrate, 30% of energy from protein and 40-45% of energy from fat and encourages consumption of fruits, vegetables and lean meat. MCD is characterized as 40-45% carbohydrate, 30% protein and 30-35% fat. Body weight and composition, adipokines such as Asprosin, chemerin, leptin, hepatokines namely CTRP-6, FGF-21 and cardiovascular disease (CVD) risk factors were tested at baseline and at the end of 10 weeks.A total of 69 participants aged 42.95 (9.27) with metabolic syndrome completed the trial. At the end of current 10-week dietary intervention trial, significant reduction in weight, waist circumference, body fat, visceral fat and waist-hip ratio (WHR) was observed in all four intervention arms (P 0.001). Also, the observed differences among groups did not reach statistical significance (P 0.05). Moreover, we found significant reduction in CTRP6 and leptin in all intervention groups (P 0.001). Reduction of Asprosin level was also marginally significant between intervention groups (P 0.05). All four intervention groups were found to improve cardiometabolic markers such as FBS, TG, total cholesterol and LDL cholesterol compared to baseline. However, despite clinically significant difference, the within- and between-group changes were not statistically significant at the end of trial.The current RCT in Iranian adults with metabolic syndrome revealed that both moderate and Paleolithic-based low carbohydrate diets with both delivery approaches have comparable beneficial effects in terms of body weight and composition, cardiometabolic factors and metabolism-related adipokines and hepatokines.Available at: https://en.irct.ir/trial/21157, identifier: (IRCT2016121925267N4), Registered on 26 July 2017.

ObjectiveMalaria remains endemic in most of sub-Saharan Africa and has a negative impact among pregnant women, resulting in morbidity and poor birth outcomes. The purpose of this study was to assess the relationship between malaria and adverse birth outcomes among prenatal women in the Northern Region of Ghana.DesignThis is a prospective cohort study of singleton pregnancies at 28 weeks of gestational age and above recruited between July 2018 and May 2019 from four public hospitals in the Northern Region of Ghana.Outcome measuresLow birth weight (LBW), preterm birth and perinatal death.ResultsA total of 1323 pregnant women completed the study out of the 1626 recruited, with an average age of 27.3±5.2 years. The incidence of malaria in this population was 9.5% (95% CI 7.9 to 11.1). After adjusting for newborn admissions to the neonatal intensive care unit, parity, maternal age and glucose-6-phosphate dehydrogenase, women who were exposed to malaria during the third trimester of pregnancy had 2.02 times (95% CI 1.36 to 2.99) higher odds of premature delivery. Furthermore, they had 2.06 times (95% CI 1.09 to 3.93) higher chance of giving birth to babies with LBW, irrespective of their socioeconomic status. With an OR of 1.02 (95% CI 0.26 to 4.01), there was no difference in perinatal mortality between pregnant women with malaria and those without malaria after adjusting for caesarean section.ConclusionThis study confirms that prenatal malaria increases the odds of both preterm and LBW deliveries. A decisive policy to eradicate or minimise perinatal malaria is needed to contribute to the prevention of LBW and adverse pregnancy outcomes.

Background: We aimed to assess prevalence and predictors of pre-existing hypertension in pregnant women in three districts of Northern region, Ghana. Methods: This cross-sectional study was conducted among 1626 women in the third trimester of pregnancy across four antenatal centers in 2018. A questionnaire was used to collect medical information including weight and height. We used descriptive statistics to characterize all qualitative variables and performed logistic regression analyses to estimate association of hypertension and other risk factors. Results: We included 1626 women; mean age standard deviation (SD) of pregnant women was 27.4 (5.1) years. About 4.5% (95% confidence interval [CI]: 3.6-5.7) of pregnant women reported they had earlier been diagnosed of having hypertension by a doctor or midwife, before pregnancy. Obese pregnant women had 2.9 times increased adjusted odds of having hypertension relative to non-obese pregnant women (Odds Ratio (OR))=2.9, 95% [CI]: 1.39-5.85, P=0.004). Further, gestational diabetes was a predictor of pre-existing hypertension at an increased odds of 4.9 times relative to those without gestational diabetes (OR= 4.9, CI: 0.92-26.75, P=0.061). Women with two or more children had 3.2 times the adjusted odds of having hypertension (OR=3.2 CI: 1.59- 6.69, P=0.001). Conclusion: Although the prevalence pre-existing hypertension was not too high, obesity, gestational diabetes and number of children were independent predictors of pre-existing hypertension in pregnant women.

Purpose To determine the agreement and validity of keratometric measurements in children with the Nidek ARK-510A auto-refractokeratometer compared to rotating Scheimpflug imaging with Pentacam and biograph with Lenstar LS 900. Methods This study was conducted on 5620 schoolchildren aged 6–12 years in Shahroud, Iran. Minimum and maximum keratometry values and corneal astigmatism magnitude were compared by calculation of Paired difference, interclass correlation coefficient, and 95% limits of agreement (LoA) between devices. Results After applying the exclusion criteria, 4215 right eyes were enrolled into the study. Mean minimum keratometry with Nidek ARK-510A, Pentacam, and Lenstar was 43.13 ± 1.51, 43.14 ± 1.48, and 42.87 ± 1.46 diopters (D), respectively, and mean maximum keratometry was 43.97 ± 1.59, 44.00 ± 1.56, and 43.75 ± 1.54 D, respectively. Nidek ARK-510A overestimated minimum and maximum keratometry by 0.25 ± 0.37 and 0.22 ± 0.41, respectively, compared to Penatcam. The LoA between Nidek ARK-510A and Pentacam for minimum and maximum keratometry measurements were −0.98 to 0.47 D and −1.02 to 0.57 D, respectively. The LoA between Nidek ARK-510A and Lenstar for minimum and maximum keratometry measurements were −0.70 to 0.72 D and −0.79 to 0.85 D, respectively. The agreement between devices was best in emmetropes, worst in hyperopes. For astigmatic vector components, the agreements between devices were poor but best agreement was between Nidek ARK-510A and Pentacam. Conclusions Keratometry measurement with Nidek ARK-510A was not significantly different from Pentacam and Lenstar, and this device can be used in screening programs in emmetropes.

Aims The aim of this study is to evaluate the effect of high-dose vitamin D on insulin sensitivity and the risk of progression to diabetes. Methods In this double-blind, placebo-controlled randomized clinical trial adults with pre-diabetes and vitamin D deficiency were randomly assigned to either vitamin D3 or placebo. Fasting plasma glucose (FPG), 2-h oral glucose tolerance test plasma glucose (OGTT PG), Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), and the rate of progression of glucose tolerance was compared. Results A total of 162 patients were randomized, from which 83 finished the 6-month follow-up (44 in intervention group and 39 in control group). In 6 months, serum 25-hydroxyvitamin D levels were significantly higher in the intervention group (36 ng/ml vs 16 ng/ml, P value Conclusions In patients with pre-diabetes and hypovitaminosis D, high dose vitamin D improves insulin sensitivity and decreases risk of progression toward diabetes.

Objectives To investigate the risk factors of COVID-19 infection in a longitudinal study of a population aged 50–74 years. Methods Data were collected from Shahroud Eye Cohort study and the COVID-19 electronic registry in Shahroud, northeast Iran. Participants were followed for about 13 months and predisposing factors for COVID-19 infection were investigated using log binominal model and calculating relative risks. Results From the beginning of the COVID-19 outbreak in Shahroud (February 20, 2020) to March 26, 2021, out of 4,394 participants in the Eye Cohort study, 271 (6.1%) were diagnosed with COVID-19 with a positive reverse transcription polymerase chain reaction test on two nasopharyngeal and oropharyngeal swabs. Risk factors for COVID-19 infection included male gender (relative risk (RR) = 1.51; 95% confidence intervals (CI), 1.15–1.99), body mass index (BMI) over 25 (RR = 1.03; 95% CI, 1.01–1.05), and diabetes (RR = 1.31; 95% CI, 1.02–1.67). Also, smoking (RR = 0.51; 95% CI, 0.28–0.93) and education (RR = 0.95; 95% CI, 0.92–0.98) showed inverse associations. Conclusions Men, diabetics, and those with BMI over 25 should be more cognizant and adhere to health protocols related to COVID-19 prevention and should be given priority for vaccination.

OBJECTIVE: Detection of epidemics is a critical issue in epidemiology of infectious diseases which enable healthcare system to better control it. This study is devoted to investigating the 5-year trend in influenza and severe acute respiratory infection cases in Iran. The epidemics were also detected using the hidden Markov model (HMM) and Serfling model. STUDY DESIGN: In this study, we used SARI data reported in the World Health Organization (WHO) FluNet web-based tool from August 2011 to August 2016. METHODS: SARI data in Iran from August 2011 to August 2016 were used. We applied the HMM and Serfling model for indicating the two epidemic and non-epidemic phases. The registered outbreak activity recorded on the WHO website was used as the gold standard. The coefficient of determination was reported to compare the goodness of fit of the models. RESULTS: Serfling models modified by 30% and 35% of the data had a sensitivity of 91.67% and 95.83%, while for 15%, 20% and 25% were 70.83%, 79.17% and 83.33%, respectively. Sensitivity of HMM and autoregressive HMM (AHMM) was 66.67% and 92.86%. All fitted models have a specificity of over 96%. The R2 for HMM and AHMM was calculated 0.73 and 0.85, respectively, showing better fitness of these models, while R2 was around 50% for different types of Serfling models. CONCLUSIONS: Both modified Serfling and HMM were acceptable models in determining the epidemic points for the detection of weekly SARI. The AHMM had better fitness, higher detection power and more accurate detection of the incidence of epidemics than Serfling model and high sensitivity and specificity. In addition to AHMM, Serfling models with 30% and 35% modification can be used to detect epidemics due to approximately the same accuracy but the simplicity of the calculations.

To determine the repeatability of corneal densitometry measured by the Scheimpflug imaging system.This cross-sectional study was conducted on photorefractive keratectomy candidates. One eye of each participant underwent imaging using Pentacam HR three times, 10 min apart. The repeatability of densitometry measurements was evaluated in four concentric annuli around the corneal apex and in different corneal depths. The repeatability of the measurements was evaluated using the intraclass correlation coefficient (ICC), repeatability coefficient (RC), and coefficient of variation (CV). The difference of repeatability between layers and zones was tested by tolerance index (TI).Sixty eyes of sixty patients with a mean age of 27.76 ± 3.93 years were studied. Half of the participants were female (Corneal densitometry measurements provided by the Pentacam had good repeatability. The repeatability of densitometry measurements decreased from the center to the periphery (with an exception for 0-2 mm and 2-6 mm) and from the posterior to the anterior of the cornea. The reliability of the 10-12 mm zone was markedly less than other zones.

PURPOSE: To examine and compare corneal cellular and subbasal nerve (SBN) characteristics in post-laser-assisted in situ keratomileusis ectasia (PLE) corneas, normal post-laser-assisted in situ keratomileusis corneas (PLC), keratoconus (KC) corneas, and normal virgin corneas (NC). METHODS: In this cross-sectional comparative study, 18 PLE eyes of 11 patients, 18 PLC of 15 cases, 32 KC eyes of 32 patients, and 29 NC of 29 subjects were assessed using in vivo confocal microscopy. The density of the basal epithelial cell (BEC), anterior keratocyte, posterior keratocyte, and endothelial cell layers, as well as the characteristics of SBN fibers, was compared between the 4 groups. RESULTS: The density of the BEC and anterior and posterior keratocyte layers was significantly lower in KC compared with NC (-650 ± 190, P = 0.013; -181 ± 39, P < 0.001; and -36 ± 11, P = 0.021, respectively). However, there was no significant difference between PLE and PLC regarding these parameters (all Ps � 0.6). Mean SBN parameters, including central corneal nerve branch density, nerve fiber length, total branch density, and nerve fiber area, were significantly lower in KC compared with NC and in PLE compared with PLC (all Ps � 0.021). CONCLUSIONS: The pathophysiology of PLE seems to differ from KC. Apparent changes in the BEC and anterior and posterior keratocytes associated with KC were not observed in PLE. However, SBNs seem to be involved in both conditions.

Background: The Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic broke out in December 2019 and is now characterized as a pandemic. Effective control of this infectious disease requires access to diagnostic techniques, for both case finding and epidemic size estimation. The molecular technique is routinely used worldwide. Although it is the "standard" case detection and management method, it has its own shortcomings. Thus, some easy-to-use rapid serological tests have been developed. Methods: One hundred and fourteen positive RT-PCR-diagnosed patients were tested by VivaDiag Kit, a brand of rapid serological kits available in hospitals affiliated to Tehran University of Medical Sciences (TUMS), Tehran, Iran. Frozen serum specimens taken from healthy people in summer and fall 2019 were also tested as negative controls. Results: Test sensitivity was 47.9% (95% confidence interval [CI]: 38.8-56.9) for IgM and 47.0% (95% CI: 38.0–56.0) for IgG. There was no difference between IgG and IgM seropositivity except in one case. Specificity was calculated as 99.0% (95% CI: 96.4–99.9) for IgM and of 100.0% (95% CI: 0.98.2–100.0) for IgG. Sensitivity was higher in men and older participants. Conclusion: This test can be used for epidemiological investigations, especially for the estimation of the level of infection in the community, after it is properly corrected for sensitivity and specificity. The low sensitivity could be attributed to the technical limitations of the kit or low levels of antibodies after infection. The different sensitivity in age and sex groups supports the hypothesis that different people show different immune responses to this virus.

Little evidence exists about the association between fuel type use and risk of respiratory symptoms among infants; we aimed to evaluate this hypothesis through a cohort study in the Northern Region of Ghana. The study was carried out from April 2018 to May 2019. We recruited 28 weeks old pregnant women at selected hospitals and prospectively followed them at birth in the hospital ward to register their newborns and at homes when the baby had attained 3 to 7 months to collect data on respiratory symptoms of infants. A logistic regression model was used to investigate the odds of respiratory symptoms in infants. Exactly 1270 infants completed the study; the average age of women was 27.1 years and standard deviation of 5.1. The study found that infants of mothers who cooked with charcoal and those with firewood had increased odds of having cough with cold 4.10 (95% CI, 2.21–7.61) and 3.95 (95% CI, 2.06–7.58), increased odds of congestion, phlegm with cold by 3.89 (95% CI, 1.73–8.79) and 3.45 (95% CI, 1.44–8.26), increased odds of wheezing 4–14 days or nights by 1.68 (95% CI, 0.72–3.91) and 3.37 (95% CI, 1.41–8.04) and increased odds of seeking medical treatments in a health facility for chest illness by 3.97 (95% CI, 1.31–12.02) and 6.67 (95% CI, 2.14–20.77) in comparison with liquid petroleum gas respectively. Some significant predictors of respiratory infections were maternal malaria, hospitalisations of an infant after birth, residence, cooking location, composite breastfeeding, sharing of a bedroom with infant and air-conditioner or fan in the living room. Our findings indicate increased odds of infant respiratory symptoms in households using solid fuel in Ghana. Although our observational design precludes ascribing any causal relationships, our results are consistent with other studies suggesting clean fuel use during pregnancy and infancy may benefit this vulnerable age group.

Background This trial aimed to evaluate the effectiveness of motivational interviewing (MINT) among medication non-adherent hypertensive patients attending primary healthcare centres in Gaza Strip. Methods and results A clustered randomized controlled trial was run among 355 hypertensive participants; who were identified as non-adherent by a self-reported adherent scale and were recruited from 10 centres by two stages cluster random sampling approach (five centres were randomly allocated to each group). Standard of hypertension care was provided to 173 participants, parallel to 182 one who received their standard of care including non-blinded MINT sessions for 3 months. The change in medication adherence status was the primary outcome and within-patient changes of systolic blood pressure (SBP), diastolic blood pressure (DBP), self-efficacy and intrinsic motivation were the secondary outcomes. Data were collected via an interview-based structured questionnaire and were analysed by generalizing equation estimation model adjusting for covariates. The results showed a significant improvement in medication adherence status among participants in the intervention group (n = 159) [OR= 6.28; 95% confidence interval (CI): 3.20, 12.33; P Conclusion Standard of care including MINT is an effective client-centred approach which promoted medication adherence, decreased mean blood pressure, and improved self-efficacy and intrinsic motivations among hypertensive patients.

Background Emerging evidence showed promising effects of vitamin D on headaches characteristics. Thus, it seems there is still a need for more researches to clarify the mechanisms by which this vitamin exerts anti-migraine effects. Methods The present study was conducted as a 16-week randomized double-blind placebo-controlled trial on 80 episodic migraine patients allocated in 2 parallel groups each consisted of 40 patients who received vitamin D 2000 IU/d or placebo. At baseline and after the intervention completion, headache diaries and migraine disability assessment questionnaire (MIDAS) were used to assess migraine related variables in patients. Also, interictal serum concentration of calcitonin gene-related peptide (CGRP) (as the dominant mediator of migraine pain pathogenesis) was evaluated using ELISA method. Results The mean (SD) of age in the vitamin D and placebo groups was 37 (8) and 38 (12) years, respectively. ANCOVA test adjusted for baseline values, and confounders showed vitamin D supplementation resulted in a significant improvement in MIDAS score after 12 weeks in the intervention group (21.49 (16.22–26.77)) compared to placebo (31.16 (25.51–36.82) P value: 0.016). Moreover, after controlling for baseline levels, and other variables using ANCOVA, CGRP level was appeared to be significantly lower following vitamin D supplementation (153.26 (133.03–173.49) ng/L) than the patients in the placebo arm (188.35 (167.15–209.54) ng/L) (P value = 0.022). Conclusion According to the current findings, vitamin D supplementation in episodic migraineurs, particularly in those with migraine with aura, may potentially improve migraine headache characteristics and disability probably through attenuating CGRP levels. Therefore, these results could provide a new insight into anti-nociceptive effects of vitamin D; however, more studies are required to confirm our findings. Trial registration The trial is registered in the Iranian registry of clinical trials (IRCT) at 11 July 2018, with IRCT code: IRCT20151128025267N6.

We aimed to investigate the potential associations between exposure to fuel types for cooking and birth outcomes in Northern Region of Ghana. Third trimester pregnant women were recruited during antenatal visit to the hospital and followed-up till delivery. Three questionnaires were administered covering baseline information, exposure to fuel types, and birth outcomes. Adjusting for potential confounding factors, log binomial regression model was applied to investigate the association between low birth weights (LBW), preterm birth and perinatal deaths in mothers and fuel types. Of the 1626 participants recruited at baseline, about 1323 women in the delivery period completed the study. At delivery period, maternal mean (SD) age was 27.3 (5.2) years. Mothers who used charcoal and firewood for cooking had 1.47 times (95% CI 1.04–2.05) and 1.18 times (95% CI 0.83–1.69) increased in risk of preterm birth respectively after controlling for potential confounding variables. Although, non-significant, mothers who used charcoal had 1.34 times (95% CI 0.45–3.97) increased risk in LBW, while those who used firewood had 1.23 times (95% CI 0.41–3.71) risk in LBW. Similarly, babies of mothers who used charcoal and those who used firewood respectively had 1.72 times (95% CI 0.52–5.65) and 1.70 times (95% CI 0.49–5.92) risk in small for gestational age after controlling for maternal BMI at first visit and anemia. Lastly, mothers who used charcoal and those who used firewood respectively had 1.87 times (95% CI 0.29–11.64) and 2.02 times (95% CI 0.31–13.04) increased risk in perinatal mortality after controlling for potential confounding variables. We observed a significant association between charcoal and preterm birth. Also, we observed a non-significant association between charcoal and firewood users and LBW, SGA and perinatal mortality respectively, compared to those using gas or electricity. This suggests cooking with charcoal and firewood could have health consequences on the outcome of pregnancy., Fuel type, LBW, perinatal mortality, Preterm birth, pregnant women, Ghana, Environmental Science; Public Health; Health Sciences, Obstetrics & Gynecology

Introduction The mortality and morbidity rates of stroke in men and women have been reported differently and its effective factors have been discussed. The purpose of this study was to investigate sex differences in 28-day mortality of ischemic stroke and its associated factors. Materials and Methods This is a prospective cohort study conducted from June 2018 to September 2019 in patients with ischemic stroke referred to Firoozgar, Shariati and Sina hospitals in Tehran. Demographic data, risk factors, disease history, drug use, severity of stroke, and patient functional status were recorded in the hospital. The patients' functional status and severity of stroke were measured using the Modified Ranking Scale (MRS) and the National Institutes of Health Stroke Scale (NIHSS). After 28 days, the patients' survival status was monitored. Logistic regression was used to analyze the data. Results In this study, 703 patients were enrolled; of them, 260 (37.00%) were female and 443 (63.00%) were male. After 28 days, 21 female cases (8.17%) and 26 male (6.08%) ones died (P = 0.299). Functional status (OR = 4.65; 95%CI: 2.09 to 10.38), diastolic blood pressure (OR = 0.91; 95%CI: 0.85 to 0.96), warfarin use (OR = 0.15; 95%CI: 0.04 to 0.55), and hemoglobin (OR = 1.17; 95%CI: 1.02 to 1.35) were associated with 28-day mortality. Poor functional status in men had a greater association with 28-day mortality than women (OR 4.65 vs. 1.64). High diastolic blood pressure had a negative association with the 28-day mortality of cases and this association is more in women than in men (OR 0.88 vs. 0.91). High hemoglobin is a risk factor in men and a protective factor in 28-day mortality in women (OR 1.73 vs. 0.73). Smoking also had a greater association with 28-day mortality in women than men (OR 2.67 vs. 1.2). Discussion Twenty eight-day mortality was more in women than in men, but this difference was not significant. Women were older, had more severe stroke and poorer functional status than men. Variables including functional status, diastolic blood pressure, hemoglobin level, and smoking had interaction with sex, and their association with 28-day mortality rate was different between men and women. Sex differences should be considered, so that we can better manage stroke patients.

To compare 5-year changes of central and peripheral corneal thickness, corneal volume, and keratometry between diabetic and non-diabetic individuals (40 years) in a population-based study.Right eye corneal indices of the 333 diabetic persons were compared with 2865 non-diabetics. Studied indices included the apical corneal thickness (ACT), minimal corneal thickness (MCT), thickness values on corneal rings of 4 mm, 6 mm, and 8 mm in diameter, the volume of the 10 mm of the corneal diameter, and the central 3 mm keratometry in two steep (Kmax) and flat (Kmin) axes as measured with Pentacam (Oculus, Inc, Lynnwood, WA).In the diabetic and non-diabetic groups, respectively, the 5-year change was +0.1 ± 11.9 and -1.2 ± 11.9 μm (p = 0.035) for ACT, -1.1 ± 12.1 and -2.4 ± 11.9 μm (p = 0.056) for MCT, -3.9 ± 12.6 and -5.1 ± 12.3 μm (p = 0.007) for the 4 mm ring, -5.0 ± 15.3 and -7.5 ± 14.5 μm (p = 0.006) for the 6 mm ring, and -7.0 ± 20.1 and -10.8 ± 19.2 μm (p = 0.011) for the 8 mm ring. The diabetic group showed less reduction in corneal volume (-0.5 ± 1.8 mmThe overall patterns of change in corneal thickness and shape in over 40-year old diabetics are similar to non-diabetics, such that with aging, reduced thickness and increased keratometry take the cornea towards a prolate shape. However, the age-related changes in central and peripheral corneal thickness, volume and corneal shape are less pronounced in diabetic subjects.

Objective Because of the incidence of a childhood obesity epidemic and the widespread changes in people's lifestyle, the prevalence of high blood pressure in children is increasing. This study was conducted to determine the prevalence of prehypertension and hypertension and its risk factors in Iranian children. Methods Using random cluster sampling in urban areas and census in rural areas, a total of 5620 schoolchildren aged 6-12 years living in Shahroud, Northeast of Iran, were studied. The prevalence of hypertension was determined on the basis of the fourth report of the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents by age, sex, and place of residence. The factors influencing blood pressure were studied using multivariate regression. Results The prevalence of prehypertension was 7.44% and the prevalence of hypertension was 6.82%. The relative risk ratio (RRR) of prehypertension was 1.17 for BMI, 1.43 for female sex, and 3.71 for residence in rural areas; in addition, the RRR of hypertension was 1.22 for BMI, 6.64 for residence in rural areas, 1.69 for moderate economic status, and 1.89 for low economic status. Conclusion The prevalence of prehypertension and hypertension is significant in children and alarming in rural areas and requires urgent intervention. As factors such as high BMI, female sex, residence in rural areas, and moderate and low economic status are associated with increased risk of prehypertension and hypertension, it is recommended to conduct routine care programs at regular intervals in schools to prevent hypertension and its related complications.