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Summary: Background: N-acetylcysteine (NAC) as a potent anti-inflammatory and antioxidant compound, has raised scientific interest to affect endothelial function. The present systematic review aimed to summarize the potential therapeutic effects of NAC in different health status. Methods: PubMed, Web of Science, Scopus, and Google Scholar were searched up to 2023 to obtain relevant studies. The PRISMA guidelines were employed during all steps. Two reviewers independently extracted the information from the included studies. The studies investigating the effect of oral and intravenous NAC on vascular function were included in the current study. Results: A total of 4455 studies were identified. Finally, fifteen studies were included in the present systematic review. Both oral and intravenous NAC administration have been evaluated in eight and seven studies, respectively. Most of included studies, illustrated no significant changes in the markers of vascular function due to NAC supplementation. However, 3 studies showed significant reduction in the Intercellular adhesion molecule-1 (ICAM-1) level based on NAC supplementation. Whereas, there was inconsistent results in term of vascular adhesion molecule-1 (VCAM-1) and NO levels. In general, NAC supplementation had led to an improvement in the markers of vascular function (ET, FMD, SVR, CVR) in a non-significant model. Conclusion: It seems that NAC may have favorable effects in vascular dysfunction. However, more studies are needed to confirm these results and clarify the relevant mechanisms.

Background: Clinical studies, investigating the effect of β-Alanine (BA) supplementation on recovery biomarkers in physically active individuals, have generated inconsistent results. This systematic review and meta-analysis study aimed to clarify the clinically relevant dietary effects of BA supplementation. Methods: A comprehensive search was done in the electronic databases of Scopus, PubMed, ISI Web of Science and Embase from inception to 2022. Meta-analysis was done using the random-effects model. Pooled effect size was evaluated using standard mean difference (SMD) and 95% confidence intervals (CI). Heterogeneity of between-study was evaluated according to Cochran’s Q test and I2 . Subgroup analysis was conducted to identify the potential sources of heterogeneity. Results: Overall, 32 studies were included in the current study. The results suggested that BA supplementation increases carnosine level significantly (SMD: 0.22mmol/L, 95%CI: -0.17, 0.61, P=0.27) but no effect was shown about lactate, fatigue, VO2 , pH and bicarbonate (HCO3 - ) (P>0.05). Subgroup analysis revealed a significant association of VO2, carnosine and fatigue with supplementation dosage, gender and duration of administration respectively. Conclusion: BA supplementation emerged its beneficial effects on enhancing carnosine level which highlights its ergogenic effects. In contrast, no significant effects had been shown in term of fatigue delay and blood levels of lactate, HCO3 - , pH, and VO2 value. These results warrant more investigation in a prospective design to clarify the exact mechanism in this way.

Abstract Background Recent studies have shown that dietary intakes and gene variants have a critical role in the obesity related comorbidities. This study aimed to evaluate the effects of the interactions between Fatty acid desaturase 2 (FADS2) gene rs174583 polymorphism and two dietary indices on cardiometabolic risk factors. Methods This cross-sectional study was carried out on 347 obese adults aged 20-50 years old in Tabriz, Iran. Healthy eating index (HEI) and Diet quality index-international (DQI-I) were evaluated by a validated semi-quantitative 147-item Food frequency questionnaire (FFQ). Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was used to determine FADS2 gene variants. Multivariate analysis of covariance (MANCOVA) was used to identify gene-diet interactions on metabolic parameters. Results Waist circumference (WC) and serum triglyceride (TG) levels were significantly higher among carriers of TT genotype of FADS2 gene (P

Abstract Objective The current study was aimed to evaluate the effects of active form of vitamin D on TGF- β, NF-κB and MCP-1 in heart tissue of obese rats. Methods Forty rats were allocated into groups of normal diet and high fat diet for sixteen weeks; then each group was divided into two groups that received either 500 IU/kg vitamin D or placebo for five weeks. Biochemical parameters were assessed by ELISA kits. Results Vitamin D reduced TGF-β in obese rats supplemented with vitamin D compared with other groups (P = 0.03). Moreover, vitamin D reduced MCP-1 concentrations in the heart tissues of both vitamin D administered groups compared to placebo one (P = 0.002). NF-κB in the heart of HFD + vitamin D group was significantly lower (P = 0.03). Current study also showed that vitamin D improves glycemic status and reduce insulin resistance significantly in HFD group (P = 0.008). Conclusion Vitamin D was a potential anti- inflammatory mediator of cardiovascular disease and markers of glycemic status in obese rats. Further investigations are needed to better identify the therapeutic role of this vitamin in CVD and to elucidate the underlying mechanisms.

Abstract Background: The dietary glycemic index (GI) has been introduced as a novel index to elucidate the potential of foods to increase postprandial glucose. According to the limited available data about the association of GI with cardio-metabolic risk factors such as lipid profile, blood glucose markers, and blood pressure in developing countries, the current study was conducted to investigate this association in apparently obese individuals. Method and material: Three hundred forty-seven obese adults were recruited in the present cross-sectional study. A validated 147-food item semi-quantitative food frequency questionnaire (FFQ) was used to evaluate the usual dietary intake of study participants. Dietary GI was calculated using the international GI database. Fatty acid desaturase (FADs)2 gene variants were determined according to polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). ANOVA was used to compare study variables across different tertile of GI. Results: We found significant differences in terms of anthropometric parameters [weight (P = 0.038), waist circumference (WC) (P = 0.023), weight to hip ratio (WHR) (P = 0.007), and fat-free mass (FFM) (P

Abstract Objective Evidence show that cocaine and amphetamine regulated transcript-prepropeptide (CART-PT) gene variants may affect obesity related traits, but little is known about its end points. In the current study, we aimed to evaluate the interaction of CARTPT gene polymorphism with diet quality indices including dietary approaches to stop hypertension (DASH) and Mediterranean diet score (MDS) on cardio-metabolic risk factors. This cross sectional study recruited 288 apparently healthy obese individuals. Diet quality indices including DASH and MDS were evaluated using semi quantitative food frequency questionnaire (FFQ). Polymerase chain reaction-restriction fragment length polymorphism (PCR–RFLP) was used for CARTPT genotypes. Results No significant differences was reported for general characteristics and biochemical parameters across genotypes except for QUICKI among females (P = 0.01) and it was higher in heterozygous genotype. There was significant CARTPT-DASH interactions affecting serum fasting glucose level (P = 0.049). However, in relation to CERTPT-MDS interactions, the highest level of insulin (P = 0.003) and HOMA-IR (P = 0.003) values were shown among AA carriers in high adherence to MDS, while AA carriers in high compliance to MDS experienced decreased level of QUICKI (P = 0.001).

Introduction: Obesity is a strong promoter of cardiometabolic risk factors and is associated with several chronic comorbidities. Recently, the role of α-melanocyte stimulating hormone (α-MSH) and agouti related peptide (Ag-RP) in regulation of energy balance has attracted much attention. In current study, we evaluated the association between α-MSH and Ag-RP with cardiometabolic factors among obese individuals with different adherence to Diet Quality Index-International (DQI-I) values. Methods: In this research, 188 obese adults aged between 20 and 50 years old and body mass index (BMI) between 30 and 40 kg/m2 were recruited. Dietary intakes of participants and DQI-I calculation was performed using a semi-quantitative food frequency questionnaire (FFQ) with 132 food items. Serum glucose, lipids, insulin, and plasma α-MSH and Ag-RP levels were measured using ELISA kits. Homeostasis model assessment for insulin resistance index (HOMA-IR) and quantitative insulin sensitivity check index (QUICKI) were also calculated. Results: Among those with the lowest adherence to DQI-I, Ag-RP was positively associated with systolic blood pressure (SBP) (P = 0.03) among males, which was associated with waist circumference (WC) (P = 0.01) and diastolic blood pressure (DBP) (P = 0.01). Moreover, among males with low and moderate adherence to DQI-I, α-MSH was positively associated with insulin (P = 0.04), weight (P = 0.03), WC (P < 0.01), SDP (P = 0.02) and DBP (P = 0.01). Also, Ag-RP showed a positive association with BMI values (R2 = 0.03; P = 0.03). Conclusion: According to our findings, in obese subjects with poor to moderate adherence to DQI-I, Ag-RP and α-MSH were in positive correlation with cardiometabolic risk factors. These findings further clarify the clinical importance of these parameters as prognostic factors of cardiometabolic abnormalities.

Abstract Background Malnutrition as a result of insufficient intake or uptake of nutrition leads to increasing rate of chronic diseases such as stroke. Stroke is one of the most common causes of death in western countries and its increasing trend has attracted lots of attention. In this regard, it seems logical to focus on modifiable risk factors such as nutrition, in order to reduce the resulting complications. Accordingly, this study aimed at evaluating nutrition status of stroke patients to estimate its relationship with clinical outcomes of stroke. Methods In the present cross-sectional study, 349 patients were recruited. Nutrition assessment was performed using Patient-Generated Subjective Global Assessment (PG-SGA). In addition, National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), and biochemical tests were performed. Results Our findings elucidated a significant positive correlation of mRS with PG-SGA and consciousness score, as well as a negative correlation with BMI, calf circumference, mid-arm circumference, and triceps skinfold at admission time (P ≤ 0.002). Moreover, a direct correlation was found between mRS and PG-SGA and consciousness score at discharge time (P ≤ 0.001). In contrast, an inverse correlation was established between mRS and mid-arm circumference (P = 0.02). Furthermore, univariate analysis indicated significant associations between mRS ≥ 3 and age (OR: 1.02; 95%CI: 1.00–1.04), PG-SGA (OR: 1.08; 95%CI: 1.03–1.13), NIHSS (OR: 1.04; 95%CI: 1.02–1.07), dysphagia (OR: 1.69; 95%CI: 1.03–2.77), consciousness (OR: 1.48; 95%CI: 1.07–2.04), and mid-arm circumference (OR: 0.95; 95%CI: 0.90–1.00). In addition, these associations remained significant in multivariate analysis for PG-SGA (OR: 1.07; 95%CI: 1.00–1.13) and NIHSS (OR: 1.04; 95%CI: 1.01–1.07). Conclusion This study revealed a positive correlation between mRS and consciousness status and PG-SGA score, as well as a negative one between mRS and MAC at discharge time.

Abstract Obesity prevalence have tripled in the past decades. It is logical to consider new approaches to halt its prevalence. In this concept, considering the effect of interaction between fatty acid desaturase 2 (FADS2) gene variants and dietary advanced glycation end products (AGEs) on obesity-related characteristics seems to be challenging. The present cross-sectional study conducted among 347 obese individuals. A validated semi-quantitative 147-item food frequency questionnaire (FFQ) was used to estimate dietary intakes and American multiethnic database was used to calculate AGEs content of food items which were not available in Iranian Food Composition Table (FCT). FADS2 gene variants were determined according to Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Analysis of covariance (ANCOVA) was used to evaluate the modifier effect of FADS2 gene-dietary AGEs on biochemical values. Based on our findings, no significant differences was reported in term of biochemical variables between AGEs tertiles. In contrast, percent of macronutrients (carbohydrate, protein and fat) of total calorie intake, amount of daily intake of fiber and meat groups showed a significant differences among AGEs tertiles. Furthermore, statistical assays clarified the modifier effects of FADS2 gene-AGEs on weight (Pinteraction = 0.04), fat mass (Pinteraction = 0.03), waist circumference (Pinteraction = 0.008) and cholesterol (Pinteraction = 0.04) level. Accordingly, higher consumption of protein or fat based foods constitute high amount of AGEs and heterozygote genotype for FADS2 tended to show lower level of AGEs content. These findings address further investigation to develop new approaches for nutritional interventions.

Abstract Background Stroke is a major cause of mortality and morbidity. Also, free radicals and oxidative stress are deleterious factor in the stroke progression. We aimed to evaluate the association between oxidative stress markers and odds of having risk factor for stroke or developing stroke. Methods The present case-control study was conducted on 556 participants in Imam-Reza hospital, Tabriz, Iran. Subjects were divided into three group, including individuals with acute ischemic stroke, those who were at risk of stroke, and healthy controls. All enrolled participants except for controls underwent neurological examinations and brain magnetic resonance imaging (MRI). Stroke-related disability and stroke severity were evaluated by modified Rankin Scale (mRS) and National Institutes of Health Stroke Scale (NIHSS), respectively. Serum malondialdehyde (MDA) level and total antioxidant capacity (TAC) were measured within 48 h of the initiation of stroke. One-way ANOVA and Chi-square tests were used for comparing characteristics between groups. Multivariable logistic regression was implemented for odds of stroke based on MDA and TAC quartiles. Also, Spearman’s correlation was utilized. Results Serum MDA, systolic and diastolic blood pressure, cholesterol, and triglyceride were significantly higher in the stroke group than controls. High levels of MDA were associated with increased development of stroke (P-value

SUMMARY: Background & aims: Malnutrition is one of the major problems in hospitalized patients which increases the risk of chronic diseases. This highlights the need for an appropriate indicator to predict the risk of cardiometabolic risk factors and numerous chronic diseases in these patients. Regarding of few studies in this context, we aimed to investigate a better understanding of associations between neck circumference (NC) with metabolic disorders and renal diseases in hospitalized patients. Methods: This cross-sectional study conducted among 303 participants (167 77 and 136 men) hospitalized from March to June 2019 in internal disease wards of Imam Reza Hospital, Tabriz, Iran. Demographic information, anthropometric (NC, height, and weight), biochemical and nutritional supportive, were collected and evaluated. Results: In the present study, the mean age of men and women in three tertiles of NC were 57.76 ± 18.22, 56.16 ± 16.78, and 60.78 ± 14.22 years, respectively and there was no significant difference in the age of the three tertiles (P = 0.144). Men showed to have higher NC compared with women (p

Introduction: Malnutrition is considered to be a severe complication in hospitalized patients, which increases the length of hospital stay, treatment costs, and mortality. The present study aimed to evaluate neck circumference as a possible predictor of metabolic disorders in the hospital settings. Methods: This study was conducted on 300 hospitalized patients selected from the internal disease ward of Imam Reza Hospital in Tabriz, Iran. Data were recorded on their demographic characteristics, medical history, medication use, and anthropometric and biochemical parameters. Dietary supplementation use, nutritional support, and physical activity (PA) were also measured using the subjective global assessment tool, and neck circumference (NC) was measured by the researcher. Data analysis was performed in SPSS version 16.0. Results: In total, 61.8% of the male and 65.9% of the female patients had an NC of equal to or higher than normal. Chi-square was applied to assess the categorical variables, and one-way ANOVA was used for the continuous variables, indicating significant correlations between the NC and gender, body mass index, marital status, occupation status, PA, current nutritional status, and medical history such as diabetes mellitus (DM), hypertension (HTN), and renal disorders, as well as the use of some medications (p

Abstract Background Dietary fatty acids are important dietary determinants of metabolic disorders in human. However, it is important to develop an index that considers not only the amount of dietary fatty acids but also the structure, fluidity and melting point of them. In the current study we investigated the association between a novel dietary lipophilic index (LI) with metabolic profile and dyslipidemia in a community based study in Tabriz-Iran. Methods Dietary data were collected using a validated, 79-food item, semi-quantitative food frequency questionnaire, and dietary LI was calculated. Anthropometric variables were measured and metabolic profile including blood sugar, serum lipids and liver enzymes were assessed. Metabolic syndrome was defined according to the adult treatment panel (ATP) III criteria. Results The mean age of the participants was 42.53 ± 12.03 years and most of the participants were women. Mean of dietary LI was 34.99 ± 6.91. Higher dietary LI was associated with higher body mass index (BMI) (β = 0.17, P

Introduction: In some cases, MMR vaccine injection causes fever, seizures, parotitis, and aseptic meningitis in children. Since in patients suspected of having meningitis, antibiotics are initially started with a meningeal dose and considering that a group of patients receive antibiotics despite the diagnosis of aseptic meningitis, evaluation of the effectiveness of antibiotics in the treatment of aseptic meningitis caused by the MMR vaccine is necessary in order to prevent drug resistance, indiscriminate use of antibiotics, and additional costs. Materials and methods: In this descriptive-analytical study, which was conducted from 2016 to 2019 at Hazrat Ali Asghar Hospital in Iran, the number of samples studied was 50 patients. The patients were included in the study after checking the children's vaccination cards and considering the inclusion and exclusion criteria. Cerebrospinal fluid samples were taken and sent to the laboratory for culture and analysis and latex agglutination test. Also, in order to ensure the viral origin of the studied meningitis patients, antibiotic effectiveness was evaluated using the disk diffusion method. The demographic and medical information of the patients was recorded in a researcher-made questionnaire, and finally, the data were analyzed using SPSS version 22 software. Results: The mean and standard deviation of the children's age was 13.35±1.26 months. Also, 36.6% of the children were girls and 63.1% of them were boys. The youngest age was 1.2 and the oldest age was 2 years. Among the studied patients, 12 children did not receive antibiotics during hospitalization and 38 people received antibiotics during hospitalization. At first, ceftriaxone was started for 38 people and vancomycin for 36 people. Then, ceftriaxone was continued for 14 people, ceftriaxone and vancomycin for 6 people, cefotaxime for 14 people, and cefotaxime and vancomycin were continued for 4 people. Among the 12 children who did not receive secondary treatment with antibiotics, 10 children had initially received ceftriaxone and 8 children had received vancomycin. Examining the relationship between hospital symptoms and antibiotic prescription showed that the degree of fever was significantly different in both groups. There was no significant relationship between the duration of fever and the use of antibiotics, and also between the duration of hospitalization and the use of antibiotics. Discussion and conclusion: Antibiotic use in children with aseptic meningitis caused by MMR vaccine injection, in addition to having no effect on the treatment, may cause the exacerbation of meningitis complications. Also, there was no significant difference between the duration of hospitalization in people who received antibiotics and patients who did not receive antibiotics. [ABSTRACT FROM AUTHOR]

Introduction: The prevalence of asymptomatic fever among children is high and may be confused with fever caused by corona. The purpose of this study is to investigate the characteristics of inflammatory factors and cardiac enzymes in children with Covid-19 hospitalized with the initial manifestation of fever without other symptoms. Methods: In this descriptive-analytical cross-sectional study, all 200 children with positive Covid-19 were hospitalized in Hazrat Ali-Asghar Hospital in Tehran between 2018 and 2019. For gathering data, clinical records and demographic information of patients were noted in the made-researcher’s checklist and the collected data were analyzed using SPSS software version 24 Results: It was found that the relationship between the degrees of fever of the patients with the number of platelets was also inverse and significant. In addition, there was a significant relationship between the degree of fever of the patients and the LDH number, ALT number and segment and lymphocyte percentage of the patients. In addition, it was found that the passing time of fever has a significant relationship with ALT and ESR in such a way that with the passage of time, there is a higher probability of seeing an increase in ESR, but in the case of ALT, it increases in a shorter period of time and decreases more after the passage of time. Conclusion: According to the results of the present study, in case of suspected to Covid and fever in patients, along with other tests, AST, ALT, D-dimer, and CKMB can be used to diagnose Covid, in such a way that in Covid, AST is probably normal and mentioned other tests can be higher than normal.

Introduction: Simulation-based learning has been an effective and safe tool for learning and practicing skills. Therefore, this study was designed to explore the satisfaction of residents and nurses from workshops held by simulation in Hazrat Ali Asghar (AS) Children's Hospital in Tehran in the academic years 2019-2020. Methods: This descriptive cross-sectional study was performed on 157 pediatric, emergency residents and nurses of Ali Asghar Hospital.Participants were selected through counting method. The instrument was a questionnaire designed by researchers that was used after validation and reliability. Statistical analysis of information was performed using descriptive statistics. Results: Pediatric, emergency assistants and nurses experienced 90% and 95% satisfaction, respectively, in relation to various aspects of teacher satisfaction and performance from a total of seven workshops held. The number of female participants (83%) was higher than men. Besides, there was no significant relationship between demographic characteristics of individuals and their satisfaction (P=0/06). Conclusion: On the other hand, the assistants and nurses were highly satisfied with the performance of the workshops and the content of the workshops and the performance of the instructors. Therefore, holding workshops through simulated training methods is recommended to enhance learning and improve the performance of assistants and nurses during the study.

Pain has been known as one of the major universal health concerns about ill children, because of its morbidity and potential mortality. Pain suitable evaluation is a challenge in children because the verbalization is difficult. Low clinical information, few pediatric researches, and the worry of opioid side effects make difficult to provide satisfactory treatments. Many pharmacologic and non-pharmacologic strategies to manage pain exist for pediatric pain treatment. The purpose of this review article is to describe exhaustively pain mechanism, evaluation and management by review literature from January 2000 to January 2019 using PubMed, EMBASE, MEDLINE, LILACS databases. Pharmacological and integrative non-pharmacological therapies has been indicated in acute and chronic pain treatment. Opioids and opioid-sparing agents target nociceptive and neuropathic pain. With due attention to available results, an early combination of pharmacological and integrative non pharmacological treatments are indicated in children pain management.

Introduction: The prevalence of asymptomatic fever among children is high and may be confused with fever caused by corona. The purpose of this study is to investigate the characteristics of inflammatory factors and cardiac enzymes in children with Covid-19 hospitalized with the initial manifestation of fever without other symptoms., Methods: In this descriptive-analytical cross-sectional study, all 200 children with positive Covid-19 were hospitalized in Hazrat Ali-Asghar Hospital in Tehran between 2018 and 2019. For gathering data, clinical records and demographic information of patients were noted in the made-researcher's checklist and the collected data were analyzed using SPSS software version 24., Results: It was found that the relationship between the degrees of fever of the patients with the number of platelets was also inverse and significant. In addition, there was a significant relationship between the degree of fever of the patients and the LDH number, ALT number and segment and lymphocyte percentage of the patients. In addition, it was found that the passing time of fever has a significant relationship with ALT and ESR in such a way that with the passage of time, there is a higher probability of seeing an increase in ESR, but in the case of ALT, it increases in a shorter period of time and decreases more after the passage of time., Conclusion: According to the results of the present study, in case of suspected to Covid and fever in patients, along with other tests, AST, ALT, D-dimer, and CKMB can be used to diagnose Covid, in such a way that in Covid, AST is probably normal and mentioned other tests can be higher than normal., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Family Medicine and Primary Care.)