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Abstract Background The prevalence of type 2 diabetes mellitus (T2DM) in the population covered by the Tehran University of Medical Sciences is unclear but crucial for healthcare programs. This study aims to validate four non-laboratory risk-score models, the American Diabetes Association (ADA) Risk Score, Australian Type 2 Diabetes Risk Assessment Tool (AUSDRISK), Finnish Diabetes Risk Score (FINDRISC), and TOPICS Diabetes Screening Score, for identifying undiagnosed diabetes and indirectly estimate the prevalence of T2DM in a subset of the Tehranian population using the selected model. Methods This research consisted of two main parts. In the first part, non-laboratory risk-score models to identify undiagnosed T2DM were validated using Iranian data from STEPs 2016 survey. The model performance was evaluated through the Area Under the Curve (AUC) and calibration via the observed-to-expected (O/E) ratio. Additional independent data from STEPs 2011 survey in Iran were utilized to test the model results by comparing indirect prevalence estimates with observed estimates. In the second part, the prevalence of T2DM was estimated indirectly by applying the selected model to a representative random sample from a Tehranian population telephone survey conducted in 2023. Results Among the different models used, AUSDRISK showed the best performance in both discrimination (AUC (95% confidence interval (CI)): 0.80 (0.78, 0.81)) and calibration (O/E ratio = 1.01). After updating the original model, there was no change in the AUC value or calibration. Additionally, our findings indicate that the indirect estimates are nearly identical to the observed values in STEPs 2011 survey. In the second part of the study, by applying the recalibrated model to a subsample, the indirect prevalence of undiagnosed diabetes and T2DM (95% CI) were estimated at 4.18% (3.87, 4.49) and 11.1% (9.34, 13.1), respectively. Conclusion Given the strong performance of the model, it appears that indirect method can provide a cost-effective and simple approach to assess disease prevalence and intervention effectiveness. Graphical Abstract

Abstract Evaluating health system interventions for elderly care necessitates a context-specific, credible and dependable instrument. This research was dedicated to creating and validating a tool to assess the health system’s age-friendliness. The study unfolded in two pivotal stages: the generation of items utilizing a hybrid model and the psychometric appraisal of the tool, encompassing both validity and reliability assessments. From an initial pool of 522 items derived from a systematic scoping review and qualitative analysis, a concise assessment tool emerged, featuring 52 items across 6 domains: governance, information, resources, service delivery, community engagement and outcomes. The 52-item tool offers a straightforward, substantiated and robust means to gauge age-friendliness, pinpoint health system deficiencies and facilitate strategic planning on the basis of its insights.

Abstract Introduction Asymmetric dimethylarginine (ADMA), a cardiovascular risk factor, increases in renal failure. The aim of this study was to investigate ADMA levels in normal weight and obese patients on hemodialysis. Methods In this cross-sectional study, 43 normal weight and 43 obese patients on regular hemodialysis were examined. Malnutrition-inflammation score (MIS), anthropometry, circulating ADMA, lipid profiles including triglycerides (TG), total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL) and lipid ratios, glucose homeostasis parameters, blood pressure, and high-sensitivity C-reactive protein (hs-CRP) were assessed. Results Serum levels of ADMA were significantly lower in the obese compared to the normal weight patients (10268.2 ± 10092.4 vs. 13765.2 ± 9951.3 ng/l, P = 0.03). At the same time MIS score (6.1 ± 2.4 vs. 10.7 ± 3.2, P

Abstract Background Extensive evidence has suggested the cardio-protective properties of the polyphenol curcumin. The aim of this study was to investigate the effects of a highly bioavailable curcumin supplement on cardiometabolic risk factors, health-related quality of life, and depression in patients with coronary slow flow phenomenon (CSFP). Methods This randomized double-blind placebo-controlled clinical trial was conducted in 42 patients with CSFP (age 35–70 years, 25 ≤ body mass index

Abstract The Persian Eye Cohort Study, a population-based cross-sectional study from 2015 to 2020, examined refractive error prevalence among 48,618 Iranian adults aged 31 to 70. The study encompassed six centers in Iran, employing random cluster sampling for demographic, medical, and socioeconomic data collection through interviews. Ophthalmic exams included visual acuity, automated and manual objective refraction, subjective refraction, slit lamp, and fundus examinations. Using the spherical equivalent definition, the sample population was categorized into groups. Results indicated a mean age of 49.52 ± 9.31 and a mean refractive error of 0.26 diopters (D) ± 1.6 SD (95% CI − 0.27 to -0.24), ranging from -26.1 to + 18.5 SD. Prevalence of myopia ( + 0.5D) was 22.6% (95% CI 22.2–23%) and 12.5% (95% CI 12.1–12.8%), respectively. Regarding different age groups, the prevalence of hyperopia and astigmatism exhibited a steady and significant rise with increasing age (p-value 1D) was prevalent in 25.5% of participants (95% CI 25.1–25.9%) and correlated with male gender, aging, urban residency, illiteracy, and higher income (p-value

Abstract This study aimed to investigate the effect of orbital wall decompression surgery and reduction of proptosis on the choroidal vascularity index (CVI) and subfoveal choroidal thickness (SFCT) in patients with thyroid eye disease (TED). Fifty-one eyes from 38 patients with controlled TED and proptosis were enrolled in this study. The majority of the patients (50.9%) had a clinical activity score (CAS) of zero, and none had a CAS greater than 2. The patients underwent a complete baseline ophthalmologic examination, and their choroidal profile alterations were monitored using enhanced depth imaging optical coherence tomography (EDI-OCT) before and during the three months after surgery. Changes in SFCT, luminance area (LA), total choroidal area (TCA), and the choroidal vascularity index (CVI) were measured as the ratio of LA to TCA in EDI-OCT images. The participants had an average age of 46.47 years, and 22 were female (57.9%). The SFCT of the patients exhibited a significant reduction over the follow-up period, decreasing from 388 ± 103 to 355 ± 95 µm in the first month (p

BackgroundEarly intervention in mammography use prevents breast cancer-related deaths. Therefore, this study aimed to apply health education interventions to mammography use in reproductive-aged women.MethodsThis was a sequential exploratory design using qualitative and quantitative methods. The qualitative part used to gain insights into the design and development of interventions. For the randomized trial, a sample of 405 participants was recruited in each arm. The mean difference of interventions on the study variables was determined using a general linear model for repeated measures (ANOVA). For dichotomous variables, nonparametric tests (Cochran Q) were used. Path analysis was used to observe how the constructs of the Health Belief Model interacted. We registered PACTR database (https://pactr.samrc.ac.za/): “PACTR201802002902886.”ResultsThe study found that there was a strong interplay between perceptions of mammography screening and the intervention, showing that the likelihood of mammography use and comprehensive knowledge increased from baseline to endpoint (p

Abstract Formaldehyde, a known carcinogenic compound, is commonly used in various medical settings. The objective of this study was to assess the carcinogenic and non-carcinogenic risks associated with occupational exposure to formaldehyde. This study was conducted in the pathology labs of four hospitals in Tehran. Cancer and non-cancer risks were evaluated using the quantitative risk assessment method proposed by the United States environmental protection agency (USEPA), along with its provided database known as the integrated risk information system (IRIS). Respiratory symptoms were assessed using the American thoracic society (ATS) questionnaire. The results indicated that 91.23% of exposure levels in occupational groups exceed the NIOSH standard of 0.016 ppm. Regarding carcinogenic risk, 41.03% of all the studied subjects were in the definite carcinogenic risk range (LCR > 10−4), 23.08% were in the possible carcinogenic risk range (10−5 1.0). Overall, the findings revealed significantly higher carcinogenic and non-carcinogenic risks among lab technicians and pathologists. Therefore, it is imperative to implement control measures across various hospital departments to mitigate occupational formaldehyde exposure levels proactively. These findings can be valuable for policymakers in the health sector, aiding in the elimination or reduction of airborne formaldehyde exposure in work environments.

Abstract Background Cardiovascular events and poor quality of life are frequently observed in patients with coronary slow flow phenomenon (CSFP). This trial evaluated the effect of nano-curcumin supplement containing curcuminoids, as multifunctional nutraceuticals, on angina status, and some traditional and novel cardiovascular risk factors in overweight or obese patients with CSFP. Methods In this double-blind, randomized, placebo-controlled clinical trial, 42 overweight or obese patients with CSFP received either 80 mg/day of nano-curcumin or placebo for 12 weeks. Seattle angina questionnaire (SAQ) as a clinical measure of angina status, circulating endocan, adropin, homocysteine, lipid profile, and the novel scores of visceral adiposity index (VAI) and waist-triglyceride index (WTI) were assessed before and after the intervention. The independent samples t-test, Mann-Whitney test, analysis of covariance, Chi-square, and Fisher’s exact tests were used where appropriate. Results All domains of SAQ including physical limitation, angina stability, angina frequency-severity, treatment satisfaction, and disease perception and quality of life improved significantly in the nano-curcumin compared with the placebo group. No significant changes were observed in serum endocan, adropin, and homocysteine following the intervention. Triglycerides, triglyceride/high-density lipoprotein cholesterol ratio, WTI and VAI values improved significantly only within the nano-curcumin group. Conclusions Supplementation with 80 mg/day nano-curcumin (containing curcuminoids) for 12 weeks significantly improved clinically important disease-specific aspects of health in patients with CSFP. Some traditional and novel cardiovascular risk factors improved significantly only compared with the baseline values, which need further investigation. Trial registration This study was approved by the Ethics Committee of Tehran University of Medical Sciences (IR.TUMS.VCR.REC.1398.794). The study protocol was registered at Iranian Registry of Clinical Trials by IRCT20131125015536N8 registration ID at 19.06.2019.

Background: Ecological conditions can change infection routes and increase the risks of outbreaks. The aim of this study is risk assessment of foodborne disease outbreaks based on dispersed regional climatic and demographic variables in Yazd Province, Iran. Methods: In this cross-sectional study, data of temporal climatic parameters and regional demographic factors linked to bacterial foodborne diseases were addressed. A multi-level regression analysis model was used to detect associations between the risk of outbreaks and ecological risk factors; the relationships were verified using (P

Abstract Purpose: To evaluate the short-term additive effects of topical ketorolac to intravitreal bevacizumab (IVB) in the management of center-involved diabetic macular edema (CI-DME). Methods: In a randomized double-masked placebo-controlled crossover clinical trial, eyes with CI-DME and the best-corrected visual acuity (BCVA) between (20/40) and (20/400) were included. These eyes should have had at least one intravitreal anti-VEGF injection in the preceding two months. They were randomized into two groups; while both groups received two IVB injections with a six-week interval, one group received topical ketorolac every 6 hr in the first interval and artificial tears every 6 hr as a placebo in the second interval and the other group received the same medications using a crossover method. The main outcome measures were changes in BCVA and central macular thickness (CMT). Results: Fifty-seven eyes of 35 patients with CI-DME were included in the study. The mean BCVA improvement was –0.09 ± 0.47 logMAR in the periods of receiving ketorolac and –0.03 ± 0.12 logMAR in the periods of placebo treatment, respectively (P = 0.99). Corresponding changes in CMT were –13.1 ± 170.1 and +11.7 ± 157.7 µm in the ketorolac and placebo periods, respectively (P = 0.322). The treatment effect was not statistically significant regarding both BCVA and CMT changes. Statistical analysis also disclosed that the carryover effect was insignificant for BCVA and CMT. Although the period effect was not significant for BCVA, it was at a meaningful level for CMT changes (P = 0.012). Conclusion: This crossover clinical trial demonstrated that in the course of DME treatment with IVB injections, topical ketorolac did not have any additive beneficial effect at least during a six-week period.

Abstract Background To assess the characteristics and outcomes of uveal melanoma management at a tertiary center in the Middle East. Methods A study on 164 patients with uveal melanoma was conducted by reviewing the available medical records, ultrasound, and pathology report results. Age at diagnosis, tumor location and size, treatment mode, visual outcome, metastasis, mortality, and survival were studied. Results The mean age of patients was 52.0 ± 15.0 years, and 52.5% were male. Choroidal melanoma was the most common uveal melanoma, followed by the ciliary body and iris melanoma. The mean thickness of tumors was 8.29 ± 3.29. The majority of patients (n = 111, 67.9%) were managed by brachytherapy with ruthenium-106 plaques. Enucleation was performed primarily in 46 (28%) patients and secondarily in nine (5.5%) patients. The sexual disparity was detected as the proximity of uveal melanoma to the fovea in males. For a 61-month mean follow-up period, mortality occurred in eight of our cases, six of which were due to metastasis. The most common site for distance metastasis was the liver (5/6), followed by the lung (1/6). The five-year and eight-year overall survival (OS) rate was 0.947%± 0.019. The 5-year survival rate reached zero in metastatic patients. OS was not statistically different depending on the age, tumor diameters, the primary treatment received, or the histopathologic findings (p > 0.50 for all). Conclusion In this study, individuals diagnosed with UM exhibited an OS rate of around 94% at the five-year mark, which remained consistent up to eight years. Notably, the presence of distance metastasis emerged as the sole statistically significant factor influencing overall survival.

Abstract Background During a COVID-19 pandemic, it is imperative to investigate the outcomes of all non-COVID-19 diseases. This study determines hospital admissions and mortality rates related to non-COVID-19 diseases during the COVID-19 pandemic among 41 million Iranians. Method This nationwide retrospective study used data from the Iran Health Insurance Organization. From September 23, 2019, to Feb 19, 2022, there were four study periods: pre-pandemic (Sept 23-Feb 19, 2020), first peak (Mar 20-Apr 19, 2020), first year (Feb 20, 2020-Feb 18, 2021), and the second year (Feb 19, 2021-Feb 19, 2022) following the pandemic. Cause-specific hospital admission and in-hospital mortality are the main outcomes analyzed based on age and sex. Negative binomial regression was used to estimate the monthly adjusted Incidence Rate Ratio (IRR) to compare hospital admission rates in aggregated data. A logistic regression was used to estimate the monthly adjusted in-hospital mortality Odds Ratio (OR) for different pandemic periods. Results During the study there were 6,522,114 non-COVID-19 hospital admissions and 139,679 deaths. Prior to the COVID-19 outbreak, the standardized hospital admission rate per million person-month was 7115.19, which decreased to 2856.35 during the first peak (IRR 0.40, [0.25–0.64]). In-hospital mortality also increased from 20.20 to 31.99 (OR 2.05, [1.97–2.13]). All age and sex groups had decreased admission rates, except for females at productive ages. Two years after the COVID-19 outbreak, the non-COVID-19 hospital admission rate (IRR 1.25, [1.13–1.40]) and mortality rate (OR 1.05, [1.04–1.07]) increased compared to the rates before the pandemic. The respiratory disease admission rate decreased in the first (IRR 0.23, [0.17–0.31]) and second years (IRR 0.35, [0.26–0.47] compared to the rate before the pandemic. There was a significant reduction in hospitalizations for pneumonia (IRR 0.30, [0.21–0.42]), influenza (IRR 0.04, [0.03–0.06]) and COPD (IRR 0.39, [0.23–0.65]) during the second year. There was a significant and continuous rise in the hematological admission rate during the study, reaching 186.99 per million person-month in the second year, reflecting an IRR of 2.84 [2.42–3.33] compared to the pre-pandemic period. The mortality rates of mental disorders (OR 2.15, [1.65–2.78]) and musculoskeletal (OR 1.48, [1.20–1.82), nervous system (OR 1.42, [1.26–1.60]), metabolic (OR 1.99, [1.80–2.19]) and circulatory diseases (OR 1.35, [1.31–1.39]) increased in the second year compare to pre-pandemic. Myocardial infarction (OR 1.33, [1.19–1.49]), heart failure (OR 1.59, [1.35–1.87]) and stroke (OR 1.35, [1.24–1.47]) showed an increase in mortality rates without changes in hospitalization. Conclusions In the era of COVID-19, the changes seem to have had a long-term effect on non-COVID-19 diseases. Countries should prepare for similar crises in the future to ensure medical services are not suspended.

Objectives The impact of population aging on health expenditure is inevitable. It affects health expenditure by causing changes in people’s health status and the demand for health care services. In this study, we aim to investigate the age-related and gender-related differences in hospital admission rate, length of stay, and hospital costs of people in Iran. Methods & Materials This is a quantitative, descriptive-analytical study with a cross-sectional design conducted on data of 41 million Iranian people covered by the Iran Health Insurance Organization in 2020. Hospital admission rate, length of stay, and hospital costs were dependent variables. Hospital costs included insurance payments, patients’ out-of-pocket spending, and government subsidies. Age and sex of the patients, ownership of the hospital, type of patients’ medical files were descriptive variables. The Mann-Whitney U test was used to compare hospital costs between elderly (>60 years of age) and non-elderly (

Abstract Background During the COVID-19 pandemic, many non-COVID-19 emergency department (ED) visits were indirectly affected. ED visits and mortality were assessed during different pandemic time periods compared with pre-pandemic. Methods The study used data from 41 million Iran Health Insurance Organization members. The outcomes were non-COVID-19 ED visits and associated mortality in 956 hospitals. An analysis of ED visits was conducted both for all-cause and cause-specific conditions: cardiovascular diseases (CVD), mental and substance use disorders, unintentional injuries, and self-harm. In addition, total in-hospital ED mortality was analyzed. A negative binomial regression and a Poisson regression with a log link were used to estimate the incidence rate ratio (IRR) of visits and mortality relative risk (RR). Results 1,789,831 ED visits and 12,377 deaths were reported during the study. Pre-pandemic (Sep 2019 to Feb 2020), there were 2,767 non-COVID-19 visits rate per million person-month, which decreased to 1,884 during the first COVID-19 wave with a national lockdown from Feb 20 to Apr 19, 2020 (IRR 0.68, [0.56–0.84]). The non-COVID-19 ED mortality risk was 8.17 per 1,000 visit-month during the pre-pandemic period, rising to 12.80 during the first wave of COVID-19 (RR 1.57, [1.49–165]). Non-COVID-19 ED visit rates decreased during the first pandemic year from Sep 2020 to Feb 2021 (IRR 0.73, [0.63–0.86]), but increased after COVID-19 vaccination two years later from Sep 2021 to Feb 2022 (IRR 1.11, [0.96–0.17]). The total ED mortality risk for non-COVID-19 was significantly higher after the COVID-19 outbreak in the first (RR 1.66, [1.59–1.72]) and second years (RR 1.27, [1.22–1.32]) of the pandemic. The visit incidence rate for mental health and substance use disorders declined from 8.18 per million person-month to 4.57 (IRR 0.53, [0.32 to 0.90]) in the first wave. In the second year, unintentional injury visits increased significantly compared with pre-pandemic (IRR 1.63, [1.30–2.03]). As compared to before the pandemic, there was no significant change in CVD and self-harm visit rates during the pandemic. Cardiac arrest was the leading cause of death in Iran hospitals’ EDs. Conclusion In the first year of the COVID-19 pandemic, non-COVID-19 hospital ED visits declined and mortality risk increased. Despite two years since the COVID-19 outbreak, non-COVID-19 ED mortality risk remains high.

Abstract Background To determine the effect of ketorolac tromethamine 0.5% in preventing post-phacoemulsification macular thickening. This randomized clinical trial. patients randomized 1:1 to receive either topical ketorolac three times a day or a placebo. Methods A total of 101 eyes of 101 diabetic patients who were scheduled for phacoemulsification and had normal macular contour and thickness enrolled consecutively. The topical ketorolac and placebo were prescribed on the day before surgery and continued up to 4 weeks after surgery. Patients with proliferative diabetic retinopathy, a history of intravitreal injection in less than three months, a history of macular photocoagulation in less than 6 months, and any other concomitant ocular pathologies were excluded. Central macular thickness (CMT) and best corrected visual acuity (BCVA) was recorded in the follow-ups of 6, 12, and 24 weeks after the surgery and compared with the controls. Results 49 eyes in the case group and 52 eyes in the control group were analyzed. Mean BCVA was significantly improved in both groups at all follow-ups (P 0.05 for all). Conclusion Based on our findings, topical ketorolac tromethamine 0.5% is not effective in the prevention of post-phacoemulsification macular thickening in diabetic patients. Trail registration The study protocol was registered into www.clinicaltrial.gov with the RCT registration number NCT03551808. (2018/06/11 ) Clinical trial registration number NCT03551808.

Abstract Background Hypertension (HTN) and diabetes mellitus (DM) as part of non-communicable diseases are among the most common causes of death worldwide, especially in the WHO’s Eastern Mediterranean Region (EMR). The family physician program (FPP) proposed by WHO is a health strategy to provide primary health care and improve the community’s awareness of non-communicable diseases. Since there was no clear focus on the causal effect of FPP on the prevalence, screening, and awareness of HTN and DM, the primary objective of this study is to determine the causal effect of FPP on these factors in Iran, which is an EMR country. Methods We conducted a repeated cross-sectional design based on two independent surveys of 42,776 adult participants in 2011 and 2016, of which 2301 individuals were selected from two regions where the family physician program was implemented (FPP) and where it wasn't (non-FPP). We used an Inverse Probability Weighting difference-in-differences and Targeted Maximum Likelihood Estimation analysis to estimate the average treatment effects on treated (ATT) using R version 4.1.1. Results The FPP implementation increased the screening (ATT = 36%, 95% CI: (27%, 45%), P-value

Introduction: Determining socio-economic status (SES) can greatly help decision makers in the field of social health. Because SES can play an important role in accessing medical services or welfare amenities. We aimed to determine SES using Principal Component Analysis (PCA), Multiple Correspondence Analysis (MCA) and Factor Analysis of Mixed Data (FAMD) methods. Methods & Materials: In this cross-sectional study (2023), 4448 employees aged 19 to 75 years were included to the study from Tehran University of Medical Sciences employees` cohort (TEC). Demographic variables and socio-economic factors were considered. Considering the weaknesses of PCA and MCA methods, we calculated the SES score using PCA, MCA and FAMD methods, and the percentile of people was determined. These weaknesses include normality assumption and considering only linear relationship for PCA, inability to interpret the relationships between variables and considering each level of classification variables as a new variable for MCA Results: We studied 4448 people (39.3% men) with a mean age of 42.3 and a standard deviation of 8.7. The correlation between the percentiles obtained through PCA, MCA and FAMD methods was very high, and the highest correlation was related to the percentiles obtained through PCA and FAMD methods with a value of 0.994. The intraclass correlation coefficient value was 0.996. Also, this value was 0.996 and 0.994 in the random samples of 250 and 100 individuals from the original data, respectively. Conclusion: All of the three methods worked similarly on determining the SES and calculating the percentile of people. PCA and FAMD methods had better agreement than others. Therefore, in studies that have both quantitative and qualitative variables, the choice of analysis method depends on the opinion of the researcher. Keywords: Socio-economic status, Principal Component Analysis, Multiple Correspondence Analysis, Factor Analysis of Mixed Data, cohort study

Abstract Background Immigration is considered as a risk factor of tuberculosis (TB). Qom province receives millions of pilgrims and significant numbers of immigrants each year. Most of the immigrants to Qom, arrive from neighboring TB-endemic countries. This study aimed to identify the current circulating Mycobacterium tuberculosis genotypes in Qom province using 24-locus MIRU-VNTR genotyping. Methods Eighty six M. tuberculosis isolates were collected during 2018–2022 from patients referring to Qom TB reference laboratory. The DNA of isolates was extracted and followed by 24 loci MIRU-VNTR genotyping which performed using the web tools available on MIRU-VNTRplus. Results Of 86 isolates, 39 (45.3%) were of Delhi/CAS genotype, 24 (27.9%) of NEW-1, 6 (7%) of LAM, 6 (7%) of Beijing, 2 (2.3%) of UgandaII, 2 (2.3%) of EAI, 1 of S (1.2%) and 6 (7%) did not match with profiles present in MIRUVNTRplus database. Conclusions About half of the isolates belong to Afghan immigrants; which warns health policy makers about the future situation of TB in Qom. Also, the similarity of Afghan and Iranian genotypes provides evidence that immigrants partake in the circulation of M. tuberculosis. This study underpin the studies about the circulating M. tuberculosis genotypes, their geographical distribution, the association of TB risk factors with these genotypes and the impact of immigration on the situation of TB in Qom province.

Abstract Purpose To evaluate the choroidal structure in patients with inherited retinal diseases (IRDs) by investigating the choroidal vascularity index (CVI). Methods The present study was conducted on 113 IRD patients and 113 sex- and age-matched healthy individuals. Patients’ data was extracted from the Iranian National Registry for IRDs (IRDReg®). Total choroidal area (TCA) was determined between retinal pigment epithelium and choroid-scleral junction,1500 microns on either side of the fovea. Luminal area (LA) was considered as the black area corresponding to the choroidal vascular spaces, following Niblack binarization. CVI was calculated as the ratio of the LA to the TCA. CVI and other parameters were compared among different types of IRD and the control group. Results The IRD diagnosis included retinitis pigmentosa (n = 69), cone-rod dystrophy (n = 15), Usher syndrome (n = 15), Leber congenital amaurosis (n = 9), and Stargardt disease (n = 5). Sixty-one (54.0%) individuals of each of the study and control groups were male. The average CVI was 0.65 ± 0.06 in the IRD patients and 0.70 ± 0.06 in the control group (P

Introduction: Ignoring outliers in data may lead to misleading results. Length of stay (LOS) is often considered a count variable with a high frequency of outliers. This study exemplifies the potential of robust methodologies in enhancing the accuracy and reliability of analyses conducted on skewed and outlier-prone count data of LOS. Methods: The application of Zero-Inflated Poisson (ZIP) and robust Zero-Inflated Poisson (RZIP) models in solving challenges posed by outlier LOS data were evaluated. The ZIP model incorporates two components, tackling excess zeros with a zero-inflation component and modeling positive counts with a Poisson component. The RZIP model introduces the Robust Expectation-Solution (RES) algorithm to enhance parameter estimation and address the impact of outliers on the model's performance. Results: Data from 254 intensive care unit patients were analyzed (62.2% male). Patients aged 65 or older accounted for 58.3% of the sample. Notably, 38.6% of patients exhibited zero LOS. The overall mean LOS was 5.89 (± 9.81) days, and 9.45% of cases displayed outliers. Our analysis using the RZIP model revealed significant predictors of LOS, including age, underlying comorbidities (p

Background: Larvicidal agents can be produced using microbial resources, which are environmentally friendly, biode­gradable, and economical. The study's goal was to evaluate the larvicidal activity of metabolites isolated from Nocardia (N. fluminea, N. soli and N. pseudobrasiliensis) and Streptomyces (S. alboflavus) bacterial species against Anopheles stephensi. Methods: Four metabolites isolated from Nocardia and Streptomyces strains were exanimated for larvicidal activity. The experiments were performed for 24, 48, and 72 hours. 300, 350, 400, 450, 500, 550, and 600 µl of Actinobacteria metabolites were added to 100 cc of dechlorinated water. Fourth-stage larvae were placed in dechlorinated water as a control. LC50 and LC90 were calculated using toxicity data and analyzed. Results: All metabolites had a statistically significant influence on mosquito larvae (P< 0.05). At 24, 48, and 72 hours, the LC50 for N2 (N. fluminea) was 417, 386, and 370 ppm, respectively, and the LC90 was 650, 595, and 561 ppm. Moreover, LC50 for N4 (N. soli) was 389, 376, and 347 and LC90 were 591, 565, and 533 and LC50 for N5 (N. pseudo­brasiliensis) was 390, 357, and 341 ppm and LC90 were 589, 532 ppm. In addition, LC50 for S921 (S. alboflavus) was 484, 416, and 382 ppm, and LC90 was 701, 612, and 574 ppm. Conclusion: The four bacterial metabolites tested in our study were found to have a notable effect on the mortality rate of Anopheles stephensi larvae, indicating their potential as natural larvicides. This is an effective technique for control­ling Anopheles stephensi that has no detrimental environmental impact.

Abstract Purpose: To estimate the level of job satisfaction among ophthalmologists in Iran and determine the associated factors that may impact their overall job satisfaction. Methods: In this cross-sectional study, 181 ophthalmologists (79.0% male) were interviewed by the Warr-Cook-Wall questionnaire with 7-point-Likert scale, which transformed responses from a 0 (most dissatisfied) to 100 (most satisfied). Questionnaires were randomly distributed among registered ophthalmologists at the 29 t h Annual Congress of the Iranian Society of Ophthalmology in November 2019. Satisfaction under each scale was considered as a score of > 60% of the total score. Results: A total of 181 ophthalmologists with a mean age of 47.8 ± 12.1 years and 16 ± 12 years of practice participated in the present study. They were mostly satisfied with their job as a whole (88.1%, mean score: 60.6 ± 20.7) and dissatisfied with their income (55.9%, mean score: 47.6 ± 20.3). High levels of job satisfaction was found among ophthalmologists with longer duration of practice (P < 0.001) while lower levels of satisfaction were identified among those who worked in academic centers (P = 0.004). Conclusion: In this study,high levels of job satisfaction were found among ophthalmologists with longer duration of practice while low levels of satisfaction were identified among ophthalmologists who worked in academic centers. The factors of salary and working hours accounted for the least levels of job satisfaction.

Objectives: Poor menstrual health may lead to school absenteeism and adverse health outcomes for adolescents. The purpose of this study was to determine the effect of pubertal and menstrual health education on health and preventive behaviors among Iranian secondary school girls. Methods: A quasi-experimental study was conducted to evaluate the effectiveness of a health intervention program. A total of 578 students (including intervention and control participants) in 12 schools in Tehran Province, Iran were included by multistage random sampling. The program comprised seven 2-hour educational sessions. After confirming the reliability and validity of a researcher-made questionnaire, that questionnaire was used to collect the required data, and the groups were followed up with after 6 months. Results: After the educational intervention, the mean scores of menstrual health-related knowledge and constructs of the theory of planned behavior were significantly higher in the intervention group than in the control group (p

Abstract Objectives Priority setting in health directly impacts the general public as payers and final consumers, so the public preferences must be considered. The present study aimed to provide public preferences about health intervention allocation criteria for the optimal allocation of public health budget in Iran. Methods A choice-based survey method was used to assess the general public’s preferences regarding 8 critical criteria with a societal aspect. One thousand sixty-four adult citizens of Tehran, Iran, participated in the study. Participants were asked to allocate a hypothetical budget between the two groups with differences in allocation criteria. Public preferences were inferred from absolute majority responses i.e., more than 50% of participants’ allocation for a criterion. The Logistic Regression Model was used to investigate the factors affecting the preferences regarding the importance of allocation criteria. Results Based on expressed participants’ preferences, criteria of disease severity, age, daily care needs, Number of alternative interventions, individual’s economic status, and diseases with absence from work were important. Thus, 77, 69, 61, 57, 54, and 51% of participants preferred to allocate the hypothetical budget to the treatment of patients with poor economic status, treatment of patients with diseases leading to absence from work, treating patients with severe diseases, treatment of diseases in need of daily care and treatment of children’s diseases, respectively. Findings from the factors affecting participants’ preferences regarding allocation criteria also showed that people with different characteristics had different preferences. Conclusions Iranian general public pays special attention to the criteria of equitable allocation, including patients’ economic status, criteria with societal aspects such as absenteeism from work and the need for daily care, as well as criteria with medical aspects such as disease severity and access to alternative interventions which may sometimes be less considered in decision making.

Introduction: Universal health coverage is a critical goal for low- and middle-income countries, with equitable access to healthcare services being essential to achieving this objective. With the elderly population requiring greater healthcare services, it is crucial to plan for their healthcare needs. This study aims to evaluate the determinants of out-of-pocket payment (OOP) and catastrophic healthcare expenditure among households with elderly individuals in Iran. Methods: This study analyzed the 2018 Household Income-Expenditure Survey in Iran to examine the socio-economic factors affecting OOP (per purchasing power parity International Doller – PPP. Int $) and catastrophic healthcare expenditure in households with elderly members. Using survey probit regression model with Heckman selection, the study identified determinants of OOP and catastrophic healthcare expenditures. A survey probit regression model with Heckman selection has been applied to identify the determinants of out-of-pocket (OOP) and catastrophic healthcare expenditures. The approach allowed for the examination of variables that may have impacted the likelihood of incurring OOP and catastrophic healthcare expenditures, while accounting for potential selection bias. Results: Rural households (with difference 60.78 PPP. Int$) and non-owning homes (with difference 98.83 PPP.Int$) had higher OOP than their urban and owning counterparts, respectively. Larger households also had higher OOP, with those with five or more members having the highest. High-income households also had higher OOP. Additionally, smaller households had a lower chance of facing catastrophic healthcare expenses. Lastly, the Mills ratio was negative. Conclusion: Our study reveals insufficient observed out-of-pocket (OOP) payments for healthcare in Iran to cover the "needed" OOP, indicating a possible financial burden on households. This highlights the need to address inequalities in healthcare access and expenditure for households with elderly individuals, particularly in rural areas and larger households. Policymakers should implement targeted interventions to reduce OOP for these vulnerable groups. Future research should include socio-economic factors that affect access to healthcare services

Introduction: Quantile regression is a valuable alternative for survival data analysis, enabling flexible evaluations of covariate effects on survival outcomes with intuitive interpretations. It offers practical computation and reliability. However, challenges arise when applying quantile regression to censored data, particularly for upper quantiles. The minimum distance approach, utilizing dual-kernel estimation and the inverse cumulative distribution function, shows promise in addressing these challenges, especially with Methods: This study contrasts two methods within the realm of quantile linear regression for survival analysis: check-based modeling and the minimum distance approach. Effectiveness is assessed across various scenarios through comprehensive simulation. Results: The simulation results showed that using the quantile regression model with the minimum distance approach reduces the percentage of root mean square error in parameter estimation compared to the quantile regression models based on the check loss function. Additionally, a larger sample size and reduced censoring percentage led to decreased root mean square error in parameter estimation. Conclusion: The research highlights the benefits of using the minimum distance approach for quantile regression. It reduces errors, improves model predictions, captures patterns, and optimizes parameters even with complete data. However, this approach has limitations. The accuracy of estimated quantiles can be influenced by the choice of distance metric and weighting scheme. The assumption of independence between censoring mechanism and survival time may not hold in real-world scenarios. Additionally, dealing with large datasets can be computationally complex.

Abstract Background The preoperative period is a good time to improve nutrition status, compensate for nutrient deficiencies, and optimize immune function in patients’ underlying surgery. In some medical conditions, supplementation with a combination of l-glutamine (Gln), β-hydroxy-β-methylbutyrate (HMB), and l-arginine (Arg) had promising effects on improving recovery. The present study aimed to evaluate the effect of supplementation with Gln/Arg/HMB in patients undergoing heart surgery. Methods This randomized clinical trial was conducted on 70 patients undergoing cardiac surgery. Participants were requested to consume 2 sachets of a combination of 7 g l-arginine, 7 g l-glutamine, and 1.5 g daily HMB or placebo 30 days before operation. At the baseline and end of the study, left ventricular ejection fraction and the serum levels of troponin, creatine phosphokinase (CPK), CPK-MB, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and bilirubin were measured. Also, the Sequential Organ Failure Assessment (SOFA) score, time of stay in hospital and intensive care unit (ICU), and postoperative complications were recorded after surgery. Results In total, 60 preoperative patients (30 in each group) with a mean age of 53.13 ± 14.35 years completed the study (attrition rate = 85.7%). Subjects in the Gln/Arg/HMB group had lower serum levels of CPK-MB (median [IQR] = 49 [39.75] vs. 83 [64.55]; P = 0.011), troponin (median [IQR] = 2.13 [1.89] vs. 4.34 [1.99]; P < 0.001), bilirubin (median [IQR] = 0.50 [0.20] vs. 0.40 [0.22]; P < 0.001), and SOFA score (median [IQR] = 2 [2] vs. 5 [2]; P < 0.001) at end of the study compared to the placebo. Also, the time of stay in the hospital (median [IQR] = 5 [1] vs. 6 [3]; P < 0.001) and ICU (median [IQR] = 2.50 [1.00] vs. 3.50 [1.50]; P = 0.002) was lower in the Gln/Arg/HMB group. Conclusion The present study showed that perioperative supplementation with a combination of Gln, Arg, and HMB enhances the recovery, reduces myocardial injury, and decreases the time of hospital and ICU stay in cardiac surgery patients. These results need to be confirmed in a larger trial. Trial registration IRCT.ir IRCT20120913010826N31. Registered on 13 October 2020.

Abstract Background Inadequate health and nutritional literacy is a common problem among adults, associated with poor health outcomes. Therefore, this study aimed to investigate the relationship between health literacy and nutritional literacy to sun exposure behaviour. Methods We conducted a cross-sectional study on 261 adults (18–65 years) in Iran. Data was collected on knowledge, motivation, health literacy, nutritional literacy, and sun exposure behaviour using an interview-assisted questionnaire. Using the information–motivation–behavioural skills model and structural equation modeling, we tested whether health and nutritional literacy were associated with the relationships between knowledge of vitamin D, attitudes toward sun exposure, and sun exposure behaviour. Different models using structural equation modeling were performed to analyze the data. Results The finding showed that health literacy (β = 0.29, p

Background The prognostic factors of survival can be accurately identified using data from different health centers, but the structure of multi-center data is heterogeneous due to the treatment of patients in different centers or similar reasons. In survival analysis, the shared frailty model is a common way to analyze multi-center data that assumes all covariates have homogenous effects. We used a censored quantile regression model for clustered survival data to study the impact of prognostic factors on survival time. Methods This multi-center historical cohort study included 1785 participants with breast cancer from four different medical centers. A censored quantile regression model with a gamma distribution for the frailty term was used, and p -value less than 0.05 considered significant. Results The 10 th and 50 th percentiles (95% confidence interval) of survival time were 26.22 (23–28.77) and 235.07 (130–236.55) months, respectively. The effect of metastasis on the 10 th and 50 th percentiles of survival time was 20.67 and 69.73 months, respectively (all p -value

Background & Objective: The emergence of antibiotic-resistant bacteria and limited treatment options for these infections is a challenging problem in the world. There is increasing interest in isolating bioactive molecules from actinobacteria and elucidating their antimicrobial mechanisms at the moment. The current study aimed to investigate the antimicrobial activities of a Nocardia strain (N4) that was previously isolated from the soil samples in Tehran, Iran. Materials & Methods: The cultural, morphological, and physiological characteristics of the strain were determined and the identity of the strain was confirmed using 16SrRNA gene sequencing. The strain was screened for antimicrobial metabolite production. The in vitro anti-microbial activity of the extracted metabolite was assessed by agar well diffusion and minimum inhibitory concentrations methods. Finally, the structure of the extracted metabolite was confirmed by HPLC and mass spectrometry methods. Results: The isolate shared 99% sequence similarity with Nocardia soli. The strain showed broad-spectrum antimicrobial activities against some pathogenic bacteria (Escherichia coli ATCC 25922, Pseudomonas aeruginosa ATCC 27853, Klebsiella pneumoniae ATCC 700603, Salmonella Typhimurium ATCC 14028 and Shigella sonnei RI366) and fungi (Aspergillus niger ATCC 1015 and Aspergillus fumigatus ATCC 1022) in the agar well diffusion method. The ethyl acetate extract of the strain exhibited the highest antimicrobial activity against E. coli (MIC= 4.67±3.055 μg/mL) and K. pneumoniae (MIC=3.33±1.155 μg/mL). The metabolite showed high similarity with C21H28N7O14. Conclusions: The current study confirmed the presence of a bioactive metabolite in strain N4, suggesting that this may be a promising candidate for discovering bioactive components with broad antibacterial activities against a variety of pathogens Keywords:

Abstract Background It is well documented that, similar to active smokers, passive smokers are also at an increased risk of developing non-communicable diseases, and it could impose high financial costs on the healthcare system. This study aimed to evaluate the trend of passive smoking and related determinants during the three phases of a school-based surveillance program. Methods This is a secondary study using the national data obtained from three phases of the surveillance program entitled The Childhood and Adolescence Surveillance and Prevention of Adult Noncommunicable Disease (CASPIAN) study, conducted from 2008 to 2014 on Iranian children and adolescents living in urban and rural areas of 30 provinces in Iran. Participants were selected by cluster multistage sampling method. Results Overall, the study participants consisted of 33,288 students (50.5% boys) with a mean (± SD) age of 12.8 ± 3.2 years. The passive smoking rate was significantly increased from 35.6% in 2008 to 43.2% in 2015 among children and adolescents. According to the multivariate logistic regression, father’s university education, mother’s employment, life satisfaction, and socioeconomic status had a protective role regarding second-hand smoke exposure. In contrast, the father’s self-employment had a positive role in increasing the rate of passive smoking. Conclusion Considering the increasing trend of passive smoking and its considerable adverse health effects, it is necessary to implement large-scale public interventions to reduce the rate and hazards of exposure to tobacco smoke.

Introduction: Prevention of heat-related diseases requires the participation of the workers. For this reason, the aim of this study was the development and validation of the tools for evaluating awareness and practice related to heat stress among the workers of warm workplaces. Material and Methods: The various items and factors related to the awareness and practice of the workers were identified by the literature review. Then, several questions for evaluating these items were designed. In the next step, the reliability and validity of the questionnaires were appraised using calculating the content validity ratio (CVR) and content validity index (CVI), and Cronbach’s alpha coefficient, respectively. After that, these questionnaires were completed by 2338 employees of six industries in various regions of Iran. Finally, collected data were analyzed using SPSS software. Results: In total, 77 questions, including 53 questions on awareness and 24 questions on practice in six groups of water and beverages, food, snacks and additives, heat exchange, thermal strain risk factors, clothing and heat protection equipment, and heat-related disorders and body reactions, were designed. The values of content validity index (CVI) of remained questions in the questionnaires of awareness and practice were equal to 0.954 and 0.824, respectively. The values of Cronbach’s alpha coefficients of these questionnaires were calculated by 0.755 and 0.716, respectively. The values of the chi-square divided by degrees of freedom (CMIN/DF) and root mean square error of approximation (RMSEA) in the construction of the awareness questionnaire were computed as 4.58 and 0.079, respectively. These values in the construction of the practice questionnaire were calculated by 2.33 and 0.084, respectively. Conclusion: The results showed that the designed questionnaires had appropriate reliability and validity and could be used to evaluate the awareness and practice in warm workplaces.

Abstract Background Cardiac surgery is associated with a widespread inflammatory response, by an additional release of free radicals. Due to the importance of these patient’s nutritional status, the present study was designed to evaluate the effectiveness of supplementation with a combination of glutamine, β-hydroxy-β-methylbutyrate (HMB) and arginine in patients undergoing to the heart surgery. Methods The experiment was performed in 1 month (30 days) before cardiac surgery. patients were asked to take 2 sachets of Heallagen® (a combination of 7 g l-arginine, 7 g l-glutamine, and 1.5 g daily HMB) or placebo with identical appearance and taste (maltodextrin) with 120 cc of water. Clinical and biochemical factors were evaluated in the baseline and end of the study. Results Totally, 60 preoperative patients (30 interventions and 30 placeboes) with a mean age of 53.13 ± 14.35 years participated in the study. Subjects in Heallagen® group had a lower serum levels of interleukin-6 (P = 0.023), erythrocyte sedimentation rate (P

Abstract Background Anti-vascular endothelial growth factor (Anti-VEGF) therapy is now considered as one of standard therapies in approaching infants with retinopathy of prematurity (ROP). The purpose of this study was to assess the time to full retinal vascularization in infants with ROP who were treated with intravitreal bevacizumab (IVB). Methods This retrospective cohort study evaluated premature infants with ROP who were treated with IVB between 2012 and 2019. Demographic and clinical data were collected from the medical records and analyzed. Main outcomes were defined as time to complete vascularization and time of zone shift. Results Eight hundred sixty-five eyes from 441 patients were included. Average gestational age and birth weight were 28 ± 4 weeks and 1121 ± 624 g, respectively. Primary treatment failure and reactivation occurred in 35 eyes (4.0%) and 33 eyes (3.8%), respectively. Recurrent ROP occurred significantly more frequently in infants with pre-treatment zone 1 ROP compared to those with zone 2 ROP (7.6% versus 3%, p

Abstract Background Diabetes is a major cause of worldwide morbidity and mortality. Diet and medication non-adherence are common among individuals with diabetes, making glycemic control difficult to attain. This study aimed to evaluate an intervention designed based on Health Action Process Approach (HAPA) to improve adherence to diet and medication among patients with type 2 diabetes in Tehran, Iran. Methods The study was a randomized controlled trial. A total of 248 patients with type 2 diabetes who had low diet and medication adherence were randomly allocated into two intervention (n = 124) and control (n = 124) groups. Intervention group received educational intervention during three months. HAPA constructs, diet and medication adherence, and Hemoglobin A1c (HbA1c) levels were assessed at baseline, one month and six months after the intervention. Mixed Model Analysis was used to compare between and within group changes in the outcomes. Results There was a statistically significant improvement in HbA1c levels after six months (7.77 ± 1.36% vs. 8.07 ± 1.52%, 95% CI, p

Background: In recent decades, the scientific evidence has demonstrated that regular physical activity (PA) provides abundant physiological and psychological benefits in people with multiple sclerosis (MS). However, most persons with MS are physically inactive. This study examined determinants of PA based on the theory of planned behavior (TPB) among women with MS. Method: Participants (178)-completed measures included Godin Leisure-Time Exercise and TPB questionnaires. Descriptive statistics and hierarchical linear regression were analyzed using IBM SPSS. Result: Most participants were homemaker and the mean age was 34.2 years. The mean of PA was 11.6 ± 7.9 and only 10% of participants had sufficient amount of PA. The result of hierarchical linear regression indicated that attitude (β = 0.27; P < 0.05), subjective norm (β = 0.18; P < 0.05), and perceived behavioral control (β = 0.44; P < 0.05) explained 58% variance in exercise intention. Intention (β = 0.20; P < 0.05) and other variables explained 18% variance in PA. Conclusion: Our findings indicate that constructs of TPB could be used in behavioral interventions by health-care providers for increasing PA among women with MS.

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

Background: Insulin resistance (IR), even in its subclinical state, is a significant risk factor for the onset and progression of coronary artery disease (CAD). IR is a multifactorial condition, and dietary composition is a factor associated with its development. Elevated advanced glycation end products (AGEs) in the body, secondary to highly processed food consumption, can impair glucose metabolism. The present study investigated whether a restricted AGE diet could affect insulin sensitivity and anthropometric indices reflecting visceral adipose tissue in nondiabetic CAD patients. Methods: This trial randomly allocated 42 angioplasty-treated patients to follow either low-AGE or control diets based on the AHA/NCEP guidelines for 12 weeks. Serum levels of total AGEs, insulin, HbA1c, and fasting blood sugar, as well as anthropometric measurements, were evaluated before and after the intervention. The Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) and anthropometric indices were calculated according to the proposed formula. The patients’ health status was assessed using the Seattle Angina Questionnaire (SAQ) at baseline and after the intervention. Results: Our study showed a significant reduction in anthropometric indices in the low-AGE group after 12 weeks. Insulin levels and IR decreased during the low-AGE diet. No significant changes were observed in the other serum biochemical markers. All SAQ domains significantly decreased in both groups, except for Treatment Satisfaction. Conclusion: A low-AGE diet for 12 weeks had beneficial effects on HOMA-IR and insulin levels in patients with CAD. Regarding the fundamental role of AGE in IR development and body fat distribution, AGE restriction may positively affect these patients.

Abstract Introduction Non-alcoholic fatty liver disease (NAFLD) is one of the main causes of chronic liver disease worldwide. Flavonoids, a group of natural compounds, have garnered a great deal of attention in the management of NAFLD because of their profitable effects on glucose and lipid metabolism, inflammation, and oxidative stress which are the pivotal pathophysiological pathways in NAFLD. Naringenin is a citrus-derived flavonoid with a broad spectrum of potential biological effects including anti-inflammatory and antioxidant properties, which may exert protective effects against NAFLD. The present clinical trial aims to examine the efficacy of naringenin supplementation on plasma adiponectin and neurogulin-4 (NRG-4) concentrations, metabolic parameters, and liver function indices in overweight/obese patients with NAFLD. Methods and analysis This is a double-blind, randomized, placebo-controlled clinical study that will investigate the impacts of naringenin supplementation in overweight/obese patients with NAFLD. Liver ultrasonography will be applied to diagnose NAFLD. Forty-four eligible overweight/obese subjects with NAFLD will be selected and randomly assigned to receive naringenin capsules or identical placebo (each capsule contains 100 mg of naringenin or cellulose), twice daily for 4 weeks. Participants will be asked to remain on their usual diet and physical activity. Safety of naringenin supplementation was confirmed by the study pharmacist. The primary outcome of this study is changes in adiponectin circulating levels. The secondary outcomes include changes in NRG-4 levels, liver function indices, metabolic parameters, body weight, body mass index (BMI), waist circumference (WC), blood pressure, and hematological parameters. Statistical analysis will be conducted using the SPSS software (version 25), and P value less than 0.05 will be regarded as statistically significant. Discussion We hypothesize that naringenin administration may be useful for treating NAFLD by modulating energy balance, glucose and lipid metabolism, oxidative stress, and inflammation through different mechanisms. The current trial will exhibit the effects of naringenin, whether negative or positive, on NAFLD status. Ethical aspects The current trial received approval from the Medical Ethics Committee of Tehran University of Medical Sciences, Tehran, Iran (IR.TUMS.MEDICNE.REC.1399.439). Trial registration Iranian Registry of Clinical Trials IRCT201311250155336N12 . Registered on 6 June 2020

Abstract Purpose: To estimate carrier frequencies of CYP1B1 mutations p.Gly61Glu and p.Arg368His, respectively, in Talesh and the east of Guilan province in Iran with a maximum error of 2%. Previously, it was shown that these CYP1B1 mutations may be relatively prevalent in these regions. Methods: Population-based screenings were performed. DNA was extracted from saliva samples of 1036 individuals from Talesh and 3029 individuals from the east of Guilan. P.Gly61Glu and p.Arg368His screenings were performed, respectively, by RFLP and ARMS-based PCR protocols. For confirmation, the DNA of individuals with mutations was sequenced using the Sanger protocol. Results: Nine individuals from Talesh (0.86%; 95%CI: 0.45–1.64%) carried the p.Gly61Glu mutation, and 73 from the east of Guilan (2.41%; 95%CI: 1.91–3.04%) carried p.Arg368His. There was no significant difference in frequencies between urban and rural regions of the various cities, nor among four cities within the east of Guilan. Conclusion: The frequencies of p.Gly61Glu carriers in Talesh and of p.Arg368His carriers in the east of Guilan were within the 95% confidence interval of a previous study based on screenings of fewer individuals. The reliability of the recent estimates is higher, as the confidence interval for p.Gly61Glu decreased from 6.5% to 1.19% and the interval for p.Arg368His decreased from 4% to 1.13%. Based on the new findings, the maximum expected frequency of p.Gly61Glu carriers in Talesh is 1.64%, and of p.Arg368His carriers in the east of Guilan is 3%. The need for performing premarital screenings in the respective cities can be evaluated.

Abstract To study the correlation of OCT parameters including central subfield macular thickness (CSMT), peripapillary retinal thickness (PRT), and peripapillary retinal nerve fiber layer thickness (PNFLT) with fluorescein angiography (FA) in evaluation of inflammatory activity in Behcet’s retinal vasculitis. In this case-series, concurrent FA and OCT were performed. A scoring system was devised for FA. PNFLT in 3.4-mm-diameter circle as well as PRT in doughnut shaped regions between the 1-mm- and 2.2-mm-diameter and between the 2.2-mm- and 3.45-mm-diameter circles was measured. The correlation of FA and OCT parameters was analyzed. A total of 105 sets of FA from 28 eyes (15 patients) were reviewed. Four (26.6%) were female and mean age was 31.6 ± 8.49 years. Each micron increase in CSMT, PRT2.2, PRT3.45, and PNFLT, caused a rise of 0.018 (95% CI 0.008–0.027, P

Background: The performance of a transplanted kidney is evaluated by monitoring variations in the value of the most important markers. These markers are measured longitudinally, and their variation is influenced by other factors. The simultaneous use of these markers increases the predictive power of the analytical model. This study aimed to determine the simultaneous longitudinal effect of serum creatinine and blood urea nitrogen (BUN) markers, and other risk factors on allograft survival after kidney transplantation.Methods: In a retrospective cohort study, the medical records of 731 renal transplant patients, dated July 2000 to December 2013, from various transplant centers in Mashhad (Iran) were examined. Univariate and multivariate joint models of longitudinal and survival data were used, and the results from both models were compared. The R package joineRML was used to implement joint models. P values

Abstract The Cox proportional hazards model is a widely used statistical method for the censored data that model the hazard rate rather than survival time. To overcome complexity of interpreting hazard ratio, quantile regression was introduced for censored data with more straightforward interpretation. Different methods for analyzing censored data using quantile regression model, have been introduced. The quantile regression approach models the quantile function of failure time and investigates the covariate effects in different quantiles. In this model, the covariate effects can be changed for patients with different risk and is a flexible model for controlling the heterogeneity of covariate effects. We illustrated and compared five methods in quantile regression for right censored data included Portnoy, Wang and Wang, Bottai and Zhang, Yang and De Backer methods. The comparison was made through the use of these methods in modeling the survival time of breast cancer. According to the results of quantile regression models, tumor grade and stage of the disease were identified as significant factors affecting 20th percentile of survival time. In Bottai and Zhang method, 20th percentile of survival time for a case with higher unit of stage decreased about 14 months and 20th percentile of survival time for a case with higher grade decreased about 13 months. The quantile regression models acted the same to determine prognostic factors of breast cancer survival in most of the time. The estimated coefficients of five methods were close to each other for quantiles lower than 0.1 and they were different from quantiles upper than 0.1.

IntroductionDiabetes is a chronic metabolic disorder that affects millions of people worldwide. Adherence to treatment is a key determinant to proper management. This study aimed to assess the factors associated treatment adherence in patients with type 2 diabetes.Materials and methodsWe conducted this cross-sectional study on 704 patients with type 2 diabetes referred to three diabetes clinics in Kerman, Iran. We used treatment adherence questionnaire and functional communicative critical health literacy (FCCHL) to collect data and descriptive statistics, as well as Pearson correlation coefficient and multivariate regression analysis to analyze data. Significance level was

No Abstract

Abstract Background To assess the potential impact of a tax-induced cigarette price increase on financial and health outcomes by different socioeconomic groups. Methods In a modeled condition using pooled cross-section data from Household Income and Expenditure Survey (2002–2017) and Iran 2019 population data, a methodology of an extended cost effectiveness analysis (ECEA) was applied to model the impact on cigarette consumption of hypothetically increased cigarette tax. The methodology was employed to evaluate: [1] health benefits (premature deaths averted); [2] health expenditures regarding smoking-related disease treatment averted; [3] additional tax revenues raised; [4] change in household expenditures on cigarettes; and [5] financial risk protection among male Iranian smokers in a time span of 60 years following a one-time increase in cigarette price of 75%. The Stata version 15.1 (StataCorp., College Station, TX, USA) was used to perform the relevant analysis and estimate regression models. Results A 75% increase in cigarettes price through taxation would reduce the number of smokers by more than half a million, 11% of them in the poorest quintile; save about 1.9 million years of life (11% of which would be gained in the lowest quintile compared to 20% in the highest one); eliminate a total of US$196.4 million of health expenditures (9% of which would benefit the bottom quintile). Such a policy could raise the additional annual tax revenues by roughly US$ 1 billion, where the top two quintiles bear around 46% of the total tax burden. We estimated that the tax increase would avert an estimated 56,287 cases of catastrophic expenditure that wholly concentrated among the bottom two expenditure quintiles. Conclusion Increasing cigarette tax can provide health and financial benefits, and would be pro-poor in terms of health gains, Out-of-Pocket (OOP) savings, and financial risk protection against smoking-related diseases.

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

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