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Background: Coronavirus disease 2019 (COVID-19) has a high rate of mortality, but data regarding its prognosis are scarce. This study aimed to identify the risk factors associated with mortality and survival of COVID-19 patients in a southern province of Iran. Materials and Methods: This was a cross-sectional study with a secondary database of 3172 people who were admitted to hospitals for COVID-19 treatment. Relative risk (RR) was computed to estimate mortality risk between groups, and the log-rank test was used to compare the survival functions in different levels of categorical variables. Finally, the multivariable extended Cox model was employed to determine the factors that affected the survival of COVID-19 patients. Results: The 10- and 15-day survival rate of 3172 patients was 89% and 80%, respectively, and the median survival time was 30 days. Based on the extended Cox model, age, oxygen therapy, intensive care unit (ICU) admission, invasive ventilation, chronic cardiac disease, chronic kidney disease, and cancer were the most important variables affecting the survival of COVID-19 patients. Conclusion: Older people (older than 40 years) and those with comorbidities (e.g., chronic cardiac disease, chronic kidney disease, and cancer) had a higher mortality rate; therefore, health-related organizations need to plan for the prevention and early detection of comorbidities to reduce the burden of diseases such as the pandemic of COVID-19 as much as possible in the future.

Introduction Over the past decades prevalence of diabetes has increased in Iran and other countries. This study aimed to update the prevalence of diabetes and prediabetes in Iran and to determine associated sociodemographic risk factors, as well as diabetes awareness and control. Methods This is a nationally representative cross-sectional survey that included 163,770 Iranian adults aged 35–70 years, from different ethnic backgrounds, between 2014 and 2020. Diabetes was diagnosed at fasting blood sugar of ≥ 6.99 mmol/L (126 mg/dL), or receiving blood glucose-lowering treatment. Multivariable logistic regression was applied to detect determinants associated with prevalence of diabetes and prediabetes, as well as predictors of diabetes awareness and glycemic control. Results Sex- and age-standardized prevalence of diabetes and prediabetes was 15.0% (95% CI 12.6–17.3) and 25.4% (18.6–32.1), respectively. Among patients with diabetes, 79.6% (76.2–82.9) were aware of their diabetes. Glycemic control was achieved in 41.2% (37.5–44.8) of patients who received treatment. Older age, obesity, high waist to hip ratio (WHR), and specific ethnic background were associated with a significant risk of diabetes and prediabetes. Higher awareness of diabetes was observed in older patients, married individuals, those with high WHR, and individuals with high wealth score. Moreover, glycemic control was significantly better in women, obese individuals, those with high physical activity, educational attainment, and specific ethnic background. Conclusions The prevalence of diabetes and prediabetes is increasing at an alarming rate in Iranian adults. High proportion of uncontrolled patients require particular initiatives to be integrated in the health care system. Supplementary Information The online version contains supplementary material available at 10.1007/s13300-021-01152-5.

Background: Gestational diabetes mellitus (GDM), the most common metabolic disorder of pregnancy, is associated with alterations in circulating lipids. Objectives: The aim of this study was to compare lipid profiles in women with and without GDM. Methods: This study was performed on 84 pregnant women at 26-30 weeks of gestation (42 pregnant women with GDM as cases and 42 healthy pregnant women as controls). After obtaining informed consent and gathering demographic data, subjects underwent a 75-g oral glucose tolerance test and lipid profile was also measured in all subjects. Results: We found that high-density lipoprotein (HDL) levels were significantly higher in the GDM group (53.10±1.72 vs 46.64±1.70 mg/dL, P=0.008). Total cholesterol (228.96±52.03 vs 211.59±41.83 mg/ dL) and triglyceride (TG) levels (225.58±89.84 vs 208.38±80.66 mg/dL) were also higher in the GDM group; however, the differences were not statistically significant (P=0.770 and P=0.327, respectively). On the contrary, low-density lipoprotein was found to be non-significantly higher in the healthy group (144.54±26.01 vs 122.41±4.82 mg/dL, P=0.709). Besides, there was a significant association between HDL levels and GDM (OR: 1.049; 95% CI: 1.009-1.090, P=0.015). This association remained significant when adjusted for age, body mass index (BMI), and gestational age (OR: 1.010; 95% CI: 1.002-1.017, P=0.009). No significant association was found between GDM and TG, cholesterol, and LDL levels. Conclusion: HDL levels are significantly higher in pregnant women with GDM compared to pregnant women without GDM. HDL level is significantly associated with GDM even after adjustment for age, BMI, and gestational age.

Purpose Type 2 diabetes mellitus (T2DM) is a disease with a steadily increasing incidence throughout the world. Some molecules regulating the innate immune responses such as toll-like receptor 4 (TLR4) have shown to be involved in late diabetic complications. This study aimed to investigate the association of TLR4 gene polymorphisms with clinicopathological aspects of T2DM in the Iranian population. Patients and methods Two TLR4 896A>G and 1196C>T polymorphisms were assessed in 100 T2DM patients and 100 healthy controls using sequence-specific primers PCR. Demographic, anthropometric, and biochemical parameters were obtained from the participants. Results After logistic regression, in 1196C>T, a significant association was shown between diabetic nephropathy (DN) and CT genotype (P= 0.04, OR= 4.35, CI= (1.04-18.1)). TG level has increased significantly in both T2DM and control subjects with CT genotype (P= 0.027, OR= 1.005, 95% CI= (1.001-1.01)). For 896A>G variant, a significant association was also detected between AG genotype and increased oral glucose tolerance test (OGTT) level (P= 0.048, OR= 1.003, 95% CI= (1.00-1.005)). Conclusion Although minor alleles of 1196C>T and 896A>G variants have not directly been associated with type 2 diabetes, by involving in the dysregulation of serum TG and blood sugar levels, they might increase the risk of DN.

Background: Metabolic syndrome (MetS) criteria consist of different but interconnected cardiovascular risk factors, including dysglycemia, hypertension, abdominal obesity, and dyslipidemia. Objectives: We aimed to determine the prevalence of MetS, its components, and related factors in the southern coastal area of Iran, Bandare-Kong Non-Communicable Diseases (BKNCD). Methods: This population-based study was performed on the baseline data from participants of BKNCD, which has recruited participants from Bandare-Kong city, one of the 18 distinct geographical areas included in the Prospective Epidemiological Research Studies in IrAN (PERSIAN). MetS was diagnosed based on the National Cholesterol Education Program (NCEP) criteria and the Iranian-specific cut-off for waist circumference (≥ 95 cm). The socioeconomic status (SES) was estimated by multiple correspondence analysis (MCA) based on participants’ different properties. Results: Of 3,927 participants included in this study, 2,230 (56.8%) were female. Age-standardized prevalence of MetS was 34.5%. The most common MetS component was central obesity (45.1%), followed by decreased high-density lipoprotein (42.6%), elevated fasting plasma glucose (39.9%), elevated triglyceride (37.7%), and increased blood pressure (37.5%). Besides, 84.7% of the subjects displayed at least one component of MetS. Binary logistic regression analysis revealed that women aged 65 - 70 years were at higher risk of having MetS compared to those aged 35 - 39 years (adjusted odds ratio [aOR] = 23.37, 95% CI 7.54 - 20.30, P < 0.001). Also, living in rural areas was a risk for MetS in women (aOR = 1.55, 95% CI 1.18 - 2.03, P = 0.002). Employment and education were protective against MetS in women. Being overweight significantly increased the risk of MetS in both men and women. Obesity was more problematic for men (aOR = 16.66, 95% CI 11.65 - 23.81, P < 0.001) compared to women (aOR = 10.43, 95% CI 7.82 - 13.90, P < 0.001). Marital status, education, smoking status, and SES did not significantly predict MetS in men. Conclusions: A high prevalence of MetS was observed in this study, emphasizing central obesity, high triglyceride, and low high-density lipoprotein. This calls on the government authorities to establish screening programs to identify individuals with a lower number of abnormal MetS components to prevent them from developing MetS and the resultant cardiovascular complications.

Background Obesity is a substantial risk factor for cardiovascular and metabolic diseases. Epidemiologic studies have shown that some obese and overweight individuals are metabolically healthy. We aimed to determine the prevalence of metabolically unhealthy obesity (MUO), metabolically unhealthy overweight (MUOW), and metabolically unhealthy normal weight (MUNW) in a southern coastal area of Iran, Bandare-Kong Non-Communicable Diseases (BKNCD) Cohort Study. Methods This population-based study included the participants of BKNCD, as part of the Prospective Epidemiological Research Studies in IrAN (PERSIAN). Metabolic health was defined as not fulfilling the metabolic syndrome (MetS) criteria. Results Among the 3917 participants in this study with the mean age of 48.29 ± 9.39 years, including 1691 (43.2%) males, the age- and sex-standardized prevalence of MUO, MUOW, and MUNW was 13.9, 16.8, and 6.4%, respectively. Binary logistic regression analysis revealed that the adjusted odds of all metabolically unhealthy states were higher in older age groups, except for MUO whose adjusted odds were lower in the 65–70 age group compared to the 55–64 age group. Illiteracy was significantly correlated with MUOW (adjusted OR: 1.43, 95% CI 1.09–1.87, P = 0.010); however, it was not associated with MUO or MUNW. Higher body mass index (BMI) was significantly correlated with MUNW but it was not associated with MUOW or MUO. Higher waist circumference (WC) was also significantly associated with all metabolically unhealthy states. Conclusion The age- and sex-standardized prevalence of MUO, MUOW, and MUNW was 13.9, 16.8, and 6.4%, respectively in the current study. Advanced age and higher WC were significantly correlated with all metabolically unhealthy states, while illiteracy and higher BMI were only associated with MUOW and MUNW, respectively. Metabolic health rather than weight loss should be the focus and objective of public prevention programs.

Background Coronavirus disease 2019 (COVID-19 patients mostly present with respiratory symptoms; however, gastrointestinal (GI) manifestations can also be seen either alone or along with respiratory symptoms. We aimed to evaluate the GI symptoms related to COVID-19. Methods This cross-sectional study retrospectively evaluated the medical files of 507 patients with confirmed or highly probable COVID-19. Based on their symptoms, patients were categorized into four groups: with GI symptoms alone (GIA), with respiratory symptoms alone (RA), with both GI and respiratory symptoms (GIR), and without GI or respiratory symptoms (WGIR). Results Of the 507 COVID-19 patients, 47.9% had at least one GI symptom; the most common was nausea and/or vomiting (31.6%). Patients in the GIA group were significantly older than those in the RA (P = 0.041) and GRI (P = 0.004) groups (54.70 ± 18.14 vs. 48.68 ± 14.67 and 46.80 ± 17.17 years, respectively). Groups were homogeneous with respect to gender. Leukopenia and lymphopenia were both less frequent in patients with GI symptoms compared to those without GI symptoms. Positive RT-PCR was significantly less frequent among patients with GI symptoms (44% vs. 100%, P Conclusion The typical respiratory symptoms of COVID-19 are quite commonly accompanied by GI symptoms, with nausea and/or vomiting being the most prevalent. A subgroup of COVID-19 patients may exclusively present with GI symptoms. Special attention should be paid to these patients in order to avoid misdiagnosis or delayed treatment.

Dyslipidemia, a major risk factor for cardiovascular diseases, has become a global issue. Due to the variations in the prevalence of dyslipidemia, this study aimed to evaluate dyslipidemia and its associated factors in women of the Bandare-Kong Cohort Study (BKNCD). This study was conducted on women from the population-based BKNCD, as part of the Prospective Epidemiological Research Studies in IrAN (PERSIAN). Sociodemographic data, medical history, and anthropometric indices were collected. Dyslipidemia was defined as any lipid abnormality including low-density lipoprotein (LDL) ≥ 160, total cholesterol (TC) ≥ 240, high-density lipoprotein (HDL) 200 mg/dl. From the 2223 women in this study (mean age: 48.28 ± 9.26 years), dyslipidemia was observed in 851 (38.3%). High TC was the most common lipid abnormality (18.5%) followed by high LDL (17.7%). Dyslipidemia was most prevalent among women aged 55–70 years, the married, those with

New investigations suggest a pivotal role of brain-derived neurotrophic factor (BDNF) in cardiovascular homeostasis. However, no data could indicate the association between BDNF methylation status and the risk of coronary artery disease (CAD). The aim of the present study was to assess the association of BDNF methylation status and its serum level with the severity of CAD. According to the angiography report, a total of 84 non-diabetic CAD patients with at least 50% stenosis in one of the major coronary arteries were selected as the CAD group. For comparison, 62 angiographically proven non-CAD participants were selected as control. Additionally, subjects were categorized according to the Gensini Scoring system. Blood sample was used for genomic DNA isolation. Methylation status of the BDNF gene in exonic region was determined using the MS-PCR method and serum BDNF levels were measured with ELISA. BDNF gene methylation was significantly higher in the CAD group than in the non-CAD group. After adjustment for confounding factors, BDNF gene hypermethylation increases the risk of CAD in the total population (OR = 2.769; 95% CI, 1.033–7.423; P = 0.043). BDNF gene hypermethylation was higher in patients with severe CAD than patients with mild CAD. Additionally, the serum BDNF level was not different from non-diabetic CAD and control groups. Our findings indicate that BDNF hypermethylation was associated with an increased risk of CAD, which may help identify subjects being at the risk of developing CAD. In addition, BDNF hypermethylation shows a significant correlation with the severity of CAD.

Introduction: Primary hyperparathyroidism (PHPT) is a rare condition in the pediatric population. Parathyroid carcinoma (PC) is a very uncommon cause of PHPT, accounting for < 1% of pediatric PHPT cases. It is challenging to distinguish between parathyroid adenoma (PA), the most common cause of PHPT, and PC. In this report, we described a young female who presented with a history of progressive limping and was finally diagnosed with PC. Case Presentation: A 15-year-old girl presented with progressive limping and bone pain for 8 years. She was referred by an orthopedic surgeon because of elevated intact parathyroid hormone (iPTH) for further evaluation. Physical examination revealed a large, firm, and non-tender neck mass, left hip tenderness, and limited range of motion. The initial biochemistry tests showed a borderline high calcium level of 10.8 mg/dl, an elevated iPTH level of 2876 pg/mL, and a decreased phosphorus level of 2.4 mg/dL. The 99mTechnetium (Tc) sestamibi scan displayed early intense activity in the right thyroid lobe persisting in the three-hour repeat scan, compatible with a parathyroid lesion. The patient underwent right-sided neck exploration and parathyroidectomy. Intraoperative and pathology findings confirmed the diagnosis of PC. Immunohistochemistry (IHC) staining revealed creatine kinase (CK) and CD31 in endothelial cells of the tumor. Ki67 staining was also positive in 2% - 3% of tumor cells. The whole exome sequencing (WES) study was negative for cell division cycle 73 (CDC73) and multiple endocrine neoplasia 1 (MEN1) genes. Conclusions: PC should be considered as a differential diagnosis of PHPT in the pediatric population, even in the presence of mild hypercalcemia.

Background: To evaluate the prevalence of type 2 diabetes mellitus (T2DM), impaired fasting glucose (IFG), and its cardio-metabolic risk factors in the southern Iranian adult population. Methods: This is a population-based cross-sectional survey on 3944 middle-aged and elderly adults (35–70 years) from Bandare-Kong. The participants were recruited from 2016 to 2018 and the first phase data of the Bandare-Kong Cohort as a part of the PERSIAN Cohort were used for analysis. Results: Among the 3944 included adults, the age-adjusted prevalence of T2DM and IFG was 17.40% and 20.61%, respectively. Mean FPG was higher among those older than 55 years, females, rural residents, current cigarette smokers, hypertriglyceridemia, hypercholesterolemia, unemployed and low educational level in subjects with diabetes and pre-diabetes. T2DM and IFG were more prevalent in women and men, respectively. Also, those with higher waist circumference (WC), higher body mass index (BMI), lower educational levels, rural residents, former cigarette smokers, hypertension (HTN), hypercholesterolemia, hypertriglyceridemia and age older 45 years, had a higher T2DM and IFG prevalence. Multivariable regression analysis showed that older age, higher WC, HTN and hypertriglyceridemia and living in rural regions were statistically significant predictors of T2DM and pre-diabetes while BMI≥25 kg/m2 was the only significant risk factor for IFG. Conclusion: The current study illustrated that T2DM and IFG have a high prevalence among the middle-aged and elderly adult Iranian population, particularly in rural dwellers. Hence, prevention strategies should be implemented to reduce diabetes and pre-diabetes, especially in rural areas.

Background: There is inconsistent data on the effects of vitamin D supplementation on metabolic profiles in pregnant women with gestational diabetes mellitus (GDM). The aim of the current study was to assess the effect of vitamin D supplementation on the glycemic and metabolic status of pregnant women with GDM.Methods: In this randomized double-blind controlled trial pregnant women with GDM referred to the Diabetes Clinic of Hormozgan University of Medical science, Bandar Abbas, 2016-2017, were randomly assigned to the intervention (n=25) and placebo (n=25) groups. Subjects in the intervention group received two 50000 IU vitamin D3 pearls (at baseline and at day 21) plus 1000 mg calcium daily, and those in the placebo group received 2 placebos at the same times and 1000 mg calcium daily. Fasting blood samples were collected at baseline and after 6 weeks for the measurement of lipid profile, fasting plasma glucose (FPG), insulin, 25-hydroxy vitamin D, calcium, and phosphorus. Homeostatic model assessment for insulin resistance (HOMA-IR) was calculated.Results: Serum 25-hydroxy vitamin D significantly increased in the intervention group (PConclusions: Vitamin D supplementation can be beneficial in the regulation of FPG, insulin level, and HOMA-IR in pregnant women with GDM.Trial registration: The research has retrospectively been registered at the Iranian Registry of Clinical Trials (IRCT) with the registration number: IRCT20150607022585N3 and is accessible at the following website: www.irct.ir.

Background: Dyslipidemia, a major risk factor for cardiovascular diseases, has become a global issue. Due to geographic and demographic variations in the prevalence of dyslipidemia, this study aimed to evaluate dyslipidemia and its associated factors in women of the Bandare-Kong Cohort Study (BKNCD).Methods: This study was conducted on women from the population-based BKNCD, as part of the Prospective Epidemiological Research Studies in IrAN (PERSIAN). Sociodemographic data, medical history, and anthropometric indices were collected. Diastolic blood pressure, systolic blood pressure, fasting plasma glucose, serum triglyceride (TG), total cholesterol (TC), high-density lipoprotein (HDL), and low-density lipoprotein (LDL) were measured. Daily calorie intake and weekly metabolic equivalent of tasks were also recorded. Dyslipidemia was defined as any lipid abnormality based on the Adult Treatment Panel III criteria. Results: From the 2223 women in this study (mean age: 48.28±9.26 years), dyslipidemia was observed in 1884 (84.8%). High TC was the most common lipid abnormality (53.9%) followed by low HDL (50.8%). Dyslipidemia was most prevalent among women aged 65-70 years, the widowed, illiterate, unemployed, and overweight, with very low socioeconomic status, diabetes, and high waist circumference, hypertension, those using hookah and living in urban areas. Logistic regression revealed that only women with high WHR were at increased risk of dyslipidemia (OR=2.48, 95% CI:1.75-3.53, PConclusions: Dyslipidemia was highly prevalent in women of BKNCD. High WHR appears to be the only significant risk factor for dyslipidemia.

Background: There is sparse information to describe the clinical features and outcomes of patients infected with coronavirus disease 2019 (COVID-19) Methods: In a single-center retrospective observational study, 50 patients infected with COVID-19 were studied Epidemiological, demographic, clinical, laboratory, radiological, and treatment data were collected and analyzed Outcomes of critically ill patients and noncritically ill patients were compared Results: The mean age of the patients was 48 8 years, with male predominance Dry cough, fever, and dyspnea were the most complaining symptoms on admission Chronic medical illnesses before admission were present in 56% of the patients The most common laboratory abnormalities were lymphopenia, neutrophilia, thrombocytopenia, increased aspartate aminotransferase, high serum creatinine level, elevated lactate dehydrogenase, and increasing ESR and CRP levels Bilateral mixed ground-glass opacity and consolidation were observed in chest CT scan of most patients Some patients required supplemental oxygen and some needed invasive mechanical ventilation Blood oxygen saturation was different between survivors and nonsurvivors 10% of patients died, of whom 60% were men 40% of dead cases had chronic medical illnesses;60% underwent invasive mechanical ventilation Conclusion: Among the patients diagnosed with COVID-19 infection, the frequent clinical presentation was with a wide range of signs and symptoms The laboratory changes suggest that COVID-19 infection may be related to cellular immune deficiency, myocardial, hepatic, and kidney injury Additional research is needed to elucidate COVID-19 pathogenesis © 2021 Iran University of Medical Sciences

Chronic Obstructive Pulmonary Disease (COPD) is one of the leading causes of mortality worldwide. Evidence shows that COPD increases the risk of type 2 diabetes possibly due to insulin resistance induced by inflammatory cytokines. The aim of the current study was to evaluate the association between forced expiratory volume in one second (FEV1) and plasma glycated hemoglobin (HbA1c) level in patients with COPD. In this study, 50 non-hospitalized patients with COPD were studied. For all patients, a spirometry test was performed and FEV1 was determined. The quality of spirometry was assessed based on Guidelines from the American Thoracic Society/European Respiratory Society Task Force and the severity of COPD was determined based on GOLD criteria. HbA1c was measured by commercial kits. Anthropometric indices were measured and a questionnaire was applied to collect general characteristics of patients. The mean age of patients was 60.18±7.63 years. Seventy-eight percent and 22% of patients were male and female, respectively. Twenty-seven subjects were current smokers and 23 subjects were non-smokers. A significant inverses association was found between HbA1c level and FEV1% in (r= -0.722, P0.05). Our study showed there is a negative correlation between the level of HgA1c and respiratory function in COPD patients

Background To examine trends in the population levels of serum lipids among a Middle-Eastern adult population with high prevalence of dyslipidemia. Methods A population-based cohort of adult Iranian participants, aged ≥20 years underwent four consecutive examinations between 1999–2001 and 2008–2011. Trends in age and multivariate-adjusted mean lipid levels were calculated using generalized estimating equations. Results At each of the 4 assessments, there were significant decreases in levels of total cholesterol (TC) (multivariate-adjusted means, 5.21 vs. 4.88 mmol/L in men; 5.42 vs. 5.07 mmol/L in women), triglycerides (TGs) (2.11 vs. 1.94 mmol/L in men; 1.88 vs. 1.74 mmol/L in women), and an increase in HDL-C level in both genders (0.95 vs. 1.058 mmol/L in men; 1.103 vs. 1.246 mmol/L in women) in multivariate analyses (all Ps