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To define reference values for various insulin sensitivity (IS) indices in healthy women in a population-based study of the five provinces in Iran In this cross-sectional study, 250 normal-weighted women without hypertension, diabetes, polycystic ovary syndrome, hormonal disorders, pregnancy, or menopause were evaluated in this study. After a 12-h fasting, blood samples were obtained from all participants, levels of metabolic markers (fasting plasma glucose, lipid profile, insulin, etc.) were measured using enzymatic colorimetric and ultrasensitive enzyme-linked radioimmunoassay methods. Multiple insulin sensitivity indices were calculated using well-known predetermined formulas. K-means cluster analysis was used to determine reference values for each insulin sensitivity index. The threshold values of homeostasis model assessment (HOMA-%β, HOMA-βcell) and fasting insulin resistance index (FIRI) were 400.41, 198.55, and 2.57 corresponding to 97th, 93rd, and 92nd percentiles, respectively. Reference values of quantitative insulin sensitivity check index (QUICKI) and TG/HDL-c were 0.44 and 4.40, both of which relate to 92nd percentile. The recently introduced single-point insulin sensitivity estimator (SPISE) was analyzed and showed a threshold of 10.10 (87th percentile) in this study. Threshold values of reciprocal insulin (1/Insulin) and glucose-to-insulin ratio (G/I) were 0.51 (95th percentile) and 76.91 (99th percentile), respectively. This study determined reference values for various insulin sensitivity indices in healthy Iranian women. These values can be used to define insulin sensitivity in women in epidemiological and clinical studies.

Summary The Middle East and north Africa are home to different populations with widely varying cultures, histories, and socioeconomic settings. Hence, their health status, health management, and access to appropriate health care differ accordingly. In this Review, we examine data on the historical and prospective status of metabolic diseases in this region including obesity, diabetes, hypertension, dyslipidaemia, and non-alcoholic fatty liver disease. Women in the Middle East and north Africa have the highest risk of metabolic diseases of all women globally, whereas men rank second of all men in this respect. Metabolic risk factors are responsible for more than 300 deaths per 100 000 individuals in this region, compared with a global mean of fewer than 250. Physical inactivity, especially in women, and an unhealthy diet (ie, low consumption of whole grains, nuts, and seafoods) stand out. More than one in every three women are obese in most countries of the region. Prevention programmes have not fully been achieved in most of these countries and the projected future is not optimistic. Comprehensive surveillance and monitoring of metabolic diseases, robust multisectoral systems that support primordial and primary preventions, continuous education of health-care providers, as well as collaboration between countries for joint projects in this region are urgently needed to overcome the paucity of data and to improve the metabolic health status of inhabitants in the Middle East and north Africa.

Objective To observe the effects of menopause, age at natural menopause (ANM), and aging on the trend in body mass index (BMI). Design Prospective cohort with a 15-year follow-up of 929 women. Data obtained from the Tehran Lipid and Glucose Study. Setting Not applicable. Intervention(s) none. Participant(s) Of women participating in the Tehran Lipid and Glucose Study, 929 who were reproductive during the study and menopaused at the last follow-up were included. Anthropometric data were measured repeatedly every 3 years, and the trend in BMI, associated with menopause and ANM, was tested using the generalized estimating equation. Main Outcome Measure(s) Body mass index in each follow-up session. Result(s) The adjusted model of the generalized estimating equation illustrates that BMI increases by age (β = 0.16) and menopausal status (β = 1.11). It also shows that women with higher ANM experienced a decreasing BMI (β = −0.03) compared with women with lower ANM. The interaction term of menopause and time (menopause × time) has a negative effect on BMI; that is, the usual increase in BMI after menopause is attenuated by time. (β = −0.4, 95% confidence interval −0.6, −0.3). Conclusion(s) Menopause and aging are independently correlated with increasing BMI. The trend in BMI, however, depends on the ANM of study participants: women with higher ANM than mean ANM of our population (i.e., 49 years) face a decreasing BMI compared with those with lower ANM.

OBJECTIVE. The purpose of this study was to assess the MR enterographic features of primary small intestinal lymphoma (PSIL) and compare them with active Crohn disease (CD) presenting with severe (≥ 10 mm) mural thickening of the small bowel. MATERIALS AND METHODS. This retrospective study included 15 patients with pathologically proven PSIL and 15 patients with active inflammatory CD with severe mural thickening. Various morphologic, enhancement, and diffusion parameters were compared between the two groups at MR enterography. The ratios of the upstream to involved luminal diameter and mural thickness to luminal diameter in the involved segment were calculated. An attempt was made to define a predictive model (morphologic score) for discriminating PSIL from CD with severe mural thickening. RESULTS. Patients with PSIL were more likely than those with CD to have unifocal disease (66.7% vs 20.0%, p = 0.025), circumferential involvement (86.7% vs 26.7%, p < 0.001), luminal dilatation (60.0% vs 7.0%, p = 0.005), and an attenuated fold pattern (53.3% vs none, p < 0.001). They were less likely to have serosal surface involvement (40.0% vs 100%, p = 0.001) and mesenteric fat infiltration (33.3% vs 100%, p < 0.001). Median upstream to involved luminal diameter ratio (1.5 vs 9.6, p < 0.001) and mural thickness to involved luminal diameter ratio (1.1 vs 4.3, p = 0.044) were significantly lower in patients with PSIL than in those with CD with severe mural thickening. No significant difference was observed in enhancement and diffusion measures. Morphologic score was based on the presence of luminal dilatation, unifocal involvement, mesenteric fat infiltration, and luminal stricture, yielding accuracy of 98% for differentiation between PSIL and CD with severe mural thickening. CONCLUSION. Morphologic features seen at MR enterography rather than enhancement or diffusion parameters may be valuable for differentiation of PSIL from active CD with severe mural thickening with significantly lower ratios of upstream to involved luminal diameter and mural thickness to involved luminal diameter in PSIL.

BACKGROUND Achalasia, as an incurable disease is defined by the lack of normal esophageal peristalsis and loss of lower esophageal sphincter relaxation due to impaired myenteric neural plexus. The exact cause of myenteric neural cells degeneration in achalasia is still unknown. One hypothesis is that certain neurotropic viruses and autoimmune factors cause the inflammatory response in myenteric network, which consequently destroy neural cells. This study was designed to find the evidence of viral causes of achalasia. METHODS In this case-control study, 52 patients with achalasia and 50 controls referred to Shariati Hospital, were evaluated for the genome of neurotropic viruses, HPV, and adenovirus by polymerase chain reaction (PCR) and reverse transcription (RT) PCR techniques. RESULTS Genome assessment of neurotropic DNA viruses turned out negative in the patients, however, the genome of HSV-1 (Herpes simplex virus) was found in tissues of six controls. No neurotropic RNA viruses were observed in the tissue samples and whole blood of both the patients and controls. Among non-neurotropic viruses, adenovirus genome was positive in tissues of two out of 52 patients and three out of 50 controls. In addition, one out of 52 patients and two out of 50 controls were positive for HPV infection in tissues. CONCLUSION We could not detect any significant relationship between achalasia and HPV, adenovirus, and neurotropic viruses in the cases. Nevertheless, it does not exclude the hypothesis of either an alternate viral species or resolved viral infection as the etiology of achalasia.

Background The risk of cardiovascular disease in women increases after menopause. It has been shown that women with lower pre-menopausal ovarian reserve may experience increased cardiovascular risk. We sought to determine whether there is any association between ovarian reserve, as assessed by Anti-Mullerian hormone (AMH), and preeclampsia (PE). Methods Subjects of this study were selected from among participants of the Tehran Lipid and Glucose Study (TLGS), a population-based cohort with a 15-year follow-up (1998–2014). Out of 2412 women aged 20–50 years, there were 781 women who met eligibility criteria, including having comprehensive data on their reproductive assessment and ovarian reserve status, identified based on age-specific AMH levels according to the exponential–normal three-parameter model that was measured before pregnancy. There were 80 and 701 participants in the preeclampsia and non-PE groups, respectively. The association between dichotomous outcome variable PE and age-specific AMH quartiles was evaluated using pooled logistic regression. Results PE was observed in 23 (11.1%), 12 (6.4%), 26 (13.3%) and 19 (10%) women in the 1st, 2nd, 3rd and 4th quartiles of pre-pregnancy age-specific AMH, respectively (P = 0.16). Median and inter-quartile range of serum AMH levels was 1.05 (0.36–2.2) mg/L in women who experienced PE compared with 0.85 (0.28–2.1) mg/L in women with normotensive pregnancies (P = 0.53). Based on the pooled logistic regression analysis, the effect of age-specific AMH quartiles on PE progression (adjusted for age, BMI, smoking status, and family history of hypertension) were not significant (OR1st vs 4th: 1.5, P-value: 0.1, CI: (0.9, 2.4)). Conclusions Age-specific AMH may not be a suitable marker for prediction of PE. Further longitudinal studies, considering pre-conception measurement of AMH, are recommended for better interpretation of the association between ovarian reserve status and PE.

The materials and methods (M&M) section is the heart of a scientific paper and is subject to initial screening of the editor to decide whether the manuscript should be sent for external review. If the M&M section of a scientific paper be considered as a recipe, its ingredients would be who, what, when, where, how, and why. M&M should effectively respond to the study question/hypothesis using the following basic elements including materials, study design, study population/subjects or animals, methods of measurements/assessments, and statistical analysis. A well-organized M&M permits other scientists to evaluate the study findings and repeat the experiments. Although there are several disciplinary differences in the M&M, similar dos and don’ts may be considered to organize a well-written M&M. Briefly, authors need to provide clear-cut, adequate, and detailed information in the M&M section. In this review, the structure, the principles, and the most common recommendations for writing the M&M section are provided, both in general and study-specific; these could help authors effectively prepare the M&M section of a scientific biomedical manuscript.

Background: Insulin resistance (IR) is a major cardiometabolic risk factor in females with polycystic ovary syndrome (PCOS). The euglycemic clamp is the gold standard method to measure IR. However, considering the time and cost that it takes, surrogate markers of IR are now widely used. The current study aimed at evaluating the cutoff points of even less invasive anthropometric and body composition variables to predict IR in females with PCOS. Methods: The current cross sectional study selected 224 females with PCOS, using Rotterdam criteria, referred to reproductive endocrinology research center; 88 of which were diagnosed with insulin resistance. Receiver operating characteristics curve was used to explore the best cutoff values of each anthropometric and body composition measures. IR was defined as homeostasis model assessment formula greater or equal to 2.6: HOMA-IR = fasting insulin (mU/L) × fasting plasma glucose (mM/L)/22.5. Results: The highest area under the curve (0.751) was for the multiplication of waist circumference (WC) by body mass index (BMI), as a single index. The highest sensitivity and specificity were for body water (BW) percentage (82% for values greater than 32.85%) and WC (79% for values greater than 88 cm), respectively. Conclusions: It was concluded that there were simple anthropometric variables; e.g., WC × BMI, percentage of BW, and WC that could help to estimate IR in clinical settings especially when the gold standard or surrogate markers of IR were unavailable.

Objective: To explore the relationship between age-specific anti-Müllerian hormone level, as a predictor of ovarian reserve status, and electrocardiographic silent coronary artery disease in a population-based, prospective cohort, the Tehran Lipid and Glucose Study. Methods: For the present study, 1015 reproductive-aged participants in the Tehran Lipid and Glucose Study met our eligibility criteria. According to the Whitehall criteria, silent coronary artery disease was defined as an electrocardiogram showing possible or probable coronary heart disease using Minnesota codes. By excluding those with a history of coronary heart disease and silent coronary artery disease at the initiation of the study (n = 49), there were 108 events of silent coronary artery disease at electrocardiograms among 752 women followed for 9.5 ± 0.9 years (missing data: n = 214); the association between this outcome with age-specific anti-Müllerian hormone levels was explored after adjustment for confounding variables using logistic regression analysis. Cardiovascular disease risk scores were assessed for all participants using the guidelines of the American College of Cardiology and the American Heart Association. Results: There were 108 events of silent coronary artery disease over the 10-year follow-up. Logistic regression analysis, considering age-specific anti-Müllerian hormone and atherosclerotic cardiovascular disease risk score as independent variables, revealed an odds ratio of 1.146 (95% confidence interval 1.008–1.303) for cardiovascular disease risk score (p = 0.038) and odds ratio of 1.002 (95% confidence interval 0.996–1.009) for age-specific anti-Müllerian hormone (p = 0.526). Conclusion: No association has been found between age-specific anti-Müllerian hormone levels and events of silent coronary artery disease in a 10-year follow-up of reproductive-aged women.