Search

Apathy is present at the onset in nearly half the patients with schizophrenia. Current therapies lack the efficiency to improve apathy in patients. The presence of apathy is also associated with poorer outcomes. Despite its clinical importance, the underlying mechanism of apathy in schizophrenia is unclear, but it seems frontostriatal connections play a role. In this study, we investigated whole-brain white matter microstructural properties associated with the severity of apathy-avolition in schizophrenia. We included 80 schizophrenia patients (60 Male, 20 Female) from the Mind Clinical Imaging Consortium database and associated Apathy-Avolition score of "Scale for Assessment of Negative Symptoms" with fiber integrity measures derived from diffusion-weighted imaging using Tract-Based Spatial Statistics (TBSS). We also did tractography on eight tracts, including bilateral superior longitudinal fasciculus, uncinate fasciculus, cingulum, genu and splenium of the corpus callosum. Age, gender, years of education, chlorpromazine equivalent cumulative dose, and acquisition site were inserted as covariates. We showed a widespread association between lower fiber integrity (by measures of increased mean diffusivity and decreased fractional anisotropy) and increased apathy-avolition in TBSS, which we also validated in tractography. Moreover, mean diffusivity, and not fractional anisotropy, was associated with apathy independent of disease severity. In conclusion, we propose diffuse white-matter pathology, within the corpus callosum, limbic system, and the frontostriatal circuit is involved in apathy-avolition in schizophrenia. Also, we suggest that diffuse neuroinflammatory processes may play a part in apathy-avolition, independent of disease severity.

Taurine (Tau) has modulatory effects on inflammatory and oxidative stress biomarkers; however, the results of clinical studies are not comprehensive enough to determine the effect of different durations and doses of Tau supplementation on inflammatory and oxidative stress biomarkers. The current study was conducted based on the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. For this purpose, PubMed/Medline, Scopus, and Embase databases were systematically searched to obtain the relevant studies published before 30th March 2021. Meta-analysis was performed on controlled clinical trials by using the random-effects method. Non-linear relationship between variables and effect size was performed using dose–response and time–response analyses. The Cochrane Collaboration’s tool was used to evaluate the quality of included studies. Tau supplementation can reduce the levels of malondialdehyde (MDA) (SMD = −1.17 µmol/l; 95% CI: −2.08, − 0.26; P = 0.012) and C-reactive protein (CRP) (SMD = −1.95 mg/l; 95% CI: −3.20, − 0.71; P = 0.002). There have been no significant effects of Tau supplementation on the levels of tumor necrosis factors-alpha (TNF-α) (SMD = −0.18 pg/ml; 95% CI: −0.56, 0.21; P = 0.368), and interleukin-6 (IL-6) (SMD = −0.49 pg/ml; 95% CI: −1.13, 0.16; P = 0.141). Besides, Tau has more alleviating effect on oxidative stress and inflammation on 56 days after supplementation (P

Introduction Serum brain-type natriuretic peptide (BNP) levels may be involved in detecting the breakdown of defense mechanisms in pregnant women. BNP and N-terminal pro-BNP (NT-proBNP) levels can be used in emergency settings as a biomarker to rule out or confirm cardiac complications. The present study was conducted as an attempt to evaluate the performance of BNP and NT-proBNP as diagnostic tools for cardiac complications, including heart failure and pre-eclampsia, in pregnant and recently-delivered women. Methods This meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. To extract the data, articles meeting the inclusion criteria were directly reviewed by two of the authors. Disputes were resolved through discussion with all authors before data mining. In cases of unresolved disagreement, a third reviewer was consulted to achieve consensus. A quantitative analysis of the total bias of publications was performed using Stata software version 14.0, using funnel plots and Deek’s test. Results Overall, 13 unique studies were included in this review. The pooled sensitivity, specificity and positive and negative predictive values for diagnosing cardiac complications in pregnant women when BNP level was ≤ 100 ng/L, were determined to be 95, 62, 71 and 91%, respectively. The corresponding measures when the BNP levels were 100–500 ng/L were calculated to be 98, 92, 97 and 92%, respectively. The pooled sensitivity, specificity and positive and negative predictive values for diagnosing cardiac complications in pregnant women using NT-proBNP were 78, 74, 20.5 and 97%, respectively. Conclusion Our results suggest that both BNP and NT-proBNP levels can be used as diagnostic tools among pregnant and newly-delivered women to diagnose cardiac complications, including heart failure and pre-eclampsia. While BNP showed a relatively better diagnostic accuracy compared to NT-proBNP, it must be noted that the number of studies evaluating NT-proBNP included in this meta-analysis was low and the studies were inconsistent in terms of cutoff value. Further studies are required to confirm the prospective use of BNP and NT-pro BNP in assessing common symptoms that indicate cardiac complications during labor. Moreover, the clinical use of the NT-proBNP test in this field requires further study.

Introduction: Hepatitis B is a common viral infection worldwide and the main cause of chronic hepatitis, cirrhosis and liver cell carcinoma. hepatitis B e-antigen (HBeAg) is one of the markers indicating chronic hepatitis B infection. In this cross-sectional study, we investigate serological markers and HBeAg positivity in in children with maternally transmitted hepatitis B virus (HBV).Materials and Methods: Overall, 26 children with congenital HBV referred to Amir Al-Mo’menin Ali hospital in Zabol in 2019 and 2020 were enrolled. After gathering demographic characteristics, blood samples were taken from the patients. Serological tests were performed by routine ELISA tests. Data were analyzed using SPSS software version 22.Results: Twenty-six children were included in the study;18 of them (69.2%) were males. The mean age of the participants was 13.98±11 years (minimum of 1 and maximum of 18 years old). The mean age of mothers was 40.45±10 years (minimum of 27 and maximum of 63 years old). Four (15.4%) of the children were HBeAg positive, and 18 (69.2%) were HBeAb positive with no significant differences between genders (P > 0.05). HBeAg positivity was not associated with the birth rank (P = 0.71) or HBV vaccination (P = 0.17). Liver enzymes, serum albumin and children’s age and duration of maternal infection were not significantly different between HBeAg positive and HBeAg negative groups (P > 0.05). Mean serum alanine transaminase (ALT) was significantly higher in HBeAb positive than HBeAb negative children (P = 0.018), and HBeAb positivity was significantly associated with HBV vaccination history (P = 0.02). Other liver enzymes as well as age of mother and child and the duration of maternal infection were not significantly different between the two groups (P > 0.99). Conclusion: The prevalence of chronic HBV infection based on HBeAg positivity was relatively high in children vertically infected with the virus. HBeAb seroconversion seems to be associated with HBV vaccination.

Studies investigating the effects of spirulina on inflammation and oxidative stress status are controversial. Therefore, the current systematic review and meta-analysis aimed to evaluate the impacts of spirulina supplementation on oxidative stress indicators and inflammatory markers. PubMed-Medline, SCOPUS, Web of Science, Embase databases and Google Scholar were searched up to 1 October 2020. Random-effect analysis was applied to perform meta-analysis. Subgroup analyses and multivariate meta-regression were performed to find heterogeneity sources. Quality assessment was conducted using Cochrane Collaboration's tool. A total of 11 studies that enrolled 465 subjects were included in our meta-analysis. Pooled results demonstrated a significant increase in interleukin-2 (IL-2) concentrations [Standardized mean difference (SMD = 2.69 pg/mL; 95% CI: 0.26, 5.11; P = .03)]; however this result changed to insignificant (SMD = 0.54 pg/mL; 95% CI: -1.29, 2.27; P > .05) when sensitivity analysis performed. A marginal decreasing effect were also found on interleukin-6 (IL-6) (SMD = -0.72 mg/dL; 95% CI: -1.50, 0.07; P = .073) and thiobarbituric acid reactive substances (TBARS) levels (SMD = -0.65; 95% CI: -1.37, 0.08; P = .08). In addition, results of subgroup analysis revealed a significant reduction in IL-6 and TBARS concentrations when the baseline body mass index (BMI) of participants was lower than 25 kg/m2 . Moreover, spirulina had no significant effect on tumour necrosis factor-α (TNF-α) (SMD = -0.07 mg/dL; 95% CI: -0.33, 0.18; P = .56) and malondialdehyde (MDA) concentrations (SMD = -0.42; 95% CI: -0.98, 0.14; P = .14). Spirulina consumption contributed to a significant increase in IL-2 concentrations changing to insignificant after sensitivity analysis and marginal decreasing effects on IL-6 and TBARS levels. No considerable impacts were observed on TNF-α and MDA concentrations.

Background: The novel coronavirus (COVID-19) is considered as the most life-threatening pandemic disease during the last decade. The individual nutritional status, though usually ignored in the management of COVID-19, plays a critical role in the immune function and pathogenesis of infection. Accordingly, the present review article aimed to report the effects of nutrients and nutraceuticals on respiratory viral infections including COVID-19, with a focus on their mechanisms of action. Methods: Studies were identified via systematic searches of the databases including PubMed/ MEDLINE, ScienceDirect, Scopus, and Google Scholar from 2000 until April 2020, using keywords. All relevant clinical and experimental studies published in English were included. Results: Protein-energy malnutrition (PEM) is common in severe respiratory infections and should be considered in the management of COVID-19 patients. On the other hand, obesity can be accompanied by decreasing the host immunity. Therefore, increasing physical activity at home and a slight caloric restriction with adequate intake of micronutrients and nutraceuticals are simple aids to boost host immunity and decrease the clinical manifestations of COVID-19. Conclusion: The most important nutrients which can be considered for COVID-19 management are vitamin D, vitamin C, vitamin A, folate, zinc, and probiotics. Their adequacy should be provided through dietary intake or appropriate supplementation. Moreover, adequate intake of some other dietary agents including vitamin E, magnesium, selenium, alpha linolenic acid and phytochemicals are required to maintain the host immunity.

Objectives According to the recent epidemiological studies, patients with diabetes mellitus (DM) may be at higher risk of hospitalization due to COVID-19. Regarding the important role of nutrition on the immunity, the present review article aimed to outline nutritional support of DM during the outbreak of COVID-19 with a mechanistic insight. Methods Searches were performed in PubMed/MEDLINE, ScienceDirect, Scopus, and Google Scholar databases from 2000 until December 2020 using the following keywords. All relevant clinical and experimental studies published in English were included. Results Evidences revealed that hyperglycemia is a significant predictor of some viral infections including COVID-19 which can exacerbate the complications of DM. According to the literature review, adequate intake of dietary protein, fiber, essential fatty acids and some micronutrients especially vitamins D, C, B12, folate, zinc and selenium has beneficial effects on the prevention and treatment of COVID-19 in diabetic patients through modulation of innate and adaptive immune responses or direct effects on virus enzymes or the rate of cell entrance. Conclusions It is well understood that malnutrition may increase susceptibility to viral infections and disease progression. Therefore, considering nutritional status of diabetic patients and reasonable supplementation of the above mentioned nutrients can ameliorate the symptoms of COVID-19 in DM. However, further well-designed clinical trials are needed to determine their therapeutic dose.

Nonalcoholic fatty liver disease (NAFLD) has become the most common cause of liver dysfunction worldwide. Recently, some natural compounds have attracted growing interest in the treatment of NAFLD. In this context, most attention has been paid to natural products derived from fruits, vegetables, and medicinal herbs. Naringenin, a natural flavanone, has been revealed to have pharmacological effects in the treatment of obesity and associated metabolic disorders such as NAFLD. The aim of this study was to examine the therapeutic effects of naringenin and its possible mechanisms of action in the management of NAFLD and related risk factors. The current systematic review was performed according to the guidelines of the 2015 PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) statements. We searched PubMed/Medline, Science Direct, Scopus, ProQuest, and Google Scholar databases up until February 2020. Of 1217 full-text articles assessed, 36 studies met the inclusion criteria. The evidence reviewed in the present study indicates that naringenin modulates several biological processes related to NAFLD including energy balance, lipid and glucose metabolism, inflammation, and oxidative stress by different mechanisms. Overall, the favorable effects of naringenin along with its more potency and efficacy, compared with other antioxidants, indicate that naringenin may be a promising therapeutic approach for the management of NAFLD and associated complications. However, due to the lack of clinical trials, future robust human randomized clinical trials that address the effects of naringenin on NAFLD and other liver-related diseases are crucial. Further careful human pharmacokinetic studies are also needed to establish dosage ranges, as well as addressing preliminary safety and tolerability of naringenin, before proceeding to larger-scale endpoint trials.

Aims and background: Obesity is recognised as a significant public health burden worldwide. Recently the cross-talk between gut microbiota and obesity has attracted much attention. To that end, Akkermansia muciniphila has been proposed as a promising microbe to manage obesity. In the present systematic review, we evaluated evidence on the effectiveness and mechanisms of action of Akkermansia muciniphila supplementation in the management of obesity. Methods: Electronic databases of MEDLINE, PubMed, Scopus, Web of Science, and Google Scholar were searched thought March 2020 to identify relevant published articles, and eligible articles were systematically reviewed. Results and conclusions: Fifteen studies were included in the present study. Findings from the present review, which included human and animal (rodent) models support the effectiveness of Akkermansia supplementation as a novel therapeutic approach for the management of obesity and metabolic complications associated with obesity. However, future clinical trials are warranted to verify these outcomes. © 2021 Informa UK Limited, trading as Taylor & Francis Group.

The prevalence of childhood obesity has increased worldwide and various environmental factors have accelerated this trend. Several reports have suggested that food advertising causes childhood obesity. We proposed a review study to evaluate the relationship between TV food advertisements and obesity in children. By searching over electronic databases (including PubMed, Web of Science, Scopus, and Google Scholar), the reference lists of original studies, and reviews using key search terms, 1181 articles were identified. Out of these, only 9 articles met the inclusion and quality criteria. Most of the longitudinal study carried out at the national level have reported a significant association between commercial viewing and BMI in children. The duration of these studies varied between 7 months and 5 years. The children’s TV viewing time was between 1.5 and 3.5 hours per day. Results of the reviewed studies have revealed a controversial attitude about the influence of TV food advertisements on obesity. However, three of four modeling studies indicated an increment in the prevalence of overweight and obesity following exposure to food advertisements. Further interventional and longitude studies are needed to achieve more precise results.

Background: This study aimed to investigate the association between dietary patterns and non-alcoholic fatty liver disease (NAFLD) among Iranian adults. Methods: This case-control study was conducted on 210 subjects. NAFLD diagnosis was made by ultrasound examination. Anthropometric measures, physical activity, fasting serum levels of glucose, alanine aminotransferase (ALT), aspartate aminotransferase, and lipid profile were assessed. A three-day food diary was used to assess dietary intakes of the subjects. Dietary patterns were determined using factor analysis. To determine the relationship between dietary patterns and NAFLD, multivariable-adjusted odds ratio (OR) obtained from the logistic regression analysis was used. Results: Two dietary patterns were extracted as follows: vegetables, legumes, fruits, and low-fat dairy products (VLFD) ; and sweet, hydrogenated fat, red and processed meat, and soft drink (SHMS) dietary patterns. By taking all possible confounders into account, the VLFD dietary pattern was found to be significantly related to lower odds of NAFLD, while the SHMS dietary pattern was independently related to higher odds of NAFLD (P < 0.05). Among major food groups, high consumption of processed meat, hydrogenated fats, sweets and desserts, and soft drinks was positively related to NAFLD (P < 0.05), whereas vegetable consumption exhibited a protective role against NAFLD (P = 0.01). Conclusion: The VLFD dietary pattern was associated with reduced likelihood of having NAFLD, while the SHMS dietary pattern was associated with higher likelihood. Therefore, the VLFD dietary pattern might be useful in the nutritional strategies for NAFLD patients. Further studies with larger sample sizes and prospective design are warranted.

Objectives: To determine the status of primary osteoporosis and evaluate the effects of curcumin nanomicelles, Nigella sativa oil, and curcumin nanomicelles plus N. sativa oil compared to placebo on cellular-molecular and clinical outcomes. Materials and Methods: The study protocol will be implemented in two phases. The first phase is a cross-sectional study aiming at determining the prevalence of primary osteoporosis and its risk factors, especially cellular-molecular factors in 528 postmenopausal women aged 50-65 years in Tabriz, Iran through simple random sampling. The second phase is a triple-blind factorial randomized controlled clinical trial. In this phase, patients with primary osteoporosis, identified with dual-energy X-ray absorptiometry, will be randomly divided into equal four groups of 30 individuals in a triple-blind factorial randomized controlled trial. The four group included N. sativa oil soft capsules (one capsule 1000 mg/d) and placebo- curcumin nanomicelles, curcumin nanomicelles soft capsules (one capsule 80 mg/d) and placebo-N. sativa, N. sativa oil, and curcumin nanomicelles soft capsules, and both placebos for six months. Results: The prevalence of primary osteoporosis and its relationship with several parameters will be determined in phase 1, including socio-demographic-obstetric-medical characteristics, anthropometric indices, body composition, lifestyle, osteoporosis-related microRNAs, inflammatory and oxidative biomarkers, bone turnovers, and some gene polymorphisms. Finally, changes in mean bone mineral density (BMD), bone turnovers, inflammatory and oxidative biomarkers, and esteoporosis-related microRNAs will be evaluated in phase 2. Conclusions: The present study can significantly contribute to the prognosis of the disease and the selection of an appropriate herbal supplement given the cost-effectiveness of herbal compounds as pharmaceutical adjuvants.

PURPOSE: Spexin, a novel 14-amino acid peptide, has multiple physiological functions. The purpose of this paper was to systematically evaluate the current literature on the role of Spexin neuropeptide in obesity and its related comorbidities, food intake and overall metabolic status in human, animal and in vitro studies. METHODS: Multiple databases, including PubMed, EMBASE, ProQuest, Scopus and Google Scholar were searched for English-language papers published since inception until December 2018, that investigated Spexin levels in relation to chronic metabolic diseases, overall metabolism control and feeding-related behaviors.The quality of the included observational studies was assessed by a version of the Newcastle Ottawa Scale (NOS) designed for non-randomized studies and SYRCLE’s assessment tool for animal models. RESULTS: Out of 224 records screened, search results led to a total of 24 related studies (12 human studies (ten cross-sectional studies, one cohort study, and one longitudinal study) and 12 studies in either animals or in vitro).Nine of the included cross-sectional studies and one Longitudinal study had moderate to good study quality, and one cross-sectional and one cohort study had high-quality (or low risk of bias). CONCLUSION: It appears that Spexin has a positive impact on overall metabolic status. As a novel appetite-regulating peptide, Spexin can act as an anorexigenic factor. Information about Spexin is very limited, and well-designed randomized controlled clinical trials are warranted for replicating, validating, and extending the current findings. PROSPERO REGISTRATION NUMBER: CRD42018117198). ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s40200-020-00636-8) contains supplementary material, which is available to authorized users.

Background: Non-alcoholic fatty liver disease (NAFLD) is the most frequent cause of chronic liver disease in the world. The current interventional trial aimed to evaluate the effects of supplementation with oleoylethanolamide (OEA) in combination with weight loss intervention on some atherogenic indices as well as hematological parameters in patients newly diagnosed with NAFLD. Methods: In this triple-blinded, randomized, placebo-controlled clinical trial, 76 obese patients with NAFLD confirmed by ultra-sonographic findings were randomly assigned to receive a weight reduction diet plus either 250 mg OEA (n=38) or placebo (n=38) for 12 weeks. Atherogenic factors including total cholesterol/high-density lipoprotein cholesterol (HDL-C),low-density lipoprotein cholesterol (LDL-C)/HDL-C, triglyceride (TG)/HDL-C, non-HDL-C/HDL-C ratios and non-HDL-C level, as well as hematological parameters were assessed before and after intervention. Results: After adjustment for potential confounding factors, between group analyses demonstrated a significantly lower LDL-C/HDL-C, TG/HDL-C, and non-HDL-C/HDL-C ratios in the OEA group compared to the placebo, post-intervention (95% confidence interval [CI]:0.06 to 0.85, P = 0.024; 95% CI: -2.06 to -0.05, P = 0.039; 95% CI: -1.05 to -0.02, P = 0.042,respectively). Additionally, OEA supplementation could significantly decrease the levels of red blood cell distribution width (RDW) compared to the placebo at the endpoint after considering potential confounding variables (95% CI: -0.56 to -0.003, P = 0.041). No significant differences were found between the two study groups in terms of other hematological parameters. Conclusion: The results of the current study indicated that OEA supplementation had beneficial effects on LDL-C/HDL-C, TG/HDL-C, and non-HDL-C/HDL-C ratios as well as RDW in obese patients with NAFLD. Trial Registration: IRCT20110530006652N2; https://www.irct.ir/trial/37228.

Background Irritable bowel syndrome (IBS) is one of the most frequent and recurrent gastrointestinal diseases. However, up to now, no pharmacological agent has been approved to treat IBS. Emerging evidence showed that inflammation has a vital role in enhancing nervous system sensitivity and perception of abdominal pain in subjects with IBS. Propolis is an herbal substance with a broad spectrum of antioxidants, anti-inflammatory, and prebiotic properties, which might exert beneficial effects to reduce the severity of IBS. The current clinical trial aims to evaluate the efficacy of propolis supplementation on IBS. Methods This single-center, randomized, double-blind, placebo-controlled clinical trial will be performed to evaluate the effect of propolis supplementation in adult patients with IBS diagnosed with Rome IV criteria. Fifty-two eligible patients will randomly be allocated to receive a propolis tablet (450 mg, containing 100 mg polyphenol compounds) or identical placebo, twice daily for 6 weeks. The primary outcome of the trial is an improvement in IBS severity from baseline to the sixth week of intervention. The secondary outcomes include the change in weight, waist circumference, and IBS quality of life. We will use the paired sample t test or Mann-Whitney U test for the within-group comparison and independent sample t test or Wilcoxon rank-sum and chi-square test or Fisher’s exact test for the between-group comparison. Besides, a multivariable-adjusted mean effect will be computed using the ANCOVA test. Discussion We hypothesize that propolis supplementation would be useful for treating IBS through its antioxidants, anti-inflammatory, and prebiotic properties. This trial will show the results of propolis supplementation, whether positive or negative, on IBS. If the current trial confirms our hypothesis, propolis supplementation can be a new choice in adjunctive therapy of IBS. Trial registration Iranian Registry of Clinical Trials IRCT20190708044154N1. Registered on 26 December 2019. Updated on 13 February 2020. https://en.irct.ir/trial/40983 Sponsor Tabriz University of Medical Sciences, Tabriz, Iran

New evidence indicates that overproduction of pro-inflammatory cytokines is responsible for the development of diabetes difficulties. Some herbals such as saffron, may control inflammation and improve the hyperglycemic states in diabetic patients. Therefore, this investigation aimed to assess the effects of saffron supplementation on fasting glucose and inflammatory markers levels in patients with type2 diabetes mellitus (T2DM).In this randomized double-blind, placebo-controlled clinical trial, 60 T2DM patients were randomly assigned into two groups as saffron and placebo (n = 30) receiving 100 mg/day saffron powder or starch capsules (1 capsule) for a duration of 8 weeks. Fasting blood sample was collected at baseline and at the end of the intervention. Fasting blood glucose (FBG) was immediately analyzed by the auto-analyzer. The serum level of Interleukin -6 (IL-6), Tumor necrosis factor-alpha (TNF-α), and Interleukin-10 (IL-10) were measured using ELISA assay by laboratory kits. Also, Real-time quantitative reverse transcription (RT-PCR) assay measured the expression level of TNF-α, IL-6, and IL-10 at the mRNA level.Saffron supplementation significantly decreased the FBG levels within 8 weeks compared to placebo (130.93 ± 21.21 vs 135.13 ± 23.03 mg/dl, P = 0.012). Moreover, the serum level of TNF-α notably reduced in the saffron group compared to the placebo group (114.40 ± 24.28 vs 140.90 ± 25.49 pg/ml, P 0.001). Also, saffron supplementation significantly down-regulated the expressions of TNF-α (P = 0.035) and IL-6 mRNA levels (P = 0.014).In our study, it was indicated that saffron modulates glucose levels as well as inflammation status in T2DM patients through decreasing the expressions levels of some inflammatory mediators. Also, further investigations are necessary to confirm the positive effects of saffron as a complementary therapy for T2DM patients.

Background and Importance: Secondary complications after SARS-CoV-2 virus infection including cardiovascular and neurological pose additional morbidity and mortality. The data on spondylodiscitis with spinal abscess after COVID-19 infection is very limited. Case Presentation: A 71-year-old man presented with tachypnea and cough since 24 hours before admission. He was febrile and his chest CT showed typical picture of bilateral covid-19 pneumonia. Nasopharyngeal swabs showed a positive PCR for COVID-19. The patient was admitted to the intensive care unit (ICU) due to low oxygen saturation. Forty-eight hours after admission, the patient started to develop paraparesis which rapidly progressed to paraplegia within a few hours. In MRI scan, multilevel spondylodiscitis and epidural abscess in the thoracic spine were observed. Urgent surgery was performed and the patient was treated medically with hydroxychloroquine and Favipiravir for COVID-19. Calculated antibiotic treatment with meropenem and vancomycin. No COVID-19 was detected in the abscess samples. The patient passed away later due to multiorgan failure. Conclusion: Spondylodiscitis with spinal abscess secondary to COVID-19 infection is a severe condition and might be a consequence of dysbalanced immune response with immunodepression after COVID-19 infection.

Background: Planning for obesity prevention is an important global health priority. Our aim in this study was to find the optimal cut-off points of waist circumference (WC), waist- to- hipratio (WHR) and waist- to- height ratio (WHtR), as three anthropometric indices, for prediction of overweight and obesity. We also aimed to compare the predictive ability of these indices to introduce the best choice. Methods: In this cross-sectional study, a total of 500 subjects were investigated. Anthropometric indicators were measured using a standard protocol. We considered body mass index (BMI) as the simple and most commonly used index for measuring general obesity as the comparison indicator in the present study to assess the diagnostic value for other reported obesity indices.We also performed receiver operating characteristic (ROC) curve analysis to define the optimal cut-off points of the anthropometric indicators and the best indices for overweight and obesity. Results: The proposed optimal cut-offs for WC, WHtR, and WHR were 84 cm, 0.48 and 0.78for women and 98 cm, 0.56 and 0.87 for men, respectively. The area under the ROC curve ofWHtR (women: AUC=0.97, 95% CI: 0.96-0.99 vs. men: AUC=0.97, 95%CI: 0.96-0.99) and WC(women: AUC=0.97, 95% CI, 0.95-0.99 vs. men: AUC=0.98, 95% CI: 0.97-0.99) were greater than WHR (women: AUC=0.79, 95% CI =0.74-0.85 vs. men: AUC=0.84, 95% CI=0.79-0.88). Conclusion: This study demonstrated that the WC and WHtR indicators are stronger indicators compared to the others. However, further studies using desirable and also local cutoffs against more accurate techniques for body fat measurement such as computerized tumor (CT) scans and dual-energy x-ray absorptiometry (DEXA) are required.

Along with an increase in overweight and obesity among all age groups, the development of efficacious and safe anti-obesity strategies for patients, as well as health systems, is critical. Oleoylethanolamide (OEA), a high-affinity endogenous ligand of nuclear receptor peroxisome proliferator-activated receptor alpha (PPAR-α), plays important physiological and metabolic actions. OEA is derived from oleic acid, a monounsaturated fatty acid, which has beneficial effects on body composition and regional fat distribution. The role of OEA in the modulation of food consumption and weight management makes it an attractive molecule requiring further exploration in obesogenic environments. This systematic review was conducted to assess the effects of OEA on the obesity management, with emphasizing on its physiological roles and possible mechanisms of action in energy homeostasis. We searched PubMed/Medline, Google Scholar, ScienceDirect, Scopus, ProQuest, and EMBASE up until September 2019. Out of 712 records screened, 30 articles met the study criteria. The evidence reviewed here indicates that OEA, an endocannabinoid-like compound, leads to satiation or meal termination through PPAR-α activation and fatty acid translocase (FAT)/CD36. Additionally, the lipid-amide OEA stimulates fatty acid uptake, lipolysis, and beta-oxidation, and also promotes food intake control. OEA also exerts satiety-inducing effects by activating the hedonic dopamine pathways and increasing homeostatic oxytocin and brain histamine. In conclusion, OEA may be a key component of the physiological system involved in the regulation of dietary fat consumption and energy homeostasis; therefore, it is suggested as a possible therapeutic agent for the management of obesity.

BACKGROUND/OBJECTIVES Clinical efficacy of zinc (Zn) supplementation in the improvement of oxidative stress biomarkers has been investigated in some clinical trial studies. The purpose of the current dose-response meta-analysis is to systematically aggregate and evaluate all related studies to highlight the possible effect of Zn supplementation on oxidative stress. METHODS Systematic search was performed on Scopus, PubMed/Medline, Web of Science and Embase up to 31 December 2020. The random effect method was used to perform pooled analysis. Possible sources of heterogeneity were found using subgroup analysis and meta-regression. In the presence of publication bias, trim and fill analysis was performed to adjust the results. Non-linear relationship between effect size and variables was investigated by performing dose-response analysis. The quality of included studies was assessed using Cochrane Collaboration's tool. RESULTS Pooled-analysis of 18 studies showed that Zn supplementation improved MDA and Hcys levels (SMD = -1.53 μmol/L; 95% CI: -2.22, -0.85; P

Objective. Studies have reported controversial findings regarding the flaxseed oil effect on antioxidant status biomarkers. The present meta-analysis aimed to determine the impact of flaxseed oil on the serum level of biomarkers of oxidative stress. Methods. A systematic search was conducted up to November 2020 on PubMed, Embase, Web of Science, Scopus, and Cochrane Central Library. Random-effects model was employed to perform meta-analysis. Subgroup analysis was carried out to determine the effect across different ranges of dosages and durations. Results. Eight trials were included with a total sample size of 429 individuals with a mean age range of 25 to 70 years. The results indicated that flaxseed oil supplementation led to a significant decrease in malondialdehyde (MDA) levels (SMD: −0.52 μmol/L; 95% CI: −0.89, −0.15; P = 0.006 , I2 = 71.3, P < 0.001 ) and increase in total antioxidant capacity (TAC) levels (WMD: 82.84 mmol/L; 95% CI: 19.80, 145.87; P = 0.006 , I2 = 92.7, P < 0.001 ). No significant effect was observed on glutathione (GSH). Conclusion. Our findings revealed that flaxseed oil supplementation might play a beneficial role in the reinforcement of the antioxidant defense system and amelioration of oxidative stress in adults.

This study aimed to investigate the consequence of Ramadan fasting on gut bacterium (Bacteroides and Firmicutes), serum concentration for butyrate, and lipid profile.Thirty healthy subjects were enlisted and investigated two times (before and at the end of Ramadan). Fasting blood samples were obtained for measuring fasting blood sugar (FBS) and lipid profile and serum butyrate concentration. Anthropometrics variables were measured before and after Ramadan for all 30 subjects. Quantitative reverse transcription polymerase chain reaction (RT-PCR) analysis, targeting the genome of Bacteroides and Firmicutes was performed to determine its presence in the stool samples. Food intake was assessed by a 3-day food record before and after Ramadan. Statistical analysis was performed by SPSS ver.13 and Minitab ver.17. P0.05 considered the level of significance.The study results showed that serum levels of butyrate significantly increase during the month from 0.23 ± 0.02 mM to 0.46 ± 0.03 mM (P0.05). The gut Bacteroides and Firmicutes increased by 21 and 13 percent after Ramadan compared to before (P0.05). The increment in Bacteroides occurred in both sexes, but Firmicutes significantly increased only in women. Food intake was decreased during Ramadan. Ramadan fasting caused significant reduction in BMI from 25.72 ± 0.58 kg/m2to 25.25 ± 0.55 kg/mIt can be stated that the promotion of Bacteroides and Firmicutes in the gut might play a crucial role in health promotion. However, more research is needed to achieve a definite conclusion.

Background Spirulina, a type of blue-green algae, is used as an adjuvant treatment of metabolic and inflammatory diseases. Evidence about the effects of spirulina on antioxidant system are conflicting. Thus, this quantitative review aimed to summarize the effects of spirulina administration on antioxidant status biomarkers. Methods Systematic searches were conducted using the PubMed/Medline, Scopus, Web of Science, and EMBASE, up to May 2021. Random effect analysis was applied to perform meta-analysis. Subgroup analyses and multivariate meta-regression were performed to find heterogeneity sources. Quality assessment was conducted using Cochrane Collaboration's tool. Trim and fill analysis were also carried out in case of the presence of publication bias. Results A total of 9 articles that enrolled 415 subjects were included in the present meta-analysis. Obtained findings exhibited that spirulina supplementation had marginal significant effect on total antioxidant capacity (TAC) (SMD= 0.49; 95% CI: -0.001, 0.98; P=0.05) and superoxide dismutase (SOD) activity (SMD=0.72; 95% CI: -0.03, 1.46; P=0.06), while did not affect glutathione peroxidase (GPx) activity (SMD= 0.27; 95% CI: -0.23, 0.77; P=0.29). Conclusions Spirulina consumption may exert beneficial effects on enhancement of antioxidant system. A marginal significant increasing effect on TAC and SOD activity were found by spirulina administration. However, it did not affect GPx activity.

Inositol is a sugar-alcohol and recognized as a key component of cell membrane phospholipids. It has crucial role in the cell signaling pathways and contribute to improving glycemic responses. Although some earlier studies have revealed the effect of inositol mediating glucose uptake by improving insulin sensitivity, the benefit of inositol supplementation in patients with overweight and obesity is not completely understood. This study aimed to assess the impact of inositol supplementation on body mass index (BMI) through a systematic review and meta-analysis of controlled clinical trials.A systematic search was performed to August 2021 in the following databases: PubMed-Medline, Embase, Web of Science and Scopus. Fifteen controlled clinical trials investigating the effect of inositol on adult's BMI were finally included in the study. A random-effects model was employed to estimate the effect size. Subgroup analysis was performed by dose, duration, age, type of inositol. Meta-regression was used to investigate presence of any linear relationship. Begg's and Egger's tests were carried out to detect small study effect.The results of pooled analysis showed that inositol supplementation significantly decreased BMI scores (WMD = -0.41 kg/mThe meta-analysis suggests that oral inositol supplementation has positive effect on BMI reduction. Inositol supplementation could be considered as an adjunct treatment to improve body mass index.

This trial evaluated the potential impacts of saffron aqueous extract (SAE) and its main carotenoid on some of the atherosclerosis-related gene expression and serum levels of oxidized low-density cholesterol (ox-LDL) and Monocyte chemoattractant protein 1 (MCP-1) in patients with coronary artery disease (CAD). Participants of this randomized controlled trial included 84 CAD patients who categorized into three groups: Group 1 received crocin (30 mg/day), Group 2 SAE (30 mg/day), and Group 3 placebo for 8 weeks. Gene expression of Sirtuin 1 (SIRT1), 5'-adenosine monophosphate-activated protein kinase (AMPK), Lectin-like oxidized LDL receptor 1 (LOX1), nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB), and MCP-1 in peripheral blood mononuclear cells assessed by real-time PCR. Furthermore, serum ox-LDL and MCP-1 levels measured at the beginning and end of the intervention. Compared with the placebo group, gene expression of SIRT1 and AMPK increased significantly in the crocin group (p = .001), and the expression of LOX1 and NF-κB decreased significantly (p = .016 and .004, respectively). Serum ox-LDL levels decreased significantly in the crocin group after the intervention (p = .002) while MCP-1 levels decreased both in crocin and SAE groups (p = .001). Crocin may have beneficial effects on CAD patients by increasing the gene expression of SIRT1 and AMPK and decreasing the expression of LOX1 and NF-κB.

Purpose This paper aims to study the impact of combination Lactobacillus Rhamnosus Heriz I and Beta glucan on quality of life (QOL) in breast cancer (BC) patients receiving chemotherapy. Design/methodology/approach In all, 30 women with BC were enrolled in this randomized double-blind placebo-controlled clinical trial. Intervention group received either daily one capsule of L. rhamnosus strain Heriz I (2 × 107 CFU) and two 10-mg capsules of soluble1–3,1–6,D-beta glucan and the placebo group receiving placebo, interval between two courses of chemotherapy. Health-related QOL was evaluated at baseline and end of the trial using the EORTC QOL Questionnaire version.3.0 (EORTC QLQ-C30). Findings The results showed that combination of L. rhamnosus Heriz I and Beta glucan supplementation in BC patients during chemotherapy improved functional scales score from 37.3 ± 12.1 to 39.8 ± 6.8 and this increase in comparison with placebo was significant after adjusting baseline value (p = 0.015). Changes in symptoms scores were not significant after intervention (p = 0.05) but the decreased score (66.1 ± 12.9 to 60.6 ± 9.4) was considerable clinically. As well as, changes in global health status/QOL score in intervention group in comparison with the placebo group was not significant (p = 0.93). Originality/value The findings suggest that combination of L. rhamnosus Heriz I and Beta glucan may be associated for improving functional scales and symptoms in patients with BC who underwent chemotherapy. To prove positive effect of supplements on other aspects of QOL, further studies are needed.

Introduction: Nowadays, prevalence of metabolic syndrome (MetS) is increasing in the world. There are inconsistence findings about the relationship between food insecurity and MetS. Therefore, the aim of this cross-sectional study was to determine the association between food insecurity and MetS in North West of Iran. Methods: The anthropometric measurements, food insecurity, dietary intake, blood pressure, fasting blood glucose (FBS), serum triglyceride and HDL levels of 151 subjects who had participated in Azar cohort study were evaluated. Food security was assessed by Household Food Security Scale (HFIAS) (six-item short questionnaire) and dietary intake (using 24- hour recall questionnaire) of participants. MetS was defined according to National Cholesterol Education Program’s Adult Treatment Panel III report (ATPIII) criteria. Results: On the basis of HFIAS and energy, 7.3% and 11.9% of participants were food insecure and hunger, respectively. We observed no significant differences in mean body weight, BMI, waist circumference and FBS between food insecure and secure groups. Moreover, obesity (41.7% vs 30.2%) and MetS (45.5% vs 30%) were more prevalent in the food insecure group but the differences were not significant. Conclusion: The most percent of participants in food insecure were obese and had MetS. However, we could not find significant differences between food insecure and food secure groups. Therefore, for achieving more clear results, further studies with large sample size are needed.

Purpose This paper aims to evaluate the prevalence of general obesity (GO) and abdominal obesity (AO) in the north-west of Iran and investigate the association with food choices and socioeconomic status (SES). Design/methodology/approach In this cross-sectional study, 500 subjects aged ≥ 18 years were studied. Data on their basic characteristics, anthropometric measurements, dietary habits and physical activity were collected. The authors examined the association between GO and AO with SES and food choices using multiple logistic regression analysis. Findings The prevalence of GO and AO was 26.6 and 43.4%, respectively. A positive association was observed between age and GO (p for trend p for trend 0.005) in both sexes. However, a negative correlation was detected between education and income with GO and AO (p for trend Originality/value Educational attainment, greater income and a higher intake of some specific food groups were associated with lower odds of obesity in the area. More population-based investigations are required to develop effective preventive strategies to control the status of being overweight and obesity in different regions.

Background: In traditional medicine, Dill has been used for the treatment of gastrointestinal disorder and also for its hypoglycemic and lipid lowering effects. So, the aim of this study was to determining effect of long-term dill extract supplementation alone and along with regular aerobic training on lipid profile in serum of men hyperlipidemic patients. Methods: 60 male patients with hyperlipidemia after completing consent forms were randomized divided into four homogeneous groups; control, aerobic training, dill extract, and aerobic training along with dill extract. Furthermore, consumption of oral dill essential oil (2 mg.kg-1.day) along with aerobic exercise training protocol for 8-weeks performed (sessions were conducted 3 times a week, each lasting 45 minutes running on the treadmill). Blood samples were taken at two phases (48 hours before and after the last training session protocol) were collected. Results: The levels of the total cholesterol and triglyceride in the experimental groups significantly decreased in compared the pre-intervention period (P

Purpose: The present study aimed to assess the effect of ginger (Zingiber officinale) powder supplementation on Helicobacter pylori eradication and improvement of dyspeptic symptoms in patients with H. pylori positive functional dyspepsia (FD). Methods: During this pilot study 15 patients with H. pylori positive FD received 3 g/d ginger powder as three 1-g tablets for 4-weeks. Dyspepsia symptoms were asked before and after the intervention using a questionnaire based on the Rome III criteria. H. pylori eradication was also assessed by a non-invasive stool antigen (HpSAg) test. Results: Ginger consumption accompanied by significant H. pylori eradication rate of 53.3% (P = 0.019) and the odds ratio (95% CI) was 8 (1.07 to 357.14). Moreover, our results showed significant changes in most of the dyspepsia symptoms after ginger supplementation. Conclusion: According to our findings, Z. officinale can be considered as a useful complementary therapy for FD. However, due to the small number of clinical trials in this area, further welldesigned clinical trials are needed to explicitly talk about its effectiveness especially about the eradication of H. pylori.

Introduction: Metabolic syndrome (Mets) has become most important public health problem in the world. We examined the association between Mets and different cardiometabolic phenotype in Azar cohort population. Methods: In the present study, the data of 13099 subjects who participated in Azar cohort study were cross-sectionally analyzed. Mets was defined according to the National Cholesterol Education Program’s Adult Treatment Panel III report (ATPIII) criteria. Participants were categorized into four cardiometabolic phenotypes including metabolically healthy Lean (MHL), metabolically unhealthy lean (MUHL), metabolically healthy Obese (MHO), metabolically unhealthy obese (MUHO) according to BMI cut–off point (25 kg/m2 ), and the presence of Mets. Results: Totally, the prevalence of Mets was 33.20% with the higher prevalence in women (40.1%). About 46.7% of participants were MHO and 1.6% of them were MHL. In both genders, MUHL had the highest prevalence of hyperglycemia, hypertrigliceridemia, hypo-HDL-cholestrolemia and Frahmingham 10-year CVD risk. In both MUHL and MUHO phenotypes, hypertriglyceridemia (OR: 31.97 [95% CI: 22.31, 45.81] and OR: 20.28 [95% CI: 17.32, 23.75]) and hypo-HDL cholestrolemia (OR:27.97 [95% CI: 17.35, 45.09] and OR:11.0 [95% CI: 9.62, 12.58]) are the strongest predictor of incidence of Mets. Also, the results of multinominal regression analyses indicated that in all cardiometabolic phenotypes, Framingham 10- year CVD risks had the lowest power for predicting of Mets incidence. Conclusion: Based on the results, in addition to obese individuals, multiple metabolic abnormalities were seen in normal weight individuals and these subjects are even at higher risk of developing Mets compared with metabolically obese individuals. So, it seems that decision on initiation of lifestyle interventions should not be only based on the BMI; rather metabolic status seems to be even more important.

Background and purpose: Molecular mechanisms of atherogenesis are considered to be emerging therapeutic targets for atherosclerosis prevention. Cell and animal studies have shown that crocetin can decelerate atherogenesis. However, the anti-atherogenic properties of crocetin in humans are still ambiguous. Methods and results: Fifty clinically diagnosed CAD patients were randomly divided into two parallel groups, crocetin and placebo, who received one capsule of crocetin (10 mg) and placebo per day, respectively, for two months. Serum circulating homocysteine (Hcy) [−1.09 (−1.64 to −0.54) μM, P = 0.001], heart-type fatty acid binding protein (h-FABP) [−2.07 (−2.72 to −1.43) ng mL−1, P = 0.001], intercellular adhesion molecule 1 [−14.92 (−21.92 to −7.92) ng mL−1, P = 0.001], vascular cell adhesion molecule 1 [−18.61 (−29.73 to −7.49) ng mL−1, P = 0.002], and monocyte chemoattractant protein 1 [−4.67 (−6.50 to −2.83) pg mL−1, P = 0.001] decreased significantly after the trial in the crocetin group, while high-density lipoprotein (HDL) significantly increased [+4.21 (0.68 to 7.73) mg mL−1, P = 0.021]. Also, systolic [−0.21 (−0.32 to −0.10) mmHg, P = 0.001] and diastolic [−0.20 (−0.34 to −0.07) mmHg, P = 0.004] blood pressures decreased significantly in the crocetin group. Nevertheless, clinically significant percentage changes were only observed in Hcy (−15.25 ± 3.15, μM), HDL (−10.70 ± 5.06, mg dL−1), and h-FABP (−21.10 ± 3.09, ng mL−1) in the crocetin group. Furthermore, the relative increase in the gene expressions of sirtuin1 and AMP-activated protein kinase and a decrease in the lectin-type oxidized LDL receptor 1 and nuclear factor-kappa B expression in isolated peripheral blood mononuclear cells in the crocetin group were significant at the end of the trial in comparison with the placebo. Conclusion: As the first human study, we showed the ability of crocetin to alter the expression of atherogenic genes and endothelial cell adhesion molecules in CAD patients. It appears that crocetin could be considered as a promising anti-atherogenic candidate for future studies.

BACKGROUND Type 2 diabetes (T2D) is a metabolic disorder that is related to hyperglycaemia, hyperlipidaemia and liver dysfunction and has detrimental effects on a patient's mental health. Hence, the current study investigated the effects of saffron supplementation on dietary intake, anthropometric measures, mood, sleep quality and metabolic biomarkers in overweight/obese patients with T2D. METHODS In a double-blind, randomised controlled trial, 70 overweight/obese patients with T2D were randomly allocated to two groups and received 100 mg/day saffron or placebo for 8 weeks. Participants completed the Beck depression inventory-II (BDI-II), Hurlbert index of sexual desire (HISD), Pittsburgh Sleep Quality Index (PSQI) and Diabetes-specific Quality-of-Life Brief Clinical Inventory questionnaires (DQOL-BCI). Dietary intake, anthropometric measures, fasting plasma glucose (FPG), haemoglobin A1C (HbA1C), insulin, lipid profile and liver enzymes were determined at baseline and the end of the study. RESULTS At the end of the eighth week, saffron supplementation significantly decreased FPG, triglyceride (TG), insulin, aspartate aminotransferase (AST) and alanine aminotransferase (ALT) (P

OBJECTIVES Obesity and dyslipidaemia are the major risk factors for non-alcoholic fatty liver disease (NAFLD), and are known to increase cardiovascular disease (CVD), which is the leading cause of death in NAFLD patients. The present cross-sectional study aimed to investigate associations among severity of hepatic steatosis, NAFLD fibrosis score and atherogenic lipid profile. METHODS A total of 265 patients with NAFLD confirmed by ultrasonographic findings were included. The NAFLD fibrosis score and the fibrosis-4 (FIB-4) index were used to classify the probability of fibrosis as low, intermediate and high probability. Serum lipids including total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) were measured, and then TC/HDL-C, LDL-C/HDL-C, TG/HDL-C and non HDL-C/HDL-C ratios were determined. Fasting blood sugar (FBS), alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were also assessed. The homeostatic model assessment for insulin resistance (HOMA-IR) was calculated. RESULTS The severity of hepatic steatosis was positively correlated with TC/HDL-C (r = 0.29, P = .002), LDL-C/HDL-C (r = 0.32, P

Background: As of now, it is unknown whether hyperuricemia can be considered as an independent risk factor or just as a marker to represent the correlation between uric acid and other metabolic syndrome (MetS) risk factors. To the best of the authors’ knowledge, no other work has been reported to study this relationship between serum uric acid (SUA) and cardiometabolic phenotypes. In this work, we intend to study the correlation between SUA and the cardiometabolic phenotype among healthcare workers in Azar cohort study. Method: In this cross-sectional study, anthropometric measurements, serum fasting blood sugar (FBS), triglyceride (TG), cholesterol, high lipoprotein density (HDL), liver enzymes, blood urea nitrogen (BUN), SUA, creatinine (Cr), and blood pressures of 1458 healthcare workers were evaluated. MetS was diagnosed based on ATP III. We classified the participants into four cardiometabolic phenotypes, i.e., metabolically-healthy lean (MHL), metabolically-unhealthy lean (MUHL), metabolically-healthy obese (MHO), and metabolically-unhealthy obese (MUHO).Results: MHL (32.6%) and MHO (66%) have the highest prevalence rate in the first and second SUA tertiles, respectively, which are statistically significant (P-value ≤0.001). We observed an ascending trend in the mean values of WC, TG, cholesterol, low HDL, FBS, BUN, Cr, SBP, DBP, BMI, and liver enzymes from the first SUA tertile to the third SUA tertile (P-value Conclusion: We proposed the use of the easily-measured SUA level as a marker for early diagnosis of at-risk MUHL and MHO individuals to administer proper interventions. Further prospective works are needed to identify the effects of SUA on the progression of MetS in various body size subgroups.

Non-alcoholic fatty liver (NAFLD) is a multi-factorial liver disease and its incidence is globally rising. Little is known about the association between triglyceride glucose (TyG) index and liver fibrosis progression in NAFLD patients.To examine the association of liver fibrosis with TyG index among patients with NAFLD in a sample of Iranian adults.The NAFLD fibrosis score and the fibrosis-4 (FIB-4) index were used for the detection of hepatic fibrosis. Multivariable-adjusted odds ratios (ORs) were applied to assess the association of liver fibrosis with TyG index.The current study included a total of 230 participants with NAFLD and low probability of fibrosis. The TyG index quartiles were higher in patients with higher body mass index (BMI), higher systolic blood pressure (SBP), and less physical activity than in participants with lower BMI, lower SBP and more physical activity, respectively. Moreover, higher serum levels of total cholesterol, triglyceride, LDL-C, aspartate and aminotransferases, and homeostatic model assessment for insulin resistance (HOMA-IR), and lower serum level of HDL-C were observed in patients with higher quartiles of TyG index (all P 0.01). The severity of NAFLD significantly increased with increment in the quartiles of TyG index. Increased TyG index was positively associated with worsening of NAFLD fibrosis score and FIB-4 index. Based on NAFLD fibrosis score, the multivariable-adjusted ORs (95% CIs) were 1.98 (1.33-2.22), 2.33 (2.09-2.94), and 3.44 (2.63-4.25) in the 2nd, 3rd, and 4th quantiles of TyG index when compared to the 1st quantile of TyG index. A similar trend was observed in the analysis using FIB-4 index.According to the results of the current study, excess TyG index contributes to the development of liver fibrosis.

Background Sepsis is a life-threatening condition caused by a dysregulated host response to infection. Several studies have indicated that flavonoids exhibit a wide variety of biological actions including free radical scavenging and antioxidant activities. Quercetin, one of the most extensively distributed flavonoids in the vegetables and fruits, presents various biological activities including modulation of oxidative stress, anti-infectious, anti-inflammatory, and neuroprotective activities. Methods The present systematic review was conducted according to the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statements. We searched Web of Sciences, Google Scholar, PubMed, Scopus, and Embase databases up to February 2021 by using the relevant keywords. Results Out of 672 records screened, 35 articles met the study criteria. The evidence reviewed here indicates that quercetin supplementation may exert beneficial effects on sepsis by attenuating inflammation and oxidative stress, downregulating the mRNA expression of toll-like receptors (TLRs), modulating the immune response, and alleviating sepsis-related organ dysfunctions. Conclusion Due to the promising therapeutic effects of quercetin on sepsis complications and the lack of clinical trials in this regard, future human randomized clinical trials are warranted.

The effects of propolis, a well-known functional food, on irritable bowel syndrome (IBS), a chronic gastrointestinal disorder, in humans have yet to be investigated. This study evaluated propolis effects in IBS subjects. In this clinical study, 56 patients with IBS diagnosed by Rome IV criteria were assigned for 6 weeks randomly to the study groups. At the baseline and endpoint phase, patients’ gastrointestinal symptoms, quality of life (QOL), anxiety state, dietary intakes, and anthropometric indices were assessed. Independent t-test, paired t-test, Mann-Whitney U test, Wilcoxon, Fisher's exact test, repeated measures analysis of variance and logistic regression test were used for analyzing the data. To adjust the effect of confounders, covariance analysis was used. The results of this study showed that after modulating the effect of potential confounders, propolis supplementation increased the chance of improving IBS severity by 6.22 (with a confidence interval of: 1.33 - 1.14 and P = 0.035). A significant abdominal pain improvement, anxiety state, and bowel habits dissatisfaction reduction was observed within- and between-group differences in propolis group compared to the placebo group (P = 0.040, P = 0.035, P = 0.029, retrospectively). The overall score of quality of life and its domains in the propolis group was statistically significant, but in comparison between the two groups, this difference was not significant. Also, regards to the food intakes and anthropometric indices, there were no significant differences between and within the two study groups. This study illustrated that propolis supplementation could be used as adjunctive therapy in IBS disease to reduce abdominal pain and anxiety state.

SYNOPSIS The effect of flotation operational parameters on froth stability and froth recovery was studied. Froth stability was measured using a special column. To determine the froth recovery, the froth height change model and froth height exponential model were used. It was found that since the interactions between the pulp and froth zones affect the time of froth formation, the exponential model is more suitable than the froth height change method for determining the froth recovery. The results showed that superficial air velocity and collector dosage have, respectively, the highest and lowest effect on the froth recovery, while froth recovery decreases sharply with increasing froth height. Keywords: froth stability, froth recovery, superficial air velocity, collector dosage, frother dosage.

Background: There is a close connection between serum gamma-glutamyltransferase (GGT), insulin resistance, and the increased number of the components of the metabolic syndrome (MetS). However, there are no studies evaluating the correlation between GGT and cardiometabolic phenotype. Thus, the main objective of the current study is to evaluate the relationship between GGT and cardiometabolic phenotypes among healthcare workers in Azar Cohort Study.Method: In this cross-sectional study, anthropometric measurements, fasting blood sugar (FBS), triglyceride (TG), cholesterol, high lipoprotein density (HDL), GGT, and blood pressure of 1458 healthcare workers were evaluated. MetS was determined according to the report by the National Cholesterol Education Program Adult Treatment Panel III (ATP III). We classified participants into four cardiometabolic phenotypes. These phenotypes consist of metabolically-healthy lean (MHL) (no MetS and BMI < 25 kg/m2), metabolically-unhealthy lean (MUHL) (MetS present and BMI < 25 kg/m2), metabolically-healthy obese (MHO) (no MetS and BMI ≥25 kg/m2), and metabolically-unhealthy obese (MUHO) (MetS present and BMI ≥ 25 kg/m2).Results: The first and third GGT tertiles have the highest prevalence of MHL (31%) and MHO (65.1%), respectively, which is statistically significant (P-value ≤ 0.001). In comparison with the lowest GGT tertile, the odds of MHO and MUHO increased by 2.84 (95% CI 2.01-4.01) and 9.12 (95%CI 5.54-15), respectively. However, the correlation between MUHL and GGT tertile does not show a similar trend. According to the ROC curve, the cutoff value of 18.5 U/l for GGT allowed us to distinguish between MHO and MUHO.Conclusions: Based on the findings of the study, the GGT can be used as a biomarker to reveal the risk of MetS, and we believe that the GGT level can be used for the early detection of MHO at risk of MetS and for administering proper interventions.

Background: Given the impact of high intake sugar sweetened beverages on type2 diabetes, intervention to reduce their consumption can be a top priority for any health system. Thus, the purpose of the present study is to simulate the impact of policy options related to reduce consumption of sugar-sweetened beverages on the prevalence and mortality of type 2 diabetes in Iranian men and women.Methods: A Markov micro-simulation (MM) model was used to predict the effect of several policy options on the incidence and death from type 2 diabetes in Azar Cohort Databases. Population age-and sex-specific prevalence and incidence rate of diagnosed diabetes were derived from the national health data. The PRIME model was used for coding the input parameters of simulation using R and Python software.Results: The prevalence and mortality rate of type 2 diabetes under the scenario of reduced consumption of sugar sweetened beverages indicated that the highest and lowest prevalence and mortality rates of type 2 diabetes for men and women were related to no policy condition and replacing sugar-sweetened beverages with healthy drinks such as water, respectively. Also, the maximum number of death postponed/prevented from type 2 diabetes was related to replacing sugar-sweetened beverages with water and levying 10% tax on sugar sweetened beverages, respectively. Conclusion: Regarding the effect of simulating different policy options on reducing the consumption of sugar sweetened beverages, the most effective policy options were replacing sugar-sweetened beverages with water.

Background and aim The adipokine zinc-alpha2-glycoprotein (ZAG), a multidisciplinary protein, is involved in lipid metabolism, glucose homeostasis and energy balance. Accumulating evidence demonstrates that the expression of ZAG is mainly downregulated in obesity and obesity-related conditions. In the present study, we assessed the association of ZAG with non-alcoholic fatty liver disease (NAFLD) and the related risk factors including obesity, metabolic factors and inflammatory parameters, with emphasis on potential mechanisms underlying these associations. Methods PRISMA guidelines were followed in this review. Systematic searches were performed using the PubMed/Medline, ScienceDirect, Scopus, EMBASE, ProQuest and Google Scholar databases, up to August 2020 for all relevant published papers. Results Out of 362 records screened, 34 articles were included in the final analysis. According to the studies reviewed here, ZAG appears to exert a protective effect against NAFLD by enhancing mRNA expression levels of peroxisome proliferator-activated receptor α (PPARα) and PPARγ, promoting mRNA expression levels of the lipolysis-related genes, reducing mRNA expression levels of the lipogenesis-related genes, increasing hepatic fatty acid oxidation, ameliorating hepatic steatosis, promoting the activity of brown adipose tissue and the expression of thermogenesis-related genes, modulating energy balance and glucose homeostasis, and elevating plasma levels of healthy adipokines such as adiponectin. ZAG can also be involved in the regulation of inflammatory responses by attenuation of the expression of pro-inflammatory and pro-fibrotic mediators. Conclusion According to the studies reviewed here, ZAG is suggested to be a promising therapeutic target for NAFLD. However, the favourable effects of ZAG need to be confirmed in prospective cohort studies.

Background : The aim of present study was to evaluate the association between diabetic retinopathy (DR), dietary inflammatory index (DII), and metabolic syndrome (MetS) in patients with type 2 diabetes in a cohort study in Iran. Methods: This cross-sectional study was a part of the large Azar eye cohort study that included 1378 patients with type 2 diabetes. To diagnose DR, two mydriatric fundus photographs were captured using a digital fundus camera. The DR severity was classified as non-proliferative diabetic retinopathy (NPDR) or proliferative diabetic retinopathy (PDR). MetS was determined on the basis of the ATPIII criteria. DII was calculated according to Shivappa et al. method. Results: Of 1378 diabetic patients, 185 (13.4%) had NPDR and 142 (10.3%) had PDR. The risk of NPDR and PDR increased by 2.65-fold and 2.01-fold, respectively, in patients having blood glucose levels that fell outside the recommended range. There was no statistically significant relationship between Mets, Mets components, and DII in NPDR and PDR. Conclusion: The results suggest that intensive glycemic control, rather than conventional control, may help reduce the progression of DR. It seems that longitudinal studies and clinical trials for evaluating role of DII in DR are necessary.

Background: In the subclinical hypothyroidism, T4 or T3 levels are normal and thyroid-stimulating hormone (TSH) is slightly high. Selenium deficiency can lead to thyroid dysfunction. The present study aims to investigate the effect of selenium supplementation on the thyroid hormone and anti-thyroid peroxidase antibody (anti-TPO AB) levels. Materials and Methods: In this double-blinded, randomized, placebo-controlled clinical trial, 42 patients with subclinical hypothyroidism were randomly assigned to receive 200 μg selenium or placebo for 8 weeks. In the both groups, the serum TSH and anti-TPO antibody levels were measured and assessed before and after the intervention. Results: After the interventions, the mean serum TSH reduction in the intervention and placebo groups was −10.98 ± 33.31 and −3.20 ± 38.36, respectively, which were not statistically significant. However, the mean serum anti-TPO Ab concentration increased in the intervention and placebo groups (109.81 ± 51.49% vs. 173.17 ± 96.26%), between which the difference was not statistically significant (P >0.05) despite a slight increase in the mean anti-TPO level in the intervention group. Conclusion: The results of the current study indicated that selenium supplementation has no significant effect on serum anti-TPO Ab and TSH levels in the patients with subclinical hypothyroidism. Studies with larger sample size and with different doses of selenium are needed to reach more precise results.

Objectives In this study, we investigate the effect of boron-containing compounds and oleoylethanolamide supplementation on the recovery trend in patients with COVID-19. Trial design The current study is a single-center, randomized, double-blind, placebo-controlled clinical trial with parallel groups. Participants The inclusion criteria include male and female patients≥18 years of age, with a confirmed diagnosis of SARS-CoV-2 infection via polymerase chain reaction (PCR) and/or antibody test and with written informed consent to participate in this trial. The exclusion criteria include regular use of any other supplement, severe and critical COVID-19 pneumonia, pregnancy and breastfeeding. This study is being conducted at Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran. Intervention and comparator Patients are randomly assigned to four groups. The first group (A) will take one capsule containing 5 mg of boron compounds twice a day for two weeks. The second group (B) will take one capsule containing 200 mg oleoylethanolamide twice a day for two weeks. The third group (C) will take one capsule containing 5 mg boron compounds with 200 mg oleoylethanolamide twice a day for two weeks, and the fourth group (D) does not receive any additional treatment other than routine treatments. Boron-containing compounds and oleoylethanolamide capsules will be synthesized at Nutrition Research Center of Tabriz University of Medical Sciences. Main outcomes The primary end point of this study is to investigate the recovery rate of clinical symptoms, including fever, dry cough, and fatigue, as well as preclinical features, including complete blood count (CBC), the erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) profiles within two weeks of randomization. Randomisation Patients are randomized into four equal groups in a parallel design (allocation ratio 1:1). A randomized block procedure is used to divide subjects into one of four treatment blocks (A, B, C, and D) by a computer-generated allocation schedule. Blinding (masking) The participants and investigators (enrolling, assessing, and analyzing) are blinded to the intervention assignments until the end of the study and data analysis. Numbers to be randomised (sample size) The calculated total sample size is 40 patients, with 10 patients in each group. Trial Status The protocol is Version 1.0, May 17, 2020. Recruitment began May 19, 2020, and is anticipated to be completed by October 19, 2020. Trial registration This clinical trial has been registered by the title of “Assessment of boron-containing compounds and oleoylethanolamide supplementation on the recovery trend in Patients with COVID-19: A double-blind randomized placebo-controlled clinical trial” in the Iranian Registry of Clinical Trials (IRCT). The registration number is “IRCT20090609002017N35”, https://www.irct.ir/trial/48058. The registration date is 17 May 2020. Full protocol The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.

Corona Virus Disease 2019 (COVID-19) pandemic is rapidly spreading all over the world. Excessive immune responses trigger life-threatening cytokine release syndrome (CRS) which can result in overproduction of pro-inflammatory cytokines including tumor necrosis factor alpha (TNFα), interleukin-6 (IL-6), and IL-1β with different pro-inflammatory roles. Anecdotal evidence suggests that the modulation of systemic immune responses may have a potential role in the treatment of patients with COVID-19. Given the importance of the issue and the lack of therapeutic treatment or vaccine; anti-cytokine therapy such as IL-6, TNFα and IL-1 antagonists have been suggested for the alleviation of hyper-inflammation status in these patients. In this mini-review, we addressed the inflammatory pathways of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its relationship with the host cytokine storm. Furthermore, the proposed therapeutic options to reverse hyper-inflammation in infected patients were mentioned., Highlights • The outbreak of COVID-19 (coronavirus) has been identified by the World Health Organization as a global pandemic. • There is an urgent need to identify safe and effective drugs or potential adjuvant therapy in this regard. • Inflammatory cytokines blockade proposed to be a novel therapeutic approach to reverse hyper-inflammatory status in COVID-19 infected patients.

Mondello, Stefania/0000-0002-8587-3614; Alizada, Orkhan/0000-0003-0942-9906; Ghorbani, Mohammad/0000-0002-7709-3095; Abedi, Vida/0000-0001-7689-933X WOS:000575454600010 PubMed ID: 32818804 Background: There is an increased attention to stroke following SARS-CoV-2. The goal of this study was to better depict the short-term risk of stroke and its associated factors among SARS-CoV-2 hospitalized patients. Methods: This multicentre, multinational observational study includes hospitalized SARS-CoV-2 patients from North and South America (United States, Canada, and Brazil), Europe (Greece, Italy, Finland, and Turkey), Asia (Lebanon, Iran, and India), and Oceania (New Zealand). The outcome was the risk of subsequent stroke. Centres were included by non-probability sampling. The counts and clinical characteristics including laboratory findings and imaging of the patients with and without a subsequent stroke were recorded according to a predefined protocol. Quality, risk of bias, and heterogeneity assessments were conducted according to ROBINS-E and Cochrane Q-test. The risk of subsequent stroke was estimated through meta-analyses with random effect models. Bivariate logistic regression was used to determine the parameters with predictive outcome value. The study was reported according to the STROBE, MOOSE, and EQUATOR guidelines. Findings: We received data from 26,175 hospitalized SARS-CoV-2 patients from 99 tertiary centres in 65 regions of 11 countries until May 1st, 2020. A total of 17,799 patients were included in meta-analyses. Among them, 156(0.9%) patients had a stroke-123(79%) ischaemic stroke, 27(17%) intracerebral/subarachnoid hemorrhage, and 6(4%) cerebral sinus thrombosis. Subsequent stroke risks calculated with meta-analyses, under low to moderate heterogeneity, were 0.5% among all centres in all countries, and 0.7% among countries with higher health expenditures. The need for mechanical ventilation (OR: 1.9, 95% CI:1.1-3.5, p = 0.03) and the presence of ischaemic heart disease (OR: 2.5, 95% CI:1.4-4.7, p = 0.006) were predictive of stroke. Interpretation: The results of this multi-national study on hospitalized patients with SARS-CoV-2 infection indicated an overall stroke risk of 0.5%(pooled risk: 0.9%). The need for mechanical ventilation and the history of ischaemic heart disease are the independent predictors of stroke among SARS-CoV-2 patients. (C) 2020 The Authors. Published by Elsevier B.V.

At the end of 2019, a novel flu-like coronavirus named COVID-19 (coronavirus disease 2019) was recognized by World Health Organization. No specific treatments exist for COVID-19 at this time. New evidence suggests that therapeutic options focusing on antiviral agents may alleviate COVID-19 symptoms as well as those that lead to the decrease in the inflammatory responses. Flavonoids, as phenolic compounds, have attracted considerable attention due to their various biological properties. In this review, the promising effects and possible mechanisms of action of naringenin, a citrus-derived flavonoid, against COVID-19 were discussed. We searched PubMed/Medline, Science direct, Scopus, and Google Scholar databases up to March 2020 using the definitive keywords. The evidence reviewed here indicates that naringenin might exert therapeutic effects against COVID-19 through the inhibition of COVID-19 main protease, 3-chymotrypsin-like protease (3CLpro), and reduction of angiotensin converting enzyme receptors activity. One of the other mechanisms by which naringenin might exert therapeutic effects against COVID-19 is, at least partly, by attenuating inflammatory responses. The antiviral activity of the flavanone naringenin against some viruses has also been reported. On the whole, the favorable effects of naringenin lead to a conclusion that naringenin may be a promising treatment strategy against COVID-19.

Purpose: Pyroptosis, a form of inflammatory programmed cell death, is activated in diabetic patients. This study was conducted to investigate the effects of daily consumption of sodium butyrate (NaBut) and high-performance (HP) inulin supplementation, individually or in combination, on the expression of pyroptosis-related genes, microRNA (miR) 146a-5p, miR-9-5p and biomarkers of oxidative stress in patients with type 2 diabetes (T2DM). Methods: In this study, we conducted a randomized, double-blinded, placebo-controlled clinical involving sixty patients with type 2 diabetes. Participants received 600 mg/d of NaBut (group A), 10 g/d of HP inulin (group B), 600 mg/d of NaBut + 10 g/d of HP inulin (group C) or placebo (group D) for 45 consecutive days. We assessed the pyroptosis-related genes mRNA expression in peripheral blood mononuclear cells (PBMCs), as well as the plasmatic levels of miR-146a and miR-9 before and after the intervention. Moreover, blood samples of the patients at baseline and following the intervention were tested for total antioxidant capacity (TAC), superoxide dismutase (SOD) and catalase levels using enzyme-linked immunosorbent assay (ELISA). This study was registered on the Iranian Registry of Clinical Trials website (identifier: IRCT201605262017N29; https://www.irct.ir/). Results: Following butyrate supplementation, the relative expression levels of TLR2/4, NF-κB1, Caspase-1, NLRP3, IL-1β & IL-18 were significantly downregulated (p < 0.05). Furthermore, butyrate and concomitant use of butyrate and inulin caused a significant increase in the fold change of miR-146a and miR-9 compared with the placebo group (p < 0.05). Interestingly, the changes in total antioxidant capacity (p = 0.047) and superoxide dismutase (p = 0.006) were significantly increased after butyrate and concomitant use of butyrate and inulin supplement, respectively. Conclusion: In summary, the change in expression level of miR-146a-5p and miR-9-5p due to butyrate supplementation may have a pivotal role in alleviating of diabetes via inhibiting pyroptosis by targeting TLR2 and NF-κB1. These microRNAs might be considered as potential therapeutic targets in the treatment of type 2 diabetes but further researches is required to prove the link.