Egg consumption and risk of cardiovascular disease: a PERSIAN cohort-based study.

BACKGROUND: Cardiovascular diseases (CVDs) are one of the main causes of death worldwide. Data on the effect of eggs consumption on the risk of CVDs are still unreliable. Therefore, this study aimed to investigate the association between CVDs and the consumption of eggs. METHODS: In this case-control study, the required data were extracted from the Prospective Epidemiologic Research Studies in Iran (PERSIAN) cohort in Sabzevar, Iran. A total of 4241 adults participated including 1535 patients with CVDs as the case group and 2706 healthy people as controls. Egg consumption was assessed using a valid food frequency questionnaire (FFQ). RESULTS: A significant association was observed between eggs consumption and stroke after adjustment for physical activity, body mass index (BMI), smoking, systolic blood pressure (SBP), diastolic blood pressure (DBP), using alcohol, lipid profile, diabetes, and the intake of energy, lipid, protein, carbohydrate, and cholestrol (OR:1.007, 95% CI:1.001-1.013, P = 0.03). No association was found between egg consumption with hypertension, cardiac ischemia, and myocardial infarction. CONCLUSIONS: There was a significant association between the consumption of eggs and stroke. However, more studies are needed to examine the effect of eggs on CVDs.

Effect of Functional Electrical Stimulation on Muscle Mass, Fatigue, and Quality of Life in Older Patients With COVID-19: A Randomized Clinical Trial Study.

OBJECTIVE: This study aimed to evaluate the effects of functional electrical stimulation (FES) on muscle strength, fatigue, muscle mass, and quality of life (QoL) in older patients with COVID-19. METHODS: Older patients with COVID-19 were randomly divided into the following 2 groups: real FES (intervention group, n = 20) and sham FES (control group, n = 20). These patients received FES concurrent with the voluntary contraction of muscles for 10 consecutive sessions. Ultrasound imaging, pressure biofeedback, Chalder fatigue scale, and QoL were utilized to measure muscle mass, muscle strength, chronic fatigue, and QoL, respectively. Evaluations were performed at the beginning, immediately, and 1 month after the end of intervention. RESULTS: All variables showed statistically significant improvement immediately and 1 month after the intervention in the real FES group (P < .05). However, the tibialis anterior muscle mass and fatigue significantly improved immediately after the intervention in the sham FES group. However, the tibialis anterior and rectus femoris muscles strength and rectus femoris muscle mass were not significantly changed immediately and 1 month after the intervention (P > .05). There were significant differences in muscle mass, physical fatigue, muscle strength, and QoL between groups with more efficacy of real FES (P < .05). CONCLUSION: For this sample of patients, FES improved fatigue, muscle strength, muscle mass, and QoL in older adults with COVID-19.

Preconception air pollution exposure and glucose tolerance in healthy pregnant women in a middle-income country.

BACKGROUND: Preconception exposure to air pollution has been associated with glucose tolerance during pregnancy. However, the evidence in low and middle-income countries (LMICs) is under debate yet. Therefore, this study aimed to assess the relationship between exposure to ambient particulate matter (PM) and traffic indicators with glucose tolerance in healthy pregnant women in Sabzevar, Iran (2019). METHODS: Two-hundred and fifty healthy pregnant women with singleton pregnancies and 24-26 weeks of gestations participated in our study. Land use regression (LUR) models were applied to estimate the annual mean of PM1, PM2.5 and PM10 at the residential address. Traffic indicators, including proximity of women to major roads as well as total streets length in 100, 300 and 500 m buffers around the home were calculated using the street map of Sabzevar. The oral glucose tolerance test (OGTT) was used to assess glucose tolerance during pregnancy. Multiple linear regression adjusted for relevant covariates was used to estimate the association of fasting blood glucose (FBG), 1-h and 2-h post-load glucose with PMs and traffic indicators. RESULTS: Exposure to PM1, PM2.5 and PM10 was significantly associated with higher FBG concentration. Higher total streets length in a 100 m buffer was associated with higher FBG and 1-h glucose concentrations. An interquartile range (IQR) increase in proximity to major roads was associated with a decrease of - 3.29 mg/dL (95% confidence interval (CI): - 4.35, - 2.23, P-value < 0.01) in FBG level and - 3.65 mg/dL (95% CI, - 7.01, - 0.28, P-value = 0.03) decrease in 1-h post-load glucose. CONCLUSION: We found that higher preconception exposure to air pollution was associated with higher FBG and 1-h glucose concentrations during pregnancy.

Urtica Dioica Distillate Regenerates Pancreatic Beta Cells in Streptozotocin-Induced Diabetic Rats.

BACKGROUND: Urtica dioica is known as an anti-hyperglycemic plant. Urtica dioica distillate (UD) is a traditional Iranian drink, locally known as "aragh gazaneh". In spite of its widespread consumption in Iran, according to traditional Iranian medicine, there is no scientific report on the usefulness of UD for diabetic patients. This survey was designed to evaluate its protective effects for the recovery from diabetes by determining the serum insulin, blood glucose, volume of pancreatic islets, and the number and volume of ß-cells in diabetic rats. METHODS: A total of 48 Sprague-Dawley male rats (200-250 g) were randomly distributed into 6 groups (n=8), including non-diabetic plus distilled water (DW), non-diabetic plus UD, diabetic plus DW, diabetic plus UD, diabetic plus insulin, and diabetic plus glibenclamide. DW, UD, and glibenclamide were administered via intragastric gavage and insulin was injected subcutaneously. After four weeks of experiments, blood samples were collected for serum insulin and blood glucose assay. Pancreas was also evaluated using stereological method. The SPSS software was used for statistical analysis. Kruskal-Wallis, repeated measurements, and Mann-Whitney U test were applied for comparisons between the groups. RESULTS: The treatment of diabetic rats with UD reduced the blood glucose dramatically (P<0.001) and increased serum insulin levels significantly (P=0.03) in comparison to the diabetic plus DW rats. Treatment with UD did not affect the mean ß-cell volumes in the diabetic rats when compared to the diabetic plus DW rats, but the islet volumes and ß-cell numbers were significantly recovered. CONCLUSION: UD treatment in diabetic rats improves hyperglycemia by partially restoring plasma insulin levels. The data suggest that UD prevents islet atrophy and/or regenerate pancreatic ß-cells.

Prevalence and risk factors of gastroesophageal reflux disease in Iran: A cross-sectional analysis from the PERSIAN cohort.

BACKGROUND: This study assessed the prevalence of gastroesophageal reflux disease (GERD) in a general adult population in Iran. The association between GERD and various factors was also evaluated. METHODS: We performed a cross-sectional study on 163,018 individuals aged over 35 who were enrolled in the PERSIAN cohort. GERD was defined as the occurrence of heartburn and/or regurgitation symptoms at least several days a month. Survey design analysis for pooled data was performed and multiple regression analysis was conducted to determine the independent risk factors for GERD. RESULTS: The prevalence of GERD in our study was estimated at 21.86% (95% confidence interval:17.4%-36.4%). The mean age of the participants was 49.84 years±9.25 (35-70) and 44.75% of the participants were male. Symptoms of heartburn and regurgitation were reported in 18.65% (n: 29,170) and 6.06% (n: 9,717) of participants, respectively. In the multivariate analysis, several factors were found to be associated with a higher prevalence of GERD: female sex, age >50, current smoking, opium use, weekly consumption of fried foods, frequent consumption of hot tea, less than 6 hours of sleep per night, psychiatric disorders, usage of NSAIDs, and poor oral hygiene, were associated with a higher prevalence of GERD. Conversely, higher education levels and average physical activity were found to be less commonly associated with GERD. CONCLUSION: We found a relatively high prevalence of GERD (21.86%) in this population-based study in Iran. By identifying modifiable risk factors, this research offers opportunities for targeted interventions and lifestyle modifications to reduce the burden of GERD.

Importance of green roof criteria for residential and governmental buildings: a multi-criteria decision analysis.

Megacities recently are experiencing a shortage of green spaces basically due to the rapid growth of urbanization and increasing demand for different building types. Consideration of sustainable urban development is essential since the expansion of city facilities should be in line with social, economic, and environmental aspects. In this regard, green roof technology has been recommended as an effective solution for the growth of green spaces per capita and improving sustainability means of urban developments due to its diverse advantages. This study thus aimed at prioritizing sustainability indicators and relative sub-criteria of adopting green roof technology for residential and governmental buildings in the city of Mashhad, Iran, which has a dry climate. For this purpose, thirteen sub-criteria, which are extracted from the existing literature, are classified into three main sustainability indicators (environmental, economic, and social). Also, the best-worth method (BWM) as a multi-criteria decision-making technique was implemented to prioritize indicators and sub-criteria by analyzing the expert's opinion. The results indicated that respective economic and environmental indicators attract the highest priority in residential and governmental buildings. Additionally, the most important sub-criteria in environmental, economic, and social groups are air quality, roof longevity, and public health in both building types, respectively. However, when all criteria were considered, the respective highest priorities belong to roof longevity and air quality in residential and governmental buildings, while biodiversity conservation is the least important one in both building types. The results of this research can be beneficial in other cities with similar economic and climate conditions.

Urtica dioica (Gazaneh) distillate restores glucose metabolism in diabetic rats.

Background: Diabetes has become an important health problem in the world. Natural agents, with antidiabetic property, are potential candidates for improving diabetes. Urtica Dioica Distillate (UDD) or Araghe Gazaneh is widely used for the treatment of diabetes as per traditional medicine. Despite the tremendous use of UDD as an antidiabetic compound in folk medicine, the antidiabetic effects of UDD has been neglected by medical scientists. In this study, we aimed to evaluate the effects of UDD on the glucose metabolism in diabetic rats. Methods: A total of 24 male rats were divided equally into four groups, two treatment and two control groups, each containing normal or Streptozotocin (STZ)-induced diabetic rats. During 4 weeks, control and treatment rats received water or UDD, respectively. Fasting blood sugar (FBS), HbA1c, serum creatinine, blood urea nitrogen, and specific activities of hepatic enzymes including glucokinase (GK), hexokinase (HK), glucose-6-phosphate dehydrogenase (G6PD), and muscle glucose transporter type 4 (GLUT4) and liver phosphoenolpyruvate carboxykinase (PEPCK) mRNA levels were measured. Results: FBS and HbA1c increased in diabetic groups. Treatment with UDD significantly lowered FBS and prevented weight loss. Decreased FBS level was associated with higher activity levels of GK and HK in UDD-treated diabetic rats. G6PD-specific activity decreased in diabetic control rats compared to nondiabetic ones, but UDD treatment improved it to the normal levels. A significant decrease in the expression level of GLUT4 was observed in diabetic control rats compared to nondiabetic ones, but UDD increased it to the normal levels. Conclusions: These findings suggest that UDD might exert therapeutic effects against diabetes by improving glucose metabolism and can be used as an alternative or complementary medicine for the treatment of diabetic patients.

Effects of the Co-Administration of Morphine and Lipopolysaccharide on Toll-Like Receptor-4/Nuclear Factor Kappa ß Signaling Pathway of MDA-MB-231 Breast Cancer Cells.

Background: The Toll-like receptor 4 (TLR4) gene promotes migration in adenocarcinoma cells. Morphine is an agonist for TLR4 that has a dual role in cancer development. The promoter or inhibitor role of morphine in cancer progression remains controversial. This study aims to evaluate the effects of morphine on the TLR4, myeloid differentiation primary response protein 88-dependent (MyD88), and nuclear factor-kappa B (NF-κB) expressions in the human MDA-MB-231 breast cancer cell line. Materials and Methods: The cells were examined after 24 hours of incubation with morphine using the Boyden chamber system. TLR4, MyD88, and NF-κB mRNA expressions were assessed using quantitative real-time polymerase chain reaction (RT-PCR). The concentration of interleukin-2 beta was also measured using the ELISA assay. Results: According to the findings, three doses of morphine (0.25, 1.25, and 0.025 µM) increased the expression of the TLR4 and NF-κB genes, whereas no significant change was observed in the mRNA expression of MyD88. Furthermore, treatment with morphine and lipopolysaccharide (LPS) significantly decreased the expression of TLR4, MyD88, and NF-κB. However, no significant change was observed in interleukin 2 beta concentration. Conclusions: These findings confirmed the excitatory effects of morphine on TRL4 expression and the MYD88 signaling pathway in vitro.

Daily Step Count and All-Cause Mortality: A Dose-Response Meta-analysis of Prospective Cohort Studies.

BACKGROUND: Uncertainty remains about the optimum step count per day for health promotion. OBJECTIVE: We aimed to investigate the association between step count per day and all-cause mortality risk. METHODS: PubMed, Scopus, and ISI Web of Science were searched to January 2021 to find prospective cohort studies of the association between device-based step count per day and all-cause mortality risk in the general population. Two reviewers extracted data in duplicate and rated the certainty of evidence using the GRADE approach. Study-specific hazard ratios (HRs) were pooled using a random-effects model. RESULTS: Seven prospective cohort studies with 175,370 person-years and 2310 cases of all-cause mortality were included. The HR for each 1000 steps per day was 0.88 (95% CI 0.83-0.93; I2 = 79%, n = 7) in the overall analysis, 0.87 (95% CI 0.78-0.97; I2 = 59%, n = 3) in adults older than 70 years, and 0.92 (95% CI 0.89-0.95; I2 = 37%, n = 2) in studies controlled for step intensity. Dose-response meta-analysis indicated a strong inverse association, wherein the risk decreased linearly from 2700 to17,000 steps per day. The HR for 10,000 steps per day was 0.44 (95% CI 0.31-0.63). The certainty of evidence was rated strong due to upgrades for large effect size and dose-response gradient. CONCLUSIONS: Even a modest increase in steps per day may be associated with a lower risk of death. These results can be used to develop simple, efficient and easy-to-understand public health messages.

Post-Hospital Discharge Strategy for COVID-19 Treatment and Control: Focus on Fangcang Hospitals.

OBJECTIVE: One of the concerns of health managers in Iran in case COVID-19 reached a new peak is a shortage of hospital beds. In response, the country designed and created intermediate treatment centers, known as fangcang hospitals, which are prepared quickly at low cost and with high capacity. The aim of this study is to provide health managers with an effective post-hospital discharge strategy for COVID-19 patients. METHOD: The study was conducted from April 2020 to June 2020, with a narrative case study design. Setting up a fangcang hospital was based on a narrative analysis of 2 in-depth interviews with 4 fangcang hospital managers in Iran, a field visit of these places, and a review of their protocols and guidelines. RESULT: The patient flow for screening, treatment, and follow-up includes the following: Patients will be hospitalized if their symptoms are severe. If they are infected with mild symptoms, they will be referred to a fangcang hospital and admitted there if necessary, to prevent further spread of the disease. Patients will be monitored regularly and treated with routine health services. At the end of the 14-day quarantine period, patients approved for discharge are sent home. CONCLUSION: Traditional hospitals and fangcang hospitals are working together under the supervision of the Iran University of Medical Sciences. Our experience can serve as guidance for other clinics and recovery shelters. Having guidelines in place assists health care workers and managers in responding quickly to patients' needs during times of a disaster.

Prevalence and predictors of low back pain among the Iranian population: Results from the Persian cohort study.

BACKGROUND AND OBJECTIVES: Low back pain (LBP) is a common health condition in populations. Limited large-scale population-based studies evaluated the prevalence and predictors of LBP in developing countries. This study aimed to evaluate the prevalence and factors associated with LBP among the Iranian population. METHODS: We used baseline information from the Prospective Epidemiological Research Studies in Iran (PERSIAN), including individuals from 16 provinces of Iran. LBP was defined as the history of back pain interfering with daily activities for more than one week during an individual's lifetime. Various factors hypothesized to affect LBP, such as age, sex, marital status, educational status, ethnicity, living area, employment status, history of smoking, body mass index (BMI), physical activity, sleep duration, wealth score, history of joint pain, and history of morning stiffness in the joints were evaluated. RESULTS: In total, 163770 Iranians with a mean age of 49.37 (SD = 9.15) were included in this study, 44.8% of whom were male. The prevalence of LBP was 25.2% among participants. After adjusting for confounders, the female gender [OR:1.244(1.02-1.50)], middle and older ages [OR:1.23(1.10-1.33) and OR:1.13(1.07-1.42), respectively], being overweight or obese [OR:1.13(1.07-1.19) and OR:1.21(1.16-1.27), respectively], former and current smokers (OR:1.25(1.16-1.36) and OR:1.28(1.17-1.39), respectively], low physical activity [OR:1.07(1.01-1.14)], and short sleep duration [OR: 1.09(1.02-1.17)] were significantly associated with LBP. CONCLUSION: In this large-scale study, we found the lifetime prevalence of LBP to be lower among the Iranian population in comparison to the global prevalence of LBP; further studies are warranted to evaluate the causality of risk factors on LBP.

Prevalence, awareness, treatment, and control of hypertension based on ACC/AHA versus JNC7 guidelines in the PERSIAN cohort study.

In this cross-sectional population-based study, we used the baseline data of the Prospective Epidemiologic Research Studies in IrAN cohort study collected in Iran from 2014 to 2020. The main outcomes were the prevalence of hypertension and proportion of awareness, treatment, and control based on the 2017 ACC/AHA guideline compared to the seventh report of the Joint National Committee (JNC7). Of the total of 163,770 participants, aged 35-70 years, 55.2% were female. The sex-age standardized prevalence of hypertension was 22.3% (95% CI 20.6, 24.1) based on the JNC7 guideline and 36.5% (31.1, 41.8) based on the ACC/AHA guideline. A total of 24,312 participants [14.1% (10.1, 18.1)] were newly diagnosed based on the ACC/AHA guideline. Compared to adults diagnosed with hypertension based on the JNC7 guideline, the newly diagnosed participants were mainly young literate males who had low levels of risk factors and were free from conventional comorbidities of hypertension. About 30.7% (25.9, 35.4) of them (4.3% of the entire population) were eligible for pharmacologic intervention based on the ACC/AHA guideline. Implementation of the new guideline may impose additional burden on health systems. However, early detection and management of elevated blood pressure may reduce the ultimate burden of hypertension in Iran.

Serum concentration of asprosin in new-onset type 2 diabetes.

BACKGROUND: Asprosin, a newly identified adipokine, is pathologically increased in individuals with insulin resistance. However, the available evidence on the association of asprosin and type 2 diabetes mellitus (T2DM) status is still scarce. Therefore, this study aimed to determine the relationship between serum concentrations of asprosin and T2DM status. METHODS: This observational study was performed based on 194 adults (97 newly diagnosed T2DM and 97 healthy individuals). Anthropometric and biochemical variables were determined in all participants. Serum concentrations of asprosin were measured using enzyme-linked immunosorbent assay (ELISA). RESULTS: In patients with T2DM, the serum concentrations of asprosin were significantly higher than the healthy controls (4.18 [IQR: 4.4] vs. 3.5 [IQR: 1.85], P < 0.001). The concentrations of asprosin were significantly correlated with body mass index (BMI) and fasting blood glucose (FBG) in healthy subjects and with BMI, FBG, hemoglobin A1c (HbA1c), homeostatic model assessment of insulin resistance (HOMA-IR), and quantitative insulin check index (QUICKI), triacylglycerol (TAG) and total cholesterol/high-density lipoprotein cholesterol (TC/HDL-C) ratio in the T2DM group. In fully adjusted model, the odds ratio (OR) of T2DM with serum concentrations of asprosin was approximately 1.547 (95% CI 1.293-1.850, P < 0.001) compared to the control group. Multiple stepwise regression analysis indicated that FBG and HOMA-IR were independently associated with asprosin in T2DM. CONCLUSION: Our findings indicated that serum concentrations of asprosin are increased in patients with T2DM. Also, asprosin is correlated with insulin resistance and TC/HDL-C ratio (atherosclerotic risk factor of cardiovascular diseases) in patients with T2DM.

The effects of two types of renin-angiotensin system inhibitors on the hypertension induced by new pressor protein associated with beta-factor XIIa in rats.

BACKGROUND AND PURPOSE: New pressor protein (NPP) is a human plasma enzyme, which is structurally related to the beta-fragment of activated factor XII. The present study aimed to compare the effects of angiotensin converting enzyme inhibitors (captopril) and angiotensin type 1 receptor blocker (losartan) on the hypertension induced by NPP injection in normal (sham-2NX) and bilaterally nephrectomized rats (2NX). EXPERIMENTAL APPROACH: In total, 60 male Wistar rats were sham operated or bilaterally nephrectomized under anesthesia. After 24 h of anesthesia with Inactin® (100 mg/kg), their systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) were measured before and after the intravenous administration of captopril, losartan, and NPP. FINDINGS / RESULTS: In the sham-2NX group, after NPP injection, changes were observed in SBP (145.99 ± 3.6 mmHg), DBP (93.9 ± 3.87 mmHg), and HR (400.29 ± 12.78 bpm). In the captopril group, SBP and DBP had no significant changes, while HR increased significantly (P = 0.001). In the losartan group, SBP and DBP decreased (P = 0.001 and P = 0.000, respectively), while HR had no significant changes. In the 2NX group, after NPP injection, changes were denoted in SBP (127.89 ± 9.03 mmHg), DBP (65.86 ± 5.69 mmHg), and HR (333.35 ± 11.47 bpm). In addition, captopril injection increased DBP (P = 0.016) and HR (P = 0.036) in response to NPP injection, while losartan injection had no significant effects in this regard. CONCLUSION AND IMPLICATIONS: It could be concluded that losartan could improve hypertension in normal rats, while captopril deteriorated hypertension in bilaterally nephrectomized rats in this hypertension model.

Loss of myelinated retinal nerve fibers from chronic papilledema.

An intracranial pilocytic astrocytoma was diagnosed in a 13-year-old boy after he presented with headaches and visual disturbances. The initial ophthalmoscopic examination revealed papilledema bilaterally and myelinated retinal nerve fibers (MRNFs) in the left eye. Serial ophthalmoscopic examinations demonstrated gradual fading of the MRNFs beginning 2 months after tumor resection and their complete disappearance by 2 years after surgery. The disappearance of MRNFs has been described in the presence of ischemia, compression, glaucoma, and demyelinating disease of the optic nerve. This patient demonstrates that loss of myelinated nerves fibers may also occur with the optic atrophy that may follow chronic papilledema.

West nile virus occlusive retinal vasculitis.

PURPOSE: To report a case of West Nile virus meningoencephalitis presenting with simultaneous chorioretinitis in the right eye and occlusive retinal vasculitis in the left eye. METHODS: Case report. Main outcome measures included ocular examination, intravenous fluorescence angiography, indocyanine green, color fundus photography, and serologic testing for West Nile virus. RESULTS: A 45-year-old white woman presented with severe loss of vision in the left eye (count fingers at 3 feet) 2 weeks after an episode of hospitalization for fever of unknown origin. Examination showed extensive retinal opacification and edema in the left eye with arteriolar narrowing. Intravenous fluorescence angiography confirmed delayed venous return superiorly, multiple arteriolar occlusions, large area of nonperfusion, and vascular staining and leakage. Indocyanine green highlighted bilateral well-deliniated hypocyanescent choroidal lesions corresponding to the subretinal lesions seen by ophthalmoscopy. Indocyanine green allowed identification of additional lesions that were not initially detected on intravenous fluorescence angiography and ophthalmoscopy. CONCLUSION: Occlusive retinal vasculitis is a rare yet important ocular manifestation of West Nile virus infection. It may occur in young patients without diabetes, and unlike West Nile virus chorioretinitis, it is often associated with poor visual outcome.

Multifocal juvenile xanthogranuloma presenting with a hand mass and bilateral vitreous hemorrhage in a neonate.

PURPOSE: To describe a rare case of multifocal juvenile xanthogranuloma (JXG) in a neonate presenting with a large hand mass, bilateral vitreous hemorrhage, and posterior segment involvement. METHODS: Biopsy of hand lesion led to the diagnosis of JXG. Further systemic workup and ocular examination revealed bilateral vitreous hemorrhage and a small, creamy yellowish subretinal lesion above the fovea in the macula of the left eye. In addition, there was a subretinal lesion with overlying vitreous fibrosis in the inferonasal quadrant of the left eye. RESULTS: Treatment with prednisone (2 mg/kg/day) for 2 weeks was initiated before final diagnosis of hand lesion. Steroids were then tapered off over the course of a week with no additional treatment. Follow-up examinations were performed over the course of the next 17 months. On the last follow-up examination at the age of 20 months, the child had central steady and maintained fixation in each eye. The findings of an external ocular examination were unremarkable except for a mild myopic shift in the right eye secondary to trace cataract changes. Dilated fundus examination showed resolution of the lesions in the macula and inferonasal quadrant of the left eye. CONCLUSION: Although rare, JXG should be included in the differential diagnosis of spontaneous vitreous hemorrhage in children under the age of 2 years. Topical, periocular, and oral steroids may improve the ocular signs and symptoms in this condition and should be considered in the management of ophthalmic manifestations of JXG.