Predicting the natural history of metabolic syndrome with a Markov-system dynamic model: a novel approach.

BACKGROUND: Markov system dynamic (MSD) model has rarely been used in medical studies. The aim of this study was to evaluate the performance of MSD model in prediction of metabolic syndrome (MetS) natural history. METHODS: Data gathered by Tehran Lipid & Glucose Study (TLGS) over a 16-year period from a cohort of 12,882 people was used to conduct the analyses. First, transition probabilities (TPs) between 12 components of MetS by Markov as well as control and failure rates of relevant interventions were calculated. Then, the risk of developing each component by 2036 was predicted once by a Markov model and then by a MSD model. Finally, the two models were validated and compared to assess their performance and advantages by using mean differences, mean SE of matrices, fit of the graphs, and Kolmogorov-Smirnov two-sample test as well as R2 index as model fitting index. RESULTS: Both Markov and MSD models were shown to be adequate for prediction of MetS trends. But the MSD model predictions were closer to the real trends when comparing the output graphs. The MSD model was also, comparatively speaking, more successful in the assessment of mean differences (less overestimation) and SE of the general matrix. Moreover, the Kolmogorov-Smirnov two-sample showed that the MSD model produced equal distributions of real and predicted samples (p = 0.808 for MSD model and p = 0.023 for Markov model). Finally, R2 for the MSD model was higher than Markov model (73% for the Markov model and 85% for the MSD model). CONCLUSION: The MSD model showed a more realistic natural history than the Markov model which highlights the importance of paying attention to this method in therapeutic and preventive procedures.

The dynamics of metabolic syndrome development from its isolated components among Iranian adults: findings from 17 years of the Tehran lipid and glucose study (TLGS).

BACKGROUND: Evaluating the process of changes in the Metabolic Syndrome (MetS) components over time is one of the ways to study of the MetS natural history. This study aimed to determine the trend of changes in the progression of MetS from its isolated components. METHODS: This longitudinal study was performed on four follow-up periods of the Tehran Lipid and Glucose Study (TLGS) between 1999 and 2015. The research population consisted of 3905 adults over the age of 18 years. MetS was diagnosed based on the Joint Interim Statement (JIS). The considered components were abdominal obesity, hypertension, hyperglycemia, and dyslipidemia. RESULTS: The highest incidence of MetS from its components was related to hypertension in the short term (3.6-year intervals). In the long run, however, the highest increase in the MetS incidence occurred due to abdominal obesity. Overall, the incidence of MetS increased due to obesity and dyslipidemia, but decreased due to the other factors. Nonetheless, the trend of MetS incidence from all components increased in total. The most common components were dyslipidemia with a decreasing trend and obesity with an increasing trend during the study. CONCLUSION: The results indicated that obesity and hypertension components played a more important role in the further development of MetS compared to other components in the Iranian adult population. This necessitates careful and serious attention in preventive and control planning.

Dynamic behavior of metabolic syndrome progression: a comprehensive systematic review on recent discoveries.

BACKGROUND: The assessment of the natural history of metabolic syndrome (MetS) has an important role in clarifying the pathways of this disorder. OBJECTIVE: This study purposed to provide a rational statistical view of MetS progression pathway. METHODS: We performed a systematic review in accordance with the PRISMA Statement until September 2019 in the Medline/PubMed, Scopus, Embase, Web of Science and Google Scholar databases. From the 68 found studies, 12 studies were eligible for review finally. RESULTS: The selected studies were divided in 2 groups with Markovian and non-Markovian approach. With the Markov approach, the most important trigger for the MetS chain was dyslipidemia with overweight/obesity in the under-50 and with hypertension in the over-50 age group, where overweight/obesity was more important in women and hypertension in men. In non-Markov approach, the most common trigger was hypertension. Transition probability (TP) from no component to MetS were higher in all Markovian studies in men than in women. In the Markovians the combination of dyslipidemia with overweight/obesity and in non-Markovians, hyperglycemia with overweight/obesity were the most common combinations. Finally, the most important components, which predict the MetS, were 2-component states and hyperglycemia in Markovian approach and overweight/obesity in non-Markovians. CONCLUSIONS: Among the components of the MetS, dyslipidemia and hypertension seems to be the main developer components in natural history of the MetS. Also, in this chain, the most likely combination over time that determines the future status of people seems to be the combination of dyslipidemia with obesity or hyperglycemia. However, more research is needed.

The dynamics of metabolic syndrome development from its isolated components among iranian children and adolescents: Findings from 17 Years of the Tehran Lipid and Glucose Study (TLGS).

BACKGROUND: Careful evaluation of the progression trend of the metabolic syndrome (MetS) in children and adolescents (C&A) is one of the important methods of studying the natural history of MetS in them. This study was performed to determine the trend of changes in the progression of MetS from its components. METHODS: This was a longitudinal study which was performed on data from 4 follow-up periods of Tehran Lipid and Glucose Study (TLGS) between 1999 and 2015. The research population consisted of 6-18-year-old children and adolescents creating 3895-person population. The criteria for the diagnosis of MetS was joint interim statement (JIS). The considered components were central adiposity, high blood pressure, insulin resistance, and dyslipidemia. RESULTS: In this study, in the long term, the highest increase in the MetS' incidence in boys occurred in obesity and in girls in dyslipidemia and in total mode, in obesity. But in the short term (3.6 year follow-up periods) in the first to fourth periods, in total mode, the highest incidence occurred in dyslipidemia, hyperglycemia, dyslipidemia, and obesity. In terms of trend, in total mode, the highest increase in MetS incidence was related to the obesity component. Also, the incidence of MetS from all components was declining in overall mode. Also, the most common components at the beginning and end of the study in all groups were dyslipidemia with a decreasing and obesity with an increasing trend, respectively. CONCLUSION: It seems that in Iranian C&As, obesity and dyslipidemia components play a more important role in the further development of the MetS than other components. This matter requires careful and serious attention in preventive and control planning.

Incidence of accidents and injuries in children under 6 years old in southern Iran: a population-based study.

BACKGROUND: Accidents and injuries are the leading cause of childhood morbidity and mortality. This study aimed to investigate the incidences of different causes of accidents in children under 6 years old. METHODS: This population-based cross-sectional study was carried out in one year (2016-2017) on a sample of 6000 children in Southern Iran with a multistage sampling method using a standard checklist for comprehensive child health monitoring. RESULTS: The annual incidence rate of accidents was 16% and the mean age of accident victims was 2.5±1.5 years. Of these, 17.3% and 14.8% were male and female, respectively. 25% of the children suffered from more than one accident. The most common causes of accidents were burns (16%), falls (14%), and accidents involving objects (10%). In multivariate analysis, a higher number of male children in the family and lower child age significantly increased the likelihood of accidents (p less than 0.05). CONCLUSIONS: This study was a direct survey of the population, and showed that the incidence rate of accidents in children in southern Iran was in line with that of other regions of Iran, but less than the world average. There was no significant difference in accident etiology and only trends in etiology were found compared to studies using existing data.

Congenital Malformations in Singleton Infants Conceived by Assisted Reproductive Technologies and Singleton Infants by Natural Conception in Tehran, Iran.

BACKGROUND: Multiple pregnancies occur more frequently in assisted reproductive technology (ART) compared to normal conception (NC). It is known that the risk of congenital malformations in a multiple pregnancy are higher than single pregnancy. The aim of this study is to compare congenital malformations in singleton infants conceived by ART to singleton infants conceived naturally. MATERIALS AND METHODS: In this historical cohort study, we performed a historical cohort study of major congenital malformations (MCM) in 820 singleton births from January 2012 to December 2014. The data for this analysis were derived from Tehran's ART linked data file. The risk of congenital malformations was compared in 164 ART infants and 656 NC infants. We performed multiple logistic regression analyses for the independent association of ART on each outcome. RESULTS: We found 40 infants with MCM 29 (4.4%) NC infants and 14 (8.3%) ART infants. In comparison with NC infants, ART infants had a significant 2-fold increased risk of MCM (P=0.046). After adjusting individually for maternal age, infant gender, prior stillbirth, mother's history of spontaneous abortion, and type of delivery, we did not find any difference in risk. In this study the majority (95.1%) of all infants were normal but 4.9% of infants had at least one MCM. We found a difference in risk of MCMs between in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). We excluded the possible role of genotype and other unknown factors in causing more malformations in ART infants. CONCLUSION: This study reported a higher risk of MCMs in ART singleton infants than in NC singleton infants. Congenital heart disease, developmental dysplasia of the hip (DDH), and urogenital malformations were the most reported major malformations in singleton ART infants according to organ and system classification.

Thematic Analysis of Persian Documents in the Field of Quran Study and Medicine in National Scientific-Research Journals from 1992 to 2013 "An Opportunity for Evidence Based Decision Making".

Several documents have investigated the area of Quran study and medicine from different points of view; the present study has been assessing all the documents about Quran study and medicine, published in Iranian scientific-research journals, to create an opportunity of revising the interventions executed in this areas and targeting the decisions in order to draw a clear and more realistic vision. In this simple review study, scientific-research and general informative websites in the period of 1992-2013 were explored by taking advantage of critical keywords such as Islamic medicine and Islamic lifestyle. After the initial retrieval, 348 articles were finally ready for the evaluation process. Chi-square test was used to assess the significance of patterns differences between years of study. Minimum and maximum numbers of articles were published in 1992 (0.28 %) and 2011 (12.35 %), respectively. The level of execution of studies by using different methods was as follows: about 3.44 % qualitative, 29.59 % cross-sectional descriptive-analytical, 30.45 % review, 1.14 % case-control, 17.52 % experimental, 3.73 % cohort methods and 12.93 % were performed by other methods. The most common subject study was "The effects of fasting and Ramadan on health" (21.83 %). The most important journals hosting this field articles were the journals of medicine and refinement (27.01 %), as well as the Quran and medicine (12.64 %), respectively. Chi-square test showed significant thematic differences during the 21 years of study. Based on the available evidences, the number of descriptive papers was yet more than the analytical, interventional and scientific-comparative articles. Also, the most studies had been reviewing the medical-Islamic documents. This reflects the need for revising the search strategies of Quran study and medicine.

A predictive model of apartment-living based on socio-economic and demographic factors with health-based approach in Iran.

OBJECTIVE: Due to importance and progressive growth of apartment-living phenomenon in the world today, it is essential to survey the different dimensions of this modern lifestyle. The aim of this study is to predict rate of apartment-living based on the different predicted variables of socio-economic and demographic factors with approach to different health aspects. METHODS: A descriptive- analytic study was carried out between 600 apartment and 800 non-apartment residents in the Shiraz (Southern Region of Iran) through multi-stage cluster sampling during the year 2011. The statistical analysis was performed on the obtained data using multi-variable logistic regression as well as ANOVA analysis. RESULT: the rate for apartment-living in above 30 years old age group was 8.31 times more than 15-30 years old, 9.6 times more in employed vs. unemployed; 6.57 and 9.49 times more in families with average and high monthly incomes, respectively, vs. family with low monthly income; 8.73 times more in owner sub-group vs. renter sub-group; and 1.30 times more in people living lonely than those living with family. People living in an apartment are in poor health status considering physical, mental and social aspects. CONCLUSION: Based on the results, it is very important that policy makers in urban areas consider the determinative role of socio-economic and demographic factors, which are involved in selecting apartment-living lifestyle by urban residents and also are effective on health.

Silymarin alleviates bleomycin-induced pulmonary toxicity and lipid peroxidation in mice.

CONTEXT: The application of bleomycin is limited due to its side effects including lung toxicity. Silymarin is a flavonoid complex isolated from milk thistle [Silybum marianum L. (Asteraceae)] which has been identified as an antioxidant and anti-inflammatory compound. OBJECTIVE: This study evaluates the effect of silymarin on oxidative and inflammatory parameters in the lungs of mice exposed to bleomycin. MATERIALS AND METHODS: BALB/c mice were divided into four groups of control, bleomycin (1.5 U/kg), bleomycin plus silymarin (50 and 100 mg/kg). After bleomycin administration, mice received 10 d intraperitoneal silymarin treatment. On 10th day, blood and lung samples were collected for measurement of oxidative and inflammatory factors. RESULTS: Silymarin led to a decrease in lung lipid peroxidation (0.19 and 0.17 nmol/mg protein) in bleomycin-injected animals. Glutathione-S-transferase (GST) which was inhibited by bleomycin (32.4 nmol/min/mg protein) induced by higher dose of silymarin (41 nmol/min/mg protein). Silymarin caused an elevation in glutathione (GSH): 2.6 and 3.1 µmol/g lung compare with bleomycin-injected animals 1.8 µmol/g lung. Catalase (CAT) was increased due to high dose of silymarin (65.7 µmol/min/ml protein) compare with bleomycin treated-mice. Myeloperoxidase (MPO) which was induced due to bleomycin (p < 0.05) reduced again by high dose of silymarin (0.51 U/min/mg protein). Bleomycin led to an increase in TNF-α and interleukin-6 (IL-6) (7.9 and 11.8 pg/ml). These parameters were reduced by silymarin (p < 0.05). CONCLUSIONS: Silymarin attenuated bleomycin induced-pulmonary toxicity. This protective effect may be due to the ability of silymarin in keeping oxidant-antioxidant balance and regulating of inflammatory mediator release.

Comparison of Congenital Abnormalities of Infants Conceived by Assisted Reproductive Techniques versus Infants with Natural Conception in Tehran.

BACKGROUND: In many countries, 1 to 3% of newborn infants are conceived by assisted reproductive techniques (ART). Despite the success of ART, there is concern about the risk of congenital malformations among these infants. We report our experience to determine whether use of ART is associated with an increase in major congenital malformations or adverse pregnancy outcomes. MATERIALS AND METHODS: Historical cohort study of major congenital malformations (MCM) was performed in 978 births from January 2008 to December 2010. The data for this analysis were derived from a Tehran's ART linked data file by simple sampling method. In our study, the risk of congenital malformations was compared in 326 ART infants and 652 naturally conceived (NC) infants. We also performed multiple logistic regression analyses to calculate the odds ratio (OR) and 95% confidence intervals (CI) for the independent association of ART on each outcome. RESULTS: We found 56 infants with major congenital malformations, these included 29 NC infants (4.4%) and 27 ART infants (8.3%). In comparison with NC infants, ART infants had a significant 1.94-fold increased risk of MCM.After adjustment for maternal age, infant's sex stillbirth, abortion and type of delivery, we found a relatively small difference in risk (OR=2.04). In this study the majority (94.3%) of all infants were normal but 5.7% of infants had at least one MCM. The prevalence rate for the intracytoplasmic sperm injection (ICSI) was 6.5% for the In vitro fertilisation (IVF) group was 15.9% or 2.73-fold higher than ICSI group (P=0.018). Also we ignore the possible role of genotype and other unknown factors in causing more malformations in ART infants. CONCLUSION: Other studies have shown a slightly increased risk of major congenital malformations in pregnancies resulting from ART. Likewise, this study reports a greater risk of MCMs in ART infants than in naturally conceived infants. We also found evidence of a difference in risk of MCMs between IVF and ICSI. Musculoskeletal and urogenital malformations were the most reported MCMs in ART infants according to organs and systems classification.