Ghrelin and ghrelin/total cholesterol ratio as independent predictors for coronary artery disease: a systematic review and meta-analysis.

The present meta-analysis aimed to summarize the available data regarding the circulating levels of ghrelin in patients with cardiovascular diseases (CVDs). A comprehensive search was performed in electronic databases including PubMed, Scopus, EMBASE, and Web of Science up to January 20, 2021. Since the circulating levels of ghrelin were measured in different units across the included studies, they were expressed as the standardized mean difference (SMD) and 95% CI (summary effect size). A random-effects model comprising the DerSimonian and Laird method was used to pool SMDs. Sixteen articles (20 studies) comprised of 1087 cases and 437 controls were included. The pooled results showed that there were no significant differences between cases and controls in terms of ghrelin levels (SMD=-0.61, 95% CI -1.38 to 0.16; p=0.120; I2=96.9%, p<0.001). The ghrelin concentrations in the CAD stratum were significantly lower than in controls, whereas they increased in other disease strata. New combined biomarkers demonstrated a significant decrease in the SMD of the ghrelin/total cholesterol (TC) ratio (-1.02; 95% CI -1.74 to -0.29, p=0.000; I2=94.5%). However, no significant differences were found in the SMD of the ghrelin/high-density lipoprotein cholesterol ratio, ghrelin/low-density lipoprotein cholesterol ratio, and ghrelin/triglyceride (TG) ratio in cases with CVDs compared with the control group. Ghrelin was associated with CAD; therefore, it may be considered a biomarker for distinguishing between patients with and without CAD. Furthermore, the ghrelin/TC ratio could be proposed as a diagnostic marker for CVD.

The effects of glucagon-like peptide-1 receptor agonists on glycemic control and anthropometric profiles among diabetic patients with non-alcoholic fatty liver disease: A systematic review and meta-analysis of randomized controlled trials.

This study was undertaken to assess the effects of glucagon-like peptide-1 receptor agonists (GLP-1RAs), mainly liraglutide and exenatide, on glycemic control and anthropometric profiles to see if they are effective in treating patients with non-alcoholic fatty liver disease (NAFLD) and type-2 diabetes mellitus (T2DM). We searched PubMed, Embase, Scopus, Web of Science (WOS), and Cochrane Library databases to identify all the randomized clinical trials (RCTs) up to August 23, 2020. Heterogeneity of the included studies was evaluated using Cochrane's Q test and the I2 statistic. Moreover, a random-effects model was used to pool the weighted mean differences (WMDs) and their 95% confidence intervals (CIs). Nine articles (12 studies) comprising a total of 780 participants aged 40-56 were finally selected. GLP-1RAs intake significantly reduced body mass index (BMI) (WMD -1.57, 95%CI; -2.74, -0.39), waist-circumference (WC) (WMD -4.14, 95%CI; -7.09, -1.19), body weight (WMD -4.20, 95%CI; -8.15, -0.25) among the body mass indices. Additionally, GLP-1RAs leads to lower postprandial plasma glucose (PPG) levels (WMD -25.73 mg/dl, 95%CI; -32.71, -18.75). We also found that GLP-1RAs intake has no significant effect on the waist-hip ratio (WHR) (WMD -0.01, 95%CI; -0.03, 0.02), fasting blood glucose (FBG) (WMD -2.12 mg/dl, 95%CI; -6.23, 1.96), hemoglobin A1c (HbA1c) (WMD -0.08%, 95%CI; -0.21, 0.04), and homeostatic model assessment for insulin resistance (HOMA-IR) levels (WMD -0.31, 95%CI; -0.69, 0.07). GLP-1RAs therapy showed a greater reduction in BMI, body weight, WC, and PPG, but not in WHR, HOMA-IR, FBG, and HbA1c compared with other therapies in patients with T2DM and NAFLD.

Prevalence, comorbidity and predictors of anxiety disorders among children and adolescents.

Childhood anxiety may lead to serious health consequences in later life. The present study provides the prevalence, comorbidity, and predictors of anxiety disorders among children and adolescents. This was a cross-sectional national project that was implemented on 28,698 children and adolescents in Iran. Participants entered the study by multistage cluster sampling with an equal number of each gender and three age groups (6-9, 10-14, and 15-18 years) within each cluster. The tools used in this research were the demographic questionnaire and K-SADS-PL. To analyze the data logistic regression and chi-square tests were used in SPSS (ver. 16). The prevalence of anxiety disorder in children and adolescents was 13.2 in boys and 15.1 in girls. Furthermore, gender, age, place of residence and history of psychiatric hospitalization of parents could predict anxiety disorders. Anxiety disorders had comorbidity with behavioral disorders, neurodevelopmental disorders, mood disorders, psychotic disorders, substance abuse disorders, and elimination disorders. According to our findings in this study, anxiety disorders affect the performance, health and life of children and adolescents, identifying the childhood anxiety, as well as finding diseases that are associated with anxiety disorders, can help in the prevention of the disorder.

Lifetime prevalence, sociodemographic predictors, and comorbidities of oppositional defiant disorder: the National Epidemiology of Iranian Child and Adolescent Psychiatric disorders (IRCAP)

Objective: This was the first national epidemiological study on oppositional defiant disorder (ODD) in Iran, which provided new information about the prevalence, comorbidities, and sociodemographic predictors of ODD. Methods: Data from a face-to-face household survey of 30,532 children and adolescents aged 6-18 years were collected from across all 31 provinces of Iran using a multistage cluster sampling design. The Persian version of the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children - Present and Lifetime Version (K-SADS-PL) was used in this study. Results: The lifetime prevalence of ODD was found to be 3.9%. ODD was significantly more common in boys than girls and appeared in late adolescence more frequently than in childhood. A lower prevalence of ODD was found among participants who lived in rural areas. ODD is highly likely to co-occur with attention deficit hyperactivity disorder, separation anxiety disorder, generalized anxiety disorder, and depressive disorders. Conclusions: The findings of this national population-based study confirm and extend previous findings on the prevalence, comorbidities, and sociodemographic predictors of ODD.

Lifetime prevalence, sociodemographic predictors, and comorbidities of oppositional defiant disorder: the National Epidemiology of Iranian Child and Adolescent Psychiatric disorders (IRCAP).

OBJECTIVE: This was the first national epidemiological study on oppositional defiant disorder (ODD) in Iran, which provided new information about the prevalence, comorbidities, and sociodemographic predictors of ODD. METHODS: Data from a face-to-face household survey of 30,532 children and adolescents aged 6-18 years were collected from across all 31 provinces of Iran using a multistage cluster sampling design. The Persian version of the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children - Present and Lifetime Version (K-SADS-PL) was used in this study. RESULTS: The lifetime prevalence of ODD was found to be 3.9%. ODD was significantly more common in boys than girls and appeared in late adolescence more frequently than in childhood. A lower prevalence of ODD was found among participants who lived in rural areas. ODD is highly likely to co-occur with attention deficit hyperactivity disorder, separation anxiety disorder, generalized anxiety disorder, and depressive disorders. CONCLUSIONS: The findings of this national population-based study confirm and extend previous findings on the prevalence, comorbidities, and sociodemographic predictors of ODD.

Prevalence and Correlates of Psychiatric Disorders in a National Survey of Iranian Children and Adolescents.

Objective: Considering the impact of rapid sociocultural, political, and economical changes on societies and families, population-based surveys of mental disorders in different communities are needed to describe the magnitude of mental health problems and their disabling effects at the individual, familial, and societal levels. Method : A population-based cross sectional survey (IRCAP project) of 30 532 children and adolescents between 6 and 18 years was conducted in all provinces of Iran using a multistage cluster sampling method. Data were collected by 250 clinical psychologists trained to use the validated Persian version of the semi-structured diagnostic interview Kiddie-Schedule for Affective Disorders and Schizophrenia-PL (K-SADS-PL). Results: In this national epidemiological survey, 6209 out of 30 532 (22.31%) were diagnosed with at least one psychiatric disorder. The anxiety disorders (14.13%) and behavioral disorders (8.3%) had the highest prevalence, while eating disorders (0.13%) and psychotic symptoms (0.26%) had the lowest. The prevalence of psychiatric disorders was significantly lower in girls (OR = 0.85; 95% CI: 0.80-0.90), in those living in the rural area (OR = 0.80; 95% CI: 0.73-0.87), in those aged 15-18 years (OR = 0.92; 95% CI: 0.86-0.99), as well as that was significantly higher in those who had a parent suffering from mental disorders (OR = 1.96; 95% CI: 1.63-2.36 for mother and OR = 1.33; 95% CI: 1.07-1.66 for father) or physical illness (OR = 1.26; 95% CI: 1.17-1.35 for mother and OR = 1.19; 95% CI: 1.10-1.28 for father). Conclusion: About one fifth of Iranian children and adolescents suffer from at least one psychiatric disorder. Therefore, we should give a greater priority to promoting mental health and public health, provide more accessible services and trainings, and reduce barriers to accessing existing services.

Gender Determines the Pattern of Correlation between Body Mass Index and Major Depressive Disorder among Children and Adolescents: Results from Iranian Children and Adolescents' Psychiatric Disorders Study.

Background: We aimed to determine the correlation of BMI with depression and to determine the role of gender in this association, in a large study sample. Methods: We used the data of participants in the Iranian Children and Adolescents' Psychiatric Disorders (IRCAP) Study, conducted in 2017. This study was a national community-based, cross-sectional study in which the urban and rural areas of all provinces of Iran were covered. Overall 30,532 children and adolescents, ages 6-18, were randomly selected with the stratified cluster sampling method. Results: Of a total of 30,532 participants, 25,321, whose BMI had been measured and who had been interviewed with Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS), entered the study (12,455 boys and 12,866 girls). We categorized the participants according to the national cutoff points for BMI classification. After controlling for age, father's and mother's job and education, and place of residence, the odds ratio (OR) of depression in underweight, healthy weight, and overweight boys compared with obese boys was 2.19 [95% confidence interval (95% CI): 1.00-4.81], 1.06 (95% CI: 0.73-1.55), and 0.80 (95% CI: 0.49-1.32), respectively. In the girls' subgroup, after controlling for the aforementioned covariates, the OR of depression in healthy weight, overweight, and obese participants compared with underweight subjects was 1.29 (95% CI: 0.52-3.19), 1.54 (95% CI: 0.59-3.98), and 1.79 (95% CI: 0.68-4.69), respectively. Conclusions: Underweight boys were more likely diagnosed with depression than normal weight and overweight boys. While in girls, the probability of depression increased by increased BMI.

The prevalence, comorbidity and socio-demographic factors of depressive disorder among Iranian children and adolescents: To identify the main predictors of depression.

BACKGROUND: Depressive disorders are a major public health problem in developed and developing countries. Recently, several risk factors have been described for depressive disorders in children and adolescents. The aim of the present study was to identify the main risk factors that can affect the incidence of depression in Iranian children and adolescents. METHODS: A total of 30,546 children and adolescents (between 6 and 18 years of age) participated in a cross-sectional study to identify the predictors of depressive disorders. Depressive disorders were assessed using the Persian version of the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS-PL). In addition, a demographic characteristics questionnaire was completed by parents of the participants. The data was analyzed using the SPSS22 software via performing the descriptive analysis and the multiple logistic regression analysis methods. P-values less than 0.05 were considered statistically significant. RESULTS: Results showed that a higher age (15-18), being female, and the father's unemployment were associated with an increased odds ratio for depressive disorders. The age of 10-14 (OR = 2.1; 95% CI, 1.57-2.81), the age of 15-18 (OR = 4.44; 95% CI, 3.38-5.83), female gender (OR = 1.44; 95% CI, 1.2-1.73) and the father's unemployment (OR = 1.59; 95% CI, 1.01-2.5) were significant positive predictors, whereas, the mother's job (as a housewife) (OR = 0.66; 95% CI, 0.45-0.96) and a history of psychiatric hospitalization of the father and mother (OR = 0.34; 95% CI, 0.15-0.78 and OR = 0.34; 95% CI, 0.14-0.84) were negative predictors for depressive symptoms. CONCLUSION: Depressive symptoms are common in children and adolescents and are correlated with age and gender. The assessment of the prevalence of psychiatric disorders, especially the depressive disorders and their comorbidities, may help to prevent mood disorders in children and adolescents.

Why Do Emergency Medicine Residents Experience Burn Out? A qualitative study.

Objective: Emergency medicine residents are a high-risk group for burnout syndrome. This was a qualitative study with content analysis on emergency medical residents with 2 aims: evaluating the incidence of occupational burnout syndrome and identifying the points of view and attitudes of emergency medical residents about factors related to occupational burnout syndrome. Method: For this study, 2 sessions of focus group discussions were set up at Imam Khomeini hospital affiliated to Tehran University of Medical Sciences. Each session took 90 minutes, and 20 emergency medicine residents in their first or second year of emergency medicine residency participated in the sessions. Data were coded by MAXQDA10 software. Results: Data were categorized in 4 themes as follow: (1) the characteristics of emergency medicine; (2) ambiguity in residents' duties; (3) educational planning; and (4) careers. Data on the proposed solutions by residents were analyzed and coded in 3 groups including (1) changes in personal life; (2) arrangement in shifts; and (3) educational issues. Conclusion: According to findings of this qualitative study, most of emergency medicine residents have experienced exhaustion sometime during the course of their residency. Psychological supports may help the residents to cope with their career difficulties and probable burn out.

Adverse effects of organophosphorus pesticides on the liver: a brief summary of four decades of research.

Organophosphorus pesticides (OPs) are widely used volatile pesticides that have harmful effects on the liver in acute and chronic exposures. This review article summarises and discusses a wide collection of studies published over the last 40 years reporting on the effects of OPs on the liver, in an attempt to propose general mechanisms of OP hepatotoxicity and possible treatment. Several key biological processes have been reported as involved in OP-induced hepatotoxicity such as disturbances in the antioxidant defence system, oxidative stress, apoptosis, and mitochondrial and microsomal metabolism. Most studies show that antioxidants can attenuate oxidative stress and the consequent changes in liver function. However, few studies have examined the relationship between OP structures and the severity and mechanism of their action. We hope that future in vitro, in vivo, and clinical trials will answer the remaining questions about the mechanisms of OP hepatotoxicity and its management.

Riluzole in augmentation of fluvoxamine for moderate to severe obsessive-compulsive disorder: Randomized, double-blind, placebo-controlled study.

AIM: The aim of the present randomized, double-blind, placebo-controlled, 8-week trial was to assess the efficacy and tolerability of riluzole augmentation of fluvoxamine in treatment of patients with moderate to severe obsessive-compulsive disorder. METHODS: Patients were randomized into two parallel groups to receive fluvoxamine plus placebo or fluvoxamine plus riluzole (50 mg twice daily). All patients, regardless of their treatment group, received fluvoxamine at 100 mg/day for the initial 4 weeks of the study followed by 200 mg/day of fluvoxamine for the rest of the trial course. A total of 50 patients (25 in each group) were evaluated for response to treatment using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) at baseline and at weeks 4, 8 and 10. Side-effects were recorded using predesigned checklists in each visit. Repeated-measure analysis of variance showed a significant effect for time × treatment interaction in the Y-BOCS total score and a significant effect for time × treatment interaction in the Y-BOCS Compulsive subscale score between the two groups. RESULTS: Repeated-measure analysis of variance showed a significant effect for time × treatment interaction (Greenhouse-Geisser corrected: F = 4.07, d.f. = 1.22, P = 0.04) in the Y-BOCS total score and a significant effect for time × treatment interaction (Greenhouse-Geisser corrected: F = 4.45, d.f. = 1.33, P = 0.028) in the Y-BOCS Compulsive subscale score between the two groups. Riluzole augmentation therapy demonstrated higher, partial or complete treatment response according to the Y-BOCS total scores. CONCLUSION: Riluzole may be of clinical use as an adjuvant agent to fluvoxamine in treatment of moderate to severe obsessive-compulsive disorder.