Effectiveness of polypill for primary and secondary prevention of cardiovascular disease: a pragmatic cluster-randomised controlled trial (PolyPars).

BACKGROUND: We aimed to investigate the effectiveness of fixed-dose combination therapy (polypill) for primary and secondary prevention of major cardiovascular diseases in a typical rural setting. METHODS: The PolyPars Study is a two-arm pragmatic cluster-randomised trial nested within the PARS cohort study, including all residents aged over 50 years in the entire district in southern Iran. The 91 villages underwent random allocation into two arms: the control arm, encompassing 45 clusters, was subjected to non-pharmacological intervention (educational training on healthy lifestyle), whereas the intervention arm, comprising 46 clusters, received the non-pharmacological interventions in conjunction with a once-daily polypill tablet. This tablet comprised two antihypertensive agents, a statin and aspirin. The primary outcome was the first occurrence of major cardiovascular events defined as a composite of hospitalisation for acute coronary syndrome (non-fatal myocardial infarction and unstable angina), fatal myocardial infarction, non-fatal and fatal stroke, sudden death and heart failure. The Cox regression model, with shared frailty, was used to account for clustering effect. RESULTS: During December 2015-December 2016, a total of 4415 participants aged 50-75 years were recruited (2200 participants in the intervention arm and 2215 participants in the control arm). The overall median of follow-up duration was 4.6 years (interquartile interval 4.4-4.9). The achieved adherence rate to polypill in intervention arm was 86%. In the control group, 176 (8.0%) of 2215 participants developed primary outcome, compared with 88 (4.0%) of 2200 participants in the polypill group. We found substantial reduction in risk of primary outcome both in relative and absolute scales (HR 0.50, 95% CI 0.38 to 0.65; absolute risk reduction 4.0%, 95% CI 2.5% to 5.3%). No difference in serious adverse events was observed between the two groups. CONCLUSIONS: The fixed-dose combination therapy using polypill can safely halve the risk of major cardiovascular diseases at the population level. TRIAL REGISTRATION NUMBER: NCT03459560.

Outcomes of Different Donor and Recipient Vessel and Ureteral Anastomoses in En Bloc Kidney Transplant From Pediatric Deceased Donors: A Retrospective Cohort.

OBJECTIVES: This study aimed to investigate the possible role of different donor and recipient vessel and ureteral anastomoses on survival and functional outcomes in en bloc kidney transplants. MATERIALS AND METHODS: This retrospective cohort included 99 en bloc kidney transplants performed from December 2005 to March 2022. Recipients were grouped based on donor's vessel (distal [n = 84] or proximal [n = 15] abdominal aorta), recipient's vessel (abdominal aorta [n = 3], external [n = 21], internal [n = 50], or common [n = 25] iliac artery), and ureteral anastomosis (separate [n = 32] or common [n = 67]). Patient and graft survival, complication rates, and estimated glomerular filtration rate trends were compared between groups. RESULTS: Pediatric brain dead donors had a mean age and weight of 37 ± 22 months and 14 ± 4 kg, respectively. Donor and recipient vessel and ureteral anastomoses did not affect overall survival (P = .306, .296, and .225), graft survival (P = .720, .172, and .124), and vascular (P = .347, .689, and .264) and urinary (P = .587, .172, and .385) complication rates. Lymphoceles requiring intervention were significantly more prevalent in the recipient external iliac artery group (P = .008) but were independent of donor vessel and ureteral anastomosis (P = .587 and 1.00). Estimated glomerular filtration rate trend was independentofdonor(P=.921) andrecipient vessel(P=.878 and .536). CONCLUSIONS: We found that different arterial and ureteral anastomoses appear to have comparable outcomes in en bloc kidney transplant with the exception of recipient external iliac artery, which may be slightly inferior because of the relatively higher rate of lymphoceles requiring intervention.

Laparoscopic gastric plication: A long-term follow-up and comparison of outcomes in severe vs. non-severe obesity.

BACKGROUND: LGGCP is a non-gastrectomy, restrictive bariatric technique. This study aims to assess its long-term efficacy. METHODS: This is a retrospective cohort study on LGGCP patients (2010-2019) from a single tertiary center, followed for up to 60 months. RESULTS: Ninety-four patients with obesity were included in the study. The mean five-year postoperative BMI was 32.00. Excess weight loss (EWL): 30%-50% and EWL<30% occurred in 16 and 9 cases, respectively. The mean EWL was higher at 3-, 6-, and 12- months post-operation in patients with a BMI<40. Weight regain was 46.3% at the five-year follow-up. Eighty-seven patients had associated comorbidity, and 76 had improved in at least one of their comorbidities. Sixteen patients (17.0%) experienced complications. CONCLUSION: LGGCP is safe and effective, with benefits in patients with BMI<40. Thus, we suggest the usage of LGGCP, especially in this group of patients, due to its less-invasive nature and acceptable cost-benefit. Further studies with larger sample sizes are required for validation.

Liver fibrosis in pars cohort study: A large-scale study on the prevalence and correlated factors.

BACKGROUNDS AND STUDY AIMS: The fibrosis-4 (FIB-4) is a non-invasive scoring system for estimating liver fibrosis severity as a biomarker of chronic liver disease. We aimed to estimate the prevalence and severity of chronic liver disease at the community level using FIB-4. PATIENTS AND METHODS: This cross-sectional study was conducted using the Pars Cohort database collected in Valashar, Fars province, Iran. Participants were divided into three groups based on their FIB-4 scores: low risk of liver fibrosis (FIB < 1.45), intermediate cases (1.45 ≤ FIB-4 ≤ 3.25), and high risk of liver fibrosis (FIB-4 > 3.25). RESULTS: In total, 9269 individuals with a mean age of 52.65 years were enrolled in the study, of which 4278 (46.2 %) were male. Among all participants, 7853 (84.7 %) were in the low-risk, and 65 (0.7 %) were in the high-risk groups. In the final ordinal regression model, male gender, being a farmer or rancher, living in rural areas, history of opioid use, history of jaundice, no history of diabetes, history of depression, and positive HBs Ag were independently associated with higher FIB-4 scores. CONCLUSION: Our study revealed that males, individuals residing in rural areas, and those engaged in farming and ranching occupations face a heightened risk of liver fibrosis. These findings emphasize the need for future programs for early detection and effective management of liver fibrosis in these at-risk populations.

A systematic review and meta-analysis of the global epidemiology of pediatric traumatic spinal cord injuries.

Despite being relatively rare, pediatric traumatic spinal cord injury (TSCI) is a debilitating event with high morbidity and long-term damage and dependency. This study aims to provide insight on the epidemiological characteristics of pediatric TSCI worldwide. The studies were included if they provided data for the pediatric population with the diagnosis of TSCI. Information sources included PubMed, Embase, Web of Science, and Scopus. All databases were searched from 1990 to April 2023. The quality of included studies was evaluated by Joanna Briggs Institute Critical Appraisal Tools. The results of the meta-analysis were presented as forest plots. PROSPERO Registration code: CRD42020189757. We identified 87 studies from 18 developed and 11 developing countries. Of the 87 studies evaluated, 52 studies were considered medium quality, 27 studies were considered high quality, and 8 studies were considered low quality. In developed countries, the proportion of TSCIs occurring in patients aged 0-15 years was 3% (95% CI: 2.2%; 3.9%), while in developing countries, it was 4.5% (95% CI: 2.8%; 6.4%). In developed countries, the pooled incidence of pediatric TSCI was 4.3/millions of children aged 0-15/year (95% CI: 3.1; 6.0/millions children aged 0-15/year) and boys comprised 67% (95% CI: 63%; 70%) of cases. The most prevalent level of injury was cervical (50% [95% CI: 41%; 58%]). The frequency of SCI Without Obvious Radiological Abnormality (SCIWORA) was 35% (95% CI: 18%; 54%) among children 0-17 years. The most common etiology in developed countries was transport injuries (50% [95% CI: 42%; 57%]), while in developing countries falls were the leading cause (31% [95% CI: 20%; 42%]). The most important limitation of our study was the heterogeneity of studies in reporting age subgroups that hindered us from age-specific analyses.   Conclusion: Our study provided accurate estimates for the epidemiology of pediatric TSCI. We observed a higher proportion of pediatric TSCI cases in developing countries compared to developed countries. Furthermore, we identified distinct epidemiological characteristics of pediatric TSCI when compared to adult cases and variations between developing and developed countries. Recognizing these unique features allows for the implementation of cost-effective preventive strategies aimed at reducing the incidence and burden of TSCI in children. What is Known: • Pediatric Traumatic Spinal Cord Injury (TSCI) can have profound physical and social consequences for affected children, their families, and society as a whole. • Epidemiological insights are vital for they provide the data and understanding needed to the identification of vulnerable populations, aiding in the development of targeted prevention strategies and effective resource allocation. What is New: • The estimated incidence of pediatric TSCI in developed countries is 4.3 cases per million children aged 0-15. The proportion of pediatric TSCI cases in relation to all-age TSCI cases is 3% in developed countries and 4.5% in developing countries. • The etiology of TSCI in pediatric cases differs between developing and developed countries. In developed countries, transport injuries are the most prevalent cause of pediatric TSCI, while falls are the least common cause. Conversely, in developing countries, falls are the leading cause of pediatric TSCI.

Intraoperative use of electrical impedance spectroscopy for adenoid cystic carcinoma of the lacrimal gland: A case report.

Key Clinical Message: Electrical Impedimetric Tumor Detection System is a novel and promising tool for fast intraoperative tumor delineation and accurate safe margin detection in orbital tumors. Abstract: Adenoid cystic carcinoma (ACC) is a rare malignant tumor of epithelial origin, typically arising from the salivary and lacrimal glands. ACC is notorious for recurrence and a high rate of morbidity and mortality despite therapy. We presented a 48-year-old male patient with lacrimal gland ACC of the right orbit who underwent radical tumor resection and adjuvant radiotherapy. We applied a new diagnostic method, the Electrical Impedimetric Tumor Detection System, during surgery and tested its performance to enhance the precision of tumor resection. Two months after surgery, he underwent external radiation of 58 Gy in 29 fractions. He showed no tumor recurrence or metastasis in the 1-year follow-up visits. ITDS showed a precision of tumor and margin detection consistent with histopathology results. This novel ITDS may be a reliable system for fast intraoperative tumor delineation and accurate, safe margin detection in orbital tumors.

Reliability, Validity, and Transcultural Adaptation of New Persian Version of Celiac Disease Quality of Life Questionnaire.

Background: Health-related quality of life (HRQOL) assessment in patients with celiac disease (CD) leads to understanding the impact of the CD and interventions on the individual and society. The aim of this study was transcultural adaptation and evaluation of the reliability and validity of the standardized questionnaire of celiac disease quality of life (CD-QOL) in the Persian language in southwest Iran. Methods:150 adults with CD were randomly selected from the celiac clinic and Fars Celiac Registry to complete the New Persian version of the CD-QOL questionnaire. Transcultural adaptation of the questionnaire was conducted by a four-step procedure. The internal consistency of the CD-QOL subscales and convergent and discriminant validity were assessed using Cronbach's alpha coefficient and Spearman's correlation, respectively. Construct validity was evaluated by exploratory and confirmatory factor analysis. Results: All domains of the CD-QOL questionnaire had acceptable internal consistency, showing excellent reliability. The scaling success rates for convergent and discriminant validity were also within an acceptable range (87-100%). In the factor analysis model, similar to the original English version, four factors were extracted characterizing the patients' answers (limitations, dysphoria, health concerns, and inadequate treatment). Conclusion: Our Persian version of the CD-QOL questionnaire had high reliability and validity and could be used in clinical practice assessing the CD-specific HRQOL in the Iranian population.

Indirect Spinal Canal Decompression Using Ligamentotaxis Compared With Direct Posterior Canal Decompression in Thoracolumbar Burst Fractures: A Prospective Randomized Study.

Background: There is still no standard of care to manage thoracolumbar burst fractures. With all the recent advances, posterior approaches are still one of the mainstays of treatment. On the other hand, while spinal canal decompression in neurological impaired patients is an important goal of treatment, its technique remains controversial.This study compared the effects of direct laminectomy decompression against ligamentotaxis/indirect canal decompression on neurological and radiographic improvements. Methods: A prospective double-blind randomized clinical trial was conducted on 60 thoracolumbar burst-fracture patients meeting our inclusion and exclusion criteria. They were randomized into 2 treatment arms: (1) direct decompression using laminectomy and (2) indirect decompression using ligamentotaxis/distraction. Each patient was observed for 6 months, and their neurological and radiographical data were collected prospectively. Statistical analysis was done by the Student t test, Friedman test, Mann Whitney-U test, Wilcoxon ranked test, and 1-way analysis of variance. Results: Among 60 patients enrolled in our study, each treatment arm had an improvement in Frankel scores but there was no difference between the groups at any given time. After 6 months of surgery, local sagittal kyphosis improved in both groups (from 32.2 to 7.43 and 29.93 to 8.77 for the indirect and direct groups, respectively), as well as anterior vertebral height ratio (from 57.73 to 70.7 and 62.17 to 66.27 for the indirect and direct group, respectively) and posterior vertebral height ratio (from 61.17 to 74.87 and 64 to 67.5 for the indirect and direct group, respectively). For between-group comparisons after 6 months, there was a significant difference only for posterior vertebral height ratio (P = 0.040). Conclusion: Posterior approaches with ligamentotaxis have shown to be safe and may present the same outcome as direct decompression techniques using wide laminectomy.

Effect of miR-4270 Suppression on Migration in Hepatocellular Carcinoma Cell Line (HepG2)

Background: Liver transplantation and surgical resection are two major strategies for treatment of hepatocellular carcinoma (HCC) patients. One approach to treating HCC is the suppression of metastasis to other tissues. Herein, we aimed to study the effect of miR-4270 inhibitor on migration of HepG2 cells as well as activity of matrix metalloproteinase (MMP) these cells in order to find a strategy to suppress metastasis in future. Methods: HepG2 cells were treated with 0, 10, 20, 30, 40, 50, 60, 70, 80, and 90 nM of miR-4270 inhibitor, and then the cell viability was measured by trypan blue staining. Afterwards, cell migration and MMP activity of HepG2 cells were assessed by wound healing assay and zymography, respectively. The MMP gene expression was determined by real-time reverse transcription polymerase chain reaction. Results: Results showed that miR-4270 inhibitor decreased the cell viability of HepG2 cells in a concentration-dependent manner. Also, inhibition of the miR-4270 reduced invasion, MMP activity, and expression of MMP genes in HepG2 cells, respectively. Conclusion: Our findings suggest that miR-4270 inhibitor decreases in vitro migration, which could help find a new approach for HCC therapy patients.

Mini-Review: Role of Drugs Affecting Renin-Angiotensin System (RAS) in Traumatic Brain Injury (TBI): What We Know and What We Should Know.

Traumatic brain injuries (TBIs) are among the most important clinical and research areas in neurosurgery, owing to their devastating effects and high prevalence. Over the last few decades, there has been increasing research on the complex pathophysiology of TBI and secondary injuries following TBI. A growing body of evidence has shown that the renin-angiotensin system (RAS), a well-known cardiovascular regulatory pathway, plays a role in TBI pathophysiology. Acknowledging these complex and poorly understood pathways and their role in TBI could help design new clinical trials involving drugs that alter the RAS network, most notably angiotensin receptor blockers and angiotensin-converting enzyme inhibitors. This study aimed to briefly review the molecular, animal, and human studies on these drugs in TBI and provide a clear vision for researchers to fill knowledge gaps in the future.

Quality of diet and odds of metabolic syndrome in Iranian adults: Baseline results from the PERSIAN Kavar cohort study (PKCS).

BACKGROUND AND AIMS: Metabolic Syndrome (MetS) is a major risk factor for cardiovascular diseases and type 2 diabetes mellitus. Diet quality has been associated with multiple chronic diseases. We aimed to investigate the association between the quality of diet and the odds of being diagnosed with MetS. METHODS AND RESULTS: This study was conducted cross-sectionally on baseline data of 2225 individuals from the PERSIAN Kavar Cohort Study (PKCS). The quality of diet was measured based on the Diet Quality Index - International (DQI-I), using Food Frequency Questionnaires. The association between DQI-I and MetS and its components was measured via logistic regression models in crude and adjusted models. We did not observe any association between DQI-I and MetS in the overall population. However, after adjustment for potential confounders, we found that male participants with higher DQI-I scores had a lower risk of MetS [adjusted odds ratio (OR) 95% confidence interval CI) = 0.62 (0.42-0.93)]. Moreover, analogous trends were observed with respect to some components of MetS, including elevated triglyceride (TG) [crude OR (95% CI) = 0.89 (0.70-0.98); adjusted OR = 0.82 (0.65-0.93)], lowered high-density lipoprotein cholesterol (HDL-c) [crude OR (95% CI) = 0.79 (0.57-0.99); adjusted OR = 0.76 (0.55-0.97)], and abnormal glucose homeostasis [crude OR (95% CI) = 0.80 (0.55-0.94); adjusted OR = 0.73 (0.51-0.91)] only in male participants, both before and after adjustment for potential confounders. CONCLUSION: In this study, we showed that higher adherence to a high-quality diet was associated with a lower chance of developing MetS in men. Biological gender might be responsible for the observed discrepancies.

Influence of Garlic on the Glycemic Control and Lipid Profile in Animals with Nonalcoholic Fatty Liver Disease: A Systematic Review and Meta-analysis.

Nonalcoholic fatty liver disease is the hepatic sign of metabolic syndrome. Here, we aimed to assess the effects of garlic and its major components on fasting plasma glucose, fasting insulin, and lipid profile levels in animal models of nonalcoholic fatty liver disease. A systematic search in PubMed, Scopus, ProQuest, and Web of Science was performed. After the screening process and data extraction, the pooled effect sizes were estimated using a random-effect model and stated as standardized mean differences and a 95% confidence interval. Out of 839 reports, 22 articles were included in the present study. The pooled results revealed that garlic and its components significantly decreased fasting plasma glucose (standardized mean difference: - 0.77, 95% confidence interval: - 1.42 to - 0.12, I2 : 58.85%), fasting insulin (standardized mean difference: - 1.88, 95% confidence interval: - 3.07 to - 0.69, I2 : 70.42%), serum triglyceride (standardized mean difference: - 1.01, 95% confidence interval: - 1.43 to - 0.59, I2 : 61.41%), cholesterol (standardized mean difference: - 1.00, 95% confidence interval: - 1.39 to - 0.60, I2 : 52.12%), and low-density lipoprotein cholesterol (standardized mean difference: - 0.98, 95% CI: - 1.63 to - 0.32, I2 : 71.58%) and increased high-density lipoprotein cholesterol (standardized mean difference: 1.05, 95% confidence interval: 0.52 to 1.58, I2 : 59.39%) levels. The type of animal, nonalcoholic fatty liver disease induction model, kind and duration of intervention, study model, and risk of bias were detected as possible sources of heterogeneity across studies. We conclude that garlic and its major components have a favorable impact on glycemic control and lipid profile in diet-induced nonalcoholic fatty liver disease animal models.

Adherence to a healthy diet and odds of metabolic syndrome: A cross-sectional study.

INTRODUCTION: Metabolic syndrome (MetS) is a major health concern around the world. Dietary factors, including diet quality, play a significant role in its pathophysiology. Healthy Eating Index (HEI) is a tool used as a valid measurement of the individual's diet quality. We aimed at investigating the relationship between diet quality as assessed by HEI-2015 and the risk of MetS and its components in a cross-sectional sample of suburban individuals from PERSIAN Kavar cohort study (PKCS), Fars province, Iran. METHODS: 2225 individuals meeting the eligibility criteria participated in the study. The relevant data were obtained from the baseline phase of PKCS. MetS was defined according to cut-offs presented by the National Cholesterol Education Program Adult Treatment Panel III (ATP III). HEI-2015 was calculated for the included individuals. Odds ratios were estimated. P-values <0.05 were considered as significant. RESULTS: The overall prevalence of MetS was 27.3%. Individuals with lower HEI-2015 scores had higher odds for MetS and its components. We observed that those who were categorized as the top HEI-2015 tertile had 42% (OR: 0.58; 95% CI: 0.38-0.90) lower odds of high blood pressure in the overall population. Also, the odds of high serum triacylglycerol was lower (OR: 0.72; 95% CI: 0.57-0.90) in those with the highest HEI-2015 scores. CONCLUSION: We found that higher dietary quality measured by HEI will decrease the risk of developing MetS, hypertension, and hypertriglyceridemia among Iranian adults. However, future interventional studies are required to further elucidate the issue.

The efficacy of intrathecal methyl-prednisolone for acute spinal cord injury: A pilot study.

Study design: Randomized clinical trial. Objectives: To evaluate the safety and effectiveness of intrathecal methyl-prednisolone compared to intravenous methyl-prednisolone in acute spinal cord injuries. Setting: Imam Reza Hospital, Tabriz University of Medical Sciences. Methods: Patients meeting our inclusion and exclusion criteria were enrolled in the study and divided randomly into two treatment arms: intrathecal and intravenous. Standard spinal cord injury care (including surgery) was given to each patient based on our institutional policy. Patients were then assessed for neurological status (based on ASIA scores, Frankel scores) and complications for six months and compared to baseline status after injury. To better understand the biological bases of methyl-prednisolone on spinal cord injuries, we measured two biomarkers for oxidative stress (serum malondialdehyde and total antioxidant capacity) in these patients at arrival and day three after injury. Results: The present study showed no significant difference between the treatment arms in neurological status (sensory scores or motor scores) or complications. However, the within-group analysis showed improvement in neurological status in each treatment arm within six months. Serum malondialdehyde and total antioxidant capacity were analyzed, and no significant difference between the groups was seen. Conclusion: This is the first known clinical trial investigating the effect of intrathecal MP in acute SCI patients. Our finding did not show any significant differences in complication rates and neurological outcomes between the two study arms. Further studies should be conducted to define the positive and negative effects of this somehow novel technique in different populations as well.

The association between low carbohydrate diet and odds of metabolic syndrome in adults: A cross-sectional study.

OBJECTIVE: Metabolic syndrome (MetS) has become a major health problem across the globe. Various investigations have been conducted to find the underlying lifestyle-related causes of MetS. Modifiable dietary factors are specifically the center of interest, including the macronutrient composition of the regimen. We aimed to study the association between a low-carbohydrate diet score (LCDS) with MetS and its components in a Kavarian population, located in the center of Iran. METHODS: The present study is a cross-sectional investigation conducted on a healthy sub-sample of PERSIAN Kavar cohort meeting our inclusion criteria (n = 2225). General, dietary, anthropometric, and laboratory data were obtained for each individual using validated questionnaires and measurements. Possible associations between LCDS and MetS and its components were verified using relevant statistical analyses, including analysis of variance and covariance (ANOVA and ANCOVA) and logistic regression. P-values <0.05 were considered as significant. RESULTS: Compared with the lowest LCDS tertiles, those who were assigned to the upper tertiles had lower chance of MetS, after adjusting for potential confounders (OR: 0.66; 95% CI: 0.51-0.85). Moreover, those who assigned to the top LCDS tertile had 23% (OR: 0.77; 95% CI: 0.60-0.98) and 24% (OR: 0.76; 95% CI: 0.60-0.98) lower odds of abdominal adiposity and abnormal glucose homeostasis, respectively. CONCLUSION: We observed a protective effect of low-carbohydrate diet against metabolic syndrome and its components, including abdominal obesity and abnormal glucose homeostasis. However, these initial findings need to be confirmed, especially in the format of clinical trials to ensure causality.

Association of plant-based dietary patterns with metabolic syndrome: baseline results from the Persian Kavar cohort study (PKCS).

Plant-based diets (PBDs) have gained a positive reputation among experts as a solution to combat the epidemic of MetS. A total of 2225 healthy Iranian individuals aged 35-70 years were considered eligible to be included in this cross-sectional investigation. Various dietary, anthropometric, and biochemical assessments were conducted using standard, valid methods/tools. Relevant PBD scores were calculated using three a posteriori indices, including the overall plant-based diet index (PDI), healthful PDI (hPDI), and unhealthful PDI (uPDI). Our findings showed that women with the highest adherence to hPDI had a lower chance of MetS. Also, participants in the top tertiles of hPDI were more likely to have a lower risk of low serum HDL-c and abnormal glucose homeostasis. Additionally, a significant increasing trend was observed for low serum HDL-c across tertiles of uPDI. Our observations suggest that healthful-rich plant foods may have a protective effect against MetS, especially in women.

Dietary selenium intake in relation to non-alcoholic fatty liver disease assessed by fatty liver index and hepatic steatosis index; a cross-sectional study on the baseline data of prospective PERSIAN Kavar cohort study.

BACKGROUND: There is limited and conflicting evidence on the association between selenium and non-alcoholic fatty liver disease (NAFLD). Therefore, the present population-based cross-sectional study aimed to explore the relationship between dietary selenium intake and the risk of NAFLD. METHODS: A total of 3026 subjects from the PERSIAN (Prospective Epidemiological Research Studies in IrAN) Kavar cohort study were included in the analysis. The daily selenium intake was evaluated using a semi-quantitative food frequency questionnaire, and energy-adjusted quintiles of selenium intake (µg/day) were calculated. NAFLD was defined as the fatty liver index (FLI) ≥ 60 or the hepatic steatosis index (HSI) > 36. The association between dietary selenium intake and NAFLD was evaluated using logistic regression analysis. RESULTS: The prevalence rates of NAFLD were 56.4% and 51.9%, based on the FLI and HSI markers, respectively. The odds ratios (ORs) for FLI-defined NAFLD were 1.31 (95% confidence interval (CI): 1.01-1.70) and 1.50 (95% CI: 1.13-1.99) for the fourth and fifth quintiles of selenium intake, respectively, after adjustment for sociodemographic variables, smoking status, alcohol drinking, physical activity, and dietary factors (P trend = 0.002). There was also a similar association between selenium intakes and HSI-defined NAFLD (OR = 1.34 (95% CI: 1.03-1.75) for the fourth quintile and OR = 1.50 (95% CI: 1.12-2.01) for the fifth quintile of selenium intake) (P trend = 0.006). CONCLUSION: In this large sample study, we observed a weak positive association between dietary selenium intake and NAFLD risk.

Polymorphism Analysis of Interleukin-18 and Interleukin-37 Genes in Hepatitis B Infections with Different Outcomes: A Preliminary Report from an Iranian Population.

OBJECTIVE: Given the vital role of cytokines in influencing the outcomes of hepatitis B virus (HBV) infections, this study aimed to investigate the association between polymorphisms of interleukin (IL)-18 and IL-37 and the outcomes of HBV infection. METHODS: In this study, we enrolled 300 subjects with chronic HBV infection, including those with cirrhosis/hepatocellular carcinoma (C/HCC), chronic active hepatitis B (CAH) infection, or asymptomatic carriers (AC), and 58 individuals whose infection was spontaneously cleared (SC). Genomic DNA was extracted, and IL-18/IL-37 genotyping was performed using PCR-RFLP and ARMS-PCR. RESULTS: The frequency of genotypes and alleles of IL-18 single nucleotide polymorphisms (SNPs) at positions rs1946519, rs1946518, and rs187238 and IL-37 at position rs4241122 were not statistically different among the four studied groups (P>0.05). Furthermore, the frequency of different haplotypes was similar among the studied groups (P>0.05). CONCLUSIONS: Polymorphisms of IL-18 SNPs at positions rs1946519, rs1946518, and rs187238 and variation of IL-37 at position rs4241122 do not appear to influence the outcome of HBV infection.

Clinical characteristics of 365 hospitalized COVID-19 patients with neurological symptoms: an observational study.

OBJECTIVE: Since the beginning of the COVID-19 pandemic, a number of COVID-related neurological manifestations have been reported. We aimed to categorize the features of hospitalized COVID-19 patients who experienced neurological symptoms. METHODS: In this descriptive, cross-sectional study, we enrolled all patients hospitalized with COVID-19 who experienced neurological symptoms in two hospitals in Tehran. Diagnosis of COVID-19 was established by PCR tests or computed tomography of the chest combined with COVID-19 clinical findings. The clinical characteristics, laboratory data, and imaging findings from 365 patients were analyzed. RESULTS: The average patient age was 59.2 ± 16.7 years and included 213 males and 152 females. The most prevalent neurological symptoms were headache (56.2%), impaired consciousness (55%), and dizziness (20.5%). During hospitalization, most of the patients did not require mechanical ventilation (81.9%). The percentage of patients with end-organ damage was 9% and mortality was 15%. Regression analysis on the neurological symptoms indicated that the mortality rate of patients with headaches was 84% lower than for the other neurological symptoms. Hyperglycemia was significantly related with end-organ damage and mortality (p = 0.029, p = 0.08, respectively). New vascular lesions were evident on brain MRIs of 9 patients and brain CTs of 16 patients. CONCLUSION: Among the neurological symptoms of patients with COVID-19, headache appeared to indicate a protective factor against development of end-organ damage as well as mortality.

Metabolic Syndrome and Nephrolithiasis; A Cross Sectional Population-based Study on the Baseline Data of the PERSIAN Kavar Cohort Study.

OBJECTIVE: To explore the relationship between metabolic syndrome and its components with nephrolithiasis. METHODS: In current study, 4,901 individuals from the PERSIAN (Prospective Epidemiological Research Studies in IrAN) Kavar cohort study were included. Metabolic syndrome was defined according to the ATP III criteria (2005 revision). The nephrolithiasis was assessed using a structured questionnaire, and ultrasound findings were reviewed in subjects who reported positive history of nephrolithiasis. We applied logistic regression to estimate the odds ratio (OR) and 95% confidence interval (CI). RESULTS: The prevalence of nephrolithiasis and metabolic syndrome was 28.5% and 40.91%, respectively. Almost 31% of the patients with metabolic syndrome had a history of nephrolithiasis. Multivariable logistic regression analysis revealed a positive association between metabolic syndrome and nephrolithiasis (OR= 1.30, 95% CI: 1.14-1.49, P<.001) after adjustment age, sex, ethnicity, physical activity, smoking status, and alcohol intake. Furthermore, the relation was higher for elders aged 50 years or more (P for interaction= .016) and Turk Nomad participants (P for interaction= 0.044) than the others. There was also a positive independent association between hypertension (OR=1.29, 95% CI: 1.12-1.48, P<.001) and hypertriglyceridemia (OR= 1.15, 95% CI: 1.01-1.31, P=.033) with nephrolithiasis. CONCLUSION: In this large sample study, we demonstrate a weak positive association between metabolic syndrome, hypertension, and hypertriglyceridemia with nephrolithiasis.