Novel anthropometric indices for predicting type 2 diabetes mellitus.

BACKGROUND: This study aimed to compare anthropometric indices to predict type 2 diabetes mellitus (T2DM) among first-degree relatives of diabetic patients in the Iranian community. METHODS: In this study, information on 3483 first-degree relatives (FDRs) of diabetic patients was extracted from the database of the Endocrinology and Metabolism Research Center of Isfahan University of Medical Sciences. Overall, 2082 FDRs were included in the analyses. A logistic regression model was used to evaluate the association between anthropometric indices and the odds of having diabetes. Furthermore, a receiver operating characteristic (ROC) curve was applied to estimate the optimal cutoff point based on the sensitivity and specificity of each index. In addition, the indices were compared based on the area under the curve (AUC). RESULTS: The overall prevalence of diabetes was 15.3%. The optimal cutoff points for anthropometric measures among men were 25.09 for body mass index (BMI) (AUC = 0.573), 0.52 for waist-to-height ratio (WHtR) (AUC = 0.648), 0.91 for waist-to-hip ratio (WHR) (AUC = 0.654), 0.08 for a body shape index (ABSI) (AUC = 0.599), 3.92 for body roundness index (BRI) (AUC = 0.648), 27.27 for body adiposity index (BAI) (AUC = 0.590), and 8 for visceral adiposity index (VAI) (AUC = 0.596). The optimal cutoff points for anthropometric indices were 28.75 for BMI (AUC = 0.610), 0.55 for the WHtR (AUC = 0.685), 0.80 for the WHR (AUC = 0.687), 0.07 for the ABSI (AUC = 0.669), 4.34 for the BRI (AUC = 0.685), 39.95 for the BAI (AUC = 0.583), and 6.15 for the VAI (AUC = 0.658). The WHR, WHTR, and BRI were revealed to have fair AUC values and were relatively greater than the other indices for both men and women. Furthermore, in women, the ABSI and VAI also had fair AUCs. However, BMI and the BAI had the lowest AUC values among the indices in both sexes. CONCLUSION: The WHtR, BRI, VAI, and WHR outperformed other anthropometric indices in predicting T2DM in first-degree relatives (FDRs) of diabetic patients. However, further investigations in different populations may need to be implemented to justify their widespread adoption in clinical practice.

Using the Bayesian variational spike and slab model in a genome-wide association study for finding associated loci with bipolar disorder.

OBJECTIVE: The genome-wide association studies (GWAS) analysis, the most successful technique for discovering disease-related genetic variation, has some statistical concerns, including multiple testing, the correlation among variants (single-nucleotide polymorphisms) based on linkage disequilibrium and omitting the important variants when fitting the model with just one variant. To eliminate these problems in a small sample-size study, we used a sparse Bayesian learning model for finding bipolar disorder (BD) genetic variants. METHODS: This study used the Wellcome Trust Case Control Consortium data set, including 1998 BD cases and 1500 control samples, and after quality control, 380,628 variants were analysed. In this GWAS, a Bayesian logistic model with hierarchical shrinkage spike and slab priors was used, with all variants considered simultaneously in one model. In order to decrease the computational burden, an alternative inferential method, Bayesian variational inference, has been used. RESULTS: Thirteen variants were selected as associated with BD. The three of them (rs7572953, rs1378850 and rs4148944) were reported in previous GWAS. Eight of which were related to hemogram parameters, such as lymphocyte percentage, plateletcrit and haemoglobin concentration. Among selected related genes, GABPA, ELF3 and JAM2 were enriched in the platelet-derived growth factor pathway. These three genes, along with APP, ARL8A, CDH23 and GPR37L1, could be differential diagnostic variants for BD. CONCLUSIONS: By reducing the statistical restrictions of GWAS analysis, the application of the Bayesian variational spike and slab models can offer insight into the genetic link with BD even with a small sample size. To uncover related variations with other traits, this model needs to be further examined.

Using Anthropometric and Demographic Factors to Predict Small Bowel Length to Prevent Malnutrition in Bariatric Surgery.

Background: Small bowel length measurements and estimation have high clinical importance, especially in bariatric surgeries to prevent postoperation malnutrition. This study aimed to investigate the possible correlation between demographic and anthropometric factors with small bowel length. Materials and Methods: This cross-sectional study was performed on 150 patients that were candidates of abdominal surgeries. Anthropometric factors including age, gender, weight, height, body mass index, right wrist and waist circumstance, length of the right hand 2nd and 4th fingers and 2nd to 4th finger ratio, and length of the right hemithorax were obtained. Whole length of the small bowel was measured during surgery from the ligament of Treitz to the ileocecal junction between the mesenteric and antimesenteric border of the intestine. Results: The mean small bowel length was 5.45 ± 1.62 meters and significantly lower in women compared to men (P = 0.003) and had a significant direct relationship with height (r = 0.3, P < 0.001), an inverse relationship to 2nd to 4th finger ratio (= -0.34, P < 0.001). There were the same correlations between small intestine length with height and the 2nd to 4th finger ratio in open surgeries (P < 0.05). There was a correlation between age (r = 0.33, P = 0.032), weight (r= -0.60, P, 0.001), waist circumstance (r = -0.43, P = 0.004), and length of the right hemithorax (r = -0.47, P = 0.001). Conclusions: Using demographic and anthropometric factors, we could predict the small bowel length. These results could be further used in bariatric surgeries to avoid possible malnutrition.

Comparison of oral candidiasis characteristics in head-and-neck cancer patients before and during radiotherapy.

Background: Patients undergoing head-and-neck radiotherapy are susceptible to Candida colonization and infection. This study aimed to identify oral Candida species type (ST), colony count (CC), and oropharyngeal candidiasis (OPC) in head-and-neck cancer patients, undergoing radiotherapy, before and 2 weeks after radiation. Materials and Methods: In this quasi-experimental study, head-and-neck cancer patients undergoing radiotherapy (up to 6000 cGy) were recruited. Samples were taken before and 2 weeks after radiation therapy (RT). CC was assigned using Sabouraud dextrose agar culture medium and morphological studies were performed to confirm OPC. For identification, polymerase chain reaction-restriction fragment length polymorphism was performed. Data were analyzed using Chi-square-test and kappa coefficient. P < 0.05 was considered statistically significant. Results: Twenty-one of 33 patients were Candida positive. The detected fungal species included Candida albicans (60%), Candida tropicalis (22%), Candida glabrata (9%), and other species (9%). Following RT, OPC and CC changed significantly (P = 0.003 and P = 0.001, respectively), whereas ST did not significantly change (P = 0.081). Two new species (Candida krusei and Candida parapsilosis) were detected after the intervention. The OPC, CC, and ST changes after RT were not significantly related to malignancy site or radiation dose (P > 0.05). Conclusion: The present study showed that OPC, CC, and ST were not related to the malignancy site. Following RT, OPC and CC changed significantly, while ST showed no significant change. The radiation dose and malignancy site had no effects on the OPC, CC, or ST alterations following RT.

Chlamydia pneumoniae Seropositivity in the Iranian Patients with the Skin Inflammatory Disorder of Rosacea.

Background: Rosacea is a skin chronic inflammation with an unknown cause and cure. Environmental and genetic factors could not entirely explain the disease pathogenesis. Recently, infections like Chlamydia pneumoniae are of more attention in the rosacea progression. This study investigated the relationship between the C. pneumoniae seropositivity and the rosacea disorder. Materials and Methods: We aimed at a cohort of 100 patients with the rosacea disorder (60 active and 40 inactive) and from 100 sex- and age-matched healthy controls in Isfahan and determined the immunoglobulin M (IgM)/IgG antibodies titers to C. pneumoniae in the serum using the enzyme-linked immunosorbent assay method. The groups were compared using the analysis of variance procedure at the significant level of P < 0.05, statistically. Results: The mean of IgG in the controls was significantly higher than the levels in both the active and the inactive rosacea patients (p < 0.022). Also, the titer of serum IgM to C. pneumoniae in the controls was different, compared with the active (p < 0.019) and the inactive (p < 0.02) rosacea patients. In addition, the median titer of serum IgG (not IgM) to C. pneumoniae in the females with the inactive rosacea disorder was lower than the active rosacea disorder (p < 0.019) and controls women (p < 0.008). Furthermore, the serum level of IgG or IgM to C. pneumoniae in the controls males was higher than the males with the rosacea disorder (p < 0.05) and (p < 0.02), alternatively. Conclusion: C. pneumoniae seropositivity in the rosacea patients and controls was insignificant.

Evaluating the efficacy of microneedling technique in treating striae alba lesions.

Striae alba, as an unsettling skin complication, has the potential to threaten the physical appearance and psychological health of individuals. So far, dermatologists' endeavors have been futile in finding an ideal treatment. This study evaluated microneedling as a novel treatment modality for striae alba scars. Microneedling was implemented in 1-3 sessions in 2-week intervals among patients with striae alba lesions. The lesions were photographed before and 3 months after the treatment, while all side effects were recorded. Two non-involved dermatologists and a patient self-report based on a visual analog score scale were utilized to evaluate the clinical improvement of striae scars. The complication rate among the 32 patients was 25%, which consisted of seven (21.9%) cases of post-inflammatory hyperpigmentation and one case (3.1%) of skin infection. The average improvement score among the patients in our study based on their self-report was 5.3 ± 1.3. (Range 4-8), while based on physician evaluation was 5.6 ± 1.2 (range 3.5-8). There was a significant association between lower age and higher self-report scores. Also, the improvement of lesions was more significant in skin type 3 compared to 2, based on physician assessment. In this study, MN was effective in ameliorating SA scars and was observed to induce better clinical satisfaction in younger patients and breast lesions. The studies concerning the use of MN in treating SA have yielded much attention lately, and they have denoted the relatively low cost of MN, its capability to be utilized over vast treatment areas, and its safety in that regard. Further research regarding the comparison of MN's efficacy in solo use versus implementing it as an adjuvant modality should be carried out.

Toxoplasmosis and symptoms severity in patients with COVID-19 in referral centers in Northern Iran.

Toxoplasmosis has been categorized as one of the long-lasting protozoan parasitic infections. It affects almost one-third of the world's population. In recent years, several documented studies have elucidated that infected individuals have a remarkably higher incidence of distinct health problems and show various adverse effects. In the PCR-positive COVID-19 patients in Gonbad-e-Kavus, Kalaleh, and Minoodasht counties in the northern part of Iran from June 2021 to December 2021, we sought to investigate any potential relationships between the severity of COVID-19 symptoms and acute and latent toxoplasmosis caused by Toxoplasma gondii (T. gondii). Whole blood samples of 161 COVID-19 patients with positive PCR. The samples were centrifuged to separate serum and screened for two important antibodies against T. gondii (IgM and IgG) by using ELISA kits for human anti-T. gondii IgM and IgG. Anti-T. gondii IgM and IgG antibodies were detected in 8/161 (5.0%) and 42/161 (26.1%) COVID-19 patients, respectively. No significant relationships were found between Toxoplasma IgM and IgG results with clinical signs, age, sex, contact with animals, comorbidities, and also the mortality rate of people with COVID-19. These findings showed that acute and latent toxoplasmosis infections are common among patients with COVID-19; however, no significant associations were found between toxoplasma infections and the symptoms of COVID-19. Therefore, toxoplasmosis is not considered a risk factor for COVID-19.

Demographic Characteristics of the Patients with Cutaneous Vasculitis Due to COVID-19 Infection.

Background: Cutaneous manifestations of coronavirus disease 2019 (COVID-19) range from mild skin rashes to severe vasculitis. In the current study, we evaluated the demographic characteristics of the patients with cutaneous vasculitis following COVID-19 infection. Materials and Methods: In the current study, we evaluated 799 hospitalised patients with COVID-19 infection for development of cutaneous vasculitis. Demographic and clinical characteristics of the patients were obtained using questionnaires and patients' records. Cutaneous vasculitis of the suspected patients were confirmed using skin biopsy and direct immunofluorescence. Results: We detected 24 hospitalised cases with cutaneous vasculitis presenting with petechia, purpura, livedoretcularis and acrocyanosis. Our data showed a significant relationship between male sex, advanced age, C-reactive protein (CRP) level and presence of comorbidities with development of cutaneous vasculitis. In addition, we found a positive association between the severity of COVID-19 infection and occurrence of cutaneous vasculitis. Conclusion: Our findings are suggestive that clinicians must be aware of cutaneous vasculitis risk as prognostic value in the patients with severe COVID-19 infection.

Foot and ankle characteristics associated with fear of falling and mobility in community-dwelling older people: a cross-sectional study.

BACKGROUND: Fear of falling is multifactorial in etiology and is associated with falls. It has been demonstrated that foot problems increase the risk of falls in older people. Therefore, the objective of this study was to investigate the associations of foot and ankle characteristics with fear of falling and mobility in community-dwelling older people. METHOD: One hundred and eighty-seven community-dwelling older adults (106 females) aged 62-90 years (mean 70.5 ± 5.2) from Isfahan, Iran, were recruited. Foot and ankle characteristics (including foot posture, range of motion, muscle strength, deformity, tactile sensation, pain and dynamic function), fear of falling (Fall Efficacy Scale International) and mobility (Timed Up and Go Test) were measured. Two multivariate linear regression analyses identified variables independently associated with fear of falling and mobility. RESULTS: Linear regression analysis revealed that less ankle plantarflexor muscle strength, greater pressure-time integral, foot pain, and reduced tactile sensitivity of the ankle were significantly and independently associated with increased fear of falling. The total variance explained by the model was 59%. Less ankle plantarflexor muscle strength, greater pressure-time integral, and slower centre of pressure velocity were significantly and independently associated with poorer mobility. The total variance explained by the model was 48%. CONCLUSION: Several foot and ankle characteristics are associated with fear of falling and mobility in older people. Targeting these modifiable risk factors may play a role in reducing fear of falling and enhancing mobility performance in this population.

Pharmacological treatment of tremor in multiple sclerosis; a systematic review.

BACKGROUND: Tremor is a relatively common symptom in Multiple Sclerosis (MS). It can negatively affect several aspects of the patients' life and is one of the most disabling symptoms in MS. Pharmacological treatment of MS-related tremor was studied for several years, though treatment is still challenging. This study will review all studies on the pharmacological treatment of tremor in MS and update the treatment recommendations. METHODS: Any relevant English-language clinical trial that investigated the pharmacological treatment of MS-related tremor in adults was eligible in this study. We searched Medline (PubMed), Scopus, EMBASE, and Web of Science. Bias assessment was performed by the CASP (Critical Appraisal Skills Programme) checklist. All methods followed PRISMA guidelines. RESULTS: The initial search resulted in 3024 articles; 26 articles were included as eligible studies, 13 articles had a low risk of bias, and remained for full manuscript review. The results of studies on 5-HT3 receptor antagonists as a single dose treatment were inconsistent. Botulinum toxin A had significant effects on MS-related tremor, but adverse effects and injection procedures limited its application. The application of cannabis-based medicine to treat MS-related tremor could not be recommended due to inconclusive therapeutic effects and several side effects. Levetiracetam had inconsistent results, and other anti-epileptic drugs were not studied precisely. Isoniazid has minor therapeutic effects and possible adverse effects in the treatment of MS-related tremor. CONCLUSION: Further well-designed comparative clinical trials with a large sample size can improve clinical management of tremor in patients with MS.

Comparison of systemic and topical isotretinoin in the treatment of facial lichen planopilaris: A randomized controlled trial.

BACKGROUND: Facial papules reflecting the lichenoid inflammation of facial vellus hair follicles can occur in the backgrounds of frontal fibrosing alopecia, lichen planopilaris (LPP), or even alone. In the present study, we aimed to compare systemic and topical isotretinoin in the treatment of facial LPP. METHOD: In a prospective randomized trial, 26 patients with facial LPP were randomly allocated to receive either 20 mg/day oral isotretinoin or isotretinoin 0.05% gel every night for 6 months. Global Aesthetic Improvement Scale (GAIS) and patient's satisfaction questionnaire were used at 1, 3, and 6 months after treatment to evaluate the outcomes. RESULTS: In both oral and topical isotretinoin groups, facial papules were significantly improved at all follow-up visits, resulting in statistically significant improvements (p = 0.005 and p = 0.007, respectively, for oral and topical groups) in GAIS score mean difference from month 1 to month 6. Overall levels of patient satisfaction were high in both groups, and no significant difference was observed between two groups (p = 0.107). However, the mean GAIS score at 3 and 6 months after treatment showed significantly greater improvements in oral isotretinoin group compared to topical group (1.85 ± 0.62 vs. 1.03 ± 0.49 at month 3, p = 0.004; 2.45 ± 54 vs. 1.59 ± 0.62 at month 6, p = 0.008). Overall, patients could well tolerate the treatments; however, topical therapy was associated with fewer side effects. DISCUSSION: Both oral and topical isotretinoin were found to be effective in improving facial papules; however, oral isotretinoin was significantly more efficacious. Considering safety profile of topical isotretinoin, it can be administrated as maintenance therapy for patients with facial LPP.

Risk Factors for In-Hospital Mortality among Patients with Coronavirus-19 in Isfahan City, Iran.

Background: The aim of the study is to explore the risk factors of mortality for hospitalized patients in three designated hospitals in Isfahan province. Materials and Methods: This retrospective cohort study was conducted on all positive coronavirus disease (COVID)-19 patients admitted to Khorshid, Isabn Maryam, and Amin hospitals in Isfahan province. The demographic, clinical, laboratory, and outcome data of patients who were died or discharged from February 24, 2020, to April 18, 2020, were extracted from patient's medical records. Results: Overall 1044 COVID-19 patients were included in this analysis. Based on the findings of this study, older age (≥65 years) (adjusted hazard ratio [aHR]: 2.06; 95% confidence interval [CI]: 1.13-3.76), chronic obstructive pulmonary disease (COPD) history (aHR: 2.52; 95% CI: 1.09-5.83), white blood cell (WBC) counts more than 10 × 10^3/L (aHR: 3.05; 95% CI: 1.42-6.55), Hb level <13 gr/L (aHR: 2.82; 95% CI: 1.34-5.93), bilateral pulmonary infiltrates (aHR: 2.02; 95% CI: 1.12-3.64) at admission, development of acute respiratory distress syndrome (ARDS) (aHR: 1.87; 95% CI: 1.01-3.47), and intensive care unit (ICU) admission (aHR: 2.09; 95% CI: 1.04-4.18) during hospitalization were risk factors for in-hospital mortality in patients with COVID-19. Conclusions: Multiple factors were found related to the severity and death among COVID-19 patients. We were found that older age (≥65 years) with COPD history, high level of WBC, low level of Hb (<13 g/L), bilateral pulmonary infiltrates at admission, development of ARDS, and ICU admission during hospitalization were identified as risk factors of death among COVID-19 patients. More related studies are needed in the future.

Performance improvement of PES membrane decorated by Mil-125(Ti)/chitosan nanocomposite for removal of organic pollutants and heavy metal.

The Mil-125(Ti)-CS nanocomposite was successfully synthesized and characterized by using scanning electron microscopy (SEM) images, Fourier-transform infrared (FTIR) analysis and X-ray diffraction (XRD). Then, to improve the membrane performance, the synthesized Mil-125(Ti)-CS nanocomposite was embedded into the polyethersulfone (PES) membrane matrix. The nanofiltration membranes were fabricated via phase inversion method. Presence of chitosan in the structure of Mil-125(Ti) has increased the compatibility of nanoparticles with the polymer and also improved the hydrophilicity of the resulted membranes. The water contact angle of bare membrane (58°) was reduced to 40° by blending of 1 wt% nanocomposite led to increasing the pure water flux. However, the incorporation of more than 1 wt% of the nanocomposite caused the accumulation of nanocomposites and this was reduced the pore radius and permeability. The membrane containing 1 wt% nanocomposite was displayed the highest flux recovery ratio (FRR) âˆ¼ 98% in bovine serum albumin (BSA) filtration. The membranes containing Mil-125(Ti)-CS also showed good performance against fouling. The performance of membranes was evaluated by treatment of six reactive dyes, antibiotic (cefixime), heavy metal, NaCl and Na2SO4 solutions. Addition of Mil-125(Ti)-CS NPs at low concentrations resulted in membranes with high pure water flux, higher separation efficiency, and remarkable anti-fouling behavior.

Trends of human brucellosis in Central Iran (2010-2018).

BACKGROUND: Brucellosis is one of the most common infectious diseases worldwide which is caused by direct contact with affected animals or their products. It puts a huge impact on the economy, society, and the environment. Iran is the fourth endemic country for brucellosis in the world. It has been described a new epidemiological feature of the disease and its trends in Isfahan province, as one of the endemic areas of brucellosis in Central Iran. MATERIALS AND METHODS: This is a cross-sectional, population-based study. Data collection was performed using epidemiological questionnaires through Epi-2006 software from the private and public sectors in 22 districts of Isfahan province over 9 years (2010-2018). The results were obtained by the description statistics using the SPSS Statistics software version 20 (SPSS Inc., Chicago, IL, USA). RESULTS: Altogether, 5751 new brucellosis patients were recorded over 9 years. About 70% of these cases were male. The majority of cases had occurred in the age group of 21-30 years. The average incidence of brucellosis over the 9 years was 14.1 cases/100,000 population including 8.8 in the urban versus 45.2 cases in the rural areas. During the 9-year study period, the incidence of brucellosis was increased between 2010 and 2014. From 2014 to 2017, the trend has been decreasing, but in the last year of the study, the trend has been increasing again. Seasonally, the incidence rate was variable between the lowest from October to January and the highest from June to July. CONCLUSION: According to the fluctuation of incidence trend of brucellosis during the 9-year study period in Central Iran, it seems some policy changes regarding to the control and prevention of brucellosis have a role, changes that should be fixed and corrected.

Bisphenol A exposure and abnormal glucose tolerance during pregnancy: systematic review and meta-analysis.

In the present work, a systematic review and meta-analysis were performed to examine the probable relation between maternal exposure to bisphenol A (BPA), as estrogen-disrupting compounds, and gestational diabetes mellitus (GDM), and impaired glucose tolerance (IGT). We comprehensively searched three electronic databases to retrieve published studies on maternal exposure to BPA and GDM/IGT, through February 2021. Cochran's Q test and I2 statistics were employed for testing heterogeneity across studies. DerSimonian and Liard random-effects model was used to determine the pooled estimates. Otherwise, the fixed-effects model with inverse-variance weights was applied. Sensitivity analysis was performed to determine the robustness of the results by excluding each study from the pooled estimate. The potential publication bias was examined using Begg's and Egger's tests. The pooled odds ratio did not show BPA exposure to be a significant risk factor for GDM (OR = 0.90, 95% CI = 0.62-1.33, I2: 50.7%). Also, no significant association was observed between BPA exposure and risk of IGT (OR = 0.93, 95% CI = 0.40-2.18, I2: 11.5%). Based on the findings of this study, no association was found between exposure to BPA during pregnancy and the risk of GDM/IGT. Albeit no heterogeneity was found between studies.

Planning of smart gating membranes for water treatment.

The use of membranes in desalination and water treatment has been intensively studied in recent years. The conventional membranes however have various problems such as uncontrollable pore size and membrane properties, which prevents membranes from quickly responding to alteration of operating and environmental conditions. As a result the membranes are fouled, and their separation performance is lowered. The preparation of smart gating membranes inspired by cell membranes is a new method to face these challenges. Introducing stimuli-responsive functional materials into traditional porous membranes and use of hydrogels and microgels can change surface properties and membrane pore sizes under different conditions. This review shows potential of smart gating membranes in water treatment. Various types of stimuli-response such as those of thermo-, pH-, ion-, molecule-, UV light-, magnetic-, redox- and electro-responsive gating membranes along with various gel types such as those of polyelectrolyte, PNIPAM-based, self-healing hydrogels and microgel based-smart gating membranes are discussed. Design strategies, separation mechanisms and challenges in fabrication of smart gating membranes in water treatment are also presented. It is demonstrated that experimental and modeling and simulation results have to be utilized effectively to produce smart gating membranes.

Structural and functional foot and ankle characteristics associated with falls in older people.

BACKGROUND: Falls affect approximately one in three older people, and foot problems are amongst the modifiable potential risk factors. RESEARCH QUESTION: what are the associations between foot and ankle functional and structural characteristics with falls in community-dwelling older adults? METHOD: One hundred eighty-seven community-dwelling older adults (106 females) aged 62-90 years (mean 70.5 ±â€¯5.2) from Isfahan, Iran were recruited. Foot and ankle structure and function (including foot posture, range of motion, muscle strength, deformity, pain and plantar loading patterns during walking) were measured. Fall history was documented in the preceding year. Univariate analyses compared fallers and non-fallers on all variables to determine significant differences and logistic regression analysis identified variables independently associated with falls. RESULTS: Seventy-four participants (39.9 %) had experienced a fall in the previous year. Logistic regression analysis revealed that less first metatarsophalangeal joint extension (odds ratio 0.82, 95 % CI 0.73-0.91), less plantarflexor muscle strength (odds ratio 0.29, 95 % CI 0.15-0.55), greater pressure-time integral in the medial forefoot (odds ratio 2.65, 95 %CI 1.10-6.38), greater center of pressure velocity in the forefoot (odds ratio 1.27, 95 % CI 1.07-1.49) and greater foot pain (odds ratio 1.09, 95 % CI 1.02-1.16) were significantly and independently associated with falls after accounting for physiological falls risk factors. SIGNIFICANCE: We have identified several structural and functional foot and ankle characteristics associated with falling in older people. Future development of interventions to help prevent or treat these potentially modifiable risk factors may help decrease the risk of falling in this population.

Fear and anxiety in patients with multiple sclerosis during COVID-19 pandemic; report of an Iranian population.

BACKGROUND: There are reports that stress-related disorders are increasing during coronavirus disease 2019 (COVID-19) pandemic. Patients with Multiple Sclerosis (MS) are at higher risk of developing psychiatric disorders, which result in worsening of their disability. There are concerns about the mental health of MS patients during this pandemic. OBJECTIVE: We aimed to evaluate the prevalence of anxiety, depression, and levels of fear about Corona in MS patients during the COVID-19 pandemic. MATERIALS AND METHODS: This was a cross-sectional study on MS patients who were admitted to the MS clinics affiliated with Isfahan University of medical sciences from May to June 2020. Anxiety and depression were evaluated according to the Hospital Anxiety and Depression Scale (HADS). The Corona Fear Questionnaire developed by Ahorsu et al. was applied to evaluate the state of fear about COVID-19. Chi-square tests were used to compare depression and anxiety between different groups, Kruskal-Wallis was used for fear scores, Spearman correlation coefficient was also reported for correlations. RESULTS: 410 MS patients with a mean age of 38.6 years (±10.35) were enrolled in the study. Among those patients who answered the HADS questionnaire completely (n=399, n=388, for anxiety and depression subscales respectively) the prevalence of anxiety and depression were 31.2% (n=128) and 39.3% (n=161), respectively. There was no significant relationship between anxiety and depression with any of the following variables: sex, marital status, history of drug abuse, smoking, duration of taking psychiatric medication, being tested for COVID-19, being quarantined. Regarding fear about COVID-19, patients with depression or anxiety showed higher scores on the fear questionnaire (p-value=0.03, p-value=0.008 respectively). CONCLUSIONS: The prevalence of anxiety and depression in MS patients was higher than previously reported. Fear about COVID-19 was correlated with anxiety and depression. Multicenter studies are required to develop specific recommendations for screening mental health problems in MS patients during COVID pandemic.

Effect of transgenic Leishmania major expressing mLLO-Bax-Smac fusion gene in the apoptosis of the infected macrophages.

Objectives: Leishmaniasis is a complex infection against which no confirmed vaccine has been reported so far. Transgenic expression of proteins involved in macrophage apoptosis-like BAX through the parasite itself accelerates infected macrophage apoptosis and prevents Leishmania differentiation. So, in the present research, the impact of the transgenic Leishmania major including mLLO-BAX-SMAC proapoptotic proteins was assayed in macrophage apoptosis acceleration. Materials and Methods: The coding sequence mLLO-Bax-Smac was designed and integrated into the pLexyNeo2 plasmid. The designed sequence was inserted under the 18srRNA locus into the L. major genome using homologous recombination. Then, mLLO-BAX-SMAC expression was studied using the Western blot, and the transgenic parasite pathogenesis was investigated compared with wild-type L. major in vitro and also in vivo. Results: Western blot and PCR results approved mLLO-BAX-SMAC expression and proper integration of the mLLO-Bax-Smac fragment under the 18srRNA locus of L. major, respectively. The flow cytometry results revealed faster apoptosis of transgenic Leishmania-infected macrophages compared with wild-type parasite-infected macrophages. Also, the mild lesion with the less parasitic burden of the spleen was observed only in transgenic Leishmania-infected mice. The delayed progression of leishmaniasis was obtained in transgenic strain-injected mice after challenging with wild-type Leishmania. Conclusion: This study recommended transgenic L. major including mLLO-BAX-SMAC construct as a pilot model for providing a protective vaccine against leishmaniasis.