Proportion of toxin and non-toxin virulence factors of Staphylococcus aureus isolates from diabetic foot infection: a systematic review and meta-analysis.

BACKGROUND: Staphylococcus aureus isolates are the leading cause of diabetic foot infections (DFIs). Identification of specific virulence factors of S. aureus involved in the pathogenesis of DFIs may help control the infection more effectively. Since the most prevalent virulence factor genes are probably related to the DFI pathogenesis, the aim of this study is to evaluate the proportion of virulence factor genes of S. aureus isolates from DFIs. MATERIALS AND METHODS: We conducted a systematic search of PubMed, Embase, Web of Science, and Scopus to identify all articles reporting the proportion of different types of virulence factors of S. aureus isolates from DFI samples. RESULTS: Seventeen studies were eligible, in which 1062 S. aureus isolates were obtained from 1948 patients and 2131 DFI samples. Among the toxin virulence factors, hld 100.0% (95% CI: 97.0, 100.0%), hlg 88.0% (95% CI: 58.0, 100.0%), hla 80.0% (95% CI: 31.0, 100.0%), hlgv 79.0% (95% CI: 35.0, 100.0%) and luk-ED 72.0% (95% CI: 42.0, 95.0%) had the highest proportion respectively. Among the genes associated with biofilm formation, both icaA and icaD had the highest proportion 100.0% (95% CI: 95.6, 100.0%). CONCLUSION: The results of the present study showed that among the toxin virulence factors, hemolysins (hld, hlg, hla, hlgv) and luk-ED and among the non-toxin virulence factors, icaA and icaD have the greatest proportion in S. aureus isolates from DFIs. These prevalent genes may have the potential to evaluate as virulence factors involved in DFI pathogenesis. Finding these probable virulence factor genes can help control diabetic foot infection more effectively via anti-virulence therapy or preparation of multi-epitope vaccines.

Behavioral and physiological pain structures of PIPP-R and parental stress: structural equation modeling approach.

BACKGROUND: Although most non-acute pain assessment tools are multi-dimensional (behavioral and physiological measures) in their approach, the outputs of such tools are considered unidimensional. This study aimed to explore and determine the behavioral and physiological pain structures of Premature Infant Pain Profile-Revised (PIPP-R) for neonates and its association with parental stress. METHODS: This cross-sectional study was conducted in 2022-2023 in Isfahan, Iran. We recruited 400 pre-term infants, i.e. with gestational age (GA) of less than 37weeks who were admitted to the NICU of educational hospitals. PIPP-R and Parental Stressor Scale: Neonatal Intensive Care Unit (PSS: NICU) were used for data gathering. The latent structures of pain and its association with parental stress were explored using latent variable modeling approach. RESULTS: A two-factor model, i.e. behavioral and physiological pain factors, was extracted, explaining 65% of the total variance. The results of confirmatory factor analysis showed that the identified structures in the exploratory factor analysis could be nearly replicated (CFI = 0.99، TLI = 0.98, RMSEA = 0.001). Behavioral pain structure, independent from gestational age had a significant direct association with parental stress score (ß = 0.005, SE = 0.002, p = 0.026). CONCLUSIONS: The PIPP-R assesses both behavioral and physiological pain factors. We also found that behavioral pain factor was associated with parental stress. IMPACT: These results may provide a potential clue for physicians, nurses, and parents to manage the pain in preterm infant. The PIPP-R scores in preterm infants consist of "Behavioral and Physiological" pain factors. Single dependence on behavioral indicators (such as facial expression) has some limitations. Multidimensional tools may be the optimal method in detecting pain in preterm infants. Parental stress can affect behavioral pain structure in preterm infants. Intensive care nurses play an effective role in reducing the parental stress and pain severity of these preterm infants by including the help of mothers in procedures and providing them with psychological support.

The association between macronutrients intake and myopia risk: a systematic review and meta-analysis.

BACKGROUND: Dietary factors have been suggested as potential risk factors for myopia, but research findings on this relationship are inconclusive. The potential predisposing or protective role of macronutrient (carbohydrate, protein, fat) intake in the development of myopia was systematically reviewed, followed by data synthesis by meta-analysis. METHODS: A systematic search was conducted in PubMed, Web of Science, Scopus, and Google Scholar up to the end of June 2023 to identify all relevant studies. All observational studies that assessed the relationship between macronutrient intake with myopia, axial length (AL) of eyes and spherical equivalent refractive error (SE) on individuals younger than 18 years old were included. RESULTS: After removing duplicates and screening studies, four studies were included in the systematic review and meta-analysis. Pooled odds ratios regarding the association between myopia development and nutritional intake were 1.01 (95% CI: 0.94, 1.08), 0.97 (95% CI: 0.86, 1.08), and 0.99 (95% CI: 0.83, 1.18) for carbohydrates, proteins, and fats, respectively, indicating no significant associations. Intake of carbohydrates, proteins, and fats was not significantly associated with either SE or AL. CONCLUSIONS: Intake of carbohydrates, fats, or proteins did not influence the risk of myopia. The relationship between the intake of other macronutrients and myopia is suggested to be scrutinized in future studies. REGISTRATION: The systematic review protocol was registered on PROSPERO (registration number: CRD42024541369).

Persian version of brief infant sleep questionnaire (BISQ): a psychometric evaluation.

BACKGROUND: The high prevalence of sleep problems and their negative consequences on children and parents highlight the need to design early screening instruments to evaluate sleep problems in early childhood. We aimed to determine the validity and reliability of the Brief Infant Sleep Questionnaire (BISQ) among the Iranian population. METHODS AND MATERIALS: This study included 646 one-year-old infants by random sampling from the PERSIAN birth cohort study. Following the forward-backward translation of the BISQ, its psychometric properties, including construct validity in terms of concurrent and convergent validities as well as reliability, were evaluated. RESULTS: The CVIs and CVR ranged between 0.8 and 1.00 for all items. Therefore, we keep all the items of the original version of the BISQ in the Persian BISQ. Concurrent validity was assessed by comparing items of the Persian BISQ among different maternal views regarding their infant's sleep. All BISQ items were significantly different among the two levels of maternal view about the infant's sleep problem except daytime sleep duration. The convergent validity of the BISQ was evaluated by calculating the correlation between BISQ items and the ISQ (infant sleep questionnaire) total score as a similar tool. ISQ score was adequately correlated with nocturnal sleep latency and the number of waking at night (rs ranged from 0.59 to 0.72). In addition, the associations of mothers' and infants' demographic variables and nutritional and gestational variables with BISQ items were presented to confirm construct validity. Strong correlations were found between the repeated sleep measures for sleep arrangement, sleep position, and sleep situation (kappa ranged from 0.65 to 0.84), nocturnal sleep duration, daytime sleep duration number of wakings at night, night waking duration, nocturnal sleep latency and sleep-onset time (ICC ranged 0.91 to 0.99). CONCLUSION: The Persian version of the BISQ is a reliable and valid measure for assessing sleep problems in infants. It would be helpful to be utilized for the early diagnosis of infants' sleep problems.

Unfavorable prognosis and clinical consequences of APOBEC3B expression in breast and other cancers: A systematic review and meta-analysis.

INTRODUCTION: Controversy exists regarding the association of apolipoprotein B mRNA editing enzyme catalytic subunit 3B APOBEC3B, (A3B) overexpression and poor prognosis, metastasis, and chemotherapy drug resistance in cancers. Here we conducted a systematic review and meta-analysis to determine its prognostic value and clinicopathological features in breast cancer and some other malignancies. MATERIALS AND METHODS: PubMed, Scopus, Cochrane Library, Web of Science, and EMBASE were searched up to Feb 2022 for the association of A3B with breast, ovarian, gastrointestinal and lung cancers. The pooled hazard ratios with 95% confidence interval (CI) were evaluated to assess disease-free survival (DFS), overall survival (OS), and recurrence-free survival (RFS) in cancers under study. RESULTS: Over 3700 patients were included in this meta-survey. Elevated levels of A3B were significantly related to low OS (pooled HR = 1.30; 95% CI:1.09-1.55, P < 0.01), poor DFS (pooled HR = 1.66; 95% CI:1.17-2.35, P < 0.01) and poor RFS (HR = 1.51, 95% CI:1.11-2.04, P = 0.01). Subgroup analysis revealed that high A3B expression was associated with poor OS in lung (HR = 1.85, 95% CI: 1.40-2.45), and breast cancers (HR = 1.38, 95% CI: 1.00-1.89). High expression of A3B did not display any significant association with clinicopathologic features. CONCLUSION: APOBEC3B overexpression is related to poor OS, DFS and RFS only in some cancer types and no generalized role could be predicted for all cancers.

"Incidence, characteristics and prognosis of cervical artery dissection-induced ischemic stroke in central Iran".

OBJECTIVES: Ischemic stroke is the most common presentation of cervical artery dissection (CAD). Information regarding CAD-induced stroke is scarce, especially in the Middle East. Here we investigated the incidence of CAD-induced stroke, its characteristics, and the clinical course in central Iran. METHODS: This is an observational study conducted in the city of Isfahan, Iran. We recruited patients with ischemic stroke during 2017-2019. We analyzed characteristics of the CAD-induced stroke patients with regards to the involved vessel (internal carotid artery dissection (ICAD) or vertebral artery dissection (VAD)). We assessed functional outcome (modified Rankin Scale [mRS]) and recanalization status after 1 year of follow-up. RESULTS: Among 3630 ischemic stroke patients, 51(1.4%) had CAD-induced stroke (mean age: 41.8 ± 12.6; 40.4% female; 28 and 19 ICAD and VAD cases, respectively). The crude incidence rate of CAD-induced stroke was 1.20/100,000/year (0.66/100,000/year and 0.45/100,000/year for strokes due to ICAD and VAD, respectively). mRS ≤ 2 was present in 63.8% of the patients after 1 year of follow-up. History of exercise during the last days before stroke occurrence was associated with a better follow-up mRS (ß = -3.1, p-value: 0.037). Administration of anticoagulant or double-antiplatelets was related neither to mRS nor recanalization results. Trauma (27.7%), smoking (21.3%), and headache disorders/migraine (21.3%) were the most common reported factors. CONCLUSION: We found a crude incidence rate of 1.20/100,000/year for CAD-induced stroke. Trauma, smoking, and headache disorders were the most common reported factors among our patients. CAD-induced stroke had a favorable long-term prognosis regardless of the type of the involved vessel or the used medication.

Association between parabens concentrations in human amniotic fluid and the offspring birth size: A Sub-study of the PERSIAN birth cohort.

OBJECTIVE: Parabens are extensively used, and cause widespread exposure of the general population including pregnant women and developing fetuses to these pollutants. In this study, we aimed to investigate the association between the maternal exposure of parabens to study their transfer passed through the placental barrier to amniotic fluid; the second objective was to determine the association of paraben concentration in the amniotic fluid with the offspring birth size. METHODS: This cross-sectional study was conducted from June 2019 to March 2021 in Isfahan, Iran. Samples of amniotic fluid were collected as set from 128 pregnant women at Cesarean section. The amniotic fluid concentrations of four parabens including methylparaben (MP), ethylparaben (EP), propylparaben (PP), and butylparaben (BP) were determined using gas chromatography tandem mass spectroscopy (GC-Mass). RESULTS: The pointed parabens were extracted from yielded clear supernatant using a dispersive liquid-liquid microextraction (DLLME) method. Four paraben derivatives including MP (normal: 0.68 ± 0.7; overweight: 1.40 ± 1.76; obese: 0.30 ± 0.26; p-value: 0.275), EP (normal: 0.14 ± 0.09; overweight: 0.72 ± 0.72; obese: 0.38 ± 0.05; p-value: 0.434), PP (normal: 0.05 ± 0.05; overweight: 0.06 ± 0.06; obese: 0.20 ± 0.17; p-value: 0.770), and BP (normal: 2.89 ± 1.80; overweight: 3.89 ± 6.48; obese: 5.80 ± 7.56; p-value: 0.341) were simultaneously detected in samples of maternal amniotic fluid using GC-MS. In 92.2% (n = 118) of pregnant women, the paraben derivatives (MP, EP, PP, BP) were detected. We found that considerable levels of MP, EP, PP, and BP existed in 22.6% (n = 29), 21.9% (n = 28), 29.7% (n = 38), and 85.2% (n = 109) of samples, respectively. In addition, the correlation between paraben concentrations in amniotic fluid and birth size was investigated. The results showed that an inverse significant association between MP and head circumference, chest, hip, and arm circumference. While a positive correlation between MP and height of newborn was observed. Similar correlations were observed for EP and weight, height, head circumference, chest, hip, and arm. CONCLUSION: The current study indicated that parabens have been detected in amniotic fluid samples and a strong/possible correlation between exposure of pregnant women to parabens and the birth size of newborns.

Fatal Outcome in Acutely Poisoned Children With Hospitalization: A 10-Year Retrospective Study From Tehran, Iran.

BACKGROUND: Acute poisoning is a significant and preventable cause of mortality among children internationally. The aims of this study were to assess the case fatality rate of children admitted to an inner-city hospital for acute poisoning and to compare the demographics and source of poisoning of fatal cases. METHODS: This was a retrospective review of patient data recorded in the Hospital Information System for Loghman Hakim Hospital, that is, the central referral hospital for poisoning in Tehran, Iran. We searched Hospital Information System for all admissions for poisoning in children (age, 0-12 years) over the 10-year period from March 2010 to March 2020, and all cases were included in the analysis. We determined the case fatality rate by dividing the number of fatal cases by the number of included cases. RESULTS: Of 8158 children admitted for poisoning, 28 cases (0.3%) died, among whom 19 (67.9%) were boys and 9 (32.1%) girls. The median age was 42 months, ranging from 2 to 144 months. Twenty-two cases (78.6%) were 0 to 5 years old. The most common cause of mortality in acute poisoning was methadone (n = 13, 46.4%), followed by raw opium (n = 5, 17.9%), aluminum phosphide, carbon monoxide, and wild mushrooms (n = 2 deaths each, 7.1%). Tramadol, colchicine, and petroleum accounted for 1 death each (3.6%). CONCLUSIONS: Mortality from unintentional poisoning disproportionately affects children younger than 5 years. Opioids (ie, methadone, opium, tramadol) accounted for two thirds of deaths in our sample. Our findings highlight the importance of educating parents that any toxic materials (licit or illicit) must be stored out of reach for children.

Vitamin D toxicity in a pediatric toxicological referral center; a cross-sectional study from Iran.

BACKGROUND: Vitamin D is an essential element for body health with its supplements generally administered to prevent vitamin D deficiency. Since these supplements are available in domestic settings, vitamin D toxicity may happen in children. METHODS: All children younger than 12 years who presented to the pediatric emergency department of Loghman Hakim Hospital, Tehran, Iran with history of ingestion of more than 1500 IU/day of vitamin D supplements were enrolled. Patients' demographic data, on-presentation signs and symptoms, laboratory findings, treatments given, and outcome were evaluated. RESULT: Fifteen patients presented during the study period. Their mean age was 46.53 ± 10.14 months and 12 (80%) were girls. All of them had unintentionally ingested vitamin D. Mean ingested dose was 406700.7 ± 227400.1 IU. In eight patients (53.3%), 25 hydroxy vitamin D level was more than 100 ng/mL. One patient experienced hypercalcemia while all of them were asymptomatic and discharged without complications. There was no significant difference between patients with and without high levels of 25 OH vitamin D regarding lab tests, toxicity course, and outcome. CONCLUSIONS: It seems that acute vitamin D toxicity is a benign condition in our pediatric population which may be due to high prevalence of vitamin D deficiency in Iran.

Effects of cinnamon supplementation on body weight and composition in adults: A systematic review and meta-analysis of controlled clinical trials.

BACKGROUND: This systematic review and meta-analysis aimed to investigate the effect of cinnamon on body weight, body mass index (BMI), waist circumference (WC), waist-hip ratio (WHR), and body fat mass including the maximum number of studies. METHODS: Medline, ISI Web of Science, Scopus, Google Scholar, and Cochrane library were searched with no limitation from inception up to August 2019 for relevant randomized controlled clinical trials (RCTs). The RCTs' risk of bias was assessed using the Cochrane collaboration's tool. Random-effects model was used for meta-analysis. RESULTS: Twenty-one RCTs with 1,480 participants were included. The meta-analysis showed that cinnamon supplementation significantly reduces BMI [weighted mean difference (WMD) = -0.40 kg/m2 , 95% confidence interval (CI): -0.57, -0.22 kg/m2 , p < .001, I2 = 78.9%], body weight (WMD = -0.92 kg; 95% CI: -1.51, -0.33 kg; p = .002; I2 = 84.2%), and WHR (WMD = -0.02, 95% CI: -0.038, -0.018; p < 0.001; I2 = 0%). Cinnamon supplementation did not significantly affect the WC (WMD = -1.76 cm, 95% CI: -3.57, -0.045 cm; p = .056; I2 = 90.8%) and body fat mass (WMD = -0.87%, 95% CI: -1.87, 0.025%; p = .057; I2 = 78.6%). CONCLUSION: Cinnamon supplementation significantly reduces body weight, BMI, and WHR. Future high-quality long-term RCTs are recommended to confirm these results.

Ultrasound-guided ethanol injection for the treatment of parathyroid adenoma: A prospective self-controlled study.

BACKGROUND: Parathyroidectomy, the standard treatment of primary hyperparathyroidism (PHP) due to parathyroid adenoma, is not suitable for all patients. We evaluated the efficacy of ultrasound-guided ethanol ablation of parathyroid adenoma in a group of patients with PHP. MATERIALS AND METHODS: In a prospective self-controlled trial, 39 patients with parathyroid adenoma, who were not candidates for surgery, were enrolled. Ethanol injections were performed by two experienced interventional radiologists under the guidance of real-time ultrasonography. Adenoma size changes were assessed at about 1 month later. Serum levels of parathyroid hormone, calcium, phosphate, 25-OH Vitamin D, and alkaline phosphatase were evaluated at the baseline, 1, 3, 6, and 12 months after the injections. The treatment effects on outcome variables were assessed by repeated measures analysis. RESULTS: Volume of the adenomas decreased during the study period from 1.87±6.45 cm3 to 0.38± 0.48cm3 (P < 0.001). Corrected serum calcium levels decreased from 10.40 ± 0.96 mg/dl to 8.82 ± 0.58 mg/dl (P < 0.001), and remained stable during one year follow-up. Serum levels of parathyroid hormone decreased gradually from 129.85 ± 63.37 to 72.58 ± 53.86 pg/mL after 3 months and to 44.78 ± 28.04 pg/mL after 1 year (P < 0.001). Overall, 46% of the patients improved after 1 month of ethanol ablation therapy which increased to 84.5% during 1-year follow-up. No major complications were observed. CONCLUSION: The current study showed the efficacy of ultrasound-guided ethanol injection in PHP and may be considered as a suitable alternative treatment in patients who are not candidates for the surgery. It has also a good safety profile without major complications if performed by experienced hands.

Association of derived patterns of musculoskeletal disorders with psychological problems: a latent class analysis.

BACKGROUND: Musculoskeletal symptoms often occur in more than one anatomical site. The present study aimed to define specific patterns of multisite musculoskeletal disorders and examine how these patterns are related to common psychological problems. METHODS: Using the data from an interview-based health survey of 358 samples of the industrial manufacturing male employees, we derived major patterns of musculoskeletal complaints using latent class analysis and investigated its association with psychological problems score extracted from depression, anxiety, and stress measured by Depression/Anxiety/Stress Scale (DASS-21). Musculoskeletal disorders were assessed by Nordic Musculoskeletal Questionnaire (NMQ). The statistical analysis was carried out by Mplus 8. RESULTS: Complaints in the lower back (42.1%) and neck (30.7%) had the highest prevalence, and in the hip (15.0%) and ankle (12.2%) the lowest. Three major patterns of musculoskeletal disorders were extracted using latent class analysis. Class 1 (12.9%) was characterized by a high rate of complaints in upper musculoskeletal sites, such as the neck, shoulder, and joints; class 2 (38.2%) was identified by a higher rate of complaints in the lower and upper back; and class 3 (48.9%) was marked by low rates of complaints in all musculoskeletal sites. After adjustment for confounding variables and specifying class 3 as the reference, it turned out that there was a statistically significant association between the psychological problems score and the chance of being in class 1 (OR = 2.47, 95% CI 1.66-3.68), but not a significant association with the chance of being in class 2 (OR = 1.51, 95% CI 0.83-2.72). CONCLUSION: Musculoskeletal disorders can be summarized in the latent class-derived patterns in the adult study population and provide additional prognostics. Common psychological problems are significantly associated with the type of musculoskeletal disorder patterns. The findings in this study could be useful for dealing with prevention and treatment programs.

The Effect of Vitamin D Supplementation on the Androgenic Profile in Patients with Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis of Clinical Trials.

It is suggested that vitamin D status is associated with androgenic profile in women with polycystic ovarian syndrome (PCOS). Although several clinical trials are known in this regard, the results were inconsistent. Therefore, this study was aimed to conduct a systematic review and meta-analysis of published clinical trials to elucidate the possible effect of vitamin D supplementation on the androgen levels in adult females with PCOS. PubMed, SCOPUS, and Google Scholar were searched to identify related articles published up to January 2017. Mean ± standard deviation (SD) of changes in serum total testosterone, sex hormone binding globulin (SHBG), and free testosterone were extracted to calculate Hedges' g to be used as effect size for meta-analysis. DerSimonian and Liard random effects model was incorporated to summarize the effects. Six clinical trials with 183 participants aged 18-41 years with follow-up period between 3-24 weeks were included. Our analysis revealed that vitamin D supplementation significantly reduces total testosterone (Hedges' g=-0.32, 95% CI: -0.55 to -0.10; p=0.005); this effect remained significant in single group trials after subgroup analysis. Vitamin D supplementation did not affect serum free testosterone (Hedges' g=-0.21, 95% CI: -0.44 to 0.079; p=0.08) or SHBG levels (Hedges' g=0, 95% CI, 0.22-0.22; p=0.98). The present systematic review and meta-analysis revealed that vitamin D supplementation might significantly affect serum total testosterone while it is not effective in improving other markers of androgenic profile. Future double-blind, placebo-controlled clinical trials are highly recommended.

A randomized controlled trial on the effects of jujube fruit on the concentrations of some toxic trace elements in human milk.

BACKGROUND: This study aims to investigate the concentrations of lead, cadmium, and arsenic in the human milk, and to assess the effect of jujube fruit consumption by lactating mothers in reducing the concentration of these heavy metals in their milk. MATERIALS AND METHODS: This randomized controlled trial was conducted in 2014 among forty postpartum mothers in Isfahan, the second largest and polluted city in Iran. Mothers were randomized into two groups; the intervention group received 15 g/day of fresh jujube fruit, and the controls received routine care for 8 weeks. RESULTS: In the beginning, the concentrations of lead, cadmium, and arsenic were high, without significant difference between groups. The mean (standard deviation) concentrations of lead, cadmium, and arsenic were 29.49 (16.6), 4.65 (3.51), and 1.23 (0.63) µg/L, respectively. The smoothed empirical distribution of environmental pollutants showed that in both groups the mean values and variance of toxic metals decreased after 8 weeks, with a sharper decline in the intervention group. Quantile regression analysis showed that in the intervention group, lead concentration decreased by 2.54 µg/L at the 90th quintile, and cadmium decreased by 0.19 µg/Lat 75th quintile; without significant change in arsenic level. The corresponding figures were not significant in the control group. CONCLUSION: The concentrations of heavy metals were high in human milk, and the consumption of jujube fruit had some beneficial effects in reducing these harmful elements. Pregnant and lactating mothers should be advised to reduce their exposure to environmental pollutants, and consumption of some natural medicinal foods can be useful in reducing the concentration of pollutants in human milk. Because of numerous benefits of breast milk, in spite of the existence of some toxic trace elements, breastfeeding must be encouraged because such contaminants are also found in water and formula. The impact of the current findings on the primary prevention of chronic disease should be determined in future longitudinal studies.

Glucose and lipid-related indicators in relation to elevated alanine aminotransferase in a pediatric population.

OBJECTIVES: To determine the associations between various glucose and lipid-related indicators with elevated alanine aminotransferase (ALT) in pediatric population. METHODS: We analyzed the cross-sectional data of 3,771 Iranian children and adolescents aged 7-18 years using the fifth survey of a national school-based surveillance program. The predictive power of 11 different glucose and lipid-related indicators for predicting elevated ALT was examined using receiver operating characteristic (ROC) curve. RESULTS: In the total sample non-HDL-C, non-HDL-C/HDL-C, and TC/HDL-C showed the largest area under the curve (AUC) for elevated ALT detection, with 0.731 (cut-off, 129.5 mg/dL), 0.706, and 0.706, respectively. In girls, non-HDL-C had the highest predictive value (AUC, 0.741, cut-off, 129.5 mg/dL). Among boys, non-HDL-C/HDL-C and TC/HDL-C showed the largest AUC of 0.753 with optimum cut-off values of 2.63 and 3.63, respectively. CONCLUSIONS: The findings of this study suggest that non-HDL-C, non-HDL-C/HDL-C, and TC/HDL-C can be predictors of elevated ALT in the pediatric population. These indices can be useful in large population-based studies for predicting children and adolescents at risk of fatty liver.

Does Gabapentin Have A Role in the Improvement of Feeding Resistance in Infants?

Background: Eating disorders in some infants can be due to the inability to reach a level of relaxation necessary to start the feeding process. Gabapentin (GB) has been proposed as a stabilizer of nerve function in improving this disorder. This study aimed to investigate the effect of GB on improving feeding resistance in infants aged 3-6 months. Materials and Methods: This randomized, controlled, double-blind clinical trial was done on 64 infants aged 3-6 months with feeding resistance who were referred to the pediatric clinics and assigned to two groups of 32. The case group was given a dose of 5 mg/kg of GB in the first week, and if not too much sedation, it was increased to 10 mg/kg in the second week every 8 hours, whereas the control group received a placebo. The number of effective breastfeeding and the volume of formula in cc before and after 2 weeks of drug usage were recorded in both groups. Results: The number of breastfeeding sessions significantly had a higher increase in the GB group compared with placebo (median [IQR]: 1 [0,1] vs. 0 [0,1], P = 0.005) as well as an increase in consumed formula volume (mean ± SD: 42.81 ± 24.49 vs. 18.67 ± 14.57, P = 0.003). Conclusion: Considering the significant increase in formula consumption and the number of breastfeeding sessions in the GB group, it is possible to use this drug as a nerve-stabilizer and pain reducer to treat this disorder.

Use of Massive Online Open Courses (MOOCs) model in virtual education development in first macro-region universities of medical sciences in countrywide territorial planning.

BACKGROUND: Massive online open cources (MOOCs) are a new chapter in the topic of teaching-learning in higher education, which have been able to acquire a significant and valuable position in higher education and prestigious universities worldwide in line with the advancement of technology. The present study was conducted pursuing the goal to investigating the effect of use of MOOCs in the development of virtual education in universities of medical sciences in the first macro-region of countrywide territorial planning. MATERIALS AND METHODS: This research is based on a mixed method and practical in terms of purpose, and it was carried out in 2021 and 2022 in first macro-region of countrywide regional planning Medical Sciences Universities. The data of the qualitative section were converted into a questionnaire using the method of qualitative content analysis in a purposeful and semi-structured interview with 24 experts in the field of virtual education who had sufficient experience in the field of MOOC courses. The statistical population of the quantitative section is 1938 faculty members of the first macro-region of countrywide regional planning, of which 324 were selected by stratified random sampling. Its validity was calculated by Lawshe and Waltz-Bausell method by R software, and the reliability was calculated using Cronbach's alpha method with SPSS-21. RESULTS: Universities are facing challenges in structural, managerial, cultural, social, technological, and evaluation dimensions, and the current situation of using MOOCs in them is not appropriate. CONCLUSION: Besides, the analysis of the optimal situation of using MOOCs in these universities indicates that technological, structural, managerial, evaluation, educational, and personal dimensions are the most important in the effect of using MOOCs on the development of virtual education.

Comparison of Blood Lead Levels in Children and Adolescents with and without Functional Abdominal Pain.

Background: Functional abdominal pain is a health concern with chronic abdominal discomfort without clear etiology. Several etiologic factors are raised in this regard, one related to environmental factors. This study aimed to compare blood lead levels between children and adolescents with and without functional abdominal pain. Materials and Methods: This case-control study was performed in 2019-2020 in Isfahan, Iran. The sample size was calculated as 70 cases and an equal number of controls. Cases were children and adolescents with functional gastrointestinal disorder (FGID), and controls were grouped age- and sex-matched. Controls were randomly selected from those referred for routine health screening. Both groups obtained blood lead, iron, and calcium levels. All participants completed the FFQ Food Consumption and Environmental Pollutants Questionnaire. Results: Participants were 139 children (68 cases and 71 controls). The mean (SD) age was 9.40 (3.91) years in the FGID group and 8.79 (3.46) years in the controls (P = 0.330). The mean (SD) blood lead level was not significantly different between the FGID group and the controls (3.98 ± 2.56 vs 3.81 ± 1.96 µg/dl, respectively, P = 0.670). We found that 55.3% of children with high lead levels had FGID, while 44.4% of children with lower lead levels had FGID, but the difference was not statistically significant (P = 0.33). Conclusion: We found that the lead level was higher in patients with FGID than in the controls; however, this difference was not significantly different. This might be because of elevated lead levels in both groups. Future ecological studies with a large sample size are necessary in this regard.

Effect of Vitamin D Supplementation on Serum 25-Hydroxyvitamin D and Homeostatic Model of Insulin Resistance Levels in Healthy Pregnancy: A Systematic Review and Meta-Analysis.

Background: Progressive insulin resistance is a physiological condition during pregnancy that can lead to gestational diabetes. Given the association between low blood vitamin D levels and insulin resistance, the present meta-analysis evaluated the effect of vitamin D supplementation on serum 25-hydroxyvitamin D (25[OH]D) and the homeostatic model of insulin resistance (HOMA-IR) levels in non-diabetic pregnant women. Methods: A comprehensive literature search was conducted using electronic databases and gateways such as Cochrane Library, Medline, Google Scholar, Science Direct, Web of Sciences, Embase, and Scopus. Articles up to 2020 in both English and Persian were included in the study. The effect of vitamin D supplementation on 25(OH)D and HOMA-IR was determined based on the differences in mean changes from baseline to post-intervention. Weighted mean and 95% confidence intervals (CI) were pooled using a random-effects model. Data were analyzed using STATA software. Results: Four studies, including six trials with 380 participants, reported that vitamin D supplementation increased 25(OH)D (mean change: 13.72, 95% CI: 7.28-20.17) and decreased HOMA-IR (mean change: 1.46, 95% CI: 0.56-2.37) levels compared with the placebo group. A high weekly dose of vitamin D further reduced HOMA-IR levels (adjusted R2=77.99, I2 residuals=80.49%, P=0.047). There was no significant association between the dose of vitamin D and 25(OH)D (P=0.974). Intervention duration was not associated with an increase in 25(OH)D (P=0.102), nor with a decrease in HOMA-IR (P=0.623). Conclusion: Vitamin D supplementation increased 25(OH)D and decreased HOMA-IR levels in non-diabetic pregnant women. Vitamin D in high doses further reduced HOMA-IR, but did not affect 25(OH)D concentrations.

The association between vitamin C dietary intake and its serum levels with anthropometric indices: A systematic review and meta-analysis.

BACKGROUND: studies showed inflammatory background of overweight and obesity. Prevalence of weight disorders has dramatically increased over the past few decades. Vitamin C is an antioxidant and may be associated with weight disorders. This study aims to systematically review the relationship between dietary and serum vitamin C levels with anthropometric indices. METHODS: A systematic search was conducted in Medline database (PubMed), Scopus, Embase, Web of Science, Cochrane library and Google Scholar up to the end of August 2021. All observational studies that assessed the relationship between dietary or circulating vitamin C levels and body mass index (BMI) and waist circumference (WC) on adults were included. The quality of included studies was assessed using the National Institute of Health quality assessment tool. RESULTS: Among 11,689 studies, 47 and 37 articles were included in the systematic review and meta-analysis, respectively. There was an inverse significant correlation between WC and serum vitamin C levels (r = -0.28, 95% CI: -0.35,-0.21, I2 = 14.2%) and between BMI and serum vitamin C levels (r = -0.17, 95% CI: -0.25, -0.09, I2 = 72.8%). Higher vitamin C consumption was significantly associated with lower BMI. There were no significant differences in serum vitamin C levels between normal-weight and overweight subjects, but serum vitamin C levels were significantly higher in obese subjects in comparison with normal-weight subjects. CONCLUSION: Results showed that both dietary and serum vitamin C levels were inversely associated with BMI and WC. More well-designed clinical trials are needed to assess the effect of vitamin C supplementation in prevention and treatment of obesity.