Development of the first Iranian clinical practice guidelines for the diagnosis, treatment, and secondary prevention of acute coronary syndrome.

Background: This article introduces the first national guidelines for the management including diagnosis, treatment, and secondary prevention of acute coronary syndrome (ACS) in Iran. Materials and Methods: The members of the guideline development group (GDG) were specialists and experts in fields related to ACS and were affiliated with universities of medical sciences or scientific associations in the country. They carefully examined the evidence and clinical concerns related to ACS management and formulated 13 clinical questions that were sent to systematic review group who developed related evidence using Grade method. Finally the GDG developed the recommendations and suggestions of the guideline. Results: The first three questions in the guideline focus on providing recommendations for handling a patient who experience chest pain at home, in a health house or center, during ambulance transportation, and upon arrival at the emergency department (ED) as well as the initial diagnostic measures in the ED. Subsequently, the recommendations related to the criteria for categorizing patients into low, intermediate and high-risk groups are presented. The guideline addressed primary treatment measures for ACS patients in hospitals with and without code 247 or having primary percutaneous coronary intervention (PCI) facilities, and the appropriate timing for PCI based on the risk assessment. In addition, the most efficacious antiplatelet medications for ACS patients in the ED as well as its optimal duration of treatment are presented. The guideline details the recommendations for therapeutic interventions in patients with ACS and acute heart failure, cardiogenic shock, myocardial infarction with nonobstructive coronary arteries (MINOCA), multivessel occlusion, as well as the indication for prescribing a combined use of anticoagulants and antiplatelet during hospitalization and upon discharge. Regarding secondary prevention, while emphasizing the referral of these patients to rehabilitation centers, other interventions that include pharmaceutical and nonpharmacological ones are addressed, In addition, necessary recommendations for enhancing lifestyle and posthospital discharge pharmaceutical treatments, including their duration, are provided. There are specific recommendations and suggestions for subgroups, such as patients aged over 75 years and individuals with heart failure, diabetes, and chronic kidney disease. Conclusion: Developing guidelines for ACS diagnosis, treatment and secondary prevention according to the local context in Iran can improve the adherence of our health care providers, patients health, and policy makers plans.

First Iranian guidelines for the diagnosis, management, and treatment of hyperlipidemia in adults.

This guideline is the first Iranian guideline developed for the diagnosis, management, and treatment of hyperlipidemia in adults. The members of the guideline developing group (GDG) selected 9 relevant clinical questions and provided recommendations or suggestions to answer them based on the latest scientific evidence. Recommendations include the low-density lipoprotein cholesterol (LDL-C) threshold for starting drug treatment in adults lacking comorbidities was determined to be over 190 mg/dL and the triglyceride (TG) threshold had to be >500 mg/dl. In addition to perform fasting lipid profile tests at the beginning and continuation of treatment, while it was suggested to perform cardiovascular diseases (CVDs) risk assessment using valid Iranian models. Some recommendations were also provided on lifestyle modification as the first therapeutic intervention. Statins were recommended as the first line of drug treatment to reduce LDL-C, and if its level was high despite the maximum allowed or maximum tolerated drug treatment, combined treatment with ezetimibe, proprotein convertase subtilisin/kexin type 9 inhibitors, or bile acid sequestrants was suggested. In adults with hypertriglyceridemia, pharmacotherapy with statin or fibrate was recommended. The target of drug therapy in adults with increased LDL-C without comorbidities and risk factors was considered an LDL-C level of <130 mg/dl, and in adults with increased TG without comorbidities and risk factors, TG levels of <200 mg/dl. In this guideline, specific recommendations and suggestions were provided for the subgroups of the general population, such as those with CVD, stroke, diabetes, chronic kidney disease, elderly, and women.

Non-HDL cholesterol and long-term follow-up outcomes in patients with metabolic syndrome.

BACKGROUND: Non-high-density lipoprotein-cholesterol (non-HDL-C) has been identified as a potential biomarker for metabolic syndrome (MetS). However, its predictive capability for MetS varies among different ethnic groups, necessitating further investigation. This study aimed to assess the role of non-HDL-C in the early diagnosis of MetS in the Iranian population through a longitudinal study with a 10-year follow-up period. METHODS: Our study enrolled 4684 individuals from the MASHAD (Mashhad Stroke and Heart Atherosclerotic Disorder) cohort who were followed for 10 years to examine the association between non-HDL-C and the incidence of MetS. Additionally, the contribution of individual MetS components to the overall burden was evaluated. RESULTS: A total of 1599 subjects developed MetS, while 3085 did not. Non-HDL-C levels ≥ 130 were associated with a 42% higher risk of developing MetS (relative risk (RR), 1.42; 95% confidence interval (CI), 1.25-1.62). Regarding MetS components, elevated waist circumference (WC) showed the strongest association with MetS incidence (RR, 2.32; 95% CI, 1.45-2.9), whereas triglyceride (TG) levels ≥ 150 mg/dL demonstrated the weakest association (RR, 1.23; 95% CI, 1.04-1.46). Additionally, higher HDL-C levels were reported to be 20% protective against the risk of MetS (RR, 0.8; 95% CI, 0.73-0.86). Moreover, fasting blood glucose (FBG) levels ≥ 100 mg/dL were not significantly linked to MetS burden, while systolic blood pressure (BP) levels ≥ 130 mmHg or diastolic BP levels ≥ 85 mmHg increased the risk of MetS incidence (RR, 1.25; 95% CI: 1.11-1.41). CONCLUSIONS: Elevated non-HDL-C and increased WC serve as significant predictors of MetS in Iranians. Strategies targeting non-HDL-C levels and weight loss should be emphasized to mitigate the risk of MetS development.

Evaluation of the knowledge regarding vitamin D, and sunscreen use of female adolescents in Iran.

BACKGROUND: Vitamin D (Vit D) deficiency/insufficiency is an important risk factor for several chronic conditions. We aimed to evaluate the knowledge and behavior of female adolescents with respect to the association between sunlight exposure, sunscreen use, and Vit D status. METHODS: This cross-sectional survey was performed in northeastern Iran, among 940 female adolescents in January 2015. Each subject completed a questionnaire containing items about demographic characteristics, knowledge about Vit D and their use of sunscreen. Serum Vit D levels were measured using an electrochemiluminescence method and dietary intake of Vit D was assessed using a Food Frequency Questionnaire. Statistical analyses were conducted using SPSS software. A P value < 0.05 was considered statistically significant. RESULTS: Few of the participants were aware of the biological functions of Vit D (8.8%), the causes of Vit D deficiency (16.7%), and the sources of Vit D (9.3%). Less than half of the participants used sunscreen during the day. The serum levels of Vit D in subjects who used sunscreen were significantly lower than those who did not (p = 0.004). However, there was no significant association between their knowledge about Vit D and serum Vit D, or dietary intake of Vit D. CONCLUSION: There appears to be a lack of coherence between lifestyle, behavior and knowledge that may affect the Vit D status of adolescent girls in northeastern Iran. This information provides a basis for developing public health planning (workshops or training at the college level) for the prevention of Vit D deficiency especially in adolescent girls.

Aptamers as potential recognition elements for detection of vitamins and minerals: a systematic and critical review.

Background: Vitamin and mineral deficiencies are prevalent globally, and extensive efforts have been made to assess their status. Most traditional methods are expensive and time-consuming; therefore, developments of rapid, simple, specific, and sensitive methods for the assessment of vitamins and minerals in biological samples are of high importance in research. Aptamers are synthetic nucleic acid single-stranded DNA or RNA that can be synthesized in vitro. They can be engineered to be analyte-specific and have been suggested as a substitute for monoclonal antibodies, due to their high sensitivity and affinity. In addition, aptamers can be chemically synthesized and readily modified for use as biosensors. These features make aptamers a promising tool for the detection of biological analytes. In this review, we provide an overview of the potential use of aptamer-based biosensors.Methods: Search terms were conducted on several online databases, including Google Scholar, PubMed, Scopus, and Science Direct from January 2000 to August 2019. Eligibility criteria were used and quality evaluation was performed. Following the review of 4349 articles, 39 articles met the inclusion criteria.Results: Aptasensors have recently been developed for the detection of vitamins by using optical methods, with a detection range from 74 pM to 204 pM, and lower limit of detection of 2.4 pM. Both electrochemical and optical methods have been used for detection of minerals, however electrochemical methods show a wider linear range and lower detection limits compared to optical methods with a wide linear range from 0.2 fM to 1.0 mM and limit of detection of 14.7 fM.Conclusion: The current report reviews recent developments in aptamer-based biosensors for detection of vitamins and minerals. Studies have shown that aptasensors' properties are suitable for the quantification of vitamins and minerals with high sensitivity, affinity, and specificity. Nevertheless, the limitations and future directions of aptamers require further research and new technological innovation.

The relationship between neuropsychological function and responsiveness to vitamin D supplementation using artificial neural networks.

BACKGROUND: Vitamin D has recently attracted interest for its pleiotropic effects. Vitamin D supplements are a potentially important public health intervention, but the response to supplementation varies between individuals. AIM: We aimed to assess the association between several neuropsychological parameters and the magnitude of response to vitamin D supplementation using an artificial neural network method. METHODS: Neuropsychological function was assessed in 619 participants using standard questionnaires. The study participants received vitamin D capsules containing 50,000 IU vitamin D per week over 9 weeks. To assess the relationship between responsiveness to vitamin D supplements and the impact on these neuropsychological parameters, the best-performing artificial neural network algorithms were selected from a combination of different transfer functions in hidden and output layers and variable numbers of hidden layers (between two and 50). The performance of the artificial neural network algorithm was assessed by receiver operating characteristic analysis and variables of importance were identified. RESULTS: The artificial neural network algorithm with sigmoid transfer function in both hidden and output layers could predict responsiveness to vitamin D supplementation effectively. The sensitivity and specificity were between 0.60 and 0.70 and 0.66 and 0.70, respectively. Cognitive abilities (42.5%), basal vitamin D (21.3%), body mass index (9.5%), and daytime sleepiness (8%) are the most widely used variables to predict changes in serum vitamin D levels. CONCLUSIONS: Cognitive abilities status and baseline 25-hydroxyvitamin D are important novel modifiers of the enhancement in circulating 25-hydroxyvitamin D after vitamin D supplementation.

High-density lipoprotein lipid peroxidation as a molecular signature of the risk for developing cardiovascular disease: Results from MASHAD cohort.

High-density lipoprotein (HDL) function rather than level may better predict cardiovascular disease (CVD). However, the contribution of the impaired antioxidant function of HDL that is associated with increased HDL lipid peroxidation (HDLox) to the development of clinical CVD remains unclear. We have investigated the association between serum HDLox with incident CVD outcomes in Mashhad cohort. Three-hundred and thirty individuals who had a median follow-up period of 7 years were recruited as part of the cohort. The primary end point was cardiovascular event, including myocardial infarction, stable angina, unstable angina, or coronary revascularization. In both univariate/multivariate analyses adjusted for traditional CVD risk factors, HDLox was an independent risk factor for CVD (odds ratio, 1.62; 95% confidence interval, 1.41-1.86; p < 0.001). For every increase in HDLox by 0.1 unit, there was an increase in CVD risk by 1.62-fold. In an adjusted analysis, there was a >2.5-fold increase in cardiovascular risk in individuals with HDLox higher than cutoff point of 1.06 compared to those with lower scores, suggesting HDLox > 1.06 is related to the impaired HDL oxidant function and in turn exposed to elevated risk of CVD outcomes (hazard ratio, 2.72; 95% CI, 1.88-3.94). Higher HDLox is a surrogate measure of reduced HDL antioxidant function that positively associated with cardiovascular events in a population-based cohort.

Familial combined hyperlipidemia: An overview of the underlying molecular mechanisms and therapeutic strategies.

Among different types of dyslipidemia, familial combined hyperlipidemia (FCHL) is the most common genetic disorder, which is characterized by at least two different forms of lipid abnormalities: hypercholesterolemia and hypertriglyceridemia. FCHL is an important cause of cardiovascular diseases. FCHL is a heterogeneous condition linked with some metabolic defects that are closely associated with FCHL. These metabolic features include dysfunctional adipose tissue, delayed clearance of triglyceride-rich lipoproteins, overproduction of very low-density lipoprotein and hepatic lipids, and defect in the clearance of low-density lipoprotein particles. There are also some genes associated with FCHL such as those affecting the metabolism and clearance of plasma lipoprotein particles. Due to the high prevalence of FCHL especially in cardiovascular patients, targeted treatment is ideal but this necessitates identification of the genetic background of patients. This review describes the metabolic pathways and associated genes that are implicated in FCHL pathogenesis. We also review existing and novel treatment options for FCHL. © 2019 IUBMB Life, 71(9):1221-1229, 2019.

The association between genetic polymorphisms of the interleukin-10, tumor necrosis factor-alpha, and annexin A5 gene loci and restenosis after percutaneous coronary angioplasty and stenting.

BACKGROUND: Advances in the technology for percutaneous coronary angioplasty, such as coated stents, have reduced its complications, but restenosis remains an important clinical problem. The factors associated with an increased risk of restenosis include diabetes mellitus and multiple coronary artery disease. It is also possible that genetic factors play a role in restenosis although there are little data on this. We have investigated the association of three genetic markers of genes involved in inflammation leading to restenosis. MATERIALS AND METHODS: In this case-control study, 306 unrelated Iranian patients who were thought to have restenosis on clinical grounds were investigated. Based on the results of angiography, 104 patients were found to have >50% stenosis within an implanted stent, and these were allocated to the in-stent restenosis (ISR) group; 202 patients with no in-stent stenosis or stenosis ≤50% were allocated to the non-ISR (NISR) group. Demographic data were collected from medical records. Biochemical parameters were measured using routine methods. Genotypes of the interleukin-10 (IL-10), annexin A5 (AnxA5), and tumor necrosis factor-alpha (TNFα) loci were determined using real-time polymerase chain reaction and a high-resolution melting assay. RESULTS: Fasting blood glucose, serum triglycerides, and serum high-sensitivity C-reactive protein (hs-CRP) concentrations were higher in the ISR group than in the NISR group (P < 0.05), and a history of diabetes mellitus was significantly related to the presence of restenosis (P < 0.001). There were no significant differences in the frequency of the genetic polymorphisms of IL-10, AnxA5, and TNFα genes and the presence of ISR. CONCLUSION: After adjustment for clinical variables, the genetic polymorphisms at the IL-10, TNFα, and ANXA5 gene loci do not appear to be risk factors for >50% ISR in our population. However, our data suggested a significant association between diabetes mellitus, serum hs-CRP, stent type, and restenosis.

Genetic and epigenetic factors influencing vitamin D status.

The global prevalence of vitamin D deficiency appears to be increasing, and the impact of this on human health is important because of the association of vitamin D insufficiency with increased risk of osteoporosis, cardiovascular disease and some cancers. There are few studies on the genetic factors that can influence vitamin D levels. In particular, the data from twin and family-based studies have reported that circulating vitamin D concentrations are partially determined by genetic factors. Moreover, it has been shown that genetic variants (e.g., mutation) and alteration (e.g., deletion, amplification, inversion) in genes involved in the metabolism, catabolism, transport, or binding of vitamin D to it receptor, might affect vitamin D level. However, the underlying genetic determinants of plasma 25-hydroxyvitamin D3 [25(OH)D] concentrations remain to be elucidated. Furthermore, the association between epigenetic modifications such as DNA methylation and vitamin D level has now been reported in several studies. The aim of current review was to provide an overview of the possible value of loci associated to vitamin D metabolism, catabolism, and transport as well epigenetic modification and environmental factors influencing vitamin D status.

Nutrients intake, and serum calcium and phosphorus levels: An evidence-based study.

INTRODUCTION: Dietary calcium and phosphorus appear to be important determinants of dyslipidemia and hypertension. We have investigated (1) the prevalence of hypocalcemia and hypophosphatemia in an Iranian population, and (2) the association between nutrient's intake and serum levels of calcium and phosphorus. METHODS: A total of 908 individuals were enrolled using a stratified-cluster sampling method from the Mashhad stroke and heart atherosclerosis disorder (MASHHAD) study. Dietplan6 software was used for 24-hour recalls and food frequency questionnaire to investigate macro- and micronutrient intakes of our population, followed by univariate analysis for evaluation of the association of dairy consumption with serum calcium and phosphorus. RESULTS: We observed that the mean dietary Ca intake was 862.4 mg/d (672.7-1052) for men and 864.2 mg/d (604.5-1123) for women in our population, which is lower than the dietary reference intake for Ca. Moreover, a significant relationship was detected between serum calcium level and dietary intakes of saturated fatty acids, copper, iodine, sucrose, potato, and juices. Of note, we observed a negative association between copper intake, and serum Ca (P˂.01). Also, a significant association was found between serum phosphorus levels and dietary intakes of chicken meat and fresh fruits. Interestingly, we observed an inverse relationship between tea and Ca/P ratio (eg, -r=.098; P=.02). CONCLUSION: We found that the dietary intake of Ca was not sufficient in our population and was associated with the dietary intake of some macro- and micronutrient, supporting further investigation on clinical impact of this condition on calcium/phosphorus deficiency related diseases.

Comparison of Dietary Macro and Micro Nutrient Intake between Iranian Patients with Long-term Complications of Sulphur Mustard Poisoning and Healthy Subjects.

BACKGROUND: Patients with long-term complications of sulfur mustard (SM) poisoning are often less able to undertake optimum levels of physical activity and adequately control their dietary intake. The aim of present study was to investigate the dietary intake of patients with SM poisoning in comparison to a control group Methods: The study was undertaken on 55 Iranian male veterans, who had > 25% disabilities due to long-term complications of SM poisoning and 55 men age-matched healthy subjects. A previously validated food frequency questionnaire (FFQ) was used for measuring dietary macro/micro nutrient intake for both groups; and the results were analysed using Dietplan6 software. RESULTS: Analysis of macro/micro nutrients in dietary intakes of the patients versus the controls showed a significantly lower intake of several nutrients including selenium and carbohydrate. On the other hand, the dietary intake of trans-fatty acids and iodine were significantly higher in these patients. CONCLUSION: Long-term complications of SM poisoning in the Iranian veterans induce both chemical and physical disabilities. Macro/micro nutrient intake in these patients was significantly different in comparison with matched, healthy subjects. Dietary advice for these patients should be strongly recommended to these patients in order to prevent other chronic diseases.

The potential therapeutic applications of CRISPR/Cas9 in colorectal cancer.

The application of the CRISPR-associated nuclease 9 (Cas9) system in tumor studies has led to the discovery of several new treatment strategies for colorectal cancer (CRC), including the recognition of novel target genes, the construction of animal mass models, and the identification of genes related to chemotherapy resistance. CRISPR/Cas9 can be applied to genome therapy for CRC, particularly regarding molecular-targeted medicines and suppressors. This review summarizes some aspects of using CRISPR/Cas9 in treating CRC. Further in-depth and systematic research is required to fully realize the potential of CRISPR/Cas9 in CRC treatment and integrate it into clinical practice.

Therapeutic Potential of Targeting Transforming Growth Factor-beta (TGF-ß) and Programmed Death-ligand 1 (PD-L1) in Pancreatic Cancer.

Pancreatic cancer (PC) is one the most lethal malignancies worldwide affecting around half a million individuals each year. The treatment of PC is relatively difficult due to the difficulty in making an early diagnosis. Transforming growth factor-beta (TGF-ß) is a multifunctional factor acting as both a tumor promoter in early cancer stages and a tumor suppressor in advanced disease. Programmed death-ligand 1 (PD-L1) is a ligand of programmed death-1 (PD-1), an immune checkpoint receptor, allowing tumor cells to avoid elimination by immune cells. Recently, targeting the TGF-ß signaling and PD-L1 pathways has emerged as a strategy for cancer therapy. In this review, we have summarized the current knowledge regarding these pathways and their contribution to tumor development with a focus on PC. Moreover, we have reviewed the role of TGF-ß and PD-L1 blockade in the treatment of various cancer types, including PC, and discussed the clinical trials evaluating TGF-ß and PD-L1 antagonists in PC patients.

Growth-hormone-releasing Hormone as a Prognostic Biomarker and Therapeutic Target in Gastrointestinal Cancer.

Gastrointestinal cancers are prevalent cancers in the world with a poor prognosis, causing about one-half of all cancer deaths in the world. Unfortunately, there is no effective treatment for GI cancers. GHRH and GHRH receptors (GHRH-R) are expressed in various tumoral tissues and cell lines. The inhibition of GHRH-R is a new area of research because it provides a possible means of treating several types of cancer. Recent publications have reported GHRH and GHRH-R expressions in breast, pancreatic, prostate, colon, gastric, ovarian, and lung cancers, along with promising data about the use of GHRH antagonists in the treatment of different cancers. This review aims to summarize the recent studies on the relationship between GHRH and GI cancers and assess whether this hormone can be our target for therapy or used as a prognostic marker for GI cancers.

Circulating Tumor Cells and Cell-free Nucleic Acids as Biomarkers in Colorectal Cancer.

Colorectal cancer (CRC) is currently the second most prevalent cancer diagnosed in women and the third most common kind of cancer in men. Despite tremendous efforts and advancements in diagnostic approaches and treatment options, the mortality rate of CRC accounts for around one million each year globally. The five-year survival rate of CRC is reported to be approximately 14 percent for patients diagnosed at an advanced stage. Due to its significant associated mortality and morbidity, diagnostic tools to identify the disease at its early stages are urgently required. Early diagnosis may lead to better outcomes. The gold standard approach for CRC diagnosis is colonoscopy with biopsy. However, it is an invasive process with a risk of complications and discomfort for the patient. Moreover, it is usually performed in symptomatic or high-risk individuals and therefore, asymptomatic patients might be missed. Thus, alternative non-invasive diagnostic techniques are required to improve CRC outcomes. The new era of personalized medicine is identifying novel biomarkers associated with overall survival and clinical outcomes. Recently, liquid biopsy, a minimally invasive analysis of body fluid biomarkers, has gained attention for diagnosis, evaluation of prognosis, and follow-up of patients with CRC. Several previous studies have demonstrated that this novel approach allows for better understanding of CRC tumor biology and leads to an improvement in clinical outcomes. Here, we explain the enrichment and detection methods of circulating biomarkers, including CTCs, ctDNA, miRNA, lncRNA, and circRNA. Furthermore, we provide an overview on their clinical potential as diagnostic, prognostic, and predictive biomarkers for CRC.

Prediction of type 2 diabetes mellitus using hematological factors based on machine learning approaches: a cohort study analysis.

Type 2 Diabetes Mellitus (T2DM) is a significant public health problem globally. The diagnosis and management of diabetes are critical to reduce the diabetes complications including cardiovascular disease and cancer. This study was designed to assess the potential association between T2DM and routinely measured hematological parameters. This study was a subsample of 9000 adults aged 35-65 years recruited as part of Mashhad stroke and heart atherosclerotic disorder (MASHAD) cohort study. Machine learning techniques including logistic regression (LR), decision tree (DT) and bootstrap forest (BF) algorithms were applied to analyze data. All data analyses were performed using SPSS version 22 and SAS JMP Pro version 13 at a significant level of 0.05. Based on the performance indices, the BF model gave high accuracy, precision, specificity, and AUC. Previous studies suggested the positive relationship of triglyceride-glucose (TyG) index with T2DM, so we considered the association of TyG index with hematological factors. We found this association was aligned with their results regarding T2DM, except MCHC. The most effective factors in the BF model were age and WBC (white blood cell). The BF model represented a better performance to predict T2DM. Our model provides valuable information to predict T2DM like age and WBC.

The association of hematological inflammatory markers and psychological function in COVID-19 patients: A cross-sectional study.

Mental health disorders are linked to systemic inflammation. Due to high inflammation and mental health disorders in COVID-19 patients, we aimed to investigate the relationship between blood inflammatory markers such as red cell distribution width to platelet ratio (RPR), platelet-lymphocyte ratio (PLR), neutrophil/lymphocyte ratio (NLR), red cell distribution width (RDW), white blood cell (WBC), and psychological function in COVID-19 patients. In the current cross-sectional study, neuro-psychological function, and a complete blood count (CBC) were measured on 120 COVID-19 patients aged >30 years from the Imam Reza Hospital in Mashhad, Iran. Our results showed that anxiety related to MCHC (mean ± SD: 32.71 ± 1.68, p < 0.05), WBC (mean ± SD: 12.23 ± 5.43, p < 0.05), and PLR (median (IQR): 28.72 (15.88-41.31), p < 0.05) significantly. In the stress subgroup, only RPR was associated with stress (p < 0.05). Linear regression between hematological parameters and psychological score indicated that RDW and PLR had a significantly positive association with depression (ß = 0.086; p = 0.045 and ß = 1.326; p = 0.016, respectively) and anxiety scores (ß = 0.100; p = 0.038 and ß = 1.356; p = 0.010, respectively). Moreover, a positive correlation was found between PLR and stress (ß = 1.102; p = 0.012). This study showed a positive association between depression/anxiety/stress symptoms and levels of hematological inflammatory markers including PLR and RDW. The findings of this study provide novel insights into mental health and physiological markers, underscoring the potential influence of inflammation on mood disorders. Our findings offer exciting prospects for future research and may lead to innovative approaches in the management and treatment of depression, anxiety, and stress.

High-dose vitamin D supplementation is related to an improvement in serum alkaline phosphatase in COVID-19 patients; a randomized double-blinded clinical trial.

BACKGROUND: The benefits and harms of vitamin D supplementation in the treatment of COVID-19 have not yet been fully documented. In this study, we aimed to evaluate the effects of high-dose vitamin D supplementation on liver function tests in COVID-19. METHOD: This double-blinded randomized clinical trial was conducted on 140 hospitalized patients aged > 30 years. Patients were randomly allocated to receive either intervention group (n = 70 receiving 50,000 IU of vitamin D capsules orally as a single dose and then 10,000 IU syrup daily from the second day of admission for 30 days) and the control group (n = 70 receiving 1000 IU vitamin D syrup orally per day). Liver function tests (LFT), including alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT), and Lactate Dehydrogenase (LDH) were evaluated at baseline and at the end of the intervention. Decision tree analysis was performed to identify the predictors for change in liver enzymes. RESULTS: Among COVID-19 patients, a significant decrease was observed in serum level of ALP between intervention and placebo groups (p = 0.04). In addition, decision tree analysis revealed that GGT, temperature, serum magnesium level at baseline and gender were the most important predictors of ALT changes in COVID-19 patients. CONCLUSION: High-dose vitamin D supplementation improved ALP markers among COVID-19 patients. More randomized controlled trials with longer follow-up times will be required.

Development of Data Mining Algorithms for Identifying the Best Anthropometric Predictors for Cardiovascular Disease: MASHAD Cohort Study.

INTRODUCTION: Many studies have been published to assess the best anthropometric measurements associated with cardiovascular diseases (CVDs), but controversies still exist. AIM: Investigating the association between CVDs and anthropometric measurements among Iranian adults. METHODS: For a total population of 9354 aged 35 to 65, a prospective study was designed. Anthropometric measurements including ABSI (A Body Shape Index), Body Adiposity Index (BAI), Body Mass Index (BMI), Waist to Height Ratio (WHtR), Body Round Index (BRI), HC (Hip Circumference), Demispan, Mid-arm circumference (MAC), Waist-to-hip (WH) and Waist Circumference (WC) were completed. The association between these parameters and CVDs were assessed through logistic regression (LR) and decision tree (DT) models. RESULTS: During the 6-year follow-up, 4596 individuals (49%) developed CVDs. According to the LR, age, BAI, BMI, Demispan, and BRI, in male and age, WC, BMI, and BAI in female had a significant association with CVDs (p-value < 0.03). Age and BRI for male and age and BMI for female represent the most appropriate estimates for CVDs (OR: 1.07, (95% CI: 1.06, 1.08), 1.36 (1.22, 1.51), 1.14 (1.13, 1.15), and 1.05 (1.02, 1.07), respectively). In the DT for male, those with BRI ≥ 3.87, age ≥ 46 years, and BMI ≥ 35.97 had the highest risk to develop CVDs (90%). Also, in the DT for female, those with age ≥ 54 years and WC ≥ 84 had the highest risk to develop CVDs (71%). CONCLUSION: BRI and age in male and age and BMI in female had the greatest association with CVDs. Also, BRI and BMI was the strongest indices for this prediction.