Efficacy of a Nutritional Cream Intervention to Treat Depression in Rescuers:A Randomized Controlled Trial

Objective To explore the effectiveness of a nutritional intervention in rescuers who screened positive for depression.Methods A randomized controlled trial design was employed.From June to August,2022,4,460 rescuers were screened using the Self-Rating Depression Scale(SDS),and 1,615 positive cases were identified.Thirty-one volunteers were recruited and randomly divided into a nutritional intervention group and a control group.The intervention group received health education and nutritional intervention(a compound paste therapy primarily composed of red roses and Seville orange flowers),while the control group received psychological education.SDS scores were assessed before and after the intervention.Results There was a statistically significant decline in SDS scores in the nutritional intervention group after the intervention(P<0.05).Furthermore,the SDS scores of the intervention group were significantly lower than those of the control group,both before and after the intervention(P<0.05).No severe adverse reactions were observed during safety evaluation.Conclusion The nutritional intervention effectively reduced the depression scores in rescuers.Early nutritional intervention is recommended for rescuers who initially screen positive for depression.

Clinical characteristics and outcome of autoimmune pancreatitis based on serum immunoglobulin G4 level:A single-center,retrospective cohort study

BACKGROUND Autoimmune pancreatitis(AIP)has been linked with elevated immunoglobulin(Ig)G4 levels.The characteristics and outcomes of AIP based on serum markers have not been fully evaluated.AIM To compare clinical features,treatment efficacy,and outcome of AIP based on serum IgG4 levels and analyze predictors of relapse.METHODS A total of 213 patients with AIP were consecutively reviewed in our hospital from 2006 to 2021.According to the serum IgG4 level,all patients were divided into two groups,the abnormal group(n=148)with a high level of IgG4[>2×upper limit of normal(ULN)]and the normal group(n=65).The t-test or Mann-Whitney U test was used to compare continuous variables.Categorical parameters were compared by theχ^(2) test or Fisher’s exact test.Kaplan-Meier curves Zhou GZ et al.Clinical characteristics and outcome of AIP WJG https://www.wjgnet.com 5126 September 21,2023 Volume 29 Issue 35 and log-rank tests were established to assess the cumulative relapse rates.Univariate and multivariate analyses were used to investigate potential risk factors of AIP relapse.RESULTS Compared with the normal group,the abnormal group had a higher average male age(60.3±10.4 vs 56.5±12.9 years,P=0.047);higher level of serum total protein(72.5±7.9 g/L vs 67.2±7.5 g/L,P<0.001),IgG4(1420.5±1110.9 mg/dL vs 252.7±106.6 mg/dL,P<0.001),and IgE(635.6±958.1 IU/mL vs 231.7±352.5 IU/mL,P=0.002);and a lower level of serum complement C3(100.6±36.2 mg/dL vs 119.0±45.7 mg/dL,P=0.050).In addition,a lower number of cases with abnormal pancreatic duct and pancreatic atrophy(23.6%vs 37.9%,P=0.045;1.6%vs 8.6%,P=0.020,respectively)and a higher rate of relapse(17.6%vs 6.2%,P=0.030)were seen in the abnormal group.Multivariate analyses revealed that serum IgG4[(>2×ULN),hazard ratio(HR):3.583;95%confidence interval(CI):1.218–10.545;P=0.020]and IgA(>1×ULN;HR:5.908;95%CI:1.199–29.120;P=0.029)and age>55 years(HR:2.383;95%CI:1.056–5.378;P=0.036)were independent risk factors of relapse.CONCLUSION AIP patients with high IgG4 levels have clinical features including a more active immune system and higher relapse rate.Several factors,such as IgG4 and IgA,are associated with relapse.

Insomnia Burden among Informal Caregivers of Hospitalized Lung Cancer Patients and Its Influencing Factors

Objective This study aimed to reveal the insomnia burden and relevant influencing factors among informal caregivers(ICs)of hospitalized patients with lung cancer.Methods A cross-sectional study on ICs of hospitalized patients with lung cancer was conducted from December 31,2020 to December 31,2021.ICs’burden was assessed using the Caregiver Reaction Assessment(CRA),Hospital Anxiety and Depression Scale(HADS),and Insomnia Severity Index(ISI).Linear and logistic regression models were used to identify the influencing factors.Results Among 289 ICs of hospitalized patients with lung cancer,83(28.72%),53(18.34%),and 14(4.84%)ICs experienced mild,moderate,and severe insomnia,respectively.The scores concerning self-esteem,lack of family support,financial problems,disturbed schedule,and health problems were 4.32±0.53,2.24±0.79,2.84±1.14,3.63±0.77,and 2.44±0.95,respectively.ICs with higher Activities of Daily Living Scale(ADLS)scores were associated with a lower risk of insomnia,with an odd ratio(OR)and 95%confidence interval(CI)of 0.940(0.898–0.983).Among the ICs,female gender(OR=2.597),alcohol consumption(OR=3.745),underlying medical conditions(OR=11.765),long-term caregiving experience(OR=37.037),and higher monthly expenses(OR=5.714)were associated with a high risk of insomnia.Conclusion Of the hospitalized patients with lung cancer,51.9%experienced insomnia.Patients’ADL,ICs gender,alcohol consumption,underlying medical conditions,caregiving duration,and monthly expenses were influencing factors.Therefore,prompt screening and early intervention for ICs of patients with lung cancer is necessary.

Quality of sleep and its determinants among people with type 2 diabetes mellitus in Northwest of Iran

AIM To examine sleep quality and its determinants among people with type 2 diabetes mellitus(T2DM).METHODS This is a cross-sectional study conducted among diabetic patients referring to Ardabil diabetes clinic in Northwest of Iran. Information on sleep quality was collected using Pittsburg Sleep Quality Index(PSQI). A questionnaire was used to collect data on sociodemographic lifestyle factors and psychological distress. This questionnaire was completed through an interview, and clinical information was extracted from patient's record. Data analysis was done using SPSS software version 23 and univariate andmultivariate analyses.RESULTS Study participants consist of 256 people with T2 DM the majority of whom were women(70%), and mean age of participants was 54.06 ± 9.09. The mean of total score of PSQI was 5.56 ± 3.34. Relative to younger age group, the middle-aged people with T2 DM were twice more likely to be poor sleeper; the adjusted OR was 2.03(95%CI: 1.01-4.08); and those with longer duration of diabetes were about 1.8 times more likely to report poor quality of sleep(ORadj = 1.77, 95%CI: 0.98-3.13). Participants with cholesterol level ≥ 240 mg/dL were about twice more likely to be poor sleeper(ORadj = 1.99, 95%CI: 1.01-3.94). The odds of being poor sleeper increased as the level of distress increased(1.84-4.09).CONCLUSION As indicated by the results of the present study, some factors including age, duration of disease, psychological distress and high level of cholesterol were independently associated with poor sleep quality.

Rate of carcass and offal condemnation in animals slaughtered at Yazd slaughterhouse,central Iran

Objective:To determine the rate of carcass and offal condemnation in the animals slaughtered at Yazd slaughterhouse,Yazd,Iran.Methods:In a nine-month retrospective survey from June 2011 to March 2012,all the carcasses and offal condemnations for large animals(cattle and camels) and small animals(sheep and goats)in Yazd Slaughterhouse were carefully recorded daily.Results:In total,2741 large animals(cattle and camels) and 77515 small animals(sheep and goats) were slaughtered during the period of this survey.Six carcasses(0.21%) of the large animals and 18 carcasses(0.02%) of the small animals were condemned.For large animals,condemnations in summer and autumn were significantly greater than winter(P<0.05).Condemnation rate of liver,lungs and kidneys for the large animals were 5.36%,21.23%and 3.68%respectively and for the small animals were 4.37%,5.46%and 0.51%respectively.The main recorded reasons for carcass condemnations in both large and small animals were icterus and cachexia.The most prevalent lesion resulting in offal condemnation was due to parasitic infection specially metacestods.Conclusions:This study aimed to show the efficiency of documentation records during meal inspection at slaughterhouses to monitor the amount of condemnation and possible approaches to better awareness about the future preventive programs.Considering the percentage of condemnation of carcass and offal in the present study and their price in Iranian markets,the overall economic losses seems to be notable at Yazd slaughterhouse.

Isolation and Characterization of Human Umbilical Cord Mesenchymal Stem Cells and Their Differentiation into Pdx-1⁺Cells

Background: Recent studies have focused on generating of insulin-producing cells (IPCs) from pluripotent stem cells. Producing of precursor's population with pancreatic endoderm properties is a challenging issue in front of regenerative medicine investigators. Previous studies have shown that during pancrease development in lower portion of foregut, signals from notochord suppress sonic hedgehog (Shh) expression and lead to increase expression of pancreatic duodenal homeobox-1 (Pdx-1) as a marker for pancreatic precursor's cells. Therefore, Shh repression is considered as a critical step in IPCs generation protocols. Objective: Isolation and characterization of human umbilical cord mesenchymal stem cells (HUC-MSCs) is the aim of current study. As well as the role of basic fibroblast growth factor (bFGF) alone and in combination with cyclopamine are investigated in creating cells with Pdx-1 expression ability. Methods: Cells differentiate into definitive endoderm by adding activin A and wnt-3α into RPMI medium supplemented with for 3 days. At the second stage, the cells are washed with phosphate-buffered saline (PBS). One group (group A) is treated with bFGF for 5 days. Second group (group B) is treated with cyclopamine-KADD for 5 days. Third group (group C) is treated with bFGF and cyclopamine-KAAD for 5 days. Forth group (group D) is untreated as control. Result: Our results show that bFGF and cyclopamine in combination induce more expression of Pdx-1 in HUC-MSCs.

A prospective analysis of factors that influence weight loss in patients undergoing radiotherapy

Malnutrition occurs frequently in patients with cancer.Indeed,a variety of nutritional and tumorrelated factors must be taken into account in these patients.Recognizing this relationship,we aimed to prospectively evaluate the risk factors that influence weight loss in patients undergoing radiotherapy with oral nutritional supplementation and dietetic counseling.Weight loss of 74 patients during radiotherapy and 1 month after treatment was analyzed.Parameters such as age,gender,tumor location,tumor stage,Eastern Cooperative Oncology Group performance status(ECOG PS)score,and the use of chemotherapy were analyzed to evaluate their influence on weight loss.All patients underwent oral nutritional supplementation and dietetic counseling.Forty-six(65.7%)patients lost weight,with a mean weight loss of(4.73±3.91)kg,during radiotherapy.At 1 month after treatment,45(66.2%)patients lost weight,presenting a mean weight loss of(4.96±4.04)kg,corresponding to a(6.84±5.24)%net reduction from their baseline weight.Head and neck cancer patients had a mean weight loss of(3.25±5.30)kg,whereas the remaining patients had a mean weight loss of(0.64±2.39)kg(P=0.028)during radiotherapy.In the multivariate analysis,the head and neck tumor location(P=0.005),use of chemotherapy(P=0.011),and ECOG PS score of 2-3(P=0.026)were considered independent risk factors.Nutritional status and parameters,such as tumor location(especially the head and neck),the use of chemotherapy,and the ECOG PS score,should be evaluated before radiotherapy because these factors can influence weight loss during radiotherapy and 1 month after treatment.

Microsporidiosis in Iran:A systematic review and meta-analysis

Objective:To examine all evidences about Microspondia infection in vertebrate/invertebrate hosts and Iranian populations distributed in different regions of the country.Methods:All published articles up to December 2015,including descriptive and cross-sectional studies related to the prevalence and genotyping of Microspondia infection in Iran,was considered in this systematic review.The meta-analysis was done using the random-effects model and Stats Direct statistical software.MEGA 5.05 software and maximum likelihood algorithm with Kimura 2-parameter model were used for phylogenetic analysis.Results:Of the 1 152 investigated studies,33 eligible studies reported a prevalence of Microspondia infection in vertebrate and invertebrate hosts.According to this systematic review,the overall prevalence rate of Microsporidia infection in immunocompromised patients in Iran was 8.18%.Furthermore,the overall prevalence rate of Microsporidia infection in immunocompromised patients with chronic diarrhoea,patients with non-diarrhoea,gastroenteritis,and patients with CD4(< 200 cells/μL) was 15.4%,4.1%,0.5%,and 12.9%respectively.The highest prevalence rate of human and animal Microsporidia was estimated in Kerman(29%) and Khuzestan(26.5%).The overall prevalence rate of Microsporidia infection in honeybees using the random-effects model was 40%.Furthermore,the highest prevalence rate of nosemosis was described in East Azerbaijan(48.2%).The maximum number of Microsporidia isolates from immunocompromised patients and pigeons in Iran belonged to genotypes D(n=16;50%) and E(n=6;20.6%) of Enterocytozoon bieneusi.Conclusions:This study may be the first systematic review and meta-analysis that provides a broad outlook on the prevalence of microsporidiosis in Iran.It is necessary to investigate Microsporidia infection in vertebrate and invertebrate hosts and environmental resources in Iran.

Interactions between pork consumption,CagA status and IL-1B-31 genotypes in gastric cancer

AIM: To explore potential interactions among Helicobacter pylori (H. pylori), CagA status, interleukin (IL)-1B-31 genotypes, and non-cardiac gastric cancer (GC) risk.

The impact of climatic variables on the population dynamics of the main malaria vector, Anopheles stephensi Liston(Diptera: Culicidae), in southern Iran

Objective:To determine the significance of temperature,rainfall and humidity in the seasonal abundance of Anopheles stephensi in southern Iran.Methods:Data on the monthly abundance of Anopheles stephensi larvae and adults were gathered from earlier studies conducted between 2002 and 2019 in malaria prone areas of southeastern Iran.Climatic data for the studied counties were obtained from climatology stations.Generalized estimating equations method was used for cluster correlation of data for each study site in different years.Results:A significant relationship was found between monthly density of adult and larvae of Anopheles stephensi and precipitation,max temperature and mean temperature,both with simple and multiple generalized estimating equations analysis(P<0.05).But when analysis was done with one month lag,only relationship between monthly density of adults and larvae of Anopheles stephensi and max temperature was significant(P<0.05).Conclusions:This study provides a basis for developing multivariate time series models,which can be used to develop improved appropriate epidemic prediction systems for these areas.Long-term entomological study in the studied sites by expert teams is recommended to compare the abundance of malaria vectors in the different areas and their association with climatic variables.

Dietary, Anthropometric, Biochemical and Psychiatric Indices in Shift Work Nurses

Objectives: The aim of this study was to compare nutrients intake, anthropometric, biochemical and psychiatric indices between shift working and day-time nurses. Methods: A cross-sectional comparative study was conducted in which ninety eight female nurses (55 day-time workers and 43 shift workers) from six educational hospitals of Jondi-Shapour University of medical sciences, Ahvaz, Iran were participated. A questionnaire including dietary, anthropometric, disease history and lifestyle pattern questions was completed and 3-day 24-hour recalls, Beck Depression Inventory (BDI) and Hospital Anxiety and Depression Scale (HADS) were collected. Serum hs-CRP and 25(OH)D3 concentrations were measured by immunoturbidimetric and electrochemiluminescent immunoassay method, respectively. Anthropometric indices were measured according to World health organization standard protocol. Independent sample t and chi-square tests were used for statistical analysis. Results: There was a lower dietary intake of thiamin, riboflavin, niacin, folate, magnesium and iron in shift worker compared with day-time nurses (p < 0.05). No significant differences in serum hs-CRP concentrations, serum 25(OH)D3 levels, vitamin D deficiency percentage, hemoglobin and hematocrite concentrations, and also anthropometric and psychiatric variables were found between two groups. Duration of exposure to sunlight was significantly higher in shift workers than in day time nurses. Engagement time in weekly physical exercise was around 11 times greater in day-time nurses compared with the shift work nurses (p = 0.001). Conclusions: This study showed that shift working is associated with some nutritional deficiencies and sedentary lifestyle among female nurses.

Clinico-epidemiological factors of health related quality of life among people with type 2 diabetes

AIM To investigate the quality of life(QOL) and its clinical and epidemiological correlates among people with type 2 diabetes.METHODS This cross-sectional study was conducted in Tabriz, Northwest of Iran, including a total of 394 people with type 2 diabetes using convenient sampling method from November 2014 to March 2015. General information including demographic, socioeconomic status and lifestyle factors were collected by trained interviewers. Clinical information was retrieved from clinic's record and QOL was assessed using the 26-item WHOQOL-BRIFE questionnaire. Univariate and multivariate linear regression were performed to assess the related factors and QOL dimensions. RESULTS The mean of overall health related QOL was 52.11 ± 11.53 and the maximum and minimum dimensions wererespectively seen in psychological(60.38 ± 14.54) and social(38.32 ± 16.94) dimensions. The results of multiple linear regression showed a significant overall relationship between HRQOL and age(b =-1.48%, 95%CI:-0.03 and-2.93) level of education(b = 4.12%, 95%CI: 2.73 and 5.5), number of comorbidities(b =-2.41%, 95%CI:-3.89 and-9.41), and level of income(b = 1.98, 95%CI: 0.05 and 3.9), functional limitation(b =-3.59, 95%CI:-2.26 and-4.92) and psychological distress(b =-2.02%, 95%CI:-2.83 and-1.21). Level of education, functional limitation, psychological distress were associated with the score of physical, mental and environmental dimensions, and number of comorbidities was associated with the score of physical and mental dimensions. CONCLUSION Based on our findings, lifestyle modification and increasing facilities of clinics providing service can be effective steps to improve the QOL among people with type 2 diabetes.

Non-medical factors on choice of delivery (CS/NVD) in hospitals of Tehran University of Medical Sciences

Background: Kind of delivery affect many aspects of individuals, families and health systems situations. The aim of this study was to identify the Role of non-medical factors on choice of delivery (CS/NVD) in hospitals affiliated to Tehran University of Medical Sciences. Materials and Method: This cross-sectional study was performed to identify the factors involved in the choice of delivery (CS/NVD) among women attending hospitals affiliated to Tehran University of Medical Sciences. Data was derived from the medical records of women who gave birth in the hospitals. Results: A significant statistical relationship was found between factors such as age of mother, level of education, occupational status, type of previous delivery, person supervising the pregnancy and dissatisfaction about delivery were more frequent in women who underwent CS than those who gave birth by NVD. Conclusion: The highly increasing rise in the rate of unnecessary CS during throughout the world, and its adverse effect on maternal and child health, the financial burden imposed on families and health systems, has highlighted the importance of studies to identify the non-medical factors that affect decision-making concerning type of delivery as well as to determine the appropriate medical indications of CS.

Operative management of acute diverticulitis in immunosuppressed compared to immunocompetent patients: A systematic review

AIM: To determine short and long-term outcomes following operative management of acute diverticulitis in immunosuppressed(IMS) compared to immunocompetent(IMC) patients.METHODS: PRISMA guidelines were followed in conducting this systematic review. We searched Pub Med(1946 to present), OVID MEDLINE(R) In-Process and Other Non-Indexed Citations, OVID MEDLINE(R) Daily and OVID MEDLINE(R)(1946 to present), EMBASE on OVID platform(1947 to present), CINAHL on EBSCO platform(1981 to present), and Cochrane Library using a systematic search strategy. There were no restrictions on publication date and language. We systematically reviewed all published cohort comparative studies, casecontrol studies, and randomized controlled trials that reported outcomes on operative management of acute episode of colonic diverticulitis in IMS in comparison to IMC patients. RESULTS: Seven hundred and fifty-five thousand five hundred and eighty-three patients were included in this systematic review; of which 1478 were IMS and 754105 were IMC patients. Of the nine studies included there was one prospective cohort, seven retrospective cohorts, one retrospective case-control study, and no randomized controlled trials. With the exception of solid organ transplant patients, IMS patients appeared to be older than IMC when they presented with an acuteepisode of diverticulitis. IMS patients presented with more severe acute diverticulitis and more insidious onset of symptoms than IMC patients. In the emergency setting, peritonitis was the main indication for operative intervention in both IMS and IMC patients. IMS patients were more likely to undergo Hartmann's procedure and less likely to undergo reconstructive procedures compared to IMC patients. Furthermore, IMS patients had higher morbidity and mortality rates in the emergency setting compared to IMC patients. In the elective settings, it appeared that reconstruction with primary anastomosis with or without a diverting loop stoma is the procedure of choice in the IMS patients and carried minimal morbidity and mortality equivalent to IMC patients. CONCLUSION: Emergency operations for diverticulitis in IMS compared to IMC patients have higher morbidity and mortality, whereas, in the elective setting both groups have comparable outcomes.

Transition Logic Regression Method to Identify Interactions in Binary Longitudinal Data

Logic regression is an adaptive regression method which searches for Boolean (logic) combinations of binary variables that best explain the variability in the outcome, and thus, it reveals interaction effects which are associated with the response. In this study, we extended logic regression to longitudinal data with binary response and proposed “Transition Logic Regression Method” to find interactions related to response. In this method, interaction effects over time were found by Annealing Algorithm with AIC (Akaike Information Criterion) as the score function of the model. Also, first and second orders Markov dependence were allowed to capture the correlation among successive observations of the same individual in longitudinal binary response. Performance of the method was evaluated with simulation study in various conditions. Proposed method was used to find interactions of SNPs and other risk factors related to low HDL over time in data of 329 participants of longitudinal TLGS study.

TCF7L2-rs7903146 polymorphism modulates the effect of artichoke leaf extract supplementation on insulin resistance in metabolic syndrome:a randomized,double-blind,placebo-controlled trial

Background： Transcription factor 7-like 2 （TCF7L2）-rs7903146 polymorphism is associated with increased risk of type 2 diabetes. The response of insulin and insulin resistance to artichoke leaf extract （ALE） may be affected by TCF7L2-rs7903146 polymorphism. Objective： This study examined the effects of ALE supplementation on metabolic parameters of the TCF7L2-rs7903146 polymorphism in patients with metabolic syndrome （MetS）. Design, setting, participants and interventions： This double-blind clinical trial was conducted on 80 patients with MetS in Sina Clinic, Khoy, Iran. The patients were randomized into ALE or placebo groups to receive either ALE （1800 mg/d as four tablets） or matching placebo for 12 weeks. Main outcome rneasures： Anthropometric indices, blood pressure, glucose and lipid profile levels were measured before and after the study. Moreover, patients were genotyped for TCF7L2 polymorphism. Results： ALE supplementation decreased insulin level and the homeostasis model assessment of insulin resistance （HOMA-IR） in patients with the ＂IT genotype of TCF7L2-rs7903146 polymorphism （P 〈 0.05）. There was no significant interaction between blood pressure, glucose and lipid profile response to ALE supplementation. Conclusion： The responses of insulin and HOMA-lR to ALE supplementation have shown an interaction with single-nucleotide polymorphism rs7903146 in TCF7L2. Trial registration： Iranian Registry of Clinical Trial IRCT201409033320N9.