Women health and microbiota:Different aspects of well-being

In this editorial,we comment on the article by Marano et al recently published in the World Journal of Gastroenterology 2023;29(45):5945-5952.We focus on the role of gut microbiota(GM)in women’s health,highlighting the need to thoroughly comprehend the sex differences in microbiota.Together,the host and GM support the host’s health.The microbiota components consist of viruses,bacteria,fungi,and archaea.This complex is an essential part of the host and is involved in neu-rological development,metabolic control,immune system dynamics,and host dynamic homeostasis.It has been shown that differences in the GM of males and females can contribute to chronic diseases,such as gastrointestinal,metabolic,neurological,cardiovascular,and respiratory illnesses.These differences can also result in some sex-specific changes in immunity.Every day,research on GM reveals new and more expansive frontiers,offering a wealth of innovative oppor-tunities for preventive and precision medicine.

Long-term metformin therapy and vitamin B12 deficiency: An association to bear in mind

To date,metformin remains the first-line oral glucose-lowering drug used for the treatment of type 2 diabetes thanks to its well-established long-term safety and efficacy profile.Indeed,metformin is the most widely used oral insulinsensitizing agent,being prescribed to more than 100 million people worldwide,including patients with prediabetes,insulin resistance,and polycystic ovary syndrome.However,over the last decades several observational studies and meta-analyses have reported a significant association between long-term metformin therapy and an increased prevalence of vitamin B12 deficiency.Of note,evidence suggests that long-term and high-dose metformin therapy impairs vitamin B12 status.Vitamin B12(also referred to as cobalamin)is a water-soluble vitamin that is mainly obtained from animal-sourced foods.At the cellular level,vitamin B12 acts as a cofactor for enzymes that play a critical role in DNA synthesis and neuroprotection.Thus,vitamin B12 deficiency can lead to a number of clinical consequences that include hematologic abnormalities(e.g.,megaloblastic anemia and formation of hypersegmented neutrophils),progressive axonal demyelination and peripheral neuropathy.Nevertheless,no definite guidelines are currently available for vitamin B12 deficiency screening in patients on metformin therapy,and vitamin B12 deficiency remains frequently unrecognized in such individuals.Therefore,in this“field of vision”article we propose a list of criteria for a cost-effective vitamin B12 deficiency screening in metformin-treated patients,which could serve as a practical guide for identifying individuals at high risk for this condition.Moreover,we discuss additional relevant topics related to this field,including:(1)The lack of consensus about the exact definition of vitamin B12 deficiency;(2)The definition of reliable biomarkers of vitamin B12 status;(3)Causes of vitamin B12 deficiency other than metformin therapy that should be identified promptly in metformin-treated patients for a proper differential diagnosis;and(4)Potential pathophysiological mechanisms underlying metformin-induced vitamin B12 deficiency.Finally,we briefly review basic concepts related to vitamin B12 supplementation for the treatment of vitamin B12 deficiency,particularly when this condition is induced by metformin.

Single-step transepithelial photorefractive keratectomy in high myopia：qualitative and quantitative visual functions

AIM：To investigate quantitative and qualitative optical outcomes of single-step transepithelial photorefractive keratectomy（Trans PRK）in high myopia.METHODS：In a prospective interventional case-series,30 eyes with high myopia（-6.00 to-8.75 D）with（up to-3.00 D）or without astigmatism were enrolled from Bina Eye Hospital,Tehran,Iran. One-step Trans PRK was performed with aberration-free aspherical optimized profile and SCHWIND AMARIS 500 laser. One-year follow-up results for refraction,visual acuities,vector analysis,ocular wavefront（OWF）and corneal wave-front（CWF）higher order aberrations（HOA）,contrast sensitivity（CS）,and postoperative haze were assessed.RESULTS：After the surgery,both photopic and mesopic CSs significantly improved（both P〈0.001）. We detected significant induction of OWF coma and trefoil（P〈0.001 for both）HOAs; CWF coma（P=0.002）,spherical（P〈0.001）,and tetrafoil（P=0.003）HOAs in 6 mm analysis diameter; and CWF trefoil（P=0.04）HOA in 4 mm analysis diameter. The range of mean induction observed for various HOAs was0.005-0.11 μm. The 86.7% of eyes reached an uncorrected distance visual acuity of 20/20 or better; 96.7% of eyes were within ±0.5 D of targeted spherical refraction. In vector analysis,mean correction index value was 1.03 and mean index of success was 0.22. By 12mo after the operation,no eye lost any number of corrected distancevisual acuity lines. We detected no corneal haze greater than 1~＋ throughout the follow-up.CONCLUSION：Our findings show promising effects of single-step Trans PRK on quality of vision in high myopic eyes. It also improves refraction and visual acuity.

Transmembrane serine protease 2 and angiotensin-converting enzyme 2 anti-inflammatory receptors for COVID-19/inflammatory bowel diseases treatment

long-term,and relapsing inflammatory disorders.IBD may spontaneously grow in the colon,and in severe cases may result in tumor lesions such as invasive carcinoma in inflamed regions of the intestine.Recent epidemiological reports indicate that old age and underlying diseases such as IBD contribute to severity and mortality in patients with coronavirus disease 2019(COVID-19).Currently,the ongoing COVID-19 pandemic caused serious morbidity and mortality worldwide.It has also been shown that the transmembrane serine protease 2 is an essential factor for viral activation and viral engulfment.Generally,viral entry causes a'cytokine storm'that induces excessive generation of proinflammatory cytokines/chemokines including interleukin(IL)-6,IL-2,IL-7,tumor necrosis factor-α,and interferon-γ.Future research could concentrate on developing inflammatory immunological responses that are efficient to encounter COVID-19.Current analysis elucidates the role of inflammation and immune responses during IBD infection with COVID-19 and provides a list of possible targets for IBD-regulated therapies in particular.Data from clinical,in vitro,and in vivo studies were collected in English from PubMed,Google Scholar,Scopus,and the Cochrane library until May 2021.

The protective effect of a standardized hydroalcoholic extract of Prosopis farcta (Banks & Sol.) J.F.Macbr. fruit in a rat model for experimental ulcerative colitis

Background:Investigating new therapies for inflammatory bowel disease among natural products has recently been gaining attention.Although Prosopis farcta has repeatedly been mentioned in traditional Persian medicine as a therapeutic option for inflammatory bowel disease,no evidence-based investigations have been conducted on this topic.The aim of this study was to assess the impact of P.farcta on acetic acid-induced colitis in rats.Methods:A hydroalcoholic extract of P.farcta fruits was prepared.Thirty-six adult Wistar rats were divided into six groups,and colitis was induced in five groups,except the sham group,using acetic acid solution.The animals received distinctive daily doses of P.farcta(50,75,and 100 mg/kg/day,p.o.)and dexamethasone(1 mg/kg/day,i.p.)as standard treatment for two progressive days,starting from colitis induction.Microscopic and histopathological examinations were performed on inflamed colonic tissue.Tissue concentrations of interleukin-1βand tumor necrosis factor-αwere assessed using enzyme-linked immunosorbent assay kits.To identify the role of oxidative stress in ulcerative colitis,the levels of malondialdehyde and myeloperoxidase were measured in colon tissues.Results:Treatment with all concentrations of P.farcta attenuated inflammation and ulcers compared with saline treatment in the control group(P<0.01 for 50 mg/kg;P<0.001 for 75 and 100 mg/kg/day).The best suppression of tumor necrosis factor-αand interleukin-1βwas observed at a dose of 100 mg/kg P.farcta(P<0.001).This dose showed the best effect in reducing myeloperoxidase and malondialdehyde in ulcerative colitis-induced rats(P<0.001).Conclusion:P.farcta can be considered a promising candidate for treating ulcerative colitis;thus,it requires further confirmation by clinical trials.

Post-discharge follow-up of patients with spine trauma in the National Spinal Cord Injury Registry of Iran during the COVID-19 pandemic:Challenges and lessons learned

Purpose:The purpose of the National Spinal Cord Injury Registry of Iran(NSCIR-IR)is to create an infrastructure to assess the quality of care for spine trauma and in this study,we aim to investigate whether the NSCIR-IR successfully provides necessary post-discharge follow-up data for these patients.Methods:An observational prospective study was conducted from April 11,2021 to April 22,2022 in 8 centers enrolled in NSCIR-IR,respectively Arak,Rasht,Urmia,Shahroud,Yazd,Kashan,Tabriz,and Tehran.Patients were classified into 3 groups based on their need for care resources,respectively:(1)non-spinal cord injury(SCI)patients without surgery(group 1),(2)non-SCI patients with surgery(group 2),and(3)SCI patients(group 3).The assessment tool was a self-designed questionnaire to evaluate the care quality in 3 phases:pre-hospital,in-hospital,and post-hospital.The data from the first 2 phases were collected through the registry.The post-hospital data were collected by conducting follow-up assessments.Telephone follow-ups were conducted for groups 1 and 2(non-SCI patients),while group 3(SCI patients)had a face-to-face visit.This study took place during the COVID-19 pandemic.Data on age and time interval from injury to follow-up were expressed as mean±standard deviation(SD)and response rate and follow-up loss as a percentage.Results:Altogether 1538 telephone follow-up records related to 1292 patients were registered in the NSCIR-IR.Of the total calls,918(71.05%)were related to successful follow-ups,but 38 cases died and thus were excluded from data analysis.In the end,post-hospital data from 880 patients alive were gathered.The success rate of follow-ups by telephone for groups 1 and 2 was 73.38%and 67.05%respectively,compared to 66.67%by face-to-face visits for group 3,which was very hard during the COVID-19 pandemic.The data completion rate after discharge ranged from 48%-100%,22%-100%and 29%-100%for groups 1-3.Conclusions:To improve patient accessibility,NSCIR-IR should take measures during data gathering to increase the accuracy of registered contact information.Regarding the loss to follow-ups of SCI patients,NSCIR-IR should find strategies for remote assessment or motivate them to participate in follow-ups through,for example,providing transportation facilities or financial support.

Pressure ulcers and acute risk factors in individuals with traumatic spinal fractures with or without spinal cord injuries:A prospective analysis of the National Spinal Column/Cord Injury Registry of Iran(NSCIR-IR)data

Purpose:To identify risk factors for developing pressure ulcers(PUs)in the acute care period of traumatic spinal fracture patients with or without spinal cord injuries(SCIs).Methods:Data were collected prospectively in participating the National Spinal column/Cord Injury Registry of Iran(NSCIR-IR)from individuals with traumatic spinal fractures with or without SCIs,in-clusive of the hospital stay from admission to discharge.Trained nursing staff examined the patients for the presence of PUs every 8 h during their hospital stay.The presence and grade of PUs were assessed according to the European Pressure Ulcer Advisory Panel classification.In addition to PU,following data were also extracted from the NSCIR-IR datasets during the period of 2015-2021:age,sex,Glasgow coma scale score at admission,having SCIs,marital status,surgery for a spinal fracture,American Spinal Injury Association impairment scale(AIS),urinary incontinence,level of education,admitted center,length of stay in the intensive care unit(ICU),hypertension,respiratory diseases,consumption of ciga-rettes,diabetes mellitus and length of stay in the hospital.Logistic regression models were used to es-timate the unadjusted and adjusted odds ratio(OR)with 95%confidence intervals(CI).Results:Altogether 2785 participants with traumatic spinal fractures were included.Among them,87(3.1%)developed PU during their hospital stay and 392(14.1%)had SCIs.In the SCI population,63(16.1%)developed PU during hospital stay.Univariate logistic regression for the whole sample showed that marital status,having SCIs,urinary incontinence,level of education,treating center,number of days in the ICU,age,and Glasgow coma scale score were significant predictors for PUs.However,further analysis by multiple logistic regression only revealed the significant risk factors to be the treating center,marital status,having SCIs,and the number of days in the ICU.For the subgroup of individuals with SCIs,marital status,AIS,urinary incontinence,level of education,the treating center,the number of days in the ICU and the number of days in the hospital were significant predictors for PUs by univariate analysis.After adjustment in the multivariate model,the treating center,marital status(singles vs.marrieds,OR=3.06,95%CI:1.55-6.03,p=0.001),and number of days in the ICU(OR=1.06,95%Cl:1.04-1.09,p<0.001)maintained significance.Conclusions:These data confirm that individuals with traumatic spinal fractures and SCIs,especially single young patients who suffer from urinary incontinence,grades A-D by AIS,prolonged ICU stay,and more extended hospitalization are at increased risk for PUs;as a result strategies to minimize PU development need further refinement.

Mammalian target of rapamycin;novel insight for management of inflammatory bowel diseases

Inflammatory bowel diseases(IBDs),with blurred etiology,show a rising trend and are of global concern.Of various factors involved in IBD pathogenesis and development,inflammation has been shown to play a major role.Recognition of the molecular and cellular pathways that induce IBD is an emerging subject to develop targeted therapies.Mammalian target of rapamycin(mTOR)is one the most common receptors of many inflammatory pathways,including that of IBD.To this end,we intend to overview the mTOR inhibitors for their possible efficacy in present and future approaches to treatment of IBD.

From Entry to Evasion:A Comprehensive Analysis of Host-Virus Interactions for Monkeypox

Monkeypox(Mpox)has posed a novel challenge and emerged as a threat to global public health since the onset of its outbreak in 2022.Mpox is spreading throughout the world in both endemic and non-endemic countries,indicating that its behavior is evolving.The prevalence of Mpox and the risk of a global pandemic necessitate a better understanding of Mpox virus replications and interactions with the host.Here,we attempted to provide a detailed comprehensive review of Mpox virus behavior at the molecular level from the entry level to the establishment of a successful infection,including attachment and entry,DNA replication,protein expression and viron assembly and egress.This review also describes its strategies to evade host immune responses and inhibit apoptosis,and uncovers underlying molecular mechanisms such as subverted signaling pathways and cellular factors behind host-viral interactions.

Prenatal risk factors and genetic causes of ADHD in children

Background Attention deficit/hyperactivity disorder(ADHD)is a common disease among children;it affected 5-7% of the population in 2015.ADHD is a multifactorial disease,and its etiology is still not clearly understood.Data Sources This narrative review has been done by searching the PubMed and Embase databases using attention deficit/hyperactivity disorder,ADHD,risk factors;genetics;pediatrics;psychiatrics as keywords.Results ADHD is considered to be a hereditary disorder in which genes play the fundamental role in the pathogenesis;however,findings from genetic-environmental studies support the hypothesis that genetic factors can exert effects on an indi-viduaFs condition by determining his/her responses to environmental exposures,especially those during the prenatal stage.Conclusion ADHD is considered as a hereditary disorder in which genes and prenatal risk factors play fundamental roles in the pathogenesis.

Pediatric endocrinopathies related to COVID‑19:an update

Background Coronavirus disease 2019(COVID-19)is a disease caused by the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),the seventh coronavirus to be linked to human disease.The SARS-CoV-2 virus may have several pathophysiologic interactions with endocrine systems,resulting in disruptions in glucose metabolism,hypothalamus and pituitary function,adrenal function,and mineral metabolism.An increasing amount of evidence demonstrates both the influence of underlying endocrine abnormalities on the outcome of COVID-19 and the effect of the SARS-CoV-2 virus on endocrine systems.However,a systematic examination of the link to pediatric endocrine diseases has been missing.Data sources The purpose of this review is to discuss the impact of SARS-CoV-2 infection on endocrine systems and to summarize the available knowledge on COVID-19 consequences in children with underlying endocrine abnormalities.For this purpose,a literature search was conducted in EMBASE,and data that were discussed about the effects of COVID-19 on endocrine systems were used in the current study.Results Treatment suggestions were provided for endocrinopathies associated with SARS-CoV-2 infection.Conclusions With the global outbreak of COVID-19,it is critical for pediatric endocrinologists to understand how SARSCoV-2 interacts with the endocrine system and the therapeutic concerns for children with underlying problems who develop COVID-19.While children and adults share certain risk factors for SARS-CoV-2 infection sequelae,it is becoming obvious that pediatric responses are different and that adult study results cannot be generalized.While pediatric research gives some insight,it also shows the need for more study in this area.

Reasons for delayed spinal cord decompression in individuals with traumatic spinal cord injuries in Iran:A qualitative study from the perspective of neurosurgeons

Purpose:The median time from the event leading to the spinal cord injury(SCI)to the time of decompressive surgery is estimated to be 6.9 days in Iran,which is much longer than the proposed ideal time(less than 24 h)in published guidelines.The current qualitative study aimed to determine the reasons for the observed decompression surgery delay in Iran from the perspective of neurosurgeons.Methods:This qualitative study is designed to perform content analysis on the gathered data from face-to-face semi-structured interviews with 12 Iranian neurosurgeons.Results:The findings of the current study suggest that patient-related factors constitute more than half of the codes extracted from the interviews.Overall,the type of injury,presence of polytrauma,and surgeons’’wrong attitude are the main factors causing delayed spinal cord decompression in Iranian patients from the perspective of neurosurgeons.Other notable factors include delay in transferring patients to the trauma center,delay in availability of necessary equipment,and scarce medical personnel.Conclusion:In the perspective of neurosurgeons,the type of injury,presence of polytrauma,and surgeons’’wrong attitude are the leading reasons for delayed decompressive surgery of individuals with SCI in Iran.