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Abstract Background Human T-cell leukemia virus type 1 (HTLV-1) is a well-known retrovirus, particularly prevalent in northeastern Iran, where it is associated with a range of disorders, including liver dysfunction. Previous studies have demonstrated that HTLV-1 infection can alter lipid profiles, yet no research has examined lipid indices and liver function tests in these patients in the long term. Methods This data is part of the Mashhad stroke and heart atherosclerotic disorder (MASHAD) study. A total of 1116 participants were randomly selected, including 837 healthy individuals and 279 HTLV-1-infected patients. Following a 10-year follow-up period, Serum levels of liver enzymes were measured. Lipid indices such as the Atherogenic Index of Plasma (AIP), Body Adiposity Index (BAC), Castelli risk index (CRI-I, CRI-II), Lipid Accumulation Product (LAP), Visceral Adiposity Index (VAI), Triglyceride-glucose index (TyG), and Triglyceride and HDL-C Ratio (THR) were calculated. Results Multivariable-adjusted regression analysis demonstrated a significant coefficient for the Visceral Adiposity Index (VAI) in HTLV-infected patients compared to healthy controls (B: -0.014, 95% CI: -0.02, 0.00, p = 0.046). However, no significant differences were observed in other lipid indices between HTLV-infected patients and healthy individuals. Regarding liver enzymes, significant variations were noted in HTLV-infected patients compared to healthy controls: Aspartate Aminotransferase (AST) (B: 2.978, 95% CI: 1.34, 4.61, p

Abstract Gas stations distributed around densely populated areas are responsible for toxic pollutant emissions such as volatile organic compounds (VOCs). This study aims to measure VOCs emission from three different kinds of gas stations to determine the extent of pollution from the gas stations and the most frequent type of VOC compound emitted. The concentrations of ambient VOCs at three refueling stations with a different type of fuels in Mashhad were monitored. The result of this study showed that CNG fuel stations are less polluting than petrol stations. In all the studied sites, the highest concentrations were related to xylene isomers, irrespective of the fuel type. Total VOCs at the supply of both compressed natural gas (CNG) and gasoline stations was 482.36 ± 563.45 µg m−3. At a CNG station and a gasoline station, total VOC concentrations were 1363.4 ± 1975 µg m−3 and 410.29 ± 483.37 µg m−3, respectively. The differences in concentrations of toluene and m,p-xylene between the fuel stations can be related to the quality and type of fuel, vapor recovery technology, fuel reserves, dripless nozzles, traffic density in these stations, meteorological conditions and the location of sampling sites. The combination of a sine function and a quadratic function could model the fluctuation behavior of air pollutants like m,p-xylene. In all the sites, the highest concentrations were related to xylene isomers, irrespective of the type of fuel. The changing rate of m,p-xylene pollutant in each station was also modeled in this study.

Abstract We aimed to investigate the association between an empirical dietary index for hyperinsulinemia (EDIH), empirical dietary index for insulin resistance (EDIR), and MetS and its components in an adult Iranian population. In this cross‐sectional study, a total of 6482 participants aged 35–65 years were recruited as part of the MASHAD cohort study. Dietary intakes were assessed using a validated food frequency questionnaire (FFQ). The International Diabetes Federation (IDF) criteria were used to define MetS. Multivariable logistic regression models were applied to determine the association between EDIH, EDIR, and MetS and its components. The mean age and BMI of participants were 48.44±8.20 years, and 27.98±4.73 kg/m2, respectively. Around 59% of the population was female. Of the total population, 35.4% had MetS. According to the full‐adjusted model, there was no significant association between higher quartiles of EDIH and EDIR and odds of MetS (Q4 EDIH; OR (95%CI):0.93 (0.74‐1.18), Q4 EDIR; OR (95%CI):1.14 (0.92‐1.40). Regarding MetS components, EDIR was associated with increased odds of hypertension and diabetes (Q4 EDIR; OR (95%CI):1.22 (1.04‐1.44) and 1.22 (1.01‐1.47), respectively). EDIH was also associated with decreased odds of hypertriglyceridemia (Q4 EDIH; OR (95%CI): 0.72 (0.60‐0.87)). This study showed no significant association between hyperinsulinemia and insulin resistance potential of diet and odds of MetS among Iranian adults. However, EDIR was significantly associated with increased odds of hypertension and diabetes as MetS components.

Abstract Background Coronary artery disease (CAD) is known as the leading cause of disability and death globally. Anxiety disorders are also recognized as common types of mental disorders that substantially impact global health. Iran ranks among the countries with a high incidence of CAD and anxiety disorders. Therefore, the present study aims to determine the potential association and epidemiological aspects of anxiety and CAD within the population of Mashhad, the second most popoulos city in Iran. Methods The present study is based on extracted data from the Mashhad stroke and heart atherosclerotic disorder (MASHAD) study which is a 10-year prospective cohort study intended to assess the effects of various CAD risk factors among Mashhad city residents. Anxiety scores were assessed at the baseline using Beck Anxiety Inventory and individuals were classified based on the BAI 4-factor structure model which included autonomic, cognitive, panic, and neuromotor components. Accordingly, the association between baseline anxiety scores and the BAI four-factor model with the risk of CAD events was analyzed using SPSS software version 21. Results Based on the results, 60.4% of the sample were female, and 5.6% were classified as having severe forms of anxiety. Moreover, severe anxiety was more prevalent in females. Results showed a 1.7% risk of CAD (p-value

Abstract Background In Lupoid Leishmaniasis, erythematous to brown papules often occur around a central old scar, which can expand over time. For unclear reasons, these lesions tend to develop on the facial area. Objectives This study was conducted to study the distribution of Lupoid Leishmaniasis lesions on the face and compare them with those of acute leishmaniasis. Methods This case‐control study included 100 patients with the acute type of cutaneous leishmaniasis and Lupoid Leishmaniasis who were referred to the dermatology clinics of Ghaem and Emamreza hospitals. We recorded lesion morphology, demographic data and locations of lesions on the face. Results We enrolled 55 patients with acute leishmaniasis and 45 patients with Lupoid Leishmaniasis, with a mean age of 21.30 ± 20.71 years. There were no significant differences in age (p = 0.78), gender (p = 0.48), and the distribution of lesions on different anatomical areas (p = 0.22) between the two groups. In both groups, the involvement of the zygoma was significantly higher than in other areas on the face (p = 0.001). Conclusions Our study reveals that the anatomical location does not play a role in lesion evolving into Lupoid form.

Abstract Objectives Iran ranks among the top six countries globally with a significant incidence of Cutaneous Leishmaniasis (CL). Using planning models is one community-based intervention to promote preventive behaviors. The purpose of our study was to evaluate the effectiveness of the PRECEDE-PROCEED model (PPM) in modifying preventive behaviors related to CL in children through mother training in a community intervention. Methods A randomized controlled trial based on the PPM model was conducted on 168 mothers (intervention (n = 84) and control group (n = 84) with 10 years old children in the rural areas of Iran. Mothers from 7 village areas were randomly allocated to the intervention (2 village) and control groups (5 village). The intervention group received a program comprising eight 90-minute training sessions and environmental interventions. In this study, we utilized the PPM as a framework to design the questionnaires on Leishmaniosis prevention behavior. Participants in both groups completed the questionnaires at baseline (before the intervention), immediately after the intervention, and at the 2-month follow-up. Analysis of the data was conducted utilizing SPSS20, with statistical significance set at p 0.05) were observed in the alterations of the PPM construct, knowledge, and preventive behaviors within the control group from pre-intervention to follow-up. Conclusions Community (education and environmental) intervention based on PPM is feasible and acceptable to modify preventive behaviors of Cutaneous Leishmaniasis in children by increasing a mother’s knowledge and attitude as well as changing enabling and reinforcing factors. Trial registration IRCT20160619028529N8.

Background & aim: Dysmenorrhea is one of the main factors affecting the quality of life. This study aimed to determine the impact of rosemary and mefenamic acid capsules on the quality of life of students with primary dysmenorrhea.Methods: This double-blind clinical trial study was performed on 82 students with primary dysmenorrhea from June to september 2018 at the Faculty of Medicine of the Islamic Azad University of Mashhad. Students with moderate dysmenorrhea, after controlling two menstrual cycles by the convenience sampling method and using PASS software, were randomly assigned to the rosemary and mefenamic acid groups using double blocks. They consumed rosemary and mefenamic acid capsules every 8 hours for the first 3 days of intervention cycles. The SF-36 questionnaire was used to assess quality of life before and after the intervention at the end of menstrual bleeding. The data were analyzed using SPSS 24 and descriptive and interpretive statistical tests.Results: The mean score of physical health in the first cycle after the intervention increased by 300.07±62.43 and 306.00±66.11and in the second cycle after the intervention increased by 306.54±63.90and 308.63±64.14 (P=0.94). The mean score of mental health in the first cycle after the intervention increased by283.90±58.48 and 282.98±65.63 and in the second cycle after the intervention increased by 261.13 ±80.61and 258.94± 86.67 (P=0.90).Conclusion: Consumption of rosemary and mefenamic acid capsules improves the quality of life by increasing the scores of physical and mental health.

Background: Premature menopause (PM) is the cessation of ovarian function before age 40. PM women are more likelyto have cardiovascular diseases (CVDs), diabetes, and mental disorders. This is the first study that assessed the associationof single nucleotide polymorphisms (SNPs) with anti-heat shock protein 27 (Hsp27), High-sensitivity C-reactive protein(hs-CRP), and PM and serum pro-oxidant-antioxidant balance (PAB), as putative risk factors for CVDs. We aimed toexplore the association of oxidative stress markers with eight different SNPs shown to be related to premature menopause.Materials and Methods: In this cross-sectional research, we included 183 healthy women and 117 premature menopausalwomen. We determined baseline characteristics for all participants and measured serum hs-CRP, anti-HSP-27 antibody titer, and PAB levels using the established methods. Genotyping for eight SNPs was done usingthe tetra amplification refractory mutation system polymerase chain reaction (Tetra-ARMS PCR) and allele-specificoligonucleotide PCR (ASO-PCR) methods.Results: We found a significant difference between mean serum PAB levels and the genetic variant of rs16991615(P=0.03). ANCOVA showed a significant effect of the genotypes rs4806660 and rs10183486 on hs-CRP serum levelsin the case and control groups, respectively (P=0.04 and P=0.007). ANCOVA also showed an association betweenrs244715 genotypes and anti-hsp27 serum levels in the case group (P=0.02). There was a significant effect of thegenotypes of rs451417 on the serum hs-CRP level in the control group (P=0.03).Conclusion: There was a significant association of the genetic variants related to PM with oxidative stress and inflammatorymarkers (serum PAB, anti-hsp27 antibody, and hs-CRP). Accordingly, this seems to be an effective approach topredicting susceptible subjects for cardiovascular and mental disorders as well as various cancers.

Abstract The pain associated with chest tube removal (CTR) is one of the significant complications of cardiac surgery. The management of this pain is recognized as a vital component of nursing care. The application of distraction techniques using virtual reality (VR) is an effective and straightforward non-pharmacological approach to alleviate pain. This study aimed to determine the impact of VR technology on the management of pain caused by CTR following coronary artery bypass grafting (CABG). This randomized clinical trial was conducted on 70 patients undergoing CABG at Imam Reza and Qaem hospitals in Mashhad, Iran, in 2020. The patients were randomly divided into two groups of 35. For the intervention group, a 360-degree video was played using VR glasses 5 min before the CTR procedure. The pain intensity was measured before, immediately after, and 15 min after CTR, using the Visual Analogue Scale. Also, the Depression Anxiety and Stress Scale-21 (DASS-21), and the Rhoten Fatigue Scale (RFS) were used to evaluate intervention and control groups before the CTR procedure. The collected data was analyzed using statistical tests, such as Chi-square, independent t-test, and Mann–Whitney test. The patients were homogeneous in terms of stress, anxiety, and fatigue levels before CTR, and they did not show any significant differences (P > 0.05). The average pain intensity score of patients in the intervention group significantly decreased immediately and 15 min after CTR, compared to the control group (P

Vitamin D deficiency is a worldwide condition, which has been linked to a variety of health-related issues. Vitamin D can be beneficial to cardiovascular patients and those suffering from depression and anxiety, based on Survey of Ultraviolet Intake by Nutritional Approach (SUVINA study), ,showing the potential effects of vitamin D-fortified dairy products on anxiety, depression, and stress in subjects with cardiovascular disease (CVD) risk factors. Methods: It was a quadruple-blind randomized controlled trial. Individuals were randomly allocated to one of four groups: fortified low-fat milk (FM), non-fortified low-fat milk (NFM), fortified low-fat yogurt (FY), and non-fortified low-fat yogurt (NFY). FM and FY groups were fortified with 1500 IU nano-encapsulated vitamin D3. Anthropometric parameters as well as depression, anxiety, and stress scores were measured at baseline and after a ten-week trial in Mashhad, Iran. Results: Totally, 289 participants (143 men, 146 women) with a mean age of 41.86±7.81years were enrolled in the study. There was no statistical difference between the scores of depression, anxiety, and stress in participants with and without CVD risk factors (P>0.05). No statistical difference was found in the subgroup analysis based on milk and yogurt consumption. Conclusions: Fortified low-fat milk containing 1,500 IU of vitamin D has no impact on improving depression, anxiety, and stress during ten weeks. However, further studies with higher vitamin D doses for a longer duration are recommended.

Abstract Background The aim was to establish a 10-year dyslipidemia incidence model, investigating novel anthropometric indices using exploratory regression and data mining. Methods This data mining study was conducted on people who were diagnosed with dyslipidemia in phase 2 (n = 1097) of the Mashhad Stroke and Heart Atherosclerotic Disorder (MASHAD) study, who were compared with healthy people in this phase (n = 679). The association of dyslipidemia with several novel anthropometric indices including Conicity Index (C-Index), Body Roundness Index (BRI), Visceral Adiposity Index (VAI), Lipid Accumulation Product (LAP), Abdominal Volume Index (AVI), Weight-Adjusted-Waist Index (WWI), A Body Shape Index (ABSI), Body Mass Index (BMI), Body Adiposity Index (BAI) and Body Surface Area (BSA) was evaluated. Logistic Regression (LR) and Decision Tree (DT) analysis were utilized to evaluate the association. The accuracy, sensitivity, and specificity of DT were assessed through the performance of a Receiver Operating Characteristic (ROC) curve using R software. Results A total of 1776 subjects without dyslipidemia during phase 1 were followed up in phase 2 and enrolled into the current study. The AUC of models A and B were 0.69 and 0.63 among subjects with dyslipidemia, respectively. VAI has been identified as a significant predictor of dyslipidemias (OR: 2.81, (95% CI: 2.07, 3.81)) in all models. Moreover, the DT showed that VAI followed by BMI and LAP were the most critical variables in predicting dyslipidemia incidence. Conclusions Based on the results, model A had an acceptable performance for predicting 10 years of dyslipidemia incidence. Furthermore, the VAI, BMI, and LAP were the principal anthropometric factors for predicting dyslipidemia incidence by LR and DT models.

Abstract Background Type 2 Diabetes Mellitus (T2DM) has become a major health concern with an increasing prevalence and is now one of the leading attributable causes of death globally. T2DM and cardiovascular disease are strongly associated and T2DM is an important independent risk factor for ischemic heart disease. T-wave abnormalities (TWA) on electrocardiogram (ECG) can indicate several pathologies including ischemia. In this study, we aimed to investigate the association between T2DM and T-wave changes using the Minnesota coding system. Methods A cross-sectional study was conducted on the MASHAD cohort study population. All participants of the cohort population were enrolled in the study. 12-lead ECG and Minnesota coding system (codes 5–1 to 5–4) were utilized for T-wave observation and interpretation. Regression models were used for the final evaluation with a level of significance being considered at p 0.05). Hypertension, age, and body mass index were significantly associated with T2DM (p

Abstract Background Intensive care unit (ICU) patients often experience significant physiological stress. This study evaluated the effect of a defined family visitation protocol on physiological responses in the ICU. Methods A randomized, block-randomized clinical trial was conducted on 78 ICU patients at Imam Reza Hospital between February 8, 2017, and August 8, 2017. The intervention group received protocol-based visits, and the control group continued with standard visitation. Block randomization was utilized for group assignments. The primary outcome was the measurement of physiological signs using designated monitoring devices. Data were analyzed using SPSS version 22, employing independent t-tests, Mann-Whitney U test, repeated measures analysis, and Friedman’s test. Results The results showed no significant differences in systolic blood pressure, diastolic blood pressure, mean arterial pressure, respiratory rate, and arterial blood oxygen levels between the two groups. However, heart rate in the intervention group was significantly lower in three stages before, during, and after the meaningful visiting (P = 0.008). Conclusion Protocol-based scheduled family visits in the ICU may reduce physiological stress, as evidenced by a decrease in patients’ heart rate. Implementing tailored visitation protocols sensitive to patient preferences and clinical contexts is advisable, suggesting the integration of family visits into standard care practices for enhanced patient outcomes. Trial Registration IRCT20161229031654N2; 25/01/2018; Iranian Registry of Clinical Trials ( https://en.irct.ir ).

Abstract Objective This study evaluates the efficacy of a novel mucoadhesive patch containing Nigella sativa 10% extract compared to triamcinolone 0.1% in alleviating symptoms and reducing lesion severity in patients with erosive‐atrophic oral lichen planus. Methods and Materials A pilot study comprising two groups, each with 10 patients, was conducted. The intervention group received mucoadhesive patches containing N. sativa 10% extract, while the control group received triamcinolone acetonide 0.1% patches. Pain and burning intensity, measured through visual analog scale, and lesion severity based on the Thongprasom scale were assessed weekly for 4 weeks. Descriptive records were kept for side effects and patient satisfaction. Results Pain and burning intensity decreased in both groups throughout the sessions, with the N. sativa group showing a greater reduction than the triamcinolone group. The reduction in burning intensity within each group was significant (p .05). Lesion severity also decreased significantly in both groups (p

ABSTRACT Objective We aimed to compare the association of three novel inflammatory indicators with metabolic syndrome (MetS) among Mashhad stroke and heart atherosclerotic disorder (MASHAD) cohort participants. Methods According to the International Diabetes Federation (IDF) criteria, the cohort participants were divided into the MetS(+) and MetS(−) groups. The lymphocyte to high‐density lipoprotein cholesterol (HDL‐C) ratio (LHR), high‐sensitivity C‐reactive protein (hs‐CRP) to HDL‐C ratio (HCHR) and hs‐CRP to lymphocyte ratio (HCLR) were calculated and were compared between the groups. Binary logistic regression (LR) analysis was performed to find the association of the indices with the presence of MetS among men and women. Receiver‐operating characteristic (ROC) curve analysis was used to establish cut‐off values in predicting MetS for men and women. p‐Values

Abstract Background Loss‐of‐function (LOF) variants of the angiopoietin‐like 3 (ANGPTL3) gene are reported to be associated with serum triglyceride (TG) and high‐density lipoprotein cholesterol (HDL‐C) concentrations and thereby affect the risk of cardiovascular disease (CVD). Objective In the present study, we examined the association of rs10789117 in the ANGPTL 3 gene locus and the risk of CVD in the group of people who were part of the Mashhad‐Stroke and Heart‐Atherosclerotic‐Disorders (MASHAD) cohort. Methods One thousand and two healthy individuals enrolled in this study of whom 849 subjects were healthy and 153 subjects developed CVD outcomes after 6 years of follow‐up. After a 12‐h overnight fasting, 20 mL of blood samples were collected for the measurement of fasting blood glucose and lipid profile. DNA was extracted, and the Tetra‐ARMS PCR (amplification refractory mutation system) was used for genotyping of rs10789117 in the ANGPTL3 gene. The genotype frequencies of the variant of rs10789117 in the ANGPTL3 gene were estimated using χ2 tests. Eventually, the statistical analysis was done by SPSS version 20. Results Individuals with AC/CC genotypes (rs10789117) were found to have to greater risk of CVD events compared to AA genotype (OR = 1.43, 95%CI = 1.01–2.02, p = 0.041). There was a 1.3‐fold increase in cardiovascular events in individuals carrying the C allele of rs10789117 variant compared to non‐carriers (OR = 1.32, 95%CI = 1.06–1.72, p value = 0.038). There were significant differences between different genotypes for serum triglyceride levels within the control group, but this difference was not significant in the group with CVD. Moreover, there was a significant association between CC genotype and CVD risk in the individuals with a normal serum HDL‐C. Conclusion We have found that a rs10789117 C>A in ANGPTL3 gene polymorphism was associated with incident CVD events, and this may be of value as a risk stratification biomarker in CVD in the Iranian population.

Abstract Background and aim Coronavirus disease (COVID-19) is an infectious disease that can spread very rapidly with important public health impacts. The prediction of the important factors related to the patient's infectious diseases is helpful to health care workers. The aim of this research was to select the critical feature of the relationship between demographic, biochemical, and hematological characteristics, in patients with and without COVID-19 infection. Method A total of 13,170 participants in the age range of 35–65 years were recruited. Decision Tree (DT), Logistic Regression (LR), and Bootstrap Forest (BF) techniques were fitted into data. Three models were considered in this study, in model I, the biochemical features, in model II, the hematological features, and in model II, both biochemical and homological features were studied. Results In Model I, the BF, DT, and LR algorithms identified creatine phosphokinase (CPK), blood urea nitrogen (BUN), fasting blood glucose (FBG), total bilirubin, body mass index (BMI), sex, and age, as important predictors for COVID-19. In Model II, our BF, DT, and LR algorithms identified BMI, sex, mean platelet volume (MPV), and age as important predictors. In Model III, our BF, DT, and LR algorithms identified CPK, BMI, MPV, BUN, FBG, sex, creatinine (Cr), age, and total bilirubin as important predictors. Conclusion The proposed BF, DT, and LR models appear to be able to predict and classify infected and non-infected people based on CPK, BUN, BMI, MPV, FBG, Sex, Cr, and Age which had a high association with COVID-19.

Introduction: Cardiovascular disease (CVD) is the leading cause of mortality and one of the main challenges for health systems worldwide. In this study, we aimed to evaluate the association of socio-demographic, lifestyle, psychological and anthropometric factors and underlying diseases such as hypertension (HTN), diabetes mellitus (DM) and metabolic syndrome (MS) with CVD risk among a subpopulation of Iranian adults.Methods: In this prospective study, a total of 235 CVD patients along with 8405 healthy and non-symptomatic individuals who participated in MASHAD cohort study were enrolled. CVD diagnosis was performed by taking electrocardiogram (ECG) and medical history and performing physical examination for each participant. Health and lifestyle questionnaires, the Beck’s anxiety inventory (BAI), Beck’s depression inventory (BDI) and the James and Schofield human energy requirements equations were completed for all participants. Anthropometric measurements were also recorded for all subjects. All statistical analyses including chi-square and student independent T-test were performed using SPSS 16.0 software (SPSS Inc., Chicago, IL, USA) at a significant level of 0.05.Results: We found that there were significant associations between CVD risk and age, body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), diabetes mellitus (DM) and family history (FH) of CVD in both genders; though, there was a significant negative correlation between physical activity level (PAL) and risk of CVD among men and women. Also hypertension (HTN), metabolic syndrome (MS), depression and anxiety were positively and higher education level was negatively associated with CVD events only in females. While, waist-to-hip ratio (WHR) was an independent predictor of CVD among males (P-value< 0.05).Conclusion: There are several modifiable and non-modifiable risk factors that are independently considered as CVD predictors among the MASHAD study population. It is recommended to prioritize the lifestyle modification, development of local risk calculators and gender-related stratified strategies in order to prevent and manage CVD among the Iranian population.

Abstract Colorectal cancer (CRC) involves epigenetic alterations. Irregular gene-methylation alteration causes and advances CRC tumor growth. Detecting differentially methylated genes (DMGs) in CRC and patient survival time paves the way to early cancer detection and prognosis. However, CRC data including survival times are heterogeneous. Almost all studies tend to ignore the heterogeneity of DMG effects on survival. To this end, we utilized a sparse estimation method in the finite mixture of accelerated failure time (AFT) regression models to capture such heterogeneity. We analyzed a dataset of CRC and normal colon tissues and identified 3406 DMGs. Analysis of overlapped DMGs with several Gene Expression Omnibus datasets led to 917 hypo- and 654 hyper-methylated DMGs. CRC pathways were revealed via gene ontology enrichment. Hub genes were selected based on Protein–Protein-Interaction network including SEMA7A, GATA4, LHX2, SOST, and CTLA4, regulating the Wnt signaling pathway. The relationship between identified DMGs/hub genes and patient survival time uncovered a two-component mixture of AFT regression model. The genes NMNAT2, ZFP42, NPAS2, MYLK3, NUDT13, KIRREL3, and FKBP6 and hub genes SOST, NFATC1, and TLE4 were associated with survival time in the most aggressive form of the disease that can serve as potential diagnostic targets for early CRC detection.

Abstract 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.

Introduction: Serum vitamin D levels are related to a wide spectrum of factors including low sunlight exposure, high oxidative stress, low physical activity and sleep disorders. In this paper we are going to investigate the most crucial parameters associated with serum vitamin D levels in survey of ultraviolet intake by nutritional approach (SUVINA) study with a data mining approach.Material and Methods: Data including demographic, anthropometric, clinical and laboratory information were extracted from the SUVINA dataset comprising 289 subjects who were enrolled into our study. The XGBoost algorithm was used to define the most important features related to vitamin D level in our population.Results: Applying XGBoost modeling for vitamin D level showed that the presented scheme can determine the most important determinants of serum vitamin D level with an accuracy of 91%. Pro-oxidant anti-oxidant balance (PAB), body fat percentage, physical activity level (PAL), age, restless leg syndrome (RLS), and dietary inflammatory index (DII) density were the most important variables correlated with vitamin D deficiency.Conclusion: Using XGBoost and with an accuracy of more than 90%, we showed that the six most important risk factors for vitamin D deficiency are PAB, PAL, age, body fat percentage, RLS and DII density, respectively.

Abstract Previous studies have proposed that heat shock proteins 27 (HSP27) and its anti-HSP27 antibody titers may play a crucial role in several diseases including cardiovascular disease. However, available studies has been used simple analytical methods. This study aimed to determine the factors that associate serum anti-HSP27 antibody titers using ensemble machine learning methods and to demonstrate the magnitude and direction of the predictors using PFI and SHAP methods. The study employed Python 3 to apply various machine learning models, including LightGBM, CatBoost, XGBoost, AdaBoost, SVR, MLP, and MLR. The best models were selected using model evaluation metrics during the K-Fold cross-validation strategy. The LightGBM model (with RMSE: 0.1900 ± 0.0124; MAE: 0.1471 ± 0.0044; MAPE: 0.8027 ± 0.064 as the mean ± sd) and the SHAP method revealed that several factors, including pro-oxidant-antioxidant balance (PAB), physical activity level (PAL), platelet distribution width, mid-upper arm circumference, systolic blood pressure, age, red cell distribution width, waist-to-hip ratio, neutrophils to lymphocytes ratio, platelet count, serum glucose, serum cholesterol, red blood cells were associated with anti-HSP27, respectively. The study found that PAB and PAL were strongly associated with serum anti-HSP27 antibody titers, indicating a direct and indirect relationship, respectively. These findings can help improve our understanding of the factors that determine anti-HSP27 antibody titers and their potential role in disease development.

Introduction: Metabolic syndrome (MetS) is comprised of a clustering of various cardiovascular risk factors that can also affect bone health. We aimed the associations between MetS and bone mineral density (BMD) and trabecular bone score (TBS) in subjects with abdominal adiposity.Methods: Individuals with body mass index less than 25 kg/m2 were enrolled from the SUVINA study and allocated into two groups according criteria of IDF for metabolic syndrome. TBS T-score and Z/T score of fore skeletal region were measured using dual-energy X-ray absorptiometry (DXA). SPSS software was used for statistical analysis and p value 0

Introduction: Depression, anxiety, and stress have been shown to be associated with quality of life and sleep quality. This association did not examine separately in men and women. In the present study, we aim to examine the association between depression, anxiety and stress with RLS, Epworth, insomnia, apnea, PSIQ and QoL by gender in Mashhad-study data.Methods: A total of 289 individuals (143 male and 146 female) aged 30-50 years old who completed the SUVINA study. They completed the Epworth sleepiness scale (ESS), Pittsburg sleep quality index (PSQI) and quality of life (QoL). For statistical analysis, SPSS software was used for data analysis and p value 0

Abstract Background Different dietary protein sources are supposed to have various effects on metabolic responses and arterial stiffness in the postprandial period. This study aims to assess the postprandial effects of dietary protein sources, including animal-based protein (AP) and plant-based protein (PP), as part of a high-protein breakfast on appetite response, energy metabolism, and arterial stiffness in overweight and obese men. Methods This acute randomized crossover clinical trial will be conducted at the Persian study research center at Imam Reza Hospital, affiliated with the Mashhad University of Medical Sciences, located in the northeast of Iran. Forty-six healthy overweight, and obese men aged 18–60 years will be enrolled based on the eligibility criteria. The subjects will complete two interventions (high-protein AP and PP meals) with 1 week washout period. The primary outcome will be the acute effect of the two test meals on appetite response, energy metabolism parameters, including resting metabolism rate (RMR), diet-induced thermogenesis (DIT), and substrate oxidation (SO), and arterial stiffness indices, including pulse wave velocity (PWV) and pulse wave analysis (PWA). The secondary outcomes include changes in lipemia, glycemia, and insulinemia. Discussion The findings of this study will provide novel insight regarding the acute effects of different protein sources on energy metabolism, appetite, and arterial stiffness as a significant cardiovascular disease (CVD) risk factor. It will help dieticians develop effective and efficient meal plans to improve weight reduction and maintenance in overweight/obese individuals. Trial registration Iranian Registry of Clinical Trials; code: IRCT20211230053570N1; registered on February 10, 2022

Introduction: The Coronavirus Disease 2019 (COVID-19) outbreak is still an ongoing problem affecting people’s well-being globally. It is known that malnutrition is an important determinant of immune function, leading to an increased risk of infection and severity of diseases. The aim of this study was to characterize the relationship between macronutrients and micronutrients and this viral infection.Methods: This study was a historical cohort including 6539 subjects (57.2% females, 42.8% males) from the Mashhad stroke and heart atherosclerotic disorder (MASHAD) cohort study. Dietary intakes were assessed using a 65-item validated food frequency questionnaire (FFQ). Data on COVID-19 diagnosis was collected from online health records of patients available in the Sina health information system from the onset of the disease to the end of July 2020. COVID-19 diagnosis has been confirmed using a lung spiral CT scan or PCR laboratory test. SPSS software (Version 20) was usedfor the analysis of data. .Results: A total of 154 subjects including 85 men (55.2%) and women (44.8%) were infected with COVID-19. Body mass index (p=0.03) and waist circumference (p=0.01) of the patients along with the protein (p=0.02), total N2 (p=0.02), calcium (p=0.02) and thiamin (p=0.04) content of their diet was significantly associated with COVID-19. After multivariate analysis, dietary calcium remained the only dietary factor that predicted COVID-19 infection (OR=0.94, 95%CI [0.87-0.99], p value=0.04).Conclusion: Our findings indicated that prevalence of COVID-19 may be affected by dietary macronutrients and micronutrients. According to our data, increased calcium intake can reduce the prevalence of COVID-19.

Introduction : It has been shown that angioplasty and endovascular stent deployment, used after coronary revascularization, are associated with an inflammatory response. Inflammation has a key role in the complications of atherosclerotic plaque, coronary artery disease (CAD) and in-stent restenosis (ISR). The objectives of the present study was to investigate serum levels of 12 pro/anti-cytokines and growth factors and their relationship with restenosis.Methods: A total of 244 subjects were recruited in current study including unrelated patients who previously underwent coronary stent implantation (between 2014 and 2017) and were subsequently indicated for coronary angiography. According to angiography results patients were allocated into two groups: cases with stenosis more than 50% within the stent (N=79) and controls with stenosis less than 50% within the stent (N=165). Serum was separated by centrifuging the blood for 15 min at 1000 rpm. Serum cytokines levels including IL-1α, IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, TNF-α, IFN-γ, MCP-1, EGF, and VEGF were measured using an EV 3513 cytokine biochip array (Randox Laboratories, Crumlin, UK).Results: The mean age of the NISR and ISR groups were 62.47±9.2 and 59.49±8.48 years, respectively. The diabetes frequency was significantly higher in the ISR group (55.1%) compared with NISR group (30.9%) (p0.05).Conclusions: The results showed that serum levels of pro/anti-inflammatory cytokines and growth factors did not have a significant difference between NISR and ISR study groups.

Abstract Background and objective Corona virus causes respiratory tract infections in mammals. The latest type of Severe Acute Respiratory Syndrome Corona-viruses 2 (SARS-CoV-2), Corona virus spread in humans in December 2019 in Wuhan, China. The purpose of this study was to investigate the relationship between type 2 diabetes mellitus (T2DM), and their biochemical and hematological factors with the level of infection with COVID-19 to improve the treatment and management of the disease. Material and method This study was conducted on a population of 13,170 including 5780 subjects with SARS-COV-2 and 7390 subjects without SARS-COV-2, in the age range of 35–65 years. Also, the associations between biochemical factors, hematological factors, physical activity level (PAL), age, sex, and smoking status were investigated with the COVID-19 infection. Result Data mining techniques such as logistic regression (LR) and decision tree (DT) algorithms were used to analyze the data. The results using the LR model showed that in biochemical factors (Model I) creatine phosphokinase (CPK) (OR: 1.006 CI 95% (1.006,1.007)), blood urea nitrogen (BUN) (OR: 1.039 CI 95% (1.033, 1.047)) and in hematological factors (Model II) mean platelet volume (MVP) (OR: 1.546 CI 95% (1.470, 1.628)) were significant factors associated with COVID-19 infection. Using the DT model, CPK, BUN, and MPV were the most important variables. Also, after adjustment for confounding factors, subjects with T2DM had higher risk for COVID-19 infection. Conclusion There was a significant association between CPK, BUN, MPV and T2DM with COVID-19 infection and T2DM appears to be important in the development of COVID-19 infection.

Abstract Background Labor pain is complex, paradoxical and varied in every parturient woman. Management of labor pain has been a crucial component in maternity care. Heat therapy is one of the proposed method for labor pain relief. Infrared is one of the methods of heat therapy but there is any study in this regard. This study aimed to compare the effect of the infrared belt and hot water bag on the severity of pain in the first stage of labor among primiparous women. Methods In this clinical trial in the first stage of labor, 20-min cycles of heat therapy were conducted at the dilations of 4–5 and 6–7 cm in the intervention group 1 by an infrared belt and in the intervention group 2 by hot water bag, respectively. The control group received routine care. The severity of the pain was measured by the short-form McGill Pain Questionnaire. Results In total, 136 women consented to participate in this clinical trial study. The mean score of pain intensity was significantly lower in the two intervention groups compared to the control group (P

Abstract Introduction We investigated the association of serum uric acid to high‐density lipoprotein ratio (UHR) with the presence and severity of metabolic syndrome (MetS) among MASHAD cohort participants. Methods In this cross‐sectional study, according to International Diabetes Federation criteria, the cohort participants were divided into MetS (+) and MetS (−) groups. MetS (+) were classified into Group 1 (those with 3 MetS criteria), Group 2 (those with 4 MetS criteria) and Group 3 (those with 5 MetS criteria). UHR was compared among the groups. Results Data related to 9637 subjects including 3824 MetS (+) and 5813 MetS (−) were analysed. The mean UHR was significantly higher (p

Abstract Background Twelve‐lead electrocardiogram (ECG) is a common and inexpensive tool for the diagnostic workup of patients with suspected cardiovascular disease, both in clinical and epidemiological settings. The present study was designed to evaluate ECG abnormalities in Mashhad population. Methods ECGs were taken as part of MASHAD cohort study (phase1) and were coded according to the Minnesota coding criteria. Data were analyzed using SPSS. Results Total 9035 ECGs were available for final analysis including 3615 (40.0%) male and 5420 (60.0%) female. Among ECG abnormalities precordial Q wave, major T‐wave abnormalities, inferior Q wave, sinus bradycardia, and left axis deviation were the most prevalent abnormalities. The frequency of precordial and inferior Q wave, inferior QS pattern, major and minor ST abnormalities, major and minor T abnormalities, Wolff‐Parkinson‐White and Brugada pattern, sinus bradycardia, sinus tachycardia, left axis deviation, ST elevation, and tall T wave were significantly different between two genders. Moreover, the frequency of Q wave in precordial and aVL leads, QS pattern in precordial and inferior leads, major and minor T‐wave abnormalities, Wolff‐Parkinson‐White, atrial fibrillation, sinus bradycardia, left axis deviation, and ST elevation were significantly different in different age groups. A comparison of the heart rate, P‐wave duration, and QRS duration between men and women indicated that there was a significant difference. Conclusions Our finding indicated that the prevalence ECG abnormalities are different between men and women and also it varied in different age groups.

Abstract Chronic shortened sleep can increase several cardiovascular risk factors, including depression, anxiety, metabolic syndrome, diabetes and hypertension. In the current study, we aimed to investigate the relationship between sleep patterns and the incidence of coronary heart disease (CHD). A total of 9704 healthy participants were recruited for the MASHAD cohort study. Within 6 years of follow-up, participants were categorized into four groups based on their number of hours of nightly sleep. Cox’s proportional hazard model was used to assess relative risks (RRs) and 95% confidence intervals (CIs). During the study, 235 heart problems, including myocardial infarction, stable angina and unstable angina, were confirmed. There were significant differences between men and women who had short and long nightly sleep (p

Background: The relation between long-term dietary intake and diseases is well known. There are several methods to determine long-term dietary intake. The food frequency questionnaire (FFQ) is used in studies to assess habitual dietary intake over a long term period. Dietary intake varies according to cultural differences, so an FFQ must be designed and validated for the target population. This protocol study aims to explain the development and validation of a semi-quantitative FFQ for the Iranian population that includes mixed dishes and single food items. Methods: The initial list of food items were extracted from interviews and expert opinion. An expert panel of ten nutritionists calculated the content validity ratio (CVR) and content validity index (CVI) of food items to finalize the FFQ. One hundred twenty eligible participants were included in the study. They completed the FFQ two times, with a ten month interval. They recorded their food intake for three days in the 2nd and 10th months of the study. In the 4th and 10th months, serum retinol and alpha-tocopherol, and 24-hour urinary potassium and nitrogen were measured. Result: Covering typical Iranian mixed dishes is the main advantage of this study. Given that the questionnaire is valid and reproducible, it can be used in epidemiologic studies. Conclusion: The current study developed a dish-based Iranian FFQ based on mixed food.

Abstract Background Metabolic syndrome (Mets) is a common metabolic disorder in which hypoadiponectinemia is one of the consequences for the body caused by inflammation, and vitamin D may help improve inflammatory symptoms. LncRNAs (long non-coding RNA) play several different regulatory roles in the body. The goal of this study was to see how adding vitamin D to milk affected the levels of adiponectin and inflammatory lncRNAs in the serum of people with Mets. Methods This clinical trial was conducted on staff and students between the ages of 30 and 50 at Mashhad University of Medical Sciences and met the International Diabetes Federation’s criteria for Mets. Eighty-two Mets were assigned randomly to one of two groups for ten weeks: fortified milk (FM) with 1500 IU vitamin D or non-fortified milk (NFM). Total RNA was extracted from both frozen clinical samples using Trizol reagent. APQ AS and MALAT1 lncRNA gene expression were measured by Real-Time PCR. Results Serum adiponectin levels in the FM group increased significantly compared to the NFM group (p = 0.01). Also, the expression of APQ AS and MALAT1 genes decreased after ten weeks, which showed a significant decrease in APQ AS (p = 0.036). Conclusion As in FM, vitamin D may have anti-inflammatory effects and increase adiponectin levels in people with Mets via decreasing APQ AS gene expression.

Abstract 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.

Background: The importance of dietary pattern and vitamins in the incidence of cancers has been demonstrated in many studies. As there are cultural differences and various dietary patterns in different countries, the results of other studies are not necessarily applicable to our society. This study aimed to evaluate the role of some vitamins and dietary patterns in developing head and neck cancer.Methods: Dietary pattern and serum levels of vitamins in 39 patients with head and neck squamous cell carcinoma (HNSCC) were compared to 37 healthy individuals. A native questionnaire was used to obtain the dietary pattern. The existence of a significant relationship between serum levels of vitamins and dietary pattern with the risk of HNSCC was assessed. The independent t test, chi-square and exact Fisher’s test were employed for statistical analysis.Results: The mean serum levels of these vitamins in the case group were significantly lower as compared to the control subjects (P < 0.005). Two dominant eating patterns were identified, and after adjusting for confounding factors such as age, education, physical activity, body mass index (BMI), and place of residence, it was found that people with unhealthy dietary patterns were 6.55 times more likely to develop cancer than people with a healthy diet.Conclusion: Lower serum levels of vitamins C and E are associated with an increased risk of HNSCC. Unhealthy dietary patterns also increase the risk of developing this cancer.

Introduction: For interpretation of the most common biochemical markers reference intervals (RIs) are widely considered and reported. Therefore, in this study, we aimed to determine age-specific RIs for some biochemical tests by removing and/or limiting critical gaps including sex, age group, geographical region, measurement device, and type of kits and reagents for routine laboratory biochemical variables in healthy adolescent girls aged 12-19 years.Materials and Methods: In this cross-sectional study a total of 1026 adolescent girl was recruited. According to the study aim, the levels of serum for some routine biochemical tests were measured on a BT-3000 auto-analyzer. On the basis of the non-parametric rank method and by use of CLSI Ep28-A3 guidelines, we determined age-specific RIs, including confidence interval 90%, under specific exclusion criteria.Results: Age partitioning was required for none of the upper and lower limits of biochemical markers. All Serum biochemical tests concentration remained relatively constant throughout the age range. Conclusion: By removing and/or limiting critical gaps involved in reference values of biochemical tests, it has provided an important understanding of metabolic processes and it has facilitated clinical application to track different diseases better

Background & aim: Changing lifestyle before pregnancy is necessary to avoid the consequences of obesity in pregnancy. This study was performed to investigate the effect of training based on extended parallel process model (EPPM) on the weight of women with high body mass index before pregnancy. Methods: In this two-group cluster randomized trial, 60 eligible women participated. Experimental and control groups were randomly selected from two comprehensive healthcare centers in Mashhad, Iran. Data collection tools included a questionnaire based on the constructs of the extended parallel process model and Baecke Physical Activity Questionnaire. The experimental group received the national nutrition guidelines based on EPPM constructs including threat as well as efficacy and the control group received the same content in a routine way. Participants' weight was measured before, two and four weeks after the intervention.Results: The two groups were homogeneous in terms of demographic and obstetric characteristics. The mean changes of construct of threat before, two and four weeks after the intervention in the experimental group compared to the control increased by 4.84 and 3.59 times, respectively, which was statistically significant (P

Objectives: Sleep is a conserved vital behavior in humans, and insufficient sleep is associated with several disorders. Recent studies have investigated the association of sleep duration, oxidative stress markers, anxiety, and depression. Therefore, we aim to assess the relationship between sleep duration, serum pro-oxidant/antioxidant balance (PAB) and superoxide dismutase 1 (SOD1) levels as markers of oxidative stress, anxiety, and depression.Methods: Participants included in our cross-sectional analysis were recruited as part of the MASHAD study (n = 9,184). Nocturnal sleep duration was identified using a self-reported questionnaire, and serum pro-oxidant/antioxidant balance (PAB) and superoxide dismutase 1 (SOD1) levels were assessed using methods that have been previously reported.Results: Serum PAB, depression, and anxiety scores were found significantly higher in subjects with very short sleep duration. In an adjusted model using MANOVA regression analysis, serum PAB was significantly higher in the subjects with a very short sleep duration (p: 0.016 in depression and p: 0.002 in anxiety).Conclusion: The present cross-sectional study demonstrates a relationship between sleep duration, oxidative balance, and depression/anxiety, especially in anxiety subjects that might predict each other.

Abstract Background and Aims The fatty acid‐binding proteins (FABPs) gene polymorphisms are related to several metabolic properties. We investigated the association of SNPs rs2241883 of FABP 1 gene with obesity to evaluate the role of FABP1 gene in the pathogenesis of obesity in the population of MASHAD study cohort. Methods In this cross‐sectional study, 2731 individuals (1883 Obese and 848 nonobese) aged 35 to 65 years old, were enrolled from the Mashhad Stroke and Heart Atherosclerotic Disorder (MASHAD) study cohort. DNA Quantitation was determined using the NanoDrop®‐1000 instrument (NanoDrop‐Technologies). The rs2241883 polymorphisms were genotyped by double ARMs PCR (double amplification refractory mutation system) reactions. Data analysis was carried out using SPSS 22 and a p

Previous studies have shown that the health burden associated with vitamin D deficiency is increasing globally. Vitamin D supplementation appears to be a feasible strategy for improving vitamin D status within populations. Little information is available on the perception and barriers to the widespread application of vitamin D supplements in Iran. Therefore, this study was conducted to explore the perception of health care providers regarding the implementation of vitamin D supplementation program in the Iranian cities of Mashhad, Qom and Zahedan.This qualitative conventional content analysis study was conducted at 3 medical universities in Iran: Mashhad (MUMS), Qom (QUMS) and Zahedan (ZAUMS) University of Medical Sciences. These universities, are within regions with differing prevalence of vitamin D deficiency, and were selected based on the results of National Integrated Micronutrient Survey 2012 (NIMS-II study). Individual semi-structured in-depth interviews were performed with 103 participants (consisting of health professionals and health providers) to understand the perceptions of health professionals and health care providers’. The data were collected from December 2018 to July 2019. Guba and Lincoln’s criteria were used to ensure the trustworthiness of the data. Data were analyzed using conventional content analysis based on the approach of Graneheim and Lundman's.There were three categories of barriers to distribution and use of individual supplements, and the funding to implement the program; there were ten subcategories. Supplement distribution were affected by three subcategories of inadequate distribution of the supplement, irregular distribution of the supplement, and insufficient space to store the supplements. Individual barriers to the use of supplement comprised five subcategories: forgetting to take them, lack of knowledge about their benefits, accessing a health care center providing them, negative advertising for supplement use, and not taking them because of cost. Funding to implement the program contained the two subcategories of financial limitation in urban and rural area and financial limitation for all target groups.The findings showed that health care providers reported a variety of barriers to supplement use. Applying a multiple strategy requires: training, conducting advertising campaigns, financial support, sufficient and regular distribution of the supplement and perhaps the use of alternative methods of supplement delivery, such as food fortification can be helpful.

Background & Aims: The rate of exclusive breastfeeding has declined in the world and therefore protection, promotion, and support of breastfeeding are considered to be a public health priorities. This study was conducted to explore breastfeeding mother’s perceptions and experiences of appraisal support needs.Method: A qualitative study carried out between 2017 and 2019, in five health centers, four hospitals, and two physicians’ offices affiliated to Mashhad University of Medical Sciences, Mashhad, Iran. Thirty three breastfeeding mothers, family members, and healthcare providers selected, purposively, for individual semi-structured in-depth interviews. Data were analyzed using directed content analysis adopting Elo and Kyngas approach.Results: Four categories and nine subcategories emerged in this study. The first category was 'affirmation from significant others' which contained two subcategories of ‘the need for approval from healthcare providers’ and ‘the need for affirmation from the husband and family members’. The second category was ‘the necessity of avoiding social comparisons due to unpleasant corollaries’, which had two subcategories: ‘unpleasant feelings caused by being compared to others’ and ‘being blamed when compared with others’. The third category was ‘offering constructive feedback’ with two subcategories of ‘providing positive feedback’ and ‘not giving negative feedback’. The fourth category was ‘persuasion’ which had three subcategories of ‘the need to encourage, ‘the need to be admired and ‘the need to be praised by significant others.Conclusion: Mothers need appraisal support to protect, promote and maintain established breastfeeding. Significant others have an important role in meeting the appraisal support needs of breastfeeding mothers.

Introduction: Diabetes (DM) is a type of metabolic disorder that its types are generated by collectingof genetic and environmental risk agents. Here, the association between HSPB1 polymorphism as a genetic risk factor and DM was investigated. Methods: Total 690 participants from MASHAD cohort study population were recruited into the study.Anti-HSP27-level was assessed followed by genotyping using Taqman®-probes-based assay. Anthropometric, demographic and hematological/biochemical characteristics were evaluated. Kaplan-Meier curves were utilized, while logistic regression models were used to assess the association of the genetic variant with clinical characteristics of population. Results: Finds was shown there are meaningful differences among groups of age, height, waist circumference, systolic blood pressure, FBG,TG, HDL-C, and hs-CRP, and was no big -significant difference between theexists in different HSP27 SNP in the two studied groups (with and without DM), also was no remarkable relation between genetic forms of HSPB1and T2DM. This investigation was the first research that analyzed the relationship between the genetic type of the HSPB1 gene (rs2868371) and Type 2 diabetes (DM2). In our population, the CC genotype (68.1%) had a higher prevalence versus GC (26.6%) and GG (5.3%) genotypes and the data shown that no genetic difference of HSPB1 gene polymorphism (rs2868371) was related with DM2. Conclusion: HSPB1 polymorphism, rs2868371, was not associated with type 2 diabetes mellitus.

Abstract Background The rise of Cesarean Sections (CS) is a global concern. In Iran, the rate of CS increased from 40.7% in 2005 to 53% in 2014. This figure is even higher in the private sector. Objective To analyze the CS rates in the last 2 years using the Robson Classification System in Iran. Methods A retrospective analysis of all in-hospital electronically recorded deliveries in Iran was conducted using the Robson classification. Comparisons were made in terms of the type of hospital, CS rate, and obstetric population, and contributions of each group to the overall cesarean deliveries were reported. Results Two million three hundred twenty-two thousand five hundred women gave birth, 53.6% delivered through CS. Robson group 5 was the largest contributing group to the overall number of cesarean deliveries (47.1%) at a CS rate of 98.4%. Group 2 and 1 ranked the second and third largest contributing groups to overall CSs (20.6 and 10.8%, respectively). The latter groups had CS rates much higher than the WHO recommendation of 67.2 and 33.1%, respectively. “Fetal Distress” and “Undefined Indications” were the most common reasons for cesarean deliveries at CS rates of 13.6 and 13.4%, respectively. There was a significant variation in CS rate among the three types of hospitals for Robson groups 1, 2, 3, 4, and 10. Conclusion The study revealed significant variations in CS rate by hospital peer-group, especially for the private maternity units, suggesting the need for further attention and audit of the Robson groups that significantly influence the overall CS rate. The study results will help policymakers identify effective strategies to reduce the CS rate in Iran, providing appropriate benchmarking to compare obstetric care with other countries that have better maternal and perinatal outcomes.

Introduction: Previous studies have suggested that diabetes mellitus and obesity are associated with an increased risk of severe complications with COVID. We aimed to investigate whether individuals with obesity and diabetes mellitus are more likely to be infected with COVID19.Methods: The information related to COVID-19 was extracted from the Sina Health system information of Mashhad Health Deputy among participants in Mashhad cohort study (n=9704 people). Information regarding the cardiac risk factors of the individuals was previously recorded during the recruitment phase of the Mashhad cohort study. The relationship between COVID infection and several CVD risk factors was investigated.Results: The results showed that obesity (P= 0.001) and diabetes mellitus (DM), (P= 0.01) were positively related to COVID-19. Furthermore, DM augmented the risk of COVID-19 by 1.79 folds (P-value= 0.004; OR: 1.79; CI:1.21-2.67).Conclusions: The incidence of COVID-19 until 2020.07.19 was 2.36% in Mashhad Study Cohort population. Moreover, DM has increased the risk of COVID-19 by 1.79 folds in the population.

Introduction: The disability-adjusted life years (DALY) may provide a better indicator of the burden of disease than mortality. This study provides the estimates of both Years of Life Lost (YLL) and COVID-19 mortality in Mashhad. Methods: This cross-sectional study was carried out in Mashhad, the second-most populous city in Iran. The mortality data in the population served by Mashhad University of Medical Sciences (MUMS) were extracted from the national mortality data system. In this system, all deaths in the whole of the country are recorded based on the International Classification of Diseases, tenth edition (ICD10). The data in the current study comprised all cases of death recorded in the population under the auspices of MUMS from January 21st to April 19th 2019 and 2020 which were transferred to SPSS software after sorting. The method recommended by the World Health Organization (WHO) was used for the estimation of YLL. Results: The YLL per 1000 caused by COVID-19 was 1.2 years and increased with age, and was higher in men (1.6 years) compared to women (0.9 years). The incidence of COVID-19 was higher in the urban area (9.8%) compared to rural areas (4.8%). During the study period, COVID-19 was the fourth most prevalent cause of death in Mashhad after cardiovascular disease (35.4%), cancer (12.9%) and respiratory disease (10.6%). Conclusions: The YLL per 1000 caused by COVID-19 was 1.2 years, increased with age and was greater in males than in females.

Background & aim: Cohesion and sense of ethnicity belonging can be effective in shaping reproductive behaviors. The aim of this study was to compare the reproductive behaviors in two ethnicities of Fars and Turkmen in North Khorasan, Iran.Methods: This cross-sectional study was performed on 406 Fars and Turkmen women using a self-structured reproductive behavior questionnaire between April and September 2017. Content validity and reliability of the tool was confirmed with Cronbach's alpha of 0.75. Data was collected on a self-report basis and analyzed using SPSS software (version 21) and descriptive and analytical indices.Results: Reproductive behaviors were significantly different between the two groups in terms of number of children (P=0.001), the timing of the first childbirth (P=0.043), interval between the first and second pregnancy (P=0.002), desire to re-childbearing (P=0.002), number of desired children (P=0.025), current method of contraception and decision to continue or terminate unwanted pregnancies (P=0.074). General linear test showed that with the introduction of demographic variables to measure the effect of the number of children in the analysis, the effect of ethnicity on the number of children was removed, but the variables of maternal age (P=0.001), husband's age (P=0.001), education of woman and husband (P=0.001) and the woman's job (P=0.001) remained as effective variables on the number of children.Conclusion: Today, the value of childbearing has changed more than other family values. In order to achieve the targets of population policies, population policy-making must be based on economic, social, cultural and demographic realities of the societies.

Abstract Background and aim Primary Ovarian Insufficiency (POI) is defined by the occurrence of menopause before the age of 40 years. It is often associated with cardiovascular disease (CVD). The purpose of this study was to explore the relationship between POI-associated genotypes cardiometabolic disorder risk factors. Methods One hundred seventeen women with POI and one hundred eighty-three healthy women without POI were recruited in this study. DNA was extracted and analyzed using ASO-PCR or Tetra ARMS-PCR. Lipid profiles were also assessed. Results Multivariate logistic regression analysis showed that individuals with GG vs. TT genotype of the rs1046089 SNP were more likely to have a higher serum LDL (p = 0.03) compared to the control group. There was also a significant association between low serum HDL and rs2303369 and rs4806660 SNP genotypes in the POI group. In the POI group, the percentage of those with high total cholesterol was lower in those with a CC genotype compared to those with a TT genotype (p = 0.03). Conclusion Some SNPs reported to be associated with POI appear to be independently associated with dyslipidemia. These results may be helpful to identify subjects with POI who may be susceptible to CVD.

Abstract Subject The Angiopoietin‐like 3 (ANGPTL3) gene has been reported to be associated with cardiovascular risk. This study is designed to compare the genetic variant (rs1748195) of the ANGPTL3 gene and the presence of a coronary artery occlusion of >50% in Iranian nation. Method In this study, 184 patients underwent angiography and 317 healthy individuals were evaluated for polymorphism of rs1748195 the ANGPTL3 gene using Tetra‐ARMs PCR. Coronary patients who experience angiography were categorized into two groups: 54 patients who had an angiography indication for the first time and coronary occlusion was 50% (N = 42). Result The fundamental of characteristics of our study design population was categorized based on undergoing angiography or not. In the present study, we investigated that the CC genotype, and also the A allele corresponding to rs1748195 at the ANGPTL3 gene loci, was associated with negative angiogram and directly related to the risk of coronary occlusion >50%. In contrast, this result was not significant in genotypes of ANGPTL3 between non‐ISR and ISR groups. Conclusion The outcomes of this study showed that rs1748195 polymorphism at the ANGPTL3 gene loci is associated with an elevated risk for the existence of a coronary occlusion of >50%.

Abstract Introduction The aim of this study was to investigate the effects of hypothyroidism on visual functions such as visual acuity, refractive errors, colour vision, and contrast sensitivity, among hypothyroid adults. Methods Forty‐three patients with clinical hypothyroidism along with 43 age‐ and sex‐matched healthy individuals underwent visual examinations, including visual acuity, refractive errors, eye deviations with the cover test, colour vision with the D15 test, and contrast sensitivity with Pelli‐Robson test. Results It was indicated that visual acuity, refractive errors, phoria, and colour vision had no significant difference between the hypothyroid and control groups. Contrast sensitivity decreased in hypothyroid subjects as compared with controls. The mean values of binocular contrast sensitivity were 1.85 ± 0.09 log in the hypothyroid group and 1.93 ± 0.09 log in controls, which showed a statistically significant difference (p = .03). Conclusions Our findings illustrated a reduced contrast sensitivity in adult hypothyroidism. Since CS is related to functioning and quality of life, a comprehensive and detailed eye examination may be beneficial for hypothyroidism patients.