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Background: The effect of ultra-processed foods (UPFs) on chronic kidney disease (CKD) has been studied in some studies. The present study aimed to investigate the association between UPF consumption and the risk of protein-energy wasting (PEW) and sarcopenia in patients with CKD in the Iranian population., Methods: The current cross-sectional study included 110 patients with CKD referred to two clinics in Shiraz, Iran. The International Society of Renal Nutrition and Metabolism (ISRNM) criteria and the Asian Working Group for Sarcopenia (AWGS) guideline were considered for the diagnosis of PEW and sarcopenia, respectively. The valid semi-quantitative food frequency questionnaire was used to assess participants' dietary intake. The logistic regression was used to examine the association of UPFs with PEW and sarcopenia., Results: We observed no significant association between sarcopenia and PEW with UPFs in the crude model. After adjusting for confounders, we observed a significantly higher odds of sarcopenia in the upper versus lower median of UPF intake (odds ratio (OR) = 3.59, 95% confidence interval (CI): 1.02-12.62, P = 0.046)., Conclusions: Our findings suggest a positive relationship between UPF intake and sarcopenia among CKD patients. Therefore, reducing the intake of UPFs may decrease the odds of sarcopenia in patients suffering from CKD., (© 2023. The Author(s).)

Objectives: Physical inactivity is a major adjustable lifestyle risk factor in renal patients; nevertheless, research on the association of physical activity (PA) with chronic kidney disease (CKD) is unclear., Design: Cross-sectional., Setting: We evaluated the secondary care related to the nephrology specialists., Participants: We evaluated PA in 3374 Iranian patients with CKD aged ≥18 years. Exclusion criteria were current or prior kidney transplantation, dementia, institutionalisation, expected to start renal replacement therapy or leave the area within study duration, participation in a clinical trial or inability to undergo the informed consent process., Primary and Secondary Outcome: The renal function parameters were measured and compared with PA, assessed by the Baecke questionnaire. Estimated glomerular filtration rate, haematuria and/or albuminuria were used to estimate decreased kidney function and the incidence of CKD. To estimate the relationship between PA and CKD, we used the multinomial adjusted regression models., Results: In the first model, findings indicate that the patients with the lowest PA score had significantly higher odds of CKD (OR 1.44, 95% CI 1.16 to 1.78; p=0.01), adjustment for age and sex attenuated this relationship (OR 1.25, 95% CI 1.56 to 1.78, p=0.04). Furthermore, adjusting for low-density lipoprotein, high-density lipoprotein, triglyceride, fasting blood glucose, body mass index, waist circumference, waist/hip ratio, coexisting diseases and smoking made this relationship insignificant (OR 1.23, 95% CI 0.97 to 1.55; p=0.076). After adjusting for potential confounders, we found that patients with lower PA have higher odds of CKD stage 2 (OR 1.62, 95% CI 1.13 to 2.32; p=0.008), no association with other CKD stages., Conclusion: These data suggest that physical inactivity contributes to the risk of early CKD, so encouraging patients with CKD to maintain higher PA levels could be used as a simple and useful tool to decrease the risk of disease progression and its related burden., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Chronic kidney disease (CKD) is one of the major global causes of mortality, described as the most neglected chronic disease. This study aimed to determine the prevalence and determinants of CKD in the setting of the Shahedieh cohort study in Yazd, Iran., Methods: This cross-sectional study was conducted on adults in the baseline phase of the Shahedieh cohort study in Yazd, Iran. In this study, 9781 participants aged 30-73-year-old were investigated. The data used in this study included demographic and clinical variables and blood samples. Adjusted odds ratios were employed using multivariate logistic regression; meanwhile, population attributable risks for CKD were calculated and reported., Results: CKD prevalence was 27.5% (95%CI: 26.57-28.34) in all participants, 24% in male, and 30.3% in female. The results of multivariate logistic regression analysis identified age (OR = 1.89, 95%CI:1.082-1.96), women (OR = 1.62, 95%CI: 1.45-1.79), BMI ≥ 30 (OR = 1.40,95%CI: 1.20-1.62), diabetes (OR = 1.38, 95%CI: 1.22-1.57), hypertriglyceridemia(OR = 1.20, 95%CI: 1.01-1.43), history of cardiovascular disease (OR = 1.20, 95%CI: 1.01-1.43), hypertension (OR = 1.18, 95%CI: 1.04-1.33), smoking (OR = 1.17, 95% CI: 1.02-1.33), LDL ≥ 130 (OR = 1.15, 95%CI: 1.01-1.31), history of kidney stone (OR = 1.14, 95%CI: 1.01-1.32) and hypercholesterolemia (OR = 1.14, 95%CI: 1.01-1.32) as risk factors for CKD. Among individual factors, obesity (11.25%), Hypertriglyceridemia (9.21%), LDL ≥ 130 (7.12%) had the greatest Population-Attributable Fraction, followed by Hypercholesterolemia (5.2%), diabetes (5.05%), smoking (3.73%) and high blood pressure (2.82%)., Conclusion: The results showed that the main determinants of CKD are potentially modifiable risk factors. Therefore, implementing early detection and screening programs in people at risk as well as preventive measures such as lifestyle modification programs and risk factors controlling can prevent the disease., (© 2022. The Author(s).)

Background: As chronic kidney disease (CKD) is amongst the current global health challenges, this study is aiming to evaluate the long-term intake of total polyphenol and its subclasses in association with CKD incidence., Methods: For the purpose of this study, a sample of 3021 Iranian adults (47 % men, aged 20-79 years) with no CKD diagnosis at baseline, were selected from the Tehran Lipid and Glucose Study population. The total intake of polyphenol and its major subclasses were assessed by a validated food frequency questionnaire and categorized as flavonoids, phenolic acids, stilbenes, and lignans. Although the morphological abnormalities of the kidneys or 3-month persistent urinalysis can distinctively define CKD, the glomerular filtration rate (eGFR) reduction is accepted as a more precise index of renal function. Therefore, eGFR < 60 mL/min/1.73m 2 was the exclusive index of CKD diagnosis in the current study. The eGFR was calculated by the Modification of Diet in Renal Disease Study equation. Cox-regression analysis was used to assess the hazard ratio and 95 % confidence intervals of CKD in quartiles of the total polyphenols., Results: In this study, 355 CKD cases over 11,058.464 person-years was reported. The median (IQR) age of participants was 36 years (27-46) at baseline. Moderate intake of lignans (≤ 6.8 mg) was negatively associated with the incidence of CKD in the adjusted model. No significant associations were detected between higher amounts of lignin and total polyphenols (HR: 0.97, 95 % CI 0.67-1.40) and CKD incidence., Conclusions: Based on the current findings, moderate intake of lignin possess CKD-protective properties by approximately 32 %. No independent associations were observed between higher amounts of lignins and CKD incidence.

Objective: The aim of this article was to assess the association between low-carbohydrate high-protein (LCHP) diet score and the risk of incident chronic kidney disease (CKD)., Design and Methods: This cohort study was conducted on 1,797 Iranian participants, aged ≥20 years, followed-up for a mean of 6.1 years. Using a valid and reliable food-frequency questionnaire at baseline, LCHP diet score between 0 and 12 points were determined. Anthropometric measures and biochemical indicators were assessed. Participants were classified based on their estimated glomerular filtration rate (eGFR) levels using the National Kidney Foundation guidelines; eGFR ≥ 60 mL/minute/1.73 m 2 as not having CKD and eGFR < 60 mL/minute/1.73 m 2 as having CKD. Multivariable logistic regression was used to estimate the odds ratio for the occurrence of CKD according to the tertiles of LCHP diet score., Results: Mean (standard) age of participants (48% male) was 37.7 (12.2) years at baseline. The median (25-75 interquartile range) of LCHP diet for all subjects was 7 (4-8), and incidence of CKD was 14.1%. After adjusting for age, sex, smoking status, physical activity, total calorie intake, body mass index, diabetes, hypertension, and baseline eGFR, participants in the highest tertile of LCHP diet had greater risk of incident CKD (odds ratio: 1.48; 95% confidence interval: 1.03-2.15), in comparison to those in the lowest one (P for trend = .027)., Conclusion: Our findings demonstrate the hypothesis that higher score of LCHP diet may have adverse effects on incidence and development of CKD., (Copyright © 2018 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.)

Background: This investigation aims to examine the relationship between diabetes and prediabetes with chronic kidney disease (CKD) while taking into account key risk factors such as gender, age, lifestyle, smoking habits, and blood pressure. Methods: Between November 17, 2016, and November 22, 2018, 4063 subjects aged 35 to 70 years were enrolled in the first phase of the Bandare-Kong Non-Communicable Disease (BKNCD) Cohort Study, which is part of the PERSIAN (Prospective Epidemiological Research Studies in IrAN) cohort and was conducted in a coastal region of the Hormozgan province in southern Iran. CKD was calculated using the Modification of Diet in Renal Disease (MDRD) formula based on glomerular filtration rate (GFR)<60 mL/min per 1.73 m², or albumin/Cr>30 mg/g in random urine, self-reported kidney failure, or dialysis. Urine albumin and creatinine were determined by standard kits (Pars Azmoon, Tehran, Iran) and the BT1500 automatic chemistry analyzer (Biotecnica Instruments, Rome, Italy). Results: The prevalence of CKD was found to be 15.3%, with 29.6% identified in diabetic individuals and 16.5% in prediabetic patients. So, the prevalence of CKD in diabetics was higher than prediabetics and normal people. Increased age, dysglycemia (diabetes or prediabetes), hypertension, and use of angiotensin receptor blockers were markedly associated with an elevated risk of CKD in adults. Conclusion: The study emphasizes the importance of early detection and management of CKD risk factors, particularly among high-risk individuals, to mitigate CKD progression and associated complications. By addressing modifiable risk factors, proactive screening, and enhanced awareness, significant strides can be made in reducing CKD burden and improving patient outcomes. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the etiology of pediatric Chronic Kidney Disease (CKD) in a tertiary care hospital in north-west of Iran. Medical records of admitted children with CKD in Children's Hospital of Tabriz from 1999 to 2009 were studied retrospectively. CKD was defined as GFR less than 60 mL min(-1) 1.73 m2 for more than 3 month. The etiology of CKD was determined by clinical, biological, radiological and histopathological examination. During 10 years 115 children including 61 boys (53%) and 54 girls (47%) were studied. The mean age of patients was 8.1 +/- 3.53 years (range: 4 months to 14 years). Urological abnormalities were the most common cause of CKD (36.5%) followed by acquired glomerular diseases (23.5%), hereditary nephropathies (21.7%), unknown etiology (9.5%) and systemic diseases (6%). The most common urologic anomaly was vesicoureteral reflux (VUR) that accounted for 24.3% of total etiologies followed by obstructive uropathies. Focal segmental glomerulosclerosis was the most frequent glomerular disease and was responsible for 13.9% of patients. Nephronophtisis, cystinosis, infantile polycystic disease and congenital nephrotic syndrome were the most frequent hereditary nephropathies in a descending order. Frequency of parental consanguinity in patients with hereditary nephropathy was significantly higher than other patients (p = 0.001). High frequency of VUR in present study compared with developed countries necessitates more efforts for improving the management and follow up of urinary tract infections.

Background: Self-efficacy of patients on hemodialysis is considered a main component of the successful management of chronic kidney diseases. The self-efficacy of these patients may be influenced by many individual and social factors. This study aimed to assess the association between perceived self-efficacy and social support by patients on hemodialysis treatment and the resilience of their families. Methods: This cross-sectional study was conducted on 183 patients and 183 families of hemodialysis patients in the largest hemodialysis center in northwest of Iran. Data was collected from July to December 2021 using chronic kidney disease self-efficacy, multidimensional perceived social support (MSPSS), and the Walsh family resilience questionnaire (WFRQ). The collected data were analyzed by SPSS software using descriptive and inferential statistical tests. Results: The findings showed that the mean score of patients' self-efficacy was 171.63 ± 38.19 in a possible range of 25 to 250. Moreover, the mean score of perceived social support was 62.12 ± 16.12 in a possible range of 7 to 84. The mean total score of family resilience was 119.08 ± 26.20 in a possible range of 32 to 84. Also, the results of the study showed a positive and significant relationship between the self-efficacy of patients with their perceived social support and the resilience of their families (p < 0.01). Conclusion: The results of the study showed that there is a significant relationship between patient self-efficacy and family resilience and social support received in chronic kidney patients undergoing hemodialysis. Therefore, it is suggested to consider practical strategies in the field of family resilience and social support to improve patients' self-efficacy. [ABSTRACT FROM AUTHOR]

Background: Systemic inflammation can be the initiator in developing chronic diseases that may be affected by the lifestyle and diet of individuals. In the current study, we aimed to assess the association of the inflammatory potential of diet and lifestyle, determined by the food-based index of dietary inflammatory potential (FBDI), dietary inflammation score (DIS), and lifestyle inflammation score (LIS), with risk of chronic kidney disease(CKD) in Iranian adults. Methods: A total of 6044 CKD-free individuals aged ≥ 18 years, were recruited from among participants of the Tehran Lipid and Glucose Study(surveys 3 and 4) and followed a mean of 6.03 years(follow-up rate:94.95%). Data on dietary intakes were determined using a food frequency questionnaire. The inflammatory potential of diet and lifestyle were determined based on three indices, including FBDI, DIS, and LIS. Using the National Kidney Foundation guidelines, we defined CKD as eGFR < 60 mL/min/1.73 m2. Results: Mean ± SD age of the study population(54.3% women) was 37.8 ± 12.8 years. We identified 1216(20.1%) new cases of CKD during the 6.03 years of follow-up (46,889.8 person-years). In the multivariable-adjusted model, the risk of CKD incident is increased across quartiles of FBDI (HR = 1.21;95%CI:1.03–1.42, Ptrend:0.014) and LIS (HR = 1.28;95%CI:1.07–1.55,Ptrend:0.006). However, no significant relationship was observed between the higher DIS score and CKD risk. Conclusion: Our findings showed that a higher inflammatory potential of diet and lifestyle, characterized by a higher score of FBDI and LIS, was related to increased incidence of CKD, while no significant relationship was reported between the DIS score and CKD incident. [ABSTRACT FROM AUTHOR]

Introduction: The prevalence of kidney disease (KD) as a global health burden is increasing rapidly and is known as a health problem that imposes a large economic cost on health systems. The present study was conducted with the aim of investigating the 30-year trend of the burden of KD in Iran from 1990 to 2019. Materials and Methods: This is a secondary data analysis study that provided information on the trend of KD in Iran during the years 1990 to 2019. The data related to the indicators of the burden of KD in Iran, the Eastern Mediterranean region and the global average were extracted from the Global Burden of Diseases (GBD) report. The results of the study have been reported descriptively and in the form the trend of disease burden in a 30-year period using three indices, including DALY, YLL and YLD. Results: The highest burden of disease caused by chronic kidney diseases in the last 30 years in Iran was related to people over 50 years old, and the corresponding DALY index was lower than the average of the region and the world. In Iran, the 30-year changes of this index in a standardized form according to age was equal to -21.54 percent (from 620.34 in 1990 to 486.68 in 2019). Moreover, the highest burden of disease caused by acute glomerulonephritis in the last 30 years was related to the age group over 70 years old, and in general, the DALY index for this disease in Iran has exceeded the average of the region and the world. In Iran, the 30-year change rate of this index standardized by age was 54.94 percent (from 5.84 in 1990 to 9.05 in 2019). Conclusions: The results of the study showed that the burden of KD is increasing over time, especially in older age and due to acute glomerulonephritis. Therefore, it is necessary to develop and implement effective preventive and treatment measures with the aim of reducing the incidence of KD and also to slow down the progress of the disease. [ABSTRACT FROM AUTHOR]

Introduction: Chronic kidney diseases are one of the problems that threaten people's physical and psychological health. Aim: The present study aims to compare the effectiveness of acceptance and commitment therapy and dialectical behavioral therapy on coherent self-knowledge, emotional regulation and life quality of hemodialysis patients. Method: The present study is a semi-experimental one with a pre-test, post-test and a control group design. The statistical population of this research was hemodialysis patients of Shafa Hospital and Javad Al-Aima Clinic in Kerman in 2022. For this research 45 hemodialysis patients were selected using convenience sampling and randomly placed into two experimental groups of effectiveness of acceptance and commitment therapy and dialectical behavioral therapy and a control group. The research tools included Qorbani Coherent Self-knowledge (2008), Gross Emotional Regulation (2003) and World Health Organization Life Quality (1996) Questionnaire. The collected data were analyzed using covariance analysis or ANACOVA statistical exams, Tukey's b post Hoc exam using SPSS-24 statistical software. Results: The result of covariance analysis showed significance difference between the experimental and control groups as (P<0.001). Compare to the control group, improvements were observed in coherent self-knowledge, emotional regulation and life quality of hemodialysis patients participated in both experimental groups. Conclusion: Acceptance and commitment therapy and dialectical behavioral therapy, are proper methods in increasing coherent self-knowledge, emotional regulation and life quality of hemodialysis patients. It is recommended that these approaches can be used alongside other medical treatments. [ABSTRACT FROM AUTHOR]

Background: Defining socio-demographic factors, clinical presentations and underlying diseases associated with COVID-19 severity could be helpful in its management. This study aimed to further clarify the determinants and clinical risk factors of the disease severity in patients infected with COVID-19.Methods: A multi-centre descriptive study on all patients who have been diagnosed with COVID-19 in the province of Tehran from March 2020 up to Dec 2020 was conducted. Data on socio-demographic characteristics, clinical presentations, comorbidities, and the health outcomes of 205,654 patients were examined. Characteristics of the study population were described. To assess the association of study variables with the disease severity, the Chi-Squared test and Multiple Logistic Regression model were applied.Results: The mean age of the study population was 52.8 years and 93,612 (45.5%) were women. About half of the patients have presented with low levels of blood oxygen saturation. The ICU admission rate was 17.8% and the overall mortality rate was 10.0%. Older age, male sex, comorbidities including hypertension, cancer, chronic respiratory diseases other than asthma, chronic liver diseases, chronic kidney diseases, chronic neurological disorders, and HIV/AIDS infection were risk markers of poor health outcome. Clinical presentations related with worse prognosis included fever, difficulty breathing, impaired consciousness, and cutaneous manifestations.Conclusion: These results might alert physicians to pay attention to determinants and risk factors associated with poor prognosis in patients with COVID-19. In addition, our findings aid decision makers to emphasise on vulnerable groups in the public health strategies that aim at preventing the spread of the disease and its mortalities. [ABSTRACT FROM AUTHOR]

Background and Aim: Hearing loss is a highly prevalent symptom in patients with chronic kidney diseases (CKD). Comorbidities such as Diabetes Mellitus is known as the most common cause of CKD and a significant risk factor for sensorineural hearing loss (SNHL). The aim of this study was to compare SNHL among diabetic with non-diabetic hemodialysis patients. Methods: In this study, 33 diabetic patients on hemodialysis were selected from Hami center, Arak, Iran. Non-diabetic subjects were 31 hemodialysis patients without diabetes were matched for age, duration of CKD and hemodialysis. Data were obtained via questionnaire, patients' files, physical examination, otoscopy and tympanometry. Hearing was analyzed using pure-tone audiometry for both groups. Results: In the study, 66.2% of diabetic patients and 52.1% of non-diabetic subjects had SNHL. Results showed that diabetic patient has 1.3 times more likely to have hearing impairment. This difference was not statistically significant. Bilateral mild SNHL was the most prevalent in both groups. No significant difference was reported in SNHL prevalence, mean thresholds of hearing and ear laterality between the groups. Gender and age had a significant effect on hearing loss after adjusting covariables. No significant association was found between diabetes and hearing loss. Conclusion: SNHL was more common in hemodialysis patients with diabetes. Patients with diabetes had poorer hearing thresholds compared to non-diabetic group, with no significant difference between groups. The periodical assessment of hearing and extending audiological care in this high-risk population is recommended due to long-term irreversible symptoms of the disease. [ABSTRACT FROM AUTHOR]

Background: Reinfection with Coronavirus Diseases 2019 (COVID-19) has raised remarkable public health concerns globally. Therefore, the present retrospective cohort study intended to investigate COVID-19 reinfection in registered patients of Fars province in Iran from February 2020 to April 2021. Methods: The patients' data, including the COVID-19 infection, symptoms, comorbidities, and demographics, were collected using the Health Information Systems (HISs). The patients were divided into three groups in terms of the duration between the initial infection and reinfection, including 28-44, 45-89, and more than 90 days. Following the univariate analysis, logistic regression was used to investigate the factors effective on COVID-19 reinfection. Results: A total of 213768 patients had a positive Polymerase Chain Reaction (PCR) test. The reinfection rate was 0.97% (2079 patients). Of these re-infected individuals, 14.9%, 18.5%, and 66.6% had their second positive test 28-45, 45-89, and ≥90 days later, respectively. The mean duration between the initial infection and reinfection was 130.56 days (29-370 days). The chance of reinfection was significantly higher in the youths (Odds Ratio (OR)=2.055; P<0.001), men (OR=1.283; P<0.001), urban population (OR=1.313; P<0.001), and healthcare providers (OR=4.453; P<0.001). The patients with chronic pulmonary diseases, chronic kidney diseases, and malignancy were 1.421 (P=0.036), 2.239 (P<0.001), and 3.437 (P<0.001) times, respectively, more likely prone to reinfection. Conclusion: The results of this study showed that there is a higher risk of reinfection in several vulnerable groups including healthcare providers, young individuals, residents of urban areas, men, and individuals with underlying diseases. [ABSTRACT FROM AUTHOR]

Background: The Coronavirus disease 2019 (COVID-19) pandemic has significantly affected various aspects of public health. The virus poses a particular threat to individuals with kidney failure undergoing hemodialysis and their caregivers. The present study investigated the experience of family caregivers of individuals undergoing hemodialysis about caring during the COVID-19 pandemic in Iran. Methods: This qualitative study was conducted with 17 family caregivers of individuals undergoing hemodialysis in Bojnurd, Iran using inductive qualitative content analysis. The participants were selected using convenience and purposive sampling method with maximum variation. Semi-structured interviews were used in data collection based on the interview guide. The data were analyzed with MAXQDA10. Results: The results culminated in the identification of a main category of the COVID-19 care burden on caregivers and two generic categories including the COVID-19 Overt (financial/constraining) care burden (subcategories: Non-adherence to Health Protocols, COVID-19 Financial Costs, COVID-19 Restrictions and Hemodialysis Appointments, and Decreased Caregiver Support during the COVID-19 Era), and the COVID-19 Covert (emotional/psychological) Care Burden (subcategories: Caregiver's Loneliness in the Care, Stress of Contracting COVID-19, Psychological Consequences of individuals undergoing hemodialysis Staying at Home, The burden of other Individuals' Expectations of the Caregiver, and Physical and emotional pressure on the Caregiver). Conclusion: Caregivers during the COVID-19 period have experienced both overt and covert care burden. The results of this study can contribute to understanding the experiences of caregivers of individuals with chronic diseases such as kidney failure, in critical conditions like the COVID-19 pandemic, by healthcare teams and devising strategies and programs to support them. [ABSTRACT FROM AUTHOR]

Background: The prevalence of pulmonary hypertension (PH) is reported between 17% and 56% in hemodialysis patients. The pathogenesis of PH in hemodialysis patients is still unclear. Malnutrition may be associated with impaired pulmonary function in hemodialysis patients. Objectives: The present study aimed to investigate the association between PH and nutritional and biochemical markers in hemodialysis patients. Methods: In this cross-sectional study, 80 patients undergoing hemodialysis at the Kowsar Medical Center, Semnan, Iran, from 1 March 2016 to 31 August 2016 were enrolled by complete enumeration. Pulmonary artery pressure was determined by echocardiography between hemodialysis sessions. Arm circumference, triceps fat mass, and body mass index (BMI) were determined. Other laboratory tests included transferrin, serum albumin, cholesterol, triglyceride, and hemoglobin. The source of receiving protein was recorded in a questionnaire. The data were analyzed by the chi-square test and logistic regression analysis at a significance level of less than 0.05. Results: Pulmonary hypertension ( > 25 mmHg) was found in 32 (40%) of the 80 patients studied. The mean of pulmonary pressure in patients with PH was 34.66 ± 5.6 mmHg compared to 16.85 ± 3.7 mmHg in patients without PH. Age, gender, arm circumference, frequency of dialysis per year, and serum levels of albumin, transferrin, triglyceride, and total cholesterol were not significantly different between patients with and without PH. There was a significant difference in the mean hemoglobin level between patients with and without PH (P = 0.003). The likelihood of developing PH was reduced by 0.3 in those with hemoglobin ≥ 11 g/dL compared to patients with hemoglobin levels below 11 g/dL (OR = 0.400, P = 0.003). The likelihood of developing PH in patients with albumin ≥ 3.8 g/L decreased by 0.126 compared to those with albumin less than 3.8 (OR = 0.126, P = 0.003). Conclusions: The results of our study indicated a higher incidence of PH in patients with lower levels of hemoglobin and albumin. So, patients undergoing hemodialysis are recommended to be regularly screened for these two variables. [ABSTRACT FROM AUTHOR]

Vitamin E and C are well‑known antioxidant vitamins. Oxidative stress is common in chronic kidney diseases. We evaluated 43 dialysis subjects prospectively in a cross‑sectional survey. Serum vitamin E concentration was checked in all subjects; 37 cases underwent blood sampling for measurement of serum vitamin C. The enrolled subjects consisted of 12 (27.9%) peritoneal dialysis (PD) and 25 (58.1%) hemodialysis (HD) patients. Six (13.9%) patients were switched from PD to HD or vice versa. Serum concentration of vitamin E was normal, low and high in 9 (20.9%), 31 (72%) and 3 (7.1%) patients, respectively. There were no significant differences regarding age, gender, modality and duration of dialysis, and characteristics of dialysis sessions, mean serum blood urea nitrogen, and albumin levels between vitamin E deficient cases with those with normal serum vitamin E concentration (P > 0.05 for all). The serum vitamin C levels were low in 5 (13.5%) and normal in 32 (86.5%) patients. vitamin C deficiency was more prevalent in HD versus continuous ambulatory peritoneal dialysis patients (P = 0.128). Mean serum vitamin C concentration was higher in patients who were supplemented by vitamin C compared with those who didn't receive the vitamin supplement (P = 0.043). Vitamin E deficiency was a prevalent finding and supplementary vitamin C 30-60 mg/day was sufficient to prevent deficiency. Regular assessments of serum vitamin E level may be needed in dialysis centers. [ABSTRACT FROM AUTHOR]

Background: The outbreak of the Covid-19 has been a serious threat to the health and lives of many people. This study aimed to determine the survival rate and its contributing factors in Covid- 19 patients who were hospitalized in hospitals in Fars province. Materials and Methods: This study is a hospital-based carried out on 119429 of Covid-19 hospitalized patients in the south of Iran within 2019 - 2022. Information of demographics and clinical characteristics, symptoms, and comorbidity of patients were extracted from medical records. The Kaplan--Meier curve and the Log rank test were used to compare survival rate in different groups. Cox regression was employed to determine the factors that affect survival. Results: The mean age of the participants was 51.5 year. The density incidence of death was estimated to be 16.8, 4.6, and 43.9 per 1000 person-days for all of patient, intensive care unit patients, and intubated patients, respectively. The Multiple Cox Regression results suggested that risk of mortality is 5.61 times higher in patients over 75 years, 3 times higher in patients admitted to the intensive care unit, and 3.4 times higher in intubated patients. Also, the risk of mortality was higher in men and those with underlying disease. Conclusion: We found out that being elder, being a male, hospitalization in the intensive care unit, and being intubated would increase the risk of mortality. Thus, it is treatment management of hospitalized patients is necessary, especially elderly patients and those with underlying diseases. [ABSTRACT FROM AUTHOR]

Introduction: Metabolic syndrome is a common disorder that puts patients at high risk for cardiovascular disease (CVD) and mortality. To our knowledge, there is no published study in Pub Med which evaluated both lifestyle and metabolic syndrome in hemodialysis patients. This study aimed to estimate the prevalence of metabolic syndrome and investigate the potential risk factors in hemodialysis patients. Methods: This was a cross-sectional study conducted on 204 patients enrolled conveniently. National Cholesterol Education Program Adult Treatment Panel III criteria considered for Metabolic Syndrome. Demographics, lifestyle, and disease characteristics were gathered. The relationship between metabolic syndrome and its severity with independent variables was investigated through multivariable multivariate logistic and linear regressions. Results: The mean (SD) age was 55 (14) years and 42% were women. 42.6% had metabolic syndrome. Low high-density lipoprotein (HDL), high fasting blood sugar, high blood pressure (BP), increased waist circumference (WC), and high triglyceride were observed in decreasing order of frequency in 54.4%, 44.1%, 38.7%, 33.3% 28.9% of patients, respectively. The logistic regression model revealed significant associations between metabolic syndrome and physical activity (OR = 0.85, 95% CI: 0.74-0.97), mood (OR = 1.04, 95% CI: 1.002-1.078), age (OR = 1.023, 95% CI: 1.001-1.046), and missed work (OR = 0.86, 95% CI: 0.76-0.97). The linear regression model revealed significant associations between metabolic syndrome severity score and physical activity (B = -0.12, 95% CI: -0.21-0.02) and sleep quality (B = 0.017, 95% CI: 0.001-0.033). Conclusion: Poorer sleep quality, lower physical activity, lower mood status, and older age were associated with higher odds of metabolic syndrome/metabolic syndrome severity score in hemodialysis patients. [ABSTRACT FROM AUTHOR]

Background: Patients with chronic renal failure face many challenges in self-care after a kidney transplant. This treatment method affects their quality of life and leads to multiple complications. Objectives: This study aimed to evaluate the impact of an educational package on the quality of life (QoL) and complications of renal transplant recipients. Methods: This clinical trial was conducted on 72 patients (control and intervention groups) who had undergone kidney transplantation for the first time. The intervention involved an educational package comprised of five sessions. Besides, an educational booklet, weekly telephone calls, and follow-up (8 weeks after the intervention) were protablevided. The data were collected by the Kidney Transplant Questionnaire (KTQ-25) completed before and after the intervention by the two groups, and the Renal Transplantation Complications Checklist completed after 8 weeks. Data analysis was performed in each group before and after the intervention and between the two groups after the intervention via chi-square, Fisher's exact test, paired t-test, and independent t-test. Results: The results showed a significant difference between the intervention and control groups in the physical dimension (P = 0.002). No significant difference was observed between the two groups in the remaining dimensions and the overall QoL. A significant difference was found between the two groups in terms of infection (P = 0.04), but no difference was observed between the two groups in terms of re-admission and transplant rejection (P > 0.05). Conclusions: The educational package affected all dimensions of QoL, especially the physical dimension and infection (as an acute complication of renal transplant); it improved QoL and reduced infection in the intervention group. Therefore, this package can be considered in the management plans of renal transplant recipients. Administration of this package can help understand the patients' needs and requests and improve their health-related behaviors. [ABSTRACT FROM AUTHOR]

Background: Drugs cause approximately 20%-40% of acute kidney injuries (AKI). Amikacin (AMK) is one of the common medications used as empiric therapy for severe infections, such as sepsis in neonates. One of the newly recommended biomarkers in AKI is Kidney Injury Molecule-1 (KIM-1). In this study, we evaluated the use of KIM-1 for diagnosing tubular injury in neonates treated with Amikacin in the neonatal intensive care unit (NICU) of our educational hospital in Gorgan, Iran. Methods: This cross-sectional descriptive study was conducted at the NICU of the two educational hospitals affiliated to the Golestan University of Medical Sciences, Gorgan, Iran. There were two groups of patients, namely neonates treated with Amikacin plus Ampicillin (group A; n=45) and neonates treated with Ampicillin plus Cefotaxime (group B; n=45). Demographic characteristics were recorded. Blood and urine samples were collected in both groups. The urinary secretion of KIM-1 was determined using an ELISA kit. Results: The total number of patients in both groups was 45, 26 (57.8%) of whom were male, and 19 (42.2%) cases were female. The mean age was obtained at 5.25±1.47 days in group A and 5.15±1.5 days in group B. None of our patients had AKI. There was no difference between leukocyte count and platelets on the first and seventh day. There was a significant difference among K, Na, urine specific gravity, C-reactive protein, Cr, and BUN on the seventh day, compared to the first day. The difference between urinary levels of KIM-1 in the two groups was not statistically significant. Conclusion: We have not found a significant relationship between urinary KIM-1 and AKI in our patients. [ABSTRACT FROM AUTHOR]

Background: While tubeless Percutaneous Nephrolithotomy (PCNL) is becoming more popular, there might still be doubt in performing it on single kidney patients. This study is performed to assess outcomes and complications of tubeless PCNL in patients with single kidney. Methods: In this cross-sectional study, 134 single kidney patients who underwent tubeless PCNL for renal stones, were assessed for outcomes including stone-free rate, duration of operation, length of hospital stay, changes in serum creatinine and hemoglobin levels, bleeding, infectious complications, damage to adjacent organs, and mortality. These outcomes were compared based on age, sex, history of comorbidities, history of interventions for kidney stones and the number of accesses during the operation. Results: Mean duration of operation was 139.14 minutes. Mean length of hospital stay was 2.59 days. In total, 11.9% of patients required intraoperative blood transfusion and 3.7% required ICU admission due to complications. The most common postoperative complications included fever, hematuria and UTI. Initial stone-free rate after surgery was 67.2% and two weeks later 76.9%. No mortality was reported. Postoperative serum creatinine levels increased slightly in short term, however, improved significantly in long-term. Comorbidities such as diabetes mellitus, hypertension, ischemic heart disease, and chronic kidney disease were associated with a higher incidence of minor and major complications of tubeless PCNL and a lower rate of stone-free rate. Conclusion: Tubeless PCNL is a relatively safe, feasible and efficient method with acceptable complications in single kidney patients. [ABSTRACT FROM AUTHOR]

Background: Early graft loss (EGL) is one of the rare complications of kidney transplantation. Several factors play a role in the occurrence of EGL in kidney transplant recipients, which must be identified and limited. Objectives: This ten-year retrospective study was conducted in a single center on 32 kidney transplant recipients with EGL to determine the reasons for and risk factors of kidney transplant rejection in Iran. Methods: This descriptive-analytical study's population included 605 kidney transplant recipients receiving kidneys during the last ten years in our center. The diagnosis of EGL was based on renal allograft biopsy examination and primary clinical complications, including a rapid increase in serum creatinine. The age, gender, blood group, and rhesus (Rh) of both donors and recipients, as well as the kinship between the donor and recipient (relative and non-relative), right/left-sided living donor/recipient kidneys, primary kidney disease, the presence of underlying disease in the recipient, dialysis duration, the year of kidney transplantation, transplant survival time, patient survival time, and complications (surgery and others) were gathered. The data were analyzed using SPSS version 18. Results: In this study, 32 out of 605 kidney transplant recipients (5.28%) experienced EGL (53.1% male and 46.9% female, average age of 41.12 years). The duration of kidney function after transplantation was 5.56 ± 0.13 days. The transplanted kidneys were functional between 72 hours and one week after transplantation in 34.4% of the patients. The causes of EGL were found to be tissue rejection in 31.3% of the patients and vascular thrombosis and hyperacute rejection in 21.8%. Nephrectomy occurred in 41% of the patients, and 43.75% died because of a heart attack. Conclusions: Our findings supported previous studies' results, suggesting that EGL is associated with receiving an incompatible kidney transplant and surgery-related complications, including bleeding and thrombosis. [ABSTRACT FROM AUTHOR]

This study aimed to identify body mass index (BMI) trajectories from childhood and their relationships with depression, anxiety, and stress symptoms in young adulthood. A total of 687 children aged 4–18 years were recruited from the Tehran Lipid and Glucose Study. Throughout 18 years of follow‐up, BMI was measured every 3 years for a maximum of 6 data points. Participants completed the depression, anxiety, and stress scale in their young adulthood (aged 22–36). The group‐based trajectory modelling was applied to identify BMI patterns. The logistic regression model was used to assess the association between BMI trajectories and depression, anxiety, and stress symptoms in adulthood. Two BMI trajectories were identified from childhood to young adulthood: healthy weight (HW = 69.6%) and persistent increasing overweight/obesity (PIO = 30.4%). After adjusting for potential confounders, compared with the HW group, men in the PIO group were more likely to experience higher stress levels (OR: 1.62, 95% CI: 0.99–2.63; p = 0.05). No significant association was observed between the PIO trajectory and depression and anxiety among both sexes and stress symptoms in females. Our results highlight that developing overweight and obesity from childhood may be related to increased stress in males. [ABSTRACT FROM AUTHOR]

This study investigates for the first time the relationship between spiritual health (SH) and health-related quality of life (HRQoL) in different periods of life in healthy women, which could be important in the current critical post-pandemic situation. We recruited data from 2238 healthy women in the Tehran Lipid and Glucose Study (TLGS) framework, performed a cross-sectional study, and divided them into four age groups: 1) 20–34, 2) 35–44, 3) 45–54, and 4) 55≤ years. HRQoL and SH were measured using Short-Form 12-Item Health Survey version 2 and spiritual health inventory in Muslim adults (SHIMA−48). We defined low and high SH as the first and third tertile of SHIMA−48 scores. Most participants were in the first age group (39 percent), were married (74.7 percent), and were housewives (74.7 percent). The mean mental component summary score and its domains were directly associated with age. This subscale was significantly higher in individuals with high SH scores in all age groups. However, except for general health, other physical subscales did not differ significantly between the two levels of SH among the age groups studied. Results indicate higher HRQoL, especially mental health, in healthy women with increased spiritual well-being. This finding can be used in programs to improve psychological health in women. [ABSTRACT FROM AUTHOR]

Objectives COVID-19 has a relationship with patients 'demographic characteristics as well as their underlying diseases. This research has been conducted to evaluate factors' effect on Covid-19 patient's hospitalization rate and period in Hormozgan, Iran. Methods The inclusion criteria of this retrospective study included all patients diagnosed as COVID-19 patients after PCR who were referred to Covid-19 hospitals from February 2020 to June 2020 in Hormozgan province (3480 patients). The checklist was designed according to COVID-19 guidelines and approved by the World Health Organization and Iran Ministry of Health and Medical Education. These data were analyzed using descriptive (average-standard deviation-percentage) and analytical (including Chi-square, t-test, and regression tests) statistics with SPSS Ver.23 software. Results In this study, 1852 male patients (53.20%) with a median age of 43.11±21.72 and 1628 female patients (46/80%) with a median age of 44.86±22.40.The median age of men was significantly lower than the women's median age(P=0.02). The hospital stay length of male and female patients was reported 2.64±4.14 and 2.76±4.297; the death rate of patients in our study was 6.6%. Conclusions The results of this study showed that the hospital stay length of HIV-positive patients and patients with cardiovascular and pulmonary diseases is much longer than other people, which imposes many human and financial costs on the country's health care system. These results can improve health care system planning and improve medical services presented to covid-19 patients. [ABSTRACT FROM AUTHOR]

Context: One of the changes that occur in a person and lead to a change in the patient's sexual desire is chronic diseases, including spinal cord injury (SCI). Objectives: This study aimed to evaluate the epidemiology of sexual dysfunction (SD) in patients with SCI in Iran by a systematic review and meta-analysis. Methods: In the present systematic review and meta-analysis, using the keywords "spinal cord injury", "sexual dysfunction", and "Iran" a list of related articles were extracted from national and international databases. The search was conducted by two researchers in the national databases (SID, Magiran, and Irandoc) and international databases (Web of Science, PubMed, and Scopus). The necessary data were collected using a specialized checklist and analyzed using CMA v.2.0 software. Results: The result showed 183 articles were extracted in the initial search, and after reviewing the articles, six articles were included in the systematic review and meta-analysis stage. The prevalence of SD in patients with SCI was equal to 45.9%, 95% (CI: 30.2 - 62.4). Conclusions: The prevalence of SD and sexual dissatisfaction in patients with SCI was reported to be high. For this reason, it is suggested to do necessary interventions to improve the sexual satisfaction of these patients. [ABSTRACT FROM AUTHOR]

Aims: To investigate the journey of patients with diabetes in the healthcare system using nationally-representative patient-reported data. Methods: Participants were recruited using a machine-learning-based sampling method based on healthcare structures and medical outcome data and were followed up for three months. We assessed the resource utilization, direct/indirect costs, and quality of healthcare services. Results: One hundred fifty-eight patients with diabetes participated. The most utilized services were medication purchases (276 times monthly) and outpatient visits (231 times monthly). During the previous year, 90% of respondents had a laboratory fasting blood glucose assessment; however, less than 70% reported a quarterly follow-up physician visit. Only 43% had been asked about any hypoglycemia episodes by their physician. Less than 45% of respondents had been trained for hypoglycemia self-management. The annual average healthrelated direct cost of a patient with diabetes was 769 USD. The average out-ofpocket share of direct costs was 601 USD (78.15%). Medication purchases, inpatient services, and outpatient services summed up 79.77% of direct costs with a mean of 613 USD. Conclusion: Healthcare services focused solely on glycemic control and the continuity of services for diabetes control was insufficient. Medication purchases, and inpatient and outpatient services imposed the most out-ofpocket costs. [ABSTRACT FROM AUTHOR]

Background: Parents' adaptation affects the health outcomes of children with chronic kidney diseases (CKD). Identifying factors that affect parents' adaptation is necessary to understand their adaptation status. This study aims to explore factors related to the adaptation of parents who have children with CKD.Methods: This was a qualitative study with a content analysis approach. Seventeen parents of children with CKD were selected by using purposive sampling. The leading researcher performed semi-structured, in-depth, face-to-face interviews to collect data. Conventional content analysis was used to analyze data.Results: Two main categories extracted from the data were "adaptation facilitators" and "adaptation barriers." Adaptation facilitators were supported by three sub-categories: "social support", "family capability" and "spiritual beliefs". Four sub-categories of "adaptation barriers" were revealed as: "family-related barriers," "mental stress by others," "the chronic nature of the disease," and "unfavorable treatment conditions."Conclusions: Identifying the factors influencing parental adaptation helps the medical staff to make the necessary interventions to support the parents. According to this study, increasing parent access to the required information, supporting them financially and emotionally, and helping them identify support resources can facilitate their adaptation to their child's chronic illness. Also, identifying and eliminating adaptation barriers can help parents deal better with their child's chronic disease. [ABSTRACT FROM AUTHOR]

Objectives: Different drugs have different effects on the prognosis of patients with COVID-19. This study aimed to evaluate the effect of different drug regimens on patients with COVID-19, hospitalized in Sanandaj city. Methods: In this retrospective cohort study, 660 patients with COVID-19, hospitalized in the Tohid, Kowsar and Besat hospitals located Sanandaj (Kurdistan Province, Iran) were studied from February 2020 to February 2021 with clinical symptoms and positive test results. Results: The results of multivariate regression analysis showed the days of hospitalization for patients who had received the drug regimen 2 (Interferons (ReciGen/Ziphron) or Interferon Vectra (lopinavir/ritonavir)) was 1.92 times higher than those who had received the drug regimen 1 (hydroxychloroquine group or a combination of chloroquine and azithromycin) while a significant association was observed (OR = 1.92, 95% CI: 1.16–3.16, P = 0.011). Also, the hospitalization in ICU was longer in patients treated by the drug regimen 2 (Interferons (ReciGen/Ziphron) or Interferon Vectra (lopinavir/ritonavir)) (OR = 4.63, 95% CI: 1.80–11.82, P = 0.001), however, drug regimens did not show a significant effect on mortality and use of ventilator in patients (P > 0.05). Conclusion: The study results showed the drug regimens 2 and 5 increased the days of hospitalization and hospitalization in ICU, respectively, while the other drug regimens had no significant effect on mortality and use a ventilator in the studied patients and none of the drug regimens had an effect on reducing mortality compared to other ones. [ABSTRACT FROM AUTHOR]

Background: Kidney stone is the major cause of morbidity, and its prevalence is increasing in the world. This study aimed to assess the prevalence and risk factors of kidney stone in the adult population of southern Iran based on the data of the Kharameh Cohort Study. Methods: This cross-sectional study was conducted on 10,663 individuals aged 40–70 years old, using the baseline data of Kharamah cohort study, which started in 2014. Among all participants, 2251 individuals had a history of kidney stone. The participants' demographic characteristics, behavioral habits, and the history of underlying diseases were investigated. The crude and Age Standardized Prevalence Rate of kidney stones was calculated. Also, logistic regression was used to identify the predictors of kidney stone. To check the goodness of fit index of the model, we used the Hosmer–Lemeshow test. All analyses were performed in STATA software. Results: The prevalence of kidney stone was estimated 21.11%. Also, the Age Standardized Prevalence Rate in men and women was calculated 24.3% and 18.7%, respectively. The mean age of the participants was 52.15 years. Higher prevalence of kidney stone was seen in women aged 40–50 years (40.47%, p = 0.0001) and moderate level of social economic status (31.47%, p = 0.03), men with overweight (44.69%, p < 0.0001) and those in a very high level of social economic status (35.75%, p = 0.001). The results of multiple logistic regression showed that the chance of having kidney stone was 1.17 times higher in diabetic individuals, 1.43 times higher in hypertensive individuals, 2.21 times higher in individuals with fatty liver, and 1.35 times higher in individuals with overweight. The level of socio economic status, male sex, and age were the other factors related to kidney stone. Conclusion: In this study, underlying diseases such as fatty liver, diabetes, and hypertension as well as age, male sex, overweight, and high social economic status were identified as important risk factors for kidney stone. Therefore, identifying individuals at risk of kidney stone and providing the necessary training can greatly help to reduce this disease. However, health policymakers should prepare preventive strategies to reduce the occurrence of kidney stone. [ABSTRACT FROM AUTHOR]

Background: This study was conducted with the intension of providing a more detailed view about the dynamics of COVID-19 pandemic. To this aim, characteristics, implemented public health measures, and health outcome of COVID-19 patients during five consecutive waves of the disease were assessed.Methods: This study was a population-based cross-sectional analysis of data on adult patients who were diagnosed with COVID-19 during five waves of the disease in Iran. Chi-squared test, One-way ANOVA, and Logistic Regression analysis were applied. A detailed literature review on implemented public health policies was performed by studying published documents and official websites responsible for conveying information about COVID-19.Results: Data on 328,410 adult patients was analyzed. Main findings indicated that the probability of dying with COVID-19 has increased as the pandemic wore on, showing its highest odd during the third wave (odds ratio: 1.34, CI: 1.283-1.395) and has gradually decreased during the next two waves. The same pattern was observed in the proportion of patients requiring ICU admission (P < 0.001). First wave presented mainly with respiratory symptoms, gastrointestinal complaints were added during the second wave, neurological manifestations with peripheral involvement replaced the gastrointestinal complaints during the third wave, and central nervous system manifestations were added during the fourth and fifth waves. A significant difference in mean age of patients was revealed between the five waves (P < 0.001). Moreover, results showed a significant difference between men and women infected with COVID-19, with men having higher rates of the disease at the beginning. However, as the pandemic progressed the proportion of women gradually increased, and ultimately more women were diagnosed with COVID-19 during the fifth wave. Our observations pointed to the probability that complete lockdowns were the key measures that helped to mitigate the virus spread during the first twenty months of the pandemic in the country.Conclusion: A changing pattern in demographic characteristics, clinical manifestations, and severity of the disease has been revealed as the pandemic unfolded. Reviewing COVID-19-related public health interventions highlighted the importance of immunization and early implementation of restrictive measures as effective strategies for reducing the acute burden of the disease. [ABSTRACT FROM AUTHOR]

Background: As the pandemic unfolds, major concerns remain with those in disadvantaged positions who may be disproportionately affected. This paper aimed to present the characteristics of COVID-19 immigrant patients and investigate whether they were disproportionately affected by COVID-19 pandemic. Methods: A cross-sectional study was performed using data on 589,146 patients diagnosed with COVID-19 in Iran. Descriptive analyses were used to summarize the study population's characteristics. Chi-squared test and logistic regression model were applied. Results: After accounting for possible confounding covariates, being an immigrant was significantly associated with increased risk of death due to COVID-19 (OR 1.64, CI 1.568–1.727). When compared to Iranian-born patients, the prevalence of low blood oxygen levels on admission was higher among immigrant patients (53.9% versus 47.7%, P value < 0.001). Moreover, greater proportions of immigrants who were diagnosed with COVID-19 were admitted to an ICU (17% versus 15.8%, P value < 0.001). Patients aged 65 and above were the largest age category in both populations. However, there was a significant difference between the age profiles of patients, with children under the age of eighteen presenting 16% of immigrant patients vs 6.6% of Iranian-born patients (P value < 0.001). In both groups, more men were affected by COVID-19 than women, yet the sex bias was more prominent for migrant patients (P value < 0.001). Conclusion: The evidence from this study revealed that immigrant patients infected with COVID-19 were more likely to suffer from severe health outcome of the disease compared to Iranian-born patients. [ABSTRACT FROM AUTHOR]

Background: Oxidative stress (OS) and inflammation are common factors in patients with chronic kidney disease and increase the risk of cardiovascular disease (CVD) and death in these patients, particularly in hemodialysis (HD) cases. Exercise training is a therapeutic approach to reduce morbidity and mortality in these patients. The purpose of this study was to determine the effect of aerobic exercise training on OS factors in HD patients. Methods: This case-control study was performed over one year (From March 2019 to February 2020) at Kerman (south of Iran). Nineteen outpatient HD patients participated in an aerobic exercise training program during HD. Cycling was performed by mini-cycle in the first hour of HD, pedaling was started with the least tolerable time by the patients, and increased up to three-quarters of an hour based on the patient’s tolerance, three times a week for eight weeks. Also control group, 18 outpatient HD patients were selected and did not enter the exercise training program. Blood samples were collected before and after the intervention in both groups. Inflammatory factors such as albumin (Alb), C-reactive protein (CRP), ferritin, white blood cell (WBC) as well as, oxidative and nitrogenous factors such as malondialdehyde (MDA), carbonyl groups, uric acid, and ionic regenerating capacity were measured. Chi-square and independent t test were used to analyze the data and compare the two groups. Results: There were no significant differences in CRP, Alb, and uric acid between the two groups. In the test group, variables such as total antioxidant capacity (TAC), glutathione (GSH), protein carbonyl (PC), lipid peroxidation (LPO) products, ferric reducing ability of plasma (FRAP), and thiobarbituric acid reactive substances (TBARST) showed a significant difference after the intervention. The values of TAC, GSH, and FRAP in the case group were significantly higher than the same values in the control group (P≤0.0001 for all), but PC (P≤0.006) and TBARS (P≤0.026) values were higher in the control group after the intervention. The intervention had no effect on Alb and ferritin. But, uric acid levels decreased significantly in both groups after the intervention. In the case group, TAC, GSH, and FRAP increased (P=0.0001 for all), but PC, LPO, and TBARST decreased (P=0.0001, P≤0.03, and P≤0.02 respectively). Conclusion: The results of the present study showed that aerobic exercise training had no effect on inflammatory factors such as CRP, ferritin, and Alb. [ABSTRACT FROM AUTHOR]

Background: Inadequate health literacy (HL) in dialysis patients increases the risk of poor self-care and decreases severe self-care and severe negative health outcomes in these patients. This study aimed to investigate HL and its related factors in dialysis patients in Kerman, Iran, in 2021. Methods: This cross-sectional study was performed on 280 dialysis patients who referred to Kerman (Iran) dialysis centres. The participants were selected through multi-stage sampling method. The study was conducted using the Iranian Health Literacy Questionnaire (IHLQ). The higher score shows a better HL. Results: The mean age of the subjects was 57.75±13.87 years. The mean score of HL was 9.12±4.54 out of 20 points. During multivariate regression, there was a significant relationship between HL and age (β=-0.08, P=0.02) and level of education (elementary/ literacy (β=4.607, P<0.001), middle school (β=6.38, P<0.001), high school (β=8.573, P<0.001) and academic education (β=9.410, P<0.001), and there was a significant relationship between HL and eye disease (β=-0.903, P=0.001). Conclusion: Most participants did not have adequate HL, while HL as the most important determinant of self-care can improve patients’ quality of life and reduce their health care costs. Therefore, in order to increase self-care, planning and necessary interventions, the HL of these patients seems to be necessary. [ABSTRACT FROM AUTHOR]

BACKGROUND: End Stage Renal Diseases (ESRD) imposes a huge economic burden on the health system; however, there is a serious lack of data related to ESRD, especially at Sub-national level, in Iran. Calculating the burden of ESRD at National and Sub-national level provides an opportunity to apply cost-effective interventions for the purpose of prevention and treatment. The current study protocol aims to explain the general structure and methods that will be used in the burden of ESRD study in Iran from 1990 to 2013. METHODS: The prevalence, incidence, mortality and geographical and socioeconomic inequality trend of ESRD will be calculated through a comprehensive systematic review of published and unpublished data. Years of Life Lost due to premature mortality, and Years Lived with Disability and Disability-Adjusted Life Years (DALYs) will be quantified for ESRD by gender, age group, and province with their uncertainly intervals. “Spatio-Temporal” and “Bayesian multilevel autoregressive” will be applied to deal with data scarcity and misalignment problem which exist in the data sources. DISCUSSION: The findings of the burden of ESRD study will be useful to organize preventive, treatment also research priorities at national and sub-national levels in Iran. Better understanding of the magnitude of ESRD burden is essential to prevent the progression of chronic kidney diseases to the end stage phase which is considered as a devastating illness. [ABSTRACT FROM AUTHOR]

COVID-19 has been distinguished as a zoonotic coronavirus, like SARS coronavirus and MERS coronavirus. Tehran metropolis, as the capital of Iran, has a high density of residents that experienced a high incidence and mortality rates which daily increase the number of death and cases. In this study, the IDW (Inverse Distance Weight), Hotspots, and GWR (Geography Weighted Regression) Model are used as methods for analyzing big data COVID-19 in Tehran. The results showed that the majority of patients and deaths were men, but the death rate was higher in women than in men; also was observed a direct relationship between the area of the houses, and the infected rate, to COVID-19. Also, the results showed a disproportionate distribution of patients in Tehran, although in the eastern regions the number of infected people is higher than in other districts; the eastern areas have a high population density as well as residential land use, and there is a high relationship between population density in residential districts and administrative-commercial and the number of COVID-19 cases in all regions. The outputs of local R2 were interesting among patients and underlying disorders; the local R2 between hypertension and neurological diseases was 0.91 and 0.79, respectively, which was higher than other disorders. The highest rates of local R2 for diabetes and heart disease were 0.67 and 0.55, respectively. From this study, it can be concluded the restrictions must be considered especially, in areas densely populated for all people. [ABSTRACT FROM AUTHOR]

Objectives: This systematic review aims to summarize the mycological and clinical features of COVID-19-associated fungal infections (CAFIs) in Iran. Methods: PubMed, Web of Science, Scopus, Cochrane Library, SID, Magiran, IranDoc, and Google Scholar were searched for Persian and English articles published from January 1, 2020, to November 5, 2021, using a systematic search strategy. Studies on Iranian patients suffering from CAFIs were included in the review. Results: Twenty-two studies comprising 169 patients were retrieved. Reported CAFIs included candidiasis (85, 50.30%), mucormycosis (35, 20.71%), aspergillosis (29, 17.16%), fusariosis (6, 3.55%), three cases caused by rare pathogens (Rhodotorula mucilaginosa, Diaporthe foeniculina, and Sarocladium kiliense) and 11 (6.51%) uncharacterized mold infections. The most common underlying diseases were diabetes (67/168, 39.88%), cardiovascular diseases (55/168, 32.74%), and hypertension (43/168, 25.59%). The use of antibiotics (111/124, 89.52%), corticosteroids (93/132, 70.44%), and mechanical ventilation (66, 51.16%) were the most common predisposing factors. Totally, 72 (50.35%) of 143 patients with CAFIs died (data were not available for 26 patients). Conclusion: Fungal infections are evident to be a complication of COVID-19 in Iran; thus, clinicians should consider them as a differential diagnosis, especially in patients with comorbidities and previous antibiotic or corticosteroid use. [ABSTRACT FROM AUTHOR]

Background: Hemodialysis (HD) patients are at risk of viral infections such as hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency viruses (HIV). Current study aimed to determine the prevalence of HBV, HCV, and HIV among HD patients who attended the dialysis center in Fasa, Iran. Methods: Collectively, 2082 HD patients (1291 men, 791 women) took part in our 6-year follow-up study. Results: 2082 HD patients with a mean age of 56.2 ± 17.8 were included in our study. One (0.09%) patient was HBsAg positive, two (0.18%) patients were anti-HCV positive, and one (0.09%) was anti-HIV positive. There was no significant correlation between the paraclinical parameters of men and women. Conclusion: The present study showed a reduction in the prevalence of HBV, HCV, and HIV infections during 6 years of follow-up in HD patients. [ABSTRACT FROM AUTHOR]

Background: Delirium is a neurobehavioral syndrome, which is characterized by a fluctuation of mental status, disorientation, confusion and inappropriate behavior, and it is prevalent among hospitalized patients. Recognizing modifiable risk factors of delirium is the key point for improving our preventive strategies and restraining its devastating consequences. This study aimed to identify and investigate various factors predisposing hospitalized patients to develop delirium, focusing mostly on underlying diseases and medications. Method: In a prospective, observational trial, we investigated 220 patients who had been admitted to the internal, emergency, surgery and hematology-oncology departments. We employed the Confusion Assessment Method (CAM) questionnaire, The Richmond Agitation Sedation Scale (RASS), the General Practitioner Assessment of Cognition (GPCOG), demographic questionnaire, patient interviews and medical records. Multivariate logistic regression models were used to analyze the predictive value of medications and underlying diseases for daily transition to delirium.; demographics were analyzed using univariate analysis to identify those independently associated with delirium. Results: Two hundred twenty patients were enrolled; the emergency department had the most incident delirium (31.3%), and the surgery section had the least (2.4%); delirium was significantly correlated with older ages and sleep disturbance. Among multiple underlying diseases and the medications evaluated in this study, we found that a history of dementia, neurological diseases and malignancies increases the odds of transition to delirium and the use of anticoagulants decreases the incident delirium. Conclusion: Approximately 1 out of 10 overall patients developed delirium; It is important to evaluate underlying diseases and medications more thoroughly in hospitalized patients to assess the risk of delirium. [ABSTRACT FROM AUTHOR]

Background: Ecological studies showed that countries with national Bacillus Calmette-Guerin (BCG) vaccination programs for tuberculosis prevention reported lower incidences of severe and fatal COVID-19 than countries without such programs. Several studies have demonstrated that the BCG vaccine can induce long-term trained Immunity in bone marrow progenitor cells. In this study, we tried to evaluate the relationship between tuberculin skin test results, BCG scar, and COVID-19 outcomes among patients with confirmed COVID-19. Materials and Methods: This was a cross-sectional study. Cases included 160 patients with confirmed COVID-19 in Zahedan hospitals (southeast Iran) in 2020, selected by convenient sampling. PPD test was performed for all patients through the intradermal technique. Collected data included demographic information, underlying conditions, PPD test results, and COVID-19 outcome. Analysis was conducted utilizing ANOVA, χ2 test, and multivariate analysis (logistic regression). Results: The univariate analysis showed a positive relationship between older age, having underlying diseases, and positive tuberculin skin test results with the outcome of COVID-19. We also found a lower frequency of BCG scar among patients with death outcomes than recovered ones. In the multivariate analysis by logistic regression through the backward method, only age and underlying diseases remained predictors of death. Conclusion: Tuberculin test results might be dependent on age and underlying conditions. Our study did not show relationship between BCG vaccine and mortality in COVID-19 patients. Further investigations in different settings are required to reveal the efficacy of the BCG vaccine in preventing this devastating disease. [ABSTRACT FROM AUTHOR]

Background. The novel coronavirus disease 2019 (COVID-19) started in Wuhan, China, in December 2019. It spread widely around the world and was described as a pandemic by the World Health Organization (WHO). The knowledge regarding the mortality rate and risk factors of COVID-19 among the pediatric population is lacking. In this regard, we aimed to report the clinical and laboratory characteristics of deceased pediatric patients with SARS-CoV-2 infection. Method. This cross-sectional study was conducted in Mofid Children's Hospital, Tehran, Iran, from February 2020 to April 2021. Recorded documents of 59 pediatric patients (under 18 years old) assumed to have COVID-19 who had died in the COVID-19 ward and COVID-19 intensive care unit (ICU) were retrospectively evaluated. All statistical analyses were performed using SPSS software (v. 26.0, Chicago, IL). A P value of less than 0.05 was considered statistically significant. Results. From 711 COVID-19 definite and suspected patients, 59 children died. Of these deceased pediatric patients, 34 were boys (57.62%) and 25 were girls (42.37%), with a total mean age of 5.6 years. The median length of stay in the hospital was 10 days (range 1–215). 91.52% had underlying comorbidities of which neurological diseases accounted for the largest share. 54 patients were admitted to the ICU and 83.05% of them had intubation during their hospitalization. In addition, the most common reasons for death in our study were related to respiratory and multiorgan failure. Conclusion. According to our knowledge, we are the first team to report such a thorough study in the field of COVID-19 pediatric mortality in Iran. Mortality was observed in all age groups of children, especially in those with previous comorbidities, specifically neurological disease. Abnormally elevated tests of ESR, CRP, LDH, AST, and ALT as well as the presence of proteinuria and hematuria were found in more than 50% of patients in our investigations, and ICU admission between both definite and suspected groups had significant differences, so monitoring and considering these factors may help to control and reduce the progression of the disease to death. [ABSTRACT FROM AUTHOR]

This study aimed to transform the input of a large dataset into the output of interpretable information. Hence, multivariate statistical methods were carried out to analyze physicochemical parameters in 34 rivers during a 17-year period (1997–2014). Cluster analysis divided the study area into spatially different riverine water quality sub-regions described in ascending order of water quality as severely polluted (SP), highly polluted (HP), polluted (P), moderately polluted (MP), lightly polluted (LP), and not polluted (NP). By diagnosing threats and identifying fragile zones, water contamination sources responsible for impaired water quality in the study area recognized as natural pollutants in LP, municipal wastes in P, discharge of industrial effluents in MP, natural geochemical formations in SP and HP, and superficial flows of agricultural lands in SP, HP, and MP. The dominant water type in each zone was classified into Na–Cl, Na–Cl, Na–Mg–Ca–Cl–SO4, Na–Ca–Mg–Cl–SO4, Na–Ca–Cl, and Ca–Mg–HCO3–SO4 groups for SP, HP, P, MP, LP, and NP, respectively. To explore aesthetic aspects of drinking water application, hazard quotient (HQ) was applied for children and adults in terms of ingestion and dermal exposure. Overall health risk assessment revealed the order of impacts of the secondary water quality parameters as Cl− > Na+ > total dissolved solids (TDS) > Ca2+ > SO42− > Mg2+. Furthermore, hazard index (HI) ranged from 0.011 to 31.439 and 0.010 to 30.122 for children and adults, respectively, indicating a potential health risk regarding chloride throughout the whole region excluding NP. To identify significant agents in water quality, principal component analysis extracted 3 varifactors (VFs), with the eigenvalues of 4.74, 1.19, and 0.85, respectively, explained about 83% of the variance. The most important parameters in the first factor were TDS, electrical conductivity, SAR, TH, Na+, Cl−, and SO42− accounting for 58% of the total variance. The most influenced parameters in the second and third factors were pH and HCO3−, respectively, with variance coverage of 26%. These factors indicated that the hydrochemical characteristics of the water originated by natural interactions (existing salt domes, evaporation, weathering, and soil erosion) and anthropogenic activities (fertilizer-rich flows of agro-fields and domestic/industrial disposals), which must be minimized in rivers to supply the population with hygienic water. [ABSTRACT FROM AUTHOR]

Introduction: To reduce mortality in hospitalized patients with COVID‐19 and cardiovascular disease (CVD), it is necessary to understand the relationship between patient's symptoms, risk factors, and comorbidities with their mortality rate. To the best of our knowledge, this paper is the first which take into account the determinants like risk factors, symptoms, and comorbidities leading to mortality in CVD patients who are hospitalized with COVID‐19. Methods: This study was conducted on 660 hospitalized patients with CVD and COVID‐19 recruited between January 2020 and January 2021 in Iran. All patients were diagnosed with the previous history of CVD like angina, myocardial infarction, heart failure, cardiomyopathy, abnormal heart rhythms, and congenital heart disease before they were hospitalized for COVID‐19. We collected data on patient's signs and symptoms, clinical and paraclinical examinations, and any underlying comorbidities. t test was used to determine the significant difference between the two deceased and alive groups. In addition, the relation between pairs of symptoms and pairs of comorbidities has been determined via correlation computation. Results: Our findings suggest that signs and symptoms such as fever, cough, myalgia, chest pain, chills, abdominal pain, nausea, vomiting, diarrhea, and anorexia had no impact on patients' mortality. There was a significant correlation between COVID‐19 cardiovascular patients' mortality rate and symptoms such as headache, loss of consciousness (LOC), oxygen saturation less than 93%, and need for mechanical ventilation. Conclusions: Our results might help physicians identify early symptoms, comorbidities, and risk factors related to mortality in CVD patients hospitalized for COVID‐19. [ABSTRACT FROM AUTHOR]

Background: In the present COVID-19 crisis, one of the greatest challenges for research funding at both the international and national level is selecting the best research topic to achieve efficiency and equity in health research and to address the knowledge gap urgently raised due to the event. Despite international recommendations, countries should consider their context-specific situation and define local research priorities. We aimed to exercise a priority-setting activity to identify the knowledge gaps and suggest research priorities in response to the COVID-19 epidemic in Iran.Methods: First, we tried to identify the contextual knowledge gaps based on an online survey, performing key informant interviews (i.e. health professionals, policy-makers and managers) and media analysis. We also performed a literature review and considered international research priorities for COVID-19. Subsequently, we prepared a list of research questions and challenges to respond to the COVID-19 crisis in Iran using a systems approach. Then we mapped approved COVID-19 research projects in the country to research questions. Finally, we compared the identified research questions (not challenges) with the prioritized research from international organizations and then prioritized them for Iran.Results: We found risk factors and epidemiological dissemination patterns of the virus and its consequences in an epidemiology domain, implementation of clinical and hygiene in a clinical management domain, genetic studies for targeting prevention and treatment in a candidate treatment and vaccine research and development (R&D) knowledge domain, examination of the manifestations of ethics in society instead of ethics in research in an ethics domain, "care, access and health system" and "public health and participation in response to public health and clinical research" as two sub-domains of a social sciences domain, and finally, no new questions in either the virology, transmission, diagnosis or animal and environmental domain.Conclusions: In the event of global health crises like COVID-19, prioritization of research questions can be done globally, but some of the research priorities are context-specific and may vary by regional needs. To better manage research resources, researchers must respond to the challenges faced in each country based on its political, economic, social and cultural characteristics, and to make evidence-informed decisions, global knowledge gaps must be customized in each country. [ABSTRACT FROM AUTHOR]

A retrospective secondary analysis of 4,200 patients was collected from two academic medical centers. Delirium was assessed using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) in all patients. Univariate and multivariate Cox models, logistic regression analysis, and Chi-square Automatic Interaction Detector (CHAID) decision tree modeling were used to explore delirium risk factors. Increased delirium risk was associated with exposed only to artificial light (AL) hazard ratio (HR) 1.84 (95 % CI: 1.66-2.044, P<0.001), physical restraint application 1.11 (95 % CI: 1.001-1.226, P=0.049), and high nursing care requirements (>8 hours per 8-hour shift) 1.18 (95 % CI: 1.048-1.338, P=0.007). Delirium incidence was inversely associated with greater family engagement 0.092 (95 % CI: 0.014-0.596, P=0.012), low staff burnout and anticipated turnover scores 0.093 (95 % CI: 0.014-0.600, P=0.013), non-ICU length-of-stay (LOS)<15 days 0.725 (95 % CI: 0.655-0.804, P<0.001), and ICU LOS ≤15 days 0.509 (95 % CI: 0.456-0.567, P<0.001). CHAID modeling indicated that AL exposure and age <65 years were associated with a high risk of delirium incidence, whereas SOFA score ≤11, APACHE IV score >15 and natural light (NL) exposure were associated with moderate risk, and female sex was associated with low risk. More rapid time to delirium onset correlated with baseline sleep disturbance (P=0.049), high nursing care requirements (P=0.019), and prolonged ICU and non-ICU hospital LOS (P<0.001). Delirium recurrence correlated with age >65 years (HR 2.198; 95 % CI: 1.101-4.388, P=0.026) and high nursing care requirements (HR 1.978, 95 % CI: 1.096-3.569), with CHAID modeling identifying AL exposure (P<0.001) and age >65 years (P=0.032) as predictive variables. Development of ICU delirium correlated with application of physical restraints, high nursing care requirements, prolonged ICU and non-ICU LOS, exposure exclusively to AL (rather than natural), less family engagement, and greater staff burnout and anticipated turnover scores. ICU delirium occurred more rapidly in patients with baseline sleep disturbance, and recurrence correlated with the presence of delirium on ICU admission, exclusive AL exposure, and high nursing care requirements. [ABSTRACT FROM AUTHOR]

Background: Decreased bone mineral density (BMD) is one of the complications of kidney transplantation, which is associated with many factors. However, the findings of relevant studies are inconsistent and contradictory. Objective: To investigate the prevalence of BMD reduction and its associated factors in kidney transplant recipients. Methods: All kidney transplant recipients (n=69), referred to Shahid Mostafa Khomeini Hospital in Ilam, southwest of Iran, were included in this study between 2016 and 2018. The BMD of the lumbar spine and femoral neck was examined using dual-energy X-ray absorptiometry. According to the Z-score and Tscore, the patients were divided into two age groups: <50 years and >50 years. All patients' demographic characteristics, background variables, and laboratory parameters were evaluated. Descriptive statistics were measured, and binary and multinomial logistic regression analyses were performed. Results: The overall prevalence of osteoporosis in the femur and lumbar spine was 38% and 32%, respectively. In patients aged <50 years, femoral head osteoporosis showed a significant relationship with the vitamin D level and sex. In patients aged >50 years, advancing age and duration of prednisolone consumption were associated with an increased risk of osteoporosis and osteopenia at the femoral neck (P<0.05). Besides, the duration of prednisolone use was associated with osteoporosis at the lumbar spine (RRR=1.02, P<0.05). Conclusion: Various factors, including prednisolone consumption, affect BMD reduction in kidney transplant recipients. Regular monitoring of BMD, maximum reduction of prednisolone dose, training on the use of effective supplements, and other preventive and supportive measures can be helpful for this group. [ABSTRACT FROM AUTHOR]

Morbidity and mortality are higher in older adults with community-acquired pneumonia (CAP) than in other age groups. Also, CAP in older adults has various clinical manifestations with other. A higher mortality rate in the elderly with CAP may contribute to a delay in management. Consequently, the purpose of this study was to investigate the clinical and laboratory manifestations of CAP in the elderly. This cross-sectional study was conducted on 221 elderly patients with CAP who were admitted to Ayatollah Rouhani Hospital, in Babol, northern of Iran, in 2017-2019. Patient outcomes included 170 cases that recovered from CAP, and 51 cases that died of complications. Patients were evaluated in terms of their clinical and laboratory manifestations. The most common symptoms of pneumonia were cough (79.6%), sputum (73.8%), weakness (72.9%), fever (56%), dyspnea (46.2%). The most frequent underlying disease was ischemic heart disease (43.9%). In our study, clinical and laboratory characteristics in older patients with CAP were evaluated and compared with other studies confirming past findings, but there were differences in some cases, such as vital signs, gastrointestinal symptoms, and disturbance of the level of consciousness. Therefore, it recommends carefully taking the patients' initial histories and accurately recording their clinical and laboratory symptoms. [ABSTRACT FROM AUTHOR]

Objective: Weight status and growth during childhood are indicative of healthy development throughout the lifespan. It is well understood that dietary patterns and overall quality of diet can prevent disease, improve health status and optimise growth and development. The current study investigates the relationship between overall diet quality and measures of childhood development including body mass index and height-for-age in 6-year-old children.Methods: This cross-sectional study was conducted across 788 6-year-old children from Tehran, Iran, in 2018. Food quality score (FQS) was used to assess overall diet quality, in addition to a modified food-based diet quality score specific to children (modified FQS) developed by our group.Results: Participants in the highest tertile using the modified FQS had the highest height-for-age z-score (HAZ) (-0.509 ± 0.028 vs -0.605 ± 0.028; P = .048). In contrast, participants in the highest tertile assessed using the original FQS had a higher BMI for age z-score (BAZ) compared to participants in the first tertile (0.391 ± 0.072 vs 0.266 ± 0.072; P = .023). Children within the highest tertile, according to the original FQS, compared to those within the lowest tertile were 49% less likely to be categorised as severely underweight (OR: 0.51; 95% CI: 0.47-0.98).Conclusions: Findings presented in this study demonstrate that FQS was significantly associated with participants characterised as severely underweight; however, FQS was not associated with other anthropometric parameters. Therefore, future well-designed cohort studies are required to address limitations of the current study. [ABSTRACT FROM AUTHOR]

Age is a known predictor of blood pressure (BP); however, the literature mostly includes cross-sectional investigations. This prospective cohort study aimed to decompose the cross-sectional and longitudinal age effects on BP. The secondary data were obtained from the Tehran lipid and glucose study, which comprised six repeated measurements of participants, with median follow-up of 15.8 (interquartile range of 14.2-16.9) years. The sample is representative of the metropolitan area of Tehran, Iran, containing 7,460 participants aged 20-70. The cross-sectional and longitudinal effects of age (age at baseline and aging, respectively) were fitted in the mixed effects models, taking systolic, diastolic, and pulse BPs as response, adjusting for adiposity, smoking, diabetes, and antihypertensive medication, and stratifying for sex and 10-year age-groups. The mean age at baseline was 41.3 (SD = 12.9) years, and 41.7% of the participants were male. Age at baseline and aging were directly associated with BP, aging owned the weaker effect, and the largest distinction were for systolic blood pressure of men aged 40-49 years (0.75 vs 0.10, p-value < .001). Moreover, the aging effects on systolic and diastolic BPs were higher in men than women, in the age groups 40-49 and 30-39 years (0.35 vs 0.10 and 0.30 vs 0.07, p-values < .001), respectively. Adjusting for adiposity remarkably declined the impact of aging on BP, among the < 50 years old. [ABSTRACT FROM AUTHOR]