Repository of Research and Investigative Information Isfahan University of Medical Sciences
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Plant-based eating pattern and psychological symptoms: a cross-sectional survey among patients with migraine
No full textObjectives:The present study evaluated the association between plant-based diet index (PDI) and psychological symptoms, including depressive symptoms, stress, and anxiety among Iranian women diagnosed with migraine headaches.Methods:A cross-sectional study was conducted on 262 patients with migraine (aged 20-50 years; body mass index, 18.5-30 kg/m(2)). Three versions of the PDI were calculated: overall PDI, healthy PDI (hPDI), and unhealthy PDI (uPDI) based on dietary data collected via a 168-item food frequency questionnaire (FFQ). Psychological symptoms, including depressive symptoms, anxiety, and stress, were assessed using the Depression, Anxiety, Stress Scale-21 (DASS-21) questionnaire.Results:After adjustment for potential confounders, patients in the highest tertile of the PDI showed a lower risk of depressive symptoms odds ratio (OR) = 0.41, 95% confidence interval (CI): 0.22, 0.77. Furthermore, inverse associations were evident between the PDI score and the risk of stress (OR = 0.46, 95% CI: 0.24, 0.85).Discussion:Higher adherence to a plant-based eating pattern is associated with a reduced risk of psychological symptoms. However, future longitudinal studies and clinical trials should replicate our observations and delineate the underlying mechanisms driving these associations
Intersecting SARS-CoV-2 spike mutations and global vaccine efficacy against COVID-19
No full textIn line with encountering the world with the emergence of vaccine-resistance variants of SARS-CoV-2, 15,669,529 samples that received COVID-19 vaccines until April 2023 were investigated as two doses in the first phase and booster vaccinations in the second phase. The analysis shows that D614G and P681 mutations occurred in both phases. The E484 and Y655 mutations significantly emerged during the second phase. The 762-889 and 254-381 regions are revealed as conserved parts and could be considered in vaccine design. The Kruskal-Wallis test revealed a significant reduction in single mutations between populations with 20-50 and those with 70-100 vaccination coverage (p=0.017). The Mann-Whitney U test proposes a link between vaccination and suppression of viral mutation rates. Dynamic modeling suggests that key mutations have facilitated the virus' evolution and immune escape. The study's findings are crucial for understanding virus genome mutations, especially E614 and P681 in Delta and E484 and H655 in Omicron. This highlights the need to adjust strategies and strengthen global efforts in combating the pandemic
First-year treatment response predicts the following 5-year disease course in patients with relapsing-remitting multiple sclerosis
No full textPredicting long-term prognosis and choosing the appropriate therapeutic approach in patients with Multiple Sclerosis (MS) at the time of diagnosis is crucial in view of a personalized medicine. We investigated the impact of early therapeutic response on the 5-year prognosis of patients with relapsing-remitting MS (RRMS). We recruited patients from MSBase Registry covering the period between 1996 and 2022. All patients were diagnosed with RRMS and actively followed-up for at least 5 years to explore the following outcomes: clinical relapses, confirmed disability worsening (CDW) and improvement (CDI), EDSS 3.0, EDSS 6.0, conversion to secondary progressive MS (SPMS), new MRI lesions, Progression Independent of Relapse Activity (PIRA). Predictors included demographic, clinical and radiological data, and sub-optimal response (SR) within the first year of treatment. Female sex (HR 1.27; 95 CI 1.16-1.40) and EDSS at baseline (HR 1.19; 95 CI 1.15-1.24) were independent risk factors for the occurrence of relapses during the first 5 years after diagnosis, while high-efficacy treatment (HR 0.78; 95 CI 0.67-0.91) and age at diagnosis (HR 0.83; 95 CI 0.79-0.86) significantly reduced the risk. SR predicted clinical relapses (HR = 3.84; 95 CI 3.51-4.19), CDW (HR = 1.74; 95 CI 1.56-1.93), EDSS 3.0 (HR = 3.01; 95 CI 2.58-3.51), EDSS 6.0 (HR = 1.77; 95 CI 1.43-2.20) and new brain (HR = 2.33; 95 CI 2.04-2.66) and spinal (HR 1.65; 95 CI 1.29-2.09) MRI lesions. This study highlights the importance of selecting the appropriate DMT for each patient soon after MS diagnosis, also providing clinicians with a practical tool able to calculate personalized risk estimates for different outcomes
DrugGen enhances drug discovery with large language models and reinforcement learning
No full textTraditional drug design faces significant challenges due to inherent chemical and biological complexities, often resulting in high failure rates in clinical trials. Deep learning advancements, particularly generative models, offer potential solutions to these challenges. One promising algorithm is DrugGPT, a transformer-based model, that generates small molecules for input protein sequences. Although promising, it generates both chemically valid and invalid structures and does not incorporate the features of approved drugs, resulting in time-consuming and inefficient drug discovery. To address these issues, we introduce DrugGen, an enhanced model based on the DrugGPT structure. DrugGen is fine-tuned on approved drug-target interactions and optimized with proximal policy optimization. By giving reward feedback from protein-ligand binding affinity prediction using pre-trained transformers (PLAPT) and a customized invalid structure assessor, DrugGen significantly improves performance. Evaluation across multiple targets demonstrated that DrugGen achieves 100 valid structure generation compared to 95.5 with DrugGPT and produced molecules with higher predicted binding affinities (7.22 6.30-8.07) compared to DrugGPT (5.81 4.97-6.63) while maintaining diversity and novelty. Docking simulations further validate its ability to generate molecules targeting binding sites effectively. For example, in the case of fatty acid-binding protein 5 (FABP5), DrugGen generated molecules with superior docking scores (FABP5/11, -9.537 and FABP5/5, -8.399) compared to the reference molecule (Palmitic acid, -6.177). Beyond lead compound generation, DrugGen also shows potential for drug repositioning and creating novel pharmacophores for existing targets. By producing high-quality small molecules, DrugGen provides a high-performance medium for advancing pharmaceutical research and drug discovery
Protective Effects of Ginsenosides on Drug-induced Cardiotoxicity: A New Therapeutic Approach with Focus on Molecular Mechanisms in Cardio-oncology Field
No full textPanax ginseng (PG), a staple in traditional medicine in Korea and China, holds a rich history of application for various diseases. Notably, its primary active components, ginsenosides, exhibit diverse therapeutic effects. Chemotherapy-induced side effects pose significant challenges to the treatment outcomes of cancer patients. Current strategies for managing the adverse effects of chemotherapy exhibit limited efficacy and have the potential to induce various detrimental side effects. In the realm of complications, cardiotoxicity poses a serious threat, ranking as the second major contributor to illness and death in individuals suffering cancer. It is linked to various cellular mechanisms such as oxidative stress, inflammation, apoptosis, autophagy, endoplasmic reticulum stress, and aberrant myocardial energy metabolism. Both in vivo and in vitro experiments confirm that ginsenosides undeniably present non-toxic and efficacious alternatives for addressing chemotherapy-induced side effects, including cardiotoxicity, neurotoxicity, nephrotoxicity, hepatotoxicity, immunotoxicity, and hematopoietic inhibition. Hence, there is a need to produce novel and potent drugs sourced from natural, non-toxic compounds to address the side effects induced by chemotherapy. The emphasis should be on the underlying mechanisms targeting mentioned cellular pathways. In this comprehensive review, we consolidate current knowledge and summarization with this aim and shed light on the future research of PG in cardio-oncology
Standardized Definition of Progression Independent of Relapse Activity (PIRA) in Relapsing-Remitting Multiple Sclerosis
No full textIMPORTANCE: Progression independent of relapse activity (PIRA) is a significant contributor to long-term disability accumulation in relapsing-remitting multiple sclerosis (MS). Prior studies have used varying PIRA definitions, hampering the comparability of study results. OBJECTIVE: To compare various definitions of PIRA. DESIGN, SETTING, AND PARTICIPANTS: This cohort study involved a retrospective analysis of prospectively collected data from the MSBase registry from July 2004 to July 2023. The participants were patients with MS from 186 centers across 43 countries who had clinically definite relapsing-remitting MS, a complete minimal dataset, and 3 or more documented Expanded Disability Status Scale (EDSS) assessments. EXPOSURE: Three-hundred sixty definitions of PIRA as combinations of the following criteria: baseline disability (fixed baseline with re-baselining after PIRA, or plus re-baselining after relapses, or plus re-baselining after improvements), minimum confirmation period (6, 12, or 24 months), confirmation magnitude (EDSS score at/above worsening score or at/above threshold compared with baseline), freedom from relapse at EDSS score worsening (90 days prior, 90 days prior and 30 days after, 180 days prior and after, since previous EDSS assessment, or since baseline), and freedom from relapse at confirmation (30 days prior, 90 days prior, 30 days before and after, or between worsening and confirmation). MAIN OUTCOME AND MEASURE: For each definition, we quantified PIRA incidence and persistence (ie, absence of a 3-month confirmed EDSS improvement over >/=5 years). RESULTS: Among 87 239 patients with MS, 33 303 patients fulfilled the inclusion criteria; 24 152 (72.5) were female and 9151 (27.5) were male. At the first visits, the mean (SD) age was 36.4 (10.9) years; 28 052 patients (84.2) had relapsing-remitting MS, and the median (IQR) EDSS score was 2.0 (1.0-3.0). Participants had a mean (SD) 15.1 (11.9) visits over 8.9 (5.2) years. PIRA incidence ranged from 0.141 to 0.658 events per decade and persistence from 0.753 to 0.919, depending on the definition. In particular, the baseline and confirmation period influenced PIRA detection. The following definition yielded balanced incidence and persistence: a significant disability worsening compared with a baseline (reset after each PIRA event, relapse, and EDSS score improvement), in absence of relapses since the last EDSS assessment, confirmed with EDSS scores (not preceded by relapses within 30 days) that remained above the worsening threshold for at least 12 months. CONCLUSION AND RELEVANCE: Incidence and persistence of PIRA are determined by the definition used. The proposed standardized definition aims to enhance comparability among studies
Dietary Quality Index-International and the odds of irritable bowel syndrome: a case-control study
No full textIrritable bowel syndrome (IBS) is a common gut-brain interaction disorder. The etiology of IBS is not entirely elucidated, however, among the risk factors, dietary factors are regarded as crucial. Previous studies have primarily investigated the association of single nutrients and food groups with odds of IBS, rather than diet quality, which considers the interaction of food groups in odds of disease. Thus, the current study sought to investigate the association of dietary quality index-international (DQI-I) and odds of IBS in Iranian adults. In this case-control study, dietary intakes of 100 IBS cases and 310 healthy controls were examined using a validated Dish-based Semi-quantitative Food Frequency Questionnaire (DS-FFQ). DQI-I score was then calculated based and categorized into tertiles. The Persian version of the Rome IV questionnaire was utilized to assess IBS. Multivariable logistic regression was used to assess the association of DQI-I score and the odds of IBS. After controlling for potential confounders, no significant association was shown between DQI-I scores and IBS odds among whole and gender-stratified groups. Although DQI-I represents a healthy diet, the results of the current case-control study demonstrated that, a higher DQI-I score was not associated with reduced odds of IBS in fully adjusted regression models. Considering inherent limitations as well as the scarce evidence regarding the association between DQI-I and odds of IBS, further large-scale, prospective studies are required to confirm our findings
Comment on: Intraocular Lens Power Calculation - Comparing Big Data Approaches to Established Formulas
No full textTreatment of Cardiovascular Manifestations in Transgender Individuals
No full textThe transgender population has been steadily increasing, with more individuals seeking gender-affirming care to align their physical characteristics with their gender identity. Despite advances in healthcare, transgender individuals face significant barriers to accessing culturally competent care, resulting in heightened cardiovascular risks and disparities. Cardiovascular disease prevalence among transgender individuals is influenced by a combination of physiological, psychological, and social factors, including the impacts of gender-affirming hormone therapy, surgical interventions, and minority stress. This review examines the cardiovascular risks associated with estrogen therapy in transfeminine individuals and testosterone therapy in transmasculine individuals, highlighting their effects on lipid profiles, thromboembolic risks, and metabolic parameters. Furthermore, it explores the implications of gender-affirming surgeries and the role of psychosocial stress in cardiovascular outcomes. Current evidence underscores the need for tailored risk assessment, proactive management strategies, and lifestyle interventions to optimize cardiovascular health in this population. Significant research gaps remain regarding the long-term cardiovascular effects of gender-affirming care. Large-scale, prospective studies and the development of transgender-specific cardiovascular care guidelines are crucial to address these gaps. This review advocates for a multidisciplinary, patient-centered approach to mitigate cardiovascular risks and improve outcomes for transgender individuals
The role of nuclear medicine in neurodegenerative diseases: a narrative review
No full textNeurodegenerative diseases, such as Alzheimer's, Parkinson's, and Lewy body dementia, are associated with the accumulation of brain proteins, leading to neuroinflammation, disruption of cellular clearance mechanisms, and neuronal death. Nuclear medicine, utilizing technologies like PET and SPECT, plays a crucial role in diagnosing and managing these disorders. Recent advancements in nuclear medicine have enhanced the understanding of disease pathophysiology and facilitated the development of tailored therapeutics. This study aims to address gaps in understanding nuclear medicine's potential to improve early diagnosis, monitor disease progression, and evaluate therapeutic effectiveness. In this review, we analyzed 28 papers and summarized their findings. PET radioligands have revolutionized the in vivo measurement of pathological targets in neurological diseases, offering new insights into the pathophysiology of neurodegenerative conditions. Amyloid PET has emerged as a reliable diagnostic imaging tool, accurately identifying cerebral amyloid-beta accumulation and enabling early differential diagnosis in clinical settings. Furthermore, radiopharmaceuticals such as 18FFlortaucipir, 18FFDOPA, and TSPO ligands provide significant advancements in the diagnosis and treatment of neurodegenerative disorders