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Clinical and psychological factors associated with fear of relapse in people with multiple sclerosis: A cross-sectional study
No full textBackground: Fear of relapse (FoR) is one of the main psychological concerns in people with relapsing-remitting multiple sclerosis (PwRRMS). It has disastrous consequences on treatment adherence, quality of life (QoL), and clinical course. Although the issue is closely linked to psychosocial aspects, it is not widely explored despite its overall impact on managing the condition. The determinants of FoR are vital for the optimization of therapeutic intervention toward ensuring patient welfare. Methods: This cross-sectional study, carried out in Isfahan, Iran, from December 2023 to September 2024, investigated demographic, clinical, and psychological characteristics in PwRRMS. The level of FoR was measured by the Fear of Relapse Scale, and for anxiety, depression, and obsessive–compulsive symptoms, the Beck Anxiety Inventory (BAI), Beck Depression Inventory-II (BDI-II), and the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) were used, respectively. Correlation between these factors were analyzed using linear regression. Results: A total of 189 PwRRMS were included. Multivariable linear regression analysis identified significant correlation between the higher annualized relapse rate (ARR) (B = 10.18, standardized 0.14, p-value < 0.05), anxiety (B = 0.32, standardized β = 0.19, p-value < 0.05), depression (B = 0.63, standardized β = 0.42, p-value < 0.001) and Expanded Disability Status Scale (EDSS) (B = 2.19, standardized β = 0.11, p-value < 0.05) with the FoR among PwRRMS. On the other hand, other demographic, clinical, and psychological variables, including disease duration, disability, and obsessive behavior, were found to lack a significant correlation with FoR (p-value < 0.05). Conclusion: This study points out that ARR, anxiety, and depression are among the leading independent risk factors of FoR in PwRRMS. Given the great potential for attenuation with focused treatments and psychological consultation, becoming major contributors to the decrease of FoR and, importantly, to improved overall patient well-being, their proper management and clinical follow-up should be considered an important issue in dealing with such patients
Characterising acute and chronic care needs: insights from the Global Burden of Disease Study 2019
No full textChronic care manages long-term, progressive conditions, while acute care addresses short-term conditions. Chronic conditions increasingly strain health systems, which are often unprepared for these demands. This study examines the burden of conditions requiring acute versus chronic care, including sequelae. Conditions and sequelae from the Global Burden of Diseases Study 2019 were classified into acute or chronic care categories. Data were analysed by age, sex, and socio-demographic index, presenting total numbers and contributions to burden metrics such as Disability-Adjusted Life Years (DALYs), Years Lived with Disability (YLD), and Years of Life Lost (YLL). Approximately 68% of DALYs were attributed to chronic care, while 27% were due to acute care. Chronic care needs increased with age, representing 86% of YLDs and 71% of YLLs, and accounting for 93% of YLDs from sequelae. These findings highlight that chronic care needs far exceed acute care needs globally, necessitating health systems to adapt accordingl
The Risk of Obstructive Sleep Apnea and Sleep Quality as Predictors of Quality of Life in Patients with Chronic Obstructive Pulmonary Disease (COPD): A Cross-sectional Study
No full textBackground: Chronic obstructive pulmonary disease (COPD) is the most common chronic respiratory disease and the fourth leading cause of death globally. Identifying factors affecting the quality of life of these patients as a key component in developing health-treatment policies can facilitate disease management and reduce its complications. Objectives: The present study aimed to identify some factors affecting the quality of life of COPD patients. Methods: This cross-sectional investigation was executed involving 110 individuals diagnosed with COPD. Referring to the respiratory clinics of teaching hospitals in Khuzestan province. They were selected using a convenience sampling method. The study instruments included the demographic checklist, the obstructive sleep apnea (OSA), Berlin Questionnaire (BQ), the Pittsburgh Sleep Quality Index (PSQI), and the St. George Respiratory Questionnaire (SGRQ). Data were analyzed using SPSS-22 software and Kolmogorov Smirnov, Pearson correlation coefficient, independent t-test, ANOVA, and multiple linear regression analyses. The level of statistical significance was established at 0.05. Results: The average age of the participants in the study was 54.59 ± 10.62. 40.9% of patients were at high risk of OSA. The mean sleep quality score was 6.55 ± 4.53, and 59.01% had poor sleep quality. The mean quality of life score was 53.86 ± 23.55, and 22.7% were at the weak level. The two variables, OSA (β = 0.361, P < 0.001) and sleep quality (β = 0.268, P < 0.001), collectively account for 27% of the variance observed in the quality of life variable (R2 = 0.271). Conclusions: Management of OSA risk and enhancement of sleep quality are regarded as critical factors in improving the quality of life for patients with COPD, thereby fostering greater productivity in their daily activities
Domestic violence in pregnancy: a systematic review of clinical guidelines
No full textBackground: Domestic violence is a public health concern and human rights violation affecting more than one-third of all pregnant women globally. Abused pregnant women need several interventions to reduce domestic violence and its negative consequences on mother and child. The purpose of this study was to determine the quality, scope, and consistency of clinical guidelines for managing domestic violence during pregnancy. Methods: This systematic review was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Electronic databases of Scopus, PubMed, Embase, Web of Science, Up-to-date, Cochrane Library database, Google Scholar, and Guideline repositories, including NICE, SIGN, GAC, NHMRC, NGC, New Zealand Guidelines Group, TRIP, AHRQ, G-I-N, and MD Consult, using appropriate keywords were searched. Included studies were clinical guidelines containing recommendations about domestic violence in pregnancy and postpartum. Two reviewers used the AGREE II (Appraisal of Guidelines, Research, and Evaluation version 2) instrument to evaluate the quality of guidelines, and textual syntheses were used to appraise and compare the relevant recommendations. Out of 381 relevant published guidelines, 14 clinical guidelines were ultimately reviewed systematically. Results: Seven countries had a clinical guideline for domestic violence during pregnancy. None of the reviewed guidelines was rated > 75% across all domains of AGREE II while the highest-rated domains were scope, purpose, and clarity. Four related categories were recognized from the synthesis of recommendations within the appropriate guidelines. These consisted of an introduction, domestic violence in pregnancy, the role of health care professionals, and the resources. Recommendations for privacy and confidentiality, screening, identification, support, and documentation were the most commonly reported, which all of the guidelines advised them, suggesting the importance of identification of violence in pregnancy and support for abused pregnant women. 93% of the reviewed guidelines had recommendations on communication, support and building trust, child protection, and professional education and training. Conclusion: The study findings suggest that there are currently gaps in clinical guidelines in various areas, including patterns of violence, the cycle of violence, identifying risk factors for violence during pregnancy, providing medical care, implementing home visitation programs, promoting self-care and empowerment, preventing violence, offering follow-up support, and conducting community education programs. Therefore, it is crucial to develop or adapt clinical guidelines for abused pregnant women, emphasizing their needs to ensure their safety and well-being
Genetic polymorphisms and enamel caries susceptibility: A comprehensive review
No full textDental caries remains a significant global public health challenge, affecting millions of individuals and highlighting the need for effective prevention strategies. Notably, genetic polymorphisms, particularly single nucleotide polymorphisms (SNPs), play a critical role in individual susceptibility to caries by influencing enamel formation, salivary composition, and immune responses. Enamel caries remains a significant public health concern, influenced by a complex interplay of genetic and environmental factors. This comprehensive review explores the critical role of genetic polymorphisms in susceptibility to enamel caries. By identifying risk alleles, dental professionals can tailor preventive strategies, including customized fluoride treatments and dietary recommendations, to individual genetic profiles. Such targeted interventions can empower patients to adopt healthier behaviors, thereby reducing caries incidence. Understanding the genetic underpinnings of dental caries will advance both research and clinical practice, leading to more effective prevention strategies and improved patient outcomes
Association of whole and refined grains food consumption with coronary artery disease in a multi-center, case-control study of Iranian adults: Iran Premature Coronary Artery Disease (IPAD)
No full textBackground and aims: Low whole grain food consumption is the leading cause of coronary artery disease (CAD) burden in middle-East countries. However, investigations examining the association of whole and refined grain foods and CAD are scarce in this region. We aimed to investigate the association of whole and refined grain foods with CAD in Iranians with different ethnicities. Methods and results: This was a multi-center case-control study among Iranian ethnicities consisting of Fars, Azari, Kurd, Arab, Lor, Gilak, Qashqaei, and Bakhtiari within the framework of the Iran premature coronary artery disease (IPAD) project. The data were collected from hospitals with catheterization laboratories. Cases were 2099 patients with a stenosis ≥75 % in at least one vessel or ≥50 % in the left main artery. Control group were 1168 individuals with normal angiography test. Grains intake was assessed using a validated semi-quantitative food frequency questionnaire. Compared with those with the lowest intake of whole grain foods, subjects in the top quartile had lower risk of CAD (OR = 0.54, 95 % CI: 0.40, 0.72; P < 0.001) after full adjustment. However, a significant direct link was found between higher refined grain foods consumption and the risk of CAD (OR = 1.43, 95 % CI: 0.91–1.84; P = 0.013). Conclusion: Our findings support dietary recommendations to increase whole grain foods and mitigating refined grain food consumption to reduce the risk of CAD and its severit
Improving Bovine Embryo Development and Quality Using Bovine Oviductal Epithelial Cell‐Derived Conditioned Medium (bOEC‐CM)
No full textBackground: The embryo co-culture systems with the monolayer cultured cells are complex, unreproducible, and have a high probability of biological contamination. Therefore, nowadays, using conditioned media is a suitable alternative to these methods. Objectives: This study aimed to investigate the impact of utilizing bovine oviductal epithelial cell-derived conditioned medium (bOEC-CM) on subsequent embryo development and quality. Methods: Bovine embryos produced in vitro were cultured in a specific medium supplemented with either 5% charcoal-stripped FBS (Charcoled Strip Serum [CSS]) or 10% bOEC-CM from either Days 1 or 3 post-fertilization. Various parameters, such as cleavage rate, blastocyst formation, hatching rate and blastocyst quality, were assessed. Results: The results indicated that adding 10% CM from Day 1 significantly reduced the cleavage rate compared to using CSS on the same day (p < 0.05). Furthermore, the CSS and CM from both Days 1 and 3 increased blastocyst formation rates (p < 0.05). Notably, the addition of 10% CM on Day 3 significantly improved the hatching rate compared to the other groups (p < 0.05). Both CM and CSS were found to enhance the inner cell mass (ICM), trophectoderm (TE) and total cell numbers in blastocysts when used on both Days 1 and 3 (p < 0.05). Additionally, CM from Day 3 positively influenced the expression levels of development-specific genes in cultured embryos (p < 0.05). Conclusion: Overall, the findings suggest that using bOEC-CM at a 10% concentration may provide a promising supplement even better than serum and traditional co-culture methods during the last 5 days of embryo cultur
The antioxidant capacity and protective ability of astaxanthin in cryopreservation of mouse spermatogonial stem cells
No full textCryopreservation of spermatogonial stem cells (SSCs) offers several benefits, but it can also cause various forms of damage that may reduce the functionality of these cells. Incorporating antioxidants into the cryopreservation medium can provide protection against the detrimental effects of cryopreservation by reducing levels of reactive oxygen species (ROS). In this study, the protective effect of astaxanthin (AST) was evaluated to establish an optimal cryopreservation method for SSCs obtained from the testes of neonatal male mice. AST was added to the freezing base medium at 1, 10, and 100 μM concentrations, and then compared with the control (freezing medium without any additives) and 100 μM vitamin E as a conventional antioxidant. Viability, oxidative stress status, intracellular ROS generation levels, and the expression of Bax and Bcl2 were measured in frozen-thawed SSCs 3 weeks after culture and purification. The data showed that the presence of antioxidants, especially 10 μM AST, in the freezing medium significantly increases the viability and total antioxidant capacity (TAC) (P < 0.05), and reduces the levels of lipid peroxidation and intracellular ROS accumulation in the frozen–thawed SSCs. Vitamin E, as well as 10 and 100 μM AST reduced apoptosis in mouse SSCs by downregulating Bax and upregulating Bcl2. The results of this study suggest that adding 10 μM of AST to the freezing medium provides protection to SSCs after thawing. Therefore, the inclusion of 10 μM AST in the cryopreservation medium significantly improves the post-thaw viability and antioxidant capacity of SSCs. These findings indicate that AST could serve as a valuable additive for improving the cryopreservation process of SSCs, thereby offering potential benefits for the preservation of male fertility
New Insight into Pathogenic Variant p.L275P on the Structure and Function of Steroidogenic Acute Regulatory Protein (STAR) Through Molecular Dynamics Simulation
No full textBackground: Lipoid congenital adrenal hyperplasia (LCAH) is the lethal form of steroid biosynthesis defects because of mutations in the steroidogenic acute regulatory (STAR) gene. There are two distinct clinical forms including classical and nonclassical without any reliable genotype-phenotype correlation, and investigation of more cases may provide valuable insights. Materials and Methods: Ten Iranian families affected by LCAH were selected for genetic linkage analysis. The STAR gene was sequenced in the linked families, and using multiple in silico tools and ACMG guidelines, the pathogenicity of candidate variants was assessed. Also, the structural effects of the identified variant on the STAR behavior were evaluated using molecular docking and molecular dynamics (MD) simulation. Results: Data analysis revealed a pathogenic variant, c.824T>C, (p.L275P), in the STAR gene in the Iranian population for the first time. Furthermore, molecular docking and MD simulation revealed that the c.824T>C variant results in a decrease in total flexibility and secondary structure, an increase in H-bonds and changed fluctuations in some residues. Conclusions: MD simulation provides the key structural and structural insights of the p.L275P -mediated conformational changes in STAR
The relationship between amino acid intake patterns and both general and central obesity
No full textBackground: Obesity is a threat to public health. Dietary protein and certain amino acids (AAs) have been associated with obesity; however, the association of AAs patterns with excess body weight has not been considered, yet. We aimed to examine the relationship between patterns of AA intake and obesity. Methods: This cross-sectional study was conducted on 3197 individuals aged 35 to 70 years. Sociodemographic, medical, physical activity, and anthropometric data were collected. Energy and AAs intake were obtained by food frequency questionnaire (FFQ). Factor analysis was utilized to determine the AA patterns. Using multiple logistic regression analysis, the odds ratio (OR) of obesity was calculated among individuals categorized into tertiles of the AAs patterns. Results: In this study, three AA patterns were identified. The aromatic pattern consists of phenylalanine, tryptophan, proline, glutamic acid, cysteine, serine, and leucine. Five essential AAs plus tyrosine, aspartic acid, arginine, and glycine were the components of the mixed pattern, and finally, the alanine pattern with high loadings for alanine and histidine was the third one. After adjusting for confounders, individuals in the highest tertile (T3) of the aromatic pattern had lower odds of central obesity compared to those in the lowest tertile (T1) (OR = 0.72, 95% CI: 0.58–0.89; p = 0.003), whereas this association was not observed in the alanine pattern. On the contrary, general obesity showed a positive association in T3 of the alanine pattern in comparison with T1 (OR = 1.65, 95% CI: 1.02–2.67; p = 0.039). Mixed pattern was not associated with any of the obesity types. Conclusions: The aromatic pattern intake may have an inverse association with central obesity, and following the alanine pattern my contribute to higher odds of general obesity. However, the elaborate relationship between AAs and adiposity warrants further investigation