Ali Delpisheh

Clinical manifestations of celiac disease (CeD) in children are often associated with malabsorption, malnutrition, and underweight. Recent evidence suggests an increased prevalence in normal-weight and obese children. Under-recognition of patients with normal or high BMI can lead to delayed diagnosis and serious complications. The present study aimed to determine the BMI status of children with CeD at diagnosis and before gluten-free diet (GFD). A systematic review and meta-analysis was conducted following the PRISMA and MOOSE guidelines and after PROSPERO registration (CRD42023390243). The information sources, including PubMed, Scopus, and Web of Science, were systematically searched through 30 September 2025 to identify relevant articles. The study's eligibility criteria included observational studies, such as retrospective, cross-sectional, and prospective designs, with participants whose CeD diagnosis was confirmed by a gastroenterologist and who reported BMI data at the time of diagnosis. Heterogeneity among studies was assessed using the I² statistic. Funnel plots and Egger's test were also used to examine publication bias. The risk of bias of studies was assessed using the Newcastle–Ottawa (NOS) scale. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework was used to determine the certainty of the evidence. Overall, 32 studies including 14,169 children with CeD were investigated. The pooled prevalence of underweight and overweight/obesity at diagnosis was 15.3% (10.8–20.4%) and 10.5% (5.7–16.4%), respectively. Subgroup analysis by WHO region revealed a marked heterogeneity (I² > 90%), with the highest prevalence of underweight observed in the Eastern Mediterranean Region (EMRO) (31.9%). On the other hand, the highest prevalence of overweight/obesity was observed in the European Region (EURO) (12.0%) and the Western Pacific Region (WPRO) (21.4%). A key finding was a significant difference across World Bank income groups; underweight prevalence was nearly four times higher in low- and middle-income countries (LMICs), 35.48 (24.29, 47.51), compared with high-income countries, 9.58 (6.88, 12.63). The certainty of the evidence for all pooled prevalence estimates was rated as very low due to serious inconsistency and imprecision. Conclusions: The prevalence of normal weight and overweight/obesity in children with celiac disease at diagnosis was higher than that of underweight, mainly in high-income countries. This finding challenges the traditional belief about the CeD and emphasizes its diagnosis in children with suspicious symptoms, regardless of their BMI status. This approach will lead to earlier diagnosis, improving clinical outcomes and quality of life for patients in the long term. What is Known: • The clinical presentation of celiac disease is evolving, and its association with underweight is inconsistent. • The structural effects of COVID-19 on the developing brain remain poorly understood due to limited pediatric imaging studies. What is New: • This is the first meta-analysis focused exclusively on children, revealing that the majority (70.2%) present with a normal BMI at diagnosis. • The clinical inconsistency in BMI presentation is strongly linked to income levels; underweight prevalence is nearly four times higher in LMICs (35.5%) than in high-income countries (9.6%).

Background: This ecological cross-sectional study examines suicide incidence and identifies high- and low-risk clusters across Iranian districts from 2009 to 2023. This study aimed to determine district-specific suicide rates and map spatial risk patterns. Methods: Overall, 52,665 suicide cases of recorded in forensic medicine were analyzed, with incidence rates calculated per 100,000 population. Spatial autocorrelation techniques were used to identify clusters of high and low suicide risk, and GIS software facilitated mapping. Hanging was the most prevalent method, accounting for 50.88% of cases. Temporal trends across months were also assessed. Results: The average age of individuals who died by suicide was 33.98 years. High-incidence districts were located in parts of different provinces of Iran, including Eshtehard (Alborz), Firuzeh (Razavi Khorasan), Varzeghan (East Azerbaijan), Sahneh (Kermanshah), Famenin (Hamadan), and Miami (Semnan). High-risk clusters were primarily concentrated in the western provinces of Kermanshah and Hamadan, particularly in Sahneh and Famenin. Conversely, districts in Sistan and Baluchestan in southeastern Iran showed markedly lower suicide rates, possibly due to underreporting or systemic differences in data collection practices, which warrants cautious further investigation. Conclusion: This study highlights substantial regional disparities in suicide incidence across Iran, with specific high-risk areas identified for targeted intervention. These findings have important implications for public health policy, emphasizing the need for regionally tailored suicide prevention strategies and improved surveillance systems. Further research is needed to understand better the low suicide rates that observed in some districts and to assess potential reporting inconsistencies.

Background: The increasing frequency and severity of unexpected events in recent years underscore the need for more effective disaster management strategies. This study aimed to identify obstacles and solutions for serving affected groups, providing practical strategies for improved disaster response. Methodology: This qualitative content analysis study of the conventional type, conducted in 2024, involved semi-structured face-to-face interviews and a focused group discussion with 17 participants, including university experts, executive bodies, and affected individuals. The method of “Granheim and Lundman” was used to analyze the data, and “Lincoln and Guba’s” four criteria were used to establish the reliability of the data. Results: A total of 348 themes were identified, ultimately refined to 245 themes after repetition analysis. These themes were categorized into eight main categories: “Management, Financial and Non-Financial Resources, Programs, Educational Affairs, Organizational Matters, Community Affairs, Participation, and Spiritual Affairs.” Additionally, 29 subcategories were extracted. Conclusion: This study reveals key obstacles in disaster service delivery, including inadequate management, resources, and coordination. Solutions such as enhancing communication, clarifying roles, and promoting community participation can address these challenges. Strengthening public education, updating regulations, and integrating local cultural and spiritual support systems are essential for improving crisis response.

Background: This study aimed to evaluate the effect of metformin and sulfonylurea (SUs) medication time on Diabetic retinopathy (DR) among newly diagnosed patients with type 2 diabetes (T2DM) using a pooled analysis. This study aimed to evaluate the effect of metformin and SUs’ medication time on DR among newly diagnosed T2DM using a pooled analysis. Methods: The data of 4,068 newly diagnosed DM individuals(mean age, 60.2 ± 0.85 years) from three prospective cohorts of Tehran Lipid and Glucose Study (TLGS), Multi-Ethnic Study of Atherosclerosis (MESA), and Atherosclerosis Risk in Communities (ARIC) with a mean age of 59.6 ± 08 years were pooled. The cumulative exposure to metformin, SUs, aspirin, statin, and anti-hypertensive medication was also determined using the same approach. The Cox proportional hazards (CPH) model was used to calculate the hazard ratio (HR) (95% CI) for the outcomes while adjusting for confounding factors such as fasting Blood Sugar (FBS), age, statin, aspirin, and anti-hypertensive medications. Results: During follow-up, DR occurred in 519 DM. Metformin alone, SUs alone, and the combination of both reduced the hazard of DR by 10%, 7%, and 11% for each year of use, respectively (p < 0.05). The protective effect of metformin and SUs, individually or in combination, on DR started approximately five years after the initial treatment and continued until approximately 15 years after the initial treatment and then reached a plato. Conclusion: Long-term treatment with metformin and SUs, individually and in combination, was associated with a reduced risk of DR in people with newly diagnosed diabetes for up to a decade compared with no treatment. These findings highlight the protective role of metformin and sulfonylureas as inexpensive and readily available drugs to prevent DR in people with newly diagnosed diabetes.

Despite successful efforts to eliminate measles in Iran, imported measles cases continue to be reported. Because measles is endemic in neighboring countries. This research aims to evaluate the risk of measles transmission in different regions of Iran. Measles case-based surveillance data of the Expanded Program of Immunization containing 31 provinces and 463 districts from 2019 to 2021 were assessed. The WHO Measles Programmatic Risk Assessment tool was used to evaluate the risk of disease transmission in four domains: population immunity, surveillance quality, program delivery performance, and threat assessment. scores were categorized as low, medium, high, or very high risk. During 2019–2021, the average incidence of measles was 1.9 per 1 million. Chabahar and Mashhad with 76 and ./6per million reported the highest and lowest incidence respectively. All 463 districts were categorized as low risk in risk assessment. Andimeshk, Chabahar, and Bojnurd obtained the highest risk scores with 27, 24, and 25 respectively. All districts were classified as low risk for population immunity. The average coverage of (MMR1) and (MMR2) was 95% or higher. All districts received the minimum points for surveillance quality. All regions are placed at a low level of disease transmission risk. However, the tool is not able to assess the risk at the rural or peripheral sectors level. The indicators used in this tool are the same for all countries with different epidemiological features (elimination, endemic). Sensitivity analysis can optimize the use of this tool for countries with different disease conditions.

Background: Large gatherings often involve extended and intimate contact among individuals, creating environments conducive to the spread of infectious diseases. Despite this, there is limited research utilizing outbreak detection algorithms to analyze real syndrome data from such events. This study sought to address this gap by examining the implementation and efficacy of outbreak detection algorithms for syndromic surveillance during mass gatherings in Iraq. Methods: For the study, 10 data collectors conducted field data collection over 10 days from August 25, 2023, to September 3, 2023. Data were gathered from 10 healthcare clinics situated along Ya Hussein Road, a major route from Najaf to Karbala in Iraq. Various outbreak detection algorithms, such as moving average, cumulative sum, and exponentially weighted moving average, were applied to analyze the reported syndromes. Results: During the 10 days from August 25, 2023, to September 3, 2023, 12202 pilgrims visited 10 health clinics along a route in Iraq. Most pilgrims were between 20 and 59 years old (77.4%, n=9444), with more than half being foreigners (58.1%, n=7092). Among the pilgrims, 40.5% (n=4938) exhibited syndromes, with influenza-like illness (ILI) being the most common (48.8%, n=2411). Other prevalent syndromes included food poisoning (21.2%, n=1048), heatstroke (17.7%, n=875), febrile rash (9.0%, n=446), and gastroenteritis (3.2%, n=158). The cumulative sum (CUSUM) algorithm was more effective than exponentially weighted moving average (EWMA) and moving average (MA) algorithms for detecting small shifts. Conclusion: Effective public health surveillance systems are crucial during mass gatherings to swiftly identify and address emerging health risks. Utilizing advanced algorithms and real-time data analysis can empower authorities to improve their readiness and response capacity, thereby ensuring the protection of public health during these gatherings.

Purpose The current umbrella review aimed to evaluate the effect of metformin on all-cause mortality (ACM), cardiovascular mortality, and cardiovascular disease (CVD) incidence in DM patients. Methods PubMed, Scopus, Cochrane, Google Scholar, and Web of Science databases were searched with special keywords. Related studies were included after screening by two independent investigators based on title and full texts. The AMSTAR2 checklist was used to assess the quality of studies, and Cochran tests were used to assess the heterogeneity between studies. Overall, seventeen systematic reviews and meta-analysis studies were included. The results revealed that the risk of ACM in patients who received metformin was lower than in patients who did not receive metformin. (OR: 0.80, 95% CI:0.744,0.855); also, the risk of CVD mortality in metformin patients was lower than in the other two groups (placebo and other anti-diabetic drugs) (OR: 0.771, 95% CI:0.688,0.853, P:0.001). The risk of CVD in metformin users was also lower than in the other two groups (OR: 0.828, 95% CI:0.781,0.785). Summary This comprehensive review showed that the risk of ACM, death due to CVD, and incidents of CVD in DM who use metformin was lower than the patients who received a placebo only or other diabetic drugs, which can guide clinicians in medical decision-making.

Background: Hip fracture is a major health problem that occurs more often in the elderly, especially in diabetic patients. Some studies have been conducted regarding the effect of anti- diabetic drugs on fractures. But so far, no meta-analysis study has been conducted to investigate the effect of diabetic drugs on hip fractures. Therefore, this study investigated the relationship between anti-diabetic drugs (Metformin, Sulfonylurea, and insulin) with hip fractures. Methods: In this systematic review and meta analysis study, PubMed, Scopus, Google Scholar, and Web of Science databases were searched with specific keywords to find relevant studies. Two researchers included related studies after screening based on the title and full text. Cochran’s Q and I2 tests were used to assess heterogeneity between studies. Publication bias between studies was evaluated for each drug using Egger’s test. A 95% confidence interval was used for effect size significance. Overall, 49 studies, including 6,631,297 participants, were reviewed. Results: The results showed that metformin significantly reduced the risk of hip fracture (HR: 0.833, 95% CI: 0.759, 0.914, P:0.001). Consumption of sulfonylurea compounds was significantly associated with an increased risk of hip fracture. (HR: 1.175, 95% CI:1.068,1.293, P:0.001), The risk of hip fracture in patients receiving insulin was significantly higher than in diabetic patients who did not receive insulin. (HR:1.366, 95% CI:1.226,1.522, P:0.001). Conclusion: The results of this study showed that taking metformin reduces the risk of hip fracture, and insulin and Sulfonylurea increase the risk of hip fracture.