scholarly journals Knowledge and Awareness on Vitamin D Deficiency among IT Employees

2020 ◽  
pp. 6-12
Author(s):  
Akifa Begum ◽  
M. Jeevitha ◽  
S. Preetha
Keyword(s):  
Risk Factors ◽  
Information Technology ◽  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Essential Role ◽  
Cardiovascular Health ◽  
Health Issues ◽  
Vitamin D Levels ◽  
It Employees ◽  
Self Administered Questionnaire

Vitamin D is well known for its essential role in maintaining healthy bones. Deficiency of this causes the bones to become soft and weak, a disease known as rickets in children and osteomalacia in adults. Vitamin D is produced via skin under the action of sunlight, with smaller amounts from dietary sources. A self-administered questionnaire was prepared consisting of 10 questions. The questionnaire consisted of open ended and close ended type of questions. The survey was conducted among the IT (Information Technology) employees of a particular region. The survey was conducted via online platform. The results were collected, analysed and interpreted. The results conveyed that a majority (83%) of the IT employees were aware that the vitamin D deficiency mainly causes obesity. 50% of the IT employees were aware that vitamin D deficiency causes mainly skin cancer. 52.1% of the IT employees were aware that vitamin D levels support lung function and cardiovascular health. The present study concluded that the IT employees were well aware about the vitamin D deficiency and its risk factors. They had a good knowledge on the fact that vitamin D deficiency causes obesity and many other health issues.

scholarly journals Vitamin D and Atherosclerotic Cardiovascular Disease

2019 ◽  
Vol 104 (9) ◽  
pp. 4033-4050 ◽  
Author(s):  
Thomas F Hiemstra ◽  
Kenneth Lim ◽  
Ravi Thadhani ◽  
JoAnn E Manson
Keyword(s):  
Cardiovascular Disease ◽  
Vitamin D ◽  
General Population ◽  
Vitamin D Deficiency ◽  
Randomized Trials ◽  
Cardiovascular Health ◽  
Vitamin D Supplementation ◽  
High Dose ◽  
Atherosclerotic Cardiovascular Disease ◽  
Vitamin D Levels

Abstract Context A large body of experimental and observational data has implicated vitamin D deficiency in the development of cardiovascular disease. However, evidence to support routine vitamin D supplementation to prevent or treat cardiovascular disease is lacking. Design and Results A comprehensive literature review was performed using PubMed and other literature search engines. Mounting epidemiological evidence and data from Mendelian randomization studies support a link between vitamin D deficiency and adverse cardiovascular health outcomes, but randomized trial evidence to support vitamin D supplementation is sparse. Current public health guidelines restrict vitamin D intake recommendations to the maintenance of bone health and prevention of fractures. Two recently published large trials (VITAL and ViDA) that assessed the role of moderate- to high-dose vitamin D supplementation as primary prevention for cardiovascular outcomes in the general population had null results, and previous randomized trials have also been generally negative. These findings from general population cohorts that are largely replete in vitamin D may not be applicable to chronic kidney disease (CKD) populations, in which the use of active (1α-hydroxylated) vitamin D compounds is prevalent, or to other high-risk populations. Additionally, recent trials in the CKD population, as well as trials using vitamin D analogs, have been limited. Conclusions Current randomized trials of vitamin D supplementation do not support benefits for cardiovascular health, but the evidence remains inconclusive. Additional randomized trials assessing larger numbers of participants with low baseline vitamin D levels, having longer follow-up periods, and testing higher vitamin D dosages are needed to guide clinical practice.

scholarly journals Vitamin D Deficiency and Outcomes after Ankle Fusion

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0007
Author(s):  
Deepak Ramanathan ◽  
Mark J. Berkowitz ◽  
Alan Davis ◽  
Stephen J. Pinney ◽  
Sara Lyn Miniaci-Coxhead
Keyword(s):  
Risk Factors ◽  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Reoperation Rate ◽  
Hardware Removal ◽  
Ankle Fusion ◽  
Vitamin D Levels ◽  
Normal Vitamin ◽  
Local Risk ◽  
The Impact

Category: Ankle Arthritis; Ankle; Basic Sciences/Biologics; Hindfoot Introduction/Purpose: Ankle fusions are associated with a complication profile including nonunion with associated poor functional outcomes, chronic pain, and need for reoperation. Local risk factors (bone and soft-tissue loss, infection, ankle and hindfoot deformity, and neuropathy) and systemic risk factors (advanced age, smoking, alcohol abuse, worker’s compensation, noncompliance, obesity, and systemic comorbidities such as diabetes and immunodeficiency) have been shown to be associated with the development of a nonunion following fusion procedures. Vitamin D has an important role in bone healing, and vitamin D deficiency has been proposed as a potential risk factor for the development of non-unions. The purpose of this study is to assess the impact of low vitamin D levels on reoperation rates and the development of nonunions following ankle fusion surgery. Methods: A retrospective chart review of all ankle fusions performed at a major health system from January 2010 to July 2019 was performed. In total, 240 ankle fusions were performed by seven surgeons. All patients who underwent primary fusion procedures were eligible for inclusion in this study. Exclusion criteria included: age less than 18 years; revision surgery; ankle fusion with the use of bulk allograft; ankle fusion performed as part of an oncologic reconstruction; and an absence of recorded vitamin D levels with 12 months of surgery. In total, 47 patients met inclusion criteria and formed the study group. In this group, 29/47 (61.7%) were female and 18/47 (38.3%) were male. Average age was 57.0 +- 12.3 years (range: 18.6 to 75.7). Patients were grouped according to their vitamin D levels as being deficient (<31 ng/ml) or normal (31-80 ng/ml). Results: Prevalence of vitamin D deficiency was 36.2% (17/47) at average of 35.7 ng/ml. In vitamin D deficient subgroup (n=17), average vitamin D level was 16.9 ng/ml. In normal vitamin D subgroup (n=30), average vitamin D was 46.4 ng/ml. Overall, reoperation rate was 21.3% (10/47). Reoperation rate was 35.3% (6/17) in vitamin D deficiency subgroup compared with 13.3% (4/30) reoperation rate in normal vitamin D subgroup (p<0.05). In vitamin D deficient subgroup, 5 procedures for nonunion included: dynamization (n=1), revision fusion (n=1), staged revision (n=2) and amputation (n=1) due to infected nonunion. There was also a symptomatic hardware removal. In normal vitamin D subgroup, reoperation indications included: malunion (n=1), elective dynamization before weightbearing (n=1), and symptomatic hardware removal (n=2). Normal vitamin D subgroup had zero nonunions. Conclusion: In patients undergoing ankle fusion, vitamin D deficiency (< 31 ng/ml) was associated with a reoperation rate over double that of patients with normal vitamin D levels. In the vitamin D deficient subgroup, nearly all reoperations were for nonunion as compared to zero nonunion incidence in those with normal vitamin D levels. These results suggest routine preoperative screening of vitamin D level is indicated as a key component of ankle fusion care. Vitamin D supplementation during the perioperative period may be indicated in regions with low sunlight to improve fusion rates and lower the risk of reoperation.

scholarly journals Prevalence of Vitamin D Deficiency and Its Associated Risk Factors Among Rural Population of the Northern Part of the Persian Gulf

2020 ◽  
Author(s):  
Maryam Marzban ◽  
Mohammadreza Kalantarhormozi ◽  
Mehdi Mahmudpour ◽  
Afshin Ostovar ◽  
Saeed Keshmiri ◽  
...  
Keyword(s):  
Risk Factors ◽  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Rural Areas ◽  
Persian Gulf ◽  
Rural Population ◽  
Vitamin D Levels ◽  
Significant Difference ◽  
The Persian Gulf ◽  
Associated Risk Factors

Abstract Background: Accumulating evidence indicates that vitamin D deficiency has been increased globally since the last two decades. However, the majority of these studies concerned on cities and there is scant information regarding the prevalence of vitamin D in rural areas. The main aim of this study was to investigate the prevalence of vitamin D deficiency and its associated risk factors among rural population in Bushehr province which has the longest border with the Persian Gulf.Methods: The rural inhabitants with ≥25 years old from three mountainous, plain, and seashore areas of Bushehr province were selected through a stratified multi-cluster random sampling method. After obtaining the participants’ demographic and anthropometric data and their past medical history, serum 25- hydroxy vitamin D was measured using ELISA.Results: A total of 1806 (means±SD, 46.30± 14.22 years old) rural subjects (34.84% males and 64.88%) participated in this study. The prevalence of vitamin D deficiency, insufficiency and sufficiency were 27.87%, 50.39% and 21.74%, respectively. The deficiency of vitamin D in women was higher than men (OR=1.27, 95% CI: 1.05 to 1.54, P=0.040). There was a positive significant correlation between age and serum vitamin D levels. Men with vitamin D deficiency had higher BMI (P=0.008); this association was not observed among women (P=0.74). There was no significant difference between the food items consumption frequencies, and vitamin D status (P>0.05). The mountainous, and plain areas had the highest and lowest vitamin D levels, respectively.Conclusion: Although, Bushehr province is located in a sunny part of Iran, the prevalence of vitamin D deficiency was high among its rural population. The shift of their life styles patterns and rapid industrialization in these rural areas may be responsible. Therefore, the enrichment of dietary sources with vitamin D and the use of vitamin D supplements are recommended to tackle the high prevalence of vitamin D deficiency in the rural population of the northern part of the Persian Gulf.

scholarly journals Factors affecting vitamin D status in Moscow adolescents

2019 ◽  
pp. 50-57
Author(s):  
I. N. Zakharova ◽  
E. A. Solov’yeva ◽  
T. M. Tvorogova ◽  
S. I. Lazareva ◽  
T. Yu. Vil’ken ◽  
...  
Keyword(s):  
Risk Factors ◽  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Respiratory Infections ◽  
Endocrine System ◽  
Risk Groups ◽  
The Body ◽  
Gastrointestinal Pathology ◽  
Vitamin D Levels ◽  
The Impact

Justification of the study. The normalization of vitamin D levels in both children and adults is the goal of numerous studies around the world, and the setting of a number of objectives related to this vector of preventive medicine, dictates the need for a more detailed study of regional features of the status of calcidiol and the identification of both risk factors and risk groups. Aim of the study: to analyze the impact of risk factors on the provision of vitamin D to adolescents in the Moscow region. Methods: 360 children over 11 years of age (average age was 14.74 ± 1.92 years) who attended a children’s polyclinic for preventive check-ups or are under observation in a day-care centre. After the examination, all schoolchildren were determined to have serum content of calcidiol – active metabolite of vitamin D. Results: the analysis revealed low vitamin D levels in children, with a median of 16.1 ng/ml. Normal vitamin D levels were found in only 6.7% of cases. The following risk factors for vitamin D deficiency were identified in Moscow schoolchildren: time of year (p < 0.001), inclusion of such foods as fish (p = 0.021) and liver (p = 0.036), gastrointestinal pathology (p < 0.001), endocrine system pathology (p < 0.001), musculoskeletal system pathology (p = 0.045): course of chronic inflammatory process (p = 0.01) in the body. The correlation between acute respiratory diseases and calcidiol supply was analyzed: at low frequency of acute respiratory infections during the year, the median level of vitamin D was 17.1 ng/ml (Q1-Q3: 12.6-22.1 ng/ml), at an average frequency – 11.4 ng/ml (Q1-Q3: 8.45-16.05 ng/ml), at high frequency – decreased to 7.94 ng/ml (Q1-Q3: 5.89-9.06 ng/ml). Conclusion: Vitamin D deficiency prophylaxis should be provided to children all year round, without a break for the summer months. If a child has a risk factor for vitamin D deficiency, the metabolite correction should be controlled by the calcidiol serum content.

High Prevalence of Vitamin D Deficiency and Associated Risk Factors among Employed Women in a Sunny Industrial City

2015 ◽  
Vol 85 (3-4) ◽  
pp. 119-128 ◽  
Author(s):  
Tahereh Hassannia ◽  
Ehsan GhaznaviRad ◽  
Rosita Vakili ◽  
Sohaila Taheri ◽  
Seyed Abdolrahim Rezaee
Keyword(s):  
Risk Factors ◽  
Vitamin D ◽  
Serum Level ◽  
Vitamin D Deficiency ◽  
Muscle Pain ◽  
Serum Vitamin ◽  
Industrial City ◽  
Serum Vitamin D ◽  
Vitamin D Levels ◽  
Employed Women

Abstract. Background: Vitamin D deficiency is a public health concern associated with the pathogenesis of several chronic disorders, particularly in women. Aim: To evaluate serum vitamin D levels and its deficiency and risk factors among employed women in a sunny industrial city. Methods: In this cross-sectional study, serum vitamin D levels, biochemical and hematological factors were assessed in 382 healthy employed women. Demographic information was collected using a standard questionnaire and data was analyzed by SPSS software. Results: The mean vitamin D serum level was 22 ± 19.8 ng/ml. Prevalence of vitamin D deficiency and insufficiency were 62 % and 12.94 %, respectively. Deficiency was more common among younger subjects (< 29 years old). 23.5 % of subjects had normal and 1.35 % had toxic levels of vitamin D. Maximum serum level was observed in part-time job employees (33 ng/ml), and the lowest in Media and Culture Organizations (15 ng/ml).Vitamin D deficiency was associated with the lack of sunlight exposure at home, and taking anti-hypertensive medications. The common symptoms in deficiency condition were history of hyperlipidemia, depression, weakness, fatigue, finger tingling, leg cramps, and body and muscle pain. Moreover, LDL-cholesterol serum levels were significantly higher in the vitamin D deficiency group, with a prevalence of 40 %. Conclusion: The symptoms of vitamin D deficiency including depression, weakness, fatigue, tingling, leg cramps and body and muscle pain have been observed in more than 90 % after recruitment and treatment. Therefore, for improving the health and productivity of employees, a routine monitoring system for vitamin D and the other factors should be put in place.

Vitamin D and Vascular Disease

2020 ◽  
Vol 19 (3) ◽  
pp. 250-268 ◽  
Author(s):  
Ioanna Gouni-Berthold ◽  
Heiner K. Berthold
Keyword(s):  
Risk Factors ◽  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Vitamin D Supplementation ◽  
Plasma Vitamin ◽  
Cvd Risk ◽  
Vitamin D Receptors ◽  
Cell Proliferation And Differentiation ◽  
Increased Risk ◽  
Vitamin D Levels

: Cardiovascular disease (CVD) is a major cause of morbidity and mortality worldwide. Vitamin D deficiency has been identified as a potential risk factor for a number of diseases unrelated to the classical skeletal pathophysiology, such as cancer and CVD, but the effects of vitamin D supplementation are less clear. Purpose of this narrative review is to discuss the evidence suggesting an association between vitamin D status and CVD as well as the results of supplementation studies. Vitamin D deficiency has been associated with CVD risk factors such as hypertension, dyslipidemia and diabetes mellitus as well as with cardiovascular events such as myocardial infarction, stroke and heart failure. While vitamin D deficiency might contribute to the development of CVD through its association with risk factors, direct effects of vitamin D on the cardiovascular system may also be involved. Vitamin D receptors are expressed in a variety of tissues, including cardiomyocytes, vascular smooth muscle cells and endothelial cells. Moreover, vitamin D has been shown to affect inflammation, cell proliferation and differentiation. While observational studies support an association between low plasma vitamin D levels and increased risk of CVD, Mendelian randomization studies do not support a causal association between the two. At present, high quality randomized trials do not find evidence of significant effects on CVD endpoints and do not support supplementation of vitamin D to decrease CVD events.

scholarly journals THE ROLE OF OBESIT Y IN THE DE VELOPMENT OF VITAMIN D DEFICIENCY RICKETS IN CHILDREN

2021 ◽  
Vol 76 (2) ◽  
pp. 109-116
Author(s):  
М. М. Puhach ◽  
V. P. Kolesnyk ◽  
O. V. Herasymova ◽  
O. H. Mazur
Keyword(s):  
Risk Factors ◽  
Vitamin D ◽  
Adipose Tissue ◽  
Vitamin D Deficiency ◽  
Vitamin D Metabolism ◽  
Metabolism Disorder ◽  
Treatment And Prevention ◽  
Vitamin D Levels ◽  
Excessive Body Weight ◽  
Deficiency Rickets

Vitamin D deficiency rickets is one of the most common diseases among children of the first years of life in many countries around the world. It is very important to understand the aforementioned nosological unit as a metabolism disorder, and not just as a D-deficiency state. In modern conditions, the risk factors for vitamin D deficiency rickets have undergone further study. The results of the research indicate that obesity is one of the risk factors for vitamin D deficiency in children. Thus, vitamin D metabolism, deposition, bioavailability and its biological role are dependent on the size of adipose tissue. The pathogenetic interaction between obesity andМvitamin D deficiency is probably predetermined by several mechanisms. Firstly, in case of obesity, vitamin D,Мwhich is a fat-soluble substance, is distributed in a considerable amount of adipose tissue, which leads toa decrease in its concentration in the blood plasma. Secondly, with excessive body weight there is a limitation of vitamin D bioavailability, caused by vitamin D capture with adipocytes and depositing in adipose tissue.Thirdly, there is a genetic proof that the increase in BMI leads to a decrease in vitamin D levels in blood serum.Recent studies have shown that adipose tissue may be the direct target of vitamin D physiological actions.It has been proved that vitamin D can affect obesity through numerous mechanisms, including protein expression, oxidative stress, inflammation and cellular metabolism. Currently, recommendations for treatment and prevention of vitamin D deficiency can be found in international foreign guidebooks whose authors state that obese children need a higher dosage of vitamin D compared to those whose physical development is consistent with age. Understanding the influence of adipose mass on bone tissue during its growth and development is a very important aspect for further health and pharmacotherapy strategies to prevent bone disorders.

scholarly journals Evaluation of vitamin D status in children with refractory epilepsy

2014 ◽  
Author(s):  
Pakize Karaoğlu ◽  
Ayşe İpek Polat ◽  
Müge Ayanoğlu ◽  
Uluç Yiş ◽  
Semra Hız
Keyword(s):  
Risk Factors ◽  
Body Mass Index ◽  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Antiepileptic Drugs ◽  
Refractory Epilepsy ◽  
Vitamin D Status ◽  
Ambulatory Status ◽  
Vitamin D Levels ◽  
25 Hydroxy Vitamin D

OBJECTIVE: Vitamin D deficiency has been implicated in children using antiepileptic drugs. Multiple antiepileptic drugs may increase the risk of vitamin D deficiency. The aim of this study is to evaluate the vitamin D status and risk factors for vitamin D deficiency in children with refractory epilepsy. METHODS: Forty children with refractory epilepsy seen in our tertiary pediatric neurology outpatient clinic were included and serum 25-hydroxy vitamin D, parathyroid hormone, calcium, phosphate and alkaline phosphatase were measured. Vitamin D deficiency was defined as 25-hydroxy vitamin D levels <20 ng/mL, and insufficiency between 21 and 29 ng/mL. Correlation between vitamin D levels and type of epilepsy (generalized or localization related), etiology of epilepsy (symptomatic vs idiopathic), body mass index, seizure frequency, number of antiepileptic drugs, type of antiepileptic drugs (old or new; enzyme inducing or not), presence of intellectual disability, ambulatory status and gross motor function classification scores were evaluated. RESULTS: The study group consisted of 17 boys and 23 girls with a mean age of 6.65 ± 5.29 years. Vitamin D deficiency was identified in 25 (62.5%) and insufficiency in 6 (15%) of the patients. There was no correlation between vitamin D levels and type of epilepsy, etiology of epilepsy, body mass index, seizure frequency, number of antiepileptic drugs, type of antiepileptic drugs, presence of intellectual disability, ambulatory status and gross motor function classification scores. CONCLUSION: We found that vitamin D deficiency was high in this cohort of children with refractory epilepsy. Vitamin D level should be monitored in patients with refractory epilepsy irrespective of the potential risk factors.

scholarly journals VITAMIN D DEFICIENCY IN PATIENTS WITH ACUTE CORONARY SYNDROME

2019 ◽  
Vol 8 (2) ◽  
pp. 12-20
Author(s):  
R. S. Bogachev ◽  
L. V. Mikhailova ◽  
E. S. Shytova ◽  
V. V. Mordvincev ◽  
V. Ankudovich ◽  
...  
Keyword(s):  
Risk Factors ◽  
Vitamin D ◽  
Acute Coronary Syndrome ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Vitamin D Deficiency ◽  
Left Ventricular ◽  
Total Serum ◽  
Coronary Syndrome ◽  
Vitamin D Levels

Aim. To assess vitamin D level in patients with acute coronary syndrome and to determine the relationships of vitamin D level with specific patterns of cardiovascular disease in this group of patients.Methods. 50 patients (35 (70%) males and 15 (30%) females) urgently admitted to the emergency cardiology department of Kaliningrad Regional Hospital were enrolled in the cross-sectional observational study. Patients with diabetes mellitus, autoimmune diseases and cancer were excluded from the study. The mean age of patients was 60 (55; 66) years. Cardiovascular risk factors (obesity, smoking, physical activity, alcohol consumption, genetic predisposition) were assessed in all patients. Total serum cholesterol levels, GFR (CKD-EPI) and troponin levels were measured in all participants. Echocardiography included the measurement of the left ventricular mass index. Coronary angiography with omnipaque contrast was performed in all cases. 25-OH vitamin D was measured with enzyme-linked immunosorbent assay (ELISA).Results. The majority of patients with acute coronary syndrome had vitamin D deficiency. 3 (6%) patients had severe vitamin D deficiency. The subgroup of patients with marked vitamin D deficiency (n = 39) more often had elevated blood pressure probably related to the left ventricular hypertrophy and left atrial enlargement. Left ventricular systolic dysfunction and occlusive coronary artery disease were more common in patients with lower vitamin D levels. Statistically significant correlations had not been found between vitamin D levels and cardiovascular risk factors as well as laboratory data.Conclusion. Vitamin D level below normal range was detected in the vast majority of patients with acute coronary syndrome, of them 6 % of patients had critically low vitamin D levels.

scholarly journals Prevalence of vitamin D deficiency and its associated risk factors among rural population of the northern part of the Persian Gulf

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Maryam Marzban ◽  
Mohammadreza Kalantarhormozi ◽  
Mehdi Mahmudpour ◽  
Afshin Ostovar ◽  
Saeed Keshmiri ◽  
...  
Keyword(s):  
Risk Factors ◽  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Rural Areas ◽  
Persian Gulf ◽  
Rural Population ◽  
Vitamin D Levels ◽  
Significant Difference ◽  
The Persian Gulf ◽  
Associated Risk Factors

Abstract Background Accumulating evidence indicates that vitamin D deficiency has been increased globally over the last two decades. However, the majority of these studies are concerned with cities and there is scant information regarding the prevalence of vitamin D in rural areas. The main aim of this study was to investigate the prevalence of vitamin D deficiency and its associated risk factors among the rural population in Bushehr province which shares the longest border with the Persian Gulf. Methods The rural inhabitants of more than 25 years old from three mountainous, plain, and seashore areas of Bushehr province were selected through a stratified multi-cluster random sampling method. After obtaining the participants’ demographic and anthropometric data and their past medical history, serum 25-hydroxyvitamin D [25(OH)D] was measured using ELISA. Results A total of 1806 (means ±SD, 46± 14years old) rural subjects (35 % males and 65 % females) participated in this study. The prevalence of vitamin D deficiency, insufficiency, and sufficiency were 28 %, 50 %, and 22 %, respectively. The deficiency of vitamin D in women was higher than in men (OR=1.27, 95 % CI: 1.05 to 1.54, P=0.04). There was a positive significant correlation between age and serum vitamin D levels. Men with vitamin D deficiency had higher BMI (P=0.008); this association was not observed among women (P=0.7). There was no significant difference between the food item’s consumption frequencies, and vitamin D status (P>0.05). The mountainous, and plain areas had the highest and lowest vitamin D levels, respectively. Conclusions Although, Bushehr province is located in a sunny part of Iran, the prevalence of vitamin D deficiency was high among its rural population. The shift of their lifestyle patterns and rapid industrialization in these rural areas may be responsible. Therefore, the enrichment of dietary sources with vitamin D and the use of vitamin D supplements are recommended to tackle the high prevalence of vitamin D deficiency in the rural population of the northern part of the Persian Gulf.

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