Scientific Publishing in Biomedicine: Revising a Peer-reviewed Manuscript

: Getting feedback from the journals’ editorial office upon the peer-review process, revising the manuscript, and responding to reviewers’ comments are the essential parts of scientific publishing. The process of revising seems cumbersome and time-consuming as authors must be engaged probably with many comments and requested changes. Authors are advised to approach the reviewer as a consultant rather than an adversary. They should carefully read and understand comments and then decide how to proceed with each requested change/suggestion. In the case of serious disagreement with reviewer comments or misunderstanding, authors can defer the issue to the editor. Preparing a scientific and well-organized "response to reviews" and the revised version of the manuscript can increase the chance of acceptance. Here, we provide a practical guide on dealing with different types of comments (ie, minor or major revisions, conflicting comments, or those that authors disagree with or cannot adhere to) and how to craft a response to reviews. We also provide the principles for making a successful revision.

Association Between Poor Sleep Quality and Glycemic Control in Adult Patients with Diabetes Referred to Endocrinology Clinic of Guilan: A Cross-sectional Study

Background: Diabetes is a prevalent chronic medical comorbid condition worldwide. Diabetes mellitus is associated with various sleep disorders. Objectives: We aimed to determine the prevalence of poor sleep and the main factors of sleep interruptions in patients with diabetes mellitus. We further evaluated the association of sleep interruptions with glycemic control in this cohort. Methods: We conducted a cross-sectional study on 266 patients with type 1 and type 2 diabetes who were recruited from a university outpatient endocrinology clinic. Patients completed a checklist including demographic and disease-related characteristics in addition to the Pittsburgh Sleep Quality Index (PSQI) to evaluate sleep quality. Using the PSQI cutoff score of 5, we created two subgroups of good sleepers (GS) and poor sleepers (PS). Results: Our results showed that good sleeper and poor sleeper diabetic patients were significantly different regarding sex, employment status, BMI, presence of diabetes-related complications, HbA1c, and 2-hour postprandial blood sugar (2HPPBS) (all significant at P < 0.05). The most prevalent factors of sleep interruptions were “waking up to use a bathroom”, “feeling hot”, “pain”, “having coughs or snores”, and “bad dreams”. Among the subjective factors of sleep interruption, problems with sleep initiation, maintenance, or early morning awakenings in addition to having pain or respiratory problems such as coughing or snoring had the most effects on HbA1c. Conclusions: Our study showed significant subjective sleep disturbances (both quality and quantity) in patients with diabetes mellitus (both type I and II) and its association with diabetes control. We further identified the main factors that led to sleep interruptions in this cohort.

The Action Plan and Strategy Development for the Community Readiness Improvement for Tackling Childhood Obesity (CRITCO) Study

Background: Community Readiness Improvement for Tackling Childhood Obesity (CRITCO) study has been developed based on the community readiness model (CRM) to improve the readiness of targeted local communities from two diverse socioeconomic districts of Tehran for tackling childhood obesity (CO) of late primary school children (10 - 12 years of age). Objectives: This study aimed to describe the rationale and process of developing the fourth phase of CRITCO study by developing an intervention package. Methods: The readiness level data was used to analyze strengths, weaknesses, opportunities, and threats (SWOT) of four intervention sites to guide proper strategies in partnership with key community members. Then, the action plan was developed as a living document to guide a 6-month quasi-experimental community-based intervention around the six dimensions of CRM. Finally, the community engagement process, outcome, and evaluation process were explained. Results: The current report described the action plan and strategy development of the CRITCO study. Expectedly, this study can provide valuable information to guide the public health policymakers in planning and executing relevant interventions.

Parvovirus B19 Infection Is Associated with Autoimmune Thyroid Disease in Adults

Background: Autoimmune thyroid diseases are the most frequent autoimmune disorders, with a global prevalence of about 10%. Several mechanisms have been proposed to induce autoimmune thyroid responses by infectious agents. In this study, we aimed to evaluate the association between parvovirus B19 infection and autoimmune thyroid disorders. Methods: Adult patients with newly diagnosed Graves’ disorder (GD) and Hashimoto’s thyroiditis (HT) and healthy euthyroid controls were recruited. Various clinical and biochemical parameters, including thyroid function tests and serum parvovirus B19 antibody level (IgG), were assessed and compared between the groups. Results: In this study, data from 404 cases with HT, 248 cases with GD, and 480 healthy individuals as a control group were analyzed. The prevalence of parvovirus B19 infection in patients with HT and GD and controls was 61.1%, 58.9%, and 47.1%, respectively. In the group of patients with HT, there was a significant positive correlation between the B19 IgG and TPOAb (r = 0.764, P < 0.001) and TgAb (r = 0.533, P < 0.001). Also, in patients with GD, the B19 IgG had a significant positive correlation with TPOAb (r = 0.779, P < 0.001) and TgAb (r = 0.467, P < 0.001). Conclusions: Parvovirus B19 infection is commonly seen in patients with autoimmune thyroid disorders.

The Frequency of CD4+ T Cells in Women with Hashimoto’s Thyroiditis

Background: Hashimoto's thyroiditis (HT) is the most prevalent autoimmune disease, and there is no definitive treatment available for this disease. To find the appropriate therapeutic approach, it is necessary to determine the mechanism of this disease. To achieve this purpose, the frequency of CD4+ T cells was evaluated in patients with HT and compared with healthy individuals. Methods: Twenty-six female patients with HT, aged 20 - 45 years, enrolled in this study. Based on the level of thyroglobulin antibody (anti-TG) and anti-thyroid peroxidase antibody (anti-TPO) in serum of patients with HT, they were divided into two groups. The serum level of anti-TPO was above 100 IU/mL in the group 1 (n = 13), whereas the serum levels of both anti-TPO and anti-TG were above 100 IU/mL in the group 2 (n = 13). Eleven healthy women were considered control group, or group 3. Using flow cytometry, the frequency of T helper (Th)1, Th2, Th17, T regulatory type 1 (Tr1), and LT CD4+IL-4+IL-17+ cells and mean fluorescent intensity (MFI) of their related cytokines were evaluated. Results: The frequency of Th2 cells in the groups 1 (anti-TPO > 100) and 2 (anti-TPO > 100 and anti-TG > 100) were more than control group. Only the difference between groups 3 (healthy control) and 2 was significant (P = 0.022). The frequency of LT CD4+IL-4+IL-17+ cells in the group 1 was significantly more than group 3 (P = 0.027); However, the difference between group 2 and 3 was not significant (P = 0.126). The expression of interferon-gamma (IFN-γ) in the group 2 (P = 0.001) and group 1 (P = 0.001) is significantly higher than group 3. The frequency of Th17, Th1, and Tr1 cells and MFI of IL-17 and IL-10 were not significantly different between the study groups. Conclusions: In the present study, no significant differences were observed in the frequency of Th17 and Tr1 cells and in MFI of IL-17 and IL-10 in comparison to healthy individuals. Therefore, trying to make a change in the population of these cells probably does not have a significant therapeutic effect. Since Th2 cells and the expression of IFN-γ increased in women with HT, reducing the frequency of Th2 cells or the expression of IFN-γ may be effective in controlling the disease progression. It may be helpful for these patients and prevent the progression of the disease.

A Systematic Review and Meta-Analysis of Diabetes Associated Mortality in Patients with COVID-19

Context: Coronavirus disease 2019 (COVID-19) has been one of the deadliest pandemics in recent decade. The virus has specifically targeted the comorbid population in terms of mortality. The present systematic review and meta-analysis aimed to determine the overall mortality and diabetes-associated mortality in COVID-19 patients. Methods: To obtain the related data, six databases, including Pubmed, Embase, MEDLINE, Web of Science, Google Scholar, and DOAJ, were searched. The full-texts of articles presenting the data of COVID-19 mortality and diabetes-associated mortality were screened and retrieved. Statistical analysis was performed using the Stata (version 13). The odds ratio (OR) of mortality in diabetic patients was calculated with 95% confidence interval (CI). Random-effects model was used to synthesize data for the relevant outcomes. Heterogeneity was evaluated using I2 statistic. Forest plots visually showed the effect estimates of the included studies. We used funnel plots to evaluate potential publication bias. A two tailed P < 0.05 was considered as statistically significant. Results: A total of 35 studies with 25,934 patients were finally included for meta-analysis. The pooled prevalence of diabetes mellitus in patients with COVID-19 was 16.8% (n = 4381). The overall mortality seen in all the studies was 12.81% (n = 3159), and diabetes-associated mortality was 22.14% (n = 970). The pooled analysis of included studies showed that diabetes mellitus had a significantly higher mortality rate (22.14% vs. 12.81%, P < 0.05) with higher odds of death (pooled OR 1.83, 95% CI: 1.61 - 2.05). The funnel plot was symmetric, thereby indicating a low risk of publication bias. Conclusions: In conclusion, the presence of diabetes was associated with a significantly increased risk of mortality in patients admitted to the hospital with COVID-19. Thus, the subpopulation must be continuously monitored for glycemic levels, coagulation abnormalities, and inflammatory surge.

Maternal Emotional States in Relation to Offspring Weight and Health-Related Quality of Life: Tehran Lipid and Glucose Study

Background: Maternal characteristics have been known to be associated with parenting practices, which could eventually influence their child’s weight and health-related quality of life (HRQoL). Objectives: This study aimed to assess the direct and indirect associations of maternal emotional states (depression, anxiety, and stress) with body mass index (BMI) and HRQoL in their children. Methods: This study was conducted within the framework of the Tehran lipid and glucose study (TLGS). Participants were the children (n = 231) enrolled in TLGS during 2014 - 2016, who had complete data on maternal emotional states. The body weight and height of children were measured using the standard protocol, and BMI Z-score was determined using Anthroplus. Also, HRQoL in children and emotional states in mothers were assessed using the Iranian version of the pediatric quality of life inventory (PedsQLTM4.0) and the depression, anxiety, and stress scale (DASS-21), respectively. Structural equations modeling (SEM) was used to assess the direct and indirect relations of maternal emotional states with children’s BMI Z-score and HRQoL. Results: Mean age, BMI Z-score, and HRQoL total score in children were 13.8 ± 3.1 years, 0.74 ± 1.5, and 84.7 ± 11.3, respectively. In the mothers, median DASS-21 scores (interquartile ranges) in the three scales of depression, anxiety, and stress were 4 (0 - 10), 6 (2 - 12), and 14 (8 - 20), respectively. Maternal level of education was significantly associated with the DASS-21 score (β = -0.23, 95% CI: -0.37,-0.07). Maternal DASS-21 score was significantly associated with BMI Z-score only in girls (β = 0.25, 95% CI: 0.06, 0.53). Significant determinants of HRQoL in boys were the child’s age (β = -0.21, 95% CI: -0.40, -0.01) and maternal education (β = -0.24, 95%CI: -0.44, -0.02) and emotional state (β = -0.24, 95% CI: -0.44, -0.03). The child’s age (β = -0.33, 95% CI: -0.53, -0.10) and maternal emotional state (β = -0.31, 95% CI: -0.54, -0.08) were significantly associated with HRQoL in girls. Conclusions: Our results indicated that the maternal emotional state was an important determinant of HRQoL in children, regardless of their weight status. Further research is recommended to examine the current hypothesized model in rural and suburban populations, taking into consideration more influential factors.

Anthropometric Indices and Age at Natural Menopause: A 15-Year Follow-Up Population-Based Study

Background: Following menopause, the risk of many diseases is increased, and this situation may be due to changes in anthropometric indices (AI), while the association between adiposity and age at natural menopause (ANM) is not clear yet. Objectives: This longitudinal study was conducted to investigate the ability of AI in predicting ANM. Methods: For this purpose, a total of 3,876 women aged > 20 years old from participants of the Tehran lipid and glucose study (TLGS) met our eligibility criteria. The association between ANM and various AIs was assessed using the Accelerated Failure Time (AFT) model, and time ratio (TR) with 95% confidence intervals were reported in this longitudinal study. Results: The median [interquartile range (IQR) 25 - 75] of the survival time was 12.5 (7.9 - 15.8) years. At the end of the follow-up, 1,479 (38.2%) of the participants reached menopause. The median time to natural menopause was decreased by about 2% with one standard deviation (SD) increase of both a body shape index (ABSI) (time ratio (TR): 0.98, 95% CI: 0.97, 0.99) and lipid accumulation product (LAP) (TR: 0.98, 95% CI: 0.98, 0.99) z-scores; and this time was increased by about 1% (TR: 1.01, 95% CI: 1.00, 1.02) with one SD increase in body mass index (BMI) z-score. Conclusions: The ABSI, LAP, and BMI were the most useful AIs for identification of the time to menopause onset, and ABSI and LAP were inversely associated with the ANM. Also, the BMI was directly associated with the ANM.

Empowering Health Care Providers and Self-Management Education in Diabetes? A Scoping Review

Context: There has been an increasing emphasis on the role of education in diabetes prevention and management, and shedding light on evidence gaps is mandatory for national action plans establishment. Data Sources: This scoping review was part of the Iranian Diabetes Road Map project that used a systematic method based on the Arksey and O'Malley approach. Results: After the screening, 173 articles were included, most of which were published in 2018 and focused on self-management. Only a limited number of articles studied healthcare provider education and educational establishment. Conclusions: Education is an important part of diabetes, and specific needs for Iranian patients should be addressed in future studies. Paying attention to new topics and conducting high-quality interventional studies will help fill evidence gaps in this field in Iran.