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According to World Health Organization (WHO), currently, 2.2 billion people are living with visual impairment worldwide, of which almost half could have been prevented. There are both modifiable and unmodifiable factors leading to visual disability and, ultimately, blindness. Several population-based studies in different parts of Iran have tried to determine these factors concerning their specific population and environment-related characteristics. AZAR Eye and Vision cohort is the second-largest cohort study in the whole country. AZAR Eye and Vision cohort is the ophthalmologic branch of AZAR cohort which is the largest eye cohort study in the country, which is trying to determine the prevalence and incidence of visual impairment, blindness, and other major ophthalmologic conditions and their associated risk factors in East Azerbaijan province located in Iran, a middle eastern country. A recently emerging phenomenon is the drying of the ultra-salty lake of Urmia located in the West Azerbaijan province which is a direct neighbor of our studied population and has caused recurrent salt storms in the immediate near areas. This phenomenon could adversely affect visual health via different conditions which our study will elucidate. The enrollment phase took place between 2014 and 2017 and 11,208 participants were enrolled out of 15,000 participants in the primary cohort. The resurvey phase will begin five years after the enrollment phase. In this phase, 30% of the participants are randomly selected to be reexamined and complete questionnaires. The participants showing any issues such as diabetes and being a glaucoma suspect will be included in the resurvey phase, too. Data categories gathered include demographics, lifestyle factors, past medical and drug histories, and a diet quality and quantity questionnaire including 130 edible items. Urine, hair, nail, and 25-ml blood samples, were collected from the participants. Then they were referred to an optometrist to complete an ophthalmologic questionnaire and undergo eye examination and lensometry. Then they underwent slit-lamp examinations and pictures were taken of the lens and fundus. People with suspected visual impairment were referred to an ophthalmology clinic. The data are processed and a four-level quality check is performed on each block. The most common visual impairment is cataracts. This study’s most important aim is to evaluate the effect of local environmental and ethnic factors on eye diseases in this specific population.

Objective Considering the rising prevalence of metabolic syndrome (MetS), this study aimed to investigate the relationship between MetS and its components with oral and dental health in the adult population of the Azar cohort. Methods In this cross-sectional study oral health care behaviors, DMFT (decayed, missing, and filled teeth) index, and demographic data related to 15,006 patients (5112 in the MetS group and 9894 in the healthy group) of the Azar Cohort population aging from 35 to 70 were collected using appropriate questionnaires. The definition of MetS was based on the National Cholesterol Education Program Adult Treatment Panel III (ATP III) criteria. Then, the risk factors of MetS related to oral health behaviors were determined by proper statistical analysis. Results The majority of MetS patients were female (66%) and uneducated (23%) (P < 0.001). In the MetS group, the DMFT index (22.15 ± 8.89) was significantly ( p  < 0.001) higher (20.81 ± 8.94) than the no MetS group. Not brushing at all was associated with increased odds of MetS (unadjusted OR = 1.12, adjusted OR = 1.18). Flossing less than once a day was associated with increased odds of abdominal obesity (unadjusted OR = 1.17, 95%CI = 1.03–1.32) and hyperglycemia (unadjusted OR = 1.88, 95%CI = 1.61–2.20). Conclusions This study showed that in MetS patients of the Azar cohort study, oral hygiene was worse compared to that in the no MetS group. Further studies are suggested to encourage oral hygiene among the general population which has more beneficiary effects than has been known before.

ObjectivesHyperinsulinaemia and insulin resistance are proposed as contributors to the incidence of cardiometabolic phenotypes (CMPs) with unhealthy metabolic status. This study analysed the association between dietary insulin load (DIL) and Dietary Insulin Index (DII) with CMPs in the AZAR cohort population.DesignThis study was a cross-sectional analysis of the AZAR Cohort Study, beginning in 2014 and continuing to this date.SettingThe AZAR cohort is a part of an Iranian screening programme named the Persian cohort and involves participants living in the Shabestar region, Iran for at least 9 months.ParticipantsA total of 15 006 participants agreed to partake in the study. We excluded participants with missing data (n=15), daily energy intake lower than 800 kcal (n=7) or higher than 8000 kcal (n=17), and cancer (n=85). Finally, 14 882 individuals remained.Primary and secondary outcome measuresThe gathered information included the participants' demographic, dietary, anthropometric and physical activity data.ResultsThe frequency of DIL and DII significantly decreased from the first to fourth quartiles in metabolically unhealthy participants (p≤0.001). The mean values of DIL and DII were greater in metabolically healthy participants than in unhealthy ones (p<0.001). The results of the unadjusted model showed that the risks of unhealthy phenotypes in the fourth DIL quartile decreased by 0.21 (0.14–0.32) and 0.37 (0.33–0.43), respectively, compared with the first quartile. The same model showed the same risks for DII decreased by 0.18 (0.11–0.28) and 0.39 (0.34–0.45), respectively. The results in both genders were the same as all participants combined.ConclusionsDII and DIL were correlated with a decreased OR of unhealthy phenotypes. We suggest the reason may be either a lifestyle change in metabolically unhealthy participants or elevated insulin secretion not being as detrimental as previously thought. Further studies can confirm these speculations.

ABSTRACT Placing a tracheostomy is challenging in patients with Klippel–Feil syndrome due to a short, flexed, and immobile neck that can limit surgical access to the trachea. Here, we report a modified technique with elements from both open and percutaneous tracheostomy without requiring sternotomy. This case report details a modified tracheostomy technique used in an adult patient with Klippel‐Feil syndrome, a condition characterized by congenital fusion of cervical vertebrae. The unique challenges posed by the patient's anatomy were addressed using a combination of open and percutaneous approaches, successfully avoiding the need for more invasive procedures.