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Background: We sought to conduct this comprehensive systematic review and meta-analysis to assess the prevalence of depression, anxiety, and sleep disturbance in Iranian medical students and resident physicians. Methods: A systematic search was conducted on 23 December 2023 in PubMed/MEDLINE, Web of Science, Scopus, and Iranian national databases. We pooled the prevalence of individual studies using the random effect model. Results: Our systematic search showed 36 articles that meet the eligibility criteria. Most included studies were cross-sectional. The most used questionnaire to assess depression, anxiety, and sleep disturbance were Beck Depression Inventory (BDI), The Depression, Anxiety and Stress Scale—21 Items (DASS-21), and The Pittsburgh Sleep Quality Index (PSQI), respectively. The overall prevalence of depression, anxiety, and sleep disturbance among Iranian medical students were 43% (95%CI: 33%–53%%, I2 = 98%), 44% (95%CI: 31%–58%%, I2 = 99%), 48% (95%CI: 39%–56%%, I2 = 97%), respectively. The results of subgroup and meta-regression analyses showed questionnaires used and the place of the medical school were significantly associated with the prevalence of aforementioned outcomes. Funnel plot and Begg's regression test did not show a significant source of funnel plot asymmetry for depression, anxiety, and sleep disturbance. Conclusion: In conclusion, our study showed that nearly half of the medical students had some type of depression, anxiety, and sleep disturbance problems. To address this serious national public health issue, efficient preventive measures, routine screenings, and prompt interventions are required. [ABSTRACT FROM AUTHOR]

Background: Anxiety symptoms in older adults can significantly impact their well-being. Physical activity is increasingly recognized as a potential intervention to alleviate anxiety in this population. We conducted a systematic review and meta-analysis to explore the impact of physical activity on anxiety symptoms in geriatric individuals. Methods: A systematic search was conducted in MEDLINE (via PubMed), Scopus, and Embase databases until November 29, 2023. Two independent reviewers screened articles based on predefined inclusion criteria. Results: Eleven randomized controlled trials were included. These trials, involving 770 geriatric participants, demonstrated a significant overall effect of physical activity on reducing anxiety symptoms (SMD =-0.60, 95% CI: -0.88 to -0.32). Subgroup analysis based on type of intervention and duration of follow-up was performed. The results showed all types of exercises reduced anxiety symptoms compared to the control group. Furthermore, those studies with shorter follow-up (less than 10 weeks) did not show a statistically significant reduction in anxiety symptoms. Moderate heterogeneity was observed (I2 = 67%). Sensitivity analyses confirmed the robustness of the overall effect size. Funnel plot inspection and Egger's test (p = 0.36) suggested no signs of publication bias or small study effects. Conclusion: This meta-analysis provides strong evidence that physical activity significantly reduces anxiety symptoms in older adults. The study highlights the differential effects of cardio and strength exercises and underscores the high quality of evidence supporting the anxiolytic benefits of physical activity in geriatric populations. [ABSTRACT FROM AUTHOR]

Introduction: The relationship between psychiatric disorders, including depression, and invasive interventions has been a topic of debate in recent literature. While these conditions can impact the quality of life and subjective perceptions of surgical outcomes, the literature lacks consensus regarding the association between depression and objective perioperative medical and surgical complications, especially in the neurosurgical domain. Methods: MEDLINE (PubMed), EMBASE, PsycINFO, and the Cochrane Library were queried in a comprehensive manner from inception until 10 November 2023, with no language restrictions, for citations investigating the association between depression and length of hospitalization, medical and surgical complications, and objective postoperative outcomes including readmission, reoperation, and non-routine discharge in patients undergoing spine surgery. Results: A total of 26 articles were considered in this systematic review. Upon pooled analysis of the primary outcome, statistically significantly higher rates were observed for several complications, including delirium (OR:1.92), deep vein thrombosis (OR:3.72), fever (OR:6.34), hematoma formation (OR:4.7), hypotension (OR:4.32), pulmonary embolism (OR:3.79), neurological injury (OR:6.02), surgical site infection (OR:1.36), urinary retention (OR:4.63), and urinary tract infection (OR:1.72). While readmission (OR:1.35) and reoperation (OR:2.22) rates, as well as non-routine discharge (OR:1.72) rates, were significantly higher in depressed patients, hospitalization length was comparable to non-depressed controls. Conclusions: The results of this review emphasize the significant increase in complications and suboptimal outcomes noted in patients with depression undergoing spinal surgery. Although a direct causal relationship may not be established, addressing psychiatric aspects in patient care is crucial for providing comprehensive medical attention. [ABSTRACT FROM AUTHOR]

Background: Post COVID-19 syndrome, also known as "Long COVID," is a complex and multifaceted condition that affects individuals who have recovered from SARS-CoV-2 infection. This systematic review and meta-analysis aim to comprehensively assess the global prevalence of depression, anxiety, and sleep disorder in individuals coping with Post COVID-19 syndrome. Methods: A rigorous search of electronic databases was conducted to identify original studies until 24 January 2023. The inclusion criteria comprised studies employing previously validated assessment tools for depression, anxiety, and sleep disorders, reporting prevalence rates, and encompassing patients of all age groups and geographical regions for subgroup analysis Random effects model was utilized for the meta-analysis. Meta-regression analysis was done. Results: The pooled prevalence of depression and anxiety among patients coping with Post COVID-19 syndrome was estimated to be 23% (95% CI: 20%—26%; I2 = 99.9%) based on data from 143 studies with 7,782,124 participants and 132 studies with 9,320,687 participants, respectively. The pooled prevalence of sleep disorder among these patients, derived from 27 studies with 15,362 participants, was estimated to be 45% (95% CI: 37%—53%; I2 = 98.7%). Subgroup analyses based on geographical regions and assessment scales revealed significant variations in prevalence rates. Meta-regression analysis showed significant correlations between the prevalence and total sample size of studies, the age of participants, and the percentage of male participants. Publication bias was assessed using Doi plot visualization and the Peters test, revealing a potential source of publication bias for depression (p = 0.0085) and sleep disorder (p = 0.02). However, no evidence of publication bias was found for anxiety (p = 0.11). Conclusion: This systematic review and meta-analysis demonstrate a considerable burden of mental health issues, including depression, anxiety, and sleep disorders, among individuals recovering from COVID-19. The findings emphasize the need for comprehensive mental health support and tailored interventions for patients experiencing persistent symptoms after COVID-19 recovery. [ABSTRACT FROM AUTHOR]

Cancer is one of the diseases, which it is not still completely curable; the existing treatments are associated with many complications, that double its complexity. One of the causes of cancer cell metastasis is Epithelial Mesenchymal Transition (EMT). Recently study demonstrated that EMT cause cardiotoxicity and heart diseases such as heart failure, hypertrophy and fibrosis. This study evaluated molecular and signaling pathway, which lead to cardiotoxicity via EMT. It was demonstrated that the processes of inflammation, oxidative stress and angiogenesis were involved in EMT and cardiotoxicity. The pathways related to these processes act as a double-edged sword. In relation to inflammation and oxidative stress, molecular pathways caused apoptosis of cardiomyocytes and cardiotoxicity induction. While the angiogenesis process inhibits cardiotoxicity despite the progression of EMT. On the other hand, some molecular pathways such as PI3K/mTOR despite causing the progression of EMT lead to the proliferation of cardiomyocytes and prevent cardiotoxicity. Therefore, it was concluded that the identification of molecular pathways can help in designing therapeutic and preventive strategies to increase patients' survival. [ABSTRACT FROM AUTHOR]

Purpose: We investigated recent evidence on the analgesics available for postoperative pain management among patients undergoing septoplasty or rhinoplasty surgery. Methods: Studies were retrieved from MEDLINE (through PubMed), Web of Science, and Embase up to 3 August 2022. Results: Forty-seven studies including 3717 patients were included. There were 45 randomized clinical trials and 2 observational cohort studies. Most of the studies were recently published and conducted in Turkey (n = 27). The majority of the studies performed the intervention preoperatively (n = 26), 11 studies postoperatively, 6 studies intraoperative, 2 studies preoperative plus intraoperative, and 2 studies performed the intervention with preoperative plus postoperative timing. The most evaluated medication was lidocaine (n = 10), followed by levobupivacaine (n = 4), and gabapentin (n = 4). Regarding post-operative pain assessment, the most used scale was the visual analog scale (VAS) (n = 36). Compared to controls, almost all interventions showed a significant benefit in managing post-operative pain. Although it should be mentioned regarding the comparison between opioids and NSAIDs consumption after surgery for pain management, most studies did not show a significant difference between the groups. No major side effects except nausea and vomiting were observed among the reviewed studies. Conclusion: This study summarized the most recent options that are available to manage pain following septorhinoplasty surgery. Recent investigations showed local interventions vs pre/post-operative analgesic medications are highly suggested to be replaced with opioids and NSAIDs as they have shown prominent efficacy with no significant adverse events. Future research is advised to determine the best dosage and administration techniques. [ABSTRACT FROM AUTHOR]

Background: Esophageal motility disorders are a group of disorders associated with dysfunctional swallowing resulting from impaired neuromuscular coordination. Phosphodiesterase 5 (PDE-5) inhibitors induce smooth relaxation and are proposed as a treatment option for esophageal motility disorders such as achalasia. Methods: This study is conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We systematically searched MEDLINE/ PubMed, Scopus, EMBASE, and Web of Science databases for esophageal outcomes of individuals treated with PDE5 inhibitors. A random effect meta-analysis was conducted. Results: A total of 14 studies were included. They were conducted in different countries, with Korea and Italy having the highest number of articles. The main drug assessed was sildenafil. PDE-5 inhibitors resulted in a significant reduction in lower esophageal sphincter pressure (SMD − 1.69, 95% CI: -2.39 to -0.99) and the amplitude of contractions (SMD − 2.04, 95% CI: -2.97 to -1.11). Residual pressure was not significantly different between the placebo and sildenafil groups (SMD − 0.24, 95% CI: -1.20 to 0.72). Furthermore, a recent study reported contractile integral, stating that ingestion of sildenafil leads to a significant reduction in distal contractile integral and a significant increase in proximal contractile integral. Conclusion: PDE-5 inhibitors significantly reduce LES resting pressure and esophageal peristaltic vigor, decreasing esophageal body contractility and contraction reserve. Therefore, using these drugs in patients affected by esophageal motility disorders may potentially improve their condition regarding symptom relief and prevention of further associated complications. Future reports investigating larger sample size is necessary in order to establish definite evidence regarding the efficacy of these drugs. [ABSTRACT FROM AUTHOR]

To provide a comprehensive systematic review and meta‐analysis regarding the cumulative incidence (incidence proportion) of human herpesvirus (HHV) reactivation among patients with coronavirus disease 2019 (COVID‐19), we searched PubMed/MEDLINE, Web of Science, and EMBASE up to 25 September 2022, with no language restrictions. All interventional and observational studies enrolling patients with confirmed COVID‐19 and providing data regarding HHV reactivation were included. The random‐effects model was used in the meta‐analyses. We included information from 32 studies. HHV reactivation was considered a positive polymerase chain reaction result taken at the time of COVID‐19 infection. Most of the included patients were severe COVID‐19 cases. The pooled cumulative incidence estimate was 38% (95% Confidence Intervals [CI], 28%–50%, I2 = 86%) for herpes simplex virus (HSV), 19% (95% CI, 13%–28%, I2 = 87%) for cytomegalovirus (CMV), 45% (95% CI, 28%–63%, I2 = 96%) for Epstein‐Barr virus (EBV), 18% (95% CI, 8%–35%) for human herpesvirus 6 (HHV‐6), 44% (95% CI, 32%–56%) for human herpesvirus 7 (HHV‐7), and 19% (95% CI, 14%–26%) for human herpesvirus 8 (HHV‐8). There was no evidence of funnel plot asymmetry based on visual inspection and Egger's regression test for the results of HSV (p = 0.84), CMV (p = 0.82), and EBV (p = 0.27) reactivation. In conclusion, the identification of HHV reactivation in severe COVID‐19 patients is helpful in the management of patients as well as the prevention of complications. Further research is required to elucidate the interaction between HHVs and COVID‐19. Systematic review registration: PROSPERO CRD42022321973. [ABSTRACT FROM AUTHOR]

Curcumin is a low‐cost and easily accessible therapeutic option for COVID‐19 patients. We aimed to conduct a meta‐analysis to assess the effect of curcumin on clinical outcomes in COVID‐19 patients. Various databases, including PubMed, the Cochrane Library and Embase were searched from inception until October 2022 for randomized controlled trials (RCTs) evaluating curcumin use in COVID‐19 patients. Results from 13 RCTs were pooled using R software version 4.1.0. Curcumin reduced the risk of all‐cause mortality (RR 0.38; 95% CI: 0.20–0.72; moderate certainty of evidence), and patients with no recovery status (RR 0.54; 95% CI: 0.42–0.70; moderate certainty of evidence) but had no effect on the incidence of mechanical ventilation and hospitalization, and the rate of a positive viral PCR test. The results of subgroup analysis suggested a higher benefit with early administration of curcumin (within 5 days of onset of symptoms) and with the use of combination regimens. Curcumin is likely to be of benefit in mild‐to‐moderate COVID‐19 patients, but large‐scale RCTs are needed to confirm these findings. The limitations of our meta‐analysis include the small sample sizes of the included RCTs and the variable formulations of curcumin used across the studies. [ABSTRACT FROM AUTHOR]

Background: SARS-CoV-2 exposure during pregnancy is related to adverse effects for both the mother and the infant. SARS-CoV-2 vaccination has lowered the risk of symptomatic disease substantially. Recently published studies have evaluated the outcomes of women who received the COVID-19 vaccine during pregnancy; systematic evidence regarding vaccination safety is crucial to ensure that COVID-19 vaccination is not associated with adverse pregnancy and neonatal outcomes. Methods: Pubmed/MEDLINE, EMBASE, Scopus, Web of Science, and Clinicaltrials.gov were searched from each database's inception through April 7, 2022. All interventional and observational studies comparing neonatal or pregnancy outcomes between pregnant women who received COVID-19 vaccines during their pregnancy and unvaccinated pregnant women were included. The random-effects model was used in the meta-analyses. Results: A total of 11 studies comprising 756,098 pregnant mothers were included. The rate of neonates with 5-min Apgar score ≤ 7 (log RR -0.08 (95% CI: -0.15 to -0.00), (P = 0.03)) and pregnant mothers with preterm birth (log RR -0.11 (95% CI: -0.21 to -0.01), (P = 0.02)) was significantly lower among vaccinated group. No significant difference was observed in adverse neonatal outcomes (log RR -0.07 (95% CI: -0.17 to 0.03)), small for gestational age (log RR -0.06 (95% CI: -0.14 to 0.02)), caesarean delivery (log RR 0.05 (95% CI: -0.05 to 0.15)), postpartum hemorrhage (log RR -0.05 (95% CI: -0.13 to 0.02)), stillbirth (log RR -0.05 (95% CI: -0.54 to 0.45)). Conclusions and relevance: In this systematic review and meta-analysis, no evident differences were observed when comparing vaccinated pregnant mothers with those who had not received COVID-19 vaccines. Based on low certainty of evidence, vaccination during pregnancy was accompanied by a favorable Apgar score in neonates and fewer preterm births. [ABSTRACT FROM AUTHOR]

Background: We conducted a systematic review and meta-analysis to evaluate the efficacy of ivermectin for COVID-19 patients based on current peer-reviewed RCTs and to address disputes over the existing evidence. Methods: MEDLINE (Pubmed), Scopus, Web of Science, Cochrane library, Google scholar and Clinicaltrials.gov were searched for RCTs assessing the efficacy of Ivermectin up to 20 February 2022. A systematic review and meta-analysis of studies was performed based on the PRISMA 2020 statement criteria. Results: 19 and 17 studies were included in this systematic review and meta-analysis, respectively. There was no significant difference in progression to severe disease (log OR − 0.27 [95% CI − 0.61 to 0.08], I2 = 42.29%), negative RT-PCR (log OR 0.25 [95% CI − 0.18–0.68], I2 = 58.73%), recovery (log OR 0.11 [95% CI − 0.22–0.45], I2 = 13.84%), duration of hospitalization (SMD − 0.40 [95% CI − 0.85–0.06], I2 = 88.90%), time to negative RT-PCR (SMD − 0.36 [95% CI − 0.89–0.17], I2 = 46.2%), and viral load (SMD -0.17 [95% CI -0.45 to 0.12], I^2 = 0%). It is worth noting that, based on low-certainty evidence, ivermectin may possibly reduce mortality (log OR − 0.67 [95% CI − 1.20 to − 0.13], I2 = 28.96%). However, studies with a higher risk of bias were more likely to indicate positive effects on the efficacy of this drug, according to our subgroup analyses based on study quality. Conclusion: Ivermectin did not have any significant effect on outcomes of COVID-19 patients and as WHO recommends, use of ivermectin should be limited to clinical trials. [ABSTRACT FROM AUTHOR]

This editorial examines what has caused the evidence around ivermectin to be so controversial, provides a brief analysis of recently published evidence, and highlights why it is important to learn lessons from ivermectin for future re-purposed drugs. [ABSTRACT FROM AUTHOR]

Objective: To investigate the cross-sectional association between dietary intakes of antioxidants and fibre and depressive symptoms among Iranian adolescent girls. Design: A cross-sectional population-based study. Setting: Primary schools in two different cities located in northeastern Iran (Mashhad and Sabzevar). Participants: A total of 988 adolescent girls aged 12–18 years were included in the study. Results: Subjects with no or minimal depression symptoms had significantly higher dietary intakes of α-carotene (P = 0·01), β-carotene (P = 0·006), lutein (P = 0·03) and vitamin C (P = 0·04) when compared with subjects with mild-to-severe depression symptoms. Soluble dietary fibre and insoluble dietary fibre intakes were also significantly higher in healthy adolescents compared with those with depression symptoms (P < 0·001). In multivariate-adjusted model 2, the OR (95 % CI) of depressive symptoms were 0·61 (95 % CI 0·37, 1·01), 0·42 (95 % CI 0·26, 0·69), 0·50 (95 % CI 0·31, 0·79), 0·71 (95 % CI 0·44, 1·15), 0·51 (95 % CI 0·32, 0·82) and 0·42 (95 % CI 0·25, 0·68) for the highest v. lowest quartile of vitamin C, β-carotene, α-carotene, lutein, soluble dietary fibre and insoluble dietary fibre cereal intakes, respectively. Conclusions: Dietary intake of some antioxidants and dietary fibre intake was inversely associated with depression symptoms among Iranian adolescent girls. [ABSTRACT FROM AUTHOR]

Objective: To investigate the cross-sectional association between dietary intakes of antioxidants and fibre and depressive symptoms among Iranian adolescent girls.Design: A cross-sectional population-based study.Setting: Primary schools in two different cities located in northeastern Iran (Mashhad and Sabzevar).Participants: A total of 988 adolescent girls aged 12-18 years were included in the study.Results: Subjects with no or minimal depression symptoms had significantly higher dietary intakes of α-carotene (P = 0·01), β-carotene (P = 0·006), lutein (P = 0·03) and vitamin C (P = 0·04) when compared with subjects with mild-to-severe depression symptoms. Soluble dietary fibre and insoluble dietary fibre intakes were also significantly higher in healthy adolescents compared with those with depression symptoms (P < 0·001). In multivariate-adjusted model 2, the OR (95 % CI) of depressive symptoms were 0·61 (95 % CI 0·37, 1·01), 0·42 (95 % CI 0·26, 0·69), 0·50 (95 % CI 0·31, 0·79), 0·71 (95 % CI 0·44, 1·15), 0·51 (95 % CI 0·32, 0·82) and 0·42 (95 % CI 0·25, 0·68) for the highest v. lowest quartile of vitamin C, β-carotene, α-carotene, lutein, soluble dietary fibre and insoluble dietary fibre cereal intakes, respectively.Conclusions: Dietary intake of some antioxidants and dietary fibre intake was inversely associated with depression symptoms among Iranian adolescent girls. [ABSTRACT FROM AUTHOR]

By growing urban population, Iran faces numerous environmental issues and solid waste management is on the top of these problems. Studies showed that a daily average of 700–1000 g of wastes are produced per person in Iran, in which organic waste accounts for a significant amount. On the other hand, hospital waste represents a part of the wastes, which need careful consideration from the environmental point of view. In the present study, the amount, composition, and management of urban and hospital wastes were evaluated in 7 Iranian metropolises, which account for about 30% of the population and produce about 35% of the country wastes. Based on prior surveys, landfill method is the current main method for waste management in these cities, which is generally not completely sanitary and therefore causes many environmental problems. The other common methods for waste management in these cities are composting of organic wastes, and the use of waste conversion methods to energy. However, the latter is ongoing only in Tehran which also includes some limitations. Therefore, the study also evaluated the future perspectives and feasibility of waste-to-energy conversion as a promising economic route for waste disposal. [ABSTRACT FROM AUTHOR]

Neonatal abstinence syndrome (NAS) which is observed in 55–94% of the newborns from opioids-taking mothers produces deleterious neurological symptoms. Various pharmacological therapies have been investigated in neonates with NAS. This article reviews all studies on NAS treatment to analyze the duration of treatment, length of hospitalization and possible drug adverse effects. The search was limited to the randomized clinical trials which examined the treatments of neonates with NAS. Scientific databases including PubMed, Cochrane Library, ISI Web of Science, Embase and Scopus were systematically searched. Retrieved articles were reviewed by two researchers and evaluated using the JADAD scoring system. Finally, the treatment duration, hospitalization length and drug side-effects were extracted. Methadone, buprenorphine and clonidine were found more effective than morphine. Diluted tincture of opium (DTO) in combination with phenobarbital or clonidine was significantly more effective than DTO alone. Clonidine was a significantly better adjunctive therapy than phenobarbital in reducing morphine treatment days. No significant difference was observed between morphine and DTO effectiveness. Deciding the optimal regimen to manage symptomatic NAS, as a single or an adjunct therapy is not possible based on the literature, due to the low quality, small size and short-term treatment considered in the published studies. [ABSTRACT FROM AUTHOR]

Background: Surgeon's hand tremor is considered as detrimental during surgery, which can potentially influence patient safety and the outcome of microsurgical operations. Various mutable factors have been shown to be associated with hand tremor of the surgeons including stress and anxiety, mental fatigue, inappropriate physical activity before the surgery, and unfavorable dietary intakes of caffeine, high sugar energy drinks, etc. Therefore, regarding the popularization of digital technologies, using gadgets as surgical instruments provide a suitable opportunity to overcome the operating room adverse issues. Objective: The goal of the present study was to develop a Persian-language medical gadget (MyMed) for surgeons, to improve surgical tremor. Material and Methods: This project was a developmental-applied study which involved three phases of analysis, design, and development. At first, a scientific review was performed on existing medical gadgets. Furthermore, several surgeons were consulted to recognize their preferences, barriers, and facilitators in using a medical gadget. Then, the main features of MyMed were designed based on the collected information. Eventually, the final version of MyMed was developed under the supervision of the team consists of surgical technologists, psychologist, nutritionists, and expert hardware technology developers. Results: MyMed can accurately detect signals of the surgeon's hand tremor compared to normal level and alarmed the associated risk situation. It also provides quick practical psychological tips such as controlling stress and anxiety, improving mental abilities, and preoperative nutritional recommendations for surgeons. Conclusion: MyMed may be a helpful approach in empowering surgeons to acquire self-care abilities and ensure overall operation outcomes. [ABSTRACT FROM AUTHOR]