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Summary Background and aim Patients hospitalized at the intensive care unit (ICU) are more prone to oxidative stress. Antioxidants such as selenium (Se) may have beneficial effects on outcomes in these patients. Studies and systematic reviews in this field have inconclusive results. Methods An updated systematic search was done to find clinical trials published in PubMed, Cochrane's library, ISI web of Science, Scopus, and Ovid databases from January 1980 up to April 2020, to assess the effects of daily Se supplementation on patient's survival, hospital and ICU stay, duration of mechanical ventilation, infection, acute renal failure (ARF) occurrence and serum creatinine levels. Results From 1394 papers found in the first step of the search, after deleting duplicate findings, 24 studies were included in this meta-analysis. Results of the pooled random-effect size analysis of 24 trials showed no remarkable effect of daily parenteral Se administration on patient's hospital and ICU stay, duration of mechanical ventilation, infectious complications, ARF, survival and serum creatinine levels (p > 0.05). The subgroup analysis showed that daily parenteral Se administration (in doses higher than 1000 μg/d) increased the length of ICU stay by 4.48-folds (95%CI: −0.5, 9.46, p = 0.07). Parenteral Se supplementation at the first and following dose of ≤1000 μg reduced the number of ARF at the hospitalized patients by 76% and 45%, respectively (p = 0.02, and p = 0.05). Conclusions High doses of Se increases days of ICU stay, but low doses decreases the number of ARF occurrence in ICU patients. More trials are needed to assess its effect on ARF occurrence.

Introduction Forensic age estimation is performed via clinical examination and utilizing various imaging modalities. Currently, radiography and CT are used. In this study we aim to evaluate if magnetic resonance imaging (MRI) can be used to determine stages of fusion in the epiphysis of the tibia and femur, and if these stages are significantly different regarding the mean age of subjects classified in each one. Methods A total of 193 subjects were included in the study. Knee MR imaging was performed on all of the patients, and the patients were categorized based on imaging findings of the tibial and femoral epiphysis. Tukey multiple comparison test and analysis of variance were used to assess if the difference in the mean age of the groups were significantly different. Results Analysis of variance revealed that the mean of the five groups, both in tibia and femur imaging were significantly different. Analysis of variance showed that in most of the cases, the groups mean age significantly differed from the other groups. Tukey multiple comparison tests showed that although the differences between stages I–III could not be regarded as significant, MR imaging was suitable in distinguishing stages IV–V from stages I–III. Conclusion MR imaging of the knee may be a suitable imaging modality to assess an individual's age, does not involve ionizing radiation, and that with imaging a single anatomical location, at least two epiphyses could be used to determine the age. Implications for practice Utilization of knee MRI by clinicians as a safe and practical age estimation method.

Objectives: Using hair dye has spread globally in recent years. Concerns have arisen about the safety of hair dyes during pregnancy. The primary goal of this study was to examine the association between hair coloring and pregnancy outcomes. Materials and Methods: This cross-sectional study was conducted on 2040 pregnant women aged 14 to 48 years, in Talegani teaching hospital of Tabriz University of Medical Sciences from January 2017 to December 2019. Three trained midwives collected relevant information from the women on the admission to the labor room and recorded pregnancy outcomes. Chi-square test of independence with post hoc tests and logistic regression analysis were used for data analysis. Odds ratios with a 95% confidence interval and contributing effect sizes were reported. The significance level was set at P ≤ 0.05. Results: The majority of participants (62.67%) colored their hair in the third trimester. There was no statistically significant association between hair coloring and neonate 1-minute (P = 0.23) and 5-minute Apgar scores (P = 0.99). The logistic regression model did not confirm a rise in overall neonatal complications (NCs) associated with hair coloring at any time during the pregnancy (odds ratio [OR]: 0.027, P

Purpose Generally, guiding clinical practice concentrates on the statistical techniques implemented for performing the diagnostic meta-analysis and test accuracy studies in a specific field of research. This study aims to implement a comprehensive diagnostic meta-analysis tool, which is user-friendly, free, and simple, and can be useful for diagnostic and bivariate model analysis purposes. Methods The Meta-MUMS DTA tool for meta-analysis developed in Matlab R2013a for the Microsoft Windows operating systems (32-bit and 64-bit). Meta-DiSc, Open-MetaAnalyst, Stata (Deeks' test) were the tools used for comparison purposes. Results The features include determination of heterogeneity and computations of chi-square (Q, df, and p-value), I2, Γ2, and Spearman correlation tests, subgroup analysis, meta-regression techniques to explore the relationships of study characteristics and accuracy estimates and performing statistical pooling of sensitivities, specificities, likelihood ratio, and diagnostic odds ratios on fixed- and random-effects models as well as providing figures for forest plots with high quality. The Egger's regression test (along with its smooth version SVE and SVT), Deeks' regression test with funnel plots, and trim and fill were the tools for detecting publication bias. Bivariate model analysis of sensitivity and specificity accuracy is also available in this software. Publication bias and bivariate model analysis are super-advantageous of the proposed software. Moreover, a worked example to evaluate the diagnostic accuracy of mammography and magnetic resonance imaging in breast cancer is proposed. Conclusion The Meta-MUMS DTA tool shows its advantages for upcoming diagnostic meta-analysis studies, especially in radiology science and hopefully may become a platform for teaching purposes.

Traditional medicine is a comprehensive term for ancient, culture-bound health care practices that existed before the use of science in health matters and has been used for centuries. Medicinal plants are used to treat patients with cardiovascular diseases, which may occur due to ailments of the heart and blood vessels and comprise heart attacks, cerebrovascular diseases, hypertension, and heart failure. Hypertension causes difficulty in the functioning of the heart and is involved in atherosclerosis, raising the risk of heart attack and stroke. Many drugs are available for managing these diseases, though common antihypertensive drugs are generally accompanied by many side effects. Medicinal herbs have several active substances with pharmacological and prophylactic properties that can be used in the treatment of hypertension. This review presents an overview of some medicinal plants that have been shown to have hypotensive or antihypertensive properties.

BACKGROUNDThe standard management of autoimmune hepatitis (AIH) is based on corticosteroids, alone or in combination with azathioprine. Second-line treatments are needed for patients who have refractory disease. However, high-quality data on the alternative management of AIH are scarce.AIMTo evaluate the efficacy and safety of tacrolimus and mycophenolate mofetil (MMF) and the quality of evidence by using the Grading of Recommendations Assessment, Development and Evaluation approach (GRADE).METHODSA systematic review and meta-analysis of the available data were performed. We calculated pooled event rates for three outcome measures: Biochemical remission, adverse events, and mortality, with their corresponding 95% confidence intervals (CI).RESULTSThe pooled biochemical remission rate was 68.9% (95%CI: 60.4-76.2) for tacrolimus, and 59.6% (95%CI: 54.8-64.2) for MMF, and rates of adverse events were 25.5% (95%CI: 12.4-45.3) for tacrolimus and 24.1% (95%CI: 15.4-35.7) for MMF. The pooled mortality rate was estimated at 11.5% (95%CI: 7.1-18.1) for tacrolimus and 9.01% (95%CI: 6.2-12.8) for MMF. Pooled biochemical remission rates for tacrolimus and MMF in patients with intolerance to standard therapy were 56.6% (CI: 43.4-56.6) vs 73.5% (CI: 58.1-84.7), and among non-responders were 59.1% (CI: 48.7-68.8) vs 40.8% (CI: 32.3-50.0), respectively. Moreover, the overall quality assessments using GRADE proved to be very low for all our outcomes in both treatment groups.CONCLUSIONTacrolimus and MMF are in practice considered effective for patients with AIH who are non-responders or intolerant to first-line treatment, but we found no high-quality evidence to support this statement.

Background: Hepatitis B is a major global health problem. It can cause chronic infections and put people at high risk of death from cirrhosis and hepatocellular carcinoma. The aim of this study was to report the epidemiological features of hepatitis B virus (HBV) infection and risk factors based on the data from Azar Cohort. Methods: The population of this study comprised the people in the age range of 35-70 yr from Azar cohort, East Azerbaijan Province, Iran between 2015 and 2016. Based on cluster sampling, 4,949 people were selected and invited to complete the questionnaire and perform the tests. Blood samples were analyzed for serum HBV markers (HBsAg, HBsAb and HBcAb) by ELFA method. The data were analyzed using SPSS statistical software. Results: The mean (SD) age of the participants was 49.15 ± 9.02 years. The frequency rates of HBsAg, HBsAb and HBcAb were estimated as 1.03%, 16.9% and 24.95%, respectively. There was statistically significant association between family history of hepatitis (P

Purpose : Non-alcoholic fatty liver disease (NAFLD) and steatohepatitis are two forms of fatty liver disease with benign and malignant nature, respectively. These two conditions can cause an increased risk of liver cirrhosis and hepatocellular carcinoma. Given the importance and high prevalence of NAFLD, it is necessary to investigate the results of different studies in related scope to provide a clarity guarantee of effectiveness. Therefore, this systematic review and metaanalysis aim to study the efficacy of various medications used in the treatment of NAFLD. Methods: A systematic search of medical databases identified 1963 articles. After exclusion of duplicated articles and those which did not meet our inclusion criteria, eta-analysis was performed on 84 articles. Serum levels of alanine aminotransferase (ALT), aspartate amino transferase (AST) were set as primary outcomes and body mass index (BMI), hepatic steatosis, and NAFLD activity score (NAS) were determined as secondary outcomes. Results: Based on the P-score of the therapeutic effects on the non-alcoholic steatohepatitis (NASH), we observed the highest efficacy for atorvastatin, tryptophan, orlistat, omega-3 and obeticholic acid for reduction of ALT, AST, BMI, steatosis and NAS respectively. Conclusion: This meta-analysis showed that atorvastatin. life-style modification, weight loss, and BMI reduction had a remarkable effect on NAFLD-patients by decreasing aminotransferases.

Background: Diabetes is referred to a group of diseases characterized by high glucose levels in blood. It is caused by a deficiency in the production or function of insulin or both, which can occur because of different reasons, resulting in protein and lipid metabolic disorders. The aim of this study was to systematically review the prevalence and incidence of type 1 diabetes in the world. Methods: A systematic search of resources was conducted to investigate the prevalence and incidence of type 1 diabetes in the world. The databases of Medline (via PubMed and Ovid),ProQuest, Scopus, and Web of Science from January 1980 to September 2019 were searched to locate English articles. The located articles were screened in multiple levels of title, abstract,and full-text and final studies that met the inclusion criteria were retrieved and included in the study. Results: From 1202 located articles, 193 studies were included in this systematic review. The results of meta-analysis showed that the incidence of type 1 diabetes was 15 per 100,000 people and the prevalence was 9.5% (95% CI: 0.07 to 0.12) in the world, which was statistically significant. Conclusion: According to the results, the incidence and prevalence of type 1 diabetes are increasing in the world. As a result, insulin will be difficult to access and afford, especially in underdeveloped and developing countries.

Background: Hepatitis D virus (HDV) is a defective RNA pathogen that requires the presence of the hepatitis B virus (HBV) for infection. Middle East countries are endemic areas for HDV infection. So, it is important to estimate the prevalence of HDV in these countries. This study aimed to estimate the prevalence of HDV in HBsAg positive patients participated in Azar cohort study, North-west of Iran. Methods: In this cross-sectional study, out of 4949 participants of the Azar cohort study, 51HBsAg positive patients were selected. Five participants did not consent to HDV testing. The presence of anti-HDV IgG was checked in 46 patients (13 chronic hepatitis B and 33 inactive chronic hepatitis B) using enzyme-linked immunosorbent assay (ELISA) kit. The serum level of liver enzymes was measured and a questionnaire about risk factors was completed.Results: In this study, the mean age of HBsAg positive patients was 50.06 (SD 9.14) years and41.3% were female. Only one out of 46 patients was positive for HDV infection. Thus, the prevalence of HDV infection among hepatitis B virus surface antigen (HBsAg) positive patients was 2.17% (95% CI: 0.1-11.5). The positive anti-HDV patient was in the inactive chronic hepatitis B state and she had a history of hospitalization and dental procedures. Conclusion: The results showed that the prevalence of HDV infection in HBsAg positive patients was 2.1% that was lower than the reported prevalence in many other regions of Iran. Health policymakers and healthcare providers should design coherent and orderly epidemiological studies for planning and monitoring HDV infection.

Background: Although, some clinical trials investigated the maternal and neonatal effect of fentanyl as a premedication before induction of general anesthesia in cesarean section, to the best of our knowledge, there is no systematic review to summarize these results. Objectives: The present systematic review and meta-analysis evaluated the maternal and neonatal effect of intravenous fentanyl as a premedication before induction of general anesthesia in cesarean section. Methods: The databases of Pubmed, Embase, Scopus and Cochrane library were searched till July 2017 to identify randomized clinical trials which evaluated the effects of intravenous fentanyl as a premedication before induction of general anesthesia compared with placebo on neonate first and fifth minute Apgar score and maternal heart rate and mean arterial pressure (MAP) in cesarean section. Standard Mean difference (SMD) was calculated and I-square statistic test was used for heterogeneity analysis. Results: The present systematic review and meta-analysis consisted of three clinical trials including 180 women in labor. Considering the results of meta-analysis, there is no significant differences between fentanyl and placebo in the case of Apgar score at 1 minute; however, the Apgar score of 5 minutes was significantly lower in fentanyl group compared with placebo (SMD -0.68, 95%CI: - 0.98, -0.38, p Conclusion: The present meta-analysis showed that using intravenous fentanyl as a premedication before induction of general anesthesia had adverse effects on neonate Apgar score. However, it had positive effects on preventing adverse consequences of intubation on maternal hemodynamics.

Background: Lidocaine is a well-known medium-acting local anesthetic with a short onset time. It is a valuable drug for managing both acute and chronic pains and is being used as a popular agent for pain control in the emergency department (ED). In this systematic review, we intended to define the effectiveness of lidocaine in pain management of the patients referring to ED. Methods: The preferred reporting items for systematic reviews and meta-analysis (PRISMA) statement was utilized for this Systematic Review (SR). We searched the databases of PubMed, Scopus, ProQuest, and Medline (Ovid) from 1990 to August 2017 for Randomized Controlled Trials (RCTs) in which the study population was referred to the emergency department and received lidocaine. Full-texts of the studies that were published in English were reviewed for inclusion. Both authors individualistically evaluated all studies. Seven articles were eligible for the meta-analysis based on their common outcomes. Results: The total number of subjects was 671. The studies were categorized based on the type of drug and administration route. Mean pain, regardless of the drug administration method, in the placebo group was 0.69 units higher than the lidocaine group. Considering the administration route, mean pain in the placebo group was 0.35 units higher than the lidocaine group when administered topically, and it was lower in the subcutaneous method than the topical method by 1.41 units. Conclusion: Infiltration of lidocaine decreases pain of different procedures in the ED whereas the effect of topical lidocaine is controversial issue.

Background Trans-radial approach for cardiac catheterisation procedures has long been associated with high operator and patient radiation dose. The aim of the present study was to determine the effect of pelvic and radial shields on decreasing coronary procedure radiation doses. Methods A total of 418 patients randomly underwent diagnostic and therapeutic cardiac procedures with and without the pelvic and rad-board lead shields during the procedures. The operator and patient doses were then determined by means of a personal dosimeter and dose area product (DAP), respectively. Results The shields decreased the operator radiation dose by 40% in coronary angiography (CA) and by 45% during angioplasty (PCI). These results were achieved at the cost of increased patient radiation dose. Conclusion Pelvic lead shields combined with rad-board shields are highly effective in reducing operator radiation dose in trans-radial approach, but it is only achieved at the cost of increased patient DAP.

Introduction Gut derived toxins such as p-cresol, p-cresyl sulfate (pCS) and indoxyl sulfate (IS), which belong to protein-bound uremic toxins that promote development of fibrosis inflammatory state associated with chronic kidney disease. One possible way to suppress the production of IS and pCS is to increase dietary fiber intake. The aim of the present study was to assess whether increasing dietary fiber, as high amylose diet, can affect the level of conventional and protein bound nitrogenous products. Methods Fifty patients with end stage renal disease (ESRD) on maintenance hemodialysis were randomly assigned to receive a diet containing resistant starch (HAM-RS2) or placebo over 8 weeks spanning February and September 2017 in the 29 Bahman hospital hemodialysis ward in Tabriz, Iran. Of these, 44 patients (23 from HAM-RS2 and 21 control) completed the study. Plasma levels of urea, creatinine, uric acid and other routine parameters were measured at the beginning and after 8 weeks of starting the supplementation. The levels of IS and p-cresol in the collected serum samples were also determined by HPLC at baseline and after intervention. Results There was significant reduction of creatinine and uric acid levels in HAM-RS2 supplemented patients when compared with control group (P

Purpose: Ketamine-propofol combination (ketofol) is being used to provide a safe and effective procedural sedation (PS) in emergency department (ED) and may theoretically have beneficial effects since using lower doses of each drug may result in a reduction of the adverse events of both agents while maintaining optimal conditions for performing procedures. This systematic review was conducted to evaluate the efficacy, advantages and disadvantages of these two drugs for PS. Methods: The PRISMA statement was used for this systematic review. We searched the databases of PubMed, Scopus, ProQuest, Medline (Ovid) from 1990 to August 2017 for randomized clinical trials (RCTs) in which the study population aged ≥18 and was referred to ED. Full-texts of the studies performed in adults that were published in English were reviewed for inclusion. Both authors independently evaluated all studies. Five articles were eligible for the meta-analysis based on their common outcomes. Results: The total number of subjects was 1250, of which 635 were treated with propofol and 615 were treated with ketofol. Although two of the five studies showed a better quality of sedation with ketofol, the other three did not find any significant difference between propofol and ketofol. This systematic review found a lower incidence of respiratory adverse effects in ketofol group than propofol group. Conclusion: Ketamine/propofol mixture (ketofol) has less respiratory adverse effects than propofol alone in ED procedural sedation.

Background It is necessary to invest in married adolescent girls’ health because of their roles in promoting the community and health of the next generation. Meanwhile, there are many concerns about their sexual and reproductive health. The International Conference on Population and Development emphasized the importance of access to adolescent girls to reproductive health services and counseling. In Iran, about 24% of registered marriages are to girls under 19, while their sexual and reproductive health needs have neglected. Therefore, this study aimed to identify married adolescent girls’ reproductive and sexual needs. Methods/design Data were obtained through in-depth, semi-structured individual interviews with 36 participants, including 11 women who got married at 10 to 21 years of age, two mothers whose daughters were married in adolescence, and 23 healthcare providers and policymakers. The participants were selected through purposive sampling with maximum variation. Data collection continued until data saturation. The interviews were analyzed by qualitative content analysis. Similar codes were merged, and sub-categorization was performed, whereby similar categories were combined until the main categories that emerged. Results The results revealed five main categories: preparing for marriage, enhancing awareness and decision—making power on sexual and reproductive health issues, developing adolescent-friendly sexual and reproductive services, providing tailored pregnancy and childbirth services, and preparing adolescents for motherhood. Conclusion Adolescents step into marital life without the required life skills or physical and mental preparedness. They often become pregnant due to social pressures and lack of access to contraception. Therefore, in countries like Iran, where there is a high frequency of early marriage, families, education, and the health system should prepare the necessary foundation to support these adolescents and provide tailored and comprehensive sexual and reproductive health services., Plain English summary Married adolescent girls have unique sexual and reproductive health needs; however, the appropriate services have not always been provided. This was a qualitative study conducted in Iran to explore married adolescent girls’ reproductive and sexual needs. We found that married adolescent girls were not prepared for marriage and had limited awareness and decision-making power on sexual and reproductive issues. There is a need to develop adolescent-friendly sexual and reproductive services. It is essential to give tailored pregnancy and childbirth services and prepare adolescents for motherhood. Adolescents step into marital life without the required life skills and physical and mental preparedness. They do not have the proper knowledge and ability to decide on sexuality and reproductive issues. Therefore, families, education, and health system should prepare the necessary foundation to support and empower these adolescents, and provide tailored and comprehensive sexual and reproductive health services.

Background: Group B streptococcus or streptococcus Agalactia is a gram positive beta hemolytic bacteria which is the main factor in neonatal infections. This study aimed at determining the prevalence of GBS in world and clarifying the rate of this infection in Islamic and non-Islamic countries. Methods: We performed a systematic search by using different databases including Medline, Scopus, Science Direct, Psycho-Info ProQuest and Web of Science published up to Feb 2019. We undertook meta-analysis to obtain the pooled estimate of prevalence of GBS colonization in Islamic and non-Islamic countries. Results: Among 3324 papers searched, we identified 245 full texts of prevalence of GBS in pregnancy; 131 were included in final analysis. The estimated mean prevalence of maternal GBS colonization was 15.5% (CI:95% (14.2-17)) worldwide; which was 14% (CI:95% (11-16.8)) in Islamic and 16.3% (CI:95% (14.6-18.1)) in nonIslamic countries and was statistically significant. Moreover, with regards to sampling area, prevalence of GBS colonization was 11.1 in vagina and 18.1 in vagina-rectum. Conclusion: Frequent washing of perineum based on religious instructions in Islamic countries can diminish the rate of GBS colonization in pregnant women.

Urinary incontinence has a profound impact on women’s quality of life. Studies have shown that changes in urinary protein levels could be a potential diagnostic biomarker in some urological diseases. The aim of present study is to determine the diagnostic value of nerve growth factor (NGF) in women with mixed urinary incontinence (MUI) as a diagnostic biomarkers of detrusor overactivity (DO). Seventy women aged between 20 and 75 years with MUI were enrolled in this prospective study. All participants underwent urodynamic study. Urine NGF levels were measured using an ELISA method. NGF level was compared between groups using Mann–Whitney U test. Receiver Operator Characteristic (ROC) analysis was employed to evaluate the diagnostic performance of urinary NGF. The results showed that the median (min, max) of NGF in patients with DO was significantly higher in comparing to its level in women without DO [184.10 (31, 346.60) pg/ml vs. 151.80 (21, 210.70)], respectively (P = 0.035). Using receiver-operator characteristics analysis, the threshold urinary NGF value of 102.00 pg/ml provided a sensitivity of 88% and specificity of 40% in diagnosing DO, PPV of 39.1%, and NPV of 88.2%, positive likelihood ratio 2.18 and negative likelihood ratio of 0.45 (P = 0.02). Based on high sensitivity and low specificity, we can conclude that NGF can be a good tool for ruling out the OAB when the test is negative. However, the future investigations are needed to expand the observed correlation in larger groups of women with DO.

Background Considering pathological significance of oxidative stress in systemic lupus erythematosus (SLE), current research aimed to evaluate the effects of melatonin supplementation on oxidative stress markers and disease activity in SLE. Method In this randomised double-blind, placebo-controlled trial, 32 SLE females were selected and randomly assigned into two groups to take 10 mg/day melatonin or placebo for 12 weeks. Before and after trial, serum malondialdehyde (MDA) and total antioxidant capacity (TAC) were measured and disease activity was determined by Systemic lupus erythematosus disease activity index 2000 (SLEDAI-2K). Results Twenty-five patients (13 in the melatonin and 12 in the placebo groups) completed the trial. Melatonin supplementation caused significant reduction in serum MDA compared with baseline (P = .003) and placebo group (P = .004). Serum TAC level did not change significantly in the melatonin group compared with baseline and placebo group (P > .05). Furthermore, melatonin supplementation did not cause significant change in disease activity compared to baseline and placebo group (P > .05). Conclusion This study demonstrated affirmative effects of melatonin in decreasing oxidative stress in SLE patients without any effect on disease activity. Further investigations are required to affirm these primitive findings and to achieve concise conclusions.What's known Free radical damage and oxidative stress has a remarkable function in systemic lupus erythematosus (SLE) pathogenesis. Products derived from oxidative modification cascades are found in biological fluids and their redundancy has a correlation with disease activity and organ damage in SLE. Dietary supplements, which decrease oxidative stress, would be useful in managing SLE. Melatonin is a potent antioxidant and has anti-inflammatory and immunomodulatory characteristics. Limited in vitro and animal studies are available indicating desirable effects of melatonin in preventing from SLE organ damage, thereby opening a new area of investigation that can contribute to using melatonin as a therapy or co-therapy for SLE. What's new Melatonin supplementation caused significant reduction in serum MDA compared with baseline and placebo group. Serum TAC level did not change significantly in the melatonin group compared with baseline and placebo group. Furthermore, melatonin supplementation did not cause significant change in disease activity compared to baseline and placebo group.

Background Active participation in group assignments is an invaluable way to realize collaborative learning; however, there are several challenges attributed to the traditional way of doing group assignments. This study explores the synergistic effects of flipped classrooms and a wiki-authoring group activity on students’ learning outcomes and the quality and quantity of their group-work. Methods In this action research, 205 master students of a medical school were involved in a course blended with flipped classrooms. While learning from online and in-class activities, students did their group assignment on an educational wiki (n = 85) or in a conventional way (n = 120). Assessment in this study was done in both formative and summative ways. Formative assessment included quizzes at the beginning of each class and students’ self-assessment (focused on their satisfaction with different educational activities of the course, using an 11-item validated satisfaction questionnaire). The summative assessment incorporated assessment of the quantity and quality of students’ participation in doing group assignments(by a five-item checklist); quizzes at the end of each class; the final exam; assessment of students’ competency in transferring their learning into creating an outline for a hypothetical article and writing topic sentences. Using SPSS 21.0 and employing independent samples t or Mann –Whitney U tests, the educational impacts of the course were compared in two groups. Results Students in the wiki-group were more satisfied with the course. Both quantity and quality of the group assignment among students in the wiki group outweighed those among the students in the non-wiki group. Univariate linear regression analysis of the models between students’ satisfaction with flipped classrooms and the quality of their participation in doing their group as well as their attitude towards the group assignment showed that the changes in the quality of the wiki students’ group assignment and their attitude were dependent on the changes of their satisfaction with flipped classrooms. Conclusions The findings of this study confirm that a wiki-authoring group assignment is effective in achieving student learning outcomes and integrating a wiki with flipped classrooms increases wiki accomplishment. Collaborating on a wiki activity improves both quality and quantity of group assignments among students.

Background: This systematic review and meta-analysis of the observational studies aimed at evaluating the infertile women’s attitude toward gestational surrogacy. Methods: Published studies until Jan 2019 were searched using PubMed/MEDLINE, Scopus, EMBASE, Cochrane Library, ISI Web of Science, Proquest and Google scholar, MagIran, SID and IranMedex. Studies in English or Persian language surveyed attitudes toward surrogacy for infertile women published until Jan 2019. Animal studies and studies with poor methodological quality were excluded from the review. Results: Six eligible studies including 1359 infertile women were identified. Of these, 559 and 742 women agreed and disagreed with surrogacy respectively. The overall event rate of positive attitude for surrogacy in infertile women was %39.7 (%95 CI=24.5 to 57.1, P=0.245). Conclusion: The infertile women’s attitude toward surrogacy is not strongly positive. We believe, more studies should be conducted among different socioeconomic, religious and cultural groups.

COVID-19 is a novel coronavirus that was reported by the world health organization in late December 2019. As an unexplained respiratory disease epidemic, which is similar to respiratory syndrome coronavirus SARS-CoV, it rapidly spread all over the world. The study aims to compare several parameters of COVID-19 and SARS-CoV infectious diseases in terms of incidence, mortality, and recovery rates. The publicly available dataset Worldometer (extracted on April 5, 2020) confirmed by WHO report was available for meta-analysis purposes using the Meta-MUMS tool. And, the reported outcomes of the analysis used a random-effects model to evaluate the event rate, and risk ratios thorough subgroup analysis forest plots. Seventeen countries for COVID-19 and eight countries of SARS infections, including COVID-19 group n = 1124243, and SARS-CoV group n = 8346, were analyzed. In this meta-analysis, a random effect model of relations of incidence, mortality, and recovery rates of COVID-19 and SARS world infections were determined. The meta-analysis and forest plots of two viral world infections showed that the incidence rate of COVID-19 infection is more than SARS infections, while recovery and mortality event rates of SARS-CoV are more than COVID-19 infection. And subgroup analysis showed that the mortality and recovery rates were higher in both SARS-CoV wand COVID-19 in comparison to incidence and mortality rates, respectively. In conclusion, the meta-analysis approach on the abovementioned dataset revealed the epidemiological and statistical analyses for comparing COVID-19 and SARS-CoV outbreaks.

Introduction: Introduction: The optimal treatment of empyema thoracis is still debatable between academics and surgeons. This study reviews advantages and disadvantages of video-assisted thoracoscopic surgery (VATS) and open thoracotomy decortication (OTD) considering outcomes of empyema thoracis. Materials and methods: A descriptive Boolean query was used for searching three databases to extract the published studies up to 27 March 2017. The outcomes of VATS and OTD were extracted and assessed by random-effects model of meta-analysis. The Egger’s test and trim-and-fill method were used for analyzing publication bias, and, meta-regression and subgroup analyses were done for determining heterogeneity. Results: A total of 2219 patients, from 13 studies, meeting the inclusion criteria were selected and subjected to further analyses. Of 2219 patients, 1120 were treated by VATS and the remaining were subjected to OTD. During VATS, 252 patients were converted to OTD. Forest plots showed that VATS was far superior in terms of incidence of duration of hospital stay and operative time (SMDs = 1.189, 1.565; p < 0.001, < 0.001) compared to OTD. Mortality, prolonged air leakage, wound infection, and recurrence rates (ORs = 1.234, 2.564, 1.363, 1.962; p = 0.576, 0.077, 0.0692, 0.4) had no advantages for both procedures while failure or conversion rate (OR = 0.198, p < 0.001) of VATS was more than those of OTD. Conclusions: The results of the current research suggest no trends of superior outcomes with VATS in the treatment of empyema thoracis. Hence, VATS and OTD could be recommended as treatments for empyema thoracis.

Introduction: There is an academic debate over surgical treatments of liver hydatid cyst disease. In this study, a systematic review and meta-analysis were carried out in order to evaluate the pros and cons of both PAIR (Puncture, Aspiration, Injection, Respiration) and laparoscopic techniques by considering the outcomes of liver hydatid cysts. Material and methods: We designed descriptive Boolean queries to search two databases, PubMed and Scopus, to derive the articles published in the period of January 2000 to December 2016 in order to evaluate the outcomes of these research articles. The outcomes of laparoscopic and PAIR procedures include the rates of cure, postoperative complications, recurrences, and mortality, which were extracted, assessed, and used as their corresponding effect sizes. Results: Fifty-seven studies including a total of 2832 patients (PAIR group n = 1650 and laparoscopic group = 1182) were analyzed. In this meta-analysis study, a random effect model of correlations of outcomes (postoperative complications, mortalities, recurrences, and cure rates) of PAIR and laparoscopy procedures was used. The meta-analysis and the forest plots of the two procedures show that the PAIR approach is superior in terms of cure, complication, and mortality rates compared with the laparoscopy technique. However, the recurrence rate is low in laparoscopic approaches. Moreover, Egger’s tests for determining publication bias and heterogeneity tests were also performed. Conclusions: This study shows promising trends toward an advantage of PAIR procedures in treatment of liver hydatid cyst in comparison with laparoscopic procedures. The PAIR procedure is superior to laparoscopy due to having a higher cure rate and lower complication and mortality rates; however, the latter has a lower recurrence rate.

Background: Serum bilirubin is considered as a natural antioxidant that may affect the prognosis of stroke. Objectives: This systematic review aimed at determining the predictive value of serum bilirubin levels in stroke. Methods: We systematically reviewed the literature published in PubMed, Web of Science, Scopus, Embase, ProQuest, and the Cochrane Library with no time limit until October 2018. The search strategy included a combination of Mesh and free keywords, such as Bilirubin, Stroke, Cerebral Ischemia, Brain Ischemia, and Brain Vascular Accident. Results: OF A total of 2013 studies, 13 studies were included in this systematic review. The results revealed that, based on the majority of studies, increased bilirubin leads to increased severity of ischemic stroke. Conclusions: This systematic review showed that there was an association between the increased serum level of bilirubin and increased severity of ischemic stroke.

Background: Biliary atresia is a rare distractive cholangiopathy in childhood and the most common cause of liver transplantation in pediatrics. Present study is the first report of biliary atresia and its incidence and outcome from northwest of Iran. Methods: In this retrospective cohort study, all patients with biliary atresia admitted to the Tabriz Children’s Hospital from March 2006 to March 2016were included. Demographical, clinical and preclinical data of all patients are extracted from the hospital records. Information about the outcome after Kasai portoenterostomy was gathered by reviewing the progress notes or by phone call from the parents. The Mann-Whitney U and chi-square or Fisher’s exact tests were used for comparison of continuous and categorical variables respectively. Survival curves and tables, Kaplan-Meier method and Cox regression were used for survival analysis. Results: The incidence rate of biliary atresia was 1/13280 live births. Isolated form of biliary atresia was seen in 85.1% of cases. Splenic malformation was not observed in our patients. The rate of successful Kasai Portoenterostomy was 42.9%. Survival analysis showed that 1, 2, 3, 5, and 10-year native liver survival rate was 73%, 56%, 54%, 40% and 31%, respectively. Median overall survival rate was 36 months [95%CI: 2.89 - 69.1]. Successful Kasai Portoenterostomy and clearance of jaundice was the only factor that affected survival rate. Conclusions: The incidence rate of biliary atresia in Northwest of Iran was lower than that in other Asian countries. Like other Asian countries, spleen anomaly was rare in our patients. The success of Kasai Portoenterostomy and survival rates of our cases were lower than that in other Asian countries.

Background Investing in adolescent’s health, especially, the role of girls in community health and future generations is one of the most important strategies of the Millennium Development Goals. In this regard, supplying adolescents’ special needs including access to educational, health and counseling services for promoting reproductive health have been emphasized. About 36% of registered marriages in Iran are under the age of 19 though, reproductive health services based on married adolescent girls` needs in social-cultural context were not predicted in national health system. Therefore, this study aim was designing a guideline for empowering married adolescents in reproductive health. Methods This is a sequential exploratory Mixed-method study conducted in three consecutive phases. The first phase, with a qualitative approach, explores needs, barriers and strategies for empowering married adolescent girls in reproductive health. In the second phase, a systematic review will be conducted to identify the recommendation and strategies for empowering married adolescent girls in reproductive health in other countries. Finally, in third phase, data from qualitative study and systematic review are emerged and the most important solutions and recommendations related to the issue are extracted and the final guideline is adapted by the experts. Discussion This study is attempting to provide a guideline containing comprehensive recommendations for health system` policy makers and providers in order to empowering adolescent girls in reproductive health.

Background: Dendritic cells (DCs) are used in many malignancies as vaccines to induce immunity against specific cancer antigens. The role of DCs in metastatic castration-resistant prostate cancer (mCRPC) is not determined. In this study, the proportion of mCRPC patients with clinically significant response to targeted therapy by DCs pulsed with prostate-specific membrane antigen was evaluated, and the possible adverse effects of this modality were investigated. Methods: Major databases were searched up to Feb 2017, to identify studies in which the antitumor efficacy of DCs pulsed with the extracellular portion of PSMA was studied for the treatment of mCRPC. Data were collected by two reviewers and analyzed using Comprehensive Meta-Analysis software, version 2.0. Findings: Our study consisted of 6 nonrandomized prospective (cohort) trials, overall reporting on 153 mCRPC patients. The event rate that is the representative of fraction of patients showing antitumor response was 0.43 (95% confidence interval = 0.355–0.512; P = 0.097). No significant between-study heterogeneity or inconsistency was detected (I2 = 5.47; Q = 5; P = 0.382). Our study failed to demonstrate a significant therapeutic efficacy for DCs in mCRPC. However, no significant adverse effects were seen. Keywords: Dendritic cells, Meta-analysis, Metastatic castration resistant, Prostate cancer, Prostate-specific membrane antigen

Objective: Behcet's disease (BD) is an inflammatory disease and smoking may have a role in its triggering. This case-control study was conducted to investigate the association between smoking and the risk of BD. Methods: We included 192 patients with BD and 822 healthy siblings of patient with BD and 373 healthy unrelated persons as control groups. Demographic data and smoking history of patients and their siblings were obtained by direct and in some cases by telephone interview with the participants. Demographic data and smoking history of healthy controls were obtained by direct interview. Propensity score matching (PSM) analyses for reducing the heterogeneity between studied groups and calculating the actual effect of smoking in BD was performed. Matching was performed based on demographic characteristics (age, gender, educational status and marital status). After PSM, we carried out multivariate analyses with BD as the main outcome variable and smoking history as the main predictor variable to calculate odds ratios with 95% confidence intervals. Results: Ever smoking was not significantly associated with an increased risk of BD compared with never smoking. In comparison with healthy siblings and healthy unrelated persons, the relative risk of developing BD was 0.8-2.6. No significant differences were observed in the clinical manifestations of BD patients in ever smokers and never smokers. However, disease activity in ever smokers at disease presentation was significantly more than never smokers. Conclusion: Smoking is not a significant risk factor for BD.

Author(s): Tayebi Khosroshahi, Hamid; Vaziri, Nosratola D; Abedi, Behzad; Asl, Bahlol Habibi; Ghojazadeh, Morteza; Jing, Wanghui; Vatankhah, Amir Mansur | Abstract: INTRODUCTION:Systemic inflammation and oxidative stress play a central role in the pathogenesis of cardiovascular disease and numerous other complications of CKD. Recent studies demonstrated that consumption of a diet enriched with amylose (HAM-RS2), attenuates oxidative stress and inflammation, and improves intestinal microbiome in CKD rats. The present study was designed to explore the effect of dietary amylose supplementation in hemodialysis patients. METHODS:Forty-six stable hemodialysis patients were randomized to receive biscuits containing 20 g/day during the first four weeks and 25 g/day in the next four weeks of either HAM-RS2 or wheat-flour. Fasting predialysis blood samples obtained before, during and at the end of trial were processed for biomarkers of oxidative stress and inflammation. FINDINGS:There was no significant difference in baseline clinical or biochemical parameters between the two groups. Serum levels of TNF-α, IL-6, and malondialdehyde declined significantly (P l 0.05) in the HAM-RS2-treated group but remained unchanged in the placebo-treated group. No significant difference was observed in serum Interleukin-1β (IL-1β) and hs-CRP concentrations and total antioxidant activity between two groups. Serum urea and creatinine concentrations significantly declined and severity of constipation improved in HAM-RS2-treated patients (P l 0.05). HAM-RS2 consumption was well tolerated and did not cause discernible side effects. DISCUSSION:Administration of HAM-RS2 for eight weeks significantly reduced levels of inflammatory and oxidative markers in hemodialysis patients confirming the results observed in CKD animals. Long term trials are needed to explore the impact of HAM-RS2 supplementation on clinical outcomes in end stage renal disease population.

Background. Diode lasers (DLs) have demonstrated equal or better desensitizing effects than fluoride varnish, 10% potas-sium nitrate (NK) gel and Gluma. The current study evaluated the desensitizing effect of combined application of DLs with two different output powers and compared it with single DL therapy. Methods. Sixty-two hypersensitive teeth were allocated randomly into two groups: the single group was treated with 3-W DL beam once and in the combined group, the teeth were irradiated three times (the first time with 0.2-W and then with 3-W and the second and third times, 48 and 96 hours after the baseline visit, with 0.2-W DL beams). The amount of dentin hyper-sensitivity (DH) was evaluated, immediately before and after each visit, and 1 week and 1 and 3 months after the first visit. Data analysis was performed using chi-squared test, repeated measurement of ANOVA and Mann-Whitney U test. P

Introduction: This study aimed at evaluating knowledge and awareness of hypertension and the risk factors for hypertension among hypertensive patients. Methods: In this study, 110 hypertensive patients were enrolled and filled out two self-administered questionnaires. The first questionnaire was about the demographic characteristics and the second one was about the knowledge (n = 10), attitude (n = 9) and practice (n = 8). The internal consistency and the stability of the questionnaires were approved. The Mann-Whitney U test and Kruskal-Wallis and Spearman correlation coefficient were used for statistical analysis. Results: Seventy-three percent of participants know the normal range of hypertension. Most of the participants truly knew that stress (87.3%), obesity (70.9%) and aging (48.2%) are risk factors for hypertension. About 60% of participants knew the complications of uncontrolled hypertension. About 82.7% of participants believed that after adaptation of body to hypertension, there is no need to use antihypertensive drug. About 13.6% of participants measured their blood pressure daily and 11.8% of them measured it once a month. The educational level of participants was significantly associated with knowledge score (P = 0.01). There was a significant correlation between knowledge (P < 0.001) and attitude and also attitude and practice (P < 0.001) scores. Conclusion: These findings have important implications for developing proper and continuous self-management hypertension education programs in Iran which should mostly emphasize on the practical information about control and prevention programs.

Background and aim: Entonox was one of the important methods for pain management in the delivery process. In previous years some studies have assessed the effect of this method in Iran. In this regard, the aim of this study was to systematically review studies addressing the effect of Entonox for pain management in labor. Methods: This systematic review and meta-analysis study was conducted in 2016. The required data was collected using keywords such as ”Entonox”, “nitrous oxide”, ”vaginal delivery”, ”pain relief”, “obstetric”, “labor pain”, and “labor analgesia”, from databases including Google scholar, PubMed, Science Direct, Magiran, SID, and Scopus, and hand-searching of related and valid journals and references of articles. Articles published from 2000 to 2016 were searched. To conduct meta-analysis, CMA:2 (Comprehensive Meta-analysis) was used. Results: Finally, 14 articles were included in the study. Pain relief standard difference in mean between-groups was -1.01 (95% CI: -1.59 to -0.43, Q=148.5, df=8, p=0.02, I2=76) this difference was significant (p

We previously showed that using the radial artery access site as opposed to the femoral artery site decreases the radiation exposure of patients during coronary artery interventions. The objective of this study was to compare radiation exposure levels of the operating physician during coronary interventions when incorporating both radial and femoral artery approaches. The study assessed all coronary angioplasties performed in a major metropolitan general hospital. The study design was prospective and observational, in which we measured the radiation exposure of the patient and the operator. Measurements of radiation levels were made using an electronic personal dosimeter (Diamentor® E2-DAP) at the radial and at the femoral artery access sites. An interventional cardiologist operator performed all the percutaneous coronary interventions (PCI) using a single-plane angiography unit via both femoral and radial artery approaches. Data from 252 PCIs were recorded. The mean physician radiation exposure levels from the femoral access site and the right radial access site were 40.5 ± 20.2 µSv and 47.5 ± 26.5 µSv, respectively (p < 0.02). There was a strong correlation between physician and patient radiation exposure levels. However, there was no correlation between patient body mass index and radiation exposure levels. We found significantly higher physician radiation exposure levels with the radial artery than with the femoral artery access site.

Introduction: Medical records contain valuable information about a patient's medical history and treatment. Patient safety is one of the most important dimensions of health care quality assurance and performance improvement. Completing the process of documentation is necessary to continue patient care and continuous quality improvement of basic services. The aim of the present study was to evaluate the effect of medical recording education on the quantity and quality of recording in gynecology residents of Tabriz University of Medical Sciences. Methods: This study is a quasi-experimental study and was conducted at Al-Zahra Teaching Hospital, Tabriz, Iran, in 2016. Thirty-two second through fourth year gynecologic residents of Tabriz University of Medical Sciences who were willing to participate in the study were included by census sampling and participated in training workshop. Three evaluators reviewed the residents’ records before and after training course by a checklist. Statistical analyses were performed using SPSS 13 software. P-values less than 0.05 were considered statistically significant. Results: The results showed that before the intervention, there were significant differences in the quantity of information status among the evaluators and no significant difference was observed in the recording of qualitative status. After the workshop, among the 3 evaluators, there were also significant differences in the quantity of data recording status; however, no significant change was observed in recording of qualitative status. Conclusion: The study findings revealed that a sectional training course of correct and standardized medical records has no effect on reforming the process of recording.

Background and study aims There is an academic debate regarding surgical interventions for liver hydatid cyst disease. The purpose of the current systematic review and meta-analysis study was to analyse the pros and cons of open surgery and laparoscopic techniques, considering the outcomes of liver hydatid cysts. Methods Descriptive Boolean queries were used to search PubMed and Scopus for articles published between January 2000 and December 2016 to evaluate the outcomes of liver hydatid cyst in terms of mortality, post-operative complications, cure rate and recurrences. The data related to the four outcomes of liver hydatid cyst were extracted, assessed and then used as their corresponding effect sizes in the meta-analysis process. Results Six studies totally consisting of 1028 patients [open surgery group = 816 (+7 converted to lap) and laparoscopic group = 212] were analysed. In this meta-analysis study, random effects models of outcomes (i.e. post-operative complications, mortalities, recurrences and cure rate) of the two procedures were OR = 0.852, LL = 0.469, UL = 1.546, Z = −0.526, p = 0.599 (for post-operative complications); OR = 0.849, LL = 0.141, UL = 5.105, Z = −0.179, p = 0.858 (for mortality); OR = 0.903, LL = 0.166, UL = 4.906, Z = −0.119, p = 0.906 (for recurrence); and OR = 0.459, LL = 0.129, UL = 1.637, Z = −1.201, p = 0.230 (for cure rate). Meta-analysis and illustrated forest plots showed that there are no superiorities between the two approaches. The results of heterogeneity tests of the above mentioned outcomes were Q = 8.083, df = 5, p = 0.152, I 2 = 38.142% for post-operative complications; Q = 0.127, df = 2, p = 0.938, I 2 = 0% for mortality; Q = 4.984, df = 2, p = 0.083, I 2 = 59.874% for recurrence; and Q = 10.639, df = 5, p = 0.059, I 2 = 53.001% for cure rate. The results of regression tests based on Egger’s, smoothed variance based on Egger (SVE) and smoothed variance based on Thomson (SVT) showed that the p value s are not significant, and there are neither significant statistical differences nor publication bias between the outcomes of the two treatment procedures. Conclusion The results show no promising trends towards advantages of open versus laparoscopic surgeries in the treatment of liver hydatid cyst. However, informative measurement values for comparing these surgeries could be derived for complications, recurrence, mortality and cure rates. Furthermore, all three tests, namely Egger’s, SVE and SVT regression models, were used to assess publication bias and showed no evidence for the existence of publication bias.

Aims The prevalence of urinary incontinence (UI) in the developing world varies widely. Factors influencing prevalence rates are a key area of interest, and knowledge of these would provide appropriate planning for preventive primary and secondary health care programs. The objective of this report was to synthesize the best available evidence to determine UI prevalence rates in adult women in a population setting. Methods A comprehensive search strategy was employed to find published and unpublished studies. Databases searched included PubMed, Embase, Scopus, Web of Science, and Google Scholar. We used the standardized Joanna Briggs Institute Meta-Analysis of Statistics, Assessment, and Review Instrument to appraise the included studies. Results In total, 54 studies with 138,722 women aged 10 to 90 years were included in this meta-analysis. Prevalence of UI ranged from 2.8% in Nigeria to 57.7% in Iran. The total prevalence of UI was 25.7% (95% CI: 22.3-29.5) and the prevalence rates for stress, urgency, and mixed UI were 12.6% (95% CI: 10.3-15.4), 5.3% (95% CI: 3.4-8.3), and 9.1% (95% CI: 7.0-11.8), respectively. When we excluded the elderly population, UI prevalence only slightly changed (26.2%; 95% CI: 22.6-30.2). Prevalence rates varied considerably during different recall periods, ranging from 15.6% for UI during the last 12 months to 41.2% for UI during the last 3 months. However, the study quality and use of validated vs nonvalidated questionnaires only had a minor impact on the prevalence rates. Conclusions The prevalence, methodology, and definition of UI vary widely. A large-scale multinational study with a homogeneous methodology is necessary to correctly calculate and compare the prevalence rates to improve health policies in the developing world.

Introduction: Dexmedetomidine is a sedative and analgesic medication that is frequently used postoperatively in children after liver transplantation, hepatic dysfunction and liver failure. Objectives: The aim of this systematic review was to determine the role of dexmedetomidine in liver disease. Methods: We systematically reviewed the literature from PubMed, Embase, Scopus, ProQuest, Web of Science, and The Cochrane Library from January 1980 to June 2019. The search strategy included a combination of Mesh and free keywords such as liver transplantation, liver diseases, liver failure, and dexmedetomidine. Results: From a total of 741 articles, 7 studies were included in this systematic review. In the selected studies, a total of 218 patients in the control and treatment groups were studied. Based on the Fixed effect model, MAP changes in the intervention group were 1.89 units less than the control group, which was not statistically significant (pooled mean difference = -1.89, 95% CI: -6.28 to 2.5, P value = 0.39). Conclusions: DEX injection prior to anesthesia potentially had a protective effect on liver and intestinal function during hepatectomy with vascular occlusion.

Aim: Behcet's disease (BD) is a vasculitis. Lines of evidence suggest miRNAs as diagnostic and prognostic markers in autoimmune diseases. This study was designed to investigate the potential role of miR-21, miR-146b and miR-326 as biomarkers for diagnosis, predicting organs involvement and measuring BD activity. Patients & methods: In this cross-sectional study, the study groups consisted of 46 BD patients and 70 age- and sex-matched healthy volunteers. The expression rates of three miRNAs were determined by quantitative real-time PCR. Results: Our results demonstrated significantly lower expression of miR-21 and miR-146b and higher expression of miR-326 in BD patients. MiR-21 expression rate in patients with severe eye involvement and miR-326 expression rate in patients with uveitis and severe eye involvement were increased. Conclusion: MiR-326 expression rate can be used as a biomarker for prediction of uveitis and severe eye involvement in patients with BD.

Abstract. Aim: In the present study, the evidence about the association between vitamin D deficiency and Behcet’s disease activity was systematically reviewed and meta-analyzed. Method: We searched the English and Persian databases of Medline (Ovid), CINHAL, Scopus, Proquest, the Cochrane library and SID, IranDoc, Magiran, Iran Medex for articles published up until May 2018 with the keywords were related to serum vitamin D and active and inactive Behcet’s disease in adults. Meta-analysis was done using the CMA software. Results: A total of 138 titles were retrieved and reduced to 80 titles after deletion of duplicates and finally after close assessing of titles and abstracts eight eligible studies including a total of 939 participants were identified for systematic review and meta-analysis. According to the results of the meta-analysis, the pooled effect size of the differences in the serum level of vitamin D in patients with inactive Behçet’s Disease and healthy controls was [OR:−0.05; 95% CI:−2.05, 1.94; p = 0.95]. The serum vitamin D level was significantly lower in active patients compared with healthy controls [OR:1.21; 95%CI: −0.12, 2.31; p = 0.03]. The pooled effect size of the differences in the serum level of vitamin D in active and inactive Behçet’s Disease was [OR:−0.71; 95%CI: −1.41, −0.007; p = 0.04] Conclusion: There is an association between vitamin D deficiency and active Behçet’s Disease. Future studies investigating the association of vitamin D deficiency and Behçet’s Disease needs to involve following information: dietary intake of calcium and vitamin D, measuring of sun exposure, report of drug consumption and physical activity level.

Background: Maintaining the results of orthodontic treatment and keeping the teeth in the corrected position is a great challenge in orthodontics. This study aimed to compare the survival time of three types of retainers including Hawley, 1-mm Vacuum-Formed (VF), and 1.5-mm VF within 6-month period. Methods: In this randomized clinical study, 152 patients were allocated into three groups to receive one type of the retainers. They were visited 1, 3, and 6 months after retainer delivery and checked for breakage, loss, local perforation, and discoloration from the patient's and clinician's point of view as indicators of failure. Chi-square and Fisher's exact tests were used as appropriated. Result: The results revealed that breakage was among the main reasons of failure of retainers within 6 months, which was statistically significantly different between Hawley and VF retainers, as well as between 1-mm and 1.5-mm VF retainers in the three intervals (p0.05). Assessing the discoloration from the patient's point of view revealed statistically significant differences between Hawley and VF retainers within the first month; however, the difference was not significant at the third and sixth months (p0.05). By the end of the sixth month, some of the VF retainers had perforation; while, perforation was not observed in Hawley retainers.Conclusion: Considering the higher breakage rate of 1-mm VF, 1.5-mm VF seems the retainer if choice.Key words: survival time; retainer; Hawley retainer; Vacuum-formed retainer

Objectives: The principal treatment of ovarian cancer is surgery with or without chemotherapy. The chemotherapy, however, might be ineffective and long with serious side-effects. To obviate these shortcomings, more efficient and safer medications are required, among which ginger has recently gained popularity because of its anti-cancer properties. This study aims to compare outcomes and side-effects of adjuvant chemotherapy with and without ginger in ovarian cancer patients. Materials and Methods: A total of 49 patients (20 patients in case group and 29 patients in control group) with stage I to III, histopathologically proved ovarian cancer underwent cytoreductive surgery followed by platinum-based adjuvant chemotherapy with and without investigator-prepared oral ginger capsules (2 g per day for 6 cycles). Potential side-effects, poor 12-month outcome (serum CA125 levels >35U, radiologic evidence of metastasis and recurrence, or death), and 12-month disease-free survival were documented and compared between the 2 groups. Results: Poor outcome including serum CA125>35, metastasis, recurrence or death was documented more common in control group (69% versus 40%). metastasis frequency confirmed by computerized tomography (CT) scan 6 month after treatment was significantly lower in case group (P = 0.04). There was no significant difference regarding mortality and disease free survival during one year follow-up after treatment between 2 groups (P = 0.55). Chemotherapy complications such as nausea, vomiting, weight loss, and peripheral neuropathy were detected in case group less than control group but the difference was not significant. Conclusion: Oral administration of ginger is along with a significantly better 12-month outcome in patients on chemotherapy because of ovarian cancer, and accordingly, considering its safety, its administration is recommended.

Background: Cystic fibrosis (CF) is an autosomal recessive disorder with several clinical presentations. This study was undertaken in the Azeri Turkish population in Iran, to investigate gender differences in the age at onset and diagnosis, age of death, and duration of illness of CF. Methods: The data of 331 CF patients from 2001 to 2015 was surveyed. Parameters including age, sex, ΔF508 mutation, age at onset, age at diagnosis, age of death and clinical presentations were evaluated for both sexes, using descriptive analysis. The association of gender with these variables was studied using logistic regression, chi-square test and Mann- Whitney U test by SPSS version 18. Odds ratio with a confidence interval of 95% and p≤0.05 was considered statistically significant. Results: The study included 191 males (57.7%) and 140 females (42.3%), all showing statistically significant difference (p

Introduction: Caustic ingestion that occurs accidently is one of the most common problems in children. Methods: This systematic review has been performed by searching the databases including Science Direct, ProQuest, Google Scholar, and PubMed. A strategic search was performed with keywords including caustic, corrosive, ingestion, and children, and was limited to articles in English and Persian. Data were analyzed using Comprehensive Meta-Analysis2 and PASW Statistics 18. Results: We selected 64 articles regarding caustic ingestion with a total sample of 11,345 cases. The data analysis indicated a higher consumption in young boys (age range 2.78 (2.02) years (OR=0.53 with a 95% confidence interval of 0.49-0.57 (P=0.08)). The most common caustic substances were household cleaning agents, particularly bleaches and cleaners. Esophageal cancer and death were reported as well as digestive and respiratory complications. Invasive and expensive techniques are frequently used for diagnosis, treatment and follow up. Conclusion: The results demonstrated that although caustic ingestion is a serious problem among children, it is a preventable and manageable issue. Therefore, appropriate efforts by families, government, factories, health team and media should be made to handle adequately this matter.

Introduction: Lactulose is a prebiotic with bifidogenic and urea reduction effects. It can improve Bifidobacteria and Lactobacilli counts in healthy humans and it may possibly have similar effects in chronic kidney disease (CKD) patients. Objectives: To investigate the effect of lactulose on fecal microflora of patients with CKD. Patients and Methods: Thirty-two patients with stages 3 and 4 of CKD (43.8% male with mean age of 58.09±12.75 years) were randomly assigned to intervention (n=16) and control (n=16) groups. Patients in intervention group received 30 mm lactulose syrup three times a day for an 8-week period. Control group received placebo 30 mm three times a day. A fecal sample was obtained from all patients at the beginning and at the end of the study and Bifidobacteria and Lactobacilli was counted. Results: Creatinine (Cr) significantly decreased in intervention group (3.90±1.43 to 3.60±1.44, P=0.003) and increased in control group (3.87±2.08 to 4.11±1.99, P=0.03). Although Bifidobacterial and Lactobacilli counts were similar before intervention, they were significantly higher at the end of the study in lactulose group (P=0.01 and P=0.04, respectively). Lactulose led to significant increase in fecal Bifidobacterial counts (3.61±0.54 to 4.90±0.96, P

Introduction: Cardiac catheterization procedure through the trans-radial access (TRA) have shown many clinical advantages over the trans-femoral (TFA), but despite its advantages, there are serious concerns regarding higher possible radiation dose for the patients and operators in TRA. This study was planned to compare the patients’ radiation dose associated with TRA and TFA during coronary angiography (CA) and percutaneous transluminal coronary angioplasty (PTCA). Methods: Of 700 candidates for angiography, 326 patients were entered the study. All the procedures were carried out by one interventional cardiologist employing the same angiography unit in Aalinasab hospital and the patients’ dose area product (DAP), air kerma (AK), fluoroscopy time (FT) and cine film time (CFT) were then determined in both access groups (TRA,TFA) in CA, PTCA and CA+PTCA procedures. Results: The mean FT, CFT and AK values in both TRA & TFA groups were the same in all procedures (P > 0.05). The mean DAP in CA+PTCA procedures was 6704.01 ± 3243.23 µGym2 in femoral access compare with 5647.46 ± 2797.74 µGym2 in radial access, which were significantly less than that in TFA with P = 0.02. Conclusion: On the basis of the results obtained in this study, no differences were found in patients’ radiation dose in both access groups, therefore with regard to comparatively more clinical advantages associated with the Trans-radial access technique it might be a good substitute for Trans-femoral access.

The use of clinical practice guidelines (CPGs) saves time and provides the highest level of evidence, allowing busy ophthalmologists to make the best clinical decisions in a short amount of time. The aim of this study is to evaluate Iranian ophthalmologists’ knowledge and attitudes toward evidence-based medicine (EBM), and knowledge of CPGs. We performed a cross-sectional survey during the Annual Congress of the Iranian Society of Ophthalmology (November 2011). We administered 2 questionnaires regarding ophthalmologists’ attitudes towards EBM and self-reported clinical practices to a self-selected sample of ophthalmologists who volunteered to be surveyed. We employed descriptive statistics and unadjusted associations to describe the results. Of 556 attendees, 100 ophthalmologists responded to the first questionnaire, and 60% of them answered the second questionnaire. Although 83% had heard about EBM, only 11% knew what EBM was. Ninety-five percent of respondents believed in evidence-based ophthalmology training. Few understood EBM terminology. More than 60% of ophthalmologists surveyed had no familiarity with the Cochrane Library, MDConsult or Turning Research Into Practice (TRIP databases. Of the ophthalmologists surveyed, 26% implemented guidelines for problem solving, and 59% utilised the internet for finding clinical guidelines. The mean proportions of correct response to evidence-based cataract and glaucoma management questions were 68 and 56, respectively. Iranian ophthalmologists had a fair to poor knowledge but good attitudes towards EBM. Improving evidence-based knowledge and attitudes may be a component of improving Iranian ophthalmologists’ clinical practices. This study is granted by Iranian Evidence Based Medicine Center of Excellence, Tabriz University of Medical Sciences, and their support is greatly appreciated. The authors also thank the members of the Iranian Society of Ophthalmology.

Introduction: Scientific Olympiads and the Talented Student Office (TSO) are two strategies for the identification and training of gifted and talented medical science students. The aim of the present study is to identify students’ viewpoints about the facilities and privileges of the TSO in stimulating them to participate in the Medical Science Olympiad. Methods: This study was a cross-sectional descriptive study and all participating in the 4th and 5 National Medical Science Olympiad in Iran from 2011 to 21012 were selected using the census method. The validity of a researcher-made questionnaire was confirmed by experts. The content validity index (CVI) was 0.95. Reliability was evaluated using Cronbach’s alpha (a=0.8) and the test-retest method (ICC=0.85). Descriptive statistics including frequency, percent, mean and standard deviation were calculated by SPSS 19. Results: In total, 261 students responded to the questionnaires. About 36% of participants in this study had low or very low familiarity with regulations of the TSO. Continuing education to higher levels (master’s, Ph.D., residency) and being recruited as a faculty member were the most motivational factors for participation and the least was the permission to select more courses (up to 27 units). Conclusion: Continuing education to higher levels and recruitment as a faculty member were two important factors for participating in the National Medical Science Olympiad. Therefore, personnel in the TSO and related managers should prompt medical students to these centers by highlighting the facilities.

Introduction: Due to the importance of holding effective scientific Olympiads for medical sciences students, this study aimed to evaluate experts’ viewpoints in regard to their necessity, costs, achievements, barriers and solutions. Methods: In this qualitative study, required data were collected using open-ended questions through self-development questionnaires, which were filled out by experts. Data were analyzed through content-analysis methods. To select participants, a purpose-based sampling method was applied up to the point of information saturation. Thus, this study was performed with 20 individuals. Results: The main necessity and philosophy of holding Olympiads expressed by the experts were: promoting health sector performance, extension of interrelationships between universities, development of scientific competition and incensement of students’ creativity. The majority of participants believed that the achievements of holding these Olympiads are negligible versus their costs. The most important barriers were: absence of appropriate relationships between universities, lack of proper support for holding these Olympiads, the low motivation of professors, noninterested students and the shortage of resources and facilities. Furthermore, the most important solutions included: performance evaluation of previous Olympiads, increasing incentives and motivations as well as suitable planning. Conclusion: According to experts’ viewpoints, although holding scientific Olympiads is necessary for medical students, during past years, the achievements of such Olympiads versus theirs costs seem negligible and there are lots of barriers in the path of achieving their goals and philosophy.

AIMS Lisinopril is an angiotensin-converting-enzyme inhibitor that is largely administered for off-label uses. This study aims to provide a comprehensive review of off-label uses of lisinopril to aid physicians to make evidence-based decisions. METHODS The following bibliographic databases were searched from inception up to 30 March 2017: PubMed, EMBASE, the Cochrane Library, Cochrane Central Register of Controlled Trials, Scopus, Ovid and Proquest. This systematic review sought all randomized trials conducted on adult individuals comparing lisinopril on its off-label uses with alternative drugs or placebos and reported direct or alternative clinical outcomes. Risk of bias assessment by using the Cochrane Collaboration risk-of-bias tool and quality evaluation took place. RESULTS Included studies demonstrated significant positive effects of lisinopril on proteinuric kidney disease; however, lisinopril caused a slight reduction of glomerular filtration rate (GFR) especially for patients with GFR < 90 ml min–1. Lisinopril offered better outcomes in comparison to other standard treatments of diabetic nephropathy. Other studies showed positive effects of lisinopril for migraine, prevention of diabetes, myocardial fibrosis, mitral valve regurgitation, cardiomyopathy in patients with Duchenne muscular dystrophy, oligospermia and infertility, and diabetic retinopathy. Conversely, the studies reported that lisinopril was ineffective for five other off-label uses. CONCLUSIONS The identified studies showed that lisinopril was highly effective for proteinuric kidney disease with a minor but inconsiderable decrease in GFR. Positive effects of lisinopril were demonstrated in seven other off-label uses; however, lisinopril cannot be recommended as the first choice for these until further clinical trials confirm these positive effects.