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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.

Background and Objectives: More than 42,000 sports-related eye injuries are brought to emergency units every year. Although multiple studies have been conducted on the prevalence of sports-related eye injuries and consequent outcomes, no systematic review has been conducted to summarize the findings of these studies. Therefore, this study was conducted to systematically review the prevalence of sports-related eye injuries and blindness. Methods: A systematic search was conducted to locate the studies that addressed the global prevalence of sports-related eye injuries. The located articles (132 studies) were screened on different levels, and their quality was assessed using the JBI checklist for prevalence studies. The statistical analysis was conducted using CMA v. 3.2, and the results were considered significant for P < 0.05. Results: From a total of 132 studies, 27 articles were included for analyzing the prevalence of sports-related blindness which was 7.2%. Further, 51 studies were used for analyzing the prevalence of sports-related eye injuries in total eye injuries, and the obtained value was 9.3%. Moreover, 29 studies were analyzed to calculate the proportion of sports-related eye injuries to total sports injuries, and the obtained value was 6.7%. Conclusion: Findings of this study suggest that sport-related eye injuries account for a major part of eye injuries and a considerable portion of these traumas lead to blindness.

Objective: to assess the prevalence of Amblyopia disease in the children of the world. Methods: In order to perform this systematic review, PICO was considered as the research question. Then, the preferred keywords were searched in Medline (via PubMed), Embase, Scopus, Web of Science, and ProQuest databases. The retrieved citations were reviewed by two independent inspectors in a three-step process in terms of the title, abstract, and full-text, based on the inclusion criteria. The studies included in the review were critically evaluated and then were extracted by two dependent expert reviewers. Finally, the prevalence of Amblyopia disease in the children of the world was pooled by meta-analysis CMA v.2 software. The heterogeneity of the selected studies was evaluated using I2 and chi-square. Also, subgroup-analysis was performed using designs and continents. Results: Out of 952 retrieved citations, 131 studies were included. The total prevalence of Amblyopia in the children of the world was calculated to be 4.3% [Pooled Prevalence: 4.3%, 95% CI: 2.6%-7.00%, P-value 0.0001]. In addition, the heterogeneity of the studies was reported to be high (Q: 48281.18, df: 56, p-value 0.001, I-square: 99.88). The subgroup analysis showed that America had the highest (5.57%, 95% CI: 2.23%-13.94%, P-value 0.0001) prevalence, and the lowest prevalence of Amblyopia in the children of the world was seen in Africa (7.1%, 95% CI: 0.003%-172.53%, P-value 0.05). Conclusion: It can be concluded that the total prevalence of Amblyopia is 3.4%, but this estimate varies in all continents, especially in Africa. The major reason for this variation was reported to be the heterogeneity of studies. These assessments have investigated different populations in terms of severity of illness, age, and gender. Therefore, further worldwide high-quality and valid studies should be carried out to allow the calculation of the real prevalence of Amblyopia among children of the world. Abbreviations: VA = visual acuity, ALSPAC = Avon Longitudinal Study of Parents and Children, JBI = Joanna Briggs Institute, PRISMA = Systematic Review and Meta-analysis, CMA = Comprehensive Meta-analysis Software.

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.

Aim In recent years, mobile applications have been developed for health education purposes. The aim of this study was to determine whether Telegram‐based virtual education versus in‐person education can be effective for improving the quality of life in adolescents with moderate‐to‐severe asthma. Design A single‐blind randomized trial. Methods Participants were 64 adolescents aged 12–19 years and were equally assigned randomly to group A (Telegram‐based education) and group B (in‐person education) during 22 June 2017–19 February 2018. The educational contents were similar for both groups. The Mini Pediatric Asthma Quality of Life Questionnaire was used prior to intervention and 5 weeks postintervention for both groups of adolescents. Results A statistically significant increase was observed in the quality of life in both groups (p

Aim The aim of this study was to evaluate the effect of a multimedia training on pain management attitudes and practices of paediatric nurses. Design A single‐blind randomized trial. Methods Paediatric nurses (N = 120) from a public hospital randomly allocated into two groups, lecturing and multimedia training groups. Nurses in the control group received four one‐hour training sessions. In the intervention group, the same educational content was used as a film with text, audio and animation and presented as a multimedia CD. In both groups, using a questionnaire, we measured pain management attitudes and skills at baseline and then 1 week and 1 month after the training over. Data were analysed in SPSS20 software, and p

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 Many of the known coronaviruses cause a wide range of respiratory infections in humans, and the novel coronavirus is no exception to this rule. Although no drug has yet been discovered to prevent or treat this disease, chloroquine (CQ) and hydroxychloroquine (HCQ) have been widely used in studies showing different results. Methods The present study is an umbrella study. The search was conducted for the articles published from January 2020 to November 2020 using the keywords ("COVID-19" OR "SARS-CoV-2" AND "Hydroxychloroquine" OR "Chloroquine" AND "Systematic Review" OR "Metanalysis"). This study was limited to human samples and systematic reviews with or without meta-analysis. The quality of the articles was also evaluated independently by two researchers. Results To evaluate the clinical efficacy of HCQ and CQ, a total of 176 papers and 643569 cases ranging from patients with mild pneumonia to intubated critically ill patients were evaluated. Finally, 8 studies were included. Conclusion There are conflicting results regarding HCQ or CQ efficacy and safety in the systematic reviews. More evidence is needed to confirm whether these drugs are useful in COVID-19 infection, and their usage as the standard care cannot be recommended based on the majority of the studies included in this umbrella review.

Context: Procedural sedation (PS) plays an important role in facilitating emergency procedures. Dexmedetomidine is an alpha-adrenergic agonist which can play a role in this issue. This study aimed to systematically review the literature about the role of dexmedetomidine in PS in the emergency department (ED). Methods: In this study, several databases, namely PubMed, Embase, Ovid, ProQuest, Scopus, Web of Science, and Cochrane Library, were searched since 1999 up to November 30, 2020. The inclusion criteria in this study were randomized clinical trials performed on ED patients using dexmedetomidine for PS and articles only in the English language. The exclusion criteria were the studies that were not clinical trials or were not performed in the ED, low-quality studies or animal studies. Results: A total of 473 articles were identified in this study. Five studies fulfilled the inclusion and exclusion criteria. Three articles studied the adult population. One study used dexmedetomidine in an intranasal way, and one study used an intramuscular route for drug administration. Conclusions: Although the reviewed studies reported dexmedetomidine as a safe and effective agent for PS, there are not sufficient data on this issue. Therefore, it is required to perform further studies to a draw firmer conclusion.

Context: The safety and efficacy of several repurposed drugs, including hydroxychloroquine and chloroquine, with or without azithromycin, were presumed to be miraculous in treating patients with COVID-19. However, as it later transpired, these therapeutic agents seem to be associated with critical adverse cardiac events. Objectives: Given the skepticism around the advantages and disadvantages of the aforementioned treatment strategies, the present study aimed to investigate the clinical efficacy and cardiac toxicity of hydroxychloroquine or chloroquine with or without azithromycin in the setting of COVID-19 infection. Method: This was an umbrella review conducted on patients with COVID-19 who received hydroxychloroquine or chloroquine with or without azithromycin from January 2020 to November 2020. We systematically searched PubMed, Scopus, Cochrane, ProQuest, Web of Science, and Embase databases. Results: Three studies (systematic review and meta-analysis) were analyzed to evaluate the arrhythmogenic potential of hydroxychloroquine or chloroquine with or without azithromycin in patients with COVID-19 and identify the clinical efficacy of such a combination. Conclusions: We found no benefit for patients with COVID-19 who received hydroxychloroquine or chloroquine alone or in combination with azithromycin. Moreover, it is noteworthy that these medications, particularly when considering co-administration, could result in both statistically and clinically elevated risks of notorious arrhythmias, such as TdP.

BackgroundThis study aimed to investigate the interaction effect of aerobic exercise and vitamin D supplementation on inflammation (TNF-α, IL-6, CC16, SP-D, and CC16/SP-D ratio) and lung function (FEV1, FVC, and FEV1/FVC ratio) in male smokers.MethodsAfter applying inclusion criteria, a total of 40 healthy male smokers were recruited in this study. The participants were randomly divided into four groups as follows: Aerobic Exercise + vitamin D Supplementation (AE + VitD,n = 10), Aerobic Exercise (AE,n = 10), vitamin D Supplementation (VitD,n = 10), and Control (C,n = 10). The participants in the AE + VitD and AE groups performed aerobic exercise training (running) up to 50% of the maximum heart rate, three times a week for four weeks. Participants in AE + VitD and VitD groups received 6000 IU/w vitamin D3for four weeks. The participants in control group did not receive any intervention. Serum tumor necrosis factor (TNF)-α, interleukin (IL)-6, Clara cell protein (CC16), surfactant protein (SP)-D, CC16/SP-D ratio, and lung function (FEV1, FVC, and FEV1/FVC ratio) were measured before and after four weeks of intervention.ResultsSerum levels of TNF-α, IL-6, and CC16 decreased significantly in AE + VitD, VitD, and AE groups after four weeks (P P = 0.011). In addition, FEV1 and FVC increased significantly (P P > 0.05). Furthermore, serum levels of 1,25-dihydroxyvitamin D increased significantly in AE + VitD and VitD groups (P P > 0.05).ConclusionsThe results of present study were that aerobic exercise combined with vitamin D supplementation can reduce serum inflammatory factors and anti-inflammatory proteins and improve lung function after four weeks of intervention. Further trials with larger sample size and longer duration are suggested to confirm these results.Trial registrationRetrospectively registered. IRCT20180513039637N4. Registration date: 2020/10/20. URL:https://www.irct.ir/search/result?query=IRCT20180513039637N4

Background: Breast cancer is responsible for up to 25% of all cancers in Iran. The age at diagnosis of Iranian breast cancer patients starts a decade earlier than most of developed countries. This study aimed to evaluate the mean age at diagnosis of Iranian breast cancer patients. Methods: In this systematic review and meta-analysis, the mean age at diagnosis of Iranian breast cancer patients and its pattern between 2008 and 2017, were evaluated. All papers with age at diagnosis of histopathological verified breast cancer patients were considered eligible to enter to the analysis. We used databases including Medline/PubMed, Scopus, Embase, Cochrane Library, Iranmedex and SID for the search process. The meta-analysis was performed only on studies with separate data for female patients, using random-effects model, Mantel and Haenszel method and the Comprehensive Meta-analysis software. Results: Finally, 92 studies with 19,784 patients (both-genders) were included. The mean age at diagnosis had increased from 47.93 (2008) to 49.91 (2016) years. The meta-analysis was done on 78 studies containing of 15,071 female patients and the mean age at diagnosis was 46.76±1.19. There was a wide range of age at diagnosis within different provinces. The mean age at Hamadan and Khuzestan provinces were the lowest and highest, respectively (42.48±7.96 vs. 51.00±11.47). The heterogeneity of studies was statistically significant (I2=99.744). Conclusion: Mean age at diagnosis of Iranian women with breast cancer was 46.76±1.19. There was an increasing pattern in mean age of diagnosis at breast cancer patients within the past 10 years.

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: 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.

bstract: BACKGROUND: Chronic neck pain is associated with various myofascial trigger points (MTrPs). OBJECTIVE: A single-blind randomized clinical trial was designed to compare the effects of extracorporeal shock wave therapy (ESWT) with dry needling (DN) techniques on the upper trapezius muscle trigger point in patients with non-specific neck pain (NSNP). METHODS: Seventy patients with NSNP and active MTrPs of the upper trapezius muscle were randomly divided into two groups: an ESWT group (n= 35) and a DN group (n= 35). Treatment sessions were performed for three weeks and all participants received related intervention once a week. The outcome measures were pain intensity, measured by a numeric pain rating scale (NPRS), pain pressure threshold (PPT), measured with a digital algometer, and functional disability, evaluated by using the neck disability index (NDI). RESULTS: NPRS and NDI were significantly decreased in the DN group and ESWT group (P< 0.05). Also, the PPT was significantly increased in the DN group and ESWT. However, there was no significant difference in pain intensity, NDI, and the PPT between the two groups (P⩾ 0.05). CONCLUSION: Both ESWT and DN can be employed to treat MTrPs of the upper trapezius muscle in patients with NSNP.

Background: Depression, causes problems in social and individual aspects of life, so is the major disease burden in modern societies. There is complex relationship between personality and depression, so some special forms of personality may predispose the person to the depression, and depression and its symptoms may manifest different as a result of the various personalities. Methods: This research case control study consisted of 128 patients with major depressive disorder and 131 normal people. Data have been collected through TCI questionnaire and Hamilton scale for depression. Results: In patients with major depression the Harm-avoidance, Reward-dependence and persistence, Self-Directedness and Cooperativeness have significant differences with normal people. Patients with major depressive disorder experience high levels of Harm-avoidance and Reward-dependence and Persistence, with low levels of Self-directedness and Cooperativeness than normal people. Conclusion: The depressed patients and normal people are different with temperament and character, and these differences can influence severity of depression.

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.

BACKGROUND Pancreatitis is a serious complication of endoscopic retrograde cholangiopancreatography (ERCP), which may lead to death. The purpose of this study was to evaluate the preventive effect of aggressive fluid therapy on the incidence of post-ERCP pancreatitis. METHODS In double-blind controlled condition, 240 patients were selected and divided into two groups. The treatment of the intervention group (n = 120) included a dose of 20 mL/kg of ringer lactate infusion within 90 minutes before ERCP and 3 mL/kg/h during ERCP followed by 3 mL/kg/h up to 8 hours. The treatment of the control group (n = 120) included a dose of 1.5 mL/kg of ringer lactate infusion during ERCP up to 8 hours later. Firstly, the patients were evaluated in terms of excessive fluid and serum amylase and pain level, and then they were re-evaluated 2, 8, and 24 hours after ERCP. RESULTS The mean age of the patients was 51.57 ± 13.5 years. Most of the patients were female (54.5%). Pancreatitis was developed in 26 patients including 5.83% of the patients in the intervention group and 15.83% of the patients in the control group (p = 0.013). Pancreatic pain was seen in 7.5% of the patients in the intervention group and in 27.5% of the control group (p < 0.005). Hyperamylasemia was seen in 20.83% of the patients in the intervention group and in 35% of the control group (p = 0.014). The mean days of hospital admission was 1.308 ± 0.807 in the intervention group and 1.425 ± 0.876 in the control group (p = 0.275). CONCLUSION Aggressive fluid therapy with ringer lactate solution before ERCP can effectively prevent postERCP pancreatitis, pancreatic pain, and hyperamylasemia.

Introduction: It has been shown that the combination therapy of Sofosbuvir-Daclatasvir (Sof/Dac) has a high rate of success in the treatment of patients. For the first time, a single pill of Sof/Dac has been formulated in Iran (Sovodak). In this regard, the present study was carried out aiming to investigate the safety and efficacy of Sovodak for 12 weeks during treatment of patients infected by genotype 1 hepatitis C virus (HCV). Methods: In this study, 50 patients (25 and 25 treatment-naïve and treatment-experienced patients, respectively) infected by HCV genotype 1 received Sovodak (1pill per day) for 12 weeks. Ribavirin was added for patients who had definitive evidence of liver cirrhosis. The sustained virological response (SVR12) was investigated 12 weeks after the end of the therapy. Results: All 50 patients completed the treatment period. The mean age of patients was 54.40 ± 11.69 years, in addition, 60% and 90% of the patients were male and infected by HCV genotype 1b, respectively. After 4 and 12 weeks of treatment with Sovodak, the HCV ribonucleic acid (RNA) titer was undetectable in 82% and 100 % of the patients, respectively and 100% of them achieved SVR12. None of the subjects reported treatment discontinuation because of adverse events, however, 3 patients reported transient side effects including foot swelling, headache, and vomiting. Conclusion: The results of this study showed that once-daily Sovodak single-pill for 12 weeks is an effective and safe medicine for treating patients infected by HCV genotype 1

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.

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.

The coronavirus disease 2019 (COVID-19) pandemic in Iran is part of the worldwide pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The present study aimed to demonstrate the clinical characteristics of patients affected by COVID-19, in our tertiary teaching hospital. Medical records and compiled data of 668 patients with suspected COVID-19 were obtained retrospectively between January to April 2020. The present study outcomes included demographic features of infected patients, underlying diseases and conditions, the relationship between the results of reverse transcription-polymerase chain reaction (RT-PCR) or CT-scan with the manifestations of the disease, mortality rate, and age distribution of fatalities among men and women. The median age of hospitalized patients was 63 years old (from 18 to 94). The patients’ chief complaints in the admission time were cough, dyspnea, fever, and gastrointestinal problems, respectively. Hospitalized patients' common comorbidities were hypertension (HTN), and cardiovascular disease (CVD) (24%), diabetes mellitus (DM) (21.5%), asthma, or chronic obstructive pulmonary disease (COPD) (6%), or other underlying diseases (15.5%). One-third of patients had no comorbidity according to the data of medical records. In hospitalized patients, 169 (84.5%) had positive RT-PCR, and 156 (78%) had positive chest CT findings. The mortality rate of males was higher than females (66.3% vs. 33.3%) and in patients with positive RT-PCR compared to patients with positive chest CT-scan findings. The majority of deaths had a history of DM or HTN/CVD in their medical records. The chief complaint of patients was cough. DM and HTN or CVD were the common underlying disease related to death in hospitalized cases. Besides, the hospitalization and mortality rate in males was higher than in females. About 87% of dead hospitalized cases had positive RT-PCR results, and this rate was 82% for chest CT results.

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.

Background:The type of pneumonia that is caused by the new coronavirus (SARS-CoV-2) has spread across the world in a pandemic. It is not clear if COVID-19 patients have any lower urinary tract signs or symptoms.Methods:The effect of COVID-19 on lower urinary tract function was studied in a multi-centre study including 238 patients who were admitted with symptoms caused by COVID-19 to the university hospital of Aachen in Germany and Tabriz in Iran. Results:None of the patients reported to have any lower urinary tract symptoms. SARS-CoV-2 was found in the urine of 19 % of the tested patients. The mortality rate in COVID-19 infected patients with microscopic haematuria together with white blood cells in their urine, was significantly increased from 48% to 61% in the Tabriz cohort (p-value=0.03) and from 30 % to 35% in the Aachen cohort (p-value =0.045). Furthermore, in the group of patients with SARS-CoV-2 urine PCR, the mortality rate rose from 33% to 50%. (p-value =0.039).Conclusion:Patients admitted with COVID-19 infection did not report to have any lower urinary tract symptoms even those patient who had a positive Urine SARS-CoV-2 PCR.In addition, hematuria, WBC in urine as well as COVID-19 positivity in urine were found to be strong negative prognostic factors in admitted COVID-19 patients.

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.

Objective Vitamin D-fibroblast growth factor-23 (FGF-23)-klotho forms an axis that takes part at least in cardiovascular complications in patients with chronic kidney disease. This study aimed to assess the effects of cholecalciferol supplementation on FGF23 and α-klotho in patients with hypovitaminosis D requiring hemodialysis. Methods In a single-center, parallel-arm, randomized, double-blind, placebo-controlled trial, 86 patients with hypovitaminosis D requiring hemodialysis were enrolled. The patients were randomized into 2 groups (n = 43 each) to receive either 50,000 IU of cholecalciferol or placebo every week for 12 weeks. Accordingly, the serum levels of FGF23 and klotho were measured by ELISA and compared between both groups. Results Serum 25OH(D) levels increased in participants who received cholecalciferol supplementation compared with participants who received placebo (P = .006). In addition, serum FGF23 decreased and α-klotho levels increased in the supplemented group compared with placebo. However, the before-after differences between cholecalciferol supplement and placebo were significant only for α-klotho (P = .035). These effects were not accompanied by changes in the levels of phosphate, total and ionized calcium, and intact parathyroid hormone. Conclusion Cholecalciferol supplementation of 50,000 IU for 12 weeks increases α-klotho levels in the serum of kidney failure patients undergoing hemodialysis. This may suggest that patients receiving maintenance hemodialysis can benefit from using cholecalciferol supplementation and increase in serum α-klotho levels.

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.

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 Due to the limited resources of the public sector, the presence of the private sector as an auxiliary to the health sector, to mitigate adverse health effects (AHEs) caused by environmental disasters, seems necessary. Therefore, the present study aimed to develop a Public-Private Partnership (PPP) framework for managing AHE of environmental disasters (case study of Lake Urmia-Iran). Methods This is a qualitative study with grounded theory approach, conducted in 2019. Required data were collected through semi-structured interviews with 20 experts selected through purposive sampling, and analyzed using Content-Analysis. To formulate the initial framework, an experts’ panel, composed of 12 experts, was formed. Delphi method was used to determine the validity of the framework. Results Most participants found the private sector participation in this field, essential and useful. The most important infrastructure for the private sector participation was designing a legal framework and providing adequate resources and facilities. Pollutant assessment and education of families for disease prevention are among the most important areas that the private sector can participate. To evaluate the performance of the private sector, periodic and short-term reports together with documentation should be used, and the evaluation tool should be the checklists agreed by two sectors. Payments to the private sector should be for periodic objectives, based on performance, and after performance confirmation, in the form of combination of fee for services, per capita and performance-based system. Preventing waste of resources, improving service coverage, greater efficiency and attracting public participation were the most important benefits of the private sector participation. Conclusions PPP can be considered by policy makers as an effective policy for reducing the AHE of environmental disasters (especially drying lakes). To this end, the framework presented in this study can be used as an action guide by national and local authorities and policymakers.

Introduction: Gastric cancer is a rather common malignancy worldwide and a major healthcare system issue. Lately, the importance of biomarkers such as macrophage migration inhibitory factor (MIF) has been demonstrated in the diagnosis of various gastrointestinal (GI) malignancies. The present study aimed to evaluate the diagnostic value of MIF, carcinoembryonic antigen (CEA), and carbohydrate antigen 19-9 (CA 19-9) in gastric cancer. Methods: In this descriptive-analytical study, 84 patients with gastric cancer referred to the gastroenterology clinic of Tabriz University of Medical Sciences, Tabriz, Iran, for diagnostic and therapeutic procedures, and 80 healthy individuals were enrolled. Serum levels of MIF, CEA, and CA 19-9 were measured in both groups. Further, the grade and stage of the cancer were determined in in the patient group. Results: Serum levels of all three MIF, CEA, and CA 19-9 biomarkers in patients with gastric cancer were significantly higher than those of the control group (P = 0.001). However, no statistically significant correlations were found between the studied biomarkers with the tumor grade and stage. The MIF cut-off point for the diagnosis of gastric cancer was found to be 7.05 pg/ml and its sensitivity and specificity were 85.7% and 73.8%, respectively. Conclusion: MIF biomarker may involve in the pathogenesis and development of gastric cancer and it is a potential diagnostic and therapeutic marker in this malignancy.

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

Introduction: Kidney transplantation restores many of the disorders accompanying endstage renal disease (ESRD). However, hypophosphatemia is common complication after renal transplantation. High levels of fibroblast growth factor 23 (FGF23) and parathyroid hormone (PTH) are two suspected factors determining the hypophosphatemia after kidney transplantation. Objectives: This observational prospective study was carried out to clarify the role of mentioned factors in hypophosphatemia after kidney transplantation. Patients and Methods: Living donor kidney transplant recipients which admitted to the ward of the renal transplantation, enrolled to the study. Parameters of bone and mineral metabolism including FGF23 and intact PTH levels were assessed. Results: High FGF23 level before transplantation was related to lower phosphate levels at 3rd month after transplantation. PTH levels showed no relationship with hypophosphatemia after kidney transplantation. Conclusion: High levels of FGF23 in ESRD patients undergoing kidney transplantation is an important determinant of hypophosphatemia in long-term follow up.

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