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BackgroundAntidepressants are prescribed widely to manage low back pain. There are a number of systematic reviews and meta-analyses which have investigated the efficacy of the treatments, while the methodological quality of them has not been assessed yet. This study aims to evaluate the methodological quality of the systematic reviews and meta-analyses investigating the effect of antidepressants on low back pain.MethodsA systematic search was conducted in PubMed, EMBASE, Medline, and Cochrane Library databases up to November 2018. The 16-item Assessment of Multiple Systematic Reviews (AMSTAR2) scale was used to assess the methodological quality of the studies. Systematic reviews and meta-analyses of the Antidepressants treatment effects on low back pain published in English language were included. There was no limitation on the type of Antidepressants drugs, clinical setting, and study population, while non-systematical reviews and qualitative and narrative reviews were excluded.ResultsA total of 25 systematic reviews and meta-analyses were evaluated; the studies were reported between 1992 and 2017. Obtained results from AMSTAR2 showed that 11 (44%), 9 (36%) and 5 (20%) of the included studies had high, moderate and low qualities, respectively. 13(52%) of studies assessed risk of bias and 2(20%) of meta analyses considered publication bias. Also, 16 (64%) of the included reviews provided a satisfactory explanation for any heterogeneity observed in the results.ConclusionsAlthough the trend of publishing high quality papers in ADs effect on LBP increased recently, performing more high-quality SRs and MAs in this field with precise subgroups of the type of pains, the class of drugs and their dosages may give clear and more reliable evidence to help clinicians and policymakers.

ObjectivesThe primary objective of this systemic review and meta-analysis was to investigate the risk of developing composite outcome of all cancers, regardless of the type of cancer among men with infertility diagnosis compared to fertile counterparts. The secondary objective was to compare the pooled risk of developing individual specific cancers between two groups.MethodsA systematic literature search was performed on the databases of PubMed (including Medline), Scopus, and Web of Science to retrieve observational studies published in English language from 01.01.1990 to 28. 02. 2021. They assessed cancer events in males with an infertility diagnosis compared to controls without infertility. The outcomes of interest were a composite outcome of cancers including all known cancer types, and also specific individual cancers. The fixed/random effects model was used to analyze heterogeneous and non-heterogeneous results. Publication bias was assessed using the Harbord test, Egger test, Begg test, and funnel plot. The pooled odds ratio of cancers was calculated using the DerSimonian and Laird, and inverse variance methods. Studies’ quality and risk of bias were assessed using structured standard tools.ResultsWe included eight cohort studies involving 168,327 men with the diagnosis of infertility and 2,252,806 men without it. The total number of composite outcome of cancers as well as individual cancers including prostate, testicular and melanoma were 1551, 324, 183 and 121 in the infertile men and 12164, 3875, 849, and 450 in the fertile men, respectively. The pooled OR of the composite outcome of cancers, regardless of the type of cancer, in men with infertility was 1.4 folds higher than those without infertility (pooled OR = 1.43, 95% confidence interval [CI]: 1.25-1.64). Meta-analysis of individual cancers including prostate, testicular and melanoma between two groups was carried out. The pooled ORs of testicular and prostate cancers in men with the diagnosis of infertility were significantly higher than controls without infertility (pooled OR = 1.91, 95% CI: 1.52-2.42 and pooled OR = 1.48, 95% CI: 1.05-2.08, respectively). Additionally, the pooled OR of melanoma in men with infertility was 1.3 folds higher than those without infertility (pooled OR = 1.31, 95% CI: 1.06-1.62).ConclusionA greater risk of cancers in men with male infertility was found suggesting that the history of male infertility might be an important risk factor for developing cancers in later life. Further well-designed long-term population-based prospective studies, considering all known cancers and their accompanying risk factors should be conducted to support our findings.

Colorectal cancer is one of the deadliest cancers worldwide. Effective screening, surveillance and prevention can decrease its incidence, mortality and burden. This meta-analysis aims to provide a pooled estimation of 5-year survival rate for colorectal cancer based on topography codes and treatment in Iranian population. A systematic search for literature was done in international and national databases up to July 2018. Twenty-seven studies from 4929 articles met the eligible criteria. The overall pooled 5-year survival rates of colorectal cancer, colon, rectal and sigmoid were 56% (95% CI: 49, 63), 53% (95% CI: 41, 65), 52% (95% CI: 41, 62) and 38% (95% CI: 22, 55), respectively. In addition, 5-year survival rate of colorectal cancer after surgery was 64% (95%CI: 50, 78). Subgroup analysis by type of data source showed significantly higher rate of survival in oncology center (29%) than hospital-based (p=0.005). As a conclusion, low survival rate of colorectal cancer in Iran necessitates effective screening and surveillance strategies to find precancerous polyps and detect early-stage cases with lower stage risk of cancer.

This study aims to illustrate the problem of (Quasi) Complete Separation in the sparse data pattern occurring medical data. We presented the failure of traditional methods and then provided an overview of popular remedial approaches to reduce bias through vivid examples. Penalized maximum likelihood estimation and Bayesian methods are some remedial tools introduced to reduce bias. Data from the Tehran Thyroid and Pregnancy Study, a two-phase cohort study conducted from September 2013 through February 2016, was applied for illustration. The bias reduction of the estimate showed how sufficient these methods are compared to the traditional method. Extremely large measures of association such as the Risk ratios along with an extraordinarily wide range of confidence interval proved the traditional estimation methods futile in case of sparse data while it is still widely applying and reporting. In this review paper, we introduce some advanced methods such as data augmentation to provide unbiased estimations.

ObjectivesIt is uncertain whether the treatment of mild gestational diabetes mellitus (GDM) improves pregnancy outcomes. The aim of this systemic review and meta-analysis was to investigate the effect of mild GDM treatment on adverse pregnancy outcomes.MethodsA comprehensive literature search was conducted on the databases of PubMed, Scopus, and Google Scholar to retrieve studies that compared interventions for the treatment of mild GDM with usual antenatal care. The fixed/random effects models were used for the analysis of heterogeneous and non-heterogeneous results. Publication bias was assessed using the Harbord test. Also, the DerSimonian and Laird, and inverse variance methods were used to calculate the pooled odds ratio of events. The quality assessment of the included studies was performed using the Modified Newcastle–Ottawa Quality Assessment scale and the CONSORT checklist. In addition, the risk of bias was evaluated using the Cochrane Collaboration’s tool for assessing risk of bias.ResultsThe systematic review and meta-analysis involved ten studies consisting of 3317 pregnant women who received treatment for mild GDM and 4407 untreated counterparts. Accordingly, the treatment of mild GDM significantly reduced the risk of macrosomia (OR = 0.3; 95%CI = 0.3–0.4), large for gestational age (OR = 0.4; 95%CI = 0.3–0.5), shoulder dystocia (OR = 0.3; 95%CI = 0.2–0.6), caesarean-section (OR = 0.8; 95%CI = 0.7–0.9), preeclampsia (OR = 0.4; 95%CI = 0.3–0.6), elevated cord C-peptide (OR = 0.7; 95%CI = 0.6–0.9), and respiratory distress syndrome (OR = 0.7; 95%CI = 0.5–0.9) compared to untreated counterparts. Moreover, the risk of induced labor significantly increased in the treated group compared to the untreated group (OR = 1.3; 95%CI = 1.0–1.6). However, no statistically significant difference was observed between the groups in terms of small for gestational age, hypoglycemia, hyperbilirubinemia, birth trauma, admission to the neonatal intensive care unit, and preterm birth. Sensitivity analysis based on the exclusion of secondary analysis data was all highly consistent with the main data analysis.ConclusionTreatment of mild GDM reduced the risk of selected important maternal outcomes including preeclampsia, macrosomia, large for gestational age, cesarean section, and shoulder dystocia without increasing the risk of small for gestational age. Nevertheless, the treatment could not reduce the risk of neonatal metabolic abnormalities or several complications in newborn.

Background and Objectives: Mild gestational diabetes (GDM) refers to the gestational hyperglycemia, which does not fulfill the diagnostic criteria for GDM. The results of studies on adverse pregnancy outcomes among women with mild GDM are controversial. Therefore, the aim of this systematic review and meta-analysis was to investigate the impact of mild GDM on the risk of adverse maternal and neonatal outcomes.Methods: A thorough literature search was performed to retrieve articles that investigated adverse maternal and neonatal outcomes in women with mild GDM in comparison with non-GDM counterparts. All populations were classified to three groups based on their diagnostic criteria for mild GDM. Heterogeneous and non-heterogeneous results were analyzed using the fixed/random effects models. Publication bias was assessed using the Harbord test. DerSimonian and Laird, and inverse variance methods were used to calculate the pooled relative risk of events. Subgroup analysis was performed based on mild GDM diagnostic criteria. Quality and risk of bias assessment were performed using standard questionnaires.Results: Seventeen studies involving 11,623 pregnant women with mild GDM and 53,057 non-GDM counterparts contributed to the meta-analysis. For adverse maternal outcomes, the results of meta-analysis showed that the women with mild GDM had a significantly higher risk of cesarean section (pooled RR: 1.3, 95% CI 1.2–1.5), pregnancy-induced hypertension (pooled RR: 1.4, 95% CI 1.1–1.7), preeclampsia (pooled RR: 1.3, 95% CI 1.1–1.5) and shoulder dystocia (pooled RR: 2.7, 95% CI 1.5–5.1) in comparison with the non-GDM population. For adverse neonatal outcomes, the pooled relative risk of macrosomia (pooled RR = 0.4, 95% CI: 1.1–1.7), large for gestational age (pooled RR = 1.7, 95% CI: 1.3–2.3), hypoglycemia (pooled RR = 1.6, 95% CI: 1.1–2.3), hyperbilirubinemia (pooled RR = 1.1, 95% CI: 1–1.3), 5 min Apgar Conclusion: The risks of sever adverse neonatal outcomes including small for gestational age and neonatal mortality are not increased with mild GDM. However, the increased risks of most adverse maternal and neonatal outcomes are observed. The risks have similar magnitudes for all mild GDM diagnostic classifications.

Background: Cancer is one of the most important causes of death in the world and has an increasing trend globally. We aimed at investigating the five leading cancers in Iranian women based on a 10-year history of cancer registry reports and illustrating the trends in all cancer sites and breast cancer as the top leading one from 2003 to 2015. Methods: Data were obtained from national cancer registry study. Age-Specific Incidence Rate (ASR) data were obtained from Iran’s annual national cancer registry reports between 2003 to 2010 and 2014 to 2015. Using Joinpoint regression, we analyzed incidence trends over time for all cancer sites and the top leading cancer from 2003 to 2015. Results: Breast cancer was ranked first in Iranian women. Its ASR raised from 15.96 in 2003 to 32.63 in 2015. Results of trend analysis based on Annual Percent Change (APC) index showed 5.6 (95%CI: 2.9 to 8.3) and 4.6 (95%CI: 2.0 to 7.2) annual increase in the incidence of all cancer sites and breast cancer from 2003 to 2015, respectively. Conclusion: This study indicates significant increasing trends in all cancer sites and breast cancer incidence in Iran. Despite the national coverage of cancer registry over the past decade, more considerations should be taken into account, especially in Breast cancer.

The article's abstract is no available.

The aim of this study was to mention some methodological issues in a study which investigate the effect of Granulocyte colony-stimulating factor on developing of aortitis.

The aim of this Letter to the Editor was to report some methodological shortcomings in a recently published Article. We proved that the obtained results are subjected to the sparse data bias and presented some remedial tools such as penalization approaches. In addition, model fitting and performance aroused some controversies. In conclusion, the results of this study should be interpreted with caution and further reanalysis is necessary.

Background: Urological cancers represent a major public problem associated with high mortality and morbidity. The pattern of these cancers varies markedly according to era, region and ethnic groups, but increasing incidence trends overall makes focused epidemiological studies important. The aim of the present study was to assess the incidence of most prevalent urological cancers in Iran from 2003 to 2009. Materials and Methods: The data for this study were obtained from the population-based Cancer Registry Center of the Iran Ministry of Health and Medical Education. Differences of mean age and age distributions of each cancer were compared between 2003 and 2009 in men and women. Results: Bladder cancer was the most common urologic cancer in both genders. The rate difference of age standardized ratio (ASR) of bladder and renal cell carcinoma in women were 1.54 and 2.01 percent per 100,000 population from 2003 to the 2009, respectively. In men, the rate difference of age standardized ratio of prostate, testis, kidney and bladder cancer was also 2.23, 1.2, 1.8 and 1.5 percent per 100,000 population from 2003 to 2009, respectively. The mean ages of patients in all cancers in both genders did not differ significantly through time (p value>0.05) but the distribution of ages of patients with bladder and prostate cancer changed significantly from 2003 to 2009 (p value