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Purpose The current study aimed to investigate the associations between metabolic syndrome (MetS) with health-related quality of life (HRQoL) using multilevel analysis among the Iranian adult population.Methods This cross-sectional study was conducted in the framework of the Tehran Lipid and Glucose Study (TLGS). Participants were 6113 participants (3318 women and 2795 men) aged≥20 years of the TLGS seventh phase who had completed data on HRQoL and MetS. HRQoL was assessed using the short-form 12-item health survey V.2 and MetS defined based on the guidelines outlined in the Joint Interim Statement. The two-level model was fitted to assess the association between MetS and HRQoL.Results The prevalence of MetS and its components was higher in men, and regardless of metabolic status, men exhibited higher HRQoL values. The deleterious impact of MetS on HRQoL was more pronounced in women, while the detrimental effects of MetS on men’s HRQoL were confined to specific subscales. These results were obtained through multilevel analysis, considering both familial and individual variation levels. Moreover, our investigation highlighted the positive influence of leisure-time physical activity on both the physical and mental component summaries (PCS and MCS, respectively), regardless of gender. Education had a greater positive impact on PCS in both sexes. Additionally, a history of cardiovascular diseases was associated with a decline in mental and physical HRQoL, while age was linked to a decline in PCS and MCS, and smoking was associated with a decline in MCS.Conclusion This study revealed the significant influence of gender, as well as the unique characteristics and circumstances of individuals, on the relationship between MetS and HRQoL in a general population with low/middle income.

Abstract Background The causes of infertility have remained an important challenge. The relationship between VDR gene polymorphisms and infertility has been reported, with controversial findings. Objective and rationale We aimed to determine this relationship by conducting a systematic review and meta-analysis. Search methods The study was started with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) declaration and the final draft was registered as a protocol in PROSPERO (ID: CRD42023416535). The international electronic databases including PubMed (Medline), Scopus, Web of Sciences, and Cumulative Index to Nursing and Allied Health Literature (CINHAL) were searched until January 30, 2023, by using appropriate keywords. The quality of the final studies was assessed using the NOS Checklist for case–control studies. The odds ratios (ORs) for each of the genetic models were pooled, and a subgroup analysis based on geographical region and types of infertility was carried out by the MetaGenyo online tool. Outcomes Case–control studies including 18 and 2 studies about infertility in women and men, respectively, and 4 miscarriage studies were entered into the meta-analysis. The VDR gene TaqI polymorphism was associated with infertility susceptibility in women in the allele contrast [OR = 1.2065, 95% CI (1.0846–1.3421); P = 0.0005], Recessive model [OR = 1.3836, 95% CI (1.1197–1.7096); P = 0.002], Dominant model [OR = 1.2146, 95% CI (0.0484–1.4072); P = 0.009], Homozygote [OR = 1.4596, 95% CI (1.1627–1.8325); P = 0.001], and TT vs. Tt [OR = 1.2853, 95% CI (1.0249–1.6117); P = 0.029. ApaI and FokI gene polymorphisms were found to be significantly protective SNPs against women and men infertility in the Dominant model [OR = 0.8379, 95% CI (0.7039- 0.9975); P = 0.046] and Recessive model [OR = 0.421, 95% CI (0.1821–0.9767); P = 0.043], respectively. Sub-group meta-analysis showed a protection association of ApaI in dominant [OR = 0.7738, 95% CI = 0.6249–0.9580; P = 0.018] and AA vs. aa [OR = 0.7404, 95 CI% (0.5860–0.9353) P = 0.011725] models in PCOS subgroup, however, a negative association with idiopathic infertility was found in AA vs. Aa [OR = 1.7063, 95% CI (1.1039–2.6375); P = 0.016187] and Aa vs. aa [OR = 0.6069, 95% CI (0.3761–0.9792); P = 0.040754]. TaqI SNP was significantly associated with infertility in the African population and BsmI was associated with the disease mostly in the Asian population. Conclusion This meta-analysis showed that the TaqI polymorphism may be linked to women’s infertility susceptibility. However, ApaI and FokI might be the protective SNPs against infertility in Women and men, respectively.

BackgroundDespite the fact that DM patients are living longer, research on the prevalence of MSDs and other related illnesses is still lacking compared to that of other comorbidities. This study systematically reviewed and meta-analyzed cohort studies to determine the association between diabetes mellitus (DM) and musculoskeletal disorders (MSDs).MethodsA comprehensive search of international databases, including Medline (PubMed), Web of Science, Scopus, and Embase, was conducted up to June 2023 to identify relevant studies investigating the association between MSDs and DM.ResultsThe meta-analysis included ten cohort studies with a total of 308,445 participants. The pooled risk ratio (RR) estimate for the association between MSDs and DM was 1.03 (95% CI 1.00-1.06). Based on subgroup analysis, the association between longer duration (more than 7), European, below the age of 70, and female patients was higher than the others.ConclusionIn conclusion, the results of this meta-analysis suggest that there may be an association between MSDs and diabetes in people with diabetes. These findings add to the existing knowledge on this topic and highlight the importance of recognition and management of MSDs in people with DM. There is a need for further research to investigate the underlying mechanisms and to develop targeted interventions for the prevention and management of MSDs in this population.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=381787, identifier CRD42022381787.

Abstract Background Urinoma, a rare condition resulting from urine leakage due to trauma to the kidney, bladder, or urethra, is typically diagnosed using enhanced computed tomography urogram with delayed imaging. This report presents two cases of urinoma likely caused by overdistention of the renal pelvis following excessive fluid intake and the presence of a ureteral stone. Case presentation We present two cases of 36-year-old and 38-year-old patients who presented with flank pain. point-of-care ultrasound (POCUS) played a pivotal role in identifying perinephric fluid in Morrison’s space and the splenorenal space, respectively. These ultrasound findings guided further investigations, leading to definitive diagnoses via abdominal pelvic CT scans. Treatment involved prophylactic antibiotics and the successful placement of a double J stent into the renal pelvis over the wire under fluoroscopic guidance, which resulted in significant clinical improvement for both patients. Conclusions This study demonstrates the rare occurrence of urinoma from urolithiasis, the use of POCUS in expediting diagnosis and treatment, and the importance of interpreting sonographic images in the correct clinical setting.

Abstract Background Chest CT is a crucial diagnostic tool in COVID-19 due to its high sensitivity. Typical chest CT findings such as reversed halo sign, vascular enlargement, and air-bronchogram are commonly recognized in the pandemic, but finding atypical signs is essential to diagnose. We aimed to investigate the prevalence of the atypical manifestations during the two months of 2022 and compare the results to studies conducted before its outbreak. Methods Those patients with positive, positive RT-PCR tests were reevaluated to see if they met the inclusion and exclusion. Demographic information of patients, including age and sex, was recorded. The computed tomography (CT) examination was carried out using a 100-slice scanner (Philips Brilliance 6 CT Scanner). Two radiology specialists evaluated SARS-CoV-2 RT-PCR-positive patients for atypical pulmonary CT findings separately. The obtained data were evaluated using R software version 4.1.1. Results 606 confirmed COVID-19 cases were included in this study based on inclusion and exclusion criteria during January and February 2022. 55% of patients were female, and the median age was 56 (IQR: 42, 69). More than half of the patients (59%) had atypical findings on their pulmonary CT examination. These findings showed that pleural abnormalities were the most frequent atypical finding. Among pleural abnormalities, pleural thickening was the most common (17%). The double halo sign represented the least frequent atypical sign (0.2%). Conclusions Atypical findings were more prevalent in this study than its predecessors, while we acknowledge that other factors, such as study design and patient population, could have impacted it. The presence of atypical signs generally was not correlated with specific demographic groups, while some of these signs were more frequent in particular groups.

Abstract Background The effect of HBV on neonatal and maternal outcomes can create a basis for more accurate clinical decision-making. So, the aim of this meta-analysis is to detrmine the effect of chronic hepatitis B virus on the risk of pregnancy outcomes by combining cohort studies. Methods International databases in this meta-analysis included the Cumulated Index to Nursing and Allied Health Literature (CINAHL), SPORT Discuss via the EBSCO interface, PubMed (Medline), Scopus, Web of Science, Embase, which were searched up to April 2023. All cohort studies reporting the risk ratio (RR) with a 95% confidence interval (CI) were included in the study. The quality assessment was done based on the Newcastle–Ottawa Scale (NOS). Results Finally, thirty-five cohort studies were selected for meta-analysis. Outcomes of interest included pre-eclampsia, gestational diabetes, abortion, preterm birth, infant death, and other related outcomes. Results showed that the pooled RR for incident gestational diabetes in pregnant women with choronic hepatitis B infection was 1.16 (RR: 1.16; 95% CI 1.13–1.18; I-square: 92.89%; P value: 0.00). Similarly, the association between the presence of hepatitis B infection in pregnant women and the occurrence of pre-eclampsia was 1.10 (RR: 1.10; 95% CI 1.04–1.16; I-square: 92.06%; P value: 0.00). The risk of preterm delivery in pregnant women with hepatitis B infection was 1.17 times that of pregnant women without hepatitis B infection (RR: 1.17; 95% CI 1.14–1.20; I-squared: 94.32%; P value: 0.00). Conclusion This meta-analysis found that hepatitis B infection during pregnancy may be associated with an increased risk of gestational diabetes, preterm delivery, pre-eclampsia, and eclampsia. However, confirmation of this association, as well as the specific biological pathways involved in the association between HBV infection and pregnancy outcomes, requires further investigation.

Background: Tremor is one of the most common movement disorders affecting the upper limb (proximal and distal), neck, or vocal cords. Primidone and propranolol are the most effective oral medications prescribed for essential tremors. 12 to 66% of those treated with propranolol have complications, and 30% of patients do not respond to oral medications. Methods: In this study, a clinical trial was conducted to compare the effect of botulinum toxin Injection and Oral Propranolol in the Treatment of essential hand Tremor on patients referred to Golestan Hospital's neurology clinic complaining of hand tremor in 2016 and 2017. Eighty essential tremor patients were assigned to the study and divided into two groups, the botulinum toxin group had muscular injection under ultrasound guidance, and the propranolol group received oral propranolol. Patients were evaluated at one-month intervals, weeks 0, 4, 8, and 12. The severity of the tremor was assessed using the TETRAS clinical scale. Another patient evaluation was the RAND SF-36 Quality of Life Questionnaire, which was presented to patients at weeks 0 and 8. Results: Our findings in this study revealed that the intramuscular injection of botulinum toxin is more effective in treating moderate-to-severe Essential Tremor hand than the intake of oral propranolol. Conclusion: Botulinum toxin is recommended for moderate-to-severe cases of essential hand Tremor, especially for patients who fail to bear the treatment course or take several medications that prompt striking drug interference.

Background: Several studies propose the protective effect of Helicobacter pylori (HP) in reducing the risk of Multiple sclerosis (MS) whereas the others reported high HP seropositivity in the MS population. Hence, we aimed to perform a comprehensive systematic review and meta-analysis to investigate the association between the risk of MS and HP infection.Methods: A systematic literature search was performed using three databases in June 2022. We selected observational studies that assessed the association between MS and HP.Results: A total of 14 articles with 2307 patients with MS and 2024 controls were included in our systematic review and meta-analysis. The pooled odds ratio (OR) estimates for HP was 0.70 (CI 95%: 0.53-0.93) which indicates HP might reduce the risk of MS. The OR for HP in developed countries was 0.71(CI 95%: 0.57-0.87) while it was 0.72 (CI 95%: 0.43-1.21) in developing countries. Furthermore, the pooled prevalence of HP in patients with MS was 45% (CI 95%: 35%-56%). The overall prevalence estimated for HP in MS patients in developed countries was 32% (CI 95%: 22%-41%). The prevalence of HP in MS patients from developing countries was 56% (CI 95%: 43%-69%) which was higher than in developed countries.Conclusion: In conclusion, this systematic review and meta-analysis showed a lower rate of HP infection in patients with MS, suggesting that HP may reduce the risk of MS occurrence. However, further investigation with a large sample size while adjusting for the effect of other leading factors should be conducted to confirm our results.

Background: Sever Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in some patients leads to cytokine storm and causes hemophagocytic lymphohistiocytosis (HLH) secondary to this viral agent. HLH is a rare and aggressive disease that increases in children, and is caused by changes in the immune system that associated with high mortality. Consideing the current pandemic, early diagnosis and treatment is important. Herein, we report a case of a 14-month-old infant presented with COVID-19 and prolonged fever who was eventually treated with the diagnosis of HLH. The study has been done in Sanandaj in January 2020. Case Presentation: A 14-month-old female infant with Covid-19, in November 2019 with prolonged fever lasting for 12 days, weakness and lethargy was admitted to Sanandaj Social Security Hospital, in November 2019. The infant did not have any history of illness, drug or allergy and had received vaccination according to the country's protocol. Later she was transferred to Besat Hospital in Sanandaj due to persistent fever and elevated liver enzymes. The patient had severe leukocytosis and hepatosplenomegaly in the second center. During the diagnostic measures for the patient and the rule out of other possible causes through imaging and laboratory investigations and also the evaluation of relevant criteria, HLH was suggested and treated with antibiotics (ceftriaxone, meropenem), IVIg, dexamethasone and pantoprazole. After that the fever decreased, then oral prednisolone was prescribed and a follow-up was recommended. She was discharged in good general condition. Conclusion: The current Covid-19 pandemic causes infection of children and may lead to occurrence of secondary HLH disease. therefore, assessment of children with liver manifestations and resistant fever should be considered by performing a PCR test to avoid complications and consequences as much as possible by timely treatment. more studies should be done in the field of its various dimensions.

Abstract Background This study aimed to investigate the pooled diagnostic ability of circular RNA (circRNA) molecules for diabetes mellitus. Methods We searched PubMed, Scopus, and Web of Science for relevant studies. A total of 2070 participants, including 775 diabetic patients and 1295 healthy individuals, from five studies were included in this meta-analysis. True positive, true negative, false positive, and false negative data were extracted to calculate pooled sensitivity, specificity, positive and negative likelihood ratios, diagnostic odds ratio, and area under the receiver operating characteristics curve. The Deeks’ funnel plot was applied for publication bias assessment, Cochran’s Q test and I2 index were applied for inter-study heterogeneity assessment. Besides, a subgroup analysis was performed for determining the source of heterogeneity between studies. P value

Abstract Objectives This study is aimed to compare the effect of oral misoprostol with vaginal misoprostol to induce labor as a systematic review and meta-analysis. Methods Electronic databases including PubMed [Medline], Scopus, Web of science, Embase, Ovid, Cochrane library, and ClinicalTrials.gov were searched using the relevant keywords. All RCTs comparing the effect of oral vs vaginal misoprostol on labor induction were considered. The Cochrane Risk of Bias checklist was used for assessing quality of included RCTs. All statistical analyses were completed using STATA (Version 16) and Revman (Version 5). Results Thirty-three RCTs with 5162 patients (1560 in oral and 2602 in vaginal groups) were included in this meta-analysis. Labor induction length did differ significantly between the two routes of misoprostol administration [Standardized Mean Difference: 0.40 h, 95% confidence interval (CI) 0.34, 0.46; I2: 66.35%; P = 0.04]. In addition, the risk of neonatal death, tachysystole, uterine hyperstimulation, preeclampsia, non-FHR and abortion was lower in the oral misoprostol group and the risk of hypertonus, PROM, oxytocin need and cesarean fever was higher in this group than the vaginal misoprostol group. Conclusions Based on results of this meta-analysis, it can be inferred that currently, clinical specialists can decide to use this drug orally or vaginally on a case-by-case basis, depending on the condition of the pregnant mother and the baby.

Abstract Introduction The aim of this review was to combine the results of published cohort studies to determine the exact association between chronic liver disorders, and the severe form of COVID‐19, and its associated complications. Methods This meta‐analysis employed a keyword search (COVID‐19 and chronic liver disorders) using PubMed (Medline), Scopus, Web of Sciences, and Embase (Elsevier). All articles related from January 2019 to May 2022 were reviewed. The STATA software was used for analysis. Results The risk of death in COVID‐19 patients with chronic liver disorders was higher than in ones without the chronic liver disease (RR: 1.52; CI 95%: 1.46–1.57; I2: 86.14%). Also, the risk of acute respiratory distress syndrome (ARDS) and hospitalization in COVID‐19 patients with chronic liver disorders was higher than in ones without the chronic liver disease ([RR: 1.65; CI 95%: 1.09–2.50; I2: 0.00%] and [RR: 1.39; CI 95%: 1.23–1.58; I2: 0.20%]). Also, the meta‐analysis showed cough, headache, myalgia, nausea, diarrhea, and fatigue were 1.37 (CI 95%: 1.20–1.55), 1.23 (CI 95%: 1.09–1.38), 1.25 (CI 95%: 1.04–1.50), 1.19 (CI 95%: 1.02–1.40), 1.89 (CI 95%: 1.30–2.75), 1.49 (CI 95%: 1.07–2.09), and 1.14 (CI 95%: 0.98–1.33), respectively, whereas the risk of all these symptoms was higher in COVID‐19 patients with chronic liver diseases than ones without chronic liver disorders. Conclusion The mortality and complications due to COVID‐19 were significantly different between patients with the chronic liver disease and the general population.

Abstract Background Covid-19 has been one of the major concerns around the world in the last 2 years. One of the challenges of this disease has been to determine its prevalence. Conflicting results of the serology test in Covid explored the need for an updated meta-analysis on this issue. Thus, this systematic review aimed to estimate the prevalence of global SARS-CoV-2 serology in different populations and geographical areas. Methods To identify studies evaluating the seroprevalence of SARS-CoV-2, a comprehensive literature search was performed from international databases, including Medline (PubMed), Web of Sciences, Scopus, EMBASE, and CINHAL. Results In this meta-analysis, the results showed that SARS-CoV-2 seroprevalence is between 3 and 15% worldwide. In Eastern Mediterranean, the pooled estimate of seroprevalence SARS-CoV-2 was 15% (CI 95% 5–29%), and in Africa, the pooled estimate was 6% (CI 95% 1–13%). In America, the pooled estimate was 8% (CI 95% 6–11%), and in Europe, the pooled estimate was 5% (CI 95% 4–6%). Also the last region, Western Pacific, the pooled estimate was 3% (CI 95% 2–4%). Besides, we analyzed three of these areas separately. This analysis estimated the prevalence in subgroups such as study population, diagnostic methods, sampling methods, time, perspective, and type of the study. Conclusion The present meta-analysis showed that the seroprevalence of SARS-CoV-2 has been between 3 and 15% worldwide. Even considering the low estimate of this rate and the increasing vaccination in the world, many people are still susceptible to SARS-CoV-2.

Abstract Background Conflicting results of recent studies on the association between Helicobacter pylori (H. pylori) infection and the risk of insulin resistance and metabolic syndrome explored the need for updated meta-analysis on this issue. Therefore, this systematic review aimed to estimate the pooled effect of H. pylori infection on the risk of insulin resistance and metabolic syndrome. Methods To identify case–control studies and cohort studies evaluating the association of H. pylori infection with insulin resistance and metabolic syndrome, a comprehensive literature search was performed from international databases including Medline (PubMed), Web of Sciences, Scopus, EMBASE, and CINHAL from January 1990 until January 2021. We used odds ratio with its 95% confidence interval to quantify the effect of case–control studies and risk ratio with its 95% CI for the effect of cohort studies. Results 22 studies with 206,911 participants were included for meta-analysis. The pooled estimate of odds ratio between H. pylori infection and metabolic syndrome in case–control studies was 1.19 (95% CI 1.05–1.35; I2 = 0%), and in cohort studies, the pooled risk ratio was 1.31 (95% CI 1.13–1.51; I2 = 0%). Besides, case–control studies showed the pooled odds ratio of 1.54 (95% CI 1.19–1.98; I2 = 6.88%) for the association between H. pylori infection and insulin resistance. Conclusion In this meta-analysis, the results showed that there was a possibility of metabolic syndrome and insulin resistance in case of H. pylori infection.