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Background. This study assessed the potential efficacy of donepezil in treating autism spectrum disorder (ASD), a neurodevelopmental condition characterized by social communication difficulties and repetitive behaviors. Donepezil, primarily used to treat Alzheimer’s disease as an acetylcholinesterase inhibitor, has gained attention as a potential treatment for ASD symptoms. Methods. Following PRISMA guidelines, a systematic review was conducted to investigate the effects of donepezil on individuals with ASD. Outcome measures assessed various aspects of ASD, including language skills, executive function, behavior, and core symptoms. Nine studies were identified, including four randomized controlled trials (RCTs), three retrospective studies, one open-label trial, and one case report. Results. One RCT reported significant improvements in expressive and receptive language skills, especially in younger children. Another study combining donepezil with choline supplementation showed enhanced receptive language skills, particularly in younger participants. An open-label trial indicated improved rapid eye movement sleep patterns in autistic children treated with donepezil. Several retrospective studies reported improvements in behavioral symptoms, such as aggression and hyperactivity. However, other RCTs did not find statistically significant improvements in executive functioning. Conclusion. In general, donepezil use in ASD demonstrates promise in specific areas, notably language development and behavioral symptom management. However, the results are contradictory, requiring further research to clarify its role, optimal dosing, long-term effects, and potential side effects in individuals with ASD. Practical Implications. Donepezil can be used to improve the clinical global impression and language skills of people with ASD.

Introduction: Diastasis recti abdominis (DRA) is prevalent among postpartum women, with various physiotherapy treatments utilized. Despite the effectiveness of diverse DRA treatment methods and the importance of evaluating its levels and methods, limited attention has been given to this aspect. This study comprehensively investigates DRA, examining evaluation levels and methods, and assessing the efficacy of diverse physiotherapy interventions. Materials and Methods: Online search was conducted in Cochrane, ProQuest, PubMed, Embase, Scopus, Web of Science, Google Scholar, and Magiran databases until the end of 2022, employing the population, intervention, comparison, and outcome framework (population = DRA, intervention = physiotherapy, comparison = control, and outcome = inter-rectus-distance [IRD]). The JBI checklist and Cochrane Collaboration RoB 2.0 tool evaluated critical appraisal and bias risk. Meta-analysis was performed using the RevMan software. Results: The study included 16 articles with 650 postpartum women. The findings revealed no significant differences in various measurement methods (P=0.25) and levels (P=0.10). Combination therapy demonstrated greater effectiveness than exercise alone in reducing IRD (P=0.04), with tape being particularly impactful (P=0.009). Conclusion: Although sonography evaluation of IRD above the umbilicus is recommended, the study highlights the limitation of diverse measurement methods and levels in determining the optimal physiotherapy intervention. Despite the preference for combined interventions, especially tape alongside exercise for women with DRA, further research is essential due to limited evidence, aiming to provide greater insights into this issue.

Introduction: Acute ischemic stroke (AIS) and intracerebral hemorrhage (ICH) are among the acute cerebrovascular diseases (CVDs) that have been reported as a result of COVID-19. It will be a significant step forward if our research helps improve the compilation and analysis of existing data from other studies. Methods: The study is registered on PROSPERO with an ID of CRD42023464058. It encompasses articles published until December 2023 and involves searching databases such as PubMed, Scopus, Web of Knowledge, Embase, and Cochrane. Additionally, we conducted manual searches in respected publications within this discipline, utilized the Google Scholar search engine, and conducted reference checks, citation checks, and study of gray literature. The publications’ reporting quality was assessed using the "Assessment of Multiple Systematic Reviews" (AMSTAR) checklist. The meta-analysis was conducted using Stata software (StataCorp, version 16). Results: We analyzed the findings of 23 meta-analyses, which included 795 articles and encompassed 5,937 patients who had previously experienced a stroke. The average age of these patients was 62.3 years, and 68.3% were male. The findings indicated that the collective incidence of stroke among individuals with COVID-19 is roughly 1.75% [95% confidence interval (CI): 0.4%-3.03], with 1.59% for ischemic strokes and 0.3% for hemorrhagic strokes. 32.3% (95% CI: 27.8%-36.9%) of COVID-19 patients with stroke passed away, approximately 27% were discharged from the hospital with very mild or no complications, and around 28.1% (95% CI: 14.1%-42.1%) were referred for rehabilitation. Conclusions: The overall rate of stroke in COVID-19 patients was approximately 1.75%, with a higher incidence in males and those with an average age of 62.3 years. Almost 80% of the strokes were ischemic, and the mortality rate was approximately 32%. Finally, 27% of the patients were discharged without complications, and 28% required rehabilitation.

Abstract Background Prone positioning (PP) is a low-cost method with minimal risk to the patient that improves the oxygenation of patients with acute hypoxic respiratory failure (AHRF) due to COVID-19 pneumonia, thereby reducing their need for tracheal intubation (TI) and transferring to the intensive care unit (ICU). We aimed to overview the results of all previous systematic reviews and meta-analyses to examine the net effect of PP on oxygenation, the rate of TI and mortality in COVID-19 patients. Methods We searched PubMed, Scopus, Web of Science, Google Scholar, and Cochrane Library databases from December 2019 through 2022 without publication language restriction for systematic reviews and meta-analysis studies on PP vs. supine position (SP) in conscious patients with hypoxic respiratory failure COVID-19. After study selection, data were extracted from published meta-analyses and pooled by comprehensive meta-analysis (CMA) software version 2.2.064 to achieve effect sizes. They were analyzed for TI and mortality rates dichotomous variables, and the results were shown as pooled odds ratios (OR) with a 95% confidence interval (CI). Continuous variables such as oxygenation indices (PaO2/FiO2 and SpO2) were also analyzed, and the data were shown as mean differences (MD) with lower and upper CI. The level of statistical significance was set at p ≤ 0.05. Results Twelve systematic reviews and meta-analyses with 19,651 patients and six systematic reviews with 2,911 patients were included in this Review of Reviews (total: 22,562). PP treatment significantly reduced the rate of TI (OR = 0.639, %95 CI (0.492, 0.829); P-value = 0.001) and decreased mortality (OR = 0.363, %95 CI (0.240, 0.549), P-value

Background: Many studies have assessed the effect of music on driving. However, their results are very scattered and contradictory. Therefore, this systematic review is conducted to determine the effect of music on driving performance and drivers’ physiological and psychological indicators. Methods: Scopus, PubMed, and Web of Science databases were searched until July 2023. A manual search in Google Scholar for gray literature was conducted. The Simulation Research Rubric (SRR) tool was used to assess the reporting quality of the studies. Stata software (StataCorp, version 16) was used to perform a meta-analysis. Results: A total of 2650 records were identified. The findings of 19 studies were analyzed. Most of them were carried out in high-income countries (HICs) using simulators. The most frequently used music style was classic rock. The meta-analysis results indicated that music with high and medium volume increases the average driving speed, and music with low volume decreases it. Although music in every mood reduces the average reaction time, it positively reduces response delay and increases coherence. Music with high volume decreases the heart rate, but music with medium and low volume increases it. Listening to music increases the level of arousal and mental load. Conclusion: It was concluded that, in some indicators, listening to music has adverse effects on driving. However, in many indicators, music has a positive impact on improving driving safety. It is better to choose appropriate music for different driving conditions and to train the drivers about it.

AbstractThe current study aims to investigate the relationship betweSen serum IL-17 (IL-17) levels and systemic lupus erythematosus disease activity index (SLE-DAEI) in systemic lupus erythematosus (SLE) patients. In this case-control study, 36 patients with SLE and 40 healthy individuals matched for age and sex were included as the control group. The study measured serum IL-17 in both groups. The correlation between serum IL-17 with disease activity (as per SLE-DAI) and organ involvement in SLE patients. The case group in this study consisted of 4 males and 32 females with a mean age of 35 (17–54) years old, and the control group included six males and 34 females with a mean age of 37 (25–53) years old (p = .35). Serum IL-17 was higher in the cases than in the controls (536 pg/mL vs. 110 pg/mL; p

Introduction: Painful bladder syndrome is known as a chronic and progressive bladder disorder. The present systematic review was performed with aim to investigate the method of posterior tibial nerve stimulation (PTNS) in the treatment of painful bladder syndrome. Methods: This systematic review study was conducted using Persian and English keywords and all their possible combinations in PubMed, Scopus, ProQuest, Google scholar, Web of science, The Cochrane Library, EMBASE, Cinhal, SID, Magiran, IranMedex and IranDoc databases without time and language limitation until April 2022. Two authors independently identified, screened and qualitatively reviewed the articles and extracted data. Results: Using the search strategy, 317 studies were retrieved. Seven studies with 174 samples were included in the present systematic review and among them 5 articles were eligible for meta-analysis. The findings showed that needle stimulation of the posterior tibial nerve caused a significant improvement and reduction in the mean frequency of nocturnal urination (mean difference: -0.78, 95% confidence interval: -0.15 to -1.41) and daily urination frequency (mean difference: -3.94, 95% confidence interval: -1.43 to -6.44) compared to the values before treatment. Also, although the values related to interstitial cystitis symptom index (ICSI) and interstitial cystitis problem index (ICPI) also decreased after the intervention compared to the values before treatment, based on the random effects model, this mean difference was not statistically significant. Conclusion: The results of the present study showed the effect of needle stimulation of the posterior tibial nerve on the mean frequency of daily urination and nighttime urination, however, due to the heterogeneity of the studies and the absence of a control arm, it is not possible to definitely determine a standard method for stimulation of the posterior tibial nerve. Therefore, it is recommended to conduct randomized clinical trials with a larger sample size.

Background: Osteoarthritis (OA) is the most common disease of joints. The management of OA is challenging due to the efficacy and safety of treatments. In recent decades, traditional herbal medicines have been introduced for treatment of disease. Delphinium denudatum Wall. (Jadwar) is a medicinal herb with a long-lasting usage in traditional Persian medicine for joint diseases. The present study aimed to investigate the effect of Jadwar on pain and symptoms of knee OA. Methods: In this randomized double-blind placebo-controlled trial, 104 patients with knee OA were randomly assigned into two groups of intervention and control. While the intervention group received one Jadwar capsule (500 mg) twice a day for four weeks, the control group received placebo capsules. The primary outcomes, including pain, stiffness, and physical activity were evaluated using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire and the Visual Analogue Scale (VAS) at baseline two and four weeks after the intervention. Results: Ninety-four participants completed the study. Considering the time of interaction, after four weeks, data analysis revealed a significant decrease in the VAS score (37.23±12.58 vs. 57.87±13.21), total WOMAC score (24.83±9.70 vs. 49.17±12.89), WOMAC pain score (7.19±2.90 vs. 12.40±4.46), stiffness (2.06± 0.845 vs. 4.11±1.14), and physical function (15.57±7.25 vs. 32.66±9.78) in the intervention group compared to the control group (P

Purpose Despite to high burden of road traffic injuries (RTIs), the RTI epidemiology has received less attention with rare investments on robust population cohorts. The PERSIAN Traffic Safety and Health Cohort (PTSHC) was designed to assess the potential causal relationships between human factors and RTI mortality, injuries, severity of the injury, hospitalised injury, violation of traffic law as well as offer the strongest scientific evidence.Participants The precrash cohort study is carried out in four cities of Tabriz, Jolfa, Shabestar and Osku in East Azerbaijan province located in northwest Iran. The participants were people who sampled among the general population. The cluster sampling method was used to enrol the households in this study. The PTSHC encompasses a wide and comprehensive range and types of data. These include not only the common cohort data collections such as medical examination measures, previous medical history, bio assays and behavioural assessments but also includes data obtained using advanced novel technologies, for example, electronic travel monitoring, driving simulation and neuro-psycho-physiologic laboratory assessments specifically developed for traffic health field.Findings to date A total of 7200 participants aged 14 years and above were enrolled at baseline, nearly half of them being men. The mean age of participants was 39.2 (SD=19.9) years. The majority of participants (55.4%) belonged to the age group of 30–56 years. Currently, approximately 1 200 000 person-measurements have been collected.Future plans PSTHC will be used to determine the human-related risk factors by adjusting for the vehicle and land-use-related factors. Therefore, a lot of crashes can be prevented using effective interventions. Although this cohort provides valuable data, it is planned to increase its size to achieve the highest level of evidence with higher generalisability. Also, according to the national agreement this cohort is going to be extended to several geographical regions in second decade.

Cancer of the thyroid has become the fastest-growing cancer among women in the past several decades. This study is aimed at using scientometric methods to identify research frontiers and development trends in the field of thyroid cancer (TC) research. We used the Scopus database to collect articles and reviews related to TC in November 2022. R software and Bibliometrix software package were used for scientometric analysis. More than 28,000 articles were obtained from Scopus using the defined specific keywords. The United States, France, and England published the most publications. Journal of Clinical Endocrinology and Metabolism and Cancer were found as the core journals in this field. Morris LGT, Sikora AG, and Davies L authored the most publications. National Cancer Institute, National Cancer Institute at NIH, and the University of Washington contributed the most publications. The most cited evidence was related to the articles of Bray (2018), Sung (2021), and Parkin (2005). Using scientometric analysis, this study mapped and visualized the knowledge landscape in the field of TC. The analysis showed that scientists in the field of TC are working collaboratively to tackle one of the most prevalent cancers in the world. This analysis showed that scientists in the field of TC are working with a scientific framework as a team to tackle one of the most common cancers in the world.

Background. Oral lichen planus (OLP) is a multifactorial chronic inflammatory condition with unknown etiology. This condition has been associated with Helicobacter pylori. This study aimed to investigate the relationship between the treatment of H. pylori infection and improvements in OLP lesions. Methods. In this cohort study, 42 patients with erosive or ulcerative OLP lesions were evaluated in terms of H. pylori infection using the H. pylori stool antigen (HpSA) test. The patients were divided into three groups. The first group consisted of 12 H. pylori-negative patients. The second group consisted of 21 H. pylori-positive patients receiving antibacterial treatment. The third group included nine H. pylori-positive patients not willing to receive treatment. All the three groups underwent the usual OLP treatment. Patients in the second and third groups were re-evaluated by the HpSA test after two months. The efficacy indexes and visual analog scale were used to evaluate clinical improvements. Results. The efficiency index and pain scores were affected by the intervention (P0.05) was obtained. Conclusion. Pain intensity was higher in patients with H. pylori than in those without H. pylori before treatment. Also, in patients with H. pylori, the treatment affects the complete recovery rate.

Gestational Diabetes Mellitus (GDM) is one of the critical risk factors for diabetes mellitus (DM). An early postpartum test done in the first few postpartum days can increase the screening rate in women with GDM. Therefore, this systematic review and meta-analysis aimed to combine and analyze data from different studies reporting the detection rate of postpartum diabetes in early and 4–12 week postpartum screening tests in women with GDM. ProQuest, Web of Science, EMBASE, PubMed, Cochrane, and Scopus were searched for English articles from January 1985 to January 2021. Two independent reviewers selected the eligible studies, and the outcomes of interest were extracted. The quality of studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for diagnostic test accuracy studies. Sensitivity and specificity, negative likelihood ratio (NLR), and positive likelihood ratio (PLR) were calculated for the early postpartum oral glucose tolerance test (OGTT). Of 1944 initially identified articles, four studies were included. The sensitivity and specificity of the early test were 74% and 56%, respectively, and the PLR and NLR were calculated as 1.7 and 0.4, respectively. The sensitivity of the early test was higher than the specificity. Based on this sensitivity and specificity, normal cases could be distinguished from abnormal cases, including diabetes and glucose intolerance. Early postpartum OGTT can be advised before hospital discharge. Early testing is a practical option in patients with GDM. Further studies are required to evaluate the early test detection rate for DM and glucose intolerance separately.

Abstract Background The developing nervous system in utero is exposed to various stimuli with effects that may be carried forward to the neonatal period. This study aims to investigate the effects of sound stimulation (music and speech) on fetal memory and learning, which was assessed later in neonatal period. Methods The MEDLINE (pubmed), Scopus, EMBASE, and Cochrane Library were searched. Two reviewers selected the studies and extracted the data independently. The quality of eligible studies was assessed using The Joanna Briggs Institute Critical Appraisal Checklist for Randomized Controlled Trials (RCTs). Results Overall 3930 articles were retrieved and eight studies met the inclusion criteria. All of the included studies had good general quality; however, high risk of selection and detection bias was detected in most of them. Fetal learning was examined through neonatal electrocardiography (ECG), electroencephalography (EEG), habituation tests, and behavioral responses. Seven studies showed that the infants had learned the fetal sound stimulus and one study indicated that the prenatally stimulated infants performed significantly better on a neonatal behavior test. There was considerable diversity among studies in terms of sound stimulation type, characteristics (intensity and frequency), and duration, as well as outcome assessment methods. Conclusions Prenatal sound stimulation including music and speech can form stimulus-specific memory traces during fetal period and effect neonatal neural system. Further studies with precisely designed methodologies that follow safety recommendations, are needed. Graphical Abstract

Background. Chronic hepatitis B is associated with different long-term outcomes in various regions. One of the critical predictors of clinical outcomes is the genotype of Hepatitis B virus (HBV). The current study investigated the frequency of worldwide and Iranian national HBV genotypes. Methods. Electronic search was performed through Medline (via Ovid), Embase, Web of Science, and Persian databases. Furthermore, the references of eligible articles were manually checked. The quantitative synthesis was conducted using the 2nd version of comprehensive Meta-analysis software (CMA.2). Results. In total, 5817 records were retrieved, and after removing duplicate studies, 3701 were screened at the title/abstract level. A total of 350 eligible studies were identified in the end.D genotype had the highest frequency (43.50%; 95% CI: 39.60 to 47.50), and the H genotype had the lowest frequency (1.2%; 95% CI: 0.6 to 2.7) globally. In 29 studies conducted in Iran (97.0%), genotype D was identified. Genotype E was the most prevalent in the African Region, followed by A in the American Region, B and C in the South-East Asian Region, D in the European Region, and C in the Western Pacific Region. Conclusion. The most prevalent genotype of HCV worldwide and in Iran is D. Furthermore, HBV genotype frequencies vary according to WHO regions. A prediction of progression could be made based on these results. Practical Implications. 1.According to the results of the meta-analyses, the D genotype had the highest frequency (43.50%; 95% CI: 39.60 to 47.50) and the genotype H had the lowest frequency (1.2%; 95% CI: 0.6 to 2.7) globally. 2.In 29 studies conducted in Iran (97.0%), genotype D was identified. 3. Genotype E was the most prevalent in the African Region, followed by A in the American Region, B and C in the South-East Asian Region, D in the European Region, and C in the Western Pacific Region.

Abstract Background Cell-Free DNA (cfDNA) is a non-invasive perinatal test (NIPT) used to assess fetal anomalies. The ability to detect fetal chromosomal aneuploidies is directly related to a sample’s fetal to total DNA fraction, known as the fetal fraction (FF). The minimum FF is considered 4%, and the test result below 4% is uncertain due to low fetal fraction (LFF). This study aimed to conduct a systematic review and a meta-analysis to determine the possible factors affecting LFF in cfDNA testing for fetal screening. Methods PubMed, Web of Science, Google Scholar, Since Direct, Scopus, CINHAL, Cochrane Library, and Persian databases, including Scientific Information Database, Irandoc, and Magiran were searched for studies investigating factors affecting LFF in cfDNA testing from 2000 until the end of 2021. Gathered data were analyzed using Comprehensive Meta-Analysis (CMA) software version 3.3.070. The quality of the included studies was assessed using the Joanna Briggs Institute Critical Appraisal of Cohort Studies tool. Results Thirteen articles related to the topic were included, and seven related articles were reviewed for meta-analysis. The other six were reviewed qualitatively. Four factors were identified that might have a potential effect on the LFF, of which only gestational age had a significant association with LFF (Pooled mean difference= -1.111, SE = 0.515, 95% CI= -2.121, -0.101, (P-value

Abstract Background Traumatic brain injury (TBI) causes mortality and long-term disability among young adults and imposes a notable cost on the healthcare system. In addition to the first physical hit, secondary injury, which is associated with increased intracranial pressure (ICP), is defined as biochemical, cellular, and physiological changes after the physical injury. Mannitol and Hypertonic saline (HTS) are the treatment bases for elevated ICP in TBI. This systematic review and meta-analysis evaluates the effectiveness of HTS in the management of patients with TBI. Methods This study was conducted following the Joanna Briggs Institute (JBI) methods and PRISMA statement. A systematic search was performed through six databases in February 2022, to find studies that evaluated the effects of HTS, on increased ICP. Meta-analysis was performed using comprehensive meta-analysis (CMA). Results Out of 1321 results, 8 studies were included in the systematic review, and 3 of them were included in the quantitative synthesis. The results of the meta-analysis reached a 35.9% (95% CI 15.0–56.9) reduction in ICP in TBI patients receiving HTS, with no significant risk of publication bias (t-value = 0.38, df = 2, p-value = 0.73). The most common source of bias in our included studies was the transparency of blinding methods for both patients and outcome assessors. Conclusion HTS can significantly reduce the ICP, which may prevent secondary injury. Also, based on the available evidence, HTS has relatively similar efficacy to Mannitol, which is considered the gold standard therapy for TBI, in boosting patients' neurological condition and reducing mortality rates.

High blood pressure is the main risk factor for cardiovascular disease and should be controlled primarily by changes in lifestyle, such as regular exercise, a low-salt diet, and weight loss in overweight or obesity. If lifestyle changes are not enough, many types of medications can be used to control high blood pressure; however, side effects constitute one of the most critical limitations of conventional medicines associated with high blood pressure. For this reason, the use of traditional and herbal medicines has been welcomed by the public for many years. Hibiscus sabdariffa is one of the most suitable herbal medicines for hypertension. According to research results, it has the same effect as conventional medicines without serious side effects. The present study introduces sour tea as a suitable herbal medicine for high blood pressure to provide readers of this article with a comprehensive understanding of the medicinal properties of Hibiscus sabdariffa for the treatment of hypertension and its effects on several other common diseases, including cancer.

Background: The association between the severity of coronary atherosclerosis and histopathologic findings in patients with non-alcoholic fatty liver disease (NAFLD) is not entirely understood. Considering the gold standard method, this study evaluates the histopathologic association between the severity of NAFLD and the grades of coronary atherosclerosis. Methods: In this descriptive-analytical study, data from 205 cadavers who were referred to an Iranian (Tabriz) forensic medicine organization between 2015 and 2017 and underwent simultaneous liver and coronary artery biopsies were examined. Finally, 168 cases were entered based on the inclusion criteria. First, pathological slides of these cadavers were extracted from the forensic medicine archive and re-examined. Then, the selected cases’ blocks were extracted from the tissue block bank, and again, after preparing a new slide, they were stained with trichrome for accurate estimation of liver fibrosis. Results: The assessment of NAFLD histological status in the studied cases revealed that 75.6% of the cases were classified as severity I, 18.4% as severity II, and 6% as severity III. Most cases with coronary atherosclerosis were classified as American Heart Association staging (AHA), type V (19.6%), and normal (19.6%). There was no statistically significant relationship between the severity of simple steatosis, steatohepatitis, and NAFLD, with coronary atherosclerosis. In subjects with higher severity of coronary atherosclerosis, the liver fibrosis rate is also higher, but no statistically significant difference was observed. Conclusion: The present study revealed no significant histopathological association between NAFLD and coronary artery atherosclerosis grade.

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 "SARSCoV-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.

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.

Abstract Background This 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. Methods After 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 D3 for 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. Results Serum levels of TNF-α, IL-6, and CC16 decreased significantly in AE + VitD, VitD, and AE groups after four weeks (P 0.05). Furthermore, serum levels of 1,25-dihydroxyvitamin D increased significantly in AE + VitD and VitD groups (P 0.05). Conclusions The 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 registration Retrospectively registered. IRCT20180513039637N4. Registration date: 2020/10/20. URL: https://www.irct.ir/search/result?query=IRCT20180513039637N4

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.

Abstract 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 prospective multi-centre, observational 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 30 to 58%. (p-value =0.039). Conclusion Patients admitted with COVID-19 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 SARS- CoV-2 presence in urine, were found to be strong negative prognostic factors in admitted COVID-19 patients.

Introduction: It has been hypothesized that the urinary microbiome might play an important role in OAB. Studies have been conducted on the association between OAB symptoms and the microbiome, although a possible causality still has to be determined. Material and Methods: In this study, 12 female patients, ≥18 years of age, with ‘OAB DO+’ and 9 female patients with ‘OAB DO-’ were included. Patients were excluded if they met one of the following exclusion criteria: bladder tumors and previous bladder operations; sacral neuromodulation; injection of Botox in the bladder; and TOT or TVT operations. Urine samples were collected and stored with patient informed consent and with the approval of the Hospital Ethical Review Board (Arnhem–Nijmegen). All OAB patients underwent urodynamics before collecting urine samples, and the diagnosis of detrusor overactivity was confirmed by two individual urologists. In addition, samples from 12 healthy controls who did not undergo urodynamic evaluation were analyzed. The 16S rRNA V1–V2 region amplification and gel electrophoresis were used to determine the microbiota. Results: 12 of the OAB patients had DO shown on their urodynamic studies; the remaining 9 patients had a normoactive detrusor on their urodynamic measurements. Overall, there were no substantial differences among the demographic characteristics of the subjects. The samples were classified as the following: 180 phyla, 180 classes, 179 orders, 178 families, 175 genera, and 138 species. The least commonly observed phyla were Proteobacteria, with an average presence of 10%, followed by Bacteroidetes with 15%, Actinobacteria with 16%, and Firmicutes with 41%. Most of the sequences could be classified according to the genus level for each sample. Discussion: Significant differences were observed in the urinary microbiome of patients with overactive bladder syndrome who have detrusor overactivity on urodynamics compared to OAB patients without detrusor overactivity and matched controls. OAB patients with detrusor overactivity have a significantly less diverse microbiome and show a higher proportion of Lactobacillus, particularly Lactobacillus iners. The results imply that the urinary microbiome could be involved in the pathogenesis of a specific phenotype of OAB. The urinary microbiome could be a new starting point to study the causes and treatments of OAB.

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.

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: In the current COVID-19 pandemic, there is a rising need for a rapid and reliable diagnostic tool. We hypothesized that chest computed tomography (CT) can be a potential alternative for reverse transcription-polymerase chain reaction (RT-PCR). The aim of this study was to compare the diagnostic value of chest CT and RT-PCR in Iranian patients with suspected COVID-19. Methods: In a retrospective, single-center case series, 568 consecutive hospitalized or outpatient patients with suspected COVID-19 underwent chest CT and/or RT-PCR testing at Imam Reza Hospital, the tertiary teaching hospital of Tabriz University of Medical Sciences in Iran, from February 21 and March 28, 2020. Results: The sensitivity of chest CT for signifying COVID-19 was 64% (95% CI: 56%–71%) on the basis of positive RT-PCR results as a standard method. CT imaging also had a specificity of 77% (95% CI: 73%–81%), positive predictive value of 35% (95% CI: 0.31–0.39), negative predictive value of 66% (95% CI: 0.61–0.69), positive likelihood ratio of 2.79 (95% CI: 2.26–3.46), and negative likelihood ratio of 0.47 (95% CI: 0.38–0.57). Conclusion: Chest CT had higher specificity than RT-PCR in the diagnosis of COVID-19, . Therefore, it can play a crucial role in the early diagnosis. Similar to the previous studies, the typical CT features were patchy ground-glass opacities as well as peripheral aspects of the lungs consolidations.

Abstract 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

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

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

Abstract Background Considering the low frequency of dairy intake in the population, interventions aiming to increase its consumption can be a priority for any health system. Objective This study aims to summarize community-based interventions for improving dairy consumption and their effectiveness to help policy-makers in designing coherent public health strategies. Methods This study was conducted in 2019, using PubMed/MEDLINE, Scopus, EMBASE, Cochrane Library, Web of Science, ProQuest, and Google Scholar. Two independent reviewers selected the eligible studies, and the outcomes of interest were extracted. The quality of eligible studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for randomized controlled trials and quasi-experimental studies. Results Out of 521 initially identified articles, 25 studies were included. Interventions reported in 19 studies were effective in increasing dairy consumption. Interventions in high-income countries were more effective than those in middle- and low-income countries. Interventions in health centers and supermarkets were more effective than the community and school-level interventions. Interventions in supermarkets and adolescents as target groups were more effective than children, middle-aged people, and the elderly. Also, educational interventions and changing buying/selling pattern were more effective than multiple interventions. Interventions longer than 24 and 48 weeks were more effective than shorter interventions. Conclusion Three policy options including educational interventions, multiple interventions, and changing the purchase pattern are suggested. It seems that applying all of the interventions together can be more effective. Also, long-term and well-designed future studies in different settings are recommended to confirm these results.

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 meta-analysis 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.

Abstract 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: 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: 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: Hepatitis C virus (HCV) is a blood-borne virus. It is a major global public health problem and can cause both acute and chronic hepatitis. The aim of this study was to report the epidemiological features of HCV infection and risk factors based on the data from Azar Cohort, East Azerbaijan province, Iran. Methods: The population of this study comprised the people in the age range of 35-70 years from Azar Cohort, East Azerbaijan province, Iran. The study was conducted 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 collected in this study were analyzed to detect the presence of antibodies against HCV using enzyme immunoassay (ELISA) Kit. The positive samples were re-tested by qualitative HCV-RNA polymerase chain reaction. All data were analyzed using SPSS version 19.0 software. Results: The mean age of the participants was 49.15±9.02 years. Of these participants, 54.3% (n=2686) were females. Seven people (0.14%) were detected as HCV positive and the highest frequency was seen in the age range of 40-50 (0.16%). There was a statistical significant relationship between history of hospitalization (P=0.02) and history of abnormal urine (P=0.01) with the frequency of HCV infection. Conclusion: The findings of this study indicated that the frequency of hepatitis C virus infection is 0.14% in the general population of Azar Cohort.

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 post- ERCP pancreatitis, pancreatic pain, and hyperamylasemia.

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.

Abstract 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.

Aims: This study aims to determine the relationship between fear of disease consequences and its relationship with quality of life, symptoms of depression, and anxiety in patients with multiple sclerosis (MS). Materials and Methods: This cross-sectional study was conducted at Tabriz University of Medical Sciences. Seventy patients suffering from MS were selected using the convinced sampling method. Data collection tools were included: Fear of Progression Questionnaire-Short Form, World Health Organizations Quality of Life-Brief, Beck Depression Inventory, and Beck Anxiety Inventory. Descriptive statistical methods, independent sample t-test, one-way ANOVA, Spearman's correlation coefficient test, and linear regression model were used to analyze data by SPSS.22 software. Results: In this study, 38 (54.3%) of patients were male. Mean score of fear of the disease, quality of life, depression, and anxiety was 28.68 ± 9.18, 86.47 ± 14.11, 15.22 ± 4.86, and 15.85 ± 5.55, respectively. Results of Spearman's test indicated a significant relationship between fear of disease consequences on the one hand and quality of life (rs= −0.53), symptoms of depression (rs= −0.52), and anxiety (rs= −0.48) on the other hand (P < 0.001). Results of linear regression analysis demonstrated that there is a strength correlation between depression – as the predictive variable – and quality of life (P = 0.018, standard error [SE] = 0.793, β = −0.283 R2 = 0.57), and anxiety – as the predictive variable – and quality of life (P = 0.005, SE = 0.681, β = 0.332 R2 = 0.64). Conclusion: Considering negative effects of fear of the disease consequences on quality of life, symptoms of depression and anxiety, the patients should be informed about their own conditions, and appropriate mental and health cares should be provided, and effective interventions should be done to alleviate the fear of the patients.

Objective: To investigate the effect of cognitive behavioral therapy on anxiety and depression in infertile women. Methods: This study was performed in 2019 by searching Google Scholar, Scopus, PubMed/ MEDLINE, Cochrane library, EMBASE, Proquest, ISI Web of Science, MagIran, SID and IranMedex. Eligible studies were selected by two reviewers and outcomes of interest were extracted. The meta-analysis was performed using the random effect models. I - square statistic test was used for heterogeneity analysis. Presence of publication bias was also checked. Results: Eleven studies were included in this review. Between-group differences (cognitive behavioral therapy and control groups) in risk ratio for infertile women's depression was d=-1.36; 95% CI=-1.81, -0.90; P

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 non-Islamic 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.