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Background: Depression is a leading public health problem globally. Inflammatory mechanisms are thought to have a role in the pathophysiology of the disease., Methods: Cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) 2017-2018 were analyzed. The study design was cross-sectional. The main variables of the study were Depression and NPAR. Covariates of the study were age, sex, race, educational level, marital status, body mass index (BMI), and alcohol intake, as well as hypertension, coronary artery disease, cancer or malignancy, and diabetes., Results: Finally, 302 participants with Depression and 3731 without Depression were included in the analysis. Multiple logistic regression analysis using backward elimination showed that participants in the fourth quartile for NPAR are at greater risk for Depression compared with participants in the first quartile (OR: 1.55, 95 % CI: 1.08-2.22). Areas under the receiver operating curve (AUROC) of the NPAR to classify depression were 57.6 % (95 % CI: 53.3-61.9), 60.4 % (95 % CI: 53.2-67.6), 61.5 % (95 % CI: 55.2-67.7), and 70.0 % (95 % CI: 52.4-87.6) in the general population, males, participants hypertension and diabetes, respectively., Conclusion: In conclusion, these results suggested that NPAR is associated with depression and could serve as a fair biomarker in subpopulations including males, and patients with diabetes and hypertension. It is suggested to use NPAR in combination with other associated factors with depression to classify or screen the subjects regarding depression in the general population. Also, present findings could be used to further elucidate the underlying pathophysiology of the disease., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2025. Published by Elsevier B.V.)

Purpose: The purpose of this study was to assess the efficacy of arthroscopic intervention on the treatment of pigmented villonodular synovitis (PVNS) patients, with a focus on the potential advantages of this approach in lowering the risk of disease recurrence., Methods: We performed a systematic review and meta-analysis following the PRISMA 2020 protocol. Our search encompassed five databases, namely PubMed, Embase, Scopus, Web of Science and Cochrane Library. Statistical analysis was conducted on the extracted data by using the R ver. 4.4.0 software. This study included English-language observational studies (case series and cohort studies) published up to 31 March 2024, focusing on in vivo human subjects with at least 2 years of follow-up. Studies with less than 2 years of follow-up, non-arthroscopic treatment methods or addressing PVNS in structures other than the knee were excluded., Results: We identified 24 articles, comprising 7 case series and 17 cohort studies, based on title, abstract, and quality assessments. Approximately 16% (95% confidence interval [CI]: 10.4%-24.75%) of knees that underwent arthroscopic surgery were found to be at risk of recurrence. In line with our expectations, sub-group analysis comparing recurrence rates among different subtypes of PVNS found that the diffuse subtype exhibited a higher recurrence rate of 19.4% (95% CI: 10.01%-34.15%), compared to the local subtype, which had a recurrence rate of 9.5% (95% CI: 4.47%-19.01%). Based on the meta-regression analysis, no significant association was found between the recurrence rate and the publication year or patient mean age. However, there was a noticeable rise in the recurrence rate with a longer follow-up period, indicating a probable correlation between extended follow-up and increased recurrence rates., Conclusion: Our findings suggest that arthroscopic surgery for PVNS, particularly for the diffuse subtype, results in a higher recurrence rate compared to the localized subtype. However, the inherent challenges in achieving complete resection through arthroscopy, particularly in cases with extensive disease involvement, may contribute to the observed recurrence rates., Level of Evidence: Level III systematic review and meta-analysis., Competing Interests: The authors declare no conflicts of interest., (© 2025 The Author(s). Journal of Experimental Orthopaedics published by John Wiley & Sons Ltd on behalf of European Society of Sports Traumatology, Knee Surgery and Arthroscopy.)

Left ventricular remodeling (LVR) refers to the changes in the size, shape, and function of the left ventricle, influenced by mechanical, neurohormonal, and genetic factors. These changes are directly linked to an increased risk of major adverse cardiac events (MACEs). Various parameters are used to assess cardiac geometry across different imaging modalities, with echocardiography being the most commonly employed technique for measuring left ventricular (LV) geometry. However, many echocardiographic evaluations of geometric changes primarily rely on two-dimensional (2D) methods, which overlook the true three-dimensional (3D) characteristics of the LV. While cardiac magnetic resonance (CMR) imaging is considered the gold standard for assessing LV volume, it has limitations, including accessibility issues, challenges in patients with cardiac devices, and longer examination times compared to standard echocardiography. In nuclear medicine, LV geometry can be analyzed using the shape index (SI) and eccentricity index (EI), which measure the sphericity and elongation of the left ventricle. Myocardial perfusion imaging (MPI) using SPECT or PET is inherently a 3D technique, making it particularly effective for accurately and consistently assessing LV size and shape parameters. In this context, LV metrics such as EI and SI can significantly enhance the range of quantitative assessments available through nuclear cardiology techniques, with particular value in identifying early LV remodeling in specific patient groups. This article explores the diagnostic significance of left ventricular geometric indices through various diagnostic methods, highlighting the important role of nuclear cardiology., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Background: While many COVID-19-induced anosmia patients recover their sense of smell within a few months, a substantial number of them continue to experience olfactory impairment. In our primary study, the metabolic patterns in orbitofrontal cortex (OFC) were observed to exhibit more alterations than other regions. Hence, this study specifically probes into alterations within OFC region in subjects with persistent COVID-19-induced anosmia., Methods: In a new categorization, 54 subjects were studied as two major groups of COVID-19-related anosmia and normal each of which includes 27 subjects. Iran Recognition-Smell Identification Test (IR-SIT) over a three-month follow-up period was utilized for olfactory function assessment and anosmia diagnosis. Proton Magnetic Resonance Spectroscopy ( 1 H-MRS) was employed to examine changes of metabolites in OFC, including N-acetyl aspartate (NAA), choline (Cho), and creatine (Cr), as well as their ratios. Additionally, a linear regression was applied to investigate the potential correlation between MRS data and IR-SIT scores., Results: Patients with COVID-19-induced anosmia exhibited a significant reduction in NAA, Cho, and Cr levels in the OFC region compared to the control group. Moreover, NAA/Cho and NAA/Cr ratios were lower in the anosmia patients, whereas the Cho/Cr ratio elevated. The NAA/Cho ratio had the highest linear correlation with IR-SIT scores in anosmia., Conclusion: This study highlights remarkable neurochemical patterns associated with COVID-19-induced anosmia in brain orbitofrontal cortex detectable by proton MRS, shedding light on the link between OFC function impairment and anosmia. The NAA/Cho ratio derived from MRS data emerged as a potential biomarker that correlates with anosmia severity and recovery examination., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025. Published by Elsevier Inc.)

Background: Chronic Kidney Disease (CKD) is a known risk factor for End-Stage Renal Disease (ESRD) and Cardiovascular Diseases (CVD). Renal Doppler Ultrasound (RDU) can detect early renal involvement in CKD using the Renal Resistive Index (RRI)., Aims: This study aimed to investigate the effects of risk factors and clinical complications associated with CKD on RRI among patients with different stages of CKD., Methods: In this analytical cross-sectional study, 186 patients referred to Poursina Hospital for RDU were categorized into six groups (normal and five stages of CKD). We analyzed the impact of demographic factors and clinical complications on RRI across all groups., Results: Our findings indicated that CKD prevalence was particularly high among older patients and those with CVD, type 2 diabetes mellitus (DM), and hypertension (HTN). Elevated RRI in CKD patients was significantly associated with age, CKD stage, CVD, and HTN (p < 0.05). Furthermore, RRI was higher in CKD patients with elevated serum phosphorus (P) levels, higher low-density lipoproteins (LDL), and lower calcium (Ca) and hemoglobin (Hb) levels. Based on a multivariate regression model, CVD, lower Ca, high LDL, and proteinuria were identified as independent predictors of elevated RRI (p < 0.05)., Conclusion: This study concludes that elevated RRI is associated with the severity of CKD and its clinical complications, suggesting that RRI can serve as a reliable indicator for assessing CKD patients, managing treatment, and preventing early death complications., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Introduction: Guillain-Barré syndrome (GBS) is an inflammatory disorder of the peripheral nervous system, causing acute flaccid paralysis. There have been occasional reports linking Hepatitis A virus (HAV) to GBS. Here we aimed to evaluate the current literature on the association between GBS and HAV, exploring potential mechanisms and clinical implications., Methods: We conducted a systematic search using PRISMA guidelines in PubMed, Web of Science, Embase, and Scopus. Only published case reports or conference abstracts presenting cases of confirmed HAV infection and GBS were included. Data extraction was performed independently by two reviewers, and quality assessment was conducted using the Joanna Briggs Institute critical appraisal tool., Results: Out of 581 studies identified, 46 studies encompassing 47 cases met the inclusion criteria. The mean age of patients was 29.47 years, with a male predominance (70.2 %). Geographically, most cases were reported in Asia (74.5 %). Clinical manifestations of HAV included fever, malaise, and jaundice, while GBS presented with muscle weakness and areflexia. Laboratory findings showed albuminocytological dissociation in 76.2 % of cases. Nerve conduction studies predominantly indicated AIDP subtype (32/46, 69.6 %). Treatment involved IVIG, plasmapheresis, and supportive care, with recovery times ranging from one week to 18 months. One fatality was reported., Conclusions: This review suggests a potential link between HAV infection and GBS, proposing a mechanism: molecular mimicry. It emphasizes the need for increased awareness and preventive measures, especially in areas with lower health standards. However, further research is needed to clarify the possible mechanisms and deepen our understanding., Competing Interests: The authors declare that they have no conflict of interest., (© 2025 The Authors.)

Placenta percreta, a rare variant of placenta accreta spectrum (PAS) disorders, poses a significant risk of life-threatening hemorrhage associated with the adherent placenta. Bladder involvement signifies an even rarer incidence and may sometimes present solely with gross hematuria. Therefore, it is imperative to consider both microscopic and gross hematuria during pregnancy as alarming signs. Among 342 cases of PAS admitted to our hospital between 2016 and 2023, 48 patients were diagnosed with placenta percreta. Two patients, one at 18 weeks and the other at 25 weeks of pregnancy, were referred to our tertiary care center due to severe gross hematuria. Following thorough preoperative evaluation, both pregnancies were terminated due to their unstable conditions. The first case underwent an elective supracervical cesarean hysterectomy at the 19th week of gestation, while the second case underwent an emergency total cesarean hysterectomy due to lack of response to blood transfusions. Both procedures included bilateral internal iliac artery ligation. Postoperatively, patients recovered without any complications; however, the fetuses did not survive. Placenta percreta, protruding into the bladder, can lead to severe hematuria at any stage of pregnancy, increasing the risk of life-threatening hemorrhage. Therefore, both microscopic and macroscopic hematuria during pregnancy should be considered alarming signs that require immediate attention. Early involvement of a urologist and a multidisciplinary medical team is also essential in suspected or confirmed cases of placenta percreta, as immediate surgical intervention may be necessary to ensure patient safety., (© 2024 Japan Society of Obstetrics and Gynecology.)

Introduction: This study aimed to compare the effects of high-intensity laser therapy (HILT) and low-level laser therapy (LLLT) on the disability and architecture of the quadriceps in patients with knee osteoarthritis (OA). Methods: Ninety-eight patients with knee OA (KOA) were selected by convenience sampling and then divided into three groups: control, LLLT and HILT. Disability was determined using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Quadriceps structures including thickness, fascicle length and pennate angle of the vastus lateralis (VL) and thickness, volume and fiber angle of vastus medialis obliquus (VMO) muscles were assessed using ultrasonography. All evaluations were performed before interventions, immediately after interventions, and one month later. Between-group data were analyzed with two-way ANOVA and paired-samples t-test. Results: The within-group comparisons of WOMAC scores before, after and at a one-month follow-up showed significant differences between the groups ( P <0.001). The VMO thickness revealed significant increases after the treatment in both HILT ( P <0.001) and LLLT ( P =00.03) groups. The between-group comparison revealed a significantly lower score of WOMAC in the HILT group compared to the other groups after a one-month follow-up ( P =00.03). VMO thickness showed a significant increase in the HILT group after the treatment ( P =0.002). The VL structures and VMO fiber angle and volume did not exhibit significant changes in within-group and between-group comparisons ( P >00.05). Conclusion: Both HILT and LLLT may improve functional ability and VMO thickness in patients with knee osteoarthritis. After a one-month follow-up, functional ability was greater in the HILT group., Competing Interests: The authors declare no conflict of interest., (Copyright © 2024 J Lasers Med Sci.)

Background: Papillary thyroid carcinoma (PTC) is the predominant form of thyroid cancer, and the presence of extrathyroidal extension (ETE) significantly impacts treatment decisions and prognosis. Accurate preoperative detection of ETE remains challenging, highlighting the need to evaluate advanced imaging techniques.This systematic review and meta-analysis aimed to investigate the diagnostic accuracy of magnetic resonance imaging (MRI) in detecting extrathyroidal extension (ETE) among patients diagnosed with papillary thyroid carcinoma (PTC)., Method: We conducted a comprehensive search of global databases including PubMed, Web of Science, EMBASE, and the Cochrane Library, spanning from inception to November 03, 2024. We included studies that utilized preoperative MRI to evaluate the presence of ETE. Quality assessment was carried out using the Joanna Briggs Institute (JBI) standard checklists. Data analysis was performed using Comprehensive Meta-Analysis (CMA) software version 3. The study protocol was registered in PROSPERO (CRD42024499536)., Result: Six studies were included in our final quantitative analysis. The included studies were classified into two groups; the first group focused on evaluating the accuracy of MRI in detecting ETE, while the second group assessed the apparent diffusion coefficient (ADC). The accuracy of MRI for overall ETE, minimal ETE (mETE), and gross ETE (gETE) was 81.0% (95% CI: 76.9%-85.6%), 72.9% (95% CI: 66.2%-78.6%), and 83.3% (95% CI: 75.2%-89.1%), respectively. MRI demonstrated a statistically significant difference in detecting gETE compared to mETE (OR = 1.85, 95% CI: 1.01-3.37, P-value = 0.045). Our analysis showed that the ADC of the lesion for b-value 500 is lower in patients with ETE compared to those without ETE (SMD = 0.95, 95% CI: 0.28-1.62, P-value = 0.005)., Conclusion: Our findings demonstrate that MRI has substantial accuracy in detecting ETE in PTC, especially for gross ETE. This suggests MRI could be a valuable tool in preoperative planning, helping to guide surgical decision-making by more precisely identifying patients at higher risk. However, the limited number of studies underscores the need for further research to confirm MRI's role in routine clinical practice and to refine imaging protocols for more accurate differentiation between minimal and gross ETE., Competing Interests: Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Radiofrequency ablation (RFA) is a minimally invasive outpatient procedure that has recently emerged as a treatment option for autonomous functioning thyroid nodules (AFTNs), offering a less invasive alternative to surgery. The objective of this systematic review and meta-analysis is to evaluate the efficacy of RFA for AFTNs., Method: Global databases of PubMed, Scopus, Embase, Web of Science, and Cochrane Library were systematically searched from 1990 until January 5, 2024, for studies on AFTNs undergoing RFA that presented volume reduction ratio (VRR) for at least one of 1, 3, 6 or 12 months post-operative follow-up with the results presented as means. The primary outcomes were VRR and TSH normalization rate, and the secondary outcomes were the cosmetic score, symptom score, and post-procedure complications. Heterogeneity was assessed by Cochrane and I 2 statistics, and a random-effects model was used for meta-analysis. The study protocol was registered on PROSPERO (CRD42024499932)., Results: A total of 10 eligible studies with a total sample size of 254 were included. The pooled VRR after 1, 3, 6, and 12 months of follow-up post-treatment with RFA was 46.6% (95% CI: 40.3-52.9%), 62% (95% CI: 57.6-66.4%), 67.4% (95% CI:62.3-72.6%), and 77.2% (95% CI: 79.2-81.5%), respectively. The overall rate of TSH normalization was 76.4% (95% CI: 58.1-88.4%). Based on included studies the overall rate of subclinical hypothyroidism as one of the most important side effects of this method was 4% (95% CI: 1.9%-8.1%)., Conclusion: RFA emerges as a promising non-surgical treatment for AFTNs, showing high rates of TSH normalization, tumor size reduction, and improved cosmetic and symptom scores. However, further research is needed to compare RFA with surgical methods and assess long-term outcomes., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.)

Background: The Stroke Self-Efficacy Questionnaire (SSEQ) is a self-report scale that measures stroke survivors' self-efficacy and covers specific domains of functioning after stroke., Objectives: We aimed to determine the validity and reliability of the Persian version of the SSEQ., Methods: This descriptive cross-sectional study included 124 stroke patients in the sub-acute phase (between 2 weeks and 3 months of stroke onset). The original SSEQ was translated to Persian and back-translated to English. Demographic, neurologic examination, 'Persian Stroke Self-Efficacy Questionnaire (SSEQ-P)', and 'General Self-Efficacy Scale' (GSE-10) data were collected. The reliability of the questionnaire was evaluated by test-retest assessment among 30 people with stroke at an interval of two weeks. Factor analysis was used to assess the validity of SSEQ-P. Cronbach's alpha assessed internal consistency in all participants. Statistical analysis was performed by SPSS software version 23 and SmartPLS version 3., Results: In this study, the mean of SSEQ scores was 87.99 ± 37.09. Content Validity Ratio (CVR) and Content Validity Index (CVI) were favorable. Convergent validity of the questionnaire was reported ( r  = 0.669) using GSE. Factor loadings of items in SSEQ ranged from 0.41 to 0.92. Validity indices (AVE = 0.75, SRMR = 0.07) showed that the single-factor model of the present study owns a favorable fit. Test-retest reliability and Cronbach's alpha values of SSEQ in the present study were calculated at 0.80 and 0.97, respectively., Conclusions: The Persian version of the SSEQ depicted acceptable reliability and validity and can be utilized to evaluate the self-efficacy of patients with stroke.HIGHLIGHTSStroke Self-Efficacy Questionnaire (SSEQ) is a self-report scale that measures stroke survivors' self-efficacy.The Persian version of the SSEQ demonstrated acceptable reliability and validity and can be used in stroke patients.

Background: Glioblastoma multiforme (GBM) poses a significant health challenge as the most common primary malignancy of the adult central nervous system. Gender- and age-related differences in GBM influence prognosis and treatment complexities. This multicenter retrospective study explores gender and age disparities in GBM patients, investigating their impact on occurrence and survival outcomes., Methods: This multicenter retrospective study involved GBM patients treated in Guilan Province, Iran. Patients' data, including age, gender, tumor location, and histopathological diagnosis date, was collected from medical records., Results: In a cohort of 164 GBM patients, the average age was 54.34 ± 14.16 years, with a higher prevalence among men (59.8%) and patients aged ≤ 60 years (64.6%). The tumor sites exhibited overlapping features in 68% of cases, with the frontal and temporal lobes being the most common specific locations. The mean survival was 12.88 ± 14.14 months, one-year survival of 45%, with women showing significantly higher one-year survival (60% vs. 40%) and longer mean survival (16.14 ± 17.35 vs. 10.75 ± 11.15 months). Furthermore, Patients ≤ 60 years had significantly higher one-year survival (75% vs. 35%). In subgroup analysis, women had significantly higher survival rates in patients ≤ 60 years. However, among patients over 60, women exhibited a more pronounced decline in survival rates, with no statistically significant difference between men and women in this age group., Conclusion: This study highlights that both age and gender significantly affect GBM survival outcomes. Younger patients, particularly women, exhibited better survival rates, while older patients, especially women, showed poorer outcomes. These findings suggest the need to stratify treatment approaches by both age and gender to optimize care and improve survival in GBM patients. Further research is recommended to explore these associations., (© 2024 The Author(s). Cancer Reports published by Wiley Periodicals LLC.)

Introduction: Ectopic pancreatic tissue (EPT), also known as Heterotopic pancreas (HP), is a rare congenital anomaly characterized by the presence of pancreatic tissue outside the primary organ. This report presents a case of EPT incidentally discovered in the submucosal area of the small intestine., Case Presentation: A 56-year-old male presented to the emergency department following a high-speed car collision, reporting abdominal pain after impact with the steering wheel. Physical examination revealed left upper quadrant tenderness. Imaging studies showed free fluid in the abdominal and pelvic cavities, mesenteric damage, and increased intestinal wall thickness. Surgical exploration confirmed hemoperitoneum and a non-viable 30 cm segment of the small intestine, which was resected. Subsequent pathological examination revealed a 1.5 cm submucosal mass, diagnosed as EPT. The patient recovered uneventfully and was discharged in stable condition., Clinical Discussion: Clinically significant lesions are typically larger than 1.5 cm and involve the mucosa, with pain as the most common symptom. They can also cause severe complications such as intestinal obstruction, perforation, peritonitis, and gastrointestinal bleeding. Additionally, EPT can be associated with malignant transformations., Conclusion: While often asymptomatic, EPT can lead to significant complications, making surgical resection essential for both symptomatic and incidental cases, particularly since diagnosis is frequently established postoperatively through histological examination. Although trauma may not directly cause EPT, its management in emergency settings can facilitate evaluations that reveal lesions capable of causing severe complications if left undiagnosed. Given the diverse symptoms associated with this condition, EPT should be considered in the differential diagnosis of intestinal lesions., Competing Interests: Declaration of competing interest There are no conflicts of interest., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: Vaccination is considered as one of the most promising strategies to overcome the COVID-19 pandemic. However, it could be associated with rare but serious complications. In the present study, we aimed to review the clinical course and etiology of post COVID-19 vaccination meningitis., Methods: After a systematic search in PubMed, Scopus, and Web of Sciences online databases as well as Google Scholar, documents were screened and qualified. Then data extraction was performed and the most frequent underlying agent of meningitis was found based on the reported cases., Results: Overall, 35 cases of post COVID-19 vaccination meningitis from 33 articles were included in the review. Among them, 12 cases had proven viral diagnosis and 23 of them were reported to be vaccine-induced. The most frequent viral pathogen among the cases was VZV. The most prevalent symptom was headache, and the most common time of appearance symptoms was one week after vaccination., Conclusion: Overall, our study suggested meningitis as a critical but not devastating complication of COVID-19 vaccination. Almost all patients responded well to common agents used to manage viral or vaccine-induced meningitis. It is recommended to monitor patients with a history of chickenpox after COVID-19 vaccination regarding the development of meningitis., (© 2024. The Author(s).)

Introduction: Headache is an illness with high prevalence and adverse effects on quality of life. As oral or dental problems such as pain can trigger or aggravate it, we aimed to investigate and compare oral and dental health status in patients affected with chronic headaches and healthy individuals., Methods: The present case-control study included 60 patients with chronic headaches (case) and 60 healthy individuals (control) in Rasht, Iran. The demographic characteristics and clinical examinations, including decayed/missing/filled teeth (DMF-T) and community periodontal index of treatment needs (CPITN) indices, as well as bruxism, frequency of tooth brushing and flossing, and maxillary and mandibular tooth wear were recorded in a checklist. Data analysis was performed using the IBM SPSS version 28 at a significance level of 0.05., Results: The case group consisted of 25 men (41.7%) and 35 women (58.3%) with an average age of 32.55 ± 6.62 years, while the control group had 27 men (45%) and 33 women (55%) with an average age of 30.95 ± 6.33 years. The study groups were not significantly different in bruxism, frequency of tooth brushing and flossing, DMFT, CPTIN, and maxillary and mandibular tooth wear., Conclusion: It seems that chronic headaches do not significantly affect the oral and dental health of the sufferers. Moreover, it appears that these patients are well aware of the role of oral and dental hygiene in triggering or aggravating the episodes of headaches., (© 2024. The Author(s).)

Background: Nonalcoholic fatty liver disease (NAFLD) is a global health challenge, with a rising rate in line with other metabolic diseases. We aimed to assess the global prevalence of NAFLD in adult and pediatric populations., Methods: PubMed, Scopus and Web of Science databases were systematically searched up to May 2023. Heterogeneity was assessed using Cochran's Q test and I 2 statistics, and random-effects model was used for meta-analysis. Analyses were performed using STATA version 18., Results: A total of 479 studies with 78,001,755 participants from 38 countries were finally included. The global prevalence of NAFLD was estimated to be 30.2% (95% CI: 28.7-31.7%). Regionally, the prevalence of NAFLD was as follows: Asia 30.9% (95% CI: 29.2-32.6%), Australia 16.1% (95% CI: 9.0-24.8%), Europe 30.2% (95% CI: 25.6-35.0%), North America 29% (95% CI: 25.8-32.3%), and South America 34% (95% CI: 16.9-53.5%). Countries with a higher human development index (HDI) had significantly lower prevalence of NAFLD (coefficient = -0.523, p = 0.005). Globally, the prevalence of NAFLD in men and women was 36.6% (95% CI: 34.7-38.4%) and 25.5% (95% CI: 23.9-27.1%), respectively. The prevalence of NAFLD in adults, adults with obesity, children, and children with obesity was 30.2% (95% CI: 28.8-31.7%), 57.5% (95% CI: 43.6-70.9%), 14.3% (95% CI: 10.3-18.8%), and 38.0% (95% CI: 31.5-44.7%), respectively., Conclusion: The prevalence of NAFLD is remarkably high, particularly in countries with lower HDI. This substantial prevalence in both adults and children underscores the need for disease management protocols to reduce the burden., (Copyright © 2024 Instituto Mexicano del Seguro Social (IMSS). Published by Elsevier Inc. All rights reserved.)

This systematic review aimed to summarize the evidence regarding death anxiety (DA) and related factors among nurses. Scopus, PubMed, Web of Science, Iranmedex, and Scientific Information Database (SID) databases were extensively searched using purpose-related keywords from the earliest to October 5, 2021. A total of 6819 nurses were included in 31 studies. The DA of nurses based on the Templer's Death Anxiety Scale was moderate. Factors such as personal anxiety, frequency and severity of job stress, burnout, dying patient avoidance behavior, euthanasia, sex, mental health status, social desirability, attitude toward the elderly, humor, social maturity, psychological hardiness, quality of life, lack of social activity, self-efficacy, coping with death, and life satisfaction were associated with nurses' DA. Therefore, nursing policymakers can promote nurses' health to improve the quality of nursing care by considering these related factors., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Patients with locked-in syndrome (LIS) and complete locked-in syndrome (CLIS) own a fully functional brain restricted within a non-functional body. In order to help LIS patients stay connected with their surroundings, brain-computer interfaces (BCIs) and related technologies have emerged. BCIs translate brain activity into actions that can be performed by external devices enabling LIS patients to communicate, leading to an increase in their quality of life. The past decade has seen the rapid development of BCIs that have the potential to be used for patients with locked-in syndrome, from which a great deal is tested only on healthy subjects and not on actual patients. This study aims to (1) provide the readers with a comprehensive study that contributes to this growing area of research by exploring the performance of BCIs tested specifically on LIS and CLIS patients, (2) give an overview of different modalities and paradigms used in different stages of the locked-in syndrome, and (3) discuss the contributions and limitations of BCIs introduced for the LIS and CLIS patients in the state-of-the-art and lay a groundwork for researchers interested in this field., Competing Interests: Competing interestsThe authors declare that they have no competing interests., (© The Author(s), under exclusive licence to Springer Nature B.V. 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Background: A significant number of referrals to the emergency departments is due to violence and conflict leading to serious injuries and death. The increasing number of such cases highlights the urgent need for investigating victimization of physical violence., Aim: The purpose of this study was to determine the frequency of demographic and clinical characteristics in victims of violence and classify them based on penetrating or blunt trauma., Methods: The data of the patients who had been the victims of violence in 2020 were extracted from the Trauma Registry System(TRS) of the Guilan Road Trauma Research Center(GTRC). All analyses were performed using SPSS software version 24. The significance level was considered less than 0.05., Results: There was a significant difference in the type of violence-related trauma in different age groups (P < 0.001), based on sex (P = 0.002), and marital status (P = 0.012). A significant difference also existed between the trauma type and clinical variables including smoking (P = 0.032), history of alcohol drinking (P = 0.005), and other substance use (P = 0.002), the anatomical location of injury (P < 0.001) and therapeutic interventions (p < 0.001(., Conclusion: Most of the clients of the violence suffered from blunt trauma, the severity of which was mild, and they were treated supportively without the need for surgery. Blunt trauma was seen more in women, divorcees, over 40 years and non-smokers. Penetrating trauma was observed more in lower limb injuries and alcohol and amphetamine users. Prevention programs and educational interventions should be programmed for the society long before men alcohol and amphetamine abusers reach their fourth decade of life. Accurately recording the type of physical violence, and the weapon used, and determining the injury severity score in TRS can lead to more reliable results in researching the field of violence issues., (© 2024. The Author(s).)

Background: Long noncoding RNAs (lncRNAs) have become a hot topic in the human nervous system. Moreover, circulating lncRNAs have been suggested as possible biomarkers for central nervous system processes and neurodegenerative diseases. The present research aimed to highlight the role of plasma lncRNAs TUG1, FEZF1-AS1, and EZH2 gene as diagnostic biomarkers in Alzheimer's disease (AD)., Methods: Plasma samples for the study were provided by 100 AD patients and 100 matched controls. Real-time quantitative reverse transcriptase PCR was used to determine the plasma level of the aforementioned lncRNAs. Furthermore, the plasma level of EZH2 protein in the participants' blood was determined using the ELISA technique., Results: In contrast to controls, down-regulation of the EZH2 gene and protein was reported in the plasma of patients with AD. Additionally, plasma samples from AD patients showed up-and-down-regulation of the lncRNAs TUG1 and FEZF1-AS1, respectively., Conclusion: Our new findings suggest that the EZH2 gene, plasma lncRNA TUG1, and FEZF1-AS1 may contribute, as valuable biomarkers, to AD diagnosis., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

Key Clinical Message: Giant chorioangiomas, despite being rare, pose significant fetal and maternal risks. Timely and individualized treatment plans are crucial to reduce morbidity and mortality when fetal compromise occurs. Additionally, successful conservative management relies on consistent ultrasound monitoring, Doppler flowmetry assessments, and amniotic fluid level measurements., Abstract: Chorioangiomas are benign placental tumors that manifest in approximately 1% of pregnancies. Giant chorioangiomas, characterized by tumors exceeding 4 cm, are exceptionally rare and pose substantial risks to maternal and fetal health. This case report details a patient with multiple giant chorioangiomas, emphasizing the rarity and consequential complications associated with these tumors. A 23-year-old woman, G3P2, at 28 weeks gestational age, was diagnosed with multiple large, well-defined placental masses with increased vascularity, indicative of giant placental chorioangiomas. Subsequent ultrasound revealed various fetal anomalies such as cleft palate and lip, as well as lung and heart abnormalities. At 34 +5  weeks of gestation, an emergency cesarean section was performed due to preeclampsia. Subsequently, a female neonate was born with hydrops fetalis. Unfortunately, she passed away within the first hour of her life. Complications associated with chorioangiomas primarily arise from arteriovenous shunts, which potentially lead to compromised fetal perfusion and cardiac failure. Although small-sized chorioangiomas are often discovered incidentally, Doppler ultrasound and magnetic resonance imaging can reliably distinguish these tumors from other placental lesions. Additionally, management strategies tailored to gestational age and maternal-fetal symptoms typically necessitate a multidisciplinary approach. However, additional research is essential to understand the mechanisms of chorioangiomas and to develop comprehensive management guidelines., Competing Interests: The authors declare that they have no competing interests., (© 2024 The Author(s). Clinical Case Reports published by John Wiley & Sons Ltd.)

Background: Wilms tumor (WT), also known as nephroblastoma, is rare in adults, accounting for merely 3% of all nephroblastomas or 0.2 cases per million individuals. Extrarenal Wilms tumor (ERWT) emerges outside the renal boundaries and comprises 0.5 to 1% of all WT cases, with even rarer incidences in adults. Oncogenic mutations associated with ectopic nephrogenic rests (NR) may contribute to ERWT development. Diagnosis involves surgical resection and pathology examination. Due to scarce cases, adults often rely on pediatric guidelines. We thoroughly searched PubMed, Scopus, and Web of Science databases to establish our case's uniqueness. To the best of our knowledge, this is the first documented incidence of extrarenal Wilms tumor within the spinal canal in the adult population., Case Presentation: A 22-year-old woman with a history of congenital lipo-myelomeningocele surgery as an infant presented with a 6-month history of back pain. This pain gradually resulted in limb weakness, paraparesis, and loss of bladder and bowel control. An MRI showed a 6 × 5 × 3 cm spinal canal mass at the L4-S1 level. Consequently, a laminectomy was performed at the L4-L5 level to remove the intramedullary tumor. Post-surgery histopathology and immunohistochemistry confirmed the tumor as ERWT with favorable histology without any teratomatous component., Conclusion: This report underscores the rarity of extrarenal Wilms tumor (ERWT) in adults, challenging conventional assumptions about its typical age of occurrence. It emphasizes the importance of clinical awareness regarding such uncommon cases. Moreover, the co-occurrence of spinal ERWTs and a history of spinal anomalies warrants further investigation., (© 2024. The Author(s).)

Background and Aims: Diabetic foot ulcers (DFU) are a severe complication in diabetes patients, often resulting in significant morbidity and mortality due to non-healing. This study investigated the effectiveness of 5% topical potassium permanganate on these ulcers., Methods: A clinical trial was conducted on 23 patients with Wagner grade I and II DFU. Patients in the control group received standard treatment, while those in the intervention group also received 5% potassium permanganate topically. Data were recorded at 0, 7, 14, and 21 days for analysis., Results: Among 23 patients studied, 7 (30.4%) were male and 16 (43.7%) female, with an average age of 59 ± 4 years. Both groups showed a statistically significant decrease in wound size and infection over time ( p  < 0.001). The intervention group, however, had a more substantial reduction in wound size and infection rate ( p  < 0.05)., Conclusion: Potassium permanganate, when applied topically, is both well-tolerated and effective in enhancing wound healing and reducing infection in DFU, suggesting its potential as a complementary treatment., Competing Interests: The authors declare no conflict of interest., (© 2024 The Authors. Health Science Reports published by Wiley Periodicals LLC.)

Introduction: Multiple Sclerosis (MS) is a chronic neurodegenerative disorder that affects the central nervous system (CNS) and results in progressive clinical disability and cognitive decline. Currently, there are no specific imaging parameters available for the prediction of longitudinal disability in MS patients. Magnetic resonance imaging (MRI) has linked imaging anomalies to clinical and cognitive deficits in MS. In this study, we aimed to evaluate the effectiveness of MRI in predicting disability, clinical progression, and cognitive decline in MS., Methods: In this study, according to PRISMA guidelines, we comprehensively searched the Web of Science, PubMed, and Embase databases to identify pertinent articles that employed conventional MRI in the context of Relapsing-Remitting and progressive forms of MS. Following a rigorous screening process, studies that met the predefined inclusion criteria were selected for data extraction and evaluated for potential sources of bias., Results: A total of 3028 records were retrieved from database searching. After a rigorous screening, 53 records met the criteria and were included in this study. Lesions and alterations in CNS structures like white matter, gray matter, corpus callosum, thalamus, and spinal cord, may be used to anticipate disability progression. Several prognostic factors associated with the progression of MS, including presence of cortical lesions, changes in gray matter volume, whole brain atrophy, the corpus callosum index, alterations in thalamic volume, and lesions or alterations in cross-sectional area of the spinal cord. For cognitive impairment in MS patients, reliable predictors include cortical gray matter volume, brain atrophy, lesion characteristics (T2-lesion load, temporal, frontal, and cerebellar lesions), white matter lesion volume, thalamic volume, and corpus callosum density., Conclusion: This study indicates that MRI can be used to predict the cognitive decline, disability progression, and disease progression in MS patients over time., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Lomer et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Placenta accreta syndrome (PAS) may led to heavy blood loss and maternal death. Here we analyzed the main risk factors of PAS + pregnancies and its complications in a referral hospital in the north of Iran., Methods: In a case control study, all pregnant women with PAS referred to our department during 2016 till 2021 were enrolled and divided in two groups case (PAS+) and control (PAS-) based on preoperative imaging, intraoperative findings, and pathological reports. The sociodemographic features and neonatal-maternal outcomes also were recorded., Results: The most frequent reason for cesarean (C/S) was repeated C/S (62.9%, 56/89). A significant difference showed up in the time lag between previous C/S and the present delivery ( p  < 0.001) which shows that when the time distance is longer, the risk of PAS rises (OR: 1.01 [95% CI: 1.003-1.017]). Also, a positive history of prior abortion and elective type of previous C/S were related to PAS+ pregnancies. Our other finding showed that PAS + pregnancies will end in lower gestational age and have a longer duration of operation and hospitalization, heavy blood transfusion, and hysterectomy. Also, PAS + pregnancies were not related to poor neonatal outcomes., Conclusions: It seems that, in addition to repeated C/S as a strong risk factor, previous abortion is a forgotten key which leads to incomplete evacuation or damage the endometrial-myometrial layers., Competing Interests: The authors declare no conflict of interest., (© 2024 The Authors. Health Science Reports published by Wiley Periodicals LLC.)

Introduction: Body dysmorphic disorder (BDD) in the Diagnostic and Statistical Manual of Mental Disorders 5th Edition, is defined as one of pseudo-obsessive disorders; a class of obsessive-compulsive disorders. Whereas BDD has been weakly investigated among the Middle east population and there are little data about the prevalence of BDD in Iran especially in the northern part, in this study we tend to investigate the prevalence rate of BDD and its relationship with demographic factors and post-operative satisfaction in a sample of candidates for cosmetic and non-cosmetic surgery in Rasht., Method: During an analytical cross-sectional study, we investigated the prevalence of BDD in 100 applicants for cosmetic surgery (rhinoplasty) and 100 applicants for non-cosmetic surgery (including septoplasty and FESS) who were referred to Amir Al-Momenin Hospital in 2022. The modified Yale-Brown Obsessive Compulsive Questionnaire was used to examine BDD. Also, postoperative satisfaction (3 months later) was evaluated and compared in these two groups through telephone calls. SPSS software version 22, Fisher's test, chi-square test, independent t-test, and multiple logistic regression analysis were used for statistical analysis of the collected data., Results: The frequency of BDD in rhinoplasty applicants is significantly higher than the non-cosmetic surgery applicants (P-value = 0.005). The chance of BDD in rhinoplasty applicants is 4 times more than in non-cosmetic surgery applicants (P-value = 0.001, OR = 4.03). There is no significant difference in post-operative satisfaction between cosmetic and non-cosmetic surgery applicants (P-value = 0.975)., Conclusion: It is recommended that all applicants for cosmetic surgeries be examined with appropriate tools in terms of mental health before being accepted by surgeons so that they can be referred to psychiatrists if needed and unnecessary cosmetic surgery should be avoided., Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-04355-3., (© Association of Otolaryngologists of India 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Objective: The time to diagnosis of multiple sclerosis (MS) is of great importance for early treatment, thereby reducing the disability and burden of the disease. The purpose of this study was to determine the time from the onset of clinical symptoms to the diagnosis of MS and to evaluate the factors associated with a late diagnosis in Iranian MS patients., Methods: The present cross-sectional study was conducted on patients with MS who were registered in the National MS Registry System of Iran (NMSRI)., Results: Overall, 23291 MS patients registered in 18 provinces of Iran were included in this study. The mean (standard deviation) interval between the onset of the disease and diagnosis of MS was 13.42 (32.40) months, and the median was one month. The diagnostic interval of 41.6% of patients was less than one month, and 14.8% of them had a one-month time to diagnosis. Patients with an age of onset below 18 years and those diagnosed after the age of 50 years had a longer time to diagnosis (P<0.001). Patients with primary progressive MS (PPMS) had the longest time to diagnose and those with relapsing-remitting MS (RRMS) had the shortest time (P<0.001). The results of negative binominal regression showed that the average rate of delay in diagnosis in women was 12% less than that in men. The average delay in diagnosis in patients with a positive family history of MS was 23% more than that in others. The rate of delay in the diagnosis of patients with PPMS and secondary progressive MS was 2.22 and 1.66 times higher, respectively, compared with RRMS., Conclusion: The findings of the present study revealed that more than half of the MS patients were diagnosed within a one-month interval from the symptom onset, which is an acceptable period. More attention should be paid to patients' access to medical facilities and MS specialists., (Copyright © 2024. Published by Elsevier B.V.)

Background: Cyclists are vulnerable traffic users and studying the cycling behavior of professional and elite cyclists, their previous history of traffic accidents combined with the current knowledge on high-risk behaviors of this group can be a useful basis for further studies on ordinary cyclists. This study aimed to determine the relationship between cycling behavior and the previous history of traffic accidents among members of the Cycling Federation of Guilan province in 2022., Methods: A descriptive-analytical study was performed in which the Bicycle Rider Behavior Questionnaire (BRBQ) constructed in the Porsline platform was distributed using the WhatsApp social network. All participants were asked to self-report their cycling behavior. The final analysis was performed by using STATA software (version 14)., Results: The study subjects included a total of 109 cyclists with a mean age of 38.62 ± 10.94 years and a mean cycling experience of 13.75 ± 11.08 years. Using the logistic regression model, the relationship between gender (P = 0.039), years of cycling experience (P = 0.000), and education level (P ≤ 0.00), with previous traffic accidents, was found significant. There was also a significant relationship between stunts and distractions (P = 0.005), signaling violation (P = 0.000), and control error (P = 0.011) with previous traffic accidents. A significant association existed between stunts and distractions (P = 0.001) and signaling violation (P = 0.001) with a previous history of traffic injury within the last 3 years., Conclusions: The findings of this study can be used to establish cyclist safety and preventative planning in society. In behavior change intervention programs, it is best to target male cyclists with higher-level education. In addition, the behavior of the cyclists whose predominant term of signaling violations must be corrected should be targeted. It is necessary to shape information campaigns and educational programs aimed for cyclists with common high-risk behaviors, especially signaling violations., (© 2024. The Author(s).)

Introduction: Spinal epidermoid tumors are exceptionally rare, comprising less than 1 % of all spinal tumors. True intramedullary epidermoid cysts (IECs) are even more infrequent, constituting only 0.8 % of all spinal epidermoid tumors, with a notable cranial preference. Due to their gradual growth, the clinical presentation varies widely based on factors such as size, location, and the patient's age., Case Presentation: A 17-year-old male patient was admitted after experiencing an eight-month-long gradual weakening of both lower limbs. Initially, he experienced paresthesia in the right lower extremities, which progressed to gait disturbances, impacting balance and coordination. Clinical examination indicated bilateral lower limb weakness, reduced vibration sense, and proprioception with a positive clonus sign and extensor plantar responses. Magnetic resonance imaging (MRI) revealed an intramedullary lesion at the T3-T4 level, appearing hypointense on T1-weighted and hyperintense on T2-weighted images. Subsequently, the patient underwent laminectomy of the T2-T5 vertebrae and microsurgical resection of the intramedullary lesion. Histopathological analysis confirmed the diagnosis of an epidermoid cyst. Following two months of physiotherapy, there was progressive improvement in the lower limb coordination and mobility., Clinical Discussion: Progressive neurological deficits emphasize the importance of comprehensive neurological evaluation. Diagnosis involves clinical manifestations, imaging, and histopathological examination. Patients often exhibit gradual motor weakness, sensory alterations, and varying degrees of pain. Advanced neuroimaging such as MRI aids diagnosis. Surgical resection is the primary treatment with potential complications., Conclusion: A multidisciplinary approach is imperative for timely diagnosis and patient management, ensuring favorable outcomes while minimizing complications., Competing Interests: Conflict of interest statement There are no conflicts of interest., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction and Importance: Medulloblastoma in adults is a rare and highly aggressive central nervous system (CNS) tumor, representing less than 1 % of all brain tumors. Supratentorial metastasis is uncommon, and extra-neural metastasis occurs in approximately 5 % of cases, primarily in frontal and temporal lobes. Here, we present an exceptional case of parietal lobe metastasis in an adult with desmoplastic/nodular medulloblastoma. To explore prior cases and establish the uniqueness of our case, we conducted a thorough search on the PubMed database., Case Presentation: A 46-year-old male, who was previously treated for medulloblastoma with surgery and adjuvant chemoradiotherapy seven years ago, presented with clinical symptoms suggestive of potential tumor recurrence. Despite two years of dedicated adjuvant chemoradiotherapy, the patient exhibited progressive right hemiparesis, ataxia, and gait disturbances. Subsequent brain magnetic resonance imaging (MRI) revealed a distinct 6 × 4 × 2 cm lesion in the left parietal lobe, which, upon post-operative histopathological examination, was identified as a supratentorial metastasis originating from desmoplastic/nodular medulloblastoma., Clinical Discussion: Medulloblastomas, once categorized as primitive neuroectodermal tumors (PNET), are now distinctly classified as high-grade embryonal tumors, mainly characterized by their histological features and cellular origin. Common clinical presentations include hydrocephalus, headache, unsteady gait, and truncal ataxia. Surgical intervention aims for radical excision, complemented by vital adjuvant chemoradiotherapy to minimize recurrence risk., Conclusion: Considering the possibility of tumor recurrence or intracranial metastasis in patients with medulloblastoma is crucial. Therefore, regular follow-ups are strongly recommended to promptly detect any signs of reoccurrence in these atypical presentations., Competing Interests: Conflict of interest statement There are no conflicts of interest., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objectives: To compare the thickness and function of the quadriceps muscle in subjects with and without patellofemoral pain syndrome (PFPS) by ultrasonography., Methods: Patients diagnosed with PFPS were included in the study. To measure the thickness of the rectus femoris (RF), vastus medialis longus and oblique (VML, VMO), vastus lateralis (VL) and vastus intermedius (VI), the ultrasonography was employed in rest and normal contraction modes and also the % rest-thickness normal as muscle function. For between-groups comparisons, the independent sample t-test was utilized., Results: Sixty subjects (30 PFPS and 30 healthy) participated in this study. There were no significant differences between two groups with respect to demographic characteristics. No significant differences were observed between two groups regarding RF (P=0.07), VMO (P=0.38), VL (P=0.40) and VI (P=0.55) at rest. However, the rest thickness of VML (P=0.01) was significant between PFPS and healthy groups. No significant differences were found between two groups regarding RF (P=0.14), VML (P=0.68), VMO (P=0.11), VL (P=0.65), and VI (P=0.07) in contraction state. However, % rest-thickness normal were significant between groups for VML (P=0.03) and VMO (P=0.02) and were not significant for RF (P=0.56), VL (P=0.14) and VI (P=0.08)., Conclusion: In all parts of the quadriceps, % rest-thickness normal, as an indicator of its function, have been decreased in patients with PFPS. In patients with PFPF, ultrasonography should be cautiously used for muscle thickness comparisons., Competing Interests: The authors declare that they have no conflicts of interest., (© 2024 Mashhad University of Medical Sciences.)

Optimal management of burns begins with first aid from the first hours of injury. Adequate knowledge of how to perform first aid for burns can reduce the consequences of injury. Therefore, this study aims to determine the knowledge, attitude, and sources of information assessment towards burn First aid among people referred to a burn centre in the north of Iran. A questionnaire-based survey was conducted to assess knowledge, attitude, and sources of information towards burn first aid among people referred to a burn centre in the north of Iran in 2023. In this survey, a convenience sampling method was adopted. The variables consisted of four items on socio-demographic information, 15 items on knowledge, ten items on attitude, and one item on sources of information related to burn First aid. A total of 371 individuals responded to the survey. The mean age of participants was 31.90 ± 8.49 years old. The mean score of the total knowledge of the participants in the research was 6.04 ± 3.05. There was a statistically significant relationship between the variables of age, sex, marital status, place of residence, level of education, and history of receiving first aid training with the participants' knowledge level. The average score of the total attitude of the participants was 44.08 ± 3.88. Out of 371 participants, 214 people (57.7%) had an average attitude, and 157 people (42.3%) had a good attitude towards burn first aid. There was a statistically significant relationship between place of residence, level of education, and history of receiving first aid training with the participants' attitudes in the research. In addition, the level of knowledge had a statistically significant relationship with the participants' attitude level in the research (p-value <0.001). The majority of participants have limited knowledge of burn first aid. This lack of knowledge could lead to severe consequences. Therefore, healthcare organizations should review and promote consistent guidelines for burn first aid to tackle and minimize the effect of this grave injury., (© 2023 The Authors. International Wound Journal published by Medicalhelplines.com Inc and John Wiley & Sons Ltd.)

Alzheimer's disease (AD), a neurological disorder, despite significant advances in medical science, has not yet been definitively cured, and the exact causes of the disease remain unclear. Due to the importance of AD in the clinic, large expenses are spent annually to deal with this neurological disorder, and neurologists warn of an increase in this disease in elderly in the near future. It has been believed that microbiota dysbiosis leads to Alzheimer's as a multi-step disease. In this regard, the presence of footprints of perturbations in the oral microbiome and the predominance of pathogenic bacteria and their effect on the nervous system, especially AD, is a very interesting topic that has been considered by researchers in the last decade. Some studies have looked at the mechanisms by which oral microbiota cause AD. However, many aspects of this interaction are still unclear as to how oral microbiota composition can contribute to this disease. Understanding this interaction requires extensive collaboration by interdisciplinary researchers to explore all aspects of the issue. In order to reveal the link between the composition of the oral microbiota and this disease, researchers from various domains have sought to explain the mechanisms of shift in oral microbiota in AD in this review., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

This study aimed to determine the factors associated with return to work (RTW) after traumatic spinal fracture and spinal cord injury. It provided a predictive model for RTW among patients with spinal fractures and spinal cord injury and determined important factors influencing the time to RTW after injury. A retrospective cohort study was conducted in Poursina Tertiary Hospital, Guilan, Iran between May 2017 and May 2020. Patients aged 18 to 65 who were hospitalized with traumatic spinal fractures and spinal cord injuries were included. Demographic and clinical data were collected from the National Spinal Column/Cord Injury Registry of Iran (NSCIR-IR). A researcher-administered questionnaire was used through a telephone interview to obtain complementary data on social and occupational variables. Kaplan-Meier survival analysis was used to estimate the average time to RTW and the predictors of RTW were determined by multivariate Cox regression model. Of the 300 patients included, 78.6% returned to work and the average time to RTW was about 7 months. The mean age of the participants was 45.63 ± 14.76 years old. Among the study variables, having a Bachelor's degree (HR 2.59; 95% CI 1.16-5.77; P = 0.019), complications after injury (HR 0.47; 95% CI 0.35-0.62; P = 0.0001), full coverage health insurance (HR 1.73; 95% CI 1.10-2.72; P = 0.016), opium use (HR 0.48; 95% CI 0.26-0.90; P = 0.023), number of vertebral fractures (HR 0.82; 95% CI 0.67-0.99; P = 0.046), and length of hospital stay (HR 0.95; 95% CI 0.93-0.98; P = 0.001) were found to be significant in predicting RTW in Cox regression analysis. Our analysis showed that wealthier people and those with high job mobility returned to work later., (© 2023. The Author(s).)

Aims: The aim of this study is to evaluate the effect of Positive End Expiratory Pressure (PEEP) on surgical field bleeding and its respiratory and hemodynamic consequences in rhinoplasty surgeries., Materials and Methods: This single-blind clinical trial performed in Amir Al-Momenin university Hospital in 2018. Seventy cases of rhinoplasty surgery patients Enrolled and were randomized into two groups; intervention (PEEP = 5) and comparison group (PEEP = 0). Surgical field bleeding and arterial oxygen saturation pulmonary dynamics and hemodynamic parameters were evaluated during operation and in post anesthesia care unit. Data were analyzed by SPSS software using descriptive and analytical statistics., Results: PEEP applying had no negative effect on surgical bleeding as well as surgeon satisfaction, heart rate and blood pressure were similar in two groups. Pulmonary dynamics and oxygenation were stable and within normal values in all cases. The mean peak airway pressure was 17.87 ± 2.24 in the PEEP group and 16.08 ± 3.37 in the ZEEP group (P = 0.029)., Conclusion: applying low level PEEP during anesthesia improved recovery oxygen saturation but had no negative effects on the patient`s hemodynamics, and did not aggravate bleeding and visual clarity., Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-03854-7., Competing Interests: Conflict of interestThe authors declare that they have no conflict of interest., (© Association of Otolaryngologists of India 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Background: Ultrasound is an important method to determine the volume of the gallbladder and check its structure. Considering the variation in the size and volume of the gallbladder in disease and physiological conditions, determining the volume of the gallbladder is clinically valuable. This study was carried out to evaluate the gallbladder volume and its association with patients' demographic data in the Prospective Epidemiological Research Studies of Iranian Adults (PERSIAN) Guilan cohort study (PGCS) population., Methods: In this cross-sectional study, 957 individuals aged 35-70 participated in determining the gallbladder volume by a radiologist based on the ultrasound method. The demographical data were collected using a questionnaire. After fasting for 12 h, the ultrasound was performed with an Ultrasonic device (Sonix SP series) with a 3.5 to 5 MHz probe., Results: The total frequency of gallbladder lesions was 2.2%. The results showed a significant association between marriage and gender with the presence or absence of lesions in the studied participants (P < 0.05). Also, significant differences were reported between the volume of gallbladder and gender, body mass index (BMI), social and economic status (SES), metabolic equivalent of task (MET), history of cardiovascular disease (CVD), and hypertension (P < 0.05). The results of a linear regression represented a significant association between gender, BMI, MET, and CVD and the mean volume of the gallbladder (P < 0.05). However, there was no significant association between the presence or absence of a lesion and the individuals' average gallbladder volume (P > 0.05)., Conclusion: According to our results, gender, BMI, MET, and CVD were significantly associated with gallbladder volume., (© 2023. The Author(s).)

Introduction: Multiple sclerosis (MS) is an inflammatory demyelinating and neurodegenerative disorder of the central nervous system, which is associated with brain atrophy and volume changes in some brain structures. This study aimed to compare the volume of the basal ganglia, thalamus, cerebellum, and brainstem in patients with relapsing-remitting MS with that of the control group using magnetic resonance imaging (MRI)., Methods: In this cross-sectional study, MRI brain scans were obtained from 25 patients with relapsing-remitting MS and 25 healthy control subjects. Volumetric analyses were performed using Brain Suite software., Results: The mean age of the MS and the control groups was 33.96±8.75 and 40.40±8.72, respectively. No statistically significant difference was found in gender (P=0.747). The bilateral putamen and caudate nuclei volumes were significantly higher in the case group than in the control group (P<0.001). Moreover, lower the volume of the brainstem, cerebellum, bilateral thalamus, and globus pallidus were identified in the MS patients compared to the control group (P<0.001). There was an inverse correlation between the disease and treatment duration with the thalamus and cerebellum volume in MS patients (P=0.001). Treatment duration also had an inverse correlation with brainstem volume (P=0.047)., Conclusion: The volume of some structures of the brain, including globus pallidus, thalamus, cerebellum, and brainstem is lower in MS and can be one of the markers of disease progression and disability among MS patients., Highlights: Due to the degenerative process in multiple sclerosis, some cerebral structures may face volume change.The present study demonstrated that the volume of globus pallidus, thalamus, cerebellum, and brainstem is lower in MS patients compared to the controls., Plain Language Summary: Multiple sclerosis (MS) is defined as an inflammatory disease involving the white matter of the brain, but experience has shown that many non-white matter structures also change in MS. In this study, we aimed to examine some parts of the brain, such as the thalamus, basal ganglia, brainstem, and cerebellum, for volume changes. The results showed that all these structures can have a smaller volume in MS patients than in healthy people. Especially in the case of the thalamus and cerebellum, this difference increases with increasing the disease duration. Changes in the size of these structures can be the result of degeneration of the neurons in these areas. These changes can cause significant disability in patients; however, there may not be significant changes in the number of plaques in patients. Attention to these changes can be essential in interpreting patients' clinical changes, including motor and cognitive disabilities., Competing Interests: The authors declared no conflict of interest., (Copyright© 2023 Iranian Neuroscience Society.)

Work-related burns can have a destructive impact; however, knowledge of the epidemiology of work-related burn injuries in Iran is limited. This study aimed to describe epidemiological characteristics of work-related burn injuries in a burn centre in the north of Iran. This study was a retrospective single-centre study of the medical records of work-related burns between 2011 and 2020. Data collection was done using the hospital information system (HIS). The data were analysed by using descriptive statistical methods and SPSS 24.0 software. Of the 9220 cases treated in the burn centre, 429 (4.65%) had work-related burns. There was an increasing trend of work-related burns during the ten years. The mean age of patients was 37.53 (SD = 13.72). Most patients were male (n = 377, 87.9%), with a male-to-female ratio of 7.25/1. The mean total body surface area burn was 23.39% (SD = 20.03). Most work-related burns occurred in the summer season (46.9%, n = 201), and the upper limb was the most common anatomical site of burns (n = 123, 28.7%). The most common mechanism of injury was fire & flames (266, 62.0%). Inhalation injury was observed in 52 (12.1%) patients, and mechanical ventilation was undertaken in 71 (16.6%) patients. The mean length of stay in the hospital was 10.38 (SD = 10.37) days, and the overall mortality rate was 11.2%. The most common activities associated with burns at the time of the incidents were food preparation and serving related (108, 25.2%), followed by welders (n = 71, 16.6%) and electricians (n = 61, 14.2%). This research is the basis for evaluating work-related burns and identifying the causes of these injuries to develop education and prevention programmes, especially for young male workers., (© 2023 The Authors. International Wound Journal published by Medicalhelplines.com Inc and John Wiley & Sons Ltd.)

Introduction and Importance: Osteoblastoma (OB) is a rare benign bone tumor, representing less than 1% of all bone neoplasms. In contrast to the typical OB, a smaller subset known as 'epithelioid osteoblastoma (EO)' exhibits a distinctive inclination for local invasion and recurrence. This rare variant can pose diagnostic challenges, particularly due to its unclear clinical and radiological presentation., Case Presentation: This study details a clinical case of a 12-year-old boy experiencing pain from a lytic bone tumor located in the thoracic vertebrae (T3-T4), initially suggesting malignancy. Following extensive curettage, histopathological analysis confirmed the diagnosis of EO through immunohistochemical staining. Subsequent follow-up at 3 months revealed the absence of no pain or recurrence of the lesion., Clinical Discussion: Distinguishing EO from a malignant tumor requires a multidisciplinary approach, considering clinical, radiographic, and histological features that differentiate the two entities., Conclusion: The goal of this case presentation is to increase awareness regarding this recurrent tumor variant, which poses diagnostic challenges, particularly in distinguishing it from malignant tumors, including osteosarcoma., Competing Interests: There are no conflicts of interest.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

Introduction and Importance: Schwannomas, originating from Schwann cells surrounding nerve sheaths, tend to be slow-growing. Among these, giant ancient schwannomas are remarkable for their rare occurrence and their capacity for substantial growth and regressive changes. Furthermore, the expansiveness and flexibility of the retroperitoneal space often conceal the symptoms of retroperitoneal schwannomas, leading to delayed diagnosis and allowing these tumors to grow significantly and become large and long-standing before detection., Case Presentation: A 24-year-old man presented with left flank pain and a growing abdominal bulge in the left upper quadrant. Computed tomography scan revealed a 15×15×10 cm lytic expansile lesion. Consequently, the encapsulated mass was surgically excised and diagnosed as an ancient retroperitoneal schwannoma through histological and immunohistochemical studies., Clinical Discussion: Comprehensive preoperative planning and a multidisciplinary strategy are imperative for the complete excision of schwannomas. These tumors can present diagnostic complexities, particularly due to nuclear atypia and pleomorphism, which might lead to misinterpretation regarding malignancy. Despite the risks associated with percutaneous biopsies, the low mitotic count is a critical diagnostic factor. Our study underscores the consensus that the definitive diagnosis should rely on postoperative histopathological findings, highlighting the importance of accurate assessment., Conclusion: Rare giant retroperitoneal ancient schwannomas pose diagnostic challenges due to their rarity, lack of distinct symptoms, and atypical locations. This study presents a successful case and management., Competing Interests: The authors declare that they have no competing interests.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

Patients with acute burns are more vulnerable to COVID-19 because of physiologically weak immune systems. This study aimed to assess and compare individual characteristics, clinical features, and clinical outcomes of acute burn among COVID-19 and non-COVID-19 patients. A retrospective study, with data collected from 611 acute burn patients with or without a COVID-19 diagnosis referred to a burn centre in Iran. Data were collected from April 2020 to 2021. The mean age of acute burns patients with COVID-19 was higher compared with acute burns patients with non-COVID-19 (47.82 vs. 32.59 years, P < .001). Acute burns occurred more frequently in COVID-19 patients with comorbidities compared with non-COVID-19 patients (48.72% vs. 26.92%, P = .003). 58.97% of COVID-19 patients and 55.42% of non-COVID-19 patients had grade II & III and II burns, respectively (P < .001). The mean total body surface area of the burn was higher in COVID-19 patients compared with non-COVID-19 patients (32.69% vs. 16.22%, P < .001). Hospitalisation in the intensive care unit (ICU) was higher in COVID-19 patients than in non-COVID-19 patients (76.92% vs. 15.73%, P < .001). Length of stay in hospital and ICU, the cost of hospitalisation, and waiting time for the operating room was higher in COVID-19 patients compared with non-COVID-19 patients (15.30 vs. 3.88 days, P < .001; 9.61 vs. 0.75 days, P < .001; 30 430 628.717 vs. 10 219 192.44 rials, P = .011; 0.84 vs. 0.24 min, P < .001, respectively). Intubation and mortality in-hospital were higher in COVID-19 patients compared with non-COVID-19 patients (41.02% vs. 6.99%, P < .001; 35.90% vs. 6.12%, P < .001, respectively). Therefore, it is recommended that health managers and policymakers develop a care plan to provide high-quality care to acute burns patients with COVID-19, especially in low-income countries., (© 2023 The Authors. International Wound Journal published by Medicalhelplines.com Inc and John Wiley & Sons Ltd.)

Background: Unwanted postoperative hypothermia is an unpleasant event that can cause various complications., Objectives: As this serious complication and its provoking causes have not been investigated sufficiently, this study was designed and conducted to determine the prevalence of hypothermia and its associated factors in the post-anesthesia care unit after elective surgery., Methods: Four hundred patients undergoing elective surgeries were enrolled in the present cross-sectional research after termination of surgery and at the time of arrival at the post-anesthesia care unit of Poursina Public University Hospital. The tympanic membrane temperature was measured and recorded at the time of arrival at the post-anesthesia care unit and every 30 minutes after arrival. The required data were collected in a researcher-made checklist and analyzed after entering the SPSS software version 25., Results: Considering the 5% error, it can be said that the prevalence of hypothermia in patients undergoing elective surgery ranges from 20 to 28% at the time of arrival at the post-anesthesia care unit and 18.5 to 26% 30 minutes after arrival., Conclusions: More than a quarter of patients experienced hypothermia following elective surgery. Therefore, appropriate treatment and control measures are necessary to manage this complication, particularly in patients with predisposing risk factors and comorbidities., Competing Interests: The authors declared no conflict of interest., (Copyright © 2023, Ashoobi et al.)

Background: Pectoralis major tendon rupture rate is increasing due to increased tendency to bodybuilding exercises, specially the bench press workout, and weight-lifting. The aim of this study was to determine the results of pectoralis major rupture repair with Achilles tendon allograft in bodybuilding athletes., Methods: In this case series study, 22 bodybuilding athlete patients (24 pectoralis major ruptures) were undergone open surgical repair during January 2016 till December 2020. 21 ruptures were chronic (2 ruptures were revision) and 3 ruptures were acute. Surgical method was based on Achilles tendon allograft used to augment the ruptured site for lengthening the shortened tendon.The results were analyzed using Bak's criteria and Constant score in pre operation visit and 6th and 12th months and in the last follow up., Results: All cases were male with the mean age of 32.1 ± 5.4. The mean duration time between injuries to surgery was 37 ± 46 month (1-182 months). Return to professional sport began at 10.9 ± 2.8 months after surgery in which 16 cases (66.7%) have returned to their pre surgery bench press workout records. No infection or hematoma occurred. At the final follow-up, Bak criteria demonstrated excellent, good and fair in 4, 18 and 2 shoulders respectively. The constant score increased from 87.9 ± 7.9 in pre operation visit to 92.7 ± 6.4 in the last follow up (P < 0.001)., Conclusions: It seems that our surgical method is an effective approach in cases with acute or chronic pectoralis major ruptures., Level of Evidence: Level IV., Competing Interests: Declaration of competing interest All named authors hereby declare that they have no conflicts of interest to disclose., (Copyright © 2022. Published by Elsevier B.V.)