Search

Abstract Background Rheumatoid arthritis (RA) is a chronic inflammatory condition primarily affecting the joints. The higher prevalence of RA among females, combined with the known effects of sex hormones on immune function, has led researchers to investigate the potential relationship between menopausal status and the risk, severity, or progression of RA. This systematic review and meta-analysis aimed to determine the association between menopause and rheumatoid arthritis. Methods In 2023, we conducted a comprehensive search across multiple databases, including Google Scholar, Scopus, PubMed/MEDLINE, Science Direct, Web of Science, EMBASE, Springer, and ProQuest. The search aimed to identify studies exploring the association between menopause and rheumatoid arthritis. Results Our analysis revealed that post-menopausal women had a higher risk of developing rheumatoid arthritis compared to pre-menopausal women, with an estimated odds ratio of 1.35 (95% CI: 1.04–1.67). Additionally, women who experienced early menopause (defined as onset before age 45) showed significantly higher odds of developing RA, with an odds ratio of 2.97 (95% CI: 1.73–4.22). Conclusion These findings highlight the importance of considering menopausal status when assessing the risk of RA development in women. The results suggest that post-menopausal women, particularly those who experience early menopause, may be at higher risk for developing RA. Further research in this area could provide valuable insights into potential preventive measures and targeted interventions for high-risk individuals.

Abstract Background Chewing gum is a healthy, cheap, and familiar solution for patients with premature irritation of the stomach and intestines. This study compared the effect of chewing gum and the routine method on ileus after burns. Methods This study is a randomized clinical trial conducted in Valiasr Hospital in Arak, Markazi Province, in the center of Iran, from December 2021 to February 2023. After the diagnosis of intestinal ileus in 83 patients hospitalized in the burn department by a general surgeon, with the available sampling method, these patients were evaluated based on the inclusion and exclusion criteria of the study. As a result, 66 patients were selected and divided into groups A (33 patients in the intervention group: routine care + gum chewing) and B (33 patients in the control group: routine care) by random allocation method. For the intervention group, from entering the ward until the beginning of oral feeding, gum (without sugar) was chewed four times a day for 15 min, while control groups received the routine diet of the department. Both groups’ condition of the bowel sounds, time of passing gas, and stool were recorded. The statistical analyses were performed using SPSS version 16. The chi-squared, Fisher’s exact, Independent t-test, and Mann-Whitney U tests were utilized. Results The results showed that the median bowel sound return time, time of the first gas discharge, earliest defecation time, and time to start the diet were significantly shorter in the intervention group than in the control group (P

Background: Major β-Thalassemia is the most prevalent singlegene disorder in Iran. Over 2 million beta-thalassemia carriersand more than 25,000 patients have been identified nationwide. This study aimed to evaluate the Major β-Thalassemia (MBT) screening surveillance system in the Jiroft district, southeast Iran.Methods: This descriptive study was conducted using the census method and was based on the information recorded in the files of all major thalassemia births (born between 2011 and 2021) in the health centers of Jiroft University of Medical Sciences. A formula was used to calculate the program’s incidence, expected incidence, and success rate. Stata version 14 and Excel software were utilized to analyze the data, and the qualitative data are presented as numerical values and percentages.Results: During the study periods, 91 patients with betathalassemia Major were born in the population covered by Jiroft University of Medical Sciences. By performing prenatal diagnosis tests in the first weeks of pregnancy and obtaining parental consent for legal abortion, the birth of 422 sick children was prevented. The 11-year incidence of beta-thalassemia major was 5.32 per 10,000, and the expected incidence (if no prevention program was implemented) was 30 per 10,000 live births. The mean success rate of the Major β-Thalassemia surveillance system during the study period was 82.26%, which reached 95.45% in 2021.Conclusion: The i mplementation of efficient, e ffective h ealth policies influenced by the native culture of the region has resulted in the thalassemia prevention program in Jiroft City being completely effective. The implementation success rate of this program has exceeded 95%. Modeling and adapting these preventive policies can assist in implementing thalassemia prevention programs in other parts of the country and developing countries.

Background: Iran has witnessed a significant and rapid decline in fertility rates over the past few decades, a phenomenon referred to as the reproductive revolution. One crucial factor influencing fertility rates is the preference for a child’s gender, which can impact family size. This study aimed to determine the gender preference and desired family size among marriage candidates in Southern Iran in 2021.Methods: This cross-sectional study involved 744 marriage candidates from Jahrom County, Fars province, Iran, selected through convenience sampling. Data were collected using a researcher-developed questionnaire. Experts confirmed the questionnaire’s face validity and its reliability was established with a Cronbach’s alpha of 0.81.Results: Of the participants, 54.6% were women, 86.8% resided in urban areas, and 60.6% had a diploma or lower educational level. The mean age at first marriage was 26.86±8.22 years, and the mean desired number of children was 2.09±1.10. The preference for a boy as the first child was 24.6% among men and 22.9% among women, while the preference for a girl was 17.4% among men and 24.1% among women (P=0.084). Furthermore, 46.4% of men and 47.8% of women believed they would continue having children if they did not have a son (P=0.72). Factors such as gender, age, education, occupation, monthly income, and place of residence showed no association with the preference for a boy as the first child (P>0.05).Conclusion: On average, marriage candidates desired two children. There was a slight preference for boys. It is recommended that adolescents and young adults receive appropriate education about gender equality in schools and universities to mitigate gender bias and discrimination at the community level.

Abstract Neospora spp. and Toxoplasma gondii are two closely related protozoan parasites that are widely distributed throughout the world. Horses can act as intermediate hosts for both parasites and can acquire disease. Blood samples were taken from 487 clinically healthy horses from 17 different mechanized stables in Tehran, the capital of Iran, during September and November of 2022. IFAT and ELISA were employed to detect antibodies directed against Neospora spp. and T. gondii. The anti-N. caninum antibodies were detected in 52 of the horses (10.67%) based on IFAT and in 86 of the 487 horses (17.65%) based on the ELISA test. Also, antibodies against T. gondii were detected in 41 horses (8.42%) based on IFAT and in 63 of 487 horses (12.94%) based on the ELISA test. Also, in 6 of the horses (1.23%) based on IFAT and in 13 of the 487 horses (2.67%) based on the ELISA test, double positivity suggested co-infection with both parasites. Gender, age groups, and the presence of dogs for neosporosis, and age groups and the presence of cats for toxoplasmosis, could be considered factors having an influence on the seroprevalences (P

Abstract Background and Aims Childbirth is a multifaceted and distressing event that can profoundly affect mothers' psychological and physical well‐being. Noninvasive interventions like music therapy have been explored to improve labor outcomes by decreasing pain and anxiety levels, promoting relaxation, and enhancing maternal–fetal health. This study aimed to investigate the effect of Iranian traditional music on cervical dilation and labor progress in the active stage of term pregnancy. Methods This study was a nonrandomized controlled trial that included pregnant women between 20 and 35, with a gravidity of two or three. Participants were assigned to either the intervention group, which received traditional Iranian music therapy during labor, or the control group, which received routine care without the music intervention. The primary outcome was the effect of music therapy on cervical dilation from 4 cm to full dilation (10 cm) during term pregnancy. The secondary outcomes included changes in fetal heart rate, maternal anxiety, and pain scores before and after the intervention. Statistical analyses were performed using appropriate methods, and the results were reported using descriptive and inferential statistics. Results The mean age of the intervention group was 28.32 ± 6.13 years, and that of the control group was 28.31 ± 3.47 years (p = 0.890). The median duration of labor was not significantly different during the active stage, with 120 min in the intervention group and 137 min in the control group (p = 0.505). However, significant differences were observed in fetal heart rate, anxiety score, and pain score changes before and after the intervention between the two groups (p

To determine the global level of knowledge, attitudes, and practices towards dengue fever among the general population. To complete this systematic review and meta-analysis, a thorough search for pertinent English-language literature was undertaken during the study's extension until October 2023. The search used Google Scholar, Scopus, PubMed/MEDLINE, Science Direct, Web of Science, EMBASE, Springer, and ProQuest. A quality assessment checklist developed using a modified Newcastle-Ottawa Scale for the cross-sectional study was used to evaluate the risk of bias in the included papers. Inverse variance and Cochran Q statistics were employed in the STATA software version 14 to assess study heterogeneity. When there was heterogeneity, the Dersimonian and Liard random-effects models were used. 59 Studies totaling 87353 participants were included in this meta-analysis. These investigations included 86278 participants in 55 studies on knowledge, 20196 in 33 studies on attitudes, and 74881 in 29 studies on practices. The pooled estimates for sufficient knowledge, positive attitudes, and dengue fever preventive behaviors among the general population were determined as 40.1% (95% CI 33.8%-46.5%), 46.8% (95% CI 35.8%-58.9%), and 38.3% (95% CI 28.4%-48.2%), respectively. Europe exhibits the highest knowledge level at 63.5%, and Africa shows the lowest at 20.3%. Positive attitudes are most prevalent in the Eastern Mediterranean (54.1%) and Southeast Asia (53.6%), contrasting sharply with the Americas, where attitudes are notably lower at 9.05%. Regarding preventive behaviors, the Americas demonstrate a prevalence of 12.1%, Southeast Asia at 28.1%, Western Pacific at 49.6%, Eastern Mediterranean at 44.8%, and Africa at 47.4%. Regional disparities about the knowledge, attitude and preventive bahaviors are evident with Europe exhibiting the highest knowledge level while Africa has the lowest. These findings emphasize the importance of targeted public health interventions tailored to regional contexts, highlighting the need for region-specific strategies to enhance dengue-related knowledge and encourage positive attitudes and preventive behaviors.

Avian Influenza is a contagious zoonotic disease that can be transmitted from birds to mammals. In this study, we conducted a systematic review and meta-analysis to investigate and summarize the occurrence of avian influenza H9N2 in humans and other mammals in Iran. Data were collected systematically until July 1 2023 from four English and two Persian databases. According to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) and inclusion criteria, 14 eligible studies were obtained. Occurrences of AI H9N2 are reported in humans, dogs, and water buffaloes (Bubalus bubalis) in Iran. The pooled prevalence of AI H9N2 using a random model among humans was 0.15 (95% CI, 0.12-0.18). Pooled prevalence using the HI test was 0.16 (95% CI, 0.13-0.20). The pooled prevalence by different cut-offs for the HI test was equal to 0.34, 0.11, 0.02, and 0.01, respectively for cut-offs 1:20 to 1:160. Pooled prevalence using the HI test, among persons with possible exposure, hospitalized persons and hospital staff (0.20, 0.31, and 0.30) was higher than the prevalence in apparently healthy individuals (0.01). The group of individuals with possible exposure revealed the highest pooled prevalence of 0.25 (95% CI, 0.17-0.33) using the HI test. This was observed predominantly in slaughterhouse workers. The pooled prevalence using the ELISA test was 0.27 (95% CI, 0.23-0.31). These results can help policymakers to create prevention and control programs for possible epidemics in the future and can help researchers to tailor the design and objectives of future studies in this area.

Abstract Background One of the new educational systems is the mentorship method. This study aimed to investigate the effect of peer mentoring program on clinical academic progress and psychological characteristics of operating room students. Methods This research was a randomized controlled trial that was conducted on undergraduate students in the operating room department of Khomein Faculty of Medical Sciences, Markazi Province in Iran. The number of operating room students were 70 that were divided into intervention and control groups by random allocation using Permuted Block Randomization. Inclusion criteria included all operating room students who were in internship, and exclusion criteria included failure to complete the questionnaires. The data collection tools were the demographic questionnaire, Depression Anxiety Stress Scale, Rosenberg Self-Esteem Scale and Situational Motivational Scale. In the control group, clinical training was done in the traditional way. In the intervention group, training was done by peer mentoring method. The obtained data were analyzed using descriptive statistics, independent t-test, paired t-test, chi-square test, ANCOVA, univariable and multivariable linear regression. Results The study revealed significant differences between the intervention and control groups. Post-intervention, the intervention group demonstrated substantial increases in self-confidence (mean difference = 5.97, p 0.05). Furthermore, the intervention significantly enhanced academic progress in the intervention group compared to the control group (mean difference = 20.31, p

Abstract Hereby, we aimed to comprehensively compare different scoring systems for pediatric trauma and their ability to predict in-hospital mortality and intensive care unit (ICU) admission. The current registry-based multicenter study encompassed a comprehensive dataset of 6709 pediatric trauma patients aged ≤ 18 years from July 2016 to September 2023. To ascertain the predictive efficacy of the scoring systems, the area under the receiver operating characteristic curve (AUC) was calculated. A total of 720 individuals (10.7%) required admission to the ICU. The mortality rate was 1.1% (n = 72). The most predictive scoring system for in-hospital mortality was the adjusted trauma and injury severity score (aTRISS) (AUC = 0.982), followed by trauma and injury severity score (TRISS) (AUC = 0.980), new trauma and injury severity score (NTRISS) (AUC = 0.972), Glasgow coma scale (GCS) (AUC = 0.9546), revised trauma score (RTS) (AUC = 0.944), pre-hospital index (PHI) (AUC = 0.936), injury severity score (ISS) (AUC = 0.901), new injury severity score (NISS) (AUC = 0.900), and abbreviated injury scale (AIS) (AUC = 0.734). Given the predictive performance of the scoring systems for ICU admission, NTRISS had the highest predictive performance (AUC = 0.837), followed by aTRISS (AUC = 0.836), TRISS (AUC = 0.823), ISS (AUC = 0.807), NISS (AUC = 0.805), GCS (AUC = 0.735), RTS (AUC = 0.698), PHI (AUC = 0.662), and AIS (AUC = 0.651). In the present study, we concluded the superiority of the TRISS and its two derived counterparts, aTRISS and NTRISS, compared to other scoring systems, to efficiently discerning individuals who possess a heightened susceptibility to unfavorable consequences. The significance of these findings underscores the necessity of incorporating these metrics into the realm of clinical practice.

Background & Objectives: The COVID-19 pandemic has had a devastating global impact, with millions of cases and varying severity of illness. Southeastern Iran has been particularly hard hit, with a high number of patients requiring hospitalization. This study aimed to identify risk factors associated with mortality from COVID-19 among hospitalized patients in this region. Materials & Methods: A case-control study compared hospitalized COVID-19 patients who succumbed to the disease (confirmed by death certificates and positive PCR tests) with those who recovered, from February 27, 2020, to June 30, 2021. Researchers analyzed data using t-tests and chi-square tests to identify significant factors associated with mortality (p < 0.05). Variables significant at a less stringent level (p < 0.2) were then included in a backward logistic regression model to explore independent predictors of mortality. Results: This retrospective study examined data from 473 patients, of whom 158 were in the case group and 315 were in the control group. Among the case group, 80.4% were elderly, compared to 41% in the control group. A significantly higher proportion of patients in the case group (12.7%) experienced critical symptoms leading to ICU hospitalization, compared to the control group (7.3%). Multivariable regression analysis identified several factors significantly associated with increased mortality risk. These included ICU hospitalization (OR=5.27, CI: 3.09-8.98), advanced age (OR=4.06, CI: 2.43-6.80), hypertension (OR=4.44, CI: 1.52-12.93), cardiovascular diseases (OR=2.56, CI: 1.1-5.98), and critical symptoms (OR=2.74, CI: 1.92-8.04). Diabetes, pregnancy, nationality, and gender did not statistically increase mortality risk (p-value ≥ 0.05). Conclusion: Advanced age, severe symptoms requiring ICU care, hypertension, and cardiovascular diseases are all critical mortality risk factors in hospitalized COVID-19 patients.

Background: Giardia duodenalis (G. duodenalis) is one of the major causes of diarrhea among children. We performed a systematic review and meta-analysis to assess the prevalence of G. duodenalis and associated risk factors among African children. Methods: We searched online databases (PubMed, Scopus, and Web of Science) as well as the Google Scholar search engine for studies measured the prevalence of G. duodenalis among African children, published between 1 January 2000 and 15 March 2022. Due to high heterogeneity among the included studies, a random-effects meta-analysis model was employed to estimate pooled prevalence and 95% confidence intervals (CI). Results: A total of 114 articles from 29 African countries met the inclusion criteria. The pooled prevalence of G. duodenalis infection among African children was estimated as 18.3% (95% CI: 16.5–20.2). The highest and lowest pooled prevalence of G. duodenalis infection were estimated in Niger and Cameroon as 65.1% (55–75.2) and 0.08% (0.02–1.05), respectively. Considering the type of study population, the highest prevalence was related to, iron-deficient children 65.2% (61.3–69.1), handicapped children 30.4% (18.3–42.4), HIV infected children 25.7% (11.2–40.2) and displaced children 20.2% (16.5–23.9). Conclusions: Giardiasis is common among African children, hence, prevention and control scheme of this protozoan in children should be considered by health officials and health policymakers, especially in African countries where prevalence is highest.

Objective: The main objective of this study was to determine various characteristics and outcomes of self-harm and suicide in men and women with data obtained from the National Trauma Registry of Iran (NTRI). Method: This retrospective multicenter study using data from the NTRI included all patients who went to the emergency department (ED) due to self-harm and suicide, considering the NTRI's specific inclusion criteria, from September 2016 to January 2023. We evaluated patients regarding demographics and clinical characteristics, various outcomes, and factors influencing in-hospital death. Statistical analyses were conducted using the STATA software version 15.0. The chi-square test was used to compare the distribution of variables between men and women. Also, the logistic regression models were applied to assess the predictors of in-hospital death. Results: Self-harm and suicide cases were gathered from eleven geographically diverse hospitals across the country, and our study included 511 men and 347 women out of 50,661 registered trauma cases. Among them, 443 men (86.7%) and 267 women (76.9%) were between 18 and 49 years old (P < 0.001). Single women constituted 130 (37.3%) of the female cases, while single men were 313 (61.6%) of the male cases (P < 0.001). The three most common methods among our patients were poisoning with 234 (45.8%) of men and 245 (70.6%) of women cases, stab/cut with 208 (40.7%) of men and 54 (15.6%) of women cases, and fall with 16 (3.1%) of men and 26 (7.5%) of women cases (P < 0.001). The risk of death in patients with a Glasgow Coma Scale (GCS) score of 3 to 8 was 46.22 (95% CI = 18.66 to 114.45) times more than patients with a GCS score of 13 to 15. Conclusion: Data on self-harm and suicide traumatology were gathered from eleven hospitals in Iran. Our findings indicated differences in the distribution of age and marital status between genders. Moreover, both genders used similar methods for self-harm and suicide, and gender did not affect the outcome.

Rationale: Rabies is a zoonotic disease with a high mortality, primarily transmitted through the bite of infected mammals, particularly dogs and cats. Despite being a well-known disease since ancient times, it continues to cause a significant number of human deaths worldwide, with approximately 65 000 fatalities reported annually. Patient concerns: We present two fatal cases of rabies in a 12-year- old immigrant boy and a 7-year-old boy. The first case was subject to a 24-hour delay in receiving appropriate medical attention and rabies preventive measures due to the lack of awareness among emergency hospital staff, leading to the administration of wound dressing only. The second case received timely rabies immunoglobulin administration; however, there was a 4-day delay in administering the fourth dose of the rabies vaccine, despite presenting evident symptoms of rabies. Diagnosis: Postmortem examination of brain samples from both patients confirmed the presence of rabies virus. Interventions: Post-exposure prophylaxis for rabies. Outcomes: Both patients were admitted to the hospital after the manifestation of rabies-related symptoms, with the 12-year-old child seeking medical care 47 days after the animal bite and the 7-year-old child seeking medical care 58 days after the exposure. Finally, the first patient died after 27 days and the second patient died after 40 days of hospitalization. Lessons: There is an urgent need for heightened awareness and education among both healthcare professionals and the public regarding the urgency of seeking immediate medical attention after potential rabies exposure. Timely recognition and initiation of post-exposure prophylaxis are pivotal in preventing the progression of the disease. Strengthening surveillance and reporting systems, coupled with continuous training for healthcare professionals, can contribute to early detection and management of rabies cases.

Background: Various factors, including family associations, school culture, personality traits, and lifestyle play a fundamental role in the development of drug addiction. This study aimed to investigate how the association of family communication patterns and school culture affect addiction tendencies among high school students in Yazd, Iran.Methods: This cross-sectional study was conducted in January 2021. A total number of 420 people were selected using the random multi-stage sampling method. To collect data, addiction tendency scale, family communication pattern and school culture questionnaires were used. Data analysis was done using SPSS version 24, Pearson’s correlation coefficient, descriptive statistics, T-Tests and ANOVA.Results: The mean±SD for addiction tendency, family communication patterns and school culture was 40.24±7.65, 65.84±5.34, and 45.69±9.24, respectively. This study showed a statistically significant association between the mean score for addiction tendency and gender (P=0.01) and economic status (P=0.02). Among the two components of communication patterns, alignment orientation (R=-0.31, P

Abstract The integration of artificial intelligence (AI) into health care has seen remarkable advancements, with applications extending to animal health. This article explores the potential benefits and challenges associated with employing AI chatbots as tools for pet health care. Focusing on ChatGPT, a prominent language model, the authors elucidate its capabilities and its potential impact on pet owners' decision‐making processes. AI chatbots offer pet owners access to extensive information on animal health, research studies and diagnostic options, providing a cost‐effective and convenient alternative to traditional veterinary consultations. The fate of a case involving a Border Collie named Sassy demonstrates the potential benefits of AI in veterinary medicine. In this instance, ChatGPT played a pivotal role in suggesting a diagnosis that led to successful treatment, showcasing the potential of AI chatbots as valuable tools in complex cases. However, concerns arise regarding pet owners relying solely on AI chatbots for medical advice, potentially resulting in misdiagnosis, inappropriate treatment and delayed professional intervention. We emphasize the need for a balanced approach, positioning AI chatbots as supplementary tools rather than substitutes for licensed veterinarians. To mitigate risks, the article proposes strategies such as educating pet owners on AI chatbots' limitations, implementing regulations to guide AI chatbot companies and fostering collaboration between AI chatbots and veterinarians. The intricate web of responsibilities in this dynamic landscape underscores the importance of government regulations, the educational role of AI chatbots and the symbiotic relationship between AI technology and veterinary expertise. In conclusion, while AI chatbots hold immense promise in transforming pet health care, cautious and informed usage is crucial. By promoting awareness, establishing regulations and fostering collaboration, the article advocates for a responsible integration of AI chatbots to ensure optimal care for pets.

BackgroundDiabetes mellitus (DM) poses a significant threat to public health, and the anticipated surge of over 100% in the age-standardized prevalence of type 2 diabetes in Iran between 2021 and 2050 underscores the pressing need for focused attention. The rationale for estimating the prevalence of type 2 diabetes in Iran becomes even more compelling when considering the potential cascading effects on the healthcare system, quality of life, and economic burden. The aim of this study was to estimate the prevalence and trends of DM from 1996 to 2023 in the Islamic Republic of Iran.MethodsUp to July 2023, without deadlines, the search for appropriate articles in Persian and English. Iranian sources including SID, Magiran, and Element were included in the databases, along with foreign ones like PubMed/MEDLINE, Web of Science, Science Direct, Embase, Scopus, ProQuest, and Google Scholar. Using the JBI quality checklist, the study’s level of quality was evaluated. Version 14 of STATA was used to carry out the statistical analysis. The Dersimonian and Liard random-effects models were used because of heterogeneity. To investigate the causes of heterogeneity, subgroup analysis and univariate meta-regression were utilized. Sensitivity analysis was then carried out to see how each study’s findings affected the final findings. The prevalence pattern over time was also followed using cumulative meta-analysis.ResultsThere were 53 studies in all, with a combined sample size of 1,244,896 people. Men were predicted to have a type 2 diabetes prevalence of 10.80% (95% CI: 9.1–12.4), while women were assessed to have a prevalence of 13.4% (95% CI: 11.6–15.3). Additionally, the prevalence of diabetes was much higher in the 55–64 age group, coming in at 21.7% (95% CI: 17.5–25.0). The anticipated prevalence of diabetes was 7.08% for 1988 to 2002, 9.05% for 2003 to 2007, 9.14% for 2008 to 2012, 15.0% for 2013 to 2017, and 13.40% for 2018 to 2023, among other time periods. Geographically, type 2 diabetes was most prevalent in Khuzestan (15.3%), followed by Razavi Khorasan (14.4%), Qazvin (14.3%), and Yazd (12.6%).ConclusionThe prevalence of type 2 diabetes was estimated at 10.8%, highlighting variations across gender, age groups, and geographic regions that underscore the necessity for specific interventions. These findings advocate for proactive measures, including tailored screening and lifestyle modification programs. The notable temporal increase from 2013 to 2017 signals the need for policymakers and healthcare practitioners to develop effective strategies, anticipating and addressing the potential future burden on the healthcare system.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023437506, identifier: CRD42023437506.

Abstract The current study aims to assess the prevalence of different genera of Rickettsiales, intracellular bacteria, in dogs across various regions of Iran. Rickettsiales, as zoonotic pathogens, can have various manifestations in different species, including immunosuppression, anaemia and neuropathy. Due to their close interactions with people and livestock, dogs can serve as reservoirs and transmit these pathogens to humans and other animals. The data from this research can be valuable for managing and controlling related diseases and complications in Iran and possibly neighbouring countries. Pertinent data for this study was gathered without time limitations until 1 March 2022, from different databases. Of all the inspected studies, 26 were eligible based on the inclusion criteria. The Egger test result and asymmetry in the funnel plot revealed significant publication bias; therefore, the meta‐analysis model was corrected with the trim‐and‐fill method. After correction, the prevalence of rickettsial infections among dogs varies by genus – 20.1% for Anaplasma spp. and 10% for Ehrlichia spp. – with an overall prevalence estimated at 18.3% by random‐effects analysis. The highest and lowest estimated pooled prevalences were associated with the southwestern (38.5%) and southern (0.3%) provinces of Iran, respectively. The pooled prevalence of rickettsial infection was higher in female dogs (OR = 1.198; p

Background: Breast cancer (BC) is the most prevalent neoplasm in females globally, with an increasing incidence trend almost in all regions. Previous studies have indicated that non-alcoholic fatty liver disease (NAFLD) may be an emerging risk factor for extrahepatic cancers, including BC. This systematic review and meta-analysis study aimed to determine the association between NAFLD and the development of BC.Method: Data were systematically collected without time limitation until 21 April 2022, from the following electronic databases: PubMed, Scopus, Embase, Web of Science, and Google Scholar. The association between NAFLD and BC with odds ratio (OR) was calculated with a 95% confidence interval (CI) and presented via forest plots. Hazard ratios along with incidence rate ratios in the cohort studies transformed into OR.Results: According to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) and the inclusion criteria herein, 11 eligible studies were obtained from various countries. The pooled OR of NAFLD as a risk of developing BC, using a random-effects model, was estimated at 1.61 (95% CI: 1.30-2.00) (Q-value: 51.35, I2 = 80.52%, P < 0.0001). Multivariate meta-regression analysis showed that the publication year-, country-, detection method-, study design-, and body mass index-adjusted status did not cause heterogeneity. The Egger's regression (P = 0.32) and the symmetry in the funnel plot showed no publication bias in the studies.Conclusion: The present research revealed that NAFLD had a significant association with BC, independent of traditional risk factors.

Abstract Objective The complications associated with miscarriages have surfaced as a major concern in maintaining women’s physical and mental health. The present study evaluated the efficacy of three medication regimes for the complete expulsion of retained intrauterine tissues in patients who underwent a miscarriage. Methods In this randomized clinical trial, 90 patients participated with their gestational age below 12 weeks, each having undergone a recent miscarriage. After being screened for underlying diseases and coagulative blood disorders, they were randomly allocated into three groups. For the first group, labeled as the control group, misoprostol was administered alone. In contrast, the combination of misoprostol plus methylergometrine and misoprostol plus oxytocin was prescribed for the second and third groups, respectively. Further, the data obtained were analyzed by descriptive and inferential statistics using Stata software version 14. Results The mean age of participants and gestational age were 29.76 ± 5.53 years and 8.23 ± 2.29 weeks, respectively. There was no significant difference between the three treatment groups regarding the amount of bleeding after the abortion(P = 0.627). Regarding pain severity, the group that received Misoprostol plus Methylergometrine had less pain intensity than the other two groups(p = 0.004). The mean rate of RPOC expulsion was in the Misoprostol plus Oxytocin (9.68 ± 10.36) group, Misoprostol plus Methylergometrine (11.73 ± 12.86), and Misoprostol groups (19.07 ± 14.31)(p = 0.013). The success rate in outpatient medical abortion in the misoprostol plus oxytocin and misoprostol plus methylergonovine group was 93.33%, but in patients treated by misoprostol alone was 83.33%. Conclusion The effectiveness of the drugs in the two drug groups combined with oxytocin and methylergometrine is higher than the misoprostol group alone. An outpatient approach was deemed more satisfactory against surgical maneuvers and hospitalizations by patients since family support influenced their pain coping mechanism. Trial registration The trial was registered in the Iranian registry of clinical trials on 04/10/2019. ( https://fa.irct.ir/trial/34519 ; registration number: IRCT20150407021653N19).

Background: It has been known that healthy nutrition is important in increasing immunity and reducing diseases. Lack of some nutrients can lead to a decrease in the function of the immune system and, as a result, an increase in the probability of infections or their exacerbation. This study was conducted with the aim of investigating knowledge, attitude and nutritional practice related to COVID-19 in the students of Kurdistan University of Medical Sciences. Methods: The present descriptive and analytical study was conducted in 2022 on 350 students of Kurdistan University of Medical Sciences. The research tools included a demographic checklist and a questionnaire of knowledge, attitude and nutritional practice related to COVID-19, used in a similar study. The collected data were analyzed by SPSS 24 software using descriptive statistics and analysis of variance, independent t-test, and Pearson's correlation coefficient. Results: The mean age of the subjects was 22.15±4.98 year. The mean scores of knowledge, attitude, and nutritional behavior of students of Kurdistan University of Medical Sciences regarding COVID-19 were 23.17 ±4.17, 18.04 ±3.29, and 41.64 ±7.16, respectively. The results showed that there was a statistically significant relationship between the knowledge score with the educational level and history of infection with COVID-19 and the nutritional practice score with the variable of history of infection with COVID-19 (P < 0.05). Also, there was a positive and significant correlation between Knowledge, attitude, and practice. Conclusion: According to the results of the study, the studied students had a relatively good knowledge, attitude, and practice towards nutritional issues related to COVID-19; however, there is still room for improvement.

Background: Through the fifth wave of the Covid-19 outbreak in Jahrom, the fatality and incidence of the virus increased. The quick spread of infection is one of the causes of this dreadful situation. Therefore, recognizing the future epidemic trend can be a useful instrument to decrease mortality and morbidity. This study aimed to determine the time trends and select the best model to predict the sixth wave of the COVID-19 outbreak using ARIMA models.Methods: We used daily data of 9533 hospital cases (Suspected and PCR-confirmed COVID-19 cases) between 4th March 2020 and 31st December 2021. Nine different ARIMA models were fitted to our data. Autocorrelation functions (ACF) and partial autocorrelation (PACF) plots were used to determine model parameters. Likelihood-ratio test for comparison of the reduced and full model was used. In addition, Akaike Information Criteria (AIC) was also used to choose the final model. Data were analyzed by STATA 14 software with a significant level of 0.05.Results: The ARIMA (3, 0, 3) model was selected among the potential models, with lower AIC (999) and MAPE (3.18%) values. This model showed that the daily number of hospitalized patients may increase from 5.85 (2.16-15.79) to 8.55 (1.47-49.48) in two months. By March 01, 2022, the predictable daily hospitalized cases could reach 468.36 (03.79-2209.88).Conclusion: Time series models is a useful tool for predictingthe hospitals’ admission trend during an epidemic. Thus, they can be used as early warning models in the readiness of hospital systems during epidemics.

Background: The overall prevalence of metabolically unhealthy (MU) phenotype in Iranian adults is a matter of debate. This study aimed to estimate the prevalence and determinants of metabolically unhealthystate in people over 30 years old in the general population in Southern Iran.Methods: In this cross-sectional population-based study, 891 participants aged ≥30 were selected using a multi-stage cluster sampling method. The study examined age, sex, education, marital status, smoking behavior, weight, height, blood pressure, fasting blood sugar, and lipid profiles. MU was defined as the existence of at least two of four constituents of metabolic abnormalities based on ATP III criteria. Data analysis was carried out in Stata version 14. Finally, a logistic regression was performed to identify the risk factors for MU prevalence.Results: The overall prevalence of MU was 49.4%, corresponding to 37.5%, 55.6%, and 60.2% of normal weight, overweight, and obese participants, respectively. MU prevalence significantly increased from 30.6% in participants aged 30-39 years to 69.7% in participants aged 60 years or older. The results of multivariate logistic regression showed that dyslipidemia (OR=2.98, CI95%:2.13-4.16), high LDL (OR=2.73, CI95%:1.77-4.20), obesity (OR=2.83, CI95%:1.84-4.36), overweight (OR=2.13, CI95%:1.53- 2.98), and higher age (OR=1.04, CI95%:1.03-1.05) was positively associated with the MU state.Conclusion: Metabolically unhealthy state is a public health problem in the study area. In terms of public health, screening for obesity and other metabolic disorders should be regularly performed in clinical practice to take appropriate preventive measures.

Abstract Background Pure testicular choriocarcinoma is a rare type of non-seminomatous germ cell tumor extremely poor prognostic with the tendency to bleed at the metastatic site. At the time of the diagnosis, 70% of patients have metastatic lesions. Depending on the site of the metastasis, symptoms vary. Gastrointestinal involvement is seen in less than 5% of cases, mostly in the duodenum. Case presentation We present a 47 years old male with testicular choriocarcinoma involving the jejunum, lung, liver, and kidney presenting with acute abdominal pain, melena, and dyspnea with some paraneoplastic symptoms. The patient had increased, severe and constant pain in the right lower quadrant for the previous four days. Additionally, he was complaining of nausea, vomiting, anorexia, and a history of melena for the last 10 days. Dyspnea on exertion, hemoptysis, and dry cough were the symptoms he was suffering from, for almost one year. The patient’s general appearance was pale, ill, and thin with 10 kg of weight loss during the last some months. The computed tomography (CT) scan reported multiple metastatic lesions in both liver lobes and the left kidney. Pathologic study of the samples of small bowel lesions showed metastatic choriocarcinoma. Following the patient had been referred to an oncologist to start the chemotherapy regime. Finally, the patient has expired after 40 days of his first admission. Conclusions Testicular choriocarcinoma is a rare but fatal malignancy among young men. Gastrointestinal metastases are infrequent involvement represented by melena and acute abdominal pain, obstruction, and mass. Physicians should consider it as a differential diagnosis for acute abdomen and gastrointestinal bleeding causation.

Abstract Background Cervical cancer is a common, and fatal cancer in women worldwide. This cancer is the fourth most common cancer in women after breast, colorectal, and lung cancer. Aims This study aims to investigate the age‐standardized incidence rate (ASR) and the geographical distribution of Cervical Cancer in Iran. Methods This study was designed as a descriptive cross‐sectional investigation. The study sample comprised all individuals registered as cervical cancer patients in the National Cancer Registry system in 2016. The crude rate and ASR for each province were computed independently. Furthermore, we employed ArcMap10.5 software and geographic information system to conduct an analysis of the gathered data. In order to ascertain the spatial distribution and clustering of cervical cancer incidence, we utilized Moran's I, which measures spatial autocorrelation. Results We studied a total of 808 cases of cervical cancer with a median age to be 52.19 years (IQR≈1.35). Among these cases, 685 (84.7%) were diagnosed based on the pathological reports with morphological verification, while 81 patients (10.1%) were clinically identified, and 42 cases (5.2%) were diagnosed using the death certificate‐only method. Squamous cell carcinoma accounted for 61% of all cases (n = 497). The ASR of cervical cancer in Iran was 1.90 per 100 000 populations. The provincial ASR ranged from 0.29 to 5.03 per 100 000, with the highest rates observed in Golestan (5.03), East Azerbaijan (4.07), and Ilam (3.72). We found no clustering patterns in the distribution of provincial crude, age‐specific, and age‐standardized incidence rates (p > .05). Conclusion The incidence of cervical cancer in Iran was lower than the global average, and we did not identify any significant disparities in the incidence rates among the provinces. Although there were differences in incidence rates among the areas, these were not clustered. It is crucial to remember that cervical cancer is still a major public health issue in Iran, and in order to lessen the disease's burden, national initiatives to enhance screening, early identification, and access to efficient treatment should continue to be top priorities.

Abstract Background Chronic health conditions were significantly correlated with an increased clinical severity of coronavirus 2019 (COVID‐19) and a heightened risk of COVID‐19 mortality. This study aims to determine global knowledge, attitudes, and practices (Knowledge Abuse Profile) of the patients with chronic diseases toward COVID‐19. Methods The study was initiated in December 2019 and extended until April 2023, during which an extensive search for relevant English‐language literature was conducted as part of this systematic review and meta‐analysis. Google Scholar, Scopus, PubMed/MEDLINE, Science Direct, Web of Science, EMBASE, Springer, and ProQuest were utilized for the search. The quality of included studies was assessed using a quality rating checklist created by Joanna Briggs Institute for cross‐sectional research. In the STATA software version 14, inverse variance and Cochran Q statistics were used for statistical analysis to assess heterogeneity among the studies. The Dersimonian and Liard random‐effects models were applied in cases where heterogeneity existed. Results A total of 23 studies involving 14,587 patients contributed to this meta‐analysis. These studies comprised 21 studies focused on knowledge, with 6864 participants, 12 studies on attitudes involving 3597 patients, and 12 on practices, encompassing 4126 patients. The pooled estimates for sufficient knowledge, positive attitudes, and COVID‐19 preventive behaviors among chronic disease patients were determined as 48.2% (95% confidence interval [95% CI]: 33.9%–62.5%), 60.8% (95% CI: 46.8%–74.8%), and 58.3% (95% CI: 39.5%–77.0%), respectively. Over the years, there was a consistent decrease in adequate knowledge, positive attitudes, and COVID‐19 preventive behaviors among the population. Specifically, regarding knowledge, the rates declined from 50.2% in 2020 to 49.7% in 2021 and dropped to 45.1%. Similarly, the percentage of individuals with a positive attitude fell, decreasing from 64.1% in 2020 to 60.3% in 2021 and dropping to 57.9% in 2022. Furthermore, COVID‐19 preventive behaviors showed fluctuations, with the rates recorded at 63.7% in 2020, increasing to 75.4% in 2021, and then decreasing to 47% in 2022, in line with the publication dates of included studies. Conclusion The findings of meta‐analysis show a significant decrease in the levels of knowledge, attitudes, and adherence to preventative interventions for COVID‐19 among individuals with chronic diseases. The findings emphasize the need for targeted interventions, and ongoing education to address this trend.

Abstract Background Considering the prevalence of overweight and abdominal obesity in middle-aged women, this study was conducted to determine the effect of empowerment program to reduce sugar consumption based on the Multi-Theory Model (MTM) on Body Mass Index (BMI) and abdominal obesity in women aged 30–60 in Joven. Methods This quasi-experimental study (include descriptive and interventional sections) was conducted on the Joven city, Khorasan Razavi province, Iran country from October 2020 to August 2021. Sampling was performed as a multi-stage cluster. First, a descriptive study was performed among 400 women, and then 128 people who were eligible to enter the interventional phase of the study were selected. In the control group, 63 people and in the intervention group, 65 people were eligible to enter the study. The educational intervention was performed in five 60-minute sessions for groups of 12 people. The instruments included the demographic questionnaire, sugar consumption checklist and researcher-made questionnaire based on MTM constructs. Before the intervention, one, three and six months after the intervention, the questionnaire was completed by both intervention and control groups also measurement of waist circumference and BMI were performed using standard instruments. The obtained data were analyzed by SPSS 17. Results After the educational intervention, there was a significant difference between the intervention and control groups in all the MTM constructs. Also, six months after the educational intervention, BMI, waist circumference and amount of consumption of sugary substances decreased significantly in the intervention group (p

Abstract Background Pregnant women form a specially vulnerable group due to unique changes in pregnancy, leading to a higher risk of getting a severe infection. As severe COVID-19 increases the risk of preeclampsia, preterm delivery, gestational diabetes, and low birth weight in pregnancy, there is a need to enhance pregnant women’s knowledge, attitudes, and practices to prevent these complications. This systematic review and meta-analysis aimed to determine their levels of knowledge, attitudes, and practice (KAP) regarding COVID-19 at the global level. Methods The systematic literature search was conducted in the English language, including Google Scholar, Scopus, PubMed/MEDLINE, Science Direct, Web of Science, EMBASE, Springer, and ProQuest, from the occurrence of the pandemic until September 2022. We used The Newcastle Ottawa scale for cross-sectional studies checklist to evaluate the risk of bias in the studies. Data were extracted by a Microsoft Excel spreadsheet and analyzed by STATA software version 14. We also employed Cochran Q statistics to assess the heterogeneity of studies and utilized Inverse variance random-effects models to estimate the pooled level of pregnant women’s KAP towards COVID-19 infection prevention. Results Based on the preferred reporting items for systematic reviews and meta-analyses (PRISMA) and inclusion criteria, 53 qualified studies were acquired from several countries. In total, 51 articles (17,319 participants) for knowledge, 15 articles (6,509 participants) for attitudes, and 24 articles (11,032 participants) for practice were included in this meta-analysis. The pooled good knowledge, positive attitude, and appropriate practice in pregnant women were estimated at 59%(95%CI: 52–66%), 57%(95%CI: 42–72%), and 53%(95%CI: 41–65%), respectively. According to subgroup analysis, the level of knowledge, attitude, and practice were 61%(95%CI: 49–72), 52%(95%CI: 30–74), and 50%(95%CI: 39–60), respectively, in Africa, and 58.8%(95%CI: 49.2–68.4), 60%(95%CI: 41–80) and 60% (95%CI: 41–78), respectively, in Asia. Conclusion The Knowledge, attitude, and practice towards COVID-19 infection prevention in pregnant women were low. It is suggested that health education programs and empowerment of communities, especially pregnant women, about COVID-19 continue with better planning. For future studies, we propose to investigate the KAP of COVID-19 in pregnant women in countries of other continents and geographical regions.

Summary: Background: The causes for immune-mediated inflammatory diseases (IMIDs) are diverse and the incidence trends of IMIDs from specific causes are rarely studied. The study aims to investigate the pattern and trend of IMIDs from 1990 to 2019. Methods: We collected detailed information on six major causes of IMIDs, including asthma, inflammatory bowel disease, multiple sclerosis, rheumatoid arthritis, psoriasis, and atopic dermatitis, between 1990 and 2019, derived from the Global Burden of Disease study in 2019. The average annual percent change (AAPC) in number of incidents and age standardized incidence rate (ASR) on IMIDs, by sex, age, region, and causes, were calculated to quantify the temporal trends. Findings: In 2019, rheumatoid arthritis, atopic dermatitis, asthma, multiple sclerosis, psoriasis, inflammatory bowel disease accounted 1.59%, 36.17%, 54.71%, 0.09%, 6.84%, 0.60% of overall new IMIDs cases, respectively. The ASR of IMIDs showed substantial regional and global variation with the highest in High SDI region, High-income North America, and United States of America. Throughout human lifespan, the age distribution of incident cases from six IMIDs was quite different. Globally, incident cases of IMIDs increased with an AAPC of 0.68 and the ASR decreased with an AAPC of −0.34 from 1990 to 2019. The incident cases increased across six IMIDs, the ASR of rheumatoid arthritis increased (0.21, 95% CI 0.18, 0.25), while the ASR of asthma (AAPC = −0.41), inflammatory bowel disease (AAPC = −0.72), multiple sclerosis (AAPC = −0.26), psoriasis (AAPC = −0.77), and atopic dermatitis (AAPC = −0.15) decreased. The ASR of overall and six individual IMID increased with SDI at regional and global level. Countries with higher ASR in 1990 experienced a more rapid decrease in ASR. Interpretation: The incidence patterns of IMIDs varied considerably across the world. Innovative prevention and integrative management strategy are urgently needed to mitigate the increasing ASR of rheumatoid arthritis and upsurging new cases of other five IMIDs, respectively. Funding: The Global Burden of Disease Study is funded by the Bill and Melinda Gates Foundation. The project funded by Scientific Research Fund of Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital (2022QN38).

Background: Nutrition and dietary habits is one of the determinant factor on glycemic control of diabetes mellitus. This study aims to investigate the association between type 1 diabetes mellitus (T1DM) and diet in the first two years of life as well as a select group of demographic variables. Methods: This case-control study was conducted on 76 children with T1DM and 209 non-diabetic children selected through convenience sampling from the population of people visiting the community health centers of the city of Jahrom, Iran. The required data were collected by a questionnaire of diet and demographic information completed by the mothers of the children. The data were analyzed using logistic regression and adjusted odds ratio. Results: Finally, the results of multiple backward logistic regression showed that the studied factors had a significant association with T1DM (P < 0.05), including body mass index (BMI) less than 18 kg/m2 for mothers before pregnancy (OR: 4.4, 95% CI: 1.61 to 11.97), mothers without a history of diabetes (OR: 0.02, 95% CI: 0.001 to 0.60), mother’s weight before pregnancy (OR: 0.88, 95% CI: 0.84 to 0.91), mother’s excess weight during pregnancy (OR: 0.83, 95% CI: 0.75 to 0.93), exclusive breastfeeding for more than six months (OR: 0.19, 95% CI: 0.03 to 0.96), low weight gain in the first two years of life (OR: 6.98, 95% CI: 2.16 to 22.5), and the breastfeeding less than 12 months (OR: 10.52, 95% CI: 1.62 to 66.64). Conclusion: BMI less than 18 kg/m2 for mothers before pregnancy, low weight gain in the first two years of life, and breastfeeding less than 12 months increased the risk of developing T1DM in children.

Background: Currently, COVID-19 is a global public health problem. This study aimed to estimate the seroprevalence of antibodies related to Covid-19 in the general population in southern Iran.Methods: This cross-sectional population-based study of the seroepidemiological type investigated the serological prevalence of COVID-19 from October to December 2020 in Jahrom, Fars province, Iran. A total of 612 participants were selected using multistage cluster random sampling regardless of age or gender. The dataset in the study included the participants’ demographic information, the history of exposure to COVID-19 patients, the history of PCR tests, and the history of COVID-19 symptoms in previous months. In addition, this study examined the raw and survey weight adjusted estimates with Stata version 14. Finally, logistic regression was performed to identify risk factors for serum prevalence.Results: The participants’ mean age was 38.88±13.91 and the majority were 30 to 49 years (51.4%), with a female preponderance (58.7%). The estimated adjusted seroprevalence was 32.66 (95%CI: 28.93-36.63), with 207 positive cases for either IgG or IgM. The results of multivariable logistic regression showed that seropositivity in the participants was 4.95 times more likely associated with a history of positive PCR test (OR: 4.95, 95%CI: 2.46-10.90) and 2.14 times in patients with a history of muscle pain in previous months (OR: 2.14, 95%CI: 1.03-4.47).Conclusion: The actual number of patients with COVID-19 is significantly higher than the number of cases confirmed by the disease monitoring system based on PCR tests. Therefore, tracking individuals’ contact with confirmed patients using extensive testing and segregation of asymptomatic patients can help control the epidemic.

Background: Visceral leishmaniasis (VL) is a neglected infection currently occurring in some regions of Europe, Asia, Africa, and America. This study was an attempt to determine the temporal patterns of VL from January 2000 to December 2019 in the Ardabil Province of north-western Iran using the Markov Switching Models (MSM).Methods: This descriptive study used monthly data of 602 VL cases during the study period. The data were provided by the Leishmaniasis National Surveillance System (LNSS), the Iran Meteorological Organization (IMO), and Space Agency (SA), and two states were considered for such modelling. Given the Akaike and Bayesian information criterion, the two-state MSM with a five-month lag is an appropriate model.Results: The MSM showed that the probability of staying in the non-epidemic state is 67%, (P11), while that of staying in an epidemic state is 93% (P22). The mean absolute percentage error (MAPE) was 31.63%, and the portmanteau test (Q=19.03, P=0.66) for the residuals of the selected model revealed that the data were completely modelled. The total VL cases in the next 24 months forecasted 14 cases.Conclusion: The MSM has a relatively acceptable predictive power and is useful in planning future interventions with more information about different stages of the epidemic it provides to policymakers for early warning of epidemics.

Background: Since breast milk is one of the ways of transferring toxic elements from the body, breast milk infection in any form can have adverse effects on the development of the baby. This study aims to investigate the effect of education on knowledge, attitude, and practice of breastfeeding mothers about heavy metals transferred by breast milk. Method: In this interventional study, 100 women referring to Abarkooh health centers were selected and randomly divided into case (n = 50) and control (n = 50) groups. The data collection tool was a questionnaire consisting of four parts, including background questions and knowledge, attitude, and practice. Then, eight two-hour classes were held weekly during two months by food health and safety expert in coordination with the test group. At the end of two months after the last training session, the questionnaires were repeated between the two groups (post-test). Results: The mean score of knowledge, attitude, and practice of the mothers in the intervention group after training significantly increased (P < 0.05), while in the control group no significant difference was observed in the variables before and after the intervention. There was a significant difference between mean of knowledge, attitude, and practice in mothers with demographic variables only between knowledge and education level (P < 0.001). Conclusion: The results showed that breastfeeding training program had a positive effect on promoting the knowledge, attitude, and behavior of the mothers. Therefore, it seems that continuous and varied educational programs are required to prevent the occurrence of heavy metal poisoning caused by breast milk and its consequences in infants.

Introduction COVID-19 has negative and sometimes irreversible effects on infertile women. This study aimed to investigate hopelessness and depression in infertile women whose treatment has been delayed due to COVID-19. Methods This case-control study was conducted online on 172 infertile women. The case group included infertile women under treatment whose treatment was delayed during the COVID-19 pandemic, and the control group was selected from infertile women who were not under infertile treatment. This study was conducted between April and December 2021 in Jahrom, Iran. Beck hopelessness standard questionnaire (BHS) and Beck Depression Inventory (BDI) were used to collect data, and p

BackgroundBreast cancer (BC) is the most common cancer in women globally. The North Africa and Middle East (NAME) region is coping hard with the burden of BC. We aimed to present the latest epidemiology of BC and its risk factors in this region.MethodsWe retrieved the data on BC burden and risk factors from the Global Burden of Disease Study 2019 to describe BC status in the 21 countries of the NAME region from 1990 to 2019. We explored BC incidence, prevalence, deaths, disability-adjusted life years (DALYs), and attributable burden to seven risk factors of female BC, namely, alcohol use, diet high in red meat, low physical activity, smoking, secondhand smoke, high body mass index, and high fasting plasma glucose. Decomposition analysis on BC incidence trend was done to find out the contributing factors to this cancer’s growth.ResultsIn 2019, there were 835,576 (95% uncertainty interval: 741,968 to 944,851) female and 10,938 (9,030 to 13,256) male prevalent cases of BC in the NAME region. This number leads to 35,405 (30,676 to 40,571) deaths among female patients and 809 (654 to 1,002) deaths in male patients this year. BC was responsible for 1,222,835 (1,053,073 to 1,411,009) DALYs among female patients in 2019, with a greater proportion (94.9%) of burden in years of life lost (YLLs). The major contributor to female BC incidence increase in the past three decades was found to be increase in age-specific incidence rates of BC (227.5%), compared to population growth (73.8%) and aging (81.8%). The behavioral risk factors were responsible for majority of attributable female BC burden (DALYs: 106,026 [66,614 to 144,247]). High fasting plasma glucose was found to be the risk factor with the largest effect (DALYs: 84,912 [17,377 to 192,838]) on female BC burden.ConclusionThe increasing incidence and burden of BC in the NAME region is remarkable, especially when considering limited resources in the developing countries of this region. Proper policies like expanding screening programs and careful resource management are needed to effectively manage BC burden.

Abstract Background and Aims Oral cancer is now a top priority for non‐communicable illnesses and universal health care plans, according to the WHO. There is no general estimate of the incidence of oral cavity cancer in Iran, despite multiple investigations. The purpose of this study is to evaluate the age‐standardized incidence rate (ASR) of oral cavity cancers in Iran. Method In accordance with the MOOSE (Meta‐analyses of Observational Studies in Epidemiology) Checklist recommendations, this systematic review was conducted. PubMed/MEDLINE, Web of Science, ScienceDirect, Embase, Scopus, ProQuest, and Google Scholar were used as the international databases for the systematic literature search, while SID (Scientific Information Database), Magiran and element were used as the Iranian databases. The heterogeneity of the research will be evaluated by means of the inverse variance and Cochran Q tests, along with random‐effect models. It was determined what caused the heterogeneity using a meta‐regression model. By eliminating experiments one at a time, sensitivity analysis was used. The meta‐analysis was corrected utilizing the Trim‐and‐fill method due to the identification of noteworthy publication bias via the Egger's test and asymmetry of the funnel plot. Results This research incorporated a total of 22 journal articles. The pooled ASR of oral cavity cancer for males and females was estimated at 1.96 (95% CI: 1.65–2.26) (Q statistic = 1118.09, df = 25, p

Summary: Background: The objective of this study is to investigate the trends of exposure and burden attributable to the four main metabolic risk factors, including high systolic blood pressure (SBP), high fasting plasma glucose (FPG), high body-mass index (BMI), and high low-density lipoproteins cholesterol (LDL) in North Africa and the Middle East from 1990 to 2019. Methods: The data were retrieved from Global Burden of Disease Study 2019. Summary exposure value (SEV) was used for risk factor exposure. Burden attributable to each risk factor was incorporated in the population attributable fraction to estimate the total attributable deaths and disability-adjusted life-years (DALYs). Findings: While age-standardized death rate (ASDR) attributable to high-LDL and high-SBP decreased by 26.5% (18.6–35.2) and 23.4% (15.9–31.5) over 1990–2019, respectively, high-BMI with 5.1% (−9.0–25.9) and high-FPG with 21.4% (7.0–37.4) change, grew in ASDR. Moreover, age-standardized DALY rate attributed to high-LDL and high-SBP declined by 30.2% (20.9–39.0) and 25.2% (16.8–33.9), respectively. The attributable age-standardized DALY rate of high-BMI with 8.3% (−6.5–28.8) and high-FPG with 27.0% (14.3–40.8) increase, had a growing trend. Age-standardized SEVs of high-FPG, high-BMI, high-SBP, and high-LDL increased by 92.4% (82.8–103.3), 76.0% (58.9–99.3), 10.4% (3.8–18.0), and 5.5% (4.3–7.1), respectively. Interpretation: The burden attributed to high-SBP and high-LDL decreased during the 1990–2019 period in the region, while the attributable burden of high-FPG and high-BMI increased. Alarmingly, exposure to all four risk factors increased in the past three decades. There has been significant heterogeneity among the countries in the region regarding the trends of exposure and attributable burden. Urgent action is required at the individual, community, and national levels in terms of introducing effective strategies for prevention and treatment that account for local and socioeconomic factors. Funding: Bill & Melinda Gates Foundation.

IntroductionMetabolic risk factors (MRFs) predispose populations to a variety of chronic diseases with a huge burden globally. With the increasing burden of these risk factors in Iran, in this study, we aimed to report the estimated burden attributed to MRFs at national and subnational scales in Iran, from 1990 to 2019.MethodsBased on the comparative risk assessment method of the Global Burden of Disease (GBD) Study 2019, data of deaths and disability-adjusted life years (DALYs) attributable to four top MRFs in Iran including high systolic blood pressure (SBP), high fasting plasma glucose (FPG), high body mass index (BMI), and high low-density lipoprotein (LDL) for the 1990–2019 period, were extracted. The socio-demographic index (SDI) was used to report the data based on the corresponding socio-economic stratifications. The results were reported in national and subnational 31 provinces of Iran to discover disparities regarding the attributable burden to MRFs. Furthermore, we reported the causes of diseases to which the attributable burden to MRFs was related.ResultsOverall, the age-standardized high LDL, high SBP, high BMI, and high FPG-attributed death rate changed by −45.1, −35.6, +2.8, and +19.9% from 1990 to 2019, respectively. High SBP was the leading risk factor regarding attributed age-standardized death rates reaching 157.8 (95% uncertainty interval: 135.3–179.1) and DALY rates reaching 2973.4 (2652.2–3280.2) per 100,000 person-years, in 2019. All rates increased with aging, and men had higher rates except for the +70 years age group. At the subnational level, provinces in the middle SDI quintile had the highest death and DALY rates regarding all four MRFs. Total deaths, DALYs, YLLs and YLDs number by the causes of diseases linked to MRFs increased over the study period. Cardiovascular diseases, diabetes mellitus, and kidney diseases were the main causes of burden of disease attributable to MRFs.ConclusionHerein, we found divergent patterns regarding the burden of MRFs as well as disparities in different regions, sex, and age groups for each risk factor and related causes. This could provide policymakers with a clearer vision toward more appropriate decision-making and resource allocation to prevent the burden of MRFs in Iran.

Abstract Background Chronic kidney disease (CKD) is one of the major global causes of mortality, described as the most neglected chronic disease. This study aimed to determine the prevalence and determinants of CKD in the setting of the Shahedieh cohort study in Yazd, Iran. Methods This cross-sectional study was conducted on adults in the baseline phase of the Shahedieh cohort study in Yazd, Iran. In this study, 9781 participants aged 30–73-year-old were investigated. The data used in this study included demographic and clinical variables and blood samples. Adjusted odds ratios were employed using multivariate logistic regression; meanwhile, population attributable risks for CKD were calculated and reported. Results CKD prevalence was 27.5% (95%CI: 26.57–28.34) in all participants, 24% in male, and 30.3% in female. The results of multivariate logistic regression analysis identified age (OR = 1.89, 95%CI:1.082–1.96), women (OR = 1.62, 95%CI: 1.45–1.79), BMI ≥ 30 (OR = 1.40,95%CI: 1.20–1.62), diabetes (OR = 1.38, 95%CI: 1.22–1.57), hypertriglyceridemia(OR = 1.20, 95%CI: 1.01–1.43), history of cardiovascular disease (OR = 1.20, 95%CI: 1.01–1.43), hypertension (OR = 1.18, 95%CI: 1.04–1.33), smoking (OR = 1.17, 95% CI: 1.02–1.33), LDL ≥ 130 (OR = 1.15, 95%CI: 1.01–1.31), history of kidney stone (OR = 1.14, 95%CI: 1.01–1.32) and hypercholesterolemia (OR = 1.14, 95%CI: 1.01–1.32) as risk factors for CKD. Among individual factors, obesity (11.25%), Hypertriglyceridemia (9.21%), LDL ≥ 130 (7.12%) had the greatest Population-Attributable Fraction, followed by Hypercholesterolemia (5.2%), diabetes (5.05%), smoking (3.73%) and high blood pressure (2.82%). Conclusion The results showed that the main determinants of CKD are potentially modifiable risk factors. Therefore, implementing early detection and screening programs in people at risk as well as preventive measures such as lifestyle modification programs and risk factors controlling can prevent the disease.

Splenectomy is necessary in beta thalassemia major patients when the spleen becomes hyperactive, leading to extreme destruction of erythrocytes. This study assessed the ferritin effect on serum pneumococcal antibody response following pneumococcal vaccination, in patients with beta thalassemia major after splenectomy. In this case series study, convenience sampling was used to recruit 347 splenectomised beta thalassemia patients under the auspices of Jahrom University of Medical Sciences. Demographic data such as age, sex, and time after splenectomy were recorded by a questionnaire. All participants had been splenectomised and received a dose of Pneumovax® 23 vaccine 14 days before surgery. The IgG antibody responses to pneumococcal vaccine and levels of serum specific ferritin were determine by commercial enzyme immunoassay kits. For the analysis, SPSS software version 16 was used. A p-value less than 0.05 was considered statistically significant. Most of the participants (63.4%) were hypo-responders to pneumococcal vaccine. Also, serum anti-pneumococcal IgG antibody was related to post splenectomy duration and serum ferritin (p< 0.001), but not to gender (p> 0.05). An important result was a relation of serum anti-pneumococcal IgG antibody to serum ferritin according to post splenectomy duration groups. Therefore, in three groups of post splenectomy duration, the serum ferritin was higher in hypo-responder than in good responder subjects. Our results indicate that serum anti-pneumococcal IgG antibody decreased with increment of serum ferritin and post splenectomy duration. Thus, there is a need to re-address the approach towards revaccination in this immune-compromised group of patients by administering a booster pneumococcal vaccination in an attempt to recover immunity and reduce morbidity.

Abstract Background and Aims The diabetes is one of the most common noncommunicable diseases, the prevalence of which is increasing worldwide. This study aimed to determine the prevalence, and correlates the factors of diabetes in the setting of Shahedieh cohort study in Yazd, Iran. Method The present study is a cross‐sectional study conducted on the data of the initial stage of Shahdieh Yazd cohort. This study examined the data of 9747 participants aged from 30 to 73 years. The data included demographic, clinical, and blood test variables. Multivariable logistic regression was used to calculate the adjusted odds ratio (OR), and the risk factors of diabetes were studied. Meanwhile, population attributable risks for diabetes were estimated, and reported. Results The prevalence of diabetes was 17.9% (CI95%: 17.1–18.9); 20.5% in women, and 15.4% in men. Based on the results of multivariable logistic regression showed female sex (OR = 1.4, CI95%: 1.24–1.58), waist‐hip ratio (OR = 1.4, CI95%: 1.24–1.58), high blood pressure (OR = 2.1, CI95%: 1.84–2.4), cardiovascular diseases (CVD) (OR = 1.52, CI95%: 1.28–1.82), stroke (OR = 1.91, CI95%: 1.24–2.94), age (OR = 1.81, CI95%: 1.67–1.96), hypercholesterolemia (OR = 1.79, CI95% triglyceride: 1.59–2.02), and low‐density lipoprotein (LDL) (OR = 1.45, CI95%: 1.4–1.51), as risk factors for diabetes. Among the modifiable risk factors, high blood pressure(52.38%), waist‐to‐hip ratio (48.19%), the history of stroke (47.64%), hypercholesterolemia (44.13%), history of CVD (34.21%), and LDL ≥ 130 (31.03%) had the greatest population‐attributable, respectively. Conclusion The results showed that some of the main determinants of diabetes are the modifiable risk factors. Therefore, implementing early detection, and screening programs for people at risk and preventive measures, such as lifestyle modification programs, and control of risk factors can prevent this disease.

Abstract Background and Aims Antimicrobial resistance (AMR) was taken as one of the high‐priority long‐lasting public health issues, although it might have been underrated in terms of COVID‐19 pandemic emergence. Regarding limited data on assessing the pandemic effect on AMR trend in Iran, this study aimed to describe the epidemiology of antibiotics resistance during the COVID pandemic in southern Iran. Methods This descriptive study was conducted on 2675 patients' samples collected and processed in a referral COVID‐19 center hospital in southern Iran from March 21, 2019, to February 18, 2020 (prepandemic), and February 19, 2020, to March 21, 2021 (pandemic). Susceptibility test results in sensitivity and resistance levels were compared in prepandemic and pandemic periods. Results Compared to prepandemic, the inpatient number has increased almost three times. On the other hand, there are around four times fewer outpatients now. More than 85% of the specimens were found in urine samples. In all, 92.22% of all bacteria samples were Gram‐negative isolates, with Escherichia coli accounting for 59.19% of them. The change rate of Gram‐negative bacteria resistance to antimicrobials is an average of 7.74% (p

PURPOSE This study aimed to assess alterations in serum creatine kinase (CK) and lactate dehydrogenase (LDH) levels after performing a lactate tolerance exercise test (LTET) in elite male swimmers. METHODS Fourteen male adolescent swimmers participated in this study. All subjects performed LTET (8×100-meter swimming) with a 1-minute recovery interval between eight trainings. Plasma CK and LDH (markers of muscle damage) levels were measured 30 minute before and 24 hours after the test. A paired t-test was used for statistical analysis of data. RESULTS Plasma CK and LDH levels increased immediately after LTET as compared to the values 30 minutes prior to exercise (188.91±34.04 vs. 148.83±29.63 mg/dL, p=.029; 318.17±53.89 vs. 272.08±52.93 mg/dL, p=.010, respectively). Both CK and LDH levels displayed a decreasing trend 24 hours post-LTET; however, there was no significant difference immediately after the test. CONCLUSIONS Plasma CK and LDH levels increased following LTET, which is representative of muscle damage.

Introduction: Systemic lupus erythematosus is an autoimmune progressive connective tissue disease characterized by multiple organ involvement and a highly variable clinical course. The aim of this study was to predict the health-related quality of life of women with lupus based on perceived stress, fear of perceptual body image and psychological resilience. Methods: This descriptive-analytical study was performed on 189 women with lupus in Hafez Hospital in Shiraz in 2019. Data were collected through the quality of life questionnaire (LupusQol), perceived stress questionnaire (PSS-14), body image fear inventory (BICI), and Conners and Davidson Technology Questionnaire, and they were analyzed using SPSS version 16 software with descriptive statistics and linear regression. Results: The mean age and duration of the disease were 40.37±9.47 and 9.45±6.01 years, respectively. Based on the level of education, 43.79% of the patients were undergraduates, 86.8% were housewives and 57.7% were in the active phase of the disease. The mean score of resilience was 67.56±16.07, quality of life 57.30±22.68, stress 25.31±7.78 and fear of body image was 37.07±13.96. Stress, fear of body image, resilience, disease phase, education and occupation accounted for 52% of the total quality of life variability. Conclusion: The quality of life of the women with lupus is affected by the variables such as stress, fear of body image and resilience. Thus, the higher the stress and fear of body image in women with lupus and the lower the rate of resilience, the lower the quality of life.

Background: Dysentery is an inflammatory bowel disease (IBD) infected by micro-organisms invading the intestinal mucosa.Objectives: This study sought to determine the epidemiologic profile of this disease and its related factors in South Khorasan Province, Iran.Methods: This cross-sectional study was conducted on 1181 patients with dysentery during 2016-2020 in South Khorasan Province. The data collection tool was the individual examination form completed in the diseases surveillance system, approved by Diseases Control of Ministry Center of Health and Medical Education. Data were analyzed using SPSS 18 software.Results: The highest prevalence was observed in counties (i.e., Sarbisheh, Zirkooh, Darmiyan, and Nehbandan) sharing a border with Afghanistan. The highest prevalence of the disease was reported in men (n=639, 54.1%) and villagers (n=702, 59.4%). As well, the age group under 6 years old had the highest frequency of the affected cases (n=110, 30.6%). The most common causes of dysentery were connected with the genus Shigella (48.2%) and E. coli (30.9%).Conclusion: The genus Shigella and E. coli were found to be the most important causes of dysentery in South Khorasan Province, Iran. In addition, the highest prevalence of diarrheal diseases had been observed in counties located on the borderlines.

Nucleic acids are programmable materials that can self-assemble into defined or stochastic three-dimensional network architectures. Various attributes of self-assembled, cross-linked Deoxyribonucleic acid (DNA) hydrogels have recently been investigated, including their mechanical properties and potential biomedical functions. Herein, for the first time, we describe the successful construction of pure DNA aerogels and DNA-wrapped carbon nanotube (CNT) composite (DNA-CNT) aerogels via a single-step freeze-drying of the respective hydrogels. These aerogels reveal highly porous and randomly branched structures with low density. The electrical properties of pure DNA aerogel mimic that of a simple capacitor; in contrast, the DNA-CNT aerogel displays a fascinating resistive switching behavior in response to an applied bias voltage sweep reminiscent of a volatile memristor. We believe these novel aerogels can serve as a platform for developing complex biomimetic devices for a wide range of applications, including real-time computation, neuromorphic computing, biochemical sensing, and biodegradable functional implants. More importantly, insight obtained here on self-assembling DNA to create aerogels will pave the way to construct novel aerogel-based material platforms from DNA coated or wrapped functional entities.

Abstract Background and Aims Suicide is a global public health issue. The covid‐19 epidemic has led to disturbance in daily life and economic activity. It is assumed that increased stress and anxiety cause suicide. This study aimed to describe the causes and methods of committing suicide during the COVID pandemic. Methods This descriptive study was conducted on all outpatients, inpatients, and those who died during the period from March 21, 2021 to March 20, 2022 due to suicide attempts, referred to hospitals and clinics affiliated with Jahrom University of Medical Sciences or were identified by the social emergency and welfare organization. Results A total of 330 suicide attempters with an average age of 26.74 ± 0.64 years were studied. They were 220 women (66.67%), 159 single (48.18%), and 309 (73.64%) people who had diplomas and high school degrees. In general, the three main reasons for committing suicide were emotional issues and problems with 169 people (51.21%), family violence with 127 people (38.48%), and economic issues and problems with 90 people (27.27%). In terms of suicide manners, 283 people (85.76%) used medicine (or pharmaceuticals), 16 people (4.85%) used agricultural pesticides, and 11 people (3.33%) used rodenticides. Furthermore, 164 people (49.70%) suffered from depression, 94 people (28.49%) were children of divorce, 60 people (18.18%) were drug users, 151 people (45.76%) had a history of alcohol consumption, and 116 people (35.15%) had a history of committing suicide. A total of 6 cases of complete suicide (leading to death) have occurred. Conclusion The most important factors for suicide throughout the covid‐19 epidemic were emotional issues, marital incompatibility, and economic issues. Medicine poisoning was the most important method of committing suicide. In times of crisis, a multisectoral public health approach is needed to prevent increased anxiety, stress, and subsequent suicide attempts.

BackgroundProstate cancer (PCa) is the second most prevalent cancer among men worldwide. This study presents estimates of PCa prevalence, incidence, death, years-of-life-lost (YLLs), years-lived-with-disability (YLDs), disability-adjusted-life-years (DALYs), and the burden attributable to smoking during 1990-2019 in North Africa and Middle East using data of Global Burden of Diseases (GBD) Study 2019.MethodsThis study is a part of GBD 2019. Using vital registration and cancer registry data, the estimates on PCa burden were modeled. Risk factor analysis was performed through the six-step conceptual framework of Comparative Risk Assessment.ResultsThe age-standardized rates (95% UI) of PCa incidence, prevalence, and death in 2019 were 23.7 (18.5-27.9), 161.1 (126.6-187.6), and 11.7 (9.4-13.9) per 100,000 population. While PCa incidence and prevalence increased by 77% and 144% during 1990-2019, respectively, the death rate stagnated. Of the 397% increase in PCa new cases, 234% was due to a rise in the age-specific incidence rate, 79% due to population growth, and 84% due to population aging. The YLLs, YLDs, and DALYs of PCa increased by 2% (-11.8-23.1), 108% (75.5-155.1), and 6% (-8.9-28.1). The death rate and DALYs rate attributable to smoking have decreased 12% and 10%, respectively. The DALYs rate attributable to smoking was 37.4 (15.9-67.8) in Lebanon and 5.9 (2.5-10.6) in Saudi Arabia, which were the highest and lowest in the region, respectively.ConclusionsThe PCa incidence and prevalence rates increased during 1990-2019; however, the death rate stagnated. The increase in the incidence was mostly due to the rise in the age-specific incidence rate, rather than population growth or aging. The burden of PCa attributable to smoking has decreased in the past 30 years.