Interaction between hepatitis B, hepatitis C and smoking in the development of hepatocellular carcinoma: a systematic review and meta-analysis.

BACKGROUND: This meta-analysis reports the relationship between hepatitis B virus (HBV), hepatitis C virus (HCV), smoking and their combined impact on the development of hepatocellular carcinoma (HCC). METHODS: We conducted a systematic search of PubMed, Web of Science and Scopus databases up to 15 July 2023. Observational studies investigating the association between HBV, HCV and smoking in the development of HCC were included. We assessed between-study heterogeneity using the I2 statistics. The effect sizes were estimated as odds ratio (OR) with 95% confidence intervals (CIs) using a random-effects model. RESULTS: Out of 20 794 studies identified in the initial search, 32 observational studies involving 22 282 participants met the inclusion criteria. Our meta-analysis showed that the combined impact of HBV and smoking was associated with an OR of 19.81 (95% CI: 14.77, 26.58), HCV and smoking was associated with an OR of 24.86 (95% CI: 12.41, 49.79), and coinfection of HBV and HCV was associated with an OR of 32.58 (95% CI: 20.57, 51.60). CONCLUSIONS: Our findings indicate a significant interaction between HBV, HCV and smoking in the development of HCC and highlight the importance of addressing smoking cessation and viral hepatitis prevention and treatment as potential strategies for reducing HCC.

Global forecasting of chronic kidney disease mortality rates and numbers with the generalized additive model.

BACKGROUND: Chronic kidney disease (CKD) is an important public health problem worldwide; therefore, forecasting CKD mortality rates and death numbers globally is vital for planning CKD prevention programs. This study aimed to characterize the temporal trends in CKD mortality at the international level from 1990 to 2019 and predict CKD mortality rates and numbers until 2030. METHODS: Data were obtained from the Global Burden of Disease 2019 Study. A joinpoint regression model was used to estimate the average annual percentage change in CKD mortality rates and numbers. Finally, we used a generalized additive model to predict CKD mortality through 2030. RESULTS: The number of CKD-related deaths worldwide increased from 591.80 thousand in 1990 to 1425.67 thousand in 2019. The CKD age-adjusted mortality rate increased from 15.95 per 100,000 people to 18.35 per 100,000 people during the same period. Between 2020 and 2030, the number of CKD deaths is forecasted to increase further to 1812.85 thousand by 2030. The CKD age-adjusted mortality rate is expected to decrease slightly to 17.76 per 100,000 people (95% credible interval (CrI): 13.84 to 21.68). Globally, it is predicted that in the next decade, the CKD mortality rate will decrease in men, women, all subgroups of disease etiology except glomerulonephritis, people younger than 40 years old, and all groupings of countries based on the sociodemographic index (SDI) except high-middle-SDI countries. CONCLUSIONS: The CKD mortality rate is predicted to decrease in the next decade. However, more attention should be given to people with glomerulonephritis, people over 40 years old, and people in high- to middle-income countries because the mortality rate due to CKD in these subgroups is expected to increase until 2030.

Risk factors associated with underweight in children aged one to two years: a longitudinal study.

BACKGROUND: Underweight is a prevalent health issue in children. This study aimed to identify factors associated with underweight in children aged 1-2 years in Hamadan city. Unlike the studies conducted in this field, which are cross-sectional and do not provide information on the effect of age changes on underweight, our longitudinal approach provides insights into weight changes over time. On the other hand, this study focuses on the high-risk age group of 1 to 2 years, which has only been addressed in a few studies. METHODS: In this longitudinal study, 414 mothers with 1 to 2 year-old children referred to the health centers of Hamadan city, whose information is in the SIB system, a comprehensive electronic system, were examined to identify factors related to underweight. The response variable was weight-for-age criteria classified into three categories: underweight, normal weight, and overweight. A two-level longitudinal ordinal model was used to determine the factors associated with underweight. RESULTS: Of the children studied, 201 (48.6%) were girls and 213 (51.4%) were boys. Significant risk factors for underweight included low maternal education (AOR = 3.56, 95% CI: 1.10-11.47), maternal unemployment (AOR = 3.38, 95% CI: 1.05-10.91), maternal height (AOR = 0.85, 95% CI: 0.79-0.92), lack of health insurance (AOR = 2.85, 95% CI: 1.04-7.84), gestational age less than 24 years (AOR = 3.17, 95% CI: 16.28-0.97), child age 12-15 months (AOR = 2.27, 95% CI: 1.37-3.74), and child's birth weight (AOR = 0.63, 95% CI: 0.70-0.58). CONCLUSION: Based on the results of the present study, it seems that the possibility of being underweight among children is more related to the characteristics of mothers; therefore, taking care of mothers can control some of the weight loss of children.

A dose-response meta-analysis of the relationship between number of pregnancies and risk of gynecological cancers.

BACKGROUND: Despite several investigations, the association between the number of pregnancies and gynecological cancers remains inconclusive. To address this issue, we conducted a dose-response meta-analysis of observational studies. METHODS: We searched PubMed, Web of Science, and Scopus databases up to Jun 8, 2023, to identify observational studies that examined the association between the number of pregnancies and gynecologic cancers. To assess the heterogeneity across studies, we used the χ2 test and I2 statistics. We also explored the possibility of publication bias using Begg's and Egger's tests. The overall effect sizes were reported as odds ratios (ORs) with a 95% confidence interval (CI) using a random-effects model. RESULTS: Out of the 87,255 studies initially identified, a total of 101 studies involving 8,230,754 participants were included in the final meta-analysis. Our analysis revealed a positive trend between the number of pregnancies and cervical cancer; however, this association was not found to be statistically significant except for fifth pregnancy. Conversely, our findings showed a significant decreasing trend between the number of pregnancies and the risk of endometrial and ovarian cancers. There was insufficient evidence to establish a relationship between the number of pregnancies and the risk of vaginal, vulvar, and fallopian tube cancers. CONCLUSIONS: Our study found a positive trend between the number of pregnancies and cervical cancer and a significant decreasing trend between the number of pregnancies and endometrial and ovarian cancers. These findings may have implications for counseling women about their reproductive health and the potential risks and benefits of pregnancy.

Outbreak detection algorithms based on generalized linear model: a review with new practical examples.

Public health surveillance serves a crucial function within health systems, enabling the monitoring, early detection, and warning of infectious diseases. Recently, outbreak detection algorithms have gained significant importance across various surveillance systems, particularly in light of the COVID-19 pandemic. These algorithms are approached from both theoretical and practical perspectives. The theoretical aspect entails the development and introduction of novel statistical methods that capture the interest of statisticians. In contrast, the practical aspect involves designing outbreak detection systems and employing diverse methodologies for monitoring syndromes, thus drawing the attention of epidemiologists and health managers. Over the past three decades, considerable efforts have been made in the field of surveillance, resulting in valuable publications that introduce new statistical methods and compare their performance. The generalized linear model (GLM) family has undergone various advancements in comparison to other statistical methods and models. This study aims to present and describe GLM-based methods, providing a coherent comparison between them. Initially, a historical overview of outbreak detection algorithms based on the GLM family is provided, highlighting commonly used methods. Furthermore, real data from Measles and COVID-19 are utilized to demonstrate examples of these methods. This study will be useful for researchers in both theoretical and practical aspects of outbreak detection methods, enabling them to familiarize themselves with the key techniques within the GLM family and facilitate comparisons, particularly for those with limited mathematical expertise.

The estimation of long and short term survival time and associated factors of HIV patients using mixture cure rate models.

BACKGROUND: HIV is one of the deadliest epidemics and one of the most critical global public health issues. Some are susceptible to die among people living with HIV and some survive longer. The aim of the present study is to use mixture cure models to estimate factors affecting short- and long-term survival of HIV patients. METHODS: The total sample size was 2170 HIV-infected people referred to the disease counseling centers in Kermanshah Province, in the west of Iran, from 1998 to 2019. A Semiparametric PH mixture cure model and a mixture cure frailty model were fitted to the data. Also, a comparison between these two models was performed. RESULTS: Based on the results of the mixture cure frailty model, antiretroviral therapy, tuberculosis infection, history of imprisonment, and mode of HIV transmission influenced short-term survival time (p-value < 0.05). On the other hand, prison history, antiretroviral therapy, mode of HIV transmission, age, marital status, gender, and education were significantly associated with long-term survival (p-value < 0.05). The concordance criteria (K-index) value for the mixture cure frailty model was 0.65 whereas for the semiparametric PH mixture cure model was 0.62. CONCLUSION: This study showed that the frailty mixture cure models is more suitable in the situation where the studied population consisted of two groups, susceptible and non-susceptible to the event of death. The people with a prison history, who received ART treatment, and contracted HIV through injection drug users survive longer. Health professionals should pay more attention to these findings in HIV prevention and treatment.

Prevention of contrast induced-acute kidney injury using coenzyme Q10 in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.

PURPOSE: We assessed the potential effect of CoQ10 administration for the prevention of contrast induced-acute kidney injury (CI-AKI) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). METHODS: One hundred fifty STEMI patients who were candidates for primary PCI, along with intravenous saline hydration, randomly received a placebo or CoQ10. CoQ10 was administrated orally, 400 mg before the procedure and 200 mg twice daily after the procedure for three consecutive days. Serum creatinine concentration and corresponding creatinine clearance (estimated by the CKD Epidemiology Collaboration (CKD-EPI) creatinine equation) were measured at baseline and 24, 48, and 72 h after primary PCI. Furthermore, the serum level of superoxide dismutase (SOD), total antioxidant capacity (TAC), and malondialdehyde (MDA) was measured before and 72 h after primary PCI. RESULTS: The mean serum creatinine concentration before contrast administration was similar in the two groups (0.98 ± 0.08 versus 0.99 ± 0.09 mg/dL). While in both study groups, compared to baseline, the mean serum creatinine concentration increased at 48 and 72 h after contrast exposure, the CoQ10 group showed a lower serum creatinine concentration than the placebo group (P-value = 0.017 and 0.004, respectively). However, comparing the mean values of creatinine clearance between the groups at the study time points did not demonstrate a statistically significant difference. CI-AKI, defined as a > 25% or 0.5 mg/dL increase in baseline serum creatinine concentration, occurred in 8.00% of the cases in the CoQ10 group versus 20.00% in the placebo group (P-value = 0.034). Furthermore, at 72 h, the CoQ10-treated group exhibited higher serum levels of SOD and TAC and a lower MDA level than the placebo-treated group. CONCLUSIONS: Our research's findings proposed CoQ10 supplementation as an adjuvant to saline hydration as a preventive approach against CI-AKI. TRIAL REGISTRATION: The trial was registered at Iranian Registry of Clinical Trials ( https://www.irct.ir/trial/60435 , identifier code: IRCT20120215009014N414). Registration date: 2021-12-29.

Impact of COVID-19 Disease Control Committee (CDCC) policies on prevention of the disease using Bayes network inference in west of Iran.

BACKGROUND: The start of the COVID-19 pandemic was an emergency situation that led each country to adopt specific regional strategies to control it. Given the spread of COVID-19 disease, it is crucial to evaluate which policy is more effective in reducing disease transmission. The purpose of this study was to determine the impact of policies made by COVID-19 Disease Control Committee (CDCC) to reduce the risk of the disease in Hamadan province. METHODS: In the observational study, the data were extracted from three sources in Hamadan, west of Iran; first, the session reports of CDCC; second, information on periodic evaluations conducted by the primary health care directory in Hamadan from April to August 2021 and third, expert panel opinion. Bayes network analysis was used to determine the effect of each policy on mortality rate by GeNIe software version 2.2. RESULTS: Among the policies adopted by CDCC in Hamadan, seven policies, i.e., vaccination, limiting gatherings, social distancing, wearing a mask, job closure, travel restriction, and personal hygiene had the most impact to prevent the spread of COVID-19, respectively. In this study, the prevalence of the disease was 17.64% with the implementation of these policies. Now, if all these policies are observed 30% more, the prevalence will decrease to 14.18%. CONCLUSION: This study showed that if the seven policies (i.e., vaccination, limiting gatherings, social distancing, wearing a mask, job closure, travel restriction, and personal hygiene) are followed simultaneously in the community, the risk of contracting the disease will be greatly reduced. Therefore, in the pandemic of infectious diseases, such policies can help prevent the spread of the disease.

Comparison of the efficacy of equivalent doses of dexamethasone, methylprednisolone, and hydrocortisone for treatment of COVID-19-related acute respiratory distress syndrome: a prospective three-arm randomized clinical trial.

BACKGROUND: This prospective controlled clinical trial aimed to compare the efficacy of methylprednisolone, dexamethasone, and hydrocortisone at equivalent doses in patients with severe COVID-19. METHODS: In total, 106 patients with mild to moderate COVID-19-related acute respiratory distress syndrome (ARDS) were randomized to receive either dexamethasone (6 mg once a day), methylprednisolone (16 mg twice a day), or hydrocortisone (50 mg thrice a day) for up to 10 days. All participants received a standard of care for COVID-19. The primary and secondary efficacy outcomes included all-cause 28-day mortality, clinical status on day 28 assessed using the World Health Organization (WHO) eight-category ordinal clinical scale, number of patients requiring mechanical ventilation and intensive care unit (ICU) care, number of ventilator-free days, length of hospital and ICU stay, change in PaO2:FiO2 ratios during the first 5 days after treatment, and incidence of serious adverse events. P-values below 0.008 based on Bonferroni's multiple-testing correction method were considered statistically significant. RESULTS: According to the obtained results, there was a trend toward more favorable clinical outcomes in terms of needing mechanical ventilation and ICU care, number of ventilator-free days, change in PaO2:FiO2 ratios during the first 5 days after treatment, clinical status score at day 28, length of ICU and hospital stay, and overall 28-day mortality in patients receiving dexamethasone compared to those receiving methylprednisolone or hydrocortisone; however, likely due to the study's small sample size, the difference between groups reached a significant level only in the case of clinical status score on day 28 (p-value = 0.003). There was no significant difference in the incidence of serious adverse events between the study groups. CONCLUSION: Based on the results, severe cases of COVID-19 treated with dexamethasone might have a better clinical status at 28-day follow-up compared to methylprednisolone and hydrocortisone at an equivalent dose. Larger multicenter trials are required to confirm our findings.

Investigating factors associated with the number of rehospitalizations among patients with schizophrenia disorder using penalized count regression models.

BACKGROUND: Schizophrenia is a chronic, severe, and debilitating mental disorder always considered one of the recurrent psychiatric diseases. This study aimed to use penalized count regression models to determine factors associated with the number of rehospitalizations of schizophrenia disorder. METHODS: This retrospective cohort study was performed on 413 schizophrenic patients who had been referred to the Sina (Farshchian) Educational and Medical Center in Hamadan, Iran, between March 2011 and March 2019. The penalized count regression models were fitted using R.3.5.2. RESULTS: About 73% of the patients were male. The mean (SD) of age and the number of rehospitalizations were 36.16 (11.18) years and 1.21 (2.18), respectively. According to the results, longer duration of illness (P < 0.001), having a positive family history of psychiatric illness (P = 0.017), having at least three children (P = 0.013), unemployment, disability, and retirement (P = 0.025), residence in other Hamadan province townships (P = 0.003) and having a history of arrest/prison (P = 0.022) were significantly associated with an increase in the number of rehospitalizations. CONCLUSION: To reduce the number of rehospitalizations among schizophrenic patients, it is recommended to provide special medical services for patients who do not have access to specialized medical centers and to create the necessary infrastructure for the employment of patients.

The influence of gastric bypass surgery on the concentration of high mobility group box 1, nuclear factor erythroid 2-related factor 2 and the genes expression of high mobility group box 1, nuclear factor erythroid2-related factor 2, interleukin 6, and tumor necrosis factor-alpha in the peripheral blood mononuclear cells of patients with morbid obesity.

BACKGROUND AND OBJECTIVES: Obesity is known as a disease with a chronic low-grade state of inflammation and high levels of oxidative stress. Given the challenges and consequences caused by obesity, obesity therapy is an essential subject to address. For sustainable weight loss, gastric bypass surgery is the most successful and essential option. METHODS: This prospective cohort study was performed on 35 patients aged (18-54) with morbid obesity (BMI: 42.06 kg/m2). Volunteers blood was taken, and peripheral blood mononuclear cells (PBMCs) were isolated, high mobility group box 1(HMGB1), nuclear factor erythroid2-related factor 2(Nrf2), Interleukin 6(IL-6), tumor necrosis factor-alpha (TNF-α), and biochemical factors were determined one day before and 4 months after surgery. RESULTS: Four months following surgery, the BMI, hip and waist circumferences, and waist-to-hip ratio (WHR) all decreased significantly. The lipid profile and antioxidant power were dramatically enhanced after surgery. IL-6 and TNF-α expression in PBMC patients showed a significant decrease after surgery. HMGB1 and Nrf2 expression in PBMC of postoperative patients decreased compared to before surgery, and HMGB1, and Nrf2 protein levels also decreased after surgery. CONCLUSION: Weight loss indicated the significant function of adipose tissue in the induction of oxidative stress and inflammatory factors. Gastric bypass reduced the inflammation conditions and improved the metabolic status and living situations in the patients with morbid obesity.

Identifying factors associated with the hospital readmission rate among patients with major depressive disorder.

BACKGROUND: Major depressive disorder (MDD) is a common recurrent mental disorder and one of the leading causes of disability in the world. The recurrence of MDD is associated with increased psychological and social burden, limitations for the patient, family, and society; therefore, action to reduce and prevent the recurrence of this disorder or hospital readmissions for depression among the patients is essential. METHODS: The data of this retrospective cohort study were extracted from records of 1005 patients with MDD hospitalized in Farshchian hospital in Hamadan city, Iran (2011-2018). The hospital readmissions rate due to depression episodes was modeled using generalized Poisson regression (GPR). Demographic and clinical characteristics of the patients were considered as explanatory variables. SAS v9.4 was used (P < 0.05). RESULTS: A majority of the patients were male (66.37%). The mean (standard deviation) of age at onset of MDD and the average number of hospital readmissions were 32.39 (13.03) years and 0.53 (1.84), respectively (most patients (74.3%) did not experience hospital readmissions). According to the results of the GPR, the lower age at the onset of the disease (IRR = 1.02;P = 0.008), illiteracy (IRR = 2.06;P = 0.003), living in urban areas (IRR = 1.56;P = 0.015), history of psychiatric illnesses in the family (IRR = 1.75;P = 0.004), history of emotional problems (IRR = 1.42;P = 0.028) and having medical disorders (IRR = 1.44;P = 0.035) were positively associated with the number of hospitalizations. CONCLUSION: According to our findings, urbanization, early onset of the disease, illiteracy, family history of mental illness, emotional problems, and medical disorders are among major risk factors associated with an increased number of hospital readmissions of MDD.

Development and Psychometric Testing of the Signed Donor Card (SDC) Scale in an Islamic Society.

The signed donor card is an important method to overcome the shortage of organs for transplantation. A valid and reliable scale is necessary to have with the development of interventions to increase the signed donor card. This study aimed to develop and psychometric testing of the Signed Donor Card (SDC) in an Islamic society. This methodological study was conducted in Hamadan city, Iran in 2018 on 600 employees of offices. A 46-item scale was developed. It was assessed by face, content, and construct validities. Reliability was examined using the calculation of the Cronbach's α and test-retest method. The SPSS software version 22 and Mplus version 7.4 were used for data analysis. Our scale demonstrated acceptable internal consistency (α = 0.58-0.93) and good test-retest reliability (ICC = 0.76). The fitness indices for the confirmatory factor analysis (CFA) indicated that the model fit was good. CFA revealed nine standalone components including attitude, subjective norms, intention, anticipated regret, descriptive norms, perceived control, knowledge, non-cognitive beliefs, and religious beliefs. Convergent validity and discriminant validity were established. This study provided evidence concerning the validity and reliability of SDC scale. It can be used for the development and implementation of effective interventions for increasing signed donor card with the consideration of contextual and cultural situations.

Upper Airway Changes Following Different Orthognathic Surgeries, Evaluated by Cone Beam Computed Tomography: A Systematic Review and Meta-analysis.

PURPOSE: This study sought to assess the upper airway changes following different orthognathic surgeries using cone-beam computed tomography. METHODS: An electronic search of the literature was conducted in major electronic databases including Medline (PubMed), Web of Science, Scopus, and Open Grey for articles published up to January 20, 2018. Human studies that evaluated the changes in the volume and minimum cross-sectional area of the upper airway or its subdivisions in patients who had undergone orthognathic surgery by use of cone-beam computed tomography were included. Manual search of the bibliographies of the included articles was also conducted. The included studies underwent risk of bias assessment. RESULTS: A total of 1330 articles were retrieved. After excluding the duplicates and irrelevant articles, 41 studies fulfilled the eligibility criteria for this systematic review; out of which, 30 entered the meta-analysis. The majority of studies had a medium risk of bias. Mandibular setback, and maxillary advancement + mandibular setback decreased the volume of the upper airway (-6042.87 mm3 and -1498.78 mm3, respectively) and all its subdivisions in long-term (>3 months), except for the nasopharynx, the volume of which increased following maxillary advancement + mandibular setback. Mandibular advancement and maxillomandibular advancement both increased the upper airway volume in long-term (7559.38 mm3 and 7967.06 mm3, respectively); however, only the changes after the former procedure were significant. The minimum cross-sectional area increased after maxillomandibular advancement (161.43 mm2), and decreased following maxillary advancement + mandibular setback (-23.79 mm2) in long-term. CONCLUSION: There is moderate evidence to suggest that mandibular advancement is the only orthognathic movement that provides a statistically significant change in long-term upper airway volume.

Application of group smoothly clipped absolute deviation method in identifying correlates of psychiatric distress among college students.

BACKGROUND: College students are at an increased risk of psychiatric distress. So, identifying its important correlates using more reliable statistical models, instead of inefficient traditional variable selection methods like stepwise regression, is of great importance. The objective of this study was to investigate correlates of psychiatric distress among college students in Iran; using group smoothly clipped absolute deviation method (SCAD). METHODS: A number of 1259 voluntary college students participated in this cross-sectional study (Jan-May 2016) at Hamadan University of Medical Sciences, Iran. The data were collected using a self-administered questionnaire consisting of demographic information, a behavioral risk factors checklist and the GHQ-28 questionnaire (with a cut-off of 23 to measure psychiatric distress, recommended by the Iranian version of the questionnaire). Penalized logistic regression with a group-SCAD regularization method was used to analyze the data (α = 0.05). RESULTS: The majority of students were aged 18-25 (87.61%), and 60.76% of them were female. About 41% of students had psychiatric distress. Significant correlates of psychiatric distress among college students selected by group-SCAD included the average grade, educational level, being optimistic about future, having a boy/girlfriend, having an emotional breakup, the average daily number of cigarettes, substance abusing during previous month and having suicidal thoughts ever (P < 0.05). CONCLUSIONS: Penalized logistic regression methods such as group-SCAD and group-Adaptive-LASSO should be considered as plausible alternatives to stepwise regression for identifying correlates of a binary response. Several behavioral variables were associated with psychological distress which highlights the necessity of designing multiple factors and behavioral changes in interventional programs.

Preoperative Anxiety and Depression Increases the Incidence of Delirium After Coronary Artery Bypass Graft Surgery.

PURPOSE: To address the effect of anxiety and depression before coronary artery bypass graft surgery on the postoperative delirium and the length of hospitalization. DESIGN: Prospective cohort study. METHODS: The anxiety and depression before surgery was measured using the 14-item Hospital Anxiety and Depression Scale. The main outcome of interest was delirium, which was assessed at baseline and then on the second, third, fourth, and fifth days after surgery, using the nine-item Neecham Confusion Scale. The incidence of delirium was compared in the positive group (153 patients with anxiety and depression at baseline) versus the negative group (153 patients without anxiety and depression at baseline). FINDINGS: There was a significant difference between the mean score of delirium in the two groups on the second, third, fourth, and fifth days after surgery (P = .001). The incidence of mild and moderate/severe delirium was significantly higher in the positive group than in the negative group for the entire length of follow-up (P = .001). The average length of hospitalization was nearly the same in the two groups (P = .156). CONCLUSIONS: This study indicated that anxiety and depression before coronary artery bypass graft surgery can significantly increase the incidence of postoperative delirium, but it has no significant effect on the length of hospitalization.

A report on three live births in women with poor ovarian response following intra-ovarian injection of platelet-rich plasma (PRP).

The prevalence of poor response to gonadotropin stimulation is approximately 9-24% in women undergoing in vitro fertilization. Interestingly, due to containing a variety of growth factors, platelet-rich plasma (PRP) can play an important role in tissue regeneration and healing. Thus, in this research, we aimed to investigate the intra-ovarian injection of PRP in women with poor ovarian response. To this goal, 23 poor responders constituted the study population, from among whom 19 women were enrolled. These patients underwent ovarian stimulation according to the Shanghai protocol. Immediately after the first follicular puncture, 2 mL of PRP was injected into each ovary. 1 day after the first puncture and PRP injection, the second stimulation was initiated. Then, oocyte retrieval was followed. About 2-3 months after the first cycle, the patients underwent another treatment with ovarian stimulation according to the Shanghai protocol and then, follicular puncture was performed. The mean numbers of oocytes before and after PRP injection were 0.64 and 2.1, respectively. Two patients experienced spontaneous conceptions. The third case achieved clinical pregnancy and delivered a healthy baby in June 2018. The results of this study appeared to be the first report on the effects of intra-ovarian PRP injection on the increase of ovarian responses, even on the spontaneous conceptions of women with poor ovarian response.

The top six risky behaviors among Iranian university students: a national survey.

BACKGROUND: Multiple risk-taking behaviors are associated with increased risk of poor educational attainment, morbidity and premature mortality. This study involved a large representative sample of Iranian university students addressing multiple risk behaviors and associated factors. METHODS: This cross-sectional study included 4261 participants, involving 13 medical universities throughout the country in 2017. The following six risky behaviors were addressed: (a) smoking cigarettes during the past month, (b) using some kinds of illicit drugs during the past month, (c) drinking alcohol during the past month, (d) engaging unprotected sex during the past year, (e) having suicidal ideation during the past month or attempting suicide in the past year, (f) and Internet addiction. The 20-item internet addiction test and the 28-item general health questionnaire were used. RESULTS: Almost 37.3% of the participants engaged in at least one out of six risky behaviors. The prevalence of Internet addiction was 24.5%, cigarette smoking 13.5%, alcohol use 7.8%, illicit drug abuse 4.9%, unprotected sex 7.8%, suicidal ideation 7.4%, attempting suicide 1.7% and general health problems 38.9%. CONCLUSION: A majority of the Iranian university students studied engaged in at least one risky behavior. Engaging in one risky behavior increases the risk of engaging in other risk-taking behaviors.

Association of long term exposure to outdoor volatile organic compounds (BTXS) with pro-inflammatory biomarkers and hematologic parameters in urban adults: A cross-sectional study in Tabriz, Iran.

This study aimed to compare the hematologic variables and pro-inflammatory biomarkers in urban adults living in Tabriz, Iran, facing various levels of outdoor volatile organic compounds (VOCs). Of all 219 people (212 male and 7 female), 71 were from the low traffic area and 148 were from high traffic and industrial areas. To validate the exposure levels, 93 air samples were taken to determine the target VOCs (benzene, toluene, xylenes, and styrene collectively called BTXS) concentrations in the studied areas. ANOVA and Tukey's tests were used for statistical analysis. Based on the results, significant differences were observed between the mean concentrations of BTXS with the following order of abundance: industrial > high traffic > low traffic. The Considerable decrease was observed in red blood cells (RBCs), hemoglobin, hematocrit, and eosinophils of 0.324 ( × 106/µL), 0.57 g/dL, 1.87%, and 0.17 ( × 103/µL), respectively in industrial area participants as compared to the low traffic area. However, a significant increase was observed in white blood cell count (WBC), neutrophils number, neutrophils percent, TNF-α and INF-γ of 0.88 ( × 103/µL), 0.80 ( × 103/µL), 3.53%, 34.2 ng/mL, and 40.06 ng/mL, respectively in the same groups. The comparison of low and high traffic areas showed significant differences in RBC (p = 0.034), tumor necrosis factor alpha (TNF-α) (p < 0.001), and interferon gamma (INF-γ) (p < 0.001). On the contrary, no significant difference was observed in TNF-α and INF-γ among the high traffic and industrial areas. In conclusion, the results showed that the samples from high traffic and industrial areas were regularly exposed to higher values of BTXS due to traffic and industrial pollutants as compared to the samples residing in low traffic regions. Based on the results living in both high traffic and industrial regions can increase adverse effects on hematologic parameters and pro-inflammatory cytokines.

Long-term exposures to Hypersaline particles associated with increased levels of Homocysteine and white blood cells: A case study among the village inhabitants around the semi-dried Lake Urmia.

The dried bed of the world's second largest permanent Hypersaline lake, Lake Urmia, acts as a Hypersaline particle emission source. In the present study we aim to assess the health impact of this disaster and examine the association of Hypersaline particles with total and differential white blood cell counts (WBC) and homocysteine (Hcy), the biomarkers of cardiovascular diseases, in the residents around Lake Urmia. Based on the previous study three regions were selected as clean and polluted regions for ambient particulate matter (APM) from 2008 to 2015. Concentration of APM (PM10, PM2.5 and PM1; particulate matter with aerodynamic diameter of less than 10, 2.5 and 1 µm, respectively) was measured in the selected regions and totally, 123 participants were selected randomly from villagers who have lived in the selected regions for at least eight years. Biomarkers and covariates were measured in the selected regions and were analyzed using multiple linear regression models. We found a statistically significant association between APM and selected biomarkers (Hcy, total WBC, neutrophil, monocyte, lymphocyte and basophile) in the polluted regions. These results are consistent with our hypothesis that long-term exposure to Hypersaline particles originated from drying Urmia Hypersaline Lake is related to increased cardiovascular risk biomarkers.