Abstract screening using the automated tool Rayyan: results of effectiveness in three diagnostic test accuracy systematic reviews.

OBJECTIVE: To evaluate the performance of the automated abstract screening tool Rayyan. METHODS: The records obtained from the search for three systematic reviews were manually screened in four stages. At the end of each stage, Rayyan was used to predict the eligibility score for the remaining records. At two different thresholds (≤2.5 and < 2.5 for exclusion of a record) Rayyan-generated ratings were compared with the decisions made by human reviewers in the manual screening process and the tool's accuracy metrics were calculated. RESULTS: Two thousand fifty-four records were screened manually, of which 379 were judged to be eligible for full-text assessment, and 112 were eventually included in the final review. For finding records eligible for full-text assessment, at the threshold of < 2.5 for exclusion, Rayyan managed to achieve sensitivity values of 97-99% with specificity values of 19-58%, while at the threshold of ≤2.5 for exclusion it had a specificity of 100% with sensitivity values of 1-29%. For the task of finding eligible reports for inclusion in the final review, almost similar results were obtained. DISCUSSION: At the threshold of < 2.5 for exclusion, Rayyan managed to be a reliable tool for excluding ineligible records, but it was not much reliable for finding eligible records. We emphasize that this study was conducted on diagnostic test accuracy reviews, which are more difficult to screen due to inconsistent terminology.

Maternal mortality and its determining factors among hospitalised mothers in Tehran, Iran, 2013-2020.

The maternal mortality ratio (MMR) is a significant indicator of the quality of a health care system. Despite considerable progress in reducing MMR in Iran in the past few years, we still face a long road ahead in eliminating preventable maternal deaths. In the present study, we evaluated all 80 cases of maternal deaths in 20 hospitals under the supervision of Tehran University of Medical Sciences between March 20 2013 and March 19 2020. During this time, these hospitals recorded 335,216 live births, with an MMR of 24 per 100,000 live births. The average age of deceased mothers was 31.9 ± 6.9 years. Direct causes accounted for 48.75% of maternal deaths, with haemorrhage being the most common direct cause of mortality (17.5%). Moreover, cancer (17.5%) and cardiovascular diseases (17.5%) were the most common indirect causes of maternal mortality. Even after accounting for the COVID-19 pandemic's effects, we have noticed an increase in maternal mortality. As a result, implementing a comprehensive approach for high-risk pregnancies is critical.Impact StatementWhat is already known on this subject? Although we have been able to reduce MMR in Iran to a reasonable level, previous measures would not be sufficient to accomplish future goals. Furthermore, we have a long way to go before reaching the ultimate goal of eradicating avoidable maternal deaths by 2030.What do the results of this study add? The causes, determinants and risk factors of maternal mortality were investigated in this study. With this level of detail, we can observe a steadily increase in MMR in recent years, regardless of the COVID-19 pandemic. The majority of pregnancy-related deaths can be avoided.What are the implications of these findings for clinical practice and/or further research? MMR reduction is a measurable goal that can be attained by improving financial resources, implementing safe delivery, team training, preparing multidisciplinary care with integration for high-risk pregnant women, establishing good provider relationships, and communicating with patients and providers for early warning signs and structural changes.

Automated diagnosis of autism with artificial intelligence: State of the art.

Autism spectrum disorder (ASD) represents a panel of conditions that begin during the developmental period and result in impairments of personal, social, academic, or occupational functioning. Early diagnosis is directly related to a better prognosis. Unfortunately, the diagnosis of ASD requires a long and exhausting subjective process. We aimed to review the state of the art for automated autism diagnosis and recognition in this research. In February 2022, we searched multiple databases and sources of gray literature for eligible studies. We used an adapted version of the QUADAS-2 tool to assess the risk of bias in the studies. A brief report of the methods and results of each study is presented. Data were synthesized for each modality separately using the Split Component Synthesis (SCS) method. We assessed heterogeneity using the I 2 statistics and evaluated publication bias using trim and fill tests combined with ln DOR. Confidence in cumulative evidence was assessed using the GRADE approach for diagnostic studies. We included 344 studies from 186,020 participants (51,129 are estimated to be unique) for nine different modalities in this review, from which 232 reported sufficient data for meta-analysis. The area under the curve was in the range of 0.71-0.90 for all the modalities. The studies on EEG data provided the best accuracy, with the area under the curve ranging between 0.85 and 0.93. We found that the literature is rife with bias and methodological/reporting flaws. Recommendations are provided for future research to provide better studies and fill in the current knowledge gaps.

Concurrent anorectal and cervical cytology in women with positive and negative cervical smear test results: A cross-sectional study.

OBJECTIVE: Considering the exponentially growing concerns about the increase of anal cancer rates in women with human papillomavirus (HPV) infection and cervical intraepithelial neoplasia, the authors evaluated concurrent anorectal and cervical cytology in women with positive and negative cervical smear tests. METHOD: The current investigation was designed as a cross-sectional study conducted in Arash Women's Hospital, Tehran, Iran, between November 2020 and November 2021. Cervical cytology, HPV test, and anal cytology samples were prepared. Then women with abnormal cervical cytology and/or positive high-risk HPV were referred to a colposcopy clinic for further evaluation. RESULTS: Five hundred and forty-three women were recruited during the study period. These women were divided into two groups of positive cervical cytology (n = 161) and negative cervical cytology (n = 382). There were no cases of anal intraepithelial neoplasia in either group. Negative anal cytology was reported in 99 (61.5%) of participants with a positive cervical cytology and 254 (66.7%) of participants with a negative cervical cytology. A total of 62 (38.5%) anal samples in the positive group and 127 (33.3%) in the negative group were unsatisfactory for further evaluation. CONCLUSION: We were unable to show any correlation between abnormal cervical cytology, dysplasia, or cervical high-risk HPV with anal abnormal cytology.

Distribution of Plasma One-Carbon Metabolism Factors and Amino Acids Profile in Depression State Treated with Paroxetine: A Model Study.

OBJECTIVE: Stress may have an important role in the origin and progress of depression and can impair metabolic homeostasis. The one-carbon cycle (1-CC) metabolism and amino acid (AA) profile are some of the consequences related to stress. In this study, we investigated the Paroxetine treatment effect on the plasma metabolite alterations induced by forced swim stress-induced depression in mice. MATERIALS AND METHODS: In this experimental study that was carried out in 2021, thirty male NMRI mice (6-8 weeks age, 30 ± 5 g) were divided into five groups: control, sham, paroxetine treatment only (7 mg/kg BW/day), depression induction, and Paroxetine+depression. Mice were subjected to a forced swim test (FST) to induce depression and then were treated with Paroxetine, for 35 consecutive days. The swimming and immobility times were recorded during the interventions. Then, animals were sacrificed, plasma was prepared and the concentration of 1-CC factors and twenty AAs was measured by spectrophotometry and high-performance liquid chromatography system (HPLC) techniques. Data were analyzed by SPSS, using One-Way ANOVA and Pearson Correlation, and P<0.05 was considered significant. RESULTS: Plasma concentrations of phenylalanine, glutamate, aspartate, arginine, ornithine, citrulline, threonine, histidine, and alanine were significantly reduced in the depression group in comparison with the control group. The Homocysteine (Hcy) plasma level was increased in the Paroxetine group which can be associated with hyperhomocysteinemia. Moreover, vitamin B12, phenylalanine, glutamate, ornithine, citrulline, and glycine plasma levels were significantly reduced in the depression group after Paroxetine treatment. CONCLUSION: This study has demonstrated an impairment in the plasma metabolites' homeostasis in depression and normal conditions after Paroxetine treatment, although, further studies are required.

Conceptualization and development of a questionnaire to determine physical activity barriers.

PURPOSE: Considering the role of physical activity on public health and the high prevalence of physical inactivity worldwide, determining physical activity barriers is critical and will be a road map for future planning. This study aimed to develop a comprehensive questionnaire to determine physical activity barriers. METHODS: By reviewing previous studies, the main domains of the questionnaire were established. A physical activity expert interviewed 20 individuals aged 18 to 65 years. The results were evaluated by an expert panel for a content validity index. Face validity, test-retest reliability, and internal consistency were established on 204 individuals. RESULTS: The content validity index in all items was within the acceptable range (>0.85). Face validity was appropriate, and the misunderstanding index was < 20% in all items. Test-retest reliability in the final questionnaire in all items based on Cohen's kappa was > 0.20, indicating fair agreement. Internal consistency with Cronbach's alpha of 0.63 was within the acceptable range. CONCLUSION: The study revealed that the newly designed survey is valid, accurate, and reliable. The use of this comprehensive tool by policymakers would help them properly identify the perceived barriers, and thus perform better physical activity interventions as promotional health programs.

Acceptance or Rejection of the COVID-19 Vaccine: A Study on Iranian People's Opinions toward the COVID-19 Vaccine.

We aimed to assess the Iranian people's attitude and confidence in the COVID-19 vaccine, their concerns about the safety of vaccines, and their reasons for accepting or rejecting the COVID-19 vaccine. We conducted a web-based cross-sectional study with a mixed qualitative−quantitative approach from December 2020 to February 2021. Our questionnaire consisted of a COVID-19 vaccine attitude questionnaire, a COVID-19 vaccine confidence inventory, a modified vaccine safety scale, and questions about participants' decision to accept or refuse the COVID-19 vaccine, and their explanations for their decisions. The research included 1928 people with an average age of 34.88 years with 1236 (64.1%) being female. A total of 1330 participants desired to have the COVID-19 vaccine (69%). Female gender, lower educational levels, following COVID-19 news through sources other than websites and social media, not following COVID-19 news, and loss of a first-degree relative due to COVID-19 were all associated with a more negative attitude toward the COVID-19 vaccine (p < 0.01). To conclude, the acceptance rate of the COVID-19 vaccine among Iranians is comparable to the international average; however, it is still unfavorable. There are serious challenges to the vaccination program in Iran, such as older adults' lower intention to undergo the COVID-19 vaccine and misinformation.

The impact of adjunctive metformin to progesterone for the treatment of non-atypical endometrial hyperplasia in a randomized fashion, a placebo-controlled, double blind clinical trial.

OBJECTIVE: Endometrial hyperplasia (EH) is a premalignant neoplasm. Most recently, metformin has been suggested as an adjuvant medication for treating of EH with better outcome. Recent evidence has suggested that metformin has anticancer activity by inhibiting cell proliferation and tumor growth. The aim of this study was to evaluate the effect of metformin plus megestrol acetate versus megestrol acetate alone on patient with EH without atypia. STUDY DESIGN: This double blind placebo-controlled clinical trial was conducted among 60 women with EH without atypia. Participants were allocated to two equal groups. Treatment group (M + M) received 40 mg megestrol acetate for 14 days of one month and 1000 mg metformin daily for three months. In placebo group (M + P) each patient received the same dose of megestrol acetate plus two tablets of placebo. Endometrial biopsy was performed in all patients three weeks after the last day of medication RESULTS: Data were evaluated based on 29 and 27 women in the M + M group and M + P group, respectively. After 3 months of therapy 27 (93.1 %) women in M + M group had not EH and responded to treatment, which was statistically higher than the rate of response (19 women, 70.4 %) in M + P group. CONCLUSIONS: This study showed that megestrol plus metformin was significantly better than megestrol alone for the treatment of endometrial hyperplasia without atypia.

Challenging case of muscle bridge; a 15-year follow-up of a patient.

BACKGROUND: Anatomically myocardial bridging (MB) consists of either superficial myocardial fibers that traverse over the LAD or deep fibers that encircle the coronary artery. In this study, we present a patient with myocardial bridging, who was primarily diagnosed with coronary artery disease which did not properly respond to full-dose medical treatment but benefited from coronary artery bypass graft (CABG). CASE PRESENTATION: In 2017, a 53-year old man was referred to Tehran Heart Center (THC) with complaint of typical chest pain (TCP). In 2003 he had TCP and underwent coronary angiogram (CAG), due to positive non-invasive tests. Muscle-bridge in LAD was diagnosed. In 2007, he was symptomatic and another CAG was done, and percutaneous coronary intervention (PCI) with stenting was performed. In 2008 he became symptomatic and his interventionist, decided to perform another CAG. At that time, he had CABG. He was asymptomatic until 2015, he referred to us with the same TCP and we decided to perform CAG for the fourth time. After two years, again another PCI was done due to in-stent restenosis. CONCLUSION: Revascularization should be considered in MB refractory to medical treatment. However, coronary perforation, in-stent restenosis and graft failure are major concerns.

Depression and Anxiety among Iranian Medical Students during COVID-19 Pandemic.

Objective: COVID-19 has spread throughout the world and has become a global pandemic. This situation can cause psychological distress among people, especially health care workers. This study aimed to determine depression and anxiety levels among Iranian medical students during the COVID-19 pandemic. Method : In this cross sectional study, we designed an online survey of Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) questionnaires. The survey link was sent to 500 medical clerks and interns studying at Tehran University of Medical Sciences (TUMS). Results: A total of 64.6% of the students completed the survey. The prevalence of mild to severe anxiety and depression among them was 38.1% and 27.6%, respectively. Anxiety and changes in sleep patterns were the most common symptoms. Higher levels of anxiety were related to female gender, lower grade point average (GPA), and experience of COVID-19 symptoms. Students with lower GPA and prior experience of COVID-19 symptoms were more likely to feel depressed. Conclusion: Depression and anxiety did not significantly differ among Iranian medical students before and after the COVID-19 outbreak. Somatic symptoms of depression are more common during this pandemic and need particular attention in future similar situations. A higher GPA is related to lower anxiety and depression among medical students.

Did Iranians respect health measures during Nowruz holidays? A study on Iranians' knowledge, attitude and practice toward COVID-19.

INTRODUCTION: Since December 2019, the COVID-19 outbreak has affected almost every country in the world, including Iran. General awareness and commitment to recommendations made by health officials have important role in control of the outbreak. The aim of the current study was to assess the knowledge, attitude, and practice (KAP) of Iranians concerning COVID-19 after Nowruz (Persian New Year Holiday) in Iran and identifying its determining demographic and socioeconomic factors. METHOD: A cross-sectional study was designed. We translated and culturally adopted Zhong's questionnaire to Persian, which is designed to assess people's knowledge, attitude, and practice toward COVID-19. We used online Google forms to send the questionnaire via social platforms throughout the country. A total of 1015 Iranians participated in the study. RESULTS: The mean knowledge score among our participants was 10.60, with an overall correct response rate of 88.35%. Higher knowledge score was associated with higher education, being a professor, and residing in cities. Lower knowledge score was associated with being unemployed, marital status other than single or married, and living in rural areas. Almost all of our participants had favorable attitudes and practices toward COVID-19. CONCLUSION: Overall, Iranians showed a satisfactory KAP towards COVID-19. We suggest more attention to informing people living in rural areas and unemployed, as they were related to more risky behaviors and had lower knowledge scores regarding COVID-19.

Does Invasive Treatment Increase the Long-Term Survival of ST-Elevation Myocardial Infarction Patients with a History of Coronary Artery Bypass Graft Surgery?

Background: Although invasive treatments such as primary percutaneous coronary intervention (PPCI) are the treatment of choice in ST-elevation myocardial infarction (STEMI) patients, the survival benefit of this treatment in patients with a history of coronary artery bypass graft (CABG) has yet to be fully evaluated. Methods: In this historical cohort study, 251 STEMI patients with a history of CABG between 2007 and 2017 were stratified into 3 groups of no reperfusion, thrombolytic, and PPCI based on their treatment strategy. Baseline clinical characteristics, details of the STEMI event, and the course of hospitalization were evaluated for all patients and they were followed up until May 2018 to assess all-cause mortality. Results: The mean age of the study population was 64.019.45 years, and 81.7% of them were male. The median follow-up time was 1304 (IQR25%-75%: 571-2269) days, the short-term (1 month) mortality rate was 5.97%, and the long-term mortality rate was 15.1%. There was no significant difference between the 3 different strategies in terms of survival. In the fully adjusted multivariate analysis, cardiopulmonary resuscitation (HR: 15.06, 95% CI: 2.25-101.14, P=0.005) was significantly associated with short-term mortality, while diabetes (HR: 5.95, 95% CI: 2.03-17.44, P=0.001), opium abuse (HR: 4.85, 95% CI: 1.45-16.23, P=0.010), and cardiopulmonary resuscitation (HR: 11.73, 95% CI: 3.44-40.28, P=0.001) were significantly associated with long-term mortality. Conclusion: Our results failed to show the superiority of invasive treatment in terms of survival. Further studies regarding the advantages and disadvantages of invasive treatment in post-CABG patients are required.