The effects of myo-inositol vs. metformin on the ovarian function in the polycystic ovary syndrome: a systematic review and meta-analysis.

OBJECTIVE: Recent studies have revealed that myo-inositol could be more influential in patients with polycystic ovary syndrome (PCOS). This study was aimed to determine and compare the effects of myo-inositol and metformin on hormonal and metabolic profiles and fertility outcomes. MATERIALS AND METHODS: A comprehensive search was carried out among the English-language databases, including PubMed, Scopus, Cochrane Library, Google Scholar, and Web of Science, and the articles published from April 2010 to February 2019 were tracked down. The fixed and random-effects meta-analysis was used to estimate the pooled effect size. The meta-analysis was performed in Stata Version 14.0. RESULTS: Nine studies with 331 patients treated with metformin and 307 patients treated with myo-inositol groups were included in the analysis. The research groups did not diverge significantly in terms of the basic characteristics, such as age and Body Mass Index (BMI). In the myo-inositol group, the levels of Luteinizing Hormone (LH) [12.55% (95% I: 11.41-13.68%)], S. testosterone [44.38% (95% CI: 38.09-50.67%)] and prolactin [7.97% (95% CI: 6.58- 9.37%)] were significantly higher than those recorded, i.e., LH [7.97% (95% CI: 6.58- 9.37%)], S. testosterone [8.48% (95% CI: 3.14-13.83%)] and prolactin [7.14% (95% CI: 1.50-14.79%)] for the metformin group (p<0.001). CONCLUSIONS: Due to the dearth of related research and the high heterogeneity of the Randomized Clinical Trials (RCTs) included in other studies, the present systematic review could not establish any differences between metformin and myo-inositol concerning the hormonal profile and the ovarian function. However, the findings indicated that myo-inositol could improve fertility outcomes by modulating hyperandrogenism. Randomized trials are required to understand the mechanistic actions of myo-inositol in comparison with those of metformin regarding oocyte and embryo quality, fertilization, pregnancy, and live birth rates.

Color Doppler ultrasonography diagnostic value in detection of malignant nodules in cysts with pathologically proven thyroid malignancy: a systematic review and meta-analysis.

AIMS: Today, the color Doppler ultrasonography is used to further evaluate suspected malignant tumors. This study investigates the malignant thyroid nodules using color Doppler. METHODS: After extracting true positive, false positive, false negative, and true negative among included studies, a quality was evaluated by the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio (with 95% confidence interval) were found using a random effect model. Summary receiver operating characteristic curves (SROC) were used to assess relationship between sensitivity and specificity. The area under the curve of the SROC was calculated to estimate the performance of color Doppler ultrasound to distinguish malignant thyroid nodules. Our registration code in PROSPERO is CRD42018111198. RESULTS: Of 1125 articles, 288 articles were selected for the further investigation. After excluding irrelevant and poor articles, 20 studies were included for the meta-analysis. According to a random effect model, the pooled sensitivity and specificity of color Doppler ultrasound to distinguish malignant thyroid nodules were estimated as 0.74 (95% CI 0.62-0.83; [Formula: see text]) and 0.70 (95% CI 0.56-0.81; [Formula: see text]), respectively. The SROC curve consists of representing the paired results for sensitivity and specificity. According to SROC, AUC = 0.78 (95% CI 0.74-0.81) is between 0.75 and 0.92, so that color Doppler ultrasound has a good accuracy. CONCLUSION: Color Doppler is a valuable non-invasive method for evaluating thyroid nodules, and it is a high-sensitivity diagnostic tool for assessing thyroid nodules. Resistive index > 0.75 and a pattern III or more in color Doppler predicts malignant with the confidence. Due to its precision, cost-efficiency, easy access, and non-invasive nature, color Doppler should be included in the standard clinical protocol for the decision-making period and the treatment evaluation.

Efficacy of nivolumab as checkpoint inhibitor drug on survival rate of patients with relapsed/refractory classical Hodgkin lymphoma: a meta-analysis of prospective clinical study.

AIMS: The primary standard treatment for classic Hodgkin's lymphoma (cHL) is chemotherapy and radiation therapy. However, some patients get relapsed, or their diseases become resistant. PD1 blocking antibodies have been used to increase the response of treatment in solid tumors, and led to potentially stable responses that are acceptable. Our purpose in this study is to investigate the effect of nivolumab as a PD1 blocking antibody on the survival rate of patients with Hodgkin's cancer. METHODS: Databases were found in International Medical Sciences, Web of Science, Medline, Scopus, Index Copernicus, PubMed, DOAJ, Google Scholar, EBSCO-CINAHL, and Persian databases containing SID and Magiran using keywords such as: "checkpoint inhibitor", "nivolumab", "Hodgkin lymphoma", and "PD1 Blockade". The risk of bias was determined by two external observers using the Cochrane checklists. After the search, the data provided in 51 documents was independently evaluated. Duplicate papers were excluded. Assessing the full texts of the remaining papers, 7 papers were approved. RESULTS: Pooled data of these seven studies revealed that the overall objective response rate was 68% (CI 64.1% to 72.1%; heterogeneity; I2 = 40.19%; p = 0.123) with partial remission (52%; CI 46.5% to 57.6%; heterogeneity; I2 = 28.36%; p = 0.212). In the pooled analysis, complete remission was 16.8 (CI 11.1% to 26.4%). Pooled data of six studies showed that stable disease was averaged to 19% (CI 16% to 23%; heterogeneity; I2 = 30%; p = 0.209; fixed-effect model). CONCLUSIONS: The results of the study indicate that nivolumab as a PD1 pathway inhibitor can be effective in treating relapsed and refractory cHL patients compared to other therapies, and lead to more effective treatment over the long term. Furthermore, the adverse effects of nivolumab are controllable and have a good safety profile.

Evaluation of thyroid gland as an organ at risk after breast cancer radiotherapy: a systematic review and meta-analysis

Background: Radiotherapy can often lead to thyroid dysfunction. Some studies demonstrated that treatment of breast cancer by RT can expose thyroid gland to high doses of radiation. The aim of this systematic review is to evaluate consideration of thyroid gland as an organ at risk. Methods: In this systematic review and meta-analysis to select initial studies, a comprehensive search by two independent reviewers was performed. Electronical databases following: Web of Science, Google Scholar, Scopus, PubMed, Elsevier, Embase, ProQuest and Persian databases such as Iranmedex, Magiran, and SID were searched. All searches were restricted to English language between 1985 and 2017. A random effect meta-analysis is applied to estimate pooled effect size across initial studies. Funnel plot with Egger’s test is used to assess potential publication bias. Results: Totally, five studies (478 samples) were included in meta-analysis. The meta-analyses of result showed that thyroid gland is affected by radiotherapy significantly and the TSH increased after radiotherapy (z = 2.68, P = 0.007). The pooled estimate of difference mean for TSH was 0.90 (95% CI 0.24, 1.55). In studies among patients with breast cancer RT, hypothyroidism was reported more than other thyroid disorders. There was not showed possibility publication bias among studies (P > 0.05). Conclusion: This study demonstrated that thyroid gland is affected by radiotherapy significantly and the TSH increased after radiotherapy. Protecting thyroid gland during radiation and follow-up of patients with breast cancer RT are suggested for the assessment of thyroid gland dysfunction

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Evaluation of thyroid gland as an organ at risk after breast cancer radiotherapy: a systematic review and meta-analysis.

BACKGROUND: Radiotherapy can often lead to thyroid dysfunction. Some studies demonstrated that treatment of breast cancer by RT can expose thyroid gland to high doses of radiation. The aim of this systematic review is to evaluate consideration of thyroid gland as an organ at risk. METHODS: In this systematic review and meta-analysis to select initial studies, a comprehensive search by two independent reviewers was performed. Electronical databases following: Web of Science, Google Scholar, Scopus, PubMed, Elsevier, Embase, ProQuest and Persian databases such as Iranmedex, Magiran, and SID were searched. All searches were restricted to English language between 1985 and 2017. A random effect meta-analysis is applied to estimate pooled effect size across initial studies. Funnel plot with Egger's test is used to assess potential publication bias. RESULTS: Totally, five studies (478 samples) were included in meta-analysis. The meta-analyses of result showed that thyroid gland is affected by radiotherapy significantly and the TSH increased after radiotherapy (z = 2.68, P = 0.007). The pooled estimate of difference mean for TSH was 0.90 (95% CI 0.24, 1.55). In studies among patients with breast cancer RT, hypothyroidism was reported more than other thyroid disorders. There was not showed possibility publication bias among studies (P > 0.05). CONCLUSION: This study demonstrated that thyroid gland is affected by radiotherapy significantly and the TSH increased after radiotherapy. Protecting thyroid gland during radiation and follow-up of patients with breast cancer RT are suggested for the assessment of thyroid gland dysfunction.

Information needs assessment of medical equipment offices based on Critical Success Factors (CSF) and Business System Planning (BSP) methods.

Introduction: Given the ever-increasing importance and value of information, providing the management with a reliable information system, which can facilitate decision-making regarding planning, organization and control, is vitally important. This study aimed to analyze and evaluate the information needs of medical equipment offices. Methods: This descriptive applied cross-sectional study was carried out in 2010. The population of the study included the managers of statistic and medical records at the offices of vice-chancellor for treatment in 39 medical universities in Iran. Data were collected by using structured questioners. With regard to different kinds of designing information systems, sampling was done by two methods, BSP (based on processes of job description) and CSF method (based on critical success factors). The data were analyzed by SPSS-16. Results: Our study showed that 41% of information needs were found to be critical success factors of managers of office. The first priority of managers was "the number of bed and bed occupancy in hospitals". Of 29 identified information needs, 62% were initial information needs of managers (from the viewpoints of managers). Of all, 4% of the information needs were obtained through the form, 14% through both the form and database, 11% through the web site, and 71% had no sources (forms, databases, web site). Conclusion: Since 71% of the information needs of medical equipment offices managers had no information sources, the development of information system in these offices seems to be necessary. Despite the important role of users in designing the information systems (identifying 62% of information needs), other scientific methods is also needed to be utilized in designing the information systems.

Spatial distribution and the prevalence of speech disorders in the provinces of Iran.

Objective: To identify the spatial distribution and prevalence of speech disorder in Iran. Materials and methods: First, the prevalence of speech disorder in 2006 and 2011 was mapped via GIS for each province. Moreover, the prevalence of this disorder was calculated and classified according to age, sex, and residential area. Results: The prevalence in the majority of provinces indicated an overall decrease. Furthermore, its prevalence among the whole population of Iran in 2006 and 2011 was 2.2 and 2 per 1000 people, respectively. The highest prevalence was observed among people aged 75 years and older. Results showed that speech disorders are more prevalent among men compared to women and also among rural residents compared to those in urban areas. Conclusion: It is necessary to identify the high-risk areas in order to well organize the limited facilities to meet the actual needs of patients with speech disorder.

Spatial distribution and prevalence of physical disabilities in the provinces of Iran.

Introduction: To identify the influential social factors and spatial distribution of physical disabilities in Iran between 2006 and 2011. Materials and Methods: First, the prevalence of physical disability in each province between 2006 and 2011 was mapped via GIS. Moreover, the percentage of physical disability was estimated with regard to age, sex, and residential area. Finally, the prevalence of physical disability was estimated with regard to the afore-mentioned variables. Findings: The findings revealed that in the majority of the provinces of Iran, there was a decreasing trend in the prevalence of physical disability from 2006 to 2011. The prevalence of physical disability in the total population of the country was also decreased during these years. The results were also indicative of a higher prevalence among men than among women and also in rural residential areas than in urban areas. Conclusion: The results of this research can be used to identify the high- and low-risk areas. In addition, this information can be used for the etiology and the specification of the factors that cause the residents of some regions to get afflicted more than the others.