Biochemical, Serological and Immunological Tests for Diagnosis of Coronavirus Disease 2019 (COVID-19) Patients: A Comprehensive Systematic Review and Meta-analysis.

BACKGROUND: Recent studies have suggested the role of primary laboratory tests in addition to clinical symptoms for patients suspected to have coronavirus disease 2019 (COVID-19), which play a significant role in the diagnosis of COVID-19. However, the results of these studies are contradictory. The present study was conducted to evaluate biochemical, serological, and immunological tests for the diagnosis of COVID-19 patients. METHODS: This study was presented in accordance with the PRISMA protocol. This protocol is registered with the code CRD42019145410 in PROSPERO. We conducted a comprehensive literature search in databases, including Web of Science, PubMed/Medline, CINAHL Scopus, Cochrane Library, EMBASE, Science Direct, and EBSCO to find citations from the beginning of January 2019 until the beginning of April 2020 without any restrictions. RESULTS: Finally, 51 studies, including 5,490 COVID-19 patients, were included in the present metaanalysis. The prevalence of different factors observed in laboratory findings was as follows: the prevalence of lymphopenia in patients with COVID-19 accounted for 51.6% (95% CI: 44.0-59.1), elevated C-reactive protein (CRP) was 63.6% (95% CI: 57.0-69.8), elevated erythrocyte sedimentation rate (ESR) was 62.5% (95% CI: 50.1-73.5), elevated tumor necrosis factor alpha (TNFα) was 28.7% (95% CI: 9.0-62.1), elevated serum amyloid-A level was 74.7% (95% CI: 50.0-89.7), elevated procalcitonin level was 72.6% (95% CI: 58.1-83.5), elevated interleukin-6 level was 59.9% (95% CI: 48.2-70.5), reduced CD3 level was 68.3% (95% CI: 50.1-82.2), reduced CD4 level was 62.0% (95% CI: 51.1- 71.6), elevated lactate dehydrogenase (LDH) level accounted for 53.1% (95% CI: 43.6-62.4), elevated brain natriuretic peptide (BNP) accounted for 48.9% (95% CI: 30.4-67.7), reduced albumin and reduced pre-albumin levels in patients with COVID-19 were estimated to be 54.7% (95% CI: 38.1-70.2) and 49.0% (95% CI: 26.6-71.8), and D-dimer level was 44.9% (95% CI: 31.0-59.6). CONCLUSION: The results show lymphopenia, elevated ESR level, elevated CRP level, elevated serum amyloid-A, elevated TNFα, elevated procalcitonin level, elevated interleukin-6 level, reduced CD3, reduced CD4, elevated BNP, elevated LDH, reduced albumin, reduced pre-albumin, and elevated Ddimer levels as the most common findings at the time of admission.

A Meta-Analysis of The Prevalence and Etiology of Infertility in Iran.

Infertility is a serious health issue in the world affecting approximately 8-10% of couples worldwide. The meta-analysis study was performed to assess the prevalence and etiologic factors associated with infertility in Iran. We made sure that the implementation of study and reporting the results were consistent with the MOOSE and PRISMA guidelines, respectively. All stages of the research were conducted by two authors, and the disagreement at each stage of the research was resolved by consensus. On January 1, 2020, we started a detailed literature search on international online databases, and Iranian Online databases, as well as specialized journals, several authentic international publishers and Google Scholar. We reviewed the reference list of identified articles for missed articles and then searched online for them. Data analysis was performed to estimate the prevalence using a random effects model. The lifetime infertility prevalence was found to be 11.3% [95% confidence interval (CI): 8.6-14.7] and the current infertility was evaluated to be 3.7% (95% CI: 3.2-4.3). The prevalence of primary infertility (based on 45 articles consisting of 51,021 samples) as well as secondary infertility (based on 13 articles consisting of 35,683 samples) in Iran were estimated to be 18.3% (95% CI: 15.4-21.6) and 2.5% (95% CI: 1.6-4.0), respectively. The prevalence of female, male, both and unexplained causes was estimated to be 32.0% (95% CI: 27.6-36.8), 43.3% (95% CI: 38.2-48.6), 12.5% (95% CI: 9.6-16.2) and 13.6% (95% CI: 10.2-17.8), respectively. The prevalence of causes related to ovulation, uterine tubes, and endometriosis in infertile women was estimated to be 54.0% (95% CI: 45.6-62.2), 15.5% (95% CI: 11.3-21.0), 6.2% (95% CI: 3.5-10.6), and 5.4% (95% CI: 2.5-11.3), respectively. In summary, the estimate of infertility burden in Iran did not change between 1990 and 2017 and its prevalence remains high. This research presents a unified and up-to-date overview regarding the burden of infertility in Iran.

COVID-19 vaccine acceptance among pregnant women worldwide: A systematic review and meta-analysis.

BACKGROUND: The COVID-19 pandemic has led to the death of many people worldwide. The World Health Organization (WHO) has declared vaccine resistance as one of the greatest health threats in the world even before the COVID-19 epidemic. The aim of this study was to evaluate the acceptance of COVID-19 vaccine in pregnant women. METHOD: We performed this systematic review and meta-analysis in accordance with the PRISMA guidelines. We applied the standard search strategy to the PubMed/Medline, Web of Science (ISI), Scopus, Science Direct, Cochrane Library, EMBASE, and EBSCO databases, and the Google Scholar search engine. Heterogeneity between studies was relatively high and therefore meta-analyses were performed based on random effects model with 95% CI using STATA version 16. RESULTS: In 16 articles with a sample size of 19219 pregnant women, the acceptance of COVID-19 vaccine was estimated 53.46% (95%CI: 47.64%-59.24%). Subgroup analysis was performed based on continent (p = 0.796), data collection method (p = 0.450) and meta-regression based on the month of the study (P<0.001), and only meta-regression was significant based on the month of the study. The effect of some variables such as graviad (OR = 1.02 [95%CI: 0.90-1.16]), maternal age was (OR = 1.02 [95%CI: 0.93-1.11]) and history of influenza vaccination (OR = 0.87 [95%CI: 0.71-1.06]) on COVID-19 vaccine acceptance was evaluated, which was not significant. CONCLUSION: The prevalence of COVID-19 vaccine acceptance in pregnant women was 53.46%, which was much lower than the general COVID-19 vaccination. Therefore, necessary interventions should be taken to increase the acceptance of the vaccine, address safety concerns and educate about it.

Asian Pacific association for the study of liver (APASL) guidelines: hepatitis B virus in pregnancy.

Hepatitis B virus (HBV) infection still remains a major public health issue in the Asia-Pacific region. Most of the burden of HBV-related disease results from infections acquired in infancy through perinatal or early childhood exposure to HBV in Asia-Pacific. Hepatitis B during pregnancy presents unique management issues for both the mother and fetus. These APASL guidelines provide a comprehensive review and recommendations based on available evidence in the literature, for the management of females with HBV infection through every stage of pregnancy and postpartum. These also address the concerns, management challenges, and required follow-up of children born to hepatitis B-positive mothers.

The association between metabolic syndrome and erosive esophagitis: A systematic review and meta-analysis.

Although several studies have shown that each of the metabolic syndrome (MetS) components can be a risk factor for erosive esophagitis (EE), the association between MetS and EE is still a challenging subject, as studies about this association have shown inconsistent results. Therefore, this study was conducted to evaluate the association between MetS and EE. In this study, we followed the MOOSE protocol and the PRISMA guidelines for reporting the results. Web of Science (ISI), Cochrane Library (Cochrane Database of Systematic Reviews - CDSR), EMBASE, Scopus, Science Direct, PubMed/Medline, EBSCO, CINAHL, and Google Scholar search engine were searched for articles published until January 2021. Heterogeneity between studies was estimated by I2 index and Q test. All analyses were performed using Comprehensive Meta-Analysis Software. Finally, 12 studies entered the meta-analysis process after qualitative assessment. MetS was significantly associated with increased risk of EE (OR=1.488 [95 % CI: 1.352-1.638], P<0.001; Heterogeneity: I2= 55.57, P<0.001) in 12 studies with a sample size of 45285 (12825 cases and 29377 controls). In subgroup analysis based on types of studies (P=0.832), MetS diagnostic criteria (P=0.083) and quality of studies (P=0.612), no significant association was found. Sensitivity analysis showed that the overall estimation of effect size is still robust after omission of individual studies from the meta-analysis. Publication bias based on the Begg's test (P=0.945) and Egger's test (P=0.753) were not significant. MetS increases the risk of EE compared to control groups. Future studies should examine if MetS treatment reduces the risk of EE.

Prevalence of Dyspepsia in Iran: A Systematic Review and Meta-analysis.

BACKGROUND: Dyspepsia is a highly prevalent gastrointestinal problem. The present study was carried out to assess the prevalence of dyspepsia in Iran. METHODS: The present study was registered at PROSPERO with the code CRD42019148610. It was carried out based on MOOSE and reporting was performed according to the PRISMA protocol. Systematic search of the literature was performed in July 2019 on international databases of PubMed/Medline, Web of Science (ISI), Cochrane Library, EBSCO, CINAHL, EMBASE, Scopus, Science Direct, and local databases as well as the Google Scholar search engine. Heterogeneity was evaluated using I2 and Chi-square tests. All analyses were done using Comprehensive Meta-Analysis software. RESULTS: Overall, 14 studies with a sample size of 54,118 subjects entered in this meta-analysis. The prevalence of dyspepsia in Iran was 14.6% (95% CI: 9.6-21.7). Large heterogeneity was detected among studies (I2=99.62%, P<0.001). The prevalence of dysmotility-like, ulcer-like, and unspecified dyspepsia was estimated to be 9.7% (95% CI: 4.9-18.4), 12.1% (95% CI: 5.2-25.7) and 17.0% (95% CI: 7.8-33.4), respectively. The prevalence of dyspepsia in Iranian men and women was found at 11.1% (95% CI: 6.3-18.8) and 17.8% (95% CI: 10.0-29.7), respectively. CONCLUSION: The prevalence of dyspepsia in Iran is relatively high. However, it is lower than global estimates.

The prevalence of depression in Iranian children: A systematic review and meta-analysis.

INTRODUCTION: The present study was conducted to evaluate the prevalence of depression in Iranian children. METHOD: This meta-analysis was registered in PROSPERO with code (CRD42020216632) and performed based on the MOOSE protocol and PRISMA guidelines. Title and abstract of articles were searched without time limit until April 2020 in international databases PubMed/Medline, Scopus, Embase, Science Direct, Cochrane Library, CINAHL, EBSCO, Web of Science, Google Scholar, and Iranian databases. RESULTS: In 34 studies with a sample size of 23,779 Iranian children, the prevalence of depression was estimated 42.3 % (95 %CI: 34.9-50.0). Prevalence of depression in girls in 20 studies with a sample size of 11,170 was estimated 42.1 % (95 %CI: 32.7-52.1) and the prevalence of depression in males in 20 studies with a sample size of 4678 was estimated 29.6 % (95 %CI: 21.2-39.7). The odds ratio of female to male depression was 1.33 (95 %CI: 1.07-1.65, P < 0.011). Prevalence of mild, moderate, major and deep depression was 20.3 % (95 %CI: 16.4-24.9), 15.0 % (95 %CI: 11.3-19.7), 14.5 % (95 %CI: 10.8-19.1), and 4.3 % (95 %CI: 1.8-9.8), respectively. In subgroup analysis for prevalence of depression in Iranian children, the variables of geographical area (P = 0.258), quality of studies (P = 0.186), type of questionnaire (P = 0.907), sample size (P = 0.500) and year of studies (P = 0.538) were not significant, but subgroup analysis of province (P < 0.001) and school grade (P < 0.001) were significant. CONCLUSION: The results of the present meta-analysis showed that depression is common in Iranian children and is much higher than global estimates. These findings emphasize the importance of identifying and providing treatment to children who are most in need.

Chest computed tomography scan findings of coronavirus disease 2019 (COVID-19) patients: a comprehensive systematic review and meta-analysis.

INTRODUCTION: Numerous cases of pneumonia caused by coronavirus disease 2019 (COVID-19) were reported in Wuhan, China. Chest computed tomography (CT) scan is highly important in the diagnosis and follow-up of lung disease treatment. The present meta-analysis was performed to evaluate chest CT scan findings in COVID-19 patients. MATERIAL AND METHODS: All research steps were taken according to the Meta-Analysis of Observational Studies In Epidemiology (MOOSE) protocol and the final report was based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We registered this review at the International Prospective Register of Systematic Reviews (PROSPERO, CRD42019127858). RESULTS: Forty eligible studies including 4598 patients with COVID-19 were used for meta-analysis. The rate of positive chest CT scan in patients with COVID-19 was 94.5% (95% CI: 91.7-96.3). Bilateral lung involvement, pure ground-glass opacity (GGO), mixed (GGO pulse consolidation or reticular), consolidation, reticular, and presence of nodule findings in chest CT scan of COVID-19 pneumonia patients were respectively estimated to be 79.1% (95% CI: 70.8-85.5), 64.9% (95% CI: 54.1-74.4), 49.2% (95% CI: 35.7-62.8), 30.3% (95% CI: 19.6-43.6), 17.0% (95% CI: 3.9-50.9) and 16.6% (95% CI: 13.6-20.2). The distribution of lung lesions in patients with COVID-19 pneumonia was peripheral (70.0% [95% CI: 57.8-79.9]), central (3.9% [95% CI: 1.4-10.6]), and peripheral and central (31.1% [95% CI: 19.5-45.8]). The pulmonary lobes most commonly involved were the right lower lobe (86.5% [95% CI:57.7-96.8]) and left lower lobe (81.0% [95% CI: 50.5-94.7]). CONCLUSIONS: The most important outcomes in chest CT scan of patients with COVID-19 pneumonia were bilateral lung involvement, GGO or mixed (GGO pulse consolidation or reticular) patterns, thickened interlobular septa, vascular enlargement, air bronchogram sign, peripheral distribution, and left and right lower lobes involvement. Our study showed that chest CT scan has high sensitivity in the diagnosis of COVID-19, and may therefore serve as a standard method for diagnosis of COVID-19.

Epidemiology of gastroesophageal reflux disease in Iran: a systematic review and meta-analysis.

BACKGROUND: Gastroesophageal reflux disease (GERD), which leads to acid reflux into the esophagus, is a common gastrointestinal disorder. Several studies have shown the prevalence of GERD in Iranian population, but their evidence is contradictory. Therefore, the present study was conducted to investigate the epidemiology of GERD in Iran. METHODS: The entire steps of this systematic review and meta-analysis were based on the MOOSE protocol, and the results were reported accordance with the PRISMA guideline. This review is registered on PROSPERO (registration number: CRD42020142861). To find potentially relevant published articles, comprehensive search was done on international online databases Scopus, Science Direct, EMBASE, PubMed/Medline, CINAHL, EBSCO, Cochrane Library, Web of Science, Iranian online databases and the Google Scholar search engine in June 2019. Cochran test and I2 index were used to assess the heterogeneity of the studies. Data were analyzed using Comprehensive Meta-Analysis software ver. 2. The significance level of the test was considered to be P <  0.05. RESULTS: The daily, weekly, monthly, and overall prevalence of GERD symptoms in Iranian population was 5.64% (95%CI [confidence interval]: 3.77-8.35%; N = 66,398), 12.50% (95%CI: 9.63-16.08%; N = 110,388), 18.62% (95%CI: 12.90-26.12%; N = 70,749) and 43.07% (95%CI: 35.00-51.53%; N = 73,189), respectively. The daily, weekly, monthly, and overall prevalence of heartburn in Iranian population was 2.46% (95%CI: 0.93-6.39%; N = 18,774), 9.52% (95%CI: 6.16-14.41%; N = 54,125), 8.19% (95%CI: 2.42-24.30%; N = 19,363) and 23.20% (95%CI: 13.56-36.79%; N = 26,543), respectively. The daily, weekly, monthly, and overall prevalence of regurgitation in Iranian population was 4.00% (95%CI: 1.88-8.32%; N = 18,774), 9.79% (95%CI: 5.99-15.60%; N = 41,140), 13.76% (95%CI: 6.18-44.31%; N = 19,363) and 36.53% (95%CI: 19.30-58.08%; N = 21,174), respectively. The sensitivity analysis for prevalence of all types GERD, heartburn and regurgitation symptoms by removing a study showed that the overall estimate is still robust. CONCLUSION: The present meta-analysis provides comprehensive and useful information on the epidemiology of GERD in Iran for policy-makers and health care providers. This study showed a high prevalence of GERD in Iran. Therefore, effective measures on GERD-related factors such as lifestyle can be among the health policies of Iran.

Thyroid dysfunction in Iranian pregnant women: a systematic review and meta-analysis.

BACKGROUND: Thyroid dysfunction during pregnancy is associated with adverse outcomes for both mother and fetus. The present meta-analysis was conducted to evaluate thyroid dysfunction in Iranian pregnant women. METHODS: We registered this review at PROSPERO (registration number: CRD42020166655). The research steps in this systematic review and meta-analysis were performed according to the MOOSE protocol, and finally, reports were provided based on the PRISMA guidelines. The literature search was performed in October 2019 using the international online databases, including Web of Science, Ovid, Science Direct, Scopus, EMBASE, PubMed/Medline, Cochrane Library, EBSCO, CINAHL, Google Scholar as well as national databases were reviewed. Data were extracted after applying the inclusion and exclusion criteria and qualitative evaluation of the studies. I2 index and Q test were used to assess differences in studies. All analyses were performed using Comprehensive Meta-Analysis Software. P-value less than 0.05 was considered statistically significant. We identified 1261 potential articles from the databases, and 426 articles remained after removing the duplicate and unrelated studies. After evaluating the full text, 52 articles were removed. RESULTS: Finally, 19 eligible studies including 17,670 pregnant women included for meta-analysis. The prevalence of thyroid dysfunction in Iranian pregnant women was 18.10% (95%CI: 13.89-23.25). The prevalence of hypothyroidism, clinical hypothyroidism, and subclinical hypothyroidism in Iranian pregnant women was respectively estimated to be 13.01% (95%CI: 9.15-18.17), 1.35% (95%CI: 0.97-1.86) and 11.90% (95%CI: 7.40-18.57). The prevalence of hyperthyroidism, clinical hyperthyroidism, and subclinical hyperthyroidism in Iranian pregnant women was respectively estimated to be 3.31% (95%CI: 1.62-6.61), 1.06% (95%CI: 0.61-1.84) and 2.56% (95%CI: 0.90-7.05). The prevalence of anti-thyroperoxidase antibody was estimated to be 11.68% (95%CI: 7.92-16.89). CONCLUSION: The results of this meta-analysis showed a high prevalence of thyroid disorders, especially hypothyroidism. The decision to recommend thyroid screening during pregnancy for all women is still under debate, because the positive effects of treatment on pregnancy outcomes must be ensured. On the other hand, evidence about the effect of thyroid screening and treatment of thyroid disorders on pregnancy outcomes is still insufficient. Nevertheless, a large percentage of general practitioners, obstetricians and gynecologists perform screening procedures in Iran.

Phenylketonuria screening in Iranian newborns: a systematic review and meta-analysis.

BACKGROUND: Phenylketonuria (PKU), which is characterized by a deficiency of phenylalanine hydroxylase activity, is an autosomal recessive disorder of phenylalanine (Phe) metabolism. Newborn screening is the main population-based public health screening program that allows successful identification and treatment of PKU with low-Phe diet. The aim of this study was to evaluate the epidemiology of PKU screening in Iranian newborns. METHODS: The present study was designed based on MOOSE protocol and reporting was done in accordance with the PRISMA guidelines. The protocol of this systematic review was published in PROSPERO before it was performed (CRD42020162626). A comprehensive search was done in 10/10/2019 to find related literature on international online databases Web of Science, Scopus, EMBASE, Science Direct, PubMed/Medline, EBSCO, CINAHL, Cochrane Library, national online databases and the Google Scholar search engine. Heterogeneity among studies was assessed by I2 index and Q test. All meta-analyses were performed using Comprehensive Meta-Analysis Software ver. 2. P < 0.05 was considered significant. RESULT: Finally, 18 studies with 3,339,327 Iranian neonates were included. The prevalence of suspected hyperphenylalaninemia (HPA) was estimated to be 45.6/100,000 (95% CI: 23.9-87.1). The prevalence of suspected HPA in girls and boys infants in Iran was estimated to be 38.0/100,000 (95% CI: 15.1-95.5) and 43.3/100,000 (95% CI: 16.2-116.2), respectively. The prevalence of PKU was estimated to be 16.5/100,000 (95% CI: 12.9-21.2). The prevalence of PKU in girls and boys infants was estimated to be 13.3/100,000 (95% CI: 7.5-15.8) and 10.9/100,000 (95% CI: 7.5-15.8), respectively. The prevalence of mild to moderate HPA was estimated 9.7/100,000 (95% CI: 5.1-18.4) and the prevalence of classical PKU was estimated 4.4/100,000 (95% CI: 2.5-7.8). Sensitivity analysis for all meta-analysis with the omission of one study showed that overall estimation is still robust. CONCLUSION: The results of this meta-analysis showed that PKU is prevalent in Iranian neonates. It should be considered that for PKU there is a highly effective dietary treatment which can prevent the clinical symptoms of PKU if initiated early after detection by newborn screening.

Epidemiology of low birth weight in Iran: A systematic review and meta-analysis.

INTRODUCTION: Low birth weight (LBW) is an important general health indicator. The present study was conducted to evaluate the prevalence and risk factors of LBW in Iran. METHOD: This meta-analysis was reported based on the PRISMA guidelines. All stages were independently performed by two authors. This review is registered with PROSPERO (CRD42020163446). We searched epidemiological studies at international databases of Scopus, Embase, Science Direct, PubMed/Medline, CINAHL, EBSCO, Cochrane Library, Web of Science, and Google Scholar search engine, as well as Iranian databases of SID, IranDoc, Iranian National Library, Barakat Knowledge Network System, RICST and Magiran using MeSH keywords without time limit until 2019. After selecting the studies, applying the inclusion and exclusion criteria, data extraction and qualitative assessment, the data were analyzed based on random effects model using Comprehensive Meta-Analysis Software version 2. P < 0.05 was considered significant. RESULTS: The prevalence of LBW in Iran was 7.95% (95% confidence interval [CI]: 7.36-8.58) in 62 studies with a sample size of 301,839 newborns. The prevalence of LBW in girls and boys was 8.41% (95%CI: 7.47-9.45) and 6.67% (95%CI: 5.86-7.59), respectively. The girls-to-boys odds ratio of LBW was 1.25 (95%CI: 1.13-1.39, P < 0.001) very LBW and extremely LBW prevalence was estimated to be 0.61% (95%CI: 0.40-0.93) and 0.29% (95% CI: 0.18-0.45), respectively. The risk factors for LBW were age of >35 versus [vs.] ≤35 (P = 0.024), age of <18 vs. ≥18 (P < 0.001), education of middle school and lower vs. high school and higher (P < 0.001), weight under 50 kg (P = 0.001), employed vs. housekeeper (P < 0.001), inadequate prenatal care (P = 0.046), interval with previous pregnancy <2 vs. >2 (P < 0.001), prematurity (P < 0.001), history of LBW (P < 0.001), multiple birth (P < 0.001), abortion (P < 0.001), vaginal bleeding (P < 0.001), hypertension (P = 0.001) and preeclampsia (P < 0.001). CONCLUSION: The results of this meta-analysis showed that LBW is prevalent in Iran. This study can be a national database for LBW that would be of interest to Iranian health policy-makers and planners.

The relationship between metabolic syndrome and increased risk of Barrett's esophagus: an updated systematic review and meta-analysis.

BACKGROUND: The relationship between metabolic syndrome (MetS) and Barrett's esophagus (BE) is still a challenging issue, and inconsistent results have been reported in different studies. Therefore, this study was conducted to determine the relationship between MetS and BE. METHODS: In this study, we followed the MOOSE protocol and results were reported according to the PRISMA guidelines. All study steps were performed independently by two authors. If necessary, the dispute was resolved by consultation with a third author. The search strategy is designed to find published studies. Comprehensive search was done in the following databases until July 2019: Cochrane Library, PubMed/Medline, Web of Science, Science Direct, EMBASE, Scopus, CINAHL, EBSCO, and Google Scholar search engine. All analyses were performed using Comprehensive Meta-Analysis Software Ver.2, while p-value lower than 0.05 was considered significant. RESULTS: In 14 studies with a sample size of 108,416, MetS significantly increased the risk of BE (OR = 1.354; 95% CI: 1.145-1.600; P < 0.001; Heterogeneity: I2 = 81.95%; P < 0.001). Sensitivity analysis by omitting one study showed that overall estimates are still robust. Subgroup analysis was significant for continent (P < 0.001) and MetS diagnostic criteria (P = 0.043), but was not significant for variables of study type (P = 0.899), study setting (P = 0.115), control groups (P = 0.671) and quality of studies (P = 0.603). The Begg (P = 0.912) and Egger's (P = 0.094) tests were not significant; therefore, the publication bias did not play a role in the results. CONCLUSION: MetS increases the risk of BE compared to control groups. The results of this study can help health practitioners by identifying a treatable risk factor for the most important risk factor for esophageal carcinoma (ie, BE). Future studies should examine whether treatment for MetS reduces the risk of BE.

The effect of yoga on the quality of life and fatigue in patients with multiple sclerosis: A systematic review and meta-analysis of randomized clinical trials.

BACKGROUND: The impact of yoga on the quality of life and fatigue in patients with multiple sclerosis (MS) has shown various results in different reports. As a result, performing a systematic review and meta-analysis to guide physicians and patients seems necessary. The present study was carried out to evaluate the effect of yoga intervention on the quality of life and fatigue in patients with MS. METHOD: The present study was designed based on PRISMA guidelines from their inception until October 2019. Two researchers independently performed all steps. We searched several international online databases such as PubMed/Medilne, Scopus, Science Direct, Cochrane Library, PsycINFO, Web of Science, CINAHL, CAM-Quest, CAMbase, IndMED and Google Scholar search engine. The data were analyzed using Comprehensive Meta-analysis Software Ver. 2, while P < 0.05 was considered significant. The protocol of this meta-analysis was registered at PROSPERO with number identifier: CRD42019127168. RESULTS: Overall, 693 patients with MS (yoga (n = 209), exercise (n = 298), control (n = 186) groups) were examined in ten randomized controlled trials (RCTs). According to this meta-analysis, the effect of yoga intervention on fatigue in patients with MS was significantly better compared to the typical MS care group [SMD = -0.872; 95%CI: -1.467 to -0.277, p = 0.004], and did not show significant difference compared to the exercise group [SMD = -0.093; 95%CI: -0.353 to 0.167, p = 0.482]. The effect of yoga intervention on the overall quality of life (compared to the typical MS care group: [SMD = 0.710; 95%CI: -0.172 to 1.592, p = 0.114], and compared to the exercise group: [SMD = -0.453; 95%CI: -0.233 to 1.138, p = 0.195]), physical component (compared to the typical MS care group: [SMD = 0.281; 95%CI: -0.157 to 0.719, p = 0.209], and compared to the exercise group: [SMD = 0.074; 95%CI: -0.125 to 0.273, p = 0.467]), psychological component (compared to the typical MS care group: [SMD = 0.250; 95% CI: - 0.132 to 0.631, p = 0.199], and compared to the exercise group: [SMD = - 0.270; 95%CI: -0.813 to 0.272, p = 0.329]), sexual function (compared to the typical MS care group: [SMD = 0.438; 95%CI: -0.350 to 1.226, p = 0.276]), and cognitive function (compared to the typical MS care group: [SMD = -0.390; 95%CI: -0.008 to 0.789, p = 0.055]) in patients with MS was not significant. CONCLUSION: Yoga is a simple exercise for patients with MS that is capable of decreasing fatigue in these patients.

Trichomonas Vaginalis Infection Among Women Attending Laboratory Centers in Ilam, Iran.

BACKGROUND: Trichomoniasis is known as a common venereal disease. It is estimated that 180 million people in the world are infected with this disease. The present study was conducted to estimate the prevalence of (Trichomonas vaginalis) T. vaginalis among women who were referred to the central laboratory in Ilam. METHODS: In this cross-sectional study, 481 women with suspicious symptoms of trichomoniasis were selected during the first six months of 2015 in the central laboratory and Shahid Mostafa laboratory in Ilam, Iran. All patients were referred to the labs by gynecologists. Sterile swabs were used to collect direct smears. The results and questionnaire data were entered into SPSS version 16 and were analyzed using chi-square test and Fisher's exact test. RESULTS: Direct smear of T. vaginalis demonstrated seven positive cases (1.5%). The highest and the lowest percentages of T. vaginalis infection in women were related to the 45-50 and 20-30 years age groups, respectively. Illiterate women had the highest percentage of infection. No significant relationship was found between the level of education and trichomoniasis infection in women (p = 0.085). The highest infection rate was associated with the use of ectopic contraceptive methods (condoms). CONCLUSION: The prevalence of T. vaginalis was low among women in Ilam but was high among women who have used tubal ligation and condom to prevent pregnancy. Therefore, more attention is required from healthcare centers for appropriate education to women about the proper use of protective equipment.

The relationship between maternal anemia during pregnancy with preterm birth: a systematic review and meta-analysis.

Objective: Iron deficiency anemia is the most common cause of anemia during pregnancy. Other causes of anemia include parasitic diseases, micronutrient deficiencies, and genetic hemoglobin apathies. Maternal anemia during pregnancy is the most important public health problem. Since the relationship between maternal anemia by the months of pregnancy and premature birth has been reported differently in various studies; thus, this study aims to determine the relationship between maternal anemia during pregnancy and premature birth.Methods: This systematic review and meta-analysis article was designed based on the recommendations of PRISMA. This study was performed from 1990 to 2018. Articles extracted using related keywords such as maternal, anemia, premature birth, and pregnancy in databases, including Cochrane, Medline, Medlib, Web of Science, PubMed, Scopus, Springer, Science Direct, Embase, Google Scholar, Sid, Irandoc, Iranmedex, and Magiran. Relative risk and its confidence interval were extracted from each of the studies. The random effects model was used to combine study results and heterogeneity among the studies measured using I2 index and the data were analyzed based by using STATA software version 3.2.Results: Overall 18 studies with sample sizes of 932 090 were entered into the meta-analysis. The overall relationship between maternal anemia during pregnancy and premature birth was significant (1.56 [95% CI: 1.25-1.95]). Maternal anemia in the first trimester increases the risk of premature birth (relative risk, 1.65 [95% CI: 1.31-2.08]). But, this relationship was not significant in the second (relative risk, 1.45 [95% CI: 0.79-2.65]) and third trimester (relative risk, 1.43 [95% CI: 0.82-2.51]).Conclusion: Maternal anemia during pregnancy can be considered as a risk factor for premature birth.

The association between caesarean section and childhood asthma: an updated systematic review and meta-analysis.

BACKGROUND: Investigating the association between caesarean section (SC) and childhood asthma has shown contradictory results in different studies. The present study was conducted to determine the association between SC and childhood asthma. MATERIAL AND METHOD: The present study was conducted based on the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. All the steps of the study were conducted independently by two reviewers from the inception until February 1, 2019. In case of disagreement, the third reviewer resolved it. We searched international online databases, including Scopus, Cochrane Library, PubMed/Medline, Embase, Web of Science (ISI), Science Direct, and Google scholar. The results of studies were combined using random effects model, and heterogeneity was measured through I2 index and Cochran's Q test. Comprehensive Meta-Analysis Software was used for meta-analysis. The significance level of all tests was considered to be P < 0.05. RESULTS: The heterogeneity rate was high (I2 = 67.31%, P < 0.001) in 37 studies. The results showed that SC increased the risk of childhood asthma (RR (relative risk) = 1.20 [95% CI 1.15-1.25, P < 0.001]). The association between emergency and elective SC and childhood asthma was significant with RR of 1.18 (95% CI 1.07-1.29, P < 0.001) in 13 studies and 1.23 (95% CI 1.20-1.26, P < 0.001) in 13 studies, respectively. The subgroup analysis for RR of childhood asthma in SC indicated that study design (P = 0.306), prospective/retrospective studies (P = 0.470), quality of studies (P = 0.514), continent (P = 0.757), age of diagnosis (P = 0.283) and year of publication (P = 0.185) were not effective in the heterogeneity of studies. Sensitivity analysis by removing one study at a time indicated that the overall estimate is robust. CONCLUSION: According to the meta-analysis, SC (overall, elective, and emergency) increased the risk of childhood asthma. Therefore, it is hoped that developing clinical guidelines and implementing appropriate management plans would diminish the risk of asthma.

The prevalence of metabolic syndrome in patients with polycystic ovary syndrome: A systematic review and meta-analysis.

INTRODUCTION: Polycystic ovary syndrome (PCOS) is an endocrinopathy with unknown pathophysiology among women of reproductive age. Several studies have been conducted to determine the prevalence of metabolic syndrome (MetS) among PCOS patients. However, the results were contradictory. The present study was conducted to evaluate the prevalence of MetS in PCOS patients using the related published data. METHOD: The present systematic review was perfumed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search was done using MeSH keywords in databases of PubMed, Scopus, Embase, CINAHL, Web of Science, Cochrane Library, EBSCO, and Google scholar search engine as well as the reference list of the retrieved papers without time limit until October 2018. We used Cochran's Q test and I2 Index to evaluate the heterogeneity among the studies and the random effects model was used to combine the results. Data analysis was performed using Stata ver. 11.1. RESULTS: Forty six studies including 8946 patients with PCOS were included in the final analysis. Total heterogeneity was high (I2: 91.43%, P < 0.001). The prevalence of MetS in PCOS patients was estimated to be 30% (95%CI: 27-33). Subgroup analysis based on MetS diagnostic criteria showed an estimated prevalence of 0.27% (95%CI: 0.18-0.37), 0.30% (95%CI: 0.27-0.34), 0.32 (95%CI: 0.25-0.39), 0.32 (95%CI: 0.27-0.37) and 0.24 (95%CI: 0.14-0.34) for IDF, NECP-ATPIII, AHA NHLBI, CDS, and unknown criteria, respectively. CONCLUSION: Considering the prevalence of MetS in PCOS patients, diagnosis of MetS in PCOS patients is necessary to reduce the mortality and morbidity rates.

The prevalence of depression and anxiety in Iranian patients with diabetes mellitus: A systematic review and meta-analysis.

INTRODUCTION: This study aims to estimate the prevalence of depression and anxiety among Iranian patients with diabetes mellitus (DM) through meta-analysis. METHODS: This is a systematic review article based on MOOSE and PRISMA guidelines. Review of the literature was done using databases including Magiran, Barakat Knowledge Network System, SID, RICST, IranDoc, PubMed/Medline, Science Direct, Embase, Scopus, Cochrane Library, Web of Science and the Google Scholar search engine without time limit until December, 2018. Heterogeneity between studies was assessed using Cochran's Q test and I2 index. Data were analyzed using Comprehensive Meta-Analysis (CMA) software version 2 according to a random-effects model. P-values less than 0.05 were considered as the significance level. RESULTS: The analysis consisted of 44 studies including 10,349 Iranian patients with DM. The prevalence of depression was estimated to be 61.8% (95% confidence interval [CI]: 56.6-66.7). The lowest and highest prevalence of depression based on regions was in the North (56.7% [95%CI: 44.9-67.8]) and the East (64.2% [95%CI: 30.7-87.9]), respectively. The depression prevalence in females and males was 63.9% (95%CI: 54.0-72.8) and 46.3% (95%CI: 36.4-56.4), respectively, The prevalence of mild, moderate, severe and highly severe depression was estimated to be 24.4% (95%CI: 21.0-28.2), 19.1% (95%CI: 15.2-23.9), 11.4% (95%CI: 8.6-14.9), and 4.6% (95%CI: 3.4-6.1), respectively. In eight studies, the prevalence of anxiety in Iranian patients with DM was estimated to be 64.5% (95%CI: 42.0-82.1). CONCLUSIONS: Depression and anxiety are more prevalent among Iranian patients with DM compared with developed countries. Therefore, regular psychiatric consultation is required for the early diagnosis and treatment of depression and anxiety in these patients.

The association between anemia and postpartum depression: A systematic review and meta-analysis.

BACKGROUND: The association between anemia and postpartum depression (PPD) has been reported to be controversial in different studies. Therefore, this study aimed to provide a comprehensive assessment of anemia and PPD. METHODS: This review study was conducted according to the MOOSE protocol and results have been reported according to the PRISMA guideline. We searched epidemiologic studies published until January 2018 in nine English databases including Scopus, PubMed/Medline, Science Direct, Embase, Web of Science, CINAHL, Cochrane Library, EBSCO and Google Scholar using English MeSH keywords. The heterogeneity of the studies was assessed using the Cochran's Q test and I2 index. Data were analyzed using a random effects model and comprehensive meta-analysis (CMA) software version 2. RESULTS: In the 10 studies, the association between postpartum anemia and PPD was significant (heterogeneity test: P<0.001, I2=74.62%), and RR=1.887 (95%CI: 1.255-2.838, P=0.002). In 8 studies, anemia during pregnancy significantly increased the risk of postpartum depression (heterogeneity test: P=0.116, I2=36.422%), RR=1.240 (1.001-1.536, P=0.048). The subgroup analysis of postpartum anemia and PPD was not significant for the variables of quality of studies, study design, and the period of evaluating depression and anemia. The subgroup analysis of anemia during pregnancy and PPD was not significant for the period of evaluating depression. Publication bias did not affect the results of the studies. CONCLUSION: Meta-analysis results showed anemia during pregnancy and after pregnancy that significantly increased the risk of postpartum depression. Therefore, prevention, identification and treatment of anemia in pregnant women seem necessary.