Diagnostic Indicators of ECG for Coronary Slow Flow Phenomenon; a Systematic Review and Meta-Analysis.

Introduction: Currently, epicardial coronary angiography is still the only diagnostic tool for Coronary Slow Flow Phenomenon (CSFP). This study aimed to systematically review studies that compared Electrocardiogram (ECG) findings between patients with and without CSFP. Methods: Using relevant key terms, we systematically searched MEDLINE, Scopus, Embase, and Web of Science to find relevant studies up to February 5th, 2023. Effect sizes in each study were calculated as mean differences and crude odds ratio; then, random-effect models using inverse variance and Mantel-Haenszel methods were used to pool standardized mean differences (SMD) and crude odds ratios, respectively. Results: Thirty-two eligible articles with a total sample size of 3,937 patients (2,069 with CSFP) were included. CSFP patients had higher P-wave maximum (Pmax) (SMD: 1.02 (95% confidence interval (CI): 0.29 - 1.76); p=0.006) and P-dispersion (Pd) (SMD: 1.63 (95% CI: 0.99 - 2.27); p<0.001) compared to the control group. CSFP group also showed significantly longer QT wave maximum duration (SMD: 0.69 (95% CI: 0.33 - 1.06); p<0.001), uncorrected QTd (SMD: 1.89(95% CI: 0.67 - 3.11); p=0.002), and corrected dispersion (QTcd) (SMD: 1.63 (95% CI: 1.09 - 2.17), p<0.001). The frontal QRS-T angle was significantly higher in the CSFP group in comparison with the control group (SMD: 1.18 (95% CI: 0.31 - 2.04; p=0.007). While CSFP patients had a significantly higher T-peak to T-end (Tp-e) (SMD:1.71 (95% CI: 0.91, 2.52), p<0.001), no significant difference was noted between groups in terms of Tp-e to QT (p=0.16) and corrected QT ratios (p=0.07). Conclusion: Our findings suggest several ECG parameters, such as P max, Pd, QT, QTc, QTd, QTcd, Tp-e, and frontal QRS-T angle, may be prolonged in CSFP patients, and they could be employed as diagnostic indicators of CSFP before angiography.

Sex hormone therapy in Multiple Sclerosis: A systematic review of randomized clinical trials.

Background: In spite of the observed immunomodulatory properties of different sex hormones on Multiple Sclerosis (MS) in different investigations, to date, there has been no study to systematically review the documents to add more powerful data to the field. Objectives: Therefore, in this paper we aim to systematically review clinical and randomized controlled trials (RCT) assessing the effect of sex hormone therapies on individuals with MS. Design: A comprehensive search of electronic databases including PubMed, EMBASE, and Scopus was conducted. Clinical trials and RCTs that assessed the impact of sex hormones on individuals with MS were selected and included in the systematic review. Data sources and methods: In the final phase of the search strategy, 9 papers reached the criteria for entering in the systematic review. Two independent reviewers extracted the relevant data from each article according to the standardized data extraction form. Two reviewers also assessed the quality of each study independently using PEDro scale. Results: We categorized three different classifications of outcomes including clinical, MRI, and immune system findings and put each measured outcome in the category which matched best. Conclusion: In conclusion, the existed investigations on the effect of sex hormones on inflammatory and neurodegenerative components of MS are promising particularly in relapsing-remitting MS (RRMS).

Immunomodulatory properties of different sex hormones on Multiple Sclerosis (MS) have been proposed. Therefore, in this paper we aim to systematically review clinical and randomized controlled trials (RCT) assessing the effect of sex hormone therapies on individuals with MS. A comprehensive search of electronic databases was conducted. Clinical trials and RCTs that assessed the impact of sex hormones on individuals with MS were selected and included in the systematic review. In the final phase of the search strategy, 9 papers reached the criteria for entering in the systematic review. Two independent reviewers extracted the relevant data from each article according to the standardized data extraction form. We categorized three different classifications of outcomes including clinical, MRI, and immune system findings and put each measured outcome in the category which matched best. The existed investigations on the effect of sex hormones on inflammatory and neurodegenerative components of MS are promising particularly in relapsing-remitting MS (RRMS).

Investigating the Relationship between Structural Features of Built Environment and Physical Activity using Geographic Information Systems (GIS).

Background: Built environment determinants of engaging in physical activity are dependent on the properties of societies. This study investigates the relationship between structural variables of the environment using geographic information systems (GIS) and the level of physical activity in 22 districts of Tehran. Methods: This cross-sectional study was based on Urban Health Equity Assessment and Response Tool (Urban HEART-2). Physical activity level was assessed via the Global Physical Activity Questionnaire (GPAQ). The characteristics of the neighborhood environment, including land use, street pattern, population density, and traffic, were determined via ArcGIS software. Walkability index (population density, street pattern, land use) was calculated to assess the effect of the main variables of living environment on physical activity level. Results: Among the built environmental variables, land use was associated with the total physical activity and travel-related physical activity level (r: 0.155, P value: 0.001, and r: 0.122, P value: 0.007, respectively). The walkability index indicated an association with the total physical activity level and travel-related physical activity level (r: 0.126, P value: 0.006, and r: 0.135, P value: 0.001, respectively). Higher levels of the walkability index were associated with an improved level of physical activity (OR: 2.04). Conclusions: Walkability index and land use positively correlate with total physical activity level, and providing action plans that improve walkability index and land use might lead to increased physical activity level.

Organized physical activity and sedentary behaviors in children and adolescents with autism spectrum disorder, cerebral palsy, and intellectual disability.

BACKGROUND: There is little data on physical activity (PA), organized PA (OPA), and sedentary behaviors in autism spectrum disorders (ASD) and other neurodevelopmental disorders in developing countries. AIM: To examine OPA, non-OPA, and sedentary behaviors and their associated factors in children and adolescents with ASD, cerebral palsy (CP), and intellectual disability (ID). METHODS: A total of 1020 children and adolescents with ASD, CP, and ID were assessed regarding the child and family information as well as the Children's Leisure Activities Study Survey. RESULTS: The results showed that the OPA level was significantly lower than non-OPA in all groups. Furthermore, the OPA level was significantly lower in the CP group compared to ASD and ID groups (P < 0.001). Also, moderate (P < 0.001), vigorous (P < 0.05), and total (P < 0.001) physical activity levels were significantly different between all three groups, with the values being higher in the ASD group compared to the other two. The mean of the total sedentary behavior duration in the ASD group (1819.4 min/week, SD: 1680) was significantly lower than in the CP group (2687 min/week, SD: 2673) (P = 0.007) but not ID group (2176 min/week, SD: 2168.9) (P = 0.525). CONCLUSION: Our findings remark on the participation rate of PA, OPA, and sedentary behaviors of children and adolescents with ASD, CP, and ID in a developing country. In contrast, the need for developing standards of PA/OPA participation in neurodevelopmental disorders is discussed.

Designing a minimum dataset for autism spectrum disorder registry in Iran.

The reported prevalence of autism spectrum disorders (ASDs) has been showing a marked increase over the past 20 years. Therefore, a uniform data gathering system for ASD registration could prominently enhance plans for managing ASD worldwide. So, in the current investigation the authors aimed to design and validate the Persian version of a minimum dataset (MDS) for being administered in the national ASD registries. Methods: The current study is a mixed-method study with both quantitative and qualitative methods providing and validating a form of MDS in four phases according to Delphi method. The proposed MDS consisted of 11 categories containing coding responses. Content validity (CV) was evaluated based on 20 expert's suggestions and opinions. Item-CV Index (I-CVI) and Scale-CVI were administered to evaluate and validate the items and questions in the proposed MDS. Results: Twenty researchers from different disciplines scored each question and item. By taking into account the scores, the validity appraisal was provided for each item by computing the I-CVI value. Results showed that 41 out of 76 items had the value I-CVI less than 0.78 and were kept as relevant; 35 items were eliminated due to a value below 0.70. The Scale-CVI /Ave of the relevance for the entire form was 0.9396. Conclusion: The Persian version of MDS for ASD registry was found to be valid. Such MDS can be utilitarian for health cares and policymaking purposes by gathering and updating standard data for developing local and national registries.

Risk of autism spectrum disorder in offspring with parental schizophrenia: a systematic review and meta-analysis.

BACKGROUND: The effect of parental schizophrenia on the risk of Autism Spectrum Disorders (ASD) in offspring has been evaluated in previous studies. However, to our knowledge, no systematic review and meta-analysis have assessed this association. In this study, we aimed to evaluate the risk of ASD in offspring with parental schizophrenia. METHODS: The electronic databases EMBASE, PubMed, and Scopus were systematically searched. We administered the Newcastle Ottawa quality assessment scale (NOS) to assess the quality of all selected studies. Combined effect values, as well as their 95% confidence intervals (CI), were calculated. We evaluated heterogeneity using Q and I2 statistics. The publication bias was evaluated by funnel plot and Egger's regression test. In addition, a leave-one-out sensitivity analysis was performed to assess the robustness of the finding. RESULTS: A total of 12 observational studies (10 cohorts and two case-control) were included. Our study found a high risk of ASD in offspring exposed to parental schizophrenia [RR = 2.38 (CI%95 2.0-2.83)]. Subgroup and sensitivity analysis confirmed the robustness of our main analysis. CONCLUSION: The risk of ASD is considerably higher in offspring with parental schizophrenia. Our findings may suggest a shared pathologic pathway between schizophrenia and ASD.

Utility of electrocardiogram to predict the occurrence of the no-reflow phenomenon in patients undergoing primary percutaneous coronary intervention (PPCI): a systematic review and meta-analysis.

Background: The no-reflow phenomenon affects about one out of five patients undergoing Primary Percutaneous Coronary Intervention (PPCI). As the prolonged no-reflow phenomenon is linked with unfavorable outcomes, making early recognition is crucial for effective management and improved clinical outcomes in these patients. Our review study aimed to determine whether electrocardiogram (ECG) findings before PCI could serve as predictors for the occurrence of the no-reflow phenomenon. Methods and materials: We systematically searched MEDLINE, Scopus, and Embase to identify relevant studies. The random-effect model using inverse variance and Mantel-Haenszel methods were used to pool the standardized mean differences (SMD) and odds ratios (OR), respectively. Result: Sixteen eligible articles (1,473 cases and 4,264 controls) were included in this study. Based on our meta-analysis of baseline ECG findings, the no-reflow group compared to the control group significantly had a higher frequency of fragmented QRS complexes (fQRS) (OR (95% CI): 1.35 (0.32-2.38), P-value = 0.01), and Q-waves (OR (95% CI): 1.97 (1.01-2.94), P-value <0.001). Also, a longer QRS duration (QRSD) (SMD (95% CI): 0.72 (0.21, 1.23), p-value <0.001) and R wave peak time (RWPT) (SMD (95% CI): 1.36 (0.8, 1.93), P < 0.001) were seen in the no-reflow group. The two groups had no significant difference regarding P wave peak time (PWPT), and P wave maximum duration (Pmax) on baseline ECG. Conclusion: Our findings suggest that prolonged QRSD, delayed RWPT, higher fQRS prevalence, and the presence of a Q wave on baseline ECG may predict the occurrence of the no-reflow phenomenon in patients undergoing PPCI.

Brace-Related Stress and Quality-of-Life Parameters in Adolescents with Idiopathic Scoliosis.

Introduction: This study investigated brace-related stress, trunk appearance perception, and quality of life in adolescent girls with idiopathic scoliosis who wear the Milwaukee brace for treatment. Methods: Fifty-two adolescent girls with idiopathic scoliosis participated in this study. They had been under treatment with Milwaukee brace for at least three months. They filled out four questionnaires, including the revised 22-item Scoliosis Research Society questionnaire (SRS-22r), the Brace Questionnaire (BrQ), the Bad Sobernheim Stress Questionnaire-Brace (BSSQ-Brace), and the Trunk Appearance Perception Scale (TAPS). Results: Twenty participants had high stress levels, and thirty-two had moderate stress levels. The total score and emotional and social function scores of the BrQ were significantly higher in participants with high stress compared to those with moderate stress. There was no significant difference between the two groups in the SRS-22r and TAPS questionnaires scores. However, a high Cobb angle had significantly worsened their perception of trunk appearance. Conclusions: It seems that among quality-of-life parameters, social and emotional functions are more affected by stress level in treating adolescent girls with idiopathic scoliosis with a brace. In addition, patients with high stress levels have a worse perception of their trunk appearance.

Validity and reliability of the persian version of the world health organization quality of life disabilities module.

This study aimed to assess the validity and reliability of the world health organization quality of life questionnaire for people with intellectual disability (WHOQOL-DIS-ID). This was a cross-sectional study of 118 adults with intellectual disability. Internal consistency and temporal reliability were evaluated using Cronbach's alpha and intraclass correlation coefficient (ICC), respectively. Construct validity of the structure was assessed using confirmatory factor analysis. Multiple linear regression analysis was performed to determine the factors associated with the quality of life. Cronbach's alpha for all, but not for discrimination area, as well as ICC for all questions except for 23 and 6, were higher than 0.7. The variables such as periodic check-up, number of friends, entertainment outside the home, parental separation, physical activity, unmet needs score, caregiver's mental health status, and available facilities were the predictors of QOL. The Persian version of the WHOQOL-DIS-ID shows acceptable validity and reliability.

Generating Human Induced Pluripotent Stem Cell Via Low-Dose Polyethylenimine-Mediated Transfection: An Optimized Protocol.

Human dermal fibroblasts (HDFs) can be reprogrammed through different strategies to generate human induced pluripotent stem cells (hiPSCs). However, most of these strategies require high-cost materials and specific equipment not readily accessible in most laboratories. Hence, liposomal and virus-based techniques can replace with polyethylenimine (PEI)-mediated transfection to overcome these challenges. However, few researchers have addressed the PEI's ability to transfect HDFs. This study used PEI reagent to transfer oriP/EBNA1-based vector into HDFs to produce hiPSC lines. We first described conditions allowing the efficient transfection of HDFs with low cytotoxicity and without specific types of equipment and optimized several parameters relevant to the transfection procedure. We then monitored the effect of different N/P ratios on transfection efficiency and cytotoxicity using flow cytometry and fluorescent microscopy. By the results, we found that transfection efficiency was greatly affected by plasmid DNA concentration, PEI concentration, order of combining reagents, serum presence in polyplexes, and the duration of serum starvations. Moreover, using the optimized condition, we found that the N/P ratio of 3 achieved the highest percentage of HDFs positive for green fluorescent protein plasmid (∼40%) with minimal cell toxicity. We finally generated hiPSCs using the optimized protocol and oriP/EBNA1-based vectors. We confirmed hiPSC formation by characterizing tests: alkaline phosphatase staining, immunocytochemistry assay, real-time PCR analysis, in vitro differentiation into three germ layers, and karyotyping test. In conclusion, our results indicated that 25 kDa branched PEI could efficiently transfect HDFs toward generating hiPSCs via a simple, cost-effective, and optimized condition.

Iran's higher education and COVID-19: the "new normal" for Tehran University of Medical Sciences.

When the emergency committee of the World Health Organization declared that the outbreak of COVID-19 meets the criteria of a "Public Health Emergency of International Concern" on January 30th, 2020, no one could ever imagine how soon it will spread globally, and a health crisis would turn to a social crisis that affects everything including higher education. However, during this uncertainty, Tehran University of Medical Sciences (TUMS) tried to respond quickly. In this study, we explain how a nerve center has helped TUMS respond to this crisis and ensure safety to keep key operations going, and set up a functional decision-making system for the future. We also share perspectives on the critical issues, the challenges ahead, and the opportunities emerging in the "new normal."

Short-term and long-term mate preference in men and women in an Iranian population.

Mate preference in short-term relationships and long-term ones may depend on many physical, psychological, and socio-cultural factors. In this study, 178 students (81 females) in sports and 153 engineering students (64 females) answered the systemizing quotient (SQ) and empathizing quotient (EQ) questionnaires and had their digit ratio measured. They rated their preferred mate on 12 black-line drawing body figures varying in body mass index (BMI) and waist to hip ratio (WHR) for short-term and long-term relationships. Men relative to women preferred lower WHR and BMI for mate selection for both short-term and long-term relationships. BMI and WHR preference in men is independent of each other, but has a negative correlation in women. For men, digit ratio was inversely associated with BMI (p = 0.039, B = - 0.154) preference in a short-term relationship, and EQ was inversely associated with WHR preference in a long-term relationship (p = 0.045, B = - 0.164). Furthermore, men and women in sports, compared to engineering students, preferred higher (p = 0.009, B = 0.201) and lower BMI (p = 0.034, B = - 0.182) for short-term relationships, respectively. Women were more consistent in their preferences for short-term and long-term relationships relative to men. Both biological factors and social/experiential factors contribute to mate preferences in men while in women, mostly social/experiential factors contribute to them.

Saffron (Crocus Sativus L.), Combined with Endurance Exercise, Synergistically Enhances BDNF, Serotonin, and NT-3 in Wistar Rats.

BACKGROUND: Evidence indicates that combined approaches based on exercise and nutrition benefit neural development. We aimed to determine the effect of saffron and endurance training on hippocampus neurogenic factors, neurotrophin-3 gene expression in soleus muscle, and short-term memory in Wistar rats. METHODS: The study analyzed four groups of ten rats each: control, exercise, saffron, and saffron plus exercise. The rats in the exercise groups were trained on a rodent motor-driven treadmill. All rats were gavage daily with either saffron extract (40 mg/kg) or water. After eight weeks of intervention all rats were evaluated using the novel object recognition (NOR) test. Blood and tissue samples were collected to measure proteins and neurotrophin-3 gene expression. RESULTS: Rats that received saffron treatment combined with exercise had significantly greater brain-derived neurotrophic factor (BDNF) and serotonin in hippocampus compared to the control and saffron-only-treated rats (p< 0.05). Neurotrophin-3 mRNA in soleus muscle was higher in the saffron plus exercise group than rats in the other three groups (p< 0.05). Hippocampus 5-hydroxyindolacetic acid and short-term memory were significantly greater in all the intervention groups than in the control group (p< 0.05). CONCLUSION: Saffron, combined with endurance exercise, synergistically increased hippocampus BDNF, serotonin, and muscular neurotrophin-3 mRNA in Wistar rats.

A Randomized Crossover, Pilot Study Examining the Effect of Acupuncture in the Management of Competitive Anxiety in Athletes.

Background: Excessive competitive anxiety induces adverse effects on athletic performance and planning efficient management methods is crucial. Objectives: We aimed to assess the effects of acupuncture on competitive anxiety. Methods: In this cross-over study, 20 male soccer players under 21 years (U-21) were randomized equally into acupuncture or control groups. The acupuncture group received acupuncture on fifteen anxiety-related points and the control group received acupuncture on fifteen points unrelated to anxiety for thirty minutes. We measured the participants' resting heart rate and galvanic skin conduction and asked them to answer the Competitive State Anxiety Inventory-2 (CSAI-2) questionnaire at baseline and the end of the intervention. Results: We detected a significant treatment effect in the cognitive anxiety level (-1.05 ± 0.91; p = 0.02) but not in the somatic anxiety level (-0.46 ± 1.68; p = 0.43), Sport Self-Confidence (-1.06 ± 2.21; p = 0.11), heart rate (0.20 ± 2.2; p = 0.93), and skin conductance (-0.50 ± 0.77; p = 0.19). Conclusion: Based on these results, acupuncture might decrease cognitive anxiety but might not affect somatic anxiety.

COVID-19 and Fear, Which Comes First?

Today people have a few unanswered questions in their mind, such as "Do negative emotions will co-survive with the COVID-19 pandemic? Which one is worse? Which one will disappear quicker? Is there any connection between negative emotions and being infected by COVID-19 or the severity of infected individuals' symptoms? How are we supposed to live with COVID-19 and adapt our emotional system to the virus for more than one upcoming year?" These uncertainties could result in massive pressure on people. While there is no clear consensus regarding what establishes psychological stress on an individual, the effect of negative affect and psychological stress on increased susceptibility to disease due to altered immune functions is well established. Here we are going through the possible effect of emotions associated with the present pandemic on COVID-19 course of disease and severity of symptoms.

Rising incidence of musculoskeletal discomfort in the wake of the COVID-19 crisis.

The COVID-19 pandemic has led to the shutdown of much of the world's economic and social operations. Given shutdown of exercise facilities, there has been a sharp uptick in a sedentary lifestyle. As people have lost their normal daily activity patterns, it is reasonable to assume that musculoskeletal pain-related syndromes will consequently begin to increase. In addition, there has been a rise in social network, television, and online home-based workouts. In the wake of the COVID-19 pandemic, it is unclear whether previous recommendations for physical activities will remain sufficient, given cessation of normal physical activities from day-to-day life. We raise a variety of questions in dealing with the potential fallout of the COVID-19 shutdown from a musculoskeletal standpoint.

Repetitive Transcranial Magnetic Stimulation for the Treatment of Lower Limb Dysfunction in Patients Poststroke: A Systematic Review with Meta-Analysis.

PURPOSE: To investigate the effectiveness of repetitive transcranial magnetic stimulation (rTMS) in recovery of lower limb dysfunction in patients poststroke. PARTICIPANTS AND METHODS: Cochrane Central Register of Controlled Trials, Medline, ISI web of knowledge, EBSCO, Embase, Cumulative Index to Nursing and Allied Health Literature and Scopus. RESULTS: Fifteen trials with 385 patients were included. Results showed that rTMS had a significant effect on balance (standard mean difference [SMD] = .38; 95% confidence interval [CI], .07: .69; I2 = 51%) and mobility (SMD: -.67; 95% CI, -1.08: -.26; I2 = 72%). However, rTMS had no significant immediate effects on the lower limb subscale of the Fugl-Meyer Assessment (FMA-L) (SMD = .01; 95% CI, -.29: .31; I2 = 0%). Continued effects of rTMS was also found to be significant during the follow-up period (SMD = .46; 95% CI, .09: .84; I2 = 14%). CONCLUSION: rTMS was found to result in positive effects on mobility, balance and long-term prognosis of FMA-L. However data indicated that there is insufficient evidence for the effectiveness of rTMS in improving lower limb function.