Plasma tissue factor pathway inhibitor levels in coronavirus disease 2019 patients: a systematic review and meta-analysis.

Studies have suggested a relationship between tissue factor pathway inhibitor (TFPI) and coronavirus disease 2019 (COVID-19) severity. However, there is inconsistency in the findings of the studies. To enhance comprehension of this relationship, a meta-analysis was conducted. PubMed, Web of Science, and Scopus databases were searched to identify eligible studies. The mean difference was employed as effect measures and the standardized mean difference (SMD) and the 95% confidence interval (CI) were utilized as a summary statistic. Heterogeneity was assessed through the application of the chi-square test and the I2 statistic. The included studies' quality and risk of bias were assessed using the Newcastle-Ottawa assessment scale, adapted for case-control studies. A total of six studies were included with 684 cases and healthy controls (180 healthy controls and 504 COVID-19 patients with different severity, 76 mild, 292 moderate, and 136 severe). The analysis revealed a significant increase in the TFPI level in COVID-19 patients with moderate severity compared with healthy controls (SMD = 0.95 ng/ml, 95% confidence interval (CI) 0.27, 1.63 ng/ml; I2: 87.2%). The increased TFPI level in mild and moderate COVID-19 was not significant, SMD = 0.68 ng/ml, 95% CI -0.64 to 2.0 ng/ml; I2 92.9% and SMD = 0.62 ng/ml, 95% CI -0.62 to 1.86 ng/ml; I2 91.5%, respectively. In addition, most studies indicate an association of the increased TFPI concentrations with increased markers of inflammation, endothelial damage, and hypercoagulation. Considering the anticoagulant and anti-inflammatory roles of TFPI, its increase seems to be aimed at modulating COVID-19-induced hyper-inflammation and hyper-coagulation state. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42023437353.

Treatment modalities for granulomatous mastitis, seeking the most appropriate treatment with the least recurrence rate: a systematic review and meta-analysis.

BACKGROUND: Granulomatous mastitis (GM) is a rare, benign, inflammatory breast disease with an unknown etiology that predominantly affects women of reproductive age. The definitive treatment of GM is currently controversial; an appropriate therapeutic strategy has yet to be identified, and the disease's high recurrence rate remains. This study aims to determine the recurrence rate for each GM treatment strategy to identify the most appropriate treatment modality. METHODS: The search for relevant articles was undertaken using three international databases, including Medline, Scopus, and Web of Science. Articles published in English until the end of 2021 evaluating the recurrence rate of GM were included. Using Stata 13.0, the pooled incidence and 95% confidence interval (CI) for the recurrence rate were determined. RESULTS: Sixty-five eligible studies were included in our study. The recurrence rates of systemic steroid use, topical steroid use, antibiotic use, methotrexate use, observation, drainage, excision, antibiotic use and surgery, steroid use and surgery, antibiotic and steroid use, methotrexate and steroid use were 24% (95% CI: 21-27%), 11% (95% CI: 6-21%), 18% (95% CI: 14-22%), 13% (95% CI: 7-22%), 11% (95% CI: 7-17%), 65% (95% CI: 50-78%), 13% (95% CI: 10-16%), 23% (95% CI: 14-36%), 7% (95% CI: 5-11%), 11% (95% CI: 6-18%), and 4% (95% CI: 2-8%), respectively. Drainage had the highest recurrence rate, while combined methotrexate and steroid treatment had the lowest rate. CONCLUSION: The optimal treatment strategy for GM depends on the disease's severity, consequences, and the patient's features. The study results indicate that combination therapy is preferable for minimizing the risk of relapse and reducing treatment complications.

Inflammatory markers and functional outcome score in different subgroups of ischaemic stroke: a prospective cohort study.

Background: Acute ischaemic stroke (AIS) is a leading cause of disability and mortality worldwide. Determining subgroups and outcomes of AIS may lead to better treatment. We aimed to investigate the relationship between inflammatory markers and subgroups of AIS with further follow-up of patients in terms of functional outcome score. Methods: In this prospective cohort study, we examined white cell count (WCC), neutrophil count, lymphocyte count, neutrophil-to-lymphocyte ratio (NLR), erythrocyte sedimentation rate (ESR) and qualitative C reactive protein (CRP), in the first 24 hours of patients' admission. Patients were assigned to AIS subgroups as defined by the TOAST criteria. Then patients' disability score was followed up after 3 and 6 months, using the modified Rankin Scale. Results: We included 217 patients with AIS. The mean age of participants was 72.07 years, and we included 92 women (42.4%). For the AIS subgroup, 83 (38.25%) patients had large artery atherosclerosis (LAA), 41 (18.89%) had cardioembolism and 62 (28.57) had small vessel obstruction. Neutrophil count and NLR showed a statistically significant difference in the subgroups of AIS and were highest in the 'other' subgroup of AIS (p<0.05). Lymphocyte count, ESR and qualitative CRP showed no statistically significant difference between subgroups (p>0.05). WCC, neutrophil count and NLR showed a positive correlation with functional outcomes (p<0.05), other markers did not correlate with outcomes (pp>0.05). Conclusion: We can conclude that neutrophil count and NLR are available inflammatory biomarkers for predicting outcomes and these two biomarkers are associated with AIS subgroups. However, ESR, qualitative CRP and lymphocyte count do not appear to be correlated with outcomes or subgroup of AIS.

Effects of ketamine, granisetron and dexmedetomidine on postoperative shivering and hemodynamic changes after general anesthesia: a double-blind randomized clinical trial.

Postoperative shivering is one of the most common complications of surgeries. The current research compared the effects of ketamine, granisetron, and dexmedetomidine on reducing postoperative shivering after general anesthesia. This double-blind clinical trial enrolled 148 patients (39.08 ± 5.99 years old) who had been admitted to Vali-Asr Hospital of Arak, Iran in 2019-2021. The study drugs, including dexmedetomidine, ketamine, granisetron and normal saline, were administered in corresponding groups 30 minutes before the end of surgery. The results showed that dexmedetomidine reduced mean arterial pressure and heart rate in patients. The lowest incidence of shivering was observed in the dexmedetomidine group and it increased the duration of recovery. Overall, dexmedetomidine is recommended to reduce postoperative shivering after general anesthesia, but the increase in duration of recovery should be considered.

Comparison of adding magnesium sulfate, dexmedetomidine and ondansetron to lidocaine for gargling before laryngoscopy and endotracheal intubation to prevent sore throat: a randomized clinical trial.

Postoperative sore throat is one well-recognized complication, occurring most frequently following tracheal intubation. Effective prevention of postoperative sore throat has been recognized as a top priority, bringing pleasant feelings and satisfaction to patients. This study aimed to assess the efficacy of magnesium sulfate, dexmedetomidine and ondansetron gargle with lidocaine administrated prior to laryngoscopy and tracheal intubation for postoperative sore throat prevention alongside hemodynamic management. This double-blind randomized clinical trial enrolled 105 general anesthesia-administered patients who had undergone laryngoscopy and endotracheal intubation, and they were equally randomized into three groups: magnesium sulfate, dexmedetomidine, and ondansetron groups. No significant intergroup difference was seen in oxygen saturation, non-invasive blood pressure, heart rate, duration of surgery, postoperative complications, analgesic consumption, and incidence of cough and hoarseness. The results showed statistically significant intergroup differences in pain scores and average pain intensity in the dexmedetomidine group was significantly lower than the other groups. Results suggest that dexmedetomidine gargle with lidocaine before general anesthesia induction could be recommended as an option depending on the patient's general condition and the anesthesiologist's discretion.

Estimation of health-related and economic impacts of PM2.5 in Arak, Iran, using BenMAP-CE.

Ambient air quality is one of the most critical threats to human health. In this study, the health and economic benefits of reducing PM2.5 were estimated in the city of Arak during the period of 2017-2019. The concentration data were obtained from the Environmental Protection Organization of Central Province, while the demographic data were obtained from the website of the Iran Statistics Center. The number of premature deaths from all causes, ischemic heart disease, chronic obstructive pulmonary disease, and lung cancer, attributable to PM2.5 pollution was estimated using the Environmental Benefits Mapping and Analysis Program-Comprehensive Version (BenMAP_CE) to limit the guidelines of the World Health Organization. The results showed that improving air quality in 2017, 2018, and 2019 in Arak could prevent the deaths of 729, 654, and 460 people, respectively. The number of years of life lost (YLL) in 2017, 2018, and 2019 was 11383, 10362, and 7260 years, respectively. The total annual economic benefits of reducing the PM2.5 concentration in Arak under the proposed scenarios in 2017, 2018, and 2019 were estimated to be 309,225,507, 262,868,727, and 182,224,053 USD, respectively, using the statistical life method (VSL). Based on the results of this study, there are significant health and economic benefits to reducing PM2.5 concentrations in Arak City. Therefore, planning and adopting control policies to reduce air pollution in this city are necessary.

Periodontal disease and visfatin level: A systematic review and meta-analysis.

Visfatin is considered an inflammatory biomarker in periodontal disease (PD). In this meta-analysis, we aimed to evaluate the relationship between Visfatin biomarker level with PD. In this study, Medline, Scopus, Web of Science, and Google Scholar were searched. We included studies that examined visfatin levels in samples from healthy people and periodontal disease until March 2023. The quality of the selected articles was evaluated using the Newcastle-Ottawa assessment scale. Depending on heterogeneity of studies, random-effects or fixed-effect models were used to pool results and report the standardized mean difference (SMD). After screening the retrieved papers, the related data were extracted. A total of 159 studies were identified, and 16 studies were included in the meta-analysis. In 9 studies, the SMD of visfatin level of gingival crevicular fluid (GCF) in patients with chronic periodontitis (CP) and healthy individuals was 4.32 (p<0.001). In 6 studies, the SMD of salivary visfatin level in patients with CP and healthy individuals was 2.95 (p = 0.004). In addition, in five studies, the SMD of serum visfatin level in patients with CP and healthy individuals was 7.87 (p<0.001). Therefore, Visfatin levels in serum, saliva, and GCF of patients with CP were increased in comparison to healthy individuals. Comparison of visfatin levels in saliva of gingivitis patients and healthy individuals showed a significant increase of visfatin in gingivitis patients (SMD:0.57, P = 0.018), but no significant difference was observed in the mean GCF visfatin level of gingivitis patients and healthy individuals (SMD:2.60, P = 0.090). In addition, the results suggested that there is no difference between gingivitis cases compared to CP patients (SMD:3.59, P = 0.217). Visfatin levels in GCF, serum, and saliva have the potential to be used as a diagnostic biomarker of periodontitis.

Waterpipe and cigarette smoking and drug and alcohol consumption, and the risk of primary progressive multiple sclerosis: A population-based case-control study.

Background: Multiple sclerosis (MS) is a chronic central nervous system disease, and primary progressive multiple sclerosis (PPMS) is one the main types of MS, which has unknown environmental risk factors. The present study was conducted with the aim to identify the association of waterpipe and cigarette smoking, substance abuse, and alcohol consumption with the risk of PPMS development. Methods: A population-based, case-control study was conducted in Tehran, Iran, on 146 PPMS cases and 294 controls. PPMS cases were diagnosed and confirmed by neurologists. Standard random digit dialing was used to select sex-matched healthy control participants from the same source population as the cases. Logistic regression analysis was used to estimate unadjusted and adjusted odds ratios (OR). Results: In total, 440 subjects participated in the study. PPMS was associated with ever smoking cigarettes [OR = 2.48; confidence interval (CI) = 1.44-4.27], and passive smoking (OR = 2.20; CI = 1.34-3.62). However, having ever smoked waterpipe was not significantly associated with PPMS risk (OR = 1.19; CI = 0.62-2.26). Those who had all 3 types of smoking had an accumulative OR that was 10.45 times higher than that in individuals without any type of smoking (OR: 10.45; 95% CI = 3.5-31.2). We did not find any significant association between PPMS risk and substance abuse and alcohol consumption. Conclusion: Cigarette smoking and being exposed to passive smoking are important risk factors for developing PPMS; in addition, the use of 3 types of smoking, showed an OR higher than that in those without any smoking. Considering the global increase in tobacco smoking, this finding emphasizes the importance of interventional programs for the prevention of tobacco smoking.

The role of fetal heart rate in first trimester sonograms in prediction of fetal sex: a systematic review and meta-analysis.

BACKGROUND: Early fetal sex determination is worthy of providing alertness about possible x-linked disorders, as well as predicting sex-related pregnancy complications and outcomes. Satisfying the curiosity of parents is another advantage. In this way, several studies have been performed which have shown conflicting results. AIM: We planned a systematic review for identifying any plausible role of Fetal Heart Rate (FHR) for early predicting fetal sex during the first trimester of non-complicated pregnancies. METHODS: This is a meta-analysis in which PubMed and Scopus databases were searched using different related keywords to find similar articles up to December 2022. Then the articles were screened to find eligible articles and finally, the articles entered in the meta-analysis were analyzed using Stata software (Stata Corp, College Station, TX). Standardized mean difference (SMD) and their 95% confidence interval (CI) were estimated. RESULTS: A total of 223 articles were evaluated and five articles were included in the meta-analysis. The results showed that there is a significant heterogeneity between the articles (p = 0.012, I-squared = 69.0%). The results of meta-analysis with a random model showed that there is no significant difference between male and female genders in terms of mean FHR (SMD = 0.04, 95%CI = -0.09-0.16, Z = 0.59, p = 0.553). CONCLUSION: This systematic review and meta-analysis showed that even though male fetuses show faster FHR but such sex-related difference is minimal. Therefore, first-trimester FHR is not a reliable predictive test for fetal sex determination. Further studies are recommended to achieve a more precise conclusion. TRIAL REGISTRATION: PROSPERO: CRD42023418291.

The Role of Hematological Parameters in Predicting the Death of Hospitalized Patients with COVID-19.

Background: The role of the hematologic indicators in the identification of severe or critical patients requires further investigation. In this study, we focused on predicting Covid-19 patients at risk of progression using blood parameters. Materials and Methods: We performed a retrospective study including 444 patients with confirmed Covid-19. Hematological parameters were evaluated. The logistic regression analysis was performed with step-wise method with dependent variables such as intensive care units admission, partial pressure of oxygen saturation, and mortality. Also, independent variables such as hematological parameters, age and sex to assess variables that are likely to predict patients at risk of progression. Results: Patients in intensive care units had significantly higher mean absolute neutrophil count than outpatients (P < 0.001). There was a statistically significant difference in the mean absolute lymphocyte count between dead and survived patients (P = 0.015). Multivariate analysis confirmed the positive association of the white blood cells (P < 0.001), absolute neutrophil count (P < 0.004), red cell distribution width (P < 0.001), and lactate dehydrogenase (P = 0.007) to be positively associated with the admission of Covid-19 patients in the intensive care units and the absolute monocyte count (P = 0.012, Odds ratios = 0.100, CI95% = 0.066-0.605) to be negatively associated with mortality. Conclusion: Based on the results of our study, it is recommended to use hematological data to make clinical decisions and evaluate the patient's prognosis.

Maternal saliva visfatin level in term and preterm labor: A case control study.

Visfatin, a colony-enhancing factor (pre-B-cell), is an inflammatory biomarker that is secreted from a different number of cells and appears to have some proinflammatory or immune-regulating effects. The aim of this study was to compare maternal saliva visfatin levels in women with preterm and term delivery. In This case-control study, women in labor before 37 weeks of gestation were the case group (n = 40) and women in labor after 37 weeks of gestation were in control group (n = 40). The saliva of the participants was sampled and maternal saliva visfatin level was measured by ELISA test. In this study, 80 pregnant women were studied in case and control groups. The mean age of case and control group was 29.1±6.9 and 30.55±5.3 years, respectively. The results revealed that the mean maternal saliva visfatin level in the preterm group (4.75±2.2) is significantly (p = 0.001) lower than that in term birth group (6.7±3.1). The results of adjusted logistic regression revealed that after adjusting for GDM, preeclampsia, pre pregnancy BMI and weight gain, the mean of maternal saliva visfatin level in the preterm group is significantly lower than that in the term group (p = 0.026). Considering that during the term pregnancy visfatin levels increase and visfatin may play a role in initiating labor, in our study due to the high visfatin level in case group although the level of maternal saliva visfatin was lower than the control group but high levels of visfatin in the case group can represent the role of visfatin in initiating labor and due to this issue can be use the role of this adipokine for early diagnosis of preterm delivery can be used to prevent, treat and improve the prognosis of this disease. Also, this study is the first study to compare the maternal saliva visfatin level between SGA and AGA group and there is no difference between these groups.

The effect of adding Montelukast to oxybutynin on daily urination in children with pollakiuria: a randomized clinical trial.

PURPOSE: Pollakiuria is defined as a change in the pattern of daily urination. Students have mentioned wetting their pants at school as the third tragic event after the death of a parent or going blind. In this study, the effect of adding Montelukast to oxybutynin on the improvement of urinary symptoms of patients with pollakiuria was studied. MATERIALS AND METHODS: This study was a pilot clinical trial in which children with pollakiuria aged 3-18 years old were included. These children were randomly divided into two groups of intervention (Montelukast plus oxybutynin) and the control group (only oxybutynin). At the beginning and the end of the study (after 14 days), mothers were asked about the frequency of daily urination. Finally, the gathered data were compared between two groups. RESULTS: In the present study, 64 patients were examined in two intervention and control groups (32 in each group). The results revealed that although significant changes were observed in both groups before and after intervention, the average changes in the intervention group were significantly higher (p = 0.014). CONCLUSION: The results of this study showed that adding montelukast to oxybutynin has a significant decrease in frequency of daily urination in patients with pollakiuria, although further studies are recommended in this area.

Does moral sensitivity contribute to patient satisfaction? A cross-sectional survey in educational hospitals.

Introduction: Our study aims to assess interactions between the moral sensitivity of physicians and the satisfaction of patients. Methods: This is a cross-sectional study. Data were collected by a standard questionnaire of the physicians' moral sensitivity about decision-making and a researcher-made patient satisfaction questionnaire. The physicians were selected through the census method, and patients were selected using quota sampling to equal the selection of each physician from each work shift. All information was analyzed by SPSS statistical software version 23. Results: The mean score for physicians' moral sensitivity was 91.6 ± 0.63 which shows a high level of moral sensitivity. The average patient satisfaction was 61.97 ± 3.55 out of the total score (23-115) which shows a moderate level of satisfaction with the highest scores in the domain of "professionalism" and the lowest scores were related to the domain of "Technical Quality of Care". Conclusion: For improving patient satisfaction, adopting appropriate strategies like performing the periodic evaluation of this phenomenon and providing some codified training in this regard are required to increase the level of moral sensitivity of physicians and provide high-quality care.

Periostin level in gingival crevicular fluid in periodontal disease: a systematic review and meta-analysis.

BACKGROUND: Periostin, a secreted adhesion molecule, is a matricellular protein secreted most in periodontal ligament and periosteum. Periostin is also needed for integrity and maturation of periodontal tissue. This meta-analysis was conducted to compare the gingival crevicular fluid (GCF) periostin levels in subjects having periodontal disease and healthy periodontium. METHODS: In this meta-analysis, three international database including PubMed, Scopus and Web of Science were searched and 207 studies retrieved. Also, the Google Scholar was searched to find more related studies (two studies were found). To assess the risk of bias of included studies, the Newcastle-Ottawa assessment scale adapted for case-control was used. Finally, required data was extracted and included into analysis. All statistical analysis were done using Stata software. RESULTS: Eight studies were included in this meta-analysis. Results showed that GCF periostin level is significant lower in chronic periodontitis group compare to healthy people (the standardized mean difference (SMD) = -3.15, 95% CI = -4.45, -1.85, p < 0.001). The syntheses of studies shown a significant decrease in the periostin level of chronic periodontitis patients compared to the gingivitis patients (SMD = -1.50, 95%CI = -2.52, -0.49, P = 0.003), while the mean level of periostin between the gingivitis patients and healthy group has no significant difference (SMD = -0.88, 95%CI = -2.14, 0.38, P = 0.173). CONCLUSION: The mean concentration of GCF periostin in people with chronic periodontitis significantly decreased compared to people with gingivitis and also compared to healthy people, while no significant difference was observed between the two groups with gingivitis and healthy people. Therefore, this marker may be used as a diagnostic criterion for the disease, which requires further studies.

Effect of an educational intervention based on the theory of planned behavior on improving medication adherence in patients with multiple sclerosis treated with injectable disease-modifying drugs: randomized controlled trial.

BACKGROUND: Adherence to prescribed treatment in chronic diseases, as occurs in multiple sclerosis (MS), is a critical factor for a successful therapeutic response. This study aimed to investigate the effect of educational program based on Theory of Planned Behavior (TPB) on treatment adherence in patients with multiple sclerosis (MS) receiving injectable immunomodulatory drugs. METHODS: The present study is an educational randomized controlled trial research that was conducted on 100 patients with MS who had gone to MS clinic in Tehran city (Iran). The samples were randomly assigned to the intervention (N = 50) and control groups (N = 50). Data collection instrument was a researcher-made questionnaire based on TPB. Then, educational program was performed for the intervention group through four educational sessions. After three months, data collection was repeated for the two groups and data were analyzed. RESULTS: The knowledge and performance of the intervention group on treatment adherence drugs increased from 56.25 ± 20.3 to 78.31 ± 15.57 and 56.22 ± 5.76 to 71.62 ± 12.01 after the education respectively (p < 0.001). The mean of construct of TPB in the intervention group also increased after the intervention (p < 0.05). CONCLUSION: Applying the TPB model proved is very effective in developing an educational program for patients with MS, to enhance treatment adherence drugs. Besides such programs, follow-up education for controlling and monitoring are highly recommended. TRIAL REGISTRATION: This trial has been registered at Iranian Registry of Clinical Trials, IRCT20210808052109N1. Prospectively registered at 12-Aug-2021, (12/8/2021) available at: URL: https://en.irct.ir/trial/57994.

Efficacy appraisal of four regimens (granisetron, ketamine, dexmedetomidine, and lidocaine combined with fentanyl) for cystoscopy-associated sedation and analgesia and catheter-related bladder tolerance: a randomized clinical trial.

The authors sought to quantify the clinical impacts of granisetron, ketamine, dexmedetomidine, and lidocaine combined with fentanyl, for procedural sedation and analgesia in cystoscopy and for bladder catheter tolerance. This double-blind trial recruited four stratified blocked randomized eligible groups of patients (n = 120) formerly identified as needing cystoscopy, each receiving one of the above four anesthetic agents. Dexmedetomidine-sedated subjects experienced less pain from 5 to 120 minutes after the beginning of procedure, and next the ketamine manifested a better pain relief experienced. Sedation score was found to be rather more satisfactory in the early-mentioned from 15 to 55 minutes and at 90 and 105 minutes after procedure. The mean opioid use was observed lower in the dexmedetomidine treated patients and next in the ketamine administered patients. Considering the findings emanating from the study and the lack of complications that need to be treated, dexmedetomidine and ketamine afforded superior pain relief, greater sedation, and less postoperative opioid use in patients undergoing cystoscopy, and thus, they could be suggested to be combined with fentanyl during outpatient cystoscopy.

Which audio distraction technique is more effective for reduction the pain and anxiety of pediatric dental patients; "music" or "kids-story"? A randomized split-mouth crossover clinical trial.

OBJECTIVE: Control of pain, fear, and anxiety of children during dental procedures is a major challenge in pediatrics. This study aimed to compare the effect of audio distraction by music and audio-story on pain and anxiety of children during dental treatment. METHODS: This randomized crossover clinical trial evaluated 60 systemically healthy children between 4 and 8 years, who were candidates for pulpotomy and steel crown of bilateral primary maxillary first or second molars. The patients were randomly divided into two groups of music-story (M first), and story-music (S first) according to the sequence of receipt of the distraction techniques with a split-mouth design. The level of pain and anxiety of patients was measured using physiological scales such as pulse rate (PR), sound-eye-motor (SEM) and faces pain rating (FPR). The pkcross package in Stata software version 14 was used to assess the treatment effect, period effect, sequence effect and carryover effect. RESULTS: In each group, 28 cases were included in the analysis. The difference in PR was not significant at the onset and termination of each treatment session between two distraction techniques and also, the mean FPR (P = 0.55) and SEM (P > 0.99) scores were not significantly different between the two groups. CONCLUSIONS: The "audio-story" and "music" distraction techniques were not significantly different for pediatrics relieving during LA administration. Thus, considering the equal efficacy of the two techniques, dental clinicians can use any of the two to distract children. REGISTRATION INFORMATION: The study registered in the Iranian Registry of Clinical Trials (IRCT20190702044077N1).

Bacterial biofilm prevalence in dental unit waterlines: a systematic review and meta-analysis.

BACKGROUNDS: Numerous studies have shown that dental unit water lines (DUWLs) are often contaminated by a wide range of micro-organisms (bacteria, fungi, protozoa) and various prevalence have been reported for it in previous studies. Therefore, this review study aims to describe the prevalence of bacterial biofilm contamination of DUWLs. METHODS: This is a systematic review and meta-analysis in which the related keywords in different international databases, including Medline (via PubMed) and Scopus were searched. The retrieved studies were screened and the required data were extracted from the included studies. Three standard methods including American Dental Association (ADA), The Center for Disease Control and Prevention (CDC) and contaminated > 100 CFU/ml(C-100) standards were used to assess the bacterial biofilm contamination of DUWLs. All studies that calculated the prevalence of bacterial biofilm contamination of DUWLs, and English full-text studies were included in the meta-analysis. Studies that did not have relevant data or used unusual laboratory methods were excluded. Methodological risk of bias was assessed by a related checklist and finally, the data were pooled by fixed or random-effect models. RESULTS: Seven hundred and thirty-six studies were identified and screened and 26 related studies were included in the meta-analysis. The oldest included study was published in 1976 and the most recent study was published in 2020. According to the ADA, CDC and C-100 standards, the prevalence of bacterial contamination was estimated to be 85.0% (95% confidence interval (CI): 66.0-94.0%), 77.0% (95%CI: 66.0-85.0%) and 69.0% (95%CI: 67.0-71.0%), respectively. The prevalence of Legionella Pneumophila and Pseudomonas Aeruginosa in DUWLs was estimated to be 12.0% (95%CI: 10.0-14.0%) and 8.0% (95%CI: 2.0-24.0%), respectively. CONCLUSION: The results of this review study suggested a high prevalence of bacterial biofilm in DUWLs; therefore, the use of appropriate disinfecting protocol is recommended to reduce the prevalence of contamination and reduce the probable cross-infection.

Preterm Birth and Breast Cancer Risk: A Systematic Review and Meta-Analysis.

BACKGROUNDS: Changes in estrogen levels during pregnancy as well as histologic changes in breast tissue can justify the relationship of preterm birth (PTB) and the risk of BC. Therefore, there is a hypothesis that the duration of pregnancy can be associated with BC, so the aim of this study was to find out whether PTB is a risk factor for BC. METHODS: Published studies were located back to the earliest available publication date (1983), using the Medline/PubMed, Embase, Scopus, and Web of Science bibliographic databases. This review included the cohort or case control studies that assessed the association between PTB and BC. Pooled effect sizes with corresponding 95% confidence intervals (CI) were calculated using random-effects models. RESULTS: Thirteen studies including a total of 2,845,553 women were included in this meta-analysis. Pooled results suggested that PTB could increase the risk of BC (RR: 1.03, 95% CI: 1.00, 1.07; I2= 62.5%). The risk was significantly increased in women who delivered at 37-39 (RR: 1.03, 95% CI: 1.01, 1.06) and 26-31 weeks of gestation (RR: 1.25, 95% CI: 1.04, 1.47) compared to women who delivered at 40-41 weeks of gestation. A significant increment in the risk of BC was observed in primiparous (RR: 1.05, 95% CI: 1.01, 1.08) and women older than 45 years (RR = 1.12, 95% CI: 1.01, 1.24). There was no difference between other gestational age categories. CONCLUSIONS: Our findings add to evidence that short gestation pregnancies may increase the risk of BC, especially in primiparous and women older than 45 years. Considering the methodological weaknesses existed in included studies, minor clinical differences, and the complexity of the exact pathophysiology of PTB on BC, the precise position of PTB as a risk factor for BC in clinical practice is undetermined. Further studies are still needed.
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The Targeted Maximum Likelihood estimation to estimate the causal effects of the previous tuberculosis treatment in Multidrug-resistant tuberculosis in Sudan.

INTRODUCTION: This study used Targeted Maximum Likelihood Estimation (TMLE) as a double robust method to estimate the causal effect of previous tuberculosis treatment history on the occurrence of multidrug-resistant tuberculosis (MDR-TB). TMLE is a method to estimate the marginal statistical parameters in case-control study design. The aim of this study was to estimate the causal effect of the previous tuberculosis treatment on the occurrence of MDR-TB using TMLE in Sudan. METHOD: A case-control study design combined with TMLE was used to estimate parameters. Cases were MDR-TB patients and controls were and patients who cured from tuberculosis. The history of previous TB treatment was considered the main exposure, and MDR-TB as an outcome. A designed questionnaire was used to collect a set of covariates including age, time to reach a health facility, number of times stopping treatment, gender, education level, and contact with MDR-TB cases. TMLE method was used to estimate the causal association of parameters. Statistical analysis was carried out with ltmle package in R-software. Result presented in graph and tables. RESULTS: A total number of 430 cases and 860 controls were included in this study. The estimated risk difference of the previous tuberculosis treatment was (0.189, 95% CI; 0.161, 0.218) with SE 0.014, and p-value (<0.001). In addition, the estimated risk ratio was (16.1, 95% CI; 12.932, 20.001) with SE = 0.014 and p-value (<0.001). CONCLUSION: Our findings indicated that previous tuberculosis treatment history was determine as a risk factor for MDR-TB in Sudan. Also, TMLE method can be used to estimate the risk difference and the risk ratio in a case-control study design.