Prevalence of hepatitis B, hepatitis C, and tuberculosis among people living with HIV in Iran: a systematic review and meta-analysis.

BACKGROUND: Up to now several studies estimate the prevalence of HBV, HCV, and TB among people living with HIV (PLWH) in Iran; however, their results are inconsistent. This study aimed to estimate the overall prevalence of HBV, HVC, and TB among Iranian PLWH. METHODS: In this systematic review and meta-analysis six databases including Medline, Web of Science, Scopus, MagIran, Scientific Information Database (SID), and Barakat Knowledge network system were searched up to October 2023 with no language restriction. All studies estimated the prevalence of HBV, HCV, and TB among PLWH in Iran were included. The random-effects model was used to report the study estimates. Results were reported at a 95% confidence interval (CI). RESULTS: Out of 1050 retrieved references, 58 articles met the eligibility criteria. Overall among PLWH, HBV prevalence was 13.0% (95% CI: 11.0, 15.0), HCV prevalence was 54% (95% CI: 45.0, 64.0), and TB prevalence was 19% (95% CI: 13.0, 24.0). The results from multivariate meta-regression analysis showed no statistically significant association between HBV and TB prevalence with the year of study, quality of studies, age, gender, and persons who inject drugs (PWID). HCV prevalence was significantly associated with PWID. CONCLUSION: We found HBV, HCV, and TB infections are common among PLWH in Iran and required to be screened and treated with effective and timely services.

Peripheral blood mononuclear cells show markers of mitochondrial dysfunction in rheumatoid arthritis.

Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease. Metabolic and mitochondrial dysregulation are critical causal factors in the pathogenesis and progression of RA. Mitochondrial dysfunction include abnormal energy metabolism, and excessive production of reactive oxygen species (ROS). This study aimed to investigate the adenosine triphosphate (ATP), mitochondrial membrane potential (ΔΨm), ROS, and mRNA expression level of ROMO1 (as ROS modulator) and OMA1 (as regulator mitochondrial dynamics) of peripheral blood mononuclear cells (PBMC) in RA patients. The study participants were 50 patients with RA and 50 sex- and age-matched healthy volunteers. PBMC of all participant were isolated by Ficoll-Paque. Alteration in ΔΨm and cellular ROS were measured using flow cytometry, ATP level was also assessed via luminometry, and ROMO1 and OMA1 mRNA expression via qRT-PCR assay. A significant decrease in ATP (p = .005) and ΔΨm (p < .001) was observed in the PBMC of RA compared to control. The ROS levels were significantly higher in the PBMC of RA compared to the control (p < .001). ROMO1 and OMA1 mRNA expression was also significantly increased in RA patients compared to control (p < .001). The decrease in ATP is strongly associated with ROS increasing in PBMC of RA patients, denoting an inverse and negative relationship between ATP and ROS production. Also, a decrease in ΔΨm was observed. It seems that in line with mitochondrial dysfunction in PBMC, increased expression of ROMO1 and OMA1 genes could also be involved in the development of RA.

The maternal factors associated with infant low birth weight: an umbrella review.

BACKGROUND: In this umbrella review, we systematically evaluated the evidence from meta-analyses and systematic reviews of maternal factors associated with low birth weight. METHODS: PubMed, Scopus, and Web of Science were searched to identify all relevant published studies up to August 2023. We included all meta-analysis studies (based on cohort, case-control, cross-sectional studies) that examined the association between maternal factors (15 risk factors) and risk of LBW, regardless of publication date. A random-effects meta-analysis was conducted to estimate the summary effect size along with the 95% confidence interval (CI), 95% prediction interval, and heterogeneity (I2) in all meta-analyses. Hedges' g was used as the effect size metric. The effects of small studies and excess significance biases were assessed using funnel plots and the Egger's test, respectively. The methodological quality of the included studies was assessed using the AMSTAR 2 tool. RESULTS: We included 13 systematic Review with 15 meta-analysis studies in our study based on the inclusion criteria. The following 13 maternal factors were identified as risk factors for low birth weight: crack/cocaine (odds ratio [OR] 2.82, 95% confidence interval [CI] 2.26-3.52), infertility (OR 1.34, 95% CI 1.2-1.48), smoking (OR 2.00, 95% CI 1.76-2.28), periodontal disease (OR 2.41, 95% CI 1.67-3.47), depression (OR 1.84, 95% CI 1.34-2.53), anemia (OR 1.32, 95% CI 1.13-1.55), caffeine/coffee (OR 1.34, 95% CI 1.14-1.57), heavy physical workload (OR 1.87, 95% CI 1.00-3.47), lifting ≥ 11 kg (OR 1.59, 95% CI 1.02-2.48), underweight (OR 1.79, 95% CI 1.20-2.67), alcohol (OR 1.23, 95% CI 1.04-1.46), hypertension (OR 3.90, 95% CI 2.73-5.58), and hypothyroidism (OR 1.40, 95% CI 1.01-1.94). A significant negative association was also reported between antenatal care and low birth weight. CONCLUSIONS: This umbrella review identified drug use (such as crack/cocaine), infertility, smoking, periodontal disease, depression, caffeine and anemia as risk factors for low birth weight in pregnant women. These findings suggest that pregnant women can reduce the risk of low birth weight by maintaining good oral health, eating a healthy diet, managing stress and mental health, and avoiding smoking and drug use.

Effectiveness of the flipped classroom method using clinical scenarios and Educational Technology versus Subject-Based Lectures in a gastrointestinal physiology course for medical students.

BACKGROUND: Medical education is evolving towards more practical, active, effective, and student-centered approaches that address the limitations of traditional lecture methods. Recently, the flipped classroom method has been considered to support these reforms. However, research on the use of flipped classroom methods in medical education, particularly related to clinical scenarios and educational technology, is still in its early stages. This study aims to evaluate the effectiveness of the flipped classroom method using clinical scenarios and educational technology versus subject-based lectures in the course of gastrointestinal physiology for medical students. METHODS: A total of 60 medical students participated in this study. The control group (n = 30) received traditional subject-based lectures and participated in question-and-answer sessions. The intervention group (n = 30) received non-attendance educational content and participated in small group discussions based on clinical scenarios. Course satisfaction was measured using an 18-item questionnaire, and learning outcomes were assessed with a 20-question multiple-choice test, corresponding to levels 1 and 2 of Kirkpatrick's model. Data were analyzed using descriptive and analytical statistical tests with SPSS software version 24. RESULTS: The findings indicated that the post-test scores in the intervention group were significantly higher compared to the control group. However, according to the student satisfaction questionnaire, satisfaction was significantly lower in the intervention group compared to the control group. CONCLUSION: This study demonstrated that the flipped classroom method, compared to traditional lectures, improved the learning and performance of medical students at Hamadan University of Medical Sciences in the course of gastrointestinal physiology.

First Iranian guidelines for the diagnosis, management, and treatment of hyperlipidemia in adults.

This guideline is the first Iranian guideline developed for the diagnosis, management, and treatment of hyperlipidemia in adults. The members of the guideline developing group (GDG) selected 9 relevant clinical questions and provided recommendations or suggestions to answer them based on the latest scientific evidence. Recommendations include the low-density lipoprotein cholesterol (LDL-C) threshold for starting drug treatment in adults lacking comorbidities was determined to be over 190 mg/dL and the triglyceride (TG) threshold had to be >500 mg/dl. In addition to perform fasting lipid profile tests at the beginning and continuation of treatment, while it was suggested to perform cardiovascular diseases (CVDs) risk assessment using valid Iranian models. Some recommendations were also provided on lifestyle modification as the first therapeutic intervention. Statins were recommended as the first line of drug treatment to reduce LDL-C, and if its level was high despite the maximum allowed or maximum tolerated drug treatment, combined treatment with ezetimibe, proprotein convertase subtilisin/kexin type 9 inhibitors, or bile acid sequestrants was suggested. In adults with hypertriglyceridemia, pharmacotherapy with statin or fibrate was recommended. The target of drug therapy in adults with increased LDL-C without comorbidities and risk factors was considered an LDL-C level of <130 mg/dl, and in adults with increased TG without comorbidities and risk factors, TG levels of <200 mg/dl. In this guideline, specific recommendations and suggestions were provided for the subgroups of the general population, such as those with CVD, stroke, diabetes, chronic kidney disease, elderly, and women.

Cardiac response to hypertension treatment: an advanced echocardiographic evaluation.

BACKGROUND: Hypertension is the most common reversible cause of cardiovascular disease worldwide and more than one billion individuals suffer from the disease. Constant heart exposure to increased afterload progresses to maladaptive remodeling, leading to cardiac dysfunction. In this study, we aimed to evaluate cardiac function in response to hypertension treatment. METHODS: One hundred patients diagnosed with hypertension were evaluated two times, with 3 to 6 months intervals, before and after antihypertensive therapy. Patients underwent clinical and echocardiographic evaluation in both visits and the interest effect of antihypertensive therapy on cardiac function was studied. RESULTS: 58 men and 42 women with a mean age of 60.81 ± 11.8 years were studied. Mean systolic and diastolic pressure in the first visit was 163.05 ± 20.6 and 95.40 ± 10.4, respectively. On the second visit, mean systolic and diastolic pressure was 129.95 ± 10.4 and 82.35 ± 7.2 respectively (P value for both < 0.001). The mean value of Global Longitudinal Strain as the main parameter for evaluating left ventricular systolic function was -15.54% on the first visit and changed to -16.95% on the second visit (P value 0.025). CONCLUSIONS: According to the results of this study, changes in parameters, indicator of systolic and diastolic function, after 3-6 months of antihypertensive therapy are significant. The most important point is that maladaptive remodeling of the heart is reversible if hypertension is diagnosed timely. To follow-up patients under antihypertensive therapy, GLS and parameters indicator of diastolic dysfunction, have the best diagnostic value in terms of detecting early stages of cardiac injury.

Unraveling the interplay between mental workload, occupational fatigue, physiological responses and cognitive performance in office workers.

Recently, cognitive demands in workplaces have surged significantly. This study explored the intricate relationship among mental workload (MWL), occupational fatigue, physiological responses, and cognitive performance in office workers by using collective semi-parametric models. One hundred office workers were selected from twenty offices involved in cognitive performance. MWL was assessed through the NASA Task Load Index (NASA-TLX), and occupational fatigue was measured using the Persian version of the Swedish Occupational Fatigue Inventory. Physiological responses, including respiratory rate, the electrical conductivity of the skin (ECS), Heart Rate (HR), and other heart-related parameters, were recorded from the participants during a work shift. Selective and Divided Attention tests were chosen to evaluate workers' cognitive function based on cognitive task analysis. The mean of MWL and occupational fatigue scores were 66.28 ± 11.76 and 1.62 ± 1.07, respectively. There was a significant moderate correlation between two dimensions, mental demand (0.429) and frustration (0.409), with functional fatigue. Also, Significant and, of course, nonlinear relationships were observed between MWL and HR (R2 = 0.44, P-value < 0.001) and ECS (R2 = 0.45, P-value < 0.001) and reaction time in selected (R2 = 0.34, P-value < 0.001) and divided test (R2 = 0.48, P-value < 0.001). Similarly, nonlinear relationships were observed between physiological responses and cognitive performance with fatigue among participants who had experienced higher levels of occupational fatigue. The MWL and fatigue seem to have a significant and non-linear effect on physiological parameters such as HR and ECS and cognitive parameters such as reaction time. Moreover, MWL can influence the dimension of functional fatigue of workers.

Comparing the Efficacy and Adverse Events of Available COVID-19 Vaccines Through Randomized Controlled Trials: Updated Systematic Review and Network Meta-analysis.

BACKGROUND: Different vaccines have so far been developed and approved to cope with COVID-19 in the world. The aim of this updated network meta-analysis (NMA) was to compare and rank all available vaccines in terms of efficacy and complications simultaneously. Study Design: A systematic review. METHODS: Three major international databases, including Web of Science, Medline via PubMed, and Scopus, were searched through September 2023. The transitivity assumption was evaluated qualitatively in terms of epidemiologic effect modifiers. The exposure of interest in this study was receiving any available COVID-19 vaccine, and the primary outcome of interest was the incidence of symptomatic COVID-19. In this NMA, the relative risk of symptomatic COVID-19 was used to summarize the efficacy of vaccines in preventing COVID-19. The data were analyzed using the frequentist-based approach, and the results were reported using a random-effects model. Finally, the vaccines were ranked using a P-score. RESULTS: In total, 34 randomized controlled trials (RCTs) met the eligibility criteria for this systematic review and NMA out of 3682 retrieved references. Based on the results of the NMA, mRNA-1273 was the most effective vaccine in preventing COVID-19 and demonstrated the highest P-score (0.93). The relative risk (RR) for mRNA-1273 versus placebo was 0.07 (95% confidence interval [CI]: 0.03, 0.17). The second and third-ranked vaccines were BNT-162b2 (RR=0.08; 95% CI: 0.04, 0.15; P-score=0.93) and Gam-COVID-Vac (0.09; 95% CI: 0.03, 0.25; 0.88). CONCLUSION: Based on the results of this NMA, it seems that all available vaccines were effective in COVID-19 prevention. However, the top three ranked vaccines were mRNA-1273, BNT-162b2, and Gam-COVID-Vac, respectively.

Comparison of Diagnostic Quality of Multidetector Computed Tomography and Cone-Beam Computed Tomography in High and Low Resolution Modes for Assessment of the Nasal Cavity.

Background: We aimed to compare the diagnostic quality of multidetector computed tomography (MDCT) and cone-beam computed tomography (CBCT) in high (HR) and low (LR) resolution modes for assessment of the nasal cavity and paranasal sinuses. Methods: This in vitro study was conducted on 5 dry human skulls by using a CBCT and a MDCT scanner in HR and LR modes to assess their diagnostic quality for 21 anatomical landmarks of the nose. The quality of images was evaluated by two oral and maxillofacial radiologists and a dentist using a four-point Likert scale of (I) poor, (II) decreased, (III) good, and (IV) excellent. Data were analyzed by STATA at 95% confidence interval. The Chi-square test was applied to compare the quality of visualization of landmarks based on the type of scanner. Results: The diagnostic quality of HR CBCT and CT for the majority of landmarks was higher than that of LR CBCT and CT (P<0.05). The diagnostic quality of HR CBCT for agger nasi cells (P=0.010), olfactory cleft (P=0.032), sphenoethmoidal recess (P=0.032), and nasolacrimal duct (P=0.014) and LR CBCT for the middle turbinate (P=0.046) and middle meatus (P=0.031) was significantly higher than that of MDCT. Conclusion: The diagnostic quality of HR CBCT and CT for the majority of the landmarks in the nasal cavity and paranasal sinuses was higher than that of LR CBCT and CT. For the majority of landmarks, the diagnostic quality of CBCT and CT was the same; while for some landmarks, the diagnostic quality of HR and LR CBCT was higher than HR and LR CT. In general, CBCT has high efficacy for evaluation of the paranasal sinuses and the nasal cavity, and provides diagnostic information comparable to those provided by CT, but with a much lower radiation dose.