The presence of abnormal septal motion on echocardiography is a predictor of abnormal cardiac magnetic resonance in systemic sclerosis.

OBJECTIVES: We aimed to perform a comprehensive analysis of the ECG, two-dimensional echocardiography (2DE) and cardiac MRI (CMR) findings in patients with systemic sclerosis (SSc), and also to investigate correlations between CMR findings and some ECG and echocardiography (ECHO) results. METHODS: We retrospectively analysed data from patients with SSc who were regularly seen at our outpatient referral centre, all assessed with ECG, Doppler ECHO and CMR. RESULTS: Ninety-three patients were included; mean (s.d.) age of 48.5 (10.3) years, 86% female, 52% diffuse SSc. Eighty-four (90%) of the patients had sinus rhythm. The most common ECG finding was the left anterior fascicular block, recorded in 26 patients (28%). The abnormal septal motion (ASM) was found in 43 (46%) patients on ECHO. Myocardial involvement (inflammation or fibrosis), as assessed by multiparametric CMR, was present in >50% of our patients. The age- and sex-adjusted model showed that ASM on ECHO increased significantly the odds of increased extracellular volume [odds ratio (OR) 4.43, 95% CI 1.73, 11.38], increased T1 Relaxation time (OR 2.67, 95% CI 1.09, 6.54), increased T2 Relaxation time (OR 2.56, 95% CI 1.05, 6.22), increased signal intensity ratio in T2-weighted imaging (OR 2.56, 95% CI 1.05, 6.22), presence of late gadolinium enhancement (OR 3.85, 95% CI 1.52, 9.76) and mid-wall fibrosis (OR 3.64, 95% CI 1.48, 8.96). CONCLUSION: This study indicates that the presence of ASM on ECHO is a predictor of abnormal CMR in SSc patients, and a precise assessment of ASM may serve as an important point for selecting the patients that should be evaluated by CMR for early detection of myocardial involvement.

Association of amino acid metabolites with osteoporosis, a metabolomic approach: Bushehr elderly health program.

INTRODUCTION AND OBJECTIVES: Amino acids are the most frequently reported metabolites associated with low bone mineral density (BMD) in metabolomics studies. We aimed to evaluate the association between amino acid metabolic profile and bone indices in the elderly population. METHODS: 400 individuals were randomly selected from 2384 elderly men and women over 60 years participating in the second stage of the Bushehr elderly health (BEH) program, a population-based prospective cohort study that is being conducted in Bushehr, a southern province of Iran. Frozen plasma samples were used to measure 29 amino acid and derivatives metabolites using the UPLC-MS/MS-based targeted metabolomics platform. We conducted Elastic net regression analysis to detect the metabolites associated with BMD of different sites and lumbar spine trabecular bone score, and also to examine the ability of the measured metabolites to differentiate osteoporosis. RESULTS: We adjusted the analysis for possible confounders (age, BMI, diabetes, smoking, physical activity, vitamin D level, and sex). Valine, leucine, isoleucine, and alanine in women and tryptophan in men were the most important amino acids inversely associated with osteoporosis (OR range from 0.77 to 0.89). Sarcosine, followed by tyrosine, asparagine, alpha aminobutyric acid, and ADMA in women and glutamine in men and when both women and men were considered together were the most discriminating amino acids detected in individuals with osteoporosis (OR range from 1.15 to 1.31). CONCLUSION: We found several amino acid metabolites associated with possible bone status in elderly individuals. Further studies are required to evaluate the utility of these metabolites as clinical biomarkers for osteoporosis prediction and their effect on bone health as dietary supplements.

Anchoring Errors in Emergency Medicine Residents and Faculties.

Background: Clinical reasoning is the basis of all clinical activities in the health team, and diagnostic reasoning is perhaps the most critical of a physician's skills. Despite many advances, medical errors have not been reduced. Studies have shown that most diagnostic errors made in emergency rooms are cognitive errors, and anchoring error was identified as the most common cognitive error in clinical settings. This research intends to determine the frequency and compare the percentage of anchoring bias perceived among faculty members versus residents in the emergency medicine department. Methods: In this quasi-experimental study, Emergency Medicine's Faculties and Residents are evaluated in clinical reasoning by nine written clinical cases. The clinical data for each clinical case was presented to the participants over three pages, based on receiving clinical and para-clinical information in real situations. At the end of each page, participants were asked to write up diagnoses. Data were analyzed using one-way ANOVA test. The SPSS software (Version 16.0) was employed to conduct statistical tests, and a P value < 0.05 was considered to be statistically significant. Results: Seventy-seven participants of the residency program in the Emergency Medical group volunteered to participate in this study. Data showed Faculties were significantly higher in writing correct diagnoses than residents (66% vs. 41%), but the anchoring error ratio was significantly lower in residents (33% vs. 75%). In addition, the number of written diagnoses, time for writing diagnoses, and Clinical experience in faculties and residents were compared. Conclusion: Findings showed that increasing clinical experience increased diagnostic accuracy and changed cognitive medical errors. Faculties were higher than residents in anchoring error ratio. This error could be the result of more exposure and more decision-making in the mode of heuristic or intuitive thinking in faculties.

Factors associated with TBS worse than BMD in non-osteoporotic elderly population: Bushehr elderly health program.

BACKGROUND: Bone mineral density (BMD) and trabecular bone score (TBS) are moderately correlated. TBS is sometimes used as an adjuvant to BMD in the fracture risk assessment. Some individuals with normal BMD or osteopenia, have more degraded TBS. We aimed to identify factors associated with TBS worse than BMD in the non-osteoporotic elderly population. METHODS: The study subjects were selected from 2384 women and men aged ≥60 years participating in the second stage of the Bushehr Elderly Health program, a population-based prospective cohort study in Iran. The BMDs of different sites and the lumbar spine texture were measured using dual-energy X-ray absorptiometry and the TBS algorithm, respectively. Subjects were categorized based on their BMD and TBS status. Logistic regression was performed to identify the factors associated with "TBS worse than BMD" in non-osteoporotic individuals. RESULTS: Of 1335 participants included in the study, 112 of 457 women, and 54 of 878 men had worse TBS than BMD. In multivariable analysis, TBS worse than BMD in women was statistically significantly associated with years since menopause (OR: 1.04 (1.00-1.07)) and waist circumference (OR: 1.09 (1.05-1.14)). However, in men, the condition was statistically significantly associated with waist circumference (OR: 1.10 (1.03-1.17)), current smoking (OR: 2.54 (1.10-5.84)), and HDL-C (OR: 1.03 (1.00-1.06)). CONCLUSION: The results of the study show that higher waist circumference is associated with more degraded TBS than BMD in both men and women. Years passed since menopause and current smoking, respectively in women and men, were associated with more degraded TBS. Considering TBS values in older individuals with higher waist circumference, or a history of smoking despite normal BMDs might help more accurate assessment of bone health. However, further studies are required to confirm the benefit.

Effect of the herbal medicines in obesity and metabolic syndrome: A systematic review and meta-analysis of clinical trials.

Obesity is a medical situation in which excess body fat has gathered because of imbalance between energy intake and energy expenditure. In spite of the fact that the variety of studies are available for obesity treatment and management, its "globesity" still remains a big challenge all over the world. The current systematic review and meta-analysis aimed to evaluate the efficacy, safety, and mechanisms of effective herbal medicines in the management and treatment of obesity and metabolic syndrome in human. We systematically searched all relevant clinical trials via Web of Science, Scopus, PubMed, and the Cochrane database to assess the effects of raw or refined products derived from plants or parts of plants on obesity and metabolic syndrome in overweight and obesity adult subjects. All studies conducted by the end of May 2019 were considered in the systematic review. Data were extracted independently by two experts. The quality assessment was assessed using Consolidated Standards of Reporting Trials checklist. The main outcomes were anthropometric indices and metabolic syndrome components. Pooled effect of herbal medicines on obesity and metabolic syndrome were presented as standardized mean difference (SMD) and 95% confidence interval (CI). A total of 279 relevant clinical trials were included. Herbals containing green tea, Phaseolus vulgaris, Garcinia cambogia, Nigella sativa, puerh tea, Irvingia gabonensis, and Caralluma fimbriata and their active ingredients were found to be effective in the management of obesity and metabolic syndrome. In addition, C. fimbriata, flaxseed, spinach, and fenugreek were able to reduce appetite. Meta-analysis showed that intake of green tea resulted in a significant improvement in weight ([SMD]: -0.75 [-1.18, -0.319]), body mass index ([SMD]: -1.2 [-1.82, -0.57]), waist circumference ([SMD]: -1.71 [-2.66, -0.77]), hip circumference ([SMD]: -0.42 [-1.02, -0.19]), and total cholesterol, ([SMD]: -0.43 [-0.77, -0.09]). In addition, the intake of P. vulgaris and N. sativa resulted in a significant improvement in weight ([SMD]: -0.88, 95 % CI: [-1.13, -0.63]) and triglyceride ([SMD]: -1.67, 95 % CI: [-2.54, -0.79]), respectively. High quality trials are still needed to firmly establish the clinical efficacy of the plants in obesity and metabolic syndrome.

Autoimmune Polyglandular Syndrome Type 1: a case report.

BACKGROUND: Mutations of the autoimmune regulator gene (AIRE), located on chromosome 21q22.3, are recognized as the cause of a rare monogenic organ-specific autoimmune disorder called autoimmune polyglandular syndrome type 1 (APS-1). Three major components of this syndrome include chronic mucocutaneous candidiasis (CMC), hypoparathyroidism, and adrenocortical failure. CASE PRESENTATION: We report a 19-year-old girl, who was born in an Iranian Muslim family with a clinical diagnosis of APS-1. To identify the causative mutation, a direct sequencing of the entire AIRE gene sequence was performed by Sanger sequencing method. Three distinct variants were discovered, including c.1095 + 2 T > A, c.1197 T > C (rs1800521) and c.1578 T > C (rs1133779), in intron 9, exons 10 and 14 of the AIRE gene, respectively. CONCLUSIONS: To the best of our knowledge, this is the first report of an Iranian Muslim APS-1 patient with combination of these variations. In addition, the effect of c.1095 + 2 T > A mutation on AIRE mRNA expression was reported for the first time. This study expands the diversity of variants that could cause APS-1. More genetic studies are required to determine the exact frequency of these variants and their diagnostic significance.

Is the association of weight disorders with perceived health status and life satisfaction independent of physical activity in children and adolescents? The CASPIAN-IV Study.

BACKGROUND: Physical activity (PA) and weight status have been suggested as predictors of life satisfaction (LS) and perceived health status (PHS). Therefore the present study aims to investigate and compare the impacts of body mass index (BMI) and PA on LS and PHS in a population of Iranian children and adolescents. MATERIAL AND METHODS: This study was conducted in 2011-12 as a nationwide population-based study among 14 880 students of age 6-18 years. Students were selected via a multistage cluster sampling method from 30 provinces of Iran. Information on demographics, PA, PHS and LS was obtained using the World Health Organization Global School-based Student Health Survey (WHO-GSHS) questionnaire. PA values were considered as low (<2 /week), moderate (2-4 h/week) and high (>2 h/week). RESULTS: The current study has a participation rate of 90.6% (50.8% boys). PA was significantly associated with both LS and PHS [odds ratio (OR), 1.37 in both), while in BMI, this association was significant for only PHS (in underweight: OR, 0.65; 95% CI, 0.57-0.75; in excess weight: OR, 0.82; 95% CI, 0.73-0.93). In the combined group of BMI-PA, the influence of PA prevailed over the impact of BMI on PHS and LS, and therefore, PA was found to be the stronger factor. CONCLUSION: Although BMI and PA could both significantly impact LS and PHS, the stronger influence of PA on LS and PHS suggests that upgrading the 'activity level' of children and adolescents should be underscored and included on the agenda, rather than merely focusing on their BMI and weight status.

Evidence-based prevention and treatment of osteoporosis after spinal cord injury: a systematic review.

PURPOSE: Spinal cord injury (SCI) results in accelerated bone mineral density (BMD) loss and disorganization of trabecular bone architecture. The mechanisms underlying post-SCI osteoporosis are complex and different from other types of osteoporosis. Findings of studies investigating efficacy of pharmacological or rehabilitative interventions in SCI-related osteoporosis are controversial. The aim of this study was to review the literature pertaining to prevention and evidence-based treatments of SCI-related osteoporosis. METHODS: In this systematic review, MEDLINE, EMBASE, PubMed, and the Cochrane Library were used to identify papers from 1946 to December 31, 2015. The search strategy involved the following keywords: spinal cord injury, osteoporosis, and bone loss. RESULTS: Finally, 56 studies were included according to the inclusion criteria. Only 16 randomized controlled trials (involving 368 patients) were found. We found following evidences for effectiveness of bisphosphonates in prevention of BMD loss in acute SCI: very low-quality evidence for clodronate and etidronate, low-quality evidence for alendronate, and moderate-quality evidence for zoledronic acid. Low-quality evidence showed no effectiveness for tiludronate. In chronic SCI cases, we found low-quality evidence for effectiveness of vitamin D3 analogs combined with 1-alpha vitamin D2. However, low-quality inconsistent evidence exists for alendronate. For non-pharmacologic interventions, very low-quality evidence exists for effectiveness of standing with or without treadmill walking in acute SCI. Other low-quality evidences indicated that electrical stimulation, tilt-table standing, and ultrasound provide no significant effects. Very low-quality evidence did not show any benefit for low-intensity (3 days per week) cycling with functional electrical stimulator in chronic SCI. CONCLUSIONS: No recommendations can be made from this review, regarding overall low quality of evidence as a result of high risk of bias, low sample size in most of the studies, and notable heterogeneity in type of intervention, outcome measurement, and duration of treatment. Therefore, future high-quality RCT studies with higher sample sizes and more homogeneity are strongly recommended to provide high-quality evidence and make applicable recommendations for prevention and treatment of SCI-related bone loss.

Association between vitamin D levels and BMI values in an Iranian population.

BACKGROUND: This study aimed to determine the relationship between vitamin D levels and body mass index (BMI) values in a group of Iranian people. METHODS: In this cross-sectional study, the anthropometric values and serum vitamin D levels were measured in more than 3500 healthy adults, representing a random sample of the Iranian population in the urban areas of five large cities of Iran. The data used in this study were from the database of the Iranian Multi-centric Osteoporosis Studies (IMOS), previously conducted to assess bone health in the country. The association between BMI values and serum level of 25(OH)D was thereafter calculated. RESULTS: About 46% of the studied 3669 subjects had moderate to severe vitamin D deficiency regardless of their gender. About 43.2% of the overweight individuals and 45.2% of the obese had moderate-to-severe vitamin D deficiency. A linear but weak increasing trend was reported in the serum levels of 25(OH)D based on increasing BMI values. The significance of the value, however, disappeared after the data was adjusted for the possible confounders. CONCLUSIONS: A statistically positive association found between serum levels of 25(OH)D and BMI values raised concerns over the available data, suggesting that more studies should be performed in this regard.

Dual-energy X-ray absorptiometry diagnostic discordance between Z-scores and T-scores in a young Iranian population.

BACKGROUND: Dual-energy X-ray Absorptiometry (DXA) is considered the gold standard for non-invasive measurement of bone mass. T-scores and Z-scores are used to present the results of bone mass. The present study was designed to evaluate the discordance between T-scores and Z-scores calculated at a same level and its relation with age, gender and body mass index (BMI) in a representative sample of normal population. METHODS: This cross-sectional study was conducted as a part of a comprehensive survey, Iranian Multicenter Osteoporosis Study (IMOS), designed to assess bone health among healthy adults. Each individual underwent both L1-L4 antero-posterior lumbar spine and hip DXA scan. The difference between the T- and Z-scores measured at each of the four skeletal sites was then calculated. RESULTS: A -1.21 to 1.21 point difference was noted in the Z- and T- scores measured at each site. While the difference between the T-and Z-scores was less than 0.5 SD in most of the cases, the difference was higher than 1 SD in about 5% of the subjects. CONCLUSION: Standardization of Z-score definition and calculation techniques as well as developing an ethnicity-matched reference population is needed to improve the reliability of DXA-generated Z-scores.

Comparative efficacy and safety of probiotics, prebiotics, and synbiotics for type 2 diabetes management: A systematic review and network meta-analysis.

AIMS: To compare the effects of probiotics, prebiotics, and synbiotics for type 2 diabetes (T2D) management. METHODS: We searched PubMed, Scopus, CENTRAL, and grey literature sources to December 2022 for randomized trials of the impacts of probiotics, prebiotics, or synbiotics in patients with T2D. We performed network meta-analyses with a Bayesian framework to calculate mean difference [MD] and 95 % credible interval [CrI] and rated the certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. RESULTS: 68 randomised trials were included. All results are presented in comparison to the placebo. Supplementation with probiotics (MD: -0.25 %, 95%CrI: -0.42, -0.08; GRADE = moderate) and synbiotics (MD: -0.31 %, 95%CrI: -0.61, -0.04; GRADE = very low) resulted in a trivial/unimportant decrease in glycated hemoglobin. Supplementation with probiotics (MD: -0.69 mmol/L, 95%CrI: -0.98, -0.40; GRADE = very low) and synbiotics (MD: -0.82 mmol/L, 95%CrI: -1.22, -0.43; GRADE = very low) resulted in a trivial/unimportant decrease in fasting plasma glucose. Supplementation with probiotics resulted in a small but important decrease in low-density lipoprotein cholesterol (MD: -0.19 mmol/L; 95%CrI: -0.34, -0.05; GRADE = very low). Supplementations had moderate effects on serum triglyceride (GRADE = low). CONCLUSIONS: Existing evidence is uncertain and does not support supplementation with probiotics, prebiotics, and synbiotics for T2D management.

Estrogen-insensitivity syndrome (EIS) in a female adolescent patient - a case report.

OBJECTIVES: Estrogen insensitivity syndrome (EIS) is a rare genetic disorder characterized by an autosomal dominant inheritance pattern. The disease results from a pathogenic variant in the ESR1 (estrogen receptor 1) gene, leading to estrogen resistance in individuals possessing the 46, XX karyotype. The alpha receptor, which is predominant in peripheral tissues, is responsible for estrogen action. As a result, pathogenic variants in the ESR1 gene can cause various disorders, such as changes in secondary sexual characteristics, increased concentrations of estrogen and gonadotropins, and delayed bone maturation. CASE PRESENTATION: Here, the case of a 13-year-old girl, with high estrogen and gonadotropin concentrations, lack of breast development, uterine growth and delayed bone age is described. The patient's parents were related. She was found to have a homozygous pathogenic variant in the ESR1 gene located on chromosome 6q25, which interferes with estrogen signaling. CONCLUSION: This case supports that disruption of ESR1 causes profound estrogen resistance in females.

A methodological quality review of citations of randomized controlled trials of diabetes type2 in leading clinical practice guidelines and systematic reviews.

Objective: Evaluate methodological quality of type 2 diabetes RCTs conducted in Iran and cited in clinical practice guidelines and systematic reviews and meta-analyses. Methods: We conducted a descriptive methodological quality review, analyzing 286 Randomized Controlled Trials (RCTs) on diabetes mellitus published in Iran from July 2004 to 2021. We searched six databases systematically and evaluated eligible articles using the CONSORT 2010 checklist for abstracts. Two investigators assessed the data using a 17-item checklist derived from CONSORT. Additionally, we examined the citations of each RCT in 260 clinical practice guidelines, with a specific focus on the adequate reporting of outcomes. Results: Out of 6667 articles, 286 analyzed. Poor reporting and failure to meet criteria observed. Only 3.8% cited in guidelines. Reporting rates: primary outcomes (41.9%), randomization (61.8%), trial recruitment (12.6%), blinding (50.8%). 27.9% cited in systematic reviews, 50.34% in systematic reviews and meta-analyses, 26.57% in meta-analyses. 67.8% of papers cited in systematic reviews. Adherence highest for participants, objective, randomization, intervention, outcome; lowest for recruitment, trial design, funding source, harms, and reporting primary outcomes. Conclusions: Poor methodological reporting and adherence to CONSORT checklist in evaluated RCTs, especially in methodological sections. Improvements needed for reliable and applicable results in guidelines, reviews, and meta-analyses. Inadequate outcome reporting challenges researchers, clinicians, and policymakers, impacting evidence-based decision-making. Urgent improvements in RCT registration necessary.

Global research trends on systemic lupus erythematosus and thyroid cancers (1964-2023): A scientometric and visualized study.

Over the past 3 decades numerous studies have reported an association between systemic lupus erythematosus (SLE) and thyroid cancers. However, there has been no scientometric analysis in this area of research. To perform a comprehensive scientometric analysis of the global literature published on the association between SLE and thyroid cancers. The data on publications within thyroid cancers in SLE patients were retrieved from the Scopus database using a defined search strategy from its first publication in 1964 to 2023. To conduct a collaboration mapping analysis among keywords, authors, journals, and territories, VOSviewer was utilized. Our final research resulted in 246 scientific publications with 8072 citations, which were published in 198 journals affiliated to 48 countries. A global upward trend has been observed in the last 20 years, with the highest number of publications in the year 2022 (n = 28; 11.4%). The United States led the global productivity ranking with 74 publications (30.1%), followed by China with 25 publications (10.2%). The most popular journals in this field were "Arthritis Research and Therapy" and "Frontiers in Endocrinology," while the most co-cited journal was "Autoimmunity Reviews." The top 3 most prolific authors were Bernatsky, S., Clarke, A.E., and Ramsey-Goldman, R with 9 publications each. This first scientometric study comprehensively offered an overview of the status of thyroid cancers in SLE patients, assessing scholarly productivity in this domain over a period of 50 years.

Research impact in randomized controlled trials of diabetes: an altmetric approach.

Purpose: This study aimed to assess the impact of research in randomized controlled trials (RCTs) of diabetes and explore the various subject areas related to diabetes that receive attention on social media platforms. Altmetric measures were utilized to collect and extract relevant data, providing valuable insights into the social reach and influence of clinical research beyond traditional citation-based metrics. Methods: The research focused on RCTs of diabetes involving at least one Iranian author, indexed in Scopus. Altmetric.com was employed to extract altmetric data, and the collected articles were categorized into 14 subject areas for individual analysis using STATA. Results: The analysis revealed that a majority of the diabetes studies examined nutrition, complications, treatment, genetics, basic mechanisms, and comorbidities of the disease. Conversely, subject areas such as diagnosis, education, gestational diabetes, psychology, physical activity, prevention, dentistry, and economics had fewer studies associated with them. Among social media platforms, Twitter, Facebook, Google+, and Reddit emerged as the most frequently mentioned platforms. Furthermore, Mendeley readership was identified as the preferred platform for engagement across several subject areas. Conclusions: The substantial number of social media mentions indicates a significant level of public interest and concern regarding diabetes. Social media platforms serve as effective tools for disseminating research findings from clinical trials. Altmetric data proves valuable to researchers and funding agencies seeking to comprehend the impact of their work, enabling them to allocate resources more effectively.

Identifying the Lowest Effective Initial Dose of Prednisolone for the Treatment of Subacute Granulomatous Thyroiditis: A Systematic Review and Meta-Analysis.

BACKGROUND: Subacute granulomatous thyroiditis (SAGT) is an inflammatory disease due to viral infections. Glucocorticoids, especially prednisolone (PSL), are one of the first approaches in the treatment of patients with SAGT. To date, no study has determined the lowest effective dose of prednisolone with the lowest recurrence rate in the treatment of SAGT. This study aimed to use meta-analysis methods to identify the appropriate dosage of prednisolone with the lowest recurrence rate in the treatment of patients with SAGT. METHODS: This study was conducted according to the PRISMA checklist in February 2021. Two independent researchers performed a search for relevant literature published before March 2021 in English databases, including Scopus, MEDLINE (via PubMed), Web of Science, Cochrane Library, Google Scholar, EMBASE, and also Persian electronic databases including SID, Iran medex, Magiran, and Irandoc. The search algorithm was initially developed by using a combination of MeSH terms, keywords, and also Boolean operators ("AND"; "OR"; "NOT"): Subacute thyroiditis, De Quervain Thyroiditis, Glucocorticoids, Prednisolone, Recurrence, and Meta-Analysis. All statistical analyses were performed using STATA 15.0 (StataCorp LLC, College Station, TX, USA) and SPSS 17.0. A random-effects model based on Metaprop was applied for the Meta-analysis. To assess heterogeneity between studies, the chi-squared test and I2 index were used, and for evaluating publication bias, funnel plots and Egger tests were performed. RESULTS: The overall recurrence rate was 14.72% [95% CI: 9.63- 20.58] and there was a significant heterogeneity among the studies [I2 = 69.56%; P=0.000]. To evaluate the lowest effective dose of prednisolone, we divided the studies into two groups based on the mean initial dose of prednisolone: less than or equal to 20 mg/day (group one) and greater than 20 mg/day (group two). The recurrence rate in group 1 was 11% [95% CI: 5.7- 16.2] and in group 2 was 23.6% [95% CI: 11.5- 35.6]. Significant correlations were observed between the initial mean dose of PSL and recurrence rate (r= 0.71; P= 0.013). Begg's funnel plot had no evidence of publication bias in these studies (p=0.160). CONCLUSION: According to the results of this meta-analysis, 15 to 20 mg/day of prednisolone is the most effective dosage with the lowest recurrence rate in the treatment of subacute Granulomatous thyroiditis.

Conceptualization of category-oriented likelihood ratio: a useful tool for clinical diagnostic reasoning.

BACKGROUND: In the diagnostic reasoning process medical students and novice physicians need to be made aware of the diagnostic values of the clinical findings (including history, signs, and symptoms) to make an appropriate diagnostic decision. Diagnostic reasoning has been understood in light of two paradigms on clinical reasoning: problem solving and decision making. They advocate the reasoning strategies used by expert physicians and the statistical models of reasoning, respectively. Evidence-based medicine (EBM) applies decision theory to the clinical diagnosis, which can be a challenging topic in medical education.This theoretical article tries to compare evidence-based diagnosis with expert-based strategies in clinical diagnosis and also defines a novel concept of category-oriented likelihood ratio (LR) to propose a new model combining both aforementioned methods. DISCUSSION: Evidence-based medicine advocates the use of quantitative evidence to estimate the probability of diseases more accurately and objectively; however, the published evidence for a given diagnosis cannot practically be utilized in primary care, especially if the patient is complaining of a nonspecific problem such as abdominal pain that could have a long list of differential diagnoses. In this case, expert physicians examine the key clinical findings that could differentiate between broader categories of diseases such as organic and non-organic disease categories to shorten the list of differential diagnoses. To approach nonspecific problems, not only do the experts revise the probability estimate of specific diseases, but also they revise the probability estimate of the categories of diseases by using the available clinical findings. SUMMARY: To make this approach analytical and objective, we need to know how much more likely it is for a key clinical finding to be present in patients with one of the diseases of a specific category versus those with a disease not included in that category. In this paper, we call this value category-oriented LR.

Evaluating obesity publications: from bibliometrics to altmetrics.

PURPOSE: study the bibliometrics indicators of Iranian authors in the field of obesity and Correlation Comparison between conventional citation counts and altmetrics scores from 2005 to 2019. METHODS: The study uses bibliometric characteristics and altmetric analysis. Population consists of 5359 articles out of 8220 in the field of obesity which have specified Iran as the affiliated country and indexed by Scopus between 2005 to 2019. Citations was extracted from Scopus database and visualized bibliographic data by VOS viewer software version 17, as well as Altmetric Explorer was applied for altmetrics data. The spearman correlation was used to analyze distributions of altmetrics and citation. Statistical analysis was utilized using SPSS software version 17. RESULTS: According to altmetrics finding among 2221 articles, 90% of articles had focused on different social media. The major interaction of researches has taken place in Twitter respectively News and Facebook. a positive correlation (r = 0.31) has been found between citation and altmetrics. As a result, Institutes with the highest degree of co-authorship had the top 10 articles with the highest altmetrics score. CONCLUSION: Depending on the degree of correlation suggest that altmetrics should be seen as complements to, rather than alternatives to citations. Altmetrics indicators will be very useful for health policymaking and aid them with identifying important factors driving altmetric events. Also it could help to reveal the hidden value of some medical papers. Our findings can help international communications for scientific collaboration at the level of business and health care industry, and emergency managers gain a comprehensive understanding of the research area.

The rationale behind systematic reviews in clinical medicine: a conceptual framework.

A systematic review (SR) is a type of review that uses a systematic method to provide a valid summary of existing literature addressing a clear and specific question. In clinical medicine (CM), the concept of SR is well recognized, especially after the introduction of evidence-based medicine; The SR of randomized clinical trials (RCTs) is considered the highest level of evidence on therapeutic effectiveness. Despite the popularity of the SRs and the increasing publication rate of SRs in CM and other healthcare literature, the concept has raised criticisms. Many of proper criticisms can be due to the deviation of some existing SRs from the original philosophy and well-established rationale behind the concept of SR. On the other hand, many criticisms are misconceptions about SRs which still exist even several decades after introducing the concept. This article presents a conceptual framework for clarifying the rationale behind SR in CM by providing the relevant concepts and their inter-relations, explaining how methodological standards of an SR and its rationale are connected, and discussing the rationale under the three-section: SR as a type of synthetic research, SR as a more informed and less biased review, and SR as an efficient scientific tool.

Effects of a curriculum integrating critical thinking on medical students' critical thinking ability in Iran: a quasi-experimental study.

PURPOSE: Improving physicians' critical thinking abilities could have meaningful impacts on various aspects of routine medical practice, such as choosing treatment plans, making an accurate diagnosis, and reducing medical errors. The present study aimed to measure the effects of a curriculum integrating critical thinking on medical students' skills at Tehran University of Medical Sciences, Iran. METHODS: A 1-group pre-test, post-test quasi-experimental design was used to assess medical students' critical thinking abilities as they progressed from the first week of medical school to middle of the third year of the undergraduate medical curriculum. Fifty-six participants completed the California Critical Thinking Skills Test twice from 2016 to 2019. RESULTS: Medical students were asked to complete the California Critical Thinking Skills Test the week before their first educational session. The post-test was conducted 6 weeks after the 2 and half-year program. Out of 91 medical students with a mean age of 20±2.8 years who initially participated in the study, 56 completed both the pre- and post-tests. The response rate of this study was 61.5%. The analysis subscale showed the largest change. Significant changes were found in the analysis (P=0.03), evaluation (P=0.04), and inductive reasoning (P<0.0001) subscales, but not in the inference (P=0.28), and deductive reasoning (P=0.42) subscales. There was no significant difference according to gender (P=0.77). CONCLUSION: The findings of this study show that a critical thinking program had a substantial effect on medical students' analysis, inductive reasoning, and evaluation skills, but negligible effects on their inference and deductive reasoning scores.