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BackgroundRandomised controlled trials (RCT) provide the highest level of evidence among interventional studies. However, RCTs may be susceptible to the risk of bias (RoB). Therefore, systematic reviews appraise the RoB in all included studies in a review by using evaluation tools. This study aimed to describe the main characteristics of RCTs conducted in Iran and included in Cochrane Reviews (CRs) by focusing on their RoB.MethodsWe searched “Iran” by selecting the “Search All Text” field and “Review” in the Cochrane Database of systematic Review within Ovid. We retrieved CRs that included Iranian controlled trials. We selected trials only if they had involved human subjects, described as a controlled clinical trial, included in CRs and therefore the review authors assessed their RoBs. The characteristics of trials have been extracted by looking at the table “Characteristics of included studies” in each CRs as well as the relevant papers. To addressing RoB, we collected the judgment of the review authors according to the table of RoB assessments in CRs.ResultsThere were 1166 Iranian RCTs included in 571 CRs. From all these studies, 44.9% were at low RoB for random sequence generation, 20.8% for allocation concealment, 32.3% for blinding of participants/personnel, 36.5% for blinding of outcome assessors, 56.3% for incomplete outcome data, 41.3% selective reporting, and 53.8% for other bias.ConclusionRoB was mainly high or unclear in Iranian RCTs. Special attention must be paid to methodological quality of RCTs in Iran accordingly.

OBJECTIVES: This review aims to evaluate the efficacy and safety of complementary and alternative medicine methods for constipation in the pediatric population. EVIDENCE ACQUISITION: Medical literature search was performed in several databases for a variety of Traditional, Complementary and Alternative Medicine in childhood constipation. Databases included Web of Science, Scopus, Embase, Cochrane Library, PubMed, ScienceDirect, Google scholar and a number of Persian databases including IranDoc, Magiran and SID. No time limitation was determined. Clinical trials or case series that had evaluated the effectiveness of CAM therapies in functional constipation of 1–18 year old children were included. Papers not in English or Persian language were excluded. Related articles were screened independently by two reviewers according to their titles and abstracts. A data extraction form was filled in for each eligible paper. Quality assessment of eligible documents was also performed. RESULTS: 30 studies were included, comprising 27 clinical trials and 3 case series. Ten documents were on herbal medicine, nine on traditional medicine, ten on manual therapies and one on homeopathy. Except for two herbal and one reflexology interventions, all studies reported positive effects on childhood constipation, with the majority being statistically significant. As the number of studies in each method was limited, we could not perform a meta-analysis. CONCLUSION: The scarcity of research on the efficacy and safety of different types of complementary and alternative medicine methods in children with constipation necessitates conducting more studies in each field. [Figure: see text] ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s40199-019-00297-w) contains supplementary material, which is available to authorized users.

Background: Gastroesophageal reflux disease (GERD) is defined as “troublesome symptoms or complications of GER”, and is a multifactorial disorder. This study aimed to compare the treatment outcomes of hypoallergenic diet vs. ranitidine on symptoms of gastroesophageal reflux disease (GERD) in infants. Methods: In this randomized clinical trial, 50 patients aged less than 1 year, who were suspected to have GERD on the basis of I-GERQ-R, were enrolled. They were randomly allocated to two groups of equal number, one group received ranitidine and the other hypoallergenic diet for 2 weeks. The frequency of GERD symptoms, including irritability, vomiting, anorexia, respiratory symptoms and arching, were compared between the two groups before and after the trial. Results: After a two-week trial, the frequency of vomiting and respiratory symptoms decreased significantly in both groups (P < 0.05). The frequency of vomiting decreased in 19 (76%) and 19 (76%) of infants in ranitidine and hypoallergenic diet groups, respectively (P = 0.05 between groups). Moreover, the respiratory symptoms improved significantly in both groups (P < 0.05). The frequency of irritability did not decrease significantly in any of the groups (P = 0.18). Conclusions: The current findings suggest that the hypoallergenic diet might have significant effect on GERD symptoms; these effects are comparable with those of ranitidine. Considering the possibility of cow’s milk protein allergy in this group of patients, we recommend that the treatment of GERD in pediatric population be initiated with hypoallergenic diet and in case of not achieving significant effect, pharmacological treatment be added and applied as a combination therapy.

Rationale, aims and objectives Attitude towards and knowledge of various groups of health care providers regarding evidence-based medicine (EBM) have been assessed worldwide. Also, barriers to practising EBM have been found to be different in different countries. However, there is little evidence on the place of EBM among some developing countries, like Iran. The aim of this study was to explore the current status of EBM among different medical specialists in Iran. Methods This cross-sectional study was conducted from August 2007 until March 2009 on a sample of 181 doctors in different medical specialties practising in Isfahan, Iran, not including faculty members. Attitude towards EBM and the barriers in practice and awareness of technical terms were investigated through a self-administered questionnaire. Results Less than half (41%) of the doctors reported they use EBM in their practice. They believed EBM improves the quality of health care services (70%); however, their understanding of the technical terms used in EBM was poor. The barrier to practising EBM identified by most respondents (74.3%) was the lack of EBM training courses in their academic curriculum. Conclusion Despite the general welcoming attitude of all groups of specialists, they had insufficient knowledge and inadequate use of EBM in their practice. Designing and conducting EBM training courses and its integration into the general practitioners' training curriculum should be considered.

Applying different institutional addresses in the scientific production of a same university has underestimated the scientific production of Iranian universities and consequently lowered their position in the international academic rankings for a long time. The present study evaluated the scientific production of Iranian medical universities according to their institutional addresses registered in the papers indexed by Science Citation Index Expanded (SCIE). By conducting a descriptive research we retrieved total SCIE indexed of top Iranian medical universities and their respective hospitals and research centers from the beginning of 1986 to the end of 2007. Then different variations of the institutional addresses of each university in the author affiliation of papers were assessed. Finally the universities were ranked according to observing a uniformed format for more registered addresses in SCIE. The findings showed unexpected diversity in the institutional affiliation of each university in their SCIE indexed papers. Although “Tehran University of Medical Sciences” showed the most variation in registering institutional addresses but ranked first according to observing unification for more addresses in the SCIE indexed papers comparing to the other universities. The problem of applying different institutional affiliations in the scientific production of the universities should be valued enough by the whole scientific community. Observing a uniformed format in registering institutional addresses of Iranian medical universities would affect their scientific credibility and international ranks through representing their real scientific productivity.

Background: Few studies are carried out on the epidemiology of amyotrophic lateral sclerosis (ALS) in Middle East with no reports from Iran. Objective: To determine the epidemiological and clinical features of ALS amongst the Iranian population living in Isfahan, Iran. Methods: Medical records of all hospitals with a neurology department and outpatient neurology clinics in Isfahan province from 2002 to 2006 were reviewed, and all patients with the diagnosis of ALS according to El Escorial diagnostic criteria were extracted and related demographic and clinical data were gathered and analyzed. Results: We found 98 new patients (66 men and 32 women) with definite, probable, or possible ALS. The average annual incidence was 0.42/100 000, with the highest incidence rate amongst those aged 70–74. On 21 March 2006, the crude prevalence was 1.57/100 000. Median survival from onset was 48 months (95% confidence interval 34–61) and survival rates for 1, 3,and 5 years after the onset were 94%, 66%, and 32%, respectively. Conclusions: The incidence and prevalence of ALS in the Iranian population seems to be lower compared to other populations and the survival of patients was longer than previously reported.

A 10-year longitudinal population-based study, entitled the Isfahan Cohort Study (ICS) is being conducted. The ICS commenced in 2001, recruiting individuals aged 35+ living in urban and rural areas of three counties in central Iran, to determine the individual and combined impact of various risk factors on the incidence of cardiovascular events. After 24379 person-years of follow-up with a median follow-up of 4.8 years, we documented 219 incident cases of ischemic heart disease (IHD) (125 in men and 94 in women) and 57 incident cases of stroke (28 in men and 29 in women). The absolute risk of IHD was 8.9 (7.8-10.2) per 1000 person-years for all participants, 10.6 (8.8-12.5) per 1000 person-years for men and 7.4 (6.0-9.0) per 1000 person-years for women. The respective risk of ischemic stroke was 2.3 (1.7-3.0), 2.3 (1.6-3.3) and 2.3 (1.5-3.2) per 1000 person-years. The risk of IHD was approximately 3.5-fold higher in the presence of hypertension, followed by diabetes mellitus and hypercholesterolemia with near 2.5- and twofold higher risk, respectively. This cohort provides confirmatory evidence of the ethnic differences in the magnitude of the impact of various risk factors on cardiovascular events. The differences may be due to varying absolute risk levels among populations and the existing ethnic disparities for using western risk equations to local requirements.

Background The impact of the metabolic syndrome among populations in the Middle East region is unknown; we therefore examined the association between the syndrome and the risk of ischemic heart disease (IHD) in an Iranian population. Methods and results The Isfahan Cohort Study (ICS) prospectively followed 6146 Iranian people (51.8% women, aged 35–75 years) from three cities and their rural districts who were initially free of ischemic heart disease. During the 5 year follow-up, 209 (56% men) cases of ischemic heart disease were detected. The metabolic syndrome was defined by the modified criteria of the National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATPIII). End points were defined as fatal and nonfatal myocardial infarction, sudden cardiac death and unstable angina. A clear dose-response relationship was found between the number of metabolic risk factors and the incidence of IHD, with the hazard ratios increasing dose-dependently from 1.72 (95% CI 0.86-3.46) for only one to 1.97 (1.00–3.90), 2.85 (1.45–5.58) and 4.44 (2.25–8.76) for 2, 3 and ≥4 metabolic syndrome component respectively, relative to those with no component. The adjusted hazard ratio (95% CI) associated with the metabolic syndrome was 1.58 (1.06–2.35) in men and 1.72 (1.08–2.74) in women for IHD. The contribution of metabolic syndrome to the IHD risk was particularly strong among smokers although there was no significant interaction. Conclusions The metabolic syndrome by NCEP/ATPIII definition is a major determinant of ischemic heart disease in this middle-aged Iranian population, especially among smokers.