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Background: Urinary incontinence (UI) is a common and debilitating condition among people with multiple sclerosis (MS) and is more prevalent among women. Over the past decade, numerous studies have investigated the effects of pelvic floor muscle training (PFMT) as a treatment for UI in people with MS. MS negatively impacts pulmonary function even in the early stages of the disease and people with MS may experience respiratory muscle weakness. Considering the synergy between the pelvic floor muscle (PFM) and respiratory muscles, this trial will evaluate the effects of PFMT and breathing exercises on PFM activity and strength, diaphragm activity, and urinary symptoms in women with MS who experience UI., Methods: Fifty women with MS and UI will participate in this parallel randomized controlled trial, comprising 32 treatment sessions. The intervention group consists of PFMT and breathing exercises, and the control group includes PFMT. The severity of UI symptoms, PFM activity, diaphragm activity, and PFM strength will be evaluated using the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form, ultrasound imaging, and modified Oxford grading scale, respectively before and after the intervention., Discussion: The current trial is designed to examine the effects of a combined exercise program for UI in women with MS. It is hypothesized that using breathing exercises in conjunction with PFM exercises will improve patient symptoms compared to PFMT alone., Trial Registration: The trial was registered in the Iranian Registry of Clinical Trials with code IRCT20180916041051N3 and was approved on 23 May 2024., Competing Interests: Declarations. Ethics approval and consent to participate: The Human Research Ethics Committee of the Iran University of Medical Sciences (IR.IUMS.REC.1403.027) reviewed and approved this study. All participants signed an informed consent form. Consent for publication: Not applicable. Competing interests: The authors declare that they have no competing interests., (© 2025. The Author(s).)

Introduction: Health literacy is an effective indicator of people's health level. Therefore, this study aimed to investigate health literacy and its relationship with mental health and quality of life in first-year medical sciences students., Methods and Materials: The cross-sectional study was conducted on freshmen- students of Babol University of Medical Sciences, Iran. 311 students were selected using a multi-stage sampling method. Data was collected by 4 questionnaires including demographic, health literacy questionnaire, General health questionnaire (GHQ-12), and quality of life (short form) (SF-12). Analysis of the data was done using SPSS version 22., Results: The subjects were 45.5% female and 54.5% male. Almost 60% had adequate/excellent health literacy. A significant relationship between health literacy and the variables of gender and place of residence was found. The results indicated that health literacy, age, educational level, and residential place were predictors of students' mental health. The regression test results showed that the variables of health literacy, age, educational program, and residential place were predictors of students' mental health. The students' mean score of quality of life was 68.81 ± 16.56. The regression test indicated that health literacy, educational level, and residential place were predictors of students' quality of life., Conclusion: This study emphasizes the central role of health literacy in shaping the mental health and quality of life of freshmen students., Competing Interests: Declarations. Ethics approval and consent to participate: The study design was approved by the Ethics Committee of Babol University of Medical Sciences (IR.MUBABOL.REC. 1400.270). Written informed consent was obtained from all the participants. All methods were carried out in accordance with relevant guidelines and regulations. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Using neuromuscular blocking agents (NMBA) in pediatric induction protocol is a challenging matter. Therefore, in this study, we aimed to find a safer way for anesthesia in children. We compared the effects of dexmedetomidine with atracurium on intubation conditions in children aged 6-12 years under general anesthesia. If dexmedetomidine has the similar effect as atracurium, we can use it for intubation and anesthesia of children in situations where the use of atracurium is challenging for any reason., Methods: This clinical trial was carried out on children between 6 and 12 years in Mashhad University of Medical Sciences, Mashhad, Iran between January 2018 and February 2020. Participants candidates for tracheal intubation and general anesthesia were enrolled. Patients were distributed into two groups: Patients received Dexmedetomidine (Group D) and patients received Atracurium (Group A)., Results: We enrolled 25 patients in each group. Most of them were male. The intubation quality score consists of 5 items including laryngoscopy, vocal cord, coughing, jaw relaxation and limb movement was assessed between two groups. This score had no statistically significant difference between study groups. Immediately after induction and one minute after it, heart rate was statistically significant higher in group A than group D (P < 0.001 & P = 0.04 respectively). All of the intubations in our study were successful. More coughing was seen in group A compared with group D (P = 0.01)., Conclusion: In children aged 6-12 years, the administration of intravenous dexmedetomidine 1mcg/kg over a period of 10 min before the induction of anesthesia with sufentanil 0.3 µg/kg and propofol 3 mg/kg showed no statistically significant difference in quality of intubation score when compared to the use of 0.5 mg/kg atracurium to facilitate intubation. Decreased heart rate and less coughing were observed when using dexmedetomidine. This trial was registered retrospectively in the Iranian Clinical Trials Registry at 2021-24-05 ( https://www.irct.ir/ ), and its registration number is IRCT20201028049177N1., Competing Interests: Declarations. Ethics approval and consent to participate: Mashhad University of Medical Sciences controlled this randomized clinical trial study from 2018 until 2020, and 50 participants between 6 and 12 years who were candidate for tracheal intubation under general anesthesia were included. All methods were carried out in accordance with Helsinki guidelines. The Ethical Committee of Mashhad University of Medical Sciences approved the study method with approval number IR.MUMS.MEDICAL.REC.1399.381 and written informed consent was obtained from a parent or guardian for participants between 6 and 12 years. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Introduction: With the spread of COVID-19, certain population groups, including pregnant women, were more susceptible than others. This disease can lead to postpartum complications, including mental disorders, in mothers. Few studies have investigated the impact of mindfulness-based interventions on mental health, and the most effective counseling approach to promote mental health has not been identified., Objective: This study aimed to determine the impact of online mindfulness-based counseling on improving mental health among women with a history of COVID-19 during pregnancy in Iran., Methods: The present study was a quasi-experimental design conducted on 100 women with a history of coronavirus infection during pregnancy referred to the Mother's Clinic of Yahya Nejad and Ayatollah Rouhani Educational-Treatment Hospital, affiliated with Babol University of Medical Sciences, Iran, via convenience sampling. The women were randomly assigned to the intervention (mindfulness-based counseling) and control groups. The intervention group received eight 45-min weekly mindfulness-based counseling sessions over 8 weeks. Data were collected via a demographic information questionnaire and the Goldberg General Health Questionnaire before and after the intervention, which were completed by both groups. Independent t-tests and analysis of covariances (ANCOVAs) were used to compare the outcomes of the two groups., Results: After controlling for confounding variables, the mean mental health scores before and after counseling were 29.42 ± 4.49 and 19.80 ± 3.88, respectively, in the intervention group and 26.26 ± 2.29 and 25.92 ± 2.15, respectively, in the control group. The mean mental health score in the intervention group was significantly lower than that in the control group (F = 266.7, p < 0.001). The mean scores for somatic symptoms (F = 89.30, p < 0.001), depression symptoms (F = 142.71, p < 0.001), anxiety and insomnia symptoms (F = 120.56, p < 0.001), and social dysfunction scores (F = 127.77, p < 0.001) were significantly different between the two groups after counseling., Conclusion: The findings indicated that online mindfulness-based counseling positively affects mental health and its domains during the postpartum period. However, further randomized clinical trials are needed before a definitive conclusion can be drawn., Trial Registration: We were not allowed to register according to the law of our country., (© 2024 The Author(s). Brain and Behavior published by Wiley Periodicals LLC.)

The present study is an evaluation of Centella asiatica ethanolic extract in terms of total phenolic content, total flavonoids, total flavonols, anthocyanin, antioxidants, and antibacterial activities. Centella asiatica plants were collected from Guilan province, Iran. High-performance liquid chromatography-Diode array detector analysis demonstrated that the ethanolic extract of C. asiatica contained phenolic substances such as sinapic acid, catechin, quercetin, p-coumaric acid, hesperidin, eugenol, and hesperetin. The predominant phenolic compound in the extract was hesperetin. The antibacterial activities of the extract were highly potent against S. aureus and B. cereus. These findings suggest that C. asiatica is rich in phenolic compounds and can be utilised for future cosmetic and pharmaceutical purposes.

Background: A better understanding of health system performance requires evaluating achievements and challenges, thereby providing a basis for effective reforms. This systematic review aims to investigate the challenges and weaknesses of leadership and governance-related health policies in Iran., Methods: In this qualitative systematic review, we followed the instructions of the Joanna Briggs Institute (JBI). It encompassed qualitative studies assessing challenges and weaknesses of leadership and governance-related health policies. Thematic synthesis was conducted in three stages to identify common themes., Results: The primary database search yielded 1890 records, of which 152 were fully assessed, resulting in the inclusion of 57 studies in this review. Thematic synthesis produced 157 structured codes and identified 11 main descriptive themes of challenges in leadership and governance-related health policies. These themes included hospital autonomy policy, challenges to the entire health system, governance of medical universities, healthcare payment systems, sustainable universal health insurance coverage, informal payments, insurance systems, induced demand, strategic purchasing of health services, the family physician program, family physician and rural health insurance programs, and primary healthcare human resources., Conclusion: The identified challenges underscore the urgent need for strategic reforms and interventions to overcome the complex issues plaguing the healthcare system. By addressing these challenges, policymakers and top healthcare managers might ensure that the population have access to high-quality care in a more responsive healthcare system., (© 2024 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

Background: Toxoplasma gondii (T. gondii) is a ubiquitous protozoan parasite on our planet that causes toxoplasmosis. This study evaluated the seroprevalence and related risk factors for T. gondii infection in a population referred to healthcare centers in Meshkin-Shahr, Northwest Iran., Methods: A total of 400 blood samples were randomly collected from the general population and assessed using the anti-Toxoplasma antibodies, Immunoglobulin G and M (IgG and IgM) Enzyme-linked immunosorbent assay (ELISA) Kits in two steps before and during the coronavirus disease 2019 (COVID-19) pandemic, 2019-2020. The results were analyzed through logistic regression via SPSS 26 software., Results: Before the COVID-19 pandemic, anti-toxoplasma antibodies were detected in 39% of individuals (IgG: 38%, IgM: 0.5%, and IgG-IgM: 0.5%). Among the eleven risk factors evaluated, contact with soil and people awareness were significantly associated with T. gondii infection (p < 0.05). However, factors such as females, 20-39 age groups, junior high schools, housewives, rural areas, raw meat or vegetable consumption, vegetable or fruits washed by water, not detergent, and cat owners did not show a significant relationship with seropositivity (p > 0.05). After the outbreak of the COVID-19 pandemic, the overall seroprevalence for anti-T. gondii antibody increased to 49.7% (IgG: 47.7%, IgM: 0.5%, and IgG and IgM: 1.5%). Among these patients, 26% were positive for COVID-19. Additionally, before the COVID-19 pandemic, 40 samples were negative for anti-T. gondii antibodies but later became positive. The crude and adjusted models suggested that toxoplasmosis may be a possible risk factor for increased susceptibility to COVID-19, with an odds ratio (OR) of 1.28 (95% confidence interval (CI), 0.82-1.99; P < 0.05). Conversely, a non-significant protective effect against latent toxoplasmosis was observed in COVID-19-positive individuals (OR = 0.99; 95% CI, 0.51-1.92; P > 0.05), and COVID-19 positivity did not increase the levels of anti-T. gondii IgG antibodies., Conclusions: The general population in this region had a moderate seroprevalence of T. gondii. The increased number of COVID-19-positive patients with latent toxoplasmosis highlights the need to pay attention to the early diagnosis and proper treatment of toxoplasmosis in these patients and implement preventive programs in these areas for future possible viral infections., (© 2024. The Author(s).)

Objectives: This study investigated the association of fear of falling with performance-based physical function and low back pain (LBP) among older adults., Design: Cross-sectional study., Setting: Participants were selected via convenient sampling from Iran University orthopaedic and/or physiotherapy outpatient clinics, between March 2022 and April 2023., Participants: 140 subjects with and without LBP, aged over 60 years, were included., Outcome Measures: The Falls Efficacy Scale International was used to measure fear of falling. A baseline questionnaire inquired about LBP. Participants performed the Timed Up and Go, 30 s Sit-To-Stand (30s-STS), single leg stance with open and closed eyes and gait speed tests to assess performance-based physical function. Demographic variables including age, gender and body mass index were considered as potential covariates. Bivariate and multivariable linear regression analyses were used to investigate the associations., Results: A significant association between fear of falling and the 30s-STS test score (β=-0.30, 95% CI -1.27 to -0.28; p=0.00) and the sex (β=0.31, 95% CI 1.53 to 4.83; p=0.00) was confirmed in multivariable analyses. LBP and other performance-based physical function tests were not associated with a fear of falling., Conclusion: Fear of falling was significantly associated with lower extremity muscle function, measured by the 30s-STS test and female gender. Older adults with a fear of falling could benefit from interventions that improve lower extremity muscle function. Also, the observed association between the fear of falling and the female sex confirms the need for effective interventions to reduce the fear of falling among older women., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: The Coronavirus disease 2019 pandemic increased global psychological distress, emotional distress, and sleep disturbances, all known risk factors for compromised oral health. Despite this, there is limited understanding of the impacts of these psychological factors on oral health in certain populations, including Iranians. Thus, the present study investigates the associations between sociodemographic characteristics, emotional distress, sleep pattern changes, tooth brushing frequency, and oral ulcer reports in a sample of Iranian adults during the Coronavirus disease 2019 pandemic., Materials and Methods: This cross-sectional, web-based study collected data from Iranian adults between July and September 2022 using respondent-driven sampling. The Mental Health and Wellness questionnaire was used to gather information on sociodemographic characteristics, emotional distress, sleep pattern changes, toothbrushing frequency, and oral ulcer reports. Simple and multiple logistic regression served for statistical analysis., Results: Among the 240 participants, comprising 164 females and 76 males, with a mean age of 35.3 years (±13.3), 28 individuals (11.7%) reported reduced tooth brushing frequency, and 35 individuals (14.6%) reported oral ulcers. Male gender (OR = 2.75, p = 0.016) and sleep patterns changes (OR = 2.93, p = 0.01) increased the likelihood of reduced tooth brushing frequency. Additionally, being younger than 30 (OR = 2.87, p = 0.025) and fearing coronavirus transmission (OR = 3.42, p = 0.009) increased the odds of oral ulcers., Conclusions: Male gender and sleep pattern changes were risk factors for reduced tooth brushing frequency among the present sample of Iranian adults during the Coronavirus disease 2019 pandemic. Additionally, being under 30 and fearing coronavirus transmission were identified as risk factors for oral ulcers in this population. To preserve and promote adults' oral health during public health crises, targeted educational initiatives, public health awareness campaigns, and integrated mental and oral healthcare approaches are encouraged., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Karimi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objective: Atherosclerotic cardiovascular disease (ASCVD) is one of the leading causes of death worldwide. Dietary interventions can directly affect several ASCVD risk factors. This study aimed to assess an association between dairy consumption and the odds of ASCVD and its risk factors in women with overweight and obesity., Methods: The present cross-sectional study was conducted on 390 Iranian women aged 18-48 years and body mass index (BMI) ≥ 25 kg/m². Dairy consumption was assessed using a 147-item food frequency questionnaire. Participants were divided into tertiles based on their dairy consumption with 130 (33.3%) women in each category., Results: The participants had an average age of 36.73 ± 9.18 years, and the mean BMI was 31.28 ± 4.30 kg/m 2 . In the unadjusted model, individuals in the third tertile of dairy consumption had 0.79 times lower odds of ASCVD compared to those in the first tertile (OR: 0.21; 95% Confidence Interval (CI): 0.11, 0.41; P-value = 0.001). Additionally, we observed a significant inverse relationship between higher dairy intake and adiposity markers, blood pressure, and Triglyceride glucose-body mass index (TyG-BMI)., Conclusion: The study revealed a negative association between dairy intake and the risk of ASCVD but this association diminished after adjusting for confounding factors. It also found a negative association between dairy consumption with BMI, fat mass index, body fat, blood pressure, and TyG-BMI., (© 2024. The Author(s).)

Multiple Sclerosis (MS), one of the most common neurological diseases, plays a major role in the ailments of adults. Studies on the role of homocysteine (Hcy) and folic acid in causing cognitive disorders in patients diagnosed with MS are still ongoing. This study aimed to evaluate the serum levels of folic acid and Hcy related to cognitive impairment in patients with multiple sclerosis. This prospective clinical study was conducted on 57 patients diagnosed with MS who were referred to Firoozgar Hospital, Tehran, Iran (Between November 2019 and September 2021). Demographic information and clinical characteristics of enrolled patients were recorded in a predesigned checklist. These characteristics were comprised of outcomes related to the Brief International Cognitive Assessment for MS, and the patient's Hcy and acid folic levels. Data were analyzed using SPSS version 25. Out of 57 enrolled patients, 39 subjects (68.4%) were female and 18 subjects (31.6%) were male, with a mean age of 36.87 ± 9.40 years old. In terms of disease time span, there was a mean duration of 3.80 ± 4.94 years (range: 1-23 years). There were no significant differences between the mean score of Brief International Cognitive Assessment for MS scale with patient's sex (P value: .88), and disease duration of patients (P value: .86). There was no significant relationship between the serum levels of acid folic and Hcy with cognitive impairment (P value > .05). The study results revealed that there were no significant relationships between the folic acid, Hcy levels, disease duration, and the type of MS disease with the severity of cognitive impairment. More randomized controlled clinical trials are needed to confirm the relationships between the folic acid and Hcy levels with cognitive impairment in patients with MS., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Objectives: The high status of midwifery within the Millennium Development Goals (MDGs) is closely tied to enhancing clinical education. The purpose of this study was to review the effect of education on the knowledge and practice of midwifery students about Intrauterine Device (IUD) and Pap smears., Methods: This quasi-experimental study was conducted over the course of four semesters, involving 128 bachelor of midwifery students. The sampling method was non-random, utilizing convenience sampling. Four consecutive 45 min weekly sessions were held, which included three theory sessions and one practical training session. Education was conducted in face-to-face training sessions using different methods such as lectures, question and answer, slide shows, educational films and brochures, and training participants with moulage. The data were gathered using a questionnaire covering demographic characteristics, various aspects of IUD and Pap smear knowledge, along with checklists for IUD insertion and Pap smear. Paired-samples T-test and multiple regression test were used to analyze the data. A significance level of p<0.05 was set for the analysis., Results: The results of this study showed that there was a significant difference in the average knowledge across various aspects of IUD and Pap smear before and after the intervention (p<0.001). On multiple regression analysis, residence and income significantly influenced knowledge ( β =0.313, p=0.001 and β =-0.384, p=0.001, respectively). Also, multiple regression analysis indicated that the use of IUD among family or friends and age significantly impacted practice ( β =-0.450, p=0.005 and  β =-0.206, p=0.030, respectively)., Conclusions: The educational intervention yielded a noticeable enhancement in the knowledge and practical skills of midwifery students. These students tend to achieve higher levels of success and deliver superior services to both patients and clients., (© 2024 Walter de Gruyter GmbH, Berlin/Boston.)

Background: Postpartum readmissions (PPRs) are an important indicator of maternal postpartum complications and the quality of medical services and are important for reducing medical costs. The present study aimed to investigate the risk factors affecting readmission after delivery in Imam Ali Hospital in Amol, Iran., Methods: This retrospective cohort study was conducted on the mothers who were readmitted after delivery within 30 days, at Imam Ali Hospital (2019-2023). The demographic and obstetrics characteristics were identified through the registry system. Univariate and multivariate logistic regressions with odds ratios (ORs) and 95% CIs were carried out. To identify the most important variables by machine learning methods, a random forest model was used. The data were analyzed using SPSS 22 software and R (4.1.3) at a significant level of 0.05., Results: Among 13,983 deliveries 164 (1.2%) had readmission after delivery. The most prevalent cause of readmission after delivery was infection (59.7%). The chance of readmission for women who underwent elective cesarean section and women who experienced labor pain onset by induction of labor was twice and 1.5 times greater than that among women who experienced spontaneous labor pain, respectively. Women with pregnancy complications had more than 2 times the chance of readmission. Cesarean section increased the chance of readmission by 2.69 times compared to normal vaginal delivery., Conclusion: The method of labor pain onset, mode of delivery, and complications during pregnancy were the most important factors related to readmission after childbirth., (© 2024. The Author(s).)

Background: We investigated acute poisonings resulting from medications affecting the nervous system and illicit substances at Loghman Hakim Hospital in Tehran., Methods: We retrospectively reviewed patient records at Iran's largest tertiary toxicology referral center between January 2010 and December 2015. We analyzed the prevalence, trend, age and gender distribution of acute poisoning caused by nervous system agents., Results: The present study included 16,657 (57.27%) males and 12,426 (42.73%) females, resulting in 29,083 patients. The median age of men and women was 29 and 26 years, respectively (p < 0.0001). There were 12,071 (72.47%) men and 10,326 (83.10%) women under the age of 40 (p < 0.001). Most cases were intentional (69.38% in men and 79.00% in women, p < 0.001) and 44.10% had a history of poisoning. The proportions of men and women varied significantly between different age groups and nervous system agents. For women, the most common agent was alprazolam, whereas for men, methadone. The overall trend of acute poisoning with drug used in addictive disorders, opioids and alcohol was increasing but decreasing with benzodiazepines and antidepressants. Acute poisoning by nervous system agents led to more deaths in men (1.95% vs. 0.56%; p < 0.001)., Conclusions: Methadone intoxication was common especially among young men and most of these intoxications were intentional. Women and men aged 20-29 most frequently suffer poisoning from alprazolam and clonazepam, respectively. Women over 60 and men over 30 used opium. Illicit drugs caused more than half of the deaths, and opium dominated. This study may create awareness and develop educational and preventive gender and age-specific local programs., (© 2024. The Author(s).)

Background: It is well-documented that using immunosuppressive drugs such as corticosteroids or cytokine blockers in treating coronavirus disease 2019 (COVID-19) increases the risk of co-infections. Here we systematically summarized the cases of COVID-19-associated parasitic infections (CAPIs) in Iran., Methods: From 19 February 2020 to 10 May 2023, all studies on Iranian patients suffering from CAPIs were collected from several databases using a systematic search strategy., Results: Of 540 records, 11 studies remained for data extraction. In this research, most of the studies were related to Lophomonas and Toxoplasma. Of 411 cases of CAPIs, toxoplasmosis (385 [93.7%]) had the highest rate of infection among Iranian patients, followed by blastocystosis (15 [3.6%]), fascioliasis (4 [0.97%]), leishmaniasis (3 [0.7%]), lophomoniasis (3 [0.7%]) and strongyloidiasis (1 [0.2%]). In general, Blastocystis enhanced diarrhoea in patients with COVID-19. Lophomonas, Toxoplasma and Strongyloides increased the severity of COVID-19, but Fasciola decreased its intensity. Patients with a history of cutaneous leishmaniasis showed mild symptoms of COVID-19. Also, patients with a prior history of hydatid cysts were not affected by COVID-19., Conclusions: Due to the similar symptoms of some parasitic diseases and COVID-19 and immunosuppressive treatment regimens in these patients that may cause the reactivation or recurrence of parasitic infections, early diagnosis and treatment are required., (© The Author(s) 2024. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.)

Research Question: Premature ovarian insufficiency (POI) is characterised by amenorrhea associated with elevated follicle stimulating hormone (FSH) under the age of 40 years and affects 1-3.7% women. Genetic factors explain 20-30% of POI cases, but most causes remain unknown despite genomic advancements., Design: We used whole exome sequencing (WES) in four Iranian families, validated variants via Sanger sequencing, and conducted the Acyl-cLIP assay to measure HHAT enzyme activity., Results: Despite ethnic homogeneity, WES revealed diverse genetic causes, including a novel homozygous nonsense variant in SYCP2L, impacting synaptonemal complex (SC) assembly, in the first family. Interestingly, the second family had two independent causes for amenorrhea - the mother had POI due to a novel homozygous loss-of-function variant in FANCM (required for chromosomal stability) and her daughter had primary amenorrhea due to a novel homozygous GNRHR (required for gonadotropic signalling) frameshift variant. WES analysis also provided cytogenetic insights. WES revealed one individual was in fact 46, XY and had a novel homozygous missense variant of uncertain significance in HHAT, potentially responsible for complete sex reversal although functional assays did not support impaired HHAT activity. In the remaining individual, WES indicated likely mosaic Turners with the majority of X chromosome variants having an allelic balance of ∼85% or ∼15%. Microarray validated the individual had 90% 45,XO., Conclusions: This study demonstrates the diverse causes of amenorrhea in a small, isolated ethnic cohort highlighting how a genetic cause in one individual may not clarify familial cases. We propose that, in time, genomic sequencing may become a single universal test required for the diagnosis of infertility conditions such as POI., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

The carbapenem-resistant Enterobacterales (CRE) pose a pressing public health concern. Here, we investigated the frequency of CRE bacteria, carbapenemase-encoding genes, and the molecular epidemiology of carbapenemase-resistant Escherichia coli in wastewater resources and healthy carriers in Iran. Out of 617 Enterobacterales bacteria, 24% were carbapenem-resistant. The prevalence of CRE bacteria in livestock and poultry wastewater at 34% and hospital wastewater at 33% was significantly higher ( P ≤ 0.05) than those in healthy carriers and municipal wastewater at 22 and 17%, respectively. The overall colonization rate of CRE in healthy individuals was 22%. Regarding individual Enterobacterales species, the following percentages of isolates were found to be CRE: E. coli (18%), Citrobacter spp. (24%), Klebsiella pneumoniae (28%), Proteus spp . (40%), Enterobacter spp. (25%), Yersinia spp. (17%), Hafnia spp. (31%), Providencia spp. (21%), and Serratia spp. (36%). The bla OXA-48 gene was detected in 97% of CRE isolates, while the bla NDM isolates, accounting for 80% of isolates. High prevalence of CRE with transmissible carbapenemase genes among healthy people and wastewater in Iran underscores the need for assertive measures to prevent further dissemination.bla VIM genes were detected in 24 and 3% of isolates, respectively. The B2 phylogroup was the most prominent group identified in carbapenem-resistant E. coli isolates, accounting for 80% of isolates. High prevalence of CRE with transmissible carbapenemase genes among healthy people and wastewater in Iran underscores the need for assertive measures to prevent further dissemination., Competing Interests: The authors declare there is no conflict., (© 2024 The Authors This is an Open Access article distributed under the terms of the Creative Commons Attribution Licence (CC BY 4.0), which permits copying, adaptation and redistribution, provided the original work is properly cited (http://creativecommons.org/licenses/by/4.0/).)

Study Objectives: In this study we aimed to conduct a comprehensive review of sleep medicine in Iran, focusing on the country's advancements, challenges, and the global context., Methods: We conducted a comprehensive review of sleep medicine in Iran, using various sources to ensure a thorough analysis. The national educational curriculum for sleep medicine and guidelines on sleep clinics issued by Iran's Ministry of Health served as a foundational resource. Additionally, we gathered information from the Iranian Sleep Medicine Society website and relevant committee data sources. To enhance our understanding of the current research landscape, we performed a targeted search on PubMed using keywords related to sleep and Iran., Results: The study presents a dynamic overview of sleep medicine in Iran, highlighting key advancements and challenges. Significant progress was observed in establishing standardized sleep medicine training and accredited sleep clinics. The Iranian Sleep Medicine Society plays a pivotal role in spearheading these developments, contributing to implementing regional guidelines for sleep tests. However, challenges such as a limited number of trained specialists, a scarcity of certified sleep clinics, and obstacles to accessing sleep disorder treatments were identified., Conclusions: We advocate for the implementation of increased research initiatives, nationwide education and screening programs, and proactive measures to strengthen the landscape of sleep and circadian medicine in the country., Citation: Behkar A, Amirifard H, Samadi S, et al. Global practice of sleep medicine: Iran. J Clin Sleep Med . 2024;20(6):1009-1015., (© 2024 American Academy of Sleep Medicine.)

Context: Patients with inflammatory bowel disease (IBD) were found to have the higher intestinal expression of Angiotensin-Converting Enzyme2 (ACE2) that could consequently increase susceptibility to COVID-19 infection. Objective: This study reports the outcomes of COVID-19 infection in a large cohort of IBD patients. We compare levels of serum ACE and IFN-α between COVID19 patients with and without IBD. We performed a cross-sectional retrospective multicenter study. Methods: We enrolled patients with IBD screened for SARS-COV-2 in six medical centres in Iran from June to November 2020. The blood samples were drawn to measure COVID-19 IgM and IgG, and serum levels of sACE2, sACE1, and interferon-α, regardless of suspicious symptoms have done the molecular test. Results: A total of 534 IBD patients were included in the study. Of these, 109 (20.0%) cases had detectable IgG and IgM against SARS-CoV-2. sACE2 levels were higher in IBD patients than controls, whereas ACE1and IFN-α levels were similar among groups.

Pollution of water resources with nitrate is currently one of the major challenges at the global level. In order to make macro-policy decisions in water safety plans, it is necessary to carry out nitrate risk assessment in underground water, which has not been done in Fars province for all urban areas. In the current study, 9494 drinking water samples were collected in four seasons in 32 urban areas of Fars province in Iran, between 2017 and 2021 to investigate the non-carcinogenic health risk assessment. Geographical distribution maps of hazard quotient were drawn using geographical information system software. The results showed that the maximum amount of nitrate in water samples in 4% of the samples in 2021, 2.5% of the samples in 2020 and 3% of the samples in 2019 were more than the standard declared by World Health Organization guidelines (50 mg/L). In these cases, the maximum amount of nitrate was reported between 82 and 123 mg/L. The HQ values for infants did not exceed 1 in any year, but for children (44% ± 10.8), teenagers (10.8% ± 8.4), and adults (3.2% ± 1.7) exceeded 1 in cities, years, and seasons, indicating that three age groups in the studied area are at noticeably significant non-carcinogenic risk. The results of the Monte Carlo simulation showed that the average value of non-carcinogenic risk was less than 1 for all age groups. Moreover, the maximum HQ values (95%) were higher than 1 for both children and teenager, indicating a significant non-carcinogenic risk for the two age groups., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

Objectives: To compare health-related quality of life (HRQOL), cost-effectiveness, and survival among different types of urinary diversion (UD) utilized after radical cystectomy (RC) for bladder cancer with consideration of the unique economic and cultural context in Iran., Patients and Methods: In this retrospective study, we examined all patients who underwent RC from May 2017 to December 2021 at two specialized centers by the same surgical team. Patients were grouped based on their UD. Post-surgical HRQOL (obtained from EORTC QLQ-C30 and QLQBLM-30), financial burden, surgical complications, and survival were compared. Kruskal-Wallis H test, One-way ANOVA, and Kaplan-Meier analyses were utilized; accordingly., Results and Limitations: In total 187 patients were identified-orthotopic neobladder (ONB) ( N  = 75), ileal conduit (IC) ( N  = 57), and cutaneous ureterostomy (CU) ( N  = 55)-and were followed for a median 17.5 (Interquartile range: 7.0, 47.0) months. ONB was associated with better HRQOL, especially in the domains addressing physical, role and social functioning ( p  = 0.003, 0.011, 0.045) as well as better body image ( p  < 0.001), lower short- and long-term financial burden ( p  = 0.034 and <0.001, respectively), marginally lower complication rate ( p  = 0.049), and better 5-year overall survival ( p  < 0.001), in comparison with other UDs. Patients who underwent CU had the lowest HRQOL and worst survival. Limitations were retrospective design and possibility of selection bias., Conclusions: In this first study that assesses a Middle Eastern collective; ONB seems to be the UD of choice with regard to HRQOL and economic burden when there is no contraindication., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objectives: The recurrence of underlying diseases remains a major cause of graft failure after liver transplant. This study aimed to identify factors associated with the recurrence of underlying diseases and investigate the incidence of these factors and recurrence at the main liver transplant center in Iran., Materials and Methods: We included adult liver transplant recipients followed at Shiraz Transplant Center between 2011 and 2018 with a confirmed diagnosis of recurrence of underlying disease in our study. We reviewed medical records and extracted data on demographic characteristics, clinical and paraclinical features, medication use, and current status. We used a systematic random sampling method to select a control group of 95 transplant recipients who did not have recurrence. Of 3022 total transplant recipients, 76 recipients experienced a recurrence of their underlying disease., Results: Model for End-Stage Liver Disease score, underlying disease, recipient blood group, donor sex, donor blood group, and rejection frequency were significantly different between study groups with and without recurrence of underlying diseases. Liver transplant recipients with recurrence had lower mean Model for End-Stage Liver Disease score. Recipients with recurrence also had higher rate of drug consumption (eg, prednisolone, tacrolimus, mycophenolate mofetil, sirolimus). Regression analysis showed that donor sex and rejection frequency had an effect on disease recurrence. Death occurred more frequently in liver transplant recipients with recurrence than in the control group (39.5% vs 26.3%), butthe difference was not significant., Conclusions: Donor sex and acute rejection frequency are independent factors predictive of the recurrence of underlying disease. Modifying risk factors can help minimize the recurrence of underlying diseases after liver transplant.

Objective: This study aimed to assess the service quality (SQ) for Type 2 diabetes mellitus (T2DM) and hypertension in primary healthcare settings from the perspective of service users in Iran., Methods: The Cross-sectional study was conducted from January to March 2020 in urban and rural public health centers in the East Azerbaijan province of Iran. A total of 561 individuals aged 18 or above with either or both conditions of T2DM and hypertension were eligible to participate in the study. The study employed a two-step stratified sampling method in East Azerbaijan province, Iran. A validated questionnaire assessed SQ. Data were analyzed using One-way ANOVA and multiple linear regression statistical models in STATA-17., Results: Among the 561 individuals who participated in the study 176 (31.3%) were individuals with hypertension, 165 (29.4%) with T2DM, and 220 (39.2%) with both hypertension and T2DM mutually. The participants' anthropometric indicators and biochemical characteristics showed that the mean Fasting Blood Glucose (FBG) in individuals with T2DM was 174.4 (Standard deviation (SD) = 73.57) in patients with T2DM without hypertension and 159.4 (SD = 65.46) in patients with both T2DM and hypertension. The total SQ scores were 82.37 (SD = 12.19), 82.48 (SD = 12.45), and 81.69 (SD = 11.75) for hypertension, T2DM, and both conditions, respectively. Among people with hypertension and without diabetes, those who had specific service providers had higher SQ scores (b = 7.03; p = 0.001) compared to their peers who did not have specific service providers. Those who resided in rural areas had lower SQ scores (b = -6.07; p = 0.020) compared to their counterparts in urban areas. In the group of patients with T2DM and without hypertension, those who were living in non-metropolitan cities reported greater SQ scores compared to patients in metropolitan areas (b = 5.09; p = 0.038). Additionally, a one-point increase in self-management total score was related with a 0.13-point decrease in SQ score (P = 0.018). In the group of people with both hypertension and T2DM, those who had specific service providers had higher SQ scores (b = 8.32; p < 0.001) compared to the group without specific service providers., Conclusion: Study reveals gaps in T2DM and hypertension care quality despite routine check-ups. Higher SQ correlates with better self-care. Improving service quality in primary healthcare settings necessitates a comprehensive approach that prioritizes patient empowerment, continuity of care, and equitable access to services, particularly for vulnerable populations in rural areas., (© 2024. The Author(s).)

Toxoplasmosis is a frequent infection among the human population. The infection can cause devastating complications for the fetus during pregnancy. The present study aimed to determine the serological and molecular prevalence of the infection and molecular characterization of Toxoplasma gondii isolates among pregnant women referred to Kowsar Hospital, Urmia, Iran. In a cross-sectional study, 340 blood samples were collected from pregnant women referred to Kowsar Hospital, Urmia, Iran from May to July 2022. Anti-T. gondii IgG and IgM seropositivity were determined by enzyme-linked immunosorbent assay. PCR was carried out by targeting the GRA6 gene of the parasite on all patients' buffy coats. Anti-T. gondii IgG and IgM antibodies were positive in two (0.6%) women, and 101 (29.7%) women had anti-T. gondii IgG and 70.3% were seronegative. PCR was positive in two IgM-positive women, and both isolates belonged to T. gondii carrying the GRA6 allele of lineage I. The risk of infection was significantly higher in women who had constant contact with cats and soil, and who were residents of rural areas. The two IgM-positive women were asymptomatic regarding acute toxoplasmosis. According to the results of the present study, the prevalence of toxoplasmosis in pregnant women in Urmia is similar to its prevalence in other areas in northwestern Iran, and despite the low prevalence of acute infection, it should not be ignored., (© 2024. The Author(s).)

Objectives: College students are often still relatively young, making their mental health more likely to be overlooked. A healthy lifestyle is considered the key to preventing and controlling mental health problems nowadays. This study aimed to investigate whether health-promoting lifestyle approaches manage mental health among adolescent/young college students., Methods: This cross-sectional study was conducted on 187 adolescent/young college students at Babol Medical Science University, Babol, Iran. Characteristic demographics, health-promoting lifestyle profile (HPLP), and general health questionnaire-28(GHQ-28) were filled out by students. The data were analyzed using correlation coefficient and simple and multiple linear regressions., Results: The majority of participants were adolescents (66.8%), single (97.9%), and bachelor's students (70.1%). The mean of the HPLP and GHQ scores was 125.09±18.12, and 33.58±10.50, respectively. HPLP was a negative significant predictor of mental health (β = -.261, P= .0001). There was a negative significant association between HPLP dimensions (except physical activity) and mental health. After adjusting for other variables, there was a significant relationship between HPLP with mother occupation (β =.186, P=.038), and mother education (β = -.219, P= .034). Furthermore, gender (β = .175, P= .031), and occupation (β =-.157, P= .040) were predictors of GHQ in adolescent/young college students., Conclusions: Regarding the health-promoting lifestyle situation among students and its relation with the better mental health, the design and implementation of HPLP education programs is recommended., (© 2024 Walter de Gruyter GmbH, Berlin/Boston.)

Background: This study aimed to evaluate the non-inferiority of the FluGuard (a quadrivalent recombinant vaccine manufactured by Nivad Pharmed Salamat Company in Iran) by comparing its immunogenicity and safety with Vaxigrip Tetra (a quadrivalent inactivated vaccine manufactured by Sanofi Pasteur in France)., Materials and Methods: In this double-blind, randomized controlled trial, eligible volunteers aged 18-60 were randomized to receive either FluGuard or Vaxigrip Tetra vaccines. Immunogenicity was evaluated using the Hemagglutination Inhibition (HAI) assay and reported with the geometric mean titer (GMT), seroprotection, and seroconversion. In addition, vaccine safety was assessed by interviewing participants through phone calls., Results: Out of 110 randomized volunteers, 51 and 53 were entered into the final analysis in the Vaxigrip and FluGuard groups, respectively. Vaxigrip had a higher seroprotection rate for the H1N1 strain compared with FluGuard (98 % vs. 91 %). Besides, FluGuard had higher seroprotection rates for H3N2 (74 % vs. 69 %), B-Yamagata (87 % vs. 84 %), and B-Victoria (66 % vs. 41 %) strains compared with Vaxigrip. In all four strains, FluGuard was non-inferior to Vaxigrip with the upper bounds of the 95 % CI on the ratio of the GMTs < 1.5: H1N1 (1.25), H3N2 (0.94), B-Yamagata (0.62), and B-Victoria (0.59). Furthermore, FluGuard was non-inferior to Vaxigrip with the upper bounds of the 95 % CI on the difference between the seroconversion rates < 10 %: H1N1 (2 %), H3N2 (10 %), B-Yamagata (-10 %), and B-Victoria (-29 %). The prevalence of solicited adverse drug reactions did not differ between groups. Furthermore, participants did not experience serious adverse events., Conclusion: Our findings support the non-inferiority of the FluGuard vaccine to the Vaxigrip vaccine regarding immunogenicity and safety., Clinical Trial Registry: The study protocol was approved by the Iranian Registry of Clinical Trials (IRCT20210901052358N5)., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dr. Davood Yadegarynia reports financial support was provided by Nivad Pharmed Salamt Pharmaceutical Company. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

People's Dietary Patterns (DPs) are influenced by culture and ethnicity, and their identification requires a holistic assessment of diet. DP reflects dietary behaviors, and its analysis may provide further details about the dietary etiology of chronic diseases. By examining people's DP and related factors, more practical solutions can be proposed to prevent overweight, obesity, and related diseases. This study aimed to describe DP, Eating Restrictions (ER), Food Involvement (FI), Nutrition Knowledge (NK), and anthropometric indices in Iranian adults and determine the mediating role of FI in the relationship between ER, NK, and DP. A descriptive cross-sectional study was conducted using the structural equation modeling approach. The study was conducted on 2421 adults in Mazandaran Province, northern Iran. The Eating Restrictions Questionnaire (ERQ), the Food Involvement Inventory (FII), the komPAN questionnaire, and a demographic characteristics and anthropometric indices questionnaire were used to collect data. We also measured the seven major food groups, the Diet Quality Scores (DQS), and the six dietary indices, including the pro-Healthy-Diet-Index (pHDI-15), non-Healthy Diet-Index (nHDI-16), high-Glycemic-Diet-Index-7 (hGIDI-7), low-Glycaemic-Diet-Index-4 (lGIDI-4), high-Sugar-Diet-Index-4 (hSDI-4), and high-sugar product (hSFDI-6) and compared their values by gender and four BMI groups. The prevalence of ER and FI was 6.25% and 49.1%, respectively. NK was insufficient for 43.1% of the participants. Most participants (71.2%) had low DQS scores on pHDI-15 and moderate scores (52.9%) on nHDI-16. DQS scores were low in 64.8% of participants in the lGIDI-4 food group, while 71.7%, 92.6%, and 77.2% possessed moderate scores in the hGIDI-7, hSFDI-6, and hSDI-4 food groups, respectively. The mean pHDI-15 and lGIDI-4 indices were higher in women than in men. The amount of unhealthy food indices (nHDI-16, hGIDI-7, hSDI-4, and hSFDI-6) was higher in lean, overweight, and obese people than in people with a normal BMI. The structural model assumed between ER and DP and the mediating role of FI fit well with Iranian adults. Moreover, FI had a mediating role in the relationship between NK and pHDI&#95;15 (Indirect Effects = 0.05, P<0.05) and nHDI&#95;16 (Indirect Effects = -0.07, P<0.01). Most participants are small portions of the healthy food groups and the low glycemic foods, and FI plays a mediating role in the relationship between NK and ER with DP. Therefore, it is necessary to pay attention to the role of FI as a mediating variable in interventions based on reducing ER, increasing NK, and shifting DP from unhealthy to healthy., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Saadati et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Brugada syndrome (BrS) is characterized by ST-segment elevation in the right precordial leads, which is not explained by ischemia, electrolyte disturbances, or obvious structural heart disease., Aim: In present study, we aim to evaluate presentation, long-term outcome, genetic findings, and therapeutic interventions in patients with BrS., Methods: Between September 2001 and June 2022, all consecutive patients with diagnosis of BrS were enrolled in the present study. All patients gave written informed consent for the procedure, and the local ethical committee approved the study., Results: Of the 76 cases, 79% were proband and 21% were detected during screening after diagnosis of BrS in a family member. Thirty-three (43%) patients had a typical spontaneous electrocardiogram (ECG) pattern. Thirty percent of the patients were symptomatic; symptomatic patients were more likely to have spontaneous type 1 Brugada ECG pattern in their ECGs (p = .01), longer PR interval (p = .03), and SCN5A mutation (p = .01) than asymptomatic patients. The mean PR interval was considerably longer in men than women (p = .034). SCN5A mutation was found in 9 out of 50 (18%) studied patients. Fifteen percent received appropriate implantable cardioverter-defibrillator (ICD) therapy and inappropriate ICD interventions were observed in 17%. Presentation with aborted SCD or arrhythmic syncope was the only predictor of adverse outcome in follow-up (odds ratio: 3.1, 95% confidence interval: 0.7-19.6, p = .001)., Conclusions: Symptomatic patients with BrS are more likely to present with spontaneous type 1 Brugada ECG pattern, longer PR interval, and pathogenic mutation in SCN5A gene. Appropriate ICD interventions are more likely in symptomatic patients and those with SCN5A mutation., (© 2024 Wiley Periodicals LLC.)

Background: Prevention of urinary stone recurrence is the ultimate goal in urolithiasis patients. In this study, we aimed to investigate the national prevalence rate and possible determinants of increased urolithiasis recurrence risk in a nationwide study in Iran., Methods: All data regarding stone occurrence and recurrence episodes were extracted from the cross-sectional Iran National Stone Survey (INSS) study, and the possible determinants of recurrence were evaluated in the subset of 2913 patients who had a positive history of at least one episode of urolithiasis., Results: The national prevalence rate of recurrent urolithiasis was 2.6% (95% CI: 2.5, 2.8) in Iran. Moreover, the relative ratio of recurrent stone formers to all stone formers was 39.8% (95% CI: 38.0, 41.6). Our univariable truncated negative binomial regressions suggested that a positive history of urolithiasis in the patient's father (prevalence ratio [PR] [95% CI]=1.83 [1.39, 2.41], P <0.001), mother (PR [95% CI]=1.92 [1.39, 2.66], P <0.001) or brother (PR [95% CI]=1.32 [1.03, 1.69], P =0.026); and residence in urban areas (PR [95% CI]=1.27 [1.04, 1.55], P =0.016) were significant predictors of repetitive recurrence episodes. However, when incorporated into a multivariable truncated negative binomial regression model, the only significant predictors of more frequent recurrence episodes were a positive history in father (PR [95% CI]=1.66 [1.24, 2.22], P <0.001) and mother (PR [95% CI]=1.68 [1.20, 2.36], P =0.002); and urban residence (PR [95% CI]=1.24 [1.01, 1.51], P =0.031)., Conclusion: Our results indicate that a positive family history of urolithiasis in mother and father and residence in urban areas are the significant predictors of recurrence risk in urolithiasis patients in Iran., (© 2024 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

Background: Adolescent obesity is considered as a major health concern worldwide which is closely linked to the quality of diet. The purpose of the present study was to assess the carbohydrate quality and quantity in relation to odds of overweight and obesity in adolescents., Methods: This case-control study with a 1:1 ratio was conducted on 406 adolescents (14 to 18 years old) matched for age and gender. Participants were selected by multistage cluster random sampling method from March to October 2019 in Shiraz, Iran. Dietary intakes of the study population were assessed by a validated semi-quantitative food frequency questionnaire. Also anthropometric indices were measured using standard methods and demographic information was recorded via face to face interview. The relation between low carbohydrate diet score (LCDS) and carbohydrate quality index (CQI), and odds of obesity was evaluated by multiple Logistic regression., Results: After adjusting the role of potential confounders, the participants in the third tertiles of LCDS (OR = 0.443, 95% CI = (0.260 to 0.755)) and CQI (OR = 0.005, 95% CI = (0.001 to 0.025)) had less odds of being overweight and obese compared to the first tertile., Conclusion: The present study found an inverse relationship between dietary quantity and quality of carbohydrate intake and the odds of overweight and obesity in a sample of Iranian adolescents., (© 2024. The Author(s).)

Considering the major role of vegetables in the transmission of gastrointestinal diseases, investigation of the presence of gastrointestinal viruses is particularly important for public health. Additionally, monitoring and investigating potential points of contamination at various stages of cultivation, harvesting, and distribution can be important in identifying the sources of transmission. This study was conducted with the aim of identifying norovirus, adenovirus, hepatitis A virus, hepatitis E virus, rotaviruses, and astroviruses in vegetable samples from the fields and fruit and vegetable centers of Tehran City, and to investigate their presence in irrigation water by RT-qPCR. This study was carried out in two phases: initial and supplementary. During phase I, a total of 3 farms and 5 fruit and vegetable centers and a total of 35 samples from farms, 102 samples from fruit and vegetable centers and 8 agricultural water samples were collected. Zero, 16 and 1 samples were positive for at least one of the viruses from each of the sources, respectively. During phase II, 88 samples from 23 farms, 226 samples from 50 fruit and vegetable centers and 16 irrigation water samples were collected, with 23, 57 and 4 samples were positive for at least one virus, respectively. Rotavirus was the most frequently identified virus among the samples, followed by NoV GII, NoV GI, AstV, and AdV. HAV and HEV were not detected in any of the tested samples. The results of this study suggest that there may be a wide presence of viruses in vegetables, farms, and fruit and vegetable centers in Tehran City, which could have significant consequences considering the fact that many of these foods are consumed raw. Additionally, the detection of some of these viruses in irrigation water suggests that this may be a potential route for viral contamination of produce., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Background: Long noncoding RNAs (lncRNAs) as critical molecules play an essential role in the development of cancers. In colorectal cancer (CRC), various lncRNAs are related to cell proliferation, apoptosis, migration, and invasion. LncRNA prostate cancer-associated transcript 1 ( PCAT-1 ), as an oncogenic factor, is a diagnostic biomarker that regulates cell proliferation, migration, invasion, and apoptosis. Methods: This study evaluated the relationship between PCAT-1 , CRC occurrence, and pathological features of Iranian patients. The studied samples included 100 colorectal tumor tissues and 100 adjacent healthy tissues of Iranian CRC patients. RNAs were extracted from cancerous and noncancerous tissues to synthesize complementary DNA. The expression level of PCAT-1 was assessed using the real-time PCR method, and the data analysis was assessed using SPSS software. Results: In this study, expression level of PCAT-1 in tumor tissue was significantly increased in Iranian patients, and pathological studies of the patients had no significant relationship with the PCAT-1 expression profile. Conclusion: Our results suggested that the high expression of PCAT-1 resulted in the occurrence of colorectal tumor tissues in Iranian patients, which can be considered a diagnostic biomarker in CRC.

Background: The aim of the current study is to assess the prevalence of different categories of thyroid dysfunction and their associated risk factors among the modern urban population of Tehran, the capital of Iran., Methods: The present investigation is a sub-study of the HAMRAH study, a population-based prospective study designed to assess the prevalence of traditional cardiovascular risk factors and their changes through a 10-year follow-up. 2228 (61% female) adults aged between 30 and 75 years old and with no overt cardiovascular diseases were selected through a multistage cluster randomized sampling. Blood levels of thyroid-stimulating hormone (TSH), thyroxin (T4), and triiodothyronine (T3) were measured with the aim of assessing the prevalence of abnormal thyroid function status among the modern urban Iranian population, and in order to report the total prevalence of participants with clinical hypo- or hyperthyroidism, the number of individuals taking thyroid-related drugs were added to the ones with overt thyroid dysfunction. A subgroup analysis was also performed to determine the associated risk factors of thyroid dysfunction., Results: The prevalence of thyroid dysfunction among the total population was 7% (95%CI: 5.9 - 8%) and 0.4% (95% CI: 0.1 - 0.6%) for subclinical and overt hypothyroidism, and 1.6% (95% CI: 1 - 2%) and 0.2% (95% CI: 0 - 0.3%) for subclinical and overt hyperthyroidism, respectively. Clinical thyroid dysfunction was detected in 10.3% of the study population (9.4% had clinical hypo- and 0.9% had clinical hyperthyroidism). In the subgroup analysis, thyroid dysfunction was significantly more prevalent among the female participants (P-value = 0.029)., Conclusions: In the current study, the prevalence of different categories of abnormal thyroid status, and also the rate of clinical hypo- and hyperthyroidism was assessed using the data collected from the first phase of the HAMRAH Study. In this study, we detected a higher prevalence of clinical and subclinical hypothyroidism among the Iranian population compared to the previous studies., (© 2023. The Author(s).)

Background: To facilitate evidence-based practice (EBP) in physiotherapy in Iran and guide future improvements, it is crucial to identify what barriers and facilitators exist in the current system from the physiotherapist's perspective. Therefore, the purpose of this study was to explore the barriers and facilitators of EBP in physiotherapy in Iran., Methods: This qualitative study was conducted using a phenomenological approach from January to July 2023 in Iran. The sampling process started with a purposive approach, and then an attempt was made to identify and interview more potential samples with the snowball approach. Thematic analysis was used to analyse the collected qualitative data., Results: 44 individuals, including 37 physiotherapists and seven faculty members, participated in this study. Several barriers and facilitators to evidence-based physiotherapy practice in Iran were found and then put into three themes: (1) individual factors, (2) practice environment factors, and (3) extra-organisational factors. The most common barriers were time/workload pressures, financial incentives, lack of motivation, weakness in English, managers' pressures, inadequate awareness among patients, infrastructure limitations, poor economic situation, Internet restrictions, inappropriateness of the educational curriculum, difficult access to scientific research, and lack of insurance coverage for up-to-date therapies., Conclusions: Although most of the participants had a very positive view of physiotherapy based on scientific evidence, various obstacles have prevented this approach from being well implemented in Iran. Therefore, it is necessary to move towards minimising the existing barriers at the individual, practice environment, and extra-organisational levels by adopting effective multilateral policies., (© 2023 John Wiley & Sons Ltd.)

Purpose: Major histocompatibility complex class II (MHC-II) deficiency is a rare inborn error of immunity (IEI). Impaired antigen presentation to CD4 + T cells results in combined immunodeficiency (CID). Patients typically present with severe respiratory and gastrointestinal tract infections at early ages. Hematopoietic stem cell transplantation (HSCT) is the only curative therapy., Methods: We describe the clinical, immunologic, and genetic features of eighteen unrelated Iranian patients with MHC-II deficiency., Results: Consanguinity was present in all affected families. The median age at the initial presentation was 5.5 months (range 7 days to 18 years). The main symptoms included failure to thrive, persistent diarrhea, and pneumonia. Autoimmune and neurologic features were also documented in about one-third of the patients, respectively. Thirteen patients carried RFXANK gene mutations, two carried RFX5 gene mutations, and three carried a RFXAP gene mutation. Six patients shared the same RFXANK founder mutation (c.162delG); limited to the Iranian population and dated to approximately 1296 years ago. Four of the patients underwent HSCT; three of them are alive. On the other hand, nine of the fourteen patients who did not undergo HSCT had a poor prognosis and died., Conclusion: MHC-II deficiency is not rare in Iran, with a high rate of consanguinity. It should be considered in the differential diagnosis of CID at any age. With the limited access to HSCT and its variable results in MHC-II deficiency, implementing genetic counseling and family planning for the affected families are mandatory. We are better determined to study the c.162delG RFXANK heterozygous mutation frequency in the Iranian population., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Toxoplasmosis is a worldwide disease of various animals and human and results from infection with the Toxoplasma gondii parasite. Abortion and congenital defects are important consequences of the T. gondii infection. The aim of this study was to determine the Toxoplasma-induced abortions among women with miscarriage and the presence of T. gondii in their aborted fetuses in Urmia, the northwest of Iran. This cross-sectional study was conducted with 215 women with abortion and their aborted fetuses, from 2020 to 2021. Seroprevalence of anti-Toxoplasma IgG and IgM were determined using the sera of the aforesaid women. Nested PCR was carried out using RE-529 gene sequences, and sequencing was performed using the T. gondii GRA6 gene on the remnant of pregnancy after abortion. The tissue positive samples were then subjected to another PCR on GRA6 gene and sequenced for genotyping. Among 215 serum samples of women with abortion, 70 (32.6%) were positive for anti-Toxoplasma IgG, and three (1.4%) were positive for IgM. The RE-529 sequence of T. gondii was positive in three (1.4%) of the aborted fetuses. The analysis of GRA6 gene indicated that all three positive samples carried a GRA6 allele (GRA6I) of T. gondii type I genotype. Our findings suggest that T. gondii is one of the causative agents of spontaneous abortion in West Azerbijan Province, the northwest of Iran., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Zeinali et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

CRISPR arrays, which are organized to fight against non-self DNA elements, have shown sequence diversity that could be useful in evolution and typing studies. In this study, 55 samples of L. monocytogenes isolated from different sources were evaluated for CRISPR sequence polymorphism. The CRISPR loci were identified using CRISPR databases. A single PCR assay was designed to amplify the target CRISPRs using an appropriate universal primer. Sequencing results were analyzed using CRISPR databases and BLASTn, and the CRISPR locus was present in all the strains. Three hundred repeats including 55 terminal repeats were identified. Four types of consensuses direct repeat (DR) with different lengths and sequences were characterized. Sixty repeat variants were observed which possessed different polymorphisms. Two hundred and fifty spacers were identified from which 35 consensus sequences were determined, indicating the high polymorphism of the CRISPR spacers. The identified spacers showed similarities to listeria phage sequences, other bacterial phage sequences, plasmid sequences and bacterial sequences. In order to control the bacterial outbreaks, a robust and precise system of subtyping is required. High levels of polymorphism in the CRISPR loci in this study might be related to the origin and time of the samples' isolation. However, it is essential to assess, on a case-by-case basis, the characteristics of any given CRISPR locus before its use as an epidemiological marker. In conclusion, the results of this study showed that the use of sequence content of CRISPR area could provide new and valuable information on the evolution and typing of the L. monocytogenes bacterium., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

The objectives of this study were to translate and validate the Persian version of the food involvement inventory (FII) and eating restriction questionnaire (ERQ) and to determine the measurement invariance based on gender, body mass index (BMI) status, and age. This cross-sectional study included 1100 Iranian adults. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to evaluate the construct validity of FII and ERQ. Convergent and discriminant validity, measurement invariance in gender, BMI and age, reliability including internal consistency, and stability were investigated for FII and ERQ. The results showed that the four-factor construct of the FII and the one-factor construct of the ERQ were 44.27% and 55.12% of the total variance, respectively. The factor loadings of all items were > .3 in both scales and none of the items were deleted. Fitting indices indicated that the four-factor construct of the FII and the one-factor construct of the ERQ had a good and acceptable fit among the Iranian adults. The Persian versions of the FII and ERQ, translated into Persian and localized according to international standards, had high construct, convergent and discriminant validity as well as high reliability., (© 2023. Springer Nature Limited.)

Objectives: The current study is aimed at evaluating epidemiological characteristics and spatiotemporal distribution of cleft lip and/or palate (CL/P) in the south of Iran., Methods: Data were extracted from the 1840 medical records of patients who were referred to the Cleft Lip and Palate Center of Shiraz University of Medical Sciences, from January 1, 2011, to September 1, 2022. The collected variables included demographic data (gender, birth date and season, place, birth order, and weight), cleft types and the subtypes, parental information (health status, education level, marital status, and age during the pregnancy), and other basic parameters. The chi-square test at a significance level of 0.05 was used to analyze collected data. The geographic information system (GIS) analysis was also used for analyzing the spatial distribution of CL/P patients., Results: Based on our inclusion criteria, 1281 nonsyndromic patients were included in this study. The most common type was cleft lip and palate (CLP) with 48.32%, whereas cleft palate (CP) and cleft lip (CL) accounted for 40.75% and 10.93% of the patients, respectively. There was a progressive increase in the frequency of all types of clefts, and most of them were male ( P ≤ 0.001). The urban population outnumbered the rural ones in all provinces. Parents were mostly healthy (>80%) with low educational status (47.5%). Most born CL/P patients were from consanguineous marriages (58.9%), especially between first-degree relatives. A majority of CL/P patients (73.1%) were born in the first two gestations with a birth weight of 2500-4000 g (77.4%). Most infants with CL/P (84.3%) were born from mothers who had at least one of the predisposing factors., Conclusion: In this study, the frequency of cleft types and subtypes was similar to the existing literature. However, high rate of consanguineous marriage, especially between first-degree relatives, was the most notable feature of this population., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2023 Nima Farshidfar et al.)

Introduction: This study investigated medical students' intended learning outcomes based on e-learning and in-person education., Methods: In this cross-sectional comparative analytical study, a group of 126 undergraduate medical students' intended learning outcomes under two different teaching methods, including e-learning and in-person, were repeatedly measured based on the census sampling method. Participants were in the preclinical curriculum phase (physiopathology) at Mashhad University of Medical Sciences (MUMS), Iran. Due to expert panel opinion, the same medical teachers and similar difficulty of lessons were considered in two investigated academic semesters. In addition, difficulty and discrimination indexes of formative and summative assessments were controlled for two study groups. The students' learning outcome index was the knowledge test scores participants received in the relevant lessons of the General Medicine (GM) curriculum preclinical courses., Results: The findings indicated that students learning outcomes were significantly higher during e-learning than in in-person education for all examined variables (P < 0.05). Moreover, the difference between students' Grade Point Average (GPA) categories among the two groups was significant (P = 0.022). Students with a GPA of less than 14 experienced higher increments in their average scores after the e-learning compared to in-person education. Compared to face-to-face courses, improvements in pharmacology, theoretical semiology, and pathology scores after e-learning courses were statistically significant (P < 0.001). The differences in mean scores related to practical pathology and semiology in the two approaches were not statistically significant, P = 0.624 and P = 0.149, respectively. Furthermore, the overall students' average scores increased significantly during e-learning versus in-person education (P < 0.001)., Conclusion: We concluded that e-learning could be appreciated as a successful method of medical education and can be used as an alternative educational method. However, considering the importance of practical or clinical courses in medical education, further research about the efficacy of the e-learning approach is highly recommended., (© 2023. The Author(s).)

Background: Gestational diabetes mellitus (GDM) is one of the most common metabolic dysfunction in pregnancy and as overweight and obesity are of the major risk factors. The aim of this study was to determine the effect of Information-Motivation and Behavioral skills (IMB) model-based counseling on preventing GDM in overweight and obese pregnant women., Methods: This randomized controlled trial study was conducted on 137 pregnant women in two groups; education and counseling IMB model-based for four sessions ( n  = 70), and antenatal usual care (AUC) ( n  = 67). This study was conducted on overweight and obese pregnant women, at the 12 to 16 weeks' gestation and recruited from the Prenatal Clinic of Rohani Hospital in north of Iran. Blood glucose was measured before and 8 weeks after the intervention. Descriptive and inferential statistics including mean, frequency, t-test, chi-square and ANCOVA were used., Results: The prevalence of GDM was lower in the intervention group than the control group (10% and 29.9%, respectively, RR = 0.33, CI 95% (0.15- 0.74) p  = .004) as well as mean fasting blood glucose (Cohen's d  = 0.28, p  = .07), and glucose tolerance test at the first and second hour ( d  = 0.41 and Cohen's d  = 0.73, respectively, p  < .01)., Conclusions: A lifestyle intervention in early pregnancy by IMB counseling in overweight and obese pregnant women can be effective in decrease GDM.

Background: The subcutaneous implantable-defibrillator (S-ICD) is a relatively new alternative to the transvenous ICD system to minimize intravascular lead-related complications. This paper presents outcome of SICD implantation in patients enrolled in Iran S-ICD registry., Methods: Between October 2015 and June 2022, this prospective multicenter national registry included 223 patients with a standard indication for an ICD, who neither required bradycardia pacing nor needed cardiac resynchronization to evaluate the early post-implant complications and long-term follow-up results of the S-ICD system., Results: The mean age of the patients was 45 ± 17 years. The majority (79.4%) were male. Ischemic cardiomyopathy (39.5%) was the most common underlying disorder among patients selected for S-ICD implant. Most study patients (68.6%) had ICD for primary prevention of sudden cardiac death. Seven patients (3.1%) were found to have suboptimal lead positions. Six patients (2.7%) developed a pocket hematoma; all were managed medically. During a mean follow-up of 2 years, the appropriate therapy was recorded in 13% of the patients and inappropriate ICD intervention mainly due to supraventricular tachycardia in 8.9%. Pocket infection was observed in four patients (1.8%) and five patients (2.2%) died mainly due to heart failure., Conclusion: S-ICDs were effective at detecting and treating both induced and spontaneous ventricular arrhythmias. Major clinical complications were rare., (© 2023 Wiley Periodicals LLC.)

Background: A widespread outbreak of epidemics like Covid-19 is a lethal threat to physical and mental health. Recent studies reported a higher prevalence of mental problems in younger individuals, contrary to the general assumption expected in older people. Therefore, it is necessary to compare anxiety, stress, depression and PTSD (post-traumatic stress disorder) symptoms in different age groups during the Covid-19 crisis., Methods: A cross-sectional online survey was performed (from Dec. 2020 to Feb. 2021) on three age groups of elderly, middle-aged and young people. Data were collected by DASS-21 (Depression, Anxiety and Stress Scale) and IES-R (Impact of Event Revised Scale) and analyzed using ANOVA, χ2 test and logistic regression analysis., Results: Overall, 601 participants completed the questionnaires, including 23.3% of the elderly (≥ 60 years), 29.5% of the young (18-29 years) and 47.3% of the middle-aged (30-59 years) with 71.4% of women. The logistic regression analysis revealed that the risk of PTSD in young people was higher than in the elderly (β = 2.242, CI: 1.03-4.87, P = 0.041), while the risk of depression, anxiety and stress did not differ significantly among the three age groups. Female gender, occupation, lower economic status, solitary life, and chronic disease were risk factors for psychological symptoms during the Covid-19 pandemic., Conclusion: Findings on the higher odds ratio of PTSD symptoms in younger individuals have interestingly potential implications to meet the needs of mental health services during Covid-19., (© 2023. The Author(s).)

Purpose: To estimate the current lifetime prevalence of urolithiasis at the national level in Iran and investigate the potential influential demographic factors in different geographical areas.   Materials and methods: An epidemiological study was conducted between October 2020 and November 2022 in 31 provinces of Iran at the national level. Data was obtained through telephone interviews with households. Items in the interview included questions about the current and past episodes of urolithiasis, family history of urolithiasis, and demographic and environmental variables of potential interest in urolithiasis.   Results: A total of 44186 participants were investigated from 31 provinces of Iran. The overall percentage of those with lifetime prevalence of urolithiasis was 6.6%, including 7.9% for males and 5.3% for females (P<.001). In addition, with regard to the residential location, men were 53% (7.9% vs. 5.2%) more susceptible than women to urinary stones in urban areas and 36% (7.8% vs. 5.7%) more susceptible in rural areas. Out of 31 provinces, the Sistan-baluchistan province had the highest lifetime prevalence (15.6%) and the Golestan province had the lowest (2.1%). The lifetime prevalence of urolithiasis in the rural areas was 6.8% versus 6.5% in the urban areas (P=.29). Regarding age differentiation, the lifetime urolithiasis prevalence has increased up to the age of 70 years. In addition, the most prominent increase in the lifetime prevalence was observed in the age range of 20 to 60 years (from 0.9% to 11.8%). The ethnicity with the highest lifetime prevalence rate of urolithiasis was the Baluch ethnicity (18%).   Conclusion: generally, 6.6% of Iranian population suffers from urinary stones during their lifetime. Urolithiasis prevalence has increased 0.06% annually compared to the latest national study that took place 15 years ago. This increasing trend seems to be less prominent than other countries. According to our findings, urinary stones are more prevalent in men than in women and in the third to sixth decade of life regardless of gender. Baluch ethnicity is associated with the highest lifetime prevalence rate of urolithiasis and there is no significant difference between rural and urban areas. However, the ratio of male to female risk of urolithiasis is higher in urban areas compared to rural areas.

Introduction: Family members are the caregivers to patients with mental disorders at home, and the mental and spiritual pressures caused by this responsibility necessitate physical, mental, and perceived social support for these families. The present mixed method study is an attempt to elaborate on the perceived social support by Iranian families of patients with chronic mental disorders., Materials and Methods: Using a sequential mixed method explanatory study (quantitative and qualitative), 200 family members of patients with chronic mental disorders were selected through convenient sampling (quantitative phase). Data gathering was started using a demographics form and Stewart and Sherburne's perceived social support scale. The qualitative phase included 10 participants who obtained low scores in the quantitative phase and took part in private, face-to-face, in-depth, and semi-structured interviews. The data obtained in the quantitative phase were analyzed using statistical tests, and the interviews were analyzed using qualitative content analysis., Findings: The perceived social support by the participants was at a moderate level in different fields of tangible support, information and emotional support, kindness, and positive social interactions. The results of the qualitative phase revealed social support status in 15 subcategories, 6 categories, and 2 themes of support and acceptance by family, relatives, and friends, with support and being understood by society. The results of the qualitative and quantitative sections emphasized the needs of the patient's family members (who acted as caregivers for patients) for support in family, social, and emotional areas., Conclusion: The family members of patients with chronic mental disorders have different needs in the area of perceived social support. Such needs are more tangible in family members such as children with mentally ill parents or parents with mentally ill children. The results of this study can be used for educational and supportive planning for caregivers of patients, most of whom are family members., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Amini, Jalali and Jalali.)

Background: Dental curriculums require regular revision to stay up to date in scientifical and societal fields. Senior dental students are among the main stakeholders of such curriculums. The present study investigated the opinions of Iranian senior dental students regarding the adequacy of their dentistry program and the national dental curriculum in training a competent dentist, the program's content, and its structure., Methods: A previously designed and validated questionnaire on the opinion of senior dental students regarding curriculum adequacy was sent to a representative in each of the country's dental schools. Before the COVID pandemic terminated data collection, a total of 16 schools (438 students) managed to respond (37%). The questionnaire asked the students to assess the adequacy of the training received in curriculum's theoretical and practical competencies with the help of a five-point Likert scale that ranged from "Completely inadequate" to "Completely adequate". It also questioned them on its teaching methods and intensity. SPSS software version 24 and Chi-square test served for statistical analysis., Results: In total, the study has 438 participants, 245 female and 193 male. Significant sex differences were spotted in the responses concerning both theoretical and practical training. Regarding general training adequacy, 50 (22.6%) female students and 50 male ones (30.7%), P = 0.08 agreed that the program was acceptable. The numbers for students of old (more than 15 years of activity) and new schools were 47 (21.7%) and 53 (31.7%), respectively (P = 0.03). Nearly one-third deemed the teaching methods appropriate. Regarding the duration of curriculum phases, 33 students (8.3%) believed that basic science required extension, while 108 (28.6%) and 266 (69.1%) reported such need for pre-clinical and clinical phases. The school's years of activity emerged as significant, as 38.1% of students from new schools versus 21.7% of those from old ones deemed the extension of pre-clinical phase necessary (P < 0.001)., Conclusion: A significant number of Iranian senior dental students found the undergraduate dental curriculum inadequate regarding competencies, content, and teaching. Further investigations will determine whether it's the curriculum or its implementation that warrants revision., (© 2023. The Author(s).)

Background: We aimed to assess potential associations of habitual dietary pattern scores in relation to the risk of pre-diabetes (Pre-DM) progression to type 2 diabetes mellitus (T2DM) or the chance of returning to normal glycemia., Methods: This cohort study included 334 Pre-DM individuals (mean age of 49.4 years, and 51.5% men) who participated in the third phase of the Tehran Lipid and Glucose Study (2006-2008) and followed up for a median of 9 years. A validated food frequency questionnaire at baseline assessed usual intakes of the participants. Major dietary patterns were identified using principal component analysis. The DASH score and Mediterranean diet score (MDS) were also calculated. Multinomial logistic regression analysis was used to estimate the odds ratios (95% confidence intervals (CIs)) of developing T2DM and returning to normal glycemia in relation to dietary pattern scores., Results: During the study follow-up, 39.8% progressed to T2DM, and 39.8% returned to normal glycemia. Three following major dietary patterns, including Western-style (with a higher load of red meats, hydrogenated fats, sodium, and total fat intakes), healthy pattern (with a higher load of whole grains, vegetables, and dairy products), and processed-foods pattern (with a higher load of processed-meats, fast-foods, salty snakes, and sweets and candies) were identified. The Western-style dietary pattern increased the risk of progressing to T2DM by 38% (OR = 1.38; 95% CI = 1.00 to 1.89, P = 0.050). Other dietary pattern scores were not related to regression or progression from Pre-DM., Conclusion: The Western-style dietary pattern (characterized by higher load of red meats, hydrogenated fats, sodium intake, and high-GI foods) may accelerate the progression of Pre-DM to T2DM., (© 2023. The Author(s).)

In this study, different K-nearest neighbors (KNN), support vector regression (SVR), decision tree (DT), and random forest (RF) algorithms integrated with the Bayesian optimization algorithm (BOP) have been applied as novel hybrid modeling/optimization tools to predict the total nitrogen in treated wastewater of Southern Tehran Wastewater Treatment Plant (STWWTP). In order to enhance the outcomes of hybrid models, the chosen sub-models (the best and least correlated hybrid models) were used to generate voting average and stacked regression ensemble models. Throughout the preprocessing step, two alternative scenarios were used to handle missing values from the samples, including elimination versus estimation via linear interpolation. The results of this research demonstrated that ensemble models were better than individual hybrid models, although not all ensemble models were superior to single models. The results also revealed that the stacking regression ensemble model using KNN-BOP and SVR-BOP as sub-models was the most superior model among the developed models, with the coefficient of determination (R 2 ) = 0.640, root mean squared error (RMSE) = 2.378, and mean absolute error (MAE) = 1.838 on the test data. The best hybrid ensemble model that can accurately predict the concentration of total nitrogen (TN) in the effluent can give people a heads-up about water pollution caused by eutrophication before it gets bad., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction: Due to the development of the academic field of prosthetics and orthotics (P&O) in recent years, scientific studies in this domain have increased. However, relevant published studies, especially randomized controlled trials (RCTs), are not always of acceptable quality. Therefore, this study aimed to evaluate the methodological and reporting quality of RCTs in the field of P&O in Iran to recognize existing shortcomings., Methods: Six electronic databases, including PubMed, Scopus, Embase, Web of Science, the Cochrane Central Register of Controlled Trials, and the Physiotherapy Evidence Database, were searched from January 1, 2000, to July 15, 2022. The Cochrane risk of bias tool was applied to evaluate the methodological quality of the included studies. In addition, the Consolidated Standards of Reporting Trials (CONSORT) 2010 checklist was used to assess the reporting quality of the included studies., Results: 35 RCTs published from 2007 to 2021 were included in our final analysis. The methodological quality of 18 RCTs was poor, and the quality of the rest of the studies was good (n = 7) or fair (n = 10). In addition, the median score (IQR) of the reporting quality of RCTs in accordance with the CONSORT items was 18 (13-24.5) out of 35. The results of the relationship analysis indicated a moderate correlation between the CONSORT score and the publication year of the included RCTs. Nonetheless, there was a low correlation between the CONSORT scores and the journals' impact factors., Conclusion: The overall methodological and reporting quality of RCTs in the field of P&O in Iran was not found to be optimal. To enhance the methodological quality, some items should be considered more strictly, such as blinding of outcome assessment, allocation concealment, and random sequence generation. Furthermore, the criteria of CONSORT, as reporting quality checklist, should be adopted in writing the papers, especially methods-related items., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)