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Background: Computed tomography (CT) scan is a common imaging technique used to evaluate the severity of a head injury. The overuse of diagnostic interventions in the health system is a growing concern worldwide. Objectives: The aim of this systematic review is to investigate the rate of CT scan overuse in cases of mild head injury., Methods: Eligibility criteria: We encompassed observational studies-either designed as cohort, case-control, or cross-sectional investigations-that reported on CT scan overuse rates for mild head injuries. Studies had to be published in peer-reviewed, English-language sources and provide full content access Information sources: Web of Sciences, Scopus, Medline via PubMed, the Cochrane Library and Embase were searched from inception until April 1, 2023. Studies were included if reporting the overuse of CT scans for mild head injuries using validated criteria. Risk of bias: We used the Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) tool to evaluate the risk bias assessment of included studies. Two independent reviewers evaluated the eligibility of studies, extracted data, and assessed study quality by using the Newcastle-Ottawa Scale. Synthesis of results: Overuse estimates were calculated using a random-effects model. Subgroup analyses were performed to investigate any sources of heterogeneity. Point rate of overuse of CT scans for mild head injuries was the main outcome measured as percentage point estimates with corresponding 95% CIs., Results: Included studies: Of the 913 potentially relevant studies identified, eight studies were selected for the final analysis. Synthesis of results: The pooled rate of CT scan overuse in patients with mild head injury was found to be 27% [95% CI: 16-43; I2 = 99%]. The rate of CT scan overuse in mild head injury cases varied depending on the criteria used. The rate of CT scan overuse was 37% [95% CI: 32-42; I2 = 0%] with the Glasgow Coma Scale (GCS), 30% [95% CI: 16-49; I2 = 99%] with the Canadian computed tomography head rule, and 10% [95% CI: 8-14; I2 = 0%] with the Pediatric Emergency Care Applied Research Network criterion (PERCAN). Based on subgroup analyses, the rate of CT scan overuse in mild head injury cases was observed to be 30% with the Canadian computed tomography head rule criterion, 43% with the National Institute for Health and Clinical Excellence criterion, and 18% with the New Orleans criterion., Conclusion: Limitations of evidence: The restricted number of included studies may impact generalizability. High heterogeneity was observed, leading to subgroup analyses based on age, assessment criteria, and study region. Absent data on overuse causes hinders drawing conclusions on contributing factors. Furthermore, this study solely addressed overuse rates, not associated harm or benefits. Interpretation: The overuse of CT scans in mild head injury patients is concerning, as it can result in unnecessary radiation exposure and higher healthcare costs. Clinicians and policymakers should prioritize the implementation of guidelines to reduce unnecessary radiation exposure, healthcare costs, and potential harm to patients., Trial Registration: The study protocol of this review was registered in PROSPERO under the identification code CRD42023416080. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023416080., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Saran 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: Non-alcoholic fatty liver disease (NAFLD) has a benign course in several patients; however, a serious form of this disease can turn into liver failure, liver cirrhosis, and hepatocellular carcinoma., Aim: This study aims to estimate the prevalence of NAFLD in Iran., Method: We searched the following databases from January 2000 to December 2022: Scopus, Pubmed/Medline, Embase, Web of Sciences, the Cochrane Library, and Google Scholar also a number of Iranian databases, namely MagIran, SID, and Elmnet. Additionally, the quality of the included studies was evaluated through the Newcastle-Ottawa Scale. We estimated heterogeneity between studies using the I 2 statistic. Furthermore, we performed a synthesis of prevalence estimates through the random-effects DerSimonian and Laird model across the included studies with a 95% confidence interval. To assess the publication bias, we also used Egger's test., Results: Thirty-one studies were eligible for inclusion. The overall number of participants in the present study was 41,971. The overall prevalence of NAFLD in Iran was 33% [CI: 27-37%], with I2 = 99.7% ( P  < 0.01). The prevalence was 35% [CI: 27-43%] and 37% [CI: 27-47%] in males and females, respectively. We used Egger's test, and no significant publication bias was identified in the overall prevalence ( P  = 0.45)., Conclusion: According to the results of this study, the prevalence of NAFLD in Iran is not only high but alsoa growing trend. Effective strategies for changing lifestyles, changing eating habits, and encouraging physical activities among Iranians are recommended. Also, providing screening tests, especially among high-risk groups, has a significant effect on early diagnosis and NAFLD control., (© 2023 Indian National Association for Study of the Liver. Published by Elsevier B.V. All rights reserved.)

Objective: Equity in the delivery of health services, including diagnostic imaging, is crucial to achieving universal health coverage. The Health Transformation Plan (HTP), launched in 2014, represents a major healthcare policy to improve the quality and accessibility of healthcare services. This study aimed to explore the impact of the HTP on equity in the access to medical imaging in Lorestan province, located in west Iran, from 2014 to 2023. Annual growth rates (AGR) of imaging devices were calculated, whilst equity assessment of medical imaging distribution was carried out by means of the Gini coefficient and the Lorenz curve per 100,000 population. The latter was generated using the cumulative distribution of imaging devices, as well as the cumulative population ratio., Results: Between 2014 and 2023, the number of imaging devices has increased threefold. The AGR of installing CT and MRI scanners in Lorestan province increased between 2014 and 2023. The Gini coefficients increased from 0.12 for CT and 0.16 for MRI in 2014 to 0.33 in 2023 for both devices. This indicates a decrease in equity in access to these fundamental health technologies despite the increase in their figures. Policymakers should better allocate medical equipment based on the specific health needs of different regions throughout Iran., (© 2023. The Author(s).)

Objective: The success of note writing has been a topic of research dating back to the days of Plato. Students now have access to complete libraries of books and notes on computers, tablets, and even phones. Modern note-taking methods use premade handouts, "Chalk Talk" lectures with faculty, and prescribed note-taking strategies. Here, we discuss one such strategy, the Cornell Note system., Methods: This is an updated review of the original Cornell Note system originally outlined in How to Study in College., Results: A detailed outline of how to construct and use Cornell Note System and how to apply to medical training., Conclusion: The outline and unique aspects of the Cornell Note system are discussed, along with how this system can be incorporated into the modern-day curriculum.

Background: Investigating antibody titers in individuals who have been both naturally infected with SARS-CoV-2 and vaccinated can provide insight into antibody dynamics and correlates of protection over time., Methods: Human coronavirus (HCoV) IgG antibodies were measured longitudinally in a prospective cohort of qPCR-confirmed, COVID-19 recovered individuals (k = 57) in British Columbia pre- and post-vaccination. SARS-CoV-2 and endemic HCoV antibodies were measured in serum collected between Nov. 2020 and Sept. 2021 (n = 341). Primary analysis used a linear mixed-effects model to understand the effect of single dose vaccination on antibody concentrations adjusting for biological sex, age, time from infection and vaccination. Secondary analysis investigated the cumulative incidence of high SARS-CoV-2 anti-spike IgG seroreactivity equal to or greater than 5.5 log10 AU/mL up to 105 days post-vaccination. No re-infections were detected in vaccinated participants, post-vaccination by qPCR performed on self-collected nasopharyngeal specimens., Results: Bivariate analysis (complete data for 42 participants, 270 samples over 472 days) found SARS-CoV-2 spike and RBD antibodies increased 14-56 days post-vaccination ( p < 0.001) and vaccination prevented waning (regression coefficient, B = 1.66 [95%CI: 1.45-3.46]); while decline of nucleocapsid antibodies over time was observed (regression coefficient, B = -0.24 [95%CI: -1.2-(-0.12)]). A positive association was found between COVID-19 vaccination and endemic human β-coronavirus IgG titer 14-56 days post vaccination (OC43, p = 0.02 & HKU1, p = 0.02). On average, SARS-CoV-2 anti-spike IgG concentration increased in participants who received one vaccine dose by 2.06 log10 AU/mL (95%CI: 1.45-3.46) adjusting for age, biological sex, and time since infection. Cumulative incidence of high SARS-CoV-2 spike antibodies (>5.5 log10 AU/mL) was 83% greater in vaccinated compared to unvaccinated individuals., Conclusions: Our study confirms that vaccination post-SARS-CoV-2 infection provides multiple benefits, such as increasing anti-spike IgG titers and preventing decay up to 85 days post-vaccination.

Background: Approximately 1 in 1000 men have a 47,XYY karyotype. Previous publications have presented cases of infertile XYY men and have suggested that the additional Y chromosome may cause disrupted meiosis leading to sperm apoptosis. The purpose of the current study was to determine whether XYY men are over-represented in infertility cohorts., Methods: In this paper, an ongoing infertility cohort was evaluated for Y chromosome microdeletions using the MLPA technique and the data from the first 2000 referrals were recorded. Moreover, the MLPA technique detected 47,XYY karyotypes., Results: Four XYY individuals were identified within the cohort. One of the four XYY men was shown to have an apparent gr/gr partial AZFc deletion on both Y chromosomes while Sertoli cell only syndrome was detected in another case. The other two cases (out of 2000) might, therefore, represent an incidental finding., Conclusion: The gr/gr deletion is not detectable by the multiplex PCR method; therefore, there might be additional explanations for the fertility problems of infertile XYY men reported in previously published articles. It seems that among other cases, their XYY karyotype may be coincidental, rather than causative of their fertility issues., Competing Interests: Conflict of Interest There are no known conflicts of interest associated with this publication and there has been no significant financial support for this work., (Copyright© 2022, Avicenna Research Institute.)

Tapia's syndrome is considered a neuropraxic injury of the recurrent laryngeal nerve and hypoglossal nerve which commonly presents after postoperative general anesthesia as hoarseness and dysphagia. Clinicians should consider this diagnosis in those presenting with symptoms of cranial nerve X and cranial nerve XII injury in the post-extubation setting for prompt diagnosis and management. Here, we report a rare case of Tapia's syndrome following cardiac surgery which was then treated with carboxymethylcellulose gel implant injection., 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.

Background: Nonalcoholic fatty liver disease (NAFLD) is present in the body with metabolic disorders such as Type 2 diabetes mellitus (T2DM), obesity, and cardiovascular disease. However, no significant evidence has been found till date exhibiting their association epidemiologically in Indian patients., Objective: To assess the association among NAFLD, T2DM, and obesity, and to validate the scoring system with grades of fatty liver (severity of liver disease) estimated by ultrasound vs. NAFLD fibrosis score, BARD score, and aspartate aminotransferase to platelet ratio index (APRI) score., Methodology: A retrospective, observational study was conducted out in patients with NAFLD (n = 316) where diagnosis and grades of fatty liver were established via ultrasound reports. The patients were divided into two groups, Group A (n = 114, NAFLD with T2DM) and Group B (n = 202, NAFLD without T2DM). R 4.0.0 was used for statistical analysis., Results: The mean age (in years) of the patients was 54.08 ± 10.78 in Group A and 48.10 ± 15.36 in Group B. The mean BMI in Group A was found to be slightly higher as compared to Group B, 27.49 ± 4.94 and 26.56 ± 4.68, respectively, and the difference was found to be statistically significant (p-value <0.05). The overall predictive ability of the NAFLD scoring system matched that to ultrasonography liver grading fibrosis report for approximately 53% of patients. The BARD scoring system was found to be matched with ultrasonography reported Grade 1 fatty liver (198/316). In the case of the APRI scoring system, the association was not observed with ultrasonography reports in any grades of fatty liver., Conclusion: Body mass index might be an independent risk factor for NAFLD. NAFLD fibrosis score appears to be a reliable non-invasive tool to determine the severity of liver fibrosis in NAFLD patients. BARD score may predict Grade 1 liver fibrosis. However, APRI scores do not correlate with imaging evidence of fibrosis like NAFLD and BARD scores., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Journal of Family Medicine and Primary Care.)

In the last decade, deep learning has been applied in a wide range of problems with tremendous success. This success mainly comes from large data availability, increased computational power, and theoretical improvements in the training phase. As the dataset grows, the real world is better represented, making it possible to develop a model that can generalize. However, creating a labeled dataset is expensive, time-consuming, and sometimes not likely in some domains if not challenging. Therefore, researchers proposed data augmentation methods to increase dataset size and variety by creating variations of the existing data. For image data, variations can be obtained by applying color or spatial transformations, only one or a combination. Such color transformations perform some linear or nonlinear operations in the entire image or in the patches to create variations of the original image. The current color-based augmentation methods are usually based on image processing methods that apply color transformations such as equalizing, solarizing, and posterizing. Nevertheless, these color-based data augmentation methods do not guarantee to create plausible variations of the image. This paper proposes a novel distribution-preserving data augmentation method that creates plausible image variations by shifting pixel colors to another point in the image color distribution. We achieved this by defining a regularized density decreasing direction to create paths from the original pixels' color to the distribution tails. The proposed method provides superior performance compared to existing data augmentation methods which is shown using a transfer learning scenario on the UC Merced Land-use, Intel Image Classification, and Oxford-IIIT Pet datasets for classification and segmentation tasks., Competing Interests: The authors declare that they have no competing interests., (© 2021 Saran et al.)

Universal health coverage (UHC) is one of the strategies that health decision- and policy-makers worldwide are implementing to guarantee a good health status to everyone. Living in slums is characterized by several issues, including homelessness and malnutrition, environmental challenges, lack of sanitation and access to safe, healthy drinking water, waste disposal problems, widespread social disruptions, job insecurity, feelings of dissatisfaction and inadequacy. In Iran, the 'Health Transformation Plan' (HTP), despite its weaknesses, has had good effects on the health level of people living in slums, ensuring insurance coverage and reducing many economic, social and cultural problems, with a dramatic decline in out-of-pocket expenditures. Good governmental financial support and an adequate revision of the initial packages of health services and provisions have resulted in a higher access rate to healthcare. The HTP has been, indeed, a major step towards reaching UHC in Iran. If policy- and decision-makers can further improve the present situation and provide more and better-quality services to these people, it can be expected that health indicators in suburbs will be significantly improved. Researchers should monitor the impact of HTP and examine its effects on health indicators, specifically among particularly vulnerable groups such as children, women and the elderly., (© 2020 John Wiley & Sons Ltd.)