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Farahnaz Joukar,1– 3,* Sara Yeganeh,2,* Mohammadreza Naghipour,1 Soheil Hassanipour,3 Hossein-Ali Nikbakht,4 Fariborz Mansour-Ghanaei1– 3 1Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran; 2Caspian Digestive Disease Research Center, Guilan University of Medical Sciences, Rasht, Iran; 3GI Cancer Screening and Prevention Research Center, Guilan University of Medical Sciences, Rasht, Iran; 4Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran*These authors contributed equally to this workCorrespondence: Fariborz Mansour-Ghanaei Tel +98(13)33535116Fax +98(13)33534951Email fmansourghanaei@gmail.comBackground: Blood pressure (BP) measurement accuracy is critical to the diagnosis and management of hypertension. The aim of the present study was to validate the Omron HBP-1100-E professional blood pressure measuring device in accordance with the American Association for the Advancement of Medical Instrumentation in Iranian adults.Materials and Methods: Simultaneous blood pressure auscultator measurements were obtained by two observers using mercury sphygmomanometers as a reference, sequentially with a measurement by using the Omron HBP-1100-E device. Absolute device-reference blood pressure differences were categorized into three error categories (within 5, 10, and 15 mmHg), and mean device-reference blood pressure difference (standard deviation) was calculated and evaluated using the American Association for the Advancement of Medical Instrumentation criteria.Results: A total of 85 participants (250 paired readings) were enrolled to the study. 26.8%, 55.6%, and 79.6% of the device-reference blood pressure differences agreed to within 5, 10 and 15 mmHg, respectively, for systolic blood pressure, and 39.6%, 69.2%, and 81.6% of measurements for diastolic blood pressure, respectively, and failed to pass the protocol criteria. The mean device-reference blood pressure difference was 8.0 ± 13.1 mmHg for systolic BP and 2.2 ± 11.3 mmHg for diastolic BP, and was > 5.0 ± 8.0 mmHg (required criteria).Conclusion: Omron HBP-1100-E professional blood pressure monitor is not desirable for measuring the BP for Iranian adults as it overestimates blood pressure in this population.Keywords: validation, electronics, blood pressure monitor, automated devices, American Association for the Advancement of Medical Instrumentation

Ali Eslahi,1,2 Hamidreza Farpour,2,3 Azar Hosseini,4 Faisal Ahmed,5 Umayir Chowdhury,4 Hossein-Ali Nikbakht6 1Department of Urology, Shiraz University of Medical Sciences, Shiraz, Iran; 2Shiraz Geriatric Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; 3Physical Medicine and Rehabilitation Specialist, Bone and Joint Diseases Research Center, Department of Physical Medicine and Rehabilitation, Shiraz University of Medical Sciences, Shiraz, Iran; 4Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran; 5Urology Research Center, Al-Thora General Hospital, Department of Urology, Ibb University of Medical Since, Ibb, Yemen; 6Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, IranCorrespondence: Faisal Ahmed Email fmaaa2006@yahoo.comBackground: Etiological factors involved in chronic prostatitis (CP) type IIIb and chronic pelvic pain are not sufficiently understood; however, the nervous system has a significant role in the generation and maintenance of chronic pelvic pain. This study was designed to evaluate the sympathetic skin response (SSR) in men with CP type IIIb compared to normal population.Patients and Methods: For two years, about 14 patients suffering from CP type IIIb according to NIH-CPSI and 26 healthy control men were enrolled in this study. SSR was performed in all the subjects with a standard method. Bilateral palmar and plantar latency and amplitude of SSR were recorded in response to the median and tibial nerve electrical stimulations. SSR is considered abnormal when the latency is prolonged, and the amplitude reduced.Results: SSR latency in the left and right median nerve was significantly prolonged in the patient with CP type IIIb group compared to the control group (p=0.039 and 0.006, respectively). Additionally, the amplitude was reduced in patients with CP type IIIb group compared to the control group in the right tibial nerve (p=0.017).Conclusion: Sympathetic skin response may be a helpful diagnostic test for men with chronic prostatitis type IIIb. However, this observation needs to be validated in a large sample cohort study with long-term follow-up.Keywords: chronic prostatitis, prostate, sympathetic skin response

Saleh Al-wageeh,1 Faisal Ahmed,2 Hossein-Ali Nikbakht,3 Ebrahim Al-shami,2 Mohammad Reza Askarpour,4 Umayir Chowdhury5 1Department of General Surgery, Ibb University of Medical Science, Ibb, Yemen; 2Urology Research Center, Al-Thora General Hospital, Department of Urology, Ibb University of Medical Science, Ibb, Yemen; 3Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran; 4Department of Urology, Shiraz University of Medical Sciences, Shiraz, Iran; 5School of Medicine, Shiraz University of Medical Sciences, Shiraz, IranCorrespondence: Faisal Ahmed Tel +967776089579Email fmaaa2006@yahoo.comBackground: Thyroid diseases are major health problems in our society, which are manifested by alteration in hormone secretion, enlargement of the thyroid gland, or both. This study was designed to determine thyroid histopathological patterns in patients who underwent thyroid operation.Materials and Methods: This retrospective study was carried out at Sana’a University Hospital over two years, from January 1, 2014, to December 30, 2015. All 260 patients who underwent thyroid surgery were included in this study. Factors such as age, sex, residency, fine needle aspiration biopsy (FNAB) result, and post-operative histopathological patterns were recorded. Patients who only underwent FNA were excluded.Results: The mean age of participants was 40.06± 13.18 years. Females were most commonly affected by thyroid diseases (90%) in comparison to males (10%). Histopathologic patterns were nodular colloid goiter (63.1%), adenoma (4.6%), papillary thyroid neoplasms (20.4%), follicular thyroid carcinoma (3.8%), medullary thyroid carcinoma (1.9%), thyroiditis (5.4%) and anaplastic thyroid carcinoma (0.8%). Papillary thyroid cancer was the most common thyroid cancer, with a prevalence of 53 (20.4%). The accuracy of FNAB and final histopathology in combine was 88.07%. However, FNAB was not precise enough in the pre-operative diagnosis of follicular carcinoma (40%). FNAB sensitivity ranged from 70.8% to 88.8%, while FNAB specificity ranged from 97.1% to 99.9%.Conclusion: Nodular colloid goiter is the most prevalent thyroid disease, while papillary thyroid carcinoma is the most frequent cancer seen in this study. We recommend further studies with a larger population to validate our study.Keywords: goiter, histopathology, papillary carcinoma, thyroidectomy

Fisal Ahmed,1 Mohammad-Reza Askarpour,1 Ali Eslahi,1 Hossein-Ali Nikbakht,2 Seyed-Hamed Jafari,3 Abbas Hassanpour,1 Alireza Makarem,1 Hussein Salama,2 Abbas Ayoub3 1Department of Urology, Shiraz University of Medical Sciences, Shiraz, Iran; 2Student Research Committee, Shiraz Medical University, Shiraz, Iran; 3Department of Radiology, Shiraz University of Medical Sciences, Shiraz, Iran Objective: To evaluate the accuracy of ultrasonography (US) in measuring the urinary tract stone using non-contrast computed tomography (NCCT) as the standard reference. Patients and methods: A total of 184 patients suspected with urolithiasis who had undergone NCCT and US radiologic investigation from 2015 to 2017 were enrolled in this study. The sensitivity, specificity, and stone size measured in US were validated by NCCT. Data of the stone size in US were classified into four groups (0–3.5, 3.6–5, 5.1–10, >10 mm) and then compared with NCCT data. Results: In 184 patients, NCCT detected 276 (97.2%) stones, while US could identify 213 (75.5%) stones. Overall sensitivity and specificity of US were 75.4% and 16.7%, respectively. Detection rate of mid and distal ureteral stone was lower than that at other locations. The detection rate increased with the stone size. About 73% concordance was obtained for the stone size measured by US and NCCT (Pearson’s correlation coefficient was 0.841). Factors such as the stone size, amount of hydronephrosis, and weight affected the detection rate of the urinary tract stone using US (P

Background and Objective: Colorectal cancer can significantly cause physical, psychological and social problems. This study was done to determine the prevalence of anxiety and depression in patients with colorectal cancer in Babol located in north of Iran. Methods: This cross-sectional, analytical study was done on 120 (75 males, 45 females) patients with colorectal cancer which registered in the Babol cancer registry in north of Iran during 2008-12. A questionnaire containing demographic information, aspects of the disease and HADS questionnaire was completed by interviewing to assess anxiety and depression for each patient. Results: The prevalence rate of depression and anxiety in patients was 23.4% and 30.8%, respectively. Gender, residency of rural area, and having comorbidities are related to depression among which location was identified as an independent predictor. Urban residency had 79% less risk of depression than rural residents (95% CI=0.06-0.67, OR=0.21, P

Background: Breast cancer commonly occurs in women, and male breast cancer makes up less than 1% of all cases of breast cancer. The limited prevalence of male breast cancer has led to decreased attention being paid to this condition, resulting in its diagnosis occurring at later ages and at more severe disease stages., Objectives: This study evaluates the demographic and clinicopathological characteristics of male patients diagnosed with breast cancer who visited the northern region of Iran from 1992 to 2023., Methods: This descriptive study reviewed data from 58 cases of male breast cancer between 1992 and 2023. The study aimed to examine and describe the information connected to these patients. The data were analyzed with SPSS.22 set at P value less than 0.05., Results: The mean age of the patients examined was 62.10±13.40 years, while their mean BMI was 27.08±4.95. The study found no statistically significant correlation between BMI with stage and kinds of recurrence, including metastasis and local recurrence ( P >0.05). The right and left breast involvement rates were equal (48.28%) in 28 cases, and 2 cases (3.40%) had bilateral involvement. The bone was the predominant site of metastasis, accounting for 69.23% of cases. The analysis revealed no significant correlation between stage and metastasis ( P =1.000) or local recurrence ( P =0.543). Most metastasis and all the local recurrence were observed in stages 3 and 4., Conclusion: Male breast cancer mainly occurs in older age and is diagnosed in the advanced stages of the disease. Therefore, it is recommended to inform men and develop suitable screening programs, especially in high-risk families., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Improper use of social media during the COVID-19 outbreak, leading to fear and misunderstanding, can contribute to psychological disorders in vulnerable populations. This descriptive and analytical cross-sectional study was conducted in 2023 on 511 medical students of Babol University of Medical Sciences. Data were collected using demographic, psychological distress, fear and misunderstanding questionnaires related to COVID-19 and social media dependency. A total of 511 medical students, with an average age of Mean and S.D; 23.57 ± 3.03 participated in the study. The average psychological distress score was 23.82 ± 7.73 (out of 54), the average score of social media dependency was 17.53 ± 3.09 (out of 30), for the fear of COVID-19 was12.63 ± 2.56 (out of 35), and for the misperception of COVID-19 was 0.53 ± 0.09 (out of 18). Path analysis results) showed that direct path from improper use of social media to psychological distress is significant (P < 0.001, B = 0.19) but this relationship is not significant through fear and misperception related to COVID-19. Improper use of social media, identified as the strongest predictor, can directly increase psychological distress in medical students, without mediation through fear and misperception related to COVID-19. These findings should be taken into consideration when designing and evaluating interventions aimed at promoting mental health and fostering appropriate use of social media among students during disease outbreaks., (© 2024. The Author(s).)

Background: Cancers of the genitourinary system, particularly prostate, bladder, and kidney cancer, exhibit a high prevalence. Consequently, predicting the morbidity and mortality of genitourinary cancers holds great significance for future planning and implementation. This study aimed to examine the crude and age-standardized rates of mortality and the trend of genitourinary cancers over nine years in northern Iran., Methods: This cross-sectional study used data on the number of deaths attributed to genitourinary cancers recorded in Babol City between 2013 and 2021 through the cause of death registration and classification system. Population estimates were derived from the latest census reports. Subsequently, crude and age-standardized rates, as well as trends for genitourinary cancers, were calculated., Results: A total of 307 deaths occurred, with an average age of 75.6 ± 14.3 years due to genitourinary cancers. The crude and age-standardized rates of genitourinary cancers increased from 2.7 and 1.9 per hundred thousand people in 2013 to 7.7 and 5.9 per hundred thousand people in 2021, respectively. Over the study period, death rates significantly rose for men (P < 0.001) and remained constant for women (P = 0.444). Examination of genitourinary cancers revealed an upward trend for bladder (P = 0.012) and prostate (P = 0.012) cancers, while a stable trend was observed for kidney (P = 0.070) and testicular (P = 0.139) cancers., Conclusions: The age-standardized rate and trend of genitourinary cancers are rising. Consequently, this study emphasizes the importance of prevention through screening programs, raising awareness, and utilizing appropriate diagnostic methods., (© 2024. The Author(s).)

Background: Body image concerns are accepted as a pervasive problem by a large segment of society. Problem-solving counseling is one of the practical counseling techniques that mainly focuses on improving people's adaptability in stressful situations. We intend to determine the effectiveness of pubertal health group counseling based on problem-solving on body image concerns and anxiety in adolescent girls., Materials and Methods: A semi-experimental study will be conducted on 12-13 years old students in Babol (Mazandaran, Iran). One hundred people were determined as the final Sample size (50 people in each group) and will be selected to enter the study. A multistage sampling method will be used. The students of the intervention group will receive the necessary training in the problem-solving method regarding pubertal health, once a week for six weeks. Students in the control group will not receive education during the intervention period. Sociodemographic questionnaire, Littleton's body image concern, and Zong's anxiety will be used to evaluate students' body image concerns and anxiety. Analyzes will be done by statistical package for the social sciences (SPSS) version 25 software and a significance level of 5% will be considered . Descriptive statistics and frequency percentage will be determined for classification variables. Median, range, and mean along with standard deviations (SD) will be calculated. The Chi-square test, Repeated Measures ANOVA and ANCOVA test will be used in this study. Percentage prevalence for each categorical variable is calculated with 95% confidence interval (CI)., Discussion: The effectiveness of counseling based on problem-solving has been reported in various studies on adolescent puberty health concerns and common adolescent mental health problems, hence its application on girls' body image can be effective., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Education and Health Promotion.)

Objective: Peyronie's disease (PD) is an abnormal wound healing in the penile tunica albuginea. After fibrotic plaque excision, different graft materials have been used to repair the defects, but the optimal graft remains unknown. This study aimed to compare the functional outcomes of testicular tunica vaginalis grafts and bovine pericardium grafts in patients with severe PD., Methods: A retrospective comparative study was conducted on 33 PD patients undergoing partial plaque excision and grafting from September 2015 to May 2021. The patients were divided into two groups depending on the type of graft used. For 15 patients in Group B, testicular tunica vaginalis grafts were used to repair the defect, while for 18 patients in Group A, bovine pericardium grafts were used. Data of the patient's age, comorbidities, sexual function, penile curvature, postoperative complications, need for further treatment, change in penile length, and satisfaction were gathered and compared between the groups. Sexual function was evaluated using the 5-item version of the International Index of Erectile Function (IIEF-5), and a functional less than 20-degree penile curvature after surgery was considered a successful intervention., Results: There was no difference in age, comorbidities, degree of curvature, perioperative IIEF-5, operative time, plaque size, or complication rates. After surgery, a statistically significant improvement in curvature degree ( p <0.05) and satisfactory penile appearance ( p <0.05) were seen in both groups without any superiority between the two groups ( p =0.423 and p =0.840, respectively). With a 30-month follow-up, the IIEF-5 was consistent in both groups, with no statistical significance between the groups ( p =0.492). The main change in penile length during the operation was increased and still positive in the last follow-up in both groups without statistical significance ( p =0.255 and p =0.101, respectively)., Conclusion: Partial plaque excision and corporoplasty with both testicular tunica vaginalis or bovine pericardium grafts are equally effective in treating males with clinically significant PD., Competing Interests: The authors declare no conflict of interest., (© 2024 Editorial Office of Asian Journal of Urology. Production and hosting by Elsevier B.V.)

Objectives: Adolescence is a critical and sensitive period of growth, marked by significant physical and psychological changes. During this time, adolescents often experience increased anxiety and concerns about their body image. This study aims to examine body image concern and demographic characteristics as predictors of anxiety in adolescent girls., Methods: This cross-sectional study included 381 female students aged 12-13 from Babol city. The participants were selected based on predefined inclusion criteria. Multi-stage sampling method was employed, and the samples were selected from six middle schools. The data collection tools consisted of a demographic information questionnaire, Littleton's body image concern scale, and Zung's anxiety scale., Results: The mean score for body image concern was 16.59±44.82, while the mean score for anxiety was 10.53±37.31. When investigating the relationship between body image concern and anxiety, a significant and positive correlation between these two variables was observed during regression analysis (p<0.001). Both univariate and multivariate regression analyses indicated that for every one-unit increase in students' body image concern score, their overall anxiety score increased by an average of 0.34 units in both models ( B : 0.34, 95 % CI: 0.29-0.39) (p<0.001). Additionally, in univariate regression analyses students who received puberty information from sources other than their mother exhibited 2.68 units higher anxiety levels, which was statistically significant ( B : 2.68, 95 % CI: 0.38-4.98) (p<0.001) and, concerning the preferred source of information, students who favored a non-mother source experienced 3.91 units increase in their anxiety score ( B : 3.91, 95 % CI: 1.74-6.08) (p<0.001). The results of multivariate regression analysis showed that with the presence of all independent variables in the model, 30 % of the dependent variable changes can be predicted (explained) ( R 2 =0.302)., Conclusions: The findings indicated a positive association between body image concerns and anxiety among students. Moreover, students who relied on sources other than their mother for obtaining information about puberty displayed higher levels of anxiety. Consequently, it is imperative to implement preventive and supportive programs targeting adolescents as well as empowering mothers to effectively deal with these issues., (© 2024 Walter de Gruyter GmbH, Berlin/Boston.)

Studies have shown that fasting during Ramadan has different effects on circulating levels of several biochemical markers. This study aims to conduct a comprehensive evaluation of studies related to the effect of fasting in the holy month of Ramadan on lipid profile, uric acid, and HbA1c in CKD patients. Studies were systematically searched and collected from three databases (PubMed, Scopus, and Web of Science). After screening, the quality and risk of bias assessment of the selected articles were evaluated. Study heterogeneity was assessed using the Cochrane test and I² statistic. In case of any heterogeneity random effects model with the inverse-variance method was applied. All analyses were performed using STATA software version 16. Four observational studies were included in this study. The results of this meta-analysis were that cholesterol (Weighted mean differences (WMD):0.21 with 95% CI:-0.09-0.51 (P-value=:0.18)), LDL (WMD:0.06 with 95% CI -0.24-0.36 (P-value:0.69)), triglyceride (WMD:0.05 with 95% CI:-0.25-0.35 (P-value:0.73)) had not-significant increase. Uric acid (WMD: -0.11 with 95% CI: -0.42-0.21 (P-value:0.51)) and HbA1c (WMD: -0.22 with 95% CI: -0.79-0.36 (P-value: 0.46)) show a non-significant decrease. The results of the analyses did not report significant changes in the lipid profile, uric acid, and HbA1c in CKD patients after Ramadan fasting., Competing Interests: Declaration of Competing Interest The authors have not disclosed any competing interests., (Copyright © 2024 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.)

The aim of this study was to determine the challenges and opportunities of virtual education during the COVID-19 pandemic. This study was conducted in 2022-2023 with a mixed method. During the quantitative phase, we chose 507 students from Mazandaran Province medical universities (both governmental and non-governmental) by stratified random sampling and during the qualitative phase 16 experts were collected by purposive sampling until we reached data saturation. Data collecting tools consisted of questionnaires during the quantitative phase and semi-structured interview during the qualitative phase. Data was analyzed using SPSS21 and MAXQDA10. Mean scores of the total score was 122.28±23.96. We found a significant association between interaction dimension and background variables (P < 0.001). The most important privilege of virtual education is uploading the teaching material in the system so that students can access the material constantly and the most important challenge regarding virtual education is lack of proper network connection and limited bandwidth. Virtual education proved to be a suitable alternate to traditional methods of medical education during the COVID-19 pandemic in theoretical topics, we recommend that educational policymakers would take the necessary actions to provide the requirements and facilities needed to improve the quality of virtual education., (© 2024. The Author(s).)

Background: Breast cancer is one of the most important causes of cancer deaths in women. The present study was conducted to determine the relationship between demographic factors and known risk factors with breast cancer in women aged 30-69., Method: This case-control study was conducted with two matched and unmatched control groups. Three hundred fifty women aged 30-69 with breast cancer, 350 age-matched women without cancer, and 350 not age-matched women were included in the study. Controls were selected from the records of women whose breast cancer screening results were normal. Study subjects were evaluated regarding the risk factors for breast cancer. The data collection tool was a checklist including the risk factors investigated in the integrated health system. The collected data were analyzed utilizing SPSS22 software at a significance level of less than 0.05., Results: The average age in the case group was 46.63±11.77 years and 49.61±8.39 in the unmatched control group. The average age of marriage in the case group was 21.54±4.31, and the average age of women at first pregnancy in the case group was 24.06±3.39 years. In the case group, 163 people (46.57%) lived in the city, 221 people (63.14%) were over 40 years old, and 337 people (96.28%) were married. In multivariate analysis, the variable 'age of marriage' 0.821 (0.691-0.976) and 'age of first pregnancy' 1.213 (1.020-1.443) showed a significant relationship with breast cancer which were observed as predictors of breast cancer in comparison to the unmatched control group ( P -value <0.05)., Conclusion: The age of the first pregnancy and the type of delivery were observed as predictors of breast cancer. Therefore, by performing breast cancer screening in women who are exposed to these risk factors, early diagnosis of the disease and increasing the speed of their treatment can be significantly helped., Competing Interests: The authors have declared no conflicts of interest.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Examining the raw and standardized mortality rates is the primary strategy for improving life expectancy and human health in society through identifying risk factors and dealing with the factors that cause them., Objectives: This study examined the trend of mortalities due to traffic and nontraffic accidents., Methods: This cross-sectional study examines the registered mortalities during the years 2016-2022 in the form of a census in the health department's death registration and classification system. Mortality was analyzed as raw and standardized mortality in each 100 000 population., Results: Out of 18 265 deaths during 2016-2022, 1305 (7.15%) were related to accidents and incidents. The age-standardized total mortality rate in the first year was 32.9, and in the final year of the study, it was 33.3 per 100 000 people; although there are fluctuations, this trend is upward (P.trend=0.021). Also, the age-standardized traffic death rate in the first year is 19, and in the final year is 12 per 100 000 people; this decreasing trend was not statistically significant (P.trend=0.061). The incidence of age-standardized intentional nontraffic deaths was 1.7 in the first year of the study interval and 9.8 in the last year in 100 000 people, which showed an upward trend (P.trend<0.001)., Conclusion: In light of the generally increasing trend of accidents, especially nontraffic accidents, universal and well-rounded measures are necessary for safety matters and reducing mortality., Competing Interests: The authors declare that they have no conflicts of interest.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Background and Objective: The need for long-term treatment and frequent visits to treatment centers for hemodialysis can lead to psychological problems such as Uncertainty about Disease and Treatment (UC about D&T) in patients with chronic kidney failure. In order to understand uncertainty about disease and treatment and to plan for preventive measures and care interventions in various dimensions, there is a need for reliable and valid tools. The present study was conducted to design and psychometrically evaluate the Uncertainty about Disease and Treatment Scale (UC about D&TS) in patients undergoing hemodialysis., Methods: This study is of a methodological type and conducted in two stages. The first stage included a deductive (literature review) and an inductive approach (face-to-face interviews). In the second stage, psychometric indices of the UC about D&TS, including face validity (qualitative-quantitative), content validity (qualitative-quantitative), construct validity (exploratory factor analysis), and reliability (using Cronbach's alpha and McDonald's omega) were examined., Results: In the literature review stage, 66 items were extracted, and in the qualitative stage, 48 items were extracted. After merging similar items, 29 items were entered into the psychometric process. No items were removed in the face and content validity stages. In the construct validity stage, five factors were extracted, including self-uncertainty, uncertain situation, uncertain future, uncertainty of treatment outcomes, and information uncertainty, which constituted a total of 82.16% of the total variance. In this stage, five items were removed from the study due to a corrected item-total correlation below 0.32, and four items were removed due to cross-loading. The α and Ω were calculated as 0.828 and 0.818, respectively. The measurement stability and standard error of measurement were estimated at 0.977 and 2.019, respectively., Conclusion: The results showed that the UC about D&TS is a valid and reliable measure for patients undergoing hemodialysis. This scale is specifically designed to measure UC about D&T in hemodialysis patients, and it is recommended that healthcare providers (Hcps) use this scale in follow-up visits., (© 2024. The Author(s).)

Background and Aim: This study aims to examine the mortality rate and trend of gastrointestinal cancers, particularly gastric cancer, as the leading cause of death among cancers in northern Iran over a 9-year period. In light of the changing incidence and mortality rates of cancer in Iran and around the world, the importance of these diseases in people's lives, and the necessity of updating and monitoring the trend of cancer mortality, we have decided to report on the mortality trend of gastrointestinal cancers, based on crude and age-standardized rates., Method: This study is a cross-sectional examination of deaths caused by gastrointestinal cancers in Babol city, Iran, between 2013 and 2021. Data was collected from the cause of death registration and classification system of Babol University of Medical Sciences. Population estimation was obtained from the latest census reports. The crude and age-standardized mortality rates and trends of the cancers were calculated., Results: Overall, there were 1345 deaths from gastrointestinal cancers with an average age of 69.11 ± 14.25 years. The crude and age-standardized rates of these cancers rose from 24.1 to 20.1 per hundred thousand people in 2012 to 29.5 and 25.5 per hundred thousand people, respectively. This trend became more prevalent significantly with the increase of each decade of age for both men (P-value Trend = 0.002) and women (P-value Trend = 0.012). An analysis of gastrointestinal cancers revealed a decreasing trend for cancers of the small intestine, an increasing trend for cancers of the colon, pancreas, and gallbladder, and a stable trend for the remaining cancers over the study period., Conclusion: The age-standardized rate and the number of gastrointestinal cancers is rising, highlighting the importance of preventative measures such as screening, increasing public awareness, and appropriate diagnostic methods., (© 2024. The Author(s).)

Background: Cancers, especially Upper Gastrointestinal Cancers (UGCs), pose a substantial burden on society, particularly in developing nations. Golestan province, Iran, is known for its high UGC rates globally., Aims: This study delves into the disease burden of UGCs in the eastern part of Golestan province., Methods and Results: This study was conducted using the results of the Golestan cohort study. 2711 patients participating in this cohort, who visited Atrak Clinic during 2001-2020, participated in this study. After excluding patients with incomplete records, 2481 patients were included in the study. To compute the metrics of years of life lost (YLL), years of life lived with disability (YLD), and disability-adjusted life years (DALY), we utilized the World Health Organization's standard life table, stratified by age and gender. The majority of UGC patients in our study were married (81.8%), had limited formal education (82.6%), and were predominantly male (61.1%). A substantial proportion resided in suburban areas (85.8%), and over half of the patients (52%) reported a history of drug addiction. The mean age at diagnosis for men was 65.76 years with a standard deviation of 11.34, while for women, it was 64.38 years with a standard deviation of 11.66. Regarding disease impact, YLL, YLD, and DALY for men were 21 240, 1956, and 23 196 (307.8 per 100 000), respectively. For women, these figures were 15 609 for YLL, 1367 for YLD, and 16 976 (223.1 per 100 000) for DALY., Conclusion: After the increasing trend of the burden of UGCs in Golestan province in the early years of the study, this rate has been decreasing in recent years. Effective strategies necessitate collaborative efforts across various sectors to alleviate this burden, focusing on preventive measures, timely diagnosis, and well-coordinated therapeutic interventions., (© 2024 The Authors. Cancer Reports published by Wiley Periodicals LLC.)

Objective: This study aims to investigate the factors affecting the severity of trauma caused by traffic accidents based on martrix Haddon; a systematic review and meta-analysis., Methods: In this study searched five international databases in this study, including Medline/PubMed, ProQuest, Scopus, Web of Knowledge, and Google Scholar, for published articles by the end of 2022. Data were entered into the statistical program and analyses were performed using STATA 17.0 software. Odds ratio (OR) values were computed for severity accidents., Results: Results of study showed that among the risk factors related to the host, not using helmet increased the risk of injury severity by 3.44 times compared to people who have used helmets (OR Not using helmet/Using helmet = 3.44, 95% CI: 2.27-5.00, P =0.001, I 2 =0.00%). Also, crossing over a centre divider has a protective role for the risk of injury severity compared to undertaking (OR crossing over a centre divider/undertaking =0.39, 95% CI: 0.20-0.75, P =0.01, I 2 =25.79%). in terms of the type of accident, accident of car-car reduces the risk of injury severity by 23% compared to accident of car-pedestrian (OR accident of car-car/accident of car-pedestrian =0.77, 95% CI: 0.61-0.96, P =0.02, I 2 =0.00%)., Conclusions: It is necessary to pay attention to the intersection of human, vehicle and environmental risks and their contribution and how they interact. Based on the Haddon matrix approach, special strategies can be designed to prevent road damage. Safety standards for vehicles should also be addressed through stricter legal requirements and inspections., Competing Interests: The authors declare that they have no conflicts of interests.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

The aim of this study was to analyze the differences in morphological and histological features of the cervical multifidus (CM) and longus colli (LC) muscles among patients with cervical disc bulging, protrusion, or extrusion. Fifteen patients with cervical disc bulging (20% male, mean age: 48.5, standard deviation (SD) 7.5 years), fifteen with cervical disc protrusion (6% male, mean age: 43, SD 7.8 years), and fifteen with cervical disc extrusion (40% male, mean age: 44, SD 8 years) diagnosed via clinical and imaging findings participated in this study. Additionally, fifteen asymptomatic controls (40% male, mean age: 40.4, SD 9.7 years) were also included. The following ultrasound measurements, cross-sectional area (CSA), anterior-posterior distance (APD), lateral dimension (LD), and mean echo-intensity (EI) of the CM and LC at C5-C6 level were examined by an assessor blinded to the subject's condition. The results revealed no group ×side significant differences among the groups ( p > 0. 00625). However, group effects were found for APD and MEI of the CM ( p = 0.006 and p < 0.001, respectively) and CSA, APD and MEI of the LC (all, p < 0.001). The LD of the LC muscle and the APD and LD of the CM were negatively associated with related disability ( p < 0.01; p < 0.05 and p < 0.01, respectively), and pain intensity was negatively associated with LC APD and LD (both p < 0.05). These results suggest that US can be used to detect bilateral morphological changes in deep cervical flexors and extensors to discriminate patients with cervical disc alterations.

Background: This study aimed to assess the construct validity and reliability of the Iranian version of the COVID-19 Yorkshire Rehabilitation Scale (C19-YRS) among the elderly population., Method: A cohort of 230 elderly individuals who tested positive for Covid-19 via PCR were administered a health and demographic information questionnaire along with the C19-YRS. Both exploratory and confirmatory factor analyses were conducted, and Cronbach's alpha was calculated., Results: Findings from the exploratory and confirmatory factor analyses of the C19-YRS revealed alterations compared to the original version, resulting in an adapted version with three factors achieved by redistributing the questions. These factors accounted for 57.46% of the total variance. Despite a relatively lower factor loading in the 6th question, it was retained due to its significance among the elderly. The Cronbach's alpha for the C19-YRS subscales ranged from 0.730 to 0.890, indicating acceptable reliability., Conclusion: The validation results indicated a well-adjusted factor structure and internal consistency, affirming the utility of this tool among the elderly population. Consequently, the C19-YRS in Iran can serve as a valuable resource in healthcare settings, aiding in the assessment of chronic complications arising from Covid-19 in the elderly. It can be utilized as an initial screening or triage test and to evaluate the effectiveness of interventions., (© 2024. The Author(s).)

Backgrounds: The abnormal umbilical cord coiling index (UCI) may be one of the ways to predict adverse pregnancy outcomes. This study attempted to determine the association between abnormal UCI and maternal, fetal, and neonatal outcomes., Methods: This longitudinal study was conducted on 400 women referred for delivery from April to August 2021. UCI was calculated by dividing the total number of coils by the total length of the umbilical cord in centimeters. In eligible cases, the length of the umbilical cord and the number of vascular coils along the total umbilical cord were measured after birth. UCI less than the 10th percentile and more than the 90th percentile was considered abnormal, and between the 10th and 90th percentiles was considered normal. Data were analyzed using SPSS version 20. P < 0.05 were considered statistically significant., Results: The mean length of the umbilical cord was 56.12±8.38 cm, the number of umbilical cord rings was 13.70±3.51, and the UCI was 0.24±0.07. In the regression analysis, women with gestational diabetes had a significant association with abnormal UCI (P = 0.044). Thus, the probability of abnormal UCI was about 3.5 times higher in women with gestational diabetes than in normal pregnancies. Also, the history of stillbirth had a significant association with abnormal UCI (P < 0.05)., Conclusion: It is recommended to perform a UCI examination after delivery as part of a neonatal examination to find an explanation for maternal, fetal, and neonatal outcomes.

Background: In Iran, cancers are known as the second leading cause of death, among which respiratory system cancers are particularly important because lung cancer is the second most common cause of death in this country. This study aimed to estimate the crude and age-standardized mortality and its trends during 9 years in the Northern city of Iran, Babol., Methods: In this cross-sectional study, all the recorded deaths due to respiratory system cancers in Babol during the years 2013-2021 on the Classification of Causes of Deaths and Death Registration System of Babol University of Medical Sciences were taken into consideration, and the population estimate was based on the latest census. Finally, the crude and age-standardized rates of mortality and trends of cancer incidents were calculated., Results: In general, 393 deaths with an overall mean age of 67.8±3.9 years have happened due to respiratory system cancers. The crude and standardized rates of respiratory system cancers increased from 6.5 and 5.5 per hundred thousand people in 2013 to 9.1 and 7.8 per hundred thousand people in 2021, respectively. With each decade in age, their trends increased significantly in men (p=0.024) and remained constant in women (p=0.262). In examining the trend of respiratory system cancers, we found an increasing trend for lung cancer and a constant trend for larynx and oropharynx cancers. There was also a decreasing trend for hypopharyngeal cancer., Conclusions: The age-standardized rate and trend of respiratory system cancers are increasing. Therefore, it is important to prevent their prevalence by reducing the risk factors and increasing the general awareness of risks and timely diagnosis., (Copyright © 2023, the Author(s).)

Objective: Cancer is one of the main causes of death, and cervical cancer is the fourth most common cancer and the fourth leading cause of death from malignancy among women. Knowing the survival rate is used to evaluate the success of current treatments and care. This study was conducted to assess the survival rate of cervical cancer in Asia., Methods: This systematic survey was conducted on four international databases, including Medline/PubMed, ProQuest, Scopus, and Web of Knowledge, and includes manuscripts that were published until the end of August 2021. Selected keywords were searched for international databases including cervical neoplasms [mesh], survival analysis or survival or survival rate, Asian countries (name of countries). The Newcastle-Ottawa Qualitative Evaluation Form was used for cohort studies to evaluate the quality of the articles. The analysis process was performed to evaluate the heterogeneity of the studies using the Cochran test and I 2 statistics. Additionally, a meta-regression analysis was performed based on the year of the study., Results: A total of 1956 articles were selected and reviewed based on their title. The results showed that 110 articles met the inclusion criteria. According to the randomized model, the 1, 3, 5, and 10-year survival rates of cervical cancer were 76.62% (95% Confidence Interval (CI), 72.91&#95;80.34), 68.77% (95% CI, 64.32&#95;73.21), 62.34% (95% CI, 58.10&#95;66.59), and 61.60% (95% CI, 52.31&#95;70.89), respectively. Additionally, based on the results of meta-regression analysis, there was an association between the year of the study and the survival rate, elucidating that the survival rate of cervical cancer has increased over the years., Conclusions: Results can provide the basic information needed for effective policy making, and development of public health programs for prevention, diagnosis, and treatment of cervical cancer., (© 2023. The Author(s).)

Background: Medical universities are responsible for educating and training healthcare workers. One of the fields significantly impacted by the pandemic is medical education. The aim of this study is to identify strategies for enhancing e-learning for active learning and finding solutions for improving its quality., Methods: This mixed-method (quantitative-qualitative) research was conducted in 2023 at three selected universities in Mazandaran Province. In the quantitative phase, 507 students participated via stratified random sampling using a standard questionnaire. In the qualitative phase, data were collected through semi-structured interviews with 16 experts until data saturation was achieved. SPSS 21 and MAXQDA 10 software were used for data analysis., Results: In the multivariate regression analysis, an increase of one point in the dimensions of student-teacher interaction, active time, immediate feedback, and active learning corresponded to an average increase in learning scores of 0.11, 0.17, 0.16, and 1.42 respectively (p≤0.001). After the final analysis in the qualitative phase, four main domains (infrastructure, resources, quantity of education, and quality of education) and 16 sub-domains with 84 items were identified., Conclusions: The greatest challenge in e-learning is the interaction and cooperation between students and teachers. The implementation of the identified strategies in this research could provide useful evidence for policymakers and educational administrators to implement interventions aimed at addressing deficiencies and enhancing e-learning., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Purpose: This study aims to build a 3D reconstruction computed simulation model and to establish a regression equation for detecting the testis's temperature by its location after first staged open orchidopexy in children with abdominal undescended testis (UDT) and short spermatic cords., Methods: In this cross-sectional study, we enrolled 31 children with abdominal UDT and short spermatic cords who underwent first staged orchiopexy between 2017 and 2020. Using ultrasonography to obtain the testis's location distance from the skin surface (X1), external iliac vessel (X2), and internal inguinal ring (X3), we input the data into a 3D reconstruction computed simulation along with COMSOL to calculate the testicular temperature. We also used multivariate regression to establish the testicular temperature regression equation from the gathered data., Result: The mean age of the participants was 4.47 ± 1.21 years. The mean size of the operated testis was 0.39 ± 0.13 cc. The mean distance of the testis from X1, X2, and X3 was 3.27 ± 1.25 mm, 21.06 ± 6.42 mm, and 27.19 ± 10.09 mm, respectively. The testicular temperature regression equation derived from testis location was calculated by the formula: 34.57 + 0.0236 X12 - 0.0105 X2 - 0.0018 X3. The concordance for testis temperature calculated via the computational method and regression equation was 83%., Conclusions: The current study provided a reference value for the testicular temperature of children with abdominal UDT and short spermatic cords after the first stage of orchiopexy. A testicular temperature regression equation can be established based on the testis location, which will provide relevant information for the testicular development assessment, disease diagnosis, and follow-up, and possibly determination of the time of the second stage of orchiopexy.

Introduction: Vaginal cancer is one of the major causes of mortality in women, which mostly takes place in low- and middle-income countries. Assessing the survival rate of vaginal cancer is essential to investigate the success rate of current treatments and screening tools. This study aims to determine the survival rate of vaginal cancer in Asia., Methods: This systematic review was carried out using four international databases, including Medline/Pubmed, ProQuest, Scopus, Web of Knowledge, and also Google Scholar. Articles were investigated up to the end of August 2021. The authors utilized the Newcastle-Ottawa Scale to evaluate the quality of the articles. Evaluating the papers for heterogeneity was performed using the Cochrane test and I ² statistic. Meta-regression analysis was also applied based on the year of the study., Results: Three articles (13 records) fulfilled the inclusion criteria. Based on the random model, the overall 5-year survival rate was 74.63%. Also, the rates of survival in relation to the type of treatment including chemotherapy, radiotherapy, or other modalities, were 78.53, 78.44, and 68.54%, respectively. According to meta-regression analysis, no correlation was found between the survival rate and the year of the study., Conclusion: The vaginal cancer survival rate is lower in Asian countries compared to that of developed countries. Increasing patient survival rates in such countries is crucial by implementing newer diagnostic tools, advanced surgical techniques, and goal-oriented treatments. Early diagnosis in lower stages and educating the populations about risk factors and preventative measures are also necessary for raising the rate of survival., Competing Interests: The authors declare that they have no conflicts of interests., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

Background: The cancer registry system is an important part of the cancer control program. Improper coding of cancers leads to misclassification and incorrect statistical information about cancer. Therefore, in this study, the main objective of the qualitative analysis was the accuracy in assigning the codes to the pathological reports in the centers responsible for cancer registry., Methods: This study was descriptive, retrospective and applied. The data source in this study included 15,659 pathology reports received during the years 2017-2019 in the population-based cancer registry centers of Mazandaran province. Out of 1800 reports, 1765 samples of reports were selected and analysis was done on them by stratified random sampling method. A researcher-made checklist was used to collect data, and the Kappa agreement coefficient and Cohen's agreement percentage were presented to check the accuracy of the reports. STATA13 was used for data analysis., Results: 1150 of 1765 pathology reports (65.0%), did not have a topographic, morphological and behavioral codes and 410 (23.2%) had grade codes. The Kappa coefficient in reports with a topography code was 0.916 and with a morphology code it was 0.929, respectively. In behavior coding, the highest agreement is in the category of benign cancers at 65.2% and in grade coding in the category without grade is 100%., Conclusion: The most reports were on carcinoma morphology, and the Kappa coefficient in morphology codes has almost complete reliability. In terms of behavior coding, there was the most agreement in the category of benign cancers. The Kappa coefficient in given behavior codes has low reliability., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Jahani 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: Hypertension (HTN) is one of the primary risk factors for heart disease and stroke worldwide. The present meta-analysis was aimed to systematically review and statistically estimate the prevalence rate of pre-hypertension (PHTN) and HTN in the Iranian child/adolescent and adult age groups., Methods: In this study, four International databases, including PubMed, Scopus, Web of Science, and Cochrane, as well as three Iranian databases, including SID, Magiran, and IranMedex, were separately investigated for articles published before January 2021. Also, we estimated the pooled effect size for the prevalence of PHTN and HTN in children/adolescent and adult age groups. Stata software (version 14.0) was used for all statistical analyses., Results: From a total of 1185 articles found in database searches, fifty-one were included in the meta-analysis. The prevalence of HTN in the Iranian adult population was 26.26% (25.11 % and 26.22 % for women and men, respectively). Meanwhile, the prevalence of PHTN and HTN in the child/adolescent age group was 8.97% (95% CI 7.33 - 10.61) and 8.98% (95% CI 7.59 - 10.36), respectively., Conclusions: This study provides information which can be used for various purposes, including study designing. Further nationwide surveys should be carried out to obtain accurate information on the HTN prevalence rate, particularly based on the American College of Cardiology /American Heart Association guidelines in the Iranian population., Competing Interests: The authors declare that they have no conflict of interest.

Background: Rapid economic progress and cultural-social changes have led to lifestyle changes and increased risk of breast cancer all around the world, including Iran. This study aims to investigate the 30-year incremental pattern of breast cancer in patients of Shahid Rajaei Radiation Therapy Center in Babolsar, North of Iran.‌‌., Methods: In this cross-sectional study, the data were retrospectively extracted from the physical and electronic files of patients diagnosed with breast cancer from 1992 to 2021 every 5 year by census method, during the study, overall, 1326 patients' information out of 6199 patients was analyzed using SPSSV.22 software at the level of p-value ≤ 0.05., Results: The average age of patients was 49.84 ± 11.26 years, which has been increasing over the years of study. 6143(99.13%) patients were women, the mean and standard deviation of their BMI was 29.63 ± 6.00, the number of patients with stage 1 is increasing, and patients with stage 3 is decreasing. 871(65.70%) people went through Radical Mastectomy (MRM), 261(19.68%) people experienced metastasis. There was a statistically significant relation between the type of surgery, stage of cancer, metastasis, and local recurrence within the years of study (p<0.001)., Conclusion: Breast cancer and the age of getting it have increased in recent years. However, advanced stages as well as metastasis and local recurrence have decreased during the investigated years. Therefore, it is recommended to continuously warn women about the risk factors and develop suitable disease screening programs and implement them effectively., Competing Interests: The authors declare that they have no competing interests.

Background & Aim: Lifestyle changes, prominently low mobility in recent years, have increased the prevalence of metabolic syndrome (MetS), and cardiovascular disease risk. This study aimed to determine the relationship between physical activity and MetS using modern statistical methods in a population-based study., Methods: The target population included 10,663 people aged 40-70 years in phase 1 of the Persian Kharameh cohort study conducted in 2017. The data used in this study had questions about physical activity, demographic, anthropometrics, blood pressure, and biochemical data., Results: Participants who their activity was within the fourth quarter were 36% less likely to develop MetS than the participants in the first quarter. In the decision-Tree algorithm with all variables, physical activity was significant after gender and comorbidity. With a lack of comorbidities and physical activity less than 2338 Metabolic Equivalent of Task (MET) and age greater than 53 years, the probability was 26.7% for the male population. For the female population, if associated with comorbidities, a history of diabetes in first-degree relatives, or both, the chance of developing MetS was estimated to be 70.4%. In the decision-tree algorithm, 56.0% of the predictions for MetS were due to gender. After gender, the presence of comorbidities, age, occupation, family history of diabetes, place of residence, and physical activity was discovered as the essential variables in predicting and identifying factors associated with MetS, respectively., Conclusion: Modern statistical methods can be used in similar research due to better presentation of results in applied clinical laws. An essential approach for treating the syndrome and preventing its complications is a lifestyle change, including educating about physical activity and promoting it., Competing Interests: Conflicts of interest None., (Copyright © 2023 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.)

Background: There is very little epidemiological evidence on the effects of ambient air pollution on brain tumor risk. The purpose of this study was to determine the relationship between exposure to air pollution and the incidence of brain tumors., Methods: A comprehensive literature search in five international databases, including PubMed/Medline, ProQuest, Scopus, Embase, and ISI/WOS on April 15, 2019, was conducted. The methodology of the present study was based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) statement. The Newcastle-Ottawa Quality Assessment Form was used to evaluate the quality of the selected papers., Results: Five studies that measured adult brain tumors as well as their long-term exposure to at least one of the pollutants criteria for air pollution, PM 2.5 absorbance, and proximity to traffic (Trafnear) were reviewed. The results showed that the pooled relative risk (RR) for incidence of brain tumor and long term exposure to Trafnear, PM 2.5 , PM 2.5 absorbance, O 3 and NOx were RR = 1.07, (95% CI 0.99-1.16), P = 0.079, for Trafnear; RR = 0.90, (95% CI 0.80-1.00), P = 0.064 for PM 2.5 ; RR = 1.63, (95% CI 1.04-2.55), P = 0.031 for PM 2.5 absorbance; RR = 1.3, (95% CI 1.03-1.6), P = 0.023 for O 3 ; and RR = 1.16, (95% CI 0.93-1.45), P = 0.173 for NOx. Exposure to other air pollutants had no statistically significant association with brain tumor incidence., Conclusion: The results showed that exposure to air pollutants, such as O 3 and PM 2.5 absorbance, had the highest correlation with brain tumor incidence. They also showed an absence of correlation between exposure to certain pollutants (SO 2 , CO, NO 2 , PM 10 , PM 2.5 ) and brain tumor incidence., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2023 The Author(s).)

Background: Ovarian cancer is amongst one of the most commonly occurring cancers affecting women, and the leading cause of gynecologic related cancer death. Its poor prognosis and high mortality rates can be attributed to the absence of specific signs and symptoms until advance stages, which frequently leads to late diagnosis. Survival rate of patients diagnosed with ovarian cancer can be used in order to better assess current standard of care; the aim of this study is to evaluate the survival rate of ovarian cancer patients in Asia., Methods: Systematic review was performed on articles that were published by the end of August 2021 in five international databases, including Medline / PubMed, ProQuest, Scopus, Web of Knowledge, and Google Scholar. The Newcastle-Ottawa quality evaluation form was used for cohort studies to evaluate the quality of the articles. The Cochran-Q and I 2 tests were used to calculate the heterogeneity of the studies. The Meta-regression analysis was also done according to when the study was published., Results: A total of 667 articles were reviewed, from which 108 were included in this study because they passed the criteria. Based on a randomized model, the survival rates of ovarian cancer after 1, 3 and 5 years were respectively 73.65% (95% CI, 68.66-78.64), 61.31% (95% CI, 55.39-67.23) and 59.60% (95% CI, 56.06-63.13). Additionally, based on meta-regression analysis, there was no relationship between the year of study and survival rate., Conclusions: The 1-year survival rate was higher than that of 3- and 5-year for ovarian cancer. This study provides invaluable information that can not only help establish better standard of care for treatment of ovarian cancer, but also assist in development of superior health interventions for prevention and treatment of the disease., (© 2023. The Author(s).)

Objective: The Gleason score is an essential factor for making decisions about prostate cancer management and its prognosis. Thus, we conducted this research to discover the histologic-grading accuracy of needle biopsy specimens, and to identify preoperative clinical and pathological factors that predict upgrading and downgrading from biopsy to radical prostatectomy specimen., Patients and Methods: This study was performed on 570 patients who were referred to the medical centers affiliated with Shiraz University of Medical Sciences and underwent radical prostatectomy from 2013 to 2017. Concordance was evaluated between the Gleason score of needle biopsy and radical prostatectomy specimens. Predictors of upgrades and downgrades were assessed in univariate and multivariate logistic regression analyses., Results: Scores were the same in 50% of cases, downgraded in 26%, and upgraded in 24%. The variables predicting a Gleason score upgrade were higher Prostate specific antigen level, larger tumors, and older age. Lower tumor volume, lower Prostate specific antigen, and low maximum percentage of cancer in cores were predictors of downgrading from Gleason score>6 to ⩽6. Also, Body mass index>30, smaller tumor size, and negative lymph nodes were predictors of downgrading from Gleason score>7 to 7., Conclusion: The correlation between biopsy and Radical prostatectomy Gleason scores was only 50%. After dividing them into the new grading groups, this coordination increased by only 5.6%. Physicians need to consider possible limitations of the Gleason score of biopsy and factors that can be predictive of upgrading to high-risk prostate cancer before making treatment decisions.

Background: During the COVID-19 pandemic, we have witnessed increased complaints from third parties about violent conditions through social media. This study aimed to determine the prevalence of domestic violence (DV) against women following exposure to the COVID-19 pandemic and its relevance to some related factors., Materials and Methods: This study was conducted from July 2020 to May 2021 on married women of Babol, Iran. Eligible women entered into the study in a multi-stage cluster random sampling method. Data collection tools included demographic and family data, questionnaire HITS (Hurt, Insult, Threaten and Scream). Relationships were estimated using the Univariate and multivariate regression models.  Results: The mean age of 488 women and their spouses was 34.62 ± 9.14 and 38.74 ± 9.07, respectively. Of the total female participants, 37 (7.6%), 68 (13.9%), and 21 (4.3%) were victims of total violence, verbal abuse, and physical violence, respectively. Ninety-five women (19.5) had a history of coronavirus infection. Women who were satisfied with their income and husbands were university educated, their chances of DV were reduced by 72% (95% CI (0.09-0.85), OR = 0.28) and 67% (95% CI (0.11-0.92), OR = 0.33) respectively. Drug abuse by husbands increased the likelihood of DV by up to 4 times (OR = 4.00), and more contact with their husbands at home due to home quarantine was more than twice as likely to have DV (OR = 2.64).  Conclusion: Since the level of domestic violence was lower than before the coronavirus pandemic, it seems that most Iranian women were more under the support of their husbands during the coronavirus pandemic to endure the fear and panic caused by the pandemic. Women whose husbands had a university education and sufficient income had less domestic violence., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Khairkhah et al.)

Background: Vaccination is one of the best ways to stop the transmission of coronavirus disease 2019 (COVID-19). In this regard, uunderstanding the features related to the intention of different populations to receive the COVID-19 vaccine is essential for an effective vaccination program. This study aimed to investigate the vaccination intention predictors in the general adult population of Iran., Methods: A cross-sectional, web-based survey was conducted on social networks, including Telegram, WhatsApp, LinkedIn, Instagram, and Facebook. Multinomial logistic regression models were used to investigate predictors associated with the intention to receive COVID-19 vaccines, including sociodemographic characteristics, trust, worry, sources of information, and conspiracy beliefs. The main outcomes included unwillingness, undecidedness, and intention to receive the COVID-19 vaccine., Results: Out of 780 respondents, 481 (61.6%) reported an intention to be vaccinated, 214 (27.4%) expressed their undecided status, and 85 (10.9%) reported unwillingness to receive any type of COVID-19 vaccine. A higher age (OR undecided = 0.97, 95% CI (0.96-0.99)), (OR unwilling = 0.97, 95% CI (0.95-0.99)); exposure with COVID-19 (OR unwilling = 0.82, 95% CI (0.76-0.89)), (OR undecided = 0.87, 95% CI (0.83-0.93)) were positively associated with vaccination intentions. No/low trust in vaccines, institutions, concerns about the future of the pandemic, and conspiracy beliefs were strongly and negatively associated with COVID-19 vaccination intentions., Conclusion: Most Iranians intended to get a COVID-19 vaccine. Higher vaccine acceptance needs to consider demographic features, exposure history, confidence in vaccines, trust in institutions, concerns, and conspiracy beliefs of people., (© 2023. The Author(s).)

Introduction: little is known about social media (SM) use among breast cancer (BC) patients and their general health (GH). This study aimed to evaluate the impact of SM and sociodemographic characteristics associated with GH in BC patients during the treatment phases., Methods: a retrospective cross-sectional study was conducted on BC patients at Shiraz University from December 2017 to August 2020. Data on clinical, epidemiological, and GH information were collected using a general health questionnaire (GHQ-28). Univariate analysis was performed to determine the impact of SM on GH. Additionally, multivariate logistic regression models [odds ratio (OR)] were performed to identify sociodemographic factors that affect the GH of BC patients., Results: amongst the 353 individuals with BC, 339 (96%) were female. Their mean age was 48.98 ± 11.57 years. Two hundred and thirty (65.2%) patients used SM; the most frequent SM application was WhatsApp by 209 participants (59.2%). Univariate analysis showed a significant social dysfunction among SM nonusers compared to their users (6.68 ± 2.87 vs. 7.87 ± 3.22) and the difference was statistically significant (p < 0.0001). The use of SM for 3 hours or less was associated with less social dysfunction. However, the difference was not statistically significant (22.80± 12.48 vs. 25.21 ± 10.17, p =0.415). Multivariate logistic regression showed that using SM and working outdoors was positively associated with GH (OR = 0.68, 95% CI =0.29-1.59) and (OR =0.92, 95% CI = 0.54-1.57), respectively. However, female gender and use of chemotherapy were negatively associated with GH (OR = 2.96, 95% CI = 0.74-11.72, and OR =1.47, 95% CI = 0.83-2.57), respectively. Age, marital status, educational level, and disease duration were not statistically associated with GH., Conclusion: using SM and working outdoors directly and positively impact the behavior of people who have BC, while the female gender and those under chemotherapy were negatively associated with GH in BC patients., Competing Interests: The authors declare no competing interests., (Copyright: Hamid Reza Farpour et al.)

Background: Liver transplantation is one of the most effective treatments for acute liver failure, chronic liver cirrhosis, and hepatocellular carcinoma. This study was implemented to evaluate the survival rate of liver transplant in Asia., Methods: Studies that investigated the survival rate of liver transplant were selected using a systematic search strategy in the following databases: Medline, Embase, Scopus, ProQuest, ISI Web of Science, and Cochrane to Nov 30th, 2020. Pooled survival rate and 95% confidence intervals were calculated using Der-Simonian and Laird method. Stata 16.0 (Stata Corp, College Station, TX, USA) was used for analysis., Results: One, 2, 3, 5, and 10-year survival rates of liver transplant were estimated to be 85%, 80%, 75%, 73%, and 71%, respectively. The results of the univariate meta-regression for defining the sources of heterogeneity for one-Year survival rate (SR) showed significant effects of bias (β high risk/moderate risk =0.059, 95% CI: 0.002, 0.115, P-Value =0.04) and follow up time (β= -0.0002, 95% CI: -0.0003, -0.00, P-Value =0.02) on heterogeneity., Conclusion: The survival rate of liver transplant in Asia is comparable with the corresponding rate reported in the United States and Europe. This study provides a better view of the efficiency of medical cares, regarding liver transplantation. Medical care be enhanced to increase the survival of liver transplant patients., Competing Interests: Conflict of interest The authors declare that there is no conflict of interest., (Copyright © 2022 Ghelichi-Ghojogh et al. Published by Tehran University of Medical Sciences.)

Background: Listening to music can reduce or manage stress, fatigue, and accompanying symptoms in mothers. Music increases oxytocin secretion which affects breast milk. This study aimed to examine the effect of lullaby on volume, fat, total protein and albumin concentration of breast milk in mothers of premature infants admitted to the NICU., Methods: This clinical trial was performed on 100 primiparous mothers whose premature infants were hospitalized in the NICU of Ayatollah Rouhani Hospital from January 2020 to December 2020. Using block randomization method, the participants were divided into three groups: control (A), playing lullaby for mother (B) and playing lullaby for a mother while holding a photo of her own baby (C). The mothers of the intervention groups listened to lullabies through headphones for 30 minutes every morning for 6 days. On the first and the sixth day of birth, the volume of breast milk (ml) and two milliliters of breast milk samples of all three groups were measured and compared in terms of fat, albumin concentration and total protein (mg/DL). ANOVA, Paired T-Test and ANCOVA model (the included variables were: basic value of dependent variable, group type, Maternal age, Birth weight, Gestational age and Maternal weight) was used for analytical statistics., Results: The difference between the mean compositions of breast milk before and after the intervention in three groups of A, B and C: in terms of the breast milk volume were 66.33 ± 4.80, 71.30 ± 4.18 and 75.91 ± 6.80 ml; in terms of triglyceride level was 177.84 ± 50.57, 210.72 ± 34.55 and 224.17 ± 12.97 mg/DL, cholesterol level was 14.57 ± 3.70, 21.96 ± 3.82 and 26.26 ± 5.16 mg/DL, albumin concentration was 0.90 ± 0.30, 1.22 ± 0.19 and 1.46 ± 0.28 mg/DL and total protein level was 1.61 ± 0.61, 2.20 ± 0.57 and 2.72 ± 0.30 mg/DL. Finally, the results of ANCOVA analysis for the effects of the intervention, taking into account the baseline values, showed that the intervention was effective and had the greatest effect on cholesterol levels., Conclusion: In this small trial, there was a statistically significant association between trial arm and biochemical composition of breastmilk though further studies are needed to see if these changes result in meaningful clinical outcomes to the infant., Trial Registration: IRCT, IRCT20191114045439N1. Registered 14 January 2020- prospective, https://en.irct.ir/trial/43671., (© 2022. The Author(s).)

Liver transplantation is a life-saving treatment for children who are in liver failure. The survival rate index is used to assess the success rate of liver transplantation. The study aimed to assess the survival rate of liver transplantation in children. We searched 5 international databases in this study, including Medline/PubMed, ProQuest, Scopus, Web of Knowledge, and Google Scholar, for published articles by the end of 2020. Also, meta-regression analysis was performed based on the year of the study, and subgroup analysis was performed according to continents. A total of 425 titles were reviewed. Based on the results, 96 articles were entered in the meta-analysis. Established on the random-effect model, the survival rates of 1, 3, 5, and 10 years of transplantation were 86.62%, 77.74%, 73.95%, and 68.60%, respectively. Also, based on the meta-regression results, there was a relationship between the year of the study and the survival rate, as the study year gets more recent, the survival rate is increased. This study can provide documented and comprehensive evidence which can be the basis of many policies and decisions in various sectors of health development, including evaluating treatment options and health interventions in transplantation., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Competing Interests: We have no conflicts of interest to disclose.

Background: Despite the significant role of the Fat Mass and Obesity-Associated (FTO) gene in obesity, the underlying mechanisms are not fully elucidated. Besides, vitamin D deficiency and obesity are mostly seen together, and it can be hypothesized that this nutrient may have an impact in the role of FTO genotype in adiposity. Objective: Thus, this study aimed to investigate the association of FTO rs9939609 gene polymorphism with eating behaviors, eating disorders, and general mental health in overweight adults, considering their vitamin D intake as a mediate confounding factor. Methods: This cross-sectional study was carried out on 197 overweight adults in Shiraz, Iran. Genotyping was performed through amplification refractory mutation system polymerase chain reaction (ARMS PCR). Mental health, vitamin D intake, eating behaviors and disorders were assessed by the validated questionnaires. Results: The risk allele of the FTO rs9939609 polymorphism (A) was significantly associated with a higher risk of eating behavior and mental health disorders (all P < 0.05). After considering vitamin D intake, the AA genotype carriers had significantly higher risks for poorer eating behavior (P = 0.002), mental health (P = 0.007), and general mental health (P = 0.039) compared with the TT carriers if they had insufficient vitamin D intake. Conclusion: In conclusion, these results indicated that the A-allele of the FTO rs9939609 polymorphism may be associated with poorer eating behaviors, mental health, and higher risk of eating disorders. It was also identified that the effect of FTO rs9939609 A risk allele on eating behavior and mental health may be limited to people with insufficient vitamin D intake.

Background: This study is a systematic review and meta-analysis on published studies about the Global Survival Rate of Graft and Patients in the Kidney Transplantation of children., Methods: Studies that investigated the survival rate of kidney transplants published until the 30th of December 2020 were selected using a systematic search strategy in the following databases: Medline, Embase, Scopus, ProQuest, ISI Web of Science, and Cochrane. The extracted data were entered into the Excel software and STATA 16.0. The search identified 6007 study references. From the total, we excluded 1348 duplicates, 3688 reference titles and abstracts that were deemed irrelevant, and 846 references that were not original articles (i.e., letter, commentary, review) or did not meet the inclusion criteria. As such, 89 studies involving 12,330 participants were included in this meta-analysis., Results: In this study 1, 3, 5, 7 and 10-year survival rates of graft were estimated to be 92, 83, 74.40, 67.10, and 63.50%, respectively. Also, 1, 3, 5, 7 and 10-year survival rates of patients were estimated to be 99.60, 97.30, 95.20, 74.60, and 97.90%, respectively., Conclusions: The findings suggest differences in graft and patient survival among children with kidney transplants. Although differences in ethnic origin, incompatibility with deceased donor kidneys, and types of kidney disease are unavoidable, interventions to improve preventive and living-donor transplantation are particularly needed in minority groups. In addition, more research is needed to establish and address the contribution of medical and sociocultural barriers to preferential treatment of these groups., (© 2022. The Author(s).)

Background: In the tubularized incised plate (TIP) procedure, flap interposition between the skin and neourethra is highly recommended to decrease the postoperative fistula rate. However, there is no consensus regarding the ideal flap for this procedure. This study aimed to report our experiences in the one-stage TIP hypospadias surgery utilizing dartos flap (DF) (penile skin subcutaneous tissue) and tunica vaginalis flap (TVF) (parietal layer of the testis) as a tissue coverage of neourethra., Methods: In a retrospective study from Sep 2018 to May 2021, 16 cases of hypospadias with different types, ranging from midpenile to penoscrotal types, were managed with TIP urethroplasty using DF or TVF as a tissue coverage of neourethra were enrolled. The demographic characteristics of the participants, type of hypospadias, outcome, and complications were analyzed and compared., Results: We used TVF and DF as soft tissue coverage in 11 (68.8%) and 5 (31.3%) patients, respectively. The mean age was 56.38 ± 47.83 months. Mid-penile, proximal, and penoscrotal hypospadias were presented in 3 (18.8%), 8 (50.0%), and 5(31.2%) patients, respectively. The total success rate was 14 (87.5%), while 2 (12.5%) patients developed a urethrocutaneous fistula, which required delayed closure later. In comparison between TVF and DF groups: the TVF was applied in all patients with moderate and severe chordee and all patients with penoscrotal hypospadias, and six patients with proximal hypospadias, while only three patients with mild chordee and two patients with proximal hypospadias used the DF and showed statistical significance between groups (p < 0.001 and 0.012) respectively. The success rate was 90.9% vs. 80.0% in TVF and DF groups, respectively, with no statistical significance between groups (p = 1.000)., Conclusions: In the primary TIP repair, the TVF is a practical option as a DF for the interposition cover of a neourethra, especially in penoscrotal and proximal hypospadias with severe chordee.

Purpose: Colorectal cancer has a significant impact on patients' physical, psychological, and social aspects. This study aimed to examine the gender difference in anxiety and depression and its relationship with some of the characteristics of the disease and demographic in the northeast of Iran., Methods: In this cross-sectional study, patients with colorectal cancer aged over 18 years who were admitted to hospitals, without considering the disease stage and type of treatment, were enrolled during 2014-2016. The Hospital Anxiety and Depression Scale (HADS) Questionnaire was completed via interview., Results: A total of 303 survivors of colorectal cancer were included in the current analysis, of whom 55.1% (167) were male. The overall frequency of depression was 44.9%, and it was 38.3% and 32.9% for men and women, respectively. The overall frequency of anxiety was 53.4% (50.3% and 57.4% for men and women, respectively). The results showed that compared to men, women (52%) were more likely to report depression (OR = 0.48, 95% CI = 0.22-1.04, P = 0.065); in contrast, men (12%) were less likely than women to report anxiety (OR = 0.88, 95% CI = 0.38-2.03, P = 0.779), which was less than 12% in men. Among other variables, education and employment were identified as independent and strong predictive variables for depression and anxiety., Conclusions: The frequency of anxiety and depression is high among colorectal cancer survivors, especially in women. Therefore, screening for psychological distress is recommended in clinical settings and there is a need to pay attention to women., (© 2021. Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Prerequisite for achieving the goals of the registration program is the existence of valid and accurate data, and the usability of this data is possible if they are coded correctly. This study assets the quality of pathological data of the population-based cancer registration centers based on ICD-O-3., Methods: This applied study was performed descriptively and retrospectively. The study population included 20129 pathology reports sent to the population-based cancer registration center of Mazandaran Province during 2018-2020. A total of 2015 out of, 2050 samples of the received reports were examined according to stratified random sampling method. A researcher checklist was made to collect the data, and STATA 13 and Cohen's Kappa agreement coefficient were used to analyze the data., Results: Among the 2015 reports of pathology, 1114 (55.3%) pathology reports were related to government centers, (42.9%) 865 cases were registered with their topographic code, morphology and behavior. Based on the registration of the exact topographic code, the kappa coefficient and the total agreement were 0.266 and 27.70%, respectively. Kappa coefficient in all received reports and reports with topographic code was 0.346 and 0.906, respectively. In the reports with topographic code, the most reports of cancers were related to cancers of the gastrointestinal organs (97.6%) 246., Conclusion: The accuracy of the codes given in the pathology centers in terms of topographic, morphological, behavioral and grade codes based on the percentage of agreement with the coding was above average, which were higher in governmental centers and also in some cancers., Competing Interests: The authors declare that there is no conflict of interest.

Background Postoperative complications (POCs) are significant concerns to surgeons because of their possible fatality or long-term disabilities. This study aimed to investigate the early POCs of gastrointestinal surgery and its associated factors in Yemeni patients treated in a teaching hospital in Sana'a University referral hospital. Method A retrospective cross-sectional study from June 2016 to June 2020 was conducted at Al-Kuwait Teaching Hospital, Sana'a University, Yemen. The patients' characteristics, causative factors, primary treatment, and POCs were recorded from their medical profiles. Univariate analysis was utilized to identify the risk factors associated with gastrointestinal POCs within 30 postoperative days. Results The 30-postoperative day mortality was 3.6%, and major POCs occurred in 22 (20%) patients. There is no statistically significant relationship between POCs and age, sex, smoking, khat chewing, comorbidities (diabetes mellitus, anemia, jaundice, heart disease), emergency cases, drain insertion, and operative time (p ˃ 0.05). There was a significant relationship between POCs and preoperative poor nutritional status, high American Society of Anesthesiologists (ASA) grade, need for blood transfusion, major abdominal surgeries, iatrogenic injury, small bowel resection, reoperation, and history of the previous laparotomy (p ≤ 0.05). Conclusion There is a significant relationship between preoperative poor nutritional status, high ASA, need for blood transfusion, major abdominal surgeries, reoperation, small bowel resection, iatrogenic injury, previous laparotomy, and POCs across different gastrointestinal procedures. These factors should be assessed when auditing surgical outcomes., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Dajenah et al.)

Objectives: This study aimed to evaluate sympathetic skin response (SSR) among patients with Raynaud phenomenon (RP). SSR is a technique for assessment of the damage of peripheral neuropathies and the disorders of the sympathetic system., Methods: Between January 2015 and December 2018, approximately 20 patients with RP and 20 healthy subjects (control group) were recruited from patients referred to the outpatient clinics of Shiraz University of Medical Sciences, Shiraz, Iran. All participants were clinically examined and the SSR was evaluated using a standard protocol. SSR is abnormal when the latency is prolonged and/or the amplitude is reduced., Results: The RP group consisted of 19 women (95%) and one male (5%); three patients (15%) had primary Raynaud's phenomenon (PRP) and 17 patients (85%) had secondary Raynaud's phenomenon. The control group consisted of 16 women (80%) and four males (20%). The mean age of the RP group and control subjects was 43.1 ± 9 and 36.7 ± 8.6 years, respectively. The SSR to the electrical stimulus was absent in three patients with PRP. The total median nerve mean latencies in the upper limb were 1.90 ± 0.57 and 1.19 ± 0.52 seconds for the RP group and control groups, respectively ( P <0.001). These findings revealed significantly prolonged SSR latencies in the RP group, while the mean amplitude showed no significant differences in both groups ( P = 0.756)., Conclusion: Absence or prolonged latency of SSR was associated with the disorders of the unmyelinated axons in the sympathetic system. The findings of the present study suggested the disorders of unmyelinated axons in Raynaud's phenomenon., Competing Interests: CONFLICT OF INTEREST The authors declare no conflicts of interest., (© Copyright 2022, Sultan Qaboos University Medical Journal, All Rights Reserved.)

Objective: The objective of the study was to assess the outcome and feasibility of ultrasonography (US)-guided minimally invasive percutaneous nephrolithotomy (mini-PCNL) in children., Materials and Methods: Twenty-five children with upper urinary tract stones who had undergone US-guided mini-PCNL from June 2017 to June 2020 were enrolled in this study. Patients' demographic information and post-treatment results were retrospectively gathered and analysed. Pyelocaliceal system was punctured in prone position using US guidance, and the tract was dilated using single-shot dilation technique. All steps of renal access were done using only US. Mini-PCNL in all cases was done by using 15 Fr rigid nephroscope. Stones were fragmented with a pneumatic lithotripter and evacuated., Results: The patients' mean age was 6.30 ± 3.25 years (range: 1.5-15). The mean stone size was 16.04 ± 3.93 mm (range: 10-30). The mean access time to the stone was 1.50 ± 0.62 min (range: 1-4). The mean operation time was 94.66 ± 3.05 min (range: 90-100 min). The final stone-free rate was 96%. Post-operation fever occurred in 4 (16%) patients who were treated successfully with an antibiotic. No major complications occurred., Conclusions: We recommend US-guided mini-PCNL as a harmless alternative treatment option, in children with renal calculi due to its excellent outcomes and little complications., Competing Interests: None