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Animal bites are a frequent reason for primary care and emergency department visits by children. Rabies is endemic in Iran, with 5 to 11 deaths reported annually. Over 90% of rabies cases in the country are caused by dog bites, and more than 50% of the victims are children under 15 years old. The mortality rate of rabies is 100%. A 4-year-old girl, who had been bitten by a dog and sustained facial lacerations 16 days prior to admission, presented with fever and loss of consciousness. Despite wound washing, receiving four doses of the rabies vaccine and immunoglobulin, and taking cephalexin on the fifth day after the bite, she developed rabies encephalitis. Rabies was confirmed through a skin biopsy and saliva PCR. Treatment included vancomycin, meropenem, and acyclovir in addition to favipiravir. The patient was intubated due to impaired consciousness and respiratory issues, and her hypertension was managed with medication. A brain CT scan showed normal findings. Cerebrospinal fluid analysis revealed protein at 52, glucose at 63, and no cellular presence. Vancomycin and acyclovir were discontinued when blood culture, wound culture, cerebrospinal fluid, and PCR results returned negative. Echocardiography results were acceptable, and the patient’s lab tests showed no other abnormalities except for leukocytosis at admission, an ESR of 60, and a CRP of 40. The patient remained intubated for two weeks and continued to receive supportive measures, ongoing drug therapy, ventilator adjustments, and water and electrolyte balance management. During hospitalization, she showed no response to the apnea test, oculovestibular reflex, or doll's eye maneuver. Two weeks later, she developed bradycardia and subsequently died, with a final diagnosis of furious rabies. Despite receiving the rabies vaccine and immunoglobulin, the patient died within a month of the bite, which may be attributed to the location of the bite on her face, the timing of her treatment, or the quality of the vaccine.

Abstract We aimed to assess the weight loss trend following Roux en Y Gastric Bypass (RYGB), One Anastomosis Gastric Bypass (OAGB), and Sleeve Gastrectomy (SG), utilizing a change-point analysis. A retrospective cohort study was conducted on 8640 patients, from 2009 to 2023. The follow-up period extended to 7 years, with a median follow-up of 3 years (interquartile range: 1.4–5). Following metabolic bariatric surgery, four weight loss phases (three change points) were observed. The primary, secondary, and tertiary phases, transitioned at 12.64–13.73 days, 4.2–4.8 months, and 11.3–13.1 months post-operation, respectively, varying based on the type of procedure. The weight loss rate decreased following each phase and plateaued after the tertiary phase. The nadir weight was achieved 11.3–13.1 months post-procedure. There was no significant difference in the %TWL between males and females, however, males achieved their nadir weight significantly earlier. Half of the maximum %TWL was achieved within the first 5 months, with the greatest reduction rate in the first 2 weeks. Our findings inform healthcare providers of the optimal timing for maximum weight loss following each surgical method and underscore the importance of close patient monitoring in the early postoperative period.

Depression is more prevalent among medical students. Its level can be changed by different factors. The present study was designed and implemented in order to determine the path analysis of factors affecting depression in students of Qazvin University of Medical Sciences. This descriptive-analytical study was conducted on 291 randomly selected students of Qazvin University of Medical Sciences in 2018. Data were collected using demographic characteristics questionnaires, Beck Depression Inventory and Gadzla Academic Stress Questionnaire. The data were analysed using one-way ANOVA and F test, independent t-test, and Pearson correlation coefficient in SPSS software version 22, and significance level 0.05. According to the path analysis final model, there was a significant relationship between age and hope for continuing education with academic stress, and there was no significant relationship between satisfaction and academic stress. There was a significant relationship between age, hope for continuing education, academic satisfaction and stress with depression (p < 0.001). According to the obtained results, measures should be taken in order to reduce individual and environmental stresses and factors effective in depression. Detection and follow-up in disease cases, especially in the younger generation, is important in preventing debilitative effects of the disease, and its consequences should be prevented by quick and timely detection.

Background and Objectives: The main cause of mortality in burn patients is infection from burns. Drug-resistant bacteria are the main causes of wound infection, so alternative antibiotic therapies hold significant importance. The objective of this study was to examine the impact of a collagen hydrogel that contains a nanoemulsion of Lavandula essential oil on the healing process of infected burn wounds. Materials and Methods: In this experimental study, 20 rats were randomly divided after applying burns with a 10 mm diameter hot plate and infecting the wounds with multidrug-resistant Pseudomonas aeruginosa into four groups, including a positive control, a negative control, the first experiment (collagen hydrogel), and the second experiment (collagen hydrogel containing Lavandula essential oil nanoemulsion). On the 4th, 11th, and 18th days, tissue samples were taken for pathology studies. The important parameters in burn wound healing with hematoxylin and eosin and Masson's trichrome staining methods were investigated and scored according to Abramov’s method. Results: Based on the pathology findings, experimental groups 1 and 2 compared to the negative and positive control groups were effective in rat infection wound healing. The hydrogel scaffold in the experimental groups increased fibroblasts and angiogenesis compared to the control groups. Epithelization was noticed only in the hydrogel group containing nanoemulsion. Conclusion: The study findings suggest that the use of collagen hydrogel with Lavandula essential oil nanoemulsion has potential as a wound dressing. This is because it has the potential to effectively promote healing and act as an antibacterial agent to prevent infections.

Background and Objectives: During the coronavirus pandemic, the overuse of antibiotics to reduce coinfections and mortality may be contributing to the rise of antimicrobial resistance. In this study, we aim to investigate the antibiotic resistance changes of Acinetobacter baumannii post-COVID-19 pandemic in Northern Iran. Materials and Methods: The current study is a cross-sectional study. Between 2022 and 2023, 2190 clinical samples were collected from patients with healthcare-associated infections (HAIs) at four hospitals in Sari, which served as corona centers after the COVID-19 pandemic. Antimicrobial sensitivity was determined using standard broth macro-dilution, and resistance genes were detected using multiplex PCR. Results: Based on the results co-amoxiclav had a resistance rate of 100%, while piperacillin/tazobactam showed the least resistance rate of 29.82%. In terms of GM MIC values, colistin was the most potent against multi-drug resistant isolates. The frequency of blaOXA-51, ampC, aphA6, and blaNDM genes were 100%, 99.12%, 90.35%, and 69.30% respectively. Conclusion: Our study revealed high multi-drug resistance rates. Piperacillin/tazobactam recommended for treating multidrug resistant Acinetobacter baumannii infections in Northern Iran.

Abstract Background Urinary tract cancers including bladder, kidney, ureter, and pelvis are a common malignancy worldwide with high mortality ratio. Aimed to investigate the prevalence of these cancers, we conducted this study. Methods In this study, all the information related to ICD10 codes, gender, age and province of residence of individuals were obtained from the data of Iran’s cancer registry by the Ministry of Health, Medicine and Medical Education and demographic evidence for each sub-country from the reports of Statistics Center of Iran (SCI). Also, the data of two Iranian national survey studies CASPIAN-III, IV, and V (information related to the care and prevention of non-communicable diseases (NCD) in childhood and adolescence) and STEPs (including information on NCD in adults over 18 years old) were used. The data was analyzed using Poisson regression with mixed effects to estimate the incidence of cancers. Results Bladder and kidney neoplasm are the most common cancers of the urinary system in Iran. The prevalence of bladder cancer has increased from 5.82 to 11.50 per 100,000 individuals. The increasing trend is growing faster in men compared with women. The incidence of kidney neoplasm has increased over the years (2.03 in 2005 vs. 7.02 in 2020 per 100,000). Having a higher incidence ratio compared with bladder cancer, kidney cancer is responsible for 35.06% of all urinary cancers in 2020 compared with 23.71% in 2005. Both neoplasms of the ureter and renal pelvis were recorded rarely and with lower incidence in both sexes during this period. Conclusion Considering the increasing trend in the incidence of urinary neoplasms in Iran during these years, the advantage of focusing on the risk of urinary cancers is highlighted. Therefore, investigating the prevalence and incidence of urinary cancers to plan and manage these cancers will result in prevention and reduction of the disease burden on the Iranian society. Future studies in this field can help in the prevention and well-timed diagnosis of these cancers.

Background: Amid the COVID-19 pandemic, the surge in hospital admissions and widespread use of broad-spectrum antibiotics have heightened the risk of hospital-acquired infections from multidrug-resistant (MDR) organisms, particularly Escherichia coli. It is imperative to implement stringent measures to curb the spread of antimicrobial resistance in hospitals and devise robust treatment strategies for patients grappling with such infections. To confront this challenge, a comprehensive study was undertaken to examine MDR extended-spectrum beta-lactamase (MDR-ESBL)-producing Escherichia coli isolates from patients with nosocomial infections following the COVID-19 pandemic in Northern Iran. Materials and Methods: The current study was conducted as a cross-sectional study. A total of 12,834 samples were collected from patients with healthcare-associated infections at four designated corona centers in Northern Iran, following the COVID-19 pandemic. Antimicrobial resistance was determined using standard broth micro-dilution, while resistance genes were accurately detected using the multiplex PCR method. Results: The results indicated that meropenem and ciprofloxacin had a resistance rate of 100% and 98.2%, respectively, while piperacillin-tazobactam showed the highest sensitivity rate at 54.4%. The frequency of specific genes, including blaIMP, blaTEM, AcrA, AcrB, blaCTX, blaOXA-58, aaclb, blaSHV, and aacla, were found to be 100%, 100%, 99.1%, 99.1%, 91.2%, 80.7%, 64.9%, 44.7%, and 37.7%, respectively. Conclusions: In the current study, over 50% of MDR-ESBL-producing Escherichia coli isolates exhibited resistance to antibiotics. A combination of antibiotics, including piperacillin-tazobactam and colistin, is recommended for treating extensively drug-resistant Escherichia coli infections.

A two-level three-factor factorial design experiment was conducted to study the influences of three critical specimen preparation parameters on the measurement results of bitumen by a dynamic shear rheometer (DSR). The investigated factors were (1) the pre-heating temperature (HT) for manufacturing the specimen, (2) the bonding temperature (BT) onto the rheometer, and (3) the trimming (Trim) operation for preparing the specimen after bonding. The analysed data were the measured shear modulus |G*|, phase angle δ, and the characteristic temperatures of bitumen’s specific stiffness TX with corresponding phase angle δTX according to the European standard EN 14770:2023. Five types of bitumen were tested, including three penetration grades and two modified bitumen specimens (with polymer and wax additives). In addition, a repeatability evaluation of the test results was conducted. We found that the trimming operation for preparing the specimen has a noticeable impact when using smaller plates (PP08) for the DSR measurement. At higher test temperatures when using larger plates (PP25), the trimming operation does not significantly impact the measured parameters, in contrast to the HT and BT. Except for bitumen type 70/100, modified binders are more susceptible to variation in the analysed parameters than unmodified ones. The three-way interaction Trim:BT:HT tends to cause relatively little variation in measured data. Interactions between two factors Trim:BT, Trim:HT, and BT:HT contribute more to the fluctuation in δ value than in TX and |G*|. The variation employed in this study affects the test repeatability of wax-modified bitumen significantly; however, for unmodified binders the repeatability of TX and δTX are within 0.4–2.1 °C and 0.3–3.1°, respectively.

BackgroundWith the rapid increase in the prevalence of DM, studies on the awareness, treatment, and control of this condition are essential. Therefore, this study aimed to review the literature and pool the awareness, treatment, and control of diabetes at the global, regional, and national levels.MethodsIn this systematic review and meta-analysis, several databases, including MEDLINE/PubMed, Institute of Scientific Information (ISI), Scopus, and Google Scholar, were searched using appropriate keywords up to June 2022. Observational studies investigating the awareness, treatment, and control of glucose levels among diabetic individuals were included. Awareness, treatment, and control were defined as the proportion of participants who were aware of their diabetes condition, treated pharmacologically, and achieved adequate glucose control, respectively. Two investigators independently conducted the study selection, data extraction, and quality assessment. Heterogeneity among studies was calculated using Chi-square, and a random-effect meta-analysis was used to pool the rates.ResultsA total of 233 studies published between 1985 and 2022 met the inclusion criteria. The included studies had a combined population of 12,537,968. The pooled awareness of DM was 60% (95%CI: 56–63) and ranged from 41% (25–57) in low-income countries to 68% (64–72) in high-income countries, with no significant trend observed over the assessed periods at the global level. The pooled treatment of DM globally was 45% (42–48) and varied from 37% (31–43) in lower-middle-income countries to 53% (47–59) in high-income countries, showing variation over the examined time period. Before 2000, the proportion of adequate DM control was 16% (12–20), which significantly improved and reached 22% (19–25) after 2010. The pooled awareness, treatment, and control of DM were higher in females, high-income countries, and urban areas compared to males, upper and lower-middle-income countries, and rural areas, respectively. The older adults population had higher awareness and treatment rates than the adult population, but their DM control did not differ significantly.ConclusionDespite the high level of awareness and treatment among the diabetic population, treatment success (control) is considerably low, particularly in low-income countries and rural areas. It is crucial to improve awareness, treatment, and control by strengthening the primary care system in all countries.

Schmidt syndrome is a polyendocrinopathy characterized by multiple organ failures. Patients with two or more of the following characteristics are diagnosed with this syndrome: Graves' disease, adrenal insufficiency, autoimmune thyroiditis, and type I diabetes. The present case report concerns a Schmidt syndrome patient (polyglandular autoimmune syndrome type II). The patient is a 42-year-old woman with type I diabetes and complaints of imbalance, weakness and lethargy, weight loss, darkened skin, blood pressure drop, hypoglycemia, and hyperkalemia who visited the Hospital frequently and was discharged every time after intravenous potassium chloride and dextrose injections and orders to reduce insulin consumption at home. Her blood cortisol level was measured in her last visit with suspicion of adrenal insufficiency, which was revealed to be low (less than 0.5 μg/dL). A high ACTH, low aldosterone, and normal renin were also reported, indicating secondary adrenal insufficiency. Furthermore, T4 and TSH tests were performed, reporting a TSH lower than 0.2 in the initial TSH test, which was revealed to be normal after the test was repeated. Subclinical hyperthyroidism was indicated, given the high TRAb figure. The patient underwent treatment with fludrocortisone and prednisolone, which improved her condition. This report accentuates that diabetic patients with reduced insulin requirements must be checked for adrenal insufficiency immediately to prevent potential complications.

Abstract Background The COVID-19 pandemic has significantly impacted healthcare services worldwide, including bariatric surgery. There is a concern that the pandemic-induced stay-at-home orders and social restrictions may negatively affect weight reduction outcomes post-bariatric surgery. This study aimed to examine the impact of the COVID-19 on weight loss up to six months after three types of bariatric surgeries including One-Anastomosis Gastric Bypass (OAGB), RY Gastric Bypass (RYGB), and Sleeve Gastrectomy (SG) before and two time periods during the COVID-19 pandemic. Methods We conducted a retrospective study using data from a comprehensive database of bariatric surgery patients in Iran. We recruited 882 patients who underwent bariatric surgery from the initiation of COVID-19 to 6 months before public vaccination (Time period 3); among them, 311 patients underwent surgery in the first six months of the pandemic (Time period 2). These patients were compared with 1368 ones in the control group who completed their 6 months follow-up before the pandemic. The study compared the BMI reduction, excess weight loss (EWL), and total weight loss (TWL) outcomes between these groups using Generalized Estimating Equations (GEE) with gamma distribution to adjust for factors that were unevenly distributed across the groups. Results The age of participants in time periods 2 and 3 had a mean (standard deviation) of 38.97 (10.99) and 38.84 (10.71), respectively. In all groups, the majority of patients were females, accounting for 76.02%, 71.06%, and 75.74% for the control group and time periods 2 and 3, respectively. There was no significant difference between the groups in terms of weight reduction, as measured by BMI reduction, EWL, and TWL (related P values: 0.283, 0.465 and 0.169). Regression analysis indicated that higher baseline BMI values were associated with greater BMI reduction (0.04, 95% CI: 0.03–0.05), but this did not translate to higher EWL or TWL. Males showed greater BMI reduction (0.33, 95% CI: 0.18–0.49) and EWL (1.58, 95% CI: 0.79–2.37) than females, while females achieved higher TWL compared to males. Among different types of surgery, the OAGB resulted in more weight reduction among patients in the study. Conclusion In conclusion, our study reveals that bariatric surgery remains effective for weight reduction during the first 6 months of the pandemic in Iran. Implementation of pandemic protocols ensures comparable efficacy to non-pandemic times. However, caution is needed in generalizing results beyond our specific context due to study limitations. Further research is essential to comprehensively assess the pandemic's broader impact on bariatric surgery outcomes under varying conditions.

Abstract Background The Naive Bayes (NB) classifier is a powerful supervised algorithm widely used in Machine Learning (ML). However, its effectiveness relies on a strict assumption of conditional independence, which is often violated in real-world scenarios. To address this limitation, various studies have explored extensions of NB that tackle the issue of non-conditional independence in the data. These approaches can be broadly categorized into two main categories: feature selection and structure expansion. In this particular study, we propose a novel approach to enhancing NB by introducing a latent variable as the parent of the attributes. We define this latent variable using a flexible technique called Bayesian Latent Class Analysis (BLCA). As a result, our final model combines the strengths of NB and BLCA, giving rise to what we refer to as NB-BLCA. By incorporating the latent variable, we aim to capture complex dependencies among the attributes and improve the overall performance of the classifier. Methods Both Expectation-Maximization (EM) algorithm and the Gibbs sampling approach were offered for parameter learning. A simulation study was conducted to evaluate the classification of the model in comparison with the ordinary NB model. In addition, real-world data related to 976 Gastric Cancer (GC) and 1189 Non-ulcer dyspepsia (NUD) patients was used to show the model's performance in an actual application. The validity of models was evaluated using the 10-fold cross-validation. Results The presented model was superior to ordinary NB in all the simulation scenarios according to higher classification sensitivity and specificity in test data. The NB-BLCA model using Gibbs sampling accuracy was 87.77 (95% CI: 84.87-90.29). This index was estimated at 77.22 (95% CI: 73.64-80.53) and 74.71 (95% CI: 71.02-78.15) for the NB-BLCA model using the EM algorithm and ordinary NB classifier, respectively. Conclusions When considering the modification of the NB classifier, incorporating a latent component into the model offers numerous advantages, particularly within medical and health-related contexts. By doing so, the researchers can bypass the extensive search algorithm and structure learning required in the local learning and structure extension approach. The inclusion of latent class variables allows for the integration of all attributes during model construction. Consequently, the NB-BLCA model serves as a suitable alternative to conventional NB classifiers when the assumption of independence is violated, especially in domains pertaining to health and medicine.

Abstract Background We compared Fakhravac and BBIBP-Corv2 vaccines in a phase III trial. Method We conducted a multicenter, parallel-group, active-control, non-inferiority clinical trial with pragmatic considerations assessing the safety and efficacy of Fakhravac and BBIBP-Corv2 vaccines. We started with two randomized double-blind arms and added two non-randomized open-label arms (based on participant preference) because of slow recruitment. The adult population received 0.5 ml (10 µg per dose) intramuscular injections of Fakhravac or BBIBP-Corv-2 vaccines 21 days apart. The primary outcome was the occurrence of PCR-positive symptomatic Covid-19 disease 14 days or more after the second injection. A 10% non-inferiority margin to the reported 72.8% efficacy of BBIBP-Corv2 was assumed. Cox proportional hazard modeling was used to estimate hazard ratios and their 95% confidence intervals. Result We enrolled 24,056 adults in four groups (randomized-Fakhravac: 824, randomized-BBIBP-Corv2: 832; Non-randomized-Fakhravac: 19,429, Non-randomized-BBIBP-Corv2: 2971). All observed local and systemic adverse reactions were generally self-limited and resolved completely. We observed similar Serious Adverse Event (SAE) rates in the BBIBP-Corv2 (2.57, 95% CI 1.33–4.49) and Fakhravac (2.25, 95% CI 1.72–2.89) groups; none of which were related to the vaccines received. We recorded 9815 Medically Attendant Adverse Events (MAAE), 736 of which were categorized as somehow related. The rate of related MAAE in the Fakhravac was similar to the BBIBP-Corv2 groups (0.31 and 0.26 per 1000 person-day) in the randomized and considerably higher (0.24 and 0.07 per 1000 person-day) in the non-randomized arms. We observed 129 (35% of the 365 required by target sample size) events of PCR + symptomatic Covid-19 during four months of active follow-up in the randomized arm, demonstrating that those receiving the Fakhravac vaccine were significantly less likely (HR = 0.69; 95% CI 0.49–0.98) to be diagnosed with PCR + symptomatic Covid-19 compared with those receiving BBIBP-Corv2 vaccine. After adjusting for type I error using the O’Brien Fleming method, the Fakhravac vaccine was non-inferior to the BBIBP-Corv2 (assuming a 10% non-inferiority margin to the reported 72.8% BBIBP-Corv2 vaccine efficacy; HR

Abstract Helicobacter pylori is one of the most common bacteria affecting human societies worldwide, and is mainly associated with gastrointestinal complications due to different virulence factors. This study aimed to investigate some virulence genes of H. pylori in gastric biopsies of patients with gastritis in Sari city, North of Iran. Informed consent forms were obtained from the studied patients, and those who needed endoscopy were included in the study. To evaluate the prevalence of cagA, iceA1, iceA2, vacA, dupA, and oipA genes, gastric biopsies with positive or negative rapid urease test were collected from 50 patients (25 in each group) with gastro-duodenal diseases. The bacterial DNAs were extracted by a specific kit, and the presence of the genes was analyzed by PCR using specific primers. Eighteen (72%) biopsies from 25 H. pylori-positive samples were cagA-positive, while 17 (68%) biopsies contained the vacA gene, and 11 (44%) samples had both vacA and cagA genes. However, 16 (64%), 12 (48%), 13 (52%), and 14 (56%) biopsies contained dupA, iceA1, iceA2, and oipA genes, respectively. Due to the significant role of the studied virulence factors in the pathogenicity of H. pylori, the high prevalence of these factors in biopsies of patients with gastritis is a concern needing to the management in this region.

The purpose of this research is to investigate different levels of country risk and its role in the relationship between renewable energy consumption and economic growth in Iran, during the period (1997-2021). In terms of purpose, this research is of applied type and in terms of causal-analytical method, and the method of collecting information is of documentary-library type. After calculating the threshold value of each variable, we analyzed the effect of renewable energy consumption on economic growth using the threshold distance of different country risks. The results indicate the non-linear effect of renewable energy consumption on economic growth under different risks in the country. This research is one of the first studies in Iran that analyzed the relationship between renewable energy consumption and economic growth based on a risk-based approach. According to the regression model described in the current research, this research provides suggestions for developing a suitable strategic plan with the aim of specifying short-term and long-term goals, and future vision, as a road map for those involved. .

BackgroundDespite the rising prevalence of Inflammatory Bowel Disease (IBD), age and sex differences in its outcomes remain understudied. We investigated age and sex differences in IBD patients using a nationwide study in Iran, the Iranian Registry of Crohn's and Colitis (IRCC).MethodsThe IRCC is a national registry that gathered information on adult IBD patients since 2017. The collected data included demographic information, medication history, disease activity, comorbidities, diagnosis age, prognosis, the extent of ulcerative colitis (UC), Crohn's disease (CD) location, and extraintestinal manifestations. The statistical methods included the independent Student's t-test, Chi-square test, and binary logistic regression, using R version 4.2.2.ResultsAmong the 9,392 IBD patients, 7,496 (3,600 females) and 1,896 (808 females) had UC and CD, respectively. Sex difference showed higher odds of active disease in the past six months in male CD patients (OR 1.24 [95%CI 1.03, 1.49]) vs. females, but in male UC patients, the OR was 0.85 [0.78, 0.93]. Severe disease was less likely in CD patients aged 19-59 and >60 vs. 60.ConclusionsThis study emphasizes the importance of understanding age and sex differences in IBD outcomes. These findings contribute to the ongoing global discussion on IBD management and facilitate the development of targeted interventions and personalized care.

Abstract Background Cancer is most commonly associated with aging. It is necessary to gain a better understanding of cancer's trend and distribution among elderlies and provide comprehensive cancer care for this population. Aims The aim of the current study was to show the trends in cancer incidence focusing on the population aged 60+ from 1990 to 2016 in Iran. Material and Results We used the dataset of the Iran Cancer Registry to estimate cancer incidences by sex, age, province, and year. In order to account for incomplete data we used a two‐stage spatiotemporal model along with random intercept mixed effect models. We calculated annual age‐standardized incidence rates (ASIRs) for age groups 60+ and 5‐interval age groups. There was an increasing trend of 25.3% to 936.9% (95% uncertainty interval: 769.6–1141.8) in ASIR in the elderly in 2016. ASIR of all cancers were 889.7 (731.3–1083.6) in women and 988.1 (811.1–1205) in men in 2016, per 100 000 respectively, which had an increasing trend comparing 1990. Skin, breast, and stomach cancers in women and prostate, skin, and stomach cancers in men were the most common types in 2016. All the most incident cancer subtypes underwent an increasing trend in both sexes, except for the bladder, esophageal, and skin cancers which almost had a similar level in 1990 and 2016. Most provinces had an increasing trend in ASIR in all cancers combined from 1990 to 2016 except Zanjan with a decreasing trend. Conclusion Regarding the persistent increasing trend of most elderly cancers' incidence, this is crucial for policymakers to establish preventive plans, determine proper resource allocation, and develop specific treatments for elderly cancer patients.

Background: The FAKHRAVAC®, an inactivated SARS-CoV-2 vaccine, was assessed for safety and immunogenicity. Methods and findings: In this double-blind, placebo-controlled, phase I trial, we randomly assigned 135 healthy adults between 18 and 55 to receive vaccine strengths of 5 or 10 μg/dose or placebo (adjuvant only) in 0–14 or 0–21 schedules. This trial was conducted in a single center in a community setting. The safety outcomes in this study were reactogenicity, local and systemic adverse reactions, abnormal laboratory findings, and Medically Attended Adverse Events (MAAE). Immunogenicity outcomes include serum neutralizing antibody activity and specific IgG antibody levels.The most frequent local adverse reaction was tenderness (28.9%), and the most frequent systemic adverse reaction was headache (9.6%). All adverse reactions were mild, occurred at a similar incidence in all six groups, and were resolved within a few days. In the 10-µg/dose vaccine group, the geometric mean ratio for neutralizing antibody titers at two weeks after the second injection compared to the placebo group was 9.03 (95% CI: 3.89–20.95) in the 0–14 schedule and 11.77 (95% CI: 2.77–49.94) in the 0–21 schedule. The corresponding figures for the 5-µg/dose group were 2.74 (1.2–6.28) and 5.2 (1.63–16.55). The highest seroconversion rate (four-fold increase) was related to the 10-µg/dose group (71% and 67% in the 0–14 and 0–21 schedules, respectively). Conclusions: FAKHRAVAC® is safe and induces a strong humoral immune response to the SARS-CoV-2 virus at 10-µg/dose vaccine strength in adults aged 18–55. This vaccine strength was used for further assessment in the phase II trial.Trial registrationThis study is registered with https://www.irct.ir; IRCT20210206050259N1.

Pregnant women are one of the endangered groups who need special attention in the COVID-19 epidemic. We conducted a systematic review and summarised the studies that reported adverse pregnancy outcomes in pregnant women with COVID-19 infection. A literature search was performed in PubMed and Scopus up to 1 September 2022, for retrieving original articles published in the English language assessing the association between COVID-19 infection and adverse pregnancy outcomes. Finally, in this review study, of 1790 articles obtained in the initial search, 141 eligible studies including 1,843,278 pregnant women were reviewed. We also performed a meta-analysis of a total of 74 cohort and case-control studies. In this meta-analysis, both fixed and random effect models were used. Publication bias was also assessed by Egger’s test and the trim and fill method was conducted in case of a significant result, to adjust the bias. The result of the meta-analysis showed that the pooled prevalence of preterm delivery, maternal mortality, NICU admission and neonatal death in the group with COVID-19 infection was significantly more than those without COVID-19 infection (p

Abstract This study aimed to elucidate the algorithm of various influential factors relating to the association between 25-hydroxyvitamin D (25(OH)D) concentration at delivery and mode of delivery. The investigation constituted a secondary analysis using data collected as part of the Khuzestan Vitamin D Deficiency Screening Program in Pregnancy, which is a stratified randomized vitamin D supplementation-controlled trial comprising 1649 eligible pregnant women. The Bayesian Network (BN) method was utilized to determine the association algorithm between diverse influential factors associated with maternal vitamin D and mode of delivery. The optimized intelligent BN algorithm revealed that women presenting with moderate (35.67%; 95% CI: 33.36–37.96) and severe vitamin D deficiency (47.22%; 95% CI: 44.81–49.63) at delivery were more likely to undergo cesarean section than those presenting with normal concentrations of this nutritional hormone (18.62%; 95% CI: 16.74–20.5). The occurrence probabilities of preeclampsia in mothers with normal, moderate, and severe vitamin D deficiency at delivery were (1.5%; 95% CI: 0.92–2.09), (14.01%; 95% CI: 12.33–15.68), and (26.81%; 95% CI: 24.67–28.95), respectively. Additionally, mothers with moderate (11.81%; 95% CI: 10.25–13.36) and severe (27.86%; 95% CI: 25.69–30.02) vitamin D deficiency exhibited a higher probability of preterm delivery in comparison to those presenting with normal concentrations (1.12%; 95% CI: 0.62–1.63). This study demonstrated that the vitamin D status of pregnant women at delivery could directly affect the mode of delivery and indirectly through maternal complications, such as preeclampsia and preterm delivery, leading to a higher occurrence probability of cesarean section.

Abstract Cancer is one of the important health problems in Iran, which is considered as the third cause of death. Endocrine cancers are rare but mostly curable. Thyroid cancer, the most common endocrine tumors, includes about one percent of malignant cancer. In this study, we examined the 15-year national trend of endocrine cancer incidence in Iranian men and women. The data in each province were evaluated based on age, gender, and cancer type according to International Classification of Disease Codes version 10 (ICD-10) from 2005 to 2020 in Iran. All data were obtained from the reports of the Statistics Center of Iran (SCI), 6 phases of the step-by-step approach to monitoring the risk factors of chronic diseases over 18 years old (STEPs), and 3 periods of the CASPIAN study (survey of non-communicable diseases in childhood and adolescence). Statistical analyzes and graph generation were done using R statistical software. Poisson regression with mixed effects was used for data modeling and incidence rate estimation. The incidence of thyroid gland malignancy is higher in women than in men. On the other hand, the incidence of adrenal gland cancer is slightly higher in men than in women. The same pattern is observed for other endocrine neoplasms and related structures. The incidence rate of these types of cancers has generally increased from 2005 to 2020 in Iran. This increase is more in women than in men. In addition, in the middle of the country, there is a strong region in terms of the occurrence of these types of cancers. The incidence rate in these provinces is relatively higher for both sexes and all studied periods. We conducted a study to observe the changing trends for various types of endocrine cancers over 15 years in men and women. Considering the increasing trend of thyroid cancers in Iran, therefore, creating essential policies for the management of these types of cancers for prevention, rapid diagnosis, and, timely treatment is particularly important.