The effect of pomegranate on oxidative stress parameters: A systematic review and meta-analysis

Objective: Pomegranate contains remarkable amounts of phenolic ingredients and it has been related to the antioxidant capacity of this fruit. Several primary studies show that pomegranate intake can improve antioxidant status. The objective of this systematic review and meta-analysis consisted in investigating the effect of pomegranate on oxidative stress (OS) parameters. Methods: A comprehensive electronic database search in Scopus, Web of science, Embase, Cochrane library and Medline was performed to identify eligible randomized controlled trials (RCTs). A meta-analysis of included studies was performed on selected variables using a random-effects model. Quality assessment was conducted by means of Cochrane risk of bias assessment tool. Results: Systematic search yielded 575 references. A total of 11 RCTs reporting data from 484 participants included. Meta-analysis of data from 11 included RCTs did not support convincing evidence as to a significant increasing effect of pomegranate intake in TAC (SMD: 0.43 ; 95 %CI: -0.19, 1.06), Gpx (SMD: 0.18, 95 % CI: -0.25, 0.62, p = 0.4) and paraxonase (SMD: 0.36, 95 % CI: -0.50, 1.22, p= 0.41) as well as not significant decrease in Malondialdehyde (MDA) (SMD: -0.81, 95 % CI: -1.79, 0.09, P = 0.08). Conclusion: Future well-designed clinical trials are needed before definite conclusive claims can be made about the effect of pomegranate on OS parameters. Keywords: Pomegranate, Oxidative stress, Antioxidant, Randomized clinical trial

Application of autologous platelet-rich plasma (PRP) on wound healing after caesarean section in high-risk patients

Background: Platelet-rich plasma (PRP) is ahumanplasma product enriched by platelets, growth factors, and fibrinogen with high hemostatic and healing properties. Objectives: The aim of this study was to evaluate the effect of autologous PRP on wound healing in high-risk women undergoing cesarean sections. Patients and Methods: In this balanced, randomized, and controlled trial, 140 patients were admitted to Arash women�s hospital, Tehran, Iran from May of 2013 to November of 2014 for elective cesarean surgery. The patients were randomly assigned into two groups. The intervention group received PRP after surgery, whereas the control group received the usual care. All patients were evaluated at baseline, five days, and eight weeks after the cesarean section. The primary endpoint used the REEDA scale for assessing the changes in wound healing. The secondary outcome measures used were the Vancouver scar scale (VSS) and the visual analog scale (VAS). All scale scores were analyzed using a repeated measures test for variance. Results: At the end of study, the PRP group showed a greater reduction in the edema ecchymosed discharge approximation (REEDA) score compared to the control group (85.5 reduction in the PRP group; 72 in the control group) (P < 0.001). Compared with the control group, the PRP group had a significantly greater reduction in the VANscore, beginning on the fifth day after the cesarean section (-0.7, 38 reduction in PRP group;-0.8, 33 in control group) (P < 0.001), and this trend was stable at the end of the eighth week (-0.6, 54 reduction in PRP group;-0.3, 18 in control group). Furthermore, patients treated with PRP experienced a 93 reduction in the VAS score at the end of follow-up, but the control group only observed a 79 reduction (P < 0.001). Conclusions: It seems that applying PRP is an effective therapeutic approach for wound healing, and faster wound healing is expected due to the presence of more platelets and growth factors. © 2016, Iranian Red Crescent Medical Journal

Malaria infection and the risk of epilepsy: a meta-analysis

Epilepsy, a chronic disease of the central nervous system, is highly prevalent in malaria-endemic regions. Therefore, several studies have evaluated the associations between malaria infection and epilepsy development. A meta-analysis of observational studies published from inception to 10 May 2022 has been conducted to synthesize and pool the existing data on this topic. The relevant publications were systematically searched in PubMed/Medline, Scopus, Embase and Web of Science database collections. A random-effects meta-analysis model (REM) was utilized to generate the pooled odds ratio (OR) at 95% confidence intervals (CIs). The between-studies heterogeneity was assessed with I2, as well as several subgroups, meta-regression and sensitivity analysis were performed to identify the source of heterogeneity. Overall, 17 eligible studies containing 6285 cases and 13 909 healthy controls were included. The REM showed a significant positive association between malaria infection and epilepsy development (OR 2.36; 95% CI 1.44–3.88). In subgroup analyses, significant positive associations were observed in studies that: epilepsy was the outcome in the follow-up of patients with cerebral malaria (OR 7.10; 95% CI 3.50–14.38); used blood smear to diagnose malaria (OR 4.80; 95% CI 2.36–9.77); included only children (OR 3.92; 95% CI 1.81–8.50); published before 2010 (OR 6.39; 95% CI 4.25–9.62). Our findings indicated that patients with malaria, especially those with cerebral malaria, are at a high risk of epilepsy development; however, further well-designed and controlled studies are needed to verify the strength of the association

Systematic review with meta-analysis: Effects of probiotic supplementation on symptoms in functional dyspepsia

The pathophysiology of functional dyspepsia (FD) remains poorly understood, but alterations of the small intestinal microbiome have been observed. The place of probiotics in treatment is uncertain. We performed a systematic review and meta-analysis of the currently available randomized, controlled trials (RCTs) to evaluate the potential beneficial effects and risks of probiotics in FD. Pubmed, EMBASE, Scopus, Web of Science and the Cochrane Controlled Trials Register were searched (up to May 2019) for RCTs evaluating the effects of probiotic supplementation compared to placebo in adults with FD. Two reviewers independently assessed eligibility, trial quality and extracted information from identified articles. To compare the effects of probiotics with placebo, risk ratios (RRs) with 95 confidence intervals (CIs) were pooled using random effects models. Six trials, including 422 participants were included but only three RCTs could be included in the meta-analysis. Lactobacillus strains showed potential positive effects in terms of improving upper gastrointestinal (GI) symptoms in patients with FD. Probiotic supplementation tended to improve global dyspepsia score (n = 3 RCTs, risk ratio RR: 1.35, 95% CI 0.99 to 1.84; P = 0.061) and bacterial composition in the GI tract. Probiotics were well tolerated without any serious adverse events. While the available data suggest that supplementation with probiotics may improve GI symptoms in patients with FD, the evidence is insufficient to draw clear conclusions regarding efficacy. Thus, high-quality RCTs are needed to establish the beneficial effects of probiotic supplementation on FD outcomes. © 2020 The Author

Socioeconomic inequality in oral health behavior in Iranian children and adolescents by the Oaxaca-Blinder decomposition method: The CASPIAN- IV study

Background: The present study set to describe the socioeconomic inequality associated with oral hygiene behavior among Iranian pediatric population. Methods: A representative sample of 13486 school students aged 6-18 years was selected through multistage random cluster sampling method from urban and rural areas of 30 provinces in Iran. Principle Component Analyses (PCA) correlated variables summarized as socioeconomic status (SES). Association of independent variables with tooth brushing was assessed through logistic regression analysis. Decomposition of the gap in tooth brushing between the first and fifth SES quintiles was assessed using the counterfactual decomposition technique. To assess the relation between tooth brushing and each socioeconomic category, Concentration Index (C) and the slope index of inequality (SII) were used, representing the linear regression coefficient. Results: The participation rate was 90.6 (50.7 boys and 75.6 urban inhabitants). The mean age of participants was 12.47 ± 3.36 years. The frequency of tooth brushing increased across SES quintiles, prevalence of tooth brushing between the first and fifth quintile, under 20 difference, increased from 58.22 (95 CI: 56.24,60.20) to 78.61 (95 CI: 77.00,80.24). Only 3 of the difference is explained by the factors considered in the study, and 17 remained unknown. Residence area, family size, and smoking status made a significant contribution to the gap between the first and last SE groups. Residence area -2.01 (95 % CI: -3.46, -0.55) was along the maximum levels of gaps between SE categories. Conclusions: The findings revealed a socio-economic inequality in oral health behavior in Iranian children and adolescents. Also, factors influencing oral health are addressed to develop and implement complementary public health actions. © 2016 The Author(s)

National and sub-national trend and burden of injuries in Iran, 1990-2013: A study protocol

Background: Worldwide, injuries are a major public health concern and make a considerable contribution to the disease burden. The present study is a component of the National and Subnational Burden of Diseases, Injuries, and Risk Factors from 1990 to 2013 (NASBOD) study in Iran, which was designed to investigate the burden of most important injuries (road traffic injuries, falls, burns, poisonings and drownings) at the national and sub-national levels in Iran. In this paper we explain definitions, organization, injuries selection process, data sources, data gathering methods, and data analyses of the national and sub-national burden of injuries study in Iran. Methods: The burden of most important injuries in current metric of DALYs at the national and sub-national levels in Iran over 1990-2013 will be estimated through comprehensive reviews of either published or national data sources. Statistical modeling will be used to impute the missing data on the burden of selected important injuries for each district-year. Conclusion: The results of present study can help health policy makers to plan more comprehensive and cost-effective strategies at national and sub-national level for prevention and control of burden caused by injuries

Mothers and their children�s health (MATCH): a study protocol for a population�based longitudinal cohort

Background: The quality of prenatal care is critical for the prevention of adverse pregnancy outcomes. However, according to the World Health Organization (WHO), only 64 of women worldwide have access to over four sessions of prenatal care throughout their pregnancy. Thus, studies that address factors affecting maternal and child health status before and after pregnancy are of immense importance. The primary aim of the mothers and their children�s health (MATCH) cohort study is to evaluate the effect of nutrition, sleep quality, and lifestyle on maternal and neonatal outcomes. Methods: A prospective cohort of > 2500 pregnant women in the first trimester (before 12 weeks� gestation) will be recruited at Arash Women�s Hospital in Tehran, Iran between February 2020 and August 2021. All eligible pregnant women will be followed from their first trimester of pregnancy until delivery at four time points and assessed through a series of in-person visits with interviewer-administered questionnaires and telephone interviews. Detailed data will be collected on maternal demographics, lifestyle, medical history, reproductive history, obstetric history, dietary intake, sleep pattern, blood specimens, and anthropometric measurements, alongside paternal demographics, lifestyle, and family history. The outcomes will include antenatal, peripartum, and postnatal maternal complications and infant growth and neurodevelopment. Discussion: The results of the MATCH cohort study will support the development of contextual interventions that can enhance antenatal, peripartum, and postnatal status, neonatal outcomes, and longevity mother and child. © 2021, The Author(s)

Global, regional, and national burden of neck pain in the general population, 1990-2017: Systematic analysis of the Global Burden of Disease Study 2017

Objective: To use data from the Global Burden of Disease Study between 1990 and 2017 to report the rates and trends of point prevalence, annual incidence, and years lived with disability for neck pain in the general population of 195 countries. Design: Systematic analysis. Data source: Global Burden of Diseases, Injuries, and Risk Factors Study 2017. Main outcome measures: Numbers and age standardised rates per 100 000 population of neck pain point prevalence, annual incidence, and years lived with disability were compared across regions and countries by age, sex, and sociodemographic index. Estimates were reported with uncertainty intervals. Results: Globally in 2017 the age standardised rates for point prevalence of neck pain per 100 000 population was 3551.1 (95 uncertainty interval 3139.5 to 3977.9), for incidence of neck pain per 100 000 population was 806.6 (713.7 to 912.5), and for years lived with disability from neck pain per 100 000 population was 352.0 (245.6 to 493.3). These estimates did not change significantly between 1990 and 2017. The global point prevalence of neck pain in 2017 was higher in females compared with males, although this was not significant at the 0.05 level. Prevalence increased with age up to 70-74 years and then decreased. Norway (6151.2 (95 uncertainty interval 5382.3 to 6959.8)), Finland (5750.3 (5058.4 to 6518.3)), and Denmark (5316 (4674 to 6030.1)) had the three highest age standardised point prevalence estimates in 2017. The largest increases in age standardised point prevalence estimates from 1990 to 2017 were in the United Kingdom (14.6 (10.6 to 18.8)), Sweden (10.4 (6.0 to 15.4)), and Kuwait (2.6 (2.0 to 3.2)). In general, positive associations, but with fluctuations, were found between age standardised years lived with disability for neck pain and sociodemographic index at the global level and for all Global Burden of Disease regions, suggesting the burden is higher at higher sociodemographic indices. Conclusions: Neck pain is a serious public health problem in the general population, with the highest burden in Norway, Finland, and Denmark. Increasing population awareness about risk factors and preventive strategies for neck pain is warranted to reduce the future burden of this condition. © 2020 Author(s)

Global, regional and national burden of bladder cancer and its attributable risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease study 2019

Introduction The current study determined the level and trends associated with the incidence, death and disability rates for bladder cancer and its attributable risk factors in 204 countries and territories, from 1990 to 2019, by age, sex and sociodemographic index (SDI; a composite measure of sociodemographic factors). Methods Various data sources from different countries, including vital registration and cancer registries were used to generate estimates. Mortality data and incidence data transformed to mortality estimates using the mortality to incidence ratio (MIR) were used in a cause of death ensemble model to estimate mortality. Mortality estimates were divided by the MIR to produce incidence estimates. Prevalence was calculated using incidence and MIR-based survival estimates. Age-specific mortality and standardised life expectancy were used to estimate years of life lost (YLLs). Prevalence was multiplied by disability weights to estimate years lived with disability (YLDs), while disability-adjusted life years (DALYs) are the sum of the YLLs and YLDs. All estimates were presented as counts and age-standardised rates per 100 000 population. Results Globally, there were 524 000 bladder cancer incident cases (95% uncertainty interval 476 000 to 569 000) and 229 000 bladder cancer deaths (211 000 to 243 000) in 2019. Age-standardised death rate decreased by 15.7% (8.6 to 21.0), during the period 1990–2019. Bladder cancer accounted for 4.39 million (4.09 to 4.70) DALYs in 2019, and the age-standardised DALY rate decreased significantly by 18.6% (11.2 to 24.3) during the period 1990–2019. In 2019, Monaco had the highest age-standardised incidence rate (31.9 cases (23.3 to 56.9) per 100 000), while Lebanon had the highest age-standardised death rate (10.4 (8.1 to 13.7)). Cabo Verde had the highest increase in age-standardised incidence (284.2% (214.1 to 362.8)) and death rates (190.3% (139.3 to 251.1)) between 1990 and 2019. In 2019, the global age-standardised incidence and death rates were higher among males than females, across all age groups and peaked in the 95+ age group. Globally, 36.8% (28.5 to 44.0) of bladder cancer DALYs were attributable to smoking, more so in males than females (43.7% (34.0 to 51.8) vs 15.2% (10.9 to 19.4)). In addition, 9.1% (1.9 to 19.6) of the DALYs were attributable to elevated fasting plasma glucose (FPG) (males 9.3% (1.6 to 20.9); females 8.4% (1.6 to 19.1)). Conclusions There was considerable variation in the burden of bladder cancer between countries during the period 1990–2019. Although there was a clear global decrease in the age-standardised death, and DALY rates, some countries experienced an increase in these rates. National policy makers should learn from these differences, and allocate resources for preventative measures, based on their country-specific estimates. In addition, smoking and elevated FPG play an important role in the burden of bladder cancer and need to be addressed with prevention programmes.publishedVersio

Sperm DNA fragmentation: A new guideline for clinicians

Sperm DNA integrity is crucial for fertilization and development of healthy offspring. The spermatozoon undergoes extensive molecular remodeling of its nucleus during later phases of spermatogenesis, which imparts compaction and protects the genetic content. Testicular (defective maturation and abortive apoptosis) and post-testicular (oxidative stress) mechanisms are implicated in the etiology of sperm DNA fragmentation (SDF), which affects both natural and assisted reproduction. Several clinical and environmental factors are known to negatively impact sperm DNA integrity. An increasing number of reports emphasizes the direct relationship between sperm DNA damage and male infertility. Currently, several assays are available to assess sperm DNA damage, however, routine assessment of SDF in clinical practice is not recommended by professional organizations