Global research trends on systemic lupus erythematosus and thyroid cancers (1964-2023): A scientometric and visualized study.

Over the past 3 decades numerous studies have reported an association between systemic lupus erythematosus (SLE) and thyroid cancers. However, there has been no scientometric analysis in this area of research. To perform a comprehensive scientometric analysis of the global literature published on the association between SLE and thyroid cancers. The data on publications within thyroid cancers in SLE patients were retrieved from the Scopus database using a defined search strategy from its first publication in 1964 to 2023. To conduct a collaboration mapping analysis among keywords, authors, journals, and territories, VOSviewer was utilized. Our final research resulted in 246 scientific publications with 8072 citations, which were published in 198 journals affiliated to 48 countries. A global upward trend has been observed in the last 20 years, with the highest number of publications in the year 2022 (n = 28; 11.4%). The United States led the global productivity ranking with 74 publications (30.1%), followed by China with 25 publications (10.2%). The most popular journals in this field were "Arthritis Research and Therapy" and "Frontiers in Endocrinology," while the most co-cited journal was "Autoimmunity Reviews." The top 3 most prolific authors were Bernatsky, S., Clarke, A.E., and Ramsey-Goldman, R with 9 publications each. This first scientometric study comprehensively offered an overview of the status of thyroid cancers in SLE patients, assessing scholarly productivity in this domain over a period of 50 years.

A methodological quality review of citations of randomized controlled trials of diabetes type2 in leading clinical practice guidelines and systematic reviews.

Objective: Evaluate methodological quality of type 2 diabetes RCTs conducted in Iran and cited in clinical practice guidelines and systematic reviews and meta-analyses. Methods: We conducted a descriptive methodological quality review, analyzing 286 Randomized Controlled Trials (RCTs) on diabetes mellitus published in Iran from July 2004 to 2021. We searched six databases systematically and evaluated eligible articles using the CONSORT 2010 checklist for abstracts. Two investigators assessed the data using a 17-item checklist derived from CONSORT. Additionally, we examined the citations of each RCT in 260 clinical practice guidelines, with a specific focus on the adequate reporting of outcomes. Results: Out of 6667 articles, 286 analyzed. Poor reporting and failure to meet criteria observed. Only 3.8% cited in guidelines. Reporting rates: primary outcomes (41.9%), randomization (61.8%), trial recruitment (12.6%), blinding (50.8%). 27.9% cited in systematic reviews, 50.34% in systematic reviews and meta-analyses, 26.57% in meta-analyses. 67.8% of papers cited in systematic reviews. Adherence highest for participants, objective, randomization, intervention, outcome; lowest for recruitment, trial design, funding source, harms, and reporting primary outcomes. Conclusions: Poor methodological reporting and adherence to CONSORT checklist in evaluated RCTs, especially in methodological sections. Improvements needed for reliable and applicable results in guidelines, reviews, and meta-analyses. Inadequate outcome reporting challenges researchers, clinicians, and policymakers, impacting evidence-based decision-making. Urgent improvements in RCT registration necessary.

The association between zinc and prostate cancer development: A systematic review and meta-analysis.

BACKGROUND: Prostate cancer is affecting males globally, with several complications. Zinc can play roles in cancers. We aimed to clarify the association between zinc levels or intake with prostate cancer development. METHODS: We searched PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science until May 1, 2023. We included case-controls and cross-sectionals that measured zinc level and/or intake in patients with prostate cancer or cohorts that evaluated the association between zinc and prostate cancer development. Studies that did not have a healthy control group were excluded. Joanna Briggs Institute was used for quality assessment. Publication bias was evaluated using Egger's and Begg's tests and funnel plot. RESULTS: Overall, 52 studies (n = 44 case controls, n = 4 cohorts, and n = 4 cross sectionals) with a total number of 163909 participants were included. Serum (standardized mean difference (SMD): -1.11; 95% confidence interval (CI): -1.67, -0.56), hair (SMD: -1.31; 95% CI: -2.19, -0.44), and prostatic fluid or tissue zinc levels (SMD: -3.70; 95% CI: -4.90, -2.49) were significantly lower in prostate cancer patients. There were no significant differences in nail zinc level and zinc intake between those with prostate cancer and healthy controls. There was no publication bias except for serum and hair zinc levels based on Begg's and Egger's tests, respectively. The mean risk of bias scores were 4.61 in case-controls, eight in cohorts, and seven in cross-sectionals. CONCLUSIONS: Overall, high zinc levels might have a protective role in prostate cancer, which can be used as a therapeutic or preventive intervention. Future large-scale studies are needed to confirm the association.

Predictors of pacemaker requirement in patients with implantable loop recorder and unexplained syncope: A systematic review and meta-analysis.

Identifying the underlying cause of unexplained syncope is crucial for appropriate management of recurrent syncopal episodes. Implantable loop recorders (ILRs) have emerged as valuable diagnostic tools for monitoring patients with unexplained syncope. However, the predictors of pacemaker requirement in patients with ILR and unexplained syncope remain unclear. In this study, we shed light on these prognostic factors. PubMed/MEDLINE, EMBASE, Web of Science, and Cochrane CENTRAL were systematically searched until May 04, 2023. Studies that evaluated the predictors of pacemaker requirement in patients with implantable loop recorder and unexplained syncope were included. The "Quality In Prognosis Studies" appraisal tool was used for quality assessment. The pooled odds ratio (OR) with 95% confidence intervals (CIs) was calculated. The publication bias was evaluated using Egger's and Begg's tests. Ten studies (n = 4200) were included. Right bundle branch block (OR: 3.264; 95% CI: 1.907-5.588, p < .0001) and bifascicular block (OR: 2.969; 95% CI: 1.859-4.742, p < .0001) were the strongest predictors for pacemaker implantation. Pacemaker requirement was more than two times in patients with atrial fibrillation, sinus bradycardia and first degree AV block. Valvular heart disease, diabetes mellitus, and hypertension were also significantly more in patients with pacemaker implantation. Age (standardized mean difference [SMD]: 0.560; 95% CI: 0.410/0.710, p < .0001) and PR interval (SMD: 0.351; 95% CI: 0.150/0.553, p = .001) were significantly higher in patients with pacemaker requirement. Heart conduction disorders, atrial arrhythmias and underlying medical conditions are main predictors of pacemaker device implantation following loop recorder installation in unexplained syncopal patients.

Fragmented QRS, a strong predictor of mortality and major arrhythmic events in patients with nonischemic cardiomyopathy: A systematic review and meta-analysis.

Background and Aims: Fragmented QRS (fQRS), which is associated with rhythm disturbances, can predispose the heart to fatal ventricular arrhythmias. Recently, accumulating studies indicates that fQRS is associated with poor prognosis in various types of cardiomyopathies. Therefore, we assessed the association between fQRS with all-cause mortality and major arrhythmic events (MAEs) in patients with nonischemic cardiomyopathy, in this systematic review and meta-analysis study. Methods: We performed a comprehensive search in databases of PubMed/Medline, EMBASE, and Web of Science from the beginning to December 31, 2022. Published observational studies (cohorts, case-control, or analytical cross-sectional studies) were included that report the prognostic value of fQRS in patients with different types of nonischemic cardiomyopathies for MAEs (sudden cardiac death, sudden cardiac arrest, sustained ventricular tachycardia [VT], ventricular fibrillation [VF], and appropriate shock) and all-cause mortality. We pooled risk ratios (RRs) through raw data and adjusted hazard ratios (aHRs) using "Comprehensive Meta-Analysis" software, Version 2.0. Results: Nineteen cohort and three analytical cross-sectional studies were included in this meta-analysis involving a total of 4318 subjects with nonischemic cardiomyopathy (1279 with fQRS and 3039 without fQRS). FQRS was significantly associated with an increased risk of all-cause mortality in patients with nonischemic cardiomyopathy (pooled RR: 1.920; 95% confidence interval [CI]: 1.388-2.656, p < 0.0001/pooled HR: 1.729; 95% CI: 1.327-2.251, p < 0.0001). Also, the risk of developing MAEs in the presence of fQRS was significantly increased (pooled RR: 2.041; 95% CI: 1.644-2.533, p < 0.0001/pooled HR: 3.626; 95% CI: 2.119-6.204, p < 0.0001). In the subgroup analysis, the strongest association between fQRS presence and increased MAEs was observed in patients with hypertrophic cardiomyopathy (HCM) (pooled RR: 3.44; 95% CI: 2.07-5.71, p < 0.0001/pooled HR: 3.21; 95% CI: 2.04-5.06, p < 0.0001). Conclusion: Fragmented QRS could be a prognostic marker for all-cause mortality and MAEs in patients with various types of nonischemic cardiomyopathies, particularly HCM.

The presence of abnormal septal motion on echocardiography is a predictor of abnormal cardiac magnetic resonance in systemic sclerosis.

OBJECTIVES: We aimed to perform a comprehensive analysis of the ECG, two-dimensional echocardiography (2DE) and cardiac MRI (CMR) findings in patients with systemic sclerosis (SSc), and also to investigate correlations between CMR findings and some ECG and echocardiography (ECHO) results. METHODS: We retrospectively analysed data from patients with SSc who were regularly seen at our outpatient referral centre, all assessed with ECG, Doppler ECHO and CMR. RESULTS: Ninety-three patients were included; mean (s.d.) age of 48.5 (10.3) years, 86% female, 52% diffuse SSc. Eighty-four (90%) of the patients had sinus rhythm. The most common ECG finding was the left anterior fascicular block, recorded in 26 patients (28%). The abnormal septal motion (ASM) was found in 43 (46%) patients on ECHO. Myocardial involvement (inflammation or fibrosis), as assessed by multiparametric CMR, was present in >50% of our patients. The age- and sex-adjusted model showed that ASM on ECHO increased significantly the odds of increased extracellular volume [odds ratio (OR) 4.43, 95% CI 1.73, 11.38], increased T1 Relaxation time (OR 2.67, 95% CI 1.09, 6.54), increased T2 Relaxation time (OR 2.56, 95% CI 1.05, 6.22), increased signal intensity ratio in T2-weighted imaging (OR 2.56, 95% CI 1.05, 6.22), presence of late gadolinium enhancement (OR 3.85, 95% CI 1.52, 9.76) and mid-wall fibrosis (OR 3.64, 95% CI 1.48, 8.96). CONCLUSION: This study indicates that the presence of ASM on ECHO is a predictor of abnormal CMR in SSc patients, and a precise assessment of ASM may serve as an important point for selecting the patients that should be evaluated by CMR for early detection of myocardial involvement.

Comparative efficacy and safety of probiotics, prebiotics, and synbiotics for type 2 diabetes management: A systematic review and network meta-analysis.

AIMS: To compare the effects of probiotics, prebiotics, and synbiotics for type 2 diabetes (T2D) management. METHODS: We searched PubMed, Scopus, CENTRAL, and grey literature sources to December 2022 for randomized trials of the impacts of probiotics, prebiotics, or synbiotics in patients with T2D. We performed network meta-analyses with a Bayesian framework to calculate mean difference [MD] and 95 % credible interval [CrI] and rated the certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. RESULTS: 68 randomised trials were included. All results are presented in comparison to the placebo. Supplementation with probiotics (MD: -0.25 %, 95%CrI: -0.42, -0.08; GRADE = moderate) and synbiotics (MD: -0.31 %, 95%CrI: -0.61, -0.04; GRADE = very low) resulted in a trivial/unimportant decrease in glycated hemoglobin. Supplementation with probiotics (MD: -0.69 mmol/L, 95%CrI: -0.98, -0.40; GRADE = very low) and synbiotics (MD: -0.82 mmol/L, 95%CrI: -1.22, -0.43; GRADE = very low) resulted in a trivial/unimportant decrease in fasting plasma glucose. Supplementation with probiotics resulted in a small but important decrease in low-density lipoprotein cholesterol (MD: -0.19 mmol/L; 95%CrI: -0.34, -0.05; GRADE = very low). Supplementations had moderate effects on serum triglyceride (GRADE = low). CONCLUSIONS: Existing evidence is uncertain and does not support supplementation with probiotics, prebiotics, and synbiotics for T2D management.

Research impact in randomized controlled trials of diabetes: an altmetric approach.

Purpose: This study aimed to assess the impact of research in randomized controlled trials (RCTs) of diabetes and explore the various subject areas related to diabetes that receive attention on social media platforms. Altmetric measures were utilized to collect and extract relevant data, providing valuable insights into the social reach and influence of clinical research beyond traditional citation-based metrics. Methods: The research focused on RCTs of diabetes involving at least one Iranian author, indexed in Scopus. Altmetric.com was employed to extract altmetric data, and the collected articles were categorized into 14 subject areas for individual analysis using STATA. Results: The analysis revealed that a majority of the diabetes studies examined nutrition, complications, treatment, genetics, basic mechanisms, and comorbidities of the disease. Conversely, subject areas such as diagnosis, education, gestational diabetes, psychology, physical activity, prevention, dentistry, and economics had fewer studies associated with them. Among social media platforms, Twitter, Facebook, Google+, and Reddit emerged as the most frequently mentioned platforms. Furthermore, Mendeley readership was identified as the preferred platform for engagement across several subject areas. Conclusions: The substantial number of social media mentions indicates a significant level of public interest and concern regarding diabetes. Social media platforms serve as effective tools for disseminating research findings from clinical trials. Altmetric data proves valuable to researchers and funding agencies seeking to comprehend the impact of their work, enabling them to allocate resources more effectively.

A Scoping Review of Adopted Information Extraction Methods for RCTs.

Background: Randomized controlled trials (RCTs) provide the strongest evidence for therapeutic interventions and their effects on groups of subjects. However, the large amount of unstructured information in these trials makes it challenging and time-consuming to make decisions and identify important concepts and valid evidence. This study aims to explore methods for automating or semi-automating information extraction from reports of RCT studies. Methods: We conducted a systematic search of PubMed, ACM Digital Library, and Web of Science to identify relevant articles published between January 1, 2010, and 2022. We focused on published Natural Language Processing (NLP), machine learning, and deep learning methods that automate or semi-automate key elements of information extraction in the context of RCTs. Results: A total of 26 publications were included, which discussed the automatic extraction of key characteristics of RCTs using various PICO frameworks (PIBOSO and PECODR). Among these publications, 14 (53.8%) extracted key characteristics based on PICO, PIBOSO, and PECODR, while 12 (46.1%) discussed information extraction methods in RCT studies. Common approaches mentioned included word/phrase matching, machine learning algorithms such as binary classification using the Naïve Bayes algorithm and powerful BERT network for feature extraction, support vector machine for data classification, conditional random field, non-machine-dependent automation, and machine learning or deep learning approaches. Conclusion: The lack of publicly available software and limited access to existing software makes it difficult to determine the most powerful information extraction system. However, deep learning models like Transformers and BERT language models have shown better performance in natural language processing.

Does motor control training improve pain and function in adults with symptomatic lumbar disc herniation? A systematic review and meta-analysis of 861 subjects in 16 trials.

OBJECTIVE: To evaluate the effectiveness of motor control training (MCT) compared with other physical therapist-led interventions, minimal/no intervention or surgery in patients with symptomatic lumbar disc herniation (LDH). DESIGN: Systematic review and meta-analysis. DATA SOURCES: Eight databases and the ClinicalTrials.gov were searched from inception to April 2021. ELIGIBILITY CRITERIA: We included clinical trial studies with concurrent comparison groups which examined the effectiveness of MCT in patients with symptomatic LDH. Primary outcomes were pain intensity and functional status which were expressed as mean difference (MD) and standardised mean difference (SMD), respectively. RESULTS: We screened 6695 articles, of which 16 clinical trials (861 participants) were eligible. Fourteen studies were judged to have high risk of bias and two studies had some risk of bias. In patients who did not undergo surgery, MCT resulted in clinically meaningful pain reduction compared with other physical therapist-led interventions (ie, transcutaneous electrical nerve stimulation (TENS)) at short-term (MD -28.85, -40.04 to -17.66, n=69, studies=2). However, the robustness of the finding was poor. For functional status, a large and statistically significant treatment effect was found in favour of MCT compared with traditional/classic general exercises at long-term (SMD -0.83 to -1.35 to -0.31, n=63, studies=1) and other physical therapist-led interventions (ie, TENS) at short-term (SMD -1.43 to -2.41 to -0.46, n=69, studies=2). No studies compared MCT with surgery. In patients who had undergone surgery, large SMDs were seen. In favour of MCT compared with traditional/classic general exercises (SMD -0.95 to -1.32 to -0.58, n=124, studies=3), other physical therapist-led interventions (ie, conventional treatments; SMD -2.30 to -2.96 to -1.64, n=60, studies=1), and minimal intervention (SMD -1.34 to -1.87 to -0.81, n=68, studies=2) for functional improvement at short-term. The overall certainty of evidence was very low to low. CONCLUSION: At short-term, MCT improved pain and function compared with TENS in patients with symptomatic LDH who did not have surgery. MCT improved function compared with traditional/classic general exercises at long-term in patients who had undergone surgery. However, the results should be interpreted with caution because of the high risk of bias in the majority of studies. PROSPERO REGISTRATION NUMBER: CRD42016038166.

Identifying the Lowest Effective Initial Dose of Prednisolone for the Treatment of Subacute Granulomatous Thyroiditis: A Systematic Review and Meta-Analysis.

BACKGROUND: Subacute granulomatous thyroiditis (SAGT) is an inflammatory disease due to viral infections. Glucocorticoids, especially prednisolone (PSL), are one of the first approaches in the treatment of patients with SAGT. To date, no study has determined the lowest effective dose of prednisolone with the lowest recurrence rate in the treatment of SAGT. This study aimed to use meta-analysis methods to identify the appropriate dosage of prednisolone with the lowest recurrence rate in the treatment of patients with SAGT. METHODS: This study was conducted according to the PRISMA checklist in February 2021. Two independent researchers performed a search for relevant literature published before March 2021 in English databases, including Scopus, MEDLINE (via PubMed), Web of Science, Cochrane Library, Google Scholar, EMBASE, and also Persian electronic databases including SID, Iran medex, Magiran, and Irandoc. The search algorithm was initially developed by using a combination of MeSH terms, keywords, and also Boolean operators ("AND"; "OR"; "NOT"): Subacute thyroiditis, De Quervain Thyroiditis, Glucocorticoids, Prednisolone, Recurrence, and Meta-Analysis. All statistical analyses were performed using STATA 15.0 (StataCorp LLC, College Station, TX, USA) and SPSS 17.0. A random-effects model based on Metaprop was applied for the Meta-analysis. To assess heterogeneity between studies, the chi-squared test and I2 index were used, and for evaluating publication bias, funnel plots and Egger tests were performed. RESULTS: The overall recurrence rate was 14.72% [95% CI: 9.63- 20.58] and there was a significant heterogeneity among the studies [I2 = 69.56%; P=0.000]. To evaluate the lowest effective dose of prednisolone, we divided the studies into two groups based on the mean initial dose of prednisolone: less than or equal to 20 mg/day (group one) and greater than 20 mg/day (group two). The recurrence rate in group 1 was 11% [95% CI: 5.7- 16.2] and in group 2 was 23.6% [95% CI: 11.5- 35.6]. Significant correlations were observed between the initial mean dose of PSL and recurrence rate (r= 0.71; P= 0.013). Begg's funnel plot had no evidence of publication bias in these studies (p=0.160). CONCLUSION: According to the results of this meta-analysis, 15 to 20 mg/day of prednisolone is the most effective dosage with the lowest recurrence rate in the treatment of subacute Granulomatous thyroiditis.

Evaluating obesity publications: from bibliometrics to altmetrics.

PURPOSE: study the bibliometrics indicators of Iranian authors in the field of obesity and Correlation Comparison between conventional citation counts and altmetrics scores from 2005 to 2019. METHODS: The study uses bibliometric characteristics and altmetric analysis. Population consists of 5359 articles out of 8220 in the field of obesity which have specified Iran as the affiliated country and indexed by Scopus between 2005 to 2019. Citations was extracted from Scopus database and visualized bibliographic data by VOS viewer software version 17, as well as Altmetric Explorer was applied for altmetrics data. The spearman correlation was used to analyze distributions of altmetrics and citation. Statistical analysis was utilized using SPSS software version 17. RESULTS: According to altmetrics finding among 2221 articles, 90% of articles had focused on different social media. The major interaction of researches has taken place in Twitter respectively News and Facebook. a positive correlation (r = 0.31) has been found between citation and altmetrics. As a result, Institutes with the highest degree of co-authorship had the top 10 articles with the highest altmetrics score. CONCLUSION: Depending on the degree of correlation suggest that altmetrics should be seen as complements to, rather than alternatives to citations. Altmetrics indicators will be very useful for health policymaking and aid them with identifying important factors driving altmetric events. Also it could help to reveal the hidden value of some medical papers. Our findings can help international communications for scientific collaboration at the level of business and health care industry, and emergency managers gain a comprehensive understanding of the research area.

Co-authorship network analysis of Iranian researchers on osteoporosis.

Our purpose was to investigate the co-authorship network of Iranian researchers in the field of osteoporosis. We used 1328 documents retrieved from databases of PubMed, Scopus, and Web of Science in the analysis. The network had 183 authors in 13 clusters, low cohesion, and slow information flow between its members. PURPOSE: This study aims to investigate the pattern and characteristics of cooperation between Iranian researchers in the field of osteoporosis through the co-authorship social network analysis. METHODS: All papers on osteoporosis with at least one Iranian author were retrieved from medical databases of PubMed, Scopus, and Web of Science from 2009 to 2019. After the removal of duplicates, the title and abstract of the papers were reviewed by two independent reviewers, and screening was performed according to the inclusion and exclusion criteria. The data were entered into the BibExecl software, and the different spelling forms in the author names were manually merged. The authors' co-occurrence matrix was then developed and entered into the UCINET software and the cohesion indexes (density, diameter, and average distance) and centrality indexes (degree, betweenness, closeness, and eigenvector) for the co-authorship network were estimated. The institutions and countries of the authors of the entered papers were also used in the network analysis and their socio-graphs were drawn. RESULTS: We used 1328 documents in the analysis. The co-authorship network was constructed only for authors with at least 5 papers. The network had 183 nodes (authors) in 13 clusters. Its density was 0.063 and its number of components was 2. The large component encompassed 95.6% and the small component 4.4% of authors. The average distance in the main component of the network was 3 and its diameter was 6. Larijani B was ranked first in the network in terms of degree, betweenness, closeness, and eigenvector centrality. In terms of the contribution of organizations in osteoporosis publications, Tehran University of Medical Sciences (with 35.5% of papers published in WoS database), Shahid Beheshti University of Medical Sciences (14.7%), and Shiraz University of Medical Sciences (9.3%) retained in the first to third place, respectively. In papers published on the WoS, most Iranian authors have collaborated with authors from the USA, Belgium, Canada, and the UK respectively. CONCLUSION: The co-authorship network had low cohesion with slow information flow between its members. The collaboration with young researchers by the network's active, efficient, and broker authors will lead to the maintenance and development of the network.

Trend of nutrition research in endocrine disorders, gaps, and future plans: a collection of experiences of an endocrinology research institute.

BACKGROUND: Nutrition plays a pivotal role in the prevention and treatment of endocrine disorders. The aim of this study was to provide a window in order to display the 25-year activities of Endocrinology & Metabolism Research Institute (EMRI), and the gaps and future plans in the field of nutrition and endocrine disorders. METHODS: To collect papers affiliated to the EMRI in field of nutrition from the inception to December 1st 2019, the electronic databases including PubMed/Medline, Web of Science, and Scopus were searched. Publications in English and Persian languages were included. Scientific Landscapes (VOS viewer) software version 1.6.13 was used to provide bibliometric maps. RESULTS: Of 4082 studies identified in the initial search, 319 relevant papers were included. They contributed systematic review and meta-analysis/review (n = 76), clinical trials (n = 58), cross-sectional (n = 171), case-control studies (n = 11), and animal studies (n = 3). Accordingly, most nutrition studies were dedicated to the level of evidence III (cross-sectional studies: 53.60%) followed by systematic review studies (23.82%) with the level of evidence I. There was also an increasing trend in the nutrition studies through years, with a peak in 2019. CONCLUSION: An increasing trend in the publications related to nutrition science is observed at EMRI. However, nutrition research and publications can grow further through expanding collaborations with other fields related to endocrine. Given nutritional assessments in national projects and focusing on the identification of preventive nutritional strategies, considering the situations of our society can be helpful to make nutritional findings more practical.

Effect of the herbal medicines in obesity and metabolic syndrome: A systematic review and meta-analysis of clinical trials.

Obesity is a medical situation in which excess body fat has gathered because of imbalance between energy intake and energy expenditure. In spite of the fact that the variety of studies are available for obesity treatment and management, its "globesity" still remains a big challenge all over the world. The current systematic review and meta-analysis aimed to evaluate the efficacy, safety, and mechanisms of effective herbal medicines in the management and treatment of obesity and metabolic syndrome in human. We systematically searched all relevant clinical trials via Web of Science, Scopus, PubMed, and the Cochrane database to assess the effects of raw or refined products derived from plants or parts of plants on obesity and metabolic syndrome in overweight and obesity adult subjects. All studies conducted by the end of May 2019 were considered in the systematic review. Data were extracted independently by two experts. The quality assessment was assessed using Consolidated Standards of Reporting Trials checklist. The main outcomes were anthropometric indices and metabolic syndrome components. Pooled effect of herbal medicines on obesity and metabolic syndrome were presented as standardized mean difference (SMD) and 95% confidence interval (CI). A total of 279 relevant clinical trials were included. Herbals containing green tea, Phaseolus vulgaris, Garcinia cambogia, Nigella sativa, puerh tea, Irvingia gabonensis, and Caralluma fimbriata and their active ingredients were found to be effective in the management of obesity and metabolic syndrome. In addition, C. fimbriata, flaxseed, spinach, and fenugreek were able to reduce appetite. Meta-analysis showed that intake of green tea resulted in a significant improvement in weight ([SMD]: -0.75 [-1.18, -0.319]), body mass index ([SMD]: -1.2 [-1.82, -0.57]), waist circumference ([SMD]: -1.71 [-2.66, -0.77]), hip circumference ([SMD]: -0.42 [-1.02, -0.19]), and total cholesterol, ([SMD]: -0.43 [-0.77, -0.09]). In addition, the intake of P. vulgaris and N. sativa resulted in a significant improvement in weight ([SMD]: -0.88, 95 % CI: [-1.13, -0.63]) and triglyceride ([SMD]: -1.67, 95 % CI: [-2.54, -0.79]), respectively. High quality trials are still needed to firmly establish the clinical efficacy of the plants in obesity and metabolic syndrome.

Efficacy, safety, and mechanisms of herbal medicines used in the treatment of obesity: A protocol for systematic review.

INTRODUCTION: This systematic review protocol aims to perform a protocol for assessing the effectiveness, safety, and mechanism of herbal medicines for the treatment of obesity and metabolic syndrome. Some systematic reviews conducted earlier have evaluated the efficacy of herbal medicine to treat obesity and metabolic syndrome. Owing to the huge burden imposed by obesity in the recent years, a need is felt for conducting new systematic reviews on the topic of obesity with a focus on randomized clinical trials, we felt the need. METHODS AND ANALYSIS: All relevant clinical trials that examine the effectiveness of herbal medicines for the treatment of obesity and metabolic syndrome without restrictions on publication status will be applied.Four electronic databases will be searched: PubMed, Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials. The main outcome is expected to be an improvement in the body weight, body mass index, waist circumference, waist-to-hip ratio, body fat (weight or mass of visceral adipose tissue, fat mass or percent), and appetite.Selection studies, data extraction, and risk of bias will be assessed independently by 2 authors. ETHICS AND DISSEMINATION: In this study, ethical approval is not required because the data that will be used are not subjects and the results will be discussed through peer-reviewed publications. TRIAL REGISTRATION NUMBER: PROSPEROCRD42016049753.

Integration of Cognitive Skills as a Cross-Cutting Theme Into the Undergraduate Medical Curriculum at Tehran University of Medical Sciences.

Nowadays, improvement of thinking skills of students is one of the universally supported aims in the majority of medical schools. This study aims to design longitudinal theme of reasoning, problem-solving and decision-making into the undergraduate medical curriculum at Tehran University of Medical Sciences (TUMS). A participatory approach was applied to design the curriculum during 2009-2011. The project was conducted by the contribution of representatives of both basic and clinical faculty members, students and graduates at Tehran University of Medical Sciences. The first step toward integrating cognitive skills into the curriculum was to assemble a taskforce of different faculty and students, including a wide variety of fields with multidisciplinary expertise using nonprobability sampling and the snowball method. Several meetings with the contribution of experts and some medical students were held to generate the draft of expected outcomes. Subsequently, the taskforce also determined what content would fit best into each phase of the program and what teaching and assessment methods would be more appropriate for each outcome. After a pilot curriculum with a small group of second-year medical students, we implemented this program for all first-year students since 2011 at TUMS. Based on findings, the teaching of four areas, including scientific and critical thinking skills (Basic sciences), problem-solving and reasoning (Pathophysiology), evidence-based medicine (Clerkship), and clinical decision-making (Internship) were considered in the form of a longitudinal theme. The results of this study could be utilized as a useful pattern for integration of psycho-social subjects into the medical curriculum.