Efficacy and Safety of Anti-Osteoporotic Agents Across CKD Stages: A Meta-Analysis of Randomized Clinical Trials.

INTRODUCTION: Osteoporosis poses a significant health concern, especially for individuals with chronic kidney disease (CKD). CKD disrupts mineral and bone metabolism, heightening the risk of fractures and complicating the management of osteoporosis. While anti-osteoporotic interventions aim to address bone health in CKD patients, ongoing research is essential to understand the comparative efficacy and safety of these medications, particularly in different CKD stages, notably in Stages 4 and 5. METHODS: We searched PubMed/MEDLINE, EMBASE, and the Cochrane CENTRAL for randomized controlled trials assessing the efficacy and safety of osteoporosis interventions in CKD up to June 15, 2024. The analysis utilized the pooled odds ratio (OR) along with the corresponding 95% confidence interval (CI), employing Comprehensive Meta-Analysis software, version 3.0. To assess heterogeneity in the results of individual studies, we used Cochran's Q statistic and the I2 statistic. RESULTS: We analyzed 12 randomized controlled trials involving 31,027 participants, revealing a significantly lower risk of vertebral fractures with anti-osteoporotic agents (Teriparatide, Denosumab, Romosozumab, Raloxifene) compared to placebo (pooled OR, 0.28 [95% CI, 0.22 to 0.36]). Stratification by CKD stages showed a lower risk in Stages 1-3 but no significant reduction in Stages 4 and 5. Teriparatide, Denosumab, and Romosozumab were effective in lowering fracture risk, whereas Raloxifene showed no significant effect. The lumbar spine, femoral neck, and total hip BMD showed no significant differences between anti-osteoporotic agents (Denosumab, Raloxifene, Risedronate, Alendronate, Teriparatide) and placebo. However, Romosozumab demonstrated a significantly greater BMD change in all kidney function categories. No reported side effects were observed in CKD stages 1 to 5 across the trials. CONCLUSIONS: Our meta-analysis highlights the effectiveness of anti-osteoporotic agents in lowering vertebral fracture risk in CKD patients, particularly in Stages 1-3. However, this benefit is not apparent in Stages 4 and 5, necessitating further research. Despite the absence of reported side effects in CKD patients, clinicians should carefully assess the suitability of these medications, considering individual risks and benefits.

Iranian Nurses' Knowledge, Attitude, and Practice of Complementary Therapies for Pain Management.

INTRODUCTION: Complementary therapies (CTs) are being increasingly used by people with health issues and recommended by their health care providers. Although there are numerous studies available that address nurses' knowledge and attitudes regarding pain management, there are few that include the use of CTs by nurses in Iran. Therefore, this study was conducted in selected areas of Iran to assess nurses' knowledge, attitudes, and current practice regarding the use of CTs. METHODS: A cross-sectional study was conducted on a random sample of 850 nurses from various regions of Iran between 2020 and 2022. A questionnaire was used that consisted of seven items addressing demographic characteristics, 15 items to assess knowledge, 25 items to address attitude and 22 items to address the practice of CTs in the area of pain relief. Descriptive and inferential statistics were used to analyze the data. RESULTS: The participants' mean age was 33.26 ± 7.24 years. Most nurses (89.9%) had not received formal education on CTs. However, 78.6% of nurses reported personal use of CTs, and 62.3% reported using or recommending it to their patients at least once. Regarding the knowledge of CTs, nurses scored 5.81 on a 15 points scale indicating a considerable gap in their knowledge of CTs. Regarding attitudes toward the specific therapies, nurses believed that massage is highly (46.4%) or moderately (31.6%) effective in pain relief. Regarding effectiveness, nurses ranked the following as the top four CTs: music therapy, humor, hydrotherapy, and use of cold / heat. CONCLUSION: The nurses in this study scored low on knowledge of CTs, meaning that they knew little about CTs. However, they showed a favorable attitude toward CTs and a majority of them had a history of personal use, and recommending some types of CTs to their patients for pain relief. Therefore, it is crucial for nurse managers to provide opportunities to acquire knowledge of CTs. Moreover, nurse educators should advocate for updating nursing curricula to include CTs as an essential component of pain management education.

The effect of mandala coloring and free coloring on the happiness in veterans with post-traumatic stress disorder in the Covid-19 pandemic: a randomized clinical trial.

BACKGROUND: Post-traumatic stress disorder (PTSD) can lead to complications such as depression and grief, which are more prevalent in veterans than in the general population. Recently, art-making, including mandala coloring, has gained attention as a potential treatment for PTSD patients. METHODS: This randomized clinical trial was conducted on 84 male veterans diagnosed with PTSD and hospitalized at the Milad Psychiatric Center in Tehran, Iran. The patients were recruited using a convenience sampling method and were assigned to either the mandala coloring group or the free coloring group. The Post-Traumatic Stress Disorder Checklist DSM-5 and the Oxford Happiness Scale were used to collect data. The intervention group colored mandala designs, while the control group colored squares freely. Coloring was done twice a week for three weeks. RESULTS: The mean baseline happiness scores did not differ significantly between mandala coloring group and free coloring group (p = 0.376). However, at the end of study, happiness scores were significantly higher in mandala coloring group than in free coloring group (p < 0.001). After the intervention, happiness score of both groups increased significantly (p < 0.001). CONCLUSION: Both coloring methods increased veterans' happiness scores; however, mandala coloring was more effective than free coloring. It is recommended that art-making be added to conventional treatments for veterans with PTSD. TRIAL REGISTRATION: This study was registered in Iranian Registry of clinical trials (No. IRCT20210604051491N1, 29/08/2021).

Delamanid and bedaquiline resistance patterns in Mycobacterium tuberculosis in Iran: A cross-sectional analysis.

Introduction: The surge of multidrug-resistant TB (MDR-TB) in Iran poses a significant challenge to global healthcare. The introduction of delamanid (DLM) and bedaquiline (BDQ), two potent antimycobacterial drugs, marks a crucial advance. Nevertheless, as resistance in Mycobacterium tuberculosis is on the rise in Iran and resistance to these newer medications is emerging, investigations in this field are of utmost importance. Methods: In this cross-sectional study, 38 MDR-TB strains were collected from five distinct regional TB laboratories in Iran. The clinical isolates were confirmed as M. tuberculosis using the phenotypic tests and IS6110-based PCR assay. Drug susceptibility testing (DST) for isoniazid, rifampicin, ethambutol, DLM, and BDQ was performed using WHO-approved methods. Sequencing was used to investigate genetic mutations in DLM (ddn, fgd1) and BDQ (Rv0678, atpE, pepQ) genes associated with resistance. Results: Among the 38 collected MDR-TB isolates, 7 (18.5 %) exhibited resistance to DLM, while all remained susceptible to BDQ. Analysis of the sequencing data revealed that the ddn gene exhibited the highest number of mutations in DLM-resistant isolates, including 18 nonsynonymous mutations and 1 indel leading to frameshift mutations. A common mutation, Gly81Ser, was present in 4 of the DLM-resistant isolates (4/7; 57.1 %). A synonymous mutation, T960C, in the fgd1 gene was uniformly found in DLM-resistant samples. Notably, no significant mutations were observed in the atpE, Rv0678, or pepQ genes in any of the BDQ-susceptible isolates. Conclusions: Our study underscores the emergence of DLM resistance in a subset of MDR-TB isolates in Iran, primarily associated with mutations in the ddn gene. This emphasizes the ongoing necessity for TB drug resistance surveillance and research. While BDQ remains efficacious, the emergence of DLM resistance is a concerning development, warranting further exploration into resistance mechanisms and the formulation of effective TB control strategies.

Impact of Obesity on Cardiac Volumes and Left Ventricular Diameter: A Cross-Sectional Study in an Iranian Heart Center.

Introduction: Obesity, a pressing global health issue worldwide, contributes to risk factors such as hypertension and dyslipidemia, creating an unfavorable cardiovascular environment and increasing the likelihood of adverse cardiac events. His study aims to assess the impact of obesity on various cardiovascular parameters. Methods: A cross-sectional analysis was conducted at a Heart Center, focusing on adults admitted for suspected heart diseases. The dataset included information on demographics, clinical history, laboratory results, and echocardiography. Descriptive analysis and multiple linear regression were employed using IBM SPSS Statistics version 26. Results: The study of 105 individuals with suspected heart diseases revealed prevalent health factors such as hypertension (47.6%) and hyperlipidemia (61%). Body mass index (BMI) averaged 30, indicating a trend toward overweight. Obesity significantly associated with higher systolic blood pressure (SBP, p=0.005) and diastolic blood pressure (DBP, p=0.002), larger cardiac volumes (end-diastolic volume, EDV, p=0.013; end-systolic volume, ESV, p=0.040), and a marginally significant influence on left ventricular end-diastolic diameter (LVEDD, p=0.068). No significant associations were found with left ventricular end-systolic diameter (LVEDS), heart rate (HR), or ejection fraction (EF). Conclusions: Our study highlights a significant association between obesity and elevated blood pressure, larger cardiac volumes, and a marginal impact on left ventricular end-diastolic diameter. While caution is needed in inferring causation due to the study's cross-sectional nature, these findings underscore the importance of addressing obesity as a potential risk factor for adverse cardiovascular outcomes. Further investigations are warranted to enhance our understanding of the complex interplay between obesity and cardiovascular health.

Dietary supplementations to mitigate the cardiopulmonary effects of air pollution toxicity: A systematic review of clinical trials.

BACKGROUND: There is a consistent association between exposure to air pollution and elevated rates of cardiopulmonary illnesses. As public health activities emphasize the paramount need to reduce exposure, it is crucial to examine strategies like the antioxidant diet that could potentially protect individuals who are unavoidably exposed. METHODS: A systematic search was performed in PubMed/Medline, EMBASE, CENTRAL, and ClinicalTrials.gov up to March 31, 2023, for clinical trials assessing dietary supplements against cardiovascular (blood pressure, heart rate, heart rate variability, brachial artery diameter, flow-mediated dilation, and lipid profile) or pulmonary outcomes (pulmonary function and airway inflammation) attributed to air pollution exposure. RESULTS: After reviewing 4681 records, 18 studies were included. There were contradictory findings on the effects of fish oil and olive oil supplementations on cardiovascular outcomes. Although with limited evidence, fish oil offered protection against pulmonary dysfunction induced by pollutants. Most studies on vitamin C did not find protective cardiovascular effects; however, the combination of vitamin C and E offered protective effects against pulmonary dysfunction but showed conflicting results for cardiovascular outcomes. Other supplements like sulforaphane, L-arginine, n-acetylcysteine, and B vitamins showed potential beneficial effects but need further research due to the limited number of existing trials. CONCLUSIONS: Although more research is needed to determine the efficacy and optimal dose of anti-inflammatory and antioxidant dietary supplements against air pollution toxicity, this low-cost preventative strategy has the potential to offer protection against outcomes of air pollution exposure.

Synthesis of PEDOT/CNTs Thermoelectric Thin Films with a High Power Factor.

In this study, we have improved the power factor of conductive polymer nanocomposites by combining layer-by-layer assembly with electrochemical deposition to produce flexible thermoelectric materials based on PEDOT/carbon nanotubes (CNTs)-films. To produce films based on CNTs and PEDOT, a dual approach has been employed: (i) the layer-by-layer method has been utilized for constructing the CNTs layer and (ii) electrochemical polymerization has been used in the synthesis of the conducting polymer. Moreover, the thermoelectric properties were optimized by controlling the experimental conditions including the number of deposition cycles and electropolymerizing time. The electrical characterization of the samples was carried out by measuring the Seebeck voltage produced under a small temperature difference and by measuring the electrical conductivity using the four-point probe method. The resulting values of the Seebeck coefficient S and σ were used to determine the power factor. The structural and morphological analyses of CNTs/PEDOT samples were carried out using scanning electron microscopy (SEM) and Raman spectroscopy. The best power factor achieved was 131.1 (µWm-1K-2), a competitive value comparable to some inorganic thermoelectric materials. Since the synthesis of the CNT/PEDOT layers is rather simple and the ingredients used are relatively inexpensive and environmentally friendly, the proposed nanocomposites are a very interesting approach as an application for recycling heat waste.

Multidrug-resistant tuberculosis in Iran: a multicenter study.

The worldwide incidence of multi-drug-resistant tuberculosis (MDR-TB) is rapidly increasing, and it has emerged as a pressing public health issue in Iran. Nevertheless, there is a scarcity of up-to-date research on the prevalence of MDR-TB in individuals with pulmonary TB in the country. In this cross-sectional study, we gathered a total of 1216 respiratory samples, each corresponding to a unique patient, from five distinct regional TB laboratories in Iran. We identified clinical isolates as Mycobacterium tuberculosis using the IS6110-based PCR assay and Xpert MTB/RIF. Drug susceptibility testing (DST) was conducted using the conventional proportion method. Out of the collected specimens, 448 tested positive for M. tuberculosis. Among these isolates, 445 (99.4%) exhibited susceptibility to the tested drugs, while 3 (0.6%) were found to be MDR. The findings from this recent study indicate that the prevalence of MDR in Iran stands at 0.6%. The absence of recently approved treatment protocols in various regions of Iran, along with inadequately equipped laboratories lacking DST capabilities, could contribute significantly to the rise in TB/MDR-TB prevalence in Iran. Therefore, the implementation of enhanced treatment management strategies and the adoption of innovative technologies are essential steps towards improving the current situation.

Ezetimibe and atherosclerotic cardiovascular disease: a systematic review and meta-analysis.

Introduction: Individuals diagnosed with atherosclerotic cardiovascular disease (ACD) are exposed to an increased risk of cardiovascular events. Reducing low-density lipoprotein cholesterol (LDL-C) levels has been established as an effective approach to mitigate these risks. However, a comprehensive and up-to-date meta-analysis investigating the LDL-C-lowering effectiveness and the impact on coronary atherosclerotic plaque compositions of Ezetimibe has been lacking. Methods: We conducted a systematic review by meticulously analyzing databases such as MEDLINE, EMBASE, and the Cochrane CENTRAL for randomized controlled trials that evaluated the efficacy of ezetimibe in lowering LDL-C levels and its influence on coronary atherosclerotic plaques among individuals with ACD. This review encompassed studies available until August 1, 2023. In our analysis, we employed the weighted mean difference (WMD) as the aggregated statistical measure, accompanied by the corresponding 95% confidence interval (CI). Results: We encompassed a total of 20 eligible studies. Our findings unveiled that the combined therapy involving ezetimibe alongside statins led to a more substantial absolute decrease in LDL-C in comparison to using statins alone. This difference in means amounted to (-14.06 mg/dl; 95% CI -18.0 to -10.0; p = 0.0001). Furthermore, upon conducting subgroup analyses, it became evident that the intervention strategies proved effective in diminishing the volume of dense calcification (DC) in contrast to the control group. Conclusions: Our study findings indicate that the inclusion of ezetimibe in conjunction with statin therapy leads to a modest yet meaningful additional reduction in LDL-C levels when compared to using statins in isolation. Importantly, the introduction of ezetimibe resulted in a significant decrease in the volume of DC. However, it is worth noting that further investigation is warranted to delve deeper into this phenomenon.

The effects of mentorship and educational videos on nursing students' physical examination skills: a clinical audit.

BACKGROUND: Poor competence in clinical examination skills among nurses has been reported in practice, and there is a strong consensus that physical examination (PE) education must be improved. However, deficiencies cannot be resolved by theoretical training alone, and new training approaches are required to enable nursing students to perform PE accurately. This study aimed to determine and compare the effect of two new educational methods (mentorship and educational video methods) on the physical examination skills of Iranian nursing students. METHODS: This study was a clinical audit with three group pretest posttest design. Eligible nursing students were recruited through the census method and assigned to three groups (mentorship, educational videos, and control group) using permuted block randomization. Students were taught PE skills in three vital systems through three approaches (mentors, educational videos, and routine educational methods). Data were collected using a two-part instrument consisting of a demographic information questionnaire and a 32-item checklist for assessing the students' skills in examining the respiratory system (10 items), cardiovascular system (13 items), and 12 cranial nerves (9 items). Data were analyzed using SPSS software version 16 and descriptive and analytical statistical tests. RESULTS: At baseline, students in all groups scored less than half of the possible scores in all three systems, and the mean scores of the three groups were not statistically different (P > 0.05). After the intervention, the mean scores of students in the mentorship group increased significantly in all three systems (P < 0.001), whereas the mean scores of students in the educational video group and the control group did not change significantly (P > 0.05). Furthermore, after the intervention, the mean scores of the educational video group and the control group did not significantly differ in any of the three systems (P > 0.05). The ANCOVA showed that with posttest score as the covariate, PE skills in all three systems improved one week after the intervention in the mentor group compared to the control group and the educational video group. However, PE skills in all three systems did not improve one week after the intervention in the educational video group compared to the control group. CONCLUSIONS: The mentorship method is more effective than the educational video and routine methods for teaching PE skills to nursing students. Nursing schools can use the mentor method in training nursing students, and it is recommended to revise the PE lesson unit in the nursing curriculum and exchange it from a purely theoretical-based unit to a mixture of theoretical and clinical-based training. Educational videos alone cannot improve nursing students' PE skills; thus, if educational videos are used to teach clinical skills, it is necessary to hold hands-on sessions to provide feedback to students and correct their mistakes.

Implications and Mechanisms of Antiviral Effects of Lactic Acid Bacteria: A Systematic Review.

Background: Lactic acid bacteria (LAB) are among the most important strains of probiotics. Some are normal flora of human mucous membranes in the gastrointestinal system, skin, urinary tract, and genitalia. There is evidence suggesting that LAB has an antiviral effect on viral infections. However, these studies are still controversial; a systematic review was conducted to evaluate the antiviral effects of LAB on viral infections. Methods: The systematic search was conducted until the end of December 17, 2022, using international databases such as Scopus, Web of Science, and Medline (via PubMed). The keywords of our search were lactic acid bacteria, Lactobacillales, Lactobacillus (as well as its species), probiotics, antiviral, inhibitory effect, and virus. Results: Of 15.408 potentially relevant articles obtained, 45 eligible in-vivo human studies were selected for inclusion in the study from databases, registers, and citation searching. We conducted a systematic review of the antiviral effects of the LAB based on the included articles. The most commonly investigated lactobacillus specie were Lactobacillus rhamnosus GG and Lactobacillus casei. Conclusion: Our study indicates that 40 of the selected 45 of the included articles support the positive effect of LAB on viral infections, although some studies showed no significant positive effect of LABs on some viral infections.

Influenza vaccination and major cardiovascular risk: a systematic review and meta-analysis of clinical trials studies.

Cardiovascular events remain a substantial global health concern, necessitating innovative strategies for prevention. This study aims to assess the potential impact of influenza vaccination on major cardiovascular events. A search of the medical English literature was conducted using PubMed/MEDLINE, EMBASE, and the Cochrane CENTRAL up to 1 August 2023. Meta-analysis and stratified analyses were performed to investigate specific outcomes, including myocardial infarction (MI), cardiovascular death, and stroke. Pooled relative risks (RR) along with their 95% confidence intervals (CI) were calculated to evaluate the associations. A comprehensive analysis was conducted on a total of 9059 patients, with 4529 patients receiving the influenza vaccine and 4530 patients receiving a placebo. Among patients who received the influenza vaccine, a notable reduction in the occurrence of major cardiovascular events was observed, with 517 cases compared to 621 cases in the placebo group (RR 0.70; 95% CI 0.55-0.91). The stratified analysis revealed a decreased risk of MI in vaccinated patients (RR 0.74; 95% CI 0.56-0.97) and a significant reduction in cardiovascular death events (RR 0.67; 95% CI 0.45-0.98). This study provides compelling evidence that influenza vaccination is associated with a decreased risk of major cardiovascular events, particularly myocardial infarction, and cardiovascular death. These findings highlight the potential of influenza vaccination as an adjunctive strategy in cardiovascular disease prevention. Further research and exploration of underlying mechanisms are warranted to elucidate the observed beneficial effects.

Genetic diversity and biofilm formation of invasive and noninvasive Streptococcus agalactiae isolates: Emergence of hypervirulent CC19 strains in Tehran, Iran.

The prevalence of Streptococcus agalactiae infections in adult populations is increasing. The current study aimed to characterize the genetic features of S. agalactiae strains responsible for different infections. A cross-sectional study was performed on 65 S. agalactiae strains (30 invasive and 35 noninvasive) isolated from non-pregnant women. All S. agalactiae isolates were confirmed by atr and dltS PCR assays. Antibiotic susceptibility patterns were determined using the disk diffusion method. Biofilm production was investigated by microtiter plate assay. PCR was done to detect resistance determinants. Isolates were characterized using the multilocus sequence typing (MLST) method. cMLSB, iMLSB, and M phenotypes accounted for 47.7%, 30.8%, and 6.2%, respectively. MDR was detected in 15.4% of noninvasive and 44.6% of invasive isolates. MtP assay indicated that 80% of isolates were biofilm producers. Biofilm formation was common among noninvasive compared with invasive strains (94.3% versus 66.7%). tet (M) (46.2%) and erm (B) (69.2%) were the most prevalent tetracycline and macrolide-resistance genes. The most prevalent serotype was type III (50.8%), followed by Ia (18.4%), II (15.4%), V (12.3%), and IV (3.1%). The frequency of serotype III among biofilm producer strains (81.8%) was found to be significantly higher than that of non-producer isolates (18.2%) (P < 0.05). S. agalactiae was resolved within four clonal complexes, including CC19 (46.2%; in both invasive and noninvasive), followed by CC23 (30.8%; only noninvasive isolates), CC1 (15.4%; only noninvasive isolates) and CC17 (7.6%; only invasive isolates). The main sequence types (STs) found were ST19 (27.7%), ST17 (7.7%), ST27 (6.2%), and ST28 (4.6%) linked with invasive infections and ST23 (18.4%), ST933 (12.3%), ST644 (9.2%), ST19 (7.7%), ST1 (6.2%) found in noninvasive infections. The high prevalence of CC19 and CC23 clones among S. agalactiae strains reflects the emergence of these lineages as successful clones in Iran.

Fecal Microbiota Transplantation in Irritable Bowel Syndrome: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Irritable bowel syndrome (IBS) poses a significant challenge due to its poorly understood pathogenesis, substantial morbidity, and often inadequate treatment outcomes. The role of fecal microbiota transplantation (FMT) in managing IBS symptoms remains inconclusive. This systematic review and meta-analysis aimed to ascertain the effectiveness of FMT in relieving symptoms in IBS patients. A thorough search was executed on PubMed/Medline and Embase databases until 14 June 2023, including all studies on FMT use in IBS patients. We examined the efficiency of FMT in reducing patients' symptoms overall and in particular subgroups, classified by placebo preparation, FMT preparation, frequency, and route of administration. Among 1015 identified studies, seven met the inclusion criteria for the meta-analysis. The overall symptomatology of FMT-treated IBS patients did not significantly differ from the control group (Odds Ratio (OR) = 0.99, 95% Confidence Interval (CI) 0.39-2.5). Multiple doses of FMT compared with non-FMT placebo, or single-donor FMT therapy compared with autologous FMT placebo also showed no significant benefit (OR = 0.32, 95%CI (0.07-1.32), p = 0.11, and OR = 1.67, 95%CI (0.59-4.67), p = 0.32, respectively). However, a single dose of multiple-donor FMT administered via colonoscopy (lower gastrointestinal (GI) administration) significantly improved patient symptoms compared with autologous FMT placebo (OR = 2.54, 95%CI (1.20-5.37), p = 0.01, and OR = 2.2, 95%CI (1.20-4.03), p = 0.01, respectively). The studies included in the analysis showed a low risk of bias and no publication bias. In conclusion, lower GI administration of a single dose of multiple-donor FMT significantly alleviates patient complaints compared with the autologous FMT used as a placebo. The underlying mechanisms need to be better understood, and further experimental studies are desired to fill the current gaps.

The battle against colistin-resistant E. coli and the need for a one health approach.

Promoting the judicious use of antibiotics is crucial. Physicians and veterinarians must adhere to evidence-based guidelines and prescribe antibiotics only when necessary [26]. Improved diagnostic tools can help identify the most appropriate treatment options.

Mandibular Canal Branching Assessed With Cone-Beam Computed Tomography.

This study aimed to evaluate the prevalence and type of mandibular canal branching in a sample of the Iranian population through cone-beam computed tomography (CBCT) images. This cross-sectional study was performed on CBCT records of 300 patients (112 males and 188 females; mean age 30.14 ± 10.96 y). The presence of mandibular canal branch (MCB) was evaluated by reconstructing multiple panoramic views and buccolingual cross-sections, according to Naitoh's classification. The prevalence of MCB, the type of MCB, and the demographic information of all patients were recorded. The maximum number of branching and the maximum type of branching were also registered for each patient. Mandibular canal branching was observed in 131(43.7%) of 300 CBCT images without side or sex differences ( P > 0.05). The most frequent type was dental, followed by the retromolar, forward, and buccolingual types, respectively. There was a statistically higher frequency of retromolar canal in females than in males (odds ratio: 1.14 ± 4.25; P = 0.013). About 46% of patients with MCB had more than one accessory canal and 29% displayed more than one type of MCB. The coincidence of dental and retromolar canals in a patient was the most prevalent combination. Considering the relatively high prevalence of MCB (43.7%), it is recommended to keep in mind the possibility of anatomical variations of the inferior alveolar nerve during dental procedures to avoid postsurgical complications. The high possibility of observing multiple numbers and types of branching in the patients should also be considered during preoperative assessments.

Gastric Cancer Risk in Association with Underweight, Overweight, and Obesity: A Systematic Review and Meta-Analysis.

This study aimed to investigate the risk of gastric cancer (GC) in abnormal body mass index (BMI) groups. A systematic search was carried out on Embase, PubMed/Medline, and Scopus from January 2000 to January 2023. The pooled risk ratio (RR) with a 95% confidence interval (CI) was assessed using a random-effect model. Thirteen studies with total of 14,020,031 participants were included in this systematic review. The pooled RR of GC was 1.124 (95% CI, 0.968-1.304, I2: 89.08%) in underweight class, 1.155 (95% CI, 1.051-1.270, I2: 95.18%) in overweight class, and in 1.218 (95% CI, 1.070-1.386, I2: 97.65%) obesity class. There is no difference between cardia and non-cardia gastric cancer, while non-Asian race and female gender have higher risk of cancer, as Meta-regression of obesity and overweight classes showed. These findings suggest that there is a positive association between excess body weight and the risk of GC, with a higher impact in women than men and in non-Asian than Asian populations. Since abnormal weight is tied to various diseases, including GC, healthcare experts, and policymakers should continue interventions aiming to achieve a normal BMI range.

COVID-19 and coronary artery disease; A systematic review and meta-analysis.

Background and aim: Patients with underlying cardiovascular disorders such as coronary artery disease (CAD) are more prone to severe forms and multiple complications of COVID-19. The present systematic review and meta-analysis aimed to investigate the impact of CAD on patients with COVID-19. Methods: Main electronic databases, including Medline (via PubMed), EMBASE, and Web of Science, were carefully searched and reviewed for original research articles published between 2019 and 2021. One hundred nine studies that address CAD in patients with COVID-19 were selected and analyzed. Results: Following search and screening processes, 109 relevant publications were selected for analysis. The meta-analysis of prevalence studies indicated that the frequency of CAD among patients with COVID-19 was reported in 10 countries with an overall frequency of 12.4% [(95% CI) 11.1-13.8] among 20079 COVID-19 patients. According to case reports/case series studies, 50.9% of COVID-19 patients suffered from CAD. Fever was the most common symptom in these patients (47%); 36.5% also had hypertension. Conclusion: The results obtained during the present study show that the simultaneous presence of COVID-19 and CAD, especially in men and elderly patients, can increase the risks and complications of both diseases. Therefore, careful examination of the condition of this group of patients for timely diagnosis and treatment is strongly recommended.

Antibacterial Efficacy of Polymer-Coated Ceramic Microparticles Loaded with a Modified Combination of Antibiotics on the Enterococcus faecalis Biofilm.

Introduction: Nano-technology applied for the local delivery of different agents and/or drugs has made its path to endodontics. In the current study, the antibacterial efficacy of biopolymer-coated ceramic microparticles loaded with a modified combination of triple antibiotics, i.e. Penicillin G, Metronidazole and Ciprofloxacin (PMC), was evaluated against two strains of Enterococcus faecalis (E.faecalis); a standard clinical strain obtained from previously root-filled teeth with persistent periapical lesions, and compared to the most common antimicrobials used in endodontics. Methods and Materials: After synthesis of the polymer-coated microparticles loaded with antibiotics, the 21-day release of antibiotics were evaluated and a stock solution was produced using the maximum released amount of drugs and distilled water. The antibacterial activity of PMC, triple antibiotic paste (TAP), calcium hydroxide (CH), chlorhexidine (CHX) and sodium hypochlorite (NaOCl) against two bacterial strains was determined using "Minimum Inhibitory Concentration" and "Agar Diffusion Test". Additionally, "Microtiter Plate Assay" was performed to assess anti-biofilm properties. Results: Minimum inhibitory concentration values reported for TAP and PMC were 1/256. PMC showed the maximum diameter of growth inhibition in both strains (33 mm and 35 mm), while CH had the minimum diameters (13 mm and13 mm). Based on microtiter plate assay, TAP showed higher biofilm formation than PMC. Biofilm formation was higher in the standard strain for PMC; however, NaOCl, CHX and CH completely inhibited biofilm formation. Conclusions: Based on the findings of the present study, it could be concluded that PMC and TAP were the most effective medicaments against E.faecalis in its planktonic form; however, none could inhibit its biofilm formation. Further studies using larger sample size and "Confocal Scanning Laser Microscopy" are recommended.