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Background/aims: Non-alcoholic fatty liver disease is one of the most common chronic liver diseases. Some risk factors are known to influence the development of non-alcoholic fatty liver disease, but the effect of tobacco smoking on the progression of non-alcoholic fatty liver disease is controversial. The main goal of this systematic review and meta-analysis is to investigate the association between smoking and non-alcoholic fatty liver disease. Method: Electronic databases (PubMed, Scopus, and ISI Web of Science) were searched to find published articles on non-alcoholic fatty liver disease and smoking until December 2016. All relevant studies were screened by inclusion and exclusion criteria and compatible studies were chosen. The Newcastle–Ottawa Scale was used to assess the methodological quality of eligible articles. Subsequently, information was gathered based on the following: author, publication year, keywords, country, inclusion and exclusion criteria, main results, study design, conclusion, and confounder variables (age, body mass index, gender, ethnicity, and diabetes). Finally, analyses were performed using Comprehensive Meta-Analysis Software. Results: Data were extracted from 20 observational studies (9 cross-sectional, 6 case-control, 4 cohort studies, and 1 retrospective cohort study). A significant association was observed between smoking and non-alcoholic fatty liver disease with a pooled odds ratio of 1.110 (95% confidence interval, 1.028–1.199), p-value = 0.008. The statistical heterogeneity was medium with an I2 of 40.012%, p-heterogeneity = 0.074. Also there was a significant relation between non-alcoholic fatty liver disease and passive smoking with a pooled odds ratio of 1.380 (95% confidence interval, 1.199–1.588; p-value = 0.001; I2 = 59.41; p-heterogeneity = 0.117). Conclusion: Our meta-analysis demonstrated that smoking is significantly associated with non-alcoholic fatty liver disease. Further prospective studies exploring the underlying mechanisms of this association should be pursued. Also passive smoking increases the risk of non-alcoholic fatty liver disease about 1.38-fold. The effects of smoking cigarettes on active smokers (current smoker, former smoker, and total smoker) are less than passive smokers. Further studies are needed to compare the of effects of passive and active smoking on non-alcoholic fatty liver disease.

Our study systematically reviews articles about the prevalence of Post-traumatic Stress Disorder (PTSD) among children and adolescents, aiming to evaluate its prevalence after earthquakes and floods.Three databases (PubMed, Scopus, and Web of Science) were searched for articles published from 1981 to 2019 containing information on PTSD prevalence among survivors of earthquakes and floods. Articles with insufficient data on the prevalence of PTSD or without any available full-text were excluded. Major study variables consist of the prevalence of PTSD of the included studies, gender, and the elapsed time after the disaster. The overall PTSD prevalence was determined using a fixed-effect model for eligible studies. Of 4107 studies listed using our search strategy, 439 underwent full-text review, 59 records included in the systematic review, and 39 records met the criteria for meta-analysis. The pooled prevalence of PTSD among children and adolescent survivors after earthquakes and floods was 19.2% (95%CI = 18.6–19.7%), 30.0% (95%CI = 29.5–30.6%), 24.4% (95%CI = 23.4–25.4%) and 20.4% (95%CI = 19.1–21.7%), in the first, second, third and fourth six-month intervals after the disaster, respectively. Our analysis also revealed that PTSD was more prevalent among girls (p < 0.001). The absence of psychological support for affected areas considerably increases the risk of PTSD among survivors. Our results indicated that children and adolescents, especially girls, are more vulnerable and should be in top priority. The governments should refine their policies on post-disaster services and run early screening, immediate intervention, and ongoing monitoring for PTSD, as well as mental and emotional supports.

Biological features of silver nanoparticles in rising the insulin level of diabetic animal models were considered in recent years, which resulted in decreasing hyperglycemia condition. We reviewed the published literature to investigate the possible role of silver nanoparticles (Ag-NPs) throughout the treatment of diabetes mellitus in animal studies. In this systematic review and meta-analysis, we performed a search throughout the English literature of electronic databases, including Scopus, PubMed, and ISI Web of Science, up to the date of May 22, 2020. Primary outcomes and data regarding fast blood sugar (FBS), lipid profile, and liver enzyme were collected from the available articles, while the studies that did not provide sufficient information on the effects of silver nanoparticles through the course of diabetes mellitus were excluded. Our search yielded 1283 results that included five animal studies in the meta-analysis. The comparison between the plasma insulin level of the diabetic group treated by Ag-NPs with the diabetic control group displayed no significant differences with the P values = 0.299. In addition, significant differences were revealed by comparing the FBS level of the diabetic group treated by Ag-NPs with the diabetic control group (P value < 0.001). According to the present meta-analysis, the application of Ag-NPs in animal models resulted in displaying the anti-diabetic effects, which can be applied in future treatments. Furthermore, a correlation was noticed between these nanoparticles and the reduction of serum FBS among diabetic cases.

Background : The newly emerged coronavirus disease 2019 (COVID-19) seems to involve different organs, including the cardiovascular system. We systematically reviewed COVID-19 cardiac complications and calculated their pooled incidences. Secondarily, we compared the cardiac troponin I (cTnI) level between the surviving and expired patients. Methods : A systematic search was conducted for manuscripts published from December 1, 2019 to April 16, 2020. Cardiovascular complications, along with the levels of cTnI, creatine kinase (CK), and creatine kinase MB (CK-MB) in hospitalized PCR-confirmed COVID-19 patients were extracted. The pooled incidences of the extracted data were calculated, and the unadjusted cTnI level was compared between the surviving and expired patients. Results : Out of 1094 obtained records, 22 studies on a total of 4,157 patients were included. The pooled incidence rate of arrhythmia was 10.11%. Furthermore, myocardial injury had a pooled incidence of 17.85%, and finally, the pooled incidence for heart failure was 22.34%. The pooled incidence rates of cTnI, CK-MB, and CK elevations were also reported at 15.16%, 10.92%, and 12.99%, respectively. Moreover, the pooled level of unadjusted cTnI was significantly higher in expired cases compared with the surviving (mean difference = 31.818, 95% CI = 17.923-45.713, P value <0.001). Conclusion : COVID-19 can affect different parts of the heart; however, the myocardium is more involved.

Introduction: Intracranial pressure (ICP) elevation leading to cerebral edema is a critical condition that should be identified and treated immediately. In this study, we systematically reviewed the articles investigating the role of hypertonic sodium lactate (HSL) in patients with traumatic brain injury (TBI).Methods: PubMed, Scopus, Embase, and Web of Science were searched to find published articles on the effects of HSL on ICP in patients with a TBI until December 2020. Animal studies, case reports, and studies, including patients with liver and renal failure, cardiac dysfunction, or hypovolemic shock, were excluded. The Newcastle-Ottawa scale checklist was used to assess the methodological quality of eligible articles. Information obtained was classified based on the following criteria: demographic data, methods, intervention, and outcomes.Results: Our initial search with the predefined search strategy proceeded with 113 studies. Finally, 7 studies were eligible for systematic review, and 3 of them were eligible for meta-analysis. A random meta-analysis of 3 articles comparing ICP before and after the infusion of HSL showed a reduced ICP following the use of HSL in traumatic brain injuries (P=0.015).Conclusion: Our study demonstrated the undeniable role of HSL in managing increased ICP in patients with brain injury. Nevertheless, conducting more clinical studies to assess the possible side effects of HSL seems crucial.

Background and aims The kidney transplant patients who receive immunosuppressive and specific medication may lead to different mortality risk factors between kidney transplant patients with COVID‐19 and the general population. We aimed to provide a model predictor and a risk analysis of mortality in kidney transplant COVID‐19 positive patients. Methods We performed our search using PubMed, MEDLINE, Web of Science, Scopus, and Google Scholar to identify English articles published from the beginning of December 2019 through August 2020. Excluded manuscripts had no full text, lacked information, were not the original article, or consisted of less than three cases. We gathered information about demographic information, comorbidities, COVID‐19 symptoms, lung radiographic findings, history of medication therapy, and changes in the kidney maintenance therapy after confirming their COVID‐19 on the data extraction forms. Results We found a total of 31 eligible articles. We set a 10% mortality rate as our cutoff point. The most common sign and symptoms were cough (53.22 [29.42]), dyspnea (50.80 [24.55]). In the bivariate analysis, fatigue (P = .04, OR of 0.92; 95% CI: 0.85‐1.00), hypertension (P = .07, OR of 1.03; 95% CI: 1.00‐1.07), and dyspnea (P = .08, OR of 1.04; 95% CI: 1.00‐1.09) showed a statistically significant relationship with increases in mortality. In multivariate regression analysis, an independent association was only found between hypertension and mortality (P = .035; AOR of 1.064; CL: 1.004‐1.127). Conclusion Clinicians should pay special attention to modifiable risk factors for COVID‐19 infection mortality, such as hypertension among kidney transplant patients, because it may be possible to decrease mortality by controlling these factors.

BackgroundWe assessed secular trends in the burden of ischaemic heart disease (IHD), stroke, and dementia in the Organization for Economic Co-operation and Development (OECD) countries.MethodsUsing the Global Burden of Disease (GBD) Study 2017, we compared sex-specific and age-standardized rates of disability-adjusted life years (DALY); mortality, incidence, and prevalence of IHD and stroke; and dementia per 100,000 people, in the world, OECD countries, and Canada.ResultsFrom 1990 to 2017, the crude incidence number of IHD, stroke, and dementia increased 52%, 76%, and 113%, respectively. Likewise, the prevalence of IHD (75%), stroke (95%), and dementia (119%) increased worldwide. In addition during the study period, the crude global number of deaths of IHD increased 52%, stroke by 41%, and dementia by 146% (9, 6, and 3 million deaths in 2017, respectively). Despite an increase in the crude number of these diseases, the global age-standardized incidence rate of IHD, stroke, and dementia decreased by −27%, − 11%, and − 5%, respectively. Moreover, there was a decline in their age-standardized DALY rates (− 1.17%, − 1.32%, and − 0.23% per year, respectively) and death rates (− 1.29%, − 1.46%, and − 0.17% per year, respectively), with sharper downward trends in Canada and OECD countries. Almost all trends flattened during the last decade.ConclusionsFrom 1990 to 2017, the age-standardized burden of IHD, stroke, and dementia decreased, more prominently in OECD countries than the world. However, their rising crude numbers mainly due to population growth and ageing require urgent identification of reversible risk and protective factors.

Background Healthcare-associated infections (HAIs) challenge modern medicine. Considering their high prevalence in Iran, we aimed to provide knowledge on the subject, and to teach about the importance of infection prevention and control (IPC) to a broad audience of pre-graduate healthcare professionals, focusing on education as the cornerstone of IPC. Main body We invited Iranian medical students to present ideas on “how to reduce HAIs.” Projects were eligible if being original and addressing the call. Accepted projects were quality assessed using a scoring system. Forty-nine projects were submitted, of which 37 met the inclusion criteria. They had a mean score of 69.4 ± 18.3 out of the maximum possible score of 115. Four reviewers assessed the 37 projects for clinical applicability, impact on patient safety, and innovation, and selected the best 12 to compete at the 2nd International Congress on Prevention Strategies for Healthcare-associated Infections, Mashhad, Iran, 2018. The competition took place in three rounds. The selected teams presented their projects in the first round and debated one by one in a knockout manner, while the jury reviewed their scientific content and presentation skills. In the second round, the top 5 projects competed for reaching the final stage, in which the teams presented their ideas in front of a panel of international IPC experts to determine the first three ranks. At the end of the contest, the participants gained valuable criticisms on how to improve their ideas. Moreover, by its motivating atmosphere, the contest created an excellent opportunity to promote IPC in medical schools. Conclusions Using innovation contests in pre-graduates is an innovative education strategy. It sensitizes medical students to the challenges of IPC and antimicrobial resistance and drives them to think about solutions. By presenting and defending their innovations, they deepen their understanding on the topic and generate knowledge transfer in both ways, from students to teachers and vice versa.

IntroductionThe aMAP score, which incorporates patient‘s age, gender, albumin-bilirubin, and platelet counts, has demonstrated effectiveness in stratifying hepatocellular carcinoma (HCC) risk among patients with chronic hepatitis, including both cirrhotic and non-cirrhotic groups. However, its performance specifically in an exclusively cirrhotic population with various aetiologies, who are under standard follow-up including routine HCC surveillance, has not been previously documented. To evaluate the performance of aMAP score in predicting HCC development in patients from a stable liver cirrhosis clinic, over a three-year period.MethodsWe analyzed 106 patients from a nurse-led stable cirrhosis clinic (with physician oversight) between December 2019 and early February 2021. aMAP scores were calculated during clinic visits. All patients were scheduled for six-monthly HCC surveillance ultrasound. The study evaluated the distribution of risk categories: high-risk (≥60), medium-risk (50-59), and low-risk (<50) scores, and tracked HCC incidence over a three-year follow-up period.ResultsThe study population comprised 106 stable cirrhotic patients with diverse aetiologies (including alcohol, non-alcoholic steatohepatitis, chronic hepatitis B and C, haemochromatosis, autoimmune liver disease, and cryptogenic liver disease). The distribution showed 43 patients (41%) with high-risk scores, 50 (47%) with medium-risk scores, and 13 (12%) with low-risk scores. Over the three-year follow-up, 6 patients (5.66%) developed HCC: four from the high-risk group (9.30% of high-risk population) and two from the medium-risk group (4.00%). Annual HCC incidence rates were 3.10% for high-risk, 1.33% for medium-risk, and 0% for low-risk groups (table 1). Among the HCC diagnoses, five patients had BCLC Stage A disease, and one had Stage 0 disease. All received microwave ablation treatment, with one patient also undergoing liver transplantation. Notably, 15 patients (14%) missed one or more routine HCC screening ultrasounds, including 5 high-risk patients (33%), 9 medium-risk patients (60%), and 1 low-risk patient (7%).Abstract P224 Table 1Table showing relative numbers of high-risk, medium-risk and low-risk patient numbers along with the number of patients who developed HCC in the 3-year period. The annual HCC incidence rates are also mentioned, for each risk-groupRisk group Number of patients Number of patients who developed HCC in the two-year follow-up period Annual HCC incidence rate High-risk 43 4 3.10% per year Medium-risk 50 2 1.33% per year Low risk 13 0 0 ConclusionsThe findings revealed a high prevalence (88%) of either high-risk or medium-risk aMAP scores in the stable cirrhotic population. The 5.66% three-year HCC development rate resulted in potentially curable diagnoses for all affected patients. While the annual HCC incidence in high-risk and low-risk groups aligned with the original aMAP validation study by Fan et al, our medium-risk group showed higher annual HCC incidence. The findings validate aMAP scoring’s predictive value while highlighting surveillance compliance challenges, particularly among higher-risk patients.

Objectives: Mesenchymal stem cells (MSCs) play an important role in treating damaged tissues, growing and developing body tissues. Nowadays, the injection of stem cells has been considered for therapeutic purposes. Some substances which can be effective in the success rate of treatment are injected with the stem cells in the stem cell therapy. Anesthetics are a group of them. Local anesthetics toxicity on tissues such as nerve, cartilage, muscle and tendon are well described in many studies. Studies show local anesthesia can be toxic for stem cells too, and induce MSCs apoptosis and necrosis As a result, repairing of tissue by stem cells can be in trouble in damaged tissue which exposure to LAs. According to this, it is important to find the appropriate LA which has the least toxic effect on stem cells. In this study, we have considered the effects of LA such as lidocaine, bupivacaine, ropivacaine and mepivacaine on MSCs. Literature review: Local anesthetics toxicity has been described on chondrocytes by several studies. In this study, we have tried to find the effects of these drugs on mesenchymal stem cells. We have arranged local anesthetics for toxic effects to MSCs from high to low. According to this arrangement bupivacaine is the first drug, after that there are mepivacaine, lidocaine and ropivacaine, respectively. This sequence can be true for increasing the cellular metabolism, adhesive cells adhesion and also cellular appendages. Conclusion: The studies have indicated that MSCs is more sensitive to local anesthetics in comparison with chondrocytes. In addition to type of LAs, exposure time and drug dose play an important role in damaging to the MSCs. In other word, LAs effects are dose-dependent and time-dependent. however, The studies consider lesser neurotoxicity and longer local anesthesia effect for bupivacaine in comparison with other LAs such as lidocaine but it is recommended to use drugs which are safer (such as ropivacaine) in procedures including stem cell therapy, prolonged anesthesia and tissues are repairing. Because bupivacaine has high toxicity effect on mesenchymal stem cells.