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Purpose The purpose of the study is to indicate a three-dimensional convective heat transfer properties evaluation of magnetohydrodynamics nanofluid flow, comprising motile oxytactic microorganisms and nanoparticles, passing through a rotating cone. Design/methodology/approach The imposed technique for solving the governing equations is the Runge–Kutta fifth-order method. The main point of this survey is to diagnosis the influence of diverse factors on velocity, temperature distributions and concentration profile. Furthermore, appending the magnetic field, thermal radiation and viscous dissipation in calculations; also, simultaneous involvement of heat absorption and excretion has been represented as novelties. Findings The results elucidate that by changing the Peclet number from 1 to 2, the dimensionless concentration of the microorganisms has been diminished by about 34.37%. In addition, variation of the magnetic parameter from 0 to 1 has been resulted in reducing the temperature distribution by about 3.11%. Originality/value Recently, attention has been absorbed to adding the motile microorganisms to nanofluid for enhancement of heat transfer and avoiding aggregation of particles. In this regard, the hydrothermal flow of microorganisms has been investigated in this study.

Osteoporosis is a common and important predictor of poor outcomes in celiac disease (CD), which puts many patients at risk of further fractures. Our objective was to evaluate the stratification of osteoporosis odds in CD patients based on their age, aiming to determine the optimal timing for initiating osteoporosis screening in this population.This cross-sectional study was performed on adult CD patients who were referred to the Celiac Clinic Center between 2015 and 2020. The exclusion criteria included individuals with endocrine disorders, corticosteroid use, smoking habit, post-menopausal women, and patients younger than 25 years old. Intestinal pathology, bone mineral density (BMD), TGA-IgA serum level, and serum vitamin D were assessed at the time of diagnosis. A total of 199 CD patients, who underwent lumbar densitometry at the time of their diagnosis, were included in the study with a mean age of 39.14 ± 8.99 years old. Osteoporosis was observed in 23.6% patients, of whom 25.5% were men and 74.5% were women. The results revealed a notable disparity across the four age groups. After accounting for potential confounding factors in multivariate analysis in fully adjusted model, our findings demonstrated that individuals between the ages of 45 and 55 had 22% higher odds of developing lumbar osteoporosis (odds ratio, 1.22; 95% CI, 1.02–1.45) compared to those aged 25–35. Individuals with CD are at an increased risk of developing lumbar osteoporosis in middle age. Therefore, it is recommended to begin BMD screening at age 45 and beyond. This recommendation further emphasizes the importance of receiving appropriate treatment to prevent fractures and preserve bone health.

Background Celiac disease (CD) is known as a reason of metabolic osteopathy. Progression of non-invasive methods such as bone densitometry has shown that an important ratio of CD cases is faced with impaired bone mass and such cases are prone to bone fractures. Variety of low bone mineral density in CD is probably because of ignored confounding factors such as age, menopause, and drug. The aim of our study was to systematically review the osteoporosis and osteopenia incidences among premenopausal females and males with CD. Methods This systematic review was done based on preferred reporting items for systematic reviews (PRISMA) guidelines. PubMed and Scopus and Cochran databases were searched according to the relevant medical subject headings (MeSH) of CD and bone mineral density until 2018. Prevalence of osteopenia and osteoporosis were used as effect size for meta-analysis. Cochrane Q ( p  < 0.05) and I 2 index were presented to reveal the heterogeneity. Results 54 eligible full text reviews were included and nineteen selected for data extraction. Eleven articles didn’t have our inclusion criteria and had ignored confounding factors like age and menopause, and we excluded; data extraction was done in eight studies. A total of 563 premenopausal women and men who were from, UK, Brazil, India, Hungary, and Poland were included. The pooled prevalence of osteoporosis was 14.4% [95%CI: 9–20.5%] (Cochrane Q = 7.889, p  = 0.96, I 2  = 49.29%), and osteopenia was 39.6% [31.1–48.8%] (Cochrane Q = 14.24, p  = 0.07, I 2  = 71.92%), respectively. Conclusion Our findings suggest that bone loss is more prevalent in celiac disease and can be associated with increased risk of fracture. However, but results are pooled prevalence and we need more case –control studies with more sample size and consideration of confounding factors.

Background The use of a tourniquet is common during anterior cruciate ligament (ACL) reconstruction, offering convenience for the surgical procedure. However, the potential adverse effects of tourniquet use have gained increasing attention from clinical researchers. We conducted this systematic review and meta-analysis to compare the clinical outcomes of tourniquet application versus non-tourniquet approach during arthroscopic ACL reconstruction. Methods A comprehensive search of PubMed, Web of Science, Embase, and Cochrane Library databases, was performed through March 2023 to identify controlled clinical trials. The main outcomes assessed included post-operative drain output, post-operative pain using a visual analogue scale (VAS), operation time, calf girth, and thigh girth. A random-effects meta-analysis was performed to account for heterogeneity, with weighted mean difference (WMD) and 95% confidence intervals (CI) used as pooled estimates for clinical outcomes. Results Of the nine potentially related studies, seven eligible studies (sufficient quantitative data) were included in the meta-analysis. Postoperative drain output in the tourniquet group was on average 100 ml higher than in the non-tourniquet group (95% CI: 36 to 168). Pain, measured by the VAS at 24 h postoperatively, was 0.42 points higher in the tourniquet group (95% CI: 0.08 to 0.76), with the increase persisting at 48 h, averaging 0.40 points (95% CI: 0.12 to 0.69). Thigh girth in the tourniquet group was reduced by 1.8 cm (95% CI: -2.7 to -0.94). No significant differences were observed for calf girth and the operation time. Conclusion Our meta-analysis indicates that tourniquet use during arthroscopic ACL reconstruction is associated with higher pain levels, increased postoperative drain output, and reduced thigh girth. However, performing the surgery without a tourniquet does not significantly extend the operation time. Trial registration The protocol was registered in the International Prospective Register of Systematic Reviews, PROSPERO (CRD42023417604).

Background Osteoarthritis is a common disease and one of the most important causes of disability in the elderly that negatively affect the quality of their life. The purpose of this study was to evaluate the effectiveness of mobile app-based-instruction in improving physical performance of female patients with knee osteoarthritis. Methods The present study was a randomized clinical trial. The sample included 64 female patients (40 to 70 years old) with knee osteoarthritis in Bojnurd city in 2018. They were selected from the available patients that were randomly divided into comparison and intervention groups. Before the intervention, demographic information questionnaire, Western Ontario and McMaster Universities Arthritis Index (WOMAC) questionnaire, and 36-item short-form health survey (SF-36) were employed to elicit data on demographic information, arthritis condition and health status of the participants. Intervention lasted for a period of two months for each group. Intervention group received mobile-app-based instruction coupled with routine cares, while comparison group just received the routine cares. After the intervention both groups were evaluated again in terms of arthritis condition and health status using the same scales. Results After the intervention, significant differences were found between the intervention and comparison groups in terms of overall WOMAC score ( p  = 0.005), pain aspect of WOMAC ( p  = 0.005), physical function aspect of WOMAC ( p  = 0.005), physical function aspect of SF-36 ( p  ≤ 0.05), and vitality aspect of SF-36 ( p  > 0.05). Conclusion The use of mobile-app-based instruction can enhance the physical function and quality of life in patients with knee osteoarthritis. Trial registration The research project was registered at Iranian Registry of Clinical Trials (IRCT20161208031300N2).

Background Cancer-related fatigue (CRF) is still undertreated in most patients, as evidence for pharmacological treatments is limited and conflicting. Also, the efficacy of the pharmacological agents relative to each other is still unclear. Therefore, medications that may potentially contribute to improving CRF will be investigated in this head-to-head trial. Our main objective is to compare the efficacy of methylphenidate vs. bupropion vs. ginseng vs. amantadine vs. placebo in patients with advanced cancer. Methods The 5-EPIFAT study is a 5-arm, randomized, multi-blind, placebo-controlled, multicenter trial that will use a parallel-group design with an equal allocation ratio comparing the efficacy and safety of four medications (Methylphenidate vs. Bupropion vs. Ginseng vs. Amantadine) versus placebo for management of CRF. We will recruit 255 adult patients with advanced cancer who experience fatigue intensity ≥ 4 based on a 0–10 scale. The study period includes a 4-week intervention and a 4-week follow-up with repeated measurements over time. The primary outcome is the cancer-related fatigue level over time, which will be measured by the functional assessment of chronic illness therapy-fatigue (FACIT-F) scale. To evaluate safety, the secondary outcome is the symptomatic adverse events, which will be assessed using the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events in cancer clinical trials (PRO-CTCAE). Also, a subgroup analysis based on a decision tree-based machine learning algorithm will be employed for the clinical prediction of different agents in homogeneous subgroups. Discussion The findings of the 5-EPIFAT trial could be helpful to guide clinical decision-making, personalization treatment approach, design of future trials, as well as the development of CRF management guidelines. Trial registration IRCT.ir IRCT20150302021307N6. Registered on 13 May 2023.

Background Migraine is a painful and disabling nervous disorder which negatively affects the quality of life. Migraineurs may suffer from a generalized vasomotor dysfunction. Statins improve vasomotor and vascular function, with their pleiotropic effects. We aimed to assess efficacy and safety of adding Atorvastatin to prophylactic regimen in better control of migraine with aura. Methods This triple-blind controlled clinical trial was on 68 patients with migraine with aura. An interval of at least 1 month was given to evaluate vitamin D3 level and eligibility. In patients with vitamin D3 deficiency, the correction with vitamin D supplementation was provided. The patients were randomly assigned to receive atorvastatin 20 mg plus sodium valproate 500 mg or placebo plus sodium valproate 500 mg once a day for 2 months. The patients were evaluated based for the number of attacks and pain severity based on Visual Analogue Scale. Results There was a significant ( p  = 0.0001) improvement in severity of pain and number of migraine attacks by adding Atorvastin to the prophylactic regimen of patients with migraine with aura. After controlling for variable parameters, the differences between two arms of the study was yet statistically significant ( p  = 0.0001). A significant number of participants in intervention group were satisfied by their treatment ( p  = 0.001) with no remarkable side effects ( P  = 0.315). Conclusions Adding atorvastatin to migraine with aura preventive regimen may help reduce the number of acute attacks and pain severity without causing considerable side effects and led to a better patient satisfaction. Trial registration IRCT20180106038242N1 . Registered: 7 February 2018.

Several barriers to mobilising elderly patients have been identified, including pathophysiological and psychological factors.5 6 Previous studies have shown that history of falls and self-perceived mobility problems are among the independent predictors for recurrent falls.5 Fear of falling, typically due to the lack of self-confidence in sustaining stability during walking, is a major psychological impediment to mobilising a patient with a previous fall.7 More than 55% of patients with previous fall experience are frightened of falling again; thus, they prefer to stay immobile.8 From the patient's perspective, immobility may be considered as a psychological response to previous falls or a self-protective behaviour to prevent a next possible fall.9 However, from the medical perspective, fear of falling is a vicious cycle that can physically and psychologically restrict patient activity and mobility, owing to the physical imbalance, lack of self-confidence, low self-efficacy, and low self-reliance.7 8 Whatever the cause, this type of fear can lead the patient to experience ‘self-imposed immobility', an immature concept that I use to express the consequence of fear of falling. [...]it seems that interdisciplinary teamwork is needed, to provide both physical and psychological interventions. [...]well-designed trials are required to evaluate the optimal physical interventions to overcome this fear, and psychological interventions, such as cognitive emotional behavioural therapy, must be evaluated and integrated into physical rehabilitation therapies.

Patients with end-stage renal disease (ESRD) are at an increased risk of cardiovascular disease due to many factors including inflammation and oxidative stress. N-acetylcysteine (NAC) is a thiol-containing anti-oxidant with anti-inflammatory properties. We aimed to assess the effect of three months treatment with oral NAC on the plasma levels of inflammatory mediators like interleukin-6 (IL-6) and C-reactive protein (hs-CRP) in patients on hemodialysis (HD). Twenty-four patients (nine males and 15 females) on maintenance HD were recruited in the study. Their mean age was 55.3 years. All the patients received oral NAC (600 mg twice a day) for a period of three months. The serum levels of biomedical parameters and IL-6 and hs-CRP were measured at baseline and three months after initiation of treatment. A significant decrease in serum levels of hs-CRP (22.4 vs. 5.2), IL-6 (8.1 vs. 3.6), parathyroid hormone (iPTH) (257.2 vs. 158.8), ferritin (632.0 vs. 515.1) and erythrocyte sedimentation rate (ESR) (54.2 vs. 38.3) was observed following NAC treatment. Female subjects presented with a significantly higher change in serum levels of hs-CRP compared with males (23 vs. 5.4). In three subjects who were less than 40 years old, the hs-CRP and IL-6 levels showed an increase following NAC treatment. Our study found that short-term oral NAC treatment might result in the reduction of IL-6 and hs-CRP in patients who are on regular HD. This suggests that patients with ESRD may benefit from the antiinflammatory effects of NAC.