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Background Clostridioides ( Clostridium ) difficile is an important pathogen of healthcare- associated diarrhea, however, an increase in the occurrence of C. difficile infection (CDI) outside hospital settings has been reported. The accumulation of antimicrobial resistance in C. difficile can increase the risk of CDI development and/or its spread. The limited number of antimicrobials for the treatment of CDI is matter of some concern. Objectives In order to summarize the data on antimicrobial resistance to C. difficile derived from humans, a systematic review and meta-analysis were performed. Methods We searched five bibliographic databases: (MEDLINE [PubMed], Scopus, Embase, Cochrane Library and Web of Science) for studies that focused on antimicrobial susceptibility testing in C. difficile and were published between 1992 and 2019. The weighted pooled resistance (WPR) for each antimicrobial agent was calculated using a random- effects model. Results A total of 111 studies were included. The WPR for metronidazole and vancomycin was 1.0% (95% CI 0–3%) and 1% (95% CI 0–2%) for the breakpoint > 2 mg/L and 0% (95% CI 0%) for breakpoint ≥32 μg/ml. Rifampin and tigecycline had a WPRs of 37.0% (95% CI 18–58%) and 1% (95% CI 0–3%), respectively. The WPRs for the other antimicrobials were as follows: ciprofloxacin 95% (95% CI 85–100%), moxifloxacin 32% (95% CI 25–40%), clindamycin 59% (95% CI 53–65%), amoxicillin/clavulanate 0% (0–0%), piperacillin/tazobactam 0% (0–0%) and ceftriaxone 47% (95% CI 29–65%). Tetracycline had a WPR 20% (95% CI 14–27%) and meropenem showed 0% (95% CI 0–1%); resistance to fidaxomicin was reported in one isolate (0.08%). Conclusion Resistance to metronidazole, vancomycin, fidaxomicin, meropenem and piperacillin/tazobactam is reported rarely. From the alternative CDI drug treatments, tigecycline had a lower resistance rate than rifampin. The high-risk antimicrobials for CDI development showed a high level of resistance, the highest was seen in the second generation of fluoroquinolones and clindamycin; amoxicillin/clavulanate showed almost no resistance. Tetracycline resistance was present in one fifth of human clinical C. difficile isolates.

Background Evidence on psychological outcomes of gaming disorder (GD) is still scarce. This study aimed to investigate the mediating role of sleep hygiene in the relationship between GD and psychological distress (depression and anxiety) among Iranian adolescents. Methods This was a cross-sectional study among school students in Qazvin city, Iran. We administered GD, anxiety, and depression questionnaires in a paper-and-pencil format. GD was measured using the GD S4-SF scale, and anxiety and depression were evaluated using the DASS-21. We assessed sleep health as a mediator using the Sleep Hygiene Behaviors scale. Covariance-Based Structural Equation Modeling (CB-SEM) was employed for data analysis, accounting for sex and physical activity as the main confounders. Statistical significance was determined using various fit indices and confidence intervals. Results The sample consisted of 600 adolescents (41% female). CB-SEM revealed a positive but not statistically significant association between GD and depression, along with a negative statistically significant association with anxiety. Notably, sleep hygiene was identified as a partial mediator in the relationship between GD and depression, indicating that poor sleep practices may exacerbate depressive symptoms among adolescents with GD. However, no mediating effect was observed for anxiety. Conclusion Our data supported a mediating role for sleep hygiene in the association between GD and depression among participants. Our results highlight the critical need for targeted policy interventions to improve sleep hygiene among adolescents with GD.

Background Mycobacterium tuberculosis (MTB) is responsible for tuberculosis; that continues to be a public health threat across the globe. Furthermore, increasing heteroresistance (HR)-the presence of resistant and susceptible isolates among MTB strains- has been reported from around the world. This phenomenon can lead to full resistance development and treatment failure. Methods We systematically searched the relevant studies in PubMed, Scopus, and Embase (Until October 21, 2020). The study outcomes revealed the weighted pooled prevalence of antibiotic HR in MTB isolates with subgroup analysis by year, quality of study, and heteroresistance detection method. Results A total of 38 studies which had investigated MTB isolates were included in the meta-analysis. Geographically, the highest number of studies were reported from Asia (n  =  24), followed by Africa (n  =  5). Nineteen studies reported HR to isoniazid, with a weighted pooled prevalence of 5% (95% CI 0–12) among 11,761 MTB isolates. Also, there is no important trend for the subgroup analysis by the study period (2001–2014 vs 2015–2017 vs 2018–2020). HR to rifampin was reported in 17 studies, with a weighted pooled prevalence of 7% (95% CI 2–14) among 3782 MTB isolates. HR to fluoroquinolone and ethambutol were reported in 12 and 4 studies, respectively, with weighted pooled prevalence of 10% and 1% among 2153 and 1509 MTB isolates, correspondingly. Conclusion Based on our analysis, HR in MTB isolates with different frequency rate is present worldwide. Thus, the selection of appropriate and reliable methods for HR detection is crucial for TB eradication.

Introduction We evaluated the IraPEN program, a localized adaptation of the WHO PEN initiative in Iran, with respect to cardiovascular disease and hypertension screening and management. Methods A cross-sectional ecological study utilizing the Input-Process-Output-Outcome framework was conducted during 2020–2021. Aggregated data from non-communicable disease (NCD) facilities were collected and analyzed by urban/rural primary healthcare settings. Results The study evaluated 610 NCD facilities, serving 1.8 million adults aged ≥ 30, of whom 515,488 underwent 10-year WHO/ISH CVD risk scoring and hypertension assessment, indicating coverage of 30%. Input/process showed all NCD facilities had functional blood pressure devices, 87% had POCT for measurement of glucose and cholesterol and 14% experienced medication stock-outs in the past three months. All staff received CVD risk scoring training, with 60% re-trained during the last two years. Output/outcome indicators revealed 3% of individuals were at moderate risk (CVD risk 10–19%), 0.6% at high risk (20–29%), 0.9% at very high risk (≥ 30%), and 2.7% had a prior CVD history. Prevalence of hypertension was 17%, compared with a national survey, indicating an observed-to-expected ratio of 55%. 80% of patients with hypertension received blood pressure-lowering medications, and 74% of them achieved blood pressure control; 38% of CVD patients received antiplatelet/anticoagulant therapy, and 66% of eligible patients took statins. Conclusion IraPEN demonstrated low coverage for CVD risk scoring and hypertension detection but acceptable treatment and control rates. Management of patients with CVD seems suboptimal. The WHO/ISH CVD risk scoring may lack in detecting high and very high-risk individuals.

Background This study aimed to evaluate the feasibility of using the HIV self-test in high-risk Iranian groups (MSM, FSWs, and TGs). Methods This study was a mixed study designed as a quantitative–qualitative study conducted between October 1, 2020, and June 22, 2021, in Tehran and Karaj, Iran. The sample size needed for this study generally was 1000 people, including FSWs, MSM, and transgender individuals. Convenience and snowball sampling methods were used to collect the samples. Results A total of 930 eligible respondents were enrolled in the study, of whom 456 (49%) were female and 49 (5.3%) were transgender (98% of TGs were male to female), and their mean age was 33.63 years (10.54 SD). The feasibility of using HIV self-tests in Iranian high-risk groups was significantly high. The majority of participants (97%) did not have any confidentiality problems while preparing or performing the test. In general, feasibility was assessed based on five questions. The overall feasibility score was 6.33 (0.824 SD). Taking tests, reading HIV test results, finding a safe place to do the test, and accessing HIV self-tests showed a high average. Conclusion HIV self-testing was highly acceptable and feasible among high-risk populations, so routine HIV testing was efficiently possible.

Background Asthma is one of the important chronic diseases. The asthma prevalence is increasing in last decades. Despite the presence of good controller drugs like corticosteroids, about 60% of asthmatic patients use alternative medicine. This study was done to determine the effectiveness of Tregonella foenum graceum (fenugreek) seeds in mild asthma. Methods It is a double blind trial with placebo effect. One of the ancient prescriptions from Persian Medicine was selected. The participants were divided to three groups randomly. On group received fenugreek syrup one received honey syrup and the third received placebo. Duration of treatment was 4 weeks. Quality of life, Lung function tests and IL-4 levels were evaluated before and after treatment. Results From 90 participants to study 79 completed the process. After study there was significant increase in quality of the life and lung function tests and IL-4 levels in fenugreek and honey groups. Conclusion FEV1 level was improved more than 10% in fenugreek group. Treatment was well tolerated. No serious side effects were reported during the study. The aqueous extract of fenugreek seeds appears to be effective and safe in treatment of mild asthma. Trial registration The study was recorded with the Iranian Registry of Clinical trials [ http://www.irci.ir ], registration code: IRCT2016011325991N1

Background While many studies have examined relationships of neuroimaging variables to cognitive measures in multiple sclerosis (MS), longitudinal studies are lacking. The relationship of cognitive changes to neuroradiological changes in MS is thus incompletely understood. The present study systematically reviews all studies reporting a relationship between MRI changes and cognitive changes after at least one year of follow-up. Method An extensive and methodical search of online databases was conducted to identify qualified studies until August 2023. Among various cognitive tests and magnetic resonance imaging (MRI) measures, Symbol Digit Modalities Test (SDMT), Paced Auditory Serial Addition Test (PASAT), verbal fluency, T2 lesion volume (T2LV), white matter lesion volume (WML), and grey matter volume (GMV) qualified for inclusion in a meta-analysis investigating the association of cognitive changes to neuroradiological changes. Results We identified 35 studies that explored the link between MRI changes and changes in cognitive outcomes. Of these, twenty studies (57.14%) investigated the association between SDMT/PASAT and MRI metrics. Eleven studies (31.42%) focused on the relationship between MRI metrics and verbal learning and memory, while ten studies (28.57%) reported associations with visuospatial learning and memory. Furthermore, eight studies (22.85%) analyzed the correlation between verbal fluency and MRI measures. Only 5 were eligible for inclusion in the meta-analysis. The meta-analysis evaluated correlations between SDMT/PASAT and GMV ( r s  = 0.67, 95% CI 0.44–0.91), and verbal fluency and T2LV ( r s  = 0.35, 95% CI 0.09–0.60). Conclusion In this rigorously conducted systematic review, we found a significant association of cognitive changes, specifically SDMT/PASAT and verbal fluency, to changes in T2LV and atrophy in individuals with MS. Findings should be interpreted cautiously due to the limited amount of high-quality research, small sample sizes, and variability in study methodologies.

Objectives This study evaluated the effectiveness of the IraPEN program, an adapted version of the WHO Package of Essential Non-communicable Disease (PEN) intervention, in managing diabetes from September 2020 to September 2021 using the Input-Process-Output-Outcome framework. Methods In this Cross-sectional/Ecological study, aggregated data was collected from IraPEN facilities by medical universities using the electronic health system. The data was presented as numbers and proportions, for urban and rural healthcare facilities separately. Results The study surveyed 610 NCD facilities from184 comprehensive health centers under the supervision of 56 medical universities, which provided services to 1,785,226 individuals aged > = 30 years. In terms of input/process, 78% of NCD facilities had functional point-of-care testing, and 14% of health centers with drugstore experienced a stock-out of core medications during the past three months. In urban facilities, 66% had at least a trained nutritionist, and 82% trained psychologist. Regarding output/outcome, 26% of expected diabetes and 23% of expected pre-diabetes, as estimated by the STEPS 2016 survey, were enrolled in NCD facilities, with higher rates in rural than urban areas. Among the referred patients, 38.7% took statins, 53% visited a physician in the last three months, 57.2% were referred for dietary assessment, and 72.5% were referred to secondary care. Around 39% of diabetic patients with at least one HbA1c laboratory test had good glycemic control. Conclusions The IraPEN program has managed only a quarter of diabetic patients, and less than half of them are in good glycemic control. Urgent improvements, mainly in coverage and effectiveness, are necessary.

Background: Vaccination seems to be the most critical means of halting the COVID-19 pandemic. It is crucial to understand the factors that influence COVID-19 vaccine acceptance to avoid low vaccination rates. This study intended to monitor the COVID-19 vaccine acceptance and its association with socio-demographic factors and prior diagnosis of COVID-19 in Iranian adults during the COVID-19 pandemic. Methods: The study utilized data from the COVID-19 Population Survey of Iran (COPSIR), a repeated national survey designed to monitor COVID-19-related behavioral insights. From April 2020 to November 2021, thirteen iterations of a series of cross-sectional studies involving computer-assisted telephone interviews were conducted. Results: The COVID-19 vaccine acceptance rate remained above 80% until the ninth wave in February 2021, when it dropped to 62.9%. However, throughout the next four surveys, it rose gradually from 72.0% to 85.7%. The multilevel regression model revealed that the COVID-19 vaccine acceptance was significantly and positively linked with age and education. Conclusion: Despite the relatively high COVID-19 vaccine acceptance rate among Iranian adults, after the emergence of vaccines on the global market and controversies about their safety in Iran, the initially high vaccine acceptance rate dropped significantly, and then increased over time and returned to its peak level (85%). According to the Commodity Theory, this rise in vaccine acceptance can be attributed to the COVID-19 vaccine shortage in the country between January and July 2022. For Iranian adults to accept vaccines more readily, health promotion programs should target the youth and the less literate adults.