---

Background and purpose: Post stroke spasticity has detrimental effects on quality of life and functions of patients. Moreover, it causes high economic and mental burden. Recognition of factors associated with spasticity can help in its treatment and prevention. The purpose of this study was to systematically review and meta-analysis of previously published studies concerning the prevalence of post stroke spasticity and its association with age, gender, type of stroke, and location of brain lesion. Materials and methods: A literature review was conducted in studies published between 2000-2014 in PubMed, Science Direct, Scopus, Google scholar, and Springer Link databases. The following terms were used as keywords: Spasticity, Ischemic stroke, hemorrhagic, location, prevalence, gender, and age. Results: We obtained 769 articles of which 42 were chosen based on their titles. After studying the abstracts and full texts, only 16 were considered that were congruent with the inclusion criteria of our study. The association between spasticity and time, age, gender, type of stroke and location was considered in 9, 9, 9, 5, and 6 articles, respectively. According to these studies the incidence rates of post stroke spasticity were 4-27% earlier than 3 months, 19-42.6% between 3 and 6 months, and 20-38% after 6 months. The intensity of the spasticity increased over time. Gender and type of stroke were not found to be significantly associated with spasticity in any study. Findings about age were contradictory in different articles. There was a significant relationship between sever upper limb spasticity and subcortical lesions. However, involved lobes or circulation sites were not significantly associated with spasticity. Conclusion: Time has an important role on incidence and intensity alternations of post stroke spasticity.

---

Background and purpose: Coronary heart disease is one of the most common reasons for mortality in many countries. High lipid levels such as high total cholesterol are recognized as the risk factors for cardiovascular diseases. Various studies investigated the prevalence of dyslipidemia in Iran, so, in current study we performed a systematic review and meta-analysis of all studies assessing the prevalence of dyslipidemia in Iran.

Materials and methods: The search was conducted using different databases such as Pubmed, SID, Magiran, Iranmedex, Irandoc, Medlib, and Google Scholar. The search keywords and terms included total cholesterol, prevalence, meta-analysis, and Iran. Finally 41 articles that were published during 1998-2011 were selected. Assigning weights to the studies was done based on number of samples and the prevalence was investigated using binomial distribution. Data was analyzed applying random effects model in STATA (version 10) and R software. Also, publication bias was assessed by funnel plot.

Results: Total number of samples in selected articles were 205913. Prevalence of total cholesterol &ge 200 mg/dl was 38% (CI95% = 30-46) which was 41% in male and 43% in female. The prevalence of cholesterol &ge 240 mg/dl (CI95%) was 17% (15-19) 15% in male and 18% in female. This prevalence was seen in both urban (18%) and rural (23%) areas.

Conclusion: Precise information and knowledge on prevalence of lipid profile disorders could help clinicians and policy makers to plan for suitable interventional programs that decrease the prevalence of cardiovascular diseases.

---

Background and purpose: Antibiotic prophylaxis is an effective strategy for reduction of postoperative infection. Prophylactic cefazolin and vancomycin are used in patients undergoing hip and knee surgeries. The aim of this meta-analysis was to determine the knee and hip infection after surgery in patients under cefazolin and vancomycin regimen/s.

Materials and methods: A literature search was performed in electronic databases including Google scholar, Pubmed, Web of science, and Scopus. The search keywords were hip, knee, cefazolin, and vancomycin. Eligible articles were determined after considering the inclusion/exclusion criteria. Finally, the heterogeneity among the results were defined by Q and I2 tests. Prevalence of infection were determined via randomized effect model based on heterogeneity results.

Results: The meta-analysis included 19 articles in which hip and knee infections were investigated in 77108 patients. Prevalence of infection (95% confidence interval) in patients receiving cefazolin, vancomycin, and both antibiotics was 1.2% (0.9-1.5), 0.9% (0.04-1.7), and 1.3% (1.04-1.6), respectively.

Conclusion: Current results showed low rates of postoperative knee and hip infections. There was no significant difference between the types of these antibiotics.

---

Background and purpose: Diabetes mellitus is one of the most common endocrine complications in thalassemic patients. Several studies investigated the prevalence of diabetes in Iranian patients with thalassemia major and reported different results but no overall estimate was calculated. Therefore, we conducted a meta-analysis to study the prevalence of diabetes in patients with thalassemia major in Iran.

Materials and methods: This review study was conducted by PRISMA checklist. Electronic databases including Magiran, Iranmedex, SID, Medlib, IranDoc, Scopus, Pubmed, Science direct, Cochrane, Web of Science, Springer, Online Library Wiley and Google Scholar were searched in chronological order without time limit, in January 2016, using relevant keywords. Two researchers independently performed article selection and data extraction. All studies meeting our inclusion criteria were investigated. Data analysis was done using random effect model in Stata Ver.11.1.

Results: Overall, 6380 patients were studied in 42 articles. Prevalence of diabetes in patients with thalassemia major in Iran was 9.5% (CI: 95%, 7.8-11.3). The minimum and maximum prevalence of diabetes were found in West (10.3%) and North of Iran (8.3%), respectively. The prevalence rate in male and female thalassemia major patients were 12.6% (CI: 95%, 6.1-19.1) and 10.8% (CI: 95%, 8.2-14.5), respectively.

Conclusion : Prevalence of diabetes in Iranian patients with thalassemia major was found to be high. Therefore, routine blood tests should be done every six-month for early diagnosis of diabetes in this population.

---

Background and purpose: Southern area of the Caspian Sea is an important resource of seafood products in Iran. One of the major factors affecting the health of seafood consumers is lead (Pb), due to its wide distribution and bio-accumulative property. In this study, all the studies, conducted during 2003-2016 on the amount of lead in white, mullet, and carp fish at the southeastern coast of the Caspian Sea were assessed.

Materials and methods: This meta-analysis used the data on 1242 muscle tissues of Rutilus frisii kutum, Liza auratus, Liza saliens, and Cyprinus carpio collected from the southern coast of the Caspian Sea. The level of lead concentration in samples was obtained from recently published articles in valid scientific journals. Then, dietary consumption risk and consumption limit of these fishes were assessed.

Results: In this study, mean concentrations of lead in fish muscle tissues were higher compared to levels accepted by various various national. However, daily and weekly absorption of this element through fish consumption was lower than the dose permitted by the Food and Agriculture Organization/World Health Organization. It was found that 0.23, 0.43, and 0.28 kg/day of Caspian white fish, mullet, and carp for adults, and 0.048, 0.09, and 0.58 kg/day of the these fishes can be consumed by children, respectively, without any non-carcinogenic effects.

Conclusion: According to the results of this study, a great difference was observed between various studies in terms of the reported effect factor. While publication bias was notable, it seems that the current amount of consumption of the evaluated fish has led to no serious health risks in consumers.

---

Background and purpose: Dentists are constantly exposed to mercury vapor and its role in the development of many chronic diseases has been proven. Therefore, this study aims to determine the mean concentrations of mercury in samples of blood, urine and area air among Iranian dentists.
Materials and methods: This study was conducted based on PRISMA guidelines. Two authors searched Persian and English online databases including Magiran, Iranmedex, SID, Medlib, Scopus, PubMed, Science Direct, Cochrane, Web of Science and the Google Scholar search engine without time limit until 2016. To evaluate the heterogeneity of the studies, Cochran's Q test and I² index were used. Data were analyzed using Stata 11.1 software based on random effects model.
Results: 12 studies with a sample size of 1,276 dentists were reviewed. The mean concentration of mercury in samples of blood, urine and area air was estimated to be 1.21 μg/dl (95% CI [confidence interval]: 0.67 to 1.75), 5.54 μg/l (95% CI: 4.03 to 7.06) and 7.58 μg/m³ (95% CI: 2.56 to 12.60), respectively. The standardized mean difference in the mercury concentration was 1.75 μg/dl (95% CI: -0.05 to 3.55) in blood and 1.79 μg/dl (95% CI: -1.40 to 4.99) in urine between the case and control groups (P>0.05).
Conclusion: The results of this study demonstrated that the 95% CI of the mean concentration of mercury in the urine samples of Iranian dentists is higher than the standard limit. Therefore, Iranian dentists should be examined annually in terms of urinary mercury concentration.

---

Background and purpose: Contradictory evidences indicate that gestational diabetes mellitus (GDM) increase the risk of spontaneous abortion (SA). Therefore, in a systematic review and meta- analysis we investigated the association between GDM and SA.
Materials and methods: Relevant articles published between January 2000 and April 2016 were identified by a systematic search in national and international databases. Eligible studies were included in meta-analysis after quality assessment. We also determined the heterogenic index using Cochran’s test (Q) and I2. Based on the heterogenetic results, a random effect model was performed to combine the results. Stata software was used for data analyses.
Results: A total of 26 studies was included in current meta-analysis in which SA was reported in 2280 pregnant women with GDM. But in 24145 pregnant women without GDM SA occurred in 2386. Significant heterogeneity was observed between the results (P< 0.001, I-square=68.3, Q=30.6). According to the findings, total odds ratio of SA among pregnant women with GDM was 3.01 times more than that in pregnant women without GDM (95% CI: 2.38–3.82).
Conclusion: Appropriate control and screening for GDM in pregnant women could reduce the risk of SA.

---

Background and purpose: Carpal Tunnel Syndrome is the most common entrapment neuropathy caused by increased pressure of median nerve in the wrist area. The results of electronic searches in several studies have shown different prevalence rates of this syndrome in Iran in different populations. So, the purpose of this study was to estimate the prevalence of carpal tunnel syndrome in Iran using meta- analysis.
Materials and methods: Relevant keywords were searched in national and international databases. The articles were then selected based on inclusion/ exclusion criteria and quality assessment. Data including author names, year of publication, sample size, sample descriptions, assessment criteria, and the prevalence rate of carpal tunnel syndrome were entered in Excel. The standard error of the prevalence of carpal tunnel syndrome in each study was calculated based on the formula for binomial distribution. According to the I-squared heterogeneity and Q indices, the random or fixed effect model were used to estimate the overall prevalence. Also, sensitivity analysis, meta-regression, and survey of publication bias were carried out.
Results: A systematic search was completed and 10 articles met the inclusion criteria with 11 evidence of the prevalence of carpal tunnel syndrome in Iran. A total of 14525 people had been studied in whom the prevalence of carpal tunnel syndrome varied from 1.82% to 64.6%. The overall prevalence of carpal tunnel syndrome with physical examination based on the random effect model was estimated to be 17.53% (95% CI, 13.74- 21.31%).
Conclusion: This meta- analysis showed a relatively high prevalence of carpal tunnel syndrome in Iran. But, the frequency of this syndrome in different target groups requires further investigations.

 

---

Background and purpose: This review study and meta-analysis aimed at providing evidence on helmet use and its efficacy on death and various types of head injuries caused by motorcycle crashes in different countries.
Methods & Materials: Relevant databanks such as PubMed, Scopus, Web of Science, Science Direct, Embase and some relevant websites were searched for suitable studies. Two authors independently performed article selection, quality assessment and data extraction. Data analysis was done in Stata Software V14 applying random effects model.
Results: Overall, 107 studies -with different qualities- were entered into the current systematic review and 100 studies were entered into our meta-analysis. Total rate of helmet use in motorcycle riders and occupants were 63% (95%CI: 56-69%) and 41% (95%CI: 33-48), respectively. The studies that examined the effectiveness of helmet use in reducing head, face and neck injuries, (while controlling the confounders) showed that wearing helmet could reduce the risk of death by 45% (OR= 0.55, 95%CI: 0.41-0.68) and the risk of head and face injuries by 57% (OR=0.43, 95% CI: 0.36-0.50). But it was found that helmet may not considerably reduce the risk of neck injury.
Conclusion: In spite of the efficacy of helmet use on reducing the rate of deaths and head injuries among motorcyclists after a traffic collision, its use is still low and varies in different countries. But, the findings suggest that more use of helmets can facilitate global efforts to reduce road traffic injuries.
 

---

Background and purpose: Cleft lip and cleft palate are the most common congenital defects in the jaw and face. These defects can make serious problems, such as facial deformity, nutritional problems, respiratory problems, and difficulties with social interaction. Awareness of the incidence of these defects in the community is important. In a systematic review and meta-analysis we aimed at investigating the prevalence of cleft lip and cleft palate in Iran.
Materials and methods: An advanced search was conducted in all credible databases to access relevant articles using related keywords until February 1, 2018. After removing the duplicate, irrelevant, and poor quality papers, 17 articles were included. Data were analyzed applying random effects model in RevMan5.3 software.
Results: Total number of samples in selected articles was 1,077,537 neonates. Prevalence of oral cleft, both cleft lip and cleft palate, cleft lip, and cleft palate was 1.24 (CI 95%; 1.10-1.38), 0.88 (CI 95%; 0.70-1.06), 0.34 (CI 95%; 0.28-0.40), and 0.35 (CI 95%; 0.27-0.43) in 1000 live births. The prevalence of this disorder was found to be higher in males (1.82 vs. 1.09).
Conclusion: The overall prevalence of cleft lip and cleft palate in this study was lower than that in other countries in the Middle East and Asia. But its prevalence varies in different parts of Iran, therefore, it is necessary to investigate the risk factors in high risk areas and making appropriate plans to reduce the rate of cleft lip and cleft palate.

---

Background and purpose: Behavioral disorders in children will provide a basis for mental disorders in adulthood. Various studies reported different results on the prevalence of behavioral disorders in children, so, this systematic review and meta-analysis aimed at determining the prevalence of these disorders in Iranian children.
Methods and Materials: A meta-analysis was performed in scientific databases including SID, Magiran, Barakat Knowledge Network System, ScienceDirect, Medline (PubMed), and Google Scholar for relevant articles published in 2000-2017. Reference lists of articles identified were reviewed for additional articles. Heterogeneity between the studies was checked using index. Data were analyzed using the Comprehensive Meta-analysis (CMA) software.
Results: The overall prevalence of behavioral disorders was 23% (95% Cl 15.1%-33.5%) in Iranian children. The highest and lowest rates of behavioral disorders in children were recorded in Hamedan (54.7% [95% Cl: 49.8%-56.9%]) and Ardebil (1.8% [95% Cl: 0.9%-3.7%]), respectively. According to the meta-regression diagram, the prevalence of behavioral disorders in Iranian Children decreased with an increase in the sample size and increased by the year (time) (p<0.05).
Conclusion: High prevalence of behavioral disorders in Iranian children highlights the need for effective measures to prevent, control and treat these disorders.

 

---

Background and purpose: A lot of research has been done on the effectiveness of rehabilitation treatment in children with cerebral palsy. Functional mobility is one of the significant aspects in treatment of these children. This systematic meta-analysis aimed at reviewing the studies on the effectiveness of task oriented training on functional mobility in children with cerebral palsy.
Materials and methods: All articles about the effectiveness of task oriented training for functional mobility in children with cerebral palsy in English or Persian, published until January 2020, were studied by a thorough search in electronic databases, including  Medline, Embase, CINAHL, PubMed, PsychInfo, Web of Science, Magiran, ISC, and SID. After screening and assessing the quality of research papers and applying inclusion and exclusion criteria, data was analyzed by Comprehensive meta-analysis software (CMA).
Results: Out of 345 articles, eight met the inclusion criteria. The meta-analysis showed that task oriented training had more significant effect on functional mobility than other conventional approaches in children with cerebral palsy (P=0.000).
Conclusion: Task oriented approach could be used as a treatment method in improving functional mobility in children with cerebral palsy.

---

 Background and purpose: Methicillin-resistant Staphylococcus aureus (MRSA) is one of the major hospital and non-hospital pathogens in children. This meta-analysis and systematic review aimed at exploring the data on prevalence of MRSA in Iranian children.
Materials and methods: Primary articles in English and Persian were searched using the following keywords: prevalence, children, methicillin-resistant staphylococcus aureus (MRSA), and Iran. Electronic databases, including Pubmed, Web of Science, Google Scholar and Iranian databases such as Magiran and SID were searched for articles published in 2007-2019. Qualitative assessment of studies was done using STROBE checklist and data analysis was done in STSTA V11.
Results: A total of 55 articles were identified and 23 met the study inclusion criteria. The prevalence of MRSA in children with S. aureus infection was 22%. The prevalence of community acquired and nosocomial MRSA was 17% and 38%, respectively.
Conclusion: The current meta-analysis showed considerable rates of nosocomial and community acquired MRSA infections among children in Iran. So, pediatricians should consider this issue in empirical treatment.

---

 Background and purpose: Pseudomonas infections include urinary tract infections (UTIs), respiratory infections, soft tissue infections, dermatitis, bacteremia, gastrointestinal, bone and joint infections, and systemic types of infections, especially in hospitalized patients with severe burns, or patients with immunosuppression such as cancer or AIDS. Considering the importance of the virulence genes of Pseudomonas aeruginosa and the drug resistance that can be caused by this bacterium, the purpose of this study was to investigate the prevalence of multidrug-resistant virulence genes in isolates of P. aeruginosa in Iranian clinical samples.
Materials and methods: Using Scopus, ISI, Web of science, Pubmed, and Web of science databases, the following were used as keywords: phzM, phzH, phzII, phzI, phzS, plcH, plcN, algD, algU, pilB, and pilA. After limiting the search strategy and removing duplicates, the remaining articles were screened by examining the titles and abstracts. Finally, the heterogeneity index between studies was determined using Cochran's test (Q) and I2. Based on this information, the fixed effect model was used to estimate the prevalence of Pseudomonas infection.
Results: In 26 studies included in the meta-analysis, the frequencies of phzM, phzH, phzII, phzI, phzS, plcH, plcN, algD, algU, pilB, and pilA genes based on random effect model were 39.6%, 38.5%, 57%, 53.1%, 41%, 77.8%, 58.3%, 61.6%, 74%, 25.5%, and 25.5%, respectively.
Conclusion: This study showed presence of genes encoding virulence factors (phzM, phzH, phzII, phzI, phzS, plcH, plcN, algD, algU, pilB, and pilA) in clinical strains of P. aeruginosa. In general, different types of virulence genes of this bacterium indicate that these genes are linked to severity of pathogenicity.
 

---

Background and Purpose: Depression and anxiety disorders are increasing globally and represent major public health concerns. The relationship between fasting and the physical, social, psychological, and mental health of both healthy individuals and those suffering from various diseases has been reported in several studies. This systematic review aims to determine the association between fasting and anxiety.
Materials and Methods: This systematic review examined studies, including cohort, case-control, cross-sectional, and clinical trials, that explored the relationship between different types of fasting and anxiety. In this study, the population (P) consisted of participants with fasting experience, the intervention (I) was fasting, the comparison (C) was between the periods before and after fasting, and the outcome (O) was the level of anxiety before and after fasting. International databases, including Google Scholar, Medline, Scopus, Web of Science, and ScienceDirect (up to the end of 2021), were searched using the keywords "anxiety" and "fasting" in both English and Persian. The extracted data were entered into a checklist, which included the researcher's name, type of study, year of implementation, instrument used, type of fasting, and the mean and standard deviation of anxiety scores before and after fasting. Data were analyzed using Stata software (version 11). To estimate the difference in standardized means, the number of samples, the mean, and the standard deviation of the anxiety scores were extracted from the primary studies. Using the Metan command, the random-effects model, and Cohen's estimator, the standardized mean difference in anxiety scores with a 95% confidence interval was calculated. Heterogeneity between the results of the primary studies was assessed using the Q statistic and I-squared index, and publication bias was evaluated using the Begg and Egger tests. The NOS checklist was used to evaluate the quality of the included studies.
Results: A total of 1,408 articles were retrieved, of which 13 were related to the topic. Four articles were excluded from the analysis because they did not report the mean. Finally, nine articles were included in the systematic review (nine studies) and meta-analysis (eight studies). The results of the eight studies included in the meta-analysis using the random-effects model showed that the standardized mean difference of the anxiety scores before and after fasting, with a 95% confidence interval (-1.14, -0.21), was estimated to be -0.67. Additionally, the results of the meta-analysis, stratified by the type of fasting and the questionnaire used in the primary studies, indicated that the overall estimate of the standardized mean difference in anxiety scores before and after fasting was not significant when considering the data collection tool and the type of fasting. Based on the heterogeneity indices (I-squared: 93.9%, Q= 114.88, P<0.001), the level of heterogeneity between the results of the primary studies was high. Publication bias was evaluated using the Begg (P=0.322) and Egger (P=0.753) tests, which indicated that publication bias was not significant.
Conclusion: The results of this systematic review and meta-analysis showed that the average anxiety score after fasting decreased by 0.67 units (67%) compared to before fasting, indicating a significant reduction in anxiety following a period of fasting.