meta

Over the past 2 decades, endoscopy has become an integral part of the surgical repertoire for pituitary procedures and over the past several decades, the endoscopic endonasal trans sphenoidal approach (EETA) has gradually become an accepted option for pituitary tumors with intra-,supra-,and para-sellar location and extension, because of its minimal invasiveness and high efficiency. Over the past several decades EETA offers improved illumination and superior panoramic visualization of the sella and the surrounding structures. Compared with traditional sub labial or trans septal microscopic approach, EETA offers minimal invasiveness, fewer complications, and overall improved outcomes. However, some EETA operations are performed through one nostril (mononostril endoscopic Trans sphenoidal approach [META]), while other EETA operations are performed through both nostrils (binostril endoscopic Tranchr(chr('39')39chr('39'))s sphenoidal approach [BETA]) and recently through one and a half nostril approach [OETA]. Both of these three approaches have some pros and cons.The real aim of this study is to compare between 3different EETAs from pros and cons viewpoint of these three approaches and some comparison between traditional microsurgery (microscopic trans sphenoidal approach) and transcranial approach and EETA in pituitary adenoma.

To provide up-to-date information on these three approaches, we concisely reviewed these three approaches and their pros and cons. Using the keywords, neuroendoscopy, META ,OETA , BETA ,pituitary adenoma,EETA,endoscopy, pituitary surgery, trans sphenoidal approach, binostril, mononostril, one and a half nostril, transcranial approach for pituitary adenoma, microscopic trans sphenoidal approach all the relevant articles were retrieved from Google Scholar,PubMed,and Medline reviewed, and critically analyzed.

Because of maneuverability of instruments and a wider view in the sphenoid sinus, the binostril technique is superior for resection of large tumors with parasellar and suprasellar extension and tumors requiring extended approaches. The mononostril technique is preferable for tumors with limited extension in the intra- and suprasellar area. Limitations to the mononostril approach may be as following: a crowded narrow nasal cavity, a harder tumor with invasive appearance or significant suprasellar extension, and lesions other than pituitary adenomas. The mononostril surgery may then be simply turned into a binostril, wider and more dynamic approach to allow for better dissection of such larger, harder, and more extensive tumors. However, we believe that these limitations resolve with changing in the lens of endoscope and some maneuver in creation of visual field in nasal cavity and transsphenoidal rout. The one-and-a-half nostril endoscopic trans sphenoidal approach is a simple and reliable technique. It provides not only a sufficient surgical corridor for a 2-surgeon/4 or 3-hands technique, but also ensures minimal invasion of the nasal canal.Its clinical results with respect to surgical outcome, maneuverability of instruments, postoperative morbidity, and postoperative quality of life support the theory that this is a highly efficient technique.

Based on the results of this study for selecting suitable EETA as META or BETA or OETA, the size and consistency of tumor,general versus invasive pituitary adenoma, and the extent of parasellar and suprasellar extension are important and transcranial approach is effective when resection becomes necessary for a portion or all of a pituitary macroadenoma that is judged to be inaccessible from the transsphenoidal route and looks like microscopic transsphenoidal approach is suitable for pediatrics pituitary adenoma, but for more reliable conclusion further studies are needed to prove this more conclusively.

The spondylo-meta-epiphyseal dysplasia (SMED) short limbs-hand type is a rare autosomal recessive disease, which is characterized by premature calcification leading to severe disproportionate short stature and various skeletal changes. Defective function of a conserved region encoding discoidin domain receptor tyrosine kinase 2 (DDR2 protein) by the discoidin domain-containing receptor 2 (DDR2 gene) is cause of this disease. The purpose of present study was to investigate disease-causing mutations on DDR2 gene in an Iranian family with SMED, and predict the DDR2 protein molecular mechanism in development of SMED.

In the present study, we evaluated a 2-year-old male with SMED. Detection of genetic changes in the studied patient was performed using Whole-Exome Sequencing (WES). PCR direct sequencing was performed for analysis of co-segregation of variants with the disease in family. Finally, in silico study was performed for further identification of molecular function of the identified genetic variant.

We detected a novel splice-site mutation (NM_001014796: exon9: c.855+1G>A; NM_006182: exon8: c.855+1G>A) in DDR2 gene of the studied patient using WES. This mutation was exclusively detected in patients with homozygous SMED, not in healthy people. The effects of detected mutation on functions of DDR2 protein was predicted using in silico study.

The causative mutation in studied patient with SMED was identified using Next-generation sequencing (NGS), successfully. The identified novel mutation in DDR2 gene can be useful in prenatal diagnosis (PND) of SMED, preimplantation genetic diagnosis (PGD), and genetic counseling.

The spondylo-meta-epiphyseal dysplasia (SMED) short limbs-hand type is a rare autosomal recessive disease, which is characterized by premature calcification leading to severe disproportionate short stature and various skeletal changes. Defective function of a conserved region encoding discoidin domain receptor tyrosine kinase 2 (DDR2 protein) by the discoidin domain-containing receptor 2 (DDR2 gene) is cause of this disease. The purpose of present study was to investigate disease-causing mutations on DDR2 gene in an Iranian family with SMED, and predict the DDR2 protein molecular mechanism in development of SMED.

In the present study, we evaluated a 2-year-old male with SMED. Detection of genetic changes in the studied patient was performed using Whole-Exome Sequencing (WES). PCR direct sequencing was performed for analysis of co-segregation of variants with the disease in family. Finally, in silico study was performed for further identification of molecular function of the identified genetic variant.

We detected a novel splice-site mutation (NM_001014796: exon9: c.855+1G>A; NM_006182: exon8: c.855+1G>A) in DDR2 gene of the studied patient using WES. This mutation was exclusively detected in patients with homozygous SMED, not in healthy people. The effects of detected mutation on functions of DDR2 protein was predicted using in silico study.

The causative mutation in studied patient with SMED was identified using Next-generation sequencing (NGS), successfully. The identified novel mutation in DDR2 gene can be useful in prenatal diagnosis (PND) of SMED, preimplantation genetic diagnosis (PGD), and genetic counseling.

The interaction between genetic and environmental factors has resulted in growing prevalence of obesity around the world. IL6-174 G/Cgene polymorphism is widely studied as the involved factor in developing obesity.

The aim of the present study is to evaluate the relationship between Interleukin 6-174 G/C promoter gene polymorphism and obesity in a systematic review and meta-analysis study.

In the present study Science Direct,Medline, Embase, Google Scholar, PubMedand SID search engines have been searched until March 2016. Articles were evaluated using the key words IL6 plus polymorphism or mutation or variant and adiposity, BMI and obesity. Data was analyzed using STATA software (12th version). OR ratio was calculated with 95% confidence interval to evaluate the strength in link between IL6 gene and obesity. Heterogeneity was calculated using I2 test. Articles bias was evaluated using funnel plot versus standard error (SE). The asymmetrydegree of the funnel plot was tested using linear regression tests ofEgger's and Begg's.

Generally, 12 articles entered systematic review and 6 articles entered final meta-analysis. After data was extracted, the total case group consisted of 5343 people and control group consisted of 3449 people. The odds ratio was estimated for additive model CC vs GC (OR= 1; CI: 95%: 0/9-1/12), recessive model CC + GC vs GG (OR= 1/04; CI: 95%: 0/95- 1/15) and for dominant model (OR= 1/10; CI: 95%: 1-1/21). Also the results showed that there is a statistically significant relationship between IL-61-74 G/C gene polymorphism and obesity (P

During lactation, metabolic changes in the bone in different areas of the body may affect the amount of bone mineral density. The aim of this study was to determine the relationship between breastfeeding and bone mineral density in women.
In this study, articles were searched at Cochran, Medline (via PubMed), Scopus, and Web of Science databases until June 2018. The search procedure was conducted with keywords related to breastfeeding and bone mineral density. The mean (SD) of bone mineral density was extracted in the lumbar spine and femoral neck. Funnel plot and Egger's test was used for publication bias assessing and I2 index were used for heterogeneity.
In this study, 10 articles involving 3,613 healthy women included for Meta analyze. We observed the decreasing trend in mean bone mineral density (BMD) of lumbar spine, femur neck in non-breastfeeding subgroup to 24 months or more breastfeeding subgroup. BMD of lumbar spine in non-breastfeeding women were [M: 0.96, 95%confidence interval [CI]; 0.89-1.02, P=0.000], in subgroup with more than 24 months breastfeeding the BMD were [M: 0.87, 95%CI; 0.79-0.95, P=0.000]. The femoral neck BMD in non-breastfeeding were [M: 0.80 95%CI; 0.73-0.87, P=0.000], and in subgroup with more than 24 months breastfeeding the BMD were [M: 0.76, 95%CI; 0.71-0.81, P=0.000]. In subgroup analyze, the mean BMD in Asian and postmenopausal sub-group was lower than others.
The results of this study showed that breastfeeding have reduced effect on bone mineral density in the lumbar spine and femoral neck of women, but there were high heterogeneity in sub-group analyze, so we recommended another studies in homogenous group of women.

Context: Depression is a highly prevalent and debilitating mental disorder, particularly among patients under hemodialysis, who are more susceptible to depression due to their complex treatment regimens, dietary limitations, side effects of medications and fear of disease outcomes. This systematic review and meta-analysis explored the prevalence of depression in Iranian hemodialysis patients.
Evidence Acquisitions: In this systematic review and meta-analysis, search was done in national and international databases, including SID, MagIran, Google Scholar, Web of Science, Medline (via PubMed), and Scopus from inception to March 2018. Key search terms included hemodialysis, renal replacement therapy, dialysis, end-stage renal disease, renal failure, depression and Iran along with all their possible combinations. Data were combined for metaanalysis using random effects model. Heterogeneity between studies was analyzed by I2 test, and data were analyzed by STATA (version 12) software.
The included 24 articles had a sample size of 2941 participants; the overall prevalence of depression in hemodialysis patients in Iran was 56.8% (95% CI: 50.5-63). The results of the univariate meta-regression analysis showed no significant correlation between prevalence of depression and methodological quality of articles (P=0.524), duration of hemodialysis (P=0.885), publication year (P=0.116), mean age of participants (P=0.224) and sample size (P=0.194).
More than half of the hemodialysis patients in Iran suffer from depression. Given the overlap of depression symptoms with uremia in this group of patients, it is necessary to identify depression in these patients for early management and interventions.

Low birth weight (LBW) affects newborns’ survival. It is also a credible sign of intra-uterine growth restriction and the most common health indicator for assessing neonates’ health conditions. The present study was conducted to determine the prevalence of LBW in Iran.
In this meta-analysis, we reviewed studies conducted in Iran through literature search in electronic databases including SID, Magiran, Irandoc, Iranmedex, PubMed [including Medline], Scopus, Web of Science, and Google Scholar. ‘Low birth weight’ and its synonyms were searched as keywords in English and Farsi languages to retrieve articles published from 2000 to 2016. Lastly, 20 articles were included in this study after appraisal using the tool of Hoy et al. The findings of the included studies were combined using a random model. The heterogeneity of reported prevalence among articles was also evaluated by Q test and I2 index. The data were analyzed by the STATA software.
Total number of the samples was 43801 individuals. The prevalence of LBW was between 2.6%-18.9% in some Iranian studies. According to the random effects model, total prevalence of LBW in Iran was estimated 9% (95% CI, 7%-10%). Differences in prevalence of LBW in terms of year (b=-2 * 10-3, P = 0.154) and sample size (b=-4.02 * 10-6, P = 0.317) were not statistically significant.
Despite differences in the designs of the included studies, LBW had a high prevalence in Iran. Therefore, there is a need to adopt meticulous care policies during pregnancy. Further investigations on the risk factors of LBW are required to be conducted in different areas of Iran.

Context: Promoting the quality of learning and teaching processes at the tertiary level, including distance education, has been considered as a strategic approach by policy makers in higher education, throughout the world. For this reason a reliable and comprehensive evaluation mechanism can play an important role in assessing the current situation and identifying the needs and problems from one hand and identifying the most important appraisal indicators on the other hand. This study aimed at critically reviewing the literature and theoretical frameworks of previous relevant researches to highlight the most important components and indicators that must be applied in appraising distance education.
Due to the importance of using the findings of previous studies as a foundation for extracting the most important appraisal indicators, 42 national and international research studies relevant to the evaluation of distance education were selected and analyzed, which were published in refereed journals during year 2006 to 2015. The eligibility criteria for selecting these studies were their relevance to any aspect of distance education. For this reason and in order to identify indicators, the content of these studies were analyzed based on the open coding method. Later on, all findings were categorized, outlined, and summarized according to the main components, which may form a comprehensive evaluation system for distance education at the higher education level.
The findings of this meta-synthesis showed that pedagogical knowledge, technology, learning organization, educator, learner, learning content, teaching models and strategies, time, place and space were the most important components of a comprehensive appraisal system that should be considered in evaluating distance education systems and its mechanisms and processes, continuously.
The rise of distance education in Iran’s higher education sector has urged that new comprehensive evaluation system has to be applied as a platform for improving and guaranteeing the quality of learning and teaching processes, curriculum and learning materials, and even the way by which these institutions are managed. Consequently, it is important to be assured that our policies and practices in higher distance education are on the right pathway. Therefore, based on the theoretical frameworks and studies performed before, the outcome of this meta-synthesis however, has highlighted some critical components which are necessary to be taken into account if this system has to be evaluated comprehensively.

Context: Hypertension is one of the most important issues in advanced and developing countries and is prevalent in diabetic patients. The present study was aimed at estimating the prevalence of hypertension in diabetic patients in Iran through meta-analysis.
Evidence Acquisitions: The search was carried out using authentic Persian and English keywords in national and international databases including IranMedex, SID, Magiran, IranDoc, Medlib, ScienceDirect, PubMed, Scopus, Cochrane, Embase, Web of Science, Medline and Google Scholar search engine without any time limitation until 2017. Heterogeneity of studies was assessed using I2 indexes. Data were analyzed using STATA software version 11.1.
In 32 reviewed studies with a sample of 34714 subjects, the prevalence of hypertension in Iranian diabetic patients was 51% (95% CI, 43%-60%). The prevalence of hypertension was 55% in type I diabetics and 53% in type II diabetic patients. Metaregression showed that there was no significant relationship between the prevalence of hypertension in diabetic patients with the sample size and year of study.
About half of the diabetic patients in Iran suffer from hypertension. Patients with type 1 diabetes suffer from hypertension 2% more than type 2 diabetes patients. The prevalence of hypertension in diabetic patients in Iran has not significantly decreased over the past years and diabetic patients in northern Iran are more likely to have hypertension than other parts of the country

Recent studies suggest that Denosumab reduces tumor size, therefore, makes the surgery easier with lower morbidity. However, some studies have reported several complications for this drug. So, this systematic review was performed to determine the effectiveness and safety of Denosumab in reducing bone destructions activity of giant cell tumor and skeletal-related events (SRE) in affected patients with giant cell tumor of bone (GCTB) and its recurrence. We explored studies in PubMed, and Cochrane Library. For this purpose, articles of various levels were retrieved until October 22, 2016. Two reviewers assessed the articles independently based on predefined criteria to extract the relevant data. Primary outcomes associated with skeletal-related event, overall survival, and secondary outcomes such as pain, quality of life and adverse events were evaluated and analyzed.The total population of this meta-analysis consisted of 686 patients. Of this population, 55% had primary GCTB and 45% had giant cell tumor recurrence, with 2% experiencing secondary recurrence. The results showed the effectiveness of Denosumab in reducing the tumor size due to inhibiting the Osteoclastogenesis. Denosumab didnot show any effect on reducing tumor recurrence, but, in cases where complete tumor surgery is not possible and tumor residuals may remain, Denosumab can be helpful. Also, the clinicians should consider the risk benefit of Denosumab.

The probability of HIV transmission through contaminated blood and blood products is eye catching. 5%-10% of blood products are contaminated with HIV. Therefore, it is essential to provide safe blood supply to prevent transmission of infectious diseases. Current systematic review and meta-analysis was conducted to evaluate the weighted prevalence of HIV in Iranian blood donors.
This study was reported according to PRISMA checklist for systematic reviews and meta- analysis. Required data were collected by using key words such as "HIV", "blood donation" OR "blood donors", "epidemiology" OR "prevalence", "blood transfusion" and "Iran", in international databases including PubMed, Scopus, Web of Science, Cochrane, Embase and national databases including Magiran, IranMedex and Scientific Information Databank. Papers were searched until December 2017. Cochran’s Q test and I2 index were used to assess the heterogeneity among studies.
A total of 49 studies including 5403170 donors entered this meta-analysis. According to analysis, the prevalence of HIVpositive patients among Iran blood donors was estimated 7.9/100000 (95% CI: 0.000052-0.000121%). The highest prevalence was related to the central region of Iran (11.3/100,000 [95% CI:0.000063-0.0002%]) and Kermanshah province (49.2/100000 [95% CI:0.000273-0.000888%]) and the lowest prevalence was related to the eastern region (1/100000 [95% CI:0.000001- 0.000072%]) and Khorasan Razavi province (0.9/100000 [95% CI:0.000001-0.000139%].
The overall HIV prevalence in Iranian blood donors is low and satisfying. However, the high prevalence in some regions and provinces should be reviewed more meticulously.

Domestic violence during pregnancy is a public health crisis, because it affects both mother ýand fetus simultaneously, resulting in irreversible consequences for mothers and their ýnewborns. This study was performed to determine the prevalence of sexual violence during ýpregnancy in the world and Iran as meta-analysis.ý
This study is a meta-analysis on the prevalence of sexual violence during pregnancy ýin the world and Iran that was conducted on Persian and English published articles up to ýý2015. To this end, through searching the information by key words and their compounds at SID, Medlib, Irandoc, Google scholar, Pubmid, ýISI, Iranmedex, Scopus and Magiran, , all related articles ýwere extracted independently by two trained researchers. The results of studies analyzed using ýthe STATA and Spss16 software.ý
In the initial searching of 167 articles, 33 articles related to Iran, 40 articles related to ýother parts of the world and totally 73 articles met inclusion criteria for study. The prevalence ýof sexual violence during pregnancy were estimated in the world 17% (CI95%:15% -18%) and ýin Iran 28% (CI95%: 23% -32%).The prevalence of sexual violence during pregnancy in Iran is ýý11 percent more than the world.ý
According to the present meta-analysis results, the prevalence of sexual violence ýduring pregnancy in Iran is high. Given that sexual violence during pregnancy causes damage to ýthe mother and infant, it is recommended that the relevant authorities with the implementation ýof intervention and educational programs reduce the prevalence of sexual violence during ýpregnancy.

Pycnogenol exhibits many biological activities, including control of blood pressure (BP). However, the reported results are inconsistent because of varied characteristics of participants and quality of studies. Thus, a meta-analysis was conducted to examine the effect of Pycnogenol supplementation on BP.
This literature search of PubMed, the Web of Science and the Cochrane library was performed in May 2016 to identify eligible studies. Reference lists of the retrieved articles were also reviewed. Either a fixed-effects or, in the presence of heterogeneity, a random-effects model was used to calculate the effect of combined treatment.
We identified nine trials involving 549 participants who received Pycnogenol supplementation ranging from 150 mg/d to 200 mg/d. Compared with the control, the pooled estimate of change in systolic and diastolic BPs were -3.22 mmHg (95% CI: -6.20, -0.24) and -3.11 mmHg (95% CI: -4.60, -1.62), respectively. Subgroup analyses showed higher BP reduction among hypertensive participants or those who received intervention for more than 12 wk. However, this significant reduction was not observed in well-designed trials.
This meta-analysis with nine trials provides better evidence that Pycnogenol exerts beneficial effects on BP.

Context: Many studies have reported contradictory results about the relationship between selenium levels and the risk of lung cancer.
This study was performed with the aim of evaluating the relationship between selenium and lung cancer.
The present systematic review and meta-analysis was carried out according to preferred reporting items for systematic reviews and metaanalyses (PRISMA) guidelines. Using MeSH keywords, two reviewers independently searched international databases including PubMed, Science Direct, Cochrane, EMBASE, Web of Science, CINAHL, Scopus, and Google Scholar. The data were combined, using comprehensive Meta-Analysis Software Version 2 based on the random effects model. The tests were considered significant at P In 15 high-quality studies including 13 case-control and 2 cohort studies, 84 199 subjects (2 434 cases and 81 765 controls) were studied. The odds ratio (OR) of lung cancer in the highest quintile of selenium exposure compared to the lowest quintile was 0.55 (95% CI: 0.35 to 0.86, P The results of the study indicated the preventive role of increased selenium levels in the incidence of lung cancer. Moreover, the selenium could be used as a predictive variable.