Tabriz University of Medical Sciences

Background: The effects of sodium–glucose cotransporter-2 (SGLT-2) inhibitors on ischemia reperfusion injury (IRI) is a novel concept and only limited number of animals studies have yet been investigated. We aimed to perform a systematic review of literature to explore the clinical studies which investigated the effects of SGLT-2 inhibitors on myocardial IRI setting. Methods: We searched MEDLINE, Embase, and Cochrane Library from inception until December 7 th , 2023. ClinicalTrials.gov was also explored for ongoing studies. Two authors independently conducted the literature search, examined the studies, and evaluated the eligibility criteria. Any disagreements or uncertainties were resolved by the corresponding author. The search strategy followed the PICO process (Population, Intervention, Comparison, and Outcome) and Emtree was used to select relevant keywords. Results: Of 220 articles identified from the literature research, five articles were included in the study, of which three studies lately were retracted. The remaining studies included 1229 participants, with 209 receiving SGLT-2 inhibitors and 1090 not receiving them. All of the participants were diabetic patients admitted with acute myocardial infarction (AMI), undergoing percutaneous coronary intervention (PCI). The results demonstrated that the use of SGLT-2 inhibitors is associated with lower troponin levels, and higher rates of ST resolution. The results of the studies also showed smaller infarct sizes, lower inflammatory biomarkers and improved left ventricular function at discharge among SGLT-2 inhibitor users. Conclusion: In line with in vivo and ex vivo findings, the results of this systematic review supported benefits of SGLT-2 inhibitors in IRI through reducing infarct size and inflammatory biomarkers. However, further clinical trials are warranted to provide robust evidence.

The intersection of nanotechnology and pharmacology has revolutionized the delivery and efficacy of chemotherapeutic agents, notably docetaxel, a key drug in cancer treatment. Traditionally limited by poor solubility and significant side effects, docetaxel’s therapeutic potential has been significantly enhanced through its incorporation into nanoplatforms, such as nanofibers and nanoparticles. This advancement offers targeted delivery, controlled release, and improved bioavailability, dramatically reducing systemic toxicity and enhancing patient outcomes. Nanofibers provide a versatile scaffold for the controlled release of docetaxel, utilizing techniques like electrospinning to tailor drug release profiles. Nanoparticles, on the other hand, enable precise drug delivery to tumor cells, minimizing damage to healthy tissues through sophisticated encapsulation methods such as nanoprecipitation and emulsion. These nanotechnologies not only improve the pharmacokinetic properties of docetaxel but also open new avenues in regenerative medicine by facilitating targeted therapy and cellular regeneration. This narrative review highlights the transformative impact of docetaxel-loaded nanoplatforms in oncology and beyond, showcasing the potential of nanotechnology to overcome the limitations of traditional chemotherapy and pave the way for future innovations in drug delivery and regenerative therapies. Through these advancements, nanotechnology promises a new era of precision medicine, enhancing the efficacy of cancer treatments while minimizing adverse effects. Graphical Abstract

Background There has been limited research on the lasting impact of giving birth on both mothers and infants. This study aimed to investigate women’s memories of their childbirth experience 4 months and 4 years after giving birth. Additionally, it aimed to examine how the childbirth experience is linked to women’s mental health, sexual satisfaction, exclusive breastfeeding, and the type of subsequent birth. Methods In this prospective cohort study, a total of 580 women giving birth in Tabriz hospitals in 2018 were followed up for 4 years. The data were collected using a childbirth experience questionnaire, a mental health inventory, and a sexual satisfaction scale for women, and were analyzed by a Pearson correlation test, an independent samples t-test, and a general linear model. Results The total scores of the childbirth experience in two short-term (4 months) and long-term (4 years) time points following the birth had a significant and strong correlation with each other (r = .51; p < .001). After adjusting for the effects of socio-demographic and obstetric characteristics, sexual satisfaction had significant relationships with childbirth experience (p < .001) and postpartum complications (p < .001). In addition, mental health had significant relationships with childbirth experience (p < .001), postpartum complications (p < .001), and low income (p = .004). Conclusions Even 4 years after giving birth, women have a clear recall of their childbirth experience. This experience has a significant association with long-term outcomes such as sexual satisfaction, mental health, exclusive breastfeeding, and subsequent birth type.

Background: Iron deficiency is frequent in patients undergoing cardiac surgery. Intravenous iron agents have been used for treating patients with iron deficiency anemia. The present study aimed to investigate the efficacy of ferric carboxymaltose (FCM) among the iron deficiency anemia patient candidates for cardiac surgery. Methods: The present non-blinded, randomized, controlled clinical study was performed among two groups of the iron deficiency anemia patients underwent cardiac surgery. The first of whom was infused with a fixed dose of 1000 mg FCM, 3-5 weeks preoperatively, while the second group received no medicine (control). The changes in hemoglobin concentration and biomarkers of iron metabolism were repeated before surgery and 3 to 5 days after surgery. Moreover, the average number of consumed packed cells was assessed. Results: In this study, clinical tests, demographic characteristics, and surgery type were similar in two groups. Regarding hemoglobin (Hb) level, a significant difference was demonstrated between FCM-administered group in the preoperative stage (12.1 g/dL, 11.6-12.9) and the control (11.5 g/dL, 10.9-11.8) (P<0.001). Additionally, the preoperative serum ferritin level of FCM group was determined 580 ng/dL (435-787) which significantly differed from that of the control (57 ng/dL, 32-100) (P=0.001). Conclusion: The use of FCM is ineffective for preoperative anemia correction in the patients undergoing cardiac surgery and fails to decrease transfusion during surgery in spite of improvement in in iron stores.

In the regulation of gene expression, epigenetic factors like non-coding RNAs (ncRNAs) play an equal role in genetics. The role of microRNAs (miRNAs), which are members of the ncRNA family, in post-transcriptional gene regulation is well-documented and has important implications for both normal and abnormal biological processes, such as angiogenesis, proliferation, survival, and apoptosis. The purpose of this study was to synthesize previous research on miR-449a by analyzing published results from various databases, as there have been a number of investigations on miR-449’s potential involvement in the development of human disorders. Based on our findings, miR-449 is strongly dysregulated in a wide range of diseases, from various cancers to cardiovascular diseases, cognitive impairments, and respiratory diseases, and it may play a pivotal role in the development of these problems. In addition, miR-449a functions as a crucial regulator of the expression of several well-known genes, including E2F-3, BCL2, NOTCH1, and SOX4. This, in turn, modulates various pathways and processes related to cancer, including Notch, PI3K, and TGF-β, and contributes to the improvement of cancer drug sensitivity. Curiously, abnormalities in the expression of this miRNA may serve as diagnostic or prognostic indicators for distinguishing between healthy people and patients or to evaluate the survival rates for specific disorders. This article provides a synopsis of the current understanding of miR-449a’s role in human disease development through its regulation of gene expression and the biological processes related to these genes and their linked processes. In addition, we have covered the topic of miR-449a’s potential as a clinical feature (diagnosis and prognosis) indicator for a range of disorders, both neoplastic and non-neoplastic. In general, our goal was to gain a thorough comprehension of the numerous functions of miR-449a in different disorders.

Background Sexual and marital satisfaction is considered one of the important factors in happiness and life satisfaction of couples. COVID-19 pandemic results in psychological effects, such as increased anxiety levels which can affect sexual and marital satisfaction. This study aimed to investigate the impact of positive psychology on women’s sexual and marital satisfaction. Methods A randomized controlled trial was conducted on 72 married women of reproductive age in Tabriz, Iran between February 2021 and May 2022. The participants were randomly divided into the intervention and control groups. There was no significant difference between the control and intervention groups in terms of the socio-demographic characteristics (p < 0.05). The mean age of the participants in the intervention and control groups was 31.8 ± 6.92 and 30.97 ± 5.09 years, respectively. The intervention group attended seven 60–90 min counseling sessions at weekly intervals. The Spielberger anxiety, sexual satisfaction and marital satisfaction questionnaires were completed before and four weeks after the intervention. Results The results of this study indicated that after counseling, the average overall score of marital satisfaction [MD: 15.46, 95% CI: 7.47 to 23.41, p = 0.034] and sexual satisfaction [MD: 7.83, 95% CI: 6.25 to 9.41, p = 0.001] significantly increased in the intervention group compared to the control group. Also, the mean score of state anxiety [MD: -2.50, 95% CI: -4.19 to -0.80, p = 0.001] and trait anxiety [MD: -1.03, 95% CI: -2.46 to -0.09, p = 0.032] significantly decreased after counseling in the intervention group compared to the control group. Conclusions Using counseling based on a positive psychology approach can improve anxiety, sexual and marital satisfaction, and anxiety of women of reproductive age during the COVID-19 pandemic. However, further randomized clinical trials are needed before making a definitive conclusion. Trial registration Iranian Registry of Clinical Trials (IRCT): IRCT20171007036615N8. Date of registration: 11/28/21. Date of first registration: 11/28/21. URL: https://www.irct.ir/user/trial/58680/view; Date of recruitment start date: 12/01/21.

miRNA-21 is regarded as both an abundant and highly conserved member of the microRNA (miRNA) family. It is expressed in virtually every cell and is responsible for critical regulatory actions that are important in health and disease. This microRNA has been shown to potentially have a role in the pathogenesis of several immune-related disorders, including autoimmune diseases, such as Multiple sclerosis and systemic lupus erythematosus, as two prominent examples of diseases that might be involved. In the current research, we looked at the role of miRNA-21, regarded as one of the most significant pathogenic miRNAs with a role in the development of autoimmune illness.

Methanol-induced optic neuropathy (MION) represents a critical public health issue, particularly prevalent in lower socioeconomic populations and regions with restricted alcohol access. MION, characterized by irreversible visual impairment, arises from the toxic metabolization of methanol into formaldehyde and formic acid, leading to mitochondrial oxidative phosphorylation inhibition, oxidative stress, and subsequent neurotoxicity. The pathogenesis involves axonal and glial cell degeneration within the optic nerve and potential retinal damage. Despite advancements in therapeutic interventions, a significant proportion of affected individuals endure persistent visual sequelae. The study comprehensively investigates the pathophysiology of MION, encompassing the absorption and metabolism of methanol, subsequent systemic effects, and ocular impacts. Histopathological changes, including alterations in retinal layers and proteins, Müller cell dysfunction, and visual symptoms, are meticulously examined to provide insights into the disease mechanism. Furthermore, preventive measures and public health perspectives are discussed to highlight the importance of awareness and intervention strategies. Therapeutic approaches, such as decontamination procedures, ethanol and fomepizole administration, hemodialysis, intravenous fluids, electrolyte balance management, nutritional therapy, corticosteroid therapy, and erythropoietin (EPO) treatment, are evaluated for their efficacy in managing MION. This comprehensive review underscores the need for increased awareness, improved diagnostic strategies, and more effective treatments to mitigate the impact of MION on global health.

Introduction In the current systematic review and meta-analysis, we aim to analyze the existing literature to evaluate the role of inflammatory biomarkers, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), C-reactive protein (CRP), tumor necrosis factor-a (TNF-a), and interleukin-6 (IL-6) among individuals with cardiac syndrome X (CSX) compared to healthy controls. Methods We used PubMed, Web of Science, Scopus, Science Direct, and Embase to systematically search relevant publications published before April 2, 2023. We performed the meta-analysis using Stata 11.2 software (Stata Corp, College Station, TX). So, we used standardized mean difference (SMD) with a 95% confidence interval (CI) to compare the biomarker level between patients and healthy controls. The I² and Cochran’s Q tests were adopted to determine the heterogeneity of the included studies. Results Overall, 29 articles with 3480 participants (1855 with CSX and 1625 healthy controls) were included in the analysis. There was a significantly higher level of NLR (SMD = 0.85, 95%CI = 0.55–1.15, I² = 89.0 %), CRP (SMD = 0.69, 95%CI = 0.38 to 1.02, p < 0.0001), IL-6 (SMD = 5.70, 95%CI = 1.91 to 9.50, p = 0.003), TNF-a (SMD = 3.78, 95%CI = 0.63 to 6.92, p = 0.019), and PLR (SMD = 1.38, 95%CI = 0.50 to 2.28, p = 0.02) in the CSX group in comparison with healthy controls. Conclusion The results of this study showed that CSX leads to a significant increase in inflammatory biomarkers, including NLR, CRP, IL-6, TNF-a, and PLR.

Purpose of review The object of this narrative review is to identify the risk factors caused by using bone cement for patients and personnel in the operating room and to provide solutions to reduce or eliminate these factors to improve the quality of treatment for patients and the health of the medical staff. Recent Findings Bone cement is one of the most frequently used items in operating rooms and has a different chemical structure. Glass Ionomer Cement, Calcium phosphate bone cement, polypropylene fumarate, and polymethyl methacrylate are types of bone cement. Bone cement is dangerous not only for the patient but also for the surgical team. The surgeon, scrub nurse, circulating nurse, and anesthesia provider are also at risk because the preparation of bone cement produces pungent vapors that everyone in the room can inhale if adequate ventilation is not provided. Complications related to the use of cement in patients can be variable. It may cause bone cement implantation syndrome in some patients or increase intramedullary pressure in others. The incidence of complications in personnel is much higher than in patients, and operating room nurses and surgeons experience various problems in the respiratory, skin, nervous, cardiovascular, and even genetic systems. Summary Based on the recent findings, it is crucial to use strategies to reduce the side effects of using bone cement in personnel who are exposed to this substance and its vapors. Therefore, it is very important to use the equipment used to combine bone cement and pay attention to security points and use personal care equipment in the operating room environment.

Prostate cancer (PrC) is the most common cancer — after skin cancer — and the fifth most aggressive neoplasm among men worldwide. In most cases, PrC grow slowly and are limited to the prostate, where they may not cause serious damage. However, although some types of prostate cancer grow slowly and may require little or no treatment, other types are highly malignant and can spread quickly. The two main treatments for early-stage prostate cancer are surgery and radiation therapy, in general. The treatment of men with prostate cancer includes surgical surgery, radiotherapy, hormone therapy, brachytherapy, chemotherapy, and using nano drugs. Nanotechnology in cancer medicine has increased the effectiveness of drugs with the targeted development of anti-cancer drugs by nanosystems. This article presents an overview of recent advances in PrC nanomedicine, especially nano drugs in the treatment of prostate cancer. Graphical Abstract

Endometrial cancer is a prevalent gynecological malignancy typically characterized by abnormal uterine bleeding in postmenopausal women, although it can also manifest in asymptomatic patients. Asymptomatic postmenopausal women often display endometrial thickening, and research has shown associations between endometrial thicknesses of 5 mm or more and certain pathologies. However, it remains unclear whether specific pathologies are related to different diameters of thickened endometrium. The purpose of this study was to evaluate the relationship between the diameters of endometrial thickness its histopathology, and the related symptoms in postmenopausal women who have incidental endometrial thickening and are not experiencing vaginal bleeding. This study was conducted in Alzahra Teaching Hospital of Tabriz University of Medical Sciences. The inclusion criteria for the study comprised of postmenopausal women who had visited the clinics with symptoms other than vaginal bleeding and exhibited an endometrial thickness of more than 5 mm in ultrasound imaging. A total of eighty-four women were included in the final analysis. The participants were scheduled to undergo a Pap smear and endometrial biopsy (Pipelle biopsy). The histopathology of the endometrial samples was examined to test the research hypothesis. There was no statistically significant association between endometrial histopathologic findings and endometrial diameter (p-value = 0.12) or participants’ chief complaints (p-value = 0.21). Our findings indicate that endometrial thickening is not a reliable predictor for a specific endometrial pathology in postmenopausal women who do not experience vaginal bleeding.

Depression is a major cause of disability and, if left untreated, can increase the risk of suicide. Evidence on the determinants of depression is incomplete, making it challenging to interpret results across studies. This study aims to identify the social, economic, environmental, political, and technological factors influencing the great recession in Iran. The study was conducted in two parts. The first step involved a literature review to identify the factors, using PubMed, Scopus, and Web of Science for the search. The reference lists of all identified articles were reviewed to find relevant studies, and the extracted information was summarized and reported descriptively. The second steps involved compiling and consulting 14 experts from different fields, using a framework analysis method. Twenty-four articles were used as primary sources of information, and a total of 28 factors were found to exist. After removing duplicates and related factors, 19 of these were subsequently declared as factors, resulting in a total of 36 determinants being identified. Most of these factors belong to the social category. The health policies implemented have a significant impact on disease risk factors and ultimately their occurrence. Political decisions and policy-making processes play a crucial role in all areas, particularly in addressing disease risk factors. Severe depression can disrupt all aspects of the healthcare system, underscoring the importance of access to care. Policies concerning physical education, transportation, nutrition, employment, green spaces, recreational facilities, and tobacco are vital in this context. The influence of health policies on disease risk factors and disease occurrence is profound. Severe depression can have far-reaching effects on the healthcare system, emphasizing the critical need for access to care. The formulation of policies to combat depression must be thoroughly evaluated in terms of economic, political, social, technological, and environmental factors. The findings suggest that addressing social inequalities and emphasizing the role of political action, as highlighted by the social determinants of health, should be top priorities in addressing depression. Efforts to prevent depression should incorporate ecological approaches that consider the impact of the socioeconomic environment on depressive symptoms.

Physiochemical tissue inducers and mechanical stimulation are both efficient variables in cartilage tissue fabrication and regeneration. In the presence of biomolecules, decellularized extracellular matrix (ECM) may trigger and enhance stem cell proliferation and differentiation. Here, we investigated the controlled release of transforming growth factor beta (TGF-β1) as an active mediator of mesenchymal stromal cells (MSCs) in a biocompatible scaffold and mechanical stimulation for cartilage tissue engineering. ECM-derived hydrogel with TGF-β1-loaded alginate-based microspheres (MSs) was created to promote human MSC chondrogenic development. Ex vivo explants and a complicated multiaxial loading bioreactor replicated the physiological conditions. Hydrogels with/without MSs and TGF-β1 were highly cytocompatible. MSCs in ECM-derived hydrogel containing TGF-β1/MSs showed comparable chondrogenic gene expression levels as those hydrogels with TGF-β1 added in culture media or those without TGF-β1. However, constructs with TGF-β1 directly added within the hydrogel had inferior properties under unloaded conditions. The ECM-derived hydrogel group including TGF-β1/MSs under loading circumstances formed better cartilage matrix in an ex vivo osteochondral defect than control settings. This study demonstrates that controlled local delivery of TGF-β1 using MSs and mechanical loading is essential for neocartilage formation by MSCs and that further optimization is needed to prevent MSC differentiation towards hypertrophy.

Glioblastoma multiforme is a highly aggressive form of brain cancer, and early diagnosis plays a pivotal role in improving patient survival rates. In this regard, molecular magnetic resonance imaging has emerged as a promising imaging modality due to its exceptional sensitivity to minute tissue changes and the ability to penetrate deep into the brain. This study aimed to assess the efficacy of a novel contrast agent in detecting gliomas during MRI scans. The contrast agent utilized modified chitosan coating on manganese oxide nanoparticles. The modification included adding methotrexate and 5-aminolevulinic acid (MnO2/CS@5-ALA-MTX) to target cells with overexpressed folate receptors and breaking down excess hydrogen peroxide in tumor tissue, resulting in enhanced signal intensity in T1-weighted MR images but diminished signal intensity in T2*-weighted MR images. The nanosystem was characterized and evaluated in MR imaging, safety, and ability to target cells both in vivo and in vitro. MTX-free nanoparticles (MnO2/CS@5-ALA NPs) had no obvious cytotoxicity on cell lines U87MG and NIH3T3 after 24/48 h at a concentration of up to 160 µgr/mL (cell viability more than 80%). In this system, methotrexate enables tumor targeting and the MnO2/5-ALA improves T1–T2*-weighted MRI. In addition, MRI scans of mice with M109 carcinoma indicated significant tumor uptake and NP capacity to improve the positive contrast effect. This developed MnO2/CS@5-ALA-MTX nanoparticle system may exhibit great potential in the accurate diagnosis of folate receptor over-expressing cancers such as glioblastoma.

Epilepsy is a common neurological disorder that significantly affects the quality of life of patients. In this study, we aim to evaluate the effectiveness of dental pulp stem cell (DPSC) transplantation in decreasing inflammation and cell death in brain cells, thus reducing seizure damage. We induced seizures in rats using intraperitoneal injections of pentylenetetrazole (PTZ). In the PTZ + DPSC group, we conducted bilateral hippocampal transplantation of DPSCs in PTZ-lesioned rat models. After 1 month, we performed post-graft analysis and measured some behavioral factors, such as working memory and long-term memory, using a T-maze test and passive avoidance test, respectively. We investigated the immunohistopathology and distribution of astrocyte cells through light microscopy and Sholl analysis. Additionally, we employed the Voronoi tessellation method to estimate the spatial distribution of the cells in the hippocampus. Compared to the control group, we observed a reduction in astrogliosis, astrocyte process length, the number of branches, and intersections distal to the soma in the hippocampus of the PTZ + DPSC group. Further analysis indicated that the grafted DPSCs decreased the expression of caspase-3 in the hippocampus of rats with induced seizures. Moreover, the DPSCs transplant protected hippocampal pyramidal neurons against PTZ toxicity and improved the spatial distribution of the hippocampal neurons. Our findings suggest that DPSCs transplant can be an effective modifier of astrocyte reactivation and inflammatory responses.

Background Methamphetamine (METH) is a psychostimulant substance with highly addictive and neurotoxic effects, but no ideal treatment option exists to improve METH‐induced neurocognitive deficits. Recently, mesenchymal stem cells (MSCs)‐derived exosomes have raised many hopes for treating neurodegenerative sequela of brain disorders. This study aimed to determine the therapeutic potential of MSCs‐derived exosomes on cognitive function and neurogenesis of METH‐addicted rodents. Methods Male BALB/c mice were subjected to chronic METH addiction, followed by intravenous administration of bone marrow MSCs‐derived exosomes. Then, the spatial memory and recognition memory of animals were assessed by the Barnes maze and the novel object recognition test (NORT). The neurogenesis‐related factors, including NeuN and DCX, and the expression of Iba‐1, a microglial activation marker, were assessed in the hippocampus by immunofluorescence staining. Also, the expression of inflammatory cytokines, including TNF‐α and NF‐κB, were evaluated by western blotting. Results The results showed that BMSCs‐exosomes improved the time spent in the target quadrant and correct‐to‐wrong relative time in the Barnes maze. Also, NORT's discrimination index (DI) and recognition index (RI) were improved following exosome therapy. Additionally, exosome therapy significantly increased the expression of NeuN and DCX in the hippocampus while decreasing the expression of inflammatory cytokines, including TNF‐α and NF‐κB. Besides, BMSC‐exosomes down‐regulated the expression of Iba‐1. Conclusion Our findings indicate that BMSC‐exosomes mitigated METH‐caused cognitive dysfunction by improving neurogenesis and inhibiting neuroinflammation in the hippocampus.

Exosomes possess a significant role in intercellular communications. In the nervous system, various neural cells release exosomes that not only own a role in intercellular communications but also eliminate the waste of cells, maintain the myelin sheath, facilitate neurogenesis, and specifically assist in normal cognitive function. In neurological conditions including Parkinson's disease (PD), Alzheimer's disease (AD), traumatic brain injury (TBI), and stroke, exosomal cargo like miRNAs take part in the sequela of conditions and serve as a diagnostic tool of neurological disorders, too. Exosomes are not only a diagnostic tool but also their inhibition or administration from various sources like mesenchymal stem cells and serum, which have shown a worthy potential to treat multiple neurological disorders. In addition to neurodegenerative manifestations, cognitive deficiencies are an integral part of neurological diseases, and applying exosomes in improving both aspects of these diseases has been promising. This review discusses the status of exosome therapy in improving neurorestorative and cognitive function following neurological disease.

Background Iron deficiency anemia (IDA) is a global health challenge, especially affecting females and children. We aimed to conduct an umbrella systematic review of available evidence on IDA’s prevalence in Iranian pregnant women and children. Methods We searched the Web of Science, Science Direct, PubMed, Scopus, and Google Scholar databases for articles published by April 2023. Meta-analyses investigating the status of IDA in Iran were included. The findings of seven meta-analyses comprising 189,627 pregnant women with a mean age of 26 and 5,890 children under six years old were included in this study. The methodological quality of each study was evaluated with the Assessment of Multiple Systematic Reviews (AMSTAR2) instrument. Results We estimated the prevalence of IDA at 15.71% in pregnant women and 19.91% in young children. According to our subgroup analysis of pregnant women, IDA’s prevalence in urban and rural regions was 16.32% and 12.75%; in the eastern, western, central, southern, and northern regions of Iran, it was estimated at 17.8%, 7.97%, 19.97%, 13.45%, and 17.82%, respectively. Conclusion IDA is common in young children and pregnant females and is a significant public health concern in Iran. The present umbrella review results estimated that Iran is in the mild level of IDA prevalence based on WHO classification. However, due to sanctions and high inflation in Iran, the prevalence of anemia is expected to increase in recent years. Multi-sectoral efforts are required to improve the iron status of these populations and reduce the burden of IDA in the country.