Medical Journal of The Islamic Republic of Iran (MJIRI)

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Knowing the nucleotide sequence of the cholera toxin operon, we designed oligonucleotide primers for its-PCR amplification from local clinical isolates of V. cholerae. The resulting amplification product was cloned in a common pUC18 vector. Subsequently, a part of this operon encoding the cholera toxin Bsubunit (CTB) was reamplified and cloned between the BamH1 and EcoR1 sites of the same vector to create a recombinant plasmid pR18CTB. Temperaturecontrolled expression of the target protein was achieved by supplementing pR18CTB with a DNA fragment which contained a strong promoter PR and the gene for a heat-sensitive repressor cI857 of bacteriophage lambda from a n expression vector pCQV2. When induced, the constructed plasmid pSCTB18 provided for the production of recombinant CTB secreted into the periplasmic space in a yield of about 3mg per liter of bacterial culture, as revealed by OM 1- ELISA.

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With the plasmid DNA from a clinical isolate of enterotoxigenic Escherichia coli (ETEC) H 10407 as template, PCR-mediated cloning of the sequence encoding the heat-labile toxin B subunit (L T -B) has been carried out. Then this sequence was recloned into the pTrc 99A and pET23a expression vectors to give the pJasmids pTRCLTB and pETLTB, respectively. After induction, the former plasmid provides for the production of rL T-B in a yield of up to 15 mg per liter of bacterial culture. The recombinant protein was shown to be structurally and immunologically identical with the native L TB. High titer antibodies capable of neutralizing the native toxin were raised in mice by oral administration of the rL T-B. Hence the constructed plasmids provide the basis for an oral ETEC vaccine, as well as for genetic fusion of foreign antigens with the aim of developing polyvalent vaccines.

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Background: Chondromalacia patella is the most common cause of mechanical knee pain in young women. Q angle and knee alignment are important clinical parameters for biomechanics of the patellofemoral joint. Objective: To identify the prevalence of knee malalignment and to find out if there is a correlation between knee mal alignment and Q angle with age at onset of disease. Methods: All patients under 40 years old complaining of mechanical knee pain with positive shrug sign and normal knee radiography who were referred to Amir A'lam Rheumatology Clinic during the period of September 2000 to September 2002 were included in this study. The patients were examined by a rheumatologist for measuring Q angle and detection of knee malalignment. Age at onset of disease was defined as initiation of knee pain according to the patient's history. Results: The cases were 260 with 189 females. Prevalence of knee mal alignment was 32.4%. The mean age at onset of disease was 22.8 ± 7.08 years. The mean age at onset in patients with knee mal alignment (21.41 ± 5.66 years) was significantly lower than the mean age at onset in those without knee malalignment (23.6 ± 7.43 years) (p= 0.002). There was a positive correlation between Q angle and age at onset of disease (r=0.17,p= 0.006). Conclusion: It seems reasonable to identify knee malalignment in chondromalacia patella patients and perform proper management to postpone progression of disease. There are many other factors that influence age at onset of disease, so further investigation is recommended.

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 Abstract

 Background: Various types of foot orthoses are prescribed for people with flatfoot. It has been reported that orthoses not only improve the biomechanics of the lower limb, but also have good effects on some balance parameters in these subjects. It is hypothesized that the latter effect is dependent on the rigidity of the orthoses. The aim of this study was to evaluate and compare the effects of rigid and soft foot orthoses on dynamic balance in females with flatfoot. The Biodex Balance System was used in a clinical trial study.

 Methods: 20 healthy students with bilateral flatfoot were randomly assigned to two equal groups. Each participant was tested on two days with 2-week interval. On each day, dynamic stability test was performed while standing in single-leg stance on an unstable platform of the balance system in 3 conditions (barefoot, with shoe, shoe with orthosis). SPSS11.5 was used for statistical analysis.

 Results: A significant group-by-day-by-condition interaction was found. Both groups on day 2 testing had a decreased overall stability index while wearing orthoses. Overall stability index was significantly lower on day 2 testing.

 Conclusion: Foot orthoses, depending on the amount of rigidity, were associated with some improvements in dynamic balance in subjects with flatfoot.

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 Abstract

 Background: End-to-side esophagojejunostomy has almost always been associated with some degree of dysphagia. To overcome this complication we decided to perform an end-to-end anastomosis and compare it with end-to-side Roux-en-Y esophagojejunostomy.

 Methods: In this prospective study, between 1998 and 2005, 71 patients with a diagnosis of gastric adenocarcinoma underwent total gastrectomy. Standard esophagojejunostomy with an end-to-side fashion was performed in 41 patients and compared with our recommended technique of end-to-end esophagojejunostomy in 30 patients.

 Results: This study showed that esophagojejunostomy with an end-to-end fashion has a low incidence of postoperative dysphagia (33.3%), whereas in those with an endto- side anastomosis the rate of ysphagia is very high (83%).

 Conclusion: A Roux-en-Y esophagojejunostomy with an end-to-end anastomosis has a low incidence of postoperative dysphagia and we strongly recommend using this technique.

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  Abstract

  Objective: The aim of this study was to evaluate the efficacy of antibiotic-loaded bone

  cement in controlling local infection and in regard to its physical characteristics, elastic

  modulus, and tensile strength in-vitro.

  Methods: Acrylic bone cement, based on polymethylmethacrylate (PMMA) was

  mixed with the powder form of three antibiotics, i.e., gentamicin, tobramycin, and cefuroxime

  with different doses below 2gr per 40gr of cement powder thereafter, liquid

  monomer was added to process the cement. Sensitivity to common clinical isolates was assessed

  by counting the inhibition zone of each ALBC disc in cultured strains. Elution with

  normal saline was performed to evaluate the effects on ALBC disks and their antimicrobial

  efficiency. Cement structure, tensile strength, and elastic modulus were assessed by biomechanical

  tests to understand the characteristics of ALBCs after loading antibiotics with

  different doses and two methods of vacuum and manual mixing.

  Results: Gentamicin, tobramycin, and cefuroxime reduced bacterial growth significantly

  with doses more than 1gr of antibiotics in 40gr of the cement. Cefuroxime was less

  efficient than the other two antibiotics in controlling pseudomonas. Elution with normal

  saline has not affected antibacterial results, significantly. All the 3 antibiotics had the same

  pattern of physical characteristics while loaded in bone cement. Gross structure of ALBCs

  with different doses of the three antibiotics was the same as non-ALBC and the elasticity or

  strength did not decline after loading antibiotics. The elastic modulus of ALBC was increased

  by boosting the doses of antibiotics however, doses of 1gr to 1.5gr were the optimal

  doses in this regard. The tensile strength of ALBC was increased by doses of 1gr to

  1.5gr of antibiotics however, below and above these doses, the strength was decreased, but

  it did not exceed the basic strength of non-ALBC. Vacuum mixing method increased

  strength and elasticity more than manual one, remarkably.

  Conclusion: Optimal protective effects of ALBCs against infection could be seen with

  mixing doses of about 1gr to 1.5gr of antibiotics in 40gr of acrylic bone cements by vacuum

  method, while optimal elastic modulus and tensile strength could be achieved at the same

  doses.

 

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 Abstract 

 Background: Reamed interlocking intramedullary nailing of the tibia is a procedure

 for the treatment of a non-infected tibial non:::union:::. The purpose of this clinical

 study was to evaluate the outcome of this method as a treatment of tibial non:::union:::.

 Methods: Twenty-nine patients with non:::union::: after initial therapy for tibial fracture

 were retrospectively assessed after a reamed interlocking intramedullary nailing.

 The main measurements were derived from radiographic and clinical :::union::: as

 well as time from reamed nailing to :::union:::.

 Results: Twenty-eight patients achieved :::union::: of their fracture (97%). The average

 time from reamed nailing to :::union::: was 7.6 months. Serious complications included

 one severe infection in the site of surgery (3%) and one tibial fracture distal to

 the nail (3%).

 Conclusion: Reamed interlocking intramedullary nailing for non:::union:::s of the

 tibia resulted in a high :::union::: rate and was associated with a low complication rate.

 This technique is recommended as a standard procedure for non-infected tibial

 non:::union:::s.

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 Abstract

 Background: In the recent decade, many primary total knee arthroplasties have

 been carried out in Iran and the number of revision cases is expected to rise with the

 aging population. The aim of this study was to report the outcome of revision surgery

 in the country and make a comparison between the outcome of revision and that of

 the primary arthroplasty.

 Methods: Retrospectively, each case of 19 consecutive revision total knee arthroplasties was matched individually with two cases of primary total knee arthroplasty

 based on gender and age (within 5 years) in order to compare the outcome in the two

 groups of revision and primary arthroplasties. Detailed demographic data, underlying

 diagnosis, patient-reported pain severity, and Knee Society score were recorded

 pre-operatively and in the third month after the surgery for each patient in the two

 groups. Using chi-square, fisher's exact, one-way ANOVA, independent, and paired

 t-tests, we compared the outcomes in two groups as well as in each group before and

 after the arthroplasty.

 Results: Knee pain was significantly decreased after the surgery in the two groups

 of revision (p = 0.031) and the primary (p < 0.001) arthroplasty. There was no statistically notable difference of post-operative pain between the two groups of revision

 and primary TKA. The Knee Society score remarkably increased in both groups after

 the surgery (both ps < 0.001). The differences of Knee Society scores before and after

 the surgery were calculated separately in each group and compared to show that the

 primary group had a better outcome (p < 0.001) rather than the revision arthroplasty

 group.

 Conclusion: Conclusion: Satisfactory outcomes were obtained in our revision total

 knee arthroplasties however, the primary arthroplasties had better results. The results

 of surgery appear to be closely related to the technical demands placed on surgeon.

 Because we have to deal with more cases of revision total knee arthroplasty in

 near future, more comprehensive risk factor assessment studies with large sample

 size are required for gaining better results.

 

 

 

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  Abstract

  Introduction: Inflammation and wear debris may be responsible for bone lysis

  and subsequent lost in aseptic arthroplasty. Prostaglandin E2, platelet activating factor,

  and histamine are important mediators of inflammatory cells. We studied

  histopathological changes of cement-bone interface after using specific antagonists

  of these mediators.

  Methods: Left and right tibiae of 120 rats in ten groups were drilled. The left side

  was filled with polymethylmethacrylate and the right side was used as control. The

  first three groups respectively received 1mg/kg, 10mg/kg, and 25mg/kg of terfenadine,

  the second three groups respectively received 0.08mg/kg, 0.32mg/kg, and

  0.64mg/kg of alprazolam, and the third three groups respectively received 1mg/kg,

  5mg/kg, and 25mg/kg of naproxen. The tenth group received no drug and served as

  the control group. The animals were killed after 16 weeks and studied by one pathologist.

  Results: Cellular reaction in the left side was significantly more than the right side

  in all cases. Medium and high doses of terfenadine and naproxen and high doses of

  alprazolam could also significantly decrease giant cells and histiocytes.

  Conclusion: Increased cellular reaction in the cement-bone interface was suppressed

  by administration of PGE2, PAF, and histamine specific inhibitors. The use

  of these agents may induce retardation of the bone loss associated with early prosthetic

  loosening.

 

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  Abstract

  Background: Osteoarthritis (OA) is the most common joint disease occuring after middle age. Because of the high mobility of the neck, OA is common in the cervical spine. The purpose of this study was to determine and compare the effects of intermittent traction on patients with mild and moderate cervical OA. Therefore, 32 patients with cervical OA were recruited.

  Methods: Aclinical trial study was designed for patients with cervical OA that were randomly assigned in two equal groups. Control group received a routine physical therapy protocol which included moist heat, transcutaneous electrical nerve stimulation (TENS), and an exercise for neck and shoulder girdle. Experimental group received a routine physical therapy protocol plus intermittent traction (IT).

  Results: Pain and mobility improved in both groups. There was significant difference in

  interaction of the improvement of cervical pain between the two groups, the rate of pain reduction sleep ease, medicine taking and range of motion (ROM) improvement in the experimental group were higher than that of the control group.

  Conclusion: The results justify the efficacy of IT, therefore it can be concluded that the

  IT is an effective modality for patients with mild and moderate cervical OA.

 

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 Background: Lower limbs antigravity muscles weakness and decreased functional ability have significant role in falling. The aim of this study was to find the effects of aging on muscle strength and functional ability, determining the range of decreasing strength and functional ability and relationship between them in healthy women.

 

Methods: Across-section study was performed on 101 healthy women aged 21-80 years. The participants were divided into six age groups. The maximum isometric strength of four muscle groups was measured using a hand-held dynamometer bilaterally. The functional ability was measured with functional reach (FR), timed get up and go (TGUG), single leg stance (SLS), and stairs walking (SW) tests.

 Results: Muscle strength changes were not significant between 21-40 years of age, but decreased significantly thereafter. Also, there was a significant relationship between muscle strength and functional ability in age groups.

 

Conclusion: Both muscle strength and functional ability is reduced as a result of aging, but the decrease in functional ability can be detected earlier.

 

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  Background :This study was performed to evaluate the effect of Stoppa hernia repair on sexual function of the patients with bilateral inguinal hernia.

  Methods: In a prospective follow-up study, 50 patients with bilateral inguinal hernia were investigated to assess sexual function before and 1 and 6 months after standardized Stoppahernioplasty using the International Index of Erectile Function (IIEF) questionnaire. The mean scores obtained on pre- and postoperative visits for all domains of sexual function were analyzed and compared with the Friedman and paired Wilcoxon tests.

  Results: The mean score of IIEF at the first month after surgery was significantly declined compared to that before surgery and 6 months after surgery (P< 0.001), while the difference between preoperative score and the score at 6 months after surgery was not significant.

  Conclusion: Bilateral inguinal mesh repair with Stoppa technique can decreased sexual activity of the patients at one month after surgery, nevertheless it returns to its initial condition at 6 months after surgery. This suggests that the Stoppa technique does not affect the sexual function of patients with bilateral inguinal hernia.

  

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  Background :Rupture of the Anterior Cruciate Ligment (ACL) is a common knee injury. The purpose of this study was to determine the balance control in football players with and without ACL reconstruction in posture of injury.

  Methods : Sway of the center of gravity of 15 patients with ACL reconstruction was compared with 15 healthy, age and sex-matched subjects as the control group. All tests were done unilaterally in the posture of injury, using a kistler force plate with the open and -closed eye conditions.

  Results : The knee of the operated side of the case group showed more displacement of the center of gravity when compared to the non-operated side in the same subject for all variables of the force plate. The operated side of the case group showed more displacement of the center of gravity for all variables of the force plate in comparison with the dominant side of knees in control group. There were significant differences between the non-operated side in the case group and the dominant side of the control group.

  Conclusion : All together, postural control in the operated side of the case group was weaker than the non-operated side of the same group and the dominant limb of the control group, which might have resulted from poor proprioception. The postural control was even weaker in the non-operated side of the case group as compared with the dominant limb of the control group, which can justify the hypo mobility of limb for several months after the surgery.

 

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  Background : To determine the role of Letrozole, an aromatase inhibitor,in the treatment of endometriotic pain.

  Methods: In this prospective, randomized, controlled clinical trial in minimallyinvasive surgery research center,51 women with pelvic endometriosis and endometriotic pain (dyspareunia, dysmenorrhea, pelvic pain) score of 5 or more (for at least one of these endometriotic pain), after laparoscopic diagnosis and conservative laparoscopic surgery were treated with either Letrozole plus OCP (n=25) or only OCP (n=26) for 4 months continuously.

  Results: Using VAS test, the score of dyspareunia, dysmenorrhea and pelvic pain 4 months after the laparoscopic surgery declined significantly in both groups but the difference between results of the two groups was not significant.

  Conclusion: Both treatment modalities showed comparable effectiveness in the treatment of pains related to endometriosis and in comparison with OCP, Letrozole did not affect the outcome.

 

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  Background: Catheter ablation is widely used for treatment of atrial fibrillation. The use of fluoroscopic and non-fluoroscopic mapping systems in catheter ablation is common. This study conducted to investigate the safety and effectiveness of Navx non-fluoroscopic mapping system.

  Methods : In this study, the appropriate electronic databases including Cochrane Library and Ovid Medline searched until August 2013 using free text and MeSH. Systematic reviews, health technology assessment reports in which systematic review was conducted and controlled trials with the sample size of 100 patients and more were included into the study. Results of included studies were analyzed qualitatively.

  Results : Seven papers were included in this study. According to these studies, non-fluoroscopic guidance systems may reduce the exposure to radiation compared to fluoroscopic system. NavX system has minimum exposure time. Non-fluoroscopic guidance systems are safer than fluoroscopic guidance system. NavX system reduces the procedure and fluoroscopy time. There was no significant difference between two systems, NavX and Carto, based on their safety and effectiveness.

  Conclusion : EnsiteNavX system is relatively safer and more effective than fluoroscopic guidance systems for treating the cardiac arrhythmia.

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  Background: Alterations in the neuromuscular control of the spine were found in patients with chronic low back pain (CLBP). Sudden loading of the spine is assumed to be the cause of approximately 12% of lower back injuries. However, some aspects of this problem, such as alterations in the sensory–motor control of the spine, remain questionable. This study investigated postural and neuro–motor changes in trunk muscles during sudden upper limb loading in patients with CLBP.

  Methods : Electromyography of the erector spinae (ES) and transverses abdominis/internal oblique (TrA/IO) and external oblique (EOA) muscles were recorded in 20 patients with CLBP and 20 asymptomatic individuals with eyes open (EO) and eyes closed (EC) conditions. Moreover, measurements of the center of pressure (COP) and vertical ground reaction force (GRF) or Fz were recorded using a force plate. Data were analyzed using paired t-test and independent t-test at the significance level of 0.05.

  Results : In patients with CLBP, decreased electrical activity of the ES muscle was observed under both the EO and EC conditions and that of the TrA/IO muscle was observed under the EO condition (p< 0.05). Other findings included a shorter peak latency of the ES muscle in the EO condition and a greater increase in the peak latency of the ES muscle following the EC condition (p< 0.05). No significant differences were observed in COP and GRF measurements between the groups.

  Conclusion : Electrical muscle activity may indicate less stiffening or preparatory muscle activity in the trunk muscle of patients with CLBP. Altered latency of the muscle may lead to microtrauma of lumbar structures and CLBP.

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Background: Hormone therapy is currently the mainstay in the management of locally advanced and metastatic prostate cancer. We performed a systematic review to compare safety, efficacy and effectiveness of degarelix, a new gonadotropin-releasing hormone (GnRH) antagonist (blocker), versus gonadotropin-releasing hormone (GnRH) agonists.

Methods: MEDLINE, Web of Science and the Cochrane library were searched to identify all of the published Randomized Controlled Trials (RCTs) that used degarelix versus gonadotropin-releasing hormone agonists with or without anti-androgen therapy for the treatment of prostate cancer. We performed meta-analysis of extracted data on safety and efficacy of the target medication.

Results: Six studies were included. They involved a total of 2296 patients which were used in the meta-analysis. Follow-up times after treatment were between 12 weeks and 12 months. Three of six RCTs compared degarelix with goserelin and the others compared it with leuprolide.Meta-analysis on safety outcomes revealed that the only statistically significant difference between the degarelix treated group and GnRH agonists treated group was complication in the injection site which was higher in degarelix-treated group (OR= 46.34, 95% CI: 15.79 to 136, p<0.001). Although general mortality rate was lower in degarelix-treated group (OR= 2.06, 95% CI: 1.08 to 3.93, p=0.03) mortality due to the drug side effects was not different. Meta-analysis of efficacy data also showed that International Prostate Symptom Score (IPSS) reduction at week 12, (MD=-1.85, 95% CI: -2.97 to -0.72, p=0.001) and Testosterone reduction between day 1-28, (OR=11.58, 95% CI: 5.77 to 23.22, p<0.001) was statistically higher in degarelix-treated group. Testosterone reduction after day 28 and prostate volume reduction did not have significant difference.

Conclusion: Our meta-analysis indicates that, compared with GnRH agonists, degarelix has significantly more effects on lower urinary tract symptoms and also Prostate Specific Antigen (PSA) and testosterone reduction in the first month of the treatment. Except minor complications in the injection site like pain, erythema and swelling, there is no increase in major side effects and mortality due to degarelix. This is while the effect on testosterone and PSA after the first month of treatment is not statistically different between the two groups.

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Background: The aim of this study was to directly compare efficacy of atomoxetine and methylphenidate in treatment of children and adolescents 6- 18 years.

  Methods: All published, randomized, open label or double blind trials, comparing the efficacy of methylphenidate with atomoxetine in treatment of children diagnosed with ADHD, using DSM-IV criteria were included in this study; ADHD Rating Scale–IV–Parent Version: Investigator Administered and Scored (ADHDRS) scores was used. The standardized mean difference (SMD) was used as a measure of effect size.

  Results: Eleven studies were included with a total of 2,772 participants. The meta-analysis did not find a significant difference in the efficacy between methylphenidate and atomoxetine (SMD= 0.09, 95% CI -0.06, 0.25) (Z= 1.18, p= 0.24). Sub group analysis showed a significant standardized mean difference favoring OROS methylphenidate (SMD= 0.31, 95% CI 0.16, 0.47 (Z= 3.91, p< 0.0001); immediate release methylphenidate was not superior to atomoxetine (SMD= -0.05, 95% CI -0.20, 0.10) (Z= 0.68, p= 0.49). Open label trials did not make a difference in the standardized mean difference (SMD= 0.10, 95% CI -0.02, 0.23) (Z= 1.17, p= 0.09). There was significant heterogeneity among the studies (p= 0.003, I2= 63%). Subgroup analysis demonstrated that heterogeneity was because of the open label trials (p= 0.009, I2= 79%).

  Conclusion: Atomoxetine and methylphenidate showed comparable efficacy in the treatment of children and adolescents with ADHD. However, Osmotic (Controlled) Release Oral (Delivery) System (OROS) methylphenidate is more effective than atomoxetine in treatment of ADHD in children and adolescents that is suggested as a first-line treatment in ADHD. Moreover, comparing the immediate release (IR) methylphenidate to atomoxetine did not lead to the benefit of IR methylphenidate.

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Background: Chronic obstructive pulmonary disease (COPD) is a chronic respiratory disease, which reduces the lung function and causes respiratory symptoms over time, and it is primarily associated with shortness of breath, cough and sputum production. Roflumilast, which is a long-acting selective inhibitor, reduces the anti-inflammatory effect of the main symptoms of COPD. The aim of this study was to compare the clinical effectiveness of adding roflumilast to the current treatment regimen of patients with severe COPD.

  Methods: To retrieve the marker studies, medical databases were searched up to February 2014. We included studies, which compared the clinical effectiveness and safety of roflumilast as concomitant to Long-acting ß2-agonist/Long-acting muscarinic antagonist (LABA/LAMA) regimen, in adult patients with severe COPD. The number of exacerbations, changes in the lung function FEV1, FEV1/FVC and quality of life were the major predefined outcomes. Meta-analysis of outcomes was performed by the RevMan software, with I²> 50%, representing considerable heterogeneity.

  Results: Seven randomized controlled trials and two systematic reviews were included. In terms of safety, participants were likely to experience more side effects from roflumilast compared to placebo, particularly gastrointestinal effects (diarrhea, nausea, vomiting), headache and weight loss. There was no significant difference in the risk of cardiac complications or flu-like symptoms or upper respiratory tract infection in the two groups. In terms of effectiveness, only a small improvement was observed in SGRQ (St George’s Respiratory Questionnaire) index. Roflumilast reduced moderate to severe attacks, and caused significant improvements in the lung function regardless of the severity of the disease and the concurrent use of other standard COPD therapies.

  Conclusion: Roflumilast anti-inflammatory therapy reduces the chronic bronchitis symptoms in patients with moderate to severe COPD, and it can be safely used with other drugs simultaneously.

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Background: After lung and prostate cancers, colorectal cancer (CRC) is the third most common cancer in men and the second most common cancer in women after breast cancer worldwide. Every year, more than one million people are diagnosed with colorectal cancer worldwide and half of these patients die from this disease, making it the fourth leading cause of death in the world. This systematic review aimed to assess the effectiveness of the two colorectal diagnostic tests of FOBT (fecal occult blood test) and FIT (fecal immunochemical test)) in terms of technical performance.

  Methods: To retrieve the relevant evidence, appropriate medical databases such as Cochrane library, NHSEED, Scopus and Google scholar were searched from February 2013 to July 2014, using free-texts and Mesh. In this study, inclusion/exclusion criteria of the papers, randomized controlled trials, economic evaluations, systematic reviews, meta-analyses and meta-syntheses of the effectiveness of FIT versus FOBT tests in moderate-risk populations (age: 50 to 70 years), which had reported the least of such outcomes as sensitivity, specificity and clinical outcomes were reviewed. The analyses of the effectiveness outcomes were performed in the form of meta-analysis.

  Results: Five papers were eligible to be included in the final phase of the study for synthesis. FIT showed a better performance in participation and positivity rate. Moreover, in terms of false positive and negative rate, FIT showed fewer rates compared to FOBT (RR:-4.06; 95% CI (-7.89-0.24), and NN-scope (Number need to scope) (2.2% vs. 1.6%), and NN-screen (Number need to screen) (84% vs. 31-49% in different cut off levels) showed significant differences in FOBT vs. FIT, respectively.

  Conclusion: In the five included studies (3, 11-14), the acceptability of FIT was more than FOBT. However, in our meta-analysis, no difference was found between the two tests. FIT was significant in positivity rate and had a better performance in participation rate, and a fewer false negative numbers compared to FOBT.