Background: We aimed to forecast the efficacy of neck stretching exercises in mitigating self-reported disability post-thyroidectomy and neck pain.
Methods: Until Feb 2025, an inclusive literature study was accomplished, and 654 related studies were reviewed. The 5 nominated studies encompassed 654 patients with thyroidectomy at the beginning of the study and were selected for the meta-analysis. The mean difference (MD) and 95% confidence intervals (CIs) were used to examine the outcome of the neck stretching exercises compared to control on thyroidectomy using continuous methods with either a fixed or random model.
Results: In cases with thyroidectomy, neck stretching exercises had significantly lower mean neck pain score after 1 week (P=0.001), mean neck pain score after 1 month (P=0.01), mean self-reported neck disability score after 1 month (P<0. 001) compared to control treatment. Nonetheless, no significant difference was detected between neck stretching exercises and control treatment in mean self-reported neck disability score after 1 week (P=0.06) in patients with thyroidectomy. In patients with thyroidectomy, neck stretching exercises had significantly lower mean neck pain score after 1 week, and after 1 month, and mean self-reported neck disability score after 1 month, however, no significant difference was found in mean self-reported neck disability score after 1 week compared to control treatment.
Conclusion: More research is necessary to confirm this discovery, and care must be used while interacting with its values since many comparisons had a low number of included articles and a small sample size of most of the selected studies.

China’s rapid transition into a super-aged society is accelerating demand for advanced wearable healthcare sensors tailored for long-term, low-burden monitoring. While numerous reviews discuss demographic and policy contexts, fewer highlight the latest wearable sensor research emerging from Chinese laboratories and companies. This Mini Review summarizes representative advances published in the last five years across three major application areas—chronic metabolic disease management, neurodegenerative disease monitoring, and cardiovascular risk mitigation—focusing on sensor design, sampling media, data integration, and clinical relevance. Rather than examining demographic trends or general market growth, we emphasize technological breakthroughs such as non-invasive glucose-sensing microneedle patches, CKD-oriented urine/breath analyzers, multimodal gait–EEG neurodegenerative platforms, and bioresorbable cardiovascular implants that reflect China's emphasis on long-term, low-burden, and telemedicine-ready care. By concentrating on these China-originated devices and research prototypes, this review aims to provide a concise update on emerging concepts and highlight how these technologies reflect localized priorities—such as non-invasive sampling and family-assisted tele-care—while shaping future global trends.

Background: The intensive care unit environment poses a substantial risk for Post-Traumatic Stress Disorder (PTSD) among nurses, stemming from frequent exposure to traumatic events and patient death This systematic review aimed to determine the epidemiology of PTSD among ICU nurses.
Methods: We systematically searched PubMed, Scopus, and Web of Science from Jan 2000 to Dec 2024 for studies reporting PTSD prevalence among ICU nurses. Inclusion criteria were observational studies with validated PTSD assessment tools; Exclusion criteria included case reports and non-English publications. Data were synthesized using a random-effects model.
Results: The study reviewed 25 papers that provided quantitative data and were included in the analysis; the sample sizes varied from 98 to 748 ICU nurses. The published frequency of PTSD among ICU nurses has been identified to range between 3.3% and 64%. The pooled prevalence was estimated to be approximately 32.78 % (CI 95%[31.6%, 33.9%]). The specific factors influencing risk for PTSD included exposure to traumatic events: having a high workload, staff shortage, and organizational issues with the absence of psychological support, as well as individual characteristics, including younger age and prior mental health disorders. The impacts of PTSD included psychological distress, poor sleep quality, feelings of loneliness, and a reduced health-related quality of life.
Conclusion: The high prevalence of PTSD among ICU nurses underscores an urgent need for targeted interventions and support programs. Providing essential support through staffing, psychological resources, and resilience training is critical. Further research should examine the longitudinal course of PTSD and evaluate intervention outcomes.

Background: Bivalirudin is increasingly used as an alternative to heparin in patients undergoing percutaneous coronary intervention (PCI) due to its potential for reducing adverse clinical outcomes. This meta-analysis aimed to compare the effectiveness and safety of bivalirudin versus heparin across various clinical outcomes.
Method: A total of 27 studies were included, comprising 63,624 patients: 30,492 received Bivalirudin, and 33,132 received Heparin. Key endpoints analyzed include net adverse clinical events (NACE), major adverse clinical events, major bleeding, mortality, stroke, and stent thrombosis. Data were pooled using a random-effects model, and heterogeneity was assessed using the I² statistic. Publication bias was evaluated using Begg’s and Egger’s tests.
Results: Bivalirudin significantly reduced the risk of major bleeding (MD=-0.4445, 95% CI [-0.6276, -0.2615], P<0.0001, I²=76.79%) compared to Heparin. However, no significant differences were found for major adverse clinical events (MD=-0.0993, P=0.3194) or mortality (MD=-0.1959, P=0.0893). There was moderate heterogeneity in most analyses, particularly for NACE (I²=68.24%) and stent thrombosis (I²=55.33%). No significant differences were observed for stroke prevention or stent thrombosis. Subgroup analyses demonstrated significant reductions in major bleeding with Bivalirudin, particularly in STEMI patients (log OR=-0.37, P<0.0001), though no differences in MACE or stent thrombosis were observed. High heterogeneity in NSTEMI populations (I²=81.4%) underscores the need for individualized therapy.
Conclusion: Although bivalirudin significantly lowers major bleeding compared with Heparin, it shows no clear advantage in mortality or other major clinical outcomes. Substantial heterogeneity across studies indicates variability in patient populations and procedural settings. Further research is needed to define its optimal role in specific PCI subgroups.

Background: We aimed to evaluate the efficacy of preventative strategies targeted at lowering these injections.
Methods: A comprehensive assessment of electronic databases (PubMed, Web of Science, and Cochrane Library) was carried out to discover relevant papers published from 2013-2024. Inclusion criteria were randomised controlled trials, quasi-experimental studies, and observational research on therapy for intravenous injection and catheter-related infections. The primary outcome examined was the incidence or prevalence of infections caused by intravenous injections. According to preliminary data from 31 studies, preventive interventions dramatically reduce the incidence of intravenous injection and catheter-related infections. Subgroup analyses indicate effectiveness differences depending on intervention type and patient variables.
Results: Chlorhexidine-based therapies can lower infection risk by 29% (Risk Ratio: 0.71), but taurolidine provides a statistically significant 53% benefit (RR = 0.47). The total risk ratio varies from 0.71 to 0.84, indicating a 29% reduction in infection rates in nations having Needlestick Safety and Prevention Acts. In contrast, the absence of such regulation may result in a 6% to 8% rise in infection rates (RR = 0.96).
Conclusion: Preventative interventions, notably chlorhexidine and taurolidine, can considerably reduce the risk of intravenous injection and catheter-related infections. Chlorhexidine may lower the risk of infection by 29%, whereas taurolidine reduces it by 53%. Nations with Needlestick Safety and Prevention Acts may expect a one-third reduction in infection rates. Conversely, the absence of such laws may result in a significant rise in infection rates.

Background: Parasitic diseases, including food-borne and vector-borne infections, remain a significant burden, especially with the increased migration from underdeveloped to developed regions. We aimed to estimate the prevalence of parasitic infections among migrant workers in the Middle East.
Methods: This systematic review and meta-analysis followed the PRISMA protocol. A search was conducted across major databases (Scopus, PubMed, Web of Science, Google Scholar) for studies on parasitic infections among migrant workers in the Middle East from April 1, 1993, to November 15, 2024. Data were analyzed using Comprehensive Meta-Analysis software (CMA), and 25 studies were included.
Results: The overall prevalence of parasitic infections in this study was estimated at 16.5%. (95% CI 2.7 to 58.5%). The prevalence based on microscopic diagnostic methods was 19.4% (95% CI 13.5% to 27.5%), and molecular diagnosis was 15.2% (95% CI 6.4% to 32.4%). The P-value in Egger's test was 0.5343, indicating no statistically significant evidence of publication bias. The pooled prevalence varied across countries: 34.7% in Iraq (n = 1 study), 19.6% in Saudi Arabia (n = 12 studies), 16.8% in the UAE (n = 4 studies), 13.2% in Qatar (n = 7 studies), and 4.2% in Kuwait (n = 1 study).
Conclusion: The prevalence of parasitic infections among migrant workers in the Middle East was estimated at 16.5%. Given this rate, routine mandatory screening is recommended along with targeted health education to reduce exposure risk and improve health. These findings highlight the public health concern that infected migrant workers may contribute to the spread of parasitic diseases in destination countries.

Background: Public-private partnerships (PPPs) address issues of access, quality, and innovation in health care. This paper assesses the impact of various PPP models on health care delivery and explores factors influencing their success. We aimed to deepen policymakers’ and practitioners’ understanding of PPP dynamics, challenges, and opportunities.
Methods: A scoping review was conducted using a systematic approach to identify relevant literature on PPPs in health care from 2000 to 2024. Searches were performed in PubMed, Scopus, and Web of Science using specific search terms and inclusion criteria. Data from selected articles were analyzed to identify key themes, drivers, and outcomes related to PPP implementation and impact.
Results: The review covered 37 PPP studies from multiple countries, revealing mixed results and challenges. Successful PPPs in China, Iran, and Kenya improved health care delivery, efficiency, and patient satisfaction. However, challenges such as regulatory barriers, financial constraints, and integration issues persist. In Spain and Portugal, PPPs often face public rejection due to perceived financial unsustainability. Legal and regulatory frameworks in Iran and Tanzania hinder effective PPP implementation.
Conclusion: PPPs have significant potential to transform health systems, especially in resource-limited settings. Their success relies on careful planning, strong governance, and adapting to local contexts. For PPPs to be effective, they must prioritize equity and sustainability in their design and execution.

Background: Maternal influenza immunization is a primary strategy for protecting mothers and infants under six months, though its comprehensive efficacy and safety profiles undergo continuous evaluation. However, the reliability of current evidence is moderated by varying degrees of primary study overlap across existing reviews.
Methods: Five electronic databases—PubMed, Embase, Web of Science, ProQuest, and Scopus—were systematically searched up to August 2024. Study eligibility and quality were assessed using the ROBIS tool. To ensure the integrity of the findings and address potential primary study overlap, the Corrected Covered Area (CCA) formula was applied.
Results: Eleven systematic reviews and meta-analyses were evaluated. Maternal influenza vaccination may reduce the risk of laboratory-confirmed influenza (LCI) in both mothers and infants; however, no clear effect was observed on influenza-like illness (ILI). Vaccination is generally associated with a reduced risk of fetal mortality and no consistent evidence suggests a significant increase in congenital anomalies or spontaneous abortion. Maternal influenza vaccination may modestly reduce preterm birth risk, shows no clear effect on small for gestational age, and is associated with reduced low birth weight (LBW). The studies on influenza vaccination in pregnant women showed high overlap for LCI (0.66), infant LCI (0.50), and varying overlap for stillbirth (0.38), congenital anomalies (0.28), spontaneous abortion (0.23), premature birth (0.13), SGA (0.27), and LBW (0.14).
Conclusion: Influenza vaccination during pregnancy effectively reduces LCI in mothers and infants without increasing adverse neonatal outcomes, though its impact on ILI remains inconsistent. Due to high study overlap and variable quality, further large-scale research is required to confirm effects on preterm birth and congenital anomalies.

Background: Leptospirosis is a widespread zoonotic disease causing over one million cases and 60,000 deaths annually. This review aimed to identify and assess policy options for leptospirosis prevention using the One Health approach and One Health Governance Index (OHGI) framework.
Methods: PubMed, Web of Science, Scopus, and Cochrane Library were searched for full-text academic articles, along with Google Scholar and reference lists from Jan 2008 to Dec 2023. A scoping review was conducted following Arksey and O’Malley’s framework and PRISMA-ScR guidelines. Articles were retrieved from major databases using defined keywords. Eligible studies focused on community-based policies for human leptospirosis prevention. Two reviewers independently assessed quality, and data were categorized by One Health domains and analyzed using the OHGI framework.
Results: Forty-two studies were included. Common policy strategies involved sanitation education, medical training, surveillance of humans, animals, and environments, legal controls on exposure sources, infrastructure upgrades, and vaccination. Tools like GIS and climate data supported preparedness. Policy options most addressed rule of law, effectiveness, and equity.
Conclusion: Preventing leptospirosis epidemics demands coordinated, context-specific One Health policies that address implementation gaps and promote equity across vulnerable settings.

Background: Measles, a highly contagious, yet vaccine-preventable disease, is currently experiencing a notable resurge in numbers, in developing countries. With limited reading time, physicians often rely on structured summaries, and well-prepared abstracts can encourage them to read the full article, facilitating patient care. We aimed to examine the reporting quality of article abstracts about measles.
Methods: Indirectly/directly address measles and its vaccine, scrutinizing on systematic reviews and meta-analyses published from 2009 to the present, and indexed in the open-access PubMed article database. With the widespread use of abstract checklists like PRISMA-A in reading systematic reviews and meta-analyses, the message intended to be conveyed can be adequately delivered to the reader by abstracts only, respecting standard rules and requirements for reporting. We used a scoring system for compliance with PRISMA-A checklist in reading measles-related reviews published over the last 15 years.
Results: On average, the abstracts were “very highly” compliant with the expected reporting criteria: The year of publication (with 2020 as the timepoint) did not make any difference in reporting quality, but structured abstract were significantly more likely to convey their message in an “expected” manner, based on PRISMA-A criteria.
Conclusion: Using standard guidelines in evaluating reporting quality of different publications and emphasizing its importance for the writers and readers, alike, will be encouraging for improved presentation of original/filtered research results, with the goal of conveying valid and reliable health-related information, in a time-efficient way.

Background: We compared abdominal muscle and subcutaneous fat thicknesses, and core stability among young Korean women with normal weight non-obesity (NWNO), normal weight obesity (NWO), and obesity (OB).
Methods: Between May and September 2024, fifty-seven female university students from K University in Gwangju, Republic of Korea, were classified into three groups (NWNO: n = 15, NWO: n = 20, and OB: n = 22) based on body mass index and body fat percentage. The thicknesses of the abdominal muscles, including the transverse abdominis (TrA), internal abdominal oblique (IO), and external abdominal oblique (EO) muscles, and of the subcutaneous fat were measured using real-time ultrasound imaging. Core stability was assessed using trunk extensor, trunk flexor, and side-bridge endurance tests. Data were analyzed using one-way ANOVA with a significance level of 0.05.
Results: Significant differences were observed in the thicknesses of the TrA (P = 0.002), EO (P = 0.001), and subcutaneous fat (P < 0.05) between groups. The OB group had the greatest TrA and subcutaneous fat thicknesses. The side-bridge endurance test revealed a significant difference in core stability (P = 0.002), with the OB group demonstrating the lowest core stability.
Conclusion: Although the OB group had the largest muscle thickness, it demonstrated lower core stability than the NWNO group. These results suggest that obesity might impair neuromuscular activation and muscle fiber recruitment, leading to functional limitations despite increased muscle mass. These findings emphasize the importance of preventing and managing normal-weight obesity in women in their 20s.

Background: This study aimed to analyze trends in the population attributable fraction (PAF) for mortality attributable to dietary risks over a 22-year period between 2000 and 2021 and to determine which type of dietary risk has a significant effect on mortality from which NCDs.
Methods: In this descriptive and ecological study, data were obtained from the Global Burden of Disease Study, 2021. Age-standardized and sex-specific PAFs for mortality attributable to dietary risks and PAFs for mortality attributable to selected and specific dietary risks were calculated for six noncommunicable diseases worldwide for the 22-year period. The trend of PAFs over time was assessed by joinpoint regression analysis.
Results: The two diseases with the highest mean PAF for mortality attributable to dietary risks were hypertensive heart disease followed by ischemic heart disease (0.63±0.01 and 0.45±0.01, respectively). The mean PAF for mortality attributable to dietary risks differed between sexes for four diseases. All six diseases had dietary risk-attributable mortality starting at a young age. Over a 22-year period, PAF for mortality attributable to dietary risks followed a significant decreasing trend for all six diseases. When the PAFs for mortality attributable to selected and specific dietary risks were examined, the majority showed a decreasing trend.
Conclusion: It is essential to clarify the relationship between NCDs and dietary risks. This is because the human body is exposed to nutritional and dietary risks every day, both as individuals and as a community.

Background: Childhood obesity poses serious long-term health risks and is a growing global concern. In South Korea, national health surveys collect behavioral and physical data from elementary students, but the large number of questionnaire items can burden young respondents and reduce accuracy. Thus, simplified models with high predictive power are needed.
Methods: We analyzed data from over 250,000 elementary students collected by the Korean Ministry of Education (2015–2022). Using the Rohrer Index as the outcome variable, key predictors were selected via Lasso and Elastic Net regression. Categorical variables were reduced using Multiple Correspondence Analysis (MCA), and a deep learning model (NECTOR) combining MLP and self-attention was developed.
Results: NECTOR achieved high predictive performance with R² scores of 0.994 (boys) and 0.996 (girls), and low mean squared errors of 3.072 and 1.841, respectively. It outperformed baseline models using the same inputs.
Conclusion: A small set of core health indicators can effectively predict the Rohrer Index. The proposed model enables efficient and reliable obesity screening in school settings, supporting early intervention efforts.

Background: IQOS (I Quit Ordinary Smoking) has been introduced as a “safer” alternative to traditional tobacco smoking. We aimed to determine how heated tobacco products influence iron metabolism by examining the impact of IQOS use and conventional cigarette smoking on hepcidin and iron-related parameters.
Methods: In this cross-sectional study, an iron panel and hepcidin levels were measured in participants who were using IQOS for at least six months and compared with those of conventional smokers or non-smokers.  
Results: A total of 185 adults (18-40 years) of both sexes participated in the study, including 80 IQOS users, 49 cigarette smokers and 56 non-smokers. No significant differences were found in hemoglobin level, red blood cell count, mean corpuscular volume, white blood cell count, platelet count or total iron level between IQOS users and non-smokers in both sexes. However, ferritin levels were significantly higher in male IQOS users compared to non-smokers (P=0.022). Hepcidin levels were markedly higher in IQOS users (375.77 ± 98.59 pg/mL) compared with cigarette smokers (26.35 ± 8.81 pg/mL; P = 0.0001) and non-smokers (31.27 ± 7.78 pg/mL; P = 0.0001). No significant difference in unsaturated iron-binding capacity, total iron-binding capacity or transferrin saturation was found between IQOS users compared to non-smokers.
Conclusion: IQOS use was associated with significantly elevated hepcidin levels and higher ferritin in males, suggesting a potential disruption of iron regulation compared to conventional smokers and non-smokers.

Background: Hearing loss (HL) constitutes a significant hazard to the health and social welfare, yet there is a lack of data on its burden in young adults (YAs) aged 15-39 yr. This study aimed to delineate the global temporal trends and predict the future burden of HL in YAs.
Methods: Using data from the Global Burden of Disease study 2021, we analyzed the prevalent cases and age-standardized prevalence rates (ASPR) of HL in YAs by age, sex, and Socio-demographic Index(SDI). The age-period-cohort (APC) model was used to assess trends, while the Bayesian Age-Period-Cohort (BAPC) model projected future epidemiological trajectories.
Results: Globally, HL prevalent cases in YAs increased from 171.77 million (95% CI: 145.95–200.16) in 1992 to 256.16 million (95% CI: 222.49–293.87) in 2021. The ASPR rose from 7862.80 to 8474.66 per 100,000 over this period, with males consistently showing higher rates than females. APC analysis revealed age-dependent increases in hearing loss risk, adverse period effects in recent years (2012–2021), and a peak relative risk in the 1997–2006 birth cohort. The BAPC model projects 291.37 million (95% CI: 182.25–400.49) prevalent cases by 2040.
Conclusion: The global burden of HL in YAs is rising, particularly since the relative risk of HL has continued to grow during the last 10 years, highlighting the need for further research and intervention.

Background: We aimed to examine the association between occupational burnout and food disgust among professional chefs working in restaurants, hotels, and catering services in Turkey.
Methods: This cross-sectional study was conducted between December 1, 2024, and April 1, 2025, using a convenience sampling method. Participants included 279 professional chefs working in restaurants, hotels, and catering services across Turkey, as well as those presenting to outpatient clinics affiliated with our institution. Eligible participants were aged 18 years or older, had at least one year of professional culinary experience, and were currently employed in a food service setting.
Results: The average burnout score was 3.88 ± 1.69, measured on a 7-point scale (1 = no burnout, 7 = severe burnout). The mean food disgust score was 119.9 ± 45.54 on a 32–192 scale, with higher scores indicating greater food disgust sensitivity. Participants with critical burnout reported significantly elevated food disgust compared to those in lower burnout categories (P=0.001). Robust regression confirmed burnout as an independent predictor of food disgust (β=4.263, P=0.008), whereas demographic and occupational variables were not significantly associated with either outcome.
Conclusion: This study provides evidence of an association between occupational burnout and food disgust among professional chefs. However, due to the cross-sectional design, no causal inferences can be made. Findings should therefore be interpreted with caution, and future longitudinal studies are needed to clarify temporal relationships.

Background: Adverse childhood experiences (ACEs) are linked to various behavioral and psychological issues. This study explored the relationship between ACEs and social media addiction (SMA), examining the mediating role of quality of life (QoL) and the moderating effect of occupational status.
Methods: Overall, 1,247 adults (55.4% females), aged 19 to 65 yr, were recruited through convenience sampling in Kerman, southeast Iran. Validated Persian versions of the ACE-ASF, WHOQOL-BREF, and Bergen Social Media Addiction Scale were used. Structural equation modeling (PLS-SEM) assessed direct, indirect, and moderated pathways.
Results: ACEs were significantly associated with higher SMA (β=0.088, P=0.002) and lower QoL (β = –0.234, P<0.001). QoL was inversely related to SMA (β = –0.225, P<0.001), and partially mediated the ACE–SMA relationship (β=0.053, P < 0.001). Occupational status moderated the effects of ACEs on both QoL (β=0.066, P=0.021) and SMA (β= –0.055, P=0.046), Higher job levels reduced adverse effects. However, no significant moderation was found in the QoL–SMA path.
Conclusion: ACEs significantly increase the risk of SMA, partly through reduced QoL. Improving occupational status and QoL can reduce the long-term behavioral effects of childhood adversity.

Background: Inflammatory indices have been linked to mood disorders. We aimed to examine whether these inflammatory indices are associated with the severity of depression and anxiety as measured by Beck scores.
Methods: This cross-sectional analysis included 9,704 participants aged 35–65 years from the Mashhad Stroke and Heart Atherosclerotic Disorder (MASHAD) cohort study. Depression and anxiety were assessed using the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI). Inflammatory indices were calculated based on hematological and biochemical parameters. Multinomial logistic regression was applied to evaluate the associations between inflammatory markers and mood disorder severity.
Results: In cases of severe depression, the neutrophil-to-lymphocyte ratio (NLR), white blood cell (WBC) count, and serum high-sensitivity C-reactive protein (hs-CRP) levels were significantly higher (OR = 1.29, 1.08, and 1.01, respectively; P < 0.05) than in individuals with minimal depression. Serum hs-CRP levels were also significantly higher (OR = 0.98; 95% CI: 0.95–0.99) in participants with moderate anxiety compared with those with minimal anxiety.
Conclusion: Higher levels of depression were associated with increased inflammatory hematological indices, and that the severity of depression was related to elevated levels of NLR, WBC, and hs-CRP.

Background: Pulmonary arterial hypertension (PAH) is characterized by high blood pressure in the lungs due to obstruction of small pulmonary arteries. Its exact cause is unknown. We aimed to identify specific genes, signaling pathways, and microRNAs (miRNAs) as novel diagnostic biomarkers for PAH progression.
Methods: We analyzed differentially expressed genes (DEGs) from PAH and control samples in the GSE144932 and GSE131793 datasets using GEO2R. We performed GO enrichment and KEGG pathway analyses. miRNAs targeting common DEGs were identified using miRDB and TargetScan.
Results: MYLK and CLU were upregulated in both datasets, implicating calcium signaling and coagulation pathways, respectively. In silico analysis showed that miR-9-5p, miR-3179, and miR-580-3p potentially target MYLK; miR-369-3p potentially targets CLU; and miR-499a-5p potentially targets both.
Conclusion: This study identifies MYLK and CLU, and their associated miRNAs (miR-9-5p, miR-3179, miR-580-3p, miR-499a-5p, and miR-369-3p), as potential noninvasive diagnostic biomarkers for PAH, requiring experimental validation. 

Background: Human T-lymphotropic virus type 1 (HTLV-1) is considered a health issue in Iran. However, its genetic diversity and molecular epidemiologic phylogeny remain poorly characterized.
Methods: The Tax gene of 9 asymptomatic individuals across Alborz, Gilan, and Ardabil provinces of Iran was sequenced and analyzed phylogenetically using MEGA-X.
Results: All strains clustered within the Cosmopolitan subtype a, showing high genetic similarity to Japanese and Chinese references. Positive selection (dN/dS > 1) was observed in all samples. Strikingly, the Alborz ISO32 strain exhibited 10 unique nonsynonymous mutations, suggesting regional evolutionary divergence.
Conclusion: This study, as the first multi-provincial study in Iran, reveals the essential requirement for systematic tracking of HTLV-1 genetic diversity and designing prevention programs tailored to each region.

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