Trend of ischemic heart disease mortality attributable to metabolic, behavioral, and environmental risk factors in the past two decades

Background

Ischemic heart diseases (IHD) is the leading cause of mortality, worldwide. Understanding of the status of risk factors contributing to IHD and mortality helps control this public health issue.

Purpose

This study aims to provide global, regional, and national estimates of the trend of IHD burden and deaths attributable to the modifiable risk factors, from 1990 to 2019.

Methods

Using the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 methodology, we evaluated the IHD incidence, mortality, years lived with disability, years of life lost, and disability-adjusted life-years (DALYs). IHD deaths attributable to the different metabolic, behavioral and environmental risk factors were estimated based on risk exposure, relative risks, and the theoretical minimum risk exposure level input from 204 countries and territories, stratified by sex and Socio-demographic Index (SDI). Trends were estimated from 1990 to 2019, with an emphasis on 2010 to 2019.

Results

Globally, there were 21·2 million (95% uncertainty interval [UI] 18·8–23·7) new cases, 9·1 million (8.4–9·7) deaths, and 182·0 million (170·2–193·5) DALYs due to IHD, in 2019. From 1990 to 2019, IHD incident cases, deaths and DALYs increased globally by 29.1·9% (27.0–31·3), 32·4% (25.3–37·8), and 53.9% (42·7–64·3), respectively. Although high SDI regions succeeded to reduce DLAYs due to IHDs by −36.7% (−33.8 to −39.2), low SDI regions faced an increase in DALYs due to IHDs by +104.4% (+75.0 to +135.3). In 2019, the five leading risk factors of deaths due to IHDs were; high systolic blood pressure [2.2 million deaths (1.7–2.7)], high LDL cholesterol [1.7 million deaths (1.2–2.3)], high fasting plasma glucose [1.1 million deaths (0.6–1.8)], high body-mass index [0.8 million deaths (0.5–1.1)], and diet low in whole grains [0.6 million deaths (0.2–0.8)]. From 1990 to 2019, high SDI regions succeeded to reduce the age standardized death rate of IHDs attributable to metabolic risk factors by −60.1% (−61.9 to −57.7), behavioral risk factors by −61.2% (−62.8 to −59.2) and environmental risk factors by −65.8% (−71.4 to −59.3). During the same period, the age standardized IHD death rate attributable to environmental risk factors decreased by −16.0% (−30.4 to −1.6), while the age standardized IHD death rate attributable to metabolic and behavioral risk factors didn't change significantly, in low SDI regions.

Conclusions

During the past two decades despite steadily increase in incident cases of IHDs, the age standardized burden of IHDs has decreased in high SDI regions most probably due to control of attributable risk factors. However, burden of IHDs has increased dramatically in low SDI regions. Preventive measures such as “polypills” for high blood pressure control programs and life-style modification should be prioritized in these settings.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): Bill & Melinda Gates Foundation Age-standardized DALY rates of IHD

Hypertensive heart disease burden attributable to high salt intake in the United States compared to the European Union and the global status: trends from 1990 to 2019

Background

Hypertensive heart disease (HHD) is a major cause of heart failure, cardiovascular related hospitalizations, and mortality. Diet high in salt is one of modifiable risk factors of HHD that can be controlled by appropriate policies.

Purpose

This study aims to provide the HHD burden attributable to diet high in sodium in the United States compared to European and the global trends from 1990 to 2019.

Methods

Using the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 methodology, we calculated the HHD, mortality, years lived with disability, years of life lost, and disability-adjusted life-years (DALYs). Diet high in sodium was defined as a diet with more than 1,000 milligrams of sodium per day. HHD deaths attributable to the diet high in sodium was estimated based on risk exposure, relative risks, and the theoretical minimum risk exposure level Trends of HHD attributable to diet high in sodium was estimated from 1990 to 2019.

Results

Globally, there were 170·3 thousand (95% uncertainty interval [UI] 31.2 to 459.5) deaths, YLLs, YLDs, DALYs due to HHD attributable to diet high in sodium, in 2019. In the United States, 4525 deaths happened because of HHD caused by the diet high in sodium, with 208.4% rise from 1990. In the European Union, 18,143 deaths happened because of HHD caused by the diet high in sodium, with 78.0% rise from 1990. To address the impact of population aging and population growth, we estimated the age standardized values for burden of HHD attributable to the diet high in sodium. From 1990 to 2019, worldwide age standardized YLL, YLD, and DALY rates per 100,000 for HHD attributable to the diet high in sodium changed by −44.0% (−63.6 to −30.6), +3.7% (−14.3 to +13.6), and −41.8% (−61.3 to −28.8), respectively (Figure 1). In the European Union, age standardized YLL, YLD, and DALY rates per 100,000 for HHD attributable to the diet high in sodium changed by −14.8% (−44.6 to −0.2), −13.5% (−45.8 to −14.0), and −14.8% (−43.5 to −0.9), respectively. Compared to the European Union and the worldwide trends, United Sates had the opposite increasing trend of HHD caused by the diet high in sodium. In the United States, age standardized YLL, YLD, and DALY rates per 100,000 for HHD attributable to the diet high in sodium changed by +110.4% (+42.0 to +631.0), +44.2% (+106.4 to +300.5), and −14.8% (−43.5 to −0.9), respectively. As shown in figure 2, the United States' increasing trend of HHD attributable to the diet high in sodium was caused mainly by the increasing trend observed in men.

Conclusions

Despite worldwide success in the restriction of the diet high in sodium, HHD burden attributable to high consumption of sodium is rising in the United States. This warning results requires public health attention to taking actions such as advocating for healthy diet, restricting foods high in sodium such as fast foods, and increasing the access to low salt foods for working groups.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): Bill & Melinda Gates Foundation Annual % DALY change of HHD due to saltTrend of HHD DALY in men vs women

Occupational exposure of health care personnel to SARS-CoV-2 particles in the intensive care unit of Tehran hospital

The outbreak of SARS-CoV-2 (COVID-19) has attracted much attention to study its possible presence and airborne transmission. The possibility of COVID-19 airborne transmission in indoor environments is debatable. The present study examined the concentration of viral RNA-containing particles produced directly or indirectly by breathing or coughing of confirmed COVID-19 patients or by carriers without symptoms. Some studies do not accept this method of transmission (COVID-19 airborne transmission). The present study aimed to measure the possible exposure of health care personnel to SARS-CoV-2 particles that may have been suspended in the air to respond to the hypothesis of COVID-19 airborne transmission. Airborne particle sampling was performed using impingement method based on NIOSH (chapter BA) and ASHRAE. Selection of sampling sections was in line with the WHO guidelines. The samples were analyzed using RT-PCR technique. Based on the given results, airborne particles of COVID-19 may present in the air and affect the health of hospital personnel. In fact, the analysis of gene expression in ambient conditions and thereby aerosol transmission of SARS-CoV-2 through air is possible and may lead to occupational exposure of health care personnel. Furthermore, it was found that airborne emission of COVID-19 through the breathing zone of patients, particularly in ICU wards with confirmed cases of COVID-19, may be higher than in other ICU wards. Also, the demonstrated results showed that there is a possibility of reaerosolization (reintroduction) of previously airborne SARS-CoV-2 particles into the atmosphere due to health care personnel frequently walking between different wards and stations of ICU.

Radial head resection versus prosthetic arthroplasty in terrible triad injury: a retrospective comparative cohort study

Aims

The crucial role of the radial head in the stability of the elbow in terrible triad injury is acknowledged. This retrospective study aims to compare the results of resection of a severely comminuted radial head with or without prosthetic arthroplasty as part of the reconstruction for this injury.

Patients and Methods

The outcome of radial head resection was compared with prosthetic arthroplasty in 29 and 15 patients with terrible triad injuries, respectively. There were ten female patients (34.5%) in the resection group and six female patients (40%) in the prosthesis group. The mean age was 40.7 years (sd 13.6) in the resection group and 36 years (sd 9.4) in the prosthesis group. The mean follow-up of the patients was 24.4 months (sd 12) in the resection group and 45.8 months (sd 6.8) in the prosthesis group. Outcome measures included visual analogue scale (VAS) for pain, Mayo Elbow Performance Score (MEPS), Disabilities of Arm, Shoulder and Hand (DASH) Score, and range of movement. Postoperative radiological complications were also recorded.

Results

The mean ranges of extension, flexion, supination, and pronation were not significantly different between the two study groups (p = 0.75, p = 0.65, p = 0.82, and p = 0.68, respectively). The mean VAS score, DASH score, and MEPS of the two groups were also not statistically significantly different (p = 0.93, p = 0.19, and p = 0.32, respectively). At the final visit, the elbow was stable in all patients. No patient was found to have developed an Essex–Lopresti injury. Osteoarthritis grade I and II was observed in five and three patients of the resection group, respectively, and four and one patients of the arthroplasty group, respectively.

Conclusion

The outcome of patients undergoing treatment for terrible triad injuries is similar whether the patient’s radial head was excised or replaced. Cite this article: Bone Joint J 2018;100-B:1499–505.

Comparative assessment of the therapeutic effects of the topical and systemic forms of Hypericum perforatum extract on induced oral mucositis in golden hamsters

Oral mucositis is a common and irritating complication of chemotherapy and radiotherapy for malignancies. Current treatments have failed to achieve complete remission of this complication. The St. John's wort plant (Hypericum perforatum) has long been known for its anti-inflammatory and antibacterial effects. The current study was designed to investigate the therapeutic efficacy of the topical and systemic administration of H. perforatum extract on oral mucositis. Oral mucositis was induced in 72 male golden hamsters by administration of 5-fluorouracil (60mg/kg), on days 0, 5, and 10 of the study. The cheek pouch was scratched with a sterile needle on days 1 and 2. On days 12-17, H. perforatum extract topical gel 10%, oral H. perforatum extract (300mg/kg), and gel base groups were treated and then compared with a control group. Weights and blood samples were evaluated, biopsies from buccal lesions were examined histopathologically, and tissue malondialdehyde (MDA) was measured. Both of the H. perforatum extract treatment groups saw a significant relief in oral mucositis compared to the control and base gel groups; the systemic form was superior to the topical form. H. perforatum extract, administered orally or topically, expedited the healing of chemotherapy-induced oral mucositis in hamsters.

Phospholipase, esterase and hemolytic activities of Candida spp. isolated from onychomycosis and oral lichen planus lesions

OBJECTIVE OF THE STUDY

Candidiasis is an opportunistic fungal infection caused by many species of Candida that affects different sites of the body. Secretion of exoenzymes plays an important role in virulence and pathogenesis. The aim of this study was to evaluate the potential role of phospholipase, esterase and hemolytic activity of Candida species isolated from onychomycosis and oral lichen planus patients in candidiasis.

METHODS

A total of 84 Candida isolates including 24 C. albicans and 46 C. parapsilosis from onychomycosis, and 14 C. albicans from oral lichen planus patients were included in our study. Egg yolk agar, Tween 80 opacity medium and blood agar plate assays were used for determining phospholipase, esterase and hemolytic activities, respectively. Statistical analyses were performed using the Fischer exact test.

RESULTS

C. parapsilosis isolates had the least exoenzyme activity among the isolates (P≤0.001). C. albicans isolates from lichen planus showed less exoenzyme activity in comparison to the onychomycosis isolates. Only 16.08% of C. parapsilosis isolates had phospholipase activity. This difference between C. albicans and C. parapsilosis was statistically significant (P≤0.001). All of the C. albicans isolates from onychomycosis patients had beta hemolysin activity. There was more hemolytic activity in the C. albicans isolates when compared with C. parapsilosis and between C. albicans isolates, no significant difference was seen. All of the C. albicans isolates produced esterase enzyme on day three and no significant differences were seen between the two groups of C. albicans for esterase activity. Two strains of C. albicans had no phospholipase or esterase activity.

CONCLUSION

This study showed that most of the isolates tested had different enzymatic patterns and C. parapsilosis strains had less phospholipase activity.

Comparing the Effect of Phenytoin Syrup and Triamcinolone Acetonide Ointment on Aphthous Ulcers in Patients with Behcet's Syndrome

BACKGROUND

Recurrent aphthous stomatitis (RAS) appears to be the most common type of oral ulcers. The lesion is usually self limited but its painful presentation results in some difficulties. Therefore, an efficient therapeutic strategy is required and currently existing therapies seem to be inadequate because of its unclear etiology. Here the therapeutic effect of triamcinolone acetonide ointment as a relatively expensive medication has been compared with phenytoin syrup on aphthous ulcers in patients with Behcet's syndrome.

METHODS

Thirty out of 60 our patients with Behcet's syndrome were randomly treated by phenytoin syrup and the remaining were advised to use 0.1% triamcinolone acetonide ointment. After a week, they were visited again to determine the status of aphthous ulcers.

RESULT

Positive response in the triamcinolone acetonide group and phenytoin group was 86.7% and 53.3%, respectively.

CONCLUSION

The effectiveness of triamcinolone acetonide ointment was more than phenytoin on aphthous ulcers in patients with Behcet's syndrome.

Does ghrelin level change after epileptic seizure in rats?

AIM

Epilepsy is one of the most common neurologic problems worldwide. A relationship between epilepsy and hormones has been demonstrated. This study was designed to investigate the effect of seizure on blood ghrelin level.

METHODS

Twenty male Wistar rats were divided into two groups. The control group received saline and the pentylenetetrazole (PTZ) group received a single convulsive dose (50mg/kg) of PTZ. Thirty minutes later blood samples were collected and acylated and unacylated ghrelin levels in the plasma were assayed.

RESULTS

Acylated or active form of ghrelin decreased significantly (p<0.05) after a PTZ-induced seizure, but the reduction of unacylated and total blood ghrelin levels failed to reach statistical significance.

CONCLUSION

These findings may reflect that PTZ-induced epilepsy decreases AG of plasma.

Needlestick Injuries among Nurses

BACKGROUND

Needlestick injuries (NSIs) are among the most important occupational injuries for health care workers (HCWs). In Iran, the problem of exposure to contaminated blood among nursing personnels has not well documented. The aim of this study was to determine the incidence of needlestick injuries in population of nurses in Shahroud Imam Hossein Hospital, northern Iran.

METHODS

A self-administrated questionnaire was completed by 180 nurses in September and October 2005 for their NSIs experience in the past year. In this study, needlestick injury was defined as percutaneous injury caused by hollow-borne needles, suturing needles, scalpel blades and lancets.

RESULTS

The case incidence of NSIs was 63.3% (114/180). The total number of episodes of NSIs among respondents was 220 (range: 1-5 episodes) with incidence rate of episodes i.e. 1.2 per person/year. 12.8% of nurses had not been vaccinated against hepatitis B virus (HBV). The causal devices in 105 cases (92.1%) were hollow-borne needles and the main causes of percutaneous injuries with hollow-bore needles were recapping (32.4%) and manipulating needles in patients (18.1%). The majority (51.8%) of injuries occurred after use and before disposal of the objects.

CONCLUSION

Nurses working in Imam Hossein Hospital are frequently exposed to blood-borne infection. NSIs were highly prevalent in these nurses therefore more intensive education programs should be directed at nurses to increase their awareness of and compliance with universal precautions (UP). We recommend a surveillance system and a center for managing injured persons.