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Avan A, Feigin VL, Bennett DA, Steinmetz JD, Hachinski V, Stranges S, Owolabi MO, Aali A, Abbasi-Kangevari M, Abbasi-Kangevari Z, Abd-Allah F, Abdollahzade S, Abidi H, Abolhassani H, Abualhasan A, Abu-Gharbieh E, Abu-Rmeileh NME, Abu-Zaid A, Ahmad A, Ahmadi S, Ahmed LA, Ajami M, Al Hamad H, Alanezi FM, Alanzi TM, Alimohamadi Y, Aljunid SM, Al-Raddadi RM, Amiri S, Arabloo J, Arulappan J, Arumugam A, Asadi-Pooya AA, Athar M, Athari SS, Atout MMW, Azadnajafabad S, Azangou-Khyavy M, Azari Jafari A, Azzam AY, Baghcheghi N, Bagherieh S, Baltatu OC, Bazmandegan G, Bhojaraja VS, Bijani A, Bitaraf S, Calina D, Darwish AH, Djalalinia S, Doheim MF, Dorostkar F, Eini E, El Nahas N, El Sayed I, Elhadi M, Elmonem MA, Eskandarieh S, Faghani S, Fallahzadeh A, Farahmand M, Ghafourifard M, Ghamari SH, Gholami A, Ghozy S, Goleij P, Hadei M, Hafezi-Nejad N, Haj-Mirzaian A, Halwani R, Hamidi S, Hasaballah AI, Hassan A, Hedna K, Hegazy MI, Heidari-Soureshjani R, Hosseini MS, Hoveidamanesh S, Jahrami H, Jamshidi E, Javaheri T, Jayapal SK, Kalankesh LR, Kalhor R, Kamiab Z, Keykhaei M, Khader YS, Khan M, Khan MAB, Khatatbeh, Khayat Kashani HR, Khosravi A, Kompani F, Koohestani HR, Larijani B, Lasrado S, Magdy Abd El Razek M, Malekpour MR, Malik AA, Mansournia MA, Mardi P, Maroufi SF, Masoudi S, Mayeli M, Mehrabi Nasab E, Menezes RG, Mirmoeeni S, Mirza-Aghazadeh-Attari M, Mobarakabadi M, Mohammadi E, Mohammadi S, Mohan S, Mokdad AH, Momtazmanesh S, Montazeri F, Moradi Sarabi M, Moraga P, Morovatdar N, Motaghinejad M, Naghavi M, Natto ZS, Nejadghaderi SA, Noroozi N, Okati-Aliabad H, Pazoki Toroudi H, Perna S, Piradov MA, Pourahmadi M, Rafiei A, Rahimi-Movaghar V, Rahmani AM, Rahmani S, Rahmanian V, Rajabpour-Sanati A, Rao CR, Rashidi MM, Rawassizadeh R, Razeghian-Jahromi I, Redwan EMM, Rezaee M, Rezaei N, Rezaei N, Rezaei N, Rezaeian M, Rikhtegar R, Saad AMA, Saddik B, Sadeghi M, Sadeghian S, Saeedi Moghaddam S, Sahebkar A, Salahi S, Salahi S, Samy AM, Sanadgol N, Sarveazad A, Sathian B, Saylan M, Shahbandi A, Shahrokhi S, Shams-Beyranvand M, Shanawaz M, Sharifi-Rad J, Sheikhi RA, Shetty JK, Shobeiri P, Shorofi SA, Siabani S, Tabatabaei SM, Taheri Abkenar Y, Taheri Soodejani M, Temsah MH, Vakilian A, Valadan Tahbaz S, Valizadeh R, Vaziri S, Vo B, Yahyazadeh Jabbari SH, Yesiltepe M, Zaki N, Zare I, Zare Dehnavi A, Zoladl M. The burden of neurological conditions in north Africa and the Middle East, 1990-2019: a systematic analysis of the Global Burden of Disease Study 2019. Lancet Glob Health 2024; 12:e960-e982. [PMID: 38604203 PMCID: PMC11099299 DOI: 10.1016/s2214-109x(24)00093-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 01/25/2024] [Accepted: 02/22/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND The burden of neurological conditions in north Africa and the Middle East is increasing. We aimed to assess the changes in the burden of neurological conditions in this super-region to aid with future decision making. METHODS In this analysis of the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 data, we examined temporal trends of disability-adjusted life-years (DALYs; deaths and disabilities combined), deaths, incident cases, and prevalent cases of 14 major neurological conditions and eight subtypes in 21 countries in the north Africa and the Middle East super-region. Additionally, we assessed neurological DALYs due to 22 potentially modifiable risk factors, within four levels of classification, during the period 1990-2019. We used a Bayesian modelling estimation approach, and generated 95% uncertainty intervals (UIs) for final estimates on the basis of the 2·5th and 97·5th percentiles of 1000 draws from the posterior distribution. FINDINGS In 2019, there were 441·1 thousand (95% UI 347·2-598·4) deaths and 17·6 million (12·5-24·7) neurological DALYs in north Africa and the Middle East. The leading causes of neurological DALYs were stroke, migraine, and Alzheimer's disease and other dementias (hereafter dementias). In north Africa and the Middle East in 2019, 85·8% (82·6-89·1) of stroke and 39·9% (26·4-54·7) of dementia age-standardised DALYs were attributable to modifiable risk factors. North Africa and the Middle East had the highest age-standardised DALY rates per 100 000 population due to dementia (387·0 [172·0-848·5]), Parkinson's disease (84·4 [74·7-103·2]), and migraine (601·4 [107·0-1371·8]) among the global super-regions. Between 1990 and 2019, there was a decrease in the age-standardised DALY rates related to meningitis (-75·8% [-81·1 to -69·5]), tetanus (-88·2% [-93·9 to -76·1]), stroke (-32·0% [-39·1 to -23·3]), intracerebral haemorrhage (-51·7% [-58·2 to -43·8]), idiopathic epilepsy (-26·2% [-43·6 to -1·1]), and subarachnoid haemorrhage (-62·8% [-71·6 to -41·0]), but for all other neurological conditions there was no change. During 1990-2019, the number of DALYs due to dementias, Parkinson's disease, multiple sclerosis, ischaemic stroke, and headache disorder (ie, migraine and tension-type headache) more than doubled in the super-region, and the burden of years lived with disability (YLDs), incidence, and prevalence of multiple sclerosis, motor neuron disease, Parkinson's disease, and ischaemic stroke increased both in age-standardised rate and count. During this period, the absolute burden of YLDs due to head and spinal injuries almost doubled. INTERPRETATION The increasing burden of neurological conditions in north Africa and the Middle East accompanies the increasing ageing population. Stroke and dementia are the primary causes of neurological disability and death, primarily attributable to common modifiable risk factors. Synergistic, systematic, lifetime, and multi-sectoral interventions aimed at preventing or mitigating the burden are needed. FUNDING Bill & Melinda Gates Foundation. TRANSLATIONS For the Persian, Arabic and Turkish translations of the abstract see Supplementary Materials section.
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Naghavi M, Ong KL, Aali A, Ababneh HS, Abate YH, Abbafati C, Abbasgholizadeh R, Abbasian M, Abbasi-Kangevari M, Abbastabar H, Abd ElHafeez S, Abdelmasseh M, Abd-Elsalam S, Abdelwahab A, Abdollahi M, Abdollahifar MA, Abdoun M, Abdulah DM, Abdullahi A, Abebe M, Abebe SS, Abedi A, Abegaz KH, Abhilash ES, Abidi H, Abiodun O, Aboagye RG, Abolhassani H, Abolmaali M, Abouzid M, Aboye GB, Abreu LG, Abrha WA, Abtahi D, Abu Rumeileh S, Abualruz H, Abubakar B, Abu-Gharbieh E, Abu-Rmeileh NME, Aburuz S, Abu-Zaid A, Accrombessi MMK, Adal TG, Adamu AA, Addo IY, Addolorato G, Adebiyi AO, Adekanmbi V, Adepoju AV, Adetunji CO, Adetunji JB, Adeyeoluwa TE, Adeyinka DA, Adeyomoye OI, Admass BAA, Adnani QES, Adra S, Afolabi AA, Afzal MS, Afzal S, Agampodi SB, Agasthi P, Aggarwal M, Aghamiri S, Agide FD, Agodi A, Agrawal A, Agyemang-Duah W, Ahinkorah BO, Ahmad A, Ahmad D, Ahmad F, Ahmad MM, Ahmad S, Ahmad S, Ahmad T, Ahmadi K, Ahmadzade AM, Ahmed A, Ahmed A, Ahmed H, Ahmed LA, Ahmed MS, Ahmed MS, Ahmed MB, 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Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet 2024; 403:2100-2132. [PMID: 38582094 DOI: 10.1016/s0140-6736(24)00367-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/15/2024] [Accepted: 02/22/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation.
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Burden of disease scenarios for 204 countries and territories, 2022-2050: a forecasting analysis for the Global Burden of Disease Study 2021. Lancet 2024; 403:2204-2256. [PMID: 38762325 DOI: 10.1016/s0140-6736(24)00685-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 03/29/2024] [Accepted: 04/02/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Future trends in disease burden and drivers of health are of great interest to policy makers and the public at large. This information can be used for policy and long-term health investment, planning, and prioritisation. We have expanded and improved upon previous forecasts produced as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) and provide a reference forecast (the most likely future), and alternative scenarios assessing disease burden trajectories if selected sets of risk factors were eliminated from current levels by 2050. METHODS Using forecasts of major drivers of health such as the Socio-demographic Index (SDI; a composite measure of lag-distributed income per capita, mean years of education, and total fertility under 25 years of age) and the full set of risk factor exposures captured by GBD, we provide cause-specific forecasts of mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) by age and sex from 2022 to 2050 for 204 countries and territories, 21 GBD regions, seven super-regions, and the world. All analyses were done at the cause-specific level so that only risk factors deemed causal by the GBD comparative risk assessment influenced future trajectories of mortality for each disease. Cause-specific mortality was modelled using mixed-effects models with SDI and time as the main covariates, and the combined impact of causal risk factors as an offset in the model. At the all-cause mortality level, we captured unexplained variation by modelling residuals with an autoregressive integrated moving average model with drift attenuation. These all-cause forecasts constrained the cause-specific forecasts at successively deeper levels of the GBD cause hierarchy using cascading mortality models, thus ensuring a robust estimate of cause-specific mortality. For non-fatal measures (eg, low back pain), incidence and prevalence were forecasted from mixed-effects models with SDI as the main covariate, and YLDs were computed from the resulting prevalence forecasts and average disability weights from GBD. Alternative future scenarios were constructed by replacing appropriate reference trajectories for risk factors with hypothetical trajectories of gradual elimination of risk factor exposure from current levels to 2050. The scenarios were constructed from various sets of risk factors: environmental risks (Safer Environment scenario), risks associated with communicable, maternal, neonatal, and nutritional diseases (CMNNs; Improved Childhood Nutrition and Vaccination scenario), risks associated with major non-communicable diseases (NCDs; Improved Behavioural and Metabolic Risks scenario), and the combined effects of these three scenarios. Using the Shared Socioeconomic Pathways climate scenarios SSP2-4.5 as reference and SSP1-1.9 as an optimistic alternative in the Safer Environment scenario, we accounted for climate change impact on health by using the most recent Intergovernmental Panel on Climate Change temperature forecasts and published trajectories of ambient air pollution for the same two scenarios. Life expectancy and healthy life expectancy were computed using standard methods. The forecasting framework includes computing the age-sex-specific future population for each location and separately for each scenario. 95% uncertainty intervals (UIs) for each individual future estimate were derived from the 2·5th and 97·5th percentiles of distributions generated from propagating 500 draws through the multistage computational pipeline. FINDINGS In the reference scenario forecast, global and super-regional life expectancy increased from 2022 to 2050, but improvement was at a slower pace than in the three decades preceding the COVID-19 pandemic (beginning in 2020). Gains in future life expectancy were forecasted to be greatest in super-regions with comparatively low life expectancies (such as sub-Saharan Africa) compared with super-regions with higher life expectancies (such as the high-income super-region), leading to a trend towards convergence in life expectancy across locations between now and 2050. At the super-region level, forecasted healthy life expectancy patterns were similar to those of life expectancies. Forecasts for the reference scenario found that health will improve in the coming decades, with all-cause age-standardised DALY rates decreasing in every GBD super-region. The total DALY burden measured in counts, however, will increase in every super-region, largely a function of population ageing and growth. We also forecasted that both DALY counts and age-standardised DALY rates will continue to shift from CMNNs to NCDs, with the most pronounced shifts occurring in sub-Saharan Africa (60·1% [95% UI 56·8-63·1] of DALYs were from CMNNs in 2022 compared with 35·8% [31·0-45·0] in 2050) and south Asia (31·7% [29·2-34·1] to 15·5% [13·7-17·5]). This shift is reflected in the leading global causes of DALYs, with the top four causes in 2050 being ischaemic heart disease, stroke, diabetes, and chronic obstructive pulmonary disease, compared with 2022, with ischaemic heart disease, neonatal disorders, stroke, and lower respiratory infections at the top. The global proportion of DALYs due to YLDs likewise increased from 33·8% (27·4-40·3) to 41·1% (33·9-48·1) from 2022 to 2050, demonstrating an important shift in overall disease burden towards morbidity and away from premature death. The largest shift of this kind was forecasted for sub-Saharan Africa, from 20·1% (15·6-25·3) of DALYs due to YLDs in 2022 to 35·6% (26·5-43·0) in 2050. In the assessment of alternative future scenarios, the combined effects of the scenarios (Safer Environment, Improved Childhood Nutrition and Vaccination, and Improved Behavioural and Metabolic Risks scenarios) demonstrated an important decrease in the global burden of DALYs in 2050 of 15·4% (13·5-17·5) compared with the reference scenario, with decreases across super-regions ranging from 10·4% (9·7-11·3) in the high-income super-region to 23·9% (20·7-27·3) in north Africa and the Middle East. The Safer Environment scenario had its largest decrease in sub-Saharan Africa (5·2% [3·5-6·8]), the Improved Behavioural and Metabolic Risks scenario in north Africa and the Middle East (23·2% [20·2-26·5]), and the Improved Nutrition and Vaccination scenario in sub-Saharan Africa (2·0% [-0·6 to 3·6]). INTERPRETATION Globally, life expectancy and age-standardised disease burden were forecasted to improve between 2022 and 2050, with the majority of the burden continuing to shift from CMNNs to NCDs. That said, continued progress on reducing the CMNN disease burden will be dependent on maintaining investment in and policy emphasis on CMNN disease prevention and treatment. Mostly due to growth and ageing of populations, the number of deaths and DALYs due to all causes combined will generally increase. By constructing alternative future scenarios wherein certain risk exposures are eliminated by 2050, we have shown that opportunities exist to substantially improve health outcomes in the future through concerted efforts to prevent exposure to well established risk factors and to expand access to key health interventions. FUNDING Bill & Melinda Gates Foundation.
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Global fertility in 204 countries and territories, 1950-2021, with forecasts to 2100: a comprehensive demographic analysis for the Global Burden of Disease Study 2021. Lancet 2024; 403:2057-2099. [PMID: 38521087 DOI: 10.1016/s0140-6736(24)00550-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/28/2023] [Accepted: 03/15/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Accurate assessments of current and future fertility-including overall trends and changing population age structures across countries and regions-are essential to help plan for the profound social, economic, environmental, and geopolitical challenges that these changes will bring. Estimates and projections of fertility are necessary to inform policies involving resource and health-care needs, labour supply, education, gender equality, and family planning and support. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 produced up-to-date and comprehensive demographic assessments of key fertility indicators at global, regional, and national levels from 1950 to 2021 and forecast fertility metrics to 2100 based on a reference scenario and key policy-dependent alternative scenarios. METHODS To estimate fertility indicators from 1950 to 2021, mixed-effects regression models and spatiotemporal Gaussian process regression were used to synthesise data from 8709 country-years of vital and sample registrations, 1455 surveys and censuses, and 150 other sources, and to generate age-specific fertility rates (ASFRs) for 5-year age groups from age 10 years to 54 years. ASFRs were summed across age groups to produce estimates of total fertility rate (TFR). Livebirths were calculated by multiplying ASFR and age-specific female population, then summing across ages 10-54 years. To forecast future fertility up to 2100, our Institute for Health Metrics and Evaluation (IHME) forecasting model was based on projections of completed cohort fertility at age 50 years (CCF50; the average number of children born over time to females from a specified birth cohort), which yields more stable and accurate measures of fertility than directly modelling TFR. CCF50 was modelled using an ensemble approach in which three sub-models (with two, three, and four covariates variously consisting of female educational attainment, contraceptive met need, population density in habitable areas, and under-5 mortality) were given equal weights, and analyses were conducted utilising the MR-BRT (meta-regression-Bayesian, regularised, trimmed) tool. To capture time-series trends in CCF50 not explained by these covariates, we used a first-order autoregressive model on the residual term. CCF50 as a proportion of each 5-year ASFR was predicted using a linear mixed-effects model with fixed-effects covariates (female educational attainment and contraceptive met need) and random intercepts for geographical regions. Projected TFRs were then computed for each calendar year as the sum of single-year ASFRs across age groups. The reference forecast is our estimate of the most likely fertility future given the model, past fertility, forecasts of covariates, and historical relationships between covariates and fertility. We additionally produced forecasts for multiple alternative scenarios in each location: the UN Sustainable Development Goal (SDG) for education is achieved by 2030; the contraceptive met need SDG is achieved by 2030; pro-natal policies are enacted to create supportive environments for those who give birth; and the previous three scenarios combined. Uncertainty from past data inputs and model estimation was propagated throughout analyses by taking 1000 draws for past and present fertility estimates and 500 draws for future forecasts from the estimated distribution for each metric, with 95% uncertainty intervals (UIs) given as the 2·5 and 97·5 percentiles of the draws. To evaluate the forecasting performance of our model and others, we computed skill values-a metric assessing gain in forecasting accuracy-by comparing predicted versus observed ASFRs from the past 15 years (2007-21). A positive skill metric indicates that the model being evaluated performs better than the baseline model (here, a simplified model holding 2007 values constant in the future), and a negative metric indicates that the evaluated model performs worse than baseline. FINDINGS During the period from 1950 to 2021, global TFR more than halved, from 4·84 (95% UI 4·63-5·06) to 2·23 (2·09-2·38). Global annual livebirths peaked in 2016 at 142 million (95% UI 137-147), declining to 129 million (121-138) in 2021. Fertility rates declined in all countries and territories since 1950, with TFR remaining above 2·1-canonically considered replacement-level fertility-in 94 (46·1%) countries and territories in 2021. This included 44 of 46 countries in sub-Saharan Africa, which was the super-region with the largest share of livebirths in 2021 (29·2% [28·7-29·6]). 47 countries and territories in which lowest estimated fertility between 1950 and 2021 was below replacement experienced one or more subsequent years with higher fertility; only three of these locations rebounded above replacement levels. Future fertility rates were projected to continue to decline worldwide, reaching a global TFR of 1·83 (1·59-2·08) in 2050 and 1·59 (1·25-1·96) in 2100 under the reference scenario. The number of countries and territories with fertility rates remaining above replacement was forecast to be 49 (24·0%) in 2050 and only six (2·9%) in 2100, with three of these six countries included in the 2021 World Bank-defined low-income group, all located in the GBD super-region of sub-Saharan Africa. The proportion of livebirths occurring in sub-Saharan Africa was forecast to increase to more than half of the world's livebirths in 2100, to 41·3% (39·6-43·1) in 2050 and 54·3% (47·1-59·5) in 2100. The share of livebirths was projected to decline between 2021 and 2100 in most of the six other super-regions-decreasing, for example, in south Asia from 24·8% (23·7-25·8) in 2021 to 16·7% (14·3-19·1) in 2050 and 7·1% (4·4-10·1) in 2100-but was forecast to increase modestly in the north Africa and Middle East and high-income super-regions. Forecast estimates for the alternative combined scenario suggest that meeting SDG targets for education and contraceptive met need, as well as implementing pro-natal policies, would result in global TFRs of 1·65 (1·40-1·92) in 2050 and 1·62 (1·35-1·95) in 2100. The forecasting skill metric values for the IHME model were positive across all age groups, indicating that the model is better than the constant prediction. INTERPRETATION Fertility is declining globally, with rates in more than half of all countries and territories in 2021 below replacement level. Trends since 2000 show considerable heterogeneity in the steepness of declines, and only a small number of countries experienced even a slight fertility rebound after their lowest observed rate, with none reaching replacement level. Additionally, the distribution of livebirths across the globe is shifting, with a greater proportion occurring in the lowest-income countries. Future fertility rates will continue to decline worldwide and will remain low even under successful implementation of pro-natal policies. These changes will have far-reaching economic and societal consequences due to ageing populations and declining workforces in higher-income countries, combined with an increasing share of livebirths among the already poorest regions of the world. FUNDING Bill & Melinda Gates Foundation.
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Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet 2024; 403:2133-2161. [PMID: 38642570 DOI: 10.1016/s0140-6736(24)00757-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 03/07/2024] [Accepted: 04/12/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND Detailed, comprehensive, and timely reporting on population health by underlying causes of disability and premature death is crucial to understanding and responding to complex patterns of disease and injury burden over time and across age groups, sexes, and locations. The availability of disease burden estimates can promote evidence-based interventions that enable public health researchers, policy makers, and other professionals to implement strategies that can mitigate diseases. It can also facilitate more rigorous monitoring of progress towards national and international health targets, such as the Sustainable Development Goals. For three decades, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has filled that need. A global network of collaborators contributed to the production of GBD 2021 by providing, reviewing, and analysing all available data. GBD estimates are updated routinely with additional data and refined analytical methods. GBD 2021 presents, for the first time, estimates of health loss due to the COVID-19 pandemic. METHODS The GBD 2021 disease and injury burden analysis estimated years lived with disability (YLDs), years of life lost (YLLs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries using 100 983 data sources. Data were extracted from vital registration systems, verbal autopsies, censuses, household surveys, disease-specific registries, health service contact data, and other sources. YLDs were calculated by multiplying cause-age-sex-location-year-specific prevalence of sequelae by their respective disability weights, for each disease and injury. YLLs were calculated by multiplying cause-age-sex-location-year-specific deaths by the standard life expectancy at the age that death occurred. DALYs were calculated by summing YLDs and YLLs. HALE estimates were produced using YLDs per capita and age-specific mortality rates by location, age, sex, year, and cause. 95% uncertainty intervals (UIs) were generated for all final estimates as the 2·5th and 97·5th percentiles values of 500 draws. Uncertainty was propagated at each step of the estimation process. Counts and age-standardised rates were calculated globally, for seven super-regions, 21 regions, 204 countries and territories (including 21 countries with subnational locations), and 811 subnational locations, from 1990 to 2021. Here we report data for 2010 to 2021 to highlight trends in disease burden over the past decade and through the first 2 years of the COVID-19 pandemic. FINDINGS Global DALYs increased from 2·63 billion (95% UI 2·44-2·85) in 2010 to 2·88 billion (2·64-3·15) in 2021 for all causes combined. Much of this increase in the number of DALYs was due to population growth and ageing, as indicated by a decrease in global age-standardised all-cause DALY rates of 14·2% (95% UI 10·7-17·3) between 2010 and 2019. Notably, however, this decrease in rates reversed during the first 2 years of the COVID-19 pandemic, with increases in global age-standardised all-cause DALY rates since 2019 of 4·1% (1·8-6·3) in 2020 and 7·2% (4·7-10·0) in 2021. In 2021, COVID-19 was the leading cause of DALYs globally (212·0 million [198·0-234·5] DALYs), followed by ischaemic heart disease (188·3 million [176·7-198·3]), neonatal disorders (186·3 million [162·3-214·9]), and stroke (160·4 million [148·0-171·7]). However, notable health gains were seen among other leading communicable, maternal, neonatal, and nutritional (CMNN) diseases. Globally between 2010 and 2021, the age-standardised DALY rates for HIV/AIDS decreased by 47·8% (43·3-51·7) and for diarrhoeal diseases decreased by 47·0% (39·9-52·9). Non-communicable diseases contributed 1·73 billion (95% UI 1·54-1·94) DALYs in 2021, with a decrease in age-standardised DALY rates since 2010 of 6·4% (95% UI 3·5-9·5). Between 2010 and 2021, among the 25 leading Level 3 causes, age-standardised DALY rates increased most substantially for anxiety disorders (16·7% [14·0-19·8]), depressive disorders (16·4% [11·9-21·3]), and diabetes (14·0% [10·0-17·4]). Age-standardised DALY rates due to injuries decreased globally by 24·0% (20·7-27·2) between 2010 and 2021, although improvements were not uniform across locations, ages, and sexes. Globally, HALE at birth improved slightly, from 61·3 years (58·6-63·6) in 2010 to 62·2 years (59·4-64·7) in 2021. However, despite this overall increase, HALE decreased by 2·2% (1·6-2·9) between 2019 and 2021. INTERPRETATION Putting the COVID-19 pandemic in the context of a mutually exclusive and collectively exhaustive list of causes of health loss is crucial to understanding its impact and ensuring that health funding and policy address needs at both local and global levels through cost-effective and evidence-based interventions. A global epidemiological transition remains underway. Our findings suggest that prioritising non-communicable disease prevention and treatment policies, as well as strengthening health systems, continues to be crucially important. The progress on reducing the burden of CMNN diseases must not stall; although global trends are improving, the burden of CMNN diseases remains unacceptably high. Evidence-based interventions will help save the lives of young children and mothers and improve the overall health and economic conditions of societies across the world. Governments and multilateral organisations should prioritise pandemic preparedness planning alongside efforts to reduce the burden of diseases and injuries that will strain resources in the coming decades. FUNDING Bill & Melinda Gates Foundation.
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Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet 2024; 403:2162-2203. [PMID: 38762324 DOI: 10.1016/s0140-6736(24)00933-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 03/11/2024] [Accepted: 05/02/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Understanding the health consequences associated with exposure to risk factors is necessary to inform public health policy and practice. To systematically quantify the contributions of risk factor exposures to specific health outcomes, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 aims to provide comprehensive estimates of exposure levels, relative health risks, and attributable burden of disease for 88 risk factors in 204 countries and territories and 811 subnational locations, from 1990 to 2021. METHODS The GBD 2021 risk factor analysis used data from 54 561 total distinct sources to produce epidemiological estimates for 88 risk factors and their associated health outcomes for a total of 631 risk-outcome pairs. Pairs were included on the basis of data-driven determination of a risk-outcome association. Age-sex-location-year-specific estimates were generated at global, regional, and national levels. Our approach followed the comparative risk assessment framework predicated on a causal web of hierarchically organised, potentially combinative, modifiable risks. Relative risks (RRs) of a given outcome occurring as a function of risk factor exposure were estimated separately for each risk-outcome pair, and summary exposure values (SEVs), representing risk-weighted exposure prevalence, and theoretical minimum risk exposure levels (TMRELs) were estimated for each risk factor. These estimates were used to calculate the population attributable fraction (PAF; ie, the proportional change in health risk that would occur if exposure to a risk factor were reduced to the TMREL). The product of PAFs and disease burden associated with a given outcome, measured in disability-adjusted life-years (DALYs), yielded measures of attributable burden (ie, the proportion of total disease burden attributable to a particular risk factor or combination of risk factors). Adjustments for mediation were applied to account for relationships involving risk factors that act indirectly on outcomes via intermediate risks. Attributable burden estimates were stratified by Socio-demographic Index (SDI) quintile and presented as counts, age-standardised rates, and rankings. To complement estimates of RR and attributable burden, newly developed burden of proof risk function (BPRF) methods were applied to yield supplementary, conservative interpretations of risk-outcome associations based on the consistency of underlying evidence, accounting for unexplained heterogeneity between input data from different studies. Estimates reported represent the mean value across 500 draws from the estimate's distribution, with 95% uncertainty intervals (UIs) calculated as the 2·5th and 97·5th percentile values across the draws. FINDINGS Among the specific risk factors analysed for this study, particulate matter air pollution was the leading contributor to the global disease burden in 2021, contributing 8·0% (95% UI 6·7-9·4) of total DALYs, followed by high systolic blood pressure (SBP; 7·8% [6·4-9·2]), smoking (5·7% [4·7-6·8]), low birthweight and short gestation (5·6% [4·8-6·3]), and high fasting plasma glucose (FPG; 5·4% [4·8-6·0]). For younger demographics (ie, those aged 0-4 years and 5-14 years), risks such as low birthweight and short gestation and unsafe water, sanitation, and handwashing (WaSH) were among the leading risk factors, while for older age groups, metabolic risks such as high SBP, high body-mass index (BMI), high FPG, and high LDL cholesterol had a greater impact. From 2000 to 2021, there was an observable shift in global health challenges, marked by a decline in the number of all-age DALYs broadly attributable to behavioural risks (decrease of 20·7% [13·9-27·7]) and environmental and occupational risks (decrease of 22·0% [15·5-28·8]), coupled with a 49·4% (42·3-56·9) increase in DALYs attributable to metabolic risks, all reflecting ageing populations and changing lifestyles on a global scale. Age-standardised global DALY rates attributable to high BMI and high FPG rose considerably (15·7% [9·9-21·7] for high BMI and 7·9% [3·3-12·9] for high FPG) over this period, with exposure to these risks increasing annually at rates of 1·8% (1·6-1·9) for high BMI and 1·3% (1·1-1·5) for high FPG. By contrast, the global risk-attributable burden and exposure to many other risk factors declined, notably for risks such as child growth failure and unsafe water source, with age-standardised attributable DALYs decreasing by 71·5% (64·4-78·8) for child growth failure and 66·3% (60·2-72·0) for unsafe water source. We separated risk factors into three groups according to trajectory over time: those with a decreasing attributable burden, due largely to declining risk exposure (eg, diet high in trans-fat and household air pollution) but also to proportionally smaller child and youth populations (eg, child and maternal malnutrition); those for which the burden increased moderately in spite of declining risk exposure, due largely to population ageing (eg, smoking); and those for which the burden increased considerably due to both increasing risk exposure and population ageing (eg, ambient particulate matter air pollution, high BMI, high FPG, and high SBP). INTERPRETATION Substantial progress has been made in reducing the global disease burden attributable to a range of risk factors, particularly those related to maternal and child health, WaSH, and household air pollution. Maintaining efforts to minimise the impact of these risk factors, especially in low SDI locations, is necessary to sustain progress. Successes in moderating the smoking-related burden by reducing risk exposure highlight the need to advance policies that reduce exposure to other leading risk factors such as ambient particulate matter air pollution and high SBP. Troubling increases in high FPG, high BMI, and other risk factors related to obesity and metabolic syndrome indicate an urgent need to identify and implement interventions. FUNDING Bill & Melinda Gates Foundation.
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Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950-2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021. Lancet 2024; 403:1989-2056. [PMID: 38484753 DOI: 10.1016/s0140-6736(24)00476-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/08/2023] [Accepted: 03/06/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020-21 COVID-19 pandemic period. METHODS 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution. FINDINGS Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5-65·1] decline), and increased during the COVID-19 pandemic period (2020-21; 5·1% [0·9-9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98-5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50-6·01) in 2019. An estimated 131 million (126-137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7-17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8-24·8), from 49·0 years (46·7-51·3) to 71·7 years (70·9-72·5). Global life expectancy at birth declined by 1·6 years (1·0-2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67-8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4-52·7]) and south Asia (26·3% [9·0-44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations. INTERPRETATION Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic. FUNDING Bill & Melinda Gates Foundation.
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Steinmetz JD, Seeher KM, Schiess N, Nichols E, Cao B, Servili C, Cavallera V, Cousin E, Hagins H, Moberg ME, Mehlman ML, Abate YH, Abbas J, Abbasi MA, Abbasian M, Abbastabar H, Abdelmasseh M, Abdollahi M, Abdollahi M, Abdollahifar MA, Abd-Rabu R, Abdulah DM, Abdullahi A, Abedi A, Abedi V, Abeldaño Zuñiga RA, Abidi H, Abiodun O, Aboagye RG, Abolhassani H, Aboyans V, Abrha WA, Abualhasan A, Abu-Gharbieh E, Aburuz S, Adamu LH, Addo IY, Adebayo OM, Adekanmbi V, Adekiya TA, Adikusuma W, Adnani QES, Adra S, Afework T, Afolabi AA, Afraz A, Afzal S, Aghamiri S, Agodi A, Agyemang-Duah W, Ahinkorah BO, Ahmad A, Ahmad D, Ahmad S, Ahmadzade AM, Ahmed A, Ahmed A, Ahmed H, Ahmed JQ, Ahmed LA, Ahmed MB, Ahmed SA, Ajami M, Aji B, Ajumobi O, Akade SE, Akbari M, Akbarialiabad H, Akhlaghi S, Akinosoglou K, Akinyemi RO, Akonde M, Al Hasan SM, Alahdab F, AL-Ahdal TMA, Al-amer RM, Albashtawy M, AlBataineh MT, Aldawsari KA, Alemi H, Alemi S, Algammal AM, Al-Gheethi AAS, Alhalaiqa FAN, Alhassan RK, Ali A, Ali EA, Ali L, Ali MU, Ali MM, Ali R, Ali S, Ali SSS, Ali Z, Alif SM, Alimohamadi Y, Aliyi AA, Aljofan M, Aljunid SM, Alladi S, Almazan JU, Almustanyir S, Al-Omari B, Alqahtani JS, Alqasmi I, Alqutaibi AY, Al-Shahi Salman R, Altaany Z, Al-Tawfiq JA, Altirkawi KA, Alvis-Guzman N, Al-Worafi YM, Aly H, Aly S, Alzoubi KH, Amani R, Amindarolzarbi A, Amiri S, Amirzade-Iranaq MH, Amu H, Amugsi DA, Amusa GA, Amzat J, Ancuceanu R, Anderlini D, Anderson DB, Andrei CL, Androudi S, Angappan D, Angesom TW, Anil A, Ansari-Moghaddam A, Anwer R, Arafat M, Aravkin AY, Areda D, Ariffin H, Arifin H, Arkew M, Ärnlöv J, Arooj M, Artamonov AA, Artanti KD, Aruleba RT, Asadi-Pooya AA, Asena TF, Asghari-Jafarabadi M, Ashraf M, Ashraf T, Atalell KA, Athari SS, Atinafu BTT, Atorkey P, Atout MMW, Atreya A, Aujayeb A, Avan A, Ayala Quintanilla BP, Ayatollahi H, Ayinde OO, Ayyoubzadeh SM, Azadnajafabad S, Azizi Z, Azizian K, Azzam AY, Babaei M, Badar M, Badiye AD, Baghdadi S, Bagherieh S, Bai R, Baig AA, Balakrishnan S, Balalla S, Baltatu OC, Banach M, Bandyopadhyay S, Banerjee I, Baran MF, Barboza MA, Barchitta M, Bardhan M, Barker-Collo SL, Bärnighausen TW, Barrow A, Bashash D, Bashiri H, Bashiru HA, Basiru A, Basso JD, Basu S, Batiha AMM, Batra K, Baune BT, Bedi N, Begde A, Begum T, Behnam B, Behnoush AH, Beiranvand M, Béjot Y, Bekele A, Belete MA, Belgaumi UI, Bemanalizadeh M, Bender RG, Benfor B, Bennett DA, Bensenor IM, Berice B, Bettencourt PJG, Beyene KA, Bhadra A, Bhagat DS, Bhangdia K, Bhardwaj N, Bhardwaj P, Bhargava A, Bhaskar S, Bhat AN, Bhat V, Bhatti GK, Bhatti JS, Bhatti R, Bijani A, Bikbov B, Bilalaga MM, Biswas A, Bitaraf S, Bitra VR, Bjørge T, Bodolica V, Bodunrin AO, Boloor A, Braithwaite D, Brayne C, Brenner H, Briko A, Bringas Vega ML, Brown J, Budke CM, Buonsenso D, Burkart K, Burns RA, Bustanji Y, Butt MH, Butt NS, Butt ZA, Cabral LS, Caetano dos Santos FL, Calina D, Campos-Nonato IR, Cao C, Carabin H, Cárdenas R, Carreras G, Carvalho AF, Castañeda-Orjuela CA, Casulli A, Catalá-López F, Catapano AL, Caye A, Cegolon L, Cenderadewi M, Cerin E, Chacón-Uscamaita PRU, Chan JSK, Chanie GS, Charan J, Chattu VK, Chekol Abebe E, Chen H, Chen J, Chi G, Chichagi F, Chidambaram SB, Chimoriya R, Ching PR, Chitheer A, Chong YY, Chopra H, Choudhari SG, Chowdhury EK, Chowdhury R, Christensen H, Chu DT, Chukwu IS, Chung E, Coberly K, Columbus A, Comachio J, Conde J, Cortesi PA, Costa VM, Couto RAS, Criqui MH, Cruz-Martins N, Dabbagh Ohadi MA, Dadana S, Dadras O, Dai X, Dai Z, D'Amico E, Danawi HA, Dandona L, Dandona R, Darwish AH, Das S, Das S, Dascalu AM, Dash NR, Dashti M, De la Hoz FP, de la Torre-Luque A, De Leo D, Dean FE, Dehghan A, Dehghan A, Dejene H, Demant D, Demetriades AK, Demissie S, Deng X, Desai HD, Devanbu VGC, Dhama K, Dharmaratne SD, Dhimal M, Dias da Silva D, Diaz D, Dibas M, Ding DD, Dinu M, Dirac MA, Diress M, Do TC, Do THP, Doan KDK, Dodangeh M, Doheim MF, Dokova KG, Dongarwar D, Dsouza HL, Dube J, Duraisamy S, Durojaiye OC, Dutta S, Dziedzic AM, Edinur HA, Eissazade N, Ekholuenetale M, Ekundayo TC, El Nahas N, El Sayed I, Elahi Najafi MA, Elbarazi I, Elemam NM, Elgar FJ, Elgendy IY, Elhabashy HR, Elhadi M, Elilo LT, Ellenbogen RG, Elmeligy OAA, Elmonem MA, Elshaer M, Elsohaby I, Emamverdi M, Emeto TI, Endres M, Esezobor CI, Eskandarieh S, Fadaei A, Fagbamigbe AF, Fahim A, Faramarzi A, Fares J, Farjoud Kouhanjani M, Faro A, Farzadfar F, Fatehizadeh A, Fathi M, Fathi S, Fatima SAF, Feizkhah A, Fereshtehnejad SM, Ferrari AJ, Ferreira N, Fetensa G, Firouraghi N, Fischer F, Fonseca AC, Force LM, Fornari A, Foroutan B, Fukumoto T, Gadanya MA, Gaidhane AM, Galali Y, Galehdar N, Gan Q, Gandhi AP, Ganesan B, Gardner WM, Garg N, Gau SY, Gautam RK, Gebre T, Gebrehiwot M, Gebremeskel GG, Gebreslassie HG, Getacher L, Ghaderi Yazdi B, Ghadirian F, Ghaffarpasand F, Ghanbari R, Ghasemi M, Ghazy RM, Ghimire S, Gholami A, Gholamrezanezhad A, Ghotbi E, Ghozy S, Gialluisi A, Gill PS, Glasstetter LM, Gnedovskaya EV, Golchin A, Golechha M, Goleij P, Golinelli D, Gomes-Neto M, Goulart AC, Goyal A, Gray RJ, Grivna M, Guadie HA, Guan B, Guarducci G, Guicciardi S, Gunawardane DA, Guo H, Gupta B, Gupta R, Gupta S, Gupta VB, Gupta VK, Gutiérrez RA, Habibzadeh F, Hachinski V, Haddadi R, Hadei M, Hadi NR, Haep N, Haile TG, Haj-Mirzaian A, Hall BJ, Halwani R, Hameed S, Hamiduzzaman M, Hammoud A, Han H, Hanifi N, Hankey GJ, Hannan MA, Hao J, Harapan H, Hareru HE, Hargono A, Harlianto NI, Haro JM, Hartman NN, Hasaballah AI, Hasan F, Hasani H, Hasanian M, Hassan A, Hassan S, Hassanipour S, Hassankhani H, Hassen MB, Haubold J, Hay SI, Hayat K, Hegazy MI, Heidari G, Heidari M, Heidari-Soureshjani R, Hesami H, Hezam K, Hiraike Y, Hoffman HJ, Holla R, Hopf KP, Horita N, Hossain MM, Hossain MB, Hossain S, Hosseinzadeh H, Hosseinzadeh M, Hostiuc S, Hu C, Huang J, Huda MN, Hussain J, Hussein NR, Huynh HH, Hwang BF, Ibitoye SE, Ilaghi M, Ilesanmi OS, Ilic IM, Ilic MD, Immurana M, Iravanpour F, Islam SMS, Ismail F, Iso H, Isola G, Iwagami M, Iwu CCD, Iyer M, Jaan A, Jacob L, Jadidi-Niaragh F, Jafari M, Jafarinia M, Jafarzadeh A, Jahankhani K, Jahanmehr N, Jahrami H, Jaiswal A, Jakovljevic M, Jamora RDG, Jana S, Javadi N, Javed S, Javeed S, Jayapal SK, Jayaram S, Jiang H, Johnson CO, Johnson WD, Jokar M, Jonas JB, Joseph A, Joseph N, Joshua CE, Jürisson M, Kabir A, Kabir Z, Kabito GG, Kadashetti V, Kafi F, Kalani R, Kalantar F, Kaliyadan F, Kamath A, Kamath S, Kanchan T, Kandel A, Kandel H, Kanmodi KK, Karajizadeh M, Karami J, Karanth SD, Karaye IM, Karch A, Karimi A, Karimi H, Karimi Behnagh A, Kasraei H, Kassebaum NJ, Kauppila JH, Kaur H, Kaur N, Kayode GA, Kazemi F, Keikavoosi-Arani L, Keller C, Keykhaei M, Khadembashiri MA, Khader YS, Khafaie MA, Khajuria H, Khalaji A, Khamesipour F, Khammarnia M, Khan M, Khan MAB, Khan YH, Khan Suheb MZ, Khanmohammadi S, Khanna T, Khatab K, Khatatbeh H, Khatatbeh MM, Khateri S, Khatib MN, Khayat Kashani HR, Khonji MS, khorashadizadeh F, Khormali M, Khubchandani J, Kian S, Kim G, Kim J, Kim MS, Kim YJ, Kimokoti RW, Kisa A, Kisa S, Kivimäki M, Kochhar S, Kolahi AA, Koly KN, Kompani F, Koroshetz WJ, Kosen S, Kourosh Arami M, Koyanagi A, Kravchenko MA, Krishan K, Krishnamoorthy V, Kuate Defo B, Kuddus MA, Kumar A, Kumar GA, Kumar M, Kumar N, Kumsa NB, Kundu S, Kurniasari MD, Kusuma D, Kuttikkattu A, Kyu HH, La Vecchia C, Ladan MA, Lahariya C, Laksono T, Lal DK, Lallukka T, Lám J, Lami FH, Landires I, Langguth B, Lasrado S, Latief K, Latifinaibin K, Lau KMM, Laurens MB, Lawal BK, Le LKD, Le TTT, Ledda C, Lee M, Lee SW, Lee SW, Lee WC, Lee YH, Leonardi M, Lerango TL, Li MC, Li W, Ligade VS, Lim SS, Linehan C, Liu C, Liu J, Liu W, Lo CH, Lo WD, Lobo SW, Logroscino G, Lopes G, Lopukhov PD, Lorenzovici L, Lorkowski S, Loureiro JA, Lubinda J, Lucchetti G, Lutzky Saute R, Ma ZF, Mabrok M, Machoy M, Madadizadeh F, Magdy Abd El Razek M, Maghazachi AA, Maghbouli N, Mahjoub S, Mahmoudi M, Majeed A, Malagón-Rojas JN, Malakan Rad E, Malhotra K, Malik AA, Malik I, Mallhi TH, Malta DC, Manilal A, Mansouri V, Mansournia MA, Marasini BP, Marateb HR, Maroufi SF, Martinez-Raga J, Martini S, Martins-Melo FR, Martorell M, März W, Marzo RR, Massano J, Mathangasinghe Y, Mathews E, Maude RJ, Maugeri A, Maulik PK, Mayeli M, Mazaheri M, McAlinden C, McGrath JJ, Meena JK, Mehndiratta MM, Mendez-Lopez MAM, Mendoza W, Mendoza-Cano O, Menezes RG, Merati M, Meretoja A, Merkin A, Mersha AM, Mestrovic T, Mi T, Miazgowski T, Michalek IM, Mihretie ET, Minh LHN, Mirfakhraie R, Mirica A, Mirrakhimov EM, Mirzaei M, Misganaw A, Misra S, Mithra P, Mizana BA, Mohamadkhani A, Mohamed NS, Mohammadi E, Mohammadi H, Mohammadi S, Mohammadi S, Mohammadshahi M, Mohammed M, Mohammed S, Mohammed S, Mohan S, Mojiri-forushani H, Moka N, Mokdad AH, Molinaro S, Möller H, Monasta L, Moniruzzaman M, Montazeri F, Moradi M, Moradi Y, Moradi-Lakeh M, Moraga P, Morovatdar N, Morrison SD, Mosapour A, Mosser JF, Mossialos E, Motaghinejad M, Mousavi P, Mousavi SE, Mubarik S, Muccioli L, Mughal F, Mukoro GD, Mulita A, Mulita F, Musaigwa F, Mustafa A, Mustafa G, Muthu S, Nagarajan AJ, Naghavi P, Naik GR, Nainu F, Nair TS, Najmuldeen HHR, Nakhostin Ansari N, Nambi G, Namdar Areshtanab H, Nargus S, Nascimento BR, Naser AY, Nashwan AJJ, Nasoori H, Nasreldein A, Natto ZS, Nauman J, Nayak BP, Nazri-Panjaki A, Negaresh M, Negash H, Negoi I, Negoi RI, Negru SM, Nejadghaderi SA, Nematollahi MH, Nesbit OD, Newton CRJ, Nguyen DH, Nguyen HTH, Nguyen HQ, Nguyen NTT, Nguyen PT, Nguyen VT, Niazi RK, Nikolouzakis TK, Niranjan V, Nnyanzi LA, Noman EA, Noroozi N, Norrving B, Noubiap JJ, Nri-Ezedi CA, Ntaios G, Nuñez-Samudio V, Nurrika D, Oancea B, Odetokun IA, O'Donnell MJ, Ogunsakin RE, Oguta JO, Oh IH, Okati-Aliabad H, Okeke SR, Okekunle AP, Okonji OC, Okwute PG, Olagunju AT, Olaiya MT, Olana MD, Olatubi MI, Oliveira GMM, Olufadewa II, Olusanya BO, Omar Bali A, Ong S, Onwujekwe OE, Ordak M, Orji AU, Ortega-Altamirano DV, Osuagwu UL, Otstavnov N, Otstavnov SS, Ouyahia A, Owolabi MO, P A MP, Pacheco-Barrios K, Padubidri JR, Pal PK, Palange PN, Palladino C, Palladino R, Palma-Alvarez RF, Pan F, Panagiotakos D, Panda-Jonas S, Pandey A, Pandey A, Pandian JD, Pangaribuan HU, Pantazopoulos I, Pardhan S, Parija PP, Parikh RR, Park S, Parthasarathi A, Pashaei A, Patel J, Patil S, Patoulias D, Pawar S, Pedersini P, Pensato U, Pereira DM, Pereira J, Pereira MO, Peres MFP, Perico N, Perna S, Petcu IR, Petermann-Rocha FE, Pham HT, Phillips MR, Pinilla-Monsalve GD, Piradov MA, Plotnikov E, Poddighe D, Polat B, Poluru R, Pond CD, Poudel GR, Pouramini A, Pourbagher-Shahri AM, Pourfridoni M, Pourtaheri N, Prakash PY, Prakash S, Prakash V, Prates EJS, Pritchett N, Purnobasuki H, Qasim NH, Qattea I, Qian G, Radhakrishnan V, Raee P, Raeisi Shahraki H, Rafique I, Raggi A, Raghav PR, Rahati MM, Rahim F, Rahimi Z, Rahimifard M, Rahman MO, Rahman MHU, Rahman M, Rahman MA, Rahmani AM, Rahmani S, Rahmani Youshanlouei H, Rahmati M, Raj Moolambally S, Rajabpour-Sanati A, Ramadan H, Ramasamy SK, Ramasubramani P, Ramazanu S, Rancic N, Rao IR, Rao SJ, Rapaka D, Rashedi V, Rashid AM, Rashidi MM, Rashidi Alavijeh M, Rasouli-Saravani A, Rawaf S, Razo C, Redwan EMM, Rekabi Bana A, Remuzzi G, Rezaei N, Rezaei N, Rezaei N, Rezaeian M, Rhee TG, Riad A, Robinson SR, Rodrigues M, Rodriguez JAB, Roever L, Rogowski ELB, Romoli M, Ronfani L, Roy P, Roy Pramanik K, Rubagotti E, Ruiz MA, Russ TC, S Sunnerhagen K, Saad AMA, Saadatian Z, Saber K, SaberiKamarposhti M, Sacco S, Saddik B, Sadeghi E, Sadeghian S, Saeed U, Saeed U, Safdarian M, Safi SZ, Sagar R, Sagoe D, Saheb Sharif-Askari F, Saheb Sharif-Askari N, Sahebkar A, Sahoo SS, Sahraian MA, Sajedi SA, Sakshaug JW, Saleh MA, Salehi Omran H, Salem MR, Salimi S, Samadi Kafil H, Samadzadeh S, Samargandy S, Samodra YL, Samuel VP, Samy AM, Sanadgol N, Sanjeev RK, Sanmarchi F, Santomauro DF, Santri IN, Santric-Milicevic MM, Saravanan A, Sarveazad A, Satpathy M, Saylan M, Sayyah M, Scarmeas N, Schlaich MP, Schuermans A, Schwarzinger M, Schwebel DC, Selvaraj S, Sendekie AK, Sengupta P, Senthilkumaran S, Serban D, Sergindo MT, Sethi Y, SeyedAlinaghi S, Seylani A, Shabani M, Shabany M, Shafie M, Shahabi S, Shahbandi A, Shahid S, Shahraki-Sanavi F, Shahsavari HR, Shahwan MJ, Shaikh MA, Shaji KS, Sham S, Shama ATT, Shamim MA, Shams-Beyranvand M, Shamsi MA, Shanawaz M, Sharath M, Sharfaei S, Sharifan A, Sharma M, Sharma R, Shashamo BB, Shayan M, Sheikhi RA, Shekhar S, Shen J, Shenoy SM, Shetty PH, Shiferaw DS, Shigematsu M, Shiri R, Shittu A, Shivakumar KM, Shokri F, Shool S, Shorofi SA, Shrestha S, Siankam Tankwanchi AB, Siddig EE, Sigfusdottir ID, Silva JP, Silva LMLR, Sinaei E, Singh BB, Singh G, Singh P, Singh S, Sirota SB, Sivakumar S, Sohag AAM, Solanki R, Soleimani H, Solikhah S, Solomon Y, Solomon Y, Song S, Song Y, Sotoudeh H, Spartalis M, Stark BA, Starnes JR, Starodubova AV, Stein DJ, Steiner TJ, Stovner LJ, Suleman M, Suliankatchi Abdulkader R, Sultana A, Sun J, Sunkersing D, Sunny A, Susianti H, Swain CK, Szeto MD, Tabarés-Seisdedos R, Tabatabaei SM, Tabatabai S, Tabish M, Taheri M, Tahvildari A, Tajbakhsh A, Tampa M, Tamuzi JJLL, Tan KK, Tang H, Tareke M, Tarigan IU, Tat NY, Tat VY, Tavakoli Oliaee R, Tavangar SM, Tavasol A, Tefera YM, Tehrani-Banihashemi A, Temesgen WA, Temsah MH, Teramoto M, Tesfaye AH, Tesfaye EG, Tesler R, Thakali O, Thangaraju P, Thapa R, Thapar R, Thomas NK, Thrift AG, Ticoalu JHV, Tillawi T, Toghroli R, Tonelli M, Tovani-Palone MR, Traini E, Tran NM, Tran NH, Tran PV, Tromans SJ, Truelsen TC, Truyen TTTT, Tsatsakis A, Tsegay GM, Tsermpini EE, Tualeka AR, Tufa DG, Ubah CS, Udoakang AJ, Ulhaq I, Umair M, Umakanthan S, Umapathi KK, Unim B, Unnikrishnan B, Vaithinathan AG, Vakilian A, Valadan Tahbaz S, Valizadeh R, Van den Eynde J, Vart P, Varthya SB, Vasankari TJ, Vaziri S, Vellingiri B, Venketasubramanian N, Verras GI, Vervoort D, Villafañe JH, Villani L, Vinueza Veloz AF, Viskadourou M, Vladimirov SK, Vlassov V, Volovat SR, Vu LT, Vujcic IS, Wagaye B, Waheed Y, Wahood W, Walde MT, Wang F, Wang S, Wang Y, Wang YP, Waqas M, Waris A, Weerakoon KG, Weintraub RG, Weldemariam AH, Westerman R, Whisnant JL, Wickramasinghe DP, Wickramasinghe ND, Willekens B, Wilner LB, Winkler AS, Wolfe CDA, Wu AM, Wulf Hanson S, Xu S, Xu X, Yadollahpour A, Yaghoubi S, Yahya G, Yamagishi K, Yang L, Yano Y, Yao Y, Yehualashet SS, Yeshaneh A, Yesiltepe M, Yi S, Yiğit A, Yiğit V, Yon DK, Yonemoto N, You Y, Younis MZ, Yu C, Yusuf H, Zadey S, Zahedi M, Zakham F, Zaki N, Zali A, Zamagni G, Zand R, Zandieh GGZ, Zangiabadian M, Zarghami A, Zastrozhin MS, Zeariya MGM, Zegeye ZB, Zeukeng F, Zhai C, Zhang C, Zhang H, Zhang Y, Zhang ZJ, Zhao H, Zhao Y, Zheng P, Zhou H, Zhu B, Zhumagaliuly A, Zielińska M, Zikarg YT, Zoladl M, Murray CJL, Ong KL, Feigin VL, Vos T, Dua T. Global, regional, and national burden of disorders affecting the nervous system, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet Neurol 2024; 23:344-381. [PMID: 38493795 PMCID: PMC10949203 DOI: 10.1016/s1474-4422(24)00038-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 01/23/2024] [Accepted: 01/26/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Disorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021. METHODS We estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined. FINDINGS Globally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378-521), affecting 3·40 billion (3·20-3·62) individuals (43·1%, 40·5-45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7-26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6-38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5-32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7-2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer. INTERPRETATION As the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed. FUNDING Bill & Melinda Gates Foundation.
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Nahidi M, Ahmadi M, Fayyazi Bordbar MR, Morovatdar N, Khadem-Rezayian M, Abdolalizadeh A. The relationship between mobile phone addiction and depression, anxiety, and sleep quality in medical students. Int Clin Psychopharmacol 2024; 39:70-81. [PMID: 37781789 DOI: 10.1097/yic.0000000000000517] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
This study investigates the prevalence of mobile phone addiction among medical students and its relationship with depression, anxiety, and sleep quality. The study was conducted at Mashhad University of Medical Sciences from 2019 to 2021, and it included medical students at four different levels of training. Participants were selected using a stratified random sampling method. All subjects completed the Mobile Phone Addiction Scale, Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory, and Beck Anxiety Inventory through online electronic self-report questionnaires. Overall, 355 medical students were included in the study, with 203 (57.2%) being female. Mild and severe mobile phone addiction was reported by 83.7 and 2.5% of the students, respectively. Furthermore, the study's findings revealed significantly higher sleep quality disorder, depression, and anxiety scores among students with severe mobile phone addiction compared to other participants ( P < 0.001, P = 0.007, and P < 0.001, respectively). Although mobile phone addiction was prevalent, severe addiction was rare among medical students. Nevertheless, severe addiction was associated with an increased prevalence of mental health problems and sleep disturbances, emphasizing the importance of interventions aimed at reducing mobile phone addiction and improving mental health.
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Affiliation(s)
- Mahsa Nahidi
- Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences
| | | | | | - Negar Morovatdar
- Clinical Research Development Unit, Faculty of Medicine, Mashhad University of Medical Sciences
| | - Majid Khadem-Rezayian
- Department of Community Medicine, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Adeleh Abdolalizadeh
- Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences
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Yeganeh A, Johannssen A, Chukhrova N, Erfanian M, Azarpazhooh MR, Morovatdar N. A monitoring framework for health care processes using Generalized Additive Models and Auto-Encoders. Artif Intell Med 2023; 146:102689. [PMID: 38042610 DOI: 10.1016/j.artmed.2023.102689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 10/11/2023] [Accepted: 10/13/2023] [Indexed: 12/04/2023]
Abstract
In recent years, there has been a considerable focus on developing effective methods for monitoring health care processes. Utilizing Statistical Process Monitoring (SPM) approaches, particularly risk-adjusted control charts, has emerged as a highly promising approach for achieving robust frameworks for this aim. Considering risk-adjusted control charts, longitudinal health care process data is typically monitored by establishing a regression relationship between various risk factors (explanatory variables) and patient outcomes (response variables). While the majority of prior research has primarily employed logistic models in risk-adjusted control charts, there are more intricate health care processes that necessitate the incorporation of both parametric and nonparametric risk factors. In such scenarios, the Generalized Additive Model (GAM) proves to be a suitable choice, albeit it often introduces higher computational complexity and associated challenges. Surprisingly, there are limited instances where researchers have proposed advancements in this direction. The primary objective of this paper is to introduce an SPM framework for monitoring health care processes using a GAM over time, coupled with a novel risk-adjusted control chart driven by machine learning techniques. This control chart is implemented on a data set encompassing two stroke types: ischemic and hemorrhagic. The key focus of this study is to monitor the stability of the relationship between stroke types and predefined explanatory variables over time within this data set. Extensive simulation results, based on real data from patients with acute stroke, demonstrate the remarkable flexibility of the proposed method in terms of its detection capabilities compared to conventional approaches.
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Affiliation(s)
- Ali Yeganeh
- University of Hamburg, 20146 Hamburg, Germany.
| | | | | | - Mahdiyeh Erfanian
- Department of Statistics, Ferdowsi University of Mashhad, Mashhad, Iran.
| | - Mahmoud Reza Azarpazhooh
- Department of Neurology, Ghaem Hospital, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran; Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
| | - Negar Morovatdar
- Clinical Research Development Unit, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
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Wu D, Jin Y, Xing Y, Abate MD, Abbasian M, Abbasi-Kangevari M, Abbasi-Kangevari Z, Abd-Allah F, Abdelmasseh M, Abdollahifar MA, Abdulah DM, Abedi A, Abedi V, Abidi H, Aboagye RG, Abolhassani H, Abuabara K, Abyadeh M, Addo IY, Adeniji KN, Adepoju AV, Adesina MA, Sakilah Adnani QE, Afarideh M, Aghamiri S, Agodi A, Agrawal A, Aguilera Arriagada CE, Ahmad A, Ahmad D, Ahmad S, Ahmad S, Ahmadi A, Ahmed A, Ahmed A, Aithala JP, Ajadi AA, Ajami M, Akbarzadeh-Khiavi M, Alahdab F, AlBataineh MT, Alemi S, Saeed Al-Gheethi AA, Ali L, Alif SM, Almazan JU, Almustanyir S, Alqahtani JS, Alqasmi I, Khan Altaf IU, Alvis-Guzman N, Alvis-Zakzuk NJ, Al-Worafi YM, Aly H, Amani R, Amu H, Amusa GA, Andrei CL, Ansar A, Ansariniya H, Anyasodor AE, Arabloo J, Arefnezhad R, Arulappan J, Asghari-Jafarabadi M, Ashraf T, Atata JA, Athari SS, Atlaw D, Wahbi Atout MM, Aujayeb A, Awan AT, Ayatollahi H, Azadnajafabad S, Azzam AY, Badawi A, Badiye AD, Bagherieh S, Baig AA, Bantie BB, Barchitta M, Bardhan M, Barker-Collo SL, Barone-Adesi F, Batra K, Bayileyegn NS, Behnoush AH, Belgaumi UI, Bemanalizadeh M, Bensenor IM, Beyene KA, Bhagavathula AS, Bhardwaj P, Bhaskar S, Bhat AN, Bitaraf S, Bitra VR, Boloor A, Bora K, Botelho JS, Buchbinder R, Calina D, Cámera LA, Carvalho AF, Kai Chan JS, Chattu VK, Abebe EC, Chichagi F, Choi S, Chou TC, Chu DT, Coberly K, Costa VM, Couto RA, Cruz-Martins N, Dadras O, Dai X, Damiani G, Dascalu AM, Dashti M, Debela SA, Dellavalle RP, Demetriades AK, Demlash AA, Deng X, Desai HD, Desai R, Rahman Dewan SM, Dey S, Dharmaratne SD, Diaz D, Dibas M, Dinis-Oliveira RJ, Diress M, Do TC, Doan DK, Dodangeh M, Dodangeh M, Dongarwar D, Dube J, Dziedzic AM, Ed-Dra A, Edinur HA, Eissazade N, Ekholuenetale M, Ekundayo TC, Elemam NM, Elhadi M, Elmehrath AO, Abdou Elmeligy OA, Emamverdi M, Emeto TI, Esayas HL, Eshetu HB, Etaee F, Fagbamigbe AF, Faghani S, Fakhradiyev IR, Fatehizadeh A, Fathi M, Feizkhah A, Fekadu G, Fereidouni M, Fereshtehnejad SM, Fernandes JC, Ferrara P, Fetensa G, Filip I, Fischer F, Foroutan B, Foroutan M, Fukumoto T, Ganesan B, Belete Gemeda BN, Ghamari SH, Ghasemi M, Gholamalizadeh M, Gill TK, Gillum RF, Goldust M, Golechha M, Goleij P, Golinelli D, Goudarzi H, Guan SY, Guo Y, Gupta B, Gupta VB, Gupta VK, Haddadi R, Hadi NR, Halwani R, Haque S, Hasan I, Hashempour R, Hassan A, Hassan TS, Hassanzadeh S, Hassen MB, Haubold J, Hayat K, Heidari G, Heidari M, Heidari-Soureshjani R, Herteliu C, Hessami K, Hezam K, Hiraike Y, Holla R, Hosseini MS, Huynh HH, Hwang BF, Ibitoye SE, Ilic IM, Ilic MD, Iranmehr A, Iravanpour F, Ismail NE, Iwagami M, Iwu CC, Jacob L, Jafarinia M, Jafarzadeh A, Jahankhani K, Jahrami H, Jakovljevic M, Jamshidi E, Jani CT, Janodia MD, Jayapal SK, Jayaram S, Jeganathan J, Jonas JB, Joseph A, Joseph N, Joshua CE, Vaishali K, Kaambwa B, Kabir A, Kabir Z, Kadashetti V, Kaliyadan F, Kalroozi F, Kamal VK, Kandel A, Kandel H, Kanungo S, Karami J, Karaye IM, Karimi H, Kasraei H, Kazemian S, Kebede SA, Keikavoosi-Arani L, Keykhaei M, Khader YS, Khajuria H, Khamesipour F, Khan EA, Khan IA, Khan M, Khan MJ, Khan MA, Khan MA, Khatatbeh H, Khatatbeh MM, Khateri S, Khayat Kashani HR, Kim MS, Kisa A, Kisa S, Koh HY, Kolkhir P, Korzh O, Kotnis AL, Koul PA, Koyanagi A, Krishan K, Kuddus M, Kulkarni VV, Kumar N, Kundu S, Kurmi OP, La Vecchia C, Lahariya C, Laksono T, Lám J, Latief K, Lauriola P, Lawal BK, Thu Le TT, Bich Le TT, Lee M, Lee SW, Lee WC, Lee YH, Lenzi J, Levi M, Li W, Ligade VS, Lim SS, Liu G, Liu X, Llanaj E, Lo CH, Machado VS, Maghazachi AA, Mahmoud MA, Mai TA, Majeed A, Sanaye PM, Makram OM, Rad EM, Malhotra K, Malik AA, Malik I, Mallhi TH, Malta DC, Mansournia MA, Mantovani LG, Martorell M, Masoudi S, Masoumi SZ, Mathangasinghe Y, Mathews E, Mathioudakis AG, Maugeri A, Mayeli M, Carabeo Medina JR, Meles GG, Mendes JJ, Menezes RG, Mestrovic T, Michalek IM, Micheletti Gomide Nogueira de Sá AC, Mihretie ET, Nhat Minh LH, Mirfakhraie R, Mirrakhimov EM, Misganaw A, Mohamadkhani A, Mohamed NS, Mohammadi F, Mohammadi S, Mohammed S, Mohammed S, Mohan S, Mohseni A, Mokdad AH, Momtazmanesh S, Monasta L, Moni MA, Moniruzzaman M, Moradi Y, Morovatdar N, Mostafavi E, Mousavi P, Mukoro GD, Mulita A, Mulu GB, Murillo-Zamora E, Musaigwa F, Mustafa G, Muthu S, Nainu F, Nangia V, Swamy SN, Natto ZS, Navaraj P, Nayak BP, Nazri-Panjaki A, Negash H, Nematollahi MH, Nguyen DH, Hien Nguyen HT, Nguyen HQ, Nguyen PT, Nguyen VT, Niazi RK, Nikolouzakis TK, Nnyanzi LA, Noreen M, Nzoputam CI, Nzoputam OJ, Oancea B, Oh IH, Okati-Aliabad H, Okonji OC, Okwute PG, Olagunju AT, Olatubi MI, Olufadewa II, Ordak M, Otstavnov N, Owolabi MO, Mahesh P, Padubidri JR, Pak A, Pakzad R, Palladino R, Pana A, Pantazopoulos I, Papadopoulou P, Pardhan S, Parthasarathi A, Pashaei A, Patel J, Pathan AR, Patil S, Paudel U, Pawar S, Pedersini P, Pensato U, Pereira DM, Pereira J, Pereira MO, Pereira RB, Peres MF, Perianayagam A, Perna S, Petcu IR, Pezeshki PS, Pham HT, Philip AK, Piradov MA, Podder I, Podder V, Poddighe D, Sady Prates EJ, Qattea I, Radfar A, Raee P, Rafiei A, Raggi A, Rahim F, Rahimi M, Rahimifard M, Rahimi-Movaghar V, Rahman MO, Ur Rahman MH, Rahman M, Rahman MA, Rahmani AM, Rahmani M, Rahmani S, Rahmanian V, Ramasubramani P, Rancic N, Rao IR, Rashedi S, Rashid AM, Ravikumar N, Rawaf S, Mohamed Redwan EM, Rezaei N, Rezaei N, Rezaei N, Rezaeian M, Ribeiro D, Rodrigues M, Buendia Rodriguez JA, Roever L, Romero-Rodríguez E, Saad AM, Saddik B, Sadeghian S, Saeed U, Safary A, Safdarian M, Safi SZ, Saghazadeh A, Sagoe D, Sharif-Askari FS, Sharif-Askari NS, Sahebkar A, Sahoo H, Sahraian MA, Sajid MR, Sakhamuri S, Sakshaug JW, Saleh MA, Salehi L, Salehi S, Farrokhi AS, Samadzadeh S, Samargandy S, Samieefar N, Samy AM, Sanadgol N, Sanjeev RK, Sawhney M, Saya GK, Schuermans A, Senthilkumaran S, Sepanlou SG, Sethi Y, Shafie M, Shah H, Shahid I, Shahid S, Shaikh MA, Sharfaei S, Sharma M, Shayan M, Shehata HS, Sheikh A, Shetty JK, Shin JI, Shirkoohi R, Shitaye NA, Shivakumar K, Shivarov V, Shobeiri P, Siabani S, Sibhat MM, Siddig EE, Simpson CR, Sinaei E, Singh H, Singh I, Singh JA, Singh P, Singh S, Siraj MS, Al Mamun Sohag A, Solanki R, Solikhah S, Solomon Y, Soltani-Zangbar MS, Sun J, Szeto MD, Tabarés-Seisdedos R, Tabatabaei SM, Tabish M, Taheri E, Tahvildari A, Talaat IM, Lukenze Tamuzi JJ, Tan KK, Tat NY, Oliaee RT, Tavasol A, Temsah MH, Thangaraju P, Tharwat S, Tibebu NS, Vera Ticoalu JH, Tillawi T, Tiruye TY, Tiyuri A, Tovani-Palone MR, Tripathi M, Tsegay GM, Tualeka AR, Ty SS, Ubah CS, Ullah S, Ullah S, Umair M, Umakanthan S, Upadhyay E, Vahabi SM, Vaithinathan AG, Tahbaz SV, Valizadeh R, Varthya SB, Vasankari TJ, Venketasubramanian N, Verras GI, Villafañe JH, Vlassov V, Vo DC, Waheed Y, Waris A, Welegebrial BG, Westerman R, Wickramasinghe DP, Wickramasinghe ND, Willekens B, Woldegeorgis BZ, Woldemariam M, Xiao H, Yada DY, Yahya G, Yang L, Yazdanpanah F, Yon DK, Yonemoto N, You Y, Zahir M, Zaidi SS, Zangiabadian M, Zare I, Zeineddine MA, Zemedikun DT, Zeru NG, Zhang C, Zhao H, Zhong C, Zielińska M, Zoladl M, Zumla A, Guo C, Tam LS. Global, regional, and national incidence of six major immune-mediated inflammatory diseases: findings from the global burden of disease study 2019. EClinicalMedicine 2023; 64:102193. [PMID: 37731935 PMCID: PMC10507198 DOI: 10.1016/j.eclinm.2023.102193] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 08/15/2023] [Accepted: 08/16/2023] [Indexed: 09/22/2023] Open
Abstract
Background The causes for immune-mediated inflammatory diseases (IMIDs) are diverse and the incidence trends of IMIDs from specific causes are rarely studied. The study aims to investigate the pattern and trend of IMIDs from 1990 to 2019. Methods We collected detailed information on six major causes of IMIDs, including asthma, inflammatory bowel disease, multiple sclerosis, rheumatoid arthritis, psoriasis, and atopic dermatitis, between 1990 and 2019, derived from the Global Burden of Disease study in 2019. The average annual percent change (AAPC) in number of incidents and age standardized incidence rate (ASR) on IMIDs, by sex, age, region, and causes, were calculated to quantify the temporal trends. Findings In 2019, rheumatoid arthritis, atopic dermatitis, asthma, multiple sclerosis, psoriasis, inflammatory bowel disease accounted 1.59%, 36.17%, 54.71%, 0.09%, 6.84%, 0.60% of overall new IMIDs cases, respectively. The ASR of IMIDs showed substantial regional and global variation with the highest in High SDI region, High-income North America, and United States of America. Throughout human lifespan, the age distribution of incident cases from six IMIDs was quite different. Globally, incident cases of IMIDs increased with an AAPC of 0.68 and the ASR decreased with an AAPC of -0.34 from 1990 to 2019. The incident cases increased across six IMIDs, the ASR of rheumatoid arthritis increased (0.21, 95% CI 0.18, 0.25), while the ASR of asthma (AAPC = -0.41), inflammatory bowel disease (AAPC = -0.72), multiple sclerosis (AAPC = -0.26), psoriasis (AAPC = -0.77), and atopic dermatitis (AAPC = -0.15) decreased. The ASR of overall and six individual IMID increased with SDI at regional and global level. Countries with higher ASR in 1990 experienced a more rapid decrease in ASR. Interpretation The incidence patterns of IMIDs varied considerably across the world. Innovative prevention and integrative management strategy are urgently needed to mitigate the increasing ASR of rheumatoid arthritis and upsurging new cases of other five IMIDs, respectively. Funding The Global Burden of Disease Study is funded by the Bill and Melinda Gates Foundation. The project funded by Scientific Research Fund of Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital (2022QN38).
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Kim MS, Hwang J, Yon DK, Lee SW, Jung SY, Park S, Johnson CO, Stark BA, Razo C, Abbasian M, Abbastabar H, Abhari AP, Aboyans V, Adane DEA, Adebayo OM, Alahdab F, Almustanyir S, Aly H, Ameyaw EK, Anderson JA, Andrei CL, Aryan Z, Aujayeb A, Bagherieh S, Baltatu OC, Banach M, Bayileyegn NS, Bearne LM, Behnoush AH, Bensenor IM, Bhaskar S, Bhat AN, Bhat V, Bikbov B, Bintoro BS, Burkart K, Cámera LA, Catapano AL, Chandrasekar EK, Charan J, Chattu VK, Chi G, Chukwu IS, Chung SC, Cirillo M, Coberly K, Costa VM, Dadras O, Dai X, Do TC, Doshi R, Ekholuenetale M, Elgendy IY, Elhadi M, Fagbamigbe AF, Feizkhah A, Fekadu G, Gill PS, Goldust M, Golechha M, Guan SY, Gupta VK, Hadei M, Hadi NR, Hammoud A, Hankey GJ, Harlianto NI, Hasaballah AI, Hassan S, Hassen MB, Heidari G, Hostiuc M, Ilesanmi OS, Iwagami M, Jokar M, Jonas JB, Joshua CE, Jozwiak JJ, Kazemian S, Keykhaei M, Khalaji A, Khan MAB, Khateri S, Kibret BG, Korzh O, Koulmane Laxminarayana SL, Krishan K, Kumar A, Kumar M, Kuttikkattu A, Laksono T, Larijani B, Le TTT, Lim SS, Liu X, Lorkowski S, Magdy Abd El Razek H, Malhotra K, Manla Y, Maugeri A, Mentis AFA, Mestrovic T, Micheletti Gomide Nogueira de Sá AC, Mirica A, Mirrakhimov EM, Misganaw A, Mishra M, Mohammad Y, Mokdad AH, Moni MA, Montasir AA, Moradi Y, Moraga P, Morovatdar N, Mousavi-Aghdas SA, Murray CJL, Naghavi M, Nair TS, Nassereldine H, Natto ZS, Nguyen DH, Nguyen HQ, Nguyen VT, Noubiap JJ, Oancea B, Oliveira GMM, Owolabi MO, Padron-Monedero A, Perico N, Petcu IR, Radfar A, Rafferty Q, Rahman M, Rahman MA, Ram P, Rashedi S, Rashid AM, Rawaf S, Remuzzi G, Renzaho AMN, Rezaee M, Roever L, Saad AMA, Saadatagah S, Sadeghi M, Sahebkar A, Saleh MA, Samy AM, Santric-Milicevic MM, Sepanlou SG, Seylani A, Sharfaei S, Shorofi SA, Singh JA, Singh P, Spartalis M, Sundström J, Tan KK, Teramoto M, Tharwat S, Tyrovolas S, Valadan Tahbaz S, Van den Eynde J, Vart P, Wang C, Wang F, Westerman R, Xia J, Xu S, Yada DY, Yamagishi K, Yonemoto N, Zahir M, Zangiabadian M, Zarrintan A, Zastrozhin MS, Zastrozhina A, Zoladl M, Hay SI, Shin JI, Roth GA. Global burden of peripheral artery disease and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Glob Health 2023; 11:e1553-e1565. [PMID: 37734799 PMCID: PMC10522777 DOI: 10.1016/s2214-109x(23)00355-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 07/11/2023] [Accepted: 07/17/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Peripheral artery disease is a growing public health problem. We aimed to estimate the global disease burden of peripheral artery disease, its risk factors, and temporospatial trends to inform policy and public measures. METHODS Data on peripheral artery disease were modelled using the Global Burden of Disease, Injuries, and Risk Factors Study (GBD) 2019 database. Prevalence, disability-adjusted life years (DALYs), and mortality estimates of peripheral artery disease were extracted from GBD 2019. Total DALYs and age-standardised DALY rate of peripheral artery disease attributed to modifiable risk factors were also assessed. FINDINGS In 2019, the number of people aged 40 years and older with peripheral artery disease was 113 million (95% uncertainty interval [UI] 99·2-128·4), with a global prevalence of 1·52% (95% UI 1·33-1·72), of which 42·6% was in countries with low to middle Socio-demographic Index (SDI). The global prevalence of peripheral artery disease was higher in older people, (14·91% [12·41-17·87] in those aged 80-84 years), and was generally higher in females than in males. Globally, the total number of DALYs attributable to modifiable risk factors in 2019 accounted for 69·4% (64·2-74·3) of total peripheral artery disease DALYs. The prevalence of peripheral artery disease was highest in countries with high SDI and lowest in countries with low SDI, whereas DALY and mortality rates showed U-shaped curves, with the highest burden in the high and low SDI quintiles. INTERPRETATION The total number of people with peripheral artery disease has increased globally from 1990 to 2019. Despite the lower prevalence of peripheral artery disease in males and low-income countries, these groups showed similar DALY rates to females and higher-income countries, highlighting disproportionate burden in these groups. Modifiable risk factors were responsible for around 70% of the global peripheral artery disease burden. Public measures could mitigate the burden of peripheral artery disease by modifying risk factors. FUNDING Bill & Melinda Gates Foundation.
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Rezazadeh M, Jokar MH, Mehrnaz Aghili S, Mirfeizi Z, Mahmoudi M, Morovatdar N, Hashemzadeh K. Association between levels of serum and urinary B cell-activating factor and systemic lupus erythematosus disease activity. Arch Rheumatol 2023; 38:429-440. [PMID: 38046245 PMCID: PMC10689013 DOI: 10.46497/archrheumatol.2023.9549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 09/15/2022] [Indexed: 12/05/2023] Open
Abstract
Objectives This study investigated the correlation between serum and urinary B cell-activating factor (BAFF) levels and systemic lupus erythematosus (SLE) disease activity. Patients and methods This case-control study was conducted with 87 participants between December 2020 and September 2021. Sixty-two SLE patients who fulfilled the eligibility criteria were enrolled. SLE patients were categorized into active (n=34) and inactive (n=28) groups based on their Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) scores. The control group consisted of 25 healthy subjects. Serum and urine samples were collected for the measurement of BAFF levels. Finally, the relationship between these variables and SLE disease activity was investigated. Results The mean age of active (SLEDAI-2K >4) and inactive (SLEDAI-2K ≤4) SLE patients and healthy individuals were 32.8±7.8, 32.5±6.8, and 31.7±7.8 years, respectively (p=0.62). The median serum BAFF (s-BAFF) and urinary BAFF (u-BAFF) in active lupus patients (10.4 [2.3] ng/mL and 8.2 [3.7] ng/mL, respectively) were significantly higher than in inactive lupus patients (6 (7.1) ng/mL and 1.7 (4.7) ng/mL, respectively; p<0.001) and the control group (3 (3.7) ng/mL and 1.6 (2.2) ng/mL, respectively; p<0.001). However, s-BAFF (p=0.07) and u-BAFF (p=0.43) did not significantly differ between the inactive group and the control group. A significant positive correlation was observed between s-BAFF (r=0.41 and p=0.001) and u-BAFF (r=0.78 and p<0.001) levels and the SLEDAI-2K score. Conclusion There is a significant positive correlation between serum and urinary BAFF levels and SLE disease activity. Furthermore, significantly higher levels of s-BAFF and u-BAFF have been observed in patients with active lupus compared to inactive and healthy subjects, indicating a possible role for BAFF in the pathogenesis of SLE disease activity.
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Affiliation(s)
- Maryam Rezazadeh
- Mashhad University of Medical Sciences, Rheumatic Diseases Research Center, Mashhad, Iran
| | - Mohammad Hasan Jokar
- Mashhad University of Medical Sciences, Rheumatic Diseases Research Center, Mashhad, Iran
| | - Seyedeh Mehrnaz Aghili
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Zahra Mirfeizi
- Mashhad University of Medical Sciences, Rheumatic Diseases Research Center, Mashhad, Iran
| | - Mahmoud Mahmoudi
- Mashhad University of Medical Sciences, Bu-Ali Research Institute, Mashhad, Iran
| | - Negar Morovatdar
- Mashhad University of Medical Sciences, Clinical Research Unit, Mashhad, Iran
| | - Kamila Hashemzadeh
- Mashhad University of Medical Sciences, Rheumatic Diseases Research Center, Mashhad, Iran
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Abdollahi Moghaddam A, Baradaran Rahimi V, Morovatdar N, Rezaee R, Babalhekam SA. Oral Nicorandil effectively attenuates the incidence of contrast-induced nephropathy in patients undergoing cardiac catheterization: a randomized, controlled, open-label clinical trial. Int Urol Nephrol 2023; 55:2327-2334. [PMID: 36881267 DOI: 10.1007/s11255-023-03541-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 02/24/2023] [Indexed: 03/08/2023]
Abstract
PURPOSE The contrast-induced nephropathy (CIN) rate is increasing globally and can increase the rate of mortality and long-term problems. This study aims to determine the effect of Nicorandil on preventing CIN among patients undergoing cardiac catheterization. METHODS In a controlled randomized open-labeled clinical trial, all included patients undergoing cardiac catheterization due to coronary problems and possessing at least two risk factors of contrast nephropathy were divided into two groups of intervention and control. The intervention group received oral Nicorandil and normal saline, while the control group was treated with intravenous normal saline. Serum creatinine was measured before and 48 h after the procedure, and patients were assessed regarding CIN. RESULTS In this study, 172 patients entered each group; 41.86% and 45.34% were male in the control and Nicorandil groups. We showed that the incidence of CIN was meaningfully lower in the Nicorandil group (12, 7%) than in the control group (34, 19.8%, P = 0.001). Additionally, the incidence of CIN was notably lower in the female patients in the Nicorandil (85.7%) than in the control group (14.3%, P = 0.001); however, these numbers were not significantly different among men (64.0% and 36.0%, respectively, P = 0.850). After the injection of the contrast agent, the serum levels of blood urea nitrogen (P = 0.248), creatinine (P = 0.081), and glomerular filtration rate (P = 0.386) showed no significant differences between the control and Nicorandil groups. Multivariate regression analysis showed that Nicorandil significantly lowered the odds of CIN [odds ratio (OR) = 0.299, 95% confidence interval (CI) 0.149-0.602; P = 0.001] after adjustment for baseline creatinine (OR = 1.404, 95% CI 0.431-4.572; P = 0.574). CONCLUSION Our results indicate that pre-procedural treatment with Nicorandil may be effective against CIN in contrast to agent-exposed patients.
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Affiliation(s)
- Alireza Abdollahi Moghaddam
- Department of Cardiovascular Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Vafa Baradaran Rahimi
- Department of Cardiovascular Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Pharmacological Research Center of Medicinal Plants, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Negar Morovatdar
- Clinical Research Development Unit, Faculty of Medicine, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ramin Rezaee
- International UNESCO Center for Health-Related Basic Sciences and Human Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sadegh Alavi Babalhekam
- Department of Cardiovascular Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
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Ong KL, Stafford LK, McLaughlin SA, Boyko EJ, Vollset SE, Smith AE, Dalton BE, Duprey J, Cruz JA, Hagins H, Lindstedt PA, Aali A, Abate YH, Abate MD, Abbasian M, Abbasi-Kangevari Z, Abbasi-Kangevari M, Abd ElHafeez S, Abd-Rabu R, Abdulah DM, Abdullah AYM, Abedi V, Abidi H, Aboagye RG, Abolhassani H, Abu-Gharbieh E, Abu-Zaid A, Adane TD, Adane DE, Addo IY, Adegboye OA, Adekanmbi V, Adepoju AV, Adnani QES, Afolabi RF, Agarwal G, Aghdam ZB, Agudelo-Botero M, Aguilera Arriagada CE, Agyemang-Duah W, Ahinkorah BO, Ahmad D, Ahmad R, Ahmad S, Ahmad A, Ahmadi A, Ahmadi K, Ahmed A, Ahmed A, Ahmed LA, Ahmed SA, Ajami M, Akinyemi RO, Al Hamad H, Al Hasan SM, AL-Ahdal TMA, Alalwan TA, Al-Aly Z, AlBataineh MT, Alcalde-Rabanal JE, Alemi S, Ali H, Alinia T, Aljunid SM, Almustanyir S, Al-Raddadi RM, Alvis-Guzman N, Amare F, Ameyaw EK, Amiri S, Amusa GA, Andrei CL, Anjana RM, Ansar A, Ansari G, Ansari-Moghaddam A, Anyasodor AE, Arabloo J, Aravkin AY, Areda D, Arifin H, Arkew M, Armocida B, Ärnlöv J, Artamonov AA, Arulappan J, Aruleba RT, Arumugam A, Aryan Z, Asemu MT, Asghari-Jafarabadi M, Askari E, Asmelash D, Astell-Burt T, Athar M, Athari SS, Atout MMW, Avila-Burgos L, Awaisu A, Azadnajafabad S, B DB, Babamohamadi H, Badar M, Badawi A, Badiye AD, Baghcheghi N, Bagheri N, Bagherieh S, Bah S, Bahadory S, Bai R, Baig AA, Baltatu OC, Baradaran HR, Barchitta M, Bardhan M, Barengo NC, Bärnighausen TW, Barone MTU, Barone-Adesi F, Barrow A, Bashiri H, Basiru A, Basu S, Basu S, Batiha AMM, Batra K, Bayih MT, Bayileyegn NS, Behnoush AH, Bekele AB, Belete MA, Belgaumi UI, Belo L, Bennett DA, Bensenor IM, Berhe K, Berhie AY, Bhaskar S, Bhat AN, Bhatti JS, Bikbov B, Bilal F, Bintoro BS, Bitaraf S, Bitra VR, Bjegovic-Mikanovic V, Bodolica V, Boloor A, Brauer M, Brazo-Sayavera J, Brenner H, Butt ZA, Calina D, Campos LA, Campos-Nonato IR, Cao Y, Cao C, Car J, Carvalho M, Castañeda-Orjuela CA, Catalá-López F, Cerin E, Chadwick J, Chandrasekar EK, Chanie GS, Charan J, Chattu VK, Chauhan K, Cheema HA, Chekol Abebe E, Chen S, Cherbuin N, Chichagi F, Chidambaram SB, Cho WCS, Choudhari SG, Chowdhury R, Chowdhury EK, Chu DT, Chukwu IS, Chung SC, Coberly K, Columbus A, Contreras D, Cousin E, Criqui MH, Cruz-Martins N, Cuschieri S, Dabo B, Dadras O, Dai X, Damasceno AAM, Dandona R, Dandona L, Das S, Dascalu AM, Dash NR, Dashti M, Dávila-Cervantes CA, De la Cruz-Góngora V, Debele GR, Delpasand K, Demisse FW, Demissie GD, Deng X, Denova-Gutiérrez E, Deo SV, Dervišević E, Desai HD, Desale AT, Dessie AM, Desta F, Dewan SMR, Dey S, Dhama K, Dhimal M, Diao N, Diaz D, Dinu M, Diress M, Djalalinia S, Doan LP, Dongarwar D, dos Santos Figueiredo FW, Duncan BB, Dutta S, Dziedzic AM, Edinur HA, Ekholuenetale M, Ekundayo TC, Elgendy IY, Elhadi M, El-Huneidi W, Elmeligy OAA, Elmonem MA, Endeshaw D, Esayas HL, Eshetu HB, Etaee F, Fadhil I, Fagbamigbe AF, Fahim A, Falahi S, Faris MEM, Farrokhpour H, Farzadfar F, Fatehizadeh A, Fazli G, Feng X, Ferede TY, Fischer F, Flood D, Forouhari A, Foroumadi R, Foroutan Koudehi M, Gaidhane AM, Gaihre S, Gaipov A, Galali Y, Ganesan B, Garcia-Gordillo MA, Gautam RK, Gebrehiwot M, Gebrekidan KG, Gebremeskel TG, Getacher L, Ghadirian F, Ghamari SH, Ghasemi Nour M, Ghassemi F, Golechha M, Goleij P, Golinelli D, Gopalani SV, Guadie HA, Guan SY, Gudayu TW, Guimarães RA, Guled RA, Gupta R, Gupta K, Gupta VB, Gupta VK, Gyawali B, Haddadi R, Hadi NR, Haile TG, Hajibeygi R, Haj-Mirzaian A, Halwani R, Hamidi S, Hankey GJ, Hannan MA, Haque S, Harandi H, Harlianto NI, Hasan SMM, Hasan SS, Hasani H, Hassanipour S, Hassen MB, Haubold J, Hayat K, Heidari G, Heidari M, Hessami K, Hiraike Y, Holla R, Hossain S, Hossain MS, Hosseini MS, Hosseinzadeh M, Hosseinzadeh H, Huang J, Huda MN, Hussain S, Huynh HH, Hwang BF, Ibitoye SE, Ikeda N, Ilic IM, Ilic MD, Inbaraj LR, Iqbal A, Islam SMS, Islam RM, Ismail NE, Iso H, Isola G, Itumalla R, Iwagami M, Iwu CCD, Iyamu IO, Iyasu AN, Jacob L, Jafarzadeh A, Jahrami H, Jain R, Jaja C, Jamalpoor Z, Jamshidi E, Janakiraman B, Jayanna K, Jayapal SK, Jayaram S, Jayawardena R, Jebai R, Jeong W, Jin Y, Jokar M, Jonas JB, Joseph N, Joseph A, Joshua CE, Joukar F, Jozwiak JJ, Kaambwa B, Kabir A, Kabthymer RH, Kadashetti V, Kahe F, Kalhor R, Kandel H, Karanth SD, Karaye IM, Karkhah S, Katoto PDMC, Kaur N, Kazemian S, Kebede SA, Khader YS, Khajuria H, Khalaji A, Khan MAB, Khan M, Khan A, Khanal S, Khatatbeh MM, Khater AM, Khateri S, khorashadizadeh F, Khubchandani J, Kibret BG, Kim MS, Kimokoti RW, Kisa A, Kivimäki M, Kolahi AA, Komaki S, Kompani F, Koohestani HR, Korzh O, Kostev K, Kothari N, Koyanagi A, Krishan K, Krishnamoorthy Y, Kuate Defo B, Kuddus M, Kuddus MA, Kumar R, Kumar H, Kundu S, Kurniasari MD, Kuttikkattu A, La Vecchia C, Lallukka T, Larijani B, Larsson AO, Latief K, Lawal BK, Le TTT, Le TTB, Lee SWH, Lee M, Lee WC, Lee PH, Lee SW, Lee SW, Legesse SM, Lenzi J, Li Y, Li MC, Lim SS, Lim LL, Liu X, Liu C, Lo CH, Lopes G, Lorkowski S, Lozano R, Lucchetti G, Maghazachi AA, Mahasha PW, Mahjoub S, Mahmoud MA, Mahmoudi R, Mahmoudimanesh M, Mai AT, Majeed A, Majma Sanaye P, Makris KC, Malhotra K, Malik AA, Malik I, Mallhi TH, Malta DC, Mamun AA, Mansouri B, Marateb HR, Mardi P, Martini S, Martorell M, Marzo RR, Masoudi R, Masoudi S, Mathews E, Maugeri A, Mazzaglia G, Mekonnen T, Meshkat M, Mestrovic T, Miao Jonasson J, Miazgowski T, Michalek IM, Minh LHN, Mini GK, Miranda JJ, Mirfakhraie R, Mirrakhimov EM, Mirza-Aghazadeh-Attari M, Misganaw A, Misgina KH, Mishra M, Moazen B, Mohamed NS, Mohammadi E, Mohammadi M, Mohammadian-Hafshejani A, Mohammadshahi M, Mohseni A, Mojiri-forushani H, Mokdad AH, Momtazmanesh S, Monasta L, Moniruzzaman M, Mons U, Montazeri F, Moodi Ghalibaf A, Moradi Y, Moradi M, Moradi Sarabi M, Morovatdar N, Morrison SD, Morze J, Mossialos E, Mostafavi E, Mueller UO, Mulita F, Mulita A, Murillo-Zamora E, Musa KI, Mwita JC, Nagaraju SP, Naghavi M, Nainu F, Nair TS, Najmuldeen HHR, Nangia V, Nargus S, Naser AY, Nassereldine H, Natto ZS, Nauman J, Nayak BP, Ndejjo R, Negash H, Negoi RI, Nguyen HTH, Nguyen DH, Nguyen PT, Nguyen VT, Nguyen HQ, Niazi RK, Nigatu YT, Ningrum DNA, Nizam MA, Nnyanzi LA, Noreen M, Noubiap JJ, Nzoputam OJ, Nzoputam CI, Oancea B, Odogwu NM, Odukoya OO, Ojha VA, Okati-Aliabad H, Okekunle AP, Okonji OC, Okwute PG, Olufadewa II, Onwujekwe OE, Ordak M, Ortiz A, Osuagwu UL, Oulhaj A, Owolabi MO, Padron-Monedero A, Padubidri JR, Palladino R, Panagiotakos D, Panda-Jonas S, Pandey A, Pandey A, Pandi-Perumal SR, Pantea Stoian AM, Pardhan S, Parekh T, Parekh U, Pasovic M, Patel J, Patel JR, Paudel U, Pepito VCF, Pereira M, Perico N, Perna S, Petcu IR, Petermann-Rocha FE, Podder V, Postma MJ, Pourali G, Pourtaheri N, Prates EJS, Qadir MMF, Qattea I, Raee P, Rafique I, Rahimi M, Rahimifard M, Rahimi-Movaghar V, Rahman MO, Rahman MA, Rahman MHU, Rahman M, Rahman MM, Rahmani M, Rahmani S, Rahmanian V, Rahmawaty S, Rahnavard N, Rajbhandari B, Ram P, Ramazanu S, Rana J, Rancic N, Ranjha MMAN, Rao CR, Rapaka D, Rasali DP, Rashedi S, Rashedi V, Rashid AM, Rashidi MM, Ratan ZA, Rawaf S, Rawal L, Redwan EMM, Remuzzi G, Rengasamy KRR, Renzaho AMN, Reyes LF, Rezaei N, Rezaei N, Rezaeian M, Rezazadeh H, Riahi SM, Rias YA, Riaz M, Ribeiro D, Rodrigues M, Rodriguez JAB, Roever L, Rohloff P, Roshandel G, Roustazadeh A, Rwegerera GM, Saad AMA, Saber-Ayad MM, Sabour S, Sabzmakan L, Saddik B, Sadeghi E, Saeed U, Saeedi Moghaddam S, Safi S, Safi SZ, Saghazadeh A, Saheb Sharif-Askari N, Saheb Sharif-Askari F, Sahebkar A, Sahoo SS, Sahoo H, Saif-Ur-Rahman KM, Sajid MR, Salahi S, Salahi S, Saleh MA, Salehi MA, Salomon JA, Sanabria J, Sanjeev RK, Sanmarchi F, Santric-Milicevic MM, Sarasmita MA, Sargazi S, Sathian B, Sathish T, Sawhney M, Schlaich MP, Schmidt MI, Schuermans A, Seidu AA, Senthil Kumar N, Sepanlou SG, Sethi Y, Seylani A, Shabany M, Shafaghat T, Shafeghat M, Shafie M, Shah NS, Shahid S, Shaikh MA, Shanawaz M, Shannawaz M, Sharfaei S, Shashamo BB, Shiri R, Shittu A, Shivakumar KM, Shivalli S, Shobeiri P, Shokri F, Shuval K, Sibhat MM, Silva LMLR, Simpson CR, Singh JA, Singh P, Singh S, Siraj MS, Skryabina AA, Sohag AAM, Soleimani H, Solikhah S, Soltani-Zangbar MS, Somayaji R, Sorensen RJD, Starodubova AV, Sujata S, Suleman M, Sun J, Sundström J, Tabarés-Seisdedos R, Tabatabaei SM, Tabatabaeizadeh SA, Tabish M, Taheri M, Taheri E, Taki E, Tamuzi JJLL, Tan KK, Tat NY, Taye BT, Temesgen WA, Temsah MH, Tesler R, Thangaraju P, Thankappan KR, Thapa R, Tharwat S, Thomas N, Ticoalu JHV, Tiyuri A, Tonelli M, Tovani-Palone MR, Trico D, Trihandini I, Tripathy JP, Tromans SJ, Tsegay GM, Tualeka AR, Tufa DG, Tyrovolas S, Ullah S, Upadhyay E, Vahabi SM, Vaithinathan AG, Valizadeh R, van Daalen KR, Vart P, Varthya SB, Vasankari TJ, Vaziri S, Verma MV, Verras GI, Vo DC, Wagaye B, Waheed Y, Wang Z, Wang Y, Wang C, Wang F, Wassie GT, Wei MYW, Weldemariam AH, Westerman R, Wickramasinghe ND, Wu Y, Wulandari RDWI, Xia J, Xiao H, Xu S, Xu X, Yada DY, Yang L, Yatsuya H, Yesiltepe M, Yi S, Yohannis HK, Yonemoto N, You Y, Zaman SB, Zamora N, Zare I, Zarea K, Zarrintan A, Zastrozhin MS, Zeru NG, Zhang ZJ, Zhong C, Zhou J, Zielińska M, Zikarg YT, Zodpey S, Zoladl M, Zou Z, Zumla A, Zuniga YMH, Magliano DJ, Murray CJL, Hay SI, Vos T. Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the Global Burden of Disease Study 2021. Lancet 2023; 402:203-234. [PMID: 37356446 PMCID: PMC10364581 DOI: 10.1016/s0140-6736(23)01301-6] [Citation(s) in RCA: 250] [Impact Index Per Article: 250.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
BACKGROUND Diabetes is one of the leading causes of death and disability worldwide, and affects people regardless of country, age group, or sex. Using the most recent evidentiary and analytical framework from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD), we produced location-specific, age-specific, and sex-specific estimates of diabetes prevalence and burden from 1990 to 2021, the proportion of type 1 and type 2 diabetes in 2021, the proportion of the type 2 diabetes burden attributable to selected risk factors, and projections of diabetes prevalence through 2050. METHODS Estimates of diabetes prevalence and burden were computed in 204 countries and territories, across 25 age groups, for males and females separately and combined; these estimates comprised lost years of healthy life, measured in disability-adjusted life-years (DALYs; defined as the sum of years of life lost [YLLs] and years lived with disability [YLDs]). We used the Cause of Death Ensemble model (CODEm) approach to estimate deaths due to diabetes, incorporating 25 666 location-years of data from vital registration and verbal autopsy reports in separate total (including both type 1 and type 2 diabetes) and type-specific models. Other forms of diabetes, including gestational and monogenic diabetes, were not explicitly modelled. Total and type 1 diabetes prevalence was estimated by use of a Bayesian meta-regression modelling tool, DisMod-MR 2.1, to analyse 1527 location-years of data from the scientific literature, survey microdata, and insurance claims; type 2 diabetes estimates were computed by subtracting type 1 diabetes from total estimates. Mortality and prevalence estimates, along with standard life expectancy and disability weights, were used to calculate YLLs, YLDs, and DALYs. When appropriate, we extrapolated estimates to a hypothetical population with a standardised age structure to allow comparison in populations with different age structures. We used the comparative risk assessment framework to estimate the risk-attributable type 2 diabetes burden for 16 risk factors falling under risk categories including environmental and occupational factors, tobacco use, high alcohol use, high body-mass index (BMI), dietary factors, and low physical activity. Using a regression framework, we forecast type 1 and type 2 diabetes prevalence through 2050 with Socio-demographic Index (SDI) and high BMI as predictors, respectively. FINDINGS In 2021, there were 529 million (95% uncertainty interval [UI] 500-564) people living with diabetes worldwide, and the global age-standardised total diabetes prevalence was 6·1% (5·8-6·5). At the super-region level, the highest age-standardised rates were observed in north Africa and the Middle East (9·3% [8·7-9·9]) and, at the regional level, in Oceania (12·3% [11·5-13·0]). Nationally, Qatar had the world's highest age-specific prevalence of diabetes, at 76·1% (73·1-79·5) in individuals aged 75-79 years. Total diabetes prevalence-especially among older adults-primarily reflects type 2 diabetes, which in 2021 accounted for 96·0% (95·1-96·8) of diabetes cases and 95·4% (94·9-95·9) of diabetes DALYs worldwide. In 2021, 52·2% (25·5-71·8) of global type 2 diabetes DALYs were attributable to high BMI. The contribution of high BMI to type 2 diabetes DALYs rose by 24·3% (18·5-30·4) worldwide between 1990 and 2021. By 2050, more than 1·31 billion (1·22-1·39) people are projected to have diabetes, with expected age-standardised total diabetes prevalence rates greater than 10% in two super-regions: 16·8% (16·1-17·6) in north Africa and the Middle East and 11·3% (10·8-11·9) in Latin America and Caribbean. By 2050, 89 (43·6%) of 204 countries and territories will have an age-standardised rate greater than 10%. INTERPRETATION Diabetes remains a substantial public health issue. Type 2 diabetes, which makes up the bulk of diabetes cases, is largely preventable and, in some cases, potentially reversible if identified and managed early in the disease course. However, all evidence indicates that diabetes prevalence is increasing worldwide, primarily due to a rise in obesity caused by multiple factors. Preventing and controlling type 2 diabetes remains an ongoing challenge. It is essential to better understand disparities in risk factor profiles and diabetes burden across populations, to inform strategies to successfully control diabetes risk factors within the context of multiple and complex drivers. FUNDING Bill & Melinda Gates Foundation.
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Poorzand H, Fazeli B, Khajavi O, Gholoobi A, Keihanian F, Morovatdar N. Association of polymorphisms of renin angiotensin system and endothelial nitric oxide synthase genes with premature cardiovascular disease in an Iranian population. BMC Cardiovasc Disord 2023; 23:254. [PMID: 37193968 DOI: 10.1186/s12872-023-03276-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 05/03/2023] [Indexed: 05/18/2023] Open
Abstract
INTRODUCTION The study of polymorphisms and their relationship with diseases is very important for risk assessment. The aim of this study was to determine the relationship between early risk of coronary artery disease(CAD) with renin-angiotensin(RAS) genes and endothelial nitric oxide synthase(eNOS) in a sample of the Iranian population. METHODS & MATERIALS In this cross-sectional study, 63 patients with premature CAD and 72 healthy samples were enrolled. Polymorphism of the promotor region of eNOS- and ACE-I/D (Angiotensin Converting Enzyme-I/D) polymorphism was evaluated. Polymerase chain reaction (PCR) test and PCR-RFLP (Restriction Fragment Length Polymorphism) was performed for ACE and eNOS-786 gene, respectively. RESULTS The frequency of deletion(D) for the ACE gene was significantly higher in patients(96% versus 61%; P < 0.001). Conversely, the number of defective C alleles for the eNOS gene was similar in both groups (p > 0.9). CONCLUSION ACE polymorphism seems to be an independent risk factor for premature CAD.
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Affiliation(s)
- Hoorak Poorzand
- Vascular and Endovascular surgery research center, Mashhad University of Medical Sciences, Mashhad, Mashhad, Iran
| | - Bahareh Fazeli
- Inflammation and Inflammatory Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Omid Khajavi
- Cardiovascular Department, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Arash Gholoobi
- Cardiovascular Department, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Faeze Keihanian
- Cardiovascular Department, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Pharmaceutical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Negar Morovatdar
- Clinical Research Unit, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Rastegar H, Torshizian A, Yaghoubi MA, Khoshhal N, Asadi M, Morovatdar N, Mohebbi M. Accuracy of fine-needle aspiration cytopathology to differentiate malignant and benign thyroid nodules with ≥4 cm diameter: A retrospective study. Diagn Cytopathol 2023; 51:263-269. [PMID: 36585850 DOI: 10.1002/dc.25096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/28/2022] [Accepted: 12/19/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Thyroid nodules (TN) are commonly present in the general population and are usually pathologically benign. An initial diagnosis with fine-needle aspiration (FNA) cytopathology could help clinical decision-making with fewer complications. As the previous studies suggest surgical procedures for >4 cm TNs, we aimed to investigate the accuracy of preoperative FNA cytology to predict malignancy risk in these nodules in a sample of the Iranian population. METHODS Patients with ≥4 cm TNs who had preoperative FNA cytology, underwent nodulectomy and had a histopathological report were included. Each patient's preoperative demographic, ultrasonographic, and cytology data were gathered. After surgery, resected samples were assessed pathologically and diagnosed as benign or malignant. Finally, data were analyzed to evaluate the presurgical accuracy of the FNA cytology. RESULTS We identified 41 (51.25%) patients with malignant legions among our study population (N = 80). The pathology reports were indeterminate in 3 patients with follicular neoplasm. Bethesda scores were substantially higher in patients with malignancy. The sensitivity, specificity, and false-negative rate of FNA cytology reports using the Bethesda system were 73.7%, 74.2%, and 26.3%, respectively. There was no association between malignancy and TNs' size, neither their volume nor their highest diameter. CONCLUSION FNA cytology is not as sensitive and specific in nodules>4 cm as in smaller ones. However, it can still be used alongside other diagnostic procedures in malignancy screening. Clinicians should make more complex decisions considering various influential factors to avoid missing malignant lesions and reduce diverse probable complications of highly invasive diagnostic surgery. Further prospective research on >4 cm TNs and their multiple features' association with malignancy is required for more precise judgment.
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Affiliation(s)
- Houra Rastegar
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ashkan Torshizian
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Ali Yaghoubi
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nastaran Khoshhal
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mehdi Asadi
- Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Negar Morovatdar
- Clinical Research Development Unit, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Masoud Mohebbi
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Vahid Lotfabadi N, Mehrabi S, Heidari‐Bakavoli A, Morovatdar N, Tayyebi M, Baradaran Rahimi V. Evaluation of the effects of isoproterenol on arrhythmia recurrence following catheter ablation in patients with atrioventricular nodal re-entrant tachycardia: A randomized controlled clinical trial. Pharmacol Res Perspect 2023; 11:e01068. [PMID: 36855813 PMCID: PMC9975462 DOI: 10.1002/prp2.1068] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 01/10/2023] [Accepted: 02/07/2023] [Indexed: 03/02/2023] Open
Abstract
We aimed to determine the effects of isoproterenol on arrhythmia recurrence in atrioventricular nodal re-entrant tachycardia (AVNRT) patients treated with catheter ablation. The present randomized controlled clinical trial was conducted on AVNRT patients candidates for radiofrequency ablation (RFA). The patients were randomly assigned to receive isoproterenol (0.5-4 μg/min) or not (control group) for arrhythmia re-induction after ablation. The results of the electrophysiological (EP) study, the ablation parameters, and the arrhythmia recurrence rate were recorded. We evaluated 206 patients (53 males and 153 females) with a mean (SD) age of 49.87 (15.5) years in two groups of isoproterenol (n = 103) and control (n = 103). No statistically significant difference was observed between the two studied groups in age, gender, EP study, and ablation parameters. The success rate of ablation was 100% in both groups. During ~16.5 months of follow-up, one patient (1%) in the isoproterenol group and four patients (3.8%) in the control group experienced AVNRT recurrence (HR = 0.245; 95% confidence interval [CI], 0.043-1.418; p = .173). Based on the Kaplan-Meier analysis, there was no significant difference in the incidence rate of arrhythmia recurrence during the follow-up period between the two studied groups (p = .129). Additionally, there were no significant differences between the arrhythmia's recurrence according to age, gender, junctional rhythm, type of AVNRT arrhythmia, and DAVN persistence after ablation. Although isoproterenol administration for arrhythmia re-induction after ablation did not alleviate the treatment outcomes and arrhythmia recurrence following RFA in AVNRT patients, further studies with a larger sample size and a longer duration of follow-up are necessary.
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Affiliation(s)
- Neda Vahid Lotfabadi
- Department of Cardiovascular Diseases, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
| | - Saeed Mehrabi
- Department of Cardiovascular Diseases, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
| | - Alireza Heidari‐Bakavoli
- Department of Cardiovascular Diseases, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
| | - Negar Morovatdar
- Clinical Research Development Unit, Faculty of MedicineImam Reza Hospital, Mashhad University of Medical SciencesMashhadIran
| | - Mohammad Tayyebi
- Department of Cardiovascular Diseases, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
| | - Vafa Baradaran Rahimi
- Department of Cardiovascular Diseases, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
- Pharmacological Research Center of Medicinal PlantsMashhad University of Medical SciencesMashhadIran
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Karbasi S, Mohamadian M, Naseri M, Yahya Hanafi-Bojd M, Khorasanchi Z, Morovatdar N, Zarban A, Bahrami A, Ferns GA. The association of maternal food quality score (FQS) with breast milk nutrient content and antioxidant content of infant urine: a cross-sectional study. BMC Pregnancy Childbirth 2023; 23:126. [PMID: 36829155 PMCID: PMC9951474 DOI: 10.1186/s12884-023-05400-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 01/20/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND Breast milk (BM) is a complex fluid with a variable composition within women over time and between women in the population. The BM compositional differences are likely to be partly due to maternal dietary patterns. This study aimed to evaluate food quality score (FQS) in lactating mothers and its association with quality indicators of BM and antioxidant content of infant urine. METHODS This cross-sectional study was undertaken in 350 lactating women aged 20 to 35 years. Data on dietary intake was collected using a validated food frequency questionnaire (FFQ) containing 65 food items. The FQS was calculated by integrating the scores obtained from healthy and unhealthy food groups. Subjects were categorized according to FQS adherence, with the greatest adherence being allocated to the third tertile and those with the lowest FQS in the first tertile. Antioxidant activity of the BM and infant urine samples was assessed using the Ferric reducing antioxidant power (FRAP), 2, 2'-diphenyl-1-picrylhydrazyl (DPPH), thiobarbituric acid reactive substances (TBARs), and Ellman's assay. The total content of BM protein, calcium, and triglyceride was measured using standard biochemical kits. RESULTS BM from mothers from the third tertile of FQS contained significantly higher DPPH, thiol, calcium, and protein levels compared to BM from those in the lowest tertile (p˂0.05). Infant urinary DPPH and FRAP was also significantly higher in the highest tertile vs. the lowest tertile (p˂0.05). CONCLUSION High maternal adherence to the FQS was associated with a high BM quality and antioxidant content of infant urine.
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Affiliation(s)
- Samira Karbasi
- grid.411701.20000 0004 0417 4622Department of Molecular Medicine, School of Medicine, Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Malihe Mohamadian
- grid.411701.20000 0004 0417 4622Cellular and Molecular Research Center, Department of Molecular Medicine, Birjand University of Medical Sciences, Birjand, Iran
| | - Mohsen Naseri
- grid.411701.20000 0004 0417 4622Cellular and Molecular Research Center, Department of Molecular Medicine, Birjand University of Medical Sciences, Birjand, Iran
| | - Mohammad Yahya Hanafi-Bojd
- grid.411701.20000 0004 0417 4622Cellular and Molecular Research Center, Department of Molecular Medicine, Birjand University of Medical Sciences, Birjand, Iran ,grid.411701.20000 0004 0417 4622Department of Pharmaceutics and Pharmaceutical Nanotechnology. School of Pharmacy, Birjand University of Medical Sciences, Birjand, Iran
| | - Zahra Khorasanchi
- grid.411583.a0000 0001 2198 6209Department of Nutrition, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Negar Morovatdar
- grid.411583.a0000 0001 2198 6209Clinical Research Development Unit, Faculty of Medicine, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Asghar Zarban
- Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran. .,Clinical Biochemistry Department, Faculty of Medicine, Birjand University of Medical Sciences, Birjand, Iran.
| | - Afsane Bahrami
- Clinical Research Development Unit, Faculty of Medicine, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. .,Clinical Research Development Unit of Akbar Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Gordon A. Ferns
- grid.414601.60000 0000 8853 076XBrighton and Sussex Medical School, Division of Medical Education, Falmer, Brighton, BN1 9PH Sussex UK
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Mohammadi F, Bigdelu L, Allahyari A, Morovatdar N, Rahimi VB. The effects of low‐dose anthracycline‐based chemotherapy on the levels of serum NT‐proBNP level and left ventricular systolic and diastolic dysfunctions: A prospective observational study. Health Sci Rep 2022; 5:e841. [PMID: 36189408 PMCID: PMC9493234 DOI: 10.1002/hsr2.841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/03/2022] [Accepted: 09/05/2022] [Indexed: 11/09/2022] Open
Abstract
Background and Aims Methods Results Conclusion
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Affiliation(s)
- Fatemeh Mohammadi
- Department of Cardiovascular Diseases, Faculty of Medicine Mashhad University of Medical Sciences Mashhad Iran
| | - Leila Bigdelu
- Division of Cardiovascular, Vascular Surgery Research Center Mashhad University of Medical Sciences Mashhad Iran
| | - Abolghasem Allahyari
- Department of Hematology‐Oncology, Faculty of Medicine Mashhad University of Medical Sciences Mashhad Iran
| | - Negar Morovatdar
- Clinical Research Development Unit, Imam Reza Hospital, Faculty of Medicine Mashhad University of Medical Sciences Mashhad Iran
| | - Vafa Baradaran Rahimi
- Department of Cardiovascular Diseases, Faculty of Medicine Mashhad University of Medical Sciences Mashhad Iran
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21
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Molooghi K, Sheybani F, Naderi H, Mirfeizi Z, Morovatdar N, Baradaran A. Central nervous system infections in patients with systemic lupus erythematosus: a systematic review and meta-analysis. Lupus Sci Med 2022; 9:9/1/e000560. [PMID: 34980679 PMCID: PMC8724813 DOI: 10.1136/lupus-2021-000560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 12/09/2021] [Indexed: 11/17/2022]
Abstract
We aimed to conduct a systematic review and meta-analysis of studies on central nervous system (CNS) infections in patients with SLE, in order to describe their clinical and microbiological characteristics, and outcomes. A systematic search of PubMed/Medline and Embase electronic databases was performed (March 2021) to identify all published studies on CNS infections and their characteristics in patients with SLE. A random-effects model was adopted and findings were reported with 95% CI. Overall, 6 studies involving 17 751 patients with SLE and 209 SLE cases with CNS infection were included in our meta-analysis. The frequency rate of CNS infections in patients with SLE was 0.012 (95% CI: 0.008 to 0.018). Meningitis was the most common clinical syndrome (93.5%, n=109/114, 95% CI: 82.6% to 97.8%) and Cryptococcus neoformans (35.9%, n=55, 95% CI: 27.2% to 45.7%) and Mycobacterium tuberculosis (27.1%, n=43, 95% CI: 14.6% to 44.8%) were the most common causative pathogens. Our patient-pool showed a mean SLE Disease Activity Index (SLEDAI) score of 7.9 (95% CI: 6.1 to 9.6), while 92.4% (n=72/76, 95% CI: 83.0% to 96.8%) of cases were on oral systemic corticosteroids, with a prednisone equivalent mean daily dose of 30.9 mg/day (95% CI: 18.0 to 43.7). Our meta-analysis revealed a mortality rate of 29.0% (95% CI: 15.0% to 48.6%). Clinicians should maintain a high index of suspicion for cryptococcal and tuberculosis (TB) meningitis in patients with SLE with suspected CNS infection, particularly in those with higher SLEDAI and on higher doses of systemic corticosteroids. In conclusion, initiation of empiric antituberculous treatment for patients with SLE who are highly suspected to have CNS TB is warranted while awaiting the results of diagnostic tests. Antifungals might also be potentially useful empirically in patients with SLE who are suspected to have fungal CNS infections. However, with respect to side effects such as toxicity and high cost of antifungals, decision regarding early antifungal therapy should be guided by early and less time-consuming fungal diagnostic tests.
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Affiliation(s)
- Kasra Molooghi
- Department of Infectious Diseases and Tropical Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fereshte Sheybani
- Department of Infectious Diseases and Tropical Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamidreza Naderi
- Department of Infectious Diseases and Tropical Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zahra Mirfeizi
- Rheumatic Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Negar Morovatdar
- Clinical Research Unit, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ashkan Baradaran
- Department of Infectious Diseases and Tropical Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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22
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Boroumand-Noughabi S, Rahmati A, Morovatdar N, Keramati M. Significant decrease in the transfusion rates during the COVID-19 pandemic in the North East of Iran. Transfus Clin Biol 2021; 29:181-182. [PMID: 34973462 PMCID: PMC8714607 DOI: 10.1016/j.tracli.2021.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 12/14/2021] [Accepted: 12/26/2021] [Indexed: 11/13/2022]
Affiliation(s)
- S Boroumand-Noughabi
- Department of Hematology and Blood Banking, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - A Rahmati
- Department of Hematology and Blood Banking, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - N Morovatdar
- Clinical Research Development Unit, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - M Keramati
- Department of Hematology and Blood Banking, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
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23
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Bahrami Moqadam S, Saleh Asheghabadi A, Norouzi F, Jafarzadeh H, Khosroabadi A, Alagheband A, Bangash G, Morovatdar N, Xu J. Conceptual Method of Temperature Sensation in Bionic Hand by Extraordinary Perceptual Phenomenon. J Bionic Eng 2021; 18:1344-1357. [PMID: 34868280 PMCID: PMC8628055 DOI: 10.1007/s42235-021-00112-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 09/30/2021] [Accepted: 10/05/2021] [Indexed: 06/13/2023]
Abstract
Lack of temperature sensation of myoelectric prosthetic hand limits the daily activities of amputees. To this end, a non-invasive temperature sensation method is proposed to train amputees to sense temperature with psychophysical sensory substitution. In this study, 22 healthy participants took part besides 5 amputee participants. The duration time of the study was 31 days with five test steps according to the Leitner technique. An adjustable temperature mug and a Peltier were used to change the temperature of the water/phantom digits to induce temperature to participants. Also, to isolate the surroundings and show colors, a Virtual Reality (VR) glass was employed. The statistical results conducted are based on the response of participants with questionnaire method. Using Chi-square tests, it is concluded that participants answer the experiment significantly correctly using the Leitner technique (P value < 0.05). Also, by applying the "Repeated Measures ANOVA", it is noticed that the time of numbness felt by participants had significant (P value < 0.001) difference. Participants could remember lowest and highest temperatures significantly better than other temperatures (P value < 0.001); furthermore, the well-trained amputee participant practically using the prosthesis with 72.58% could identify object's temperature with only once time experimenting the color temperature.
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Affiliation(s)
- Saeed Bahrami Moqadam
- State Key Laboratory of Tribology, Department of Mechanical Engineering, Tsinghua University, Beijing, 100084 China
| | - Ahamd Saleh Asheghabadi
- State Key Laboratory of Tribology, Department of Mechanical Engineering, Tsinghua University, Beijing, 100084 China
| | | | - Hamed Jafarzadeh
- Center for Computational and Data Intensive Science and Engineering (CDISE), Skolkovo Institute of Science and Technology (Skoltech), Moscow, 121205 Russia
| | - Ali Khosroabadi
- Department of Mechanical Engineering, Ferdowsi University, Mashhad, 9177948974 Iran
| | - Afshin Alagheband
- Department of Electrical Engineering, Ferdowsi University, Mashhad, 9177948974 Iran
| | - Ghazal Bangash
- Department of Computer Engineering, Ferdowsi University, Mashhad, 9177948974 Iran
| | - Negar Morovatdar
- Clinical Research Unit, Imam Reza Hospital, Mashhad University of Medical Sciences, 13131–99137 Mashhad, Iran
| | - Jing Xu
- State Key Laboratory of Tribology, Department of Mechanical Engineering, Tsinghua University, Beijing, 100084 China
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Rehman S, Phan HT, Reeves MJ, Thrift AG, Cadilhac DA, Sturm J, Breslin M, Callisaya ML, Vemmos K, Parmar P, Krishnamurthi RV, Barker-Collo S, Feigin V, Chausson N, Olindo S, Cabral NL, Carolei A, Marini C, Degan D, Sacco S, Correia M, Appelros P, Kõrv J, Vibo R, Minelli C, Sposato L, Pandian JD, Kaur P, Azarpazhooh MR, Morovatdar N, Gall S. Case-Fatality and Functional Outcome after Subarachnoid Hemorrhage (SAH) in INternational STRoke oUtComes sTudy (INSTRUCT). J Stroke Cerebrovasc Dis 2021; 31:106201. [PMID: 34794031 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 10/15/2021] [Accepted: 10/21/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND There are few large population-based studies of outcomes after subarachnoid hemorrhage (SAH) than other stroke types. METHODS We pooled data from 13 population-based stroke incidence studies (10 studies from the INternational STRroke oUtComes sTudy (INSTRUCT) and 3 new studies; N=657). Primary outcomes were case-fatality and functional outcome (modified Rankin scale score 3-5 [poor] vs. 0-2 [good]). Harmonized patient-level factors included age, sex, health behaviours (e.g. current smoking at baseline), comorbidities (e.g.history of hypertension), baseline stroke severity (e.g. NIHSS >7) and year of stroke. We estimated predictors of case-fatality and functional outcome using Poisson regression and generalized estimating equations using log-binomial models respectively at multiple timepoints. RESULTS Case-fatality rate was 33% at 1 month, 43% at 1 year, and 47% at 5 years. Poor functional outcome was present in 27% of survivors at 1 month and 15% at 1 year. In multivariable analysis, predictors of death at 1-month were age (per decade increase MRR 1.14 [1.07-1.22]) and SAH severity (MRR 1.87 [1.50-2.33]); at 1 year were age (MRR 1.53 [1.34-1.56]), current smoking (MRR 1.82 [1.20-2.72]) and SAH severity (MRR 3.00 [2.06-4.33]) and; at 5 years were age (MRR 1.63 [1.45-1.84]), current smoking (MRR 2.29 [1.54-3.46]) and severity of SAH (MRR 2.10 [1.44-3.05]). Predictors of poor functional outcome at 1 month were age (per decade increase RR 1.32 [1.11-1.56]) and SAH severity (RR 1.85 [1.06-3.23]), and SAH severity (RR 7.09 [3.17-15.85]) at 1 year. CONCLUSION Although age is a non-modifiable risk factor for poor outcomes after SAH, however, severity of SAH and smoking are potential targets to improve the outcomes.
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Affiliation(s)
- Sabah Rehman
- Menzies Institute for Medical Research, Hobart, Tasmania, University of Tasmania, Australia
| | - Hoang T Phan
- Menzies Institute for Medical Research, Hobart, Tasmania, University of Tasmania, Australia
| | - Mathew J Reeves
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan, USA
| | - Amanda G Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Dominique A Cadilhac
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Jonathan Sturm
- Faculty of Health and Medicine, University of Newcastle, New South Wales, Australia
| | - Monique Breslin
- Menzies Institute for Medical Research, Hobart, Tasmania, University of Tasmania, Australia
| | - Michele L Callisaya
- Menzies Institute for Medical Research, Hobart, Tasmania, University of Tasmania, Australia; Struttura Complessa di Neurologia, Ospedale Michele e Pietro Ferrero, Verduno (Cuneo), ASL CN2, Italy
| | | | - Priya Parmar
- National Institute for Stroke and Applied Neurosciences, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Rita V Krishnamurthi
- National Institute for Stroke and Applied Neurosciences, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | | | - Valery Feigin
- National Institute for Stroke and Applied Neurosciences, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Nicolas Chausson
- Stroke Unit, Centre Hospitalier Sud Francilien, Corbeil-Essonnes, France
| | - Stephane Olindo
- Stroke Unit, University Hospital of Bordeaux, Bordeaux, France
| | - Norberto L Cabral
- Deceased. Formerly Clinica Neurológica de Joinville, Joinville Stroke Registry, University of Joinville Region-Univille, Joinville, Brazil
| | - Antonio Carolei
- Department of Biotechnological and Applied Clinical Sciences, Neurological Institute, University of L'Aquila, Italy
| | - Carmine Marini
- Department of Life, Health, and Environmental Sciences, University of L'Aquila, Italy
| | - Diana Degan
- Struttura Complessa di Neurologia, Ospedale Michele e Pietro Ferrero, Verduno (Cuneo), ASL CN2, Italy
| | - Simona Sacco
- Department of Biotechnological and Applied Clinical Sciences, Neurological Institute, University of L'Aquila, Italy
| | - Manuel Correia
- Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Portugal
| | - Peter Appelros
- Department of Neurology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Janika Kõrv
- Department of Neurology and Neurosurgery, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Riina Vibo
- Department of Neurology and Neurosurgery, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Cesar Minelli
- Hospital Carlos Fernando Malzoni and Neurologic Center of Research and Rehabilitation, Matão, SP, Brazil
| | - Luciano Sposato
- Department of Neurology, Western University, London, Ontario, Canada
| | | | - Paramdeep Kaur
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, Canada
| | - M Reza Azarpazhooh
- Department of Clinical Neurological Sciences, University of Western, London, Ontario, Canada
| | - Negar Morovatdar
- Clinical Research Development Unit, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seana Gall
- Menzies Institute for Medical Research, Hobart, Tasmania, University of Tasmania, Australia; Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.
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Poorzand H, Sharifipour F, Kerachian A, Ghaderi F, Alimi H, Bigdelu L, Fazlinejad A, Morovatdar N, Ataei B. Echocardiographic parameters in patients with and without hypotension during dialysis. J Cardiovasc Thorac Res 2021; 13:228-233. [PMID: 34630971 PMCID: PMC8493227 DOI: 10.34172/jcvtr.2021.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 07/08/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Hypotension during dialysis is a common complication of hemodialysis and is associated with increased patient mortality and morbidity. Intradialytic hypotension is a decrease in systolic BP ≥20 mm Hg or a reduction in mean arterial pressure by 10 mm Hg along with clinical events and the need for correction. This study compares cardiac function, using transthoracic echocardiography with strain modality in patients with intradialytic hypotension with those without hypotension during dialysis. Methods: We studied 60 patients with chronic renal failure undergoing regular hemodialysis from April 2018 to February 2019. We compared thirty patients in the intradialytic hypotension group, with the remaining 30 patients in the control group. We did transthoracic echocardiography a day after hemodialysis using conventional, tissue doppler, and strain imaging. Results: Early diastolic mitral annulus velocity (e’) was lower in the intradialytic hypotension group in comparison with the control group which their difference was statistically significant (5.540 ± 1.51 versus 6.920 ± 1.98, P value:0.007) Left Ventricular Ejection Fraction (LVEF) was also significantly lower in the intradialytic hypotension group (51.07 ± 8.714 versus 59.43 ± 4.133, P value < 0.001). Global Longitudinal Strain (GLS) was significantly lower in the intradialytic hypotension group (-14.17 ± 2.79 versus -18.99 ± 2.25, P value < 0.001). The receiver operator characteristics (ROC) curve point-coordinates that GLS of -16.85 and lower (more positive) has 83% sensitivity and 87% specificity for intradialytic hypotension. Conclusion: The echocardiographic assessment could be used as a tool for the prediction of hypotension during dialysis.
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Affiliation(s)
- Hoorak Poorzand
- Vascular and Endovascular Surgery Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farzaneh Sharifipour
- Kidney Transplantation Research Center, Department of Internal Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abdollah Kerachian
- Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fereshteh Ghaderi
- Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hedieh Alimi
- Vascular and Endovascular Surgery Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Leila Bigdelu
- Department of Cardiology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Afsoon Fazlinejad
- Department of Cardiology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Negar Morovatdar
- Clinical Research Unit, Faculty of Medicine,Mashhad University of Medical Sciences, Mashhad, Iran
| | - Banafsheh Ataei
- Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Mokhber N, Sheikh Andalibi MS, Morovatdar N, Thrift AG, Kapral MK, Stranges S, Saber H, Farzadfard MT, Amiri A, Akbarzadeh F, Ghanei N, Khorram B, Azarpazhooh MR. Self-perceived acute psychological stress and risk of mortality, recurrence and disability after stroke: Mashhad Stroke Incidence Study. Stress Health 2021; 37:819-825. [PMID: 33481317 DOI: 10.1002/smi.3031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 12/15/2020] [Accepted: 01/18/2021] [Indexed: 01/25/2023]
Abstract
This longitudinal study was designed to evaluate the association between acute pre-stroke stress and the severity stroke and its outcomes including mortality, recurrence, disability and functional dependency. Patients with first-ever stroke (FES) were recruited from the Mashhad Stroke Incidence Study. Patients were asked about any acute severe pre-stroke stress in the 2 weeks prior to index stroke. Disability and functional disability were defined using modified the Rankin Scale and Barthel Index, respectively. We used logistic and ordinal regression tests to assess the association between acute pre-stroke stress and study outcomes. Among 624 patients with FES, 169 reported acute pre-stroke stress. Patients with acute pre-stroke stress were younger than those without stress (60.7 ± 14.4 vs. 66.2 ± 14.7; p < 0.001). The frequency of traditional vascular risk factors was not different in patients with and without acute pre-stroke stress. We did not find any association between acute pre-stroke stress and stroke outcomes. Although acute stress was common in our cohort, our results did not support an association between acute pre-stroke stress and the severity of stroke at admission and long-term stroke outcomes.
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Affiliation(s)
- Naghmeh Mokhber
- Department of Psychiatry, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Psychiatry & Behavioral Neurosciences, Western University, London, Canada
| | - Mohammad Sobhan Sheikh Andalibi
- International UNESCO Center for Health-Related Basic Sciences and Human Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Negar Morovatdar
- Clinical Research Development Unit, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amanda G Thrift
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Clayton, Australia
| | - Moira K Kapral
- Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Saverio Stranges
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Canada.,Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Canada.,Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Hamidreza Saber
- David Geffen School of Medicine, Comprehensive Stroke Center, Department of Neurology, University of California, Los Angeles, USA
| | | | - Amin Amiri
- Department of Neurology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farzad Akbarzadeh
- Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Neda Ghanei
- Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Bita Khorram
- Department of Neurology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahmoud Reza Azarpazhooh
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Canada.,Department of Neurology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Clinical Neurological Science, University Hospital, London Health Science Center, Western University, London, Canada
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Nikooei Noghani S, Milani N, Afkhamizadeh M, Kabiri M, Bonakdaran S, Vazifeh-Mostaan L, Asadi M, Morovatdar N, Mohebbi M. Assessment of insulin resistance in patients with primary hyperparathyroidism before and after Parathyroidectomy. Endocrinol Diabetes Metab 2021; 4:e00294. [PMID: 34505755 PMCID: PMC8502214 DOI: 10.1002/edm2.294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/20/2021] [Accepted: 07/03/2021] [Indexed: 12/31/2022]
Abstract
Background Primary hyperparathyroidism (PHPT) can lead to renal and skeletal disorders, as well as insulin resistance and impaired glucose metabolism. The current study aimed to assess the effects of parathyroidectomy on insulin resistance in patients with PHPT. Materials and Methods The present study was conducted on 65 patients with PHPT and indications for parathyroidectomy who were referred to the endocrinology clinics of Mashhad University of Medical Sciences. Thereafter, the demographic characteristics of the patients were recorded. Blood tests, including haemoglobin A1c (HbA1c), fasting blood glucose (FBG) and insulin levels, were assessed one week before and three months after the surgery. The insulin resistance score (HOMA‐IR) was calculated and compared using the relevant formula. Results A total of 65 participants with a mean age of 45.44 ± 9.59 years were included in the current study. In one‐month postoperative tests, mean scores of FBG (p < .05), insulin level (p < .05) and HbA1c (p < .05) were significantly reduced. Moreover, the HOMA‐IR index decreased in 51 patients after the surgery. Conclusion According to our findings, parathyroidectomy can be effective in the reduction of insulin resistance and corresponding complications in patients with PHPT in the present short‐term study. However, it has yet to be confirmed as a treatment method for insulin resistance in these patients. Future long‐term studies are required to be done to investigate the effect of parathyroidectomy on insulin resistance. The present study aimed to assess the effects of parathyroidectomy on insulin resistance in patients with primary hyperparathyroidism (PHPT). The present study was conducted on 65 patients with PHPT and indications for parathyroidectomy. Demographic characteristics of the patients were recorded. Blood tests, including fasting blood sugar (FBS), haemoglobin A1c (HbA1c) and insulin levels, were assessed one week before and three months after the surgery. The Homeostatic Model Assessment for Insulin Resistance (HOMA‐IR index) was calculated. In one‐month postoperative tests, mean scores of FBS (p < .05), insulin level (p < .05) and HbA1c (p < 0.05) were significantly reduced compared to these variables prior to the surgery. Moreover, the HOMA‐IR index decreased in 51 patients after the surgery. As evidenced by the results of the present study, parathyroidectomy can be effective in reducing insulin resistance and its complications in patients with primary hyperparathyroidism (PHPT).
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Affiliation(s)
- Soudabeh Nikooei Noghani
- Department of Internal Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nasrin Milani
- Department of Internal Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mozhgan Afkhamizadeh
- Faculty of Medicine, Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mona Kabiri
- Faculty of Medicine, Clinical Research Development Unit, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Shokoufeh Bonakdaran
- Faculty of Medicine, Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Leila Vazifeh-Mostaan
- Department of ORL-Head & Neck Surgery, Faculty of Medicine, Otolaryngologist - Head & Neck Surgeon, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahdi Asadi
- Faculty of Medicine, Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Negar Morovatdar
- Faculty of Medicine, Clinical Research Development Unit, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Masoud Mohebbi
- Faculty of Medicine, Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Hamidi-Alamdari D, Hafizi-Lotfabadi S, Bagheri-Moghaddam A, Safari H, Mozdourian M, Javidarabshahi Z, Peivandi-Yazdi A, Ali-Zeraati A, Sedaghat A, Poursadegh F, Barazandeh-Ahmadabadi F, Agheli-Rad M, Tavousi SM, Vojouhi S, Amini S, Amini M, Majid-Hosseini S, Tavanaee-Sani A, Ghiabi A, Nabavi-Mahalli S, Morovatdar N, Rajabi O, Koliakos G. METHYLENE BLUE FOR TREATMENT OF HOSPITALIZED COVID-19 PATIENTS: A RANDOMIZED, CONTROLLED, OPEN-LABEL CLINICAL TRIAL, PHASE 2. Rev Invest Clin 2021; 73:190-198. [PMID: 34019535 DOI: 10.24875/ric.21000028] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background There is no pharmacological intervention on the treatment of hypoxemia and respiratory distress in COVID-19 patients. Objective The objective of the study was to study the effect of the reduced form of methylene blue (MB) on the improvement of oxygen saturation (SpO2) and respiratory rate (RR). Methods In an academic medical center, 80 hospitalized patients with severe COVID-19 were randomly assigned to receive either oral MB along with standard of care (SOC) (MB group, n = 40) or SOC only (SOC group, n=40). The primary outcomes were SpO2 and RR on the 3rd and 5th days. The secondary outcomes were hospital stay and mortality within 28 days. Results In the MB group, a significant improvement in SpO2 and RR was observed on the 3rd day (for both, p < 0.0001) and also the 5th day (for both, p < 0.0001). In the SOC group, there was no significant improvement in SpO2 (p = 0.24) and RR (p = 0.20) on the 3rd day, although there was a significant improvement of SpO2 (p = 0.002) and RR (p = 0.01) on the 5th day. In the MB group in comparison to the SOC group, the rate ratio of increased SpO2 was 13.5 and 2.1 times on the 3rd and 5th days, respectively. In the MB group compared with the SOC group, the rate ratio of RR improvement was 10.1 and 3.7 times on the 3rd and 5th days, respectively. The hospital stay was significantly shortened in the MB group (p = 0.004), and the mortality was 12.5% and 22.5% in the MB and SOC groups, respectively. Conclusions The addition of MB to the treatment protocols significantly improved SpO2 and respiratory distress in COVID-19 patients, which resulted in decreased hospital stay and mortality. ClinicalTrials.gov: NCT04370288.
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Affiliation(s)
| | | | | | - Hossin Safari
- Infectious Diseases Ward, Hasheminejad Hospital, Mashhad, Iran
| | | | | | | | - Abass Ali-Zeraati
- Kidney Transplantation Complications Research Center, Faculty of Medicine, Mashhad, Iran
| | | | | | | | | | - Seyed M Tavousi
- Kidney Transplantation Complications Research Center, Faculty of Medicine, Mashhad, Iran
| | - Shohreh Vojouhi
- Metabolic Syndrome Research Center, School of Medicine, Mashhad, Iran
| | - Shahram Amini
- Anaesthesiology and Critical Care Lung Research Center, Faculty of Medicine, Mashhad, Iran
| | | | | | | | - Amin Ghiabi
- Department of Internal Medicine, Ghaem Hospital, Karaj, Iran
| | | | - Negar Morovatdar
- Clinical Research Development Unit, Imam Reza Hospital, Faculty of Medicine, Mashhad, Iran
| | - Omid Rajabi
- Department of Pharmaceutical Control, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - George Koliakos
- Department of Biochemistry, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Morovatdar N, Watts GF, Bondarsahebi Y, Goldani F, Rahmanipour E, Rezaee R, Sahebkar A. Ankylosing Spondylitis and risk of Cardiac Arrhythmia and Conduction Disorders: A systematic review and meta analysis. Curr Cardiol Rev 2021; 17:e150521193326. [PMID: 33992063 PMCID: PMC8950453 DOI: 10.2174/1573403x17666210515164206] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 01/10/2021] [Accepted: 02/17/2021] [Indexed: 12/02/2022] Open
Abstract
Objective The objective of this study isto assess the association between ankylosing spondylitis (AS) and risk of heart conduction disorders and arrhythmia. Methods PubMed, Embase, and Web of Science databases were systematically searched for observational studies that investigated the association between AS and risk of heart conduction disorders and arrhythmia with no language or date restrictions until September 16, 2019. We used random- and fixed-effects models to pool the results of the studies. Publication bias was assessed by Egger’s test. Subgroup analysis was carried out based on the study design. A p-value less than 0.05 was considered significant. Comprehensive Meta-Analysis (CMA) software was used to perform meta-analysis. Results After removing duplicates, we reviewed 135 articles. Finally, we included seven articles in our meta-analysis, of which four studies reported AV block and any conductive abnormality and three focused on atrial fibrillation and any arrhythmia. Based on our meta-analysis, an increased risk of atrial fibrillation (RR: 1.85, 95%CI: 1.15-2.98) and atrioventricular block (OR: 3.46, 95%CI: 1.09-10.93) was found in AS subjects compared to the general population. In a subgroup analysis based on study design, we found a greater association between AS and atrioventricular block in cohort studies (RR: 5.14, 95%CI: 1.001-26.50) compared to cross-sectional ones. However, we did not find any association between AS and any arrhythmia (OR=3.36, 95% CI: 0.93-12.15), or conduction disorders (OR: 0.64, 95%CI: 0.38-1.06). No publication bias was found. Conclusion Our results support an association between AS and a higher risk of atrial fibrillation and atrioventricular block.
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Affiliation(s)
- Negar Morovatdar
- Clinical Research Development Unit, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Gerald F Watts
- Cardiometabolic Service, Department of Cardiology, Royal Perth Hospital, School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Yones Bondarsahebi
- Students Research Committee, Faculty of Medicine, Mashhad University of medical sciences, Mashhad, Iran
| | - Fatemeh Goldani
- Evidence Based Medicine Research Group, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Elham Rahmanipour
- Evidence Based Medicine Research Group, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ramin Rezaee
- Clinical Research Development Unit, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amirhossein Sahebkar
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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30
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Sheikh Andalibi MS, Rezaei Ardani A, Amiri A, Morovatdar N, Talebi A, Azarpazhooh MR, Mokhber N. The Association between Substance Use Disorders and Long-Term Outcome of Stroke: Results from a Population-Based Study of Stroke among 450,229 Urban Citizens. Neuroepidemiology 2021; 55:171-179. [PMID: 33975326 DOI: 10.1159/000514401] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 01/04/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Little is known regarding long-term stroke outcomes in patients with substance use disorder (SUD). Based on anecdotal data, some individuals use illicit drugs, particularly opioids, in an attempt to reduce stroke mortality, disability, or recurrence. This study is aimed to assess the effect of SUD on stroke outcomes. METHODS Patients were recruited from the Mashhad Stroke Incidence Study, a population-based study of stroke in Iran. For a period of 1 year, all patients with first-ever stroke (FES) were recruited and then followed up for the next 5 years. Disability and functional dependency were defined using modified Rankin Scale (>2) and Barthel Index (<60), respectively. We compared the cumulative rates of mortality in follow-up points using the log-rank test. We used multivariable logistic, Cox regression and competing risk models to assess adjusted hazard ratio (aHR) with 95% confidence interval (CI) of stroke disability, functional dependency, mortality, and recurrence among those with a history of SUD. RESULTS 595 FES patients (mean age of 64.6 ± 14.8 years) were recruited in this study. Eighty-one (13.6%) were current substance users, including opium (n = 68), naswar (n = 5, 6.1%), hashish (n = 1), heroin (n = 1), and (n = 7) others. The frequency of vascular risk factors was similar between the SUD and non-SUD groups, except for a higher rate of cigarette smoking in the SUD group (p < 0.001). After adjusting for various sociodemographic variables, vascular risk factors, and the severity of stroke at admission, SUD increased the 3-month (aHR: 1.60, CI: 1.01-2.49), 1-year (aHR: 1.73, CI: 1.20-2.65), and 5-year (aHR: 1.72, CI: 1.23-2.35) poststroke mortality risk. We did not observe a significant change in the risk of stroke recurrence, disability, and functional dependency in those with a history of SUD. CONCLUSION SUD increased the hazard ratio of stroke mortality with no effect on the disability rate. The public should be advised about the potential harm of substance abuse.
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Affiliation(s)
- Mohammad Sobhan Sheikh Andalibi
- International UNESCO Center for Health-Related Basic Sciences and Human Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amir Rezaei Ardani
- Psychiatry and Behavioural Sciences Research Centre, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amin Amiri
- Department of Neurology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Negar Morovatdar
- Clinical Research Development Unit, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amirhossein Talebi
- Department of Neurology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mahmoud Reza Azarpazhooh
- Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada.,Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.,Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, Western University, London, Ontario, Canada
| | - Naghmeh Mokhber
- Department of Psychiatry, St Joseph's Health Care London, Western University, London, Ontario, Canada
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Morovatdar N, Avan A, Azarpazhooh MR, Di Napoli M, Stranges S, Kapral MK, Rezayat AA, Shariatzadeh A, Abootalebi S, Mokhber N, Spence JD, Hachinski V. Secular trends of ischaemic heart disease, stroke, and dementia in high-income countries from 1990 to 2017: the Global Burden of Disease Study 2017. Neurol Sci 2021; 43:255-264. [PMID: 33934273 DOI: 10.1007/s10072-021-05259-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 04/12/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND We assessed secular trends in the burden of ischaemic heart disease (IHD), stroke, and dementia in the Organization for Economic Co-operation and Development (OECD) countries. METHODS Using the Global Burden of Disease (GBD) Study 2017, we compared sex-specific and age-standardized rates of disability-adjusted life years (DALY); mortality, incidence, and prevalence of IHD and stroke; and dementia per 100,000 people, in the world, OECD countries, and Canada. RESULTS From 1990 to 2017, the crude incidence number of IHD, stroke, and dementia increased 52%, 76%, and 113%, respectively. Likewise, the prevalence of IHD (75%), stroke (95%), and dementia (119%) increased worldwide. In addition during the study period, the crude global number of deaths of IHD increased 52%, stroke by 41%, and dementia by 146% (9, 6, and 3 million deaths in 2017, respectively). Despite an increase in the crude number of these diseases, the global age-standardized incidence rate of IHD, stroke, and dementia decreased by -27%, - 11%, and - 5%, respectively. Moreover, there was a decline in their age-standardized DALY rates (- 1.17%, - 1.32%, and - 0.23% per year, respectively) and death rates (- 1.29%, - 1.46%, and - 0.17% per year, respectively), with sharper downward trends in Canada and OECD countries. Almost all trends flattened during the last decade. CONCLUSIONS From 1990 to 2017, the age-standardized burden of IHD, stroke, and dementia decreased, more prominently in OECD countries than the world. However, their rising crude numbers mainly due to population growth and ageing require urgent identification of reversible risk and protective factors.
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Affiliation(s)
- Negar Morovatdar
- Clinical Research Development Unit, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abolfazl Avan
- Department of Public Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - M Reza Azarpazhooh
- Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, Western University, Siebens-Drake Building, 1400 Western Rd, London, ON, N6G 2V4, Canada. .,Department of Clinical Neurological Sciences, Western University, London, ON, Canada. .,Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.
| | - Mario Di Napoli
- Department of Neurology and Stroke Unit, San Camillo de' Lellis General District Hospital, Rieti, Italy.,Neurological Section, Neuro-epidemiology Unit, SMDN-Centre for Cardiovascular Medicine and Cerebrovascular Disease Prevention, Sulmona, L'Aquila, Italy
| | - Saverio Stranges
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.,Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Moira K Kapral
- Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Arash Akhavan Rezayat
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Aidin Shariatzadeh
- Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, Western University, Siebens-Drake Building, 1400 Western Rd, London, ON, N6G 2V4, Canada
| | - Shahram Abootalebi
- Dr. Everett Chalmers Regional Hospital, Dalhousie University, New Brunswick, Canada
| | - Naghmeh Mokhber
- Department of Psychiatry and Behavioural Neurosciences, Western University, London, Ontario, Canada.,Department of Psychiatry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - J David Spence
- Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, Western University, Siebens-Drake Building, 1400 Western Rd, London, ON, N6G 2V4, Canada.,Department of Clinical Neurological Sciences, Western University, London, ON, Canada.,Division of Clinical Pharmacology, Western University, London, Ontario, Canada
| | - Vladimir Hachinski
- Department of Clinical Neurological Sciences, Western University, London, ON, Canada.,Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
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Rehman S, Phan HT, Reeves MJ, Thrift AG, Cadilhac DA, Sturm J, Breslin M, Callisaya M, Vemmos KN, Parmar PG, Krishnamurthi RV, Barker-Collo S, Feigin VL, Chausson N, Olindo S, Cabral N, Carolei A, Marini C, Sacco S, Correia M, Appelros P, Korv J, Vibo R, Minelli C, Sposato L, Pandian JD, Kaur P, Azarpazhooh MR, Morovatdar N, Gall SL. Abstract P38: Pooled Analysis of Long and Short Term Outcomes After Subarachnoid Hemorrhage - International Stroke Outcomes Study (INSTRUCT). Stroke 2021. [DOI: 10.1161/str.52.suppl_1.p38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Outcomes after subarachnoid hemorrhage (SAH) have been rarely examined in large cohorts.
Methods:
This is an extension of the International Stroke Outcomes Study (INSTRUCT) pooling 13 ‘ideal’ stroke incidence studies (n=657 with SAH from 1993-2017, median age 56 years; 46% men). The primary outcomes were mortality and functional outcome (mRS score 3-5). Harmonized study factors included age, sex, behaviors (current smoking, alcohol intake), comorbidities (history of hypertension, ischemic heart disease, atrial fibrillation), stroke severity (e.g. NIHSS score) and year of stroke. In the pooled dataset, we estimated predictors of mortality using Poisson regression, to estimate incidence rate ratio (IRR) at 1 month (11 studies), 1 year (12 studies) and 5 years (7 studies). Generalized equation estimates in the log-binomial family were used to calculate risk ratios (RRs) for predictors of poor functional outcome at 1 month (5 studies) and 1 year (8 studies).
Results:
Mortality was 33% at 1 month, 43% at 1 year, and 47% at 5 years (Fig 1). Poor functional outcome was 25% at 1 month and 15% at 1 year (Fig 1). In multivariable analysis, age and stroke severity were associated with mortality at all time points, together with current smoking at 1 and 5 years, and history of hypertension at 5 years (Fig 2). Poor functional outcome was predicted by age (RR 1.03; 95% CI 1.01-1.04) at 1 month and by age (RR 1.04; 95% CI 1.00-1.08) and stroke severity (RR 1.94; 95% CI 1.02-2.87) at 1 year.
Conclusion:
Risk factors that predict SAH incidence including hypertension and smoking make outcomes worse. Better management of older patients and those with severe strokes could improve outcomes after SAH.
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Affiliation(s)
- Sabah Rehman
- Menzies Institute for Med Rsch, Univ of Tasmania, Hobart, Australia
| | | | | | | | | | - Jonathan Sturm
- Dept of Neurology, Gosford and Wyong Hosps, Gosford, Australia
| | | | - Michele Callisaya
- Menzies Institute for Med Rsch, UNIVERSITY OF TASMANIA, Hobart, Australia
| | | | | | | | | | | | - Nicolas Chausson
- Stroke Unit, Cntr Hospier Suc Francilien, Corbeil-Essonnes, France
| | | | | | | | | | | | | | - Peter Appelros
- Dept of Neurology, Faculty of Medicine and Health, Orebro Univ, Orebro, Sweden
| | - Janika Korv
- Dept of Neurology and Neurosurgery, Institute of Clinical Medicine, Univ of Tartu, Tartu, Estonia
| | | | | | | | | | | | - M. Reza Azarpazhooh
- Dept of Clinical Neurological Sciences, Univ of Western Ontario, London, Canada
| | - Negar Morovatdar
- Clinical Rsch Development Unit, Faculty of Medicine, Mashhad Univ of Medicine Sciences, Mashhad, Iran, Islamic Republic of
| | - Seana L Gall
- Menzies Institute for Med Rsch, UNIVERSITY OF TASMANIA, Hobart, Australia
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Milani S, Shahroudi A, Morovatdar N, Zirak N, Jafari Farkhod M. Perioperative Changes in Platelet Counts During Adult Liver Transplantation. EXP CLIN TRANSPLANT 2021; 19:137-141. [PMID: 33605209 DOI: 10.6002/ect.2020.0195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Thrombocytopenia is a common problem among liver transplant recipients. However, various patterns of change in platelet counts during adult liver transplant have been reported in the literature. This study aimed to evaluate alterations in platelet count according to the surgical phase (preanhepatic, anhepatic, after reperfusion) and during the early postoperative period of liver transplant. MATERIALS AND METHODS Perioperative data from 100 patients undergoing deceased donor liver transplant were reviewed, including platelet count-related data. Platelet counts were measured at predefined time points throughout the procedure: immediately before induction of anesthesia, at the early neo-hepatic stage (10 min after graft reperfusion), immediately after admission to the intensive care unit posttransplant, and 6 hours posttransplant. Platelet counts were then measured daily during stay in the intensive care unit. RESULTS Mean baseline platelet count before transplant and anesthesia was 97.92 × 109/L. A peak platelet count was seen in the early neo-hepatic stage. Platelet counts then decreased sharply in the first 6 hours after transplant. A slight decrease in platelet counts continued until the third day after the surgery; finally, on day 6 posttransplant, platelet counts increased significantly. CONCLUSIONS Our study showed a significant sudden increase in platelet counts during the early neo-hepatic phase in many liver transplant recipients. Therefore, our results suggest that it is reasonable to avoid platelet transfusion for most liver transplant recipients during transplant surgery.
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Affiliation(s)
- Soheila Milani
- From the 1Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Bahari A, Esmaeilzadeh A, Soltani M, Morovatdar N, Babaei N, Ganji A. How Good Is Trans Abdominal Ultrasound for Evaluating NAFLD in the General Population? A Cross-Sectional Study. ACTA 2021. [DOI: 10.18502/acta.v58i11.5142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Nonalcoholic fatty liver disease (NAFLD) is one of the most common cause of liver test abnormality and chronic liver disease in the world and can increase liver related mortality. Association of NAFLD with metabolic syndrome increase mortality due to cardiovascular disease too. NAFLD is categorized histologically into the nonalcoholic fatty liver (NAFL) and nonalcoholic steatohepatitis (NASH). Liver biopsy has been known as gold standard of evaluating NAFLD, but this procedure is invasive. It is time to replace available and easier way to diagnose, and predict the prognosis for better management of NAFLD. This study was comparing the result of transabdominal ultrasonography with Fibroscan as a new and accurate method for evaluating severity of fatty liver disease. This was a cross-sectional study that was conducted using 101 patients with NAFLD. All patients who had TUS by one experienced radiologist and fibro scan at the same time were included. Visual liver echogenicity was basis of grading in TUS. Fibro scans results are based on controlled attenuation parameters (CAP) which is not operator dependent. Other information, such as age, waist, and BMI, were also gathered. TUS has a low value for the diagnosis of liver fibrosis in NAFLD patients and predicting prognosis. TUS has a good correlation with fibroscan in grade 0 and 1of fatty liver, but in grade 2 and 3 of fatty liver, we can not rely on TUS for accurate grading.
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Shirzad F, Morovatdar N, Rezaee R, Tsarouhas K, Abdollahi Moghadam A. Cinnamon effects on blood pressure and metabolic profile: A double-blind, randomized, placebo-controlled trial in patients with stage 1 hypertension. Avicenna J Phytomed 2021; 11:91-100. [PMID: 33628723 PMCID: PMC7885002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 04/25/2020] [Accepted: 04/26/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Cinnamon effect on blood pressure remains controversial. The present pilot study assessed cinnamon effect on blood pressure, and metabolic profile of stage 1 hypertension patients (S1HTN). MATERIALS AND METHODS This double-blind placebo-controlled randomized trial was conducted between June and October 2019, in Mashhad, Iran. Study inclusion criteria comprised S1HTN diagnosis, based on 24-hour ambulatory blood pressure monitoring (ABPM). Subjects were randomly assigned to two groups: cinnamon group (capsule, 1500 mg/day, 90 days) and placebo group. On days 0 and 90, ABPM derived systolic and diastolic blood pressure (SBP and DBP, respectively), blood lipid profile, and fasting blood sugar (FBS) were recorded. RESULTS The two groups did not differ significantly regarding vascular risk factors, educational status, lipid profile and blood pressure at baseline, except for lower HDL-c in cinnamon group (p=0.03). On day 90, there was no significant difference between two study groups for lipid profile and blood pressure. A statistically significant decrease in mean 24-hr SBP and mean day SBP was observed in the cinnamon group, while mean night SBP and mean night DBP were decreased significantly in the placebo group after 90 days. A statistically significant decrease in mean change of day value of SBP was found in the cinnamon group, compared to the placebo. On day 90, FBS remained practically unchanged but a significant increase in HDL-c (5.8 unit; p=0.01) and a significant decrease in LDL-c levels (17.7 unit; p=0.009) were observed in the cinnamon group compared to placebo group. CONCLUSION Cinnamon caused a statistically significant decrease in mean ambulatory SBP but in a clinically moderate way, and lipid profile was significantly improved. Therefore, cinnamon might be considered a complementary treatment in subjects with S1HTN.
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Affiliation(s)
- Fatemeh Shirzad
- Department of Cardiology, Emam Reza Educational Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Equal first author
| | - Negar Morovatdar
- Clinical Research Development Unit, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Equal first author
| | - Ramin Rezaee
- Clinical Research Development Unit, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Neurogenic Inflammation Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Konstantinos Tsarouhas
- Department of Cardiology, University Hospital of Larissa, Larissa, Greece
- Center for Adolescent Medicine and UNESCO Chair on Adolescent Health Care, First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece
| | - Alireza Abdollahi Moghadam
- Department of Cardiology, Emam Reza Educational Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Morovatdar N, Poorzand H, Bondarsahebi Y, Hozhabrossadati SA, Montazeri S, Sahebkar A. Water pipe tobacco smoking and risk of Coronary Artery Disease: A systematic review and meta-analyses. Curr Mol Pharmacol 2020; 14:986-992. [PMID: 33357208 DOI: 10.2174/1874467213666201223121322] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 08/19/2019] [Accepted: 07/20/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Water pipe smoking has become a vitally important public health issue in the world with untruthful assumed less harmful effect. OBJECTIVE The aim of this study was to systematically review the association of water pipe tobacco smoking and risk of coronary artery disease (CAD). METHODS Up to September 25, 2018, we electronically searched the PubMed, Embase, and ISI Web of Science with no time restriction. We included observational studies and excluded conference abstracts, editorials, case-reports, case series, and reviews. With fixed model effect, we conducted Meta-analysis to evaluate the association between Water pipe smoking and coronary artery disease. Heterogeneity among studies was assessed by I2 square test. Publication bias was assessed by Egger test. P<0.05 set as significant level. RESULTS Among 248 paper records identified through database search, 52 full texts were eligible for full text assessment whereas 49 papers were excluded. Additionally, three studies were eligible for meta-analysis, which involved 58,960 adults with 1334 in the water pipe smoker group. Risk of CAD was increased in water pipe smokers compared to individuals who had never smoked water pipe but the result did not reach statistical significance (OR=1.18, 95% CI: 0.98- 1.38, p=0.06). We found that heavy water pipe smoking (40 to 50 sessions of water-pipe smoking/year) was associated with CAD compared to lower smokers defined as less than 40 to 50 water pipe/year (OR=2.001, 95% CI: 1.13-2.87). CONCLUSIONS Heavy Water pipe smoking was associated to coronary artery disease on a clinical level. It seems very crucial to increase public awareness on adverse effects of water pipe smoking and its cessation in clinical setting.
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Affiliation(s)
- Negar Morovatdar
- Clinical Research Development Unit, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hoorak Poorzand
- Atherosclerosis Prevention Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad. Iran
| | - Yones Bondarsahebi
- Students research committee, Faculty of medicine, Mashhad University of medical sciences, Mashhad. Iran
| | | | - Sanaollah Montazeri
- Students research committee, Faculty of medicine, Mashhad University of medical sciences, Mashhad. Iran
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad. Iran
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Vafadar Moradi E, Teimouri A, Rezaee R, Morovatdar N, Foroughian M, Layegh P, Rezvani Kakhki B, Ahmadi Koupaei SR, Ghorani V. Increased age, neutrophil-to-lymphocyte ratio (NLR) and white blood cells count are associated with higher COVID-19 mortality. Am J Emerg Med 2020; 40:11-14. [PMID: 33333477 PMCID: PMC7717776 DOI: 10.1016/j.ajem.2020.12.003] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 11/30/2020] [Accepted: 12/01/2020] [Indexed: 02/08/2023] Open
Abstract
Objective Coronavirus disease 19 (COVID-19) caused by the highly pathogenic SARS-CoV-2, was first reported from Wuhan, China, in December 2019. The present study assessed possible associations between one-month mortality and demographic data, SpO2, underlying diseases and laboratory findings, in COVID-19 patients. Also, since recent studies on COVID-19, have focused on Neutrophil-to-lymphocyte ratio (NLR) as an independent risk factor of the in-hospital death and a significant prognostic biomarker of outcomes in critically ill patients, in this study, we assessed predictive potential of this factor in terms of one-month mortality. Methods Patients admitted to Imam Reza hospital, affiliated to Mashhad University of Medical Sciences, Mashhad, Iran, from March to June 2020, with positive RT-PCR results for SARS-CoV-2, were included in this study. Kaplan-Meier survival analysis and Cox proportional hazard model were used to respectively estimate one-month mortality since admission and determine factors associated with one-month mortality. Results In this retrospective cohort study, 219 patients were included (137 men and 82 women (mean age 58.2 ± 16 and 57 ± 17.3 years old, respectively)). Hypertension, ischemic heart disease and diabetes were respectively the most common comorbidities. Among these patients, 63 patients were admitted to the ICU and 31 deaths occurred during one-month follow-up. With respect to mean peripheral capillary oxygen saturation (SpO2), 142 patients had SpO2 ≤ 90%. Based on our analysis, older age and increased Neutrophil-to-lymphocyte ratio (NLR), and White blood cells (WBC) count were associated with increased risk of one-month mortality. Patients with SpO2 ≤ 90% had a 3.8-fold increase in risk of one-month death compared to those with SpO2 > 90%, although the difference did not reach a significant level. Conclusion Multivariate analysis introduced age, WBC count, and NLR as predictors of one-month mortality in COVID-19 patients.
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Affiliation(s)
- Elnaz Vafadar Moradi
- Emergency Department, Faculty of Medicine, Mashhad University of Medical Science, Mashhad, Iran.
| | - Ali Teimouri
- Student research Committee, Faculty of Medicine, Mashhad University of Medical Science, Mashhad, Iran
| | - Ramin Rezaee
- Clinical Research Unit, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; Neurogenic Inflammation Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Negar Morovatdar
- Clinical Research Unit, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahdi Foroughian
- Emergency Department, Faculty of Medicine, Mashhad University of Medical Science, Mashhad, Iran
| | - Parvaneh Layegh
- Radiology department, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Behrang Rezvani Kakhki
- Emergency Department, Faculty of Medicine, Mashhad University of Medical Science, Mashhad, Iran
| | | | - Vahideh Ghorani
- Clinical Research Unit, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Morovatdar N, Di Napoli M, Stranges S, Thrift AG, Kapral M, Behrouz R, Farzadfard MT, Andalibi MSS, Oskooie RR, Sawant A, Mokhber N, Azarpazhooh MR. Regular physical activity postpones age of occurrence of first-ever stroke and improves long-term outcomes. Neurol Sci 2020; 42:3203-3210. [PMID: 33241533 DOI: 10.1007/s10072-020-04903-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 11/11/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Few data are available on the associations between the level of pre-stroke physical activity and long-term outcomes in patients with stroke. This study is designed to assess the associations between pre-stroke physical activity and age of first-ever stroke occurrence and long-term outcomes. METHODS Six hundred twenty-four cases with first-ever stroke were recruited from the Mashhad Stroke Incidence Study a prospective population-based cohort in Iran. Data on Physical Activity Level (PAL) were collected retrospectively and were available in 395 cases. According to the PAL values, subjects were classified as inactive (PAL < 1.70) and active (PAL ≥ 1.70). Age at onset of stroke was compared between active and inactive groups. Using logistic model, we assessed association between pre-stroke physical activity and long-term (5-year) mortality, recurrence, disability, and functional dependency rates. We used multiple imputation to analyze missing data. RESULTS Inactive patients (PAL < 1.70) were more than 6 years younger at their age of first-ever-stroke occurrence (60.7 ± 15.5) than active patients (67.0 ± 13.2; p < 0.001). Patients with PAL< 1.7 also had a greater risk of mortality at 1 year [adjusted odds ratio (aOR) = 2.31; 95%CI: 1.14-4.67, p = 0.02] and 5 years after stroke (aOR = 1.81; 95%CI: 1.05-3.14, p = 0.03) than patients who were more physically active. Recurrence rate, disability, and functional dependency were not statistically different between two groups. Missing data analysis also showed a higher odds of death at one and 5 years for inactive patients. CONCLUSIONS In our cohort, we observed a younger age of stroke and a higher odds of 1- and 5-year mortality among those with less physical activity. This is an important health promotion strategy to encourage people to remain physically active.
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Affiliation(s)
- Negar Morovatdar
- Clinical Research Development Unit, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mario Di Napoli
- Department of Neurology and Stroke Unit, San Camillo de' Lellis General Hospital, Rieti, Italy.,Neurological Section, Neuro-epidemiology Unit, SMDN-Centre for Cardiovascular Medicine and Cerebrovascular Disease Prevention, Sulmona, L'Aquila, Italy
| | - Saverio Stranges
- Department of Epidemiology & Biostatistics, Western University, London, Canada.,Department of Family Medicine, Western University, London, Canada.,Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Amanda G Thrift
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Moira Kapral
- Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Reza Behrouz
- Department of Neurology, Lozano-Long School of Medicine, University of Texas Health, San Antonio, TX, USA
| | | | | | - Reza Rahimzadeh Oskooie
- Student Research Committee, Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Anuradha Sawant
- Department of Clinical Neurological Science, University Hospital, Western University, London, Canada
| | - Naghmeh Mokhber
- Department of Psychiatry, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Psychiatry & Behavioral Neurosciences, Western University, London, Canada
| | - M Reza Azarpazhooh
- Department of Epidemiology & Biostatistics, Western University, London, Canada. .,Department of Neurology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. .,Department of Clinical Neurological Science, University Hospital, Western University, London, Canada.
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Shahlaee S, Alimi H, Poorzand H, Morovatdar N, Vakilian F, Shahlaee S. <p>Relationship Between Isovolumic Acceleration (IVA) and TEI Index with Pro-BNP in Heart Failure</p>. RRCC 2020. [DOI: 10.2147/rrcc.s253688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Azarpazhooh MR, Amiri A, Morovatdar N, Steinwender S, Rezaei Ardani A, Yassi N, Biller J, Stranges S, Tokazebani Belasi M, Neya SK, Khorram B, Sheikh Andalibi MS, Arsang-Jang S, Mokhber N, Di Napoli M. Correlations between COVID-19 and burden of dementia: An ecological study and review of literature. J Neurol Sci 2020; 416:117013. [PMID: 32659508 PMCID: PMC7334961 DOI: 10.1016/j.jns.2020.117013] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 07/01/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Current evidence on the association between COVID-19 and dementia is sparse. This study aims to investigate the associations between COVID-19 caseload and the burden of dementia. METHODS We gathered data regarding burden of dementia (disability-adjusted life years [DALYs] per 100,000), life expectancy, and healthy life expectancy (HALE) from the Global Burden of Disease (GBD) 2017 study. We obtained COVID-19 data from Our World in Data database. We analyzed the association of COVID-19 cases and deaths with the burden of dementia using Spearman's rank correlation coefficient. RESULTS Globally, we found significant positive (p < .001) correlations between life expectancy (r = 0.60), HALE (r = 0.58), and dementia DALYs (r = 0.46) with COVID-19 caseloads. Likewise, we found similar correlations between life expectancy (r = 0.60), HALE (r = 0.58) and dementia DALYs (r = 0.54) with COVID-19 mortality. CONCLUSION Health policymakers should clarify a targeted model of disease surveillance in order to reduce the dual burden of dementia and COVID-19.
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Affiliation(s)
- M Reza Azarpazhooh
- Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, Western University, London, Ontario, Canada; Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada; Department of Neurology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Amin Amiri
- Department of Neurology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Negar Morovatdar
- Clinical Research Development Unit, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sandy Steinwender
- Health Information Science, PhD (candidate) Western University, London, Ontario, Canada.
| | - Amir Rezaei Ardani
- Psychiatry and Behavioural Sciences Research Centre, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Nawaf Yassi
- Departments of Medicine and Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia.
| | - Jose Biller
- Department of Neurology, Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA.
| | - Saverio Stranges
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada; Department of Family Medicine Schulich School of Medicine, Dentistry Western University, London, ON, Canada; Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg.
| | - Masoud Tokazebani Belasi
- Research Centre for Prevention of cardiovascular disease, Institute of Endocrinology & Metabolism, Iran University of Medical Sciences, Tehran, Iran.
| | - Sepideh Kazemi Neya
- Research Centre for Prevention of cardiovascular disease, Institute of Endocrinology & Metabolism, Iran University of Medical Sciences, Tehran, Iran.
| | - Bita Khorram
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
| | - Mohammad Sobhan Sheikh Andalibi
- International UNESCO Center for Health-Related Basic Sciences and Human Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Shahram Arsang-Jang
- Department of Biostatistics and Epidemiology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Naghmeh Mokhber
- Department of Psychiatry, St Joseph's Health Care London, Western University, Canada.
| | - Mario Di Napoli
- Department of Neurology and Stroke Unit, San Camillo de' Lellis General District Hospital, Rieti, Italy; Neurological Section, Neuro-epidemiology Unit, SMDN-Centre for Cardiovascular Medicine and Cerebrovascular Disease Prevention, Sulmona, L'Aquila, Italy.
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Azarpazhooh MR, Morovatdar N, Avan A, Phan TG, Divani AA, Yassi N, Stranges S, Silver B, Biller J, Tokazebani Belasi M, Kazemi Neya S, Khorram B, Frydman A, Nilanont Y, Onorati E, Di Napoli M. COVID-19 Pandemic and Burden of Non-Communicable Diseases: An Ecological Study on Data of 185 Countries. J Stroke Cerebrovasc Dis 2020; 29:105089. [PMID: 32807484 PMCID: PMC7315949 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105089] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/11/2020] [Accepted: 06/16/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The interaction between coronavirus disease 2019 (COVID-19) and non-communicable diseases may increase the global burden of disease. We assessed the association of COVID-19 with ageing and non-communicable diseases. METHODS We extracted data regarding non-communicable disease, particularly cardiovascular disease, deaths, disability-adjusted life years (DALYs), and healthy life expectancy (HALE) from the Global Burden of Disease Study (GBD) 2017. We obtained data of confirmed COVID-19 cases, deaths, and tests from the Our World in Data database as of May 28, 2020. Potential confounders of pandemic outcomes analyzed include institutional lockdown delay, hemispheric geographical location, and number of tourists. We compared all countries according to GBD classification and World Bank income level. We assessed the correlation between independent variables associated with COVID-19 caseload and mortality using Spearman's rank correlation and adjusted mixed model analysis. FINDINGS High-income had the highest, and the Southeast Asia, East Asia, and Oceania region had the least cases per million population (3050.60 vs. 63.86). Sub-saharan region has reported the lowest number of COVID-19 mortality (1.9). Median delay to lockdown initiation varied from one day following the first case in Latin America and Caribbean region, to 34 days in Southeast Asia, East Asia, and Oceania. Globally, non-communicable disease DALYs were correlated with COVID-19 cases (r = 0.32, p<0.001) and deaths (r = 0.37, p<0.001). HALE correlated with COVID-19 cases (r = 0.63, p<0.001) and deaths (r = 0.61, p<0.001). HALE was independently associated with COVID-19 case rate and the number of tourists was associated with COVID-19 mortality in the adjusted model. INTERPRETATION Preventive measures against COVID-19 should protect the public from the dual burden of communicable and non-communicable diseases, particularly in the elderly. In addition to active COVID-19 surveillance, policymakers should utilize this evidence as a guide for prevention and coordination of health services. This model is timely, as many countries have begun to reduce social isolation.
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Affiliation(s)
- M Reza Azarpazhooh
- Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, Western University, London, Ontario, Canada; Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Negar Morovatdar
- Clinical Research Development Unit, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abolfazl Avan
- Department of Public Health, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Thanh G Phan
- Department of Neurology Monash Health, Clinical Trials, Imaging and Informatics division of Stroke and Ageing Research Group, Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Afshin A Divani
- Department of Neurology, School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Nawaf Yassi
- Departments of Medicine and Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
| | - Saverio Stranges
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Department of Family Medicine, Schulich School of Medicine and Dentistry Western University, London, ON, Canada; Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Brian Silver
- Department of Neurology, University of Massachusetts Medical School, Worcester, MA, USA
| | - José Biller
- Department of Neurology, Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
| | - Masoud Tokazebani Belasi
- Research centre for Prevention of cardiovascular disease, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | - Sepideh Kazemi Neya
- Research centre for Prevention of cardiovascular disease, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | - Bita Khorram
- Dalla Lana School of Public Health, University of Toronto; Toronto, ON, Canada
| | - Asher Frydman
- Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, Western University, London, Ontario, Canada
| | - Yongchai Nilanont
- Siriraj Stroke Center, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Elisa Onorati
- Department of Neurology and Stroke Unit, San Camillo de' Lellis General District Hospital, Rieti, Italy
| | - Mario Di Napoli
- Department of Neurology and Stroke Unit, San Camillo de' Lellis General District Hospital, Rieti, Italy; Neurological Section, Neuro-epidemiology Unit, SMDN-Centre for Cardiovascular Medicine and Cerebrovascular Disease Prevention, Sulmona, L'Aquila, Italy.
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Memarzadeh Z, Layegh P, Maleki M, Sazgarnia A, Morovatdar N, Shiva F, Ferezeghi MR. Efficacy of blue light vs. fluocinolone 0.025% ointment in treatment of localized plaque psoriasis. Photodermatol Photoimmunol Photomed 2020; 37:78-81. [PMID: 32681545 DOI: 10.1111/phpp.12594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 05/09/2020] [Accepted: 07/05/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Zeinab Memarzadeh
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Pouran Layegh
- Cutaneous Leishmaniasis Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Masoud Maleki
- Cutaneous Leishmaniasis Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ameneh Sazgarnia
- Medical Physics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Negar Morovatdar
- Clinical Research Unit, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farshid Shiva
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
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Tafazzoli Z, Nahidi Y, Mashayekhi Goyonlo V, Morovatdar N, Layegh P. Evaluating the efficacy and safety of vascular IPL for treatment of acute cutaneous leishmaniasis: a randomized controlled trial. Lasers Med Sci 2020; 36:631-640. [PMID: 32681219 DOI: 10.1007/s10103-020-03102-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 07/13/2020] [Indexed: 11/28/2022]
Abstract
Treatment of cutaneous leishmaniasis (CL) continues to be a health concern, and alternative therapies with fewer side effects are substantially needed. This study aimed to determine the efficacy of intense pulsed light (IPL) with wavelength spectrum affecting vascular lesions on acute cutaneous leishmaniasis. In this randomized clinical trial study, 30 patients with acute CL were enrolled. Baseline clinical and demographic data were recorded in the checklist after obtaining written informed consent. Patients were randomly allocated to receive either IPL fortnightly (intervention group) or intralesional meglumine antimoniate (MA) weekly (control group) over 10 weeks. Patients were assessed every 2 weeks to determine the size of induration and improvement rate of lesions. Follow-up visits were arranged at 3rd and 6th months. Overall, 15 patients (21 lesions) in the intervention group and 15 patients (22 lesions) in the control group were studied. The size of lesions in the control group was significantly higher at the baseline (P = 0.014) and the second week (P = 0.034), and significantly lower in the eighth week (P = 0.009), compared with the intervention group. The size of lesions in the control group changed during the study (P < 0.001), whereas changes were not significant in the intervention group. The trend of changes in size of lesions was faster in the control group (P < 0.001). More patients in the control group had higher improvement rate at the sixth (P = 0.005) and tenth (P < 0.001) weeks. At the end of study, the cure rate was 35% (7 out of 20 lesions) in intervention group and 81.8% (18 out of 22 lesions) in the control group. Complete response happened earlier in the control group (P < 0.001). None of the lesions that were cured before the tenth week relapsed after 6 months. The frequency of blistering was significantly higher in intervention group (P = 0.001). Our results indicated that IPL with wavelength spectrum affecting vascular lesions was inferior to intralesional MA in treatment of CL. However, it can be considered as a second-line option, especially in patients with limitations for use of MA. Trial registry: https://www.irct.ir/trial/34246 IRCT20140414017271N5.
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Affiliation(s)
- Zahra Tafazzoli
- Cutaneous Leishmaniasis Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Yalda Nahidi
- Cutaneous Leishmaniasis Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Negar Morovatdar
- Clinical Research Development Unit, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Pouran Layegh
- Cutaneous Leishmaniasis Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
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Taghizadeh M, Foroughian M, Vakili H, Habibzadeh SR, Boostani R, Morovatdar N, Bolvardi E. A study of the factors associated with non-traumatic intracerebral hemorrhage (ICH) in patients with chronic systemic hypertension. J Emerg Pract Trauma 2020. [DOI: 10.34172/jept.2020.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objective: Intracerebral hemorrhage (ICH) following systemic and chronic hypertension is one of the main causes of acute stroke leading to disability and death. Identifying the risk factors in ICH patients can be effective in reducing bleeding and the rates of mortality and disability in these patients. This study was carried out to investigate the factors associated with ICH. Methods: A total of 134 patients with chronic systemic hypertension who had ICH were enrolled in this study. The amount of ICH was measured through computed tomography (CT scan). The subjects were divided into two groups of high (>30 mL) and low (<30 mL) ICH volume, and the related risk factors in the two groups were studied and compared using SPSS software version 21. Results: The mean age of the subjects was 66.04 years, and 71 (52.99%) individuals were females. The mean volume of ICH was 24.47 mL, with 29.10% of the subjects (39 patients) having >30 mL and 70.90% (95 patients) having <30 mL of ICH. The results of studying ICHrelated factors in the multiple logistic regression showed that ischemic heart disease (IHD) (odds ratio [OR] = 2.243, P value <0.05) and cardiovascular disease (OR = 3.294, P value <0.05) were the co-existing diseases that increased the odds of developing ICH. Conclusion: The results of this study showed that less than 30% of the subjects had high volumes of bleeding, and the co-existence of IHD was considered as a strong independent risk factor affecting the volume of ICH associated with worse prognosis.
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Affiliation(s)
- Mozhgan Taghizadeh
- Department of Emergency Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahdi Foroughian
- Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical sciences, Mashhad, Iran
| | - Hamidreza Vakili
- Neuroscience Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Seyed Reza Habibzadeh
- Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical sciences, Mashhad, Iran
| | - Reza Boostani
- Department of Neurology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Negar Morovatdar
- Clinical Research Unit, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ehsan Bolvardi
- Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical sciences, Mashhad, Iran
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Abootalebi S, Aertker BM, Andalibi MS, Asdaghi N, Aykac O, Azarpazhooh MR, Bahit MC, Barlinn K, Basri H, Shahripour RB, Bersano A, Biller J, Borhani-Haghighi A, Brown RD, Campbell BC, Cruz-Flores S, De Silva DA, Di Napoli M, Divani AA, Edgell RC, Fifi JT, Ghoreishi A, Hirano T, Hong KS, Hsu CY, Huang JF, Inoue M, Jagolino AL, Kapral M, Kee HF, Keser Z, Khatri R, Koga M, Krupinski J, Liebeskind DS, Liu L, Ma H, Maud A, McCullough LD, Meyer DM, Mifsud V, Morovatdar N, Nilanont Y, Oxley TJ, Özdemir AÖ, Pandian J, Pantoni L, Papamitsakis NIH, Parry-Jones A, Phan T, Rodriguez G, Romano JG, Sabaa-Ayoun Z, Saber H, Sasannezhad P, Saver JL, Scharf E, Shuaib A, Silver B, Singhal S, Smith CJ, Stranges S, Sylaja PN, Torbey M, Toyoda K, Tsivgoulis G, Wasay M, Yassi N, Yoshimoto T, Zamani B, Zand R. Call to Action: SARS-CoV-2 and CerebrovAscular DisordErs (CASCADE). J Stroke Cerebrovasc Dis 2020; 29:104938. [PMID: 32807412 PMCID: PMC7205703 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104938] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/01/2020] [Accepted: 05/02/2020] [Indexed: 12/31/2022] Open
Abstract
Background and purpose The novel severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2), now named coronavirus disease 2019 (COVID-19), may change the risk of stroke through an enhanced systemic inflammatory response, hypercoagulable state, and endothelial damage in the cerebrovascular system. Moreover, due to the current pandemic, some countries have prioritized health resources towards COVID-19 management, making it more challenging to appropriately care for other potentially disabling and fatal diseases such as stroke. The aim of this study is to identify and describe changes in stroke epidemiological trends before, during, and after the COVID-19 pandemic. Methods This is an international, multicenter, hospital-based study on stroke incidence and outcomes during the COVID-19 pandemic. We will describe patterns in stroke management, stroke hospitalization rate, and stroke severity, subtype (ischemic/hemorrhagic), and outcomes (including in-hospital mortality) in 2020 during COVID-19 pandemic, comparing them with the corresponding data from 2018 and 2019, and subsequently 2021. We will also use an interrupted time series (ITS) analysis to assess the change in stroke hospitalization rates before, during, and after COVID-19, in each participating center. Conclusion The proposed study will potentially enable us to better understand the changes in stroke care protocols, differential hospitalization rate, and severity of stroke, as it pertains to the COVID-19 pandemic. Ultimately, this will help guide clinical-based policies surrounding COVID-19 and other similar global pandemics to ensure that management of cerebrovascular comorbidity is appropriately prioritized during the global crisis. It will also guide public health guidelines for at-risk populations to reduce risks of complications from such comorbidities.
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Affiliation(s)
- Shahram Abootalebi
- Dr. Everett Chalmers Regional Hospital, Dalhousie University, New Brunswick, Canada.
| | - Benjamin M Aertker
- Department of Neurology, UTHealth McGovern Medical School, The University of Texas at Houston, Houston, Texas, USA.
| | - Mohammad Sobhan Andalibi
- International UNESCO Center for Health-Related Basic Sciences and Human Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Negar Asdaghi
- Department of Neurology, University of Miami, Miami, Florida, USA.
| | - Ozlem Aykac
- Department of Neurology and Neurocritical Care, Eskisehir Osmangazi University, Eskişehir, Turkey
| | - M Reza Azarpazhooh
- Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, Western University, London, Ontario, Canada; Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Department of Neurology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - M Cecilia Bahit
- Chief of Cardiology, INECO Neurociencias, Rosario, Argentina
| | - Kristian Barlinn
- Department of Neurology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany.
| | - Hamidon Basri
- Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia.
| | | | - Anna Bersano
- Fondazione Istituto Neurologico 'Carlo Besta', Milan, Italy.
| | - Jose Biller
- Department of Neurology, Loyola University Health System, Stritch School of Medicine, Chicago, USA.
| | | | - Robert D Brown
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.
| | - Bruce Cv Campbell
- Department of Medicine and Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia.
| | | | | | - Mario Di Napoli
- Department of Neurology and Stroke Unit, San Camillo de' Lellis General District Hospital, Rieti, Italy; Neurological Section, Neuro-epidemiology Unit, SMDN-Centre for Cardiovascular Medicine and Cerebrovascular Disease Prevention, Sulmona, L'Aquila, Italy.
| | - Afshin A Divani
- Department of Neurology, School of Medicine, University of New Mexico, Albuquerque, New Mexico, USA
| | - Randall C Edgell
- Department of Neurology, Souers Stroke Institute, Saint Louis University, USA
| | - Johanna T Fifi
- Departments of Neurology and Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, USA.
| | - Abdoreza Ghoreishi
- Department of Neurology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Teruyuki Hirano
- Department of Stroke and Cerebrovascular Medicine, Kyorin University, Japan.
| | - Keun-Sik Hong
- Department of Neurology, Inje University, Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Chung Y Hsu
- Graduate Institute of Clinical Medical Science, China Medical University, Taipei, Taichung.
| | | | - Manabu Inoue
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
| | - Amanda L Jagolino
- Department of Neurology, UTHealth McGovern Medical School, The University of Texas at Houston, Houston, Texas, USA.
| | - Moira Kapral
- Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; Institute for Clinical Evaluative Sciences, Toronto, Canada.
| | - Hoo Fan Kee
- Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Zafer Keser
- Department of Neurology, UTHealth McGovern Medical School, The University of Texas at Houston, Houston, Texas, USA.
| | - Rakesh Khatri
- Neurology Department, Texas Tech Health University, El Paso, Texas, USA.
| | - Masatoshi Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
| | - Jerzy Krupinski
- Department of Neurology, Hospital Universitari MutuaTerrassa, Terrassa (Barcelona), Spain; Department of Life Sciences, CBS, Manchester Metropolitan University, Manchester, UK.
| | | | - Liping Liu
- Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Henry Ma
- Department of Neurology, Monash Health and Department of Medicine, School of Clinical Sciences Monash University, Australia
| | - Alberto Maud
- Neurology Department, Texas Tech Health University, El Paso, Texas, USA
| | - Louise D McCullough
- Department of Neurology, UTHealth McGovern Medical School, The University of Texas at Houston, Houston, Texas, USA.
| | | | | | - Negar Morovatdar
- Clinical Research Development Unit, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Yongchai Nilanont
- Siriraj Stroke Center, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Thomas J Oxley
- Department of Neurosurgery, Mount Sinai Hospital, New York, USA.
| | - Atilla Özcan Özdemir
- Department of Neurology and Neurocritical Care, Eskisehir Osmangazi University, Eskişehir, Turkey
| | - Jeyaraj Pandian
- Department of Neurology, Christian Medical College, Ludhiana, India
| | - Leonardo Pantoni
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Milan, Italy.
| | | | - Adrian Parry-Jones
- Manchester Centre for Clinical Neurosciences, Salford Royal National Health Service Foundation Trust, Manchester Academic Health Science Centre, Salford, UK.
| | - Thanh Phan
- Department of Neurology, Monash Health and Department of Medicine, School of Clinical Sciences Monash University, Australia.
| | - Gustavo Rodriguez
- Neurology Department, Texas Tech Health University, El Paso, Texas, USA
| | - Jose G Romano
- Department of Neurology, University of Miami, Miami, Florida, USA.
| | - Ziad Sabaa-Ayoun
- Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, Western University, London, Ontario, Canada; Schulich School of Medicine and Dentistry, Western University, London, Ontario Canada.
| | - Hamidreza Saber
- David Geffen School of Medicine, Comprehensive Stroke Center, Department of Neurology, University of California, Los Angeles, USA.
| | - Payam Sasannezhad
- Department of Neurology, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Jeffrey L Saver
- Department of Neurology, Geffen School of Medicine, UCLA, USA.
| | - Eugene Scharf
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.
| | - Ashfaq Shuaib
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
| | - Brian Silver
- Department of Neurology, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
| | - Shaloo Singhal
- Department of Neurology, Monash Health and Department of Medicine, School of Clinical Sciences Monash University, Australia
| | - Craig J Smith
- Division of Cardiovascular Sciences, Lydia Becker Institute of Immunology and Inflammation, University of Manchester, UK; Manchester Centre for Clinical Neurosciences, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Salford, UK.
| | - Saverio Stranges
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg.
| | - P N Sylaja
- Comprehensive Stroke Care Program, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum 695 011, Kerala, India
| | - Michel Torbey
- Department of Neurology, School of Medicine, University of New Mexico, Albuquerque, New Mexico, USA.
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
| | - Georgios Tsivgoulis
- Second Department of Neurology, Attikon University Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | | | - Nawaf Yassi
- Department of Medicine and Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, University of Melbourne; Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia.
| | - Takeshi Yoshimoto
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
| | - Babak Zamani
- Neurology department of Iran University of Medical Sciences, Tehran, Iran
| | - Ramin Zand
- Neurology Department, Neuroscience Institute, Geisinger Health System, Danville, Pennsylvania, USA
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Yousefian A, Shokoohi-Rad S, Abbaszadegan MR, Rad DM, Zargari S, Milanizadeh S, Morovatdar N, Daneshvar R. Primary Angle Closure Glaucoma-associated Genetic Polymorphisms in Northeast Iran. J Ophthalmic Vis Res 2020; 15:45-52. [PMID: 32095208 PMCID: PMC7001019 DOI: 10.18502/jovr.v15i1.5942] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 08/11/2019] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate the association of five different polymorphisms from a genome-wide-associated study with susceptibility to glaucoma in the northeast Iranian population. Methods Hundred and thirty patients with primary angle closure glaucoma (PACG) and 130 healthy controls were genotyped for the polymorphic regions with the aid of tetra-amplification refractory mutation system-polymerase chain reaction. The association of these variants with the disease susceptibility was measured statistically with the logistic regression method. Results Hundred and thirty patients with PACG (53 males, 77 females) with a mean age of 64.5 ± 6.2 years and 130 healthy control subjects (51 males, 79 females) with a mean age of 64.0 ± 5.7 years were selected for evaluation. There was a significant association between rs3816415 (P = 0.005), rs736893 (P< 0.001), rs7494379 (P< 0.001), and rs1258267 (P = 0.02) with PACG susceptibility. This association could not be shown for rs3739821. Conclusion It was revealed that studied variants in GLIS3, EPDR1, FERMT2, and CHAT genes can contribute to the incidence of PACG. Additional studies in other populations are needed to evaluate DPM2-FAM102A.
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Affiliation(s)
- Ali Yousefian
- Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Saeed Shokoohi-Rad
- Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Dorsa Morshedi Rad
- Immunology Research Center, Avicenna Research Institute, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Selma Zargari
- Medical Genetics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Saman Milanizadeh
- Medical Genetics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Negar Morovatdar
- Clinical Research Unit, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ramin Daneshvar
- Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Rahemi Karizaki S, Alamdaran SA, Bonakdaran S, Morovatdar N, Jafarain AH, Sharifi Hadad A, Hadadzade A. NEW PROPOSED FORMULA OF TI-RADS CLASSIFICATION BASED ON ULTRASOUND FINDINGS. Acta Endocrinol (Buchar) 2020; 16:199-207. [PMID: 33029237 DOI: 10.4183/aeb.2020.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Introduction The present study aimed to introduce a new formula for classification of nodules in TI-RADS and describe ultrasonography features of benign and malignant thyroid nodules. Methods This study was conducted on thyroid mass in 1033 patients. The incidence of malignancy for thyroid nodules was determined by selecting malignancy coefficients. Then the patients were first classified using conventional TI-RADS classification criteria and once again according to a new proposed formula. Results Among ultrasonography features of thyroid nodules, the irregular shape (46.7%), unclear margin (47.3%), extension to the capsule (irregular and infiltrative margin) (85%), the marked hypo-echoic nodules (63.8%), micro-calcification (49%), and to have vertical axis (74.0%) were associated with high incidence of malignancy. Conclusion According to the proposed new formula for TI-RADS, there are four coefficients of 7, 3, 1 and 0 for incidence of malignancy of each one of ultrasound findings that help to standardization and unifying of TI-RADS classification. The incidence of malignancy in TI-RADS classification according to the new proposed formula was achieved as follows: group 2: 0.0%, group 3: 0.7%, groups 4a, 4b, 4c: 16.7%, 43.4%, 68.5%, and group 5: 95.2%, respectively.
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Affiliation(s)
- S Rahemi Karizaki
- Mashhad University of Medical Sciences, Omid Hospital - Radiology - Mashhad, Iran
| | - S A Alamdaran
- Mashhad University of Medical Sciences, Omid Hospital - Radiology - Mashhad, Iran
| | - S Bonakdaran
- Mashhad University of Medical Sciences, Omid Hospital - Endocrine Research Center-Ghaem Hospital, Mashhad, Iran
| | - N Morovatdar
- Mashhad University of Medical Sciences, Omid Hospital - Social Medicine, Mashhad, Iran
| | - A H Jafarain
- Mashhad University of Medical Sciences, Omid Hospital - Pathology, Mashhad, Iran
| | - A Sharifi Hadad
- Mashhad University of Medical Sciences, Omid Hospital - Radiology - Mashhad, Iran
| | - A Hadadzade
- Mashhad University of Medical Sciences, Omid Hospital - Radiology - Mashhad, Iran
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Hajzadeh G, Ghaemi N, Hadjzadeh MAR, Noroozi S, Morovatdar N. The Effects of Gonadotropin-Releasing Hormone Analog and a Combination of Gonadotropin-Releasing Hormone Analog and Recombinant Human Growth Hormone on Adult Height in Girls with Early Puberty. Adv Biomed Res 2019; 8:57. [PMID: 31673530 PMCID: PMC6777143 DOI: 10.4103/abr.abr_121_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background: Early puberty (EP) is due to the activation of gonadotropin-releasing hormone (GnRH) pulse generator in lower ages; EP may be a potential cause for impairment of adult height, leading to short stature. The aim of this study was to determine the effects of GnRH analog (GnRHa) and GnRHa plus recombinant human growth hormone (rhGH) treatment on final height in healthy girls with EP. Materials and Methods: Fifty EP girls (sexual maturity rating: 2–3) with chronological age (CA) 9.22 ± 0.56 and bone age (BA) 9.74 ± 0.59 years were treated with GnRHa (Triptorelin) at a dose of 100 μg/kg body weight (BW) as intramuscular every 28 days for 2.82 ± 0.57 years; 45 EP girls with CA 9.84 ± 0.57 and BA 10.14 ± 1.02 years were also treated with the same GnRHa plus rhGH (Norditropin) at a dose of 0.1 unit/kg BW daily for 6 days in a week for 2.55 ± 0.6 years. In the control group, 33 EP girls followed for the same period without treatment. Height, weight, and body mass index of girls and parents were assessed. Predicted adult height (PAH) at the start and the end of the study and target height were assessed. Results: PAH at the end of the study in the GnRHa group was not different with untreated girls. PAH at the end of the treatment in GnRHa plus rhGH group was significantly higher than both untreated and GnRHa group. PAH at the end of therapy in GnRHa plus rhGH group was significantly more than their target height. Conclusion: GnRHa therapy has a benefit effect in achievement of target height. Combination therapy with GnRHa plus rhGH increased their PAH more than both untreated and GnRHa groups.
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Affiliation(s)
- Ghodsieh Hajzadeh
- Department of Pediatric Endocrinology and Metabolism, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Norsrat Ghaemi
- Department of Pediatric Endocrinology and Metabolism, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mousa-Al-Reza Hadjzadeh
- Department of Physiology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Division of Neurocognitive Sciences, Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Neurogenic Inflammation Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Samaneh Noroozi
- Department of Pediatric Endocrinology and Metabolism, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Negar Morovatdar
- Clinical Research Unit, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Tayyebi M, Danesh Sani M, Mashreghi Moghadam HR, Gholoobi A, Morovatdar N, Ramezani J. Investigating the Manifestation of Coronary Artery Disease and Determining the Role of Effective Factors in the Need for Pacemaker Insertion in These Patients. Open Access Maced J Med Sci 2019; 7:2108-2113. [PMID: 31456834 PMCID: PMC6698118 DOI: 10.3889/oamjms.2019.608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 07/08/2019] [Accepted: 07/09/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND: Many patients who are candidates for a pacemaker are also at the same time risk factors for coronary artery disease such as high blood pressure, hypertension, diabetes, and hyperlipidemia, and therefore the probability of having coronary artery disease is significant. Effective diagnostic measures can be taken to prove the factors affecting the incidence of CAD in patients undergoing pacemakers at high-risk, including angiography. Therefore, it can prevent complications during and after pacemaker implantation, which leads to an increase in the quality of treatment in patients requiring pacemaker implantation. AIM: Therefore, the purpose of this study was to determine the predictive factors of significant coronary artery disease in patients with pacemaker implantation to identify patients in need of coronary angiography at the time of pacemaker implantation. METHODS: This retrospective study was carried out to examine the patients’ files that were placed at the heart of Imam Reza Hospital during the period between March 2017 and September 2017. Demographic data, risk factors, echocardiography findings, and angiography, were collected and then recorded using a checklist. Statistical analysis was performed using SPSS software version 22 and Chi-square, and Mann-Whitney tests were used for determining significates variables. RESULTS: A group of 102 patients who had undergone a permanent cardiac pacemaker insertion due to an atrioventricular (AV) Block were included in the study, and also coronary anatomy was determined coronary angiography. Based on the results, 13.7% of patients with cardiac pacemaker had obstructive coronary artery disease (stenosis > 70%). Factors affecting coronary artery stenosis on angiography include gender, chest pain, history of myocardial infarction, angioplasty, diabetes, smoking, history of aspirin intake, calcium blocker and Plavix, high hematocrit, ST elevation and ST depression in the ECG, and severe mitral regurgitation. CONCLUSION: It seems that in most patients requiring permanent pacemaker insertion because of the atrioventricular (AV) Block, angiography does not change the patient’s fate, and so can be ignored. However, in patients who have several risk factors from the listed above, coronary angiography is recommended during admission.
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Poorzand H, Tsarouhas K, Hozhabrossadati SA, Khorrampazhouh N, Bondarsahebi Y, Bacopoulou F, Rezaee R, Jafarzadeh Esfehani R, Morovatdar N. Risk factors of premature coronary artery disease in Iran: A systematic review and meta-analysis. Eur J Clin Invest 2019; 49:e13124. [PMID: 31038733 DOI: 10.1111/eci.13124] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 02/25/2019] [Accepted: 04/26/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND The aim of this study was to determine the mean age at which coronary artery disease (CAD) hase decreased in recent years in Iran. This systematic review and meta-analysis compares the prevalence of different risk factors of premature CAD (PCAD) in patients vs healthy individuals. METHODS Medline, Web of Science, Embase and Scientific Information Database were searched for studies about PCAD risk factors in Iran until 28 October 2017. Observational studies of Iranians, comparing risk factors between patients with PCAD and age- and sex-matched healthy subjects, were included. Fixed-effects and random-effects model were used for pooling data. Odds ratio (OR) with 95% CI and mean difference were used for effect size estimation among studies. RESULTS Twelve studies were eligible for meta-analysis. Diabetes mellitus (OR: 2.4, 95% CI: 1.9-3.03; P = 0.0001, I2 = 25.5%; P = 0.2), family history of CAD (OR: 2.09, 95% CI: 1.22-3.6; P = 0.007, I2 = 86%; P = 0.0001), dyslipidaemia (OR: 2.05, 95% CI: 1.15-3.64; P = 0.01, I2 = 54%; P = 0.08), smoking (OR: 1.65, 95% CI: 1.11-2.46; P = 0.01, I2 = 77.2%; P = 0.000) and hypertension (OR: 1.35, 95% CI: 1.21 to-1.50; P < 0.001, I2 = 31%, P = 0.1) associated with PCAD. Sensitivity analysis demonstrated that patients with PCAD had significantly lower levels of high-density lipoprotein (HDL) cholesterol and significantly higher levels of triglycerides compared to healthy subjects (MD: -2.56, 95% CI: -3.54 to -1.58, P < 0.001, I2 = 42%, P = 0.01 and MD: 21.17, 95% CI: 14.73-27.62, P < 0.001, I2 = 80.12%, P < 0.001, respectively). It should be noted that although high levels of heterogeneity in LDL and HDL values among the studies were observed, when dyslipidaemia was studied as a binary variable, no significant heterogeneity among studies was observed. CONCLUSION Diabetes mellitus, family history of CAD, dyslipidaemia, smoking, and hypertension were significantly and positively associated with CAD in young adults compared to healthy age- and sex-matched population in Iran.
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Affiliation(s)
- Hoorak Poorzand
- Atherosclerosis Prevention Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Konstantinos Tsarouhas
- Department of Cardiology, University Hospital of Larissa, Larissa, Greece.,Center for Adolescent Medicine and UNESCO Chair on Adolescent Health Care, First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece
| | | | - Nastaran Khorrampazhouh
- Students Research Committee, Faculty of Medicine, Mashhad University of medical sciences, Mashhad, Iran
| | - Yones Bondarsahebi
- Students Research Committee, Faculty of Medicine, Mashhad University of medical sciences, Mashhad, Iran
| | - Flora Bacopoulou
- Center for Adolescent Medicine and UNESCO Chair on Adolescent Health Care, First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece
| | - Ramin Rezaee
- Clinical Research Unit, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Neurogenic Inflammation Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Chemical Engineering, Aristotle University of Thessaloniki, Environmental Engineering Laboratory, University Campus, Thessaloniki, Greece.,HERACLES Research Center on the Exposome and Health, Center for Interdisciplinary Research and Innovation, Balkan Center, Thessaloniki, Greece
| | - Reza Jafarzadeh Esfehani
- Department of Medical Genetics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Negar Morovatdar
- Clinical Research Unit, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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