ABSTRACT
Gastrointestinal and liver diseases [GILDs] are major causes of death and disability in Middle East and North Africa [MENA]. However, they have different patterns in countries with various geographical, cultural, and socio-economic status. We aimed to compare the burden of GILDs in Iran with its neighboring countries using the results of the Global Burden of Disease [GBD] Study in 2010. Classic metrics of GBD have been used including: age-standardized rates [ASRs] of death, years of life lost due to premature death [YLL], years of life lost due to disability [YLD], and disability adjusted life years [DALY]. All countries neighboring Iran have been selected. In addition, all other countries classified in the MENA region were included. Five major groups of gastrointestinal and hepatic diseases were studied including: infections of gastrointestinal tract, gastrointestinal and pancreatobilliary cancers, acute hepatitis, cirrhosis, and other digestive diseases. The overall burden of GILDs is highest in Afghanistan, Pakistan, and Egypt. Diarrheal diseases have been replaced by gastrointestinal cancers and cirrhosis in most countries in the region. However, in a number of countries including Afghanistan, Pakistan, Turkmenistan, Egypt, and Yemen, communicable GILDs are still among top causes of mortality and morbidity in addition to non-communicable GILDs and cancers. These countries are experiencing the double burden. In Iran, burden caused by cancers of stomach and esophagus are considerably higher than other countries. There is an overall overestima-tion of liver cancer and underestimation of other gastrointestinal and pancreatobilliary cancers. The diseases that are mainly diagnosed in outpatient settings have not been captured by GBD
ABSTRACT
The general pattern of epidemiologic transition from communicable to non-communicable diseases is also observed for gastrointestinal and liver diseases [GILD], which constitute a heterogeneous array of causes of death and disability. We aimed to describe the trend of GILD in Iran based on the global burden of disease [GBD2010] study from 1990 to 2010. The trend of number of deaths, disability, adjusted life years [DALYs] and their age-standardized rates caused by 5 major GILD have been reported. The change in the rankings of major causes of death and DALY has been described as well. The age standardized rates of death and DALYs in both sexes have decreased from 1990 to 2010 for most GILD. The most prominent decreases in death rates are observed for diarrheal diseases, gastritis and duodenitis, and peptic ulcer disease. Positive trends are observed for liver cancer, pancreatic cancer, and gall bladder cancer. Diarrheal diseases have retained their 1[st] rank among children under 5. Among adults, decreased ranks are observed for diarrheal diseases, appendicitis, gastritis and duodenitis, gall bladder diseases, pancreatitis, and all types of cirrhosis. The trends in age standardized rates of DALYs, deaths, and YLLs are negative for almost all GILD, and especially for diarrheal diseases. However, there is no upward or downward trend in rates of years lost due to disability [YLDs] for most diseases. Total numbers of DALYs and deaths due to acute hepatitis C, stomach cancer, and liver cancers are rising. The total DALYs due to overall digestive diseases except cirrhosis and DALYs due to cirrhosis are both somehow stable. No data has been reported for GILD that are mainly diagnosed in outpatient settings, including gastroesophageal reflux disease, irritable bowel syndrome, and non-alcoholic fatty liver disease. The results of GBD 2010 demonstrate that the rates of most GILD are decreasing in Iran but total DALYs are somehow stable. However, as diseases detected in outpatient settings have not been captured, the burden of GILD seems to be underestimated. Population-based studies at national level are required for accurate reports
Subject(s)
Humans , Male , Female , Liver Diseases , Mortality , Cost of IllnessABSTRACT
Gastrointestinal and liver diseases [GILD] constitute a noteworthy portion of causes of death and disability in Iran. However, data on their prevalence and burden is sparse in Iran. The Global Burden of Disease [GBD] study in 2010 has provided invaluable comprehensive data on the burden of GILD in Iran. Estimations of death, years of life lost due to premature death [YLL], years of life lost due to disability [YLD], disability-adjusted life years [DALY], life expectancy, and healthy life expectancy have been reported for 291 diseases, 67 risk factors, 1160 sequelae, for both sexes and 19 age groups, form 1990 to 2010 for 187 countries. In the current paper, 5 major categories of gastrointestinal [GI] and liver diseases have been investigated as follows: GI infectious diseases, GI and liver cancers, liver infections, chronic end stage liver disease, and other digestive diseases. Among women, 7.6% of all deaths and 3.9% of all DALYs were due to digestive and liver diseases in 2010. The respective figures in men were 7.8% of deaths and 4.6% of DALYs. The most important cause of death among children under 5 is diarrhea. Among adults between 15 to 49 years old, the main causes of death are GI and liver cancers and cirrhosis, while diarrhea still remains a major cause of DALY. Among adults 50 years and above, GI and liver cancers and cirrhosis are the main causes of both deaths and DALYs. Gastritis and duodenitis, diarrheal diseases, gall bladder and bile duct diseases, acute hepatitis A, peptic ulcer disease, appendicitis, and acute hepatitis A mainly cause disability rather than death. GBD study provides invaluable source of data on burden of GILD in Iran. However, there exist limitations, namely overestimation of burden of liver cancer and underestimation of the burden of GI diseases that are usually diagnosed in outpatient settings. The collaboration of scientists across the world and specifically those from developing countries is necessary for improving the accuracy of future updates of GBD in these countries
Subject(s)
Humans , Male , Female , Liver Diseases , Mortality , Wounds and Injuries , Risk Factors , Developing Countries , Cost of IllnessABSTRACT
The threshold of thyroid-stimulating hormone [TSH] in current screening for congenital hypothyroidism [CH] from the heel prick test is 5 mU/l. This study uses cost-effective analysis to evaluate increasing the threshold to minimize false-positive results and recall rates. Cost of screening, diagnosis and treatment, education, and care of mentally retarded patients were gathered from the Ministry of Health State Welfare Organization and Department of Education in Tehran. Screening data were obtained from 34,007 neonates in the Central Health Laboratory of Tehran University of Medical Sciences in 2009. Sensitivity analysis and calculation of confidence interval for incremental costs and effects [gained disability adjusted life years - DALYs] and incremental cost-effectiveness ratios [ICER] were performed by Monte Carlo simulation with Ersatz software. ICER for screening programs with different TSH cut-off points versus no screening was similar, and approximately -4.5 +/- 0.2 thousand US dollars per gained DALY. In the proposed cohort [10,000 neonates], gained DALYs were 316 +/- 50 for a cut off point of 5 mU/l, 251 +/- 40 for 10 mU/l, 146 _ 23 for 15 mU/l, and 113 +/- 18 for a cut-off point of 20 mU/l. Sensitivity analysis showed that the model remained the same when the input parameters were changed. This study demonstrates that the current threshold of TSH in the national CH screening program in terms of cost-effectiveness is the most appropriate threshold. However, more studies are needed to examine new strategies and methods to reduce recall rates and related consequences such as repeated thyroid testing in neonates
ABSTRACT
To evaluate the outcome in patients who underwent anterior cervical discectomy without interbody fusion. Prospective study. Imam Hospital, Tabriz, Iran. Forty-one patients with single level cervical disc herniation were included in the study. Simple anterior cervical discectomy technique without fusion was performed in all patients by one surgeon. Morbidity and functional disability. The study was carried out between March 1999 and March 2003. The mean age was 41 years. Thirty-one [75.6%] patients were male whereas ten [24.4%] were female. C5-C6 level was the most common site of discal herniation. Presentation was as follows: 80% radiculopathy, 5% myelopathy, and 15% radiculomyelopathy. 80% patients had soft disc and 20% hard disc herniation. Twenty-five [61%] patients had excellent, 13 [31.5%] good, 2 [5%] satisfactory and 1 [2.5%] poor outcome. Result was significantly better in patients with radiculopathy than in patients with myelopathy or radiculomyelopathy [p < 0.001]. All patients with soft disc herniation and 62.5% patients with hard disc herniation had good or excellent results [p < 0.05]. Outcome was not significantly related to sex, age, and disc level [p > 0.05]. Postoperative complications included transient neck and interscapular pain [46.3%], and transient hoarseness [9.7%]. Transient dysphagia [lasting for less than two weeks] was also seen in three out of four patients with hoarseness. Postoperative neck pain was more frequent in patients with hard disc herniation [p = 0.016]. Definite fusion was seen in 75.6%, partial fusion in 9.8%, and non-union in 14.6% cases. 87.8% patients were able to return to work postoperatively. Single level cervical discectomy without fusion was found to have satisfactory outcomes. This method may provide a good approach for achieving root and cord decompression without the potential for graftrelated complications