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
Statement of the Problem: Refractory nocturnal enuresis possesses a heavy psychosocial burden for the affected child. Only a 15% spontaneous annual cure rate is reported
Purpose: This patient-level meta-analysis aimed to evaluate the efficacy of rapid palatal expansion to treat nocturnal enuresis among children
Materials and Method: A sensitive search of electronic databases of PubMed [since 1966], SCOPUS [containing EMBASE, since 1980], Cochrane Central Register of Controlled Trials, CINAHL and EBSCO till Jan 2014 was performed. A set of regular terms was used for searching in data banks except for PubMed, for which medical subject headings [MeSH] keywords were used. Children aged at least six years old at the time of recruitment of either gender who underwent rapid palatal expansion and had attempted any type of pharmacotherapy prior to orthodontic intervention were included
Results: Six non-randomized clinical trials were found relevant, of which five studies had no control group. Eighty children were investigated with the mean age of 118 [28.12] months ranged from 74 to 185 months. The median time to become completely dry was 2.87 months [confidence interval [CI] 95% 2.07-2.93 months]. After one year, the average rate of becoming complete dry was 31%. The presence of posterior cross bite [relative risk [RR]: 0.31, CI 95%: 0.12-0.79] and signs of upper respiratory obstruction during sleep [RR: 5.1, CI 95%: 1.44-18.04] significantly decreased and increased the chance of improvement, respectively. Meanwhile, the other predictors did not significantly predict the outcome after simultaneous adjustment in Cox regression model
Conclusion: Rapid palatal expansion may be considered when other treatment modalities have failed. The 31% rate of cure is promising when compared to the spontaneous cure rate. Though, high-level evidence from the rigorous randomized controlled trials is scarce [Level of evidence: C]
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 recent studies show that Rotavirus is important cause of the acute gastroenteritis. The aim of this review is to estimate the number of Rotavirus infection among Iranian children by performing a systematic review and estimating a pooled data. We performed a systematic literature review in relevant databases including PUBMED, MEDLINE, OVID, SID, MAGIRAN, and IRANMEDEX. Search in databases was done in October 10, 2013. Meta-analysis was performed using the STATA statistical package version 11. We assessed heterogeneity by Q-test and used random model for pooling measures of proportion of Rotavirus infection among Iranian children with diarrhea [and 95% confidence intervals [CI]]. Sub group analysis between in-patient and outpatient group were done and publication bias was assessed by Egger and Begg tests. A total of 154 records were identified in our searching. There were 36 studies including a total of 15,368 children with diarrhea. Out of 15,368 children, 6,338 were positive for Rota virus gastroenteritis. Overall pooled estimate of infection with Rotavirus among cases of gastroenteritis was 0.35 [95% CI, 0.28-0.41]. Pooled estimates for hospitalized children and outpatient subgroups were 0.39 [95% CI, 0.30-0.48], and 0.31 [95% CI, 0.23-0.38], respectively. This study supports the importance of Rotavirus in the Iranian population such as common cause of diarrhea among children. Therefore, decision to adopt immunization programs to prevent Rotavirus infection might be helpful in Iran
Subject(s)
Humans , Gastroenteritis , Child , Acute Disease , Meta-Analysis as Topic , DiarrheaABSTRACT
Background: Nowadays, it is of utmost importance to critically appraise the research evidences presented in scientific congresses by the audiences. In addition to improvement in scientific and practical skills of critical appraisal, it is important to use a standard framework as the major tool for peer reviewing. We aimed to assess the validity and reliability of one proposed checklist for critical appraisal of the original research abstracts by student peer reviewers.
Methods and Materials: This study was a part of an educational interventional project that was performed in a setting of a workshop where 40 medical students from the medical faculties of the universities in Tehran were recruited. Participants were selected using a non-probability purposive sampling method. Educational curriculum of the workshop included clarifying explanations on the 31-item checklist for peer reviewing of the abstracts as well as several tips about each item using lectures, simulations and group discussions during 10 hours. Medical students used the checklist twice, at beginning and the end of the workshop to score three sample abstracts. Data were collected and analyzed using Spearman correlation [internal consistency] and Cronbach's' alpha methods to calculate the reliability of different items and domains of the introduced peer reviewing checklist by SPSS software. Moreover, Delphi method was applied to confirm the validity of the instrument by experts' opinion.
Results: A group of experts finally confirmed the validity of this checklist by means of Delphi method. Moreover, internal consistency of the main domains of the checklist consisting of "Introduction", "Methods", "Results" and "Conclusion" were statistically significant [P<0.05]. The coefficient of Cronbach's alpha was calculated as excellent [0.926] in "Methods", and acceptable in two other domains of "Results" [0.650] and "Conclusion" [0.739] in pre-test data.
Conclusion: The introduced checklist was shown to be a structured, valid and reliable tool, which could be used in research congresses to improve the quality of peer reviewing.
ABSTRACT
Sepsis is one of the major causes of death in intensive care units. Oxidative stress and hyper-inflammation has been shown to be major cause of mortality and morbidity in septic cases. Pomegranate is a fruit considered for its antioxidant and anti-inflammatory properties. The aim of this study is to evaluate the effect of a standard pomegranate fruit liquid extract[POMx], on mortality and peritoneal bacterial load in cecal ligation and perforation [CLP] sepsis model. Male wistar rats were divided into four groups of 24 each: sham; CLP; prevention [consumed POMx [250 mg of polyphenols/kg/day] for 4 weeks before CLP]; treatment [received a single drink of POMx [250 mg of polyphenols/kg] after CLP]. Each group was divided into three subgroups, each containing eight animals, for bacterial load and survival [with and without antibiotics] studies. Sepsis was induced by CLP surgery. Ten day survival rate was recorded. Peritoneal bacterial load was also assessed. Data were analyzed using Log-rank and Kruskal-Wallis tests. There was no significant difference in survival rate of CLP, prevention and treatment groups, in subgroups without antibiotics. However, in subgroups with antibiotics, the prevention group had significantly lower survival rate than sham group [P 0.05]. Conversely, the bacterial load of prevention and treatment groups were significantly higher than sham group [P< 0.01]. Our study demonstrates for the first time that pomegranate extract could increase mortality rate via increasing peritoneal cavity bacterial load, in CLP sepsis model. More studies to assess mechanisms of this effect are warranted
ABSTRACT
Haemophilus Influenzae type b [Hib] is an important cause of morbidity and mortality in children. Although its burden is considerably preventable by vaccine, routine vaccination against Hib has not been defined in the National Immunization Program of Iran. This study was performed to assess the cost-benefit and cost utility of running an Hib vaccination program in Iran. Based on a previous systematic review and meta analysis for vaccine efficacy, we estimated the averted DALYs [Disability adjusted life years] and cost benefit of vaccination. Different acute invasive forms of Hib infection and the permanent sequels were considered for estimating the attributed DALYs. We used a societal perspective for economic evaluation and included both direct and indirect costs of alternative options about vaccination. An annual discount rate of 3% and standard age weighting were used for estimation. To assess the robustness of the results, a sensitivity analysis was performed. The incidence of Hib infection was estimated 43.0 per 100000, which can be reduced to 6.7 by vaccination. Total costs of vaccination were estimated at US$ 15,538,129. Routine vaccination of the 2008 birth cohort would prevent 4079 DALYs at a cost per averted DALY of US$ 4535. If we consider parents' loss of income and future productivity loss of children, it would save US$ 8,991,141, with a benefit cost ratio of 2.14 in the base case analysis. Sensitivity analysis showed a range of 0.78 to 3.14 for benefit to cost ratios. Considering costs per averted DALY, vaccination against Hib is a cost effective health intervention in Iran, and allocating resources for routine vaccination against Hib seems logical
Subject(s)
Humans , Child , Child, Preschool , Vaccination/economics , Cost-Benefit Analysis , Health Care Costs , /epidemiology , Meningitis, Haemophilus/prevention & controlABSTRACT
Laboratory turnaround time [TAT] is an important determinant of patient stay and quality of care. Our objective is to evaluate laboratory TAT in our emergency department [ED] and to generate a simple model for identifying the primary causes for delay. We measured TATs of hemoglobin, potassium, and prothrombin time tests requested in the ED of a tertiary-care, metropolitan hospital during a consecutive one-week period. The time of different steps [physician order, nurse registration, blood-draw, specimen dispatch from the ED, specimen arrival at the laboratory, and result availability] in the test turnaround process were recorded and the intervals between these steps [order processing, specimen collection, ED waiting, transit, and within-laboratory time] and total TAT were calculated. Median TATs for hemoglobin and potassium were compared with those of the 1990 Q-Probes Study [25min for hemoglobin and 36 min for potassium] and its recommended goals [45 min for 90% of tests]. intervals were compared according to the proportion of TAT they comprised. Median TATs [170 min for 132 homoglobin tests, 225 min for 172 potassium tests, and 195.5 min for 128 prothrombin tests] were drastically longer than Q-Probes reported and recommended TATs. The longest intervals were ED waiting ime and order processing. Laboratory TAT varies among institutions, and data are sparse in developing countries. In our Ed, actions to reduce Ed waiting time and order processing are top priorities. We recommend utilization of this model by other institutions in setting with limited resources to identify their own priorities for reducing laboratory TAT
ABSTRACT
PURPOSE: The Pediatric Lower Urinary Tract Scoring System (PLUTSS) is a standardized questionnaire used for screening and evaluation of the response of children with lower urinary tract symptoms (LUTS) to therapy. We presumed that adding the Child Behavior Check List (CBCL) and bladder volume wall index (BVWI) to the PLUTSS would increase its validity in the detection of children with LUTS. MATERIALS AND METHODS: One hundred twenty-two children aged 5 to 15 years with LUTS were enrolled in the study. Seventy-two healthy, age-matched children without urinary complaints were considered as controls. The PLUTSS and CBCL were filled out for all children. Sonography was performed to measure BVWI. Chi-square test and likelihood ratio were used to compare frequencies, receiver operating curve (ROC) analysis was used to evaluate the correlation, and Cohen's kappa was used to measure the agreement between variables. p-values 0.05). ROC analysis showed that there was no correlation between PLUTSS, CBCL, and BVWI in either the LUTS subgroup or in the controls (p>0.05). The PLUTSS had the highest sensitivity and specificity, and adding the two other tests decreased its validity for the diagnosis of children with LUTS. CONCLUSIONS: The PLUTSS by itself was the best predictor of LUTS. The CBCL and BVWI were not helpful in making a diagnosis; however, the CBCL was useful in the detection of behavior problems in children with non-monosymptomatic enuresis.
Subject(s)
Aged , Child , Humans , Child Behavior , Enuresis , Lower Urinary Tract Symptoms , Mass Screening , Pediatrics , ROC Curve , Sensitivity and Specificity , Urinary Bladder , Urinary TractABSTRACT
To assess the quality of care in patient with acute exacerbation of chronic obstructive pulmonary disease [COPD] through comparison of provided care with recommendations of an evidence-based guideline. The index of quality of care [IQC] was defined as the percent of applicable grade A, B or C recommendations of the National Institute for Health and Clinical Excellence [NICE] guideline for each case. Then we made a data check list for patients' information according to guideline. A list of cases with COPD exacerbation who admitted in Rasool Akram of Firoozgar academic hospitals was provided and 101 cases were randomly selected. One of the investigators read all clinical records and compared the provided care with recommendations of the guideline. The IQC was estimated for all cases and compared in different subgroups. The average IQC was 88.4% [standard deviation: 14.8%]. Considering applicable recommendations for each case, concordance rate between practices and recommendations was 90.7% for grade A [95%CI: 87.8-93.6%], 84.9% for grade B [95%CI: 75.3-94.5%] and 79.1% for grade C [95%CI: 71.5- 86.7%]. The IQC was statistically higher in patients who discharged alive compared to deceased cases [87.4 vs. 74.6, P<0.05]. Considering greater IQC in patients who were discharged alive, it seems using evidence-based guideline has better outcomes for patient with COPD exacerbation; using such guidelines seems to be logical in academic hospitals
Subject(s)
Humans , Quality of Health Care , Disease Progression , Evidence-Based Practice , Evidence-Based MedicineABSTRACT
The role of initial serum uric acid on admission in critically ill patients is controversial; we presumed that uric acid level can predict the mortality of the admitted patients to intensive care unit as a simple test. Totally 220 consecutively admitted children [96 girls, 124 boys] with mean age 3.5 years, who were at least 24 hours in pediatric intensive care unit [PICU], were enrolled in a prospective cohort study during January 2006 to December 2007. The subsequent PICU admission in the same hospitalization, those who were discharged from the hospital and then re-admitted to the PICU during the observation period, and the patients with chronic renal failure were excluded. Serum uric acid level was measured during the first day of PICU admission. Death or transfer from PICU was considered as final outcome. The statistical analysis was done by suing linear regression analysis, ROC curve, student t-test, and Chi-square. P value less than 0.05 was considered significant. From 44 patients who had serum uric acid level more than 8 mg/dl, 17 cases died showing with a higher relative risk of 1.88, higher mortality [P<0.05]. The relative risk of death in patients who had serum uric acid > 8mg/dl and needed vasopressor was 1.04, and in those under mechanical ventilation 1.33. In patients who scored pediatric risk of mortality of > 38 it was 1.4, and in septic cases 4 [P<0.05]. Stepwise linear regression analysis showed that mainly the need for mechanical ventilation [P=0.001] and vasopressor had statistically significant correlation with the poor outcome [P=0.001]. Uric acid level during the first day of intensive critical care admission is not an independent risk of mortality in PICU. Need for mechanical ventilation or inotropic agents was associated with poor outcome and only higher uric acid level in sepsis played an additive risk factor role
Subject(s)
Humans , Male , Female , Critical Illness/mortality , Mortality , Child , Predictive Value of Tests , Intensive Care Units , Prospective Studies , Cohort Studies , Death , PediatricsABSTRACT
To determine equality in safe delivery indexes [appropriate place for delivery, kind of delivery and appropriate attendant for delivery] and their relative factors in Iran. We did this descriptive-analytic study with the use of data of DHS [demographic and health survey], which was done in Iran in 2000. Our sample was internationally representative and includes 17991 Iranian married, 10-49 years old women that had delivered during 2 years before DHS. We calculated equality status by concentration index and its 95% confidence interval and we investigated relative factors to safe delivery indexes, by logistic regression. Our factors were age, job, residency [urban or rural] and education of mother and household economic status. Concentration index [95% confidence interval] for appropriate place for delivery, kind of delivery and appropriate attendant for delivery, were 0.111 [0.107, 0.115],-0.100 [-0.105,-0.095], 0.095 [0.091, 0.099] respectively. These results showed which opportunity of delivery in appropriate place and by appropriate attendant, were more in high economic and educational levels and proportion of natural delivery were less at those levels. Also, mother's age and education and household economic status, had significant relation with safe delivery indexes and in the all cases, mother's education was the most important factor. Despite developing in delivery cares in Iran, during 2 recent decades, there is a significant difference between existing situation of safe delivery indexes in Iran and complete equality due to economic status; and socioeconomic factors have contribution in this inequality
Subject(s)
Humans , Female , Socioeconomic Factors , Quality of Health Care , Delivery of Health Care , Social Justice , SafetyABSTRACT
Cardiac involvement in systemic sclerosis [SSc] is more prevalent than previously thought. In this study, the frequency and severity of cardiovascular involvement were assessed in SSc patients referred to Firouzgar Hospital. Fifty-eight patients with SSc, selected from the data bank of SSc patients, were reviewed for the frequency and severity of 8 organ involvements in this case series. The preliminary severity scale, published by international SSc study groups, was employed for the determination of the severity grade in the cardiovascular system. In the cardiac scoring scale, grade 0 represents normal heart [no cardiac involvement], grade 1 denotes mild involvement [electrocardiography [ECG] conduction defect and a left ventricular ejection fraction [LVEF] of 45-49%]], grade 2 signifies moderate involvement [arrhythmia, LVEF = 40-44%], grade 3 indicates severe involvement [LVEF <40%], and grade 4 stands for end stage [congestive heart failure and arrhythmia requiring treatment]. In this study, 24 [41.4%] patients were in the diffuse cutaneous [dcSSc] subset. The female to male ratio was 10.5:1, and the mean duration from symptom onset to diagnosis was 7.35 years for the dcSSc subset and 8.41 years for the limited cutaneous [lcSSc] subset of disease, there being no significant difference. Cardiac involvement in this series was seen in 13 [22.4%] cases; and there was no significant difference in terms of frequency and severity between the two disease subgroups [p value = 0.96 and p value = 0.46 respectively]. Our findings showed that the cardiac involvement in this series was infrequent and that there was no significant difference in the severity of cardiovascular involvement between the two subtypes of SSc in the late stage of the disease