Effects of Supplementation with Different Forms of Vitamin E on Liver Enzymes: A Systematic Review of Randomized Clinical Trials

Background: Obesity and non-alcoholic fatty liver disease (NAFLD) are considered as the main causes of liver-associatedmorbidity and mortality. Antioxidant administration was proposed as a remedy for liver problems such as steatohepatitis. This systematic review aimed to examine the effects of supplementation with various forms of Vitamin E on liver enzymes.Methods: To find relevant articles, in our systematic review article, we searched PubMed, Scopus, Embase, Cochrane library, and Web of Science up to 20 MAY, 2021. Randomized controlled trials (RCTs) on the effects of vitamin E supplementation, in isolation or combined with other nutrients, on liver health were included. After excluding irrelevant records, 21 studies remained.Results: According to the results of the included studies, vitamin E, especially α-Tocopherol or its co-supplementation with other antioxidants, at specific dosage could possibly have positive effects on improving liver functions and levels of Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) enzymes.Conclusion: Vitamin E,could possibly have positive effects on improving the liver function and the levels of ALT and AST enzymes

Sarcopenia and Health-related Quality of Life in Community-dwelling Older Adults

Background: Sarcopenia, an age-related decline in muscle mass, strength, and function, contributes to various adverse health outcomes and physical impairments. This study aimed to investigate the association between sarcopenia components and health-related quality of life (HRQoL) among communitydwelling older adults.Methods: In this cross-sectional study, 501 adults aged 65 years or older participated. Sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia (AWGS) guideline. Muscle mass was measured by bioelectrical impedance analysis (BIA), muscle strength by hand dynamometer, and physical function by 4-m gait speed. The HRQoL was assessed using 12 item shortform healthy survey (SF-12) questionnaire.Results: There was a significant relationship between the sarcopenia and demographic characteristics (educational levels and smoking habits). After adjustment for age, sex, Body Mass Index, education level, smoking habits, and number of comorbidities, a significant relationship was observed between sarcopenia and physical components of HRQoL. According to multivariate linear regression, low muscle mass was negatively related to physical aspects of HRQoL. Low handgrip strength (HGS) and gait speed (GS) were inversely correlated to both physical and mental components of HRQoL.Conclusion: Our study highlighted the adverse impact of sarcopenia on HRQoL in elderly population. Reduction in muscle strength and physical performance not only affected physical aspects but also were linked with mental components of HRQoL. Therefore, it seems HGS and GS might be good indicators affecting all aspects of HRQoL in the elderly groups

Topical Remedies for the Treatment of Men’s Sexual Dysfunction from the Perspective of Traditional Persian Medicine: A Review Article

Background: Sexual dysfunction is one of the most prevalent complaints in men over 50 years old, which can negatively affect marital life and self-esteem. Consumption of oral drugs has various limitations, and they have serious interactions with other oral agents.Methods: In this review article, the main traditional Persian medicine (TPM) sources were reviewed for topical suggestions for the treatment of men with sexual dysfunction. In addition, the herbal medicines and their constituents were reviewed in electronic databases including PubMed, Scopus, and Web of Sciences.Results: In TPM sources, various agents in oil, decoction, dry powder, suppository, and enema preparations are suggested to treat decreased libido, premature ejaculation, and erectile dysfunction. These preparations often include volatile agents that enhance percutaneous absorption. Accordingly, the literature review suggested that the mechanisms of these remedies could be related to enhancing the regional blood flow to the genitalia, inducing venous smooth muscle relaxation and increasing the tonicity of pelvic floor muscles.Conclusion: TPM suggestions in treating sexual dysfunction in men can ignite new ideas for further research based on the proposed mechanisms of action

The unfinished agenda of communicable diseases among children and adolescents before the COVID-19 pandemic, 1990-2019: a systematic analysis of the Global Burden of Disease Study 2019

BACKGROUND: Communicable disease control has long been a focus of global health policy. There have been substantial reductions in the burden and mortality of communicable diseases among children younger than 5 years, but we know less about this burden in older children and adolescents, and it is unclear whether current programmes and policies remain aligned with targets for intervention. This knowledge is especially important for policy and programmes in the context of the COVID-19 pandemic. We aimed to use the Global Burden of Disease (GBD) Study 2019 to systematically characterise the burden of communicable diseases across childhood and adolescence. METHODS: In this systematic analysis of the GBD study from 1990 to 2019, all communicable diseases and their manifestations as modelled within GBD 2019 were included, categorised as 16 subgroups of common diseases or presentations. Data were reported for absolute count, prevalence, and incidence across measures of cause-specific mortality (deaths and years of life lost), disability (years lived with disability [YLDs]), and disease burden (disability-adjusted life-years [DALYs]) for children and adolescents aged 0-24 years. Data were reported across the Socio-demographic Index (SDI) and across time (1990-2019), and for 204 countries and territories. For HIV, we reported the mortality-to-incidence ratio (MIR) as a measure of health system performance. FINDINGS: In 2019, there were 3·0 million deaths and 30·0 million years of healthy life lost to disability (as measured by YLDs), corresponding to 288·4 million DALYs from communicable diseases among children and adolescents globally (57·3% of total communicable disease burden across all ages). Over time, there has been a shift in communicable disease burden from young children to older children and adolescents (largely driven by the considerable reductions in children younger than 5 years and slower progress elsewhere), although children younger than 5 years still accounted for most of the communicable disease burden in 2019. Disease burden and mortality were predominantly in low-SDI settings, with high and high-middle SDI settings also having an appreciable burden of communicable disease morbidity (4·0 million YLDs in 2019 alone). Three cause groups (enteric infections, lower-respiratory-tract infections, and malaria) accounted for 59·8% of the global communicable disease burden in children and adolescents, with tuberculosis and HIV both emerging as important causes during adolescence. HIV was the only cause for which disease burden increased over time, particularly in children and adolescents older than 5 years, and especially in females. Excess MIRs for HIV were observed for males aged 15-19 years in low-SDI settings. INTERPRETATION: Our analysis supports continued policy focus on enteric infections and lower-respiratory-tract infections, with orientation to children younger than 5 years in settings of low socioeconomic development. However, efforts should also be targeted to other conditions, particularly HIV, given its increased burden in older children and adolescents. Older children and adolescents also experience a large burden of communicable disease, further highlighting the need for efforts to extend beyond the first 5 years of life. Our analysis also identified substantial morbidity caused by communicable diseases affecting child and adolescent health across the world. FUNDING: The Australian National Health and Medical Research Council Centre for Research Excellence for Driving Investment in Global Adolescent Health and the Bill & Melinda Gates Foundation

The global burden of cancer attributable to risk factors, 2010-19 : a systematic analysis for the Global Burden of Disease Study 2019

Background Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. Methods The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk-outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. Findings Globally, in 2019, the risk factors included in this analysis accounted for 4.45 million (95% uncertainty interval 4.01-4.94) deaths and 105 million (95.0-116) DALYs for both sexes combined, representing 44.4% (41.3-48.4) of all cancer deaths and 42.0% (39.1-45.6) of all DALYs. There were 2.88 million (2.60-3.18) risk-attributable cancer deaths in males (50.6% [47.8-54.1] of all male cancer deaths) and 1.58 million (1.36-1.84) risk-attributable cancer deaths in females (36.3% [32.5-41.3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20.4% (12.6-28.4) and DALYs by 16.8% (8.8-25.0), with the greatest percentage increase in metabolic risks (34.7% [27.9-42.8] and 33.3% [25.8-42.0]). Interpretation The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.Peer reviewe

Role of QT dispersion and Tp-e interval after biventricular pacing in the incidence of sustained ventricular arrhythmias in patients with implanted cardiac resynchronization therapy device

Introduction: QT dispersion (QTd) and Tp-e interval show controversial results in incidence of sustained ventricular arrhythmias (SVA) in patients with heart failure (HF). In patients with implanted cardiac resynchronization therapy (CRT) device, there is a unique opportunity to record SVAs. The aim of this study was to evaluate the effects of QTd and Tp-e interval on the incidence of SVAs after simultaneous biventricular (Biv) pacing. Methods: In the present study, 31 consecutive patients with advanced HF and implanted CRT device were evaluated one year for possible SVAs, corrected QT (QTc), QTd, and Tp-e interval. Patients were divided into two groups; with (group 1) and without (group 2) SVAs. Results: Among the studied patients, 5 (16%) experienced SVAs. The intrinsic and Biv pacing QTd were 70.74 ± 18.00 and 89.26 ± 28.00 msec, and 95.09 ± 44 and 88.09 ± 33 msec in group 1 and group 2, respectively (P = 0.18 and P = 0.16, respectively). Tp-e was not different between the two groups. In group 1, QTc increased from 438.83 ± 64 msec to 488.24 ± 48 msec (P = 0.13), and in group 2, it decreased from 499.70 ± 65.00 msec to 480.00 ± 31.00 msec after simultaneous Biv pacing (P = 0.13). Conclusion: QTd, Tp-e, and QTc did not differ significantly after Biv pacing to show any positive effect on the incidence of SVAs in part due to the severity of changes which already occur in patients with advanced HF. QTc, QTd, and Tp-e showed little changes after Biv pacing and probably do not have a significant role in the incidence of SVAs

Improving interns\u27 patient-physician communication skills: Application of self-efficacy theory, a pilot study

Aim: This quasi-experimental study explored application of the self-efficacy theory in improving self-efficacy, communication skills and patient satisfaction among medical interns. Methods: This study was conducted among 70 medical intern students. Being selected by human judgment and homogenous sampling method, participants were assigned into control and intervention groups. Participants in the invention group received an e-book, two one-on-one training sessions and feedback on their shared experiences in group discussions by peers. The Kirkpatrick model was applied to evaluate the intervention. Participants\u27 knowledge, self-efficacy and communication skills as well as their patients\u27 satisfaction were assessed. Data from self and observational assessments were compared in and between groups at different time-points. Results: Participants\u27 knowledge, self-efficacy and communication skills as well as their patients\u27 satisfaction were improved significantly in the intervention group compared to that of the control group. Correlation coefficient between interns\u27 self-efficacy and communication skills scores was 0.74 (P = 0.03). Conclusions: Application of self-efficacy theory could improve medical interns\u27 communication knowledge, self-efficacy and skills leading to patient satisfaction

Improving interns’ patient–physician communication skills: Application of self-efficacy theory, a pilot study

Aim: This quasi-experimental study explored application of the self-efficacy theory in improving self-efficacy, communication skills and patient satisfaction among medical interns. Methods: This study was conducted among 70 medical intern students. Being selected by human judgment and homogenous sampling method, participants were assigned into control and intervention groups. Participants in the invention group received an e-book, two one-on-one training sessions and feedback on their shared experiences in group discussions by peers. The Kirkpatrick model was applied to evaluate the intervention. Participants’ knowledge, self-efficacy and communication skills as well as their patients’ satisfaction were assessed. Data from self and observational assessments were compared in and between groups at different time-points. Results: Participants’ knowledge, self-efficacy and communication skills as well as their patients’ satisfaction were improved significantly in the intervention group compared to that of the control group. Correlation coefficient between interns’ self-efficacy and communication skills scores was 0.74 (P = 0.03). Conclusions: Application of self-efficacy theory could improve medical interns’ communication knowledge, self-efficacy and skills leading to patient satisfaction

Burden of breast cancer and attributable risk factors in the North Africa and Middle East region, 1990–2019:a systematic analysis for the Global Burden of Disease Study 2019

Background: Breast cancer (BC) is the most common cancer in women globally. The North Africa and Middle East (NAME) region is coping hard with the burden of BC. We aimed to present the latest epidemiology of BC and its risk factors in this region. Methods: We retrieved the data on BC burden and risk factors from the Global Burden of Disease Study 2019 to describe BC status in the 21 countries of the NAME region from 1990 to 2019. We explored BC incidence, prevalence, deaths, disability-adjusted life years (DALYs), and attributable burden to seven risk factors of female BC, namely, alcohol use, diet high in red meat, low physical activity, smoking, secondhand smoke, high body mass index, and high fasting plasma glucose. Decomposition analysis on BC incidence trend was done to find out the contributing factors to this cancer’s growth. Results: In 2019, there were 835,576 (95% uncertainty interval: 741,968 to 944,851) female and 10,938 (9,030 to 13,256) male prevalent cases of BC in the NAME region. This number leads to 35,405 (30,676 to 40,571) deaths among female patients and 809 (654 to 1,002) deaths in male patients this year. BC was responsible for 1,222,835 (1,053,073 to 1,411,009) DALYs among female patients in 2019, with a greater proportion (94.9%) of burden in years of life lost (YLLs). The major contributor to female BC incidence increase in the past three decades was found to be increase in age-specific incidence rates of BC (227.5%), compared to population growth (73.8%) and aging (81.8%). The behavioral risk factors were responsible for majority of attributable female BC burden (DALYs: 106,026 [66,614 to 144,247]). High fasting plasma glucose was found to be the risk factor with the largest effect (DALYs: 84,912 [17,377 to 192,838]) on female BC burden. Conclusion: The increasing incidence and burden of BC in the NAME region is remarkable, especially when considering limited resources in the developing countries of this region. Proper policies like expanding screening programs and careful resource management are needed to effectively manage BC burden