Assessment of Neurocognitive Functions in Children Treated for Cancer

Background: About eight percent of adults and children who receive a cancer diagnosis today are projected to live at least 5 years thanks to advancements in pediatric cancer therapy over the last several decades. More than half a million people will have survived childhood cancer by 2020, according to current estimates. Objective: To evaluate the association between childhood cancer, antineoplastic treatment and neurocognitive dysfunction.Patients and Methods: In the Pediatrics Department of the Faculty of Medicine at Zagazig University, a case control study was undertaken on 25 cancer patients who had completed their treatment and on 25 healthy children between August 2020 and July 2021. Children of both sexes, aged 5-15, were enrolled in the study. Results: In terms of full and performance intelligence quotient (IQ) scale, there was statistically significant difference between the groups (much higher in the control group), but the verbal scale did not differ statistically between the groups. Regarding verbal IQ, there was no statistically significant difference between the groups examined. However, there were no significant differences in IQ subtests for information, vocabulary, arithmetic, comprehension, picture completion, mazes or block design between groups. Control group was significantly higher as regard similarity and geometric design. Conclusions: Neurocognitive function is affected in cancer survivors of children as there is statistically significant difference between the studied groups regarding full, and performance IQ scale (significantly higher in control group) but verbal scale was not statistically different between the groups

Maternal mortality and morbidity burden in the Eastern Mediterranean Region: findings from the Global Burden of Disease 2015 study.

OBJECTIVES: Assessing the burden of maternal mortality is important for tracking progress and identifying public health gaps. This paper provides an overview of the burden of maternal mortality in the Eastern Mediterranean Region (EMR) by underlying cause and age from 1990 to 2015. METHODS: We used the results of the Global Burden of Disease 2015 study to explore maternal mortality in the EMR countries. RESULTS: The maternal mortality ratio in the EMR decreased 16.3% from 283 (241-328) maternal deaths per 100,000 live births in 1990 to 237 (188-293) in 2015. Maternal mortality ratio was strongly correlated with socio-demographic status, where the lowest-income countries contributed the most to the burden of maternal mortality in the region. CONCLUSION: Progress in reducing maternal mortality in the EMR has accelerated in the past 15 years, but the burden remains high. Coordinated and rigorous efforts are needed to make sure that adequate and timely services and interventions are available for women at each stage of reproductive life

Global, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015.

BACKGROUND: Healthy life expectancy (HALE) and disability-adjusted life-years (DALYs) provide summary measures of health across geographies and time that can inform assessments of epidemiological patterns and health system performance, help to prioritise investments in research and development, and monitor progress toward the Sustainable Development Goals (SDGs). We aimed to provide updated HALE and DALYs for geographies worldwide and evaluate how disease burden changes with development. METHODS: We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015) for all-cause mortality, cause-specific mortality, and non-fatal disease burden to derive HALE and DALYs by sex for 195 countries and territories from 1990 to 2015. We calculated DALYs by summing years of life lost (YLLs) and years of life lived with disability (YLDs) for each geography, age group, sex, and year. We estimated HALE using the Sullivan method, which draws from age-specific death rates and YLDs per capita. We then assessed how observed levels of DALYs and HALE differed from expected trends calculated with the Socio-demographic Index (SDI), a composite indicator constructed from measures of income per capita, average years of schooling, and total fertility rate. FINDINGS: Total global DALYs remained largely unchanged from 1990 to 2015, with decreases in communicable, neonatal, maternal, and nutritional (Group 1) disease DALYs offset by increased DALYs due to non-communicable diseases (NCDs). Much of this epidemiological transition was caused by changes in population growth and ageing, but it was accelerated by widespread improvements in SDI that also correlated strongly with the increasing importance of NCDs. Both total DALYs and age-standardised DALY rates due to most Group 1 causes significantly decreased by 2015, and although total burden climbed for the majority of NCDs, age-standardised DALY rates due to NCDs declined. Nonetheless, age-standardised DALY rates due to several high-burden NCDs (including osteoarthritis, drug use disorders, depression, diabetes, congenital birth defects, and skin, oral, and sense organ diseases) either increased or remained unchanged, leading to increases in their relative ranking in many geographies. From 2005 to 2015, HALE at birth increased by an average of 2·9 years (95% uncertainty interval 2·9-3·0) for men and 3·5 years (3·4-3·7) for women, while HALE at age 65 years improved by 0·85 years (0·78-0·92) and 1·2 years (1·1-1·3), respectively. Rising SDI was associated with consistently higher HALE and a somewhat smaller proportion of life spent with functional health loss; however, rising SDI was related to increases in total disability. Many countries and territories in central America and eastern sub-Saharan Africa had increasingly lower rates of disease burden than expected given their SDI. At the same time, a subset of geographies recorded a growing gap between observed and expected levels of DALYs, a trend driven mainly by rising burden due to war, interpersonal violence, and various NCDs. INTERPRETATION: Health is improving globally, but this means more populations are spending more time with functional health loss, an absolute expansion of morbidity. The proportion of life spent in ill health decreases somewhat with increasing SDI, a relative compression of morbidity, which supports continued efforts to elevate personal income, improve education, and limit fertility. Our analysis of DALYs and HALE and their relationship to SDI represents a robust framework on which to benchmark geography-specific health performance and SDG progress. Country-specific drivers of disease burden, particularly for causes with higher-than-expected DALYs, should inform financial and research investments, prevention efforts, health policies, and health system improvement initiatives for all countries along the development continuum. FUNDING: Bill & Melinda Gates Foundation

Loco-regional staging of cervical carcinoma: Is there a place for Multidetector CT?

Objectives: Computer tomography (CT) is the most widely used diagnostic modality in the routine evaluation of distant metastatic disease. We aimed to evaluate the role of Multidetector CT (MDCT) in local staging of cervical malignancies. Patients and methods: In this prospective study 26 patients with pathologically proven cervical malignancies performed postcontrast MDCT of the abdomen and pelvis for local staging. Reconstruction of images was performed in the workstation. In a sample of 12 patients an extended study in which delayed images were obtained for more accurate ureteric evaluation. Data were analyzed using SPSS and McNemar test was used to calculate accuracy. Results: The overall accuracy of CT was 61.5% excluding the discrepancy in staging between CT and examination under anesthesia (EUA) due to distant metastases (three cases had distant metastases in CT which was not evaluated in EUA). This value was raised to 77% if vagina was assessed clinically rather than by CT. Conclusion: In cervical cancer; CT gave better results in staging of advanced cases than in early staged ones. Local staging was improved by acquisition of delayed scans

The burden of mental disorders in the Eastern Mediterranean region, 1990-2015: findings from the global burden of disease 2015 study

Mokdad AH, Charara R, El Bcheraoui C, et al. The burden of mental disorders in the Eastern Mediterranean region, 1990-2015: findings from the global burden of disease 2015 study. INTERNATIONAL JOURNAL OF PUBLIC HEALTH. 2018;63(Suppl. 1):25-37.Mental disorders are among the leading causes of nonfatal burden of disease globally. We used the global burden of diseases, injuries, and risk factors study 2015 to examine the burden of mental disorders in the Eastern Mediterranean region (EMR). We defined mental disorders according to criteria proposed in the diagnostic and statistical manual of mental disorders IV and the 10th International Classification of Diseases. Mental disorders contributed to 4.7% (95% uncertainty interval (UI) 3.7-5.6%) of total disability-adjusted life-years (DALYs), ranking as the ninth leading cause of disease burden. Depressive disorders and anxiety disorders were the third and ninth leading causes of nonfatal burden, respectively. Almost all countries in the EMR had higher age-standardized mental disorder DALYs rates compared to the global level, and in half of the EMR countries, observed mental disorder rates exceeded the expected values. The burden of mental disorders in the EMR is higher than global levels, particularly for women. To properly address this burden, EMR governments should implement nationwide quality epidemiological surveillance of mental disorders and provide adequate prevention and treatment services