4-(9-Anthr­yl)-1-(3-bromo­phen­yl)spiro­[azetidine-3,9′-xanthen]-2-one

In the title mol­ecule, C35H22BrNO2, the four-membered ring of the β-lactam unit is nearly planar [maximum deviation = 0.003 (3) Å] and makes dihedral angles of 87.07 (15), 59.80 (16) and 20.81 (19)°, respectively, with the xanthene system, the anthracene system and the bromo-substituted benzene ring. The mol­ecular conformation is stabilized by weak intra­molecular C—H⋯O and C—H⋯N hydrogen bonds. The crystal structure features weak C—H⋯π inter­actions

4-(9-Anthr­yl)-1-(1-naphth­yl)spiro­[azetidine-3,9′-xanthen]-2-one n-hexane hemisolvate

In the title compound, C39H25NO2·0.5C6H14, the β-lactam ring is nearly planar [maximum deviation of 0.012 (2) Å from the mean plane] and makes dihedral angles of 36.41 (13), 88.87 (13) and 54.16 (12)°, respectively, with the naphthalene, xanthene and anthracene ring systems. The mol­ecular conformation is stabilized by intra­molecular C—H⋯O and C—H⋯N contacts. The complete solvent mol­ecule is generated by inversion. In the crystal structure, mol­ecules are linked to each other by C—H⋯π inter­actions

4-(9-Anthr­yl)-1-phenylspiro­[azetidine-3,9′-xanthen]-2-one

The β-lactam ring of the title compound, C35H23NO2, is nearly planar with a maximum deviation of 0.003 (3) Å from the mean plane. It makes dihedral angles of 17.4 (2), 85.22 (17) and 65.39 (16)°, respectively, with the phenyl, xanthene and anthracene ring systems. In the crystal structure, there are intra­molecular C—H⋯O and C—H⋯N contacts and mol­ecules are also linked by C—H⋯π inter­actions

Comparison of International Study Group Criteria and International Criteria for Behcet's Disease in the Azeri population of Iran

Introduction: Behcet's disease (BD) is a chronic systemic inflammatory disease affecting multiple organs and systems such as mucosa, skin, eye, joints and cardiovascular, nervous and gastrointestinal systems. Various criteria are proposed for the assessment of BD. This study was designed to compare performance of two internationally collaborated criteria for diagnosis of BD, namely International Study Group (ISG) criteria and International Criteria for Behcet's Disease (ICBD) in the Azeri population of Iran. Methods: In a descriptive analytical study, 859 consecutive patients with one of the major clinical manifestations of BD were included. All patients were examined and evaluated by an expert rheumatologist and diagnosis was confirmed clinically. All patients were assessed by ISG and ICBD criteria. Finally, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of both criteria were calculated. Results: We included 859 patients in this study. BD was diagnosed in 211 patients. Sensitivity, specificity and accuracy of ISG criteria were 64.9%, 100%, and 91.4%, respectively. Sensitivity, specificity and accuracy of ICBD criteria were 94.7%, 99.6% and 98.5%, respectively. Conclusion: Based on the finding of the present study, sensitivity and accuracy of ICBD criteria for diagnosis of BD in Azeri population are higher than ISG criteria. So we propose to use ICBD criteria for the evaluation of patients with suspected BD to decrease the rate of missed diagnosis

4-(9-Anthr­yl)-1-(2-methoxy­phen­yl)spiro­[azetidin-3,9′-xanthen]-2-one

The stabilized conformation of the title compound, C36H25NO3, 4-(9-anthryl)-1-(2-methoxyphenyl)-spiro[azetid­in-3,9′-xanthen]-2-one, may be compared with that of the isomeric compound 4-(9-anthr­yl)-1-(4-methoxy­phen­yl)spiro­[azetidin-3,9′-xanthen]-2-one. In the title isomer, the meth­oxy group is slightly twisted out of the plane of the attached benzene ring, with a C—O—C—C torsion angle of 31.5 (2)°. Its β-lactam ring is essentially planar, with a maximum deviation of −0.021 (1) Å. The β-lactam ring makes dihedral angles of 18.815 (9), 83.33 (7) and 53.62 (8)° with the mean planes of the benzene, xanthene and anthracene ring systems, respectively. The structure is stabilized by C—H⋯π, C—H⋯N and C—H⋯O inter­actions

4-(9-Anthr­yl)-1-(2,4-dimethoxy­phen­yl)spiro­[azetidine-3,9′-xanthen]-2-one

The title compound, C37H27NO4, crystallizes with two mol­ecules in the asymmetric unit. The β-lactam ring of each mol­ecule is very nearly planar, with maximum deviations of 0.001 (2) and 0.017 (2) Å in the two mol­ecules. The crystal structure is stabilized by inter­molecular C—H⋯O and C—H⋯N contacts, as well as by weak C—H⋯π inter­actions

4-(9-Anthr­yl)-1-(4-methoxy­phen­yl)spiro­[azetidin-3,9′-xanthen]-2-one

In the title mol­ecule, C36H25NO3, the β-lactam ring is essentially planar, with a dihedral angle of 3.3 (2)° between the two separate three-atom N/C/C planes. The β-lactam ring makes dihedral angles of 28.45 (14), 87.4 (1) and 51.8 (1)° with the mean planes of the benzene, xanthene and anthracene ring systems, respectively. In addition to a weak intra­molecular C—H⋯N hydrogen bond, the crystal structure is stabilized by two weak inter­molecular C—H⋯O hydrogen bonds

Disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE) in Iran and its neighboring countries, 1990–2015

BACKGROUND: Summary measures of health are essential in making estimates of health status that are comparable across time and place. They can be used for assessing the performance of health systems, informing effective policy making, and monitoring the progress of nations toward achievement of sustainable development goals. The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015) provides disability-adjusted life-years (DALYs) and healthy life expectancy (HALE) as main summary measures of health. We assessed the trends of health status in Iran and 15 neighboring countries using these summary measures. METHODS: We used the results of GBD 2015 to present the levels and trends of DALYs, life expectancy (LE), and HALE in Iran and its 15 neighboring countries from 1990 to 2015. For each country, we assessed the ratio of observed levels of DALYs and HALE to those expected based on socio-demographic index (SDI), an indicator composed of measures of total fertility rate, income per capita, and average years of schooling. RESULTS: All-age numbers of DALYs reached over 19 million years in Iran in 2015. The all-age number of DALYs has remained stable during the past two decades in Iran, despite the decreasing trends in all-age and age-standardized rates. The all-cause DALY rates decreased from 47,200 in 1990 to 28,400 per 100,000 in 2015. The share of non-communicable diseases in DALYs increased in Iran (from 42% to 74%) and all of its neighbors between 1990 and 2015; the pattern of change is similar in almost all 16 countries. The DALY rates for NCDs and injuries in Iran were higher than global rates and the average rate in High Middle SDI countries, while those for communicable, maternal, neonatal, and nutritional disorders were much lower in Iran. Among men, cardiovascular diseases ranked first in all countries of the region except for Bahrain. Among women, they ranked first in 13 countries. Life expectancy and HALE show a consistent increase in all countries. Still, there are dissimilarities indicating a generally low LE and HALE in Afghanistan and Pakistan and high expectancy in Qatar, Kuwait, and Saudi Arabia. Iran ranked 11th in terms of LE at birth and 12th in terms of HALE at birth in 1990 which improved to 9th for both metrics in 2015. Turkey and Iran had the highest increase in LE and HALE from 1990 to 2015 while the lowest increase was observed in Armenia, Pakistan, Kuwait, Kazakhstan, Russia, and Iraq. CONCLUSIONS: The levels and trends in causes of DALYs, life expectancy, and HALE generally show similarities between the 16 countries, although differences exist. The differences observed between countries can be attributed to a myriad of determinants, including social, cultural, ethnic, religious, political, economic, and environmental factors as well as the performance of the health system. Investigating the differences between countries can inform more effective health policy and resource allocation. Concerted efforts at national and regional levels are required to tackle the emerging burden of non-communicable diseases and injuries in Iran and its neighbors

Burden of cancer in the Eastern Mediterranean Region, 2005-2015: findings from the Global Burden of Disease 2015 Study

Fitzmaurice C, Alsharif U, El Bcheraoui C, et al. Burden of cancer in the Eastern Mediterranean Region, 2005-2015: findings from the Global Burden of Disease 2015 Study. INTERNATIONAL JOURNAL OF PUBLIC HEALTH. 2018;63(Suppl. 1):151-164.To estimate incidence, mortality, and disability-adjusted life years (DALYs) caused by cancer in the Eastern Mediterranean Region (EMR) between 2005 and 2015. Vital registration system and cancer registry data from the EMR region were analyzed for 29 cancer groups in 22 EMR countries using the Global Burden of Disease Study 2015 methodology. In 2015, cancer was responsible for 9.4% of all deaths and 5.1% of all DALYs. It accounted for 722,646 new cases, 379,093 deaths, and 11.7 million DALYs. Between 2005 and 2015, incident cases increased by 46%, deaths by 33%, and DALYs by 31%. The increase in cancer incidence was largely driven by population growth and population aging. Breast cancer, lung cancer, and leukemia were the most common cancers, while lung, breast, and stomach cancers caused most cancer deaths. Cancer is responsible for a substantial disease burden in the EMR, which is increasing. There is an urgent need to expand cancer prevention, screening, and awareness programs in EMR countries as well as to improve diagnosis, treatment, and palliative care services

Burden of cardiovascular diseases in the Eastern Mediterranean Region, 1990-2015 : findings from the Global Burden of Disease 2015 study

To report the burden of cardiovascular diseases (CVD) in the Eastern Mediterranean Region (EMR) during 1990-2015. We used the 2015 Global Burden of Disease study for estimates of mortality and disability-adjusted life years (DALYs) of different CVD in 22 countries of EMR. A total of 1.4 million CVD deaths (95% UI: 1.3-1.5) occurred in 2015 in the EMR, with the highest number of deaths in Pakistan (465,116) and the lowest number of deaths in Qatar (723). The age-standardized DALY rate per 100,000 decreased from 10,080 in 1990 to 8606 in 2015 (14.6% decrease). Afghanistan had the highest age-standardized DALY rate of CVD in both 1990 and 2015. Kuwait and Qatar had the lowest age-standardized DALY rates of CVD in 1990 and 2015, respectively. High blood pressure, high total cholesterol, and high body mass index were the leading risk factors for CVD. The age-standardized DALY rates in the EMR are considerably higher than the global average. These findings call for a comprehensive approach to prevent and control the burden of CVD in the region.Peer reviewe