High prevalence of chronic kidney disease in Iran: a large population-based study

<p>Abstract</p> <p>Background</p> <p>Chronic kidney disease (CKD) is a global public health threat, associated with an alarming increase in morbidity and mortality. The importance is the worldwide increase in its incidence and prevalence.</p> <p>Methods</p> <p>In this cross-sectional study, we estimate the prevalence and determine the associated factors of chronic kidney disease in a representative sample of 10063 participants aged over 20 years, in Tehran, Iran. Chronic kidney disease was defined as estimated glomerular filtration rate less than 60 mL/min/1.73 m2. Glomerular filtration rate was estimated from abbreviated prediction equation provided by the Modification of Diet in Renal Disease study (MDRD).</p> <p>Results</p> <p>Overall prevalence of CKD with the abbreviated MDRD equation was 18.9% (95% confidence interval (CI) 18.2, 20.6). Age adjusted prevalence of CKD was 14.9% (95%CI 14.2, 15.6). Factors associated to CKD include age(years)(odds ratio(OR) 1.1, 95% CI 1.0 to 1.2), female gender (OR 3.1, 95% CI 2.6, 3.7), BMI (BMI 25 to <30 OR 1.5, 95% CI 1.3, 1.8 and BMI ≥ 30 OR 1.6, 95% CI 1.3, 2.0), high waist circumference (OR 1.2, 95% CI 1.1, 1.4), hypertension (OR 1.2, 95% CI 1.1, 1.4), and dyslipidemia (OR 1.3, 95% CI 1.1, 1.5).</p> <p>Conclusion</p> <p>CKD with its high prevalence poses a definite health threat in Iran.</p

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BackgroundDisorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.MethodsWe estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.FindingsGlobally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.InterpretationAs the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed

Viability of focal dose escalation to prostate cancer intraprostatic lesions using HDR prostate brachytherapy

PURPOSE: This study aimed to determine the viability of focal dose escalation to prostate cancer intraprostatic lesions (IPLs) from multiparametric magnetic resonance (mpMRI) and prostate-specific membrane antigen positron emission tomography (PSMA-PET) images using high-dose-rate (HDR) prostate brachytherapy (pBT). METHODS AND MATERIALS: Retrospective data from 20 patients treated with HDR pBT was utilized. The interobserver contouring variability of 5 observers was quantified using the dice similarity coefficient (DSC) and mean distance to agreement (MDA). Uncertainty in propagating IPL contours to trans-rectal ultrasound (TRUS) was quantified using a tissue equivalent prostate phantom. Feasibility of incorporating IPLs into HDR pBT planning was tested on retrospective patient data. RESULTS: The average observer DSC was 0.65 (PSMA-PET) and 0.52 (mpMRI). The uncertainty in propagating IPL contours was 0.6 mm (PSMA-PET), and 0.4 mm (mpMRI). Uncertainties could be accounted for by expanding IPL contours by 2 mm to create IPL PTVs. The mean D98% achieved using HDR pBT was 166% and 135% for the IPL and IPL PTV contours, respectively. CONCLUSIONS: Focal dose escalation to IPLs identified on either PSMA-PET or mpMRI is viable using TRUS-based HDR pBT. Utilizing HDR pBT allows dose escalation of up to 166% of the prescribed dose to the prostate

Does a peer review group consensus process for MR-Linac patients affect clinical care? Evaluation of impact and feasibility

Background and purpose: Peer review is an important component of quality assurance in radiotherapy. To our knowledge, there are no studies reporting on the feasibility and outcomes of the peer review process for magnetic resonance (MR) guided radiotherapy (MRgRT) on the MR linear accelerator (MR-Linac) despite the planning complexity involved and its evolving clinical indications. This study aimed to quantify the rate of change in treatment plans post-peer review and the time and resources required. Materials and methods: Fifty-five cases presented at weekly MR-Linac peer review meetings across two centres from 8 June to 21 September 2023 were prospectively collected. Cases were analysed to determine the rate and extent of plan changes based on the Peer Review Audit Tool for radiation oncology (PRAT) developed by the Royal Australian and New Zealand College of Radiologists (RANZCR). Results: Peer review resulted in changes to 36.4 % of treatment plans (n = 20), with 3.6 % (n = 2) having major changes requiring deferment of treatment. The most frequent changes were to organs at risk (OAR) volumes involving both delineation and increased OAR sparing (16.4 %, n = 9), total dose and fractionation (10.9 %, n = 6) and target volume dose coverage (5.5 %, n = 3). Patients with SBRT plans (39.1 % cf 22.2 %), oligometastatic/ oligoprogressive sites (38.1 % cf 30.7 %) and reirradiation cases (41.2 % cf 34.2 %) had higher rates of change. Cases took a mean of 7 min (range 2–15 minutes) to discuss. Conclusion: The high rates of plan changes support the value of peer review in MRgRT. We recommend, where possible that all MRgRT cases, particularly those involving SBRT plans, oligometastatic/oligoprogressive sites, and/or reirradiation, be subject to peer revie

Global Burden of Cardiovascular Diseases and Risks, 1990-2022

The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) is a multinational collaborative research study with >10,000 collaborators around the world. GBD generates a time series of summary measures of health, including prevalence, cause-specific mortality (CSMR), years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs) to provide a comprehensive view of health burden for a wide range of stakeholders including clinicians, public and private health systems, ministries of health, and other policymakers. These estimates are produced for 371 causes of death and 88 risk factors according to mutually exclusive, collectively exhaustive hierarchies of health conditions and risks. The study is led by a principal investigator and governed by a study protocol, with oversight from a Scientific Council, and an Independent Advisory Committee.1 GBD is performed in compliance with Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER).2 GBD uses de-identified data, and the waiver of informed consent was reviewed and approved by the University of Washington Institutional Review Board (study number 9060). This almanac presents results for 18 cardiovascular diseases (CVD) and the CVD burden attributed to 15 risk factors (including an aggregate grouping of dietary risks) by GBD region. A summary of methods follows. Additional information can be found online at https://ghdx.healthdata.org/record/ihme-data/cvd-1990-2022, including:Funding was provided by the Bill and Melinda Gates Foundation, and the American College of Cardiology Foundation. The authors have reported that they have no relationships relevant to the contents of this paper to disclose. The contents and views expressed in this report are those of the authors and do not necessarily reflect the official views of the National Institutes of Health, the Department of Health and Human Services, the U.S. Government, or the affiliated institutions

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

International audienc