The Effects of Air Pollution on Cardiovascular and Respiratory Causes of Emergency Admission

Introduction: Today, air pollution is one of the critical problems in metropolitans and necessary preparations are needed for confronting with this crisis. The present study was based on the goal of determining the relation of air pollutant levels with the rate of emergency admission for respiratory and cardiovascular patients. Methods: In the present retrospective cross- sectional study, all respiratory and cardiovascular patients, referred to emergency department during 2012, was assessed. The meteorological and pollution data were collected. Information of the numbers and dates (month, day) of daily admission of respiratory and cardiovascular diseases was achieved from hospital's electronic registration system. The relation of air pollution and respiratory and cardiovascular admissions were analyzed by Generalize additive model (GAM). Results: Totally 5922 patients were assessed included 4048 (68.36%) cardiovascular and 1874 (31.64%) respiratory disease. Carbon monoxide (CO) level was independent risk factor of cardiovascular disease on the same day (RR=1.49; 95% CI: 1.25- 1.77; P<0.001), the last day (RR=1.22; 95% CI: 1.02- 1.45; P=0.03), and the two last days (RR=1.3; 95% CI: 1.09- 1.54; P<0.001). The same process was similarly repeated for ozone (O3). In addition, the O3 level in the same day (RR=1.49; 95% CI: 1.25- 1.77; P<0.001), the last day (RR=1.22; 95% CI: 1.02- 1.45; P=0.03), the two last days (RR=1.3; 95% CI: 1.09- 1.54; P<0.001), and the last weak (RR=1.004; 95% CI: 1.0007-1.008; P=0.02) were independent risk factors of respiratory admissions. The increased level of particulate matter less than 2.5 micrometers in diameter (PM2.5) like O3 led to grow the admissions in emergency department with respiratory causes. Conclusion: The findings of the present study suggested that rising the levels of CO and O3 during two days leads to a significant increase in cardiovascular admission in the third day. Furthermore, increase the O3, PM2.5, nitrogen oxides (NO2), and CO levels causes to rising respiratory admissions in emergency department

Assessment of systemic effects of ginger on salivation in patients with post-radiotherapy xerostomia

BACKGROUND AND AIM: Our aim was to assess the clinical efficacy of ginger capsule (Zintoma herbal capsule) in the relief of symptoms in patients with post-radiotherapy xerostomia. METHODS: This study was a randomized double-blind, parallel clinical trial of ginger usage in patients with post-radiotherapy xerostomia. Sixty-one subjects were selected from patients with xerostomia of Imam Khomeini Cancer Institute, Tehran, Iran. Subject-based dry mouth scores derived from 100 mm visual analogue scales (VAS) were recorded at baseline. Patients also completed a questionnaire on the first visit regarding the symptoms of xerostomia. The patients received ginger capsule (30 persons) or placebo (31 persons) three times daily over a 2-weeks period. At the end of day 14, dry mouth scores derived from VAS were recorded again and patients responded to the additional variables regarding dry mouth symptoms and quality of life issues. P < 0.05 was considered significant. Data were analyzed using SPSS. RESULTS: The mean treatment effect on day 14 was 33.7 ± 20.9 mm in the ginger group and 23.6 ± 17.3 mm in the placebo group. The analysis indicated marginally significant improvement of xerostomia with ginger prescription (P = 0.057). At the end of intervention there was no significant difference between the two groups regarding improvement of quality of life or dry mouth symptoms. CONCLUSION: It seems that ginger could be helpful in the treatment of xerostomia. Since ginger is considered a safe herbal medicine with only few and insignificant adverse/side effects further studies in larger group of patients are recommended to provide the effect of ginger on different complaints of xerostomia. KEYWORDS: Ginger, Radiation, Xerostomi

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950-2019 : a comprehensive demographic analysis for the Global Burden of Disease Study 2019

Background: Accurate and up-to-date assessment of demographic metrics is crucial for understanding a wide range of social, economic, and public health issues that affect populations worldwide. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 produced updated and comprehensive demographic assessments of the key indicators of fertility, mortality, migration, and population for 204 countries and territories and selected subnational locations from 1950 to 2019. Methods: 8078 country-years of vital registration and sample registration data, 938 surveys, 349 censuses, and 238 other sources were identified and used to estimate age-specific fertility. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate age-specific fertility rates for 5-year age groups between ages 15 and 49 years. With extensions to age groups 10–14 and 50–54 years, the total fertility rate (TFR) was then aggregated using the estimated age-specific fertility between ages 10 and 54 years. 7417 sources were used for under-5 mortality estimation and 7355 for adult mortality. ST-GPR was used to synthesise data sources after correction for known biases. Adult mortality was measured as the probability of death between ages 15 and 60 years based on vital registration, sample registration, and sibling histories, and was also estimated using ST-GPR. HIV-free life tables were then estimated using estimates of under-5 and adult mortality rates using a relational model life table system created for GBD, which closely tracks observed age-specific mortality rates from complete vital registration when available. Independent estimates of HIV-specific mortality generated by an epidemiological analysis of HIV prevalence surveys and antenatal clinic serosurveillance and other sources were incorporated into the estimates in countries with large epidemics. Annual and single-year age estimates of net migration and population for each country and territory were generated using a Bayesian hierarchical cohort component model that analysed estimated age-specific fertility and mortality rates along with 1250 censuses and 747 population registry years. We classified location-years into seven categories on the basis of the natural rate of increase in population (calculated by subtracting the crude death rate from the crude birth rate) and the net migration rate. We computed healthy life expectancy (HALE) using years lived with disability (YLDs) per capita, life tables, and standard demographic methods. Uncertainty was propagated throughout the demographic estimation process, including fertility, mortality, and population, with 1000 draw-level estimates produced for each metric. Findings: The global TFR decreased from 2·72 (95% uncertainty interval [UI] 2·66–2·79) in 2000 to 2·31 (2·17–2·46) in 2019. Global annual livebirths increased from 134·5 million (131·5–137·8) in 2000 to a peak of 139·6 million (133·0–146·9) in 2016. Global livebirths then declined to 135·3 million (127·2–144·1) in 2019. Of the 204 countries and territories included in this study, in 2019, 102 had a TFR lower than 2·1, which is considered a good approximation of replacement-level fertility. All countries in sub-Saharan Africa had TFRs above replacement level in 2019 and accounted for 27·1% (95% UI 26·4–27·8) of global livebirths. Global life expectancy at birth increased from 67·2 years (95% UI 66·8–67·6) in 2000 to 73·5 years (72·8–74·3) in 2019. The total number of deaths increased from 50·7 million (49·5–51·9) in 2000 to 56·5 million (53·7–59·2) in 2019. Under-5 deaths declined from 9·6 million (9·1–10·3) in 2000 to 5·0 million (4·3–6·0) in 2019. Global population increased by 25·7%, from 6·2 billion (6·0–6·3) in 2000 to 7·7 billion (7·5–8·0) in 2019. In 2019, 34 countries had negative natural rates of increase; in 17 of these, the population declined because immigration was not sufficient to counteract the negative rate of decline. Globally, HALE increased from 58·6 years (56·1–60·8) in 2000 to 63·5 years (60·8–66·1) in 2019. HALE increased in 202 of 204 countries and territories between 2000 and 2019

Evaluation of Effects of Zingiber officinale on Salivation in Rats

There are some herbal plants in Iranian traditional system of medicine which are believed to be excellent remedies to alleviate the symptoms of xerostomia. The aim of the present study was to evaluate the effect of systemic administration of seven different herbal extracts on the rate of salivation in rats. The extracts of 7 herbs; Zingiber officinale Roscoe (Zingiberaceae), Citrus sinensis (L.) Osbeck (Rutaceae), Artemisia absinthium L. (Asteraceae), Cichorium intybus L. (Asteraceae), Pimpinella anisum L.(Apiaceae), Portulaca oleracea L.(Portulacaceae), Tribulus terrestris L. (Zygophyllaceae) were prepared. Nine groups of animals (including negative and positive control groups) were used and seven rats were tested in each group. After the injection of extracts, saliva volume was measured gravimetrically in four continuous seven-minute intervals. The results showed that after injection of ginger extracts salivation was significantly higher as compared to the negative control group and other herbal extracts in all of the four intervals (P<0.01). The peak action of the ginger was during the first 7-minute interval and following this, salivation decreased to some extent. The present study suggests that the extract of Zingiber offiicianle can increase the rate of salivation significantly in animal model. Further investigations on different constituents of ginger seem to be essential to identify the responsible constituent for stimulation of saliva secretion

Assessment of systemic effects of ginger on salivation in patients with post-radiotherapy xerostomia

BACKGROUND AND AIM: Our aim was to assess the clinical efficacy of ginger capsule (Zintoma herbal capsule) in the relief of symptoms in patients with post-radiotherapy xerostomia. METHODS: This study was a randomized double-blind, parallel clinical trial of ginger usage in patients with post-radiotherapy xerostomia. Sixty-one subjects were selected from patients with xerostomia of Imam Khomeini Cancer Institute, Tehran, Iran. Subject-based dry mouth scores derived from 100 mm visual analogue scales (VAS) were recorded at baseline. Patients also completed a questionnaire on the first visit regarding the symptoms of xerostomia. The patients received ginger capsule (30 persons) or placebo (31 persons) three times daily over a 2-weeks period. At the end of day 14, dry mouth scores derived from VAS were recorded again and patients responded to the additional variables regarding dry mouth symptoms and quality of life issues. P < 0.05 was considered significant. Data were analyzed using SPSS. RESULTS: The mean treatment effect on day 14 was 33.7 ± 20.9 mm in the ginger group and 23.6 ± 17.3 mm in the placebo group. The analysis indicated marginally significant improvement of xerostomia with ginger prescription (P = 0.057). At the end of intervention there was no significant difference between the two groups regarding improvement of quality of life or dry mouth symptoms. CONCLUSION: It seems that ginger could be helpful in the treatment of xerostomia. Since ginger is considered a safe herbal medicine with only few and insignificant adverse/side effects further studies in larger group of patients are recommended to provide the effect of ginger on different complaints of xerostomia

Prevalence of celiac disease in Iranian patients with type 1 diabetes: A systematic review and meta-analysis

Patients with type 1 diabetes mellitus (T1DM) are at high risk for celiac disease (CD) due to the common genetic background and interaction between environmental and immunological factors. The purpose of this systematic review and meta-analysis was to estimate the prevalence of CD among Iranian patients with type 1 diabetes. The search for articles was conducted using the following keywords: ``celiac disease,'' ``celiac,'' ``coeliac disease,'' ``diabetes,'' ``Iran,'' and all other possible combinations of these terms. The following databases were searched from inception to June 2019: Scientific Information Database (SID), MagIran, Web of Science, PubMed, and Scopus. Meta-analysis was performed using the random-effects models, and the heterogeneity of results across the studies was assessed using the Cochran's Q test and quantified by the I-2 statistic. Data analysis was performed by Stata version 14. A total of 14 papers were included in the meta-analysis, involving 2030 Iranian patients with T1DM. The pooled prevalence of CD in patients with T1DM was 5% (95% CI 3-7). The prevalence of CD in Tehran (4%; 95% CI 1-6) was lower than in other provinces of the country (6%; 95% CI 4-8). Meta-regression analysis showed that, with increasing sample size, the prevalence of CD was significantly reduced (p = 0.018).Given the adverse effects of CD , such as osteoporosis and malignancy (especially lymphoma), patients with T1DM must be screened for CD