Comparing the patterns of hypertension and type 2 diabetes mellitus in patients with colorectal cancer

Background: Type 2 diabetes mellitus (DM) and hypertension are worldwide epidemic. Colorectal cancer (CRC) is the most prevalent gastrointestinal cancer in Iran. Prevalence of type 2 diabetes mellitus and hypertension in the patients with colorectal cancer had not reported in Iran, before this study. Methods: Overall, 2570 individual-year follow-ups were conducted for 1127 patients with colorectal cancer. For diagnosis of type 2 diabetes mellitus, fasting blood sugar and glycosylated hemoglobin tests were used and for that of hypertension, blood pressure was measured in two turns. The descriptive indices were calculated and the mean and median survivals, from colorectal cancer diagnosis time, were calculated using survival analysis and the comparison among survival times was done through log-rank test. Stata12 software was used for data analysis. Findings: The prevalences of hypertension and type 2 diabetes mellitus in the patients with colorectal cancer were 13.38 (95 CI: 11.1-15.8) and 8.69 (95 CI: 7.0-10.7), respectively. Median survival time in patients with hypertension and diabetes mellitus were 8.52 and 4.90 years, respectively. According to log-rank test, no significant difference was observed between the survival time of patients with colorectal cancer suffering from hypertension and type 2 diabetes mellitus. Conclusion: The obtained findings in this study indicate that survival time in patients with type 2 diabetes mellitus is less than those with hypertension; but two metabolic diseases have same effect on survival rate of the patients with colorectal cancer. © 2014, Isfahan University of Medical Sciences(IUMS). All rights reserved

Traffic Police Effectiveness and Efficiency Evaluations, an Overview of Methodological Considerations

Context: Every government implements various policies to mitigate road traffic injuries (RTIs). Many of these interventions are performed by traffic police. To evaluate effectiveness and efficiency of police enforcement, numerous studies have been conducted. Potential capabilities of epidemiology could get opportunity to improve these studies. The aim of this study was to extract and discuss some related methodological points of traffic police effectiveness and efficiency from related studies, in view of epidemiology discipline. Evidence Acquisition: Related articles were searched with “traffic police”, “effectiveness”, “efficiency” and “road safety” keywords in ScienceDirect, PubMed and Safetylit databases. Related papers were selected and read carefully to summarize and discuss the epidemiological points with aims of giving clues to improve quality of studies. Results: From a total of 797 articles, 20 were eligible which among them 17 articles were about effectiveness and 3 of them were about efficiency evaluations. Discussed points were the method of study, taking a holistic view to all positive and negative side effects, desired inputs and outputs, relation pattern between police enforcement and outcome and potential confounders. Conclusions: Better understanding of the effectiveness and efficiency mechanism and having valid evaluation required considering specific theories and points in this field. Applying a dynamic approach with considering epidemiological concepts and sophisticated statistical models could improve quality of studies in this field

Rate of the incidence of hospital-acquired infections in Iran based on the data of the national nosocomial infections surveillance

Hospital-acquired infections (HAIs) lead to increased length of hospital stay, inappropriate use of broad-spectrum antibiotics and multiple antibiotic resistance. This study aimed to investigate the rate of HAIs in Iran. In this multi-centre study, the rate of HAIs was calculated based on the data collected through Iranian nosocomial infections surveillance for patients with HAIs, as well as through hospital statistics and information systems on hospital-related variables. Data were analysed using STATA software; in addition, ArcGIS was used for plotting the geographical distribution of HAIs by different provinces. The mean age of the 107 669 patients affected by HAIs was 52 ± 26.71 years. Just over half (51.55) of the patients were male. The overall rate of HAIs was 26.57 per 1000 patients and 7.41 per 1000 patient-days. The most common HAIs were urinary tract infections (26.83; 1.99 per 1000 patient-days), ventilator-associated events (20.28; 1.5 per 1000 patient-days), surgical-site infections (19.73; 1.45 per 1000 patient-days) and bloodstream infections (13.51; 1 per 1000 patient-days), respectively. The highest rate of HAIs was observed in intensive care units. Device, catheter and ventilator-associated infections accounted for 38.72, 18.79 and 16 of all HAIs, respectively. Based on the results, HAIs are common in intensive care units, and urinary tract infections and device-related infections are more prevalent in Iran. To reduce HAIs it is recommended to implement appropriate policies and interventions, train staff about the use of devices, and prepare and update protocols and guidelines for improving the quality of care. © 2020 The Author(s

Comparison of the effect of cycloplegic versus NSAID eye drops on pain after photorefractive keratectomy

Purpose: To compare the effect of Homatropine and Diclofenac eye drops for reducing pain after photorefractive keratectomy (PRK). Methods: This randomized, double-masked, interventional study included 32 patients (64 eyes) who underwent bilateral PRK. After operation, patients received Homatropine eye drops in one eye and Diclofenac eye drops in the fellow eye for 48 h. The level of pain was evaluated using visual analogue scale (VAS), verbal rating scale (VRS), and pain rating index (PRI) at 0.5, 24, and 48 h after operation. Results: The level of pain was statistically similar between the two eyes half an hour after operation; however, Diclofenac eyes had significantly less pain 24 h after operation (1.7 ± 1.4 vs 5.8 ± 2.1, P < 0.001 for VAS, 0.6 ± 0.6 vs 2.4 ± 1.1, P < 0.001 for VRS, and 3.4 ± 3.4 vs 12.0 ± 6.9, P < 0.001 for PRI, respectively). Also, 48 h after surgery, the pain scores were less in the Diclofenac eyes (1.6 ± 1.8 vs 3.4 ± 2.8, P < 0.001 for VAS, 0.6 ± 0.6 vs 1.2 ± 0.9, P < 0.001 for VRS, and 3.3 ± 3.7 vs 6.5 ± 6.2, P < 0.001 for PRI). No case with delayed epithelial healing in both groups was observed. Conclusion: The effect of Homatropine seems to be lower compared to Diclofenac for reducing pain after photorefractive keratectomy. © 2015 Iranian Society of Ophthalmology

The national rate of intensive care units-acquired infections, one-year retrospective study in Iran

Background: Hospital-acquired infections (HAIs) in intensive care units (ICUs) are among the avoidable morbidity and mortality causes. This study aimed at investigating the rate of ICU-acquired infections (ICU-AIs) in Iran. Methods: For the purpose of this multi-center study, the rate of ICU-AIs calculated based on the data collected through Iranian nosocomial infections surveillance system and hospital information system. The data expanded based on 12 months of the year (13,632 records in terms of �hospital-ward-month�), and then, the last observation carried forward method was used to replace the missing data. Results: The mean (standard deviation) age of 52,276 patients with HAIs in the ICUs was 47.37 (30.78) years. The overall rate of ICU-AIs was 96.61 per 1000 patients and 16.82 per 1000 patient-days in Iran�s hospitals. The three main HAIs in the general ICUs were ventilator-associated events (VAE), urinary tract infection (UTI), and pneumonia events & lower respiratory tract infection (PNEU & LRI) infections. The three main HAIs in the internal and surgical ICUs were VAE, UTI, and bloodstream infections/surgical site infections (BSI/SSI). The most prevalent HAIs were BSI, PNEU & LRI and eye, ear, nose, throat, or mouth (EENT) infections in the neonatal ICU and PNEU & LRI, VAE, and BSI in the PICU. Device, catheter, and ventilator-associated infections accounted for 60.96, 18.56, and 39.83 of ICU-AIs, respectively. The ventilator-associated infection rate was 26.29 per 1000 ventilator-days. Based on the Pabon Lasso model, the lowest rates of ICU-AIs (66.95 per 1000 patients and 15.19 patient-days) observed in zone III, the efficient area. Conclusions: HAIs are common in the internal ICU wards. In fact, VAE and ventilator-related infections are more prevalent in Iran. HAIs in the ICUs leads to an increased risk of ICU-related mortality. Therefore, to reduce ICU-AIs, the specific and trained personnel must be responsible for the use of the devices (catheter use and ventilators), avoid over use of catheterization when possible, and remove catheters earlier. © 2021, The Author(s)

Survival rate in patients with ICU-acquired infections and its related factors in Iran�s hospitals

Background: Hospital-acquired infections (HAIs) are a well-known cause of morbidity and mortality in hospitalized patients. This study aimed at investigating the survival rate in patients with ICU-acquired infections (ICU-AIs) and its related factors in Iran�s hospitals. Methods: Data were obtained from the Iranian Nosocomial Infections Surveillance (INIS), which registers all necessary information on the main types of infection from different units of each included hospital. One thousand one hundred thirty-four duplicate cases were removed from the analysis using the variables of name, father�s name, age, hospital code, infection code, and bedridden date. From 2016 to 2019, 32,998 patients diagnosed with ICU-AI from about 547 hospitals. All patients were followed up to February 29, 2020. Results: The median age of patients with ICU-AIs was 61 (IQR = 46) years. 45.5, 20.69, 17.63, 12.08, and 4.09 of infections were observed in general, surgical, internal, neonatal and pediatric ICUs, respectively. Acinetobacter (16.52), E.coli (12.01), and Klebsiella (9.93) were the major types of microorganisms. From total, 40.76 of infected patients (13,449 patients) died. The 1, 3, 6-months and overall survival rate was 70, 25.72, 8.21 1.48 in ICU-AI patients, respectively. The overall survival rate was 5.12, 1.34, 0.0, 51.65, and 31.08 for surgical, general, internal, neonatal and pediatric ICU, respectively. Hazard ratio shows a significant relationship between age, hospitalization-infection length, infection type, and microorganism and risk of death in patients with ICU-AI. Conclusions: Based on the results, it seems that the nosocomial infections surveillance system should be more intelligent. This intelligence should act differently based on related factors such as the age of patients, hospitalization-infection length, infection type, microorganism and type of ward. In other words, this system should be able to dynamically provide the necessary and timely warnings based on the factors affecting the survival rate of infection due to the identification, intervention and measures to prevent the spread of HAIs based on a risk severity system. © 2021, The Author(s)

The global burden of adolescent and young adult cancer in 2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In estimating the global burden of cancer, adolescents and young adults with cancer are often overlooked, despite being a distinct subgroup with unique epidemiology, clinical care needs, and societal impact. Comprehensive estimates of the global cancer burden in adolescents and young adults (aged 15–39 years) are lacking. To address this gap, we analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, with a focus on the outcome of disability-adjusted life-years (DALYs), to inform global cancer control measures in adolescents and young adults. Methods: Using the GBD 2019 methodology, international mortality data were collected from vital registration systems, verbal autopsies, and population-based cancer registry inputs modelled with mortality-to-incidence ratios (MIRs). Incidence was computed with mortality estimates and corresponding MIRs. Prevalence estimates were calculated using modelled survival and multiplied by disability weights to obtain years lived with disability (YLDs). Years of life lost (YLLs) were calculated as age-specific cancer deaths multiplied by the standard life expectancy at the age of death. The main outcome was DALYs (the sum of YLLs and YLDs). Estimates were presented globally and by Socio-demographic Index (SDI) quintiles (countries ranked and divided into five equal SDI groups), and all estimates were presented with corresponding 95% uncertainty intervals (UIs). For this analysis, we used the age range of 15–39 years to define adolescents and young adults. Findings: There were 1·19 million (95% UI 1·11–1·28) incident cancer cases and 396 000 (370 000–425 000) deaths due to cancer among people aged 15–39 years worldwide in 2019. The highest age-standardised incidence rates occurred in high SDI (59·6 [54·5–65·7] per 100 000 person-years) and high-middle SDI countries (53·2 [48·8–57·9] per 100 000 person-years), while the highest age-standardised mortality rates were in low-middle SDI (14·2 [12·9–15·6] per 100 000 person-years) and middle SDI (13·6 [12·6–14·8] per 100 000 person-years) countries. In 2019, adolescent and young adult cancers contributed 23·5 million (21·9–25·2) DALYs to the global burden of disease, of which 2·7% (1·9–3·6) came from YLDs and 97·3% (96·4–98·1) from YLLs. Cancer was the fourth leading cause of death and tenth leading cause of DALYs in adolescents and young adults globally. Interpretation: Adolescent and young adult cancers contributed substantially to the overall adolescent and young adult disease burden globally in 2019. These results provide new insights into the distribution and magnitude of the adolescent and young adult cancer burden around the world. With notable differences observed across SDI settings, these estimates can inform global and country-level cancer control efforts. Funding: Bill &amp; Melinda Gates Foundation, American Lebanese Syrian Associated Charities, St Baldrick's Foundation, and the National Cancer Institute

The global burden of adolescent and young adult cancer in 2019 : a systematic analysis for the Global Burden of Disease Study 2019

Background In estimating the global burden of cancer, adolescents and young adults with cancer are often overlooked, despite being a distinct subgroup with unique epidemiology, clinical care needs, and societal impact. Comprehensive estimates of the global cancer burden in adolescents and young adults (aged 15-39 years) are lacking. To address this gap, we analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, with a focus on the outcome of disability-adjusted life-years (DALYs), to inform global cancer control measures in adolescents and young adults. Methods Using the GBD 2019 methodology, international mortality data were collected from vital registration systems, verbal autopsies, and population-based cancer registry inputs modelled with mortality-to-incidence ratios (MIRs). Incidence was computed with mortality estimates and corresponding MIRs. Prevalence estimates were calculated using modelled survival and multiplied by disability weights to obtain years lived with disability (YLDs). Years of life lost (YLLs) were calculated as age-specific cancer deaths multiplied by the standard life expectancy at the age of death. The main outcome was DALYs (the sum of YLLs and YLDs). Estimates were presented globally and by Socio-demographic Index (SDI) quintiles (countries ranked and divided into five equal SDI groups), and all estimates were presented with corresponding 95% uncertainty intervals (UIs). For this analysis, we used the age range of 15-39 years to define adolescents and young adults. Findings There were 1.19 million (95% UI 1.11-1.28) incident cancer cases and 396 000 (370 000-425 000) deaths due to cancer among people aged 15-39 years worldwide in 2019. The highest age-standardised incidence rates occurred in high SDI (59.6 [54.5-65.7] per 100 000 person-years) and high-middle SDI countries (53.2 [48.8-57.9] per 100 000 person-years), while the highest age-standardised mortality rates were in low-middle SDI (14.2 [12.9-15.6] per 100 000 person-years) and middle SDI (13.6 [12.6-14.8] per 100 000 person-years) countries. In 2019, adolescent and young adult cancers contributed 23.5 million (21.9-25.2) DALYs to the global burden of disease, of which 2.7% (1.9-3.6) came from YLDs and 97.3% (96.4-98.1) from YLLs. Cancer was the fourth leading cause of death and tenth leading cause of DALYs in adolescents and young adults globally. Interpretation Adolescent and young adult cancers contributed substantially to the overall adolescent and young adult disease burden globally in 2019. These results provide new insights into the distribution and magnitude of the adolescent and young adult cancer burden around the world. With notable differences observed across SDI settings, these estimates can inform global and country-level cancer control efforts. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.Peer reviewe

OVARIAN HEMANGIOMA A RARE PATHOLOGIC FINDING

Hemangioma of the ovary is reported in a 66 years old woman. Vascular tumors of the female genital tract are rare, especially those of the ovaiy. Most cases are discovered incidentally. The case presented here was missed clinically

Risk of gestational diabetes mellitus by pre-pregnancy body mass index: A systematic review and meta-analysis

Gestational diabetes mellitus (GDM) is serious health challenges. This study aimed at determining the risk of GDM among pregnant women by pre-pregnancy BMI. Five electronic databases including Medline (PubMed), Scopus, Embase, Web of Science and Google Scholar were searched for literature published form 2015 to January 1, 2021. The pooled estimate risk of GDM among pregnant women was 16.8 (95 CI: 15.3�18.4). The risk of GDM in underweight/normal group and overweight/obese group were 10.7 (95 CI: 9.1�12.4) and 23 (95 CI: 20.2�25.9), respectively. The risk of GDM is high among overweight/obese pregnant women. © 2021 Diabetes Indi