Comparison of social values in health priority setting: the experiences of seven countries

Background: Priority setting is a key function to optimize the allocation of limited healthcare resources. Technical and judgmental criteria are used in priority setting decisions. The present study aims to compare the social values in some countries’ health care system based on Clark-Weale framework.  Methods: We searched the PubMed and Scopus to find published studies on the role of social values in priority setting based on the Clark-Weale framework. We checked references in order to include landmark papers which were not found in the previous step. On the basis of this framework, we subsequently compared content and process values based on which priorities are set in identified studies.    Results: Our review showed that this framework is applied to describe social values in priority setting in Australia, England, China, Germany, Iran, Republic of Korea, Thailand, Latin American countries, and USA. Countries apply the social values in different ways. Some of them consider an extended range of values and some use only a limited number of values. Content values are often more reliable than process values. Contextual characteristics and having committees in operation to advise priority setting tasks had significant roles in taking social values into consideration in the process of health priority setting.  Conclusion: It is difficult to examine how exactly health priority setting decisions are influenced by social values in health systems. However, a comparative picture of values and their relative importance can contribute to understand the status quo and under-represented values

Research Paper: Effectiveness of Corticosteroid Therapy for Caustic Esophageal Injury

Background: Delayed caustic injury complications are common, especially in developing countries, and several treatments have been proposed to prevent the resulting esophageal strictures so far. Although inflammatory nature of caustic injury makes the anti-inflammatory agents a viable option, few studies have investigated these agents. High-dose corticosteroids therapy for reduction of stricture formation in the esophagus after the ingestion of caustic material is still a controversial topic. In this regard, this study aimed to determine the impact of high doses of methylprednisolone in preventing esophageal stricture.Methods: A total of 112 patients with grade II esophageal caustic injury, diagnosed by esophagogastroscopy within 24 hours of injury, were enrolled in our study. The treatment group (n=44) received methylprednisolone (1 g/d for 3 days), pantoprazole, ceftriaxone, and metronidazole and the control group (n=58) received the same regimen excluding methylprednisolone. Endoscopic and radiologic findings were used to compare the severity of the damage to the esophagus and stomach between the two groups.Results: After 8 months of follow-up, stricture development was observed in 3 (5.6%) patients in the treatment group and in 11 (19%) patients in the control group. The difference was statistically significant (P=0.038). The gastric outlet obstruction was observed in 4 (7.4%) patients in the treatment group and in 19 (32.7%) patients in the control group. Again, the difference was statistically significant (P<0.05). There were not any side effects due to the high doses of methylprednisolone in the study group.Conclusion: High doses of methylprednisolone can prevent the development of esophageal stricture in grade II of caustic injury

Post Helicobacter pylori Treatment Histopathological Findings in Laparoscopic Sleeve Gastrectomy Specimens

Background: Obesity nowadays becomes a major medical and social problem in the world. Obesity is a pandemic health problem recognized as a disease of time and is also an important cause of morbidity and mortality. The aim of this study was to investigate the persistent histopathologic changes after Helicobacter pylori (H. pylori) treatment in laparoscopic sleeve gastrectomy (LSG) specimens and correlation between high body mass index (BMI) and histopathological findings. Materials and Methods: Asymptomatic 520 patients were candidate for laparoscopic sleeve gastrectomy (2017-2019) who had not symptom of Helicobacter pylori infection, visually normal endoscopy and had positive H. pylori urease recently. They treated with triple regimen (clarithromycin, amoxicillin for 2 weeks and proton-pump inhibitor (PPI) for 2 month). Eradication was confirmed by urea breath test (UBT). After operation specimens were evaluated histopathologically. Results: Females were 58.3% of the patients. Mean BMI were 44.2 (females) and 46.3 (males). Normal LSG specimens were 58.3%. Most common abnormal histopathology findings were; chronic mild active and inactive gastritis (21.3%), chronic moderate active and inactive gastritis (16.0%), chronic severe active and inactive gastritis (3.3%), had not follicular gastritis, lymphoid aggregates (0.6 %), intestinal metaplasia (0.2%) and PPI effect (0.2%). Significant correlation was observed between the higher patients BMI (BMI>45) with abnormal histopathology findings specially moderate and severe degree of chronic active and inactive gastritis. Conclusion: Patients with higher BMI was at more risk for post H. pylori treatment abnormal pathology like chronic active gastritis which is the risk factor for atrophic gastritis may lead to preventable gastric cancer. Patients with higher BMI (≥45) and H. pylori positive urease test with visually normal endoscopy, mainly candidate for the laparoscopic Roux-en-Y gastric bypass (LRYGB). Permanent endoscopic follow up in these patients are impossible, therefore, endoscopic random tissue mapping even after H. pylori treatment is appropriate

Lung cancer risk and the inhibitors of angiotensinconverting enzyme: A mini-review of recent evidence

Angiotensin-converting enzyme inhibitors (ACEIs) are among the most widely prescribed antihypertensive medications. They are indicated in the management of multiple chronic conditions including hypertension, diabetes mellitus and heart failure. ACEIs prevent angiotensin II (Ang II) production and bradykinin catabolism leading to vasodilation and reduction of arterial blood pressure. Recently, the role of the reninangiotensin system (RAS) inhibitors has become the subject of scrutiny in the treatment of cancer metastasis. The administration of ACEIs, however, has been described to be accompanying with carcinogenic effects

Association between the metabolic syndrome parameters and serum level of uric acid

Introduction: It is well-known that metabolic syndrome is a pathophysiological state with increased risks for diabetes mellitus (DM) and the atherosclerotic cardiovascular disease. Moreover, hyperuricemia can be considered as the main component in metabolic syndrome. Objectives: The present research aimed at the investigation of the association between serum level of uric acid with metabolic syndrome parameters. Patients and Methods: The present cross-sectional study population consisted of 200 subjects susceptible to metabolic syndrome. Data related to weight, height, waist circumference, body mass index (BMI), history of the disease, as well as drug consumption were recorded. All patients underwent routine blood tests for C-reactive protein (CRP ) as well as uric acid levels. According to the diagnostic criteria for metabolic syndrome, we divided the patients into two groups. The first group was affected by metabolic syndrome(case) and the second was without metabolic syndrome (control). Then, we utilized Pearson’s correlation coefficient to investigate the correlation of the serum level of uric acid with the continuous metabolic syndrome parameters. Finally, significant level was P<0.05 throughout this survey. Results: In the case group, the level of uric acid was higher (6.55 ± 1.24 mg/dL) than the control level (4.76 ± 1.24 mg/dL) (P<0.001). We found a significant correlation between the uric acid level and hip circumference, waist circumference, fasting blood sugar, and CRP only in obese patients. Conclusion: As demonstrated, a positive association between the level of serum uric acid and BMI ≥30 kg/m2 in the case group suggests greater role of obesity in metabolic syndrome. Since there is a strong correlation between serum CRP and uric acid levels in the case group with BMI ≥30 kg/m2 . High plasma concentration of uric acid can be an inflammatory marker and risk factor for obesity. Therefore, obese people with metabolic syndrome are recommended to control their hyperuricemia

Acute post sleeve surgery bleeding as rare cause of acute renal failure: a case report

Abstract Background Bariatric surgeries have been considered as one of the most important treatment procedures in recent years. Being aware of the side effects of this surgery will lead to better results after the surgery. Case presentation A 37-year-old Iranian male patient presented one day after sleeve surgery with symptoms of weakness, lethargy, and shortness of breath, which hospitalization and workup to were done to rule out pulmonary embolism. Because of the high creatinine and anuria, we couldn’t perform computed tomography angiography. A bedside ultrasound was done for the patient and showed a mild to moderate amount of fluid around the spleen and some blood clots. Due to the progressive clinical findings and suspected internal bleeding, the patient was a candidate for laparoscopic revision procedure. Gradually, after performing the surgery, removing the blood clot and reducing the compressive effect of that on the inferior verna cava which was the main reason of renal failure, the patient was able to urinate afterwards and was discharged in good general condition. Conclusion Surgeons should be aware of the management of rare surgical complications after bariatric surgeries. To be best of our knowledge, this was the first case report of a patient with acute renal failure after bariatric surgery and the rare cause of clot compression on inferior vena cava and raised abdominal compartment pressure