Mining of mortality-related findings in rare bleeding disorders: A retrospective study from two centers

Background Rare bleeding disorders include inherited coagulation disorders except for von Willebrand disease and hemophilia A and B. These disorders affect both men and women worldwide and mainly have an autosomal recessive pattern of inheritance. Given the paucity of cases of rare bleeding disorders, there are limited data regarding some topics among bleeding disorders. Methods This retrospective study from 2005�2019 collected demographic data and the causes of death among cases with rare bleeding disorders from 2 provinces of Iran. Results Overall, 5 deaths were reported, including 3 cases with factor V deficiency, a case with factor XIII deficiency, and a case with combined factor V and factor VIII deficiencies. The main causes of death were bleeding in the central nervous system (2 cases; 1 with factor V deficiency and 1 with combined factor XIII deficiency). Post-partum hemorrhage was the cause of death in a woman with factor V deficiency while anaphylaxis shock was the cause of death in the case with combined factor V and factor VIII deficiencies. A woman with factor V deficiency died from an internal bleeding episode. Conclusion Gathering data on the causes of death in rare bleeding disorders through worldwide registries can be helpful for the management of this rare group of bleeding disorders. © 2020 Korean Society of Hematology. All rights reserved

Human umbilical cord-mesenchymal stem cells conditioned medium attenuates CCl4 induced chronic liver fibrosis

Although the efficacy of MSCs on the liver fibrosis is investigated, it is not exactly clear whether released molecules by MSCs are sufficient to mediate the anti-fibrotic effects or not. In this study, the possible hepatoprotective effects of human umbilical cord MSCs derived conditioned medium (UC-CM) was investigated. 30 male rats were divided into 3 groups (n = 10): C: control; F: fibrosis were intraperitoneally injected with CCl4 (1 ml/kg, i.p); F/UC-CM: fibrosis rats that received UC-CM (100 µg/kg, i.v). At the end of the 12th week, serum and liver samples were collected to analyze biochemical, molecular, and histopathological parameters. In comparison with CCl4 intoxicated animals, the results showed a significant amelioration of weight loss, histological changes as well as attenuation of serum activity of ALT, AST, and ALP in F/UC-CM. The liver hydroxyproline content was significantly reduced by UC-CM treatment. Accordingly, improvement in oxidative parameters such as MDA, TAC, and TOS was also observed in the F/UC-CM group. UC-CM administration down-regulated gene expression of TGF-β1, TNF-α, TβRII, MMP-2, and MMP-9 as well as the protein level in TGF-β1 and TNF-α. Immunohistochemical analysis showed a notable lower hepatic α-SMA expression in the F/UC-CM group. In conclusion, these findings revealed that the remarkable hepatoprotective property of UC-CM could lend support to its anti-inflammatory and antioxidative and anti-fibrotic effects

Injury burden in individuals aged 50 years or older in the Eastern Mediterranean region, 1990–2019: a systematic analysis from the Global Burden of Disease Study 2019

Background: Injury poses a major threat to health and longevity in adults aged 50 years or older. The increased life expectancy in the Eastern Mediterranean region warrants a further understanding of the ageing population's inevitable changing health demands and challenges. We aimed to examine injury-related morbidity and mortality among adults aged 50 years or older in 22 Eastern Mediterranean countries. Methods: Drawing on data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we categorised the population into adults aged 50–69 years and adults aged 70 years and older. We examined estimates for transport injuries, self-harm injuries, and unintentional injuries for both age groups, with sex differences reported, and analysed the percentage changes from 1990 to 2019. We reported injury-related mortality rates and disability-adjusted life-years (DALYs). The Socio-demographic Index (SDI) and the Healthcare Access and Quality (HAQ) Index were used to better understand the association of socioeconomic factors and health-care system performance, respectively, with injuries and health status in older people. Healthy life expectancy (HALE) was compared with injury-related deaths and DALYs and to the SDI and HAQ Index to understand the effect of injuries on healthy ageing. Finally, risk factors for injury deaths between 1990 and 2019 were assessed. 95% uncertainty intervals (UIs) are given for all estimates. Findings: Estimated injury mortality rates in the Eastern Mediterranean region exceeded the global rates in 2019, with higher injury mortality rates in males than in females for both age groups. Transport injuries were the leading cause of deaths in adults aged 50–69 years (43·0 [95% UI 31·0–51·8] per 100 000 population) and in adults aged 70 years or older (66·2 [52·5–75·5] per 100 000 population), closely followed by conflict and terrorism for both age groups (10·2 [9·3–11·3] deaths per 100 000 population for 50–69 years and 45·7 [41·5–50·3] deaths per 100 000 population for ≥70 years). The highest annual percentage change in mortality rates due to injury was observed in Afghanistan among people aged 70 years or older (400·4% increase; mortality rate 1109·7 [1017·7–1214·7] per 100 000 population). The leading cause of DALYs was transport injuries for people aged 50–69 years (1798·8 [1394·1–2116·0] per 100 000 population) and unintentional injuries for those aged 70 years or older (2013·2 [1682·2–2408·7] per 100 000 population). The estimates for HALE at 50 years and at 70 years in the Eastern Mediterranean region were lower than global estimates. Eastern Mediterranean countries with the lowest SDIs and HAQ Index values had high prevalence of injury DALYs and ranked the lowest for HALE at 50 years of age and HALE at 70 years. The leading injury mortality risk factors were occupational exposure in people aged 50–69 years and low bone mineral density in those aged 70 years or older. Interpretation: Injuries still pose a real threat to people aged 50 years or older living in the Eastern Mediterranean region, mainly due to transport and violence-related injuries. Dedicated efforts should be implemented to devise injury prevention strategies that are appropriate for older adults and cost-effective injury programmes tailored to the needs and resources of local health-care systems, and to curtail injury-associated risk and promote healthy ageing. Funding: Bill & Melinda Gates Foundation