Letter to the Editor on article: "Study on Comparative Analysis on Fistulotomy and Fistulectomy in the Management of Low Anal Fistula"

Iread with great interest the publication entitled “Comparative Analysis of Fistulotomy and Fistulectomy in Managing Low Anal Fistulas” by Mohammad Shahbaz et al

Massive Open Online Courses (MOOCs) Dropout Rate in the World: A Protocol for Systematic Review and Meta-analysis

Introduction: Massive open online course (MOOC) is an online course that is open, meaning there are no barriers to entry, and entails no special educational costs or features. Recently, MOOCs have received increasing popularity throughout the world. Regardless of the subject taught and the university providing the course, the dropout rate of MOOCs is one of the most important challenges ahead. The objective of this systematic review is to estimate the global rate of MOOCs dropout and factors affecting this frequency. Methods: This systematic review will search MEDLINE/PubMed, Scopus, Web of Science (Clarivate Analytics), Embase (Embase.com), ASSIA, CINAHL, Education Research, BEI, and Eric databases systematically according to predefined criteria without language restrictions to retrieve prospective and retrospective observational studies conducted between the 1st of January 2000 and 30th of December 2021, evaluating the frequency of leaving MOOCs throughout the world. Discordances between the two different authors through the processes of screening, selection, quality assessment, and data extraction will be settled via discussion and if the issue cannot be resolved, a third expert advice will be requested. For all studies, forest plots will be shown to represent the separate and pooled frequency along with their 95% confidence intervals. To examine statistical heterogeneity, the Q-statistic test and the I2statistic will be utilized. To investigate potential reporting bias and non-significant study effects, funnel plots will be employed. Tests, such as Begg’s and Egger’s will also be carried out. The time trends for MOOCs dropout rate will be calculated using a cumulative meta-analysis. Conclusion: As dropout rate is one of the most challenges that universities may encounter, this systematic review will help universities extend their view, save their resources, or maybe design their MOOCs differently. This protocol is registered in Open Science Framework (OSF), available at: https://osf.io/jgyqx

Potential Impact of Probiotics on Low Anterior Resection Syndrome: An Emerging Area of Research

The worldwide age-standardized incidence and mortality rates of rectal cancer are estimated to be 7.6 and 3.3 per 100,000, respectively

A cross-sectional study on the association between major dietary pattern and impaired fasting glucose

BackgroundImpaired fasting glucose (IFG) is a precursor to type 2 diabetes and is influenced by dietary factors. This cross-sectional study assessed the association between major dietary patterns and IFG in the baseline phase of PERSIAN Kavar cohort study (PKCS).MethodsThe study included 3,144 participants aged 35–70 years. After assessing dietary intakes by a food frequency questionnaire, principal component analysis was used to identify dietary patterns. Logistic regression model was applied to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for the association between dietary patterns and IFG.ResultsThree major dietary patterns were identified: healthy, Western-like, and CarnFat (Carnivorous-fat). In the fully adjusted model, individuals in the highest tertile of the healthy dietary pattern had a lower likelihood of IFG compared to those in the lowest tertile (OR = 0.68, 95% CI: 0.53–0.88). The second tertile of the healthy pattern was also associated with lower odds of IFG (OR = 0.77, 95% CI: 0.62–0.96). No significant associations were found for the Western-like and CarnFat dietary patterns.ConclusionA healthy dietary pattern characterized by high intakes of fruits, vegetables, low-fat dairy, nuts, seeds, olive oil, legumes, fish, and whole grains was associated with a lower risk of IFG. These findings highlight the importance of promoting healthy dietary patterns for the prevention of prediabetes and type 2 diabetes

Exploring the Prevalence of Burnout in Medical Residents: Socio-Demographic and Job Characteristics as Predictors in Iran

Introduction: Burnout is a psychological syndrome that develops due to chronic stressors in a person's professional life, resulting in emotional exhaustion and detachment. The objective of this study was to determine the prevalence of burnout among medical residents, considering socio-demographic variables and job characteristics, and to predict burnout in this group. Medical residents often face specific pressures such as long working hours, sleep deprivation, high patient loads, and emotional demands from patient care, which contribute to their overall stress levels. Methods: A cross-sectional study was conducted in the academic year 2019-2020, involving 164 residents from two general hospitals who completed the Persian versions of the Job Content Questionnaire (JCQ) and Maslach Burnout Inventory (MBI-HSS). Results: A significant proportion of residents reported burnout symptoms, with 73.7% experiencing moderate to high levels of emotional exhaustion and 64.4% indicating moderate to high levels of depersonalization. Additionally, 90.1% of residents reported low perceived professional efficacy. Among the subscales of MBI-HSS, reduced professional efficacy was found to be the highest. Psychological demands and limited decision latitude were significant predictors of burnout, particularly in relation to emotional exhaustion and depersonalization. Conversely, support from family and co-workers, as well as higher levels of experience, were associated with lower depersonalization and improved professional efficacy. Conclusion: Overall, medical residents in Iran face significantly high levels of burnout, which are influenced by specific personal and job characteristics. Consequently, preventive and therapeutic interventions are necessary to address this pressing issues

Incontinence and quality of life in ulcerative colitis patients after total proctocolectomy with an ileal pouch anal anastomosis

Objective: Total proctocolectomy with ileal pouch-anal anastomosis (IPAA) is a surgical procedure performed on patients with ulcerative colitis (UC) to avoid the need for permanent stoma. The objective of this study was to assess the quality of life and fecal incontinence in UC patients after IPAA and compare the quality of life among different subgroups. Patients and Methods: This cross-sectional study included all UC patients who had underwent IPAA between 2017 and 2021 at Shahid Faghihi Hospital, Iran. Data were collected from medical records and through direct contact with the patients. Fecal incontinence was evaluated using Wexner questionnaire, while quality of life was assessed using the inflammatory bowel disease questionnaire (IBDQ). Patients were categorized into groups based on the severity of their fecal incontinence, classified as no/mild (0-4) or moderate to severe (≥5), according to their Wexner scores. Results: A total of 138 patients completed the Wexner questionnaire, and 119 completed the IBDQ questionnaire. The mean age of participants at the time of questionnaire completion was 43.39 years (±11.16). Among the included patients, 19% experienced moderate to severe fecal incontinence. These patients had lower scores across all domains and the total score of IBDQ compared to patients with no/mild fecal incontinence. Additionally, those who underwent IPAA more than four years ago had significantly lower scores in the social function domain (P-value=0.047) and total score of IBDQ (P-value=0.027). Conclusions: Patients with fecal incontinence and those who have undergone IPAA for a longer duration have better quality of life scores

Nationwide Prevalence of Diabetes and Prediabetes and Associated Risk Factors Among Iranian Adults: Analysis of Data from PERSIAN Cohort Study

Introduction Over the past decades prevalence of diabetes has increased in Iran and other countries. This study aimed to update the prevalence of diabetes and prediabetes in Iran and to determine associated sociodemographic risk factors, as well as diabetes awareness and control. Methods This is a nationally representative cross-sectional survey that included 163,770 Iranian adults aged 35-70 years, from different ethnic backgrounds, between 2014 and 2020. Diabetes was diagnosed at fasting blood sugar of >= 6.99 mmol/L (126 mg/dL), or receiving blood glucose-lowering treatment. Multivariable logistic regression was applied to detect determinants associated with prevalence of diabetes and prediabetes, as well as predictors of diabetes awareness and glycemic control. Results Sex- and age-standardized prevalence of diabetes and prediabetes was 15.0% (95% CI 12.6-17.3) and 25.4% (18.6-32.1), respectively. Among patients with diabetes, 79.6% (76.2-82.9) were aware of their diabetes. Glycemic control was achieved in 41.2% (37.5-44.8) of patients who received treatment. Older age, obesity, high waist to hip ratio (WHR), and specific ethnic background were associated with a significant risk of diabetes and prediabetes. Higher awareness of diabetes was observed in older patients, married individuals, those with high WHR, and individuals with high wealth score. Moreover, glycemic control was significantly better in women, obese individuals, those with high physical activity, educational attainment, and specific ethnic background. Conclusions The prevalence of diabetes and prediabetes is increasing at an alarming rate in Iranian adults. High proportion of uncontrolled patients require particular initiatives to be integrated in the health care system

Global injury morbidity and mortality from 1990 to 2017 : results from the Global Burden of Disease Study 2017

Correction:Background Past research in population health trends has shown that injuries form a substantial burden of population health loss. Regular updates to injury burden assessments are critical. We report Global Burden of Disease (GBD) 2017 Study estimates on morbidity and mortality for all injuries. Methods We reviewed results for injuries from the GBD 2017 study. GBD 2017 measured injury-specific mortality and years of life lost (YLLs) using the Cause of Death Ensemble model. To measure non-fatal injuries, GBD 2017 modelled injury-specific incidence and converted this to prevalence and years lived with disability (YLDs). YLLs and YLDs were summed to calculate disability-adjusted life years (DALYs). Findings In 1990, there were 4 260 493 (4 085 700 to 4 396 138) injury deaths, which increased to 4 484 722 (4 332 010 to 4 585 554) deaths in 2017, while age-standardised mortality decreased from 1079 (1073 to 1086) to 738 (730 to 745) per 100 000. In 1990, there were 354 064 302 (95% uncertainty interval: 338 174 876 to 371 610 802) new cases of injury globally, which increased to 520 710 288 (493 430 247 to 547 988 635) new cases in 2017. During this time, age-standardised incidence decreased non-significantly from 6824 (6534 to 7147) to 6763 (6412 to 7118) per 100 000. Between 1990 and 2017, age-standardised DALYs decreased from 4947 (4655 to 5233) per 100 000 to 3267 (3058 to 3505). Interpretation Injuries are an important cause of health loss globally, though mortality has declined between 1990 and 2017. Future research in injury burden should focus on prevention in high-burden populations, improving data collection and ensuring access to medical care.Peer reviewe

Global variation in diabetes diagnosis and prevalence based on fasting glucose and hemoglobin A1c

Fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) are both used to diagnose diabetes, but these measurements can identify different people as having diabetes. We used data from 117 population-based studies and quantified, in different world regions, the prevalence of diagnosed diabetes, and whether those who were previously undiagnosed and detected as having diabetes in survey screening, had elevated FPG, HbA1c or both. We developed prediction equations for estimating the probability that a person without previously diagnosed diabetes, and at a specific level of FPG, had elevated HbA1c, and vice versa. The age-standardized proportion of diabetes that was previously undiagnosed and detected in survey screening ranged from 30% in the high-income western region to 66% in south Asia. Among those with screen-detected diabetes with either test, the age-standardized proportion who had elevated levels of both FPG and HbA1c was 29-39% across regions; the remainder had discordant elevation of FPG or HbA1c. In most low- and middle-income regions, isolated elevated HbA1c was more common than isolated elevated FPG. In these regions, the use of FPG alone may delay diabetes diagnosis and underestimate diabetes prevalence. Our prediction equations help allocate finite resources for measuring HbA1c to reduce the global shortfall in diabetes diagnosis and surveillance

Worldwide trends in diabetes prevalence and treatment from 1990 to 2022: a pooled analysis of 1108 population-representative studies with 141 million participants

Background: Diabetes can be detected at the primary health-care level, and effective treatments lower the risk of complications. There are insufficient data on the coverage of treatment for diabetes and how it has changed. We estimated trends from 1990 to 2022 in diabetes prevalence and treatment for 200 countries and territories. Methods: We used data from 1108 population-representative studies with 141 million participants aged 18 years and older with measurements of fasting glucose and glycated haemoglobin (HbA1c), and information on diabetes treatment. We defined diabetes as having a fasting plasma glucose (FPG) of 7·0 mmol/L or higher, having an HbA1c of 6·5% or higher, or taking medication for diabetes. We defined diabetes treatment as the proportion of people with diabetes who were taking medication for diabetes. We analysed the data in a Bayesian hierarchical meta-regression model to estimate diabetes prevalence and treatment. Findings: In 2022, an estimated 828 million (95% credible interval [CrI] 757-908) adults (those aged 18 years and older) had diabetes, an increase of 630 million (554-713) from 1990. From 1990 to 2022, the age-standardised prevalence of diabetes increased in 131 countries for women and in 155 countries for men with a posterior probability of more than 0·80. The largest increases were in low-income and middle-income countries in southeast Asia (eg, Malaysia), south Asia (eg, Pakistan), the Middle East and north Africa (eg, Egypt), and Latin America and the Caribbean (eg, Jamaica, Trinidad and Tobago, and Costa Rica). Age-standardised prevalence neither increased nor decreased with a posterior probability of more than 0·80 in some countries in western and central Europe, sub-Saharan Africa, east Asia and the Pacific, Canada, and some Pacific island nations where prevalence was already high in 1990; it decreased with a posterior probability of more than 0·80 in women in Japan, Spain, and France, and in men in Nauru. The lowest prevalence in the world in 2022 was in western Europe and east Africa for both sexes, and in Japan and Canada for women, and the highest prevalence in the world in 2022 was in countries in Polynesia and Micronesia, some countries in the Caribbean and the Middle East and north Africa, as well as Pakistan and Malaysia. In 2022, 445 million (95% CrI 401-496) adults aged 30 years or older with diabetes did not receive treatment (59% of adults aged 30 years or older with diabetes), 3·5 times the number in 1990. From 1990 to 2022, diabetes treatment coverage increased in 118 countries for women and 98 countries for men with a posterior probability of more than 0·80. The largest improvement in treatment coverage was in some countries from central and western Europe and Latin America (Mexico, Colombia, Chile, and Costa Rica), Canada, South Korea, Russia, Seychelles, and Jordan. There was no increase in treatment coverage in most countries in sub-Saharan Africa; the Caribbean; Pacific island nations; and south, southeast, and central Asia. In 2022, age-standardised treatment coverage was lowest in countries in sub-Saharan Africa and south Asia, and treatment coverage was less than 10% in some African countries. Treatment coverage was 55% or higher in South Korea, many high-income western countries, and some countries in central and eastern Europe (eg, Poland, Czechia, and Russia), Latin America (eg, Costa Rica, Chile, and Mexico), and the Middle East and north Africa (eg, Jordan, Qatar, and Kuwait). Interpretation: In most countries, especially in low-income and middle-income countries, diabetes treatment has not increased at all or has not increased sufficiently in comparison with the rise in prevalence. The burden of diabetes and untreated diabetes is increasingly borne by low-income and middle-income countries. The expansion of health insurance and primary health care should be accompanied with diabetes programmes that realign and resource health services to enhance the early detection and effective treatment of diabetes