Track D Social Science, Human Rights and Political Science

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138414/1/jia218442.pd

The global burden of cancer attributable to risk factors, 2010–19: a systematic analysis for the Global Burden of Disease Study 2019

BACKGROUND: Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. METHODS: The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk–outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. FINDINGS: Globally, in 2019, the risk factors included in this analysis accounted for 4·45 million (95% uncertainty interval 4·01–4·94) deaths and 105 million (95·0–116) DALYs for both sexes combined, representing 44·4% (41·3–48·4) of all cancer deaths and 42·0% (39·1–45·6) of all DALYs. There were 2·88 million (2·60–3·18) risk-attributable cancer deaths in males (50·6% [47·8–54·1] of all male cancer deaths) and 1·58 million (1·36–1·84) risk-attributable cancer deaths in females (36·3% [32·5–41·3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20·4% (12·6–28·4) and DALYs by 16·8% (8·8–25·0), with the greatest percentage increase in metabolic risks (34·7% [27·9–42·8] and 33·3% [25·8–42·0]). INTERPRETATION: The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden

STUDIES ON THE CHICKEN EYE PROPERTIES EXPOSED TO ARGON LASER BY DIELECTRIC METHODS

Argon Laser is commonly used now as a powerful tool in the human eye operations. On the other hand, the exposure of the eye to laser, in the visible range, may cause many alterations in the retinal structure. The aim of the present work is to study the structural variations in the eye caused by argon laser exposure, of the same intensity and duration as that used in medical treatments and at different temperatures of 10, 20, and 30°C, by dielectric measurements. These measurements were carried out immediately after laser exposure and after a certain period (1 - 5 days) needed for the recovery processes. The results of the experiments showed that the impedance components (ZR and ZI) and the dielectric loss (∊'') changed with temperature and after eye exposure to 1mW/cm2 argon laser of duration 0.12 sec. The dielectric loss, ∊'', increased immediately after laser exposure and then decreased during the recovery periods indicating a repairing process after laser treatments in the fourth or fifth day which is greatly significant at a temperature of 10°C. The exact reactive mechanism of laser effects on the eye is still not really understood. These effects may be due to vasodillation of blood vessels of the retina which is accompanied by an increase in blood capillary permeability. This increase in permeability permits larger serum proteins to inter the cells, shifting the osmotic pressure at the capillary wall such that cell swelling takes place due to water entrance. The repairing processes occurred due to that some intracellular substances are released and gradually diffused out of the cells and this would explain the latent period of several days. Based on the results of the present work, we may conclude that, in order to decrease the damage/repair ratio, it is preferable to place the dark adapted patient's eye at low temperature during the laser exposure

Value of FNAC in abnormal axillary lymph nodes with non specific mammograms

Objective: This study aimed to evaluate the role of fine-needle aspiration cytology (FNAC) in the diagnosis of abnormal axillary lymph nodes identified in patients with nonspecific mammographic findings. Patients and methods: This study included 60 patients (a mean age 52.1 years ± 15.2) with suspected abnormal axillary lymph nodes. Mammography was done using medio-lateral oblique (MLO) view. Ultrasound (US) was done as a complementary examination for all patients with an otherwise normal or benign findings on mammogram, US was done as a first diagnostic modality in patients under age of thirty. Fifty-one patients were recalled for further US guided FNAC. The other 9 patients had a known underlying diagnosis. Results: From December 2014 to August 2016, A total of 60 patients (56 women and 4 men) had abnormal axillary lymph nodes with nonspecific mammogram were included; 9 patients who had a known underlying cause were not recalled for US guided biopsy. The other 51 cases required an US guided FNAC. An excisional biopsy was done in 32 cases (63%) (14 were malignant& 18 were benign). The other 19 cases (37%) had follow-up (range, 3–18 months; mean, 7.9 months). The overall diagnostic performance of FNAC in diagnosing axillary lymph adenopathy was: Sensitivity 65%; specificity, 97%; positive predictive value 93%; and negative predictive value, 81% with accuracy of 88%. The diagnostic performance of FNAC in differentiating benign from malignant axillary lymph adenopathy was: Sensitivity 85%; specificity, 97%; positive predictive value 92%; and negative predictive value, 94% with accuracy of 94%. Conclusions: FNAC was a good cytological predictor in the majority of patients with abnormal lymph nodes and nonspecific mammography. FNAC is cost effective in assessing axillary lymph node status especially in limited resource setting like in our developing country. FNAC is preferred diagnostic tool in all cases of abnormal axillary lymph adenopathy

Identification and management of Lynch syndrome in the Middle East and North African countries: outcome of a survey in 12 countries

Background Lynch syndrome (LS), the most common inherited form of colorectal cancer (CRC), is responsible for 3% of all cases of CRC. LS is caused by a mismatch repair gene defect and is characterized by a high risk for CRC, endometrial cancer and several other cancers. Identification of LS is of utmost importance because colonoscopic surveillance substantially improves a patient's prognosis. Recently, a network of physicians in Middle Eastern and North African (ME/NA) countries was established to improve the identification and management of LS families. The aim of the present survey was to evaluate current healthcare for families with LS in this region. Methods A questionnaire was developed that addressed the following issues: availability of clinical management guidelines for LS; attention paid to family history of cancer; availability of genetic services for identification and diagnosis of LS; and assessment of knowledge of LS surveillance. Members of the network and authors of recent papers on LS from ME/NA and neighbouring countries were invited to participate in the survey and complete the online questionnaire. Results A total of 55 individuals were invited and 19 respondents from twelve countries including Algeria, Azerbaijan, Cyprus, Egypt, Iran, Jordan, Kuwait, Lebanon, Morocco, Palestine, Tunisia, and Turkey completed the questionnaire. The results showed that family history of CRC is considered in less than half of the surveyed countries. Guidelines for the management of LS are available in three out of twelve countries. The identification and selection of families for genetic testing were based on clinical criteria (Amsterdam criteria II or Revised Bethesda criteria) in most countries, and only one country performed universal screening. In most of the surveyed countries genetic services were available in few hospitals or only in a research setting. However, surveillance of LS families was offered in the majority of countries and most frequently consisted of regular colonoscopy. Conclusion The identification and management of LS in ME/NA countries are suboptimal and as a result most LS families in the region remain undetected. Future efforts should focus on increasing awareness of LS amongst both the general population and doctors, and on the improvement of the infrastructure in these countries