Diffuse Large B-cell Lymphoma during Pregnancy

Introduction:Non-Hodgkin Lymphoma (NHL) during pregnancy are very uncommon, and primary symptoms of NHL are similar to pregnancy physiologic changes.Case presentation:We report a case of NHL during pregnancy that didn’t have any peripheral lymphadenopathy, with mediastinal involvement. Chemotherapy began during pregnancy and after delivery treatment continued with chemotherapy and radiotherapy, and mother and baby were both healthy.Conclusion: Early diagnosis of NHL cause to better prognosis of disease andmaking a chance for mother to make a decision about continue pregnancy or not and about her treatments

A review for discovering hepatoprotective herbal drugs with least side effects on kidney

The liver is a vital organ which plays a major role in the metabolism and excretion of xenobiotics from the body, and liver disease is a worldwide health problem. The currently available synthetic drugs to treat liver disorders cause further damage to the liver and kidney so it is imperative to find new drugs with least side effects. There are a number of treatment combinations which are derived from medicinal plants and commonly administered as tonic for the liver. In this review, we have introduced most important medicinal plants that are used in liver disorders and have least side effects on kidney. In this regards, we have focused on their active constituents, effects and trial studies, mechanisms of action, pharmacokinetic characteristics, dosages, and toxicity. Amaranthus spinosus L., Glycyrrhiza glabra, Cichorium inthybus L., Phyllanthus species (amarus, niruri, emblica), Picrorhiza kurroa, and Silybum marianum have been extensively administered for the treatment of liver disorders. The introduced medicinal plants can be used for production of new drugs via antioxidant-related properties, hepatoprotective activities and least side effects on kidney for the prevention and treatment of liver disorders

The effect of life skills face to face meeting on mental health of children of divorce

. زمینه و هدف: کودکان طلاق در معرض مسایل زیادی از قبیل اختلالات روانی و شخصیتی و کمبود توانایی های ارتباط اجتماعی هستند. هدف برنامه آموزش مهارت های زندگی ارتقای مهارت های روانی اجتماعی در برخورد با چالشهای طبیعی که در زندگی با آن روبرو می شوند، می باشد. این مطالعه با هدف تعیین تاثیر جلسات مشاوره حضوری بر سلامت روان در فرزندان زوجین طلاق گرفته در شهرکرد انجام شد. روش بررسی: در این مطالعه مداخله ای 60 کودک طلاق به روش در دسترس در شهرستان شهرکرد انتخاب و به صورت تصادفی به دو گروه 30 نفری شاهد و مداخله تقسیم شدند. پس از تکمیل پیش آزمون با استفاده از پرسشنامه توانایی ها و مشکلات (SDQ) فرم والدین در هر دو گروه، آموزش گروه مداخله به صورت جلسه ای یکی از مهارت های ده گانه زندگی با حضور والدین و با تاکید بر مشکلات کودکان طلاق انجام شد. پس از دو ماه پرسشنامه توانایی ها و مشکلات مجدداً برای هر دو گروه تکمیل گردید و اطلاعات به کمک آزمون های آماری t مستقل، t زوجی و کای اسکور آنالیز گردید. یافته ها: قبل از آموزش میانگین نمره دو گروه از نظر علایم هیجانی، اختلال سلوک، پیش فعالی، مشکلات با همسالان، رفتار مطلوب اجتماعی و نمره کل پرسشنامه و بعد از آموزش در علائم هیجانی، پیش فعالی و رفتار مطلوب اجتماعی اختلاف معنی‌دار وجود نداشت (05/0P). نتیجه گیری: برگزاری جلسات حضوری و گروهی آموزش مهارت های زندگی با تاکید بر مشکلات کودکان طلاق، برای خانواده ها و کودکان در افزایش سلامت روانی کودکان آنها موثر است

Global Research Trends in Pediatrics from 1990 to 2020: A Bibliometric Analysis

Background: This bibliometric analysis and visualization aimed at depicting bibliometric indicators of papers published globally in pediatrics during the recent three decades. Methods: Using Web of Knowledge database, all papers published on pediatrics during 1990-2020 were retrieved. Bibliometric data on paper type, language, and publishing year, and publishing journal, country of origin, affiliated institutes, and subject areas were extracted. Using visualization techniques in VOSviewer software package, the collaboration / co-authorship networks, co-citation maps and keyword co-occurrence maps were depicted. Results: Top hot papers were mainly on childhood overweight and obesity, cerebral palsy, and body-mass index. David Isaacs, Prem Puri and Anne were the top most productive authors. Seetha Shankaran from Wayne State University, USA, ranked first in citation counts. Top publishing journals were Pediatric Research, Pediatric Blood and Cancer and Pediatrics, respectively. Highly-productive countries were the USA and UK, respectively. Among research areas, neurosciences neurology, oncology and surgery were heavily considered and had top h-indices, respectively. Five subject clusters focused on diseases, metabolism, neurology, psychiatry and immunology. These clusters cover all main research areas in the field, each with its own research methodologies and highlighted keywords. Conclusions: Global research on pediatrics found its way and ever-increasingly develops as its bibliometric indicators clearly show

Capacity building for priority setting in Farrokhshahr population

زمینه و هدف: تعیین‌ اولویت‌های پژوهشی فرآیندی‌ مهم‌ در مدیریت‌ پژوهش‌ها در تمام حوزه ها بخصوص حوزه سلامت‌ کشورها بشمار می رود که‌ اهمیت‌ آن‌ بویژه‌در زمان‌ تخصیص‌ منابع‌ محدود مالی‌ و انسانی‌ دو چندان‌ می شود. فرآیند تعیین‌ اولویت‌ها به‌ تمامی‌ کشورها در زمینه‌ طرح‌ ریزی‌ برنامه‌های‌ پژوهش‌ در حوزه‌ سلامت‌ و بسیج‌ و تخصیص‌ منابع‌ پژوهشی‌ و همچنین‌ تقویت ‌ظرفیت‌ پژوهشی‌ بومی‌ خود کمک‌ خواهد کرد. گروههای‌ ذینفعی‌ که‌ باید در فرآیند تعیین‌ اولویت‌ها شرکت‌ داده‌ شوند علاوه‌ برپژوهشگران‌ شامل‌ بهره‌ گیرندگان‌ بالقوه‌ و مردمی‌ می‌باشند که‌ از نتایج‌ پژوهش‌ تأثیر خواهند پذیرفت‌. در این مطالعه توانمند سازی مردم در تعیین اولویت های مشکلات مردم فرخشهر در استان چهار محال و بختیاری به صورت مشارکتی مورد بررسی قرار گرفته است. روش بررسی: این‌ پروژه‌ یک‌ تحقیق‌ مشارکتی است که‌ در آن‌ مشکلات‌ شناسایی‌ شده‌ با روش‌ ارزیابی‌ سریع (Rapid appraisal) در شهر فرخشهر، استان‌ چهارمحال‌ و بختیاری‌ در سال‌ 83 توسط تیم توسعه فرخشهر با مشارکت معاونت پژوهشی دانشگاه علوم پزشکی شهرکرد مورد اولویت‌ بندی‌ قرار گرفتند پس‌ از طبقه‌ بندی‌ اطلاعات‌ بدست‌ آمده‌ از نیازسنجی‌ با در نظر گرفتن‌ عوامل‌ محیطی‌، اقتصادی‌، اجتماعی‌، ساختار نهادها و مؤسسات‌ منطقه‌ و همچنین‌ شناسایی‌ عوامل‌ کند کننده‌ و مانع‌ شونده‌ و شرایط زندگی‌ و معیشتی‌ گروههای‌ مختلف‌ مردم و تعیین‌ ارتباط آن‌ با عوامل‌ فوق‌ الذکر مشکلات‌ اولویت‌ بندی‌ و تجزیه‌ و تحلیل‌ شد. در فرآیند مشارکت جامعه، پرسنل ناظر و اجرائی ابتدا هدف از تعیین اولویت هارا برای عموم شرکت کنندگان شرح دادند و تمامی نکات مبهم را روشن ساختند فرآیند مشارکت بصورت تبادل فعال مشارکت یا مشاوره که از پیشنهادات و نظرات مردم در برنامه ریزی و تصمیم گیری استفاده شود دنبال شد و در آخر تصمیم گیری در مورد تعیین اولویت ها به مردم واگذار شد کل فرآیند با مشارکت فعال اعضای تیم توسعه فرخشهر و با نظارت محققین دانشگاه که به عنوان ناظر شرکت داشتند انجام گردید. ابزارهای اولویت بندی در گروههای ذینفع شامل: ماتریس دو بعدی، دیاگرام اولویت ها، جدول تجزیه و تحلیل مشکلات، دیاگرام ون گروهها دینفع، ماتریس اختلاف و همکاری بین گروههای ذینفع بود. یافته ها: در این‌ مطالعه‌ 40 مشکل‌ مردم‌ فرخشهر شناسایی‌ و در 9 گروه طبقه‌ بندی‌ گردید: مشکلات‌ سالمندان‌، فرهنگی‌ هنری‌، عمرانی‌، ورزشی‌، زنان‌، بهداشت‌ روان‌، جوانان‌، امنیت‌ اجتماعی‌ و مشکلات‌ اشتغال طی فرآیند فوق 20 مشکل به عنوان اولویت های اول تا بیستم تعیین گردید. نهایتاَ با تجزیه و تحلیل داده های بدست آمده از ابزار های اولویت بندی، درک صحیحی از مشکلات حائز اولویت، فرصت ها، اقدامات صورت گرفته، راه حل ها و منابع بالقوه و بالفعل پیش رو برای حل مشکلات حاصل شد

Burden of disease scenarios for 204 countries and territories, 2022–2050: a forecasting analysis for the Global Burden of Disease Study 2021

Background: Future trends in disease burden and drivers of health are of great interest to policy makers and the public at large. This information can be used for policy and long-term health investment, planning, and prioritisation. We have expanded and improved upon previous forecasts produced as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) and provide a reference forecast (the most likely future), and alternative scenarios assessing disease burden trajectories if selected sets of risk factors were eliminated from current levels by 2050. Methods: Using forecasts of major drivers of health such as the Socio-demographic Index (SDI; a composite measure of lag-distributed income per capita, mean years of education, and total fertility under 25 years of age) and the full set of risk factor exposures captured by GBD, we provide cause-specific forecasts of mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) by age and sex from 2022 to 2050 for 204 countries and territories, 21 GBD regions, seven super-regions, and the world. All analyses were done at the cause-specific level so that only risk factors deemed causal by the GBD comparative risk assessment influenced future trajectories of mortality for each disease. Cause-specific mortality was modelled using mixed-effects models with SDI and time as the main covariates, and the combined impact of causal risk factors as an offset in the model. At the all-cause mortality level, we captured unexplained variation by modelling residuals with an autoregressive integrated moving average model with drift attenuation. These all-cause forecasts constrained the cause-specific forecasts at successively deeper levels of the GBD cause hierarchy using cascading mortality models, thus ensuring a robust estimate of cause-specific mortality. For non-fatal measures (eg, low back pain), incidence and prevalence were forecasted from mixed-effects models with SDI as the main covariate, and YLDs were computed from the resulting prevalence forecasts and average disability weights from GBD. Alternative future scenarios were constructed by replacing appropriate reference trajectories for risk factors with hypothetical trajectories of gradual elimination of risk factor exposure from current levels to 2050. The scenarios were constructed from various sets of risk factors: environmental risks (Safer Environment scenario), risks associated with communicable, maternal, neonatal, and nutritional diseases (CMNNs; Improved Childhood Nutrition and Vaccination scenario), risks associated with major non-communicable diseases (NCDs; Improved Behavioural and Metabolic Risks scenario), and the combined effects of these three scenarios. Using the Shared Socioeconomic Pathways climate scenarios SSP2-4.5 as reference and SSP1-1.9 as an optimistic alternative in the Safer Environment scenario, we accounted for climate change impact on health by using the most recent Intergovernmental Panel on Climate Change temperature forecasts and published trajectories of ambient air pollution for the same two scenarios. Life expectancy and healthy life expectancy were computed using standard methods. The forecasting framework includes computing the age-sex-specific future population for each location and separately for each scenario. 95% uncertainty intervals (UIs) for each individual future estimate were derived from the 2·5th and 97·5th percentiles of distributions generated from propagating 500 draws through the multistage computational pipeline. Findings: In the reference scenario forecast, global and super-regional life expectancy increased from 2022 to 2050, but improvement was at a slower pace than in the three decades preceding the COVID-19 pandemic (beginning in 2020). Gains in future life expectancy were forecasted to be greatest in super-regions with comparatively low life expectancies (such as sub-Saharan Africa) compared with super-regions with higher life expectancies (such as the high-income super-region), leading to a trend towards convergence in life expectancy across locations between now and 2050. At the super-region level, forecasted healthy life expectancy patterns were similar to those of life expectancies. Forecasts for the reference scenario found that health will improve in the coming decades, with all-cause age-standardised DALY rates decreasing in every GBD super-region. The total DALY burden measured in counts, however, will increase in every super-region, largely a function of population ageing and growth. We also forecasted that both DALY counts and age-standardised DALY rates will continue to shift from CMNNs to NCDs, with the most pronounced shifts occurring in sub-Saharan Africa (60·1% [95% UI 56·8–63·1] of DALYs were from CMNNs in 2022 compared with 35·8% [31·0–45·0] in 2050) and south Asia (31·7% [29·2–34·1] to 15·5% [13·7–17·5]). This shift is reflected in the leading global causes of DALYs, with the top four causes in 2050 being ischaemic heart disease, stroke, diabetes, and chronic obstructive pulmonary disease, compared with 2022, with ischaemic heart disease, neonatal disorders, stroke, and lower respiratory infections at the top. The global proportion of DALYs due to YLDs likewise increased from 33·8% (27·4–40·3) to 41·1% (33·9–48·1) from 2022 to 2050, demonstrating an important shift in overall disease burden towards morbidity and away from premature death. The largest shift of this kind was forecasted for sub-Saharan Africa, from 20·1% (15·6–25·3) of DALYs due to YLDs in 2022 to 35·6% (26·5–43·0) in 2050. In the assessment of alternative future scenarios, the combined effects of the scenarios (Safer Environment, Improved Childhood Nutrition and Vaccination, and Improved Behavioural and Metabolic Risks scenarios) demonstrated an important decrease in the global burden of DALYs in 2050 of 15·4% (13·5–17·5) compared with the reference scenario, with decreases across super-regions ranging from 10·4% (9·7–11·3) in the high-income super-region to 23·9% (20·7–27·3) in north Africa and the Middle East. The Safer Environment scenario had its largest decrease in sub-Saharan Africa (5·2% [3·5–6·8]), the Improved Behavioural and Metabolic Risks scenario in north Africa and the Middle East (23·2% [20·2–26·5]), and the Improved Nutrition and Vaccination scenario in sub-Saharan Africa (2·0% [–0·6 to 3·6]). Interpretation: Globally, life expectancy and age-standardised disease burden were forecasted to improve between 2022 and 2050, with the majority of the burden continuing to shift from CMNNs to NCDs. That said, continued progress on reducing the CMNN disease burden will be dependent on maintaining investment in and policy emphasis on CMNN disease prevention and treatment. Mostly due to growth and ageing of populations, the number of deaths and DALYs due to all causes combined will generally increase. By constructing alternative future scenarios wherein certain risk exposures are eliminated by 2050, we have shown that opportunities exist to substantially improve health outcomes in the future through concerted efforts to prevent exposure to well established risk factors and to expand access to key health interventions

Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Background: Detailed, comprehensive, and timely reporting on population health by underlying causes of disability and premature death is crucial to understanding and responding to complex patterns of disease and injury burden over time and across age groups, sexes, and locations. The availability of disease burden estimates can promote evidence-based interventions that enable public health researchers, policy makers, and other professionals to implement strategies that can mitigate diseases. It can also facilitate more rigorous monitoring of progress towards national and international health targets, such as the Sustainable Development Goals. For three decades, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has filled that need. A global network of collaborators contributed to the production of GBD 2021 by providing, reviewing, and analysing all available data. GBD estimates are updated routinely with additional data and refined analytical methods. GBD 2021 presents, for the first time, estimates of health loss due to the COVID-19 pandemic. Methods: The GBD 2021 disease and injury burden analysis estimated years lived with disability (YLDs), years of life lost (YLLs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries using 100 983 data sources. Data were extracted from vital registration systems, verbal autopsies, censuses, household surveys, disease-specific registries, health service contact data, and other sources. YLDs were calculated by multiplying cause-age-sex-location-year-specific prevalence of sequelae by their respective disability weights, for each disease and injury. YLLs were calculated by multiplying cause-age-sex-location-year-specific deaths by the standard life expectancy at the age that death occurred. DALYs were calculated by summing YLDs and YLLs. HALE estimates were produced using YLDs per capita and age-specific mortality rates by location, age, sex, year, and cause. 95% uncertainty intervals (UIs) were generated for all final estimates as the 2·5th and 97·5th percentiles values of 500 draws. Uncertainty was propagated at each step of the estimation process. Counts and age-standardised rates were calculated globally, for seven super-regions, 21 regions, 204 countries and territories (including 21 countries with subnational locations), and 811 subnational locations, from 1990 to 2021. Here we report data for 2010 to 2021 to highlight trends in disease burden over the past decade and through the first 2 years of the COVID-19 pandemic. Findings: Global DALYs increased from 2·63 billion (95% UI 2·44–2·85) in 2010 to 2·88 billion (2·64–3·15) in 2021 for all causes combined. Much of this increase in the number of DALYs was due to population growth and ageing, as indicated by a decrease in global age-standardised all-cause DALY rates of 14·2% (95% UI 10·7–17·3) between 2010 and 2019. Notably, however, this decrease in rates reversed during the first 2 years of the COVID-19 pandemic, with increases in global age-standardised all-cause DALY rates since 2019 of 4·1% (1·8–6·3) in 2020 and 7·2% (4·7–10·0) in 2021. In 2021, COVID-19 was the leading cause of DALYs globally (212·0 million [198·0–234·5] DALYs), followed by ischaemic heart disease (188·3 million [176·7–198·3]), neonatal disorders (186·3 million [162·3–214·9]), and stroke (160·4 million [148·0–171·7]). However, notable health gains were seen among other leading communicable, maternal, neonatal, and nutritional (CMNN) diseases. Globally between 2010 and 2021, the age-standardised DALY rates for HIV/AIDS decreased by 47·8% (43·3–51·7) and for diarrhoeal diseases decreased by 47·0% (39·9–52·9). Non-communicable diseases contributed 1·73 billion (95% UI 1·54–1·94) DALYs in 2021, with a decrease in age-standardised DALY rates since 2010 of 6·4% (95% UI 3·5–9·5). Between 2010 and 2021, among the 25 leading Level 3 causes, age-standardised DALY rates increased most substantially for anxiety disorders (16·7% [14·0–19·8]), depressive disorders (16·4% [11·9–21·3]), and diabetes (14·0% [10·0–17·4]). Age-standardised DALY rates due to injuries decreased globally by 24·0% (20·7–27·2) between 2010 and 2021, although improvements were not uniform across locations, ages, and sexes. Globally, HALE at birth improved slightly, from 61·3 years (58·6–63·6) in 2010 to 62·2 years (59·4–64·7) in 2021. However, despite this overall increase, HALE decreased by 2·2% (1·6–2·9) between 2019 and 2021. Interpretation: Putting the COVID-19 pandemic in the context of a mutually exclusive and collectively exhaustive list of causes of health loss is crucial to understanding its impact and ensuring that health funding and policy address needs at both local and global levels through cost-effective and evidence-based interventions. A global epidemiological transition remains underway. Our findings suggest that prioritising non-communicable disease prevention and treatment policies, as well as strengthening health systems, continues to be crucially important. The progress on reducing the burden of CMNN diseases must not stall; although global trends are improving, the burden of CMNN diseases remains unacceptably high. Evidence-based interventions will help save the lives of young children and mothers and improve the overall health and economic conditions of societies across the world. Governments and multilateral organisations should prioritise pandemic preparedness planning alongside efforts to reduce the burden of diseases and injuries that will strain resources in the coming decades. Funding: Bill & Melinda Gates Foundation

Analyzing the Edge Cracked Semicircular Disc under Uniform Compressive (ECSD(UD)) Load

In this study, by employing the edge cracked semicircular disc under uniform (ECSD(UC)) and calculating the shape factor, the toughness of brittle materials under uniform compressive load has been quickly evaluated. Samples, on the loading location and the support, under angle β changing from 0 to 10 degrees, with the crack length (a) changing from 1 to 29 mm and the thickness (t) changing from 1 to 30 mm were investigated. By taking into account the simultaneous effect of thickness and crack length, a relationship for the shape factor (F) of the ECSD(UC) was presented

The effects of clofibrate on neonatal jaundice: A systematic review

Background: Neonatal jaundice is a prevalent disease that causes many complications, including kernicterus and even death. Previous studies have shown that clofibrate as an aryloxy isobutyric acid derivate can be effectively applied for the treatment of neonatal jaundice. Thus, this review was carried out to investigate the effects and mechanism of action of clofibrate on neonatal jaundice. Methods: The keywords such as 'Clofibrate' in combination with 'Neonatal jaundice' or 'Neonatal hyperbilirubinemia' or 'Newborn Jaundice' were used to search for relevant publications indexed in the Institute for Scientific Information (ISI), Scopus, PubMed, and Google Scholar databases. Finally, after reviewing the studies, 24 papers were included in this study. Results: Results showed that the processes of albumin-bound bilirubin transfer to the hepatocytes, hepatic uptake, and storage via ligandin, hepatic conjugation via uridine diphosphate glucuronosyltransferase 1A1 (UGT1A1), conjugation into the bile via MRP2 represent the main action mechanism of clofibrate that turns it into the bilirubin conjugates and expels it from the bile. Besides, clofibrate has been shown to reduce the level of Total Serum Bilirubin (TSB) in infants even at a dosage of 25 mg/kg without leaving side effects. Conclusions: The results of this review revealed that clofibrate effectively reduces TSB in short-term usage and can even have a promising effect at the dosage of 25 mg/kg in full-term infants. Most studies have shown this property over a short period in term infants, and there is no evidence about long-term usage in this regard

Effect of Intravenous Fluid Adjuvant Therapy on Decreasing Serum Bilirubin during Intensive Phototherapy in Healthy Term Neonate with Severe Nonhemolytic Hyperbilirubinemia

Background: Phototherapy is the most common form of treatment and prevention of neonatal nonconjugated hyperbilirubinemia. It seems that intravenous fluid therapy as a complementary method of phototherapy can accelerate the healing process in affected infants. This study aimed at investigating intravenous fluid therapy's effect in decreasing serum bilirubin in healthy term neonates with nonhemolytic hyperbilirubinemia under intensive phototherapy. Methods: As many as 160 healthy term infants with severe nonhemolytic hyperbilirubinemia and without exclusion criteria were enrolled. Infants were randomized to the two treatment groups (phototherapy alone and combination with intravenous fluid therapy). Serum bilirubin at admission time, 6, 12, 24, and 48 h later were measured. We evaluated decreasing serum bilirubin levels and duration of hospitalization in both groups. Results: In this study, the mean levels of serum bilirubin on admission time, 6, 12, 24, and 48 h after treatment gradually reduced in both groups; still, the decrease was not statistically significant between the two groups. Conclusions: Intravenous fluids therapy does not have a significant advantage in the process of phototherapy in healthy term neonates with severe nonhemolytic hyperbilirubinemia. Keywords: Hyperbilirubinemia; neonatal; phototherapy