Nima Hafezi-Nejad

The global burden of injury: incidence, mortality, disability-adjusted life years and time trends from the Global Burden of Disease study 2013

Background The Global Burden of Diseases (GBD), Injuries, and Risk Factors study used the disability-adjusted life year (DALY) to quantify the burden of diseases, injuries, and risk factors. This paper provides an overview of injury estimates from the 2013 update of GBD, with detailed information on incidence, mortality, DALYs and rates of change from 1990 to 2013 for 26 causes of injury, globally, by region and by country. Methods Injury mortality was estimated using the extensive GBD mortality database, corrections for ill-defined cause of death and the cause of death ensemble modelling tool. Morbidity estimation was based on inpatient and outpatient data sets, 26 cause-of-injury and 47 nature-of-injury categories, and seven follow-up studies with patient-reported long-term outcome measures. Results In 2013, 973 million (uncertainty interval (UI) 942 to 993) people sustained injuries that warranted some type of healthcare and 4.8 million (UI 4.5 to 5.1) people died from injuries. Between 1990 and 2013 the global age-standardised injury DALY rate decreased by 31% (UI 26% to 35%). The rate of decline in DALY rates was significant for 22 cause-of-injury categories, including all the major injuries. Conclusions Injuries continue to be an important cause of morbidity and mortality in the developed and developing world. The decline in rates for almost all injuries is so prominent that it warrants a general statement that the world is becoming a safer place to live in. However, the patterns vary widely by cause, age, sex, region and time and there are still large improvements that need to be made.

α-Thalassemia Mutations in Gilan Province, North Iran

One hundred and three patients from Gilan Province, Iran, presenting with hypochromic and microcytic anemia parameters without iron deficiency were included in this study. Using gap-polymerase chain reaction (gap-PCR), reverse hybridization StripAssay and DNA sequencing, we detected a total of 113 α-globin mutations in 94 (91.3%) of these patients. Most prevalent of the 16 different α-thalassemia (α-thal) alleles was −α3.7 (42.5%), followed by the polyadenylation signal (poly A2) (AATAAA>AATGAA) (12.4%), Hb Constant Spring [Hb CS, α142, Term→Gln (TAA>CAA in α2] (10.6%), – –MED (8.8%), IVS-I donor site [GAG GTG AGG>GAG G– – – – –, α−5 nt (−TGAGG)] (7.1%), −α4.2 (4.4%) and poly A1 (AATAAA>AATAAG) (3.5%). An additional nine mutations were observed at frequencies below 2%. We also found two novel α1 gene mutations: α−9 (HBA1: c.−9 G>C) and αIVS-I-4 (HBA1: c.95+4 A>G). Our new findings will be valuable for improving targeted thalassemia screening and prevention strategies in this area.

α-Thalassemia Mutations in Khuzestan Province, Southwest Iran

Although α-thalassemia (α-thal) is the most common hereditary hemoglobin (Hb) disorder in Iran, no comprehensive data are so far available on the prevalence of the disease in the province of Khuzestan in Southwest Iran. This study investigates the spectrum of α-thal mutations in this region. One hundred and twenty-one subjects from Khuzestan Province, Iran, were initially tested for the three most common Iranian α-thal mutations ( − α3.7, − α4.2, and − − MED) by gap-polymerase chain reaction (gap-PCR). Reverse hybridization test strips and DNA sequencing were used to identify additional α-globin mutations. A total of 131 mutated α-globin alleles were identified in these patients. Of the 13 mutations that were detected in Khuzestan Province, Iran, the − α3.7 single gene deletion was the most frequently identified variant, representing 62.6% of the total; we also observed significant numbers of individuals with compound heterozygous mutations. On the basis of our results, we strongly recommend screening for the most common mutations to improve the molecular diagnosis of anemia in this region.

Homocysteine and metabolic syndrome: from clustering to additional utility in prediction of coronary heart disease.

BACKGROUND The association between homocysteine (Hcy) and metabolic syndrome (MetS)-related disorders remains to be unveiled. First, the role of Hcy-MetS interaction in prediction of coronary heart disease (CHD) was assessed. Next, we investigated whether serum Hcy improves CHD risk-prediction beyond MetS and traditional risk factors (TRFs). DESIGN A prospective study of 5893 community-dwelling participants (two sub-cohorts, 3286 diabetic and 2607 non-diabetic; ∼ 8.5 years of follow-up). METHODS Clustering of Hcy with MetS components was assessed using exploratory factor-analysis. Cox regression hazard ratio (HR) was used to predict CHD using Hcy level and MetS status. Baseline model included MetS and TRFs. Addition of Hcy and hyper-homocysteinemia (HHcy) to the baseline model was evaluated in two separate models. RESULTS Hcy was correlated with MetS components, especially with systolic blood pressure. The factor linking MetS to CHD is the factor through which Hcy is linked to MetS. HHcy and MetS interacted as risk factors for CHD. CONCLUSION Hcy adds to the value of MetS and TRFs for CHD risk-prediction by reclassifying around 47.3-49.0% of the overall and 21.6-28.1% of the intermediate-risk population.

Serum Uric Acid, the Metabolic Syndrome, and the Risk of Chronic Kidney Disease in Patients with Type 2 Diabetes

BACKGROUND Serum uric acid (SUA) has been suggested as a potentially modifiable mediator associated with the metabolic syndrome. Hyperuricemia and metabolic syndrome were both associated with adverse renal outcome. However, epidemiologic data are limited regarding this relationship in patients with type 2 diabetes mellitus (T2DM). This study aims to determine whether elevated SUA is associated with an increased prevalence of metabolic risk factors, albuminuria, and chronic kidney disease (CKD) in a large sample of patients with T2DM. It also examines the combined effect of SUA and metabolic syndrome components on the odds of CKD. METHODS A total of 1463 patients with T2DM were recruited. Blood samples were obtained to measure metabolic parameters. Patients with macroalbuminuria or an estimated glomerular filtration rate of <60 mL/min per 1.73 m(2) were considered as CKD cases. RESULTS The prevalence of metabolic syndrome, central obesity, hypertension, high triglycerides (TGs), CKD, and macroalbuminuria was significantly higher in patients with hyperuricemia than those in the lowest tertile of SUA (T1). One standard deviation (SD) increment of SUA was significantly associated with metabolic syndrome, central obesity, and high TGs after adjustment for age, sex, estimated glomerular filtration rate (eGFR), and albuminuria. The odds of CKD went up to 1.37-fold with every 1 SD increment of SUA, independent of age, sex, and components of metabolic syndrome. There was a significant, graded increase in odds of CKD by increasing SUA levels and the number of metabolic syndrome risk factors (P<0.001). CONCLUSION This study proposed a synergistic effect between SUA and metabolic syndrome components on the odds of CKD.

From Radical Mastectomy to Breast-Conserving Therapy and Oncoplastic Breast Surgery: A Narrative Review Comparing Oncological Result, Cosmetic Outcome, Quality of Life, and Health Economy

Surgical management of breast cancer has evolved considerably over the last two decades. There has been a major shift toward less-invasive local treatments, from radical mastectomy to breast-conserving therapy (BCT) and oncoplastic breast surgery (OBS). In order to investigate the efficacy of each of the three abovementioned methods, a literature review was conducted for measurable outcomes including local recurrence, survival, cosmetic outcome, quality of life (QOL), and health economy. From the point of view of oncological result, there is no difference between mastectomy and BCT in local recurrence rate and survival. Long-term results for OBS are not available. The items assessed in the QOL sound a better score for OBS in comparison with mastectomy or BCT. OBS is also associated with a better cosmetic outcome. Although having low income seems to be associated with lower BCT and OBS utilization, prognosis of breast cancer is worse in these women as well. Thus, health economy is the matter that should be studied seriously. OBS is an innovative, progressive, and complicated subspeciality that lacks published randomized clinical trials comparing surgical techniques and objective measures of outcome, especially from oncologic and health economy points of view.

Value of FDG PET/CT in Patient Management and Outcome of Skeletal and Soft Tissue Sarcomas

Fluorodeoxyglucose (FDG)-PET/computed tomography (CT) has been increasingly used in bone and soft tissue sarcomas and provides advantages in the initial tumor staging, tumor grading, therapy assessment, and recurrence detection. FDG-PET/CT metabolic parameters are reliable predictors of survival in sarcomas and could be implemented in risk stratification models along with other prognostic factors in these patients.

Conventional and novel imaging modalities in osteoarthritis: current state of the evidence.

Purpose of reviewImaging modalities are currently an inseparable part of osteoarthritis diagnosis. In this review, we describe the current state of evidence regarding conventional and novel imaging modalities in evaluation of osteoarthritis. Modalities including radiography (qualitative and semi-quantitative assessments), ultrasonography, computed tomography [CT; conventional multidetector CT (MDCT), cone-beam CT (CBCT) and four-dimensional CT (4DCT)], MRI (MRI; semi-quantitative, quantitative and compositional) and PET and their applications are reviewed. Recent findingsRadiography is the modality of choice for initial assessment of osteoarthritis. However, due to its low sensitivity and specificity, numerous recent investigations have proposed MRI as a powerful addition to detect and grade osteoarthritis features, which are not apparent in radiography. Semi-quantitative MRI measurements are feasible to perform in routine clinical practice. Quantitative and compositional MRI measurements have extended the amount of information an MRI examination can provide regarding the three-dimensional shape and tissue composition of articular cartilage. 4DCT and CBCT are introduced as imaging examinations that may reveal biomechanical cartilage abnormalities in osteoarthritis joint by dynamic and weight-bearing evaluations, respectively. Recent PET studies may unveil the underlying metabolic activities that can be associated with osteoarthritis. SummaryIn addition to the established role of radiographs, MRI is the advanced modality of choice for detection and quantification of various osteoarthritis features. 4DCT and CBCT may have specified applications when diagnosis of underlying motion abnormality or dynamic changes in weight-bearing situation is suspected. Future studies should elucidate the specific clinical applications of ultrasonography and PET.

Patterns of Antimicrobial Resistance in the Causative Organisms of Spontaneous Bacterial Peritonitis: A Single Centre, Six-Year Experience of 1981 Samples

Background/Aims. Spontaneous bacterial peritonitis (SBP) is one of the leading causes of morbidity and mortality in patients with cirrhosis. This study aims to determine the microbial agents of SBP and the pattern of antibiotic resistance, in a large number of ascitic samples. Methodology. In a cross-sectional, single center, hospital based study, 1981 consecutive ascitic fluid samples were recruited from 2005 to 2011. Samples were dichotomized into three-year periods, in order to assess the trend of resistance to the first-line empirical antibiotics. Results. SBP was found in 482 (24.33%) of samples, of which 314 (65.15%) were culture positive. The most prevalent isolated pathogen was E. coli (33.8%), followed by staphylococcus aureus (8.9%) and Enterococcus (8.6%). No significant changes in the proportion of gram-negative/gram-positive infections occurred during this period. A percentage of resistant strains to cefotaxime (62.5%, 85.7%), ceftazidim (73%, 82.1%), ciprofloxacin (30, 59.8%), ofloxacin (36.8%, 50%), and oxacilin (35%, 51.6%) were significantly increased. E. coli was most sensitive to imipenem, piperacillin-tazobactam, amikacin, ceftizoxime, and gentamicin. Conclusions. The microbial aetiology of SBP remains relatively constant. However, the resistance rate especially to the first-line recommended antibiotics was significantly increased. This pattern must be watched closely and taken into account in empirical antibiotic treatment.

Risk of coronary heart disease associated with metabolic syndrome and its individual components in Iranian subjects: A matched cohort study

BACKGROUND AND OBJECTIVES To evaluate the risk of coronary heart disease (CHD) associated with metabolic syndrome (MetS) and its individual components in a representative sample of diabetic and nondiabetic Iranians. Moreover, we aimed to define the most hazardous MetS components. METHODS Two cohorts consisting of 1737 nondiabetic and 2385 diabetic participants were followed for the first CHD event during 8.5 years (until December 2013). RESULTS MetS is defined as having 3 individual components associated with increased risk of CHD (hazard ratio [HR] for MetS: in the unadjusted were 2.85 [2.27-3.57] and in the fully adjusted model 1.80 [1.42-2.28]). MetS was associated with lower hazard of CHD in subjects older than 65 (HR: 1.50 vs. 3.47; P for interaction < .05) and in men (HR: 1.68 vs. 4.87; P for interaction < .05). Presence of 4 of 5 individual MetS components increased the risk of CHD associated with MetS as a constellation. The value of MetS is augmented in the presence of low high-density lipoprotein-cholesterol (HR: 5.74 [2.52-13.08]) versus its absence (HR 1.91 [1.33-2.75]), high triglycerides (HR: 3.39 [1.38-8.34] vs. 1.99 [1.40-2.82] in its absence) and elevated blood pressure (HR: 2.61 [1.43-4.76] vs. 1.80 [1.26-2.58] in its absence). CONCLUSIONS We address the value of MetS components in the prediction of CHD and in the absence of traditional risk factors. This study provides evidence for the synergistic effect of MetS components on the incidence of CHD.