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Abstract Background To investigate the global, regional, and national burden of the diseases attributable to excess body weight (EBW) from 1990 to 2019, stratified by age, sex, underlying cause, and sociodemographic index (SDI). Methods Using the Comparative Risk Assessment approach of the Global Burden of Disease (GBD) study 2019, the burden of diseases attributable to EBW was reported for the period from 1990 to 2019. For adults, EBW was defined as a body mass index (BMI) exceeding 25 kg/m2, while for children aged 1 to 19 years, EBW was determined according to the standards set by the International Obesity Taskforce. The burden was reported in terms of numbers, proportions, and age-standardised rates per 100,000, accompanied by corresponding 95% uncertainty intervals (UIs). Results In 2019, there were an estimated 5.0 million deaths (95% UI: 3.2–7.1) and 160.3 million DALYs (106.0–218.9) attributable to EBW worldwide. The age-standardised DALY rate attributable to EBW increased by 18.0% (2.2–42.3) from 1990 to 2019, with notable regional variations. Southeast Asia and South Asia exhibited the highest age-standardised DALY rates. Conversely, the age-standardised death rate due to EBW showed no significant change, with an increase of 4.9% (-7.3 to 24.6) over the same period. Significant regional variations were again observed, particularly in Southeast Asia and South Asia, which recorded the highest age-standardised death rates. Moreover, a non-linear association was observed between the SDI and the regional age-standardised DALY rate of diseases attributable to EBW. Conclusions The global burden of EBW has increased over the past three decades. This trend aligns with socio-demographic indices and is influenced by the physical activity levels and dietary habits of these populations.

Abstract Background Cardiac surgery is a major contributor to acute kidney injury (AKI); approximately 22% of patients who undergo cardiac surgery develop AKI, and among them, 2% will require renal replacement therapy (RRT). AKI is also associated with heightened risks of mortality and morbidity, longer intensive care stays, and increased treatment costs. Due to the challenges of treating AKI, prevention through the use of care bundles is suggested as an effective approach. This review aimed to assess the impact of care bundles on kidney outcomes, mortality, and hospital stay for cardiac patients in critical care. Methods PubMed, Scopus, Web of Science, and EMBASE were searched up to November 2024. Inclusion criteria were studies on individuals with cardiac diseases receiving critical care, that used AKI care bundle as the intervention, and reported outcomes related to AKI, mortality, and other kidney-related events. We used the Cochrane Collaboration’s risk of bias tool 2 and the Newcastle-Ottawa scale for quality assessment. Pooled odds ratios (ORs) or risk ratios (RRs) with 95% confidence intervals (CIs) were calculated. Results Seven studies on total 5045 subjects, including five observational and two randomized controlled trials (RCTs) were included. The implementation of care bundles significantly reduced the incidence of all-stage AKI (OR: 0.78; 95%CI: 0.61–0.99) and moderate-severe AKI (OR: 0.56; 95%CI: 0.43–0.72). Also, the implementation of care bundle increased the incidence of persistent renal dysfunction after 30 days by 2.39 times. However, there were no significant changes in RRT, major adverse kidney events, or mortality between the groups. The mean quality assessment score for observational studies was 7.2 out of ten, while there were noted concerns in the risk of bias assessment of the RCTs. Conclusions The application of care bundles in patients, including those undergoing cardiac surgeries as well as non-cardiac critical illness, appears to be effective in reducing AKI, particularly in moderate and severe stages. However, given the inclusion of non-cardiac patients in some studies, the observed effect may not be solely attributable to cardiac surgery cases. Future large-scale RCTs focusing specifically on cardiac surgery patients are recommended to clarify the impact of care bundles within this subgroup. Registration ID in PROSPERO CRD42024498972.

Abstract Background Gout is one of the oldest known diseases and the most common form of inflammatory arthritis. The established risk factors for gout include hyperuricemia, chronic renal disease, genetic, alcohol consumption, dietary factors, diuretic use, hypertension, obesity, and metabolic syndrome. Patients with gout have an increased risk of all-cause mortality, particularly from cardiovascular disease, cancer, and infectious diseases. Gout is also associated with several complications, such as nephrolithiasis. This literature review describes the global epidemiology and trends associated with gout, before providing an overview of its risk factors and complications. Methods This research used the narrative review method. Thorough searches were performed in PubMed and Google scholar, up to June 15, 2024, for articles that evaluated the risk factors, comorbidities or complications associated with gout. Moreover, we also included studies that reported the epidemiological characteristics or burden of gout at the global, regional, or national level. Results Gout is more prevalent in developed countries, than in developing countries, although its prevalence is increasing globally. In addition, gout is much more prevalent among males than among females. Hyperuricemia has the largest role in the development of gout, although many risk factors contribute to the increasing prevalence of gout, including genes, several medications, and diet. Gout is associated with several comorbidities and complications, which need to be taken into consideration when managing gout. In recent years, gout has been found to be associated with several new comorbidities. Conclusions Our findings provide a comprehensive and informative overview that can be useful for the prevention, diagnosis, and management of gout.

Background: The published experience with restrictive and liberal blood transfusion approaches in pediatric intensive care units (ICUs) is not extensive. We investigated the outcomes of restrictive compared to liberal transfusion strategies in critically ill children. Methods: A search was conducted on PubMed, Embase, Scopus, and the Web of Science until February 16, 2024. The first 300 results from Google Scholar and records from the clinicaltrials.gov registry were manually screened. Backward and forward citation searches were also performed. We included randomized controlled trials examining outcome measures of children aged

Abstract Hodgkin lymphoma (HL) is a rare malignancy affecting the lymphatic system. Our study examined the incidence rates of adult HL based on sex, race/ethnicity, age, and histological subgroups in the United States (US) from 2000 to 2020. Data for this study were extracted from the Surveillance, Epidemiology, and End Results 22 database. HL patients were identified utilizing the International Classification of Diseases for Oncology version 3 and categorized as classical HL, lymphocyte-rich/mixed cell/lymphocyte depleted, nodular sclerosis, classical HL, not otherwise specified, and nodular lymphocyte-predominant HL. The study reported average annual percent change (AAPC). All estimates were presented as counts and age-standardized incidence rates (ASIRs) per 100,000 individuals. Between 2000 and 2019, a total of 70,924 cases of HL were reported in the US. Classical HL was the predominant subtype (94.27%), and most incident cases were among non-Hispanic Whites (66.92%) and those aged 20–29 years (24.86%). The ASIR per 100,000 population was 3.83 for men and 2.92 for women. Both sexes showed declines in the AAPCs between 2000 and 2019 (− 0.64% [− 0.99, − 0.28] and − 0.40% [− 0.77, − 0.03] for men and women, respectively). There was a significant decrease in ASIRs after COVID-19 among both sexes (percent change: − 7.49% [− 11.58, − 3.40]). Throughout all age groups, men had a higher incidence rate compared to women, except for those aged 20–29 years. Although the overall HL incidence rate was lowered in the study period from 2000 to 2019, a dramatic decrease in ASIRs of HL patients following COVID-19 pandemic was observed.

Abstract Brain and central nervous system (CNS) cancers constitute a heterogeneous group of cancers with poor 5-year survival rates. We aimed to report the epidemiology of brain and CNS cancers in Asia in 2020 and their projections up to 2040 by age, sex, and country, as well as their correlation with socioeconomic status. We extracted data from the 2020 Global Cancer Observatory (GLOBOCAN). Numbers, age-standardized incidence rates (ASIRs) and mortality rates (ASMRs), 5-year prevalent cases and rates, mortality-to-incidence ratios (MIRs), and crude rates were calculated. The human development index (HDI) and current healthcare expenditure (CHE)-to-gross domestic product (GDP) ratio were included as indicators of socioeconomic status. Additionally, the numbers of new cases and deaths were predicted from 2025 to 2040 by multiplying the anticipated population during this period by age-standardized rates. In 2020, there were 166,925 new cases of brain and CNS cancers in Asia, indicating a 5-year prevalence rate of 9.40 per 100,000. We also estimated the total ASIR, ASMR, and MIR as 3.20, 2.60, and 0.83, respectively. There were significant negative correlations between HDI and MIR (correlation coefficient: − 0.538, p value

Abstract Background Lung cancer, accounting for a significant proportion of global cancer cases and deaths, poses a considerable health burden. Non-small cell lung cancer (NSCLC) patients have a poor prognosis and limited treatment options due to late-stage diagnosis and drug resistance. Dysregulated of the mitogen-activated protein kinase (MAPK) pathway, which is implicated in NSCLC pathogenesis, underscores the potential of MEK inhibitors such as binimetinib. Despite promising results in other cancers, comprehensive studies evaluating the safety and efficacy of binimetinib in lung cancer are lacking. This systematic review aimed to investigate the safety and efficacy of binimetinib for lung cancer treatment. Methods We searched PubMed, Scopus, Web of Science, and Google Scholar until September 2023. Clinical trials evaluating the efficacy or safety of binimetinib for lung cancer treatment were included. Studies were excluded if they included individuals with conditions unrelated to lung cancer, investigated other treatments, or had different types of designs. The quality assessment was conducted utilizing the National Institutes of Health tool. Results Seven studies with 228 participants overall were included. Four had good quality judgments, and three had fair quality judgments. The majority of patients experienced all-cause adverse events, with diarrhea, fatigue, and nausea being the most commonly reported adverse events of any grade. The objective response rate (ORR) was up to 75%, and the median progression-free survival (PFS) was up to 9.3 months. The disease control rate after 24 weeks varied from 41% to 64%. Overall survival (OS) ranged between 3.0 and 18.8 months. Notably, treatment-related adverse events were observed in more than 50% of patients, including serious adverse events such as colitis, febrile neutropenia, and pulmonary infection. Some adverse events led to dose limitation and drug discontinuation in five studies. Additionally, five studies reported cases of death, mostly due to disease progression. The median duration of treatment ranged from 14.8 weeks to 8.4 months. The most common dosage of binimetinib was 30 mg or 45 mg twice daily, sometimes used in combination with other agents like encorafenib or hydroxychloroquine. Conclusions Only a few studies have shown binimetinib to be effective, in terms of improving OS, PFS, and ORR, while most of the studies found nonsignificant efficacy with increased toxicity for binimetinib compared with traditional chemotherapy in patients with lung cancer. Further large-scale randomized controlled trials are recommended.

Abstract Introduction Laryngeal cancers account for one-third of all head and neck cancers. We aimed to report the incidence trends of laryngeal cancer over 2000–2020 in the United States (US), by age, sex, race/ethnicity, and histological subtypes. Methods Data from the Surveillance, Epidemiology, and End Results 22 database were used to identify patients with laryngeal cancer based on the International Classification of Diseases for Oncology, version 3. Age-standardized incidence rates (ASIRs) for laryngeal cancer, adjusted for reporting delays, were calculated. The Joinpoint Regression Program was then utilized to determine annual percent changes (APCs) and average annual percent changes (AAPCs) in the trends. The analysis excluded data from 2020 to prevent potential bias related to the COVID-19 pandemic. Results A total of 104,991 cases of laryngeal cancer were identified in the US from 2000 to 2019. Squamous cell carcinoma was the predominant subtype, accounting for 94.53% of cases. Above 73.20% occurred among non-Hispanic whites, with the highest incidence observed among individuals aged 55–69 years (46.71%). The ASIRs were 5.98 and 1.25 per 100,000 population for men and women, respectively. Over 2000–2019, there was a significant reduction in ASIRs for laryngeal cancer in both sexes. Non-Hispanic black men exhibited the highest ASIR (9.13 per 100,000) and the largest decline in the ASIRs over 2000–2019 (AAPC: -3.26%). Conclusions Laryngeal cancer incidence rates showed a decline from 2000 to 2019, in addition to 2020, during the COVID-19 pandemic. Additional research is required to investigate risk factors and their influence on incidence rates of laryngeal cancer.

Abstract High systolic blood pressure (HSBP) is associated with several metabolic and non-metabolic disorders. This research aimed to document the deaths and disability-adjusted life-years (DALYs) attributable to HSBP in the Middle East and North Africa (MENA) region between 1990 and 2019, by age, sex, underlying cause and socio-demographic index (SDI). We used the methodological framework and data drawn from the Global Burden of Disease study 2019 to identify the burden of diseases attributable to HSBP, from 1990 to 2019, in the MENA region. The estimates reported were presented as counts, population-attributable fractions, and age-standardised rates (per 100,000), along with 95% uncertainty intervals. In 2019, 803.6 thousand (687.1 to 923.8) deaths were attributed to HSBP in MENA, which accounted for 25.9% (22.9–28.6%) of all deaths. The number of regional DALYs caused by HSBP in 2019 was 19.0 million (16.3–21.9 million), which accounted for 11.6% (10.1–13.3%) of all DALYs, and was 23.4% (15.9–31.5%) lower than in 1990. The highest age-standardised DALY rate for 2019 was observed in Afghanistan, with the lowest in Kuwait. Additionally, the DALY rate in MENA rose with age for both sexs. Furthermore, a negative linear relationship was found between SDI and the age-standardised DALY rates. The region has a substantial HSBP-related burden. Policymakers and healthcare professionals should prioritize interventions that effectively promote the early detection of HSBP, access to quality healthcare, and lifestyle modifications to mitigate the HSBP burden in the MENA countries.

Abstract Kidney cancer, a type of urogenital cancer, imposes a high burden on patients. Despite this, no recent research has evaluated the burden of this type of cancer in the Middle East and North Africa (MENA) region. This study explored the burden of kidney cancer from 1990 to 2019 according to age, sex and socio-demographic index (SDI). The Global Burden of Disease (GBD) 2019 data was utilized to estimate the incidence, death, and disability-adjusted life-years (DALYs) caused by kidney cancer. These estimates were reported as counts and as age-standardised rates with 95% uncertainty intervals (UIs). The estimated age-standardised incidence, mortality, and DALY rates of kidney cancer in 2019 were 3.2 (2.8–3.6), 1.4 (1.2–1.6), and 37.2 (32.0–42.6) per 100,000, respectively. Over the period from 1990 to 2019, these rates have increased by 98.0%, 48.9%, and 37.7%, respectively. In 2019, the United Arab Emirates, Qatar, and Lebanon had the largest age-standardised incidence, mortality, and DALY rates. The smallest age-standardised incidence rates were seen in Yemen, Afghanistan, and the Syrian Arab Republic. Additionally, the smallest age-standardised mortality and DALY rates were observed in the Syrian Arab Republic, Yemen, and Morocco. The highest incidence rates were found among individuals aged 75–79 in both males and females. In 2019, the MENA/Global DALY ratio exceeded one for females aged 5–19 age and males aged 5–14, compared to 1990age groups in males. The burden of kidney cancer consistently rose with increasing SDI levels from 1990 to 2019. The increasing burden of kidney cancer highlights the urgent need for interventions aimed at improving early diagnosis and treatment in the region.

Background: Non-Hodgkin lymphoma (NHL) originates from the lymphoid tissues with a great morbidity and economic burden. It accounts for about 5 % of cancers in the United States (US) in 2024. We aimed to report the incidence trend of pediatric NHL in the US over 2000–2020, by age, sex, and subtype. Methods: We utilized data from the Surveillance, Epidemiology, and End Results (SEER) Program. Cases were categorized using the International Classification of Diseases for Oncology version 3. We reported age-standariszed incidence rates (ASIRs) and average annual percent changes (AAPC). Results: From 2000 to 2019, there were 38,098 reported cases of pediatric NHL, with B-cell NHL being the most common subtype (84.31 %). Most cases were observed in non-Hispanic Whites (46.71 %) and children aged ≤4 years (37.26 %). The ASIR per 100,000 population was 5.47 (5.40–5.54) for males and 3.95 (3.89–4.01) for females. Over the study period, both sexes showed significant increases in ASIRs (AAPCs of 0.93 % for males and 0.51 % for females). However, no significant changes were observed in the ASIRs of pediatric NHL across all races and both sexes after the COVID-19 pandemic (percent change: 1.30 % [-5.10, 7.70]). Conclusions: While overall incidence rates remained stable, significant demographic variations were evident, including increases among Hispanic males and decreases among NHB females. There is a need for targeted interventions to address demographic disparities and the complex interplay of genetic, environmental, and lifestyle factors influencing NHL ASIRs in pediatric populations.

BackgroundMultiple sclerosis (MS) is a progressively debilitating disorder that has seen a notable rise in prevalence in recent years. This study examines the burden of MS from 1990 to 2019, providing a detailed analysis by age, sex, and sociodemographic index (SDI) across 204 countries and territories.MethodsData on the prevalence, death and disability-adjusted life years (DALYs) attributable to MS were obtained from the publically available Global Burden of Disease 2019 project. The estimates are reported as numbers, percentages, and age-standardized rates per 100,000, accompanied by 95% uncertainty intervals.ResultsIn 2019, MS accounted for 1.8 million prevalent cases, 22.4 thousand deaths and 1.2 million DALYs worldwide. There were significant declines in the global age-standardized prevalence, mortality and DALY rates of MS over the period 1990–2019. In 2019, females exhibited a higher global point prevalence and a greater total number of prevalent MS cases than males across all age groups. At the regional level, a non-linear relationship was observed between the age-standardized DALY rate of MS and SDI.ConclusionAlthough the global age-standardized DALY rate of MS decreased between 1990 and 2019, MS continues to account for a considerable number of DALYs and prevalent cases. Integrating MS and its associated risk factors into healthcare planning is vital, especially in areas with high levels of socioeconomic development.

BackgroundHypopharyngeal cancer (HC) comprises less than 5% of all malignant tumors in the head and neck. They often present at an advanced stage, thereby resulting in high mortalities. We aimed to report the epidemiology of HC globally, regionally, and nationally by age, sex, and socioeconomic status in 2020 and its projection to 2040.MethodsData on HC incidence and mortality were extracted from the GLOBOCAN 2020. Age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and mortality-to-incidence ratios (MIRs) were calculated. We used bivariate correlation test, presenting results through Pearson’s correlation coefficient (r) to investigate the correlation between the metrics, human development index (HDI), and current healthcare expenditure (CHE) as a percentage of gross domestic product (GDP) (CHE/GDP).ResultsIn 2020, there were 84254 new HC cases globally (ASIR: 0.91 per 100000). Moreover, HC resulted in 38599 mortalities in 2020 (ASMR: 0.41). Furthermore, the global MIR of HC was 0.45. The ASIR and ASMR of HC were higher in men than women. Also, HDI demonstrated significant correlations with HC ASIR (r= 0.249, p

Abstract Cancers of the kidney and renal pelvis are among the most prevalent types of urinary cancers. We aimed to outline the incidence trends of kidney and renal pelvis cancers by age, sex, race/ethnicity, and histology in the United States (US) from 2000 to 2020. The data was obtained from the Surveillance, Epidemiology, and End Results (SEER) 22 database. The identification of patients with kidney and renal pelvis cancers with morphologies of renal cell carcinoma, nephroblastoma, sarcoma, and neuroendocrine tumor was conducted utilizing the International Classification of Diseases for Oncology version 3. The average annual percent change (AAPC) were presented. All estimates were given in the form of counts and delayed age-standardized incidence rates (ASIRs) per 100,000 people. From 2000 to 2019, a total of 490,481 cases of kidney and renal pelvic cancer were recorded across all age groups in the US. The majority of them were among Non-Hispanic Whites (NHWs) (69.75%) and those aged 55–69 years (39.96%). The ASIRs per 100,000 for kidney and pelvis cancers were 22.03 for men and 11.14 for women. Non-Hispanic Black men had the highest ASIR (24.53 [24.24, 24.81]), and increase in ASIR over the 2000–2019 period (AAPC: 2.19% [1.84, 2.84]). There was a noticeable increase in incidence of kidney and renal pelvis cancers. Individuals aged 70–84 years had the highest ASIR for kidney and renal pelvis cancers. The COVID-19 era has resulted in a significant reduction in incidence rates across all demographics.

Abstract Schizophrenia ranks as the third-most common cause of disability among mental disorders globally. This study presents findings on the prevalence, incidence and years lived with disability (YLDs) as a result of schizophrenia in the Middle East and North Africa (MENA), stratified by age, sex and sociodemographic index (SDI). We collected publicly accessible data from the Global Burden of Disease (GBD) study 2019. This study reports the burden of schizophrenia, from 1990 to 2019, for the 21 countries that comprise MENA. In 2019, MENA exhibited an age-standardised point prevalence of 248.2, an incidence rate of 14.7 and an YLD rate of 158.7 per 100,000, which have not changed substantially between 1990 and 2019. In 2019, the age-standardised YLD rate was highest in Qatar and lowest in Afghanistan. No MENA countries demonstrated noteworthy changes in the burden of schizophrenia from 1990 to 2019. Furthermore, in 2019, the highest number of prevalent cases and the point prevalence were observed among those aged 35–39, with a higher prevalence among males in almost all age categories. Additionally, in 2019, the age-standardised YLD rates in MENA were below the worldwide average. Finally, there was a positive correlation between the burden of schizophrenia and the SDI from 1990 to 2019. The disease burden of schizophrenia has remained relatively stable over the past thirty years. Nevertheless, as the regional life-expectancy continues to increase, the burden of schizophrenia is also expected to rise. Therefore, early planning for the increase in the burden of the disease is urgently needed in the region.

Abstract Background Obesity is a worldwide health concern with serious clinical effects, including myocardial infarction (MI), stroke, cardiovascular diseases (CVDs), and all-cause mortality. The present study aimed to assess the association of obesity phenotypes and different CVDs and mortality in males and females by simultaneously considering the longitudinal and survival time data. Methods In the Tehran Lipid and Glucose Study (TLGS), participants older than three years were selected by a multi-stage random cluster sampling method and followed for about 19 years. In the current study, individuals aged over 40 years without a medical history of CVD, stroke, MI, and coronary heart disease were included. Exclusions comprised those undergoing treatment for CVD and those with more than 30% missing information or incomplete data. Joint modeling of longitudinal binary outcome and survival time data was applied to assess the dependency and the association between the changes in obesity phenotypes and time to occurrence of CVD, MI, stroke, and CVD mortality. To account for any potential sex-related confounding effect on the association between the obesity phenotypes and CVD outcomes, sex-specific analysis was carried out. The analysis was performed using packages (JMbayes2) of R software (version 4.2.1). Results Overall, 6350 adults above 40 years were included. In the joint modeling of CVD outcome among males, literates and participants with a family history of diabetes were at lower risk of CVD compared to illiterates and those with no family history of diabetes in the Bayesian Cox model. Current smokers were at higher risk of CVD compared to non-smokers. In a logistic mixed effects model, odds of obesity phenotype was higher among participants with low physical activity, family history of diabetes and older age compared to males with high physical activity, no family history of diabetes and younger age. In females, based on the results of the Bayesian Cox model, participants with family history of diabetes, family history of CVD, abnormal obesity phenotype and past smokers had a higher risk of CVD compared to those with no history of diabetes, CVD and nonsmokers. In the obesity varying model, odds of obesity phenotype was higher among females with history of diabetes and older age compared to those with no history of diabetes and who were younger. There was no significant variable associated with MI among males in the Bayesian Cox model. Odds of obesity phenotype was higher in males with low physical activity compared to those with high physical activity in the obesity varying model, whereas current smokers were at lower odds of obesity phenotype than nonsmokers. In females, risk of MI was higher among those with family history of diabetes compared to those with no history of diabetes in the Bayesian Cox model. In the logistic mixed effects model, a direct and significant association was found between age and obesity phenotype. In males, participants with history of diabetes, abnormal obesity phenotype and older age were at higher risk of stroke in the Bayesian Cox model compared to males with no history of diabetes, normal obesity phenotype and younger persons. In the obesity varying model, odds of obesity phenotype was higher in males with low physical activity, family history of diabetes and older age compared to those with high physical activity, no family history of diabetes and who were younger. Smokers had a lower odds of obesity phenotype than nonsmokers. In females, past smokers and those with family history of diabetes were at higher risk of stroke compared to nonsmokers and females with no history of diabetes in the Bayesian Cox model. In the obesity varying model, females with family history of diabetes and older ages had a higher odds of obesity phenotype compared to those with no family history of diabetes and who were younger. Among males, risk of CVD mortality was lower in past smokers compared to nonsmokers in the survival model. A direct and significant association was found between age and CVD mortality. Odds of obesity phenotype was higher in males with a history of diabetes than in those with no family history of diabetes in the logistic mixed effects model. Conclusions It seems that modifications to metabolic disorders may have an impact on the heightened incidence of CVDs. Based on this, males with obesity and any type of metabolic disorder had a higher risk of CVD, stroke and CVD mortality (excluding MI) compared to those with a normal body mass index (BMI) and no metabolic disorders. Females with obesity and any type of metabolic disorder were at higher risk of CVD(, MI and stroke compared to those with a normal BMI and no metabolic disorders suggesting that obesity and metabolic disorders are related. Due to its synergistic effect on high blood pressure, metabolic disorders raise the risk of CVD.

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic affected many aspects of lifestyle and medical education during the recent years. We aimed to determine the impacts of COVID-19 pandemic on medical education to provide an overview of systematic reviews on it.MethodsWe searched PubMed, Scopus, Web of Science, Cochrane library, Google Scholar, and medRxiv, with the following keywords: “SARS-CoV-2,” “COVID-19,” “Medical Education,” “E-learning,” “Distance Education,” “Online Learning,” “Virtual Education,” “systematic review,” and “meta-analysis,” up to 15 April 2023. Studies were included if they were systematic reviews assessing the impacts of the COVID-19 pandemic on medical sciences students. We used A MeaSurement Tool to Assess systematic Reviews 2 (AMSTAR-2) checklist for quality assessment.ResultsA total of 28 systematic reviews were included. The eligible reviews included between five and 64 primary studies, ranging from 897 to 139,381 participants. Technology-enhanced learning and simulation-based learning were the most frequently used strategies. Virtual teaching has several drawbacks like technical difficulties, confidentiality problems, lower student involvement, connection problems, and digital fatigue. The overall satisfaction rate for online learning was above 50%. Also, favorable opinions about perception, acceptability, motivation, and engagement were reported. The quality of 27 studies were critically low and one was low.ConclusionThere were reduced clinical exposure and satisfaction for medical students during the pandemic. Further high-quality systematic reviews are required.

BackgroundVitamin A deficiency (VAD) is a common micronutrient deficiency that imposes a substantial burden worldwide. This study examined the burden of VAD from 1990 to 2019 in the Middle East and North Africa (MENA) region by age, sex and sociodemographic index (SDI).MethodsThe data were obtained from the Global Burden of Disease (GBD) 2019 database. We reported the prevalence, incidence, and years lived with disability (YLDs) that were attributable to VAD for the MENA region, along with its constituent countries.ResultsIn 2019, the MENA region had 30.6 million prevalent cases of VAD, with an age-standardized prevalence rate of 5249.9 per 100,000 population. In addition, VAD was responsible for 62.2 thousand YLDs, with an age-standardized YLD rate of 10.2 per 100,000. The age-standardized prevalence [50.3% (−55.9 to −44.7)] and YLD [−49.3% (−55.3 to −43.1)] rates of VAD have significantly decreased since 1990. In 2019, the MENA region’s VAD-attributable YLD rate was below the global average for males and females across all age groups. Additionally, SDI was negatively associated the age-standardized YLD rate of VAD.ConclusionThis study underscores the necessity of frequently updating health data and developing guidelines and regulations to prevent, detect early, and effectively treat VAD in the MENA countries.

ABSTRACT Background Despite being uncommon, vulvar cancer is a serious health concern with a 5‐year relative survival rate of 71%. Aims The objective was to investigate the incidence rates of this disease across different racial, ethnic, and histological subgroups in the United States, as well as the effects of the COVID‐19 pandemic on this cancer. Methods We used the Surveillance, Epidemiology, and End Results (SEER) 22 database. The International Classification of Diseases for Oncology Version 3 topologic code C51 was assigned for vulvar cancer. Average annual percent change (AAPC) and the pairwise comparison with the parallelism and coincidence were reported. Counts and age‐adjusted incidence rates per 100 000 individuals with their corresponding 95% confidence intervals (CIs) were reported. Results The age‐adjusted incidence rate of vulvar cancer was 2.40 (95% CI, 2.38–2.43) over the period 2000–2019, with an AAPC of 0.80 (95% CI, 0.63–0.99). By race/ethnicity, only non‐Hispanic Whites had an increasing trend over 2000–2019 (AAPC: 1.30; 95% CI, 1.07–1.54). The highest age‐adjusted incidence rate of vulvar cancer in the United States was for squamous cell carcinoma (SCC). There was a significant decrease in the age‐standardized incidence rate of vulvar cancer in all races/ethnicities in all age groups (AAPC: −10.15; 95% CI, −15.35 to −4.94) over 2019–2020. Also, the incidence rates and incident numbers of vulvar cancer increased with aging and peaked at the 85+ age group. Conclusion There was an increase in the incidence rate of vulvar cancer in all races, with a significantly increased trend in non‐Hispanic White women from 2000 to 2019. SCC displayed the highest incidence rate among vulvar cancer histological types. It is recommended to conduct further research to identify the relevant risk factors of vulvar cancer in the United States.

Abstract Background There are several types of dermatitis, each capable of causing enduring changes that extend beyond physical discomfort. In severe cases, dermatitis can significantly affect mental health, social interactions, and the overall quality of life. This study reports the burden of dermatitis in the Middle East and North Africa (MENA) region from 1990 to 2019, according to sex, age category, and socio-demographic index (SDI). Methods Publicly available data regarding the point prevalence, incidence, and years lived with disability (YLDs) were collected from the Global Burden of Disease 2019 study for both the MENA region and its constituent countries. The point prevalence, incidence, and YLDs of dermatitis were represented as counts and age-standardised rates with 95% uncertainty intervals (UIs). Results In 2019, the age-standardised point prevalence of dermatitis was 2744.6 (2517.8–3003.1) per 100,000 population, which was 2.3% lower than in 1990. The YLD rate was 92.3 (55.6–143.4) per 100,000 population, which was 3.1% lower than in 1990. The largest point prevalence rates were observed among those aged 70–74, for both sexes. The 2019 MENA/Global DALY ratio was not above one in any age group for either sex. During the period 1990 to 2019, there was no clear correlation between the burden of dermatitis and the SDI level. Conclusion The dermatitis burden in the MENA region remained relatively stable from 1990 to 2019. Future prevention efforts should focus on improving healthcare access, health education, and workplace safety regulations.

Abstract Background Cardiovascular diseases (CVDs) are a major cause of morbidity and mortality worldwide. Controversial views exist over the effects of metabolically unhealthy obesity phenotypes on CVDs. This study aimed to perform a meta-analysis to assess the association between metabolic syndrome and myocardial infarction (MI) among individuals with excess body weight (EBW). Methods We searched PubMed/Medline, Scopus, and Web of Science databases as of December 9, 2023. Cohort studies involving patients with overweight or obesity that reported the relevant effect measures for the association between metabolic syndrome and MI were included. We excluded studies with incomplete or unavailable original data, reanalysis of previously published data, and those that did not report the adjusted effect sizes. We used the Newcastle Ottawa Scale for quality assessment. Random-effect model meta-analysis was performed. Publication bias was assessed by Begg’s test. Results Overall, nine studies comprising a total of 61,104 participants were included. There was a significant positive association between metabolic syndrome and MI among those with obesity (hazard ratio (HR): 1.68; 95% confidence interval (CI): 1.27, 2.22). Subgroup analysis showed higher HRs for obesity (1.72; 1.03, 2.88) than overweight (1.58; 1.-13-2.21). Meta-regression revealed no significant association between nationality and risk of MI (p = 0.75). All studies had high qualities. There was no significant publication bias (p = 0.42). Conclusions Metabolic syndrome increased the risk of MI in those with EBW. Further studies are recommended to investigate other risk factors of CVDs in EBW, in order to implement preventive programs to reduce the burden of CVD in obesity.

Abstract Background Tislelizumab is an anti-programmed death-1 (PD-1) monoclonal antibody with a construction that enables it to have a higher affinity to its target. We aimed to evaluate tislelizumab’s safety and efficacy for treating non-small cell lung cancer (NSCLC). Methods Embase, Scopus, PubMed, Web of Science, and Google Scholar were searched up to December 20, 2022. The review only included randomized controlled trials (RCTs) that evaluated the safety or efficacy of tislelizumab for treating patients with lung cancer. The revised Cochrane risk-of-bias tool (RoB2) was utilized to evaluate study quality. Results There were four RCTs identified, which included 1565 patients with confirmed locally advanced or metastatic squamous and/or non-squamous types of NSCLC. Treatment with tislelizumab was associated with better progression-free survival (PFS) and objective response rate (ORR), particularly when used in combination with chemotherapy. Almost all patients in both arms reported at least one treatment-emergent adverse event (TEAE). Decreased hematologic indexes accounted for more than 20% of the grade ≥ 3 TEAEs in the tislelizumab plus chemotherapy group. The proportion of TEAE that led to death in the tislelizumab plus chemotherapy arms ranged from 3.2 to 4.2%. Hypothyroidism, pneumonitis, and hyperglycemia were the most frequently noted immune-mediated adverse events in the tislelizumab group. Conclusions Tislelizumab, whether used alone or in combination with chemotherapy, seems to demonstrate both a safety and efficacy as a treatment for NSCLC.

Abstract Myeloma is one of the most common types of haematological malignancies. We aimed to investigate the incidence rates of myeloma by sex, race, age, and histological subgroups in the United States (US) over 2000–2020. Data were retrieved from the the Surveillance, Epidemiology, and End Results (SEER) 22 database. The International Classification of Diseases for Oncology version 3 morphological codes 9731, 9732, and 9734 were assigned for solitary plasmacytoma of bone, plasma cell myeloma, and extraosseous plasmacytoma, respectively. Average annual percent change (AAPC) and the pairwise comparison with the parallelism and coincidence were reported. All estimates were reported as counts and age-adjusted incidence rates per 100,000 individuals. Over 2000–2019, most of myeloma cases were among those aged at least 55 years (85.51%), men (54.82%), and non-Hispanic Whites (66.67%). Among different subtypes, plasma cell myeloma with 193,530 cases had the highest frequency over the same period. Also, there was a significant decrease in the age-standardized incidence rate of myeloma across all races/ethnicities in both sexes within all age groups (AAPC: − 8.02; 95% confidence interval (CI): − 10.43 to − 5.61) and those aged

Abstract High body mass index (BMI), or excess body weight (EBW), represents a significant risk factor for a range of diseases, including cardiovascular diseases and cancers. The study sought to determine the burden of diseases attributable to EBW in the Middle East and North Africa (MENA) region from 1990 and 2019. The analysis also included an exploration of this burden by age, sex, underlying cause, and sociodemographic index (SDI). We utilized publicly available data from the Global Burden of Disease (GBD) study 2019 to identify the deaths and disability-adjusted life-years (DALYs) of diseases associated with EBW in MENA, spanning the period from 1990 to 2019. The GBD estimated the mean BMI and the prevalence of EBW using hierarchical mixed-effects regression, followed by spatiotemporal Gaussian process regression to determine the most accurate BMI distribution through comparison with actual data. In 2019, there were an estimated 538.4 thousand deaths (95% UI 369.9–712.3) and 17.9 million DALYs (12.9–23.1) attributable to EBW in the region. The DALYs attributable to EBW were higher in men (9.3 million [6.5–12.4]) than in women (8.5 million [6.4–10.8]). The age-standardized death and DALY rates for the diseases associated with EBW increased by 5.1% (− 9.0–25.9) and 8.3% (− 6.5–28.8), respectively, during the study period which was not significant. Egypt had the highest age-standardized mortality rate due to EBW (217.7 [140.0, 307.8]), while Yemen (88.6 [45.9, 143.5]) had the lowest. In 2019, the highest number of DALYs occurred among individuals aged 60 to 64 years old. Furthermore, we found a positive association between a nation's SDI and the age-standardized DALY rate linked to EBW. Cardiovascular disease emerged as the leading contributor to the EBW burden in MENA. The disease burden attributable to EBW showed a non-significant increase in MENA from 1990 to 2019.

Abstract Background The loss of vision is a substantial public health concern that has important implications for an individual’s quality of life. The primary objective of this research was to document the burden of vision loss in the Middle East and North Africa (MENA) region, spanning the years 1990–2019, by age group, sex, underlying cause and sociodemographic index (SDI). Methods Publicly available data concerning the burden of vision loss were acquired from the Global Burden of Disease study 2019. The data encompassed all 21 countries within the MENA region for the period spanning 1990 to 2019. The estimates were reported as raw counts and age-standardised rates per 100,000, accompanied by their corresponding 95% uncertainty intervals (UIs). Results In 2019, MENA had an age-standardised point prevalence of 7040.0 (95% UI: 6195.0, 8002.7) and an YLD rate of 314.5 (222.1, 427.6) per 100,000 for vision loss, which were 11.1% (-12.5, -9.7) and 24.3% (-27.6, -20.8) lower, respectively, than in 1990. In 2019, Afghanistan [469.6 (333.0, 632.8)] had the largest age-standardised YLD rate and Turkey [210.7 (145.3, 290.9)] had the lowest. All countries showed a decrease in the age-standardised point prevalence and YLD rate between 1990 and 2019, except for Oman, Afghanistan, and Yemen. Furthermore, in 2019 the largest number of prevalent cases and YLDs were found in the 65–69 age group. Also in 2019, the age-standardised YLD rates in MENA exceeded the global averages for most age groups, for both males and females. In 2019, refractive disorders were the most common types of vision loss among children, adolescents, and middle-age adults in MENA, while near vision loss and cataracts were the most common among older adults. Finally, the burden of vision loss had a slightly negatively association with SDI over the period 1990–2019. Conclusion Although the burden of vision loss has decreased over the last three decades, the prevalence remains high. These results underscore the importance of healthcare policymakers taking action to implement preventive measures, especially among the elderly and those living in low socioeconomic countries, to decrease the attributable burden in MENA.

Abstract Background and Aims Osteoarthritis (OA) is one of the most common debilitating diseases among the aging population. Nigella sativa is one potential treatment for OA. Here, we sought to evaluate the efficacy and safety of Nigella sativa for treating patients with OA. Methods PubMed, Scopus, Embase, and Web of Science were searched up to October 20, 2022. The primary outcome was changes in the pain score after receiving Nigella sativa or control agents based on the results of randomized controlled trials (RCTs). The secondary outcome was set as the frequency of adverse events reported during the follow‐up period. Results Six RCTs involving a total of 370 patients with knee OA were included in the present systematic review. Among the four screened studies, the topical administration of Nigella sativa oil was found to be more effective than the placebo in relieving pain in three trials. Additionally, the oral use of Nigella sativa oil was assessed in two trials, and an improvement in pain score relative to placebo was documented in only one of the studies. Also, the trial that evaluated the effectiveness of Nigella sativa oral capsules did not demonstrate any difference in pain reduction between the intervention and placebo groups. Overall, either topical or oral administration of Nigella sativa was well tolerated, and no serious adverse events were reported. Conclusion Nigella sativa is generally safe, but conflicting findings from low‐quality studies hinder the ability to make clinical recommendations for or against treating OA. Robust trials are needed for informed decisions.

Glaucoma is the primary cause of irreversible blindness globally. Different glaucoma subtypes are identified by their underlying mechanisms, and treatment options differ by its pathogenesis. Current management includes topical medications to lower intraocular pressure and surgical procedures like trabeculoplasty and glaucoma drainage implants. Fecal microbiota transplantation (FMT) is an almost effective and safe treatment option for recurrent Clostridium difficile infection. The relationship between bacterial populations, metabolites, and inflammatory pathways in retinal diseases indicates possible therapeutic strategies. Thus, incorporating host microbiota-based therapies could offer an additional treatment option for glaucoma patients. Here, we propose that combining FMT with standard glaucoma treatments may benefit those affected by this condition. Also, the potential safety, efficacy, cost-effectiveness and clinical applications are discussed.

BackgroundAlthough rare, small intestine cancer is on the rise in the developed world. We aimed to investigate the incidence trends of small intestine cancer by sex, race/ethnicity, age, and histological subgroups in the United States (US) over 2000-2020. Also, we evaluated the COVID-19 impacts on the incidence trends of this cancer.MethodsData were collected from the Surveillance, Epidemiology, and End Results 22 database. Both the average annual percent change (AAPC) and age-standardized incidence rates (ASIRs) were determined. The findings were expressed as counts and incidence rates adjusted for age per 100,000 people with 95% confidence intervals (CIs).ResultsA total of 67,815 cases of small intestine cancer across all age groups were reported in the US between 2000 and 2019. Neuroendocrine carcinoma was the most often reported subtype (54.26%). The age group of 55 to 69 years (38.08%), men (53.10%), and Non-Hispanic Whites (69.07%) accounted for the majority of cases. Over 2000-2019, the ASIRs for small intestine cancer among men and women were 2.61 (95% CI: 2.59-2.64) and 1.92 (95% CI: 1.89-1.94) per 100,000, indicating a significant increase of 2.01% and 2.12%, respectively. Non-Hispanic Black men had the highest ASIR (4.25 per 100,000). Also, those aged 80-84 age group had the highest ASIR. During COVID-19, the ASIR of small intestine cancer decreased by 8.94% (5.06-12.81%).ConclusionsSmall intestine cancer incidence raised in all sexes and ethnicities. Following COVID-19, reported cases declined, possibly due to pandemic-related diagnostic challenges. The impact of underdiagnosis on patient survival needs further investigations.

BackgroundThe incidence rate of testicular cancer has risen in many countries during recent decades. This study aimed to outline the impact of testicular cancer on the Middle East and North Africa (MENA) region from 1990 to 2019, examining its burden by age group and according to the socio-demographic index (SDI).MethodsData on the incidence, death, and disability-adjusted life-years (DALYs) due to testicular cancer were retrieved from the Global Burden of Disease study 2019. The counts and age-standardized rates (per 100,000) were reported, and all rates were accompanied by 95% uncertainty intervals (UIs).ResultsIn MENA, the age-standardized incidence rate of testicular cancer was 1.4 per 100,000 in 2019, showing a 244.0% increase since 1990. Similarly, the annual death rate, at 0.1, experienced a 2.6% rise during the same period. In 2019, testicular cancer accounted for 31.1 thousand DALYs, marking an age-standardized rate of 5.0, which was 2.8% higher than in 1990. The 1-4 age group exhibited the largest incidence rate in 2019. In addition, in both 1990 and 2019 the MENA/Global DALY ratio was higher than one in the 1-14 year age groups. During the period 1990 to 2019, the age-standardized DALY rate of testicular cancer steadily rose with higher SDI values, except for a decrease observed at an SDI of 0.8.ConclusionOver the last thirty years, there has been a notable rise in the burden of testicular cancer in the MENA region.

Abstract Background The present study reported the cancer deaths and disability‐adjusted life years (DALYs) that were attributable to high fasting plasma glucose (HFPG) in the Middle East and North Africa (MENA) region by country, age, sex, cancer type and Socio‐demographic Index (SDI), from 1990 to 2019. Methods Global Burden of Disease (GBD) 2019 data were used to report the cancer‐related deaths and DALYs that were attributable to HFPG, for all MENA countries over the period 1990–2019. The results were presented as numbers, population attributable fractions (PAFs) and rates (per 100,000) with 95% uncertainty intervals. Results In 2019, there were an estimated 19.8 thousand (5.5–40.2) cancer deaths attributable to HFPG in MENA, which represents 4.7% (1.3–9.3) of all cancer‐related deaths. The number of regional DALYs due to HFPG‐related cancers was 462.2 thousand (127.3–959.5), which represents 3.8% (1.1–7.6) of all cancer‐related DALYs in 2019. From 1990 to 2019, the age‐standardized DALY rate of cancers attributable to HFPG (per 100,000) grew from 56.3 (14.6–121.1) to 107.0 (29.8–220.8), which was a 90.1% (64.4–127.8) increase. In 2019, the highest age‐standardized DALY rate of cancers attributable to HFPG was in Qatar (270.4) and the lowest was in Sudan (75.3). The DALY rate of cancers attributable to HFPG increased with age, peaking for males in the 70–74 age group and for females in the 75–79 age group, and then decreased for both sexes. A broadly positive relationship was found between the national SDI and the national age‐standardized DALY rate of all cancers attributable to FPG over the measurement period. Conclusions The burden of HFPG‐related cancers has increased over the past three decades in MENA, and was higher than the global average in multiple age groups. Implementing a battery of preventive measures and therapeutic interventions is suggested to address the adverse effects of this modifiable risk factor.

Background: With roughly 50 million people affected in the world, epilepsy is a particularly important disorder of the brain commonly diagnosed based on findings of quantitative electroencephalography (QEEG). The present investigation was aimed to evaluate differences in QEEG readings of drug-resistant and drug-responsive patients with idiopathic generalized epilepsy (IGE) with tonic-clonic seizures in a northwestern Iranian population.Methods: A total of 60 participants, consisting of 30 drug-resistant and 30 drug-responsive patients with IGE, were enrolled. Data, including demographic information and Z-transformed absolute power values of QEEG in anterior, central, and posterior alpha, beta, delta, and theta bands were collected. The analysis was conducted using IBM SPSS and a p-value

Abstract Background Lower respiratory infections (LRIs) cause substantial mortality and morbidity. The present study reported and analysed the burden of LRIs in the Middle East and North Africa (MENA) region between 1990 and 2019, by age, sex, etiology, and socio-demographic index (SDI). Methods The data used in this study were sourced from the Global Burden of Disease (GBD) study 2019. The annual incidence, deaths, and disability-adjusted life-years (DALYs) due to LRIs were presented as counts and age-standardised rates per 100,000 population, along with their 95% uncertainty intervals (UIs). The average annual percent changes (AAPC) in the age-standardised incidence, death and DALYs rates were calculated using Joinpoint software and correlations (Pearson’s correlation coefficient) between the AAPCs and SDIs were calculated using Stata software. Results In 2019, there were 34.1 million (95% UI 31.7–36.8) incident cases of LRIs in MENA, with an age-standardised rate of 6510.2 (95% UI 6063.6–6997.8) per 100,000 population. The number of regional DALYs was 4.7 million (95% UI 3.9–5.4), with an age-standardised rate of 888.5 (95% UI 761.1–1019.9) per 100,000 population, which has decreased since 1990. Furthermore, Egypt [8150.8 (95% UI 7535.8–8783.5)] and Afghanistan [61.9 (95% UI 52.1–72.6)] had the highest age-standardised incidence and death rates, respectively. In 2019, the regional incidence and DALY rates were highest in the 1–4 age group, in both females and males. In terms of deaths, pneumococcus and H. influenza type B were the most and least common types of LRIs, respectively. From 1990 to 2019, the burden of LRIs generally decreased with increasing SDI. There were significant positive correlations between SDI and the AAPCs for the age-standardised incidence, death and DALY rates (p

Abstract Background Parkinson’s disease (PD) remains a common disabling progressive neurodegenerative disorder. We aimed to report the prevalence, death and disability-adjusted life-years (DALYs) attributable to PD in the Middle East and North Africa (MENA) region and its 21 countries by age, sex and socio-demographic index (SDI), between 1990 and 2019. Methods Publicly available data on the burden of PD in the MENA countries were retrieved from the Global Burden of Disease (GBD) 2019 project. The results are presented with age-standardised numbers and rates per 100,000 population, along with their corresponding 95% uncertainty intervals (UIs). Results In 2019, PD had an age-standardised point prevalence of 82.6 per 100,000 population in MENA and an age-standardised death rate of 5.3, which have increased from 1990 to 2019 by 15.4% and 2.3%, respectively. In 2019, the age-standardised DALY rate of PD was 84.4, which was 0.9% higher than in 1990. The highest and lowest age-standardised DALY rates of PD in 2019 were found in Qatar and Kuwait, respectively. Also in 2019, the highest number of prevalent cases and number of DALYs were found in the 75–79 age group for both sexes. In 2019, females in MENA had an overall higher DALY rate. Furthermore, from 1990 to 2019 the burden of PD generally decreased with increasing socio-economic development, up to an SDI of around 0.4, and then increased with higher levels of SDI. Conclusion An upward trend was observed in the point prevalence of PD over the last three decades. This highlights the need to allocate more resources for research. Furthermore, properly equipped healthcare services are needed for the increasing number of patients with PD.

Abstract Background Low back pain (LBP) is the most common musculoskeletal disorder globally. Providing region- and national-specific information on the burden of low back pain is critical for local healthcare policy makers. The present study aimed to report, compare, and contextualize the prevalence, incidence and years lived with disability (YLDs) of low back pain in the Middle East and North Africa (MENA) region by age, sex and sociodemographic index (SDI), from 1990 to 2019. Methods Publicly available data were obtained from the Global Burden of Disease (GBD) study 2019. The burden of LBP was reported for the 21 countries located in the MENA region, from 1990 to 2019. All estimates were reported as counts and age-standardised rates per 100,000 population, together with their corresponding 95% uncertainty intervals (UIs). Results In 2019, the age-standardised point prevalence and incidence rate per 100,000 in MENA were 7668.2 (95% UI 6798.0 to 8363.3) and 3215.9 (95%CI 2838.8 to 3638.3), which were 5.8% (4.3 to 7.4) and 4.4% (3.4 to 5.5) lower than in 1990, respectively. Furthermore, the regional age-standardised YLD rate in 2019 was 862.0 (605.5 to 1153.3) per 100,000, which was 6.0% (4.2 to 7.7) lower than in 1990. In 2019, Turkey [953.6 (671.3 to 1283.5)] and Lebanon [727.2 (511.5 to 966.0)] had the highest and lowest age-standardised YLD rates, respectively. There was no country in the MENA region that showed increases in the age-standardised prevalence, incidence or YLD rates of LBP over the measurement period. Furthermore, in 2019 the number of prevalent cases were highest in the 35–39 age group, with males having a higher number of cases in all age groups. In addition, the age-standardised YLD rates for males in the MENA region were higher than the global estimates in almost all age groups, in both 1990 and 2019. Furthermore, the burden of LBP was not associated with the level of socio-economic development during the measurement period. Conclusion The burden attributable to LBP in the MENA region decreased slightly from 1990 to 2019. Furthermore, the burden among males was higher than the global average. Consequently, more integrated healthcare interventions are needed to more effectively alleviate the burden of low back pain in this region.

Abstract Background Anorexia nervosa (AN) is a complex and heritable psychiatric disorder, which imposes significant mortality and morbidity on sufferers globally. We aimed to report the prevalence, incidence and disability-adjusted life-years (DALYs) attributable to AN in the Middle East and North Africa (MENA) region by age, sex and socio-demographic index (SDI), between 1990 and 2019. Methods The disease burden attributable to AN was obtained for the 21 countries located in the MENA region between 1990 and 2019 using publicly available data from the Global Burden of Disease (GBD) 2019 study. All estimates were provided as counts and age-standardized rates per 100,000 population, along with 95% uncertainty intervals (UIs). Results In 2019, the estimated age-standardised point prevalence and incidence rate of AN (per 100,000) in MENA were 49.3 (95% UI: 34.6–70.4) and 16.0 (11.3–22.0), which were 11.4% (7.3–15.4) and 5.9% (2.6–9.1) higher than in 1990, respectively. Furthermore, the regional age-standardised DALY rate was 10.6 (6.3–17.0) per 100,000 in 2019, which was 11.8% (5.2–19.1) higher than in 1990. In 2019, Kuwait [17.3 (10.3-27.9)] and Afghanistan [6.3 (3.7-10.3)] had the highest and lowest age-standardised DALY rates, respectively. In addition, Iran showed the largest increases in the age-standardised point prevalence [30.0% (24.1–36.2)], incidence [24.6% (18.6–30.4)] and DALY [30.5% (22.6–38.9)] rates between 1990 and 2019. In 2019, the number of prevalent cases and prevalence estimates peaked in the 15–19 age group for males and the 20–24 age group for females, with females having a higher number of cases and prevalence in all age groups. In 2019, the age-standardised DALY rates in MENA were higher than the global rates among males aged 10–34 years, but were lower than the global estimates among females in almost all age groups. In addition, the burden of AN was positively associated with the level of socio-economic development during the measurement period. Conclusions The burden of AN in the MENA region increased between 1990 and 2019, which indicates that it is likely to become a more serious public health issue in the future. Up-to-date information about the epidemiological trends in the region would allow health policymakers to make informed and appropriate decisions to help address this issue. Plain English summary The findings of the present study showed that the point prevalence and incidence rate of anorexia nervosa have increased in the Middle East and North Africa region between 1990 and 2019. The highest burden in 2019 was found in Kuwait, while Afghanistan had the lowest attributable burden. In addition, between 1990 and 2019 Iran had the largest increase in the point prevalence of anorexia nervosa. Also in 2019, anorexia nervosa was more prevalent in females and peaked in the 15–19 age group for males and the 20–24 age group for females. Furthermore, as the level of socioeconomic development increased, so did the burden attributable to anorexia nervosa.

Abstract Background and Objective Obesity has historically been seen as a sign of wealth and social privilege, as can be inferred from studying the ancient works. We aimed to report the causes, diagnostic approaches, and treatment among the authentic books of traditional Iranian medicine. Methods We searched the original versions of historical books and used a narrative approach to report the history of obesity. Results Obesity was often seen as an indicator of complete health. Obesity in healthy women was a requirement for beauty, based on descriptions of women from the Zoroaster period and from antiquity to the late Qajar period. This point of view existed during various ages. However, after the constitutional period, the view of obesity changed into that of an illness, due to modern ideas and offshore role models, especially during the Pahlavi era. This change led to serious attempts to treat obesity. Obesity is a critical problem that needs immediate attention to prevent substantial health consequences. Different medical paradigms have presented their criteria and foundations throughout history. The emphasis of Iranian alternative medicine was on prevention and the maintenance of health, with the next step being treatment. Prevention, treatment, consuming medicinal plants, and recovery have often been written about in the traditional books of medicine. Conclusions Throughout the traditional Iranian medical texts, physicians have made recommendations about maintaining an appropriate body weight. The best treatment was prevention and a healthy lifestyle. The treatments for controlling and restricting obesity included paying attention to nourishment, mobility, and even the habitat.

Abstract Background Neck pain is a complex musculoskeletal disorder that can result in substantial morbidity. The present article presents the neck pain burden in Iranians who were at least 70 years old, from 1990 to 2019, by sex, age group, and province. Methods Publicly available information on the prevalence, incidence, and years lived with disability (YLD) caused by neck pain was extracted from the Global Burden of Disease study 2019. The estimates were all provided as counts and age‐standardized rates (per 100,000), and included 95% uncertainty intervals. Results The point prevalence of neck pain in 2019 was 8710.6, while the incidence rate was 1334.7 per 100,000 population. That same year, there were number of 27.8 thousand YLDs and an YLD rate of 801.7 per 100,000. The prevalence, incidence, and YLD rates did not change substantially over the measurement period (1990–2019). The highest YLD rate was found in Tehran (960.9 per 100,000), while Kohgiluyeh and Boyer‐Ahmad had the lowest (730.5 per 100,000). Females had slightly higher prevalent cases, incident cases, and YLDs, as well as their corresponding rates in 2019. In 2019, the number of prevalent cases, incident cases, and YLDs peaked in the 70–74 age group, for both sexes, and in all cases they reduced with age. In both 1990 and 2019, Iran had a higher YLD rate than that found among elderly adults in the Middle East and North Africa region. Conclusions The burden of neck pain in Iran has decreased slightly over the last three decades, but it still imposes a substantial burden and is higher than that found in the rest of the region. Therefore, preventive programs should be initiated at a young age to reduce the attributable burden later in life.

Background: Neck pain is a common cause of disability across the world. The objective of the present study was to present a thorough investigation of the burden caused by neck pain in the Middle East and North Africa (MENA) region, by country, sex, age group and socio-demographic index (SDI). Methods: The data on the burden of neck pain, encompassing its prevalence, incidence and years lived with disability (YLDs), were extracted from the Global Burden of Disease (GBD) 2019 study. These findings are reported as age-standardised numbers and rates (per 100,000), accompanied by 95 % uncertainty intervals (UIs). Results: The age-standardised point prevalence of neck pain in 2019 was 3066.7 (95 % UI: 2407.8 to 3894.3) per 100,000, with an age-standardised incidence rate of 649.2 (509.2–829.2) in the MENA region, neither of which have changed since 1990. The age-standardised YLD rate of neck pain was 303.0 (201.5–438.8) per 100,000 population in 2019. The highest YLD rate of neck pain was found in Iran [423.5 (280.3–609.8)] and the lowest in Kuwait [215.0 (141.0–314.1)]. The highest number of prevalent cases were seen in the 45–49 age-group for both sexes in 2019, but overall females had a higher point prevalence than males. Furthermore, over the study period (1990–2019) there was no clear and consistent relationship between the SDI and the burden of neck pain. Conclusion: Although the burden of neck pain has largely remained stable over the past three decades, the prevalence and morbidity in the MENA region remains high. Preventive and rehabilitative programs should be implemented that firstly target middle-aged females and males.

IntroductionThe Mediterranean diet is marked by the regular intake of olive oil, which may play a role in preventing and protecting against cognitive deterioration and dementia. The strength of these effects have been examined by several recent randomized controlled trials (RCTs), but their findings have not been consistent. In light of this inconsistency, the present study performed a systematic review to examine the relationship between the consumption of olive oil and cognition.MethodsThe Web of Science, Scopus, PubMed, and Google Scholar were systematically searched up to August 11, 2023. The review included RCTs, cross-sectional studies, cohort studies and case–control studies that explored the impact of olive oil consumption on cognitive performance among those older than 55 years old. Studies were excluded if they employed a design other than those mentioned above, involved participants under 55 years old, or did not specifically examine the cognitive effects of olive oil consumption. The quality of the included studies were measured using the Cochrane risk-of-bias tool and the Newcastle Ottawa Scale checklists.ResultsEleven studies were identified, which were comprised of four cross-sectional studies, four prospective cohort studies and three RCTs. The cohort studies and RCTs consistently found that olive oil consumption had a favorable effect on cognitive performance across a number of cognitive domains over time. Similarly, all of the cross-sectional studies reported that the consumption of olive oil was positively associated with cognitive health.ConclusionThe consumption of olive oil was found to enhance cognitive functioning and to reduce cognitive decline. Further large-scale investigations are required to strengthen this conclusion.

Abstract Background and Aims Low back pain (LBP) is one of the most debilitating and prevalent disorders. The prevalence of LBP ranges from 30% to 80%, depending on the population, and increases with age. Causes of LBP are typically classified as spinal and non‐spinal. The main goal of this study was to investigate the non‐spinal causes of LBP, since neglecting these factors leads to increases in the financial, psychological, and physical burden of LBP on individuals as well as on society. Methods The data were extracted after searching the PubMed database and Google Scholar search engine up to October 27, 2021. We included all studies that were conducted on a human population and assessed the effects of epidemiological, biological, psychological, and sociodemographic factors on the incidence or progression of LBP. Results The most common causes of non‐spinal LBP were diseases such as nephrolithiasis, endometriosis, tumors, fibromyalgia, and conditions like psychological disorders and pregnancy. Nevertheless, the perceived intensity of the pain can be affected by factors such as socioeconomic level, genetics, age, habits, diet, and psychological status. Conclusion The epidemiology, etiologies, and risk factors associated with LBP should be more clearly recognized to better prevent, diagnose, and treat the underlying disease and to reduce the burden of LBP.

Abstract Alcohol consumption is associated with a number of diseases and injuries, including cardiovascular diseases, cancers, mental and neurological disorders, as well as transport-related injuries. This article reports the alcohol-attributable burden of diseases and injuries at the regional and national levels in the Middle East and North Africa (MENA) region between 1990 and 2019, by sex, age, underlying cause, and Socio-demographic Index (SDI). The regional deaths and disability-adjusted life-years (DALYs) attributable to alcohol consumption were reported for the MENA region, between 1990 and 2019, using the methodological framework and analytical strategies adopted by the Global Burden of Disease (GBD) study 2019. The estimates were all reported as counts, population-attributable fractions, and age-standardised rates per 100,000 population, along with their corresponding 95% uncertainty intervals (UIs). Also, the average annual percentage changes were used to represent the trends of age-standardised rates. In 2019, there were an estimated 22.0 thousand deaths (95% UI: 16.1–29.4) and 1.1 million DALYs (0.8–1.3) attributable to alcohol consumption in the MENA region. The number of DALYs attributable to alcohol consumption were much higher in men (878.0 thousand, 691.4–1104.8) than among women (181.8, 138.6–232.0). The overall age-standardised death and DALY rates attributable to alcohol consumption decreased by 34.5% (13.2–48.3) and 31.9% (16.9–42.5), respectively, over the study period. Egypt (10.1 [5.7–16.6]) and Kuwait (1.1 [0.8–1.5]) had the highest and lowest age-standardised death rates attributable to alcohol consumption, respectively. In 2019, the number of deaths and DALYs in the MENA region were highest in those aged 60–64 and 50–54 years, respectively. A negative association was observed between a country’s SDI and their corresponding age-standardised DALY rates over the period 1990 to 2019. Digestive diseases were the main contributor to the alcohol-attributable burden. Over 1990–2019, the regional deaths and DALYs of diseases and injuries attributable to alcohol consumption decreased with AAPC of − 1.45 (− 1.78 to − 1.12) and − 1.31 (− 1.46 to − 1.15), respectively. The death and DALY rates attributable to alcohol consumption in the MENA region have decreased over the past three decades. Further decreases can be facilitated by implementing country-level policies and increasing public awareness.

Abstract Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease. The present study reported the burden of RA in the Middle East and North Africa (MENA) region from 1990 to 2019 by age, sex, and socio-demographic index (SDI). Publicly available data from the Global Burden of Disease (GBD) 2019 study was used to report the modelled point prevalence, annual incidence, and disability-adjusted life-years (DALYs) of RA, as counts and age-standardised rates with their corresponding 95% uncertainty intervals (UIs). In 2019, RA had an age-standardised point prevalence of 120.6 per 100,000 population (107.0–135.7) and an annual incidence rate of 5.9 (5.2–6.6) in MENA, which have increased 28.3% and 25.2%, respectively, since 1990. In 2019, the number of DALYs due to RA in the region was 103.6 thousand (74.2–136.7), with an age-standardised rate of 19.0 (13.9–24.9) DALYs per 100,000 population, which has increased by 18.6% since 1990 (6.7–28.2). The highest point prevalence was found in females aged 50–54, and in males aged 45–49. The highest number of DALYs was observed in the 50–54 age group. The MENA DALY rate was lower than the global rate (19.0 vs. 39.6 per 100,000), but the rate was higher in all age groups in 2019, when compared with 1990. In addition, from 1990 to 2019 an increased burden from RA was associated with an increase in SDI. In line with global trends, the burden of RA in the MENA region showed a steady increase from 1990 to 2019. This highlights the increasing need for updating the available health data to design more accurate guidelines to enable the early detection and treatment of RA in the MENA countries.

Abstract Introduction MicroRNAs (miR or miRNA) are short regulatory RNAs, which modulate post-transcriptional gene expression. Dysregulation of these molecules contributes to pathogenicity of autoimmune disorders, such as multiple sclerosis (MS). Aims This study was conducted to investigate changed expression pattern of miRNA-145 and miRNA-155 in MS. Methods We collected blood samples of 75 patients with relapsing-remitting MS patients and 75 healthy controls. Ficoll-Hypaque density gradient method was used to isolate peripheral blood mononuclear cells. Also, total RNA was extracted and subjected to RT-PCR analysis. We used the Mann–Whitney U test to evaluate the differences in expression levels of target miRNAs between the groups. Results We found that expression of miRNA-145 (P = 0.012) and miRNA-155 (P = 0.005) were partly reduced in patients with relapse-remitting MS in comparison with healthy controls. The miRNA-145 had an area under curve (AUC) of 0.621 (P = 0.01) and miRNA-155 levels had an AUC of 0.625 (P = 0.008). Conclusion Decreased expression of miRNA-145 and miRNA-155 contributes to development of relapse-remitting MS, while further large scale observational studies and meta-analyses are required.

Abstract Background Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease that is characterised by persistent respiratory symptoms and airflow limitation. The present study reported the burden of COPD, and its attributable risk factors, in the Middle East and North Africa (MENA) region between 1990 and 2019, by age, sex and socio-demographic index (SDI). Methods Data from the Global Burden of Disease (GBD) 2019 study were used to report the burden of COPD in the MENA countries. The prevalence, deaths, and disability-adjusted life-years (DALYs) were presented as counts and age-standardised rates per 100,000 population, with their associated 95% uncertainty intervals (UIs). Results In 2019, the regional age-standardised point prevalence and rates of death due to COPD were 2333.9 (2230.1, 2443.6) and 26.1 (22.2, 29.5) per 100,000, which represent a 30.6% (28.2%, 33.0%) increase and an 18.0% (2.8%, 30.9%) decrease, respectively, since 1990. The regional age-standardised DALY rate in 2019 was 649.1 (574.6, 717.7) per 100,000, which had decreased by 11.8% (0.9%, 21.1%) since 1990. Turkey had the highest age-standardised point prevalence in 2019 [3287.1 (3187.4, 3380.3)], while Afghanistan had the highest age-standardised death [40.4 (24.2, 52.6)] and DALY [964.5 (681.8, 1203.2)] rates. The regional age-standardised point prevalence, death and DALY rates in 2019 increased with advancing age and were higher in males in almost all age groups. There was a U-shaped association between SDI and the burden of COPD over the period 1990 to 2019. Moreover, in 2019 smoking (43.7%), ambient particulate matter pollution (22.8%) and occupational particulate matter (11.4%) had the largest proportion of attributable DALYs for both sexes. Conclusions COPD is one of the leading causes of death and disability in the MENA region, although the age-standardised burden has decreased over the last 30 years. Nevertheless, COPD accounted for a substantial number of deaths and DALYs, especially among the elderly. Programs targeting risk factors, like smoking, should be taken into consideration.

Abstract Population aging and its consequences are a substantial global concern. The growth in the number of older people is one of the most important factors increasing the burden of non-communicable diseases (NCDs) on society. The Tabriz Older People Health Survey aimed to understand the socio-demographics, health-related behaviors, and health profile of older adults. This cross-sectional study was conducted on a representative sample of 1362 community-dwelling older adults in Tabriz, the most populated city in northwest Iran. The study used probability proportionate to size sampling and the data collection was undertaken in each participants’ place of residence from July 2019 to January 2020. Trained interviewers administered the questionnaire, which measured each participant’s socio-demographics, health-related behaviors, and health profile. The sample of 1362 participants consisted of 56.4% women and 54.4% were young older people (60–69 years old). Almost half of the sample were completely illiterate. There was no daily walking in 13.3% of the sample, with women reporting a more sedentary lifestyle than men. Almost 10% of the participants (n = 135, 9.9%) were current smokers, which was higher among men (20.9% vs. 1.5%) and women made up over 88% of those living alone. In terms of sleep quality score (men: 4.63 ± 2.70, women: 5.97 ± 2.93), anxiety (men: 5.79 ± 4.70, women: 7.59 ± 5.51), depression (men: 9.54 ± 3.20, women: 10.63 ± 3.09), and social support (men: 23.65 ± 4.50, women: 22.69 ± 4.77), men were significantly better than women. There were also significant sex differences between women and men in the prevalence of diabetes (31.6% vs. 19.5%) and hypertension (86.5% vs. 73.4%). Furthermore, overall hypertension was the most common underlying disease (81.0%). Older women were significantly worse off than older men, in terms of social and disability-related, as well as having a higher burden from several NCDs. The results of this study might help regional health policymakers to identify targets for improving the health status among community-housed geriatrics.

Abstract Background Lead exposure (LE) and its attributable deaths and disability-adjusted life years (DALYs) have declined in the recent decade; however, it remains one of the leading public health concerns, particularly in regions with low socio-demographic index (SDI) such as the North Africa and Middle East (NAME) region. Hence, we aimed to describe the attributable burden of the LE in this region. Methods Data on deaths, DALYs, years of life lost (YLLs), and years lived with disability (YLDs) attributable to LE in the NAME region and its 21 countries from 1990 to 2019 were extracted from the Global Burden of Disease (GBD) 2019 study. Results In 2019, the age-standardized death and DALY rates attributable to LE were 23.4 (95% uncertainty interval: 15.1 to 33.3) and 489.3 (320.5 to 669.6) per 100,000 in the region, respectively, both of which were higher among men than women. The overall age-standardized death and DALY rates showed 27.7% and 36.8% decreases, respectively, between 1990 and 2019. In this period, Bahrain, the United Arab Emirates, and Turkey had the highest decreases in the age-standardized death and DALY rates, while Afghanistan, Egypt, and Yemen had the lowest ones. Countries within high SDI quintile had lower attributable burden to LE compared with the low SDI quintile. Cardiovascular diseases and chronic kidney diseases accounted for the 414.2 (258.6 to 580.6) and 28.7 (17.7 to 41.7) LE attributable DALYs per 100,000 in 2019, respectively. The attributable YLDs was 46.4 (20.7 to 82.1) per 100,000 in 2019, which shows a 25.7% reduction (-30.8 to -22.5%) over 1990–2019. Conclusions The overall LE and its attributed burden by cause have decreased in the region from 1990–2019. Nevertheless, the application of cost-effective and long-term programs for decreasing LE and its consequences in NAME is needed.

Abstract Background As a natural antioxidant, uric acid plays a protective role against neurodegenerative disorders, including Parkinson’s disease (PD). Therefore, the risk of PD has been found to be lower in people with hyperuricemia. In this article, we conducted a systematic review and meta-analysis to investigate whether gout affects the future risk of developing PD. Methods We searched PubMed, Scopus, the Web of Science, and Google Scholar to find relevant studies, up to March 16, 2022. Studies investigating the risk of PD, following a gout diagnosis, were included if they were cross-sectional, case–control or cohort studies. The Newcastle Ottawa Scale (NOS) checklist was used to assess the quality of all included studies. The meta-analysis was performed using STATA 17.0. Results Ten studies were included, which were comprised of three case-controls, six cohort studies and one nested case–control study. We found no significant association between gout and the risk of PD among both sexes (RR = 0.94, 95% CI: 0.86–1.04), although the association was significant for females (RR = 1.09; 95% CI: 1.02–1.17). Subgroup analysis also showed no significant findings by age group, whether they were receiving treatment for gout, study design, quality assessment score, and method of gout ascertainment. In contrast, the studies that defined PD according to the use of drugs showed significant results (RR = 0.82; 95% CI: 0.76–0.89). There was a significant publication bias on the association between gout and PD. Conclusions The presence of gout had no significant effect on the risk of subsequently developing PD. Further analyses are recommended to investigate the effects of demographic and behavioral risk factors.

BackgroundBreast cancer (BC) is the most common cancer in women globally. The North Africa and Middle East (NAME) region is coping hard with the burden of BC. We aimed to present the latest epidemiology of BC and its risk factors in this region.MethodsWe retrieved the data on BC burden and risk factors from the Global Burden of Disease Study 2019 to describe BC status in the 21 countries of the NAME region from 1990 to 2019. We explored BC incidence, prevalence, deaths, disability-adjusted life years (DALYs), and attributable burden to seven risk factors of female BC, namely, alcohol use, diet high in red meat, low physical activity, smoking, secondhand smoke, high body mass index, and high fasting plasma glucose. Decomposition analysis on BC incidence trend was done to find out the contributing factors to this cancer’s growth.ResultsIn 2019, there were 835,576 (95% uncertainty interval: 741,968 to 944,851) female and 10,938 (9,030 to 13,256) male prevalent cases of BC in the NAME region. This number leads to 35,405 (30,676 to 40,571) deaths among female patients and 809 (654 to 1,002) deaths in male patients this year. BC was responsible for 1,222,835 (1,053,073 to 1,411,009) DALYs among female patients in 2019, with a greater proportion (94.9%) of burden in years of life lost (YLLs). The major contributor to female BC incidence increase in the past three decades was found to be increase in age-specific incidence rates of BC (227.5%), compared to population growth (73.8%) and aging (81.8%). The behavioral risk factors were responsible for majority of attributable female BC burden (DALYs: 106,026 [66,614 to 144,247]). High fasting plasma glucose was found to be the risk factor with the largest effect (DALYs: 84,912 [17,377 to 192,838]) on female BC burden.ConclusionThe increasing incidence and burden of BC in the NAME region is remarkable, especially when considering limited resources in the developing countries of this region. Proper policies like expanding screening programs and careful resource management are needed to effectively manage BC burden.