Examining the evolving landscape of liver cancer burden in the United States from 1990 to 2019.

INTRODUCTION: Liver cancer (LC) is frequently preceded by cirrhosis and poses a significant public health challenge in the United States (US). Recent decades have seen notable shifts in the epidemiological patterns of LC, yet national data guiding the optimal allocation of resources and preventive efforts remain limited. This study aims to investigate the current trends, risk factors, and outcomes of LC in the US. METHODS: This study utilized the Global Burden of Disease (GBD) dataset to collect data on the annual incident cases, deaths, Disability-Adjusted Life Years (DALYs), age-standardized incidence rates (ASIR), age-standardized death rates, and age-standardized DALY rates of primary LC and its etiologies and risk factors, between 1990 and 2019. Percentage changes in incident cases, DALYs, and deaths and the estimated annual percentage change (EAPC) in ASIR and deaths rates of LC were calculated to conduct temporal analysis. Linear regression was applied for the calculation of EAPCs. Correlations of EAPC with socio-demographic index (SDI) were separately evaluated by Pearson correlation analyses. RESULTS: We observed a marked increase in the ASIR of LC, increasing from 2.22 (95% CI: 2.15-2.27) per 100,000 people in 1990 to 5.23 (95% CI: 4.28-6.29) per 100,000 people in 2019, a percentage change of 135.4%. LC due to hepatitis C followed by alcohol use were the primary factors driving this increase. The ASIR and age-standardized death rates of LC showed a significant average annual increase of 3.0% (95% CI: 2.7-3.2) and 2.6% (95% CI: 2.5-2.8), respectively. There was a significant negative correlation between the SDI and the EAPC in ASIR (ρ = -0.40, p = 0.004) and age-standardized death rates (ρ = -0.46, p < 0.001). In 2019, drug and alcohol use, followed by elevated body mass index (BMI) were the primary risk factors for age-standardized DALY rates attributable to LC. CONCLUSION: The increased burden of LC in the US highlights the need for interventions. This is particularly important given that LC is mostly influenced by modifiable risk factors, such as drug and alcohol use, and elevated BMI. Our findings highlight the urgent need for public health interventions targeting socio-economic, lifestyle, and modifiable risk factors to mitigate the escalating burden of LC.

The impact of overweight and obesity on health outcomes in the United States from 1990 to 2021.

AIM: Elevated body mass index (BMI) presents a significant public health challenge in the United States, contributing to considerable morbidity, mortality and economic burden. This study investigates the health burden of overweight and obesity in the United States from 1990 to 2021, leveraging the Global Burden of Disease data set to analyse trends, disparities and potential determinants of high BMI-related health outcomes. MATERIALS AND METHODS: Our study focused on the United States, analysing trends in disability-adjusted life years (DALY) and deaths attributable to high BMI, defined as a BMI of 25 kg/m2 or higher for adults. Statistical analyses included estimated annual percentage change (EAPC) in age-standardized DALY rates and age-standardized death rates. Pearson correlation was performed between EAPCs and the socio-demographic index (SDI), with significance set at p < 0.05. RESULTS: From 1990 to 2021, age-standardized DALY rates attributable to high BMI increased by 24.9%, whereas the age-standardized death rates increased by 5.2%. Age disparities showed DALYs peaking at 60-64 years for males and 65-69 years for females, with deaths peaking at 65-69 years for males and 90-94 years for females. A strong negative correlation was found between the EAPC in age-standardized DALY and death rates and the SDI. CONCLUSIONS: Overweight and obesity significantly impact public health in the United States, especially among older adults and lower socio-demographic regions. Comprehensive public health strategies integrating behavioural, technological and environmental interventions are crucial. Future research should focus on longitudinal studies, personalized interventions and policy-driven approaches to address the multifaceted influences on high BMI.

Temporal trends in lower extremity amputation in Middle East and North Africa (MENA) region: analysis of the GBD dataset 1990-2019.

BACKGROUND: Lower extremity amputations (LEAs) significantly contribute to mortality and morbidity, often resulting from peripheral artery disease and diabetes mellitus (DM). Traumatic injuries also account for many LEAs. Despite the global burden, the epidemiology of LEAs, particularly in the Middle East and North Africa (MENA) region, remains underexplored. This study utilizes the Global Burden of Disease (GBD) dataset to analyze temporal trends in LEAs in the MENA region from 1990 to 2019. METHODS: The study utilized the 2019 GBD dataset, which includes estimates for incidence, prevalence, and disability-adjusted life-years (DALYs) across 369 diseases. Age-standardized incidence rates (ASIRs) for LEAs were extracted for 21 MENA countries. Trends were analyzed using percentage change calculations and Joinpoint regression to identify significant shifts in LEA rates over time. RESULTS: From 1990 to 2019, male LEA rates generally decreased, while female rates increased. Significant increases in LEA rates were observed in Syria, Yemen, and Afghanistan, correlating with periods of conflict and instability. Conversely, countries like Iraq, Palestine, Sudan, Lebanon, Iran, and Kuwait saw marked decreases. The study highlighted a complex interplay of socio-political factors, natural disasters, and chronic diseases like DM in shaping LEA trends across the region. CONCLUSION: The study reveals variable LEA trends in the MENA region, influenced by conflicts, natural disasters, and chronic diseases. These findings underscore the need for targeted public health interventions, improved healthcare access, and robust data collection systems to reduce the burden of LEAs and improve patient outcomes in the MENA region.

Role of ammonia and glutamine in the pathogenesis and progression of metabolic dysfunction-associated steatotic liver disease: A systematic review.

Metabolic dysfunction-associated steatotic liver disease (MASLD) affects over 30% of the global population, with a significant risk of advancing to liver cirrhosis and hepatocellular carcinoma. The roles of ammonia and glutamine in MASLD's pathogenesis are increasingly recognized, prompting this systematic review. This systematic review was conducted through a meticulous search of literature on December 21, 2023, across five major databases, focusing on studies that addressed the relationship between ammonia or glutamine and MASLD. The quality of the included studies was evaluated using CASP checklists. This study is officially registered in the PROSPERO database (CRD42023495619) and was conducted without external funding or sponsorship. Following PRISMA guidelines, 13 studies were included in this review. The studies were conducted globally, with varying sample sizes and study designs. The appraisal indicated a mainly low bias, confirming the reliability of the evidence. Glutamine's involvement in MASLD emerged as multifaceted, with its metabolic role being critical for liver function and disease progression. Variable expressions of glutamine synthetase and glutaminase enzymes highlight metabolic complexity whereas ammonia's impact through urea cycle dysfunction suggests avenues for therapeutic intervention. However, human clinical trials are lacking. This review emphasizes the necessity of glutamine and ammonia in understanding MASLD and identifies potential therapeutic targets. The current evidence, while robust, points to the need for human studies to corroborate preclinical findings. A personalized approach to treatment, informed by metabolic differences in MASLD patients, is advocated, alongside future large-scale clinical trials for a deeper exploration into these metabolic pathways.

Safety and efficacy of sparsentan versus irbesartan in focal segmental glomerulosclerosis and IgA nephropathy: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Sparsentan has shown positive effects on managing different subtypes of glomerulonephritis. The recent results of trials require a pooled analysis to validate these results. AIM: We aim to assess the safety and efficacy of sparsentan versus irbesartan for patients with IgA nephropathy and focal glomerulosclerosis (FSGS). METHODS: We conducted a systematic review and meta-analysis of randomized controlled trials retrieved by systematically searching PubMed, Web of Science, Scopus, and Cochrane through March 2024. We used Review Manager v.5.4 to pool dichotomous data using risk ratio (RR) and continuous data using mean difference (MD) with a 95% confidence interval (CI). RESULTS: Three studies with a total of 884 patients were included. Sparsentan was superior to irbesartan in improving urine protein to creatinine ratio (UP/C) (ratio of percentage reduction 0.66, 95% CI [0.58 to 0.74], P < 0.001); as well as the proportion of patients achieved complete and partial remission of proteinuria (RR = 2.57, 95% CI [1.73 to 3.81], P < 0.001) and (RR = 1.63, 95% CI [1.4 to 1.91], P < 0.001) respectively. Regarding the effect on the glomerular filtration rate, the results estimate did not favor either sparsentan or irbesartan (MD = 1.98 ml/min per 1.73mm2, 95% CI [-1.05 to 5.01], P = 0.2). There were no significant differences in adverse events except for hypotension, which showed higher rates in the sparsentan group (RR = 2.02, 95% CI [1.3 to 3.16], P = 0.002). CONCLUSION: Sparsentan is effective and has a good safety profile for treating FSGS and patients with IgA nephropathy. However, more well-designed RCTs against ARBs, ACE inhibitors, and steroids with larger sample sizes are needed to get conclusive evidence.

The burden of Cardiovascular diseases in Jordan: a longitudinal analysis from the global burden of disease study, 1990-2019.

BACKGROUND: Cardiovascular Disease (CVD) is the leading cause of mortality worldwide. While countries in the Arab world continue to lack public health data and be severely understudied in health research, previous research has shown that compared to 1990, CVDs had a higher burden of disease in the Arab World in 2010. Jordan, a middle-income Arab country, is profiled with unique attributes such as a dual-sector healthcare system, political stability, and its role as a haven for refugees and migrants. These distinctive factors emphasize Jordan's suitability as a case study. This investigation aims to quantify CVD burden in Jordan and identify risk factors, contributing to a broader understanding of health challenges in the Arab region and beyond. METHODS: The Global Burden of Disease (GBD) dataset was used to estimate prevalence, death, and disability-adjusted life-years (DALYs) as age-standardized rates from 1990 to 2019. We calculated percentage change for nine specific CVDs and reported trends by gender and age groups. Additionally, data on twelve a priori selected behavioral, clinical, and environmental risk factors attributing to overall age-standardized CVDs DALY were reported per 100,00 population. RESULTS: In 2019, the age-standardized CVD prevalence, death, and DALYs rates in Jordan were 7980 (95% uncertainty interval [UI] 7629, 8360), 248 (95% UI 211, 288), and 4647 (95% UI 4028, 5388), respectively. Despite an increase in the absolute number of mortality and prevalence, between 1990 and 2019, the age-standardized prevalence, death, and DALYs rates all decreased by 5.5%, 45.1%, and 46.7%, respectively. In 2019, the leading risk factors contributing to overall age-standardized CVDs DALY per 100,000 population were high systolic blood pressure, high BMI, dietary risks, and high LDL cholesterol. CONCLUSION: Despite decreasing burden rate of CVDs in Jordan between 1990 and 2019, CVDs remain the leading cause of mortality in Jordan, with an increase in the total number of prevalence and mortality. Overall, this contributes to increased healthcare costs. Further research is required to quantify the burden of CVDs and understand it better. Intervention measures and policies tailored to specific CVDs should be designed to reduce the burden of CVDs in Jordan.

From Fear to Resilience: A Scoping Review of Psychological Components in Anterior Cruciate Ligament Rehabilitation.

CONTEXT: Anterior cruciate ligament (ACL) injuries, prevalent in athletic contexts have profound physical and psychological impacts. Despite extensive research on the physiological aspects of ACL recovery, the psychological dimensions of this process have gained increased attention. This scoping review delves into the intricate landscape of psychological factors influencing ACL rehabilitation. DESIGN: Scoping review. METHODS: A literature search across multiple databases was conducted to identify relevant published studies that provide insight into the psychological aspects of ACL recovery. This search spanned various study designs, enabling a nuanced understanding of the psychological intricacies surrounding ACL recovery. Overall, a total of 1830 unique articles were screened, of which 66 were included in this review. Our findings are further contextualized through alignment with insights from prior reviews on similar themes. Through a comprehensive analysis of diverse literature, we explore 3 key themes: psychological challenges, current rehabilitation programs, and the integration of psychological support. RESULTS: Psychological challenges emerged as a pervasive aspect of ACL rehabilitation, encompassing fear, anxiety, motivation, and depression. The nuanced emotional responses, particularly the fear of reinjury, impact treatment adherence and overall well-being. Contemporary rehabilitation programs revealed inconsistencies in incorporating psychological support, emphasizing the need for standardized, multidisciplinary approaches. The alignment with prior reviews in the literature reinforced the importance of psychological traits, such as knee self-efficacy, in predicting positive outcomes. CONCLUSION: This scoping review provides a comprehensive overview of psychological factors within ACL rehabilitation, highlighting the importance of tailored interventions and standardized approaches. The integration of multidisciplinary expertise emerges as crucial for optimizing patient outcomes. Our findings not only contribute to a nuanced understanding of psychological nuances in ACL rehabilitation but also offer valuable implications for clinical practice and policy development.

The burden of musculoskeletal disorders in the Middle East and North Africa (MENA) region: a longitudinal analysis from the global burden of disease dataset 1990-2019.

BACKGROUND: Musculoskeletal (MSK) disorders are one of the main causes of disability among adults globally. The burden of MSK disorders varies greatly between different regions and is the highest in low- and middle income- countries. This study sought to investigate trends in the burden of MSK disorders across the MENA region, utilizing the GBD 2019 dataset. METHODS: This ecological study utilized data from the Global Burden of Disease (GBD) to report on the burden of musculoskeletal (MSK) disorders in The Middle East and North Africa (MENA) region between 1990 and 2019. Our analysis involved descriptive statistics and sociodemographic trends and did not employ any specific statistical analyses. Using age-standardized rates of prevalence and disability-adjusted life-years (DALYs), we reported trends in the burden of MSK disorders, as well as national variation between different countries. Furthermore, we analyzed trends in risk factors contributing to MSK disorders by age and gender. RESULTS: The longitudinal analysis from 1990 to 2019 showed an increase in the age-standardized rate for prevalence and DALYs of MSK disorders by 5% and 4.80%, respectively. Low back pain continued to be the most prevalent MSK condition, while RA and other MSK disorders had the largest percentage increase for DALYs between 1990 and 2019. The study found that Afghanistan had the lowest age standardized DALYs rate attributed to MSK disorders, while Iran, Turkey, and Jordan had the highest. Further, Syria showed the most dramatic decrease while Saudi Arabia had the most notable increase in age standardized DALY rates from 1990 to 2019. In 2019, occupational risks, high body mass index, and tobacco smoking were the main risk factors for MSK disorders, with occupational risks being the largest contributor, and between 1990 and 2019, there was a decrease in the contribution of occupational risks but an increase in the contribution of high body mass index as a risk factor. CONCLUSION: This study highlights the significant burden of MSK disorders in the MENA region, with various risk factors contributing to its increasing prevalence in recent decades. Further research is needed to better understand the underlying factors and potential interventions that could improve health outcomes. Addressing MSK disorders should be a public health priority in the region, and efforts should be made to develop effective strategies to prevent and manage this debilitating condition.

COVID-19 stressors and symptoms of depression and anxiety among Black cisgender sexual minority men and Black transgender women during the initial peak of the COVID-19 pandemic.

PURPOSE: To examine associations between COVID-19-related stressors and symptoms of depression and anxiety in Black cisgender sexual minority men (SMM) and transgender women during the initial peak of the COVID-19 pandemic. METHODS: Participants from the N2 Cohort Study comprised Black cisgender SMM and Black transgender women in Chicago, IL, completed a face-to-face video or phone interview between April 20 and July 31, 2020. The survey included 18 measures of individual, network, and structural COVID-19 stressors such as income loss, network COVID-19 diagnoses, and housing loss, as well as 5 outcome measures: anxiety, depression, loneliness, worry and hope. RESULTS: Of 226 participants, 56.6% experienced anxiety on at least 1 of the last 14 days, 48.7% experienced depression, 48.7% experienced loneliness, 42.0% experienced worry, and 51.8% did not experience hope. Completing the study during a later phase of reopening was associated with hopefulness, RR = 1.37 95% CI [1.02, 1.85]. Fifteen of the 18 multi-level COVID-19 stressors were associated with 1 or more symptoms of depression and anxiety, for example, physical stress reactions, income loss, food loss, medication loss, network COVID-19 diagnoses, partner violence, housing loss, and neighborhood pandemic concerns (aRRs = 0.61-2.78, ps < 0.05). CONCLUSION: COVID-19-related stressors were associated with depression and anxiety symptoms in Black cisgender SMM and transgender women. Mitigation strategies to reduce virus transmission should be supplemented with measures to prevent depression and anxiety among marginalized populations, such as targeted economic relief and eHealth/mHealth interventions.

Financial Hardship, Condomless Anal Intercourse and HIV Risk Among Men Who Have Sex with Men.

The objective of this study was to examine the association between financial hardship, condomless anal intercourse and HIV risk among a sample of men who have sex with men (MSM). Users of a popular geosocial networking application in Paris were shown an advertisement with text encouraging them to complete a anonymous web-based survey (n = 580). In adjusted multivariate models, high financial hardship (compared to low financial hardship) was associated with engagement in condomless anal intercourse (aRR 1.28; 95% CI 1.08-1.52), engagement in condomless receptive anal intercourse (aRR 1.34; 95% CI 1.07-1.67), engagement in condomless insertive anal intercourse (aRR 1.30; 95% CI 1.01-1.67), engagement in transactional sex (aRR 2.36; 95% CI 1.47-3.79) and infection with non-HIV STIs (aRR 1.50; 95% CI 1.07-2.10). This study suggests that interventions to reduce financial hardships (e.g., income-based strategies to ensure meeting of basic necessities) could decrease sexual risk behaviors in MSM.

Residential and GPS-Defined Activity Space Neighborhood Noise Complaints, Body Mass Index and Blood Pressure Among Low-Income Housing Residents in New York City.

Little is known about how neighborhood noise influences cardiovascular disease (CVD) risk among low-income populations. The aim of this study was to investigate associations between neighborhood noise complaints and body mass index (BMI) and blood pressure (BP) among low-income housing residents in New York City (NYC), including the use of global positioning system (GPS) data. Data came from the NYC Low-Income Housing, Neighborhoods and Health Study in 2014, including objectively measured BMI and BP data (N = 102, Black = 69%), and 1 week of GPS data. Noise reports from "NYC 311" were used to create a noise complaints density (unit: 1000 reports/km2) around participants' home and GPS-defined activity space neighborhoods. In fully-adjusted models, we examined associations of noise complaints density with BMI (kg/m2), and systolic and diastolic BP (mmHg), controlling for individual- and neighborhood-level socio-demographics. We found inverse relationships between home noise density and BMI (B = -2.7 [kg/m2], p = 0.009), and systolic BP (B = -5.3 mmHg, p = 0.008) in the fully-adjusted models, and diastolic BP (B = -3.9 mmHg, p = 0.013) in age-adjusted models. Using GPS-defined activity space neighborhoods, we observed inverse associations between noise density and systolic BP (B = -10.3 mmHg, p = 0.019) in fully-adjusted models and diastolic BP (B = -7.5 mmHg, p = 0.016) in age-adjusted model, but not with BMI. The inverse associations between neighborhood noise and CVD risk factors were unexpected. Further investigation is needed to determine if these results are affected by unobserved confounding (e.g., variations in walkability). Examining how noise could be related to CVD risk could inform effective neighborhood intervention programs for CVD risk reduction.

Mortality, Hepatic Decompensation, and Cardiovascular- and Renal-Related Outcomes in Lean Versus Non-lean Patients Hospitalized With Metabolic Dysfunction-Associated Steatohepatitis (MASH).

INTRODUCTION: Metabolic dysfunction-associated steatohepatitis (MASH) is an important cause of cirrhosis and end-stage liver disease. In addition, there have been reports of worse extrahepatic outcomes, especially cardiovascular events, in patients with lean patients' fatty liver disease compared to the non-lean group. There is limited data on hepatic, cardiac, and renal outcomes in lean compared to non-lean patients with MASH. This study aims to evaluate the cardiovascular, renal, and hepatic outcomes in hospitalized US adults with MASH, focusing on a comprehensive comparison between lean and non-lean patients. METHODS: The National Inpatient Sample (NIS) database was queried from 2016 to 2020 to identify hospitalizations with MASH. Hospitalizations with a history of overweight and obesity (lean body mass index (BMI) <25 vs. lean BMI >25) were also identified. The primary outcome was in-hospital mortality. Secondary outcomes were major adverse cardiovascular outcomes (MACE: a composite of acute myocardial infarction, cardiac arrest, stroke, heart failure, and atrial fibrillation); major adverse kidney outcome (MAKE: a composite outcome of acute kidney injury (AKI), renal replacement therapy, and renal cancer), and hepatic decompensation (esophageal varices with bleeding, ascites, spontaneous bacterial peritonitis (SBP), hepatic encephalopathy, and hepatorenal syndrome) Multivariate logistic regression analysis was used to derive risk ratios for clinical outcomes. RESULTS: We included 539,275 MASH patients in our sample; 324,330 (60%) were lean. The included patients were mostly female (61%), the mean age was 64 years, and 76% were White. At baseline, non-lean patients had a higher prevalence of heart failure, hypertension, and hyperlipidemia. There was no difference in the prevalence of smoking among both groups. In a multivariate analysis, with adjustment for age, sex, race, sarcopenia, cardiometabolic risk factors, hospital characteristics, admission type, socioeconomic factors, and all comorbidities (including 31 Elixhauser comorbidities), lean status was associated with a 40% increased risk of mortality (adjusted odds ratio (aOR) 1.40, confidence interval (CI) 1.29-1.53), 19% increased risk of MACE (aOR 1.19; 95% CI 1.14-1.24), 20% increased risk of renal decompensation (aOR 1.25; 95% CI 1.20-1.30), and 33% increased risk of hepatic decompensation (aOR 1.33 CI 1.28-1.38). CONCLUSION: Lean patients with MASH are at higher risk of cardiovascular and renal outcomes and may benefit from enhanced screening for early identification and treatment to improve outcomes.

Association of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) With an Increased Risk of Congestive Heart Failure in Hospitalized Patients With Cirrhosis: A Propensity Score-Matched Analysis.

INTRODUCTION: Metabolic dysfunction-associated steatotic liver disease (MASLD) is linked to increased cardiovascular (CV) risks, notably congestive heart failure (CHF). We evaluated the influence of MASLD on CHF and mortality among hospitalized cirrhotic patients. METHODS: We analyzed the National Inpatient Sample from 2016 to 2020, identifying adult cirrhosis patients. We focused on CHF and in-hospital mortality, plus hospital stay length, costs, and discharge status. Propensity score matching created balanced cohorts for comparison. Poisson and logistic regression provided adjusted CHF risks and mortality odds ratios (ORs) for MASLD patients. RESULTS: Before matching, 4.1% of 672,625 cirrhotic patients had MASLD. Post-matching, each group had 23,161 patients. Patients with MASLD showed higher CHF risk (OR 1.14, 95% CI 1.10-1.21, p<0.001) but lower in-hospital mortality (OR 0.57, 95% CI 0.52-0.63, p<0.01) and decreased costs (median $24,447 vs. $28,630, OR 0.86, 95% CI 0.85-0.87, p<0.001). CONCLUSION: In this nationwide study of patients with cirrhosis, MASLD was associated with a higher prevalence of CHF and lower in-patient mortality. These findings mirror the "adiposity paradox" phenomenon, where obese/overweight individuals with cardiometabolic dysfunction may experience less severe or beneficial health outcomes than those with a normal weight. Further investigation is warranted to decode the intricate interplay between MASLD, cirrhosis, CHF, and in-hospital mortality and its clinical practice implications.

Atypical femur fracture in a male without history of bisphosphonate use: a case report.

BACKGROUND: Atypical femur fractures are a rare occurrence, especially in bisphosphonate-naïve men, and merit reporting owing to their unusual presentation and clinical implications. This case report highlights a unique instance of atypical femur fractures in a 73-year-old male with no prior bisphosphonate exposure. CASE PRESENTATION: The patient, a 73-year-old Indian male with no history of bisphosphonate use, presented with left thigh pain and swelling following a minor fall. Radiographic assessment unveiled a closed left mid diaphyseal femoral shaft fracture. Subsequent imaging revealed an impending fracture in the contralateral femur. A comprehensive diagnostic evaluation, encompassing radiographic analysis, laboratory tests, and clinical assessment confirmed the diagnosis. Surgical management via intramedullary nailing was pursued for both fractures. Notably, the patient's medical history was characterized by radiographic manifestations, the infrequent occurrence of atypical femur fractures in men, and associated risk factors. Treatment encompassed anabolic bone therapy employing teriparatide, alongside discontinuation of antiresorptive agents. CONCLUSIONS: This case underscores the significance of considering atypical femur fractures in older individuals with limited trauma history. It accentuates the role of anabolic agents in the therapeutic regimen and contributes to the evolving understanding of atypical femur fractures. The report underscores the need for vigilant monitoring and tailored management strategies in similar cases, thereby enhancing clinical practice and patient care.

Health data sharing attitudes towards primary and secondary use of data: a systematic review.

Background: To receive the best care, people share their health data (HD) with their health practitioners (known as sharing HD for primary purposes). However, during the past two decades, sharing for other (i.e., secondary) purposes has become of great importance in numerous fields, including public health, personalized medicine, research, and development. We aimed to conduct the first comprehensive overview of all studies that investigated people's HD sharing attitudes-along with associated barriers/motivators and significant influencing factors-for all data types and across both primary and secondary uses. Methods: We searched PubMed, MEDLINE, PsycINFO, Web of Science, EMBASE, and CINAHL for relevant studies published in English between database inception and February 28, 2023, using a predefined set of keywords. Studies were included, regardless of their design, if they reported outcomes related to attitudes towards sharing HD. We extracted key data from the included studies, including the type of HD involved and findings related to: HD sharing attitudes (either in general or depending on type of data/user); barriers/motivators/benefits/concerns of the study participants; and sociodemographic and other variables that could impact HD sharing behaviour. The qualitative synthesis was conducted by dividing the studies according to the data type (resulting in five subgroups) as well as the purpose the data sharing was focused on (primary, secondary or both). The Newcastle-Ottawa Scale (NOS) was used to assess the quality of non-randomised studies. This work was registered with PROSPERO, CRD42023413822. Findings: Of 2109 studies identified through our search, 116 were included in the qualitative synthesis, yielding a total of 228,501 participants and various types of HD represented: person-generated HD (n = 17 studies and 10,771 participants), personal HD in general (n = 69 studies and 117,054 participants), Biobank data (n = 7 studies and 27,073 participants), genomic data (n = 13 studies and 54,716 participants), and miscellaneous data (n = 10 studies and 18,887 participants). The majority of studies had a moderate level of quality (83 [71.6%] of 116 studies), but varying levels of quality were observed across the included studies. Overall, studies suggest that sharing intentions for primary purposes were observed to be high regardless of data type, and it was higher than sharing intentions for secondary purposes. Sharing for secondary purposes yielded variable findings, where both the highest and the lowest intention rates were observed in the case of studies that explored sharing biobank data (98% and 10%, respectively). Several influencing factors on sharing intentions were identified, such as the type of data recipient, data, consent. Further, concerns related to data sharing that were found to be mutual for all data types included privacy, security, and data access/control, while the perceived benefits included those related to improvements in healthcare. Findings regarding attitudes towards sharing varied significantly across sociodemographic factors and depended on data type and type of use. In most cases, these findings were derived from single studies and therefore warrant confirmations from additional studies. Interpretation: Sharing health data is a complex issue that is influenced by various factors (the type of health data, the intended use, the data recipient, among others) and these insights could be used to overcome barriers, address people's concerns, and focus on spreading awareness about the data sharing process and benefits. Funding: None.

An explainable machine learning model for prediction of high-risk nonalcoholic steatohepatitis.

Early identification of high-risk metabolic dysfunction-associated steatohepatitis (MASH) can offer patients access to novel therapeutic options and potentially decrease the risk of progression to cirrhosis. This study aimed to develop an explainable machine learning model for high-risk MASH prediction and compare its performance with well-established biomarkers. Data were derived from the National Health and Nutrition Examination Surveys (NHANES) 2017-March 2020, which included a total of 5281 adults with valid elastography measurements. We used a FAST score ≥ 0.35, calculated using liver stiffness measurement and controlled attenuation parameter values and aspartate aminotransferase levels, to identify individuals with high-risk MASH. We developed an ensemble-based machine learning XGBoost model to detect high-risk MASH and explored the model's interpretability using an explainable artificial intelligence SHAP method. The prevalence of high-risk MASH was 6.9%. Our XGBoost model achieved a high level of sensitivity (0.82), specificity (0.91), accuracy (0.90), and AUC (0.95) for identifying high-risk MASH. Our model demonstrated a superior ability to predict high-risk MASH vs. FIB-4, APRI, BARD, and MASLD fibrosis scores (AUC of 0.95 vs. 0.50, 0.50, 0.49 and 0.50, respectively). To explain the high performance of our model, we found that the top 5 predictors of high-risk MASH were ALT, GGT, platelet count, waist circumference, and age. We used an explainable ML approach to develop a clinically applicable model that outperforms commonly used clinical risk indices and could increase the identification of high-risk MASH patients in resource-limited settings.

Genetic and epigenetic determinants of non-alcoholic fatty liver disease (NAFLD) in lean individuals: a systematic review.

Background: Non-alcoholic fatty liver disease (NAFLD) is common in obese individuals, but its occurrence in lean individuals and the underlying mechanisms are not well understood. This study aimed to systematically review the literature on the genetic and epigenetic factors influencing NAFLD in lean individuals. Methods: A comprehensive search was conducted on April 2nd, 2023, in seven databases using specific criteria. Only peer-reviewed studies in English, focusing on genetic or epigenetic effects on NAFLD in lean individuals, were included for qualitative synthesis. The Newcastle Ottawa Scale (NOS) was used for quality assessment. This study is registered with PROSPERO (CRD42023413809). Results: Following PRISMA guidelines, 18 studies were included in this review. The studies were conducted globally, with varying sample sizes and study designs. The NOS quality assessment revealed a moderate overall quality with variations in risk of bias and limitations in comparability and ascertainments of exposure among contributing studies. Genetic determinants related to lipid metabolism, inflammation, and oxidative stress pathways were identified, including PNPLA3 and TM6SF2 gene variants associated with increased NAFLD risk in lean individuals. Epigenetic modifications, particularly depletion of histone variants, were also implicated. However, some studies found no significant associations between genetic or clinical characteristics and lean NAFLD. Less frequent genetic risk factors, such as CETP and APOC3 gene variants, were reported. Conclusions: This systematic review underscores the importance of investigating genetic and epigenetic factors in lean NAFLD. The findings highlight the role of PNPLA3 and TM6SF2 gene variants and suggest potential epigenetic contributions. Further research is needed to fully understand the genetic and epigenetic mechanisms underlying NAFLD in lean individuals.

Exploring cardiopulmonary rehabilitation in the middle east and North Africa region: A narrative review of challenges and opportunities.

BACKGROUND AND OBJECTIVES: Cardiopulmonary Rehabilitation (CR) is crucial for managing conditions like congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), and post-COVID-19 complications. This review examines CR practices in the Middle East and North Africa (MENA) region, exploring challenges, disparities, and emerging trends. METHODS: A comprehensive literature search was conducted in PubMed, Scopus, and Web of Science to identify studies published between date of inception and April 24th, 2024, focusing on CR programs, outcomes, challenges, and strategies specific to the MENA region. Data extraction included study design, population characteristics, CR interventions, and key findings. RESULTS: CR programs in the MENA region vary widely in scope and execution. While efforts are underway to integrate CR services into national healthcare policies, significant challenges persist, including limited infrastructure, shortages of trained professionals, and cultural barriers. Emerging trends include the use of telehealth and digital monitoring tools to expand access to CR services and policy reforms aimed at improving service delivery and patient access. CONCLUSION: CR plays a crucial role in improving the quality of life and health outcomes for cardiopulmonary patients, including those in the MENA region. However, significant challenges hinder the widespread adoption and effectiveness of CR programs. Addressing these challenges requires efforts to increase public education, reduce costs, expand funding, and enhance interprofessional collaboration. Future research should assess virtual rehabilitation, cultural adjustments, and long-term outcomes to tailor interventions to MENA's needs, ultimately enhancing CR accessibility and patient outcomes.

Burden of cardiovascular disease in Sub-Saharan Africa, 1990-2019: An analysis of the Global Burden of Disease Study.

INTRODUCTION: The rise in cardiovascular disease (CVD) in Sub-Saharan Africa (SSA) reflects a major shift from communicable to noncommunicable diseases as primary health challenges. Consequently, this study aims to explore the burden of CVD and associated risk factors in SSA using data from the Global Burden of Disease (GBD) database. METHODS: This study utilized data from the GBD 1990 to 2019 to examine CVD prevalence in 46 SSA countries. We employed Bayesian regression models, demographic techniques, and mortality-to-incidence ratios to analyze both prevalence and mortality rates. Additionally, disability-adjusted life years (DALYs) were computed, and various risk factors were examined using the GBD's comparative risk assessment framework. RESULTS: Between 1990 and 2019, CVD raw counts in SSA rose by 131.7 %, with a 2.1 % increase in age-standardized prevalence rates. The most prevalent conditions were ischemic heart disease, stroke, and rheumatic heart disease. During the same period, the age-standardized CVD deaths per 100,000 individuals decreased from 314 (1990) to 269 (2019), reflecting a -14.4 % decline. Age-standardized CVD DALY rates also showed a decrease from 6,755 in 1990 to 5,476 in 2019, with translates to 18.9 % reduction. By 2019, the Central African Republic, Madagascar, and Lesotho were the countries with the highest age-standardized DALY rates for all CVDs. CONCLUSIONS: The study highlights a contrasting trend in SSA's CVD landscape: a decrease in age-standardized mortality and DALYs contrasts with increasing CVD prevalence, emphasizing the need for targeted public health strategies that balance treatment advancements with intensified prevention and control measures.

Efficacy, safety, and patient satisfaction of norditropin and sogroya in patients with growth hormone deficiency: a systematic review and meta-analysis of randomized controlled trials.

INTRODUCTION: Growth hormone deficiency occurs when the pituitary gland does not produce enough growth hormone. Norditropin®, a recombinant human growth hormone, and Sogroya®, an albumin-binding growth hormone derivative, are prescribed for patients with growth hormone deficiency. This systematic review assesses the efficacy, safety, and patient satisfaction associated with Norditropin and Sogroya. METHODS: We systematically searched PubMed, Web of Science, and Scopus databases to identify eligible comparative studies. All studies published until June 2023 were included in our analysis. Our outcomes for children included height velocity and height velocity standard deviation score. In contrast, adult outcomes included adverse events, insulin-like growth factor 1-standard deviation score (IGF-1 SDS), and the Treatment Satisfaction Questionnaire for Medication-9 (TSQM-9). Results are reported as odds ratio (OR) and mean difference (MD) with a 95% confidence interval (95% CI). RESULTS: Ten studies involving 1058 participants (665 children and 393 adults) were included in the meta-analysis. In children, Norditropin at doses of 0.034 and 0.067 mg/kg/day was compared to Sogroya at doses of 0.04, 0.08, 0.16, and 0.24 mg/kg/week. The results showed that 0.034 mg/kg/day Norditropin had a favorable impact on height velocity (MD -2.01, 95% CI -3.7 to -2.12, p < 0.00001) and height velocity standard deviation score (Mean Difference -3.61, 95% CI -5.06 to -2.16, p < 0.00001) when compared to Sogroya 0.04 mg/kg/day. Other doses showed comparable results. In adults, the only significant side effect noted was rash, which favored Sogroya (OR 0.1, 95% CI 0.04-0.27, p < 0.00001). Additionally, IGF-1 SDS was significantly higher in the Sogroya group than in the Norditropin group (MD 0.25, 95% CI 0.02-0.48, p = 0.03). Furthermore, the overall score of the TSQM-9 questionnaire, which includes three domains: convenience, effectiveness, and satisfaction, was significantly higher in the Sogroya group compared to the Norditropin group (OR 6.36, 95% CI 3.92-8.8, p < 0.00001). CONCLUSION: Norditropin and Sogroya showed comparable efficacy and safety profiles, except for the prevalence of rash in the Norditropin group, and Sogroya has higher satisfaction among adults. More high-quality studies with more patients are required to confirm these results.