NHC-Catalyzed Enantioselective Transformations Involving α-Bromoenals.

α-Haloenals, especially, α-bromoenals considered as one of the important building blocks in organic synthesis. They can participate in various (3+2)-, (3+3)-, (3+4)-, and (2+4)-annulation reactions with other organic molecules in the presence of an NHC catalyst to produce enantioenriched carbo-, and heterocyclic compounds. Herein, we have described NHC-catalyzed enantioselective transformations of α-bromoenals in the synthesis of various heterocycles, and carbocycles, as well as acyclic organic compounds.

Transition Metal-Catalyzed Dual C-H Activation/Annulation Reactions Involving Internal Alkynes.

Recently, transition metal-catalyzed ortho-C-H bond activation/annulations involving two internal alkyne molecules have been extensively used to synthesize highly substituted polycyclic aromatic scaffolds. Such reactions have emerged as a powerful atom and step-economical strategy for the assembly of multifunctional bioactive molecules. In this context, we focused on the recent achievements of dual C-H bond activation/annulations, as well as functionalization reactions involving diaryl/alkyl alkynes.

Burden and quality of care index of chronic kidney disease: Global Burden of Disease analysis for 1990-2019.

BACKGROUND: Chronic kidney disease (CKD) imposes a heavy obscure burden on individuals and health systems. Besides its burden, the quality of care of CKD is less well investigated. In this study, we aimed to explore the global, regional and national trends of CKD burden and quality of care. METHODS: The Global Burden of Disease Study 2019 data were used. Trends of incidence, prevalence, deaths and disability-adjusted life years were studied for the 1990-2019 period in the global aspect. By generating four secondary indices to assess different aspects of quality of care the quality of care index (QCI) was developed to explore the care provided for CKD. Inequities and disparities between various geographic, socio-demographic and age stratifications, and sex were studied using the QCI values. RESULTS: In 2019, there were 18 986 903 (95% uncertainty interval 17 556 535 to 20 518 156) incident cases of CKD, globally. The overall global QCI score had increased slightly from 78.4 in 1990 to 81.6 in 2019, and it was marginally better in males (QCI score 83.5) than in females (80.3). The highest QCI score was observed in the European region with a score of 92.5, while the African region displayed the lowest QCI with 61.7. Among the age groups, the highest QCI was for children aged between 5 and 9 years old (92.0), and the lowest was in the age group of 20-24 year olds (65.5). CONCLUSIONS: This study revealed that significant disparities remain regarding the quality of care of CKD, and to reach better care for CKD, attention to and care of minorities should be reconsidered. The evidence presented in this study would benefit health policymakers toward better and more efficient control of CKD burden alongside improving the care of this condition.

Transition metal-catalyzed transformations of 2-formylarylboronic acids.

2-Formylarylboronic acids are easily available precursors in organic chemistry. Different types of transition metal catalysts, such as Pd(0), Pd(II), Rh(I), Ir(I), Ni(II), Cu(I), Cu(II), and Co(II), can efficiently catalyze coupling reactions of 2-formylarylboronic acids with other organic reactants. In this review, we describe the synthesis of a diverse range of carbocyclic and heterocyclic compounds, as well as acyclic compounds, via transition metal-catalyzed reactions of 2-formylarylboronic acids over the past two decades.

Evaluation of the prevalence of cardiometabolic disorders (diabetes, hypertension, and hyperlipidemia) diagnosed, undiagnosed, treated, and treatment goal in the elderly: Bushehr Elderly Health Program (BEH).

As the population ages, the global burden of cardiometabolic disorders will increase. This study aimed to investigate the prevalence of cardiometabolic disorders (diabetes, hypertension, and hyperlipidemia) in elderly and to evaluate the effects of various variables including age, sex, education, marital status, smoking, income, physical activity, dementia and depressed mood on untreated cardiometabolic disorders. This was a cross sectional study conducted in Bushehr Elderly Health Program. A total 2381 participants were included. Medical data were collected by trained interviewers. The mean age of the study participants was 69.34 years. Proportions of diabetes, hypertension, hyperlipidemia and hypercholesterolemia were 43.25%, 75.71%, 64.74% and 35.31% respectively. Untreated diabetes prevalence was higher for males (OR = 1.60, 95%CI = 1.20-2.15), older adults (OR = 1.02, 95%CI = 1.00-1.05), and pre-frail status (OR = 0.69, 95%CI = 0.52-0.92). Males (OR = 2.16, 95%CI = 1.64-2.84) and current smokers (OR = 1.42, 95%CI = 1.05-1.93), in contrast to married participants (OR = 0.25, 95%CI = 0.08-0.78), people with higher education levels (OR = 0.51, 95%CI = 0.29-0.89) and dementia (OR = 0.78, 95%CI = 0.61-1.00) were more likely to have untreated HTN. Untreated dyslipidemia is more common in smokers (OR = 1.78, 95%CI = 1.19-2.66) and males (OR = 1.66, 95%CI = 1.21-2.27), while untreated hypercholesteremia is more common in males (OR = 3.20, 95%CI = 1.53-6.69) and is reported lower in people with dementia (OR = 0.53, 95%CI = 0.28-1.01).

The association between continuous metabolic syndrome score and its components with electrocardiographic abnormalities in community-dwelling older adults: the Bushehr elderly health (BEH) program.

BACKGROUND: Metabolic syndrome (MetS) known as a risk factor for cardiovascular diseases (CVDs) has developed into a major source of health issue, especially for the elderly. In the present study, we investigated the association between continuous MetS (cMetS) score and its components with electrocardiographic (ECG) abnormalities in the community-dwelling older adults. METHODS: This cross-sectional study is derived from the second phase of BEH cohort study which is conducted on individuals aged over 60 years old. Standard 12-lead ECGs were recorded and coded by qualified physicians and continuous values of metabolic syndrome risk scores (cMetS) were measured. Data regarding socio-demographic, medical history, and lifestyle variables were collected by trained interviewers. The multinomial regression analysis was used to investigate the relationship between cMetS and its components with ECG abnormalities in the included participants. RESULTS: 2426 individuals (mean age ± standard deviation: 69.30 ± 6.33 years) were included in the final analysis. Overall, 22.5% of the participants showed ECG abnormalities. Among these, 8.0% (n = 139) of participants had minor and 14.6% (n = 354) had major ECG abnormalities. In the final models, cMetS (OR = 1.04), mean arterial pressure (MAP((OR = 1.01), and higher fasting blood glucose (FBG) (OR = 1.01) increased the risk of ECG abnormalities (p < 0.05). Also, cMetS (OR = 1.05) and MAP (OR = 1.02) were associated with an increased risk of major ECG abnormalities (p < 0.05). CONCLUSION: MetS and MAP were significantly associated with ECG abnormalities. The results of the present study suggest that ECG screening in the older population with MetS could potentially help to detect those at the higher risk of CVDs.

α-Glucosidase inhibition assay of galbanic acid and it amide derivatives: New excellent semi-synthetic α-glucosidase inhibitors.

α-Glucosidase inhibitory activity of galbanic acid and its new amide derivatives 3a-n were investigated. Galbanic acid and compounds 3a-n showed excellent anti-α-glucosidase activity with IC50 values ranging from 0.3 ± 0.3 µM to 416.0 ± 0.2 µM in comparison to positive control acarbose with IC50 value of = 750.0 ± 5.6. In the kinetic study, the most potent compound 3h demonstrated a competitive mode of inhibition with Ki = 0.57 µM. The interaction of the most potent compound 3h with the α-glucosidase was further elaborated by in vitro Circular dichroism assessment and in silico molecular docking and Molecular dynamics studies. Compound 3h was also non-cytotoxic on human normal cells. In silico study on pharmacokinetics and toxicity profile of the most potent galbanic acid derivatives demonstrated that these compounds are valuable lead compounds for further study in order to achieve new anti-diabetic agents.

Pyrano[2,3-b]chromone derivatives as novel dual inhibitors of α-glucosidase and α-amylase: Design, synthesis, biological evaluation, and in silico studies.

Inhibition of α-glucosidase and α-amylase is an important target for treatment of type 2 diabetes. In this work, a novel series of pyrano[2,3-b]chromene derivatives 5a-m was designed based on potent α-glucosidase and α-amylase inhibitors and synthesized by simple chemical reactions. These compounds were evaluated against the latter enzymes. Most of the title compounds exhibited high inhibitory activity against α-glucosidase and α-amylase in comparison to standard inhibitor (acarbose). Representatively, the most potent compound, 4-methoxy derivative 5d, was 30.4 fold more potent than acarbose against α-glucosidase and 6.1 fold more potent than this drug against α-amylase. In silico molecular modeling demonstrated that compound 5d attached to the active sites of α-glucosidase and α-amylase with a favorable binding energies and established interactions with important amino acids. Dynamics of compound 5d also showed that this compound formed a stable complex with the α-glucosidase active site. In silicodrug-likeness as well as ADMET prediction of this compound was also performed and satisfactory results were obtained.

Metal-free 2-isocyanobiaryl-based cyclization reactions: phenanthridine framework synthesis.

The development of transition metal-free 2-isocyanobiaryl-based reactions has received much attention due to the widespread presence of phenanthidine frameworks as products in pharmacological chemistry and materials science. This review article focuses on the achievements from 2013 until now in various metal-free catalyzed reactions and discusses challenging mechanisms and features of the transformations.

Global, regional, and national quality of care index of cervical and ovarian cancer: a systematic analysis for the global burden of disease study 1990-2019.

BACKGROUND AND OBJECTIVE: Cervical cancer is the most preventable and ovarian cancer is the most lethal gynecological cancer. However, in the world, there are disparities in health care performances resulting in differences in the burden of these cancers. The objective of this study was to compare the health-system quality of care and inequities for these cancers using the Quality of Care Index (QCI). MATERIAL AND METHODS: The 1990-2019 data of the Global Burden of Disease (GBD) was analyzed to extract rates of incidence, prevalence, mortality, Disability-Adjusted Life Years (DALYs), Years of Life Lost (YLL), and Years of healthy life lost due to disability (YLD) of cervical and ovarian cancer. Four indices were developed as a proxy for the quality of care using the above-mentioned rates. Thereafter, a Principal Components Analysis (PCA) was applied to construct the Quality of Care Index (QCI) as a summary measure of the developed indices. RESULTS: The incidence of cervical cancer decreased from 1990 to 2019, whereas the incidence of ovarian cancer increased between these years. However, the mortality rate of both cancers decreased in this interval. The global age-standardized QCI for cervical cancer and ovarian cancer were 43.1 and 48.5 in 1990 and increased to 58.5 and 58.4 in 2019, respectively. QCI for cervical cancer and ovarian cancer generally decreased with aging, and different age groups had inequitable QCIs. Higher-income countries generally had higher QCIs for both cancers, but exceptions were also observed. CONCLUSIONS: Uncovering disparities in cervical and ovarian cancer care across locations, Socio-Demographic Index levels, and age groups necessitate urgent improvements in healthcare systems for equitable care. These findings underscore the need for targeted interventions and prompt future research to explore root causes and effective strategies for narrowing these gaps.

The association between quality of life and diabetes: the Bushehr Elderly Health Program.

BACKGROUND AND OBJECTIVE: Considering the importance of diabetes and its increased prevalence with aging, this study aimed to evaluate the association between diabetes status and quality of life (QOL) and the determining factors in individuals over 60. METHODS: Two thousand three hundred seventy-five individuals including 819 (34.5%) with diabetes, aged 69.4 ± 6.4, from Bushehr Elderly Health Program (BEHP) were enrolled. We categorized the participants as non-diabetic, controlled diabetic, and poorly controlled diabetic. The QOL was assessed using the SF-12 questionnaire. The physical (PCS) and mental (MCS) component summaries of QOL were estimated. We compared the SF-12 domains and components between the categories using ANOVA. Further, the association of diabetes status with PCS and MCS was assessed after adjustment for possible confounders including age, sex, depression, cognitive impairment, physical activity, and other relevant factors using linear regression analysis. RESULTS: Individuals with diabetes had lower PCS (40.9 ± 8.8 vs. 42.7 ± 8.6, p-value < 0.001), and MCS scores (45.0 ± 10.2 vs. 46.4 ± 9.4, p-value < 0.001) compared to participants without diabetes. No significant differences were observed in PCS or MCS scores between controlled or poorly controlled individuals with diabetes. Diabetes status was associated with PCS and MCS scores in univariable analysis. Regarding physical component of QOL, after adjusting for other confounders, poorly controlled diabetes was significantly associated with PCS [beta: -1.27 (-2.02, -0.52)]; some other determinants include depression [-7.66 (-8.51, -6.80)], male sex [3.90 (3.24,4.57)], and good physical activity [1.87 (1.17,2.57)]. As for the mental component, controlled diabetes was significantly associated with MCS [-1.17 (-2.13, -0.22)]; other contributing factors include depression [-14.35 (-15.34, -13.37)], male sex [1.97 (1.20,2.73)], good physical activity [-1.55 (-2.35, -0.75)], and smoking [-1.42 (-2.24, -0.59)]. BMI had an inverse association with PCS [-0.19 (-0.26, -0.13)] and a direct association with MCS [0.14 (0.07,0.21)]. CONCLUSION: Individuals with diabetes exhibited reduced QOL scores. Upon adjusting for other variables, it was found that uncontrolled diabetes correlated with decreased PCS scores, whereas controlled diabetes was linked to lower MCS scores. Factors such as depression and being female were identified as contributors to diminished QOL in both physical and mental aspects. These results have the potential to guide healthcare decision-making, facilitating the creation of tailored interventions aimed at improving the QOL for individuals with diabetes, with a specific focus on women and depression.

Identifying determinants for falls among Iranian older adults: insights from the Bushehr Elderly Health Program.

BACKGROUND: Falls are a common cause of fractures in older adults. This study aimed to investigate the factors associated with spontaneous falls among people aged ≥ 60 years in southern Iran. METHODS: The baseline data of 2,426 samples from the second stage of the first phase of a prospective cohort, the Bushehr Elderly Health (BEH) program, were included in the analysis. A history of spontaneous falls in the year before recruitment was measured by self-report using a standardized questionnaire. Demographic characteristics, as well as a history of osteoarthritis, rheumatoid arthritis, low back pain, Alzheimer's disease, epilepsy, depression, and cancer, were measured using standardized questionnaires. A tandem gait (heel-to-toe) exam, as well as laboratory tests, were performed under standard conditions. A multiple logistic regression model was used in the analysis and fitted backwardly using the Hosmer and Lemeshow approach. RESULTS: The mean (standard deviation) age of the participants was 69.34 (6.4) years, and 51.9% of the participants were women. A total of 260 (10.7%, 95% CI (9.5-12.0)%) participants reported a spontaneous fall in the year before recruitment. Adjusted for potential confounders, epilepsy (OR = 4.31), cancer (OR = 2.73), depression (OR = 1.81), low back pain (OR = 1.79), and osteoarthritis (OR = 1.49) increased the risk of falls in older adults, while the ability to stand ≥ 10 s in the tandem gait exam (OR = 0.49), being male (OR = 0.60), engaging in physical activity (OR = 0.69), and having high serum triglyceride levels (OR = 0.72) reduced the risk of falls. CONCLUSION: The presence of underlying diseases, combined with other risk factors, is significantly associated with an increased risk of falls among older adults. Given the relatively high prevalence of falls in this population, it is crucial to pay special attention to identifying and addressing these risk factors.

Determinants of multimorbidity in older adults in Iran: a cross-sectional study using latent class analysis on the Bushehr Elderly Health (BEH) program.

BACKGROUND AND OBJECTIVES: Multimorbidity, defined as the presence of two or more long-term health conditions in an individual, is one of the most significant challenges facing health systems worldwide. This study aimed to identify determinants of classes of multimorbidity among older adults in Iran. RESEARCH DESIGN AND METHODS: In a cross-sectional sample of older adults (aged ≥ 60 years) from the second stage of the Bushehr Elderly Health (BEH) program in southern Iran, latent class analysis (LCA) was used to identify patterns of multimorbidity. Multinomial logistic regression was conducted to investigate factors associated with each multimorbidity class, including age, gender, education, household income, physical activity, smoking status, and polypharmacy. RESULTS: In 2,426 study participants (mean age 69 years, 52% female), the overall prevalence of multimorbidity was 80.2%. Among those with multimorbidity, 3 latent classes were identified. These comprised: class 1, individuals with a low burden of multisystem disease (56.9%); class 2, individuals with predominantly cardiovascular-metabolic disorders (25.8%) and class 3, individuals with predominantly cognitive and metabolic disorders (17.1%). Compared with men, women were more likely to belong to class 2 (odds ratio [OR] 1.96, 95% confidence interval [CI] 1.52-2.54) and class 3 (OR 4.52, 95% CI 3.22-6.35). Polypharmacy was associated with membership class 2 (OR 3.52, 95% CI: 2.65-4.68) and class 3 (OR 1.84, 95% CI 1.28-2.63). Smoking was associated with membership in class 3 (OR 1.44, 95% CI 1.01-2.08). Individuals with higher education levels (59%) and higher levels of physical activity (39%) were less likely to belong to class 3 (OR 0.41; 95% CI: 0.28-0.62) and to class 2 (OR 0.61; 95% CI: 0.38-0.97), respectively. Those at older age were less likely to belong to class 2 (OR 0.95). DISCUSSION AND IMPLICATIONS: A large proportion of older adults in Iran have multimorbidity. Female sex, polypharmacy, sedentary lifestyle, and poor education levels were associated with cardiovascular-metabolic multimorbidity and cognitive and metabolic multimorbidity. A greater understanding of the determinants of multimorbidity may lead to strategies to prevent its development.

Mortality and re-fracture rates in low trauma hip fracture.

OBJECTIVES: This study aimed to estimate the incidence rate of re-fracture and all-cause mortality rate in patients with hip fractures caused by minor trauma in the first year following the event. MATERIALS AND METHODS: This is a retrospective cohort study of patients over 50 years of age conducted in a referral hospital located in Tehran (Shafa-Yahyaian). Using the hospital information system (HIS), all patients hospitalized due to hip fractures caused by minor trauma during 2013-2019 were included in the study. We investigated the occurrence of death and re-fracture in all patients one year after the primary hip fracture. RESULTS: A total of 945 patients with hip fractures during a 307,595 person-days of follow-up, were included. The mean age of the participants was 71 years (SD = 11.19), and 533 (59%) of them were women. One hundred forty-nine deaths were identified during the first year after hip fracture, resulting in a one-year mortality rate of 17.69% (95% CI: 15.06-20.77). The one-year mortality rate was 20.06% in men and 15.88% in women. Out of all the participants, 667 answered the phone call, of which 29 cases had experienced a re-fracture in the first year (incidence rate = 5.03%, 95% CI: 3.50-7.24). The incidence rates in women and men were 6.07% and 3.65%, respectively. CONCLUSION: Patients with low-trauma hip fractures have shown a high rate of mortality in the first year. Considering the increase in the incidence of hip fractures with age, comprehensive strategies are needed to prevent fractures caused by minor trauma in the elderly population.

Burden of type 2 diabetes mellitus and its risk factors in North Africa and the Middle East, 1990-2019: findings from the Global Burden of Disease study 2019.

BACKGROUND: The prevalence of Type 2 Diabetes Mellitus (T2DM) in the North Africa and Middle East region is alarmingly high, prompting us to investigate the burden and factors contributing to it through the GBD study. Additionally, there is a lack of knowledge about the epidemiological status of T2DM in this region, so our aim is to provide a comprehensive overview of the burden of T2DM and its associated risk factors. METHODS: Using data from the 2019 Global Burden of Disease Study, we calculated the attributable burden of T2DM for each of the 21 countries in the region for the years 1990 and 2019. This included prevalence, mortality, disability-adjusted life years (DALYs), and risk factors. RESULTS: Between 1990 and 2019, there was a significant increase in the age-standardized incidence (79.6%; 95% Uncertainty Interval: 75.0 to 84.5) and prevalence (85.5%; [80.8 to 90.3]) rates of T2DM per 100,000 populations. The age-standardized mortality rate (1.7%; [-10.4 to 14.9]), DALYs (31.2%; [18.3 to 42.2]), and years lived with disability (YLDs) (82.6%; [77.2 to 88.1]) also increased during this period. Modifiable risk factors, such as high body mass index (56.4%; [42.8 to 69.8]), low physical activity (15.5%; [9.0 to 22.8]), and ambient particulate matter pollution (20.9%; [15.2 to 26.2]), were the main contributors to the number of deaths. CONCLUSION: The burden of T2DM, in terms of mortality, DALYs, and YLDs, continues to rise in the region. The incidence rate of T2DM has increased in many areas. The burden of T2DM attributed to modifiable risk factors continues to grow in most countries. Targeting these modifiable risk factors could effectively reduce the growth and disease burden of T2DM in the region.

The global, regional, and national burden and quality of care index of kidney cancer; a global burden of disease systematic analysis 1990-2019.

Kidney cancer (KC) is a prevalent cancer worldwide. The incidence and mortality rates of KC have risen in recent decades. The quality of care provided to KC patients is a concern for public health. Considering the importance of KC, in this study, we aim to assess the burden of the disease, gender and age disparities globally, regionally, and nationally to evaluate the quality and inequities of KC care. The 2019 Global Burden of Disease study provides data on the burden of the KC. The secondary indices, including mortality-to-incidence ratio, disability-adjusted life years -to-prevalence ratio, prevalence-to-incidence ratio, and years of life lost-to-years lived with disability ratio, were utilized. These four newly merged indices were converted to the quality-of-care index (QCI) as a summary measure using principal component analysis. QCI ranged between 0 and 100, and higher amounts of QCI indicate higher quality of care. Gender disparity ratio was calculated by dividing QCI for females by males to show gender inequity. The global age-standardized incidence and mortality rates of KC increased by 29.1% (95% uncertainty interval 18.7-40.7) and 11.6% (4.6-20.0) between 1990 and 2019, respectively. Globally, the QCI score for KC increased by 14.6% during 30 years, from 71.3 to 81.6. From 1990 to 2019, the QCI score has increased in all socio-demographic index (SDI) quintiles. By 2019, the highest QCI score was in regions with a high SDI (93.0), and the lowest was in low SDI quintiles (38.2). Based on the World Health Organization regions, the QCI score was highest in the region of America, with Canada having the highest score (99.6) and the lowest in the African Region, where the Central African Republic scored the lowest (17.2). In 1990, the gender disparity ratio was 0.98, and in 2019, it was 0.97 showing an almost similar QCI score for females and males. Although the quality of care for KC has improved from 1990 to 2019, there is a significant gap between nations and different socioeconomic levels. This study provides clinicians and health authorities with a global perspective on the quality of care for KC and identifies the existing disparities.

New phenylthiosemicarbazide-phenoxy-1,2,3-triazole-N-phenylacetamides as dual inhibitors against α-glucosidase and PTP-1B for the treatment of type 2 diabetes.

This study describes the design, synthesis, and evaluation of a novel series of phenylthiosemicarbazide-phenoxy-1,2,3-triazole-N-phenylacetamide derivatives (7a-l) as dual inhibitors of α-glucosidase and protein tyrosine phosphatase 1-B (PTB-1B). The latter enzymes are two important targets in the treatment of type 2 diabetes. The in vitro obtained data demonstrated that all title compounds 7a-l were more potent than the standard inhibitor acarbose against α-glucosidase while only four derivatives (7a, 7g, 7h, and 7h) were more potent than the standard inhibitor suramin against PTP-1B. Furthermore, these data showed that the most potent α-glucosidase inhibitor was compound 7i, with sixfold higher inhibitory activity than acarbose, and the most potent PTP-1B inhibitor was compound 7a with 3.5-fold higher inhibitory activity than suramin. Kinetic studies of compounds 7i and 7a revealed that they inhibited their target enzymes in a competitive mode. The docking study demonstrated that compounds 7i and 7a well occupied the active site pockets of α-glucosidase and PTP-1B, respectively. In silico pharmacokinetic and toxicity assays of the most potent compounds were performed, and the obtained results were compared with those of the standard inhibitors.

Global, regional, and national burden and quality of care index (QCI) of oral disorders: a systematic analysis of the global burden of disease study 1990-2017.

BACKGROUND: Oral disorders are still a major global public health challenge, considering their perpetuating and chronic nature. Currently, there is no direct index to measure the quality of care on a population scale. Hence, we aim to propose a new index to measure the quality of care for oral disorders worldwide. METHODS: We generated our database using the data from the Global Burden of Disease (GBD) study 2017. Among different variables such as prevalence, incidence, years lived with disability, and disability-adjusted life years, we utilised principal component analysis (PCA) to determine the component that bears the greatest proportion of information to generate the novel quality of care index (QCI) for oral disorders. RESULTS: Global QCI for oral disorders gradually increased from 1990 to 2017 (from 70.5 to 74.6). No significant gender disparity was observed during this period, and the gender disparity ratio (GDR) was considered optimal in 1990 and 2017. Between 1990 and 2017, the age-standardised QCI for all oral disorders increased in all the SDI regions. The highest QCI for all oral disorders in 2017 belonged to high-middle SDI countries (=80.24), and the lowest YLDs rate was seen in the low SDI quintile. In 1990, the quality of care in European, Central Asian, and Central and South American countries was in the lowest quintiles, whereas the North American, East Asian, Middle Eastern, and some African countries had the highest quality of dental care. Maynmar (=100), Uganda (=92.5), Taiwan (=92.0), China (=92.5), and the United States (=89.2) were the five countries with the highest age-standardised QCI. Nicaragua (=41.3), Belgium (=40.2), Venezuela (=38.4), Sierra Leone (=30.5), and the Gambia (=30.3) were the five countries with the least age-standardised QCI values. CONCLUSION: The quality of care for all oral disorders showed an increasing trend on a global scale from 1990 to 2017. However, the QCI distribution was not homogenous among various regions. To prevent the exacerbation of imminent disparities in this regard, better attention to total tooth loss in high-income countries and prioritising primary healthcare provision in low-income countries are recommended for oral disorders.

National and subnational burden of female and male breast cancer and risk factors in Iran from 1990 to 2019: results from the Global Burden of Disease study 2019.

BACKGROUND: Breast cancer (BC) is one of the most burdensome cancers worldwide. Despite advancements in diagnostic and treatment modalities, developing countries are still dealing with increasing burdens and existing disparities. This study provides estimates of BC burden and associated risk factors in Iran at the national and subnational levels over 30 years (1990-2019). METHODS: Data on BC burden for Iran were retrieved from the Global Burden of Disease (GBD) study from 1990 to 2019. GBD estimation methods were applied to explore BC incidence, prevalence, deaths, disability-adjusted life years (DALYs), and attributable burden to risk factors based on the GBD risk factors hierarchy. Moreover, decomposition analysis was performed to find the contribution of population growth, aging, and cause-specific incidence in the total incidence change. Age-standardized rates (per 100,000 population) and 95% uncertainty intervals (UI) were reported based on sex, age, and socio-demographic index (SDI). RESULTS: Age-standardized incidence rate (ASIR) increased from 18.8 (95% UI 15.3-24.1)/100,000 in 2019 to 34.0 (30.7-37.9)/100,000 in 2019 among females and from 0.2/100,000 (0.2-0.3) to 0.3/100,000 (0.3-0.4) among males. Age-standardized deaths rate (ASDR) increased slightly among females from 10.3 (8.2-13.6)/100,000 in 1990 to 11.9 (10.8-13.1)/100,000 in 2019 and remained almost the same among males-0.2/100,000 (0.1-0.2). Age-standardized DALYs rate also increased from 320.2 (265.4-405.4) to 368.7 (336.7-404.3) among females but decreased slightly in males from 4.5 (3.5-5.8) to 4.0 (3.5-4.5). Of the 417.6% increase in total incident cases from 1990-2019, 240.7% was related to cause-specific incidence. In both genders, the BC burden increased by age, including age groups under 50 before routine screening programs, and by SDI levels; the high and high-middle SDI regions had the highest BC burden in Iran. Based on the GBD risk factors hierarchy, high fasting plasma glucose (FPG) and alcohol were estimated to have the most and the least attributed DALYs for BC among females, respectively. CONCLUSIONS: BC burden increased from 1990 to 2019 in both genders, and considerable discrepancies were found among different provinces and SDI quintiles in Iran. These increasing trends appeared to be associated with social and economic developments and changes in demographic factors. Improvements in registry systems and diagnostic capacities were also probably responsible for these growing trends. Raising general awareness and improving screening programs, early detection measures, and equitable access to healthcare systems might be the initial steps to tackle the increasing trends.

Using ChatGPT to predict the future of personalized medicine.

Personalized medicine is a novel frontier in health care that is based on each person's unique genetic makeup. It represents an exciting opportunity to improve the future of individualized health care for all individuals. Pharmacogenomics, as the main part of personalized medicine, aims to optimize and create a more targeted treatment approach based on genetic variations in drug response. It is predicted that future treatments will be algorithm-based instead of evidence-based that will consider a patient's genetic, transcriptomic, proteomic, epigenetic, and lifestyle factors resulting in individualized medication. A generative pretrained transformer (GPT) is an artificial intelligence (AI) tool that generates language resembling human-like writing enabling users to engage in a manner that is practically identical to speaking with a human being. GPT's predictive algorithms can respond to questions that have never been addressed. Chat Generative Pretrained Transformer (ChatGPT) is an AI chatbot's advanced with conversational capabilities. In the present study, questions were asked from ChatGPT about the future of personalized medicine and pharmacogenomics. ChatGPT predicted both to be a promising approach with a bright future that holds great promises in improving patient outcomes and transforming the field of medicine. But it still has several limitations that need to be solved.