Systematic Review and Meta-analysis of the Relationship Between Proton Pump Inhibitors and Esophageal Adenocarcinoma.

INTRODUCTION AND AIM: Esophageal adenocarcinoma (EAC) mortality continues to increase across the world. This meta-analysis was aimed to investigate the relationship between proton pump inhibitors (PPIs) and the risk of EAC. METHODS: This meta-analysis was done as per the PRISMA checklist using relevant keywords. To this end, an extensive search was done on 29/6/2022 in EMBASE, Web of Science (ISI), PubMed, and Scopus. In this study, 95% confidence interval (CI) and standardized mean difference (SMD) were used to estimate the overall effect size. Analysis of the odds ratio (OR) for EAC was done using a random effects model. RESULTS: A total of 20 studies were included in the review. Compared to the group that received PPIs, the OR of EAC in the recipients of the PPIs group was obtained at 0.67 (95% CI = 0.39-1.29, P = 0.240). The meta-regression, including year, follow-up time, study design, sample size, quality of the study, study period, and geographical location, demonstrated no source of heterogeneity (P > 0.10). CONCLUSION: No significant relationship was found between PPIs use and the risk of EAC. Accordingly, PPIs do not have a protective or risk factor effect on EAC.

Do lifestyle interventions work in developing countries? Findings from the Isfahan Healthy Heart Program in the Islamic Republic of Iran.

OBJECTIVE: To assess the effects of a comprehensive, integrated community-based lifestyle intervention on diet, physical activity and smoking in two Iranian communities. METHODS: Within the framework of the Isfahan Healthy Heart Program, a community trial was conducted in two intervention counties (Isfahan and Najaf-Abad) and a control area (Arak). Lifestyle interventions targeted the urban and rural populations in the intervention counties but were not implemented in Arak. In each community, a random sample of adults was selected yearly by multi-stage cluster sampling. Food consumption, physical exercise and smoking behaviours were quantified and scored as 1 (low-risk) or 0 (other) at baseline (year 2000) and annually for 4 years in the intervention areas and for 3 years in the control area. The scores for all behaviours were then added to derive an overall lifestyle score. FINDINGS: After 4 years, changes from baseline in mean dietary score differed significantly between the intervention and control areas (+2.1 points versus -1.2 points, respectively; P < 0.01), as did the change in the percentage of individuals following a healthy diet (+14.9% versus -2.0%, respectively; P < 0.001). Daily smoking had decreased by 0.9% in the intervention areas and by 2.6% in the control area at the end of the third year, but the difference was not significant. Analysis by gender revealed a significant decreasing trend in smoking among men (P < 0.05) but not among women. Energy expenditure for total daily physical activities showed a decreasing trend in all areas, but the mean drop from baseline was significantly smaller in the intervention areas than in the control area (-68 metabolic equivalent task (MET) minutes per week versus -114 MET minutes per week, respectively; P < 0.05). Leisure time devoted to physical activities showed an increasing trend in all areas. A significantly different change from baseline was found between the intervention areas and the control area in mean lifestyle score, even after controlling for age, sex and baseline values. CONCLUSION: The results suggest that community-based lifestyle intervention programmes can be effective in a developing country setting.

Diseases Led to Refer Iranian Pilgrims From Hajj in 2012.

BACKGROUND: Some Iranian pilgrims are referred to Iran because of catching a new disease or exacerbation of their disease during the Hajj ceremony. These diseases need prolonged and specialized treatments. Investigation of the reasons led to their return to Iran is useful and effective in policy-making and planning of preventive health services. OBJECTIVES: This study aimed to investigate the causes of referring Iranian patients to Iran during Hajj in 2010. PATIENTS AND METHODS: In this cross-sectional study, all Iranian pilgrim cases in Hajj (2012) who referred to Iran were studied, and data analysis was performed. Demographic data and the causes of return to Iran during and after Hajj rituals were analyzed. RESULTS: A total of 106 cases were referred Iran during Hajj 2012. Psychiatric problems, with 26.4% allocated the highest rate of return to Iran during Hajj days, and significant difference was observed in the reasons before and after performing Hajj rituals (P = 0.001). CONCLUSIONS: Psychiatric, neurological, gastrointestinal, and respiratory diseases are the most frequent reasons of referring patients to Iran. More accuracy in screening and care of patients are recommended before Hajj in order to prevent references to Iran and its complications.