Does Referral Distance Deteriorates the Burn Patients Outcome? Results From an Academic Tertiary Hospital in a Developing Country

Every year millions of people are burned and many of them are transported to specialized burn centers. One of the most important challenges in the face of burn patients in urban areas is deciding about referring patients to specialized burn centers. In this study, correlation between referral distance and mortality rate is investigated. Our cross-sectional analytic study included admission data of 7248 burn patients from Imam Reza Burn Center (Mashhad, Iran) over 9 years. The outcomes of interest were mortality, length of hospital stay, and the Abbreviated Burn Severity Index (ABSI). Also, we measured the distance between the patient referral location to Mashhad. SPSS version 16 was used for data analysis. Overall, 52.7% of admitted patients were referred from hospitals in other cities. The referred group had more severe burn injury (P < .001), higher mortality rate (P < .001), and longer length of hospital stay (P < .001). The referred distance was associated with an increased risk of death (Odds ratio = 1.68, 95% CI, 1.47-1.92), but after controlling the severity of burns, only ABSI was the statistically significant predictor of mortality (Odds ration = 2.17, 95% CI, 2.05-2.28). Therefore, increasing the distance from urban areas to specialized burn center did not increase the mortality rate. After adjusting for ABSI, the mortality rate in referred patients was not related to referral distance. By observing referral points based on available guidelines, distance from a referral burn center does not affect mortality rate independently. Therefore, equipping the existing burn centers instead of building new ones and focusing on improving referral system can be a good strategy in low- and middle-income countries with limited resources.

Ankylosing Spondylitis and risk of Cardiac Arrhythmia and Conduction Disorders: A systematic review and meta analysis

Objective

The objective of this study isto assess the association between ankylosing spondylitis (AS) and risk of heart conduction disorders and arrhythmia.

Methods

PubMed, Embase, and Web of Science databases were systematically searched for observational studies that investigated the association between AS and risk of heart conduction disorders and arrhythmia with no language or date restrictions until September 16, 2019. We used random- and fixed-effects models to pool the results of the studies. Publication bias was assessed by Egger’s test. Subgroup analysis was carried out based on the study design. A p-value less than 0.05 was considered significant. Comprehensive Meta-Analysis (CMA) software was used to perform meta-analysis.

Results

After removing duplicates, we reviewed 135 articles. Finally, we included seven articles in our meta-analysis, of which four studies reported AV block and any conductive abnormality and three focused on atrial fibrillation and any arrhythmia. Based on our meta-analysis, an increased risk of atrial fibrillation (RR: 1.85, 95%CI: 1.15-2.98) and atrioventricular block (OR: 3.46, 95%CI: 1.09-10.93) was found in AS subjects compared to the general population. In a subgroup analysis based on study design, we found a greater association between AS and atrioventricular block in cohort studies (RR: 5.14, 95%CI: 1.001-26.50) compared to cross-sectional ones. However, we did not find any association between AS and any arrhythmia (OR=3.36, 95% CI: 0.93-12.15), or conduction disorders (OR: 0.64, 95%CI: 0.38-1.06). No publication bias was found.

Conclusion

Our results support an association between AS and a higher risk of atrial fibrillation and atrioventricular block.

MicroRNAs as Potential Diagnostic and Prognostic Biomarkers in Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC) is a common cancer, and the second most common cause of cancer-associated death globally. One of the major reasons for this high rate of mortality is a failure to make an early diagnosis. The average survival in untreated HCC patients is estimated to be approximately three months. The 5-year overall survival rate after radical resection is about 15-40% and within two years, more than two third of patients experience a relapse. To date, the most common biomarker which has been used for the diagnosis of HCC is serum alpha-fetoprotein (AFP). However, there is a lack of sensitive and specific tumor biomarkers for the early diagnosis of HCC. MicroRNAs are a class of short endogenous RNA with crucial role in many biological activities and cellular pathways and can be found in various tissues and body fluids. The aim of this review was to summarize the results of recent studies investigating miRNAs as novel biomarkers for the early diagnosis and prognostic risk stratification of patients with this type of liver cancer.

The Prognostic and Predictive Value of microRNAs in Patients with H. pylori-positive Gastric Cancer

Gastric cancer (GC) has a high mortality rate with a poor 5-year survival. Helicobacter pylori (H. pylori) is present as part of the normal flora of stomach. It is found in the gastric mucosa of more than half of the world population. This bacterium is involved in developing H. pylori-induced GC due to the regulation of different micro ribonucleic acid (miRNA or miR). miRNAs are small noncoding RNAs and are recognized as prognostic biomarkers for GC that may control gene expression. miRNAs may function as tumor suppressors, or oncogenes. In this review, we evaluated studies that investigated the ectopic expression of miRNAs in the prognosis of H. pylori positive and negative GC.

Association between non-alcoholic fatty liver disease and colorectal cancer

Introduction: Colorectal cancer (CRC) is a common malignancy, ranking fourth among the causes of cancer-related deaths globally. Its incidence has increased in recent decades, and now more than one million CRC patients are diagnosed and thousands die annually. The 5-year survival rate varies with the stage at diagnosis, are approximately 90% in the early stages of disease, and less than 10% in advanced disease. Non-alcoholic fatty liver disease (NAFLD), which is a major cause of chronic liver disease, and characterized by the accumulation of fat in hepatocytes, has also emerged as a risk factor for CRC, and to be related with the development of colorectal polyps. Areas covered: The purpose of this current review is to summarize the main findings of studies that have investigated the role of NAFLD in development of CRC. Expert opinion: Various molecular pathways are altered during the development of NAFLD, which are also important in CRC tumorigenesis. There is growing body of evidence showing the potential role of activation of pro-inflammatory, disruption of anti-inflammatory pathways, increasing the activity of pathways involved in cell proliferation/survival. Thus targeting these dysregulated pathways via novel inhibitors can be a potential therapy for CRC prevention in cases with NAFLD.