The association between smoking status and hospital length of stay: evidence from a hospital-based cohort

Objectives: Smoking is recognized as one of the main preventable causes of mortality and morbidity that imposes a high financial burden on healthcare systems and society. This study aimed to examine the association between smoking status and hospital length of stay (LOS) among patients with lung cancer (LC), chronic obstructive pulmonary disease (COPD) and ischemic heart diseases (IHD) in Iran in 2014.

Methods: A total of 1271 patients (415 LC patients, 427 COPD patients and 429 IHD patients) were included in the study. Data on age, sex, insurance status and LOS was extracted from the patients’ medical records and smoking status was obtained from the patients using telephone survey. The LOS among current smokers, former smokers, and nonsmokers was compared using a zero-truncated poisson regression. Analysis was done using STATA v.12.

Results: The mean LOS for current smokers, former smokers and nonsmokers was 9.4±8.4, 7.3 ±5.3 and 6.02±5.05 days, respectively. The unadjusted and adjusted probabilities of LOS for current smokers and former smokers were 56% and 21% and 48% and 15% higher, respectively, than when compared with the nonsmoker category.

Conclusion: The study demonstrated longer LOS for the current and former smokers, contributing to the drain on large hospital resources in Iran. The results of the study provide useful information for health-policy makers that contribute to the planning and designing of smoking cessation interventions in this area.     

Economic Burden of Smoking in Iran: A Prevalence-Based Annual Cost Approach

Objectives: The burden of smoking on the health system and society is significant. The current study aimed to estimate the annual direct and indirect costs of smoking in Iran for the year 2014. Methods: A prevalence-based disease-specific approach was used to determine costs associated with the three most common smoking-related diseases: lung cancer (LC), chronic obstructive pulmonary disease (COPD) and ischaemic heart disease (IHD). Data on healthcare utilization were obtained from an original survey, hospital records and questionnaires. The number of deaths was extracted from the global burden diseases study (GBD). The human capital approach was applied to estimate the costs of morbidity and mortality due to smoking-related diseases, classified as direct (hospitalization, outpatients and non-medical costs) and indirect (mortality and morbidity). Results: The total economic cost of the three most common smoking-attributable diseases in Iran was US$1.46 billion in 2014, including US$1.05 billion (71.7%) in indirect and US$0.41 billion (28.3%) in direct costs. Direct costs of the three smoking-related diseases accounted for 1.6% of total healthcare expenditures and total costs were about 0.26% of Iran’s gross domestic product (GDP) in 2014. Conclusions: Our study indicated that smoking places a substantial economic burden on Iranian society. Therefore, sustained smoking cessation interventions and tobacco control policies are required to reduce the magnitude and extent of smoking-attributable costs in Iran.     

Association of combined cigarette smoking and ARMS2/LOC387715 A69S polymorphisms with age-related macular degeneration: A meta-analysis

Purpose: The age-related maculopathy susceptibility2 (ARMS2)/LOC387715 A69S (rs10490924) polymorphism and cigarette smoking have been shown to have significant association with AMD. In this meta-analysis we used the results of available association studies of combined ARMS2/LOC387715 genotypes and cigarette smoking with AMD to estimate the possible synergistic or multiplicative effects.

Methods: Heterogeneity of studies was evaluated using the Cochran Q-test and the I-square index. To compensate for the heterogeneity of the variables in the study we used a random effects model. Meta-analysis was performed using STATA. To estimate the additive or supra-additive effects, we calculated relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP), synergy index (S), and multiplicative index (V).

Results: We could include four studies with 1982 AMD patients and 1797 control subjects. Considering the GG-no smoking as a reference line the meta-analysis result of AMD odds ratios for stratified combined factors was 3.05 (95% CI 2.32–4.02) for nonGG-no smoking, 2.24 (95% CI 1.39–3.63) for GG-smoking and 4.59 (95% CI 3.51–6.01) for nonGG-smoking. The meta-analysis of synergy analysis revealed RERI = 2.01 (95% CI 1.01–3.25), AP = 0.40 (95% CI 0.22–0.54), S = 2.02 (95% CI 1.35–3.01), and V = 1.31 (95% CI 0.94–1.83).

Conclusion: This analysis revealed the synergistic effect of these two factors indicating that there is a common pathway of ARMS2/LOC387715 and smoking in AMD pathogenesis which may be the complement system pathway.     

Complications among premature neonates treated with beractant and poractant alfa

Objective  

To compare the complications among preterm infants treated with two different natural surfactants.     

Can Vero cell co-culture improve in-vitro maturation of bovine oocytes?

This study was carried out to evaluate the effect of Vero cell co-culture on developmental competence of immature oocytes. Bovine cumulus-oocyte complexes (COC) were matured in presence or absence of Vero cells. Matured oocytes were inseminated and cultured for up to 9 days. Cleavage percentages were recorded on day 2 after insemination and embryos were evaluated on a daily basis. Expanding/expanded and hatching/hatched blastocysts were used for cell number assay. Results indicated a significantly greater cleavage percentage in oocytes matured in presence of Vero cells than control (86% versus 76%, P < or = 0.05). The percentages of advanced embryos appear to be greater on a daily basis in COC matured in presence of Vero cells compared with control. However, these differences were not significant. Blastocysts derived from COC matured in the presence of Vero cells had a significantly higher (P < or = 0.05) number of inner cell mass, trophectoderm and total cell number in expanding/expanded (65.25, 224.5 and 289.7 respectively) and hatching/hatched (67.75, 289.75 and 357.5) embryos in comparison to the control (42, 203.5, 245.5 and 51.3, 265, 316.3 respectively). Results confirm that co-culture of bovine COC during in-vitro maturation, enhances their ability for cleavage and for producing blastocysts with higher quality.     

New morphometric findings in adhesive otitis media: Petroclival angle and eustachian tube-tympanic cavity ventilation angle

Objective

Observations during adhesive otitis media (OM) surgery led us to consider that morphometric variations might cause formation of the middle ear cavity with smaller bony boundaries during developmental process. Among the various factors mentioned in the literature, we thought that angle of the petrous bone relative to the midsagittal line and the eustachian tube-tympanic cavity ventilation angle might be factors in the course of adhesive otitis media.

Methods

Axial computerized tomography scans from 14 patients with adhesive OM and 19 cases (control group) with normal middle ear-tympanic membrane were retrospectively examined in terms of petroclival angle and eustachian tube-tympanic cavity ventilation angle. Measurements of these two angles were compared between the two groups. A correlation was also investigated between these two angles.

Results

The petroclival angle (54.5° vs 62.3°) and the eustachian tube-tympanic cavity ventilation angle (156° vs 162.6°) in the adhesive OM group were narrower than those of controls (p < 0.01). The correlation analysis showed that there was a strong association between two angles (r, 0.803; p < 0.01).

Conclusions

More medially positioning of the petrous bone and acutely angled-eustachian tube-tympanic cavity ventilation axis were observed in this study. It would be reasonable to conclude that these findings might take part in development of adhesive OM. We should also admit that these results do not decline the previous theories that account for development of the adhesive otitis media.     

Surgical treatment of asymptomatic popliteal aneurysms using midline posterior incision

The authors report eight cases of surgical treatment of popliteal aneuryms via a strictly posterior approach. The aneurysm was asymptomatic in each case and was diagnosed during assessment of a symptomatic contralateral popliteal aneurysm treated by a conventional technique (exclusion—interposition of a femoropopliteal vein graft or prosthetic tube via a medial incision). The operation was performed with the patient in the ventral supine position and consisted of excision graft with direct anatomical interposition of a femoropopliteal prosthetic tube. This approach has limitations as it cannot be extended superiorly and is therefore indicated in saccular or short fusiform aneurysms whose superior pole does not extend beyond Hunter's canal. In all eight cases, the prosthesis consisted of a 8 mm PTFE spiral tube. All patients underwent postoperative bilateral dynamic angiography and all were asymptomatic. During the same period, four postoperative thromboses of the grafts requiring embolectomy were observed in four cases of conventional repair of symptomatic contralateral aneurysms. The use of the posterior approach for popliteal aneurysm surgery, considering very precise criteria, appears to be a very attractive alternative, decreasing the morbidity, restoring a strictly anatomical course, and allowing a reduction in the incidence of the graft's thrombosis, ensuring a better long-term patency.Presented at the 37th Annual World Congress of The International College of Angiology, Helsinki, Finland, July 1995     

Troponin T and NT ProBNP Levels in Gestational,Type 1 and Type 2 Diabetic Mothers and Macrosomic Infants

This study compares NT proBNP and troponin T levels in umbilical cord arterial blood and postnatal echocardiographic findings for infants of gestational and pregestational diabetic mothers and macrosomic infants. Twenty-seven infants of pregestational diabetic mothers, 61 infants of gestational diabetic mothers and 37 macrosomic infants of nondiabetic mothers were prospectively enrolled in this study along with a control group of 58 healthy infants of mothers without any pregestational or gestational disorders as the control group. All enrollees were born after 34 weeks of gestation. For this study, umbilical cord blood was drawn during delivery to determine NT proBNP and troponin T levels. Echocardiography was performed 24–72 h after the delivery. Umbilical cord troponin T and NT proBNP levels were found to be higher in the diabetic and macrosomic groups than in the control group (all of them p < 0.001). NT proBNP levels were positively correlated with interventricular septum thickness in the pregestational and gestational infants of diabetic mothers groups (r = 0.564 and r = 0.560, respectively, p < 0.01). Both pregestational and gestational diabetic mothers were divided into two groups according to HbA1c levels in the third trimester as good (<6.1 %) and suboptimal (>6.1 %) metabolic control. In the good and suboptimal metabolic control diabetic groups, NT proBNP levels were also positively correlated with interventricular septum thickness (r = 0.536 and r = 0.576, respectively, p < 0.01). In the suboptimal metabolic control diabetic group, NT proBNP was only found to be positively correlated with the left ventricular mass index (r = 0.586, p < 0.01). While there was no correlation in the myocardial performance index between infants of diabetic mothers and the control group, the myocardial performance index of macrosomic infants was lower than that of the control group (p = 0.017). Cardiac biomarkers (NT proBNP and troponin T) were elevated in infants of diabetic mothers and macrosomic infants. While there was a positive correlation between NT proBNP levels and cardiac structure in infants of pregestational and gestational diabetic mothers, there was no relationship between NT proBNP levels and cardiac function.