Prospective study of hepatitis B and D epidemiology and risk factors in Romania:A 10-year update

BACKGROUND The global burden of hepatitis D virus(HDV)infection represents a major medical challenge and a public health crisis worldwide.However,there is a lack of accurate data on the epidemiology and risk factors for HDV.Hepatitis B virus(HBV)and HDV coinfection causes the most severe form of viral hepatitis,leading to a higher cumulative incidence of liver-related events compared with HBV monoinfection,including the need for liver transplantation and death.AIM To investigate the epidemiology,natural history,risk factors and clinical management of HBV and HDV coinfection in Romanian patients.METHODS This prospective study was conducted between January and July 2022 in six tertiary gastroenterology and hepatology referral centres in Romania.All consecutive adults admitted for any gastroenterology diagnosis who were HBV-positive were enrolled.Patients with acute hepatitis or incomplete data were excluded.Of the 25390 individuals who presented with any type of gastroenterology diagnosis during the study period,963 met the inclusion criteria.Testing for anti-HDV antibodies and HDV RNA was performed for all participants.Demographic and risk factor data were collected by investigators using medical charts and patient questionnaires.All data were stored in an anonymized online database during the study.RESULTS The prevalence of HBV was 3.8%;among these patients,the prevalence of HBV/HDV coinfection was 33.1%.The median age of the study population was 54.0 years,and it consisted of 55.1%men.A higher prevalence of HBV/HDV coinfection was observed in patients 50–69 years old.Patients with HBV/HDV coinfection were significantly older than those with HBV monoinfection(P=0.03).Multivariate multiple regression analysis identified female gender(P=0.0006),imprisonment(P<0.0001),older age at diagnosis(P=0.01)and sexual contact with persons with known viral hepatitis(P=0.0003)as significant risk factors for HDV.CONCLUSION This study shows that HDV infection among those with HBV remains endemic in Romania and updates our understanding of HDV epidemiology and associated risk factors.It emphasizes the need for systematic screening for HDV infection and collaborative initiatives for controlling and preventing HBV and HDV infection.

Uncovering the epidemiology of bladder cancer in the Arab world: A review of risk factors, molecular mechanisms, and clinical features

Objective:Bladder cancer(BC)is a significant public health concern in the Middle East and North Africa,but the epidemiology and clinicopathology of the disease and contributors to high mortality in this region remain poorly understood.The aim of this systematic review was to investigate the epidemiological features of BC in the Arab world and compare them to those in Western countries in order to improve the management of this disease.Methods:An extensive electronic search of the PubMed/PMC and Cochrane Library databases was conducted to identify all articles published until May 2022,following the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines.A total of 95 articles were included in the final analysis after title,abstract,and full-text screening,with additional data obtained from the GLOBOCAN and WHO 2020 databases.

Hepatocellular carcinoma: Epidemiology, risk factors and pathogenesis

Hepatocellular carcinoma (HCC) is the commonest primary malignant cancer of the liver in the world. Given that the burden of chronic liver disease is expected to rise owing to increasing rates of alcoholism, hepatitis B and C prevalence and obesity-related fatty liver disease, it is expected that the incidence of HCC will also increase in the foreseeable future. This article summarizes the international epidemiology, the risk factors and the pathogenesis of HCC, including the roles of viral hepatitis, toxins, such as alcohol and aflatoxin, and insulin resistance.

Epidemiology and risk factors of colorectal cancer in China

In China, colorectal cancer(CRC) ranked fourth and fifth in the highest incidence and mortality rates of all malignancies in 2018, respectively. Although these rates are below the world average, China placed first worldwide in the number of new CRC cases and CRC-related deaths because of its comparatively large population. This disease represents a threat to the health of population and incurs a heavy economic burden on the society and individuals. CRC has various risk factors, including age, sex, lifestyle, genetic factors, obesity, diabetes, gut microbiota status, and precancerous lesions. Furthermore, incidence and mortality rates of CRC are closely related to socioeconomic development levels, varying according to regional and population characteristics. Prevention is the main strategy to reduce incidence and mortality rates of CRC. This can be achieved through strategies stimulating lifestyle changes, healthy diet habits, and early screening for high-risk individuals. To reduce the burden of CRC, public health officials should promote prevention and management of modifiable risk factors through national policies. The rising incidence and mortality rates of CRC in China may be timely curbed by clarifying specific epidemiological characteristics, optimizing early screening strategies, and strictly implementing diagnosis and treatment guidelines. Thus, this study aimed to collect and report the current research status on epidemiology and risk factors of CRC in China.

Cervical cancer: Epidemiology, risk factors and screening

Cervical cancer is one of the leading causes of cancer death among females worldwide and its behavior epidemiologically likes a venereal disease of low infectiousness. Early age at first intercourse and multiple sexual partners have been shown to exert strong effects on risk. The wide differences in the incidence among different countries also influenced by the introduction of screening. Although the general picture remains one of decreasing incidence and mortality, there are signs of an increasing cervical cancer risk probably due to changes in sexual behavior. Smoking and human papillomavirus(HPV) 16/18 are currently important issues in a concept of multifactorial, stepwise carcinogenesis at the cervix uteri. Therefore, society-based preventive and control measures, screening activities and HPV vaccination are recommended. Cervical cancer screening methods have evolved from cell morphology observation to molecular testing. High-risk HPV genotyping and liquid-based cytology are common methods which have been widely recommended and used worldwide. In future, accurate,cheap, fast and easy-to-use methods would be more popular. Artificial intelligence also shows to be promising in cervical cancer screening by integrating image recognition with big data technology. Meanwhile, China has achieved numerous breakthroughs in cervical cancer prevention and control which could be a great demonstration for other developing and resource-limited areas. In conclusion, although cervical cancer threatens female health, it could be the first cancer that would be eliminated by human beings with comprehensive preventive and control strategy.

Pancreatic cancer:A review of epidemiology,trend,and risk factors

Despite rapid advances in modern medical technology and significant improvements in survival rates of many cancers,pancreatic cancer is still a highly lethal gastrointestinal cancer with a low 5-year survival rate and difficulty in early detection.At present,the incidence and mortality of pancreatic cancer are increasing year by year worldwide,no matter in the United States,Europe,Japan,or China.Globally,the incidence of pancreatic cancer is projected to increase to 18.6 per 100000 in 2050,with the average annual growth of 1.1%,meaning that pancreatic cancer will pose a significant public health burden.Due to the special anatomical location of the pancreas,the development of pancreatic cancer is usually diagnosed at a late stage with obvious clinical symptoms.Therefore,a comprehensive understanding of the risk factors for pancreatic cancer is of great clinical significance for effective prevention of pancreatic cancer.In this paper,the epidemiological characteristics,developmental trends,and risk factors of pancreatic cancer are reviewed and analyzed in detail.

Esophageal cancer:Epidemiology,risk factors and screening

More than 600,000 people are diagnosed with esophageal cancer(EC)every year globally,and the five-year survival rate of EC is less than 20%.Two common histological subtypes of EC,esophageal squamous cell carcinoma(ESCC)and esophageal adenocarcinoma(EAC),have great geographical variations in incidence rates.About half of the world’s EC was diagnosed in China and a majority of which belong to ESCC.Globally,the overall incidence rate of EC is decreasing.In some high-risk Asian regions,such as China,the incidence rate of ESCC has generally declined,potentially due to economic growth and improvement of diet habits.In some European high-income countries and the United States,the decline is mainly attributed to the decrease in smoking and drinking.The risk factors of EC are not well understood,and the importance of environmental and genetic factors in the pathogenesis is also unclear.The incidence and mortality of advanced EC can be reduced through early diagnosis and screening.White light endoscopy is still the gold standard in the current screening technology.This article reviews the epidemiology,risk factors,and screening strategies of EC in recent years to help researchers determine the most effective management strategies to reduce the risk of EC.

Breast cancer: Epidemiology, risk factors and screening

Breast cancer is a global health concern with a significant impact on the well-being of women. Worldwide, the past several decades have witnessed changes in the incidence and mortality of breast cancer. Additionally,epidemiological data reveal distinct geographic and demographic disparities globally. A range of modifiable and non-modifiable risk factors are established as being associated with an increased risk of developing breast cancer.This review discusses genetic, hormonal, behavioral, environmental, and breast-related risk factors. Screening plays a critical role in the effective management of breast cancer. Various screening modalities, including mammography,ultrasound, magnetic resonance imaging(MRI), and physical examination, have different applications, and a combination of these modalities is applied in practice. Current screening recommendations are based on factors including age and risk, with a significant emphasis on minimizing potential harms to achieve an optimal benefits-to-harms ratio. This review provides a comprehensive insight into the epidemiology, risk factors, and screening of breast cancer. Understanding these elements is crucial for improving breast cancer management and reducing its burden on affected individuals and healthcare systems.

Epidemiology and risk factors of retinoblastoma in Chongqing area

AIM： To investigate the risk factors of retinoblastoma in Chongqing and offer the bases for scientific measures. METHODS： One hundred and thirty-three retinoblastoma patients were taken as case group, and 133 children were taken as control group in 1：1 ratio. The relevant factors were collected from a questionnaire survey which was made by our research group. First, Chi-square and t-test were used to discuss the various factors, and then the logistic regression analysis was made by statistics software SPSS17.0 based on the result of 266 people. RESULTS： Single factor analysis results showed the differences between the two groups were statistically significant （P〈0.05） in 17 factors which were education level of their parents, occupation of their parents, exposure to harmful chemicals of their parents 6mo before pregnancy, the history of pelvic inflammatory disease of mother before pregnancy, childbearing history of their parents, pregnant age of their parents, the medication history of father 6mo before pregnancy, living place of their parents, the pollution living place of mother, hobbies of their parents. Multivariate analysis showed that the living place of parents, mother who feed pets before pregnancy, and exposure to harmful chemicals of father before pregnancy were the independent risk factors of retinoblastoma （P〈0.05）. CONCLUSION： The living place of parents, mother who feed pets before pregnancy, exposure to harmful chemicals of father before pregnancy were the risk factors of retinoblastoma which affects the occurrence of retinoblastoma in a certain extent.

A Review on Brucellosis in Cameroon: Diagnostic Approaches, Epidemiology and Risk Factors for Infection

Brucellosis is a neglected tropical zoonotic disease that threatens the food production and public health sectors. It is of considerable animal welfare and economic importance and is underreported in most parts of the world, especially in developing countries like Cameroon. Brucellosis has been reported in cattle, other domestic animals and humans in Cameroon. The burden of the disease is unclear, and the awareness remains questionable. It became necessary for this review to be carried out to highlight the diagnostic approaches used to confirm brucellosis in animals and humans, disease epidemiology and risk factors for infection. So far, reports of brucellosis in previous studies have been based on serology only. Seroprevalence data of Brucella antibodies in animals indicate the risk of human brucellosis in Cameroon. However, few investigations have been undertaken on human brucellosis, considering the different epidemiological settings. There is no report or unsuccessful attempts to identify Brucella species circulating in Cameroon. It could largely be attributed to a lack of standard laboratories for testing and the lack of consumables. The way forward will require a surveillance system for brucellosis in the country, educating all sectors affected and drafting a diagnostic protocol for high-risk individuals.

Pelvic Organs Prolapse in Low-Resources Countries: Epidemiology, Risk Factors, Quality of Life. Narrative Review

Objective: Pelvic organ prolapse is an emerging public health problem affecting adult women of all ages with a negative impact on social, physical well-being, and psychological. Its presents several challenges in countries with low resources. This literature review aims to examine POP in its epidemiological aspects, risk factors, and staging by taking up the challenges associated with low-resource settings and identifying some avenues for future research. Methods: We searched the PubMed, Google Scholar, and Scopus databases. The other studies were identified by checking the secondary references in the original citation. We have collected studies on adult women published in English for the last 30 years. In total, 71 articles were read. We excluded studies from all newspaper articles, Studies presenting co-morbidities (fistulas, cervical cancer, pregnancy), those evaluating treatment, letters, comments, case reports, practice guidelines, news, historical articles, legal cases, published erratum, and congresses. Results: 16 studies examining the epidemiology have been identified with 11 in countries defined by the World Bank as limited or intermediate resources. 18 on risk factors whose 10 in countries with limited or intermediate resources, 10 on staging and 27 on physiopathology. Conclusion: POP affects the young more in low-resource settings. Its prevalence remains underestimated for several reasons. Several risk factors found are the same as those of women in countries with a high standard of living. However, there are some specific risk factors for these resource-limited settings.

Gastric cancer: Epidemiology, risk factors and prevention strategies

Gastric cancer(GC) is a global health problem, with more than 1 million people newly diagnosed with GC worldwide each year. GC is more prevalent in less developed countries than in more developed countries. About half of all GC cases worldwide occur in East Asia, notably China. Globally, overall incidence rates of GC are declining, which is potentially attributed to a decrease in Helicobacter pylori(H. pylori) infection and the use of refrigeration to preserve foods rather than salt. GC is a multifactorial disease, and its occurrence and development were impacted by environmental and genetic factors. H. pylori infection is the primary risk factor for GC, especially for non-cardia. The prognosis of GC is poor due to stages at the first diagnosis. The 5-year survival rate is less than 10% when patients are diagnosed at an advanced stage, but the rate is as high as 85% if patients are detected at an earlier stage. Endoscopic screening can potentially prevent GC by early diagnosis and early treatment and has been widely adopted in screening programs in East Asian countries, such as Japan and Korea. This review summarizes updated epidemiological aspects, risk factors, and prevention strategies of GC in recent years to help researchers determine the most effective intervention strategies for reducing risk of GC.

Intra-hepatic and extra-hepatic cholangiocarcinoma:New insight into epidemiology and risk factors

Cholangiocarcinoma(CCA) is a malignant tumour that arises from biliary epithelium at any portion of the biliary tree.CCA is currently classified as intra-hepatic or extra-hepatic CCA(EH-CCA).Recent evidences suggest that intra-hepatic CCA(IH-CCA) and EH-CCA are biologically different cancers,giving further support to a number of recent epidemiological studies showing large differences in terms of incidence,mortality and risk factors.The purpose of this manuscript is to review recent literature dealing with the descriptive epidemiology and risk factors of CCA with a special effort to compare IH-with EH-CCA.

Inflammatory bowel disease:Epidemiology,pathology and risk factors for hypercoagulability

Hypercoagulability observed in patients with inflammatory bowel diseases (IBD) may lead to thromboembolic events (TE), which affect the venous and arterial systems alike and are an important factor in patients&#x02019; morbidity and mortality. The risk of TE in IBD patients has been demonstrated to be approximately three-fold higher as compared to the general population. The pathogenesis of thrombosis in IBD patients is multifactorial and not fully explained. The most commonly listed factors include genetic and immune abnormalities, disequilibrium between procoagulant and anticoagulant factors, although recently, the role of endothelial damage as an IBD-triggering factor is underlined. Several studies report that the levels of some coagulation enzymes, including fibrinogen, factors V, VII, VIII, active factor XI, tissue factor, prothrombin fragment 1 + 2 and the thrombin-antithrombin complex, are altered in IBD patients. It has been demonstrated that there is a significant decrease of tissue plasminogen activator level, a marked increase of plasminogen activator inhibitor type 1 and thrombin-activable fibrinolysis inhibitor, a significantly lower level of antithrombin III and tissue factor pathway inhibitor. IBD patients have been also observed to produce an increased amount of various anticoagulant antibodies. Hyperhomocysteinemia, which is a potential risk factor for TE was also observed in some IBD patients. Further studies are necessary to assess the role of coagulation abnormalities in IBD etiology and to determine indications for thromboprophylactic treatment in patients at high risk of developing TE.

Seroepidemiology of hepatitis C and its risk factors in Khuzestan Province, South-West of Iran:A case-control study

AIM：To evaluate possible risk factors for the spread of hepatitis C infection and to analyze the characteristics of the epidemiological and clinical patterns among the patients with hepatitis C infection. METHODS： During a five-year period a cross-sectional study was conducted among HCV positive individuals referred to the Ahwaz JundiShapour University Hospitals （AJSUH） and Hepatitis Clinic from 1 Sept 1999 to 1 Sept 2003. The control group consisted of first time blood donors referred to the Regional Blood Transfusion organization. Enzyme-linked immunosorbent assay and recombinant immunoblot assay anti-hepatitis C virus （HCV） tests were performed for two groups. Positive serum specimens were retested using polymerase chain reaction （PCR） for HCV RNA. Risk factors were evaluated using a questionnaire. Reported risk factors among infected subjects （＂HCV-positive＂） were compared to those of subjects never exposed （＂HCV-negative＂） to HCV. RESULTS： A total of 514 subjects were studied for HCV, of which 254 were HCV-positive and 260 HCV- negative donors comprised the control group. Mean age of the patients was 28.4 （Std 15.22） years. HCV-positive subjects were more likely to be of male gender （63% versus 37%）. Transfusion 132 （52%）, non-intravenous （n-iv） drug abuse and iv drug abuse 37 （14.5%）, haemodialysis 25 （10%）, receiving wounds at war and extramarital sexual activities （2.4%）, tattooing （3.6%） were found to be independent risk factors of being HCV-positive. No apparent risk factors could be demonstrated in 29 （11.2%） of the positive cases. CONCLUSION： Our data indicate that a history of transfusion and iv drug abuse and haemodialysis are important risk factors for HCV infection in our area and that more careful pretransfusion screening of blood for anti- HCV must be introduced in our blood banks. Improvements in certain lifestyle patterns, and customs in this area may be essential to prevent transmission of the infection.

Molecular Epidemiology and Risk Factors of Herpes Simplex Virus Type 2 in Pregnant Women

Background:Herpes simplex virus type 2(HSV-2)infection is the main cause of genital and neonatal herpes infections.It has considerable public health importance among women as the virus may lead to adverse outcomes in pregnancy and neonatal infection.This study determines the molecular epidemiology and risk factors ofHSV-2 infection among pregnant women.Methods:In this cross-sectional study,all pregnant women admitted to three university hospitals for natural birth and Caesarean sections were enrolled.HSV detection and typing were carried out based on PCR and reverse dot blotting method,respectively.ANOVA and bivariate correlations were used to analyze the data.Results:In this study,the prevalence of genital herpes infection was 5.7%.A significant positive correlation was found between age group<25 years and HSV-2 shedding(P=0.026).Twelve participants(60%)with HSV-2 shedding were younger than 25.A significant correlation was found between the presence of genital lesion and HSV-2(P=0.02).Among participants with HSV-2 infection,the use of condom was low.Neonatal complications were not seen in newborns from mothers with HSV-2 shedding.Conclusion:PCR assay may help in promoting early diagnosis and more effective treatment for patients.Also,it shortens hospital stay and enhances patients?condition.HSV-2 transmission is rapid following the onset of sexual activity and likely to result in the significant prevalence of genital disease.

Population-based epidemiology,risk factors and screening of intraductal papillary mucinous neoplasm patients

Intraductal papillary mucinous neoplasm(IPMN) was first recognized in the 1980s with increasing publications over the last decade as the incidence increased sharply,especially at tertiary-care referral centers.Populationbased studies have estimated the age and sex-adjusted cumulative incidence of IPMN to be 2.04 per 100 000 person-years(95% conf idence interval:1.28-2.80).It is now understood that IPMN can be classified anywhere along the spectrum of the adenoma to carcinoma sequence and often harbors mutations in genes such as KRAS early in the disease process.Many patients are diagnosed incidentally after imaging of the abdomen for other diagnostic purposes.Patients that present with a history of symptoms such as pancreatitis and abdominal pain are at high risk of harboring a malignancy.Clini-copathologic features such as involvement of the main pancreatic duct,presence of mural nodules,and side branch disease > 3.0 cm in size may indicate that there is an underlying invasive component to the IPMN.In addition,the incidence of extra-pancreatic neoplasms is higher in patients with IPMN,with reported rates of 25% to 50%.There are no current screening recommendations to detect and diagnose IPMN but once the diagnosis is made,screening for extrapancreatic neoplasms such as colon polyps and colorectal cancer should be considered.Surgical resection is the recommend treatment for patients with high-risk features while close observation can be offered to patients without worrisome signs and symptoms of carcinoma.

Update on Gastric Cancer Epidemiology and Risk Factors

Gastric adenocarcinoma is the most common gastric tumor. It is the fifth most common cancer worldwide after lung cancer, breast, colo rectal and prostate cancer. Long considered enigmatic, its epidemiology has changed over time. In fact, the incidence of distal gastric cancer has declined while that of the cardia was stable or increased. This cancer is multifactorial but reducing the incidence of distal cancer is particularly attributed to advances in the treatment of H. pylori infection. In this review, we analyzed the available data concerning the changing epidemiology of gastric cancer and the main risk factors. The incidence of distal cancer is definitely declining due to the control of Helicobacter pylori infection. Proximal gastric cancer and cardia cancer is particularly due to smoking, overweight.

Association between autoimmune gastritis and gastric polyps:Clinical characteristics and risk factors

BACKGROUND The relationship between autoimmune gastritis(AIG)and gastric polyps(GPs)is not well understood.AIM To explore the clinical characteristics and risk factors of AIG with GPs in patients.METHODS This double center retrospective study included 530 patients diagnosed with AIG from July 2019 to July 2023.We collected clinical,biochemical,serological,and demographic data were of each patient.Logistic regression analyses,both multivariate and univariate,were conducted to pinpoint independent risk factors for GPs in patients with AIG patients.Receiver operating characteristic curves were utilized to establish the optimal cutoff values,sensitivity,and specificity of these risk factors for predicting GPs in patients with AIG.RESULTS Patients with GPs had a higher median age than those without GPs[61(52.25-69)years vs 58(47-66)years,P=0.006].The gastrin-17 levels were significantly elevated in patients with GPs compared with those without GPs[91.9(34.2-138.9)pmol/mL vs 60.9(12.6-98.4)pmol/mL,P<0.001].Additionally,the positive rate of parietal cell antibody(PCA)antibody was higher in these patients than in those without GPs(88.6%vs 73.6%,P<0.001).Multivariate and univariate analyses revealed that PCA positivity[odds ratio(OR)=2.003,P=0.017],pepsinogen II(OR=1.053,P=0.015),and enterochromaffin like cells hyperplasia(OR=3.116,P<0.001)were significant risk factors for GPs,while pepsinogen I was identified as a protective factor.CONCLUSION PCA positivity and enterochromaffin like cells hyperplasia are significant risk factor for the development of GPs in patients with AIG.Elevated gastrin-17 levels may also play a role in this process.These findings suggest potential targets for further research and therapeutic intervention in managing GPs in patients with AIG.

Burden of mental disorders and risk factors in the Western Pacific region from 1990 to 2021

BACKGROUND The burden of mental disorders(MD)in the Western Pacific Region(WPR)re-mains a critical public health concern,with substantial variations across demogra-phics and countries.AIM To analyze the burden of MD in the WPR from 1990 to 2021,along with associated risk factors,to reveal changing trends and emerging challenges.METHODS We used data from the Global Burden of Disease 2021,analyzing prevalence,incidence,and disability-adjusted life years(DALYs)of MD from 1990 to 2021.Statistical methods included age-standardisation and uncertainty analysis to address variations in population structure and data completeness.RESULTS Between 1990 and 2021,the prevalence of MD rose from 174.40 million cases[95%uncertainty interval(UI):160.17-189.84]to 234.90 million cases(95%UI:219.04-252.50),with corresponding DALYs increasing from 22.8 million(95%UI:17.22-28.79)to 32.07 million(95%UI:24.50-40.68).During this period,the burden of MD shifted towards older age groups.Depressive and anxiety disorders were predominant,with females showing higher DALYs for depressive and anxiety disorders,and males more affected by conduct disorders,attention-deficit hyperactivity disorder,and autism spectrum disorders.Australia,New Zealand,and Malaysia reported the highest burdens,whereas Vietnam,China,and Brunei Darussalam reported the lowest.Additionally,childhood sexual abuse and bullying,and intimate partner violence emerged as significant risk factors.CONCLUSION This study highlights the significant burden of MD in the WPR,with variations by age,gender,and nation.The coronavirus disease 2019 pandemic has exacerbated the situation,emphasizing the need for a coordinated response.