Spatial-temporal analysis of head injuries at the northwest of Iran 2014–2018

Abstract

Background: head injuries (HI) are considered as a major public health concern across the world. This study aims to explore the incidence rate and spatial distribution of HI incidence at rural district levels in Zanjan province, Iran from 2014-2018.Materials & Methods: This study was a cross-sectional and geospatial analysis of head injury incidence pattern in rural areas at Zanjan province, Iran. Data were collected from nine hospital information system databases. Age-adjusted incidence rate and three different spatial analysis methods (Spatial autocorrelation, hotspot analysis and Anselin Local Moran's I) were used to detect the potential high-risk areas of HI incidence in the study area.Results: 4562 patients were registered at Zanjan hospitals due to HI from 2014-2018. The age-adjusted incidence rate of HI was 429 cases (95% CI, 418,443) per 100,000 person which increased from 74 cases in 2014 to 86 cases in 2018, (an 18% increase, P<0001). The highest incidence rate observed among men (80%, P<0001) and at the age group of 15-29 (44.4%, P<0001). Qarabolagh region had the highest incidence rate and five hotspot, seven coldspot, two high-high cluster and seven low-low cluster of HI incidence were detected using spatial analysis.Conclusion: This study provided an overview about the incidence rate and spatial pattern of HI incidence at finer geographical level at the northwest of Iran. This study detected high-risk areas and also showed a significant relationship between HI, geographical areas and genders, which can provide useful information for local health authorities to apply prevention programs for reducing the burden of HI in the society.

Nephrolithiasis in Renal Tubular Acidosis: Pathophysiology, Diagnosis, and Management Strategies

“…Renal tubular acidosis (RTA) is a group of disorders classified based on the affected portion of the nephron into Distal RTA (Type I or dRTA), Proximal RTA (Type II or pRTA), Type III RTA, a combination of Proximal and Distal RTA, and Type IV RTA or hyperkalemic distal tubular RTA [4,5]. Under the influence of aldosterone, the distal collecting ducts produce new bicarbonate.…”

“…Type I RTA occurs when α-intercalated cells of the Collecting Tubules cannot secrete H+ into the lumen. This results in the inability of new bicarbonate to be produced and released to the interstitium, with consequent metabolic acidosis and hypokalemia due to failure of the H+/K+ ATPase [4,5]. There are several causes of type I RTA.…”

“…These include Amphotericin B toxicity, autoimmune diseases such as systemic lupus erythematosus (SLE) and Sjögren syndrome, analgesic nephropathy, and congenital obstruction anomalies of the urinary tract [4]. The inability of H+ excretion into the lumen leads to alkaline urine pH >5.5 [5,6]. Given the H+ ion retention seen in patients with Type I RTA, hypercalciuria develops due to elevated intestinal calcium absorption, excess release from bone, and decreased renal absorption.…”

“…Type II RTA occurs when the Proximal Convoluted Tubule cannot reabsorb bicarbonate from the lumen, leading to elevated bicarbonate excretion in the urine and consequent metabolic acidosis. Often, Type II RTA is caused by Fanconi Syndrome, multiple myeloma, and carbonic anhydrase inhibitors [4,5]. The defect of bicarbonate reabsorption leads to elevated urinary pH >5.5 when filtered bicarbonate exceeds the threshold for reabsorption.…”