Timely and comprehensive analyses of causes of death stratified by age, sex, and location are essential for shaping effective health policies aimed at reducing global mortality. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 provides cause-specific mortality estimates measured in counts, rates, and years of life lost (YLLs). GBD 2023 aimed to enhance our understanding of the relationship between age and cause of death by quantifying the probability of dying before age 70 years (70q0) and the mean age at death by cause and sex. This study enables comparisons of the impact of causes of death over time, offering a deeper understanding of how these causes affect global populations. GBD 2023 produced estimates for 292 causes of death disaggregated by age-sex-location-year in 204 countries and territories and 660 subnational locations for each year from 1990 until 2023. We used a modelling tool developed for GBD, the Cause of Death Ensemble model (CODEm), to estimate cause-specific death rates for most causes. We computed YLLs as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. Probability of death was calculated as the chance of dying from a given cause in a specific age period, for a specific population. Mean age at death was calculated by first assigning the midpoint age of each age group for every death, followed by computing the mean of all midpoint ages across all deaths attributed to a given cause. We used GBD death estimates to calculate the observed mean age at death and to model the expected mean age across causes, sexes, years, and locations. The expected mean age reflects the expected mean age at death for individuals within a population, based on global mortality rates and the population's age structure. Comparatively, the observed mean age represents the actual mean age at death, influenced by all factors unique to a location-specific population, including its age structure. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 250-draw distribution for each metric. Findings are reported as counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2023 include a correction for the misclassification of deaths due to COVID-19, updates to the method used to estimate COVID-19, and updates to the CODEm modelling framework. This analysis used 55 761 data sources, including vital registration and verbal autopsy data as well as data from surveys, censuses, surveillance systems, and cancer registries, among others. For GBD 2023, there were 312 new country-years of vital registration cause-of-death data, 3 country-years of surveillance data, 51 country-years of verbal autopsy data, and 144 country-years of other data types that were added to those used in previous GBD rounds. The initial years of the COVID-19 pandemic caused shifts in long-standing rankings of the leading causes of global deaths: it ranked as the number one age-standardised cause of death at Level 3 of the GBD cause classification hierarchy in 2021. By 2023, COVID-19 dropped to the 20th place among the leading global causes, returning the rankings of the leading two causes to those typical across the time series (ie, ischaemic heart disease and stroke). While ischaemic heart disease and stroke persist as leading causes of death, there has been progress in reducing their age-standardised mortality rates globally. Four other leading causes have also shown large declines in global age-standardised mortality rates across the study period: diarrhoeal diseases, tuberculosis, stomach cancer, and measles. Other causes of death showed disparate patterns between sexes, notably for deaths from conflict and terrorism in some locations. A large reduction in age-standardised rates of YLLs occurred for neonatal disorders. Despite this, neonatal disorders remained the leading cause of global YLLs over the period studied, except in 2021, when COVID-19 was temporarily the leading cause. Compared to 1990, there has been a considerable reduction in total YLLs in many vaccine-preventable diseases, most notably diphtheria, pertussis, tetanus, and measles. In addition, this study quantified the mean age at death for all-cause mortality and cause-specific mortality and found noticeable variation by sex and location. The global all-cause mean age at death increased from 46·8 years (95% UI 46·6-47·0) in 1990 to 63·4 years (63·1-63·7) in 2023. For males, mean age increased from 45·4 years (45·1-45·7) to 61·2 years (60·7-61·6), and for females it increased from 48·5 years (48·1-48·8) to 65·9 years (65·5-66·3), from 1990 to 2023. The highest all-cause mean age at death in 2023 was found in the high-income super-region, where the mean age for females reached 80·9 years (80·9-81·0) and for males 74·8 years (74·8-74·9). By comparison, the lowest all-cause mean age at death occurred in sub-Saharan Africa, where it was 38·0 years (37·5-38·4) for females and 35·6 years (35·2-35·9) for males in 2023. Lastly, our study found that all-cause 70q0 decreased across each GBD super-region and region from 2000 to 2023, although with large variability between them. For females, we found that 70q0 notably increased from drug use disorders and conflict and terrorism. Leading causes that increased 70q0 for males also included drug use disorders, as well as diabetes. In sub-Saharan Africa, there was an increase in 70q0 for many non-communicable diseases (NCDs). Additionally, the mean age at death from NCDs was lower than the expected mean age at death for this super-region. By comparison, there was an increase in 70q0 for drug use disorders in the high-income super-region, which also had an observed mean age at death lower than the expected value. We examined global mortality patterns over the past three decades, highlighting-with enhanced estimation methods-the impacts of major events such as the COVID-19 pandemic, in addition to broader trends such as increasing NCDs in low-income regions that reflect ongoing shifts in the global epidemiological transition. This study also delves into premature mortality patterns, exploring the interplay between age and causes of death and deepening our understanding of where targeted resources could be applied to further reduce preventable sources of mortality. We provide essential insights into global and regional health disparities, identifying locations in need of targeted interventions to address both communicable and non-communicable diseases. There is an ever-present need for strengthened health-care systems that are resilient to future pandemics and the shifting burden of disease, particularly among ageing populations in regions with high mortality rates. Robust estimates of causes of death are increasingly essential to inform health priorities and guide efforts toward achieving global health equity. The need for global collaboration to reduce preventable mortality is more important than ever, as shifting burdens of disease are affecting all nations, albeit at different paces and scales. Gates Foundation.
For more than three decades, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has provided a framework to quantify health loss due to diseases, injuries, and associated risk factors. This paper presents GBD 2023 findings on disease and injury burden and risk-attributable health loss, offering a global audit of the state of world health to inform public health priorities. This work captures the evolving landscape of health metrics across age groups, sexes, and locations, while reflecting on the remaining post-COVID-19 challenges to achieving our collective global health ambitions. The GBD 2023 combined analysis estimated years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) for 375 diseases and injuries, and risk-attributable burden associated with 88 modifiable risk factors. Of the more than 310 000 total data sources used for all GBD 2023 (about 30% of which were new to this estimation round), more than 120 000 sources were used for estimation of disease and injury burden and 59 000 for risk factor estimation, and included vital registration systems, surveys, disease registries, and published scientific literature. Data were analysed using previously established modelling approaches, such as disease modelling meta-regression version 2.1 (DisMod-MR 2.1) and comparative risk assessment methods. Diseases and injuries were categorised into four levels on the basis of the established GBD cause hierarchy, as were risk factors using the GBD risk hierarchy. Estimates stratified by age, sex, location, and year from 1990 to 2023 were focused on disease-specific time trends over the 2010-23 period and presented as counts (to three significant figures) and age-standardised rates per 100 000 person-years (to one decimal place). For each measure, 95% uncertainty intervals [UIs] were calculated with the 2·5th and 97·5th percentile ordered values from a 250-draw distribution. Total numbers of global DALYs grew 6·1% (95% UI 4·0-8·1), from 2·64 billion (2·46-2·86) in 2010 to 2·80 billion (2·57-3·08) in 2023, but age-standardised DALY rates, which account for population growth and ageing, decreased by 12·6% (11·0-14·1), revealing large long-term health improvements. Non-communicable diseases (NCDs) contributed 1·45 billion (1·31-1·61) global DALYs in 2010, increasing to 1·80 billion (1·63-2·03) in 2023, alongside a concurrent 4·1% (1·9-6·3) reduction in age-standardised rates. Based on DALY counts, the leading level 3 NCDs in 2023 were ischaemic heart disease (193 million [176-209] DALYs), stroke (157 million [141-172]), and diabetes (90·2 million [75·2-107]), with the largest increases in age-standardised rates since 2010 occurring for anxiety disorders (62·8% [34·0-107·5]), depressive disorders (26·3% [11·6-42·9]), and diabetes (14·9% [7·5-25·6]). Remarkable health gains were made for communicable, maternal, neonatal, and nutritional (CMNN) diseases, with DALYs falling from 874 million (837-917) in 2010 to 681 million (642-736) in 2023, and a 25·8% (22·6-28·7) reduction in age-standardised DALY rates. During the COVID-19 pandemic, DALYs due to CMNN diseases rose but returned to pre-pandemic levels by 2023. From 2010 to 2023, decreases in age-standardised rates for CMNN diseases were led by rate decreases of 49·1% (32·7-61·0) for diarrhoeal diseases, 42·9% (38·0-48·0) for HIV/AIDS, and 42·2% (23·6-56·6) for tuberculosis. Neonatal disorders and lower respiratory infections remained the leading level 3 CMNN causes globally in 2023, although both showed notable rate decreases from 2010, declining by 16·5% (10·6-22·0) and 24·8% (7·4-36·7), respectively. Injury-related age-standardised DALY rates decreased by 15·6% (10·7-19·8) over the same period. Differences in burden due to NCDs, CMNN diseases, and injuries persisted across age, sex, time, and location. Based on our risk analysis, nearly 50% (1·27 billion [1·18-1·38]) of the roughly 2·80 billion total global DALYs in 2023 were attributable to the 88 risk factors analysed in GBD. Globally, the five level 3 risk factors contributing the highest proportion of risk-attributable DALYs were high systolic blood pressure (SBP), particulate matter pollution, high fasting plasma glucose (FPG), smoking, and low birthweight and short gestation-with high SBP accounting for 8·4% (6·9-10·0) of total DALYs. Of the three overarching level 1 GBD risk factor categories-behavioural, metabolic, and environmental and occupational-risk-attributable DALYs rose between 2010 and 2023 only for metabolic risks, increasing by 30·7% (24·8-37·3); however, age-standardised DALY rates attributable to metabolic risks decreased by 6·7% (2·0-11·0) over the same period. For all but three of the 25 leading level 3 risk factors, age-standardised rates dropped between 2010 and 2023-eg, declining by 54·4% (38·7-65·3) for unsafe sanitation, 50·5% (33·3-63·1) for unsafe water source, and 45·2% (25·6-72·0) for no access to handwashing facility, and by 44·9% (37·3-53·5) for child growth failure. The three leading level 3 risk factors for which age-standardised attributable DALY rates rose were high BMI (10·5% [0·1 to 20·9]), drug use (8·4% [2·6 to 15·3]), and high FPG (6·2% [-2·7 to 15·6]; non-significant). Our findings underscore the complex and dynamic nature of global health challenges. Since 2010, there have been large decreases in burden due to CMNN diseases and many environmental and behavioural risk factors, juxtaposed with sizeable increases in DALYs attributable to metabolic risk factors and NCDs in growing and ageing populations. This long-observed consequence of the global epidemiological transition was only temporarily interrupted by the COVID-19 pandemic. The substantially decreasing CMNN disease burden, despite the 2008 global financial crisis and pandemic-related disruptions, is one of the greatest collective public health successes known. However, these achievements are at risk of being reversed due to major cuts to development assistance for health globally, the effects of which will hit low-income countries with high burden the hardest. Without sustained investment in evidence-based interventions and policies, progress could stall or reverse, leading to widespread human costs and geopolitical instability. Moreover, the rising NCD burden necessitates intensified efforts to mitigate exposure to leading risk factors-eg, air pollution, smoking, and metabolic risks, such as high SBP, BMI, and FPG-including policies that promote food security, healthier diets, physical activity, and equitable and expanded access to potential treatments, such as GLP-1 receptor agonists. Decisive, coordinated action is needed to address long-standing yet growing health challenges, including depressive and anxiety disorders. Yet this can be only part of the solution. Our response to the NCD syndemic-the complex interaction of multiple health risks, social determinants, and systemic challenges-will define the future landscape of global health. To ensure human wellbeing, economic stability, and social equity, global action to sustain and advance health gains must prioritise reducing disparities by addressing socioeconomic and demographic determinants, ensuring equitable health-care access, tackling malnutrition, strengthening health systems, and improving vaccination coverage. We live in times of great opportunity. Gates Foundation and Bloomberg Philanthropies.
Cardiovascular diseases (CVDs) are the leading cause of mortality and are among the foremost causes of disability globally. CVD burden has continued to increase in most countries since 1990, with trends driven by changing exposures to harmful risk factors, population growth, and population aging. We report estimates of global, national, and subnational CVD burden, including 18 subdiseases and 12 associated modifiable risk factors. We analyzed change in CVD burden from 1990 to 2023 and identified drivers of change including population growth, population aging, and risk factor exposure. The Global Burden of Disease (GBD) 2023 study, a multinational collaborative research study, quantified burden due to 375 diseases including CVD burden and identified drivers of change from 1990 to 2023 using all available data and statistical models. GBD 2023 estimated the population-level burden of diseases in 204 countries and territories from 1990 to 2023. CVDs were the leading cause of disability-adjusted life years (DALYs) and deaths estimated in the GBD. As of 2023, there were 437 million (95% UI: 401 to 465 million) CVD DALYs globally, a 1.4-fold increase from the number in 1990 of 320 million (292 to 344 million). Ischemic heart disease, intracerebral hemorrhage, ischemic stroke, and hypertensive heart disease were the leading cardiovascular causes of DALYs in 2023 globally. As of 2023, age-standardized CVD DALY rates were highest in low and low-middle Socio-demographic Index (SDI) settings and lowest in high SDI settings. The number of CVD deaths increased globally from 13.1 million (95% UI: 12.2 to 14.0 million) in 1990 to 19.2 million (95% UI: 17.4 to 20.4 million) in 2023. The number of prevalent cases of CVD more than doubled since 1990, with 311 million (95% UI: 294 to 333 million) prevalent cases of CVD in 1990 and 626 million (95% UI: 591 to 672 million) prevalent cases in 2023 globally. A total of 79.6% (95% UI: 75.7% to 82.5%) of CVD burden is attributable to modifiable risk factors 347 million [95% UI: 318 to 373 million] DALYs in 2023). Globally, high systolic blood pressure, dietary risks, high low-density lipoprotein cholesterol, and air pollution were the modifiable risks responsible for most attributable CVD burden in 2023. Since 1990, changes in exposure to modifiable risk factors have had mixed effects on CVD burden, with increases in high body mass index, high fasting plasma glucose, and low physical activity leading to higher burden, while reductions in tobacco usage have mitigated some of these increases. Population growth and population aging were the main drivers of the increasing burden since 1990, adding 128 million (95% UI: 115 to 139 million) and 139 million (95% UI: 126 to 151 million) CVD DALYs to the increase in CVD burden since 1990. CVD remains the leading cause of disease burden and death worldwide with the greatest burden in low, low-middle, and middle SDI regions. Large variation exists in CVD burden even for countries at similar levels of development, a gap explained substantially by known, modifiable risk factors that are inadequately controlled. The decades-long increase in CVD burden was the result of population growth, population aging, and increased exposure to a subset of risk factors led by metabolic risks. Countries will need to adopt effective health system and public health strategies if they are to progress in achieving global goals to reduce the burden of CVD.
Cancer is a leading cause of death globally. Accurate cancer burden information is crucial for policy planning, but many countries do not have up-to-date cancer surveillance data. To inform global cancer-control efforts, we used the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 framework to generate and analyse estimates of cancer burden for 47 cancer types or groupings by age, sex, and 204 countries and territories from 1990 to 2023, cancer burden attributable to selected risk factors from 1990 to 2023, and forecasted cancer burden up to 2050. Cancer estimation in GBD 2023 used data from population-based cancer registration systems, vital registration systems, and verbal autopsies. Cancer mortality was estimated using ensemble models, with incidence informed by mortality estimates and mortality-to-incidence ratios (MIRs). Prevalence estimates were generated from modelled survival estimates, then multiplied by disability weights to estimate years lived with disability (YLDs). Years of life lost (YLLs) were estimated by multiplying age-specific cancer deaths by the GBD standard life expectancy at the age of death. Disability-adjusted life-years (DALYs) were calculated as the sum of YLLs and YLDs. We used the GBD 2023 comparative risk assessment framework to estimate cancer burden attributable to 44 behavioural, environmental and occupational, and metabolic risk factors. To forecast cancer burden from 2024 to 2050, we used the GBD 2023 forecasting framework, which included forecasts of relevant risk factor exposures and used Socio-demographic Index as a covariate for forecasting the proportion of each cancer not affected by these risk factors. Progress towards the UN Sustainable Development Goal (SDG) target 3.4 aim to reduce non-communicable disease mortality by a third between 2015 and 2030 was estimated for cancer. In 2023, excluding non-melanoma skin cancers, there were 18·5 million (95% uncertainty interval 16·4 to 20·7) incident cases of cancer and 10·4 million (9·65 to 10·9) deaths, contributing to 271 million (255 to 285) DALYs globally. Of these, 57·9% (56·1 to 59·8) of incident cases and 65·8% (64·3 to 67·6) of cancer deaths occurred in low-income to upper-middle-income countries based on World Bank income group classifications. Cancer was the second leading cause of deaths globally in 2023 after cardiovascular diseases. There were 4·33 million (3·85 to 4·78) risk-attributable cancer deaths globally in 2023, comprising 41·7% (37·8 to 45·4) of all cancer deaths. Risk-attributable cancer deaths increased by 72·3% (57·1 to 86·8) from 1990 to 2023, whereas overall global cancer deaths increased by 74·3% (62·2 to 86·2) over the same period. The reference forecasts (the most likely future) estimate that in 2050 there will be 30·5 million (22·9 to 38·9) cases and 18·6 million (15·6 to 21·5) deaths from cancer globally, 60·7% (41·9 to 80·6) and 74·5% (50·1 to 104·2) increases from 2024, respectively. These forecasted increases in deaths are greater in low-income and middle-income countries (90·6% [61·0 to 127·0]) compared with high-income countries (42·8% [28·3 to 58·6]). Most of these increases are likely due to demographic changes, as age-standardised death rates are forecast to change by -5·6% (-12·8 to 4·6) between 2024 and 2050 globally. Between 2015 and 2030, the probability of dying due to cancer between the ages of 30 years and 70 years was forecasted to have a relative decrease of 6·5% (3·2 to 10·3). Cancer is a major contributor to global disease burden, with increasing numbers of cases and deaths forecasted up to 2050 and a disproportionate growth in burden in countries with scarce resources. The decline in age-standardised mortality rates from cancer is encouraging but insufficient to meet the SDG target set for 2030. Effectively and sustainably addressing cancer burden globally will require comprehensive national and international efforts that consider health systems and context in the development and implementation of cancer-control strategies across the continuum of prevention, diagnosis, and treatment. Gates Foundation, St Jude Children's Research Hospital, and St Baldrick's Foundation.
Analyzing the clinical efficacy and mechanism of action of cardiac rehabilitation after revascularization for coronary multibranch lesions. 150 patients with multiple coronary artery lesions were selected for the study from July 2022 to March 2023, and were randomly divided into observation group (75 cases, complete revascularization + cardiac rehabilitation intervention) and control group (75 cases, complete revascularization). The level of patients' 6 min walking experiment, quality of life, cardiac function indexes, and laboratory indexes were analyzed. The level of 6-min walking test was significantly higher in the observation group than in the control group (p<0.05); the quality of life of patients in the observation group was significantly higher than that of the control group (p<0.05); the levels of left ventricular end-systolic internal diameter (LVESD), left ventricular end-diastolic internal diameter (LVEDD), left ventricular pressure (LVP), and interventricular septal thickness (LVS) in patients in the observation group were significantly lower than that of the control group; and the level of LV ejection fraction (LVEFA) levels were significantly higher than those of the control group (P=0.00); serum homocysteine (Hcy) and blood uric acid (SUA) levels of patients in the observation group were significantly lower than those of the control group (P=0.00). Complete revascularization + cardiac rehabilitation intervention can effectively improve patients' 6-min walking test level, improve patients' cardiac function indexes, improve patients' quality of life, improve patients' laboratory index levels, and play a significant role in improving patients' prognosis, which is worthy of widespread promotion.
Despite growing knowledge in microbiome studies data about the diversity of cultivable bacteria and their drug resistance patterns in patients with gastritis are scant. Two gastric biopsies of 171 symptomatic patients were collected and examined by histological and microbiological methods. Viable bacteria were characterized using conventional techniques, and antimicrobial susceptibility of the isolates was detected. Acute gastritis, chronic gastritis, and peptic ulcers were detected in 3.5%, 86.5%, and 5.8% of the patients, respectively. Culturable bacteria were isolated from 71.3% of the patients, including Helicobacter pylori (H. pylori) (26.9%), Staphylococcus epidermidis (19.8%), Micrococcus (1.1%), Streptococcus viridans (S. viridans) (13.4%), Enterococcus faecalis (E. faecalis) (4.6%), Staphylococcus aureus (S. aureus) (1.7%), and Group D Streptococcus (7.1%). Single infection and coexistence of two and three types of bacteria were detected in 43.2%, 15.2%, and 5.2% of the patients, respectively. An odd ratio of 4.4 was measured for Staphylococcus spp. in patients with acute gastritis (P-value = 0.08). E-test results showed intermediate resistance to penicillin in 66.6% of the S. aureus isolates, while resistance to vancomycin was detected only in the S. viridans (30.4%). Resistance to linezolid was detected in 100%, 17.4%, and 16.7% of E. faecalis, S. viridans, and group D Streptococci isolates, respectively. A high frequency of resistance to penicillin, clindamycin, linezolid, erythromycin, and tetracycline was detected in S. epidermidis strains. Our results highlighted the importance of Gram-positive bacteria in the etiology of gastritis. Resistance of these bacteria to different classes of antibiotics should be considered in the clinical setting.
Breast cancer is a major global health concern, with the highest incidence in women and the main cause of cancer-related deaths in them worldwide. The purpose of this study was to investigate the risk factors related to breast cancer in women. This is a case-control study on breast cancer patients referred to the Surgery Clinic during the years 2011 to 2021. There were 131 participants in the case group and 131 in the control group. Patient information was collected through medical records, face-to-face or telephone interviews. This study has the ethics code IR.MUBABOL.HRI.REC.1401.226 from the National Organization for Ethics in Biomedical Research of the Ministry of Health and Medical Education of Iran. 262 participants were included in the study, 50% were in the case group (breast cancer) and 131 (50%) were in the control group. Between the case and control group in terms of demographic variables, age (P=0.289), height (P=0.254), education level (P=0.785), marital status (P=0.421), place of birth (P=0.668) and place of residence (P=0.454) have been no statistically significant difference. Presence of underlying disease (P=0.005), less physical activity (p<0.001), older age at first delivery (P=0.003), lower menstrual age (P=0.001), history of breastfeeding for at least one year (P=0.002) and use of oral contraceptives (P=0.015) can significantly predict the incidence of breast cancer. OCP use, underlying disease, less physical activity, older age at first delivery, younger age at menstruation, and history of breastfeeding for at least one year are associated with the incidence of breast cancer.
Information on childhood cancer burden is crucial for effective cancer policy planning. Unfortunately, observed paediatric cancer data are not available in every country, and previous global burden estimates have not discretely reported several common cancers of childhood. We aimed to inform efforts to address childhood cancer burden globally by analysing results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023, which now include nine additional cancer causes compared with previous GBD analyses. GBD 2023 data sources for cancer estimation included population-based cancer registries, vital registration systems, and verbal autopsies. For childhood cancers (defined as those occurring at ages 0-19 years), mortality was estimated using cancer-specific ensemble models and incidence was estimated using mortality estimates and modelled mortality-to-incidence ratios (MIRs). Years of life lost (YLLs) were estimated by multiplying age-specific cancer deaths by the standard life expectancy at the age of death. Prevalence was estimated using survival estimates modelled from MIRs and multiplied by sequelae-specific disability weights to estimate years lived with disability (YLDs). Disability-adjusted life-years (DALYs) were estimated as the sum of YLLs and YLDs. Estimates are presented globally and by geographical and resource groupings, and all estimates are presented with 95% uncertainty intervals (UIs). Globally, in 2023, there were an estimated 377 000 incident childhood cancer cases (95% UI 288 000-489 000), 144 000 deaths (131 000-162 000), and 11·7 million (10·7-13·2) DALYs due to childhood cancer. Deaths due to childhood cancer decreased by 27·0% (15·5-36·1) globally, from 197 000 (173 000-218 000) in 1990, but increased in the WHO African region by 55·6% (25·5-92·4), from 31 500 (24 900-38 500) to 49 000 (42 600-58 200) between 1990 and 2023. In 2023, age-standardised YLLs due to childhood cancer were inversely correlated with country-level Socio-demographic Index. Childhood cancer was the eighth-leading cause of childhood deaths and the ninth-leading cause of DALYs among all cancers in 2023. The percentage of DALYs due to uncategorised childhood cancers was reduced from 26·5% (26·5-26·5) in GBD 2017 to 10·5% (8·1-13·1) with the addition of the nine new cancer causes. Target cancers for the WHO Global Initiative for Childhood Cancer (GICC) comprised 47·3% (42·2-52·0) of global childhood cancer deaths in 2023. Global childhood cancer burden remains a substantial contributor to global childhood disease and cancer burden and is disproportionately weighted towards resource-limited settings. The estimation of additional cancer types relevant in childhood provides a step towards alignment with WHO GICC targets. Efforts to decrease global childhood cancer burden should focus on addressing the inequities in burden worldwide and support comprehensive improvements along the childhood cancer diagnosis and care continuum. St Jude Children's Research Hospital, Gates Foundation, and St Baldrick's Foundation.
Multiple cystic brain metastases are a rare form of cancer dissemination and usually originate from adenocarcinomas of the lung and breast. Managing these lesions is challenging, and cyst drainage plays an essential role in reducing intracranial pressure. This article presents a case of multiple cystic brain metastases from lung adenocarcinoma. A 40-year-old female with a two-year history of stage IV lung adenocarcinoma presented with debilitating progressive neurologic symptoms. Imaging studies showed multiple cystic lesions on brain MRI most consistent with brain metastases. She underwent a craniotomy to drain the biggest cysts, followed by whole-brain radiotherapy (WBRT). The patient experienced dramatic alleviation of symptoms. Following a year of follow-up, she had no neurological symptoms. Despite the rarity of cystic brain metastases, these lesions should be ruled out in case of signs of increased intracranial pressure in a patient with a history of malignant disease.
Diet can play a significant role in sleep regulation, particularly in older adults. This study aimed to investigate the association between the Dietary Phytochemical Index (DPI) and sleep quality among the elderly in Amirkola City. This case-control study was part of the second phase of the Amirkola Cohort Study on aging. A total of 800 elderly individuals aged ≥60 years (400 with good sleep quality and 400 with poor sleep quality, matched for age and sex) were randomly selected. Inclusion criteria comprised having complete demographic data in the cohort profile, no known history of malignancy (including gastric and intestinal cancers), absence of psychiatric or cognitive disorders (such as psychiatric hospitalization), and no drug addiction. Data were collected using the Pittsburgh Sleep Quality Index (PSQI) and a semi-quantitative food frequency questionnaire (SQ-FFQ), which were then analyzed statistically. Total energy intake and the number of chronic diseases significantly impacted sleep quality (OR=1.002, 95% CI: 1.001-1.003, P = 0.004 and OR=1.257, 95% CI:1.170-1.352, p < 0.001, respectively). Furthermore, Poorer sleep quality was significantly associated with a higher number of chronic diseases in both gender, male and female (OR=1.244, 95% CI: 1.097-1.411, P = 0.001 and OR=1.225, 95% CI: 1.106-1.357, P < 0.001). However, Dietary Phytochemical Index (DPI) and Energy intake from plant sources did not show a significant effect on sleep quality. Dietary modifications and management of chronic diseases could be effective in improving sleep quality among the elderly. However, further research is recommended.
This study aimed to evaluate the effect of pirfenidone on lung CT scan lesions in patients with severe COVID-19. In this cross-sectional study, data were extracted from the electronic medical records of patients with severe COVID-19 who received one of the following treatments: pirfenidone alone (n= 40), prednisolone alone (n= 55), pirfenidone combined with methylprednisolone (n= 18), or supportive care only (n= 32). Chest CT images taken at baseline and two months post-treatment were assessed by a trained radiologist. p< 0.05 was considered statistically significant. The distribution of initial CT scan findings, Comparison of CT scan findings at admission and two months post-discharge, as well as the extent of pulmonary fibrosis and ground-glass opacity (GGO) grades across the groups, showed no statistically significant differences. However, significant differences were observed in CT scan findings and GGO grades between the four study groups at two months post-discharge. Moreover, in both the pirfenidone (p= 0.00) and supportive care (p= 0.01) groups, the extent of pulmonary fibrosis between admission and two months post-discharge showed statistically significant changes. In summary, although antifibrotic agents such as pirfenidone may not lead to significant improvement in lung CT scan findings in patients with severe COVID-19, they may help slow the progression of pulmonary fibrosis following the acute phase of the disease.
Investigating the importance of exercise tolerance test (ETT) in the diagnosis of coronary artery disease (CAD) among people with left-sided dominant coronary circulation is very important. This retrospective study aimed to explore the relevance of ETT in CAD diagnosis by analyzing medical records of 2084 patients who underwent ETT and coronary angiography in Urmia's educational therapeutic hospitals between 2018 and 2019. SPSS Version 16 was used for data analysis. The study included 5.58% males and 5.41% females. The prevalence of co-dominancy was 10.2%, right coronary dominance (RD) was 65%, and left coronary dominance (LD) was 24.8%. There were no significant differences between gender, age, smoking, blood pressure, diabetes mellitus (DM), the prevalence of hyperlipidemia (HLP), family history (FH) and left ventricular ejection fraction (LVEF). The frequency of non-significant CAD was higher in women than in men. Additionally, the frequency of women with LD was significantly higher than that of men. The results of angiography in normal cases, it was observed that the highest frequency was related to female patients with a history of DM. The sensitivity of the ETT was 94%, and the accuracy and diagnostic power of the exercise test for the presence of CAD in individuals with LD were 53% (p = 0.03). The study highlights the potential for false-positive exercise tests in diabetic individuals with left coronary dominance, providing valuable insights into the nuanced interplay of gender, cardiovascular health, and coronary circulation patterns in CAD risk.
Thrombin generation (TG) assays have been developed to assess the overall coagulability of blood, as thrombin plays a pivotal role in hemostasis and thrombosis. Although increased TG has been associated with acute myocardial infarction (MI) in some previous reports, the results have been inconsistent. This study aimed to evaluate TG in platelet-poor plasma specimens from patients with confirmed acute MI. In this case-control study, we enrolled a total of 50 patients diagnosed with acute MI using convenience sampling, along with 50 healthy individuals. TG assays were performed in both groups, and the calculated TG indices were compared. Forty-one patients with confirmed acute MI (24 males, 17 females; mean age 62.7±14.9 years) and 50 healthy controls (40 males, 10 females; mean age 57.5±12.9) were included in the analysis. TG assay indices were not significantly different in acute MI patients compared to healthy subjects (p >0.05). In terms of the diagnostic utility of TG assays, a five-variable panel yielded an AUC of 0.659 [95% CI: 0.547-0.770, P=0.010], with a sensitivity of 65.9% and specificity of 62% for identifying acute MI. All TG parameters taken together appear to have a predictive value in detecting acute MI. However, further studies with larger sample sizes are needed to confirm this finding.
Diabetic nephropathy (DN) is the most prevalent reason for chronic kidney diseases that end up with renal failure if it is not diagnosed and treated at early stages. Therefore, low-cost, non-invasive, and easy-to-use tests are necessary for efficient follow-up and early diagnosis of DN in diabetic patients. Interleukin-8 (IL-8) as the main recruiter of neutrophils may play a role in inflammatory responses that end up with renal damage and dysfunction in DN. In a case-control study, serum levels of IL-8 and neutrophil-to-lymphocyte ratios (NLR) were evaluated in correlation with clinical findings in 60 patients with DN, 60 type 2 diabetic patients without renal involvement, and 60 age and sex-matched healthy subjects. IL-8 levels were significantly higher in diabetic nephropathy patients than in diabetic patients without nephropathy and healthy controls (both p-value<0.0001). However, the frequency of neutrophils in both groups of patients was higher than that of healthy individuals. Despite increased NLRs in diabetic patients, the difference was only significant between DN and healthy groups (P-value: 0.03). A direct correlation was observed between IL-8 levels and NLR (P-value: 0.02), and a negative correlation between IL-8 and eGFR (P-value: 0.01). In addition, UACR was associated with IL-8 concentrations (P-value: 0.04) in DN patients. IL-8 level showed a higher diagnostic value for diabetic nephropathy [AUC: 0.87 (p<0.0001)] than NLR and neutrophil count. Increased level of IL-8 in DN is associated with elevated NLR and UACR, and reduced eGFR. Therefore, IL-8 levels might be considered a diagnostic or prognostic biomarker for DN.
Hypotension after spinal anesthesia is a serious complication during cesarean sections, potentially reducing maternal cardiac output and placental blood flow, affecting both mother and baby. This study aimed to compare the effects of norepinephrine and phenylephrine on maternal hemodynamic changes following spinal anesthesia in elective cesarean surgeries. In this clinical trial study, 52 pregnant mothers' candidates for elective cesarean surgery were divided into two groups. After spinal anesthesia, the norepinephrine group received a 10-microgram bolus of norepinephrine, while the phenylephrine group received 100 micrograms of phenylephrine. The primary outcomes included blood pressure, heart rate, and measurement time. These were recorded three times before the start of spinal anesthesia, immediately after, and every 3 minutes until discharge, and then twice at 3-minute intervals after childbirth. Mean arterial pressure in norepinephrine group was always higher than phenylephrine. Their difference was significant at the ninth minute (p<0.001) and the twelfth minute (P=0.009). Diastolic pressure in the two studied groups was significant at the ninth minute (p<0.001). 2 patients in norepinephrine group (7.6%) and 6 (23%)patients in phenylephrine group needed vasopressor. 3.8% of patients in norepinephrine group and 34% of patients in phenylephrine group had bradycardia (P=0.020). This study shows that norepinephrine is as effective as phenylephrine in preventing blood pressure drop in patients undergoing cesarean section, but it does not cause bradycardia.
Celiac disease (CD) is a gluten-induced autoimmune disorder that can present with gastrointestinal, extraintestinal, or no symptoms. The prevalence of CD in migraine patients and the nature of their potential association is not well established. Therefore, the purpose of this study was to investigate the prevalence of CD in migraine patients using a systematic review and meta-analysis. PRISMA guidelines created a framework for the construction of this review article. Two investigators independently searched the electronic databases of Scopus, PubMed, Web of Science and Google Scholar search engine up to May 2024. To assess heterogeneity among the studies, we used Cochran's Q test and the I² index. The statistical analyses were performed using Stata software, version 14.2, and a p-value of less than 0.05 was considered statistically significant. This meta-analysis included a total of 6 articles, comprising 14,526 migraine patients. The overall prevalence of CD in migraine patients was estimated to be (2% (95% CI: 0%-5%, I2=75.37, P=0.001)). Also, the Odds of CD disease in migraine patients compared to non-migraine patients was estimated to be equal (2.20 (95% CI: 0.87-5.54, I2=48.4, P=0.121)). Additionally, the majority of the research was conducted in Europe. Although the small amount of research accomplished in this particular situation, our data indicate a relatively low prevalence of CD in migraine patients. Therefore, more frequent and thorough research in this field is advised. Patients with migraines experienced fewer attacks when they received gluten-free diets and were screened for celiac disease.
Accurate diagnosis of aortic stenosis (AS) severity is crucial for effective treatment. This study aimed to define cutoff values for aortic ejection dynamic parameters, including ejection time (ET), acceleration time (AT), and the AT/ET ratio in patients with severe AS. In both severe AS and control groups, the aortic valve area (AVA) was estimated using the continuity equation, and the trans-aortic mean pressure gradient (MPG) was measured using continuous-wave Doppler echocardiography. Blood flow time-velocity integral in the left ventricular outflow tract (LVOT TVI) was measured with pulsed-wave Doppler ultrasound, placing the sample volume 1 cm below the aortic valve. Severe AS was defined as AVA ≤1 cm2 and MPG ≥ 40 mmHg. Clinical data were recorded, and 2D and Doppler echocardiography, including ejection dynamic parameters were analyzed. AT with a cutoff of 73 ms demonstrated perfect accuracy in diagnosing severe AS, with both sensitivity and specificity of 100%. ET with a cutoff of 278 ms showed 90% sensitivity and 100% specificity for identifying severe AS. Additionally, the AT/ET ratio exhibited a positive relationship with MPG (r = 0.55, P = 0.001) and a negative relationship with AVA (r = -0.52, P = 0.003). The AT/ET ratio, using a cutoff value of 0.278, yielded a sensitivity of 96% and a specificity of 100% for diagnosing severe AS. Aortic Doppler ejection dynamic parameters can serve as complementary assessment indices, diagnosing severe AS with acceptable accuracy.
The geographic diversity of molecular genetic abnormalities in AML can help understand the genetic and environmental factors involved in the development of leukemia. In addition, high-risk groups can be recognized by identifying common mutations in AML patients, and appropriate treatment based on the type of mutation can be adopted. This systematic study and meta-analysis analyzed the common mutations in AML patients in Iran. In this systematic study, common mutations in Iranian AML patients were comprehensively examined across four databases: PubMed, Scopus, Web of Science, and Magiran, from 1980 to 2024, following the PRISMA guidelines. Meta-Analysis Version 2 (CMA2 was used for data analysis, and I²-test values greater than 50% were considered to indicate high heterogeneity among the studies. By reviewing 40 articles, it was found that the prevalence of FLT3-ITD mutation was 21.9% (CI: 19.19 - 24.1) in 34 studies (3,152 AML cases), FLT3-TKD mutation 6.6% (CI: 4.7 - 9.3) in 19 studies, NPM1 mutation 19% (CI: 15.9-22.6) in 18 studies DNMT3A mutation 13.9% (CI: 11.1 - 17.2) in 5 studies, CEBPA mutation was 18.5% (CI: 10.3 - 31) in 5 studies, and WT-1 mutation prevalence was 8.2% (CI: 5.6-11.8) in 4 studies. Other mutations investigated in the studies included NRAS, IDH1, IDH2, TET2, c-kit, ASXL1, and RUNX1. Studies have shown that the FLT3-ITD mutation is the most prevalent mutation among Iranian AML patients. Following this, the most common mutations identified were NPM1, CEBPA, DNMT3A, and WT1, in that order.
This systematic review aimed to assess the efficacy and safety of PCAB versus PPI in eradicating H. pylori and GERD. The studies were searched through databases of PubMed, ScienceDirect, Wiley Online Library, and CENTRAL. A random-effects meta-analysis was performed to evaluate the efficacy and safety of PCAB in eradicating H. pylori and treating GERD, using odds ratios (OR) and 95% confidence intervals (95%CI) as the effect measures. PCAB therapy demonstrated superior efficacy and safety compared to PPI-based therapy in eradicating H. pylori (efficacy OR 1.40 [95% CI 1.12-1.76]; safety OR 0.71 [0.52-0.95]) and treating GERD (efficacy OR 1.62 [1.01-2.61]; safety OR 0.90 [0.71-1.14]). Vonoprazan therapy, but not tegoprazan, particularly showed superiority, with ORs of 1.66 [1.24-2.23] for H. pylori eradication (safety OR 0.71 [0.52-0.95]) and 1.80 [1.00-3.25] for GERD (safety OR 1.03 [0.83-1.27]). For H. pylori eradication, vonoprazan triple therapy showed greater efficacy overall (OR 1.94 [1.19-3.17]) and compared to lansoprazole (OR 2.84 [1.97-4.11]) and rabeprazole (OR 2.63 [1.05-6.58]), though not compared to esomeprazole (OR 1.62 [0.69-3.81]). In GERD treatment, both short-term (8 weeks) and long-term (24 weeks) vonoprazan therapies were similarly effective (OR 2.55 [1.71-3.80] and OR 2.17 [1.00-4.72], respectively) and showed particular efficacy in patients with severe (grade C/D) reflux esophagitis (OR 3.51 [1.65-7.46]). Vonoprazan had a superior efficacy than PPI in eradicating H. pylori and treating GERD, but not for tegoprazan. PCAB demonstrated a favorable safety profile.
For patients with advanced, diffuse Coronary artery disease (CAD), surgical myocardial revascularization via coronary artery bypass grafting (CABG) continues to represent the gold standard therapeutic approach. Given the paucity of studies demonstrating CABG benefits in patients with significant left intraventricular dyssynchrony (LVD), we conducted this study to evaluate how viable myocardial tissue volume, quantified by dobutamine stress echocardiography (DSE), predicts postoperative LVD improvement. This investigation employed a cross-sectional analytical design to assess 30 CABG candidates with moderate-severe ischemic cardiomyopathy. Myocardial viability evaluation utilized dobutamine stress echocardiography, complemented by tissue Doppler Imaging for synchronized assessment of regional LV contractility. Demographic analysis revealed a study population aged 61.5±7.9 years (range: 47 to 85 years), comprising 73.3% males. Left ventricular ejection fraction (LVEF) measurements improved from 32.2±4.6% at baseline to 39.6±5.2 % following surgical revascularization (p<0.001). Postoperative resolution of left ventricular dyssynchrony occurred in 9 patients (30.0 %), whereas 19 patients (63.3 %) showed no improvement (p<0.001). Two patients (6.6 %) died due to progressive heart failure and inadequate revascularization. Our current study demonstrates significant postoperative improvements in LVEF, LVEDD, and left ventricular dyssynchrony. However, given that approximately two-thirds of cases showed only minimal improvement in dyssynchrony, it would be reasonable to consider cardiac resynchronization therapy (CRT) for these patients.