Burden Of Disease Research Articles

Effect of non‐invasive neuroelectric stimulation of oral cavity for obstructive sleep apnoea: A systematic review

AbstractObjectivesWith an estimated disease burden of one billion adults aged 30–69, obstructive sleep apnea (OSA) offers considerable challenges in terms of both identification and management Neuroelectric stimulation offers benefit with studies showing improvement in both the respiratory disturbance index and apnoea‐hypopnoea index. This systematic review aims to examine the effects of non‐invasive neuroelectric stimulation of the oral cavity utilized in the treatment of OSA.MethodsA systematic search of PubMed, EBSCO CINAHL Plus, EBSCO Dentistry and Oral Sciences Source and Wiley Cochrane Library was utilized to identify articles. A total of 4 articles investigating 154 participants were included in the final synthesis. Data was extracted to by two authors (MOA and HI) working independently of each other. Any discrepancies that arose were discussed and resolved.ResultsOur results demonstrated that non‐invasive neurostimulation serves as an avenue for management that can allow for improvements in functionality as well as oxygen saturation amongst patients suffering from mild to moderate OSA.ConclusionDue to the dearth of research, it is imperative that further studies are done to investigate the efficacy of neuromuscular stimulation, as these findings cannot be generalized across different populations.

Treatment satisfaction in patients with hidradenitis suppurativa: A real-world survey from the EU5 and US.

Introduction Hidradenitis suppurativa (HS) is a debilitating, inflammatory skin disorder. Treatment strategies in patients with HS are challenging; real-world evidence in a HS population is warranted for greater disease understanding. The objective of this analysis was to describe real-world treatment patterns and treatment satisfaction in patients with HS. Methods This was a cross-sectional market research survey with retrospective data collection in patients with HS from the United States and five European countries (France, Germany, Italy, Spain, United Kingdom) between November 2020 and April 2021, using physician- and patient-reported surveys. Eligible physicians were general dermatologists actively managing patients with HS; dermatologists were required to have consulted with ≥2 patients with HS in the previous 12 months. Adult (≥18 years) and adolescent (10‒17 years) HS patients visiting a participating dermatologist were included. Outcomes included treatment patterns, flare status, treatments prescribed in response to flares, previous surgeries, barriers to biologics, and patient- and physician-reported satisfaction with the disease control provided by treatment. Results Survey data from 1787 patients were collected from 312 dermatologists. The most frequently prescribed treatments were topicals, oral antibiotics, and antiseptic washes/creams at diagnosis and sampling. At sampling, biologics were more frequently prescribed in patients with more severe disease (prescribed in 26.6%, 31.0% and 52.4% of patients with mild, moderate, and severe disease, respectively); oral antibiotics (48.8%), topicals (37.4%), and biologics (34.3%) were the most frequently prescribed treatment classes in response to a flare. Of patients currently not receiving a biologic, dermatologists reported that 18.9% of patients' condition warranted their use. Approximately one quarter of dermatologists (24.5%) and patients (27.4%) were not satisfied with current treatment; of patients who were dissatisfied, 12.8% reported they would never raise their dissatisfaction with their doctor. Conclusion These real-world data suggest a high disease burden and potential undertreatment in patients with HS. Patients received multiple treatments, and a notable proportion underwent surgery. Robustly integrating the patient voice in HS treatment decisions may lead to better outcomes and improved treatment satisfaction.

Nutrition and diet in children with orofacial clefts in Africa: a scoping review

Background and aimThe burden of orofacial clefts (OFCs) has declined globally except in sub-Saharan Africa, with a great disease burden in North Africa. Children with OFCs have a high risk of malnutrition, and African countries have some of the highest malnutrition rates. This scoping review assessed the status of research on OFCs and nutrition and feeding among children living in African countries.MethodsWe followed the Joanna Briggs Institute guidelines for conducting scoping reviews. We searched eleven databases for articles on malnutrition and feeding among children with OFCs living in African countries. No restriction was done by type of study or publication date. Books, book chapters, and reviews were excluded. Only publications in English language were included. We extracted information about the publication year, study design, setting, location, participants’ age, data collection methods, international collaboration, and funding. We classified articles into studies assessing (1) the impact of nutritional deficiencies during pregnancy on OFCs, (2) the impact of OFCs on malnutrition, (3) feeding problems in children with OFCs, and (4) the impact of nutritional status on OFCs repair outcomes. We calculated frequencies and used bar charts and a map.ResultsOut of 208 search results, 36 were duplicates, and 25 eventually fit the inclusion criteria, with 52% retrieved from Google Scholar. About 80% of the studies were from four countries: Nigeria, South Africa, Ghana, and Uganda; 72% were hospital-based and 52% were cross-sectional. The most frequent data collection method was clinical examination and questionnaires. Most studies focused on feeding problems in children with OFCs (44%) and the impact of OFCs on malnutrition (32%). International collaboration was observed in six studies, with one study showing South-South collaboration. Only two studies were funded.ConclusionsThere is a predominance of under-funded descriptive research not indexed by international databases. Minimal research has been directed to population-level OFC preventive programs in primary healthcare settings and assessing interventions supporting children with OFCs. A research agenda is needed to prioritize research needs and secure funds to support South-South collaboration to address the nutrition and feeding-related problems associated with OFCs.

Laboratory analysis of 124 chronic lymphocytic leukemia cases: Single center study

Abstract BACKGROUND: Chronic lymphocytic leukemia (CLL) is a disease characterized by an uncontrolled proliferation of malfunctioning mature B-lymphocytes. It represents a variable range of clinical presentation and prognoses. Understanding the demographic and cellular characteristics of CLL patients can aid in better disease management and treatment outcomes. OBJECTIVES: To identifying hematological parameters and patterns and potential markers that could assist in better diagnosis and of CLL in the local population. PATIENTS, MATERIALS AND METHODS: A retrospective analysis of 124 cases of newly diagnosed CLL was conducted. Data were collected from reports over 2 years (April 2022-April2024), including demographics, Hb levels, WBC counts, platelet counts and expression of CD markers (5, 19, 20, 23, 200, FMC7, LAIR1 and others) using flow cytometry on peripheral blood specimens. Based on FC findings, patients were categorized into two groups for better assessment; definite diagnosis CLL and possible diagnosis CLL; then further subdivided into poor prognosis CLL and good prognosis CLL. RESULTS: Male patients represented 59.5% of cases and females were 40.5% with a median age of 61 years at diagnosis. The mean Hb level was 109 ± 2 g/L, the mean WBC count was 58.0 ± 25.0 × 109/L, and the mean platelet count was 190 ± 40 × 109/L. CD5 was positive in 97.6% of cases, with CD23 in 96%. CONCLUSION: This study provides an overview of the demographic and cellular marker characteristics of CLL patients in FC unit. The findings underscore the heterogeneity of CLL immunophenotype and the importance of detailed characterization in improving patient management protocols; however, further research is warranted to correlate these findings with other parameters of disease burden and prognosis to optimize the therapeutic approaches for CLL patients.

Developing an AI-based application for caries index detection on intraoral photographs.

This study evaluates the effectiveness of an Artificial Intelligence (AI)-based smartphone application designed for decay detection on intraoral photographs, comparing its performance to that of junior dentists. Conducted at The Aga Khan University Hospital, Karachi, Pakistan, this study utilized a dataset comprising 7,465 intraoral images, including both primary and secondary dentitions. These images were meticulously annotated by two experienced dentists and further verified by senior dentists. A YOLOv5s model was trained on this dataset and integrated into a smartphone application, while a Detection Transformer was also fine-tuned for comparative purposes. Explainable AI techniques were employed to assess the AI's decision-making processes. A sample of 70 photographs was used to directly compare the application's performance with that of junior dentists. Results showed that the YOLOv5s-based smartphone application achieved a precision of 90.7%, sensitivity of 85.6%, and an F1 score of 88.0% in detecting dental decay. In contrast, junior dentists achieved 83.3% precision, 64.1% sensitivity, and an F1 score of 72.4%. The study concludes that the YOLOv5s algorithm effectively detects dental decay on intraoral photographs and performs comparably to junior dentists. This application holds potential for aiding in the evaluation of the caries index within populations, thus contributing to efforts aimed at reducing the disease burden at the community level.

High Blood Pressure and Impaired Brain Health: Investigating the Neuroprotective Potential of Magnesium

High blood pressure (BP) is a significant contributor to the disease burden globally and is emerging as an important cause of morbidity and mortality in the young as well as the old. The well-established impact of high BP on neurodegeneration, cognitive impairment, and dementia is widely acknowledged. However, the influence of BP across its full range remains unclear. This review aims to explore in more detail the effects of BP levels on neurodegeneration, cognitive function, and dementia. Moreover, given the pressing need to identify strategies to reduce BP levels, particular attention is placed on reviewing the role of magnesium (Mg) in ageing and its capacity to lower BP levels, and therefore potentially promote brain health. Overall, the review aims to provide a comprehensive synthesis of the evidence linking BP, Mg and brain health. It is hoped that these insights will inform the development of cost-effective and scalable interventions to protect brain health in the ageing population.

2024 Recommendations on the Optimal Use of Lipid-Lowering Therapy in Established Atherosclerotic Cardiovascular Disease and Following Acute Coronary Syndromes: A Position Paper of the International Lipid Expert Panel (ILEP).

Atherosclerotic cardiovascular disease (ASCVD) and consequent acute coronary syndromes (ACS) are substantial contributors to morbidity and mortality across Europe. Fortunately, as much as two thirds of this disease's burden is modifiable, in particular by lipid-lowering therapy (LLT). Current guidelines are based on the sound premise that, with respect to low-density lipoprotein cholesterol (LDL-C), "lower is better for longer", and recent data have strongly emphasised the need for also "the earlier the better". In addition to statins, which have been available for several decades, ezetimibe, bempedoic acid (also as fixed dose combinations), and modulators of proprotein convertase subtilisin/kexin type 9 (PCSK9 inhibitors and inclisiran) are additionally very effective approaches to LLT, especially for those at very high and extremely high cardiovascular risk. In real life, however, clinical practice goals are still not met in a substantial proportion of patients (even in 70%). However, with the options we have available, we should render lipid disorders a rare disease. In April 2021, the International Lipid Expert Panel (ILEP) published its first position paper on the optimal use of LLT in post-ACS patients, which complemented the existing guidelines on the management of lipids in patients following ACS, which defined a group of "extremely high-risk" individuals and outlined scenarios where upfront combination therapy should be considered to improve access and adherence to LLT and, consequently, the therapy's effectiveness. These updated recommendations build on the previous work, considering developments in the evidential underpinning of combination LLT, ongoing education on the role of lipid disorder therapy, and changes in the availability of lipid-lowering drugs. Our aim is to provide a guide to address this unmet clinical need, to provide clear practical advice, whilst acknowledging the need for patient-centred care, and accounting for often large differences in the availability of LLTs between countries.

Education in lifestyle medicine for future physicians – a strategy to reduce the burden of cardiovascular disease

ABSTRACT There is a compelling need to improve all physicians’ knowledge on lifestyle medicine (LM). This training needs to start early during medical education. This case report describes the feasibility and effects of integrating LM into an existing core curriculum of a Swedish undergraduate medical programme. A curriculum development project was organized using a six-step model: general needs assessment, targeted needs assessment, goals and objectives, educational strategies, implementation, and evaluation. New learning objectives regarding health, prevention and lifestyle medicine were formulated throughout the five-and-a-half-year programme. Learning activities and examinations were integrated in all courses with a structured progression and with focus on preventive activities in the workplace learning. The project was evaluated using student surveys of curricular quality, teacher survey of curricular content and integration in 2020, and an external review of adherence to the national qualitative target on preventive medicine. The project was executed during 2017–2018. Course evaluations and exit poll at graduation showed an overall high-quality student rating of education in prevention and in lifestyle counselling: on average, a score of 4.1/5 and 4.1/6, respectively. The teacher survey showed that over 70% of courses had a lasting increase in LM curricular content and that this content was to a large extent integrated into the existing course material. The external review concluded that the topic was well covered and integrated into the curriculum. LM could be successfully integrated into an existing medical programme curriculum with positive effects on student learning.

Peripheral Endothelial Dysfunction Is Associated With Incident Major Depressive Disorder.

A subset of individuals with major depressive disorder (MDD) have a high burden of cardiovascular risk factors and cerebral small-vessel disease, implicating vascular disease in the development of depression. Cross-sectional studies demonstrate a link between endothelial dysfunction and MDD, but the prospective association between peripheral endothelial dysfunction (PED) and an incident diagnosis of MDD is unknown. Patients undergoing a baseline assessment of cardiovascular risk were evaluated for PED using reactive hyperemia-peripheral arterial tonometry (≤1.8 consistent with PED). Patient medical records were reviewed to identify those who underwent a formal clinical evaluation of MDD after the index PED evaluation. The frequency of PED was compared in those with and without MDD. Logistic regression analyses were performed to assess the association between baseline PED and incident MDD. Between January 2006 and December 2020, 1614 patients underwent testing for PED. Four hundred eighty-four (30.1%) patients underwent a formal evaluation for MDD after (0-15 years) the index procedure (mean±SD age, 52.8±13.8 years; 65.2% women). Of these, 157 (32.4%) had PED and 108 (31.0%) were diagnosed with MDD. Individuals with MDD had a higher frequency of PED (40.2% versus 30.2%; P=0.034) compared with those without MDD. In multivariable analyses, PED was significantly associated with MDD (odds ratio, 2.3 [95% CI, 1.4-3.8]; P<0.001). PED is significantly associated with incident MDD. Thus, PED may be a useful marker to identify individuals at increased risk of depression who may benefit from more frequent and earlier management strategies.

Association of Homelessness and Unstable Housing With Cardiovascular Care Utilization Among Veterans.

Veterans are disproportionately more likely to experience homelessness and unstable housing (HUH) compared with the general population. Cardiovascular disease is the leading cause of death among Veterans experiencing HUH. We aimed to understand whether HUH status among Veterans with preexisting cardiovascular disease was associated with disparities in cardiovascular care access and utilization. Retrospective study of all Veterans with preexisting cardiovascular disease between 2017 and 2019 using Veterans Affairs Corporate Data Warehouse and Homeless registry data. Primary outcomes were annual outpatient visits for cardiovascular disease management and visits with cardiovascular disease-related specialists. Secondary outcomes included cardiovascular disease-related procedures and emergency department visits and hospitalizations. HUH status was determined based on response to a screener, diagnostic codes, or use of homelessness services, and outcomes were assessed in the first year HUH status was determined. After applying inverse probability of treatment weighting, negative binomial and logistic regression models were fit to estimate the association between experiencing HUH and the outcomes of interest. Among 1 357 973 Veterans (mean age, 71.6 [SD=10.6] years; 2.5% female) with preexisting cardiovascular disease, 56 093 were identified as experiencing HUH during the study period. Veterans experiencing HUH had fewer outpatient visits for cardiovascular disease management or with cardiovascular disease-related specialists (4.3% [95% CI, 2.5%-6.1%] and 14.1% [95% CI, 12.5%-15.8%], respectively) compared with housed Veterans. HUH status was associated with lower rates of receiving certain procedures including coronary artery bypass graft, lower extremity revascularization, and carotid artery stenosis interventions and higher rates of all-cause and cardiovascular emergency department visits and hospitalizations. Veterans with chronic cardiovascular conditions experiencing HUH had lower rates of outpatient visits for cardiovascular disease management and higher rates of emergency department visits and hospitalizations. Given the disproportionate burden of cardiovascular disease in this population, interventions to improve access to cardiovascular care are needed.

Quadrivalent Conjugate Vaccine and Invasive Meningococcal Disease in US Adolescents and Young Adults.

Beginning in 2005, the US implemented routine immunization of adolescents with a quadrivalent conjugate vaccine (MenACWY) for the prevention of invasive meningococcal disease (IMD). To assess whether MenACWY immunization was associated with a reduced IMD burden among the US adolescent population and how the downward trajectory of IMD that began in the mid-1990s might have evolved in the absence of vaccination efforts. In this decision analytical study, a bayesian hierarchical Poisson regression model was developed to investigate the potential trajectory of IMD among US adolescents and young adults without vaccination and evaluate the direct association of vaccination with IMD burden. The model included the entire age-stratified US population and was fitted to national incidence data for serogroups C, W, and Y from January 1, 2001, to December 31, 2021, with stratification by vaccination status for IMD cases. Simulated counterfactual scenario of absent vaccination from 2005 to 2021, while retaining the incidence rate of IMD for unvaccinated individuals estimated during model fitting. The main outcomes were the estimated numbers of IMD cases and deaths averted by MenACWY vaccination among US adolescents and young adults aged 11 to 23 years. Among the entire US population from 2005 to 2021, MenACWY vaccination prevented an estimated 172 (95% credible interval [CrI], 85-345) cases of IMD among US adolescents 11 to 15 years of age and 328 (95% CrI, 164-646) cases of IMD among those aged 16 to 23 years. Absent vaccination, the cumulative incidence of IMD in these age groups would have been at least 59% higher than reported over the same period with vaccination. Using case fatality rates of unvaccinated individuals derived from national data, vaccination averted an estimated 16 (95% CrI, 8-31) deaths among adolescents aged 11 to 15 years and 38 (95% CrI, 19-75) deaths among those aged 16 to 23 years. This decision analytical model suggests that the MenACWY vaccination program in the US was associated with a reduced burden of meningococcal disease. Without vaccination, the incidence rates per 100 000 adolescents and young adults would have been substantially higher than those observed during the vaccine era.

AI-Driven Cardiomegaly Detection Using Cutting-Edge Chest X–ray imagery

This project aims to develop an innovative approach for detecting cardiomegaly, a condition characterized by an enlarged heart, using machine learning techniques, specifically Support Vector Machines (SVM), and state-of-the-art chest X-ray imagery. Cardiomegaly serves as a significant indicator of various cardiac diseases, and early detection through accurate imaging analysis can lead to timely intervention and improved patient outcomes. The proposed machine learning solution utilizes SVM algorithms trained on a diverse dataset of chest X-ray images to automatically identify signs of cardiomegaly with high precision and reliability. By harnessing the power of SVM, this system offers a non-invasive and cost-effective method for screening large populations for cardiac abnormalities, facilitating early diagnosis and appropriate medical management. Key features of the developed solution include robust feature extraction techniques, real-time analysis, and integration with existing healthcare infrastructure for seamless implementation in clinical settings. Moreover, the system prioritizes patient privacy and data security by adhering to relevant regulations and standards governing medical imaging and information management. Overall, this project represents a significant advancement in the field of cardiac health monitoring, providing healthcare professionals with a valuable tool for early detection and management of cardiomegaly, ultimately improving patient care and reducing the burden of cardio vascular disease

Tracking myasthenia gravis severity over time: Insights from the French health insurance claims database.

Few data are available on the course of myasthenia gravis (MG) regarding disease severity and stability over time in real-world settings. This study used the French National Health Insurance Database (SNDS) to assess markers of disease severity in patients with MG longitudinally. All patients with MG-related claims in the SNDS between 2013 and 2020 were identified. Patients were followed for up to 8 years after the first claim. Intensive care unit (ICU) stays, treatment with intravenous immunoglobulin (IVIg) or plasma exchange (PE), and death were documented throughout the follow-up period. Standardized mortality rates were estimated, and mortality-related variables were identified using a Cox model. In all, 14,459 individuals constituted the full study population, including 6354 incident patients. In the incident population, 2199 (34.6%) were admitted to ICUs at least once, principally during the first year after the index date (N = 1477; 23.3%). This proportion decreased progressively to reach 3.0% in the seventh year. A total of 2817 patients received IVIg and 432 PE, again principally in the first year. In the full study population, the standardized mortality rate was 1.08 (95% confidence interval [CI] 1.03-1.13), being lower in men (0.95, 95% CI 0.89-1.02) than in women (1.15, 95% CI 1.07-1.23) and in patients aged >65 years (1.06, 95% CI 1.01-1.11) than in younger patients (1.50, 95% CI 1.24-1.76). Male gender, older age and higher comorbidity were independently associated with mortality. A subgroup of patients with MG require ICU admission and rescue therapy with IVIg or PE, indicative of poor disease control. New therapies are needed to improve disease control and reduce disease burden.

RSSDI Expert Consensus for Optimal Glucose Monitoring in Diabetes Mellitus in India and Recommendations for Clinical Practice

Effective management of diabetes warrants accurate and regular monitoring of glucose levels to prevent serious diabetes-associated complications and long-term health consequences. Hence, achieving target glucose levels and maintaining adequate glycemic control is essential in diabetes to prevent episodes of hypoglycemia. Multiple glucose monitoring tools have been developed over time, each with differing degrees of precision, convenience, and real-time input. The management of diabetes has been considerably improved by using these various glucose monitoring devices, both in terms of treatment outcomes and patient quality of life. However, in India, the lack of awareness, patient education, availability, and affordability of glucose monitoring devices poses a significant concern resulting in poor adherence to glucose monitoring and low medication adherence thereby increasing disease burden. Consequently, there is an urgent need for healthcare professionals and policymakers in India to collaborate and address the challenges associated with glucose monitoring in patients with diabetes, while also providing recommendations to overcome these concerns. This recommendation article offers a comprehensive evaluation of various glucose monitoring tools available for use by patients suffering from different types of diabetes, explores the challenges associated with glucose monitoring in India, and also presents expert panel recommendations to enhance diabetes management effectively.

Neurosurgery in Pakistan: Past, Present, and Future.

Since its independence from India in 1947, Pakistan has struggled with economic crises such as global debt, corruption, constant regime change, and a decades-long war against terrorism. The resulting socioeconomic barriers have stymied efforts to develop a comprehensive and equitably accessible healthcare system, especially regarding safe, timely, and affordable surgical care. This article evaluates neurosurgery's development, current state, and prospects in Pakistan, a lower-middle-income country. We performed a literature search using PubMed and analyzed relevant articles to better understand the state and landscape of neurosurgery in Pakistan. Moreover, we conducted ecological research by querying the databases of the World Bank and the Institute of Health Metrics and Evaluation to evaluate the neurological and neurosurgical disease burden in the Pakistani population. The neurosurgical workforce in Pakistan has demonstrated rapid growth over the past two decades, with approximately 450 neurosurgeons and a neurosurgeon-per-100 000 population density of 0.114. Nonetheless, access to essential neurosurgical procedures for the treatment of diseases such as stroke has been difficult to ensure, which likely contributes to Pakistan's stroke burden, ie, stroke was still the third most common cause of death in 2019, causing 21.7% of all deaths. While Pakistan's political and economic instability has adversely affected the development of neurosurgery, the field has still made great strides and demonstrates a promising future in providing equitable neurosurgical care to all Pakistan's people.

Long-term trends and future projections of larynx cancer burden in China: a comprehensive analysis from 1990 to 2030 using GBD data

Larynx cancer poses a significant public health challenge in China, with rising incidence and mortality rates over the past decades. Understanding the long-term trends and underlying factors is crucial for effective intervention and policy formulation. Data were utilized from the global burden of disease (GBD) Study 2021 to analyze the incidence, prevalence, mortality, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs) due to larynx cancer in China from 1990 to 2021. Joinpoint regression analysis identified key changes in trends, while age-period-cohort (APC) analysis and decomposition analysis quantified the contributions of aging, epidemiological changes, and population growth to these trends. Our study found a significant increase in the incidence and prevalence of larynx cancer in China, particularly among males. The age-standardized incidence rate (ASIR) and age-standardized mortality rate (ASMR) for males were substantially higher than those for females. Decomposition analysis revealed that aging was the primary driver of increasing incidence and mortality rates, while epidemiological changes had a mitigating effect. Joinpoint analysis identified periods of rapid urbanization and economic growth as key turning points for increased incidence. Bayesian APC models projected a continued upward trend in incidence rates up to 2030. The rising burden of larynx cancer in China underscores the need for targeted public health interventions, including smoking cessation programs, environmental pollution control, and early detection strategies. Addressing gender disparities and implementing effective prevention measures are crucial to mitigating the impact of larynx cancer in China.

Time trends in incidence of pilonidal sinus disease from 1996 to 2021: A Danish population-based cohort study.

Pilonidal sinus disease (PSD) is a common condition, but no data on disease occurrence exist outside highly selected settings. The aim of this study was to assess time trends in the incidence of PSD in a nationwide setting. Using data from nationwide Danish registries, we identified 48 247 patients recorded with diagnostic or surgical procedure codes representing PSD between 1996 and 2021. We stratified by sex and computed the age-adjusted and age-specific incidence rate, comparing 5-year intervals with the incidence rate ratio (IRR). The overall incidence of PSD increased from 26.1 to 39.6/100 000 person-years (PY) from the period 1996-2000 to the period 2016-2021 (IRR 1.52, 95% CI 0.78-2.94). The incidence increased from 35.8 to 56.9/100 000 PY (IRR 1.59, 95% CI 0.52-4.89) in male patients and from 16.4 to 22.5/100 000 PY (IRR 1.37, 95% CI 0.68-2.76) in female patients. The peak of age-specific incidence was 215.7/100 000 PY (95% CI 206.1-245.4) among 20-year-old men and 107.9/100.000 PY (95% CI 100.0-114.0) among 18-year-old women. Over the study period, the median age at first hospital contact decreased from 27 years [interquartile range (IQR) 22-34 years) to 25 years (IQR 20-34 years) in men but remained stable around 23 years (IQR 18-32 years) in women. However, for both sexes, the highest increase in incidence was seen in early adolescence. The incidence of PSD has increased significantly over the last decades. The increase is driven primarily by men and boys, with the highest increase in incidence seen in early adolescence. The increased burden of disease is not reflected in the literature, and more studies are warranted to understand the drivers of this development.

Systematic Review on Influenza Burden in Emerging Markets in 2018–2023—An Evidence Update to Guide Influenza Vaccination Recommendations

Background: Influenza is a contagious respiratory illness responsible for seasonal epidemics and with potential to cause pandemics. The decline in influenza-related studies published since 2018 resulted in data gaps, particularly in emerging markets. Methods: This systematic review searched for studies in six databases and gray literature sources to define the clinical burden of influenza and influenza-like illness (ILIs) and their associated sequelae among humans across emerging markets. Eligible studies were published in English, Spanish, or Chinese between January 2018 and September 2023 and conducted in Asia, the Middle East, Africa, and Latin America. Results: In total, 256 articles were included, mostly on lab-confirmed influenza infections (n = 218). Incidences of lab-confirmed influenza cases in Asia (range 540–1279 cases/100,000 persons) and Sub-Saharan Africa (range 34,100–47,800 cases/100,000 persons) were higher compared to Latin America (range 0.7–112 cases/100,000 persons) and the Middle East and North Africa (range 0.1–10 cases/100,000 persons). Proportions of lab-confirmed influenza cases and influenza-associated outcomes (i.e., hospitalization, ICU admission and death) varied widely across regions. Temporal variation in influenza trend was observed before and during the COVID-19 pandemic. Conclusions: In conclusion, influenza causes significant disease burden in emerging markets. Robust large real-world studies using a similar methodology are needed to have more accurate estimates and compare studies within age groups and regions. Continuous monitoring of influenza epidemiology is important to inform vaccine programs in emerging markets with heavy influenza disease burden.

5-years patency results of Zilver PTX on the femoro-popliteal arterial segment: A Northern Sydney experience.

The burden of peripheral arterial disease is increasing. Treatment of femoro-popliteal lesions remains challenging despite novel endovascular devices. Drug-eluting stents suppress post-treatment inflammation and reducing neo-intimal hyperplasia to reduce in-stent restenosis. A multi-centre retrospective 5-years longitudinal study was undertaken to evaluate freedom from clinically driven target limb revascularisation (FF CD-TLR) and patency of Zilver PTX stents in treating symptomatic femoro-popliteal stenotic lesions. Kaplan-Meier survival curves were used to demonstrate FF CD-TLR, primary, primary assisted and secondary patency. There were 148 patients and 183 lesions treated with a mean age of 80.3years and 52% males. The all-cause 5-years mortality was 25%. FF CD-TLR yearly patencies to 5years were 81%, 67%, 62%, 57% and 52%, respectively, with significantly poorer outcomes for in-stent restenosis, longer stent lengths and lesions at the femoro-popliteal junction. Primary patencies were 63%, 47%, 40%, 34% and 24%, assisted primary patencies were 90%, 75%, 68%, 59% and 48% and secondary patencies were 96%, 94%, 94%, 92% and 92%. Major adverse limb events were 5% at 1-year and cumulative at 5-years was 16%. The clinical outcomes in this study population are comparable to recent publications with smaller cohorts. Our study confirms Zilver PTX has very good primary patency over 5years with no discernible effect on all-cause mortality in an elderly cohort with particularly long treated lesions. Our results are similar to those seen in younger patients with shorter lesions. Nonetheless, longer lesions required more reinterventions to maintain patency. Zilver PTX is a safe and durable drug-eluting stent when utilised in the management of femoro-popliteal stenotic lesions with good long-term patency and limited need for re-intervention.

Access to radiotherapy in improving gastric cancer care quality and equality

BackgroundQuality health services could improve patient outcomes and prognosis. Gastric cancer care was of great disparity across genders. Disparities within radiotherapy units could impact gastric cancer care, potentially exacerbating gender-based inequalities.MethodsWe retrieved the disease burden data from Global Burden of Disease 2019. A quality of care index was constructed by applying principal component analysis techniques. The disparity of gastric cancer care across genders was described, and the association of access to radiotherapy with gastric cancer care as well as gender disparity was explored.ResultsMales receive better quality of gastric cancer care than females, and this gender disparity is widening in middle-low socio-development regions. A positive correlation emerges between the density of radiotherapy facilities and an elevated quality of care, and reduced gender-based disparities.ConclusionsThe association between robust radiotherapy access, improved gastric cancer QCI, and reduced gender-based disparities spotlights the imperative of fortifying radiotherapy infrastructure within areas and populations in greatest need.