Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND

Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations.

METHODS

The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds.

FINDINGS

The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles.

INTERPRETATION

Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere.

FUNDING

Bill & Melinda Gates Foundation.

The sensory evaluation and antimicrobial efficacy of Lactobacillus acidophilus supernatant on Salmonella enteritidis in milk

Postbiotics are metabolites derived from living probiotic bacteria like Lactobacillus strains, during the fermentation process and/or produced in pure form on laboratory scales. These compounds, depending on the type of probiotic from which they are prepared, have specific antibacterial agents such as: organic acids, bacteriocins, short-chain fatty acids, and peptides. The objective of this study was to investigate the effect of Lactobacillus acidophilus supernatant (LAS) on the growth pattern of Salmonella enteritidis at fluctuating temperatures and the sensory evaluation of milk that contains this probiotic. Baranyi and Roberts's model determined the best-fit curve for the microbial growth. According to mathematical equations, the highest and lowest specific growth (μ max) rates of S. enteritidis were obtained at 0.055 h-1 and 0.0059 h-1 and also highest and lowest maximum generation time (MGT) values were obtained at 20.06 h and 8.85 h, respectively. Sensory evaluation by the Triangel test reveals that LAS could not establish a significant (p > .05) adverse effect on milk perceptible. Regarding the results obtained in the present study, LAS, without causing adverse sensory change, could act as a safe food additive for the control of bacterial pathogens and reducing food waste, particularly in milk and milk-containing food products.

Anticancer Properties of Saccharomyces boulardii Metabolite Against Colon Cancer Cells

Saccharomyces cerevisiae var. boulardii has been used as a probiotic yeast in the medical and food industries. Colon cancers have been known as the third most common cancer type worldwide. Nowadays, cell-free extract and metabolites of probiotics have been employed for the treatment or prevention of different cancer diseases. This study investigates the anticancer properties of S. boulardii metabolites against human colon carcinoma. We evaluated cytotoxicity, apoptosis induction, and suppression of survivin, IL-8, and NFƙB gene expression effects of SBM against caco-2 cells after 24 and 48 h. IC50 concentrations of SBM were measured at 815 and 1411 µg/mL for 24 and 48 h treatments, respectively. The total proportion of apoptotic caco-2 cells treated with SBM after 24 and 48 h were calculated at 62.23 and 88.7%, respectively. Also, relative expression of survivin, IL-8, and NFƙB genes were significantly suppressed in caco-2 cells treated with SBM after 24 and 48 h. In conclusion, we found that SBM induced apoptosis, inhibited the growth rate, and suppressed the expression of the survivin, IL-8, and NFƙB genes in human colorectal cancer cells and it can be considered as a perspective supplement or drug for the treatment or prevention of colon cancer in humans.

Measurement of polychlorinated biphenyls in different high consumption canned foods, using the QuEChERS/GC-MS method

Polychlorinated biphenyls (PCBs) are organic pollutants containing chlorine, which can be carcinogenic to humans. The current research focused on the heart risk and determination of PCBs levels in canned foods using the modified QuEChERS (fast, easy, cheap, effective, resistant and safe) method and gas chromatograph/mass spectrometer (GC-MS) technique. In this study, LOD (limit of detection), LOQ (limit of quantification), and recovery ranged from 0.06 to 0.32, 0.18 to 1.07 ng/g, and 97.05 to 102.5 %, respectively. In canned foods, the highest median of PCBs was PCB 52 (0.27 ± 0.20 ng/g fat) and the lowest median were PCB 28 and 138 (not detected in samples). Also, the maximum median of PCB 28, 52, 101, 138, 153, and 180 were detected in eggplant samples (0.06 ng/g), haricot samples (0.49 ng/g), eggplant samples (0.36 ng/g), eggplant samples (0.19 ng/g), eggplant samples (0.11 ng/g) and lentiform samples (0.66 ng/g), respectively. The median PCBs levels of oral exposure were estimated to be in the range of 9.80E-07to 4.30E-05 ng/g.d for all population groups, which were meaningfully lesser than the Tolerable daily intake value. The Monte Carlo simulation (MCS) outcomes indicated that the rank order of PCBs in adults based on incremental lifetime cancer risk (ILCR) was Lentiform (7.05E-8) > canned fish (5.73E-8) > Eggplant (5.38E-8) > Haricot (4.33E-8) > pasta source (2.06E-8); and in children was Lentiform (3.40E-7) > canned fish (2.72E-7) > Eggplant (2.44E-7) > Haricot (2.06E-7) > pasta source (9.83E-8). The median values of the ILCR induced oral exposure for all groups were within safe limits (lower than 10-6). The heat map and multivariate principal component analysis (PCA) showed significantly different contributions of PCBs profile in samples as the PCA axis scores were correlated with the type of cans. Based on the obtained outcomes, it can be concluded that the PCBs of canned food do not potential health risks to Iranian consumers.

Genotyping and antibiotic susceptibility of Campylobacter species isolated from raw milk samples in Qazvin, Iran

OBJECTIVE

Campylobacter species are major causes of foodborne illnesses, with unpasteurized milk being a significant carrier of these bacteria, posing a public health risk. One of the challenges in managing Campylobacter infections is the emergence and spread of antibiotic resistance. We conducted a study in Qazvin, Iran, testing 84 raw cow's milk samples to determine the frequency of C. jejuni and C. coli using culture-based and multiplex PCR methods. Additionally, the disk diffusion and RAPD-PCR approaches were utilized to evaluate the phenotypic antibiotic resistance profile and genetic diversity of Campylobacter strains.

RESULTS

The findings indicated that Campylobacter spp. was present in 19.05% of the samples, with C. coli being the predominant isolate. We tested eight antibiotic agents, and the resistance levels of the isolates were as follows: erythromycin 100%, tetracycline 75%, doxycycline 56.25%, ceftriaxone 43.75%, chloramphenicol 37.5%, amoxicillin-clavulanic acid 25%, nalidixic acid 12.5%, and azithromycin 6.25%. Genetic diversity analysis categorized Campylobacter isolates into 39 clusters, indicating a wide diversity among strains. However, no significant correlation was observed between antibiotic resistance and cluster patterns. These findings underscore the role of raw milk as a reservoir for Campylobacter spp. and highlight the substantial antibiotic resistance and genetic diversity within the species population.

Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND

Diabetes is one of the leading causes of death and disability worldwide, and affects people regardless of country, age group, or sex. Using the most recent evidentiary and analytical framework from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD), we produced location-specific, age-specific, and sex-specific estimates of diabetes prevalence and burden from 1990 to 2021, the proportion of type 1 and type 2 diabetes in 2021, the proportion of the type 2 diabetes burden attributable to selected risk factors, and projections of diabetes prevalence through 2050.

METHODS

Estimates of diabetes prevalence and burden were computed in 204 countries and territories, across 25 age groups, for males and females separately and combined; these estimates comprised lost years of healthy life, measured in disability-adjusted life-years (DALYs; defined as the sum of years of life lost [YLLs] and years lived with disability [YLDs]). We used the Cause of Death Ensemble model (CODEm) approach to estimate deaths due to diabetes, incorporating 25 666 location-years of data from vital registration and verbal autopsy reports in separate total (including both type 1 and type 2 diabetes) and type-specific models. Other forms of diabetes, including gestational and monogenic diabetes, were not explicitly modelled. Total and type 1 diabetes prevalence was estimated by use of a Bayesian meta-regression modelling tool, DisMod-MR 2.1, to analyse 1527 location-years of data from the scientific literature, survey microdata, and insurance claims; type 2 diabetes estimates were computed by subtracting type 1 diabetes from total estimates. Mortality and prevalence estimates, along with standard life expectancy and disability weights, were used to calculate YLLs, YLDs, and DALYs. When appropriate, we extrapolated estimates to a hypothetical population with a standardised age structure to allow comparison in populations with different age structures. We used the comparative risk assessment framework to estimate the risk-attributable type 2 diabetes burden for 16 risk factors falling under risk categories including environmental and occupational factors, tobacco use, high alcohol use, high body-mass index (BMI), dietary factors, and low physical activity. Using a regression framework, we forecast type 1 and type 2 diabetes prevalence through 2050 with Socio-demographic Index (SDI) and high BMI as predictors, respectively.

FINDINGS

In 2021, there were 529 million (95% uncertainty interval [UI] 500-564) people living with diabetes worldwide, and the global age-standardised total diabetes prevalence was 6·1% (5·8-6·5). At the super-region level, the highest age-standardised rates were observed in north Africa and the Middle East (9·3% [8·7-9·9]) and, at the regional level, in Oceania (12·3% [11·5-13·0]). Nationally, Qatar had the world's highest age-specific prevalence of diabetes, at 76·1% (73·1-79·5) in individuals aged 75-79 years. Total diabetes prevalence-especially among older adults-primarily reflects type 2 diabetes, which in 2021 accounted for 96·0% (95·1-96·8) of diabetes cases and 95·4% (94·9-95·9) of diabetes DALYs worldwide. In 2021, 52·2% (25·5-71·8) of global type 2 diabetes DALYs were attributable to high BMI. The contribution of high BMI to type 2 diabetes DALYs rose by 24·3% (18·5-30·4) worldwide between 1990 and 2021. By 2050, more than 1·31 billion (1·22-1·39) people are projected to have diabetes, with expected age-standardised total diabetes prevalence rates greater than 10% in two super-regions: 16·8% (16·1-17·6) in north Africa and the Middle East and 11·3% (10·8-11·9) in Latin America and Caribbean. By 2050, 89 (43·6%) of 204 countries and territories will have an age-standardised rate greater than 10%.

INTERPRETATION

Diabetes remains a substantial public health issue. Type 2 diabetes, which makes up the bulk of diabetes cases, is largely preventable and, in some cases, potentially reversible if identified and managed early in the disease course. However, all evidence indicates that diabetes prevalence is increasing worldwide, primarily due to a rise in obesity caused by multiple factors. Preventing and controlling type 2 diabetes remains an ongoing challenge. It is essential to better understand disparities in risk factor profiles and diabetes burden across populations, to inform strategies to successfully control diabetes risk factors within the context of multiple and complex drivers.

FUNDING

Bill & Melinda Gates Foundation.

Effects of Probiotic Saccharomyces boulardii Supernatant on Viability, Nano-Mechanical Properties of Cytoplasmic Membrane and Pro-Inflammatory Gene Expression in Human Gastric Cancer AGS Cells

BACKGROUND

Gastric cancer has been recognized as the second most probable cause of death in humans from cancer diseases around the world. Postbiotics, supernatant, and metabolites from probiotic microorganisms have recently been used widely to prevent and treat cancer diseases in humans, without any undesirable side effects. This study explores the antiproliferative and antitumor activities of the probiotic Saccharomyces cerevisiae var. boulardii supernatant (SBS) against AGS cancer cells, a human gastric adenocarcinoma cell line.

METHODS

We evaluated cell growth inhibitory and mechanical properties of the cytoplasmic membrane and the downregulation of survivin and proinflammatory genes in AGS cells treated with SBS after 24 and 48 h.

RESULTS

SBS significantly inhibits the AGS cell growth, and the concentrations with IC₅₀ values after 24 and 48 h treatments are measured as 2266 and 1956 µg/mL, respectively. Regarding the AFM images and Young`s modulus analysis, SBS significantly induces morphological changes in the cytoplasmic membrane of the treated AGS cells. Expression of survivin, NFƙB, and IL-8 genes is significantly suppressed in AGS cells treated with SBS.

CONCLUSIONS

Considering the antitumor activities of SBS on AGS cell line, it can be regarded as a prospective therapeutic and preventive strategy against human stomach cancer disease.

Prevalence of foodborne and zoonotic viral pathogens in raw cow milk samples

Foodborne and zoonotic viral pathogens are responsible for substantial morbidity and mortality worldwide. These viruses can be transmitted through foods such as dairy products to humans and cause several acute and chronic diseases. This study aimed to investigate the prevalence and profile of different foodborne and zoonotic viruses in raw cow milk samples. We collected 492 raw cow milk samples from local dairy markets in Qazvin, Iran. Then we evaluated the presence of hepatitis A virus, noroviruses, rotavirus, astrovirus, bovine leukaemia virus (BLV) and tick-borne encephalitis virus (TBEV) in samples using conventional and nested reverse transcription-polymerase chain reaction methods. We found that 34.95, 7.72, 25.81, 14.63, 66.86, 12.80 and 21.34% of raw milk samples were contaminated with norovirus GI, norovirus GII, hepatitis A virus, rotavirus, astrovirus, BLV and TBEV viruses, respectively. Interestingly, the samples collected from the city's south area revealed a higher prevalence of foodborne and zoonotic viruses. Astrovirus and its combination with norovirus GI were the most prevalent virus profiles. Also, the highest correlations were observed among the presence of rotavirus and hepatitis A viruses (0.36) and TBEV and norovirus GII (0.31). Considering the prevalence rate and virus profiles of different foodborne and zoonotic viruses in raw milk samples, hygiene practices and the pasteurization process are strongly suggested to be conducted throughout the cow milk production chain and in dairy industries to prevent infections with these pathogens.

Age-sex differences in the global burden of lower respiratory infections and risk factors, 1990-2019: results from the Global Burden of Disease Study 2019

BACKGROUND

The global burden of lower respiratory infections (LRIs) and corresponding risk factors in children older than 5 years and adults has not been studied as comprehensively as it has been in children younger than 5 years. We assessed the burden and trends of LRIs and risk factors across all age groups by sex, for 204 countries and territories.

METHODS

In this analysis of data for the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we used clinician-diagnosed pneumonia or bronchiolitis as our case definition for LRIs. We included International Classification of Diseases 9th edition codes 079.6, 466-469, 470.0, 480-482.8, 483.0-483.9, 484.1-484.2, 484.6-484.7, and 487-489 and International Classification of Diseases 10th edition codes A48.1, A70, B97.4-B97.6, J09-J15.8, J16-J16.9, J20-J21.9, J91.0, P23.0-P23.4, and U04-U04.9. We used the Cause of Death Ensemble modelling strategy to analyse 23 109 site-years of vital registration data, 825 site-years of sample vital registration data, 1766 site-years of verbal autopsy data, and 681 site-years of mortality surveillance data. We used DisMod-MR 2.1, a Bayesian meta-regression tool, to analyse age-sex-specific incidence and prevalence data identified via systematic reviews of the literature, population-based survey data, and claims and inpatient data. Additionally, we estimated age-sex-specific LRI mortality that is attributable to the independent effects of 14 risk factors.

FINDINGS

Globally, in 2019, we estimated that there were 257 million (95% uncertainty interval [UI] 240-275) LRI incident episodes in males and 232 million (217-248) in females. In the same year, LRIs accounted for 1·30 million (95% UI 1·18-1·42) male deaths and 1·20 million (1·07-1·33) female deaths. Age-standardised incidence and mortality rates were 1·17 times (95% UI 1·16-1·18) and 1·31 times (95% UI 1·23-1·41) greater in males than in females in 2019. Between 1990 and 2019, LRI incidence and mortality rates declined at different rates across age groups and an increase in LRI episodes and deaths was estimated among all adult age groups, with males aged 70 years and older having the highest increase in LRI episodes (126·0% [95% UI 121·4-131·1]) and deaths (100·0% [83·4-115·9]). During the same period, LRI episodes and deaths in children younger than 15 years were estimated to have decreased, and the greatest decline was observed for LRI deaths in males younger than 5 years (-70·7% [-77·2 to -61·8]). The leading risk factors for LRI mortality varied across age groups and sex. More than half of global LRI deaths in children younger than 5 years were attributable to child wasting (population attributable fraction [PAF] 53·0% [95% UI 37·7-61·8] in males and 56·4% [40·7-65·1] in females), and more than a quarter of LRI deaths among those aged 5-14 years were attributable to household air pollution (PAF 26·0% [95% UI 16·6-35·5] for males and PAF 25·8% [16·3-35·4] for females). PAFs of male LRI deaths attributed to smoking were 20·4% (95% UI 15·4-25·2) in those aged 15-49 years, 30·5% (24·1-36·9) in those aged 50-69 years, and 21·9% (16·8-27·3) in those aged 70 years and older. PAFs of female LRI deaths attributed to household air pollution were 21·1% (95% UI 14·5-27·9) in those aged 15-49 years and 18·2% (12·5-24·5) in those aged 50-69 years. For females aged 70 years and older, the leading risk factor, ambient particulate matter, was responsible for 11·7% (95% UI 8·2-15·8) of LRI deaths.

INTERPRETATION

The patterns and progress in reducing the burden of LRIs and key risk factors for mortality varied across age groups and sexes. The progress seen in children younger than 5 years was clearly a result of targeted interventions, such as vaccination and reduction of exposure to risk factors. Similar interventions for other age groups could contribute to the achievement of multiple Sustainable Development Goals targets, including promoting wellbeing at all ages and reducing health inequalities. Interventions, including addressing risk factors such as child wasting, smoking, ambient particulate matter pollution, and household air pollution, would prevent deaths and reduce health disparities.

FUNDING

Bill & Melinda Gates Foundation.

The Effect of Aqueous Extract of Saffron (Crocus sativus L. Stigma) on the Behavior of Salmonella Typhimurium in A Food Model during Storage at Different Temperatures

Background: Given the concerns about the use of chemical preservatives in food, the consumers and producers have been interested in natural alternatives, such as plant essential oils and extracts. Since there are limited studies about the effect of saffron (Crocus sativus L.) on the behavior of foodborne pathogens in food models, this study aimed to determine the inhibitory effect of aqueous extract of saffron stigma on the growth behavior of Salmonella Typhimurium (S. Typhimurium) in commercial barley soup (as a food model) during storage at different temperatures. Methods: The minimum inhibitory concentration (MIC) and the minimum bactericidal concentration (MBC) of the extract were determined against S. Typhimurium using broth microdilution method. The growth of S. Typhimurium was investigated in the presence of this extract in commercial barley soup during 12 days of storage at 10, 20, and 30 °C. Results: The MIC and MBC values ​​for saffron extract against S. Typhimurium were 100 and >200 mg/ml, respectively. Also, the saffron extract at a concentration of 200 mg/ml and temperature of 10 °C had the highest inhibitory effect on the growth of bacteria in commercial barley soup during storage. Conclusion: According to the results of this study, the antimicrobial effect of this extract increased in a dose-dependent manner against this bacterium. Therefore, the use of proper concentrations of this extract together with appropriate storage temperature can have an appropriate inhibitory effect on the growth of this bacterium, improving food safety shelf life.

Global prevalence and epidemiology of Strongyloides stercoralis in dogs: a systematic review and meta-analysis

BACKGROUND

Strongyloides stercoralis, a soil-transmitted helminth, occurs in humans, non-human primates, dogs, cats and wild canids. The zoonotic potential between these hosts is not well understood with data available on prevalence primarily focused on humans. To increase knowledge on prevalence, this review and meta-analysis was performed to estimate the global status of S. stercoralis infections in dogs.

METHODS

Following the PRISMA guidelines, online literature published prior to November 2020 was obtained from multiple databases (Science Direct, Web of Science, PubMed, Scopus and Google Scholar). Prevalence was calculated on a global and country level, by country income and climate, and in stray/animal shelter dogs versus owned dogs. Statistical analyses were conducted using R-software (version 3.6.1).

RESULTS

From 9428 articles, 61 met the inclusion criteria. The estimated pooled global prevalence of S. stercoralis in dogs was 6% (95% CI 3-9%). Infection was found to be the most prevalent in low-income countries with pooled prevalence of 22% (95% CI 10-36%). The highest pooled prevalence of S. stercoralis in dogs was related to regions with average temperature of 10-20 °C (6%; 95% CI 3-11%), an annual rainfall of 1001-1500 mm (9%; 95% CI 4-15%) and humidity of 40-75% (8%; 95% CI 4-13%). Prevalence was higher in stray and shelter dogs (11%; 95% CI 1-26%) than in owned dogs (3%; 95% CI 1-7%).

CONCLUSIONS

As with S. stercoralis in humans, higher prevalence in dogs is found in subtropical and tropical regions and lower-income countries, locations which also can have high dog populations. While this study presents the first estimated global prevalence of S. stercoralis in dogs, it is potentially an underestimation with 15 of 61 studies relying on diagnostic methods of lower sensitivity and a paucity of data from most locations. Standardized protocols (e.g. quantity of feces and number of samples for a Baermann) in future studies could improve reliability of results. More prevalence studies and raising veterinary awareness of S. stercoralis are needed for a One Health approach to protect humans and dogs from the impact of the infection.

The prevalence of human trichuriasis in Asia: a systematic review and meta-analysis

Trichuriasis is one of the most common soil-transmitted helminth (STH) infections, affecting populations globally. The condition is particularly prevalent in tropical and subtropical areas with low levels of sanitation and poor living conditions. The objective of this systematic review and meta-analysis was to evaluate the prevalence of Trichuris trichiura infection in Asia at the country and region level. Multiple databases/academic search engines (Web of Science, PubMed, ProQuest, Scopus, and Google Scholar) were searched for literature on T. trichiura prevalence in Asia published through January 2021. Pooled prevalence was determined using the meta-package in R (version 3.6.1). Out of 13,836 articles, 226 studies (5,439,500 individuals) from 26 countries met the inclusion criteria. Of the 226 studies, 151 were community-based studies that included individuals across the age spectrum, while 75 studies focused on school children (typically in the 5-16 years age range). The overall T. trichiura pooled prevalence was 15.3% (95% CI: 12.4-19.1%), with a pooled prevalence of 13.3% (95% CI: 10.0-17.1%) for the community studies and 20.9% (95% CI: 14.7-27.9%) for the studies only including school children. For studies including all age groups, individuals in the 1-15 years age group had the highest pooled prevalence at 23.4% (95% CI: 1.7-49.4%). There was a significant difference found in overall pooled prevalence by sex (p < 0.001) and community type (rural versus urban) (p < 0.001). Although prevalence appears to be decreasing, study findings suggest that T. trichiura infection continues to be a public health problem in Asia. Therefore, control programs focused on at-risk individuals in endemic areas are needed.

Essential Oils from Indigenous Iranian Plants: A Natural Weapon vs. Multidrug-Resistant Escherichia coli

Aim of this study was to investigate the antimicrobial properties of herbal plant essential oils (EOs) from selected Iranian plant species such as Ferulago angulata, Zataria multiflora, Cuminum cyminum, and Mentha longifolia against antibiotic-resistant Escherichia coli (E. coli) strains. For this purpose, the Escherichia coli strains, isolated from raw cow’s milk and local dairy products (yogurt, cream, whey, cheese, and confectionery products) collected from different areas of Hamedan province, Iran, were investigated for their resistance to antibiotics (i.e., streptomycin, tetracycline, gentamicin, chloramphenicol, ciprofloxacin, and cefixime). Thus, the E. coli strains were tested for their susceptibility to the above-mentioned essential oils. Regarding antibiotics, the E. coli strains were highly sensitive to ciprofloxacin. In relation to essential oils, the most effective antibacterial activity was observed with Zataria multiflora; also, the bacteria were semi-sensitive to Cuminum cyminum and Mentha longifolia essential oils. All strains were resistant to Ferulago angulata essential oil. According to the results, the essential oil of Zataria multiflora can be considered as a practical and alternative antibacterial strategy to inhibit the growth of multidrug-resistant E. coli of dairy origin.

Impact of COVID-19 on 2020 transplant activity and waiting lists in France✰,✰✰

The COVID-19 pandemic strongly affected organ procurement and transplantation in France, despite the intense efforts of all participants in this domain. In 2020, the identification and procurement of deceased donors fell by 12% and 21% respectively, compared with the mean of the preceding 2 years. Similarly, the number of new registrations on the national waiting list declined by 12% and the number of transplants by 24%. The 3-month cumulative incidence of death or drop out for worsening condition of patients awaiting a liver transplant was significantly greater in 2020 compared to the previous 2 years. Continuous monitoring at the national level of early post-transplant outcomes showed no deterioration for any organ in 2020. At the end of 2020, less than 1% of transplant candidates and less than 1% of graft recipients - of any organ - had died of COVID-19.

Parasites in surgically removed appendices as a neglected public health concern: a systematic review and meta-analysis

The role of various parasitic infections in the occurrence of appendicitis is illustrated through cases recorded all over the world. The purpose of the current study was to estimate the global prevalence of parasite infestation (other than E. vermicularis) in appendectomy specimens.In the setting of the PRISMA guidelines, multiple databases (Science Direct, Scopus, Web of Science, PubMed, and Google Scholar) were explored in articles published until 28 September 2020. Totally, 62 studies (106 datasets) with 77, 619 participants were included in the analysis.The pooled prevalence of parasites in appendectomy samples was as follows; 0.012% (95% CI; 0.004-0.025) for Ascaris lumbricoides, 0.004% (95% CI; 0.001-0.009) for Trichuris trichiura, 0.025% (95% CI; 0.007-0.052) for Schistosoma mansoni, 0.002% (95% CI; 0.001-0.005) for Taenia spp., 0.061% (95% CI; 0.020-0.122) for Entamoeba histolytica and 0.034% (95% CI; 0.018-0.056) for Giardia lamblia.Our results demonstrated that the risk of appendicitis may increase in the presence of helminth and protozoan infections. As such, the most cases of parasites in appendectomy specimens were reported in developing countries. Regular screening plans for diagnosis, treatment and prevention are needed for prevention of parasitic infection as well as parasitic associated appendicitis, especially in endemic regions of the world.

Genetic diversity and antibiotic resistance of Shigella spp. isolates from food products

The emergence of multidrug-resistant Shigella is a significant threat to global public health. Limited studies have investigated the incidence, antimicrobial susceptibility, and genetic diversity of Shigella isolated from food products. Conventional culture-based, serologic, molecular, disk diffusion, PCR, and RAPD-PCR methods were used to determine the prevalence rate, phenotypic and genotypic antibiotic resistance profile, and genetic diversity of the Shigella isolates from food samples including vegetable salad, ground meat, and raw cow's milk (405 samples). The prevalence rate of Shigella in food samples was 4.44%. The incidence of S. sonnei (3.7%) was higher than that of S. flexneri (0.74%). S. dysenteriae and S. boydii were not detected in food samples examined. Also, no Shigella were recovered from raw cow's milk. This study showed that the Shigella isolates were resistant to sulfamethoxazole/trimethoprim (83.3%), amoxicillin (66.6%), streptomycin (66.6%), tetracycline (61.1%), ampicillin (50%), amoxicillin-clavulanic acid (50%), azithromycin (50%), and chloramphenicol (50%) and completely sensitive to cefoxitin, cefepime, amikacin, and gentamicin. All Shigella isolates were multidrug-resistant. We detected bla SHV resistance gene in all isolates; however, no isolate harbored bla TEM gene. RAPD-PCR categorized the Shigella isolates into five main clusters. The highest antibiotic resistance was observed in the isolates of cluster R4. The finding of this study also indicated an association between antimicrobial resistance profiles and genotyping properties of the isolates. Novel food monitoring systems, including surveillance of multidrug-resistant foodborne pathogens, especially in developing countries, are required to control the foodborne diseases.

Prevalence, Phylogroups and Antimicrobial Susceptibility of Escherichia coli Isolates from Food Products

The emergence of multi-drug resistant E. coli is an important matter of increasing considerable concern to global public health. The aim of this study was to investigate the incidence, antibiotic resistance pattern and phylogroups of E. coli isolates obtained from raw milk, vegetable salad and ground meat samples collected from Qazvin Province (Iran). Culture-based techniques, Kirby-Bauer disk diffusion susceptibility testing and PCR assays were used to determine the incidence rate, antimicrobial resistance pattern and phylogenetic groups of the E. coli isolates. The E. coli isolates were highly resistant to amoxicillin (79.1%), trimethoprim-sulfamethoxazole (70.8%), amoxicillin-clavulanic acid (62.5%), tetracycline (54.1%), chloramphenicol (54.1%), nitrofurantoin (54.1%), ampicillin (45.8%), streptomycin (45.8%), and kanamycin (33.3%); and completely susceptible to norfloxacin and azithromycin and 70.8% of the isolates were multi-drug resistant. Most E. coli isolates (46%) belonged to phylogroup A. Novel, practical, efficient food safety control and surveillance systems of multi-drug resistant foodborne pathogens are required to control the foodborne pathogen contamination.

Antibiotic susceptibility and genetic relatedness of Shigella species isolated from food and human stool samples in Qazvin, Iran

Objective

The aim of this study was to investigate the genetic relatedness and antimicrobial resistance among Shigella species isolated from food and stool samples. Using cross sectional study method, Shigella spp. were isolated from food and clinical samples using culture-based, biochemical and serological methods. Antimicrobial susceptibility and genetic relatedness among the isolates were evaluated using disk diffusion and RAPD-PCR methods respectively.

Results

The prevalence of Shigella spp. were 4.84 and 7.7% in food and stool samples respectively. All food isolates were Sh. sonnei. 91.42% of the Shigella stool isolates were Sh. sonnei. 62.5% of food isolates were resistant to tetracycline. 46.8, 50 and 65.8% of clinical isolates were resistant to imipenem, amikacin and azithromycin respectively. 50 and 85.7% of the food and clinical isolates respectively were MDR. Dendrogram generated by RAPD-PCR showed that the isolates from food and stool samples were categorized in a same group. Close genetic relatedness between MDR Shigella isolates from food and clinical samples indicate that foods can be considered as one of the main vehicles for transmission of MDR Shigella to human causing acute diseases. Survey of MDR Shigella among food and clinical samples is strongly suggested to be implemented.

Genotypic and antimicrobial resistance characterizations of Cronobacter sakazakii isolated from powdered milk infant formula: A comparison between domestic and imported products

Cronobacter sakazakii, an opportunistic foodborne pathogen and a main cause of meningitis in neonates, is usually isolated from powdered milk infant formula (PMIF). At the present study, C. sakazakii were isolated from imported and domestically produced PMIF samples and identified by detection of ompA gene using real-time PCR SYBR green melting curve following the evaluation of antimicrobial susceptibility and genotyping of the isolates employing BOX-PCR and RAPD methods. We detected totally 5% contamination rate and a significantly higher prevalence of C. sakazakii in bulky imported domestically packaged PMIF samples. Also, our isolates were recognized as multidrug-resistant pathogen completely resistant to ampicillin and amoxicillin; and intermediately resistant to ciprofloxacin and tetracycline antimicrobials. Genotype clustering patterns of bulky imported and imported product isolates were identical by both genotyping methods. Far genetic relatedness of domestic isolate to other isolates and the reference strain indicated higher genetic diversity of the domestic isolate genome. Multidrug resistance and diverse population genetic make complicated situation for determination of strategies for infectious disease prevention.

[Evaluation of the prescription of furosemide in persons aged 75years and older in a geriatric acute-care unit]

INTRODUCTION

Furosemide is very often prescribed in France. It may cause important adverse effects especially in elderly persons. In order to limit its misuse and excessive expenditure for health insurance organizations, the European Society of Cardiology drafted strict guidelines for its prescription. We conducted a study in this population to determine the rate of prescription of furosemide in elderly persons outside the guidelines.

METHOD

This was a prospective, single-centre, observational study bearing on elderly persons aged 75years and more admitted to a geriatric acute-care unit over a period of 6months. The prevalence of furosemide prescription and the proportion of prescriptions outside guidelines were calculated. The sociodemographic and medical characteristics of patients treated with furosemide were studied as were the modalities of furosemide prescription.

RESULTS

In the 818 patients hospitalized during the period of the study, 267 were taking furosemide at admission (32.6%). Among these prescriptions, 69.2% were outside the guidelines. Arterial hypertension was the leading indication for furosemide (38.2%), followed by chronic heart failure (24.3%).

CONCLUSION

This study confirmed the high prevalence of furosemide prescription and its misuse. Furosemide is often re-prescribed with no medical re-evaluation.

[The Confusion Assessment Method: Transcultural adaptation of a French version]

INTRODUCTION

The Confusion Assessment Method (CAM) is a validated key tool in clinical practice and research programs to diagnose delirium and assess its severity. There is no validated French version of the CAM training manual and coding guide (Inouye SK). The aim of this study was to establish a consensual French version of the CAM and its manual.

METHODS

Cross-cultural adaptation to achieve equivalence between the original version and a French adapted version of the CAM manual.

RESULTS

A rigorous process was conducted including control of cultural adequacy of the tool's components, double forward and back translations, reconciliation, expert committee review (including bilingual translators with different nationalities, a linguist, highly qualified clinicians, methodologists) and pretesting. A consensual French version of the CAM was achieved.

CONCLUSION

Implementation of the CAM French version in daily clinical practice will enable optimal diagnosis of delirium diagnosis and enhance communication between health professionals in French speaking countries. Validity and psychometric properties are being tested in a French multicenter cohort, opening up new perspectives for improved quality of care and research programs in French speaking countries.

Lead concentration in the muscles of slaughtered buffalos in northwest regions of Iran

Background

The topic of food safety has become a major public health issue worldwide. Over recent decades, the growing concern for food safety has brought about greater research regarding the risks associated with the consumption of produce that has been contaminated by pesticides, heavy metals and/or toxins.

Objective

The study was conducted to determine the concentration of Pb in the muscle of buffalos slaughtered in the northwest regions of Iran (Ardabil, Urmia and Tabriz cities).

Methods

The present was a descriptive cross-sectional study in the northwest regions of Iran during 2013 to 2014. A total of 30 muscle samples from individual buffalos were analyzed for Pb concentrations using Atomic Absorption Spectrophotometer (ASS). Statistical analysis was performed using SPSS 17.0. All results were computed as mean standard deviation and subjected to one-way analysis of variance to establish whether the differences in Pb concentrations in meat samples from different cities were significant or not. The Statistical significance was determined at p<0.05.

Results

The results showed that the mean concentration of Pb in muscle samples were measured 0.043±0.035 ppm. The highest Pb concentration (0.11 ppm) was detected in the buffalo muscle samples from Urmia city. In total, 25 muscle samples (80.33%) were contaminated with Pb and concentration of Pb in 3.33% of contaminated samples exceeded the permissible limits advised by the European Commission (EC) (0.1 ppm).

Conclusion

We recommend identifying Pb sources in order to eliminate or control Pb contamination of food, and monitor environmental exposures and hazards to prevent lead poisoning.

Effects of chitosan edible coating containing grape seed extract on the shelf-life of refrigerated rainbow trout fillet

In recent years, use of edible coatings as carriers of food additives and antimicrobial compounds has been considered in fishery products. This study was carried out to evaluate the effects of 2.00% chitosan coating singly and combined with 0.10% grape seed extract (GSE) on microbial (mesophils and psychrophils counts), chemical (thiobarbituric acid; TBA), pH and peroxide value (PV) and sensorial properties of rainbow trout fillet stored at 4 ^°C over a period of 15 days. The coating had a significant effect in reducing aerobic mesophilic and psychrophilic bacteria counts. The TBA, PV and pH of samples of chitosan coating alone and with GSE were lower than control ones indicating a significant influence of coating on fillet shelf-life. Moreover, chitosan coating represented an equal sensorial quality with controls. It can be concluded that chitosan coating containing GSE can help to maintain the sensorial quality and increase the shelf-life of rainbow trout fillets at refrigerated conditions.

Screening for frailty in community-dwelling elderly subjects: Predictive validity of the modified SEGA instrument

AIMS

To study the capacity of the SEGAm instrument to predict loss of independence among elderly community-dwelling subjects.

METHODS

The study was performed in four French departments (Ardennes, Marne, Meurthe-et-Moselle, Meuse). Subjects aged 65 years or more, living at home, who could read and understand French, with a degree of autonomy corresponding to groups 5 or 6 in the AGGIR autonomy evaluation scale were included. Assessment included demographic characteristics, comprehensive geriatric assessment, and the SEGAm instrument at baseline. Subjects had follow-up visits at home at 6 and 12 months. During follow-up, vital status and level of independence were recorded. Logistic regression was used to study predictive validity of the SEGAm instrument.

RESULTS

Among the 116 subjects with complete follow-up, 84 (72.4%) were classed as not very frail at baseline, 23 (19.8%) as frail, and 9 (7.8%) as very frail; 63 (54.3%) suffered loss of at least one ADL or IADL at 12 months. By multivariable analysis, frailty status at baseline was significantly associated with loss of independence during the 12 months of follow-up (OR=4.52, 95% CI=1.40-14.68; p=0.01). We previously validated the SEGAm instrument in terms of feasibility, acceptability, internal structure validity, reliability, and discriminant validity.

CONCLUSIONS

This instrument appears to be a suitable tool for screening frailty among community-dwelling elderly subjects, and could be used as a basis to plan early targeted interventions for subjects at risk of adverse outcome.

[Transfusion in elderly: Take account frailty]

The conjunction of the demographic aging and the increase in the frequency of anemia with the advancing age, mean that the number of globular concentrates delivered each year increases with a consequent heavy pressure on blood collection. The etiologies of anemia in the elderly are often multifactorial and their investigation is an indispensable step and prior to any treatment. Transfusion thresholds, particularly in the elderly, are gradually evolving and a so-called restrictive strategy is now favored. Immediate and delayed complications of transfusion are more frequent in the elderly due to vulnerability factors associated with frailty and the risk of multiple transfusions. The screening of complications related to transfusion of RBCs is essential and makes it possible to avoid their recurrence. The impact of transfusion on the quality of life of elderly patients is not obvious and is a controversial issue. In addition, transfusion of red blood cells (RBCs) is accompanied by an increase in health expenditure and an increase in morbidity and mortality, whose risks can be reduced through alternatives to transfusion. Longitudinal studies, including elderly subjects, would allow a better understanding of the issues involved in the transfusion of RBCs in this population.

Adjudication of osteonecrosis of the jaw in phase III randomized controlled trials of denosumab: a systematic review

PURPOSE

Denosumab (an anti RANKL antibody) is known to be associated with an increased risk for osteonecrosis of the jaw (ONJ). Due to the variety of clinical presentation, many ONJ definitions are used. Evaluation of ONJ's frequency during phase III randomized controlled trials (RCTs) is crucial to assess benefit-risk ratio. We verified that phase III RCTs involving denosumab reported the definition of ONJ used.

METHODS

We systematically searched in Central, Medline, Cochrane, and Scopus, until 31 August 2015. We included original phase III RCTs, involving denosumab. Post hoc analysis and trial extension were excluded. Articles that did not mention ONJ in their methods or results were excluded. The primary outcome was the prevalence of a complete definition of ONJ. When no definition was provided, ONJ adjudication process was analyzed.

RESULTS

Of 313 articles found, 13 RCTs were included. A definition of ONJ was detailed in two RCTs (15%). For the remaining 11 RCTs, adjudication process was mentioned for nine. In those processes, "blinded," "expert," and "independent" were the most used words.

CONCLUSION

Most of the published phase III RCTs involving denosumab did not specify the definition of ONJ used to adjudicate events in the study. Instead of definition, non-scientific and non-reproducible expressions were used. Because the chosen definition could impact the ONJ estimated frequency, it should be mandatory to give the precise definition used in each RCT publication involving denosumab.

PHYSICOCHEMICAL AND RHEOLOGICAL PROPERTIES OF DOOGH UNDER SPECIFIC FERMENTATION

Fermented dairy products such as doogh are more nutritious than the natural milk from which they are made. In this study enhancing the viscosity of Doogh (Iranian yogurt drink) fermented by Leuconostoc mesenteroides under the optimum condition of exopolysaccharide (EPS) production including temperature of 25°C, agitation of 120 RPM and different sucrose contents from 0 to 2%, w/w, was investigated. Addition of sucrose was not influenced the rheological and sensory characteristics of Doogh samples before the fermentation significantly according to sensory and rheological analysis. The results of chemical, microbiological, viscosity, serum separation and sensory analysis showed that viscosity of Doogh increased corresponding to sucrose contents during the fermentation up to 10.01 cp with no change in the taste of the Doogh samples. Also, sensory analysis of consistency confirmed the viscosity results. Serum separation values of samples also showed enhancement in stability after the fermentation and finally, this special fermentation process contributed to enhancement in viscosity of Doogh as an edible suspension, with reasonable economic targets compared with other stabilizing methods.

Predictors of Long-Term Mortality in Oldest Old Patients (90+) Hospitalized to Medical Wards via the Emergency Department: The SAFES Cohort

OBJECTIVES

To identify risk factors for long-term mortality in patients aged 90 years and over who are admitted to hospital through the emergency department.

DESIGN

Prospective cohort study (SAFES cohort; Sujet Agé Fragile - Évaluation Suivi).

SETTING

8 university teaching hospitals and one regional, non-academic hospital in France.

PARTICIPANTS

Among 1306 patients in the SAFES cohort, 291 patients aged 90 or over were included.

MEASUREMENTS

At inclusion, we recorded socio-demographic data (age, sex, level of education, living alone or in an institution, number of children, presence of helper/caregiver), and data from geriatric evaluation (dependence status, risk of depression, dementia, delirium, nutritional status, walking disorders, risk of falls, comorbidities, risk of pressure sores). Vital status at 36 months was obtained from the treating physician, the general practitioner, administrative registers, or during follow-up consultations.

RESULTS

Among 291 patients included, 190 (65.3%) had died at 36 months. Risk factors for mortality at 36 months identified by multivariate analysis were risk of malnutrition (HR 1.6, 95%CI 1.1-2.3, p=0.004) and delirium (HR 1.6, 95%CI 1.1-2.3, p=0.01).

CONCLUSION

Risk of malnutrition and presence of delirium are risk factors for mortality at 36 months in subjects aged 90 years and over hospitalized through the emergency department.

Antinociceptive effects, acute toxicity and chemical composition of Vitex agnus-castus essential oil

OBJECTIVE

Vitex agnus-castus (VAC) and its essential oil have been traditionally used to treat many conditions and symptoms such as premenstrual problems, mastalgia, inflammation, sexual dysfunction, and pain. In this study, the effects of essential oil extracted from Vitex agnus-castus (EOVAC) leaves were investigated in three behavioral models of nociception in adult male Wistar rats.

MATERIALS AND METHODS

Chemical composition of EOVAC was analyzed using gas chromatography - mass spectrometry (GC-MS) and also its possible toxicity was determined in mice. Analgesic effect of EOVAC was determined using tail immersion test, formalin test, and acetic acid-induced visceral pain in rats.

RESULTS

EOVAC (s.c.) and morphine (i.p.) significantly (p<0.05) reduced pain responses in both formalin and tail immersion tests. In the study of evolved mechanisms, pretreatment with naloxone or atropine significantly (p <0.05) reversed the essential oil-induced analgesia in both formalin and tail immersion tests. Moreover, EOVAC and Piroxicam produced significant (p<0.05) inhibition in the acetic acid-induced writhing response. EOVAC did not show any mortality even at high dose (5 g/kg, p.o.) of administration in toxicity test. Moreover, according to GC-MS results, major components of the EOVAC were α-pinene (14.83%), limonene (10.29%), β-caryophyllene (6.9%), sabinene (5.27%), and β-farnesene (5.9%).

CONCLUSIONS

These results suggest that endogenous opioidergic system as well as muscarinergic receptors of cholinergic system may be involve in the antinociceptive activity of Vitex agnus-castus essential oil in these models of pain in rats.