METHODS: We estimated all-age and age-specific deaths and disability-adjusted life-years (DALYs) attributable to and associated with bacterial AMR for 22 pathogens, 84 pathogen-drug combinations, and 11 infectious syndromes in 204 countries and territories from 1990 to 2021. We collected and used multiple cause of death data, hospital discharge data, microbiology data, literature studies, single drug resistance profiles, pharmaceutical sales, antibiotic use surveys, mortality surveillance, linkage data, outpatient and inpatient insurance claims data, and previously published data, covering 520 million individual records or isolates and 19 513 study-location-years. We used statistical modelling to produce estimates of AMR burden for all locations, including those with no data. Our approach leverages the estimation of five broad component quantities: the number of deaths involving sepsis; the proportion of infectious deaths attributable to a given infectious syndrome; the proportion of infectious syndrome deaths attributable to a given pathogen; the percentage of a given pathogen resistant to an antibiotic of interest; and the excess risk of death or duration of an infection associated with this resistance. Using these components, we estimated disease burden attributable to and associated with AMR, which we define based on two counterfactuals; respectively, an alternative scenario in which all drug-resistant infections are replaced by drug-susceptible infections, and an alternative scenario in which all drug-resistant infections were replaced by no infection. Additionally, we produced global and regional forecasts of AMR burden until 2050 for three scenarios: a reference scenario that is a probabilistic forecast of the most likely future; a Gram-negative drug scenario that assumes future drug development that targets Gram-negative pathogens; and a better care scenario that assumes future improvements in health-care quality and access to appropriate antimicrobials. We present final estimates aggregated to the global, super-regional, and regional level.
FINDINGS: In 2021, we estimated 4·71 million (95% UI 4·23-5·19) deaths were associated with bacterial AMR, including 1·14 million (1·00-1·28) deaths attributable to bacterial AMR. Trends in AMR mortality over the past 31 years varied substantially by age and location. From 1990 to 2021, deaths from AMR decreased by more than 50% among children younger than 5 years yet increased by over 80% for adults 70 years and older. AMR mortality decreased for children younger than 5 years in all super-regions, whereas AMR mortality in people 5 years and older increased in all super-regions. For both deaths associated with and deaths attributable to AMR, meticillin-resistant Staphylococcus aureus increased the most globally (from 261 000 associated deaths [95% UI 150 000-372 000] and 57 200 attributable deaths [34 100-80 300] in 1990, to 550 000 associated deaths [500 000-600 000] and 130 000 attributable deaths [113 000-146 000] in 2021). Among Gram-negative bacteria, resistance to carbapenems increased more than any other antibiotic class, rising from 619 000 associated deaths (405 000-834 000) in 1990, to 1·03 million associated deaths (909 000-1·16 million) in 2021, and from 127 000 attributable deaths (82 100-171 000) in 1990, to 216 000 (168 000-264 000) attributable deaths in 2021. There was a notable decrease in non-COVID-related infectious disease in 2020 and 2021. Our forecasts show that an estimated 1·91 million (1·56-2·26) deaths attributable to AMR and 8·22 million (6·85-9·65) deaths associated with AMR could occur globally in 2050. Super-regions with the highest all-age AMR mortality rate in 2050 are forecasted to be south Asia and Latin America and the Caribbean. Increases in deaths attributable to AMR will be largest among those 70 years and older (65·9% [61·2-69·8] of all-age deaths attributable to AMR in 2050). In stark contrast to the strong increase in number of deaths due to AMR of 69·6% (51·5-89·2) from 2022 to 2050, the number of DALYs showed a much smaller increase of 9·4% (-6·9 to 29·0) to 46·5 million (37·7 to 57·3) in 2050. Under the better care scenario, across all age groups, 92·0 million deaths (82·8-102·0) could be cumulatively averted between 2025 and 2050, through better care of severe infections and improved access to antibiotics, and under the Gram-negative drug scenario, 11·1 million AMR deaths (9·08-13·2) could be averted through the development of a Gram-negative drug pipeline to prevent AMR deaths.
INTERPRETATION: This study presents the first comprehensive assessment of the global burden of AMR from 1990 to 2021, with results forecasted until 2050. Evaluating changing trends in AMR mortality across time and location is necessary to understand how this important global health threat is developing and prepares us to make informed decisions regarding interventions. Our findings show the importance of infection prevention, as shown by the reduction of AMR deaths in those younger than 5 years. Simultaneously, our results underscore the concerning trend of AMR burden among those older than 70 years, alongside a rapidly ageing global community. The opposing trends in the burden of AMR deaths between younger and older individuals explains the moderate future increase in global number of DALYs versus number of deaths. Given the high variability of AMR burden by location and age, it is important that interventions combine infection prevention, vaccination, minimisation of inappropriate antibiotic use in farming and humans, and research into new antibiotics to mitigate the number of AMR deaths that are forecasted for 2050.
FUNDING: UK Department of Health and Social Care's Fleming Fund using UK aid, and the Wellcome Trust.
RESULTS: A total of 240,611 T2DM admissions, representing 35.1% of 684,809 CVDE admissions, were included in this study. Among these, 32.9% were treated for myocardial infarction (MI), 20.1% for cerebrovascular accident (CVA), 19.4% for heart failure, 12.8% for ischemic heart disease (IHD), 8.2% for hypertensive heart disease (HHD), 5.6% for cardiomyopathy, and 1.0% for atherosclerosis and peripheral vascular disease (PVD). CVDE admissions were prevalent among males (59.2%) and associated with higher cost of admission (β = 1.13, P < 0.001), patients aged 40-49 years old had 24% high odd for high cost (β = 1.24, P < 0.001) compared to those aged 19-29 years. Compared to Malay, Chinese and other ethnicities were significantly associated with high cost (β = 1.13, P < 0.001). Patients with severity level III were 10 times more likely to have higher costs as compared to severity level I (β = 10.39, P < 0.001), 72.6% were admitted in less than five days, and 23.1% were less likely to incur high cost as compared to patients admitted more than five days (β = 0.769, P < 0.001). The trend of admissions is increasing each year, with the median total hospital expenditure higher in IHD patients with T2DM, which increased by 55.5% from 2014 to 2020 (from RM 4,187.98 to RM 6,510.43). This was followed by MI, which saw an 8% increase (from RM 3,881.80 to RM 4,211.18).
CONCLUSIONS: The findings of this research indicated cardiovascular disease (CVD) admission trends and costs increased substantially over the years and higher costs in dual noncommunicable diseases (NCDs). These findings underscore the urgent need for enhanced preventive strategies targeting high-risk populations, such as males, individuals with severe disease levels, and specific ethnic groups. Policies should emphasize lifestyle modification programs, early diagnosis of cardiovascular risks among T2DM patients, and cost-effective treatments to mitigate the growing financial burden. Furthermore, resource allocation must be adjusted to address the increasing demand for care, particularly for conditions like IHD and MI, ensuring equitable access to quality care while containing healthcare costs.
METHODOLOGY: A retrospective cohort study was conducted for patients who underwent treatment for ameloblastoma from 2007 to 2021. All patients with histopathologically proven ameloblastoma and underwent at least 2 years of follow-up were included in the study.
RESULTS: Fifty-one patients met the study's inclusion criteria. The mean age was 39.8 +/- 18.8 years old, and the mean follow-up period was 80 +/- 51 months. A recurrence was observed in 10 patients out of 51 patients (19.6%). There was significant association between histologic pattern and tumor recurrence ( P <0.05). Most of the recurrence cases showed mixed histologic subtypes with the predominant variant lead by acanthomatous-follicular subtypes.
DISCUSSION: The recurrence rate in our study, 19.6% was in line with other studies. (17.2%-24.0%) Conventional ameloblastoma with mixed acanthomatous and follicular subtypes were the most common histologic variant in recurrence cases of our study. In our study, the recurrence rate for enucleation with peripheral ostectomy was 26.7% in conventional ameloblastoma, which was lower than the reported rates, 33.3%.
CONCLUSIONS: Our data indicate that the conservative treatment can preserve the appearance and function well, at the same time keeping the risk of recurrence lower than currently published figures.
METHODS: A comprehensive literature search was conducted to gather information on the synthesis methods, complex matrices, characterization techniques, and potential applications of CDs derived from medicinal plants in cancer therapy.
RESULT: Carbon dots (CDs) have emerged as a subject of significant interest due to their favorable chemical and biological properties. Various precursors, including graphite, carbon black, and organic molecules, are utilized in the synthesis of CDs through chemical or physical methods. Notably, CDs derived from medicinal plants offer environmentally friendly alternatives, leveraging complex matrices such as aqueous, alcoholic, and hydroalcoholic extracts. This review emphasizes the green synthesis approaches, characterization techniques, and diverse applications of CDs, including drug transport, bioimaging, biosensing, and anti-cancer therapies. Furthermore, it highlights the advantages and disadvantages of different synthesis methods, aiding researchers in selecting appropriate techniques for continuous production.
CONCLUSION: Carbon dots (CDs) represent a transformative advancement in nanotheranostics, offering a versatile platform for precise cancer diagnosis and therapy. With inherent anticancer properties, CDs hold promise in photodynamic therapy (PDT) and photothermal therapy (PTT), enabling precise tumor targeting while minimizing systemic toxicity. To address the limitations of standalone PDT and PTT, researchers are exploring multimodal treatment approaches integrating CDs. By leveraging the unique properties of CDs derived from medicinal plants, a new era of precision cancer therapy may be realized, emphasizing enhanced therapeutic outcomes and reduced adverse effects.
METHODS: This study used a descriptive qualitative method with in-depth interviews using a semi-structured interview guide. Ethical clearance was obtained, and fourteen young adults who smoked were recruited by purposive sampling. Before the interview, participants watched five videos with the following categories: 1) the health impact of active smoking, 2) the health impact of passive smoking, and 3) the burden on the family of smokers getting smoking-related diseases. Data analysis was conducted using inductive content analysis.
RESULTS: Five themes describe smokers' perceptions of videos depicting the effects of smoking: a) The video is interesting and can help imagine real condition visualization of the impact of smoking; b) The video deeply resonates with smokers; c) The health impact of the passive smoker and family video is more impactful than the health impact of active smoking video; d) The health impact of active smoking videos make smokers aware of smoking on themselves; e) These videos can increase motivation to quit smoking.
CONCLUSION: This research can be a recommendation in health education and smoking cessation counseling using videos that describe the health impact of smoking, especially with an approach that highlights the effects on passive smokers and families.
METHODS: From inception to March 2024, we systematically searched six key electronic databases: PubMed, Web of Science, Embase, Cochrane Library, Scopus, and CINAHL to identify potential studies that reported the prevalence or unfavourable outcomes of OF amongst older adult. Studies that did not have accessible data were excluded. Two researchers worked independently to retrieve the literature, collect data, and evaluate the quality of the included studies. Data analysis was conducted using R Project 4.1.1 and Review Manager 5.3 software.
RESULTS: We identified 28 studies that met the inclusion criteria, including 27,927 older adult. The pooled prevalence of OF amongst older adult was 32% (95% confidence interval (CI): 0.24, 0.41). Subgroup analyses indicated that the setting, sample, design of studies, and assessment instruments influence the prevalence of OF. In addition, OF was associated with a high risk of physical frailty (odds ratio (OR) = 1.67; 95% CI: 1.38, 2.02), malnutrition (OR = 2.27; 95% CI: 1.75, 2.96), low dietary variety (OR = 1.98, 95% CI: 1.15, 3.39), and social withdrawal (OR = 1.42; 95% CI: 1.18, 1.71).
CONCLUSION: This systematic review and meta-analysis revealed that OF is prevalent amongst older adult. OF may affect the prognosis of older adult and thus necessitates comprehensive assessment and management as part of an integrated approach.
SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=537884.
METHODS: To develop this tool, published literature on assessment tools was searched on various databases. A panel of 12 steering committee members conducted an advisory board meeting to review the findings. Specific outcome measures to be included in a comprehensive assessment tool and follow-up sheet were then collated following consensus approval from the panel. The tool was further validated for content and revised with expert recommendations to arrive at the finalized Nasal Polyp Patient Assessment Scoring Sheet (N-PASS) tool.
RESULTS: The N-PASS tool was developed by integrating the subjective and objective measures for CRS assessment. Based on expert opinions, N-PASS was revised to be used as an easy-to-use guidance tool that captures patient-reported and physician-assessed components for comprehensively assessing disease status and response to treatment.
CONCLUSION: The N-PASS tool can be used to aid in the diagnosis and management of CRS cases with nasal polyps. The tool would also aid in improved monitoring of patients and pave the way for an international disease registry.
LEVEL OF EVIDENCE: Oxford Level 3.
METHOD: We synthesised the evidence from our three previous systematic reviews (covering all literature from inception to 2023 from PubMed, Embase, and PsychInfo) on dementia risk prediction modelling. The aim was to identify models that have been specifically developed and tested specifically in LMICs. There were no language or time restrictions applied.
RESULT: To date, over 50 different dementia risk prediction models have been developed and tested with only 7 models reported from two LMICs including five studies from China and two studies from Mexico. The models incorporated variables typically linked to dementia including demographics (e.g., age, sex, education), health (e.g., diabetes, hypertension, heart disease) and lifestyle (e.g., smoking and alcohol) variables. The 7 models also have varying degrees of predictive accuracy (c-statistic range 0.65 [95%CI: 0.64-0.67] to 0.92 [95%CI: 0.88-0.95]) and none has undergone external validation. These models have been developed using traditional statistical approaches including Cox and Logistic Regression. Further, model development has not considered factors such as socioeconomic status, literacy, access to healthcare, diet, stress, pollution, and workplace hazards that may be crucial in predicting dementia risk in LMICs.
CONCLUSION: There is an urgent need to create context-specific dementia prediction models to inform the development of risk reduction and preventative interventions in LMICs where dementia case numbers are greatest. Dementia risk model development and testing need to be extended to LMICs across different regions (e.g., Asia, Middle East, Global South, Africa) and income levels (e.g., low, lower-middle, and upper-middle income).
RECOMMENDATIONS: Greater investment is needed into understanding dementia, and its risk factors in LMICs to inform the development of risk mitigation programs. Research should focus on developing accurate, resource-conscious models with affordable and obtainable variables for identifying those individuals likely to benefit the most from interventions targeting risk reduction.
METHOD: A scoping review was conducted utilizing the Joanna Briggs Institute guidance. Four databases (OvidMedline, Scopus, PsycINFO, and CINAHL) were searched for eligible studies reporting dementia research priorities in LMICs in Southeast Asian. Comparisons were made to a stakeholders' consultation during a two-day workshop from the 9th to 10th February 2023 in Kuala Lumpur, Malaysia. Participants included the Southeast Asia-Dementia (SEA-Dem) Research Network members key stakeholders from Malaysia, Indonesia, Vietnam, Philippines, Singapore, and Hong Kong (n = 20). Research priorities from each participating country were generated and ranked, harmonized with those from the nominal group technique into tiers of priorities.
RESULT: Only two studies from Malaysia and Vietnam were eligible, reporting unranked research priorities. Nominal group technique ranked outcomes from Malaysia, Vietnam, Indonesia, and the Philippines were included. Top dementia research priorities were (1) local research and data collection capacity, (2) community awareness and engagement, and (3) health policy. Second-tier research priorities included harmonizing guidelines and tools standardization, health inequalities, and availability of carer support. The third tier comprised multisectoral collaboration, integration of care, telemedicine, digital approaches, dementia risk reduction, health economics, and sustainable interventions.
CONCLUSION: Our ranked and harmonized latest dementia research priorities list can serve as a more nuanced and contextually informed dementia research directional guide for countries with similar backgrounds. Collaborative efforts to increase high-quality dementia research capacity in Southeast Asian LMICs should be intensified for better dementia care in the region.
METHOD: Data were obtained from 36 members of COSMIC, representing 28 countries across 6 continents (HICs: Australia, Canada, Faroe Islands, France, Germany, Greece, Italy, Japan, Netherlands, South Korea, Spain, Sweden, & USA; LMICs: Brazil, China, Cuba, Dominican Republic, Ecuador, Indonesia, Malaysia, Mexico, Nigeria, Peru, Philippines, Republic of Congo, & Tanzania). For each member study, we calculated incidence rates for all-cause dementia. Findings from 14 studies, with a consensus diagnosis are presented in the results. Using an Item Response Theory approach, we are currently calculating a comparable incidence rate for those studies without a consensus diagnosis.
RESULT: Consistent with previous trends, incidence rates (per 100 person-years) increased with age, from 65-70 years-old to 85-90 years-old, for both males (i.e., Republic of Congo, 4.41 to 19.57; France, 0.46 to 3.89; USA, 0.17 to 3.22; Spain, 0.31 to 4.22; 65-70 & 85-90 cohorts respectively) and females (i.e., Republic of Congo, 3.57 to 15.31; France, 0.45 to 3.72; USA, 0.22 to 4.25; Spain, 0.36 to 4.96; 65-70 & 85-90 cohorts respectively). There were no sex differences in incidence rates in younger age groups (60-65). Among older age groups, however, women tended to have higher incidence rates than men, in some countries (Faroe Islands, Germany, Sweden, and USA).
CONCLUSION: Geographical differences in dementia incidence rates likely represent inherent variation among countries, beyond methodological considerations. We are working to expand the range of studies and regions for which we calculate dementia incidence rates. This involves the development of approaches to classify and harmonise incident dementia in studies lacking consensus diagnoses. Doing so will bolster LMIC representation.