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1. Application of the intracranial arterial pulsatility index for determination of prognosis after lacunar infarct

Author

Mohammad Saadatnia, Alireza Zandifar, Maryam Alizadeh, Jorge Du Ub Kim, Omid Shafaat, Luis Octavio Tierradentro-García, Navid Manouchehri, and Fariborz Khorvash

Subjects
arterial blood flow velocity, lacunar infarct, pulsatility index, transcranial color-coded sonography, Medicine, Biology (General), QH301-705.5
Abstract

Background: We aimed to investigate the usefulness of intracranial arterial pulsatility index to assess the prognosis of lacunar infarcts. Materials and Methods: Forty-nine patients with confirmed acute lacunar infarct were enrolled in the study. A transcranial color-coded sonography was performed to assess the pulsatility index of bilateral middle cerebral, posterior cerebral, vertebral, and proximal internal carotid arteries. Patients' clinical status was assessed using a modified Rankin scale. Spearman correlation was used for reporting the relation between quantitative data. Statistical significance was defined as a two-tail p-value of less than 0.05. Results: The mean age ± standard deviation was 64.1 ± 9.07 years old, and 57.1% of the patients were male. Upon discharge, only 8.2% of the patients were ranked as 0 on the modified Rankin scale; however, after a 6-month follow-up period, this number increased to 49%. There were no significant differences between the left and right pulsatility index measurements in any of the assessed arteries. Patients with vertebral artery pulsatility indexes >1 on their primary assessment had significantly worse outcomes during the first, third, and sixth months follow-up (all r > 0.3, p-values < 0.01). Pulsatility indexes from other arteries did not predict the prognosis. Conclusion: Sonography-assisted assessment of the vertebral artery blood flow during the early stage of lacunar infarct provides a reliable reference for prognosis estimation.

Published
2023
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2. Luxury perfusion: A paradoxical finding and pitfall of CT perfusion in subacute infarction of brain

Author

Houman Sotoudeh, Assistant Professor, Omid Shafaat, Research Fellow, Aparna Singhal, Assistant Professor, and Asim Bag, Associated Professor

Subjects
Medical physics. Medical radiology. Nuclear medicine, R895-920
Abstract

In the context of recent guidelines for stroke management, application of computed tomographic perfusion (CTP) is anticipated to increase, especially within 6-24 hours after stroke onset. There are commercially available software packages to help to detect the infarct core and the penumbra, however, the results of these software are not always straightforward that might cause incorrect CTP interpretation. We present here a case of acute ischemic stroke in which the CTP software misinterpreted the results by labeling the normal hemisphere as infarction and ischemia due to luxury perfusion of the infarcted hemisphere. Awareness of laterality of the patient's symptoms and the understanding of functioning of perfusion analysis software is necessary to avoid this pitfall. Keywords: Perfusion imaging, Stroke, Neurologic examination

Published
2019
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3. Superior ophthalmic vein thrombosis: What radiologist and clinician must know?

Author

Houman Sotoudeh, Omid Shafaat, Noha Aboueldahab, Michael Vaphiades, Ehsan Sotoudeh, and Joshua Bernstock

Subjects
Medical physics. Medical radiology. Nuclear medicine, R895-920
Abstract

Purpose: Superior ophthalmic vein thrombosis (SOVT) is an extremely rare condition. Few studies have been published about clinical aspects of this condition. In this study, we have studied the symptoms, underlying etiologies, treatment, pathogenesis and complication of the SOVT and we tried to classify it based on the etiology, treatment, and prognosis. Methods: We reviewed the patients’ data from a tertiary academic referral center. Each patient with SOVT was then reviewed for symptoms associated with SOVT, underlying etiology, treatment protocol, treatment response, complications, possible pathogens, and final outcome. Results: Twenty-four cases of SOVT were included in this study. Overall, 13 cases were diagnosed as right-sided SOVT, out of which, eight had simultaneous right-sided cavernous sinus thrombosis (CST). Eighteen cases were diagnosed to have left-sided SOVT, out of which, 11 had simultaneous left-sided CST. Conclusions: The SOVT can be secondary to different mechanisms. The SOVT secondary to trauma, recent surgery and coagulopathy are mostly non-aggressive, and can be managed by conservative therapy and anticoagulation. The SOVT in patients with orbital cellulitis, history of active sinusitis or paranasal sinus surgery are aggressive presenting with acute orbital swelling, abscess and visual loss. This type of SOVT can be complicated by extension to the cavernous sinus and intracranial structures. These patients require urgent antibiotics therapy and sinus surgery. The most severe type of SOVT is caused by mucormycosis which may also extend intracranially resulting in stroke and is often life-threatening. Keywords: Superior ophthalmic vein thrombosis, Thrombophlebitis, Cavernous sinus thrombosis, Orbital cellulitis, Sinusitis

Published
2019
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4. Artificial Intelligence in the Management of Glioma: Era of Personalized Medicine

Author

Houman Sotoudeh, Omid Shafaat, Joshua D. Bernstock, Michael David Brooks, Galal A. Elsayed, Jason A. Chen, Paul Szerip, Gustavo Chagoya, Florian Gessler, Ehsan Sotoudeh, Amir Shafaat, and Gregory K. Friedman

Subjects
glioma, artificial intelligence, neural network, deep neural network, convolution neural network, support vector machines, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

Purpose: Artificial intelligence (AI) has accelerated novel discoveries across multiple disciplines including medicine. Clinical medicine suffers from a lack of AI-based applications, potentially due to lack of awareness of AI methodology. Future collaboration between computer scientists and clinicians is critical to maximize the benefits of transformative technology in this field for patients. To illustrate, we describe AI-based advances in the diagnosis and management of gliomas, the most common primary central nervous system (CNS) malignancy.Methods: Presented is a succinct description of foundational concepts of AI approaches and their relevance to clinical medicine, geared toward clinicians without computer science backgrounds. We also review novel AI approaches in the diagnosis and management of glioma.Results: Novel AI approaches in gliomas have been developed to predict the grading and genomics from imaging, automate the diagnosis from histopathology, and provide insight into prognosis.Conclusion: Novel AI approaches offer acceptable performance in gliomas. Further investigation is necessary to improve the methodology and determine the full clinical utility of these novel approaches.

Published
2019
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5. Prevalence of Students’ Misconceptions in Cardiovascular Physiology, and the Role of Taking Physiology Courses

Author

Mohammad Reza Palizvan, Aboulfazl Jand, Mohammad Reza Tahere nejad, Omid Shafaat, and Mohammad Rafiei

Subjects
learning, misconception, cardiovascular physiology, medical students, Medicine, Medicine (General), R5-920
Abstract

Introduction: The cases of misconceptions are intellectual models of phenomena that are different from accepted scientific models of the same phenomena. The purpose of this study was to investigate the prevalence of cardiovascular misconceptions among students, and evaluate the role of cardiovascular physiology courses in eliminating them. Methods: This descriptive study was performed on 348 undergraduates in three faculties of medicine, nursing, and biology of Arak University of Medical Sciences and Arak University (year 2009). Students were asked to answer four cardiovascular questions through a questionnaire. The answers of students were analyzed by SPSS software using descriptive statistic and two tailed comparison of proportions to reveal any difference between groups. Results: The prevalence of misconception about comparison of left and right ventricular output ranged from 80 to 98 percents. The misconception was prevalent among 79 to 84 percent of students considering pulse velocity comparison to blood velocity in vessel. Between 95 to 99 percent of them had this problem about the effect of resistance increase on blood flow. Sixty Nine to 73 percent of students had trouble with parallel resistance and effect of removal of one limb on total peripheral resistance. Overall, passing cardiovascular physiology courses was not accompanied with significantly different rate of misconceptions. Conclusion: There is a wide prevalence of misconception about at least 4 cardiovascular concepts among students, and passing the courses of cardiovascular physiology has significant effect in reducing this prevalence.

Published
2011

6. How may Doppler indices help in the differentiation of obstructive from nonobstructive hydronephrosis?

Author

Maryam Riahinezhad, Amir Hossein Sarrami, Alaleh Gheisari, Omid Shafaat, Alireza Merikhi, Mehdi Karami, Maryam Farghadani, and Masoud Moslehi

Subjects
Doppler, hydronephrosis, pediatric, radioisotope renography, ultrasonography, ureteropelvic junction obstruction, Medicine
Abstract

Background: We assess the potency of different Doppler indices in the differentiation of obstructive and nonobstructive hydronephrosis. Materials and Methods: In this study, infants and children who were referred for the evaluation of unilateral hydronephrosis were enrolled. Ultrasonography for the assessment of the degree of hydronephrosis and a voiding cystourethrogram for the exclusion of vesicoureteral reflux was performed. Then, Doppler ultrasonography was done for both kidneys of each patient using four classic Doppler indices as well as the difference (delta) of each index between to kidneys. Diuretic renography with 99 mTc-ethylene dicysteine (99 mTc-EC) was performed for each patient. Results: Thirty-nine patients met the inclusion criteria. After diuretic renography, 29 (74.35%) patients had shown a nonobstructive pattern, and ten (25.65%) patients had a partial (intermediate) or complete obstruction. Using receiver operating characteristic (ROC) curve, none of the classic indices of Doppler duplex (i.e., resistive index [RI], resistance index, end diastolic velocity, and peak systolic velocity) had the ability to make a difference between obstructive and nonobstructive hydronephrosis. However, by calculating the difference (delta) of these indices between two kidneys of each patient, delta RI could differentiate the nonobstructive condition, significantly (P = 0.006). A cutoff value of 0.055 has 60% sensitivity and 82.8% specificity. The area under the ROC curve for delta RI is 0.795 (standard error: 0.086, 95% confidence interval [CI]: 0.626, 0.964). Furthermore, RI ratio between two kidneys of each patient could differentiate the nonobstructive condition, significantly (P = 0.012). A cutoff point of 1.075 has 70% sensitivity and 82.8% specificity. The area under the ROC curve for RI ratio was 0.769 (standard error: 0.104, 95% CI: 0.565, 0.973). Conclusion: This study shows that RI ratio and delta RI with a high specificity could differentiate nonobstructive hydronephrosis and therefore it is a promising way to use especially in the follow-up of children with hydronephrosis.

Published
2018
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7. Arginine Adjunctive Therapy in Active Tuberculosis

Author

Aliasghar Farazi, Omid Shafaat, Masoomeh Sofian, and Manijeh Kahbazi

Subjects
Medicine
Abstract

Background. Dietary supplementation has been used as a mechanism to augment the immune system. Adjunctive therapy with L-arginine has the potential to improve outcomes in active tuberculosis. Methods. In a randomized clinical trial 63 participants with smear-positive pulmonary tuberculosis in Markazi Province of Iran were given arginine or placebo for 4 weeks in addition to conventional chemotherapy. The final treatment success, sputum conversion, weight gain, and clinical symptoms after one and two months were considered as primary outcomes and secondary outcomes were ESR, CRP, and Hg. Data were collected and analyzed with SPSS software (ver. 18). Results. Arginine supplementation reduced constitutional symptoms (P=0.032) in patients with smear-positive TB at the end of the first month of treatment. Arginine treated patients had significantly increased BMI at the end of the first and second months of treatment (P=0.032 and P=0.04) and a reduced CRP at the end of the first month of treatment (P=0.03) versus placebo group. Conclusion. Arginine is useful as an adjunctive therapy in patients with active tuberculosis, in which the effects are more likely mediated by the increased production of nitric oxide and improved constitutional symptoms and weight gain. This trial is registered with Clinical Trials Registry of Iran: IRCT201211179855N2.

Published
2015
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11. Leveraging artificial intelligence in ischemic stroke imaging

Author

Ehsan Sotoudeh, Joshua D. Bernstock, Omid Shafaat, Vivek Yedavalli, Amir Shafaat, David M. Yousem, Saksham Gupta, Galal A. Elsayed, Houman Sotoudeh, and Haris I. Sair

Subjects
Diagnostic Imaging, Prognosis prediction, Infarction, Patient care, 030218 nuclear medicine & medical imaging, Machine Learning, Brain ischemia, 03 medical and health sciences, 0302 clinical medicine, Artificial Intelligence, medicine, Humans, Radiology, Nuclear Medicine and imaging, cardiovascular diseases, Stroke, Ischemic Stroke, Radiological and Ultrasound Technology, business.industry, Ischemic strokes, medicine.disease, Clinical diagnosis, Ischemic stroke, Neurology (clinical), Artificial intelligence, business, 030217 neurology & neurosurgery
Abstract

Artificial intelligence (AI) is having a disruptive and transformative effect on clinical medicine. Prompt clinical diagnosis and imaging are critical for minimizing the morbidity and mortality associated with ischemic strokes. Clinicians must understand the current strengths and limitations of AI to provide optimal patient care. Ischemic stroke is one of the medical fields that have been extensively evaluated by artificial intelligence. Presented herein is a review of artificial intelligence applied to clinical management of stroke, geared toward clinicians. In this review, we explain the basic concept of AI and machine learning. This review is without coding and mathematical details and targets the clinicians involved in stroke management without any computer or mathematics' background. Here the AI application in ischemic stroke is summarized and classified into stroke imaging (automated diagnosis of brain infarction, automated ASPECT score calculation, infarction segmentation), prognosis prediction, and patients' selection for treatment.

Published
2022

13. Association between Abdominal CT Measurements of Body Composition before Deceased Donor Liver Transplant with Posttransplant Outcomes

Author

Omid Shafaat, Yi Liu, Kyle R. Jackson, Jennifer D. Motter, Brian J. Boyarsky, Muhammad A. Latif, Frank Yuan, Adham Khalil, Elizabeth A. King, Atif Zaheer, Ronald M. Summers, Dorry L. Segev, Mara McAdams-DeMarco, and Clifford R. Weiss

Subjects
Radiology, Nuclear Medicine and imaging
Abstract

Background Pre-liver transplant (LT) sarcopenia is associated with poor survival. Methods exist for measuring body composition with use of CT scans; however, it is unclear which components best predict post-LT outcomes. Purpose To quantify the association between abdominal CT-based body composition measurements and post-LT mortality in a large North American cohort. Materials and Methods This was a retrospective cohort of adult first-time deceased-donor LT recipients from 2009 to 2018 who underwent pre-LT abdominal CT scans, including at the L3 vertebral level, at Johns Hopkins Hospital. Measurements included sarcopenia (skeletal muscle index [SMI]50 in men and39 in women), sarcopenic obesity, myosteatosis (skeletal muscle CT attenuation41 mean HU for body mass index [BMI]25 and33 mean HU for BMI ≥25), visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and VAT/SAT ratio. Covariates in the adjusted models were selected with use of least absolute shrinkage and selection operator regression with lambda chosen by means of 10-fold cross-validation. Cox proportional hazards models were used to quantify associations with post-LT mortality. Model discrimination was quantified using the Harrell C-statistic. Results A total of 454 recipients (median age, 57 years [IQR, 50-62 years]; 294 men) were evaluated. In the adjusted model, pre-LT sarcopenia was associated with a higher hazard ratio (HR) of post-LT mortality (HR, 1.6 [95% CI: 1.1, 2.4]; C-statistic, 0.64

Published
2023

14. Health system performance in Iran: a systematic analysis for the Global Burden of Disease Study 2019

Author

Farshad Farzadfar, Mohsen Naghavi, Sadaf G Sepanlou, Sahar Saeedi Moghaddam, William James Dangel, Nicole Davis Weaver, Arya Aminorroaya, Sina Azadnajafabad, Sogol Koolaji, Esmaeil Mohammadi, Negar Rezaei, Jaffar Abbas, Behzad Abbasi, Mitra Abbasifard, Mohsen Abbasi-Kangevari, Zeinab Abbasi-Kangevari, Hedayat Abbastabar, Amir Abdoli, Mohammad Abdollahi, Sina Abdollahzade, Hassan Abolhassani, Zahra Abrehdari-Tafreshi, Soodabeh Aghababaei, Bahman Ahadinezhad, Ali Ahmadi, Sepideh Ahmadi, Hamid Ahmadieh, Mohammad Esmaeil Akbari, Yousef Alimohamadi, Vahid Alipour, Hesam Alizade, Saba Alvand, Saeed Amini, Sohrab Amiri, Ali Arash Anoushirvani, Fereshteh Ansari, Jalal Arabloo, Morteza Arab-Zozani, Zahra Aryan, Armin Aryannejad, Mehran Asadi-Aliabadi, Ali A Asadi-Pooya, Zatollah Asemi, Samaneh Asgari, Saeed Asgary, Babak Asghari, Mohammad Asghari Jafarabadi, Elham Ashrafi, Zahra Atafar, Seyyed Shamsadin Athari, Abolfazl Avan, Abbas Azadmehr, Hiva Azami, Mohammadreza Azangou-Khyavy, Samad Azari, Amirhossein Azari Jafari, Ghasem Azarian, Alireza Badirzadeh, Elham Bahrami, Mohammad Amin Bahrami, Nastaran Barati, Mohsen Bayati, Gholamreza Bazmandegan, Masoud Behzadifar, Ali Bijani, Somayeh Bohlouli, Shiva Borzouei, Parnaz Daneshpajouhnejad, Abdollah Dargahi, Ahmad Daryani, Jalal Davoodi Lahijan, Mojtaba Didehdar, Shirin Djalalinia, Saeid Doaei, Fariba Dorostkar, Leila Doshmangir, Mohammadreza Edraki, Amir Emami, Babak Eshrati, Sharareh Eskandarieh, Firooz Esmaeilzadeh, Shahriar Faghani, Mahdi Fakhar, Hamid Reza Farpour, Hossein Farrokhpour, Majid Fasihi Harandi, Mohammad Fereidouni, Masoud Foroutan, Mansour Ghafourifard, Azin Ghamari, Seyyed-Hadi Ghamari, Ahmad Ghashghaee, Fariba Ghassemi, Ali Gholami, Asadollah Gholamian, Abdolmajid Gholizadeh, Salime Goharinezhad, Pouya Goleij, Mostafa Hadei, Nima Hafezi-Nejad, Sanam Hariri, Edris Hasanpoor, Hossein Hassanian-Moghaddam, Soheil Hassanipour, Hadi Hassankhani, Mohammad Heidari, Reza Heidari-Soureshjani, Mohammad Hoseini, Mohammad-Salar Hosseini, Mostafa Hosseini, Seyed Kianoosh Hosseini, Ali Hosseinzadeh, Mehdi Hosseinzadeh, Soodabeh Hoveidamanesh, Pooya Iranpour, Seyed Sina Naghibi Irvani, Jalil Jaafari, Roxana Jabbarinejad, Morteza Jafarinia, Hamed Jafari-Vayghan, Mohammad Ali Jahani, Nader Jahanmehr, Mahsa Jalili, Roksana Janghorban, Fatemeh Javanmardi, Farahnaz Joukar, Ali Kabir, Leila R Kalankesh, Rohollah Kalhor, Zahra Kamiab, Naser Kamyari, Behzad Karami Matin, Amirali Karimi, Salah Eddin Karimi, Ali Kazemi Karyani, Leila Keikavoosi-Arani, Maryam Keramati, Pedram Keshavarz, Mohammad Keykhaei, Ali Khaleghi, Mohammad Khammarnia, Javad Khanali, Maryam Khayamzadeh, Sajad Khosravi, Mina Khosravifar, Omid Khosravizadeh, Neda Kianipour, Ali-Asghar Kolahi, Amirhosein Maali, Mokhtar Mahdavi Mahdavi, Afshin Maleki, Mohammad-Reza Malekpour, Kamyar Mansori, Borhan Mansouri, Mohammad Ali Mansournia, Mohammad Reza Maracy, Abdoljalal Marjani, Sahar Masoudi, Seyedeh Zahra Masoumi, Hossein Masoumi-Asl, Mahsa Mayeli, Entezar Mehrabi Nasab, Fereshteh Mehri, Mohammad Miri, Seyyedmohammadsadeq Mirmoeeni, Hamed Mirzaei, Maryam Mirzaei, Roya Mirzaei, Ashraf Mohamadkhani, Heidar Mohammadi, Seyyede Momeneh Mohammadi, Shadieh Mohammadi, Abdollah Mohammadian-Hafshejani, Noushin Mohammadifard, Reza Mohammadpourhodki, Mohammad Mohseni, Amin Mokari, Sara Momtazmanesh, Abdolvahab Moradi, Masoud Moradi, Yousef Moradi, Mohammad Moradi-Joo, Farhad Moradpour, Maliheh Moradzadeh, Rahmatollah Moradzadeh, Abbas Mosapour, Shandiz Moslehi, Simin Mouodi, Mehdi Naderi, Homa Naderifar, Zhila Najafpour, Javad Nazari, Seyed Aria Nejadghaderi, Leila Nemati-Anaraki, Amin Reza Nikpoor, Marzieh Nojomi, Maryam Noori, Hasti Nouraei, Ali Nowroozi, Morteza Oladnabi, Fatemeh Pashazadeh Kan, Majid Pirestani, Meghdad Pirsaheb, Mohammadreza Pourahmadi, Hadis Pourchamani, Hadi Pourjafar, Akram Pourshams, Mohammad Rabiee, Navid Rabiee, Alireza Rafiei, Sima Rafiei, Fakher Rahim, Amir Masoud Rahmani, Sina Rashedi, Vahid Rashedi, Amirfarzan Rashidi, Mahsa Rashidi, Mohammad-Mahdi Rashidi, Ramin Ravangard, Reza Rawassizadeh, Iman Razeghian-Jahromi, Mohammad Sadegh Razeghinia, Sofia B Redford, Maryam Rezaei, Nazila Rezaei, Nima Rezaei, Saeid Rezaei, Hossein Rezaei Aliabadi, Mohsen Rezaeian, Mohammad Sadegh Rezai, Aziz Rezapour, Hossein Rezazadeh, Sahba Rezazadeh-Khadem, Morteza Rostamian, Ehsan Sadeghi, Erfan Sadeghi, Masoumeh Sadeghi, Reihaneh Sadeghian, Saeid Sadeghian, Hamid Safarpour, Mahdi Safdarian, Sare Safi, Maryam Sahebazzamani, Amirhossein Sahebkar, Mohammad Ali Sahraian, Sarvenaz Salahi, Payman Salamati, Hossein Samadi Kafil, Yaser Sarikhani, Maryam Sarkhosh, Arash Sarveazad, Maryam Seyed-Nezhad, Omid Shafaat, Zahra Shaghaghi, Saeed Shahabi, Sarvenaz Shahin, Elaheh Shaker, Saeed Shakiba, MohammadBagher Shamsi, Erfan Shamsoddin, Kiomars Sharafi, Sakineh Sharifian, Maryam Shaygan, Abbas Sheikhtaheri, Amir Shiani, Kiarash Shirbandi, Reza Shirkoohi, Parnian Shobeiri, Azad Shokri, Soraya Siabani, Ali Reza Sima, Ahmad Sofi-Mahmudi, Amin Soheili, Shahin Soltani, Mohammad Sadegh Soltani-Zangbar, Moslem Soofi, Seidamir Pasha Tabaeian, Mohammadreza Tabary, Alireza Tahamtan, Majid Taheri, Amir Taherkhani, Masih Tajdini, Hamed Tavolinejad, Arash Tehrani-Banihashemi, Amir Tiyuri, Seyed Abolfazl Tohidast, Alireza Vakilian, Sahel Valadan Tahbaz, Bay Vo, Seyed Hossein Yahyazadeh Jabbari, Vahid Yazdi-Feyzabadi, Zabihollah Yousefi, Taraneh Yousefinezhadi, Mazyar Zahir, Telma Zahirian Moghadam, Maryam Zamanian, Hamed Zandian, Alireza Zangeneh, Hadi Zarafshan, Fariba Zare, Ali Zare Dehnavi, Kourosh Zarea, Ahmad Zarei, Zahra Zareshahrabadi, Arash Ziapour, Sina Zoghi, Nizal Sarrafzadegan, Vafa Rahimi-Movaghar, Hamid Reza Jamshidi, Ali H Mokdad, Simon I Hay, Christopher J L Murray, Ardeshir Khosravi, Maziar Moradi-Lakeh, Mohsen Asadi-Lari, Reza Malekzadeh, and Bagher Larijani

Subjects
General Medicine
Published
2022

15. Revision of frailty assessment in kidney transplant recipients: Replacing unintentional weight loss with CT-assessed sarcopenia in the physical frailty phenotype

Author

Xiaomeng Chen, Omid Shafaat, Yi Liu, Elizabeth A. King, Clifford R. Weiss, Qian-Li Xue, Jeremy D. Walston, Dorry L. Segev, and Mara A. McAdams-DeMarco

Subjects
Transplantation, Immunology and Allergy, Pharmacology (medical), Article
Abstract

Kidney transplantation (KT) experts did not support the use of subjective unintentional weight loss to measure shrinking in the Physical Frailty Phenotype (PFP); a clinically feasible and predictive measure of shrinking is needed. To test whether unintentional weight loss could be replaced by an assessment of sarcopenia using existing CT scans, we performed a prospective cohort study of adult KT recipients with original PFP (oPFP) measured at admission (12/2008–2/2020). We ascertained sarcopenia by calculating skeletal muscle index from available, clinically obtained CTs within 1-year pre-KT (male

Published
2022

16. Clinical applications of diffusion-weighted sequence in brain imaging: beyond stroke

Author

Ali Rezaei, Siddhartha Gaddamanugu, Zahra Saadatpour, Houman Sotoudeh, Aparna Singhal, Omid Shafaat, and Amir Hossein Sarrami

Subjects
medicine.medical_specialty, Neurology, Brain tumors, Epilepsy, Review, Trauma, Brain Ischemia, Physical medicine and rehabilitation, Neuroimaging, Humans, Medicine, Radiology, Nuclear Medicine and imaging, cardiovascular diseases, Stroke, Neuroradiology, Sequence (medicine), Demyelinations, business.industry, Brain, medicine.disease, Magnetic Resonance Imaging, Diffusion imaging, Diffusion Magnetic Resonance Imaging, Diffusion-weighted imaging, Neurology (clinical), Neurosurgery, Infection, Cardiology and Cardiovascular Medicine, business, Diffusion MRI
Abstract

Diffusion-weighted imaging (DWI) is a well-established MRI sequence for diagnosing early stroke and provides therapeutic implications. However, DWI yields pertinent information in various other brain pathologies and helps establish a specific diagnosis and management of other central nervous system disorders. Some of these conditions can present with acute changes in neurological status and mimic stroke. This review will focus briefly on diffusion imaging techniques, followed by a more comprehensive description of the utility of DWI in common neurological entities beyond stroke.

Published
2021

19. Bariatric Embolization

Author

Omid Shafaat, Jenanan P. Vairavamurthy, and Clifford R. Weiss

Subjects
medicine.medical_specialty, medicine.diagnostic_test, business.industry, General surgery, medicine.medical_treatment, Interventional radiology, General Medicine, medicine.disease, Obesity, Endoscopy, Weight loss, medicine, Embolization, medicine.symptom, business
Published
2020

20. The global burden of cancer attributable to risk factors, 2010–19 : A systematic analysis for the Global Burden of Disease Study 2019

Author

Khanh Bao Tran, Justin J Lang, Kelly Compton, Rixing Xu, Alistair R Acheson, Hannah Jacqueline Henrikson, Jonathan M Kocarnik, Louise Penberthy, Amirali Aali, Qamar Abbas, Behzad Abbasi, Mohsen Abbasi-Kangevari, Zeinab Abbasi-Kangevari, Hedayat Abbastabar, Michael Abdelmasseh, Sherief Abd-Elsalam, Ahmed Abdelwahab Abdelwahab, Gholamreza Abdoli, Hanan Abdulkadir Abdulkadir, Aidin Abedi, Kedir Hussein Abegaz, Hassan Abidi, Richard Gyan Aboagye, Hassan Abolhassani, Abdorrahim Absalan, Yonas Derso Abtew, Hiwa Abubaker Ali, Eman Abu-Gharbieh, Basavaprabhu Achappa, Juan Manuel Acuna, Daniel Addison, Isaac Yeboah Addo, Oyelola A Adegboye, Miracle Ayomikun Adesina, Mohammad Adnan, Qorinah Estiningtyas Sakilah Adnani, Shailesh M Advani, Sumia Afrin, Muhammad Sohail Afzal, Manik Aggarwal, Bright Opoku Ahinkorah, Araz Ramazan Ahmad, Rizwan Ahmad, Sajjad Ahmad, Sohail Ahmad, Sepideh Ahmadi, Haroon Ahmed, Luai A Ahmed, Muktar Beshir Ahmed, Tarik Ahmed Rashid, Wajeeha Aiman, Marjan Ajami, Gizachew Taddesse Akalu, Mostafa Akbarzadeh-Khiavi, Addis Aklilu, Maxwell Akonde, Chisom Joyqueenet Akunna, Hanadi Al Hamad, Fares Alahdab, Fahad Mashhour Alanezi, Turki M Alanzi, Saleh Ali Alessy, Abdelazeem M Algammal, Mohammed Khaled Al-Hanawi, Robert Kaba Alhassan, Beriwan Abdulqadir Ali, Liaqat Ali, Syed Shujait Ali, Yousef Alimohamadi, Vahid Alipour, Syed Mohamed Aljunid, Motasem Alkhayyat, Sadeq Ali Ali Al-Maweri, Sami Almustanyir, Nivaldo Alonso, Shehabaldin Alqalyoobi, Rajaa M Al-Raddadi, Rami H Hani Al-Rifai, Salman Khalifah Al-Sabah, Ala'a B Al-Tammemi, Haya Altawalah, Nelson Alvis-Guzman, Firehiwot Amare, Edward Kwabena Ameyaw, Javad Javad Aminian Dehkordi, Mohammad Hosein Amirzade-Iranaq, Hubert Amu, Ganiyu Adeniyi Amusa, Robert Ancuceanu, Jason A Anderson, Yaregal Animut Animut, Amir Anoushiravani, Ali Arash Anoushirvani, Alireza Ansari-Moghaddam, Mustafa Geleto Ansha, Benny Antony, Maxwell Hubert Antwi, Sumadi Lukman Anwar, Razique Anwer, Anayochukwu Edward Anyasodor, Jalal Arabloo, Morteza Arab-Zozani, Olatunde Aremu, Ayele Mamo Argaw, Hany Ariffin, Timur Aripov, Muhammad Arshad, Al Artaman, Judie Arulappan, Raphael Taiwo Aruleba, Armin Aryannejad, Malke Asaad, Mulusew A Asemahagn, Zatollah Asemi, Mohammad Asghari-Jafarabadi, Tahira Ashraf, Reza Assadi, Mohammad Athar, Seyyed Shamsadin Athari, Maha Moh'd Wahbi Atout, Sameh Attia, Avinash Aujayeb, Marcel Ausloos, Leticia Avila-Burgos, Atalel Fentahun Awedew, Mamaru Ayenew Awoke, Tewachew Awoke, Beatriz Paulina Ayala Quintanilla, Tegegn Mulatu Ayana, Solomon Shitu Ayen, Davood Azadi, Sina Azadnajafabad, Saber Azami-Aghdash, Melkalem Mamuye Azanaw, Mohammadreza Azangou-Khyavy, Amirhossein Azari Jafari, Hosein Azizi, Ahmed Y Y Azzam, Amirhesam Babajani, Muhammad Badar, Ashish D Badiye, Nayereh Baghcheghi, Nader Bagheri, Sara Bagherieh, Saeed Bahadory, Atif Amin Baig, Jennifer L Baker, Ahad Bakhtiari, Ravleen Kaur Bakshi, Maciej Banach, Indrajit Banerjee, Mainak Bardhan, Francesco Barone-Adesi, Fabio Barra, 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Melinda Gates Foundation, Kuwait University (Kuwait), Ministry of Higher Education (Malasia), Lega Italiana per la Lotta ai Tumori, Health Effects Institute (Estados Unidos), Unión Europea. Comisión Europea. European Research Council (ERC), Unión Europea. Comisión Europea. H2020, Fundação para a Ciência e Tecnologia (Portugal), African-German Network of Excellence in Science (AGNES), Federal Ministry of Education & Research (Alemania), Alexander von Humboldt Foundation, Novo Nordisk Foundation, National Institute for Health Research (Reino Unido), National Health and Medical Research Council (Australia), Romanian National Authority for Scientific Research and Innovation, Romanian Ministry of Research Innovation and Digitalization, Ministry of Education, Science and Technological Development (Serbia), Sigrid Jusélius Foundation, Finnish Cancer Foundation, Datta Meghe Institute of Medical Sciences (India), Xiamen University (Malasia), Manipal Academy of Higher Education (India), Panjab University (India), Sistema Nacional de Investigación (Panamá), Secretaría Nacional de Ciencia, Tecnología e Innovación (Panamá), Ministry of Science and Technology (Taiwan), Lung Foundation Australia, National Natural Science Foundation of China, Wellcome Trust, UNSW Sydney (Australia), ICMR - National Institute of Epidemiology (India), University of Tasmania (Australia), National Council for Scientific and Technological Development (Brasil), Coordenação de Aperfeicoamento de Pessoal de Nível Superior (Brasil), Institute for Advanced Studies in Basic Sciences (Irán), Ain Shams University (Egipto), International Center of Medical Sciences Research (Islamabad), National Institutes of Health (Estados Unidos), University of Oxford (Reino Unido), National Institute of Genetic Engineering and Biotechnology (Irán), Marga und Walter Boll - Stiftung, Ministero della Salute (Italia), IRCCS Materno Infantile Burlo Garofolo (Italia), King College London, Wellcome Trust/DBT India Alliance (India), Public Health, University of St Andrews. School of Medicine, and University of St Andrews. Population and Behavioural Science Division

Subjects
Male, DEATHS, DALY, cancer, risk factors, Medizin, systematic analysis, Global Health, Risk Assessment, Cancer prevention, Global Burden of Disease, RC0254, Risk-attributable cancer deaths, SDG 3 - Good Health and Well-being, RA0421, Risk Factors, RA0421 Public health. Hygiene. Preventive Medicine, Quality-Adjusted Life Year, Neoplasms, cancer, Humans, Global Burden of Disease Study, UK, Medicine(all), MCC, RC0254 Neoplasms. Tumors. Oncology (including Cancer), Risk Factor, Smoking, COVID-19, 3rd-DAS, General Medicine, Disability-adjusted life-years, SOCIAL DETERMINANTS, Risk assessments, risk factor, Cardiovascular and Metabolic Diseases, 3121 General medicine, internal medicine and other clinical medicine, OBESITY, Cancer burden, Neoplasm, Female, LIFE-STYLE, Quality-Adjusted Life Years, HEALTH, RA, Human, RC
Abstract

Background: Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. Methods: The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk-outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. Findings: Globally, in 2019, the risk factors included in this analysis accounted for 4·45 million (95% uncertainty interval 4·01-4·94) deaths and 105 million (95·0-116) DALYs for both sexes combined, representing 44·4% (41·3-48·4) of all cancer deaths and 42·0% (39·1-45·6) of all DALYs. There were 2·88 million (2·60-3·18) risk-attributable cancer deaths in males (50·6% [47·8-54·1] of all male cancer deaths) and 1·58 million (1·36-1·84) risk-attributable cancer deaths in females (36·3% [32·5-41·3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20·4% (12·6-28·4) and DALYs by 16·8% (8·8-25·0), with the greatest percentage increase in metabolic risks (34·7% [27·9-42·8] and 33·3% [25·8-42·0]). Interpretation: The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden. We are grateful to the surveillance systems, including cancer registries, that generated and shared observed cancer burden data. S M Aljunid acknowledges the Department of Health Policy and Management, College of Public Health, Kuwait University for the approval and support to participate in this research project. H Ariffin acknowledges support from the Ministry of Higher Education, Malaysia (grant FRGS/1/2021/SKK0/UM/01/1). F Barra acknowledges support from Lega Italiana per la Lotta contro i Tumori - LILT - Bando 5 x 1000 anno 2019. L Belo and M Carvalho acknowledge the support from FCT in the scope of the project UIDP/04378/2020 and UIDB/04378/2020 of UCIBIO and the project LA/P/0140/2020 of i4HB. A J Cohen was supported by the Health Effects Institute, Boston, MA, USA. J Conde acknowledges financial support from the European Research Council - ERC Starting Grant 848325. V M Costa acknowledges her grant (SFRH/BHD/110001/2015), received by Portuguese national funds through Fundação para a Ciência e Tecnologia (FCT), IP, under the Norma Transitória DL57/2016/CP1334/CT0006. T C Ekundayo was supported by the African-German Network of Excellence in Science (AGNES), the Federal Ministry of Education and Research (BMBF) and the Alexander von Humboldt Foundation (AvH). N Ghith acknowledges support from a grant from Novo Nordisk Foundation (NNF16OC0021856). J C Glasbey is support by a Doctoral Research Fellowship from the National Institute of Health Research (NIHR300175). V K Gupta and V B Gupta acknowledge funding support from National Health and Medical Research Council (NHMRC), Australia. C Herteliu, A Pana, and M Ausloos acknowledge partial support by a grant of the Romanian National Authority for Scientific Research and Innovation, CNDS-UEFISCDI, project number PN-III-P4-ID-PCCF-2016-0084. C Herteliu is also partially supported by a grant of the Romanian Ministry of Research Innovation and Digitalization, MCID, project number ID-585-CTR-42-PFE-2021. S Hussain was supported from Operational Programme Research, Development and Education–Project, Postdoc2MUNI (number CZ.02.2. 69/0.0/0.0/18_053/0016952). M Jakovljevic acknowledges partial support through the grant OI 175 014 of the Ministry of Education Science and Technological Development of the Republic of Serbia. J H Kauppila acknowledges research grants from Sigrid Jusélius Foundation and the Finnish Cancer Foundation. M N Khatib acknowledges support from Datta Meghe Institute of Medical Sciences (deemed-to-be-university). Y J Kim was supported by the Research Management Centre, Xiamen University Malaysia [XMUMRF/2020-C6/ITCM/0004]. S L Koulmane Laxminarayana acknowledges institutional assistance by Manipal Academy of Higher Education, Manipal. K Krishan is supported by the UGC Centre of Advanced Study (Phase II), awarded to the Department of Anthropology, Panjab University, Chandigarh, India. I Landires is a member of the Sistema Nacional de Investigación (SNI), which is supported by Panama’s Secretaría Nacional de Ciencia, Tecnología e Innovación (SENACYT). M-C Li was supported by the Ministry of Science and Technology, Taiwan (MOST 110-2314-B-003-001). G Liu acknowledges support from the CREATE Hope scientific fellowship from Lung Foundation Australia. J Liu acknowledges support from the National Natural Science Foundation (72122001). J A Loureiro was supported by Scientific Employment Stimulus (FCT; CEECINST/00049/2018). E Mathews is supported by a Clinical and Public Health Early Career Fellowship (grant number IA/CPHE/17/1/503345) from the DBT India Alliance/Wellcome Trust Department of Biotechnology, India Alliance (2018–2023). T J Meretoja was supported by an unrestricted grant from Cancer Foundation Finland sr. S Mohammed acknowledges a fellowship grant from Alexander von Humboldt Foundation, outside the submitted work. M Molokhia is supported by the National Institute for Health Research Biomedical Research Center at Guy’s and St Thomas’ National Health Service Foundation Trust and King’s College London. L Monasta received support from the Italian Ministry of Health at the Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste - Italy (RC 34/2017). U Mons is supported by the Marga and Walter Boll Foundation, Kerpen, Germany. M A Moosavi acknowledges the financial support of National Institute of Genetics Engineering and Biotechnology (NIGEB). J Musa acknowledges support from the NIH/FICK43TW011416 for research-protected time for cervical cancer research and career development at University of Jos. V Nuñez-Samudio is a member of the Sistema Nacional de Investigación (SNI), which is supported by Panama’s Secretaría Nacional de Ciencia, Tecnología e Innovación (SENACYT). O O Odukoya acknowledges support by the Fogarty International Center of the National Institutes of Health under the award number K43TW010704 for research-protected time. The content is solely the responsibility of all the authors and does not necessarily represent the official views of the National Institutes of Health. A S Oguntade acknowledges funding by a doctoral scholarship from the Nuffield Department of Population Health, University of Oxford (Oxford Population Health). J R Padubidri acknowledges Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal for their constant support in research collaborations. R G Pestell acknowledges support from NIH grant W81XWH1810605 Breast Cancer Research, Breakthrough Grant R21 CA235139-01. Z Z Piracha acknowledges the International Center of Medical Sciences Research (ICMSR), Islamabad (44000), Pakistan. R A Radhakrishnan acknowledges support from Wellcome Trust/DBT India Alliance - IA/CPHI/18/1/503927. U Saeed acknowledges the International Center of Medical Sciences Research (ICMSR), Islamabad, Pakistan. A M Samy acknowledges the support from Ain Shams University and the Egyptian Fulbright Mission Program. F Sha was supported by the Shenzhen Science and Technology Program (grant number KQTD20190929172835662). H R Shahsavari acknowledges the Institute for Advanced Studies in Basic Sciences (IASBS) Research Council. A Shetty acknowledges Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal for all the academic support. D A S Silva acknowledges financing in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior—Brazil (CAPES)—Finance Code 001 and D A S Silva is supported in part by CNPq-Brazil (309589/2021-5). L M L R Silva was supported by project CENTRO-04-3559-FSE-000162, Fundo Social Europeu (FSE). Am Singh is supported by the International Graduate Research Scholarship, University of Tasmania. R Suliankatchi Abdulkader acknowledges support from ICMR—National Institute of Epidemiology. B Unnikrishnan acknowledges Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal. H Xiao acknowledges support from the Public Health Sciences Division of the Fred Hutchinson Cancer Research Center. X Xu is supported by the University of New South Wales (Australia) Scientia Program. C Yu was supported by the National Natural Science Foundation of China (grant number 82173626) and Wuhan Medical Research Program of Joint Fund of Hubei Health Committee (grant number WJ2019H304). Sí

Published
2022

21. The global burden of adolescent and young adult cancer in 2019: a systematic analysis for the Global Burden of Disease Study 2019

Author

Elysia M Alvarez, Lisa M Force, Rixing Xu, Kelly Compton, Dan Lu, Hannah Jacqueline Henrikson, Jonathan M Kocarnik, James D Harvey, Alyssa Pennini, Frances E Dean, Weijia Fu, Martina T Vargas, Theresa H M Keegan, Hany Ariffin, Ronald D Barr, Yana Arturovna Erdomaeva, D Sanjeeva Gunasekera, Yetunde O John-Akinola, Tyler G Ketterl, Tezer Kutluk, Marcio Henrique Malogolowkin, Prashant Mathur, Venkatraman Radhakrishnan, Lynn Ann Gloeckler Ries, Carlos Rodriguez-Galindo, Garik Barisovich Sagoyan, Iyad Sultan, Behzad Abbasi, Mohsen Abbasi-Kangevari, Zeinab Abbasi-Kangevari, Hedayat Abbastabar, Michael Abdelmasseh, Sherief Abd-Elsalam, Amir Abdoli, Haimanot Abebe, Aidin Abedi, Hassan Abidi, Hassan Abolhassani, Hiwa Abubaker Ali, Eman Abu-Gharbieh, Basavaprabhu Achappa, Juan Manuel Acuna, Isaac Akinkunmi Adedeji, Oyelola A Adegboye, Qorinah Estiningtyas Sakilah Adnani, Shailesh M Advani, Muhammad Sohail Afzal, Mohamad Aghaie Meybodi, Bahman Ahadinezhad, Bright Opoku Ahinkorah, Sajjad Ahmad, Sepideh Ahmadi, Muktar Beshir Ahmed, Tarik Ahmed Rashid, Yusra Ahmed Salih, Wajeeha Aiman, Gizachew Taddesse Akalu, Hanadi Al Hamad, Fares Alahdab, Abdulhadi A AlAmodi, Fahad Mashhour Alanezi, Turki M Alanzi, Adugnaw Zeleke Alem, Dejene Tsegaye Alem, Yosef Alemayehu, Fadwa Naji Alhalaiqa, Robert Kaba Alhassan, Saqib Ali, Gianfranco Alicandro, Vahid Alipour, Syed Mohamed Aljunid, Motasem Alkhayyat, Sunitha Alluri, Nihad A Almasri, Sadeq Ali Al-Maweri, Sami Almustanyir, Rajaa M Al-Raddadi, Nelson Alvis-Guzman, Edward Kwabena Ameyaw, Saeed Amini, Hubert Amu, Robert Ancuceanu, Catalina Liliana Andrei, Tudorel Andrei, Fereshteh Ansari, Alireza Ansari-Moghaddam, Davood Anvari, Anayochukwu Edward Anyasodor, Jalal Arabloo, Morteza Arab-Zozani, Ayele Mamo Argaw, Muhammad Arshad, Judie Arulappan, Armin Aryannejad, Zatollah Asemi, Mohammad Asghari Jafarabadi, Mohammad Reza Atashzar, Prince Atorkey, Alok Atreya, Sameh Attia, Avinash Aujayeb, Marcel Ausloos, Leticia Avila-Burgos, Atalel Fentahun Awedew, Beatriz Paulina Ayala Quintanilla, Alemu Degu Ayele, Solomon Shitu Ayen, Mohammed A Azab, Sina Azadnajafabad, Hiva Azami, Mohammadreza Azangou-Khyavy, Amirhossein Azari Jafari, Ghasem Azarian, Ahmed Y Azzam, Saeed Bahadory, Jianjun Bai, Atif Amin Baig, Jennifer L Baker, Maciej Banach, Till Winfried Bärnighausen, Francesco Barone-Adesi, Fabio Barra, Amadou Barrow, Huda Basaleem, Abdul-Monim Mohammad Batiha, Masoud Behzadifar, Niguss Cherie Bekele, Rebuma Belete, Uzma Iqbal Belgaumi, Arielle Wilder Bell, Alemshet Yirga Berhie, Devidas S Bhagat, Akshaya Srikanth Bhagavathula, Nikha Bhardwaj, Pankaj Bhardwaj, Sonu Bhaskar, Krittika Bhattacharyya, Vijayalakshmi S Bhojaraja, Sadia Bibi, Ali Bijani, Antonio Biondi, Setognal Birara, Tone Bjørge, Obasanjo Afolabi Bolarinwa, Srinivasa Rao Bolla, Archith Boloor, Dejana Braithwaite, Hermann Brenner, Norma B Bulamu, Katrin Burkart, Maria Teresa Bustamante-Teixeira, Nadeem Shafique Butt, Zahid A Butt, Florentino Luciano Caetano dos Santos, Chao Cao, Yin Cao, Giulia Carreras, Ferrán Catalá-López, Francieli Cembranel, Ester Cerin, Raja Chandra Chakinala, Promit Ananyo Chakraborty, Vijay Kumar Chattu, Pankaj Chaturvedi, Akhilanand Chaurasia, Prachi P Chavan, Odgerel Chimed-Ochir, Jee-Young Jasmine Choi, Devasahayam J Christopher, Dinh-Toi Chu, Michael T Chung, Joao Conde, Vera Marisa Costa, Omar B Da'ar, Omid Dadras, Saad M A Dahlawi, Xiaochen Dai, Giovanni Damiani, Emanuele D'Amico, Lalit Dandona, Rakhi Dandona, Parnaz Daneshpajouhnejad, Amira Hamed Darwish, Ahmad Daryani, Fernando Pio De la Hoz, Sisay Abebe Debela, Takele Gezahegn G Demie, Getu Debalkie Demissie, Zeleke Geto Demissie, Edgar Denova-Gutiérrez, Meseret Derbew Molla, Rupak Desai, Abebaw Alemayehu Desta, Deepak Dhamnetiya, Samath Dhamminda Dharmaratne, Mandira Lamichhane Dhimal, Meghnath Dhimal, Mostafa Dianatinasab, Mojtaba Didehdar, Mengistie Diress, Shirin Djalalinia, Huyen Phuc Do, Saeid Doaei, Fariba Dorostkar, Wendel Mombaque dos Santos, Thomas M Drake, Michael Ekholuenetale, Iman El Sayed, Maysaa El Sayed Zaki, Maha El Tantawi, Hassan El-Abid, Mostafa Ahmed Elbahnasawy, Iffat Elbarazi, Hala Rashad Elhabashy, Muhammed Elhadi, Shaimaa I El-Jaafary, Daniel Berhanie Enyew, Ryenchindorj Erkhembayar, Babak Eshrati, Sharareh Eskandarieh, Mohammed Faisaluddin, Jawad Fares, Umar Farooque, Abidemi Omolara Fasanmi, Wafa Fatima, José Miguel P Ferreira de Oliveira, Simone Ferrero, Lorenzo Ferro Desideri, Getahun Fetensa, Irina Filip, Florian Fischer, James L Fisher, Masoud Foroutan, Takeshi Fukumoto, Peter Andras Gaal, Mohamed M Gad, Piyada Gaewkhiew, Silvano Gallus, Tushar Garg, Teferi Gebru Gebremeskel, Belete Negese Belete Gemeda, Tamiru Getachew, Mansour Ghafourifard, Seyyed-Hadi Ghamari, Ahmad Ghashghaee, Fariba Ghassemi, Nermin Ghith, Ali Gholami, Jamshid Gholizadeh Navashenaq, Syed Amir Gilani, Themba G Ginindza, Abraham Tamirat Gizaw, James C Glasbey, Amit Goel, Mahaveer Golechha, Pouya Goleij, Davide Golinelli, Sameer Vali Gopalani, Giuseppe Gorini, Houman Goudarzi, Bárbara Niegia Garcia Goulart, Ayman Grada, Mohammed Ibrahim Mohialdeen Gubari, Maximiliano Ribeiro Guerra, Avirup Guha, Bhawna Gupta, Sapna Gupta, Veer Bala Gupta, Vivek Kumar Gupta, Rasool Haddadi, Nima Hafezi-Nejad, Alemayehu Hailu, Arvin Haj-Mirzaian, Rabih Halwani, Randah R Hamadeh, Mitiku Teshome Hambisa, Sajid Hameed, Samer Hamidi, Shafiul Haque, Sanam Hariri, Josep Maria Haro, Ahmed I Hasaballah, S M Mahmudul Hasan, Seyedeh Melika Hashemi, Treska S Hassan, Soheil Hassanipour, Simon I Hay, Khezar Hayat, Sultan H Hebo, Golnaz Heidari, Mohammad Heidari, Brenda Yuliana Herrera-Serna, Claudiu Herteliu, Demisu Zenbaba Heyi, Kamal Hezam, Michael K Hole, Ramesh Holla, Nobuyuki Horita, Md Mahbub Hossain, Mohammad Bellal Hossain, Mohammad-Salar Hosseini, Mostafa Hosseini, Ali Hosseinzadeh, Mehdi Hosseinzadeh, Mihaela Hostiuc, Sorin Hostiuc, Mowafa Househ, Mohamed Hsairi, Junjie Huang, Nawfal R Hussein, Bing-Fang Hwang, Segun Emmanuel Ibitoye, Olayinka Stephen Ilesanmi, Irena M Ilic, Milena D Ilic, Kaire Innos, Lalu Muhammad Irham, Rakibul M Islam, Sheikh Mohammed Shariful Islam, Nahlah Elkudssiah Ismail, Gaetano Isola, Masao Iwagami, Louis Jacob, Farhad Jadidi-Niaragh, Vardhmaan Jain, Mihajlo Jakovljevic, Roksana Janghorban, Amirreza Javadi Mamaghani, Shubha Jayaram, Ranil Jayawardena, Seyed Behzad Jazayeri, Rime Jebai, Ravi Prakash Jha, Tamas Joo, Nitin Joseph, Farahnaz Joukar, Mikk Jürisson, Billingsley Kaambwa, Ali Kabir, Leila R Kalankesh, Feroze Kaliyadan, Zul Kamal, Ashwin Kamath, Himal Kandel, Sitanshu Sekhar Kar, Ibraheem M Karaye, Amirali Karimi, Bekalu Getnet Kassa, Joonas H Kauppila, Phillip M Kemp Bohan, Andre Pascal Kengne, Amene Abebe Kerbo, Mohammad Keykhaei, Yousef Saleh Khader, Himanshu Khajuria, Nastaran Khalili, Neda Khalili, Ejaz Ahmad Khan, Gulfaraz Khan, Maseer Khan, Md Nuruzzaman Khan, Moien AB Khan, Javad Khanali, Maryam Khayamzadeh, Omid Khosravizadeh, Jagdish Khubchandani, Roba Khundkar, Min Seo Kim, Yun Jin Kim, Adnan Kisa, Sezer Kisa, Katarzyna Kissimova-Skarbek, Ali-Asghar Kolahi, Jacek A Kopec, Rajasekaran Koteeswaran, Sindhura Lakshmi Koulmane Laxminarayana, Ai Koyanagi, Nuworza Kugbey, G Anil Kumar, Nithin Kumar, Alexander Kwarteng, Carlo La Vecchia, Qing Lan, Iván Landires, Savita Lasrado, Paolo Lauriola, Caterina Ledda, Sang-woong Lee, Wei-Chen Lee, Yeong Yeh Lee, Yo Han Lee, James Leigh, Elvynna Leong, Bingyu Li, Jiarui Li, Ming-Chieh Li, Stephen S Lim, Xuefeng Liu, Stany W Lobo, Joana A Loureiro, Alessandra Lugo, Raimundas Lunevicius, Hassan Magdy Abd El Razek, Muhammed Magdy Abd El Razek, Morteza Mahmoudi, Azeem Majeed, Alaa Makki, Shilpa Male, Mohammad-Reza Malekpour, Reza Malekzadeh, Ahmad Azam Malik, Mohammed A Mamun, Navid Manafi, Fariborz Mansour-Ghanaei, Borhan Mansouri, Mohammad Ali Mansournia, Santi Martini, Seyedeh Zahra Masoumi, Clara N Matei, Manu Raj Mathur, Colm McAlinden, Ravi Mehrotra, Walter Mendoza, Ritesh G Menezes, Alexios-Fotios A Mentis, Tuomo J Meretoja, Amanual Getnet Mersha, Mohamed Kamal Mesregah, Tomislav Mestrovic, Junmei Miao Jonasson, Bartosz Miazgowski, Irmina Maria Michalek, Ted R Miller, Alemu Basazin Mingude, Seyyedmohammadsadeq Mirmoeeni, Hamed Mirzaei, Sanjeev Misra, Prasanna Mithra, Karzan Abdulmuhsin Mohammad, Mokhtar Mohammadi, Seyyede Momeneh Mohammadi, Abdollah Mohammadian-Hafshejani, Reza Mohammadpourhodki, Arif Mohammed, Shafiu Mohammed, Teroj Abdulrahman Mohammed, Nagabhishek Moka, Ali H Mokdad, Mariam Molokhia, Sara Momtazmanesh, Lorenzo Monasta, Mohammad Ali Moni, Ghobad Moradi, Yousef Moradi, Maliheh Moradzadeh, Rahmatollah Moradzadeh, Paula Moraga, Shane Douglas Morrison, Ebrahim Mostafavi, Amin Mousavi Khaneghah, Christine Mpundu-Kaambwa, Sumaira Mubarik, Lillian Mwanri, Ashraf F Nabhan, Shankar Prasad Nagaraju, Chie Nagata, Mohsen Naghavi, Mukhammad David Naimzada, Luigi Naldi, Vinay Nangia, Atta Abbas Naqvi, Sreenivas Narasimha Swamy, Aparna Ichalangod Narayana, Biswa Prakash Nayak, Vinod C Nayak, Javad Nazari, Sabina Onyinye Nduaguba, Ionut Negoi, Serban Mircea Negru, Seyed Aria Nejadghaderi, Samata Nepal, Sandhya Neupane Kandel, Haruna Asura Nggada, Cuong Tat Nguyen, Chukwudi A Nnaji, Hamed Nosrati, Hasti Nouraei, Ali Nowroozi, Virginia Nuñez-Samudio, Vincent Ebuka Nwatah, Chimezie Igwegbe Nzoputam, Bogdan Oancea, Oluwakemi Ololade Odukoya, Ayodipupo Sikiru Oguntade, In-Hwan Oh, Andrew T Olagunju, Tinuke O Olagunju, Babayemi Oluwaseun Olakunde, Mojisola Morenike Oluwasanu, Emad Omar, Ahmed Omar Bali, Sokking Ong, Obinna E Onwujekwe, Doris V Ortega-Altamirano, Nikita Otstavnov, Stanislav S Otstavnov, Bilcha Oumer, Mayowa O Owolabi, Mahesh P A, Alicia Padron-Monedero, Jagadish Rao Padubidri, Keyvan Pakshir, Adrian Pana, Anamika Pandey, Shahina Pardhan, Fatemeh Pashazadeh Kan, Maja Pasovic, Jenil R Patel, Siddhartha Pati, Sanjay M Pattanshetty, Uttam Paudel, Renato B Pereira, Mario F P Peres, Arokiasamy Perianayagam, Maarten J Postma, Hadi Pourjafar, Akram Pourshams, Akila Prashant, Thejodhar Pulakunta, Mirza Muhammad Fahd Fahd Qadir, Mohammad Rabiee, Navid Rabiee, Amir Radfar, Raghu Anekal Radhakrishnan, Ata Rafiee, Alireza Rafiei, Sima Rafiei, Fakher Rahim, Shadi Rahimzadeh, Mosiur Rahman, Muhammad Aziz Rahman, Amir Masoud Rahmani, Aashish Rajesh, Vajiheh Ramezani-Doroh, Kamal Ranabhat, Priyanga Ranasinghe, Chythra R Rao, Sowmya J Rao, Sina Rashedi, Mahsa Rashidi, Mohammad-Mahdi Rashidi, Goura Kishor Rath, David Laith Rawaf, Salman Rawaf, Lal Rawal, Reza Rawassizadeh, Mohammad Sadegh Razeghinia, Misganu Teshoma Regasa, Andre M N Renzaho, Maryam Rezaei, Negar Rezaei, Nima Rezaei, Mohsen Rezaeian, Aziz Rezapour, Sahba Rezazadeh-Khadem, Abanoub Riad, Ligia Estefania Rios Lopez, Jefferson Antonio Buendia Rodriguez, Luca Ronfani, Gholamreza Roshandel, Godfrey M Rwegerera, Maha Mohamed Saber-Ayad, Siamak Sabour, Basema Saddik, Erfan Sadeghi, Saeid Sadeghian, Umar Saeed, Amirhossein Sahebkar, KM Saif-Ur-Rahman, S Mohammad Sajadi, Sarvenaz Salahi, Sana Salehi, Marwa Rashad Salem, Hamideh Salimzadeh, Abdallah M Samy, Juan Sanabria, Francesco Sanmarchi, Arash Sarveazad, Brijesh Sathian, Monika Sawhney, Susan M Sawyer, Mete Saylan, Ione Jayce Ceola Schneider, Abdul-Aziz Seidu, Mario Šekerija, Endalew Gemechu Sendo, Sadaf G Sepanlou, Allen Seylani, Kenbon Seyoum, Feng Sha, Omid Shafaat, Masood Ali Shaikh, Erfan Shamsoddin, Mohammed Shannawaz, Rajesh Sharma, Sara Sheikhbahaei, Adithi Shetty, B Suresh Kumar Shetty, Pavanchand H Shetty, Jae Il Shin, Reza Shirkoohi, K M Shivakumar, Parnian Shobeiri, Soraya Siabani, Migbar Mekonnen Sibhat, Sudeep K Siddappa Malleshappa, Negussie Boti Sidemo, Diego Augusto Santos Silva, Guilherme Silva Julian, Achintya Dinesh Singh, Jasvinder A Singh, Jitendra Kumar Singh, Surjit Singh, Abiy H Sinke, Yitagesu Sintayehu, Valentin Yurievich Skryabin, Anna Aleksandrovna Skryabina, Lee Smith, Ahmad Sofi-Mahmudi, Mohammad Sadegh Soltani-Zangbar, Suhang Song, Emma Elizabeth Spurlock, Paschalis Steiropoulos, Kurt Straif, 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H., Barr R.D., Erdomaeva Y.A., Gunasekera D.S., John-Akinola Y.O., Ketterl T.G., Kutluk T., Malogolowkin M.H., Mathur P., Radhakrishnan V., Ries L.A.G., Rodriguez-Galindo C., Sagoyan G.B., Sultan I., Abbasi B., Abbasi-Kangevari M., Abbasi-Kangevari Z., Abbastabar H., Abdelmasseh M., Abd-Elsalam S., Abdoli A., Abebe H., Abedi A., Abidi H., Abolhassani H., Abubaker Ali H., Abu-Gharbieh E., Achappa B., Acuna J.M., Adedeji I.A., Adegboye O.A., Adnani Q.E.S., Advani S.M., Afzal M.S., Aghaie Meybodi M., Ahadinezhad B., Ahinkorah B.O., Ahmad S., Ahmadi S., Ahmed M.B., Ahmed Rashid T., Ahmed Salih Y., Aiman W., Akalu G.T., Al Hamad H., Alahdab F., AlAmodi A.A., Alanezi F.M., Alanzi T.M., Alem A.Z., Alem D.T., Alemayehu Y., Alhalaiqa F.N., Alhassan R.K., Ali S., Alicandro G., Alipour V., Aljunid S.M., Alkhayyat M., Alluri S., Almasri N.A., Al-Maweri S.A., Almustanyir S., Al-Raddadi R.M., Alvis-Guzman N., Ameyaw E.K., Amini S., Amu H., Ancuceanu R., Andrei C.L., Andrei T., Ansari F., Ansari-Moghaddam A., Anvari D., Anyasodor A.E., Arabloo J., Arab-Zozani M., Argaw A.M., Arshad M., Arulappan J., Aryannejad A., Asemi Z., Asghari Jafarabadi M., Atashzar M.R., Atorkey P., Atreya A., Attia S., Aujayeb A., Ausloos M., Avila-Burgos L., Awedew A.F., Ayala Quintanilla B.P., Ayele A.D., Ayen S.S., Azab M.A., Azadnajafabad S., Azami H., Azangou-Khyavy M., Azari Jafari A., Azarian G., Azzam A.Y., Bahadory S., Bai J., Baig A.A., Baker J.L., Banach M., Barnighausen T.W., Barone-Adesi F., Barra F., Barrow A., Basaleem H., Batiha A.-M.M., Behzadifar M., Bekele N.C., Belete R., Belgaumi U.I., Bell A.W., Berhie A.Y., Bhagat D.S., Bhagavathula A.S., Bhardwaj N., Bhardwaj P., Bhaskar S., Bhattacharyya K., Bhojaraja V.S., Bibi S., Bijani A., Biondi A., Birara S., Bjorge T., Bolarinwa O.A., Bolla S.R., Boloor A., Braithwaite D., Brenner H., Bulamu N.B., Burkart K., Bustamante-Teixeira M.T., Butt N.S., Butt Z.A., Caetano dos Santos F.L., Cao C., Cao Y., Carreras G., Catala-Lopez F., Cembranel F., Cerin E., Chakinala R.C., Chakraborty P.A., Chattu V.K., Chaturvedi P., Chaurasia A., Chavan P.P., Chimed-Ochir O., Choi J.-Y.J., Christopher D.J., Chu D.-T., Chung M.T., Conde J., Costa V.M., Da'ar O.B., Dadras O., Dahlawi S.M.A., Dai X., Damiani G., D'Amico E., Dandona L., Dandona R., Daneshpajouhnejad P., Darwish A.H., Daryani A., De la Hoz F.P., Debela S.A., Demie T.G.G., Demissie G.D., Demissie Z.G., Denova-Gutierrez E., Derbew Molla M., Desai R., Desta A.A., Dhamnetiya D., Dharmaratne S.D., Dhimal M.L., Dhimal M., Dianatinasab M., Didehdar M., Diress M., Djalalinia S., Do H.P., Doaei S., Dorostkar F., dos Santos W.M., Drake T.M., Ekholuenetale M., El Sayed I., El Sayed Zaki M., El Tantawi M., El-Abid H., Elbahnasawy M.A., Elbarazi I., Elhabashy H.R., Elhadi M., El-Jaafary S.I., Enyew D.B., Erkhembayar R., Eshrati B., Eskandarieh S., Faisaluddin M., Fares J., Farooque U., Fasanmi A.O., Fatima W., Ferreira de Oliveira J.M.P., Ferrero S., Ferro Desideri L., Fetensa G., Filip I., Fischer F., Fisher J.L., Foroutan M., Fukumoto T., Gaal P.A., Gad M.M., Gaewkhiew P., Gallus S., Garg T., Gebremeskel T.G., Gemeda B.N.B., Getachew T., Ghafourifard M., Ghamari S.-H., Ghashghaee A., Ghassemi F., Ghith N., Gholami A., Gholizadeh Navashenaq J., Gilani S.A., Ginindza T.G., Gizaw A.T., Glasbey J.C., Goel A., Golechha M., Goleij P., Golinelli D., Gopalani S.V., Gorini G., Goudarzi H., Goulart B.N.G., Grada A., Gubari M.I.M., Guerra M.R., Guha A., Gupta B., Gupta S., Gupta V.B., Gupta V.K., Haddadi R., Hafezi-Nejad N., Hailu A., Haj-Mirzaian A., Halwani R., Hamadeh R.R., Hambisa M.T., Hameed S., Hamidi S., Haque S., Hariri S., Haro J.M., Hasaballah A.I., Hasan S.M.M., Hashemi S.M., Hassan T.S., Hassanipour S., Hay S.I., Hayat K., Hebo S.H., Heidari G., Heidari M., Herrera-Serna B.Y., Herteliu C., Heyi D.Z., Hezam K., Hole M.K., Holla R., Horita N., Hossain M.M., Hossain M.B., Hosseini M.-S., Hosseini M., Hosseinzadeh A., Hosseinzadeh M., Hostiuc M., Hostiuc S., Househ M., Hsairi M., Huang J., Hussein N.R., Hwang B.-F., Ibitoye S.E., Ilesanmi O.S., Ilic I.M., Ilic M.D., Innos K., Irham L.M., Islam R.M., Islam S.M.S., Ismail N.E., Isola G., Iwagami M., Jacob L., Jadidi-Niaragh F., Jain V., Jakovljevic M., Janghorban R., Javadi Mamaghani A., Jayaram S., Jayawardena R., Jazayeri S.B., Jebai R., Jha R.P., Joo T., Joseph N., Joukar F., Jurisson M., Kaambwa B., Kabir A., Kalankesh L.R., Kaliyadan F., Kamal Z., Kamath A., Kandel H., Kar S.S., Karaye I.M., Karimi A., Kassa B.G., Kauppila J.H., Kemp Bohan P.M., Kengne A.P., Kerbo A.A., Keykhaei M., Khader Y.S., Khajuria H., Khalili N., Khan E.A., Khan G., Khan M., Khan M.N., Khan M.A., Khanali J., Khayamzadeh M., Khosravizadeh O., Khubchandani J., Khundkar R., Kim M.S., Kim Y.J., Kisa A., Kisa S., Kissimova-Skarbek K., Kolahi A.-A., Kopec J.A., Koteeswaran R., Koulmane Laxminarayana S.L., Koyanagi A., Kugbey N., Kumar G.A., Kumar N., Kwarteng A., La Vecchia C., Lan Q., Landires I., Lasrado S., Lauriola P., Ledda C., Lee S.-W., Lee W.-C., Lee Y.Y., Lee Y.H., Leigh J., Leong E., Li B., Li J., Li M.-C., Lim S.S., Liu X., Lobo S.W., Loureiro J.A., Lugo A., Lunevicius R., Magdy Abd El Razek H., Magdy Abd El Razek M., Mahmoudi M., Majeed A., Makki A., Male S., Malekpour M.-R., Malekzadeh R., Malik A.A., Mamun M.A., Manafi N., Mansour-Ghanaei F., Mansouri B., Mansournia M.A., Martini S., Masoumi S.Z., Matei C.N., Mathur M.R., McAlinden C., Mehrotra R., Mendoza W., Menezes R.G., Mentis A.-F.A., Meretoja T.J., Mersha A.G., Mesregah M.K., Mestrovic T., Miao Jonasson J., Miazgowski B., Michalek I.M., Miller T.R., Mingude A.B., Mirmoeeni S., Mirzaei H., Misra S., Mithra P., Mohammad K.A., Mohammadi M., Mohammadi S.M., Mohammadian-Hafshejani A., Mohammadpourhodki R., Mohammed A., Mohammed S., Mohammed T.A., Moka N., Mokdad A.H., Molokhia M., Momtazmanesh S., Monasta L., Moni M.A., Moradi G., Moradi Y., Moradzadeh M., Moradzadeh R., Moraga P., Morrison S.D., Mostafavi E., Mousavi Khaneghah A., Mpundu-Kaambwa C., Mubarik S., Mwanri L., Nabhan A.F., Nagaraju S.P., Nagata C., Naghavi M., Naimzada M.D., Naldi L., Nangia V., Naqvi A.A., Narasimha Swamy S., Narayana A.I., Nayak B.P., Nayak V.C., Nazari J., Nduaguba S.O., Negoi I., Negru S.M., Nejadghaderi S.A., Nepal S., Neupane Kandel S., Nggada H.A., Nguyen C.T., Nnaji C.A., Nosrati H., Nouraei H., Nowroozi A., Nunez-Samudio V., Nwatah V.E., Nzoputam C.I., Oancea B., Odukoya O.O., Oguntade A.S., Oh I.-H., Olagunju A.T., Olagunju T.O., Olakunde B.O., Oluwasanu M.M., Omar E., Omar Bali A., Ong S., Onwujekwe O.E., Ortega-Altamirano D.V., Otstavnov N., Otstavnov S.S., Oumer B., Owolabi M.O., P A M., Padron-Monedero A., Padubidri J.R., Pakshir K., Pana A., Pandey A., Pardhan S., Pashazadeh Kan F., Pasovic M., Patel J.R., Pati S., Pattanshetty S.M., Paudel U., Pereira R.B., Peres M.F.P., Perianayagam A., Postma M.J., Pourjafar H., Pourshams A., Prashant A., Pulakunta T., Qadir M.M.F.F., Rabiee M., Rabiee N., Radfar A., Radhakrishnan R.A., Rafiee A., Rafiei A., Rafiei S., Rahim F., Rahimzadeh S., Rahman M., Rahman M.A., Rahmani A.M., Rajesh A., Ramezani-Doroh V., Ranabhat K., Ranasinghe P., Rao C.R., Rao S.J., Rashedi S., Rashidi M., Rashidi M.-M., Rath G.K., Rawaf D.L., Rawaf S., Rawal L., Rawassizadeh R., Razeghinia M.S., Regasa M.T., Renzaho A.M.N., Rezaei M., Rezaei N., Rezaeian M., Rezapour A., Rezazadeh-Khadem S., Riad A., Rios Lopez L.E., Rodriguez J.A.B., Ronfani L., Roshandel G., Rwegerera G.M., Saber-Ayad M.M., Sabour S., Saddik B., Sadeghi E., Sadeghian S., Saeed U., Sahebkar A., Saif-Ur-Rahman K.M., Sajadi S.M., Salahi S., Salehi S., Salem M.R., Salimzadeh H., Samy A.M., Sanabria J., Sanmarchi F., Sarveazad A., Sathian B., Sawhney M., Sawyer S.M., Saylan M., Schneider I.J.C., Seidu A.-A., Sekerija M., Sendo E.G., Sepanlou S.G., Seylani A., Seyoum K., Sha F., Shafaat O., Shaikh M.A., Shamsoddin E., Shannawaz M., Sharma R., Sheikhbahaei S., Shetty A., Shetty B.S.K., Shetty P.H., Shin J.I., Shirkoohi R., Shivakumar K.M., Shobeiri P., Siabani S., Sibhat M.M., Siddappa Malleshappa S.K., Sidemo N.B., Silva D.A.S., Silva Julian G., Singh A.D., Singh J.A., Singh J.K., Singh S., Sinke A.H., Sintayehu Y., Skryabin V.Y., Skryabina A.A., Smith L., Sofi-Mahmudi A., Soltani-Zangbar M.S., Song S., Spurlock E.E., Steiropoulos P., Straif K., Subedi R., Sufiyan M.B., Suliankatchi Abdulkader R., Sultana S., Szerencses V., Szocska M., Tabaeian S.P., Tabares-Seisdedos R., Tabary M., Tabuchi T., Tadbiri H., Taheri M., Taherkhani A., Takahashi K., Tampa M., Tan K.-K., Tat V.Y., Tavakoli A., Tbakhi A., Tehrani-Banihashemi A., Temsah M.-H., Tesfay F.H., Tesfaye B., Thakur J.S., Thapar R., Thavamani A., Thiyagarajan A., Thomas N., Tobe-Gai R., Togtmol M., Tohidast S.A., Tohidinik H.R., Tolani M.A., Tollosa D.N., Touvier M., Tovani-Palone M.R., Traini E., Tran B.X., Tran M.T.N., Tripathy J.P., Tusa B.S., Ukke G.G., Ullah I., Ullah S., Umapathi K.K., Unnikrishnan B., Upadhyay E., Ushula T.W., Vacante M., Valadan Tahbaz S., Varthya S.B., Veroux M., Villeneuve P.J., Violante F.S., Vlassov V., Vu G.T., Waheed Y., Wang N., Ward P., Weldesenbet A.B., Wen Y.F., Westerman R., Winkler A.S., Wubishet B.L., Xu S., Yahyazadeh Jabbari S.H., Yang L., Yaya S., Yazdi-Feyzabadi V., Yazie T.S., Yehualashet S.S., Yeshaneh A., Yeshaw Y., Yirdaw B.W., Yonemoto N., Younis M.Z., Yousefi Z., Yu C., Yunusa I., Zadnik V., Zahir M., Zahirian Moghadam T., Zamani M., Zamanian M., Zandian H., Zare F., Zastrozhin M.S., Zastrozhina A., Zhang J., Zhang Z.-J., Ziapour A., Zoladl M., Murray C.J.L., Fitzmaurice C., Bleyer A., Bhakta N., Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET), Value, Affordability and Sustainability (VALUE), Microbes in Health and Disease (MHD), NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM), HUS Comprehensive Cancer Center, University of Helsinki, Bill & Melinda Gates Foundation, American Lebanese Syrian Associated Charities, St. Baldrick's Foundation, NIH - National Cancer Institute (NCI) (Estados Unidos), Epidemiologie, and RS: NUTRIM - R3 - Respiratory & Age-related Health

Subjects
adolescent cancer, global burden of disease, epidemiology, Adult, Male, Adolescent, 3122 Cancers, UNITED-STATES, Disability-Adjusted Life Year, Adolescents, Socioeconomic Factor, Global Health, Global Burden of Disease, Young Adult, Life Expectancy, SDG 3 - Good Health and Well-being, Risk Factors, WORLDWIDE, Neoplasms, Cause of Death, Prevalence, Humans, 1112 Oncology and Carcinogenesis, Oncology & Carcinogenesis, Mortality, Cancer burden analyses, Cancer, ACUTE LYMPHOBLASTIC-LEUKEMIA, disease, Global burden, OUTCOMES, CHILDHOOD-CANCER, Incidence, Risk Factor, the GBD 2019 methodology, Disability-Adjusted Life Years, GBD 2019 Adolescent Young Adult Cancer Collaborators, CARE, Cancer control efforts, Socioeconomic Factors, Oncology, Neoplasm, Female, Young adults, Human
Abstract

Funding: J A Loureiro acknowledges support from Base Funding UIDB/00511/2020 of the LEPABE funded by national funds through the FCT/MCTES (PIDDAC) and Scientific Employment Stimulus (FCT) [CEECINST/00049/2018]. Background: In estimating the global burden of cancer, adolescents and young adults with cancer are often overlooked, despite being a distinct subgroup with unique epidemiology, clinical care needs, and societal impact. Comprehensive estimates of the global cancer burden in adolescents and young adults (aged 15–39 years) are lacking. To address this gap, we analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, with a focus on the outcome of disability-adjusted life-years (DALYs), to inform global cancer control measures in adolescents and young adults. Methods: Using the GBD 2019 methodology, international mortality data were collected from vital registration systems, verbal autopsies, and population-based cancer registry inputs modelled with mortality-to-incidence ratios (MIRs). Incidence was computed with mortality estimates and corresponding MIRs. Prevalence estimates were calculated using modelled survival and multiplied by disability weights to obtain years lived with disability (YLDs). Years of life lost (YLLs) were calculated as age-specific cancer deaths multiplied by the standard life expectancy at the age of death. The main outcome was DALYs (the sum of YLLs and YLDs). Estimates were presented globally and by Socio-demographic Index (SDI) quintiles (countries ranked and divided into five equal SDI groups), and all estimates were presented with corresponding 95% uncertainty intervals (UIs). For this analysis, we used the age range of 15–39 years to define adolescents and young adults. Findings: There were 1·19 million (95% UI 1·11–1·28) incident cancer cases and 396 000 (370 000–425 000) deaths due to cancer among people aged 15–39 years worldwide in 2019. The highest age-standardised incidence rates occurred in high SDI (59·6 [54·5–65·7] per 100 000 person-years) and high-middle SDI countries (53·2 [48·8–57·9] per 100 000 person-years), while the highest age-standardised mortality rates were in low-middle SDI (14·2 [12·9–15·6] per 100 000 person-years) and middle SDI (13·6 [12·6–14·8] per 100 000 person-years) countries. In 2019, adolescent and young adult cancers contributed 23·5 million (21·9–25·2) DALYs to the global burden of disease, of which 2·7% (1·9–3·6) came from YLDs and 97·3% (96·4–98·1) from YLLs. Cancer was the fourth leading cause of death and tenth leading cause of DALYs in adolescents and young adults globally. Interpretation: Adolescent and young adult cancers contributed substantially to the overall adolescent and young adult disease burden globally in 2019. These results provide new insights into the distribution and magnitude of the adolescent and young adult cancer burden around the world. With notable differences observed across SDI settings, these estimates can inform global and country-level cancer control efforts. Funding: Bill & Melinda Gates Foundation, American Lebanese Syrian Associated Charities, St Baldrick's Foundation, and the National Cancer Institute. publishersversion published

Published
2022

22. Emerging Applications of Radiomics in Neurological Disorders: A Review

Author

Houman Sotoudeh, Manoj Tanwar, Zahra Sadaatpour, Ehsan Sotoudeh, Glenn H. Roberson, Ali Rezaei, Omid Shafaat, Amir Hossein Sarrami, Aparna Singhal, and Gagandeep Choudhary

Subjects
medicine.medical_specialty, business.industry, General Engineering, Neurosurgery, artificial intelligence, stroke, demyelinating disorders, Radiomics, Neurology, radiomics, Medicine, business, Intensive care medicine, Radiology
Abstract

Radiomics has achieved significant momentum in radiology research and can reveal image information invisible to radiologists' eyes. Radiomics first evolved for oncologic imaging. Oncologic applications (histopathology, tumor grading, gene mutation analysis, patient survival, and treatment response prediction) of radiomics are widespread. However, it is not limited to oncologic analysis, and any digital medical images can benefit from radiomics analysis. This article reviews the current literature on radiomics in non-oncologic, neurological disorders including ischemic strokes, hemorrhagic stroke, cerebral aneurysms, and demyelinating disorders.

Published
2021

24. The Role of Machine Learning and Radiomics for Treatment Response Prediction in Idiopathic Normal Pressure Hydrocephalus

Author

Houman Sotoudeh, Ali Rezaei, Mohsen Tabatabaie, Omid Shafaat, Zahra Sadaatpour, Aparna Singhal, Manoj Tanwar, and Ehsan Sotoudeh

Subjects
normal pressure hydrocephalus, medicine.diagnostic_test, business.industry, Medical record, General Engineering, Magnetic resonance imaging, artificial intelligence, medicine.disease, Machine learning, computer.software_genre, Random forest, Shunting, Support vector machine, machine learning, Radiomics, radiomics, Modified Rankin Scale, Normal pressure hydrocephalus, medicine, magnetic resonance imaging, Artificial intelligence, Radiology, business, computer
Abstract

Introduction Ventricular shunting remains the standard of care for patients with idiopathic normal pressure hydrocephalus (iNPH); however, not all patients benefit from the shunting. Prediction of response in advance can result in improved patient selection for ventricular shunting. This study aims to develop a machine learning predictive model for treatment response after shunt placement using the clinical and radiomics features. Methods In this retrospective pilot study, the medical records of iNPH patients who underwent ventricular shunting were evaluated. In each patient, the “idiopathic normal pressure hydrocephalus grading scale” (iNPHGS) and a “Modified Rankin Scale” were calculated before and after surgery. The subsequent treatment response was calculated as the difference between the iNPHGS scores before and after surgery. iNPHGS score reduction of two or more than two were considered as treatment response. The presurgical MRI scans were evaluated by radiologists, the ventricular systems were segmented on the T2-weighted images, and the radiomics features were extracted from the segmented ventricular system. Using Orange data mining open-source platform, different machine learning models were then developed based on the presurgical clinical features and the selected radiomics features to predict treatment response after shunt placement. Results After the implementation of the inclusion criteria, 78 patients were included in this study. One hundred twenty radiomics features were extracted, and the 12 best predictive radiomics features were selected. Using only clinical data (iNPHGS and Modified Rankin Scale), the random forest model achieved the best performance in treatment prediction with an area under the curve (AUC) of 0.71. Adding the Radiomics analysis to the clinical data improved the prediction performance, with the support vector machine (SVM) achieving the highest rank in treatment prediction with an AUC of 0.8. Adding age and sex to the analysis did not improve the prediction. Conclusion Using machine learning models for treatment response prediction in patients with iNPH is feasible with acceptable accuracy. Adding the Radiomics analysis to the clinical features can further improve the predictive performance. SVM is likely the best model for this task.

Published
2021

25. Accuracy of Machine Learning Models to Predict Mortality in COVID-19 Infection Using the Clinical and Laboratory Data at the Time of Admission

Author

Omid Shafaat, Mojtaba Didehdar, Amir Hossein Sarrami, Mohsen Tabatabaie, Houman Sotoudeh, and Baharak Tasorian

Subjects
2019-20 coronavirus outbreak, Artificial neural network, Ensemble forecasting, Coronavirus disease 2019 (COVID-19), business.industry, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), General Engineering, Feature selection, Infectious Disease, pandemics, Machine learning, computer.software_genre, artificial intelligence, mortality, Test (assessment), Naive Bayes classifier, machine learning, covid-19, Epidemiology/Public Health, Internal Medicine, Medicine, Artificial intelligence, prognosis, business, computer
Abstract

Aim This study aimed to develop a predictive model to predict patients' mortality with coronavirus disease 2019 (COVID-19) from the basic medical data on the first day of admission. Methods The medical data including the demographic, clinical, and laboratory features on the first day of admission of clinically diagnosed COVID-19 patients were documented. The outcome of patients was also recorded as discharge or death. Feature selection models were then implemented and different machine learning models were developed on top of the selected features to predict discharge or death. The trained models were then tested on the test dataset. Results A total of 520 patients were included in the training dataset. The feature selection demonstrated 22 features as the most powerful predictive features. Among different machine learning models, the naive Bayes demonstrated the best performance with an area under the curve of 0.85. The ensemble model of the naive Bayes and neural network combination had slightly better performance with an area under the curve of 0.86. The models had relatively the same performance on the test dataset. Conclusion Developing a predictive machine learning model based on the basic medical features on the first day of admission in COVID-19 infection is feasible with acceptable performance.

Published
2021

26. Burden of diabetes and hyperglycaemia in adults in the Americas, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019

Author

Ewerton Cousin, Maria Inês Schmidt, Kanyin Liane Ong, Rafael Lozano, Ashkan Afshin, Abdelrahman I Abushouk, Gina Agarwal, Marcela Agudelo-Botero, Ziyad Al-Aly, Jacqueline Elizabeth Alcalde-Rabanal, Nelson Alvis-Guzman, Nelson J Alvis-Zakzuk, Benny Antony, Malke Asaad, Till Winfried Bärnighausen, Sanjay Basu, Isabela M Bensenor, Zahid A Butt, Ismael R Campos-Nonato, Vijay Kumar Chattu, Michael H Criqui, Parnaz Daneshpajouhnejad, Claudio Alberto Dávila-Cervantes, Edgar Denova-Gutiérrez, Samath Dhamminda Dharmaratne, Daniel Diaz, Irina Filip, Mohamed M Gad, MA Garcia-Gordillo, Shakiba Ghasemi Assl, Sameer Vali Gopalani, Rafael Alves Guimarães, Rajat Das Gupta, Nima Hafezi-Nejad, Maryam Hashemian, Simon I Hay, Tanvir Kahlon, Jagdish Khubchandani, Ruth W Kimokoti, Adnan Kisa, Barthelemy Kuate Defo, Iván Landires, Ted R Miller, Ali H Mokdad, Linda Morales, Shane Douglas Morrison, Yeshambel T Nigatu, Virginia Nuñez-Samudio, Andrew T Olagunju, Seithikurippu R Pandi-Perumal, Urvish K Patel, Amir Radfar, Maria Rios-Blancas, Leonardo Roever, Seyedmohammad Saadatagah, Juan Sanabria, Itamar S Santos, Thirunavukkarasu Sathish, Mahsima Shabani, Omid Shafaat, Sara Sheikhbahaei, Diego Augusto Santos Silva, Ambrish Singh, Jasvinder A Singh, Marcos Roberto Tovani-Palone, Diana Zuleika Velazquez, Siddhesh Zadey, Mohsen Naghavi, Theo Vos, and Bruce B Duncan

Subjects
Adult, Blood Glucose, Endocrinology, Diabetes and Metabolism, Global Health, Global Burden of Disease, Endocrinology, Life Expectancy, Diabetes Mellitus, Type 2, Socioeconomic Factors, Risk Factors, Cause of Death, Hyperglycemia, Internal Medicine, Humans, Quality-Adjusted Life Years, Renal Insufficiency, Chronic
Abstract

High prevalence of diabetes has been reported in the Americas, but no comprehensive analysis of diabetes burden and related factors for the region is available. We aimed to describe the burden of type 1 and type 2 diabetes and that of hyperglycaemia in the Americas from 1990 to 2019.We used estimates from GBD 2019 to evaluate the burden of diabetes in adults aged 20 years or older and high fasting plasma glucose in adults aged 25 years or older in the 39 countries and territories of the six regions in the Americas from 1990 to 2019. The main source to estimate the mortality attributable to diabetes and to chronic kidney disease due to diabetes was vital registration. Mortality due to overall diabetes (ie, diabetes and diabetes due to chronic kidney disease) was estimated using the Cause of Death Ensemble model. Years of life lost (YLLs) were calculated as the number of deaths multiplied by standard life expectancy at the age that the death occurred, years lived with disability (YLDs) were estimated based on the prevalence and severity of complications of diabetes. Disability-adjusted life-years (DALYs) were estimated as a sum of YLDs and YLLs. We assessed the association of diabetes burden with the level of development of a country (according to the Socio-demographic Index), health-care access and quality (estimated with the Healthcare Access and Quality Index), and diabetes prevalence. We also calculated the population attributable fraction (PAF) of diabetes burden due to each of its risk factors. We report the 95% uncertainty intervals for all estimates.In 2019, an estimated total of 409 000 (95% uncertainty interval 373 000-443 000) adults aged 20 years or older in the Americas died from diabetes, which represented 5·9% of all deaths. Diabetes was responsible for 2266 (1930-2649) crude DALYs per 100 000 adults in the Americas, and high fasting plasma glucose for 4401 DALYs (3685-5265) per 100 000 adults, with large variation across regions. DALYs were mostly due to type 2 diabetes and distribution was heterogeneous, being highest in central Latin America and the Caribbean and lowest in high-income North America and southern Latin America. Between 1990 and 2019, age-standardised DALYs due to type 2 diabetes increased 27·4% (22·0-32·5). This increase was particularly high in Andean Latin America and high-income North America. Burden for both type 1 and type 2 diabetes across countries increased with higher diabetes prevalence and decreased with greater Socio-demographic and Healthcare Access and Quality Indices. Main risk factors for the burden were high BMI, with a PAF of 63·2% and dietary risks, with a PAF of 27·5%. The fraction of burden due to disability has increased since 1990 and now represents nearly half of the overall burden in 2019.The burden of diabetes in the Americas is large, increasing, heterogeneous, and expanding. To confront the rising burden, population-based interventions aimed to reduce type 2 diabetes risk and strengthening health systems to provide effective and cost-efficient care for those affected are mandatory.BillMelinda Gates Foundation.

Published
2021

28. Misleading CT perfusion in subacute ischemic stroke

Author

Omid Shafaat, Ehsan Sotoudeh, and Houman Sotoudeh

Subjects
Male, medicine.medical_specialty, Subacute phase, Computed Tomography Angiography, Infarction, Perfusion scanning, Conservative Treatment, Brain Ischemia, 030218 nuclear medicine & medical imaging, Diagnosis, Differential, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, Radiology, Nuclear Medicine and imaging, cardiovascular diseases, Radiation treatment planning, Stroke, medicine.diagnostic_test, business.industry, Penumbra, 030208 emergency & critical care medicine, Magnetic resonance imaging, Middle Aged, medicine.disease, Ischemic stroke, Emergency Medicine, Radiographic Image Interpretation, Computer-Assisted, Radiology, Tomography, X-Ray Computed, business, Software
Abstract

The RAPID© software is the most commonly used computed tomography perfusion (CTP) software in stroke centers. It is estimated that about 1300 hospitals in the world are using this software for decision-making in ischemic stroke. The software provides the estimated volume of infarction and ischemic penumbra, so it is the backbone of treatment planning in these patients. In this manuscript, we present two cases of subacute infarction with misleading CTP using RAPID© software. We believe that given the popularity of this software and increasing application of CTP in subacute infarction, this pitfall is likely underdiagnosed in many patients. In a subacute phase of infarction, we recommend diffusion-weighted imaging magnetic resonance imaging (DWI-MRI) for estimation of infarction to avoid this pitfall and possible mismanagement.

Published
2019

29. Superior ophthalmic vein thrombosis: What radiologist and clinician must know?

Author

Omid Shafaat, Ehsan Sotoudeh, Houman Sotoudeh, Michael S. Vaphiades, Noha A. Aboueldahab, and Joshua D. Bernstock

Subjects
lcsh:Medical physics. Medical radiology. Nuclear medicine, medicine.medical_specialty, lcsh:R895-920, RA, rheumatoid arthritis, B/L, bilateral, CCF, carotid cavernous fistula, N/A, not applicable, Cavernous sinus thrombosis, SOVT, superior ophthalmic vein thrombosis, Article, 030218 nuclear medicine & medical imaging, SLE, systemic lupus erythematosus, 03 medical and health sciences, 0302 clinical medicine, UTI, Urinary Tract Infection, Medicine, Radiology, Nuclear Medicine and imaging, SOV, superior ophthalmic vein, Sinusitis, CST, cavernous sinus thrombosis, Abscess, Carotid-cavernous fistula, SCC, Squamous Cell Carcinoma, MRI, magnetic resonance Imaging, business.industry, F, female, L, left, R, right, Superior ophthalmic vein thrombosis, Thrombophlebitis, medicine.disease, Thrombosis, CT, computed tomography, Y, yes, Orbital cellulitis, 030220 oncology & carcinogenesis, Cavernous sinus, M, male, Radiology, business, Superior ophthalmic vein, IRB, institutional review board
Abstract

Highlights • Incidental SOVT: good prognosis, self-limited and treated by anticoagulation. • Post-traumatic and surgical SOVT: good prognosis, treated by anticoagulation. • Septic SOVT: secondary to infections, high risk, requires specific interventions. • Aseptic SOVT: secondary to inflammatory diseases, need to treat underlying etiology. • CT and MRI are vital to the correct diagnosis and management of patients with SOVT., Purpose Superior ophthalmic vein thrombosis (SOVT) is an extremely rare condition. Few studies have been published about clinical aspects of this condition. In this study, we have studied the symptoms, underlying etiologies, treatment, pathogenesis and complication of the SOVT and we tried to classify it based on the etiology, treatment, and prognosis. Methods We reviewed the patients’ data from a tertiary academic referral center. Each patient with SOVT was then reviewed for symptoms associated with SOVT, underlying etiology, treatment protocol, treatment response, complications, possible pathogens, and final outcome. Results Twenty-four cases of SOVT were included in this study. Overall, 13 cases were diagnosed as right-sided SOVT, out of which, eight had simultaneous right-sided cavernous sinus thrombosis (CST). Eighteen cases were diagnosed to have left-sided SOVT, out of which, 11 had simultaneous left-sided CST. Conclusions The SOVT can be secondary to different mechanisms. The SOVT secondary to trauma, recent surgery and coagulopathy are mostly non-aggressive, and can be managed by conservative therapy and anticoagulation. The SOVT in patients with orbital cellulitis, history of active sinusitis or paranasal sinus surgery are aggressive presenting with acute orbital swelling, abscess and visual loss. This type of SOVT can be complicated by extension to the cavernous sinus and intracranial structures. These patients require urgent antibiotics therapy and sinus surgery. The most severe type of SOVT is caused by mucormycosis which may also extend intracranially resulting in stroke and is often life-threatening.

Published
2019

30. Susceptibility-Weighted Imaging in Neurodegenerative Disorders: A Review

Author

Aparna Singhal, Amir Hossein Sarrami, Omid Shafaat, Ali Razaei, Houman Sotoudeh, Siddhartha Gaddamanugu, Jian-Xiong Wang, Gagandeep Choudhary, and Zahra Saadatpour

Subjects
Lewy Body Disease, Male, Context (language use), Neuroimaging, Disease, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, Alzheimer Disease, medicine, Dementia, Humans, Radiology, Nuclear Medicine and imaging, Amyotrophic lateral sclerosis, medicine.diagnostic_test, business.industry, Dementia, Vascular, Brain, Magnetic resonance imaging, Neurodegenerative Diseases, Parkinson Disease, medicine.disease, Magnetic Resonance Imaging, Cerebral Amyloid Angiopathy, Susceptibility weighted imaging, Neurology (clinical), Cerebral amyloid angiopathy, Cerebral Arterial Diseases, business, Neuroscience, 030217 neurology & neurosurgery
Abstract

As human life expectancy increases, there is an increased prevalence of neurodegenerative disorders and dementia. There are many ongoing research trials for early diagnosis and management of dementia, and neuroimaging is a critical part of such studies. However, conventional neuroimaging often fails to provide enough diagnostic findings in patients with neurodegenerative disorders. In this context, different MRI sequences are currently under investigation to facilitate the accurate diagnosis of such disorders. Susceptibility-weighted imaging (SWI) is an innovative MRI technique that utilizes "magnitude" and "phase" images to produce an image contrast that is sensitive for the detection of susceptibility differences of the tissues. As many neurodegenerative disorders are associated with accelerated iron deposition and/or microhemorrhages in different parts of the brain, SWI can be applied to detect these diagnostic clues. For instance, in cerebral amyloid angiopathy, SWI can demonstrate cortical microhemorrhages, which are predominantly in the frontal and parietal regions. Or in Parkinson disease, abnormal swallow-tail sign on high-resolution SWI is highly diagnostic. Also, SWI is a useful sequence to detect the low signal intensity of precentral cortices in patients with amyotrophic lateral sclerosis. Being familiar with SWI findings in neurodegenerative disorders is critical for an accurate diagnosis. In this paper, the authors review the technical parameters of SWI, physiologic, and pathologic iron deposition in the brain, and the role of SWI in the evaluation of neurodegenerative disorders in daily practice.

Published
2021

31. Spatial, temporal, and demographic patterns in prevalence of chewing tobacco use in 204 countries and territories, 1990-2019: A systematic analysis from the Global Burden of Disease Study 2019

Author

Mohsen Naghavi, Saman Esmaeilnejad, Irena Ilic, Chhabi Lal Ranabhat, Hubert Amu, Jalil Jaafari, Walter Mendoza, Yanzhong Wang, Atta Abbas Naqvi, Mahesh P A, Afshin Maleki, Songhomitra Panda-Jonas, Akila Prashant, Jessica Y Islam, Ali H. Mokdad, Rahmatollah Moradzadeh, Roman Shrestha, Muhammad Naveed, Andre M. N. Renzaho, Santi Martini, Reza Rawassizadeh, Chisom Joyqueenet Akunna, Tudorel Andrei, Jason A. Anderson, Martin McKee, Iffat Elbarazi, Golnaz Heidari, Abdollah Mohammadian-Hafshejani, Soewarta Kosen, Davood Anvari, Randah R. Hamadeh, G. K. Mini, Emerito Jose A. Faraon, Farhad Islami, Yasir Waheed, Fahad Alanezi, Maciej Banach, Sheikh Mohammed Shariful Islam, Ismaeel Yunusa, Suresh Mehata, Tarun Gupta, Mavra A Riaz, Derrick A Bennett, Nithin Kumar, Ali Soroush, Kurt Straif, Muhammad Aziz Rahman, Hasan Yusefzadeh, Avirup Guha, Catalina Liliana Andrei, Muhammed Shahriar Zaman, Arief Hargono, Sandhya Neupane Kandel, Adam E. Berman, Giulia Carreras, Ali Bijani, Christoph Nowak, Rafael Alves Guimarães, Aziz Sheikh, Kamal Hezam, Carlo Eduardo Medina-Solís, Simon I. Hay, Deborah Carvalho Malta, Rahman Shiri, Ashok Pandey, Ramesh Holla, Gyu Ri Kim, Aidin Abedi, Sharath Burugina Nagaraja, Andem Effiong, Samad Azari, Bhaskar Thakur, Mohsen Mazidi, Vahid Yazdi-Feyzabadi, Prashant Mathur, Bay Vo, Robert Ancuceanu, Eun-Kee Park, Mehdi Fazlzadeh, Thomas Hsiao, Richard G Pestell, Sindhura Lakshmi Koulmane Laxminarayana, Doo Woong Lee, Bayew Kelkay, Erkin M. Mirrakhimov, Hualiang Lin, Mohsen Bayati, Florian Fischer, Wei Liu, Stefan Stortecky, Javad Nazari, Fatemeh Pashazadeh Kan, Virginia Núñez-Samudio, Nitish Naik, Sreenivas Narasimha Swamy, Rajat Gupta, Rakhi Dandona, Hermann Brenner, Chandrashekhar T Sreeramareddy, Mohammad Ali Mansournia, Yuichiro Yano, Pankaj Bhardwaj, Samath D Dharmaratne, Constantine I. Vardavas, Gabriela Fernanda Gil, Azeem Majeed, Akram Pourshams, Nachimuthu Senthil Kumar, Florentino Luciano Caetano dos Santos, Juan Sanabria, Iván Landires, Parkes J Kendrick, Dinh-Toi Chu, Asma Tahir Awan, Khem Narayan Pokhrel, Siddharudha Shivalli, Omid Shafaat, Shankar Prasad Nagaraju, Manu Raj Mathur, Rachel L Updike, Mohammad Ebrahimi Kalan, Ryan David Kennedy, Alessandra Lugo, Olalekan A. Uthman, Tarek Tawfik Amin, Jiregna Darega Gela, Zhi-Jiang Zhang, Yeshambel T. Nigatu, Bedanta Roy, Arielle Wilder Eagan, Jalal Arabloo, Milena Ilic, Mehdi Hosseinzadeh, Jost B. Jonas, Dian Kusuma, Shahrzad Bazargan-Hejazi, Yo Han Lee, Mohammed Shannawaz, Mohammad Ali Moni, Valery L. Feigin, Himal Kandel, Lalit Dandona, Milena Santric-Milicevic, Jasvinder A. Singh, Till Bärnighausen, Neeraj Bhala, Sara Sheikhbahaei, Alireza Ansari-Moghaddam, Borhan Mansouri, Narayana Manjunatha, Giuseppe Gorini, Saif Ullah, Sheikh M. Alif, Giang Thu Vu, Ai Koyanagi, Mahaveer Golechha, Ingan Ukur Tarigan, Sumaira Mubarik, Naohiro Yonemoto, Ahmad Ghashghaee, Yves Miel H Zuniga, Bach Xuan Tran, Sorin Hostiuc, Catherine P. Benziger, Ritesh G. Menezes, Leonardo Roever, Xiaochen Dai, Meghnath Dhimal, Medhat Farwati, Chenwen Zhong, Seyed Sina Naghibi Irvani, G Anil Kumar, Jaya Prasad Tripathy, Amirhossein Sahebkar, Simiao Chen, Zubair Kabir, Meseret Derbew Molla, Tilahun Ali, Animut Tagele Tamiru, Negussie Boti Sidemo, Monika Sawhney, Bright Opoku Ahinkorah, Ruxandra Irina Negoi, Segun Emmanuel Ibitoye, Vin Gupta, Mona Pathak, Lorenzo Monasta, Andrew T Olagunju, Nermin Ghith, Nuwan Darshana Wickramasinghe, Kazumasa Yamagishi, Virendra Singh, Takahiro Tabuchi, Gholamreza Roshandel, Andre R. Brunoni, Hayley D. Tymeson, Madhur Verma, Eyayou Girma Tadesse, Adrian Pana, Isabela M. Benseñor, Abdullah Al Mamun, Jianrong Zhang, Hai Quang Pham, Mihaela Hostiuc, Sung-In Jang, Vinay Nangia, Luca Ronfani, Rizwan Suliankatchi Abdulkader, Dhirendra N Sinha, Josip Car, Sohail Ahmad, Rekha Thapar, Salman Rawaf, Joanna L Whisnant, Sanjay Basu, Abdallah M. Samy, Michal Grivna, Zahid A Butt, Abera Getachew Obsa, Mahdi Nalini, Ted R. Miller, Sanjeev Misra, Utsav Parekh, Budi Aji, Saeed Amini, João Pedro Silva, Felix Akpojene Ogbo, Mihajlo Jakovljevic, Demosthenes B. Panagiotakos, Baye Dagnew, Yousef Khader, Atif Amin Baig, Habib Benzian, Keivan Ahmadi, Marco Vacante, Brijesh Sathian, Akshaya Srikanth Bhagavathula, Savita Lasrado, Maryam Khayamzadeh, Darshan B B, Mohammad Rifat Haider, Yonas Akalu, Irmina Maria Michalek, Simone Vidale, Getie Lake Aynalem, Rosa A. S. Couto, Yigizie Yeshaw, Syed Mohamed Aljunid, Pradhum Ram, Shrikant Pawar, Kevin Welding, Suzanne Barker-Collo, Hamideh Salimzadeh, Luisa Sorio Flor, Priya Rathi, Hiba Jawdat Barqawi, Marcos Roberto Tovani-Palone, K M Shivakumar, Gebiyaw Wudie Tsegaye, Fares Alahdab, Vafa Rahimi-Movaghar, Om P Kurmi, Nataliya Foigt, André Karch, Marina Pinheiro, Basema Saddik, Paschalis Steiropoulos, Chuanhua Yu, Graeme J. Hankey, Panniyammakal Jeemon, Abdul-Aziz Seidu, Ramaiah Itumalla, Befikadu Legesse Wubishet, Vera Marisa Costa, Shanshan Li, Ambrish Singh, Yuming Guo, Reza Malekzadeh, Nikha Bhardwaj, Mikhail Sergeevich Zastrozhin, Maryam Zamanian, Onyema greg Chido-Amajuoyi, Ibtihal Fadhil, Sabina O Nduaguba, Turki Alanzi, Eun-Cheol Park, Nicholas Arian, Salah Eddin Karimi, Parnaz Daneshpajouhnejad, Minale Tareke, Paramjit Gill, Chukwudi A Nnaji, Haroon Ahmed, Irina Filip, Juwel Rana, Aziz Rezapour, Huong Lan Thi Nguyen, Ashish Badiye, Kewal Krishan, Nima Hafezi-Nejad, Masood Ali Shaikh, Tanuj Kanchan, Shilpashree Madhava Kunjathur, Reza Ghanei Gheshlagh, Thomas R. Hird, Yousef Mohammad, Soraya Siabani, Falk Schwendicke, Ziyad Al-Aly, Desta Debalkie Atnafu, Krittika Bhattacharyya, Mika Kivimäki, Ayodipupo Sikiru Oguntade, Zabihollah Yousefi, Neeti Kapoor, Syed Mahboob Shah, Kavumpurathu Raman Thankappan, Mika Shigematsu, Ben Lacey, Ireneous N. Soyiri, Amir Radfar, Lemma Getacher, Sameer Vali Gopalani, David Laith Rawaf, Amir Masoud Rahmani, Birhan Gebresillassie Gebregiorgis, Morenike Oluwatoyin Folayan, Salime Goharinezhad, Ambuj Roy, Ruth W Kimokoti, Nuworza Kugbey, Getinet Ayano, Mohammad Hifz Ur Rahman, Benny Antony, Katrin Burkart, Christopher J L Murray, Khalid F. AlHabib, Mariam Molokhia, Mansour Ghafourifard, Abebaw Alemayehu Desta, Tariku Tesfaye Bekuma, Shailesh Advani, Kiomars Sharafi, Kurnia Dwi Artanti, E S Abhilash, Ejaz Ahmad Khan, Sana Salehi, Dan J. Stein, Pankaj Chaturvedi, Mahmoud A. Alomari, Kawkab Shishani, Dejana Braithwaite, Jung-Chen Chang, Rajeev Gupta, Giovanni Damiani, Maha El Tantawi, Maria Sofia Sofia Cattaruzza, Amir Abdoli, Narayanaswamy Venketasubramanian, Rakibul M Islam, Ibrahim Abdelmageed Ginawi, Victor Aboyans, Ganesh Kumar Saya, Silvano Gallus, João Mauricio Castaldelli-Maia, Vardhmaan Jain, Masoud Foroutan, Janni Leung, Mohammad Abdollahi, Mohammed Zewdu Yimmer, Vahid Alipour, Wondwossen Niguse Asmare, Ravi Prakash Jha, Gerhard Sulo, Brigid Unim, Sheng-Chia Chung, Sadaf G. Sepanlou, Hamed Mirzaei, Anna Aleksandrovna Skryabina, In-Hwan Oh, Rannveig Sigurvinsdottir, Oladimeji Adebayo, Farshad Farzadfar, Anasthasia Zastrozhina, Shafiu Mohammed, Johan Sundström, Ali Kabir, Paolo Lauriola, Tilahun Belete Mossie, Sadia Bibi, Bartosz Miazgowski, Erin C Mullany, Keyvan Pakshir, Srikanta Banerjee, Mowafa Househ, Mohamed M. Gad, Leila R Kalankesh, Mikk Jürisson, Ismail Tareque, Albertino Damasceno, Musliu Adetola Tolani, Andrea Werdecker, Shane D. Morrison, Inga Dora Sigfusdottir, Marcel Ausloos, Monika Arora, Marissa B Reitsma, Filippos Filippidis, Biniyam Sahiledengle Geberemariyam, Bruno Piassi Sao Jose, Leeberk Raja Inbaraj, Antonio Biondi, Mohsen Abbasi-Kangevari, Junjie Huang, Mohammad Mahdi Zamani, Jean Jacques Noubiap, Emmanuela Gakidou, Valentin Yurievich Skryabin, Mayowa O. Owolabi, Shubha Jayaram, Hiroyasu Iso, Charles Ugochukwu Ibeneme, Molly R Nixon, Rachel Feldman, Liliana G Ciobanu, Kristina Edvardsson, Claudiu Herteliu, Andreea Mirica, Kindie Mitiku Kebede, Department of Public Health, Collaborators, GBD 2019 Chewing Tobacco, and Lacey, B

Subjects
Male, Health Status, Smoking Prevention, DETERMINANTS, Global Health, 01 natural sciences, Global Burden of Disease, SMOKELESS TOBACCO, 0302 clinical medicine, Risk Factors, Global health, Prevalence, 030212 general & internal medicine, 610 Medicine & health, RISK, High prevalence, WOMEN, Public Health, Global Health, Social Medicine and Epidemiology, Articles, Middle Aged, 3142 Public health care science, environmental and occupational health, Chewing tobacco, Smokeless tobacco, Population Surveillance, A990 Medicine and Dentistry not elsewhere classified, Female, Quality-Adjusted Life Years, Burden of disease, Adult, medicine.medical_specialty, Tobacco, Smokeless, Adolescent, WHO Framework Convention on Tobacco Control, VALIDATION, 03 medical and health sciences, Young Adult, Age Distribution, SDG 3 - Good Health and Well-being, Environmental health, medicine, Humans, 0101 mathematics, Sex Distribution, Chewing tobacco, Prevalence, Global Burden, Smokeless tobacco, business.industry, Public health, Smoking Tobacco, 010102 general mathematics, Public Health, Environmental and Occupational Health, Global Burden, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, STATES, Socioeconomic Factors, Smoking Cessation, business
Abstract

Interpretation Chewing tobacco remains a substantial public health problem in several regions of the world, and predominantly in south Asia. We found little change in the prevalence of chewing tobacco use between 1990 and 2019, and that control efforts have had much larger effects on the prevalence of smoking tobacco use than on chewing tobacco use in some countries. Mitigating the health effects of chewing tobacco requires stronger regulations and policies that specifically target use of chewing tobacco, especially in countries with high prevalence. Findings In 2019, 273 center dot 9 million (95% uncertainty interval 258 center dot 5 to 290 center dot 9) people aged 15 years and older used chewing tobacco, and the global age-standardised prevalence of chewing tobacco use was 4 center dot 72% (4 center dot 46 to 5 center dot 01). 228 center dot 2 million (213 center dot 6 to 244 center dot 7; 83 center dot 29% [82 center dot 15 to 84 center dot 42]) chewing tobacco users lived in the south Asia region. Prevalence among young people aged 15-19 years was over 10% in seven locations in 2019. Although global agestandardised prevalence of smoking tobacco use decreased significantly between 1990 and 2019 (annualised rate of change: -1 center dot 21% [-1 center dot 26 to -1 center dot 16]), similar progress was not observed for chewing tobacco (0 center dot 46% [0 center dot 13 to 0 center dot 79]). Among the 12 highest prevalence countries (Bangladesh, Bhutan, Cambodia, India, Madagascar, Marshall Islands, Myanmar, Nepal, Pakistan, Palau, Sri Lanka, and Yemen), only Yemen had a significant decrease in the prevalence of chewing tobacco use, which was among males between 1990 and 2019 (-0 center dot 94% [-1 center dot 72 to -0 center dot 14]), compared with nine of 12 countries that had significant decreases in the prevalence of smoking tobacco. Among females, none of these 12 countries had significant decreases in prevalence of chewing tobacco use, whereas seven of 12 countries had a significant decrease in the prevalence of tobacco smoking use for the period. Summary Background Chewing tobacco and other types of smokeless tobacco use have had less attention from the global health community than smoked tobacco use. However, the practice is popular in many parts of the world and has been linked to several adverse health outcomes. Understanding trends in prevalence with age, over time, and by location and sex is important for policy setting and in relation to monitoring and assessing commitment to the WHO Framework Convention on Tobacco Control. Methods We estimated prevalence of chewing tobacco use as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 using a modelling strategy that used information on multiple types of smokeless tobacco products. We generated a time series of prevalence of chewing tobacco use among individuals aged 15 years and older from 1990 to 2019 in 204 countries and territories, including age-sex specific estimates. We also compared these trends to those of smoked tobacco over the same time period. Findings In 2019, 273 & middot;9 million (95% uncertainty interval 258 & middot;5 to 290 & middot;9) people aged 15 years and older used chewing tobacco, and the global age-standardised prevalence of chewing tobacco use was 4 & middot;72% (4 & middot;46 to 5 & middot;01). 228 & middot;2 million (213 & middot;6 to 244 & middot;7; 83 & middot;29% [82 & middot;15 to 84 & middot;42]) chewing tobacco users lived in the south Asia region. Prevalence among young people aged 15-19 years was over 10% in seven locations in 2019. Although global age standardised prevalence of smoking tobacco use decreased significantly between 1990 and 2019 (annualised rate of change: -1 & middot;21% [-1 & middot;26 to -1 & middot;16]), similar progress was not observed for chewing tobacco (0 & middot;46% [0 & middot;13 to 0 & middot;79]). Among the 12 highest prevalence countries (Bangladesh, Bhutan, Cambodia, India, Madagascar, Marshall Islands, Myanmar, Nepal, Pakistan, Palau, Sri Lanka, and Yemen), only Yemen had a significant decrease in the prevalence of chewing tobacco use, which was among males between 1990 and 2019 (-0 & middot;94% [-1 & middot;72 to -0 & middot;14]), compared with nine of 12 countries that had significant decreases in the prevalence of smoking tobacco. Among females, none of these 12 countries had significant decreases in prevalence of chewing tobacco use, whereas seven of 12 countries had a significant decrease in the prevalence of tobacco smoking use for the period. Interpretation Chewing tobacco remains a substantial public health problem in several regions of the world, and predominantly in south Asia. We found little change in the prevalence of chewing tobacco use between 1990 and 2019, and that control efforts have had much larger effects on the prevalence of smoking tobacco use than on chewing tobacco use in some countries. Mitigating the health effects of chewing tobacco requires stronger regulations and policies that specifically target use of chewing tobacco, especially in countries with high prevalence. For complete list of authors see http://dx.doi.org/10.1016/S2468-2667(21)00065-7

Published
2021

32. Global, regional, and national sex differences in the global burden of tuberculosis by HIV status, 1990–2019: results from the Global Burden of Disease Study 2019

Author

Akram Pourshams, Mostafa Dianatinasab, Alberto L. García-Basteiro, Seyed Sina Naghibi Irvani, Patrick D. M. C. Katoto, Daiane Borges Machado, Alireza Rafiei, Aziz Rezapour, Khaled Khatab, Chukwudi A Nnaji, Fatemeh Javanmardi, Asrat Arja, Asif Hanif, Arianna Maever L. Amit, Min Seo Kim, Tomislav Mestrovic, Razique Anwer, Gulrez Shah Azhar, Milena Ilic, Jost B. Jonas, Sreenivas Narasimha Swamy, Fisaha Haile Tesfay, Fakher Rahim, Christopher J L Murray, Molly H Biehl, Hesam Alizade, Souranshu Chatterjee, Jalal Arabloo, Mariam Molokhia, Sachin R Atre, Maciej Banach, Ashwin Kamath, Gebiyaw Wudie Tsegaye, Irina Filip, Mohammad Sadegh Rezai, Robert Reiner, Shrikant Pawar, Anasthasia Zastrozhina, Vardhmaan Jain, Shafiu Mohammed, Benn Sartorius, Sindhura Lakshmi Koulmane Laxminarayana, Harapan Harapan, Hiba Jawdat Barqawi, Tahvi Frank, Yasir Waheed, Seyed Hossein Yahyazadeh Jabbari, Shaun Wen Huey Lee, Jorge R. Ledesma, Yosef Alemayehu, Sajjad Ahmad, Deepak Dhamnetiya, Khezar Hayat, Preetam Bhalchandra Mahajan, Ramesh Holla, Atif Amin Baig, Azeem Majeed, Darshan B B, Catherine M. Antony, Allen Seylani, Avinash Kumar, Alimuddin Zumla, Irena Ilic, Sofia Androudi, Liaqat Ali, Rafael Lozano, Carl Abelardo T. Antonio, Sanjay M Pattanshetty, Bach Xuan Tran, Eduarda Fernandes, Marissa B Reitsma, Ramaiah Itumalla, Catrin E. Moore, Amir Masoud Rahmani, Daniel Diaz, Mohsen Naghavi, R V Polibin, Nithin Kumar, Archith Boloor, Norberto Perico, Vahit Yigit, Emma Elizabeth Spurlock, Zaheer-Ud-Din Babar, Veer Bala Gupta, Nima Rezaei, Arief Hargono, Maarten J. Postma, Jitendra Singh, Sandhya Neupane Kandel, Sapna Gupta, Omid Dadras, Takahiro Tabuchi, Sanjeev Misra, Salman Rawaf, Devasahayam J. Christopher, Francisco Rogerlândio Martins-Melo, Omid Shafaat, Florian Fischer, Satish Saroshe, Simon I. Hay, Mosiur Rahman, Mohammad Ali Moni, Sathish Kumar Jayapal, Jalil Jaafari, Walter Mendoza, Sepideh Ahmadi, Deepak Madi, Alexander Kwarteng, Omid Rezahosseini, Segun Emmanuel Ibitoye, Hassan Mehmood Lak, Iván Landires, Mahesh P A, Biniyam Sahiledengle Geberemariyam, Hayimro Edemealem Merie, Himanshu Khajuria, Kathryn H. Jacobsen, Magdalene K. Walters, Ali H. Mokdad, Sharath Burugina Nagaraja, Avina Vongpradith, Mehrnoosh Samaei, Shubha Jayaram, Beriwan Abdulqadir Ali, Giang Thu Vu, Chukwuma David Umeokonkwo, Adnan Kisa, Mehdi Hosseinzadeh, Danilo Buonsenso, Nitin Joseph, G Anil Kumar, Rekha Thapar, Sanjeev Nair, Eyayou Girma Tadesse, Joanna L Whisnant, Amanual Getnet Mersha, Savita Lasrado, Pintu Paul, Burcu Kucuk Bicer, Dharmesh Kumar Lal, Mowafa Househ, Vivek Gupta, Chandrashekhar T Sreeramareddy, Sanjay Basu, Andre M. N. Renzaho, Saira Afzal, Nahlah Elkudssiah Ismail, Akine Eshete Abosetugn, Jennifer M. Ross, Ai Koyanagi, Tushar Garg, Chythra R Rao, Sezer Kisa, Yigizie Yeshaw, Paschalis Steiropoulos, Brijesh Sathian, Zemenu Tamir, Amene Abebe Kerbo, Christine Lin, Dana Bryazka, Jason A. Anderson, Majid Pirestani, Austin Carter, Chuanhua Yu, Berhan Tsegaye, Elvis Enowbeyang Tarkang, Mareli M Claassens, Hmwe H Kyu, Lorenzo Ferro Desideri, Akila Prashant, Smriti Sinha, Linh Phuong Doan, Befikadu Legesse Wubishet, Fabio Barra, Rovshan Khalilov, Joshua A. Salomon, Virginia Núñez-Samudio, Imad I. Tleyjeh, David Laith Rawaf, Mikhail Sergeevich Zastrozhin, Dimas Ria Angga Pribadi, Kamal Hezam, Shilpashree Madhava Kunjathur, Nasir Salam, Wei-Chen Lee, Stephen S Lim, Bay Vo, Mahaveer Golechha, K. M. Saif-Ur-Rahman, Sahel Valadan Tahbaz, Muhammed Elhadi, Fatemeh Pashazadeh Kan, Fares Alahdab, Vafa Rahimi-Movaghar, Subramanian Senthilkumaran, Boris Bikbov, Addis Aklilu, Ritesh G. Menezes, Amare Belachew Dagnew, Ravi Prakash Jha, Tanuj Kanchan, Siamak Sabour, Theo Vos, Amir Radfar, Amir Emami, João Pedro Silva, Uzma Belgaumi, Vijay Kumar Chattu, Parnaz Daneshpajouhnejad, Ahmed Al Montasir, Oladimeji Adebayo, Rabia Hussain, Masoud Moghadaszadeh, Suma Nair, Ahmed I. Hasaballah, Félix Carvalho, Yun Jin Kim, Hanadi Al Hamad, Valentin Yurievich Skryabin, Mu'awiyyah Babale Sufiyan, Farahnaz Joukar, Krittika Bhattacharyya, Farshad Farzadfar, Hadi Hassankhani, Aso Mohammad Darwesh, Kefyalew Addis Alene, Himal Kandel, Susan M Sawyer, Soosanna Kumary Chattu, Keyghobad Ghadiri, Zahid A Butt, Mokhtar Mohammadi, Belay Tessema, Nikha Bhardwaj, Hossein Samadi Kafil, Kiomars Sharafi, Siyan Yi, Jianing Ma, Denis O Roshchin, Pankaj Bhardwaj, Jagdish Khubchandani, Rajaa Al-Raddadi, Shymaa Enany, Akshaya Srikanth Bhagavathula, Andrew T Olagunju, Parkes J Kendrick, Amador Goodridge, Zhi-Jiang Zhang, Mulusew A Asemahagn, Saeed Amini, Ziad A. Memish, Ruoyan Tobe-Gai, Ali Bijani, Nour Mheidly, Priyanga Ranasinghe, Abdallah M. Samy, Mahfuzar Rahman, Giuseppe Remuzzi, Abdullah T Khoja, Biswa Prakash Nayak, Samer Hamidi, Javad Nazari, Ramakrishnan Parthasarathi, Lalit Dandona, Molly R Nixon, Parvaiz A Koul, Mika Shigematsu, Gbenga A. Kayode, Rachel Feldman, Mohammad Rifat Haider, Nelson Alvis-Guzman, Mesfin Agachew Woldekidan, Deepa Jahagirdar, Kate E. LeGrand, Yusra Ahmed Salih, Nikolay Ivanovich Briko, Xuefeng Liu, Qorinah Estiningtyas Sakilah Adnani, Christian Garcia-Calavaro, Dinh-Toi Chu, Mihaela Hostiuc, Yohannes Tekalegn, Rajan Paudel, Prasanna Mithra, Narinder Kumar, Masood Ali Shaikh, Zubair Kabir, Natalia V. Bhattacharjee, Chisom Joyqueenet Akunna, Masoud Foroutan, Bogdan Oancea, Anayat Ullah, Saurabh Mehta, Abdollah Mohammadian-Hafshejani, Soewarta Kosen, Vahid Alipour, Tarik A. Rashid, Melese Abate Reta, Atta Abbas Naqvi, Emilie R Maddison, Mpiko Ntsekhe, Naohiro Yonemoto, Ahmad Ghashghaee, Mohamed Kamal Mesregah, Amadou Barrow, Ismaeel Yunusa, Gholamreza Roshandel, Ahamarshan Jayaraman Nagarajan, Hassan Abolhassani, Ahmad Azam Malik, Xiaochen Dai, Trang Huyen Nguyen, Eyal Oren, Bright Opoku Ahinkorah, Taklo Simeneh Yazie Yazie, Kewal Krishan, Ranjitha S Shetty, Emerito Jose A. Faraon, Jae Il Shin, Shafiul Haque, Veincent Christian Filipino Pepito, Sahar Eftekharzadeh, Bhawna Gupta, Platon D. Lopukhov, Abdiwahab Hashi, Amanda Novotney, Eman Abu-Gharbieh, Oluwakemi Ololade Odukoya, Anna Aleksandrovna Skryabina, Shoaib Hassan, Rakhi Dandona, Jaykaran Charan, Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET), Value, Affordability and Sustainability (VALUE), Microbes in Health and Disease (MHD), and Collaborators, GBD 2019 Tuberculosis

Subjects
Male, PNEUMONIA, COUNTRIES, Tuberculosis, Population, HIV Infections, CHILDREN, Genders, Mortalities, Global Health, DIAGNOSIS, Microbiology, Global Burden of Disease, 1117 Public Health and Health Services, Acquired immunodeficiency syndrome (AIDS), Risk Factors, 1108 Medical Microbiology, Sex differences, INFECTION, medicine, Global health, Humans, education, Sex Characteristics, education.field_of_study, Global disease burdens, business.industry, Mortality rate, GBD 2019 Tuberculosis Collaborators, HIV, Bayes Theorem, 1103 Clinical Sciences, DIABETES-MELLITUS, medicine.disease, Verbal autopsy, Tuberculosis treatment, PREVALENCE, Infectious Diseases, Attributable risk, Coinfection, Female, INJURIES, GENDER, HEALTH, business, Demography
Abstract

Background Tuberculosis is a major contributor to the global burden of disease, causing more than a million deaths annually. Given an emphasis on equity in access to diagnosis and treatment of tuberculosis in global health targets, evaluations of differences in tuberculosis burden by sex are crucial. We aimed to assess the levels and trends of the global burden of tuberculosis, with an emphasis on investigating differences in sex by HIV status for 204 countries and territories from 1990 to 2019. Methods We used a Bayesian hierarchical Cause of Death Ensemble model (CODEm) platform to analyse 21 505 site-years of vital registration data, 705 site-years of verbal autopsy data, 825 site-years of sample-based vital registration data, and 680 site-years of mortality surveillance data to estimate mortality due to tuberculosis among HIV-negative individuals. We used a population attributable fraction approach to estimate mortality related to HIV and tuberculosis coinfection. A compartmental meta-regression tool (DisMod-MR 2.1) was then used to synthesise all available data sources, including prevalence surveys, annual case notifications, population-based tuberculin surveys, and tuberculosis cause-specific mortality, to produce estimates of incidence, prevalence, and mortality that were internally consistent. We further estimated the fraction of tuberculosis mortality that is attributable to independent effects of risk factors, including smoking, alcohol use, and diabetes, for HIV-negative individuals. For individuals with HIV and tuberculosis coinfection, we assessed mortality attributable to HIV risk factors including unsafe sex, intimate partner violence (only estimated among females), and injection drug use. We present 95% uncertainty intervals for all estimates. Findings Globally, in 2019, among HIV-negative individuals, there were 1·18 million (95% uncertainty interval 1·08–1·29) deaths due to tuberculosis and 8·50 million (7·45–9·73) incident cases of tuberculosis. Among HIV-positive individuals, there were 217 000 (153 000–279 000) deaths due to tuberculosis and 1·15 million (1·01–1·32) incident cases in 2019. More deaths and incident cases occurred in males than in females among HIV-negative individuals globally in 2019, with 342 000 (234 000–425 000) more deaths and 1·01 million (0·82–1·23) more incident cases in males than in females. Among HIV-positive individuals, 6250 (1820–11 400) more deaths and 81 100 (63 300–100 000) more incident cases occurred among females than among males in 2019. Age-standardised mortality rates among HIV-negative males were more than two times greater in 105 countries and age-standardised incidence rates were more than 1·5 times greater in 74 countries than among HIV-negative females in 2019. The fraction of global tuberculosis deaths among HIV-negative individuals attributable to alcohol use, smoking, and diabetes was 4·27 (3·69–5·02), 6·17 (5·48–7·02), and 1·17 (1·07–1·28) times higher, respectively, among males than among females in 2019. Among individuals with HIV and tuberculosis coinfection, the fraction of mortality attributable to injection drug use was 2·23 (2·03–2·44) times greater among males than females, whereas the fraction due to unsafe sex was 1·06 (1·05–1·08) times greater among females than males. Interpretation As countries refine national tuberculosis programmes and strategies to end the tuberculosis epidemic, the excess burden experienced by males is important. Interventions are needed to actively communicate, especially to men, the importance of early diagnosis and treatment. These interventions should occur in parallel with efforts to minimise excess HIV burden among women in the highest HIV burden countries that are contributing to excess HIV and tuberculosis coinfection burden for females. Placing a focus on tuberculosis burden among HIV-negative males and HIV and tuberculosis coinfection among females might help to diminish the overall burden of tuberculosis. This strategy will be crucial in reaching both equity and burden targets outlined by global health milestones. Funding Bill & Melinda Gates Foundation.

Published
2021

33. Clinical and molecular characterization of patients with hereditary hemorrhagic telangiectasia: Experience from an HHT Center of Excellence

Author

Gina M. Robinson, Nara Lygia D. Sobreira, Mina Motaghi, Kelsey S. Guthrie, Anna J. Gong, Omid Shafaat, Clifford R. Weiss, and Muhammad A. Latif

Subjects
Adult, Male, medicine.medical_specialty, Activin Receptors, Type II, Pulmonary Artery, Gastroenterology, Internal medicine, otorhinolaryngologic diseases, Genetics, medicine, Growth Differentiation Factor 2, Osler-Weber-Rendu Syndrome, Humans, In patient, Genetic Predisposition to Disease, Telangiectasia, Genetics (clinical), Likely pathogenic, Genetic testing, Retrospective Studies, Smad4 Protein, medicine.diagnostic_test, business.industry, Endoglin, Arteriovenous malformation, ACVRL1, p120 GTPase Activating Protein, medicine.disease, Pulmonary Veins, Arteriovenous Fistula, Mutation, Female, Telangiectasia, Hereditary Hemorrhagic, medicine.symptom, business
Abstract

In this retrospective single-center study, we evaluated whether/how pathogenic/likely pathogenic variants of three hereditary hemorrhagic telangiectasia (HHT)-associated genes (ENG, ACVRL1, and SMAD4) are associated with specific clinical presentations of HHT. We also characterized the morphological features of pulmonary arteriovenous malformations (AVMs) in patients with these variants. Pathogenic or likely pathogenic variants were detected in 64 patients. Using nonparametric statistical tests, we compared the type and prevalence of specific HHT diagnostic features associated with these three variants. Pathogenic variants in these genes resulted in gene-specific HHT clinical presentations. Epistaxis was present in 93%, 94%, and 100% of patients with ENG, ACVRL1, and SMAD4 variants, respectively (p = 0.79). Pulmonary AVMs were more common in patients with the ENG variant (p = 0.034) compared with other subgroups. ACVRL1 variant was associated with the lowest frequency of pulmonary AVMs (p = 0.034) but the highest frequency of hepatic AVMs (p = 0.015). Patients with the ACVRL1 variant did not have significantly more pancreatic AVMs compared with the other groups (p = 0.72). ENG, ACVRL1, and SMAD4 pathogenic or likely pathogenic variants are associated with gene-specific HHT presentations, which is consistent with results from other HHT centers.

Published
2020

35. Abstract No. 218 Diagnostic accuracy of computed tomography angiogram chest in detecting pulmonary arteriovenous malformation: a comparison with invasive catheter pulmonary angiogram

Author

Muhammad A. Latif, P.A. Uppal, Yingli Fu, Frank Yuan, Omid Shafaat, P. Gowda, and Clifford R. Weiss

Subjects
medicine.medical_specialty, Catheter, Pulmonary angiogram, medicine.diagnostic_test, business.industry, medicine, Radiology, Nuclear Medicine and imaging, Computed tomography, Diagnostic accuracy, Radiology, Cardiology and Cardiovascular Medicine, Pulmonary arteriovenous malformation, business
Published
2021

36. Abstract No. 197 Using intraoperative neurophysiologic monitoring to prevent peripheral nerve injury during embolization of low-flow vascular malformations

Author

Clifford R. Weiss, Frank Yuan, Omid Shafaat, Yingli Fu, A. Gong, A. Farhan, Sally E. Mitchell, B. Holly, P. Gowda, Muhammad A. Latif, and Christopher R. Bailey

Subjects
Neurophysiologic Monitoring, business.industry, Anesthesia, medicine.medical_treatment, Peripheral nerve injury, medicine, Radiology, Nuclear Medicine and imaging, Embolization, Cardiology and Cardiovascular Medicine, business
Published
2021

37. Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Author

Soufiane Boufous, Yousef Veisani, Mehran Asadi-Aliabadi, Sharath Burugina Nagaraja, Maziar Moradi-Lakeh, Getachew Mullu Kassa, Edward J Mills, Dimas Ria Angga Pribadi, William James Dangel, Mohamad-Hani Temsah, Catherine O. Johnson, Gregory A. Roth, Giuseppe Gorini, Fariborz Mansour-Ghanaei, Alberto Ortiz, Samad Azari, Assefa Ayalew Ayalew Ayalew Gebreslassie, Salime Goharinezhad, Stephanie R. M. Zimsen, Peng Zheng, Michael Assmus, Elisabetta Pupillo, Bach Xuan Tran, Lal B. Rawal, Narayanaswamy Venketasubramanian, Noushin Mohammadifard, Stephen S Lim, Ata Rafiee, Maria Inês Schmidt, Vincent C. Iannucci, Suzanne Lyn Barker-Collo, Leah E. Cahill, Tauseef Ahmad, Platon D. Lopukhov, Kazumasa Yamagishi, Abdullah Al Mamun, Iqbal R. F. Elyazar, Giovanni Damiani, Mohammad Hossein Bakhshaei, Mehdi Fazlzadeh, Virginia Núñez-Samudio, Alyssa Pennini, Dietrich Plass, Atkilt Esaiyas Etisso, Gebre Teklemariam Demoz, Alexandrea Watson, Arvin Haj-Mirzaian, Paul S Briant, Frank B. Osei, Blair R. Bumgarner, Maciej Banach, Ravensara S. Travillian, Kai-Lan Chang, Shirin Djalalinia, Hasan Yusefzadeh, Silvano Gallus, Seyyed Meysam Mousavi, Bernhard T. Baune, Aaron van Donkelaar, Azeem Majeed, Hans Kromhout, Robert Ancuceanu, Blessing J. Akombi, Pushpendra Singh, Nayu Ikeda, William M. Gardner, Zahid A Butt, Mohammad Abdollahi, Temesgen Yihunie Akalu, Rahman Shiri, Benn Sartorius, Ai-Min Wu, Bing Fang Hwang, Flavia M. Cicuttini, Hiroyasu Iso, Luis Camera, Amin Soheili, Félix Carvalho, Yun Jin Kim, Caleb Mackay Salpeter Irvine, Mehdi Mirzaei-Alavijeh, Iman Halvaei, Saqib Ali, Giulio Castelpietra, Catalina Liliana Andrei, Ali Kazemi Karyani, Parkes J Kendrick, Hamidreza Haririan, Lucas Guimarães Abreu, Mukhammad David Naimzada, Jeff T. Zhao, Samiah Alam, Sorin Hostiuc, Shaun Wen Huey Lee, João Mauricio Castaldelli-Maia, Behzad Karami Matin, Cyrus Alinia, Takahiro Tabuchi, Manu Raj Mathur, Søren Thorgaard Skou, Thomas Khaled Dwayne Classen, Reza Heidari-Soureshjani, Massimo Cirillo, Nikita Otstavnov, Mehdi Bohluli, Ruth W. Kimokoti, Animut Tagele Tamiru, Masoumeh Sadeghi, Mohammad Ali Jahani, Itamar S. Santos, Mekdes Tigistu Yilma, Lars Johansson, Arielle Wilder Eagan, Nevine El Nahas, Silvia Schiavolin, Kevin D. Shield, Dinh-Toi Chu, Shiva Borzouei, Paul S. F. Yip, Beatrix Haddock, Gianfranco Alicandro, Vasily Vlassov, Deanna Anderlini, Giuseppe Remuzzi, Khalid A Altirkawi, Farahnaz Joukar, Aso Mohammad Darwesh, Ratilal Lalloo, Panniyammakal Jeemon, Rohollah Kalhor, Daniel Youngwhan Cho, Weijia Fu, João Pedro Silva, Rodrigo Sarmiento-Suarez, Seth Christopher Yaw Appiah, Mehdi Ahmadi, Jacob Olusegun Olusanya, José Neves, Gaorui Guo, Tomas Y. Yeheyis, John S. Ji, Charles D. H. Parry, Maryam Ghadimi, Seyed-Mohammad Fereshtehnejad, Serge Resnikoff, Anna E. Torre, Vinod C Nayak, Jamileh Shadid, Susanne Breitner, Mohammad Khammarnia, Mathilde Touvier, Ensiyeh Jenabi, Hosna Janjani, Floriane Ausloos, Irmina Maria Michalek, Alexandra S. Boon-Dooley, Jessica A. Cruz, Syed Mohamed Aljunid, Abiodun M. Adeoye, André Faro, Bartosz Miazgowski, Jobert Richie Nansseu, Erin C Mullany, Giannina Ferrara, Martin McKee, Emmanuel Peprah, Oommen John, Reza Saeedi, Yasser Vasseghian, Dragos Virgil Davitoiu, Sarah Wulf Hanson, Yingxi Zhao, Omid Shafaat, Ali Rajabpour-Sanati, Farid Najafi, Ana Maria Mantilla Herrera, Fatemeh Rajati, Tarun Gupta, Łukasz Szumowski, Mohammed Ibrahim Mohialdeen Gubari, Peter Njenga Keiyoro, Dharmesh Kumar Lal, Zhi Jiang Zhang, Osayomwanbo Osarenotor, Tanvir M. Huda, Perminder S. Sachdev, Farhad Ghamari, Era Upadhyay, Vivek Kumar, Guoqing Hu, Vinay Nangia, Vladimir Andreevich Korshunov, Saeed Shahabi, Golnaz Heidari, Ashraf Nabhan, Robert C. Reiner, Aziz Rezapour, Justin J. Lang, Rakhi Dandona, Josephine W. Ngunjiri, Anna-Karin Danielsson, André Karch, Filippo Ariani, Ahmed Abdelalim, Masih Tajdini, Stefanos Tyrovolas, Mohamed Hsairi, Jae Il Shin, Jasvinder A. Singh, Meghan D. Mooney, Fiona B. Bennitt, Hesam Alizade, Segun Emmanuel Ibitoye, Pradhum Ram, Soraya Siabani, Evanson Z. Sambala, Reza Malekzadeh, Falk Schwendicke, Lalit Dandona, Masoud Moradi, Molly R Nixon, Roya Mirzaei, Rachel Feldman, Hosni Salem, Alberto L. García-Basteiro, Lorainne Tudor Car, Sharareh Eskandarieh, Ramesh Holla, Ritesh G. Menezes, Taraneh Yousefinezhadi, Hai Quang Pham, Hamideh Salimzadeh, Luisa Sorio Flor, Priya Rathi, Ali Bijani, Harvey Whiteford, Shanshan Li, Aleksandr Y. Aravkin, Joshua A. Salomon, Franz Castro, Lisa M. Force, Abdilahi Yousuf Yousuf, Mina Anjomshoa, Ken Takahashi, Maigeng Zhou, Telma Zahirian Moghadam, Maseer Khan, Irina Filip, Santi Martini, Randah R. Hamadeh, Somayeh Bohlouli, Joana Morgado-da-Costa, Tim Driscoll, Jingkai Wei, Hermann Brenner, Reza Rawassizadeh, Radoslaw Sierpinski, Saman Esmaeilnejad, Emmanuel Wandera Okunga, Marisa Freitas, Srikanta Banerjee, Feleke Mekonnen Demeke, Shahin Soltani, Naser Mohammad Gholi Mezerji, Reed J D Sorensen, Elena V. Gnedovskaya, Johan Ärnlöv, Ivo Rakovac, Reza Mohammadpourhodki, Hussain Jafari, Atte Meretoja, Yasir Waheed, Fahad Alanezi, Arya Haj-Mirzaian, Sezer Kisa, Jaifred Christian F. Lopez, Khalid F. Alhabib, Basema Saddik, Michael R. Phillips, Vishnu Renjith, Yafeng Wang, Kevan R. Polkinghorne, Liliana G Ciobanu, Jacek Jerzy Jozwiak, Gelin Xu, Richard C. Franklin, Junjie Wu, Thomas R. Hird, Mohammad Zamani, Diana Silva, Fotis Topouzis, Irena Ilic, Jeffrey D. Stanaway, Hadi Pourjafar, Huong Lan Thi Nguyen, Khaled Khatab, Ammas Siraj Mohammed, Ziyad Al-Aly, A. A. Fomenkov, Charlie Ashbaugh, Mowafa Househ, Paul I. Dargan, Endalkachew Worku Mengesha, Shaimaa I. El-Jaafary, Ernoiz Antriyandarti, Iffat Elbarazi, Dara K. Mohammad, Naznin Hossain, Reza Shirkoohi, João M. Furtado, Arash Ziapour, Morteza Jafarinia, M. Mofizul Islam, Anamika Pandey, Ahmed I. Hasaballah, Tanuj Kanchan, Lee Ling Lim, Muktar Omer Omer, Charles D.A. Wolfe, Ulrich O Mueller, Helen Bitew, V. Prakash, Fereshteh Mehri, Randall V. Martin, Claudiu Herteliu, Constance D. Pond, Min Jeong Shin, Morteza Oladnabi, Antonio Maria Borzì, Yousef Mohammad, Yuichiro Yano, Luke D. Knibbs, Kevin S Ikuta, Maryam Mirzaei, Andreea Mirica, Sofia Boston Redford, Siamak Sabour, Mariya Vladimirovna Titova, Davood Anvari, Ghobad Moradi, Jordi Alonso, Shiwei Liu, Theo Vos, Tuomo J. Meretoja, Ireneous N. Soyiri, Owen R. Cooper, Seyed Sina Naghibi Irvani, Kejia Hu, Hannah J. Henrikson, Sanni Yaya, Robert P. Dellavalle, Chidozie Declan Iwu, Sergey Soshnikov, Jee-Young Jasmine Choi, Satinath Mukhopadhyay, Zabihollah Yousefi, Iman El Sayed, Biresaw Wassihun Alemu, Neeti Kapoor, Ahmad Daryani, Cathleen Keller, Ibrahim Abdollahpour, Nuno Taveira, Masoud Foroutan, Fatemeh Amiri, Mariam Molokhia, Songhomitra Panda-Jonas, Amy E. Peden, Rufus Akinyemi, Ejaz Ahmad Khan, Mostafa Amini-Rarani, J. Becker, Hamidreza Pazoki Toroudi, Ben Lacey, Kidanemaryam Berhe, Simon Yadgir, Spencer L. James, Cory N. Spencer, Aletta E. Schutte, Mu'awiyyah Babale Sufiyan, Arash Tehrani-Banihashemi, Govinda Prasad Dhungana, Fereshteh Ansari, Rixing Xu, Jonathan F. Mosser, Josep Maria Haro, Enrico Rubagotti, Anurag Agrawal, Zahiruddin Quazi Syed, Hoa Thi Do, Ettore Beghi, Seyed Mohammad Kazem Aghamir, Abraham Geremew, Alireza Esteghamati, Paramjit Gill, Farzad Jalilian, J. Jason West, Mikhail Sergeevich Zastrozhin, Albertino Damasceno, Bruce Bartholow Duncan, Nazir Fattahi, Daniel Cury Ribeiro, Michael Brauer, Mark A. Stokes, Veincent Christian Filipino Pepito, Lidia Morawska, Fiona J Charlson, Babak Moazen, Dejana Braithwaite, Jonathan M. Kocarnik, Sergio I. Prada, Andrea Farioli, Zahra Atafar, Heather Orpana, Daniela Balzi, Marco Vacante, Rahmatollah Moradzadeh, Jacek A. Kopec, Iván Landires, Robert G. Weintraub, Leonardo Roever, Yannick Béjot, Markus P. Schlaich, Hamed Zandian, Subramanian Senthilkumaran, Klara Dokova, Vahid Alipour, Sowmya J. Rao, Rakesh Ghosh, Omar Mukhtar Salman, Faris Lami, Marcos Roberto Tovani-Palone, Hamid Reza Tohidinik, Seyed Mohammad Riahi, Adnan Kisa, Ghasem Azarian, Caroline Stein, Zulfiqar A. Bhutta, Sinead Langan, Kunihiro Matsushita, Lauren E. Schaeffer, Kathryn H. Jacobsen, Mehdi Naderi, Mehdi Hosseinzadeh, Nizal Sarrafzadegan, Bahram Armoon, Dan J. Stein, Jessica Fanzo, Morenike Oluwatoyin Folayan, Luca Ronfani, Phetole Walter Mahasha, Nicholas J K Breitborde, Adrian Oţoiu, Arash Sarveazad, Marc L. Serre, Mostafa Hosseini, Nicolas Cherbuin, George D. Thurston, Jalal Arabloo, Mokhtar Mahdavi, Andre Rodrigues Duraes, Ana Laura Manda, Ahmed Abualhasan, Nima Rezaei, Yuan-Pang Wang, Theodore Patrick Younker, Alireza Ansari-Moghaddam, Borhan Mansouri, Adam E. Berman, Khezar Hayat, Rosario Cárdenas, Bolajoko O. Olusanya, Tommi Vasankari, Simon I. Hay, Fatemeh Ghaffarifar, Leo Stockfelt, Ai Koyanagi, Giorgia Giussani, Yuming Guo, Sonia Saxena, Deborah Carvalho Malta, Mehedi Hasan, Negar Rezaei, Maja Pasovic, Jukka Takala, Bogdan Oancea, Sare Safi, A. Werdecker, Florian Fischer, Beatriz Paulina Ayala Quintanilla, Muhammad Shahdaat Bin Sayeed, Takeshi Fukumoto, Maha Atout, Brijesh Sathian, Cristina Bosetti, Mitchell T. Wallin, Agegnehu Bante, Helen Ippolito, Anthony Masaka, Chantal Huynh, Justin Lo, Jordan Weiss, Joemer C. Maravilla, Alberto Raggi, Peter W. Gething, Cristiana Abbafati, Daniela Ribeiro, Mohammad Farahmand, Yetunde O. John-Akinola, Isabela M. Benseñor, Emilie R Maddison, John J. McGrath, Salman Khazaei, Scott B. Patten, Jean Jacques Noubiap, Emmanuela Gakidou, Celine M. Barthelemy, Ashish Badiye, George C. Patton, Obinna Onwujekwe, Peter Allebeck, Victor Aboyans, Olayinka Stephen Ilesanmi, Mousa Yaminfirooz, Neeraj Bedi, Nicholas L S Roberts, Joht Singh Chandan, Hans W. Hoek, Usman Iqbal, Nima Hafezi-Nejad, Haley Lescinsky, Naohiro Yonemoto, Ahmad Ghashghaee, Anders Larsson, David C. Schwebel, Milena Ilic, Richard T. Burnett, Yang Liu, Carlo La Vecchia, Felix Akpojene Ogbo, Morteza Naserbakht, Sangram Kishor Patel, Melanie S. Hammer, Prasanna Mithra, Mohammad Amin Bahrami, Kanyin L. Ong, Mona Pathak, Afshin Maleki, Saeid Safiri, Masood Ali Shaikh, Kate Causey, Michael R.M. Abrigo, Jost B. Jonas, Dian Kusuma, Jagadish Rao Padubidri, Mihajlo Jakovljevic, Ali S. Shalash, Abdiwahab Hashi, Ionut Negoi, Nataliya A. Foigt, Andrey Nikolaevich Briko, François Alla, Giuseppe Grosso, Houman Goudarzi, Di H. Cross, Vera Marisa Costa, Eduarda Fernandes, Chandrashekhar T Sreeramareddy, Odgerel Chimed-Ochir, Sonia Rodríguez-Ramírez, Bo Norrving, Kerem Shuval, Jacob L. Stubbs, Muhammad Ali, Shuhei Nomura, Man Mohan Mehndiratta, Chisom Joyqueenet Akunna, Abdollah Mohammadian-Hafshejani, Navid Rabiee, Dana Bryazka, Hussen Mohammed, Asadollah Gholamian, Ashley Marks, Rizwan Kalani, Molly E. Herbert, Islam Y. Elgendy, Moritz U. G. Kraemer, Chuanhua Yu, Suzanne Polinder, Pascual R. Valdez, Jennifer Rickard, Kylie Ball, Turki Alanzi, Mohsen Bayati, Hamed Mirzaei, Christopher M Odell, Amira Shaheen, Ziad A. Memish, Thirunavukkarasu Sathish, Michael A. Piradov, Hamed Kalani, Lorenzo Monasta, Christopher S Yilgwan, Desalegn Getnet Demsie, Riaz Uddin, Rizwan Suliankatchi Abdulkader, Vinay Srinivasan, Hamid Ahmadieh, Claudio Alberto Dávila-Cervantes, Raffaele Palladino, Chukwudi A Nnaji, Mika Shigematsu, Stein Emil Vollset, Abbas Sheikhtaheri, Paulo A. Lotufo, Nasir Salam, Binyam Minuye Birihane, Mohammad Ali Mansournia, Tomislav Mestrovic, Samer Hamidi, Rajesh Sagar, Mayowa O. Owolabi, Kara Estep, Ester Cerin, Michael T. Chung, Simon Øverland, Amir Taherkhani, Sheng Chia Chung, Martin Amogre Ayanore, Nikolaos Dervenis, Joan B. Soriano, Tahereh Javaheri, Victor Adekanmbi, Seid Tiku Mereta, Gbenga A. Kayode, Christopher R. Cederroth, Razique Anwer, Rajan Nikbakhsh, Kaja Abbas, Fatemeh Heydarpour, Louisa Degenhardt, Tahiya Alam, Mohammad Miri, Alibek Mereke, David Laith Rawaf, Ippazio Cosimo Antonazzo, Erkin M. Mirrakhimov, Seyed Hossein Yahyazadeh Jabbari, Desta Debalkie Atnafu, Davide Sattin, Moslem Soofi, Edris Hasanpoor, Krittika Bhattacharyya, Mika Kivimäki, Nikolay Ivanovich Briko, Joanna L Whisnant, Christopher J L Murray, Simin Mouodi, Alize J. Ferrari, Damian Santomauro, Katrin Burkart, Tudorel Andrei, Alberto Baldasseroni, Hafiz Ansar Rasul Suleria, Valery L. Feigin, Nauman Khalid, Ewerton Cousin, S. Mohammad Sajadi, Francisco Rogerlândio Martins-Melo, Shankar M Bakkannavar, Themba G.G. Ginindza, Sadaf G. Sepanlou, Sheikh Mohammed Shariful Islam, Sanjay Basu, Getinet Ayano, Paula Moraga, Soheil Hassanipour, Jason A. Anderson, Catherine Bisignano, Iyad Sultan, Deepak Kumar Pasupula, Keivan Ahmadi, Fariba Dorostkar, Rajeev Gupta, David M. Pereira, Mustafa Z. Younis, Adel Spotin, Rasmus Havmoeller, Yeshambel T. Nigatu, Barthelemy Kuate Defo, Mithila Faruque, Alan D. Lopez, Shailesh Advani, Behshad Naghshtabrizi, Shane D. Morrison, Inga Dora Sigfusdottir, Konrad Pesudovs, Anna Gershberg Hayoon, Raaj Kishore Biswas, Reshmi Bhageerathy, H. Dean Hosgood, Giulia Carreras, Sarika Chaturvedi, James L. Fisher, In-Hwan Oh, G Anil Kumar, Christoph Nowak, Vijay Kumar Chattu, Puja C Rao, Marcel Ausloos, Ali Kabir, Rannveig Sigurvinsdottir, Leeberk Raja Inbaraj, Edgar Denova-Gutiérrez, Rafael Tabarés-Seisdedos, Minh Nguyen, Ashkan Afshin, Payman Salamati, Colin Angus, Mona M. Khater, Ehsan Sadeghi, Mahalaqua Nazli Khatib, Antonio Biondi, Valentin Yurievich Skryabin, Mohsen Abbasi-Kangevari, Andrew T Olagunju, Amir Radfar, Laith J. Abu-Raddad, Marcello Tonelli, Hesam Ghiasvand, Hanne Christensen, Juan Jesus Carrero, Maryam Adabi, Saravanan Muthupandian, Kurt Straif, Hossein Samadi Kafil, Lope H Barrero, Harish Chander Gugnani, Mohammad Fareed, Morteza Shamsizadeh, Jemal Abdu Mohammed, Juan A Rivera, Shai Linn, Saad M.A. Dahlawi, Janni Leung, Shokofeh Maleki, Mohd Anisul Karim, Kamarul Imran Musa, Farshad Pourmalek, Dietrich Rothenbacher, Kiomars Sharafi, Alessandra C. Goulart, Leila Doshmangir, Gabriele Nagel, Helena Manguerra, Olatunji O. Adetokunboh, Srinivasa Vittal Katikireddi, Nermin Ghith, Maha El Tantawi, Awoke Misganaw, Yunquan Zhang, Carl Abelardo T. Antonio, Vahid Rashedi, Mehran Shams-Beyranvand, Bhaskaran Unnikrishnan, Holly E. Erskine, Ann Kristin Knudsen, Marissa B Reitsma, Getayeneh Antehunegn Tesema, Javad Javidnia, Ismael R. Campos-Nonato, Biniyam Sahiledengle Geberemariyam, Godfrey Mutashambara Rwegerera, Alaa Badawi, James Leigh, Morteza Arab-Zozani, Kyle E. Simpson, Muluken Bekele Sorrie, Roghiyeh Faridnia, Vivekanand Jha, Tomasz Miazgowski, Aaron J Cohen, Chukwuma David Umeokonkwo, Alessandra Lugo, Adhanom Gebreegziabher Baraki, Akshaya Srikanth Bhagavathula, Caitlyn Steiner, Gholamreza Roshandel, Cuong Tat Nguyen, Tania G Sánchez-Pimienta, Ahamarshan Jayaraman Nagarajan, Laura Kemmer, Ihoghosa Osamuyi Iyamu, Seyedeh Zahra Masoumi, Vivian Chia-Rong Hsieh, Kris J. Krohn, Phoebe Anne Rhinehart, Sarah Wozniak, Sahar Saeedi Moghaddam, Kate E. LeGrand, Christian Kieling, Vahid Yazdi-Feyzabadi, Robin Room, Zelalem Nigussie Azene, Kelly Cercy, Paul H. Lee, Stanislav S. Otstavnov, Dinesh Bhandari, Rafael Alves Guimarães, Zemenu Tadesse Tessema, Aziz Sheikh, Michellr L. Bell, Marwa Rashad Salem, Kirsten E. Wiens, Emma U.R. Smith, Hassan Abolhassani, Cristiano Piccinelli, Kedir Hussein Abegaz, G.K. Mini, Christian Razo, Manuela L. Ferreira, Diego De Leo, Francesco Saverio Violante, Aristidis Tsatsakis, Zahra Sadat Dibaji Forooshani, Tea Lallukka, Dickson A. Amugsi, Anna Poznańska, Graeme J. Hankey, Kewal Krishan, Maryam Zamanian, Eirini Skiadaresi, Jai K Das, Felix Greaves, Tessa M. Pilz, Sameer Vali Gopalani, Mansour Ghafourifard, M. DeLang, Morteza Mahmoudi, Alton Lu, Brian J. Hall, Ravi Prakash Jha, David Edvardsson, Xiu Ju George Zhao, Farshad Farzadfar, Hadi Hassankhani, Samuel M. Ostroff, Gerhard Sulo, Keyghobad Ghadiri, Neeraj Bhala, Stefan Lorkowski, Mohammad Rabiee, Sivan Yegnanarayana Iyer Saraswathy, Amirhossein Sahebkar, Rashid Abdi Guled, Abdallah M. Samy, Roman Topor-Madry, Michal Grivna, Afsaneh Arzani, Ayesha Humayun, Simin Liu, Maryam Khayamzadeh, Davoud Adham, Ahad Bakhtiari, Shafiu Mohammed, Paolo Lauriola, Abbas Mosapour, Sophia Emmons-Bell, Khurshid Alam, Rajat Das Gupta, Matilde Leonardi, Muktar Beshir Ahmed, Jeffrey V. Lazarus, Mohamed M. Gad, Kelly Compton, Leila R Kalankesh, Abdelrahman Ibrahim Abushouk, Mikk Jürisson, Catherine M. Antony, Ali A. Asadi-Pooya, Daniel Diaz, Salman Rawaf, Gina Agarwal, Ted R. Miller, Rebecca Ivers, João Vasco Santos, Savita Lasrado, Abdul Moiz Hafiz, Amir Almasi-Hashiani, Praveen Hoogar, Fares Alahdab, Om P Kurmi, Anbissa Muleta Senbeta, Tomi Akinyemiju, Boris Bikbov, Muhammad Aziz Rahman, Amin Mousavi Khaneghah, Yahya Safari, Guilherme Borges, Carlos A Castañeda-Orjuela, Kenji Shibuya, Bahman Yousefi, Berrin Serdar, Karen M. Tabb, Sonali Kochhar, Till Bärnighausen, Kala M. Mehta, Mostafa Dianatinasab, Arash Etemadi, Melissa Y. Wei, Kiana Ramezanzadeh, Lingkan Barua, Zubair Kabir, Rade Vukovic, Hesham M. Al-Mekhlafi, Shoshana H. Ballew, Miriam Levi, Zainab Samad, Florentino Luciano Caetano dos Santos, Juan Sanabria, Ramu Rawat, Chinwe Juliana Iwu, Gabrielle B. Britton, Colm McAlinden, Mohsen Naghavi, Maarten J. Postma, Chhabi Lal Ranabhat, Jalil Jaafari, Walter Mendoza, Mahesh P A, Pallab K. Maulik, Ali H. Mokdad, Andre M. N. Renzaho, Milena Santric-Milicevic, Parvaiz A Koul, Foad Abd-Allah, Mihaela Hostiuc, Richard G. Cowden, Ronny Westerman, Meghdad Pirsaheb, Department of Earth Observation Science, UT-I-ITC-ACQUAL, Faculty of Geo-Information Science and Earth Observation, Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET), Value, Affordability and Sustainability (VALUE), Microbes in Health and Disease (MHD), Tampere University, Tays Research Services, Health Sciences, Murray, C. J. L., Aravkin, A. Y., Zheng, P., Abbafati, C., Abbas, K. M., Abbasi-Kangevari, M., Abd-Allah, F., Abdelalim, A., Abdollahi, M., Abdollahpour, I., Abegaz, K. H., Abolhassani, H., Aboyans, V., Abreu, L. G., Abrigo, M. R. M., Abualhasan, A., Abu-Raddad, L. J., Abushouk, A. I., Adabi, M., Adekanmbi, V., Adeoye, A. M., Adetokunboh, O. O., Adham, D., Advani, S. 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W., Ausloos, F., Ausloos, M., Ayala Quintanilla, B. P., Ayano, G., Ayanore, M. A., Azari, S., Azarian, G., Azene, Z. N., Badawi, A., Badiye, A. D., Bahrami, M. A., Bakhshaei, M. H., Bakhtiari, A., Bakkannavar, S. M., Baldasseroni, A., Ball, K., Ballew, S. H., Balzi, D., Banach, M., Banerjee, S. K., Bante, A. B., Baraki, A. G., Barker-Collo, S. L., Barnighausen, T. W., Barrero, L. H., Barthelemy, C. M., Barua, L., Basu, S., Baune, B. T., Bayati, M., Becker, J. S., Bedi, N., Beghi, E., Bejot, Y., Bell, M. L., Bennitt, F. B., Bensenor, I. M., Berhe, K., Berman, A. E., Bhagavathula, A. S., Bhageerathy, R., Bhala, N., Bhandari, D., Bhattacharyya, K., Bhutta, Z. A., Bijani, A., Bikbov, B., Bin Sayeed, M. S., Biondi, A., Birihane, B. M., Bisignano, C., Biswas, R. K., Bitew, H., Bohlouli, S., Bohluli, M., Boon-Dooley, A. S., Borges, G., Borzi, A. M., Borzouei, S., Bosetti, C., Boufous, S., Braithwaite, D., Breitborde, N. J. K., Breitner, S., Brenner, H., Briant, P. S., Briko, A. N., Briko, N. I., Britton, G. B., Bryazka, D., Bumgarner, B. R., Burkart, K., Burnett, R. T., Burugina Nagaraja, S., Butt, Z. A., Caetano dos Santos, F. L., Cahill, L. E., Camera, L. L. A., Campos-Nonato, I. R., Cardenas, R., Carreras, G., Carrero, J. J., Carvalho, F., Castaldelli-Maia, J. M., Castaneda-Orjuela, C. A., Castelpietra, G., Castro, F., Causey, K., Cederroth, C. R., Cercy, K. M., Cerin, E., Chandan, J. S., Chang, K. -L., Charlson, F. J., Chattu, V. K., Chaturvedi, S., Cherbuin, N., Chimed-Ochir, O., Cho, D. Y., Choi, J. -Y. J., Christensen, H., Chu, D. -T., Chung, M. T., Chung, S. -C., Cicuttini, F. M., Ciobanu, L. G., Cirillo, M., Classen, T. K. D., Cohen, A. J., Compton, K., Cooper, O. R., Costa, V. M., Cousin, E., Cowden, R. G., Cross, D. H., Cruz, J. A., Dahlawi, S. M. A., Damasceno, A. A. M., Damiani, G., Dandona, L., Dandona, R., Dangel, W. J., Danielsson, A. -K., Dargan, P. I., Darwesh, A. M., Daryani, A., Das, J. K., Das Gupta, R., das Neves, J., Davila-Cervantes, C. 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J., Jurisson, M., Kabir, A., Kabir, Z., Kalani, H., Kalani, R., Kalankesh, L. R., Kalhor, R., Kanchan, T., Kapoor, N., Karami Matin, B., Karch, A., Karim, M. A., Kassa, G. M., Katikireddi, S. V., Kayode, G. A., Kazemi Karyani, A., Keiyoro, P. N., Keller, C., Kemmer, L., Kendrick, P. J., Khalid, N., Khammarnia, M., Khan, E. A., Khan, M., Khatab, K., Khater, M. M., Khatib, M. N., Khayamzadeh, M., Khazaei, S., Kieling, C., Kim, Y. J., Kimokoti, R. W., Kisa, A., Kisa, S., Kivimaki, M., Knibbs, L. D., Knudsen, A. K. S., Kocarnik, J. M., Kochhar, S., Kopec, J. A., Korshunov, V. A., Koul, P. A., Koyanagi, A., Kraemer, M. U. G., Krishan, K., Krohn, K. J., Kromhout, H., Kuate Defo, B., Kumar, G. A., Kumar, V., Kurmi, O. P., Kusuma, D., La Vecchia, C., Lacey, B., Lal, D. K., Lalloo, R., Lallukka, T., Lami, F. H., Landires, I., Lang, J. J., Langan, S. M., Larsson, A. O., Lasrado, S., Lauriola, P., Lazarus, J. V., Lee, P. H., Lee, S. W. H., Legrand, K. 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J., Nowak, C., Nunez-Samudio, V., Otoiu, A., Oancea, B., Odell, C. M., Ogbo, F. A., Oh, I. -H., Okunga, E. W., Oladnabi, M., Olagunju, A. T., Olusanya, B. O., Olusanya, J. O., Omer, M. O., Ong, K. L., Onwujekwe, O. E., Orpana, H. M., Ortiz, A., Osarenotor, O., Osei, F. B., Ostroff, S. M., Otstavnov, N., Otstavnov, S. S., Overland, S., Owolabi, M. O., P A, M., Padubidri, J. R., Palladino, R., Panda-Jonas, S., Pandey, A., Parry, C. D. H., Pasovic, M., Pasupula, D. K., Patel, S. K., Pathak, M., Patten, S. B., Patton, G. C., Pazoki Toroudi, H., Peden, A. E., Pennini, A., Pepito, V. C. F., Peprah, E. K., Pereira, D. M., Pesudovs, K., Pham, H. Q., Phillips, M. R., Piccinelli, C., Pilz, T. M., Piradov, M. A., Pirsaheb, M., Plass, D., Polinder, S., Polkinghorne, K. R., Pond, C. D., Postma, M. J., Pourjafar, H., Pourmalek, F., Poznanska, A., Prada, S. I., Prakash, V., Pribadi, D. R. A., Pupillo, E., Quazi Syed, Z., Rabiee, M., Rabiee, N., Radfar, A., Rafiee, A., Raggi, A., Rahman, M. A., Rajabpour-Sanati, A., Rajati, F., Rakovac, I., Ram, P., Ramezanzadeh, K., Ranabhat, C. L., Rao, P. C., Rao, S. J., Rashedi, V., Rathi, P., Rawaf, D. L., Rawaf, S., Rawal, L., Rawassizadeh, R., Rawat, R., Razo, C., Redford, S. B., Reiner, R. C., Reitsma, M. B., Remuzzi, G., Renjith, V., Renzaho, A. M. N., Resnikoff, S., Rezaei, N., Rezapour, A., Rhinehart, P. -A., Riahi, S. M., Ribeiro, D. C., Ribeiro, D., Rickard, J., Rivera, J. A., Roberts, N. L. S., Rodriguez-Ramirez, S., Roever, L., Ronfani, L., Room, R., Roshandel, G., Roth, G. A., Rothenbacher, D., Rubagotti, E., Rwegerera, G. M., Sabour, S., Sachdev, P. S., Saddik, B., Sadeghi, E., Sadeghi, M., Saeedi, R., Saeedi Moghaddam, S., Safari, Y., Safi, S., Safiri, S., Sagar, R., Sahebkar, A., Sajadi, S. M., Salam, N., Salamati, P., Salem, H., Salem, M. R. R., Salimzadeh, H., Salman, O. M., Salomon, J. A., Samad, Z., Samadi Kafil, H., Sambala, E. Z., Samy, A. M., Sanabria, J., Sanchez-Pimienta, T. G., Santomauro, D. F., Santos, I. 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Saeedi Moghaddam, S, Safari, Y, Safi, S, Safiri, S, Sagar, R, Sahebkar, A, Sajadi, S, Salam, N, Salamati, P, Salem, H, Salem, M, Salimzadeh, H, Salman, O, Salomon, J, Samad, Z, Samadi Kafil, H, Sambala, E, Samy, A, Sanabria, J, Sanchez-Pimienta, T, Santomauro, D, Santos, I, Santos, J, Santric-Milicevic, M, Saraswathy, S, Sarmiento-Suarez, R, Sarrafzadegan, N, Sarveazad, A, Sathian, B, Sathish, T, Sattin, D, Saxena, S, Schaeffer, L, Schiavolin, S, Schlaich, M, Schmidt, M, Schutte, A, Schwebel, D, Schwendicke, F, Senbeta, A, Senthilkumaran, S, Sepanlou, S, Serdar, B, Serre, M, Shadid, J, Shafaat, O, Shahabi, S, Shaheen, A, Shaikh, M, Shalash, A, Shams-Beyranvand, M, Shamsizadeh, M, Sharafi, K, Sheikh, A, Sheikhtaheri, A, Shibuya, K, Shield, K, Shigematsu, M, Shin, J, Shin, M, Shiri, R, Shirkoohi, R, Shuval, K, Siabani, S, Sierpinski, R, Sigfusdottir, I, Sigurvinsdottir, R, Silva, J, Simpson, K, Singh, J, Singh, P, Skiadaresi, E, Skou, S, Skryabin, V, Smith, E, Soheili, A, Soltani, S, Soofi, M, Sorensen, R, Soriano, J, Sorrie, M, Soshnikov, S, Soyiri, I, Spencer, C, Spotin, A, Sreeramareddy, C, Srinivasan, V, Stanaway, J, Stein, C, Stein, D, Steiner, C, Stockfelt, L, Stokes, M, Straif, K, Stubbs, J, Sufiyan, M, Suleria, H, Suliankatchi Abdulkader, R, Sulo, G, Sultan, I, Tabares-Seisdedos, R, Tabb, K, Tabuchi, T, Taherkhani, A, Tajdini, M, Takahashi, K, Takala, J, Tamiru, A, Taveira, N, Tehrani-Banihashemi, A, Temsah, M, Tesema, G, Tessema, Z, Thurston, G, Titova, M, Tohidinik, H, Tonelli, M, Topor-Madry, R, Topouzis, F, Torre, A, Touvier, M, Tovani-Palone, M, Tran, B, Travillian, R, Tsatsakis, A, Tudor Car, L, Tyrovolas, S, Uddin, R, Umeokonkwo, C, Unnikrishnan, B, Upadhyay, E, Vacante, M, Valdez, P, van Donkelaar, A, Vasankari, T, Vasseghian, Y, Veisani, Y, Venketasubramanian, N, Violante, F, Vlassov, V, Vollset, S, Vos, T, Vukovic, R, Waheed, Y, Wallin, M, Wang, Y, Watson, A, Wei, J, Wei, M, Weintraub, R, Weiss, J, Werdecker, A, West, J, Westerman, R, Whisnant, J, 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S. B., Caetano Dos Santos, F. L., Camera, L. A., Elyazar, I. R. F., Ayalew Gebreslassie, A. A. A., Ginindza, T. G., Matin, B. K., Morgado-Da-Costa, J., Khaneghah, A. M., Mahesh, P. A., Toroudi, H. P., Syed, Z. Q., Salem, M. R., Skou, S. T., Tovani-Palone, M. R., Tudor Car, L. T., and Moghadam, T. Z.

Subjects
Male, Nutritional Sciences, Specific risk, Contaminación del Aire Interior, 030204 cardiovascular system & hematology, Socioeconomic Factor, systematic analysis, Global Health, Body Mass Index, Global Burden of Disease, Health Risk Behavior, Health Risk Behaviors, Disease studies, 0302 clinical medicine, Risk Factors, METABOLIC RISKS, 030212 general & internal medicine, 11 Medical and Health Sciences, Factores de Riesgo, 2. Zero hunger, education.field_of_study, Public health, Injuries, Public Health, Global Health, Social Medicine and Epidemiology, General Medicine, GBD, risck factors, attributable burden of disease, 3142 Public health care science, environmental and occupational health, 3. Good health, Relative risk, Environmental health, Health, Hypertension, Global Burden of Diseases, Injuries, Risk Factors, A990 Medicine and Dentistry not elsewhere classified, Female, Leading risk factors, Global Health Metrics, Cohort study, Human, medicine.medical_specialty, Substance-Related Disorders, Population, UNITED-STATES, Risk Assessment, DIET, ITC-HYBRID, 03 medical and health sciences, Life Expectancy, MORTALITY, DISABILITY, POLLUTION, CLUSTERS, SDG 3 - Good Health and Well-being, General & Internal Medicine, medicine, Humans, Global Burden of Disease Study, Risk factor, education, Global burden, business.industry, Risk Factor, Malnutrition, Klinisk medicin, Global Burden of Diseases, Environmental Exposure, medicine.disease, Enfermedades, purl.org/pe-repo/ocde/ford#3.02.00 [https], Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, Years of potential life lost, Socioeconomic Factors, Risk factors, Disease study, Hyperglycemia, ITC-ISI-JOURNAL-ARTICLE, NA, Clinical Medicine, business, RA
Abstract

Background Rigorous analysis of levels and trends in exposure to leading risk factors and quantification of their effect on human health are important to identify where public health is making progress and in which cases current efforts are inadequate. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a standardised and comprehensive assessment of the magnitude of risk factor exposure, relative risk, and attributable burden of disease. Methods GBD 2019 estimated attributable mortality, years of life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 87 risk factors and combinations of risk factors, at the global level, regionally, and for 204 countries and territories. GBD uses a hierarchical list of risk factors so that specific risk factors (eg, sodium intake), and related aggregates (eg, diet quality), are both evaluated. This method has six analytical steps. (1) We included 560 risk-outcome pairs that met criteria for convincing or probable evidence on the basis of research studies. 12 risk-outcome pairs included in GBD 2017 no longer met inclusion criteria and 47 risk-outcome pairs for risks already included in GBD 2017 were added based on new evidence. (2) Relative risks were estimated as a function of exposure based on published systematic reviews, 81 systematic reviews done for GBD 2019, and meta-regression. (3) Levels of exposure in each age-sex-location-year included in the study were estimated based on all available data sources using spatiotemporal Gaussian process regression, DisMod-MR 2.1, a Bayesian meta-regression method, or alternative methods. (4) We determined, from published trials or cohort studies, the level of exposure associated with minimum risk, called the theoretical minimum risk exposure level. (5) Attributable deaths, YLLs, YLDs, and DALYs were computed by multiplying population attributable fractions (PAFs) by the relevant outcome quantity for each age-sex-location-year. (6) PAFs and attributable burden for combinations of risk factors were estimated taking into account mediation of different risk factors through other risk factors. Across all six analytical steps, 30 652 distinct data sources were used in the analysis. Uncertainty in each step of the analysis was propagated into the final estimates of attributable burden. Exposure levels for dichotomous, polytomous, and continuous risk factors were summarised with use of the summary exposure value to facilitate comparisons over time, across location, and across risks. Because the entire time series from 1990 to 2019 has been re-estimated with use of consistent data and methods, these results supersede previously published GBD estimates of attributable burden. Findings The largest declines in risk exposure from 2010 to 2019 were among a set of risks that are strongly linked to social and economic development, including household air pollution; unsafe water, sanitation, and handwashing; and child growth failure. Global declines also occurred for tobacco smoking and lead exposure. The largest increases in risk exposure were for ambient particulate matter pollution, drug use, high fasting plasma glucose, and high body-mass index. In 2019, the leading Level 2 risk factor globally for attributable deaths was high systolic blood pressure, which accounted for 10.8 million (95% uncertainty interval [UI] 9.51-12.1) deaths (19.2% [16.9-21.3] of all deaths in 2019), followed by tobacco (smoked, second-hand, and chewing), which accounted for 8.71 million (8.12-9.31) deaths (15.4% [14.6-16.2] of all deaths in 2019). The leading Level 2 risk factor for attributable DALYs globally in 2019 was child and maternal malnutrition, which largely affects health in the youngest age groups and accounted for 295 million (253-350) DALYs (11.6% [10.3-13.1] of all global DALYs that year). The risk factor burden varied considerably in 2019 between age groups and locations. Among children aged 0-9 years, the three leading detailed risk factors for attributable DALYs were all related to malnutrition. Iron deficiency was the leading risk factor for those aged 10-24 years, alcohol use for those aged 25-49 years, and high systolic blood pressure for those aged 50-74 years and 75 years and older. Interpretation Overall, the record for reducing exposure to harmful risks over the past three decades is poor. Success with reducing smoking and lead exposure through regulatory policy might point the way for a stronger role for public policy on other risks in addition to continued efforts to provide information on risk factor harm to the general public. Copyright (C) 2020 The Author(s). Published by Elsevier Ltd.

Published
2020

38. Heavily calcified parapharyngeal space mesenchymal chondrosarcoma: Imaging and pathological findings and a review of the literature

Author

Omid Shafaat, Ehsan Sotoudeh, Erin Baumgartner, Alireza Zandifar, Houman Sotoudeh, and Philip R. Chapman

Subjects
Adult, Male, Pathology, medicine.medical_specialty, education, Case Reports, Lesion, Pleomorphic adenoma, Diagnosis, Differential, 03 medical and health sciences, 0302 clinical medicine, Parapharyngeal Space, Ossified Mass, Parapharyngeal space, Medicine, Humans, Radiology, Nuclear Medicine and imaging, 030223 otorhinolaryngology, Head and neck, Pathological, health care economics and organizations, business.industry, Calcinosis, General Medicine, medicine.disease, Mesenchymal chondrosarcoma, stomatognathic diseases, 030220 oncology & carcinogenesis, Chondrosarcoma, Mesenchymal, Neurology (clinical), medicine.symptom, Chondrosarcoma, business
Abstract

Parapharyngeal space (PPS) masses are relatively rare lesions of the head and neck, and account for 0.5–1.5% of head and neck lesions. The most common lesion to occur in the PPS is a benign salivary neoplasm, typically pleomorphic adenoma either from the deep parotid or from ectopic parotid tissue rests within the PPS. A calcified or ossified mass in this location is exceedingly rare, but a calcified variant of pleomorphic adenoma has been reported. In this study, we present a patient with a heavily calcified PPS mesenchymal chondrosarcoma with an unusual presentation. We discuss the imaging and pathologic findings followed by a review of the current literature.

Published
2020

39. Brainstem Encephalitis. The Role of Imaging in Diagnosis

Author

Houman Sotoudeh, Aparna Singhal, Zahra Saadatpour, Omid Shafaat, Ali Razaei, Gagandeep Choudhary, and Siddhartha Gaddamanugu

Subjects
medicine.medical_specialty, business.industry, medicine.disease, Magnetic Resonance Imaging, humanities, Pons, 030218 nuclear medicine & medical imaging, Brainstem encephalitis, 03 medical and health sciences, 0302 clinical medicine, Pathognomonic, 030220 oncology & carcinogenesis, Etiology, Medicine, Encephalitis, Humans, Radiology, Nuclear Medicine and imaging, Radiology, Presentation (obstetrics), business, Medulla, Brain Stem
Abstract

Encephalitis is a relatively challenging rare condition caused by a diverse group of etiologies. Brainstem encephalitis/Rhombencephalitis (BE), which affects the cerebellum, pons, and medulla, is even less common and more challenging for diagnosis and treatment. At this time, there is scattered data about BE in the literature, mainly in the form of case reports and case series. In this manuscript, the imaging presentation of BE is reviewed with the help of case examples. Many imaging presentations are not pathognomonic for BE; however, in many cases, clinical presentation, the spatial distribution of lesions, and other associated radiological lesions can provide the radiologists and clinician the clues to an accurate diagnosis.

Published
2020

40. Author correction: Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017

Author

SAVITA LASRADO, Fakher Rahim, Saeid Safari, Hassan Magdy Abd El Razek, Baye Dagnew, Farshad Pourmalek, Ali Rostami, Daniel Ketema, Aletta Schutte, Nasir Salam, Nicole Davis Weaver, Agus Sudaryanto, Martin Ayanore, Nataliya Foigt, Masoud Moradi, Susanna Dunachie, Ziad El-Khatib, Zahra Kamiab, Ashish Badiye, Vijay Kumar Chattu, Maryam Khazaee-Pool, Dabere Nigatu, Jalal Arabloo, Garumma Feyissa, Khalil Eskandari, Kewal Krishan, Bolajoko Olusanya, Gebremicheal Gebreslassie Kasahun, Takahiro Tabuchi, Gebrekiros Meles, Babak Moazen, Jaifred Christian Lopez, Ivy Shiue, Keyvan Pakshir, Tomasz Miazgowski, Surendra Karki, Shivakumar KM, Yasir Waheed, Hamideh Salimzadeh, Ali Akbar Fazaeli, Akram Pourshams, Manoochehr Karami, Yasser El-Sherbiny, Tinuke Olagunju, Vafa Rahimi-Movaghar, Ali Yadollahpour, Assefa Desalew, Ali Shalash, Preeti Dhillon, Ali Asadi-Pooya, Venkatesh Maled, Mihajlo Jakovljevic, John Ji, RAJESH SAGAR, GK Mini, Sebastian Vollmer, Ayman Grada, Boris Bikbov, Neda Izadi, Muhammad Aziz Rahman, Victor Adekanmbi, Reza Mohammadpourhodki, Rahman Shiri, Turki Alanzi, Afsaneh Arzani, Om Prakash Kurmi, Rajat Das Gupta, Masoumeh Sadeghi, Irfan Ullah, Phetole Mahasha, Neeti Kapoor, Hamed Zandian, Bruno Sunguya, Khalid Altirkawi, João Fernandes, Simon Hay, Ana Isabel Ribeiro, Krittika Bhattacharyya, Parastoo Ansari, Gebre Teklemariam Demoz, Hossein Samadi Kafil, Sojib Bin Zaman, Joan B Soriano, Sandra B Munro, Josip Car, Collins Chansa, Navid Rabiee, Sharath Burugina Nagaraja, Palash Banik, Maha El Tantawi, Muawiyyah Babale Sufiyan, Rupak Desai, Davide Rasella, Nicola Bragazzi, Borhan Mansouri, Keivan Ahmadi, Yogesh Sabde, Sergio Ivan Prada Rios, Amir Hasanzadeh, Chinwe Juliana Iwu-Jaja, Syed Amir Gilani, Seyed Sina Naghibi Irvani, Lucero Cahuana-Hurtado, Arya Haj-mirzaian, Reza Heidari-Soureshjani, Rajaa Al-Raddadi, Hagazi Gebre Meles, Muhammad Shahdaat Bin Sayeed, Peng Jia, Mostafa Dianatinasab, Ireneous Soyiri, Jennifer Ross, Erkin Mirrakhimov, Ali Koolivand, Diego Augusto Santos Silva, Olufemi Ajumobi, Muhammad Usman, Hesham Al-Mekhlafi, Enayatollah Homaie Rad, Farhad Moradpour, Fatemeh Rajati, Norberto Perico, Francis Zotor, Omid Shafaat, Joel Francis, Muktar Omer, Hedayat Abbastabar, Mohammad Aghaali, Mulat Tirfie Bayih, Sorin Hostiuc, Era Upadhyay, Daniel Diaz, Mustafa Younis, Ambrish Singh, Mohammad Zamani, Mehran Asadi-Aliabadi, Andre Pascal Kengne, Mohammad Sadegh Rezai, Bruce Duncan, Javad Nazari, Vahid Yazdi-Feyzabadi, Anemaw Asrat, Biagio Simonetti, Neda Milevska Kostova, Mariya Titova, Mohammad Rabiee, Hassan Abolhassani, Morteza Shamsizadeh, Shyam Sundar Budhathoki, Zelalem Nigussie Azene, Pallab Kumar Maulik, Rafael Tabares-Seisdedos, Maha Atout, ANDRE RENZAHO, Fatemeh Amiri, Nelsensius Klau Fauk, Yousef Khader, Mohammad Saud Khan, Davood Anvari, Shymaa Enany, Ahad Bakhtiari, Farnam Mohebi, Yuan-Pang Wang, Naser Kamyari, Tewodros Wonde, Dadi Marami, Arash Ziapour, Azmeraw T. Amare, Nima Rezaei, S.mohammad Sajadi, Vahid Rashedi, Ayesha Humayun, Jacob Olusanya, Yousef Moradi, Reta Tsegaye, Dr. Dereje Bayissa Demissie, Vivekanand Jha, Behnam Nabavizadeh, Vivek Kumar, Andrew Olagunju, Mehran Shams-beyranvand, Farshad Farzadfar, Hagos Tasew, Ninuk Hariyani, Nelson Alvis-Guzmán, Girmay Teklay, Jan-Walter De Neve, Bereket Duko Adema, Jagadish Rao Padubidri, Md Nuruzzaman Khan, Abbas Yadegar, Anurag Agrawal, Vera Marisa Costa, Francisco Rogerlândio Martins-Melo, ORISH EBERE ORISAKWE, Khem Pokhrel, Amir Kasaeian, Artem Fomenkov, Birkneh Tilahun Tadesse, Georgy Lebedev, Razique Anwer, Dimas Ria Angga Pribadi, Alex Yeshaneh, Nuno Taveira, Deepesh Lad, Claudiu Herteliu, Ali Bijani, Zahiruddin Quazi Syed, Elena Varavikova, Antonio Maria Borzì, Phuc Huyen Do, Demelash Elemineh, Abel Fekadu Dadi, Taweewat Wiangkham, Ted Miller, Zubair Kabir, Duduzile Ndwandwe, Habtamu Kasaye, Mario Herrero, Nauman Khalid, Adnan Kisa, Sergey Soshnikov, Alberto Ortiz Arduan, Paul Doku, Saravanan Muthupandian, Bing-Fang Hwang, Meghnath Dhimal, Hamidreza Komaki, Ritesh Menezes, Kedir Abegaz, Claudio Davila, Dinesh Bhandari, Mohamad-Hani Temsah, André Faro, Navid Manafi, Hamidreza Haririan, Nazli Khatib, Wahengbam Bigyananda Meitei, RAVI PRAKASH JHA, Mahdi Mirzaei, Abdallah Samy, Priya Rathi, Alireza Esteghamati, Hailay Gesesew, Eduarda Fernandes, Ghasem Azarian, Shafiu Mohammed, Tauseef Ahmad, Derrick Bennett, Stefan Lorkowski, Yunquan Zhang, Karzan Mohammad, Carlos Castañeda-Orjuela, Mohd Anisul Karim, Tissa Wijeratne, Ahmed I. Hasaballah, Somayeh Bohlouli, Mohammed Madadin, and Mohd Shannawaz

Subjects
Immunology, General Medicine, Medical and Health Sciences, General Biochemistry, Genetics and Molecular Biology, Geography, Childhood Overweight, Low and middle income countries, Environmental health, medicine, medicine.symptom, Wasting, LBD Double Burden of Malnutrition Collaborators, 11 Medical and Health Sciences
Abstract

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Published
2020

41. Prevalence of Sigmoid Sinus Dehiscence and Diverticulum among Adults with Skull Base Cephaloceles

Author

David J Segar, Galal A. Elsayed, Travis J. Atchley, Houman Sotoudeh, Omid Shafaat, S. Ghandili, Gustavo Chagoya, Joshua D. Bernstock, Aparna Singhal, P. Talati, and Saksham Gupta

Subjects
Adult, Male, medicine.medical_specialty, Dehiscence, Cranial Sinuses, digestive system, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, Left sigmoid sinus, medicine, otorhinolaryngologic diseases, Prevalence, Humans, Radiology, Nuclear Medicine and imaging, Head & Neck, Encephalocele, Retrospective Studies, Sigmoid sinus, Skull Base, Univariate analysis, Brain Diseases, Cephalocele, business.industry, Retrospective cohort study, Middle Aged, medicine.disease, digestive system diseases, Surgery, Skull, Diverticulum, medicine.anatomical_structure, Female, Neurology (clinical), business, 030217 neurology & neurosurgery
Abstract

BACKGROUND AND PURPOSE: Cephaloceles are relatively rare conditions caused by a congenital and/or acquired skull defect. The incidence of associated venous brain anomalies with regard to cephaloceles remains to be fully elucidated. Accordingly, we sought to assess the prevalence of sigmoid sinus dehiscence and diverticula in patients with spontaneous skull base cephaloceles. MATERIALS AND METHODS: Our institutional data base was retrospectively queried from 2005 to 2018. Patients in whom spontaneous skull base cephaloceles were identified were ultimately included in the study cohort. These patients subsequently had their sigmoid sinuses re-evaluated with focused attention on the possible presence of dehiscence and/or diverticula. RESULTS: We identified 56 patients: 12 men and 44 women. After re-evaluation of the sigmoid sinuses, evidence of dehiscence and/or diverticula was noted in 21 patients. The right sigmoid sinus was involved in 11 patients, and the left sigmoid sinus was involved in 7 patients, including 3 cases of diverticulum. In 3 patients, evidence of bilateral sigmoid sinus dehiscence and diverticula was noted. Female sex was associated with sigmoid sinus dehiscence and diverticula by univariate analysis (P = .019). By linear regression, cephalocele volume was negatively associated with sigmoid sinus dehiscence and diverticula (coefficient, −2266, P value < .007, adjusted R(2) = 0.1077). By univariate logistic regression using average cephalocele volume as a cutoff, we demonstrate a statistically significant finding of lower volumes being associated with sigmoid sinus dehiscence and diverticula with an odds ratio of 3.58 (P = .05). CONCLUSIONS: The prevalence of sigmoid sinus dehiscence and diverticula in patients with cephalocele is high. Female sex is associated with sigmoid sinus dehiscence and diverticula. The cephalocele volume appears to be inversely proportional to sigmoid sinus dehiscence and diverticula.

Published
2020

42. Critical illness-associated cerebral microbleed in a patient with sickle cell disease: A case report and review of the literature

Author

Aparna Singhal, Houman Sotoudeh, Philip R. Chapman, Ehsan Sotoudeh, Glenn H. Roberson, Alireza Zandifar, and Omid Shafaat

Subjects
Icu patients, medicine.medical_specialty, business.industry, Critically ill, Critical Illness, High mortality, Neuroimaging, Disease, Anemia, Sickle Cell, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, 030220 oncology & carcinogenesis, Critical illness, Etiology, Medicine, Humans, Radiology, Nuclear Medicine and imaging, business, Intensive care medicine, Cerebral Hemorrhage
Abstract

Critical illness-associated cerebral microbleed (CICM) is a relatively rare and newly described condition. It can occur in critically ill ICU patients and can be secondary to many underlying etiologies. CICM is associated with high mortality and permanent neurologic deficits in surviving patients. Distribution of cerebral microhemorrhages in neuroimaging findings is critical for accurate diagnosis of this condition. Here, we present an ICU admitted patient with sickle cell disease crisis and CICM and will discuss their clinically and radiologically distinct phenomenon followed by a review of current literature.

Published
2020

44. Clinical characterization and chest CT findings in laboratory-confirmed COVID-19: a systematic review and meta-analysis

Author

Raheleh Karimi, Omid Shafaat, Behrooz Ataei, Golnaz Vaseghi, Amir Hossein Pezeshki, Shaghayegh Haghjoo Javanmard, Sadegh Baradaran Mahdavi, Marjan Mansourian, Kiyan Heshmat-Ghahdarijani, and Alireza Zandifar

Subjects
medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Pleural effusion, business.industry, Cochrane Library, medicine.disease, Pericardial effusion, Ground-glass opacity, Confidence interval, Meta-analysis, medicine, Radiology, medicine.symptom, Abnormality, business
Abstract

BackgroundImagery techniques have been used as essential parts of diagnostic workup for patients suspected for 2019-nCoV infection, Multiple studies have reported the features of chest computed tomography (CT) scans among a number of 2019-nCoV patients.MethodStudy Identification was carried out in databases (PubMed, Embase and Cochrane Library) to identify published studies examining the diagnosis, the 2019 novel coronavirus (2019-nCoV). Heterogeneity among reported prevalence was assessed by computing p-values of Cochrane Q-test and I2 -statics. The pooled prevalence of treatment failure was carried out with a fixed effects meta-analysis model, generating the pooled 95% confidence interval. A random-effect model was used to pool the results since this model could incorporate the heterogeneity of the studies and therefore proved a more generalized result.ResultsAccording to the combined results of meta-analysis, the total 55% of corona patients were males. The mean age of the patients was 41.31 (34.14, 48.47). Two prevalent clinical symptoms between patients were fever, cough with prevalence of 85%, and 62%, respectively. Either Ground Glass Opacity GGO or consolidation was seen in 86% but 14% had NO GGO or consolidation.The other rare CT symptoms were pericardial effusion, and pleural effusion with 4, 5, 7% prevalence, respectively. The most prevalent event was Either GGO or consolidation in 85% of patients.ConclusionThe most CT-scan abnormality is Either Ground Glass Opacity GGO or consolidation however in few patients none of them might be observed, so trusting in just CT findings will lead to miss some patients.

Published
2020

45. Luxury perfusion: A paradoxical finding and pitfall of CT perfusion in subacute infarction of brain

Author

Asim K. Bag, Houman Sotoudeh, Omid Shafaat, and Aparna Singhal

Subjects
lcsh:Medical physics. Medical radiology. Nuclear medicine, medicine.medical_specialty, lcsh:R895-920, Ischemia, Infarction, Context (language use), Perfusion scanning, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Radiology, Nuclear Medicine and imaging, cardiovascular diseases, Stroke, business.industry, Penumbra, medicine.disease, Perfusion imaging, Neurologic examination, Neuroradiology, Laterality, Cardiology, business, Perfusion, 030217 neurology & neurosurgery
Abstract

In the context of recent guidelines for stroke management, application of computed tomographic perfusion (CTP) is anticipated to increase, especially within 6-24 hours after stroke onset. There are commercially available software packages to help to detect the infarct core and the penumbra, however, the results of these software are not always straightforward that might cause incorrect CTP interpretation. We present here a case of acute ischemic stroke in which the CTP software misinterpreted the results by labeling the normal hemisphere as infarction and ischemia due to luxury perfusion of the infarcted hemisphere. Awareness of laterality of the patient's symptoms and the understanding of functioning of perfusion analysis software is necessary to avoid this pitfall. Keywords: Perfusion imaging, Stroke, Neurologic examination

Published
2018

46. Abstract No. 598 Clinical manifestations of patients with novel mutations associated with hereditary hemorrhagic telangiectasia and related vascular anomalies

Author

A. Gong, Sally E. Mitchell, Clifford R. Weiss, Yingli Fu, P. Gowda, Christopher R. Bailey, Muhammad A. Latif, A. Farhan, Omid Shafaat, and Frank Yuan

Subjects
Pathology, medicine.medical_specialty, business.industry, Medicine, Radiology, Nuclear Medicine and imaging, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Telangiectasia
Published
2021

47. Artificial Intelligence in the Management of Glioma: Era of Personalized Medicine

Author

Joshua D. Bernstock, Paul Szerip, Ehsan Sotoudeh, Houman Sotoudeh, Galal A. Elsayed, Florian Gessler, Amir Shafaat, Gregory K. Friedman, Gustavo Chagoya, Omid Shafaat, Michael David Brooks, Jason A. Chen, and Krieg, Sandro

Subjects
0301 basic medicine, Cancer Research, neural network, business.industry, deep neural network, Review, lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens, artificial intelligence, medicine.disease, lcsh:RC254-282, support vector machines, convolution neural network, 03 medical and health sciences, 030104 developmental biology, 0302 clinical medicine, Transformative learning, Oncology, glioma, 030220 oncology & carcinogenesis, Glioma, medicine, ddc:610, Personalized medicine, Artificial intelligence, business
Abstract

Purpose: Artificial intelligence (AI) has accelerated novel discoveries across multiple disciplines including medicine. Clinical medicine suffers from a lack of AI-based applications, potentially due to lack of awareness of AI methodology. Future collaboration between computer scientists and clinicians is critical to maximize the benefits of transformative technology in this field for patients. To illustrate, we describe AI-based advances in the diagnosis and management of gliomas, the most common primary central nervous system (CNS) malignancy. Methods: Presented is a succinct description of foundational concepts of AI approaches and their relevance to clinical medicine, geared toward clinicians without computer science backgrounds. We also review novel AI approaches in the diagnosis and management of glioma. Results: Novel AI approaches in gliomas have been developed to predict the grading and genomics from imaging, automate the diagnosis from histopathology, and provide insight into prognosis. Conclusion: Novel AI approaches offer acceptable performance in gliomas. Further investigation is necessary to improve the methodology and determine the full clinical utility of these novel approaches.

Published
2019
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48. Pseudohypoxic Brain Swelling: Report of 2 Cases and Introduction of the Lentiform Rim Sign as Potential MRI Marker

Author

Ehsan Sotoudeh, Aparna Singhal, Omid Shafaat, Gagandeep Choudhary, Philip R. Chapman, and Houman Sotoudeh

Subjects
Male, medicine.medical_specialty, medicine.medical_treatment, Encephalopathy, Intracranial Hypotension, Brain Edema, Neurosurgical Procedures, 03 medical and health sciences, 0302 clinical medicine, Cerebrospinal fluid, Postoperative Complications, Edema, medicine, Humans, Craniotomy, Neuroradiology, Aged, Aged, 80 and over, Cerebrospinal fluid leak, medicine.diagnostic_test, business.industry, Brain, Magnetic resonance imaging, medicine.disease, Magnetic Resonance Imaging, 030220 oncology & carcinogenesis, Surgery, Female, Neurology (clinical), Radiology, medicine.symptom, business, 030217 neurology & neurosurgery
Abstract

Background A rare but important complication related to otherwise uneventful brain and spine surgery is becoming more recognized and more frequently reported in the medical literature. This has been variably labeled as pseudohypoxic brain swelling or postoperative hypotension-associated venous congestion. This poorly understood condition occurs in the setting of surgical intervention and is thought to be related to cerebrospinal fluid leak or evacuation, decreased intracranial pressure, and subsequent development of deep venous congestion affecting the basal ganglia, thalami, and cerebellum. Clinically, patients may have global neurologic deficit and outcomes range from full recovery to vegetative state or death. The imaging correlate includes atypical edema, infarction, or hemorrhage and can overlap the appearance of diffuse hypoxic injury, for which this condition can be mistaken both clinically and radiologically. Although this deep brain tissue edema can be associated with other signs of cerebrospinal fluid hypotension such as dural thickening, brain sagging, and cerebellar herniation, it can be isolated, making the diagnosis challenging. Case Description We present 2 cases of unexpected clinical deterioration occurring in patients with otherwise uncomplicated neurosurgery, 1 with craniotomy and the other with lumbar spine intervention. Both patients exhibit similar appearing edema in the deep gray structures on postoperative magnetic resonance imaging scans. In addition to reviewing the prior literature and imaging findings, we evaluate the imaging findings to determine if there are unique features or signatures that might allow differentiation of PHBS from hypoxic-ischemic encephalopathy. Conclusions The lentiform rim sign can be helpful for differentiation of pseudohypoxic brain swelling versus hypoxic-ischemic encephalopathy.

Published
2019

49. Angiosarcoma of the Temporal Bone: Case Report and Review of the Literature

Author

Brandon M. Fox, Omid Shafaat, Andrew A. Hardigan, James R. Hackney, Winfield S. Fisher, Joshua D. Bernstock, Benjamin M. McGrew, Galal A. Elsayed, Lindsay S. Moore, Florian Gessler, Adeel Ilyas, Daisuke Yamashita, Gustavo Chagoya, and Houman Sotoudeh

Subjects
CD31, Male, Reoperation, Pathology, medicine.medical_specialty, CD99, Hemangiosarcoma, Bone Neoplasms, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Cervical lymphadenopathy, Head Injuries, Closed, Temporal bone, medicine, Humans, Angiosarcoma, neoplasms, business.industry, Temporal Bone, medicine.disease, Magnetic Resonance Imaging, digestive system diseases, Staining, 030220 oncology & carcinogenesis, Neoplastic cell, Surgery, Neurology (clinical), Sarcoma, medicine.symptom, Neoplasm Recurrence, Local, business, Tomography, X-Ray Computed, 030217 neurology & neurosurgery
Abstract

Background Angiosarcomas are rare malignant tumors of endothelial origin. Nearly half of all angiosarcomas occur in the head and neck. Temporal bone angiosarcomas are extremely uncommon, and in this case report, we present a case of temporal bone angiosarcoma and a review of the relevant literature. Case report We present a 20-year-old male with a painful right postauricular mass following a closed head injury. Radiologic studies demonstrated a large right osteolytic and heterogeneously enhancing mass. The patient underwent right transpetrosal craniectomy for resection. Histologic studies confirmed high-grade sarcoma. Immunohistochemical stains demonstrated uniformly positive ERG endothelial marker, CD31 stain with cytoplasmic and membranous patterns of immunopositivity, positive nuclear staining for FLI-1, positive cytoplasmic and membranous staining for CD99 and STAT6, and negative SMA stains in the neoplastic cells. The Ki-67 staining showed approximately 94% positivity in the neoplastic cell nuclei. Post-surgical follow-up imaging demonstrated evidence of metastatic right cervical lymphadenopathy. Conclusions Angiosarcoma of the temporal bone is extremely uncommon. In this case report, we explore a relationship between trauma and angiosarcoma of the temporal bone. We reviewed the literature regarding the pathogenesis, diagnosis, treatment, radiologic findings, and histologic characteristics of angiosarcoma of the temporal bone.

Published
2019

50. Fungal Peritonitis with Fungus Balls, a Complication of Trichobezoars and Rapunzel Syndrome

Author

Omid Shafaat, Shabbir Hussain, Houman Sotoudeh, and Ehsan Sotoudeh

Subjects
medicine.medical_specialty, medicine.medical_treatment, Bacterial Peritonitis, Peritonitis, Fungus, 030204 cardiovascular system & hematology, Gastroenterology, Bezoars, 03 medical and health sciences, Fungal peritonitis, 0302 clinical medicine, Laparotomy, Internal medicine, medicine, Humans, Rapunzel syndrome, Child, biology, business.industry, Stomach, Candidiasis, Fungi, General Medicine, Articles, biology.organism_classification, medicine.disease, medicine.anatomical_structure, 030220 oncology & carcinogenesis, Female, Complication, business, Tomography, X-Ray Computed, Intestinal Obstruction
Abstract

Patient: Female, 7 Final Diagnosis: Rapunzel syndrome Symptoms: Abdominal pain Medication: — Clinical Procedure: Laparatomy Specialty: Surgery Objective: Unusual clinical course Background: Rapunzel syndrome is a rare condition involving the extension of bezoars from the stomach to the distal gastrointestinal tract. Laparotomy remains the gold standard treatment for this condition because of the size of the bezoars. Although bacterial peritonitis is a known complication of laparotomy in Rapunzel syndrome, very few cases of post-surgical fungal peritonitis have been reported in these patients. Case Report: In this case report, we present a case of Rapunzel syndrome complicated by post-surgical fungal peritonitis and formation of fungus balls. To our knowledge, fungal peritonitis with fungus balls has never been reported in the English literature as a Rapunzel syndrome complication. Conclusions: It is important to cover Candida and other fungi with an antifungal regimen in pediatric patients with Rapunzel syndrome pre- and post-surgery. In addition, prolonged fever and septic symptoms post-surgery warrant a search for peritoneal fungus balls that are not simply responsive to anti-fungal therapy and may necessitate repeat laparotomy.

Published
2019

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