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1. Risk factors associated with influenza A (H1N1)pdm09: a nested case control study of TB patients with ILI in Lahore District, Pakistan

Author: Gulshan Umbreen, Abdul Rehman, Sadaf Aslam, Chanda Jabeen, Muhammad Iqbal, Aayesha Riaz, Shakera Sadiq, Rubab Maqsood, Hamad Bin Rashid, Saira Afzal, Nimra Arshad, Muhammad Hassan Mushtaq, and Mamoona Chaudhry
Subjects: Influenza, Viruses, Risk factors, Tuberculosis (TB), Infectious and parasitic diseases, RC109-216
Abstract: Abstract Background Co-morbidity with respiratory viruses including influenza A, cause varying degree of morbidity especially in TB patients compared to general population. This study estimates the risk factors associated with influenza A (H1N1)pdm09 in TB patients with ILI. Methods A cohort of tuberculosis (TB) patients who were admitted to and enrolled in a TB Directly Observed Therapy Program (DOTs) in tertiary care hospitals of Lahore (Mayo Hospital and Infectious Disease Hospital) were followed for 12 weeks. At the start of study period, to record influenza-like illness (ILI), a symptom card was provided to all the participants. Every participant was contacted once a week, in person. When the symptoms were reported by the participant, a throat swab was taken for the detection of influenza A (H1N1)pdm09. A nested case control study was conducted and TB patients with ILI diagnosed with influenza A (H1N1)pdm09 by conventional RT-PCR were selected as cases, while those who tested negative by conventional RT-PCR were enrolled as controls. All cases and controls in the study were interviewed face-to-face in the local language. Epidemiological data about potential risk factors were collected on a predesigned questionnaire. Logistic analysis was conducted to identify associated risk factors in TB patients with ILI. Results From the main cohort of TB patients (n = 152) who were followed during the study period, 59 (39%) developed ILI symptoms; of them, 39 tested positive for influenza A (H1N1)pdm09, while 20 were detected negative for influenza A (H1N1)pdm09. In univariable analysis, four factors were identified as risk factors (p
Published: 2024
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2. SPE-UHPLC-ESI-MS/MS Analysis of Cocaine and Its Metabolites in Conventional and Alternative Biological Specimens: Application to Real Samples

Author: Humera Shafi Makhdoom, Saira Afzal, Kishwar Sultana, Syed Nisar Hussain Shah, Majida Mujahid, Zulfiqar ul Hassan, Farida Munir, Faryal Jahan, Zeerak Abbas, Ali Imran Abid, and Najm ul Hassan Khan
Subjects: Chemistry, QD1-999
Published: 2024
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3. Policy implementation and recommended actions to create healthy food environments using the Healthy Food Environment Policy Index (Food-EPI): a comparative analysis in South AsiaResearch in context

Author: Elisa Pineda, Petya Atanasova, Nalinda Tharanga Wellappuli, Dian Kusuma, Himali Herath, Alexa Blair Segal, Stefanie Vandevijvere, Ranjit Mohan Anjana, Abu Ahmed Shamim, Saira Afzal, Fahmida Akter, Faiza Aziz, Ananya Gupta, Abu Abdullah Hanif, Mehedi Hasan, Renuka Jayatissa, Sujeet Jha, Vinitaa Jha, Prasad Katulanda, Khadija Irfan Khawaja, Balachandran Kumarendran, Menka Loomba, Sara Mahmood, Malay Kanthi Mridha, Rajendra Pradeepa, Garudam Raveendiran Aarthi, Akansha Tyagi, Anuradhani Kasturiratne, Franco Sassi, and Marisa Miraldo
Subjects: South Asia, Food policy, Policy monitoring, Food environment, Policy mapping, Public health policy, Public aspects of medicine, RA1-1270
Abstract: Summary: Background: The increasing prevalence of diet-related non-communicable diseases (NCDs) in South Asia is concerning, with type 2 diabetes projected to rise to 68%, compared to the global increase of 44%. Encouraging healthy diets requires stronger policies for healthier food environments. Methods: This study reviewed and assessed food environment policies in Bangladesh, India, Pakistan, and Sri Lanka from 2020 to 2022 using the Healthy Food Environment Policy Index (Food-EPI) and compared them with global best practices. Seven policy domains and six infrastructure support domains were considered, employing 47 good practice indicators to prevent NCDs. Stakeholders from government and non-governmental sectors in South Asia (n = 148) were invited to assess policy and infrastructure support implementation using the Delphi method. Findings: Implementation of food environment policies and infrastructure support in these countries was predominantly weak. Labelling, monitoring, and leadership policies received a moderate rating, with a focus on food safety, hygiene, and quality rather than obesity prevention. Key policy gaps prioritized for attention included front-of-pack labelling, healthy food subsidies, unhealthy food taxation, restrictions on unhealthy food promotion, and improvements in school nutrition standards to combat NCDs. Interpretation: Urgent action is required to expand food policies beyond hygiene and food security measures. Comprehensive strategies targeting NCD prevention are crucial to combat the escalating burden of NCDs in the region. Funding: This research was funded by the NIHR (16/136/68 and 132960) with aid from the UK Government for global health research. Petya Atanasova also acknowledges funding from the Economic and Social Research Council (ESRC) (ES/P000703/1). The views expressed are those of the authors and not necessarily of the NIHR, the UK government or the ESRC.
Published: 2024
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4. Synthesis, DFT and molecular docking of novel (Z)-4-bromo-N-(4-butyl-3 (quinolin-3-yl)thiazol-2(3H)-ylidene)benzamide as elastase inhibitor

Author: Muhammad Naeem Mustafa, Pervaiz Ali Channar, Syeda Abida Ejaz, Saira Afzal, Mubashir Aziz, Tahira Shamim, Aamer Saeed, Aisha A. Alsfouk, Rabail Ujan, Qamar Abbas, and Tuncer Hökelek
Subjects: Elastase, Molecular docking, Hirshfeld, DFT studies, Crystallography, Chemistry, QD1-999
Abstract: Abstract A new compound, C23H20BrN3OS, containing a quinoline-based iminothiazoline with a thiazoline ring, was synthesized and its crystal and molecular structures were analyzed through single crystal X-ray analysis. The compound belongs to the triclinic system P − 1 space group, with dimensions of a = 9.2304 (6) Å, b = 11.1780 (8) Å, c = 11.3006 (6) Å, α = 107.146 (5)°, β = 93.701 (5)°, γ = 110.435 (6)°, Z = 2 and V = 1025.61 (12) Å3. The crystal structure showed that C–H···N and C–H···O hydrogen bond linkages, forming infinite double chains along the b-axis direction, and enclosing R2 2(14) and R2 2(16) ring motifs. The Hirshfeld surface analysis revealed that H…H (44.1%) and H…C/C…H (15.3%) interactions made the most significant contribution. The newly synthesized (Z)-4-bromo-N-(4-butyl-3 (quinolin-3-yl)thiazol-2(3H)-ylidene)benzamide, in comparison to oleanolic acid, exhibited more strong potential against elastase with an inhibition value of 1.21 µM. Additionally, the derivative was evaluated using molecular docking and molecular dynamics simulation studies, which showed that the quinoline based iminothiazoline derivative has the potential to be a novel inhibitor of elastase enzyme. Both theoretical and experimental findings suggested that this compound could have a number of biological activities.
Published: 2023
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5. Burden of influenza A (H1N1)pdm09 infection among tuberculosis patients: a prospective cohort study

Author: Gulshan Umbreen, Abdul Rehman, Muhammad Avais, Chanda Jabeen, Shakera Sadiq, Rubab Maqsood, Hamad Bin Rashid, Saira Afzal, and Mamoona Chaudhry
Subjects: Influenza, Viruses, Tuberculosis, Humans, Incidence, Prospective studies, Infectious and parasitic diseases, RC109-216
Abstract: Abstract Background Influenza and tuberculosis both cause significant morbidity and mortality worldwide. Therefore, this study aimed to estimate the burden of influenza A (H1N1)pdm09 virus infection among human tuberculosis patients and the general population. Methods A prospective cohort study was conducted among a cohort group (TB positive patients) as exposed and a comparison group (general population) as non-exposed. A total of 304 participants were recruited in both groups and followed for a period of 12 weeks. Of the 304 concurrently enrolled individuals, 152 were TB-positive patients (cohort group) and 152 were from the general population (comparison group).To calculate the sample size, the power of study was kept at 80% for detecting a difference at 5% alpha level assuming the 25% prevalence of respiratory viruses in cohort group compared to 12.5% in general population. An oropharyngeal swab was taken from a participant with symptoms of influenza-like illness (ILI). Samples were tested by conventional reverse transcription polymerase chain reaction (RT-PCR) for the detection of influenza A (H1N1)pdm09. All statistical analyses were conducted using R software. Results A total of 95 participants developed influenza-like illness (ILI) symptoms. Among these, 64 tested positive for influenza A(H1N1)pdm09, of which 39 were from the exposed group and 25 were from the non-exposed group. During the 12-week period of follow-up, the influenza A (H1N1)pdm09 incidence rate was 20 per 1000 people. The risk of testing positive for influenza A (H1N1)pdm09 was 1.66 times higher in the exposed group compared to the non-exposed group. The cumulative incidence indicated that 25% of the TB cohort and 16% of the comparison group were at risk of getting influenza A (H1N1)pdm09 during the 12 weeks of follow-up. Conclusion Participants from the TB cohort had a higher incidence of influenza A (H1N1)pdm09 than the general population suggesting that they should be prioritized for influenza vaccination.
Published: 2023
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6. Mapping age- and sex-specific HIV prevalence in adults in sub-Saharan Africa, 2000–2018

Author: Emily Haeuser, Audrey L. Serfes, Michael A. Cork, Mingyou Yang, Hedayat Abbastabar, E. S. Abhilash, Maryam Adabi, Oladimeji M. Adebayo, Victor Adekanmbi, Daniel Adedayo Adeyinka, Saira Afzal, Bright Opoku Ahinkorah, Keivan Ahmadi, Muktar Beshir Ahmed, Yonas Akalu, Rufus Olusola Akinyemi, Chisom Joyqueenet Akunna, Fares Alahdab, Fahad Mashhour Alanezi, Turki M. Alanzi, Kefyalew Addis Alene, Robert Kaba Alhassan, Vahid Alipour, Amir Almasi-Hashiani, Nelson Alvis-Guzman, Edward Kwabena Ameyaw, Saeed Amini, Dickson A. Amugsi, Robert Ancuceanu, Davood Anvari, Seth Christopher Yaw Appiah, Jalal Arabloo, Olatunde Aremu, Mulusew A. Asemahagn, Mohammad Asghari Jafarabadi, Atalel Fentahun Awedew, Beatriz Paulina Ayala Quintanilla, Martin Amogre Ayanore, Yared Asmare Aynalem, Samad Azari, Zelalem Nigussie Azene, B. B. Darshan, Tesleem Kayode Babalola, Atif Amin Baig, Maciej Banach, Till Winfried Bärnighausen, Arielle Wilder Bell, Akshaya Srikanth Bhagavathula, Nikha Bhardwaj, Pankaj Bhardwaj, Krittika Bhattacharyya, Ali Bijani, Zebenay Workneh Bitew, Somayeh Bohlouli, Obasanjo Afolabi Bolarinwa, Archith Boloor, Ivana Bozicevic, Zahid A. Butt, Rosario Cárdenas, Felix Carvalho, Jaykaran Charan, Vijay Kumar Chattu, Mohiuddin Ahsanul Kabir Chowdhury, Dinh-Toi Chu, Richard G. Cowden, Saad M. A. Dahlawi, Giovanni Damiani, Eugene Kofuor Maafo Darteh, Aso Mohammad Darwesh, José das Neves, Nicole Davis Weaver, Diego De Leo, Jan-Walter De Neve, Kebede Deribe, Keshab Deuba, Samath Dharmaratne, Mostafa Dianatinasab, Daniel Diaz, Alireza Didarloo, Shirin Djalalinia, Fariba Dorostkar, Eleonora Dubljanin, Bereket Duko, Maha El Tantawi, Shaimaa I. El-Jaafary, Babak Eshrati, Sharareh Eskandarieh, Oghenowede Eyawo, Ifeanyi Jude Ezeonwumelu, Sayeh Ezzikouri, Farshad Farzadfar, Nazir Fattahi, Nelsensius Klau Fauk, Eduarda Fernandes, Irina Filip, Florian Fischer, Nataliya A. Foigt, Masoud Foroutan, Takeshi Fukumoto, Mohamed M. Gad, Abhay Motiramji Gaidhane, Birhan Gebresillassie Gebregiorgis, Ketema Bizuwork Gebremedhin, Lemma Getacher, Keyghobad Ghadiri, Ahmad Ghashghaee, Mahaveer Golechha, Mohammed Ibrahim Mohialdeen Gubari, Harish Chander Gugnani, Rafael Alves Guimarães, Mohammad Rifat Haider, Arvin Haj-Mirzaian, Samer Hamidi, Abdiwahab Hashi, Soheil Hassanipour, Hadi Hassankhani, Khezar Hayat, Claudiu Herteliu, Hung Chak Ho, Ramesh Holla, Mostafa Hosseini, Mehdi Hosseinzadeh, Bing-Fang Hwang, Segun Emmanuel Ibitoye, Olayinka Stephen Ilesanmi, Irena M. Ilic, Milena D. Ilic, Rakibul M. Islam, Chidozie C. D. Iwu, Mihajlo Jakovljevic, Ravi Prakash Jha, John S. Ji, Kimberly B. Johnson, Nitin Joseph, Vasna Joshua, Farahnaz Joukar, Jacek Jerzy Jozwiak, Leila R. Kalankesh, Rohollah Kalhor, Naser Kamyari, Tanuj Kanchan, Behzad Karami Matin, Salah Eddin Karimi, Gbenga A. Kayode, Ali Kazemi Karyani, Maryam Keramati, Ejaz Ahmad Khan, Gulfaraz Khan, Md Nuruzzaman Khan, Khaled Khatab, Jagdish Khubchandani, Yun Jin Kim, Adnan Kisa, Sezer Kisa, Jacek A. Kopec, Soewarta Kosen, Sindhura Lakshmi Koulmane Laxminarayana, Ai Koyanagi, Kewal Krishan, Barthelemy Kuate Defo, Nuworza Kugbey, Vaman Kulkarni, Manasi Kumar, Nithin Kumar, Dian Kusuma, Carlo La Vecchia, Dharmesh Kumar Lal, Iván Landires, Heidi Jane Larson, Savita Lasrado, Paul H. Lee, Shanshan Li, Xuefeng Liu, Afshin Maleki, Preeti Malik, Mohammad Ali Mansournia, Francisco Rogerlândio Martins-Melo, Walter Mendoza, Ritesh G. Menezes, Endalkachew Worku Mengesha, Tuomo J. Meretoja, Tomislav Mestrovic, Andreea Mirica, Babak Moazen, Osama Mohamad, Yousef Mohammad, Abdollah Mohammadian-Hafshejani, Reza Mohammadpourhodki, Salahuddin Mohammed, Shafiu Mohammed, Ali H. Mokdad, Masoud Moradi, Paula Moraga, Sumaira Mubarik, Getaneh Baye B. Mulu, Lillian Mwanri, Ahamarshan Jayaraman Nagarajan, Mukhammad David Naimzada, Muhammad Naveed, Javad Nazari, Rawlance Ndejjo, Ionut Negoi, Frida N. Ngalesoni, Georges Nguefack-Tsague, Josephine W. Ngunjiri, Cuong Tat Nguyen, Huong Lan Thi Nguyen, Chukwudi A. Nnaji, Jean Jacques Noubiap, Virginia Nuñez-Samudio, Vincent Ebuka Nwatah, Bogdan Oancea, Oluwakemi Ololade Odukoya, Andrew T. Olagunju, Babayemi Oluwaseun Olakunde, Bolajoko Olubukunola Olusanya, Jacob Olusegun Olusanya, Ahmed Omar Bali, Obinna E. Onwujekwe, Orish Ebere Orisakwe, Nikita Otstavnov, Stanislav S. Otstavnov, Mayowa O. Owolabi, P. A. Mahesh, Jagadish Rao Padubidri, Adrian Pana, Ashok Pandey, Seithikurippu R. Pandi-Perumal, Fatemeh Pashazadeh Kan, George C. Patton, Shrikant Pawar, Emmanuel K. Peprah, Maarten J. Postma, Liliana Preotescu, Zahiruddin Quazi Syed, Navid Rabiee, Amir Radfar, Alireza Rafiei, Fakher Rahim, Vafa Rahimi-Movaghar, Amir Masoud Rahmani, Kiana Ramezanzadeh, Juwel Rana, Chhabi Lal Ranabhat, Sowmya J. Rao, David Laith Rawaf, Salman Rawaf, Reza Rawassizadeh, Lemma Demissie Regassa, Nima Rezaei, Aziz Rezapour, Mavra A. Riaz, Ana Isabel Ribeiro, Jennifer M. Ross, Enrico Rubagotti, Susan Fred Rumisha, Godfrey M. Rwegerera, Sahar Saeedi Moghaddam, Rajesh Sagar, Biniyam Sahiledengle, Maitreyi Sahu, Marwa Rashad Salem, Hossein Samadi Kafil, Abdallah M. Samy, Benn Sartorius, Brijesh Sathian, Abdul-Aziz Seidu, Amira A. Shaheen, Masood Ali Shaikh, Morteza Shamsizadeh, Wondimeneh Shibabaw Shiferaw, Jae Il Shin, Roman Shrestha, Jasvinder A. Singh, Valentin Yurievich Skryabin, Anna Aleksandrovna Skryabina, Shahin Soltani, Mu’awiyyah Babale Sufiyan, Takahiro Tabuchi, Eyayou Girma Tadesse, Nuno Taveira, Fisaha Haile Tesfay, Rekha Thapar, Marcos Roberto Tovani-Palone, Gebiyaw Wudie Tsegaye, Chukwuma David Umeokonkwo, Bhaskaran Unnikrishnan, Jorge Hugo Villafañe, Francesco S. Violante, Bay Vo, Giang Thu Vu, Yohannes Dibaba Wado, Yasir Waheed, Richard G. Wamai, Yanzhong Wang, Paul Ward, Nuwan Darshana Wickramasinghe, Katherine Wilson, Sanni Yaya, Paul Yip, Naohiro Yonemoto, Chuanhua Yu, Mikhail Sergeevich Zastrozhin, Yunquan Zhang, Zhi-Jiang Zhang, Simon I. Hay, Laura Dwyer-Lindgren, and on behalf of Local Burden of Disease sub-Saharan Africa HIV Prevalence Collaborators
Subjects: HIV, Mapping, Africa, Geostatistics, Spatial statistics, HIV prevalence, Medicine
Abstract: Abstract Background Human immunodeficiency virus and acquired immune deficiency syndrome (HIV/AIDS) is still among the leading causes of disease burden and mortality in sub-Saharan Africa (SSA), and the world is not on track to meet targets set for ending the epidemic by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the United Nations Sustainable Development Goals (SDGs). Precise HIV burden information is critical for effective geographic and epidemiological targeting of prevention and treatment interventions. Age- and sex-specific HIV prevalence estimates are widely available at the national level, and region-wide local estimates were recently published for adults overall. We add further dimensionality to previous analyses by estimating HIV prevalence at local scales, stratified into sex-specific 5-year age groups for adults ages 15–59 years across SSA. Methods We analyzed data from 91 seroprevalence surveys and sentinel surveillance among antenatal care clinic (ANC) attendees using model-based geostatistical methods to produce estimates of HIV prevalence across 43 countries in SSA, from years 2000 to 2018, at a 5 × 5-km resolution and presented among second administrative level (typically districts or counties) units. Results We found substantial variation in HIV prevalence across localities, ages, and sexes that have been masked in earlier analyses. Within-country variation in prevalence in 2018 was a median 3.5 times greater across ages and sexes, compared to for all adults combined. We note large within-district prevalence differences between age groups: for men, 50% of districts displayed at least a 14-fold difference between age groups with the highest and lowest prevalence, and at least a 9-fold difference for women. Prevalence trends also varied over time; between 2000 and 2018, 70% of all districts saw a reduction in prevalence greater than five percentage points in at least one sex and age group. Meanwhile, over 30% of all districts saw at least a five percentage point prevalence increase in one or more sex and age group. Conclusions As the HIV epidemic persists and evolves in SSA, geographic and demographic shifts in prevention and treatment efforts are necessary. These estimates offer epidemiologically informative detail to better guide more targeted interventions, vital for combating HIV in SSA.
Published: 2022
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7. Phenobarbital-Based Protocol for Alcohol Withdrawal Syndrome in a Medical ICU: Pre-Post Implementation Study

Author: Mahmoud Alwakeel, MD, Dina Alayan, MD, Talha Saleem, MD, Saira Afzal, MD, Ellen Immler, PharmD, Xiaofeng Wang, PhD, Bassel Akbik, MD, and Abhijit Duggal, MD
Subjects: Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract: OBJECTIVES:. We assessed the efficacy and safety of PB compared with benzodiazepine (BZD)-based protocols in treating AWS in MICU. DESIGN:. Single-center, pre-post protocol implementation study. SETTING:. The setting is a forty-bed MICU in a tertiary-level academic medical center. PATIENTS:. We included all patients admitted to the MICU with a primary diagnosis of AWS. INTERVENTIONS:. Intravenous PB 260 mg followed by 130-mg doses every 15–30 minutes as needed up to 15 mg/kg of ideal body weight versus escalating doses of BZD, to achieve a Clinical Institute Withdrawal Assessment Alcohol Scale-Revised score less than 10. MEASUREMENTS AND MAIN RESULTS:. ICU and hospital length of stay (LOS), in addition to safety measures were the main outcomes of the study. A total of 102 patients were included, 51 in the PB arm and 51 in the BZD arm. There were no differences in baseline clinical characteristics. Half the patients in each group were admitted with delirium tremens. The use of PB-based protocol was associated with 35% reduction in median ICU LOS (1.5 d [interquartile range, 1.2–2.4 d] vs 2.3 d [1.4–4.8 d]; p = 0.009) and 50% reduction in hospital LOS (3 d [2.7–4 d] vs 6 d [4–10 d]; p < 0.001). After adjustment for comorbidities and clinical factors, PB protocol decreased ICU LOS days by 40% (95% CI; 25.8–53.5%). PB group required fewer adjunctive medications to control symptoms (0.7 [0.5–1] vs 2.5 [2–3]; p < 0.001), less need for intubation (1/51 [2%] vs 10/10 [19.6%]; p = 0.023) and less need for physical restraint (19/51 [37.3%] vs 29/51 [56.9%]; p = 0.047), compared with the BZD group. CONCLUSIONS:. A protocol utilizing rapidly escalating doses of PB over a short period is an effective and safe alternative to BZD in treating AWS in MICU.
Published: 2023
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8. Impact of Refractive Errors on the Academic Performance of High School Children of Lahore

Author: Muhammad Zahid Latif, Intzar Hussain, Saira Afzal, Muhammad Asif Naveed, Rahila Nizami, Muhammad Shakil, Abdul Majeed Akhtar, Shabbir Hussain, and Syed Amir Gilani
Subjects: prevalence, refractive error, refractive corrections, school children, academic score, Public aspects of medicine, RA1-1270
Abstract: IntroductionThe process of learning begins in childhood and accurate vision can greatly affects a child's learning capacity. It is documented that visual impairment in children can have a significant impact on their performance at school as well as their social interaction and development.ObjectiveThis research aimed to study the impact of refractive corrections on the academic performance of high school children in Lahore.MethodologyA total of 2,000 students with equal distribution of gender, public, private school, and locality were included in the study. All students were screened for defective vision. The academic performance before and after corrections was recorded on the prescribed proforma.ResultsThe prevalence of refractive error was high among the public high schools 244 (59.2%) as compared to the private schools 168 (40.8%). The area-based prevalence was higher among the students in urban settings 255 (62%) while in rural it was 157 (38%). It was found that in the public sector, the average score of academic results before the intervention was 56.39 ± 13.24 which was increased to 60.27 ± 14.94 after the intervention while in the private sector, before the intervention, the average score was 63.53 ± 17.50 which was improved to 67.12 ± 18.48. It was found to be statistically significant at p-value < 0.05.ConclusionA significant impact was observed in the average academic scores of the results after refractive corrections.
Published: 2022
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9. VSeq-Toolkit: Comprehensive Computational Analysis of Viral Vectors in Gene Therapy

Author: Saira Afzal, Raffaele Fronza, and Manfred Schmidt
Subjects: Genetics, QH426-470, Cytology, QH573-671
Abstract: Viral vector characterization and analysis are important components for the development of safe gene therapeutic products, elucidating the potential genotoxic and immunogenic effects of vectors and establishing their safety profiles. Here, we present VSeq-Toolkit, which offers varying analysis modes for viral gene therapy data. The first mode determines the undesirable known contaminants and their frequency in viral preparations or other sequencing data. The second mode is designed for the analysis of intra-vector fusion breakpoints and the third mode for unraveling the viral-host fusion events distribution. Analysis modes of our toolkit can be executed independently or together and allow the analysis of multiple viral vectors concurrently. It has been designed and evaluated for the analysis of short read high-throughput sequencing data, including whole-genome or targeted sequencing. VSeq-Toolkit is developed in Perl and Bash programming languages and is available at https://github.com/CompMeth/VSeq-Toolkit.
Published: 2020
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10. Differential Effect of Heat Stress on Drought and Salt Tolerance Potential of Quinoa Genotypes: A Physiological and Biochemical Investigation

Author: Ghulam Abbas, Fiza Areej, Saeed Ahmad Asad, Muhammad Saqib, Muhammad Anwar-ul-Haq, Saira Afzal, Behzad Murtaza, Muhammad Amjad, Muhammad Asif Naeem, Muhammad Akram, Naseem Akhtar, Muhammad Aftab, and Kadambot H. M. Siddique
Subjects: high temperature, drought, quinoa, salinity, oxidative stress, climate change, Botany, QK1-989
Abstract: Soil salinity, drought, and increasing temperatures are serious environmental issues that drastically reduce crop productivity worldwide. Quinoa (Chenopodium quinoa Willd) is an important crop for food security under the changing climate. This study examined the physio-biochemical responses, plant growth, and grain yield of four quinoa genotypes (A7, Titicaca, Vikinga, and Puno) grown in pots containing normal (non-saline) or salt-affected soil exposed to drought and elevated-temperature treatments. Combinations of drought, salinity, and high-temperature stress decreased plant growth and yield more than the individual stresses. The combined drought, salinity, and heat stress treatment decreased the shoot biomass of A7, Puno, Titicaca, and Vikinga by 27, 36, 41, and 50%, respectively, compared to that of control plants. Similar trends were observed for grain yield, chlorophyll contents, and stomatal conductance. The combined application of these three stresses increased Na concentrations but decreased K concentrations in roots and shoots relative to control. Moreover, in the combined salinity, drought, and high-temperature treatment, A7, Puno, Titicaca, and Vikinga had 7.3-, 6.9-, 8-, and 12.6-fold higher hydrogen peroxide contents than control plants. All four quinoa genotypes increased antioxidant enzyme activities (CAT, SOD, and POD) to overcome oxidative stress. Despite A7 producing the highest biomass under stress, it did not translate into increased grain production. We conclude that Puno and Titicaca are more tolerant than Vikinga for cultivation in salt-affected soils prone to drought and heat stress.
Published: 2023
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11. Knowledge, Attitude, Practice and Barriers Associated with Influenza Vaccination among Health Care Professionals Working at Tertiary Care Hospitals in Lahore, Pakistan: A Multicenter Analytical Cross-Sectional Study

Author: Gulshan Umbreen, Abdul Rehman, Muhammad Avais, Chanda Jabeen, Shakera Sadiq, Rubab Maqsood, Hamad Bin Rashid, Saira Afzal, Richard J. Webby, and Mamoona Chaudhry
Subjects: knowledge, attitude, and practice (KAP), barriers, influenza, influenza vaccination, Health Care Professionals (HCPs), World Health Organization, Medicine
Abstract: Health Care Professionals (HCPs), including doctors, nurses, pharmacists, and paramedics, are a high-risk group for influenza infection due to their continuous exposure to patients having a known or unknown history of influenza-like illnesses. Influenza vaccination is the most effective method of primary prevention. This study was conducted to assess knowledge, attitude, practice, and barriers associated with influenza vaccination among HCPs at tertiary care hospitals in Lahore, Pakistan. A multicenter analytical cross-sectional study was conducted among HCPs. Data were collected using a structured questionnaire. All statistical analyses were conducted in R software. A total of 400 HCPs were enrolled, and among these, 67% had a high level of knowledge and 65.5% had a positive attitude towards influenza vaccination. About 51% of HCPs adopted good practices leading to influenza vaccination. Results identified major barriers for influenza vaccinations, including unfamiliarity with vaccine availability (RII = 0.760), insufficient staff for administering the vaccine (RII = 0.649), lack of proper storage (RII = 0.625), safety concerns (RII = 0.613), and cost of vaccine (RII = 0.602). More than half of the HCPs showed a high level of knowledge, a positive attitude, and good practice against influenza vaccination. Despite the positive Knowledge, Attitude, and Practice (KAP) scores and published guidelines, a very low percentage of HCPs were vaccinated against influenza. Many hindering factors were associated with influenza vaccination.
Published: 2023
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12. Amidated Pluronic Decorated Muco-Penetrating Self-Nano Emulsifying Drug Delivery System (SNEDDS) for Improved Anti-Salmonella typhi Potential

Author: Rabia Arshad, Muhammad Salman Arshad, Tanveer A. Tabish, Syed Nisar Hussain Shah, Saira Afzal, and Gul Shahnaz
Subjects: amidated pluronic, mucopenetration, biofilm dispersion, anti-salmonella potential, Pharmacy and materia medica, RS1-441
Abstract: The enteric system residing notorious Salmonella typhimurium (S. typhi) is an intracellular, food-borne, and zoonotic pathogen causing typhoid fever. Typhoid fever is one of the leading causes of mortality and morbidity in developing and underdeveloped countries. It also increased the prevalence of multidrug resistance globally. Currently, available anti-bacterial modalities are unable to penetrate into the intracellular compartments effectively for eradicating S. typhi infection. Therefore, in this study, we developed nanostructured lipid-based carriers in the form of a self-nanoemulsifying drug delivery system (SNEDDS) for targeted delivery of ciprofloxacin (CIP) into the S. typhi intracellular reservoirs. Capryol 90, Tween 80, and Span 20 were finalized as suitable oil, surfactant, and co-surfactant, respectively, according to the pseudoternary phase diagram emulsifying region. Targeting capability and mucopenetration of the SNEDDS was attributed to the inclusion of amidated pluronic (NH2-F127). Developed NH2-F127 SNEDDS were characterized via physicochemical, in vitro, ex vivo, and in vivo evaluation parameters. The size of the SNEDDS was found to be 250 nm, having positively charged zeta potential. In vitro dissolution of SNEDDS showed 80% sustained release of CIP in 72 h with maximum entrapment efficiency up to 90% as well as good hemocompatibility by showing less than 0.2% hemolysis and 90% biocompatibility. The survival rate of S. typhi in macrophages (RAW 264.7) was minimal, i.e., only 2% in the case of NH2-F127 SNEDDS. Macrophage uptake assay via nanostructures confirmed the maximum cellular uptake as evidenced by the highest fluorescence. Biofilm dispersion assay showed rapid eradication of developed resistant biofilms on the gall bladder. In vivo pharmacokinetics showed improved bioavailability by showing an increased area under the curve (AUC) value. Taken together, NH2-F127-SNEDDS can be utilized as an alternative and efficient delivery system for the sustained release of therapeutic amounts of CIP for the treatment of S. typhi.
Published: 2022
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13. A Multicenter Evaluation of Survival After In-Hospital Cardiac Arrest in Coronavirus Disease 2019 Patients

Author: Abhishek Bhardwaj, MD, FACP, Mahmoud Alwakeel, MD, Talha Saleem, MD, Saira Afzal, MD, Sura Alqaisi, MD, Aisha R. Saand, MD, Hanan Al. Najjar, MD, Lori Griffiths, RN, MPH, Xiaozhen Han, MS, Xiaofeng Wang, PhD, Silvia Perez-Protto, MD, MS, FCCM, Benjamin S. Abella, MD, MPhil, FAHA, FACEP, David F. Gaieski, MD, FACEP, FCCM, Abhijit Duggal, MD, MPH, MSc, and Francois Abi Fadel, MD, FACP, FCCP
Subjects: Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract: IMPORTANCE:. In-hospital cardiac arrest survival among coronavirus disease 2019 patients has been reported to range from 0% to 12%. These numbers are significantly lower than reported prepandemic in-hospital cardiac arrest survival rates of approximately 20–25% in the United States for non–coronavirus disease 2019 patients. OBJECTIVE:. To assess the incidence of in-hospital cardiac arrest survival of coronavirus disease 2019 patients. DESIGN:. A retrospective cohort study of adult patients with coronavirus disease 2019 subsequently found to have in-hospital cardiac arrest and underwent cardiopulmonary resuscitation (cardiopulmonary resuscitation). SETTING:. Multiple hospitals of the Cleveland Clinic Health System. PATIENTS:. All adult patients (age ≥ 18 yr) admitted to Cleveland Clinic Health System with a diagnosis of coronavirus disease 2019 who experienced in-hospital cardiac arrest requiring cardiopulmonary resuscitation. MEASUREMENTS AND MAIN RESULTS:. From March 01, 2020 to October 15, 2020, 3,555 patients with coronavirus disease 2019 were hospitalized; 1,372 were admitted to the ICU; 58 patients had in-hospital cardiac arrest. Median age of this cohort was 66.5 years (interquartile range, 55.0–76.0 yr). Patients were predominantly male (62.5%), White (53.4%), with a median body mass index of 29.7 (interquartile range, 25.8–34.6). Most in-hospital cardiac arrests were in critical care environments (ICU), 51 of 58 (87.9%); seven of 58 (12.1%) were on ward locations. Thirty-four of 58 patients (58.6%) were on mechanical ventilation prior to in-hospital cardiac arrest with a median duration of mechanical ventilation of 9 days (interquartile range, 2–18 d). Twenty-four of 58 patients (44%) were on vasopressors prior to arrest. Initial arrest rhythm was pulseless electrical activity at (63.8%), asystole (29.3%), and pulseless ventricular tachycardia/fibrillation (6.9%). Of the 58 patients, 35 (60.3%) attained return of spontaneous circulation, and 13 of 58 (22.4%) were discharged alive. CONCLUSIONS:. We report a 22% survival to discharge after in-hospital cardiac arrest in coronavirus disease 2019 patients, a survival rate similar to before the coronavirus disease 2019 pandemic.
Published: 2021
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14. Healthcare strategies and initiatives about COVID19 in Pakistan: Telemedicine a way to look forward

Author: Ayesha Humayun, Syed Shahabuddin, Saira Afzal, Ahmad Azam Malik, Suleman Atique, and Usman Iqbal
Subjects: COVID-19, Global pandemic, Telemedicine, Public health, Guidelines, Strategies, Computer applications to medicine. Medical informatics, R858-859.7
Abstract: The COVID-19 pandemic is one of the unprecedented devastating catastrophes with severe public health threat globally. Low and middle income countries (LMICs) are trying hard to cope with the rapidly changing global scenario and trying to mitigate this double crisis of pandemic and economic recession. This pandemic, has led to major changes in global and regional health care delivery proceedings with surge in telemedicine to provide the required services and also giving priority to control the disease spread.
Published: 2021
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15. Ethical issues among healthcare workers using electronic medical records: A systematic review

Author: Saira Afzal and Amber Arshad
Subjects: Ethical issues, Health care provides, Electronic medical records, Digital health records, Computer applications to medicine. Medical informatics, R858-859.7
Abstract: Background: Electronic Medical Records (EMR) give patients, doctors, and clinical groups advantages and bring up moral issues. Exploring to provide care in computerized age requires an evaluation of the effect of the EMR on the care of the patient and the patient-doctor relationship. The aim of the study is to classify all possible ethical concerns of healthcare professionals who are engaged in research, and service provision and to understand how they integrate the EMR into their workflow and whether specific ethical questions arise while sharing medical information both with other practitioners and with patients. Methods: Conducted A systematic literature review, for which we searched four databases (PubMed/ Medline, Google scholar, and PakMediNet) between January 2011 to June 2021. Used broad terms like (Ethical issues, health care provides, electronic medical records, digital health records) as keyword searches. The authors used a narrative approach according to PRISMA guidelines 2020 (Checklist). The authors performed no meta-analysis, and did a qualitative synthesis of selected studies according to inclusion criteria. The inclusion criteria required articles that reported ethical issues; the full-text articles were electronically available and published in English between January 2011 and June 2021. All identified studies like KAP studies, case reports, prospective, randomized interventional studies, and papers in other languages are not part of the study Results: From the 24 papers reviewed, authors identified or discussed the following ethical principles concerning ethical issues faced by healthcare professionals during usage of electronic medical records. Autonomy was addressed in 62.5% (n=15/24) studies, beneficence 33% (n=8/24), non-maleficence 25% (n=6/24), confidentiality 58 % (n=14/24), Privacy 83% (n= 20/24), justice 50% (n=12/24), Fidelity 16% (n=4/24), veracity 8.3% (n=2/24). Conclusions: The findings show that most of the ethical issues related to EMR are consistent with the ethical challenges that digital technologies introduce in healthcare, such as privacy, anonymity, security, and informed consent. Despite some evidence, more efforts need to promote ethical technology use and analysis of the ethical difficulties.
Published: 2021
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16. Functionalized Oxoindolin Hydrazine Carbothioamide Derivatives as Highly Potent Inhibitors of Nucleoside Triphosphate Diphosphohydrolases

Author: Saira Afzal, Mariya al-Rashida, Abdul Hameed, Julie Pelletier, Jean Sévigny, and Jamshed Iqbal
Subjects: carbothioamide, ectonucleotidases, nucleoside triphosphate diphosphohydrolase-3, oxoindolin hydrazine, molecular docking, Therapeutics. Pharmacology, RM1-950
Abstract: Ectonucleoside triphosphate diphosphohydrolases (NTPDases) are ectoenzymes that play an important role in the hydrolysis of nucleoside triphosphate and diphosphate to nucleoside monophosphate. NTPDase1, -2, -3 and -8 are the membrane bound members of this enzyme family that are responsible for regulating the levels of nucleotides in extracellular environment. However, the pathophysiological functions of these enzymes are not fully understood due to lack of potent and selective NTPDase inhibitors. Herein, a series of oxoindolin hydrazine carbothioamide derivatives is synthesized and screened for NTPDase inhibitory activity. Four compounds were identified as selective inhibitors of h-NTPDase1 having IC50 values in lower micromolar range, these include compounds 8b (IC50 = 0.29 ± 0.02 µM), 8e (IC50 = 0.15 ± 0.009 µM), 8f (IC50 = 0.24 ± 0.01 µM) and 8l (IC50 = 0.30 ± 0.03 µM). Similarly, compound 8k (IC50 = 0.16 ± 0.01 µM) was found to be a selective h-NTPDase2 inhibitor. In case of h-NTPDase3, most potent inhibitors were compounds 8c (IC50 = 0.19 ± 0.02 µM) and 8m (IC50 = 0.38 ± 0.03 µM). Since NTPDase3 has been reported to be associated with the regulation of insulin secretion, we evaluated our synthesized NTPDase3 inhibitors for their ability to stimulate insulin secretion in isolated mice islets. Promising results were obtained showing that compound 8m potently stimulated insulin secretion without affecting the NTPDase3 gene expression. Molecular docking studies of the most potent compounds were also carried out to rationalize binding site interactions. Hence, these compounds are useful tools to study the role of NTPDase3 in insulin secretion.
Published: 2020
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17. Spatial and Temporal Epidemiology of Vector-borne Diseases in Punjab province of Pakistan-2018

Author: Muhammad Mohsan Wattoo, Ambreen Chaudhry, Zillay Noor Rana, Junaid Rashid, and Saira Afzal
Subjects: dengue fever, malaria, spatial trends, temporal trends, vector-borne diseases, Infectious and parasitic diseases, RC109-216, Public aspects of medicine, RA1-1270
Abstract: Background: Vector-borne diseases are major public health problem worldwide. Dengue Fever (DF), Dengue Hemorrhagic Fever (DHF), and Malaria are endemic in Pakistan. The current study is aimed to find out temporal and spatial distribution of vector-borne diseases in Punjab province of Pakistan. Materials & Methods: The data of temporal, spatial and personal characteristics were collected from the health department of Punjab from July 1, 2016 to June 30, 2017 after taking departmental approval. The collected data was analyzed using Microsoft Excel and SPSS version 24.0. Frequencies and rates were calculated and graphically presented. Results: A total of 2,640 cases of malaria were reported during from July 1, 2016 to June 30, 2017 and with 1415(53%) male cases and male to female ratio of 1.3:1. A total of 2,520 cases of dengue fever were reported with 1829 (72%) male cases with male to female ratio of 2.6:1. Mean age was 17 years and 32 years for malaria and dengue fever cases respectively. For malaria, most affected age group was 5-9 years while for dengue fever 20-24 years. The highest number (n= 821) of malaria cases reported from Muzaffargarh (southern Punjab) and 1139 dengue cases reported from Rawalpindi (northern Punjab). Temporal characteristics of dengue indicated the highest frequency during September to November while malaria from August to October. Conclusion: Social, temporal and spatial distribution is suggestive of targeted interventions for both diseases yet integrated with their respective vector control measures. Dengue fever time trend is more demands robust outdoor preventive activities in north of Pakistan
Published: 2020
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18. AAV vector-mediated in vivo reprogramming into pluripotency

Author: Elena Senís, Lluc Mosteiro, Stefan Wilkening, Ellen Wiedtke, Ali Nowrouzi, Saira Afzal, Raffaele Fronza, Henrik Landerer, Maria Abad, Dominik Niopek, Manfred Schmidt, Manuel Serrano, and Dirk Grimm
Subjects: Science
Abstract: In vivo reprogramming of somatic cells is hampered by the need for vectors to express the OKSM factors in selected organs. Here the authors report new AAV-based vectors capable of in vivo reprogramming at low doses.
Published: 2018
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19. GENE-IS: Time-Efficient and Accurate Analysis of Viral Integration Events in Large-Scale Gene Therapy Data

Author: Saira Afzal, Stefan Wilkening, Christof von Kalle, Manfred Schmidt, and Raffaele Fronza
Subjects: Therapeutics. Pharmacology, RM1-950
Abstract: Integration site profiling and clonality analysis of viral vector distribution in gene therapy is a key factor to monitor the fate of gene-corrected cells, assess the risk of malignant transformation, and establish vector biosafety. We developed the Genome Integration Site Analysis Pipeline (GENE-IS) for highly time-efficient and accurate detection of next-generation sequencing (NGS)-based viral vector integration sites (ISs) in gene therapy data. It is the first available tool with dual analysis mode that allows IS analysis both in data generated by PCR-based methods, such as linear amplification method PCR (LAM-PCR), and by rapidly evolving targeted sequencing (e.g., Agilent SureSelect) technologies. GENE-IS makes use of trimming strategies, customized reference genome, and soft-clipped information with sequential filtering steps to provide annotated IS with clonality information. It is a scalable, robust, precise, and reliable tool for large-scale pre-clinical and clinical data analysis that provides users complete flexibility and control over analysis with a broad range of configurable parameters. GENE-IS is available at https://github.com/G100DKFZ/gene-is. Keywords: gene therapy, bioinformatical analysis, next-generation sequencing, viral integration sites, LAM-PCR, targeted sequencing
Published: 2017
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20. Recent Updates and Evidence on COVID-19: A Public Health Emergency

Author: Saira Afzal and Mehreen Nasir
Subjects: Medicine, Biology (General), QH301-705.5
Abstract: N/A
Published: 2020
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21. Branding in Islamic Commercial Law – Eyeing Commercial Gains Versus Opportunities for Introducing SharÊ‘ah Legal Ethics

Author: LUTFULLAH SAQIB and SAIRA AFZAL
Subjects: Islam, BP1-253
Abstract: According to recent research, the ×alÉl (permissible in Islamic law) food market represents 16% of the total global market, which is expected to double in the near future. A huge potential, therefore, lies in the target market of Muslim consumers. In order to penetrate the ×alÉl markets, firms are employing brand Islamization strategies as per rules of Islamic Commercial Law. Most firms, however, are doing so for extra commercial gains. In this paper an effort has been made to introduce and highlight some of the legal ethical aspects of the branding practices in Islamic law, predominantly, in Islamic commercial law. The purpose of this paper is to analyze specific commercial activities carried out in the name of brand Islamization. One of the objectives is to raise awareness that increasing aspirations related to Islamic branding are, in fact, masked activities of utilizing huge potentials that exist both for Muslim and non-Muslim firms. New methods of incorporation of Islamic legal ethics in the brand design and developmental strategies are also explored in this paper. The paper clarifies that Islamic brandingis not merely limited to the “Halal” factor but is one that is purely SharÊ‘ah (Islamic Law) compliant, both in substance and form.
Published: 2018

22. Synthesis of some new 5-substituted-2-((6-chloro-3,4-methylenedioxyphenyl)methylthio)-1,3,4-oxadiazole derivatives as suitable antibacterial inhibitors

Author: Aziz-ur-Rehman, Asia Siddiqa, Muhammad A. Abbasi, Shahid Rasool, Sabahat Z. Siddiqui, Irshad Ahmad, and Saira Afzal
Subjects: 1,3,4-Oxadiazoles, Antibacterial activity, Carboxylic acids, Spectral analysis, Therapeutics. Pharmacology, RM1-950, Pharmacy and materia medica, RS1-441, Pharmaceutical industry, HD9665-9675
Abstract: Heterocyclic molecules belong to the most attractive group owing to their broad spectrum of antimicrobial activities. In the undertaken research, a number of new 5-substituted-2-((6-chloro-3,4-methylenedioxyphenyl)methylthio)-1,3,4-Oxadiazole derivatives (6a–l) were synthesized by converting various aryl/aralkyl carboxylic acids (1a–l) into corresponding esters (2a–l), carbohydrazides (3a–l) and 5-substituted-1,3,4-Oxadiazol-2-thiols (4a–l). The last step included the synthesis of target molecules, 6a–l, by stirring 4a–l and 6-chloro-3,4-methylenedioxybenzyl chloride (5) in a polar aprotic solvent. The structures of all the synthesized molecules were corroborated through spectral analysis. The screening of these molecules against antibacterial activity rendered them moderate inhibitors and most likely against Escherichia coli, relative to the reference standard, ciprofloxacin.
Published: 2015
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23. Synthesis, spectral analysis and anti-bacterial study of N-substituted derivatives of 2-(5-(1-(phenylsulfonyl)piperidin-4-yl)-1,3,4-oxadiazol-2-ylthio)acetamide

Author: Hira Khalid, Aziz-ur-Rehman, M. Athar Abbasi, Abdul Malik, Shahid Rasool, Khadija Nafeesa, Irshad Ahmad, and Saira Afzal
Subjects: Ethyl isonipecotate, Acetamides, 1,3,4-Oxadiazole, IR, 1H-NMR, EIMS, Chemistry, QD1-999
Abstract: 1,3,4-Oxadiazole bearing compounds are one of the most attractive class for researchers due to their biological activities. In the undertaken research, a number of N-substituted derivatives of 2-(5-(1-(phenylsulfonyl)piperidin-4-yl)-1,3,4-oxadiazol-2-ylthio)acetamide (6a–n) were synthesized through a series of steps. The reaction of benzenesulfonyl chloride with ethyl isonipecotate yielded ethyl 1-(phenylsulfonyl)piperidin-4-carboxylate (1), which was further converted into 1-(phenylsulfonyl)piperidin-4-carbohydrazide (2) and 5-(1-(phenylsulfonyl)piperidin-4-yl)-1,3,4-oxadiazol-2-thiol (3) respectively. The target compounds 6a–n were synthesized by the reaction of compound 3 with different N-aralkyl/aryl substituted 2-bromoacetamides (5a–n) in the presence of a weak base and polar aprotic solvent. The structures of the synthesized compounds were elucidated through 1H-NMR, IR and mass spectral data. The synthesized compounds were screened against Gram-negative and Gram-positive bacteria and exhibited moderate to talented activity.
Published: 2016
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24. Global fertility in 204 countries and territories, 1950-2021, with forecasts to 2100: a comprehensive demographic analysis for the Global Burden of Disease Study 2021

Author: V Bhattacharjee, N, E Schumacher, A, Aali, A, Habtegiorgis Abate, Y, Abbasgholizadeh, R, Abbasian, M, Abbasi-Kangevari, M, Abbastabar, H, Abd ElHafeez, S, Abd-Elsalam, S, Abdollahi, M, Abdollahifar, M, Abdoun, M, Abdullahi, A, Abebe, M, Shawel Abebe, S, Abiodun, O, Abolhassani, H, Abolmaali, M, Abouzid, M, Beressa Aboye, G, Guimarães Abreu, L, Aberhe Abrha, W, M Abrigo, M, Abtahi, D, Abualruz, H, Abubakar, B, Abu-Gharbieh, E, Me Abu-Rmeileh, N, Girum Girum Adal, T, Molla Adane, M, Atanda Adeagbo Adeagbo, O, Adesoji Adedoyin, R, Adekanmbi, V, Aden, B, Victor Adepoju, A, O Adetokunboh, O, Bunmi Adetunji, J, Adedayo Adeyinka, D, Israel Adeyomoye, O, Estiningtyas Sakilah Adnani, Q, Adra, S, Felix Afolabi, R, Afyouni, S, Sohail Afzal, M, Afzal, S, Aghamiri, S, Agodi, A, Agyemang-Duah, W, Opoku Ahinkorah, B, J Ahlstrom, A, Ahmad, A, Ahmad, D, Ahmad, F, M Ahmad, M, Ahmad, S, Ahmad, T, Ahmed, A, Ahmed, H, A Ahmed, L, Saleh Ahmed, M, Anees Ahmed, S, Ajami, M, Aji, B, Taddesse Akalu, G, Akbarialiabad, H, Olusola Akinyemi, R, Ahmed Akkaif, M, Akkala, S, Al Hamad, H, Mahfuz Al Hasan, S, Al Qadire, M, Mohammed Ali Al-Ahdal, T, O Alalalmeh, S, A Alalwan, T, Al-Aly, Z, Alam, K, Mustafa Al-Amer, R, Mashhour Alanezi, F, M Alanzi, T, Albakri, A, Albashtawy, M, T AlBataineh, M, Alemi, H, Alemi, S, Mulugeta Alemu, Y, Al-Eyadhy, A, Ali Saeed Al-Gheethi, A, F Alhabib, K, Alhajri, N, Alhalaiqa Naji Alhalaiqa, F, Kaba Alhassan, R, Ali, A, Abdulqadir Ali, B, Ali, L, Usman Ali, M, Ali, R, Shujait Shujait Ali, S, Mohammad Alif, S, Aligol, M, Alijanzadeh, M, M Aljasir, M, Mohamed Aljunid, S, Al-Marwani, S, Uy Almazan, J, M Al-Mekhlafi, H, Almidani, O, A Alomari, M, Al-Omari, B, S Alqahtani, J, Yaseen Alqutaibi, A, M Al-Raddadi, R, Khalifah Al-Sabah, S, Altaf, A, A Al-Tawfiq, J, A Altirkawi, K, Oyine Aluh, D, Jawad Alvi, F, Alvis-Guzman, N, Alwafi, H, Mohammed Al-Worafi, Y, Aly, H, Aly, S, H Alzoubi, K, Kwabena Ameyaw, E, Tawfik Amin, T, Amindarolzarbi, A, Amini-Rarani, M, Amiri, S, Gyamfuah Ampomah, I, A Amugsi, D, Adeniyi Amusa, G, Ancuceanu, R, Anderlini, D, Prata Andrade, P, Liliana Andrei, C, Andrei, T, Anil, A, Anil, S, Ansar, A, Ansari-Moghaddam, A, M Antony, C, Antriyandarti, E, Anvari, S, Anwar, S, Anwer, R, Edward Anyasodor, A, Arabloo, J, Arabzadeh Bahri, R, A Arafa, E, Arafat, M, Margarida Araújo, A, Y Aravkin, A, Aremu, A, Aripov, T, Arkew, M, Armocida, B, Ärnlöv, J, Arooj, M, A Artamonov, A, Arulappan, J, Taiwo Aruleba, R, Arumugam, A, Asadi-Lari, M, Asemi, Z, Asgary, S, Asghariahmadabad, M, Asghari-Jafarabadi, M, Yesse Ashemo, M, Ashraf, M, Ashraf, T, O Asika, M, Shamsadin Athari, S, Moh'd Wahbi Atout, M, Atreya, A, Aujayeb, A, Ausloos, M, Avan, A, Mulat Aweke, A, Melaku Ayele, G, Mohammad Ayyoubzadeh, S, Azadnajafabad, S, S Azevedo, R, Y Azzam, A, Badar, M, D Badiye, A, Baghdadi, S, Bagheri, N, Bagherieh, S, Bahmanziari, N, Bai, R, Amin Baig, A, L Baker, J, T Bako, A, Kaur Bakshi, R, Balasubramanian, M, Constantin Baltatu, O, Bam, K, Banach, M, Bandyopadhyay, S, Banik, B, Chandra Banik, P, Bansal, H, Firat Baran, M, Barchitta, M, Bardhan, M, Bardideh, E, Lyn Barker-Collo, S, Winfried Bärnighausen, T, Barone-Adesi, F, Jawdat Barqawi, H, Barrow, A, Barteit, S, Basharat, Z, J Bashir, A, Akande Bashiru, H, Basiru, A, Diogo Basso, J, Basu, S, Mohammad Batiha, A, Batra, K, T Baune, B, Bayati, M, Begum, T, Behboudi, E, Hossein Behnoush, A, Beiranvand, M, Fernanda Bejarano Ramirez, D, Bekele, A, Assefa Belay, S, Iqbal Belgaumi, U, L Bell, M, Omolaja Bello, O, Beloukas, A, M Bensenor, I, Berezvai, Z, Yirga Berhie, A, C Bermudez, A, G Bettencourt, P, Srikanth Bhagavathula, A, Bhardwaj, N, Bhardwaj, P, V Bhardwaj, P, Bhaskar, S, Bhat, V, Kaur Bhatti, G, Singh Bhatti, J, S Bhatti, M, Bhatti, R, Biondi, A, Bisignano, C, Biswas, A, Kishore Biswas, R, R Bitra, V, Bjørge, T, Bliss, E, Kofi Boachie, M, Vasilica Bobirca, A, Bodolica, V, Olalekan Bodunrin, A, Ketema Bogale, E, Angaw Bogale, K, Bonakdar Hashemi, M, Bora Basara, B, Bouaoud, S, Braithwaite, D, Brauer, M, K Breitborde, N, Bryazka, D, B Bulamu, N, Buonsenso, D, Burkart, K, A Burns, R, Bustanji, Y, Shafique Butt, N, A Butt, Z, Luciano Caetano Dos Santos, F, Calina, D, R Campos-Nonato, I, Cao, F, Cao, S, Capodici, A, Carreras, G, Carugno, A, A Castañeda-Orjuela, C, Castelpietra, G, Sofia Cattaruzza, M, Caye, A, Cegolon, L, Cembranel, F, Cerin, E, Chadwick, J, Chahine, Y, Chakraborty, C, Chalek, J, Shi Kai Chan, J, Charalampous, P, Kumar Chattu, V, Chaturvedi, S, Paul Chavula, M, Chen, A, Chen, H, Chen, S, Chi, G, Chichagi, F, Chien, J, R Ching, P, S Cho, W, Choi, S, Chong, B, Chopra, H, Gajanan Choudhari, S, J Christopher, D, Chu, D, Sunday Chukwu, I, Chung, E, Chung, S, Cindi, Z, Cioffi, I, Ciuffreda, R, M Claro, R, Coberly, K, Columbus, A, Comfort, H, Conde, J, H Criqui, M, Cruz-Martins, N, Magali Cuadra-Hernández, S, Dadana, S, Dadras, O, Dahiru, T, Dai, Z, Dalton, B, Damiani, G, Mohammad Darwesh, A, K Das, J, Das, S, Dashti, M, Dastiridou, A, Alberto 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Juexiao Zhou, Bin Zhu, Lei Zhu, Magdalena Zielińska, Zhiyong Zou, Samer H Zyoud, Christopher J L Murray, Amanda E Smith, and Stein Emil Vollset
Abstract: Background: Accurate assessments of current and future fertility-including overall trends and changing population age structures across countries and regions-are essential to help plan for the profound social, economic, environmental, and geopolitical challenges that these changes will bring. Estimates and projections of fertility are necessary to inform policies involving resource and health-care needs, labour supply, education, gender equality, and family planning and support. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 produced up-to-date and comprehensive demographic assessments of key fertility indicators at global, regional, and national levels from 1950 to 2021 and forecast fertility metrics to 2100 based on a reference scenario and key policy-dependent alternative scenarios. Methods: To estimate fertility indicators from 1950 to 2021, mixed-effects regression models and spatiotemporal Gaussian process regression were used to synthesise data from 8709 country-years of vital and sample registrations, 1455 surveys and censuses, and 150 other sources, and to generate age-specific fertility rates (ASFRs) for 5-year age groups from age 10 years to 54 years. ASFRs were summed across age groups to produce estimates of total fertility rate (TFR). Livebirths were calculated by multiplying ASFR and age-specific female population, then summing across ages 10-54 years. To forecast future fertility up to 2100, our Institute for Health Metrics and Evaluation (IHME) forecasting model was based on projections of completed cohort fertility at age 50 years (CCF50; the average number of children born over time to females from a specified birth cohort), which yields more stable and accurate measures of fertility than directly modelling TFR. CCF50 was modelled using an ensemble approach in which three sub-models (with two, three, and four covariates variously consisting of female educational attainment, contraceptive met need, population density in
Published: 2024

25. Epidemiology of viral hepatitis B and C in Punjab, Pakistan: a multicenter cross-sectional study, 2017-18 [version 1; peer review: 2 approved with reservations]

Author: Amjad Khan, Saira Afzal, Aashifa Yaqoob, Razia Fatima, Mahboob Ul Haq, Khunsa Junaid, and Abdul Nadir
Subjects: Research Article, Articles, Epidemiology, viral hepatitis, seroprevalence, risk factors, Pakistan
Abstract: Background: Globally, approximately 240 million people are chronically infected with hepatitis B virus (HBV) and hepatitis C virus (HCV), which are responsible for 96% of all hepatitis-related mortality. Pakistan has the second highest prevalence of HCV in the world. Methods: We conducted this study to ascertain the prevalence and potential risk factors associated with HBV and HCV infections in Punjab. A multi-center cross-sectional study was conducted, involving 24 Hepatitis Prevention and Treatment Clinics of the Pakistan Kidney and Liver Institute and Research Center clinics, Lahore. A total of 141,705 individuals who visited the clinics during 2017-18 were included for seroprevalence analysis of hepatitis B (HBsAg) and C (Anti-HCV). In addition, 12,427 individuals from the main group underwent detailed face-to-face interviews based on a predesigned questionnaire for risk factor assessment. Results: The overall prevalence for HBV and HCV was 8.4% and 42.7%, respectively. Of those with HCV infection, 4.2% had a co-infection. The transgender population had a higher seroprevalence of HBV (11.8%) and HCV (58.8%). Higher HBV seroprevalence was found in a younger age group (16-30 years), while the older age group ( >61 years) had a higher HCV seroprevalence. Geographically, Muzaffargarh district had the highest HBV seroprevalence at 26%, followed by Rajanpur district (20.3%). HCV seroprevalence was significantly (P value 1; p Conclusions: There is an urgent need for proper implementation of preventive and control strategies, as well as formal evaluation and monitoring mechanisms. Sustainable and adequate funding of public-sector hepatitis programs is also an extremely important area that should not be neglected.
Published: 2019
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26. The state of health in Pakistan and its provinces and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Author: Assad Hafeez, William James Dangel, Samuel M Ostroff, Ayyaz Gul Kiani, Scott D Glenn, Jaffar Abbas, Muhammad Sohail Afzal, Saira Afzal, Sajjad Ahmad, Ali Ahmed, Haroon Ahmed, Liaqat Ali, Muhammad Ali, Zahid Ali, Muhammad Arshad, Tahira Ashraf, Zulfiqar A Bhutta, Sadia Bibi, Zahid A Butt, Jai K Das, Zehra Fadoo, Asif Hanif, Khezar Hayat, Ayesha Humayun, Khalid Iqbal, Usman Iqbal, Nauman Khalid, Ejaz Ahmad Khan, Muhammad Shahzeb Khan, Ahmad Azam Malik, Muhammad Naveed, Shumaila Naz, Robina Khan Niazi, Zahra Zahid Piracha, Umar Saeed, Muhammad Salman, Zainab Samad, Muhammad Arif Nadeem Saqib, Syed Mahboob Shah, Izza Shahid, Masood Ali Shaikh, Hina Shamshad, Kanwar Hamza Shuja, Muhammad Suleman, Anayat Ullah, Irfan Ullah, Saif Ullah, Sana Ullah, Yasir Waheed, Abdul Waris, Simon I Hay, Christopher J L Murray, and Ali H Mokdad
Subjects: General Medicine
Published: 2023

27. Global mortality associated with 33 bacterial pathogens in 2019

Author: Kevin S Ikuta, Lucien R Swetschinski, Gisela Robles Aguilar, Fablina Sharara, Tomislav Mestrovic, Authia P Gray, Nicole Davis Weaver, Eve E Wool, Chieh Han, Anna Gershberg Hayoon, Amirali Aali, Semagn Mekonnen Abate, Mohsen Abbasi-Kangevari, Zeinab Abbasi-Kangevari, Sherief Abd-Elsalam, Getachew Abebe, Aidin Abedi, Amir Parsa Abhari, Hassan Abidi, Richard Gyan Aboagye, Abdorrahim Absalan, Hiwa Abubaker Ali, Juan Manuel Acuna, Tigist Demssew Adane, Isaac Yeboah Addo, Oyelola A Adegboye, Mohammad Adnan, Qorinah Estiningtyas Sakilah Adnani, Muhammad Sohail Afzal, Saira Afzal, Zahra Babaei Aghdam, Bright Opoku Ahinkorah, Aqeel Ahmad, Araz Ramazan Ahmad, Rizwan Ahmad, Sajjad Ahmad, Sohail Ahmad, Sepideh Ahmadi, Ali Ahmed, Haroon Ahmed, Jivan Qasim Ahmed, Tarik Ahmed Rashid, Marjan Ajami, Budi Aji, Mostafa Akbarzadeh-Khiavi, Chisom Joyqueenet Akunna, Hanadi Al Hamad, Fares Alahdab, Ziyad Al-Aly, Mamoon A Aldeyab, Alicia V Aleman, Fadwa Alhalaiqa Naji Alhalaiqa, Robert Kaba Alhassan, Beriwan Abdulqadir Ali, Liaqat Ali, Syed Shujait Ali, Yousef Alimohamadi, Vahid Alipour, Atiyeh Alizadeh, Syed Mohamed Aljunid, Kasim Allel, Sami Almustanyir, Edward Kwabena Ameyaw, Arianna Maever L Amit, Nivedita Anandavelane, Robert Ancuceanu, Catalina Liliana Andrei, Tudorel Andrei, Dewi Anggraini, Adnan Ansar, Anayochukwu Edward Anyasodor, Jalal Arabloo, Aleksandr Y Aravkin, Demelash Areda, Timur Aripov, Anton A Artamonov, Judie Arulappan, Raphael Taiwo Aruleba, Muhammad Asaduzzaman, Tahira Ashraf, Seyyed Shamsadin Athari, Daniel Atlaw, Sameh Attia, Marcel Ausloos, Tewachew Awoke, Beatriz Paulina Ayala Quintanilla, Tegegn Mulatu Ayana, Sina Azadnajafabad, Amirhossein Azari Jafari, Darshan B B, Muhammad Badar, Ashish D Badiye, Nayereh Baghcheghi, Sara Bagherieh, Atif Amin Baig, Indrajit Banerjee, Aleksandra Barac, Mainak Bardhan, Francesco Barone-Adesi, Hiba Jawdat Barqawi, Amadou Barrow, Pritish Baskaran, Saurav Basu, Abdul-Monim Mohammad Batiha, Neeraj Bedi, Melaku Ashagrie Belete, Uzma Iqbal Belgaumi, Rose G Bender, Bharti Bhandari, Dinesh Bhandari, Pankaj Bhardwaj, Sonu Bhaskar, Krittika Bhattacharyya, Suraj Bhattarai, Saeid Bitaraf, Danilo Buonsenso, Zahid A Butt, Florentino Luciano Caetano dos Santos, Jiao Cai, Daniela Calina, Paulo Camargos, Luis Alberto Cámera, Rosario Cárdenas, Muge Cevik, Joshua Chadwick, Jaykaran Charan, Akhilanand Chaurasia, Patrick R Ching, Sonali Gajanan Choudhari, Enayet Karim Chowdhury, Fazle Rabbi Chowdhury, Dinh-Toi Chu, Isaac Sunday Chukwu, Omid Dadras, Fentaw Teshome Dagnaw, Xiaochen Dai, Saswati Das, Anna Dastiridou, Sisay Abebe Debela, Fitsum Wolde Demisse, Solomon Demissie, Diriba Dereje, Msganaw Derese, Hardik Dineshbhai Desai, Fikadu Nugusu Dessalegn, Samuel Abebe A Dessalegni, Belay Desye, Kartik Dhaduk, Meghnath Dhimal, Sameer Dhingra, Nancy Diao, Daniel Diaz, Shirin Djalalinia, Milad Dodangeh, Deepa Dongarwar, Bezabih Terefe Dora, Fariba Dorostkar, Haneil Larson Dsouza, Eleonora Dubljanin, Susanna J Dunachie, Oyewole Christopher Durojaiye, Hisham Atan Edinur, Habtamu Bekele Ejigu, Michael Ekholuenetale, Temitope Cyrus Ekundayo, Hassan El-Abid, Muhammed Elhadi, Mohamed A Elmonem, Amir Emami, Luchuo Engelbert Bain, Daniel Berhanie Enyew, Ryenchindorj Erkhembayar, Babak Eshrati, Farshid Etaee, Adeniyi Francis Fagbamigbe, Shahab Falahi, Aida Fallahzadeh, Emerito Jose A Faraon, Ali Fatehizadeh, Ginenus Fekadu, João C Fernandes, Allegra Ferrari, Getahun Fetensa, Irina Filip, Florian Fischer, Masoud Foroutan, Peter Andras Gaal, Muktar A Gadanya, Abhay Motiramji Gaidhane, Balasankar Ganesan, Mesfin Gebrehiwot, Reza Ghanbari, Mohammad Ghasemi Nour, Ahmad Ghashghaee, Ali Gholamrezanezhad, Abdolmajid Gholizadeh, Mahaveer Golechha, Pouya Goleij, Davide Golinelli, Amador Goodridge, Damitha Asanga Gunawardane, Yuming Guo, Rajat Das Gupta, Sapna Gupta, Veer Bala Gupta, Vivek Kumar Gupta, Alemu Guta, Parham Habibzadeh, Atlas Haddadi Avval, Rabih Halwani, Asif Hanif, Md. Abdul Hannan, Harapan Harapan, Shoaib Hassan, Hadi Hassankhani, Khezar Hayat, Behzad Heibati, Golnaz Heidari, Mohammad Heidari, Reza Heidari-Soureshjani, Claudiu Herteliu, Demisu Zenbaba Heyi, Kamal Hezam, Praveen Hoogar, Nobuyuki Horita, Md Mahbub Hossain, Mehdi Hosseinzadeh, Mihaela Hostiuc, Sorin Hostiuc, Soodabeh Hoveidamanesh, Junjie Huang, Salman Hussain, Nawfal R Hussein, Segun Emmanuel Ibitoye, Olayinka Stephen Ilesanmi, Irena M Ilic, Milena D Ilic, Mohammad Tarique Imam, Mustapha Immurana, Leeberk Raja Inbaraj, Arnaud Iradukunda, Nahlah Elkudssiah Ismail, Chidozie C D Iwu, Chinwe Juliana Iwu, Linda Merin J, Mihajlo Jakovljevic, Elham Jamshidi, Tahereh Javaheri, Fatemeh Javanmardi, Javad Javidnia, Sathish Kumar Jayapal, Umesh Jayarajah, Rime Jebai, Ravi Prakash Jha, Tamas Joo, Nitin Joseph, Farahnaz Joukar, Jacek Jerzy Jozwiak, Salah Eddine Oussama Kacimi, Vidya Kadashetti, Laleh R Kalankesh, Rohollah Kalhor, Vineet Kumar Kamal, Himal Kandel, Neeti Kapoor, Samad Karkhah, Bekalu 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Ravi Mehrotra, Addisu Melese, Oliver Mendoza-Cano, Ritesh G Menezes, Alexios-Fotios A Mentis, Georgia Micha, Irmina Maria Michalek, Ana Carolina Micheletti Gomide Nogueira de Sá, Neda Milevska Kostova, Shabir Ahmad Mir, Mojgan Mirghafourvand, Seyyedmohammadsadeq Mirmoeeni, Erkin M Mirrakhimov, Mohammad Mirza-Aghazadeh-Attari, Abay Sisay Misganaw, Awoke Misganaw, Sanjeev Misra, Esmaeil Mohammadi, Mokhtar Mohammadi, Abdollah Mohammadian-Hafshejani, Shafiu Mohammed, Syam Mohan, Mohammad Mohseni, Ali H Mokdad, Sara Momtazmanesh, Lorenzo Monasta, Catrin E Moore, Maryam Moradi, Mostafa Moradi Sarabi, Shane Douglas Morrison, Majid Motaghinejad, Haleh Mousavi Isfahani, Amin Mousavi Khaneghah, Seyed Ali Mousavi-Aghdas, Sumaira Mubarik, Francesk Mulita, Getaneh Baye B Mulu, Sandra B Munro, Saravanan Muthupandian, Tapas Sadasivan Nair, Atta Abbas Naqvi, Himanshi Narang, Zuhair S Natto, Muhammad Naveed, Biswa Prakash Nayak, Shumaila Naz, Ionut Negoi, Seyed Aria Nejadghaderi, Sandhya Neupane Kandel, Che Henry Ngwa, Robina Khan Niazi, Antonio Tolentino Nogueira de Sá, Nafise Noroozi, Hasti Nouraei, Ali Nowroozi, Virginia Nuñez-Samudio, Jerry John Nutor, Chimezie Igwegbe Nzoputam, Ogochukwu Janet Nzoputam, Bogdan Oancea, Rahman Md Obaidur, Vivek Anand Ojha, Akinkunmi Paul Okekunle, Osaretin Christabel Okonji, Andrew T Olagunju, Bolajoko Olubukunola Olusanya, Ahmed Omar Bali, Emad Omer, Nikita Otstavnov, Bilcha Oumer, Mahesh P A, Jagadish Rao Padubidri, Keyvan Pakshir, Tamás Palicz, Adrian Pana, Shahina Pardhan, Jose L Paredes, Utsav Parekh, Eun-Cheol Park, Seoyeon Park, Ashish Pathak, Rajan Paudel, Uttam Paudel, Shrikant Pawar, Hamidreza Pazoki Toroudi, Minjin Peng, Umberto Pensato, Veincent Christian Filipino Pepito, Marcos Pereira, Mario F P Peres, Norberto Perico, Ionela-Roxana Petcu, Zahra Zahid Piracha, Indrashis Podder, Nayanum Pokhrel, Ramesh Poluru, Maarten J Postma, Naeimeh Pourtaheri, Akila Prashant, Ibrahim Qattea, Mohammad Rabiee, Navid Rabiee, Amir Radfar, Saber Raeghi, Sima Rafiei, Pankaja Raghav Raghav, Leila Rahbarnia, Vafa Rahimi-Movaghar, Mosiur Rahman, Muhammad Aziz Rahman, Amir Masoud Rahmani, Vahid Rahmanian, Pradhum Ram, Muhammad Modassar Ali Nawaz Ranjha, Sowmya J Rao, Mohammad-Mahdi Rashidi, Azad Rasul, Zubair Ahmed Ratan, Salman Rawaf, Reza Rawassizadeh, Mohammad Sadegh Razeghinia, Elrashdy Moustafa Mohamed Redwan, Misganu Teshoma Regasa, Giuseppe Remuzzi, Melese Abate Reta, Nazila Rezaei, Aziz Rezapour, Abanoub Riad, Rezaul Karim Ripon, Kristina E Rudd, Basema Saddik, Saeid Sadeghian, Umar Saeed, Mohsen Safaei, Azam Safary, Sher Zaman Safi, Maryam Sahebazzamani, Amirhossein Sahebkar, Harihar Sahoo, Saina Salahi, Sarvenaz Salahi, Hedayat Salari, Sana Salehi, Hossein Samadi Kafil, Abdallah M Samy, Nima Sanadgol, Senthilkumar Sankararaman, Francesco Sanmarchi, Brijesh Sathian, Monika Sawhney, Ganesh Kumar Saya, Subramanian Senthilkumaran, Allen Seylani, Pritik A Shah, Masood Ali Shaikh, Elaheh Shaker, Murad Ziyaudinovich Shakhmardanov, Mequannent Melaku Sharew, Athena Sharifi-Razavi, Purva Sharma, Rahim Ali Sheikhi, Ali Sheikhy, Pavanchand H Shetty, Mika Shigematsu, Jae Il Shin, Hesamaddin Shirzad-Aski, K M Shivakumar, Parnian Shobeiri, Seyed Afshin Shorofi, Sunil Shrestha, Migbar Mekonnen Sibhat, Negussie Boti Sidemo, Mustafa Kamal Sikder, Luís Manuel Lopes Rodrigues Silva, Jasvinder A Singh, Paramdeep Singh, Surjit Singh, Md Shahjahan Siraj, Samarjeet Singh Siwal, Valentin Yurievich Skryabin, Anna Aleksandrovna Skryabina, Bogdan Socea, Damtew Damtew Solomon, Yimeng Song, Chandrashekhar T Sreeramareddy, Muhammad Suleman, Rizwan Suliankatchi Abdulkader, Saima Sultana, Miklós Szócska, Seyed-Amir Tabatabaeizadeh, Mohammad Tabish, Majid Taheri, Elahe Taki, Ker-Kan Tan, Sarmila Tandukar, Nathan Y Tat, Vivian Y Tat, Belay Negash Tefera, Yibekal Manaye Tefera, Gebremaryam Temesgen, Mohamad-Hani Temsah, Samar Tharwat, Arulmani Thiyagarajan, Imad I Tleyjeh, Christopher E Troeger, Krishna Kishore Umapathi, Era 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Rogier van Doorn, Siavash Vaziri, Georgios-Ioannis Verras, Harimadhav Viswanathan, Bay Vo, Abdul Waris, Gizachew Tadesse Wassie, Nuwan Darshana Wickramasinghe, Sajad Yaghoubi, Gahin Abdulraheem Tayib Yahya Yahya, Seyed Hossein Yahyazadeh Jabbari, Arzu Yigit, Vahit Yiğit, Dong Keon Yon, Naohiro Yonemoto, Mazyar Zahir, Burhan Abdullah Zaman, Sojib Bin Zaman, Moein Zangiabadian, Iman Zare, Mikhail Sergeevich Zastrozhin, Zhi-Jiang Zhang, Peng Zheng, Chenwen Zhong, Mohammad Zoladl, Alimuddin Zumla, Simon I Hay, Christiane Dolecek, Benn Sartorius, Christopher J L Murray, Mohsen Naghavi, Ikuta, Kevin S, Swetschinski, Lucien R, Robles Aguilar, Gisela, Sharara, Fablina, Mestrovic, Tomislav, Gray, Authia P, Davis Weaver, Nicole, Wool, Eve E, Han, Chieh, Gershberg Hayoon, Anna, Aali, Amirali, Abate, Semagn Mekonnen, Abbasi-Kangevari, Mohsen, Abbasi-Kangevari, Zeinab, Abd-Elsalam, Sherief, Abebe, Getachew, Abedi, Aidin, Abhari, Amir Parsa, Abidi, Hassan, Aboagye, Richard Gyan, Absalan, Abdorrahim, Abubaker Ali, Hiwa, Acuna, Juan Manuel, Adane, Tigist Demssew, Addo, Isaac Yeboah, Adegboye, Oyelola A, Adnan, Mohammad, Adnani, Qorinah Estiningtyas Sakilah, Afzal, Muhammad Sohail, Afzal, Saira, Aghdam, Zahra Babaei, Ahinkorah, Bright Opoku, Ahmad, Aqeel, Ahmad, Araz Ramazan, Ahmad, Rizwan, Ahmad, Sajjad, Ahmad, Sohail, Ahmadi, Sepideh, Ahmed, Ali, Ahmed, Haroon, Ahmed, Jivan Qasim, Ahmed Rashid, Tarik, Ajami, Marjan, Aji, Budi, Akbarzadeh-Khiavi, Mostafa, Akunna, Chisom Joyqueenet, Al Hamad, Hanadi, Alahdab, Fare, Al-Aly, Ziyad, Aldeyab, Mamoon A, Aleman, Alicia V, Alhalaiqa, Fadwa Alhalaiqa Naji, Alhassan, Robert Kaba, Ali, Beriwan Abdulqadir, Ali, Liaqat, Ali, Syed Shujait, Alimohamadi, Yousef, Alipour, Vahid, Alizadeh, Atiyeh, Aljunid, Syed Mohamed, Allel, Kasim, Almustanyir, Sami, Ameyaw, Edward Kwabena, Amit, Arianna Maever L, Anandavelane, Nivedita, Ancuceanu, Robert, Andrei, Catalina Liliana, Andrei, Tudorel, Anggraini, Dewi, Ansar, Adnan, Anyasodor, Anayochukwu Edward, Arabloo, Jalal, Aravkin, Aleksandr Y, Areda, Demelash, Aripov, Timur, Artamonov, Anton A, Arulappan, Judie, Aruleba, Raphael Taiwo, Asaduzzaman, Muhammad, Ashraf, Tahira, Athari, Seyyed Shamsadin, Atlaw, Daniel, Attia, Sameh, Ausloos, Marcel, Awoke, Tewachew, Ayala Quintanilla, Beatriz Paulina, Ayana, Tegegn Mulatu, Azadnajafabad, Sina, Azari Jafari, Amirhossein, B, Darshan B, Badar, Muhammad, Badiye, Ashish D, Baghcheghi, Nayereh, Bagherieh, Sara, Baig, Atif Amin, Banerjee, Indrajit, Barac, Aleksandra, Bardhan, Mainak, Barone-Adesi, Francesco, Barqawi, Hiba Jawdat, Barrow, Amadou, Baskaran, Pritish, Basu, Saurav, Batiha, Abdul-Monim Mohammad, Bedi, Neeraj, Belete, Melaku Ashagrie, Belgaumi, Uzma Iqbal, Bender, Rose G, Bhandari, Bharti, Bhandari, Dinesh, Bhardwaj, Pankaj, Bhaskar, Sonu, Bhattacharyya, Krittika, Bhattarai, Suraj, Bitaraf, Saeid, Buonsenso, Danilo, Butt, Zahid A, Caetano dos Santos, Florentino Luciano, Cai, Jiao, Calina, Daniela, Camargos, Paulo, Cámera, Luis Alberto, Cárdenas, Rosario, Cevik, Muge, Chadwick, Joshua, Charan, Jaykaran, Chaurasia, Akhilanand, Ching, Patrick R, Choudhari, Sonali Gajanan, Chowdhury, Enayet Karim, Chowdhury, Fazle Rabbi, Chu, Dinh-Toi, Chukwu, Isaac Sunday, Dadras, Omid, Dagnaw, Fentaw Teshome, Dai, Xiaochen, Das, Saswati, Dastiridou, Anna, Debela, Sisay Abebe, Demisse, Fitsum Wolde, Demissie, Solomon, Dereje, Diriba, Derese, Msganaw, Desai, Hardik Dineshbhai, Dessalegn, Fikadu Nugusu, Dessalegni, Samuel Abebe A, Desye, Belay, Dhaduk, Kartik, Dhimal, Meghnath, Dhingra, Sameer, Diao, Nancy, Diaz, Daniel, Djalalinia, Shirin, Dodangeh, Milad, Dongarwar, Deepa, Dora, Bezabih Terefe, Dorostkar, Fariba, Dsouza, Haneil Larson, Dubljanin, Eleonora, Dunachie, Susanna J, Durojaiye, Oyewole Christopher, Edinur, Hisham Atan, Ejigu, Habtamu Bekele, Ekholuenetale, Michael, Ekundayo, Temitope Cyru, El-Abid, Hassan, Elhadi, Muhammed, Elmonem, Mohamed A, Emami, Amir, Engelbert Bain, Luchuo, Enyew, Daniel Berhanie, Erkhembayar, Ryenchindorj, Eshrati, Babak, Etaee, Farshid, Fagbamigbe, Adeniyi Franci, Falahi, Shahab, Fallahzadeh, Aida, Faraon, Emerito Jose A, Fatehizadeh, Ali, Fekadu, Ginenu, Fernandes, João C, Ferrari, Allegra, Fetensa, Getahun, Filip, Irina, Fischer, Florian, Foroutan, Masoud, Gaal, Peter Andra, Gadanya, Muktar A, Gaidhane, Abhay Motiramji, Ganesan, Balasankar, Gebrehiwot, Mesfin, Ghanbari, Reza, Ghasemi Nour, Mohammad, Ghashghaee, Ahmad, Gholamrezanezhad, Ali, Gholizadeh, Abdolmajid, Golechha, Mahaveer, Goleij, Pouya, Golinelli, Davide, Goodridge, Amador, Gunawardane, Damitha Asanga, Guo, Yuming, Gupta, Rajat Da, Gupta, Sapna, Gupta, Veer Bala, Gupta, Vivek Kumar, Guta, Alemu, Habibzadeh, Parham, Haddadi Avval, Atla, Halwani, Rabih, Hanif, Asif, Hannan, Md. Abdul, Harapan, Harapan, Hassan, Shoaib, Hassankhani, Hadi, Hayat, Khezar, Heibati, Behzad, Heidari, Golnaz, Heidari, Mohammad, Heidari-Soureshjani, Reza, Herteliu, Claudiu, Heyi, Demisu Zenbaba, Hezam, Kamal, Hoogar, Praveen, Horita, Nobuyuki, Hossain, Md Mahbub, Hosseinzadeh, Mehdi, Hostiuc, Mihaela, Hostiuc, Sorin, Hoveidamanesh, Soodabeh, Huang, Junjie, Hussain, Salman, Hussein, Nawfal R, Ibitoye, Segun Emmanuel, Ilesanmi, Olayinka Stephen, Ilic, Irena M, Ilic, Milena D, Imam, Mohammad Tarique, Immurana, Mustapha, Inbaraj, Leeberk Raja, Iradukunda, Arnaud, Ismail, Nahlah Elkudssiah, Iwu, Chidozie C D, Iwu, Chinwe Juliana, J, Linda Merin, Jakovljevic, Mihajlo, Jamshidi, Elham, Javaheri, Tahereh, Javanmardi, Fatemeh, Javidnia, Javad, Jayapal, Sathish Kumar, Jayarajah, Umesh, Jebai, Rime, Jha, Ravi Prakash, Joo, Tama, Joseph, Nitin, Joukar, Farahnaz, Jozwiak, Jacek Jerzy, Kacimi, Salah Eddine Oussama, Kadashetti, Vidya, Kalankesh, Laleh R, Kalhor, Rohollah, Kamal, Vineet Kumar, Kandel, Himal, Kapoor, Neeti, Karkhah, Samad, Kassa, Bekalu Getnet, Kassebaum, Nicholas J, Katoto, Patrick DMC, Keykhaei, Mohammad, Khajuria, Himanshu, Khan, Abba, Khan, Imteyaz A, Khan, Maseer, Khan, Md Nuruzzaman, Khan, Moien AB, Khatatbeh, Moawiah Mohammad, Khater, Mona M, Khayat Kashani, Hamid Reza, Khubchandani, Jagdish, Kim, Hanna, Kim, Min Seo, Kimokoti, Ruth W, Kissoon, Niranjan, Kochhar, Sonali, Kompani, Farzad, Kosen, Soewarta, Koul, Parvaiz A, Koulmane Laxminarayana, Sindhura Lakshmi, Krapp Lopez, Fiorella, Krishan, Kewal, Krishnamoorthy, Vijay, Kulkarni, Vishnutheertha, Kumar, Naveen, Kurmi, Om P, Kuttikkattu, Ambily, Kyu, Hmwe Hmwe, Lal, Dharmesh Kumar, Lám, Judit, Landires, Iván, Lasrado, Savita, Lee, Sang-woong, Lenzi, Jacopo, Lewycka, Sonia, Li, Shanshan, Lim, Stephen S, Liu, Wei, Lodha, Rakesh, Loftus, Michael J, Lohiya, Ayush, Lorenzovici, László, Lotfi, Mojgan, Mahmoodpoor, Ata, Mahmoud, Mansour Adam, Mahmoudi, Razzagh, Majeed, Azeem, Majidpoor, Jamal, Makki, Alaa, Mamo, Galana Ayana, Manla, Yosef, Martorell, Miquel, Matei, Clara N, McManigal, Barney, Mehrabi Nasab, Entezar, Mehrotra, Ravi, Melese, Addisu, Mendoza-Cano, Oliver, Menezes, Ritesh G, Mentis, Alexios-Fotios A, Micha, Georgia, Michalek, Irmina Maria, Micheletti Gomide Nogueira de Sá, Ana Carolina, Milevska Kostova, Neda, Mir, Shabir Ahmad, Mirghafourvand, Mojgan, Mirmoeeni, Seyyedmohammadsadeq, Mirrakhimov, Erkin M, Mirza-Aghazadeh-Attari, Mohammad, Misganaw, Abay Sisay, Misganaw, Awoke, Misra, Sanjeev, Mohammadi, Esmaeil, Mohammadi, Mokhtar, Mohammadian-Hafshejani, Abdollah, Mohammed, Shafiu, Mohan, Syam, Mohseni, Mohammad, Mokdad, Ali H, Momtazmanesh, Sara, Monasta, Lorenzo, Moore, Catrin E, Moradi, Maryam, Moradi Sarabi, Mostafa, Morrison, Shane Dougla, Motaghinejad, Majid, Mousavi Isfahani, Haleh, Mousavi Khaneghah, Amin, Mousavi-Aghdas, Seyed Ali, Mubarik, Sumaira, Mulita, Francesk, Mulu, Getaneh Baye B, Munro, Sandra B, Muthupandian, Saravanan, Nair, Tapas Sadasivan, Naqvi, Atta Abba, Narang, Himanshi, Natto, Zuhair S, Naveed, Muhammad, Nayak, Biswa Prakash, Naz, Shumaila, Negoi, Ionut, Nejadghaderi, Seyed Aria, Neupane Kandel, Sandhya, Ngwa, Che Henry, Niazi, Robina Khan, Nogueira de Sá, Antonio Tolentino, Noroozi, Nafise, Nouraei, Hasti, Nowroozi, Ali, Nuñez-Samudio, Virginia, Nutor, Jerry John, Nzoputam, Chimezie Igwegbe, Nzoputam, Ogochukwu Janet, Oancea, Bogdan, Obaidur, Rahman Md, Ojha, Vivek Anand, Okekunle, Akinkunmi Paul, Okonji, Osaretin Christabel, Olagunju, Andrew T, Olusanya, Bolajoko Olubukunola, Omar Bali, Ahmed, Omer, Emad, Otstavnov, Nikita, Oumer, Bilcha, P A, Mahesh, Padubidri, Jagadish Rao, Pakshir, Keyvan, Palicz, Tamá, Pana, Adrian, Pardhan, Shahina, Paredes, Jose L, Parekh, Utsav, Park, Eun-Cheol, Park, Seoyeon, Pathak, Ashish, Paudel, Rajan, Paudel, Uttam, Pawar, Shrikant, Pazoki Toroudi, Hamidreza, Peng, Minjin, Pensato, Umberto, Pepito, Veincent Christian Filipino, Pereira, Marco, Peres, Mario F P, Perico, Norberto, Petcu, Ionela-Roxana, Piracha, Zahra Zahid, Podder, Indrashi, Pokhrel, Nayanum, Poluru, Ramesh, Postma, Maarten J, Pourtaheri, Naeimeh, Prashant, Akila, Qattea, Ibrahim, Rabiee, Mohammad, Rabiee, Navid, Radfar, Amir, Raeghi, Saber, Rafiei, Sima, Raghav, Pankaja Raghav, Rahbarnia, Leila, Rahimi-Movaghar, Vafa, Rahman, Mosiur, Rahman, Muhammad Aziz, Rahmani, Amir Masoud, Rahmanian, Vahid, Ram, Pradhum, Ranjha, Muhammad Modassar Ali Nawaz, Rao, Sowmya J, Rashidi, Mohammad-Mahdi, Rasul, Azad, Ratan, Zubair Ahmed, Rawaf, Salman, Rawassizadeh, Reza, Razeghinia, Mohammad Sadegh, Redwan, Elrashdy Moustafa Mohamed, Regasa, Misganu Teshoma, Remuzzi, Giuseppe, Reta, Melese Abate, Rezaei, Nazila, Rezapour, Aziz, Riad, Abanoub, Ripon, Rezaul Karim, Rudd, Kristina E, Saddik, Basema, Sadeghian, Saeid, Saeed, Umar, Safaei, Mohsen, Safary, Azam, Safi, Sher Zaman, Sahebazzamani, Maryam, Sahebkar, Amirhossein, Sahoo, Harihar, Salahi, Saina, Salahi, Sarvenaz, Salari, Hedayat, Salehi, Sana, Samadi Kafil, Hossein, Samy, Abdallah M, Sanadgol, Nima, Sankararaman, Senthilkumar, Sanmarchi, Francesco, Sathian, Brijesh, Sawhney, Monika, Saya, Ganesh Kumar, Senthilkumaran, Subramanian, Seylani, Allen, Shah, Pritik A, Shaikh, Masood Ali, Shaker, Elaheh, Shakhmardanov, Murad Ziyaudinovich, Sharew, Mequannent Melaku, Sharifi-Razavi, Athena, Sharma, Purva, Sheikhi, Rahim Ali, Sheikhy, Ali, Shetty, Pavanchand H, Shigematsu, Mika, Shin, Jae Il, Shirzad-Aski, Hesamaddin, Shivakumar, K M, Shobeiri, Parnian, Shorofi, Seyed Afshin, Shrestha, Sunil, Sibhat, Migbar Mekonnen, Sidemo, Negussie Boti, Sikder, Mustafa Kamal, Silva, Luís Manuel Lopes Rodrigue, Singh, Jasvinder A, Singh, Paramdeep, Singh, Surjit, Siraj, Md Shahjahan, Siwal, Samarjeet Singh, Skryabin, Valentin Yurievich, Skryabina, Anna Aleksandrovna, Socea, Bogdan, Solomon, Damtew Damtew, Song, Yimeng, Sreeramareddy, Chandrashekhar T, Suleman, Muhammad, Suliankatchi Abdulkader, Rizwan, Sultana, Saima, Szócska, Mikló, Tabatabaeizadeh, Seyed-Amir, Tabish, Mohammad, Taheri, Majid, Taki, Elahe, Tan, Ker-Kan, Tandukar, Sarmila, Tat, Nathan Y, Tat, Vivian Y, Tefera, Belay Negash, Tefera, Yibekal Manaye, Temesgen, Gebremaryam, Temsah, Mohamad-Hani, Tharwat, Samar, Thiyagarajan, Arulmani, Tleyjeh, Imad I, Troeger, Christopher E, Umapathi, Krishna Kishore, Upadhyay, Era, Valadan Tahbaz, Sahel, Valdez, Pascual R, Van den Eynde, Jef, van Doorn, H. Rogier, Vaziri, Siavash, Verras, Georgios-Ioanni, Viswanathan, Harimadhav, Vo, Bay, Waris, Abdul, Wassie, Gizachew Tadesse, Wickramasinghe, Nuwan Darshana, Yaghoubi, Sajad, Yahya, Gahin Abdulraheem Tayib Yahya, Yahyazadeh Jabbari, Seyed Hossein, Yigit, Arzu, Yiğit, Vahit, Yon, Dong Keon, Yonemoto, Naohiro, Zahir, Mazyar, Zaman, Burhan Abdullah, Zaman, Sojib Bin, Zangiabadian, Moein, Zare, Iman, Zastrozhin, Mikhail Sergeevich, Zhang, Zhi-Jiang, Zheng, Peng, Zhong, Chenwen, Zoladl, Mohammad, Zumla, Alimuddin, Hay, Simon I, Dolecek, Christiane, Sartorius, Benn, Murray, Christopher J L, and Naghavi, Mohsen
Subjects: Male, Bacteria, Syndrome, Bacterial Infections, General Medicine, Global Health, Global Burden of Disease, Risk Factors, Sepsis, Humans, Female, Mortality, Child, Africa South of the Sahara
Abstract: Background: Reducing the burden of death due to infection is an urgent global public health priority. Previous studies have estimated the number of deaths associated with drug-resistant infections and sepsis and found that infections remain a leading cause of death globally. Understanding the global burden of common bacterial pathogens (both susceptible and resistant to antimicrobials) is essential to identify the greatest threats to public health. To our knowledge, this is the first study to present global comprehensive estimates of deaths associated with 33 bacterial pathogens across 11 major infectious syndromes. Methods: We estimated deaths associated with 33 bacterial genera or species across 11 infectious syndromes in 2019 using methods from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, in addition to a subset of the input data described in the Global Burden of Antimicrobial Resistance 2019 study. This study included 343 million individual records or isolates covering 11 361 study-location-years. We used three modelling steps to estimate the number of deaths associated with each pathogen: deaths in which infection had a role, the fraction of deaths due to infection that are attributable to a given infectious syndrome, and the fraction of deaths due to an infectious syndrome that are attributable to a given pathogen. Estimates were produced for all ages and for males and females across 204 countries and territories in 2019. 95% uncertainty intervals (UIs) were calculated for final estimates of deaths and infections associated with the 33 bacterial pathogens following standard GBD methods by taking the 2·5th and 97·5th percentiles across 1000 posterior draws for each quantity of interest. Findings: From an estimated 13·7 million (95% UI 10·9–17·1) infection-related deaths in 2019, there were 7·7 million deaths (5·7–10·2) associated with the 33 bacterial pathogens (both resistant and susceptible to antimicrobials) across the 11 infectious syndromes estimated in this study. We estimated deaths associated with the 33 bacterial pathogens to comprise 13·6% (10·2–18·1) of all global deaths and 56·2% (52·1–60·1) of all sepsis-related deaths in 2019. Five leading pathogens—Staphylococcus aureus, Escherichia coli, Streptococcus pneumoniae, Klebsiella pneumoniae, and Pseudomonas aeruginosa—were responsible for 54·9% (52·9–56·9) of deaths among the investigated bacteria. The deadliest infectious syndromes and pathogens varied by location and age. The age-standardised mortality rate associated with these bacterial pathogens was highest in the sub-Saharan Africa super-region, with 230 deaths (185–285) per 100 000 population, and lowest in the high-income super-region, with 52·2 deaths (37·4–71·5) per 100 000 population. S aureus was the leading bacterial cause of death in 135 countries and was also associated with the most deaths in individuals older than 15 years, globally. Among children younger than 5 years, S pneumoniae was the pathogen associated with the most deaths. In 2019, more than 6 million deaths occurred as a result of three bacterial infectious syndromes, with lower respiratory infections and bloodstream infections each causing more than 2 million deaths and peritoneal and intra-abdominal infections causing more than 1 million deaths. Interpretation: The 33 bacterial pathogens that we investigated in this study are a substantial source of health loss globally, with considerable variation in their distribution across infectious syndromes and locations. Compared with GBD Level 3 underlying causes of death, deaths associated with these bacteria would rank as the second leading cause of death globally in 2019; hence, they should be considered an urgent priority for intervention within the global health community. Strategies to address the burden of bacterial infections include infection prevention, optimised use of antibiotics, improved capacity for microbiological analysis, vaccine development, and improved and more pervasive use of available vaccines. These estimates can be used to help set priorities for vaccine need, demand, and development. Funding: Bill & Melinda Gates Foundation, Wellcome Trust, and Department of Health and Social Care, using UK aid funding managed by the Fleming Fund.
Published: 2022

28. Multifactorial Complexity and Zoonotic Aspects of Dog-Mediated Human Rabies in Pakistan

Author: Saira Afzal
Subjects: General Veterinary
Abstract: Rabies, a viral illness classified as a neglected tropical disease by the World Health Organization (WHO), causes thousands of people to die annually, primarily in underprivileged communities of Africa and Asia. In the context of a single health framework, one of the primary objectives of this literature review is to examine the major factors and challenges that maintain the endemic status of dog-mediated human rabies in Pakistan. Rabies-endemic countries have an imperative need to work on preventive strategies to lessen the burden of this terrible disease as per guidelines of World Organization for Animal Health (WOAH) and WHO. Lack of public awareness, free-roaming dogs, and cold chain mismanagement of vaccinations are the 3 most significant factors contributing to the increasing number of dog bite injuries and suspected rabies cases in animals and humans. To control dog-mediated rabies, Pakistan must initiate and strongly support a national One Health project, a subsidized supply of human and animal rabies vaccine in public hospitals, and designated rabies prevention centers at an affordable cost. People should be educated regarding responsible pet ownership and follow-up of basic preventive measures. Empowerment of labs equipped with surveillance systems are also additionally required to strengthen rabies control and prevention activities at least in regional levels. This article gives valuable information for scholars and policymakers who wish to comprehend why this disease remains endemic due to multiplex interplay of zoonotic, medical, and anthropological risk factors and transmission chains in animal and human sectors through viral reservoirs. Achieving the 'Zero By 2030' goal in Pakistan requires joint immediate action from the government, society, and all health departments at regional, provincial, and national level
Published: 2022

29. Implementation of National Licensing Examination (NLE) and its Impact on Global Healthcare: A Systematic Review

Author: Shehzad Saleem and Saira Afzal
Subjects: General Medicine
Abstract: Background: A license required for full practice - National licensing examinations (NLEs) are required in most of the countries with well-established medical regulatory authorities. Objective: This systematic review aims to investigate the impact of NLEs after their implementation worldwide. Methods: Systematic review designed as per Kane's validity framework developed by Olivary et al. by exploring online databases such as: Wiley Online, Embase Medline (EBSCO); PubMed; JSTOR; Google Scholar and Science Direct; from January 2005 to December 2020. Results: NLE exams and better patient outcomes (communication, satisfaction) are positively related and such exams help in development of a common medical curriculum and a better post-graduation entry point. Conclusions: In the present era, where more medical graduates are flying all across the globe for employment than ever before, NLE is becoming inevitable and helps to ensure that medical training satisfies a minimum standard of quality, which varies among Medical schools and colleges within a country and globally. Continual improvement is crucial for the identification of gaps in the medical licensing exams. The license holders must comply with National authorities and stay active in academic and clinical activities to stay licensed.
Published: 2022

30. Longitudinal analyses of CLL in mice identify leukemia-related clonal changes including a Myc gain predicting poor outcome in patients

Author: Sascha Dietrich, Irene Gil-Farina, Selcen Öztürk, Marc Zapatka, Peter Lichter, Lavinia Arseni, Manfred Schmidt, Bola S. Hanna, Philipp M. Roessner, Anna Jauch, Stephan Stilgenbauer, Peter-Martin Bruch, Saira Afzal, Yashna Paul, Martina Seiffert, and Verena Kalter
Subjects: Cancer Research, Adoptive cell transfer, Chronic lymphocytic leukaemia, Chronic lymphocytic leukemia, Mice, Transgenic, Biology, Somatic evolution in cancer, Article, Chromosomes, Clonal Evolution, Proto-Oncogene Proteins c-myc, Chromosome 15, Mice, hemic and lymphatic diseases, Proto-Oncogene Proteins, medicine, Cancer genomics, Animals, Humans, Cancer models, Exome, Hematology, medicine.disease, Leukemia, Lymphocytic, Chronic, B-Cell, Mice, Inbred C57BL, Leukemia, Oncology, Gain of Function Mutation, Monoclonal, Chromosomal region, Cancer research
Abstract: Chronic lymphocytic leukemia (CLL) is a B-cell malignancy mainly occurring at an advanced age with no single major genetic driver. Transgenic expression of TCL1 in B cells leads after a long latency to a CLL-like disease in aged Eµ-TCL1 mice suggesting that TCL1 overexpression is not sufficient for full leukemic transformation. In search for secondary genetic events and to elucidate the clonal evolution of CLL, we performed whole exome and B-cell receptor sequencing of longitudinal leukemia samples of Eµ-TCL1 mice. We observed a B-cell receptor stereotypy, as described in patients, confirming that CLL is an antigen-driven disease. Deep sequencing showed that leukemia in Eµ-TCL1 mice is mostly monoclonal. Rare oligoclonality was associated with inability of tumors to develop disease upon adoptive transfer in mice. In addition, we identified clonal changes and a sequential acquisition of mutations with known relevance in CLL, which highlights the genetic similarities and therefore, suitability of the Eµ-TCL1 mouse model for progressive CLL. Among them, a recurrent gain of chromosome 15, where Myc is located, was identified in almost all tumors in Eµ-TCL1 mice. Interestingly, amplification of 8q24, the chromosomal region containing MYC in humans, was associated with worse outcome of patients with CLL., Clonal evolution and genomic alterations in the Eµ-TCL1 mouse model mirror human CLL and identify Myc as oncogenic hit associated with disease progression in patients.
Published: 2021

31. Misinformation and Misconceptions About COVID-19 Vaccination in Pakistan: The Need to Control Infodemic

Author: Saira Afzal
Subjects: General Medicine
Abstract: A unprecedented global public health and economic disaster have emerged from the spread of SARS-CoV-2, the COVID-19 causal agent. The World Health Organization (WHO) has labeled the outbreak a pandemic on March 11, 2020. The spread of this infectious disease has created a humanitarian and economic crisis throughout the world. Vaccination has been shown to be effective in preventing such pandemics 1. To prevent the spread of COVID-19, researchers developed COVID-19 vaccines in record time with the assistance of pharmaceutical industries. By December 2020, many candidate vaccines had demonstrated safety and efficacy in phase III trials, with efficacy rates as high as 95%. The public's acceptance of vaccination is critical to the success of any immunization program2. Public suspicion about vaccines reduces their acceptance rate. It is well known that conspiracy theories and religious beliefs are linked to vaccine hesitation. During the 2009 pandemic, studies revealed low vaccine acceptance rates (17–67%)2,3,4. Contrary to developed countries, developing countries' vaccination refusal and hesitancy is more common, as preventable diseases like polio persist5. Vaccine hesitancy is one of the top ten global health threats in 2019, according to the World Health Organization (WHO)6,7.
Published: 2022

32. Population-level risks of alcohol consumption by amount, geography, age, sex, and year: a systematic analysis for the Global Burden of Disease Study 2020

Author: Dana Bryazka, Marissa B Reitsma, Max G Griswold, Kalkidan Hassen Abate, Cristiana Abbafati, Mohsen Abbasi-Kangevari, Zeinab Abbasi-Kangevari, Amir Abdoli, Mohammad Abdollahi, Abu Yousuf Md Abdullah, E S Abhilash, Eman Abu-Gharbieh, Juan Manuel Acuna, Giovanni Addolorato, Oladimeji M Adebayo, Victor Adekanmbi, Kishor Adhikari, Sangeet Adhikari, Qorinah Estiningtyas Sakilah Adnani, Saira Afzal, Wubetu Yimam Agegnehu, Manik Aggarwal, Bright Opoku Ahinkorah, Araz Ramazan Ahmad, Sajjad Ahmad, Tauseef Ahmad, Ali Ahmadi, Sepideh Ahmadi, Haroon Ahmed, Tarik Ahmed Rashid, Chisom Joyqueenet Akunna, Hanadi Al Hamad, Md Zakiul Alam, Dejene Tsegaye Alem, Kefyalew Addis Alene, Yousef Alimohamadi, Atiyeh Alizadeh, Kasim Allel, Jordi Alonso, Saba Alvand, Nelson Alvis-Guzman, Firehiwot Amare, Edward Kwabena Ameyaw, Sohrab Amiri, Robert Ancuceanu, Jason A Anderson, Catalina Liliana Andrei, Tudorel Andrei, Jalal Arabloo, Muhammad Arshad, Anton A Artamonov, Zahra Aryan, Malke Asaad, Mulusew A Asemahagn, Thomas Astell-Burt, Seyyed Shamsadin Athari, Desta Debalkie Atnafu, Prince Atorkey, Alok Atreya, Floriane Ausloos, Marcel Ausloos, Getinet Ayano, Martin Amogre ayanore Ayanore, Olatunde O Ayinde, Jose L Ayuso-Mateos, Sina Azadnajafabad, Melkalem Mamuye Azanaw, Mohammadreza Azangou-Khyavy, Amirhossein Azari Jafari, Ahmed Y Azzam, Ashish D Badiye, Nasser Bagheri, Sara Bagherieh, Mohan Bairwa, Shankar M Bakkannavar, Ravleen Kaur Bakshi, Awraris Hailu Balchut/Bilchut, Till Winfried Bärnighausen, Fabio Barra, Amadou Barrow, Pritish Baskaran, Luis Belo, Derrick A Bennett, Isabela M Benseñor, Akshaya Srikanth Bhagavathula, Neeraj Bhala, Ashish Bhalla, Nikha Bhardwaj, Pankaj Bhardwaj, Sonu Bhaskar, Krittika Bhattacharyya, Vijayalakshmi S Bhojaraja, Bagas Suryo Bintoro, Elena A Elena Blokhina, Belay Boda Abule Bodicha, Archith Boloor, Cristina Bosetti, Dejana Braithwaite, Hermann Brenner, Nikolay Ivanovich Briko, Andre R Brunoni, Zahid A Butt, Chao Cao, Yin Cao, Rosario Cárdenas, Andre F Carvalho, Márcia Carvalho, Joao Mauricio Castaldelli-Maia, Giulio Castelpietra, Luis F S Castro-de-Araujo, Maria Sofia Cattaruzza, Promit Ananyo Chakraborty, Jaykaran Charan, Vijay Kumar Chattu, Akhilanand Chaurasia, Nicolas Cherbuin, Dinh-Toi Chu, Nandita Chudal, Sheng-Chia Chung, Chuchu Churko, Liliana G Ciobanu, Massimo Cirillo, Rafael M Claro, Simona Costanzo, Richard G Cowden, Michael H Criqui, Natália Cruz-Martins, Garland T Culbreth, Berihun Assefa Dachew, Omid Dadras, Xiaochen Dai, Giovanni Damiani, Lalit Dandona, Rakhi Dandona, Beniam Darge Daniel, Anna Danielewicz, Jiregna Darega Gela, Kairat Davletov, Jacyra Azevedo Paiva de Araujo, Antonio Reis de Sá-Junior, Sisay Abebe Debela, Azizallah Dehghan, Andreas K Demetriades, Meseret Derbew Molla, Rupak Desai, Abebaw Alemayehu Desta, Diana Dias da Silva, Daniel Diaz, Lankamo Ena Digesa, Mengistie Diress, Milad Dodangeh, Deepa Dongarwar, Fariba Dorostkar, Haneil Larson Dsouza, Bereket Duko, Bruce B Duncan, Kristina Edvardsson, Michael Ekholuenetale, Frank J Elgar, Muhammed Elhadi, Mohamed A Elmonem, Aman Yesuf Endries, Sharareh Eskandarieh, Azin Etemadimanesh, Adeniyi Francis Fagbamigbe, Ildar Ravisovich Fakhradiyev, Fatemeh Farahmand, Carla Sofia e Sá Farinha, Andre Faro, Farshad Farzadfar, Ali Fatehizadeh, Nelsensius Klau Fauk, Valery L Feigin, Rachel Feldman, Xiaoqi Feng, Zinabu Fentaw, Simone Ferrero, Lorenzo Ferro Desideri, Irina Filip, Florian Fischer, Joel Msafiri Francis, Richard Charles Franklin, Peter Andras Gaal, Mohamed M Gad, Silvano Gallus, Fabio Galvano, Balasankar Ganesan, Tushar Garg, Mesfin Gebrehiwot Damtew Gebrehiwot, Teferi Gebru Gebremeskel, Mathewos Alemu Gebremichael, Tadele Regasa Gemechu, Lemma Getacher, Motuma Erena Getachew, Abera Getachew Obsa, Asmare Getie, Amir Ghaderi, Mansour Ghafourifard, Alireza Ghajar, Seyyed-Hadi Ghamari, Lilian A Ghandour, Mohammad Ghasemi Nour, Ahmad Ghashghaee, Sherief Ghozy, Franklin N Glozah, Ekaterina Vladimirovna Glushkova, Justyna Godos, Amit Goel, Salime Goharinezhad, Mahaveer Golechha, Pouya Goleij, Mohamad Golitaleb, Felix Greaves, Michal Grivna, Giuseppe Grosso, Temesgen Worku Gudayu, Bhawna Gupta, Rajeev Gupta, Sapna Gupta, Veer Bala Gupta, Vivek Kumar Gupta, Nima Hafezi-Nejad, Arvin Haj-Mirzaian, Brian J Hall, Rabih Halwani, Tiilahun Beyene Handiso, Graeme J Hankey, Sanam Hariri, Josep Maria Haro, Ahmed I Hasaballah, Hossein Hassanian-Moghaddam, Simon I Hay, Khezar Hayat, Golnaz Heidari, Mohammad Heidari, Delia Hendrie, Claudiu Herteliu, Demisu Zenbaba Heyi, Kamal Hezam, Mbuzeleni Mbuzeleni Hlongwa, Ramesh Holla, Md Mahbub Hossain, Sahadat Hossain, Seyed Kianoosh Hosseini, Mehdi hosseinzadeh, Mihaela Hostiuc, Sorin Hostiuc, Guoqing Hu, Junjie Huang, Salman Hussain, Segun Emmanuel Ibitoye, Irena M Ilic, Milena D Ilic, Mustapha Immurana, Lalu Muhammad Irham, M Mofizul Islam, Rakibul M Islam, Sheikh Mohammed Shariful Islam, Hiroyasu Iso, Ramaiah Itumalla, Masao Iwagami, Roxana Jabbarinejad, Louis Jacob, Mihajlo Jakovljevic, Zahra Jamalpoor, Elham Jamshidi, Sathish Kumar Jayapal, Umesh Umesh Jayarajah, Ranil Jayawardena, Rime Jebai, Seyed Ali Jeddi, Alelign Tasew Jema, Ravi Prakash Jha, Har Ashish Jindal, Jost B Jonas, Tamas Joo, Nitin Joseph, Farahnaz Joukar, Jacek Jerzy Jozwiak, Mikk Jürisson, Ali Kabir, Robel Hussen Kabthymer, Bhushan Dattatray Kamble, Himal Kandel, Girum Gebremeskel Kanno, Neeti Kapoor, Ibraheem M Karaye, Salah Eddin Karimi, Bekalu Getnet Kassa, Rimple Jeet Kaur, Gbenga A Kayode, Mohammad Keykhaei, Himanshu Khajuria, Rovshan Khalilov, Imteyaz A Khan, Moien AB Khan, Hanna Kim, Jihee Kim, Min Seo Kim, Ruth W Kimokoti, Mika Kivimäki, Vitalii Klymchuk, Ann Kristin Skrindo Knudsen, Ali-Asghar Kolahi, Vladimir Andreevich Korshunov, Ai Koyanagi, Kewal Krishan, Yuvaraj Krishnamoorthy, G Anil Kumar, Narinder Kumar, Nithin Kumar, Ben Lacey, Tea Lallukka, Savita Lasrado, Jerrald Lau, Sang-woong Lee, Wei-Chen Lee, Yo Han Lee, Lee-Ling Lim, Stephen S Lim, Stany W Lobo, Platon D Lopukhov, Stefan Lorkowski, Rafael Lozano, Giancarlo Lucchetti, Farzan Madadizadeh, Áurea M Madureira-Carvalho, Soleiman Mahjoub, Ata Mahmoodpoor, Rashidul Alam Mahumud, Alaa Makki, Mohammad-Reza Malekpour, Narayana Manjunatha, Borhan Mansouri, Mohammad Ali Mansournia, Jose Martinez-Raga, Francisco A Martinez-Villa, Richard Matzopoulos, Pallab K Maulik, Mahsa Mayeli, John J McGrath, Jitendra Kumar Meena, Entezar Mehrabi Nasab, Ritesh G Menezes, Gert B M Mensink, Alexios-Fotios A Mentis, Atte Meretoja, Bedasa Taye Merga, Tomislav Mestrovic, Junmei Miao Jonasson, Bartosz Miazgowski, Ana Carolina Micheletti Gomide Nogueira de Sá, Ted R Miller, GK Mini, Andreea Mirica, Antonio Mirijello, Seyyedmohammadsadeq Mirmoeeni, Erkin M Mirrakhimov, Sanjeev Misra, Babak Moazen, Maryam Mobarakabadi, Marcello Moccia, Yousef Mohammad, Esmaeil Mohammadi, Abdollah Mohammadian-Hafshejani, Teroj Abdulrahman Mohammed, Nagabhishek Moka, Ali H Mokdad, Sara Momtazmanesh, Yousef Moradi, Ebrahim Mostafavi, Sumaira Mubarik, Erin C Mullany, Beemnet Tekabe Mulugeta, Efrén Murillo-Zamora, Christopher J L Murray, Julius C Mwita, Mohsen Naghavi, Mukhammad David Naimzada, Vinay Nangia, Biswa Prakash Nayak, Ionut Negoi, Ruxandra Irina Negoi, Seyed Aria Nejadghaderi, Samata Nepal, Sudan Prasad Prasad Neupane, Sandhya Neupane Kandel, Yeshambel T Nigatu, Ali Nowroozi, Khan M Nuruzzaman, Chimezie Igwegbe Nzoputam, Kehinde O Obamiro, Felix Akpojene Ogbo, Ayodipupo Sikiru Oguntade, Hassan Okati-Aliabad, Babayemi Oluwaseun Olakunde, Gláucia Maria Moraes Oliveira, Ahmed Omar Bali, Emad Omer, Doris V Ortega-Altamirano, Adrian Otoiu, Stanislav S Otstavnov, Bilcha Oumer, Mahesh P A, Alicia Padron-Monedero, Raffaele Palladino, Adrian Pana, Songhomitra Panda-Jonas, Anamika Pandey, Ashok Pandey, Shahina Pardhan, Tarang Parekh, Eun-Kee Park, Charles D H Parry, Fatemeh Pashazadeh Kan, Jay Patel, Siddhartha Pati, George C Patton, Uttam Paudel, Shrikant Pawar, Amy E Peden, Ionela-Roxana Petcu, Michael R Phillips, Marina Pinheiro, Evgenii Plotnikov, Pranil Man Singh Pradhan, Akila Prashant, Jianchao Quan, Amir Radfar, Alireza Rafiei, Pankaja Raghav Raghav, Vafa Rahimi-Movaghar, Azizur Rahman, Md Mosfequr Rahman, Mosiur Rahman, Amir Masoud Rahmani, Shayan Rahmani, Chhabi Lal Ranabhat, Priyanga Ranasinghe, Chythra R Rao, Drona Prakash Rasali, Mohammad-Mahdi Rashidi, Zubair Ahmed Ratan, David Laith Rawaf, Salman Rawaf, Lal Rawal, Andre M N Renzaho, Negar Rezaei, Saeid Rezaei, Mohsen Rezaeian, Seyed Mohammad Riahi, Esperanza Romero-Rodríguez, Gregory A Roth, Godfrey M Rwegerera, Basema Saddik, Erfan Sadeghi, Reihaneh Sadeghian, Umar Saeed, Farhad Saeedi, Rajesh Sagar, Amirhossein Sahebkar, Harihar Sahoo, Mohammad Ali Sahraian, KM Saif-Ur-Rahman, Sarvenaz Salahi, Hamideh Salimzadeh, Abdallah M Samy, Francesco Sanmarchi, Milena M Santric-Milicevic, Yaser Sarikhani, Brijesh Sathian, Ganesh Kumar Saya, Mehdi Sayyah, Maria Inês Schmidt, Aletta Elisabeth Schutte, Michaël Schwarzinger, David C Schwebel, Abdul-Aziz Seidu, Nachimuthu Senthil Kumar, SeyedAhmad SeyedAlinaghi, Allen Seylani, Feng Sha, Sarvenaz Shahin, Fariba Shahraki-Sanavi, Shayan Shahrokhi, Masood Ali Shaikh, Elaheh Shaker, Murad Ziyaudinovich Shakhmardanov, Mehran Shams-Beyranvand, Sara Sheikhbahaei, Rahim Ali Sheikhi, Adithi Shetty, Jeevan K Shetty, Damtew Solomon Shiferaw, Mika Shigematsu, Rahman Shiri, Reza Shirkoohi, K M Shivakumar, Velizar Shivarov, Parnian Shobeiri, Roman Shrestha, Negussie Boti Sidemo, Inga Dora Sigfusdottir, Diego Augusto Santos Silva, Natacha Torres da Silva, Jasvinder A Singh, Surjit Singh, Valentin Yurievich Skryabin, Anna Aleksandrovna Skryabina, David A Sleet, Marco Solmi, YONATAN SOLOMON, Suhang Song, Yimeng Song, Reed J D Sorensen, Sergey Soshnikov, Ireneous N Soyiri, Dan J Stein, Sonu Hangma Subba, Miklós Szócska, Rafael Tabarés-Seisdedos, Takahiro Tabuchi, Majid Taheri, Ker-Kan Tan, Minale Tareke, Elvis Enowbeyang Tarkang, Gebremaryam Temesgen, Worku Animaw Temesgen, Mohamad-Hani Temsah, Kavumpurathu Raman Thankappan, Rekha Thapar, Nikhil Kenny Thomas, Chalachew Tiruneh, Jovana Todorovic, Marco Torrado, Mathilde Touvier, Marcos Roberto Tovani-Palone, Mai Thi Ngoc Tran, Sergi Trias-Llimós, Jaya Prasad Tripathy, Alireza Vakilian, Rohollah Valizadeh, Mehdi Varmaghani, Shoban Babu Varthya, Tommi Juhani Vasankari, Theo Vos, Birhanu Wagaye, Yasir Waheed, Mandaras Tariku Walde, Cong Wang, Yanzhong Wang, Yuan-Pang Wang, Ronny Westerman, Nuwan Darshana Wickramasinghe, Abate Dargie Wubetu, Suowen Xu, Kazumasa Yamagishi, Lin Yang, Gesila Endashaw E Yesera, Arzu Yigit, Vahit Yiğit, Ayenew Engida Ayenew Engida Yimaw, Dong Keon Yon, Naohiro Yonemoto, Chuanhua Yu, Siddhesh Zadey, Mazyar Zahir, Iman Zare, Mikhail Sergeevich Zastrozhin, Anasthasia Zastrozhina, Zhi-Jiang Zhang, Chenwen Zhong, Mohammad Zmaili, Yves Miel H Zuniga, Emmanuela Gakidou, University of St Andrews. School of Medicine, University of St Andrews. Population and Behavioural Science Division, Department of Public Health, University of Helsinki, Hjelt Institute (-2014), Helsinki Inequality Initiative (INEQ), Clinicum, Helsinki University Hospital Area, Bill & Melinda Gates Foundation, King Edward Medical University (Pakistán), Alexander von Humboldt Foundation, University of Oxford (Reino Unido), Medical Research Council (Reino Unido), NIH - National Institute of Mental Health (NIMH) (Estados Unidos), Canada Research Chairs, National Health and Medical Research Council (Australia), National Heart Foundation of Australia, Ministry of Education, Science and Technological Development (Serbia), Wellcome Trust, NIH - National Institute on Aging (NIA) (Estados Unidos), Finlands Akademi (Finlandia), Panjab University (India), Federal Ministry of Education & Research (Alemania), National Council for Scientific and Technological Development (Brasil), Danish National Research Foundation, Queensland Centre for Mental Health Research (Australia), South African Medical Research Council, National Natural Science Foundation of China, Charles Sturt University (Australia), Ain Shams University (Egipto), Mizoram University (India), Kasturba Medical College (India), Manipal Academy of Higher Education (India), Coordenação de Aperfeicoamento de Pessoal de Nível Superior (Brasil), Ministerio de Ciencia e Innovación (España), Collaborators, GBD 2020 Alcohol, Bryazka, Dana, Reitsma, Marissa B, Griswold, Max G, Abate, Kalkidan Hassen, Abbafati, Cristiana, Abbasi-Kangevari, Mohsen, Abbasi-Kangevari, Zeinab, Abdoli, Amir, Abdollahi, Mohammad, Abdullah, Abu Yousuf Md, Abhilash, E S, Abu-Gharbieh, Eman, Acuna, Juan Manuel, Addolorato, Giovanni, Adebayo, Oladimeji M, Adekanmbi, Victor, Adhikari, Kishor, Adhikari, Sangeet, Adnani, Qorinah Estiningtyas Sakilah, Afzal, Saira, Agegnehu, Wubetu Yimam, Aggarwal, Manik, Ahinkorah, Bright Opoku, Ahmad, Araz Ramazan, Ahmad, Sajjad, Ahmad, Tauseef, Ahmadi, Ali, Ahmadi, Sepideh, Ahmed, Haroon, Ahmed Rashid, Tarik, Akunna, Chisom Joyqueenet, Al Hamad, Hanadi, Alam, Md Zakiul, Alem, Dejene Tsegaye, Alene, Kefyalew Addi, Alimohamadi, Yousef, Alizadeh, Atiyeh, Allel, Kasim, Alonso, Jordi, Alvand, Saba, Alvis-Guzman, Nelson, Amare, Firehiwot, Ameyaw, Edward Kwabena, Amiri, Sohrab, Ancuceanu, Robert, Anderson, Jason A, Andrei, Catalina Liliana, Andrei, Tudorel, Arabloo, Jalal, Arshad, Muhammad, Artamonov, Anton A, Aryan, Zahra, Asaad, Malke, Asemahagn, Mulusew A, Astell-Burt, Thoma, Athari, Seyyed Shamsadin, Atnafu, Desta Debalkie, Atorkey, Prince, Atreya, Alok, Ausloos, Floriane, Ausloos, Marcel, Ayano, Getinet, Ayanore, Martin Amogre ayanore, Ayinde, Olatunde O, Ayuso-Mateos, Jose L, Azadnajafabad, Sina, Azanaw, Melkalem Mamuye, Azangou-Khyavy, Mohammadreza, Azari Jafari, Amirhossein, Azzam, Ahmed Y, Badiye, Ashish D, Bagheri, Nasser, Bagherieh, Sara, Bairwa, Mohan, Bakkannavar, Shankar M, Bakshi, Ravleen Kaur, Balchut/bilchut, Awraris Hailu, Bärnighausen, Till Winfried, Barra, Fabio, Barrow, Amadou, Baskaran, Pritish, Belo, Lui, Bennett, Derrick A, Benseñor, Isabela M, Bhagavathula, Akshaya Srikanth, Bhala, Neeraj, Bhalla, Ashish, Bhardwaj, Nikha, Bhardwaj, Pankaj, Bhaskar, Sonu, Bhattacharyya, Krittika, Bhojaraja, Vijayalakshmi S, Bintoro, Bagas Suryo, Blokhina, Elena A Elena, Bodicha, Belay Boda Abule, Boloor, Archith, Bosetti, Cristina, Braithwaite, Dejana, Brenner, Hermann, Briko, Nikolay Ivanovich, Brunoni, Andre R, Butt, Zahid A, Cao, Chao, Cao, Yin, Cárdenas, Rosario, Carvalho, Andre F, Carvalho, Márcia, Castaldelli-Maia, Joao Mauricio, Castelpietra, Giulio, Castro-de-Araujo, Luis F S, Cattaruzza, Maria Sofia, Chakraborty, Promit Ananyo, Charan, Jaykaran, Chattu, Vijay Kumar, Chaurasia, Akhilanand, Cherbuin, Nicola, Chu, Dinh-Toi, Chudal, Nandita, Chung, Sheng-Chia, Churko, Chuchu, Ciobanu, Liliana G, Cirillo, Massimo, Claro, Rafael M, Costanzo, Simona, Cowden, Richard G, Criqui, Michael H, Cruz-Martins, Natália, Culbreth, Garland T, Dachew, Berihun Assefa, Dadras, Omid, Dai, Xiaochen, Damiani, Giovanni, Dandona, Lalit, Dandona, Rakhi, Daniel, Beniam Darge, Danielewicz, Anna, Darega Gela, Jiregna, Davletov, Kairat, de Araujo, Jacyra Azevedo Paiva, de Sá-Junior, Antonio Rei, Debela, Sisay Abebe, Dehghan, Azizallah, Demetriades, Andreas K, Derbew Molla, Meseret, Desai, Rupak, Desta, Abebaw Alemayehu, Dias da Silva, Diana, Diaz, Daniel, Digesa, Lankamo Ena, Diress, Mengistie, Dodangeh, Milad, Dongarwar, Deepa, Dorostkar, Fariba, Dsouza, Haneil Larson, Duko, Bereket, Duncan, Bruce B, Edvardsson, Kristina, Ekholuenetale, Michael, Elgar, Frank J, Elhadi, Muhammed, Elmonem, Mohamed A, Endries, Aman Yesuf, Eskandarieh, Sharareh, Etemadimanesh, Azin, Fagbamigbe, Adeniyi Franci, Fakhradiyev, Ildar Ravisovich, Farahmand, Fatemeh, Farinha, Carla Sofia e Sá, Faro, Andre, Farzadfar, Farshad, Fatehizadeh, Ali, Fauk, Nelsensius Klau, Feigin, Valery L, Feldman, Rachel, Feng, Xiaoqi, Fentaw, Zinabu, Ferrero, Simone, Ferro Desideri, Lorenzo, Filip, Irina, Fischer, Florian, Francis, Joel Msafiri, Franklin, Richard Charle, Gaal, Peter Andra, Gad, Mohamed M, Gallus, Silvano, Galvano, Fabio, Ganesan, Balasankar, Garg, Tushar, Gebrehiwot, Mesfin Gebrehiwot Damtew, Gebremeskel, Teferi Gebru, Gebremichael, Mathewos Alemu, Gemechu, Tadele Regasa, Getacher, Lemma, Getachew, Motuma Erena, Getachew Obsa, Abera, Getie, Asmare, Ghaderi, Amir, Ghafourifard, Mansour, Ghajar, Alireza, Ghamari, Seyyed-Hadi, Ghandour, Lilian A, Ghasemi Nour, Mohammad, Ghashghaee, Ahmad, Ghozy, Sherief, Glozah, Franklin N, Glushkova, Ekaterina Vladimirovna, Godos, Justyna, Goel, Amit, Goharinezhad, Salime, Golechha, Mahaveer, Goleij, Pouya, Golitaleb, Mohamad, Greaves, Felix, Grivna, Michal, Grosso, Giuseppe, Gudayu, Temesgen Worku, Gupta, Bhawna, Gupta, Rajeev, Gupta, Sapna, Gupta, Veer Bala, Gupta, Vivek Kumar, Hafezi-Nejad, Nima, Haj-Mirzaian, Arvin, Hall, Brian J, Halwani, Rabih, Handiso, Tiilahun Beyene, Hankey, Graeme J, Hariri, Sanam, Haro, Josep Maria, Hasaballah, Ahmed I, Hassanian-Moghaddam, Hossein, Hay, Simon I, Hayat, Khezar, Heidari, Golnaz, Heidari, Mohammad, Hendrie, Delia, Herteliu, Claudiu, Heyi, Demisu Zenbaba, Hezam, Kamal, Hlongwa, Mbuzeleni Mbuzeleni, Holla, Ramesh, Hossain, Md Mahbub, Hossain, Sahadat, Hosseini, Seyed Kianoosh, Hosseinzadeh, Mehdi, Hostiuc, Mihaela, Hostiuc, Sorin, Hu, Guoqing, Huang, Junjie, Hussain, Salman, Ibitoye, Segun Emmanuel, Ilic, Irena M, Ilic, Milena D, Immurana, Mustapha, Irham, Lalu Muhammad, Islam, M Mofizul, Islam, Rakibul M, Islam, Sheikh Mohammed Shariful, Iso, Hiroyasu, Itumalla, Ramaiah, Iwagami, Masao, Jabbarinejad, Roxana, Jacob, Loui, Jakovljevic, Mihajlo, Jamalpoor, Zahra, Jamshidi, Elham, Jayapal, Sathish Kumar, Jayarajah, Umesh Umesh, Jayawardena, Ranil, Jebai, Rime, Jeddi, Seyed Ali, Jema, Alelign Tasew, Jha, Ravi Prakash, Jindal, Har Ashish, Jonas, Jost B, Joo, Tama, Joseph, Nitin, Joukar, Farahnaz, Jozwiak, Jacek Jerzy, Jürisson, Mikk, Kabir, Ali, Kabthymer, Robel Hussen, Kamble, Bhushan Dattatray, Kandel, Himal, Kanno, Girum Gebremeskel, Kapoor, Neeti, Karaye, Ibraheem M, Karimi, Salah Eddin, Kassa, Bekalu Getnet, Kaur, Rimple Jeet, Kayode, Gbenga A, Keykhaei, Mohammad, Khajuria, Himanshu, Khalilov, Rovshan, Khan, Imteyaz A, Khan, Moien AB, Kim, Hanna, Kim, Jihee, Kim, Min Seo, Kimokoti, Ruth W, Kivimäki, Mika, Klymchuk, Vitalii, Knudsen, Ann Kristin Skrindo, Kolahi, Ali-Asghar, Korshunov, Vladimir Andreevich, Koyanagi, Ai, Krishan, Kewal, Krishnamoorthy, Yuvaraj, Kumar, G Anil, Kumar, Narinder, Kumar, Nithin, Lacey, Ben, Lallukka, Tea, Lasrado, Savita, Lau, Jerrald, Lee, Sang-woong, Lee, Wei-Chen, Lee, Yo Han, Lim, Lee-Ling, Lim, Stephen S, Lobo, Stany W, Lopukhov, Platon D, Lorkowski, Stefan, Lozano, Rafael, Lucchetti, Giancarlo, Madadizadeh, Farzan, Madureira-Carvalho, Áurea M, Mahjoub, Soleiman, Mahmoodpoor, Ata, Mahumud, Rashidul Alam, Makki, Alaa, Malekpour, Mohammad-Reza, Manjunatha, Narayana, Mansouri, Borhan, Mansournia, Mohammad Ali, Martinez-Raga, Jose, Martinez-Villa, Francisco A, Matzopoulos, Richard, Maulik, Pallab K, Mayeli, Mahsa, Mcgrath, John J, Meena, Jitendra Kumar, Mehrabi Nasab, Entezar, Menezes, Ritesh G, Mensink, Gert B M, Mentis, Alexios-Fotios A, Meretoja, Atte, Merga, Bedasa Taye, Mestrovic, Tomislav, Miao Jonasson, Junmei, Miazgowski, Bartosz, Micheletti Gomide Nogueira de Sá, Ana Carolina, Miller, Ted R, Mini, Gk, Mirica, Andreea, Mirijello, Antonio, Mirmoeeni, Seyyedmohammadsadeq, Mirrakhimov, Erkin M, Misra, Sanjeev, Moazen, Babak, Mobarakabadi, Maryam, Moccia, Marcello, Mohammad, Yousef, Mohammadi, Esmaeil, Mohammadian-Hafshejani, Abdollah, Mohammed, Teroj Abdulrahman, Moka, Nagabhishek, Mokdad, Ali H, Momtazmanesh, Sara, Moradi, Yousef, Mostafavi, Ebrahim, Mubarik, Sumaira, Mullany, Erin C, Mulugeta, Beemnet Tekabe, Murillo-Zamora, Efrén, Murray, Christopher J L, Mwita, Julius C, Naghavi, Mohsen, Naimzada, Mukhammad David, Nangia, Vinay, Nayak, Biswa Prakash, Negoi, Ionut, Negoi, Ruxandra Irina, Nejadghaderi, Seyed Aria, Nepal, Samata, Neupane, Sudan Prasad Prasad, Neupane Kandel, Sandhya, Nigatu, Yeshambel T, Nowroozi, Ali, Nuruzzaman, Khan M, Nzoputam, Chimezie Igwegbe, Obamiro, Kehinde O, Ogbo, Felix Akpojene, Oguntade, Ayodipupo Sikiru, Okati-Aliabad, Hassan, Olakunde, Babayemi Oluwaseun, Oliveira, Gláucia Maria Morae, Omar Bali, Ahmed, Omer, Emad, Ortega-Altamirano, Doris V, Otoiu, Adrian, Otstavnov, Stanislav S, Oumer, Bilcha, P A, Mahesh, Padron-Monedero, Alicia, Palladino, Raffaele, Pana, Adrian, Panda-Jonas, Songhomitra, Pandey, Anamika, Pandey, Ashok, Pardhan, Shahina, Parekh, Tarang, Park, Eun-Kee, Parry, Charles D H, Pashazadeh Kan, Fatemeh, Patel, Jay, Pati, Siddhartha, Patton, George C, Paudel, Uttam, Pawar, Shrikant, Peden, Amy E, Petcu, Ionela-Roxana, Phillips, Michael R, Pinheiro, Marina, Plotnikov, Evgenii, Pradhan, Pranil Man Singh, Prashant, Akila, Quan, Jianchao, Radfar, Amir, Rafiei, Alireza, Raghav, Pankaja Raghav, Rahimi-Movaghar, Vafa, Rahman, Azizur, Rahman, Md Mosfequr, Rahman, Mosiur, Rahmani, Amir Masoud, Rahmani, Shayan, Ranabhat, Chhabi Lal, Ranasinghe, Priyanga, Rao, Chythra R, Rasali, Drona Prakash, Rashidi, Mohammad-Mahdi, Ratan, Zubair Ahmed, Rawaf, David Laith, Rawaf, Salman, Rawal, Lal, Renzaho, Andre M N, Rezaei, Negar, Rezaei, Saeid, Rezaeian, Mohsen, Riahi, Seyed Mohammad, Romero-Rodríguez, Esperanza, Roth, Gregory A, Rwegerera, Godfrey M, Saddik, Basema, Sadeghi, Erfan, Sadeghian, Reihaneh, Saeed, Umar, Saeedi, Farhad, Sagar, Rajesh, Sahebkar, Amirhossein, Sahoo, Harihar, Sahraian, Mohammad Ali, Saif-Ur-Rahman, Km, Salahi, Sarvenaz, Salimzadeh, Hamideh, Samy, Abdallah M, Sanmarchi, Francesco, Santric-Milicevic, Milena M, Sarikhani, Yaser, Sathian, Brijesh, Saya, Ganesh Kumar, Sayyah, Mehdi, Schmidt, Maria Inê, Schutte, Aletta Elisabeth, Schwarzinger, Michaël, Schwebel, David C, Seidu, Abdul-Aziz, Senthil Kumar, Nachimuthu, Seyedalinaghi, Seyedahmad, Seylani, Allen, Sha, Feng, Shahin, Sarvenaz, Shahraki-Sanavi, Fariba, Shahrokhi, Shayan, Shaikh, Masood Ali, Shaker, Elaheh, Shakhmardanov, Murad Ziyaudinovich, Shams-Beyranvand, Mehran, Sheikhbahaei, Sara, Sheikhi, Rahim Ali, Shetty, Adithi, Shetty, Jeevan K, Shiferaw, Damtew Solomon, Shigematsu, Mika, Shiri, Rahman, Shirkoohi, Reza, Shivakumar, K M, Shivarov, Velizar, Shobeiri, Parnian, Shrestha, Roman, Sidemo, Negussie Boti, Sigfusdottir, Inga Dora, Silva, Diego Augusto Santo, Silva, Natacha Torres da, Singh, Jasvinder A, Singh, Surjit, Skryabin, Valentin Yurievich, Skryabina, Anna Aleksandrovna, Sleet, David A, Solmi, Marco, Solomon, Yonatan, Song, Suhang, Song, Yimeng, Sorensen, Reed J D, Soshnikov, Sergey, Soyiri, Ireneous N, Stein, Dan J, Subba, Sonu Hangma, Szócska, Mikló, Tabarés-Seisdedos, Rafael, Tabuchi, Takahiro, Taheri, Majid, Tan, Ker-Kan, Tareke, Minale, Tarkang, Elvis Enowbeyang, Temesgen, Gebremaryam, Temesgen, Worku Animaw, Temsah, Mohamad-Hani, Thankappan, Kavumpurathu Raman, Thapar, Rekha, Thomas, Nikhil Kenny, Tiruneh, Chalachew, Todorovic, Jovana, Torrado, Marco, Touvier, Mathilde, Tovani-Palone, Marcos Roberto, Tran, Mai Thi Ngoc, Trias-Llimós, Sergi, Tripathy, Jaya Prasad, Vakilian, Alireza, Valizadeh, Rohollah, Varmaghani, Mehdi, Varthya, Shoban Babu, Vasankari, Tommi Juhani, Vos, Theo, Wagaye, Birhanu, Waheed, Yasir, Walde, Mandaras Tariku, Wang, Cong, Wang, Yanzhong, Wang, Yuan-Pang, Westerman, Ronny, Wickramasinghe, Nuwan Darshana, Wubetu, Abate Dargie, Xu, Suowen, Yamagishi, Kazumasa, Yang, Lin, Yesera, Gesila Endashaw E, Yigit, Arzu, Yiğit, Vahit, Yimaw, Ayenew Engida Ayenew Engida, Yon, Dong Keon, Yonemoto, Naohiro, Yu, Chuanhua, Zadey, Siddhesh, Zahir, Mazyar, Zare, Iman, Zastrozhin, Mikhail Sergeevich, Zastrozhina, Anasthasia, Zhang, Zhi-Jiang, Zhong, Chenwen, Zmaili, Mohammad, Zuniga, Yves Miel H, Gakidou, Emmanuela, Bryazka, D, Reitsma, Mb, Griswold, Mg, Abate, Kh, Abbafati, C, Kangevari, Ma, Kangevari, Za, Abdoli, A, Abdollahi, M, Abdullah, Am, Abhilash, E, Abu Gharbieh, E, Acuna, Jm, Addolorato, G, Adebayo, Om, Adekanmbi, V, Adhikari, K, Adhikari, S, Adnani, Qe, Afzal, S, Agegnehu, Wy, Aggarwal, M, Ahinkorah, Bo, Ahmad, Ar, Ahmad, S, Ahmad, T, Ahmadi, A, Ahmadi, S, Ahmed, H, Rashid, Ta, Akunna, Cj, Al Hamad, H, Alam, Mz, Alem, Dt, Alene, Ka, Alimohamadi, Y, Alizadeh, A, Allel, K, Alonso, J, Alvand, S, Guzman, Na, Amare, F, Ameyaw, Ek, Amiri, S, Ancuceanu, R, Anderson, Ja, Andrei, Cl, Andrei, T, Arabloo, J, Arshad, M, Artamonov, Aa, Aryan, Z, Asaad, M, Asemahagn, Ma, Burt, Ta, Athari, S, Atnafu, Dd, Atorkey, P, Atreya, A, Ausloos, F, Ausloos, M, Ayano, G, Ayanore, Ma, Ayinde, Oo, Mateos, Jla, Azadnajafabad, S, Azanaw, Mm, Khyavy, Ma, Jafari, Aa, Azzam, Ay, Badiye, Ad, Bagheri, N, Bagherieh, S, Bairwa, M, Bakkannavar, Sm, Bakshi, Rk, Balchut, Ah, Null, T, Barra, F, Barrow, A, Baskaran, P, Belo, L, Bennett, Da, Bensenor, Im, Bhagavathula, A, Bhala, N, Bhalla, A, Bhardwaj, N, Bhardwaj, P, Bhaskar, S, Bhattacharyya, K, Bhojaraja, V, Bintoro, B, Blokhina, Eae, Bodicha, Bba, Boloor, A, Bosetti, C, Braithwaite, D, Brenner, H, Briko, Ni, Brunoni, Ar, Butt, Za, Cao, C, Cao, Y, Cardenas, R, Carvalho, Af, Carvalho, M, Maia, Jmc, Castelpietra, G, de Araujo, Lfsc, Cattaruzza, M, Chakraborty, Pa, Charan, J, Chattu, Vk, Chaurasia, A, Cherbuin, N, Chu, Dt, Chudal, N, Chung, Sc, Churko, C, Ciobanu, Lg, Cirillo, M, Claro, Rm, Costanzo, S, Cowden, Rg, Criqui, Mh, Martins, Nc, Culbreth, Gt, Dachew, Ba, Dadras, O, Dai, Xc, Damiani, G, Dandona, L, Dandona, R, Daniel, Bd, Danielewicz, A, Gela, Jd, Davletov, K, de Araujo, Jap, de Sa, Ar, Debela, Sa, Dehghan, A, Demetriades, Ak, Molla, Md, Desai, R, Desta, Aa, da Silva, Dd, Diaz, D, Digesa, Le, Diress, M, Dodangeh, M, Dongarwar, D, Dorostkar, F, Dsouza, Hl, Duko, B, Duncan, Bb, Edvardsson, K, Ekholuenetale, M, Elgar, Fj, Elhadi, M, Elmonem, Ma, Endries, Ay, Eskandarieh, S, Etemadimanesh, A, Fagbamigbe, Af, Fakhradiyev, Ir, Farahmand, F, Farinha, Cse, Faro, A, Farzadfar, F, Fatehizadeh, A, Fauk, Nk, Feigin, Vl, Feldman, R, Feng, Xq, Fentaw, Z, Ferrero, S, Desideri, Lf, Filip, I, Fischer, F, Francis, Jm, Franklin, Rc, Gaal, Pa, Gad, Mm, Gallus, S, Galvano, F, Ganesan, B, Garg, T, Gebrehiwot, Mgd, Gebremeskel, Tg, Gebremichael, Ma, Gemechu, Tr, Getacher, L, Getachew, Me, Obsa, Ag, Getie, A, Ghaderi, A, Ghafourifard, M, Ghajar, A, Ghamari, Sh, Ghandour, La, Nour, Mg, Ghashghaee, A, Ghozy, S, Glozah, Fn, Glushkova, Ev, Godos, J, Goel, A, Goharinezhad, S, Golechha, M, Goleij, P, Golitaleb, M, Greaves, F, Grivna, M, Grosso, G, Gudayu, Tw, Gupta, B, Gupta, R, Gupta, S, Gupta, Vb, Gupta, Vk, Nejad, Nh, Mirzaian, Ah, Hall, Bj, Halwani, R, Handiso, Tb, Hankey, Gj, Hariri, S, Haro, Jm, Hasaballah, Ai, Moghaddam, Hh, Hay, Si, Hayat, K, Heidari, G, Heidari, M, Hendrie, D, Herteliu, C, Heyi, Dz, Hezam, K, Hlongwa, Mm, Holla, R, Hossain, Mm, Hossain, S, Hosseini, Sk, Hosseinzadeh, M, Hostiuc, M, Hostiuc, S, Hu, Gq, Huang, Jj, Hussain, S, Ibitoye, Se, Ilic, Im, Ilic, Md, Immurana, M, Irham, Lm, Islam, Mm, Islam, Rm, Islam, Sm, Iso, H, Itumalla, R, Iwagami, M, Jabbarinejad, R, Jacob, L, Jakovljevic, M, Jamalpoor, Z, Jamshidi, E, Jayapal, Sk, Jayarajah, Uu, Jayawardena, R, Jebai, R, Jeddi, Sa, Jema, At, Jha, Rp, Jindal, Ha, Jonas, Jb, Joo, T, Joseph, N, Joukar, F, Jozwiak, Jj, Jurisson, M, Kabir, A, Kabthymer, Rh, Kamble, Bd, Kandel, H, Kanno, Gg, Kapoor, N, Karaye, Im, Karimi, Se, Kassa, Bg, Kaur, Rj, Kayode, Ga, Keykhaei, M, Khajuria, H, Khalilov, R, Khan, Ia, Ab Khan, M, Kim, H, Kim, J, Kim, M, Kimokoti, Rw, Kivimaki, M, Klymchuk, V, Knudsen, Ak, Kolahi, Aa, Korshunov, Va, Koyanagi, A, Krishan, K, Krishnamoorthy, Y, Kumar, Ga, Kumar, N, Ben, Lacey, Lallukka, T, Lasrado, S, Lau, J, Lee, Sw, Lee, Wc, Lee, Yh, Lim, Ll, Lim, S, Lobo, Sw, Lopukhov, Pd, Lorkowski, S, Lozano, R, Lucchetti, G, Madadizadeh, F, Mahjoub, S, Mahmoodpoor, A, Mahumud, Ra, Makki, A, Malekpour, Mr, Manjunatha, N, Mansouri, B, Mansournia, Ma, Raga, Jm, Villa, Fam, Matzopoulos, R, Maulik, Pk, Mayeli, M, Mcgrath, Jj, Meena, Jk, Nasab, Em, Menezes, Rg, Mensink, Gbm, Mentis, Afa, Meretoja, A, Merga, Bt, Mestrovic, T, Jonasson, Jm, Miazgowski, B, de Sa, Acmgn, Miller, Tr, Mini, G, Mirica, A, Mirijello, A, Mirmoeeni, S, Mirrakhimov, Em, Misra, S, Moazen, B, Mobarakabadi, M, Moccia, M, Mohammad, Y, Mohammadi, E, Hafshejani, Am, Mohammed, Ta, Moka, N, Mokdad, Ah, Momtazmanesh, S, Moradi, Y, Mostafavi, E, Mubarik, S, Mullany, Ec, Mulugeta, Bt, Zamora, Em, Murray, Cjl, Mwita, Jc, Naghavi, M, Naimzada, Md, Nangia, V, Nayak, Bp, Negoi, I, Negoi, Ri, Nejadghaderi, Sa, Nepal, S, Neupane, Spp, Kandel, Sn, Nigatu, Yt, Nowroozi, A, Nuruzzaman, Km, Nzoputam, Ci, Obamiro, Ko, Ogbo, Fa, Oguntade, A, Aliabad, Ho, Olakunde, Bo, Oliveira, Gmm, Bali, Ao, Omer, E, Altamirano, Dvo, Otoiu, A, Otstavnov, S, Oumer, B, Mahesh, Pa, Monedero, Ap, Palladino, R, Pana, A, Jonas, Sp, Pandey, A, Pardhan, S, Parekh, T, Park, Ek, Parry, Cdh, Kan, Fp, Patel, J, Pati, S, Patton, Gc, Paudel, U, Pawar, S, Peden, Ae, Petcu, Ir, Phillips, Mr, Pinheiro, M, Plotnikov, E, Pradhan, Pm, Prashant, A, Quan, Jc, Radfar, A, Rafiei, A, Raghav, Pr, Movaghar, Vr, Rahman, A, Rahman, Mm, Rahman, M, Rahmani, Am, Rahmani, S, Ranabhat, Cl, Ranasinghe, P, Rao, Cr, Rasali, Dp, Rashidi, Mm, Ratan, Za, Rawaf, Dl, Rawaf, S, Rawal, L, Renzaho, Amn, Rezaei, N, Rezaei, S, Rezaeian, M, Riahi, Sm, Rodriguez, Er, Roth, Ga, Rwegerera, Gm, Saddik, B, Sadeghi, E, Sadeghian, R, Saeed, U, Saeedi, F, Sagar, R, Sahebkar, A, Sahoo, H, Sahraian, Ma, Rahman, Ksu, Salahi, S, Salimzadeh, H, Samy, Am, Sanmarchi, F, Milicevic, Mm, Sarikhani, Y, Sathian, B, Saya, Gk, Sayyah, M, Schmidt, Mi, Schutte, Ae, Schwarzinger, M, Schwebel, Dc, Seidu, Aa, Seyedalinaghi, S, Seylani, A, Sha, F, Shahin, S, Sanavi, F, Shahrokhi, S, Shaikh, Ma, Shaker, E, Shakhmardanov, Mz, Beyranvand, M, Sheikhbahaei, S, Sheikhi, Ra, Shetty, A, Shetty, Jk, Shiferaw, D, Shigematsu, M, Shiri, R, Shirkoohi, R, Shivakumar, Km, Shivarov, V, Shobeiri, P, Shrestha, R, Sidemo, Nb, Sigfusdottir, Id, Silva, Da, da Silva, Nt, Singh, Ja, Singh, S, Skryabin, Vy, Skryabina, Aa, Sleet, Da, Solmi, M, Solomon, Y, Song, S, Song, Ym, Sorensen, Rjd, Soshnikov, S, Soyiri, In, Stein, Dj, Subba, Sh, Szocska, M, Seisdedos, Rt, Tabuchi, T, Taheri, M, Tan, Kk, Tareke, M, Tarkang, Ee, Temesgen, G, Temesgen, Wa, Temsah, Mh, Thankappan, Kr, Thapar, R, Thomas, Nk, Tiruneh, C, Todorovic, J, Torrado, M, Touvier, M, Palone, Mrt, Tran, Mtn, Llimos, St, Tripathy, Jp, Vakilian, A, Valizadeh, R, Varmaghani, M, Varthya, Sb, Vasankari, Tj, Vos, T, Wagaye, B, Waheed, Y, Walde, Mt, Wang, C, Wang, Yz, Wang, Yp, Westerman, R, Wickramasinghe, Nd, Wubetu, Ad, Xu, S, Yamagishi, K, Yang, L, Yesera, Gee, Yigit, A, Yimaw, Ae, Yon, Dk, Yonemoto, N, Yu, Ch, Zadey, S, Zahir, M, Zare, I, Zastrozhin, M, Zastrozhina, A, Zhang, Zj, Zhong, Cw, Zmaili, M, Zuniga, Ymh, Gakidou, E, Madureira-Carvalho, Am, Ciobanu, LG, Gakidou, Emma, and GBD 2020 Alcohol Collaborators
Subjects: Adult, Male, Alcohol Drinking, CONTROL POLICIES, adult, Child, Preschool, Female, Geography, Global Burden of Disease, Global Health, Humans, Middle Aged, Quality-Adjusted Life Years, Risk Factors, NDAS, ALL-CAUSE, GUIDELINES, GBD 2020 Alcohol Collaborators, COST-EFFECTIVENESS, Medicine, General & Internal, DRINKING, SDG 3 - Good Health and Well-being, RA0421, General & Internal Medicine, Quality-Adjusted Life Year, RA0421 Public health. Hygiene. Preventive Medicine, DRINKERS, Child, Preschool, 11 Medical and Health Sciences, METAANALYSIS, MCC, Science & Technology, global burden of disease, Risk Factor, General Medicine, CANCER, alcohol drinking, AC, 3121 General medicine, internal medicine and other clinical medicine, REDUCED MORTALITY, Life Sciences & Biomedicine, Human
Abstract: Background: The health risks associated with moderate alcohol consumption continue to be debated. Small amounts of alcohol might lower the risk of some health outcomes but increase the risk of others, suggesting that the overall risk depends, in part, on background disease rates, which vary by region, age, sex, and year. Methods: For this analysis, we constructed burden-weighted dose-response relative risk curves across 22 health outcomes to estimate the theoretical minimum risk exposure level (TMREL) and non-drinker equivalence (NDE), the consumption level at which the health risk is equivalent to that of a non-drinker, using disease rates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2020 for 21 regions, including 204 countries and territories, by 5-year age group, sex, and year for individuals aged 15-95 years and older from 1990 to 2020. Based on the NDE, we quantified the population consuming harmful amounts of alcohol. Findings: The burden-weighted relative risk curves for alcohol use varied by region and age. Among individuals aged 15-39 years in 2020, the TMREL varied between 0 (95% uncertainty interval 0-0) and 0·603 (0·400-1·00) standard drinks per day, and the NDE varied between 0·002 (0-0) and 1·75 (0·698-4·30) standard drinks per day. Among individuals aged 40 years and older, the burden-weighted relative risk curve was J-shaped for all regions, with a 2020 TMREL that ranged from 0·114 (0-0·403) to 1·87 (0·500-3·30) standard drinks per day and an NDE that ranged between 0·193 (0-0·900) and 6·94 (3·40-8·30) standard drinks per day. Among individuals consuming harmful amounts of alcohol in 2020, 59·1% (54·3-65·4) were aged 15-39 years and 76·9% (73·0-81·3) were male. Interpretation: There is strong evidence to support recommendations on alcohol consumption varying by age and location. Stronger interventions, particularly those tailored towards younger individuals, are needed to reduce the substantial global health loss attributable to alcohol. Research reported in this publication was supported by the Bill & Melinda Gates Foundation. S Afzal acknowledges the support for intellectual contributions to this manuscript by the Department of Community Medicine and Epidemiology at King Edward Medical University, Lahore, Pakistan. T Bärnighausen was supported by the Alexander von Humboldt Foundation through the Alexander von Humboldt Professor award, funded by the German Federal Ministry of Education and Research. L Belo acknowledges 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. D Bennett is supported by the UK Medical Research Council Population Health Research Unit at the University of Oxford (Oxford, UK). M Carvalho acknowledges 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. L Castro-de-Araujo was funded by the Medical Research Council (UK), Grant no. MR/T03355X/1 and by the National Institute of Mental Health Grant no. R01MH128911. FJ Elgar is supported by the Canada Research Chairs program. F Greaves acknowledges support from the NIHR Applied Research Collaboration for NW London. V K Gupta acknowledges funding support from the National Health and Medical Research Council (NHMRC), Australia. VB Gupta acknowledges funding support from the National Health and Medical Research Council (NHMRC), Australia. C Herteliu is partially supported by a grant from the Romanian National Authority for Scientific Research and Innovation, CNDS-UEFISCDI, project number PN-III-P4-ID-PCCF-2016-0084. C Herteliu is partially supported by a grant from the Romanian Ministry of Research Innovation and Digitalization, MCID, project number ID-585-CTR-42-PFE-2021. S Hussain was supported by the Operational Programme Research, Development and Education –Project, Postdoc2MUNI “(No. CZ.02.2.69/0.0/0.0/18_053/0016952). S M S Islam is funded by the National Health and Medical Research Council and received funding from the National Heart Foundation of Australia. The Serbian part of this GBD-related contribution has been co-financed through Grant OI 175 014 of the Ministry of Education Science and Technological Development of the Republic of Serbia. M Kivimaki was supported by the Wellcome Trust (221854/Z/20/Z), the UK Medical Research Council (MR/S011676/1), the US National Institute on Aging (R01AG056477), and the Academy of Finland (350426). K Krishan is supported by the UGC Centre of Advanced Study (Phase II), awarded to the Department of Anthropology, Panjab University, Chandigarh, India. B Lacey acknowledges support from the UK Biobank, funded largely by the UK Medical Research Council and Wellcome. S Lorkowski acknowledges institutional support from the Competence Cluster for Nutrition and Cardiovascular Health (nutriCARD) Halle-Jena-Leipzig (Germany; German Federal Ministry of Education and Research; grant agreement number 01EA1808A). G Lucchetti received a productivity scholarship from the Brazilian National Council for Scientific and Technological Development — CNPq (Level 1D). J McGrath was supported by the Danish National Research Foundation (Niels Bohr Professor). J McGrath is employed by the Queensland Centre for Mental Health Research (Australia), which receives support from the Queensland Health Department. C Parry acknowleges the South African Medical Research Council. A Peden is supported by a National Health and Medical Research Council Emerging Leadership Fellowship (Grant ID: APP2009306). M R Phillips was supported in part by the Global Alliance for Chronic Diseases - National Natural Science Foundation of China (NSFC. No. 81761128031). M Pinheiro acknowledges FCT for funding through program DL 57/2016 – Norma transitória. A Rahman acknowledges the support from the Data Science Research Unit in Charles Sturt University (Bathurst, NSW, Australia). U Saeed would like to acknowledge the International Center of Medical Sciences Research (ICMSR), Islamabad, Pakistan. A M Samy acknowledges support from Ain Shams University (Cairo, Egypt) and the Egyptian Fulbright Mission Program. N Senthil Kumar acknowledges the DBT, New Delhi sponsored Advanced State Level Biotech Hub (BT/NER/143/SP44475/2021), Mizoram University (Aizawl, Mizoram, India) for facilitating this work. F Sha is supported by the Shenzhen Science and Technology Program (Grant No. KQTD20190929172835662). A Shetty acknowledges Kasturba Medical College (Mangalore, India) and Manipal Academy of Higher Education (Manipal, India) for all the academic support. R Shrestha acknowledges a career development award from the National Institutes of Health (K01DA051346). D Silva was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior-Brazil (CAPES)-Finance Code 001 and is supported in part by CNPq - Brazil (309589/2021-5). D Sleet acknowledges partial support from Veritas Management Group, Inc and The Bizzell Group, LLC. S Trias-Llimós acknowledges research funding from the Juan de la Cierva-Formación program of the Spanish Ministry of Science and Innovation (FJC-2019-039314-I). Sí
Published: 2022

33. Highly Potent and Selective Ectonucleoside Triphosphate Diphosphohydrolase (ENTPDase1, 2, 3 and 8) Inhibitors Having 2-substituted-7- trifluoromethyl-thiadiazolopyrimidones Scaffold

Author: Jean Sévigny, Sumera Zaib, Saira Afzal, Peter Langer, Behzad Jafari, Jamshed Iqbal, and Joanna Lecka
Subjects: Adenosine Triphosphatases, chemistry.chemical_classification, Molecular Structure, Chemistry, Suramin, Apyrase, Pyrimidinones, Isozyme, Isoenzymes, Molecular Docking Simulation, Structure-Activity Relationship, Enzyme, Biochemistry, Docking (molecular), Thiadiazoles, Drug Discovery, Extracellular, medicine, Humans, Nucleotide, Enzyme Inhibitors, Nucleoside, IC50, medicine.drug
Abstract: Background: The ecto-nucleoside triphosphate diphosphohydrolases (NTPDases) terminate nucleotide signaling via the hydrolysis of extracellular nucleoside-5'-triphosphate and nucleoside- 5'-diphosphate, to nucleoside-5'-monophosphate and composed of eight Ca2+/Mg2+ dependent ectonucleotidases (NTPDase1-8). Extracellular nucleotides are involved in a variety of physiological mechanisms. However, they are rapidly inactivated by ectonucleotidases that are involved in the sequential removal of phosphate group from nucleotides with the release of inorganic phosphate and their respective nucleoside. Ectonucleoside triphosphate diphosphohydrolases (NTPDases) represent the key enzymes responsible for nucleotides hydrolysis and their overexpression has been related to certain pathological conditions. Therefore, the inhibitors of NTPDases are of particular importance in order to investigate their potential to treat various diseases e.g., cancer, ischemia and other disorders of the cardiovascular and immune system. Methods: Keeping in view the importance of NTPDase inhibitors, a series of thiadiazolopyrimidones were evaluated for their potential inhibitory activity towards NTPDases by the malachite green assay. Results: The results suggested that some of the compounds were found as non-selective inhibitors of isozyme of NTPDases, however, most of the compounds act as potent and selective inhibitors. In case of substituted amino derivatives (4c-m), the compounds 4m (IC50 = 1.13 ± 0.09 μM) and 4g (IC50 = 1.72 ± 0.08 μM) were found to be the most potent inhibitors of h-NTPDase1 and 2, respectively. Whereas, compound 4d showed the best inhibitory potential for both h-NTPDase3 (IC50 = 1.25 ± 0.06 μM) and h-NTPDase8 (0.21 ± 0.02 μM). Among 5a-t derivatives, compounds 5e (IC50 = 2.52 ± 0.15 μM), 5p (IC50 = 3.17 ± 0.05 μM), 5n (IC50 = 1.22 ± 0.06 μM) and 5b (IC50 = 0.35 ± 0.001 μM) were found to be the most potent inhibitors of h-NTPDase1, 2, 3 and 8, respectively. Interestingly, the inhibitory concentration values of above-mentioned inhibitors were several folds greater than suramin, a reference control. In order to determine the binding interactions, molecular docking studies of the most potent inhibitors were conducted into the homology models of NTPDases and the putative binding analysis further confirmed that selective and potent compounds bind deep inside the active pocket of the respective enzymes. Conclusions: The docking analysis proposed that the inhibitory activity correlates with the hydrogen bonds inside the binding pocket. Thus, these derivatives are of interest and may further be investigated for their importance in medicinal chemistry.
Published: 2020

34. Hydrazine clubbed 1,3-thiazoles as potent urease inhibitors: design, synthesis and molecular docking studies

Author: Syeda Aaliya Shehzadi, Pervaiz Ali Channar, Jamshed Iqbal, Aamer Saeed, Markus Kalesse, Saira Afzal, and Dilawar Hussain
Subjects: Urease, Hydrazine, Mass spectrometry, Catalysis, Inorganic Chemistry, Structure-Activity Relationship, chemistry.chemical_compound, Drug Discovery, Physical and Theoretical Chemistry, Molecular Biology, IC50, Ethanol, biology, Organic Chemistry, Biological activity, General Medicine, Combinatorial chemistry, In vitro, Molecular Docking Simulation, Canavalia, Thiazoles, Hydrazines, chemistry, Thiourea, Drug Design, biology.protein, Information Systems
Abstract: Synthesis of a novel series of hydrazine clubbed 1,3-thiazoles (5a–m) has been described by reacting hydrazine-1-carbothioamides (3a–k) with α-chloro- or bromo-acetophenones (4a–d) in refluxing ethanol in good to excellent yields (65–86%). Structural confirmation was based upon spectroscopic techniques such as 1H-NMR, 13C-NMR, FT-IR and mass spectrometry. The biological application of these motifs has been demonstrated in terms of their strong urease inhibition activity. The results of in vitro study revealed that all the compounds are the potent inhibitors of urease. The IC50 (ranging in between 110 and 440 nM) values were higher as compared to that of standard, i.e., thiourea (IC50 = 490 ± 10 nM). The synthesized compounds were docked at the active sites of the Jack bean urease enzyme in order to explore the possible binding interactions of enzyme–ligand complexes; the results reinforced the in vitro biological activity results.
Published: 2020

35. Global, regional, and national burden of hepatitis B, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Author: Brittney S Sheena, Lindsey Hiebert, Hannah Han, Helen Ippolito, Mohsen Abbasi-Kangevari, Zeinab Abbasi-Kangevari, Hedayat Abbastabar, Amir Abdoli, Hiwa Abubaker Ali, Mesafint Molla Adane, Oyelola A Adegboye, Qorinah Estiningtyas Sakilah Adnani, Shailesh M Advani, Muhammad Sohail Afzal, Saira Afzal, Mohamad Aghaie Meybodi, Bahman Ahadinezhad, Bright Opoku Ahinkorah, Sajjad Ahmad, Tauseef Ahmad, Sepideh Ahmadi, Haroon Ahmed, Muktar Beshir Ahmed, Tarik Ahmed Rashid, Gizachew Taddesse Akalu, Addis Aklilu, Tayyaba Akram, Hanadi Al Hamad, Fares Alahdab, Adugnaw Zeleke Alem, Dejene Tsegaye Alem, Fadwa Alhalaiqa Naji Alhalaiqa, Robert Kaba Alhassan, Liaqat Ali, Muhammad Ashar Ali, Yousef Alimohamadi, Vahid Alipour, Motasem Alkhayyat, Sami Almustanyir, Rajaa M Al-Raddadi, Haya Altawalah, Saeed Amini, Hubert Amu, Robert Ancuceanu, Catalina Liliana Andrei, Tudorel Andrei, Amir Anoushiravani, Adnan Ansar, Anayochukwu Edward Anyasodor, Jalal Arabloo, Morteza Arab-Zozani, Ayele Mamo Argaw, Zeleke Gebru Argaw, Muhammad Arshad, Anton A Artamonov, Tahira Ashraf, Daniel Atlaw, Floriane Ausloos, Marcel Ausloos, Sina Azadnajafabad, Mohammadreza Azangou-Khyavy, Amirhossein Azari Jafari, Ghasem Azarian, Sayna Bagheri, Saeed Bahadory, Atif Amin Baig, Maciej Banach, Nastaran Barati, Amadou Barrow, Abdul-Monim Mohammad Batiha, Diana Fernanda Bejarano Ramirez, Uzma Iqbal Belgaumi, Alemshet Yirga Berhie, Devidas S Bhagat, Nikha Bhardwaj, Pankaj Bhardwaj, Krittika Bhattacharyya, Vijayalakshmi S Bhojaraja, Ali Bijani, Antonio Biondi, Belay Boda Abule Bodicha, Hunduma Amensisa Bojia, Archith Boloor, Cristina Bosetti, Dejana Braithwaite, Nikolay Ivanovich Briko, Zahid A Butt, Luis Alberto Cámera, Raja Chandra Chakinala, Promit Ananyo Chakraborty, Jaykaran Charan, Shu Chen, Jee-Young Jasmine Choi, Sonali Gajanan Choudhari, Fazle Rabbi Chowdhury, Dinh-Toi Chu, Sheng-Chia Chung, Paolo Angelo Cortesi, Benjamin C Cowie, Garland T Culbreth, Omid Dadras, Xiaochen Dai, Lalit Dandona, Rakhi Dandona, Fernando Pio De la Hoz, Sisay Abebe Debela, Mohammed Gebre Dedefo, Feleke Mekonnen Demeke, Takele Gezahegn G Demie, Getu Debalkie Demissie, Meseret Derbew Molla, Abebaw Alemayehu Desta, Deepak Dhamnetiya, Mandira Lamichhane Dhimal, Meghnath Dhimal, Mojtaba Didehdar, Linh Phuong Doan, Fariba Dorostkar, Thomas M Drake, Fatemeh Eghbalian, Michael Ekholuenetale, Iman El Sayed, Maysaa El Sayed Zaki, Muhammed Elhadi, Mohamed A Elmonem, Aisha Elsharkawy, Shymaa Enany, Daniel Berhanie Enyew, Ryenchindorj Erkhembayar, Sharareh Eskandarieh, Firooz Esmaeilzadeh, Sayeh Ezzikouri, Hossein Farrokhpour, Getahun Fetensa, Florian Fischer, Masoud Foroutan, Mohamed M Gad, Abhay Motiramji Gaidhane, Shilpa Gaidhane, Natalie C Galles, Silvano Gallus, Teferi Gebru Gebremeskel, Eyob Alemayehu Gebreyohannes, Keyghobad Ghadiri, Kazem Ghaffari, Mansour Ghafourifard, Seyyed-Hadi Ghamari, Ahmad Ghashghaee, Ali Gholami, Abdolmajid Gholizadeh, Aima Gilani, Amit Goel, Mahaveer Golechha, Pouya Goleij, Davide Golinelli, Giuseppe Gorini, Yitayal Ayalew Goshu, Max G Griswold, Mohammed Ibrahim Mohialdeen Gubari, Bhawna Gupta, Sapna Gupta, Veer Bala Gupta, Vivek Kumar Gupta, Rasool Haddadi, Rabih Halwani, Saeed S Hamid, Samer Hamidi, Asif Hanif, Shafiul Haque, Harapan Harapan, Arief Hargono, Sanam Hariri, Ahmed I Hasaballah, S M Mahmudul Hasan, Soheil Hassanipour, Hadi Hassankhani, Simon I Hay, Khezar Hayat, Golnaz Heidari, Claudiu Herteliu, Demisu Zenbaba Heyi, Kamal Hezam, Ramesh Holla, Mohammad-Salar Hosseini, Mostafa Hosseini, Mehdi Hosseinzadeh, Mihaela Hostiuc, Mowafa Househ, Junjie Huang, Nawfal R Hussein, Ivo Iavicoli, Segun Emmanuel Ibitoye, Olayinka Stephen Ilesanmi, Irena M Ilic, Milena D Ilic, Lalu Muhammad Irham, Jessica Y Islam, Nahlah Elkudssiah Ismail, Kathryn H Jacobsen, Farhad Jadidi-Niaragh, Amirreza Javadi Mamaghani, Shubha Jayaram, Ranil Jayawardena, Rime Jebai, Ravi Prakash Jha, Nitin Joseph, Farahnaz Joukar, Billingsley Kaambwa, Ali Kabir, Zubair Kabir, Rohollah Kalhor, 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Subjects: Liver Cirrhosis, Hepatology, Seroepidemiologic Studies, 3121 General medicine, internal medicine and other clinical medicine, Liver Neoplasms, Gastroenterology, Humans, Bayes Theorem, HBV, Global burden of diseases, HCC, Cirrhosis, Child, Hepatitis B, Global Burden of Disease
Abstract: Publisher Copyright: © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Background: Combating viral hepatitis is part of the UN Sustainable Development Goals (SDGs), and WHO has put forth hepatitis B elimination targets in its Global Health Sector Strategy on Viral Hepatitis (WHO-GHSS) and Interim Guidance for Country Validation of Viral Hepatitis Elimination (WHO Interim Guidance). We estimated the global, regional, and national prevalence of hepatitis B virus (HBV), as well as mortality and disability-adjusted life-years (DALYs) due to HBV, as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. This included estimates for 194 WHO member states, for which we compared our estimates to WHO elimination targets. Methods: The primary data sources were population-based serosurveys, claims and hospital discharges, cancer registries, vital registration systems, and published case series. We estimated chronic HBV infection and the burden of HBV-related diseases, defined as an aggregate of cirrhosis due to hepatitis B, liver cancer due to hepatitis B, and acute hepatitis B. We used DisMod-MR 2.1, a Bayesian mixed-effects meta-regression tool, to estimate the prevalence of chronic HBV infection, cirrhosis, and aetiological proportions of cirrhosis. We used mortality-to-incidence ratios modelled with spatiotemporal Gaussian process regression to estimate the incidence of liver cancer. We used the Cause of Death Ensemble modelling (CODEm) model, a tool that selects models and covariates on the basis of out-of-sample performance, to estimate mortality due to cirrhosis, liver cancer, and acute hepatitis B. Findings: In 2019, the estimated global, all-age prevalence of chronic HBV infection was 4·1% (95% uncertainty interval [UI] 3·7 to 4·5), corresponding to 316 million (284 to 351) infected people. There was a 31·3% (29·0 to 33·9) decline in all-age prevalence between 1990 and 2019, with a more marked decline of 76·8% (76·2 to 77·5) in prevalence in children younger than 5 years. HBV-related diseases resulted in 555 000 global deaths (487 000 to 630 000) in 2019. The number of HBV-related deaths increased between 1990 and 2019 (by 5·9% [–5·6 to 19·2]) and between 2015 and 2019 (by 2·9% [–5·9 to 11·3]). By contrast, all-age and age-standardised death rates due to HBV-related diseases decreased during these periods. We compared estimates for 2019 in 194 WHO locations to WHO-GHSS 2020 targets, and found that four countries achieved a 10% reduction in deaths, 15 countries achieved a 30% reduction in new cases, and 147 countries achieved a 1% prevalence in children younger than 5 years. As of 2019, 68 of 194 countries had already achieved the 2030 target proposed in WHO Interim Guidance of an all-age HBV-related death rate of four per 100 000. Interpretation: The prevalence of chronic HBV infection declined over time, particularly in children younger than 5 years, since the introduction of hepatitis B vaccination. HBV-related death rates also decreased, but HBV-related death counts increased as a result of population growth, ageing, and cohort effects. By 2019, many countries had met the interim seroprevalence target for children younger than 5 years, but few countries had met the WHO-GHSS interim targets for deaths and new cases. Progress according to all indicators must be accelerated to meet 2030 targets, and there are marked disparities in burden and progress across the world. HBV interventions, such as vaccination, testing, and treatment, must be strategically supported and scaled up to achieve elimination. Funding: Bill & Melinda Gates Foundation.
Published: 2022

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

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Abdelazeem M Algammal, Fadwa Alhalaiqa Naji Alhalaiqa, Robert Kaba Alhassan, Beriwan Abdulqadir Ali, Liaqat Ali, Musa Mohammed Ali, Syed Shujait Ali, Yousef Alimohamadi, Vahid Alipour, Adel Al-Jumaily, Syed Mohamed Aljunid, Sami Almustanyir, Rajaa M Al-Raddadi, Rami H Hani Al-Rifai, Saif Aldeen S AlRyalat, Nelson Alvis-Guzman, Nelson J Alvis-Zakzuk, Edward Kwabena Ameyaw, Javad Javad Aminian Dehkordi, John H Amuasi, Dickson A Amugsi, Etsay Woldu Anbesu, Adnan Ansar, Anayochukwu Edward Anyasodor, Jalal Arabloo, Demelash Areda, Ayele Mamo Argaw, Zeleke Gebru Argaw, Judie Arulappan, Raphael Taiwo Aruleba, Mulusew A Asemahagn, Seyyed Shamsadin Athari, Daniel Atlaw, Engi F Attia, Sameh Attia, Avinash Aujayeb, Tewachew Awoke, Tegegn Mulatu Ayana, Martin Amogre Ayanore, Sina Azadnajafabad, Mohammadreza Azangou-Khyavy, Samad Azari, Amirhossein Azari Jafari, Muhammad Badar, Ashish D Badiye, Nayereh Baghcheghi, Sara Bagherieh, Atif Amin Baig, Maciej Banach, Indrajit Banerjee, Mainak Bardhan, 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Kochhar, Farzad Kompani, Hamid Reza Koohestani, Vladimir Andreevich Korshunov, Soewarta Kosen, Parvaiz A Koul, Ai Koyanagi, Kewal Krishan, Barthelemy Kuate Defo, G Anil Kumar, Om P Kurmi, Ambily Kuttikkattu, Dharmesh Kumar Lal, Judit Lám, Iván Landires, Caterina Ledda, Sang-woong Lee, Miriam Levi, Sonia Lewycka, Gang Liu, Wei Liu, Rakesh Lodha, László Lorenzovici, Mojgan Lotfi, Joana A Loureiro, Farzan Madadizadeh, Ata Mahmoodpoor, Razzagh Mahmoudi, Marzieh Mahmoudimanesh, Jamal Majidpoor, Alaa Makki, Elaheh Malakan Rad, Ahmad Azam Malik, Tauqeer Hussain Mallhi, Yosef Manla, Clara N Matei, Alexander G Mathioudakis, Richard James Maude, Entezar Mehrabi Nasab, Addisu Melese, Ziad A Memish, Oliver Mendoza-Cano, Alexios-Fotios A Mentis, Tuomo J Meretoja, Mehari Woldemariam Merid, Tomislav Mestrovic, Ana Carolina Micheletti Gomide Nogueira de Sá, Gelana Fekadu Worku Mijena, Le Huu Nhat Minh, Shabir Ahmad Mir, Reza Mirfakhraie, Seyyedmohammadsadeq Mirmoeeni, Agha Zeeshan Mirza, Moonis Mirza, Mohammad Mirza-Aghazadeh-Attari, Abay Sisay Misganaw, Awoke Temesgen Misganaw, Esmaeil Mohammadi, Mokhtar Mohammadi, Arif Mohammed, Shafiu Mohammed, Syam Mohan, Mohammad Mohseni, Nagabhishek Moka, Ali H Mokdad, Sara Momtazmanesh, Lorenzo Monasta, Md Moniruzzaman, Fateme Montazeri, Catrin E Moore, Abdolvahab Moradi, Lidia Morawska, Jonathan F Mosser, Ebrahim Mostafavi, Majid Motaghinejad, Haleh Mousavi Isfahani, Seyed Ali Mousavi-Aghdas, Sumaira Mubarik, Efrén Murillo-Zamora, Ghulam Mustafa, Sanjeev Nair, Tapas Sadasivan Nair, Houshang Najafi, Atta Abbas Naqvi, Sreenivas Narasimha Swamy, Zuhair S Natto, Biswa Prakash Nayak, Seyed Aria Nejadghaderi, Huy Van Nguyen Nguyen, Robina Khan Niazi, Antonio Tolentino Nogueira de Sá, Hasti Nouraei, Ali Nowroozi, Virginia Nuñez-Samudio, Chimezie Igwegbe Nzoputam, Ogochukwu Janet Nzoputam, Bogdan Oancea, Chimedsuren Ochir, Oluwakemi Ololade Odukoya, Hassan Okati-Aliabad, Akinkunmi Paul Okekunle, Osaretin Christabel Okonji, Andrew T Olagunju, Isaac Iyinoluwa Olufadewa, Ahmed Omar Bali, Emad Omer, Eyal Oren, Erika Ota, Nikita Otstavnov, Abderrahim Oulhaj, Mahesh P A, Jagadish Rao Padubidri, Keyvan Pakshir, Reza Pakzad, Tamás Palicz, Anamika Pandey, Suman Pant, Shahina Pardhan, Eun-Cheol Park, Eun-Kee Park, Fatemeh Pashazadeh Kan, Rajan Paudel, Shrikant Pawar, Minjin Peng, Gavin Pereira, Simone Perna, Navaraj Perumalsamy, Ionela-Roxana Petcu, David M Pigott, Zahra Zahid Piracha, Vivek Podder, Roman V Polibin, Maarten J Postma, Hamid Pourasghari, Naeimeh Pourtaheri, Mirza Muhammad Fahd Qadir, Mathieu Raad, Mohammad Rabiee, Navid Rabiee, Saber Raeghi, Alireza Rafiei, Fakher Rahim, Mehran Rahimi, Vafa Rahimi-Movaghar, Azizur Rahman, Md Obaidur Rahman, Mosiur Rahman, Muhammad Aziz Rahman, Amir Masoud Rahmani, Vahid Rahmanian, Pradhum Ram, Kiana Ramezanzadeh, Juwel Rana, Priyanga Ranasinghe, Usha Rani, Sowmya J Rao, Sina Rashedi, Mohammad-Mahdi Rashidi, Azad Rasul, Zubair Ahmed Ratan, David Laith Rawaf, Salman Rawaf, Reza Rawassizadeh, 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Samarjeet Singh Siwal, Valentin Yurievich Skryabin, Anna Aleksandrovna Skryabina, Mohammad Sadegh Soltani-Zangbar, Suhang Song, Yimeng Song, Prashant Sood, Chandrashekhar T Sreeramareddy, Paschalis Steiropoulos, Muhammad Suleman, Seyed-Amir Tabatabaeizadeh, Alireza Tahamtan, Majid Taheri, Moslem Taheri Soodejani, Elahe Taki, Iman M Talaat, Mircea Tampa, Sarmila Tandukar, Nathan Y Tat, Vivian Y Tat, Yibekal Manaye Tefera, Gebremaryam Temesgen, Mohamad-Hani Temsah, Azene Tesfaye, Degefa Gomora Tesfaye, Belay Tessema, Rekha Thapar, Jansje Henny Vera Ticoalu, Amir Tiyuri, Imad I Tleyjeh, Munkhsaikhan Togtmol, Marcos Roberto Tovani-Palone, Derara Girma Tufa, Irfan Ullah, Era Upadhyay, Sahel Valadan Tahbaz, Pascual R Valdez, Rohollah Valizadeh, Constantine Vardavas, Tommi Juhani Vasankari, Bay Vo, Linh Gia Vu, Birhanu Wagaye, Yasir Waheed, Yu Wang, Abdul Waris, T Eoin West, Nuwan Darshana Wickramasinghe, Xiaoyue Xu, Sajad Yaghoubi, Gahin Abdulraheem Tayib Yahya, Seyed Hossein Yahyazadeh Jabbari, Dong Keon Yon, Naohiro Yonemoto, Burhan Abdullah Zaman, Alireza Zandifar, Moein Zangiabadian, Heather J Zar, Iman Zare, Zahra Zareshahrabadi, Armin Zarrintan, Mikhail Sergeevich Zastrozhin, Wu Zeng, Mengxi Zhang, Zhi-Jiang Zhang, Chenwen Zhong, Mohammad Zoladl, Alimuddin Zumla, Stephen S Lim, Theo Vos, Mohsen Naghavi, Michael Brauer, Simon I Hay, Christopher J L Murray, Kyu, H. 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Population and Behavioural Science Division, Tampere University, Health Sciences, Clinical Medicine, Kyu, H, Vongpradith, A, Sirota, S, Novotney, A, Troeger, C, Doxey, M, Bender, R, Ledesma, J, Biehl, M, Albertson, S, Frostad, J, Burkart, K, Bennitt, F, Zhao, J, Gardner, W, Hagins, H, Bryazka, D, Dominguez, R, Abate, S, Abdelmasseh, M, Abdoli, A, Abdoli, G, Abedi, A, Abedi, V, Abegaz, T, Abidi, H, Aboagye, R, Abolhassani, H, Abtew, Y, Abubaker Ali, H, Abu-Gharbieh, E, Abu-Zaid, A, Adamu, K, Addo, I, Adegboye, O, Adnan, M, Adnani, Q, Afzal, M, Afzal, S, Ahinkorah, B, Ahmad, A, Ahmad, S, Ahmadi, A, Ahmadi, S, Ahmed, H, Ahmed, J, Ahmed Rashid, T, Akbarzadeh-Khiavi, M, Al Hamad, H, Albano, L, Aldeyab, M, Alemu, B, Alene, K, Algammal, A, Alhalaiqa, F, Alhassan, R, Ali, B, Ali, L, Ali, M, Ali, S, Alimohamadi, Y, Alipour, V, Al-Jumaily, A, Aljunid, S, Almustanyir, S, Al-Raddadi, R, Al-Rifai, R, Alryalat, S, Alvis-Guzman, N, Alvis-Zakzuk, N, Ameyaw, E, Aminian Dehkordi, J, Amuasi, J, Amugsi, D, Anbesu, E, Ansar, A, Anyasodor, A, Arabloo, J, Areda, D, Argaw, A, Argaw, Z, Arulappan, J, Aruleba, R, Asemahagn, M, Athari, S, Atlaw, D, Attia, E, Attia, S, Aujayeb, A, Awoke, T, Ayana, T, Ayanore, M, Azadnajafabad, S, Azangou-Khyavy, M, Azari, S, Azari Jafari, A, Badar, M, Badiye, A, Baghcheghi, N, Bagherieh, S, Baig, A, Banach, M, Banerjee, I, Bardhan, M, Barone-Adesi, F, Barqawi, H, Barrow, A, Bashiri, A, Bassat, Q, Batiha, A, Belachew, A, Belete, M, Belgaumi, U, Bhagavathula, A, Bhardwaj, N, Bhardwaj, P, Bhatt, P, Bhojaraja, V, Bhutta, Z, Bhuyan, S, Bijani, A, Bitaraf, S, Bodicha, B, Briko, N, Buonsenso, D, Butt, M, Cai, J, Camargos, P, Camera, L, Chakraborty, P, Chanie, M, Charan, J, Chattu, V, Ching, P, Choi, S, Chong, Y, Choudhari, S, Chowdhury, E, Christopher, D, Chu, D, Cobb, N, Cohen, A, Cruz-Martins, N, Dadras, O, Dagnaw, F, Dai, X, Dandona, L, Dandona, R, Dao, A, Debela, S, Demisse, B, Demisse, F, Demissie, S, Dereje, D, Desai, H, Desta, A, Desye, B, Dhingra, S, Diao, N, Diaz, D, Digesa, L, Doan, L, Dodangeh, M, Dongarwar, D, Dorostkar, F, dos Santos, W, Dsouza, H, Dubljanin, E, Durojaiye, O, Edinur, H, Ehsani-Chimeh, E, Eini, E, Ekholuenetale, M, Ekundayo, T, El Desouky, E, El Sayed, I, El Sayed Zaki, M, Elhadi, M, Elkhapery, A, Emami, A, Engelbert Bain, L, Erkhembayar, R, Etaee, F, Ezati Asar, M, Fagbamigbe, A, Falahi, S, Fallahzadeh, A, Faraj, A, Faraon, E, Fatehizadeh, A, Ferrara, P, Ferrari, A, Fetensa, G, Fischer, F, Flavel, J, Foroutan, M, Gaal, P, Gaidhane, A, Gaihre, S, Galehdar, N, Garcia-Basteiro, A, Garg, T, Gebrehiwot, M, Gebremichael, M, Gela, Y, Gemeda, B, Gessner, B, Getachew, M, Getie, A, Ghamari, S, Ghasemi Nour, M, Ghashghaee, A, Gholamrezanezhad, A, Gholizadeh, A, Ghosh, R, Ghozy, S, Goleij, P, Golitaleb, M, Gorini, G, Goulart, A, Goyomsa, G, Guadie, H, Gudisa, Z, Guled, R, Gupta, S, Gupta, V, Guta, A, Habibzadeh, P, Haj-Mirzaian, A, Halwani, R, Hamidi, S, Hannan, M, Harorani, M, Hasaballah, A, Hasani, H, Hassan, A, Hassani, S, Hassanian-Moghaddam, H, Hassankhani, H, Hayat, K, Heibati, B, Heidari, M, Heyi, D, Hezam, K, Holla, R, Hong, S, Horita, N, Hosseini, M, Hosseinzadeh, M, Hostiuc, M, Househ, M, Hoveidamanesh, S, Huang, J, Hussein, N, Iavicoli, I, Ibitoye, S, Ikuta, K, Ilesanmi, O, Ilic, I, Ilic, M, Immurana, M, Ismail, N, Iwagami, M, Jaafari, J, Jamshidi, E, Jang, S, Javadi Mamaghani, A, Javaheri, T, Javanmardi, F, Javidnia, J, Jayapal, S, Jayarajah, U, Jayaram, S, Jema, A, Jeong, W, Jonas, J, Joseph, N, Joukar, F, Jozwiak, J, K, V, Kabir, Z, Kacimi, S, Kadashetti, V, Kalankesh, L, Kalhor, R, Kamath, A, Kamble, B, Kandel, H, Kanko, T, Karaye, I, Karch, A, Karkhah, S, Kassa, B, Katoto, P, Kaur, H, Kaur, R, Keikavoosi-Arani, L, Keykhaei, M, Khader, Y, Khajuria, H, Khan, E, Khan, G, Khan, I, Khan, M, Khan, Y, Khatatbeh, M, Khosravifar, M, Khubchandani, J, Kim, M, Kimokoti, R, Kisa, A, Kisa, S, Kissoon, N, Knibbs, L, Kochhar, S, Kompani, F, Koohestani, H, Korshunov, V, Kosen, S, Koul, P, Koyanagi, A, Krishan, K, Kuate Defo, B, Kumar, G, Kurmi, O, Kuttikkattu, A, Lal, D, Lam, J, Landires, I, Ledda, C, Lee, S, Levi, M, Lewycka, S, Liu, G, Liu, W, Lodha, R, Lorenzovici, L, Lotfi, M, Loureiro, J, Madadizadeh, F, Mahmoodpoor, A, Mahmoudi, R, Mahmoudimanesh, M, Majidpoor, J, Makki, A, Malakan Rad, E, Malik, A, Mallhi, T, Manla, Y, Matei, C, Mathioudakis, A, Maude, R, Mehrabi Nasab, E, Melese, A, Memish, Z, Mendoza-Cano, O, Mentis, A, Meretoja, T, Merid, M, Mestrovic, T, Micheletti Gomide Nogueira de Sa, A, Mijena, G, Minh, L, Mir, S, Mirfakhraie, R, Mirmoeeni, S, Mirza, A, Mirza, M, Mirza-Aghazadeh-Attari, M, Misganaw, A, Mohammadi, E, Mohammadi, M, Mohammed, A, Mohammed, S, Mohan, S, Mohseni, M, Moka, N, Mokdad, A, Momtazmanesh, S, Monasta, L, Moniruzzaman, M, Montazeri, F, Moore, C, Moradi, A, Morawska, L, Mosser, J, Mostafavi, E, Motaghinejad, M, Mousavi Isfahani, H, Mousavi-Aghdas, S, Mubarik, S, Murillo-Zamora, E, Mustafa, G, Nair, S, Nair, T, Najafi, H, Naqvi, A, Narasimha Swamy, S, Natto, Z, Nayak, B, Nejadghaderi, S, Nguyen, H, Niazi, R, Nogueira de Sa, A, Nouraei, H, Nowroozi, A, Nunez-Samudio, V, Nzoputam, C, Nzoputam, O, Oancea, B, Ochir, C, Odukoya, O, Okati-Aliabad, H, Okekunle, A, Okonji, O, Olagunju, A, Olufadewa, I, Omar Bali, A, Omer, E, Oren, E, Ota, E, Otstavnov, N, Oulhaj, A, P A, M, Padubidri, J, Pakshir, K, Pakzad, R, Palicz, T, Pandey, A, Pant, S, Pardhan, S, Park, E, Pashazadeh Kan, F, Paudel, R, Pawar, S, Peng, M, Pereira, G, Perna, S, Perumalsamy, N, Petcu, I, Pigott, D, Piracha, Z, Podder, V, Polibin, R, Postma, M, Pourasghari, H, Pourtaheri, N, Qadir, M, Raad, M, Rabiee, M, Rabiee, N, Raeghi, S, Rafiei, A, Rahim, F, Rahimi, M, Rahimi-Movaghar, V, Rahman, A, Rahman, M, Rahmani, A, Rahmanian, V, Ram, P, Ramezanzadeh, K, Rana, J, Ranasinghe, P, Rani, U, Rao, S, Rashedi, S, Rashidi, M, Rasul, A, Ratan, Z, Rawaf, D, Rawaf, S, Rawassizadeh, R, Razeghinia, M, Redwan, E, Reitsma, M, Renzaho, A, Rezaeian, M, Riad, A, Rikhtegar, R, Rodriguez, J, Rogowski, E, Ronfani, L, Rudd, K, Saddik, B, Sadeghi, E, Saeed, U, Safary, A, Safi, S, Sahebazzamani, M, Sahebkar, A, Sakhamuri, S, Salehi, S, Salman, M, Samadi Kafil, H, Samy, A, Santric-Milicevic, M, Sao Jose, B, Sarkhosh, M, Sathian, B, Sawhney, M, Saya, G, Seidu, A, Seylani, A, Shaheen, A, Shaikh, M, Shaker, E, Shamshad, H, Sharew, M, Sharhani, A, Sharifi, A, Sharma, P, Sheidaei, A, Shenoy, S, Shetty, J, Shiferaw, D, Shigematsu, M, Shin, J, Shirzad-Aski, H, Shivakumar, K, Shivalli, S, Shobeiri, P, Simegn, W, Simpson, C, Singh, H, Singh, J, Singh, P, Siwal, S, Skryabin, V, Skryabina, A, Soltani-Zangbar, M, Song, S, Song, Y, Sood, P, Sreeramareddy, C, Steiropoulos, P, Suleman, M, Tabatabaeizadeh, S, Tahamtan, A, Taheri, M, Taheri Soodejani, M, Taki, E, Talaat, I, Tampa, M, Tandukar, S, Tat, N, Tat, V, Tefera, Y, Temesgen, G, Temsah, M, Tesfaye, A, Tesfaye, D, Tessema, B, Thapar, R, Ticoalu, J, Tiyuri, A, Tleyjeh, I, Togtmol, M, Tovani-Palone, M, Tufa, D, Ullah, I, Upadhyay, E, Valadan Tahbaz, S, Valdez, P, Valizadeh, R, Vardavas, C, Vasankari, T, Vo, B, Vu, L, Wagaye, B, Waheed, Y, Wang, Y, Waris, A, West, T, Wickramasinghe, N, Xu, X, Yaghoubi, S, Yahya, G, Yahyazadeh Jabbari, S, Yon, D, Yonemoto, N, Zaman, B, Zandifar, A, Zangiabadian, M, Zar, H, Zare, I, Zareshahrabadi, Z, Zarrintan, A, Zastrozhin, M, Zeng, W, Zhang, M, Zhang, Z, Zhong, C, Zoladl, M, Zumla, A, Lim, S, Vos, T, Naghavi, M, Brauer, M, Hay, S, Murray, C, HUS Comprehensive Cancer Center, and Department of Oncology
Subjects: Adult, Male, Global Health, Time, Global Burden of Disease, SDG 3 - Good Health and Well-being, Risk Factors, RA0421, RA0421 Public health. Hygiene. Preventive Medicine, Humans, Ambient air-quality, Child, Respiratory Tract Infections, Aged, Aged, 80 and over, MCC, Sex Characteristics, Malnutrition, Pyridinolcarbamate, Bayes Theorem, 3rd-DAS, 3142 Public health care science, environmental and occupational health, Infectious Diseases, 3121 General medicine, internal medicine and other clinical medicine, Child, Preschool, Female, Particulate Matter, Quality-Adjusted Life Years, Covid-19, LRI
Abstract: Funding: Bill & Melinda Gates Foundation. Background: The global burden of lower respiratory infections (LRIs) and corresponding risk factors in children older than 5 years and adults has not been studied as comprehensively as it has been in children younger than 5 years. We assessed the burden and trends of LRIs and risk factors across all age groups by sex, for 204 countries and territories. Methods: In this analysis of data for the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we used clinician-diagnosed pneumonia or bronchiolitis as our case definition for LRIs. We included International Classification of Diseases 9th edition codes 079.6, 466–469, 470.0, 480–482.8, 483.0–483.9, 484.1–484.2, 484.6–484.7, and 487–489 and International Classification of Diseases 10th edition codes A48.1, A70, B97.4–B97.6, J09–J15.8, J16–J16.9, J20–J21.9, J91.0, P23.0–P23.4, and U04–U04.9. We used the Cause of Death Ensemble modelling strategy to analyse 23 109 site-years of vital registration data, 825 site-years of sample vital registration data, 1766 site-years of verbal autopsy data, and 681 site-years of mortality surveillance data. We used DisMod-MR 2.1, a Bayesian meta-regression tool, to analyse age–sex-specific incidence and prevalence data identified via systematic reviews of the literature, population-based survey data, and claims and inpatient data. Additionally, we estimated age–sex-specific LRI mortality that is attributable to the independent effects of 14 risk factors. Findings: Globally, in 2019, we estimated that there were 257 million (95% uncertainty interval [UI] 240–275) LRI incident episodes in males and 232 million (217–248) in females. In the same year, LRIs accounted for 1·30 million (95% UI 1·18–1·42) male deaths and 1·20 million (1·07–1·33) female deaths. Age-standardised incidence and mortality rates were 1·17 times (95% UI 1·16–1·18) and 1·31 times (95% UI 1·23–1·41) greater in males than in females in 2019. Between 1990 and 2019, LRI incidence and mortality rates declined at different rates across age groups and an increase in LRI episodes and deaths was estimated among all adult age groups, with males aged 70 years and older having the highest increase in LRI episodes (126·0% [95% UI 121·4–131·1]) and deaths (100·0% [83·4–115·9]). During the same period, LRI episodes and deaths in children younger than 15 years were estimated to have decreased, and the greatest decline was observed for LRI deaths in males younger than 5 years (–70·7% [–77·2 to –61·8]). The leading risk factors for LRI mortality varied across age groups and sex. More than half of global LRI deaths in children younger than 5 years were attributable to child wasting (population attributable fraction [PAF] 53·0% [95% UI 37·7–61·8] in males and 56·4% [40·7–65·1] in females), and more than a quarter of LRI deaths among those aged 5–14 years were attributable to household air pollution (PAF 26·0% [95% UI 16·6–35·5] for males and PAF 25·8% [16·3–35·4] for females). PAFs of male LRI deaths attributed to smoking were 20·4% (95% UI 15·4–25·2) in those aged 15–49 years, 30·5% (24·1–36·9) in those aged 50–69 years, and 21·9% (16·8–27·3) in those aged 70 years and older. PAFs of female LRI deaths attributed to household air pollution were 21·1% (95% UI 14·5–27·9) in those aged 15–49 years and 18·2% (12·5–24·5) in those aged 50–69 years. For females aged 70 years and older, the leading risk factor, ambient particulate matter, was responsible for 11·7% (95% UI 8·2–15·8) of LRI deaths. Interpretation: The patterns and progress in reducing the burden of LRIs and key risk factors for mortality varied across age groups and sexes. The progress seen in children younger than 5 years was clearly a result of targeted interventions, such as vaccination and reduction of exposure to risk factors. Similar interventions for other age groups could contribute to the achievement of multiple Sustainable Development Goals targets, including promoting wellbeing at all ages and reducing health inequalities. Interventions, including addressing risk factors such as child wasting, smoking, ambient particulate matter pollution, and household air pollution, would prevent deaths and reduce health disparities. Publisher PDF
Published: 2022

37. The Sustainable Development Goals: A Way Forward for Pakistan

Author: Saira Afzal and Khunsa Junaid
Subjects: General Medicine
Abstract: The Sustainable Development Goals (SDGs) were adopted globally in September 2015 as a set of universal and transformative goals and targets to be implemented by 2030. The 17 development goals include 169 concise, global, and applicable to all countries; developing and developed—the SDGs address three interconnected dimensions: social, economic, and environmental. Health is interconnected with social, economic, and developmental/environmental determinants. 1 The SDGs include 244 indicators related to the five Ps: People, Planet, Prosperity, Peace, and Partnership. The SDGs are more comprehensive and people-centered than the MDGs, with the commitment to & quot; leave no one behind, & quot; i.e., reach vulnerable populations. Among the SDGs, Goal 3 directs countries to & quot; Ensure healthy lives and promote well-being for all ages & quot;; SDG3 includes 13 targets, four of which address implementation. 2 Thirteen SDGs are related to health and well-being and may be informed by less than 169 indicators. SDG 3 addresses chronic diseases, tobacco, alcohol, narcotics use, mental health, road safety, and pollution. However, health is not solely a component of Goal 3. Throughout the majority of the SDGs, some targets have a direct or indirect effect on health gains and thus require special consideration when developing strategies, policies, and plans to achieve the health goal and monitor progress. 2,3
Published: 2022

38. System within System: World Health Organization Building Blocks and Public-Private Partnership in Healthcare sector of Pakistan

Author: Saira Afzal and Amber Arshad
Subjects: General Medicine
Abstract: "Health systems" (also called "health care systems" and "healthcare systems") are organizations that provide health care services to target populations by integrating people, institutions, and resources. A health care system is nothing more than a collection of interdependent pieces and their relationships. People, organizations, and behaviors whose primary goal is to promote, restore, or maintain health are part of a "health system." This system relies on the interdependence of its various components. Numerous components that make up a health care system, like patients, families, communities, health departments, health care professionals, and organizations responsible for funding health care are just a few examples. The duties and functions of each component are intertwined. WHO proposes supporting and building a health care system based on the following framework, the Six Health System Building Blocks? It is possible to produce more equitable and long-lasting gains in health services and outcomes by enhancing the six components of the health system and 1 managing their interrelationships .
Published: 2022

39. Aspergillosis and Mucormycosis in COVID-19 Patients; a Systematic Review and Meta-analysis

Author: Mehreen Nasir and Saira Afzal
Subjects: Pediatrics, medicine.medical_specialty, business.industry, Incidence (epidemiology), Mucormycosis, MEDLINE, medicine.disease, Aspergillosis, Comorbidity, Diabetes mellitus, Meta-analysis, Case fatality rate, medicine, business
Abstract: Fungal infections have increased in number since the onset of this lethal pandemic. The aim of this study is to assess risk factors and case fatality in COVID-19 cases with aspergillosis or mucormycosis. Systematic review and meta-analysis was done according to PRISMA guidelines. Data bases used were Google scholar, Pakmedinet, PUBMED and MEDLINE. 21 case reports and case series of mucormycosis in COVID-19 patients were identified and mean age was 56.3 years (36 males and 12 females). The most common comorbidity was diabetes and site was Rhino orbital mucormycosis. Case fatality of 48 combined cases was calculated to be 52%. 19 articles of aspergillosis were included. Diabetes was the most common comorbidity in cases. The number of male cases were more than females. Incidence of aspergillosis in critically sick COVID-19 patients was calculated to be 9.3%. Case fatality was calculated to be 51.2%. Screening can be a beneficial tool for decreasing the morbidity and mortality.
Published: 2021

40. Infodemics: Use of Peer Reviewed and Non-Peer Reviewed Information by Post Grad-uate Trainee Doctors for COVID-19 Pandemic in Pakistan

Author: Saira Tariq, Muhammad Hasan Masood, Mehreen Nasir, Khunsa Junaid, and Saira Afzal
Subjects: General Medicine
Abstract: Background: Reliable and peer reviewed information is of immense importance for preventive, diagnostic and curative solutions and efforts should be done to minimize inaccurate infodemics among post graduate trainee doctors. Objective: The aim of the study was to access the use of Peer Reviewed and Non-Peer Reviewed Information by post graduate trainee doctors for COVID-19 Pandemic in Pakistan. Methods: The study was analytical cross sectional in design and was conducted in 3193 post graduate trainee doctors employing Electronic Logbook (elog) system of College of Physicians and Surgeons, Pakistan. An online survey included demographic characteristics, year of training, specialty and sources of information used for COVID-19 pandemic. Results: Total 3193 study participants from all provinces of Pakistan were included with mean age of 28.68 years. Majority of participants (58.66%) used both peer reviewed and non-peer reviewed information source for getting updated guidelines and information about COVID-19. According to bivariate analysis results, significant differences were revealed between the source of information and the age (p < 0.001), province (p < 0.001) and gender (p < 0.002). Multivariate logistic regression results showed that the age less than 30 years (AOR = 1.311, 95% (CI: 0.800, 2.146), working in Khyber Pakhtunkhwa province (AOR = 1.549, 95% (CI: 1.210-1.982) and female gender(AOR = 1.551, 95% (CI: 1.303, 1.847). was significantly associated with increased use of social media for getting information. Conclusion: Use of non-peer reviewed information for COVID-19 pandemic by postgraduate trainee doctors is common.
Published: 2021

41. Aspergillosis and Mucormycosis in COVID-19 Patients: A Systematic Review

Author: Saira, Afzal and Mehreen, Nasir
Subjects: Male, SARS-CoV-2, Diabetes Mellitus, Aspergillosis, COVID-19, Humans, Mucormycosis, Female, Middle Aged
Abstract: Fungal infections have increased in number since the onset of this lethal pandemic. This study aimed to assess risk factors and case fatality in COVID-19 cases with aspergillosis or mucormycosis. A systematic review was done according to PRISMA guidelines. Databases used were Google scholar, Pakmedinet, PUBMED, and MEDLINE. Twenty-one case reports and case series of mucormycosis in COVID-19 patients were identified and the mean age was 56.3 years (36 men and 12 women). The most common comorbidity was diabetes and the site was rhino orbital mucormycosis. Case fatality of 48 combined cases was calculated to be 52%. Nineteen articles of aspergillosis were included. Diabetes was the most common comorbidity in cases. The number of affected men cases was more than women. The incidence of aspergillosis in critically sick COVID-19 patients was calculated to be 9.3%. Case fatality was calculated to be 51.2%. Screening can be a beneficial tool for decreasing morbidity and mortality. Key Words: COVID-19, Mucormycosis, Aspergillosis.
Published: 2021

42. Association of seeking ophthalmic assessment in children with parental history of refractive errors

Author: Muhammad Zahid, Latif, Muhammad Athar, Khan, Saira, Afzal, and Syed Amir, Gilani
Subjects: Ophthalmic examination, School children, education, Myopia, Astigmatism, Original Article, Refractive Errors
Abstract: Objective: To find out the association of seeking ophthalmic assessment in children with parental history of refractive errors. Methods: After the approval of ethical review board, an analytical cross-sectional study was conducted in eight high schools of public and private sector at Lahore during the period of seven months from August 2017 to March 2018. Multistage random sampling technique was opted and 2000 study subjects were recruited including 50% boys and 50% girls. Informed consent was obtained and data was collected on a structured questionnaire. The data was organized, entered in version 23 of IBM SPSS and analyzed by the use of statistical tools. Results: Age of the respondents ranged between nine to 18 years with a mean of 13.40 ± 1.82 SD. Parental history of wearing spectacles was present in 21.3% of the fathers and 28.6% of the mothers. Moreover, 72.4% of the participants never visited eye care professional. Among private schools, an association was found between the visit of boys to eye care professional and maternal positive history of wearing spectacles (p-value 0.019). A significant association was found between the positive paternal history of wearing spectacles and visit of the female strudy subjects to an eye care professional (p-value 0.001). In public schools, there was an association between visit of children to eye care services and positive history of mothers about the use of spectacles (p-value 0.018). Conclusions: This study concludes that positive maternal history of wearing spectacles is associated with the ophthalmic examination of children in both public and private school.
Published: 2019

43. Divergent synthesis and elaboration of structure activity relationship for quinoline derivatives as highly selective NTPDase inhibitor

Author: Gohar Zaman, Julie Pelletier, Jamshed Iqbal, Aamer Saeed, Saira Afzal, Abbas Hassan, Jean Sévigny, and Amna Murtaza
Subjects: Stereochemistry, Biochemistry, Isozyme, 03 medical and health sciences, chemistry.chemical_compound, Structure-Activity Relationship, 0302 clinical medicine, Drug Discovery, Structure–activity relationship, Humans, Enzyme Inhibitors, Molecular Biology, IC50, 030304 developmental biology, Adenosine Triphosphatases, 0303 health sciences, Dose-Response Relationship, Drug, Molecular Structure, Chemistry, Organic Chemistry, Quinoline, Apyrase, Highly selective, 030220 oncology & carcinogenesis, Nucleoside triphosphate, Quinolines, Selectivity, Divergent synthesis
Abstract: Quinoline derivatives have interesting biological profile. In continuation for the comprehensive evaluations of substituted quinoline derivatives against human nucleoside triphosphate diphosphohydrolases (h-NTPDases) a series of substituted quinoline derivatives (2a-g, 3a-f, 4, 5a-c, 6) was synthesized. The inhibitory activities of the synthesized compounds were evaluated against four isoenzymes of human nucleoside triphosphate diphosphohydrolases (h-NTPDases). These quinoline derivatives had IC50 (µM) values in the range of 0.20–1.75, 0.77–2.20, 0.36–5.50 and 0.90–1.82 for NTPDase1, NTPDase2, NTPDase3 and NTPDase8, respectively. The derivative 3f was the most active compound against NTPDase1 (IC50, 0.20 ± 0.02 µM) that also possessed selectivity towards NTPDase1. Similarly, derivative 3b (IC50, 0.77 ± 0.06), 2h (IC50, 0.36 ± 0.01) and 2c (IC50, 0.90 ± 0.08) displayed excellent activity corresponding to NTPDase2, NTPDase3 and NTPdase8. The compound 5c emerged as a selective inhibitor of NTPDase8. The most active compounds were then investigated to determine their mode of inhibition and finally binding interactions of the active compounds were analyzed through molecular docking studies. The obtained results strongly support the quinoline scaffold’s potential as potent and selective NTPDase inhibitor.
Published: 2021

44. Synthesis, characterization and biological evaluation of thiadiazole amide derivatives as nucleoside triphosphate diphosphohydrolases (NTPDases) inhibitors

Author: Peter Langer, Jean Sévigny, Dilawar Hussain, Sadia Abbas, Humaira Nadeem, Saira Afzal, Zaman Ashraf, and Jamshed Iqbal
Subjects: chemistry.chemical_classification, Adenosine Triphosphatases, P2Y receptor, Dose-Response Relationship, Drug, Molecular Structure, Organic Chemistry, Apyrase, Ligand (biochemistry), Biochemistry, Isozyme, Amides, Dephosphorylation, chemistry.chemical_compound, Structure-Activity Relationship, Enzyme, chemistry, Drug Discovery, Thiadiazoles, Extracellular, Nucleoside triphosphate, Humans, Nucleotide, Enzyme Inhibitors, Molecular Biology
Abstract: Importance of extracellular nucleotides is widely understood. These nucleotides act as ligand for P2X and P2Y receptors and modulate a variety of biological functions. However, their extracellular concentration is maintained by a chain of enzymes termed as ecto-nucleotidases. Amongst them, nucleoside triphosphate diphosphohydrolases (NTPDases) is an important enzyme family responsible for the dephosphorylation of these nucleotides. Overexpression of NTPDases leads to many pathological conditions such as cancer and thrombosis. So far, only a few NTPDase inhibitors have been reported. Considering this scarcity of (NTPDase) inhibitors, a number of thiadiazole amide derivatives were synthesized and screened against human (h)-NTPDases. Several compounds showed promising inhibitory activity; compound 5a (IC50 (µM); 0.05 ± 0.008) and 5g (IC50 (µM); 0.04 ± 0.006) appeared to be the most distinguished molecules corresponding to h-NTPDase1 and -2. However, h-NTPDase3 was the least susceptible isozyme and only three compounds (5d, 5e, 5j) strongly inhibited h-NTPDase3. Interestingly, compound 5e was recognized as the most active compound that showed dual inhibition against h-NTPDase3 as well as against h-NTPDase8. For better comprehension of binding mode of these inhibitors, most potent inhibitors were docked with their respective isozyme.
Published: 2021

45. Tracking development assistance for health and for COVID-19: a review of development assistance, government, out-of-pocket, and other private spending on health for 204 countries and territories, 1990–2050

Author: Junaid Khan, Blake Angell, Marcel Ausloos, Catherine M. Antony, Elham Ehsani-Chimeh, Edgar Denova-Gutiérrez, Kewal Krishan, Mohamed Kamal Mesregah, Arrigo Francesco Giuseppe Cicero, Simona Cătălina Ştefan, Tanuj Kanchan, Maysaa El Sayed Zaki, Mohamed I Hegazy, Richard James Maude, Salman Rawaf, Viktória Szerencsés, Milena Santric-Milicevic, Martin McKee, Reza Rawassizadeh, Anton C Harle, Neda Milevska Kostova, Hamidreza Pazoki Toroudi, Saravanan Muthupandian, Mohammad Hifz Ur Rahman, Hassan Abolhassani, Christine Mpundu-Kaambwa, Atta Abbas Naqvi, John Dube, Habib Benzian, Cristiano Piccinelli, Kedir Hussein Abegaz, Mohammad Khammarnia, Carlo Eduardo Medina-Solís, Tanvir M. Huda, Fakher Rahim, Modhurima Moitra, Valentin Yurievich Skryabin, Emily Joy Callander, David Laith Rawaf, Saeed Shahabi, Mohsen Bayati, Raffaele Palladino, Shahin Soltani, Mohammad Ali Mansournia, Rafael Lozano, Himal Kandel, João Vasco Santos, MA Garcia-Gordillo, Savita Lasrado, Alexey V Breusov, Nicola Luigi Bragazzi, Deepak Dhamnetiya, Mohammad Amin Bahrami, Teroj Abdulrahman Mohamed, Reinhard Busse, Veer Bala Gupta, Ionut Negoi, Xiaochen Dai, Eun-Cheol Park, Trang Huyen Nguyen, Gulrez Shah Azhar, Annie Haakenstad, Asadollah Gholamian, Vafa Rahimi-Movaghar, Subramanian Senthilkumaran, Ismaeel Yunusa, Hubert Amu, G. K. Mini, Francesco Saverio Violante, Michael Abdelmasseh, Yun Jin Kim, Yousef Moradi, Nataliya Foigt, Afshin Maleki, Pavanchand H Shetty, Mesfin Agachew Woldekidan, Ramesh Holla, Mina Anjomshoa, Seyyed Meysam Mousavi, Azeem Majeed, Bright Opoku Ahinkorah, Hassan Magdy Abd El Razek, Avirup Guha, Telma Zahirian Moghadam, Olayinka Stephen Ilesanmi, Alessandro Arrigo, Neda Kianipour, Marcos Roberto Tovani-Palone, Mosiur Rahman, Tomas Y Ferede, Catalina Liliana Andrei, Alaa Makki, Joseph L Dieleman, Shuhei Nomura, Kanwar Hamza Shuja, Ileana Heredia-Pi, Mukhammad David Naimzada, Ali Kazemi Karyani, Chisom Joyqueenet Akunna, Souranshu Chatterjee, Yonas Akalu, Hanadi Al Hamad, Abdollah Mohammadian-Hafshejani, Hayley N Stutzman, Getinet Ayano, Atte Meretoja, Fahad Alanezi, Aravind Thavamani, Sonu Bhaskar, Claudiu Herteliu, Andreea Mirica, Masood Ali Shaikh, Soewarta Kosen, Nelson J. Alvis-Zakzuk, Emma Elizabeth Spurlock, Ferrán Catalá-López, Samath D Dharmaratne, Stany W. Lobo, Alemayehu Hailu, Sebastian Vollmer, Tarik Ahmed Rashid, Sheikh Mohammed Shariful Islam, Lalit Dandona, Farahnaz Joukar, Jacob Olusegun Olusanya, Befikadu Legesse Wubishet, Sezer Kisa, Songhomitra Panda-Jonas, Nasir Umar, Adrian Otoiu, Yonas Getaye Tefera, Harapan Harapan, Ivo Iavicoli, Jakub Morze, Mihajlo Jakovljevic, Nicholas J K Breitborde, Ian E Cogswell, Mehdi Hosseinzadeh, Sadia Bibi, Stefan Kohler, Florian Fischer, Jagdish Khubchandani, Justice Nonvignon, Salah Eddin Karimi, Yousef Khader, Jan-Walter De Neve, Stanislav S. Otstavnov, Ruoyan Tobe-Gai, Tommi Vasankari, Carlos A Castañeda-Orjuela, Nahlah Elkudssiah Ismail, Khezar Hayat, Chythra R Rao, Priya Rathi, Asma Tahir Awan, Jean Jacques Noubiap, Salime Goharinezhad, Ai Koyanagi, Rafael Tabarés-Seisdedos, Angela E Micah, Rakhi Dandona, Jaykaran Charan, Lorainne Tudor Car, Michael R.M. Abrigo, Kenji Shibuya, Aziz Sheikh, B Reshmi, Rovshan Khalilov, Haroon Ahmed, Andrea Werdecker, Alberto Freitas, Tara Ballav Adhikari, Vasily Vlassov, Risky Kusuma Hartono, Leila Keikavoosi-Arani, Gyu Ri Kim, Ana Laura Manda, Carlos Alberto Marrugo Arnedo, Obinna Onwujekwe, Van C. Lansingh, Miklós Szócska, Gelin Xu, Ted R. Miller, Saad M.A. Dahlawi, Till Bärnighausen, Jagadish Rao Padubidri, Bernhard T. Baune, Fatemeh Pashazadeh Kan, Juan Sanabria, Bruno Ramos Nascimento, Stefano Olgiati, Navid Rabiee, Mark G. Shrime, Mayowa O. Owolabi, V. E. Nwatah, Tesleem Kayode Babalola, Ranil Jayawardena, Robert Kaba Alhassan, Takeshi Fukumoto, Lucero Cahuana-Hurtado, Aparna Ichalangod Narayana, Mohammad Ali Sahraian, Atif Amin Baig, Carl Abelardo T. Antonio, Jost B. Jonas, Dian Kusuma, Priyanga Ranasinghe, Mikhail Sergeevich Zastrozhin, Ali Bijani, Arash Ziapour, Seyed Behzad Jazayeri, Francesco Sanmarchi, Seyed Sina Naghibi Irvani, Allen Seylani, Theo Vos, Tuomo J. Meretoja, Delia Hendrie, Mostafa Amini-Rarani, Manthan D Janodia, Sathish Kumar Jayapal, Sorin Hostiuc, Marjan Ajami, Ali Gholamrezanezhad, Muhammad Aqeel, Muhammed Magdy Abd El Razek, Shaun Wen Huey Lee, Rawlance Ndejjo, Maarten J. Postma, Luis Camera, Chhabi Lal Ranabhat, Sadaf G. Sepanlou, Adnan Kisa, Tahira Ashraf, Tudorel Andrei, Mohammad Ali Jahani, Virginia Bodolica, Chuanhua Yu, Moses K. Muriithi, Pascual R. Valdez, Paul S. F. Yip, Demetris Lamnisos, Amir Masoud Rahmani, Hamed Zandian, Anna Aleksandrovna Skryabina, Yeong Yeh Lee, Sana Salehi, Syed Mohamed Aljunid, Kyle E. Simpson, Sami Almustanyir Almustanyir, Bogdan Oancea, Biswa Prakash Nayak, Omid Dadras, Fariborz Mansour-Ghanaei, Turki Alanzi, Mahaveer Golechha, Bach Xuan Tran, Lal B. Rawal, Shoaib Hassan, Rahul R. Zende, Sandhya Neupane Kandel, Martin Amogre Ayanore, Adam E. Berman, Long Khanh Dao Le, Dragos Virgil Davitoiu, Adithi Shetty, Getinet Kassahun, Birhanu Wubale Yirdaw, Usha Ram, Linh Gia Vu, Emilie R Maddison, Yosef Alemayehu, Ali H. Mokdad, Tomislav Mestrovic, Mavra A Riaz, Muhammad Naveed, Koustuv Dalal, Syed Amir Gilani, Reza Malekzadeh, Nikha Bhardwaj, Desta Debalkie Atnafu, Rohollah Kalhor, Naohiro Yonemoto, Ahmad Ghashghaee, Andre M. N. Renzaho, Amadou Barrow, Christopher J L Murray, Budi Aji, Maitreyi Sahu, Sara D Friedman, Konrad Pesudovs, Robert Reiner, Mohammad Rifat Haider, Mustafa Z. Younis, Aidin Abedi, Sanjay Basu, Nancy Fullman, Darrah McCracken, Rajasekaran Koteeswaran, Falk Schwendicke, Ionela-Roxana Glavan, Mohamed H Hassanein, Sindhura Lakshmi Koulmane Laxminarayana, Javad Nazari, Khurshid Alam, Bulat Idrisov, Nelson Alvis-Guzman, Mokhtar Mohammadi, Golnaz Heidari, Asif Hanif, Ghozali Ghozali, Vijay Kumar Chattu, Leila Doshmangir, Simiao Chen, Maha El Tantawi, Stephen S Lim, Bay Vo, Deepak Saxena, Jasvinder A. Singh, Robert Ancuceanu, Yves Miel H Zuniga, Kamal Hezam, Andrew T Olagunju, Sheikh Jamal Hossain, Lindsey E Wallace, Dejana Braithwaite, Sergio I. Prada, Adolfo Martinez-Valle, Brandon Cunningham, Vivek Gupta, Joseph Salama, Rezaul Karim Ripon, Bing-Fang Hwang, Mokhtar Mahdavi, Tamás Joó, Cristiana Abbafati, Behzad Karami Matin, Tushar Garg, Cyrus Alinia, Yingxi Zhao, Richard G. Wamai, Satoshi Ezoe, Anders Larsson, Seyedeh Zahra Masoumi, Arokiasamy Perianayagam, Sharareh Eskandarieh, Maciej Banach, Billingsley Kaambwa, Nader Jahanmehr, Saeed Amini, Foluke Adetola Ojelabi, Nikolay Ivanovich Briko, Samer Hamidi, Gaetano Isola, Tahereh Javaheri, Gbenga A. Kayode, Nikita Otstavnov, Vahid Yazdi-Feyzabadi, David M. Pereira, Mansour Ghafourifard, Saira Afzal, Ravi Prakash Jha, Erkin M. Mirrakhimov, Ahamarshan Jayaraman Nagarajan, Giang Thu Vu, G Anil Kumar, Vahit Yigit, Farshad Farzadfar, Anasthasia Zastrozhina, Shafiu Mohammed, Leticia Avila-Burgos, Nastaran Barati, Morteza Arab-Zozani, Eduardo A. Undurraga, Muktar Beshir Ahmed, Mohamed M. Gad, Mikk Jürisson, Himanshu Khajuria, Anas M. Saad, Mohammad Rabiee, Abdallah M. Samy, Srinivas Goli, Roman Topor-Madry, Golsum Tsakalos, Mariam Molokhia, Biruk Wogayehu Taddele, Mohammad Ali Moni, E S Abhilash, Timur Aripov, Sepideh Ahmadi, Mehdi Sayyah, Jorge Hugo Villafañe, Peter Andras Gaal, Babayemi O Olakunde, Brijesh Sathian, Anayat Ullah, Ritesh G. Menezes, Samad Azari, Ahmed I. Hasaballah, Soosanna Kumary Chattu, Pankaj Bhardwaj, Sanni Yaya, Zhi-Jiang Zhang, Jalal Arabloo, Saif Ullah, Akshaya Srikanth Bhagavathula, Bahram Mohajer, Ekaterina Vladimirovna Glushkova, Vinay Nangia, Shrikant Pawar, Moslem Soofi, Antonio Reis de Sá-Junior, Simon I. Hay, Miloje Savic, 2. Global Burden of Disease 2020 Health Financing Collaborator Network, Cicero AFG, Network, Global Burden of Disease 2020 Health Financing Collaborator, Bill & Melinda Gates Foundation, Micah, A. E., Cogswell, I. E., Cunningham, B., Ezoe, S., Harle, A. C., Maddison, E. R., Mccracken, D., Nomura, S., Simpson, K. E., Stutzman, H. N., Tsakalos, G., Wallace, L. E., Zhao, Y., Zende, R. R., Abbafati, C., Abdelmasseh, M., Abedi, A., Abegaz, K. H., Abhilash, E. S., Abolhassani, H., Abrigo, M. R. M., Adhikari, T. B., Afzal, S., Ahinkorah, B. O., Ahmadi, S., Ahmed, H., Ahmed, M. B., Ahmed Rashid, T., Ajami, M., Aji, B., Akalu, Y., Akunna, C. J., Al Hamad, H., Alam, K., Alanezi, F. M., Alanzi, T. M., Alemayehu, Y., Alhassan, R. K., Alinia, C., Aljunid, S. M., Almustanyir, S. A., Alvis-Guzman, N., Alvis-Zakzuk, N. J., Amini, S., Amini-Rarani, M., Amu, H., Ancuceanu, R., Andrei, C. L., Andrei, T., Angell, B., Anjomshoa, M., Antonio, C. A. T., Antony, C. M., Aqeel, M., Arabloo, J., Arab-Zozani, M., Aripov, T., Arrigo, A., Ashraf, T., Atnafu, D. D., Ausloos, M., Avila-Burgos, L., Awan, A. T., Ayano, G., Ayanore, M. A., Azari, S., Azhar, G. S., Babalola, T. K., Bahrami, M. A., Baig, A. A., Banach, M., Barati, N., Barnighausen, T. W., Barrow, A., Basu, S., Baune, B. T., Bayati, M., Benzian, H., Berman, A. E., Bhagavathula, A. S., Bhardwaj, N., Bhardwaj, P., Bhaskar, S., Bibi, S., Bijani, A., Bodolica, V., Bragazzi, N. L., Braithwaite, D., Breitborde, N. J. K., Breusov, A. V., Briko, N. I., Busse, R., Cahuana-Hurtado, L., Callander, E. J., Camera, L. A., Castaneda-Orjuela, C. A., Catala-Lopez, F., Charan, J., Chatterjee, S., Chattu, S. K., Chattu, V. K., Chen, S., Cicero, A. F. G., Dadras, O., Dahlawi, S. M. A., Dai, X., Dalal, K., Dandona, L., Dandona, R., Davitoiu, D. V., De Neve, J. -W., de Sa-Junior, A. R., Denova-Gutierrez, E., Dhamnetiya, D., Dharmaratne, S. D., Doshmangir, L., Dube, J., Ehsani-Chimeh, E., El Sayed Zaki, M., El Tantawi, M., Eskandarieh, S., Farzadfar, F., Ferede, T. Y., Fischer, F., Foigt, N. A., Freitas, A., Friedman, S. D., Fukumoto, T., Fullman, N., Gaal, P. A., Gad, M. M., Garcia-Gordillo, M. A., Garg, T., Ghafourifard, M., Ghashghaee, A., Gholamian, A., Gholamrezanezhad, A., Ghozali, G., Gilani, S. A., Glavan, I. -R., Glushkova, E. V., Goharinezhad, S., Golechha, M., Goli, S., Guha, A., Gupta, V. B., Gupta, V. K., Haakenstad, A., Haider, M. R., Hailu, A., Hamidi, S., Hanif, A., Harapan, H., Hartono, R. K., Hasaballah, A. I., Hassan, S., Hassanein, M. H., Hayat, K., Hegazy, M. I., Heidari, G., Hendrie, D., Heredia-Pi, I., Herteliu, C., Hezam, K., Holla, R., Hossain, S. J., Hosseinzadeh, M., Hostiuc, S., Huda, T. M., Hwang, B. -F., Iavicoli, I., Idrisov, B., Ilesanmi, O. S., Irvani, S. S. N., Islam, S. M. S., Ismail, N. E., Isola, G., Jahani, M. A., Jahanmehr, N., Jakovljevic, M., Janodia, M. D., Javaheri, T., Jayapal, S. K., Jayawardena, R., Jazayeri, S. B., Jha, R. P., Jonas, J. B., Joo, T., Joukar, F., Jurisson, M., Kaambwa, B., Kalhor, R., Kanchan, T., Kandel, H., Karami Matin, B., Karimi, S. E., Kassahun, G., Kayode, G. A., Kazemi Karyani, A., Keikavoosi-Arani, L., Khader, Y. S., Khajuria, H., Khalilov, R., Khammarnia, M., Khan, J., Khubchandani, J., Kianipour, N., Kim, G. R., Kim, Y. J., Kisa, A., Kisa, S., Kohler, S., Kosen, S., Koteeswaran, R., Koulmane Laxminarayana, S. L., Koyanagi, A., Krishan, K., Kumar, G. A., Kusuma, D., Lamnisos, D., Lansingh, V. C., Larsson, A. O., Lasrado, S., Le, L. K. D., Lee, S. W. H., Lee, Y. Y., Lim, S. S., Lobo, S. W., Lozano, R., Magdy Abd El Razek, H., Magdy Abd El Razek, M., Mahdavi, M. M., Majeed, A., Makki, A., Maleki, A., Malekzadeh, R., Manda, A. L., Mansour-Ghanaei, F., Mansournia, M. A., Marrugo Arnedo, C. A., Martinez-Valle, A., Masoumi, S. Z., Maude, R. J., Mckee, M., Medina-Solis, C. E., Menezes, R. G., Meretoja, A., Meretoja, T. J., Mesregah, M. K., Mestrovic, T., Milevska Kostova, N., Miller, T. R., Mini, G. K., Mirica, A., Mirrakhimov, E. M., Mohajer, B., Mohamed, T. A., Mohammadi, M., Mohammadian-Hafshejani, A., Mohammed, S., Moitra, M., Mokdad, A. H., Molokhia, M., Moni, M. A., Moradi, Y., Morze, J., Mousavi, S. M., Mpundu-Kaambwa, C., Muriithi, M. K., Muthupandian, S., Nagarajan, A. J., Naimzada, M. D., Nangia, V., Naqvi, A. A., Narayana, A. I., Nascimento, B. R., Naveed, M., Nayak, B. P., Nazari, J., Ndejjo, R., Negoi, I., Neupane Kandel, S., Nguyen, T. H., Nonvignon, J., Noubiap, J. J., Nwatah, V. E., Oancea, B., Ojelabi, F. A. O., Olagunju, A. T., Olakunde, B. O., Olgiati, S., Olusanya, J. O., Onwujekwe, O. E., Otoiu, A., Otstavnov, N., Otstavnov, S. S., Owolabi, M. O., Padubidri, J. R., Palladino, R., Panda-Jonas, S., Park, E. -C., Pashazadeh Kan, F., Pawar, S., Pazoki Toroudi, H., Pereira, D. M., Perianayagam, A., Pesudovs, K., Piccinelli, C., Postma, M. J., Prada, S. I., Rabiee, M., Rabiee, N., Rahim, F., Rahimi-Movaghar, V., Rahman, M. H. U., Rahman, M., Rahmani, A. M., Ram, U., Ranabhat, C. L., Ranasinghe, P., Rao, C. R., Rathi, P., Rawaf, D. L., Rawaf, S., Rawal, L., Rawassizadeh, R., Reiner Jr, R. C., Renzaho, A. M. N., Reshmi, B., Riaz, M. A., Ripon, R. K., Saad, A. M., Sahraian, M. A., Sahu, M., Salama, J. S., Salehi, S., Samy, A. M., Sanabria, J., Sanmarchi, F., Santos, J. V., Santric-Milicevic, M. M., Sathian, B., Savic, M., Saxena, D., Sayyah, M., Schwendicke, F., Senthilkumaran, S., Sepanlou, S. G., Seylani, A., Shahabi, S., Shaikh, M. A., Sheikh, A., Shetty, A., Shetty, P. H., Shibuya, K., Shrime, M. G., Shuja, K. H., Singh, J. A., Skryabin, V. Y., Skryabina, A. A., Soltani, S., Soofi, M., Spurlock, E. E., Stefan, S. C., Szerencses, V., Szocska, M., Tabares-Seisdedos, R., Taddele, B. W., Tefera, Y. G., Thavamani, A., Tobe-Gai, R., Topor-Madry, R., Tovani-Palone, M. R., Tran, B. X., Tudor Car, L., Ullah, A., Ullah, S., Umar, N., Undurraga, E. A., Valdez, P. R., Vasankari, T. J., Villafane, J. H., Violante, F. S., Vlassov, V., Vo, B., Vollmer, S., Vos, T., Vu, G. T., Vu, L. G., Wamai, R. G., Werdecker, A., Woldekidan, M. A., Wubishet, B. L., Xu, G., Yaya, S., Yazdi-Feyzabadi, V., Yigit, V., Yip, P., Yirdaw, B. W., Yonemoto, N., Younis, M. Z., Yu, C., Yunusa, I., Zahirian Moghadam, T., Zandian, H., Zastrozhin, M. S., Zastrozhina, A., Zhang, Z. -J., Ziapour, A., Zuniga, Y. M. H., Hay, S. I., Murray, C. J. L., and Dieleman, J. L.
Subjects: Economic growth, Financing, Government, International Cooperation, HN, HM, Global Health, Gross domestic product, International Agencies/economics, 0302 clinical medicine, RA0421, Per capita, Global health, Healthcare Financing, 11 Medical and Health Sciences, 2. Zero hunger, COVID 19, develompment assistance, health financing, projection 1995-250, INCOME, COVID-19, Development assistance, Health financing, COVID-19/economics, 1. No poverty, Public Health, Global Health, Social Medicine and Epidemiology, Articles, General Medicine, 3. Good health, Government Programs, Health Expenditures/statistics & numerical data, 030220 oncology & carcinogenesis, Transparency (graphic), QR180, Economic Development, International development, Life Sciences & Biomedicine, medicine.medical_specialty, Government Programs/economics, Gross Domestic Product, Context (language use), 03 medical and health sciences, Medicine, General & Internal, General & Internal Medicine, medicine, Humans, Developing Countries/economics, Developing Countries, Government, Science & Technology, Public health, COVID-19, development assistance, global health, Global Burden of Disease 2020 Health Financing Collaborator Network, International Agencies, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, Business, Global Health/economics, Health Expenditures, 030217 neurology & neurosurgery, RC, Financing, Government/economics
Abstract: Background The rapid spread of COVID-19 renewed the focus on how health systems across the globe are financed, especially during public health emergencies. Development assistance is an important source of health financing in many low-income countries, yet little is known about how much of this funding was disbursed for COVID-19. We aimed to put development assistance for health for COVID-19 in the context of broader trends in global health financing, and to estimate total health spending from 1995 to 2050 and development assistance for COVID-19 in 2020. Methods We estimated domestic health spending and development assistance for health to generate total health-sector spending estimates for 204 countries and territories. We leveraged data from the WHO Global Health Expenditure Database to produce estimates of domestic health spending. To generate estimates for development assistance for health, we relied on project-level disbursement data from the major international development agencies' online databases and annual financial statements and reports for information on income sources. To adjust our estimates for 2020 to include disbursements related to COVID-19, we extracted project data on commitments and disbursements from a broader set of databases (because not all of the data sources used to estimate the historical series extend to 2020), including the UN Office of Humanitarian Assistance Financial Tracking Service and the International Aid Transparency Initiative. We reported all the historic and future spending estimates in inflation-adjusted 2020 US$, 2020 US$ per capita, purchasing-power parity-adjusted US$ per capita, and as a proportion of gross domestic product. We used various models to generate future health spending to 2050. Findings In 2019, health spending globally reached $8. 8 trillion (95% uncertainty interval [UI] 8.7-8.8) or $1132 (1119-1143) per person. Spending on health varied within and across income groups and geographical regions. Of this total, $40.4 billion (0.5%, 95% UI 0.5-0.5) was development assistance for health provided to low-income and middle-income countries, which made up 24.6% (UI 24.0-25.1) of total spending in low-income countries. We estimate that $54.8 billion in development assistance for health was disbursed in 2020. Of this, $13.7 billion was targeted toward the COVID-19 health response. $12.3 billion was newly committed and $1.4 billion was repurposed from existing health projects. $3.1 billion (22.4%) of the funds focused on country-level coordination and $2.4 billion (17.9%) was for supply chain and logistics. Only $714.4 million (7.7%) of COVID-19 development assistance for health went to Latin America, despite this region reporting 34.3% of total recorded COVID-19 deaths in low-income or middle-income countries in 2020. Spending on health is expected to rise to $1519 (1448-1591) per person in 2050, although spending across countries is expected to remain varied. Interpretation Global health spending is expected to continue to grow, but remain unequally distributed between countries. We estimate that development organisations substantially increased the amount of development assistance for health provided in 2020. Continued efforts are needed to raise sufficient resources to mitigate the pandemic for the most vulnerable, and to help curtail the pandemic for all. For complete list of authors see http://dx.doi.org/10.1016/S0140-6736(21)01258-7
Published: 2021

46. 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

47. The Effect of COVID-19 Pandemic on Performance of Postgraduate Medical Trainee Doctors: A Nationwide Epidemiological Study in Pakistan

Author: Saira Afzal, Muhammad Hasan Masood, Khalid Masud Gondal, Fariha Salman, and Amber Arshad
Subjects: Adult, Male, medicine.medical_specialty, Telemedicine, Multivariate analysis, Cross-sectional study, MEDLINE, Comorbidity, Anxiety, Care provision, Autoimmune Diseases, Risk Factors, Physicians, Surveys and Questionnaires, Epidemiology, medicine, Humans, Pakistan, Pandemics, business.industry, Depression, SARS-CoV-2, COVID-19, General Medicine, medicine.disease, Cross-Sectional Studies, Education, Medical, Graduate, Family medicine, Female, medicine.symptom, business
Abstract: Objective To find out various organizational, personal, and systemic factors influencing the performance of the postgraduate trainee doctors in managing COVID-19 pandemic. Study design Analytical cross-sectional study. Place and duration of study Conducted in various medical institutions of Pakistan from 15th April to 30th June, 2020. Methodology An analytical cross-sectional study was conducted on 11,656 postgraduate doctors. They were contacted through the e-log system of College of Physicians and Surgeons Pakistan. Semi-structured questionnaire was used consisting of demographic details, presenting symptoms, systemic involvements, clinical features, diagnostic tests, management of cases, authenticity of the information used, telemedicine services, practice of preventive measures, training and interactive educational activities, performance-based tasks and details about workplace environment. Mean and standard deviation was reported for continuous variables. Bivariate and multivariate analyses were used to report p values. Results Among 11,656 postgraduate doctors, 3,193 (27.4%) were directly involved in the management of COVID-19 patients in designated special corona facilities. Multivariate analysis was performed to control confounders. The risk factors, found statistically significant with performance, were presence of comorbidity (OR 1.261; 95% C.I.1.06-1.50), allergic and autoimmune disorders (OR 1.18; 95% C.I.1.03-1.35), confirmed COVID-19 status due to exposure (OR 0.570; 95% C.I.0.41-0.81), and care provision to old parents (OR 1.299; 95% C.I.1.19-1.42). Conclusion The effect of COVID-19 on performance of postgraduate doctors was multi-factorial. Significant risk factors were presence of a comorbidity, allergic and autoimmune disorders, and confirmed COVID-19 due to exposure. Key Words: COVID 19, Postgraduate trainee, Pandemic, Comorbidity, PCR.
Published: 2020

48. Data Resource Profile: Understanding the patterns and determinants of health in South Asians - South Asia Biobank

Author: Jaspal S. Kooner, Anuradhani Kasturiratne, Malabika Sarker, Marisa Miraldo, Samreen Siddiqui, Fred Hersch, Rajendra Pradeepa, Sujeet Jha, Ranjit Mohan Anjana, Marie Loh, Franco Sassi, Malay K Mridha, Sophie E. Day, Garudam R Aarthi, Polly Page, Jonathan Valabhji, Mehedi Hasan, Soren Brage, Ian Y. Goon, Sara Mahmood, Rajan Kamalesh, John C. Chambers, Wnurinham Silva, Ananda R. Wickremasinghe, Peige Song, Khadija Irfan Khawaja, Gary Frost, Sajjad Ahmed, Nicholas J. Wareham, Baldeesh Rai, Ananya Gupta, Saira Afzal, Bridget A. Holmes, Prasad Katulanda, Dian Kusuma, Elisa Pineda, and Nita G. Forouhi
Subjects: education.field_of_study, Waist, business.industry, Population, Disease, medicine.disease, Biobank, Obesity, Environmental health, medicine, Medical history, Social determinants of health, education, business, Socioeconomic status
Abstract: Background and aimsThis paper describes the data resource profile of South Asia Biobank (SAB), which was set up in South Asia from November 2018 to March 2020, to identify the risk factors and their complex interactions underlying the development of type-2 diabetes mellitus, cardiovascular disease and other chronic diseases in South Asians.Data resource basicsThis cross-sectional population-based study has recruited 52713 South Asian adults from 118 surveillance sites at five centres of excellence in South Asia (Bangladesh, North India, South India, Pakistan and Sri Lanka). Structured assessments of participants included six complementary domains: i). Registration and consent; ii). Questionnaire (information on behavioural risk factors, personal and family medical history, medications, socioeconomic status); iii). Physical measurements (height, weight, waist and hip circumference and bio-impedance for body fat composition, blood pressure, cardiac evaluation, retinal photography, respiratory evaluation); iv). Biological samples (blood and urine); v). Physical activity monitoring and vi). Dietary intake by a 24-hour recall. Aliquots of whole blood, serum, plasma, and urine were put into storage at −80°C for further analysis.Key resultsThe prevalence of obesity is 6.6% in Bangladesh, 19.7% in India, 33.9% in Pakistan and 15.7% in Sri Lanka. The prevalence of diabetes is 11.5%, 27.7%, 25.3%, and 24.8%, and the prevalence of hypertension is 26.7%, 36.9%, 44.5%, 35.0% in Bangladesh, India, Pakistan and Sri Lanka respectively.Collaboration and data accessSAB is the first comprehensive biobank of South Asian individuals. Collected data are available to the global scientific community upon request.
Published: 2020

49. Loeffler's Endocarditis and the Diagnostic Utility of Multimodality Imaging

Author: Taha Ahmed, Saira Afzal, Talha Saleem, and Albert W. Chan
Subjects: medicine.medical_specialty, Diagnostic information, Endomyocardial fibrosis, Diastole, Cardiology, 030204 cardiovascular system & hematology, Allergy/Immunology, 03 medical and health sciences, 0302 clinical medicine, Cardiac magnetic resonance imaging, Internal medicine, Internal Medicine, Medicine, Eosinophilia, Endocarditis, loeffler’s endocarditis, medicine.diagnostic_test, business.industry, General Engineering, Restrictive cardiomyopathy, medicine.disease, cardiac mri, medicine.symptom, Transthoracic echocardiogram, business, transthoracic echocardiogram, eosinophilia, 030217 neurology & neurosurgery
Abstract: Loeffler's endocarditis is a rare form of restrictive cardiomyopathy associated with eosinophilia and endomyocardial fibrosis. It manifests most commonly as diastolic dysfunction or valvular abnormalities due to eosinophilic infiltration and degranulation. Herein, we chronicle a case of left ventricular involvement with Loeffler's endocarditis. We emphasize the utility of multimodality imaging including two-dimensional echocardiography and cardiac magnetic resonance imaging in providing diagnostic information, as there is no standardized diagnostic criteria to date.
Published: 2020

50. Message From

Author: Saira Afzal
Published: 2020
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