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1. Evaluation of building washing machines as an extreme environment for potentially pathogenic fungi

Author

Zahra Zareshahrabadi, Neda Amirzadeh, Keyvan Pakshir, Reza Nasr, Rasoul Mohammadi, and Kamiar Zomorodian

Subjects
Medicine, Science
Abstract

Abstract Washing machines are commonly used in households and are considered indispensable appliances for maintaining cleanliness and hygiene. Environmental conditions within household washing machines are ideal for fungal colonization, which may pose risks to human health and contribute to sick building syndrome. This study aimed to investigate the fungal species contamination in the building washing machines. A total of 50 building washing machines were swab-sampled at three locations: the detergent drawer, the inner and outer parts of the rubber door seal. The housekeeping conditions of these appliances were assessed through a questionnaire. The isolated fungi were identified using standard mycological diagnostic procedures and molecular analysis based on the ITS1/ITS4 and β-tubulin gene regions. The possibility of fungal agents transferring from contaminated washing machines to autoclaved clothes during laundry cycles was investigated. Fungi were detected in 82% of the sampled appliances, with the inner rubber door seal being the most frequently colonized area. Using conventional and molecular techniques, we identified 122 fungal isolates, encompassing 17 diverse genera of molds, yeast-like, and yeast fungi. The mold fungi included 14 genera of hyaline and black genus. Among these, the most frequently identified genera of hyaline and black fungi were Aspergillus (27.7%), and Cladosporium (10.7%), respectively. This study demonstrates that building washing machines may serve as suitable ecological niches for fungal growth and transmission. Therefore, regular cleaning and disinfection of these devices are necessary.

Published
2023
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2. Development of a high-resolution melt-based assay to rapidly detect the azole-resistant Candida auris isolates

Author

Hamid Morovati, Hamid Badali, Mahdi Abastabar, Keyvan Pakshir, Kamiar Zomorodian, Bahram Ahmadi, Behrouz Naeimi, Sadegh Khodavaysi, Sanam Nami, Esmaeel Eghtedar nejad, and Hossein Khodadadi

Subjects
azole resistance, candida auris, high-resolution melt curve analysis, mutation screening, real-time pcr, Internal medicine, RC31-1245, Biology (General), QH301-705.5
Abstract

Background and Purpose: Candida auris is a multidrug-resistant yeast that rapidly spreads, making it the leading Candidate for the next pandemic. One main leading cause of emerging resistant C. auris isolates is nonsynonymous mutations. This study aimed to detect the Y132F mutation, one of the most important azole resistance-associated mutations in the ERG-11 gene of C. auris, by developing a reliable high-resolution melt (HRM)-based method.Materials and Methods: Five C. auris isolates from Iran, plus three control isolates from other Clades were used in the study. The antifungal susceptibility testing through micro broth dilution was performed to recheck their susceptibility to three azole antifungals,including fluconazole, itraconazole, and voriconazole. Moreover, the polymerase chain reaction (PCR) sequencing of the ERG-11 gene was performed. Following the bioinformatic analysis and HRM-specific primer design, an HRM-based assay was developed and evaluated to detect ERG-11 mutations.Results: The minimum inhibitory concentrations of fluconazole among Iranian C. auris isolates ranged from 8 to 64 μg/mL. The PCR-sequencing of the ERG-11 gene and bioinformatic analyses revealed the mutation of Y132F, a substitution consequence of A to T on codon 395 in one fluconazole-resistant isolate (IFRC4050). The developed HRM assay successfully differentiated the targeted single nucleotide polymorphism between mutant and wild types (Melting temperature [Tm]: 81.79 ℃ - cycle threshold [CT]: 20.06 for suspected isolate). For both mutant and non-mutant isolates, the mean Tm range was 81.79-82.39 °C and the mean CT value was 20.06-22.93. These results were completely in accordance with the findings of DNA sequencing.Conclusion: The fast-track HRM-based method successfully detected one of the most common mechanisms of resistance in the ERG-11 gene of C. auris within 3 h. Finally, the development of more panels of HRM assays for the detection of all azole resistance mutations in C. auris ERG-11 is recommended to expand the scope of the field and facilitate the elaboration of rapid and accurate methods of antifungal resistance assessment.

Published
2023
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3. Vitamin D3: A Promising Antifungal and Antibiofilm Agent Against Candida Species

Author

Zahra Kherad, Somayeh Yazdanpanah, Farshid Saadat, Keyvan Pakshir, and Kamiar Zomorodian

Subjects
antifungal agent, biofilm, candidiasis, candida albicans, vitamin d3, Internal medicine, RC31-1245, Biology (General), QH301-705.5
Abstract

Background and Purpose: Candida species are opportunistic fungal pathogens that cause mild to life threatening infections in both immunocompetent and immunocompromised populations. The increasing prevalence of drug-resistant Candida species has posed a significant challenge to the management of infections in clinical settings. Therefore, this study aimed to investigate the direct antifungal and antibiofilm effect of vitamin D3 against Candida species.Materials and Methods: The antifungal activity of vitamin D3 was evaluated by broth microdilution method based on the Clinical and Laboratory Standard Institute. Prevention of biofilm formation by Candida albicans was measured using the XTT assay following exposure to different concentrations of vitamin D3. Moreover, expression of Agglutinin-like sequence gene 1 (ALS1), hyphal wall protein gene (HWP1), secreted aspartyl proteinase 6 gene (SAP6), and morphogenesis pathway regulatory gene (EFG1) were analyzed by real-time polymerase chain reaction using the comparative Ct method (ΔΔ Ct) after exposure to vitamin D3.Results: Vitamin D3 showed antifungal activity against Candida species ranging from 1-128 μg/mL. Furthermore, vitamin D3 inhibited biofilm formation in a dose-dependent manner, with IC50 of 7.5 μg/mL. Treatment with vitamin D3 resulted in significant upregulation of the EFG1, ALS1, and SAP6 genes under hypha-inducing conditions to overcome environmental challenges.Conclusion: Results of the current study demonstrated that vitamin D3 has a significant inhibitory effect on Candida growth and biofilm formation. Considering its demonstrated antifungal and antibiofilm properties, vitamin D3 holds promise as a potential agent for medical applications.

Published
2023
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4. In Vivo Antifungal Activity and Computational Studies of Some Azole Derivatives against Candida Albicans

Author

Leila Emami, Akram Jamshidzadeh, Soghra Khabnadideh, Keyvan Pakshir, Maryam Jamshidi, Shirin Rahat, Sepideh Arya, and Zahra Rezaei

Subjects
Chemistry, QD1-999
Abstract

Resistance of Candida species is a major problem in the management of Candida infection. This study investigated in vivo antifungal activities of several new imidazole and triazole derivatives in a C. albicans systemic infection. The efficacy of derivatives was determined against systemic infection by C. albicans in mice with cyclophosphamide-induced immunosuppression, and the antifungal activities of the synthesized compounds were evaluated in comparison with fluconazole. Compounds 3 and 8 had the highest efficacy with minimum inhibitory concentration (MIC) values of 0.5–1 μM against the C. albicans pathogen. In vivo activities in immunosuppressed mice were also greater than fluconazole. Furthermore, docking analysis was carried out to know the binding mode of imidazole and triazole derivatives to the CYP51 active site of C. albicans and dihydrofolate reductase as a valid antifungal target. The docking study found that the antifungal results are well correlated with docking results. ADMET and in silico physicochemical parameters were also performed. This study demonstrates that compounds 3 and 8 are potential antifungal candidates against the C. albicans pathogen.

Published
2023
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5. Molecular characterization and antifungal activity against non-dermatophyte molds causing onychomycosis

Author

Keyvan Pakshir, Mandana Kamali, Hasti Nouraei, Kamiar Zomorodian, Marjan Motamedi, and Mozhgan Mahmoodi

Subjects
Medicine, Science
Abstract

Abstract Onychomycosis is a fungal disease that caused by different types of fungi. Non-dermatophyte molds are a large saprophytic fungi group that live in nature and could affect traumatic nails. The aim of this study was to identify non-dermatophyte molds causing onychomycosis and evaluation of several antifungal activities against the isolates. The samples consisted of 50 non-dermatophyte molds isolated from patients with onychomycosis confirmed by direct and culture examination fungal. DNA was extracted, amplified, and sequenced. Disk diffusion method was used to evaluate itraconazole, fluconazole, ketoconazole, terbinafine, posaconazole, and econazole activity against the isolates. The species identified as: Aspergillus flavus 22 (44%), A. niger 12 (24%), A. fumigates, 3 (6%), A. sydowii 3 (6%), A. terreus 1 (2%), Penicillium commune 2 (4%), P. glabrum 2 (4%), P. chrysogenum, 1 (2%), Fusarium solani 3 (6%) and F. thapsinum 1 (2%). Most of the samples were sensitive to terbinafine, itraconazole, and econazole and 94% of the isolates were resistant to fluconazole. This study showed that Aspergillus species were the most common cause of non-dermatophyte mold onychomycosis and fluconazole was the most resistant antifungals. Care must be taken to choose the appropriate antifungal drug for a better cure.

Published
2021
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6. Chemical composition and antifungal activities of aromatic water of Zataria multiflora Boiss

Author

Ali Arabi Monfared, Maryam yazdanpanah, Zahra Zareshahrabadi, Keyvan Pakshir, Mehdi Ghahartars, Davood Mehrabani, Samira Yazdanpanah, Aida Iraji, and Kamiar Zomorodian

Subjects
aromatic water, antifungal property, candida albicans, essential oil, zataria multiflora boiss, Internal medicine, RC31-1245, Biology (General), QH301-705.5
Abstract

Background and Purpose: In Iranian culture, aromatic waters harboring a slight amount of essential oil have been popularly used for many years as a pleasant non-alcoholic drink with various medicinal properties.In this study, chemical composition of Zataria multiflora Boiss. (ZM) aromatic water was determined and its in vitro and in vivo antifungal properties were investigated.Materials and Methods: Chemical composition of the essential oil extracted from aromatic water (AW) of ZM was analyzed by Gas chromatography and gas chromatography-mass spectrometry (GC-MS). The antimicrobial activity of the AW against Candida species was determined by broth micro-dilution methods. Additionally, biofilm formation inhibition and antioxidant activity of the AW were measured using XTT reduction and DPPH methods, respectively. Antifungal activities of the AW in the prevention and/or treatment of gastrointestinal (GI) candidiasis in animal models were also evaluated.Results: The GC-MS analysis revealed that the major constituents of ZM AW were Carvacrol (46.56%) and Thymol (40.67%). The ZM AW inhibited the growth and biofilm formation of Candida species in the range of 0.25-0.5 V/V. Moreover, ZM AW significantly decreased Candida colonization in therapeutic groups (P

Published
2021
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7. Molecular identification of Malassezia species isolated from neonates hospitalized in Neonatal intensive care units and their mothers

Author

Kamiar Zomorodian, Maryam Naderibeni, Hossein Mirhendi, Mostajab Razavi Nejad, Seyed Mojtaba Saneian, Mozhgan Mahmoodi, mahboobeh kharazi, Hossein Khodadadi, Keyvan Pakshir, and Marjan Motamedi

Subjects
breastfeedings, malassezia, m. arunalokei, neonate, sequencing, Internal medicine, RC31-1245, Biology (General), QH301-705.5
Abstract

Background and Purpose: Given the important role of Malassezia spp. in skin diseasesand other associated infections in neonates, this study aimed to investigate the presenceand frequency of Malassezia spp. in the skin of neonates hospitalized in neonatalintensive care units and their mothers using culture and accurate molecular-basedmethods.Materials and Methods: In total, 205 samples were collected from 130 neonates (>4-day-old) and 75 mothers. Isolation of Malassezia spp. from the skin was performed usingLeeming-Notman agar and modified Dixon agar media. To compare the Malasseziamicroflora on the skin of the neonates and their mothers, a polymerase chain reactionsequencing method was performed for spp. identification of 92 isolates obtained fromneonates and their mothers. Moreover, possible associated risk factors for thecolonization of Malassezia spp. on the skin were recorded.Results: Cultures from 62.3% of neonates and 77.3% of mothers were positive forMalassezia spp. growth. Malassezia globosa was the most prevalent isolated spp. foundin the skin of the study population. It is noteworthy that a rare Malassezia spp.,Malassezia arunalokei, was isolated from the skin of one neonate. There was a 76%similarity between the mother-neonate isolate sequences results. The statistical analysisshowed that the type of feeding is a significant (P

Published
2021
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8. COVID‐19‐associated facial cutaneous mucormycosis superinfection: A potentially life‐threatening disease

Author

Zahra Zareshahrabadi, Amir Emami, Keyvan Pakshir, Amir Roudgari, Behzad Ghaffari, Tahere Rezaei, Golsa Shekarkhar, and Kamiar Zomorodian

Subjects
coronavirus infections, facial skin, fatal infection, mucormycosis, Medicine, Medicine (General), R5-920
Abstract

Abstract A 49‐year‐old male was involved in an accident and an abdominal computer tomographic examination revealed papillary renal cell carcinoma of the right kidney. During hospitalization, the patient was infected with COVID‐19. In the following COVID‐19 treatment, a black dot developed on the right side of the head and face. Antifungal therapy and surgical debridement were initiated and gradual improvement was observed.

Published
2022
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9. Climate changes and emerging fungal infections

Author

Hossein Khodadadi, Mohammad Taghizadeh, Firozeh Shabankareh, and Keyvan Pakshir

Subjects
candida auris, climate changes, fungal infections, global warming., Medicine (General), R5-920
Abstract

Background: Candida auris is a globally emerging yeast pathogen that has shown not only resistance to most anti-fungal drugs but also thermo-tolerance to temperatures higher than the mammalian’s body temperature. Although it has been only a decade since the fungus was identified, its spread of infections has been rapid and quasi-epidemics have been reported. Co-occurrences of the fungus infections in all five continents are one of the strangest aspects of this fungus. All isolates, despite slight genetic differences, belong to a common genetic ancestor. However, different clades appear to have independent evolutionary paths. We have discussed the relationship between the acquired thermal tolerance of C. auris and the environmental temperature changes with the genetic affinities of the isolates. Methods: This basic science survey was carried out at the Shiraz University of medical sciences from July to December 2019. Phylogenetic analysis was used to compare the temperature sensitivity of C. auris and the species with which it is genetically related. The sequences of Internal transcribed spacer (ITS) region and the growth temperature ranges for C. auris and yeasts belonging to the Candida haemulonis complex as well as other environmental yeasts isolated from different geographical areas of the world were randomly selected and evaluated. Their phylogenetic relationship was investigated with the mapping of the phylogenetic tree based on ITS sequences. Results: Study of temperature ranges which the fungi are capable of growing clearly shows that all species of C. auris can tolerate temperatures higher than the mammalian body temperature. Genetic distances, as well as geographic distances between species of C. auris are visible during phylogenetic studies. These results illustrate the possibility that, despite these distances, the temperature tolerance attribute for each C. auris clade was independently and under a common external pressure such as global warming. Conclusion: The results of this study have discussed the increased incidence of emerging fungal infections due to climate changes; however the role of other contributing factors in the spread of these infections needs further investigation.

Published
2020

10. Translation elongation factor 1-alpha gene as a marker for diagnosing of candidal onychomycosis

Author

Keyvan Pakshir, Forough Farazmand, Farnoush Ghasemi, Hossein Mirhendi, Kamiar Zomorodian, Mahboobeh Kharazi, Ramtin Alborzi pour, Hajar Golestani, and Marjan Motamedi

Subjects
candidal onychomycosis, pan-candida pcr assay, translation elongation factor 1-alpha, Internal medicine, RC31-1245, Biology (General), QH301-705.5
Abstract

Background and Purpose: Culture-based identification methods have been the gold standard for the diagnosis of candidal onychomycosis. Molecular technologies, such as polymerase chain reaction (PCR) assays, can provide an alternative for the rapid detection of Candida species. The present study was conducted to investigate a pan-Candida PCR assay based on the translation elongation factor 1-alpha (TEF-1α) gene for the detection of the most prevalent pathogenic Candida species. Materials and Methods: For the purpose of the study, an optimized pan-Candida PCR primer pair was designed, and the target was amplified and sequenced. The analytical and clinical diagnostic performance of the designed primers was tested using 17 reference strains, 137 nail scrapings suspected of onychomycosis, and 10 healthy nail specimens. Results: The use of the universal pan-Candida primers designed on TEF-1α gene resulted in the successful amplification of a 270-base pair fragment in all Candida species tested, except for C. glabrata, and reacted neither with other fungi nor with E. coli. The sequence difference count matrix showed poor insertion/deletion differences (0-2 nt) among Candida species. Among 137 nail specimens, 35% (n=48), 30.7% (n=42), and 40.1% (n=55) of the samples were found to be positive by direct microscopy, culture, and pan-Candida PCR, respectively. Conclusion: Based on the findings, the PCR-based detection targeting the DNA TEF-1α gene is a rapid and simple procedure for the diagnosis of candidal onychomycosis directly from nail sample.

Published
2020
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11. Evaluating the typing power of six isoenzymatic systems for differentiation of clinical and standard isolates of Candida species

Author

Gholamreza Hatam, Hamid Morovati, Marzieh Alikhani, Amir Rahimi, Keyvan Pakshir, Sara Amini, and Kamiar Zomorodian

Subjects
candida, electrophoresis, isoenzymes, mycological typing techniques, Medicine, Biology (General), QH301-705.5
Abstract

Background: Due to the increasing prevalence of candidiasis, early detection of the causative agents may pave the way for the management of this infection. The present study aimed to assess the discriminative power of the six isoenzymatic systems for differentiating the Candida species. Materials and Methods: Sixteen standard Candida albicans and Candida dubliniensis strains and 30 fluconazole-sensitive and fluconazole-resistant clinical strains of Candida albicans were analyzed using a Multilocus Enzyme Electrophoresis (MLEE) method, including six enzymatic systems consisting of malate dehydrogenase (MDH), phosphoglucomutase (PGM), glucose-phosphate isomerase (GPI), glucose-6-phosphate dehydrogenase (G6PDH), 6-phosphogluconate dehydrogenase (6PGD), and malic enzyme (ME). Results: Among the six enzymatic systems, ME showed no diagnostic activity, whereas MDH provided the best species-specific pattern for species discrimination. In addition, the MDH and G6PD systems provided a discriminatory pattern for differentiating C. dubliniensis from C. albicans isolates. The same isoenzymatic activity was detected in all 36 standard and clinical isolates. Moreover, the results showed no correlation between the isoenzymatic profiles and drug resistance. Conclusion: Among the investigated MLEE systems, MDH was able to differentiate between Candida albicans and Candida dubliniensis. Although no association was detected between isoenzyme patterns and fluconazole resistance in this investigation, isoenzyme patterns are likely correlated with virulence factors between species and even within species. To answer these questions, additional studies should be done on more strains.

Published
2023
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12. Chemical compositions and antifungal activities of Satureja macrosiphon against Candida and Aspergillus species

Author

Marjan Motamedi Motamedi, Mohammad Jamal Saharkhiz, Keyvan Pakshir, Sara Amini Akbarabadi, Marzieh Alikhani Khordshami, Fatemeh Asadian, Zahra Zareshahrabadi, and Kamiar Zomorodian

Subjects
essential oil, mtt assay, satureja macrosiphon, xtt assay, Internal medicine, RC31-1245, Biology (General), QH301-705.5
Abstract

Background and Purpose: Despite the various applications of Satureja species, there are limited data in this domain. Regarding this, the present study was conducted to investigate the essential oil (EO) biological activity of S. macrosiphon species in Iran. Materials and Methods: The EO of S. macrosiphon flowers was obtained by hydrodistillation. Chemical compositions of the EO were analyzed using gas chromatography-mass spectrometry. In addition, minimum inhibitory concentrations (MIC) were measured by means of the broth microdilution method. The estimation of antibiofilm and cytotoxic activities was also accomplished using the tetrazolium salt and MTT assays, respectively. Results: A total of 26 components were identified in the EO with linalool as the main constituent (28.46%). A MIC range value of 0.25-8 μL/mL was obtained against all of the tested fungi. The EO inhibited the biofilm development of the Candida tested strains at a concentration of 4-8 μL/mL. Cytotoxicity (IC50) of EO against the HeLa cell was greater than the MIC concentration (6.49 μL/mL). Conclusion: Based on the findings, it was concluded that the EO of S. macrosiphon has the potential for further use as an antifungal agent.

Published
2019
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13. Evaluation of biofilm formation in the homozygous and heterozygous strains of vaginal Candida albicans isolates

Author

Keyvan Pakshir, Sahar Sheykhi, Kamiar Zomorodian, Hasti Nouraei, and Zahra Zareshahrabadi

Subjects
biofilm, candida albicans, heterozygous, homozygous, virulence factor, Internal medicine, RC31-1245, Biology (General), QH301-705.5
Abstract

Background and Purpose: Candida albicans is one of the most opportunistic yeasts around the world. This species has two heterozygous and homozygous strains at hyphal wall protein 1 (hwp1) gene locus. A simple method for the discrimination of these two strains is the amplification of HWP1 gene. Regarding this, the aim of this study was to discriminate C. albicans heterozygous and homozygous strains via the amplification of hwp1 gene and evaluation of biofilm formation between the strains. Materials and Methods: A total of 60 homozygous (n=30) and heterozygous (n=30) strains were discriminated among 126 C. albicans vaginal isolates by the amplification of HWP1 gene, using specific primers. The evaluation of biofilm formation was accomplished using the visual method. Results: According to the results, the homozygous and heterozygous strains produced one and two DNA fragments, respectively. The frequency of homozygous strains among the C. albicans vaginal isolates was 76.2%. Biofilm formation activity in the heterozygous strains was more than that in the homozygous strains. However, statistical analysis showed no significant difference between the strains in terms of biofilm formation. Conclusion: As the findings indicated, the frequency of the heterozygous strains in C. albicans was lower than that of the homozygous strains. Both of the strains could form biofilm in the different ranges of severity. High activity of biofilm formation in heterozygous strains may set the ground for its pathogenicity.

Published
2019
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14. Comparative Analysis of Virulence Factors of Homozygous and Heterozygous Strains of Candida albicans Vaginal Isolates

Author

Hasti Nouraei, Sahar Sheykhi, Zahra ZareShahrabadi, Hossein Khodadadi, Kamiar Zomorodian, and Keyvan Pakshir

Subjects
Microbiology, QR1-502
Abstract

Although the epidemiology of pathogenic Candida species is changing due to invasive diseases, Candida albicans has become the common cause of human infections worldwide. Candida albicans is a diploid yeast with a mostly clonal mode of reproduction and without known complete sexual cycle. This species has two heterozygous and homozygous strains at hyphal wall protein 1 gene locus (hwp1). Little is known about virulence factors of these strains. The aim of this study was to evaluate the exoenzyme activity of heterozygous and homozygous C. albicans strains. A total of 60 stock Candida albicans species isolates, which consisted of 30 homozygous and 30 heterozygous strains, were used for exoenzyme activities. We used egg yolk agar, Sabouraud blood agar, and bovine serum albumin agar for evaluation of phospholipase, hemolysin, and proteinase activity, respectively. Homozygous strains of Candida albicans had more phospholipase and proteinase activity than heterozygous strains. However, there were no significant statistical differences between the two strains in the severity of exoenzymes production. Beta hemolysin activity was seen in 100% and 96.7% of the homozygous and heterozygous strains, respectively. The results of this study indicated that both of the strains exhibited exoenzyme activities in different ranges. There were no significant statistical differences in virulence factors between the homozygous and heterozygous strains.

Published
2020
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15. Proteolytic activity and cooperative hemolytic effect of dermatophytes with different species of bacteria

Author

Keyvan Pakshir, Tooba Mohammadi, Hossein khodadadi, Mohammad Motamedifar, kamiar Zomorodian, Saeideh Alipour, and Marjan Motamedi

Subjects
CAMP-like, Dermatophyte, Hemolysin, Proteolytic, Trichophyton mentagrophytes, Internal medicine, RC31-1245, Biology (General), QH301-705.5
Abstract

Background and Purpose: Globally, dermatophytes are the most common filamentous group of fungi causing cutaneous mycoses. Dermatophytes were shown to secrete a multitude of enzymes that play a role in their pathogenesis. There is limited data on co-hemolytic (CAMP-like) effect of different bacterial species on dermatophyte species. In this study, we sought to the evaluate exoenzyme activity and co-hemolytic effect of four bacteria on clinical dermatophytes isolated from patients in Shiraz, Iran. Materials and Methods: A total of 84 clinical dermatophyte species were isolated from patients suffering dermatophytosis and identified by conventional methods. Hemolytic activity was evaluated with Columbia 5% sheep blood agar. Proteolytic activity was determined by plate clearance assay method, using gelatin 8% agar. CAMP-like factor was evaluated with four bacteria, namely, S. areus, S. saprophyticus, S. pyogenes, and S. agalactiae. Fisher's exact test was run for statistical analysis. Results: T. mentagrophytes was the most predominant agent (27 [32.1%]) followed by T. verrucosum (20 [23.8%]), T. tonsurans (10 [11.9%]), Microsporum canis (7 [8.3%]), T. rubrum (6 [7.1%]), E. floccosum (6 [7.1%]), M. gypseum (5 [6%]), and T. violaceum (3[3.6%]). The most common clinical area of dermatophytosis was the skin. All the isolates expressed the zone of incomplete alpha hemolysis. All the isolates had CAMP - positive reaction with S. aureus and the other bacteria were CAMP-negative. All the isolates expressed proteolytic activity and no significant differences were noted among diverse genera of dermatophytes and severities of proteolytic activity. Conclusion: This study indicated that hemolysin and proteolytic enzymes potentially play a role in dermatophyte pathogenesis and S. aureus could be considered as a main bacterium for creation of co-hemolytic effect in association with dermatophyte species.

Published
2016

16. Evaluation of exoenzyme activities, biofilm formation, and co-hemolytic effect in clinical isolates of Candida parapsilosis species complex

Author

Keyvan Pakshir, Mostafa Ravandeh, Hossein Khodadadi, Mohamad Motamedifar, Kamiar Zomorodian, and Saeideh Alipour

Subjects
Biofilm, CAMP-like, Candida orthopsilosis, Candida parapsilosis, coagulase, Infectious and parasitic diseases, RC109-216
Abstract

Candida parapsilosis species complex is considered as important emerging pathogens and little is known about their pathogenicity factors and co-hemolytic activity with different bacteria species. The aim of this study was to determine in vitro exoenzyme activities, biofilm formation, and co-hemolytic effect of different bacteria species on clinical C. parapsilosis complex isolates. In total, 67 C. parapsilosis complex isolates consist of C. parapsilosis sensu stricto 63/67 and Candida orthopsilosis 4/67 were used in this study. To determine the hemolytic activity of these species, Sabouraud dextrose sheep blood agar was used. Evaluation of the CAMP-like phenomenon carried out in the presence of Staphylococcus aureus, Staphylococcus saprophyticus, Staphylococcus epidermidis, and Streptococcus agalactiae. Tube test method with ethylenediaminetetraacetic acid-rabbit plasma was used to determine coagulase activity, and biofilm formation was assessed by the tube method in assist of Sabouraud glucose broth (8%) medium. Fisher's exact tests were used for data statistical analysis. Sixty-six of 67 (98.5%) and 3/67 (4.5%) of the species showed hemolysin and coagulase activity, respectively. Fifty-five of 67 (82.1%) of species had ability for biofilm formation, and none of the samples exhibited co-hemolytic effect in the presence of four mentioned bacteria. No significant difference was found between the level of enzyme production and biofilm formation among the isolates.

Published
2018
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17. Molecular identification and in-vitro antifungal susceptibility testing of Candida species isolated from patients with onychomycosis

Author

Keyvan Pakshir, kamiar zomorodian, Alireza Zakaei, Marjan Motamedi, Mossa Rahimi Ghiasi, and Mohsen Karamitalab

Subjects
Candida albicans, Candida dubliniensis, Candida parapsilosis, Clotrimazole, Fluconazole, Onychomycosis, Voriconazole, Internal medicine, RC31-1245, Biology (General), QH301-705.5
Abstract

Background and Purpose: Candida species are the most opportunistic fungi affecting the nails and resulting in onychomycosis. In this study, we identified and evaluated in-vitro susceptibility of the recovered isolates against fluconazole (FLC), voriconazole (VRC), and clotrimazole (CLT) using the Clinical and Laboratory Standards Institute (CLSI) M27-A3 document. Materials and Methods: From patients with either clinically or mycologically proven onychomycosis, 97 isolates comprising of seven Candida species were isolated, which were identified by both conventional and molecular techniques such as polymerase chain reaction-restriction fragment length polymorphism. In addition, Candida dubliniensis was confirmed by restriction endonuclease analysis. Antifungal susceptibility of each isolate against the three azoles applied in this study was determined using the CLSI microdilution reference method M27-A3. Results: Candida parapsilosis (C. parapsilosis) was the most frequently isolated species (n=44), followed by C. albicans (n=23), C. tropicalis (n=13), C. glabrata (n=7), C. krusei (n=6), C. guilliermondii (n=3), and C. dubliniensis (n=1). All the isolates were susceptible to CLT. VRC had lower minimum inhibitory concentration (MIC) values for the isolates compared to FLC. Geometric mean MIC values of VRC, FLC, and CLT for C. parapsilosis isolates were 0.07 µg/ml, 0.8 µg/ml, and 0.35 µg/ml, respectively. Collectively, all species exhibited greater susceptibility to VRC in comparison to C. albicans (P≤0.001). Conclusion: This study showed that non-albicans Candida species were the most common etiologic agents of non-dermatophyte onychomycosis. The major antifungal agents used in clinics to empirically treat yeast onychomycosis are FLC and CLT. Our data suggested that CLT is a better choice for the treatment of Candida onychomycosis, especially in drug resistant cases.

Published
2015

18. Chemical Composition and Antimicrobial Activities of the Essential Oil From Leaves

Author

Kamiar Zomorodian PhD, Mahmoodreza Moein PhD, Keyvan Pakshir PhD, Forough Karami MS, and Zahra Sabahi PhD

Subjects
Other systems of medicine, RZ201-999, Homeopathy, RX1-681
Abstract

Resistance of many pathogens to available drugs is a global challenge and is leading to growing interest in natural alternative products. In this study, chemical composition and in vitro antibacterial and antifungal activities of the essential oil from Salvia mirzayanii were investigated. The chemical constituents of essential oil from S mirzayanii were analyzed by gas chromatography–mass spectrometry. The antimicrobial activity was determined by broth microdilution. The main identified compounds were 1,8-cineole (41.2 ± 1.3%), linalool acetate (11.0 ± 0.5%), and α-terpinyl acetate (6.0 ± 0.4%) (mL of essential oil/g of plant material). The MIC 95 were 0.03 to 0.5 µL/mL and 16 to 128 µL/mL for gram-positive and gram-negative bacteria, respectively. These results indicated that Salvia mirzayanii essential oil significantly inhibited the growth of standard and clinically isolated tested yeasts by MIC 50 0.03 to 1 µL/mL. Potent antibacterial and antifungal activities of Salvia mirzayanii essential oil may be considered in future study, particularly against antibiotic-resistant cases.

Published
2017
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19. Evaluation of CAMP-Like Effect, Biofilm Formation, and Discrimination of Candida africana from Vaginal Candida albicans Species

Author

Keyvan Pakshir, Mahboubeh Bordbar, Kamiar Zomorodian, Hasti Nouraei, and Hossein Khodadadi

Subjects
Infectious and parasitic diseases, RC109-216, Microbiology, QR1-502
Abstract

Candida africana as a species recovered from female genital specimens is highly close to C. albicans. The present study was conducted to discriminate C. africana from presumptive vaginal C. albicans strains by molecular assay and evaluate their hemolysin activity, biofilm formation, and cohemolytic effect (CAMP) with vaginal bacterial flora. A total of 110 stock vaginal C. albicans isolates were examined by HWP1 gene amplification. Hemolysin activity and the ability of biofilm formation were evaluated by blood plate assay and visual detection methods, respectively. Staphylococcus aureus, Staphylococcus epidermidis, and Streptococcus agalactiae were used to evaluate the CAMP-like effects in Sabouraud blood agar media. Based on the size of the amplicons (941 bp), all isolates were identified as C. albicans. All samples were able to produce beta-hemolysin. Moreover, 69 out of 110 of the isolates (62.7%) were biofilm-positive, 54 out of 110 Candida isolates (49%) demonstrated cohemolytic effects with S. agalactiae, and 48 out of 110 showed this effect with S. aureus (43.6%). All isolates were CAMP-negative with S. epidermidis. We detected all isolates as Candida albicans and almost half of the isolates were CAMP-positive with S. aureus and S. agalactiae, suggesting that these bacteria increase the pathogenicity of Candida in vaginal candidiasis.

Published
2017
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20. The effect of seating preferences of the medical students on educational achievement

Author

Kamiar Zomorodian, Mohammad Parva, Iman Ahrari, Samar Tavana, Camellia Hemyari, Keyvan Pakshir, Peyman Jafari, and Ali Sahraian

Subjects
seating position, educational achievement, class attendance, education, medical student, architecture, Special aspects of education, LC8-6691, Medicine (General), R5-920
Abstract

Background: The seat selection and classroom dynamics may have mutual influence on the student performance and participation in both assigned and random seating arrangement. Purpose: The aim of the study was to understand the influence of seat selection on educational achievement. Methods: The seating positions of the medical students were recorded on an architectural plan during each class session and the means and standard deviations of the students’ locations were calculated in X and Y orientations. The locations of the students in the class were analyzed based on three architectural classifications: interactional zone, distance from the board, and access to the aisles. Final exam scores were used to measure the students’ educational achievement. Results: Our results demonstrate that there is a statistically significant relationship between the student's locations in the class and their attendance and educational achievements. Conclusion: Two factors may effect on educational achievement: student seating in the high interactional zone and minimal changes in seating location. Seating in the high interaction zone was directly associated with higher performance and inversely correlated with the percentage of absences. This observation is consistent with the view that students in the front of the classroom are likely more motivated and interact with the lecturer more than their classmates.

Published
2012
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21. Ergonomic Intervention Effect in Reducing Musculoskeletal Disorders in Staff of Shiraz Medical School

Author

Keyvan Pakshir, Mohammad Mehdi Movahedi, Saeid Shaban Sarvestani, Peyman Jafari, Fakhroddin Naghib-Alhosseini, Mostafa Shidmosavi, Fakhroddin Mesbah, Alireza Choobineh, and Marzieh Sadat Tozihian

Subjects
Ergonomic Intervention, Musculoskeletal Disorders, Medical School, QEC, RULA., Medicine
Abstract

Background and aims: High percentage of musculoskeletal disorders occurs due to awkward working posture and poor workstation design. So this study was conducted to determine the prevalence rate of musculoskeletal disorders , evaluate workstations and investigate the effectiveness of ergonomic interventional measures among medical school staff of Shiraz University of Medical Sciences (SUMS). Methods: In this interventional study, 200 employees of different units of medical school of SUMS participated. They were randomly divided into experimental and control groups. Data were collected via anonymous questionnaire, RULA and QEC techniques as well as an ergonomic workstation checklist that was used to evaluate working conditions. Results: The results showed that after conducting interventional program for the experimental group there was a significant relationship between employees' increased awareness of ergonomics and workstation improvement (p≤0.05). Additionally, the prevalence rate of reported musculoskeletal disorders in experimental group was significantly reduced following intervention (p≤0.05). After corrective measures, level of risk was decreased and working postures were improved. A significant relationship was observed between risk levels and neck and shoulder pain in the experimental group (p≤0.05) . Following the intervention, workstations scores were increased significantly. Conclusion: On the basis of the findings of this study, it could be noted that the ergonomic interventional program was effective to improve working posture and workstations as well as to reduce the prevalence of musculoskeletal disorders among the staff.

Published
2012

22. A Comparative Study on the Therapeutic Effect of the Propolis Vaginal Cream and Clotrimazole on Candida Vulvovaginitis in Reproductive Aged Women

Author

Mahsa Sadat Mousavi, Tahereh Keshavarz, Hashem Montaseri, Keyvan Pakshir, Maryam Yazdani, Najaf Zare, and Hooshang Afrouzan

Subjects
Propolis, Clotrimazole, Candidiasis vulvoginitis, Medicine, Medicine (General), R5-920
Abstract

Background: Candidiasis vulvoginitis is the second prevalent infection of the vagina; azole topical drugs are the most common methods of treatment. Due to the frequent recurrence of the disease, many women desire to use herbal therapy. Propolis is among these therapies which it's anti-fungal property has been proved. This study was carried out to compare the effect of Propolis vaginal cream with clotrimazole on the treatment results of candidiasis vulvoginitis in reproductive aged women . Methods: This clinical trial was conducted on 100 ladies at fertility age for a period of 8 months. From the viewpoint of clinical complaints and laboratory culture, all the patients were diagnosed to be afflicted and underwent treatment in two groups of 50 individuals each with clotrimazole and Propolis randomly. The results were compared after 10 days of therapy and reculturing. Finding: The itching and cheesy leukorrhea was recovered in 92.0% and 68.0% of the patients treated with clotrimazole and Propolis, respectively with a significant statistically diference. Propolis had a weak effect on the improvement of the patients' complaints as compared to clotimazole. From the viewpoint of the reduction of colony, no significant statistical difference was observed. That is, in reducing the colony, Propolis had the same effect as that of clotrimazole. Conclusion: Considering the same effect of both drugs in reducing the colony, Propolis can be used as a complimentary treatment besides the main therapy.

Published
2011

23. Design, Synthesis, and Biological Activity of New Triazole and Nitro-Triazole Derivatives as Antifungal Agents

Author

Hossein Sadeghpour, Soghra Khabnadideh, Kamiar Zomorodian, Keyvan Pakshir, Khadijeh Hoseinpour, Nabiollah Javid, Ehsan Faghih-Mirzaei, and Zahra Rezaei

Subjects
fluconazole, synthesis, antifungal, lanosterol 14α-demethylase, docking, nitrotriazole, Organic chemistry, QD241-441
Abstract

In this study two series of fluconazole derivatives bearing nitrotriazole (series A) or piperazine ethanol (series B) side chain were designed and synthesized and then docked in the active site of lanosterol 14α-demethylase enzyme (1EA1) using the Autodock 4.2 program (The scripps research institute, La Jolla, CA, USA). The structures of synthesized compound were confirmed by various methods including elemental and spectral (NMR, CHN, and Mass) analyses. Then antifungal activities of the synthesized compound were tested against several natural and clinical strains of fungi using a broth microdilution assay against several standard and clinical fungi. Nitrotriazole derivatives showed excellent and desirable antifungal activity against most of the tested fungi. Among the synthesized compounds, 5a–d and 5g, possessing nitrotriazole moiety, showed maximum antifungal activity, in particular against several fluconazole-resistant fungi.

Published
2017
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24. Chemical composition and antimicrobial activities of essential oil of nepeta cataria L. Against common causes of oral infections.

Author

Kamiar Zomorodian, Mohammad Jamal Saharkhiz, Mohammad Javad Rahimi, Samaneh Shariatifard, Keyvan Pakshir, and Reza Khashei

Subjects
Anti-infective Agents, Candida, Enterococcus, Mouth, Nepeta Cataria, Staphylococcus, Dentistry, RK1-715
Abstract

Over the past two decades, there has been a growing trend in using oral hygienic products from natural resources such as essential oils and plant extracts. Nepeta cataria L. is a member of the mint family (Labiatae) with several medicinal properties. The objective of this study was to determine the chemical composition and antimicrobial activities of essential oils (EOs) from N. cataria leaves against pathogens causing oral infections.The chemical composition of EOs from N. cataria was analyzed by gas chromatography/mass spectrometry (GC/MS). The antimicrobial activity of the essential oil was evaluated by broth micro-dilution in 96 well plates as recommended by the Clinical and Laboratory Standards Institute (CLSI) methods. The plates were incubated at 30°C for 24-48 h (fungi) or at 37°C for 24 h (bacteria).The analysis of the EOs indicated that 4a-α, 7-α, 7a-β-nepetalactone (55-58%), and 4a-α, 7-β, 7a-α-nepetalactone (30-31.2%) were the major compounds of the EOs at all developmental stages. The tested EOs exhibited antimicrobial activities against the tested bacteria at concentrations of 0.125-4 μL/mL. Moreover, the oils entirely inhibited the growth of Candida species at a concentration less than 1 μL/mL.Based on these results, the EO of N. cataria can possibly be used as an antimicrobial agent in the treatment and control of oral pathogens.

Published
2013

25. The concentration of aflatoxin M 1 in the mothers′ milk in Khorrambid City, Fars, Iran

Author

Hossein Rafiei, Parvin Dehghan, Keyvan Pakshir, Mostafa Chadegani Pour, and Mojtaba Akbari

Subjects
Aflatoxin M 1, enzyme-linked immunosorbent assay, milk, mothers, mycotoxins, Medicine, Biology (General), QH301-705.5
Abstract

Introduction: Aflatoxins are secondary toxic metabolites produced by certain group of Aspergillus species in suitable conditions. These toxins are highly toxic, immunosuppressive, mutagenic, teratogenic and carcinogenic metabolites. The purpose of this study was to detection aflatoxin M 1 concentration in mother′s milk from rural area of Khorrambid town of Fars Province. Materials and Methods: In this study, 87 milk samples of mothers were collected by cluster sampling methods in the period between June and July 2011 and the amount of aflatoxin M 1 was measured by a competitive ELISA method. Results: From 87 mother′s milk, 24 (27.6%) samples were contaminated with aflatoxin M 1 with mean concentration of 0.56 ΁ 1.23 pg/ml (range 0.13-4.91 pg/ml). Conclusion: The amount of aflatoxin M 1 in mothers′ milk was lower than 50 ng/l (Europe Union and Iranian standard). Detection of Aflatoxin M 1 in mothers′ milk is due to consuming contaminated food. This contamination not only threatens the health of the mothers but also has irreversible effects on the growth and health of their babies.

Published
2014
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26. Effect of air pollution on disease burden, mortality, and life expectancy in North Africa and the Middle East: a systematic analysis for the Global Burden of Disease Study 2019

Author

Mohsen Abbasi-Kangevari, Mohammad-Reza Malekpour, Masoud Masinaei, Sahar Saeedi Moghaddam, Seyyed-Hadi Ghamari, Zeinab Abbasi-Kangevari, Negar Rezaei, Nazila Rezaei, Ali H Mokdad, Mohsen Naghavi, Bagher Larijani, Farshad Farzadfar, Christopher J L Murray, Amirali Aali, Sina Abdollahzade, Salam Abdulqadir Abdulrahman, Hiwa Abubaker Ali, Aqeel Ahmad, Rizwan Ahmad, Ali Ahmadi, Mohammad Ahmadian, Haroon Ahmed, Tarik Ahmed Rashid, Marjan Ajami, Hanadi Al Hamad, Fadwa Alhalaiqa Naji Alhalaiqa, Vahid Alipour, Sami Almustanyir, Javad Aminian Dehkordi, Sohrab Amiri, Jalal Arabloo, Judie Arulappan, Zahra Aryan, Seyyed Shamsadin Athari, Sina Azadnajafabad, Nayereh Baghcheghi, Farshad Bahrami Asl, Ovidiu Constantin Baltatu, Azadeh Bashiri, Akshaya Srikanth Bhagavathula, Ali Bijani, Saeid Bitaraf, Michael Brauer, Maria Cheraghi, Saad M A Dahlawi, Abdollah Dargahi, Reza Darvishi Cheshmeh Soltani, Mostafa Dianatinasab, Milad Dodangeh, Ebrahim Eini, Maysaa El Sayed Zaki, Hassan El-Abid, Muhammed Elhadi, Sharareh Eskandarieh, Shahab Falahi, Mohammad Fareed, Ali Fatehizadeh, Mehdi Fazlzadeh, Farhad Ghamari, Reza Ghanbari, Ahmad Ghashghaee, Abdolmajid Gholizadeh, Mohamad Golitaleb, Gholamreza Goudarzi, Mostafa Hadei, Randah R Hamadeh, Samer Hamidi, Ahmed I Hasaballah, Hamidreza Hasani, Soheil Hassanipour, Kamal Hezam, Mohammad Hoseini, Mohammad-Salar Hosseini, Mehdi Hosseinzadeh, Soodabeh Hoveidamanesh, Jalil Jaafari, Hosna Janjani, Sathish Kumar Jayapal, Laleh R Kalankesh, Rohollah Kalhor, Samad Karkhah, Neda Kaydi, Yousef Saleh Khader, Morteza Abdullatif Khafaie, Javad Khanali, Moawiah Mohammad Khatatbeh, Ali Koolivand, Mohammed Kuddus, Faris Hasan Lami, Soleiman Mahjoub, Afshin Maleki, Ahmad Azam Malik, Sahar Masoudi, Ritesh G Menezes, Shabir Ahmad Mir, Ashraf Mohamadkhani, Esmaeil Mohammadi, Mohammad Javad Mohammadi, Mokhtar Mohammadi, Fateme Montazeri, Paula Moraga, Negar Morovatdar, Abbas Norouzian Baghani, Keyvan Pakshir, Hamidreza Pazoki Toroudi, Meghdad Pirsaheb, Ashkan Pourabhari Langroudi, Fakher Rahim, Mehran Rahimi, Shayan Rahmani, Sina Rashedi, Azad Rasul, Elrashdy Moustafa Mohamed Redwan, Mohsen Rezaeian, Saeid Sadeghian, Amirhossein Sahebkar, Mohammad Ali Sahraian, Payman Salamati, Hedayat Salari, Abdallah M Samy, Brijesh Sathian, Kiomars Sharafi, Ali Sheikhy, Parnian Shobeiri, Zahra Shokri Varniab, Seyed Afshin Shorofi, Ensiyeh Taheri, Sahel Valadan Tahbaz, Siavash Vaziri, Mehdi Vosoughi, Kheirollah Yari, Arzu Yigit, Vahit Yigit, Leila Zaki, Iman Zare, Ahmad Zarei, and Zahra Zareshahrabadi

Subjects
Health (social science), Health Policy, Public Health, Environmental and Occupational Health, Medicine (miscellaneous)
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 Getnet Kassa, Nicholas J Kassebaum, Patrick DMC Katoto, Mohammad Keykhaei, Himanshu Khajuria, Abbas Khan, Imteyaz A Khan, Maseer Khan, Md Nuruzzaman Khan, Moien AB Khan, Moawiah Mohammad Khatatbeh, Mona M Khater, Hamid Reza Khayat Kashani, Jagdish Khubchandani, Hanna Kim, Min Seo Kim, Ruth W Kimokoti, Niranjan Kissoon, Sonali Kochhar, Farzad Kompani, Soewarta Kosen, Parvaiz A Koul, Sindhura Lakshmi Koulmane Laxminarayana, Fiorella Krapp Lopez, Kewal Krishan, Vijay Krishnamoorthy, Vishnutheertha Kulkarni, Naveen Kumar, Om P Kurmi, Ambily Kuttikkattu, Hmwe Hmwe Kyu, Dharmesh Kumar Lal, Judit Lám, Iván Landires, Savita Lasrado, Sang-woong Lee, Jacopo Lenzi, Sonia Lewycka, Shanshan Li, Stephen S Lim, Wei Liu, Rakesh Lodha, Michael J Loftus, Ayush Lohiya, László Lorenzovici, Mojgan Lotfi, Ata Mahmoodpoor, Mansour Adam Mahmoud, Razzagh Mahmoudi, Azeem Majeed, Jamal Majidpoor, Alaa Makki, Galana Ayana Mamo, Yosef Manla, Miquel Martorell, Clara N Matei, Barney McManigal, Entezar Mehrabi Nasab, 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 Upadhyay, Sahel Valadan Tahbaz, Pascual R Valdez, Jef Van den Eynde, H. 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. Magnetic chitosan nanoparticles loaded with Amphotericin B: Synthesis, properties and potentiation of antifungal activity against common human pathogenic fungal strains

Author

Zahra, Zareshahrabadi, Mohammad, Khorram, Keyvan, Pakshir, Ali-Mohammad, Tamaddon, Mahboobeh, Jafari, Hasti, Nouraei, Niloofar Torabi, Ardekani, Neda, Amirzadeh, Cambyz, Irajie, Alireza, Barzegar, Aida, Iraji, and Kamiar, Zomorodian

Subjects
Chitosan, Antifungal Agents, Structural Biology, Amphotericin B, Magnetic Phenomena, Spectroscopy, Fourier Transform Infrared, Candida albicans, Humans, Nanoparticles, General Medicine, Hemolysis, Molecular Biology, Biochemistry
Abstract

Amphotericin B has long been regarded as the gold standard for treating invasive fungal infections despite its toxic potential. The main objective of this research was to develop a novel IONPs@CS-AmB formulation in a cost-effective manner in order to enhance AmB delivery performance, with lowering the drug's dose and adverse effects. The chitosan-coated iron oxide nanoparticles (IONPs@CS) were synthesized afterward, AmB-loaded IONPs@CS (IONPs@CS-AmB) prepared and characterized by AFM, FT-IR, SEM, EDX, and XRD. Biological activity of the synthesized NPs determined and the cytotoxicity of IONPs@CS-AmB evaluated using the MTT and in vitro hemolysis tests. The IONPs@CS-AmB was synthesized using the coprecipitation method with core-shell structure in size range of 27.70 to ∼70 nm. The FT-IR, XRD and EDX pattern confirmed the successful synthesis of IONPs @CS-AmB. The IONPs@CS-AmB exhibited significant antifungal activity and inhibited the metabolic activity of Candida albicans biofilms. The hemolysis and MTT assays showed that IONPs@CS-AmB is biocompatible with high cell viability when compared to plain AmB and fungizone. The IONPs@CS-AmB is more effective, less toxic and may be a suitable alternative to conventional drug delivery. IONPs@CS-AmB may be a viable candidate for use as a microbial-resistant coating on the surfaces of biomedical devices.

Published
2022

30. Accompanying a semi-nested PCR assay to support histopathology findings of fungal keratitis in formalin-fixed paraffin-embedded corneal samples

Author

Mohammad Javad Ashraf, Foroogh Shamsizadeh, Hamid Morovati, Safoora Hejazinia, Mohammad Kord, Saham Ansari, Keyvan Pakshir, Golsa Shekarkhar, and Kamiar Zomorodian

Subjects
Microbiology (medical), Medical Laboratory Technology, Biochemistry (medical), Clinical Biochemistry, Public Health, Environmental and Occupational Health, Immunology and Allergy, Hematology
Abstract

Fungal species are responsible for 40%-50% of all microbial keratitis cases. Due to the low amount of extracted DNA in ocular Formalin-fixed Paraffin-embedded (FFPE) samples, selecting a reliable molecular method is a substantial issue in this field.Sixty-six samples were collected via the penetrating keratoplasty (PK) technique. Histopathology assays were performed using hematoxylin-eosin (HE) and periodic acid Schiff (PAS) staining methods. The ITS1/ITS4 and ITS1/ITS2 primer pairs were used in a semi-nested polymerase chain reaction (PCR) to target the universal internal transcribed spacer (ITS) region. Some PCR results were validated through sequencing.Fungal DNA was detected in 44 of 66 samples (66.7%), and histopathology was positive for 41 of 66 samples (62.1%). Of 41 histopathologically proven fungal-positive cases, 39 were PCR-positive (95%). Moreover, of 44 PCR-positive samples, 39 (88.6%) were histopathology-positive, and 5 (11.3%) were histopathology-negative. Totally in 39 cases (59%), both histopathology and PCR yielded positive results. The Kappa agreement rate between the two diagnostic methods, including histopathology and PCR, was 0.77. Sensitivity, specificity, positive predictive value, and false predictive value were reported as 88.64%, 90.9%, 95.12%, and 80%, respectively.As we reached the acceptable Kappa agreement rate, we concluded that applying the semi-nested PCR assay is a promising method for supporting the evidence by histopathology. Finally, we suggest targeting more specific gene regions using primer pairs that amplify smaller amplicon sizes and surveying novel molecular methods such as NGS to achieve higher sensitivity and Kappa agreement rates.

Published
2022

32. Potential Pathogenicity of Candida Species Isolated from Oral Cavity of Patients with Diabetes Mellitus

Author

Mehdi Ghaderian Jahromi, Hasti Nouraei, Leila Razeghian Jahromi, Keyvan Pakshir, and Kamiar Zomorodian

Subjects
0301 basic medicine, education.field_of_study, Article Subject, General Immunology and Microbiology, 030106 microbiology, Population, Virulence, 030209 endocrinology & metabolism, Hemolysin, General Medicine, Biology, biology.organism_classification, Esterase, General Biochemistry, Genetics and Molecular Biology, Corpus albicans, Microbiology, Agar plate, 03 medical and health sciences, 0302 clinical medicine, biology.protein, Medicine, Exoenzyme, Candida albicans, education
Abstract

Introduction. In the recent decade, the increased immunocompromised population such as diabetic patients makes a high incidence of invasive Candida infections. Diabetes mellitus is the most common endocrine metabolic disorder, and diabetic patients are more susceptible to oral candidiasis infection. Candidiasis is an opportunistic fungal infection caused by many species of Candida. Secretion of exoenzymes plays an important role in the virulence and pathogenesis of Candida species. The aim of this study was to evaluate the potential role of phospholipase, esterase, and hemolytic activity of Candida species isolated from oral cavity lesions of diabetic patients. Methods. A total of 108 Candida species including 75 Candida albicans and 33 non-Candida albicans species were recovered from the oral cavity of diabetic patients included in our study. Egg yolk agar, Tween 80 opacity medium, and blood agar plate assays were used for determining phospholipase, esterase, and hemolytic activities, respectively. Results. Candida albicans species had the most exoenzyme activity in comparison to non-albicans isolates. Candida albicans isolates showed 97.3%, 100%, and 77.3% phospholipase, hemolysin, and esterase activities, respectively. The difference between Candida albicans and non-Candida albicans was significant in phospholipase ( P < 0.001 ) and hemolytic activity ( P = 0.027 ), but not significant in esterase activity ( P = 0.076 ). Conclusion. This study showed that most of the isolates had different enzymatic patterns, and Candida albicans isolates had the most exoenzyme activity. So due to the potential effects of these enzymes in pathogenesis and virulence effects of Candida species, we can conclude that the severity of extracellular enzymes may play a role in the severity of signs and symptoms of Candida oral cavity infections in diabetic patients.

Published
2021

33. Chemical Composition and Effectiveness of Ocimum basilicum L. Extracts on the Adhesion of Candida albicans and C. dubliniensis on Acrylic Surfaces of Removable Orthodontic Appliances

Author

Keyvan Pakshir, Farzaneh Golfeshan, and Seyed Ali Mosaddad

Subjects
Molecular Medicine, Molecular Biology, Biochemistry, Biotechnology
Abstract

The outbreak of diseases caused by Candida species is growing. These opportunistic pathogens can produce biofilm on non-biological surfaces, such as removable orthodontic appliances. Over the past two decades, there has been a significant increase in resistance to several types of antifungal drugs. Recently, there is a growing interest in using herbal plants and their extracts as an alternative to antifungal drugs. A common plant is basil, which belongs to Lamiaceae family. This study aimed to determine the effect of basil extracts on the adhesion of C. albicans and C. dubliniensis to acrylic surfaces of removable orthodontic appliances. Basil dried leaves were macerated in ethanol to extract its constituent, and then the extract was dissolved in water and fractioned by other solvents, including n-hexane and ethyl acetate, successively. The minimum inhibitory concentrations (MIC) of the extracts against standard species of Candida were determined by the broth microdilution method based on clinical and laboratory standard institute (CLSI) protocol. Afterward, adherence and biofilm formation tests were done on acrylic specimens in the vicinity of proper concentration of fractions with the help of the Crystal Violet and spectrophotometry method. MIC for ethyl acetate fraction, n-hexane fraction, ethanol crude extract, and the aqueous fraction was 1024, 2048, ≥2048, >2048 µg/ml, respectively. Inhibition of adherence and biofilm formation for Candida albicans and Candida dubliniensis in the vicinity of ethyl acetate fraction was 73% and 78%, respectively. In the vicinity of n-hexane fraction was 65% and 78%, respectively. Two fractions could inhibit the growth, adherence, and biofilm formation of two Candida species.

Published
2020

34. MORPHOGENESIS AND PATHOGENESIS REGULATION OF CANDIDA ALBICANS BY PROBIOTIC BACTERIUM – PEDIOCOCCUS ACIDILACTICI

Author

Hasti Nouraei, Kazem Ahmadikia, Alireza Ranjbaran, Sassan Rezaie, Keyvan Pakshir, Zahra Zareshahrabadi, Kamiar Zomorodian, Seyed Jamal Hashemi, Ladan Nazemi, Marjan Motamedi, and Davood Mehrabani

Subjects
0303 health sciences, biology, 030306 microbiology, Chemistry, Biofilm, food and beverages, Pediococcus acidilactici, Germ tube, biology.organism_classification, Microbiology, Corpus albicans, Yeast, law.invention, 03 medical and health sciences, Probiotic, law, Candida albicans, Molecular Biology, Bacteria, 030304 developmental biology, Food Science, Biotechnology
Abstract

The transition of Candida albicans from yeast to hyphae cause the attachment to epithelial cells, forming biofilm and invasion. Therefore, the effect of Pediococcus acidilactici on morphogenesis and pathogenesis of C. albicans were examined. Inhibitory activity of P. acidilactici on Candida species growth was investigated and inhibition of C. albicans biofilm formation was measured by XTT method. Also, expression of seven genes as: Agglutinin-like protein 1 (ALS1,3), hyphal cell-wall protein (HWP1), secreted aspartyl proteinase (SAP4,6), Enhanced filamentous growth 1 (EFG1) and Enhanced activated protein 1 (EAP1) were studied by RT-PCR with different concentrations of P. acidilactici. The experimental activity of this probiotic bacterium was evaluated in an animal model by culture and histopathological methods. P. acidilactici inhibited the growth of Candida species at concentrations of 8-512 µg/mL (approximately 8 × 106 to 5 × 108 CFU/ml). This probiotic bacterium inhibited the germ tube and biofilm formation in a dose-dependent manner. RT-PCR analysis showed a reduction in genes expression. The P. acidilactici reduced the CFUs in mice receiving this probiotic bacterium. Histopathological analyses showed that Candida colonization was diminished in mice following the administration of probiotic. Since the wide range of antifungal activity of this bacterium bacterium, it can be used to manage oral candidiasis.

Published
2020

35. Comparative Analysis of Virulence Factors of Homozygous and Heterozygous Strains of Candida albicans Vaginal Isolates

Author

Hossein Khodadadi, Sahar Sheykhi, Keyvan Pakshir, Zahra Zareshahrabadi, Hasti Nouraei, and Kamiar Zomorodian

Subjects
Microbiology (medical), food.ingredient, Article Subject, Virulence, Hemolysin, Biology, biology.organism_classification, Microbiology, QR1-502, Yeast, Corpus albicans, Agar plate, food, biology.protein, Agar, Exoenzyme, Candida albicans
Abstract

Although the epidemiology of pathogenic Candida species is changing due to invasive diseases, Candida albicans has become the common cause of human infections worldwide. Candida albicans is a diploid yeast with a mostly clonal mode of reproduction and without known complete sexual cycle. This species has two heterozygous and homozygous strains at hyphal wall protein 1 gene locus (hwp1). Little is known about virulence factors of these strains. The aim of this study was to evaluate the exoenzyme activity of heterozygous and homozygous C. albicans strains. A total of 60 stock Candida albicans species isolates, which consisted of 30 homozygous and 30 heterozygous strains, were used for exoenzyme activities. We used egg yolk agar, Sabouraud blood agar, and bovine serum albumin agar for evaluation of phospholipase, hemolysin, and proteinase activity, respectively. Homozygous strains of Candida albicans had more phospholipase and proteinase activity than heterozygous strains. However, there were no significant statistical differences between the two strains in the severity of exoenzymes production. Beta hemolysin activity was seen in 100% and 96.7% of the homozygous and heterozygous strains, respectively. The results of this study indicated that both of the strains exhibited exoenzyme activities in different ranges. There were no significant statistical differences in virulence factors between the homozygous and heterozygous strains.

Published
2020

36. Emergence of Terbinafine Resistant Trichophyton mentagrophytes in Iran, Harboring Mutations in the Squalene Epoxidase (SQLE) Gene

Author

Simin Taghipour, Keyvan Pakshir, Ivan M. Pchelin, Mahdi Abastabar, Ali Zarei Mahmoudabadi, Kamiar Zomorodian, Forough Shamsizadeh, Farzad Katiraee, Saham Ansari, Reza Valadan, and Ali Rezaei-Matehhkolaei

Subjects
0301 basic medicine, Pharmacology, Ciclopirox, biology, Squalene monooxygenase, Luliconazole, 030106 microbiology, Broth microdilution, Antifungal drug, biology.organism_classification, Microbiology, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Infectious Diseases, chemistry, medicine, Terbinafine, Pharmacology (medical), Trichophyton, 030212 general & internal medicine, Efinaconazole, medicine.drug
Abstract

Introduction Trichophyton mentagrophytes and T. interdigitale are important causative agents of superficial mycoses, demonstrating emergent antifungal drug resistance. We studied the antifungal susceptibility profiles in Iranian isolates of these two species. Methods A total of 96 T. interdigitale and 45 T. mentagrophytes isolates were subjected to molecular typing by ribosomal ITS region. Antifungal susceptibility profiles for terbinafine, griseofulvin, clotrimazole, efinaconazole, luliconazole, amorolfine and ciclopirox were obtained by CLSI broth microdilution method. The squalene epoxidase (SQLE) gene was subjected to sequencing for mutations, if any, in isolates exhibiting elevated MICs for terbinafine. Results Luliconazole and efinaconazole showed the lowest MIC values against T. mentagrophytes and T. interdigitale isolates. There were five isolates with terbinafine MICs ≥32 µg/mL in our sample. They belonged to T. mentagrophytes type VIII and harbored two alternative SQLE gene sequence variants, leading to Phe397Leu and Ala448Thr or Leu393Ser and Ala448Thr substitutions in the enzyme. All terbinafine resistant strains could be inhibited by luliconazole and efinaconazole. Conclusion This study documented a step in the global spread of resistance mechanisms in T. mentagrophytes. However, treatment alternatives for resistant isolates were available.

Published
2020

37. Estimating global injuries morbidity and mortality

Author

Zohreh Arefi, Rasmus Havmoeller, Pietro Ferrara, Vijay Kumar Chattu, Payman Salamati, Agegnehu Bante Getenet, Seyedeh Zahra Masoumi, Alexander C. Tsai, Andrew T Olagunju, Carl Abelardo T. Antonio, Morteza Abdullatif Khafaie, Tim Driscoll, Reza Rawassizadeh, Vishnu Renjith, Taras Kavetskyy, Ejaz Ahmad Khan, Gebreamlak Gebremedhn Gebremeskel, Richard C. Franklin, Naznin Hossain, Bhaskaran Unnikrishnan, Fariborz Mansour-Ghanaei, Arash Tehrani-Banihashemi, Morteza Naserbakht, Sangram Kishor Patel, Vera Marisa Costa, Suzanne Polinder, Ziad El-Khatib, Ashish Pathak, Mika Shigematsu, Bryan L. Sykes, David M. Pigott, Zeleke Aschalew Melketsedik, Hadi Hassankhani, Nuworza Kugbey, Lal B. Rawal, Masoud Foroutan, Dejana Braithwaite, Muluken Bekele Sorrie, Grant M. A. Wyper, Joht Singh Chandan, Akbar Barzegar, Hamid Safarpour, Kate E. LeGrand, Giulio Castelpietra, Dina Nur Anggraini Ningrum, Seth Christopher Yaw Appiah, Amin Soheili, Azeem Majeed, Akshaya Srikanth Bhagavathula, Nikolay Ivanovich Briko, Vahid Yazdi-Feyzabadi, Walter Mendoza, Ghulam Mustafa, Cuong Tat Nguyen, Pengpeng Ye, Mahesh P A, Carlos Miguel Rios González, Ahmad Daryani, Ibrahim Abdollahpour, Masoud Moradi, Haileab Fekadu Wolde, Mohammad Rabiee, Jaya Prasad Tripathy, Jack T Fox, Diep Ngoc Nguyen, Pallab K. Maulik, Ai-Min Wu, Félix Carvalho, Yun Jin Kim, Fatemeh Rajati, Nathaniel J Henry, David C. Schwebel, Ali H. Mokdad, Akine Eshete Abosetugn, Leonardo Roever, Ketema Bizuwork Gebremedhin, Khalid A Altirkawi, Hayimro Edemealem Merie, Farhad Ghamari, Ramesh Holla, Arash Sarveazad, Devasahayam J. Christopher, Kedir Hussein Abegaz, Suresh Jungari, Rohan Borschmann, Irfan Ullah, Nitin Joseph, Catalina Liliana Andrei, Abdallah M. Samy, Roman Topor-Madry, Michal Grivna, Ivo Rakovac, Mohammad Zamani, Antonio Maria Borzì, Atif Amin Baig, Mohsen Bayati, Mohammad Ali Mansournia, Fatemeh Heydarpour, Juanita A. Haagsma, Segun Emmanuel Ibitoye, Mehdi Sayyah, Teshome Abegaz Kamil, Fakher Rahim, Dillon O Sylte, Feng Sha, Palash Chandra Banik, Mohan Bairwa, Mariya Vladimirovna Titova, Yong Yu, Delia Hendrie, Spencer L. James, Anusha Ganapati Bhat, Seok Jun Yoon, Siavash Rahimi, Jost B. Jonas, Michael R. Phillips, Diana Silva, Amir Hossein Goudarzian, Samath D Dharmaratne, Roba Khundkar, Jemal Abdu Mohammed, Joemer C. Maravilla, Eleonora Dubljanin, Arun Balachandran, Arman Latifi, Randah R. Hamadeh, G. K. Mini, Alessandra C. Goulart, Andreea Mirica, Fatemeh Zarei, Habte Belete, Telma Zahirian Moghadam, Maseer Khan, Morenike Oluwatoyin Folayan, Atte Meretoja, Jasvinder A. Singh, Guilherme Borges, Yasir Waheed, Fahad Alanezi, Masoud Moghadaszadeh, Guoqing Hu, Archith Boloor, Luca Ronfani, Olayinka Stephen Ilesanmi, Vahid Rashedi, Mehran Shams-Beyranvand, Trang Huyen Nguyen, Yonatal Mesfin Tefera, Yousef Khader, Adnan Kisa, Simon I. Hay, Takeshi Fukumoto, Shahrzad Bazargan-Hejazi, Yuichiro Yano, Carlos A Castañeda-Orjuela, Suzanne Barker-Collo, Ghasem Azarian, Sezer Kisa, Basema Saddik, Leake Gebremeskel, Yetunde O. John-Akinola, Jennifer Rickard, Ilais Moreno Velásquez, Priya Rathi, Ali Bijani, Smita Pakhale, Francesco Saverio Violante, Neeraj Bedi, Efat Mohamadi, Deborah Carvalho Malta, Marek Majdan, Feleke Mekonnen Demeke, Chukwudi A Nnaji, Richard Ofori-Asenso, Prateek Rastogi, Xuefeng Liu, Monika Sawhney, Ayman Grada, Prasanna Mithra, Shanshan Li, Masood Ali Shaikh, Erin B Hamilton, Hung Chak Ho, Zichen Liu, Irini Chatziralli, Paulo A. Lotufo, Yuming Guo, Daniel N. Kiirithio, Hamidreza Komaki, Aristidis Tsatsakis, Brijesh Sathian, Daniel Kim, Yoosik Youm, Kebreab Paulos, Saqib Ali, Beriwan Abdulqadir Ali, M. Mofizul Islam, Ahad Bakhtiari, Karen M. Tabb, Davood Anvari, Tomislav Mestrovic, Yunquan Zhang, Muhammad Aziz Rahman, Naohiro Yonemoto, Rupak Desai, Peter Njenga Keiyoro, Rajan Nikbakhsh, Zahra Sadat Dibaji Forooshani, Carlo La Vecchia, Amrit Banstola, Niguse Meles Alema, Shivakumar K.M. Kondlahalli, Soraya Seedat, Filippo Ariani, Chi Linh Hoang, Maziar Moradi-Lakeh, Erika Ota, Dimas Ria Angga Pribadi, Van C. Lansingh, Mohammed Madadin, Mostafa Dianati Nasab, Biniyam Sahiledengle Geberemariyam, Amanda J. Mason-Jones, Marcela Agudelo-Botero, Dinh-Toi Chu, Bach Xuan Tran, Till Bärnighausen, Mehdi Mirzaei-Alavijeh, Mohammad Ali Jahani, Bereket Duko Adema, In-Hwan Oh, Paul S. F. Yip, Ionut Negoi, Eduarda Fernandes, Reza Ghanei Gheshlagh, Kelly Jones, Mahdi Safdarian, Josep Maria Haro, Zahiruddin Quazi Syed, Diego De Leo, Khanh Bao Tran, Syed Mohamed Aljunid, Yasser S. Amer, Tommi Vasankari, Vasily Vlassov, Jose C. Adsuar, Zoubida Zaidi, Asadollah Gholamian, Theo Vos, Nauman Khalid, Malke Asaad, André Faro, Rushdia Ahmed, Tuomo J. Meretoja, Ireneous N. Soyiri, Ana Isabel Ribeiro, Hoa Thi Do, Temesgen Gebeyehu Wondmeneh, Vladimir Andreevich Korshunov, Manasi Kumar, Josip Car, Shoaib Hassan, Mukhammad David Naimzada, Gurudatta Naik, Ali Rajabpour-Sanati, Mustafa Z. Younis, Farid Najafi, Ester Cerin, Lorenzo Monasta, Amit Arora, Rizwan Suliankatchi Abdulkader, Huong Lan Thi Nguyen, Javad Nazari, Joel M. Francis, Martin Amogre Ayanore, Farahnaz Joukar, Babak Moazen, Kebede Deribe, Nithin Kumar, Seyed-Mohammad Fereshtehnejad, Getinet Ayano, Serge Resnikoff, Mark A. Stokes, Alaa Badawi, Narinder Kumar, Habibolah Khazaie, Sojib Bin Zaman, Faris Lami, Jens R. Chapman, Onome Bright Oghenetega, Dhirendra N Sinha, Engida Yisma, Aso Mohammad Darwesh, Demelash Abewa Elemineh, Junaid Khan, Shane D. Morrison, Mansour Ghafourifard, Ata Rafiee, Hadush Gebremariam, Oghenowede Eyawo, Amir Hasanzadeh, Ana Laura Manda, Muhammed Magdy Abd El Razek, Morteza Arab-Zozani, Narayana Manjunatha, Navid Manafi, Ritesh G. Menezes, Ferrán Catalá-López, Hossein Poustchi, Ghobad Moradi, Suliman Alghnam, Tinuke O Olagunju, Mohiuddin Ahsanul Kabir Chowdhury, Man Mohan Mehndiratta, Sorin Hostiuc, Jalal Arabloo, Shaun Wen Huey Lee, Chris D Castle, Joan B. Soriano, Syed Amir Gilani, Mariam Molokhia, Gaurav Gupta, Inga Dora Sigfusdottir, Isabela M. Benseñor, Desalegn Getnet Demsie, Atalay Goshu Muluneh, Young Eun Kim, Olatunde Aremu, Leeberk Raja Inbaraj, Jae Il Shin, Berhe Etsay Tesfay, Neha Chaudhary, Juan Sanabria, Soosanna Kumary Chattu, Sanni Yaya, Rekha Thapar, Biruk Wogayehu Taddele, Maciej Banach, Salman Rawaf, Nicholas L S Roberts, Jagadish Rao Padubidri, Manoochehr Karami, Derrick A Bennett, Duduzile Ndwandwe, Soheil Hassanipour, Ashish Badiye, Krittika Bhattacharyya, Obinna Onwujekwe, Kewal Krishan, João Coelho, Ahmed Abdelalim, Kerrie E. Doyle, Tomasz Miazgowski, Rahman Shiri, Demelash Woldeyohannes Handiso, Navid Rabiee, Nikita Otstavnov, Brian J. Hall, Olalekan A. Uthman, Rohollah Kalhor, Swayam Prakash, Beatriz Paulina Ayala Quintanilla, Gebre Teklemariam Demoz, Ted R. Miller, Rebecca Ivers, Chuanhua Yu, Pascual R. Valdez, Martha Híjar, Taweewat Wiangkham, Maysaa El Sayed Zaki, Rafael Tabarés-Seisdedos, Melkamu Merid Mengesha, Seyedmojtaba Seyedmousavi, Ravi Prakash Jha, Songhomitra Panda-Jonas, Aidin Abedi, Savita Lasrado, Veincent Christian Filipino Pepito, Amir Almasi-Hashiani, Burcu Kucuk Bicer, Hagazi Gebremedhin Kassaye, Yousef Veisani, Ayenew Kassie Tesema, Amir Radfar, Pawan Faris, Oladimeji Adebayo, Fares Alahdab, Heather Orpana, Narayan Bahadur Mahotra, Tripti Khanna, Girikumar Kumaresh, Alireza Rafiei, João Mauricio Castaldelli-Maia, Subramanian Senthilkumaran, Cyrus Alinia, Era Upadhyay, Stanislav S. Otstavnov, Ahmed Omar Bali, Farshad Farzadfar, Vivek Kumar, Sanghamitra Pati, Gholamreza Roshandel, Daiane Borges Machado, Yuan-Pang Wang, Rafael Alves Guimarães, Aziz Sheikh, Jeevan Pereira, Ahamarshan Jayaraman Nagarajan, Soraya Siabani, Kamarul Imran Musa, Farshad Pourmalek, Janet L Leasher, Shafiu Mohammed, Shyam Sundar Budhathoki, Mehdi Naderi, Mehdi Hosseinzadeh, Eun-Kee Park, Marwa Rashad Salem, Alireza Ansari-Moghaddam, Achala Upendra Jayatilleke, Paolo Lauriola, Amir Kasaeian, Adam Belay Wondmieneh, Tilahun Belete Mossie, Rovshan Khalilov, Milena M Santric Milicevic, Ai Koyanagi, Shailesh Advani, Felix Akpojene Ogbo, Nihad A. Almasri, Abdur Razzaque Sarker, Salman Khazaei, Narayanaswamy Venketasubramanian, Josephine W. Ngunjiri, Mihajlo Jakovljevic, Matthew Cunningham, Shaimaa I. El-Jaafary, Hosni Salem, Sharareh Eskandarieh, Muktar Beshir Ahmed, Amy E. Peden, Rajaram Yadav, Srikanta Banerjee, Kenean Getaneh Tlaye, Ronan A Lyons, Farzad Jalilian, Jacek Jerzy Jozwiak, Soufiane Boufous, Leila R Kalankesh, Abdelrahman Ibrahim Abushouk, Mikk Jürisson, Hamid Reza Tohidinik, Flavia M. Cicuttini, Zachary V Dingels, Florian Fischer, Saad M.A. Dahlawi, Rahmatollah Moradzadeh, Getnet Gedefaw, Tauseef Ahmad, Faramarz Shaahmadi, Hamed Zandian, Bruno Ramos Nascimento, Gregory J. Bertolacci, Hamid Yimam Hassen, Christian Lycke Ellingsen, Zulfiqar A Bhutta, Pankaj Bhardwaj, Dawit Habte Woldeyes, Robert C. Reiner, Rakhi Dandona, Akram Pourshams, Lorainne Tudor Car, Inbal Salz, Reza Mohammadpourhodki, Farnam Mohebi, A. A. Fomenkov, Abraham Getachew Kelbore, Benjamin B. Massenburg, Yousef Mohammad, Arash Ziapour, Zabihollah Yousefi, Biresaw Wassihun Alemu, Neeti Kapoor, Seyed Sina Naghibi Irvani, Vinod C. Nayak, Yoshan Moodley, Venkatesh Maled, Zhi-Jiang Zhang, Arielle Wilder Eagan, Saif Ullah, Anwar Rafay, Ali Koolivand, Ibrahim A Khalil, Parul Puri, Lidia Sanchez Riera, Vinay Nangia, Tanuj Kanchan, Mu'awiyyah Babale Sufiyan, Lidia Morawska, Saeed Shahabi, Tiffany K. Gill, Traolach S. Brugha, Michael K. Hole, Vahid Alipour, Sowmya J. Rao, Pankaj Singh, Rosario Cárdenas, Abdollah Mohammadian-Hafshejani, Sanjay Zodpey, Birhanu Geta, Amaha Kahsay, Moritz U. G. Kraemer, Claudio Alberto Dávila-Cervantes, Samer Hamidi, Gbenga A. Kayode, Miloud Taki Eddine Aichour, Peter Memiah, Erkin M. Mirrakhimov, Sheikh Mohammed Shariful Islam, Sadia Bibi, Bartosz Miazgowski, Daniel Y. Cho, Keyvan Pakshir, Aziz Rezapour, R V Polibin, Sudha Jayaraman, S. Mohammad Sajadi, Amir Manafi, Berhe Gebremichael, Ali Yadollahpour, Barthelemy Kuate Defo, Alan D. Lopez, Masoud Behzadifar, Mohammad A. Mohseni Bandpei, Ali Kabir, Jee-Young Jasmine Choi, Gebretsadkan Hintsa Tekulu, Kidanemaryam Berhe, Bill & Melinda Gates Foundation, Sanofi, HUS Comprehensive Cancer Center, Clinicum, University of Helsinki, Helsinki University Hospital Area, HUS Neurocenter, James, S. L., Castle, C. D., Dingels, Z. V., Fox, J. T., Hamilton, E. B., Liu, Z., Roberts, N. L. S., Sylte, D. O., Bertolacci, G. J., Cunningham, M., Henry, N. J., Legrand, K. E., Abdelalim, A., Abdollahpour, I., Abdulkader, R. S., Abedi, A., Abegaz, K. H., Abosetugn, A. E., Abushouk, A. I., Adebayo, O. M., Adsuar, J. C., Advani, S. M., Agudelo-Botero, M., Ahmad, T., Ahmed, M. B., Ahmed, R., Aichour, M. T. E., Alahdab, F., Alanezi, F. M., Alema, N. M., Alemu, B. W., Alghnam, S. A., Ali, B. A., Ali, S., Alinia, C., Alipour, V., Aljunid, S. M., Almasi-Hashiani, A., Almasri, N. A., Altirkawi, K., Amer, Y. S. A., Andrei, C. L., Ansari-Moghaddam, A., Antonio, C. A. T., Anvari, D., Appiah, S. C. Y., Arabloo, J., Arab-Zozani, M., Arefi, Z., Aremu, O., Ariani, F., Arora, A., Asaad, M., Quintanilla, B. P. A., Ayano, G., Ayanore, M. A., Azarian, G., Badawi, A., Badiye, A. D., Baig, A. A., Bairwa, M., Bakhtiari, A., Balachandran, A., Banach, M., Banerjee, S. K., Banik, P. C., Banstola, A., Barker-Collo, S. L., Barnighausen, T. W., Barzegar, A., Bayati, M., Bazargan-Hejazi, S., Bedi, N., Behzadifar, M., Belete, H., Bennett, D. A., Bensenor, I. M., Berhe, K., Bhagavathula, A. S., Bhardwaj, P., Bhat, A. G., Bhattacharyya, K., Bhutta, Z. A., Bibi, S., Bijani, A., Boloor, A., Borges, G., Borschmann, R., Borzi, A. M., Boufous, S., Braithwaite, D., Briko, N. I., Brugha, T., Budhathoki, S. S., Car, J., Cardenas, R., Carvalho, F., Castaldelli-Maia, J. M., Castaneda-Orjuela, C. A., Castelpietra, G., Catala-Lopez, F., Cerin, E., Chandan, J. S., Chapman, J. R., Chattu, V. K., Chattu, S. K., Chatziralli, I., Chaudhary, N., Cho, D. Y., Choi, J. -Y. J., Chowdhury, M. A. K., Christopher, D. J., Chu, D. -T., Cicuttini, F. M., Coelho, J. M., Costa, V. M., Dahlawi, S. M. A., Daryani, A., Davila-Cervantes, C. A., De Leo, D., Demeke, F. M., Demoz, G. T., Demsie, D. G., Deribe, K., Desai, R., Nasab, M. D., Da Silva, D. D., Forooshani, Z. S. D., Do, H. T., Doyle, K. E., Driscoll, T. R., Dubljanin, E., Adema, B. D., Eagan, A. W., Elemineh, D. A., El-Jaafary, S. I., El-Khatib, Z., Ellingsen, C. L., El Sayedzaki, M., Eskandarieh, S., Eyawo, O., Faris, P. S., Faro, A., Farzadfar, F., Fereshtehnejad, S. -M., Fernandes, E., Ferrara, P., Fischer, F., Folayan, M. O., Fomenkov, A. A., Foroutan, M., Francis, J. M., Franklin, R. C., Fukumoto, T., Geberemariyam, B. S., Gebremariam, H., Gebremedhin, K. B., Gebremeskel, L. G., Gebremeskel, G. G., Gebremichael, B., Gedefaw, G. A., Geta, B., Getenet, A. B., Ghafourifard, M., Ghamari, F., Gheshlagh, R. G., Gholamian, A., Gilani, S. A., Gill, T. K., Goudarzian, A. H., Goulart, A. C., Grada, A., Grivna, M., Guimaraes, R. A., Guo, Y., Gupta, G., Haagsma, J. A., Hall, B. J., Hamadeh, R. R., Hamidi, S., Handiso, D. W., Haro, J. M., Hasanzadeh, A., Hassan, S., Hassanipour, S., Hassankhani, H., Hassen, H. Y., Havmoeller, R., Hendrie, D., Heydarpour, F., Hijar, M., Ho, H. C., Hoang, C. L., Hole, M. K., Holla, R., Hossain, N., Hosseinzadeh, M., Hostiuc, S., Hu, G., Ibitoye, S. E., Ilesanmi, O. S., Inbaraj, L. R., Irvani, S. S. N., Islam, M. M., Islam, S. M. S., Ivers, R. Q., Jahani, M. A., Jakovljevic, M., Jalilian, F., Jayaraman, S., Jayatilleke, A. U., Jha, R. P., John-Akinola, Y. O., Jonas, J. B., Jones, K. M., Joseph, N., Joukar, F., Jozwiak, J. J., Jungari, S. B., Jurisson, M., Kabir, A., Kahsay, A., Kalankesh, L. R., Kalhor, R., Kamil, T. A., Kanchan, T., Kapoor, N., Karami, M., Kasaeian, A., Kassaye, H. G., Kavetskyy, T., Kayode, G. A., Keiyoro, P. N., Kelbore, A. G., Khader, Y. S., Khafaie, M. A., Khalid, N., Khalil, I. A., Khalilov, R., Khan, M., Khan, E. A., Khan, J., Khanna, T., Khazaei, S., Khazaie, H., Khundkar, R., Kiirithio, D. N., Kim, Y. -E., Kim, Y. J., Kim, D., Kisa, S., Kisa, A., Komaki, H., Kondlahalli, S. K. M., Koolivand, A., Korshunov, V. A., Koyanagi, A., Kraemer, M. U. G., Krishan, K., Defo, B. K., Bicer, B. K., Kugbey, N., Kumar, N., Kumar, M., Kumar, V., Kumaresh, G., Lami, F. H., Lansingh, V. C., Lasrado, S., Latifi, A., Lauriola, P., Vecchia, C. L., Leasher, J. L., Lee, S. W. H., Li, S., Liu, X., Lopez, A. D., Lotufo, P. A., Lyons, R. A., Machado, D. B., Madadin, M., Abd El Razek, M. M., Mahotra, N. B., Majdan, M., Majeed, A., Maled, V., Malta, D. C., Manafi, N., Manafi, A., Manda, A. -L., Manjunatha, N., Mansour-Ghanaei, F., Mansournia, M. A., Maravilla, J. C., Mason-Jones, A. J., Masoumi, S. Z., Massenburg, B. B., Maulik, P. K., Mehndiratta, M. M., Melketsedik, Z. A., Memiah, P. T. N., Mendoza, W., Menezes, R. G., Mengesha, M. M., Meretoja, T. J., Meretoja, A., Merie, H. 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Z.A., Memiah, P.T.N., Mendoza, W., Menezes, R.G., Mengesha, M.M., Meretoja, T.J., Meretoja, A., Merie, H.E., Mestrovic, T., Miazgowski, B., Miazgowski, T., Miller, T.R., Mini, G.K., Mirica, A., Mirrakhimov, E.M., Mirzaei-Alavijeh, M., Mithra, P., Moazen, B., Moghadaszadeh, M., Mohamadi, E., Mohammad, Y., Darwesh, A.M., Mohammadian-Hafshejani, A., Mohammadpourhodki, R., Mohammed, S., Mohammed, J.A., Mohebi, F., Bandpei, M.A.M., Molokhia, M., Monasta, L., Moodley, Y., Moradi, M., Moradi, G., Moradi-Lakeh, M., Moradzadeh, R., Morawska, L., Velásquez, I.M., Morrison, S.D., Mossie, T.B., Muluneh, A.G., Musa, K.I., Mustafa, G., Naderi, M., Nagarajan, A.J., Naik, G., Naimzada, M.D., Najaf, F., Nangia, V., Nascimento, B.R., Naserbakht, M., Nayak, V., Nazari, J., Ndwandwe, D.E., Negoi, I., Ngunjiri, J.W., Nguyen, T.H., Nguyen, C.T., Nguyen, D.N., Nguyen, H.L.T., Nikbakhsh, R., Ningrum, D.N.A., Nnaji, C.A., Ofori-Asenso, R., Ogbo, F.A., Oghenetega, O.B., Oh, I.-H., Olagunju, A.T., Olagunju, T.O., Bali, A.O., Onwujekwe, O.E., Orpana, H.M., Ota, E., Otstavnov, N., Otstavnov, S.S., Mahesh, A.P., Padubidri, J.R., Pakhale, S., Pakshir, K., Panda-Jonas, S., Park, E.-K., Patel, S.K., Pathak, A., Pati, S., Paulos, K., Peden, A.E., Pepito, V.C.F., Pereira, J., Phillips, M.R., Polibin, R.V., Polinder, S., Pourmalek, F., Pourshams, A., Poustchi, H., Prakash, S., Pribadi, D.R.A., Puri, P., Syed, Z.Q., Rabiee, N., Rabiee, M., Radfar, A., Rafay, A., Rafee, A., Rafei, A., Rahim, F., Rahimi, S., Rahman, M.A., Rajabpour-Sanati, A., Rajati, F., Rakovac, I., Rao, S.J., Rashedi, V., Rastogi, P., Rathi, P., Rawaf, S., Rawal, L., Rawassizadeh, R., Renjith, V., Resnikoff, S., Rezapour, A., Ribeiro, A.I., Rickard, J., González, C.M.R., Roever, L., Ronfani, L., Roshandel, G., Saddik, B., Safarpour, H., Safdarian, M., Sajadi, S.M., Salamati, P., Salem, M.R.R., Salem, H., Salz, I., Samy, A.M., Sanabria, J., Riera, L.S., Milicevic, M.M.S., Sarker, A.R., Sarveazad, A., Sathian, B., Sawhney, M., Sayyah, M., Schwebel, D.C., Seedat, S., Senthilkumaran, S., Seyedmousavi, S., Sha, F., Shaahmadi, F., Shahabi, S., Shaikh, M.A., Shams-Beyranvand, M., Sheikh, A., Shigematsu, M., Shin, J.I., Shiri, R., Siabani, S., Sigfusdottir, I.D., Singh, J.A., Singh, P.K., Sinha, D.N., Soheili, A., Soriano, J.B., Sorrie, M.B., Soyiri, I.N., Stokes, M.A., Sufiyan, M.B., Sykes, B.L., Tabarés-Seisdedos, R., Tabb, K.M., Taddele, B.W., Tefera, Y.M., Tehrani-Banihashemi, A., Tekulu, G.H., Tesema, A.K.T., Tesfay, B.E., Thapar, R., Titova, M.V., Tlaye, K.G., Tohidinik, H.R., Topor-Madry, R., Tran, K.B., Tran, B.X., Tripathy, J.P., Tsai, A.C., Tsatsakis, A., Car, L.T., Ullah, I., Ullah, S., Unnikrishnan, B., Upadhyay, E., Uthman, O.A., Valdez, P.R., Vasankari, T.J., Veisani, Y., Venketasubramanian, N., Violante, F.S., Vlassov, V., Waheed, Y., Wang, Y.-P., Wiangkham, T., Wolde, H.F., Woldeyes, D.H., Wondmeneh, T.G., Wondmieneh, A.B., Wu, A.-M., Wyper, G.M.A., Yadav, R., Yadollahpour, A., Yano, Y., Yaya, S., Yazdi-Feyzabadi, V., Ye, P., Yip, P., Yisma, E., Yonemoto, N., Yoon, S.-J., Youm, Y., Younis, M.Z., Yousef, Z., Yu, C., Yu, Y., Moghadam, T.Z., Zaidi, Z., Zaman, S.B., Zamani, M., Zandian, H., Zarei, F., Zhang, Z.-J., Zhang, Y., Ziapour, A., Zodpey, S., Dandona, R., Dharmaratne, S.D., Hay, S.I., Mokdad, A.H., Pigott, D.M., Reiner, R.C., Vos, T., Instituto de Saúde Pública da Universidade do Porto, James, Spencer L, Castle, Chris D, Dingels, Zachary V, Fox, Jack T, Adema, Bereket Duko, Yisma, Engida, Vos, Theo, and Public Health

Subjects
Male, Populations/contexts, 1106 Human Movement and Sports Sciences, Global injuries, population, 030204 cardiovascular system & hematology, Global Health, contexts, context, Global Burden of Disease, 0302 clinical medicine, Quality-Adjusted Life Year, Global health, 030212 general & internal medicine, Original Research, Data, populations/contexts, Incidence (epidemiology), Incidence, methodology, 3142 Public health care science, environmental and occupational health, Female, Public Health, TERRITORIES, Quality-Adjusted Life Years, descriptive epidemiology, Human, Disabilities, 195 COUNTRIES, statistical issue, 1117 Public Health and Health Services, 03 medical and health sciences, AGE, Life Expectancy, Environmental health, Injury prevention, SYSTEMATIC ANALYSIS, statistical issues, Humans, Mortality, Estimation, SEX-SPECIFIC MORTALITY, DISABILITY, Public Health, Environmental and Occupational Health, populations, Morbidity, Wounds and Injuries, 1106 Human Movement and Sports Sciences, 1117 Public Health and Health Services, 1701 Psychology, Quality-adjusted life year, Years of potential life lost, 1701 Psychology, Life expectancy, Estimates, Human medicine, populations/context
Abstract

Background. While there is a long history of measuring death and disability from injuries, modern research methods must account for the wide spectrum of disability that can occur in an injury, and must provide estimates with sufficient demographic, geographical and temporal detail to be useful for policy makers. The Global Burden of Disease (GBD) 2017 study used methods to provide highly detailed estimates of global injury burden that meet these criteria. Methods. In this study, we report and discuss the methods used in GBD 2017 for injury morbidity and mortality burden estimation. In summary, these methods included estimating cause-specific mortality for every cause of injury, and then estimating incidence for every cause of injury. Non-fatal disability for each cause is then calculated based on the probabilities of suffering from different types of bodily injury experienced. Results. GBD 2017 produced morbidity and mortality estimates for 38 causes of injury. Estimates were produced in terms of incidence, prevalence, years lived with disability, cause-specific mortality, years of life lost and disability-adjusted life-years for a 28-year period for 22 age groups, 195 countries and both sexes. Conclusions. GBD 2017 demonstrated a complex and sophisticated series of analytical steps using the largest known database of morbidity and mortality data on injuries. GBD 2017 results should be used to help inform injury prevention policy making and resource allocation. We also identify important avenues for improving injury burden estimation in the future. Seyed Aljunid acknowledges the Department of Health Policy and Management, Faculty of Public Health, Kuwait University and International Centre for Casemix and Clinical Coding, Faculty of Medicine, National University of Malaysia for the approval and support to participate in this research project. Alaa Badawi acknowledges support by the Public Health Agency of Canada. Till Bärnighausen acknowledges support by the Alexander von Humboldt Foundation through the Alexander von Humboldt Professor award, funded by the German Federal Ministry of Education and Research. Traolach Brugha received support from NatCen Social Research (http://natcen.ac.uk/) via NHS Digital and Department of Health and Social Care London, for the Adult Psychiatric Morbidity Survey (APMS) programme. Felix Carvalho received support from UID/MULTI/04378/2019 with funding from FCT/MCTES through national funds. Vera M Costa acknowledges support from grant (SFRH/BHD/110001/2015), received by Portuguese national funds through Fundação para a Ciência e Tecnologia (FCT), IP, under the Norma Transitória DL57/2016/CP1334/CT0006. Kebede Deribe is supported by a grant from the Wellcome Trust [grant number 201900] as part of his International Intermediate Fellowship. Tim Driscoll acknowledges that work on occupational risk factors was partially supported by funds from the World Health Organization. Eduarda Fernandes acknowledges support from UID/QUI/50006/2019 with funding from FCT/MCTES through national funds. Yuming Guo acknowledges support from Career Development Fellowships of the Australian National Health and Medical Research Council (numbers APP1107107 and APP1163693). Sheikh Mohammed Shariful Islam is funded by a Fellowship from National Heart Foundation of Australia and Institute for Physical Activity and Nutrition, Deakin University. Mihajlo Jakovljevic acknowledges support by the Ministry of Education Science and Technological Development of the Republic of Serbia through the Grant number OI175014; publication of results was not contingent upon Ministry's censorship or approval. Sudha Jayaraman acknowledges support from: NIH R21: 1R21TW010439-01A1 (PI); Rotary Foundation Global Grant #GG1749568 (PI); NIH P20: 1P20CA210284-01A1 (Co-PI) and DOD grant W81XWH-16-2-0040 (Co-I), during the period of this study. Yun Jin Kim acknowledges support from a grant from the Research Management Centre, Xiamen University Malaysia [grant number: XMUMRF/2018-C2/ITCM/0001]. Kewal Krishan is supported by UGC Centre of Advanced Study (CAS II) awarded to the Department of Anthropology, Panjab University, Chandigarh, India. Mansai Kumar acknowledges support from FIC/ NIH K43 1K43MH114320-01. Amanda Mason-Jones acknowledges support by the University of York. Mariam Molokhia is supported by the National Institute for Health Research Biomedical Research Center at Guy’s and St Thomas’s National Health Service Foundation Trust and King’s College London. Ilais Moreno Velasquez is supported by the Sistema Nacional de Investigación (SNI, Senacyt, Panama). Mukhammad David Naimzada acknowledges support from Government of the Russian Federation (Agreement No – 075-02-2019-967). Duduzile Ndwandwe acknowledges support from Cochrane South Africa, South African Medical Research Council. Stanislav S. Otstavnov acknowledges the support from the Government of the Russian Federation (Agreement No – 075-02-2019-967). Ashish Pathak acknowledges support from Indian Council of Medical Research (ICMR), New Delhi, India (Grant number 2013-1253). Michael R Phillips acknowledges support in part by a grant from the National Natural Science Foundation of China (No.81761128031). Abdallah M. Samy received a fellowship from the Egyptian Fulbright Mission Program. Milena Santric Milicevic acknowledges the support from the Ministry of Education, Science and Technological Development, Republic of Serbia (Contract No. 175087). Seyedmojtaba Seyedmousavi was supported by the Intramural Research Program of the National Institutes of Health, Clinical Center, Department of Laboratory Medicine, Bethesda, MD, USA. Rafael Tabarés-Seisdedos was supported in part by the national grant PI17/00719 from ISCIII-FEDER. Sojib Bin Zaman acknowledges support from an "Australian Government Research Training Program (RTP) Scholarship.

Published
2020

38. Translation elongation factor 1-alpha gene as a marker for diagnosing of candidal onychomycosis

Author

Farnoush Ghasemi, Kamiar Zomorodian, Hossein Mirhendi, Marjan Motamedi, Mahboobeh Kharazi, Forough Farazmand, Hajar Golestani, Keyvan Pakshir, and Ramtin Alborzi Pour

Subjects
Identification methods, lcsh:Internal medicine, Pan-Candida PCR assay, Translation elongation factor 1-alpha, Translation elongation factor 1 alpha, Biology, Microbiology, law.invention, chemistry.chemical_compound, law, Candidal onychomycosis, medicine, lcsh:RC31-1245, Gene, lcsh:QH301-705.5, Polymerase chain reaction, Gold standard (test), medicine.disease, Molecular biology, Infectious Diseases, medicine.anatomical_structure, chemistry, lcsh:Biology (General), Nail (anatomy), Original Article, DNA
Abstract

Background and Purpose: Culture-based identification methods have been the gold standard for the diagnosis of candidal onychomycosis. Molecular technologies, such as polymerase chain reaction (PCR) assays, can provide an alternative for the rapid detection of Candida species. The present study was conducted to investigate a pan-Candida PCR assay based on the translation elongation factor 1-alpha (TEF-1α) gene for the detection of the most prevalent pathogenic Candida species. Materials and Methods: For the purpose of the study, an optimized pan-Candida PCR primer pair was designed, and the target was amplified and sequenced. The analytical and clinical diagnostic performance of the designed primers was tested using 17 reference strains, 137 nail scrapings suspected of onychomycosis, and 10 healthy nail specimens. Results: The use of the universal pan-Candida primers designed on TEF-1α gene resulted in the successful amplification of a 270-base pair fragment in all Candida species tested, except for C. glabrata, and reacted neither with other fungi nor with E. coli. The sequence difference count matrix showed poor insertion/deletion differences (0-2 nt) among Candida species. Among 137 nail specimens, 35% (n=48), 30.7% (n=42), and 40.1% (n=55) of the samples were found to be positive by direct microscopy, culture, and pan-Candida PCR, respectively. Conclusion: Based on the findings, the PCR-based detection targeting the DNA TEF-1α gene is a rapid and simple procedure for the diagnosis of candidal onychomycosis directly from nail sample.

Published
2020

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

Author

Khanh Bao Tran, Justin J Lang, Kelly Compton, Rixing Xu, Alistair R Acheson, Hannah Jacqueline Henrikson, Jonathan M Kocarnik, Louise Penberthy, Amirali Aali, Qamar Abbas, Behzad Abbasi, Mohsen Abbasi-Kangevari, Zeinab Abbasi-Kangevari, Hedayat Abbastabar, Michael Abdelmasseh, Sherief Abd-Elsalam, Ahmed Abdelwahab Abdelwahab, Gholamreza Abdoli, Hanan Abdulkadir Abdulkadir, Aidin Abedi, Kedir Hussein Abegaz, Hassan Abidi, Richard Gyan Aboagye, Hassan Abolhassani, Abdorrahim Absalan, Yonas Derso Abtew, Hiwa Abubaker Ali, Eman Abu-Gharbieh, Basavaprabhu Achappa, Juan Manuel Acuna, Daniel Addison, Isaac Yeboah Addo, Oyelola A Adegboye, Miracle Ayomikun Adesina, Mohammad Adnan, Qorinah Estiningtyas Sakilah Adnani, Shailesh M Advani, Sumia Afrin, Muhammad Sohail Afzal, Manik Aggarwal, Bright Opoku Ahinkorah, Araz Ramazan Ahmad, Rizwan Ahmad, Sajjad Ahmad, Sohail Ahmad, Sepideh Ahmadi, Haroon Ahmed, Luai A Ahmed, Muktar Beshir Ahmed, Tarik Ahmed Rashid, Wajeeha Aiman, Marjan Ajami, Gizachew Taddesse Akalu, Mostafa Akbarzadeh-Khiavi, Addis Aklilu, Maxwell Akonde, Chisom Joyqueenet Akunna, Hanadi Al Hamad, Fares Alahdab, Fahad Mashhour Alanezi, Turki M Alanzi, Saleh Ali Alessy, Abdelazeem M Algammal, Mohammed Khaled Al-Hanawi, Robert Kaba Alhassan, Beriwan Abdulqadir Ali, Liaqat Ali, Syed Shujait Ali, Yousef Alimohamadi, Vahid Alipour, Syed Mohamed Aljunid, Motasem Alkhayyat, Sadeq Ali Ali Al-Maweri, Sami Almustanyir, Nivaldo Alonso, Shehabaldin Alqalyoobi, Rajaa M Al-Raddadi, Rami H Hani Al-Rifai, Salman Khalifah Al-Sabah, Ala'a B Al-Tammemi, Haya Altawalah, Nelson Alvis-Guzman, Firehiwot Amare, Edward Kwabena Ameyaw, Javad Javad Aminian Dehkordi, Mohammad Hosein Amirzade-Iranaq, Hubert Amu, Ganiyu Adeniyi Amusa, Robert Ancuceanu, Jason A Anderson, Yaregal Animut Animut, Amir Anoushiravani, Ali Arash Anoushirvani, Alireza Ansari-Moghaddam, Mustafa Geleto Ansha, Benny Antony, Maxwell Hubert Antwi, Sumadi Lukman Anwar, Razique Anwer, Anayochukwu Edward Anyasodor, Jalal Arabloo, Morteza Arab-Zozani, Olatunde Aremu, Ayele Mamo Argaw, Hany Ariffin, Timur Aripov, Muhammad Arshad, Al Artaman, Judie Arulappan, Raphael Taiwo Aruleba, Armin Aryannejad, Malke Asaad, Mulusew A Asemahagn, Zatollah Asemi, Mohammad Asghari-Jafarabadi, Tahira Ashraf, Reza Assadi, Mohammad Athar, Seyyed Shamsadin Athari, Maha Moh'd Wahbi Atout, Sameh Attia, Avinash Aujayeb, Marcel Ausloos, Leticia Avila-Burgos, Atalel Fentahun Awedew, Mamaru Ayenew Awoke, Tewachew Awoke, Beatriz Paulina Ayala Quintanilla, Tegegn Mulatu Ayana, Solomon Shitu Ayen, Davood Azadi, Sina Azadnajafabad, Saber Azami-Aghdash, Melkalem Mamuye Azanaw, Mohammadreza Azangou-Khyavy, Amirhossein Azari Jafari, Hosein Azizi, Ahmed Y Y Azzam, Amirhesam Babajani, Muhammad Badar, Ashish D Badiye, Nayereh Baghcheghi, Nader Bagheri, Sara Bagherieh, Saeed Bahadory, Atif Amin Baig, Jennifer L Baker, Ahad Bakhtiari, Ravleen Kaur Bakshi, Maciej Banach, Indrajit Banerjee, Mainak Bardhan, Francesco Barone-Adesi, Fabio Barra, Amadou Barrow, Nasir Z Bashir, Azadeh Bashiri, Saurav Basu, Abdul-Monim Mohammad Batiha, Aeysha Begum, Alehegn Bekele Bekele, Alemayehu Sayih Belay, Melaku Ashagrie Belete, Uzma Iqbal Belgaumi, Arielle Wilder Bell, Luis Belo, Habib Benzian, Alemshet Yirga Berhie, Amiel Nazer C Bermudez, Eduardo Bernabe, Akshaya Srikanth Bhagavathula, Neeraj Bhala, Bharti Bhandari Bhandari, Nikha Bhardwaj, Pankaj Bhardwaj, Krittika Bhattacharyya, Vijayalakshmi S Bhojaraja, Soumitra S Bhuyan, Sadia Bibi, Awraris Hailu Bilchut, Bagas Suryo Bintoro, Antonio Biondi, Mesfin Geremaw Birega Birega, Habitu Eshetu Birhan, Tone Bjørge, Oleg Blyuss, Belay Boda Abule Bodicha, Srinivasa Rao Bolla, Archith Boloor, Cristina Bosetti, Dejana Braithwaite, Michael Brauer, Hermann Brenner, Andrey Nikolaevich Briko, Nikolay Ivanovich Briko, Christina Maree Buchanan, Norma B Bulamu, Maria Teresa Bustamante-Teixeira, Muhammad Hammad Butt, Nadeem Shafique Butt, Zahid A Butt, Florentino Luciano Caetano dos Santos, Luis Alberto Cámera, Chao Cao, Yin Cao, Giulia Carreras, Márcia Carvalho, Francieli Cembranel, Ester Cerin, Promit Ananyo Chakraborty, Periklis Charalampous, Vijay Kumar Chattu, Odgerel Chimed-Ochir, Jesus Lorenzo Chirinos-Caceres, Daniel Youngwhan Cho, William C S Cho, Devasahayam J Christopher, Dinh-Toi Chu, Isaac Sunday Chukwu, Aaron J Cohen, Joao Conde, Sandra Cortés, Vera Marisa Costa, Natália Cruz-Martins, Garland T Culbreth, Omid Dadras, Fentaw Teshome Dagnaw, Saad M A Dahlawi, Xiaochen Dai, Lalit Dandona, Rakhi Dandona, Parnaz Daneshpajouhnejad, Anna Danielewicz, An Thi Minh Dao, Reza Darvishi Cheshmeh Soltani, Aso Mohammad Darwesh, Saswati Das, Dragos Virgil Davitoiu, Elham Davtalab Esmaeili, Fernando Pio De la Hoz, Sisay Abebe Debela, Azizallah Dehghan, Biniyam Demisse, Fitsum Wolde Demisse, Edgar Denova-Gutiérrez, Afshin Derakhshani, Meseret Derbew Molla, Diriba Dereje, Kalkidan Solomon Deribe, Rupak Desai, Markos Desalegn Desalegn, Fikadu Nugusu Dessalegn, Samuel Abebe A Dessalegni, Gashaw Dessie, Abebaw Alemayehu Desta, Syed Masudur Rahman Dewan, Samath Dhamminda Dharmaratne, Meghnath Dhimal, Mostafa Dianatinasab, Nancy Diao, Daniel Diaz, Lankamo Ena Digesa, Shilpi Gupta Dixit, Saeid Doaei, Linh Phuong Doan, Paul Narh Doku, Deepa Dongarwar, Wendel Mombaque dos Santos, Tim Robert Driscoll, Haneil Larson Dsouza, Oyewole Christopher Durojaiye, Sareh Edalati, Fatemeh Eghbalian, Elham Ehsani-Chimeh, Ebrahim Eini, Michael Ekholuenetale, Temitope Cyrus Ekundayo, Donatus U Ekwueme, Maha El Tantawi, Mostafa Ahmed Elbahnasawy, Iffat Elbarazi, Hesham Elghazaly, Muhammed Elhadi, Waseem El-Huneidi, Mohammad Hassan Emamian, Luchuo Engelbert Bain, Daniel Berhanie Enyew, Ryenchindorj Erkhembayar, Tegegne Eshetu, Babak Eshrati, Sharareh Eskandarieh, Juan Espinosa-Montero, Farshid Etaee, Azin Etemadimanesh, Tahir Eyayu, Ifeanyi Jude Ezeonwumelu, Sayeh Ezzikouri, Adeniyi Francis Fagbamigbe, Saman Fahimi, Ildar Ravisovich Fakhradiyev, Emerito Jose A Faraon, Jawad Fares, Abbas Farmany, Umar Farooque, Hossein Farrokhpour, Abidemi Omolara Fasanmi, Ali Fatehizadeh, Wafa Fatima, Hamed Fattahi, Ginenus Fekadu, Berhanu Elfu Feleke, Allegra Allegra Ferrari, Simone Ferrero, Lorenzo Ferro Desideri, Irina Filip, Florian Fischer, Roham Foroumadi, Masoud Foroutan, Takeshi Fukumoto, Peter Andras Gaal, Mohamed M Gad, Muktar A Gadanya, Abduzhappar Gaipov, Nasrin Galehdar, Silvano Gallus, Tushar Garg, Mariana Gaspar Fonseca, Yosef Haile Gebremariam, Teferi Gebru Gebremeskel, Mathewos Alemu Gebremichael, Yohannes Fikadu Geda, Yibeltal Yismaw Gela, Belete Negese Belete Gemeda, Melaku Getachew, Motuma Erena Getachew, Kazem Ghaffari, Mansour Ghafourifard, Seyyed-Hadi Ghamari, Mohammad Ghasemi Nour, Fariba Ghassemi, Ajnish Ghimire, Nermin Ghith, Maryam Gholamalizadeh, Jamshid Gholizadeh Navashenaq, Sherief Ghozy, Syed Amir Gilani, Paramjit Singh Gill, Themba G Ginindza, Abraham Tamirat T Gizaw, James C Glasbey, Justyna Godos, Amit Goel, Mahaveer Golechha, Pouya Goleij, Davide Golinelli, Mohamad Golitaleb, Giuseppe Gorini, Bárbara Niegia Garcia Goulart, Giuseppe Grosso, Habtamu Alganeh Guadie, Mohammed Ibrahim Mohialdeen Gubari, Temesgen Worku Gudayu, Maximiliano Ribeiro Guerra, Damitha Asanga Gunawardane, Bhawna Gupta, Sapna Gupta, Veer Bala Gupta, Vivek Kumar Gupta, Mekdes Kondale Gurara, Alemu Guta, Parham Habibzadeh, Atlas Haddadi Avval, Nima Hafezi-Nejad, Adel Hajj Ali, Arvin Haj-Mirzaian, Esam S Halboub, Aram Halimi, Rabih Halwani, Randah R Hamadeh, Sajid Hameed, Samer Hamidi, Asif Hanif, Sanam Hariri, Netanja I Harlianto, Josep Maria Haro, Risky Kusuma Hartono, Ahmed I Hasaballah, S M Mahmudul Hasan, Hamidreza Hasani, Seyedeh Melika Hashemi, Abbas M Hassan, Soheil Hassanipour, Khezar Hayat, Golnaz Heidari, Mohammad Heidari, Zahra Heidarymeybodi, Brenda Yuliana Herrera-Serna, Claudiu Herteliu, Kamal Hezam, Yuta Hiraike, Mbuzeleni Mbuzeleni Hlongwa, Ramesh Holla, Marianne Holm, Nobuyuki Horita, Mohammad Hoseini, Md Mahbub Hossain, Mohammad Bellal 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Melinda Gates Foundation, Kuwait University (Kuwait), Ministry of Higher Education (Malasia), Lega Italiana per la Lotta ai Tumori, Health Effects Institute (Estados Unidos), Unión Europea. Comisión Europea. European Research Council (ERC), Unión Europea. Comisión Europea. H2020, Fundação para a Ciência e Tecnologia (Portugal), African-German Network of Excellence in Science (AGNES), Federal Ministry of Education & Research (Alemania), Alexander von Humboldt Foundation, Novo Nordisk Foundation, National Institute for Health Research (Reino Unido), National Health and Medical Research Council (Australia), Romanian National Authority for Scientific Research and Innovation, Romanian Ministry of Research Innovation and Digitalization, Ministry of Education, Science and Technological Development (Serbia), Sigrid Jusélius Foundation, Finnish Cancer Foundation, Datta Meghe Institute of Medical Sciences (India), Xiamen University (Malasia), Manipal Academy of Higher Education (India), Panjab University (India), Sistema Nacional de Investigación (Panamá), Secretaría Nacional de Ciencia, Tecnología e Innovación (Panamá), Ministry of Science and Technology (Taiwan), Lung Foundation Australia, National Natural Science Foundation of China, Wellcome Trust, UNSW Sydney (Australia), ICMR - National Institute of Epidemiology (India), University of Tasmania (Australia), National Council for Scientific and Technological Development (Brasil), Coordenação de Aperfeicoamento de Pessoal de Nível Superior (Brasil), Institute for Advanced Studies in Basic Sciences (Irán), Ain Shams University (Egipto), International Center of Medical Sciences Research (Islamabad), National Institutes of Health (Estados Unidos), University of Oxford (Reino Unido), National Institute of Genetic Engineering and Biotechnology (Irán), Marga und Walter Boll - Stiftung, Ministero della Salute (Italia), IRCCS Materno Infantile Burlo Garofolo (Italia), King College London, Wellcome Trust/DBT India Alliance (India), Public Health, University of St Andrews. School of Medicine, and University of St Andrews. Population and Behavioural Science Division

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

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

Published
2022

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

Author

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

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

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

Published
2022

41. 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

Author

Hmwe Hmwe Kyu, Avina Vongpradith, Sarah Brooke Sirota, Amanda Novotney, Christopher E Troeger, Matthew C Doxey, Rose G Bender, Jorge R Ledesma, Molly H Biehl, Samuel B Albertson, Joseph Jon Frostad, Katrin Burkart, Fiona B Bennitt, Jeff T Zhao, William M Gardner, Hailey Hagins, Dana Bryazka, Regina-Mae Villanueva Dominguez, Semagn Mekonnen Abate, Michael Abdelmasseh, Amir Abdoli, Gholamreza Abdoli, Aidin Abedi, Vida Abedi, Tadesse M Abegaz, Hassan Abidi, Richard Gyan Aboagye, Hassan Abolhassani, Yonas Derso Abtew, Hiwa Abubaker Ali, Eman Abu-Gharbieh, Ahmed Abu-Zaid, Kidist Adamu, Isaac Yeboah Addo, Oyelola A Adegboye, Mohammad Adnan, Qorinah Estiningtyas Sakilah Adnani, Muhammad Sohail Afzal, Saira Afzal, Bright Opoku Ahinkorah, Aqeel Ahmad, Araz Ramazan Ahmad, Sajjad Ahmad, Ali Ahmadi, Sepideh Ahmadi, Haroon Ahmed, Jivan Qasim Ahmed, Tarik Ahmed Rashid, Mostafa Akbarzadeh-Khiavi, Hanadi Al Hamad, Luciana Albano, Mamoon A Aldeyab, Bezatu Mengistie Alemu, Kefyalew Addis Alene, 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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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. H., Vongpradith, A., Sirota, S. B., Novotney, A., Troeger, C. E., Doxey, M. C., Bender, R. G., Ledesma, J. R., Biehl, M. H., Albertson, S. B., Frostad, J. J., Burkart, K., Bennitt, F. B., Zhao, J. T., Gardner, W. M., Hagins, H., Bryazka, D., Dominguez, R. -M. V., Abate, S. M., Abdelmasseh, M., Abdoli, A., Abdoli, G., Abedi, A., Abedi, V., Abegaz, T. M., Abidi, H., Aboagye, R. G., Abolhassani, H., Abtew, Y. D., Abubaker Ali, H., Abu-Gharbieh, E., Abu-Zaid, A., Adamu, K., Addo, I. Y., Adegboye, O. A., Adnan, M., Adnani, Q. E. S., Afzal, M. S., Afzal, S., Ahinkorah, B. O., Ahmad, A., Ahmad, A. R., Ahmad, S., Ahmadi, A., Ahmadi, S., Ahmed, H., Ahmed, J. Q., Ahmed Rashid, T., Akbarzadeh-Khiavi, M., Al Hamad, H., Albano, L., Aldeyab, M. A., Alemu, B. M., Alene, K. A., Algammal, A. M., Alhalaiqa, F. A. N., Alhassan, R. K., Ali, B. A., Ali, L., Ali, M. M., Ali, S. S., Alimohamadi, Y., Alipour, V., Al-Jumaily, A., Aljunid, S. M., Almustanyir, S., Al-Raddadi, R. M., Al-Rifai, R. H. H., Alryalat, S. A. S., Alvis-Guzman, N., Alvis-Zakzuk, N. J., Ameyaw, E. K., Aminian Dehkordi, J. J., Amuasi, J. H., Amugsi, D. A., Anbesu, E. W., Ansar, A., Anyasodor, A. E., Arabloo, J., Areda, D., Argaw, A. M., Argaw, Z. G., Arulappan, J., Aruleba, R. T., Asemahagn, M. A., Athari, S. S., Atlaw, D., Attia, E. F., Attia, S., Aujayeb, A., Awoke, T., Ayana, T. M., Ayanore, M. A., Azadnajafabad, S., Azangou-Khyavy, M., Azari, S., Azari Jafari, A., Badar, M., Badiye, A. D., Baghcheghi, N., Bagherieh, S., Baig, A. A., Banach, M., Banerjee, I., Bardhan, M., Barone-Adesi, F., Barqawi, H. J., Barrow, A., Bashiri, A., Bassat, Q., Batiha, A. -M. M., Belachew, A. B., Belete, M. A., Belgaumi, U. I., Bhagavathula, A. S., Bhardwaj, N., Bhardwaj, P., Bhatt, P., Bhojaraja, V. S., Bhutta, Z. A., Bhuyan, S. S., Bijani, A., Bitaraf, S., Bodicha, B. B. A., Briko, N. I., Buonsenso, D., Butt, M. H., Cai, J., Camargos, P., Camera, L. A., Chakraborty, P. A., Chanie, M. G., Charan, J., Chattu, V. K., Ching, P. R., Choi, S., Chong, Y. Y., Choudhari, S. G., Chowdhury, E. K., Christopher, D. J., Chu, D. -T., Cobb, N. L., Cohen, A. J., Cruz-Martins, N., Dadras, O., Dagnaw, F. T., Dai, X., Dandona, L., Dandona, R., Dao, A. T. M., Debela, S. A., Demisse, B., Demisse, F. W., Demissie, S., Dereje, D., Desai, H. D., Desta, A. A., Desye, B., Dhingra, S., Diao, N., Diaz, D., Digesa, L. E., Doan, L. P., Dodangeh, M., Dongarwar, D., Dorostkar, F., dos Santos, W. M., Dsouza, H. L., Dubljanin, E., Durojaiye, O. C., Edinur, H. A., Ehsani-Chimeh, E., Eini, E., Ekholuenetale, M., Ekundayo, T. C., El Desouky, E. D., El Sayed, I., El Sayed Zaki, M., Elhadi, M., Elkhapery, A. M. R., Emami, A., Engelbert Bain, L., Erkhembayar, R., Etaee, F., Ezati Asar, M., Fagbamigbe, A. F., Falahi, S., Fallahzadeh, A., Faraj, A., Faraon, E. J. A., Fatehizadeh, A., Ferrara, P., Ferrari, A. A., Fetensa, G., Fischer, F., Flavel, J., Foroutan, M., Gaal, P. A., Gaidhane, A. M., Gaihre, S., Galehdar, N., Garcia-Basteiro, A. L., Garg, T., Gebrehiwot, M. D., Gebremichael, M. A., Gela, Y. Y., Gemeda, B. N. B., Gessner, B. D., Getachew, M., Getie, A., Ghamari, S. -H., Ghasemi Nour, M., Ghashghaee, A., Gholamrezanezhad, A., Gholizadeh, A., Ghosh, R., Ghozy, S., Goleij, P., Golitaleb, M., Gorini, G., Goulart, A. C., Goyomsa, G. G., Guadie, H. A., Gudisa, Z., Guled, R. A., Gupta, S., Gupta, V. B., Gupta, V. K., Guta, A., Habibzadeh, P., Haj-Mirzaian, A., Halwani, R., Hamidi, S., Hannan, M. A., Harorani, M., Hasaballah, A. I., Hasani, H., Hassan, A. M., Hassani, S., Hassanian-Moghaddam, H., Hassankhani, H., Hayat, K., Heibati, B., Heidari, M., Heyi, D. Z., Hezam, K., Holla, R., Hong, S. H., Horita, N., Hosseini, M. -S., Hosseinzadeh, M., Hostiuc, M., Househ, M., Hoveidamanesh, S., Huang, J., Hussein, N. R., Iavicoli, I., Ibitoye, S. E., Ikuta, K. S., Ilesanmi, O. S., Ilic, I. M., Ilic, M. D., Immurana, M., Ismail, N. E., Iwagami, M., Jaafari, J., Jamshidi, E., Jang, S. -I., Javadi Mamaghani, A., Javaheri, T., Javanmardi, F., Javidnia, J., Jayapal, S. K., Jayarajah, U., Jayaram, S., Jema, A. T., Jeong, W., Jonas, J. B., Joseph, N., Joukar, F., Jozwiak, J. J., K, V., Kabir, Z., Kacimi, S. E. O., Kadashetti, V., Kalankesh, L. R., Kalhor, R., Kamath, A., Kamble, B. D., Kandel, H., Kanko, T. K., Karaye, I. M., Karch, A., Karkhah, S., Kassa, B. G., Katoto, P. D., Kaur, H., Kaur, R. J., Keikavoosi-Arani, L., Keykhaei, M., Khader, Y. S., Khajuria, H., Khan, E. A., Khan, G., Khan, I. A., Khan, M., Khan, M. N., Khan, M. A., Khan, Y. H., Khatatbeh, M. M., Khosravifar, M., Khubchandani, J., Kim, M. S., Kimokoti, R. W., Kisa, A., Kisa, S., Kissoon, N., Knibbs, L. D., Kochhar, S., Kompani, F., Koohestani, H. R., Korshunov, V. A., Kosen, S., Koul, P. A., Koyanagi, A., Krishan, K., Kuate Defo, B., Kumar, G. A., Kurmi, O. P., Kuttikkattu, A., Lal, D. K., Lam, J., Landires, I., Ledda, C., Lee, S. -W., Levi, M., Lewycka, S., Liu, G., Liu, W., Lodha, R., Lorenzovici, L., Lotfi, M., Loureiro, J. A., Madadizadeh, F., Mahmoodpoor, A., Mahmoudi, R., Mahmoudimanesh, M., Majidpoor, J., Makki, A., Malakan Rad, E., Malik, A. A., Mallhi, T. H., Manla, Y., Matei, C. N., Mathioudakis, A. G., Maude, R. J., Mehrabi Nasab, E., Melese, A., Memish, Z. A., Mendoza-Cano, O., Mentis, A. -F. A., Meretoja, T. J., Merid, M. W., Mestrovic, T., Micheletti Gomide Nogueira de Sa, A. C., Mijena, G. F. W., Minh, L. H. N., Mir, S. A., Mirfakhraie, R., Mirmoeeni, S., Mirza, A. Z., Mirza, M., Mirza-Aghazadeh-Attari, M., Misganaw, A. S., Misganaw, A. T., Mohammadi, E., Mohammadi, M., Mohammed, A., Mohammed, S., Mohan, S., Mohseni, M., Moka, N., Mokdad, A. H., Momtazmanesh, S., Monasta, L., Moniruzzaman, M., Montazeri, F., Moore, C. E., Moradi, A., Morawska, L., Mosser, J. F., Mostafavi, E., Motaghinejad, M., Mousavi Isfahani, H., Mousavi-Aghdas, S. A., Mubarik, S., Murillo-Zamora, E., Mustafa, G., Nair, S., Nair, T. S., Najafi, H., Naqvi, A. A., Narasimha Swamy, S., Natto, Z. S., Nayak, B. P., Nejadghaderi, S. A., Nguyen, H. V. N., Niazi, R. K., Nogueira de Sa, A. T., Nouraei, H., Nowroozi, A., Nunez-Samudio, V., Nzoputam, C. I., Nzoputam, O. J., Oancea, B., Ochir, C., Odukoya, O. O., Okati-Aliabad, H., Okekunle, A. P., Okonji, O. C., Olagunju, A. T., Olufadewa, I. I., Omar Bali, A., Omer, E., Oren, E., Ota, E., Otstavnov, N., Oulhaj, A., P A, M., Padubidri, J. R., Pakshir, K., Pakzad, R., Palicz, T., Pandey, A., Pant, S., Pardhan, S., Park, E. -C., Park, E. -K., Pashazadeh Kan, F., Paudel, R., Pawar, S., Peng, M., Pereira, G., Perna, S., Perumalsamy, N., Petcu, I. -R., Pigott, D. M., Piracha, Z. Z., Podder, V., Polibin, R. V., Postma, M. J., Pourasghari, H., Pourtaheri, N., Qadir, M. M. F., Raad, M., Rabiee, M., Rabiee, N., Raeghi, S., Rafiei, A., Rahim, F., Rahimi, M., Rahimi-Movaghar, V., Rahman, A., Rahman, M. O., Rahman, M., Rahman, M. A., Rahmani, A. M., Rahmanian, V., Ram, P., Ramezanzadeh, K., Rana, J., Ranasinghe, P., Rani, U., Rao, S. J., Rashedi, S., Rashidi, M. -M., Rasul, A., Ratan, Z. A., Rawaf, D. L., Rawaf, S., Rawassizadeh, R., Razeghinia, M. S., Redwan, E. M. M., Reitsma, M. B., Renzaho, A. M. N., Rezaeian, M., Riad, A., Rikhtegar, R., Rodriguez, J. A. B., Rogowski, E. L. B., Ronfani, L., Rudd, K. E., Saddik, B., Sadeghi, E., Saeed, U., Safary, A., Safi, S. Z., Sahebazzamani, M., Sahebkar, A., Sakhamuri, S., Salehi, S., Salman, M., Samadi Kafil, H., Samy, A. M., Santric-Milicevic, M. M., Sao Jose, B. P., Sarkhosh, M., Sathian, B., Sawhney, M., Saya, G. K., Seidu, A. -A., Seylani, A., Shaheen, A. A., Shaikh, M. A., Shaker, E., Shamshad, H., Sharew, M. M., Sharhani, A., Sharifi, A., Sharma, P., Sheidaei, A., Shenoy, S. M., Shetty, J. K., Shiferaw, D. S., Shigematsu, M., Shin, J. I., Shirzad-Aski, H., Shivakumar, K. M., Shivalli, S., Shobeiri, P., Simegn, W., Simpson, C. R., Singh, H., Singh, J. A., Singh, P., Siwal, S. S., Skryabin, V. Y., Skryabina, A. A., Soltani-Zangbar, M. S., Song, S., Song, Y., Sood, P., Sreeramareddy, C. T., Steiropoulos, P., Suleman, M., Tabatabaeizadeh, S. -A., Tahamtan, A., Taheri, M., Taheri Soodejani, M., Taki, E., Talaat, I. M., Tampa, M., Tandukar, S., Tat, N. Y., Tat, V. Y., Tefera, Y. M., Temesgen, G., Temsah, M. -H., Tesfaye, A., Tesfaye, D. G., Tessema, B., Thapar, R., Ticoalu, J. H. V., Tiyuri, A., Tleyjeh, I. I., Togtmol, M., Tovani-Palone, M. R., Tufa, D. G., Ullah, I., Upadhyay, E., Valadan Tahbaz, S., Valdez, P. R., Valizadeh, R., Vardavas, C., Vasankari, T. J., Vo, B., Vu, L. G., Wagaye, B., Waheed, Y., Wang, Y., Waris, A., West, T. E., Wickramasinghe, N. D., Xu, X., Yaghoubi, S., Yahya, G. A. T., Yahyazadeh Jabbari, S. H., Yon, D. K., Yonemoto, N., Zaman, B. A., Zandifar, A., Zangiabadian, M., Zar, H. J., Zare, I., Zareshahrabadi, Z., Zarrintan, A., Zastrozhin, M. S., Zeng, W., Zhang, M., Zhang, Z. -J., Zhong, C., Zoladl, M., Zumla, A., Lim, S. S., Vos, T., Naghavi, M., Brauer, M., Hay, S. I., Murray, C. J. L., University of St Andrews. School of Medicine, University of St Andrews. 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

43. Evaluation of fungal contamination and ochratoxin A detection in different types of coffee by HPLC-based method

Author

Keyvan Pakshir, Kamiar Zomorodian, Andishe Dehghani, Hasti Nouraei, and Zahra Zareshahrabadi

Subjects
Microbiology (medical), Ochratoxin A, ochratoxin, Clinical Biochemistry, Fungal contamination, coffee, high‐performance liquid chromatography, High-performance liquid chromatography, mycotoxin, chemistry.chemical_compound, Limit of Detection, Immunology and Allergy, Food science, Mycotoxin, Ochratoxin, Chromatography, High Pressure Liquid, Research Articles, Aspergillus species, Aspergillus, biology, Biochemistry (medical), Public Health, Environmental and Occupational Health, food and beverages, Reproducibility of Results, Hematology, Contamination, biology.organism_classification, Ochratoxins, Medical Laboratory Technology, chemistry, Food Microbiology, Linear Models, Research Article
Abstract

Background Mycotoxins are secondary fungal metabolites that are produced by some toxigenic fungi on foodstuffs which are poisoning and potentiate for human's health hazards. In coffee samples, ochratoxin A and fungal contamination were examined. Methods Immunoaffinity columns were used for treating of all 50 samples from four types of coffee, after that high‐performance liquid chromatography was used for determining the amount of ochratoxin. For the identification of fungi, all coffee samples were cultured in appropriated media. Results The results showed that all samples were contaminated by ochratoxin A but only up to 50% of them had toxins higher than acceptable level as detected in black beans (47%), green beans (33.3%), torch (33.3%), and espresso (25%). Black coffee had a higher mean concentration of ochratoxin A than green coffee. Conclusion Predominant fungi isolated from coffee samples were Aspergillus species. Finally, careful monitoring of mycotoxins in coffee samples is essential to improve the quality of this favorable beverage in future., Different steps of ochratoxin A extraction from coffee.

Published
2021

44. Molecular characterization and antifungal activity against non-dermatophyte molds causing onychomycosis

Author

Kamiar Zomorodian, Hasti Nouraei, Mozhgan Mahmoodi, Marjan Motamedi, Keyvan Pakshir, and Mandana Kamali

Subjects
Male, Posaconazole, Econazole, Antifungal Agents, Itraconazole, Science, Antifungal drug, Diseases, Microbial Sensitivity Tests, Biology, medicine.disease_cause, Microbiology, Article, Medical research, Onychomycosis, medicine, Humans, Multidisciplinary, Fungi, Mycoses, Dermatophyte, Terbinafine, Medicine, Ketoconazole, Female, Fluconazole, medicine.drug
Abstract

Onychomycosis is a fungal disease that caused by different types of fungi. Non-dermatophyte molds are a large saprophytic fungi group that live in nature and could affect traumatic nails. The aim of this study was to identify non-dermatophyte molds causing onychomycosis and evaluation of several antifungal activities against the isolates. The samples consisted of 50 non-dermatophyte molds isolated from patients with onychomycosis confirmed by direct and culture examination fungal. DNA was extracted, amplified, and sequenced. Disk diffusion method was used to evaluate itraconazole, fluconazole, ketoconazole, terbinafine, posaconazole, and econazole activity against the isolates. The species identified as: Aspergillus flavus 22 (44%), A. niger 12 (24%), A. fumigates, 3 (6%), A. sydowii 3 (6%), A. terreus 1 (2%), Penicillium commune 2 (4%), P. glabrum 2 (4%), P. chrysogenum, 1 (2%), Fusarium solani 3 (6%) and F. thapsinum 1 (2%). Most of the samples were sensitive to terbinafine, itraconazole, and econazole and 94% of the isolates were resistant to fluconazole. This study showed that Aspergillus species were the most common cause of non-dermatophyte mold onychomycosis and fluconazole was the most resistant antifungals. Care must be taken to choose the appropriate antifungal drug for a better cure.

Published
2021

45. Molecular identification of

Author

Kamiar, Zomorodian, Maryam, Naderibeni, Hossein, Mirhendi, Mostajab, Razavi Nejad, Seyed Mojtaba, Saneian, Mozhgan, Mahmoodi, Mahboobeh, Kharazi, Hossein, Khodadadi, Keyvan, Pakshir, and Marjan, Motamedi

Abstract

Given the important role ofIn total, 205 samples were collected from 130 neonates (4-day-old) and 75 mothers. Isolation ofCultures from 62.3% of neonates and 77.3% of mothers were positive forThe findings support the hypothesis that the colonization of

Published
2021

46. Interactions between immune response to fungal infection and microRNAs: The pioneer tuners

Author

Veghar Ebrahimzadeh, Keyvan Pakshir, Hamed Mirzaei, Hamid Badali, Hamid Morovati, and Sanam Nami

Subjects
0301 basic medicine, medicine.medical_treatment, 030106 microbiology, Dermatology, Biology, 030207 dermatology & venereal diseases, 03 medical and health sciences, 0302 clinical medicine, Immune system, microRNA, medicine, Animals, Aspergillosis, Humans, AIDS-Related Opportunistic Infections, Coinfection, Mechanism (biology), Gene Expression Profiling, High mortality, Candidiasis, Cryptococcosis, General Medicine, Immunotherapy, Review article, MicroRNAs, Infectious Diseases, Gene Expression Regulation, Mycoses, Host-Pathogen Interactions, Immunology, Paracoccidioidomycosis, Biogenesis, Signal Transduction, Healthcare system
Abstract

Due to their physiological and biological characteristics, numerous fungi are potentially emerging pathogens. Active dynamicity of fungal pathogens causes life-threatening infections annually impose high costs to the health systems. Although immune responses play crucial roles in controlling the fate of fungal infections, immunocompromised patients are at high risk with high mortality. Tuning the immune response against fungal infections might be an effective strategy for controlling and reducing the pathological damages. MicroRNAs (miRNAs) are known as the master regulators of immune response. These single-stranded tuners (18-23 bp non-coding RNAs) are endogenously expressed by all metazoan eukaryotes and have emerged as the master gene expression controllers of at least 30% human genes. In this review article, following the review of biology and physiology (biogenesis and mechanism of actions) of miRNAs and immune response against fungal infections, the interactions between them were scrutinised. In conclusion, miRNAs might be considered as one of the potential goals in immunotherapy for fungal infections. Undoubtedly, advanced studies in this field, further identifying of miRNA roles in governing the immune response, pave the way for inclusion of miRNA-related immunotherapeutic in the treatment of life-threatening fungal infections.

Published
2019

47. Potential Pathogenicity of

Author

Hasti, Nouraei, Mehdi Ghaderian, Jahromi, Leila Razeghian, Jahromi, Kamiar, Zomorodian, and Keyvan, Pakshir

Subjects
Mouth, Virulence, Virulence Factors, Mouth Mucosa, Polysorbates, Egg Yolk, Hemolysis, Diabetes Complications, Agar, Hemolysin Proteins, Species Specificity, Candidiasis, Oral, Phospholipases, Risk Factors, Candida albicans, Diabetes Mellitus, Humans, Research Article
Abstract

Introduction In the recent decade, the increased immunocompromised population such as diabetic patients makes a high incidence of invasive Candida infections. Diabetes mellitus is the most common endocrine metabolic disorder, and diabetic patients are more susceptible to oral candidiasis infection. Candidiasis is an opportunistic fungal infection caused by many species of Candida. Secretion of exoenzymes plays an important role in the virulence and pathogenesis of Candida species. The aim of this study was to evaluate the potential role of phospholipase, esterase, and hemolytic activity of Candida species isolated from oral cavity lesions of diabetic patients. Methods A total of 108 Candida species including 75 Candida albicans and 33 non-Candida albicans species were recovered from the oral cavity of diabetic patients included in our study. Egg yolk agar, Tween 80 opacity medium, and blood agar plate assays were used for determining phospholipase, esterase, and hemolytic activities, respectively. Results Candida albicans species had the most exoenzyme activity in comparison to non-albicans isolates. Candida albicans isolates showed 97.3%, 100%, and 77.3% phospholipase, hemolysin, and esterase activities, respectively. The difference between Candida albicans and non-Candida albicans was significant in phospholipase (P < 0.001) and hemolytic activity (P = 0.027), but not significant in esterase activity (P = 0.076). Conclusion This study showed that most of the isolates had different enzymatic patterns, and Candida albicans isolates had the most exoenzyme activity. So due to the potential effects of these enzymes in pathogenesis and virulence effects of Candida species, we can conclude that the severity of extracellular enzymes may play a role in the severity of signs and symptoms of Candida oral cavity infections in diabetic patients.

Published
2021

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

Author

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

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

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

Published
2021

49. Hearing loss prevalence and years lived with disability, 1990-2019: findings from the Global Burden of Disease Study 2019

Author

Rezaul Karim Ripon, Lydia M. Haile, Richard C. Franklin, Virginia Núñez-Samudio, Sonali G. Choudhari, Chythra R Rao, Maria Inês Schmidt, Jeff T. Zhao, Hanadi Al Hamad, Bing-Fang Hwang, Christopher R. Cederroth, Howard J. Hoffman, Naohiro Yonemoto, Rajaa Al-Raddadi, Avina Vongpradith, David Laith Rawaf, Valentin Yurievich Skryabin, Maja Pasovic, Ismail Tareque, Alessandra Lugo, Theo Vos, Rabia Hussain, Golnaz Heidari, Tarik A. Rashid, Ghozali Ghozali, Stephen S Lim, Bay Vo, Emma Elizabeth Spurlock, Himal Kandel, Jitendra Singh, Adrian Davis, Pankaj Bhardwaj, Houman Sotoudeh, Arif Mohammed, Rekha Thapar, Mohammad Rabiee, Florian Fischer, Deepika Singhal, Haroon Ahmed, Irina Filip, Michael Ekholuenetale, Amirhossein Sahebkar, Abdallah M. Samy, Fatemeh Pashazadeh Kan, Sathish Kumar Jayapal, Ionela-Roxana Glavan, Mikhail Sergeevich Zastrozhin, Bruce Bartholow Duncan, Aziz Rezapour, Jalal Arabloo, Sahel Valadan Tahbaz, Chuanhua Yu, Huong Lan Thi Nguyen, Vahid Rashedi, Shrikant Pawar, Shelly Chadha, Mahaveer Golechha, Bach Xuan Tran, Jaimie D Steinmetz, Deepak Dhamnetiya, Olayinka Stephen Ilesanmi, Masood Ali Shaikh, Charlie Ashbaugh, Stany W. Lobo, Akshaya Srikanth Bhagavathula, Biruk Wogayehu Taddele, Baye Dagnew, Walter Mendoza, Morteza Arab-Zozani, Turki Alanzi, Sandhya Neupane Kandel, Kebadnew Mulatu Mihretie, Zaheer-Ud-Din Babar, Jasvinder A. Singh, Veer Bala Gupta, Maheswar Satpathy, Ali H. Mokdad, Simon I. Hay, Sadia Bibi, Louis Jacob, Christopher J L Murray, Liaqat Ali, Keyvan Pakshir, Allen Seylani, Andre M. N. Renzaho, Eman Abu-Gharbieh, Till Bärnighausen, Segun Emmanuel Ibitoye, Voilet Rodrigues, Vahit Yigit, Mohammed Shannawaz, Mohammad Ali Moni, Ali Yadollahpour, Rose G Bender, Victor M. Oguoma, Rohollah Kalhor, Saif Ullah, Mohammad Zamani, Anna Aleksandrovna Skryabina, Mowafa Househ, Milena Santric-Milicevic, Juwel Rana, Fakher Rahim, Soraya Siabani, Mokhtar Mohammadi, Bolajoko O. Olusanya, Khezar Hayat, Teroj Abdulrahman Mohamed, Palash Chandra Banik, Nikha Bhardwaj, Brijesh Sathian, Fahad Alanezi, Jean Jacques Noubiap, Jagadish Rao Padubidri, Hans Orru, Nawzad K. Al-Salihi, Navid Rabiee, Xuefeng Liu, Iván Landires, Paul S Briant, Jost B. Jonas, Mayowa O. Owolabi, Zhi Jiang Zhang, Farhad Ghamari, Vahid Alipour, Sowmya J. Rao, Mehdi Hosseinzadeh, Desta Debalkie Atnafu, Lalit Dandona, Molly R Nixon, Rovshan Khalilov, Ai Koyanagi, Silvano Gallus, Saad M.A. Dahlawi, Salman Rawaf, Mohammad Abdollahi, Ted R. Miller, Masao Iwagami, Amanual Getnet Mersha, Savita Lasrado, Marcos Roberto Tovani-Palone, Umar Saeed, Fares Alahdab, Vafa Rahimi-Movaghar, Ivo Iavicoli, Yonas Akalu, Amir Masoud Rahmani, Kathleen Pillsbury Hopf, Assefa Desalew, Sheikh Mohammed Shariful Islam, Amare Belachew Dagnew, Ravi Prakash Jha, Jacob Olusegun Olusanya, Jingkai Wei, Mandira Lamichhane Dhimal, Kaloyan Kamenov, Anasthasia Zastrozhina, Samer Hamidi, Gbenga A. Kayode, Katrin Burkart, Anjali Singal, Shahina Pardhan, Rakhi Dandona, Jaykaran Charan, Akram Pourshams, Xiaochen Dai, Meghnath Dhimal, Kerrie E. Doyle, Seyed Sina Naghibi Irvani, Shilpa Gaidhane, Francesco Saverio Violante, Monika Sawhney, Animut Tagele Tamiru, Hai Quang Pham, Atif Amin Baig, Hubert Amu, Judie Arulappan, Ayele Semachew Kasa, Alaa Makki, Syed Amir Gilani, Abdollah Mohammadian-Hafshejani, Soewarta Kosen, Abhay Gaidhane, Birhanu Wubale Yirdaw, Ismaeel Yunusa, Ali Bijani, Billy Randall Hammond, Neeti Rustagi, Bogdan Oancea, Ahmad Ghashghaee, Amadou Barrow, Mosiur Rahman, Ashkan Afshin, Yigizie Yeshaw, Mahalaqua Nazli Khatib, Amir Radfar, Winfried Schlee, Andrew T Olagunju, Dinh-Toi Chu, Vasily Vlassov, Ejaz Ahmad Khan, Sanjeev Misra, Rosa A. S. Couto, Marina Pinheiro, Mohammad Hifz Ur Rahman, Amir Abdoli, Bárbara Niegia Garcia de Goulart, Wondimeneh Shibabaw Shiferaw, Seyed Hossein Yahyazadeh Jabbari, Aislyn U. Orji, Vivek Gupta, Giang Thu Vu, G Anil Kumar, Haile L.M., Kamenov K., Briant P.S., Orji A.U., Steinmetz J.D., Abdoli A., Abdollahi M., Abu-Gharbieh E., Afshin A., Ahmed H., Rashid T.A., Akalu Y., Alahdab F., Alanezi F.M., Alanzi T.M., Al Hamad H., Ali L., Alipour V., Al-Raddadi R.M., Amu H., Arabloo J., Arab-Zozani M., Arulappan J., Ashbaugh C., Atnafu D.D., Babar Z.-U.-D., Baig A.A., Banik P.C., Barnighausen T.W., Barrow A., Bender R.G., Bhagavathula A.S., Bhardwaj N., Bhardwaj P., Bibi S., Bijani A., Burkart K., Cederroth C.R., Charan J., Choudhari S.G., Chu D.-T., Couto R.A.S., Dagnew A.B., Dagnew B., Dahlawi S.M.A., Dai X., Dandona L., Dandona R., Desalew A., Dhamnetiya D., Dhimal M.L., Dhimal M., Doyle K.E., Duncan B.B., Ekholuenetale M., Filip I., Fischer F., Franklin R.C., Gaidhane A.M., Gaidhane S., Gallus S., Ghamari F., Ghashghaee A., Ghozali G., Gilani S.A., Glavan I.-R., Golechha M., Goulart B.N.G., Gupta V.B., Gupta V.K., Hamidi S., Hammond B.R., Hay S.I., Hayat K., Heidari G., Hoffman H.J., Hopf K.P., Hosseinzadeh M., Househ M., Hussain R., Hwang B.-F., Iavicoli I., Ibitoye S.E., Ilesanmi O.S., Irvani S.S.N., Islam S.M.S., Iwagami M., Jacob L., Jayapal S.K., Jha R.P., Jonas J.B., Kalhor R., Al-Salihi N.K., Kandel H., Kasa A.S., Kayode G.A., Khalilov R., Khan E.A., Khatib M.N., Kosen S., Koyanagi A., Kumar G.A., Landires I., Lasrado S., Lim S.S., Liu X., Lobo S.W., Lugo A., Makki A., Mendoza W., Mersha A.G., Mihretie K.M., Miller T.R., Misra S., Mohamed T.A., Mohammadi M., Mohammadian-Hafshejani A., Mohammed A., Mokdad A.H., Moni M.A., Kandel S.N., Nguyen H.L.T., Nixon M.R., Noubiap J.J., Nunez-Samudio V., Oancea B., Oguoma V.M., Olagunju A.T., Olusanya B.O., Olusanya J.O., Orru H., Owolabi M.O., Padubidri J.R., Pakshir K., Pardhan S., Kan F.P., Pasovic M., Pawar S., Pham H.Q., Pinheiro M., Pourshams A., Rabiee N., Rabiee M., Radfar A., Rahim F., Rahimi-Movaghar V., Ur Rahman M.H., Rahman M., Rahmani A.M., Rana J., Rao C.R., Rao S.J., Rashedi V., Rawaf D.L., Rawaf S., Renzaho A.M.N., Rezapour A., Ripon R.K., Rodrigues V., Rustagi N., Saeed U., Sahebkar A., Samy A.M., Santric-Milicevic M.M., Sathian B., Satpathy M., Sawhney M., Schlee W., Schmidt M.I., Seylani A., Shaikh M.A., Shannawaz M., Shiferaw W.S., Siabani S., Singal A., Singh J.A., Singh J.K., Singhal D., Skryabin V.Y., Skryabina A.A., Sotoudeh H., Spurlock E.E., Taddele B.W., Tamiru A.T., Tareque M.I., Thapar R., Tovani-Palone M.R., Tran B.X., Ullah S., Tahbaz S.V., Violante F.S., Vlassov V., Vo B., Vongpradith A., Vu G.T., Wei J., Yadollahpour A., Jabbari S.H.Y., Yeshaw Y., Yigit V., Yirdaw B.W., Yonemoto N., Yu C., Yunusa I., Zamani M., Zastrozhin M.S., Zastrozhina A., Zhang Z.-J., Zhao J.T., Murray C.J.L., Davis A.C., Vos T., Chadha S., Haile, Lydia M, Kamenov, Kaloyan, Briant, Paul Svitil, Orji, Aislyn U, Steinmetz, Jaimie D, Abdoli, Amir, Abdollahi, Mohammad, Abu-Gharbieh, Eman, Afshin, Ashkan, Ahmed, Haroon, Ahmed Rashid, Tarik, Akalu, Yona, Alahdab, Fare, Alanezi, Fahad Mashhour, Alanzi, Turki M, Al Hamad, Hanadi, Ali, Liaqat, Alipour, Vahid, Al-Raddadi, Rajaa M, Amu, Hubert, Arabloo, Jalal, Arab-Zozani, Morteza, Arulappan, Judie, Ashbaugh, Charlie, Atnafu, Desta Debalkie, Babar, Zaheer-Ud-Din, Baig, Atif Amin, Banik, Palash Chandra, Bärnighausen, Till Winfried, Barrow, Amadou, Bender, Rose G, Bhagavathula, Akshaya Srikanth, Bhardwaj, Nikha, Bhardwaj, Pankaj, Bibi, Sadia, Bijani, Ali, Burkart, Katrin, Cederroth, Christopher R, Charan, Jaykaran, Choudhari, Sonali Gajanan, Chu, Dinh-Toi, Couto, Rosa A S, Dagnew, Amare Belachew, Dagnew, Baye, Dahlawi, Saad M A, Dai, Xiaochen, Dandona, Lalit, Dandona, Rakhi, Desalew, Assefa, Dhamnetiya, Deepak, Dhimal, Mandira Lamichhane, Dhimal, Meghnath, Doyle, Kerrie E, Duncan, Bruce B, Ekholuenetale, Michael, Filip, Irina, Fischer, Florian, Franklin, Richard Charle, Gaidhane, Abhay Motiramji, Gaidhane, Shilpa, Gallus, Silvano, Ghamari, Farhad, Ghashghaee, Ahmad, Ghozali, Ghozali, Gilani, Syed Amir, Glavan, Ionela-Roxana, Golechha, Mahaveer, Goulart, Bárbara Niegia Garcia, Gupta, Veer Bala, Gupta, Vivek Kumar, Hamidi, Samer, Hammond, Billy Randall, Hay, Simon I, Hayat, Khezar, Heidari, Golnaz, Hoffman, Howard J, Hopf, Kathleen Pillsbury, Hosseinzadeh, Mehdi, Househ, Mowafa, Hussain, Rabia, Hwang, Bing-Fang, Iavicoli, Ivo, Ibitoye, Segun Emmanuel, Ilesanmi, Olayinka Stephen, Irvani, Seyed Sina Naghibi, Islam, Sheikh Mohammed Shariful, Iwagami, Masao, Jacob, Loui, Jayapal, Sathish Kumar, Jha, Ravi Prakash, Jonas, Jost B, Kalhor, Rohollah, Kameran Al-Salihi, Nawzad, Kandel, Himal, Kasa, Ayele Semachew, Kayode, Gbenga A, Khalilov, Rovshan, Khan, Ejaz Ahmad, Khatib, Mahalaqua Nazli, Kosen, Soewarta, Koyanagi, Ai, Kumar, G Anil, Landires, Iván, Lasrado, Savita, Lim, Stephen S, Liu, Xuefeng, Lobo, Stany W, Lugo, Alessandra, Makki, Alaa, Mendoza, Walter, Mersha, Amanual Getnet, Mihretie, Kebadnew Mulatu, Miller, Ted R, Misra, Sanjeev, Mohamed, Teroj Abdulrahman, Mohammadi, Mokhtar, Mohammadian-Hafshejani, Abdollah, Mohammed, Arif, Mokdad, Ali H, Moni, Mohammad Ali, Neupane Kandel, Sandhya, Nguyen, Huong Lan Thi, Nixon, Molly R, Noubiap, Jean Jacque, Nuñez-Samudio, Virginia, Oancea, Bogdan, Oguoma, Victor Maduabuchi, Olagunju, Andrew T, Olusanya, Bolajoko Olubukunola, Olusanya, Jacob Olusegun, Orru, Han, Owolabi, Mayowa O, Padubidri, Jagadish Rao, Pakshir, Keyvan, Pardhan, Shahina, Pashazadeh Kan, Fatemeh, Pasovic, Maja, Pawar, Shrikant, Pham, Hai Quang, Pinheiro, Marina, Pourshams, Akram, Rabiee, Navid, Rabiee, Mohammad, Radfar, Amir, Rahim, Fakher, Rahimi-Movaghar, Vafa, Rahman, Mohammad Hifz Ur, Rahman, Mosiur, Rahmani, Amir Masoud, Rana, Juwel, Rao, Chythra R, Rao, Sowmya J, Rashedi, Vahid, Rawaf, David Laith, Rawaf, Salman, Renzaho, Andre M N, Rezapour, Aziz, Ripon, Rezaul Karim, Rodrigues, Voilet, Rustagi, Neeti, Saeed, Umar, Sahebkar, Amirhossein, Samy, Abdallah M, Santric-Milicevic, Milena M, Sathian, Brijesh, Satpathy, Maheswar, Sawhney, Monika, Schlee, Winfried, Schmidt, Maria Inê, Seylani, Allen, Shaikh, Masood Ali, Shannawaz, Mohammed, Shiferaw, Wondimeneh Shibabaw, Siabani, Soraya, Singal, Anjali, Singh, Jasvinder A, Singh, Jitendra Kumar, Singhal, Deepika, Skryabin, Valentin Yurievich, Skryabina, Anna Aleksandrovna, Sotoudeh, Houman, Spurlock, Emma Elizabeth, Taddele, Biruk Wogayehu, Tamiru, Animut Tagele, Tareque, Md Ismail, Thapar, Rekha, Tovani-Palone, Marcos Roberto, Tran, Bach Xuan, Ullah, Saif, Valadan Tahbaz, Sahel, Violante, Francesco S, Vlassov, Vasily, Vo, Bay, Vongpradith, Avina, Vu, Giang Thu, Wei, Jingkai, Yadollahpour, Ali, Yahyazadeh Jabbari, Seyed Hossein, Yeshaw, Yigizie, Yigit, Vahit, Yirdaw, Birhanu Wubale, Yonemoto, Naohiro, Yu, Chuanhua, Yunusa, Ismaeel, Zamani, Mohammad, Zastrozhin, Mikhail Sergeevich, Zastrozhina, Anasthasia, Zhang, Zhi-Jiang, Zhao, Jeff T, Murray, Christopher J L, Davis, Adrian C, Vos, Theo, and Chadha, Shelly

Subjects
Hearing aid, Male, Hearing loss, medicine.medical_treatment, Psychological intervention, 030204 cardiovascular system & hematology, Affect (psychology), Health Services Accessibility, Global Burden of Disease, 03 medical and health sciences, Tinnitus, Medicine, General & Internal, 0302 clinical medicine, Neonatal Screening, Hearing Aids, Acquired immunodeficiency syndrome (AIDS), Hearing, General & Internal Medicine, Health care, otorhinolaryngologic diseases, Prevalence, Medicine, Humans, Age Factor, Disabled Persons, 030212 general & internal medicine, Hearing Loss, Hearing Lo, 11 Medical and Health Sciences, Science & Technology, business.industry, Infant, Newborn, Age Factors, Infant, GBD 2019 Hearing Loss Collaborators, General Medicine, Articles, medicine.disease, Otitis, Hearing Aid, Cytomegalovirus Infections, Disabled Person, Female, medicine.symptom, business, Life Sciences & Biomedicine, Human, Demography
Abstract

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Hearing loss affects access to spoken language, which can affect cognition and development, and can negatively affect social wellbeing. We present updated estimates from the Global Burden of Disease (GBD) study on the prevalence of hearing loss in 2019, as well as the condition's associated disability. Methods: We did systematic reviews of population-representative surveys on hearing loss prevalence from 1990 to 2019. We fitted nested meta-regression models for severity-specific prevalence, accounting for hearing aid coverage, cause, and the presence of tinnitus. We also forecasted the prevalence of hearing loss until 2050. Findings: An estimated 1·57 billion (95% uncertainty interval 1·51–1·64) people globally had hearing loss in 2019, accounting for one in five people (20·3% [19·5–21·1]). Of these, 403·3 million (357·3–449·5) people had hearing loss that was moderate or higher in severity after adjusting for hearing aid use, and 430·4 million (381·7–479·6) without adjustment. The largest number of people with moderate-to-complete hearing loss resided in the Western Pacific region (127·1 million people [112·3–142·6]). Of all people with a hearing impairment, 62·1% (60·2–63·9) were older than 50 years. The Healthcare Access and Quality (HAQ) Index explained 65·8% of the variation in national age-standardised rates of years lived with disability, because countries with a low HAQ Index had higher rates of years lived with disability. By 2050, a projected 2·45 billion (2·35–2·56) people will have hearing loss, a 56·1% (47·3–65·2) increase from 2019, despite stable age-standardised prevalence. Interpretation: As populations age, the number of people with hearing loss will increase. Interventions such as childhood screening, hearing aids, effective management of otitis media and meningitis, and cochlear implants have the potential to ameliorate this burden. Because the burden of moderate-to-complete hearing loss is concentrated in countries with low health-care quality and access, stronger health-care provision mechanisms are needed to reduce the burden of unaddressed hearing loss in these settings. Funding: Bill & Melinda Gates Foundation and WHO.

Published
2020

50. Global injury morbidity and mortality from 1990 to 2017 : results from the Global Burden of Disease Study 2017

Author

Giulio Castelpietra, Feng Sha, Khalid A Altirkawi, Seyedeh Zahra Masoumi, Gebreamlak Gebremedhn Gebremeskel, Ahmad Daryani, Ibrahim Abdollahpour, Simon I. Hay, Deborah Carvalho Malta, Erin B Hamilton, Kate E. LeGrand, Nikolay Ivanovich Briko, Ana-Laura Manda, Aziz Eftekhari, Irfan Ullah, Seth Christopher Yaw Appiah, Zichen Liu, Maida Umar, Shaimaa I. El-Jaafary, Marina Pinheiro, Farhad Ghamari, Milad Mohammadoo-Khorasani, Rajaram Yadav, Syed Mohamed Aljunid, Ramesh Holla, Farzad Jalilian, Jacek Jerzy Jozwiak, Omar Mukhtar Salman, Bayew Kelkay, Tanuj Kanchan, Irina Filip, Michael R. Phillips, Hamid Reza Tohidinik, Demelash Abewa Elemineh, Reza Malekzadeh, Tomasz Miazgowski, Diana Silva, Samath D Dharmaratne, Eleonora Dubljanin, Fatemeh Zare, Jasvinder A. Singh, Hagazi Gebremedhin Kassaye, Nathaniel J Henry, Venkatesh Maled, Girikumar Kumaresh, Alireza Rafiei, Zhi-Jiang Zhang, Arielle Wilder Eagan, Merhawi Gebremedhin Tekle, Gholamreza Roshandel, Jeevan Pereira, Tinuke O Olagunju, Olatunde Aremu, Mohammad Zamani, Mu'awiyyah Babale Sufiyan, Lidia Morawska, Bayisa Abdissa Baye, Eduarda Fernandes, Feleke Mekonnen Demeke, Beriwan Abdulqadir Ali, Ibrahim A Khalil, Hafte Kahsay Kebede, Songhomitra Panda-Jonas, Yuichiro Yano, Haileab Fekadu Wolde, Antonio Maria Borzì, Delia Hendrie, Azeem Majeed, Vahid Rashedi, Mehran Shams-Beyranvand, Ilais Moreno Velásquez, Derrick A Bennett, Roba Khundkar, Mohammed Madadin, Biniyam Sahiledengle Geberemariyam, Parul Puri, Lidia Sanchez Riera, Yetunde O. John-Akinola, Jennifer Rickard, Saeed Shahabi, Tiffany K. Gill, Jemal Abdu Mohammed, Alessandra C. Goulart, Mohiuddin Ahsanul Kabir Chowdhury, Roya Safari-Faramani, Pawan Faris, Farhad Moradpour, Guilherme Borges, Sadia Bibi, Bartosz Miazgowski, Wubalem Fekadu, Rakhi Dandona, Ali Reza Soltanian, Alaa Badawi, Amir Hasanzadeh, Hassan Haghparast Bidgoli, Carlos A Castañeda-Orjuela, Morteza Arab-Zozani, Vinay Nangia, Gaurav Gupta, Farkhonde Salehi, Isabela M. Benseñor, Rekha Thapar, Yasser S. Amer, Naohiro Yonemoto, Ahmad Ghashghaee, Amanda J. Mason-Jones, Marcela Agudelo-Botero, Ashraf Nabhan, Saeed Safari, Lorainne Tudor Car, Ayman Grada, Stanislav S. Otstavnov, Keyvan Pakshir, Nefsu Awoke, Ahamarshan Jayaraman Nagarajan, Adnan Kisa, Ghasem Azarian, Yogesh Sabde, Soufiane Boufous, Fatemeh Khosravi Shadmani, Ketema Bizuwork Gebremedhin, Heather Orpana, Narayan Bahadur Mahotra, Tripti Khanna, Peter Nyasulu, Tommi Vasankari, Reza Mohammadpourhodki, Peter Njenga Keiyoro, Andrea Werdecker, Sanghamitra Pati, Rajan Nikbakhsh, Sorin Hostiuc, Prateek Rastogi, Xuefeng Liu, Manasi Kumar, Josip Car, Chuanhua Yu, Aziz Rezapour, Narayana Manjunatha, Ritesh G. Menezes, Michael K. Hole, Asadollah Gholamian, Pascual R. Valdez, Lorenzo Monasta, Amit Arora, Marek Majdan, Abraham Getachew Kelbore, Irini Chatziralli, Rafael Alves Guimarães, Mohammad Hassan Emamian, Filippo Ariani, Jeadran N. 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Subjects
Dánarmein, Fötlun, Dánartíðni, Lífslíkur, Life expectancy, 1106 Human Movement and Sports Sciences, burden of disease, Global Health, Global Burden of Disease, 0302 clinical medicine, Quality-Adjusted Life Year, Global health, Medicine, LIFE EXPECTANCY, 030212 general & internal medicine, POPULATION, Cause of death, Original Research, RISK, education.field_of_study, Global disease burdens, Injuries, Sjúkdómar, Incidence (epidemiology), Incidence, Population health, Burden of disease, Global, global, 3142 Public health care science, environmental and occupational health, 3. Good health, Descriptive epidemiology, Lýðheilsa, Quality-Adjusted Life Years, Public Health, TERRITORIES, descriptive epidemiology, Human, Population, 195 COUNTRIES, Humans, Life Expectancy, Morbidity, Wounds and Injuries, 1117 Public Health and Health Services, 03 medical and health sciences, AGE, SYSTEMATIC ANALYSIS, Mortality, education, Disability, SEX-SPECIFIC MORTALITY, business.industry, Faraldsfræði, DISABILITY, Public Health, Environmental and Occupational Health, Quality-adjusted life year, Years of potential life lost, Áverkar, 1701 Psychology, Human medicine, business, 030217 neurology & neurosurgery, Demography
Abstract

Publisher's version (útgefin grein), Background Past research in population health trends has shown that injuries form a substantial burden of population health loss. Regular updates to injury burden assessments are critical. We report Global Burden of Disease (GBD) 2017 Study estimates on morbidity and mortality for all injuries. Methods We reviewed results for injuries from the GBD 2017 study. GBD 2017 measured injury-specific mortality and years of life lost (YLLs) using the Cause of Death Ensemble model. To measure non-fatal injuries, GBD 2017 modelled injury-specific incidence and converted this to prevalence and years lived with disability (YLDs). YLLs and YLDs were summed to calculate disability-adjusted life years (DALYs). Findings In 1990, there were 4 260 493 (4 085 700 to 4 396 138) injury deaths, which increased to 4 484 722 (4 332 010 to 4 585 554) deaths in 2017, while age-standardised mortality decreased from 1079 (1073 to 1086) to 738 (730 to 745) per 100 000. In 1990, there were 354 064 302 (95% uncertainty interval: 338 174 876 to 371 610 802) new cases of injury globally, which increased to 520 710 288 (493 430 247 to 547 988 635) new cases in 2017. During this time, age-standardised incidence decreased non-significantly from 6824 (6534 to 7147) to 6763 (6412 to 7118) per 100 000. Between 1990 and 2017, age-standardised DALYs decreased from 4947 (4655 to 5233) per 100 000 to 3267 (3058 to 3505). Interpretation Injuries are an important cause of health loss globally, though mortality has declined between 1990 and 2017. Future research in injury burden should focus on prevention in high-burden populations, improving data collection and ensuring access to medical care., Bill and Melinda Gates Foundation OPP1152504, "Peer Reviewed"

Published
2020

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