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1. Impact of fragmentation in quantum signal channel of quantum key distribution enabled optical networks

Author

Purva Sharma, Vimal Bhatia, and Shashi Prakash

Subjects
optical fibre networks, quantum communication, Telecommunication, TK5101-6720
Abstract

Abstract In QKD‐enabled optical networks (QKD‐enabled ONs), fragmentation is one of the serious issues which can be mitigated through appropriate management of network resources. Thus, efficient allocation of network resources during routing and resource assignment is important to minimise the impact of time slot fragmentation in the quantum signal channel (QSCh) of QKD‐enabled ONs. The authors address the fragmentation problem in the QSCh and propose a new fragmentation‐suppressed routing and resource assignment (FS‐RRA) approach. To evaluate the performance and to analyse the effect of time slot fragmentation in QSCh of QKD‐enabled ONs, the proposed FS‐RRA approach is compared with two existing resource assignment approaches, namely, the first‐fit (FF) and random‐fit (RF) for two different networks. Simulation results show that the proposed approach reduces fragmentation by 2.97% and 6.69% for NSFNET and 1.77% and 5.91% for UBN24 in terms of external fragmentation compared to FF and RF, respectively. Furthermore, the proposed approach reduces blocking by 4.03% and 14.28% for NSFNET and 2.61% and 13.44% for UBN24 and improves resource utilisation up to 3.44% and 5.96% for NSFNET and 3.08% and 7.64% for UBN24 compared to FF and RF, respectively.

Published
2024
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2. Deep reinforcement learning‐based routing and resource assignment in quantum key distribution‐secured optical networks

Author

Purva Sharma, Shubham Gupta, Vimal Bhatia, and Shashi Prakash

Subjects
deep reinforcement learning, optical network, quantum key distribution, routing and resource assignment, Telecommunication, TK5101-6720
Abstract

Abstract In quantum key distribution‐secured optical networks (QKD‐ONs), constrained network resources limit the success probability of QKD lightpath requests (QLRs). Thus, the selection of an appropriate route and the efficient utilisation of network resources for establishment of QLRs are the essential and challenging problems. This work addresses the routing and resource assignment (RRA) problem in the quantum signal channel of QKD‐ONs. The RRA problem of QKD‐ONs is a complex decision making problem, where appropriate solutions depend on understanding the networking environment. Motivated by the recent advances in deep reinforcement learning (DRL) for complex problems and also because of its capability to learn directly from experiences, DRL is exploited to solve the RRA problem and a DRL‐based RRA scheme is proposed. The proposed scheme learns the optimal policy to select an appropriate route and assigns suitable network resources for establishment of QLRs by using deep neural networks. The performance of the proposed scheme is compared with the deep‐Q network (DQN) method and two baseline schemes, namely, first‐fit (FF) and random‐fit (RF) for two different networks, namely The National Science Foundation Network (NSFNET) and UBN24. Simulation results indicate that the proposed scheme reduces blocking by 7.19%, 10.11%, and 33.50% for NSFNET and 2.47%, 3.20%, and 19.60% for UBN24 and improves resource utilisation up to 3.40%, 4.33%, and 7.18% for NSFNET and 1.34%, 1.96%, and 6.44% for UBN24 as compared with DQN, FF, and RF, respectively.

Published
2023
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3. Histomorphological Study of Acalculus and Calculus Gall Bladder in a Tertiary Care Hospital of Western Uttar Pradesh

Author

Purva Sharma, Deepak Bali, Naveen Kumar, Ruchika Bhargava, Nitin Siwach, and Dushyant Sharma

Subjects
gall bladder, cholelithiasis, cholecystitis, dysplasia, cancer, Microbiology, QR1-502, Chemistry, QD1-999
Abstract

Introduction: Gall bladder is the most common surgically resected specimen as gallstones are one of the major causes of morbidity. There is increasing incidence of gall stones in India and more so in North India. It can be due to changes in life style such as fat rich food and sedentary life style. Stones can produce a wide variety of mucosal changes ranging from inflammatory, metaplastic, dysplastic and neoplastic lesions. Aim: This study was performed to find out the spectrum of histopathological lesions in gall bladder in cholecystectomy specimens with or without stones. Materials and Methods: This was a hospital based cross- sectional study conducted on 415 cholecystectomy specimens received between 1st November 2019 to 31st October 2020 in the department of Pathology of NCR Institute of Medical Sciences, Meerut. The specimens were received in 10% formalin, the gross details of specimens and stones were studied. Sections were taken from the representative areas, processed and stained with Haematoxylin and Eosin stain. These sections were studied meticulously. Demographic data was expressed as percentages. The p-value was calculated by chi-square test. Results: Of the 415 cholecystectomy specimens 337 were from females and 78 were from males with female to male ratio of 4.3:1. The most common histopathological finding was chronic cholecystitis followed by cholesterolosis observed in 206/231 (89.17%) and 28/31 (90.32%) respectively in gall bladders with stones and in 25/231 (10.82%) and 3/31 (9.36%) of gall bladders without stones. Metaplasia and dysplasia was found in 81/83 (97.59%) and 15/16 (93.75%) of cases with stones, and in 2/83 (2.40%) and 1/16 (6.25%) cases without stones. Conclusion: Cholelithiasis produces diverse mucosal alterations some of which are precancerous and can progress to cancer. So, histopathological examination of all the gall bladders is essential for the detection of premalignant and malignant conditions.

Published
2023
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4. Quantum Key Distribution Secured Optical Networks: A Survey

Author

Purva Sharma, Anuj Agrawal, Vimal Bhatia, Shashi Prakash, and Amit Kumar Mishra

Subjects
Quantum-classical coexistence, quantum key distribution, lightpath attacks, optical networks, routing, wavelength and time-slot allocation, Telecommunication, TK5101-6720, Transportation and communications, HE1-9990
Abstract

Increasing incidents of cyber attacks and evolution of quantum computing poses challenges to secure existing information and communication technologies infrastructure. In recent years, quantum key distribution (QKD) is being extensively researched, and is widely accepted as a promising technology to realize secure networks. Optical fiber networks carry a huge amount of information, and are widely deployed around the world in the backbone terrestrial, submarine, metro, and access networks. Thus, instead of using separate dark fibers for quantum communication, integration of QKD with the existing classical optical networks has been proposed as a cost-efficient solution, however, this integration introduces new research challenges. In this paper, we do a comprehensive survey of the state-of-the-art QKD secured optical networks, which is going to shape communication networks in the coming decades. We elucidate the methods and protocols used in QKD secured optical networks, and describe the process of key establishment. Various methods proposed in the literature to address the networking challenges in QKD secured optical networks, specifically, routing, wavelength and time-slot allocation (RWTA), resiliency, trusted repeater node (TRN) placement, QKD for multicast service, and quantum key recycling are described and compared in detail. This survey begins with the introduction to QKD and its advantages over conventional encryption methods. Thereafter, an overview of QKD is given including quantum bits, basic QKD system, QKD schemes and protocol families along with the detailed description of QKD process based on the Bennett and Brassard-84 (BB84) protocol as it is the most widely used QKD protocol in the literature. QKD system are also prone to some specific types of attacks, hence, we describe the types of quantum hacking attacks on the QKD system along with the methods used to prevent them. Subsequently, the process of point-to-point mechanism of QKD over an optical fiber link is described in detail using the BB84 protocol. Different architectures of QKD secured optical networks are described next. Finally, major findings from this comprehensive survey are summarized with highlighting open issues and challenges in QKD secured optical networks.

Published
2021
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5. Securing Optical Networks Using Quantum-Secured Blockchain: An Overview

Author

Purva Sharma, Kwonhue Choi, Ondrej Krejcar, Pavel Blazek, Vimal Bhatia, and Shashi Prakash

Subjects
quantum key distribution, blockchain, quantum-secured blockchain, optical networks, attacks, security, Chemical technology, TP1-1185
Abstract

The deployment of optical network infrastructure and development of new network services are growing rapidly for beyond 5/6G networks. However, optical networks are vulnerable to several types of security threats, such as single-point failure, wormhole attacks, and Sybil attacks. Since the uptake of e-commerce and e-services has seen an unprecedented surge in recent years, especially during the COVID-19 pandemic, the security of these transactions is essential. Blockchain is one of the most promising solutions because of its decentralized and distributed ledger technology, and has been employed to protect these transactions against such attacks. However, the security of blockchain relies on the computational complexity of certain mathematical functions, and because of the evolution of quantum computers, its security may be breached in real-time in the near future. Therefore, researchers are focusing on combining quantum key distribution (QKD) with blockchain to enhance blockchain network security. This new technology is known as quantum-secured blockchain. This article describes different attacks in optical networks and provides a solution to protect networks against security attacks by employing quantum-secured blockchain in optical networks. It provides a brief overview of blockchain technology with its security loopholes, and focuses on QKD, which makes blockchain technology more robust against quantum attacks. Next, the article provides a broad view of quantum-secured blockchain technology. It presents the network architecture for the future research and development of secure and trusted optical networks using quantum-secured blockchain. The article also highlights some research challenges and opportunities.

Published
2023
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6. Acute exposure of 532 nm laser differentially regulates skin tissue transcription factors.

Author

Rajkumar Tulsawani, Purva Sharma, Niroj Kumar Sethy, Pooja Kumari, Lilly Ganju, Satya Prakash, and Satish Chouhan

Subjects
Medicine, Science
Abstract

High energy laser, particularly 532 nm, is widely used in defense and medical applications and there is need to address its occupational safety. Thermal and non-thermal effects of 532 nm high energy laser on skin are cause of concern. This study indicates impact of 532 nm laser on rat skin and first of its kind of attempt to understand transcriptional activation of genes as an early response following laser exposure. Skin of experimental rats were exposed to 532 nm radiance at 0.1, 0.25 and 0.50 W/cm2 for 10 sec. Thermographic changes of skin exposed to 532 nm laser exhibited increased Tmax temperature in radiance dependent manner. After thermal imaging, skin of experimental rats was collected 1 h post laser exposure for studying differential gene expression. The skin exposed to lower power density (0.1 W/cm2) did not show significant changes in expression of gene pathways studied. At moderate radiance (0.25 W/cm2), predominantly canonical wnt/B-catenin pathway genes notch1, axin2, ccdn1, wnt5a and redox homeostasis genes; txn1, nqo1 and txnrd1 were expressed. At higher radiance (0.5 W/cm2), significant repression of genes related to wound healing process particularly notch/wnt pathway viz. hes5, wnt1, wn3b with higher expression of dab2 was recorded. The data obtained from these studies would help in drawing safety limits for skin exposure to 532 nm laser. Further, genes expressed at moderate and high level of radiance exposure to skin were distinct and differential and provide new avenue to configure pathway to counteract laser induced delay in tissue injury and hair follicular damage.

Published
2020
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7. Non-ST Elevation Myocardial Infarction and Severe Peripheral Artery Disease in a 20-Year-Old with Perinatally Acquired Human Immunodeficiency Virus Infection

Author

Purva Sharma, Mohamad Kabach, Samineh Sehatbakhsh, Rashida Tharpe, Shaun Isaac, Robert Chait, and Kleper De Almeida

Subjects
Infectious and parasitic diseases, RC109-216
Abstract

Human immunodeficiency virus (HIV) infection confers an increased risk of cardiovascular disease, including acute coronary syndrome (ACS). Patients with perinatally acquired HIV may be at increased risk due to the viral infection itself and exposure to HAART in utero or as part of treatment. A 20-year-old female with transplacentally acquired HIV infection presented with symptoms of transient aphasia, headache, palpitations, and blurry vision. She was admitted for hypertensive emergency with blood pressure 203/100 mmHg. Within a few hours, she complained of typical chest pain, and ECG showed marked ST depression. Troponin I levels escalated from 0.115 to 10.8. She underwent coronary angiogram showing 95% stenosis of the right coronary artery (RCA) and severe peripheral arterial disease including total occlusion of both common iliacs and 95% infrarenal aortic stenosis with collateral circulation. She underwent successful percutaneous intervention with a drug-eluting stent to the mid-RCA. Patients with HIV are at increased risk for cardiovascular disease. Of these, coronary artery disease is one of the most critical complications of HIV. Perinatally acquired HIV infection can be a high-risk factor for cardiovascular disease. A high degree of suspicion is warranted in such patients, especially if they are noncompliant to their ART.

Published
2018
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8. Critical investigations on performance of ANN and wavelet fault classifiers

Author

Purva Sharma and Akash Saxena

Subjects
wavelet transforms, mra level, supervised learning method, phasor measurement units (pmus), Engineering (General). Civil engineering (General), TA1-2040
Abstract

With increasing demands and competitive business environment, the structure of power system has become very complex. Moreover, power system is a dynamic framework due to faults and rapid load variations. Hence, the detection algorithms for faults are potential areas of research. To discuss this issue and to provide the solution methodology for detection of faults and further classification of those in a smart grid is a primary motivation of this manuscript. This paper presents application of supervised learning algorithms based on different neural network topologies for detection and classification of the faults in transmission lines in power system. Different wavelet transforms on different Multi Resolution Analysis levels are applied for detection of the potential features from the voltage waveforms of the Phasor Measurement Units (PMUs). These wavelet transforms are then applied to several neural networks classification engines to classify faults. Binary classification technique is used for definitions of faults. Different faults namely single line to ground, line to line, double line to ground and three phase symmetrical faults are designated as a binary digit. These definitions are employed to train the classification engine. Different plots of confusion and errors are plotted to establish a fair comparison between supervised learning algorithms.

Published
2017
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13. Acute-onset heart failure secondary to biventricular non-compaction cardiomyopathy and atrial septal defect in a woman presenting in the seventh decade

Author

Purva Sharma, Yash Jobanputra, Robert Chait, and Waqas Ghumman

Subjects
Heart Failure, Cardiac Catheterization, Treatment Outcome, Septal Occluder Device, Humans, Female, General Medicine, Middle Aged, Cardiomyopathies, Echocardiography, Transesophageal, Heart Septal Defects, Atrial
Abstract

We present a case of a previously asymptomatic 63-year-old woman who presented with worsening dyspnoea for 3 weeks. Initial transthoracic and later transoesophageal echocardiography confirmed biventricular non-compaction cardiomyopathy and a large secundum atrial septal defect (ASD) measuring 1.4 cm. Additionally, there was a haemodynamically significant left to right shunt causing acute decompensated systolic heart failure. She eventually underwent closure of the septal defect using a AMPLATZER Septal Occluder device. Decision to close the defect was made as the left to right shunt was causing severe pulmonary hypertension and acute heart failure. Since most heart failure treatments involve lowering of the LV afterload there was consideration that this could cause right to left shunting and could cause an Eisenmenger physiology. Hence the AMPLATZER Septal Occluder device was placed to eliminate the shunt through the ASD. The ASD combined with the non-compaction posed significant treatment challenge in this case.

Published
2024

14. Burkitt lymphoma: interpreting FISH testing for

Author

Purva, Sharma, Sakshi, Singal, Patrick, Costello, and Koyamangalath, Krishnan

Subjects
Gene Rearrangement, Male, Genes, myc, Humans, Burkitt Lymphoma, In Situ Hybridization, Fluorescence, Translocation, Genetic
Abstract

Burkitt lymphoma is a highly aggressive B cell non-Hodgkin's lymphoma characterised by translocation of

Published
2024

17. 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

18. Spectrum of histomorphological pattern of endometrium in different age groups in abnormal uterine bleeding in a tertiary care centre of western Uttar Pradesh

Author

Purva Sharma, Apurva Vedi, Naveen Kumar, Sumit Giri, and Dushyant Sharma

Subjects
General Nursing, Education
Abstract

Objectives:- The aim of the study was to find out the histomorphological pattern of endometrium in different age groups presenting with abnormal uterine bleeding. Methods :- This is a hospital based cross - sectional study which was performed on 569 cases (120 endometrial currettings and 449 hysterectomy specimens) received in department of pathology NCR Institute of Medical Sciences, Meerut during a period of two years (1st august 2020 to 31st july 2022). Specimens were fixed in 10% formol saline, routine processing was done and sections were stained with haematoxylin and eosin stain (H&E stain). Results were expressed as percentages and p value was calculated. Results:- The age range of these patients was from 25-75 years with mean age of 43 years. Majority of patients were in the perimenopausal age group.The most common pattern in reproductive age group was secretory phase (51.28%) whereas in perimenopausal females it was proliferative phase (68.04%) and in post menopausal females it was atrophic phase (84.85%). Precancerous lesions such as endometrial polyp and endometrial hyperplasia was dominant in perimenopausal age group. Conclusions:- Abnormal Uterine Bleeding is a common cause of morbidity amongst woman of all age groups.

Published
2022

19. Comparison of HER-2/neu with histological grade and hormone (ER, PR) status in carcinoma breast

Author

Purva Sharma, Deepak Bali, Hemant Kumar Singh, and Alok Mohan

Subjects
General Nursing, Education
Abstract

Objectives :- The study was performed with the aim to compare HER-2/neu over expression with age, size of tumor, histopathological type, grade of tumor, lymph node positivity, NPI, and hormone receptors ER and PR. Methods :- The study was conducted on 66 cases of breast carcinoma. All the cases underwent immunohistochemistry for ER, PR and HER-2/neu over expression. HER-2/neu over expression was compared with prognostic factors. Results :- The age range of these patients was from 30-70 years with mean age of 49.92 years. HER-2/neu was strongly positive (score 3) in 12/66 ( 18.18%), moderate or equivocal ( score 2) in 7 /66 (10.60 %) and mild ( score 1) in 16/66 (24.24%) and it was negative ( score 0) in 31/66 (46.97 %). Estrogen Receptor ( ER) was positive in 38/66 (57.57%) cases, progesterone receptors (PR) was positive in 30/66 (45.45%) cases. Triple negative cases were 16/66 (24.24%) and triple receptor positive cases were 04/66 (6.06%).

Published
2022

22. Efficacy of Aqueous Extract of Chinese Caterpillar Mushroom Ophiocordyceps sinensis (Ascomycota) Against Simulated Altitude Stress and Subacute Toxicity Studies

Author

Purva, Sharma and Rajkumar, Tulsawani

Subjects
Pharmacology, China, Altitude, Cordyceps, Body Weight, Drug Discovery, Animals, Hypoxia, Applied Microbiology and Biotechnology, Rats
Abstract

Exposure to high altitude severely impacts performance of unacclimatized individuals and contraindications associated with synthetic drugs ascertain the need for development of herbal drugs. Thus, the present study investigated the adaptogenic potential of Ophiocordyceps sinensis aqueous extract (CSAQ) using simulated altitude stress models such as severe hypoxia (SH) in hermetic vessel, cold restraint (CR) at 4°C, and hypobaric hypoxia (HBH) at 7,620 meter, ~ 282 mm Hg. To further address safety limits of extract, subacute toxicity studies were conducted in rats orally administered with CSAQ (0, 100, 500 and 1000 mg/kg) in a single dose/day for 28 days. Results revealed that animals administered with CSAQ increased convulsion time and core body temperature during SH and CR stress. CSAQ modulated thermogenic response by upregulating uncoupling protein 1 and maintaining metabolic homeostasis. Further, CSAQ improved antioxidant status (glutathione and 2,3-diposhphoglycerate), attenuated pro-inflammatory cytokine NF-κB, and augmented hypoxia inducible factor and nuclear erythroid 2 related factor 2 in HBH exposed animals. Toxicity studies revealed no observed adverse effect level with 1000 mg/kg extract in body weight gain, organ/body weight ratio, hematological variables, biochemical parameters and histoarchitecture of vital organs. In conclusion, CSAQ initiated dose dependent adaptive response and exhibited high safety margins, which strongly suggests the therapeutic potential of CSAQ in mitigating high altitude maladies.

Published
2022

23. ANCA Vasculitis Induction Management During the COVID-19 Pandemic

Author

Jennifer Scott, Adam D. Morris, Andreas Kronbichler, Vimal K. Derebail, Lauren Floyd, Mark A. Little, Stephen P. McAdoo, Philipp Gauckler, Silke R. Brix, Maria Prendecki, Tingting Li, Isabelle Ayoub, Sam Kant, Vladimir Tesar, Caroline J. Poulton, Antonio Salas, Ulf Schönermarck, Ajay Dhaygude, Manish K. Saha, Vojtech Kratky, Zdenka Hruskova, Purva Sharma, Duvuru Geetha, and Philip Seo

Subjects
2019-20 coronavirus outbreak, Coronavirus disease 2019 (COVID-19), business.industry, Anca vasculitis, viruses, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), induction therapy, COVID pandemic, ANCA vasculitis, Virology, Nephrology, Induction therapy, Pandemic, Research Letter, Medicine, business
Abstract

As the severe acute respiratory syndrome coronavirus 2 pandemic evolved and became a global health threat, the safety of immunosuppression in antineutrophil cytoplasmic antibody-associated vasculitis (AAV) became of utmost important for clinicians and patients. Although timely initiation of immunosuppressive therapy is critical to quell the acute inflammation and prevent AAV-associated mortality and morbidity, concerns for increased susceptibility to Coronavirus Disease 2019 (COVID-19), delayed viral clearance, and decreased humoral response to infection led to speculation about modification in induction therapy practices may be deployed by physicians caring for patients with AAV. This international retrospective cohort study investigated the influence of the COVID-19 pandemic on AAV induction therapy and patient outcomes in different parts of the world by studying differences in treatment regimens in the United States, United Kingdom, and Europe.

Published
2021

26. CRRT-associated ketoacidosis: A series of 5 cases

Author

Rushang Parikh, Yuriy Khanin, Rimda Wanchoo, Purva Sharma, and Richard Barnett

Subjects
medicine.medical_specialty, Continuous Renal Replacement Therapy, medicine.medical_treatment, Critical Illness, Dialysis Solutions, Ketogenesis, medicine, Humans, Renal replacement therapy, Intensive care medicine, Dialysis, Acidosis, business.industry, Acute kidney injury, Metabolic acidosis, Phosphorus, General Medicine, Ketosis, Acute Kidney Injury, medicine.disease, Ketoacidosis, Renal Replacement Therapy, Glucose, Nephrology, medicine.symptom, business, Hypophosphatemia
Abstract

Continuous renal replacement therapy (CRRT) is a dialysis modality used in critically ill patients with acute kidney injury (AKI). Although most dialysate and replacement fluids are dextrose-containing, CRRT-associated hypophosphatemia sometimes warrants the use of phosphorus-containing solutions which are dextrose free. The other less commonly used dextrose-free dialysate solutions are certain formulations of Prismasol and Prismasate. As glucose is a small molecule, which is readily cleared with dialysis, use of these solutions can result in increased caloric loss, net glucose deficit, and shifting of the metabolic pathway towards gluconeogenesis and ketogenesis. Starvation ketosis is usually a benign entity, however when combined with factors such as stress of critical illness, can produce metabolic acidosis which at times can be severe. We describe five patients who developed worsening metabolic acidosis despite adequate clearance from CRRT and were diagnosed with CRRT-associated ketoacidosis. Administration of dextrose-containing fluids or tube feeds promptly resulted in resolution of ketonemia and acidosis. Recognition of this entity is of great importance as the reflexive reaction to increase the prescribed dose of CRRT to improve the acidosis, in fact worsens the problem.

Published
2022

28. Understanding the luxury purchase intentions of young consumers: a qualitative analysis

Author

Sudeepta Pradhan, Ankur Srivastava, and Purva Sharma

Subjects
Qualitative analysis, Public Administration, Content analysis, 0502 economics and business, 05 social sciences, 050211 marketing, Advertising, Psychology, General Business, Management and Accounting, 050203 business & management, Consumer behaviour
Abstract

PurposeThe study intends to investigate the key purchase drivers of luxury brands in India. Given that a major segment of this target audience is the young consumers, the study focuses on determining these antecedents of luxury purchase from a young Indian consumer lens.Design/methodology/approachThe study uses an interpretive research position, employing qualitative techniques in the form of in-depth interviews. In total, 62 respondents were interviewed, and later the transcribed interviews were analyzed using content analysis.FindingsThe study identifies the three main value dimensions that contribute to the final purchase decision: functional, social and emotional. The study also highlights the importance of Internet and web for luxury brands and how young Indian consumer consumes luxury online.Originality/valueResearch on luxury brands is still at a nascent stage. Though variables such as economic value, brand origin, social identity, prestige, self-congruity and so on have been examined in the context of luxury brands in prior studies. However, these studies are restricted because either they were product-specific or actual users of luxury brands were not approached as the sample. Most importantly none of these studies reflect the purchase behavior of young consumers in an emerging market, especially India. Given the growth of luxury brands in India, it would be worthwhile to investigate the factors influencing the customer purchase intention of luxury brands in emerging markets.

Published
2021

29. Identifying patients with CKD risk at the time of nephrectomy: When to initiate nephrology consult

Author

Oksana Yaskiv, Purva Sharma, Shashank Pandya, Yihe Yang, Kenar D. Jhaveri, Madhu Bhaskaran, Jose Torres, Zachary Kozel, Manish Vira, and Vanesa Bijol

Subjects
Nephrology, medicine.medical_specialty, business.industry, medicine.medical_treatment, 030232 urology & nephrology, Kidney Neoplasm, medicine.disease, Nephrectomy, 03 medical and health sciences, 0302 clinical medicine, 030220 oncology & carcinogenesis, Internal medicine, Medicine, business, Kidney cancer, Kidney disease
Abstract

Introduction: The prevalence of chronic kidney disease (CKD) is high among kidney neoplasm patients because of the overlapping risk factors. Our purpose is to identify kidney cancer survivors with higher CKD risk. Methods: We studied a retrospective cohort of 361 kidney tumor patients with partial or radical nephrectomy. Linear mixed model was performed. Results: Of patients with follow-up >3 months, 84% were identified retrospectively to fulfill criteria for CKD diagnosis, although CKD was documented in only 15%. Urinalysis was performed in 205 (57%) patients at the time of nephrectomy. Multivariate analysis showed interstitial fibrosis and tubular atrophy (IFTA) >25% ( p = 0.005), severe arteriolar sclerosis ( p = 0.013), female gender ( p = 0.024), older age ( p = 0.012), BMI ⩾ 25 kg/m2 ( p < 0.001), documented CKD ( p < 0.001), baseline eGFR ⩽ 60 ml/min/1.73 m2 ( p < 0.001), and radical nephrectomy ( p < 0.001) were independent risk factors of lower eGFR at baseline and during follow-up. Average eGFR decreased within 3 months post nephrectomy. However, patients with different risk levels showed different eGFR time trend pattern at longer follow-ups. Multivariate analysis of time × risk factor interaction showed BMI, radical nephrectomy and baseline eGFR had time-dependent impact. BMI ⩾ 25 kg/m2 and radical nephrectomy were associated with steeper eGFR decrease slope. In baseline eGFR > 90 ml/min/1.73 m2 group, eGFR rebounded to pre-nephrectomy levels during extended follow-up. In partial nephrectomy patients with baseline eGFR ⩾ 90 ml/min/1.73 m2 ( n = 61), proteinuria ( p < 0.001) and BMI ( p < 0.001) were independent risk factors of decreased eGFR during follow up. Conclusions: As have been suggested by others and confirmed by our study, proteinuria and CKD are greatly under-recognized. Although self-evident as a minimum workup for nephrectomy patients to include SCr, eGFR, urinalysis, and proteinuria, the need for uniform applications of this practice should be reinforced. Non-neoplastic histology evaluation is valuable and should include an estimate of global sclerosis% (GS) and IFTA%. Patients with any proteinuria and/or eGFR ⩽ 60 at the time of nephrectomy or in follow-up with urologists, and/or >25% GS or IFTA, should be referred for early nephrology consultation.

Published
2021

30. Glomerular Disease in Liver Disease

Author

Purva Sharma and Medha Airy

Subjects
Male, Hepatology, Liver Diseases, Humans, Female, Kidney Diseases, Vascular Diseases, Hepatitis B, Antiviral Agents
Abstract

Glomerular diseases are an important cause of kidney disease in patients with liver disease. Although kidney involvement due to tubular or vascular disease is more common, glomerular diseases became more prevalent as hepatitis infections increased and then subsequently decreased with the widespread availability of hepatitis A and B vaccines and the development of effective antiviral treatments for hepatitis B and C. In this review, we discuss the common glomerular pathologies that are seen in patients with liver disease and the current treatment options available to them.

Published
2022

31. Prevalence and outcomes of hyponatremia and hypernatremia in patients hospitalized with COVID-19

Author

Jamie S, Hirsch, Nupur N, Uppal, Purva, Sharma, Yuriy, Khanin, Hitesh H, Shah, Deepa A, Malieckal, Alessandro, Bellucci, Mala, Sachdeva, Helbert, Rondon-Berrios, Kenar D, Jhaveri, Steven, Fishbane, Jia H, Ng, and Rimda, Wanchoo

Subjects
Transplantation, 2019-20 coronavirus outbreak, Pediatrics, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), business.industry, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), MEDLINE, medicine.disease, Nephrology, Research Letter, medicine, In patient, Hypernatremia, AcademicSubjects/MED00340, business, Hyponatremia
Published
2021

32. 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 Hossain Hossain, Mohammad-Salar Hosseini, Ali Hosseinzadeh, Mehdi Hosseinzadeh, Mihaela Hostiuc, Sorin Hostiuc, Mowafa Househ, Junjie Huang, Fernando N Hugo, Ayesha Humayun, Salman Hussain, Nawfal R Hussein, Bing-Fang Hwang, Segun Emmanuel Ibitoye, Pulwasha Maria Iftikhar, Kevin S Ikuta, Olayinka Stephen Ilesanmi, Irena M Ilic, Milena D Ilic, Mustapha Immurana, Kaire Innos, Pooya Iranpour, Lalu Muhammad Irham, Md Shariful Islam, Rakibul M Islam, Farhad Islami, Nahlah Elkudssiah Ismail, Gaetano Isola, Masao Iwagami, Linda Merin J, Abhishek Jaiswal, Mihajlo Jakovljevic, Mahsa Jalili, Shahram Jalilian, Elham Jamshidi, Sung-In Jang, Chinmay T Jani, Tahereh Javaheri, Umesh Umesh Jayarajah, Shubha Jayaram, Seyed Behzad Jazayeri, Rime Jebai, Bedru Jemal, Wonjeong Jeong, Ravi Prakash Jha, Har Ashish Jindal, Yetunde O John-Akinola, Jost B Jonas, Tamas Joo, Nitin Joseph, Farahnaz Joukar, Jacek Jerzy Jozwiak, Mikk Jürisson, Ali Kabir, Salah Eddine Oussama Kacimi, Vidya Kadashetti, Farima Kahe, Pradnya Vishal Kakodkar, Laleh R Kalankesh, Leila R Kalankesh, Rohollah Kalhor, Vineet Kumar Kamal, Farin Kamangar, Ashwin Kamath, Tanuj Kanchan, Eswar Kandaswamy, Himal Kandel, HyeJung Kang, Girum Gebremeskel Kanno, Neeti Kapoor, Sitanshu Sekhar Kar, Shama D Karanth, Ibraheem M Karaye, André Karch, Amirali Karimi, Bekalu Getnet Kassa, Patrick DMC Katoto, Joonas H Kauppila, Harkiran Kaur, Abinet Gebremickael Kebede, Leila Keikavoosi-Arani, Gemechu Gemechu Kejela, Phillip M Kemp Bohan, Maryam Keramati, Mohammad Keykhaei, Himanshu Khajuria, Abbas Khan, Abdul Aziz Khan Khan, Ejaz Ahmad Khan, Gulfaraz Khan, Md Nuruzzaman Khan, Moien AB Khan, Javad Khanali, Khaled Khatab, Moawiah Mohammad Khatatbeh, Mahalaqua Nazli Khatib, Maryam Khayamzadeh, Hamid Reza Khayat Kashani, Mohammad Amin Khazeei Tabari, Mehdi Khezeli, Mahmoud Khodadost, Min Seo Kim, Yun Jin Kim, Adnan Kisa, Sezer Kisa, Miloslav Klugar, Jitka Klugarová, Ali-Asghar Kolahi, Pavel Kolkhir, Farzad Kompani, Parvaiz A Koul, Sindhura Lakshmi Koulmane Laxminarayana, Ai Koyanagi, Kewal Krishan, Yuvaraj Krishnamoorthy, Burcu Kucuk Bicer, Nuworza Kugbey, Mukhtar Kulimbet, Akshay Kumar, G Anil Kumar, Narinder Kumar, Om P Kurmi, Ambily Kuttikkattu, Carlo La Vecchia, Arista Lahiri, Dharmesh Kumar Lal, Judit Lám, Qing Lan, Iván Landires, Bagher Larijani, Savita Lasrado, Jerrald Lau, Paolo Lauriola, Caterina Ledda, Sang-woong Lee, Shaun Wen Huey Lee, Wei-Chen Lee, Yeong Yeh Lee, Yo Han Lee, Samson Mideksa Legesse, James Leigh, Elvynna Leong, Ming-Chieh Li, Stephen S Lim, Gang Liu, Jue Liu, Chun-Han Lo, Ayush Lohiya, Platon D Lopukhov, László Lorenzovici, Mojgan Lotfi, Joana A Loureiro, Raimundas Lunevicius, Farzan Madadizadeh, Ahmad R Mafi, Sameh Magdeldin, Soleiman Mahjoub, Ata Mahmoodpoor, Morteza Mahmoudi, Marzieh Mahmoudimanesh, Rashidul Alam Mahumud, Azeem Majeed, Jamal Majidpoor, Alaa Makki, Konstantinos Christos Makris, Elaheh Malakan Rad, Mohammad-Reza Malekpour, Reza Malekzadeh, Ahmad Azam Malik, Tauqeer Hussain Mallhi, Sneha Deepak Mallya, Mohammed A Mamun, Ana Laura Manda, Fariborz Mansour-Ghanaei, Borhan Mansouri, Mohammad Ali Mansournia, Lorenzo Giovanni Mantovani, Santi Martini, Miquel Martorell, Sahar Masoudi, Seyedeh Zahra Masoumi, Clara N Matei, Elezebeth Mathews, Manu Raj Mathur, Vasundhara Mathur, Martin McKee, Jitendra Kumar Meena, Khalid Mehmood, Entezar Mehrabi Nasab, Ravi Mehrotra, Addisu Melese, Walter Mendoza, Ritesh G Menezes, SIsay Derso Mengesha, Laverne G Mensah, Alexios-Fotios A Mentis, Andry Yasmid Mera Mera-Mamián, Tuomo J Meretoja, Mehari Woldemariam Merid, Amanual Getnet Mersha, Belsity Temesgen Meselu, Mahboobeh Meshkat, Tomislav Mestrovic, Junmei Miao Jonasson, Tomasz Miazgowski, Irmina Maria Michalek, Gelana Fekadu Worku Mijena, Ted R Miller, Shabir Ahmad Mir, Seyed Kazem Mirinezhad, Seyyedmohammadsadeq Mirmoeeni, Mohammad Mirza-Aghazadeh-Attari, Hamed Mirzaei, Hamid Reza Mirzaei, Abay Sisay Misganaw, Sanjeev Misra, Karzan Abdulmuhsin Mohammad, Esmaeil Mohammadi, Mokhtar Mohammadi, Abdollah Mohammadian-Hafshejani, Reza Mohammadpourhodki, Arif Mohammed, Shafiu Mohammed, Syam Mohan, Mohammad Mohseni, Nagabhishek Moka, Ali H Mokdad, Alex Molassiotis, Mariam Molokhia, Kaveh Momenzadeh, Sara Momtazmanesh, Lorenzo Monasta, Ute Mons, Ahmed Al Montasir, Fateme Montazeri, Arnulfo Montero, Mohammad Amin Moosavi, Abdolvahab Moradi, Yousef Moradi, Mostafa Moradi Sarabi, Paula Moraga, Lidia Morawska, Shane Douglas Morrison, Jakub Morze, Abbas Mosapour, Ebrahim Mostafavi, Seyyed Meysam Mousavi, Haleh Mousavi Isfahani, Amin Mousavi Khaneghah, Christine Mpundu-Kaambwa, Sumaira Mubarik, Francesk Mulita, Daniel Munblit, Sandra B Munro, Efrén Murillo-Zamora, Jonah Musa, Ashraf F Nabhan, Ahamarshan Jayaraman Nagarajan, Shankar Prasad Nagaraju, Gabriele Nagel, Mohammadreza Naghipour, Mukhammad David Naimzada, Tapas Sadasivan Nair, Atta Abbas Naqvi, Sreenivas Narasimha Swamy, Aparna Ichalangod Narayana, Hasan Nassereldine, Zuhair S Natto, Biswa Prakash Nayak, Rawlance Ndejjo, Sabina Onyinye Nduaguba, Wogene Wogene Negash, Seyed Aria Nejadghaderi, Kazem Nejati, Sandhya Neupane Kandel, Huy Van Nguyen Nguyen, Robina Khan Niazi, Nurulamin M Noor, Maryam Noori, Nafise Noroozi, Hasti Nouraei, Ali Nowroozi, Virginia Nuñez-Samudio, Chimezie Igwegbe Nzoputam, Ogochukwu Janet Nzoputam, Bogdan Oancea, Oluwakemi Ololade Odukoya, Onome Bright Oghenetega, Ropo Ebenezer Ogunsakin, Ayodipupo Sikiru Oguntade, In-Hwan Oh, Hassan Okati-Aliabad, Akinkunmi Paul Okekunle, Andrew T Olagunju, Tinuke O Olagunju, Babayemi Oluwaseun Olakunde, Isaac Iyinoluwa Olufadewa, Emad Omer, Abidemi E Emmanuel Omonisi, Sokking Ong, Obinna E Onwujekwe, Hans Orru, Stanislav S Otstavnov, Abderrahim Oulhaj, Bilcha Oumer, Oluwatomi Funbi Owopetu, Babatunji Emmanuel Oyinloye, Mahesh P A, Alicia Padron-Monedero, Jagadish Rao Padubidri, Babak Pakbin, Keyvan Pakshir, Reza Pakzad, Tamás Palicz, Adrian Pana, Anamika Pandey, Ashok Pandey, Suman Pant, Shahina Pardhan, Eun-Cheol Park, Eun-Kee Park, Seoyeon Park, Jay Patel, Siddhartha Pati, Rajan Paudel, Uttam Paudel, Mihaela Paun, Hamidreza Pazoki Toroudi, Minjin Peng, Jeevan Pereira, Renato B Pereira, Simone Perna, Navaraj Perumalsamy, Richard G Pestell, Raffaele Pezzani, Cristiano Piccinelli, Julian David Pillay, Zahra Zahid Piracha, Tobias Pischon, Maarten J Postma, Ashkan Pourabhari Langroudi, Akram Pourshams, Naeimeh Pourtaheri, Akila Prashant, Mirza Muhammad Fahd Qadir, Zahiruddin Quazi Syed, Mohammad Rabiee, Navid Rabiee, Amir Radfar, Raghu Anekal Radhakrishnan, Venkatraman Radhakrishnan, Mojtaba Raeisi, Ata Rafiee, Alireza Rafiei, Nasiru Raheem, Fakher Rahim, Md Obaidur Rahman, Mosiur Rahman, Muhammad Aziz Rahman, Amir Masoud Rahmani, Shayan Rahmani, Vahid Rahmanian, Nazanin Rajai, Aashish Rajesh, Pradhum Ram, Kiana Ramezanzadeh, Juwel Rana, Kamal Ranabhat, Priyanga Ranasinghe, Chythra R Rao, Sowmya J Rao, Sina Rashedi, Amirfarzan Rashidi, Mahsa Rashidi, Mohammad-Mahdi Rashidi, Zubair Ahmed Ratan, David Laith Rawaf, Salman Rawaf, Lal Rawal, Reza Rawassizadeh, Mohammad Sadegh Razeghinia, Ashfaq Ur Rehman, Inayat ur Rehman, Marissa B Reitsma, Andre M N Renzaho, Maryam Rezaei, Nazila Rezaei, Negar Rezaei, Nima Rezaei, Saeid Rezaei, Mohsen Rezaeian, Aziz Rezapour, Abanoub Riad, Reza Rikhtegar, Maria Rios-Blancas, Thomas J Roberts, Peter Rohloff, Esperanza Romero-Rodríguez, Gholamreza Roshandel, Godfrey M Rwegerera, Manjula S, Maha Mohamed Saber-Ayad, Bahar Saberzadeh-Ardestani, Siamak Sabour, Basema Saddik, Erfan Sadeghi, Mohammad Reza Saeb, Umar Saeed, Mohsen Safaei, Azam Safary, Maryam Sahebazzamani, Amirhossein Sahebkar, Harihar Sahoo, Mirza Rizwan Sajid, Hedayat Salari, Sana Salehi, Marwa Rashad Salem, Hamideh Salimzadeh, Yoseph Leonardo Samodra, Abdallah M Samy, Juan Sanabria, Senthilkumar Sankararaman, Francesco Sanmarchi, Milena M Santric-Milicevic, Muhammad Arif Nadeem Saqib, Arash Sarveazad, Fatemeh Sarvi, Brijesh Sathian, Maheswar Satpathy, Nicolas Sayegh, Ione Jayce Ceola Schneider, Michaël Schwarzinger, Mario Šekerija, Subramanian Senthilkumaran, Sadaf G Sepanlou, Allen Seylani, Kenbon Seyoum, Feng Sha, Omid Shafaat, Pritik A Shah, Saeed Shahabi, Izza Shahid, Mohammad Amin Shahrbaf, Hamid R Shahsavari, Masood Ali Shaikh, Mohammed Feyisso Shaka, Elaheh Shaker, Mohammed Shannawaz, Mequannent Melaku Sharew Sharew, Azam Sharifi, Javad Sharifi-Rad, Purva Sharma, Bereket Beyene Shashamo, Aziz Sheikh, Mahdi Sheikh, Sara Sheikhbahaei, Rahim Ali Sheikhi, Ali Sheikhy, Peter Robin Shepherd, Adithi Shetty, Jeevan K Shetty, Ranjitha S Shetty, Kenji Shibuya, Reza Shirkoohi, Hesamaddin Shirzad-Aski, K M Shivakumar, Siddharudha Shivalli, Velizar Shivarov, Parnian Shobeiri, Zahra Shokri Varniab, Seyed Afshin Shorofi, Sunil Shrestha, Migbar Mekonnen Sibhat, Sudeep K Siddappa Malleshappa, Negussie Boti Sidemo, Diego Augusto Santos Silva, Luís Manuel Lopes Rodrigues Silva, Guilherme Silva Julian, Nicola Silvestris, Wudneh Simegn, Achintya Dinesh Singh, Ambrish Singh, Garima Singh, Harpreet 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Kenny Thomas, Jansje Henny Vera Ticoalu, Amir Tiyuri, Daniel Nigusse Tollosa, Roman Topor-Madry, Mathilde Touvier, Marcos Roberto Tovani-Palone, Eugenio Traini, Mai Thi Ngoc Tran, Jaya Prasad Tripathy, Gebresilasea Gendisha Ukke, Irfan Ullah, Saif Ullah, Sana Ullah, Bhaskaran Unnikrishnan, Marco Vacante, Maryam Vaezi, Sahel Valadan Tahbaz, Pascual R Valdez, Constantine Vardavas, Shoban Babu Varthya, Siavash Vaziri, Diana Zuleika Velazquez, Massimiliano Veroux, Paul J Villeneuve, Francesco S Violante, Sergey Konstantinovitch Vladimirov, Vasily Vlassov, Bay Vo, Linh Gia Vu, Abdul Wadood Wadood, Yasir Waheed, Mandaras Tariku Walde, Richard G Wamai, Cong Wang, Fang Wang, Ning Wang, Yu Wang, Paul Ward, Abdul Waris, Ronny Westerman, Nuwan Darshana Wickramasinghe, Melat Woldemariam, Berhanu Woldu, Hong Xiao, Suowen Xu, Xiaoyue Xu, Lalit Yadav, Seyed Hossein Yahyazadeh Jabbari, Lin Yang, Fereshteh Yazdanpanah, Yigizie Yeshaw, Yazachew Yismaw, Naohiro Yonemoto, Mustafa Z Younis, Zabihollah 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Thomas, N, Ticoalu, J, Tiyuri, A, Tollosa, D, Topor-Madry, R, Touvier, M, Tovani-Palone, M, Traini, E, Tran, M, Tripathy, J, Ukke, G, Ullah, I, Ullah, S, Unnikrishnan, B, Vacante, M, Vaezi, M, Valadan Tahbaz, S, Valdez, P, Vardavas, C, Varthya, S, Vaziri, S, Velazquez, D, Veroux, M, Villeneuve, P, Violante, F, Vladimirov, S, Vlassov, V, Vo, B, Vu, L, Wadood, A, Waheed, Y, Walde, M, Wamai, R, Wang, C, Wang, F, Wang, N, Wang, Y, Ward, P, Waris, A, Westerman, R, Wickramasinghe, N, Woldemariam, M, Woldu, B, Xiao, H, Xu, S, Xu, X, Yadav, L, Yahyazadeh Jabbari, S, Yang, L, Yazdanpanah, F, Yeshaw, Y, Yismaw, Y, Yonemoto, N, Younis, M, Yousefi, Z, Yousefian, F, Yu, C, Yu, Y, Yunusa, I, Zahir, M, Zaki, N, Zaman, B, Zangiabadian, M, Zare, F, Zare, I, Zareshahrabadi, Z, Zarrintan, A, Zastrozhin, M, Zeineddine, M, Zhang, D, Zhang, J, Zhang, Y, Zhang, Z, Zhou, L, Zodpey, S, Zoladl, M, Vos, T, Hay, S, Force, L, Murray, C, Epidemiologie, RS: NUTRIM - R3 - Respiratory & Age-related Health, Bill & 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

33. 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, Francesco Barone-Adesi, Hiba Jawdat Barqawi, Amadou Barrow, Azadeh Bashiri, Quique Bassat, Abdul-Monim Mohammad Batiha, Abate Bekele Belachew, Melaku Ashagrie Belete, Uzma Iqbal Belgaumi, Akshaya Srikanth Bhagavathula, Nikha Bhardwaj, Pankaj Bhardwaj, Parth Bhatt, Vijayalakshmi S Bhojaraja, Zulfiqar A Bhutta, Soumitra S Bhuyan, Ali Bijani, Saeid Bitaraf, Belay Boda Abule Bodicha, Nikolay Ivanovich Briko, Danilo Buonsenso, Muhammad Hammad Butt, Jiao Cai, Paulo Camargos, Luis Alberto Cámera, Promit Ananyo Chakraborty, Muluken Genetu Chanie, Jaykaran Charan, Vijay Kumar Chattu, Patrick R Ching, Sungchul Choi, Yuen Yu Chong, Sonali Gajanan Choudhari, Enayet Karim Chowdhury, Devasahayam J Christopher, Dinh-Toi Chu, Natalie L Cobb, Aaron J Cohen, Natália Cruz-Martins, Omid Dadras, Fentaw Teshome Dagnaw, Xiaochen Dai, Lalit Dandona, Rakhi Dandona, An Thi Minh Dao, Sisay Abebe Debela, Biniyam Demisse, Fitsum Wolde Demisse, Solomon Demissie, Diriba Dereje, Hardik Dineshbhai Desai, Abebaw Alemayehu Desta, Belay Desye, Sameer Dhingra, Nancy Diao, Daniel Diaz, Lankamo Ena Digesa, Linh Phuong Doan, Milad Dodangeh, Deepa Dongarwar, Fariba Dorostkar, Wendel Mombaque dos Santos, Haneil Larson Dsouza, Eleonora Dubljanin, Oyewole Christopher Durojaiye, Hisham Atan Edinur, Elham Ehsani-Chimeh, Ebrahim Eini, Michael Ekholuenetale, Temitope Cyrus Ekundayo, Eman D El Desouky, Iman El Sayed, Maysaa El Sayed Zaki, Muhammed Elhadi, Ahmed Mahmoud Rabie Elkhapery, Amir Emami, Luchuo Engelbert Bain, Ryenchindorj Erkhembayar, Farshid Etaee, Mohamad Ezati Asar, Adeniyi Francis Fagbamigbe, Shahab Falahi, Aida Fallahzadeh, Anwar Faraj, Emerito Jose A Faraon, Ali Fatehizadeh, Pietro Ferrara, Allegra Allegra Ferrari, Getahun Fetensa, Florian Fischer, Joanne Flavel, Masoud Foroutan, Peter Andras Gaal, Abhay Motiramji Gaidhane, Santosh Gaihre, Nasrin Galehdar, Alberto L Garcia-Basteiro, Tushar Garg, Mesfin Damtew Gebrehiwot, Mathewos Alemu Gebremichael, Yibeltal Yismaw Gela, Belete Negese Belete Gemeda, Bradford D Gessner, Melaku Getachew, Asmare Getie, Seyyed-Hadi Ghamari, Mohammad Ghasemi Nour, Ahmad Ghashghaee, Ali Gholamrezanezhad, Abdolmajid Gholizadeh, Rakesh Ghosh, Sherief Ghozy, Pouya Goleij, Mohamad Golitaleb, Giuseppe Gorini, Alessandra C Goulart, Girma Garedew Goyomsa, Habtamu Alganeh Guadie, Zewdie Gudisa, Rashid Abdi Guled, Sapna Gupta, Veer Bala Gupta, Vivek Kumar Gupta, Alemu Guta, Parham Habibzadeh, Arvin Haj-Mirzaian, Rabih Halwani, Samer Hamidi, Md Abdul Hannan, Mehdi Harorani, Ahmed I Hasaballah, Hamidreza Hasani, Abbas M Hassan, Shokoufeh Hassani, Hossein Hassanian-Moghaddam, Hadi Hassankhani, Khezar Hayat, Behzad Heibati, Mohammad Heidari, Demisu Zenbaba Heyi, Kamal Hezam, Ramesh Holla, Sung Hwi Hong, Nobuyuki Horita, Mohammad-Salar Hosseini, Mehdi Hosseinzadeh, Mihaela Hostiuc, Mowafa Househ, Soodabeh Hoveidamanesh, Junjie Huang, Nawfal R Hussein, Ivo Iavicoli, Segun Emmanuel Ibitoye, Kevin S Ikuta, Olayinka Stephen Ilesanmi, Irena M Ilic, Milena D Ilic, Mustapha Immurana, Nahlah Elkudssiah Ismail, Masao Iwagami, Jalil Jaafari, Elham Jamshidi, Sung-In Jang, Amirreza Javadi Mamaghani, Tahereh Javaheri, Fatemeh Javanmardi, Javad Javidnia, Sathish Kumar Jayapal, Umesh Jayarajah, Shubha Jayaram, Alelign Tasew Jema, Wonjeong Jeong, Jost B Jonas, Nitin Joseph, Farahnaz Joukar, Jacek Jerzy Jozwiak, Vaishali K, Zubair Kabir, Salah Eddine Oussama Kacimi, Vidya Kadashetti, Laleh R Kalankesh, Rohollah Kalhor, Ashwin Kamath, Bhushan Dattatray Kamble, Himal Kandel, Tesfaye K Kanko, Ibraheem M Karaye, André Karch, Samad Karkhah, Bekalu Getnet Kassa, Patrick DMC Katoto, Harkiran Kaur, Rimple Jeet Kaur, Leila Keikavoosi-Arani, Mohammad Keykhaei, Yousef Saleh Khader, Himanshu Khajuria, Ejaz Ahmad Khan, Gulfaraz Khan, Imteyaz A Khan, Maseer Khan, Md Nuruzzaman Khan, Moien AB Khan, Yusra H Khan, Moawiah Mohammad Khatatbeh, Mina Khosravifar, Jagdish Khubchandani, Min Seo Kim, Ruth W Kimokoti, Adnan Kisa, Sezer Kisa, Niranjan Kissoon, Luke D Knibbs, Sonali Kochhar, Farzad Kompani, Hamid Reza Koohestani, Vladimir Andreevich Korshunov, Soewarta Kosen, Parvaiz A Koul, Ai Koyanagi, Kewal Krishan, Barthelemy Kuate Defo, G Anil Kumar, Om P Kurmi, Ambily Kuttikkattu, Dharmesh Kumar Lal, Judit Lám, Iván Landires, Caterina Ledda, Sang-woong Lee, Miriam Levi, Sonia Lewycka, Gang Liu, Wei Liu, Rakesh Lodha, László Lorenzovici, Mojgan Lotfi, Joana A Loureiro, Farzan Madadizadeh, Ata Mahmoodpoor, Razzagh Mahmoudi, Marzieh Mahmoudimanesh, Jamal Majidpoor, Alaa Makki, Elaheh Malakan Rad, Ahmad Azam Malik, Tauqeer Hussain Mallhi, Yosef Manla, Clara N Matei, Alexander G Mathioudakis, Richard James Maude, Entezar Mehrabi Nasab, Addisu Melese, Ziad A Memish, Oliver Mendoza-Cano, Alexios-Fotios A Mentis, Tuomo J Meretoja, Mehari Woldemariam Merid, Tomislav Mestrovic, Ana Carolina Micheletti Gomide Nogueira de Sá, Gelana Fekadu Worku Mijena, Le Huu Nhat Minh, Shabir Ahmad Mir, Reza Mirfakhraie, Seyyedmohammadsadeq Mirmoeeni, Agha Zeeshan Mirza, Moonis Mirza, Mohammad Mirza-Aghazadeh-Attari, Abay Sisay Misganaw, Awoke Temesgen Misganaw, Esmaeil Mohammadi, Mokhtar Mohammadi, Arif Mohammed, Shafiu Mohammed, Syam Mohan, Mohammad Mohseni, Nagabhishek Moka, Ali H Mokdad, Sara Momtazmanesh, Lorenzo Monasta, Md Moniruzzaman, Fateme Montazeri, Catrin E Moore, Abdolvahab Moradi, Lidia Morawska, Jonathan F Mosser, Ebrahim Mostafavi, Majid Motaghinejad, Haleh Mousavi Isfahani, Seyed Ali Mousavi-Aghdas, Sumaira Mubarik, Efrén Murillo-Zamora, Ghulam Mustafa, Sanjeev Nair, Tapas Sadasivan Nair, Houshang Najafi, Atta Abbas Naqvi, Sreenivas Narasimha Swamy, Zuhair S Natto, Biswa Prakash Nayak, Seyed Aria Nejadghaderi, Huy Van Nguyen Nguyen, Robina Khan Niazi, Antonio Tolentino Nogueira de Sá, Hasti Nouraei, Ali Nowroozi, Virginia Nuñez-Samudio, Chimezie Igwegbe Nzoputam, Ogochukwu Janet Nzoputam, Bogdan Oancea, Chimedsuren Ochir, Oluwakemi Ololade Odukoya, Hassan Okati-Aliabad, Akinkunmi Paul Okekunle, Osaretin Christabel Okonji, Andrew T Olagunju, Isaac Iyinoluwa Olufadewa, Ahmed Omar Bali, Emad Omer, Eyal Oren, Erika Ota, Nikita Otstavnov, Abderrahim Oulhaj, Mahesh P A, Jagadish Rao Padubidri, Keyvan Pakshir, Reza Pakzad, Tamás Palicz, Anamika Pandey, Suman Pant, Shahina Pardhan, Eun-Cheol Park, Eun-Kee Park, Fatemeh Pashazadeh Kan, Rajan Paudel, Shrikant Pawar, Minjin Peng, Gavin Pereira, Simone Perna, Navaraj Perumalsamy, Ionela-Roxana Petcu, David M Pigott, Zahra Zahid Piracha, Vivek Podder, Roman V Polibin, Maarten J Postma, Hamid Pourasghari, Naeimeh Pourtaheri, Mirza Muhammad Fahd Qadir, Mathieu Raad, Mohammad Rabiee, Navid Rabiee, Saber Raeghi, Alireza Rafiei, Fakher Rahim, Mehran Rahimi, Vafa Rahimi-Movaghar, Azizur Rahman, Md Obaidur Rahman, Mosiur Rahman, Muhammad Aziz Rahman, Amir Masoud Rahmani, Vahid Rahmanian, Pradhum Ram, Kiana Ramezanzadeh, Juwel Rana, Priyanga Ranasinghe, Usha Rani, Sowmya J Rao, Sina Rashedi, Mohammad-Mahdi Rashidi, Azad Rasul, Zubair Ahmed Ratan, David Laith Rawaf, Salman Rawaf, Reza Rawassizadeh, 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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

34. Transformation of Chronic Myeloid Leukemia to Acute Biphenotypic Leukemia

Author

Stanislav Ivanov, Yuanming Zhang, Purva Sharma, and Yash Jobanputra

Subjects
Oncology, medicine.medical_specialty, Acute leukemia, Myeloid, Acute myeloblastic leukemia, business.industry, Acute Biphenotypic Leukemia, Myeloid leukemia, Case Report, Context (language use), Disease, medicine.disease, medicine.anatomical_structure, hemic and lymphatic diseases, Internal medicine, Blast crisis, medicine, Biphenotypic leukemia, Extramedullary involvement, Bone marrow, business, CML
Abstract

Chronic myeloid leukemia (CML) is a myeloproliferative disorder with clonal proliferation of all myeloid cell lines. The disease typically manifests in three phases: chronic course followed by an accelerated phase and finally a terminal blast crisis. A blast crisis is defined as the presence of > 20% blasts in the peripheral blood or bone marrow. The blasts could be characterized as either myeloid (60-80% of cases) resulting in acute myeloblastic leukemia or lymphoid (20-30% of cases) resulting in acute lymphoblastic leukemia. In rare instances, a blast crisis could present with biphenotypic expression for both myeloid and lymphoid blasts. In such cases, about 6-10% of the time, the course of the disease is more aggressive and renders a poorer prognosis especially if there is evidence of extramedullary involvement. We present a case of a 41-year-old woman with history of CML who presented with acute biphenotypic blast crisis with extramedullary involvement in the context of aggressive chemotherapy. Literature review reveals < 10 reported cases of CML with biphasic transformation and only three cases of CML with acute leukemia on presentation. Most cases described are in pediatric patients with varied presentations and none involving extramedullary sites. Mortality rates in such cases are near 100% despite aggressive chemotherapy.

Published
2020

35. Recurrent chylous ascites in patient with previous retroperitoneal radiation treatment

Author

Purva, Sharma and Kanishka, Chakraborty

Subjects
Male, Abdomen, Humans, Drainage, Paracentesis, General Medicine, Neoplasm Recurrence, Local, Chylous Ascites
Abstract

Chylous ascites is the accumulation of lymphatic fluid in the peritoneal cavity due to disruption of lymphatic drainage caused due to obstruction or trauma. We report a man in his 60s who was previously treated for diffuse large B cell lymphoma with radiation to bulky abdominal/mesenteric lymphadenopathy. He was later found to have recurrent chylous ascites several years later, requiring multiple paracentesis. Recurrent lymphoma was ruled out with negative cytology of peritoneal fluid as well as lymph node biopsy with no evidence of malignancy. We believe that the patient had obstruction of lymphatic drainage due to previous radiation therapy causing fibrosis. The patient underwent lymphangiography which did not visualise the central lymphatic duct within the abdomen raising suspicion for obstruction of the ducts secondary to previous radiation.

Published
2022

36. Nanobioremediation: A sustainable approach towards the degradation of sodium dodecyl sulfate in the environment and simulated conditions

Author

Maulin P. Shah, Raman Kumar Ravi, Vineet Tirth, Virendra Kumar Yadav, Shreya Modi, Samreen Heena Khan, Pankaj Kumar, Purva Sharma, Nisha Choudhary, Meena Godha, and Areeba Khayal

Subjects
chemistry.chemical_classification, Environmental remediation, Bacterial degradation, Sodium Dodecyl Sulfate, General Medicine, Applied Microbiology and Biotechnology, chemistry.chemical_compound, Surface-Active Agents, chemistry, Environmental chemistry, Degradation (geology), Sodium dodecyl sulfate, Sulfate, Pesticides, Effluent, Alkyl
Abstract

Nanotechnology has gained huge importance in the field of environmental clean-up today. Due to their remarkable and unique properties, it has shown potential application for the remediation of several pesticides and textile dyes. Recently it has shown positive results for the remediation of sodium dodecyl sulfate (SDS). One of the highly exploited surfactants in detergent preparation is anionic surfactants. The SDS selected for the present study is an example of anionic linear alkyl sulfate. It is utilized extensively in industrial washing, which results in the high effluent level of this contaminant and ubiquitously toxic to the environment. The present review is based on the research depicting the adverse effects of SDS in general and possible strategies to minimizing its effects by bacterial degradation which are capable of exploiting the SDS as an only source of carbon. Moreover, it has also highlighted that how nanotechnology can play a role in the remediation of such recalcitrant pesticides.

Published
2021

37. Medullary Carcinoma of the Colon: A Histopathologic Challenge

Author

Purva Sharma, Bahaaeldin Youssef, Zainab Fatima, and Koyamangalath Krishnan

Subjects
Pathology, medicine.medical_specialty, Colorectal cancer, medicine.medical_treatment, medullary carcinoma, chemotherapy, Metastasis, Internal Medicine, Medicine, metastasis, Chemotherapy, business.industry, General Engineering, Microsatellite instability, medicine.disease, Lynch syndrome, digestive system diseases, Medullary carcinoma, Oncology, colon cancer, immunohistochemistry, Immunohistochemistry, DNA mismatch repair, microsatellite instability, business
Abstract

Medullary carcinoma (MC) of the colon is a rare and unique histologic subtype of colorectal cancer. It is commonly associated with deficient mismatch repair proteins and has a strong association with Lynch syndrome. Diagnosis is challenging as it does not have the usual immunohistochemical stains on pathology seen in colorectal adenocarcinoma. Here, we discuss an interesting case of MC of the colon that was metastatic on presentation and constituted a diagnostic challenge.

Published
2021

38. BRCA1 expression and its association with histological typing, grade, ER, PR, HER2 in carcinoma of breast

Author

Rajnish Kumar, Veena K Sharma, Kush Juneja, Anupam Varshney, Purva Sharma, and Mamta Singla

Subjects
Oncology, medicine.medical_specialty, Clinical pathology, business.industry, Cancer, medicine.disease, Surgical pathology, 03 medical and health sciences, 0302 clinical medicine, Breast cancer, Invasive carcinoma of no special type, 030220 oncology & carcinogenesis, Internal medicine, Invasive lobular carcinoma, medicine, Carcinoma, skin and connective tissue diseases, Breast carcinoma, business
Abstract

Breast cancer is the most commonly diagnosed cancer in female worldwide. BRCA 1 is located predominantly in nucleus. BRCA 1 is associated with breast cancer. Materials and Methods: This was retroprospective study, 50 known cases of breast carcinoma were analysed in Muzaffarnagar Medical College, Muzaffarnagar. Observation and Results: The age range of patients was from 28-70 years and mean age of patients was 50.24 years. Majority of breast carcinoma were above 45 years of age (64%) and of upper outer quadrant (52%) and of grade II (48%). Invasive carcinoma of no special type (NST) formed the majority of cases (82%) followed by Invasive lobular carcinoma (6%). Altered BRCA 1 expression was seen in ER, PR and HER 2 negative cases. Conclusions: Invasive Carcinoma of no special type was the commonest morphological type. Majority of cases of breast carcinoma were of grade II. Keywords: BRCA 1, Invasive Carcinoma NST, ER, PR, Her 2 neu, IHC.

Published
2019

39. Effect of Storage Temperature on Bio efficacy of Aqueous Extract of Ganoderma lucidum

Author

Purva Sharma, Rajkumar Tulsawani, and Mamta Rautela

Subjects
Aqueous extract, Traditional medicine, Chemistry, General Pharmacology, Toxicology and Pharmaceutics, General Agricultural and Biological Sciences, General Biochemistry, Genetics and Molecular Biology, Ganoderma lucidum, Bio efficacy
Abstract

Stability testing is key requirement in the drug development process along with storage temperature which may deteriorate bio-constituents and efficacy of natural products. Aqueous extract of Ganoderma lucidum has revealed pharmacological effects against high altitude stressors and has potential for mitigating high altitude maladies. In the present study, the extract of Ganoderma lucidum was stored at different storage conditions such as room temperature, 4 °C and -20 °C for two year and qualitative and quantitative analysis of bio-constituents and bio-efficacy was carried out. No significant change was observed in any extract kept in different temperature conditions in terms of its polysaccharide, phenolic and flavonoids content. The extract kept at room temperature absorbed slight moisture in few samples but no change in overall polysaccharide, phenolic and flavonoids content was recorded. The moisture absorption problem was not observed in extracts stored at 4 °C and -20 °C. The bio-efficacy of the extract at room temperature, 4 °C or -20 °C were comparable to the freshly prepared extract and the data from the studies suggest that extract has good shelf life up to two year without loss of bio-efficacy. Overall, the extract retained its bio-efficacy for two years at different temperature storage conditions.

Published
2019

41. Advances in Understanding of Pathogenesis and Treatment of Immune-Mediated Kidney Disease: A Review

Author

Andreas Kronbichler, Sam Kant, Duvuru Geetha, and Purva Sharma

Subjects
business.industry, Anti-Glomerular Basement Membrane Disease, Lupus nephritis, Glomerulonephritis, Glomerulonephritis, IGA, Disease, medicine.disease, Kidney, Glomerulonephritis, Membranous, Lupus Nephritis, Nephropathy, Immune system, Focal segmental glomerulosclerosis, Membranous nephropathy, Nephrology, Immunology, medicine, Humans, business, Kidney disease
Abstract

There continues to be rapid advancement in our understanding of the pathogenesis of immune-mediated kidney disease. This progress has culminated in the development of multiple therapeutic agents that have consistently improved renal and patient outcomes. The focus of this review is to discuss these recent advancements in immune-mediated kidney disease via the lens of direct and indirect immune-mediated mechanisms. In the direct immune-mediated disease, recently described antigens in anti-glomerular basement membrane (GBM) disease and membranous nephropathy are discussed, along with new therapeutic regimens in membranous nephropathy and focal segmental glomerulosclerosis. From an indirect immune-mediated disease standpoint, recent pivotal trials in antineutrophil cytoplasmic antibody vasculitis, lupus nephritis, and IgA nephropathy are examined from a real-world practice perspective. New molecular pathways in various disorders of alternate complement pathway are described, which in turn have led to development of various experimental therapies. In addition, pivotal and ongoing therapeutic trials in the aforementioned diseases are presented.

Published
2021

42. Priority Order-Based Key Distribution in QKD-Secured Optical Networks

Author

Shashi Prakash, Purva Sharma, and Vimal Bhatia

Subjects
Computer science, business.industry, ComputerSystemsOrganization_COMPUTER-COMMUNICATIONNETWORKS, Key distribution, 020206 networking & telecommunications, Topology (electrical circuits), Throughput, Data_CODINGANDINFORMATIONTHEORY, 02 engineering and technology, Quantum key distribution, Blocking (statistics), Network topology, 01 natural sciences, 010309 optics, 0103 physical sciences, 0202 electrical engineering, electronic engineering, information engineering, Key (cryptography), Routing (electronic design automation), business, Computer network
Abstract

In quantum key distribution (QKD)-secured optical networks, blocking increases with the number of QKD lightpath requests as well as with the number of times modification required to improve the security level of QKD lightpath requests. The blocking is severe problem in such networks because of the limited number of resources (wavelengths and time-slots) in each fiber link. In this paper, we propose a priority order-based routing wavelength and time-slot allocation (POB-RWTA) scheme to reduce the blocking of QKD lightpath requests. In the proposed POB-RWTA scheme, the QKD lightpath requests are served according to their priority order. The priority order of each QKD lightpath request is based on the security level. The blocking of high priority lightpath requests (HPLRs) and total incoming QKD lightpath requests due to limited resources can be reduced using the above criterion of priority order. The performance analysis of the proposed POB-RWTA scheme is made in terms of the success probability of QKD lightpath requests considering different wavelengths for QSCh and the probability of secret key update failure. We compared the proposed POB-RWTA scheme with a non-priority order-based routing wavelength and time-slot allocation (NPOB-RWTA) scheme. Simulations performed on NSFNET topology show that by using the POB-RWTA scheme, the success probability of HPLRs and total incoming QKD lightpath requests are significantly improved as compared to NPOB-RWTA.

Published
2020

43. Pathology of COVID-19-associated acute kidney injury

Author

Purva Sharma, Vanesa Bijol, Kenar D. Jhaveri, Jia H. Ng, and Rimda Wanchoo

Subjects
Pathology, medicine.medical_specialty, Thrombotic microangiopathy, Coronavirus disease 2019 (COVID-19), 030232 urology & nephrology, Autopsy, Disease, 030204 cardiovascular system & hematology, urologic and male genital diseases, 03 medical and health sciences, AKI, 0302 clinical medicine, medicine, TMA, AcademicSubjects/MED00340, Transplantation, Kidney, collapsing glomerulopathy, medicine.diagnostic_test, urogenital system, business.industry, Acute kidney injury, COVID-19, medicine.disease, COVAN, female genital diseases and pregnancy complications, CKJ review, medicine.anatomical_structure, Nephrology, ATN, pathology, Renal biopsy, Vasculitis, business
Abstract

Acute kidney injury (AKI) is common among hospitalized patients with coronavirus disease 2019 (COVID-19), with the occurrence of AKI ranging from 0.5% to 80%. An improved knowledge of the pathology of AKI in COVID-19 is crucial to mitigate and manage AKI and to improve the survival of patients who develop AKI during COVID-19. In this review, we summarize the published cases and case series of various kidney pathologies seen with COVID-19. Both live kidney biopsies and autopsy series suggest acute tubular injury as the most commonly encountered pathology. Collapsing glomerulopathy and thrombotic microangiopathy are other encountered pathologies noted in both live and autopsy tissues. Other rare findings such as anti-neutrophil cytoplasmic antibody vasculitis, anti-glomerular basement membrane disease and podocytopathies have been reported. Although direct viral infection of the kidney is possible, it is certainly not a common or even widespread finding reported at the time of this writing (November 2020).

Published
2020

44. De Novo ANCA-Associated Vasculitis With Glomerulonephritis in COVID-19

Author

Nina Kello, Nupur N. Uppal, Ivan Ramirez De Oleo, Yuriy Khanin, Hitesh H. Shah, Purva Sharma, Edward Epstein, Kenar D. Jhaveri, Christopher P. Larsen, and Vanesa Bijol

Subjects
medicine.medical_specialty, Thrombotic microangiopathy, 030232 urology & nephrology, Kidney biopsy, Autopsy, 030204 cardiovascular system & hematology, medicine.disease_cause, Gastroenterology, Article, 03 medical and health sciences, 0302 clinical medicine, Glomerulonephritis, Internal medicine, Biopsy, medicine, Coronavirus, medicine.diagnostic_test, business.industry, ANCA, Acute kidney injury, COVID-19, Acute Kidney Injury, medicine.disease, Renal pathology, Nephrology, Pauci-immune, medicine.symptom, business, Immunosuppression
Abstract

Coronavirus disease 2019 (COVID-19) is a pandemic caused by a novel coronavirus that has been identified to belong to the β-coronavirus family.1 As the COVID-19 pandemic continues to evolve, more aspects of this illness are being defined and described. In the United States, the incidence of acute kidney injury (AKI) in patients hospitalized with COVID-19 has been reported to be around 37%.2 Different autopsy and kidney biopsy series have revealed acute tubular injury (ATI) to be the most common renal pathology lesion in these patients.3,S1 Although cases of collapsing glomerulopathy and thrombotic microangiopathy (TMA) with COVID-19 have been reported,4,5 an association between COVID-19 and crescentic glomerulonephritis (GN) has rarely been described.6 Herein, we report 2 cases of pauci immune GN with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, who clinically improved with treatment of COVID-19 and cautious use of immunosuppressants.

Published
2020
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45. Anti-Lan Antibodies: A Rare Etiology of Severe Blood Transfusion Reaction

Author

Purva Sharma, Kanishka Chakraborty, Emily Patterson, Bahaaeldin Youssef, and Sukesh Manthri

Subjects
medicine.medical_specialty, Abdominal pain, Blood transfusion, medicine.medical_treatment, transfusion reaction, blood group, 030204 cardiovascular system & hematology, Gastroenterology, Immunoglobulin G, Allergy/Immunology, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Internal Medicine, Medicine, Clinical significance, Billroth I, biology, business.industry, General Engineering, Gastric outlet obstruction, Hematology, medicine.disease, Red blood cell, medicine.anatomical_structure, biology.protein, Antibody, medicine.symptom, business, anti-lan antibodies, 030217 neurology & neurosurgery, clinical immunology
Abstract

Lan is a high prevalence red blood cell antigen present in the majority of the populations that belong to the Lan (Langereis) blood group system. Anti-Lan antibody is an immunoglobulin G (IgG) antibody that is known to cause delayed hemolytic transfusion reactions in adults as well as hemolytic disease in fetuses and newborns, however with variable clinical significance ranging from mild to severe. We present a 58-year-old woman with diffuse abdominal pain and a large gastric ulcer causing gastric outlet obstruction. She underwent antrectomy and Billroth I reconstruction surgery without complications. The patient’s hemoglobin upon presentation was 10g/dL and dropped acutely post-operatively to 6.4 g/dL requiring blood transfusion. The patient developed acute respiratory distress within minutes of starting a packed red blood cell (pRBC) transfusion, requiring discontinuation. Laboratory testing demonstrated pan-reactivity with additional reference testing demonstrating an anti-Lan antibody. The rarity of Lan negative pRBC units is a challenge in managing such patients requiring blood transfusions. Autologous blood donation or donation by a compatible family member is another option to consider in these rare cases.

Published
2020

47. Efficient ordering policy for secret key assignment in quantum key distribution-secured optical networks

Author

Purva Sharma, Vimal Bhatia, and Shashi Prakash

Subjects
Key assignment, business.industry, Computer science, Quantum key distribution, Network topology, Blocking (statistics), Atomic and Molecular Physics, and Optics, Electronic, Optical and Magnetic Materials, Control and Systems Engineering, Order (exchange), Electrical and Electronic Engineering, Routing (electronic design automation), Security level, business, Instrumentation, Computer network, Data transmission
Abstract

Quantum key distribution (QKD) is a promising solution to protect data transmission in optical networks against security breaches. Hence, several studies have paid attention on integration of QKD with the existing optical networks. Meanwhile, blocking is a challenging issue for QKD lightpath requests (QLRs) due to limited number of network resources (wavelengths and time-slots) in existing optical networks. In QKD-secured optical networks, the blocking increases with increase in the number of QLRs as well as with the modifications of secret keys for enhancing the security level of QLRs. Hence, the blocking affects the QLRs of different security levels, especially the QLRs of high and moderate security levels. Thus, the prioritization of QLRs based on the security level is essential for reducing the impact of blocking in such networks. In this paper, we propose a secret key assignment priority ordering policy (SKA-POP) for routing, wavelength and time-slot assignment (RWTA) to improve the success probability of QLRs. In the proposed SKA-POP, the resources during assignment and re-assignment are allocated based on the proposed priority criteria. The performance of the proposed SKA-POP is analyzed in terms of the success probability and the probability of secret key update failure (PSKUF). Simulations performed on two different network topologies, namely, NSFNET and UBN24, indicate that the proposed SKA-POP performs better than the non-priority based RWTA (NP-RWTA), priority order-based RWTA (POB-RWTA), partial-priority based RWTA (PP-RWTA), and a version of SKA-POP, i.e., SKA-POP with the longest route first (SKA-POP-LRF) schemes, when the number of QLRs (traffic load) increase in the network. .

Published
2022

48. Outcomes of patients with end-stage kidney disease hospitalized with COVID-19

Author

Jia H. Ng, Jamie S. Hirsch, Rimda Wanchoo, Mala Sachdeva, Vipulbhai Sakhiya, Susana Hong, Kenar D. Jhaveri, Steven Fishbane, Mersema Abate, Hugo Paz Andrade, Richard L. Barnett, Alessandro Bellucci, Madhu C. Bhaskaran, Antonio G. Corona, Bessy Suyin Flores Chang, Mark Finger, Michael Gitman, Candice Halinski, Shamir Hasan, Azzour D. Hazzan, Yuriy Khanin, Aireen Kuan, Varun Madireddy, Deepa Malieckal, Abdulrahman Muzib, Gayatri Nair, Jia Hwei Ng, Rushang Parikh, Daniel W. Ross, Richard Schwarz, Hitesh H. Shah, Purva Sharma, Pravin C. Singhal, Nupur N. Uppal, and Vinay V. Nair

Subjects
0301 basic medicine, Adult, Male, medicine.medical_specialty, medicine.medical_treatment, 030232 urology & nephrology, New York, Lower risk, Article, Odds, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Internal medicine, medicine, Humans, ESRD, Blood urea nitrogen, Aged, Retrospective Studies, Mechanical ventilation, Aged, 80 and over, Inpatients, ESKD, hemodialysis, business.industry, COVID-19, Retrospective cohort study, Odds ratio, Length of Stay, Middle Aged, medicine.disease, Respiration, Artificial, Confidence interval, 030104 developmental biology, peritoneal dialysis, Nephrology, dialysis, Kidney Failure, Chronic, Female, business, Kidney disease
Abstract

Given the high risk of infection-related mortality, patients with end-stage kidney disease (ESKD) may be at increased risk with COVID-19. To assess this, we compared outcomes of patients with and without ESKD, hospitalized with COVID-19. This was a retrospective study of patients admitted with COVID-19 from 13 New York. hospitals from March 1, 2020, to April 27, 2020, and followed through May 27, 2020. We measured primary outcome (in-hospital death), and secondary outcomes (mechanical ventilation and length of stay), Of 10,482 patients with COVID-19, 419 had ESKD. Patients with ESKD were older, had a greater percentage self-identified as Black, and more comorbid conditions. Patients with ESKD had a higher rate of in-hospital death than those without (31.7% vs 25.4%, odds ratio 1.38, 95% confidence interval 1.12 - 1.70). This increase rate remained after adjusting for demographic and comorbid conditions (adjusted odds ratio 1.37, 1.09 - 1.73). The odds of length of stay of seven or more days was higher in the group with compared to the group without ESKD in both the crude and adjusted analysis (1.62, 1.27 - 2.06; vs 1.57, 1.22 - 2.02, respectively). There was no difference in the odds of mechanical ventilation between the groups. Independent risk factors for in-hospital death for patients with ESKD were increased age, being on a ventilator, lymphopenia, blood urea nitrogen and serum ferritin. Black race was associated with a lower risk of death. Thus, among patients hospitalized with COVID-19, those with ESKD had a higher rate of in-hospital death compared to those without ESKD., Graphical abstract

Published
2020

49. Acute kidney injury in patients hospitalized with COVID-19

Author

Jamie S. Hirsch, Jia H. Ng, Daniel W. Ross, Purva Sharma, Hitesh H. Shah, Richard L. Barnett, Azzour D. Hazzan, Steven Fishbane, Kenar D. Jhaveri, Mersema Abate, Hugo Paz Andrade, Alessandro Bellucci, Madhu C. Bhaskaran, Antonio G. Corona, Bessy Flores Chang, Mark Finger, Michael Gitman, Candice Halinski, Shamir Hasan, Susana Hong, Yuriy Khanin, Aireen Kuan, Varun Madireddy, Deepa Malieckal, Abdulrahman Muzib, Gayatri Nair, Vinay V. Nair, Rushang Parikh, Vipulbhai Sakhiya, Mala Sachdeva, Richard Schwarz, Pravin C. Singhal, Nupur N. Uppal, Rimda Wanchoo, null Bessy Suyin Flores Chang, and Jia Hwei. Ng

Subjects
0301 basic medicine, renal failure, medicine.medical_specialty, medicine.medical_treatment, 030232 urology & nephrology, CRRT, urologic and male genital diseases, Article, 03 medical and health sciences, AKI, 0302 clinical medicine, Internal medicine, Diabetes mellitus, medicine, Intubation, Renal replacement therapy, Dialysis, Mechanical ventilation, urogenital system, business.industry, Acute kidney injury, COVID-19, Retrospective cohort study, medicine.disease, female genital diseases and pregnancy complications, 030104 developmental biology, Respiratory failure, Nephrology, dialysis, business
Abstract

The rate of acute kidney injury (AKI) associated with patients hospitalized with Covid-19, and associated outcomes are not well understood. This study describes the presentation, risk factors and outcomes of AKI in patients hospitalized with Covid-19. We reviewed the health records for all patients hospitalized with Covid-19 between March 1, and April 5, 2020, at 13 academic and community hospitals in metropolitan New York. Patients younger than 18 years of age, with end stage kidney disease or with a kidney transplant were excluded. AKI was defined according to KDIGO criteria. Of 5,449 patients admitted with Covid-19, AKI developed in 1,993 (36.6%). The peak stages of AKI were stage 1 in 46.5%, stage 2 in 22.4% and stage 3 in 31.1%. Of these, 14.3% required renal replacement therapy (RRT). AKI was primarily seen in Covid-19 patients with respiratory failure, with 89.7% of patients on mechanical ventilation developing AKI compared to 21.7% of non-ventilated patients. 276/285 (96.8%) of patients requiring RRT were on ventilators. Of patients who required ventilation and developed AKI, 52.2% had the onset of AKI within 24 hours of intubation. Risk factors for AKI included older age, diabetes mellitus, cardiovascular disease, black race, hypertension and need for ventilation and vasopressor medications. Among patients with AKI, 694 died (35%), 519 (26%) were discharged and 780 (39%) were still hospitalized. AKI occurs frequently among patients with Covid-19 disease. It occurs early and in temporal association with respiratory failure and is associated with a poor prognosis., Graphical abstract

Published
2020
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50. Recurrent Bacteremia in the Setting of a Coronary Artery Fistula

Author

Yash Jobanputra, Khushali Shah, and Purva Sharma

Subjects
medicine.medical_specialty, Fistula, Cardiology, 030204 cardiovascular system & hematology, cardiac imaging, 03 medical and health sciences, 0302 clinical medicine, medicine.artery, Ascending aorta, medicine, Internal Medicine, bacteremia, Cardiac imaging, Coronary sinus, business.industry, congenital anomalies, Osteomyelitis, General Engineering, Cavitary pneumonia, medicine.disease, Surgery, Infective endocarditis, Bacteremia, Cardiac/Thoracic/Vascular Surgery, cardiovascular system, business, 030217 neurology & neurosurgery
Abstract

We present an interesting case of a 31-year-old female with recurrent Staphylococcus lugdunensis bacteremia in the setting of a coronary artery fistula (CAF). Over the course of several months, the patient was admitted to the hospital on three separate occasions with an unclear source of bacteremia. She suffered from numerous complications, including cavitary pneumonia, osteomyelitis, synovitis and septic emboli. On each admission, the patient received intravenous (IV) antibiotic therapy. CT scan of the chest with contrast on the third admission revealed a prominent tortuous vessel coursing from the ascending aorta and main pulmonary artery to the left atrium. Coronary CT angiogram confirmed the presence of a fistula connecting the left circumflex artery to the coronary sinus. Common complications of CAF include infective endocarditis and myocardial ischemia; however, we report a novel case of recurrent bacteremia in the context of an anomalous coronary artery. Two months after diagnosis, surgical closure of the CAF was performed. This case illustrates the importance of utilizing different cardiac imaging modalities in order to diagnose congenital cardiac anomalies in a timely fashion and intervene appropriately.

Published
2020

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