Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

Utilization of scrotal orchidopexy for palpable undescended testes among surgeons

Introduction: Scrotal orchidopexy for palpable undescended testicle (UDT) has received attention in the last decade due to its lower morbidity. This study was conducted to determine the frequency and factors related to the use of the scrotal approach in the surgical treatment of palpable UDT among surgeons. Methods: An observational cross-sectional study was carried out using an online survey, which was sent to different pediatric urologists, pediatric surgeons, and urologists groups. The survey consisted of questions on demographics as well as surgeons opinions and experience toward scrotal orchidopexy. Results: Of 163 respondents, 57 (35.0%) were pediatric surgeons, 98 (60.1%) were pediatric urologists, and 8 (4.9%) were urologists. There were 86 respondents (52.8%) who used the scrotal orchidopexy approach for UDT at any time in their practice. Pediatric urologists tended to use the scrotal orchidopexy approach for UDT more significantly than others (P < 0.001). There were significantly more scrotal orchidopexies for UDT performed by the pediatric urologists throughout their practice and per year compared to others, respectively (P < 0.001). Fifty-two respondents (31.9%) claimed that scrotal orchidopexy is not a good option for their patients, while seven respondents (4.3%) claimed that the procedure was hard to perform. Discussion: Based on the results of this study, we believe that there is a discrepancy in the reported advantages and success rate of scrotal orchidopexy in the published literature and the utilization of such an approach among surgeons managing palpable UDT in children. Conclusion: Scrotal orchidopexy is an underutilized approach in the management of palpable UDT in children. Only 52.8% of our respondents used it for UDT. One of the main reasons why scrotal orchidopexy is underutilized is due to the surgeons' perception that scrotal orchidopexy is not the procedure of choice for their patients and their unfamiliarity with the procedure

Awareness of Lactose Intolerance Disorder in Saudi Arabia Population

Background: Lactose intolerance is defined as “Lactose malabsorption with gastrointestinal symptoms.” Also, lactose malabsorption can be defined as “Not all ingested lactose was absorbed and that some has reached the large intestine.” The common symptoms associated with the maldigestion of lactose are bloating, diarrhoea, nausea, and abdominal pain. Aim: The current study aims to assess knowledge of people awareness of the lactose intolerance disorder and its relation to nutrition and dietary habits in Saudi Arabia. Methods: A descriptive cross-sectional approach was used targeting all accessible population in Saudi Arabia aging 18 years or more and accept to participate in the study. Data were collected from participants using an online pre-structured questionnaire. The researchers constructed the survey tool after intensive literature review and expert's consultation. The questionnaire covered the following data: participants' socio-demographic data like age, gender, and monthly income. Second section covered participants' dairy products intake with associated symptoms. Third part covered personal and family history of glucose intolerance disorder among the study participants. Awareness was assessed using multiple repose and mutually exclusive questions. Results: A total of 1189 participants fulfilling the inclusion criteria completed the study questionnaire. Participants ages ranged from 18 to 58 years old with mean age of 25.1 ± 12.9 years. Exact of 692 (58.2%) participants were females. Exact of 104 (8.7%) of the study participants reported that they had lactose intolerance disorder which started at the age of 11 to 20 years among 41 (39.4%) and at the age of 21 to 30 years among 36 (34.6%). About 77% of the study participants know that lactose indolence disorder symptoms appear after eating dairy or its derivatives. A total of 45.8% reported that leaky gut syndrome (diarrhoea and bloating) is caused by symptoms that occur with lactose intolerance and 39.4% know lactose intolerance is an uncurable disease. Conclusion: In conclusion, this study revealed that nearly one out of each three persons on Saudi Arabia is knowledgeable regarding lactose intolerance disorder and its related factors and relieving factors. Dairy products use in daily basis was reported among two thirds of the study population with abdominal distention and abdominal pain was the main accompanying symptoms

AN OVERVIEW ON HEREDITARY AND ACQUIRED HYPERCOAGULABILITY

A typical definition of hypercoagulability is the predisposition to develop venous thromboembolism due to an underlying hypercoagulable state caused by hereditary or acquired blood coagulation or fibrinolysis problems. Clinical signs of hypercoagulability can be fatal or extremely damaging. About 80% to 90% of patients can have hypercoagulability diseases accurately recognised. Determining the origin of hypercoagulability may influence the kind and length of treatment for the accompanying thrombosis. As a result, hypercoagulability is not a single, unified disease process but rather a collection of risk factors that may or may not lead to thrombosis, depending on the severity and number of risk variables as well as environmental exposures. The former includes prothrombotic polymorphisms in the genes encoding for factor V (i.e., factor V Leiden) and prothrombin, as well as shortages of natural anticoagulants such antithrombin, protein C, and protein S. It also includes elevated values of clotting factors (particularly factor VIII). The latter problems mostly include hyperhomocysteinemia, acquired elevations of coagulation factors or acquired reductions of natural inhibitors, malignancy, and antiphospholipid antibody syndrome

Lifestyle habits and obesity indices among male adolescents in Riyadh, Saudi Arabia

Abstract Obesity among adolescents is a global health apprehension which requires early prevention. The aim of this study was to determine the association between lifestyle habits including physical activity, sedentary behaviors and eating habits with obesity indices of body mass index (BMI) and waist-to-height ratio (WHtR) among male adolescents in Riyadh, Saudi Arabia. We randomly selected 471 secondary school male adolescents aged 14–18 years. A pre-validated self-reported questionnaire was used to record the data on physical activity level, sedentary behaviors, sleep duration and eating habits. The International Obesity Task Force (IOTF) cutoff values for adolescents under 18 years of age were used to define overweight and obesity. Total energy expenditure was calculated using metabolic equivalent-minutes per week. Anthropometry including weight, height, BMI, waist circumference, waist/height ratio (WHtR), were assessed. 53.7% and 48.4% of the adolescents were overweight/obese and had abdominal obesity; respectively. Those with overweight and obesity or above 50% of WHtR were much less active in terms of METs-min/week from vigorous-intensity sports, sum of all METs-min/week from all vigorous-intensity physical activity, total METs-min/week from all physical activity compared with non-obese adolescents and below 50% of WHtR. The present study identified the lifestyle habits that were associated with obesity and may represent valid targets for the prevention and management of obesity among Saudi adolescents. Knowledge of the factors that contribute to obesity could be used in preventive programs for the control of obesity among adolescents

FLOATING ELBOW: AN INTEGRATIVE LITERATURE REVIEW

Background: Floating elbow is a rare condition caused by ipsilateral humeral and forearm fractures, resulting in an unstable intermediate articulation. High-velocity or high-energy trauma, such as car accidents or high-angle falls, are the main causes of floating elbow injuries. The multiple injuries, open fractures, and neurovascular injury that occur concurrently are the most common. A clinical and radiological diagnosis has been made. Epiphyseal closure and stiffness are problems associated with fractures of the forearm and elbow. Objectives: To state the epidemiology of the floating elbow, assess and describe the classification then summarize the management of the injuries of floating elbow. Methods: The PubMed database and EBSCO Information Services were utilized to choose the articles. In our review, all pertinent articles related to both our topic and other articles were used. Other articles that have nothing to do with this subject were not included. The group members looked through a certain format in which the data had been extracted. Conclusion: Floating elbow is a rare and intricate injury pattern that can result in a variety of functional consequences. The expression describes joint fractures of the humerus and forearm bones in the same extremity. It may affect both adults and children. This damage pattern has been documented in a few published publications, but none of them include epidemiological data, therefore its prevalence remains unknown. Hence, this systemic article state all that helps in knowing the disease