Incidence and risk factors of adjacent segment disease following short segment posterior instrumentation in Bahraini patients: a five-year retrospective analysis

Background: Despite advances in spinal surgery, adjacent segment disease (ASD) and adjacent disc degeneration (ADD) remain notable postoperative complications following spinal fusion, mainly due to suspected increased biomechanical stress that leads to adjacent disc degeneration. This research focuses on the Bahraini population, utilizing MRI to compare pre-op and post-op Adjacent disc conditions to identify the incidence and risk factors of ASD and ADD after short segment spinal fusion. Methods: A retrospective cohort study conducted over a five-year period at Salmaniya Medical Complex, the largest tertiary care center in the Kingdom of Bahrain. Reviewing pre-operative and post-operative MRI scans of 41 symptomatic patients who underwent short segment spinal fusion between 2014 and 2019. Patients were selected based on specific pre-operative and post-operative criteria developed by the orthopaedic team and were followed up to October 2023. Statistical analyses were performed using R software. Results: The analysis of 41 patients revealed a significant incidence of adjacent segment changes and the main risk factor that showed significance was advancing age. While other reported risk factors like level of fusion and number of fused segments did not significantly correlate with advancing ADD or ASD. There was no statistically significant association between hypertension, diabetes or multiple comorbidities and worsening conditions for either ASD or ADD post operation. Conclusions: The findings from our study contribute to the understanding of ASD and ADD after lumbar fusion surgeries, particularly in highlighting the significance of age. These insights can aid surgeons in better anticipating the risks associated with specific demographic and clinical profiles. More controlled studies on larger populations will help delineate more concrete risk factors

Antimicrobial activity of 7,3ʹ,4ʹ-trihydroxyflavonol isolated from Acacia nilotica var. ad stringens

Acacia species (Mimosaceae) is widely distributed in tropical and subtropical countries and has a variety of ethnomedicinal uses. There is inadequate laboratory investigation to identify bioactive compounds and therapeutic effect of Acacia nilotica var. ad stringens. This research has been conducted to extract, isolate and identify major compounds from heartwood of Acacia nilotica var. ad stringens and to test them against representative bacteria. Powdered air-dried heartwood of A. nilotica var. ad stringens has been extracted with methanol/water, 4:1 and the extract has been then purified using chromatographic techniques (column and paper chromatography). A pure flavonoid compound has been isolated and the structure has been elucidated based on extensive spectroscopic analysis procedures (IR, UV, 1H NMR, and mass spectrometery). The isolated compound has then been evaluated for antimicrobial potential against Gram-negative (Escherichia coli and Pseudomonas aeruginosa) and Gram-positive bacteria (Bacillus subtilis, Bacillus cereus, and Staphylococcus aureus) using cup-plate agar diffusion method. The spectroscopic analysis of the isolated compound has led to its identification as 7,3ʹ,4ʹ-trihydroxyflavonol. The compound shows varying antimicrobial responses with high potency against Gram-negative human pathogens. The Gram-positive bacteria which are inhibited are Bacillus cereus, Corynebacterium sp., Enterococcus faecalis, Staphylococcus aureus , and Streptococcus agalactiae. The Gram-negative bacteria are Acinetobacterbaumannii , Acinetobacter sp. , Escherichia coli, Pseudomonas aeruginosa and yeasts are Candida albicans and Cryptococcus neoformans. The present study has demonstrated that 7,3ʹ,4ʹ-trihydroxyflavonol is an effective antimicrobial compound. If applied in suitable pharmaceutical formulations it could be valuable for treating various bacterial infections or introduced as adjunct treatment along with standard agents.

Antimicrobial activity of 7,3ʹ,4ʹ-trihydroxyflavonol isolated from Acacia nilotica var. ad stringens

1117-1120Acacia species (Mimosaceae) is widely distributed in tropical and subtropical countries and has a variety of ethnomedicinal uses. There is inadequate laboratory investigation to identify bioactive compounds and therapeutic effect of Acacia nilotica var. ad stringens. This research has been conducted to extract, isolate and identify major compounds from heartwood of Acacia nilotica var. ad stringens and to test them against representative bacteria. Powdered air-dried heartwood of A.nilotica var. ad stringens has been extracted with methanol/water, 4:1 and the extract has been then purified usingchromatographic techniques (column and paper chromatography). A pure flavonoid compound has been isolated and thestructure has been elucidated based on extensive spectroscopic analysis procedures (IR, UV, 1H NMR, and mass spectrometery). The isolated compound has then been evaluated for antimicrobial potential against Gram-negative (Escherichia coli and Pseudomonas aeruginosa) and Gram-positive bacteria (Bacillus subtilis, Bacillus cereus, and Staphylococcus aureus) using cup-plate agar diffusion method. The spectroscopic analysis of the isolated compound has led to its identification as 7,3ʹ,4ʹ-trihydroxyflavonol. The compound shows varying antimicrobial responses with high potency against Gram-negative human pathogens. The Gram-positive bacteria which are inhibited are Bacillus cereus, Corynebacterium sp., Enterococcus faecalis, Staphylococcus aureus , and Streptococcus agalactiae. The Gram-negative bacteria are Acinetobacterbaumannii , Acinetobacter sp. , Escherichia coli, Pseudomonas aeruginosa and yeasts are Candida albicans and Cryptococcus neoformans. The present study has demonstrated that 7,3ʹ,4ʹ-trihydroxyflavonol is an effective antimicrobial compound. If applied in suitable pharmaceutical formulations it could be valuable for treating various bacterial infections or introduced as adjunct treatment along with standard agents

Identify Survey: Community and advocacy report

The Identify survey is the largest study focused on rainbow young people (aged 14-26) in Aotearoa New Zealand to date. This survey was live between February and August 2021. The research team is a diverse array of rainbow community youth organisations, leaders and researchers. The research team are united in our belief that excellent survey results can help inform ways in which we can improve rainbow lives in Aotearoa New Zealand and beyond. In total, 4784 rainbow young people and 434 of their allies took part in the survey. The findings in this report are based on the survey responses of rainbow young people. Identify was very successful at generating a wide and diverse sample of rainbow young people, including 2045 (43%) who were currently in secondary education, 1640 (34%) who were in post-secondary education, and 1099 (23%) who were not in education but were either in paid or unpaid employment, or were unemployed. There was a good spread of ethnicities reported, and at a total-response level, 12% were Māori; 4% Pacific; 9% Asian; and 71% Pākehā, NZ European, or another European identity. There were also around 1% respectively of participants who were Middle Eastern, Latin American, African, or North American. For this age bracket, this distribution is disproportionally white and underrepresents Pacific populations, which is a limitation we recognise in our recommendations. Participants reported a wide array of gender identities and modalities. Broadly, 52% of participants were classified as cisgender women/girls (39%) or men/ boys (13%), 14% as trans men/boys or trans women/girls, 30% as non-binary and 4% as questioning their gender. Similarly, a wide array of sexualities was reported. Participants with intersex variations or variations of sex characteristics were also registered, accounting for approximately 1% of the cohort. Just over two in five participants were identified as disabled

Surgical Management of Lumbar Spine Fractures and Dislocations

Background: Lumbar spine fractures and dislocations, which are part of the thoracolumbar region, are critical injuries with significant morbidity. The epidemiological shift in the median age of injury and the high prevalence of these injuries, particularly in the T10-L2 region, highlight the necessity for effective therapeutic interventions. With advancements in spine biomechanics, imaging technologies, and surgical techniques, there has been a paradigm shift from conservative to surgical management, though high-quality comparative studies remain limited. Objective: To synthesize recent data on the epidemiology, evaluation, and management of lumbar spine fractures and dislocations, and to elucidate the comparative efficacy of surgical interventions and conservative approaches in optimizing patient outcomes. Method: This paper conducts a comprehensive review of epidemiological data on thoracolumbar traumatic injuries, diagnostic techniques, and management strategies, especially focusing on surgical interventions. The review also details specific surgical techniques utilized for lumbar spine fractures and their underlying rationale. Findings and Conclusion: Thoracolumbar injuries primarily affect the transitional zone (T11-L2) and show a higher incidence in males aged between 20 and 40. Imaging, especially CT scans, offers a definitive diagnostic approach, with MRI providing insights on soft tissue interactions. While historically, conservative methods dominated therapeutic interventions, surgical techniques, including Posterior Instrumentation, Anterior Lumbar Interbody Fusion (ALIF), Transforaminal Lumbar Interbody Fusion (TLIF), and Posterior Lumbar Interbody Fusion (PLIF), are increasingly being utilized. Some specific fractures even warrant a combined posterior-anterior surgical approach. Notably, certain case studies highlight the potential for superior outcomes with surgical intervention, even in the absence of neurological deficits. Selecting the appropriate management strategy should be tailored to individual patient factors, nature of the injury, and available expertise and resources

Global, regional, and national prevalence of adult overweight and obesity, 1990–2021, with forecasts to 2050: a forecasting study for the Global Burden of Disease Study 2021

Background: Overweight and obesity is a global epidemic. Forecasting future trajectories of the epidemic is crucial for providing an evidence base for policy change. In this study, we examine the historical trends of the global, regional, and national prevalence of adult overweight and obesity from 1990 to 2021 and forecast the future trajectories to 2050. Methods: Leveraging established methodology from the Global Burden of Diseases, Injuries, and Risk Factors Study, we estimated the prevalence of overweight and obesity among individuals aged 25 years and older by age and sex for 204 countries and territories from 1990 to 2050. Retrospective and current prevalence trends were derived based on both self-reported and measured anthropometric data extracted from 1350 unique sources, which include survey microdata and reports, as well as published literature. Specific adjustment was applied to correct for self-report bias. Spatiotemporal Gaussian process regression models were used to synthesise data, leveraging both spatial and temporal correlation in epidemiological trends, to optimise the comparability of results across time and geographies. To generate forecast estimates, we used forecasts of the Socio-demographic Index and temporal correlation patterns presented as annualised rate of change to inform future trajectories. We considered a reference scenario assuming the continuation of historical trends. Findings: Rates of overweight and obesity increased at the global and regional levels, and in all nations, between 1990 and 2021. In 2021, an estimated 1·00 billion (95% uncertainty interval [UI] 0·989–1·01) adult males and 1·11 billion (1·10–1·12) adult females had overweight and obesity. China had the largest population of adults with overweight and obesity (402 million [397–407] individuals), followed by India (180 million [167–194]) and the USA (172 million [169–174]). The highest age-standardised prevalence of overweight and obesity was observed in countries in Oceania and north Africa and the Middle East, with many of these countries reporting prevalence of more than 80% in adults. Compared with 1990, the global prevalence of obesity had increased by 155·1% (149·8–160·3) in males and 104·9% (95% UI 100·9–108·8) in females. The most rapid rise in obesity prevalence was observed in the north Africa and the Middle East super-region, where age-standardised prevalence rates in males more than tripled and in females more than doubled. Assuming the continuation of historical trends, by 2050, we forecast that the total number of adults living with overweight and obesity will reach 3·80 billion (95% UI 3·39–4·04), over half of the likely global adult population at that time. While China, India, and the USA will continue to constitute a large proportion of the global population with overweight and obesity, the number in the sub-Saharan Africa super-region is forecasted to increase by 254·8% (234·4–269·5). In Nigeria specifically, the number of adults with overweight and obesity is forecasted to rise to 141 million (121–162) by 2050, making it the country with the fourth-largest population with overweight and obesity. Interpretation: No country to date has successfully curbed the rising rates of adult overweight and obesity. Without immediate and effective intervention, overweight and obesity will continue to increase globally. Particularly in Asia and Africa, driven by growing populations, the number of individuals with overweight and obesity is forecast to rise substantially. These regions will face a considerable increase in obesity-related disease burden. Merely acknowledging obesity as a global health issue would be negligent on the part of global health and public health practitioners; more aggressive and targeted measures are required to address this crisis, as obesity is one of the foremost avertible risks to health now and in the future and poses an unparalleled threat of premature disease and death at local, national, and global levels. Funding: Bill & Melinda Gates Foundation

Global, regional, and national prevalence of adult overweight and obesity, 1990–2021, with forecasts to 2050: a forecasting study for the Global Burden of Disease Study 2021

Background: Overweight and obesity is a global epidemic. Forecasting future trajectories of the epidemic is crucial for providing an evidence base for policy change. In this study, we examine the historical trends of the global, regional, and national prevalence of adult overweight and obesity from 1990 to 2021 and forecast the future trajectories to 2050. Methods: Leveraging established methodology from the Global Burden of Diseases, Injuries, and Risk Factors Study, we estimated the prevalence of overweight and obesity among individuals aged 25 years and older by age and sex for 204 countries and territories from 1990 to 2050. Retrospective and current prevalence trends were derived based on both self-reported and measured anthropometric data extracted from 1350 unique sources, which include survey microdata and reports, as well as published literature. Specific adjustment was applied to correct for self-report bias. Spatiotemporal Gaussian process regression models were used to synthesise data, leveraging both spatial and temporal correlation in epidemiological trends, to optimise the comparability of results across time and geographies. To generate forecast estimates, we used forecasts of the Socio-demographic Index and temporal correlation patterns presented as annualised rate of change to inform future trajectories. We considered a reference scenario assuming the continuation of historical trends. Findings: Rates of overweight and obesity increased at the global and regional levels, and in all nations, between 1990 and 2021. In 2021, an estimated 1·00 billion (95% uncertainty interval [UI] 0·989–1·01) adult males and 1·11 billion (1·10–1·12) adult females had overweight and obesity. China had the largest population of adults with overweight and obesity (402 million [397–407] individuals), followed by India (180 million [167–194]) and the USA (172 million [169–174]). The highest age-standardised prevalence of overweight and obesity was observed in countries in Oceania and north Africa and the Middle East, with many of these countries reporting prevalence of more than 80% in adults. Compared with 1990, the global prevalence of obesity had increased by 155·1% (149·8–160·3) in males and 104·9% (95% UI 100·9–108·8) in females. The most rapid rise in obesity prevalence was observed in the north Africa and the Middle East super-region, where age-standardised prevalence rates in males more than tripled and in females more than doubled. Assuming the continuation of historical trends, by 2050, we forecast that the total number of adults living with overweight and obesity will reach 3·80 billion (95% UI 3·39–4·04), over half of the likely global adult population at that time. While China, India, and the USA will continue to constitute a large proportion of the global population with overweight and obesity, the number in the sub-Saharan Africa super-region is forecasted to increase by 254·8% (234·4–269·5). In Nigeria specifically, the number of adults with overweight and obesity is forecasted to rise to 141 million (121–162) by 2050, making it the country with the fourth-largest population with overweight and obesity. Interpretation: No country to date has successfully curbed the rising rates of adult overweight and obesity. Without immediate and effective intervention, overweight and obesity will continue to increase globally. Particularly in Asia and Africa, driven by growing populations, the number of individuals with overweight and obesity is forecast to rise substantially. These regions will face a considerable increase in obesity-related disease burden. Merely acknowledging obesity as a global health issue would be negligent on the part of global health and public health practitioners; more aggressive and targeted measures are required to address this crisis, as obesity is one of the foremost avertible risks to health now and in the future and poses an unparalleled threat of premature disease and death at local, national, and global levels. Funding: Bill & Melinda Gates Foundation

Burden of 375 diseases and injuries, risk-attributable burden of 88 risk factors, and healthy life expectancy in 204 countries and territories, including 660 subnational locations, 1990–2023: a systematic analysis for the Global Burden of Disease Study 2023

Background: For more than three decades, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has provided a framework to quantify health loss due to diseases, injuries, and associated risk factors. This paper presents GBD 2023 findings on disease and injury burden and risk-attributable health loss, offering a global audit of the state of world health to inform public health priorities. This work captures the evolving landscape of health metrics across age groups, sexes, and locations, while reflecting on the remaining post-COVID-19 challenges to achieving our collective global health ambitions. Methods: The GBD 2023 combined analysis estimated years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) for 375 diseases and injuries, and risk-attributable burden associated with 88 modifiable risk factors. Of the more than 310 000 total data sources used for all GBD 2023 (about 30% of which were new to this estimation round), more than 120 000 sources were used for estimation of disease and injury burden and 59 000 for risk factor estimation, and included vital registration systems, surveys, disease registries, and published scientific literature. Data were analysed using previously established modelling approaches, such as disease modelling meta-regression version 2.1 (DisMod-MR 2.1) and comparative risk assessment methods. Diseases and injuries were categorised into four levels on the basis of the established GBD cause hierarchy, as were risk factors using the GBD risk hierarchy. Estimates stratified by age, sex, location, and year from 1990 to 2023 were focused on disease-specific time trends over the 2010–23 period and presented as counts (to three significant figures) and age-standardised rates per 100 000 person-years (to one decimal place). For each measure, 95% uncertainty intervals [UIs] were calculated with the 2·5th and 97·5th percentile ordered values from a 250-draw distribution. Findings: Total numbers of global DALYs grew 6·1% (95% UI 4·0–8·1), from 2·64 billion (2·46–2·86) in 2010 to 2·80 billion (2·57–3·08) in 2023, but age-standardised DALY rates, which account for population growth and ageing, decreased by 12·6% (11·0–14·1), revealing large long-term health improvements. Non-communicable diseases (NCDs) contributed 1·45 billion (1·31–1·61) global DALYs in 2010, increasing to 1·80 billion (1·63–2·03) in 2023, alongside a concurrent 4·1% (1·9–6·3) reduction in age-standardised rates. Based on DALY counts, the leading level 3 NCDs in 2023 were ischaemic heart disease (193 million [176–209] DALYs), stroke (157 million [141–172]), and diabetes (90·2 million [75·2–107]), with the largest increases in age-standardised rates since 2010 occurring for anxiety disorders (62·8% [34·0–107·5]), depressive disorders (26·3% [11·6–42·9]), and diabetes (14·9% [7·5–25·6]). Remarkable health gains were made for communicable, maternal, neonatal, and nutritional (CMNN) diseases, with DALYs falling from 874 million (837–917) in 2010 to 681 million (642–736) in 2023, and a 25·8% (22·6–28·7) reduction in age-standardised DALY rates. During the COVID-19 pandemic, DALYs due to CMNN diseases rose but returned to pre-pandemic levels by 2023. From 2010 to 2023, decreases in age-standardised rates for CMNN diseases were led by rate decreases of 49·1% (32·7–61·0) for diarrhoeal diseases, 42·9% (38·0–48·0) for HIV/AIDS, and 42·2% (23·6–56·6) for tuberculosis. Neonatal disorders and lower respiratory infections remained the leading level 3 CMNN causes globally in 2023, although both showed notable rate decreases from 2010, declining by 16·5% (10·6–22·0) and 24·8% (7·4–36·7), respectively. Injury-related age-standardised DALY rates decreased by 15·6% (10·7–19·8) over the same period. Differences in burden due to NCDs, CMNN diseases, and injuries persisted across age, sex, time, and location. Based on our risk analysis, nearly 50% (1·27 billion [1·18–1·38]) of the roughly 2·80 billion total global DALYs in 2023 were attributable to the 88 risk factors analysed in GBD. Globally, the five level 3 risk factors contributing the highest proportion of risk-attributable DALYs were high systolic blood pressure (SBP), particulate matter pollution, high fasting plasma glucose (FPG), smoking, and low birthweight and short gestation—with high SBP accounting for 8·4% (6·9–10·0) of total DALYs. Of the three overarching level 1 GBD risk factor categories—behavioural, metabolic, and environmental and occupational—risk-attributable DALYs rose between 2010 and 2023 only for metabolic risks, increasing by 30·7% (24·8–37·3); however, age-standardised DALY rates attributable to metabolic risks decreased by 6·7% (2·0–11·0) over the same period. For all but three of the 25 leading level 3 risk factors, age-standardised rates dropped between 2010 and 2023—eg, declining by 54·4% (38·7–65·3) for unsafe sanitation, 50·5% (33·3–63·1) for unsafe water source, and 45·2% (25·6–72·0) for no access to handwashing facility, and by 44·9% (37·3–53·5) for child growth failure. The three leading level 3 risk factors for which age-standardised attributable DALY rates rose were high BMI (10·5% [0·1 to 20·9]), drug use (8·4% [2·6 to 15·3]), and high FPG (6·2% [–2·7 to 15·6]; non-significant). Interpretation: Our findings underscore the complex and dynamic nature of global health challenges. Since 2010, there have been large decreases in burden due to CMNN diseases and many environmental and behavioural risk factors, juxtaposed with sizeable increases in DALYs attributable to metabolic risk factors and NCDs in growing and ageing populations. This long-observed consequence of the global epidemiological transition was only temporarily interrupted by the COVID-19 pandemic. The substantially decreasing CMNN disease burden, despite the 2008 global financial crisis and pandemic-related disruptions, is one of the greatest collective public health successes known. However, these achievements are at risk of being reversed due to major cuts to development assistance for health globally, the effects of which will hit low-income countries with high burden the hardest. Without sustained investment in evidence-based interventions and policies, progress could stall or reverse, leading to widespread human costs and geopolitical instability. Moreover, the rising NCD burden necessitates intensified efforts to mitigate exposure to leading risk factors—eg, air pollution, smoking, and metabolic risks, such as high SBP, BMI, and FPG—including policies that promote food security, healthier diets, physical activity, and equitable and expanded access to potential treatments, such as GLP-1 receptor agonists. Decisive, coordinated action is needed to address long-standing yet growing health challenges, including depressive and anxiety disorders. Yet this can be only part of the solution. Our response to the NCD syndemic—the complex interaction of multiple health risks, social determinants, and systemic challenges—will define the future landscape of global health. To ensure human wellbeing, economic stability, and social equity, global action to sustain and advance health gains must prioritise reducing disparities by addressing socioeconomic and demographic determinants, ensuring equitable health-care access, tackling malnutrition, strengthening health systems, and improving vaccination coverage. We live in times of great opportunity