Global, regional, and national incidence, prevalence, and mortality of HIV, 1980–2017, and forecasts to 2030, for 195 countries and territories: a systematic analysis for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017

Background Understanding the patterns of HIV/AIDS epidemics is crucial to tracking and monitoring the progress of prevention and control efforts in countries. We provide a comprehensive assessment of the levels and trends of HIV/AIDS incidence, prevalence, mortality, and coverage of antiretroviral therapy (ART) for 1980–2017 and forecast these estimates to 2030 for 195 countries and territories. Methods We determined a modelling strategy for each country on the basis of the availability and quality of data. For countries and territories with data from population-based seroprevalence surveys or antenatal care clinics, we estimated prevalence and incidence using an open-source version of the Estimation and Projection Package—a natural history model originally developed by the UNAIDS Reference Group on Estimates, Modelling, and Projections. For countries with cause-specific vital registration data, we corrected data for garbage coding (ie, deaths coded to an intermediate, immediate, or poorly defined cause) and HIV misclassification. We developed a process of cohort incidence bias adjustment to use information on survival and deaths recorded in vital registration to back-calculate HIV incidence. For countries without any representative data on HIV, we produced incidence estimates by pulling information from observed bias in the geographical region. We used a re-coded version of the Spectrum model (a cohort component model that uses rates of disease progression and HIV mortality on and off ART) to produce age-sex-specific incidence, prevalence, and mortality, and treatment coverage results for all countries, and forecast these measures to 2030 using Spectrum with inputs that were extended on the basis of past trends in treatment scale-up and new infections. Findings Global HIV mortality peaked in 2006 with 1·95 million deaths (95% uncertainty interval 1·87–2·04) and has since decreased to 0·95 million deaths (0·91–1·01) in 2017. New cases of HIV globally peaked in 1999 (3·16 million, 2·79–3·67) and since then have gradually decreased to 1·94 million (1·63–2·29) in 2017. These trends, along with ART scale-up, have globally resulted in increased prevalence, with 36·8 million (34·8–39·2) people living with HIV in 2017. Prevalence of HIV was highest in southern sub-Saharan Africa in 2017, and countries in the region had ART coverage ranging from 65·7% in Lesotho to 85·7% in eSwatini. Our forecasts showed that 54 countries will meet the UNAIDS target of 81% ART coverage by 2020 and 12 countries are on track to meet 90% ART coverage by 2030. Forecasted results estimate that few countries will meet the UNAIDS 2020 and 2030 mortality and incidence targets. Interpretation Despite progress in reducing HIV-related mortality over the past decade, slow decreases in incidence, combined with the current context of stagnated funding for related interventions, mean that many countries are not on track to reach the 2020 and 2030 global targets for reduction in incidence and mortality. With a growing population of people living with HIV, it will continue to be a major threat to public health for years to come. The pace of progress needs to be hastened by continuing to expand access to ART and increasing investments in proven HIV prevention initiatives that can be scaled up to have population-level impact

Mapping 123 million neonatal, infant and child deaths between 2000 and 2017

Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2—to end preventable child deaths by 2030—we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000–2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations

Investigating the Glycating Effects of Glucose, Glyoxal and Methylglyoxal on Human Sperm

Glycation is the non-enzymatic reaction between reducing sugars, such as glucose, and proteins, lipids or nucleic acids, producing Advanced Glycation End (AGE) products. AGEs, produced during natural senescence as well as through lifestyle factors such as diet and smoking, are key pathogenic compounds in the initiation and progression of diabetes. Importantly, many of these factors and conditions also have influence on male fertility, affecting sperm count and semen quality, contributing to the decreasing trend in male fertility. This study investigated the impact of AGEs on sperm damage. In vitro sperm glycation assays were used to determine the levels and localization of the potent AGE compound, carboxymethyl-lysine (CML) in response to treatment with the glycating compounds glucose, glyoxal and methylglyoxal. Sperm function assays were then used to assess the effects of glycation on motility and hyaluronan binding, and levels of oxidative DNA damage were analyzed through measurement of the marker, 8-oxoguanine. Results showed that glyoxal, but not glucose or methylglyoxal, induced significant increases in CML levels on sperm and this correlated with an increase in 8-oxoguanine. Immunocytochemistry revealed that AGEs were located on all parts of the sperm cell and most prominently on the head region. Sperm motility and hyaluronidase activity were not adversely affected by glycation. Together, the observed detrimental effects of the increased levels of AGE on DNA integrity, without an effect on motility and hyaluronidase activity, suggest that sperm may retain some fertilizing capacity under these adverse conditions

THE STUDY OF CLINICAL SYMPTOMS OF MYOCARDIAL INFARCTION IN MEN AND WOMEN HOSPITALIZED IN THE CCU OF IMAM-ALI HOSPITAL, ZAHEDAN

Coronary heart diseases are the main reason of mortality in most of the industrial countries. At present, the most important cause of mortality is the cardiovascular diseases on top of which one can find coronary artery disease. The present research aims at studying the clinical symptoms of myocardial infarction in men and women hospitalized in the CCU of Imam Ali Hospital in Zahedan. The present study is an analytical cross-sectional study in which 210 patients were studied; they were diagnosed with acute myocardial infraction that was confirmed by a cardiologist. The patients were hospitalized in Imam Ali Hospital in Zahedan in 2016. The information of the patients was collected through the researcher-made questionnaire. The questionnaire includes demographic information and symptoms of acute myocardial infraction. The data were analyzed using SPSS 18 and chi-square test. Moreover, in the present study p0.05). However, symptoms such as vomiting, dyspnea, fatigue, and anxiety were significantly more in women than men were. The findings of the present study indicate that atypical symptoms especially in women are likely to cause women's delay to visit the doctor and delayed decision of diagnosing and treating by the medical team. Thus, it is essential and recommended to provide programs to teach the whole society as well as the healthcare workers especially in the emergency units of the hospitals

THE RELATIONSHIP BETWEEN VITAMIN D AND GESTATIONAL DIABETES-A REVIEW ARTICLE

Introduction: Gestational diabetes manifests itself as not having glucose tolerance, and is seen in around 2-13 of all cases of pregnancy. One of the important factors in the development of gestational pregnancy is vitamin D deficiency. so, this study is designed to determine the relationship between low levels of vitamin D in pregnancy and gestational diabetes mellitus. Methods: In this review article, the databases Medline, Cochrane, Science Direct, and Google Scholar were thoroughly searched to identify the studies investigating the relationship between vitamin D and gestational diabetes. Results: vitamin D deficiency will definitely leave harmful effects on the pregnant women's health and on their infants, in a way that vitamin D deficiency condition during pregnancy is accompanied by the development of gestational diabetes, mother's blood pressure disorder, the embryo's skeletal growth disorder, brain growth and development disorders, and disorders in the functioning of the embryonic immune system. Discussion and conclusion: Given that pregnancy is diabetogenic and that the incidence of gestational diabetes is the society is high, paying more attention to providing adequate amounts of vitamin D can be an important factor in this area

A meta-analysis on diagnostic accuracy of serum HLA-G level in breast cancer

Background: According to the role of human leukocyte antigen (HLA)-G in tumor progression and tumor escape from immune system as well as diagnostic role of biomarkers in breast cancer, this meta-analysis is designed to reach a pooled diagnostic accuracy for this biomarker. Methods: The present work is a meta-analysis on diagnostic accuracy studies using preferred reporting items for systematic reviews and meta-analyses guideline. All documents studying the serum level of HLA-G both in breast cancer patients and in healthy controls using receiver operating characteristics (ROC) curve with reporting area under ROC curve (AUC) were eligible for inclusion. Results: Five articles including 754 participants were eligible for quantitative synthesis. The range of AUC of the selected studies was 0.735�0.953. The pooled AUC was 0.922 (95 confidence interval CI 0.903�0.941) based on fixed effect model (P < 0.001) and 0.896 (95% CI 0.834�0.959) based on random effect model (P < 0.001). Conclusion: This meta-analysis updated the level of evidence for using serum HLA-G in diagnosis of breast cancer. However, this piece of evidence cannot be used as a diagnostic tool. This biomarker can be used for investigation of recurrence and response to treatment in future. Further studies are suggested to complete this evidence gap. © 2020, © 2020 Informa UK Limited, trading as Taylor & Francis Group