Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

Prevalence and risk factors associated with Cryptosporidium spp. infection in local breed of dogs in Enugu State, Nigeria

Aims: Cryptosporidiosis is an important zoonotic disease of major public and veterinary concern. The disease affects humans and a variety of animal species including the domestic dog. This study aimed to determine the prevalence and risk factors associated with Cryptosporidium spp. infection in local breed of dogs from different homes and those presented at veterinary hospitals and clinics in Enugu State, Nigeria. Materials and Methods: A total of 203 fresh fecal samples were collected from domestic dogs in six local government areas in Enugu State from February 2015 to August 2015. All the samples were examined using the formol-ether sedimentation method. Fecal smears were then stained by the modified Ziehl-Neelsen technique and examined under direct light microscopy. Results: A total of 74 (36.5%) dogs were infected with Cryptosporidium spp. oocysts. There was a strong association (p0.05) between the presence of Cryptosporidium spp. oocysts and age, sex, and fecal consistency. Conclusion: The findings of this work suggest that domestic dogs in Enugu State harbor and shed Cryptosporidium spp. oocysts in the environment, especially those managed semi-intensively. Such fecal shedding is particularly so and of greater zoonotic and epidemiological importance in animals that do not show clinical signs and therefore not treated. They, therefore, pose a greater public health risk, especially to immune-compromised humans and animals. Public education on the zoonotic implication of this protozoan infection is of paramount importance in Enugu State, in particular, and Nigeria, in general, considering the closeness of dogs and man

Magnetic supported activated carbon obtained from walnut shells for bisphenol-a uptake from aqueous solution

Abstract This work investigated the usability of activated carbon walnut shell (ACWS) and magnetic activated carbon walnut shell (MACWS) for Bisphenol-A (BPA) elimination from aqueous solution. Fourier-transform infrared (FT-IR) and X-ray diffraction (XRD) were used to study the chemistry of the adsorbents. Batch sorption studies at different temperatures, contact time, adsorbent dosage, pH and varied Bisphenol-A concentrations were performed, while pseudo-first-order and pseudo-second-order kinetics models were deployed to investigate the kinetic data. Equilibrium parameters were computed using the Dubinin–Radushkevich, Freundlich, Temkin and Langmuir isotherms, while Box–Behnken design was used to optimize the adsorption factors. FT-IR report showed the existence of O–H, C=O, C–O and C=C stretches in both adsorbents and Fe–O in MACWS, while XRD revealed an amorphous morphology. BPA removal by ACWS and MACWS with correlation coefficient (R2) > 0.9 showed that the pseudo-first-order kinetic model was the most appropriate for explaining the kinetic data. Judging from the values of the maximum adsorption capacity (115.85 and 166.67 mg/g for ACWS and MACWS, respectively), it can be inferred that the Langmuir isotherm best describes the equilibrium results. Thermodynamic investigation showed the process of Bisphenol-A uptake to be spontaneous and endothermic with entropy change (∆So) values of 0.033 and 0.039 kJ/mol for ACWS and MACWS, respectively. The data obtained from the kinetics, isotherm and equilibrium studies revealed that ACWS and MACWS adsorbents were effective for the treatment of Bisphenol-A

Maxillary fungus ball in a diabetic patient. An odontogenic origin

INTRODUCTION: Fungus ball (FB) represents a granulomatous mass due to a fungal colonization which may disseminate and potentially lead to a systemic infection. Maxillary fungus ball is considered to be a complication of dental treatment and, according to relevant literature, it often stems from improper endodontic therapies. MATERIAL AND METHODS: The authors report the case of a 69-year-old caucasian woman with nasal respiratory distress and frequent sinusitis symptoms. According to clinical and radiological evidence, FESS surgery was planned, thus validating FB diagnostic hypothesis. CONCLUSIONS: Fungal infection should always be considered in patients with sinusitis and previous root canal theraphy. Misdiagnosis can lead to severe complications. Surgical removal seems to be effective and resolutive. KEY WORDS: Endoscopic surgery, Fungus Ball, Maxillary sinusitiss. Una massa granulomatosa sviluppatasi da una colonia fungina viene indicata come “palla di fungo” (FB), che può diffondersi e potenzialmente portare a un’infezione sistemica. La palla fungina mascellare è considerata una complicazione di un trattamento odontoiatrico e, secondo la letteratura di riferimento, spesso trae origine da trattamenti endodontici impropri. Gli autori riportano il caso di una donna caucasica di 69 anni con difficoltà respiratoria nasale e frequenti sintomi di sinusite. Dopo analisi cliniche e radiologiche, è stata trattata con FESS (Functional Endoscopic Sinus Surgey), convalidando così l’ipotesi diagnostica di FB. In conclusione l’infezione fungina deve essere sempre presa in considerazione nei pazienti con sinusite e precedente terapia del canale radicolare. La diagnosi errata può portare a gravi complicazioni. La rimozione chirurgica sembra essere efficace e risolutiva

Do Agriculture Commodities Spill over onto Latin Stock Markets?

Addressing the volatility spillovers of agricultural commodities is important for at least two reasons. First, for the last several years, the volatility of agricultural commodity prices seems to have increased. Second, according to the Food and Agriculture Organization, there is a strong need for understanding the potential (negative) impacts on food security caused by food commodity volatilities. This paper aims at investigating the presence, the size, and the persistence of volatility spillovers among five agricultural commodities (corn, sugar, wheat, soybean and bioethanol) and five Latin American (Argentina, Brazil, Chile, Colombia, Peru) stock market indexes. It is possible to identify a spillover index (and hence the direction), the main sources, and the recipients of the spillovers. It was shown that there exist some (more precisely, seven) volatility spillovers, robust to different lagged periods, that is: corn Chile, corn Colombia, and corn Peru; sugar Colombia and sugar Peru; and, finally, wheat Chile and wheat Peru. Overall, when a negative shock hits the commodity market, Latin American stock market volatility tends to increase. This happens, for instance, for the relationships from corn to Chile and Colombia and from wheat to Peru and Chile