Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BackgroundDisorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.MethodsWe estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.FindingsGlobally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.InterpretationAs the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed

Fibroma traumático en mucosa labial superior: Reporte de caso

El Fibroma traumático es una alteración caracterizada por una producción exagerada de tejido conjuntivo fibroso, producida por traumas crónicos. Generalmente se encuentra en mucosa oral como carrillos o lengua. En este caso en particular debido a que la paciente tiene dentición en el maxilar inferior y edentulismo total superior, se puede apreciar como progresó la lesión en la mucosa labial. La paciente de ochenta años acudió por renovación de su prótesis total superior debido a que dejo de usarla porque estaba desadaptada. Al examen clínico se observa un agrandamiento a nivel de mucosa labial superior izquierda, no dolorosa a la palpación y de coloración ligeramente blanquecina. Se decide tomar una biopsia excisional para establecer el diagnóstico definitivo debido a que existen varias lesiones con presentación clínica similar, la lesión fue compatible con un fibroma traumático, este trabajo se presenta con el objetivo de presentar las características clínicas e histopatológicas de un fibroma traumático, enfatizando la importancia de un diagnóstico temprano y oportuno para efectuar un tratamiento eficaz. Es importante considerar que, si la intervención quirúrgica no se acompaña con la rehabilitación protésica oral, pudiera aparecer una recidiva de la lesión

Relación entre las posturas de trabajo y síntomas musculoesqueléticos en estudiantes de Odontología en Lima

Introduction: The early appearance of musculoskeletal symptoms is an important occupational health problem for dental students that affects their quality of life.Objective: To determine the relationship between work postures and the early appearance of musculoskeletal symptoms in dental students of the National University of San Marcos.Material and methods: Descriptive, observational and cross-sectional study. The sample consisted of 70 students of the Faculty of Dentistry of the National University of San Marcos. The Kuorinka Nordic questionnaire was used for the determination of the early onset of musculoskeletal symptoms, and a postural checklist was used for the type of clinical work posture.Results: It was found that 77,1 % (n=54) presented some type of incorrect posture. Also, 67,7 % (n=46) indicated that the dorsal lumbar region presented the highest perception of musculoskeletal symptoms, while the level of intensity of pain that prevailed most was the moderate level in the cervical region (52,6 %), shoulder (50 %) and wrist/hand (40,9 %); in the lumbar area (43,9 %) a strong level prevailed. The time of suffering from musculoskeletal symptoms was predominantly between 6 months and 1 year.Conclusions: In the population evaluated, there is no relationship between the type of posture and the early onset of musculoskeletal symptoms. Likewise, the dorsal lumbar region is the one that is frequently affected during clinical dental work.Introducción: La aparición temprana de síntomas musculoesqueléticos es un importante problema de salud ocupacional para los estudiantes de odontología y que repercute en su calidad de vida.Objetivo: Determinar la relación entre las posturas de trabajo y la aparición temprana de síntomas musculoesqueléticos en los estudiantes de Odontología de la Universidad Nacional Mayor de San Marcos.Material y métodos: Estudio descriptivo, observacional y transversal. La muestra estuvo conformado por 70 estudiantes de la Facultad de Odontología de la Universidad Nacional Mayor de San Marcos. Para la determinación de la aparición temprana de síntomas musculoesqueléticos se empleó el cuestionario nórdico de Kuorinka y para el tipo de postura de trabajo clínico se empleó una lista de verificación postural.Resultados: Se encontró que el 77,1% (n=54) presentaron algún tipo de postura incorrecta. El 67,7% (n=46) indicaron que la zona dorsal/lumbar fue la que presentó una mayor percepción de síntomas músculo esqueléticos, mientras el tipo de nivel de intensidad de dolor que más predominó fue el nivel moderado en la zona cervical (52,6%), hombro (50%) y muñeca/mano (40,9%); en la zona lumbar (43,9%) predominó un nivel fuerte. El tiempo de padecimiento de los síntomas musculoesqueléticos fue predominantemente entre 6 meses a 1 año.Conclusiones: En la población evaluada, no existe una relación entre el tipo de postura y la aparición temprana de síntomas musculoesqueléticos. Así mismo, la zona dorsal lumbar es la que frecuentemente es afectada durante el trabajo clínico odontológico

Tipo de edentulismo parcial bimaxilar y su asociación con el nivel socioeconómico-cultural

Introduction: Partial edentulism is a final condition to the presence of dental caries related to various social, demographic and cultural factors. Currently, there are few studies that assess the state of partial edentulism and its association with the socioeconomic cultural level.Objective: To determine the frequency of the type of bimaxillary partial edentulism according to Kennedy´s Class and its possible association with the socioeconomic cultural level in patients treated in the clinic of the Faculty of Dentistry of the National University of San Marcos in 2016.Material and methods: A descriptive, observational and cross-sectional study was conducted. The sample consisted of 100 randomly selected partial edentulous adult patients who were evaluated by means of a survey and an oral clinical examination. The survey was made up of the data that relate socioeconomic cultural level. The clinical examination was evaluated with an odontogram to determine the type of edentulism according to Kennedy´s classification.Results: The most frequent type of partial edentulism was Kennedy's Class III in the maxillary arch (50%) and in the mandible (49%), which was mainly present in patients that belonged to the average socioeconomic cultural level (83%). There was no statistically significant association between the socioeconomic cultural level and the type of partial edentulism according to Kennedy´s Class in both dental arches.Conclusions: In the studied population, there is a greater frequency of partial bimaxilar edentulism according to Kennedy's Class III and a preponderance of the socioeconomic cultural level. However, there is no association between the type of partial edentulism according to Kennedy´s Class and the socioeconomic cultural level.Keywords: Prevalence, jaw, partially edentulous arcade, social class, culture, dental caries, periodontal diseases, Kennedy´s class.Introducción: El edentulismo parcial es una condición final a la presencia de caries dental relacionado con diversos factores sociales, demográficos y culturales. Actualmente, existen escasos estudios que valoren el estado de edentulismo parcial y su asociación con el nivel socioeconómico-cultural.Objetivo: Determinar la frecuencia del tipo de edentulismo parcial bimaxilar según la Clase de Kennedy y su posible asociación con el nivel socioeconómico-cultural en los pacientes de la clínica de la Facultad de Odontología de la Universidad Nacional Mayor de San Marcos del año 2016.Material y Métodos: Estudio descriptivo, observacional y transversal. La muestra estuvo conformada por 100 pacientes adultos edéntulos parciales seleccionados aleatoriamente que fueron evaluados mediante una encuesta y un examen clínico oral. La encuesta estuvo conformada por los datos sobre el nivel socioeconómico-cultural. El examen clínico se evaluó con un odontograma para determinar el tipo de edentulismo según la clasificación de Kennedy.Resultados: El tipo de edentulismo parcial más frecuente fue la Clase III de Kennedy en la arcada maxilar (50%) y en la mandibular (49%), los portadores   pertenecían en gran medida al nivel socioeconómico-cultural medio (83%). No se evidenció una asociación estadísticamente significativa entre el nivel socioeconómico-cultural y el tipo de edentulismo parcial según la Clase de Kennedy en ambas arcadas dentarias.Conclusiones: En la población estudiada existe una mayor frecuencia de edentulismo parcial bimaxilar Clase III de Kennedy y una preponderancia del nivel socioeconómico-cultural medio. Sin embargo, no existe asociación entre el tipo de edentulismo parcial según la Clase de Kennedy y el nivel socioeconómico-cultural. Palabras clave: Frecuencia; arcada parcialmente edéntula; clase social; cultura; Clases de Kennedy

Presencia de Streptococcus Mutans Genotipo C en niños y adolescentes peruanos con caries

Caries is one of the diseases of infectious nature, chronic transmissible very prevalent in Peru, related to the presence of Streptococcus mutans, hygienic and nutritional habits. Objective: The purpose of this study was to determine the presence of genotype C in Streptococcus mutans in Peruvian children and adolescents, using the PCR-Multiplex technique; and its association with the prevalence of dental caries. Materials and methods: The study was done with a sample of 78 children and adolescents of both sexes from Lima. The study consisted of two phases, on the first one the stimulated saliva was obtained, for the bacterial culture, the same ones that were grown on Mitis Salivarius agar with bacitracin and sulfisoxasol. On the second phase, genotyping was carried out according to its enzymatic profile. For the extraction of DNA, the Gene Extraction Kit GG-1 Bacterial DNA was used, for which cultures of Streptococcus sp strains were performed in the BHI broth with sucrose at 37ºC for 24 hours. Results: The presence of Streptococcus mutans was evidenced in 59 (75.6%) of 78 saliva samples. The results of the genotyping by PCR Multiplex demonstrate the presence of 22 saliva samples of Streptococcus mutans with genotypes C (37,297%) and 37 samples 62, 71 % without this Genotype. Conclusions: The results showed that the presence of genotype C is not related to sex, age group or the presence of dental caries.La caries es una de las enfermedades de naturaleza infecciosa, crónica transmisible muy prevalente en el Perú, relacionada a la presencia del Streptococcus mutans, los hábitos de higiene y nutricionales. Objetivo: El propósito de este estudio fue determinar la presencia del genotipo C en el Streptococcus mutans en niños y adolescentes peruanos, utilizando la técnica PCR- Multiplex; y su asociación con la prevalencia de caries dental. Material y método: Se trabajó con una muestra de 78 niños y adolescentes de ambos sexos de Lima. El estudio consistió en dos fases, en la primera se obtuvo la saliva estimulada, para el cultivo bacteriano, las mismas que fueron sembradas en agar Mitis Salivarius con bacitracina y sulfisoxasol. En la segunda fase se realizó la genotipificación de acuerdo con su perfil enzimático. Para la extracción de ADN se utilizó el GF-1 Bacterial DNA Extraction Kit de GeneONGmbH para lo cual se realizó cultivos de las cepas de Streptococcus sp en el caldo BHI con sacarosa a 37ºC por 24 horas. Resultados: Se evidencia la presencia de Streptococcus mutans en 75.6%: 59 de 78 muestras de saliva. Los resultados de la genotipificación por PCR Multiplex demuestran la presencia de 22 muestras de saliva de Streptococcus mutans con genotipos C (37,29%) y 37 muestras (62,71%) que no pertenecen a dicho Genotipo. Conclusiones: Los resultados evidenciaron que el Streptococcus mutans genotipo C no está relacionado al sexo, grupo etario ni a la presencia de caries dental

Estimating mortality and disability in Peru before the COVID-19 pandemic : a systematic analysis from the Global Burden of the Disease Study 2019

Background: Estimating and analyzing trends and patterns of health loss are essential to promote efficient resource allocation and improve Peru’s healthcare system performance. Methods: Using estimates from the Global Burden of Disease (GBD), Injuries, and Risk Factors Study (2019), we assessed mortality and disability in Peru from 1990 to 2019. We report demographic and epidemiologic trends in terms of population, life expectancy at birth (LE), mortality, incidence, prevalence, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) caused by the major diseases and risk factors in Peru. Finally, we compared Peru with 16 countries in the Latin American (LA) region. Results: The Peruvian population reached 33.9 million inhabitants (49.9% women) in 2019. From 1990 to 2019, LE at birth increased from 69.2 (95% uncertainty interval 67.8-70.3) to 80.3 (77.2-83.2) years. This increase was driven by the decline in under-5 mortality (-80.7%) and mortality from infectious diseases in older age groups (+60 years old). The number of DALYs in 1990 was 9.2 million (8.5–10.1) and reached 7.5 million (6.1–9.0) in 2019. The proportion of DALYs due to non-communicable diseases (NCDs) increased from 38.2% in 1990 to 67.9% in 2019. The all-ages and age-standardized DALYs rates and YLLs rates decreased, but YLDs rates remained constant. In 2019, the leading causes of DALYs were neonatal disorders, lower respiratory infections (LRIs), ischemic heart disease, road injuries, and low back pain. The leading risk factors associated with DALYs in 2019 were undernutrition, high body mass index, high fasting plasma glucose, and air pollution. Before the COVID-19 pandemic, Peru experienced one of the highest LRIs-DALYs rates in the LA region. Conclusions: In the last three decades, Peru experienced significant improvements in LE and child survival and an increase in the burden of NCDs and associated disability. The Peruvian healthcare system must be redesigned to respond to this epidemiological transition. The new design should aim to reduce premature deaths and maintain healthy longevity, focusing on effective coverage and treatment of NCDs and reducing and managing the related disability

Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021

BackgroundEstimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020–21 COVID-19 pandemic period.Methods22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution.FindingsGlobal all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5–65·1] decline), and increased during the COVID-19 pandemic period (2020–21; 5·1% [0·9–9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98–5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50–6·01) in 2019. An estimated 131 million (126–137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7–17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8–24·8), from 49·0 years (46·7–51·3) to 71·7 years (70·9–72·5). Global life expectancy at birth declined by 1·6 years (1·0–2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67–8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4–52·7]) and south Asia (26·3% [9·0–44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations.InterpretationGlobal adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic