Measuring the health-related Sustainable Development Goals in 188 countries : a baseline analysis from the Global Burden of Disease Study 2015

Background In September, 2015, the UN General Assembly established the Sustainable Development Goals (SDGs). The SDGs specify 17 universal goals, 169 targets, and 230 indicators leading up to 2030. We provide an analysis of 33 health-related SDG indicators based on the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015). Methods We applied statistical methods to systematically compiled data to estimate the performance of 33 health-related SDG indicators for 188 countries from 1990 to 2015. We rescaled each indicator on a scale from 0 (worst observed value between 1990 and 2015) to 100 (best observed). Indices representing all 33 health-related SDG indicators (health-related SDG index), health-related SDG indicators included in the Millennium Development Goals (MDG index), and health-related indicators not included in the MDGs (non-MDG index) were computed as the geometric mean of the rescaled indicators by SDG target. We used spline regressions to examine the relations between the Socio-demographic Index (SDI, a summary measure based on average income per person, educational attainment, and total fertility rate) and each of the health-related SDG indicators and indices. Findings In 2015, the median health-related SDG index was 59.3 (95% uncertainty interval 56.8-61.8) and varied widely by country, ranging from 85.5 (84.2-86.5) in Iceland to 20.4 (15.4-24.9) in Central African Republic. SDI was a good predictor of the health-related SDG index (r(2) = 0.88) and the MDG index (r(2) = 0.2), whereas the non-MDG index had a weaker relation with SDI (r(2) = 0.79). Between 2000 and 2015, the health-related SDG index improved by a median of 7.9 (IQR 5.0-10.4), and gains on the MDG index (a median change of 10.0 [6.7-13.1]) exceeded that of the non-MDG index (a median change of 5.5 [2.1-8.9]). Since 2000, pronounced progress occurred for indicators such as met need with modern contraception, under-5 mortality, and neonatal mortality, as well as the indicator for universal health coverage tracer interventions. Moderate improvements were found for indicators such as HIV and tuberculosis incidence, minimal changes for hepatitis B incidence took place, and childhood overweight considerably worsened. Interpretation GBD provides an independent, comparable avenue for monitoring progress towards the health-related SDGs. Our analysis not only highlights the importance of income, education, and fertility as drivers of health improvement but also emphasises that investments in these areas alone will not be sufficient. Although considerable progress on the health-related MDG indicators has been made, these gains will need to be sustained and, in many cases, accelerated to achieve the ambitious SDG targets. The minimal improvement in or worsening of health-related indicators beyond the MDGs highlight the need for additional resources to effectively address the expanded scope of the health-related SDGs.Peer reviewe

Trace elements and cell-mediated immunity in gestational and pre-gestational diabetes mellitus at third trimester of pregnancy

Objective. The aim of the study: To evaluate the correlations betweenZn2+, Cu2+, Mg2+, Se2+ and Cr3+ and alteration in T cell subsetsduring diabetic and normal pregnancy. Methods. The study involved63 women with gestational diabetes mellitus (GD) and 16 pregnantwomen with Type 2 diabetes and 48 healthy, non-pregnant womenwere included as controls. Ten ml of whole venous blood from eachparticipant was analyzed for electrolytes by atomic absorption; totalantioxidant activity, individual enzymatic antioxidants by spectrophotometry; and lymphocyte sub-populations by flow cytometry. Results. There were significant changes in lymphocyte sub-populations: Naïve T cells were decreased and memory T-cells and activated T cells(CD4+HLA-DR+, CD4+CD29+) were increased in diabetes in pregnancy.Zn2+ and Cr3+ deficiency were observed in Type 2 diabetics with an increase in Cu2+ in all pregnant cohorts. In healthy pregnantsubjects, CD4+-HLA-DR+ was increased in direct proportion to serumMg2+ (p<0.05) and Se2+ (p<0.01). In insulin-treated GD patients,CD4+CD29+ cells were increased proportionally to serum Zn2+(p<0.05) while in diet controlled GD cohort CD45RO+/ CD45RA+ Tcells correlated directly with serum Mg (p<0.05) and Zn2+ (p<0.01)while it correlated inversely with serum Cu2+ (p<0.01). Conclusions.The results of the present study show a correlation between trace element deficiency and increased lipid peroxidation in diabetes in pregnancy and lymphocyte activation. Dietary manipulation may, therefore, point to improvement in existing approaches to management of diabetes mellitus in pregnancy

Knowledge, Attitude and Practice of Hypercholesterolemic Type 2 Diabetic Subjects on Dyslipidemia

This study was undertaken to assess the knowledge, attitude and practice (KAP) of hypercholesterolemic type 2 diabetic subjects on dyslipidemia and to analyze the influence of some demographic and socioeconomic factors on the level of KAP.It was a descriptive cross-sectional survey. One hundred eleven newly diagnosed type 2 diabetic subjects (male 61%, female 39%, age 45±9 years, BMI 24±4.8 Kg/m2) with hypercholesterolemia (fasting plasma total cholesterol >200 mg/dl) were selected from the out patient department of BIRDEM by purposive sampling method. Data were collected by a pre-designed, pretested, interviewer-administered questionnaire. Three categories were defined on the basis of the score obtained by each subject namely low, medium and high as follows: knowledge-score 60%; attitude-score 80%; and practice-score 70% respectively. The levels of knowledge were low in 42%, medium in 35% and high in 23% of the study subjects. The corresponding attitude levels were low in 1%, medium in 31% and high in 68%, and the levels of practice were low in 80%, medium in 14% and high in 6% of the subjects. The knowledge score was higher in secondary and graduate (53.4±8.9%, and 54.9±10.1%) groups compared to illiterate-primary group (48.9±9.9%). Practice score of illiterate-primary group (34.5±16.8%) was lower than secondary and graduate (43.1±13.9% and 46.7±18.1%) groups, but they did not differ on attitude. The various income groups did not differ on knowledge. Attitude score of high-income group (78.7±8.4%) was better than low-income group (70.9±11.8%). Practice score in high-income group (44.7±16.0%) was better than medium income and low-income groups (31.3±14.5% and 28.6±15.0%). Knowledge and practice score in Bangladeshi hypercholesterolemic type 2 diabetic subjects are not satisfactory although they have fairly good attitude levels. Education and income status are the major determinants of knowledge, attitude and practice regarding dyslipidemia in diabetes. A coordinated policy is required to promote knowledge and attitude on healthy lifestyle and to translate those into practice. Ibrahim Med. Coll. J. 2011; 5(2): 37-4

Le corticosurrénalome: une cause exceptionnelle d’hyperaldostéronisme primaire

Le corticosurrénalome est une tumeur maligne rare de la cortico-surrénale. Il secrète souvent des corticostéroïdes, des stéroïdes sexuels et des précurseurs. Le corticosurrénalome producteur d'aldostérone est très rare, 1cas/10 millions d'habitants. Nous rapportons l'observation d'un homme de 38 ans se présentant pour hypertension artérielle sévère associée à une hypokaliémie profonde (2.2 mmol/l). L'exploration a conclu à un hyperaldostéronisme primaire (aldostérone = 2645pmol/l, rapport aldostérone/rénine = 327pmol/mUI), avec hypersécrétion de glucocorticoïdes. Le scanner abdomino-pelvien a montré une masse surrénalienne gauche de 9cm, mal limitée et hétérogène, infiltrant la graisse autour et le diaphragme, envahissant la veine rénale gauche, avec adénopathie régionale et nodule hépatique de 4 cm. Le patient a eu une néphrectomie élargie, suivie d'une hépatectomie droite deux mois après entrainant une rémission. Un an après le patient a développé des métastases pulmonaires. Nous concluons que l'hyperaldostéronisme primaire peut être un mode de révélation du corticosurrénalome, on devra y penser malgré son caractère exceptionnel

Molecular and Physicochemical Factors Governing Solubility of the HIV gp41 Ectodomain

The HIV gp41 ectodomain (e-gp41) is an attractive target for the development of vaccines and drugs against HIV because of its crucial role in viral fusion to the host cell. However, because of the high insolubility of e-gp41, most biophysical and structural analyses have relied on the production of truncated versions removing the loop region of gp41 or the utilization of nonphysiological solubilizing conditions. The loop region of gp41 is also known as principal immunodominant domain (PID) because of its high immunogenicity, and it is essential for gp41-mediated HIV fusion. In this study we identify the aggregation-prone regions of the amino acid sequence of the PID and engineer a highly soluble mutant that preserves the trimeric structure of the wild-type e-gp41 under physiological pH. Furthermore, using a reverse mutagenesis approach, we analyze the role of mutated amino acids upon the physicochemical factors that govern solubility of e-gp41. On this basis, we propose a molecular model for e-gp41 self-association, which can guide the production of soluble e-gp41 mutants for future biophysical analyses and biotechnological applications

Molecular and Physicochemical Factors Governing Solubility of the HIV gp41 Ectodomain

The HIV gp41 ectodomain (e-gp41) is an attractive target for the development of vaccines and drugs against HIV because of its crucial role in viral fusion to the host cell. However, because of the high insolubility of e-gp41, most biophysical and structural analyses have relied on the production of truncated versions removing the loop region of gp41 or the utilization of nonphysiological solubilizing conditions. The loop region of gp41 is also known as principal immunodominant domain (PID) because of its high immunogenicity, and it is essential for gp41-mediated HIV fusion. In this study we identify the aggregation-prone regions of the amino acid sequence of the PID and engineer a highly soluble mutant that preserves the trimeric structure of the wild-type e-gp41 under physiological pH. Furthermore, using a reverse mutagenesis approach, we analyze the role of mutated amino acids upon the physicochemical factors that govern solubility of e-gp41. On this basis, we propose a molecular model for e-gp41 self-association, which can guide the production of soluble e-gp41 mutants for future biophysical analyses and biotechnological applications