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

Background Estimates 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. Methods 22 223 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. Findings Global 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. Interpretation Global 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

Malignant melanoma of the oral cavity: A review of literature

Oral malignant melanoma is a rare aggressive neoplasm of the middle age. This malignancy commonly affects male subjects and is more frequently seen at the level of the hard palate and gingiva. At present, the clinicopathological classification of oral melanoma is not yet clearly outlined; consequently, the skin form is often taken as a reference. In many cases (up to 30%), the diagnosis of melanoma is made on lesions, which have evolved from the pre-existing pigmented lesions. The poor prognosis of oral melanomas requires that pigmented lesions of undetermined origin be routinely biopsied. The surgical approach, combined with the chemotherapeutic one, is the first choice treatment. The purpose of this study is to review literature that has been published about malignant melanoma of the oral cavity. Materials and Methods: Thirty-eight published articles and 8 textbooks related to oral malignant melanoma and been published in the last two decades are reviewed. Conclusion: The review of literature in the field of malignant melanoma of the oral cavity show that this malignancy might be different from cutaneous malignant melanomas, and new criteria for diagnosis and therapy should be considered for this disease. Physicians and dentists who treat problems of the oral cavity should be aware of the need for early diagnosis of oral melanomas and performing biopsies of doubtful pigmented lesions

Perceptual adaptation to noise vocoded speech by lipread information:No difference between dyslexic and typical readers

Auditory speech can be difficult to understand but seeing the articulatory movements of a speaker can drastically improve spoken word recognition and on the longer-term, it helps listeners to adapt to acoustically distorted speech. Given that individuals with developmental dyslexia (DD) have sometimes been reported to rely less on lipread speech than typical readers, we examined lipread-driven adaptation to distorted speech in a group of adults with DD (N=29) and a comparison group of typical readers (N = 29). Participants were presented with acoustically distorted Dutch words (6-channel noise vocoded speech, NVS) in audiovisual training blocks (where the speaker could be seen) interspersed with audio-only test blocks. Results showed that words were more accurately recognized if the speaker could be seen (a lipread advantage), and that performance steadily improved across subsequent auditory-only test blocks (adaptation). There were no group differences, suggesting that perceptual adaptation to disrupted spoken words is comparable for dyslexic and typical readers. These data open up a research avenue to investigate the degree to which lipread-driven speech adaptation generalizes across different types of auditory degradation, and across dyslexic readers with decoding versus comprehension difficulties

Malignant Salivary Glands Tumors in Kerman Province: A Retrospective Study

Introduction: Malignant salivary glands tumors (MSGTs) are uncommon cancers. The most common site of these cancers is the parotid gland. Some investigations show these cancers preference for males than females. The majority of MSGTs arise in sixth decade of human life. According to the literature review for the present work, there is a few epidemiological researches about MSGTs in Iran and especially there isn't any study in Kerman province. So the aim of this study was investigation the incidence, sex, age, histological types, and site distribution of MSGTs in the Kerman province during the time period from March 1991 to March 2002.Methods and Materials: Documents and records of 70 patients with MSGTs diagnosed from March 1991 to March 2002 were reviewed. The patients' records were analyzed based on gender, age, location, and histopathological type of the tumor. Data were analyzed by SPSS-13.5 statistical software using t-test, chi-square, and ANOVA tests.Results: During this period of time, 70 cases (43men, 27 women) of MSGTs had been diagnosed. Mucoepidermoid carcinoma was the most common cancer (30%) and the parotid was the most affected site (70%). The age range was 10-86 years old with the overall mean age of 50.18 ± 17.97.Discussion: Despite a considerable volume of literatures written about MSGTs in many countries, the incidence of these cancers haven't as yet been thoroughly documented or analyzed in Iran. However, comparison between the findings of this study with the results of other investigations showed a relative consistency

Tuberculous osteomyelitis of the long bones and joints

Skeletal tuberculosis(TB) is usually a rare osteoarticular disease in which bones or joints are involved. We studied 4 such cases admitted to Iranian National Research Institute of Tuberculosis and Lung Diseases from 2000 to 2003. In the initial stages of the disease, diagnosis is very difficult and conventional radiographies often reveal nonspecific findings. Our experience in these cases showed that a high index of suspicion is the most important step in early diagnosis of skeletal tuberculosis. © 2008 Dr. K C Chaudhuri Foundation

THYROID FUNCTION IN MALIGNANT PEDIATRIC PATIENTS AFTER RADIOTHERAPY

Introduction. Malignancy is seen in pediatrics, frequently. Radiotherapy as a common procedure in malignancy management may has many side effects and complications, especially about endocrine system. In this study, we evaluate the incidence of post radiotherapy hypothyroidism In malignant pediatric patients.
 Methods. In a cross sectional study one hundred and eighty children between 1 to 20 years old that survived of malignancy were selected. They have been treated in Sayyed-Alshohada hospital (affiliated to Isfahan University of Medical Sciences) from 1993 Sep. until 1998 Sep. by radiotherapy.
 Baseline characteristics (e.g. sex, age, dose, location and number of radiotherapy fraction, type of malignancy) were derived from medical records. Subjects were invited by letters to evaluate their thyroid functions in 1999. Serum T4 and FT4 concentrations assayed by RIA and TSH by IRMA methods.
 Results. The incidence of hypothyroidism was 13.3 percent (1.2 percent secondary hypothyroidism and 12.1 percent primary hypothyroidism). There was no statistical difference in age and sex distribution between patients with or without hypothyroidism. History of cervical region radiotherapy was taken in 45.8 percent of hypothyroid patients. There was no significant difference in dose and number of radiotherapy fraction between hypothyroid and euthyroid patients.
 Discussion. Radiotherapy may have a role in developing hypothyroidism in patients who received radiotherapy. This role has no relation to age and sex, dose and number of radiation fraction in development of hypothyroidism. Region of radiotherapy is important. It is suggested that this study continues and data will be collected during several years in future. Of course, many of hypothyroid patients will become euthyroid spontaneously

Proximal onychomycosis due to Malassezia furfur: a case report

Background: The etiologic role of Malassezia furfur in onychomycosis, because of its controversial keratinolytic ability, has not been proven. The most reported cases are distal subungual onychomycosis (DSO). In our knowledge no cases of proximal onychomycosis (PO) has been reported. For the first time we report proximal onychomycosis. This case report describes the isolation of Malassezia furfur from fingernails. Case presentation: An Iranian 56- year- old women had been referred to mycology lab with hyperkeratosis in proximal regions of right hand nails and clinical diagnosis of onychomycosis without paronychia in May 2012. She used several medicines for her cardiac disease, mental illness, severe stress and blood glucose fluctuation diseases. Scraping and sampling from nail lesions were done, budding yeast cells with broadband connections were observed in 15% KOH wet mounts. Also, other differentiation tests, consist of staining with methylen blue, cultures and biochemical tests were done. In order to rejecting the probable etiologic role of any dermatophytic or non-dermatophytic fungi in this case, samples were collected from other parts of the body by scotch tape and scraping with scalpel blade too, but the results of direct microscopy and culture were negative. Finally, Malassezia furfur was identified as the causative agent of onychomycosis.Conclusion: Despite failure to prove Malassezia furfur keratinolytic ability, it can be the etiologic agent of proximal onychomycosis that shows the aggressive properties of this species. Its clinical importance is the easier transmission to hospitalized patients and other people