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

Symmetrical polyneuropathy in coronavirus disease 2019 (COVID-19)

The outbreak of the novel coronavirus that began in late December 2019 was announced as a pandemic by the World Health Organization as the number of cases is increasing exponentially throughout the globe. We presented a patient with confirmed SARS-CoV-2 pneumonia developing symmetric polyneuropathy. To our knowledge, extrapulmonary clinical presentations of 2019 novel coronavirus disease (COVID-19) have rarely been reported. This case highlights the possible association between SARS-CoV-2 infection and nervous system involvement

Water reuse in closed hydroponic systems : comparison of GAC adsorption, ion exchange and ozonation processes to treat recycled nutrient solution

In this study, the removal of root exudates from recycled nutrient solution (RNS) in hydroponic systems was investigated by using alternative advanced treatment processes. In particular, the performance of adsorption on granular activated carbon (GAC adsorption), ion exchange (using Amberlite IRA96) and ozonation was evaluated. The characterization of a RNS from a lettuce hydroponic company showed the occurrence of several organic acids including benzoic, maleic, palmitic, stearic, phthalic, succinic, acrylic, adipic, myristic, mannonic, oleic, arachidic and acetic acid. Furthermore, benzoic, acrylic, myristic and palmitic acid were detected even after the RNS treatment by GAC adsorption, ion exchange or ozonation. Further experiments were performed to evaluate the removal efficiency of root exudates from RNS by the selected treatment processes. For this purpose benzoic acid (BA), which is a potent growth inhibitor, was selected as target compound. Benzoic acid occurring at 23 lig/L in the RNS was completely removed by GAC adsorption, ion exchange or ozonation process. In addition, GAC adsorption was the most efficient technique for organic matter removal. Indeed, the COD removal efficiency was 74%, 67% and 22% for GAC adsorption, ozonation and ion exchange treatments, respectively. The results from UV vis absorbance measurements corroborated the best performance of activated carbon in organic compounds removal from RNS. For instance, the absorbance removal at 280 rim reached 82%, 51% and 27% after GAC adsorption, ozonation and ion exchange treatments, respectively

Combining ozone with UV and H2O2 for the degradation of micropollutants from different origins : lab-scale analysis and optimization

The degradation of micropollutants (MPs), including pesticides, herbicides, pharmaceuticals and endocrine disrupting compounds, by ozone-based advanced oxidation techniques (AOP) was investigated in this study. The effect of different factors, such as ozone concentration, hydrogen peroxide concentration and initial pH, on the removal rate was studied in detail. The combination of UV with ozone/ H2O2 increased the MPs degradation. For example, atrazine removal increased from 12.6% to 66.9%. Increasing the concentration of ozone and H2O2 can enhance the degradation efficiency of MPs, while excess H2O2 plays a role as a scavenger for (OH)-O-?. In addition, the optimizing conditions of degradation of MPs by an ozone-based AOP were investigated in this study. The optimal dosages of ozone for atrazine (ATZ), alachlor (ALA), carbamazepine (CBZ), 17-?-ethinylestradiol (EE2) and pentachlorophenol (PCP), were in the range of 0.6?0.75, while for ATZ a much higher dosage (5.4?mg/l) is needed. The optimal dosages of H2O2 concentration were at 0.75, 0.2, 0.47, 0.75 and 0.63?mM, and pH were at 10, 10, 7, 10 and 10, and reaction time at 38.5, 33.5 43, 6 and 6 min, respectively. Ozone-based AOP and in particular combination of UV with ozone and H2O2 is efficient to degrade atrazine, alachlor, carbamazepine, 17-?-ethinylestradiol and pentachlorophenol, and is attractive for future application of real wastewater treatment

Recirculating water treatment in closed hydroponic systems : assessment of granular activated carbon and soft templated Mesoporous carbon for adsorptive removal of root exudates

The present study deals with the characterization of reused nutrient solution (RNS) from a hydroponic farm (lettuce). Chemical analysis with GC-MS revealed the presence of eleven individual organic acids as a part of root exudates (acetic, acrylic, maleic, succinic, benzoic, phthalic, sebacic, myristic, palmitic, oleic and stearic acid). Based on these results, first batch tests were developed to determine the breakthrough time and the best kinetic model for adsorption of benzoic acid (as an indicator of these 11 organic acids) on two different types of carbon based adsorbents (granular activated carbon-GAC and soft templated mesoporous carbon-SMC). In order to evaluate the adsorption kinetics, four different kinetic models were fit to the experimental data. The pseudo-second-order best represented the experimental data for both adsorbents at all dosages, exhibiting high linear correlation coefficients (R(2)0.98). Second, to gain a better understanding of the adsorption efficiency during the batch experiments, several parameters were measured (i.e., COD, UV254, pH and EC) and the effect of adsorbent dosages on these parameters was studied. Third, the effect of different flow rates and bed heights on the breakthrough curve was studied during column tests. These curves were fitted to four well-known fixed-bed adsorption models, namely Thomas, Bohart-Adams, Yoon-Nelson and BDST models. The latter model was found to be most suitable (R(2)0.88) to predict the breakthrough curve for benzoic acid uptake on GAC in fixed bed column. Scale up analysis revealed that approximately 72kg GAC is required to treat RNS during 27days for a typical flow rate of 360Lh(-1) (3200kgL(-1))