Global burden of chronic respiratory diseases and risk factors, 1990–2019: an update from the Global Burden of Disease Study 2019

Background: Updated data on chronic respiratory diseases (CRDs) are vital in their prevention, control, and treatment in the path to achieving the third UN Sustainable Development Goals (SDGs), a one-third reduction in premature mortality from non-communicable diseases by 2030. We provided global, regional, and national estimates of the burden of CRDs and their attributable risks from 1990 to 2019. Methods: Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we estimated mortality, years lived with disability, years of life lost, disability-adjusted life years (DALYs), prevalence, and incidence of CRDs, i.e. chronic obstructive pulmonary disease (COPD), asthma, pneumoconiosis, interstitial lung disease and pulmonary sarcoidosis, and other CRDs, from 1990 to 2019 by sex, age, region, and Socio-demographic Index (SDI) in 204 countries and territories. Deaths and DALYs from CRDs attributable to each risk factor were estimated according to relative risks, risk exposure, and the theoretical minimum risk exposure level input. Findings: In 2019, CRDs were the third leading cause of death responsible for 4.0 million deaths (95% uncertainty interval 3.6–4.3) with a prevalence of 454.6 million cases (417.4–499.1) globally. While the total deaths and prevalence of CRDs have increased by 28.5% and 39.8%, the age-standardised rates have dropped by 41.7% and 16.9% from 1990 to 2019, respectively. COPD, with 212.3 million (200.4–225.1) prevalent cases, was the primary cause of deaths from CRDs, accounting for 3.3 million (2.9–3.6) deaths. With 262.4 million (224.1–309.5) prevalent cases, asthma had the highest prevalence among CRDs. The age-standardised rates of all burden measures of COPD, asthma, and pneumoconiosis have reduced globally from 1990 to 2019. Nevertheless, the age-standardised rates of incidence and prevalence of interstitial lung disease and pulmonary sarcoidosis have increased throughout this period. Low- and low-middle SDI countries had the highest age-standardised death and DALYs rates while the high SDI quintile had the highest prevalence rate of CRDs. The highest deaths and DALYs from CRDs were attributed to smoking globally, followed by air pollution and occupational risks. Non-optimal temperature and high body-mass index were additional risk factors for COPD and asthma, respectively. Interpretation: Albeit the age-standardised prevalence, death, and DALYs rates of CRDs have decreased, they still cause a substantial burden and deaths worldwide. The high death and DALYs rates in low and low-middle SDI countries highlights the urgent need for improved preventive, diagnostic, and therapeutic measures. Global strategies for tobacco control, enhancing air quality, reducing occupational hazards, and fostering clean cooking fuels are crucial steps in reducing the burden of CRDs, especially in low- and lower-middle income countries

ECG changes of hyperkalemia during paced rhythm

Paced rhythms can mask ECG changes of several conditions. ECG changes due to hyperkalemia during paced rhythm have not been well described. We report a patient with isolated noncompaction of left ventricle with left ventricular dysfunction and complete heart block on a permanent pacemaker who developed hyperkalemia. Typical ECG changes of hyperkalemia including widening of QRS complex and sine waves were seen even during paced rhythm that reverted with correction of hyperkalemia.Ajay Bahl, Ajay Swamy, Harsha Jeevan, Rajiv Mahajan and Kewal K. Talwarhttp://indianheartjournal.com/ihj09/jan_feb_09/93-94.htm

Reversibility of echocardiographic changes in human immunodeficiency virus infection and acquired immune deficiency syndrome

Background: Echocardiographic abnormalities in patients with human immunodeficiency virus (HIV) infection have been well documented. However, their relation with CD4 count and reversibility with treatment has not been studied prospectively. We studied prevalence and nature of echocardiographic abnormalities in HIV-infected patients and prospectively correlated with their CD4 count. Materials and Methods: We studied 108 consecutive patients with HIV infection. Baseline CD4 cell count and two-dimensional echocardiography were done. The study participants were categorized into two; one with CD4 count 100/mm3. They were followed up quarterly with CD4 count and repeat echocardiography for 1 year. Results: Abnormalities on echocardiography were noted in 36 of 108 patients (33.3%). Thirty-two patients (29.6%) were detected to have diastolic dysfunction of the left ventricle, ten patients (9.25%) left ventricular (LV) systolic dysfunction and eight patients (7.4%) pericardial effusion. Abnormalities were more frequent when CD4 was <100/c.mm. LV systolic dysfunction (and dilated cardiomyopathy) occurred exclusively in patients with CD4 <100/c.mm. As the CD4 count improved with treatment, many of the echocardiographic changes reversed. Conclusions: HIV-infected individuals frequently have asymptomatic and subclinical cardiac involvement. LV diastolic dysfunction, systolic dysfunction, and pericardial effusion are more common with lower CD4 cell count. With treatment, as the CD4 count improved, there was reversibility of systolic dysfunction, diastolic dysfunction, and pericardial effusion

Detection of Nail Oncometabolite SAICAR in Oral Cancer and Its Molecular Interactions with PKM2 Enzyme

Oncometabolites are known to drive metabolic adaptations in oral cancer. These oncometabolites serve as biomarkers for early detection of oral cancer. Among potential oncometabolite, SAICAR is one of them that support growth and invasiveness of cancer cells. SAICAR has been reported to activate Pyruvate Kinase M2 (PKM2) enzyme, which in turn favors the survival of cancer cells in low glucose tumor microenvironment. There is a significant gap in detection of SAICAR in biological fluids/materials including nails of oral cancer patients. </p

Congenital Third Nerve Palsy Associated With Midbrain Hypoplasia Due to Bilateral Segmental Internal Carotid Artery Agenesis

A 15-year-old girl, diagnosed with a partial right third nerve palsy, was found to have bilateral internal carotid artery agenesis. Neuroimaging with 3D-constructive interference in steady state scanning identified the possible etiology of the third nerve palsy as midbrain hypoplasia

Prognosis of different glaucomas seen at a tertiary center: A 10-year overview

Aim: This study aims to determine treatment patterns, long-term intraocular pressure (IOP) and perimetric control in different glaucomas seen at a tertiary eye center. Settings and Design: Hospital-based, cross-sectional chart review of patients routinely following up at an outpatient glaucoma service. Methods: Patients with a follow-up of at least 10 years were evaluated. Their mean IOP, visual field (VF) status, and medications/surgery required at final assessment were noted. Statistical Analysis: Descriptive statistics (mean, standard deviation, and range) were used for all parameters. Results: A total of 230 patients met our inclusion and exclusion criteria, 79 having ocular hypertension with open angles or primary angle closure (PAC), 35 primary open angle glaucoma (POAG), 50 PAC glaucoma (PACG), 20 primary congenital glaucoma (PCG), 46 secondary glaucoma patients. Ocular hypertensives with open angles showed progression to POAG in 3.7%, those with PAC in 5.2%, at a mean IOP of 17.3 ± 3.37 mmHg and 17.13 ± 4.41 mmHg, respectively. A progression on Humphrey Field Analyzer was seen in 11% of POAG and PACG eyes at a mean IOP of 13.50 ± 5.07 and 13.09 ± 3.95 mmHg, respectively. Fifteen percent of primary congenital glaucomas (PCGs) showed a glaucomatous VF defect after 10 years. In secondary glaucoma eyes, the mean IOP at last follow-up visit was 12.38 ± 3.74 mmHg, with progression noted in 7.69% of eyes. Conclusion: This study provides evidence that routine delivery of care can provide well controlled IOP in glaucomas, both primary and secondary, and the VF stabilized in about 90% of patients over a period of 10 years, with the currently available glaucoma medications and trabeculectomy

Estimation of regional surface deformation post the 2001 Bhuj earthquake in the Kachchh region, Western India using RADAR interferometry

The key objective of the present study is to estimate the surface displacement and to understand/monitor the active deformation pattern in the Kachchh region post the 2001 Bhuj Earthquake by implementing the Persistent Scatterer Interferometric Synthetic Aperture Radar (PSI) and Differential Interferometric Synthetic Aperture Radar (DInSAR) techniques. We employed the ENVISAT ASAR (15 images), ALOS PALSAR (6 pairs) and SENTINEL-1A (117 images) data sets acquired during the periods 2003–2005, 2007–2009, and 2016–2020 respectively. The PSI results of the Envisat dataset reveals that the Kachchh mainland region has undergone an average surface deformation of ± 22 mm/yr during 2003–2005. The maximum displacement observed from the ALOS PALSAR data sets (Window-1 to 6) during the period 2007–2009 is ∼ ± 1.2 cm. Further, the ground displacement observed from the Sentinel-1A dataset during the period 2016–2020 is ±16 mm/yr for the west-central region and 6 mm/yr uplift and 8 mm/yr subsidence in the eastern Kachchh mainland region. Surprisingly, high rate of deformation is detected towards the Pachham Island, Banni, Rann and the eastern region of the Kachchh after the 2001 Bhuj event. Correlating the results of different data sets, it is concluded that the deformation is high near the vicinity of the fault zones indicating the tectonically active nature of the faults. From the obtained results, we infer that, post the 2001 Bhuj earthquake, the surface displacement in the Kachchh mainland region is escalated till 2009 which is due to continuous aftershock activity and then started declining because of the ongoing seismic settlement. The acquired deformation rates are correlating well with the GPS derived displacement rates. Further, our results will assist in accurately demarcating the extent of the fault zones and also helps in precisely marking the areas undergoing active deformation, which will aid in micro zonation studies, mitigation planning and also for the preparation of an active tectonic map for the region