The global burden of adolescent and young adult cancer in 2019 : a systematic analysis for the Global Burden of Disease Study 2019

Background In estimating the global burden of cancer, adolescents and young adults with cancer are often overlooked, despite being a distinct subgroup with unique epidemiology, clinical care needs, and societal impact. Comprehensive estimates of the global cancer burden in adolescents and young adults (aged 15-39 years) are lacking. To address this gap, we analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, with a focus on the outcome of disability-adjusted life-years (DALYs), to inform global cancer control measures in adolescents and young adults. Methods Using the GBD 2019 methodology, international mortality data were collected from vital registration systems, verbal autopsies, and population-based cancer registry inputs modelled with mortality-to-incidence ratios (MIRs). Incidence was computed with mortality estimates and corresponding MIRs. Prevalence estimates were calculated using modelled survival and multiplied by disability weights to obtain years lived with disability (YLDs). Years of life lost (YLLs) were calculated as age-specific cancer deaths multiplied by the standard life expectancy at the age of death. The main outcome was DALYs (the sum of YLLs and YLDs). Estimates were presented globally and by Socio-demographic Index (SDI) quintiles (countries ranked and divided into five equal SDI groups), and all estimates were presented with corresponding 95% uncertainty intervals (UIs). For this analysis, we used the age range of 15-39 years to define adolescents and young adults. Findings There were 1.19 million (95% UI 1.11-1.28) incident cancer cases and 396 000 (370 000-425 000) deaths due to cancer among people aged 15-39 years worldwide in 2019. The highest age-standardised incidence rates occurred in high SDI (59.6 [54.5-65.7] per 100 000 person-years) and high-middle SDI countries (53.2 [48.8-57.9] per 100 000 person-years), while the highest age-standardised mortality rates were in low-middle SDI (14.2 [12.9-15.6] per 100 000 person-years) and middle SDI (13.6 [12.6-14.8] per 100 000 person-years) countries. In 2019, adolescent and young adult cancers contributed 23.5 million (21.9-25.2) DALYs to the global burden of disease, of which 2.7% (1.9-3.6) came from YLDs and 97.3% (96.4-98.1) from YLLs. Cancer was the fourth leading cause of death and tenth leading cause of DALYs in adolescents and young adults globally. Interpretation Adolescent and young adult cancers contributed substantially to the overall adolescent and young adult disease burden globally in 2019. These results provide new insights into the distribution and magnitude of the adolescent and young adult cancer burden around the world. With notable differences observed across SDI settings, these estimates can inform global and country-level cancer control efforts. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.Peer reviewe

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

Block copolymer assisted preparation of functional nano-composites

Block copolymers are widely used in the field of nanotechnology for the production of functional nanomaterials and nanocomposites. We report a technique for the synthesis of C60/polymer colloid nanocomposites in aqueous medium from a non-aqueous system via complex formation. A tri-block poly(4-vinylpyridine)-b-polyethylene-b-poly(4-vinylpyridine), P4VP8-b-PEO105-b-P4VP8 was complexed with fullerene (C60) in toluene via charge transfer complex formation, which resulted in a fullerene assembly in cluster form. A nanocomposite dispersion in aqueous solution could be obtained using an aged solution of the polymer/C60/toluene by solvent evaporation technique. However, the rate of complexation was found to be slow in toluene and took several months for unmodified fullerene (C60) to complete. Rate enhancement of the charge transfer complex formation was attempted using fullerene derivative (PCBM) instead of fullerene (C60) in toluene and THF system. The reaction was found to be typically fast in THF compared with toluene system, which allowed us to study the interaction kinetics of the reaction both qualitatively and quantitatively. Our results show that the reaction follows pseudo-first order kinetics and the P4VP units in the copolymer interact with the fullerene derivative more than two order of magnitude faster than does the small molecular model compound tert-butylpyridine. Based on this understanding, studies were carried out to enhance the rate o charge transfer complex formation of underivatized fullerene (C60) with PS-b-P4VP. Rapid assembly of C60/PS-b-P4VP composite was realized using a mixed solvent. The poor solubility of C60 in THF was overcome by first dissolving C60 in toluene before adding in THF. The complexation reaction was completed within 10 days in THF whereas negligible reaction occurs even after one month when toluene used as solvent as observed previously. Significant morphological refining was observed in C60/PS-b-P4VP complex after a solvent exchange process when the THF of was exchanged with toluene.DOCTOR OF PHILOSOPHY (MSE

Antiinflammatory, analgesic and antipyretic activities of <i style="">Linum usitatissimum</i> L. (flaxseed/linseed) fixed oil

932-938The fixed oil of L. usitatissimum (flaxseed/linseed) inhibited PGE2-, leukotriene-, histamine- and bradykinin-induced inflammation. The oil also inhibited arachidonic acid-induced inflammation, suggesting its capacity to inhibit both cyclooxygenase and lipoxygenase pathways of arachidonate metabolism. In tail immersion model, the oil raised the pain threshold to a lesser extent than morphine but showed excellent peripherally acting, analgesic activity comparable to aspirin, against acetic acid-induced writhing in mouse. In typhoid paratyphoid A/B vaccine-induced pyrexia, the oil showed antipyretic activity comparable to aspirin. The oil contains 57.38% -linolenic acid. Dual inhibition of arachidonic acid metabolism, antihistaminic and antibradykinin activities of the oil could account for the biological activity and the active principle could be -linolenic acid an omega-3 (18:3, n-3) fatty acid. </span

Development and Characterization of Biocompatible Fullerene [C60]/Amphiphilic Block Copolymer Nanocomposite

We report a supramolecular process for the synthesis of well-defined fullerene (C60)/polymer colloid nanocomposites in an aqueous solution via complex formation. A biocompatible triblock poly(4-vinylpyridine)-b-polyethylene-b-poly(4-vinylpyridine), P4VP8-b-PEO105-b-P4VP8, was synthesized by atom transfer radical polymerization. The block copolymer formed complexes with C60 in toluene and resulted in fullerene assembly in cluster form. Nanocomposite dispersion in an aqueous solution could be obtained using an aged solution of the polymer/C60/toluene solution by a solvent evaporation technique. The UV-Vis and FTIR spectroscopy confirmed the complex formation of fullerene with the polymer which plays a significant role in controlling the PDI and size of polymer/C60 micelles in the toluene solution. The particle size and morphology of P4VP8-b-PEO105-b-P4VP8 and P4VP8-b-PEO105-b-P4VP8/C60 mixture were studied by dynamic light scattering (DLS) and transmission electron microscopy (TEM). In a cytotoxicity test, both pure polymer and the resulting polymer/C60 composite in water showed more than 90% cell viability at 1 mg/mL concentration.NRF (Natl Research Foundation, S’pore)Published versio

Post-irradiation bilateral basal ganglia calcification in a patient with cerebral metastasis: A case report and review of literature

Background:  Basal Ganglia calcification is now being diagnosed with increasing frequency with the widespread application of computed tomography (CT) scan in clinical practice. One of the rare causes of bilateral basal ganglia calcification is post-irradiation sequelae. So far, there are a total of 11 reported cases of post-radiotherapy basal ganglia calcification. Case report: Here, we report another case of bilateral basal ganglia calcification following radiotherapy for cerebral metastasis from Ca- ovary along with a review of the other reported cases. The exact pathogenesis of this condition is not clear. It appears, however, to be related to radiation vasculitis of the small vessels of the brain with resultant hyalinization and calcification. Conclusions: A long-term follow-up study would be necessary to evaluate the significance and implication of post-irradiation calcification of the grey matter

Post-irradiation bilateral basal ganglia calcification in a patient with cerebral metastasis

Background:  Basal Ganglia calcification is now being diagnosed with increasing frequency with the widespread application of computed tomography (CT) scan in clinical practice. One of the rare causes of bilateral basal ganglia calcification is post-irradiation sequelae. So far, there are a total of 11 reported cases of post-radiotherapy basal ganglia calcification. Case report: Here, we report another case of bilateral basal ganglia calcification following radiotherapy for cerebral metastasis from Ca- ovary along with a review of the other reported cases. The exact pathogenesis of this condition is not clear. It appears, however, to be related to radiation vasculitis of the small vessels of the brain with resultant hyalinization and calcification. Conclusions: A long-term follow-up study would be necessary to evaluate the significance and implication of post-irradiation calcification of the grey matter

Reality of having bed nets at home, their status and pattern of using it at night among the population of Lakhantari Village Development Committee of Nepal

Background &amp; Objectives:The use of insecticide treated nets has been advocated for the prevention of the vector borne transmitted disease (malaria) by the World Health Organization and UNICEF for more than a decade. In spite of this, there is no significant reduction in the transmission of the disease. Main objectives of study were to find out the real pattern of using it, to find out the physical integrity of the bed nets being used, and to prove the correlation in between the physical integrity of bed nets and the disease outcome. Torn bed nets with holes size more than 1.2 mm were considered as “holes” in this study.Materials &amp; Methods:A community based cross- sectional study was carried out in Lakhantari VDC within the duration of two weeks. This VDC has been named recently as Gramthan Gaupalika one of State one.  Sample size of 384 was determined by the WHO sample size calculator. Face to face interview technique was used after taking consent from individual. Confidentiality was maintained. It was ethically approved by the IRC (Institutional Review Committee) of Nobel Medical College.Results:A total of 384 household were studied. Total household had bed nets but the physical integrity of bed nets was not intact. Almost 73% of the bed nets were torn having more than four holes in them. Nearly 94% of household used bed nets only for three to four days a week. Nearly half of the   Malaria was found among 22% and encephalitis in 17% of household. Conclusion:Use of bed nets do not prevent and provide guarantee from vector borne disease unless it is properly used. Torn bed nets are of almost no use unless people are using other preventive measures.</p