Diagnostic accuracy of serum albumin for diagnosis of esophageal varices in patients of chronic liver disease

Objective: To determine the diagnostic accuracy of serum albumin for detection of esophageal varices (EVs) in patients of chronic liver disease (CLD) taking Esophagogastroduodenoscopy (EGD)as a gold standard.Methodology: The cross sectional study was accomplished at the department of gastroenterology, Isra University Hospital Hyderabad in collaboration with department of Gastroenterology, AIMS Hospital, Hyderabad, during six months from February 2017 to July 2017. All the Patients of age 20-60 years of either gender presenting with CLD were included. Blood samples from each patient submitted to laboratory to assess serum albumin level. Serum albumin level <3.4 g/dl was assessed as positive. Then patients were referred to department of gastroenterology for EGD. The data recording process was carried out by a proforma. Results: mean age of the patients was 53.63±14.61 years with male to female ratio was 2.3:1. Esophageal varices on serum albumin were found positive in 39 (41.1%) cases and EGD was found positive in 38.95% cases. The sensitivity of esophageal varices on serum albumin was 81.08% with specificity of 84.48%. The PPV value was 76.92%, NPV value was 87.5% and diagnostic accuracy of esophageal varices on serum albumin was 83.16% taking esophageal varices on EGD as gold standard.Conclusion: Serum albumin is a useful forecaster of esophageal varices among patients of chronic hepatic disorder with 81.08% sensitivity and of 84.48% specificity

Correlation of Chronic Obstructive Pulmonary Disease severity with C-Reative Protien levels in patients at tertiary care Hospital

Objective: To determine the correlation of chronic obstructive pulmonary disease (COPD) severity and C-reactive protein (CRP) among patients at tertiary care Hospital. Methodology: This cross-sectional study was conducted at Medicine department of Isra University Hospital Hyderabad. All the patients of chronic pulmonary disease either of gender were included. The severity of the disease was assessed as per GOLD standards criteria as mild, moderate, severe and very severe based on spirometry. After taking informed consent, 3 ml blood sample was taken from each patient for C - reactive protein measurement. All the data was recorded in the proforma. Results:  Total of 101 patients were studied; their mean age was 56.59±13.35 years. Males were in majority 94.06%. 43.6% patients had mild COPD, 25.7% had moderate, 20.7% had severe and 9.9% patients had very severe COPD. There was a significant association between the severity of disease and elevated CRP level, p-value 0.001. A strong positive correlation was found between C - reactive protein level and chronic pulmonary disease, r-value 0.726 and p-value 0.005. Conclusion: Elevated serum level of CRP is a predictive factor for COPD as an inflammatory biomarker because it increases in chronic obstructive pulmonary disease patients causing a systemic chronic inflammatory process

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

Diagnostic accuracy of serum albumin for diagnosis of esophageal varices in patients of chronic liver disease

Objective: To determine the diagnostic accuracy of serum albumin for detection of esophageal varices (EVs) in patients of chronic liver disease (CLD) taking Esophagogastroduodenoscopy (EGD)as a gold standard.Methodology: The cross sectional study was accomplished at the department of gastroenterology, Isra University Hospital Hyderabad in collaboration with department of Gastroenterology, AIMS Hospital, Hyderabad, during six months from February 2017 to July 2017. All the Patients of age 20-60 years of either gender presenting with CLD were included. Blood samples from each patient submitted to laboratory to assess serum albumin level. Serum albumin level <3.4 g/dl was assessed as positive. Then patients were referred to department of gastroenterology for EGD. The data recording process was carried out by a proforma. Results: mean age of the patients was 53.63±14.61 years with male to female ratio was 2.3:1. Esophageal varices on serum albumin were found positive in 39 (41.1%) cases and EGD was found positive in 38.95% cases. The sensitivity of esophageal varices on serum albumin was 81.08% with specificity of 84.48%. The PPV value was 76.92%, NPV value was 87.5% and diagnostic accuracy of esophageal varices on serum albumin was 83.16% taking esophageal varices on EGD as gold standard.Conclusion: Serum albumin is a useful forecaster of esophageal varices among patients of chronic hepatic disorder with 81.08% sensitivity and of 84.48% specificity

Correlation of Chronic Obstructive Pulmonary Disease severity with C-Reative Protien levels in patients at tertiary care Hospital

Objective: To determine the correlation of chronic obstructive pulmonary disease (COPD) severity and C-reactive protein (CRP) among patients at tertiary care Hospital. Methodology: This cross-sectional study was conducted at Medicine department of Isra University Hospital Hyderabad. All the patients of chronic pulmonary disease either of gender were included. The severity of the disease was assessed as per GOLD standards criteria as mild, moderate, severe and very severe based on spirometry. After taking informed consent, 3 ml blood sample was taken from each patient for C - reactive protein measurement. All the data was recorded in the proforma. Results:  Total of 101 patients were studied; their mean age was 56.59±13.35 years. Males were in majority 94.06%. 43.6% patients had mild COPD, 25.7% had moderate, 20.7% had severe and 9.9% patients had very severe COPD. There was a significant association between the severity of disease and elevated CRP level, p-value 0.001. A strong positive correlation was found between C - reactive protein level and chronic pulmonary disease, r-value 0.726 and p-value 0.005. Conclusion: Elevated serum level of CRP is a predictive factor for COPD as an inflammatory biomarker because it increases in chronic obstructive pulmonary disease patients causing a systemic chronic inflammatory process

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

BackgroundEstimates 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.Methods22 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.FindingsGlobal 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.InterpretationGlobal 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