Quaid-e-Azam Medical College

Foot-and-mouth disease (FMD) is one of the most contagious viral infections affecting livestock, including cattle, water buffalo, pigs, sheep, goats, and African buffalo. Caused by the foot-and-mouth disease virus (FMDV), it continues to impose a significant economic burden, with annual losses estimated at up to 21 billion U.S. dollars. This review examines the worldwide epidemiology and control of FMD through a One Health approach, emphasizing the interconnectedness of animal, human, and environmental health. Vaccination remains the most effective strategy for preventing and controlling FMD in both endemic and non-endemic regions, particularly when vaccines are well-matched to circulating strains. However, silent circulation of FMDV, where animals carry and shed the virus without showing clinical signs, presents a critical challenge to eradication efforts. Mucosal immunity emerges as a key component of protection, serving as the first line of defense at the virus’s point of entry and playing a vital role in blocking transmission. Equally important is the establishment of robust and systematic surveillance systems capable of detecting asymptomatic FMDV infections, which are essential for identifying hidden reservoirs and preventing undetected spread. Effectively combating FMD requires coordinated efforts that go beyond vaccine development alone. Success depends on integrated surveillance networks, strict quarantine and movement restriction policies, reliable diagnostic infrastructure, and the implementation of One Health frameworks that bring together veterinary services, agricultural authorities, and public health sectors. Together, these strategies bridge the gap between disease control and ultimate eradication.

INTRODUCTION:Ischemic stroke, comprising nearly 85% of all strokes, remains a leading cause of death and disability worldwide. Annually, about 795,000 individuals in the United States (US) experience a new or recurrent stroke. Despite advancements in diagnosis, treatment, and prevention, significant disparities and geographic variability persist, highlighting the need for targeted strategies to address these ongoing challenges. METHODS:We analyzed US death certificate data from Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (1968-2023) for ischemic stroke mortality using International Classification of Diseases (ICD-8, ICD-9, and ICD-10) codes. Demographics included age, sex, and race/ethnicity. Crude and age-adjusted mortality rates (AAMRs), annual percent change (APC), and average annual percent changes (AAPC) were calculated using joinpoint regression, and a p-value less than 0.05 defined significance. RESULTS:From 1968 to 2023, ischemic stroke mortality declined substantially, with 1,363,668 total deaths and the AAMR decreasing from 76.2 to 10.0 per 100,000 (AAPC: -3.59%). Early steep declines occurred from 1968 to 1982 and continued through 2014, followed by pronounced increases between 2014-2017 (APC 38.69) and 2017-2023 (APC 7.48). Men consistently exhibited higher AAMRs than women, with long-term declines, yet both experienced recent upward trends. Racial disparities persisted, with Black adults declining from 85.9 to 14.2 (AAPC: -3.30%) and White from 75.5 to 9.8 (AAPC: -3.63%), but both showed reversals after 2014. Older adults (≥65 years) bore the greatest burden (AAPC: -3.91%), while younger age groups exhibited smaller reductions. CONCLUSION:Despite long-term declines in mortality, recent increases and persistent disparities by age, sex, and race underscore the need for targeted prevention and equitable healthcare interventions in particularly high-risk populations.

Congenital malformations of the urinary system contribute significantly to pediatric morbidity and mortality. Understanding national and subgroup-specific mortality trends can guide targeted healthcare interventions and policy responses. Mortality data for individuals aged 0 to 14 years from 1999 to 2020 were obtained from the CDC WONDER database. Deaths attributed to congenital anomalies of the urinary system were identified using the International Classification of Diseases, Tenth Revision (ICD-10) codes Q60-Q64. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated, stratified by sex, race/ethnicity, geographic region, urban-rural classification, and state. Temporal trends in mortality were analyzed using Joinpoint regression models to estimate annual percentage changes and corresponding 95% confidence intervals. A total of 9412 deaths were recorded due to congenital anomalies of urinary system during the study period. The overall AAMR increased modestly from 0.61 in 1999 to 0.68 in 2020, representing an average annual percent change of + 0.62% (95% CI: -1.34 to 2.62) over the study period, with a significant decrease from 2007 to 2020 (APC: -1.36%; 95% CI: -2.01 to - 0.71). Males exhibited higher AAMRs than females (0.87 vs 0.49). Non-Hispanic Black (0.76) and Hispanic (0.70) children had AAMRs comparable to or higher than non-Hispanic Whites (0.70). The South region had the highest regional AAMR (0.79), and noncore rural areas showed the highest urbanization-specific AAMR (0.98). The District of Columbia recorded the highest state-level AAMR (1.35), while Massachusetts had the lowest (0.33). Despite an overall low and declining mortality rate, significant disparities persist across gender, race, geography, and urbanization. These findings highlight the need for equity-focused maternal-child health strategies to reduce preventable deaths from congenital urinary system anomalies.

The opioid epidemic in the United States has led to a sharp rise in overdose deaths over the past two decades. Although some progress was observed prior to the coronavirus disease 2019 pandemic, opioid-related mortality has increased again in recent years, underscoring the need to re-examine national trends. A retrospective analysis of opioid overdose mortality among US adults aged 25 years and older from 1999 to 2024 was performed using data from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiological Research (CDC WONDER) Multiple Cause-of-Death database. Opioid-related deaths were identified using the International Classification of Diseases, Tenth Revision, codes T40.0-T40.4 and T40.6. Mortality rates were calculated by year, sex, age, race/ethnicity, and US census region. Temporal trends were evaluated using Joinpoint regression to estimate annual percent changes. A total of 806,765 opioid overdose deaths occurred during the study period. The age-adjusted mortality rate (AAMR) increased from 4.41 to 22.84 per 100,000. Men consistently had higher AAMRs than women (men: 20.64; women: 9.52). Racial disparities were evident, with the highest rates observed among non-Hispanic American Indian/Alaska Native (21.79), non-Hispanic White (18.07), and non-Hispanic Black (15.97) populations. Adults aged 35-44 years had the highest crude mortality rates (20.52). Among US regions, the Northeast had the highest AAMR (18.09), followed by the Midwest (15.69), South (14.74), and West (13.09). These findings confirm that opioid overdose remains a major public health issue, with persistent demographic and regional disparities necessitating targeted strategies to reduce mortality.

PURPOSE:Bangladesh, a lower-middle-income country in South Asia, faces a rapidly rising cancer burden. In the absence of a population-based cancer registry (PBCR), monitoring national patterns remains challenging and constrains evidence-informed policymaking. We analyzed temporal trends in cancer distribution at the country's largest national cancer hospital to inform priorities for a cancer control strategy. METHODS:We conducted a retrospective analysis of 82,209 histologically and/or clinically confirmed cancer cases diagnosed or treated at the National Institute of Cancer Research & Hospital, between January 2014 and December 2020. Demographic and clinical data were extracted from hospital records, and cancers were grouped according to their primary anatomic site. Annual distributions and sex-specific patters of the 10 most common cancers were examined, and temporal changes were illustrated using trend diagrams. RESULTS:Over 7 years, the most common cancers were of the respiratory system (19.6%-22.5%), digestive organs (18.8%-22.8%), and breast (12%-14.9%). Comparison between 2014 and 2020 revealed notable increases in the proportion of digestive organ cancers (+3.6%), hematopoietic and reticuloendothelial malignancies (+1%), and breast cancer (+0.8%), whereas respiratory cancers (-2.3%), lymph node cancers (-1.1%), and bone and cartilage cancers (-1%) decreased. A marked spike in female genital cancers was observed in 2015 (11.84% v 9.9% average across other years). Findings should be interpreted in the context of hospital-based case mix and referral patterns. CONCLUSION:In this large tertiary cancer hospital in Bangladesh, respiratory system, digestive organ, and breast cancers represented the highest burden, with rising proportions of proportional increases in digestive, hematopoietic, and breast cancers and declines in respiratory and lymph node cancers, provide early signals of an evolving cancer landscape. While not population-representative, these trends highlight the urgent need to establish government-supported PBCRs in well-defined subnational regions to inform effective cancer control strategies for Bangladesh.