Objectives: Precise localization of the infraorbital foramen (IOF) is crucial in maxillofacial surgery, regional anesthesia, and esthetic procedures, as even minor deviations may lead to neurovascular complications or suboptimal outcomes. Conventional reliance on surface landmarks and two-dimensional imaging is limited by anatomical variability. With the advent of non-contrast computed tomography (NCCT) and cinematic volume rendering technology, accurate three-dimensional visualization of craniofacial structures is now feasible. This study aimed to establish population-specific, landmark-based three-dimensional reference data for IOF localization in a North Indian adult cohort using NCCT, with cinematic volume rendering utilized to enhance anatomical visualization. Materials and Methods: A retrospective analysis was performed using NCCT scans of 200 North Indian adults (100 males and 100 females) obtained from a tertiary care center. Bilateral linear measurements were recorded from the IOF to the inferior orbital margin (IOM), lateral piriform margin, and maxillary occlusal plane. Stratified analyses were conducted based on age and sex. Statistical significance was set at p < 0.05. Results: The mean IOF-IOM distance was 0.75 ± 0.10 cm bilaterally. Mean distances to the lateral piriform margin and occlusal plane ranged from 1.56 to 1.59 cm and approximately 3.70 cm, respectively. Males demonstrated significantly greater measurements than females across all landmarks ( p < 0.01). The IOF was most frequently vertically aligned with the maxillary second premolar across all age and sex groups. No statistically significant age-related variations were observed. Accessory infraorbital foramina were identified in 8.5% of cases, demonstrating consistent spatial distribution patterns relevant to infraorbital nerve block planning. Conclusion: This in vivo three-dimensional imaging study provides population-specific anatomical reference data for localizing the IOF in North Indian adults. The recognition of additional infraorbital foramina underscores the importance of CT-based anatomical evaluation to reduce the risk of anesthetic failure and surgical complications. While sex-related differences were evident, IOF-IOM positioning remained stable across age groups. These findings support the reliability of the IOM as a surgical and anesthetic landmark within this population, while underscoring the need for caution when extrapolating to other ethnic groups.

Background:Cerebral Palsy (CP) secondary to Hypoxic-Ischemic Encephalopathy (HIE) is a leading cause of childhood motor disability, particularly in low-middle income countries where delayed presentation precludes neonatal MRI assessment. Standardized and Validated MRI injury scoring systems exist for the neonatal period, but not for children beyond this window. Objectives:To evaluate the validity and clinical usefulness of a neonatal MRI injury scoring system (adapted from Trivedi et al,) when applied to children (1-13years) with CP secondary to HIE, correlating imaging severity with functional and cognitive outcomes.Methods:In this prospective cross-sectional study, 93-children aged 1-13 years with clinico-radiologically confirmed CP secondary to HIE were enrolled from tertiary-care centre in Punjab, India, for 18months. 3-Tesla MRI Brain with 30-Direction diffusion-tensor-imaging was done. MRI injury was scored across 32 components. Functional assessment using Gross Motor Functional Classification System-Expanded and Revised (GMFCS-ER) and Bimanual Fine Motor Functional Classification System (BFMFCS). Cognition using Vineland Social Maturity Scale (VSMS) [and Raven-Coloured Progressive Matrix where applicable]. Internal consistency was assessed using Cronbach’s alpha; associations were tested using chi-square/Fisher’s Exact test and Spearman correlation; linear regression evaluated the MRI score-fractional anisotropy (FA) relationship. Results:Mean age-66.74±41.09 months; 73.1%-male. Spastic Quadriparetic CP predominated (76.3%). MRI injury was mild (46.2%), moderate (44.1%) and severe (9.7%). MRI injury severity was significantly associated with CP type (p=0.033), GMFCS-ER (p=0.0001), BFMFCS (p=0.0001), and VSMS-based IQ (p=0.002). MRI injury severity correlated significantly with GMFCS-ER(r=0.548,p<0.001), BFMFCS (r=0.549,p=0.001), VSMS(r=0.457, p<0.001). Cronbach’s alpha was 0.88. Higher MRI injury scores were associated with lower FA (regression coefficient = -0.264,p=0.011;r= -0.334, p=0.01).

BACKGROUND:Major depressive disorder (MDD) is a prevalent and debilitating psychiatric condition defined by complex genetic and neurobiological underpinnings. The current study investigated the genetic variants associated with the disease and impact of significant variants on neurotransmitter pathways and their association with inherent brain connectivity patterns in MDD. METHODS:A total of 69 patients diagnosed with MDD were recruited. Whole-exome sequencing (WES) was carried out in 30 patients to identify relevant genetic variants. This was followed by the genotyping of two frequently observed variants in TPH1 (rs1799913) and DAOA (rs2391191) genes in additional 39 patients using Sanger Sequencing. All subjects participated in resting-state functional MRI (rs-fMRI), and genotype-connectivity associations were analysed using the CONN toolbox. Functional connectivity was evaluated within the Default Mode Network (DMN), and its associations with HAM-D scores and the incidence of depressive episodes were also examined. RESULTS:WES revealed variants in 21 genes involved in neurotransmission, synaptic plasticity, and intracellular signaling pathways. Individuals possessing altered TPH1 (rs1799913) and DAOA (rs2391191) genotypes demonstrated significantly increased connectivity within the DMN, particularly involving the posterior cingulate cortex, precuneus, dorsomedial prefrontal cortex, and subcalcarine gyrus. The heightened synchrony of the DMN exhibited a positive correlation with the severity of the Hamilton Depression Rating Scale and the occurrence of depressive episodes, suggesting a relationship between genotype, connectivity, and symptoms. CONCLUSION:This study demonstrates that variations in TPH1 (rs1799913) and DAOA (rs2391191) genes are associated with atypical reinforcement of DMN connectivity in MDD. The findings support the role of serotonergic and glutamatergic pathways in maladaptive neural coupling and suggest that genotype-stratified DMN metrics may serve as intermediate neural phenotypes. Their status as disease-specific endophenotypes cannot be established in the absence of healthy or familial comparison groups. Further comprehensive, longitudinal research is essential to validate these results and evaluate their relevance for tailored interventions.

Background Resting-state functional connectivity analysis has a potential to unearth the putative neuronal underpinnings of various disorders of the brain. Major depressive disorder (MDD) is regarded as a disorder arising from alterations in functional networks of the brain. Purpose There is paucity of literature on resting-state functional magnetic resonance imaging (Rs-fMRI) in MDD, especially from the Indian subcontinent. The purpose of our study was to elucidate the differences in Rs-fMRI connectivity between MDD patients and age and gender matched healthy controls (HC). Methods In this prospective single institute-based study, the patients were recruited consecutively based on Hamilton depression rating scale (HAM-D). Age and gender matched HC were also recruited. Rs-fMRI and anatomical MRI images were acquired for all the subjects (MDD and HC group) and subsequent analysis was done using the CONN toolbox. Results A total of 49 subjects were included in the final analysis (MDD = 28 patients, HC = 21). HAM-D score was noted to be 24.4 ± 4.8 in the MDD group. There was no significant difference between MDD and HC groups as far as age, gender, employment status, and level of education is concerned. Region-of-interest-based analysis of Rs-fMRI data showed a significantly lower connectivity between the left insula and left nucleus accumbens and between left paracingulate gyrus and bilateral posterior middle temporal gyri in MDD group as compared to HC group. Conclusion There is reduced connectivity between certain key regions of the brain in MDD patients, that is, between the left insular cortex and the left nucleus accumbens and between the left paracingulate gyrus and the bilateral posterior middle temporal gyrus. These findings could explain the basis of clinical features of MDD such as anhedonia, rumination of thoughts, reduced visuo-spatial comprehension, reduced language function, and response to external stimuli.

IMPORTANCE Nontraumatic subarachnoid hemorrhage (SAH) represents the third most common stroke type with unique etiologies, risk factors, diagnostics, and treatments. Nevertheless, epidemiological studies often cluster SAH with other stroke types leaving its distinct burden estimates obscure. OBJECTIVE To estimate the worldwide burden of SAH. DESIGN, SETTING, AND PARTICIPANTS Based on the repeated cross-sectional Global Burden of Disease (GBD) 2021 study, the global burden of SAH in 1990 to 2021 was estimated. Moreover, the SAH burden was compared with other diseases, and its associations with 14 individual risk factors were investigated with available data in the GBD 2021 study. The GBD study included the burden estimates of nontraumatic SAH among all ages in 204 countries and territories between 1990 and 2021. EXPOSURES SAH and 14 modifiable risk factors. MAIN OUTCOMES AND MEASURES Absolute numbers and age-standardized rates with 95% uncertainty intervals (UIs) of SAH incidence, prevalence, mortality, and disability-adjusted life-years (DALYs) as well as risk factor-specific population attributable fractions (PAFs). RESULTS In 2021, the global age-standardized SAH incidence was 8.3 (95% UI, 7.3-9.5), prevalence was 92.2 (95% UI, 84.1-100.6), mortality was 4.2 (95% UI, 3.7-4.8), and DALY rate was 125.2 (95% UI, 110.5-142.6) per 100000 people. The highest burden estimates were found in Latin America, the Caribbean, Oceania, and high-income Asia Pacific. Although the absolute number of SAH cases increased, especially in regions with a low sociodemographic index, all age-standardized burden rates decreased between 1990 and 2021: the incidence by 28.8% (95% UI, 25.7%-31.6%), prevalence by 16.1% (95% UI, 14.8%-17.7%), mortality by 56.1% (95% UI, 40.7%-64.3%), and DALY rate by 54.6% (95% UI, 42.8%-61.9%). Of 300 diseases, SAH ranked as the 36th most common cause of death and 59th most common cause of DALY in the world. Of all worldwide SAH-related DALYs, 71.6% (95% UI, 63.8%-78.6%) were associated with the 14 modeled risk factors of which high systolic blood pressure (population attributable fraction [PAF]=51.6%; 95% UI, 38.0%-62.6%) and smoking (PAF=14.4%; 95% UI, 12.4%-16.5%) had the highest attribution. CONCLUSIONS AND RELEVANCE Although the global age-standardized burden rates of SAH more than halved over the last 3 decades, SAH remained one of the most common cardiovascular and neurological causes of death and disabilities in the world, with increasing absolute case numbers. These findings suggest evidence for the potential health benefits of proactive public health planning and resource allocation toward the prevention of SAH.

Background: The global incidence of fatty liver (FL) [alcoholic and nonalcoholic FL disease (NAFLD)] is increasing. Imaging-based elastography techniques, being noninvasive, may eliminate the need for more invasive techniques for the diagnosis and staging of liver fibrosis in FL disease. Objective: Our study aims to address the gap in the current research by exploring the correlation between mean liver stiffness measurement (LSM) as obtained through magnetic resonance elastography (MRE) and transient elastography (TE), and two commonly used clinical scores, fibrosis-4 index (FIB-4) score and aspartate aminotransferase to platelet ratio index (APRI) score. Materials and methods: In this hospital-based cross-sectional study, 62 patients diagnosed with FL on ultrasound were recruited. The patients were further subjected to MR liver elastography and TE, and LSM using both modalities was recorded. A history of diabetes mellitus and alcohol intake was taken. Moreover, noninvasive fibrosis scores such as FIB-4 and APRI were calculated using standard formulas. Results: The correlation analysis revealed a strong positive correlation between LSM values obtained from MRE and TE (r = 0.88) (Cohen’s κ = 0.87), a moderate correlation between MRE and FIB-4 score (r = 0.44), and weak positive correlations involving MRE and APRI (r = 0.34), TE and FIB-4 score (r = 0.36), and TE and APRI (r = 0.29). Additionally, significantly higher fat fractions were quantified [median (IQR)] in grade III FL [23.6 (15.9–29.5)] as compared to grades I [8.45 (2.25–13.9)] and grade II [13.1 (8.4–19.7)]. Conclusion: MRE shows a strong positive correlation with TE for LSM and stage of fibrosis. Our findings suggest that MRE could be a valuable tool in the diagnostic armamentarium of FLD.

BACKGROUND:Cavernous sinus thrombosis (CST) in rhino-orbital cerebral mucormycosis (ROCM) poses a challenge for clinicians in predicting outcomes and formulating management strategies, particularly with the concurrent coronavirus disease 2019 (COVID-19) infection. PURPOSE:This study was done to evaluate cavernous sinus (CS) involvement in ROCM. Additionally, we explored the association between CS thrombosis and COVID-19, exploring its potential impact on patient mortality. MATERIALS AND METHODS:A retrospective analysis was conducted on 106 ROCM patients, examining their COVID-19 status and reviewing imaging findings from contrast-enhanced computed tomography (CT) and magnetic resonance (MR). The imaging assessment focused on evaluating fungal sinusitis, identifying CS involvement qualitatively, and detecting extension to orbit or other intracranial areas. Findings were correlated with patient mortality. RESULTS:CS involvement in ROCM was 48.1%, with a higher distribution (clinically insignificant) in COVID-positive patients (51.8%) compared to the COVID-negative group (34.8%). Most participants showed unilateral (78%) and diffuse pattern (71%) of CS involvement. A statistically significant association was observed between CS imaging parameters (filling defect, diffuse involvement pattern, convex shape of the lateral wall, and orbital cellulitis) and patient mortality, according to bivariate analysis (p < 0.05). Among 106 ROCM patients, 9.4% succumbed to the disease, with significantly higher mortality in those with CS thrombosis. However, subgroup analysis for the additional effect of COVID-19 on mortality yielded nonsignificant results. CONCLUSION:CS involvement in ROCM does not significantly impact mortality in both COVID-positive and negative patients. Imaging parameters such as filling defects, diffuse CS involvement, convex lateral wall, and orbital cellulitis may suggest the disease severity when observed.

Nontraumatic subarachnoid hemorrhage (SAH) represents the third most common stroke type with unique etiologies, risk factors, diagnostics, and treatments. Nevertheless, epidemiological studies often cluster SAH with other stroke types leaving its distinct burden estimates obscure. To estimate the worldwide burden of SAH. Based on the repeated cross-sectional Global Burden of Disease (GBD) 2021 study, the global burden of SAH in 1990 to 2021 was estimated. Moreover, the SAH burden was compared with other diseases, and its associations with 14 individual risk factors were investigated with available data in the GBD 2021 study. The GBD study included the burden estimates of nontraumatic SAH among all ages in 204 countries and territories between 1990 and 2021. SAH and 14 modifiable risk factors. Absolute numbers and age-standardized rates with 95% uncertainty intervals (UIs) of SAH incidence, prevalence, mortality, and disability-adjusted life-years (DALYs) as well as risk factor–specific population attributable fractions (PAFs). In 2021, the global age-standardized SAH incidence was 8.3 (95% UI, 7.3-9.5), prevalence was 92.2 (95% UI, 84.1-100.6), mortality was 4.2 (95% UI, 3.7-4.8), and DALY rate was 125.2 (95% UI, 110.5-142.6) per 100 000 people. The highest burden estimates were found in Latin America, the Caribbean, Oceania, and high-income Asia Pacific. Although the absolute number of SAH cases increased, especially in regions with a low sociodemographic index, all age-standardized burden rates decreased between 1990 and 2021: the incidence by 28.8% (95% UI, 25.7%-31.6%), prevalence by 16.1% (95% UI, 14.8%-17.7%), mortality by 56.1% (95% UI, 40.7%-64.3%), and DALY rate by 54.6% (95% UI, 42.8%-61.9%). Of 300 diseases, SAH ranked as the 36th most common cause of death and 59th most common cause of DALY in the world. Of all worldwide SAH-related DALYs, 71.6% (95% UI, 63.8%-78.6%) were associated with the 14 modeled risk factors of which high systolic blood pressure (population attributable fraction [PAF] = 51.6%; 95% UI, 38.0%-62.6%) and smoking (PAF = 14.4%; 95% UI, 12.4%-16.5%) had the highest attribution. Although the global age-standardized burden rates of SAH more than halved over the last 3 decades, SAH remained one of the most common cardiovascular and neurological causes of death and disabilities in the world, with increasing absolute case numbers. These findings suggest evidence for the potential health benefits of proactive public health planning and resource allocation toward the prevention of SAH.

Neurofibromatosis (NF) is a common disorder that affects the nerves and skin. There are two main types: neurofibromatosis Type 1 (NF-1) (also called von Recklinghausen's disease) and neurofibromatosis Type 2 (NF-2) (previously known as bilateral acoustic NF or central NF). NF-1 makes up approximately 85% of cases, with a prevalence of 1 in 5000 in the general population. In 30%-50% of NF-1 cases, there is no family history, suggesting that these cases likely result from germ cell mutations, often from the father. Here, we present the case of a 7-year-old boy with skin and radiological features of NF-1. NF-1 is the most common neurocutaneous syndrome, requiring long-term monitoring for related complications. In this case, we aimed to highlight the typical clinical and radiological features of NF-1 in a child.

Background Kidney failure with replacement therapy (KFRT) such as dialysis or transplantation represents a severe stage of chronic kidney disease (CKD) and poses a major global health burden. Although many CKD cases are diagnosed in the earlier stages, the greatest risk occurs when CKD progresses to KFRT. Despite its considerable financial and imposing impact on public health, there is a notable gap in international policies addressing CKD and KFRT. To bridge this gap and help policy makers and health systems effectively tackle the public health challenge of KFRT, a better understanding of the disease burden is essential. Thus, this analysis aims to provide a detailed overview of the global prevalence of KFRT and its associated aetiologies with estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) from 1990 to 2023. Methods This study defined KFRT as individuals on maintenance dialysis for 90 days or more or those who have undergone a kidney transplant, aligning with the Kidney Disease: Improving Global Outcomes (KDIGO) 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Renal registries served as the primary data sources. Prevalence and underlying aetiology estimates (type 1 diabetes, type 2 diabetes, hypertension, glomerulonephritis, and other causes) were generated with DisMod-MR 2.1, an epidemiological Bayesian mixed-effects meta-regression modelling tool. Both all-age and age-standardised estimates were reported and accompanied with 95% uncertainty intervals (UIs). Findings In 2023, the number of global cases of KFRT was 4 center dot 59 million (95% UI 4 center dot 17-5 center dot 08) for both sexes and all ages, with an age-standardised prevalence of 50 center dot 7 (46 center dot 1-56 center dot 0) per 100 000 population. Over the past three decades, there has been a steady increase in KFRT prevalence globally. The highest prevalence was found in the GBD high-income regions, while the lowest was observed in sub-Saharan Africa. KFRT prevalence was generally higher in countries classified within the World Bank's high-income and upper-middle-income groups, while lower prevalence was more common in countries within the World Bank's low-income and lower-middle-income groups. Additionally, a pronounced sex disparity was identified, where male dialysis and transplant prevalence estimates were consistently higher than those for females in most countries. Type 2 diabetes and hypertension were among the leading associated aetiologies of KFRT globally. From 1990 to 2023, the all-age and age-standardised prevalence estimates across the ascribed aetiologies increased for KFRT, with the largest increases associated with type 2 diabetes and hypertension. Interpretation KFRT affects approximately 5 million people globally, with high treatment and mortality costs. Our study unveiled considerable geographical variation in KFRT prevalence, which should be seen as indicators of healthcare system opportunities. As the prevalence of the leading aetiologies of KFRT-type 2 diabetes and hypertension-continues to rise, there is a crucial need to prioritise the development and implementation of cost-effective strategies aimed at preventing CKD and its progression to KFRT, particularly in low-resource settings. These preventive efforts must happen in tandem with efforts to expand capacity for dialysis and transplant services. Copyright (c) 2025 The Author(s). Published by Elsevier Ltd.

Hereditary multiple osteochondromas (HMO) are benign neoplasms that predominantly affect the bones around the knee joint, proximal humerus, wrist, pelvis, and to a lesser extent, the rib. Although rib-origin osteochondromas are uncommon and often asymptomatic, they can lead to pleural, pericardial, and diaphragmatic injuries secondary to tumour related pressure. We are presenting a unique case of a vascular-related giant osteochondroma rib that is hereditary, originating from the right second, third, and fourth ribs causing compression symptoms in a young child. The child underwent wide local excision and reconstruction using polypropylene mesh that was managed successfully with no recurrence. A 9-year-old male experiencing fullness and pain in the right chest for two months with a parallel medical history of swellings in first- and second-generation relatives that is hereditary in origin underwent contrast-enhanced computed tomography revealing a sessile rib osteochondroma arising from the anterior aspects of the right second to fourth ribs with an associated large cartilaginous cap. The bony growth measured 4.5 × 2.5 cm indenting the right upper lobe while, its cartilaginous cap measured 2.5 × 4.8 cm posterior-superiorly seen encasing the axillary artery and 3D volumetric reconstructive image revealed the proximity of the axillary and subclavian artery with the lesion. A biopsy was inconclusive with no malignant cells, so he underwent wide local excision of the tumour and reconstruction with polypropylene mesh. Follow-ups at one, three, six, and nine months were uneventful with normal thoracic curvature and no sign of recurrence. This case illustrates the surgical challenges addressed and the successful outcome of a paediatric chest wall reconstruction in a growing child, utilizing advanced imaging techniques, to underscore the importance of an individualized, innovative approach in managing rare skeletal anomalies.

BACKGROUND:Alzheimer's disease is a neurodegenerative disorder characterized by severe cognitive, behavioral, and psychological symptoms, such as dementia, cognitive decline, apathy, and depression. There are no accurate methods to diagnose the disease or proper therapeutic interventions to treat AD. Therefore, there is a need for novel diagnostic methods and markers to identify AD efficiently before its onset. Recently, there has been a rise in the use of imaging techniques like Magnetic Resonance Imaging (MRI) and functional Magnetic Resonance Imaging (fMRI) as diagnostic approaches in detecting the structural and functional changes in the brain, which help in the early and accurate diagnosis of AD. In addition, these changes in the brain have been reported to be affected by variations in genes involved in different pathways involved in the pathophysiology of AD. METHODOLOGY:A literature review was carried out to identify studies that reported the association of genetic variants with structural and functional changes in the brain in AD patients. Databases like PubMed, Google Scholar, and Web of Science were accessed to retrieve relevant studies. Keywords like 'fMRI', 'Alzheimer's', 'SNP', and 'imaging' were used, and the studies were screened using different inclusion and exclusion criteria. RESULTS:15 studies that found an association of genetic variations with structural and functional changes in the brain were retrieved from the literature. Based on this, 33 genes were identified to play a role in the development of disease. These genes were mainly involved in neurogenesis, cell proliferation, neural differentiation, inflammation and apoptosis. Few genes like FAS, TOM40, APOE, TRIB3 and SIRT1 were found to have a high association with AD. In addition, other genes that could be potential candidates were also identified. CONCLUSION:Imaging genetics is a powerful tool in diagnosing and predicting AD and has the potential to identify genetic biomarkers and endophenotypes associated with the development of the disorder.

Background Cancers represent a challenging public health threat in Asia. This study examines the temporal patterns of incidence, mortality, disability and risk factors of 29 cancers in Asia in the last three decades. Methods The age, sex and year -wise estimates of incidence, mortality, and disability -adjusted life years (DALYs) of 29 cancers for 49 Asian countries from 1990 through 2019 were generated as a part of the Global Burden of Disease, Injuries and Risk Factors 2019 study. Besides incidence, mortality and DALYs, we also examined the cancer burden measured in terms of DALYs and deaths attributable to risk factors, which had evidence of causation with different cancers. The development status of countries was measured using the socio-demographic index. Decomposition analysis was performed to gauge the change in cancer incidence between 1990 and 2019 due to population growth, aging and age -specific incidence rates. Findings All cancers combined claimed an estimated 5.6 million [95% uncertainty interval, 5.1-6.0 million] lives in Asia with 9.4 million [8.6-10.2 million] incident cases and 144.7 million [132.7-156.5 million] DALYs in 2019. The agestandardized incidence rate (ASIR) of all cancers combined in Asia was 197.6/100,000 [181.0-214.4] in 2019, varying from 99.2/100,000 [76.1-126.0] in Bangladesh to 330.5/100,000 [298.5-365.8] in Cyprus. The age -standardized mortality rate (ASMR) was 120.6/100,000 [110.1-130.7] in 2019, varying 4 -folds across countries from 71.0/100,000 [59.9-83.5] in Kuwait to 284.2/100,000 [229.2-352.3] in Mongolia. The age -standardized DALYs rate was 2970.5/ 100,000 [2722.6-3206.5] in 2019, varying from 1578.0/100,000 [1341.2-1847.0] in Kuwait to 6574.4/100,000 [5141.7-8333.0] in Mongolia. Between 1990 and 2019, deaths due to 17 of the 29 cancers either doubled or more, and 20 of the 29 cancers underwent an increase of 150% or more in terms of new cases. Tracheal, bronchus, and lung cancer (both sexes), breast cancer (among females), colon and rectum cancer (both sexes), stomach cancer (both sexes) and prostate cancer (among males) were among top -5 cancers in most Asian countries in terms of ASIR and ASMR in 2019 and cancers of liver, stomach, hodgkin lymphoma and esophageal cancer posted the most significant decreases in age -standardized rates between 1990 and 2019. Among the modifiable risk factors, smoking, alcohol use, ambient particulate matter (PM) pollution and unsafe sex remained the dominant risk factors between 1990 and 2019. Cancer DALYs due to ambient PM pollution, high body mass index and fasting plasma glucose has increased most notably between 1990 and 2019. Interpretation With growing incidence, cancer has become more significant public health threat in Asia, demanding urgent policy attention and guidance. Its heightened risk calls for increased cancer awareness, preventive measures, affordable early -stage detection, and cost-effective therapeutics in Asia. The current study can serve as a useful resource for policymakers and researchers in Asia for devising interventions for cancer management and control. Funding The GBD study is funded by the Bill and Melinda Gates Foundation. Copyright (c) 2023 The Author. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

BackgroundPulmonary Mucormycosis (PM) is a relatively uncommon fungal disease, usually manifested in immunocompromised patients. It has an aggressive course, along with dilemmas in diagnosis and treatment. In view of the surge of Mucormycosis patients in COVID 19 pandemic, clinicians need to consider PM in suspected cases, and act in an expedited manner to avoid misdiagnosis and initiate prompt treatment.Case presentationIn this case series, we present four cases of PM with varied presentation, clinical course and discuss management strategies.ConclusionsA strong suspicion of PM based on epidemiological and clinical findings should be considered, to ensure appropriate and timely treatment. It should be accompanied by judicious use of corticosteroids and aggressive control of comorbid conditions to decrease preventable morbidity and mortality.

Download This Paper Open PDF in Browser Add Paper to My Library Share: Permalink Using these links will ensure access to this page indefinitely Copy URL Copy DOI

A 5-month-old girl presented with developmental delay and seizures since birth. Birth history was uneventful. Examination revealed macrocephaly and central hypotonia. Ophthalmologic examination, renal evaluation, and creatine phosphokinase levels were normal. MRI of the brain (Figure) showed severe porencephaly. Clinicoradiologic differentials included isolated sulfite oxidase deficiency, molybdenum cofactor deficiency, COL4A-related cerebral microangiopathy, leukoencephalopathy with cerebral calcifications and cysts, megalencephalic leukoencephalopathy with subcortical cysts, and RNAse T2 deficiency.(1) Whole-exome sequencing revealed a de novo heterozygous nonsense variant in exon 42 of the COL4A2 gene, resulting in premature truncation of the protein (p.Trp1327Ter; ENST00000360467.7). This likely pathogenic autosomal dominant variant confirmed the diagnosis of COL4A2-related cerebral microangiopathy in which abnormal collagen causes microangiopathy increasing the risk of early and recurrent hemorrhages and strokes leading to cerebral palsy, intellectual disability, and drug-resistant epilepsy.(2) Imaging features vary from asymmetric ventricular enlargement to periventricular leukoencephalopathy, microbleeds, porencephaly, cortical malformations, or rarely brain calcifications.(2) Treatment is symptomatic with variable prognosis.

Background Anaemia is a major health problem worldwide. Global estimates of anaemia burden are crucial for developing appropriate interventions to meet current international targets for disease mitigation. We describe the prevalence, years lived with disability, and trends of anaemia and its underlying causes in 204 countries and territories. Methods We estimated population-level distributions of haemoglobin concentration by age and sex for each location from 1990 to 2021. We then calculated anaemia burden by severity and associated years lived with disability (YLDs). With data on prevalence of the causes of anaemia and associated cause-specific shifts in haemoglobin concentrations, we modelled the proportion of anaemia attributed to 37 underlying causes for all locations, years, and demographics in the Global Burden of Disease Study 2021. Findings In 2021, the global prevalence of anaemia across all ages was 24 center dot 3% (95% uncertainty interval [UI] 23 center dot 9-24 center dot 7), corresponding to 1 center dot 92 billion (1 center dot 89-1 center dot 95) prevalent cases, compared with a prevalence of 28 center dot 2% (27 center dot 8-28 center dot 5) and 1 center dot 50 billion (1 center dot 48-1 center dot 52) prevalent cases in 1990. Large variations were observed in anaemia burden by age, sex, and geography, with children younger than 5 years, women, and countries in sub-Saharan Africa and south Asia being particularly affected. Anaemia caused 52 center dot 0 million (35 center dot 1-75 center dot 1) YLDs in 2021, and the YLD rate due to anaemia declined with increasing Socio-demographic Index. The most common causes of anaemia YLDs in 2021 were dietary iron deficiency (cause-specific anaemia YLD rate per 100 000 population: 422 center dot 4 [95% UI 286 center dot 1-612 center dot 9]), haemoglobinopathies and haemolytic anaemias (89 center dot 0 [58 center dot 2-123 center dot 7]), and other neglected tropical diseases (36 center dot 3 [24 center dot 4-52 center dot 8]), collectively accounting for 84 center dot 7% (84 center dot 1-85 center dot 2) of anaemia YLDs. Interpretation Anaemia remains a substantial global health challenge, with persistent disparities according to age, sex, and geography. Estimates of cause-specific anaemia burden can be used to design locally relevant health interventions aimed at improving anaemia management and prevention. Funding Bill & Melinda Gates Foundation. Copyright (c) 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.

This systematic analysis assesses the total and risk-attributable burden of lip and oral cavity cancer and other pharyngeal cancer for 204 countries and territories and by Socio-demographic Index using 2019 Global Burden of Diseases, Injuries, and Risk Factors Study estimates.