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Global, regional, and national age-sex-specific burden of diarrhoeal diseases, their risk factors, and aetiologies, 1990-2021, for 204 countries and territories: a systematic analysis for the Global Burden of Disease Study 2021
No full textBackground Diarrhoeal diseases claim more than 1 million lives annually and are a leading cause of death in children younger than 5 years. Comprehensive global estimates of the diarrhoeal disease burden for specific age groups of children younger than 5 years are scarce, and the burden in children older than 5 years and in adults is also understudied. We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021 to assess the burden of, and trends in, diarrhoeal diseases overall and attributable to 13 pathogens, as well as the contributions of associated risk factors, in children and adults in 204 countries and territories from 1990 to 2021. Methods We used the Cause of Death Ensemble modelling strategy to analyse vital registration data, verbal autopsy data, mortality surveillance data, and minimally invasive tissue sampling data. We used DisMod-MR (version 2.1), a Bayesian meta-regression tool, to analyse incidence and prevalence data identified via systematic reviews, population-based surveys, and claims and inpatient data. We calculated diarrhoeal disability-adjusted life-years (DALYs) as the sum of years of life lost (YLLs) and years lived with disability (YLDs) for each location, year, and age-sex group. For aetiology estimation, we used a counterfactual approach to quantify population-attributable fractions (PAFs). Additionally, we estimated the diarrhoeal disease burden attributable to the independent effects of risk factors using the comparative risk assessment framework. Findings In 2021, diarrhoeal diseases caused an estimated 1.17 million (95% uncertainty interval 0.793-1.62) deaths globally, representing a 60.3% (50.6-69.0) decrease since 1990 (2.93 million [2.31-3.73] deaths). The most pronounced decline was in children younger than 5 years, with a 79.2% (72.4-84.6) decrease in diarrhoeal deaths. Global YLLs also decreased substantially, from 186 million (147-221) in 1990 to 51.4 million (39.9-65.9) in 2021. In 2021, an estimated 59.0 million (47.2-73.2) DALYs were attributable to diarrhoeal diseases globally, with 30.9 million (23.1-42.0) of these affecting children younger than 5 years. Leading risk factors for diarrhoeal DALYs included low birthweight and short gestation in the neonatal age groups, child growth failure in children aged between 1-5 months and 2-4 years, and unsafe water and poor sanitation in older children and adults. We estimated that the removal of all evaluated diarrhoeal risk factors would reduce global DALYs from 59.0 million (47.2-73.2) to 4.99 million (1.99-10.0) among all ages combined. Globally in 2021, rotavirus was the predominant cause of diarrhoeal deaths across all ages, with a PAF of 15.2% (11.4-20.1), followed by norovirus at 10.6% (2.3-17.0) and Cryptosporidium spp at 10.2% (7.03-14.3). In children younger than 5 years, the fatal PAF of rotavirus was 35.2% (28.7-43.0), followed by Shigella spp at 24.0% (15.2-37.9) and adenovirus at 23.8% (14.8-36.3). Other pathogens with a fatal PAF greater than 10% in children younger than 5 years included Cryptosporidium spp, typical enteropathogenic Escherichia coli, and enterotoxigenic E coli producing heat-stable toxin. Interpretation The substantial decline in the global burden of diarrhoeal diseases since 1990, particularly in children younger than 5 years, supports the effectiveness of health interventions such as oral rehydration therapy, enhanced water, sanitation, and hygiene (WASH) infrastructure, and the introduction and scale-up of rotavirus vaccination. Targeted interventions and preventive measures against key risk factors and pathogens could further reduce this burden. Continued investment in the development and distribution of vaccines for leading pathogens remains crucial. Copyright (c) 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
Dekompresif kraniyektomi uygulanan hastalarda sağkalım: Retrospektif bir kohort analizi
No full textAmaç: Bu çalışmanın amacı, kliniğimizde farklı etyolojiler nedeniyle dekompresif kraniyektomi (DC) uygulanan hastalarda mortalite ve morbidite oranlarını değerlendirmek ve sağkalımı etkileyen prognostik faktörleri analiz etmektir.Gereç ve Yöntem: Ocak 2018 – Aralık 2024 tarihleri arasında DC uygulanan 50 hastanın demografik, klinik, radyolojik ve cerrahi verileri retrospektif olarak incelendi. Primer sonlanım noktası hastane içi mortalite; sekonder sonlanım noktaları ise klinik takip süresi, yatış süresi ve komorbidite ilişkili sonuçlardı. Veriler uygun istatistiksel testlerle analiz edildi; p<0.05 anlamlı kabul edildi.Bulgular: Hastaların ortalama yaşı 55,9 ± 14,2 yıl olup, %56’sı erkekti. En sık patoloji subaraknoid kanama (%44) idi. Ortalama takip süresi 42,4 ± 57,0 gün olarak hesaplandı. Genel mortalite oranı %40 (n=20) idi. Sağ kalan ve eksitus olan hastalar arasında yaş ve cinsiyet açısından anlamlı fark saptanmadı (p>0.05). Buna karşın komorbidite varlığı mortalite ile anlamlı ilişkiliydi (p=0.020). En sık uygulanan cerrahi teknik frontotemporoparietal dekompresyondu (%62). Bilateral DC yalnızca bir hastada uygulandığı için karşılaştırma yapılamadı.Sonuç: DC, refrakter intrakraniyal hipertansiyon ve malign beyin ödemi yönetiminde yaşam kurtarıcı bir seçenek olmaya devam etmektedir. Ancak mortalite oranları yüksek olup, özellikle komorbid hastalıklar sağkalımı olumsuz etkilemektedir. Cerrahi karar sürecinde yaş, komorbidite yükü, radyolojik bulgular ve klinik durum bir arada değerlendirilmelidir. Çalışmamızın sonuçları literatürle uyumlu olup, daha geniş ve prospektif çalışmalara ihtiyaç vardır.Objective: To evaluate mortality, morbidity, and prognostic factors affecting survival in patients who underwent decompressive craniectomy (DC) for various etiologies in a tertiary neurosurgical center.Materials and Methods: A retrospective review was conducted on 50 patients who underwent DC between January 2018 and December 2024. Demographic, clinical, radiological, and surgical variables were analyzed. The primary outcome was in-hospital mortality; secondary outcomes included length of clinical follow-up, hospitalization duration, and comorbidity-related effects. Statistical significance was set at p<0.05.Results: The mean age was 55.9 ± 14.2 years, and 56% of the patients were male. The most common pathology was subarachnoid hemorrhage (44%). Mean clinical follow-up duration was 42.4 ± 57.0 days. Overall mortality rate was 40% (n=20). There were no significant differences in age or sex between survivors and non-survivors (p>0.05). Comorbidity was significantly associated with higher mortality (p=0.020). The most frequently performed surgical technique was frontotemporoparietal decompression (62%). Bilateral DC was performed in only one patient, preventing meaningful comparison.Conclusion: DC remains a life-saving intervention in the management of refractory intracranial hypertension and malignant cerebral edema. Despite its benefits, mortality remains substantial, and comorbidities significantly worsen survival. Surgical decision-making should incorporate clinical status, radiological findings, patient age, and systemic disease burden. These findings are consistent with the existing literature, underscoring the need for larger prospective studies.</p
Ebeveyn Besin Neofobisinin ve Ebeveynlik Stilinin Fenilketonürili Çocuklarda Besin Neofobisine Etkisinin Değerlendirilmesi
No full textOtizmli Çocuğa Sahip Annelerin Ebeveynlik Rolü Kendilik Algıları ve Tükenmişlik Düzeylerinin İncelenmesi
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Treatment options for depression in Parkinson's disease: a mini-review
No full textDepression is a common comorbidity in Parkinson's disease (PD), significantly reducing patients' quality of life. This mini-review examines pharmacological and nonpharmacological therapies for managing depression in PD, analyzing their benefits, and limitations. Pharmacological options include tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), levodopa, dopaminergic agonists, and monoamine oxidase B inhibitors. Nonpharmacological strategies involve brief psychodynamic therapy, cognitive-behavioral therapy (CBT), physical exercise, phytomedicine, massage therapy, music therapy, phototherapy, yoga, repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation, electroconvulsive therapy (ECT), and deep brain stimulation. SSRIs, SNRIs, and some dopamine agonists have shown effectiveness and good tolerability, especially when combined with CBT or rTMS. For severe or refractory cases, ECT remains a viable option. Although many of these therapies show promise, the limited number and scale of studies for each treatment restrict the strength of current evidence. Further large-scale, multicenter randomized-controlled trials are essential to validate these preliminary findings and establish evidence-based guidelines. In addition, the potential benefits of social support and brief psychodynamic therapy in the context of PD-related depression require further exploration to provide holistic care strategies for this population
