Global,regional,and national burden of upper respiratory infections,1990–2021:findings from the Global Burden of Disease study 2021

Background:Upper respiratory infections(URIs)are common infectious diseases worldwide.Accurate and timely assessment of the disease burden of URIs is crucial for governments to develop comprehensive prevention and control strategies,and to allocate and utilize healthcare resources more efficiently.Methods:For URIs in Global Burden of Disease(GBD)2021 database,age-standardized incidence rates(ASIR),age-standardized prevalence rates(ASPR),age-standardized mortality rates(ASMR),disability-adjusted life-years(DALYs),and case numbers for incidence,prevalence,deaths,and DALYs across the globe,five socio-demographic index(SDI)regions,21 geographical regions,and 204 countries and territories were provided and analyzed.Trends from 1990 to 2021 were described using the average annual percentage change(AAPC),and future URIs burden was projected with a Bayesian age-period-cohort(BAPC)model.Results:From 1990 to 2021,there was a significant decline in global ASIR(APCC=-289.86,95%confidence interval[CI]:-298.59 to-281.12),ASPR(AAPC=-4.04,95%CI:-4.16 to-3.92),ASMR(AAPC=-0.02,95%CI:-0.02 to-0.03)and age-standardized DALY rate(AAPC=-0.75,95%CI:-0.76 to-0.74).The ASIR,ASPR,ASMR,and age-standardized DALY rate were high in elderly for both males and females,and both genders.Similarly,the number of incident cases,prevalence cases,deaths,and DALY cases for URIs was highest in children under five years.The ASMR and age-standardized DALY rate exhibited a negative correlation with SDI across 204 countries and territories in 2021.The ASIR and ASPR for URIs will show an upward trend from 2022 to 2050,while ASMR and age-standardized DALY rate are expected to decline.Low birth weight for gestation remains the leading contributor to deaths related to URIs.

Multi-modal deep learning based on multi-dimensional and multi-level temporal data can enhance the prognostic prediction for multi-drug resistant pulmonary tuberculosis patients

Despite the advent of new diagnostics,drugs and regimens,multi-drug resistant pulmonary tuberculosis(MDRPTB)remains a global health threat.It has a long treatment cycle,low cure rate and heavy disease burden.Factors such as demographics,disease characteristics,lung imaging,biomarkers,therapeutic schedule and adherence to medications are associated with MDR-PTB prognosis.However,thus far,the majority of existing studies have focused on predicting treatment outcomes through static single-scale or low dimensional information.Hence,multi-modal deep learning based on dynamic data for multiple dimensions can provide a deeper understanding of personalized treatment plans to aid in the clinical management of patients.

Efficacy of traditional Chinese medicine on shortening the negative conversion time of SARS-CoV-2 ribonucleic acid in patients with mild COVID-19:a retrospective cohort study

BackgroundThe holistic view of the‘The unity of man and nature’promotes the development and application of traditional Chinese medicine(TCM).Despite the absence of modern pharmacological therapies with robust efficacy against coronavirus disease 2019(COVID-19),TCM has exhibited potential utility for treating the disease in clinical practice.MethodsA retrospective cohort study was conducted to investigate the therapeutic effect of TCM treatment intensity(TCMTI)in patients with mild COVID-19.A total of 6120 laboratory-confirmed patients with mild COVID-19 were recruited from temporary isolation facilities.The primary outcome measure was severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)ribonucleic acid conversion time.In addition,restricted cubic spline models were employed to elucidate nonlinear relationships.ResultsThe median age(range)of the study participants was 43.0(2.0–75.0)years,with a median hospitalization duration of 9.7(4.1–22.5)days.The median time for achieving SARS-CoV-2 ribonucleic acid negativity was 6.67 days.The restricted cubic spline models revealed a remarkable nonlinear association between TCMTI and the time-to-ribonucleic acid negativity.After adjusting for potential confounders,the high TCMTI group exhibited a markedly shorter median time to SARS-CoV-2 ribonucleic acid negativity and reduced hospitalization duration(P<0.001)than the low TCMTI group.Moreover,the mean time to achieve SARS-CoV-2 ribonucleic acid negativity was shortened by 1.909 days(P<0.001)in the high-TCMTI group compared to the low-TCMTI group.ConclusionThis study suggests that early initiation and intensified use of TCM may accelerate the time required to achieve SARS-CoV-2 ribonucleic acid negativity in patients with COVID-19,bearing considerable implications for public health.

Epidemiological features and temporal trends of the co-infection between HIV and tuberculosis, 1990-2021: findings from the Global Burden of Disease Study 2021

Background The co-infection of human immunodeficiency virus(HIV)/acquired immune deficiency syndrome(AIDS)and tuberculosis(TB)poses a significant clinical challenge and is a major global public health issue.This study aims to elucidate the disease burden of HIV-TB co-infection in global,regions and countries,providing critical informa-tion for policy decisions to curb the HIV-TB epidemic.Methods The ecological time-series study used data from the Global Burden of Disease(GBD)Study 2021.The data encompass the numbers of incidence,prevalence,mortality,and disability-adjusted life year(DALY),as well as age-standardized incidence rate(ASIR),prevalence rate(ASPR),mortality rate(ASMR),and DALY rate for HIV-infected drug-susceptible tuberculosis(HIV-DS-TB),HIV-infected multidrug-resistant tuberculosis(HIV-MDR-TB),and HIV-infected extensively drug-resistant tuberculosis(HIV-XDR-TB)from 1990 to 2021.from 1990 to 2021.The estimated annual percentage change(EAPC)of rates,with 95%confidence intervals(C/s),was calculated.Results In 2021,the global ASIR for HIV-DS-TB was 11.59 per 100,000 population(95%UI:0.37-13.05 per 100,000 population),0.55 per 100,000 population(95%UI:0.38-0.81 per 100,000 population),for HIV-MDR-TB,and 0.02 per 100,000 population(95%UI:0.01-0.03 per 100,000 population)for HIV-XDR-TB.The EAPC for the ASIR of HIV-MDR-TB and HIV-XDR-TB from 1990 to 2021 were 4.71(95%CI:1.92-7.59)and 13.63(95%CI:9.44-18.01),respectively.The global ASMR for HIV-DS-TB was 2.22 per 100,000 population(95%UI:1.73-2.74 per 100,000 population),0.21 per 100,000 population(95%UI:0.09-0.39 per 100,000 population)for HIV-MDR-TB,and 0.01 per 100,000 population(95%UI:0.00-0.03 per 100,000 population)for HIV-XDR-TB in 2021.The EAPC for the ASMR of HIV-MDR-TB and HIV-XDR-TB from 1990 to 2021 were 4.78(95%CI:1.32-8.32)and 10.00(95%Cl:6.09-14.05),respectively.Conclusions The findings indicate that enhancing diagnostic and treatment strategies,strengthening healthcare infrastructure,increasing access to quality medical care,and improving public health education are essential to combat HIV-TB co-infection.

Global, regional, and national burden of HIV-negative tuberculosis, 1990-2021: findings from the Global Burden of Disease Study 2021

Background Tuberculosis(TB)is a major infectious disease with significant public health implications.Its widespread transmission,prolonged treatment duration,notable side effects,and high mortality rate pose severe challenges.This study examines the epidemiological characteristics of TB globally and across major regions,providing a scientific basis for enhancing TB prevention and control measures worldwide.Methods The ecological study used data from the Global Burden of Disease(GBD)Study 2021.It assessed new incidence cases,deaths,disability-adjusted life years(DALYs),and trends in age-standardized incidence rates(ASIRs),mortality rates(ASMRs),and DALY rates for drug-susceptible tuberculosis(DS-TB),multidrug-resistant tuberculosis(MDR-TB),and extensively drug-resistant tuberculosis(XDR-TB)from 1990 to 2021.A Bayesian age-period-cohort model was applied to project ASIR and ASMR.Results In 2021,the global ASIR for all HIV-negative TB was 103.00 per 100,000 population 95%uncertainty interval(UI):92.21,114.91 per 100,000 populationl,declining by 0.40%(95%UI:-0.43,-0.38%)compared to 1990.The global ASMR was 13.96 per 100,000 population(95%UI:12.61,15.72 per 100,000 population),with a decline of 0.44%(95%UI:-0.61,-0.23%)since 1990.The global age-standardized DALY rate for HIV-negative TB was 580.26 per 100,000 population(95%UI:522.37,649.82 per 100,000 population),showing a decrease of 0.65%(95%UI:-0.69,-0.57 per 100,000 population)from 1990.The global ASIR of MDR-TB has not decreased since 2015,instead,it has shown a slow upward trend in recent years.The ASIR of XDR-TB has exhibited significant increase in the past 30 years.The projections indicate MDR-TB and XDR-TB are expected to see signifcant increases in both ASIR and ASMR from 2022 to 2035,highlighting the growing challenge of drug-resistant TB.Conclusions This study found that the ASIR of MDR-TB and XDR-TB has shown an upward trend in recent years.To reduce the TB burden,it is essential to enhance health infrastructure and increase funding in low-SDl regions.Developing highly efficient,accurate,and convenient diagnostic reagents,along with more effective therapeutic drugs,and improving public health education and community engagement,are crucial for curbing TB transmission.

Impact of co-infections with enteric pathogens on children suffering from acute diarrhea in southwest China

Background:Acute diarrhea is a global health problem,resulting in high morbidity and mortality in children.It has been suggested that enteric pathogen co-infections play an important role in gastroenteritis,but most research efforts have only focused on a small range of species belonging to a few pathogen groups.This study aimed to assess the impact of co-infections with a broad range of enteric pathogens on children aged below five years who suffer from acute diarrhea in southwest China.Method:A total of 1020 subjects(850 diarrhea cases and 170 healthy controls)were selected from four sentinel hospitals in Kunming,Yunnan province,southwest China,from June 2014 to July 2015.Stool specimens were collected to detect five virus(rotavirus group A,RVA;norovirus,NoV;Sapovirus,SaV;astrovirus,As;and adenovirus,Ad),seven bacterial(diarrheagenic Escherichia coli,DEC;non-typhoidal Salmonella,NTS;Shigella spp.;Vibrio cholera;Vibrio parahaemolyticus;Aeromonas spp.;and Plesiomonas spp.),and three protozoan(Cryptosporidium spp.,Giardia lamblia,and Blastocystis hominis,B.hominis)species using standard microbiologic and molecular methods.Data were analyzed using the partial least square regression technique and chi-square test.Results:At least one enteric pathogen was detected in 46.7%(n=397)of acute gastroenteritis cases and 13.5%(n=23)of healthy controls(χ^(2)=64.4,P<0.05).Single infection with RVA was associated with acute diarrhea(26.5%vs.5.8%,P<0.05).The prevalence of a single infection with B.hominis in diarrhea cases was higher than in healthy controls(3.1%vs.0.5%,OR=4.7,95%CI:1.01–112.0).Single infection with NoV GII was not associated with diarrhea(4.4%vs.3.5%,OR=1.2,95%CI:0.5–3.3).Single infections with bacterial species were not observed.The prevalence of co-infections with two enteric pathogens in diarrhea cases was higher than in asymptomatic children(20.1%vs.5.3%,P<0.05).RVA-NoV GII was the most common co-infection in symptomatic children(4.4%),with it aggravating the severity of diarrhea.Conclusions:Although it is clear that RVA has an overwhelming impact on diarrhea illnesses in children,co-infection with other enteric pathogens appears to also aggravate diarrhea severity.These findings should serve as evidence for public health services when planning and developing intervention programs.

Risk factors for Blastocystis infection in HIV/AIDS patients with highly active antiretroviral therapy in Southwest China

Background:Blastocystis is a widespread zoonotic protozoan of mammalian species,especially in HIV/AIDS individuals.The aim of this study was to analyze the prevalence and risk factors related with Blastocystis infection among HIV/AIDS patients in Southwest China.Methods:The cross-sectional study was performed in 311 HIV/AIDS cases in Tengchong City,Yunnan Province from July 2016 to March 2017.For each subject,stool specimen was collected to detect the Blastocystis,and the blood sample was used to detect HIV virus load and CD4+T cell count,in addition,structured questionnaire was used to collect the basic information and risk factors.Findings:The result showed that the detection rate of Blastocystis was 3.86%(95%CI:2.22-6.62)among HIV/AIDS patients.Both raising animal(OR=12.93,95%CI:1,54-108.36)and drinking un-boiled water(OR=8A7,95%CI:1.76-37.90)were risk factors for Blastocystis infection in HIV/AIDS individuals.In addition,the interaction of CD4^+T cell count and HIV virus load was also contribution to Blastocystis infection(P=0.007).Conclusions:A high prevalence of Blastocystis infection was found in HIV/AIDS patients in Tengchong.Poor hygienic habits,the interaction of HIV virus load and CD4^+T cell count were identified as main risk factors for infection.These results will help us to develop efficient control strategies to intervene with and prevent the occurrence of Blastocystis among HIV-infected individuals.

Antibiotic resistance and molecular characterization of diarrheagenic Escherichia coli and non-typhoidal Salmonella strains isolated from infections in Southwest China

Background:Bacterial diarrhea is one of the most common causes for medical consultations,mortality and morbidity in the world.Diarrheagenic Escherichia coli(DEC)and non-typhoidal Salmonella(NTS)are major intestinal pathogens in developing countries,and the indiscriminate use of antibiotics has greatly contributed to resistant strains.Hence,the aim of the present study is to identify the antimicrobial resistance patterns and the molecular characteristics of DEC and NTS in southwest,China.Methods:1121 diarrheal patients and 319 non-diarrheal subjects across all age groups were recruited from four sentinel hospitals from June 2014 to July 2015 in Kunming City,Yunnan Province.Each stool specimen was collected to detect DEC and NTS with standard microbiological and molecular methods.Antimicrobial resistance testing was performed with the Kirby-Bauer disk diffusion method,and the standards for antimicrobial susceptibility testing complied with the Clinical and Laboratory Standards Institute(CLSI).Molecular characterization of strains was carried out using pulsed-field gel electrophoresis(PFGE).A structured questionnaire was used to record basic epidemiological data(e.g.sex,age,residence,season,etc.).Data were analyzed using Chi-square or Fisher’s exact test.Results:DEC was detected in 127(11.33%)diarrhea cases and 9(2.82%)non-diarrheal cases(χ^(2)=20.69,P<0.001,OR=4.36,95%CI:2.19-8.65),and the prevalence of NTS isolated from diarrhea cases was higher than that of non-diarrheal cases across all age groups(n=42,3.75%,n=1,0.31%,χ^(2)=10.10,P=0.002,OR=12.38,95%CI:1.70-90.29).The rates of resistance to ten antibiotics of DEC and NTS showed significant differences(χ^(2)=386.77,P<0.001;χ^(2)=191.16,P<0.001).The rates of resistance to Amoxicillin and Clavulafiate(AMC),Cephalothin(CEP),Gentamicin(GEN)and Sulfamethoxazole-Trimethoprim(SXT)of DEC isolated from diarrhea cases were higher than those of NTS isolated from diarrhea patients(37.01%vs 14.29%,χ^(2)=7.57,P=0.006;29.92%vs 11.90%,χ^(2)=5.40,P=0.02;37.01%vs 11.90%,χ^(2)=5.80,P=0.016;62.20%vs 26.19%,χ^(2)=16.44,P<0.001;respectively).Ciprofloxacin(CIP)was the most sensitive antibiotic for DEC and NTS strains isolated from diarrhea cases.Resistance rates of DEC isolates from cases and controls to more than three kinds antimicrobials(multidrug resistance,MDR)showed no significant differences(81.10%vs 88.89%,P=0.33).Pulsotype patterns of DEC strains were highly diverse;however,the pulsotype pattern of NTS strains was closely related to the serotype.The pattern of S.enteritidis was highly similar,but the S.enterica Typhimurium strain was discrete.Conclusions:Antibiotic resistance of Enterobacteriaceae is of great concern.The societal effects of antibiotic use justify strict monitoring to combat increases in antimicrobial resistance.Molecular epidemiology and systematic epidemiological investigation can provide accurate evidence for tracking the infection source.

Efficacy of integrating short-course chemotherapy with Chinese herbs to treat multi-drug resistant pulmonary tuberculosis in China: a study protocol

Background:Tuberculosis(TB)causedMycobacterium tuberculosis(M.tb)is one of infectious disease that lead a large number of morbidity and mortality all over the world.Although no reliable evidence has been found,it is considered that combining chemotherapeutic drugs with Chinese herbs can significantly improves the cure rate and the clinical therapeutic effect.Methods:Multi-drug resistant pulmonary tuberculosis(MDR-PTB,n=258)patients with Qi-yin deficiency syndrome will be randomly assigned into a treatment group(n=172)or control/placebo group(n=86).The treatment group will receive the chemotherapeutic drugs combined with Chinese herbs granules(1+3 granules),while the control group will receive the chemotherapeutic drugs combined with Chinese herbs placebo(1+3 placebo granules).In addition,MDR-PTB(n=312)patients with Yin deficiency lung heat syndrome will be randomly assigned to a treatment(n=208)or control/placebo(n=104)group.The treatment group will receive the chemotherapeutic regimen combined with Chinese herbs granules(2+4 granules),while the control group will receive the chemotherapeutic drugs and Chinese herbs placebo(2+4 placebo granules).The primary outcome is cure rate,the secondary outcomes included time to sputum culture conversion,lesion absorption rate and cavity closure rate.BACTEC^(TM)MGIT^(TM)automated mycobacterial detection system will be used to evaluate theM.tb infection and drug resistance.Chi-square test and Cox regression will be conducted with SAS 9.4 Statistical software to analyze the data.Discussion:The treatment cycle for MDR-PTB using standardized modern medicine could cause lengthy substantial side effects.Chinese herbs have been used for many years to treat MDR-PTB,but are without high-quality evidence.Hence,it is unknown whether Chinese herbs enhances the clinical therapeutic effect of synthetic drugs for treating MDR-PTB.Therefore,this study will be conducted to evaluate the clinical therapeutic effect of combining Chinese herbs and chemotherapeutic drugs to treat MDR-PTB cases.It will assist in screening new therapeutic drugs and establishing treatment plan that aims to improve the clinical therapeutic effect for MDR-PTB patients.Trial registration This trial was registered at ClinicalTrials.gov(ChiCTR1900027720)on 24 November 2019(prospective registered).

Impact factors of Blastocystis hominis infection in persons living with human immunodeficiency virus:a large-scale,multi-center observational study from China

Background Blastocystis hominis(Bh)is zoonotic parasitic pathogen with a high prevalent globally,causing opportunistic infections and diarrhea disease.Human immunodeficiency virus(HIV)infection disrupts the immune system by depleting CD4^(+)T lymphocyte(CD4^(+)T)cell counts,thereby increasing Bh infection risk among persons living with HIV(PLWH).However,the precise association between Bh infection risk and HIV-related biological markers and treatment processes remains poorly understood.Hence,the purpose of the study was to explore the association between Bh infection risk and CD4^(+)T cell counts,HIV viral load(VL),and duration of interruption in antiviral therapy among PLWH.Methods A large-scale multi-center cross-sectional study was conducted in China from June 2020 to December 2022.The genetic presence of Bh in fecal samples was detected by real-time fluorescence quantitative polymerase chain reaction,the CD4^(+)T cell counts in venous blood was measured using flowcytometry,and the HIV VL in serum was quantified using fluorescence-based instruments.Restricted cubic spline(RCS)was applied to assess the non-linear association between Bh infection risk and CD4^(+)T cell counts,HIV VL,and duration of interruption in highly active antiretroviral therapy(HARRT).Results A total of 1245 PLWH were enrolled in the study,the average age of PLWH was 43 years[interquartile range(IQR):33,52],with 452(36.3%)being female,50.4%(n=628)had no immunosuppression(CD4^(+)T cell counts>500 cells/μl),and 78.1%(n=972)achieved full virological suppression(HIV VL<50 copies/ml).Approximately 10.5%(n=131)of PLWH had interruption.The prevalence of Bh was found to be 4.9%[95%confidence interval(CI):3.8-6.4%]among PLWH.Significant nonlinear associations were observed between the Bh infection risk and CD4^(+)T cell counts(Pfor nonlinearity<0.001,L-shaped),HIV VL(Pfor nonlinearity<0.001,inverted U-shaped),and duration of interruption in HARRT(Pfor nonlinearity<0.001,inverted U-shaped).Conclusions The study revealed that VL was a better predictor of Bh infection than CD4^(+)T cell counts.It is crucial to consider the simultaneous surveillance of HIV VL and CD4^(+)T cell counts in PLWH in the regions with high level of socioeconomic development.The integrated approach can offer more comprehensive and accurate understanding in the aspects of Bh infection and other opportunistic infections,the efficacy of therapeutic drugs,and the assessment of preventive and control strategies.

Efficacy of the combination of modern medicine and traditional Chinese medicine in pulmonary fibrosis arising as a sequelae in convalescent COVID-19 patients: a randomized multicenter trial

Background:The coronavirus disease 2019(COVID-19)caused by severe acute respiratory syndrome coronavirus-2(SARS-CoV-2)has led to a significant number of mortalities worldwide.COVID-19 poses a serious threat to human life.The clinical manifestations of COVID-19 are diverse and severe and 20%of infected patients are reported to be in a critical condition.A loss in lung function and pulmonary fibrosis are the main manifestations of patients with the severe form of the disease.The lung function is affected,even after recovery,thereby greatly affecting the psychology and well-being of patients,and significantly reducing their quality of life.

Reduced SARS-CoV-2 infection risk is associated with the use of Seven-Flavor Herb Tea:A multi-center observational study in Shanghai,China

Objective:Omicron,a severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)variant,is responsible for numerous infections in China.This study investigates the association between the use of Seven-Flavor Herb Tea(SFHT)and the risk of SARS-CoV-2 infection to develop precise and differentiated strategies for control of the coronavirus disease 2019(COVID-19).Methods:This case-control study was conducted at shelter hospitals and quarantine hotels in China.A total of 5348 laboratory-confirmed COVID-19 patients were enrolled between April 1 and May 31,2022,while 2190 uninfected individuals served as healthy controls.Structured questionnaires were used to collect data on demographics,underlying diseases,vaccination status,and use of SFHT.Patients were propensity-score-matched using 1:1 nearest-neighbor matching of the logit of the propensity score.Subsequently,a conditional logistic regression model was used for data analysis.Results:Overall,7538 eligible subjects were recruited,with an average age of[45.54±16.94]years.The age of COVID-19 patients was significantly higher than that of uninfected individuals([48.25±17.48]years vs[38.92±13.41]years;t=22.437,P<0.001).A total of 2190 COVID-19 cases were matched with uninfected individuals at a 1:1 ratio.The use of SFHT(odds ratio=0.753,95%confidence interval:0.692,0.820)was associated with a lower risk of SARS-CoV-2 infection compared to untreated individuals.Conclusion:Our findings suggest that taking SFHT reduces the risk of SARS-CoV-2 infection.This is a useful study in the larger picture of COVID-19 management,but data from large-sample multi-center,randomized clinical trial are warranted to confirm the finding.

Comprehensive strategies and measures to control COVID-19

Background Infectious diseases pandemic can lead to explosive effect with unpredictability on the world,as exemplified the bubonic–pneumonic plague pandemic in the fourteenth century[1],the 1918 influenza pandemic and the coronavirus disease 2019(COVID-19)pandemic caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2).From January 2020 to May 2022,a total of 527.5 million individuals were suffered from an COVID-19,and more than 6.2 million individuals were died[2].The global all-age rate of excess mortality due to the COVID-19 pandemic was 120.3 deaths per 100,000[3].Its threat to human beings,especially those with underlying health issues,no one overlook this outcome.