Antimicrobial resistance (AMR) poses an important global health challenge in the 21st century. A previous study has quantified the global and regional burden of AMR for 2019, followed with additional publications that provided more detailed estimates for several WHO regions by country. To date, there have been no studies that produce comprehensive estimates of AMR burden across locations that encompass historical trends and future forecasts. We estimated all-age and age-specific deaths and disability-adjusted life-years (DALYs) attributable to and associated with bacterial AMR for 22 pathogens, 84 pathogen-drug combinations, and 11 infectious syndromes in 204 countries and territories from 1990 to 2021. We collected and used multiple cause of death data, hospital discharge data, microbiology data, literature studies, single drug resistance profiles, pharmaceutical sales, antibiotic use surveys, mortality surveillance, linkage data, outpatient and inpatient insurance claims data, and previously published data, covering 520 million individual records or isolates and 19 513 study-location-years. We used statistical modelling to produce estimates of AMR burden for all locations, including those with no data. Our approach leverages the estimation of five broad component quantities: the number of deaths involving sepsis; the proportion of infectious deaths attributable to a given infectious syndrome; the proportion of infectious syndrome deaths attributable to a given pathogen; the percentage of a given pathogen resistant to an antibiotic of interest; and the excess risk of death or duration of an infection associated with this resistance. Using these components, we estimated disease burden attributable to and associated with AMR, which we define based on two counterfactuals; respectively, an alternative scenario in which all drug-resistant infections are replaced by drug-susceptible infections, and an alternative scenario in which all drug-resistant infections were replaced by no infection. Additionally, we produced global and regional forecasts of AMR burden until 2050 for three scenarios: a reference scenario that is a probabilistic forecast of the most likely future; a Gram-negative drug scenario that assumes future drug development that targets Gram-negative pathogens; and a better care scenario that assumes future improvements in health-care quality and access to appropriate antimicrobials. We present final estimates aggregated to the global, super-regional, and regional level. In 2021, we estimated 4·71 million (95% UI 4·23-5·19) deaths were associated with bacterial AMR, including 1·14 million (1·00-1·28) deaths attributable to bacterial AMR. Trends in AMR mortality over the past 31 years varied substantially by age and location. From 1990 to 2021, deaths from AMR decreased by more than 50% among children younger than 5 years yet increased by over 80% for adults 70 years and older. AMR mortality decreased for children younger than 5 years in all super-regions, whereas AMR mortality in people 5 years and older increased in all super-regions. For both deaths associated with and deaths attributable to AMR, meticillin-resistant Staphylococcus aureus increased the most globally (from 261 000 associated deaths [95% UI 150 000-372 000] and 57 200 attributable deaths [34 100-80 300] in 1990, to 550 000 associated deaths [500 000-600 000] and 130 000 attributable deaths [113 000-146 000] in 2021). Among Gram-negative bacteria, resistance to carbapenems increased more than any other antibiotic class, rising from 619 000 associated deaths (405 000-834 000) in 1990, to 1·03 million associated deaths (909 000-1·16 million) in 2021, and from 127 000 attributable deaths (82 100-171 000) in 1990, to 216 000 (168 000-264 000) attributable deaths in 2021. There was a notable decrease in non-COVID-related infectious disease in 2020 and 2021. Our forecasts show that an estimated 1·91 million (1·56-2·26) deaths attributable to AMR and 8·22 million (6·85-9·65) deaths associated with AMR could occur globally in 2050. Super-regions with the highest all-age AMR mortality rate in 2050 are forecasted to be south Asia and Latin America and the Caribbean. Increases in deaths attributable to AMR will be largest among those 70 years and older (65·9% [61·2-69·8] of all-age deaths attributable to AMR in 2050). In stark contrast to the strong increase in number of deaths due to AMR of 69·6% (51·5-89·2) from 2022 to 2050, the number of DALYs showed a much smaller increase of 9·4% (-6·9 to 29·0) to 46·5 million (37·7 to 57·3) in 2050. Under the better care scenario, across all age groups, 92·0 million deaths (82·8-102·0) could be cumulatively averted between 2025 and 2050, through better care of severe infections and improved access to antibiotics, and under the Gram-negative drug scenario, 11·1 million AMR deaths (9·08-13·2) could be averted through the development of a Gram-negative drug pipeline to prevent AMR deaths. This study presents the first comprehensive assessment of the global burden of AMR from 1990 to 2021, with results forecasted until 2050. Evaluating changing trends in AMR mortality across time and location is necessary to understand how this important global health threat is developing and prepares us to make informed decisions regarding interventions. Our findings show the importance of infection prevention, as shown by the reduction of AMR deaths in those younger than 5 years. Simultaneously, our results underscore the concerning trend of AMR burden among those older than 70 years, alongside a rapidly ageing global community. The opposing trends in the burden of AMR deaths between younger and older individuals explains the moderate future increase in global number of DALYs versus number of deaths. Given the high variability of AMR burden...

A possible association between blood group systems (ABO and Rh) and coronavirus disease 2019 (COVID-19) severity has recently been investigated by various studies with conflicting results. However, due to variations in the prevalence of the ABO and Rh blood groups in different populations, their association with COVID-19 might be varied as well. Therefore, we conducted this study on Libyan participants to further investigate this association and make population-based data available to the worldwide scientific community. In this case-control study, ABO and Rh blood groups in 419 confirmed COVID-19 cases in Zawia, Libya, and 271 healthy controls were compared using descriptive statistics and χ ² tests. Blood group A was significantly more prevalent in patients with severe COVID-19 (64/125; 51.2%) than in patients with nonsevere COVID-19 (108/294, 36.7%) (P < .034), whereas the O blood group prevalence was higher in nonsevere COVID-19 cases (131/294, 44.5%) compared with severe cases (43/125, 34.4%) (P < .001). The results showed a significant association between blood group A and the severity of COVID-19, whereas patients with blood group O showed a low risk of developing severe COVID-19 infection. No significant association was found between Rh and susceptibility/severity of the disease.

The symptoms of long COVID (LC) can be debilitating and may be associated with anxiety, social stigma, and quality of life deterioration. Identifying patients at risk of LC is important to offer follow-up care and plan population-level public health measures. The current multinational study aimed to assess the prevalence and predictors of LC in the general population. We conducted an online, multinational, cross-sectional survey between April 2022 and January 2023, targeting participants 18 years and older with a previously confirmed COVID-19 infection. We used convenience sampling to recruit participants through an online Google form. We collected demographic data, past medical history, infection details, post-COVID-19 symptoms, and quality of life. Responses were then translated into English. LC was defined as per the World Health Organization. A single-variable analysis was conducted to identify factors significantly associated with LC development. Following the removal of multicollinear variables, a generalized linear model was established to estimate the contribution of different predictors to LC occurrence. A total of 11,801 respondents from 33 countries were included in the analysis. The mean age for participants was 32.7 ± 12.8 years, with 61% being females. BMI averaged 25.2 ± 4.8 across participants, and 14.8% of them were smokers. Seventy-eight percent of participants reported receiving the COVID-19 vaccine. Respondents with PCR-confirmed COVID-19 were then categorized into those with LC (N = 2335, 19.8%) and without LC (N = 9466 individuals, 80.2%). Our model identified 25 significant predictors. The predictors of higher LC risk included ICU admission (OR 2.08; 95% CI 1.36, 3.18; P = 0.001), female sex (OR 1.8; 95% CI 1.61, 2.02; P < 0.001), fatigue during the infection (OR 1.6; 95% CI 1.43, 1.78; P < 0.001), identifying as Hispanic (OR 1.53; 95% CI 1.26, 1.85; P < 0.001), and pre-existing gastrointestinal disease (OR 1.48; 95% CI 1.22, 1.8; P < 0.001). In conclusion, we identified key LC predictors, including ICU admission, female sex, and acute fatigue as primary risk factors, while African American and Asian ethnicities and receiving even one dose of vaccination demonstrated protective effects.

OBJECTIVES: Cancer is a major cause of morbidity and mortality worldwide, and it is an increasing problem in developing countries. Estimation of the incidence of cancer is important, especially in regions with limited epidemiological data on cancer. Therefore, the aim of this study was to provide an updated report on the incidence of cancers in the Tobruk region in eastern Libya.METHODS: Data on cancer patients from the records of the Department of Histopathology of Tobruk Medical Centre from January 2013 to June 2020 were included.RESULTS: In total, 402 cases were recorded. Men patients accounted for 30.3% (n=122) of cases, and women patients represented 69.6% (n=280). The overall mean age at the time of the first diagnosis was 49.0±17.1 years. The most common malignancies were breast and uterine cancer in women (18.4%, n=74; 15.9%, n=64, respectively), colorectal cancer (11.6%, n=47; 26 in women and 21 in men), bladder cancer (8.2%, n=33; 8 in women and 25 in men), and thyroid cancer (8.0%, n=32; 23 in women and 9 in men).CONCLUSIONS: Breast and uterine cancers were the most common cancers in women, and bladder and colorectal cancer were the most common cancers in men, followed by colorectal cancer in both genders. These data will help health authorities launch preventive plans for cancer in the region. Further studies to identify aetiological factors and cancer-related risk factors need to be conducted in the region.

Background: Post transfusion hepatitis B (PTHB) continues to be an important public health concern with regard to blood transfusion in Libya and in Africa. This concern is related to the screening test which is still used but it is not enough to detect infective cases during window period. Objectives: To determine the presence of total anti-HBc (hepatitis B core antibodies) and HBV-DNA (hepatitis B viral DNA (in healthy HBsAg (hepatitis B surface antigen) negative blood donors in Tripoli-Libya, North Africa. Methods: A total of 1256 HBsAg negative blood samples, obtained from healthy blood donors who attended Tripoli’s central blood bank, were tested for anti-HBc using the VITROS® 3600 Immunodiagnostic System. The reactive samples were further tested for the presence of HBV-DNA. Results: From the sample of 1256, 123 (10%) were total anti-HBc positive. Of the 123 anti-HBc positive samples, 13 (10.5%) tested positive for HBV-DNA by PCR (Polymerase chain reaction). The frequency of anti-HBc positive cases among the voluntary donors was 59.2%, and among the replacement donors was 40.7% (p<0.0001). The number of anti-HBc positive samples was found to be particularly high in the age group 30-39 years 44).7%) (p<0.0001). All the positive PCR samples were from the age groups 20-39 and 40-59 with highest prevalence among 20-29 (p<0.0001). Most occupation who had positivity with anti-HBc and HBV-DNA were civil governmental workers specially militants, free workers and was less in students. Most positive cases were from east of Tripoli the capital (Tagora, SoqAljomaha). Conclusion: The frequency of anti-HBc among this sample was 10% which is high compared with the international findings. The current study estimated the expected exclusion rate of anti-HBc positive donated blood, as this would be an important factor to consider before adopting anti-HBc testing in addition to HBsAg testing as a mandatory screening test to further enhance transfusion safety.