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Global burden of vision impairment due to age-related macular degeneration, 1990-2021, with forecasts to 2050: a systematic analysis for the Global Burden of Disease Study 2021
(Elsevier Ltd., 2025-07) GBD 2021 Global AMD Collaborators including Mettananda, S.
BACKGROUND: Age-related macular degeneration (AMD) is a growing public health concern worldwide, as one of the leading causes of vision impairment. We aimed to estimate global, national, and region-specific prevalence and disability-adjusted life-years (DALYs) along with tobacco as a modifiable risk factor to aid public policy addressing AMD. METHODS: Data on AMD were extracted from the Global Burden of Disease, Injuries, and Risk Factor Study 2021 database in 204 countries and territories, 1990-2021. Vision impairment was defined and categorised by severity as follows: moderate to severe vision loss (visual acuity from <6/18 to 3/60) and blindness (visual acuity <3/60 or a visual field <10 degrees around central fixation). The burden of vision impairment attributable to AMD was subsequently estimated. These estimates were further stratified by geographical region, age, year, sex, Healthcare Access and Quality (HAQ) Index, and Socio-demographic Index (SDI) levels. Additionally, the effect of tobacco use, a modifiable risk factor, on the burden of AMD was analysed, and projections of AMD burden were estimated through to 2050. These projections also included scenario modelling to assess the potential effects of tobacco elimination. FINDINGS: Globally, the number of individuals with vision impairment due to AMD more than doubled, rising from 3·64 million (95% uncertainty inverval [UI] 3·04-4·35) in 1990 to 8·06 million (6·71-9·82) in 2021. Similarly, DALYs increased by 91% over the same period, from 0·30 million (95% UI 0·21-0·42) to 0·58 million (0·40-0·80). By contrast, age-standardised prevalence and DALY rates declined, with prevalence rates decreasing by 5·53% (99·50 per 100 000 of the population [95% UI 83·16-118·04] in 1990 to 94·00 [78·32-114·42] in 2021) and DALY rates dropping by 19·09% (8·38 [5·70-11·53] to 6·78 [4·70-9·32]). These rates showed a consistent decrease in higher SDI quintiles, reflecting the negative correlation between HAQ Index and AMD burden. A general downward trend was observed from 1990 to 2021, with the largest age-standardised reduction occurring in the low-middle SDI quintile. The global contribution of tobacco to age-standardised DALYs decreased by 20%, declining from 12·45% (95% UI 7·73-17·37) in 1990 to 9·96% (6·12-14·06) in 2021. By 2050, the number of individuals affected by AMD is projected to increase from 3·40 million males (95% UI 2·81-4·17) in 2021 to 9·02 million (5·72-14·20) and from 4·66 million females (3·88-5·65) to 12·32 million (8·88-17·08). Eliminating tobacco use could reduce these numbers to 8·17 million males (5·59-11·92) and 11·15 million females (8·58-14·48) in 2050. INTERPRETATION: While the total prevalence and DALYs due to AMD have steadily increased from 1990 to 2021, age-standardised prevalence and DALY rates have declined, probably reflecting the effect of population ageing and growth. The consistent decrease in age-standardised rates with higher SDI levels highlights the crucial role of health-care resources and public policies in mitigating AMD-related vision impairment. The downward trend observed from 1990 to 2021 might also be partially attributed to the reduced effect of tobacco as a modifiable risk factor, with declines in tobacco use seen globally and across all SDI quintiles. The burden of vision impairment due to AMD is projected to increase to about 21·34 million in 2050. However, effective tobacco regulation has the potential to substantially reduce AMD-related vision impairment, particularly in lower SDI quintiles where health-care resources are limited.
Mosquito Control Strategies Based on Genetic Manipulation
(Mosquitoes of India, 2025-06) Dassanayake, R. S.; Gunawardene, Y. I. N. S.; Hapugoda, M.; Ranathunga, T.; Dilani, P. V. D.; Ramyasoma, H. P. B. K. D.; Wickramasinghe, P. D. S. U.; Patil, P. B.; Dasgupta, S. K.; Tyagi, B. K.
Mosquito-borne diseases are becoming a major global health challenge, threatening nearly half the world’s population. Despite the major advances in malaria control, it is still estimated to result in over 400,000 deaths yearly. Additionally, the global incidence of dengue has grown rapidly, and outbreaks of chikungunya and yellow fever have increased in size and frequency since 2014. Given the lack of effective vaccines and therapeutics against many mosquito-borne pathogens, disease control is primarily reliant on sustainable vector control strategies. However, the traditional vector control methods have been largely ineffective, and therefore, the development of innovative control measures against these mosquito-borne diseases is urgently required. Advancements in genetics provide the underlying motivation to develop new genetics-based approaches to combat these diseases. Among them, the sterile insect technique (SIT) is an effective, species-specific, and environmentally benign method for mosquito population suppression. It is based on mosquito mass rearing, radiation sterilization, and inundative release of male mosquitoes. The advent of mosquito transgenesis has paved the way for other novel strategies in mosquito control. One possibility is a release of insects carrying the dominant lethal gene (RIDL), which offers genetic sterilization, genetic sexing, and genetic containment to provide significant cost-effectiveness to the SIT. RNA interference (RNAi) is another powerful tool to inhibit the expression of RNA viruses. The RNA interference pathway is the key component of the innate immune system of mosquitoes. Currently, the use of CRISPR/Cas 9-based gene editing tools has significantly increased the interest in generating mosquitoes to suppress the mosquito population or alter their capacity to transmit diseases. This chapter examines the role of genetic manipulation in developing current and future cutting-edge mosquito control strategies to fight against mosquito-borne diseases.
Frontal lobe seizure presenting as disorganised behaviour to a mental health service: A case report
(London : Royal College of Psychiatrists, 2025-06) Wickramarathna, T.; Jayamaha, G.; Chandradasa, M.; Kuruppuarachchi, K. A. L. A.
AIMS: Epilepsy can present with a wide range of neuropsychiatric manifestations. A seizure episode may take the form of motor convulsions, complex abnormal behaviours or unusual subjective experiences. Seizures originating in different anatomical locations take characteristic forms, however, there is considerable overlap in the presentation. Frontal lobe seizures are characterised by motor phenomena which may include complex posturing and behavioural automatism which tend to begin and end abruptly. This condition is of particular importance to psychiatrists, due to the bizarre nature of automatic behaviour. They may be mistaken as dissociative phenomena or psychotic disorders. METHODS: A 55-year-old female who was previously well, presented to the psychiatric service following episodic disorganised behaviour for two weeks duration. For example, she had cooked rice three times per meal without an apparent reason. Also, she had started collecting a large number of vegetables repeatedly in a shopping centre without a clear purpose. At that time her husband had to forcefully stop her. When inquired later she was unable to recall these events. Family members also noticed that the patient is having episodic repetitive facial movements without losing consciousness. General physical and neurological examination was normal. Her EEG showed right frontal sharp waves which progress into generalised spikes, suggestive of frontal lobe epilepsy with secondary generalisation. The contrast CT brain was normal. Haematological tests including random blood sugar, serum electrolytes, full blood count, serum calcium levels and the ECG were normal. Intravenous phenytoin sodium was given to control repetitive seizures at the onset. Subsequently, oral sodium valproate was commenced. She responded well, and symptoms disappeared within a couple of days. RESULTS: Epilepsy presenting as behavioural and psychiatric manifestations is common but can be easily overlooked. Frontal lobe epilepsy with common aetiology like post traumatic, tumours and genetic causes can have complex seizure semiology. Overall frontal lobe seizures tend to begin and end abruptly, are brief and frequent. They show a tendency to occur at night and in clusters. Motor phenomena which may include complex posturing and behavioural automatism are usually the most conspicuous feature. This patient had several bizarre behaviours which could be complex behavioural automatism. The bizarre nature of automatism means that they can often be mistaken for non-epileptic dissociative seizures as well as another psychiatric diagnosis like mania or psychosis. Conclusion: Our patient highlights the unusual way of presentation of frontal lobe seizures. Clinicians need to be aware of this presentation to minimise possible misdiagnosis and mismanagement.
Pathogenic effects of telomerase reverse transcriptase (TERT) promoter mutations in nonalcoholic steatohepatitis (NASH) related hepatocellular carcinoma (HCC) and its potentials as a diagnostic biomarker
(SpringerOpen, 2025-06) Liman, U. U.; Hawage, A. S.; Silva, S. D.; Samarasinghe, S. M.; Tennekoon, K. H.; Siriwardana, R. C.; Niriella, M. A.
BACKGROUND Hepatocellular carcinoma (HCC) is the most common type of liver cancer globally due to its diverse aetiologies, poor diagnosis and prognosis as well as low survival rate. Nonalcoholic steatohepatitis-related HCC (NASH-HCC), the progressive form of nonalcoholic fatty liver, is the most prevalent subtype of HCC in this century, and genetic predisposition significantly influences its pathogenesis. Several genes associated with NASH–HCC development have been recently studied. One key regulatory gene is the TERT gene encoding for the TERT protein. MAIN BODY OF THE ABSTRACT Hence, the goal of this mini-review is to present the most recent findings about TERT promoter mutations, the mechanism of upregulation of TERT gene expression, the downstream mechanism of promoting NASH-HCC, and its potential as a NASH-HCC diagnostic biomarker. CONCLUSION Relevant and up-to-date findings were presented in this review, but more thorough researches in multi-ethnic and diver population are needed to determine the prevalence of TERT promoter mutations, its gene expression levels and their potentiality as early diagnostic molecular biomarkers with application in clinical settings.
Abdominal Migraine in Adults: A Narrative Review
(Palo Alto, CA : Cureus, Inc., 2025-06) Niriella, M. A.; Jayasena, H.; Nishad, N.; Wijesingha, I. P.; Prabagar, K.
Abdominal migraine (AM) is a debilitating condition characterized by paroxysmal episodes of abdominal pain accompanied by vasomotor symptoms, leading to a significant reduction in quality of life. While more commonly observed in children, AM is rare and less well understood in adults. Diagnostic criteria for adult AM remain poorly defined, and treatment options, both pharmacological and non-pharmacological, have not been extensively evaluated in this population. Pharmacological management may be either prophylactic, aimed at preventing episodes, or abortive, used during acute attacks. Treatment is typically individualized, with a focus on symptom relief and reducing the frequency of attacks. This review summarizes available literature published between 1995 and 2024, with an emphasis on the clinical presentation, diagnosis, and therapeutic strategies for AM in adult patients.