Maximum Mortality Research Articles

Quantifying the historical and future heat-related mortality above the heat alert thresholds of the inaugural Chinese national heat-health action plan

BackgroundChina published its inaugural national heat-health action plan (HHAP) in 2023, but the mortality burden associated with temperatures exceeding the heat alert thresholds specified by this HHAP (maximum temperatures >35, 37, or 40 °C) remains unknown. We aimed to estimate the historical and future mortality burden associated with temperatures above the heat alert thresholds of the Chinese national HHAP. MethodsWe conducted time-series analyses to estimate the mortality burden associated with temperatures exceeding the three heat alert thresholds from 2016-2019 in Jiangsu Province (including 13 cities, population ∼80.7 million), China. A quasi-Poisson regression in conjunction with a distributed lag non-linear model was used to estimate the dose-response association between maximum temperature and mortality risk from 2016-2019, adjusting for potential covariates. We then projected the future mortality burden associated with temperatures exceeding these thresholds under three distinct levels of greenhouse gas (GHG) emission scenarios via scenario shared socioeconomic pathways [SSP] 1-2.6 (low), SSP2-4.5 (intermediate), and SSP5-8.5 (high), respectively, by assuming that there will be no adaptation to heat. Climate scenarios derived from the General Circulation Model (GCM) under the Coupled Model Intercomparison Project Phase 6 (CMIP6) were used. ResultsFrom 2016-2019, temperatures above 35 °C were associated with 0.51% of mortality, including 0.40% associated with 35 °C – 37 °C and 0.11% associated with >37 °C. Heat-related mortality risk was most prominent in those who were single/divorced/widowed and had <10 years of education. Under SSP2-4.5, compared with the 2020s, the excess mortality associated with >37 °C would increase by 1.4 times in the 2050s and 1.7 times in the 2090s. Under SSP5-8.5, the annual number of days with maximum temperature >37 °C would approximately double every 20 years (67 days annually in the 2090s). Consequently, compared with the 2020s, the excess mortality associated with >37 °C would increase by 2.8 times in the 2050s and 18.4 times in the 2090s. ConclusionSignificant mortality risk is associated with temperatures above the lowest heat alert threshold of the Chinese national HHAP (35 °C). If the high GHG emission scenario occurred, the annual number of days and excess mortality associated with maximum temperatures >37 °C would largely increase in the coming decades.

To Study the Incidence &amp; Various Causes of Maternal Mortality in OBGY Dept

Background &amp; Methods: The aim of the study is to study incidence &amp; various causes of maternal mortality in OBGY Dept. All causes of maternal mortality particularly direct causes of maternal mortality for which management usually involves maternity care professional. Convulsion during pregnancy or in the 1st - 10 days postpartum together with at least two of the following features within 24 hrs after convulsion. BP&gt; 170/110 mmHg, proteinuria &gt; 1 + on random dipstick or &gt; 0.3 g in 24 hours, thrombocytopenia &lt;100x109/L increased aspartate aminotransferase &gt; 42 u/I.Results: 37.32% Maternal Death occurred in Primi Patients out of 418 cases of Maternal Death. 50.25% Maternal Death occurred in direct cases out of 400 cases. We found ANC 84.50% &amp; PNC 15.50%. We found maximum mortality in Toxemia (35.25%), followed by Severe Anemia (13.5%).Conclusion: Age wise Mortality is more in 21-30 yrs, i.e. 65.5% &amp; teen age 15-20 yrs mortality is 24.75%. 50.25% cases were Direct &amp; 49.75% cases were referred from peripheral areas. Out of all cases 84.50% cases reported with ANC &amp; 15.50% cases PNC. According to my observation cause of deaths are – 35.25% due to eclampsia/ toxemia/PIH, 27.5% cases due to Severe anemia/APH/PPH &amp; remaining due to septicemia, Abruptio/Ectopic/Hepatic coma/Dengue/HIV/Ruptured Uterus etc.

In vitro and in vivo studies of Vitex negundo-derived silver oxide nanoparticles against Meloidogyne incognita (Root-knot nematode) on tomato plants

Meloidogyne incognita (M. incognita) is an important obligatory pest affecting a large number of horticultural crops. The pest is widely distributed in tropical, subtropical, and warmer regions of the world. M. incognita induces root gall formation that interferes with nutrient supply leading to stunted growth, wilting, chlorosis and significant drop in plant productivity. In recent years biogenic nanoparticles have emerged as an alternative approach for controlling agricultural pests. The current study investigates the nematicidal potential of green-synthesized silver oxide nanoparticles derived from Vitex negundo against second-stage juvenile (J2) and eggs of M. incognita. The maximum mortality (97.20 %) of M. incognita was found after 96 h of treatment. The lowest egg hatching (7.40 %) in comparison with the control (86.93 %) was found in 500 ppm concentration after six days of exposure. The bioassay results revealed that both juveniles and eggs generally showed a concentration-dependent response. The in vivo treatment with biogenic nanoparticles showed reduced gall formation and increased plant growth in tomato plants. Maximum reduction in the galls and plant growth parameters was observed in higher concentrations (1000 ppm) of VND-AgONPs after 60 days compared to untreated inoculated control. To best of our knowledge, this is the first report of the nematicidal efficacy of VND-AgONPs against J2 and eggs of M. incognita. These biogenic nanoparticles could be recommended for managing Root-knot nematodes due to their higher efficacy, cost-effectiveness, and environmentally safe nature.

Green synthesis and evaluation of dual herb-extracted DHM-AgNPs: Antimicrobial efficacy and low ecotoxicity in agricultural and aquatic systems

Uncontrolled applications of weedicide and fertilizer can harm the soil ecology, and most significantly, earthworms are hazardous soil engineers. Thus, we aimed at the toxicity and histopathological alterations in the earthworm Eudrilus euginae following exposure to glyphosate (weedicide), urea (fertilizer), and environmentally friendly dual herb-mixed silver nanoparticles (DHM-AgNPs). The DHM-AgNPs were synthesized using a blend of Alfinia officinarum and Curcuma longa aqueous leaf extracts with 1 mM silver nitrate. The color change from yellow to brown after an hour of incubation was a significant indicator of successful DHM-AgNP synthesis. Characterization of the DHM-AgNPs using UV–Vis spectra indicated a surface plasmon resonance (SPR) peak at 430 nm. In addition to FT-IR spectroscopy and XRD analysis, SEM, TEM, and SEM investigations were performed to identify the DHM-AgNPs. The XPS analysis revealed the oxidation state and surface chemical composition, and Ag NP's specific surface area and degree of porosity were measured using BET. Furthermore, different concentrations of urea and glyphosate were administered to Artemia nauplii and E. euginae to assess their toxicity. The mortality rate for E. euginae exposed to a higher urea concentration (10 g/kg of soil) was 100%. In contrast, a % mortality rate of 83% was noted at 0.5 g/kg of soil. The maximum mortality (90 ± 0.64%) was observed at a 10 mL/kg/L concentration for glyphosate. In contrast, low mortality was noted in E. euginae and A. nauplii exposed with gradient concentrations of DHM-AgNPs compared to glyphosate and urea. As aquaculture and foodborne diseases are widespread, DHM-AgNPs showed significant anti-Vibrio activity against pathogenic Vibrio-related bacteria, inhibiting 80% at 100,100 μg/L, which is of great concern. This study suggests the potential use of DHM-AgNPs in field aqua and crops culture for eco-friendly pest control and anti-Vibrio activity without causing soil and environmental pollution. Further research is warranted to determine the efficacy, safety, and cost-effectiveness of DHM-AgNPs in aqua and agricultural practices.

Prediction of heatwave related mortality magnitude, duration and frequency with climate variability and climate change information

Given the link between climatic factors on one hand, such as climate change and low frequency climate oscillation indices, and the occurrence and magnitude of heat waves on the other hand, and given the impact of heat waves on mortality, these climatic factors could provide some predictive skill for mortality. We propose a new model, the Mortality-Duration-Frequency (MDF) relationship, to relate the intensity of an extreme summer mortality event to its duration and frequency. The MDF model takes into account the non-stationarities observed in the mortality data through covariates by integrating information concerning climate change through the time trend and climate variability through climate oscillation indices. The proposed approach was applied to all-cause mortality data from 1983 to 2018 in the metropolitan regions of Quebec and Montreal in eastern Canada. In all cases, models introducing covariates lead to a substantial improvement in the goodness-of-fit in comparison to stationary models without covariates. Climate change signal is more important than climate variability signal in explaining maximum summer mortality. However, climate indices successfully explain a part of the interannual variability in the maximum summer mortality. Overall, the best models are obtained with the time trend and the North Atlantic Oscillation (NAO) used as covariates. No country has yet integrated teleconnection information in their heat-health watch and warning systems or adaptation plans. MDF modeling has the potential to be useful to public health managers for the planning and management of health services. It allows predicting future MDF curves for adaptive management using the values of the covariates.

Determination of insecticidal potential of selected plant extracts against fall armyworm (Spodoptera frugiperda) larvae

The fall armyworm, Spodoptera frugiperda (J.E. Smith), is a devastating pest that attacks a wide range of crops, including sugarcane, rice, and maize. The purpose of this study is to evaluate the toxicity potential of native plant extracts (Azadirachta indica, Eucalyptus globulus, Parthenium hysterophorus, Cannabis sativa, Citrullus colocynthis, Nicotiana tabacum) against S. frugiperda. Four different concentrations (50, 100, 200, and 400 ppm) of the ethanolic plant extracts was evaluated against S. frugiperda third-instar larvae to determine their median lethal concentration (LC50). After 72 h of exposure, the LC50 values of A. indica, E. globulus, P. hysterophorus, C. sativa, C. colocynthis, N. tabacum, and positive control (Spinetoram) were 186.104, 518.438, 320.027, 334.259, 252.651, 720.980 and 189.369 ppm respectively. The maximum percent mortality was caused by the highest concentration (400 ppm) of A. indica (64 ± 0.18), E. globulus (48 ± 0.22), P. hysterophorus (56 ± 0.18), C. sativa (56 ± 0.18), C. colocynthis (60 ± 0.00), and N. tabacum (40 ± 0.28), after 72 h of treatment while Spinetoram induced 100 ± 0.00 percent mortality of S. frugiperda and only 4 ± 0.18 percent mortality was recorded in a control group. Results showed that all plant extracts were found to be effective against S. frugiperda. The compounds from the two most effective ethanolic plant extracts were identified by using Gas chromatography-mass spectrometry analysis (GC-MS). The key compounds identified in neem leaf extract and kortuma fruit extract are predominantly biologically active molecules. Many of them were volatile compounds that belonged to different chemical categories, such as fatty acids, hydrocarbons, esters, terpenoids, phenolic compounds, and amines. Terpenes exhibited a wide range of different biological activities, such as serving as insecticides and antifeedant. The presence of various functional groups in the plant extract was determined by conducting a Fourier Transform Infrared Spectroscopy (FTIR). Farmers should employ these kinds of environmental friendly insecticides to lessen the impact of fall armyworm because these products are cheaper to use and better for the economy and the environment.

Potent and selective ‘genetic zipper’ method for DNA-programmable plant protection: innovative oligonucleotide insecticides against Trioza alacris Flor

Chemical insecticides increased the chemical burden on natural ecosystems posing environmental health risk factor. The urgent need for a more sustainable and ecological approach has produced many innovative ideas, including eco-friendly ‘genetic zipper’ method (or CUAD platform) based on contact oligonucleotide insecticides. Oligonucleotide insecticides have enjoyed success recently on many sternorrhynchans showing highly adaptable structure for distinct insect pest species and selective mode of action. In this article, we describe the efficiency of the oligonucleotide insecticides (briefly, olinscides or DNA insecticides) Alacris-11 and Laura-11, as well as their combined use in mixture (1:1), designed for control of bay sucker (Trioza alacris Flor), an important psyllid pest of noble laurel (Laurus nobilis L.). These olinscides are based on short unmodified antisense DNA oligonucleotides that target ITS2 between 5.8S rRNA and 28S rRNA in pre-rRNA (Laura-11) and 28S rRNA region in mature 28S rRNA and pre-rRNA (Alacris-11). The maximum pest mortality, observed on the 14th day of the experiment, comprised 95.01 ± 4.42% for Alacris-11, 97.16 ± 2.48% for Laura-11, and 98.72 ± 1.14% for their mixture (1:1). The control oligonucleotide CTGA-11 did not cause any significant mortality (9.38 ± 0.57%), emphasizing selectivity in the action of oligonucleotide insecticides. The results show potent and specific nature of oligonucleotide insecticides for pest control and open up new frontiers in control of economically important psyllids in agriculture and forestry, including Asian citrus psyllid (Diaphorina citri Kuwayama) and many others. Scientists can easily adopt ‘genetic zipper’ method for plethora of insect pests because DNA is a programmable molecule and provides game-changing characteristics for plant protection.Graphical

EFFICACY OF TWO BIOPESTICIDES NECO 50 EC AND LIMOCIDE 60 ME ON COELAENOMENODERA LAMEENSIS (COLEOPTERA, CHRYSOMELIDAE: HISPINAE), THE MAIN PEST OF OIL PALM (DALOA, COTE DIVOIRE)

Coelaenomenodera lameensis (Coleoptera: Chrysomelidae, Hispinae), the leafminer of oil palm, is the most feared insect for this crop in Côte d'Ivoire. The aim of this study was to evaluate the efficacy of two biopesticides (NECO 50 EC and LIMOCIDE 60 ME) on C. lameensis adults. Trials were carried out under controlled infestation on an oil palm plot at the University Jean Lorougnon Guédé in Daloa. To assess the insecticidal effect of the products, male and female adults of C. lameensis were introduced into cages placed on palms containing palm leaflets. These adults were sprayed 48 hours later, at concentrations ranging from: 1.92×10-3 to 8.33×10-3 g/ml (NECO); from 3.58×10-4 to 1.75×10-3 g/ml (LIMOCIDE) and from 3.02×10-4 to 2.07×10-3 g/ml (Sivanto Energy, chemical reference insecticide). Controls were carried out from the 1st to the 15th day after treatment. NECO 50 EC induced maximum mortality rates of 100% (females and males) from day 4 after treatment. For LIMOCIDE, concentrations of 8.9×10-4 g/ml and 1.75×10-3 g/ml respectively induced mortality rates reaching 100%(females) on days 13 and 10 post-treatment. In males, only the 1.75×10-3 g/ml concentration produced mortality rates of 100% on day 12. In the case of Sivanto Energy, mortality rates of 100% (females and males) were recorded as early as day 2 at a concentration of 8.42×10-4 g/ml. Lethal Concentrations (LC50) were 4.96×10-3 g/ml (females) and 5.37×10-3g/ml (males) for NECO, 1.15×10-3g/ml (females) and 1.38×10-3 g/ml (males) for LIMOCIDE. These two biopesticides could be used as an alternative to the abusive use of synthetic insecticides to reduce C. lameensis damage and increase palm oil production in Côte d'Ivoire.

Associations Between Changes in Maximum Daily Atrial Fibrillation Duration, Ischemic Stroke, and Mortality

BackgroundAtrial fibrillation (AF) outcomes are strongly associated with continuous measures of AF burden. ObjectivesThis study sought to assess the association between changes in maximum daily AF duration (MDAFD) and stroke or mortality in patients with cardiac implantable electronic devices (CIEDs). MethodsThe Optum deidentified electronic health record data set (2007-2021) was linked with the Medtronic CareLink heart rhythm database. Patients with CIEDs and health care activity recorded in the electronic health record were included, excluding those with oral anticoagulation prescription. MDAFD was assessed 30 days post implant (baseline period) and 30 days before censoring or an event. HRs for the primary analysis were adjusted for components of CHA2DS2-VASc, baseline MDAFD category, and chronic kidney disease. ResultsOf 26,400 patients (age 68 ± 13 years; follow-up 2.6 ± 1.6 years) analyzed, 2,544 (9.6%) had AF during baseline. Increased (vs stable or decreased) MDAFD category in follow-up was associated with a higher adjusted rate of stroke and mortality (HR: 1.80; 95% CI: 1.61-2.01). There was no association between decreased MDAFD in follow-up and the combined endpoint (HR: 0.82; 95% CI: 0.68-1.00). Subgroup analysis by baseline MDAFD category demonstrated that increased MDAFD in follow-up was associated with a greater risk of stroke or mortality among patients with no AF at baseline, and decreased MDAFD in follow-up was associated with a lower risk of stroke or mortality among patients with baseline MDAFD of 1 to <5.5 hours and 5.5 to <23.5 hours. ConclusionsIn CIED patients not on oral anticoagulation, increased MDAFD in follow-up was associated with a higher rate of stroke and mortality. These results suggest that AF burden, and associated risk, s not stable over time.

Host Preference and Developmental Dynamics of Fall Armyworm &lt;i&gt;Spodoptera frugiperda&lt;/i&gt; (J E Smith)

The invasive fall army worm Spodoptera frugiperda (J E Smith) is a major global agricultural pest, originally from tropical and subtropical America, now affecting over 80 plant species across Africa, Asia, and beyond. This study examines its host preferences and developmental dynamics, focusing on four host plants: Zea mays L., Glycine max L., Carica papaya L., and Brassica oleraceae var. acephala L. Using a complete randomized design, mortality and developmental rates of larvae were evaluated. These results revealed that C. papaya and B. oleraceae leaves resulted in maximum larval mortality (80 and 65%, respectively). This can be attributed to the presence of secondary metabolites like tannins, terpenoids, flavonoids, and alkaloids, which exhibit toxic and antifeedant properties. This study highlights the armyworm's ability to adapt to alternative hosts like G. max and B. oleraceae, even surviving on C. papaya leaves, typically used as a botanical pesticide.

Identification of bioactive compounds in cavalcade leaves for nematicidal activity against Hirschmanniella mucronata and Meloidogyne graminicola using LC-QTOF-MS

Hirschmanniella mucronata and Meloidogyne graminicola are the main plant-parasitic nematodes found in paddy fields in Thailand causing significant rice production yield losses. Although these nematodes are found widely in fields, an effective management method has not been documented. Here, we examined the nematicidal effects of different cavalcade leaf ages (1-, 2- and 3-month-old), used as aqueous extracts and soil amendments, on H. mucronata and M. graminicola. In vitro tests evidenced maximum mortality of H. mucronata (55.6–60.0%) in 50 mg ml−1 extract from all leaf ages, while mortality (65.9%) and hatchability (67.0%) of M. graminicola second-stage juveniles were observed in 50 mg ml−1 extract from 1-month-old leaves only. Moreover, aqueous extracts of cavalcade showed a repellent effect on both nematodes. Similarly, greenhouse experiments showed a significant reduction of H. mucronata population densities and reproduction of M. graminicola in soil amended with 0.5 and 1.0% (w/w) from each leaf age. LC-QTOF-MS analysis determined that three bioactive compounds, including quercetin, rutin, and kaempferol, are associated with the nematicidal activity of cavalcade against H. mucronata and M. graminicola. The information derived from this study indicates that the leaves of cavalcade are a source of promising phytonematicidals. This is the first study to assess and document its potential for nematicidal activity against H. mucronata and M. graminicola in Thailand. However, further research is needed to evaluate their efficacy under paddy field conditions.

Assessment of clinical and histopathological characteristics in COVID-19-associated mucormycosis (CAM) patients correlating with outcome: A hospital-based cross-sectional study.

The second wave of the COVID-19 pandemic led to a very dreaded complication of mucormycosis. Immunosuppressive action of the COVID-19 virus, co-morbidities, for example, diabetes mellitus (DM), hypertension, use of steroids, and humidified oxygen, are among the important factors that make the patients susceptible to developing mucormycosis. The present study was conducted to identify and understand all the significant histological changes including the type and extent of tissue involvement, the pattern of inflammation, the volume of fungal hyphae, hemorrhage, etc., in patients with COVID-19 associated mucormycosis (CAM) and correlate with clinical outcome. It was a retrospective cross-sectional observational study involving all the patients of CAM, who underwent debridement or biopsy over a period of 5 months, from April 01, 2021, to August 31, 2021. CAM was classified based on the radiological evaluation, clinical features, and organs involved. Different demographic, clinical, laboratory, and histologic parameters were recorded. The variables were assessed for their association with poor clinical outcomes using multiple logistic regression. P < 0.05 was considered statistically significant. A total of 146 patients were included in the study with a mean age of 49.4 years and 71.2% were male. Sino-naso-palatal was the most common type of CAM (32.9%), while sino-naso-cerebral was the least common (14.3%). DM was present in 54.1% of patients, out of which 26.6% were recently diagnosed. The death occurred in 21.9% of patients. Maximum mortality was observed in CAM of sino-naso-cerebral involvement (42.9%). Total leucocyte count (TLC) [OR = 0.87; 95%CI: 0.76-0.97; P = 0.02] and C-reactive protein (CRP) [OR = 0.97; 95%CI: 0.96-0.99; P = 0.008] were significantly associated with poor outcomes. Other factors, that is, high prothrombin time, DM, ferritin, and the involvement of muscle, skin, and cartilage, were also associated with poor clinical outcomes but were not statistically significant. Similarly, high fungal volume and the presence of thrombosis were also associated with poor outcomes but were not statistically significant. CAM more commonly affects males with co-morbidities. TLC and CRP were significantly associated with poor outcomes. Histologically, the involvement of skin, muscle, and cartilage and the presence of excessive fungal hyphae and thrombosis were also associated with poor outcomes.

Evaluation of endophytic colonization and establishment of entomopathogenic fungi against Tuta absoluta (Lepidoptera: Gelechiidae) in tomato plants.

The tomato, Solanum lycopersicum L., is one of the most important horticultural crops that can be consumed fresh or after being processed worldwide. The tomato leaf miner (Tuta absoluta) is one of the most devastating pest to tomato plants due to its mine-feeding nature in the mesophyll tissue of the plant. Fungal entomopathogens can exist naturally in plants as an asymptote. This study aimed to detect the endophytic colonization of Beauveria bassiana and Metarhizium robertsii within tomato plants via artificial inoculation and their virulence effects on Tuta absoluta. Isolates with the highest percent germination and virulence against T. absoluta were selected for endophytic evaluation within tomato plants by different artificial inoculation techniques. This study revealed that, isolates with the highest percent germination and virulent to Tuta absoluta had the potential to colonize tomato plants. The result showed that, the maximum mortality rate (97.5%) of Tuta absoluta larvae was achieved by Metarhizium robertsii isolate K-61 at a concentration of 1x10 8conidial/ml at 7 days post inoculated. However, the highest cumulative mortality (100%) was recorded by Beauveria bassiana isolate APPRC-27 at 10 days post inoculated through the direct contact method. The highest endophytic colonization was registered by isolate APPRC-27 (76.67%) at 7 days post-inoculated using the leaf spray technique, but it declined to 11.67% after 28 days of inoculated. In the case of the seedling inoculation technique, the highest endophytic colonization was obtained in the root tissues of tomatoes at 28 days of inoculated by isolate K-61. This study revealed that the leaf spray inoculation technique was the most effective method, followed by seedling inoculation, for the deployment of Beauveria bassiana and Metarhizium robertsii endophytes in tomato plant tissues. Therefore, virulent Beauveria bassiana and Metarhizium robertsii, are promising bioagents for the control of Tuta absoluta if deployed as endophytes.

Laboratory Assessment of the Efficacy of Some Biopesticides on Aspects of the Life Performance of the Callsobruchus maculates

Callosobruchus maculatus, the Southern Cowpea Beetle, is one of the most damaging pests that feeds on stored seeds, severely reducing their nutritional content by compromising their quality and marketability. It is critical to identify a viable substitute for chemical pesticides, which not only have high costs but also numerous detrimental effects on both humans and the environment, as a result of the beetles' development of resistance to them. Therefore, the goal of the current study was to employ various biopesticides made from entomopathogenic fungus, which are fungi that feed on insects, and investigate the potential effects of these pesticides on the life performance of the C. maculatus, which is significant for both nutrition and the economy. The study aimed to find a promising alternative to chemical pesticides by using biopesticides derived from entomopathogenic fungi. The results of the current laboratory study showed a significant effect of the two biopesticides, L. lecanii and M. anisopliae, in increasing the mortality rate of eggs and adult stages of the C. maculatus. After 9 days of exposure to the biopesticide, M. anisopliae produced the maximum mortality rate for both eggs and adults at a concentration of 5x10⁷ g/L. The biopesticides M. anisopliae and L. lecani iwere exposed to the eggs and adults that had the lowest death rate one day later. Based on the current study's findings, it can be said that using the biopesticides M. anisopliae and L. lecanii can help control the Southern Cowpea Beetle and lessen the need for chemical pesticides.

Association between maximum norepinephrine dosage and mortality risk in neonates with septic shock

The high-dose usage of norepinephrine is thought to cause high mortality in patients with septic shock. This study aims to explores the correlation between the maximum norepinephrine (NE) dosage (MND) and mortality in neonates with septic shock. This retrospective cohort study included neonates with evidence of septic shock and those who received NE infusion. The study included 123 neonates, with 106 in the survival group and 17 in the death group. The death group exhibited significantly lower birth weight (p = 0.022), 1-min Apgar score (p = 0.005), serum albumin (p < 0.001), and base excess (BE) (p = 0.001) levels, but higher lactate (LAC) levels (p = 0.009) compared to the survival group. MND demonstrated an ROC area under the curve of 0.775 (95% CI 0.63–0.92, p < 0.001) for predicting mortality, with an optimal threshold of 0.3 µg/(kg·min), a sensitivity of 82.4%, and a specificity of 75.5%. Multivariate logistic regression indicated that an MND > 0.3 µg/(kg·min) (OR, 12.08, 95% CI 2.28–64.01) was associated with a significantly higher mortality risk. Spearman rank correlation showed a positive correlation between MND and LAC (r = 0.252, p = 0.005), vasoactive-inotropic score (VIS) (r = 0.836, p < 0.001), and a negative correlation with BE (r = − 0.311, p = 0.001). MND > 0.3 µg/(kg min) is a useful predictive marker of mortality in neonatal septic shock.

Need for Blood Transfusion Volume Is Associated With Increased Mortality in Severe Traumatic Brain Injury

IntroductionMany patients suffering from isolated severe traumatic brain injury (sTBI) receive blood transfusion on hospital arrival due to hypotension. We hypothesized that increasing blood transfusions in isolated sTBI patients would be associated with an increase in mortality. MethodsWe performed a trauma quality improvement program (TQIP) (2017-2019) and single-center (2013-2021) database review filtering for patients with isolated sTBI (Abbreviated Injury Scale head ≥3 and all other areas ≤2). Age, initial Glasgow Coma Score (GCS), Injury Severity Score (ISS), initial systolic blood pressure (SBP), mechanism (blunt/penetrating), packed red blood cells (pRBCs) and fresh frozen plasma (FFP) transfusion volume (units) within the first 4 h, FFP/pRBC ratio (4h), and in-hospital mortality were obtained from the TQIP Public User Files. ResultsIn the TQIP database, 9257 patients had isolated sTBI and received pRBC transfusion within the first 4 h. The mortality rate within this group was 47.3%. The increase in mortality associated with the first unit of pRBCs was 20%, then increasing approximately 4% per unit transfused to a maximum mortality of 74% for 11 or more units. When adjusted for age, initial GCS, ISS, initial SBP, and mechanism, pRBC volume (1.09 [1.08-1.10], FFP volume (1.08 [1.07-1.09]), and FFP/pRBC ratio (1.18 [1.08-1.28]) were associated with in-hospital mortality. Our single-center study yielded 138 patients with isolated sTBI who received pRBC transfusion. These patients experienced a 60.1% in-hospital mortality rate. Logistic regression corrected for age, initial GCS, ISS, initial SBP, and mechanism demonstrated no significant association between pRBC transfusion volume (1.14 [0.81-1.61]), FFP transfusion volume (1.29 [0.91-1.82]), or FFP/pRBC ratio (6.42 [0.25-164.89]) and in-hospital mortality. ConclusionsPatients suffering from isolated sTBI have a higher rate of mortality with increasing amount of pRBC or FFP transfusion within the first 4 h of arrival.

Evaluation of trend and mortality pattern of communicable diseases in a teaching institution in Kerala.

Even in this era of epidemiologic transition communicable disease is still a major public health problem. Surveillance and timely prevention and control activities are the key to the reduction of morbidity and mortality of communicable diseases. Identifying the trend in communicable diseases and pattern of mortality for a period of ten years will be an insight into the ongoing surveillance. In this study we have analysed data from 2013 to 2022 to evaluate the trend and mortality pattern of communicable diseases in a teaching institution in Kerala. A retrospective record-based cross-sectional study conducted at the Department of Community Medicine, Government Medical College, Kottayam. All confirmed communicable disease cases reported from 2013 to 2022 were included in this study except COVID-19-positive cases. The communicable diseases were grouped as: airborne, waterborne, vector-borne, zoonosis, bloodborne diseases and others. SPSS version 20.0 software, Microsoft Word, and Excel were used in data handling and analysis. Total cases reported were 48124. The majority of the morbidity was due to airborne diseases (17585,37%) followed by waterborne diseases (6381, 13%). The total number of deaths reported was 1842. Airborne and zoonotic diseases together accounted for more than 50% of the mortality. Case fatality rate of zoonosis (20.2%) was the highest followed by bloodborne diseases (10.2%). Communicable diseases still continue as a public health problem contributing to morbidity and mortality. Airborne diseases and zoonotic diseases constitute the maximum mortality.

Gamma irradiation induced thermotolerance in Metarhizium spp. enhancing biocontrol of Nilapavarta lugens (Stål)

The Brown Planthopper (BPH), Nilaparvata lugens (Stål), is a devastating pest to rice crops in Southeast Asia, primarily due to its resistance to insecticides. As a result, the fungus Metarhizium spp. is used as an alternative control for BPH. However, their efficiency is limited due to delayed infectivity and sensitivity to environmental variables. In this study, two isolates of Metarhizium spp. MLUBN038 and MNMHN031, were induced for thermotolerance and biocontrol potential against Nilapavarta lugens (Stål). A multilocus phylogeny of four protein-coding genes including Beta-tubulin, rpb1, rpb2, and tef has identified the two isolates to be Metarhizium koreanum. Seventy-nine potential thermotolerant mutants were screened from the two isolates. These mutant isolates demonstrated significant tolerance to vegetative heat at 39 °C and enhanced resistance to wet heat stress at 45 °C after exposure for 60 h, outperforming the wild-type (WT) isolates. The mutant isolates also showed increased mycelial growth, conidial germination, and spore production compared to the WT isolates. Two mutant isolates, ML038_Mt 71 and MN031_Mt 46, exhibited the highest efficacy against BPH nymphs (4th-5th instars), resulting in a maximum mortality of 88.82 % and 83.55 %, respectively, compared to the WT (54.07 % and 47.54 %) after 14 days of inoculation in the greenhouse. These two highly virulent mutant isolates presented the lowest LT50 values of 2.88 and 3.72 days at a concentration of 1 × 109 conidia/mL. RAPD analysis revealed genetic diversity between the mutant and WT isolates, indicating distinct diversity profiles and supporting the successful generation of mutant variants. These findings suggest that the use of gamma irradiation and heat stress to induce mutations is crucial for the successful production of thermotolerant mutant isolates. Our results suggest that ML031_Mt 71 and MN031_Mt 46 have potential as effective biocontrol agents.

Optimal timing of a colonoscopy screening schedule depends on adenoma detection, adenoma risk, adherence to screening and the screening objective: A microsimulation study.

Colonoscopy-based screening provides protection against colorectal cancer (CRC), but the optimal starting age and time intervals of screening colonoscopies are unknown. We aimed to determine an optimal screening schedule for the US population and its dependencies on the objective of screening (life years gained or incidence, mortality, or cost reduction) and the setting in which screening is performed. We used our established open-source microsimulation model CMOST to calculate optimized colonoscopy schedules with one, two, three or four screening colonoscopies between 20 and 90 years of age. A single screening colonoscopy was most effective in reducing life years lost from CRC when performed at 55 years of age. Two, three and four screening colonoscopy schedules saved a maximum number of life years when performed between 49-64 years; 44-69 years; and 40-72 years; respectively. However, for maximum incidence and mortality reduction, screening colonoscopies needed to be scheduled 4-8 years later in life. The optimum was also influenced by adenoma detection efficiency with lower values for these parameters favoring a later starting age of screening. Low adherence to screening consistently favored a later start and an earlier end of screening. In a personalized approach, optimal screening would start earlier for high-risk patients and later for low-risk individuals. In conclusion, our microsimulation-based approach supports colonoscopy screening schedule between 45 and 75 years of age but the precise timing depends on the objective of screening, as well as assumptions regarding individual CRC risk, efficiency of adenoma detection during colonoscopy and adherence to screening.

Efficacy of Some Aquatic Plant Extracts on the Khapra Beetle &lt;i&gt;Trogoderma Granarium&lt;/i&gt; Everts

Khapra beetle is one of the dangerous pests that infests fields and warehouses, and using safe alternatives such as plant extracts is one of the options. The efficacy of aqueous extracts of Achillea fragrantissima and Chenopodium album (5, 10, 15%) at different exposure durations (48, 96, and, 144 hr) has been evaluated in this study. Mortality of fifth-instar larvae and adults was observed, and it was shown that an exposure period of 144 hr was superior with hot and coldwater extracts of C. album. The results also showed that maximum mortality of fifth instar larva (65,000 and 92,405%), respectively, was at a concentration of 15% for the cold and boiling water extracts. Mortality of adults was maximum with cold and hot water extracts of the C. album, at an exposure period of 144 hr, as well as at 15% (36,809 and 55,671%, and (51,299 and 74,671%, respectively). Thus the results showed that C. album extract was superior, there existed a significant effect of the interaction between (extract type, concentration, and treatment duration) on the mortality of larvae and adults.