Mango sudden decline pathogen, Ceratocystis manginecans, is vectored by Hypocryphalus mangiferae (Coleoptera : Scolytinae) in Oman

In Oman, the bark beetle Hypocryphalus mangiferae is closely associated with trees affected by mango sudden decline disease caused by Ceratocystis manginecans. Although it has previously been assumed that this beetle plays a role in the dispersal of the pathogen, this has not been established experimentally. The aim of this study was to determine whether H. mangiferae vectors C. manginecans from infected to healthy mango trees. A survey conducted in northern Al Batinah region of Oman revealed that H. mangiferae was closely associated with mango sudden decline disease symptoms and it was found on trees in the early stages of the disease. Healthy, 2- year-old mango seedlings were exposed to H. mangiferae collected from diseased mango trees. Seedlings were infested by the bark beetles and after 6 weeks, typical mango sudden decline disease symptoms were observed. Ceratocystis manginecans was isolated from the wilted mango seedlings while uncolonized control seedlings remained healthy. The results show that H. mangiferae vectors C. manginecans in Oman and is, therefore, an important factor in the epidemiology of this disease.The National Research Foundation (NRF)http://www.springerlink.com /content/100265

Clonal structure of Ceratocystis manginecans populations from mango wilt disease in Oman and Pakistan

Ceratocystis manginecans has recently been described from Oman and Pakistan where the fungus causes a serious wilt disease of mango. In both countries, the disease has moved rapidly throughout mango producing areas leading to the mortality of thousands of mango trees. The disease is associated with the infestation of the wood-boring beetle Hypocryphalus mangiferae that consistently carries C. manginecans. The aim of this study was to consider the population structure of C. manginecans isolated from Oman and Pakistan using microsatellite markers and amplified fragment length polymorphisms (AFLPs).Population genetic analysis of C. manginecans isolates from diseased mango tissue and bark beetles associated with the disease in Oman and Pakistan, showed no genetic diversity. The apparently clonal nature of the population suggests strongly that C. manginecans was introduced into these countries as a single event or from another clonal source.Tree Protection Co-operative Programme (TPCP), National Research Foundation (NRF), South Africa and the Ministry of Agriculture and Fisheries in Sultanate of Oman.http://link.springer.com/journal/13313hb201

Evaluation of mango cultivars for resistance to infection by ceratocystis manginecans

Ceratocystis manginecans has been reported to cause a serious wilt disease of mango in Oman and Pakistan. To identify plants resistant to this disease, 30 mango cultivars were artificially inoculated with isolates of C. manginecans in three trials. Statistical analysis revealed significant differences (P < 0.0001) in lesion lengths among mango cultivars. Similarly, there were significant differences in the aggressiveness of the isolates used for inoculations. However, in trials where more than one isolate was used, there was no significant isolate x cultivar interaction suggesting that isolates do not affect the ranking of cultivars as susceptible or resistant. Cultivar ‘Pairi’ and local mango cultivars had the longest lesions and were ranked as highly susceptible. In contrast, cultivars ‘Hindi Besennara’, ‘Sherokerzam’, ‘Mulgoa’, ‘Baneshan’, ‘Rose’ and ‘Alumpur Baneshan’, had the smallest lesions and are considered as relatively resistant against C. manginecans. The inoculation results are concurrent with the incidence of wilt of these cultivars under field conditions.The Tree Protection Co-operative Programme (TPCP), National Research Foundation (NRF) in South Africa, the Ministry of Agriculture and Sultan Qaboos University in Sultanate of Oman and Food and Agriculture organization (FAO).http://www.actahort.org/am201

Ceratocystis manginecans associated with a serious wilt disease of two native legume trees in Oman and Pakistan

A serious wilt disease has recently been found on Prosopis cineraria (Ghaf) in Oman and on Dalbergia sissoo (Shisham) in Pakistan. Disease symptoms on both these native, leguminous hosts include vascular discolouration and partial or complete wilt of affected trees. A species of Ceratocystis was consistently isolated from symptomatic material. Morphological comparisons and analyses of DNA sequence data of the ITS, β-tubulin, and EF 1-α gene regions showed that the Ceratocystis isolates obtained from both tree species represent C. manginecans. This is the same pathogen that is causing the devastating mango sudden decline disease in Oman and Pakistan. This is also the same pathogen that has been reported causing a wilting disease on Acacia mangium in Indonesia. Cross inoculation with C. manginecans isolates from P. cineraria, D. sissoo and mango showed that the fungus can cause disease on all three trees.Tree Protection Cooperative Programme (TPCP), University of Pretoria, South Africa, and the Ministry of Agriculture and Fisheries, Omanhttp://link.springer.com/journal/13313hb201

Two new Ceratocystis species associated with mango disease in Brazil

Mangifera indica, a disease known as mango blight, murcha or seca da mangueira in Brazil, is caused by the canker wilt pathogen Ceratocystis fimbriata sensu lato. It is also closely associated with infestation by the non-native wood-boring beetle Hypocryphalus mangiferae (Coleoptera: Scolytinae). The aim of this study was to characterize Ceratocystis isolates obtained from diseased mango trees in Brazil. Identification was based on sequence data from ITS1+5.8S+ITS2 rDNA, part of the Beta-tubulin 1 gene, and part of the Transcription Elongation Factor 1-alpha gene. The Brazilian isolates grouped in two well defined and unique clades within C. fimbriata s.l. These were also distinct from C. manginecans, which causes a similar disease associated with H. mangiferae in Oman and Pakistan. Based on sequence comparisons and morphological characteristics, isolates representing the two phylogenetic clades are described as C. mangicola sp. nov. and C. mangivora sp. nov.The National Research Foundation (NRF), members of the Tree Protection Co-operative Programme (TPCP), the THRIP initiative of the Department of Trade and Industry, and the Department of Science and Technology (DST)/NRF Centre of Excellence in Tree Health Biotechnology (CTHB).http://www.mycotaxon.com/nf201

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p&lt;0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p&lt;0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Studies on Ceratocystis spp. associated with mango die-back in Oman

Mango wilt disease represents one of destructive diseases threatening mango cultivation in areas where it has been reported. Studies in this thesis represent the first to be undertaken after it was recognized that the disease is caused by the vascular wilt and canker pathogen Ceratocytis manginecans in Oman and Pakistan. Studies in this thesis showed clearly that the pathogen in the area represents a single clonal entity, adding credence to the view that the pathogen was introduced into Oman and Pakistan. Furthermore, the pathogen was shown to be vectored by the bark beetle Hypocryphalus mangiferae, which is native to India and has apparently been introduced into Oman, Pakistan and various other parts of the world such as Brazil where mango wilt is a serious disease. Concurrent with the appearance of mango wilt, two leguminous trees Prosopis cineraria and Dalbergia sissoo, began to wilt and die in Oman and Pakistan respectively. In this study, it was possible to show that these trees are also dying as result of infection by C. manginecans and that the pathogen appears to have undergone a host shift to these native trees. Both these tree species were shown to be susceptible to be equally susceptible to infection by C. manginecans as is mango. A final part of this investigation considered opportunities to select mango cultivars resistant to mango wilt in Oman. Here, the local mango accessions other than Pairi were shown to be highly susceptible to infection. In contrast, several mango cultivars such as Hindi Besennara, Sherokerzam, Mulgoa, Baneshan, Rose and Alumpur Baneshan had small lesions after inoculation with C. manginecans and can be considered amongst the tolerant mango cultivars. These results were also consistent with field evaluations. Studies undertaken in this thesis have added substantial information concerning mango wilt disease in Oman and it is hoped that this will help to reduce the devastation due to C. manginecans in the future.Thesis (PhD)--University of Pretoria, 2012.Microbiology and Plant PathologyPhDUnrestricte

Fusarium mangiferae associated with mango malformation in the Sultanate of Oman

Mango malformation, caused by Fusarium mangiferae, represents the most important floral disease of mango. The first symptoms of this disease were noticed in the beginning of 2005 in plantations at Sohar in the Sultanate of Oman. The affected inflorescences were abnormally enlarged and branched with heavy and dried-out panicles. Based on morphology and DNA-sequence data for the genes encoding translation elongation factor 1α and β-tubulin, the pathogen associated with these symptoms was identified as F. mangiferae

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

Background: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit