Non-immune hydrops fetalis: a case of parvovirus B19 infection in pregnancy

Parvovirus B19 infection during pregnancy is mostly asymptomatic, but in approximately 3% of infected women, it can cause hydrops fetalis, severe fetal anemia and even fetal demise. A 23 year old primigravida with 33+5 weeks period of gestation came to our hospital with threatened preterm labour and polyhydramnios. Ultrasound with Doppler showed features of fetal hydrops with fetal anemia. She was tested positive for parvovirus IgM and was planned for intra uterine transfusion. But patient went into preterm labour and delivered a single, stillborn, male of 2.75 kg with no visible gross anamolies. There is currently no approved vaccine or antiviral treatment for parvovirus B19 infection, but counselling of non-immune mothers and active management of confirmed maternal infections with intrauterine transfusion to correct fetal anemia is likely to improve the survival rates with significant reduction in neonatal morbidity and mortality

Knowledge, attitude and practices towards consumption of caffeine containing drinks among the student population of Ras al-Khaimah medical and health sciences university, UAE

Background: Caffeine, world’s most widely consumed and legally accepted psychoactive substance which is commonly found ingredient in many drinks like coffee, tea, carbonated drinks and energy drinks. The objective was to explore how much dependent are the teenagers and young adults on caffeine containing drinks, reasons and circumstances for the consumption and to know the knowledge and attitude of the consumers about the health effects of the caffeine containing drinks.Methods: A validated questionnaire was administered randomly to about 298 students from MBBS, BDS, B Pharma and Nursing programmes of RAK Medical and Health Sciences University (RAKMHSU).Results: Out of 298 students in the study, 97% (n=290) of them drink caffeinated beverages in the form of coffee (53%), tea (43%), energy drinks (17%), carbonated drinks (18%) and all of the above (11%). The major reasons for consuming varied, where more than half of them gave the reason as to keep them awake for study purpose (53%), to get refreshed (51%), taste and flavour (49%). About 56% were of an opinion that they do experience different symptoms if they don’t consume their daily caffeine intake. 54% students admitted their caffeine consumption has been increased after joining the university. When knowledge and attitude were questioned, 63% of them think caffeine addiction is a health issue and majority of them were aware of the ingredients of these drinks but not the safest amount.Conclusions: Drinking caffeine containing drinks by the students are variable from different sources, so monitoring is necessary for the daily intake and there is need for educational programmes about the health effects related to high consumption of caffeine.

Clinical profile of high-risk febrile neutropenia in a tertiary care hospital

BackgroundInfection in the immunocompromised host has been a reason of concern in the clinical setting and a topic of debate for decades. In this study, the aim was to analyse the clinical profile of high-risk febrile neutropenic patients.AimsTo study the clinical profile of high risk febrile neutropenia patients with the objective of identifying the most common associated malignancy, most common associated pathogen, the source of infection, to correlate the treatment and management with that of the Infectious Diseases Society of America (IDSA) 2010 guidelines and to assess the clinical outcome.MethodsA cross-sectional time bound study was carried out and a total of 80 episodes of high-risk febrile neutropenia were recorded among patients with malignancies from September 2011 to July 2013 with each episode being taken as a new case.ResultsNon-Hodgkin’s lymphoma (30 per cent) was the most common malignancy associated, commonest source of infection was due to central venous catheters, the commonest pathogens were gram negative (52 per cent) the treatment and management of each episode of high risk febrile neutropenia correlated with that of IDSA 2010 guidelines and the mortality rate was 13.75 per cent.ConclusionFebrile neutropenia is one of the major complications and cause of mortality in patients with malignancy and hence understanding its entire spectrum can help us reduce morbidity and mortality

Snake bite: An unusual cause of ischaemic stroke

Snake bite continues to be one of the major and potential contributors for morbidity and mortality in India. Intracranial haemorrhage causing neurological deficits is a known entity due to snake bite but presentation with infarction is rare. The authors report a case of a healthy middle aged female who presented within hours of envenomation with altered sensorium and evaluation revealed left hemiplegia with deranged coagulation profile and multiple ischaemic infarcts instead of haemorrhage as a consequence of vasculotoxic envenomation due to viper bite

Snake bite: An unusual cause of ischaemic stroke

Snake bite continues to be one of the major and potential contributors for morbidity and mortality in India. Intracranial haemorrhage causing neurological deficits is a known entity due to snake bite but presentation with infarction is rare. The authors report a case of a healthy middle aged female who presented within hours of envenomation with altered sensorium and evaluation revealed left hemiplegia with deranged coagulation profile and multiple ischaemic infarcts instead of haemorrhage as a consequence of vasculotoxic envenomation due to viper bite

Seed Longevity in Legumes: Deeper Insights Into Mechanisms and Molecular Perspectives

Sustainable agricultural production largely depends upon the viability and longevity of high-quality seeds during storage. Legumes are considered as rich source of dietary protein that helps to ensure nutritional security, but associated with poor seed longevity that hinders their performance and productivity in farmer's fields. Seed longevity is the key determinant to assure proper seed plant value and crop yield. Thus, maintenance of seed longevity during storage is of prime concern and a pre-requisite for enhancing crop productivity of legumes. Seed longevity is significantly correlated with other seed quality parameters such as germination, vigor, viability and seed coat permeability that affect crop growth and development, consequently distressing crop yield. Therefore, information on genetic basis and regulatory networks associated with seed longevity, as well as molecular dissection of traits linked to longevity could help in developing crop varieties with good storability. Keeping this in view, the present review focuses towards highlighting the molecular basis of seed longevity, with special emphasis on candidate genes and proteins associated with seed longevity and their interplay with other quality parameters. Further, an attempt was made to provide information on 3D structures of various genetic loci (genes/proteins) associated to seed longevity that could facilitate in understanding the interactions taking place within the seed at molecular level. This review compiles and provides information on genetic and genomic approaches for the identification of molecular pathways and key players involved in the maintenance of seed longevity in legumes, in a holistic manner. Finally, a hypothetical fast-forward breeding pipeline has been provided, that could assist the breeders to successfully develop varieties with improved seed longevity in legumes

Mortality and disability-adjusted life years in North Africa and Middle East attributed to kidney dysfunction : a systematic analysis for the Global Burden of Disease Study 2019

The authors would like to thank the hard work of the staff of the Institute for Health Metrics and Evaluation (IHME) for providing the best possible epidemiologic estimation of diseases in almost all regions and countries of the world, trying to reduce and eliminate poverty of knowledge and information about the diseases globally. Also, the core team authors sincerely thank all the collaborators of the GBD 2019 study who contributed to this study by providing data or a precise review of the manuscript. Publisher Copyright: © The Author(s) 2023. Published by Oxford University Press on behalf of the ERA. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.Peer reviewe

Global, regional, and national burden of low back pain, 1990–2020, its attributable risk factors, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021

Background: Low back pain is highly prevalent and the main cause of years lived with disability (YLDs). We present the most up-to-date global, regional, and national data on prevalence and YLDs for low back pain from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021. Methods: Population-based studies from 1980 to 2019 identified in a systematic review, international surveys, US medical claims data, and dataset contributions by collaborators were used to estimate the prevalence and YLDs for low back pain from 1990 to 2020, for 204 countries and territories. Low back pain was defined as pain between the 12th ribs and the gluteal folds that lasted a day or more; input data using alternative definitions were adjusted in a network meta-regression analysis. Nested Bayesian meta-regression models were used to estimate prevalence and YLDs by age, sex, year, and location. Prevalence was projected to 2050 by running a regression on prevalence rates using Socio-demographic Index as a predictor, then multiplying them by projected population estimates. Findings: In 2020, low back pain affected 619 million (95% uncertainty interval 554–694) people globally, with a projection of 843 million (759–933) prevalent cases by 2050. In 2020, the global age-standardised rate of YLDs was 832 per 100 000 (578–1070). Between 1990 and 2020, age-standardised rates of prevalence and YLDs decreased by 10·4% (10·9–10·0) and 10·5% (11·1–10·0), respectively. A total of 38·8% (28·7–47·0) of YLDs were attributed to occupational factors, smoking, and high BMI. Interpretation: Low back pain remains the leading cause of YLDs globally, and in 2020, there were more than half a billion prevalent cases of low back pain worldwide. While age-standardised rates have decreased modestly over the past three decades, it is projected that globally in 2050, more than 800 million people will have low back pain. Challenges persist in obtaining primary country-level data on low back pain, and there is an urgent need for more high-quality, primary, country-level data on both prevalence and severity distributions to improve accuracy and monitor change. Funding: Bill and Melinda Gates Foundation

Diabetes mortality and trends before 25 years of age: an analysis of the Global Burden of Disease Study 2019

Background: Diabetes, particularly type 1 diabetes, at younger ages can be a largely preventable cause of death with the correct health care and services. We aimed to evaluate diabetes mortality and trends at ages younger than 25 years globally using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. Methods: We used estimates of GBD 2019 to calculate international diabetes mortality at ages younger than 25 years in 1990 and 2019. Data sources for causes of death were obtained from vital registration systems, verbal autopsies, and other surveillance systems for 1990–2019. We estimated death rates for each location using the GBD Cause of Death Ensemble model. We analysed the association of age-standardised death rates per 100 000 population with the Socio-demographic Index (SDI) and a measure of universal health coverage (UHC) and described the variability within SDI quintiles. We present estimates with their 95% uncertainty intervals. Findings: In 2019, 16 300 (95% uncertainty interval 14 200 to 18 900) global deaths due to diabetes (type 1 and 2 combined) occurred in people younger than 25 years and 73·7% (68·3 to 77·4) were classified as due to type 1 diabetes. The age-standardised death rate was 0·50 (0·44 to 0·58) per 100 000 population, and 15 900 (97·5%) of these deaths occurred in low to high-middle SDI countries. The rate was 0·13 (0·12 to 0·14) per 100 000 population in the high SDI quintile, 0·60 (0·51 to 0·70) per 100 000 population in the low-middle SDI quintile, and 0·71 (0·60 to 0·86) per 100 000 population in the low SDI quintile. Within SDI quintiles, we observed large variability in rates across countries, in part explained by the extent of UHC (r2=0·62). From 1990 to 2019, age-standardised death rates decreased globally by 17·0% (−28·4 to −2·9) for all diabetes, and by 21·0% (–33·0 to −5·9) when considering only type 1 diabetes. However, the low SDI quintile had the lowest decline for both all diabetes (−13·6% [–28·4 to 3·4]) and for type 1 diabetes (−13·6% [–29·3 to 8·9]). Interpretation: Decreasing diabetes mortality at ages younger than 25 years remains an important challenge, especially in low and low-middle SDI countries. Inadequate diagnosis and treatment of diabetes is likely to be major contributor to these early deaths, highlighting the urgent need to provide better access to insulin and basic diabetes education and care. This mortality metric, derived from readily available and frequently updated GBD data, can help to monitor preventable diabetes-related deaths over time globally, aligned with the UN's Sustainable Development Targets, and serve as an indicator of the adequacy of basic diabetes care for type 1 and type 2 diabetes across nations. Funding: Bill & Melinda Gates Foundation

Population-level risks of alcohol consumption by amount, geography, age, sex, and year: a systematic analysis for the Global Burden of Disease Study 2020

Background: The health risks associated with moderate alcohol consumption continue to be debated. Small amounts of alcohol might lower the risk of some health outcomes but increase the risk of others, suggesting that the overall risk depends, in part, on background disease rates, which vary by region, age, sex, and year. Methods: For this analysis, we constructed burden-weighted dose–response relative risk curves across 22 health outcomes to estimate the theoretical minimum risk exposure level (TMREL) and non-drinker equivalence (NDE), the consumption level at which the health risk is equivalent to that of a non-drinker, using disease rates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2020 for 21 regions, including 204 countries and territories, by 5-year age group, sex, and year for individuals aged 15–95 years and older from 1990 to 2020. Based on the NDE, we quantified the population consuming harmful amounts of alcohol. Findings: The burden-weighted relative risk curves for alcohol use varied by region and age. Among individuals aged 15–39 years in 2020, the TMREL varied between 0 (95% uncertainty interval 0–0) and 0·603 (0·400–1·00) standard drinks per day, and the NDE varied between 0·002 (0–0) and 1·75 (0·698–4·30) standard drinks per day. Among individuals aged 40 years and older, the burden-weighted relative risk curve was J-shaped for all regions, with a 2020 TMREL that ranged from 0·114 (0–0·403) to 1·87 (0·500–3·30) standard drinks per day and an NDE that ranged between 0·193 (0–0·900) and 6·94 (3·40–8·30) standard drinks per day. Among individuals consuming harmful amounts of alcohol in 2020, 59·1% (54·3–65·4) were aged 15–39 years and 76·9% (73·0–81·3) were male. Interpretation: There is strong evidence to support recommendations on alcohol consumption varying by age and location. Stronger interventions, particularly those tailored towards younger individuals, are needed to reduce the substantial global health loss attributable to alcohol. Funding: Bill & Melinda Gates Foundation