Actividad molusquicida del Paraiso (Melia azedarach L.) (Meliaceae) sobre Lymnaea cubensis, molusco vector de Fasciolosis

INTRODUCTION: Fasciolosis is a source of serious economic loss in various regions of Brazil and when control measures of its host (molluscs) are not taken under favorable ecological conditions, isolated cases of human Fasciolosis may occur. Among the alternative measures for its control is the use of vegetable extracts and the purpose of this project is the assessment of the use of juice extracted from the fruit and seeds of the Paraiso plant (Melia azedarach L.) in the control of Lymnaea cubensis, the main vector of Fasciolosis in Cuba. MATERIAL AND METHOD: Various concentrations of the juice extracted from the Paraiso fruit (Melia azedarach L.) were tested to determine the average and maximum lethal doses (DL50 and DL90, respectively) used in a computerized PROBIT-LOG program. Seven experimental series were undertaken, 72 molluscs being used in each of them. Three groups of ten molluscs were tested to determine the effect on cardiac frequency, two of them being treated with CL50=0.88627 and CL90=1.7641, respectively, the third being used as control. RESULTS AND CONCLUSIONS: A considerable effect of both doses on the cardiac frequency of the mollusc studied was observed. The results were encouraging, for they demonstrated the potential use of this plant in the control of undesirable molluscs.INTRODUÇÃO: A Fasciolosis constitui em diversas regiões fonte importante de perdas econômicas, e quando não se adotam medidas de controle de seus hospedeiros (moluscos), junto a condições ecológicas favoráveis, pode ocorrer o aparecimento de casos isolados de Fasciolosis humana. Dentro dos métodos alternativos para o seu controle está o uso de extratos vegetais e se tem pretendido avaliar o provável emprego do suco extraído do fruto e sementes do Paraíso (Melia azedarach L.), no controle de Lymnaea cubensis, principal vetor da Fasciolosis em Cuba. MATERIAL E MÉTODO: Diferentes concentrações do suco extraído do fruto e semente do Paraiso (Melia azedarach L.) foram testadas para determinar as doses médias letais (DL50) e máxima (DL90) usando um programa computadorizado PROBIT-LOG. Sete séries experimentais foram realizadas , usando 72 moluscos em cada uma. Para determinar a influência sobre a freqûência cardíaca foram testados três grupos de 10 moluscos, dois foram tratados com as CL50= 0,88627 e CL90= 1,7641, respectivamente, enquanto que o terceiro foi considerado como controle. RESULTADOS E CONCLUSÕES: Observou-se uma marcada influência de ambas as doses sobre a freqüência cardíaca do molusco estudado. Os resultados foram alentadores, pois demonstraram um potencial uso dessa planta no controle de moluscos não desejados.INTRODUCCIÓN: La Fasciolosis constituye en diversas regiones una fuente importante de pérdidas económicas y cuando se descuidan las medidas de control de sus hospedadores (moluscos), junto a condiciones ecológicas favorables, pueden ocurrir casos aislados de Fasciolosis humana. Dentro de los métodos alternativos para su control está el uso de extractos vegetales y se pretendió evaluar el probable empleo del jugo extraído del fruto y semillas del Paraiso (Melia azedarach L.) en el control de Lymnaea cubensis, principal vector de la Fasciolosis en Cuba. MATERIAL Y MÉTODO: Diferentes concentraciones del jugo extraído del fruto y semillas del Paraiso (Melia azedarach L.) fueron testados para determinar las dosis letales media (DL50) y máxima (DL90) usando un programa computarizado Probit-Log. Siete series experimentales fueron probadas usando 72 moluscos en cada una. Para determinar la influencia sobre la frecuencia cardíaca fueron testados tres grupos de 10 moluscos, dos fueron tratados con las DL50=0,88627 y DL90=1,7641, respectivamente, mientras que el tercero fue considerado como testigo. RESULTADOS Y CONCLUSIONES: Se observó una marcada influencia de ambas dosis sobre la frecuencia cardíaca del molusco estudiado. Estos resultados son alentadores, pues demuestran el potencial empleo de esta planta en el control de moluscos indeseables

Actividad molusquicida del Paraiso (Melia azedarach L.) (Meliaceae) sobre Lymnaea cubensis, molusco vector de Fasciolosis

INTRODUCCIÓN: La Fasciolosis constituye en diversas regiones una fuente importante de pérdidas económicas y cuando se descuidan las medidas de control de sus hospedadores (moluscos), junto a condiciones ecológicas favorables, pueden ocurrir casos aislados de Fasciolosis humana. Dentro de los métodos alternativos para su control está el uso de extractos vegetales y se pretendió evaluar el probable empleo del jugo extraído del fruto y semillas del Paraiso (Melia azedarach L.) en el control de Lymnaea cubensis, principal vector de la Fasciolosis en Cuba. MATERIAL Y MÉTODO: Diferentes concentraciones del jugo extraído del fruto y semillas del Paraiso (Melia azedarach L.) fueron testados para determinar las dosis letales media (DL50) y máxima (DL90) usando un programa computarizado Probit-Log. Siete series experimentales fueron probadas usando 72 moluscos en cada una. Para determinar la influencia sobre la frecuencia cardíaca fueron testados tres grupos de 10 moluscos, dos fueron tratados con las DL50=0,88627 y DL90=1,7641, respectivamente, mientras que el tercero fue considerado como testigo. RESULTADOS Y CONCLUSIONES: Se observó una marcada influencia de ambas dosis sobre la frecuencia cardíaca del molusco estudiado. Estos resultados son alentadores, pues demuestran el potencial empleo de esta planta en el control de moluscos indeseables

Actividad molusquicida del Paraiso (Melia azedarach L.) (Meliaceae) sobre Lymnaea cubensis, molusco vector de Fasciolosis Molluscicidal activity of Paraiso (Melia azedarach L.) (Meliaceae) on Lymnaea cubensis, host snail of Fasciolosis

INTRODUCCIÓN: La Fasciolosis constituye en diversas regiones una fuente importante de pérdidas económicas y cuando se descuidan las medidas de control de sus hospedadores (moluscos), junto a condiciones ecológicas favorables, pueden ocurrir casos aislados de Fasciolosis humana. Dentro de los métodos alternativos para su control está el uso de extractos vegetales y se pretendió evaluar el probable empleo del jugo extraído del fruto y semillas del Paraiso (Melia azedarach L.) en el control de Lymnaea cubensis, principal vector de la Fasciolosis en Cuba. MATERIAL Y MÉTODO: Diferentes concentraciones del jugo extraído del fruto y semillas del Paraiso (Melia azedarach L.) fueron testados para determinar las dosis letales media (DL50) y máxima (DL90) usando un programa computarizado Probit-Log. Siete series experimentales fueron probadas usando 72 moluscos en cada una. Para determinar la influencia sobre la frecuencia cardíaca fueron testados tres grupos de 10 moluscos, dos fueron tratados con las DL50=0,88627 y DL90=1,7641, respectivamente, mientras que el tercero fue considerado como testigo. RESULTADOS Y CONCLUSIONES: Se observó una marcada influencia de ambas dosis sobre la frecuencia cardíaca del molusco estudiado. Estos resultados son alentadores, pues demuestran el potencial empleo de esta planta en el control de moluscos indeseables.<br>INTRODUÇÃO: A Fasciolosis constitui em diversas regiões fonte importante de perdas econômicas, e quando não se adotam medidas de controle de seus hospedeiros (moluscos), junto a condições ecológicas favoráveis, pode ocorrer o aparecimento de casos isolados de Fasciolosis humana. Dentro dos métodos alternativos para o seu controle está o uso de extratos vegetais e se tem pretendido avaliar o provável emprego do suco extraído do fruto e sementes do Paraíso (Melia azedarach L.), no controle de Lymnaea cubensis, principal vetor da Fasciolosis em Cuba. MATERIAL E MÉTODO: Diferentes concentrações do suco extraído do fruto e semente do Paraiso (Melia azedarach L.) foram testadas para determinar as doses médias letais (DL50) e máxima (DL90) usando um programa computadorizado PROBIT-LOG. Sete séries experimentais foram realizadas , usando 72 moluscos em cada uma. Para determinar a influência sobre a freqûência cardíaca foram testados três grupos de 10 moluscos, dois foram tratados com as CL50= 0,88627 e CL90= 1,7641, respectivamente, enquanto que o terceiro foi considerado como controle. RESULTADOS E CONCLUSÕES: Observou-se uma marcada influência de ambas as doses sobre a freqüência cardíaca do molusco estudado. Os resultados foram alentadores, pois demonstraram um potencial uso dessa planta no controle de moluscos não desejados.<br>INTRODUCTION: Fasciolosis is a source of serious economic loss in various regions of Brazil and when control measures of its host (molluscs) are not taken under favorable ecological conditions, isolated cases of human Fasciolosis may occur. Among the alternative measures for its control is the use of vegetable extracts and the purpose of this project is the assessment of the use of juice extracted from the fruit and seeds of the Paraiso plant (Melia azedarach L.) in the control of Lymnaea cubensis, the main vector of Fasciolosis in Cuba. MATERIAL AND METHOD: Various concentrations of the juice extracted from the Paraiso fruit (Melia azedarach L.) were tested to determine the average and maximum lethal doses (DL50 and DL90, respectively) used in a computerized PROBIT-LOG program. Seven experimental series were undertaken, 72 molluscs being used in each of them. Three groups of ten molluscs were tested to determine the effect on cardiac frequency, two of them being treated with CL50=0.88627 and CL90=1.7641, respectively, the third being used as control. RESULTS AND CONCLUSIONS: A considerable effect of both doses on the cardiac frequency of the mollusc studied was observed. The results were encouraging, for they demonstrated the potential use of this plant in the control of undesirable molluscs

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

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 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

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

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: 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<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<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. Funding: National Institute for Health and Care Research

Clinical and genetic characteristics of late-onset Huntington's disease

Background: The frequency of late-onset Huntington's disease (&gt;59 years) is assumed to be low and the clinical course milder. However, previous literature on late-onset disease is scarce and inconclusive. Objective: Our aim is to study clinical characteristics of late-onset compared to common-onset HD patients in a large cohort of HD patients from the Registry database. Methods: Participants with late- and common-onset (30–50 years)were compared for first clinical symptoms, disease progression, CAG repeat size and family history. Participants with a missing CAG repeat size, a repeat size of ≤35 or a UHDRS motor score of ≤5 were excluded. Results: Of 6007 eligible participants, 687 had late-onset (11.4%) and 3216 (53.5%) common-onset HD. Late-onset (n = 577) had significantly more gait and balance problems as first symptom compared to common-onset (n = 2408) (P &lt;.001). Overall motor and cognitive performance (P &lt;.001) were worse, however only disease motor progression was slower (coefficient, −0.58; SE 0.16; P &lt;.001) compared to the common-onset group. Repeat size was significantly lower in the late-onset (n = 40.8; SD 1.6) compared to common-onset (n = 44.4; SD 2.8) (P &lt;.001). Fewer late-onset patients (n = 451) had a positive family history compared to common-onset (n = 2940) (P &lt;.001). Conclusions: Late-onset patients present more frequently with gait and balance problems as first symptom, and disease progression is not milder compared to common-onset HD patients apart from motor progression. The family history is likely to be negative, which might make diagnosing HD more difficult in this population. However, the balance and gait problems might be helpful in diagnosing HD in elderly patients

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P &lt; 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)