Malaria and pregnancy: the perspective in Pakistan

Objective: To study the effects of malaria on pregnancy outcome.Methods: A case control study conducted on patients identified by ICD-9 coding system of the hospital medical records. Demographic and clinical data recorded on standardized data sheet and analyzed using SPSS 11.5 software.Results: Of the total patients, 67.4% were multigravid and 32.6% were primigravid with 78.6% of patients having platelets \u3c 150,000. Mean haemoglobin was 9.4 gm/dl in patients and 12.2 gm/dl in controls. Plasmodium Vivax was accounted for 55.8%, P. Falciparum for 41.9%, and P. Ovale 2.3% of infections. In all, 48.8% of patients received oral Chloroquine, 16.3% oral Quinine, 30.3% intravenous Quinine, 20.9% of patients received combination treatment with IV Clindamycin, and one each patient received oral Artemether or oral halofantrine. Two patients had an abortion. One of the following complications including, threatened abortion, preterm labour, ARDS or Cerebral malaria, was observed in one patient each. Mean weight of babies born to cases was 2.8 kg (range 1.4-3.8) and of control babies was 3.2 kg (range 2.5-4.0 kg). No congenital malformations were reported.CONCLUSION: Plasmodium falciparum sp, moderate parasitic load, haemoglobin \u3c 10 gm/dL, platelet count \u3c 50,000/mm3 and IV quinine with loading dose of 20 mg/kg are identified as few of the potential risk factors for poor outcome in pregnancy

Economic Returns to Education in France: OLS and Instrumental Variable Estimations

En ligne sur : http://121.52.153.179/JOURNAL/LJE%20VOL%2018-2/Bhatti,%20Bourdon%20and%20Aslam.pdfInternational audienceThis article estimates the economic returns to schooling as well as analyzing other explanatory factors for the French labor market. It addresses the issue of endogeneity bias and proposes two new instruments for use in the instrumental variable two-stage least squares technique. Our results show that the proposed instruments are relevant and adequate, based on evidence from the available literature. After using the proposed instruments, we find that the OLS coefficients for schooling are biased downwards. Finally, we choose between the two proposed instruments

Improved Model Predictive Direct Power Control for Parallel Distributed Generation in Grid-Tied Microgrids

This research proposes an improved finite control set direct power model predictive control method (FCS-DPMPC) for grid-tie distributed generation (DG). FCS-DPMPC predicts the system outcomes using the system model. During the next sampling time, a voltage vector is defined using the cost function to minimize the power ripple, consequently allowing flexibility for power regulation. Furthermore, the impact of implementing a one-step delay is studied and compensated through a model forecast pattern. In addition, a new two-step horizon technique has been developed to minimize switching frequency and computation burden. Simulation results for single DG and parallel operated DGs in a grid-tie manner confirm the effectiveness of the suggested control strategy, which signifies that this is an appropriate approach for distributed generation in microgrids.© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).fi=vertaisarvioitu|en=peerReviewed

Urinary Amylase as the First Line Diagnostic Tool for Acute Pancreatitis

Background: Diagnosis of acute pancreatitis is based on raised serum lipase and serum amylase in the blood. However, the levels of urinary amylase can be sought for being less invasive. The study aimed to find out the diagnostic accuracy of urinary amylase compared to serum amylase and serum lipase and their association with the degree of severity of acute pancreatitis. Methods: A randomized clinical control study was conducted on n=180 acute pancreatitis patients (18-50 year) in the Ziauddin and PNS Shifa Hospital, Karachi from September 2019- August 2020. Serum amylase, serum lipase and urinary amylase levels were checked at the time of admission followed by 24 hours and at discharge. ANOVA with post-hoc Tuckey’s test was used to determine the association of amylases with the severity of acute pancreatitis and p˂0.05 was considered as statistically significant. Results: The patients with acute pancreatitis had a mean age of 51.76 ±10.8. Urinary amylase had a strong significant association (p˂0.05) with acute pancreatitis compared to serum amylase and lipase (p=0.024). There was an insignificant association of urinary amylase with acute pancreatitis after 24 hours. Similarly, urinary amylase reported good diagnostic discrimination of acute pancreatitis as the accuracy index, the area under the ROC curve was one, showing higher sensitivity and specificity by covering the maximum population under the ROC curve. Conclusion: The significance of Urinary amylase (p˂0.05) was higher than serum amylase, serum lipase because of sensitivity and specificity for diagnosing acute pancreatitis representing a positive association with the degree of severity of the disease. Keywords: Acute Pancreatitis; Amylase; Lipase; Amylase

Microbial Diversity Analysis in Malachite Green Dye Treating Sequencing Batch Reactor

ABSTRACT Microbial diversity was investigated in an optimized sequencing batch reactor (SBR), treating malachite green containing wastewater, with the decolorization efficiency of 89 % and chemical oxygen demand (COD) removing ability of 93%. Both culture-independent 16S rRNA gene method and culture-dependent plate-dilution method were utilized. Phylogenetic trees were sketched by neighbor-joining method using bioinformatics tools. Cultureindependent method showed the SBR community affiliation with the Alpha, Beta, Gamma and Delta proteobacteria, in addition to the moderate resemblances with Verrucomicrobia, and some uncultured bacteria. The culture-dependent isolates, however, identified only with the Beta and Gamma proteobacteria. Some sequences had less than 95% homology to the data in GenBank indicates the possibility of novel bacterial species

LC-MS/MS-Based Serum Protein Profiling for Identification of Candidate Biomarkers in Pakistani Rheumatoid Arthritis Patients

Rheumatoid arthritis is an autoimmune disorder of complex disease etiology. Currently available serological diagnostic markers lack in terms of sensitivity and specificity and thus additional biomarkers are warranted for early disease diagnosis and management. We aimed to screen and compare serum proteome profiles of rheumatoid arthritis serotypes with healthy controls in the Pakistani population for identification of potential disease biomarkers. Serum samples from rheumatoid arthritis patients and healthy controls were enriched for low abundance proteins using ProteoMinerTM columns. Rheumatoid arthritis patients were assigned to one of the four serotypes based on anti-citrullinated peptide antibodies and rheumatoid factor. Serum protein profiles were analyzed via liquid chromatography-tandem mass spectrometry. The changes in the protein abundances were determined using label-free quantification software ProgenesisQITM followed by pathway analysis. Findings were validated in an independent cohort of patients and healthy controls using an enzyme-linked immunosorbent assay. A total of 213 proteins were identified. Comparative analysis of all groups (false discovery rate &lt; 0.05, &gt;2-fold change, and identified with ≥2 unique peptides) identified ten proteins that were differentially expressed between rheumatoid arthritis serotypes and healthy controls including pregnancy zone protein, selenoprotein P, C4b-binding protein beta chain, apolipoprotein M, N-acetylmuramoyl-L-alanine amidase, catalytic chain, oncoprotein-induced transcript 3 protein, Carboxypeptidase N subunit 2, Apolipoprotein C-I and Apolipoprotein C-III. Pathway analysis predicted inhibition of liver X receptor/retinoid X receptor activation pathway and production of nitric oxide and reactive oxygen species pathway in macrophages in all serotypes. A catalogue of potential serum biomarkers for rheumatoid arthritis were identified. These biomarkers can be further evaluated in larger cohorts from different populations for their diagnostic and prognostic potential.</jats:p

Kinetics of the pyrolysis of cobalt-impregnated sesame stalk biomass

In this work, thermogravimetric analysis of sesame biomass samples was conducted in inert atmosphere at heating rate of 10 °C/min in the temperature range 30–1000 °C. Kinetic parameters were calculated applying the Coats-Redfern (CR) method. TG/DTG of sesame biomass showed that pyrolysis mainly occurred in the temperature range 205–412 °C. Therefore, the biomass was thermally decomposed in the same temperature range in the presence of cobalt oxide in an indigenously made salt bath furnace. The pyrolysis oil was collected and analyzed using GC-MS. The Physicochemical properties of the oil were determined, and the results have shown that sesame biomass can be utilized as fuel if the oil obtained from it is properly upgraded to make it equivalent to commercial fuel

Time Series Analysis and Forecasting of Air Pollutants Based on Prophet Forecasting Model in Jiangsu Province, China

Due to recent developments in the global economy, transportation, and industrialization, air pollution is one of main environmental issues in the 21st century. The current study aimed to predict both short-term and long-term air pollution in Jiangsu Province, China, based on the Prophet forecasting model (PFM). We collected data from 72 air quality monitoring stations to forecast six air pollutants: PM10, PM2.5, SO2, NO2, CO, and O3. To determine the accuracy of the model and to compare its results with predicted and actual values, we used the correlation coefficient (R), mean squared error (MSE), root mean squared error (RMSE), and mean absolute error (MAE). The results show that PFM predicted PM10 and PM2.5 with R values of 0.40 and 0.52, RMSE values of 16.37 and 12.07 μg/m3, and MAE values of 11.74 and 8.22 μg/m3, respectively. Among other pollutants, PFM also predicted SO2, NO2, CO, and O3 with R values are between 5 μg/m3 to 12 μg/m3; and MAE values between 2 μg/m3 to 11 μg/m3. PFM has extensive power to accurately predict the concentrations of air pollutants and can be used to forecast air pollution in other regions. The results of this research will be helpful for local authorities and policymakers to control air pollution and plan accordingly in upcoming years

Burden of disease scenarios for 204 countries and territories, 2022–2050: a forecasting analysis for the Global Burden of Disease Study 2021

Background: Future trends in disease burden and drivers of health are of great interest to policy makers and the public at large. This information can be used for policy and long-term health investment, planning, and prioritisation. We have expanded and improved upon previous forecasts produced as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) and provide a reference forecast (the most likely future), and alternative scenarios assessing disease burden trajectories if selected sets of risk factors were eliminated from current levels by 2050. Methods: Using forecasts of major drivers of health such as the Socio-demographic Index (SDI; a composite measure of lag-distributed income per capita, mean years of education, and total fertility under 25 years of age) and the full set of risk factor exposures captured by GBD, we provide cause-specific forecasts of mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) by age and sex from 2022 to 2050 for 204 countries and territories, 21 GBD regions, seven super-regions, and the world. All analyses were done at the cause-specific level so that only risk factors deemed causal by the GBD comparative risk assessment influenced future trajectories of mortality for each disease. Cause-specific mortality was modelled using mixed-effects models with SDI and time as the main covariates, and the combined impact of causal risk factors as an offset in the model. At the all-cause mortality level, we captured unexplained variation by modelling residuals with an autoregressive integrated moving average model with drift attenuation. These all-cause forecasts constrained the cause-specific forecasts at successively deeper levels of the GBD cause hierarchy using cascading mortality models, thus ensuring a robust estimate of cause-specific mortality. For non-fatal measures (eg, low back pain), incidence and prevalence were forecasted from mixed-effects models with SDI as the main covariate, and YLDs were computed from the resulting prevalence forecasts and average disability weights from GBD. Alternative future scenarios were constructed by replacing appropriate reference trajectories for risk factors with hypothetical trajectories of gradual elimination of risk factor exposure from current levels to 2050. The scenarios were constructed from various sets of risk factors: environmental risks (Safer Environment scenario), risks associated with communicable, maternal, neonatal, and nutritional diseases (CMNNs; Improved Childhood Nutrition and Vaccination scenario), risks associated with major non-communicable diseases (NCDs; Improved Behavioural and Metabolic Risks scenario), and the combined effects of these three scenarios. Using the Shared Socioeconomic Pathways climate scenarios SSP2-4.5 as reference and SSP1-1.9 as an optimistic alternative in the Safer Environment scenario, we accounted for climate change impact on health by using the most recent Intergovernmental Panel on Climate Change temperature forecasts and published trajectories of ambient air pollution for the same two scenarios. Life expectancy and healthy life expectancy were computed using standard methods. The forecasting framework includes computing the age-sex-specific future population for each location and separately for each scenario. 95% uncertainty intervals (UIs) for each individual future estimate were derived from the 2·5th and 97·5th percentiles of distributions generated from propagating 500 draws through the multistage computational pipeline. Findings: In the reference scenario forecast, global and super-regional life expectancy increased from 2022 to 2050, but improvement was at a slower pace than in the three decades preceding the COVID-19 pandemic (beginning in 2020). Gains in future life expectancy were forecasted to be greatest in super-regions with comparatively low life expectancies (such as sub-Saharan Africa) compared with super-regions with higher life expectancies (such as the high-income super-region), leading to a trend towards convergence in life expectancy across locations between now and 2050. At the super-region level, forecasted healthy life expectancy patterns were similar to those of life expectancies. Forecasts for the reference scenario found that health will improve in the coming decades, with all-cause age-standardised DALY rates decreasing in every GBD super-region. The total DALY burden measured in counts, however, will increase in every super-region, largely a function of population ageing and growth. We also forecasted that both DALY counts and age-standardised DALY rates will continue to shift from CMNNs to NCDs, with the most pronounced shifts occurring in sub-Saharan Africa (60·1% [95% UI 56·8–63·1] of DALYs were from CMNNs in 2022 compared with 35·8% [31·0–45·0] in 2050) and south Asia (31·7% [29·2–34·1] to 15·5% [13·7–17·5]). This shift is reflected in the leading global causes of DALYs, with the top four causes in 2050 being ischaemic heart disease, stroke, diabetes, and chronic obstructive pulmonary disease, compared with 2022, with ischaemic heart disease, neonatal disorders, stroke, and lower respiratory infections at the top. The global proportion of DALYs due to YLDs likewise increased from 33·8% (27·4–40·3) to 41·1% (33·9–48·1) from 2022 to 2050, demonstrating an important shift in overall disease burden towards morbidity and away from premature death. The largest shift of this kind was forecasted for sub-Saharan Africa, from 20·1% (15·6–25·3) of DALYs due to YLDs in 2022 to 35·6% (26·5–43·0) in 2050. In the assessment of alternative future scenarios, the combined effects of the scenarios (Safer Environment, Improved Childhood Nutrition and Vaccination, and Improved Behavioural and Metabolic Risks scenarios) demonstrated an important decrease in the global burden of DALYs in 2050 of 15·4% (13·5–17·5) compared with the reference scenario, with decreases across super-regions ranging from 10·4% (9·7–11·3) in the high-income super-region to 23·9% (20·7–27·3) in north Africa and the Middle East. The Safer Environment scenario had its largest decrease in sub-Saharan Africa (5·2% [3·5–6·8]), the Improved Behavioural and Metabolic Risks scenario in north Africa and the Middle East (23·2% [20·2–26·5]), and the Improved Nutrition and Vaccination scenario in sub-Saharan Africa (2·0% [–0·6 to 3·6]). Interpretation: Globally, life expectancy and age-standardised disease burden were forecasted to improve between 2022 and 2050, with the majority of the burden continuing to shift from CMNNs to NCDs. That said, continued progress on reducing the CMNN disease burden will be dependent on maintaining investment in and policy emphasis on CMNN disease prevention and treatment. Mostly due to growth and ageing of populations, the number of deaths and DALYs due to all causes combined will generally increase. By constructing alternative future scenarios wherein certain risk exposures are eliminated by 2050, we have shown that opportunities exist to substantially improve health outcomes in the future through concerted efforts to prevent exposure to well established risk factors and to expand access to key health interventions

Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021

Background: Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020–21 COVID-19 pandemic period. Methods: 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution. Findings: Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5–65·1] decline), and increased during the COVID-19 pandemic period (2020–21; 5·1% [0·9–9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98–5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50–6·01) in 2019. An estimated 131 million (126–137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7–17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8–24·8), from 49·0 years (46·7–51·3) to 71·7 years (70·9–72·5). Global life expectancy at birth declined by 1·6 years (1·0–2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67–8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4–52·7]) and south Asia (26·3% [9·0–44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations. Interpretation: Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic