Glucose metabolism abnormalities after renal transplantation: studies on epidemiology, mechanisms and outcomes

Abnormal glucose metabolism, including new-onset diabetes after transplantation (NODAT), is a common complication following kidney transplantation. Better understanding of the causes, associations, prediction and outcomes of NODAT in the modern era of kidney transplantation is essential. Our central hypothesis was that early NODAT is distinct from type 2 diabetes mellitus (T2DM), and is due to factors unique to the transplant setting, of which the predominant factor is the use of specific immunosuppressive agents (calcineurin inhibitors-CNIs), and that traditional risk factors for T2DM are the more significant factors late after transplantation. In a series of observational studies, we found that recipient age, body mass index and baseline plasma glucose levels were associated with the development of NODAT, both early and late after transplantation. Exposure to tacrolimus and being transplanted in an older era were associated with early NODAT development, but had no effect on late NODAT. There was increasing insulin resistance but no compensatory increase in insulin secretion in patients developing NODAT, suggesting an effect of CNIs. In an observational study using paired oral glucose tolerance tests, there was worsening of glucose tolerance late after transplantation. Metabolic syndrome was a risk factor for this deterioration. Finally, in an epidemiological study, we show that immunosuppression regimens in Cardiff have evolved, with the introduction of induction therapy and tacrolimus as the CNI of choice. Blood tacrolimus levels, corticosteroid exposure and acute rejection rates were lower in a recent era of transplantation, as was the incidence of NODAT. NODAT developing within the first year, higher systolic blood pressure and higher serum creatinine level were all associated with increased mortality. In conclusion, traditional T2DM risk factors are important in causing both early and late NODAT, with a strong influence from immunosuppressive agents early after transplantation. NODAT and other cardiovascular risk factors were associated with mortality. Therefore, less diabetogenic immunosuppressive regimes and interventions to reduce hyperglycaemia may not improve mortality unless other cardiovascular factors are also managed simultaneously

Assessment of Forest Encroachment in Shimoga District of Western Ghats, India, Using Remote Sensing and Gis

Sustainable management of Forest ecosystem is necessary as it serves the important functions such as supplementing human dietary requirements, ecological significance in terms of biodiversity conservation, flood control, water purifica-tion and micro climate regulation etc. Hence, an inventory of reserve forest in a given area is a pre-requisite for their con-servation and management. The present study is focused on RS and GIS based assessment of forest encroachment in Shimoga district of Karnataka for the years 1990, 2000 and 2010 using Landsat TM/MSS/ETM+ for 1990 and 2000, and IRS P6 LISS III for the year 2010. It’s located in the mid south western part of malnad region of Karnataka state, geographically lies between 13°27' and 14°39' N latitudes and 74°38' and 76°4'E longitudes. It covers an area of 8,482.32 km2 a apart of western ghats areas (Sahayadrihill ranges), the densely forested high hilly Malnad in the west and sparsely forested tablelands semi-malnad in the east of Karnataka state with a forest area constituting 32.66% of the total geographical area of the district. The study revealed that the encroachment in reserve forest area accounts for 282.92 km2, 257.27 km2 and 192.43 km2 for the year 2010, 2000 and 1990 respectively. Extension of cultivation is the major cause of large-scale encroachment in the district. There is no proper demarcation of the forest boundaries in some places. This has also resulted in encroachment of for-est land. It has led to forest fragmentation, loss of habitat and corridor for movement of wild animals, etc. The policy mak-ers and judiciary have stressed the need for use of recent satellite data to assess the forest encroachment in Western Ghats region. In this regard, an attempt has been made to study the two decadal forest encroachment patterns of Shimoga district. The extent of encroachment was observed to be 12.13 % in 2010. Encroachment is more prevalent in the moist and dry deciduous forests than the evergreen forests and is seen increasing day by day. This information will help for frontline forest officials to trace and book forest offences occurring in their jurisdiction and also to prevent encroachments

Assessment of Forest Encroachment at Belgaum District of Western Ghats of Karnataka Using Remote Sensing and GIS

The present study focuses on the assessment of forest encroachment in Belgaum district of Karnataka for the year 1975, 1990, 2000 and 2010 using RS and GIS. The study area is located in the north-western part of Karnataka state, with a total area of 13,415 km2.The study revealed that the forest encroachment is 4245.6, 16133.1, 28304.4 and 29010.0 ha for the year 1975, 1990, 2000 and 2010 respectively. The extent of encroachment in 2010 amounted to 9.66 % in evergreen to semi evergreen, 15.84 % moist deciduous and 74.50 % in scrub forests.The highest percentage of encroachment was in Hukkeri taluk with mixed plantation and the major part was scrubland whose average encroached area was 31.38% over the years. The major factors accelerating encroachments were agricultural expansion, population dependency on forest livelihood, limited land for cultivation, lack of grazing land and poverty

Assessing the historical forest Encroachment of Kodagu region of Western Ghats, South India using remote sensing and GIS

The present study is focused on RS and GIS based assessment of forest encroachment in Kodagu district of Karnataka for the year 1990, 2000 and 2010 using Landsat TM/MSS for 1990 and 2000, and IRS LISS III for the year 2010. It’s located in the south-western part of Karnataka state, geographically stretched between 11 0 56'to12 0 52’N and 750 22’to76 0 12’E, with a total area of 4101.21 Km 2. The study revealed that the encroachment in reserve forest area accounts for 291.6 ha, 284.8 ha and 173.7 ha respectively for the year, 2010, 2000 and 1990. The highest encroachment is being noticed in Somavarpet, Kushalnagar ranges in Madikeri division and major encroachment is witnessed moist and dry deciduous, other plantation and mixed forest plantation. The major factors accelerating are expansion of agriculture, plantations, rapid growth of urbanization, development of utility services, population dependency of forest livelihood and poverty

Assessing the historical forest Encroachment of Kodagu region of Western Ghats, South India using remote sensing and GIS

The present study is focused on RS and GIS based assessment of forest encroachment in Kodagu district of Karnataka for the year 1990, 2000 and 2010 using Landsat TM/MSS for 1990 and 2000, and IRS LISS III for the year 2010. It’s located in the south-western part of Karnataka state, geographically stretched between 11 0 56'to12 0 52’N and 750 22’to76 0 12’E, with a total area of 4101.21 Km 2. The study revealed that the encroachment in reserve forest area accounts for 291.6 ha, 284.8 ha and 173.7 ha respectively for the year, 2010, 2000 and 1990. The highest encroachment is being noticed in Somavarpet, Kushalnagar ranges in Madikeri division and major encroachment is witnessed moist and dry deciduous, other plantation and mixed forest plantation. The major factors accelerating are expansion of agriculture, plantations, rapid growth of urbanization, development of utility services, population dependency of forest livelihood and poverty

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

Global, regional, and national progress towards Sustainable Development Goal 3.2 for neonatal and child health: all-cause and cause-specific mortality findings from the Global Burden of Disease Study 2019

Background Sustainable Development Goal 3.2 has targeted elimination of preventable child mortality, reduction of neonatal death to less than 12 per 1000 livebirths, and reduction of death of children younger than 5 years to less than 25 per 1000 livebirths, for each country by 2030. To understand current rates, recent trends, and potential trajectories of child mortality for the next decade, we present the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 findings for all-cause mortality and cause-specific mortality in children younger than 5 years of age, with multiple scenarios for child mortality in 2030 that include the consideration of potential effects of COVID-19, and a novel framework for quantifying optimal child survival. Methods We completed all-cause mortality and cause-specific mortality analyses from 204 countries and territories for detailed age groups separately, with aggregated mortality probabilities per 1000 livebirths computed for neonatal mortality rate (NMR) and under-5 mortality rate (USMR). Scenarios for 2030 represent different potential trajectories, notably including potential effects of the COVID-19 pandemic and the potential impact of improvements preferentially targeting neonatal survival. Optimal child survival metrics were developed by age, sex, and cause of death across all GBD location-years. The first metric is a global optimum and is based on the lowest observed mortality, and the second is a survival potential frontier that is based on stochastic frontier analysis of observed mortality and Healthcare Access and Quality Index. Findings Global U5MR decreased from 71.2 deaths per 1000 livebirths (95% uncertainty interval WI] 68.3-74-0) in 2000 to 37.1 (33.2-41.7) in 2019 while global NMR correspondingly declined more slowly from 28.0 deaths per 1000 live births (26.8-29-5) in 2000 to 17.9 (16.3-19-8) in 2019. In 2019,136 (67%) of 204 countries had a USMR at or below the SDG 3.2 threshold and 133 (65%) had an NMR at or below the SDG 3.2 threshold, and the reference scenario suggests that by 2030,154 (75%) of all countries could meet the U5MR targets, and 139 (68%) could meet the NMR targets. Deaths of children younger than 5 years totalled 9.65 million (95% UI 9.05-10.30) in 2000 and 5.05 million (4.27-6.02) in 2019, with the neonatal fraction of these deaths increasing from 39% (3.76 million 95% UI 3.53-4.021) in 2000 to 48% (2.42 million; 2.06-2.86) in 2019. NMR and U5MR were generally higher in males than in females, although there was no statistically significant difference at the global level. Neonatal disorders remained the leading cause of death in children younger than 5 years in 2019, followed by lower respiratory infections, diarrhoeal diseases, congenital birth defects, and malaria. The global optimum analysis suggests NMR could be reduced to as low as 0.80 (95% UI 0.71-0.86) deaths per 1000 livebirths and U5MR to 1.44 (95% UI 1-27-1.58) deaths per 1000 livebirths, and in 2019, there were as many as 1.87 million (95% UI 1-35-2.58; 37% 95% UI 32-43]) of 5.05 million more deaths of children younger than 5 years than the survival potential frontier. Interpretation Global child mortality declined by almost half between 2000 and 2019, but progress remains slower in neonates and 65 (32%) of 204 countries, mostly in sub-Saharan Africa and south Asia, are not on track to meet either SDG 3.2 target by 2030. Focused improvements in perinatal and newborn care, continued and expanded delivery of essential interventions such as vaccination and infection prevention, an enhanced focus on equity, continued focus on poverty reduction and education, and investment in strengthening health systems across the development spectrum have the potential to substantially improve USMR. Given the widespread effects of COVID-19, considerable effort will be required to maintain and accelerate progress. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd