Multiseason recoveries of organic and inorganic nitrogen-15 in tropical cropping systems

In tropical agroecosystems, limited N availability remains a major impediment to increasing yield. A 15N-recovery experiment was conducted in 13 diverse tropical agroecosystems. The objectives were to determine the total recovery of one single 15N application of inorganic or organic N during three to six growing seasons and to establish whether the losses of N are governed by universal principles. Between 7 and 58% (average of 21%) of crop N uptake duringthe first growing season was derived from fertilizer. On average, 79% of crop N was derived from the soil. When 15N-labeled residues were applied, in the first growing season 4% of crop N was derived from the residues. Average recoveries of 15N- labeled fertilizer and residue in crops after the first growing season were 33 and 7%, respectively. Corresponding recoveries in the soil were 38 and 71 %. An additional 6% of the fertilizer and 9.1 % of the residue was recovered by crops during subsequent growing seasons. There were no significant differences in total 15N recovery (average 54%) between N from fertilizer and N from residue. After five growing seasons, more residue N (40%) than fertilizer N (18%) was recovered in the soil, better sustaining the soil organic matter N content. Long-term total recoveries of 15N-labeled fertilizer or residue in the crop and soil were similar. Soil N remained the primary source of N for crops. As higher rainfall and temperature tend to cause higher N losses, management practices to improve N use efficiency and reduce losses in wet tropical regions will remain a challenge

A case report of anti-NMDA receptor encephalitis in a young Egyptian female patient presenting with hyperreligiosity

Abstract Anti-n-methyl-d-aspartate receptor (NMDAR) encephalitis is a form of autoimmune encephalitis that remains under-recognized due to the variability of the initial symptoms and can be misdiagnosed as viral encephalitis or other pathogens. This syndrome has been predominantly described in young females including personality changes, autonomic dysfunctions, and neurologic decompensation. About half of the cases have tumors, most commonly teratomas of the ovaries; another established trigger is herpes viral encephalitis, while the cause in other cases is unclear. In case of clinical suspicion, electroencephalogram and brain magnetic resonance imaging are useful, but lumbar puncture for cerebrospinal fluid analysis is used to confirm the diagnosis. Treatment for this disease includes immunosuppression, plasmapheresis, and tumor resection when indicated. In this case report, we present a case that presented with hyperreligiosity and proved to have autoimmune encephalitis. The main purpose of our case is to increase awareness regarding immune-mediated encephalitis, especially the anti-NMDAR encephalitis

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially