Red blood cell transfusion in critically-ill children and its association with outcome

Objective: To determine the indications and threshold of haemoglobin levels for packed red blood cell transfusion and its association with outcomes in a paediatric intensive care setting.Methods: The retrospective study was conducted in the paediatric intensive care unit of the Aga Khan University Hospital, Karachi, and comprised medical records of all inpatients with age between 1 month and 16 years who received packed red blood cell transfusions between January and December 2017. Data was retrieved from the hospital database and was analyzed using SPSS 22.Results: Of the 147 subjects with a mean age of 67.89±65.8 months, 76(51.7%) were males. Mean paediatric risk of mortality score was 11.72±7.86. Major admitting diagnosis included sepsis and multiorgan dysfunction 50(34%), respiratory diseases 26(17.7%) and haematology/oncology diseases 22(15%). The indications for transfusion was low haemoglobin in 90(61.2%) patients, shock 29(19.7%) and hypoxia 28(19%). Acute transfusion reaction was observed in 1(0.7%) patient; 120(82%) required mechanical ventilation; and 94(64%) required inotropic support. Of the total, 88(59.9%) patients survived. Paediatric risk of mortality score, need for inotropic support and mechanical ventilation were associated with mortality (p\u3c0.05).Conclusions: Packed red blood cell transfusion, which is frequently prescribed in intensive care settings, was not found to be associated with favourable outcome

Performance of the TIMI risk score in predicting mortality after primary percutaneous coronary intervention in elderly women: Results from a developing country

Background: Despite women undergoing primary percutaneous coronary intervention (PPCI) having a higher rate of adverse outcomes than men, data evaluating prognostic risk scores, especially in elderly women, remains scarce. This study was conducted to validate the predictive value of Thrombolysis in Myocardial Infarction (TIMI) risk score in elderly female patients. Materials and Methods: This was a retrospective analysis of elderly (\u3e65 years) female patients who underwent PPCI for ST-elevated myocardial infarction (STEMI) from October 2016 to September 2018. Patients\u27 demographic details and elements of TIMI risk score including age, co-morbidities, Killip classification; weight, anterior MI and total ischemic time were extracted from hospital records. The primary outcome was in-hospital mortality and post-discharge mortality reported on telephonic follow-up. Results: A total of 404 elderly women with a median age of 70 years were included. The mean TIMI score was 5.25±1.45 with 40.3% (163) patients of TIMI score \u3e 5. In-hospital mortality rate was 6.4% (26) and was found to be associated with TIMI score (p\u3c0.001). The in-hospital mortality rate increased from 3.1% at TIMI score of 0-4 to 34.6% at the score of 8. On follow-up (16.43±7.40 months) of 211 (55.8%) patients, the overall mortality rate was 20.3%, and this was also associated with TIMI score (p\u3c0.001). The mortality rate increased from 5.6% at the score of 0-4 to 54.5% at the score of 8. The predictive values (area under the curve) of TIMI risk score for in-hospital and post-discharge mortality were 0.709 (95% CI 0.591-0.827; p \u3c0.001) and 0.689 (95% CI 0.608-0.770; p \u3c0.001), respectively. Conclusion: Increased adverse outcomes were observed with higher TIMI risk score for in hospital and post-discharge follow-up. Therefore, the prognostic TIMI risk score is a robust tool in predicting both in-hospital as well as post-discharge mortality in elderly females

Dengue fever outbreaks in Eritrea, 2005-2015: a case for strengthening surveillance, control and reporting

BACKGROUND: The geographic distribution and burden of dengue is increasing globally. This study aims to evaluate dengue outbreaks and to substantiate the need for strengthened surveillance, reporting and control in Eritrea. METHODS: Data from two cross-sectional dengue epidemic investigations in 2005 and 2010 were analyzed. Samples were tested for dengue virus-specific IgM and IgG antibodies using capture enzyme-linked immunosorbent assays. Dengue vectors' breeding attributes were characterized and epidemic risk indices determined. National routine surveillance weekly reports from 2005 to the second quarter of 2015 were analyzed for spatiotemporal trends. RESULTS: Dengue outbreaks increased in Eritrea from 2005 to 2015 with clinical presentation varying markedly among patients. The house and container indices for Aedes aegypti were 40 and 39.6 % respectively, with containers having A. aeqypti varying significantly (P < 0.04). Serum from 33.3 % (n = 15) and 88 % (n = 26) of clinical dengue cases in Aroget sub-Zoba (district) of Gash Barka Zoba (region) contained anti-DENV IgM antibody in 2005 and 2006, respectively. The national surveillance data from 2005 to 2015 indicate an overall spatiotemporal increase of dengue fever. CONCLUSIONS: The increase in dengue outbreaks has been confirmed in Eritrea and necessitates strengthening of surveillance and health worker and laboratory capacity, as well as targeted vector control interventions

Isotherm, kinetic and modeling studies

Funding Information: Funding: The Deanship of Scientific Research at King Khalid University General Research Project under the grant number (R.G.P.2/138/42) and Taif University researchers supporting project number (TURSP–2020/157), Taif University, Taif, Saudi Arabia. Funding Information: Acknowledgments: The co‐author Ali E. Anqi would like to extend his appreciation to the Deanship of Scientific Research at King Khalid University for the support he received through General Re‐ search Project under the grant number (R.G.P.2/138/42). This work was supported by Taif Univer‐ sity researchers supporting project number (TURSP–2020/157), Taif University, Taif, Saudi Arabia. The first author was thankful to the Directorate of Minorities, Govt. of Karnataka for providing PhD fellowship to conduct the research. Publisher Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland.The first-ever use of halloysite nanotube (HNT), a relatively low-cost nanomaterial abun-dantly available with minor toxicity for removing brilliant green dye from aqueous media, is re-ported. The factors affecting adsorption were studied by assessing the adsorption capacity, kinetics, and equilibrium thermodynamic properties. All the experiments were designed at a pH level of around 7. The Redlich-Peterson isotherm model fits best amongst the nine isotherm models studied. The kinetic studies data confirmed a pseudo model of the second order. Robotic investigations pro-pose a rate-controlling advance being overwhelmed by intraparticle dispersion. The adsorbent fea-tures were interpreted using infrared spectroscopy and electron microscopy. Process optimization was carried out using Response Surface Methodology (RSM) through a dual section Fractional Fac-torial Experimental Design to contemplate the impact of boundaries on the course of adsorption. The examination of fluctuation (ANOVA) was utilized to consider the joined impact of the boundaries. The possibilities of the use of dye adsorbing HNT (“sludge”) for the fabrication of the composites using plastic waste are suggested.publishersversionpublishe

A recent study on remediation of direct blue 15 dye using halloysite nanotubes

R.G.P.2/138/42 TURSP–2020/157A set of lab‐scale experiments were designed and conducted to remedy Direct Blue 15 (DB15) dye using nontoxic halloysite nanotubes (HNT) with the view to be utilized in a textile industrial effluent (TIE). The DB15 adsorbed‐HNT “sludge” was used as a reinforcing agent and plas-tic waste to fabricate the composite. To advance the knowledge and further understand the chemical phenomena associated with DB15 adsorption on HNT, different factors like pH value, adsorbate initial concentration, adsorbent dosage, and temperature on the composite were affected experi-mentally tested. To estimate the adsorption capacity of HNT, nine isotherm models were applied, and it was identified that the Brouers–Sotolongo adsorption isotherm model represented the best accuracy for predicting the adsorption behavior of the HNT. Likewise, the pseudo‐second‐order reaction was the predominant mechanism for the overall rate of the multi‐step dye adsorption pro-cess. Additionally, it was demonstrated that the mass transfer during the process is diffusion‐con-trolled, and thermodynamic assessments showed that the process is physisorption.publishersversionpublishe

Efficacy of using plant ingredients as partial substitute of fishmeal in formulated diet for a commercially cultured fish, Labeo rohita

Reliance on fish meal can be reduced by incorporating plant-based ingredients, making aquaculture more economical, sustainable and environmental friendly. In this study, the efficacy of plant protein ingredients (PPI) such as mustard oil cake (MOC), soybean meal (SBM) and rice bran (RB) as Partial substitute of fishmeal (FM) was investigated for a commercially important fish, Labeo rohita in cages for 90 days. Three experimental diets, labeled as Diet 1, Diet 2, and Diet 3, were formulated to be isonitrogenous (with protein content ranging from 32.20 to 32.29%) and iso-caloric (with gross energy ranging from 4.12 to 4.17 kcal/g). These diets contained different proportions of PPI (45, 68, and 79%) and FM (46, 23, and 11%, respectively). Square-shaped cages with a volume of 1m3 (1 m × 1 m × 1 m) were stocked with 40 fish/m3 each with an average initial weight of 52.97 g in triplicates. Fish were hand-fed to apparent satiation twice daily for 7 days a week at a feeding rate of 5% in the initial month and 3% for the rest of the culture period. 50% of the caged fish was sampled monthly to monitor growth performance and at the termination of the experiment, all the fish was harvested to measure production economics performance. The results indicated improved growth performance and higher feed utilization at Diet 2, yielding significantly (p &lt; 0.05) higher fish production compared to Diet 3, while these parameters were insignificant with Diet 1. By replacing FM with PPI, the total feed cost compared to Diet 1 was reduced to 20.62 and 32.76% for Diet 2 and Diet 3, respectively. The replacement of 50% FM in Diet 2 also yielded a 15.61% higher total economic net return than the Diet 1 group. However, a higher inclusion rate of PPI in Diet 3 potentially reduced fish growth, with a consequent decline of 41.61% total economic net return compared to the Diet 1 group. In conclusion, the replacement of 50% FM in Diet 2 compared to Diet 1 returned a higher benefit–cost ratio (1.72) among the feeding groups. Therefore, this FM replacement experiment suggested a 50% FM replaced diet as an unconventional, cost-effective, and readily available novel protein source without compromising the inherent nutritional quality of fish and feed in the cage culture of L. rohita. The results could be widely applicable to the fast-growing approach of cage culture technology across Asia and beyond

The “Haunt” project: An attempt to build a “haunted” room by manipulating complex electromagnetic fields and infrasound

Recent research has suggested that a number of environmental factors may be associated with a tendency for susceptible individuals to report mildly anomalous sensations typically associated with “haunted” locations, including a sense of presence, feeling dizzy, inexplicable smells, and so on. Factors that may be associated with such sensations include fluctuations in the electromagnetic field and the presence of infrasound. A review of such work is presented, followed by the results of the “Haunt” project in which an attempt was made to construct an artificial “haunted” room by systematically varying such environmental factors. Participants (N = 79) were required to spend 50 minutes in a specially constructed chamber, within which they were exposed to infrasound, complex electromagnetic fields, both or neither. They were informed in advance that during this period they might experience anomalous sensations and asked to record on a floor-plan their location at the time occurrence of any such sensations, along with a note of the time of occurrence and a brief description of the sensation. Upon completing the session in the experimental chamber, they were asked to complete three questionnaires. The first was an EXIT scale asking respondents to indicate whether or not they had experienced particular anomalous sensations. The second was the Australian Sheep-Goat Scale, a widely used measure of belief in and experience of the paranormal. The third was Persinger’s Personal Philosophy Inventory, although only the items that constitute the Temporal Lobe Signs Inventory (TLS) sub-scale were scored. These items deal with psychological experiences typically associated with temporal lobe epilepsy but normally distributed throughout the general population. Although many participants reported anomalous sensations of various kinds, the number reported was unrelated to experimental condition but was related to TLS scores. The most parsimonious explanation for our findings is in terms of suggestibility

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Measuring routine childhood vaccination coverage in 204 countries and territories, 1980-2019 : a systematic analysis for the Global Burden of Disease Study 2020, Release 1

Background Measuring routine childhood vaccination is crucial to inform global vaccine policies and programme implementation, and to track progress towards targets set by the Global Vaccine Action Plan (GVAP) and Immunization Agenda 2030. Robust estimates of routine vaccine coverage are needed to identify past successes and persistent vulnerabilities. Drawing from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2020, Release 1, we did a systematic analysis of global, regional, and national vaccine coverage trends using a statistical framework, by vaccine and over time. Methods For this analysis we collated 55 326 country-specific, cohort-specific, year-specific, vaccine-specific, and dosespecific observations of routine childhood vaccination coverage between 1980 and 2019. Using spatiotemporal Gaussian process regression, we produced location-specific and year-specific estimates of 11 routine childhood vaccine coverage indicators for 204 countries and territories from 1980 to 2019, adjusting for biases in countryreported data and reflecting reported stockouts and supply disruptions. We analysed global and regional trends in coverage and numbers of zero-dose children (defined as those who never received a diphtheria-tetanus-pertussis [DTP] vaccine dose), progress towards GVAP targets, and the relationship between vaccine coverage and sociodemographic development. Findings By 2019, global coverage of third-dose DTP (DTP3; 81.6% [95% uncertainty interval 80.4-82 .7]) more than doubled from levels estimated in 1980 (39.9% [37.5-42.1]), as did global coverage of the first-dose measles-containing vaccine (MCV1; from 38.5% [35.4-41.3] in 1980 to 83.6% [82.3-84.8] in 2019). Third- dose polio vaccine (Pol3) coverage also increased, from 42.6% (41.4-44.1) in 1980 to 79.8% (78.4-81.1) in 2019, and global coverage of newer vaccines increased rapidly between 2000 and 2019. The global number of zero-dose children fell by nearly 75% between 1980 and 2019, from 56.8 million (52.6-60. 9) to 14.5 million (13.4-15.9). However, over the past decade, global vaccine coverage broadly plateaued; 94 countries and territories recorded decreasing DTP3 coverage since 2010. Only 11 countries and territories were estimated to have reached the national GVAP target of at least 90% coverage for all assessed vaccines in 2019. Interpretation After achieving large gains in childhood vaccine coverage worldwide, in much of the world this progress was stalled or reversed from 2010 to 2019. These findings underscore the importance of revisiting routine immunisation strategies and programmatic approaches, recentring service delivery around equity and underserved populations. Strengthening vaccine data and monitoring systems is crucial to these pursuits, now and through to 2030, to ensure that all children have access to, and can benefit from, lifesaving vaccines. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.Peer reviewe

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