The burden of inflammatory bowel disease (IBD) is rising globally, with substantial variation in levels and trends of disease in different countries and regions. Understanding these geographical ...differences is crucial for formulating effective strategies for preventing and treating IBD. We report the prevalence, mortality, and overall burden of IBD in 195 countries and territories between 1990 and 2017, based on data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017.
We modelled mortality due to IBD using a standard Cause of Death Ensemble model including data mainly from vital registrations. To estimate the non-fatal burden, we used data presented in primary studies, hospital discharges, and claims data, and used DisMod-MR 2.1, a Bayesian meta-regression tool, to ensure consistency between measures. Mortality, prevalence, years of life lost (YLLs) due to premature death, years lived with disability (YLDs), and disability-adjusted life-years (DALYs) were estimated. All of the estimates were reported as numbers and rates per 100 000 population, with 95% uncertainty intervals (UI).
In 2017, there were 6·8 million (95% UI 6·4–7·3) cases of IBD globally. The age-standardised prevalence rate increased from 79·5 (75·9–83·5) per 100 000 population in 1990 to 84·3 (79·2–89·9) per 100 000 population in 2017. The age-standardised death rate decreased from 0·61 (0·55–0·69) per 100 000 population in 1990 to 0·51 (0·42–0·54) per 100 000 population in 2017. At the GBD regional level, the highest age-standardised prevalence rate in 2017 occurred in high-income North America (422·0 398·7–446·1 per 100 000) and the lowest age-standardised prevalence rates were observed in the Caribbean (6·7 6·3–7·2 per 100 000 population). High Socio-demographic Index (SDI) locations had the highest age-standardised prevalence rate, while low SDI regions had the lowest age-standardised prevalence rate. At the national level, the USA had the highest age-standardised prevalence rate (464·5 438·6–490·9 per 100 000 population), followed by the UK (449·6 420·6–481·6 per 100 000). Vanuatu had the highest age-standardised death rate in 2017 (1·8 0·8–3·2 per 100 000 population) and Singapore had the lowest (0·08 0·06–0·14 per 100 000 population). The total YLDs attributed to IBD almost doubled over the study period, from 0·56 million (0·39–0·77) in 1990 to 1·02 million (0·71–1·38) in 2017. The age-standardised rate of DALYs decreased from 26·5 (21·0–33·0) per 100 000 population in 1990 to 23·2 (19·1–27·8) per 100 000 population in 2017.
The prevalence of IBD increased substantially in many regions from 1990 to 2017, which might pose a substantial social and economic burden on governments and health systems in the coming years. Our findings can be useful for policy makers developing strategies to tackle IBD, including the education of specialised personnel to address the burden of this complex disease.
Bill & Melinda Gates Foundation.
The Botswana Combination Prevention Project tested the impact of combination prevention (CP) on HIV incidence in a community-randomized trial. Each trial arm had ∼55,000 people, 26% HIV prevalence, ...and 72% baseline ART coverage. Results showed intensive testing and linkage campaigns, expanded antiretroviral treatment (ART), and voluntary male medical circumcision (VMMC) referrals increased coverage and decreased incidence over ∼29 months follow-up. We projected lifetime clinical impact and cost-effectiveness of CP in this population.
Rural and peri-urban communities in Botswana.
We used the Cost-Effectiveness of Preventing AIDS Complications (CEPAC) model to estimate lifetime health impact and cost of 1) earlier ART initiation, and 2) averting an HIV infection, which we applied to incremental ART initiations and averted infections calculated from trial data. We determined the incremental cost-effectiveness ratio (ICER, US$/QALY) for CP vs. standard of care.
In CP, 1,418 additional people with HIV initiated ART and an additional 304 infections were averted. For each additional person started on ART, life expectancy increased 0.90 QALYs and care costs increased by $869. For each infection averted, life expectancy increased 2.43 QALYs with $9,200 in care costs saved. With CP, an additional $1.7 million were spent on prevention and $1.2 million on earlier treatment. These costs were mostly offset by decreased care costs from averted infections, resulting in an ICER of $79 per QALY.
Enhanced HIV testing, linkage, and early ART initiation improves life expectancy, reduces transmission, and can be cost-effective or cost-saving in settings like Botswana.
A systematic review and a meta‐analysis were performed to quantify the accumulated information from genetic association studies investigating the impact of the CYP4F2 rs2108622 (p.V433M) polymorphism ...on coumarin dose requirement. An additional aim was to explore the contribution of the CYP4F2 variant in comparison with, as well as after stratification for, the VKORC1 and CYP2C9 variants. Thirty studies involving 9,470 participants met prespecified inclusion criteria. As compared with CC‐homozygotes, T‐allele carriers required an 8.3% (95% confidence interval (CI): 5.6–11.1%; P < 0.0001) higher mean daily coumarin dose than CC homozygotes to reach a stable international normalized ratio (INR). There was no evidence of publication bias. Heterogeneity among studies was present (I2 = 43%). Our results show that the CYP4F2 p.V433M polymorphism is associated with interindividual variability in response to coumarin drugs, but with a low effect size that is confirmed to be lower than those contributed by VKORC1 and CYP2C9 polymorphisms.
Clinical Pharmacology & Therapeutics (2012); 92 6, 746–756. doi:10.1038/clpt.2012.184
Coagulation–flocculation is a relatively simple physical–chemical technique in treatment of old and stabilized leachate which has been practiced using a variety of conventional coagulants. Polymeric ...forms of metal coagulants which are increasingly applied in water treatment are not well documented in leachate treatment. In this research, capability of poly-aluminum chloride (PAC) in the treatment of stabilized leachate from Pulau Burung Landfill Site (PBLS), Penang, Malaysia was studied. The removal efficiencies for chemical oxygen demand (COD), turbidity, color and total suspended solid (TSS) obtained using PAC were compared with those obtained using alum as a conventional coagulant. Central composite design (CCD) and response surface method (RSM) were applied to optimize the operating variables viz. coagulant dosage and pH. Quadratic models developed for the four responses (COD, turbidity, color and TSS) studied indicated the optimum conditions to be PAC dosage of 2
g/L at pH 7.5 and alum dosage of 9.5
g/L at pH 7. The experimental data and model predictions agreed well. COD, turbidity, color and TSS removal efficiencies of 43.1, 94.0, 90.7, and 92.2% for PAC, and 62.8, 88.4, 86.4, and 90.1% for alum were demonstrated.
Spectropolarimetric fluctuations in a sunspot chromosphere Stangalini, M; Baker, D; Valori, G ...
Philosophical transactions - Royal Society. Mathematical, Physical and engineering sciences/Philosophical transactions - Royal Society. Mathematical, physical and engineering sciences,
02/2021, Letnik:
379, Številka:
2190
Journal Article
Recenzirano
Odprti dostop
The instrumental advances made in this new era of 4 m class solar telescopes with unmatched spectropolarimetric accuracy and sensitivity will enable the study of chromospheric magnetic fields and ...their dynamics with unprecedented detail. In this regard, spectropolarimetric diagnostics can provide invaluable insight into magneto-hydrodynamic (MHD) wave processes. MHD waves and, in particular, Alfvénic fluctuations associated with particular wave modes were recently recognized as important mechanisms not only for the heating of the outer layers of the Sun's atmosphere and the acceleration of the solar wind, but also for the elemental abundance anomaly observed in the corona of the Sun and other Sun-like stars (also known as first ionization potential) effect. Here, we take advantage of state-of-the-art and unique spectropolarimetric Interferometric BIdimensional Spectrometer observations to investigate the relation between intensity and circular polarization (CP) fluctuations in a sunspot chromosphere. Our results show a clear link between the intensity and CP fluctuations in a patch which corresponds to a narrow range of magnetic field inclinations. This suggests the presence of Alfvénic perturbations in the sunspot. This article is part of the Theo Murphy meeting issue 'High-resolution wave dynamics in the lower solar atmosphere'.
After planned withdrawal of life support and determination of death by cardiac criteria, 14% of 480 patients had one or more cycles of a return of blood pressure of more than 5 mm Hg detected by ...arterial catheter monitoring after a period of pulselessness, all occurring within 5 minutes.
Background
Acute necrotizing encephalopathy of children (ANEC) is a rare fulminant type of acute encephalopathy that mainly occurs in children with a characteristic clinico-radiological pattern. It ...is commonly preceded by viral infections. The condition carries a poor prognosis with high morbidity and mortality rates. We highlight the relationship between diagnostic multi-parametric magnetic resonance imaging (MRI) findings and correlate them with the clinical outcome of children with ANEC by enrollment of MRI scoring.
Results
The thalami were involved in all 30 patients, brain stem in 80%, basal ganglia (13.3%), cerebral white matter (WM) in 73%, and cerebellar WM in 33%. Hemorrhage was present in 86.7% patients, edema 80%, and necrosis in 13.3%. We found that the patients having the highest MRI scores were in the poor outcome category; whereas the patients with lower MR score (1 or 2) had better outcomes. Statistically positive correlation (
r=
0.1198) was found between the multi-parametric MR score and the outcome category
.
Conclusion
An extended multi-parametric MRI should be performed in ANEC, allowing early detection and scoring of the disease for better prognosis. There is a positive correlation between the clinical outcome and the MR scoring.
The Cardiac Surgery-Associated Neutrophil Gelatinase-Associated Lipocalin (CSA-NGAL) score has been developed to stratify patients with cardiac surgery-associated acute kidney injury (CSA-AKI). Its ...predictive power needs to be validated to guide clinical decision for such high-risk patients.
A prospective study was conducted on 637 consecutive adult patients who developed postoperative AKI after cardiac surgery with cardiopulmonary bypass. AKI was defined according to Kidney Disease: Improving Global Outcomes criteria (KDIGO). The CSA-NGAL score was calculated. Assessment of the diagnostic performance of the scoring model was performed by area under the receiver operating curve analysis.
The area under the curve for the postoperative Urinary NGAL showed an area under the curve (standard error (SE) 0.80 (0.38); p<0.001; 95% CI 0.72–0.87). Its sensitivity for CSA-AKI in the first 24 hours was 66% and specificity was 80% (cut-off value 300.1 ng/mL). There was a positive correlation between NGAL score and KDIGO criteria, with a significant increase in postoperative mean Urinary NGAL values as the KDIGO stage increased.
The CSA-NGAL score has a high sensitivity, specificity and positive predictive value that can translate into improved outcomes and resource allocation. It is believed that adding it to the existing clinical scoring systems for AKI prediction will be productive.
The southern part of the Eastern Desert of Egypt—about 30 km southwest of Abu-Ramad city—is mainly covered by ophiolitic rocks (Sul Hamed), island arc assemblage, younger granites (muscovite granites ...of Qash Amer and two mica granites of El Sela), and various acidic and basic dikes. Field, petrological, and geochemical studies indicate that the El Sela shear zone has been subject to hydrothermal and supergene alteration such as kaolinization, albitization, sericitization, and hematitization. It is invaded by quartz ENE–WSW veins associated with hydrothermal alteration accompanied by radioactive mineralization. The investigated younger granitic rocks had very low contents of compatible elements, such as Cr, Ni, and Co; and high contents of incompatible elements, such as Zr, and large ion lithophiles, such as Sr, especially in the El Sela shear zone. Major oxide and trace element analyses revealed calc-alkaline affinity and peraluminous character. These highly differentiated granitic rocks’ lower Zr/Hf and higher Y/Ho than the normal ratio are consistent with hydrothermal alteration. Most samples had rare earth element (REE)-patterns with an M-type tetrad effect in the first and fourth segments and a W-type tetrad in the third segment. The average ∑REE in the studied granites was lower than the world granite average; the ratio of light to heavy REEs greater. The main radioactive, uranium-bearing, and uraniferous Fe and Mn minerals are uranothorite, autunite, uranophane and autunite as compounds, kasolite, columbite, xenotime, uranophane-bearing zircon and jarosite, silver-bearing pyrite, hematite, and autunite-bearing pyrolusite.
Objective: To assess the efficacy and safety of Melissa officinalis extract using a fixed dose (60 drops/day) in patients with mild to moderate Alzheimer’s disease. Design: A four month, parallel ...group, placebo controlled trial undertaken in three centres in Tehran, Iran. Methods: Patients with mild to moderate Alzheimer’s disease aged between 65 and 80 years (n = 42; 18 women, 24 men) with a score of ≥ 12 on the cognitive subscale of Alzheimer’s disease assessment scale (ADAS-cog) and ≤ 2 on the clinical dementia rating (CDR) were randomised to placebo or fixed dose of Melissa officinalis extract. The main efficacy measures were the change in the ADAS-cog and CDR-SB scores compared with baseline. Side effects were systematically recorded. Results: At four months, Melissa officinalis extract produced a significantly better outcome on cognitive function than placebo (ADAS-cog: df = 1, F = 6.93, p = 0.01; CDR: df = 1, F = 16.87, p < 0.0001). There were no significant differences in the two groups in terms of observed side effects except agitation, which was more common in the placebo group (p = 0.03). Conclusions:Melissa officinalis extract is of value in the management of mild to moderate Alzheimer’s disease and has a positive effect on agitation in such patients.
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