The current study aimed to explore some important insights into the breast cancer mortality (BCM) trends and projections among four Asian countries by using five advanced stochastic mortality models. ...BCM data over 28 years from 1990-2017 with ages 20-84 were retrieved from the Global Burden of Disease (GBD) Study 2017 for four Asian countries, namely, China, India, Pakistan, and Thailand. Five stochastic mortality models with the family of generalized age-period-cohort were implemented to find the present and future BCM trends in these four Asian countries. Based on Cairns-Blake-Dowd (CBD) model and Lee-Carter model (LCM), overall, results revealed that BCM increased with the passage of time. Aging factor was the most influential factor of elevated BCM in each Asian country under consideration. Projection of BCM showed that mortality rates might continue to grow with time, especially in older ages in each Asian country under study. The highest forecasted BCM rates were observed in Pakistan as compared to other countries. The obvious increase in BCM suggested that earlier tactics should be implemented to reduce the subsequent morbidity and mortality due to breast cancer. The last but not least, some additional tactics to mitigate the BCM in older ages must be adopted.
Chickpea (Cicer arietinum L.) is a major pulse crop worldwide, renowned for its nutritional richness and adaptability. Weeds are the main biotic factor deteriorating chickpea yield and nutritional ...quality, especially Asphodelus tenuifolius Cav. The present study concerns a two-year (2018–19 and 2019–20) field trial aiming at evaluating the effect of weed management on chickpea grain quality. Several weed management practices have been here implemented under a factorial randomized complete block design, including the application of four herbicides bromoxynil (C7H3Br2NO) + MCPA (Methyl-chlorophenoxyacetic acid) (C9H9ClO3), fluroxypyr + MCPA, fenoxaprop-p-ethyl (C18H16ClNO5), pendimethalin (C13H19N3O4), the extracts from two allelopathic weeds (Sorghum halepense and Cyperus rotundus), two mulches (wheat straw and eucalyptus leaves), a combination of A. tenuifolius extract and pendimethalin, and an untreated check (control). Chickpea grain quality was measured in terms of nitrogen, crude protein, crude fat, ash, and oil content. The herbicides pendimethalin (Stomp 330 EC (emulsifiable concentrate) in pre-emergence at a rate of 2.5 L ha−1) and fenoxaprop-p-ethyl (Puma Super 7.5 EW (emulsion in water) in post-emergence at a rate of 1.0 L ha−1), thanks to A. tenuifolius control, showed outstanding performance, providing the highest dietary quality of chickpea grain. The herbicides Stomp 330 EC, Buctril Super 40 EC, Starane-M 50 EC, and Puma Super 7.5 EW provided the highest levels of nitrogen. Outstanding increases in crude protein content were observed with all management strategies, particularly with Stomp 330 EC and Puma Super 7.5 EW (+18% on average). Ash content was highly elevated by Stomp 330 EC and Puma Super 7.5 EW, along with wheat straw mulching, reaching levels of 2.96% and 2.94%. Crude fat content experienced consistent elevations across all treatments, with the highest improvements achieved by Stomp 330 EC, Puma Super 7.5 EW, and wheat straw mulching applications. While 2018–19 displayed no significant oil content variations, 2019–20 revealed the highest oil content (5.97% and 5.96%) with herbicides Stomp 330 EC and Puma Super 7.5 EW, respectively, followed by eucalyptus leaves mulching (5.82%). The results here obtained are of key importance in the agricultural and food sector for the sustainable enhancement of chickpea grain’s nutritional quality without impacting the environment.
Background and purposeHigh admission blood pressure (BP) levels have been associated with lower recanalization rates after endovascular treatment (EVT) for patients with acute ischemic stroke (AIS) ...with emergent large vessel occlusion (ELVO). We sought to evaluate the association of admission BP with early outcomes in patients with ELVO treated with EVT.MethodsConsecutive patients with AIS presenting with ELVO in a tertiary stroke center during a 4-year period were prospectively evaluated. Admission systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured using automated cuff recordings. A blinded neuroradiologist calculated the final infarct volume (FIV) using standardized ABC/2 methodology. A favorable functional outcome (FFO) at 3 months was defined as modified Rankin Scale score of 0–2.ResultsOur study population consisted of 116 patients with AIS (mean age 63±13 years, median NIH Stroke Scale score 17 points (IQR 14–21), median FIV 30 cm3 (IQR 8–94)). Higher admission SBP correlated with higher FIV (r +0.225; p=0.020). Patients with FFO had lower admission SBP (151±24 mm Hg vs 165±28 mm Hg; p=0.010), while admission SBP levels were higher in patients who died during hospitalization (169±34 mm Hg vs 156±24 mm Hg; p=0.043). A 10 mm Hg increment in admission SBP was independently (p=0.010) associated with an increase of 12 cm3 in FIV (95% CI 3 to 21) in multiple linear regression models adjusting for potential confounders. A 10 mm Hg increment in admission SBP was independently (p=0.012) associated with a lower likelihood of FFO at 3 months (OR 0.64; 95% CI 0.45 to 0.91) in multiple logistic regression models adjusting for potential confounders.ConclusionsHigher admission SBP is an independent predictor of increased FIV and lower likelihood of 3-month FFO in patients with ELVO treated with EVT.
Background Stroke patients who have cerebral micro bleeds (CMBs) could be potentially at a greater risk for symptomatic intracerebral hemorrhage (sICH) than those patients without CMBs. The aim of ...our study was to investigate whether the presence and burden of CMBs are associated with post IVT sICH. Methods In this multicenter study, consecutive patients treated with intravenous tissue plasminogen activator were prospectively identified and analyzed. Patients without magnetic resonance imaging (MRI) within 24 hours of treatment were excluded. CMBs were defined as round or oval, hypointense lesions with associated blooming on T2*-weighted MRI up to 10 mm in diameter. Outcome measures included the occurrence of sICH or death. Results Of 672 patients with IVT (mean age 62 ± 14 years, 52% men, median admission NIHSS: 7 points), 103 patients had CMBs on T2*-MRI. Ten patients had more than 10, whereas the remaining 93 patients had 1-10 CMBs on T2*-MRI. The rates of sICH did not differ between patients with and patients without 1-10 CMBs (5.8% versus 3.5%; P = .27). However, sICH occurred more frequently ( P = .0009) in patients with > 10 CMBs (30%, 95% confidence interval CI by the adjusted Wald method: 10%-61%). After adjusting for potential confounders, the presence of >10 CMBs on T2*-MRI was independently ( P = .0004) associated with a higher likelihood for sICH (odds ratio OR:13.4, 95%CI:3.2-55.9). Conclusions Our findings indicate an increased risk of sICH after IVT when more than 10 CMBs are present.
OBJECTIVE:There are limited data evaluating the effect of post mechanical thrombectomy (MT) blood pressure (BP) levels on early outcomes of patients with large vessel occlusions (LVO). We sought to ...investigate the association of BP course following MT with early outcomes in LVO.
METHODS:Consecutive patients with LVO treated with MT during a 3-year period were evaluated. Hourly systolic BP (SBP) and diastolic BP (DBP) values were recorded for 24 hours following MT and maximum SBP and DBP levels were identified. LVO patients with complete reperfusion following MT were stratified in 3 groups based on post-MT achieved BP goals<140/90 mm Hg (intensive), <160/90 mm Hg (moderate), and <220/110 mm Hg or <180/105 mm Hg when pretreated with IV thrombolysis (permissive hypertension). Three-month functional independence was defined as modified Rankin Scale score of 0–2.
RESULTS:A total of 217 acute ischemic stroke patients with LVO were prospectively evaluated. A 10 mm Hg increment in maximum SBP documented during the first 24 hours post MT was independently (p = 0.001) associated with a lower likelihood of 3-month functional independence (odds ratio OR 0.70; 95% confidence interval CI 0.56–0.87) and a higher odds of 3-month mortality (OR 1.49; 95% CI 1.18–1.88) after adjusting for potential confounders. In addition, achieving a BP goal of <160/90 mm Hg during the first 24 hours following MT was independently associated with a lower likelihood of 3-month mortality (OR 0.08; 95% CI 0.01–0.54; p = 0.010) in comparison to permissive hypertension.
CONCLUSIONS:High maximum SBP levels following MT are independently associated with increased likelihood of 3-month mortality and functional dependence in LVO patients. Moderate BP control is also related to lower odds of 3-month mortality in comparison to permissive hypertension.
A survey was carried out to determine the major factors influencing chickpea productivity. Weeds may be one of the main causes of low productivity in Pakistan. In order to highlight the most ...significant and challenging weeds of the chickpea crop in the southern regions of Khyber Pakhtunkhwa, Pakistan, during the Rabi season 2022. Five chickpea growing regions were selected in chickpea growing area of district Karak. The quadrate method was used to determine the relative weed density. The data were recorded on density (%), relative density (%), frequency (%), relative frequency (%) and importance value of weed species. The present findings revealed that Asphodelus tenuifolius Cav., Carthamus oxycantha M. Bieb., Medicago denticulata Willd., Anagallis arvensis, Lathyrus aphaca L. Euphorbia helioscopia L., Convolvulus arvensis L., Cyprus rotundus, Vicia sativa L. Ehrh., Cynodon dactylon L. Pers. and Fumaria indica Hausskn were all found in five locations around the district. The main species in the district emerged as A. tenuifolius Cav. The highest relative weed density (64.2%) and relative weed frequency (45.2%), respectively was noted for A. tenuifolius Cav. While, the lowest value of relative weed density (3.5%) and relative weed frequency (1.2%), respectively was documented for E. helioscopia L. A good judgement for determining the status of a particular weed in a community is the assessment of importance value of the weed species. The data showed that the highest importance value (55.7%) was considered for A. tenuifolius Cav. While, the minimum importance value (3.2%) was noted for E. helioscopia L. Thus, farmers and the scientific community found the information from this study to be extremely helpful in developing a strong integrated weed management plan for the chickpea crop in District Karak.
Background. There is a paucity of data regarding health consequences of Ebola virus disease among survivors. Methods. We surveyed 105 Ebola virus disease survivors postdischarge from an Ebola ...treatment unit in Guinea using a standard data collection form. Patients rated recovery as the percentage of improvement in functional status, where 0% represents "unable to perform" and 100% represents "able to perform at prior level." Results. The mean ± standard deviation time interval between hospital discharge and administration of questionnaire was 103.5 ± 47.9 days in 105 survivors. Anorexia was reported by 103 patients, with varying severity levels: mild (n = 33), moderate (n = 65), or severe (n = 5). Reported pain according to site was chest (30.7%), joint (86.7%), muscle (26.7%), and back (45.7%), among others. Recovery in functional status was graded as mild (10%–30%) (n = 2 1.9%), moderate (40%–70%) (n = 52 50.0%), and excellent (80%–100%) (n = 50 48.1%). Severity of arthralgia (R2 = 0.09; P = .008) was directly associated with lower recovery in functional status in multivariate analysis. Conclusions. Ebola virus disease survivors frequently reported anorexia and arthralgia. Severity of arthralgia was related to lower functional recovery. There may be a role for focused screening and intervention for symptoms identified in this study of survivors.
BACKGROUND AND PURPOSE—Pharmacokinetic and prior studies on thienopyridine and proton pump inhibitors (PPI) coadministration provide conflicting data for cardiovascular outcomes, whereas there is no ...established evidence on the association of concomitant use of PPI and thienopyridines with adverse cerebrovascular outcomes.
METHODS—We conducted a systematic review and meta-analysis of randomized controlled trials and cohort studies from inception to July 2017, reporting following outcomes among patients treated with thienopyridine and PPI versus thienopyridine alone (1) ischemic stroke, (2) combined ischemic or hemorrhagic stroke, (3) composite outcome of stroke, myocardial infarction (MI), and cardiovascular death, (4) MI, (5) all-cause mortality, and (6) major or minor bleeding events. After the unadjusted analyses of risk ratios, we performed additional analyses of studies reporting hazard ratios adjusted for potential confounders.
RESULTS—We identified 22 studies (12 randomized controlled trials and 10 cohort studies) comprising 131 714 patients. Concomitant use of PPI with thienopyridines was associated with increased risk of ischemic stroke (risk ratio, 1.74; 95% confidence interval CI, 1.41–2.16; P<0.001), composite stroke/MI/cardiovascular death (risk ratio, 1.14; 95% CI, 1.01–1.29; P=0.04), and MI (risk ratio, 1.19; 95% CI, 1.00–1.40; P=0.05). Likewise, in adjusted analyses concomitant use of PPI with thienopyridines was again associated with increased risk of stroke (hazard ratios adjusted, 1.30; 95% CI, 1.04–1.61; P=0.02), composite stroke/MI/cardiovascular death (hazard ratios adjusted, 1.23; 95% CI, 1.03–1.47; P=0.02), but not with MI (hazard ratios adjusted, 1.19; 95% CI, 0.93–1.52; P=0.16).
CONCLUSIONS—Co-prescription of PPI and thienopyridines increases the risk of incident ischemic strokes and composite stroke/MI/cardiovascular death. Our findings corroborate the current guidelines for PPI deprescription and pharmacovigilance, especially in patients treated with thienopyridines.
There is mounting evidence supporting infection as an independent risk factor for ischemic stroke (IS), while preliminary data indicate that vaccination may prevent IS. We performed a systematic ...review and meta-analysis of available randomized clinical trials (RCTs) or prospective observational cohorts reporting associations of influenza vaccination (IV) and/or pneumococcal vaccination (PV) with IS. We identified a total of 12 studies (543,311 patients; 47.4% vaccinated). Vaccination was not related to the risk of IS (RR=1.06, 95%CI: 0.74–1.51, p=0.77), with no significant differences (p=0.26) among RCTs (RR=0.66, 95%CI: 0.30–1.47) and observational studies (RR=1.11, 95%CI: 0.76–1.61). Evidence of considerable heterogeneity was identified within observational studies (I2=98%), but not within RCTs (I2=0%). In subgroup analyses according to vaccination type, IV was associated with a significantly lower risk of IS (RR=0.87, 95%CI: 0.79–0.96, p=0.004) with moderate evidence of heterogeneity (I2=53%). No association was seen for PV (RR=1.38, 95%CI: 0.60–3.16, p=0.45), where considerable heterogeneity was identified (I2=97%). In the additional adjusted analyses of observational studies, vaccination tended to be associated with lower risk of IS (HRadjusted=0.87; 95%CI: 0.75–1.01; p=0.07). The findings of this meta-analysis indicate that IV may be associated with a lower risk of IS. This association was not reproduced for PV or the combination of two vaccines. Substantial heterogeneity was detected across observational studies for all outcome events, while moderate to low heterogeneity was identified across included RCTs. These preliminary findings require independent validation in large RCTs.
•Evidence support infection as an independent risk factor for ischemic stroke (IS).•Preliminary data also indicate that vaccination may prevent IS.•We investigated the aforementioned association in a systematic review/meta-analysis.•Influenza vaccination was found to be associated with a lower risk of IS.•Our finding requires independent validation in large RCTs.
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