Search results for: infant mortality

Authors: Charlotte Bach, Albrecht Jahn, Mahnaz Motamedi, Maryam Karimi-Ghahfarokhi

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Background: Maternal and infant deaths are most prevalent in the first month after birth, emphasizing the critical need for quality healthcare services during this period. Immigrant women, who are more susceptible to adverse pregnancy outcomes, often face neglect in accessing proper healthcare. The lack of adequate postpartum care significantly contributes to mortality rates. Therefore, utilizing maternal health care services and implementing postpartum care is crucial in reducing maternal and child mortality. Aims: This study aims to evaluate the assessment of pre- and postnatal care among women with and without migration background. In addition, the study explores the impact of COVID-19 procedures on women's experiences during pregnancy, birth, and the postpartum period. Methods: This research employs a cross-sectional Mixed-Method design. Data collection was facilitated through structured questionnaires administered to participants, alongside the utilization of patient bases, including Maternity and child medical records. Following the assumption that the investigator aimed to gain comprehensive insights, qualitative sampling focused on individuals with substantial experiences related to COVID-19, regarded as rich cases. Results: our study highlighted the influence of educational level, marital status, and consensual partnerships on the likelihood of Cesarean deliveries. Regarding breastfeeding practices, migrant women exhibited higher rates of breastfeeding initiation and continuation. Contraception utilization revealed interesting patterns, with non-migrants displaying higher odds of contraceptive use. The qualitative component of our research adds depth to the exploration of women's experiences during the COVID-19 pandemic, revealing nuanced challenges related to anxiety, hospital restrictions, breastfeeding support, and postnatal ward routines. Conclusion: Dissimilarity among studies toward cesarean rate between migrants and non-migrants underscores the importance of targeted interventions considering the diverse needs of distinct population groups. It also acknowledges potential cultural, contextual, and healthcare system influences on the association between mode of delivery and infant feeding practices. Studies acknowledge the influence of contextual variables on contraceptive preferences among migrants and non-migrants, emphasizing the need for tailored healthcare policies. The findings contribute to existing research, highlighting the need for a nuanced understanding of the impact of birth preparation courses on maternal and infant outcomes. Furthermore, they emphasize the universality of certain maternity care experiences, regardless of pandemic contexts, reinforcing the importance of patient-centred approaches in healthcare delivery.

Keywords: migration background, pregnancy outcome, covid-19, postpartum

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Authors: Niyada Naksuk, Thoetchai Peeraphatdit, Vitaly Herasevich, Peter A. Brady, Suraj Kapa, Samuel J. Asirvatham

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Introduction: Little is known about the safety of antipsychotic therapy for delirium in the coronary care unit (CCU). Our aim was to examine the effect of delirium and antipsychotic therapy among CCU patients. Methods: Pre-study Confusion Assessment Method-Intensive Care Unit (CAM–ICU) criteria were implemented in screening consecutive patients admitted to Mayo Clinic, Rochester, the USA from 2004 through 2013. Death status was prospectively ascertained. Results: Of 11,079 study patients, the incidence of delirium was 8.3% (n=925). Delirium was associated with an increased risk of in-hospital mortality (adjusted OR 1.49; 95% CI, 1.08-2.08; P=.02) and one-year mortality among patients who survived from CCU admission (adjusted HR 1.46; 95% CI, 1.12-1.87; P=.005). A total of 792 doses of haloperidol (5 IQR [3-10] mg/day) or quetiapine (25 IQR [13-50] mg/day) were given to 244 patients with delirium. The clinical characteristics of patients with delirium who did and did not receive antipsychotic therapy were not different (baseline corrected QT [QTc] interval 460±61 ms vs. 457±58 ms, respectively; P = 0.57). In comparison to baseline, mean QTc intervals after the first and third doses of the antipsychotics were not significantly prolonged in haloperidol (448±56, 458±57, and 450±50 ms, respectively) or quetiapine groups (459±54, 467±68, and 462±46 ms, respectively) (P > 0.05 for all). Additionally, in-hospital mortality (adjusted OR 0.67; 95% CI, 0.42-1.04; P=.07), ventricular arrhythmia (adjusted OR 0.87; 95% CI, 0.17-3.62; P=.85) and one-year mortality among the hospital survivors (adjusted HR 0.86; 95% CI 0.62-1.17; P = 0.34) were not different in patients with delirium irrespective of whether or not they received antipsychotics. Conclusions: In patients admitted to the CCU, delirium was associated with an increase in both in-hospital and one-year mortality. Low doses of haloperidol and quetiapine appeared to be safe, without an increase in risk of sudden cardiac death, in-hospital mortality, or one-year mortality in carefully monitored patients.

Keywords: arrhythmias, haloperidol, mortality, qtc interval, quetiapine

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Authors: Ovanes Chakoyan

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MOH (mineral oil hydrocarbons), which consist of mineral oil saturated hydrocarbons(MOSH) and mineral oil aromatic hydrocarbons(MOAH), are present in various products such as vegetable oils, animal feed, foods, and infant formula. Contamination of foods with mineral oil hydrocarbons, particularly mineral oil aromatic hydrocarbons(MOAH), exhibiting carcinogenic, mutagenic, and hormone-disruptive effects. Identifying toxic substances among the many thousands comprising mineral oils in food samples is a difficult analytical challenge. A method based on an offline-solid phase extraction approach coupled with gas chromatography-triple quadrupole(GC-MS/MS) was developed for the determination of MOSH/MOAH in various products such as vegetable oils, animal feed, foods, and infant formula. A glass solid phase extraction cartridge loaded with 7 g of activated silica gel impregnated with 10 % silver nitrate for removal of olefins and lipids. The MOSH/MOAH fractions were eluated with hexane and hexane: dichloromethane : toluene, respectively. Each eluate was concentrated to 50 µl in toluene and injected on splitless mode into GC-MS/MS. Accuracy of the method was estimated as measurement of recovery of spiked oil samples at 2.0, 15.0, and 30.0 mg kg -1, and recoveries varied from 85 to 105 %. The method was applied to the different types of samples (sunflower meal, chocolate ships, santa milk chocolate, biscuits, infant milk, cornflakes, refined sunflower oil, crude sunflower oil), detecting MOSH up to 56 mg/kg and MOAH up to 5 mg/kg. The limit of quantification(LOQ) of the proposed method was estimated at 0.5 mg/kg and 0.3 mg/kg for MOSH and MOAH, respectively.

Keywords: MOSH, MOAH, GC-MS/MS, foods, solid phase extraction

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Authors: Lei Zhou, Chao Li, Ruiqi Ren, Dan Li, Yali Wang, Daxin Ni, Zijian Feng, Qun Li

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Background: Since the first human infection with avian influenza A(H7N9) case was reported in China on 31 March 2013, five epidemics have been observed in China through February 2013 and September 2017. Though the overall mortality rate of H7N9 has remained as high as around 40% throughout the five epidemics, the specific mortality rate in Mainland China varied by provinces. We conducted a descriptive analysis of mortality rates of H7N9 cases to explore the various severity features of the disease and then to provide clues of further analyses of potential factors associated with the severity of the disease. Methods: The data for analysis originated from the National Notifiable Infectious Disease Report and Surveillance System (NNIDRSS). The surveillance system and identification procedure for H7N9 infection have not changed in China since 2013. The definition of a confirmed H7N9 case is as same as previous reports. Mortality rates of H7N9 cases are described and compared by time and location of reporting, age and sex, and genetic features of H7N9 virus strains. Results: The overall mortality rate, the male and female specific overall rates of H7N9 is 39.6% (608/1533), 40.3% (432/1072) and 38.2% (176/461), respectively. There was no significant difference between the mortality rates of male and female. The age-specific mortality rates are significantly varied by age groups (χ²=38.16, p < 0.001). The mortality of H7N9 cases in the age group between 20 and 60 (33.17%) and age group of over 60 (51.16%) is much higher than that in the age group of under 20 (5.00%). Considering the time of reporting, the mortality rates of cases which were reported in the first (40.57%) and fourth (42.51%) quarters of each year are significantly higher than the mortality of cases which were reported in the second (36.02%) and third (27.27%) quarters (χ²=75.18, p < 0.001). The geographic specific mortality rates vary too. The mortality rates of H7N9 cases reported from the Northeast China (66.67%) and Westeast China (56.52%) are significantly higher than that of H7N9 cases reported from the remained area of mainland China. The mortality rate of H7N9 cases reported from the Central China is the lowest (34.38%). The mortality rates of H7N9 cases reported from rural (37.76%) and urban (38.96%) areas are similar. The mortality rate of H7N9 cases infected with the highly pathogenic avian influenza A(H7N9) virus (48.15%) is higher than the rate of H7N9 cases infected with the low pathogenic avian influenza A(H7N9) virus (37.57%), but the difference is not statistically significant. Preliminary analyses showed that age and some clinical complications such as respiratory failure, heart failure, and septic shock could be potential risk factors associated with the death of H7N9 cases. Conclusions: The mortality rates of H7N9 cases varied by age, sex, time of reporting and geographical location in mainland China. Further in-depth analyses and field investigations of the factors associated with the severity of H7N9 cases need to be considered.

Keywords: H7N9 virus, Avian Influenza, mortality, China

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Authors: Cecília M. Antão, Paulo Jorge Nogueira

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Breast cancer (BC) is the first cause of cancer mortality among Portuguese women. This retrospective observational study aimed at identifying comorbidities associated with BC female patients admitted to Portuguese public hospitals (2010-2018), investigating the effect of comorbidities on BC mortality rate, and building a predictive model using logistic regression. Results showed that the BC mortality in Portugal decreased in this period and reached 4.37% in 2018. Adjusted odds ratio indicated that secondary malignant neoplasms of liver, of bone and bone marrow, congestive heart failure, and diabetes were associated with an increased chance of dying from breast cancer. Although the Lisbon district (the most populated area) accounted for the largest percentage of BC patients, the logistic regression model showed that, besides patient’s age, being resident in Bragança, Castelo Branco, or Porto districts was directly associated with an increase of the mortality rate.

Keywords: breast cancer, comorbidities, logistic regression, adjusted odds ratio

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Authors: G. A. Khalid, M. D. Jones, R. Prabhu, A. Mason-Jones, W. Whittington, H. Bakhtiarydavijani, P. S. Theobald

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Head injury in childhood is a common cause of death or permanent disability from injury. However, despite its frequency and significance, there is little understanding of how a child’s head responds during injurious loading. Whilst Infant Post Mortem Human Subject (PMHS) experimentation is a logical approach to understand injury biomechanics, it is the authors’ opinion that a lack of subject availability is hindering potential progress. Computer modelling adds great value when considering adult populations; however, its potential remains largely untapped for infant surrogates. The complexities of child growth and development, which result in age dependent changes in anatomy, geometry and physical response characteristics, present new challenges for computational simulation. Further geometric challenges are presented by the intricate infant cranial bones, which are separated by sutures and fontanelles and demonstrate a visible fibre orientation. This study presents an FE model of a newborn infant’s head, developed from high-resolution computer tomography scans, informed by published tissue material properties. To mimic the fibre orientation of immature cranial bone, anisotropic properties were applied to the FE cranial bone model, with elastic moduli representing the bone response both parallel and perpendicular to the fibre orientation. Biofiedility of the computational model was confirmed by global validation against published PMHS data, by replicating experimental impact tests with a series of computational simulations, in terms of head kinematic responses. Numerical results confirm that the FE head model’s mechanical response is in favourable agreement with the PMHS drop test results.

Keywords: finite element analysis, impact simulation, infant head trauma, material properties, post mortem human subjects

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Authors: Neda Valizadeh, Mani Mofidi, Sama Haghighi, Ali Hashemaghaee, Soudabeh Shafiee Ardestani

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Background: There are many systems and parameters to evaluate trauma patients in the emergency department. Most of these evaluations are to distinguish patients with worse conditions so that the care systems have a better prediction of condition for a better care-giving. The purpose of this study is to determine the relationship between axillary body temperature and mortality in patients hospitalized in the intensive care unit (ICU) with multiple traumas and with other clinical and para-clinical factors. Methods: All patients between 16 and 75 years old with multiple traumas who were admitted into Emergency Department then hospitalized in the ICU were included in our study. An axillary temperature in the first and the second day of admission, Glasgow cola scale (GCS), systolic blood pressure, Serum glucose levels, and white blood cell counts of all patients at the admission day were recorded and their relationship with mortality were analyzed by SPSS software with suitable statistical tests. Results: Axillary body temperatures in the first and second day were statistically lower in expired traumatic patients (p=0.001 and p<0,001 respectively). Patients with lower GCS had a significantly lower first-day temperature and a significantly higher mortality. (p=0.006 and p=0.006 respectively). Furthermore, the first-day axillary temperature was significantly lower in patients with a lower first-day systolic blood pressure (p=0.014). Conclusion: Our results showed that lower axillary body temperature in the first day is associated with higher mortality, lower GCS, and lower systolic blood pressure. Thus, this could be used as a predictor of mortality in evaluation of traumatic patients in emergency settings.

Keywords: fever, trauma, mortality, emergency

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Authors: T. Motsima, K. Zuma, E Rapoo

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Childhood mortality is a key sign of the coverage of child survival interventions, social and economic progressions. Although the level of under-five mortality has been declining, it is still unacceptably high. The primary aim of this paper is to establish and analyse the levels and trends of under-five mortality for the periods 1998, 2003 and 2012 in South Africa. Methods: The data used for analysis came from the 1998 SADHS, the 2003 SADHS and the 2012 SABSSM which collected information on the survival status of children. The Kaplan-Meier estimate of the survival function method was used to determine the probabilities of failure (death) from birth up to 59 months. Results and Conclusion: The overall U5MR declined by 28.2% from 53.1 in 1998 to 38.1 in 2012. The U5MR of male children declined from 59.2 in 1998 to 46.2 in 2003 and dropped further to 41.4 in 2012. The U5MR of children of mothers aged 40 years and older increased from 64.0 in 1998 to 89.0 in 2003 and rose further to 129.9 in 2012. The U5MR of children of mothers with education level of 12 years or more increased from 32.2 in 1998 to 35.2 in 2003 and declined substantially to 17.5 in 2012.

Keywords: demographic and health survey, Kaplan-Meier, levels and trends, under-five mortality

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Authors: Thoetchai Peeraphatdit, Peter A. Brady, Suraj Kapa, Samuel J. Asirvatham, Niyada Naksuk

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Background: Serum electrolyte abnormalities are a common cause of an acquired prolonged QT syndrome, especially, in the coronary care unit (CCU) setting. Optimal electrolyte ranges among the CCU patients have not been sufficiently investigated. Methods: We identified 8,498 consecutive CCU patients who were admitted to the CCU at Mayo Clinic, Rochester, the USA, from 2004 through 2013. Association between first serum electrolytes and baseline corrected QT intervals (QTc), as well as in-hospital mortality, was tested using multivariate linear regression and logistic regression, respectively. Serum potassium 4.0- < 4.5 mEq/L, ionized calcium (iCa) 4.6-4.8 mg/dL, and magnesium 2.0- < 2.2 mg/dL were used as the reference levels. Results: There was a modest level-dependent relationship between hypokalemia ( < 4.0 mEq/L), hypocalcemia ( < 4.4 mg/dL), and a prolonged QTc interval; serum magnesium did not affect the QTc interval. Association between the serum electrolytes and in-hospital mortality included a U-shaped relationship for serum potassium (adjusted odds ratio (OR) 1.53 and OR 1.91for serum potassium 4.5- < 5.0 and ≥ 5.0 mEq/L, respectively) and an inverted J-shaped relationship for iCa (adjusted OR 2.79 and OR 2.03 for calcium < 4.4 and 4.4- < 4.6 mg/dL, respectively). For serum magnesium, the mortality was greater only among patients with levels ≥ 2.4 mg/dL (adjusted OR 1.40), compared to the reference level. Findings were similar in sensitivity analyses examining the association between mean serum electrolytes and mean QTc intervals, as well as in-hospital mortality. Conclusions: Serum potassium 4.0- < 4.5 mEq/L, iCa ≥ 4.6 mg/dL, and magnesium < 2.4 mg/dL had a neutral effect on QTc intervals and were associated with the lowest in-hospital mortality among the CCU patients.

Keywords: calcium, electrocardiography, long-QT syndrome, magnesium, mortality, potassium

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Authors: Musadiq Idris, Sajjad Ali, Syed A. Khaliq, Umer Farooq

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Postmortem record of 217 captive ungulates including Black-buck (n=31), Chinkara (n=20), Hog deer (n=116), Spotted deer (n=35), Red Deer n=(04), and Rusa deer (n=11) submitted to the Veterinary Research Institute, Lahore, Pakistan was analyzed to determine the primary cause of mortality in these animals. The submissions included temporal distribution from Government wildlife captive farms, zoo, and private ownerships, over a three year period (2007-2009). The most common cause of death was found to be trauma (20.27%), followed by parasitic diseases (15.67%), bacterial diseases (11.98%), stillbirths (9.21%), snakebites (2.76%), gut affections (2.30%), neoplasia (1.38%) and starvation (0.92%). The exact cause of death could not be determined in 77 of 217 animals. Pneumonia (8.29%) and tuberculosis (3.69%) were the most common bacterial diseases. Analyses for parasitic infestation revealed tapeworms to be highest (11.05%), followed by roundworms (8.29%) and hemoparasitism (5.07%) (babesiosis and theileriosis). The mortality rate in young ungulates was lower as compared to adults (32.26% and 67.74%). Gender wise data presented higher mortality in females (55.30%) compared to males (44.70%). In conclusion, highest mortality factor in captive ungulates was trauma, followed by parasitic and bacterial infestations/infections of tapeworms and pneumonia, respectively. Furthermore, necropsies provided substantial information on etiology of death and other related epidemiological aspects.

Keywords: age, epidemiology, gender, mortality, ungulates

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Authors: Nabaweesi Josephine, Namwanje Regina Germina

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Antenatal care is referred to as the totality of care given to pregnant women from conception to delivery from a certified health care setting. A number of 8 contacts is recommended throughout pregnancy, according to WHO, 2016. Antenatal services are free in Uganda courtesy of the government of Uganda, though attendance is still very low, which has continued to cause maternal and infant mortality and morbidity from preventable causes. Early booking has an advantage for proper pregnancy information sharing and pregnancy monitoring. The purpose of this study was to determine pregnant women's knowledge, attitudes, and practices towards attendance of antenatal care at Mukono General Hospital. A sample of 60 pregnant women was used, and a descriptive quantitative design was employed. Data was collected using a structured questionnaire consisting of questions about socio-demographic factors, knowledge, attitude, and practice, and this was affected using the structured interview method. Pregnant women had good practice at 90.2%, a positive attitude of 94.6%, and slightly less knowledge of 66.7%. Only 12% were knowledgeable about the number of antenatal care visits recommended, 45% had knowledge about when to initiate first antenatal care visit, and 79% had a positive attitude towards the early booking. We recommend that pregnant women are given all the necessary information regarding antenatal care with special emphasis on the recommended number of visits and when to initiate their first visit and encourage early booking in order to achieve the 8 contacts WHO policy for antenatal care since when we increase knowledge, we increase antenatal care utilization according to Anderson's behavioral model.

Keywords: ANC- antenatal care, contacts, mortality, morbidity

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Authors: Mohd Asrul Affedi, Nyi Nyi Naing

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Overdispersion is present in count data, and basically when a phenomenon happened, a Negative Binomial (NB) is commonly used to replace a standard Poisson model. Analysis of count data event, such as mortality cases basically Poisson regression model is appropriate. Hence, the model is not appropriate when existing a zero values. The zero-inflated negative binomial model is appropriate. In this article, we modelled the mortality cases as a dependent variable by age categorical. The objective of this study to determine existing overdispersion in mortality data of AIDS co-infection patients in Kelantan.

Keywords: negative binomial death rate, overdispersion, zero-inflation negative binomial death rate, AIDS

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Authors: Ravid Yinon

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Introduction: Pelvic trauma causes high mortality, particularly among the elderly population. Pelvic injury ranges from low-energy incidents such as falls to high-energy trauma like motor vehicle accidents. The mortality rate among high-energy trauma patients is higher, as can be expected. The elderly population is more vulnerable to pelvic trauma even at low energy mechanisms due to the fragility and diminished physiological reserve of these patients. The aim of this study is to examine whether there is a higher long-term mortality in pelvic injuries in the elderly from the low-energy mechanism than those injured in high energy. Methods: A retrospective cohort study was conducted in a level 1 trauma center with injured patients aged 65 years and over with pelvic trauma. The patients were divided into two groups of low and high-energy mechanisms of injury. Multivariate analysis was conducted to characterize the differences between the groups. Results: There were 585 consecutive injured patients over the age of 65 with a documented pelvic injury who were treated at the primary trauma center between 2008-2020. The injured in the high energy group were younger (mean HE- 75.18, LE-80.73), with fewer comorbidities (mean 0.78 comorbidities at HE and 1.28 at LE), more men (52.6% at HE and 27.4% at LE), were consumed more treatments facilities such as angioembolization, ICU admission, emergency surgeries and blood products transfusion and higher mortality rate at admission (HE- 19/133, 14.28%, LE- 10/452, 2.21%) compared to the low energy group. However, in a long-term follow-up of one year after the injury, mortality in the low-energy group was significantly higher (HE- 14/114, 12.28%, LE- 155/442, 35.06%). Discussion: Although it can be expected that in the mechanism of high energy, the mortality rate in the long term would be higher, it was found that mortality at the low energy patient was higher. Apparently, low-energy pelvic injury in geriatric patients is a measure of frailty in these patients, causes injury to more frail and morbid patients, and is a predictor of mortality in this population in the long term. Conclusion: The long-term follow-up of injured elderly with pelvic trauma should be more intense, and the healthcare provider should put more emphasis on the rehabilitation of these special patient populations in an attempt to prevent long-term mortality.

Keywords: pelvic trauma, elderly trauma, high energy trauma, low energy trauma

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Authors: Osama Moustafa Zayed

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Aim of the work: To evaluate the effectiveness of venous glucose, levels of serum lactate and base deficit in polytraumatized patients as simple parameters to predict the mortality in these patients. Compared to the predictive value of Trauma and injury severity (TRISS) and Acute Physiology And Chronic Health Evaluation IV (APACHE IV). Introduction: Trauma is a serious global health problem, accounting for approximately one in 10 deaths worldwide. Trauma accounts for 5 million deaths per year. Prediction of mortality in trauma patients is an important part of trauma care. Several trauma scores have been devised to predict injury severity and risk of mortality. The trauma and injury severity score (TRISS) was most common used. Regardless of the accuracy of trauma scores, is based on an anatomical description of every injury and cannot be assigned to the patients until a full diagnostic procedure has been performed. So we hypothesized that alterations in admission glucose, lactate levels and base deficit would be an early and easy rapid predictor of mortality. Patient and Method: a comparative cross-sectional study. 282 Polytraumatized patients attended to the Emergency Department(ED) of the Suez Canal university Hospital constituted. The period from 1/1/2012 to 1/4/2013 was included. Results: We found that the best cut off value of TRISS probability of survival score for prediction of mortality among poly-traumatized patients is = 90, with 77% sensitivity and 89% specificity using area under the ROC curve (0.89) at (95%CI). APACHE IV demonstrated 67% sensitivity and 95% specificity at 95% CI at cut off point 99. The best cutoff value of Random Blood Sugar (RBS) for prediction of mortality was>140 mg/dl, with 89%, sensitivity, 49% specificity. The best cut off value of base deficit for prediction of mortality was less than -5.6 with 64% sensitivity, 93% specificity. The best cutoff point of lactate for prediction of mortality was > 2.6 mmol/L with 92%, sensitivity, 42% specificity. Conclusion: According to our results from all evaluated predictors of mortality (laboratory and scores) and mortality based on the estimated cutoff values using ROC curves analysis, the highest risk of mortality was found using a cutoff value of 90 in TRISS score while with laboratory parameters the highest risk of mortality was with serum lactate > 2.6 . Although that all of the three parameter are accurate in predicting mortality in poly-traumatized patients and near with each other, as in serum lactate the area under the curve 0.82, in BD 0.79 and 0.77 in RBS.

Keywords: APACHE IV, emergency department, polytraumatized patients, serum lactate

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Authors: Zakheleni P. Dube, Phatu W. Mashela

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Minimum inhibition concentration (MIC) is the lowest concentration of a chemical that brings about significant inhibition of target organism. The conventional method for establishing the MIC for phytonematicides is tedious. The objective of this study was to use the Curve-fitting Allelochemical Response Data (CARD) to determine the MIC for pure cucurbitacin A on Meloidogyne incognita second-stage juveniles (J2) hatch, immobility and mortality. Meloidogyne incognita eggs and freshly hatched J2 were separately exposed to a series of pure cucurbitacin A concentrations of 0.00, 0.25, 0.50, 0.75, 1.00, 1.25, 1.50, 1.75, 2.00, 2.25 and 2.50 μg.mL⁻¹for 12, 24, 48 and 72 h in an incubator set at 25 ± 2°C. Meloidogyne incognita J2 hatch, immobility and mortality counts were determined using a stereomicroscope and the significant means were subjected to the CARD model. The model exhibited density-dependent growth (DDG) patterns of J2 hatch, immobility and mortality to increasing concentrations of cucurbitacin A. The average MIC for cucurbitacin A on M. incognita J2 hatch, immobility and mortality were 2.2, 0.58 and 0.63 µg.mL⁻¹, respectively. Meloidogyne incognita J2 hatch had the highest average MIC value followed by mortality and immobility had the least. In conclusion, the CARD model was able to generate MIC for cucurbitacin A, hence it could serve as a valuable tool in the chemical-nematode bioassay studies.

Keywords: inhibition concentration, phytonematicide, sensitivity index, threshold stimulation, triterpenoids.

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Authors: Rahul Kumar

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Background: Under-FiveMortality Rate(U5MR)ofanationiswidelyacceptedandlong-standing indicators of well-beingofherchildren.They measuredtheprobability of dying before theageoffive(expressedper1000livebirths).TheU5MRisanappropriate indicator of the cumulative exposure totheriskofdeathduringthefirstfiveyearsoflife, and accepted globalindicator ofthehealthandsocioeconomicstatusofagiven population.Itisalsousefulforassessing theimpactofvariousintervention programmes aimed at improving child survival.Under-fivemortalitytrendsconstitutealeadingindicatorofthelevel ofchildhealthandoveralldevelopmentincountries. Objectives: The first aim of our research is to study the level, trends, and Pattern of Under-five mortality using different sources of data. The second objective is to examine the survival pattern of Under-five mortality by different background characteristics. Data Source and Methodology: SRS and NFHS data have been used forobservingthelevelandtrendofUnder-Five mortality rate. Kaplan Meier Estimate has been used to understand the survival Pattern of Under-five mortality. Result: WefindthatallmostallthestatesmadesomeprogressbyreducingU5MRin recent decades.During1992-93highestU5MR(per thousand live birth) was observed in Assam(142)followed by up(141),Odisha(131),MP(130),andBihar(127.5).While the least U5MR(perthousandlive birth)wasobservedinRajasthan(102). The highestU5MR(per thousandlive birth)isobservedinUP(78.1), followed by MP(64.9)and Chhattisgarh(63.7)which are far away from the national level(50). Among them, Uttarakhand(46.7)hadleastU5MR(perthousandlivebirth), followed by Odisha(48.6). TheU5MR(perthousandlivebirth)ofcombinedhighfocusstateis63.7whichisfar away fromthenationallevel(50). Weidentified thatthesurvivalprobability ofunder-fivechildrenfromadolescentmotherislessin comparisontootherchildrenbornby differentagegroupofmothers. thatduringneonatalperiodusually male mortality exceedsthefemale mortality butthisdifferentialreversedinthepostneonatalperiod. Astheirageincreasesand approachingtofiveyears,weidentifiedthatthesurvivalprobability ofbothsexdecreasesbut female’s survival probabilitydecrement is more than male as their ageincreases. The poorer children’s survival probability is minimum. Children using improved toilet facility has more survival probability throughout thefiveyearsthan who uses unimproved. The survival probability of children under five who got Full ANCis more than the survival probability of children under five who doesn’t get any ANC. Conclusions: Improvement of maternal education is an urgent need to improve their health seeking behavior and thus the health of their children. Awareness on reproductive health and environmental sanitation should be strengthened.

Keywords: under-five mortality, survival pattern, ANC, trend

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Authors: Farzad Masoud Kabir, Jamshid Bagheri, Khosro Barkhordari

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This historical cohort study included 17,751 patients patients who underwent isolated CABG at our center between 2007 and 2016. The endpoints of this study were all-cause mortality and major adverse cardio-cerebrovascular events (MACCEs), comprising acute coronary syndromes, cerebrovascular accidents, and all-cause mortality at five years. Our findings suggest that preoperative obesity (BMI>30 kg/m2) in patients who survive early after CABG is associated with an increased risk of 5-year all-cause mortality and 5-year MACCEs.

Keywords: body mass index, surgical outcomes, midterm, cardiac surgery patients

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Authors: Sarah-Anne Schumann, Chintan Shah, Sandeep Ponniah, Syeachia Dennis

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Effective interventions to prevent childhood obesity include limiting sugar-sweetened beverage intake (SOR: B, longitudinal study), school and home based strategies to reduce total screen time and increase physical activity, behavioral and dietary counseling, and support for parents and families (SOR: A, meta-analysis of randomized and non-randomized controlled trials). Risk factors for childhood obesity include maternal pre-pregnancy weight, high infant birth weight, early infant rapid weight gain and maternal smoking during pregnancy which may provide opportunities to intervene and prevent childhood obesity (SOR: B, meta-analysis of observational studies).

Keywords: childhood, obesity, prevent obesity, interventions to prevent obesity

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Authors: Theresia F. Mrema, Innocent Semali

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Food insecurity to pregnant women seriously impedes efforts to reduce maternal mortality in resource poor countries. This study was carried out to assess determinants food insecurity among pregnant women in urban areas. A cross sectional study design was used to collect data for the period of two weeks. A structured questionnaire with both closed and open ended questions was used to interview a total of 225 randomly selected pregnant women who attend the three randomly selected antenatal care clinics in Temeke Municipal council. The food insecurity was measured using a modified version of the USDA’s core food security module which consists of 15questions. Logistic regression analysis was used to obtain strength of association between dependent and independent variables. Among 225 pregnant women attending antenatal care (ANC) interviewed 55.1% were food insecure. Food insecurity declined with increasing household wealth, it was also significantly low among those with less than three children compared with having more. Low level of food insecurity was associated with having Secondary education (Adjusted OR=0.24; 95%CI, 0.12–0.48), College Education (OR=0.156; 95%CI, 0.05-0.46), paid employment (OR=0.322; 95%CI, 0.11-0.96) and high income (OR=0.031; 95%CI, 0.01–0.07). Also, having head of the household with secondary education (OR=0.51; 95%CI, 0.07-0.32) college education (OR=0.04; 95%CI, 0.01-0.13) and paid employment (OR=0.225; 95%CI, 0.12-0.42). Food insecurity is a significant problem among pregnant women in Temeke Municipal which might significantly affect health of the pregnant woman and foetus due to higher maternal malnutrition which increases risk of miscarriage, maternal and infant mortality, and poor pregnancy outcomes. The study suggests a multi-sectoral approach in order to address this problem.

Keywords: food security, nutrition, pregnant women, urban settings

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Authors: Onyia Comfort Ngozi, Iketaku Ifeoma Roseline

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Inspite of the laudable goals and objectives in education, Nigerian women, still face a lot of challenges that hinder the personal and national development. There are unbalances between males and females at all levels of the science education sector in Nigeria. Educate a woman, and you educate a nation, and if you educate a man, you educate an individual. It is on this note that the paper focuses on bridging the gender gap as it concerns science education in Nigeria. Suggestions were made as measures of bridging the gender gap in Nigerian education sector. The researchers concluded that achieving gender equality will promote greater equality in employment, help postpone early marriages, reduce infant mortality rates and improve health and education for a future generation. Thus, the paper recommended that government should involve women in policy making to take care of any gender issue and bias that may be included either consciously or not, during formulation stage.

Keywords: education, gender, science education, women, equality

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Authors: Atitallah Sofien, Bouyahia Olfa, Romdhani Meriam, Missaoui Nada, Ben Rabeh Rania, Yahyaoui Salem, Mazigh Sonia, Boukthir Samir

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Introduction: Traditional medicine refers to a diverse range of therapeutic practices and knowledge systems that have been employed by different cultures over an extended period to uphold and rejuvenate health. These practices can involve herbal remedies, acupuncture, massage, and alternative healing methods that deviate from conventional medical approaches. In Tunisia, we often use unidentified utensils to scratch the oral cavity internally in infants in order to widen the oral cavity for better breathing and swallowing. However, these practices can be risky and may jeopardize the patients' prognosis or even their lives. Aim: This is the case of a nine-month-old infant, admitted to the pediatric department and subsequently to the intensive care unit due to a peritonsillar abscess following the utilization of an unidentifiable tool to scrape the interior of the oral cavity. Case Report: This is a 9-month-old infant with no particular medical history, admitted for high respiratory distress and a fever persisting for 4 days. On clinical examination, he had a respiratory rate of 70 cycles per minute with an oxygen saturation of 97% and subcostal retractions, along with a heart rate of 175 beats per minute. His white blood cell count was 40,960/mm³, and his C-reactive protein was 250 mg/L. Given the severity of the clinical presentation, the infant was transferred to the intensive care unit, intubated, and mechanically ventilated. A cervical-thoracic CT scan was performed, revealing a ruptured 18 mm left peritonsillar abscess in the oropharynx associated with cellulitis of the retropharyngeal space. The oto-rhino-laryngoscopic examination revealed an asymmetry involving the left lateral wall of the oropharynx with the presence of a fistula behind the posterior pillar. Dissection of the collection cavity was performed, allowing the drainage of 2 ml of pus. The culture was negative. The patient received cefotaxime in combination with metronidazole and gentamicin for a duration of 10 days, followed by a switch to amoxicillin-clavulanic acid for 7 days. The patient was extubated after 4 days of treatment, and the clinical and radiological progress was favorable. Conclusions: Traditional medicine remains risky due to the lack of scientific evidence and the potential for injuries and transmission of infectious diseases, especially in children, who constitute a vulnerable population. Therefore, parents should consult healthcare professionals and rely on evidence-based care.

Keywords: children, peritonsillar abscess, traditional medicine, respiratory distress

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Authors: S. Saleem, L. J. Mason, M. Hasan, M. Sagheer, Q. Ali, S. Akhtar, C. M. S. Hanif

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Ozone has been documented as a potential fumigant against major insect pests of stored commodities due to its highly oxidative properties. Present studies were conducted in the Smith Hall (Department of Entomology), Purdue University, USA, to examine the fumigant toxicities of ozone gas (O₃) against stored grain insect pests. Adults of Tribolium castaneum and Cryptolestes ferrugineus were exposed to different concentrations (100, 200, 480, 700, and 800 ppm) of ozone gas. Test insects were fumigated by keeping a constant temperature of 27 ± 2 °C and 75 ± 5% relative humidity, while dead insects were recorded after 6, 12, 18, 24, 30, and 36 hr of treatment. C. ferrugineus was found susceptible, with mean mortality of 90.99% as compared to T. castaneum (53.22%). Fumigation, even with lower concentrations (100 ppm) of ozone gas for 36 hr, exhibited 100% mortality against C. ferrugineus. Mortality increased with the increase in concentration and exposure time. 100% mortality was achieved with 800 ppm concentration after 18hr of treatment against T. castaneum and with 700 ppm after 6 hr of treatment against C. ferrugineus.

Keywords: ozone gas, toxicity, O₃, Tribolium castaneum, Cryptolestes ferrugineus, stored grain insect pests

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Authors: Maryam Borjali

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Introduction. Mortality due to noncommunicable diseases has increased in the world today with the advent of demographic shifts, growing age, and lifestyle patterns in the world, which have been affected by economic and social crises. Congenital heart defects are one of the forms of diseases that have raised infant mortality worldwide. e objective of present study was to identify nonmedical determinants related to this abnormality from the mother’s perspectives. Methods. is research was a qualitative study and the data collection method was a semistructured interview with mothers who had children with congenital heart diseases referring to the Shahid Rajaei Heart Hospital in Tehran, Iran. A thematic analysis approach was employed to analyze transcribed documents assisted by MAXQDA Plus version 12. Results. Four general themes and ten subthemes including social contexts (social harms, social interactions, and social necessities), psychological contexts (mood disorders and mental well-being), cultural contexts (unhealthy lifestyle, family culture, and poor parental health behaviors), and environmental contexts (living area and polluted air) were extracted from interviews with mothers of children with congenital heart diseases. Conclusions. Results suggest that factors such as childhood poverty, lack of parental awareness of congenital diseases, lack of proper nutrition and health facilities, education, and lack of medical supervision during pregnancy were most related with the birth of children with congenital heart disease from mothers’ prospective. In this regard, targeted and intersectorial collaborations are proposed to address nonmedical determinants related to the incidence of congenital heart diseases.

Keywords: congenital_cou, cultural, social, platform

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Authors: Peri Harish Kumar, Sai Sharan Dwarka, Tajbinder Singh Bains, Suneet John Joseph, Chaitanya Kiran, Sambhu Dutta, Sarah Makram, Mohamed Sayed Zaazouee, Alaa Ahmed Elshanbary

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Objective: To identify cancer and non-cancer causes of death in hepatocellular carcinoma (HCC) patients over different time periods after diagnosis and to compare the mortality risk of each cause in HCC patients with the general population. Methods: In this retrospective cohort study, data of 67,637 HCC patients from 1975 to 2016 were collected from the Surveillance, Epidemiology, and End Results (SEER) database. We investigated the association between different causes of death and the following variables: age, race, tumor stage at diagnosis, and treatment (surgery, chemotherapy, and radiotherapy); each according to the periods of <1 year, 1-5 years, 5-10 years, and >10 years following the diagnosis. Standardized mortality ratios (SMRs) and their 95% confidence intervals (CIs) were calculated for cancer and non-cancer deaths in each of the mentioned periods following diagnosis. Results: Data of 67,637 patients, of whom 50,571 patients died during the follow-up period, were analyzed. Most deaths were due to HCC itself (35,535, 70.3%), followed by other cancers (3,983, 7.9%). Common causes of non-cancer mortality included infectious and parasitic diseases including HIV (2,823 patients, SMR=105.68, 95% CI: 101.82-109.65), chronic liver disease (2,719 patients, SMR=76.56, 95% CI: 73.71,79.5), and heart diseases (1,265 patients, SMR=2.26, 95% CI: 2.14-2.39), with higher mortality risk in HCC patients than in the general population. Conclusion: Cancers stand for most deaths in patients with HCC. Besides, infectious, and parasitic diseases including HIV represent the commonest non-cancer cause of mortality.

Keywords: hepatocellular carcinoma, seer, causes of death, mortality

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Authors: Patrick C. H. Morel, Ian W. Barugh, Kirsty L. Chidgey

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The aim of this study was to quantify the level of piglet deaths in outdoor farrowing systems in New Zealand. A total of 14 farms were visited, the farmers interviewed, and data collected. A total of 10,154 sows were kept on those farms representing an estimated 33% of the NZ sow herd or 80% of the outdoor sow herd in 2016. Data from 25,911 litters was available for the different analyses. The characteristics and reproductive performance for the years 2015-2016 from the 14 farms surveyed in this study were analysed, and the following results were obtained. The average percentage of stillbirths was 7.1% ranging between 3.5 and 10.7%, and the average pre-weaning live-born mortality was 16.7% ranging between 3.7% and 23.6%. The majority of piglet deaths (89%) occurred during the first week after birth, with 81% of deaths occurring up to day three. The number of piglets born alive was 12.3 (8.0 to 14.0), and average number of piglets weaned per sow per year was 22.4, range 10.5-27.3. The average stocking rate per ha (number of sows and mated gilts) was 15.3 and ranged from 2.8 to 28.6. The sow to boar ratio average was 20.9:1 and the range was 7.1: 1 to 63:1. The sow replacement rate ranged between 37% and 78%. There was a large variation in the piglet live-born mortality both between months within a farm and between farms within a given month. The monthly recorded piglet mortality ranged between 7.7% and 31.5%, and there was no statistically significant difference between months on the number of piglets born, born alive, weaned or on pre-weaning piglet mortality. Twelve different types of hut/farrowing systems were used on the 14 farms. No difference in piglet mortality was observed between A-Frame, A-Frame Modified and for Box-shape huts. There was a positive relationship between the average number of piglets born per litter and the number of piglets born alive (r=0.975) or the number weaned per litter (r=0.845). Moreover, as the average number of piglets born-alive increases, both pre-weaning live-born mortality rate and the number of piglets weaned increased. An increase of 1 piglet in the number born alive corresponds to an increase of 2.9% in live-born mortality and an increase of 0.56 piglets weaned. Farmers reported that staff are the key to success with the key attributes being: good and reliable with attention to detail and skills with the stock.

Keywords: mortality, piglets, outdoor, pig farm

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Authors: Hadjeb Ayoub, Mehaoua Med Seghir, Ouakid M. Laid

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Currently, chemical control is the only means used to control populations of the date moth (Ectomyelois ceratoniae) which is the most important and dangerous pest to palm groves in Algeria, conventional insecticides act faster, but their main drawback is it can’t be destroyed or degraded. In this context we conducted our work to explore the insecticidal activity of Spinpsad which is a bio-pesticide on the larval stages of Ectomyelois ceratoniae. The study of the effect of Spinosad on the mortality of different larval stages revealed that the doses used were significantly and positively correlated with mortality adjusted for different durations of exposure of larvae bio- pesticide. Lowest corrected mortality was observed in a short time and lethal in older larvae treated with the lowest concentration. While the higher mortality was observed in a longer duration of exposure in younger instars treated with the highest concentration.

Keywords: Ectomyelois ceratoniae, date palm, Spinosad, biological control, toxicology

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Authors: Abdolghani Ebrahimi, Diego Klabjan, Chenxi Ge, Daniela Ladner, Parker Stride

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In this work, we use machine learning and novel data analysis techniques to predict the one-year mortality of cirrhotic patients. Data from 2,322 patients with liver cirrhosis are collected at a single medical center. Different machine learning models are applied to predict one-year mortality. A comprehensive feature space including demographic information, comorbidity, clinical procedure and laboratory tests is being analyzed. A temporal pattern mining technic called Frequent Subgraph Mining (FSM) is being used. Model for End-stage liver disease (MELD) prediction of mortality is used as a comparator. All of our models statistically significantly outperform the MELD-score model and show an average 10% improvement of the area under the curve (AUC). The FSM technic itself does not improve the model significantly, but FSM, together with a machine learning technique called an ensemble, further improves the model performance. With the abundance of data available in healthcare through electronic health records (EHR), existing predictive models can be refined to identify and treat patients at risk for higher mortality. However, due to the sparsity of the temporal information needed by FSM, the FSM model does not yield significant improvements. To the best of our knowledge, this is the first work to apply modern machine learning algorithms and data analysis methods on predicting one-year mortality of cirrhotic patients and builds a model that predicts one-year mortality significantly more accurate than the MELD score. We have also tested the potential of FSM and provided a new perspective of the importance of clinical features.

Keywords: machine learning, liver cirrhosis, subgraph mining, supervised learning

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Authors: Gudakesh Yadav

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Utter Pradesh, which is one of the largest states of India with unequal distribution of resources and different socioeconomic and cultural characteristics, level of different new born health care indicators varies a lot from one district to another district. State shared more than 21 percent of total live births of India; whereas, it accounts for 28 percent of total infant deaths of the country, with the 53 per thousand infant mortality rate. The present paper attempts to examine tempo-spatial changes in new born care practices during NFHS-1 to NFHS-3 and DLHS-2 to DLHS-3 in Uttar Pradesh and different regions. Descriptive statistics, rate-ratios, concentration index, multivariate and decomposition analysis has been used for the study. Findings of the study reveal that new born care practices have improved over the time in the state and across all the regions because of giving more emphasis on venerable groups like poor, rural, less educated mothers and scheduled caste & tribes but still it did not achieve the desired successes. Regional analysis of third rounds of DLHS shows that, coverage of intuitional delivery was the lowest in the central region. Performance of the southern region was the lowest in terms of initiation of breastfeeding, keeping baby warm and dry after the birth. The study calls for proper follow up of new born children to accelerate new born and child health care service and prioritises increasing antenatal check-ups and institutional delivery, which helps to improve level of other new born care services. At the policy level there is need to reach venerable groups like scheduled caste and tribes, poor and uneducated, and new mother especially in rural areas. High focused district should be allocated for better implementation of new born care promotion programme in low performing districts. Partnership with the private sector health professional is necessary to reach the every part of population.

Keywords: decomposition, inequality, initiation of breastfeeding, institutional delivery

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Authors: Zunnu Raen Akhtar, Farhan Ali, Muhammad Saeed-Ur-Rehman

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Jassids are considered as serious sucking pests in eggplants. Jassids can be controlled using imidacloprid, but it can also result in non-target ecological impacts on eco-system. It can also result in reduced population of predators of jassids in the field. An experiment was conducted on jassids, Amrasca sp. reared on eggplant leaves were treated with insecticide imidacloprid at lower, recommended and higher doses including 1L, 2L, 3L respectively. 3rd instar larvae and adults of jassids were exposed to lower, recommended, higher doses. Mortality tests were repeated three times for each dose and insect growth stage. Imidacloprid was sprayed on the leaves followed by drying. Data was recorded for 4, 8, 12, 16, 20, 24 hours after spraying insecticide on the leaves. Results showed that higher mortality was observed in higher and recommended doses, while slow mortality was observed in the case of lower dose. It can be asserted that higher and recommended doses causing immediate mortality of insects are better to control Amrasca sp. in the field, it will not cause immediate resistance development in insects against imidacloprid.

Keywords: Amrasca sp., imidacloprid, egg plant, efficacy

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Authors: Anjelika Kremer, Irina Nachimov, Dan Justo

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Background: C-reactive protein (CRP) serum levels are commonly measured in hospitalized patients. Elevated admission CRP serum levels and in-hospital mortality has been seldom studied in the general population of elderly patients admitted to the acute Geriatrics department. Methods: A retrospective cross-sectional study was conducted at a tertiary medical center. Included were all elderly patients (age 65 years or more) admitted to a single acute Geriatrics department from the emergency room between April 2014 and January 2015. CRP serum levels were measured routinely in all patients upon the first 24 hours of admission. A logistic regression analysis was used to study if admission CRP serum levels were associated with in-hospital mortality independent of age, gender, functional status, and co-morbidities. Results: Overall, 498 elderly patients were included in the analysis: 306 (61.4%) female patients and 192 (38.6%) male patients. The mean age was 84.8±7.0 years (median: 85 years; IQR: 80-90 years). The mean admission CRP serum levels was 43.2±67.1 mg/l (median: 13.1 mg/l; IQR: 2.8-51.7 mg/l). Overall, 33 (6.6%) elderly patients died during the hospitalization. A logistic regression analysis showed that in-hospital mortality was independently associated with history of stroke (p < 0.0001), heart failure (p < 0.0001), and admission CRP serum levels (p < 0.0001) – and to a lesser extent with age (p = 0.042), collagen vascular disease (p=0.011), and recent venous thromboembolism (p=0.037). Receiver operating characteristic (ROC) curve showed that admission CRP serum levels predict in-hospital mortality fairly with an area under the curve (AUC) of 0.694 (p < 0.0001). Cut-off value with maximal sensitivity and specificity was 19.7 mg/L. Conclusions: Admission CRP serum levels may be used to predict in-hospital mortality in the general population of elderly patients admitted to the acute Geriatrics department.

Keywords: c-reactive protein, elderly, mortality, prediction

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