Risk-Adjusting Mortality in the Nationwide Veterans Affairs Healthcare System

Background The US Veterans Affairs (VA) healthcare system began reporting risk-adjusted mortality for intensive care (ICU) admissions in 2005. However, while the VA’s mortality model has been updated and adapted for risk-adjustment of all inpatient hospitalizations, recent model performance has not been published. We sought to assess the current performance of VA’s 4 standardized mortality models: acute care 30-day mortality (acute care SMR-30); ICU 30-day mortality (ICU SMR-30); acute care in-hospital mortality (acute care SMR); and ICU in-hospital mortality (ICU SMR). Methods Retrospective cohort study with split derivation and validation samples. Standardized mortality models were fit using derivation data, with coefficients applied to the validation sample. Nationwide VA hospitalizations that met model inclusion criteria during fiscal years 2017–2018(derivation) and 2019 (validation) were included. Model performance was evaluated using c-statistics to assess discrimination and comparison of observed versus predicted deaths to assess calibration. Results Among 1,143,351 hospitalizations eligible for the acute care SMR-30 during 2017–2019, in-hospital mortality was 1.8%, and 30-day mortality was 4.3%. C-statistics for the SMR models in validation data were 0.870 (acute care SMR-30); 0.864 (ICU SMR-30); 0.914 (acute care SMR); and 0.887 (ICU SMR). There were 16,036 deaths (4.29% mortality) in the SMR-30 validation cohort versus 17,458 predicted deaths (4.67%), reflecting 0.38% over-prediction. Across deciles of predicted risk, the absolute difference in observed versus predicted percent mortality was a mean of 0.38%, with a maximum error of 1.81% seen in the highest-risk decile. Conclusions and Relevance The VA’s SMR models, which incorporate patient physiology on presentation, are highly predictive and demonstrate good calibration both overall and across risk deciles. The current SMR models perform similarly to the initial ICU SMR model, indicating appropriate adaption and re-calibration.

Compatibility of indigenous isolates HR1, HR2 of entomopathogenic nematodes, with low-toxicity insecticides for control of fall armyworm, Spodoptera frugiperda (J.E. Smith) (Lepidoptera: Noctuidae) and tomato leafminer, Tuta absoluta (Meyrick) (Lepidoptera: Gelechiidae)

Invasive species are a major danger to agronomic and natural ecosystems, and due to environmental concerns about pesticide use, EPNs have the potential to replace larvicidal action in pest management. The goal was to see how well local isolates of Steinernema feltiae (HR1) and Heterorhabditis bacteriophora (HR2) controlled invasive species when combined with low-toxicity pesticides. HR1 + Spinosad, chlorantraniliprole produced over 90% mortality in larvae at 96 hours, while HR2 + Spinosad, chlorantraniliprole caused over 95% mortality at 96 hours. After treatment, the high dose was regarded the least hazardous technique for controlling fall armyworm. At the high dose, HR1 + Spinosad, chlorantraniliprole produced larvae death of over 100 percent at 96 hours, and HR2 + Spinosad, chlorantraniliprole caused mortality of over 97.50 percent at 96 hours, and should be considered as a least hazardous strategy for T. absoluta management. Controlling larvae mortality of above 100% at 96 hours in combination with low-toxicity insecticide dosages should be included as a least harmful technique to control T. absoluta. The results showed that these HR2 strains have high pathogenicity against T. absoluta and S. frugiperda and have potential for control in integrated approaches, causing 100 percent and 90.00 percent mortality of T. absoluta and S. frugiperda at 96 hours at the high dose as a least toxic strategy to control.

A comparative study on the virulence of entomopathogenic fungi against Trogoderma granarium (Everts) (Coleoptera: Dermestidae) in stored grains rice

Entomopathogenic fungi (EPF) now a possible safer microbial control measure that could be considered as a substitute for chemical control of insect pests. Three EPF viz., Metarihizium anisopliae, Isaria furnosoroseus and Beauveria bassiana were evaluated for their virulence against the grubs of Khapra beetle, Trogoderma granarium (Everts) under laboratory conditions. The isolates were applied by two methods viz., diet incorporation and an immersion method with 3rd instar 20 grubs of T. granarium for each. The virulence of EPF was determined using percent mortality. Significantly higher mortality was observed in M. anisopliae applied through immersion (98.33%) and diet incorporation (93.33%) methods followed by B. bassiana (90.83 and 85.83%, respectively). The mortality caused by I. furnosoroseus was statistically lower in immersion and diet incorporation methods i.e. 81.67 and 73.33%, respectively. Based on the immersion method, all EPF were studied for multiple conidial concentration i.e., 1×104, 1×105, 1×106, 1×107 and 1×108 under the same in-vitro conditions. All the isolates were pathogenic to grub of T. granarium at the highest conidial concentration. M. anisopliae was proved the most effective virulent resulting in 98.33% mortality of the pest with LT50 4.61 days at 1 × 108 conidial concentration followed by 90.83 and 81.67 percent mortality with 5.07 and 8.01 days LT50, in the application of B. bassiana and I. furnosoroseus, respectively. M. anisopliae showed higher efficacy and could be considered as promising EPF for the development of myco-insecticides against effective biocontrol of T. granarium.

Insecticidal and growth regulatory effect of Jatropha curcas and Linum usitatissimum extracts along with new chemistry pesticide spinetoram against Sargodha strain of Rhyzopertha Dominica

Store grain insect pests such as Lesser grain borer (Rhyzopertha dominica) is a key feeder and cause substantial weight loss of wheat during storage. Present study was planned to evaluate insecticidal, repellent and growth regulator potential of botanical extracts of two plants Jatropha curcas and Linum usitatissimum along with Spinetoram against Rhyzopertha Dominica. This study was conducted at the Department of Entomology, University of Agriculture, Faisalabad (UAF) Grain Research, Training, and Storage Management Cell. Each treatment with three replication of 5%, 10%, and 15% concentrations of plant extracts and 100ppm, 200ppm, and 300ppm concentrations of insecticide were used against the adults of R. dominica by using Complete Randomized Design. Insect mortality was taken after 24, 48, and 72 hours after treatment. Data of growth regulation data was observed after 30 and 60 days. Data was analyzed by statistic 8.1 software for analysis of variance at 5% level of significance and treatment means was compared with the help of Tukey's Honestly Significant Difference (THSD) test. After 72 hours, Spinetoram showed maximum percent mortality (84%) followed by J. curcas (19.17%) and L. usitatissimum (12.28%) at their higher concentrations rate. Among treatments, after 60 days of exposure, Spinetoram was proved to be more effective against the R. dominica with maximum growth inhibition (70%) as compared to J. curcas (44%) and Linseed (28%). Overall the results indicated that these plant extracts and Spinetoram can be used as efficient alternatives of synthetic chemicals for management of stored grains insect pests.

Cemented Bipolar Hemiarthroplasty for Fracture Neck of Femur and Unstable Intertrochanteric Fractures - Prospective and Retrospective Study

Hip fractures in elderly patients are becoming a major social problem from various perspectives, including the progressive aging of global societies. The elderly have a high risk of hip fracture, even with minor injuries because of osteoporosis, while early surgical treatment may be difficult due to comorbidities and medication. In this study, significant risk factors were identified. Patients over age 70 had three times the mortality of younger patients. Greater than three pre-existing medical conditions is associated with a 25 percent mortality rate, more than twice that of healthier patients. Surgery performed on the first day of admission and beyond the fifth day was associated with a 34 percent mortality rate. Those patients operated in during days 2 through 5 had a 5.8 percent mortality rate. There was no failures related to inadequate stem or mechanical loosening. The tendency to dislocation can be clinically identifiable by major discrepancy in length, there was no failures related to inadequate stem or mechanical loosening. The tendency to dislocation can be clinically identifiable by major discrepancy in length and only 1 patient had shortening of about 2 cms post operatively which was slightly better than that of James et al (11%).

Anesthetic Preconditioning of Traumatic Brain Injury is Ineffective in a Drosophila Model of Obesity

We tested the hypothesis that obesity influences the pharmacodynamics of volatile general anesthetics (VGAs) by comparing effects of anesthetic exposure on mortality from traumatic brain injury (TBI) in lean and obese Drosophila melanogaster. We induced TBI with a High-Impact Trauma device. Starvation-selection over multiple generations resulted in an obese phenotype (SS flies). Fed flies served as lean controls (FC flies). Adult (1-7 day old) SS and FC flies were exposed to equianesthetic doses of isoflurane or sevoflurane either before or after TBI. The principal outcome was percent mortality 24 hours after injury, expressed as the Mortality Index at 24 hours (MI24). TBI resulted in lower MI24 in FC than in SS flies (21 (2.35) and 57.8 (2.14), respectively n= 12, p=0.0001). Preexposure to isoflurane or sevoflurane preconditioned FC flies to TBI reducing the risk of death to 0.53 [0.25 to 1.13] and 0.82 [0.43 to 1.58], respectively, but had no preconditioning effect in SS flies. Postexposure to isoflurane or sevoflurane increased the risk of death in SS flies. Only postexposure to isoflurane increased the risk in FC flies (1.39 [0.81 to 2.38]). Thus, obesity affects the pharmacodynamics of VGAs, thwarting the preconditioning effect of isoflurane and sevoflurane in TBI.

Hope and Fear in the Midst of Coronavirus: What Accounts for COVID-19 Preparedness?

Objective: The present study asks the question: What variables accounted for people’s tendencies to take steps to prepare for COVID-19 during the earliest stage of the pandemic? Data collection took place from March 6 to 11, 2020. In particular, the study examines variables that have been shown to predict health behavior in previous research outside the context of the present pandemic, including hope, optimism, perceived risk, fear, and mental health variables. Method: Participants (222 adults in 39 U.S. states) were recruited via Amazon Mechanical Turk. Online surveys included the Adult Hope Scale (AHS), Life Orientation Test (LOT-R), Health Anxiety Inventory (HAI), Depression, Anxiety, and Stress Scale (DASS-21), Impact of Events Scale (IES-R), and Positive and Negative Affect Schedule (PANAS). Also included were items inquiring about COVID-19 perceived mortality risk, fear/anxiety, and preparedness. Results and Conclusion: Participants were asked to imagine that COVID-19 had different hypothetical levels of mortality risk, ranging from 1 to 10 percent mortality (at the time of data collection, the WHO estimated actual mortality of the disease at approximately 3 percent). For each level, participants rated the degree to which they would be willing to take steps to prepare and protect themselves from the disease on a 7-point scale. Nearly 49 percent of participants said they would be relatively unlikely (i.e., provided a rating below the midpoint of the scale) to take steps to protect themselves if the mortality rate were at the 3 percent level. Stepwise multiple regression including the aforementioned predictors showed that three variables accounted for unique variance in participants’ levels of current preparedness: COVID-19 fear/anxiety, posttraumatic stress (as measured by the IES-R), and hope. Implications of these results are briefly discussed in the context of raising preparedness given that future public health crises are likely inevitable.

Larvicidal activity of ethanolic leaf and seed extract of Croton tiglium against Aedes aegypti

Aim and objectives: Mosquitoes are the transmitters of serious human diseases that cause millions of deaths every year. The use of synthetic insecticides causes harmful side effects to the environment and human health. So a natural alternative way is needed to solve this problem. Extracts from the various parts of plants like leaves, seeds, barks and roots can be used to control mosquitoes. This study aims to evaluate the larvicidal activity of ethanolic seed and leaf extracts of a traditionally used medicinal plant Croton tiglium, against Aedes aegypti, the vector of dengue fever. Material and methods: In this study, extracts from the dried leaf and seed powder of the Croton tiglium plant were extracted using ethanol in a soxhlet apparatus. Different concentrations were prepared from the extracts. Third instar larvae of Aedes aegypti were collected from the mosquito culture laboratory of the Life Sciences Department of Dibrugarh University. Prepared concentrations of the extracts were tested against the larvae of Aedes aegypti to evaluate the larvicidal activity by calculating percent mortality. Result: The ethanolic leaf and seed extracts of the selected plant were found effective against the larvae of Aedes aegypti. The 250 ppm concentration of both leaf and seed extracts showed the highest mortality of mosquito larva. The seed extract of this plant was found more effective in killing mosquito larva. Conclusion: From the study, it can be concluded that the ethanolic leaf and seed extracts of Croton tiglium possess larvicidal activity against Aedes aegypti. Hence, it could be useful in controlling mosquitoes without any harmful effects. However, further study and investigation will be needed to isolate and characterize bioactive components from this plant with larvicidal activity and the development of drugs for dengue from the components

Our experience in treating Fournier’s gangrene at Max Hospital, Gurugram

French venereologist Jean-Alfred Fournier described this gangrene as a fulminant gangrene of the penis and scrotum in young men. He reported five cases in his clinical lectures in 1883 though it was first described by Baurienne in 1764. Fournier’s gangrene is a form of necrotizing fasciitis that affects the genital and surrounding perineal and perianal areas. It’s a life-threatening disease leading to 20 to 80 percent mortality. It destroys tissues quickly and infection progresses to septic shock which kills patient if prompt and aggressive treatment is not started. Common symptoms of Fournier’s gangrene are pain in scrotum and or perineum, redness, fever and weakness. Advanced cases have foul smelling discharge from infected tissues. It is due to polymicrobial infection, both aerobic and anaerobic. Fournier’s gangrene is usually diagnosed clinically but imaging investigations such as X-rays, Ultrasound and CT scan help a lot to reach the diagnosis early. Treatment mainly consists of resuscitation, intravenous antibiotics and debridement. We have treated successfully four cases of advanced Fournier’s gangrene with team work of surgeons, anaesthesiologists, physicians and critical care specialists. Full recovery is possible due to a good team work and understanding the disease.

Acute and Chronic Toxicity of a glyphosate on Danio rerio

Glyphosate herbicides are the most widely produced and used herbicides in the world. The intensive applications of glyphosate and its half-life in water result into many aquatic ecosystems. The present study focuses on the evaluation of glyphosate toxicity on the early life stages of the fish Danio rerio. Analysis of the test results revealed that glyphosate is toxic to zebrafish. This effect is marked by the increase in percent mortality at peak concentrations. Long-term exposure to glyphosate affects the hatching rate, heart rate and swimming ability of zebrafish. Significant malformations were observed at the highest concentration in the form of tail bending or fin absence.