Background A systematic understanding of population-level trends in deaths due to road injuries at the subnational level over time for India's 1•4 billion people, by age, sex, and type of road user is not readily available; we aimed to fill this knowledge gap. Methods As part of the Global Burden of Diseases, Injuries, and Risk Factors Study, we estimated the rate of deaths due to road injuries in each state of India from 1990 to 2017 based on several verbal autopsy data sources. We calculated the number of deaths and death rate for road injuries by type of road user, and assessed the age and sex distribution of these deaths over time. Based on the trends of the age-standardised death rate from 1990 to 2017, we projected the age-standardised death rate to 2030 to assess if the states of India would meet the Sustainable Development Goal (SDG) target to halve the death rate for road injuries from 2015 by 2020 or 2030. We calculated 95% uncertainty intervals (UIs) for the point estimates. Findings In 2017, 218 876 deaths (95% UI 201 734 to 231 141) due to road injuries occurred in India, with an agestandardised death rate for road injuries of 17•2 deaths (15•7 to 18•1) per 100 000 population, which was much higher in males (25•7 deaths [23•5 to 27•4] per 100 000) than in females (8•5 deaths [7•2 to 9•1] per 100 000). The number of deaths due to road injuries in India increased by 58•7% (43•6 to 74•7) from 1990 to 2017, but the agestandardised death rate decreased slightly, by 9•2% (0•6 to 18•3). In 2017, pedestrians accounted for 76 729 (35•1%) of all deaths due to road injuries, motorcyclists accounted for 67 524 (30•9%), motor vehicle occupants accounted for 57 802 (26•4%), and cyclists accounted for 15 324 (7•0%). India had a higher age-standardised death rate for road injury among motorcyclists (4•9 deaths [3•9-5•4] per 100 000 population) and cyclists (1•2 deaths [0•9-1•4] per 100 000 population) than the global average. Road injury was the leading cause of death in males aged 15 to 39 years in India in 2017, and the second leading cause in this age group for both sexes combined. The overall agestandardised death rate for road injuries varied by up to 2•6 times between states in 2017. Wide variations were seen between the states in the percentage change in age-standardised death rate for road injuries from 1990 to 2017, ranging from a reduction of 38•2% (22•3 to 51•7) in Delhi to an increase of 17•0% (0•6 to 34•7) in Odisha. If the trends estimated up to 2017 were to continue, no state in India or India overall would achieve the SDG 2020 target in 2020 or even in 2030. Interpretation India's contribution to the global number of deaths due to road injuries is increasing, and the country is unlikely to meet the SDG targets if the trends up to 2017 continue. India needs to implement evidence-based road safety interventions, promote strong policies and traffic law enforcement, have better road and vehicle design, and improve care for road injuries at the state level to meet the SDG goal.
Background: Primary gliosarcoma is a rare malignant brain tumor with dismal prognosis. Previous reports are limited to case reports and small retrospective case series. Objective: To evaluate treatment and survival outcomes in a large cohort of primary gliosarcoma patients treated in the United States. Results: 1622 patients met the inclusion criterion. Median age was 63 years. The 3-year OS rate for the entire cohort was 11.9%. Patients aged 18 to 60 years were significantly more likely to receive trimodality therapy (defined as the use of surgery, radiotherapy [RT] and chemotherapy [CT]) than patients older than 60 (68.1% vs. 56.7%, p < 0.001). The utilization of trimodality therapy significantly increased during the study period (57.5% in 2004-2008 vs. 65.1% in 2009-2013; p = 0.002). On multivariate Cox regression analysis, GTR, surgery followed by RT and the use of trimodality therapy were associated with longer OS, while older age, Charlson-Deyo score ≥ 1 and multi-focal tumor were associated with shorter OS. The use of trimodality therapy was consistently associated with longer OS in subgroup analyses based on age and extent of resection. Materials and Methods: The National Cancer Database was used to identify all primary gliosarcoma patients aged 18 to 90 years who were diagnosed between 2004 and 2013. Overall survival (OS) was evaluated by Kaplan-Meir analysis, univariate and multivariate Cox proportional hazard regression analysis. Conclusions: The use of trimodality therapy significantly increased during the study period and was associated with improved outcomes regardless of age and extent of resection.
l-Asparaginase-producing microbes are conventionally screened on phenol red l-asparagine-containing plates. However, sometimes the contrast of the zone obtained (between yellow and pink) is not very sharp and distinct. In the present investigation, an improved method for screening of the microorganisms producing extracellular l-asparaginase is reported wherein bromothymol blue (BTB) is incorporated as pH indicator in l-asparagine-containing medium instead of phenol red. Plates containing BTB at acidic pH are yellow and turn dark blue at alkaline pH. Thus, a dense dark blue zone is formed around microbial colonies producing l-asparaginase, differentiating between enzyme producers and non-producers. The present method is more sensitive and accurate than the conventional method for screening of both fungi and bacteria producing extracellular l-asparaginase. Furthermore, BTB gives a transient green colour at neutral pH (7.0) and dark blue colour at higher pH 8.0-9.0, indicating the potency of the microorganism for l-asparaginase production.
Background:Hyponatremia is the most common electrolyte abnormality seen in patients with aneurysmal SAH. Clinically significant hyponatremia (Serum Sodium <131 mEq/L) which needs treatment, has been redefined recently and there is a paucity of outcome studies based on this. This study aims to identify the mean Serum Sodium (S.Na+) level and its duration among inpatients with SAH and to identify the relationship between hyponatremia and the outcome status of patients undergoing surgery for SAH.Materials and Methods:This outcome study is undertaken in the department of neurosurgery, The Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala. Medical records of all patients with SAH from 1st January to 31st July 2010 were reviewed. Preoperative status was assessed using World Federation of Neurosurgical Societies (WFNS) grading system. Discharge status was calculated using the Glasgow outcome score scale.Results:Fifty nine patients were included in the study and 53 (89.8%) of them have undergone surgical treatment. Hyponatremia was observed in 22 of 59 patients (37%). The mean Sodium level of hyponatremic patients was 126.97 mEq/L for a median duration of two days. Glasgow outcome score was good in 89.8% of patients. We lost two patients, one of whom had hyponatremia and vasospasm.Conclusion:Hyponatremia is significantly associated with poor outcome in patients with SAH. Anticipate hyponatremia in patients with aneurysmal subarachnoid hemorrhage, timely detect and appropriately treat it to improve outcome. It is more common in patients who are more than 50 years old and whose aneurysm is in the anterior communicating artery. Our comprehensive monitoring ensured early detection and efficient surgical and nursing management reduced morbidity and mortality.
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