Trends in Rheumatic Heart Disease-Related Mortality in the United States from 1999 to 2020.

There is a lack of mortality data on rheumatic heart disease (RHD) in the United States (US). In light of this, a retrospective analysis was conducted to investigate the temporal, sex-based, racial, and regional trends in RHD-related mortality in the US, ranging from 1999 to 2020. The Center for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC-WONDER) dataset was analyzed, where crude and age-adjusted mortality rates (AAMR) were identified, along with annual percentage changes (APCs) determined by Joinpoint regression. Through the period of 1999 to 2020, there were 141,137 RHD-related deaths reported, with a marginal decline from 4.05/100,000 in 1999 to 3.12/100,000 in 2020. However, the recent rise in AAMR from 2017 to 2020 has created a source of concern (APC: 6.62 [95% CI, 3.19-8.72]). Similar trends were observed in the Black or African American race from 2017 to 2020 (APC: 10.58 [95% CI, 6.29-17.80]). Moreover, the highest percentage change from 2018 to 2020 was observed in residents of large metropolitan areas (APC: 7.6 [95% CI, 2.8-10.5]). A prominent disparity was observed among states, with values ranging from 1.74/100,000 in Louisiana to 5.27/100,000 in Vermont. States within the top 90th percentile of RHD-related deaths included Alaska, Minnesota, Washington, Wyoming, and Vermont. In conclusion, it is imperative to delve deeper into the evidently rising trends of RHD-related mortality and outline the possible sources of social determinants within US healthcare in order to provide equal and quality medical care throughout the nation.

Effects of Zinc-Gluconate Levels on Growth Performance, Whole-Body Composition, and Mineral and Enzyme Activities of Juvenile Mori (Cirrhinus mrigala).

Zinc (Zn) is an important dietary nutrient for the optimum growth performance, feed efficiency, normal metabolism, and fish health. Unfortunately, Zn requirement for mori (Cirrhinus mrigala) is not available. This experiment was designed to assess the impacts of Zn-gluconate levels on growth performance, feed utilization, mineral composition, and enzyme activities of mori and determines the optimum requirement of Zn-gluconate for this species. For this purpose, seven isonitrogenous (29.18%) and isolipidic (10.71%) purified diets were formulated with graded Zn-gluconate levels (0, 10, 20, 30, 40, 50, and 60 mg/kg). A total of 525 juveniles (4.30 ± 0.13 g) were distributed in 21 tanks. All treatments were assessed in triplicates. At the end of the trial (90 days), a progressive increase in final weight (FW) was observed in mori fed with 0-40 mg/kg of Zn-gluconate, remained constant at 50 mg/kg of Zn-gluconate, and significantly decreased at 60 mg/kg of Zn-gluconate. Similarly, weight gain and specific growth rate followed a similar pattern, while weight gain% increased till 40 mg/kg of Zn-gluconate. However, further increase (40-60 mg/kg) had a non-significant effect on weight gain%. Diet supplemented with 40 mg/kg of Zn-gluconate resulted in optimum values for feed intake and feed conversion ratio. Supplementation of Zn-gluconate did not affect dry matter, crude fat, and crude ash at all graded levels. However, whole body crude protein was significant in response to Zn-gluconate supplementation. Furthermore, Zn-gluconate absorption enhanced from 0 to 40 mg/kg of Zn-gluconate and remained constant afterward. Whole body mineral activity also followed a similar pattern. Overall, Zn-gluconate supplementation enhanced (P < 0.05) mineral activity in all parts of the tested parts of mori, including bones, scales, skin, eyes, heart, liver, and kidney. Moreover, the highest (P < 0.05) mineral activity in the skin, heart, liver, and kidney was observed in 60 mg/kg of Zn-gluconate. Supplementation of Zn-gluconate significantly increased the activity of alkaline phosphatase while it reduced thiobarbituric acid reactive substance contents of mori. The optimal dietary requirement of Zn-gluconate was recorded as 43.86 mg/kg through broken-line regression for maximum weight gain% of mori juveniles. Conclusively, 40 mg/kg of Zn-gluconate supplementation significantly enhanced the health of C. mrigala. However, a further increase in Zn-gluconate supplementation from 40 to 60 mg/kg did not significantly improve the above-mentioned parameters.

Prevalence and Impact of Gastrointestinal Manifestations in COVID-19 Patients: A Systematic Review.

Background and objective: The aim of this study is to systematically analyze and summarize the implications of COVID-19 on the digestive system by quantitatively evaluating the prevalence of gastrointestinal symptoms such as nausea, vomiting, abdominal pain, constipation, diarrhea, anorexia. reported in COVID-19 cases. We simultaneously investigated other variables to determine the association of such symptoms in COVID-19 patients which can potentially influence the disease prognosis and outcome. This systematic review presents an updated literature on the issue as it requires more scientific discussion in order to better inform the medical community and authorities so that appropriate measures can be taken to control the virus outbreak. Methods: MEDLINE database was searched to identify relevant articles. Data was analyzed and synthesized from the 16 eligible studies which exclusively reported GI symptoms in COVID-19 patients along with the disease prognosis. A meta-analysis of studies having adequate information regarding the prevalence of specific GI symptoms in association with other relevant independent variables was performed. Results: From the search strategy, we identified 16 articles which fit our eligibility criteria comprising of 10 cross-sectional studies, 2 cohort study, 1 RCT and 3 observational studies. From these pooled studies, 6 articles exclusively talked about COVID-19 patients in which GI symptoms were reported and adequately discussed. In a total of 3646 patients, GI symptoms were documented in (16.2%-10.1%) patients. The most prevalent GI symptom was diarrhea (47%) but the most common clinical manifestation reported was fever (77.4%). Among the adult patients, hypertension (11.6%) was the most frequently reported comorbidity. Presence of viral RNA in stool sample was noted in 16.7% patients with GI symptom. In patients who complained of having GI symptoms, an abnormal liver function was largely observed, with an elevated ALT level in (10.9%) and an elevated AST in (8.8%) of the patients. Evidence of vertical transmission (14.2%) was reported in one study which highlights the extent and mode of viral transmission. It was observed that a great majority of the patients in the 6 studies reporting specifically on patients with GI symptoms were on antiviral therapy (68.6%) as the standard disease management protocol but the eventual disease outcome as in this case died (8.4%), discharged (45.6%) was not linked to just one therapeutic factor but other indicators of disease severity such as positive chest CT findings (87.82%) have led to a poor disease prognosis which was noted in (28.9%) severe patients with GI symptoms compared to (71.1%) non-severe COVID-19 patients with GI symptom. Conclusion: Presence of GI symptoms in COVID-19 patients has shown to have a positive association with the poor disease prognosis likely as a result of direct viral toxicity. It is important for the physicians to recognize digestive symptoms as an important characteristic in COVID-19 patients. Hence, precise and targeted documentation of GI symptoms and viral stool sample investigations should be performed in order to understand the rapidly evolving disease symptomology.