Grilled Knuckle scored higher than roast Knuckle by 13.6%, 23.9%, 14.4% and 15.8% for tenderness, juiciness, flavor, and overall liking, respectively. The grilled Outside flat scored higher than roast Outside flat by 14.1%, 27.1%, 10.9%, and 14.3% for tenderness, juiciness, flavor, and overall liking, respectively. Finally, grilled Topside scored higher than roast Topside by 21.3%, 7.4%, and 6.6% for juiciness, flavor, and overall liking, respectively. Carcass traits for intramuscular fat and shear force had a significant (p < 0.001) effect on all eating quality traits for both grill and roast cuts. Girth rib fat had a significant effect (p = 0.01) on tenderness and juiciness (p = 0.03) for Outside flat and Topside but had no effect (p > 0.05) on Knuckle for both grill and roast. This study identified that specific cooking methods can improve sensory traits for individual cuts and suggests that a cut-by-cook method eating quality model for sheepmeat can therefore increase consumer satisfaction.Lamb eating quality was measured using untrained consumer sensory panels to determine the difference in intrinsic eating quality scores of grilled and roasted leg cut muscles. The Knuckle, Outside flat, and Topside from both legs of 65 mixed-sex lambs from diverse genetic backgrounds were prepared using alternative grill and roast cook methods. Each sample was eaten by 10 consumers and scored for tenderness, juiciness, flavor, and overall liking. All cuts scored higher ( To main roasted . Thus, t roasted . For exa grilled , and whe grilled . The bee roasted  Lamb eat roasted ,6,12. Hom. semimembranosus, adductor femoris (Topside); m. biceps femoris (Outside flat); and m. rectus femoris, vastus lateralis, and vastus intermedius (Knuckle) to further develop the sheepmeat eating quality prediction model. It was hypothesized that the Outside flat, Topside, and Knuckle will have lower consumer eating qualities when cooked using a grill compared to a roast. The MSA protocol for cooking and serving lamb leg roasts involves cooking and slicing the rolled netted leg roast  as a whole. Samples are then portioned from the resulting slice, without regard for a specific muscle or muscle direction. As such, the resulting eating quality scores are a combination of all muscles within the leg. This limits the ability to market individual muscles as roasting cuts. As consumer preferences lead to an increased demand for small, easy-to-cook meals , the abin = 65) carcasses were selected for utilization in the current study. Carcasses were subjected to medium-voltage electrical stimulation [m. longissimus lumborum LL) until loin pH < 6.0 or carcasses were <12 °C. The pH meter was calibrated for temperature at 2 °C which aligns with chiller temperature and calibrated for pH before use and every 2 h using pH 4.00 and pH 6.88 buffers at room temperature as per Pearce, Van De Ven, Mudford, Warner, Hocking-Edwards, Jacob, Pethick, and Hopkins [The experiment was approved by the Animal Ethics Committee of the University of New England . The research was conducted on lambs from the Meat and Livestock Australia resource flock, which is run at the University of New England Kirby research station . The lambs were the progeny of industry Terminal, Maternal and Merino sires representing the major production types in the Australian sheep industry mated from Merino ewes. Lambs were born, raised together, grazed on improved pastures, and fed supplementary feeds from weaning when pasture availability was insufficient. Lambs were weighed prior to transport to a commercial abattoir where they were held overnight and slaughtered the following day. Sixty-five (mulation  within 2mulation  portion  Hopkins . Hot stam. longissimus thoracis (13th thoracic vertebrae) and the cranial end of the LL (1st lumber vertebrae). The samples were freeze-dried in a Cool Safe Touch 95-15 Pro , ground, and analyzed using a bench top near-infrared technology using Bruker MAP II Fourier Transform Near-Infrared Spectrometer  calibrated to chloroform Soxhlet fat extraction to estimate chemical fat content as detailed by [2 cross-sectional) from each steak were cut with the grain and measured using a Lloyd texture analyzer with a Warner–Bratzler shear blade fitted [Forty-eight hours post-mortem, samples (40 g) for intramuscular fat (IMF%) were collected from the caudal end of the ailed by ,18,19. Failed by . Then, se fitted .m. semimembranosus and adductor femoris ; m. biceps femoris ; and m. rectus femoris, vastus lateralis, and vastus intermedius  were collected from the left and right legs of each lamb carcass. The sensory cook method was alternated between the left and right leg across all carcasses. Sensory sample fabrication followed the protocol presented by Thompson et al. [Carcasses were broken down and consumer sensory samples were fabricated for grilling and roasting. Legs were portioned into individual grill cuts from one side, and a Knuckle roast plus a boneless leg roast (Topside and Outside together) from the alternative side. As such, three different cuts; The grill samples were defrosted in a 2 °C chiller for 24 h prior to grilling. For 30 min prior to grilling, the meat samples were left at room temperature to equilibrate. The samples were grilled using a Silex grill , with the top set to a temperature of 180 °C and the bottom plate set to 195 °C. Ten steaks at a time were placed on the grill in a known order to maintain identity. After 2 min and 25 s of cooking with the lid closed, the steaks were removed at an internal temperature ~65 °C (medium doneness) and were then rested for 1.5 min before serving. Each sample was then cut in half and served to ten different consumers who provided sensory scores on each sample. Roast samples were defrosted 24 h before the sensory session at 2 °C and cooked in a Rational electric oven set to a temperature of 160 °C . Roasts were removed when they reached an internal temperature of 65 °C and rested in a thermal insulated box for a minimum of 10 min prior to slicing. Each roast was then sliced into 4 mm thick slices and 10 slice samples were selected from across the whole roast for 10 consumers. All the subcutaneous intermuscular fat and connective tissue were removed and slices were trimmed to approximately 5 cm wide by 5 cm long. Then, samples were placed in stainless steel pans (Bain-marie) with a temperature of 55 °C maintained until serving. All sensory data presented here were collected with the approval of the University of New England Human Ethics committee HE17-253). Briefly, ten untrained consumers assessed each grill and roast cut for tenderness, juiciness, flavor, and overall liking using a visual analog scale from 0 to 100. The analogue scale is anchored by dislike extremely at 0 and like extremely at 100 for flavor and overall liking, while tenderness is anchored by not tender at 0 and very tender at 100 and juiciness is anchored by not juicy at 0 and very juicy at 100 [7-253. BrThe experimental samples were served and allocated to untrained consumers using a 6 × 6 Latin square design to avoid any sensory sample order bias between consumers  and ensuThe consumer meat eating quality score (MQ4) was calculated based on the combined mean consumer score of tenderness, juiciness, flavor, and overall liking for each cut. This study weighted the sensory scores 0.3 × tenderness, 0.1 × juiciness, 0.3 × flavor, and 0.3 × overall liking to estimate the MQ4 score for each cut ,10.p value equal or less than 0.05. The base model for each sensory trait included cut  and cooking method (roast and grill) as fixed effects, and the associated interaction. Animal identification was used as a random term. Consumer session was included as a random term; however, it did not have a significant impact on the least square means so was subsequently removed from the models along with all non-significant (p > 0.05) terms in a stepwise manner. The effect of the cut and cook on meat sensory scores  was analyzed using the lmer package for linear mixed effects models in R . Statistp > 0.05) terms were removed in a stepwise manner. Animal identification was not used as a random term in the analysis when carcass traits were added because there is a strong positive correlation between C-site fat and GR fat. Both traits were initially added in the models, which showed that GR fat had the larger F value and explained more variation in eating quality traits so it was used as the fat descriptor of the carcasses in the analysis.The effect of carcass traits , includip < 0.001, Consumer sensory scores for tenderness, juiciness, flavor, and overall liking varied between grill and roast for the three cuts tested in this study . The basp > 0.05).The grilled Knuckle scored higher than the roast Knuckle by 13.6%, 23.9%, 14.4%, 15.8%, and 15.6% for tenderness, juiciness, flavor, overall liking, and MQ4, respectively. The grilled Outside flat scored higher than roast Outside flat by 14.1%, 27.1%, 10.9%, 14.3%, and 14.5% for tenderness, juiciness, flavor, overall liking, and MQ4, respectively. The grilled scored higher by 21.3%, 7.4%, 6.6% and 6.9% for juiciness, flavor, overall liking, and MQ4, respectively, when grilled compared to roasted. However, tenderness was not different between Topside grill and roast (p < 0.001). The tenderness of the grilled Outside flat was 7 points lower than the Knuckle (p < 0.001). The Topside also scored lowest for tenderness when roasted, scoring 48.2 ± 1.36 points, which was significantly lower than the tenderness of the roasted Knuckle by 10.1 points (p = 0.001). On the other hand, the tenderness of the roasted Topside did not differ from the Outside flat; however, the tenderness of the roasted Outside flat was 6.3 points lower than the roasted Knuckle’s tenderness (p = 0.001)  .p < 0.001). The juiciness of the grilled Outside flat was 5.5 points lower than the Knuckle (p = 0.004). The Topside also scored the lowest for juiciness when roasted, scoring 42.6 ± 1.27 points, which was significantly lower than the tenderness of the roasted Knuckle by 9.1 points (p = 0.001). The juiciness of the roasted Topside did not differ from the Outside flat; however, the juiciness of the roasted Outside flat was 6.2 points lower than Knuckle juiciness (p = 0.001)  .p < 0.001). The flavor of the grilled Outside flat was 3.7 points lower than the Knuckle . The Topside also scored the lowest for flavor when roasted scoring 51.7 ± 1.13 points, which was significantly lower than the flavor of the roasted Knuckle, by 4.13 points (p = 0.013). The flavor of the roasted Topside did not differ from the Outside flat and the Outside flat did not differ in flavor from the Knuckle . The overall liking of the grilled Outside flat was 4.8 points lower than the Knuckle (p = 0.007). The Topside also scored the lowest for overall liking when roasted, scoring 49.8 ± 1.22 points, which was significantly lower than the overall liking of the roasted Knuckle by 6.2 points (p = 0.001). The overall liking of the roasted Topside did not differ from the outside flat and the Outside flat did not differ from the Knuckle . The MQ4 of the grilled Outside flat was 5.3 points lower than the Knuckle (p = 0.002). The Topside also scored the lowest for MQ4 when roasted, scoring 49.2 ± 1.17 points, which was significantly lower than the MQ4 of the roasted Knuckle by 7 points (p = 0.001). The MQ4 of the roasted Topside did not differ from the Outside flat (p = 0.07) and the Outside flat was significantly (p = 0.03) different in MQ4 to the Knuckle (p = 0.04) by 3.75 points  positive effect of IMF% on Knuckle and Outside flat for grill and roast, and grilled Topside (p > 0.05) of IMF% on flavor and overall liking of the roast Topside.There was a significant effect of carcass traits for IMF%, GR fat, and SF5 on the sensory scores, which varied for the different cuts by cooking methods ( Topside . As IMF%p < 0.001) negative effect of GR fat on the tenderness and juiciness of the grilled and roasted Outside flat and Topside. As GR fat increased from 10 mm to 30 mm, tenderness decreased by 15.3% and 19.2% in the grilled Outside flat and Topside and by 10.5% and 12.4% for roasted Outside flat and Topside. Juiciness decreased by 12% and 12.9% for grilled Outside flat and Topside and 15.4% and 15.5% for roasted Outside flat and Topside as GR fat increased from 10 mm to 30 mm. However, GR fat had no significant effect on flavor, overall liking, or MQ4 for any cut (p > 0.05). In addition, there was no GR fat effect on tenderness or juiciness of the Knuckle when grilled or roasted (p > 0.001).There was a significant (p < 0.001) negative effect of loin SF5 on tenderness, juiciness, flavor, overall liking, and MQ4 score for both grilled and roasted Knuckle, Outside flat, and Topside (p < 0.001). Across this SF5 range from 10 N to 45 N, roasted Topside decreased by 35.4% for tenderness, 35.1% for juiciness, 20.5% for flavor, 29.8% for overall liking, and 19.1% for MQ4 (p < 0.001). Additionally, as SF5 increased from 10 N to 45 N, the tenderness, juiciness, flavor, overall liking, and MQ4 of grilled Knuckle decreased by 13%, 6.6%, 9.6%, 13.7%, and 14.4%, respectively (p < 0.001). Roasted Knuckle decreased by 15.1% for tenderness, 14.4% for juiciness, 6.6% for flavor, 14.8% for overall liking, and 16.9% for MQ4 as SF5 increased from 10 N to 45 N (p < 0.001). The tenderness, juiciness, and MQ4 of grilled Outside flat decreased by 23.2%, 11.5%, and 15.6% while both flavor and overall liking decreased by 17.6%, respectively, as SF5 increased from 10 N to 45 N (p < 0.001). Roasted Outside flat decreased by 26.5% for tenderness, 21.5% for juiciness, 15.7% for flavor, 8.8% for overall liking, and 18% for MQ4 as SF5 increased from 10 N to 45 N (p < 0.001).There was a significant ( Topside . The larThere was a consistent effect of the cooking method on consumer scores across muscle type cuts tested, with grilled muscle cuts yielding higher sensory scores than roasted muscle cuts, which contradicts the initial hypothesis. Watson et al.  found thm. gluteus medius, can produce higher sensory scores when compared with grilling [The MSA beef and sheepmeat eating quality prediction models are designed to determine the eating quality of a cut for relevant cooking methods using a number of animal and processing inputs. The reason for this approach is due to the fact that the amount of connective tissue can impact the sensory score  and, thegrilling  because grilling . In contTenderness is one of the most important sensory properties of bovine  and ovinm. rectus femoris and the m. semimembranosis was not different; however, it is well established that muscle collagen solubility can also be impacted by cooking methods [There is a known negative relationship between collagen concentration and sensory score . Muscles methods . The qua methods ,46. In tThe differences between cooking methods might be related to water-holding capacity  and lipiThe fat in meat plays an important role in overall meat palatability, and IMF% positively influences eating quality traits such as tenderness, flavor, juiciness, and overall liking . The genThe study by Pannier et al.  showed tWarner–Bratzler shear force of LL measured 5 days post mortem had a significant negative relationship with tenderness for all cuts, whereas there were minimal negative effects on other sensory traits for the Knuckle, Outside flat, and Topside. This finding aligns well with other studies that show lower sensory scores when SF5 increases ,56. The These findings demonstrate the huge impact that cooking methods and different cuts have on the tenderness, juiciness, and flavor of lamb leg muscles. Grilled cuts scored significantly higher than roasted cuts for all three muscles across all sensory traits. The results of this study provide the opportunity to develop better eating quality prediction models for specific cuts with changing cooking methods. The MSA sheepmeat eating quality model will be enhanced by these results, allowing greater extraction of value for cuts for specific cooking methods. The results also showed that all sensory scores for all cuts by different cooking methods were positively impacted by higher IMF% and negatively impacted by higher shear force. GR fat had a positive but smaller impact on the tenderness and juiciness of the grilled and roasted Outside flat and Topside only. These results support the immense importance of selecting animals with higher IMF% and lower shear force to generate a greater eating quality experience for consumers, which ultimately leads to greater extraction of value for the supply chain. The mechanisms causing the differences between cuts are unclear, but might be caused by the collagen content, IMF%, or other intrinsic factors such as sarcomere lengths. These factors can impact the cooking process under different cooking methods and, therefore, impact sensory scores. Further research is required to determine the influence of other cooking methods on a wider variety of cuts to understand the sensory attributes which are impacted by cooking method. In conclusion, hind leg cuts that have been traditionally roasted from lambs have an improved eating quality when grilled.


Viral aetiology of childhood diarrhoea is often associated with rotavirus infection of which preventable vaccines exist. Here we document circulating strains of rotavirus in the Kassena-Nankana Districts of Northern Ghana nearly a decade after the introduction of the rotavirus vaccine.a cross-sectional survey of children aged 0-60 months was conducted in six health facilities within the Kassena-Nankana Districts. Faecal samples obtained from the children were analysed and characterized for rotavirus detection and genotyping using Semi-Nested Polymerase Chain Reaction.a total of 263 stool samples were analyzed. Out of which 14.8% and 18.6% of the diarrhoea cases were of rotavirus and parasitic etiologies respectively, with 17.4% being co-infections. Almost 27.5% of rotavirus diarrhoeal cases resulted in hospitalization. Household size (p=0.035), location (p=0.018), treatment outcome (p=0.007), vomiting (p=0.039), season (p=0.017) and month of sampling (p=0.000) were significantly associated with rotavirus infection. The rotavirus genotypes identified were G1P8, G3P6, G4P9, G10P6 and G12P8. Rotavirus vaccine-type, G1P8 was absent in Kassena-Nankana West District.the prevalence of rotavirus was low compared to the pre-vaccination era. Also, a new rotavirus strain, G4P9 was identified to be circulating in the study area which calls for surveillance measures and more studies to better understand the situation for appropriate public health intervention. Diarrhoea is one of the top five causes of morbidity and mortality for children less than five years of age . Accordiet al. found several non-typeable strains that have been speculated to be a result of a shift in primer binding sites or emerging new strains [Diarrhoeal disease has remained one of the causes of hospitalization and death in Ghana for several years . A recen strains . It was  strains . There aThe study was conducted in the Navrongo Health Research Centre (NHRC) using the Navrongo Health and Demographic Surveillance System (NHDSS). This system monitors the health and demographic parameters of the two districts where the study took place . Data coThis study was a hospital-based cross-sectional study of children zero to sixty months presenting with moderate to severe diarrhoea. Participants' recruitment procedure and enrolment criteria are shown in About a spoonful of stool was collected directly into a sterile, wide-mouth container with a lid. For participants who were unable to produce stool, a rectal swab was performed using a sterile cotton swab. These swabs were then placed inside a solution of Phosphate Buffered Saline (PBS) to preserve the sample. Stool samples were labelled with a unique participant´s identification number and transported on ice immediately to the Navrongo Health Research Center Laboratory for analysis. Stool samples collected were first described in terms of colour, presence of blood or mucous (for exclusion from the study), and whether the stool was formed, semi-formed, watery or loose. Stool samples were also examined physically for the presence of adult worms. Wet mounts were prepared for stool samples and examined for the presence of parasites/protozoa upon arrival at the laboratory. The remaining stool samples were processed using PBS and stored in a -20°C freezer till analysis. The swab sticks with their storage medium were frozen as well till further analysis. Information on the presence or absence of malaria parasites was obtained from routine laboratory examinations at the hospital if requested by the clinician. A portion of each stool sample was suspended in normal saline to help view the motility of trophozoites as well as other stages of development of the parasites. A drop of the suspension was placed on a clean, sterile slide and covered with a coverslip. Slides were observed under 10x and 40x objective lenses for motile trophozoites and larvae, eggs, and cysts of parasites.Frozen stool samples were brought out of the freezer and made to thaw at room temperature before use. The RNA extraction procedure was performed using a nucleic acid extraction kit  according to the manufacturer's instructions. A two-step semi-nested PCR procedure was used to determine rotavirus presence in samples and genotypes. First-round VP7 amplifications were performed using Qiagen OneStep RT-PCR Kit (Cat No. 210212). Thin-walled tubes (0.2ml) were labelled for each sample including a positive and negative control. A PCR master mix was prepared and placed on ice. This master mix was made up of 10μl of 5x Qiagen OneStep RT-PCR buffer, 2μl of 10mM dNTP mix, 2μl Qiagen One-Step RT-PCR enzyme mix, and 25μl of RNase-free water for each reaction. For VP7 amplification, 3μl of each 20pmol Beg9 and End9 were added to all sample tubes. Con2 and Con3 were used for VP4 amplification. Five microliters (5μl) of the extracted RNA were added to the primers in each reaction tube. The samples were denatured for 5 minutes at 94°C and transferred immediately to an ice bath. Thirty-nine (39μl) of the PCR master mix was added to each tube and mixed. The tubes containing the samples were placed in a thermocycler  and incubated using the following cycles conditions: reverse transcription at 50°C for 30 minutes, initial PCR activation at 95°C for 15 minutes, both for one cycle each, then denaturation at 94°C for 30s, 60°C for 30s, 72°C for 1 min all for 30 cycles, and 72°C for 10 min for one cycle.The concentration of DNA was checked using a Qubit Fluorometer 4.0. These concentrations ranged from 0.644ng/μl to 4.28ng/μl. One percent (1%) agarose gel was prepared with 5μl of SafeView classic dye. Samples with dye and a 1kb ladder were loaded and run at 90v for 45 minutes and were visualized under a gel documentation system . Images of the gel were interpreted to determine the status of each sample. The second amplification was performed using the nested PCR protocol of the Qiagen one-step RT-PCR kit. A second amplification involved using RVG9 and type-specific primers  for VP7. Con3 and type-specific primers  were used for VP4 second amplification. A genotype master mix was prepared to contain 0.5μl each of these primers at 100pmol concentration, 1μl of dNTPs, 5μl of Qiagen OneStep RT-PCR buffer, 1μl of Qiagen One-Step RT-PCR enzyme mix, and 12.5μl of RNase free water in a 25μl reaction. Twenty-four microliters (24μl) of the mix were added to the labelled tubes. One microliter (1µl) of positive first-round RT-PCR products was added to each of the tubes containing the master mix. The tubes were placed in a thermocycler and activated at 95°C for 15 minutes then run for 25 cycles at 94°C for 30s, 60°C for 2 minutes, 72°C for 1 minute, and one cycle at 72°C for 10 minutes. The PCR fragments were run on 2% TAE agarose gel at 95 volts for 45 minutes with a 100bp molecular marker to determine the genotype of the rotavirus strain.Data was entered and analysed using IBM SPSS Version 21. All descriptive statistics and analyses were done using the same software. Simple proportions were presented using bar graphs and pie charts. Graphs and tables were generated using Microsoft Excel. Bivariate and multiple logistic regressions were used to establish the association between rotavirus infection and potential risk factors. Results were presented in confidence intervals (95% CI), odds ratios (OR) and P-values were significant if less than 0.05.Scientific and ethical clearance was obtained from the Kwame Nkrumah University of Science and Technology (KNUST) Committee on Human Research Publication and Ethics (CHRPE/AP/355/20) as well as from the Navrongo Health Research Centre Institutional Review Board (NHRCIRB385) before the commencement of the study. Permission was obtained from the Upper East Regional Health Directorate and all heads of institutions where samples were collected. Informed consent was obtained from the guardians of children before enrolment procedures were initiated. Samples and case report forms were coded to anonymize study participants.A total of 278 participants consented and were recruited into the study from two hospitals and four health centres. Fifteen participants were excluded from the analysis for non-completeness of data. Eventually, 263 samples were included in the final analysis. Out of these 263 participants data analyzed, 53.6% (141) were males while the females were 46.4% (122). The average age for females was 17.62 months and that of males was 17.27 months, with an overall average of 17.46 months . During Out of the 263 children screened, 39 (14.8%) were infected with rotavirus. Children aged 21 - 30 months were the most prevalent  whereas there was no case recorded in older children . During the dry season, the detection among urban-dwelling % while 3.6% of the cases detected were observed during the rainy season. A total of 27.5% of the rotavirus cases resulted in hospital admission while 12.6% were treated and discharged at the outpatient department. The odds of rotavirus case detection among urban-dwelling children were 2.5 higher  compared to those from rural area with diarrhoea . Small hAfter first-round amplification, 39 samples were positive for the VP7 gene. Out of this, 35 (89.7%) had VP7 specificities. Four samples did not yield any bands after the second-round amplification hence could not be typed. G10 genotype was the predominant genotype detected with a frequency of 41.3%. This was followed by G12 genotype with 18.0%, G3, G1 and G4 were 15.4%, 10.3%, and 5.1% respectively. All 39 samples were subjected to VP4 amplification and 35 (89.7%) were amplified. All these were VP4 genotyped after second-round amplification. The P6 genotype of the VP4 gene was the predominant genotype which was 62.9% of all VP4 positive samples typed. There was also 31.4% of P8 genotype detected and 5.7% of the rare human VP4 genotype, P9 detected in the samples. In terms of genotype combinations, four of the common rotavirus genotype combinations; G10P6 (41%), G12P8 (18%), G3P6 (16%) and G1P8(10%)  were obsGeospatial distribution of the rotavirus cases shows that majority of the positive cases were from the main towns of the two districts (Paga and Navrongo)  A,B. HotPlasmodium falciparum, Ascaris lumbricoides, Trichomonas hominis, and Giardia lamblia  detected G12P8, G10P6, G3P6 and G1P8 strains as the most predominant genotypes circulating in Ghana [A few years before the Rotarix vaccine was introduced in Ghana, the prevalence of rotavirus related diarrhoea among children was 58% . A compaduction, ,18. Out duction, ,19,20. Rduction, . There hduction, . The genduction, ,23. In Gtroduced . Post-vain Ghana . The proin Ghana . These dIt was observed that the Kassena-Nankana East Municipal showed great diversity of rotavirus genotypes compared to those in the Kassena-Nankana West District. This was unexpected because the two are adjourning districts. Kassena-Nankana East Municipal is however more populated and developed, accounting for its great diversity in strains detected. A rare rotavirus genotype, the G4P9 genotype was detected in both districts suggesting both areas are at risk of new and emerging animal rotavirus genotypes since both areas have similar animal-rearing characteristics. The time or month of the year sample was collected, was a significant determinant of rotavirus positivity . This obPlasmodium falciparum alone accounted for 89.8% of the infections. The rest were A. lumbricoides, Giardia Lamblia, and T. hominis. It was not surprising that the malaria parasite was the predominant diarrhoea-causing parasite since it has always been the cause of most children reporting at the hospital [G. lamblia, were reported previously in a similar study in Northern Ghana [Parasitic cause of diarrhoea was shown to be a major concern responsible for 18.6% of the diarrhoea cases screened. This is consistent with findings from a study in neighbouring Burkina Faso which reported that 24.08% of diarrhoea cases tested were of parasitic aetiology . Of the hospital . Malariarn Ghana . In thisThe major challenge faced during this study was the inability to collect the samples from all the major health centres within the study area which greatly affected the overall prevalence. Another challenge was that children were only brought in after some days of illness. Due to the self-limiting nature of the virus, this could have accounted for the low prevalence found. Also, most parents reported to the health facilities without the vaccination cards of the children, making it difficult to obtain the number of vaccinated children.A relatively low prevalence rate of rotavirus infection, 14.8% was observed which suggests the success of various interventions especially the rotavirus vaccine, Rotarix, in eliminating rotavirus infections. The vaccine-type genotype, G1P8 was detected in only one of the districts. The predominant genotype was the G10P6 genotype and a rare animal-type combination, G4P9 was also detected. Factors such as the location of the participant, household size, the outcome of treatment, and season were risk factors for rotavirus infection in the area. Molecular surveillance is recommended to detect vaccine escape mutants, serotype replacement and zoonotic potential.Rotavirus is the leading cause of childhood diarrhoea;Rotavirus vaccines have played a role in reducing the incidence of childhood diarrhoea;Genotypes of rotavirus keep changing with time.Vaccine strains of rotavirus are eliminated in some populations;Urban populations are more at risk of rotavirus infections than rural populations;Parasites play a key role in childhood diarrhoea.


Conclusion: MPL and MSLR scores are potential predictors of mortality in COVID-19 patients within 30 days in a resource-limited country.The mortality of COVID-19 patients has left the world devastated. Many scoring systems have been developed to predict the mortality of COVID-19 patients, but several scoring components cannot be carried out in limited health facilities. Herein, the authors attempted to create a new and easy scoring system involving mean arterial pressure (MAP), PF Ratio, or SF ratio-respiration rate (SF Ratio-R), and lymphocyte absolute, which were abbreviated as MPL or MSLR functioning, as a predictive scoring system for mortality within 30 days for COVID-19 patients. Of 132 patients with COVID-19 hospitalized between March and November 2021, we followed up on 96 patients. We present bivariate and multivariate analyses as well as the area under the curve (AUC) and Kaplan–Meier charts. From 96 patients, we obtained an MPL score of 3 points: MAP < 75 mmHg, PF Ratio < 200, and lymphocyte absolute < 1500/µL, whereas the MSLR score was 6 points: MAP < 75 mmHg, SF Ratio < 200, lymphocyte absolute < 1500/µL, and respiration rate 24/min. The MPL cut-off point is 2, while the MSLR is 4. MPL and MSLR have the same sensitivity (79.1%) and specificity (75.5%). The AUC value of MPL vs. MSLR was 0.802 vs. 0.807. The MPL ≥ 2 and MSLR ≥ 4 revealed similar predictions for survival within 30 days ( Still ongoing and expanding worldwide, up until 2023, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic continues in Indonesia. The Indonesian government has reported that, as of 2023, the number of confirmed COVID-19 patients had reached more than 6 million cases, with the number of mortalities reaching more than 160 thousand cases  vs. 145.5f [73.1–251.2]) ) .2 in the first 24 h in the ICU was 16.2 kPa (122.44 + 31.8 mmHg) and the mean FiO2 was 60%. The PaO2 was 115.92 ± 46 mmHg in the non-survivor group and 122.07 ± 59.37 mmHg in the survivor group. Statistical analysis showed no difference between these two groups. Data analysis based on the PaO2/FiO2 group showed insignificant results, which were 218.82 ± 97.81 mmHg for survivors and 213.67 ± 98.9 for non-survivors p = 0.583 [Oxygen supplementation for critically ill patients has been a serious dilemma. Although adequate oxygenation is extremely needed in respiratory failure to maintain microcirculation and tissue function, high doses of oxygen may instead induce toxicity. The study by Kaydu et al. noted that the mean PaO = 0.583 .2 in critically ill patients [2 and low PaO2 in the first 24 h in the ICU. The similarity of results between De Longe et al. and Kaydu et al. was in FiO2 levels (50.4% vs. 60%) and PaO2 values (13.1 kPa vs. 16.2 kPa) in the initial 24 h. These studies also revealed differences in outcomes in critical patient mortality (23% vs. 56%). This discrepancy was due to different research methods in determining the low cutoff PaO2 in the first 24 h  and also to differences in the diagnosis and treatment of patients in the ICU [However, another study conducted by Eastwood et al. showed significant results in PaOpatients . De’Jong the ICU ,38.2/FiO2 ratio . Statistical analysis showed that the AUC was 0.895 , with sensitivity and specificity of 81.2% and 83.1%, respectively, when the cut-off value was 152.86 mmHg [Research involving the COVID-19 population in China showed that, of several laboratory and clinical markers, the independent predictor of ICU admission and mortality was the PaO.86 mmHg .p = 0.179). There was also no difference in length of stay in the ICU, duration of mechanical ventilation, ventilator-free days, length of hospital stay, or hospital mortality between the two groups [Acute respiratory distress syndrome (ARDS) in COVID-19 patients is a threat leading to a high mortality rate. Acute respiratory distress syndrome (ARDS) criteria that include blood gas analysis raise the question of whether the clinical criteria for saturation ratio and oxygen fraction are comparable markers for respiratory failure. The use of pulse oximetry can reduce the need for blood gas analyzers. Of 329 patients with ARDS (91%) with mechanical ventilation, evaluation in the initial 4 days showed no difference in the clinical characteristics, PF ratio, or SF ratio . According to the SF ratio criteria, the mortality rates of patients with mild, moderate, and severe ARDS were 30.6%, 23.1%, and 61.1%, respectively (p = 0.001). Therefore, these two criteria did not show any differences in clinical characteristics or outcome. The PF ratio was considered insufficient to determine the outcome of ARDS due to its high dependency on the type and strategy of mechanical ventilation. SF ratio criteria in one study was used to determine the severity of ARDS. The results came out promising; therefore, the conclusion stated that the SF ratio prognosticate patients with mild and moderate ARDS better than the PF ratio [Further studies from Chen et al. stated that the mortality rates of mild, moderate, and severe ARDS according to the Berlin criteria were 37.8%, 36.7%, and 33.7%, respectively  [p = 0.001) [Basheer et al. showed that the non-survival group had lymphopenia with levels of 1.4 ± 4 vs. 2.06 ± 11 (= 0.001) . In addi= 0.001) .p < 0.05).Of the 96 patients we thoroughly followed, the MPL score consisted of 3 points: MAP < 75 (1 point), PF Ratio < 200 (1 point), and lymphocyte absolute < 1500 (1 point), while the MSLR consisted of 6 points: MAP < 75 (1 point), SF Ratio < 200 (1 point), lymphocyte absolute < 1500 (2 points), and respiration rate 24/min (2 points). MPL cutoff is at point 2, while MSLR is at point 4. Both MPL and MSLR have the same sensitivity and specificity . AUC value of MPL vs. MSLR (0.802 vs. 0.807). Thirty-day mortality survival scores for MPL 2 and MSLR 4 were the same (We obtained these variables after analyzing some of the data from the preliminary research by Asmarawati et al. ,18. Base2, but also by pH and venous and arterial oxygen saturation. Low SaO2 also indicates arterial hypoperfusion and hypoxemia. In general, this data is a predictive score that can be obtained with lower medical expenses and used to determine the disease’s severity in its early stages. It can be serially compared to reflect the prognosis and enhance patient care.Various physicians with different fields took part in this study and indirectly underwent randomization. The study population was taken consecutively from the first and second waves of COVID-19, so the characteristics of the population are heterogeneous. The majority of the patients that we followed up on needed blood gas analysis data, making it difficult to perform outside the ICU. Pulse oximetry measurements are affected not only by PaOThis study has some limitations. First, age and comorbidities such as diabetes, hypertension, and cardiovascular disease, which are no less important in affecting the severity of COVID-19, were not adjusted accordingly in the scoring system. Second, the sample size was small and only obtained in a single-center study. Thus, further multi-center studies with a larger sample size and better-adjusted analyses are highly anticipated.MPL and MSLR scores convey a promising value in predicting the mortality of COVID-19 patients within 30 days. Moreover, these two scoring systems can replace each other because they show the same results. In conclusion, they can help clinicians at hospitals with deficient resources foretell the deterioration and mortality of COVID-19 patients.


Metabolic syndrome; a constellation of obesity, hypertension, and disturbances of lipid and carbohydrate metabolism is a common phenomenon in chronic obstructive pulmonary disease. Systemic inflammation plays an important role in both conditions. The aim of this study was to find out the prevalence of metabolic syndrome among stable chronic obstructive pulmonary disease patients visiting the outpatient Department of a tertiary care centre.A descriptive cross-sectional study was done in the outpatient Department of Pulmonology and General Practice from 1 August 2019 to 31 December 2020. Ethical approval was obtained from Institutional Review Committee [Registration number: 5/(6-11)E2/076/077]. Convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated.Among 57 patients with stable chronic obstructive pulmonary disease, the prevalence of metabolic syndrome was 22 (38.59%) . The prevalence of metabolic syndrome in patients with Global Initiative for Obstructive Lung Disease stages 1, 2, 3, and 4 were 6 (27.27%), 9 (40.90%), 6 (27.27%) and 1 (4.54%) respectively.The prevalence of metabolic syndrome was similar to the other studies done in similar settings. The screening of metabolic syndrome is necessary and stratification for cardiovascular disease risk is important for timely intervention to prevent and decrease morbidities and mortalities. Written informed consent was taken from the participants. Adult patients (>18 years) diagnosed with COPD, not in exacerbation visiting the outpatient clinic were included in the study. Patients in exacerbation as per GOLD criteria, patients with active infections, patients currently smoking and patients with a known malignancy or chronic inflammatory diseases were excluded from the study. Convenience sampling method was used. The sample size was calculated using the following formula:Where,n = minimum required sample sizeZ = 1.64 at 90% Confidence Interval (CI)6p = prevalence of metabolic syndrome was taken from a previous study, 35.71%q = 1-pe = margin of error, 11%7 Patients with central obesity  and any of two among raised triglycerides (≥150 mg/ dl or 1.7 mmol/l) or previously under treatment for hypertriglyceridemia, reduced HDL-cholesterol (<40 mg/dl or 1.03 mmol/L) in males and (<50 mg/dl or 1.29 mmol/l) in females) or previously under treatment for lipid abnormality, raised blood pressure (≥130 mm Hg systolic and ≥85 mm Hg diastolic blood pressure) or previously under treatment for hypertension and raised fasting blood sugar level (>100 mg/dl or 5.6 mmol/l) or previously diagnosed type 2 diabetes mellitus were diagnosed as MetS.Metabolic syndrome was defined using International Diabetes Federation 2006 criteria.Data were entered in Microsoft Excel Version 2016 and analysed using IBM SPSS Statistics version 25.0. Point estimate and 90% CI were calculated.Among 57 stable COPD patients, the prevalence of metabolic syndrome was found to be 22 (38.59%) . Out of which, 6 (27.27%) were from the General Practice outpatient clinic and 16 (72.72%) were from Pulmonology outpatient clinic. The mean age of the patients was 68.96±8.06 years (Range: 45-87 years). A total of 44 (77.19%) patients were between 61-80 years and the male:female ratio of the study population was 9:10 .A total of 9 (42.85%) patients in GOLD stage II had MetS, and 6 (50%) in GOLD stage I had MetS .The mean CRP of COPD patients with MetS is 5.01±0.58mg/L .The mean waist circumference of patients with MetS in male and female were 96.08±2.71 cm and 92.63±6.78 cm respectively. Hypertension 20 (90.90%) was the most common finding followed by 19 (86.36%) elevated fasting blood sugar (FBS) levels, reduced HDL level 9 (40.90%) and increased triglyceride level 7 (31.80%) among the patients MetS.7 for diagnosis of MetS, the prevalence was 47.5%.8 Similarly, a study conducted, using IDF criteria found a prevalence of 37.8%.9 On the other hand, a similar study using ATP III criteria10 and excluding patients with diabetes, cardiovascular disease and other co-morbidities found a prevalence of 21%.11 And, in a study in Egypt MetS was present in 40% of the COPD patients.12 The prevalence depends on the criteria used to diagnose MetS along with the geography of where the study is conducted.In our study, 38.59% of stable COPD patients had coexisting MetS. In a study done in Germany using IDF criteria13 Similarly, another study showed a prevalence of 50%, 53%, 37%, and 44% in Gold stage I-IV.8 In a Canadian study the overall prevalence of MetS in patients was 47% and the frequency decreased to about 10% at Gold stage III and IV.14 Several studies conducted around the world concluded that the MetS is less frequent in the severe form of the disease and is a consequence of weight loss which occurs in patients with advanced disease.Our study concluded that metabolic syndrome is less frequent in the severe form of the disease. More than one-third of the patients (36.8%) were in Gold stage II and only (10.5%) were in Gold stage IV. There was a gradual decline in the prevalence of MetS with an increase in the severity of the disease. In a study, the prevalence of MetS in Gold I-IV was 38.5%, 52.8%, 30%, and 33.3% respectively.8 Another study noticed higher CRP levels in COPD patients with MetS. This observation indicates that the presence of MetS in COPD patients is associated with more intensive systemic inflammation.13 Similarly, other studies revealed higher levels of serum TNF-alpha and hs-CRP.15 Our finding of higher values of CRP in COPD patients with MetS is in line with the findings from other studies performed around the world. This clearly states that ongoing systemic inflammation is a phenomenon that occurs in COPD patients and the basis of this might be explained collectively by mechanisms like local inflammation spilling to the systemic compartments, smoking, hypoxia and obesity.16C-reactive protein, a marker of systemic inflammation is found consistently higher in all stable COPD patients. And, the level of CRP in Gold I-IV is in an increasing trend from 4.21±0.41 to 4.97±0.73 mg/L. A study showed an increased level of systemic inflammatory markers among COPD patients with MetS in the form of high-sensitivity CRP and interleukin-6.17 Similarly, the INDACO project, a pilot study on the incidence of co-morbidities in COPD patients found 53% prevalence of hypertension in COPD patients.18 The results of our study showed a significantly higher prevalence of hypertension among the participants. Despite being the most common co-morbidity in COPD patients this extraordinarily higher frequency might be due to the small sample size and use of IDF criteria which classified hypertension as systolic BP >130 mm of Hg and diastolic BP >85 mm of Hg.In this study, the commonest MetS component was hypertension (90.9%), followed by altered fasting blood glucose (86.4%). In a study conducted on 1,003 COPD patients, the frequency of hypertension was 55%.There were a few limitations of our study. Increasing the sample size would have made the results more reliable. And, there was an uneven distribution of the sample size in different stages of COPD. The comparison would have been statistically more significant if there was an even distribution of sample size.The prevalence of MetS in stable COPD patients was similar to the other studies done in similar settings. Treating physicians should screen all COPD patients for metabolic syndrome and intervene timely to prevent and decrease morbidities and mortalities.


Since 2010, several guidelines and consensus papers have been proposed to support surgeons in the decision-making process :557–566, 2013; Silecchia et al. in Surg Endosc 29:2463–2484, 2015; Bittner et al. in Surg Endosc 33(11):3511–3549, 2015) with the conclusion that laparoscopic repair (LR) has gained popularity in the treatment of IH.To date, however, it is not yet clear as to the uptake of LR for IH on national basis. Only dated studies encompassing of all types of incisional hernia repairs are available in literature . The aim of our study is to present a snapshot of Italian data for LR of ventral hernias, over a 6 years period, including volume of LR, procedural features and major postoperative outcomes. Data were extracted from the Italian Hospital Information System (HIS) that collects clinical and administrative information regarding each hospital admission of every patient discharged from any hospital in Italy. Using Hospital Discharge records regional Databases (HDD), all laparoscopic ventral hernia procedures carried out in public and private hospitals between 2015 and 2020, in patients over 18 years and resident in Italy, were collected based on diagnosis and procedure codes. The National Agency for Regional Health Services (AgeNaS) oversees the management and analysis of data. All hospital admissions that occurred between 2015 and 2020 were analyzed.p < 0.0001).A total of 154,546 incisional hernia repairs were performed in Italy from 2015 to 2020. Of these, 20,789 (13.45%) were minimally invasive repairs. The number of procedures performed increased significantly over time, constituting 11.96 and 15.24% of all procedures performed in 2015 and 2020 respectively. However, considering the whole period, the mean annual change was—5.58% . However, when considering the period from 2015 to 2019, the mean annual change was 10.42% . To our knowledge this is the first nationwide Italian report presenting the national workload of surgical units and the main perioperative features of minimally invasive surgery for ventral hernia repairs.Urgent minimally invasive repairs were performed in 1968 cases (1.27%). The absolute rate of laparoscopically treated patients needing an urgent surgical procedure increased overtime (from 7.36% in 2015 to 13.418% in 2020). The mean annual change registered over the whole period was 7.42%. 92% (CI − 0.03 to 14.09%; The online version contains supplementary material available at 10.1007/s13304-023-01460-4. Following abdominal surgery, incisional hernias (IH) are associated with 20% of procedures, with a global lifetime risk of 5% . The heaSince 2010, several guidelines and consensus papers have been proposed to support surgeons in the decision-making process –5 with tTo date, however, it is not yet clear as to the uptake of LR for IH on national basis. Only dated studies encompassing of all types of incisional hernia repairs are available in literature .The aim of our study is to present a snapshot of Italian data for LR of ventral hernias, over a six years period, including volume of LR, procedural features and major postoperative outcomes.Data were extracted from the Italian Hospital Information System (HIS) that collects clinical and administrative information regarding each hospital admission of every patient discharged from any hospital in Italy. Using Hospital Discharge records regional Databases (HDD), all laparoscopic ventral hernia procedures carried out in public and private hospitals between 2015 and 2020, in patients over 18 years and resident in Italy, were collected based on diagnosis and procedure codes.The National Agency for Regional Health Services (AgeNaS) oversees the management and analysis of data. All hospital admissions that occurred between 2015 and 2020 were analyzed. Subsequently, information on every admission with a diagnosis of incisional hernia as either primary or secondary  were extracted. The presence of intestinal obstruction at the time of the operation was also registered .Gender, age and preexisting comorbidities were considered. As for the latter they were divided into general comorbidities  additionally, the presence of colostomy or ileostomy [ICD-9-CM V44.3 V44.2] was registered.In this study, the discrimination between laparoscopic or open incisional hernia repair was defined as the presence or the absence of the ICD-9-CM code 54.21 as secondary diagnosis while robotic-assisted procedure was classified with the ICD-9-CM code 0039. The conversion to open surgery from minimally invasive surgery has a separate ICD-9-CM codification (6411). The association with other surgical procedures was also considered.Based on HIS data and patient discharge records, the analysis included total hospital stay (primary plus readmission within 30 days), readmission rate, early mortality (within the first admission and < 30 days from the operation), late mortality  and 30-day morbidity.Data were processed using the MedCalc statistical package (version 12.5). Qualitative variables were summarized by frequency and percentage, while non-normally distributed quantitative variables were described by the median and standard deviation (SD).p value < 0.05 was considered statistically significant. The sample size was the Italian population, reported by region, according to the average yearly population for the period 2015–2020, reported by the Italian National Institute of Statistics (ISTAT) .Statistical analysis was performed using Student’s t test and the Cochran Armitage test for trend as appropriate. A two-tailed A total of 154,546 incisional hernia repairs were performed in Italy from 2015 to 2020. Of these, 20,789 (13.45%) were minimally invasive repairs.p < 0.0001).The number of procedures performed increased significantly over time, constituting 11.96 and 15.24% of all procedures performed in 2015 and 2020 respectively. However, considering the whole period, the mean annual change was − 5.58%  Fig. Specifically, a negative trend was observed between 2016 and 2017 (– 2.65%), and between 2019 and 2020 was − 51, 60%. However, if considering the period between 2015 and 2019 the mean annual change was 5.92%  between 2015 and 2020 and of 36.71%  when considering only the first five years.A significant increase was also registered in the number of ventral hernias performed robotically, with a mean annual change of 9.37% . However, when considering the period from 2015 to 2019 the mean annual change was 10.42%  Fig. Urgent minimally invasive repairs were performed in 1968 cases 1.27%). The absolute rate of laparoscopically treated patients needing an urgent surgical procedure increased overtime (from 7.36% in 2015 to 13.418% in 2020). The mean annual change registered over the whole period was 7.42% 0.92% , while the mean annual change for the whole period was − 4.64%   incisional hernia repairs were associated with other surgical procedures during this period. The most performed concurrent procedure was minimally invasive adhesiolysis, here, a slight increase was observed from 2015 to 2020 , however, a positive mean annual change was observed if considering only the first five years .The number of patients treated as elective admissions ranged from 2640 in 2020 to 3991 in 2019 as absolute numbers and from 95.21% to 97.43% as relative values to overall procedures in 2019 and 2017 respectively. The mean annual change was -5.81 , however, a positive mean annual change was observed if considering only the first five years .The number of procedures managed as day case procedures ranged from 80 in 2020 to 199 in 2019 as absolute numbers and from 2.38 to 4.75% as rates of overall procedures in 2017 and 2019 respectively. Overall, the mean annual change was − 5.27  from 2015 to 2020 and of 13.12% 5.27 . Complications ranged from 26 in 2016 to 40 in 2017 as absolute numbers and from 0.87 to 1.19% as rate of overall procedures in 2017 and 2019 respectively . Readmissions ranged from 6 in 2020 to 15 in 2019,  Fig. Overall, a total of 271 (1.3%) conversions, 193 (0.93%) complications and 58 (0.28%) readmissions within 30 days were registered. Conversion rate significantly increased over the considered period with a mean annual change of 10.10% .A total of 60 (0.28%) deaths were registered . The mean annual change for late mortality was -5.09% and -20% with and without considering 2020 respectively .Thirty-two (53.33%) deaths occurred within 30 days from the operations and 28 after 30 days (46.67%). The mean annual change for early mortality was − 38.94% and − 40.34% with and without considering 2020 respectively . The minimum annual intervention rate was observed in Calabria AIR = 1) while the maximum was registered in Valle d’Aosta (19 in 2018). Table  while thConsidering urgent procedures, an increase in the adoption of laparoscopy was observed, however, in 9 regions, this increase was not significant considering both the whole period and the first five years excluding the 2020 data . Many regions showed the same annual intervention rate (AIR = 0) while the maximum was registered in Trentino . Table 2The indications and limitations for laparoscopic ventral hernia repair are well established by different guidelines –5, some In Italy, between 2015 and 2019 more than 26,000 patients underwent surgery for ventral hernia repair. The number of laparoscopic ventral hernia procedures in this period reached over 3000 patients annually, with a significant increase in its adoption from 2015 to 2019 Supplementary file2 (DOCX 917 KB)Supplementary file3 (DOCX 928 KB)Supplementary file4 (DOCX 619 KB)Below is the link to the electronic supplementary material.


Capsule endoscopy (CE) is the first-choice exploration in case of overt small bowel bleeding (SBB). An early CE is known to increase diagnostic yield, but long reading times may delay therapeutics. The study evaluates the diagnostic performance of the artificial intelligence tool TOP100 in patients with overt SBB undergoing early CE with Pillcam SB3.Patients who underwent early CE (up to 14 days from the bleeding episode) for suspected overt SBB were included. One experienced endoscopist prospectively performed standard reading (SR) and a second blind experienced endoscopist performed a TOP100-based reading (TR). The primary endpoint was TR diagnostic accuracy for lesions with high bleeding potential (P2).p = 0.019). The median reading time for SR and TR was 23 min (18.0–26.8) and 1.9 min (range 1.7–2.1), respectively (p < 0.001).A total of 111 patients were analyzed. The most common clinical presentation was melena (64%). CE showed angiodysplasias in 40.5% of patients (45/111). In per-patient analysis, TR showed a sensitivity of 90.48% (95% CI 82.09–95.80), specificity of 100% (95% CI 87.23–100) with a PPV of 100% (95% CI 94.01–100), NPV of 77.14% (95% CI 63.58–86.71) and diagnostic accuracy of 92.79 (86.29–96.84). At multivariate analysis, adequate intestinal cleansing was the only independent predictor of concordance between TR and SR (OR 2.909, TOP100 provides a fast-reading mode for early CE in case of overt small bowel bleeding. It identifies most patients with active bleeding and angiodysplasias, aiding in the prioritization of therapeutic procedures. However, its accuracy in detecting ulcers, varices and P1 lesions seems insufficient. Small bowel bleeding (SBB) accounts for 5 to 10% of all gastrointestinal bleeding and is defined as overt or occult bleeding which originates in the small bowel (SB) in patients with an inconclusive exploration of the upper and lower gastrointestinal tracts .  It repreNowadays, SBCE represents a safe and efficient technique.  However,Pillcam SB3  has been the first capsule endoscopy device to integrate AI tools in its reading software  to assist with video assessment and potentially reduce reading times . TOP100 Little is known about the utility and impact of TOP100 on lesion detection and reading times in acute and urgent settings like overt SBB, where a rapid diagnosis is needed to schedule the appropriate therapeutic procedure. The present study aimed to evaluate the diagnostic performance of TOP100 in patients submitted to early SBCE due to overt SBB.Research was conducted in the SBCE database of Hospital Clínic of Barcelona, searching for all consecutive early SBCE explorations performed with the Pillcam SB3 Capsule Endoscopy from March 2018 to March 2021. Inclusion criteria were: (1) SBCE indication for overt suspected small bowel bleeding ; (2) recent bleeding (up to 14 days from SBCE placement); (3) availability of TOP100 tool in reading software. Exclusion criteria were: (1) incomplete capsule studies; (2) patients with no upper and lower gastrointestinal endoscopy before undergoing SBCE; (3) repeated SBCE explorations in the same patient.A new reading was performed for all SBCE videos. The study’s primary endpoint was to assess TOP100 diagnostic performance  for P2 lesions in patients with overt SBB in comparison with standard reading (SR) as the gold standard. Secondary endpoints were: (1) to compare SBCE reading time between SR and TOP100 (TR); (2) to assess the diagnostic performance of TOP100 for P1 lesions; (3) to detect predictors of concordance between TR and SR.The study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Ethics Committee (IEC) of Hospital Clínic de Barcelona (HCB/2020/1204). Informed consent was waived due to the study design and the use of anonymized data according to IEC requirements and local laws.A Pillcam SB3®  was used in all patients. A 12-h clear liquid diet and 8-h fasting from solid food were requested before the procedure. A 1L polyethyleneglycol bowel preparation  had to be ingested 2 h before the procedure. Prokinetic drug (Metoclopramide) was administered 15 min before capsule ingestion in all inpatients according to local protocols, except for drug contraindication. The endoscopic capsule was swallowed with 200 ml of water with 300 mg of simethicone. Patients could start a liquid diet at 2 h from capsule ingestion followed by a normal solid diet after 4 h.. Lesions characterization and reading time were assessed as per SR.SBCE procedures included in the analysis were first anonymized and coded. Two independent endoscopists (AG & BGS), with experience in more than 1000 endoscopic capsule explorations, performed the new SBCE reading. Both endoscopists were blind to the previous report on the exploration, patients’ demographic, and clinical background. One endoscopist performed SR according to ESGE  guidelines : brieflyAll detected lesions were classified as per Saurin classification , 13: P0 Diagnostic yield was defined as the number (percentage) of patients with at least one P2 lesion. The detection rate was defined as the percentage of patients or lesions found by TR in comparison with SR; lesions not confirmed by SR were considered false positives.SB cleansing was assessed according to a qualitative scale  described by Brotz et al. . ExcelleU test or Chi-squared test, when appropriate. Predictors of concordance were entered in a multivariate model (forward stepwise method) and analyzed with multiple binary logistic regression. Statistical analysis was performed with SPSS Statistics for Windows, Version 26.0 .Data were analyzed with the Kolmogorov–Smirnov test to exclude normal distribution. Qualitative variables were expressed as absolute numbers and percentages, quantitative values were expressed as median and interquartile range (IQR). Positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were expressed as percentages and 95% confidence interval (95% CI). Reading time was measured in minutes and seconds and expressed in decimals. The concordance between SR and TR was calculated with Cohen’s kappa coefficient . Univariate analysis was conducted with the Mann–Whitney n = 9), duplicate patients (n = 20), or having a prior upper gastrointestinal endoscopy or ileo-colonoscopy realized > 14 days before SBCE (n = 20). Finally, 111 SBCE videos were analyzed , accounting for 23 min (18.0–26.8) and 1.9 min (range 1.7–2.1), respectively. Diagnostic yield resulted in 75.7% (84/111) for SR and 68.5% (76/111) for TR. The diagnostic yield for P1 lesions was 29.7% (33/111) for SR and 22.5% (25/111) for TR, with a significant concordance coefficient of 0.74.Complete technical data related to SBCE explorations are presented in Table TR showed an overall detection rate of 90.5% (76/84 patients), with 100% in case of active bleeding (12/12), 97.7% for angiodysplasias (44/45), 76.5% for ulcers (13/17), 75% for multiple erosions areas (3/4) and 66.7% for varices (4/6).Overall, TOP100 demonstrated an accuracy of 92.79% for the identification of patients with P2 lesions, with high sensitivity (90.48%) and specificity (100%). As regards P1 lesions, SR identified 34 positive patients, of these 25 were detected by TR with a sensitivity of 73.53%, specificity of 97.40%, and diagnostic accuracy of 90.09%. A detailed analysis of diagnostic performance is shown in Table Globally, 266 P2 lesions were identified by SR, of these 235 (88.35%) were detected by TOP100. In more detail, TR detected 100% of active bleeding (12/12), 91.3% of angiodysplasias (189/207), 79.3% of ulcers (23/29), 75% of multiple erosions areas 3/4) and 57.1% of varices (8/14). TR showed a total sensitivity of 88.35% (95% CI 83.87–91.94) and a specificity of 55% (95% CI 39.32–68.19) with PPV of 91.09% (95% CI 88.29–93.26) and NPV of 46.55 (95% CI 32.44–56.96). A complete analysis is shown in Table  and 57.1TOP100 and SR showed a substantial agreement k 0.75). In 84 patients, TR and SR were concordant as per-lesion type and the number of lesions. Potential predictors of concordance were analyzed, as shown in Table . In 84 pThe growing complexity of endoscopic procedures and the advances in optical diagnosis claim higher precision and shorter procedure times, thus opening the door to artificial intelligence as a promising technology for a rapid and effective diagnosis. , 16 “SusThe present study focuses on the efficacy of the AI tool TOP100 for the diagnosis of suspected overt SBB in Pillcam® capsule endoscopy. In per-patient analysis, TR detected 90.5% of patients with significant P2 lesions identified by SR, thus showing a diagnostic accuracy of 92.79% with high specificity (100%) and PPV (100%), independent of lesion type; moreover, considering patients with active bleeding and angiodysplasias, sensitivity accounted for 97%–100% with a specificity of 100%, thus correctly identifying patients with potentially treatable lesions. In the case of P1 lesions, which present a lower bleeding potential, TOP100 showed inferior performance in per-patient analysis. It exhibited a sensitivity of 73.53%, specificity of 97.4%, and diagnostic accuracy of 90.09%. Consequently, a second reading is necessary to fully report P1 lesions.In per-lesion analysis, TR detected 88.35% of P2 lesions diagnosed by SR. TOP100 showed the highest accuracy for intestinal bleeding (100%), whereas, in the case of angiodysplasias, it showed a sensitivity of 91.3% and a specificity of 74.16% with a total accuracy of 86.15%. Sensitivity decreased with other P2 lesions such as ulcers (79%), areas with multiple erosions (75%), and non-bleeding varices (57%).To the best of our knowledge, this is the first comprehensive study to illustrate the diagnostic accuracy of TOP100. Present results are in line with a previous study by Ariera et al. who evaluated TOP100 in SBB, showing an 83.5% detection rate for patients with P2 lesions (91.2% for patients with angiodysplasias), although with a lower detection rate (54.5%) for P1 lesions. .In the case of positive significant findings, TOP100 permits an adequate definition of lesions and presumptive location based on the Pillcam reading software detector or intestinal transit time, without the need for SR.  Moreoverp = 0.019). This finding suggests that when employing AI-based reading, the use of a cleansing agent is recommended.Both per-patient and per-lesion analysis show an insufficient NPV of 77.14% and 44.65%, respectively; this percentage of miss rate implies that completely negative explorations must pass a second conventional reading to finally discard the presence of significant lesions. Both present study results and previously published studies indicate that TOP100 is mainly designed for the detection of red-colored lesions, showing high sensitivity and NPV for active bleeding and angiodysplasias, probably due to the abundant red color in frames, yet lower results for ulcers and varices, in the white and blue/green color spectrum. [The study strength of the study is the description of the impact of AI on reading time. A conventional reading requires between 30 and 60 min. , 21, 12 The study’s main limitation is its retrospective design; however, two new independent readings were performed based on anonymized videos to reduce potential biases. Moreover, this study was designed to directly compare TOP100 with the standard reading as the gold standard, therefore it lacks the second review of both TOP100 and standard reading to confirm or discard possible false positive and negative cases and this might potentially underestimate its real diagnostic performance.All in all, TOP100 showed the ability to detect 90.5% of patients with significant lesions and 100% of active bleeding with a median reading time of less than 2 min. Rapidity and high sensitivity make TOP100 an ideal tool for a quick review of SBCE videos and for prioritizing therapeutics in patients with overt SBB. A second standard reading is still required in most cases to fully exclude the presence of lesions, however, the clinical impact of this miss rate is still unknown and should be evaluated in future prospective clinical trials.


Antidepressants do not differ significantly in their ability to treat depression. Excluding the tricyclic antidepressants (TCAs), these drugs also do not differ significantly in their incidence of adverse events. Therefore, the initial choice of antidepressant medication should be based, in part, on cost. The objective of this study was to evaluate the impact on utilization and costs of a generic steptherapy edit for antidepressant drugs excluding TCAs in a health maintenance organization (HMO) in an integrated health system (IHS).The pharmacy department of the 440,000-member HMO in an HIS collaborated with the Behavioral Health Clinical Program to design an intervention that required generic antidepressants as first-line pharmacotherapy. Under the GenericStart! Program, a brand-name antidepressant was covered only after trial with a generic antidepressant, excluding TCAs. A step-therapy edit was added to the pharmacy claims processing system on January 1, 2005. All new starts, defined as members with no claims history of antidepressant treatment within the preceding 6 months, were required to use a generic antidepressant. The member copayment was waived for the first prescription. All generic antidepressants were in tier 1 of the drug formulary, with an average copayment of $5 to $10. All brand-name antidepressants were in either tier 2 (preferred brand), with an average copayment of $20 to $25 or 25% coinsurance, or tier 3 (nonformulary brand), with an average copayment of $40 to $45 or 50% coinsurance. Pharmacy claims data from a national pharmacy benefit manager (PBM) without interventions for antidepressants in 2004 or 2005 were used for the comparison group.The generic antidepressant dispensing rate increased by 20 points (32.5% to 52.5%) in the intervention group but only 7.4 points (24.9% to 32.3%) in the comparison group in 2005 compared with 2004. The principal measure of antidepressant drug cost per day of therapy in the intervention group decreased by 11.7% (from $2.40 to $2.12) in 2005 compared with 2004 versus a 2.7% decrease (from $2.60 to $2.53) in the comparison group (P less than0.001). Days of antidepressant drug therapy per member per month (PMPM) dropped by 1.5% (from 1.74 to 1.71) in the intervention group versus a decrease of 5.0% (from 1.37 to 1.30) in the comparison group in 2005 compared with 2004. The combination of change in drug cost and utilization resulted in a 13.0% decrease in antidepressant drug cost, from $4.16 PMPM in 2004 to $3.62 in 2005, compared with a 7.6% decrease (from $3.57 to $3.30 PMPM) in the comparison group. The 9.0% difference in drug cost per day represents drug cost savings of approximately $0.36 PMPM or $1,880,562 in 2005 dollars for this HMO of approximately 440,000 members.A step-therapy edit requiring HMO members to use a generic antidepressant, excluding tricyclics, prior to use of a brand-name antidepressant resulted in drug cost savings of 9.0% for the entire class of antidepressants, equal to $1,880,562 ($0.36 PMPM) in 2005 dollars in the first year of the intervention. A small (-1.5%) decrease in use of antidepressants occurred in the intervention group, which was less than the 5.0% decrease in utilization of antidepressants in the comparison group.


Orthorexia is a neuotic behavior characterized by an obsession with healthy eating. This trend is growing among medical students; it may be related to the stress experienced by these young people.The aim of this study was to determine the prevalence of orthorexic eating behaviors among medical students in Tunisia and to examine the relationship with perceived stress.Our study was descriptive and analytical cross-sectional, carried out with medical students in the faculty of medicine of sfax (Tunisia) during October 2022.An anonymous survey was asked to the students.Data collection was done by a self-administered questionnaire via Google Forms administered in the students’ Facebook groups. The questionnaire was composed of a part for the collection of socio-demographic data and two psychometric scales :-The ORTO-15 was used to assess orthorexia- Cohen’s Perceived Stress Scale (PSS) to determine the level of stressAtotal of 95 responses was collected.The average age of our samplewas 25.8±3.4 with sex ratio M/F=0,25.Tobacco and alcohol usewere found in 14.7% and 13.6% of casesrespectively.A psychiatric history was reported by 17.9% of students, 76.5% of whom are anxiety disorders.Average body mass index was 23.64 ± 3.53 kg/m2. More than half (58%)of the students were dissatisfied with their feed. In our sample, 8.4% of students have already consulted a nutritionist and 58.9% regularly practiced sport at gym.According to the ORTO 15, 52.6% of the students presented orthorexia. The mean score of the ORTO-15 was 39.19±4.48.According to PSS scores, 21.1% of students had severe level of stress, 69.5% had moderate stress level while 9.5% had low level of stress.Severe stress was significantly correlated with female gender and psychiatric follow (p=0.047), (p=0.001) respectively.Orthorexia was significantly correlated with the practice of sport (p=0.042).Orthorexics students had a higher level of stress without significant correlations.Our study showed significant frequencies of orthorexia and a considerable level of stress among medical students. A high level of stress was observed in these orthorexic students. Further studies should be conducted to better investigate this relationship in order to promote student mental healthNone Declared


Helicoverpa armigera (Hub.) is the major insect pest of pigeonpea and prediction of number of generations (no. of gen.) and generation time (gen. time) using growing degree days (GDD) approach during three future climate change periods viz., Near (NP), Distant (DP) and Far Distant (FDP) periods at eleven major pigeonpea growing locations of India was attempted. Multi-model ensemble of Maximum (Tmax) and Minimum (Tmin) temperature data of four Representative Concentration Pathways viz., RCP 2.6, 4.5, 6.0 and 8.5 of Coupled Model Inter comparison Project 5 (CMIP5) models was adopted here. The increase in projected Tmax and Tmin are significant during 3 climate change periods (CCPs) viz., the NP, DP and FDP over base line (BL) period under four RCP scenarios at all locations and would be higher (4.7–5.1 °C) in RCP 8.5 and in FDP. More number of annual (10–17) and seasonal (5–8) gens. are expected to occur with greater percent increase in FDP (8 to 38%) over base line followed by DP (7 to 22%) and NP (5to 10%) periods with shortened annual gen. time (4 to 27%) across 4 RCPs. The reduction of crop duration was substantial in short, medium and long duration pigeonpeas at all locations across 4 RCPs and 3 CCPs. The seasonal no.of gen. is expected to increase (5 to 35%) with shortened gen. time (4 to 26%) even with reduced crop duration across DP and FDP climate periods of 6.0 and 8.5 RCPs in LD pigeonpea. More no. of gen. of H. armigera with reduced gen. time are expected to occur at Ludhiana, Coimbatore, Mohanpur, Warangal and Akola locations over BL period in 4 RCPs when normal duration of pigeonpeas is considered. Geographical location (66 to 72%), climate period (11 to 19%), RCPs (5–7%) and their interaction (0.04–1%) is vital and together explained more than 90% of the total variation in future pest scenario. The findings indicate that the incidence of H. armigera would be higher on pigeonpea during ensuing CCPs in India under global warming context.Gram pod borer,  Understanding of the complex, spatially variable and species-specific effects of climate change is essential to develop an appropriate pest management strategy. Complete comprehension and quantification of insect herbivore-climate relationship is the crux of the pest management strategy as insect growth and development is driven by the climate. IPCC2 summary report projected that global mean surface temperatures would rise in the range of 1–3 °C by the end of this century. When averaged over 2081–2100, the global surface temperature is very likely to be higher by 1.0 to 1.8 °C in the very low, 2.1 to 3.5 °C in the intermediate and 3.3 to 5.7 °C in the very high GHG emission scenarios in comparison with the average between 1850 and 1900. The projected temperature rise for India is in the range of 1.7–2.0 °C by 2030s & 3.3–4.8 °C by 2080s over preindustrial period3. Further, the average temperature over India is projected to rise by approximately 4.4 °C relative to the recent past (1951–2014) under RCP 8.5 scenario4.Climate change is a major threat to sustainable agriculture5. Bale et al. (2002)6 reported that insect development and its distribution is mostly temperature driven. Under warming conditions, early infestation, increased survival of insects and more crop damage would occur. About two to four-fold increase in herbivory7 and severity in pest outbreak8 are reported as a result of climate change. Thermal requirement of insects is species-specific, and the role of temperature is vital and prominent on development of each insect species9. Degree days are the amount of heat required for an organism to develop within certain life stages and growing degree day (GDD) is the summation of heat units that accumulated above base temperature during a 24-h period. Degree days concept is an effective way to explain shifts in phenology, arising from climate change over space and time10 and it is a very strong, integrative measure of the spatio-temporal variation of temperature that imposes the thermal limits within which insect species grow11.The variation of temperature is prominent and non-uniform among different areas, provinces, locations and negative impacts have been projected on various crops12. The development and distribution of insects are influenced by their thermal thresholds; though thermal requirements vary with species; climate warming can expand the survival limits13 and often may lead to higher number of generations (no. of gen.) in a year or a season. Increased adult moth activity14, increased number of generations15, higher incidence16, higher population growth rate17 were the effects of increased temperature on insect biology.Temperature effects on insect pests are species-specific and elaborative studies were conducted earlier. The effect of temperature on the insects is direct and dependent on the amount of time they are exposed, as that causes physiological changes that aid survival18. Increased temperature leads to higher developmental rate and in turn increases the voltinism of the pest. The possibility of number of generations in a year is a function of temperature, precipitation and availability of host19. Insects are sensitive to increased temperature20 and its impact on insect leads to advancement of phenology/ life stages. In case of insect pests, longer developmental duration at low temperatures and a shorter developmental duration at high temperatures was documented earlier21.Temperature is crucial in deciding the insect population growth rate and development and further reflected in number of generations which indicates the number of reproductive events in a given period . It affects the crop-insect interactions, implying the level of incidence indirectly. More generations not only promote the population growth but also hastens the evolutionary process and adaptation to climateCajanus cajan L.), a legume crop belonging to the tribe Phaseoleae, is one of the most important grain legumes. It has 21% of dietary protein22 in seeds and is rich in minerals like phosphorus, magnesium, iron, calcium, sulphur and potassium23.The global area under cultivation of pigeonpea is 5.7 Mha with a productivity of 861.3 kg/ha and overall production of 4.91 Mt per annum over the triennium of 2017–202024. India is the major producer (78%). Myamnar, Malawi, Tanzania, Kenya and Uganda also have significant area under pigeonpea. Among the pigeonpea growing countries, India ranked 1 in area and production representing around 82% of world pigeonpea area and 78% of total production. Pigeonpea is grown in all states of India for various purposes. In the triennium of 2017–2020, pigeonpea was cultivated on an average area of 4.6 Mha with an average production of 3.8 Mt per year and with a productivity of 824 kg per hectare25 in India.Pigeonpea (Helicoverpa armigera (Hub.) is a major insect pest which causes up to 20–30% yield losses26. Prediction of ensuing pest scenarios using temperature data based on climate projections of Coupled Model Inter comparison Project 3 (CMIP3)27 was attempted by several research workers30. These climate projections are generally with more accuracy at the global scale than at smaller regional scale31. Recently the Coupled Model Inter-comparison Project phase 5 (CMIP5) models are available with high resolution and are more comprehensive in nature over CMIP332 and these projections for India are far more reliable3. Individual GCM projections have uncertainty and to alleviate the uncertainty, multiple and/or ensemble of GCMs is generally preferred33.Among the several insect pests (about 150) that attack pigeonpea, gram pod borer 34 have used the World Climate Research Program’s (WRCP’s) CMIP5 multi-model dataset for generating multi-model ensemble climate change scenarios. The advantage of the CMIP5 multi-model dataset is the accuracy of newly developed representative concentration pathways (RCPs)3. We adopted ensembled mean climate data here which is closer to the observed climate than any individual model. IPCC Fifth Assessment Report’s RCP based climate change projections for 4 RCPs, viz., 2.6, 4.5, P 6.0 and 8.5 are adopted for our analysis.Earlier, many authorsH. armigera on pigeonpea for the future CCPs using temperature data of four RCPs across eleven locations of India.The present study was attempted to understand the impact of simulated scenario of increased temperatures on no. of gen. and gen. time of Currently, climate models are the best tools to simulate future climate change scenarios and the accuracy of temperature projections mainly depends on type of model and scenario adopted.34, mentioned more about details of climate change projections and advantages of hybrid ensemble data35 in their earlier publication.We followed the IPCC AR 5 climate change projections based on emission scenarios known as RCPs (Representative Concentration Pathways). As explained earlier, ensemble multimodel climate change scenarios were obtained with bias correction and at 0.5 × 0.5° spatially disaggregated climate change projections from WRCPs CMIP5 multi-model data set. In total 32 GCM climate change projections from 23 modeling Centers/Groups were used. As different GCMs have multiple runs, we used 51, 61, 34 and 64 projections (runs) for RCP2.6, RCP4.5, RCP6.0 and RCP8.5, respectively, for simulating climate change scenarios. Srinivasa Rao et al.H. armigera. Minimum (Tmin) and maximum (Tmax) temperatures for 11 pigeonpea growing locations of India for the future/ensuing periods under 4 RCPs were compared over baseline period (1976–2005). The details of these eleven pigeonpea growing locations of India are- Akola , Ananthapur , Bengaluru , Bhubaneshwar , Coimbatore , Gulbarga , Jabalpur , Kanpur , Ludhiana , Mohanpur  and Warangal  depicted in a map  viz. NP—Near Period (2020–2039), DP—Distant Period (2040–2069) and FDP—Far Distant Period (2070–2099). Two approaches viz., calendar year  and pigeonpea crop duration (150 days from 26th to 52nd Standard Weeks) were considered for predicting the number of generations (no. of gen.) and generation time (gen. time) of H. armigera was done using ‘ingen’ software36 which is openly accessible (http://www.nicra-icar.in/). The ingen software was earlier37 used to obtain output of estimated thermal requirements /growing degree days, insect pest generations & gen. time. Lower threshold temperature of 10 °C was adopted to calculate the Growing Degree Days (GDD) with horizontal cutoff method. Prediction of no. of gen. and gen. time of H. armigera was done separately for annual/ calendar year and crop/growing season.Prediction of no. of gen. of 38 location39 and variety40. We calculated the degree day requirement for short-duration pigeonpea (SDP-130 days), medium-duration pigeonpea (MDP-150 days) and long-duration pigeonpea (LDP-180 days) was in the range of 2100 to 3600 DD. Here, the accumulated heat units of 1900–2700, 2100–3000 and 2450–3550 GDD for SD, MD and LD pigeonpeas respectively were considered across 11 locations for the estimation of reduction in duration. Increased temperature influences the duration of crops41 by causing the advancement of phenological events and in the present study, no. of gen. and gen. time of H. armigera was also estimated with reduced duration of pigeonpea across SDP, MDP and LDPs.Advancement of phenological stages of crop leads to reduction of duration for maturity with increased temperature. The degree day requirement of pigeonpea varies with sowing datet test for unequal variances for comparisons with heterogenous variances. Further, two sample t test becomes valid only when the distributions of the two populations being compared are normal. To ascertain this assumption, Shapiro–Wilk test was conducted. The standard Analysis of Variance (ANOVA) was adopted to partition the variation in the study parameters viz., no. of gen. and gen. time of H. armigera into various sources viz., location, scenario, climate period and their interactions42 and quantified their contribution to total variability. All statistical analyses were conducted using SPSS 16.0 version.Change in gen. time  and no. of gen.  from baseline to near period (NP), distant period (DP) and far distant period (FDP) across 4 RCPs and 11 pigeonpea growing locations were tested for their statistical significance using two sample t test. Usually it is assumed that two populations being compared are homogenous with respect to their variances which may not always be true. In view of this, Levene test was employed to establish equality of variances or otherwise. Corrective measures were taken by employing two sample p value > 0.05) in the groups compared in no. of gen.  and gen. time  of H.armigera for 515 datasets out of 528 (11 locations × 4 RCPs × 3 CCPs with 30 observations in each period × 4 variables) studied showing the homogeneity of the data. The remaining 13 datasets were compared with unequal variances to compare the means. The Shapiro–Wilk test of significance indicated the normality of no. of gen.  and gen. time .The findings of Levene’s test indicate equal variance  would follow increasing trend during 3 CCPs at 11 locations. Tmax (0.7 to 4.7 °C) and Tmin (0.8 to 5.1 °C) would increase considerably during NP, DP and FDP of 4 RCP scenarios. This trend was more evident in RCP 8.5 of FDP followed by 6.0 and 4.5 scenarios.3, 3828 = 1768.82, P < 0.001) differences were observed  among RCPs with RCP 8.5  followed by RCP 6.0 , RCP 4.5  over RCP 2.6 . Similar trend was observed during the crop season also with significant  increase no. of gen. with shortened gen. time  in RCP 8.5  followed by RCP 6.0  RCP 4.5  and RCP 2.6 Scenarios   differences were recorded  reduction in gen. time during FDP  followed by DP  and NP  over BL period. During the crop season,  increase in the no. of gen. (8.49 ± 0.28) with significant  reduction in gen. time (21.21 ± 0.06) was noticed in FDP. The comparison of pest incidence between DP and NP CCPs revealed that pest incidence would be higher for DP  than NP  period over BL period   in RCP 8.5. Moderate levels were observed in Bhubaneshwar  and Jabalpur  locations. Bengaluru  and Ludhiana  locations experience less no. of gen. in FDP. Similar incidence was followed in these locations in DP and NP.Among eleven pigeonpea growing locations, Coimbatore  and Warangal  would get significantly  with reduced gen. time . Moderate levels were estimated for Jabalpur  and Gulbarga . Ananthapur  and Bengaluru  would have lesser no. of gen.The interaction between RCPs x location; RCPs x time slice; location x time slice and RCPs x location x time slice were significant with respect to annual gen. time and seasonal gen. time. With annual and seasonal no. of gen., the interaction was significant with RCPs × time slice; location x time slice only Table . During H. armigera was predicted to happen in FDP period (7.65 to 37.83%) over BL period followed by DP (7.47 to 21.89%) and NP (5.25 to 9.51%) across 4 RCPs  in annual gen. time over BL was predicted for FDP (6.86 to 26.83%) followed by DP (6.78 to 17.67%) over NP (3.69 to 8.96%) in four RCPs. The highest percent reduction was noticed with RCP 8.5 over other three scenarios. Similar trend was with seasonal time and the percent reduction was greater in FDP (4.87 to 25.77%) followed by DP (4.70 to 18.37%) and NP (3.78 to 10.42%) over the baseline.Higher percent increase of annual no. of gen. of 7.47 to 2.89% and H. armigera, which together explained about 82.03% of the total variation. Rest of the variables viz., scenarios and interactions contributed less than 20% of the variation (17.97%). Similarly, in annual gen. time of H. armigera, geographical location (66.33%) and time period (14.22%) explained most of the variation (80.55%)  and time period 15.74%) were the key sources of variation in annual no. of gen. of .74% wereAmong four RCPs, the higher reduction of gen. time is noted in RCP 8.5 scenario followed by 6.0 and 4.5 scenarios. Across three CCPs, it is more evident in FDP, DP climate change period than NP period. The trend is more reflected in Coimbatore location followed by Kanpur and Ludhiana locations and least reflection was recorded in Bengaluru and Ananthapur locations across 4 RCP scenarios  in SDP (2–22), MDP (3–35) and LDP (5–57) was substantial at all locations across 4 RCPs and 3 CCPs and was more evident in RCP 6.0 and 8.5 . However, the changes in the number of generations are relatively low in the case of MD pigeonpea in most locations  was predicted across the four RCPs45. The increases in temperature reported by Chaturvedi et al.3 were about 1.7–2.0 °C by 2030s in RCP 4.5 and RCP 6.0, with overall increase in temperature for India by 1–4 °C.Increase in temperature causes advancement of insect developmental stages which in turn results in reduction of duration of life cycle and thus more generations of insects may occur in shorter period of time. The role of temperature is vital and impactful on insects in completing the life cycles and producing more generationsH. armigera using the projected temperature data from four RCP scenarios by adopting standard GDD approach in three future TSPs viz., NP, DP and FDP at eleven pigeonpea growing locations in India. There was a similar increase of temperatures for other parts of Asia46 by 2.06–3.63 °C and for other parts of the world47 by 2 °C and 6 °C.Results of the present study also exhibit a similar rise in temperature (Tmax and Tmin) across eleven pigeonpea locations of India in Tmax (0.7–4.7 °C) and Tmin (0.8 to 5.1 °C) over the baseline during NP, DP and FDP of 4 RCP scenarios. We predicted the pest scenario i.e., no. of gen. of 15 predicted the no. of gen. of H. armigera on pigeonpea with temperature data of MarkSim, GCM multimodel (7) data of three scenarios  of CMIP3 at eight pigeonpea locations of India. Here, we used RCP-based climate projections of CMIP5 group of climate models with several advantages48. We used temperature data of RCP scenarios as they eliminate or reduce the uncertainty (http://www.cawcr.gov.au/projects/Climatechange) in projections over the earlier ones based on SRES49 and RCPs have greater applicability in Indian conditions. Further, we estimated the possible reduction in duration of LDP, MDP and SDP and hypothesized that the no. of gen. would vary with reduction of crop duration among three pigeonpeas, while in our earlier study15, we considered a constant crop duration. In the present study, we attempted the estimation of the number of generations with altered crop duration also. Different degree day models and quantified equations/relationships are often adopted50 to predict the pest scenarios.Srinivasa Rao et al.52 predicted the pest status in different climate change scenarios using GDD and pest modelling approach and mentioned that the pest scenario is a function of emission scenarios, geographical location, climate change period and model adopted. The present paper predicted the status of H. armigera on pigeonpea during future CCPs using RCP projected temperature ensemble data across India, as little or no studies have been attempted so far.Several studies53. Temperature is the key factor which affects the growth and development of crop plants and insect herbivores remarkably. GDD approach was adopted earlier55 for prediction of pest status.Insects are poikilothermic and thermo-sensitive, and their distribution and abundance get influenced by the smaller variations of temperature56 was due to the considerable increase in surface temperatures and similar findings were with lepidopteran pests Endopiza viteana57 and Paralobesia viteana58. Our present findings showed that more number of annual generations of H. armigera on pigeonpea (6 to 38%) would be in RCP 8.5 followed by 6.0, 4.5 over 2.6 RCPs and parallel trend is expected in growing season also. Several research workers59 also found increased number of insect generations with increase in temperature.More no. of gen. per year in multivoltine speciesLymantria dispar60, Brachmia macroscopa61 and Athetis dissimilis on maize62. Our findings using temperature data of seven different models of Marksim indicated the occurrence of 1 to 2 additional generations with reduced gen. time of S. litura29 on peanut and H. armigera15 on pigeonpea. It was mentioned that adaptation of insects would be quicker to climate change due to short gen. time63 and the same is reflected in present findings. Direct influence of increased temperature on metabolic rate and developmental rate of insects64 and multivoltine insects are believed to take advantage of climate warming. Present findings are in tune with Altermatt18 who observed that increased temperature causes advancement of phenology, which in turn lead to more no. of gen. of an insect.Shortened gen. time was noticed in all four RCPs in both the approaches adopted by us viz., calendar year (4–27%) and growing season (4–26%) and the trend was more evident in RCP 8.5 of FDP over BL. Similar reduction of gen. time with increased temperature was in 65. More crop losses are expected due to higher no. of gen. during the crop season or calendar year. No. of gen. shows the hastening of reproductive events which in turn affect the host-insect herbivore interactions implying the increased level of incidence18. Increased voltinism of insect pest may lead to higher infestation66. Often, voltinism may amplify the outbreak of pest species67 also. Though occurrence of no. of gen. is dependent on several factors, the role of increased temperature is vital and often leads to higher developmental rate. The preference of the host by the insect, the presence of natural enemies and other collateral factors also influence the voltinism which are not covered by the ingen software, however, it takes care of temperature-driven influences. Though the impact is confounding in nature, temperature plays a major and significant role and the same is captured in the present study. The findings of present study indicate higher percent increase in no. of gen. (6–38%) with reduced gen. time (7–27%) of H. armigera in RCP scenario 8.5 during 3 CCPs in both season and calendar year at majority of pigeonpea locations of India which are higher than earlier studies by Srinivasa Rao et al.15, with Marksim model data.Among the three variables studied viz., emission scenarios, TSPs and locations, the no. of gen. and gen. time varied significantly among the locations. Among the locations, Coimbatore would experience higher seasonal no. of gen. (7.33–8.48) followed by Mohanpur 6.49–7.805) Warangal and Akola locations over the BL period of the location across the four RCPs and TSPs. The increment is least in Ludhiana (4.72–5.62)  Fig.  of geogr71. Earlier authors40 justified the advancement of phenological stages of crops and maturity with increased temperature causing variation in thermal requirement of pigeonpea. The present findings also indicated the reduction of crop duration based on Growing Degree Days and noted that the advancement of crop maturity was considerable in MDP and LDP and the reduction of crop duration was higher in medium (3–35 days) and long (5–57 days) duration pigeonpeas as against SDP (2–22) at 11 locations across 4 RCPs and 3 CCPs  than distant and near periods and was more evident in RCP 8.5 scenario. In case of SDP, no much difference in no. of gen. and gen. time was noted in RCP 2.6 and 4.5 scenarios and in NP period. An increase in the number of generations of H. armigera at eleven pigeonpea growing locations during future TSPs across four RCPs. Similar trend is expected with altered crop duration of pigeonpea also. Pest scenario is not only driven by temperature but also other factors like elevated CO2, differential rainfall, crop phenology and different trophic interactions. The present findings captured the significance of increased temperature and its impact on pest scenario only and the availability of complete dataset on other parameters may give the clear-cut comprehension of impact of climate change.Increase in mean atmospheric temperature can often influence insect generations by causing the reduction in gen. time. The present findings predict more no. of gen. of Supplementary Information.