Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Rumen ammonia concentrations, and non-ammonia nitrogen passage to and apparent absorption from the small intestine of sheep ingesting subtropical, temperate, and tannin-containing forages

Non-ammonia nitrogen (NAN) passage to the small intestine and disappearance of NAN in that organ have been studied in multi-cannulated sheep on pasture or fed indoors. Forages under investigation included a number of subtropical grasses, foggages and hay, temperate grasses, lucerne (Medicago sativa), triticale (Triticale X Secale), oven-dried ryegrass (Lolium multiflorum), and the tannin-containing forages sainfoin (Onobrychis viciifolia) and sheeps' burnet (Sanguisorba minor). Digesta flow was measured with reference to Yb-acetate and Cr-EDTA as particulate and fluid markers, respectively. Rumen ammonia concentrations were exponentially associated with the nitrogen (N) content of the forage, with concentrations increasing progressively above 2.5% N in the forage dry matter. Ruminal fermentation of tannin-containing forages resulted in much lower ammonia concentrations than ruminal fermentation of forages without tannins. NAN passage to the small intestine as a proportion of N intake was significantly (P ≤ 0.05) different between forage classes: 0.97 ± 0.09 for subtropical forages, 0.75 ± 0.09 for temperate grasses plus lucerne and triticale, and 1.12 ± 0.08 for tannin-containing forages and dried grass. NAN passage as a proportion of N intake declined with increasing N intake in all non-tannin forages, the decline being especially severe in forages with high total (above 3%) and/ or high soluble N. NAN disappearance in the small intestine as a proportion of NAN entering that organ differed significantly (P ≤ 0.01) between tannin-containing forages and subtropical foggages and hay on the one hand (0.64 ± 0.06), and all other forages on the other hand (0.76 ± 0.02). NAN disappearance as a proportion of N intake increased in the order: temperate grasses plus lucerne and triticale, subtropical foggages and hay, subtropical grasses, tannin-containing forages, and dried grass.Die vloei van nie-ammoniak stikstof (NAN) na, en die verdwyning daarvan in die dunderm is bestudeer in meervoudig-gefistuleerde skape op weiding of binnenshuis gevoer. Ruvoere wat bestudeer is het ingesluit: 'n aantal subtropiese grasse, staande hooie, gematigde grasse, lusern (Medicago sativa), korog (Triticale X Secale), oondgedroogde raaigras (Lolium multiflorum), en die tannien-bevattende weidings sainfoin (Onobrychis viciifolia) en skaapburnet (Sanguisorba minor). Digestavloei is gemeet deur gebruik te maak van Yb-asetaat en Cr-EDTA as vastestof- en vloeistofmerkers, onderskeidelik. Rumenammoniakkonsentrasie was eksponensieel verwant aan stikstof(N)-inhoud van die ruvoer, veral bokant 2.5% N in die ruvoer droë materiaal. Rumenfermentasie van tannienbevattende ruvoere het tot laer ammoniakkonsentrasies gelei as rumenfermentasie van ruvoere wat nie tannien bevat het nie. NAN-vloei na die dunderm as 'n verhouding van N-inname het betekenisvol (P ≤ 0.05) verskil tussen ruvoerklasse: 0.97 ± 0.09 vir subtropiese ruvoere, 0.75 ± 0.09 vir gematigde grasse plus lusern en korog, en 1.12 ± 0.08 vir tannien-bevattende ruvoere en gedroogde gras. NAN-vloei as 'n verhouding van N-inname het progressief afgeneem met 'n toename in N-inname by alle nie-tannien ruvoere, en die afname was veral merkbaar by ruvoere met hoë totale (meer as 3%) en/of hoë oplosbare N. NAN-verdwyning in die dunderm as 'n verhouding van NAN wat na die dunderm gevloei het, het betekenisvol (P ≤ 0.01) verskil tussen tannien-bevattende ruvoere en subtropiese staande en gesnyde hooie aan die een kant (0.64 ± 0.06), en alle ander ruvoere aan die ander kant (0.76 ± 0.02). NAN-verdwyning as 'n verhouding van N-inname het toegeneem, en wel in die volgorde: gematigde grasse plus lusern en korog, subtropiese staande en gesnyde hooie, subtropiese grasse, tannien-bevattende ruvoere, en gedroogde grasKeywords: Absorption, digestion, forage, non-ammonia nitrogen, sheep

Entomophagous Response of Albino Rats to Cockroach (Periplaneta Americana) Meal

An experiment was conducted to determine the nutrient composition and effects of cockroach (Periplaneta americana) meal on the growth performance, economics of production and the absolute and relative weights of some internal organs of albino rats. Twelve (12) male albino rats with an average weight of 67.5g were randomly allotted three dietary treatments: T0 with no cockroach meal, and T1 and T2 with 2% and 4% cockroach meal respectively in a Randomised Complete Block Design (RCBD). Each treatment had four rats and each rat served as a replicate. Feed and water were provided ad libitum. The rats were euthanized and their internal organs were weighed at the end of a 28-day feeding trial. Data obtained were analysed using the analysis of variance procedure of the GenStat Statistical Package version 11.1. There were no significant differences in feed intake (P = 0.633), average daily gain (ADG)(P = 0.670) and feed conversion ratio (FCR)(P = 0.326) for the various treatments. The FCR figures recorded for T0, T1 and T2 were 4.81, 4.37 and 4.17 respectively whilst the inclusion of cockroach meal reduced feed cost by 3% and 7% in dietary treatments T1 and T2 respectively. Most of the internal organs recorded no significant difference (P >0.05) but rats on the cockroach meal diets recorded significantly (P = 0.001) lower relative heart weights. Relative kidney weights were also smaller (P = 0.034) for rats on diets containing 4% cockroach meal. Feeding diets containing up to 4% cockroach meal had no negative effects on the feed intake, ADG and FCR of the rats, and can therefore be safely fed to monogastrics up to 4% of the diet

Effects of dietary replacement of maize grain with popcorn waste products on nutrient digestibility and performance by lambs

A study was conducted to evaluate the effects of dietary replacement of maize with popcorn waste (PW) on the intake, nutrient digestibility and growth performance of lambs. Diets replacing 0, 25, 50, 75 and 100% maize with PW were formulated and fed ad libitum to 40 South African Mutton Merino lambs (25.0 ± 0.45 kg live-weight). The diets had similar intake and nutrient digestibility of dry matter (DM), organic matter (OM) and neutral detergent fibre (NDF). Lambs fed the 25 and 50% PW diets had higher intakes of crude protein (CP), metabolizable energy and ether extract compared to the other diets. Growth rate was highest (226 g/d) on the 25% diet and lowest (109 g/d) on the 75% PW diet. Best feed conversion ratio (FCR), of 5.1 (kg feed/kg live weight) was obtained with the 0% PW diet. Improved digestibility of CP and EE occurred in the 25 and 75% PW diets. Higher intake of nitrogen (N) and N retention were obtained in the 25 and 50% PW diets. Dietary replacement of >75% of maize resulted in poor animal performance (ADG 7.00). It was concluded that PW can replace up to 50% of the maize in diets for growing lambs.Keywords: Average daily gain, by-products, lambs, maize, popcor

Circulating Adiponectin Is Associated with Renal Function Independent of Age and Serum Lipids in West Africans

Adiponectin, a protein secreted by adipose tissue, has been associated with renal dysfunction. However, these observations have not been adequately investigated in large epidemiological studies of healthy individuals in general and in African populations in particular. Hence, we designed this study to evaluate the relationship between adiponectin and renal function in a large group of nondiabetic West Africans. Total adiponectin was measured in 792 participants. MDRD and Cockroft-Gault (CG-) estimated GFR were used as indices of renal function. Linear and logistic regression models were used to determine the relationship between adiponectin and renal function. Adiponectin showed an inverse relationship with eGFR in univariate (BetaMDRD=-0.18, BetaCG=-0.26) and multivariate (BetaMDRD=-0.10, BetaCG=-0.09) regression analyses. The multivariate models that included age, sex, BMI, hypertension, smoking, HDL-C, LDL-C, triglycerides, and adiponectin explained 30% and 55.6% of the variance in GFR estimated by MDRD and CG methods, respectively. Adiponectin was also a strong predictor of moderate chronic kidney disease (defined as eGFR < 60 mL/min/1.73 m2). We demonstrate that adiponectin is associated with renal function in nondiabetic West Africans. The observed relationship is independent of age and serum lipids. Our findings suggest that adiponectin may have clinical utility as a biomarker of renal function