Effect of Chronic Administration of Methanol Extract of Moringa Oleifera on Some Biochemical Indices in Female Wistar Rats

The study was conducted to investigate safety associated with prolonged consumption of Moringa oleifera leaves as beverage. Fourteen rats were used in this study. They were divided into 2 groups each containing 7 rats. Rats in group I received 2ml/kg of corn oil (standard vehicle drug). Animals in groups II were administered with 400mg/kg body of methanolic extract of Moringa oleifera (MEMO) for five weeks respectively. Serum collected was analyzed for alanine aminotransferase (ALT), aspartate aminotransferase (AST), total protein, albumin, globulin, blood urea nitrogen (BUN) and creatinine. There was significant (P<0.05) decrease in serum total protein, albumin, globulin and AST activity. The activity of ALT decreased but not significant. Similarly, 400mg/kg body of MEMO led to significant (P<0.05) decrease in serum BUN and creatinine. All experimental animals that received 400mg/kb of MEMO had significant (P<0.05) decrease in body weight from week to week 4 of the experiment. Taken together, 400mg/kg body of MEMO seemed to be toxic to the liver with apparently no toxicity in the kidney. Hence, prolonged exposure is not advisable as such could portend danger to the liver.Keywords: Moringa oleifera, toxicity, hepatic damage, kidney

Melatonin and Vitamin C modulate cholinergic neurotransmission and oxidative stress in scopolamine-induced rat model of memory impairment

Background: Cognitive dysfunction which characterizes dementia is reportedly caused by multiple factors including oxidant-antioxidant imbalance, inflammation, alteration in synaptic neurotransmission. Despite the arrays of drugs available in managing dementia, it appears no single drug can effectively treat dementia. Since it is multifactorial, combining potential drugs may provide neuroprotective impact. As such, this study investigated the neuroprotective effects of melatonin and vitamin C on scopolamine model of cognitive impairment in rats and the possible mechanism of action. Methods: Thirty male Wistar rats were divided to receive either normal saline (5 ml/kg, p.o), scopolamine (1 mg/kg, i.p.), donepezil (2 mg/kg, p.o), melatonin (10 mg/kg, p.o), vitamin C (100 mg/kg. p.o) or melatonin plus vitamin C. Cognitive impairment was induced by daily injection of scopolamine (1 mg/kg, i.p.), after which different treatment regimen were administered for 15 days. Spatial memory was assessed using Morris Water Maze and modified light and dark box. The brain was processed for malondialdehyde (MDA), reduced glutathione (GSH) and acetylcholinesterase (AchE) activity. Results: Scopolamine-treated rats with no intervention showed impaired learning and memory as depicted by a significant (p<0.05) increase in escape latency, reduction in the frequency of visit to the escape aperture, increased MDA, decreased GSH and elevated acetylcholinesterase activity when compared to other groups. Interventions with melatonin or/and vitamin C reversed these responses respectively. The melatonin plus vitamin C treated group compared favorably with donepezil (reference group). Conclusion: Melatonin and vitamin C show neuroprotective effect in attenuating cognitive impairment in scopolamine-induced model by modulating oxidative stress pathway and enhancing cholinergic neurotransmission. Keywords: Dementia, Melatonin, Vitamin C, Memory, Scopolamine

Effects of Organic and Inorganic Fertilizers on the Growth of Senecio biafrae (WOROWO) OLIVE & HIERN

Soils have shown a negative balance in nutrient budget which poses a great threat to sustainable soil management for increase in growth and crop yield. This study thus investigated the effects of organic and inorganic fertilizers on the growth of Senecio biafrae (Oliv. &Hiern). Topsoil, organic (poultry manure) and inorganic fertilizers (NPK 15:15:15) were used. The fertilizers were weighed and applied to the soil at 5g, 10g, 15g each; control topsoil without application of fertilizers and were replicated five times. Growth parameters including height, number of leaves and stem diameter were taken weekly for the period of the experiment. Application of poultry manure and NPK fertilizer had significant effects on all the growth parameters considered. The application of poultry manure resulted into significant increase in the growth parameters towards the latter part of the study. This study has shown that organic manure has great potential for improving soil productivity and plant growth

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study

Purpose Delirium is a neuropsychiatric disorder delineated by an acute change in cognition, attention, and consciousness. It is common, particularly in older adults, but poorly recognised. Frailty is the accumulation of deficits conferring an increased risk of adverse outcomes. We set out to determine how severity of frailty, as measured using the CFS, affected delirium rates, and recognition in hospitalised older people in the United Kingdom. Methods Adults over 65 years were included in an observational multi-centre audit across UK hospitals, two prospective rounds, and one retrospective note review. Clinical Frailty Scale (CFS), delirium status, and 30-day outcomes were recorded. Results The overall prevalence of delirium was 16.3% (483). Patients with delirium were more frail than patients without delirium (median CFS 6 vs 4). The risk of delirium was greater with increasing frailty [OR 2.9 (1.8–4.6) in CFS 4 vs 1–3; OR 12.4 (6.2–24.5) in CFS 8 vs 1–3]. Higher CFS was associated with reduced recognition of delirium (OR of 0.7 (0.3–1.9) in CFS 4 compared to 0.2 (0.1–0.7) in CFS 8). These risks were both independent of age and dementia. Conclusion We have demonstrated an incremental increase in risk of delirium with increasing frailty. This has important clinical implications, suggesting that frailty may provide a more nuanced measure of vulnerability to delirium and poor outcomes. However, the most frail patients are least likely to have their delirium diagnosed and there is a significant lack of research into the underlying pathophysiology of both of these common geriatric syndromes