Effect of processing on the quality, composition and antioxidant properties of Terminalia catappa (Indian almond) seed oil

This study was aimed at extracting and purifying T. catappa seed oil with a view to investigating the effect of processing on the composition and antioxidant activity of the oil. Oil was extracted from the dried and roasted T. catappa seed and subjected to degumming and bleaching. The different processed oils were analysed for their fatty acid, phytosterols, and fat soluble vitamins composition. Antioxidant properties of the oils were also determined by measuring the Diphenylpicrylhydrazyl (DPPH) radical scavenging activity and inhibition of heat induced peroxidation. Roasting and processing caused a reduction in acid value, increased peroxide value, but had no effect on the iodine and saponification values of T. catappa oil. Palmitic acid was the most abundant saturated fatty acid (42.466%) while oleic acid was the most abundant unsaturated fatty acid (23.445%). Roasting significantly reduced fatty acid concentration of the oil, and bleaching of both unroasted and roasted oils increased the concentration of fatty acids except linoleic acid. Gamma-sitosterol and Betasitosterol were present in appreciable amounts only in the crude oils. Roasting increased Vitamins A and D concentrations but drastically reduced that of vitamin E. Degumming had no effect on the fat soluble vitamins of T. catappa oil, but bleaching significantly reduced the concentrations of all the vitamins. The DPPH radical scavenging activity of the seed oil was between 26.93 ± 15.42% and 65.47 ± 31.59%. Refining increased the free radical scavenging activity of the unroasted oil, but did not affect the antioxidant activity of roasted oil. The capacity of the oil in preventing heat induced peroxidation was comparable to that of Butylated hydroxytoluene (BHT). Processing of the oil significantly increased its antioxidant activity. Loss of vitamin E did not affect the antioxidant activity of the oil. Thus, suggesting the presence of a heat stable antioxidant in the oil. This study indicated T. catappa seed oil to be potential pharmaceutical oil with good antioxidant characteristics.Key words: Terminalia catappa, composition, antioxidant, processing, oi

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

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

Effect Of Processing On The Quality, Composition And Antioxidant Properties Of Terminalia Catappa (Indian Almond) Seed Oil

This study was aimed at extracting and purifying T. catappa seed oil with a view to investigating the effect of processing on the composition and antioxidant activity of the oil. Oil was extracted from the dried and roasted T. catappa seed and subjected to degumming and bleaching. The different processed oils were analysed for their fatty acid, phytosterols, and fat soluble vitamins composition. Antioxidant properties of the oils were also determined by measuring the Diphenylpicrylhydrazyl (DPPH) radical scavenging activity and inhibition of heat induced peroxidation. Roasting and processing caused a reduction in acid value, increased peroxide value, but had no effect on the iodine and saponification values of T. catappa oil. Palmitic acid was the most abundant saturated fatty acid (42.466%) while oleic acid was the most abundant unsaturated fatty acid (23.445%). Roasting significantly reduced fatty acid concentration of the oil, and bleaching of both unroasted and roasted oils increased the concentration of fatty acids except linoleic acid. Gamma-sitosterol and Beta-sitosterol were present in appreciable amounts only in the crude oils. Roasting increased Vitamins A and D concentrations but drastically reduced that of vitamin E. Degumming had no effect on the fat soluble vitamins of T. catappa oil, but bleaching significantly reduced the concentrations of all the vitamins. The DPPH radical scavenging activity of the seed oil was between 26.93 ± 15.42% and 65.47 ± 31.59%. Refining increased the free radical scavenging activity of the unroasted oil, but did not affect the antioxidant activity of roasted oil. The capacity of the oil in preventing heat induced peroxidation was comparable to that of Butylated hydroxytoluene (BHT). Processing of the oil significantly increased its antioxidant activity. Loss of vitamin E did not affect the antioxidant activity of the oil. Thus, suggesting the presence of a heat stable antioxidant in the oil. This study indicated T. catappa seed oil to be potential pharmaceutical oil with good antioxidant characteristics

Maternal and neonatal outcomes after caesarean delivery in the African Surgical Outcomes Study: a 7-day prospective observational cohort study.

BACKGROUND: Maternal and neonatal mortality is high in Africa, but few large, prospective studies have been done to investigate the risk factors associated with these poor maternal and neonatal outcomes. METHODS: A 7-day, international, prospective, observational cohort study was done in patients having caesarean delivery in 183 hospitals across 22 countries in Africa. The inclusion criteria were all consecutive patients (aged ≥18 years) admitted to participating centres having elective and non-elective caesarean delivery during the 7-day study cohort period. To ensure a representative sample, each hospital had to provide data for 90% of the eligible patients during the recruitment week. The primary outcome was in-hospital maternal mortality and complications, which were assessed by local investigators. The study was registered on the South African National Health Research Database, number KZ_2015RP7_22, and on ClinicalTrials.gov, number NCT03044899. FINDINGS: Between February, 2016, and May, 2016, 3792 patients were recruited from hospitals across Africa. 3685 were included in the postoperative complications analysis (107 missing data) and 3684 were included in the maternal mortality analysis (108 missing data). These hospitals had a combined number of specialist surgeons, obstetricians, and anaesthetists totalling 0·7 per 100 000 population (IQR 0·2-2·0). Maternal mortality was 20 (0·5%) of 3684 patients (95% CI 0·3-0·8). Complications occurred in 633 (17·4%) of 3636 mothers (16·2-18·6), which were predominantly severe intraoperative and postoperative bleeding (136 [3·8%] of 3612 mothers). Maternal mortality was independently associated with a preoperative presentation of placenta praevia, placental abruption, ruptured uterus, antepartum haemorrhage (odds ratio 4·47 [95% CI 1·46-13·65]), and perioperative severe obstetric haemorrhage (5·87 [1·99-17·34]) or anaesthesia complications (11·47 (1·20-109·20]). Neonatal mortality was 153 (4·4%) of 3506 infants (95% CI 3·7-5·0). INTERPRETATION: Maternal mortality after caesarean delivery in Africa is 50 times higher than that of high-income countries and is driven by peripartum haemorrhage and anaesthesia complications. Neonatal mortality is double the global average. Early identification and appropriate management of mothers at risk of peripartum haemorrhage might improve maternal and neonatal outcomes in Africa. FUNDING: Medical Research Council of South Africa.Medical Research Council of South Africa