Anti-inflammatory Activity of the Plant Cannabis sativa (L) Petrolium Ether Extract in Albino Rats

In this study the plant Cannabis sativa seeds petroleum oil extract was investigated for anti- inflammatory activity on albino rats. The inflammation was firstly obtained by using carrageenan suspension 0.1 ml of 10% saline injected at the sub – plantar region of the left limb for inducing a local acute oedema. A decreased in oedema size was reported after 24 hours for the rats pretreated with carrageenan30 minutes before injection with suspension( 4.56, 0.59 and 0.93 for control, 1ml/kg per day and 0.5ml/kg per day groups given C. sativa seed extracts respectively.), compared to Indomethacin standard antiinflammatory drug which reported a decrease in oedema size diameter to 0.55mm, which indicated an increase inhibition percentages were reported for the different pretreated groups 0.00, 87.03, 79.56 and 87.91 including the comparative Indomethacin treated groups of rats respectively. On the other hand, the post-treated groups of rats (given C. sativa oil extract after 30 minutes of injection of suspension) showed a similar results for maximum concentration 1 ml/day of C. sativa oil extract in comparison to the standard drug. Hence, such results recommend the prospect focus for the preventive medication use of the extract. The study also highlights no significant changes for serum and protein of the blood taken from rats of the experiments. Although there were significant decrease in lymphocyte and neutrophil, but the changes were not significant. Indomethacin was given to the rats used for a comparative drug (10mg/kg). Moreover, the drug indomethacin used as a comparative parameter showed similar results in comparison to the extract, hence wise the reported results may be recommended for use as anti-inflammatory agent and should be explored more to formulate drug on basis of its activity

Učinak zamjene obroka od pšeničnih mekinja obrokom sa sjemenkama kima na nesenje, kvalitetu jaja i masnokiselinski profil u kokoši nesilica

The objective of the present study was to investigate the effect of substituting wheat bran (WB) with cumin seed meal (CSM) on laying performance, egg quality characteristics and egg-yolk fatty acids profile in laying hens. A total of 180 Bovans hens at 55 weeks of age were divided randomly into three treatments. The CSM was incorporated into a standard corn- and soybean meal-based diet by replacing 0, 50, and 100% of WB [i.e., 100% WB (control), 50% WB+50% CSM and 100% CSM] from 55 to 61 weeks of age. Body weight was measured at the beginning and end of the experiment. Feed intake, hen-day egg production and egg weight were recorded daily. At 61 weeks of age, 30 eggs were taken at random from each treatment group to determine the egg quality characteristics. Replacing 100% of WB by CSM did not affect body weight, however, hen-day egg production, egg weight and egg mass significantly increased, while feed conversion ratio significantly decreased (P<0.05). Haugh unit, shell thickness and yolk color significantly increased by CSM substitution in comparison with 100% WB. Plasma concentrations of total cholesterol, triglycerides, LDL-cholesterol and glutamic oxalacetic transaminase (GOT) significantly decreased by replacing WB with CSM, while, plasma HDL-cholesterol significantly increased. Furthermore, the liver malondialdehyde (MDA) concentration significantly decreased, while vitamin E, linoleic acid and alpha-linolenic acid significantly increased (P<0.05) due to CSM inclusion. Therefore, it could be concluded that substitution of WB with CSM could improve laying performance and egg quality characteristics, and reduce lipid peroxidation in laying hens.Cilj ovoga rada bio je istražiti učinak zamjene obroka s pšeničnim mekinjama (WB) obrokom sa sjemenkama kima (CSM) na nesenje, kvalitetu jaja te profil masnih kiselina u žumanjku jajeta kokoši nesilica. Ukupno je 180 Bovans kokoši u dobi od 55 tjedana slučajnim odabirom podijeljeno u tri pokusne skupine, u kojima su sjemenke kima dodane u standardni obrok s kukuruzom i sojom zamjenjujući 0, 50 i 100 % pšeničnih mekinja. Tako je kontrolna skupina hranjena obrocima sa 100 % pšeničnih mekinja, druga skupina s 50 % obroka s pšeničnim mekinjama i 50 % obroka sa sjemenkama kima, a treća skupina obrokom koji je sadržavao 100 % sjemenki kima. Pokusno razdoblje je trajalo od 55. do 61. tjedna starosti nesilica. Tjelesna je masa mjerena na početku i na kraju pokusa. Unos hrane, dnevna proizvodnja jaja i njihova masa bilježili su se svaki dan. U dobi od 61 tjedna iz svake je skupine slučajnim odabirom uzeto 30 jaja kako bi se odredila njihova kvaliteta. zamjenjujući 100 % obrok od pšeničnih mekinja sjemenke kima nisu utjecale na tjelesnu masu, no ipak su dnevna proizvodnja, težina i masa jaja znakovito porasle, dok se stopa konverzije hrane znakovito smanjila (P<0,05). Haugh-ova jedinica, debljina ljuske i boja žumanjka znakovito su porasle u skupinama u kojima su pšenične mekinje zamijenjene sjemenkama kima u odnosu na kontrolnu skupinu. Ukupni kolesterol, trigliceridi, LDL-kolesterol i glutaminska oksalooctena transaminaza (GOT) znakovito su sniženi u skupinama u kojima su pšenične mekinje zamijenjene sjemenkama kima, dok je HDL-kolesterol znakovito povišen. nadalje, koncentracija malondialdehida (MDA) u jetri znakovito je snižena, dok su vitamin E, linolna i alfa-linolna kiselina znakovito porasli (P<0,05) uslijed dodanih sjemenki kima. Može se zaključiti da zamjena obroka s pšeničnim mekinjama obrokom sa sjemenkama kima može poboljšati nesenje i kvalitetu jaja te smanjiti lipidnu peroksidaciju u kokoši nesilica

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

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

Mortality of emergency abdominal surgery in high-, middle- and low-income countries

Background: Surgical mortality data are collected routinely in high-income countries, yet virtually no low- or middle-income countries have outcome surveillance in place. The aim was prospectively to collect worldwide mortality data following emergency abdominal surgery, comparing findings across countries with a low, middle or high Human Development Index (HDI). Methods: This was a prospective, multicentre, cohort study. Self-selected hospitals performing emergency surgery submitted prespecified data for consecutive patients from at least one 2-week interval during July to December 2014. Postoperative mortality was analysed by hierarchical multivariable logistic regression. Results: Data were obtained for 10 745 patients from 357 centres in 58 countries; 6538 were from high-, 2889 from middle- and 1318 from low-HDI settings. The overall mortality rate was 1⋅6 per cent at 24 h (high 1⋅1 per cent, middle 1⋅9 per cent, low 3⋅4 per cent; P < 0⋅001), increasing to 5⋅4 per cent by 30 days (high 4⋅5 per cent, middle 6⋅0 per cent, low 8⋅6 per cent; P < 0⋅001). Of the 578 patients who died, 404 (69⋅9 per cent) did so between 24 h and 30 days following surgery (high 74⋅2 per cent, middle 68⋅8 per cent, low 60⋅5 per cent). After adjustment, 30-day mortality remained higher in middle-income (odds ratio (OR) 2⋅78, 95 per cent c.i. 1⋅84 to 4⋅20) and low-income (OR 2⋅97, 1⋅84 to 4⋅81) countries. Surgical safety checklist use was less frequent in low- and middle-income countries, but when used was associated with reduced mortality at 30 days. Conclusion: Mortality is three times higher in low- compared with high-HDI countries even when adjusted for prognostic factors. Patient safety factors may have an important role. Registration number: NCT02179112 (http://www.clinicaltrials.gov)