Socio-Economic Variations Determine the Clinical Presentation, Aetiology and Outcome of Infective Endocarditis: a Prospective Cohort Study from the ESC-EORP EURO-ENDO (European Infective Endocarditis) Registry.

peer reviewedBACKGROUND: Infective endocarditis (IE) is a life-threatening disease associated with high mortality and morbidity worldwide. We sought to determine how socio-economic factors might influence its epidemiology, clinical presentation, investigation and management, and outcome, in a large international multi-centre registry. METHODS: The EurObservationalProgramme (EORP) of the European Society of Cardiology (ESC) EURO-ENDO registry comprises a prospective cohort of 3113 adult patients admitted for IE in 156 hospitals in 40 countries between January 2016 and March 2018. Patients were separated in 3 groups, according to World Bank economic stratification (Group 1 - high income [75.6%]; Group 2 - upper-middle income [15.4%]; Group 3 - lower-middle income [9.1%]). RESULTS: Group 3 patients were younger (median age [IQR]: Group 1 - 66 [53-75] years; Group 2 - 57 [41-68] years; Group 3 - 33 [26-43] years; p<0.001) with a higher frequency of smokers, intravenous drug use and human immunodeficiency virus (HIV) infection (all p<0.001) and presented later (median [IQR) days since symptom onset: Group 1 - 12 [3-35]; Group 2 - 19 [6-54]; Group 3 - 31 [12-62]; p<0.001) with a higher likelihood of developing congestive heart failure (13.6%; 11.1%; and 22.6%, respectively; p<0.001) and persistent fever (9.8%; 14.2%; 27.9%; p<0.001). Among 2157 (69.3%) patients with theoretical indication for cardiac surgery, surgery was performed less frequently in Group 3 patients (75.5%, 76.8% and 51.3%, respectively p<0.001) who also demonstrated the highest mortality (15.0%, 23.0% and 23.7%, respectively; p<0.001). CONCLUSIONS: Socio-economic factors influence the clinical profile of patients presenting with IE across the world. Despite younger age, patients from the poorest countries presented with more frequent complications and higher mortality associated with delayed diagnosis and lower use of surgery

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10&nbsp;years; 78.2% included were male with a median age of 37&nbsp;years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

The role of iron in the pathogenesis of COVID-19 and possible treatment with lactoferrin and other iron chelators

Iron overload is increasingly implicated as a contributor to the pathogenesis of COVID-19. Indeed, several of the manifestations of COVID-19, such as inflammation, hypercoagulation, hyperferritinemia, and immune dysfunction are also reminiscent of iron overload. Although iron is essential for all living cells, free unbound iron, resulting from iron dysregulation and overload, is very reactive and potentially toxic due to its role in the generation of reactive oxygen species (ROS). ROS react with and damage cellular lipids, nucleic acids, and proteins, with consequent activation of either acute or chronic inflammatory processes implicated in multiple clinical conditions. Moreover, iron-catalyzed lipid damage exerts a direct causative effect on the newly discovered nonapoptotic cell death known as ferroptosis. Unlike apoptosis, ferroptosis is immunogenic and not only leads to amplified cell death but also promotes a series of reactions associated with inflammation. Iron chelators are generally safe and are proven to protect patients in clinical conditions characterized by iron overload. There is also an abundance of evidence that iron chelators possess antiviral activities. Furthermore, the naturally occurring iron chelator lactoferrin (Lf) exerts immunomodulatory as well as anti-inflammatory effects and can bind to several receptors used by coronaviruses thereby blocking their entry into host cells. Iron chelators may consequently be of high therapeutic value during the present COVID-19 pandemic

Grape seed proanthocyanidin extract inhibits DNA and protein damage and labile iron, enzyme, and cancer cell activities

Abstract Grape seed extract from (Vitis vinifera) (VGSE) is an excellent source of various polyphenols that exhibit highly potent antioxidant and disease prevention properties. Although numerous biological activities, with potential for improving human health, have been reported for VGSE, there is a lack of data relating to the health benefits of VGSE on DNA damage, protein damage, labile iron activity, and enzyme inhibitory effects. This investigation demonstrated, for the first time, that VGSE inhibits DNA and BSA damage and labile iron activity in-vitro. Moreover, VGSE also inhibited in-vitro activities of AChE, tyrosinase, and α-amylase. VGSE treatment significantly reduced viability of MCF-7, Hep-G2, Caco-2, and Huh-7 cells after 48-h treatments. The results obtained provide additional support for the purported health benefits of VGSE and reinforce its potential in disease prevention and therapy, especially in relation to cancer

Polyphenolic compounds in date fruit seed (Phoenix dactylifera): characterisation and quantification by using UPLC-DAD-ESI-MS

Background Date fruit seeds have been demonstrated to possess high antioxidant activities due to their high content of flavonoids and phenolic compounds. The objective of this work was to identify and quantify the phenolic composition of date seeds. Methods Two UPLC-DAD-ESI-MS analyses were performed on the seed of the Khalas variety as follows: (1) an analysis of simple phenolic compounds [phenolic acids, hydroxycinnamic acids, flavonols, flavones, flavan-3-ols (monomers, dimers and trimers)]; and (2) an analysis of all flavan-3-ols (monomers, and proanthocyanidin oligomers and polymers) after depolymerisation. Results The amount of total phenolic compounds before depolymerisation was found to be 2.194 +/- 0.040 g kg(-1) date seed. The analysis of flavan-3-ol monomers and constitutive units of proanthocyanidins after depolymerisation revealed 50.180 +/- 1.360 g kg(-1) flavan-3-ols with 46.800 +/- 1.012 g kg(-1) epicatechin and 3.380 +/- 0.349 g kg(-1) catechin. Conclusion The results indicate that date seeds are a very rich source of bioactive compounds, thus constituting strong candidates for functional food additives and nutraceuticals

Physicochemical and Sensory Properties and Shelf Life of Block-Type Processed Cheeses Fortified with Date Seeds (Phoenix dactylifera L.) as a Functional Food

Processed cheese has rapidly been established as a commercial product in recent years. A new ingredient, a byproduct from date fruit seed (DFS), was obtained and tested as a fortified fiber from food industrial waste in block-type processed cheese. This is the first inclusive investigation to report such a test. Different concentrations of DFS (0%, 5%, 10%, 15%, and 20%) were added to block-type processed cheese as a partial substitution for butter. The current investigation was undertaken to estimate the impact of the partial substitution of butter by DFS and its effect on the product&rsquo;s quality in terms of its shelf life and physicochemical, microstructure, color, and sensory properties. Quality was assessed over a 150-day storage period. The results indicate that adding DFS to cheese increased its nutritional value due to the addition of fiber. Additionally, the texture profile of cheese was decreased in terms of hardness, adhesion, springiness, and cohesiveness. The overall structure of cheeses became less compact and had a more open cheese network, which increased with increasing DFS% and duration of storage. Moreover, DFS exhibited the darkest color with increasing ratios of supplementary DFS and duration of storage. Based on the results found in the present investigation, it was concluded that an acceptable quality of block-type processed cheese could be achieved using DFS fiber at 5% and 10% levels of fortification

Graded levels of sugar syrup in broiler rations and its effect on growth performance and blood biochemical parameters

Dietary energy for chickens normally includes cereal grains and fat. This innovative study investigated the effect of replacing part of the corn and fat in broiler chicken rations with graded levels of sugar syrup on growth performance and biochemical parameters. Experimental treatments consisted of feeding a corn-soy basal diet alone, or with graded levels of sugar syrup in increments of 5%, 10% and 15%. All starter diets were isonitrogenous and isocaloric. Body weight gain and efficiency of feed utilization of chicks fed the control diet alone were not significantly (P < 0.05) different from chicks fed diets supplemented with either 5% or 15% sugar syrup. Supplementation of sugar syrup to broiler diets had no significant effect on blood glucose, creatinine, total protein, or liver enzymes. Adding 5% sugar syrup to broiler rations significantly decreased blood cholesterol and triglycerides in chickens fed the sugar syrup diet compared with birds fed the control diet. In conclusion, the results shows sugar syrup can be used in poultry ration to replace part of the corn as a source of energy. These results allowed the authors to recommend the safe usage of sugar syrup in broiler rations

Valorization of Second-Grade Date Fruit Byproducts and Nonstandard Sweet Potato Tubers to Produce Novel Biofortified Functional Jam

Byproducts of second-grade dates and sweet potato tubers of noncommercial standard are produced along with the main product and are just as important as the main product but cannot be sold in the open market, as they may not be considered acceptable by consumers. Such byproducts can be valorized through the manufacture of a wide range of functional food products with high market appeal, such as jams. The research approach of this study included measuring antioxidant activity, total flavonoids, polyphenols, physicochemical and color indices, pH, and total sugar, as well as conducting a sensory evaluation, of mixed jams composed of different ratios of date jam (DFJ) to sweet potato jam (SPJ), namely, DP1 (80:20), DP2 (70:30), DP3 (60:40), and DP4 (50:50). To date, no other studies have considered producing mixed jam from dates and sweet potato byproducts. The sensory evaluation results indicated that jam DP4 (consisting of 50% date and 50% sweet potato) had the maximum overall acceptability. This investigation reveals the potential of using mixed byproducts in jams as natural functional ingredients, suggesting the economic value of valorization byproducts as low-cost ingredients to expand the properties, nutritional value, antioxidant content, and overall acceptability of jams. The discovered optimal mixed fruit jam has significant potential for further development as a commercial product

Effect of dietary inclusion of sugar syrup on production performance, egg quality and blood biochemical parameters in laying hens

The effects of dietary inclusion of sugar syrup on quality of egg, cholesterol level, production performance, serum total protein and blood biochemical parameters were evaluated in laying hens. A total of 300 commercial Lohmann LSL hens (30 weeks of age) were randomly distributed into 3 dietary treatments which consisted of a normal corn diet containing corn–soy and 2 diets containing 5% and 10% sugar syrup. Each treatment was replicated 5 times (n = 20). Egg production, feed intake, body weight and egg weight of laying hens fed different diets were recorded. The experiment lasted for 20 weeks. The Haugh unit scores of hens fed diets with sugar syrup were significantly increased (P < 0.05) compared with the control treatment. The sugar syrup had no significant effect on liver enzymes, total protein, blood glucose and creatinine in all treatments. The eggs laid by hens fed sugar syrup diets had lower cholesterol level (P < 0.05) compared with those laid by hens fed the control diet. Electrophoresis analysis showed that comparable electrophoretic patterns were noticed between serum proteins of treatment groups. From the results, it can be concluded that sugar syrup diets and corn diets have similar effects on feed intake, body weight, production of eggs and blood biochemical parameters in layer hens, which suggests sugar syrup can be used as an energy source for replacing part of corn in poultry layer diets. Keywords: Cholesterol, Sugar syrup diet, Egg, Egg quality, Protei