The effect of fermentation process on bioactive properties, essential oil composition and phenolic constituents of raw fresh and fermented sea fennel (Crithmum maritimum L.) leaves

800-804The influence of fermentation on antioxidant activity, total phenol, total flavonoid and phenolic compounds of sea fennel and also volatile compounds of sea fennel essential oil was investigated and compared with fresh samples. Antioxidant activity, total fenolic and flavonoid contents decresed from 89.79 to 63.13%; from 259.58 to 77.92 mg/100 g; from 2114.67 to 390.50 mg/100 g, respectively. Twenty-six and thirty-three components of sea fennel oils were identified in raw and fermented sea fennel, accounting to about 99.99% and 99.44% of the total oil, respectively. The raw and fermented sea fennel leaves contained 22.31 and 1.32% sabinene, 12.08% and 7.45% limonene, 10.30% and 11.61% β-phellandrene, 8.59% and 9.17% (Z)-β-ocimene, 7.08% and 3.55% α-pinene, 28.36% and 42.05% γ-terpinene, 2.57% and 8.64% terpinene-4-ol, respectively. Dominant phenolic compounds were (+)-catechin, gallic acid, 3,4-dihydroxybenzoic acid and p-coumaric acid. Generally, all of the phenolic compounds reduced the effect of microorganisms during,. However, essential oil contents of sea fennel were not effected from fermentation process

Nutritional composition, extraction, and utilization of wheat germ oil: A review

Wheat germ is a by-product of wheat milling from which wheat germ oil (WGO) can be obtained using different techniques. For a better quality WGO, techniques such supercritical fluid fractionation, molecular distillation, and other innovative methods can be adopted. WGO is composed of nonpolar lipids, glycolipids, phospholipids, alcohols, esters, alkene, aldehydes, tocopherols, n-alkanols, sterols, 4-methyl sterols, triterpenols, hydrocarbons, pigments, and volatile components. The most abundant WGO fatty acid is linoleic acid which composes 42–59% of total triglycerides followed by palmitic (16:0) and oleic acids (18:1). The stearic acid, a saturated fatty acid, is usually less than 2%. WGO is rich in tocopherols particularly vitamin E. It contains a-tocopherol and b-tocopherol which gives various health benefits to it. It is being used in medicine, cosmetic, agricultural, and food industry. Some of its applications include production of vitamins and food supplements, animal feed and biological insect control and for treating circulatory/cardiac disorders and weaknesses. More studies are required for producing better quality WGO such as application of more innovative and optimized techniques that can increase its health benefits and hence utilization. More mechanistic approaches for extraction, evaluation, and utilization of WGO can help in making this by-product of wheat processing more valuable

Changes in sugar contents, amino acid, sterol and tocopherol compositions of prickly pear fruit and seed oils

In the present study, moisture, sugar, protein, amino acid, sterol and tocopherols contents and composition of prickly pear fruits and seed oils grown in different locations (Fethiye, Hatay, Anamur, Adana and Alanya) in Turkey were determined. Prickly pear fruit samples contained 38.92 (Adana) - 44.71% (Antalya) glucose, 24.95 (Fethiye) - 29.17% (Alanya) fructose and 0.15 (hatay) and 0.36% (Antalya) and 6.17 (Muğla)-0.34% (Antalya) protein depending on locations. While alanine contents of prickly pear pulp change between 0.09% (Fethiye) and 0.13% (Alanya), valine contentsof fruit samples changed between 0.09% (Fethiye) and 0.13% (Alanya). Proline contents of prickly pear fruits varied between 0.84 (Alanya) to 1.07% (Fethiye). β-sitosterol contents of fruits ranged from 762.76 (Adana) to 974.86 mg/100 g (İskenderun-Hatay) whereas the total sterol amounts of prickly pear seed oils were identified between 1113.76 (Fethiye) and 1710.35 mg/100 g (Hatay). ɣ-tocopherol amounts of prickly pear seed oils varied between 17.4 Mersin (Anamur) and 25.5 mg/100 g Antalya (Alanya) and other tocopherols were found at very low levels depending on the location.The most abundant tocopherol was ɣ-tocopherol (17.4 mg/100 g (Anamur) and 25.5 mg/100 g (Alanya). Hence it may be inferred that habitat (locations) had significant effects on protein, sugar, amino acid, sterol and tocopherol contents of prickly pear samples. Results were found partly similar, and differences observed can be due to genetic factors of prickly pear seeds and climatic factors of habitats because habitat is an effective factor on phytochemical constituents of plants

The effect of fermentation process on bioactive properties, essential oil composition and phenolic constituents of raw fresh and fermented sea fennel (Crithmum maritimum L.) leaves

The influence of fermentation on antioxidant activity, total phenol, total flavonoid and phenolic compounds of sea fennel and also volatile compounds of sea fennel essential oil was investigated and compared with fresh samples. Antioxidant activity, total fenolic and flavonoid contents decresed from 89.79 to 63.13%; from 259.58 to 77.92 mg/100 g; from 2114.67 to 390.50 mg/100 g, respectively. Twenty-six and thirty-three components of sea fennel oils were identified in raw and fermented sea fennel, accounting to about 99.99% and 99.44% of the total oil, respectively. The raw and fermented sea fennel leaves contained 22.31 and 1.32% sabinene, 12.08% and 7.45% limonene, 10.30% and 11.61% β-phellandrene, 8.59% and 9.17% (Z)-β-ocimene, 7.08% and 3.55% α-pinene, 28.36% and 42.05% γ-terpinene, 2.57% and 8.64% terpinene-4-ol, respectively. Dominant phenolic compounds were (+)-catechin, gallic acid, 3,4-dihydroxybenzoic acid and p-coumaric acid. Generally, all of the phenolic compounds reduced the effect of microorganisms during,. However, essential oil contents of sea fennel were not effected from fermentation process

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

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

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to &lt;90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], &gt;300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of &lt;15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P&lt;0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P&lt;0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Clove Polyphenolic Compounds Improve the Microbiological Status, Lipid Stability, and Sensory Attributes of Beef Burgers during Cold Storage

This study investigated the phenolic composition of clove powder extract (CPE), determined by high-pressure liquid chromatography, as well as the effect of the clove powder (CP) concentration (0, 2, 4, and 6%) on the quality of beef burgers during 21 days of cold storage at 4 &deg;C. The CPE contained a high amount of total phenolic content (455.8 mg Gallic acid equivalent/g) and total flavonoid content (100.4 mg catechin equivalent/g), and it exhibited high DPPH antioxidant scavenging activity (83.9%). Gallic acid, catechol, and protocatechuic acid were the highest phenolic acids (762.6, 635.8, and 544.9 mg/100 g, respectively), and quercetin and catechin were the highest flavonoid acids (1703.1 and 1065.1 mg/100 g, respectively). Additionally, the CPE inhibited the growth of both Gram-positive and Gram-negative bacteria effectively at 100 &mu;g/disc. The addition of the CP had no discernible influence on the pH of the meat patties. The addition of CP at 4 and 6% increased the phenolic content and antioxidant activity of the beef patties, which consequently resulted in reduced lipid oxidation and microbial spoilage throughout the storage period. Furthermore, the CP significantly (p &le; 0.05) improved the beef burger cooking characteristics (cooking yield, fat retention, moisture retention, and shrinkage). Additionally, the sensory acceptability was higher (p &le; 0.05) for the burgers that contained 2% and 4% CP compared with the other treatments. In conclusion, the bioactive compounds in CP can extend the shelf life and improve the safety of beef burgers