hytochemical and nutritional properties of dried leaf powder of Moringa oleifera Lam. from machala el oro province of ecuador

Moringa oleífera commonly called Moringa, is a valuable tree whose fruits, roots and leaves have been advocated for traditional, medicinal and industrial uses. The phytochemical and nutritional properties of the dried leaf powder of M. oleifera used as nutraceuticals, dietary supplements, functional foods or a source of vegetable in meal preparation were investigated in this study to scientifically provide an empirical evidence for its use and benefits. Using standard phytochemical screening procedures the phytochemicals identified were tannins, saponins, alkaloids, flavonoids, cardiac glycosides and reducing sugars. The physico-chemical analysis using standard official methods and gas chromatography revealed the following nutrients; proteins (24.31%), carbohydrate (55.97%), ashes (11.50%), crude fiber (10.28%), total fat (9.22%), moisture (6.12 %), caloric value (404.10 Kcal/100g) and saturated fatty acids (3.77 %), unsaturated fatty acids (5.45 %), monounsaturated fatty acids (0.87 %), polyunsaturated fatty acids (4.58 %) and Trans fatty acid (0.00 %) for fatty acid profile. Using acid hydrolysis and ion-exchange chromatography, the amino acid analysis report showed the presence of essential and semi essential amino acids in varying amounts with a total of 27.16 nmol at 570nm and proline was 1.432 nmol at 440nm. These findings have far reaching nutritional importance in the healthcare system of this country and will help to address undernutrition in acost effective manner. Thus, the use of M. oleifera leaves as nutrients should be encouraged and sustained in this and other countries

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)