Anemia in relation to body mass index among female students of North Kerala: a pilot study

Background: Anemia among women causes many serious health problems and is pervasive in developing country. Many research studies have documented that malnutrition affects body growth and development, especially during the crucial period of adolescence. The association between anemia and body mass index (BMI) is a measure of nutrition and health status of adults. Aim was to study the association between anemia and BMI among female students.Methods: An observational study was conducted among first year medical and dental female students (n=109) aged 18-20years. Hemoglobin (Hb) levels (g/dL) by Sahli’s hemoglobinometer and BMI (kg/m2) were estimated. Anemia was defined as Hb content <12g/dL. Subjects were classified by BMI categories as underweight (BMI <18.5kg/m2), normal weight (BMI:18.5-24.99kg/m2), overweight (BMI ≥25kg/m2) and obesity (BMI ≥30kg/m2) according to WHO. Then the relation between anemia and BMI were statistically analyzed.Results: Overall, 48.62% female students were anemic. Of which 43.4% were underweight, 22.6% normal weight and 34.5% were above normal weight (over weight and obese). Mean value of hemoglobin was significantly decreased in underweight and overweight compared to normal weight (p<0.001). Anemia was significantly associated with BMI (χ2 =46.48, p=0.000).Conclusions: The study concludes the occurrence of anemia in both undernourished and over-nourished individuals which were significantly associated. Further studies are needed with larger sample size to document the factors that may be associated with anemia in females

What is the empirical evidence that hospitals with higher-risk adjusted mortality rates provide poorer quality care? A systematic review of the literature

<p>Abstract</p> <p>Background</p> <p>Despite increasing interest and publication of risk-adjusted hospital mortality rates, the relationship with underlying quality of care remains unclear. We undertook a systematic review to ascertain the extent to which variations in risk-adjusted mortality rates were associated with differences in quality of care.</p> <p>Methods</p> <p>We identified studies in which risk-adjusted mortality and quality of care had been reported in more than one hospital. We adopted an iterative search strategy using three databases – Medline, HealthSTAR and CINAHL from 1966, 1975 and 1982 respectively. We identified potentially relevant studies on the basis of the title or abstract. We obtained these papers and included those which met our inclusion criteria.</p> <p>Results</p> <p>From an initial yield of 6,456 papers, 36 studies met the inclusion criteria. Several of these studies considered more than one process-versus-risk-adjusted mortality relationship. In total we found 51 such relationships in a widen range of clinical conditions using a variety of methods. A positive correlation between better quality of care and risk-adjusted mortality was found in under half the relationships (26/51 51%) but the remainder showed no correlation (16/51 31%) or a paradoxical correlation (9/51 18%).</p> <p>Conclusion</p> <p>The general notion that hospitals with higher risk-adjusted mortality have poorer quality of care is neither consistent nor reliable.</p

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p&lt;0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p&lt;0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

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

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

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

Interaction of lysozyme with antibiotics-binding of penicillins to lysozyme

Binding of lysozyme with the antibiotics such as penicillin-G, penicillin-V and methicillin at different concentrations and pH was studied by equilibrium dialysis. Co-operative binding isotherms were observed at pH 5.0,7.0 and 9.0 with all the penicillins and the binding ratios decreased slightly with the increase of pH. The Gibbs free energy change calculated on the basis of Wyman's binding potential concept decreased slightly with the increase of pH indicating slight decrease in the binding strength at higher pH in the case of all penicillins. The ultra-violet difference spectra of lysozyme-penicillin complexes showed a less intense peak in the region of 284-300 nm at pH 5.0. Only penicillin-G complex had a peak at pH 7.0 at these wavelengths with less intensity compared to that at pH 5.0. However, none of the penicillins showed discrete peaks in this region at pH 9.0. The appearance of peaks in the difference spectra of all these complexes at pH 5.0 and with only penicllin-G complex at pH 7.0 in the aromatic region indicated hydrophobic interactions with tryptophan residues as the binding sites. In addition, the ionic interactions with lysine residues in lysozyme were also occurring. The conformational changes induced by the binding of penicillins to lysozyme monitored by circular dichroism showed a slight decrease in the aromatic bands in the 320-250 nm region. However, in the 250-200 nm region, θ222nm values obtained at various concentrations of penicillins in the complex indicated an increased α-helical content generating a more ordered structure. These results led to the conclusion that both the hydrophobic and electrostatic interactions prevail in the binding of penicillins to lysozyme. © 1983 Indian Academy of Sciences

Interaction of proteins with detergents: Binding of cationic detergents with lysozyme

Binding studies of cationic detergents such as cetyl trimethylammonium bromide, Cetylpyridinium bromide and dodecyl trimethylammonium bromide with lysozyme were carried out by equilibrium dialysis, ultraviolet difference and circular dichroism techniques at 25 C. Binding isotherms at pH 5·0, 7·0 and 9·0 show cooperative binding at all concentrations of detergents and the number of available binding sites in lysozyme increases with pH. Gibbs free energy of binding calculated on the basis of Wymans' binding potential concept increases with pH indicating increased binding strength at higher pH. The ultraviolet difference spectra of the detergent complexes with lysozyme at pH 7·0 and 9·0 in the region of 250-300 nm indicate the involvement of aromatic amino acid residues as probable binding sites and also the carboxylate groups since the binding is cooperative. The circular dichroism spectra also indicate the involvement of aromatic amino acid residues in the binding of these detergents. This is substantiated by the decrease in the intensity of the aromatic positive bands in the near ultraviolet region. The increase in the magnitude of θ222 nm values in the far ultraviolet region with the increase in the concentration of the detergent in the complex indicates conformational changes resulting in an increase of α-helical content producing a more ordered structure of lysozyme.These binding studies show that at pH 7·0 and 9·0, hydrophobic interactions play a major role, while at pH 5·0 only electrostatic interactions play prominent role in the binding of these detergents. © 1986 Indian Academy of Sciences

Interaction of cationic detergents, cetyl- and dodecyl-trimethylammonium bromides, with lysozyme

Binding of lysozyme with cetyltrimethylammonium bromide (CTAB) and dodecyl-trimethylammonium bromide (DTAB) at various detergent concentrations and pH was studied at 25°C by equilibrium dialysis technique. In the case of CTAB, binding isotherms at pH 5.0, 7.0, and 9.0 show cooperative binding at all the concentrations of the detergent and the binding ratios increase with pH. Cooperative binding is also shown by DTAB at all the concentrations and pH, but the binding ratios are lower compared to CTAB. The Gibb's free energy change calculated on the basis of Wyman's binding potential concept increases with pH, indicating increased binding strength of CTAB at higher pH.The UV difference spectra of CTAB and DTAB with lysozyme and its model compounds such as L-Trp, L-Tyr.HCl and L-Phe show two peaks at 297 nm and 250 nm at pH 9.0 indicating the possible involvement of tryptophans as the binding sites along with the carboxylate anion or the phenolic group of a tyrosine on lysozyme. The effect of higher ionic strength on the binding of CTAB with lysozyme at pH 9.0 is evidenced by lower binding ratios and decreased intensities of the UV difference bands, thus indicating the involvement of electrostatic interactions. However, the hydrophobic interactions between the detergents and the aromatic amino acid residues in lysozyme contribute more to the binding strength.The binding of these cationic detergents by lysozyme induces conformational changes in the enzyme. They are followed by the circular dichroism (CD) technique which shows a decrease in the aromatic bands in the 320-250 nm region. In the 250-200 nm region, the θ 222 values obtained at various concentrations of CTAB in the complex indicate an increase in the α-helical content indicating a more ordered structure. The CD spectra of lysozyme-DTAB complex were found to be very similar to those of CTAB complex, but the effect was less pronounced probably due to the decrease in the hydrocarbon chain length.Therefore, it is concluded that hydrophobic interactions play an important role in the detergent binding, whereas electrostatic interactions play only a minor role. © 1984 BY THE JOURNAL OF BIOCHEMISTRY

Interaction of lysozyme with dyes: II. Binding of bromophenol blue

The binding of lysozyme with bromophenol blue (BPB) at various dye concentrations and pH was carried out at 25°C by equilibrium dialysis, ultraviolet (UV) difference and circular dichroism (CD) spectral techniques.Binding isotherms at pH 5.0 show non-cooperative binding at low dye concentrations, which change over to cooperative binding at higher concentrations indicating biphasic nature. However, binding isotherms at pH 7.0 and 9.0 show cooperative binding only, at all concentrations of the dye. The number of available binding sites decreases with the increase of pH. Gibbs free energy change, calcUlated on the basis of Wyman's binding potential concept, decreases with the increase of pH. Binding isotherms at pH 5.0 obtained at a lower temperature of 8°C, also indicate the biphasic nature similar to those observed at 25°C, but with a slight decreased strength of binding.The UV difference spectra of the complex do not show any distinct peaks in the 285 to 297 nm region eliminating any possible interaction of BPB with tryptophan and tyrosine residues of the lysozyme molecule. The CD spectra of lysozyme-BPB complex show a decrease in ellipticities with reference to native lysozyme in the near UV and far UV regions. This indicates that the lysozyme-BPB complex has a lower helical content probably due to the conformational changes induced into the native enzyme. The appearance of new positive peaks at 315 nm in the near UV region and at 592 nm in the visible region of the CD spectra may be due to the induced asymmetry into the BPB molecule as a result of its binding to a cationic residue (probably a lysine residue) of lysozyme.Thus, the types of interactions involved in the binding of BPB to lysozyme are mainly electrostatic in nature in addition to hydrogen bonding and van der Waals forces. © 1984 Oxford University Press

Stability Constants of Complexes of Cu(II), Ni(II), Co(II), Mn(II), Zn(II) & Cd(II) with 5-Hydroxy-2- methyl-1, 4-naphthoquinone

209-21