Vascular effects of a single high salt meal

Background: High salt intakes are associated with a greater incidence of strokes and cardiovascular events. Increased dietary salt for a long time impairs endothelial function. However, the immediate effect of only one high salt meal is not fully elucidated. Aim of study: To detect vascular responses of a group of healthy adults to a single high-salt meal. Subjects and methods: 63 volunteers (35 male and 28 female) aged 21–40 years were subjected to measurement of office blood pressure, plasma sodium, flow mediated dilatation and both resistive (RI) and pulsatility (PI) indices of renal as well as carotid arteries at baseline (fasting 8 h over night and only water is allowed) and 60 min after consumption of high sodium soup containing 4 g salt (equal to 68 mmol Na). Results: There is significant increase in FMD as well as the resistive and pulsatility indices of both the carotid and femoral arteries after ingestion of the test meal compared to before meal (P < 0.001). Blood pressure is increased in the post-prandial phase but no correlation detected with these parameters (P = 0.89, 0.61 & 0.73 for carotid, 0.43 & 0.74 for renal). Plasma sodium increased after high salt meal (mean ± SD = 1.32 ± 0.83) and correlated with carotid PI (P = 0.0001). Conclusion: High salt intake may acutely impair vascular function in different vascular beds independent of the increase of blood pressure. Plasma sodium increase may be one of the underlying mechanisms

Ischemia modified albumin (IMA) in acute coronary syndrome (ACS) and left bundle branch block (LBBB). Does it make the difference?

Background: Management of patients with a suspected ACS and LBBB is a challenge to the clinician. Aim: To detect the ability of IMA to exclude myocardial ischemia in suspected patients with ACS and LBBB. Material and methods: A total of 68 patients with suspected ACS and LBBB (group I) and another twenty patients age and sex matched known to have LBBB with normal coronary angiography (group II) were included in this study and subjected to: routine laboratory tests, 12 lead ECG, echocardiography, and measurement of serum troponin I (TnI) and IMA (measured by ELISA). Diagnostic coronary angiography was performed on all patients and scored by severity and modified Gensini scores. Results: IMA and TnI levels are significantly increased in group I compared to group II (P value 95 could predict significant CAD (lesions >50%) with AUC of 0.923, sensitivity of 88%, specificity of 83.33%, PPV of 93.6%, NPV of 71.4% and accuracy 86.76%. Moreover, by using both simple and multiple logistic regression analyses IMA could also independently detect significant CAD. The combined use of IMA and TnI significantly improved the sensitivity and the negative predictive value to 98% and 90.9% respectively. Conclusion: There was a distinct advantage of measuring IMA in patients presenting to the emergency department with acute chest pain and LBBB to rule out a final diagnosis of ACS

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

Microalbuminuria is a late event in patients with hypertension: Do we need a lower threshold?

Background: Microalbuminuria (MA) is a marker of vascular damage. However, many studies have observed an increased risk at lower levels of albuminuria than are currently used to define MA. Aim: To verify early cardiovascular changes occurring before MA in hypertensive patients. Materials and methods: One hundred and fifty hypertensive patients and 60 normotensive individuals were divided into normotensive individuals with normal left ventricular (LV) geometry (Group I), hypertensive patients with normal LV geometry (Group II), and hypertensive patients with abnormal LV geometry (Group III). The LV mass index, ambulatory arterial stiffness index, flow-mediated dilatation of the brachial artery, and intima-media thickness (IMT) of the common carotid were assessed. Urinary albumin/creatinine ratio was determined using a morning spot-urine sample. Results: Compared with Group I, ambulatory arterial stiffness index and IMT were significantly increased and flow-mediated dilatation was significantly decreased in Group II; however, MA did not differ between both groups. These changes were augmented when Group III was compared with Group II. MA significantly increased in Group III compared with Group II. Receiver operating characteristic analysis revealed that MA, with a cut-off value of 19.25 mg/g, predicted increased IMT, and abnormal LV geometry in a statistically significant manner. Conclusion: Many vascular changes, in the form of increased IMT, reduced vasodilator capacity, and increased arterial stiffness, preceded MA and any change in LV geometry. The results presented here strengthen the usefulness of adopting a lower cut-off to define MA

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

The clinical value of anti-cyclic citrullinated peptide (anti-ccp) antibodies and insulin resistance (IR) in detection of early and subclinical atherosclerosis in rheumatoid arthritis (RA)

Background: Patients with rheumatoid arthritis (RA) have increased coronary atherosclerosis possibly related to several factors including insulin resistance. Anti-CCP antibodies are highly specific for RA but their association with cardiovascular morbidity has not been examined by enough studies. Aim: The aim of this study was to evaluate the role of anti ccp antibodies and IR for detection of early and sub-clinical atherosclerosis in RA patients. Subjects and methods: 56 RA patients and 19 age and sex matched healthy subjects were included in the present study. All patients and controls were subjected to full history, clinical examination, and laboratory investigations (including CBC, ESR, high sensitive CRP, rheumatoid factor and lipid profile). All patients were also subjected to measurement of intima-media thickness (IMT) of both carotid arteries as well as the flow mediated dilatation (FMD) of brachial artery. Also, measurements of IR (by HOMA 2) and anti-CCP were done for all subjects. Results: IMT was significantly increased (P = 0.01) and FMD significantly decreased (P = 0.001) in RA patients than controls in spite of the absence of significant differences in traditional atherosclerotic risk factors. Both IR and anti-CCP (which are significantly increased in RA compared to controls, P = 0.02 and 0.001 respectively) were significantly positively correlated to IMT (P = 0.009 and 0.001 respectively) and negatively correlated to FMD (P = 0.0005 and 0.005 respectively). Conclusion: IR and anti-CCP may be helpful in the early detection of subclinical atherosclerosis in RA patients

Comparative Effects of Different Organic and Inorganic Fertilisers on Soil Fertility, Plant Growth, Soil Microbial Community, and Storage Ability of Lettuce

The current study was conducted to assess whether organic fertilisation could replace mineral fertilisation in lettuce production without adverse effects on yield, quality, and postharvest behaviour. The effect of either mineral or organic fertiliser on soil fertility or the microbial community was also studied. Control plots were fertilised with recommended rates of mineral fertiliser (150: 45: 65 kg/ha NPK) and the other treatments were 15 t/ha compost, 10 t/ha rabbit manure, and 10 t/ha chicken manure. Our results indicated that all sources of organic fertiliser significantly increased total nitrogen, organic carbon, total fungi, and bacteria contents of soils compared with mineral fertiliser. Rabbit and chicken manure fertilisers resulted in a significant increase in yield. Compared with conventional fertiliser and other organic treatments, plots receiving rabbit manure showed a lower weight loss and microbial load on fresh lettuce head. Moreover, rabbit manure significantly reduced polyphenol oxidase and peroxidase activity. Hence, these results suggest that rabbit manure fertiliser could be an alternative to conventional production without significant reduction in yield and with low enzymatic browning and better storability

Isatis phytogenic relieved atrazine induced growth retardation, hepato-renal dysfunction, and oxidative stress in Nile tilapia

The influence of herbicides causes health and economic loss, which requires innovative solutions to sustain the aquaculture industry. In this regard, dietary isatis is included in Nile tilapia diets to relieve atrazine (ATZ)-induced growth retardation, hepato-renal dysfunction, and oxidative stress. The first and second groups offered the control diet (control), while the third and fourth groups offered the isatis supplemented diet (1%). Meantime, half of the water was replaced and mixed with ATZ (1.39 mg/L) in the second and fourth groups for 30 days. The group of fish delivered isatis had significantly enhanced FBW, WG, and SGR, while fish intoxicated with ATZ had meaningfully impaired growth behavior (p \u3c 0.05). Further, the FCR was improved by isatis, and ATZ resulted in the worst FCR among the groups. Interestingly fish fed isatis and exposed with ATZ (88.89%) had a higher survival rate than fish exposed with ATZ without isatis feeding, and both are lower than the control (97.78%) (p \u3c 0.05). The histological structure in the isatis-treated groups showed distinguished enhancement and branching of the intestinal villi. The intestine of ATZ–treated fish revealed damage and inflammatory cell infiltration in the intestinal mucosa with separation of lining epithelium. Generally, fish fed isatis and intoxicated with ATZ had lower uric acid, urea, creatinine, ALT, and AST and higher total protein, globulin, and albumin than fish exposed with ATZ without feeding with isatis (p \u3c 0.05). Markedly, fish-fed isatis had the highest SOD, CAT, GPx, and the lowest MDA level compared to the other groups (p \u3c 0.05). Meanwhile, fish exposed with ATZ had the worst SOD, CAT, GPx, and the highest MDA level compared to the other groups (p \u3c 0.05). In summary, dietary isatis relieved ATZ induced growth retardation, hepato-renal dysfunction, and oxidative stress in Nile tilapia