Assessment of Different Tannin Extracts on Avian Pathogenic Escherichia coli Metabolites Using Nuclear Magnetic Resonance

Tannins have been demonstrated to inhibit the growth of several chicken illnesses in vitro. The complex compositions of tannins make it difficult for microorganisms to develop bacterial resistance. This study aimed to evaluate the effect of condensed tannins (CT) extracts on metabolic profile of Avian Pathogenic Escherichia coli (APEC) using Nuclear Magnetic Resonance (1H-NMR). The experimental groups were divided into three groups:control (no CT added), high in procyanidins (PC-CT) group, and high in prodelphinidins (PDCT) group, with exposure times of 0, 10, and 24 h. APEC was observed to respond to CT extracted from Tilia flowers (high PC-CT) and black locust leaves (high PD-CT). The levels of amino acids including lysine, leucine, glutamate, phenylalanine, and pyroglutamate were increased with the high PD-CT treatment; however, no significant differences were observed between the PC-CT group and the control. Treatment of APEC culture with high PD-CT also led to a significant decrease in the level of lactate. Thus, high PD-CT affected these metabolisms and could be exploited to control the proliferation of APEC in poultry, thereby improving their health and performance

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

The influence of condensed tannin extracts on gut health in chickens

Tannins belong to the group of polyphenols, which occur naturally in many plants. They exist in the form of two different groups: hydrolysable tannins and condensed tannins (CTs), the latter are also called proanthocyanidins. This thesis investigated the antimicrobial activities in vitro of CTs and studied their impacts on the fermentation and metabolism in chicken caecum. An initial screening of a plant collection for CTs identified plant materials that contained different CT-types, e.g. high and low procyanidin/prodelphinidin or cis/trans, flavan-3-ol ratios and also of CTs with small or large mean degrees of polymerisation. After CT extraction and purification, the effects of these structural CT-features were studied and tested against two bacteria, avian pathogenic E. coli (APEC) as Gram negative bacteria and Staphylococcus epidermidis as Gram positive bacteria by the broth microdilution assays. Subsequent experiments investigated the effects of these different CT compositions on in vitro fermentation and metabolism, and determined the metabolic end products. These CTs were effective at minimal bactericidal concentrations (MBCs) of 5 – 10 mg/ml against APEC and at 5 – 1.25 mg/ml against S. epidermidis. At these concentrations they significantly (P≤0.05) inhibited bacterial growth. Scanning electron microscopy (SEM) revealed antimicrobial activity of these extracts on the bacterial cells of both bacteria, but CTs were more potent against the Gram positive compared to the Gram negative bacteria, which required higher MBC values of 5 - 10 mg/ml. Interestingly, this study found that low concentrations (0.6 mg/ml) of tilia flower extracts, which contain mostly procyanidins (PC), showed slightly enhancement of APEC growth. The anti-biofilm and anti-motility activity of the CTs were also evaluated. All CT extracts also affected significantly (P≤0.05) the biofilm formation of APEC depending on their concentrations and compositions. Significant (P≤0.05) anti-biofilm activity against APEC was observed for almost all CT extracts, especially at higher concentrations (10 – 2.5 mg/ml). More importantly, concentrations of 0.6 - 1.25 mg/ml, especially with extracts that contained low molecular weight of CTs, enhanced the bacterial cell attachment of APEC. This could be because surviving bacteria prefer to form the biofilm in stressful conditions, indicating further investigations due to CT’s high the anti-biofilm activity potential. In contrast, the CT extracts containing either high molar proportions of prodelphinidins (PD) or procyanidins (PC) interrupted and blocked swarming and swimming motility at 10h and 24h compared to the controls. These data support the theory that antimicrobial activity of the CTs, whether with high PC% and PD%, can elicit a positive relationship between anti-biofilm formation and anti-motility capacities. These findings are the first results that provide knowledge about the effect of different CTs on biofilm formation and motility of APEC. The most potent CTs chosen from the above experiments were then tested in vitro using a fermentation culture over a 24h period. A nuclear magnetic resonance (1H-NMR) experiment combined with multivariate statistics was used for the first time to investigate how CT compositions influenced either metabolic end products in a chicken contents or APEC metabolites in a nutrient medium. Both experiments showed interesting results of how CT compositions, in terms of PC% and PD%, impacted on metabolic compounds. Amino acids such as glutamate, leucine, lysine, pyroglutamate, phenylalanine, proline and sarcosine were significantly (P≤0.05/times) decreased. However, leucine and lysine were measured a highest significant difference (P≤0.05) by the interaction between treatments and times. Both CT compositions also influenced significantly (P≤0.05) on fermentation of some fatty acids such as acetate, butyrate and propionate were increased in the treatments. However, lactate was recorded statistically decreasing (P≤0.05) between the treatments. In addition, other metabolites such as some of carbohydrates (e.g. mannitol, glucose, fructose, lactose and galactose) were observed slightly fluctuations on their levels (but not significantly, P≥0.05) at different time-points. Conversely, APEC culture responded metabolically and statistically to these CT compositions. Both CT compositions showed different effect on some amino acids such as lysine, leucine, glutamate phenylalanine and pyroglutamate, which illustrated a significant value (P≤0.05) in CT-groups, especially high PD% treatment, whilst the values of these amino acids showed very close results between PC treated and controls. Similarly, the fatty acids, such as butyrate, iso-butyrate, valerate and iso-valerate were increased in high PD of CTs compared to the high PC and controls. These values did not record significant difference at P>0.05 between the integration of times and treatments, but they showed a significant different (P≤0.05) at different time-points. However, CTs with high PD% led to a significant decreasing (P≤0.05) of lactate, which should normally be increased by E. coli mixed acid fermentation. This is new finding that shows the effect of CTs, particularly high PD% group can influence on the biological process of mixed acid fermentation. The most important results were that CTs with high PD% showed different effects to CTs compared to high PC % in APEC cultures, and that the PC results were close to the controls. Therefore, more research is recommended to investigate the effects of the different CT compositions and concentrations separately by using other NMR techniques e.g. 2D-NMR. In conclusion, this thesis identified the key structural features of CTs, which contain either high molar proportions of PD or PC that might be useful to improve the efficiency of feed utilisation and to reduce the incidence of pathogenic bacterial infections in chickens. This study was also the first investigation of the effects of different CT compositions on in vitro metabolism by 1H-NMR and provided new findings that could establish a powerful database for the future experiments by including the CT extracts in chicken diets

Efficacy of Lepidium sativum against carbon tetra chloride induced hepatotoxicity and determination of its bioactive compounds by GC–MS

Lepidium sativum seed (LSS) (family: Cruciferae) has been used in traditional medicine for the treatment of jaundice, liver problems, spleen diseases and gastrointestinal disorders. It was also reported to possess antihypertensive, diuretic, anti-asthmatic, antioxidant, and anti-inflammatory activities. Attempt has been made to study hepatoprotective potential of LSS available in Saudi Arabian Market. The aim of the present study was to determine the hepatoprotective effect of ethanolic extracts of LSS against carbon tetrachloride (CCl4) induced acute liver injury in rats. The bioactive compounds responsible for this activity have been analyzed by GC–MS. To evaluate the hepatoprotective activity, six groups (n = 6) of rats were taken. First group was control, second was toxic and other groups received oral test solutions: 100 mg/kg silymarin, or LSS (100, 200, and 400 mg/kg), once daily for 7 consecutive days, followed by hepatotoxicity induction with CCl4. Blood and liver tissues were collected for biochemical, antioxidant and microscopic analyses. The bioactive constituents present in the extract were analyzed by GC–MS. Results showed that pretreatment with LSS and silymarin significantly reduced the level of serum alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP) and bilirubin (BIL), which was increased significantly in toxic group treated with only CCl4. Histological analysis of liver tissues in groups pretreated with LSS and silymarin showed mild necrosis and inflammation of the hepatocytes compared to the toxic group. GC–MS analysis of LSS showed the presence of twelve major fatty acids including alpha-linolenic acid as a major constituent. These results indicated that LSS exerts enhance hepatoprotective activity that could be attributed towards its antioxidant activity, coupled together with the presence of anti-inflammatory compounds in LSS extract

Community-Acquired Methicillin-Resistant <i>Staphylococcus aureus</i> in Hospitals: Age-Specificity and Potential Zoonotic–Zooanthroponotic Transmission Dynamics

Methicillin-resistant Staphylococcus aureus (MRSA) lineages are a devastating clinical and public health issue. Data on local lineage profiles are limited. We report on the frequency of community-acquired and hospital-acquired cases (CA-MRSA, HA-MRSA). We studied 147 isolates from King Khalid tertiary care hospitals (KKH), each from a case in a patient and including 33 patients at the Maternity and Children’s Hospital (MCH). Of the 147 isolates, 87 males (59%) and 60 females (41%) were in KKH. The overwhelming majority (80%; n = 119/147) were CA-MRSA in KKH. Intriguingly, despite significant differences between males (70%) and females (53%), lineage-acquisition remained age-specific around 58–60 years in both genders. However, while CA-MRSA dominated early in life (0–20, 70% MCH), it increased with age in KKH adults; 21–50 (28%), >50 (59%) until the overall 80% (n = 144/180). Major specimens included skin-wounds, surgeries (70.3%), blood (13.5%), sputum (8.8%), very rarely urine (4.1%), and nasal (3.4%), albeit most patients showed severe enteritis and necrotizing pneumonia. Antibiograms showed high beta lactam resistances, including amoxicillin–clavulanate (83%), oxacillin (84%), cefoxitin FOX (100%), penicillin and ampicillin (~100%), as well as high resistance (82%) to carbapenem. Fortunately, high susceptibility was seen to non-beta lactams and, to a lesser extent, gentamicin, erythromycin, and fusidic acid; 33%, 34%, and 38%, respectively, in KKH. A similar pattern was seen in MCH except for a low resistance pattern to gentamicin CN, clindamycin CD, erythromycin E, and tobramycin TOB; 34%, 31%, 39%, and 41%, respectively, except for fusidic acid. These findings have significant clinical implications for MRSA patient management strategies. Clinical- and lineage-profiles imply host-selection and zoonotic–zooanthroponotic transmission dynamics. Future molecular typing, sequencing, and characterization of dominant clone(s) is imperative

Pancreatic surgery outcomes: multicentre prospective snapshot study in 67 countries

Background: Pancreatic surgery remains associated with high morbidity rates. Although postoperative mortality appears to have improved with specialization, the outcomes reported in the literature reflect the activity of highly specialized centres. The aim of this study was to evaluate the outcomes following pancreatic surgery worldwide.Methods: This was an international, prospective, multicentre, cross-sectional snapshot study of consecutive patients undergoing pancreatic operations worldwide in a 3-month interval in 2021. The primary outcome was postoperative mortality within 90 days of surgery. Multivariable logistic regression was used to explore relationships with Human Development Index (HDI) and other parameters.Results: A total of 4223 patients from 67 countries were analysed. A complication of any severity was detected in 68.7 percent of patients (2901 of 4223). Major complication rates (Clavien-Dindo grade at least IIIa) were 24, 18, and 27 percent, and mortality rates were 10, 5, and 5 per cent in low-to-middle-, high-, and very high-HDI countries respectively. The 90-day postoperative mortality rate was 5.4 per cent (229 of 4223) overall, but was significantly higher in the low-to-middle-HDI group (adjusted OR 2.88, 95 per cent c.i. 1.80 to 4.48). The overall failure-to-rescue rate was 21 percent; however, it was 41 per cent in low-to-middle-compared with 19 per cent in very high-HDI countries.Conclusion: Excess mortality in low-to-middle-HDI countries could be attributable to failure to rescue of patients from severe complications. The authors call for a collaborative response from international and regional associations of pancreatic surgeons to address management related to death from postoperative complications to tackle the global disparities in the outcomes of pancreatic surgery (NCT04652271; ISRCTN95140761)