The role of lipids in drug absorption throught the GIT

Os vectores lipídicos apresentam inúmeras vantagens para a administração oral de substâncias farmacológicas, p.ex. são compostos por moléculas lipídicas semelhantes àquelas que figuram nos tecidos humanos, tornando-se biocompatíveis, biotoleráveis e biodegradáveis. São exemplos as tradicionais emulsões O/A, as suspensões de nanopartículas lipídicas (SLNs e NLC s) e, recentemente, as SolEmuls®, que permitem localizar fármacos fracamente solúveis em ambas as fases das emulsões, na camada interfacial de lecitina. Este artigo aborda o papel dos lípidos no aumento da absorção e da biodisponibilidade de fármacos administrados oralmente. Lipid carriers show several advantages for oral delivery of pharmacologically active drugs, e.g. are composed of lipid molecules similar to those in human tissues, becoming therefore biocompatible, biotolerable and biodegradable. Examples include traditional o/w emulsions, suspensions of lipid nanoparticles (SLNs and NLC s) and, recently, the SolEmuls®, which allows localizing poorly soluble drug molecules both in oil and aqueous phases, in the interfacial layer of lecithin. This paper reports on the role of lipids in enhancing both drug absorption and bioavailability when administered orally

The role of lipids in drug absorption throught the GIT

Os vectores lipídicos apresentam inúmeras vantagens para a administração oral de substâncias farmacológicas, p.ex. são compostos por moléculas lipídicas semelhantes àquelas que figuram nos tecidos humanos, tornando-se biocompatíveis, biotoleráveis e biodegradáveis. São exemplos as tradicionais emulsões O/A, as suspensões de nanopartículas lipídicas (SLNs e NLC s) e, recentemente, as SolEmuls®, que permitem localizar fármacos fracamente solúveis em ambas as fases das emulsões, na camada interfacial de lecitina. Este artigo aborda o papel dos lípidos no aumento da absorção e da biodisponibilidade de fármacos administrados oralmente. Lipid carriers show several advantages for oral delivery of pharmacologically active drugs, e.g. are composed of lipid molecules similar to those in human tissues, becoming therefore biocompatible, biotolerable and biodegradable. Examples include traditional o/w emulsions, suspensions of lipid nanoparticles (SLNs and NLC s) and, recently, the SolEmuls®, which allows localizing poorly soluble drug molecules both in oil and aqueous phases, in the interfacial layer of lecithin. This paper reports on the role of lipids in enhancing both drug absorption and bioavailability when administered orally

Effects of two enzyme feed additives on digestion and milk production in lactating Egyptian buffaloes

The aim of this study was to evaluate the effect of two commercial enzyme products on milk production in Egyptian buffaloes. Twenty-one lactating buffaloes (570±15 kg BW) were divided into three groups (n=7) in a randomized block design for four months. Buffaloes were fed a total mixed ration containing 60% forage [rice straw and berseem hay (Trifolium alexandrinum)] and 40% concentrates with either no enzymes added (Control) or an addition of 40 g of Veta-Zyme Plus® (VET) or 40 g of Tomoko® (TOM ) enzyme product per day for each buffalo. Enzyme addition did not affect feed intake (P>0.05), but increased the digestibility of nutrients (P<0.05) and serum glucose concentration (P=0.011). Furthermore, the addition of VET increased milk (P=0.017) and fat corrected milk (P=0.021) yields, fat content (P=0.045), total unsaturated fatty acid (P=0.045) and total conjugated linoleic acid (P=0.031) contents in milk and decreased the content of total saturated fatty acids (P=0.046), while the addition of TOM increased milk total protein (P=0.023) and true protein (P=0.031) contents. The two enzyme products both resulted in higher concentrations of lysine (P=0.045) and total essential amino acids (P=0.036) in milk. It was concluded that addition of commercial fibrolytic enzyme products (i.e. Veta-Zyme Plus® and Tomoko®) to the diet of early lactating buffaloes enhanced nutrient digestibility and milk production and quality

Pulse Pressure Variation-Guided Fluid Therapy during Supratentorial Brain Tumour Excision: A Randomized Controlled Trial

BACKGROUND: Goal-directed fluid therapy (GDFT) improved patient outcomes in various surgical procedures; however, its role during mass brain resection was not well investigated. AIM: In this study, we evaluated a simple protocol based on intermittent evaluation of pulse pressure variation for guiding fluid therapy during brain tumour resection. METHODS: Sixty-one adult patients scheduled for supratentorial brain mass excision were randomized into either GDFT group (received intraoperative fluids guided by pulse pressure variation) and control group (received standard care). Both groups were compared according to the following: brain relaxation scale (BRS), mean arterial pressure, heart rate, urine output, intraoperative fluid intake, postoperative serum lactate, and length of hospital stay. RESULTS: Demographic data, cardiovascular data (mean arterial pressure and heart rate), and BRS were comparable between both groups. GDFT group received more intraoperative fluids {3155 (452) mL vs 2790 (443) mL, P = 0.002}, had higher urine output {2019 (449) mL vs 1410 (382) mL, P &lt; 0.001}, and had lower serum lactate {0.9 (1) mmol versus 2.5 (1.1) mmol, P = 0.03} compared to control group. CONCLUSION: In conclusion, PPV-guided fluid therapy during supratentorial mass excision, increased intraoperative fluids, and improved peripheral perfusion without increasing brain swelling

Fennel seeds dietary inclusion as a sustainable approach to reduce methane production and improve nutrient utilization and ruminal fermentation

Ruminants are considered a major producer of methane (CH4). Therefore, the present study aimed to determine the ability of dry fennel seeds to affect in vitro gas production and fermentation. Fennel seeds were included at 0% (Control), 0.5%, 1%, 1.5%, and 2% DM of a diet containing per kg DM: 500 g concentrate feed mixture, 400 g berseem hay, and 100 g of rice straw. The incubations lasted 48 h. Fennel seeds increased (P < 0.001) the asymptotic gas production and decreased its rate, while decreasing the production and proportion of CH4 (P < 0.05) and increased its rate. Moreover, fennel seed increased DM and neutral detergent fiber (P < 0.01) degradability, and increased total production of short-chain fatty acids, acetate, and propionate (P < 0.05). Compared to the control, fennel seeds increased (P < 0.01) metabolizable energy, partitioning factor, and microbial crude protein production. Overall, fennel seeds can be included up to 2% DM in ruminant diets as an environmentally friendly product in animal farming due to its ability to improve feed utilization, ruminal fermentation and while reducing CH4 production

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

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

Clinical, laboratory, and virological characteristics of patients with positive hepatitis B surface antigen in Upper Egypt

Aim The aim of the study was to determine the clinical, laboratory, and virological characteristics of patients with chronic HBV infection in Upper Egypt. Patients and methods This descriptive, cross-sectional study included 252 patients with positive hepatitis B surface antigen (HBsAg). It was conducted in the Tropical Medicine and Gastroenterology Department and Outpatient Clinic, Assiut University Hospital (Egypt), from May 2012 to May 2014. All patients underwent clinical evaluation, were administered a questionnaire about risk factors for transmission of HBV, underwent liver function tests, abdominal ultrasonographic examination, and complete blood count, evaluation of serological markers of HBV, and quantitative detection of HBV-DNA. Results Of the 252 patients included, 88.5% were male with a mean age of 35.4 years. Arthralgia was the most common complaint (15.5%) and hepatomegaly was the most common finding (8.3%). As regards imaging Results (ultrasonographic) the following were found: normal liver in 83.3%, coarse liver in 11.9%, hepatomegaly in 7.5%, splenomegaly in 6.3%, and cirrhosis in 5.9%. As regards laboratory Results normal alanine aminotransferase was found in 79.8%, normal aspartate aminotransferase in 85.7%, reduced serum albumin in 4.4%, and low platelet count in 9.9%. The majority of patients (91.7%) were hepatitis B envelope antigen negative; 65.9% of patients were positive for HBV on PCR. No significant differences were found between positive HBV-DNA status (by PCR) and negative HBV-DNA status as regards clinical, imaging, and laboratory characteristics of patients. Conclusion Most of the patients had normal liver on ultrasonographic examination and normal liver function tests. No significant difference was found between positive HBV-DNA status (by PCR) and negative HBV-DNA status as regards clinical, imaging, and laboratory characteristics of patients

Effects of two enzyme feed additives on digestion and milk production in lactating Egyptian buffaloes

The aim of this study was to evaluate the effect of two commercial enzyme products on milk production in Egyptian buffaloes. Twenty-one lactating buffaloes (570±15 kg BW) were divided into three groups (n=7) in a randomized block design for four months. Buffaloes were fed a total mixed ration containing 60% forage [rice straw and berseem hay (Trifolium alexandrinum)] and 40% concentrates with either no enzymes added (Control) or an addition of 40 g of Veta-Zyme Plus® (VET) or 40 g of Tomoko® (TOM ) enzyme product per day for each buffalo. Enzyme addition did not affect feed intake (P>0.05), but increased the digestibility of nutrients (P<0.05) and serum glucose concentration (P=0.011). Furthermore, the addition of VET increased milk (P=0.017) and fat corrected milk (P=0.021) yields, fat content (P=0.045), total unsaturated fatty acid (P=0.045) and total conjugated linoleic acid (P=0.031) contents in milk and decreased the content of total saturated fatty acids (P=0.046), while the addition of TOM increased milk total protein (P=0.023) and true protein (P=0.031) contents. The two enzyme products both resulted in higher concentrations of lysine (P=0.045) and total essential amino acids (P=0.036) in milk. It was concluded that addition of commercial fibrolytic enzyme products (i.e. Veta-Zyme Plus® and Tomoko®) to the diet of early lactating buffaloes enhanced nutrient digestibility and milk production and quality