Study on myrmecodia platytyrea antoinii tuber and its potential benefits in preventing hypercholesterolemia related diseases / Mohd Kamal Nik Hasan

This study was designed in order to investigate the effect of Myrmecodia platytyrea (MyP) extract as an anti-hypercholesterolemic agent. The acute toxicological test was done by administration of single dose and followed by 14 days observation on the rat. The subchronic toxicological test was done by administration of 28 days repeated dose. Both tests showed that MyP water extract was not toxic. The bioassay-guided isolation revealed that the MyP water extract containing 2-(2-methylbutyryl) phloroglucinol glucoside which reduced 3-hydroxy-3-methylglutaryl-CoA reductase (HMGR) activity (p<0.05) with inhibition concentration 50 (IC₅₀) of 75 μg/ml. Besides that, polysaccharide showed effective concentration 50 (EC₅₀) of 50.5 μg/ml for bile acid binding. Meanwhile, rutin actively decreased pancreatic lipase activity with IC₅₀ of 130 μg/ml. Moreover, in vivo study results showed that treatment of MyP water extract can significantly reduce (p<0.05) low-density lipoprotein (LDL) compared to negative control group. The extract significantly increased (p<0.05) high-density lipoproteins (HDL) concentration compared to negative control group. In addition, MyP water extract increased faecal cholesterol and faecal bile compared to normal control group. Lipid peroxidation was significantly decreased (p<0.05) in MyP water extract treatment group. The extract also decreased the formation of the fatty streak at the aorta and significantly decreased (p<0.05) the thickness of foam cell in high cholesterol diet (HCD) induced rat

Toxicity screening and hypocholesterolemic effect evaluation of aqueous extract of anacardium occidentale Linn. in hypercholesterolemic induced rabbits.

Previous findings have supported to the ethnopharmacological use of Anacardium occidentale Linn. in folk medicine. In this study, the toxicity properties and the hypocholesterolemic effect of aqueous extract of Anacardium occidentale Linn. were evaluated in hypercholesterolemic induced rabbits. Thirty Five male New Zealand White Rabbits were randomly assigned into five groups and fed with normal diet (NC), 0.5% high cholesterol diet (PC), 0.5% high cholesterol diet+10 mg/kg simvastatin (SC), 0.5% high cholesterol diet+100 mg/kg AOE (AOE100) and 0.5% high cholesterol diet+200 mg/kg AOE (AOE200). The study duration was set for 12 weeks. In vitro toxicity study has been performed using brine shrimp lethality test and MTT assay to determine the LC50 and IC50 values respectively while in vivo toxicity study has been evaluated in hypercholesterolemic induced rabbits. Blood samples were withdrawn at week 0 and 12. Supplementation of 0.5% high cholesterol diet caused the elevation of TC, LDL and TG and also significantly rise (p<0.05) the level of liver enzymes compared to the normal control group. For in vitro toxicity screening, extracts demonstrated very low LC 50 values and no IC 50 value detected. For in vivo hypercholesterolemic induced rabbits, extracts were able to prevent the increment of liver enzymes: gammaglutamyl transferase, alkaline phosphatase, aspartate aminotransferase and alanine aminotransferase compared to positive control group. Aqueous extract of AO found to be not toxic and posses hypocholesterolemic and hepatoprotective effects in hypercholesteromic induced rabbits

Toxicity Screening and Hypocholesterolemic Effect Evaluation of Aqueous Extract of Anacardium occidentale Linn. in Hypercholesterolemic Induced Rabbits

Background: Previous findings have supported to the ethnopharmacological use of Anacardium occidentale Linn. in folk medicine. In this study, the toxicity properties and the hypocholesterolemic effect of aqueous extract of Anacardium occidentale Linn. were evaluated in hypercholesterolemic induced rabbits. Methods: Thirty Five male New Zealand White Rabbits were randomly assigned into five groups and fed with normal diet (NC), 0.5% high cholesterol diet (PC), 0.5% high cholesterol diet+10 mg/kg simvastatin (SC), 0.5% high cholesterol diet+100 mg/kg AOE (AOE100) and 0.5% high cholesterol diet+200 mg/kg AOE (AOE200). The study duration was set for 12 weeks. In vitro toxicity study has been performed using brine shrimp lethality test and MTT assay to determine the LC50 and IC50 values respectively while in vivo toxicity study has been evaluated in hypercholesterolemic induced rabbits. Blood samples were withdrawn at week 0 and 12. Results: Supplementation of 0.5% high cholesterol diet caused the elevation of TC, LDL and TG and also significantly rise (p&lt;0.05) the level of liver enzymes compared to the normal control group. For in vitro toxicity screening, extracts demonstrated very low LC50 values and no IC50 value detected. For in vivo hypercholesterolemic induced rabbits, extracts were able to prevent the increment of liver enzymes: gamma-glutamyl transferase, alkaline phosphatase, aspartate aminotransferase and alanine aminotransferase compared to positive control group. Conclusion: Aqueous extract of AO found to be not toxic and posses hypocholesterolemic and hepatoprotective effects in hypercholesteromic induced rabbits

Toxicity Screening and Hypocholesterolemic Effect Evaluation of Aqueous Extract of Anacardium occidentale Linn. in Hypercholesterolemic Induced Rabbits

Background: Previous findings have supported to the ethnopharmacological use of Anacardium occidentale Linn. in folk medicine. In this study, the toxicity properties and the hypocholesterolemic effect of aqueous extract of Anacardium occidentale Linn. were evaluated in hypercholesterolemic induced rabbits. Methods: Thirty Five male New Zealand White Rabbits were randomly assigned into five groups and fed with normal diet (NC), 0.5% high cholesterol diet (PC), 0.5% high cholesterol diet+10 mg/kg simvastatin (SC), 0.5% high cholesterol diet+100 mg/kg AOE (AOE100) and 0.5% high cholesterol diet+200 mg/kg AOE (AOE200). The study duration was set for 12 weeks. In vitro toxicity study has been performed using brine shrimp lethality test and MTT assay to determine the LC50 and IC50 values respectively while in vivo toxicity study has been evaluated in hypercholesterolemic induced rabbits. Blood samples were withdrawn at week 0 and 12. Results: Supplementation of 0.5% high cholesterol diet caused the elevation of TC, LDL and TG and also significantly rise (p&lt;0.05) the level of liver enzymes compared to the normal control group. For in vitro toxicity screening, extracts demonstrated very low LC50 values and no IC50 value detected. For in vivo hypercholesterolemic induced rabbits, extracts were able to prevent the increment of liver enzymes: gamma-glutamyl transferase, alkaline phosphatase, aspartate aminotransferase and alanine aminotransferase compared to positive control group. Conclusion: Aqueous extract of AO found to be not toxic and posses hypocholesterolemic and hepatoprotective effects in hypercholesteromic induced rabbits

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

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake