Growth of lettuce with different content of inorganic nitrate as a feeding strategy for placebo-controlled nutritional interventions to test the effects of inorganic nitrate on human health

PhD ThesisThe chemical composition of vegetables is dependent on several growing conditions. This effect relates to phytochemical compounds including secondary metabolites and other bioactive non-nutritional compounds. This study aimed to use different nitrogen fertilizer regimes to produce vegetables with so large differences in nitrate content that they can be used as treatment and placebo to study the effect of nitrate on human health. Green leafy vegetables, such as lettuce or rocket, are rich in inorganic nitrate (NO3) and an increased consumption has been associated with beneficial effects on blood pressure (BP). The objective of this study was to compare whether two lettuce materials with controlled high and low NO3 content may have different effects on BP in healthy subjects. Firstly a gas chromatography mass spectrometry (GC-MS) method using pentafluorobenzyl bromide and chemical ionisation to determine nitrate and nitrite levels was modified to optimise the analytical process. This method has been used to measure samples of lettuce as well as samples of human plasma, urine and saliva obtained from this study and several other projects. In this study, two sets of lettuce were produced as a model vegetable with high and low nitrogen fertiliser in controlled growing conditions to manipulate nitrate concentration of the vegetable as a tool for investigating the effect of nitrate content of food on human health. This was tested by determining the correlations between nitrate intake and blood pressure (BP), by measuring the short effect on systolic and diastolic BP and nitrate and nitrite contents in blood, urine and saliva samples. The novelty of this study is that the placebo and the treatment (lettuce with low and high nitrate content, respectively) have similar appearance despite being very different in nitrate content, making it possible to blind the subjects to the treatment and control placebo effects of vegetable consumption. Using 26 and 154ppm ammonium nitrate in the fertigation solution, lettuce was produced with a high (~530 mg nitrate/50g FW portion) or low (~3 mg/50g) nitrate content. However not all confounding factors could be controlled, e.g. the low nitrate lettuce produced a high amount of phenolic acids which was 69.5 mg/50g FW and high nitrate lettuce produced a much lower amount which10.5mg/50g FW (P<0.001). So while the nitrate content can be manipulated substantially via fertilizer treatments, the low-nitrate lettuce also differs from the high-nitrate lettuce in the content of other non-nutrient phytochemicals. An intervention trial was carried out with twenty healthy young volunteers (12 females and 8 males) in a randomised, double-blind placebo controlled cross-over design, with two 24-hour ii intervention phases separated by a 3-week washout period to avoid carry-over effects. Blood pressure was recorded by 24-hour ambulatory blood pressure monitoring (ABPM), every 30 mins during day-time and every 60 min at night-time. Consumption of high nitrate lettuce significantly increased plasma NO3 (3 hrs post-ingestion: 395±133 μM; P<0.001), salivary NO3 (3 hrs post-ingestion: 7362±4666 μM; P<0.001) and urinary NO3 (3 hrs post-ingestion: 2287±1233μM; P<0.001) concentrations whereas non-significant changes were measured in the low nitrate lettuce group. High nitrate lettuce significantly reduced systolic BP (-2.80±4.43 mmHg and -6.85±4.91 mmHg after 3 and 6 hrs, respectively; P=0.003) and diastolic BP (-2.25±2.34mmHg and Δ3.85±3.01 mmHg after 3h and 6 hrs, respectively; P=0.002) compared to low nitrate lettuce. No significant difference was observed between high nitrate lettuce and low nitrate lettuce for TEAC (P = 0.32), FRAP (P = 0.26), cGMP (P = 0.19) and plasma concentrations of phenolic compounds. The results showed that the amount of urinary nitrate excreted during a 24-hour period increased from 104mg with low nitrate lettuce to 391mg (P<0.001) with the high nitrate lettuce. In conclusion, ingestion of high nitrate lettuce significantly increases plasma, saliva and urinary nitrate and lowers systolic and diastolic BP compared to low nitrate lettuce. The development of NO3-enriched and NO3-depleted vegetable products with similar organoleptic characteristics could provide a unique opportunity to conduct double-blind nutritional interventions and advance knowledge on the role of dietary nitrate on human health.Iraqi Government, The Higher Committee for Education Development (HCED) in Iraq for providing this scholarship to doctoral studies

Black hole algorithm along edge detector and circular hough transform based iris projection with biometric identification systems

The circular parameters between the pupil and the iris are found using current iris identification techniques but the accuracy creates an issue for the detection process during image processing. The procedure of extracting the iris region from an eye image using circular parameters can be improved via approximately too many approaches in literature but remain some portions under slightly unconstrained circumstances. In this study, we presented a Black Hole Algorithm (BHA) along the Canny edge detector and circular Hough transform-based optimization technique for circular parameter identification of iris segmentation. The iris boundary is discovered using the suggested segmentation approach and a computational model of the pixel value. The BHA looks for the central radius of the iris and pupil. The system uses MATLAB to test the CASIA-V3 database. The segmented images exhibit 98.71% accuracy. For all future access control applications, the segmentation-based BHA is effective at identifying the iris. The integration of the BHA with the Hough transforms and Canny edge detector is the main method by which the iris segmentation is accomplished. This novel technique improves the accuracy and effectiveness of iris segmentation, with potential uses in image analysis and biometric identification

Determination of some heavy metals in imported rice grains (Oryza sativa) available in Sulaymaniyah market and evaluation of their health risk assessment

This investigation was conducted to assess the levels of some heavy metals such as arsenic, lead, cadmium, chromium, copper, zinc, iron, nickel, and manganese in imported rice sold on the Sulaymaniyah market – Iraqi Kurdistan. The potential human health risk assessment was conducted by considering estimated weekly intake (EWI) of heavy metals from eating rice and calculated values compared with provisional tolerable weekly intake (PTWI). The mean values for copper, manganese and zinc were considerably higher than allowable limits set by FAO/WHO. While the lead value in the entire rice types were lower than allowable limits set by FAO/WHO except (Uruguayan rice R9 and R12, Iranian rice R20, American rice R24, and Russian rice R26). The concentration of iron and nickel in some rice brands were less than the standard limit, and the chromium value was within the safe limit except for these (Indian rice R1, Uruguayan rice R12, Iranian rice R20, Chinese rice R33) brands, which were higher than the acceptable limit. EWI for chromium and nickel in most samples were higher than the PTWI. Also, EWI for zinc, manganese, and copper was higher than the PTWI set by FAO/WHO. Moreover, the EWI for lead were considerably higher than other measured toxic metals, and the highest mean level of EWI for lead was observed in some imported rice samples. Thus, the high consumption of rice contaminated with heavy metals can cause potential health risks to the Kurdish population in Kurdistan. More consideration should be given to contaminated rice and prevention and control measures should be taken

Effect of Video Game on School Achievement in School Age Children in Erbil/City

Background and objectives: Playing video games is associated with poor academic achievement, Student who got their game systems directly spent less time on homework and, four months later, they got lower reading and writing scores, their teachers were more likely to report academic difficulties. The aim of study is to identify the effect of play video game on school achievement. Methods: A cross sectional descriptive study was carried out at five primary school in Erbil city 50 students was taken as a case group compared with 200 students as control group started from 15 September to 15 November 2020. A Questionnaire format was used as a tool for data collection and consists, demographic information of the students, parents and some Items about students game, Official permission has been obtained from College of Nursing / Hawler Medical University, Ministry of Education and primary schools. Data was analyzed through using frequency, percentage and chi-square by using SPSS, 22. Results: The study reveal that 58% of participants were age group between 12-14 years old, 74% of them were boys among playing group, 18% of father were graduated from college, 60% of played children were from middle socioeconomic status, 16% of game players have missed school, 66% of played students were missed homework, about 10% of the students have a good school achievement among who played video games and more than half (58%) among non-play students. There is highly significant association between parent educational levels with their children school achievement. Conclusions: Playing video game was negatively associated with poor school achievement. The study recommended the parent to limit the time of playing less than one hour daily, also limit the number and type of game especially fighting game and replaced with educational game.

Lack of association between the eNOS rs1800779 (A/G) polymorphism and the myocardial infarction incidence among the Iraqi Kurdish population

Objectives The genetic polymorphisms of the endothelial nitric oxide synthase (eNOS) gene are strongly associated with several cardiovascular diseases (CVDs) in various populations. The current study aimed to investigate the association of the eNOS rs1800779 (A/G) polymorphism with the progress of myocardial infarction (MI). Methods Eighty-five healthy subjects and 80 patients with MI admitted to the Erbil Cardiac Centre in the Kurdistan Region of Iraq were enrolled in the study. All participants were Kurdish from the same ethnic group. The amplification refractory mutation system polymerase chain reaction (ARMS-PCR) was used to determine the rs1800779 (A/G) polymorphism of eNOS, and the nitric oxide (NO) serum level was detected by spectrophotometer. Results The genotypic frequencies of the eNOS rs1800779 AA (wild type), AG, and GG were 58.75%, 33.75%, and 7.50%, respectively, in the MI patients, and 49.41%, 43.53%, and 7.06%, respectively, for the control group. The frequencies of the A and the G alleles were 75.6% and 24.4%, respectively, in the MI group, and 71.2% and 28.8%, respectively, in the control subjects. The results revealed a lack of association of the rs1800779 genotype distribution with the level of NO serum and increased risk of MI. Conclusion The study concluded that there is a lack of association between the genotypes and alleles of the rs1800779 eNOS and susceptibility to MI in the studied population

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Global Retinoblastoma Presentation and Analysis by National Income Level.

Importance: Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale. Objectives: To report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis. Design, Setting, and Participants: A total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017. Main Outcomes and Measures: Age at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis. Results: The cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4%) were female. Most patients (n = 3685 [84.7%]) were from low- and middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n = 2638 [62.8%]), followed by strabismus (n = 429 [10.2%]) and proptosis (n = 309 [7.4%]). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5%) patients having intraocular retinoblastoma and 2 (0.3%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1%) having extraocular retinoblastoma and 94 of 498 (18.9%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle-income countries and HICs, 17.92 [95% CI, 12.94-24.80], and for lower-middle-income countries vs upper-middle-income countries and HICs, 5.74 [95% CI, 4.30-7.68]). Conclusions and Relevance: This study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs

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

The global retinoblastoma outcome study : a prospective, cluster-based analysis of 4064 patients from 149 countries

DATA SHARING : The study data will become available online once all analyses are complete.BACKGROUND : Retinoblastoma is the most common intraocular cancer worldwide. There is some evidence to suggest that major differences exist in treatment outcomes for children with retinoblastoma from different regions, but these differences have not been assessed on a global scale. We aimed to report 3-year outcomes for children with retinoblastoma globally and to investigate factors associated with survival. METHODS : We did a prospective cluster-based analysis of treatment-naive patients with retinoblastoma who were diagnosed between Jan 1, 2017, and Dec 31, 2017, then treated and followed up for 3 years. Patients were recruited from 260 specialised treatment centres worldwide. Data were obtained from participating centres on primary and additional treatments, duration of follow-up, metastasis, eye globe salvage, and survival outcome. We analysed time to death and time to enucleation with Cox regression models. FINDINGS : The cohort included 4064 children from 149 countries. The median age at diagnosis was 23·2 months (IQR 11·0–36·5). Extraocular tumour spread (cT4 of the cTNMH classification) at diagnosis was reported in five (0·8%) of 636 children from high-income countries, 55 (5·4%) of 1027 children from upper-middle-income countries, 342 (19·7%) of 1738 children from lower-middle-income countries, and 196 (42·9%) of 457 children from low-income countries. Enucleation surgery was available for all children and intravenous chemotherapy was available for 4014 (98·8%) of 4064 children. The 3-year survival rate was 99·5% (95% CI 98·8–100·0) for children from high-income countries, 91·2% (89·5–93·0) for children from upper-middle-income countries, 80·3% (78·3–82·3) for children from lower-middle-income countries, and 57·3% (52·1-63·0) for children from low-income countries. On analysis, independent factors for worse survival were residence in low-income countries compared to high-income countries (hazard ratio 16·67; 95% CI 4·76–50·00), cT4 advanced tumour compared to cT1 (8·98; 4·44–18·18), and older age at diagnosis in children up to 3 years (1·38 per year; 1·23–1·56). For children aged 3–7 years, the mortality risk decreased slightly (p=0·0104 for the change in slope). INTERPRETATION : This study, estimated to include approximately half of all new retinoblastoma cases worldwide in 2017, shows profound inequity in survival of children depending on the national income level of their country of residence. In high-income countries, death from retinoblastoma is rare, whereas in low-income countries estimated 3-year survival is just over 50%. Although essential treatments are available in nearly all countries, early diagnosis and treatment in low-income countries are key to improving survival outcomes.The Queen Elizabeth Diamond Jubilee Trust and the Wellcome Trust.https://www.thelancet.com/journals/langlo/homeam2023Paediatrics and Child Healt