The use of thyme and orange essential oils blend to improve quality traits of marinated chicken meat

Abstract Poultry meat contains large quantities of polyunsaturated fatty acids, which lead to oxidative deterioration. Plant essential oils (EO) and natural compounds, with antioxidant properties, may be used to alleviate this problem. Two replications were conducted to evaluate the effects of a mixture (1:1) of thyme and orange oils (EO) on the quality characteristics and the oxidative stability of chicken meat (breast and wing). For each replication, 24 fresh breast fillets and 24 wings were procured from a local grocery store. The EO were added to marinade solution to achieve a final concentration of 0.55% sodium chloride, 0.28% polyphosphate, and 0.05% wt/vol of EO blend. Breasts and wings were split in 2 different groups with homogenous pH and lightness and vacuum tumbled in 2 treatments, a 0.5% EO and a control (CON, no EO). Each group was tested for pH, Commission Internationale d'Eclairage color (lightness, L*; redness, a*; yellowness, b*), moisture content, marinade uptake, purge loss, cook yield, and shear force. Susceptibility to lipid oxidation was determined on fresh and frozen meat by TBA reactive substance analysis (induced oxidation from 0 to 150 min at 37°C). The EO breasts had lower purge loss compared with CON meat. Breast did not show any color, pH, marinade uptake, cooking yield, shear force, or moisture differences due to treatment, although cooked EO breast was slightly less red than CON. The EO wings presented higher a* and b* values after marination and lower purge loss and shear force than CON. No differences were detected on wings for color, pH, marinade uptake, cooking yield, or moisture between EO and CON wings. Both fresh and frozen EO breasts and EO wings were less susceptible to the lipid oxidation during all induced oxidation times compared with CON breasts and wings. In conclusion, EO had a positive effect on broiler breast and wing lipid oxidation without negatively affecting meat quality traits

A hospital Protocol for decision making in Emergency Admission for Acute Diverticulitis: Initial Results from Small Cohort series

Background and objectives: We present initial results from a small cohort series for a hospital protocol related to the emergency hospitalization decision-making process for acute diverticulitis. We performed a retrospective analysis of 53 patients with acute diverticulitis admitted to the Department of Emergency and Trauma Surgery of the "Azienda Ospedaliero Universiaria-Ospedali Riuniti" in Ancona and to the Department of General and Emergency Surgery of the "Azienda Ospedaliera-Universitaria" in Perugia. Materials and Methods: All patients were evaluated according to hemodynamic status: stable or unstable. Secondly, it was distinguished whether patients were suffering from complicated or uncomplicated forms of diverticulitis. Finally, each patient was assigned to a risk class. In this way, we established a therapeutic/diagnostic process for each group of patients. Results: Non-operative treatment (NonOP) was performed in 16 patients, and it was successful in 69% of cases. This protocol primarily considers the patient's clinical condition and the severity of the disease. It is based on a multidisciplinary approach, in order to implement the most suitable treatment for each patient. In stable patients with uncomplicated diverticulitis or complicated Hinchey grade 1 or 2 diverticulitis, the management is conservative. In all grade 3 and grade 4 forms, patients should undergo urgent surgery. Conclusions: This protocol, which is based on both anatomical damage and the severity of clinical conditions, aims to standardize the choice of the best diagnostic and therapeutic strategy for the patient in order to reduce mortality and morbidity related to this pathology

The role of grade of injury in non-operative management of blunt hepatic and splenic trauma. Case series from a multicenter experience

This retrospective study shows the results of a 2 years application of a clinical pathway concerning the indications to NOM based on the patient's hemodynamic answer instead of on the injury grade of the lesions.We conducted a retrospective study applied on a patient's cohort, admitted in "Azienda Ospedaliero-Universitaria Ospedali Riuniti of Ancona" and in the Digestive and Emergency Surgery Department of the Santa Maria of Terni hospital between September 2015 and December 2017, all affected by blunt abdominal trauma, involving liver, spleen or both of them managed conservatively. Patients were divided into 3 main groups according to their hemodynamic response to a fluid administration: stable (group A), transient responder (group B) and unstable (group C). Management of patients was performed according to specific institutional pathway, and only patients from category A and B were treated conservatively regardless of the injury grade of lesions.From October 2015 to December 2017, a total amount of 111 trauma patients were treated with NOM. Each patient underwent CT scan at his admission. No contrast pooling was found in 50 pts. (45.04%). Contrast pooling was found in 61 patients (54.95%). The NOM overall outcome resulted in success in 107 patients (96.4%). NOM was successful in 100% of cases of liver trauma patients and was successful in 94.7% of splenic trauma patients (72/76). NOM failure occurred in 4 patients (5.3%) treated for spleen injuries. All these patients received splenectomy: in 1 case to treat pseudoaneurysm, (AAST, American Association for the Surgery of Trauma, grade of injury II), in 2 cases because of re-bleeding (AAST grade of injury IV) and in the remaining case was necessary to stop monitoring spleen because the patient should undergo to orthopedic procedure to treat pelvis fracture (AAST grade of injury II).Non-operative management for blunt hepatic and splenic lesions in stable or stabilizable patients seems to be the choice of treatment regardless of the grade of lesions according to the AAST Organ Injury Scale

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Damage Control Surgery for Perforated Diverticulitis with Generalized Peritonitis: Better a Delayed Anastomosis than a Stoma Right Away.

Introduction. In the last decade, Damage Control Surgery (DCS) has been emerging as a feasible alternative management of patients with abdominal infection and sepsis. So far, there is no consensus about the role of DCS in perforated acute diverticulitis. In this study, we present the outcome from a multi-institutional series of patients presenting with grade III and IV Hinchey’s diverticulitis and managed by DCS. Method. All the partecipating centers were tertiary referral hospitals. A total of 34 patients with perforated diverticulitis treated with DCS and admitted between June 2015 and September 2017 were included in the study. During the first laparotomy, a limited resection of the diseased segment followed by a lavage and the application of an open abdomen technique was performed. After patient resuscitation, a second look was performed after 24/48 hours. Demographics, clinical, intra-operative and post-operative variables were carefully analyzed. Mortality, morbidity, and restoration of bowel continuity were the major outcomes of the study. Results. There were 15 male (44%) and 19 female (56%) with a mean age of 66,9 years (SD ± 12,7). Mean BMI was 28,42 Kg/m² (SD ± 3,33). Based on the severity of the disease, 13 cases (38%) were classified as Wasvary’s modified Hinchey’s stage III, and 21 cases (62%) as Hinchey IV. Mean Mannheim Peritonitis Index (MPI) was 25,12 (SD ± 6,28). In 22 (65%), ASA score was ≥ grade III. In all cases, the open abdomen was created by using a Negative Pressure Wound Therapy (NPWT) technique. At the second operation, twenty-four patients (71%) had a primary anastomosis, while 10 (29%) were treated with an end colostomy (Hartmann’s procedure). In 7/34 (21%) cases, a third look was needed. In 2/24 patients, a temporary loop ileostomy was required: both of them were closed in a second moment. Mortality rate was 12%. Overall morbidity rate was 53% (18/34). According to Claviend and Dindo classification, there were no grade I, 6/18 grade II, 1/18 grade IIIa, 5/18 grade IIIb and 2/18 grade IV. Reinterventions were required in 4/34 (12%): two for intestinal anastomosis dehiscence and two for abdominal wound dehiscence. Mean lenght of hospital stay was 21,9 days. Conclusion. DCS is feasable for patients with generalized peritonitis from perforated diverticulitis and it seems related to a higher rate of bowel reconstruction. Due to the open abdomen, it requires a stay in ICU with a prolonged mechanical ventilation but these same needs are often the burden of the majority of patients undergone surgery for a perforated diverticulitis, whatever the procedure is done