Physico-Chemical and Functional Properties of Cookies Produced from Sweet Potato- Maize Flour Blends

This study was carried out to observe the physico-chemical and functional properties of cookies produced from sweet potato- maize flour blends. Substitution of maize flour with sweet potato flour reduced the protein from 6.8-4.4%, moisture from 5.3-5.0%, crude fibre 3.4-2.5% and fat 9.8-8.5% of the composite flours and the cookies. The ash and sugar contents were increased from 4.3-5.8% for ash and 2.1-3.9% for sugar with increase in sweet potato flour substitution. The calorific value of the cookies decreased from 457-397cal/100g as the percentage of sweet potato flour increased in the maize flour cookies. The water binding capacity increased from 0.9-1.7 and the starch swelling power decreased from 10.1-5.3 at 950C with increase in sweet potato flour content in the flour mixture. The bulk density and dispensability decreased from 4.6-3.3g/ml and 48.3-47.1ml/g respectively in the flour as the content of the sweet potato in the composition increased. Keywords: cookies, sweet potato, maize, flour, quality

Performance, haemato-biochemical indices and antioxidant status of growing rabbits fed on diets supplemented with Mucuna pruriens leaf meal

[EN] The effects of dietary Mucuna pruriens leaf meal (MLM) supplementation on rabbits’ performance, haemato-biochemical indices and antioxidant status outside their thermal neutrality zone (21 to 25°C) were evaluated. One hundred and twenty 35-d old crossbreed (Chinchilla×New Zealand) rabbits weighing 694±5 g were allotted to 4 treatments (30 rabbits/treatment; 3 rabbits/replicate). A basal diet (crude protein: 16.9%, crude fibre: 17.6%, digestible energy: 2671 kcal/kg) was divided into 4 equal portions i.e. diets 1, 2, 3 and 4, supplemented with 0, 4, 8 and 12 g MLM/kg, respectively, and pelleted. The average body weight in rabbits fed on diets 3 and 4 was higher compared to those fed on diet 1 (control) at 91 d of age (+228 and +262 g, respectively; P=0.01). Within 35 to 91 d, the average daily weight gain in rabbits fed on diets 3 and 4 was higher compared to those fed on the control diet (+4.1and +4.8 g/d, respectively; P=0.01). The dressing-out percentage of rabbits fed on diets 3 and 4 increased (P=0.05) compared to those fed the control diet. At 63 d and 91 d of age, the white blood cell level of rabbits fed on diet 4 increased significantly compared to those fed the control diet (+5.05×109 and +5.32×109/L, respectively). At 63 and 91 d of age, the cholesterol level of rabbits fed on diets 3 (–1.0 and –1.16 mmol/L, respectively) and 4 (–1.10 and –1.21 mmol/L, respectively), were significantly lower compared to those fed on the control diet. The aspartate aminotransferase (AST) concentration in rabbits fed on diet 4 was reduced compared to those on control diet at 63 d of age (–33.68 IU/L; P=0.02). 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Shelf Life Study and Quality Attributes of Cocoyam Chips

The study was carried out to determine changes in the quality indices (levels of peroxides values, acid values, pH and colour) of cocoyam chips and microbiological safety (bacterial, yeast and mould counts) of cocoyam chips as influenced by temperature during storage period of fried cocoyam chips. Cocoyam tubers were processed into chips of 3mm thickness; the slices were then fried at a frying temperature of 170°C in a shallow pot for 7 minutes and was packaged in polyethylene bags and stored under room and refrigerator temperature. The results showed that there was significant difference (p≤0.05) between quality indices, microbiological safety and storage temperature and packaging materials. From week 0-5, peroxide values of samples stored under refrigeration temperature were found to be low, ranged from 3.39 - 11.58 meq kg-1, while the samples stored in the room temperature were found to be higher 3.81 - 12.87 meq kg-1. Acid values were also found to be low in the samples stored in the refrigerator, ranged from 5.79 - 16 3.34mg/g and the samples that were stored in the room temperature ranged from 9.94 - 24.05mg/g. The samples stored under refrigeration temperature had low bacterial counts ranged from 5.0 x 101 - 6.2 x 101 cfu/ml while samples stored in the room temperature had higher bacterial counts, ranged from 9.0 x 101 – 74 x 101 cfu/ml. Yeast and mould counts in samples stored under refrigeration temperature ranged from 4.0 x 101 - 32 x 10 cfu/ml while the samples that were stored in room temperature had higher counts, ranged from 3.0 x 10 – 38 x 10 cfu/ml. pH ranged between 6.88 - 7.02 for both samples during storage period. The results showed that storage temperature and properly sealed packaging material has effect on the above parameters that were determined. There were also colour changes during the storage period

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

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

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 wealth disparities drive adherence to COVID-safe pathways in head and neck cancer surgery

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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

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