Differences in zinc status and the leptin axis in anorexic and recovered adolescents and young adults: a pilot study

Evidence from animal studies suggests that leptin metabolism is associated with zinc (Zn) status. However, research investigating this relationship in adolescents and young adults with anorexia nervosa (AN) is scarce; the present study aims to fill that gap.Serum concentrations of leptin, the soluble leptin receptor (sOB-R) and the free leptin index (FLI) were obtained in healthy control subjects (n=19), acutely ill individuals (n=14) and recovered patients with AN (n=15). Serum Zn concentrations noted in previous research data were also incorporated for all groups.Leptin, FLI and Zn concentrations were higher in recovered subjects with AN when compared with acutely ill AN patients. Remitted patients showed higher sOB-R concentrations but no difference in FLI compared with the control group. Leptin and FLI were lower in the acutely ill patients compared with the control subjects, who showed no differences in Zn concentrations. Zn concentrations were not correlated with leptin, sOB-R or FLI concentrations in any of the three investigated subgroups.The present investigation does not entirely support an association between Zn, Leptin and FLI concentrations in subjects with AN, possibly due to limited statistical power. Further research and replication of the present findings related to the interaction between leptin and Zn is warranted. However, with respect to serum leptin levels the data of the present investigation indicate that acutely ill and remitted patients with AN differ as regards serum leptin concentrations and FLI, which is in line with previous research

Rationale and design of a proof-of-concept trial investigating the effect of uninterrupted perioperative (par)enteral nutrition on amino acid profile, cardiomyocytes structure, and cardiac perfusion and metabolism of patients undergoing coronary artery bypass grafting

<p>Abstract</p> <p>Background</p> <p>Malnutrition is very common in patients undergoing cardiac surgery. Malnutrition can change myocardial substrate utilization which can induce adverse effects on myocardial metabolism and function. We aim to investigate the hypothesis that there is a disturbed amino acids profile in the cardiac surgical patient which can be normalized by (par)enteral nutrition before, during and after surgery, subsequently improving cardiomyocyte structure, cardiac perfusion and glucose metabolism.</p> <p>Methods/Design</p> <p>This randomized controlled intervention study investigates the effect of uninterrupted perioperative (par)enteral nutrition on cardiac function in 48 patients undergoing coronary artery bypass grafting. Patients are given enteral nutrition (n = 16) or parenteral nutrition (n = 16), at least two days before, during, and two days after coronary artery bypass grafting, or are treated according to the standard guidelines (control) (n = 16). We will illustrate the effect of (par)enteral nutrition on differences in concentrations of amino acids and asymmetric dimethylarginine and in activity of dimethylarginine dimethylaminohydrolase and arginase in cardiac tissue and blood plasma. In addition, cardiomyocyte structure by histological, immuno-histochemical and ultrastructural analysis will be compared between the (par)enteral and control group. Furthermore, differences in cardiac perfusion and global left ventricular function and glucose metabolism, and their changes after coronary artery bypass grafting are evaluated by electrocardiography-gated myocardial perfusion scintigraphy and ¹⁸F-fluorodeoxy-glucose positron emission tomography respectively. Finally, fat free mass is measured before and after intervention with bioelectrical impedance spectrometry in order to evaluate nutritional status.</p> <p>Trial registration</p> <p>Netherlands Trial Register (NTR): <a href="http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2183">NTR2183</a></p

Effectiveness of a multidimensional approach for prevention of ventilator-associated pneumonia in 11 adult intensive care units from 10 cities of Turkey: Findings of the International Nosocomial Infection Control Consortium (INICC)

Purpose: To evaluate the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional approach on the reduction of ventilator-associated pneumonia (VAP) in adult patients hospitalized in 11 intensive care units (ICUs), from 10 hospitals, members of the INICC, in 10 cities of Turkey. Methods: A prospective active before-after surveillance study was conducted to determine the effect of the INICC multidimensional approach in the VAP rate. The study was divided into two phases. In phase 1, active prospective surveillance of VAP was conducted using the definitions of the Centers for Disease Control and Prevention National Health Safety Network, and the INICC methods. In phase 2, we implemented the multidimensional approach for VAP. The INICC multidimensional approach included the following measures: (1) bundle of infection control interventions, (2) education, (3) outcome surveillance, (4) process surveillance, (5) feedback of VAP rates, and (6) performance feedback of infection control practices. We compared the rates of VAP obtained in each phase. A time series analysis was performed to assess the impact of our approach. Results: In phase 1, we recorded 2,376 mechanical ventilator (MV)-days, and in phase 2, after implementing the multidimensional approach, we recorded 28,181 MV-days. The rate of VAP was 31.14 per 1,000 MV-days during phase 1, and 16.82 per 1,000 MV-days during phase 2, amounting to a 46 % VAP rate reduction (RR, 0.54; 95 % CI, 0.42-0.7; P value, 0.0001.) Conclusions: The INICC multidimensional approach was associated with a significant reduction in the VAP rate in these adult ICUs of Turkey. © 2013 Springer-Verlag Berlin Heidelberg

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Somatostatin: Possible cause of bacterial translocation in obstructive jaundiced rats

The purpose of this study was to examine the effect of endogenous somatostatin hormone on bacterial translocation in obstructive jaundiced rats. Five groups of rats were studied: group I (n = 10), non-operated group (control); group II (n = 10), sham-operated group which underwent laparotomy and dissection of portal elements, while the common bile duct was not ligated and somatostatin was not injected; group III (n = 10), same as group II, plus injection of somatostatin; group IV (n = 10), common bile duct was ligated with laparotomy but somatostatin was not injected; group V (n = 10), same as group IV, plus somatostatin injection. The blood was analyzed for somatostatin, alkaline phosphatase, and bilirubin levels on the third and tenth days in all animals. At study termination (tenth day), peritoneal swab and blood cultures were taken, and liver, spleen, lung, and mesenteric lymph nodes were harvested for microbiological studies. Bacterial translocation levels were higher in groups III, IV, and V when compared with levels in groups I and II. Similar translocation levels were obtained when blood somatostatin levels were comparable. However, the highest translocation rate was found in groups IV and V in which the blood somatostatin level was also higher when compared with that in other groups. This finding shows that blood somatostatin level is increased in obstructive jaundice. This may explain the bacterial translocation and related sepsis found in obstructive jaundice. © Springer-Verlag 1999

Nosocomial infections encountered in the anesthesiology intensive care unit

Materials and methods: The study was performed within a six-month period in 117 patients (69 men, 48 women; mean age 61 18 years) who stayed at our intensive care unit for more than 48 hours and had no signs of infection on admission. The patients were followed-up prospectively by a laboratory-and patient-based active surveillance system. Diagnosis of nosocomial infections was based on the criteria of the Centers for Disease Control and Prevention.Objective: The aim of this study was to determine the types of nosocomial infections, pathogens, and their antimicrobial resistance patterns in patients admitted to the Anesthesiology Intensive Care Unit of Medicine Faculty of Pamukkale University.Results: Sixty-one patients (52.1%) developed 89 episodes of nosocomial infections. The infection rate was 38.5% among all the patients admitted to our intensive care unit in the same period. The types of infections were as follows: ventilator-associated pneumonia (42 episodes, 47.2%), bloodstream infections (n=20, 22.5%), urinary tract infections (n=14, 15.7%), catheter-related infections (n=7, 7.9%), and surgical site infections (n=6, 6.7%). A total of 121 pathogens were isolated, including gram-positive bacteria (n=38, 31.4%), gram-negative bacteria (n=69, 57%), and Candida spp. and Aspergillus spp. (n=14, 11.6%). The most frequently isolated five pathogens were Pseudomonas aeruginosa (25.1%), Acinetobacter baumannii (17.4%), Staphylococcus aureus (15.7%), coagulase-negative staphylococci (12.4%), and Candida spp. (10.7%). Resistance to methicillin was 84.6% among S. aureus isolates, with none being resistant to vancomycin. The lowest resistance rate in P. aeruginosa strains was against amikacin (21%), while the most susceptible antibiotics were netilmicin (69.3%) and trimethoprimsulfannethoxazole (61.6%) for A. baumannii isolates.Conclusion: Nosocomial infection surveillance studies should be performed meticulously in intensive care units and new and effective infection control policies should be developed with a multidisciplinary approach