Statin therapy in critical illness : an international survey of intensive care physicians' opinions, attitudes and practice

Background Pleotropic effects of statins on inflammation are hypothesised to attenuate the severity of and possibly prevent the occurrence of the host inflammatory response to pathogen and infection-related acute organ failure. We conducted an international survey of intensive care physicians in Australia, New Zealand (ANZ) and United Kingdom (UK). The aims of the survey were to assess the current prescribing practice patterns, attitudes towards prescribing statin therapy in critically ill patients and opinions on the need for an interventional trial of statin therapy in critically ill patients. Methods Survey questions were developed through an iterative process. An expert group reviewed the resulting 26 items for face and content validity and clarity. The questions were further refined following pilot testing by ICU physicians from Australia, Canada and the UK. We used the online Smart SurveyTM software to administer the survey. Results Of 239 respondents (62 from ANZ and 177 from UK) 58% worked in teaching hospitals; most (78.2%) practised in ‘closed’ units with a mixed medical and surgical case mix (71.0%). The most frequently prescribed statins were simvastatin (77.6%) in the UK and atorvastatin (66.1%) in ANZ. The main reasons cited to explain the choice of statin were preadmission prescription and pharmacy availability. Most respondents reported never starting statins to prevent (65.3%) or treat (89.1%) organ dysfunction. Only a minority (10%) disagreed with a statement that the risks of major side effects of statins when prescribed in critically ill patients were low. The majority (84.5%) of respondents strongly agreed that a clinical trial of statins for prevention is needed. More than half (56.5%) favoured rates of organ failure as the primary outcome for such a trial, while a minority (40.6%) favoured mortality. Conclusions Despite differences in type of statins prescribed, critical care physicians in the UK and ANZ reported similar prescription practices. Respondents from both communities agreed that a trial is needed to test whether statins can prevent the onset of new organ failure in patients with sepsis

Effect of Nitrophoska® and irrigation interval on root and sugar yield of sugar beet (Beta vulgaris L.), Gezira State, Sudan

Sugar beet is one of the promising crops in the Sudan due to its high root, sugar yield and by-products as an industrial crop. The crop is also a promising alternative energy crop for the production of ethanol. An experiment was conducted at the experimental Farm of the Faculty of Agricultural Sciences, University of Gezira, Wad Medani, Sudan, during seasons 2012/13 and 2013/14. The objective was to investigate the effects of irrigation intervals (7, 14 and 21 days) and Nitrophoska (NPK compound fertilizer) rates (0, 100, 150 and 200 kg/ha) on root and sugar yield of sugar beet (Ballade cultivar) under Gezira conditions. Split-plot design with three replicates was used. Irrigation intervals were allotted to the main plots and Nitrophoska rates to the subplots. Results showed that shortening irrigation intervals from 21 to 14 and 7 days increased root diameter, root weight and root and sugar yields in both seasons. In addition, Nitrophoska rate of 150 kg/ha substantially improved most of the studied root characters and sugar yield in both seasons. Depending on the results of this study, to obtain high root and sugar yields from sugar beet Ballade cultivar, it could be recommended  to apply 150 kg/ha of  Nitrophoska  and  irrigate every 7 to14 days.   بنجر السكر من المحاصيل الواعدة في السودان وذلك نسبة لإنتاجيته العالية من الجذور والسكر ومنتجاته كمحصول صناعي. بنجر السكر من محاصيل الطاقة البديلة الواعدة لإنتاج الإيثانول. أجريت التجربة في المزرعة التجريبية، كلية العلوم الزراعية، جامعة الجزيرة، وادمدني، السودان في الموسمين 2012/ 13 و 2013/14م على التوالي. الهدف من التجربة هو دراسة تأثير فترات الري (7 و14 و21 يوم) ومعدلات سماد النيتروفوسكا المركب (0 و100 و150 و200 كجم للهكتار) على إنتاجية الجذور والسكر لبنجر السكر (صنف بلدي) تحت ظروف الجزيرة. تم إستخدام تصميم القطع المنشقة بثلاث تكرارات. أوضحت النتائج أن تقليل فترات الري من 21 الي 14 و7 زاد قطر الجذر ووزن الجذر وإنتاجية الجذور والسكر في كلا الموسمين. زيادة معدلات سماد النيتروفوسكا المركب من 0 الى أكثر 150 كجم للهكتار حسن بشكل كبير أغلب الصفات المدروسة للجذر وإنتاجية السكر في كلا الموسمين. إعتماداً على نتائج هذه الدراسة للحصول على أعلى إنتاجية من الجذور والسكر لمحصول بنجر السكر نوصي بإضافة سماد النيتروفوسكا بمعدل 150 كجم/هكتار على أن يروى المحصول كل 7 إلى 14 يو

Forage yield potential of Sudan grass-cowpea irrigated mixtures in central Sudan

     The study was conducted at the Gezira University Farm, Wad Medani, Sudan, during the winter of 1998 and autumn of 1999 to investigate the effects of nine cropping systems, two rates of nitrogen and two harvesting dates on the quantity and quality of the forage produced by Sudan grass-cowpea mixtures. In both seasons, Sudan grass in around two months from sowing while cowpea flowered in about one month. Black seeded Sudan grass variety (SG2) outperformed the light brown seeded Sudan grass variety (SGI). The autumn forage yields were higher than those of winter. Mixing increased the per plant growth parameters of both crops and across seasons. In winter, the fresh forage yield of pure cowpea and the highest yielding mixture (40 SG2 + 20 CP) were comparable (averaging 6.6 t/ha), while in autumn, the highest yielding crop mixture was 30 SG2 + 30 CP (19.01 t/ha) which is not siB1ificantly different from that of pure SG2 (19.08 t/ha). The land equivalent ratio (LER) values exceeded 1.00, in both seasons, showing a clear advantage of mixtures over monocultures. The addition of 44 kg N/ha significantly increased the growth parameters and forage yield of sole Sudan grass and its mixtures with cowpea but not that of pure cowpea. Harvesting at 60 days from sowing appreciably increased growth parameters, fresh forage yield and quality of forage produced by all seeding combinations. Mixing showed significant effects on crude protein percentage, crude fibre percentage, total crude protein and total crude fibre

Influence of Some Innovation Attributes on the Adoption of Growing Sunflower in Rahad Scheme

The vital economic importance of sunflower as one of the oil crops encouraged its introduction to the Sudan in the last twenty years. The production of sunflower crop began in Rahad scheme, as in other irrigated areas in the country, in 1992/93 growing season. Field survey was used to collect data from 100 sunflower growers (adopters) in Rahad Scheme (block 10) in 2002/2003 growing season selected from a total population of 1000-1100 farmers by using the simple random sample technique. An equal number of non-adopters was selected for comparison. The total number of interviewed farmers was 200. The collected data was statistically analyzed using the chi-square test. The results showed significant association (dependency) between adoption of growing sunflower (the innovation) and some of its attributes: Relative advantage on perceived production cost and income, compatibility with farmers need as cash crop and animal feed, complexity associated with use of technical package for sunflower. From the findings of this study, we can conclude that the adoption of this crop was dependent on some innovation attributes and the results were expected to reveal factors influencing adoption of the crop. The authors recommend that more attention should be given by agronomists to this crop in order to improve the yield of the crop and extension services should design special programs for the crop to promote its rate of adoption

User innovations through online communities from the perspective of social network analysis

Organizations have begun to leverage both internal and external sources for innovation. Specifically, organizations are increasingly relying on end users that engage via user innovation communities to identify potentially valuable ideas for an organization to adopt. However, research has shown that organizational success in leveraging these communities relies on a thorough understanding of how users behave within the community. The purpose of this manuscript is to provide further analysis and develop a richer understanding of user behavior in the Dell IdeaStorm user innovation community. Findings illustrate different patterns of user behaviors when they comments or rate posted idea

Effects of mixed cropping with cowpea and nitrogen source on growth and yield of sunflower (Helianthus annuus L.)

Field experiments were conducted during winter (2011/12) and summer (2012/13) seasons. The objective of the study was to examine the effects of mixed cropping with cowpea, nitrogen and chicken manure on growth and yield of sunflower. Randomized complete block design with four replicates was used. The experiment comprised 8 treatments; two sunflower cultivars namely, Hysun33 and Damazin-1, and three nitrogen sources viz: mixed cropping with cowpea, urea (43kgN/ha), chicken manure (5t/ha) plus control. Results showed that the two cultivars were significantly different in plant height, days to 50% flowering, 1000-seed weight and empty seed percentage in both seasons. Hysun33 had taller plants, late to flower, heavier seeds and lower empty seeds percentage than Damazin-1. They were also significantly different in LAI, head diameter, number of filled seeds/ head and total yield in the summer season only. Fertilizers significantly influenced plant height and stem diameter in both seasons. In the winter season, however, fertilizers had significantly affected LAI, days to 50% flowering, head diameter, number of filled seeds/head and total yield. Chicken manure resulted in the tallest plants and largest stem diameter in both seasons. Chicken manure expressed the largest LAI, biggest head diameter, highest number of filled seeds/head and highest total yield. The three-way interaction(seasonx fertilizerx cultivar) showed significant effects on percentage of empty seeds and total yield. The highest total yield was obtained by Hysun33 in the summer season when chicken manure was applied. The mean total yield of the summer season was higher than that of the winter season. To obtain high total yield of sunflower, it is recommended that sowing should be commenced during the summer season and chicken manure should be applied at the rate of 5 t/ha for both Hysun33 and Damazin-

Relationship between physical and chemical characteristics of getable tanned sole leathers of indian origin

The relationship between some of the chemical characteristics and important physical characteristics of vegetable tanned Indian Buffalo hides is studied. Samples from both the front and back regions are taken up for the studies to arrive at different conclusions. Systematic analysis of the data obtained are carried out and then correlations are illustrated through graphs

Intestinal tuberculosis in a child living in a country with a low incidence of tuberculosis: a case report

Background: Relatively common in adults, intestinal tuberculosis is considered rare in children and adolescents. The protean manifestations of intestinal tuberculosis mean that the diagnosis is often delayed (sometimes even for years), thus leading to increased mortality and unnecessary surgery. The main diagnostic dilemma is to differentiate intestinal tuberculosis and Crohn’s disease because a misdiagnosis can have dramatic consequences. Case presentation: A 13-year-old Caucasian, Italian female adolescent attended the Emergency Department complaining of abdominal pain, a fever of up to 38°C, night sweats, diarrhea with blood in stool, and a weight loss of about three kilograms over the previous two months. Physical examination revealed a marked skin pallor and considerable abdominal distension with relevant discomfort in all the abdominal quadrant. Laboratory tests revealed a decreased white blood cell count with anemia and increased C-reactive protein levels. The Mantoux tuberculin skin test was negative. A chest X-ray and an abdominal ultrasonography did not reveal any significant findings. The patient underwent colonoscopy that showed diffuse mucosal congestion and significant blood loss, and laparatomy showed small bowel and colon loops with a whitish appearance. A biopsy of the ileal mucosa revealed inflammation with noncaseating granulomas possibly due to bacterial infection. Given the suspicion of an opportunistic bacterial infection in a child with chronic inflammatory bowel disease (possibly Crohn’s disease), treatment with a third-generation cephalosporin was started. However, the abdominal pain, fever and poor general condition persisted and so, after 11 days, the patient underwent total body computed tomography and magnetic resonance imaging of the brain. On the basis of the radiological findings, miliary tuberculosis was suspected and bronchoscopy was performed and resulted positive for Mycobacterium tuberculosis. Miliary tuberculosis was confirmed and an effective treatment with four drugs was started. Conclusion: This case shows that the manifestations of intestinal tuberculosis can be very difficult to diagnose and mimic those of Chron’s disease. Total body computed tomography and laparotomy with an intestinal biopsy for the detection of Mycobacterium tuberculosis are the means of avoid the risks of a misdiagnosis in children with unexplained chronic abdominal problems

Mediterranean diet and cancer: epidemiological evidence and mechanism of selected aspects

Background: Populations living in the area of the Mediterranean Sea suffered by decreased incidence of cancer compared with those living in the regions of northern Europe and US countries, attributed to healthier dietary habits. Nowadays, we are assisting to a moving away from the traditional Mediterranean dietary pattern, but whether this changing is influencing risk of cancers is still unclear. The aim of the study was to review recent evidence on potential relationship between the adherence to the Mediterranean diet and cancer. Discussion: The most recent pooled analyses of epidemiological studies supported strongly the hypothesis that the Mediterranean diet may play a role in preventing several types of cancers, especially those of digestive tract, whereas contrasting results were reported for hormone-dependent cancers. Specific aspects of the Mediterranean diet such as high fruit and vegetables and low red processed meat intake may explain such protective effects. Moreover, evidence regarding olive oil and whole grains increase the beneficial effects of such dietary pattern against cancer. Conclusions: Literature evidence actually demonstrates that the increased adherence to the Mediterranean dietary pattern is beneficial to health across populations and may translate a protective effect with certain cancers