P11 Variations in subjective and objective metabolic equivalents in patients undergoing aortic surgery

Introduction

Metabolic equivalents (METs) are measures of patient's functional capacity. It provides insight into patient's risk of perioperative complications. METs are usually obtained from estimation based on patient's history or by cardiopulmonary exercise testing (CPET). However, the validity of estimated METs has been questioned in multiple studies. In this study, we sought to compare the subjective METs from preoperative evaluation and objective METs derived from CPET, to investigate the reliability and validity of subjective METs.

Methods

A retrospective study was carried out for patients scheduled for aortic surgery from March 2017 to September 2018. Patients were classified into 3 subjective categories: Poor (< 4 METs), Moderate (4–10 METs) and Good (> 10 METs), whereas objective METs values were obtained from CPET. Comparative analysis between patient's objective METs and subjective METs was carried out to identify any variations.

Results

Subjective METs correlate with objective METs. Although subjective METs tends to overestimate patient's functional capacity, leading to 44.4% misclassified in the Moderate category. In contrast, Poor category only misclassified 5% by underestimation. In addition, the results confirmed significant differences between the Moderate and Poor categories as expected.

Conclusion

Although subjective METs categories correlate with objective METs, it tends to overestimate patient's METs. They are more accurate in identifying patients with Poor functional capacity (< 4 METs). Therefore, it is a convenient tool for clinician to effectively exclude patients with Poor METs. However, use of subjective METs should be considered carefully due to its limitation in estimating Moderate or Good METs.

Take-home message

Subjective metabolic equivalents correlate with objective metabolic equivalents.

216 Fix or Replace: Is Internal Fixation Still A Viable Option in The Elderly with Un-Displaced Intracapsular Femoral Neck Fractures?

Aim

The treatment of impacted or un-displaced femoral neck fractures in the elderly osteoporotic patient is still largely debated, with arthroplasty versus internal fixation two surgical options1. Our aim was to retrospectively review patients over the age of 80 with un-displaced intracapsular hip fractures who had undergone internal fixation and assess their rate of mortality and revision surgery.

Method

We conducted a retrospective review of all patients with femoral neck fractures over a 4-year period between January 2015 to December 2018. We refined this to only patients over the age of 80 with un-displaced intracapsular femoral neck fractures fixed with cannulated screws. We noted their mental and mobility status, their follow-up attendance over 3 years, their mortality and rate of revision surgery.

Results

There were a total of 1232 femoral neck fractures in a 4-year period. Of these, 37 were >80 with un-displaced intracapsular femoral neck fractures, with 23 fixed with cannulated screws and 14 with a Dynamic Hip Screw. Mean age – 85, M:F (1:4.75). All patients were either Garden Classification Type I or II. 4% had cognitive impairment. All patients were independently mobile. 83% were followed up for 3 years, with 1 patient (4%) undergoing revision surgery 3 years following cannulated screw fixation. The 30-day mortality rate was 5%.

Conclusions

The treatment choice for un-displaced intracapsular femoral neck fractures in the elderly remains debateable. Our retrospective review shows that the rate of re-operation is low in patients who have undergone fixation with cannulated screws and so this remains a viable option.

Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study

BACKGROUND

This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery.

METHODS

This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery.

RESULTS

A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498).

CONCLUSION

There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.

Optimization of BS4 Enzyme production with Different Substrate Thickness and Type of Trays

BS4 enzyme that is produced from solid substrate fermentation (SSF) on coconut cake with Eupenicillium javanicum BS4 in tray bioreactor has been applied as a feed additive. It increases the nutritional value of animal feedstuff. The BS4 production on SSF may be influenced by the better aeration through the perforated trays or by the thinner substrate. The aim of this research is to optimize the production of BS4 with different substrate thicknesses and types of trays. The trial was carried out using a factorial randomized design (2x2x3) with 6 replicates. The first factor was the type of trays: i.e., non-perforated and perforated tray. The second factor was the thickness of the substrate: i.e., 1.5 and 3.0 cm, while the third factor was the duration of fermentation: i.e. 5, and 7 days. The variables observed were moisture content, dry matter loss (DML), mannanase and saccharification activities, soluble protein content, their specific activities, and yield. Statistical analysis showed no interactions between the three factors, but there were interactions between types of trays and substrate thicknesses, as well as type of trays and incubation times on the mannanase activity and yield of mannanase. The results showed that DML was observed on day 7 were around 31.43- 36.89. The highest mannanase activity was observed on the non-perforated tray with 3 cm thickness on day 7. The saccharification activity towards palm kernel meal was better in the non-perforated tray on day 7 but not influenced by The yield value of mannanase and saccharification activities on a non-perforated tray with 3.0 cm thickness on day 7 was also the highest. Based on energy efficiency and the cost of production, it can be concluded that the optimum condition to produce the BS4 enzyme was observed in the non-perforated tray with 3 cm thickness and fermented for 7 days.

Interactions between the cecal microbiota and non-alcoholic steatohepatitis using laying hens as the model

Chronic liver disease has caused increasing numbers of deaths worldwide. Fatty liver hemorrhagic syndrome, one of the chronic liver diseases in laying hens, has great similarity to non-alcoholic fatty liver disease (NAFLD) in humans. It is characterized by the pathological accumulation of liver fat. Non-invasive techniques are needed for early identification of fibrosis. As primary de novo lipogenesis in the liver of chicken is similar to that of humans, mature chicken is an ideal animal model for the understanding of NAFLD. This study was aimed to evaluate the relationships between gut microbiota and natural chronic liver disease (i.e., non-alcoholic steatohepatitis [NASH] and fibrosis stages) in a well-characterized laying hen population. One hundred 20-wk-old Hy-Line Brown laying hens were used and fed with basal diets until 52 wk of age. At the end of the experiment, birds were killed for sampling blood, liver, and cecal contents, and then classified by liver histology measurement into different groups. We investigated microbial community structure of cecum using 16S rRNA gene sequencing. Subjects in stage 0 fibrosis without NASH were classified as low NAFLD (Group A), subjects in stage 1-2 fibrosis with mild to moderate NASH were defined as low NASH (Group B), and subjects in stage 3 fibrosis were defined as severe NASH (Group C). The abundance of Firmicutes was reduced in Groups B and C (P < 0.001), whereas opposite results were observed for the abundance of Bacteroidetes. Additionally, the families Bacteroidaceae, Ruminococcaceae Lachnospiraceae, and lactobacillae were significantly different between groups of differing fibrosis stages (P < 0.001), driven entirely by alterations of Bacteroides and lactobacillus and lachnospiraceae genera (P < 0.001), were observed. Results indicated that cecal dysbiosis was linked with the severity of fibrosis and NASH; importantly, increased levels of serum AST, alkaline phosphatase, and uric acid were accompanied with liver fibrosis and NASH severity. Collectively, these data highlight the role of gut-liver axis and associations between the gut microbiota and fibrosis and NASH severity.

Influence of acidified drinking water on growth performance and gastrointestinal function of broilers

The ban on the use of antibiotic feed additives as growth promoters compelled the researchers for exploring the future utility of other alternatives. This experiment was designed to evaluate the effect of acidified drinking water on growth performance, gastrointestinal pH, digestive enzymes, intestinal histomorphology, and cecum microbial counting of the broiler chicken. A total of 540 one-day-old male broilers (Arbor Acre) were randomly assigned to 5 treatments, with 6 replicates of 18 chicks per replicate. Broilers received diets and water as follows: NC (negative control, basal diet, normal water), PC (positive control, basal diet + 8 ppm colistin sulfate + 8 ppm enduracidin, normal water), A1 (basal diet, continuous supply of acidified water during whole experiment period), A2 (basal diet, intermittent acidification of water during 0 to 14 d, 22 to 28 d, and 36 to 42 d), and A3 [basal diet, intermittent acidification of water (24 h/d from 0 to 14 d and from 10:00 am to 4:00 pm on d 15 to 42)]. During the entire period, the acidified groups (A1, A2, and A3) and PC group showed improve on weight gain, average daily gain and feed conversion ratio compared to NC group (P < 0.05). The pH in crop, proventriculus and ileum at 43 d declined by 0.04, 1.03, 1.23; 0.55, 0.69, 0.70; and 0.63, 0.74, 1.21 in A1, A2, and A3 group, respectively. There was a significant decline of lipase activity in the PC and acidified groups compared to NC group. The A2 group had higher villus height in jejunum than NC group. The PC and acidified groups reduced (P < 0.05) the total aerobic bacteria count of cecum when contrasted to NC group. Therefore, we conclude that acidified drinking water can improve growth performance, compensate for gastric acidity, and control pathogenic bacteria in broilers and may be considered as a potential alternative to improve production parameters. Discontinuous supply of acidified water had the same or even better influence on broilers compared to continuous supply.

Application of BS4-enzyme on the methane production from mixture of cattle manures and waste paper

<p class="abstrak2">Cellulose from abundant newspaper waste could be transformed into methane through anaerobic fermentation. This research was carried out to compare the gas production including methane between samples containing feces and waste paper mixture as inoculum and substrate, respectively and added with and without BS4 enzyme. The enzyme was produced in Indonesian Research Institute of Animal Produce (IRIAP) by growing Eupenicillium javanicum BS4 in coconut meals. There were three treatments,  i.e., 30% manure (M30); 15 %  manure + 15 % paper waste  (MP 30); MP30 + 3 mL BS4 enzyme equal to 0.42 U/g dry matter (MPE30) The percentage of waste papers addition in feces was calculated on dry matter (DM) basis and every treatment had five replications. Total gas and methane productions were measured weekly, while dry matter losses were determined during 5 week fermentation. Interactions between treatments and incubation time were analyzed using completely randomized design each week. Kind of substrates influenced both total gas and methane productions during incubation time. Both waste papers and enzyme addition enhanced gas production. The highest total gas and methane productions for five weeks incubation were highly significantly observed (P&lt;0.01) in MP30 and MPE30 compared to M30. Addition of enzyme significantly increased total gas and methane productions in the first week. The highest methane and total gas yield/g dry matter were obtained by BS4 enzyme addition. It was concluded that BS4 enzyme is good in accelerating and increasing the transformation efficiency of waste paper and manure mixture for biogas production.</p><p><strong>Key Words</strong>: Methane, Fibrenolytic-Enzyme, Waste Papers, Cattle Manures</p>

Physico-chemical, rheological and antioxidant properties of sweet chestnut (Castanea sativa Mill.) as affected by pan and microwave roasting

Sweet chestnut (Castanea sativa Mill.) belongs to the family Fagaceae and sub family Castaneoideae. Bioactive components such as tannins are present in sweet chestnut in high proportion giving astringent bitter taste and reducing their palatability. Roasting reduces the anti-nutritional factors in chestnut. This study was conducted to compare the effects of pan and microwave roasting on physicochemical, functional, rheological and antioxidant properties of sweet chestnut. Antioxidant activity was determined using DPPH inhibition activity, reducing power, and total phenolic content. Structural analysis was carried out using FT-IR analysis. Protein, fat, and ash contents displayed insignificant (P > 0.05) variations. "L" value decreased from 90.66 to 81.43, whereas, "a" and "b" values increased from 0.02 to 0.90 and 11.99 to 20.5, respectively, upon roasting. Significant (P < 0.05) increase in water absorption capacity (1.32-3.39 g/g), oil absorption capacity (1.22-1.63 g/g), and antioxidant properties was observed following roasting. Flour obtained from roasted chestnuts exhibited a significant decrease in light transmittance, foaming, and pasting properties. Higher gelatinization temperatures and lower enthalpies were reported in microwave and pan roasted chestnut flours. Roasting also reduced the viscoelastic behavior of native sweet chestnut and changed the transmittance of identical functional groups as revealed by FT-IR analysis.

Association of metabolic syndrome components with insulin resistance in normal weight population: the Qazvin Metabolic Diseases study

PURPOSE

Metabolically obese but normal weight (MONW) is associated with higher risk of type 2 diabetes, dyslipidemia, and hypertension. The aim of this study was to evaluate the association of metabolic syndrome components with MONW in each sex in Iranian population.

METHODS

This cross-sectional study was performed on 417 normal weight subjects in Qazvin, Iran between September 2010 and April 2011. MONW was defined by insulin resistance (IR) using the homeostatic model assessment (HOMA). Cut off point for IR was defined as the lower limit of top quintile of HOMA-IR values in normal weight population without any metabolic risk factors. Data were analyzed using T test, Mann-Whitney U test, and multi-variant logistic regression analysis.

RESULTS

Of 417 subjects, 44.3 % were female. The prevalence of MONW was 33.8 % in men and 39.8 % in women. Triglycerides levels were significantly higher in both men and women with MONW. Waist circumference was significantly higher in men with MONW, while high-density lipoprotein cholesterol levels were significantly lower in women with MONW. In logistic regression analysis, hypertriglyceridemia in women (OR 3.398; 95 % CI 1.306-8.846) and waist circumference (per 5 cm increment) in men (OR 1.653; 95 % CI 1.279-2.136) had independent association with MONW.

CONCLUSION

Association of metabolic syndrome components with MONW is different in men and women. Waist circumference had an independent association with IR in men but not in women. IR and its complications should be considered in lean women with hypertriglyceridemia.

Neuropsychiatric symptoms, seizure severity, employment, and quality of life of Jordanians with epilepsy

RATIONALE

Depression and anxiety are more strongly associated with quality of life (QOL) than seizure frequency in several populations with epilepsy. However, QOL is culturally determined and may be influenced by cultural values and norms as well as local policies and resources. The goal of this study is to investigate the impact of neuropsychiatric symptoms and seizure severity on QOL and employment in people with epilepsy living in Jordan.

METHODS

Seizure severity and complications, antiepileptic drug side effects, social stigma, neuropsychiatric symptoms, and mental health (MH-SF36) and physical health (PH-SF36) domains of QOL were assessed in 45 adult patients with epilepsy in a university neurology clinic. Multivariate regression analysis was used to evaluate the relationship between these variables and the quality of life of Jordanians with epilepsy.

RESULTS

Neuropsychiatric symptoms, seizure frequency, and history of injury due to seizure were associated with the MH-SF36. However, earlier age of seizure onset, longer duration of epilepsy, unemployment, and history of chronic disease was associated with lower PH-SF36 scores. Furthermore, there were no differences in QOL, neuropsychiatric symptoms, and seizure frequency in Jordanians who were employed versus unemployed in this study.

CONCLUSIONS

Neuropsychiatric symptoms were significantly associated with mental health-related QOL measures, but not with physically-related QOL measures, in Jordanians with epilepsy. For studies across populations, it is critical to separate mental health from physical health QOL measures. Furthermore, regional differences in culture and policy may more strongly influence employment status than individuals' experiences of epilepsy, neuropsychiatric symptoms, or QOL in some populations.

Long-term association between seizure outcome and depression after resective epilepsy surgery

OBJECTIVE

This study explored the association between long-term epilepsy surgery outcome and changes in depressive symptoms.

METHODS

Adults were enrolled between 1996 and 2001 in a multicenter prospective study to evaluate outcomes of resective epilepsy surgery. The extent of depressive symptoms and depression case status (none, mild, or moderate/severe) were assessed using the Beck Depression Inventory (BDI) preoperatively and 3, 12, 24, 48, and 60 months postoperatively. A mixed-model repeated-measures analysis was performed, adjusting for covariates of seizure location, gender, age, race, education, and seizure control.

RESULTS

Of the total 373 subjects, 256 were evaluated at baseline and 5 years after surgery. At baseline, 164 (64.1%) were not depressed, 34 (13.3%) were mildly depressed, and 58 (22.7%) had moderate to severe depression. After 5 years, 198 (77.3%) were not depressed, 20 (7.8%) were mildly depressed, and 38 (14.8%) were moderately to severely depressed. Five years after surgery, the reduction in mean change from baseline in BDI score was greater in subjects with excellent seizure control than in the fair and poor seizure control groups (p = 0.0006 and p = 0.02 respectively). Those with good seizure control had a greater reduction in BDI score than the poor seizure control group (p = 0.02) and borderline significant reduction compared with the fair seizure control group (p = 0.055).

CONCLUSION

Although study participants had initial improvement in depressive symptoms, on average, after resective surgery, only patients with good or excellent seizure control had sustained long-term improvement in mood.

The perceived role of Islam in immigrant Muslim medical practice within the USA: an exploratory qualitative study

BACKGROUND

Islam and Muslims are underrepresented in the medical literature and the influence of physician's cultural beliefs and religious values upon the clinical encounter has been understudied.

OBJECTIVE

To elicit the perceived influence of Islam upon the practice patterns of immigrant Muslim physicians in the USA.

DESIGN

Ten face-to-face, in-depth, semistructured interviews with Muslim physicians from various backgrounds and specialties trained outside the USA and practising within the the country. Data were analysed according to the conventions of qualitative research using a modified grounded-theory approach.

RESULTS

There were a variety of views on the role of Islam in medical practice. Several themes emerged from our interviews: (1) a trend to view Islam as enhancing virtuous professional behaviour; (2) the perception of Islam as influencing the scope of medical practice through setting boundaries on career choices, defining acceptable medical procedures and shaping social interactions with physician peers; (3) a perceived need for Islamic religious experts within Islamic medical ethical deliberation.

LIMITATIONS

This is a pilot study intended to yield themes and hypotheses for further investigation and is not meant to fully characterise Muslim physicians at large.

CONCLUSIONS

Immigrant Muslim physicians practising within the USA perceive Islam to play a variable role within their clinical practice, from influencing interpersonal relations and character development to affecting specialty choice and procedures performed. Areas of ethical challenges identified include catering to populations with lifestyles at odds with Islamic teachings, end-of-life care and maintaining a faith identity within the culture of medicine. Further study of the interplay between Islam and Muslim medical practice and the manner and degree to which Islamic values and law inform ethical decision-making is needed.

Ischaemic stroke in Jordan: a 2-year hospital-based study of subtypes and risk factors

A retrospective study was made of 200 consecutive patients with first-ever ischaemic stroke, admitted to Jordan University Hospital over a 2-year period. The mean age was 61.2 years [range 29-95]. The most common stroke subtype was lacunar infarct [51.5%], but frequency of cardioembolic stroke was low [8.0%]. Hypertension, diabetes mellitus and smoking were the most common risk factors for atherosclerotic non-cardioembolic stroke. Chronic atrial fibrillation was the most common risk factor for cardioembolic stroke. No patient had severe extracranial carotid or vertebral artery stenosis [>50% narrowing]. Lacunar strokes presented predominantly as pure motor stroke [67/103] and were mainly in the internal capsule [34/ 103]. The favourable outcome [85% discharged home] may be due to the relatively young age and the predominance of lacunar infarcts

Ischaemic stroke in Jordan: a 2-year hospital-based study of subtypes and risk factors

A retrospective study was made of 200 consecutive patients with first-ever ischaemic stroke, admitted to Jordan University Hospital over a 2-year period. The mean age was 61.2 years (range 29-95). The most common stroke subtype was lacunar infarct (51.5%), but frequency of cardioembolic stroke was low (8.0%). Hypertension, diabetes mellitus and smoking were the most common risk factors for atherosclerotic non-cardioembolic stroke. Chronic atrial fibrillation was the most common risk factor for cardioembolic stroke. No patient had severe extracranial carotid or vertebral artery stenosis (> 50% narrowing). Lacunar strokes presented predominantly as pure motor stroke (67/103) and were mainly in the internal capsule (34/ 103). The favourable outcome (85% discharged home) may be due to the relatively young age and the predominance of lacunar infarcts.

Two new anthraquinones from the roots of Rubia cordifolia Linn

Two new anthraquinones, named cordifoliol and cordifodiol, have been isolated from the roots of Rubia cordifolia. Their structures have been established as 1-hydroxy-3-ethyl-9,10-anthraquinone (1) and 1,8-dihydroxy-11, 20 (15-pentyl-naphthaquinonyl) phenanthrene (2) on the basis of spectral data analyses and chemical reactions.

Metallic stents in benign biliary strictures: long-term effectiveness and interventional management of stent occlusion

OBJECTIVE

The objective of our study was to evaluate the long-term effectiveness of metallic stent placement in the treatment of benign biliary strictures and to report our experience with interventional procedures for the management of stent occlusion to achieve secondary patency.

CONCLUSION

The clinical course of these patients is compromised by repeated stent occlusions, caused by stone or mucosal hyperplasia. The results of primary stent patency are disappointing with the primary patency rate decreasing from 75% after 12 months to 25% after 36 months. The different interventional procedures used to restore bile flow make an important contribution to the secondary stent patency and provide a satisfactory clinical result in a patient subpopulation in whom stent placement is considered the last resort.

Angiotensin II-induced constrictions are masked by bovine retinal vessels

PURPOSE

To unmask the vasoconstricting effect of angiotensin II (Ang II) on retinal smooth muscle by studying its interaction with endothelium-derived paracrine substances. This study focused specifically on determining the changes in vascular diameter and the release of endothelial-derived vasodilators, nitric oxide (NO) and prostaglandin (PG) I2, from isolated retinal microvessels.

METHODS

Bovine retinal central artery and vein were cannulated, and arterioles and venules were perfused with oxygenated/heparinized physiological salt solution at 37 degrees C. This ex vivo perfused retinal microcirculation model was used to observe the contractile effects of Ang II on arterioles and venules of different diameters. The NO and PGI2 synthase inhibitors, 1-NOARG and flurbiprofen, respectively, were used to unmask Ang II vasoconstriction; the changes in vascular diameters were then measured. Enzyme immunoassays were used to measure the release of cGMP (an index of NO release) and 6-keto-PG-F1alpha (a stable metabolite of PGI2) from isolated bovine retinal vessels.

RESULTS

Topically applied Ang II (10(-10) M to 10(-4) M) caused significant (P < 0.05) arteriolar and venular constrictions in a dose-dependent manner, with the smallest retinal arterioles (7+/-0.2 microm luminal diameter) and venules (12+/-2 microm luminal diameter) significantly more sensitive than larger vessels. After the inhibition of endogenous NO and PGI2 synthesis by 1-NOARG and flurbiprofen, respectively, the vasoconstriction effects of Ang II became more pronounced. Again, the smallest vessels tested were significantly more sensitive, and synthesis of endothelial-derived relaxing factor (EDRF), therefore, may be most important in these vessels. Vasoactive doses of Ang II (10(-10) M to 10(-4) M) caused a dose-dependent increase in the release of NO and PGI2 from isolated bovine retinal vessels, indicating that the increase in EDRF may nullify direct Ang II-induced vasoconstriction. Interestingly, intraluminal administration of Ang II caused only vasodilation.

CONCLUSIONS

This study demonstrates that the retinal vascular endothelium acts as a buffer against the vasoconstricting agent Ang II via release of vasodilators NO and PGI2, and the vasoconstriction effects due to Ang II are most prominent in the smallest diameter vessels.

Photosensitisation and crystal-associated cholangiohepatopathy in sheep grazing Brachiaria decumbens

Two outbreaks of photosensitivity and jaundice in sheep grazing the grass, Brachiaria decumbens. In West Java in 1983 and 1983 and 1990 are described. Aggregates of acicular clefts and crystals were present in bile canaliculi, bile ducts, Kupffer cells, hepatocytes and in kidney tubules. The number of crystals increased with the length of exposure to the plant and sheep that died had the largest accumulations. These crystalline structures have been reported before in this syndrome, but are similar to those seen in Tribulus terrestris and Panicum spp toxicities.