Preoperative predictors of mortality in adult patients with perforation peritonitis

INTRODUCTION

There is paucity of data from India regarding the etiology, prognostic indicators, morbidity, and mortality patterns of perforation peritonitis. The objective of our study was to evaluate the predictors of mortality, preoperatively, for risk stratification of the patients and institution of an early goal-directed therapy.

MATERIALS AND METHODS

Eighty-four consecutive patients presenting with perforation peritonitis, in the age group of 14-70 years scheduled for emergency laparotomy were studied prospectively. The parameters studied were age and sex of the patients, associated co-morbidities, duration of symptoms, delay in initiating surgical intervention, and preoperative biochemical parameters such as hemoglobin, random blood sugar, blood urea, serum creatinine, pH, base excess, and serum lactate levels. In-hospital mortality was taken as the outcome.

RESULTS

We encountered a mortality of 17.8% in our study. Multiple linear (enter) regression identified the age, duration of symptoms, preoperative blood sugar levels, blood urea, serum creatinine levels, Mannheim Peritonitis Index, and the delay in instituting surgical intervention as independent predictors of mortality. Hyperlactatemia, acidosis and base excess were not found to be associated with mortality.

CONCLUSION

Routine biochemical investigations, delay in presentation, and surgical intervention are good predictors of mortality. Recognizing such patients early may help the anesthesiologists in risk stratification and in providing an early goal-directed therapy.

Proxy Measures and Novel Strategies for Estimating Nitrogen Utilisation Efficiency in Dairy Cattle

Simple Summary

Dairy cow diets contain nitrogen, mostly in the form of protein. However, dietary nitrogen is used with a low efficiency for milk production, and much of the unused nitrogen is converted to urea and excreted in urine and faeces (manure). Nitrogen within manure can then be lost to the environment, and this is a particular issue when dairy cows are offered diets containing excess dietary protein. As a result, there is increasing pressure on the dairy sector to improve the efficiency with which dairy cows utilise dietary nitrogen. While nitrogen utilisation efficiency can be measured accurately on research farms, this is more difficult on commercial farms. For that reason, there is much interest in developing low-cost and easy-to-use proximate measures that can provide accurate estimates of nitrogen utilisation. This review examines a number of proximate analyses that are already used as indicators of nitrogen use efficiency in dairy cows (e.g., blood urea and milk urea), and a number of more novel measures that may have potential for use in the future (including analysis of milk, blood, urine, breath, and predictions of intake). These ‘proxy’ measurements can be used to improve feeding management and might be used to monitor adherence to legislation.

Abstract

The efficiency with which dairy cows convert dietary nitrogen (N) to milk N is generally low (typically 25%). As a result, much of the N consumed is excreted in manure, from which N can be lost to the environment. Therefore there is increasing pressure to reduce N excretion and improve N use efficiency (NUE) on dairy farms. However, assessing N excretion and NUE on farms is difficult, thus the need to develop proximate measures that can provide accurate estimates of nitrogen utilisation. This review examines a number of these proximate measures. While a strong relationship exists between blood urea N and urinary N excretion, blood sampling is an invasive technique unsuitable for regular herd monitoring. Milk urea N (MUN) can be measured non-invasively, and while strong relationships exist between dietary crude protein and MUN, and MUN and urinary N excretion, the technique has limitations. Direct prediction of NUE using mid-infrared analysis of milk has real potential, while techniques such as near-infrared spectroscopy analysis of faeces and manure have received little attention. Similarly, techniques such as nitrogen isotope analysis, nuclear magnetic resonance spectroscopy of urine, and breath ammonia analysis may all offer potential in the future, but much research is still required.

Atorvastatin Therapy Modulates Telomerase Activity in Patients Free of Atherosclerotic Cardiovascular Diseases

Background: Telomerase activity (TA) is considered as the biomarker for cardiovascular aging and cardiovascular diseases (CVDs). Recent studies suggest a link between statins and telomere biology that may be explained by anti-inflammatory actions of statins and their positive effect on TA. Until now, this effect has not been investigated in prospective randomized studies. We hypothesized that 12 months of atorvastatin therapy increased TA in peripheral blood mononuclear cells. Methods: In a randomized, placebo-controlled study 100 hypercholesterolemic patients, aged 35-75 years, free of known CVDs and diabetes mellitus type 2 received 20 mg of atorvastatin daily or placebo for 12 months. TA was measured by quantitative polymerase chain reaction. Results: At study end, 82 patients had sufficient peripheral blood mononuclear cells needed for longitudinal analysis. TA expressed as natural logarithms changed from 0.46 ± 0.05 to 0.68 ± 0.06 (p = 0.004) in the atorvastatin group and from 0.67 ± 0.06 to 0.60 ± 0.07 (p = 0.477) in the control group. In multiple regression analysis, atorvastatin therapy was the only independent predictor (p = 0.05) of the changes in TA independently of markers of chronic inflammation and oxidative stress. Atorvastatin therapy was associated with increases in interleukin-6 within the normal range and a tendency toward reduction in blood urea. Conclusion: These initial observations suggest atorvastatin can act as telomerase activator and potentially as effective geroprotector. Trial registration: The trial was registered in ISRCTN registry ISRCTN55050065.

Commencing Nutrient Supplements before Full Enteral Feed Volume Achievement Is Beneficial for Moderately Preterm to Late Preterm Low Birth Weight Babies: A Prospective, Observational Study

The aim of this study was to observe after following a routine change in the feeding protocol whether the earlier introduction of nutrient supplements improved nutritional outcomes in moderately preterm to late preterm low birth weight (LBW) babies. In this prospective observational study, LBW babies between 31 and 39 weeks’ gestation admitted to a Special Care Nursery were assigned to two groups (F80, n = 45, F160, n = 42) upon commencing nutrient supplement at total fluid intake achievement of 80 or 160 mL/kg/day. Outcomes included weight, protein intake, biochemical markers, feeding intolerance, and length of stay (LOS). F80 nutrient supplements commenced before F160 (2.8 vs. 6.7 days, p < 0.0001) and lasted longer (15.2 vs. 12.2 days, p < 0.03). Weight gain velocity and LOS were similar. F80 mean protein intake during the first 10 days was higher (3.38 vs. 2.74 g/kg/day, p < 0.0001). There were fewer infants with protein intake <3 g/kg/day in the F80 group (8% vs. 65%, p < 0001). F80 babies regained birthweight almost two days earlier (7.5 vs. 9.4 days, p < 0.01). Weight gain Z-scores revealed an attenuation of the trend towards lower weight percentiles in the F80 group. Feeding intolerance was decreased for F80 (24.4% vs. 47.6%, p < 0.03). There were no adverse outcomes. Earlier nutrient supplementation for LBW babies lifts mean protein intake to above 3 g/kg/day and reduces both the duration of post-birth weight loss and incidence of feeding intolerance.

Comparing of the effects of sesame oil and rapeseed oil versus suet oil and animal butter on the reproductive system of male rats

BACKGROUND

The aim of this study was to compare the effect of vegetable oils and animal oils on the reproductive system of male rats.

METHODS

This study was a random and observational study conducted on 36 male rats with the age of 6 weeks weighing 200 ± 20 grams. Different groups were fed by sesame oil, suet oil, rapeseed oil and animal butter. The control group was fed by standard food used normally to feed animals in the laboratories. At the end of six weeks, testosterone level changes and weight changes were compared among different groups. Data were analyzed by SPSS-IBM version 16.

RESULT

Weight changes among groups did not show a dramatic statistical difference (P = .571 > 0.005). Average weight in control group was 202 and about the male rats fed by 10% of animal butter and by sesame oil were 206.5 and 99, respectively. Weight changes among groups were significant (P value = 0.005 > 0.0004). The average testosterone level in the control group was 2.4. This value in the different groups fed by 10% oils, the maximum was 12.2 and the minimum was 1.35 assigned to animal butter and rapeseed oil, respectively. So we concluded that using 10% of different oils causes an increase in testosterone level (P value = 0.001 > 0.05). The maximum testosterone level was 3.6 in the rapeseed 20% group and lowest 0.45 in the sesame 20% group.

CONCLUSION

We found that animal oil-containing diet has no significant harmful effect on male rat reproductive system in comparison with plant oils.

Predictive Value of Baseline Biochemical Parameters for Clinical Response of Macular Edema to Bevacizumab in Eyes With Central Retinal Vein Occlusion: A Retrospective Analysis

PURPOSE

To evaluate the influence of baseline biochemical parameters on the improvement in best corrected visual acuity (BCVA) and reduction in central foveal thickness (CFT) in patients treated with intravitreal bevacizumab (IVB; Avastin, Genentech, Inc) for macular edema (ME) secondary to central retinal vein occlusion (CRVO).

DESIGN

A retrospective study.

METHODS

Seventy eyes of 70 participants with CRVO who underwent IVB for ME and had at least 1 month of follow-up after the last injection were studied. Demographic variables, systolic and diastolic blood pressure (SBP and DBP), BCVA, CFT measured by optical coherence tomography (OCT), and biochemical investigations [hemoglobin, fasting and postprandial blood sugar (FBS and PPBS), lipid profile, blood urea (BU), serum creatinine (SC), glycosylated hemoglobin (HbA1c)] at baseline were noted. IVB need at every visit was based on clinical and OCT parameters. Changes in BCVA (ΔBCVA) and CFT (ΔCFT) from baseline to last injection were estimated.

RESULTS

After IVB, there was a statistically significant reduction in mean CFT (P < 0.01). The group of patients with normal BU and SC had more than 2 lines of improvement compared with those with elevated values (P = 0.043 and 0.009, respectively). Other parameters like FBS, PPBS, hemoglobin, HbA1c, and serum lipids were not associated with improvement of BCVA and reduction of CFT.

CONCLUSIONS

Normal baseline renal parameters (BU and SC) predict better visual outcome after treatment for ME in CRVO and offer additional benefit over and above that obtained with ME reduction.

Association of Covid-19 with blood type A in relation to blood sugar, urea, and blood test (D-dimer and ferritin) in patients from Al-Najaf

COVID-19 is an emerging infectious disease caused by the novel enveloped single-stranded RNA virus quickly declared a pandemic. This study aimed to investigate the severity of COVID-19 infection in patients with blood group type A. A cross-sectional study was conducted at Al-Amal specialized hospital, Al-Najaf (March 8 to March 20/2021). The study included 123 hospitalized patients (63 females and 60 males), aged between 15-95 years, diagnosed with COVID-19, tested for blood group, blood sugar, blood urea, D-dimer, and serum ferritin. Results indicated significant differences in blood sugar and D-dimer in patients with type A blood group at P>0.05. At the same time, no significant difference was found in blood urea and ferritin at P>0.05. The majority of patients showed elevated levels of blood sugar, blood urea, serum D-dimer and ferritin. COVID-19 can infect people of all ages and causes severe infection in all blood groups.