Background:Postoperative acute kidney injury (AKI) is common in patients with chronic liver disease. We prospectively evaluated effectiveness of the N-acetylcysteine (NAC) in preserving postoperative renal functions in cirrhotic patients undergoing major abdominal surgeries.Materials and Methods:A total of 60 cirrhotic patients child A to B were randomized into two groups of 30 each. NAC groupwas received intravenous infusion of NAC (1200 mg/12h starting immediately before surgery and continued for 72h h postoperative) and controls group received a similar volume of glucose 5% solution as a a placebo. Systemic hemodynamics, hepatic and renal functions, serum cystatin C and cystatin C glomerular filtration rate (GFR) (GFR) were compared between both groups.Results:Serum level of cystatin C was raised significantly above the basal value at postoperative day 1 and day 3 associated with significantly decreased in cystatin C GFR below the basal value in the control group (P = 0.001). 6 (20%) (PP = 0.03) in control group developed AKI based on cystatin C GFR criteria (GFR <55 ml/min/1.73m2). Mean values of alanine aminotransferase and aspartate aminotransferase were increased significantly above the basal values in both groups, but the increases were significantly lower in NAC group (P = 0.00). Chest infection was significantly lower associated with shorter hospital stay in the NAC group than the control group.Conclusion:Intravenous administration of NAC NAC in cirrhotic patients undergoing major abdominal surgeries reduces the incidence of cystatin C GFR-based AKI, postoperative renal and liver functions were well-preserved and improved outcome.
Purpose: We evaluated the effects of postoperative administration of (ONSs) on the liver function and the outcome of cirrhotic patients using ultrasound (US) assessment of rectus femoris (RF) and anterior tibialis (AT) muscles. Patients and Methods: Forty-three malnourished adult hepatic patients who underwent major liver resections were recruited in this study. In the conventional diet (CD) group, the patients took water at postoperative day (POD) 0 and routine soft diet starting from POD1. In the ONS group, a commercially elemental diet was started from POD1 for 7 days postoperatively, with a target endpoint of 35-40 kcal/kg and 1.2-1.5 g/kg of protein per day. US assessment of the RF and AT muscles was done preoperatively and at POD3 and 7, including anterior-posterior (AP) diameter, lateral–lateral (LL) diameter, and cross-sectional area (CSA). Muscles' echogenicity was defined by the Heckmatt scale. The outcome of the patients was also recorded. Results: Consumption of ONS preserved the measured RF and AT characteristics (AP and LL diameters and CSA) in the ONS group at POD3 and 7 compared to the CD group. Heckmatt scale was significantly increased at POD3 and 7 in the CD group compared to the ONS group. Both total protein and albumin levels at POD3 and 7 were significantly lower in the CD group compared to the ONS group [P = (0.02, 0.03) and (0.05, 0.04), respectively]. Serum phosphate was significantly lower at POD7 in the ONS group than the CD group (p = 0.04). There were significant decreases in the ICU stay and time of passing flatus (h) in the ONS group comparing with the CD group ( P = 0.045 and P = 0.00, respectively). Conclusions: ONS maintains muscle mass and echogenicity of RF and AT along with better liver function and intestinal function recovery.
Water scarcely is a common problem especially in arid and semi-arid areas of the world like the Mediterranean region. Therefore, enormous efforts directed to improve the adaptation of plants to use less irrigation water by increasing their tolerant and resistant to water deficit by different means. In this study, tomato plants cv. "Alisa" were irrigated with three different amounts of water i.e. optimum amount which was the amount of water that added to raise soil field capacity (FC) from 70% (as re-irrigated tomato when FC drop to 70% is considered the most suitable irrigation regime) to 100% (T1), 66% (T2) and 33% (T3) of optimum water amount. Also, three different drought adaptable treatments were applied to tomato plants, i.e. drought pretreatment of seedlings (seedling priming), spraying plants with a reflecting antitranspirant (a suspension of calcium carbonate at concentration of 6%) or infected plants with arbuscular mycorrizal fungus, as well as control which was not treat with any of adaptable treatment. Decreasing amount of irrigation water applied decreased gradually relative water content (RWC), No of fruits/ plant, average fruit weight and early and total yields, than those of well-watered plants (T1). The reduction in total yield was mainly due to the reduction of both fruit weight and fruit number. However, water deficit treatments (T2 & T3) enhanced water use efficiency (WUE) and improved fruit quality i.e. increased vit. C, TSS, titratable acidity, and lycopene contents and fruit firmness in ripe fruits. The increase in fruit quality traits by water stress could be interpreted on the base that plants grown under such conditions react by stimulate the secondary metabolism which increasing plant defense, the secondary metabolites involved sugars, organic acids, vitamins, carotenoids and etc. All adaptable treatments used, often alleviated (even partly) the detrimental effects of water deficit treated plants (T2&T3) as they promoted plant productivity of both well watered and water stressed plants than those of untreated (control) plants. The increase in total yield resulted from using adaptable treatments was mainly due to the increase in average fruit weight, and to lesser extent fruit number. Adaptable treatments also enhanced plant water relation (RWC &WUE) compared to those of untreated control, but they considerably reduced fruit quality traits. In most cases, spraying plants with the antitranspirant material gave the highest values of yield and its components particularly when combined with well watered treatment (T 1 ) and moderate water stress treatment (T2) but not with severe water stress treatment (T3). Using mycorrizal inoculation treatment gave the highest values of average fruit weight, also it gave the second highest values of plant water relations and productivity characters alternately with drought pretreatment. In addition, mycorrizal treatment gave the highest total yield when combined with lowest water supply (T3) than those obtained by other two adaptable treatments.
Objectives: This prospective cohort study evaluate the reliability of ultrasonography in nutritional assessment for patients with liver cirrhosis undergoing major abdominal surgery by follow up the quantitative and morphological changes of rectus femoris (RF) and anterior tibialis (AT) muscles. Methods: Seventy-two adults cirrhotic patients, subjective global assessment grade (SGA A&B) scheduled for major abdominal surgery were assessed preoperative and postoperative days (POD) 1, 3, 5 and 7 in ICU using anthropometric measurements, laboratory investigations, ultrasonography for cross-sectional area (CSA), anteroposterior (AP) and laterolateral (LL) diameters of (RF) and (AT) muscles and record hospital stay time. Results: We reported significant decrease in all measures of RF and AT muscle masses (CSA, AP and LL) diam. started early after ICU admission up to 7 days. All statistically significant decreased compared to POD0 and 1 (p = 0.000). There was 0.56%, 2.05%, 3.28% and 3.67% loss of CSA of RF at POD1, POD3, POD5 and POD7 correspondingly. As well as there was 0.23%, 1.03%, 1.84%, 2.49% loss of CSA of AT in POD1, POD3, POD5 and POD7 correspondingly. Echogenicity score of both muscles were significant increase in POD3, 5 and 7 compared to POD0 (p = 0.000). Conclusion: We used the ultrasound easily for skeletal muscle assessments as well as it helped us to detect the qualitative changes of these muscles and subsequently it can be used as a nutritional assessment tool in LC patients. Muscle US is an emerging tool can used in nutritional guided protocol on malnourished hepatic patient in the future.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.