The CHA 2 DS 2 -VASc score was found useful in predicting POAF after CABG. This scoring system is simple and convenient to use in the preoperative period to alert the clinician about higher probability of POAF after CABG surgery.
Introduction: All major international guidelines for the management of infective endocarditis (IE) have undergone major revisions, recommending antibiotic prophylaxis (AP) restriction to high-risk patients or foregoing AP completely. We performed a systematic review to investigate the effect of these guideline changes on the global incidence of IE. Methods: Electronic database searches were performed using Ovid Medline, EMBASE and Web of Science. Studies were included if they compared the incidence of IE prior to and following any change in international guideline recommendations. Relevant studies fulfilling the predefined search criteria were categorized according to their inclusion of either adult or pediatric patients. Incidence of IE, causative microorganisms and AP prescription rates were compared following international guideline updates. Results: Sixteen studies were included, reporting over 1.3 million cases of IE. The crude incidence of IE following guideline updates has increased globally. Adjusted incidence increased in one study after European guideline updates, while North American rates did not increase. Cases of IE with a causative pathogen identified ranged from 62% to 91%. Rates of streptococcal IE varied across adult and pediatric populations, while the relative proportion of staphylococcal IE increased (range pre-guidelines 16–24.8%, range post-guidelines 26–43%). AP prescription trends were reduced in both moderate and high-risk patients following guideline updates. Discussion: The restriction of AP to only high-risk patients has not resulted in an increase in the incidence of streptococcal IE in North American populations. The evidence of the impact of AP restriction on IE incidence is still unclear for other populations. Future population-based studies with adjusted incidence of IE, AP prescription rates and accurate pathogen identification are required to delineate findings further in these other regions.
Background: One of the most frequent complications of coronary artery bypass grafting (CABG) is pleural effusion. Limited previous studies have found post-CABG pleural effusion to be associated with increased length-of-stay and greater morbidity post-CABG. Despite this the associations of this common complication are poorly described. This study sought to identify modifiable risk factors for effusion post-CABG.Methods: A retrospective cohort study of prospectively collected data assessed patients who underwent CABG over two-years. Data was collected for risk factors and sequelae related to pleural effusion requiring drainage. Results: A total of 409 patients were included. Average age was 64.9±10.2 years, 330 (80.7%) were male. 59 (14.4%) patients underwent drainage of pleural effusion post-CABG. Effusions were drained on average 9.9±8.4 days post-CABG. Earlier removal of drain tubes and removal near time of extubation were associated with development of pleural effusion. Post-CABG pleural effusion was associated with post-operative renal impairment (P<0.01) and pericardial effusion (P<0.01). Patients with pleural effusion were more likely to require readmission to ICU (P<0.01), reintubation (P=0.03) and readmission to hospital (P=0.03). Conclusions: Pleural effusion is a common complication of cardiac surgery and is associated with significant morbidity and resource utilization. This study identifies several associated complications that should be considered in the presence of pleural effusion. Modifiable associated factors in the management of drains that may contribute to accumulation of pleural effusion include: early removal of chest drains, higher outputs and removal during or close to mechanical ventilation. Further research is required to assess how adjusting these modifiable factors can decrease rates of effusion post-operatively.
Background
Population growth which has resulted in a need for increased crop yields to sustain food security, in addition to the effects of climate change, have led to the widespread use of chemical pesticides. The indiscriminate use of pesticides has in turn led to contamination of the environment, food commodities and bioaccumulation in human tissues, particularly in agrarian regions of India including the northern state of Haryana.
Methods
We conducted a pilot screening study to investigate the presence of organochlorine, organophosphate, and pyrethroid pesticides in breastmilk samples (n = 75) from Haryana, India. Pesticide analyses were conducted using gas chromatography mass spectrometry (GC-MS) for OC and OP pesticides and GC-electron capture detector for pyrethroids. The study was complemented by a qualitative evaluation of maternal and community perceptions, knowledge, attitudes and practices associated with pesticide use and risk of exposure (n = 30 in-depth interviews; n = 9 focus group discussions).
Results
Analysis of breastmilk showed the presence of p,p’-dichlorodiphenyltrichloroethane (DDT) and p,p’-dichlorodiphenyldichloroethylene (DDE) in 4% (range: <LOQ - 28 μg/L) and 5% (range: < LOQ – 107 μg/L) of samples, respectively. No other pesticides were detected.
Our qualitative findings showed that community members commonly held perceptions of pesticides as medicines and poison but acknowledged their widespread use to ensure crop yields. Given the gendered engagement in farming in this setting, lactating women in study communities do not directly handle chemical pesticides, thus lowering risk of inhalation and dermal exposure.
Conclusions
In our small sample, breastmilk pesticide concentrations were low and did not pose a risk to infants. Based on the persistent nature of many organic pollutants and reported widespread use, we recommend more comprehensive and longitudinal investigation of upstream pesticide contamination in the food supply and exposures among mothers and children.
Trial registration
CTRI/2017/01/007636, Date Registered: 06/01/2017.
CTRI website: http://ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=17249&EncHid=&modid=&compid=%27,%2717249det%27
The analgesic and anti‐inflammatory properties of liver oils of four different sharks, namely Neohariotta raleighana, Centrosymnus crepidater, Apristurus indicus and Centrophorus scalpratus, captured from the Arabian Sea and the Indian Ocean were evaluated. While the analgesic property was determined using the acetic acid‐induced mouse writhings and hot‐plate reaction time, the anti‐inflammatory activity was evaluated using the formalin‐induced rat‐paw edema. The oils examined were found to possess significant (P < 0.05) analgesic activity against acetic acid‐induced writhings and hot‐plate reaction in mice. In the formalin‐induced edema, a significant (P < 0.05) inhibition of inflammation was observed between the 2nd and 4th hour showing 58–65% inhibition. These results suggest that liver oils of sharks from Indian waters are effective as analgesic and anti‐inflammatory agents. The role of lipid components (squalene, alkylglycerols and polyunsaturated fatty acids) on anti‐inflammatory and antinociceptive properties is highlighted. Inhibition of the synthesis of prostaglandins and other inflammatory mediators which probably account for the properties is discussed.
PRACTICAL APPLICATIONS
Studies on the pharmacological properties of liver oils from sharks, inhabiting the waters beyond 600 m depth of the Indian Exclusive Economic Zone are scanty. Shark liver oils contain high fractions of health‐boosting unsaponifiable matter and unsaturated fatty acids that could render beneficial effects. Results suggest that these oils possess excellent anti‐inflammatory and peripheral antinociceptive effects that may contribute to its use in the treatment of arthritis and other inflammatory disorders.
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