Annual and seasonal trends in cow's milk quality determined by FT-MIR spectroscopy in Hungary between 2011 and 2020.

We analysed and monitored the major chemical composition of cow's bulk milk by Fourier transform mid-infrared (FT-MIR) spectroscopy over a 10-year period in the whole territory of Hungary. In addition, the two most important key parameters for milk quality assessment, total bacterial count (TBC) and somatic cell count (SCC) were also followed. Production parameters showed significant seasonal and yearly changes. The overall mean fat, protein, lactose and solids-non-fat (SNF) contents of cow's milk were 3.81%, 3.32%, 4.74% and 8.76%, respectively. A circannual variation was observed in the chemical composition and yield of milk components of samples examined between 2011 and 2020. Concerning milk fat, milk protein and SNF, the values were the lowest in summer and the highest in winter. In the case of lactose, the minimum values were measured in autumn and the maximum values in spring. An obvious trend of long-term elevation of lactose and SNF was found in the raw cow milk samples over the observed period. The overall mean TBC and SCC of cow's milk were 52 × 103 CFU ml-1 and 270 × 103 cells/ml, respectively. Although there were differences in the monthly average values, no seasonal cyclicality was observed.

Does standing or sitting position of the anesthesiologist in the operating theatre influence sevoflurane exposure during craniotomies?

BACKGROUND: Exposure of the OR staff to inhalational anesthetics has been proven by numerous investigators, but its potential adverse effect under the present technical circumstances is a debated issue. The aim of the present work was to test whether using a laminar flow air conditioning system exposure of the team to anesthetic gases is different if the anesthetist works in the sitting as compared to the standing position. METHODS: Sample collectors were placed at the side of the patient and were fixed at two different heights: at 100 cm (modelling sitting position) and 175 cm (modelling standing position), whereas the third collector was placed at the independent corner of the OR. Collected amount of sevoflurane was determined by an independent chemist using gas chromatography. RESULTS: At the height of the sitting position the captured amount of sevoflurane was somewhat higher (median and IQR: 0.55; 0.29-1.73 ppm) than that at the height of standing (0.37; 0.15-0.79 ppm), but this difference did not reach the level of statistical significance. A significantly lower sevoflurane concentration was measured at the indifferent corner of the OR (0.14; 0.058-0.36 ppm, p < 0.001). CONCLUSIONS: Open isolation along with the air flow due to the laminar system does not result in higher anesthetic exposure for the sitting anesthetist positioned to the side of the patient. Evaporated amount of sevoflurane is below the accepted threshold limits in both positions.

Correlation of Inflammatory Parameters with the Development of Cerebral Vasospasm, Takotsubo Cardiomyopathy, and Functional Outcome after Spontaneous Subarachnoid Hemorrhage.

Background: The present work aimed to determine whether a relationship exists between inflammatory parameters and the development of vasospasm (VS) and Takotsubo cardiomyopathy (TTC), as well as clinical outcome, in patients suffering from spontaneous subarachnoid hemorrhage (SAH). Methods: In this study, the authors processed the prospectively collected laboratory and clinical data of spontaneous SAH patients admitted to the neurointensive care unit between March 2015 and October 2023. The highest values of neutrophils (NEUpeak), monocytes (MONOpeak), neutrophil-to-lymphocyte ratio (NLRpeak), and CRP (CRPpeak) during the initial 7 days were correlated with the occurrence of VS and TTC, and with the outcome measures at day 30 after onset. Results: Data were collected from 175 SAH patients. Based on ROC analysis, for the development of VS, MONOpeak was the most accurate indicator (AUC: 0.619, optimal cut-off: 1.45 G/L). TTC with severe left ventricular dysfunction (ejection fraction < 40%) was indicated most sensitively by NEUpeak (ROC: 0.763, optimal cut-off: 12.34 G/L). Both for GOS and Barthel Index at day 30, CRPpeak was the best predictor for the outcome (GOS: ROC: 0.846, optimal cut-off: 78.33 mg/L and Barthel Index: ROC: 0.819, optimal cut-off: 78.33 mg/L). Conclusions: Laboratory parameters referring to inflammation during the initial 7 days after SAH correlate with the development of VS and TTC, and thus may predict functional outcome.

Administration of preemptive analgesia by diclofenac to prevent acute postcraniotomy headache.

PURPOSE: Postcraniotomy headache (PCH) is a frequent perioperative complication in neuroanesthesia. The aim of the present work was to assess the incidence of PCH and to test the efficacy and safety of preoperatively administered diclofenac. METHODS: Patients undergoing craniotomies for intracranial tumor resections were enrolled. In the case group 100 mg diclofenac p.o. one hour prior to surgery was used as a preemptive analgesic along with infiltration of the surgical site with a combination of lidocaine and epinephrine. In controls only surgical site infiltration was used. VAS scores were assessed preoperatively, on the day of surgery (DoS), on the 1st and 5th postoperative days. RESULTS: We have found that PCH of any severity is between 50-90% during the first five days after surgery. The number of cases characterized as "no pain" significantly decreased in the early postoperative period, but remained in both groups still higher on the 5th postoperative day than observed preoperatively. In both groups, the number of headaches characterized as mild pain remained relatively stable and substantial increases in case numbers were observed in moderate and severe headaches, showing a declining tendency over time in the postoperative period. A significant effect of diclofenac pretreatment was observed compared to controls on DoS (chi2: 10.429, p<0.015), on the 1st (chi2: 8.75, p<0.032) and 5th postoperative days (chi2: 14.3, p<0.002). CONCLUSIONS: The relatively low incidence of severe PCH on day five in the diclofenac group may indicate that preoperatively administered diclofenac effectively reduces postcraniotomy headache. A randomized study is encouraged to test this hypothesis.

Takotsubo cardiomyopathy in patients suffering from acute non-traumatic subarachnoid hemorrhage-A single center follow-up study.

BACKGROUND: Takotsubo cardiomyopathy (TTC) is an important complication of subarachnoid hemorrhage (SAH), that may delay surgical or endovascular treatment and may influence patient outcome. This prospective follow-up study intended to collect data on the prevalence, severity, influencing factors and long-term outcome of TTC in patients suffering from non-traumatic SAH. METHODS: Consecutive patients admitted with the diagnosis of non-traumatic SAH were included. Intitial assessment consisted of cranial CT, Hunt-Hess, Fisher and WFNS scoring, 12-lead ECG, transthoracic echocardiography (TTE), transcranial duplex sonography and collecting laboratory parameters (CK, CK-MB, cardiac troponin T, NT-proBNP and urine metanephrine and normetanephrine). Diagnosis of TTC was based on modified Mayo criteria. TTC patients were dichotomized to mild and severe forms. Follow-up of TTE, Glasgow Outcome Scale assessment, Barthel's and Karnofsky scoring occurred on days 30 and 180. RESULTS: One hundred thirty six patients were included. The incidence of TTC in the entire cohort was 28.7%; of them, 20.6% and 8.1% were mild and severe, respectively. TTC was more frequent in females (30/39; 77%) than in males (9/39; 23%) and was more severe. The occurrence of TTC was related to mFisher scores and WFNS scores. Although the severity of TTC was related to mFisher score, Hunt-Hess score, WFNS score and GCS, multivariate analysis showed the strongest relationship with mFisher scores. Ejection fraction differences between groups were present on day 30, but disappeared by day 180, whereas wall motion score index was still higher in the severe TTC group at day 180. By the end of the follow-up period (180 days), 70 (74.5%) patients survived in the non-TTC, 22 (81.5%) in the mild TTC and 3 (27%) in the severe TTC group (n = 11) (p = 0.002). At day 180, GOS, Barthel, and Karnofsky outcome scores were higher in patients in the control (non-TTC) and the mild TTC groups than in the severe TTC group. CONCLUSIONS: Takotsubo cardiomyopathy is a frequent finding in patients with SAH, and severe TTC may be present in 8% of SAH cases. The severity of TTC may be an independent predictor of mortality and outcome at 6 months after disease onset. Therefore, a regular follow-up of ECG and TTE abnormalities is warranted in patients with subrachnoid hemorrhage for early detection of TTC. TRIAL REGISTRATION: The study was registered at the Clinical Trials Register under the registration number of NCT02659878 (date of registration: January 21, 2016).

Quality assurance of national internet-based patient register data: Experiences during the operation of the Hungarian Myocardial Infarction Registry, 2010­2020 / Internetalapú, országos betegségregiszter adatainak minoségbiztosítása: Tapasztalatok a Nemzeti Szívinfarktus Regiszter muködtetése során, 2010­2020

Összefoglaló. Bevezetés: A Nemzeti Szívinfarktus Regiszterben 111 788 beteg 122 351 infarktusos eseményéhez kapcsolódó 145 292 kezelés adatai szerepelnek. Módszer: A rögzített adatokat az üzemeltetok folyamatosan kontrollálják, bemutatják azokat a minoségbiztosítási módszereket, amelyekkel az adatbázis teljességét és megfeleloségét biztosítják. Az online informatikai rendszerben az adatbevitel során 119 automatikus ellenorzési algoritmust muködtetnek. Az automatikus ellenorzési algoritmussal nem kezelheto adatok ellenorzését 5 részállású, egészségügyi képzettségu kontroller és 2 foállású munkatárs végzi. A regiszter muködése során folyamatosan fejlesztették az ellenorzés módszereit, ennek során 2018-tól a kontrollerek által ellenorzött adatlapok utóellenorzésére is sor kerül. Az utóellenorzés során a már ellenorzött adatlapok 2,4%-ában további javításra volt szükség. Eredmények: Az utóellenorzés eredménye, hogy a kontrolleri munkát hatékonyabbá sikerült tenni, mivel egyre kevesebb az utóellenorzés során hibásnak talált adatlapok száma. Megvizsgálták, hogy az adatlap kérdéseire milyen arányban kaptak értékelheto választ. Az értékelheto válaszok aránya a legtöbb esetben meghaladta a 90%-ot, azonban a panaszok kezdetének ideje az adatlapok 39%-ában volt megadva, míg a dohányzási szokásokkal kapcsolatos válasz az esetek 59%-ában volt megfelelo. Megbeszélés: A szerzok rámutatnak arra, hogy a Nemzeti Egészségbiztosítási Alapkezelo és a Nemzeti Szívinfarktus Regiszter adatbázisának folyamatos egyeztetése hozzájárul a regisztráció teljességének biztosításához, lehetové teszi a betegek állapotának hosszú távú követését. Miután a program kötelezo jelleguvé vált 2014. 01. 01-jén, az elso évben a szívinfarktus-diagnózissal finanszírozott betegek kétharmada (67%) szerepelt a regiszter adatbázisában; ez az arány a 2017-2019-es években meghaladta a 90%-ot (91,7-93,6-91,3%). Következtetés: Vizsgálatukból a szerzok azt a következtetést vonják le, hogy a betegségregiszter muködése során szükséges az adatok teljességének és megfeleloségének folyamatos ellenorzése. A regiszter adatbázisának 90% feletti teljessége az ellátórendszer minoségi paramétereinek folyamatos követését teszi lehetové. Orv Hetil. 2021; 162(2): 61-68. INTRODUCTION: The Hungarian Myocardial Infarction Registry contains data on 145 592 treatments related to the 111 788 patients and the 122 351 myocardial infarctions. METHOD: The recorded information is continuously monitored, and the quality assurance methods used to ensure the completeness and adequacy of the database are presented. In the online IT system, 119 automatic verification algorithms are operated during data entry. Data that cannot be handled by the automated verification algorithm is checked by five part-time health-qualified controllers and two full-time employees. During the operation of the register, the control methods were continuously developed, during which the data sheets checked by the controllers will be post-checked from 2018 onwards. During the post-checked process, 2.4% of the datasheets required further correction. RESULTS: The number of data sheets found to be incorrect during the post-audit was decreasing. The authors examined the proportion of evaluable answers to the questionnaire. The rate of evaluable responses was over 90% in most cases; however, the time of the onset of symptoms was given in 39% of the datasheets, while the answer to smoking habits was adequate in 59% of cases. DISCUSSION: The authors point out that the continuous consultation of the database of the National Health Fund Management Centre and the Hungarian Myocardial Infarction Registry contributes to ensuring the completeness of registration, enabling long-term monitoring of the condition of patients. In the first year of the mandatory period of the program, two-thirds (67%) of patients treated with a diagnosis of myocardial infarction were included in the registry database, and this proportion exceeded 90% in the years 2017-2019 (91.7-93.6-91.3%). CONCLUSION: The study of the authors concludes that the completeness and adequacy of the data need to be constantly monitored during the operation of the patient registry. The integrity of the register database above 90% enables the continuous monitoring of the quality parameters of the system. Orv Hetil. 2021; 162(2): 61-68.

Assessment of two prophylactic fluid strategies in aneurysmal subarachnoid hemorrhage: A randomized trial.

OBJECTIVE: To compare the effect of two prophylactic euvolemic fluid strategy regimens on the incidence of cerebral vasospasm and clinical outcomes in patients with aneurysmal subarachnoid hemorrhage (SAH). METHODS: Ninety-six patients with a basal intravenous intake of 15 mL/kg/day of Ringer's lactate solution were included, and an additional 15 to 50 mL/kg/day Ringer's lactate (RL-group) or hydroxyethyl starch 130/0.4 solution (HES-group) was administered to maintain the targeted mean arterial pressure. The primary end point was the occurrence of cerebral vasospasm during the first 14 days. The secondary end points were case fatality, Barthel's index, and Glasgow Outcome Scores (GOS) at 30 days after SAH. RESULTS: Cerebral vasospasm developed in 42 patients (43.7%), and nine of these events were severe. The vasospasm rate among the RL- and HES-based groups was 25/48 and 17/48, respectively. For the secondary endpoint, four patients (4%) died by the end of follow-up (two in each group). Unfavorable outcome cases were not different in the RL and HES groups (9 vs. 14, respectively). There was no difference between the Barthel's scores at 30 days between the two groups. CONCLUSIONS: Using starches in a prophylactic treatment strategy in aneurysmal SAH in not supported by the study.The trial was registered at Clinicaltrials.gov under the number NCT02064075.

Cobalt and secondary poisoning in the terrestrial food chain: data review and research gaps to support risk assessment.

Cobalt is a naturally occurring element found in rocks, soil, water, plants, and animals and has diverse industrial importance. It is cycled in surface environments through many natural processes (e.g. volcanic eruptions, weathering) and can be introduced through numerous anthropogenic activities (e.g. burning of coal or oil, or the production of cobalt alloys). The environmental behaviour of cobalt in terrestrial environment is relatively poorly studied and in particular where Co is used in industrial processes, the baseline information to support wider and long-term environmental impacts is widely dispersed. To support the adoption of new EU regulations on the risk assessment of chemicals, we review here the various aspects of the environmental chemistry, fate and transport of Co across environmental interfaces and discuss the toxicology and potential for bio magnification and food chain accumulation. The soil-to-plant transfer of Co appears to be viable route to expose lower trophic levels to biologically significant concentrations and Co is potentially accumulated in biomass and top soil. Evidence for further accumulation through soil-invertebrate transfer and to higher trophic levels is suggested by some studies but this is obscured by the relatively high variability of published transfer data. This variation is not due to one particular aspect of the transfer of Co in terrestrial environments. Influences are from the variability of geological sources within soil systems; the sensitivity of Co mobility to environmental factors (e.g. pH) and the variety of life strategies for metal elimination/use within biological species. Toxic effects of Co have been suggested for some soil-plant animal studies however, uncertainty in the extrapolation from laboratory to field is a major limitation.

A single preoperative dose of diclofenac reduces the intensity of acute postcraniotomy headache and decreases analgesic requirements over five postoperative days in adults: A single center, randomized, blinded trial.

OBJECTIVE: Postcraniotomy headache causes considerable pain and can be difficult to treat. We therefore tested the hypothesis that a single 100-mg preoperative dose of diclofenac reduces the intensity of postcraniotomy headache, and reduces analgesic requirements. METHODS: 200 patients having elective craniotomies were randomly assigned to diclofenac (n = 100) or control (n = 100). Pain severity was assessed by an independent observer using a 10-cm-long visual analog scale the evening of surgery, and on the 1st and 5th postoperative days. Analgesics given during the first five postoperative days were converted to intramuscular morphine equivalents. Results were compared using Mann-Whitney-tests; P < 0.05 was considered statistically significant. RESULTS: Baseline and surgical characteristics were comparable in the diclofenac and control groups. Visual analog pain scores were slightly, but significantly lower with diclofenac at all times (means and 95% confidence intervals): the evening of surgery, 2.47 (1.8-3.1) vs. 4. 37 (5.0-3.7), (P < 0.001); first postoperative day, 3.98 (3.4-4.6) vs. 5.6 (4.9-6.2) cm (P < 0.001) and 5th postoperative day: 2.8 (2.2-3.4) vs. 4.0 ± (3.3-4.7) cm (P = 0.013). Diclofenac reduced systemic analgesic requirements over the initial five postoperative days (mean and 95% CI): 3.3 (2.6-3.9) vs. 4.3 (3.5-5.1) mg morphine equivalents (P < 0.05). CONCLUSIONS: Preoperative diclofenac administration reduces postcraniotomy headache and postoperative analgesic requirements - a benefit that persisted throughout five postoperative days.

Metal uptake by woodlice in urban soils.

This study evaluated the uptake of bioavailable metal (Cd, Cr, Cu, Fe, Pb and Zn) by woodlice (Isopoda) collected from public open spaces in urban areas of Renfrewshire, Central West Scotland, UK. The species Oniscus asellus and Porcellio scaber were collected at 13 different locations together with associated surface soil samples. Soils were subject to sequential extraction to evaluate metal availability and analyzed by ICP-AES and flame AAS for Cd, Cr, Cu, Fe, Pb and Zn concentrations. The soil samples had metal concentrations typical of general urban environments and the potentially toxic elements were well below published guideline values for contaminated sites. The metal concentration showed differing inputs of natural and anthropogenic sources. Metals were bioconcentrated in the order Cu>Cd>Pb>Cr>Zn>Fe for O. asellus and Cu>Zn>Cd>Cr>Fe for P. scaber. Principal Component Analysis of soil geochemical properties and Isopoda metal concentration identified metal to metal variation in uptake. Multiple linear regression analysis was applied in order to investigate the metal uptake in relation to soil properties (total metal concentration, pH and organic matter (OM)). The results showed that factors affecting metal concentration were both species and site specific. The most available forms of metals were generally poorly related to metal accumulation by woodlice, with the only exception being for Cu, which was related to the exchangeable soil fraction. Soil conditions e.g. pH and OM, influenced metal association within the soil and OM played a significant role in restricting uptake of Cr and Pb in particular. For most of the metals studied, despite differences in the environmental availability of the metals, accumulation from ambient soil concentration is controlled by ecological and physiological factors influencing metal assimilation, storage and excretion and that the two biological species vary considerably in their regulation of individual metals.

Bioavailability of arsenic and antimony in soils from an abandoned mining area, Glendinning (SW Scotland).

The mobility and bioavailability of As and Sb in relation to soil-biota transfer were evaluated at a former Sb mining and smelting site (Glendinning, SW Scotland, UK). The study specifically assessed the accumulation of As and Sb in different environmental components (soil, plants and earthworms) across mining area to estimate risk factors for the biota. Total concentrations and fractions of As and Sb in soils were determined. The latter using both a single solute and a non-specific stepwise sequential extraction (CISED) method. Mineralogical information was gathered from XRD and SEM analysis used to identify element distribution patterns. Pseudo-total (aqua-regia) levels of As and Sb in the soils varied between 50-17,400 mg kg(-1) and 10-1,200 mg kg(-1), respectively. Both elements are predominantly associated with Fe (or Al) oxides/hydroxides, by adsorption around silicate grains, representing a potentially bioavailable fraction. Antimony was also associated with sulphide phases. The highest values of As and Sb in biota were recorded in the earthworms (960 mg kg(-1) and 27 mg kg(-1), respectively). Bioconcentration factors for both elements were below 1 and the highest for earthworms. Total and leached As levels in soils and biota were positively and significantly correlated, but only for Sb in earthworms and grass. Bioavailability of As in the biota, was shown to be limited by pH. In spite of the considerably high As and Sb contents of the soil the plant contamination remained comparably low, but still exceeded background values.