Comparison of Black Tea Waste and Legume Roughages: Methane Mitigation and Rumen Fermentation Parameters.

The chemical composition, in vitro total gas and CH4 production and performance of cattle fed on factory black tea waste (Camellia sinensis) (BTW), alfalfa (Medicago Sativa), sainfoin (Onobrychis sativa) and white clover (Trifolium repens) was investigated. The gas production was quantified at the 24th hour of the incubation process. BTW was found to vary from roughages in chemical composition (p < 0.05). In addition, the roughages differed in terms of nutrient composition and gas production (p < 0.05). In legume roughages, acetic acid (AA), propionic acid (PA), butyric acid (BA), and total volatile fatty acids (TVFA) values ranged from 52.36-57.00 mmol/L, 13.46-17.20 mmol/L, 9.79-12.43 mmol/L, and 79.71-89.05 mmol/L, respectively. In comparison with black tea waste, legume roughages had higher values of AA, PA, BA, and TVFA. Black tea waste contained a higher acetic acid ratio than legume roughages when compared as a percentage. There was a similar ratio of propionic acid to the rate calculated for sainfoin (Onobrychis sativa) and clover (Trifolium repens), and a similar ratio of butyric acid to the ratio determined for alfalfa (Medicago Sativa). The current study shows that the 5.7-6.3% tannin content of black tea waste can be used in ruminant rations with high-quality roughages. Due to the fact that BTW reduces methane emissions from ruminants and eliminates energy waste from them, the environment can be improved. To obtain more reliable results, further animal feeding experiments on legume roughages and BTW are required.

Evaluation of fibrosis with noninvasive biochemical tests in chronic viral hepatitis B.

Background and Aim: Early diagnosis and treatment of chronic hepatitis B (CHB) disease are important for the prevention of complications such as cirrhosis and hepatocellular cancer. Liver biopsy is an invasive, complicated, and expensive diagnostic method, which is the gold standard for detecting fibrosis. The aim of this study was to investigate the role of these tests in predicting liver fibrosis and treatment decision. Materials and Methods: A total of 1051 patients diagnosed with CHB between 2010 and 2020 in the Gaziantep University Gastroenterology Department were retrospectively evaluated. AAR, API, APRI, FIB-4, KING score, and FIBROQ score were calculated at the time of onset diagnosis. In addition, the Zeugma score, a new formula that is thought to be more sensitive and specific, was determined. Noninvasive fibrosis scores were compared according to the biopsy results of the patients. Results: In this study, the area values under the curve were 0.648 for the API score, 0.711 for the APRI score, 0.716 for the FIB-4 score, 0.723 for the KING score, 0.595 for the FIBROQ score, and 0.701 for the Zeugma score (p<0.05). No statistically significant difference was obtained for the AAR score. The KING, FIB-4, APRI, and Zeugma scores were the best indicators for detecting advanced fibrosis. For KING, FIB-4, APRI, and Zeugma scores, the cutoff value for the prediction of advanced fibrosis were ≥8.67, ≥0.94, ≥16.24, and ≥9.63 with a sensitivity of 50.52%, 56.77%, 59.64%, and 52.34%, specificity of 87.26%, 74.96%, 73.61%, and 78.11%, respectively (p<0.05). In our study, we compared the globulin and GGT parameters with fibrosis, which we used in the Zeugma score formula. Globulin and GGT mean values were significantly higher in the fibrosis group (p<0.05). There was a statistically significant correlation between fibrosis and globulin and GGT values (p<0.05, r=0.230 and p<0.05, r=0.305, respectively). Conclusion: The KING score was found to be the most reliable method for the noninvasive detection of hepatic fibrosis in patients with chronic HBV. The FIB-4, APRI, and Zeugma scores were also shown to be effective in determining liver fibrosis. It was shown that the AAR score was not sufficient for detecting hepatic fibrosis. The Zeugma score, a novel noninvasive test, is a useful and easy tool to evaluate liver fibrosis in patients with chronic HBV and has better accuracy than AAR, API, and FIBROQ.

Comparison of national early warning score-2 and qSOFA in predicting the prognosis of older adults with altered mental status.

BACKGROUND: Altered mental status occurs in one in four older adults, and the risk increases with age. Numerous scoring systems have been improved to predict mortality, but data are limited for these scoring systems to interpret older adult patients. AIM: We aimed to compare qSOFA and National Early Warning Score-2 (NEWS2) scores in predicting the prognosis of older adults with altered mental status. METHOD: We included 500 older adults with altered mental status. We noted the qSOFA and NEWS2 scores of the patients. We compared the qSOFA and NEWS2 scores for the prediction of 30-day mortality, 48-h mortality, hospitalization clinic, outcome, and hospitalization length. RESULTS: The mean NEWS2 score was 6.4, and the mean qSOFA score was 1.3. For 30-day mortality, the sensitivity and specificity of the NEWS2 score ≥ 5 were 68.29% and 69.6%, respectively, and those of qSOFA score > 1 were 47.14% and 78.75%, respectively. AUC values for 30-day mortality prediction were 0,725 (CI: 0.683-0.763) and 0.631 (CI: 0.587-0.673). For intensive care unit hospitalization prediction, the sensitivity and specificity of the NEWS2 score ≥ 5 were 52.73% and 77.67%, respectively, and those of qSOFA score > 1 were 35.32% and 81.55%, respectively. In patients with a NEWS2 score > 10 points, the predicted 48-h mortality had a specificity of 80.6%, which was higher than the qSOFA score. CONCLUSION: NEWS2 score can be used to predict 48-h mortality, 30-day mortality, and intensive care unit hospitalization compared with qSOFA in older adults with altered mental status.

The relationship between infarct volume and high sensitivity troponin I level in patients diagnosed with ischemic stroke.

BACKGROUND: Various biomarkers and clinical variables are used to determine the probability risk, diagnosis, and the prognosis of acute ischemic stroke, but effective markers are still warranted. AIM: We aimed to determine the effectiveness of Hs-cTnI levels to predict the prognosis of AIS. METHODS: This study was planned as a retrospective observational study. Patients with available data and over 18 years old were included in the study. Diffusion magnetic resonance images were evaluated by a senior radiologist and the infarct size was calculated. RESULTS: We included 110 (54.2%) males and 93 (45.8%) females; a total of 203 patients with a mean age of 68.9 were included in the present study. Patients were divided into two groups according to the cut-off level of Hs-troponin-I (group I: lower than 8.5 mg/dL; group 2: higher than 8.5 mg/dL). These two groups were compared for mortality and infarct volume. Infarct volume and the mortality ratio of the group 2 was significantly higher [p = 0.041, U = 4294.5, LV = 6.5 (IQR = 1.8-25.4)]. CONCLUSIONS: Hs-troponin I may be an effective biomarker in predicting the prognosis of patients with acute ischemic stroke. Multicenter comprehensive prospective studies are warranted to obtain stronger results.

Adding eosinophil count to EMERALD rules predicts subarachnoid haemorrhage better in emergency department.

BACKGROUND: Subarachnoid haemorrhage (SAH) clinical decision rules can provide successful results in the differential diagnosis of non-traumatic headache. AIM: The aim of this study is to investigate whether a laboratory parameter that can be added to clinical decision-making rules can better predict subarachnoid haemorrhages in patients presenting to the emergency department with headache. METHODS: We conducted a retrospective cohort study between March 2017 and March 2019. Patients over the age of 18 who admitted to the emergency department with non-traumatic, acute headache last 14 days before admission and evaluated by imaging and laboratory studies were included in the study. RESULTS: A total of 867 patients were included and 141 of them had SAH. In detecting the SAH, Ottawa SAH rule sensitivity (85.1%), specificity (47.1%), positive predictive value (PPV) (23.8%) and negative predictive value (NPV) (94.2%), and for EMERALD SAH, rule sensitivity (96.4%), specificity (43.2%), PPV (24.8%) and NPV (98.4%). In the regression analysis, statistically significant result was obtained to exclude the diagnosis of SAH with the decrease in the eosinophil value (cutoff < 0.085 10^3/µL, OR: 0.011, 95% CI: 0.001-0.213, p = 0.003). When eosinophil value was added to EMERALD SAH rule, it provided a 100% of sensitivity, a 38.4% of specificity, a 24% of PPV and a 100% of NPV in detecting the SAH. CONCLUSIONS: EMERALD SAH rule plus eosinophil, which offers 100% sensitivity and NPV for predicting SAH in adult non-traumatic headaches, may be recommended as a successful and practical decision rule for clinical use according to the Ottawa and EMERALD SAH rule.

Tannin in Ruminant Nutrition: Review.

Tannins are polyphenols characterized by different molecular weights that plants are able to synthetize during their secondary metabolism. Macromolecules (proteins, structural carbohydrates and starch) can link tannins and their digestion can decrease. Tannins can be classified into two groups: hydrolysable tannins and condensed tannins. Tannins are polyphenols, which can directly or indirectly affect intake and digestion. Their ability to bind molecules and form complexes depends on the structure of polyphenols and on the macromolecule involved. Tannins have long been known to be an "anti-nutritional agent" in monogastric and poultry animals. Using good tannins' proper application protocols helped the researchers observe positive effects on the intestinal microbial ecosystem, gut health, and animal production. Plant tannins are used as an alternative to in-feed antibiotics, and many factors have been described by researchers which contribute to the variability in their efficiencies. The objective of this study was to review the literature about tannins, their effects and use in ruminant nutrition.

Prediction of prognosis and outcome of patients with pulmonary embolism in the emergency department using early warning scores and qSOFA score.

OBJECTIVE: To determine the prediction ability of the National Early Warning Score (NEWS), National Early Warning Score 2 (NEWS2), and quick Sequential Organ Failure Assessment (qSOFA) score for the prognosis of pulmonary embolism (PE) in the emergency department. METHODS: This retrospective study involved 245 patients with PE. The NEWS, NEWS2, and qSOFA scores were compared according to the hospitalization clinic (ward vs. intensive care unit), hospitalization length (<10 vs. >10 days), severity of embolism (massive vs. submassive), and outcome (discharged vs. died). RESULTS: The areas under the curve of the NEWS, NEWS2, and qSOFA score for 1-week mortality were 0.854 (sensitivity, 78%; specificity, 73%; cutoff, 7.5; confidence interval, 0.807-0.902), 0.870 (sensitivity, 83%; specificity, 73%; cutoff, 5.5; confidence interval, 0.825-0.915), and 0.789 (sensitivity, 83%; specificity, 51%; cutoff, 0.5; confidence interval, 0.720-0.858), respectively. CONCLUSION: The NEWS2 more accurately predicts 1-week mortality than do the NEWS and qSOFA score in patients with PE.

Ecofriendly Usability of Mushroom Cultivation Substrate as a Ruminant Feed: Anaerobic Digestion Using Gas Production Techniques.

The current study was carried out to evaluate the nutritive value of mushroom-uncultivated and -cultivated substrates, and their in vitro gas and methane production. The experiment was conducted in a completely randomized design, and analyzed with GLM using SAS 9.4. Analysis of the structural morphology of mushroom-cultivated substrate was performed using a scanning electron microscope. Mushroom cultivation led to lower ether extract, acid detergent fiber, and crude fiber level of substrate (p < 0.05). Mushroom-cultivated substrate showed higher in vitro cumulative gas production (p < 0.05). Moreover, mushroom cultivation led to a higher sample surface, and improved the microorganisms' access to feed materials, thus stimulating rumen fermentation and increasing methane production (p < 0.05). The organic matter digestibility, metabolizable energy, and net energy lactation values were higher for mushroom-cultivated substrate than uncultivated substrate. The results demonstrate that mushroom-cultivation not only increases the contact surface of cellulose, leading to higher ruminal microorganisms' access to feedstuff, but could also had higher nutritive value; this material might be used in ruminant ration formulation, to reduce environmental pollution and feed costs.

Do biomarkers have predictive value in the treatment modality of the patients diagnosed with bowel obstruction?

SUMMARY OBJECTIVES: This study aimed to investigate the ability of the biomarkers to predict the surgery treatment and mortality in patients above 18 years of age who were hospitalized with the diagnosis of bowel obstruction from the emergency department. METHODS: This is a 2-year retrospective study. The patients' demographic data, laboratory parameters on admission to emergency department, treatment modalities, and the length of hospital stay were recorded. Patients were divided into two groups: conservative and surgical treatment. Statistical analysis was performed to investigate the value of biomarkers in predicting mortality and the need for surgery. Data were analyzed using IBM SPSS version 22. RESULTS: A total of 179 patients were included in this study. Of these, 105 (58.7%) patients were treated conservative and 74 (41.3%) were treated operatively. The elevated procalcitonin (PCT) level, C-reactive protein, blood urea nitrogen-to-albumin ratio, and lactate-to-albumin ratio were significantly correlated with surgical treatment, length of hospital stay, and mortality. procalcitonin threshold value of 0.13 ng/mL was able to predict the need for surgical treatment, with a sensitivity of 79% and a specificity of 70.3%. Procalcitonin threshold value of 0.65 ng/mL was able to predict the mortality rate of the patients, with a sensitivity of 92.9% and a specificity of 78.1%. CONCLUSIONS: Biomarkers, especially procalcitonin, may be useful in bowel obstruction treatment management and may predict mortality.

Do biomarkers have predictive value in the treatment modality of the patients diagnosed with bowel obstruction?

OBJECTIVES: This study aimed to investigate the ability of the biomarkers to predict the surgery treatment and mortality in patients above 18 years of age who were hospitalized with the diagnosis of bowel obstruction from the emergency department. METHODS: This is a 2-year retrospective study. The patients' demographic data, laboratory parameters on admission to emergency department, treatment modalities, and the length of hospital stay were recorded. Patients were divided into two groups: conservative and surgical treatment. Statistical analysis was performed to investigate the value of biomarkers in predicting mortality and the need for surgery. Data were analyzed using IBM SPSS version 22. RESULTS: A total of 179 patients were included in this study. Of these, 105 (58.7%) patients were treated conservative and 74 (41.3%) were treated operatively. The elevated procalcitonin (PCT) level, C-reactive protein, blood urea nitrogen-to-albumin ratio, and lactate-to-albumin ratio were significantly correlated with surgical treatment, length of hospital stay, and mortality. procalcitonin threshold value of 0.13 ng/mL was able to predict the need for surgical treatment, with a sensitivity of 79% and a specificity of 70.3%. Procalcitonin threshold value of 0.65 ng/mL was able to predict the mortality rate of the patients, with a sensitivity of 92.9% and a specificity of 78.1%. CONCLUSIONS: Biomarkers, especially procalcitonin, may be useful in bowel obstruction treatment management and may predict mortality.

Perfusion index: Could this be a new triage tool for upper gastrointestinal system bleeding in the emergency department? A prospective cohort study

ABSTRACT BACKGROUND: Many scoring systems for predicting mortality, rebleeding and transfusion needs among patients with upper gastrointestinal bleeding (UGIB) have been developed. However, no scoring system can predict all these outcomes. OBJECTIVE: To show whether the perfusion index (PI), compared with the Rockall score (RS), helps predict transfusion needs and prognoses among patients presenting with UGIB in emergency departments. In this way, critical patients with transfusion needs can be identified at an early stage. DESIGN AND SETTING: Prospective cohort study in an emergency department in Turkey, conducted between June 2018 and June 2019. METHODS: Patients' demographic parameters, PI, RS, transfusion needs and prognosis were recorded. RESULTS: A total of 219 patients were included. Blood transfusion was performed in 174 patients (79.4%). The PI cutoff value for prediction of the need for blood transfusion was 1.17, and the RS cutoff value was 5. The area under the curve (AUC) value for PI (AUC: 0.772; 95% confidence interval, CI: 0.705-0.838; P < 0.001) was higher than for RS (AUC: 0.648; 95% CI: 0.554-0.741; P = 0.002). 185 patients (84.5%) were discharged, and 34 patients (15.5%) died. The PI cutoff value for predicting mortality was 1.1, and the RS cutoff value was 7. The AUC value for PI (AUC: 0.743; 95% CI: 0.649-0.837; P < 0.001) was higher than for RS (AUC: 0.725; 95% CI: 0.639-0.811; P < 0.001). CONCLUSION: PI values for patients admitted to emergency departments with UGIB on admission can help predict their need for transfusion and mortality risk.

Perfusion index: Could this be a new triage tool for upper gastrointestinal system bleeding in the emergency department? A prospective cohort study.

BACKGROUND: Many scoring systems for predicting mortality, rebleeding and transfusion needs among patients with upper gastrointestinal bleeding (UGIB) have been developed. However, no scoring system can predict all these outcomes. OBJECTIVE: To show whether the perfusion index (PI), compared with the Rockall score (RS), helps predict transfusion needs and prognoses among patients presenting with UGIB in emergency departments. In this way, critical patients with transfusion needs can be identified at an early stage. DESIGN AND SETTING: Prospective cohort study in an emergency department in Turkey, conducted between June 2018 and June 2019. METHODS: Patients' demographic parameters, PI, RS, transfusion needs and prognosis were recorded. RESULTS: A total of 219 patients were included. Blood transfusion was performed in 174 patients (79.4%). The PI cutoff value for prediction of the need for blood transfusion was 1.17, and the RS cutoff value was 5. The area under the curve (AUC) value for PI (AUC: 0.772; 95% confidence interval, CI: 0.705-0.838; P < 0.001) was higher than for RS (AUC: 0.648; 95% CI: 0.554-0.741; P = 0.002). 185 patients (84.5%) were discharged, and 34 patients (15.5%) died. The PI cutoff value for predicting mortality was 1.1, and the RS cutoff value was 7. The AUC value for PI (AUC: 0.743; 95% CI: 0.649-0.837; P < 0.001) was higher than for RS (AUC: 0.725; 95% CI: 0.639-0.811; P < 0.001). CONCLUSION: PI values for patients admitted to emergency departments with UGIB on admission can help predict their need for transfusion and mortality risk.

Activated Charcoal and Poisoning: Is It Really Effective?

BACKGROUND: This study aims to compare the poisoned patients who could not be administered activated charcoal because of its unavailability with the poisoned patients who were administered charcoal in the later period and to reveal the results about its effectiveness. STUDY QUESTION: Is the use of activated charcoal effective against poisoning caused by oral medication? STUDY DESIGN: This retrospective cohort study with historical control was planned at a tertiary hospital. Patients older than 18 years were admitted to the emergency department because of oral drug poisoning during the study periods. A total of 1159 patients who were not given activated charcoal and 877 patients who were given activated charcoal were included in this study. MEASURES AND OUTCOMES: The frequency of clinical findings secondary to the drug taken, the frequency of antidote use, the frequency of intubation, and the hospitalization length were determined as clinical outcome parameters. RESULTS: There was no statistically significant difference in the development of central nervous system findings, cardiovascular system findings, frequency of intubation, and blood gas disorders, as well as the length of hospitalization periods according to the activated charcoal application. Hepatobiliary system findings and electrolyte disturbances were found to be less common in patients given activated charcoal. The frequency of tachycardia, speech impairment, coma, and respiratory acidosis was found to be statistically higher in patients who were administered activated charcoal. The hospitalization period of the patients who were given activated charcoal was longer in patients with drug findings; however, there was no difference in the hospitalization periods of the patients who were given an antidote. CONCLUSIONS: The use of activated charcoal in poisoned patients may not provide sufficient clinical benefits. However, clinical studies with strong evidence levels are needed to determine activated charcoal's clinical efficacy, which is still used as a universal antidote.

Check the diastolic blood pressure twice in aortic dissection as it is associated with prognosis.

OBJECTIVE: In this study we aimed to determine the prediction level of admission diastolic blood pressure (DBP) on the prognosis and mortality in aortic dissection patients over 65 years old and under 65 years old. METHODS: We included 72 patients in this retrospective study and study groups were divided into two groups according to 65 age. Demographic data, dissection type (Stanford A-B), DBP, systolic blood pressure (SBP), mean arteriel pressure (MAP), heart rate (/min) main complaints, preoperative length of stay, hospitalisation clinic (clinic/intensive care unit), length of hospitaliisation, complications during hospitalisation (renal failure etc..) and the outcome (death/dischargement) results were noted. Preoperative lenth of stay, hospitalisation length, outcome and complications were compared between groups according to SBP, DBP, MAP and heart rate. RESULTS: Mean blood pressure values of the Stanford type B patients over 65 years old were higher than the other group (p<0.05). Fifty percent of patients under 65 years old were discharged but this ratio was 26.9% in the elder group. DBP was positively correlated with preoperative length of stay and hospitalisation length and negatively correlated with mortality. DBP under 65 mmHg was significantly related with high mortality (p<0.05). When the age and presentation time heart rate is added to each other, the values over 142 were significantly related with high mortality (p<0.05). CONCLUSIONS: The presentation time vital signs especially the DBP may be helpful for emergency clinicians to predict the prognosis and outcome in aortic dissection patients which has high mortality ratio in patients over 65 years of age.

Effects of supplementation of dietary humate, probiotic, and their combination on performance, egg quality, and yolk fatty acid composition of laying hens.

This study was carried out to determine the effects of addition of humate, probiotic, and their combination into diets on performance, egg quality, and yolk fatty acid composition of hens during the second laying period. Lohmann LSL white layers (n = 192), 46 weeks of age, were randomly divided into 4 groups and fed with basal diet (control, C), 0.3% humate (H), 0.3% probiotic (P), 0.15% humate + 0.15% probiotic (HP) for 18 weeks. Feed consumption and egg production were determined daily, egg weight was measured biweekly, and body weights were recorded at the beginning and the end of the experiment. Also, 12 egg samples from each group were randomly collected to determine the egg quality every 30 days. Laying performance, yolk color, and fatty acid composition were significantly (P < 0.05 and P < 0.01) affected by addition of humate, probiotic, and their combination into diets of layers. The HP group had higher cracked egg yield and feed conversion ratio values than control and H and P groups. Except for egg yolk color, the other egg quality parameters such as shape index, shell strength, shell thickness, albumen index, yolk index, and Haught unit were not affected by treatment (P < 0.05 and P < 0.01). The egg yolks of treatment groups had less stearic acid than those of control group. In conclusion, supplementation of humate and probiotic into the diets of laying hens increased monounsaturated fatty acids in yolk and improved feed conversion ratio and egg yolk color.

The Effectiveness of Neutrophil-Lymphocyte Ratio in Predicting in-Hospital Mortality in Non-ST-Elevation Myocardial Infarction.

BACKGROUND: Myocardial infarction is the most common cause of death all over the world. There are many studies in predicting mortality. The aim of this study was to determine the effectiveness of hematologic parameters measured at the moment of admission to the emergency room in predicting in-hospital mortality and to determine cutoff values of strongly predictive values. METHODS: A total of 681 patients over 18 years of age, whose date could be obtained, were included in the study. From the hemogram parameters, white blood cells (WBC), red cell distribution width (RDW), mean platelet volume (MPV), and neutrophils-to-lymphocytes ratio (NLR) values were determined and recorded. CK-MB and high-sensitive troponin T values were recorded as cardiac markers. For statistical analysis, "SPSS for Windows version 21" package program was used. RESULTS: 62.6% (n = 426) of the patients were male, and 37.4% (n = 426) of the patients were male, and 37.4% (. CONCLUSION: According to the hemogram results which were acquired with a simple and cheap method, we found that WBC and especially NLR values obtained with a simple method can be used as powerful predictors.

The prediction levels of emergency clinicians about the outcome of the ambulance patients and outpatients.

AIM: The increased number of emergency clinic patients causes the length of stay in the emergency department, low patient satisfaction and dismiss of real emergency patients. In this study, we aimed to determine the prediction levels of emergency clinicians according to working year on the outcome of the ambulance patients and outpatients presented to the emergency department (ED). MATERIALS & METHODS: This prospective study included patients over 18 years old. The triage of outpatients was made by a senior nurse and patients were divided into three triage categories such as green, yellow and red. Then these patients were evaluated by the emergency physician at the examination areas. Ambulance patients were directly evaluated by the emergency physician. These ambulance patients were noted as yellow or red according to triage categories. The main complaints, triage category, presentation method, vital signs, predicted outcome noted by the clinicians. RESULTS: The correct prediction levels of hospitalisation (clinic/intensive care unit) were higher in clinicians whose working year is between 6 and 10 years (p < 0.05). There was no significant difference between 6-10 year and >10 year group according to prediction level (p > 0.05). Prediction of dischargement was higher in 0-5 year group than 6-10 year (p < 0.05) and >10 year (p < 0.05) group. CONCLUSION: Experienced clinicians can make much more accurate prediction on length of stay and the prognosis of the emergency patients so crowded follow-up areas of the emergency room can be planned much more effectively.