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Friday, July 29, 2022

Need of Humility in Election Rallies_Crimson Publishers

Need of Humility in Election Rallies by Pradeep Kumar Panda in Archaeology & Anthropology:Open Access_Journal of Archaeology


Opinion

The attitudes of arrogance and hate seem to have suffused the electoral campaign of the 2019 Lok Sabha General election. Although such expressions were evident in varied degrees among campaigners belonging to different parties contesting the elections, this attitude was consistently seen in the members of the ruling party and was arguably more prominent among the leaders and supporters of the incumbent ruling combination.

This is despite the fact that the Election Commission of India (ECI) has been intervening to pull up the offenders. Yet, such interventions of the ECI in order to control these morally offensive tendencies were limited and discriminatory in nature.

It showed both helplessness and unwillingness to exercise its power and this has left no decisive impact in curtailing the growing use of offensive language in Indian politics. The ECIis supposed to police the limits of free speech, which it does by banning some leaders while giving regular clean chits to powerful others. The question that we need to raise is, why is it that some leaders do not feel the moral burden of carrying within them an intense hate and arrogance that creates a corrosive impact on not just their opponents, but also on those who expect the expansion of decent society? What is the value of humility and what function does it perform in controlling the “social evil” of arrogance and hate?

Humility has been understood as the ethical capacity for continuous self-appraisal. Self-appraisal in turn serves to control the flames of pride stoked by the ambition to retain political power. Humility as a virtue has the power to filter out hateful, bad speech. It does not allow the accumulation of such expressions. The necessary condition for being humble in the Indian context is to respect differences and dissent and tolerate plurality of opinion. Humility promotes the political culture of engaging in robust debate on issues that matter more to the people than to the leaders. Democracy can create the condition for humility to acquire articulation through tolerating plurality of opinion.

Humility as a virtue, however, has to exist not as an afterthought or in a post facto situation where leaders begin to see an imminent danger (in the present case) in the elections, but through the confidence sustained by the amount of good work done by a leader or their ruling party for the public. Genuine humility is not premised on an opportune time such as during elections, but all the time, that is, also apart from the elections. The attempt to adopt the image of a humble person can result in producing an instrumental if not completely elusive form of humility. This instrumental practice of humility can result in humiliating opponents through ridicule and insults. What we have witnessed during the past two months is the instrumental, time-tested view of humility, as practiced by some leaders through the media.

Humility, however, finds it difficult to succeed against electoral politics that seem to have been over determined by the presence of the language of “entitlements” and the skewed notion of “pride.” Pride as an expression of appreciation of a nation’s progress should emerge from an affirmative indexing of human well-being. Creating hatred for certain religion and casting aspersions can be considered one of the parameters. However, reducing pride to one index would give rise to arrogance. The category of pride as the overtaxing content of communal hatred necessarily eliminates the grounds on which the possibility of humble democracy could be imagined and perhaps practiced.

Why does humility not succeed against arrogance? Because these leaders’ priorities the language of entitlements over the common good that underlies the need for a decent society. In fact, the language of rights seeks to eliminate the grounds for humility. Here, we are referring to rights that are unilaterally asserted by a certain section of society and which underlie and renew unqualified arrogance and unfounded pride. Such a partisan conception of rights necessarily suggests that a particular party or a social group possesses exclusive claim over a nation.

This is evident among the supporters of the all parties. In their attempt to establish exclusive rights over India, they often discount similar rights that others too have over the nation. “Hindu Terrorist”, “Hindu Taliban”, “Hindu Pakistan”, “Go To Pakistan”, “Bharat Tere Tukde Honge” are some common expressions that the members of the Fringe Elements use for those who question some of their vocal supporters trying to infringe on the democratic culture of this country. When they do not accept the right of the other to rule the country, they do not have to be humble. The capacity to repent gets destroyed due to the tendency to defend one’s mistake by referring to the mistake of one’s opponents and holding them guilty for their past mistakes.

It actually promotes a recalcitrant attitude that denies the person from taking a moral lead in creating new norms that could direct politics towards the creation of a decent society and its concrete realization. However, one of the fundamental challenges facing pluralistic political culture in India today is a decline in the practice of being humble. We need to realize that controlling bad speech is less the function of a public institution and more the result of democratizing the value of humility.

https://crimsonpublishers.com/aaoa/fulltext/AAOA.000579.php

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Thursday, July 28, 2022

Perioperative Echocardiographic Hemodynamic Parameters and Postoperative Outcome in Pediatric Surgical Patients: A Descriptive Observational Prospective Pilot Study Protocol_Crimson publishers

Perioperative Echocardiographic Hemodynamic Parameters and Postoperative Outcome in Pediatric Surgical Patients: A Descriptive Observational Prospective Pilot Study Protocol by Claudine Kumba in Research in Pediatrics & Neonatology_Neonatology Open Access Journals


Abstract

Background: A randomized controlled trial (RCT) protocol in pediatric patients scheduled for surgery will be elaborated. In this RCT protocol trans-thoracic echocardiography will be realized perioperatively to guide fluid and hemodynamic therapy in these patients. This RCT will determine the impact of goal directed therapy with echocardiography on postoperative outcome in terms of morbidity, Length of Intensive Care Unit Stays (LOSICU), Length of Mechanical Ventilation (LMV), Length of Hospital Stays (LOS), fluid therapy and vasopressor-inotropic therapy. There are no trials in pediatric surgical patients which have identified echocardiographic hemodynamic parameters predictive of postoperative outcome in terms of morbidity, LOSICU, LMV and LOS. The objective of this pilot observational prospective trial protocol is to describe the study which will determine echocardiographic hemodynamic parameters predictive of postoperative outcomes. These hemodynamic parameters will be integrated in the RCT which has the objective to determine the impact of goal directed fluid and hemodynamic therapy guided by trans-thoracic echocardiography on postoperative adverse outcome.

Methods: Patients aged less than 18 years admitted for surgery will be included. Trans-thoracic echocardiography will be realized to measure different hemodynamic parameters perioperatively in included patients. Primary outcome will be postoperative morbidity, secondary outcomes will be LOSICU, LMV and LOS; tertiary outcomes will be fluid therapy, vasopressor and inotropic therapy. Primary outcome measure will be the presence of postoperative organ dysfunction. Secondary outcome measures will be the number of postoperative days spent in the Intensive Care Unit (ICU), number of postoperative days spent on invasive or non-invasive mechanical ventilation and the number of postoperative days spent in the conventional hospitalization ward. Tertiary outcome measures will be the quantity of fluid administered and the Vasopressor-Inotropic Score (VIS). The study will be monocentric. XLSAT 2018.3 or plus will be the software for statistical analysis. Results are expected in the first semester of 2022.

Conclusion: This pilot study will identify echocardiographic hemodynamic parameters predictive of postoperative adverse outcome which will be integrated in the second RCT where goal directed fluid and hemodynamic therapy will be guided with echocardiography.

Keywords: Pediatric surgery; Children; Echocardiography; Hemodynamics; Fluid therapy; Postoperativeoutcome

Introduction

Perioperative goal directed fluid and hemodynamic therapy (PGDFHT) has been studied in adults where it has demonstrated its efficacy in terms of reduced postoperative complications and length of hospital stay (LOS) [1-7]. The objective of PGDFHT is to monitor fluid responsiveness and hemodynamic status with the aim to improve oxygen delivery to different systemic organs and to improve tissular perfusion [8]. Tissular hypoperfusion can have side effects in terms of organ failure. Unoptimal fluid and hemodynamic status (insufficient or plethoric) can alter tissular perfusion. Therefore, monitoring fluid responsiveness and hemodynamic status using tools to assess adequate cardiac output to maintain sufficient tissular oxygen delivery is mandatory. There are no studies in children demonstrating the impact of PGDFHT with echocardiography on postoperative outcome. However, there are studies in pediatric cardiac surgery mostly which identified perioperative biomarkers of postoperative adverse outcome [9].

These biomarkers were lactate levels, central venous oxygen saturation SCVO2, regional cerebral, renal, splanchnic oxygen saturation and veno-arterial carbon dioxide gradient. Unoptimal values of these biomarkers predicted adverse postoperative outcome in terms of mortality, morbidity and length of hospital stay (LOS) [9]. Concerning the tool to assess cardiac output, fluid responsiveness and hemodynamic status, transthoracic echocardiography is a noninvasive mean which can bring solutions and some parameter like the variation of peak velocity at the aortic annulus has been validated to predict fluid responsiveness in children [10]. There are no studies which have clarified echocardiographic hemodynamic parameters predictive of postoperative outcome in children scheduled for surgery in general. Nevertheless, there is one retrospective study in pediatric and adult cardiac surgery which showed that intraoperative transesophageal echocardiography after surgical repair in congenital heart disease reduced LOS [11]. We have elaborated an RCT trial where fluid and hemodynamic therapy will be guided with trans-thoracic echocardiography. In this RCT echocardiography hemodynamic parameters will be integrated in a protocol to guide fluid, inotropic and or vasopressive therapy. To validate these echocardiographic hemodynamic parameters, we will conduct a pilot observational prospective study to identify those which are predictive of postoperative adverse outcome. We describe here this pilot trial. We have elaborated 2 similar protocols in pediatric patients with congenital heart disease [12,13]. We would like to generalize the protocol to other pediatric surgical patients. The primary objective of this study protocol is to describe the pilot trial which will be undertaken to identify echocardiographic hemodynamic parameters predictive of postoperative outcome in terms of morbidity.

The secondary objective is to clarify echocardiographic hemodynamic parameters predictive of postoperative LOSICU, LMV and LOS. The tertiary objectives are to determine echocardiographic hemodynamic parameters predictive of fluid therapy, vasopressor and inotropic therapy. The primary outcome measures will be postoperative organ dysfunction until discharge from hospital. The secondary outcome measures will be the number of postoperative days spent in the Intensive Care Unit (ICU), the number of postoperative days spent on invasive or noninvasive mechanical ventilation and the number of postoperative days spent in the conventional hospitalization ward. The tertiary outcome measures will be the quantity of postoperative fluid administered in terms of crystalloids, colloids, blood product and postoperative vasopressor inotropic score. Once the echocardiographic hemodynamic parameters predictive of postoperative outcome have been identified in this pilot study, they will be integrated in a randomized controlled trial which will determine the impact of intraoperative goal directed therapy with echocardiography in general pediatric surgery on postoperative outcome.

Methods and Materials

This trial has been declared at the French National Agency of Drugs and Medications Security, ANSM (National Agency for The Safety of Medicines and Health Products) and registered under the number RCB: 2019-A03256-51. After approval from the Ethics Committee, and after parents and or patient’s information, patients will be included prospectively in one cohort. The patients included will be managed according to the usual local practices. Echocardiography Figure 1 will be realized in each patient perioperatively after induction of anesthesia. The echocardiographic hemodynamic parameters measured are precised below. The patients included will be children aged less than 18 years admitted for surgery or other intervention under anesthesia. General variables registered will be age, gender, type of surgery, elective or urgent surgery, American Society of Anesthesiologists status (ASA), weight, height, prematurity, blood pressure, heart rate, pulse oximetry and hemoglobin levels. Preoperatively basal values of blood pressure, heart rate, pulse oximetry, body temperature will be registered prior to anesthesia and surgery and intraoperatively during surgery hourly. Other intraoperative parameters registered are blood product transfusion (Packed Red Blood Cells (PRBC), Fresh Frozen Plasma (FFP), Concentrated Platelet Units (CUP), fibrinogen, cryoprecipitate, Concentrated Complex of Prothrombin (CPP) or other blood product derivatives, crystalloids and colloids or other fluids administered, blood loss, urinary output, quantity of inotrops, diuretics, anesthetic drugs administered and mechanical ventilation parameters, central venous pressure if monitored. Normal blood pressure and heart rate values are those defined according to the patient age [14]. In addition to echocardiographic hemodynamic parameters, postoperative variables registered once daily until discharge from hospital will be blood pressure, heart rate, core temperature, pulse oximetry, CVP if monitored, blood product transfusion (PRBC, FFP, CUP), fibrinogen, cryoprecipitate, concentrated complex of prothrombin, other blood product derivatives, crystalloids, colloids or other fluids administered, blood loss, urinary output, quantity of inotropes, diuretics, anesthetic drugs administered, mechanical ventilation parameters, hemoglobin levels. Trans-thoracic echocardiographic parameters measured perioperatively are described here after. Since echocardiography is operator dependent, all the echocardiographic hemodynamic parameters will be measured by one experienced medical doctor in pediatric echocardiography and validated by a second experienced medical doctor. Cardiac output measures will be realized with Velocity Time Integral (VTI) at the aortic valve in the apical five chamber view. Normal values of aortic VTI have been defined in children [15].

Fluid responsiveness will be assessed with aortic peak velocity at the apical five chambers view with peak velocity variation (ΔVpeak) of ≥10% defining responders to fluid therapy. ΔVpeak is defined as (Vmax-Vmin ⁄[(Vmax+Vmin)2]) X 100 (10). Right ventricular (RV) and left ventricular (LV) systolic function will be assessed in the apical four chamber view with lateral S (Slat) wave velocity in tissue Doppler, with mitral and tricuspid annular plane systolic excursion (MAPSE, TAPSE) in time motion mode (TM) and with ejection fraction EF with Simpson’s method. Normal MAPSE, TAPSE and Slat values have been defined in children [16-21]. Fractional shortening (FS) will be assessed in the parasternal longitudinal axis view, normal values are the same as in adults (28-42%). Right ventricular and left ventricular diastolic function will be assessed in the apical four chamber view at the tricuspid and mitral valves with pulsed Doppler to assess for E wave velocity, A wave velocity and E/A ratio. E/A ratios will be analyzed according to age [22- 29]. To assess for normal, relaxation alteration, pseudonormal and restrictive profiles. Right and left filling pressures will be assessed with tissue Doppler at the apical four chamber view at the tricuspid and mitral valves to assess lateral E’ wave velocity and E/E’lat ratio.

Figure 1:Echocardiographic hemodynamic parameters.


Normal E/E’ and E’lat values have been defined in children [22- 29]. To assess for pulmonary over circulation, Qp/Qs ratio (where Qp is pulmonary output and Qs is systemic cardiac output) will be calculated using the formula Qp/Qs= Pulmonary VTI x Area of the pulmonary annulus x HR /Aortic VTI x Area of the aortic annulus x HR= VTIp x IIx (D/2)2/VTIao x IIx (D/2)2, where D is the diameter of the annulus and HR the heart rate [30]. Pulmonary VTI and pulmonary annulus diameter will be assessed at the parasternal transverse axis view. Aortic VTI will be assessed at the apical 5 chamber view and the aortic annulus diameter at the parasternal longitudinal axis view. The inferior veina cava diameter (IVC) and the variation of the latter (ΔIVC) will be assessed at the subcostal view and will be defined as Δ IVC=[(Dmax-Dmin/(Dmax+Dmin/2)]x100. Where Dmax is the maximum and Dmin is the minimum diameter of the IVC. Supra-hepatic Doppler waves velocity V, A, S, D and S/D ratios will be assessed in the subcostal view. Pulmonary Doppler waves velocity S, D, E, Ap and S/D ratios will be assessed in the apical four chamber view. Postoperative organ dysfunction until discharge from hospital will be registered to assess for primary outcome. The number of days spent in ICU, under invasive or noninvasive mechanical ventilation and days in the conventional hospitalization ward postoperatively will be registered to assess for secondary outcomes. The quantity of postoperative fluid (crystalloids, colloids, blood products) administered and postoperative vasopressor inotropic score will be registered to assess for tertiary outcomes. Statistical analysis will be realized with XLSTAT 2018.3 or plus software. Normally distributed and non-normally distributed variables will be compared using Student t or Mann-Whitney tests and Wilcoxon or Kruksal-Wallis tests respectively.

Normally distributed variables will be expressed in terms of means with standard deviation. Non normally distributed variables will be expressed in terms of medians with interquartile ranges. Categorical variables will be compared with the exact Fisher’s test or Chi squared test accordingly. Categorical variables will be expressed as percentages with 95% confidence intervals. To assess for independent predictors of adverse postoperative outcome, multivariate analysis will be realized. A P-value≤0.05 will be considered significative. Missing data will not be included. The study is expected to begin first semester of 2021 and will terminate end 2021. The number of patients included will be 1000 patients to have a normally distributed population. The study will be monocentric.

Result

Results are expected in the first semester of 2022.

Conclusion

This study protocol was designed to describe the pilot observational prospective trial which will identify echocardiography parameters predictive of postoperative outcome in terms of morbidity, LOSICU, LMV, LOS, fluid therapy and vasopressor inotropic score in children scheduled for surgery or other interventions. These echocardiographic predictors of the abovementioned outcomes will be integrated in randomized controlled mono-multicentric trials which will determine the impact of intraoperative goal directed fluid and hemodynamic therapy with echocardiography on postoperative outcome in children scheduled for surgery or other interventions under general anesthesia.

Disclosure

This study is part of the Thesis entitled ‘Do goal directed therapies improve postoperative outcome in children? (Perioperative Goal Directed Fluid and Hemodynamic Therapy; Transfusion goal directed therapy using viscoelastic methods and enhanced recovery after surgery and Postoperative outcome)’ [31-33]. This Thesis is registered online http://www.theses.fr/ s232762.

References

  1. Sun Y, Chai F, Pan C, Romeiser JL, Gan TJ (2017) Effect of perioperative goal-directed hemodynamic therapy on postoperative recovery following major abdominal surgery-a systematic review and meta-analysis of randomized controlled trials. Crit Care 21(1): 141.
  2. Giglio M, Marucci M, Testini M, Brienza N (2009) Goal-directed haemodynamic therapy and gastrointestinal complications in major surgery: a meta-analysis of randomized controlled trials. Br J Anaesth 103(5): 637-646.
  3. Aya H, Cecconi M, Hamilton M, Rhodes A (2013) Goal-directed therapy in cardiac surgery: a systematic review and meta-analysis. Br J Anaesthesia 110(4): 510-517.
  4. Dalfino L, Giglio M, Puntillo F, Marucci M, Brienza N (2011) Haemodynamic goal-directed therapy and postoperative infections: earlier is better. A systematic review and meta-analysis. Critical Care 15(3): R154.
  5. Giglio M, Dalfino L, Puntillo F, Rubino G, Marucci M, et al. (2012) Haemodynamic goal-directed therapy in cardiac and vascular surgery. A systematic review and meta-analysis. Interact Cardiovasc Thorac Surg 15: 878-887.
  6. Giglio M, Manca F, Dalfino L, Brienza N (2016) Perioperative hemodynamic goal-directed therapy and mortality: a systematic review and meta-analysis with meta-regression. Minerva Anestesiol 82(11): 1199-1213.
  7. Chong M, Wang Y, Berbenetz N, McConachie I (2018) Does goal-directed haemodynamic and fluid therapy improve peri-operative outcomes? A systematic review and meta-analysis. Eur J Anaesthesiol 35(7): 469-483.
  8. Lemson J, Nusmeier A, Van der Hoeven J (2011) Advanced hemodynamic monitoring in critically ill children. Pediatrics 128(3): 560-571.
  9. Kumba C, Willems A, Querciagrossa S, Harte C, Blanc T, et al. (2019) A systematic review and meta- analysis of intraoperative goal directed fluid and haemodynamic therapy in children and postoperative outcome. J Emerg Med Critical Care 5(1): 9.
  10. Pereira de Souza Neto E, Grousson S, Duflo F, Ducreux C, Joly H, et al. (2011) Predicting fluid responsiveness in mechanically ventilated children under general anaesthesia using dynamic parameters and transthoracic echocardiography. Br J Anaesth 106(6): 856-864.
  11. Madriago E, Punn R, Geeter N, Silverman NH (2016) Routine intra-operative trans-oesophageal echocardiography yields better outcomes in surgical repair of CHD. Cardiol Young 26(2): 263-268.
  12. Kumba C, Raisky O, Bonnet D, Treluyer JM (2019) Perioperative goal directed fluid and hemodynamic therapy with echocardiography in pediatric congenital heart disease: a study protocol. EC Paediatrics 8(12): 01-06.
  13. Kumba C, Raisky O, Bonnet D, Tréluyer JM (2019) Perioperative echocardiographic hemodynamic parameters and postoperative outcome in pediatric congenital heart disease: a descriptive observational prospective pilot study protocol. Int J Pediatr Neonat Care 5: 160.
  14. de Graaff JC, Pasma W, van Buuren S, Duijghuisen JJ, Nafiu OO, et al. (2016) Reference values for noninvasive blood pressure in children during anesthesia. a multicentered retrospective observational cohort study. Anesthesiology 125(5): 904-913.
  15. Solinski A, Klusmeier E, Horst JP, Körperich H, Hass AN, et al. (2018) Centile curves for velocity-time integral times heart as a function of ventricular length: the use of minute distance is advantageous to enhance clinical reliability in children. J Am Soc Echocardiogr 31(1): 105-112e.
  16. Koestenberger M, Ravekes W, Everett AD, Stueger HP, Heinzl B, et al. (2009) Right ventricular function infants, children and adolescents: reference values of the tricuspid annular plane systolic excursion (tapse) in 640 healthy patients and calculation of z score values. J Am Soc Echocardiogr 22(6): 715-719.
  17. Terada T, Mori K, Inoue M, Yasunobu H (2016) Mitral annular plane systolic excursion/left ventricular length (MAPSE/L) as a simple index for assessing left ventricular longitudinal function in children. Echocardiography 33(11): 1703-1709.
  18. Koestenberger M, Nagel B, Ravekes W, Avian A, Cvirn G, et al. (2014) Reference values of the mitral annular peak systolic velocity (sm) in 690 healthy pediatric patients, calculation of z-score values, and comparison to the mitral annular plane systolic excursion (MAPSE). Echocardiography 31(9): 1122-1130.
  19. Koestenberger M, Nagel B, Ravekes W, Avian A, Heinzl B, et al. (2102) Left ventricular long-axis function: reference values of the mitral annular systolic excursion in 558 healthy children and calculation of z-score values. Am Heart J 164(1): 125-131.
  20. Eiden B, McMahon C, Cohen RR, Wu J, Finkelshteyn I, et al. (2004) Impact of cardiac growth on doppler tissue imaging velocities: a study in healthy children. J Am Soc Echocardiogr 17(3): 212-221.
  21. Frommelt PC, Ballweg JA, Whitstone BN, Frommelt MA (2002) Usefulness of doppler tissue imaging analysis of tricuspid annular motion for determination of right ventricular function in normal infants and children. American Journal of Cardiology 89(5): 610-613.
  22. Lester SJ, Tajik J, Nishimura RA, Oh JK, Khandheria BK (2008) Unlocking the mysteries of diastolic function. deciphering the rosetta stone 10 years later. J Am Coll Cardiol 51(7): 679-689.
  23. Vitarelli A, Conde Y, Cimino E, D Angeli I, D Orazio S, et al. (2005) Quantitative assessment of systolic and diastolic ventricular function with tissue doppler imaging after fontan type of operation. Int J Cardiol 102(1): 61-69.
  24. Ichihashi K, Sato A, Shiraishi H, Momoi M (2011) Tissue doppler combined with pulsed-wave doppler echocardiography for evaluating ventricular diastolic function in normal children. Echocardiography 28(1): 93-96.
  25. Cantinotti M, Giordano R, Scalese M, Murzi B, Assanta N, et al. (2016) Normograms for mitral inflow doppler and tissue doppler velocities in caucasian children. J Cardiol 68(4): 288-299.
  26. Dallaire F, Slorach C, Hui W, Sarkola T, Friedberg MK, et al. (2015) Reference values for pulse wave doppler and tissue doppler imaging in pediatric echocardiography. Circ Cardiovasc Imaging 8(2): e002167.
  27. Harada K, Orino T, Yasuoka K, Tamura M, Takada G (2000) Tissue doppler imaging of left and right ventricles in normal children. Tohoku J Exp Med 191(1): 21-29.
  28. Lee A, Nestaas E, Brunvand L, Liestøl K, Brunvand L, et al. (2014) Tissue doppler imaging in very preterm infants during the first 24h of life: an observational study. Arch Dis Child Fetal Neonatal 99(1): F64-F69.
  29. Mi YP, Abdul-Khaliq H (2013) The pulsed doppler and tissue doppler-derived septal E/e’ ratio is significantly related to invasive measurement of ventricular end-diastolic pressure in biventricular rather than univentricular physiology in patients with congenital heart diasease. Clin Res Cardiol 102(8): 563-570.
  30. Klimczak C (2010) Clinical echocardiography (6th ), Elsevier Masson, Paris, France, pp. 32-34.
  31. Kumba C, Mélot C (2019) The era of goal directed therapies in paediatric anaesthesia and critical care. EC Emergency Medicine and Critical Care 3(5): 306-309.
  32. Kumba C (2019) Do goal directed therapies improve postoperative outcome in children? (Perioperative goal directed fluid and hemodynamic therapy; transfusion goal directed therapy using viscoelastic methods and enhanced recovery after surgery and postoperative outcome): A study research protocol. Acta Scientific Paediatrics 2(7): 17-19.
  33. Kumba C (2019) Future evolution of intraoperative goal directed fluid and hemodynamic therapy in Children. Adv Pediatr Res 6(2): 1-2.
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Wednesday, July 27, 2022

Testicular Cancer and Microbiota_Crimson Publishers

Testicular Cancer and Microbiota by Álvaro Zamudio Tiburcio in Gastroenterology Medicine & Research_Gastroenterology Medicine & Research


Abstract

We analized a Male with 33 years old. 2003 is detected Seminoma of the left testis, which is removed. Twenty sessions of radiotherapy are administered and observed for 5 years. In 2008, right testicle was removed, and prostheses were placed. Classic teratoma-endodermal seminoma is diagnosed. 2011, AFP control study (400ng/mL), with lessions in the iliac and Cavo-aortic arteries. In laparotomy, the necrotic is removed. New Chemo. Retroperitoneal process appears and is kept under observation for one year, without elevated markers. 2013 detect AFP (69ng/mL). They operate it by removing the metastases again. The AFP rises and is operated again in 2016. In 2017 ACE is 100 (ng/mL). With intra-aortic metastases. They operate it. 2018, the necrosis is removed again. “Last surgery.” Intestinal Microbiota Transplantation (IMT) is carried out on March 21, 2019.

Keywords: Testicular cancer; Intestinal Microbiota Transplantation (IMT); Intestinal Microbiota (IM)

Introduction

33-year-old Male with left testicle removed cancer. Classic seminoma is diagnosed. Provide radiotherapy and decided to observe it for 5 years. Operate on 6 occasions, removing the second testicle and numerous intra-abdominal metastases. Intestinal Microbiota Transplant is carried out Anxiety dropped from 22 to 8 points [1], He looks better. The joints hurt, allergic pictures and in tolerates all foods, finish. IBS with stool formed. (He says that he had not evacuated solid for years).

Diagnosis

A. Retroperitoneal cancer secondary to classic left seminoma, removed

B. Seminoma and classic endodermal left teratoma (removed)

C. Five times retroperitoneal metastases (operated)

D. Anxiety 22 points. Hamilton Scale

E. Insufficient weight (BMI 17)

F. IBS, diarrhea variety

G. Multi-allergic

Cites in a month and then in 5 months and looks better. The joints hurt 70% less. The allergic pictures to dust and pollen, decreased 70%. Tolerates all foods, including mole, spicy candy, guacamole and beer. IBS with stool formed. (He says that he had not evacuated solid for years). Increased 200 grams. Abdominal diameter 76 centimeters, Blood Pressure 102/65, Pulse 78X´. Temperature 98.0600° F. Breathes 18X´ Tolerated Lactobacillus reuteri (Pylopass). Inulin 0.453Gm. One a day. After breakfast: One month.

Comments

The Intestinal Microbiota Transplant (IMT) is a methodology that can be used in patients affected by Cancer, due to its good results. It has been suggested that the Intestinal Microbiota can modulate the effectiveness of cancer therapies, especially immunotherapy [2]. Although it has been shown that the microbiota may have no actions, decrease or increase in susceptibility to cancer. It turns out that investigating these effects, as well as applying knowledge to try to remedy these frequent illnesses, is currently an extraordinarily interesting fact [3]. Thus, we see that in addition to the impact that the microbiota has on cancer, the one that has some probiotic of the Lactobacillus rhamnoses type is added [4].

One of the most significant aspects that must be taken into account in cancer patients is whether they are immunocompromised or not. Therefore, IMT we suggest, is carried out on that waiting measure, when the immune compromise is minimal. Since in case of performing IMT in patients with great immune compromise, it can fall into the complex terrain of infectious processes [5].

Now, where is the mind-heart link with cancermicrobiota?

The gut-microbiota-brain axis has already been described and more articles are observed in this regard, in the world literature, where it is pointed out, that in this axis, there is two-way communication, between the brain and the intestine, through biochemical signals. That is this two-way communication, which perfectly coordinates the immunological status, allows the microbiota to act, once determined-between both components - the actions to be followed and, thus, it is seen that the immune system responds favorably to this communication, allowing clinical improvements, not only in testicular cancer, but in most cancers, as well as in another series of conditions of different kinds, highlighting those generated in the systems, Gastrointestinal, dermatological, psychiatric, neurological, endocrinological and others [6-9]. Where the mind-heart link with cancer-microbiota lies, because in the gut-microbiota-brain axis, already described.

Conflicts of Interest

The authors declare that they do not have affiliation or participation in organizations with financial interests.

Ethical Approval

This report does not contain any study with human or animal subjects carried out by the authors.

Informed Consent

The authors obtained informed written consent from the patient, in order to develop this article.

References

  1. Hamilton M (1959) The assessment of anxiety states by rating. Br J Med Psychol 32(1): 50-55.
  2. Chen D, Wu J, Jin D, Wang B, Cao H (2018) Fecal microbiota transplantation in cancer management: Current status and perspectives. Int J Cancer 145(8): 2021-2031.
  3. Garret WS (2015) Cancer and the microbiota. Science 348(6230): 80-86.
  4. Vivarelli S, Salemi R, Candido S, Falzone L, Santagati M, et al. (2019) Gut microbiota and cancer: From pathogenesis to therapy. Cancers (Basel) 11(1): E38.
  5. Wardill HR, Secombe KR, Bryant RV, Hazenberg MD, Costello SP (2019) Adjuntive fecal microbiota transplantation in supportive oncology: Emerging indications and considerations in immunocompromised patients. E Bio Medicine 44: 730-740.
  6. Dinan TG, Cryan JF (2017) Brain gut microbiota axis and mental health. Psychosom Med 79(8): 820-926.
  7. Hong XW, Ping YW (2016) Gut microbiota brain Axis. Chin Med J (Eng) 129(19): 2373-2380.
  8. Tiburcio ÁZ, Ruiz HB, López RPA (2019) Microbiota disease. Open J Bac 3(1): 008-010.
  9. Molina TC, Rodriguez AM, Roman P, Snachez LN, Cardona D (2019) Stress and the gut microbiota brain axis. Behav Phamacol 30(2-3): 187-200.
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Tuesday, July 26, 2022

Third Ventricle’s Chordoid Gliomas_Crimson Publishers

Third Ventricle’s Chordoid Gliomas by Behzad Saberi in Novel Approaches in Cancer Study_Cancer Research Articles


Abstract

Chordoid gliomas are low grade tumors which are most commonly seen in women and in the adult population. Clinical signs and symptoms of these tumors are mostly related to hydrocephalus which is obstructive in nature. Headache, nausea, visual disturbances, imbalances in the endocrine system and autonomic dysfunction can be seen in these tumors. MRI with contrast is the best diagnostic imaging method for such tumors. The best treatment method for such tumors would be complete surgical resection. In case of incomplete resection, the prognosis can be poorer in comparison with complete surgical resection.

Mini Review

This is a brief review on the Third Ventricle’s Chordoid Gliomas and their pathogenesis. Chordoid gliomas of the third ventricle are histologically characterized by chordoma-like features. These rare tumors can be seen mostly in the adult patients group specifically in the women population. These solid tumors are well-circumscribed which are adhered to the wall of the third ventricle [1]. Their location is in the anterior part of the third ventricle. These glioma tumors may be extended to reach the suprasellar region. Also, they may cause a hydrocephalus which is obstructive in nature. Regarding differential diagnosis for chordoid glioma, chordoid meningioma and chordoma should be of notice [2].

Chordomas contain physaliphorous cells. They also stain positive for cytokeratins. CD34 and lack of immunoreactivity for Glial fibrillary acidic protein, can also be seen in these tumors. These findings differentiate chordomas from gliomas [3]. Chordoid meningiomas show some meningeal features like psammoma bodies and whorl formation. Also, cordoid meningiomas are negative for CD34 and Glial fibrillary acidic protein and positive for Epithelial membrane antigen [4]. These characteristics differentiate chordoid meningiomas from chordoid gliomas. Chordoid gliomas are different from common glioma and meningioma types. They do not have chromosal imbalances. Also, there are not any CDK4, TP53, EGFR, MDM2 and CDKN2A genetic alterations in chordoid gliomas [5].

Positivity for vimentin, CD34 and Glial fibrillary acidic protein can also be seen in the chordoid glioma tumors. Different expressions of cytokeratines, S-100 and Epithelial membrane antigen can be seen in chordoid gliomas. Lack of P53 nuclear accumulation can be seen in such tumors either. The MIB1 index is less than five percent and the synaptophysin is negative in the immunohistochemical profile of the chordoid gliomas [6]. The lymphoplasmacellular infiltrations, are regular features of chordoid gliomas. There is no sign of anaplasia and there is a low amount of mitotic activity in such tumors. Reactive astrogliosis usually with Rosenthal fibers can be seen in these tumors which are demarcated from the brain tissue around them [7].

References

  1. Tonami H, Kamehiro M, Oguchi M, Higashi K, Yamamoto I, et al. (2000) Chordoid glioma of the third ventricle: CT and MR findings. J Comput Assist Tomogr 24(2): 336-338.
  2. Desouza RM, Bodi I, Thomas N, Marsh H, Crocker M (2010) Chordoid glioma: Ten years of a low-grade tumor with high morbidity. Skull Base 20(2):125-138.
  3. Ni HC, Piao YS, Lu DH, Fu YJ, Ma XL, et al. (2013) Chordoid glioma of the third ventricle: Four cases including one case with papillary features. Neuropathology 33(2):134-139.
  4. Jung TY, Jung S (2006) Third ventricular chordoid glioma with unusual aggressive behavior. Neurol Med Chir (Tokyo) 46(12): 605-608.
  5. Nakajima M, Nakasu S, Hatsuda N, Takeichi Y, Watanabe K, et al. (2003) Third ventricular chordoid glioma: Case report and review of the literature. Surg Neurol 59(5): 424-428.
  6. Brat DJ, Scheithauer BW, Staugaitis SM, Cortez SC, Brecher K, et al. (1998) Third ventricular chordoid glioma: A distinct clinicopathologic entity. J Neuropathol Exp Neurol 57(3): 283-290.
  7. Kobayashi T, Tsugawa T, Hashizume C, Arita N, Hatano H, et al. (2013) Therapeutic approach to chordoid glioma of the third ventricle. Neurol Med Chir (Tokyo) 53(4): 249-255.
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Monday, July 25, 2022

Production and Characterization of Nutritious Peanut Butter Enhanced with Orange Fleshed Sweet Potato_Crimson Publishers

Production and Characterization of Nutritious Peanut Butter Enhanced with Orange Fleshed Sweet Potato by Naveen Puppala in Novel Techniques in Nutrition and Food Science_journal of food technology


Abstract

Peanuts worldwide are popular for their nutritional quality and commercial potential. Their consumption in Uganda is high and second after common beans thus making them a suitable food for fortification to fight the increasing vitamin A deficiency in the country. Consumption of orange fleshed sweet potato (OFSP) is equally high in the country and this too offers potential to fortify peanut butter for increased intake of vitamin A. The objective of this study was to investigate the potential of producing a nutritious peanut butter, with high shelf-life. An OFSP ratios of 0% (Control), 5% (Treatment 1), 10% (Treatment 2) and 15% (Treatment 3) were mixed with peanut butter. The product was assessed for proximate composition using AOAC methods and sensory qualities. The shelf-life of product was also established by determining the fat quality, beta-carotene retention and microbial quality. Fortifying peanut butter with OFSP significantly increased the protein content from 20.47 to 27.76%, fat from 30.8 to 32.4%, sugars from 2.96 to 25.51% and, beta-carotene from 244 to 1388μg 100g-1. In all treatments, the control had the lowest amount of nutrient, while OFSP that was fortified with 15% peanut butter had the highest levels of the nutrient. When OFSP was fortified with 10 and 15% peanut butter it resulted in higher retention of β-carotene between 400 to 600μg 100-1g which could meet the daily World Health Organization (WHO) recommendations of 350 to 500μg 100-1g. After storing the product for five months, OFSP that was fortified with 10 and 15% peanut butter had good fat quality as reflected by the low acid value (AV) below 0.9mg KOH-1 and peroxide value (PV) below 4mEq kg-1 respectively. There was a strong negative correlation (r=0.049; p˂0.05) between peroxide formation and the amount of β-carotene in the peanut butter. All peanut butter samples were free of dangerous levels of microbes. The peanut butter treated with OFSP had acceptable sensory score of 6-7 on the scale of 1 to 9. The results suggest that peanut butter fortified at 15% OFSP had greater shelf-life and meet the vitamin A requirements of school going children.

Keywords: Peanut butter; OFSP; β-carotene; Fat quality

Introduction

Peanuts (Arachis hypogaea L) are popular worldwide because of their value as plant protein source (23-35%) and fat (45-52%) [1]. The peanuts possess high nutritional and commercial value due to the presence of fatty acids, protein, carbohydrates, minerals and vitamins [2,3]. Globally, peanut consumption is relatively high and is consumed either as roasted, cooked or as peanut butter [4]. In Uganda, peanuts rank second with annual production of 210,000 tons in shell after common beans (Phaseolus vulgaris; FAO, 2017). Peanuts are potential food source for fortification since they are consumed widely in Uganda in various forms as sauce, peanut butter and paste. In Uganda increasing prevalence of vitamin A deficiency amongst children and pregnant women has been reported at a rate of 19% to 20% respectively [5]. This situation along with limited access to nutritious foods adversely affects the wellbeing of children and adults. Consumption of peanut butter fortified with vitamin A is considered as a way to reduce vitamin A deficiency [6,7].

Peanut butter is a semi-perishable product with prolonged shelf life due to its low moisture content [8]. Peanut products in storage are exposed to ambient conditions, with exposure to sunlight. The heat accumulated during storage and accelerates rancidity [8-10]. The rancid peanut butter is unfit for consumption because of off flavors [11,12]. The β-carotene is a powerful antioxidant that provide protection against oxidative processes in food systems [13,14]. The antioxidant activity of β-carotene is attributed to their polyene frameworks [15]. Orange Fleshed Sweet Potato (OFSP), one of the major sources of beta-carotene is widely grown and consumed in Uganda [16]. In the year 1995, researchers recognized the potential of OFSP varieties to address widespread vitamin A deficiency in Sub Saharan Africa using integrated agriculture-nutrition approach [17]. Use of OFSP is a rich plant-based source of β-carotene, which the body converts into vitamin A [17]. Through the multi-partner initiative, OFSP was launched in Uganda headed by Harvest-Plus. Various Non-Government Organizations (NGO), Volunteer Efforts for Development Concerns (VEDCO), Farming for Food and Development Program-Eastern Uganda (FFDP-EU) and National Agricultural Research Organization (NARO) have since disseminated OFSP in Uganda to create awareness and have released varieties such as Ejumula, Vita, and Kabodeamong others; and value addition for increased consumption [18]. Research has shown that OFSP has the potential to improve the vitamin A status of individuals [19,20]. Study by Jaarsveld et al. (2005) showed that, there was a 10% significant improvement in Vitamin A that liver stores amongst the school children who were fed on OFSP. Product diversity can be a driver to its increased consumption especially amongst the children. This study therefore aimed at production of a shelf stable, high nutritious OFSP-fortified peanut butter product that could be used by school-going children.

Materials and Methods

Materials

Twenty kilograms of peanut (Valencia variety) were obtained from the National Semi-Arid Resources Research Institute, Soroti, Uganda. Triglyceride stabilizer was purchased from Dansico Company, United States of America (USA). Two hundred (200)kg of Orange fleshed sweet potato roots (Kabode variety) were purchased from VEDCO Uganda at maturity age of 4 months when roots have attained dark orange color and expected to contain highest β-carotene content. Chemicals and reagents used in laboratory analysis were obtained from Westford laboratory, Kampala, Uganda.

Preparation of OFSP peanut butter

Peanut butter was produced following [21], with some modifications to suit the available technology. Peanut kernels were selected, cleaned using a 2-step wise cleaning method; 1) dry cleaning where sorting is done, and 2) wet cleaning where the kernels were washed to remove dust on the surfaces. The peanut kernels were then roasted in the electrical oven (Model: GU-6) for 25 minutes at a temperature of 140 °C, then cooled for 5 minutes and test was removed to ease sorting of seeds by color to reduce the incidences of aflatoxin infection [22]. Peanuts that passed sorting, were ground using a blade grinder (Capacitor Start Motor; type: YC112M-2; HP 248A) till a smooth peanut butter was formed. The OFSP flour was added to the smooth peanut butter in ratios of 0% (C0), 5% (Treatment 1), 10% (Treatment 2) and 15% (Treatment 3). Varying ratios were used to increase the concentration of β-carotene and putting into consideration the effect of solids on the quality of peanut butter [23]. The OFSP flour was chosen over OFSP pulp because of the deteriorative effect that pulp can impose on the product due to high moisture content. Mixing was done using a dough mixer (Type: 94/R10; No. 21602) for 15 minutes to achieve uniform and consistence mixture, and 0.7% of triglyceride stabilizer was added. The OFSP peanut butter and control sample were packed in food grade plastic jars.

Chemical analyses

The samples packaged in food grade containers were delivered to Makerere University chemistry laboratory for proximate analysis (Moisture content, protein, fat, sucrose, fiber and beta-carotene), and shelf stability (acid value, peroxide value, β-carotene retention and microbial quality) studies.

Moisture

About 3g of each sample was weighted in the dry dishes and weight recorded. The dishes with the sample were put in the oven and dried for about 6 hours at temperature of 95 °C. The dishes were then cooled in a desiccator and weights recorded and percent moisture determined,

Protein

Crude protein content of samples was determined using the standard Kjeldahl method [24]. About 0.2g of each sample was digested using 5ml concentrated Sulphur acid and Kjeldahl tablets as catalysts. The sample solution was heated slowly for the first 6 minutes, heated rapidly after stabilization for 2 hours then left to cool. The digest was quantitatively transferred to a 50ml volumetric flask and made to volume with distilled water, then shaken to homogenize the solution. The sample distillate was prepared by pipetting 10ml aliquots of the digest in a Markham still (Foss, Tecator, Britain), 20 ml of 40% sodium hydroxide was introduced into the distillation chamber and distillation was allowed to proceed for about 4 minutes. The distillate was collected into the conical flask containing 10 ml boric acid (4%) and mixed indicators (bromocresol green and methyl red); the end point was marked by color change back to the original brown color. The blank titer was subtracted from the sample titer and the total crude protein determined using the equation below:

Note: (Titre X NHCL/1000 = No. of mole NH3)

Dietary fiber

Dietary fiber was determined on the basis of Acid Detergent Fibre (ADF) standard method [24]. One gram of each sample was weighed and mixed in 100ml of acid detergent fiber (28ml concentrated Sulphur acid and 20g cetyltrimethylammonium ammonium Bromide) solution. The solution was boiled for 1 hour on the fiber analyzer (Labconco Corporation, Kansascity, Missouri 64132. Serial No. 246719) and then filtered through a pre-weighed glass sintered crucible. The crucible was dried in the oven for 30 minutes and cooled in the desiccator before weighing. The fiber was determined using the formula below:

Fat

About 3g of sample was weighed into a thimble in triplicates. The thimbles and their contents were placed into 50ml of petroleum ether (PE) in a beaker assembled in the Soxhlet system. The fat in the sample was extracted using PE, by boiling at 115 °C for 20 minutes and then rinsed for 45 minutes. The beakers were transferred to the oven to evaporate off the PE and other water-soluble material for 30 minutes at 90 ᵒC. The beakers were cooled in the desiccator to room temperature and weights taken.

Sugar

Total sugars were determined by hot water extraction method (AOAC, 2002). One gram of each sample of peanut butter was accurately weighed into 250ml beakers to which 1ml lead acetate was added followed by 70ml of hot water. The beakers with the contents were then placed on a hot water bath at 80 °C and heated for 1 hour. To the cooled sample solution, half a spatula of sodium bicarbonate was added to precipitate all the excess lead acetate. The sample was then transferred to 100ml volumetric flask quantitatively and shaken to mix well. A portion of the sample was poured into test tubes and centrifuged at 700rpm for 5 minutes.

Five (5) ml of the clear solution of the sample, 1 ml of concentrated Sulphur acid and 20ml of distilled water were added to 100ml conical flasks and then heated to boiling for 10 minutes. The cooled solution was neutralized with sodium bicarbonate and transferred quantitatively to 50ml volumetric flask and made to volume with distilled water and mixed. To develop the color, 1ml of sample was added followed by 1ml of phenol (5%) and 5ml of concentrated sulphuric acid to a clean test tube and mixed well. The absorbance of the solution was read off at 470nm.

β-carotene

Following Rodriguez et al. [18], three (3)g of peanut butter was weighed in the mortar. Using 50ml of cold acetone, the sample was ground to extract the carotenoids. Experiment was repeated until the sample was colorless, and then mixture was filtered through a funnel. About 30ml of petroleum ether where added to filtrate. To remove the acetone residue, the mixture was washed in a 500ml separator funnel using 300ml of distilled water, this was repeated three times. Petroleum ether (PE) phase was collected in a 50ml volumetric flask through a funnel containing 15g anhydrous sodium sulfate to remove residual water. Absorbance of beta-carotene was read at 450nm using a spectrophotometry.

Shelf stability of OFSP peanut butter under different conditions

The peanut butter with added OFSP and control sample were stored on shelf under ambient conditions that reflected the retail environment of peanut butter and then analyzed for quality changes over a period of 5 months. Fat quality (acid value and peroxide value), β-carotene retention and microbial quality (microorganisms of interest were E. coli, S.aureus, yeasts and moulds)was determined every after a month.

Fat quality

Acid value (AV): Acid value of treatments and control sample was determined [24] by weighing 3g of each sample into 100ml conical flask. Solvent mixture (50ml; neutral 95% ethanol: diethyl ether, v/v) with phenolphthalein were added to the sample in the flask. The mixture was allowed to stand for 20 minutes shaking at an interval of 3 minutes to ensure that the free fatty acids in the sample dissolve into the solvent. The supernatant was decanted off and was titrated with standard sodium hydroxide solution to the pink endpoint (the pink color persisting for at least 10 seconds). The acid value was expressed as percentage.

Where;

V is the number of ml of NaOH solution used

N is the exact normality, and

M is the mass in g of the sample

Peroxide Value (PV)

The Peroxide value was determined [24] by weighing 5g of sample into a beaker and mixed thoroughly in a 30ml mixture of 3:2 glacial acetic acid and chloroform solution by vigorous shaking. Saturated potassium iodide solution (0.5ml) was added to the mixture, as a result of which iodine was liberated due to reaction with the peroxide. This was then titrated against a standard solution of sodium thiosulphate, using starch solution as indicator. The procedure was repeated to determine the titration value for a blank sample. PV was calculated as below:

Where;

S=Titration value of the sample (ml)

B=Titration value of the blank sample (ml)

N= Normality of the Sodium Thiosulphate solution= 0.01N

Sample Weight=5gm

Microbial Analysis

Staphylococcus auerus

Ten (10) grams of peanut butter sample was added into sterile bottles having 90ml peptone water. After thoroughly mixing, the sample was serially diluted up to 10-6. Twenty ml Baird parker agar (BPA) was poured on Petri-dishes and left to set at room temperature. After complete solidification, the plates were inverted to avoid dripping of condensed water on solidified agar. Duplicate samples (0.1ml) of dilutions 10-1 and 10-2 were surface spread on the solidified plated petri-dishes using sterile glass rod. The plates were incubated at 37 °C for 3 days. Enumeration was done considering spreaders and clusters as a single colony (ISO 21527-2)

Yeasts and moulds

Yeasts and moulds count were made by adding 10g of peanut butter sample into sterile bottles having 90ml peptone water. After thoroughly mixing, the sample was serially diluted up to 10-6. Acidified agar (15-20ml) was poured on Petri dishes and left to set at room temperature. After complete solidification, the plates were inverted to avoid dripping of condensed water onto the solidified agar. Duplicate samples (0.1ml) of 10-1 and 10-2 dilutions were surface spread on the solidified plated petri-dishes using sterile glass rod. The plates were incubated at 30 °C for 3 days in upright position because yeasts and molds grow upwards. Enumeration was done considering spreading colonies and clusters as a single colony (ISO 21527-2)

Coliforms (E-coli)

Ten grams of peanut butter sample were added into sterile test bottles having 90ml peptone water. After thoroughly mixing, the sample was serially diluted up to 10-6. Dilutions of 10-1 and 10-2 were taken in duplicate samples (1ml) and pour plated using 20ml of violet red bile agar. After thoroughly mixing, the plated sample was allowed to solidify and then incubated at 37 °C for 24 hours. Counts were made considering the purplish red colonies as coliform colonies and clusters as single colonies (ISO 4832).

Assessing acceptability of OFSP peanut butter

Fifty (50) consumer panelists were recruited from the School of Food Technology, Nutrition and Bioengineering, Makerere University. The panelists were briefed before the start of session. Four samples from the five treatment combinations were presented to each panelist. Samples were evaluated in the order of appearance on the ballot. Panelists were asked to place a spoonful of peanut butter on plain bread to evaluate the spread ability and consistency. They were also asked to rinse their mouths with water between samples. The samples were evaluated and ranked by the panelists for color, flavor, spread ability, consistency and overall acceptability using 9-point Hedonic Scale, where 1=dislike extremely, and 9=like extremely [25].

Data analysis

Data for sensory evaluation was analyzed using SPSS [26]. Data on proximate analysis and keeping quality of the peanut butter sample were tabulated and means subjected to ANOVA using Genstat 13th Edition). The means were separated using LSD (P≤0.05) to determine significant differences.

Result and Discussion

Although the moisture content of the control (C0) was significantly lower than the treatment samples (P< 0.05), the moisture content of the latter did not differ significantly implying that increased amount of OFSP have no influence on the moisture content of the fortified peanut butter. The moisture content of the control sample was 1.89% which is in agreement with findings of McDaniel et al., 2012 who reported that peanuts have moisture content between 1.4 to 2%. Fiber content increased significantly (P<0.05) with an increase in the ratio of added OFSP flour to peanut butter. The control sample had the least fiber content, followed by treatment 1, 2, and 3. The increase in the fiber content of the samples with increased ratio of OFSP could be due to relatively high fiber content of OFSP which is reported to be in the range of 1.8 to 3% [27].

The results showed that addition of OFSP to peanut butter does not significantly affect the fat content of the peanut butter (Table 1). The fat content of the control and treatments ranged between 30.83 to 32.45% though there was no significant difference among the samples. The control sample (32.45%) and treatment 1 (32.53%) had the highest fat content while treatment 3 (30.83%) had the least amount. The findings also show that, the amount of fat decreased with increasing ratio of OFSP flour added to the peanut butter. The current study showed that the fat content of the peanut butter was between 32-30%, this is in agreement with the findings of [28] who also reported peanut butter fat content of 32% in the peanut butter. However, others reported higher fat content between 49 to 51% [29-31]. This variation in fat content could be due to differences in agro-ecology and varietal differences [21]. OFSP flour is devoid of fat 0.41% [32] and this could explain why there was decrease in fat content of treatments with high ratio of OFSP flour.

Table 1: Proximate analysis for peanut butter samples.

Values are means±standard deviations. Means followed by the same letter in the same column are not significantly different (p>0.05). Note: Control (0% OFSP), treatment 1 (5% OFSP flour), treatment 2 (10%OFSP flour) and treatment 3 (15% OFSP flour).


The sugar and β-carotene contents in the study significantly increased with increasing addition of OFSP flour in peanut butter, implying that the more OFSP flour used, the more sugar and β-carotene content of the peanut butter. The control sample had the least content of sugar and β-carotene of 2.96% and 244µg100g-1 respectively while Treatment 3 had the highest levels, over eight times and five times of sugar (25.51%) and beta-carotene (1388µg100g-1) respectively. The results also show that treatment 2 had higher sugar and β-carotene content than Treatment 1, and both treatments had significantly greater sugar and β-carotene than control. The sugar content of the peanut butter was 2.96% which was in agreement with the literature as stated by Settaluri et al. [2]. Sweet potatoes have a relatively high sugar content, and this explains why increase in its concentration led to significantly increased percentage of sugars.

According to study done by King et al. [33], he reported that peanuts contain around 3µg/100g β-carotene, while [34] reported β-carotene content in peanuts of 15.23µg/100g and Pattee et al. [35] reported β-carotene of 60µg/100g. All the findings are in contrary to the results of the current study, and this natural variation may be explained by the geographical and varietal differences. On addition of OFSP to peanut butter, beta-carotene increased to values that could meet the World Health Organization [36] daily recommended in takes of 350 to 500µg100g-1 for children between 5 and 16 years.

The protein content significantly ranged from 20.47 to 27.76%, with control having the highest protein content (27.76%), followed by treatment 1 (25.79%), then treatment 2 (24.36%) and lastly treatment 3 (20.47%). The results reflect that, as substitution ratio of OFSP increased, the protein content of peanut butter reduced significantly. The results obtained in the study are in agreement with what was reported by Shakerardekani et al. [30]; Riveros et al. [31] and Singh et al. [37], who reported protein content in peanut butter in the range of 22 to 30%. According to Low et al., 2010, OFSP has a low protein value of 0.016% and this could explain why there was significant decrease in protein content of product with increased substitution ratio of OFSP.

Fat quality

Fat quality is very important as far as storage of peanut butter is concerned because it affects peanut butter shelf life due to oil susceptibility to rancidity [30,31]. Rancidity is often used as an indicator of the stability and edibility of oils [38-40].

Acid value (AV)

Changes in the AV of control (C0), Treatment 1 (5% OFSP), Treatment 2 (10% OFSP), and Treatment 3 (15% OFSP) (Figure 1) showed a gradual increase as the OFSP ratios and storage time increased. Acid Value in 5th month of storage increased significantly in all samples, with control (C0) showing 109% increase followed by 91% in treatment 1, 81% in treatment 2, and 76% in treatment 3. By the fifth month, AV of control and treatment 1 had increased to 1.08 milli-grams of potassium hydroxide per gram of fat (mgKOHg-1) and 1.004 mg KOHg-1respectively. Treatment 2 and treatment 3 were still below 1mgKOHg-1. Kirk et al. [40] stated that when acid value is in the range of 1 to 1.5mgKOHg-1, rancidity is detected by sensory tests.

Figure 1: Changes in AV concentration of the OFSP peanut butter and control sample with storage time. Line labeled ** shows the limit beyond which acidity of oils can start to affect sensory properties. Control sample (C0), Treatment 1(5% OFSP), Treatment 2 (10% OFSP) and Treatment 3 (15% OFSP).


The AV represents the amount of the free fatty acids present in food sample and is determined by measuring the number of milligrams of potassium hydroxide required to neutralize the free fatty acids in 1g of the sample. The AV also shows the extent to which the glycerides in the oil have been decomposed by lipase [40]. Thus, every increase in the potassium hydroxide shows the presence of more free fatty acids and also indicates lipase activity on fats [41]. The free fatty acids increase with storage time as described by Bendini et al. [38]. The increase is triggered by exposure of lipase and other lipolytic materials to atmospheric oxygen after peanut crushing [42]. Light and heat also accelerate the breakdown and decomposition of fats to free fatty acids [43]. Since the peanut butter samples were stored at ambient conditions, there was a possibility of exposure to elevated temperatures and light conditions during storage, which could have led to increased formation of free fatty acids.

Peroxide value (PV) of OFSP peanut butter samples

From the first to the third month of storage, the treatment 2 and 3 did not register any peroxide unlike treatment 1which recorded some peroxides. The control sample (C0) had peroxides formed in the second month of storage. During the fourth and fifth month of storage, all the samples had registered some levels of peroxides but with C0 registering significantly high increase to a value of 19.62meqkg-1 (Figure 2). The results also show that, treatments with low OFSP ratio had high rate of increase in the peroxide value. At peroxide value of 10meqkg-1, oxidation reactions are initiated, and rancid flavors may start to be noticed. The results however showed that, for the first four months of storage PV was not high to cause rancidity unlike in the fifth month where the PV for C0 significantly increased above the limit.

Figure 2: Changes in PV with storage time for the different peanut butter with added OFSP and control sample. Line labeled** indicates the induction period beyond which peroxide formation accelerates rapidly and development of off flavors. Control sample (C0), Treatment 1 (5% OFSP), Treatment 2(10% OFSP) and Treatment 3 (15% OFSP).


PV is an indicator of the initial stages of oxidative change in food [44]. This method utilizes the principle of ferric ion complexion where hydrogen peroxide (ROOH) is reduced with Fe2+ leading to formation of Fe3+ complexes [41]. The concentration of peroxides as represented by the PV is useful in assessing the extent to which spoilage has advanced. The report by Azhar et al. [45] indicated that PV increased with storage time which is in agreement with the current study which showed that PVs of the samples increased with increasing storage time. Mailer et al. [46] also claimed that more oxidation occurs in lipids with prolonged time of storage. When the concentration of peroxides reaches an induction point (10mEq/kg), complex chemical changes occur, and volatile products are formed that are mainly the rancid taste and odour [38]. In the current study, the PV for the different samples was between 2.5-19mEq/kg of fat with C0 (19mEq/kg) having the highest and Treatment 3 the least PV (2.5mEq/kg). Therefore, the OFSP peanut butter had not yet attained the values necessary to produce the rancid flavors during the five months of storage.

The presence of carotenoids in OFSP can inhibit the formation of peroxides. Amongst the carotenoids, β-carotene has a higher potent for peroxides, which involves formation of hydrogen radical abstraction (ROO-CAR) complex, thus inhibiting utilization of the free radicals by oxygen [15]. This may explain the reduced rates of peroxide formation in samples with OFSP flour. Furthermore, peanuts have naturally occurring phytochemicals like tocopherols and polyphenolics; these also play a role in slowing or preventing lipid oxidation due to their anti-oxidative nature [41,47].

Relationship of PV and AV with OFSP levels and storage time

Table 2: Correlation of PV with independent variable AV, storage time and OFSP ratio.

R2=68.9; Values with * have a significant positive or negative relationship at P≤0.05


There was no linear relationship between AV and OFSP ratio (r= -0.1847, P≥0.05) (Table 2). However, a strong positive relationship between AV and time of storage (r=0.8955, P≤0.05) was detected. PV was significantly negatively (r=-0.4971) and positively (r=0.5852) associated with OFSP ratio and storage time, respectively (Table2). The correlations further show that AV significantly affected PV positively (r= 0.758). The negative relationship between PV and OFSP indicates that OFSP was resisting the formation of peroxides. This may be because β-carotene contained in OFSP reacts with fat radical to form a stable radical which does not quickly react with oxygen [48]. Antioxidants terminate the free radical intermediates, by being oxidized themselves, thus acting as reducing agents [48,49].

β-carotene retention of treatment samples with storage time

In all the samples, β-carotene significantly reduced as the storage time increased (Figure 3). The control sample (C0) had the least β-carotene which also significantly kept on reducing with storage time. Treatment 3 with highest level of β-carotene (1388.2µg/100g) in the 1st month of storage and it had reduced to 580.6µg/100g in the 5th month. The results further show that, the reduction in β-carotene was proportion to the amount present in the samples. Treatment 2 and 3 which had high values, also registered a significantly high loss with storage. However, at the end of the fifth month of storage, treatment 2 and 3 still had considerably high β-carotene levels compared to treatment 1 and control (C0).

Figure 3: Changes in β-carotene with storage time for the different peanut butter with added OFSP and control sample. Control sample (C0), Treatment 1: (5% OFSP flour), Treatment 2: (10%OFSP flour) and Treatment 3: (15% OFSP flour).


The losses in β-carotene over time may be due to exposure of peanut butter samples to light during storage as β-carotene is sensitive to heat and light [50]. The processing procedures and time also expose β-carotene to oxygen which may further influence the losses as noted by Bechoff et al. [51] and Wheatley [52]. In addition, the difficulty in complete extraction of the carotenoids during analysis may have introduced variability in the results obtained as it was also noted by Bengtsson et al. [16]. Despite the fact that there was significant loss in β-carotene during storage, the quantities retained by the Treatments 2 and 3 were high compared to the control sample. Thus, peanut butter fortified with 10% and 15% OFSP can contribute some level of β-carotene o the daily β-carotene requirements.

Relationship between β-carotene with storage time, OFSP ratio and PV units

Results in Table 3 show that β-carotene was significantly correlated with storage time, OFSP flour and PV value while both storage time and PV were negatively correlated (r=-0.5483 and; r=-0.5852) with the β-carotene retention, respectively. On the other hand, there was a strong positive correlation observed between OFSP ratio and the β-carotene (r=0.7547, P≤0.05). The literature indicates that a decrease in β-carotene during storage is natural [51]. This was also reflected in the study as a strong negative correlation was noted between beta-carotene and storage time (r=0.5483, P≤0.05). The decrease in β-carotene can be addressed by increasing the amount added to the food. The current study showed that β-carotene content correlates positively with the amount of OFSP flour added in the sample (r=0.7547, P≤0.05) indicating that an increase in the OFSP flour increased positively the level of β-carotene. These findings agree with Bechoff et al. [12] and Bengtsson et al. [16] who reported that more OFSP flour added in foods increases the β-carotene content.

Table 3: Correlation of B-carotene with other independent variables.

R2=89.2; values with *have a significant positive or negative relationship (P≤0.05)


Among other factors that influence β-carotene content, is oxidation. Since β-carotene plays an anti-oxidative role, the increasing PVs of the peanut butter samples negatively affected the retention of β-carotene as it is expected that β-carotene is used up in the process of inhibition of peroxide formation. β-carotene binds with the free radicals and blocks oxygen uptake during oxidation and it is depleted as it binds with the free radicals [37]. This phenomenon explains why β-carotene correlates negatively with the PV and may also explain why treatments with high OFSP registered lower values of PV since β-carotene inhibited the formation of peroxides

Changes in microbial quality of OFSP peanut butter during storage. The presence of microbes such as Escherichia coli, Staphylococcus aureus, yeasts and molds in peanut butter can be detrimental to human health [53,54]. In the present study (Table 4), all samples tested negative for yeasts and molds and E. coli. However, Treatments 1, 2 and 3 tested positive for presence of S. aureus and C0 tested negative (Table 3). The S. aureus ranged from 5.1*100cfu/g to 4*101cfu/g with treatment 3 recording the highest and treatment 2 had the least. The counts of S. aureus in treated peanut butter decreased with storage time.

Table 4: Changes in colony counts for microorganisms in peanut butter with OFSP and control sample during storage.

N. D= Not Detected Note: Control sample (C0), treatment 1 (5% OFSP flour), treatment 2 (10%OFSP flour) and treatment 3 (15% OFSP flour).


aureus has several strains, and some are known for causing food spoilage which doesn’t result into harm to the consumers but leads to food wasting (Institute of Food Technologists and Food and Drug Administration [55]. The production of S. aureus toxins is favored by minimum water activity (aw) of 0.9 [56], yet the peanut butter is known to have very low water activity of below 0.7 [56], which does not support production of toxins.

S.aureus competes poorly in most foods with low moisture content [56,57], and owing to the fact the samples had moisture in the range of 1.8 to 2% which is far below the required for growth S. aureus and toxin production. This may also explain the reduction trend of Staphylococci numbers in the peanut butter samples with storage time.

USDA (2010) set the minimum Coliform content to be below 3.6cfu/g and all samples were free of E. coli. This indicates good hygiene since the presence of coliform (E. coli) in peanut butter can reflect the possibility of fecal contamination as coliforms are considered normal flora of the intestinal tract of humans and animals [52]. The set standard for the yeasts and moulds by UNBS et al. [58] in peanut butter is ˂103cfu/g of sample which also shows that the peanut butter produced is safe for consumption since the results from microbial analysis reported absence of yeasts and moulds.

Changes in sensory attributes of peanut butter with storage time

No significant changes in color were noticed in all the samples (Table 5). Although significant changes in aroma, spread ability, oiliness, taste, flavor and overall acceptability were noticed in samples with storage time; the sensory scores were within desirable range of 6 to 7and according to sensory scale 6 represents like moderately and 7 like much (Table 5). The sensory attributes are mainly affected by the changes in the fat quality of the peanut butter products due to fat oxidation [7,59]. However, the effect of fat oxidation was not noticed in the OFSP enriched peanut butter samples except in the control (C0). In the present study, microbial testing was done prior to sensory evaluation [60-62] and all treatments were found to be microbiologically safe for sensory evaluation.

Table 5: Sensory changes for the control sample and peanut butter with added OFSP with storage time.

All values represent means ±SD; Values with same letter in a column are not significantly different (p≤0.05). Control sample (C0), Treatment 1: (5% OFSP flour), Treatment 2: (10%OFSP flour) and Treatment 3: (15% OFSP flour).


Conclusion

The findings suggest that use of OFSP in the production of peanut butter improved β-carotene content, which increases with high substitution levels. Treatment 3 with 15% OFSP had the highest β-carotene, highest beta-carotene retention on shelf, better fat quality and had acceptable sensory score. Thus, it is concluded that OFSP can be used in peanut butter to enhance its nutritional value (vitamin A requirements) of the school-going children. There is a need to encourage the diverse utilization of OFSP in peanut butter production to improve the vitamin A status of school going children. This could be one of the most possible ways of improving OFSP utilization by incorporating it in common local products like Oddi.

Acknowledgement

This research was supported in part by Makerere University, Uganda; by the Office of Agriculture, Research and Policy, Bureau of Food Security, US Agency for International Development, under the terms of Award No. AID-ECG-A-00-07-0001 to the University of Georgia as management entity for the US Feed the Future Innovation Lab on Peanut Productivity and Mycotoxin Control. The laboratory technicians of the School of Food Technology, Nutrition and Bio-engineering (FTNB) are appreciated for the technical support during the study.

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