Changes in frailty among patients hospitalized for spine pathologies during the COVID-19 pandemic in Germany-a nationwide observational study.

PURPOSE: In spine care, frailty is associated with poor outcomes. The aim of this study was to describe changes in frailty in spine care during the coronavirus disease 2019 (COVID-19) pandemic and their relation to surgical management and outcomes. METHODS: Patients hospitalized for spine pathologies between January 1, 2019, and May 17, 2022, within a nationwide network of 76 hospitals in Germany were retrospectively included. Patient frailty, types of surgery, and in-hospital mortality rates were compared between pandemic and pre-pandemic periods. RESULTS: Of the 223,418 included patients with spine pathologies, 151,766 were admitted during the pandemic and 71,652 during corresponding pre-pandemic periods in 2019. During the pandemic, the proportion of high-frailty patients increased from a range of 5.1-6.1% to 6.5-8.8% (p < 0.01), while the proportion of low frailty patients decreased from a range of 70.5-71.4% to 65.5-70.1% (p < 0.01). In most phases of the pandemic, the Elixhauser comorbidity index (ECI) showed larger increases among high compared to low frailty patients (by 0.2-1.8 vs. 0.2-0.8 [p < 0.01]). Changes in rates of spine surgery were associated with frailty, most clearly in rates of spine fusion, showing consistent increases among low frailty patients (by 2.2-2.5%) versus decreases (by 0.3-0.8%) among high-frailty patients (p < 0.02). Changes in rates of in-hospital mortality were not associated with frailty. CONCLUSIONS: During the COVID-19 pandemic, the proportion of high-frailty patients increased among those hospitalized for spine pathologies in Germany. Low frailty was associated with a rise in rates of spine surgery and high frailty with comparably larger increases in rates of comorbidities.

Trends in frailty in brain tumor care during the COVID-19 pandemic in a nationwide hospital network in Germany.

PURPOSE: Among brain tumor patients, frailty is associated with poor outcomes. The COVID-19 pandemic has led to increased frailty in the general population. To date, evidence on changes in frailty among brain tumor patients during the pandemic is lacking. We aimed to compare frailty among brain tumor patients in Germany during the COVID-19 pandemic to the pre-pandemic era and to assess potential effects on brain tumor care. METHODS: In this retrospective observational study, we compared frailty among brain tumor patients hospitalized during the COVID-19 pandemic in years 2020 through 2022 to pre-pandemic years 2016 through 2019 based on administrative data from a nationwide network of 78 hospitals in Germany. Using the Hospital Frailty Risk Score (HFRS), frailty was categorized as low, intermediate, or high. We examined changes in frailty, patient demographics, the burden of comorbidity, rates of surgery, and mortality rates for different frailty groups during the pandemic and compared them to pre-pandemic levels. RESULTS: Of the 20,005 included hospitalizations for brain tumors, 7979 were during the pandemic (mean age 60.0 years (± 18.4); females: 49.8%), and 12,026 in the pre-pandemic period (mean age: 59.0 years [± 18.4]; females: 49.2%). Average daily admissions decreased from 8.2 (± 5.1) during pre-pandemic years to 7.3 (± 4.5) during the pandemic (p < 0.01). The overall median HFRS decreased from 3.1 (IQR: 0.9-7.3) during the pre-pandemic years to 2.6 (IQR: 0.3-6.8) during the pandemic (p < 0.01). At the same time, the Elixhauser Comorbidity Index (ECI) decreased from 17.0 (± 12.4) to 16.1 (± 12.0; p < 0.01), but to a larger degree among high compared to low frailty cases (by 1.8 vs. 0.3 points; p = 0.04). In the entire cohort, the mean length of stay was significantly shorter in the pandemic period (9.5 days [± 10.7]) compared with pre-pandemic levels (10.2 days [± 11.8]; p < 0.01) with similar differences in the three frailty groups. Rates of brain tumor resection increased from 29.9% in pre-pandemic years to 36.6% during the pandemic (p < 0.001) without differences between frailty levels. Rates of in-hospital mortality did not change during the pandemic (6.1% vs. 6.7%, p = 0.07), and there was no interaction with frailty. CONCLUSION: Even though our findings are limited in that the HFRS is validated only for patients ≥ 75 years of age, our study among patients of all ages hospitalized for brain tumors in Germany suggests a marked decrease in levels of frailty and in the burden of comorbidities during the COVID-19 pandemic.

Decompressive Surgery in the Treatment of Acute Ischemic Stroke during the First Four Waves of the COVID-19 Pandemic in Germany: A Nationwide Observational Cohort Study.

BACKGROUND: The COVID-19 pandemic has significantly affected acute ischemic stroke (AIS) care. In this study, we examined the effects of the pandemic on neurosurgical AIS care by means of decompressive surgery (DS). METHODS: In this retrospective observational study, we compared the characteristics, in-hospital processes, and in-hospital mortality rates among patients hospitalized for AIS during the first four waves of the pandemic (between January 1, 2020 and October 26, 2021) versus the corresponding periods in 2019 (prepandemic). We used administrative data from a nationwide hospital network in Germany. RESULTS: Of the 177 included AIS cases with DS, 60 were from 2019 and 117 from the first four pandemic waves. Compared with the prepandemic levels, there were no changes in weekly admissions for DS during the pandemic. The same was true for patient age (range: 51.7-60.4 years), the number of female patients (range: 33.3-57.1%), and the prevalence of comorbidity, as measured by the Elixhauser Comorbidity Index (range: 13.2-20.0 points). Also, no alterations were observed in transfer to the intensive care unit (range: 87.0-100%), duration of in-hospital stay (range: 14.6-22.7 days), and in-hospital mortality rates (range: 11.8-55.6%). CONCLUSION: In Germany, compared with the prepandemic levels, AIS patients undergoing DS during the first four waves of the pandemic showed no changes in demographics, rates of comorbidity, and in-hospital mortality rates. This is in contrast to previous evidence on patients with less critical types of AIS not requiring DS and underlines the uniqueness of the subgroup of AIS patients requiring DS. Our findings suggests that these patients, in contrast to AIS patients in general, were unable to forgo hospitalization during the COVID-19 pandemic. Maintaining the delivery of DS is an essential aspect of AIS care during a pandemic.

Feeding Damascus goats humic or fulvic acid alone or in combination: in vitro and in vivo investigations on impacts on feed intake, ruminal fermentation parameters, and apparent nutrients digestibility.

In vitro and in vivo experiments were carried out to investigate the effects of the supplementation of different levels of humic and fulvic acids alone or their combination (2:1 ratio) on ruminal fermentation constituents, and nutrients digestibility in goats. The treatments in Exp. 1 were the following: (1) basal substrate (50% concentrate: 50% forage) was incubated humic at 0, 2, 4, and 6 g/kg DM; (2) fulvic at 0, 1, 2, and 3 g/kg DM; and (3) a combination of humic and fulvic (in a 2:1 ratio) at 0, 3, 6, and 9 g/kg DM" of treatments. The results of Exp. 1 revealed that methane (CH4) production was linearly decreased (P < 0.001) upon increasing humic doses. Whereas, the combination of fulvic acid with humic acid resulted in a quadratic decrease (P < 0.001) in net CH4 production. Supplementing humic and fulvic acids, either separately or in combination, resulted in reduced (P < 0.05) ammonia nitrogen (NH3-N) and total volatile fatty acid (VFA) concentrations. In Exp. 2 to further examine the findings obtained in Exp. 1, forty Damascus non-lactating goats (2-3 years of age and body weight 29 ± 1.5 kg) were fed the same basal diet as in Exp. 1, plus one of four treatments. Treatments were the following: (1) control (no supplement); (2) basal diet plus 5 g humic alone; (3) basal diet plus 2.5 g fulvic alone, and (4) basal diet plus 7.5 g their combination. Goats fed diets supplemented with humic acid, fulvic acid, either alone or in combination, increased concentrations of butyrate (P = 0.003), total VFA (P < 0.001), and improved (P < 0.001) digestibility of nutrients, but reduced (P < 0.001) ruminal NH3-N concentrations. In conclusion, applying humic and fulvic acids alone or in combination attenuated in vitro CH4 production, while improved intake and diet digestibility without adverse effect on rumen fermentation profiles in Damascus goats.

N-Acetylcysteine Alleviated the Deltamethrin-Induced Oxidative Cascade and Apoptosis in Liver and Kidney Tissues.

Deltamethrin (DLM) is a synthetic pyrethroid with anti-acaricide and insecticidal properties. It is commonly used in agriculture and veterinary medicine. Humans and animals are exposed to DLM through the ingestion of polluted food and water, resulting in severe health issues. N-acetylcysteine (NAC) is a prodrug of L-cysteine, the precursor to glutathione. It can restore the oxidant-antioxidant balance. Therefore, this research aimed to examine whether NAC may protect broiler chickens against oxidative stress, at the level of biochemical and molecular alterations caused by DLM intoxication. The indicators of liver and kidney injury in the serum of DLM-intoxicated and NAC-treated groups were examined. Furthermore, lipid peroxidation, antioxidant markers, superoxide dismutase activity, and apoptotic gene expressions (caspase-3 and Bcl-2) were investigated. All parameters were significantly altered in the DLM-intoxicated group, suggesting that DLM could induce oxidative damage and apoptosis in hepato-renal tissue. The majority of the changes in the studied parameters were reversed when NAC therapy was used. In conclusion, by virtue of its antioxidant and antiapoptotic properties, NAC enabled the provision of significant protection effects against DLM-induced hepato-renal injury.

Bioremediation role of Spirulina platensis against deltamethrin-mediated toxicity and its chemical residues in chicken meat.

Deltamethrin (DM) is a synthetic pyrethroid insecticide commonly used in veterinary and agriculture. However, both animal and human exposure are associated with hepatorenal toxicity. Our experimental goal was to assess the protective effects of Spirulina platensis (SP) against DM-induced hepatorenal injury, growth performance, meat chemical composition, and its residues in meat, liver, and skin of broiler chickens. Sixty 1-day-old Cobb broiler chicks were assigned to 4 experimental groups; each was divided into 3 replicates with five chicks each; the 1st group received basal diet alone (control), 2nd group supplemented with SP 20 g/kg diet, 3rd group supplemented with DM 300 mg/kg diet, and 4th group supplemented with DM and SP diet. All groups have received the treatment for 35 days. DM, decreased body weight, weight gain, and increased feed conversion rate. DM showed a significant increase in ALT, AST, urea, creatinine, and MDA and a significant decrease in SOD, and GSH levels. Also, SP significantly reduced DM levels in meat, skin, and liver with a reduction 63.01, 63.00, and 62.90 %, respectively. The DM intoxicated group showed a significant decrease in protein and a marked increase in fat, cholesterol, and triglycerides when compared to the control group. Histopathological changes were also recorded. Dietary SP improved these parameters. Dietary inclusion of SP can be recommended due to the protective effects on DM-induced toxicity in broiler chickens.

Satellite cells in the latissimus dorsi of the rat.

This study was carried out with the aid of the electron microscope to determine the frequency of satellite cells in mammalian skeletal muscle fibre. 10 normal adult male albino rats were used and specimens from the latissimus dorsi muscle were removed, processed and prepared for electron microscope examination. Satellite cells were first identified by their location, shape and organelles. Counts were then carried out on 72 electron microscope fields at X 8,000 magnification from both longitudinal and transverse sections. The total number of nuclei was counted first, then the nuclei of satellite cells were identified and recorded. It has been found that satellite cell nuclei accounted for only 4.5% of all the nuclei seen. The rest being myonuclei within the muscle fibre. This surprisingly small number of satellite cells leaves the question of their role in muscle regeneration and that of the origin of the large numbers of 'myoblasts' that appear in the early stages of muscle repair after injury yet to be answered.