Oral Carbohydrate Research Articles

Effect of preoperative oral carbohydrate on the postoperative recovery quality of patients undergoing daytime oral surgery: a randomized controlled trial

BackgroundPreoperative oral carbohydrate intake can improve the postoperative recovery of fasting patients in many kinds of surgeries; however, the effect of carbohydrates on patients undergoing daytime oral surgery is still unclear. This study was designed to evaluate the effect of preoperative oral carbohydrate intake on the quality of recovery of patients undergoing daytime oral surgery using the quality of recovery-15 (QoR-15) questionnaire.MethodsNinety-two patients scheduled for daytime oral surgery were randomly allocated to the midnight fasting group (F group, n = 45) or the carbohydrate-Outfast loading group (O group, n = 47). Participants in the F group fasted from midnight the day before surgery. Patients in the O group also fasted but received the Outfast drink (4 ml/kg) 2–3 h before the induction of anesthesia. QoR-15 questionnaire, patient well-being, and satisfaction were assessed before anesthesia induction and 24 h after surgery. Perioperative blood glucose, postoperative exhaust time, and adverse events were also recorded.ResultsThe QoR-15 scores were significantly higher in the O group than in the F group preoperatively and postoperatively. Seven parameters representing patient well-being evaluated on a numeric rating scale (NRS, 0–10) were lower in the O group than in the F group postoperatively, except for the hunger and sleep quality scores. Patient satisfaction scores on a 5-point scale were higher in the O group than in the F group preoperatively and postoperatively. Meanwhile, the postoperative exhaust time was significantly shorter in the O group compared to the F group, while there were no significant differences in blood glucose concentrations between two groups.ConclusionsPreoperative oral carbohydrate intake could improve postoperative recovery quality, well-being, and satisfaction of patients undergoing daytime oral surgery 24 h after surgery, and may serve as a treatment option for patients undergoing daytime oral surgery.Trial registrationThis trial was registered in the Chinese Clinical Trial Registry (ChiCTR2100053753) on 28/11/2021.

6765 Surveillance For Side Effects Of Glycemic Control: Von Gierke Disease And Recurrent Diarrhea With Hospitalized Approach

Abstract Disclosure: J. Gone: None. E. Fegahli: None. T. Thompson: None. Background: Von Gierke disease is an autosomal recessive disorder leading to the inability to break down glycogen. Clinical features manifest at 3-6 months including symptoms of hypoglycemia, short stature, thin legs, round face, protruding abdomen, muscular hypotonia, and psychomotor retardation. Workup shows hypoglycemia, lactic acidosis, hyperuricemia, hyperlipidemia, anemia, hepatomegaly, and renomegaly. Patients may develop inflammatory bowel disease, osteopenia, renal failure, hepatic tumors, and pulmonary hypertension. Molecular sequencing confirms the diagnosis. Feeding glucose at regular intervals prevents hypoglycemia. One should avoid fructose, lactose, sucrose, and galactose. Oral citrate or bicarbonate is used to treat lactic acidosis. Gout, hyperlipidemia, anemia, IBD and osteoporosis are managed accordingly. Regular screening for osteoporosis, renal failure, hepatic tumors, and pulmonary hypertension is recommended. Liver transplantation results in optimal management. Gene therapy clinical trials are underway. Clinical Case: We present a case of von Gierke disease in a 20-year-old male presenting to the Emergency Department for recurrent nausea, emesis, poor oral intake, water diarrhea and subjective fever. Inpatient workup showed lactic acidosis, hyperuricemia, hypertriglyceridemia, transaminitis, and fibrofatty hepatomegaly. Intravenous fluids, antiemetics and cornstarch were given. Symptoms including nausea, emesis, and diarrhea improved, most notably after adjustments made to cornstarch dosage and frequency. The patient was discharged with an antiemetic and an antidiarrheal and with recommendations to continue scheduled cornstarch. Patient was educated about the importance of proper diet compliance and close outpatient follow up. Hence, management of von Gierke disease should include not only strict glycemic control but also close surveillance for possible side effects, such as diarrhea. Moreover, future studies are necessary to support empiric modifications in management despite a basis of a hypothetical rationale. Conclusion: An essential goal of managing GSD-1 is not only strict glycemic control but also close surveillance for possible side effects, such as diarrhea. Adjustments to maintaining normoglycemia may be mandatory by manipulating factors including dosage and frequency of oral carbohydrates, such as cornstarch, to reduce the recurrence of side effects as much as possible. Treatment regimens should be individualized to each case because the initial presentation and response to treatment in every patient can be different, whether it is minor or major. Future studies about the mechanisms regarding possible side effects of treatment, such as diarrhea, are warranted to corroborate empiric changes in management, like adjusting dosage and frequency or medications, despite having a hypothetical rationale. Presentation: 6/1/2024

9182 Metastatic Extra-Gastrointestinal Stromal Tumor Presenting As Hypoglycemia

Abstract Disclosure: O. faour: None. D. John: None. S.K. Suryanarayanan: None. A.A. Rizvi: None. Introduction: Non islet cell tumor hypoglycemia (NICTH) is a rare paraneoplastic syndrome seen in association with solid abdominal tumors of mesenchymal and epithelial origin. We report a case of metastatic extra-gastrointestinal stromal tumor (E-GIST) presenting with severe hypoglycemia as its initial manifestation. CASE DESCRIPTION: A 46-year-old patient was found to have a blood glucose of <45 mg/dl during a routine clinic visit with her primary care physician. Although she was asymptomatic, she was sent to the emergency room (ER) for further evaluation. She had a history of prediabetes managed by lifestyle modification. She has been experiencing multiple episodes of hypoglycemia previously which fulfilled the Whipple’s triad in the preceding months. These hypoglycemic episodes included loss of unconsciousness, falls in the shower with head injury, and several hospital visits. Serum glucose in the ER was 14 mg/dl and hypoglycemia persisted despite continuous dextrose solution. Physical examination was notable for a distended, non-tender abdomen and cervical lymphadenopathy. CT scan showed a 15 cm mass in the liver, multiple large masses in the mesentery, and a 11 cm lesion in the left pelvis. There were enlarged lymph nodes in the abdomen, chest, and neck. Serum chemistries drawn when the patient was hypoglycemic revealed potassium level of 2.7 mg/dl (3.5-5.5) an insulin level of <1.0 mIU/L (5-25), C-peptide <0.1 ng/mL (0.5-2), cortisol 13.8 mcg/dL (5-25), and insulin-like growth factor-2 (IGF-2) was 270 ng/mL (38-267). The IGF-2/IGF-1 molar ratio was 3.4 (normal <3:1). The sulfonylurea drug screen came back negative. Upper and lower endoscopies were unrevealing. Biopsy of the liver lesion showed cytology and immunohistochemical findings consistent with a epithelioid metastatic extra-gastrointestinal stromal tumor. A provisional diagnosis of NICTH was made. The patient responded well to intravenous glucose, oral carbohydrate intake and high-dose corticosteroids. She was subsequently started on therapy with the tyrosine kinase inhibitor (TKI) imatinib. Discussion: Paraneoplastic hypoglycemia is often seen in association with metastatic epithelial and mesenchymal tumors. IGF-2 and incompletely processed pro-IGF-2 activates autocrine, paracrine, and endocrine pathways that lead to tumor growth, fasting hypoglycemia, rarely of acromegalic features. Treatment with octreotide, diazoxide, and glucagon is generally ineffective, while glucocorticoid use and surgical intervention are helpful in ameliorating the hypoglycemia. Tumor-directed therapy with TKIs, primarily imatinib, appears promising in achieving remission. Our case is a clinical reminder that hypoglycemia secondary to NICTH can be the predominant presenting feature in patients with underlying E-GIST. Presentation: 6/3/2024

Effects of oral carbohydrate loading in patients scheduled for painless bidirectional endoscopy: a prospective randomized controlled trial

PurposeTraditional fasting causes considerable discomfort without added assurance of security, whereas oral carbohydrate beverage offers an alternative to improve medical experience. This study aims to explore the impact of different types and dosages of oral fluids loading before painless bidirectional endoscopy on the gastric emptying and wellbeing.Methods180 patients arranged for bidirectional endoscopy with intravenous anesthesia were randomized: patients in the control group (Group C) obeyed standard fasting; the 200 mL carbohydrate group (Group P1), 400 mL carbohydrate group (Group P2), 200 mL water group (Group W1) and 400 mL water group (Group W2) respectively consumed 200 mL or 400 mL corresponding clear liquids 2 h before the procedure. Gastric emptying metrics under ultrasound, subjective comfort indexes, periprocedural blood glucose and vital signs were contrasted among the groups.ResultsNo significant differences were detected in the gastric emptying including CSA (cross-sectional area), GV (gastric volume), cGV (corrected gastric volume) and the three-point grading system among groups, and none had a cGV > 1.5 mL/kg before anesthesia. Participants in Group P2 experienced less preprocedural thirst and mouth dryness, so as the postprocedural thirst, mouth dryness and hunger. Periprocedural blood glucose and MAP had the similar trend in all groups. The occurrence of hypotension, bradycardia, hypoxia, and the required norepinephrine was comparable among the groups.ConclusionsOral beverage loading with 200 mL or 400 mL can be safely applicated 2 h before painless bidirectional endoscopy without increasing the gastric volume. 400 mL carbohydrate solution effectively relieves the discomfort and could serve as a consideration.Trial registrationRegistered in the Chinese Clinical Trial Registry on December 5, 2023 (ChiCTR2300078319).

Effect of Preoperative Carbohydrate Loading on Postoperative Recovery of Individuals Who Have Type 2 Diabetes After Total Knee Arthroplasty: A Randomized Controlled Trial

BackgroundMany individuals undergoing surgery involving general anesthesia are asked to fast for a prolonged period to ensure perioperative safety, yet this can initiate stress reactions and insulin resistance, harming postoperative recovery. Such fasting may be particularly problematic for those who have type 2 diabetes. Here, we assessed how giving such individuals’ oral carbohydrates before total knee arthroplasty can affect outcomes. MethodsWe randomized 90 patients who had non–insulin-dependent type 2 diabetes mellitus who were scheduled for elective total knee arthroplasty at one medical center between April 2022 and January 2023 to receive oral carbohydrates at two or four hours before surgery or to receive a carbohydrate-free "placebo" drink at four hours before surgery. The three groups were compared in terms of postoperative blood glucose, insulin resistance, β cell activity, postoperative wound complications, and other clinical outcomes. ResultsThe group who received oral carbohydrates at two or four hours before surgery showed significantly lower insulin resistance than the placebo group (group at two hours, 9.0 ± 3.4; group at four hours, 15.8 ± 6.9 versus placebo, 30.9 ± 10.5, P < 0.001) and lower β cell activity (207.7 ± 106.7%; group at four hours, 243.2 ± 114.9% versus 421.5 ± 209.3%, P < 0.001). Those groups were also significantly less likely than the placebo group to experience preoperative hunger or postoperative hyperglycemia. Among patients who received oral carbohydrates, those who received them two hours before surgery showed significantly lower insulin resistance and better glycemic control on postoperative day 1 than those who received carbohydrates four hours before surgery. None of the subjects developed intraoperative aspiration or experienced severe postoperative complications. ConclusionOral carbohydrates at two to four hours before total knee arthroplasty are safe and can significantly alleviate preoperative hunger while mitigating postoperative insulin resistance and improving glycemic control in patients who have non–insulin-dependent type 2 diabetes mellitus.

Oral high-carbohydrate solution as an alternative dietary modality in patients with acute pancreatitis

Background/objectivesEarly enteral feeding is crucial in acute pancreatitis (AP) to preserve the intestinal mucosa, prevent bacterial overgrowth, and prevent progression to pancreatic necrosis, multi-organ failure, and death. However, the optimal early diet remains unclear. This study compared an oral carbohydrate solution (OCS) diet versus a conventional diet (CD) in patients with AP. MethodsWe retrospectively enrolled 538 patients diagnosed with AP in 2018–2022: 346 received a CD and 192 received an OCS diet. Because of differences in AP severity between groups, we performed 1:1 propensity score matching to obtain comparable groups (n = 182 in each). The CD group progressed from a liquid diet to soft foods and finally solid foods. The OCS group followed the same progression but received OCS instead of a liquid diet. Primary outcomes were the rate of recurrent postprandial pain after initiating the dietary intervention and hospital length of stay (LOS). Secondary outcomes included intensive care unit admission, mortality, 28-day hospital readmission, and AP-related complications. ResultsAfter propensity score matching, baseline characteristics of the OCS and CD groups were comparable. The rate of recurrent pain was significantly higher in the CD group than in the OCS group (13.2 % vs. 3.8 %, p < 0.001), but hospital LOS was similar between groups (CD vs. OCS: 9.2 days vs. 8.7 days, p = 0.533). There were no significant differences in secondary outcomes between groups. ConclusionsIn patients with AP, OCS diet was associated with a lower rate of recurrent postprandial pain compared to a CD. Thus, OCS appears to be a beneficial dietary alternative for initial management of AP.

Examination of Postgraduate Theses on ERAS Protocol Applications in the Field of Nursing in Türkiye

Aim: This study is designed to examine postgraduate theses conducted in the field of nursing in Türkiye focusing on the Enhanced Recovery After Surgery (ERAS) protocols. Method: In this retrospective literature review, theses conducted in the field of nursing between 2011-2023, focusing on the utilization of ERAS practices, were examined. The inclusion criteria for the theses retrieved from the National Thesis Center database of the Higher Education Council were as follows: having key terms such as "Postoperative enhanced recovery protocol," "Enhanced recovery," "Oral carbohydrate," or "ERAS" in their thesis titles, and being conducted by departments of Nursing and/or Nursing Science. After categorizing the theses into master's and doctoral theses, they were examined in chronological order. Results: The screening process identified 21 theses conducted between 2011-2023, excluding one thesis that was inaccessible for full text. All theses were written within the last 12 years, with 3 theses at the doctoral level and 17 at the master's level. When examining the study designs, one these was a meta-analysis, 13 were descriptive, and 6 were conducted using experimental methods. Among the studies, 75% were conducted with patients, 10% with healthcare workers, and 10% with nursing students. Conclusion: The nursing theses conducted on ERAS have concluded that ERAS practices are effective based on their intended purposes. Additionally, it has been determined that healthcare professionals have insufficient knowledge regarding ERAS practices. Therefore, it is recommended to increase the number of studies conducted in the field of nursing to promote the widespread implementation of ERAS practices and raise awareness.

Effect of preoperative oral carbohydrate loading on postoperative insulin resistance, patient-perceived well-being, and surgical outcomes in elective colorectal surgery: a randomized controlled trial

BackgroundInsulin resistance (IR) is one of the independent determinants influencing the length of hospital stay (LOHS) and postoperative complications in colorectal procedures. Preoperative oral carbohydrate loading (OCL) has emerged as a prospective countermeasure for IR. This study aimed to investigate the effects of preoperative carbohydrate loading on postoperative IR, inflammatory parameters, and clinical outcomes in patients undergoing elective colorectal surgery. MethodsThis was an open-label, parallel arm, superiority randomized controlled trial conducted over 2 years. Participants were assigned to conventional fasting and oral OCL groups. IR, insulin sensitivity, Glasgow Prognostic Score (GPS), and interleukin 6 levels were analyzed on the day of surgery and on the first postoperative day (POD-1) and third POD (POD-3). Clinical parameters, such as thirst, hunger, dry mouth, anxiety, weakness, pain, nausea, and vomiting, were compared in the perioperative period. In addition, surgical clinical outcomes, such as intestinal recovery, time to independent ambulation, postoperative morbidity, and LOHS, were studied. ResultsA total of 72 participants were included, with 36 in each group. In the OCL group, there was a statistically significant decrease in postoperative IR on the day of surgery, POD-1, and POD-3 (P = .0336). Similarly, inflammatory parameters and the GPS were found to be significantly lower in the OCL group (P < .001). Clinical parameters, such as thirst, hunger, and dry mouth, were significantly lower in the intervention group (P =.00), with a shortened LOHS. ConclusionThis study demonstrated that preoperative carbohydrate loading is associated with reduced IR and inflammatory markers, shortened hospital stays, and improved overall clinical outcomes in elective colorectal surgery.

A randomized translational study on protein- and glucose metabolism in skeletal muscles evaluated by gene-ontology, following preoperative oral carbohydrate loading compared to overnight peripheral parenteral nutrition (PPN) before major cancer surgery

BackgroundEffects of preoperative drinks on muscle metabolism are unclear despite general recommendations. The aim of the present study was therefore to compare metabolic effects of a preoperative oral nutrition drink, recommended by protocols for enhanced recovery after surgery (ERAS), compared to overnight preoperative peripheral total parenteral nutrition (PPN) on skeletal muscle metabolism in patients aimed at major gastrointestinal cancer surgery.MethodsPatients were randomized, based on diagnosis and clinical characteristics, to receive either a commercial carbohydrate-rich nutrition drink (Drink); or overnight (12 h) peripheral parenteral nutrition (PPN) as study regimens; compared to isotone Ringer-acetate as Control regimen. Arterial blood- and abdominal muscle tissue specimens were collected at start of surgery. Blood chemistry included substrate- and hormone concentrations. Muscle mRNA transcript analyses were performed by microarray and evaluated for changes in gene activities by Gene Ontology algorithms.ResultsPatient groups were comparable in all measured preoperative assessments. The Nutrition Drink had significant metabolic alterations on muscle glucose metabolism (p < 0.05), without any significant effects on amino acid- and protein metabolism. PPN showed similar significant effects on glucose metabolism as Drinks (p < 0.05), but indicated also major positive effects on amino acid- (p < 0.001) and protein anabolism (p < 0.05), particularly by inhibition of muscle protein degradation, related to both ubiquitination of proteins and autophagy/lysosome pathways (p < 0.05).ConclusionConventional overnight preoperative PPN seems effective to induce and support improved muscle protein metabolism in patients aimed at major cancer surgery while preoperative oral carbohydrate loading, according to ERAS-protocols, was ineffective to improve skeletal muscle catabolism and should therefore not be recommended before major cancer surgery.Trial registration Clinical trials.gov: NCT05080816, Registered June 10th 2021- Retrospectively registered. https://clinicaltrials.gov/study/NCT05080816

In silico validation of a customizable fully-autonomous artificial pancreas with coordinated insulin, glucagon and rescue carbohydrates

Artificial pancreas systems should be designed considering different patient profiles, which is challenging from a control theory perspective. In this paper, a flexible-hybrid dual-hormone control algorithm for an artificial pancreas is proposed. The algorithm handles announced/unannounced meals by means of a non-interacting feedforward scheme that safely incorporates prandial boluses. Also, a coordination strategy is employed to distribute the counter-regulatory actions, which can be delivered as a continuous glucagon infusion via an automated pump, as an oral rescue carbohydrate recommendation, or as a rescue glucagon dose recommendation to be administrated through a glucagon pen. The different configurations of the proposed controller were evaluated in silico using a 14-day virtual scenario with random meal intakes and exercise sessions, achieving above 80% time-in-range and low time spent in hypoglycemia.

Comparative evaluation of the antihyperglycemic effects of three extracts of sea mustard (Undaria pinnatifida): In vitro and in vivo studies

Undaria pinnatifida (UP) contains multiple bioactive substances, such as polyphenols, polysaccharides, and amino acids, which are associated with various biological properties. This study aimed to evaluate the antihyperglycemic effects of three extracts obtained from UP. UP was extracted under three different conditions: a low-temperature water extract at 50 °C (UPLW), a high-temperature water extract at 90 °C (UPHW), and a 70 % ethanol extract (UPE). Nontargeted chemical profiling using high-performance liquid chromatography-triple/time-of-flight mass spectrometry (HPLC−Triple TOF−MS/MS) was conducted on the three UP extracts. Subsequently, α-glucosidase inhibitory (AGI) activity, glucose uptake, and the mRNA expression of sodium/glucose cotransporter 1 (SGLT1) and glucose transporter 2 (GLUT2) were evaluated in Caco-2 cell monolayers. Furthermore, an oral carbohydrate tolerance test was performed on C57BL/6 mice. The mice were orally administered UP at 300 mg/kg body weight (B.W.), and the blood glucose level and area under the curve (AUC) were measured. Compared with glucose, UPLW, UPHW and UPE significantly inhibited both glucose uptake and the mRNA expression of SGLT1 and GLUT2 in Caco-2 cell monolayers. After glucose, maltose, and sucrose loading, the blood glucose levels and AUC of the UPLW group were significantly lower than those of the control group. These findings suggest that UPLW has antihyperglycemic effects by regulating glucose uptake through glucose transporters and can be expected to alleviate postprandial hyperglycemia. Therefore, UPLW may have potential as a functional food ingredient for alleviating postprandial hyperglycemia.

The Effect of Preoperative Carbohydrate-containing Fluid Consumption on Maternal Oxidative Stress Markers During Elective Cesarean Delivery

PurposeThe purpose of this study was to evaluate the effect of carbohydrate loading prior to the cesarean surgery under spinal anesthesia on thiols and ischemia-modified albumin (IMA) levels. DesignProspective, randomized placebo-controlled study. MethodsSeventy-nine pregnant women planned for cesarean sections under spinal anesthesia at Karaman Training and Research Hospital were randomized into a control group (group C) (n = 42), and an oral carbohydrate preloading group (group OCH) (n = 37). OCH loading requires consuming 400 mL the night before surgery and 200 mL up to 2 hours before anesthesia. Group OCH consumed an oral carbohydrate-rich beverage (Nutricia-Fantomalt), and group C consumed an equal volume of water. This study investigated thiol-disulfide homeostasis after preoperative carbohydrate consumption. Preoperative gastric fluid, volume, antral cross-sectional area, hypotension following the birth, and fetal blood gas parameters were compared across groups. FindingsThiols and IMA levels did not differ across groups before and after surgery (P > .05). Gastric ultrasonography showed similar antral cross-sectional area and stomach volume between groups (P = .172, P = .128, respectively). When surgery caused hypotension, group OCH received more ephedrine for surgery-induced hypotension, although this difference is not statistically significant (P = .704). A clustered error bar (95% confidence interval) plot with an interpolation line was used for a time-based comparison of mean differences in heart rate and mean arterial pressure between the groups. ConclusionsThis study supports that mothers' thiols and IMA levels were unaffected by preoperative OCH loading before cesarean surgery. We did not examine thiol and its derivatives in umbilical cord blood; hence, we can not comment on thiol/disulfide homeostasis levels in neonates.

Preoperative Oral Carbohydrates for Children: A Meta-Analysis and Systematic Review.

Background: Many studies have reported the use of preoperative oral carbohydrates (CHO) in children, but the results are inconsistent. The aim of this meta-analysis is to assess the effectiveness and safety of oral CHO administration in children prior to surgery, with the goal of offering a dependable reference for clinical nursing practices and surgical interventions. Methods: Two authors searched PubMed, Clinical trials, Web of Science, Embase, Cochrane Library, China national knowledge infrastructure (CNKI), Wanfang and Weipu databases for randomized controlled trial (RCT) on the effects of preoperative oral CHO in children up to April 12, 2024. We used RevMan 5.4 software for data analysis. Results: Nine RCTs involving a total of 1279 children were included. The meta-analysis showed that there was statistical difference in the pH of gastric juice (MD = 1.54, 95%CI: 1.40-1.67, p < .001), intraoperative sedation score (MD = 0.62, 95%CI: 0.27-0.97, p < .001), and the incidence of postoperative nausea and vomiting (OR = 0.40, 95%CI: 0.20-0.80, p = .009) between the CHO and control groups. There was no statistical difference in the RGV (MD = -0.23, 95%CI: -0.47-0.01, p = .06) and the postoperative blood glucose level (MD = -0.91, 95%CI: -5.03-3.21, p = .67) between the CHO and control groups. Egger regression analysis showed that there were no publication biases amongst the synthesized outcomes (all p > .05). Conclusion: The administration of oral CHO to children before surgery is safe and practicable. There is a need for additional, well-conducted studies with more participants to further elucidate the role of preoperative CHO administration.

Effects of an Oral Multi-vitamin Carbohydrate Beverage on Intraoperative Nausea and Vomiting in Women Converted from Vaginal Delivery to Cesarean Section

Effects of an Oral Multi-vitamin Carbohydrate Beverage on Intraoperative Nausea and Vomiting in Women Converted from Vaginal Delivery to Cesarean Section

Determining Oral Health Status and Lifestyle related Behaviors on the Example of 149 Children Aged 7 to 12 Years Old Living in Tbilisi

The level of oral hygiene in school-aged children in different countries is primarily low. Behavioral factors are the most important contributors to this low level of hygiene. It is also important to note that identifying the specific behaviors that significantly reduce disease burden is critical. The research was provided in Tbilisi, in public schools, to evaluate Oral health indicators (OHI, DMF, def), mean value of intensity of caries in school-aged children (7 to 12 years old), the role of behavioral factors in relation to oral hygiene and carbohydrate nutrition, and the popularity and relevance of preventive measures were determined. A cross-sectional study was conducted, where 149 children aged 7 to 12 were selected by simple random sampling from Tbilisi public schools. Evaluation of DEF, def, and S-OHI indices was carried out. Based on the oral health questionnaire, children’s oral care and carbohydrate nutrition behaviors were assessed, as well as attitudes toward preventive interventions. SPSS version 23 software for statistical data processing was used for statistical analysis. On the example of 149 children in the 7-12-year-old population of Tbilisi, the simplified hygiene index is evaluated by the criterion average (1.56). Urban distribution affects the hygiene index, which is statistically significant (P=0.009). Caries intensity and hygiene index in primary and permanent dentition do not depend on gender - statistical certainty is not fixed. Caries intensity is “medium” for both permanent (3.2) and primary dentition (3.9), and the mean value of caries intensity for the whole population is 6.31, which is rated as “high.” The popularity and relevance of preventive measures are low. Lifestyle behaviors related to both oral hygiene and carbohydrate-rich diets are not consistent with the recommendations provided by the FDI to reduce caries burden.

Investigation of glucagon-like peptide-1 response to six oral carbohydrates in ponies

Glucagon-like peptide-1 (GLP-1), the principal incretin in horses, may play a role in the pathophysiology of insulin dysregulation (ID). This study aimed to describe its concentration in response to three preserved forages and four dynamic tests for ID in ponies. Twelve adult ponies of mixed ID status were given a meal of hay, soaked hay or haylage, an in-feed oral glucose test (OGT), oral sugar test (OST), an oral test using a proprietary breakfast cereal (WEET) or a combined glucose-insulin tolerance test (CGIT) weekly in a randomised cross-over study. Glucose, insulin and GLP-1 concentrations were measured before and following each intervention. Ponies were designated ID or non-ID and insulin resistant (IR) or non-IR according to OGT and CGIT results, respectively.All interventions apart from the CGIT provoked a GLP-1 response within 30 min. The OGT and WEET interventions, (containing the greatest dose of non-structural carbohydrate, 1.06 and 1 g/kg BW, respectively), resulted in a greater area under the curve (AUC) for GLP-1 compared to all other interventions (P < 0.001). No difference in GLP-1 response was detected according to ID or IR status, despite there being strong positive correlations (rs [95 % CI]) between GLP-1 and insulin concentrations measured at individual time points (0.67 [0.62 – 0.71]; P < 0.001) and as AUC (0.66 [0.49–0.79], P < 0.001). These data do not support of the use of GLP-1 as an adjunctive diagnostic test for ID or IR, as defined by conventional intravenous or oral dynamic tests.

Perioperative urinary ketosis and metabolic acidosis in patients fasted for undergoing gynecologic surgery.

Our bodies have adaptive mechanisms to fasting, in which glycogen stored in the liver and muscle protein are broken down, but also lipid mobilisation is triggered. As a result, glycerol and fatty acids are released into the bloodstream, increasing the production of ketone bodies in liver. However, there are limited studies on the incidence of perioperative urinary ketosis, the intraoperative blood glucose changes and metabolic acidosis after fasting for surgery in non-diabetic adult patients. We conducted a retrospective cohort study involving 1831 patients undergoing gynecologic surgery under general anesthesia from January to December 2022. Ketosis was assessed using a postoperative urine test, while blood glucose levels and acid-base status were collected from intraoperative arterial blood gas analyses. Of 1535 patients who underwent postoperative urinalysis, 912 (59.4%) patients had ketonuria. Patients with ketonuria were younger, had lower body mass index, and had fewer comorbidities than those without ketonuria. After adjustments, younger age, higher body mass index and surgery starting late afternoon were significant risk factors for postoperative ketonuria. Of the 929 patients assessed with intraoperative arterial blood gas analyses, 29.0% showed metabolic acidosis. Multivariable logistic regression revealed that perioperative ketonuria and prolonged surgery significantly increased the risk for moderate-to-severe metabolic acidosis. Perioperative urinary ketosis and intraoperative metabolic acidosis are common in patients undergoing gynecologic surgery, even with short-term preoperative fasting. The risks are notably higher in younger patients with lower body mass index. Optimization of preoperative fasting strategies including implementation of oral carbohydrate loading should be considered for reducing perioperative metabolic derangement due to ketosis.

Effect of Preoperative Oral Carbohydrate Intake on Perioperative Hyperglycemia in Indian Patients Undergoing Hip Fracture Fixation.

Preoperative fasting leads to a catabolic state aggravated by surgical stress. This leads to poor patient outcomes. This study aimed to determine the effect of preoperative oral carbohydrate administration on perioperative hyperglycemia and patient comfort. This prospective, randomized study was conducted on 60 adult American Society of Anesthesiologist I/II patients undergoing hip fracture fixation after obtaining institutional ethical committee clearance. Patients were randomly kept conventionally fasted before surgery (group F, n = 30) or were given oral carbohydrate 2 h before surgery (group C, n = 30). Under all aseptic precautions, a combined spinal epidural block was administered, and surgery was allowed. The primary outcome was blood glucose, and secondary outcomes included incidence of postoperative hyperglycemia, insulin level, blood urea, hunger, thirst, and anxiety. Blood glucose levels were not statistically different between the two groups at baseline (T0; P=0.400), immediately after surgery (T1; P=0.399) and 24h after surgery (T2; P=0.619). The incidence of postoperative hyperglycemia was significantly higher in group F than in group C (P=0.045) at T2. Insulin levels, blood urea levels, and hunger scores were also not statistically different between the groups. The thirst and anxiety scores were lower at T0 and T1 in group C. Preoperative oral carbohydrate administration does not prevent perioperative increases in blood glucose levels. However, it reduces the incidence of perioperative hyperglycemia and decreases perioperative thirst and anxiety, thereby improving the quality of perioperative patient care.

Effects of Preoperative Oral Carbohydrate on Perioperative Maternal Outcomes Undergoing Cesarean Section: A Systematic Review and Meta-Analysis.

Preoperative oral carbohydrate (CHO) is a rapid postoperative rehabilitation protocol that improves perioperative outcomes and is widely used in adult surgical patients. However, pregnant women are excluded because of the possibility of aspiration due to delayed gastric emptying. This meta-analysis was conducted to evaluate the efficacy of preoperative oral CHO in elective cesarean section. PubMed, Embase, Web of Science, and the Cochrane Library were searched from inception to July 2023. Randomized controlled trials were included. The risk of bias was assessed using the Cochrane tool. Risk ratios and 95% confidence intervals were calculated. Meta-analysis was performed using random-effects models to estimate risk ratios and mean differences (MDs) with 95% confidence intervals (CIs). The outcomes included thirst and hunger scores, incidence of vomiting and nausea, time to flatus, and homeostatic model assessment of insulin resistance (HOMA-IR). A total of nine studies with 1211 patients were included in the analysis. The levels of thirst and hunger were evaluated using a 10-point visual analog scale, with 0 representing the best and 10 representing the worst. The severity of hunger (weighted mean difference (WMD: -2.34, 95% CI: -3.13 to -1.54), time to flatus (WMD: -3.51 hours, 95% CI: -6.85 to -0.17), and HOMA-IR (WMD: -1.04, 95% CI: -1.31 to -0.77) were significantly lower in the CHO group compared to the control group. However, there were no significant differences in the severity of thirst or the incidence of vomiting and nausea between the CHO and control groups. Preoperative oral CHO during cesarean section alleviates thirst and hunger, shortens the time of postoperative flatus, and reduces HOMA-IR. However, the available evidence is insufficient to reach a clear consensus on the benefits or harms of preoperative oral CHO during cesarean section. Therefore, it is premature to make a definitive recommendation for or against its routine use.

Impact of preoperative carbohydrate loading on postoperative course and morbidity in debulking surgery for epithelial ovarian cancer.

Despite the theoretical benefits, the favorable effect of preoperative carbohydrate loading on postoperative morbidity remains controversial. Most of the outcomes reported in the literature are derived from non-gynecologic surgery data, with only one study involving a limited number of patients specifically in gynecological oncology. The present study aimed to investigate the impact of carbohydrate loading, as a single element of enhanced recovery after surgery protocols, on postoperative course and morbidity in patients undergoing debulking surgery for epithelial ovarian cancer (EOC). The present study was a non-randomized, prospective cohort trial enrolling patients with EOC who underwent surgery between June 2018 and December 2021. An oral carbohydrate supplement with a dose of 50 g was given to patients 2-3 h before anesthesia. Data on postoperative course and morbidity were collected and compared with data of a historical cohort including consecutive patients who underwent surgery without a carbohydrate loading between January 2015 and June 2018. Analyses were performed on a total of 162 patients, including 72 patients in the carbohydrate loading group and 90 patients in the control group. Median length of hospital stay (11 days vs. 11 days; P=0.555), postoperative days 1-7 serum c-reactive protein levels (P=0.213), 30-day readmission (11.6% vs. 11.5%, P=0.985), 30-day relaparotomy (2.8% vs. 3.4%, P=0.809) and 30-day morbidity (48.6% vs. 46.7%; P=0.805) were comparable between the cohorts. No significant differences in grades of morbidities were identified between the cohorts (P=0.511). Multivariate analysis revealed that the sole independent risk factor for any postoperative morbidity was operative time. In conclusion, based on the results of the present study, postoperative course and morbidity seemed to be unaffected by carbohydrate loading in patients undergoing debulking surgery for EOC.