http://theses.ncl.ac.uk/jspui/handle/10443/207 2026-02-03T19:44:11Z http://theses.ncl.ac.uk/jspui/handle/10443/6392 Title: Effect of organic and conventional agronomic practices and variety of choice on nutritional quality, the contents of undesirable compounds and yield of cereals Authors: Wang, Juan Abstract: Cereal products are one of the most important sources of nutrients and energy in the human diet, and common wheat is the most consumed crop globally. Spelt wheat -one of the most ancient cereals- is increasing its share in the food markets because of its ability to grow under low inputs and consumers’ belief about its high quality. The demand for spelt wheat and other minor cereals is particularly high in the organic food market, much of which is driven by consumers’ expectations that organic farming practices could improve the content of beneficial nutrients and decrease the content of undesirable compounds such as pesticides. The aim of this thesis was to explore the effect of organic and conventional agronomic practices (fertilisation and irrigation) and variety choice on the nutritional quality and undesirable compounds (heavy metals, mycotoxins and pesticides) of grain/flour of different cereal species (mainly common wheat and spelt wheat). The objectives were to carry out (1) a meta-analysis of data on effects of organic and conventional agronomic practices on mycotoxin contamination in cereals and (2) a shopping basket study to collect flour from supermarkets in the UK and Germany over three years; and (3) to carry out a field experiment, where various spelt wheat genotypes were cultivated under different fertility treatment and irrigation regimes. The contents of nutritionally relevant compounds such as phenolic acids, flavonoids, protein, and macro- and micronutrients, as well as undesirable compounds such as heavy metals were measured in the shopping basket and field study. In addition, mycotoxins and pesticide residues were measured in the shopping basket study. The meta-analysis of mycotoxin content of cereal grains was based on 79 published studies and found that, historically, conventional cereals had consistently higher levels of Fusarium mycotoxin contamination and organic cereals had higher levels of OTA contamination. However, the contamination and prevalence of OTA in organic cereals has decreased in cereal grains/products in the last 15 years in Europe due to the improvement of post-harvest drying and storage management. Results of the shopping basket study found that antioxidant capacity, concentrations of phenolic phytochemicals and mineral micronutrients were significantly higher in organic and wholegrain flours compared with conventional and white common wheat and spelt wheat flour, repectively, while conventional wholemeal flour was contaminated with significantly higher pesticide residues than conventional white flour. These results suggest that switching to organic wholemeal flour allows for higher intakes of phenolic phytochemicals and mineral micro-nutrients. These have been associated with potential health benefits of consuming wholegrain foods to be achieved without simultaneously increasing dietary exposure to pesticides. No differences in mycotoxin contamination were found between conventional and organic II farming systems. Results of a controlled experiment in Crete indicated that, supplementary irrigation substantially improved grain yield of spelt but had no negative effects on mineral and phenolic phytochemical content, and sheep and chicken manure fertilisation resulted in similar yields as mineral fertilisation which emphasised the suitability of spelt for organic production in semi-arid conditions. No major impact of fertiliser type was seen, but a significant impact of spelt variety was found on concentrations of phenolic phytochemicals and some minerals. The main achievements and novelty of the project were  carrying out the most comprehensive meta-analysis to date of mycotoxin contamination in organic vs conventional cereals;  carrying out an extensive and comprehensive investigation of the nutritionally relevant compounds and the content of undesirable compounds found in organic vs conventional common wheat and spelt wheat flours available in supermarkets in the UK and Germany, predicting the potential health effects for consumers switching to organic from conventional cereals consumption, which enables 11%, 16% and 30 % more phenolics, Fe and Zn intake and at least 4 times lower pesticide intake respectively, and switching to spelt from common wheat enable 2 times higher Zn intake.  carrying out the first assessment of the yield and grain quality performance of different spelt varieties with different irrigation management and fertility management in a semi-arid region of the Mediterranean; when taking both yield and grain quality, the “organic” spelt variety ZOR was recommended together with sheep or chicken manure fertilisation and sustainable drip irrigation. Description: PhD Thesis 2019-01-01T00:00:00Z http://theses.ncl.ac.uk/jspui/handle/10443/6376 Title: Asthma and obstructive sleep apnoea in the UK and the UAE : clinical association, pathophysiological inter-relation and impact of therapy Authors: Kharaba, Zelal Jaber Abstract: Introduction: Asthma and Obstructive Sleep Apnoea (OSA) are highly prevalent respiratory disorders and frequently coexist. Although both asthma and OSA are common, the overlap between the two disorders seems to be more that would be expected by chance alone. This observation suggests there may be some links, possibly causative, between the two disorders. In fact, there is a need for more data regarding clinical pharmacists’ intervention on drug therapy improvement especially with respiratory and GOR diseases. In this regard, the importance of clinical pharmacy-based services that improve medication adherence and dosage regimen in patients with respiratory diseases and GOR is not negligible. Thus, an additional studies that evaluate the effect of such services on certain clinical and pharmaco-therapeutic aspects of asthma, OSA and GOR treatments for larger patient samples are required. Aims: To examine some proposed clinical and pathophysiological mechanisms (Reflux, lung pathophysiology and cough) between asthma and OSA and to investigate the therapeutic impact of CPAP on the pharmacotherapy of asthma (asthma medications) and GOR (Proton Pump Inhibitors (PPIs) in an international collaboration involving centres in the UK and UAE. Methodology: Patients were recruited directly from designated consultant clinics at Newcastle upon Tyne hospitals, UK. Data from four groups of participants (n= 42): patients with OSA and asthma (n=10), asthma alone (n=10), OSA alone (n=10) and control subjects (n=12) were studied. All subjects at recruitment underwent detailed pulmonary function tests (PFTs) (FEV1, FVC, FEV1/VC, FEF50, FEF 25-75, SGaw, SGaw ratio), completed questionnaires about symptoms of gastro-oesophageal reflux, sleepiness and cough; Reflux Symptoms Index (RSI score), Epworth Sleepiness Scale (ESS) and Leicester-Cough and provided a sample of saliva. Subjects then underwent one hour CPAP as intervention. PFTs were repeated for all subjects after 1-hour CPAP. For patients with OSA, with or without asthma, there was a one-month period of treatment with home CPAP after which all PFTs, questionnaires and saliva collection were repeated. Medications for all groups were reviewed and recorded at baseline and after 1- month of CPAP therapy for statistical analysis and interpretation. In a parallel study, another independent cross-sectional observational study of 312 patients was performed at Rashid Hospital, Dubai, UAE in the time period between September 2014 to September 2016 to investigate OSA associated comorbidities (including asthma) using Polysomnography and consultants diagnosis. Results: The RSI score discriminated reflux symptoms among subject groups at baseline; with pathophysiological levels of symptoms found in 0% of Controls, 40% of asthmatics, 60% of OSA patients and 80% of patients when asthma was overlapped with OSA. Salivary pepsin showed no statistical significance between all groups at baseline (P= 0.30). The asthma + OSA group had higher levels of pepsin than the asthma group (P= 0.01). Cough assessment showed a significant difference for all groups at baseline (P= 0.01) and between all asthma groups compared to controls (P=0.00). No significant difference was found in salivary pepsin concentration for all asthma patients compared to controls at baseline (P= 0.74). CPAP showed no measurable effect on airways function (P> 0.05). Reflux measured by salivary pepsin concentration (Pepsin ≥ 25ng/ml) and RSI (RSI ≥13) significantly reduced after a month CPAP treatment in patients with OSA (P= 0.05), (P= 0.04) respectively and in asthma overlapped OSA (P=0.00), (P= 0.00) respectively. ESS showed a trend for improvement following one month CPAP in OSA (P= 0.07) and asthma + OSA (P= 0.07) patients. In a novel finding, around 23% (n= 10) of the total number of participants (n=42) were on different PPI medications (Omeprazole and Lansoprazole) at baseline. The impact of CPAP on PPI medications was significant after 1-month therapy. All OSA patients who were taking PPIs discontinued these medications after 1-month CPAP, associated with the symptomatic resolution of their reflux (p= 0.00). On the other hand, CPAP showed no effect on asthma medications after 1-month treatment. The UAE study showed a statistical association between OSA and obesity (P= 0.00), diabetes (P= 0.04) and hypertension (P=0.00) and a non-significant association with asthma (P= 0.49). Conclusion: This pilot work showed that coordinated studies of airways physiology, sleep and assessment of reflux was possible in this patient setting and that OSA, asthma and overlap is an international healthcare problem. This study, implied a pathophysiological plausible association between reflux and dysregulated sleep physiology and that CPAP may modulate reflux and microaspiration. The significant impact of CPAP on GORD pharmacotherapy was confirmed in VII this study. PPIs were discontinued after 1-month CPAP in all OSA patients as a result of GORD symptoms resolution. If confirmed, these novel findings could be of translational significance in a patient population that is international, large and expanding and where new therapeutic strategies are a healthcare priority Description: PhD Thesis 2019-01-01T00:00:00Z http://theses.ncl.ac.uk/jspui/handle/10443/6022 Title: Trends in vitamin D and its influence on outcomes following total hip and knee arthroplasty Authors: Morrison, Rory John McGillivray Abstract: There is increasing interest in the extra-skeletal effects of vitamin D. In patients undergoing total hip (THR) or knee (TKR) replacement surgery, insufficiency has been linked to adverse outcomes including longer length of stay, lower patient reported outcome measure scores (PROMs), and increased complication rates. This work aims to explore this further. Using vitamin D data from an NHS hospital trust, the temporal trends in the local population were explored. Vitamin D levels in patients undergoing THR and TKR were measured and linked to Oxford and EQ-5D-3L scores to determine if baseline vitamin D status is associated with post-operative outcome. The current evidence base for optimising vitamin D levels with supplementation prior to arthroplasty surgery was sought through a systematic review. Finally, a randomised trial to establish the feasibility of supplementing patients with insufficiency prior to surgery to improve outcomes was completed. The influence of this feasibility study in the design of future interventional trials is discussed. This work has shown increasing trends in vitamin D testing in the local population. Preoperative deficiency is associated with lower PROM scores following THR/TKR. There is a paucity of evidence for supplementation prior to arthroplasty surgery, but a randomised trial investigating the role of optimising vitamin D levels with supplementation is feasible. Suggestions for how this could be done in the NHS setting are discussed, and future studies should develop this work through adequately powered multicentre trials. Description: Ph. D. Thesis. 2023-01-01T00:00:00Z http://theses.ncl.ac.uk/jspui/handle/10443/5771 Title: Understanding the Clinical Impact of Autoimmune Hepatitis Authors: Wong, Lin Lee Abstract: Background: Autoimmune hepatitis (AIH) is a heterogenous, chronic inflammatory liver disease that remains a challenge in diagnosis and management. Failure to achieve biochemical remission has serious consequences (cirrhosis, liver failure and death). Existing immunosuppressive treatments (mainly prednisolone and azathioprine) are usually lifelong and some patients develop intolerable side effects. There is a pervading perception amongst clinicians that AIH is easy to treat and the treatments are effective. There is a gap between clinician perception, clinical data and viewpoints of patients. Aims and Methods: To explore the mechanistic evidence behind three domains of unmet need in AIH (inadequate response to therapy, effective therapy with undesirable side-effects and quality of life) using the national UK-AIH multicentre cohort. Clinical indices and quality of life (QOL) information were analysed. A novel thiopurine metabolite (deoxythioguanosine in DNA of leukocytes, dtG DNA) as a potential biomarker for treatment optimisation was explored in a subgroup of 57 patients, divided by treatment response. Findings: In a cohort of approximately 1000 patients, 29 different treatment regimens were reported and biochemical remission rate was 59%. Remission rates were significantly higher in transplant centres compared to non-transplant centres. 55% remain on corticosteroids. There was no significant correlation in the leukocyte metabolite (dtG DNA) levels with disease response or azathioprine dose which suggests that this biomarker is not clinically useful. There was evidence of QOL impairment compared to the general population with corticosteroid use being strongly associated with decreased QOL, independent of remission status. Conclusions: This demonstrates suboptimal areas of care for patients with AIH with variable treatment regimens, suboptimal remission rates, high use of corticosteroids and poor QOL. This highlights the need for better corticosteroid-free therapy approaches and emphasizes the need for continued future efforts in improving treatment approaches for AIH (which encompasses better therapies combined with focus on improving QOL). Description: Ph. D. Thesis. 2022-01-01T00:00:00Z