Delayed Surgery Does Not Increase Risk in Urgent Colectomy for Ulcerative Colitis.

BACKGROUND: Medical management is the cornerstone of therapy for ulcerative colitis (UC). In the setting of fulminant disease, hospitalized patients may undergo medical rescue therapy (MRT) or urgent surgery. We hypothesized that delayed attempts at MRT result in increased morbidity and mortality following urgent surgery for UC. OBJECTIVE: The aim is to assess the outcomes for patients requiring urgent, inpatient surgery for UC in a prompt or delayed fashion. DESIGN: The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) general and colectomy-specific databases from 2013 to 2016 were queried. Urgent surgery was defined as nonelective, nonemergency surgery. Patients were divided into prompt and delayed groups based on time from admission to surgery of <48 hours or >48 hours. Baseline characteristics and 30-day outcomes were compared using univariate and multivariate analyses. SETTING: The ACS NSQIP database from 2013 to 2016 was evaluated. PATIENTS: Adult patients undergoing nonelective, nonemergency colectomy for UC. MAIN OUTCOME MEASURES: 30-day morbidity and mortality. RESULTS: 921 patients underwent urgent inpatient surgery for UC. In univariate analysis, there was no significant difference between prompt and delayed surgery for wound infection, sepsis, return to operating room, or readmission. LIMITATIONS: Retrospective study of a quality improvement database. Patients who underwent successful MRT did not receive surgery, so are not included in the database. CONCLUSIONS: Delaying surgery to further attempt MRT does not alter short-term outcomes and may allow conversion to elective future surgery. Contrarily, medical optimization does not improve short-term outcomes.

The Impact of a Colorectal Care Bundle for Surgical Site Infections at an Academic Disproportionate Share Hospital With a Level I Trauma Center.

OBJECTIVES: Colorectal care bundles for surgical site infections (CRCB-SSIs) have been shown to reduce SSIs following elective colorectal surgery (CRS). There are limited data evaluating the effect of CRCB-SSI at Academic Disproportionate Share Hospitals (ADSH) with significant rates of urgent and emergent cases. METHODS: A CRCB-SSI was implemented in April 2016. We reviewed medical records of all patients undergoing colon resections between August 2015 and December 2017. Patients were divided into preimplementation and postimplementation groups. The primary endpoint was the SSI rate, and the secondary endpoint included types of SSI (superficial, deep, organ space). Univariable and multivariable analyses were performed. A subset analysis was performed in elective cases. RESULTS: We analyzed a total of 417 patients. Of these, 116 (28%) and 301 (72%) patients were in the preimplementation and postimplementation groups, respectively. The rate of SSI decreased from 30.1% to 15.9% in the postimplementation group (P = .0012); however, it was not statistically significant after adjusting for baseline differences (relative risk [RR] 0.65; 95% CI 0.41-1.02).The elective subset included 219 patients. The rate of SSI in this cohort decreased from 25% to 10.5% in the postimplementation group (P = .0012) and remained significant following multivariable analysis (RR 0.41, 95% CI 0.19- 0.88). There were no differences in the subtypes of SSI. DISCUSSION: While the CRCB-SSI was effective in decreasing the postoperative SSI rate for elective cases, its effect on the overall patient population was limited. CRCB-SSIs are not enough to bring SSI rates to accepted rates in high-risk patients such as those seen at ADSH.

Geospatial risk assessment and trace element concentration in reef associated sediments, northern part of Gulf of Mannar biosphere reserve, Southeast Coast of India.

Fifty two surface sediments were collected from the northern part of the Gulf of Mannar biosphere reserve to assess the geospatial risk of sediments. We found that distribution of organic matter and CaCO3 distributions were locally controlled by the mangrove litters and fragmented coral debris. In addition, Fe and Mn concentrations in the marine sediments were probably supplied through the riverine input and natural processes. The Geo-accumulation of elements fall under the uncontaminated category except Pb. Lead show a wide range of contamination from uncontaminated-moderately contaminated to extremely contaminated category. The sediment toxicity level of the elements revealed that the majority of the sediments fall under moderately to highly polluted sediments (23.07-28.84%). The grades of potential ecological risk suggest that predominant sediments fall under low to moderate risk category (55.7-32.7%). The accumulation level of trace elements clearly suggests that the coral reef ecosystem is under low to moderate risk.

A baseline record of trace elements concentration along the beach placer mining areas of Kanyakumari coast, South India.

Trace element concentration in the beach placer mining areas of Kanyakumari coast, South India was assessed. Sewage and contaminated sediments from mining sites has contaminated the surface sediments. Enrichment factor indicates moderately severe enrichment for Pb, minor enrichment for Mn, Zn, Ni, Fe and no enrichment for Cr and Cu. The Igeo values show higher concentration of Pb ranging in the scale of 3-4, which shows strong contamination due to high anthropogenic activity such as mining and terrestrial influences into the coastal regions. Correlation coefficient shows that most of the elements are associated with each other except Ni and Pb. Factor analysis reveals that Mn, Zn, Fe, Cr, Pb and Cu are having a significant loading and it indicates that these elements are mainly derived from similar origin. The cluster analysis clearly indicated that the mining areas are grouped under cluster 2 and non-mining areas are clustered under group 1.

Trace element concentrations in reef associated sediments of Koswari Island, Gulf of Mannar biosphere reserve, southeast coast of India.

Extensive field work was conducted in order to assess the sediment pollution level and potential ecological risk on coral reef ecosystem. Thirty three surface sample was collected using grid sampling technique. The calcium carbonate and organic matter were primarily controlled by the distribution of coral rubbles and seagrass meadows. The concentration of trace elements is higher than the crustal average in few locations and the same result was derived from index calculations. However, the significant concentration of lead was observed throughout the study area. The elevated level of lead is probably due to coal incinerating power plants, and confluence of urban runoff from the nearby coastal areas. Based on the sediment pollution index, the majority of the sediments belongs to highly polluted to dangerously polluted category. The ecological risk indicates that the sediments are under low risk to moderate risk category and this result was proved by correlation analysis.

Trace element contamination in the nearshore sediments of the Tamiraparani estuary, Southeast coast of India.

The present study focused on the elemental distribution of nearshore environment and to understand the interrelationship between different parameters such as trace elements, organic matter, calcium carbonate and sediment texture. For this purpose, 24 surface samples were collected from the nearshore environment using a stainless steel Van Veen grab sampler. The above said parameters indicate that nearshore sediment transport, contaminants from estuarine source and anthropogenic activities deteriorates the sediment quality in the nearshore area. The enrichment factor reveals that the sediments are enriched with Pb, Co, Ni and Cr, whereas the geoaccumulation index highlights that the sediments are polluted with Pb, Ni and Co. The elevated concentration of Pb in the nearshore sediments are possibly from the port activities and thermal power plants situated in the north of the study area. Proper management of industrial effluents is needed to curb further metal pollution in the nearshore environment off Tamiraparani estuary.

Assessment of trace element accumulation in surface sediments off Chennai coast after a major flood event.

The present study was conducted to assess the trace element concentration in marine surface sediments after major flood event of Chennai metropolis, India. Thirty surface samples were collected from off Chennai coast. Trace elements, organic matter, CaCO3, sand-silt-clay and C/N ratios were studied to understand the accumulation dynamics on sediments. The elemental concentration, calcium carbonate and OM distribution suggest that they are derived from urban runoff and transported through Adyar and Cooum Rivers. The enrichment factor reveals that the sediments are enriched by Pb, Cu, Zn, Cr, Co, Ni followed by Fe. The observed Igeo value shows that the samples are contaminated by Pb, Cu and Zn. The elemental concentration of the surface sediments is low when compared to other coastal region except Pb. The elevated level of Pb in the surface sediments is probably due to migration of contaminated urban soil from industrial and transportation sectors into marine environment.

Metal concentrations in the growth bands of Porites sp.: A baseline record on the history of marine pollution in the Gulf of Mannar, India.

The present study was carried out on the Porites coral growth bands (1979 to 2014) to measure the metal accumulation for assessing the environmental pollution status. The concentrations of studied metals are compared with similar global studies, which indicate that the metals are probably derived from natural sources. The identical peaks of Fe and Mn are perfectly matched with Cu, Cr and Ni concentrations. However, the metal profile trend is slightly depressed from a regular trend in Zn, Cd and Pb peaks. The metal accumulation affinity of the reef skeleton is ranked in the following order Cr>Cd>Pb>Fe>Mn>Cu>Ni>Zn. The distribution of metal constituents in coral growth bands is primarily controlled by Fe and Mn in the reef skeleton. Other reef associated metals such as Pb and Cd are derived from other sources like coastal developments and anthropogenic sources.