A systematic review of living kidney donor enhanced recovery after surgery.

Enhanced recovery after surgery (ERAS) reduces complications and shortens hospital stay without increasing readmission or mortality. However, its role in living donor nephrectomy (LDN) has not yet been defined. Medline, Embase, CINAHL, PsycINFO, and Cochrane Central were searched prior to 08/01/21 for all randomized controlled and cohort studies comparing ERAS to standard of care in LDN. The study was registered on PROSPERO (CRD: CRD42019141706). One thousand, three hundred seventy-seven patients were identified from 14 studies (698 patients with ERAS and 679 patients without). There were considerable differences in the protocols used, and compliance with general ERAS recommendations was poor. Meta-analysis of laparoscopic procedures (including hand- and robot-assisted) revealed that duration of stay was significantly reduced by 0.98 days with ERAS (95% CI = 0.36-1.60, P = .002) and opiate requirement by 32.4 mg (95% CI = 1.1-63.7, P = .04). There was no significant difference n readmission rates or complications. Quality of evidence was low to moderate assessed using the GRADE tool. This review suggests there is a positive benefit of ERAS in laparoscopic LDN. However, there was considerable variation in ERAS protocols used, and the quality of evidence was low; as such, a guideline for ERAS in LDN should be developed and validated.

Cadmium Sub-Lethal Concentration Effect on Growth, Haematological and Biochemical Parameters of Mystus seenghala (Sykes, 1839).

The current study aims to assess the cadmium sub-lethal concentration influence on growth and haematological and biochemical parameters of Mystus seenghala. A total of 60 fish of three different length groups (20 each) were collected from Head Qadirabad, Pakistan. The fish were treated to the sub-lethal concentration viz. one-third of LC50, for 16 weeks except for the control groups. Water quality parameters were kept constant during the entire course of the research, and the major parameters were measured as temperature (28.03 ± 0.03 °C), DO (5.82 ± 0.14 mg L-1), pH (8.00 ± 0.01) and total hardness (249.98 ± 0.01 mg L-1). Findings revealed that the growth of three treated variant length groups was affected negatively by cadmium exposure and showed significantly (P < 0.05) lower average wet weight, body length and condition factor as compared to control groups, while the feed conversion ratio (FCR) increases by increasing the exposure duration. The haematological parameters including values of Hct, Hb and MCHC were significantly (P < 0.05) reduced in all Cd-treated groups than control groups, whereas the level of MCH and MCV were significantly higher, but no significant difference was found in the value of RBCs in all treated groups. Biochemical parameters such as ALT, AST, total lipid and glucose level in Cd exposure groups were significantly higher, while the total protein level was significantly (P < 0.05) reduced in all treated groups as compared to control groups. From the current study, it has been concluded that the growth, haematology and biochemical parameters are important indicators of ecotoxicology particularly contamination of the cadmium and health of the fish.

Effect of Fortified Feed with Phyto-Extract on the First Physical Barrier (Mucus) of Labeo rohita.

The aim of the current study was to assess the effect of two different fortified feeds with different concentrations of two important medicinal plants (Withania coagulans and Zingiber officinale) on the mucosal immunity of Labeo rohita. After a dietary intervention, mucus was tested against five pathogenic bacteria (in-vitro), while experimental fish were tested against the ectoparasite (Lernaea) (in-vivo). Our results revealed that all fish groups fed with different concentrations (1, 1.5, and 2%) of Z. officinale had low molecular weight proteins and did not develop any significant signs of parasitic infection, with low mortality rate; whereas the groups that were fed with W. coagulans (particularly with 1% and 2%), including a control group, developed rapid signs of infection with high mortality rate. The highest hemagglutination titer value was recorded for the fish fed with 1% and 1.5% of Z. officinale. The lowest value was found for the fish fed with 2% of W. coagulans. The mucus of all fish of fortified groups was active and inhibited the growth of tested bacterial pathogens as compared to the control group. Further, Z. officinale groups showed greater efficacy against bacteria as compared to the W. coagulans groups. In conclusion, Z. officinale can be considered as a potential and functional ingredient in aquaculture feed. Furthermore, future studies should be conducted to investigate more details on the subject.

Mannheim Peritonitis Index and APACHE II--prediction of outcome in patients with peritonitis.

BACKGROUND: Early prognostic evaluation of patients with peritonitis is desirable to select high-risk patients for intensive management and also to provide a reliable objective classification of severity and operative risk. This study attempts to evaluate the use of scoring systems such as Acute Physiological and Chronic Health Evaluation score (APACHE II) and Mannheim Peritonitis Index (MPI) in patients with peritonitis. METHODS: A prospective study was conducted using 101 consecutive patients (69 male, 32 female) having generalized peritonitis over a two-year period. Both scoring systems were applied to patients before laparotomy. Based upon the scores, patients were arranged into three groups. The outcome of patients was noted and the accuracy of the two systems was evaluated. RESULTS: In the MPI system, mortality was 0 in the group of patients with a score of less than 15, while it was 4% in the patients scoring 16-25 and 82.3% in those with scores of more than 25. Similarly, in the APACHE II system, no mortality was noted in patients with scores less than 10. Mortality was 35.29% and 91.7% in the groups scoring 10-20 and more than 20, respectively. CONCLUSION: Both scoring systems are accurate in predicting mortality; however, the APACHE II has definitive advantages and is therefore more useful.

UroMark-a urinary biomarker assay for the detection of bladder cancer.

BACKGROUND: Bladder cancer (BC) is one of the most common cancers in the western world and ranks as the most expensive to manage, due to the need for cystoscopic examination. BC shows frequent changes in DNA methylation, and several studies have shown the potential utility of urinary biomarkers by detecting epigenetic alterations in voided urine. The aim of this study is to develop a targeted bisulfite next-generation sequencing assay to diagnose BC from urine with high sensitivity and specificity. RESULTS: We defined a 150 CpG loci biomarker panel from a cohort of 86 muscle-invasive bladder cancers and 30 normal urothelium. Based on this panel, we developed the UroMark assay, a next-generation bisulphite sequencing assay and analysis pipeline for the detection of bladder cancer from urinary sediment DNA. The 150 loci UroMark assay was validated in an independent cohort (n = 274, non-cancer (n = 167) and bladder cancer (n = 107)) voided urine samples with an AUC of 97%. The UroMark classifier sensitivity of 98%, specificity of 97% and NPV of 97% for the detection of primary BC was compared to non-BC urine. CONCLUSIONS: Epigenetic urinary biomarkers for detection of BC have the potential to revolutionise the management of this disease. In this proof of concept study, we show the development and utility of a novel high-throughput, next-generation sequencing-based biomarker for the detection of BC-specific epigenetic alterations in urine.

Shoulder replacements: a review.

Shoulder replacement surgery is a common elective surgical procedure for those with progressive osteoarthritis and rheumatoid arthritis. This review explores the history of shoulder replacements, the different types of replacements and their advantages or disadvantages.

Left paraduodenal hernia: a rare cause of large bowel obstruction and gangrene.

Internal hernias are a rare cause of intestinal obstruction. Paraduodenal hernias are the most common type of internal hernias. Although small bowel obstruction is associated with internal hernias, large bowel obstruction is unique. The authors here report a case of left para duodenal hernia with simultaneous small and large bowel obstruction and gangrene. The patient underwent emergency laparotomy and generous resection of gangrenous small and large bowel was carried out and stoma was created. Postoperatively, the patient had a smooth recovery and was discharged after a few days.Reversal of stoma was carried out after 2 months.