The role of laparoscopy in emergency colorectal surgery.

OBJECTIVES: To assess the outcomes of the laparoscopic approach compared to those of the open approach in emergency colorectal surgery. METHODS: This retrospective cohort study included all patients aged >15 years who underwent emergency colorectal surgery from 2016-2021 at King Abdulaziz Medical City, Riyadh, Saudi Arabia. Patients were divided based on the surgical approach into laparoscopic and open groups. RESULTS: A total of 241 patients (182 open resections, 59 laparoscopic approaches) were included in this study. The length of stay in the intensive care unit was shorter in the laparoscopic than in the open group (1±3 days vs. 7±16 days). After multivariable logistic regression, patients undergoing laparoscopic resection had a 70% lower risk of surgical site infection than those undergoing open surgery (adjusted odds ratio=0.33, 95% confidence interval: [0.06-1.67]), a difference that was not significant (p=0.18). Lastly, patients who underwent open surgery had a high proportion of 30-day mortality (n=26; 14.3%), compared to those who underwent laparoscopic resection (n=2; 3.4%, p=0.023). CONCLUSION: Laparoscopy in emergency colorectal surgery is safe and feasible, with a trend toward better outcomes. Colorectal surgery specialization is an independent predictor of an increased likelihood of undergoing laparoscopy in emergency colorectal surgery.

Microplastics pollution in salt pans from the Maheshkhali Channel, Bangladesh.

Microplastics (MP) were recognized as an emergent pollution problem due to their ubiquitous nature and bioaccumulative potential. Those present in salt for consumption could represent a human exposure route through dietary uptake. The current study, conducted in Bangladesh, reports microplastics contamination in coarse salt prepared for human consumption. Sea salt samples were collected from eight representative salt pans located in the country's largest salt farming area, in the Maheshkhali Channel, along the Bay of Bengal. Microplastics were detected in all samples, with mean concentrations ranging from 78 ± 9.33 to 137 ± 21.70 particles kg-1, mostly white and ranging in size from 500-1000 µm. The prevalent types were: fragments (48%) > films (22%) > fibers (15%) > granules and lines (both 9%). Fourier transform mid-IR and near-IR spectra (FT-MIR-NIR) analysis registered terephthalate (48%), polypropylene (20%), polyethylene (17%), and polystyrene (15%) in all samples. These results contribute to the MP's pollution knowledge in sea salts to understand and reduce this significant human exposure route and environmental pollution source in the future.

Macroalgae in biomonitoring of metal pollution in the Bay of Bengal coastal waters of Cox's Bazar and surrounding areas.

Although coastal water marine algae have been popularly used by others as indicators of heavy metal pollution, data within the Bay of Bengal for the estuarine Cox's Bazar region and Saint Martin's Island has remained scarce. Using marine algae, the study herein forms an effort in biomonitoring of metal contamination in the aforementioned Bangladesh areas. A total of 10 seaweed species were collected, including edible varieties, analyzed for metal levels through the use of the technique of EDXRF. From greatest to least, measured mean metal concentrations in descending order have been found to be K > Fe > Zr > Br > Sr > Zn > Mn > Rb > Cu > As > Pb > Cr > Co. Potential toxic heavy metals such as Pb, As, and Cr appear at lower concentration values compared to that found for essential mineral elements. However, the presence of Pb in Sargassum oligocystum species has been observed to exceed the maximum international guidance level. Given that some of the algae species are cultivated for human consumption, the non-carcinogenic and carcinogenic indices were calculated, shown to be slightly lower than the maxima recommended by the international organizations. Overall, the present results are consistent with literature data suggesting that heavy metal macroalgae biomonitoring may be species-specific. To the best of our knowledge, this study represents the first comprehensive macroalgae biomonitoring study of metal contamination from the coastal waters of Cox's Bazar and beyond.

Efficacy of interspace between the popliteal artery and the capsule of the posterior knee (iPACK) block versus periarticular local infiltration analgesia after unilateral total knee arthroplasty: Prospective randomized control trial.

OBJECTIVES: To compare the efficacy of interspace between the popliteal artery and the capsule of the posterior knee (iPACK) block with periarticular local infiltration analgesia (LIA) to assess postoperative pain control and enhanced recovery after total knee arthroplasty (TKA). METHODS: This research was carried out at King Saud University Medical City, Riyadh, Saudi Arabia, from September 2020 to March 2021. Eighty Patients scheduled for elective unilateral TKA were randomized to receive either iPACK or periarticular LIA along with adductor canal block under spinal anesthesia. The primary outcome was postoperative pain score, and secondary outcomes included physical rehabilitation, duration of surgery, length of post-anesthesia care unit stay, hemodynamics, and length of hospital stay. RESULTS: The pain score during activity in iPACK group was significantly lower compared to LIA group at 4 hours postoperatively, but no significant difference was observed at 24 or 48 hours. The timed up and go test took significantly longer for patients in LIA group at 4, 24, and 48 hours compared to those in iPACK group. No significant differences in knee range of motion were observed between the 2 groups at any point. CONCLUSION: Based on our findings, iPACK block is an effective technique in reducing pain in the immediate postoperative period without affecting motor function, resulting in enhanced recovery following primary TKA.

Levels and health risk assessment of heavy metals in dried fish consumed in Bangladesh.

As a cheap source of high-quality protein, healthy fats and essential nutrients, dried fish is a common item in the daily diet of the Bangladesh populace. In this study, ten types of widely consumed dried fish (H. neherius, T. lepturu, P.chinensis, P. affinis, A. mola, P. microdon, I. megaloptera, C. dussumieri, L. calcarifer, and G. chapra) were analyzed for Cr, Mn, Fe, Co, Cu, Zn, Se, Rb, Hg, Pb, Ni and As by using an Energy Dispersive X-ray Fluorescence (EDXRF) technique. The concentration of the studied metals was found in the order Fe > Zn > Hg > Cu > Se > Cr > Mn > Co > Rb > Pb, while As and Ni were below the limit of detection. All fish species showed moderate to high pollution, where the species H. Neherius and P. Chinensis are the most and least polluted ones, respectively. The probable source of contamination is the leaching from the drying pans into the fish samples, atmospheric deposition, anthropogenic contamination, etc. of the water body where these fish were harvested. The calculated hazard index for the general population was below the maximum limiting value (i.e., < 1) except for Hg to children. The carcinogenic risk showed values lower than the acceptable limit for cancer risks (10-6 to 10-4). Periodic monitoring of trace metals in the aquatic organisms along with fish is recommended to avoid any unexpected health hazards caused by the toxic heavy metals via fish consumption.

Elevated Concentrations of Metal(loids) in Seaweed and the Concomitant Exposure to Humans.

While the consumption of seaweed and seaweed-based products is very common amongst East Asian nations, forming a notable component of the daily diet, relatively very few studies have concerned the concentrations of heavy metals in these together with potential effects on human health. The present study analyses the concentrations of 17 elements in locally resourced seaweed, also assessing potential noncarcinogenic and carcinogenic risks. The samples were ground, homogenized, and quantified using the ICP-OES technique. It has been found that the essential elements K, Ca, Mg, Zn, and Na typically show concentrations somewhat greater than a number of potentially toxic metals, in particular, Cd, Pb, Ag, and As, with exceptions being Ni, Cr-VI, and Si. Statistical analysis indicates all of the latter to have similar origin, with increased concentration of these metals within the marine ecosystem. While the daily estimated intake of most metals is seen to be within the daily dietary allowance level recommended by various international organizations, the noncarcinogenic risk shows a value greater than unity, estimated via the hazard quotient. This indicates a potential for adverse effects to health arising from consumption of the sampled seaweed. The carcinogenic risk resulting from nonessential elements shows values greater than the United States Environmental Protection Agency (US-EPA) reference limit of 10-4. Considering the nonbiodegradability of heavy metals and metalloids and their potential accumulation in seaweed, there is need for critical examination of metal levels in the seaweeds obtained from the present study locations, together with the introduction of practices of removal of heavy metals via bio-adsorbent techniques.

Treatment response in elderly patients with advanced colorectal cancer at King Abdulaziz Medical City, Princess Norah Oncology Center, Jeddah.

INTRODUCTION: Colorectal carcinoma is the most evident carcinoma in the elderly. Despite its high incidence and mortality rate, there is insufficient research about the best treatment options for colorectal carcinoma. OBJECTIVE: This study was designed to assess the best treatment modality for colorectal carcinoma in elderly Saudi patients. METHODS: We conducted a retrospective analysis of medical records at the Princess Norah Oncology Center (PNOC), King Abdulaziz Medical City, Jeddah, Saudi Arabia. We included patients treated at PNOC between 2010 and 2015. Only patients aged above 70 years with advanced colon were included in the study. RESULTS: The cohort included 57 patients with an average age of 76.51 with 27 alive patients and 30 dead patients. Nonmucinous adenocarcinoma had significant higher mortality (n = 20). Most patients received surgical treatment which was associated with less risk for mortality; however, it was nonsignificant. Surgery was followed by first-line treatment which had a mortality rate of 50%. The least treatment associated with mortality was local liver treatment (n = 0). Survival analysis found that only treatment with significant higher survival was shift to next line of treatment (at least once) [HR = 0.06, 95% CI (0.00, 0.79), P value = 0.03]. Other treatments were not associated with significant mortality reduction. First-line treatment was associated with higher mortality risk; nevertheless, it was nonsignificant. CONCLUSION: Local radiotherapy and local liver ablation had the least mortality rate. However, in multivariate Cox regression analysis, we found that shift to next line of treatment was associated with the significant high survival rate.