Preoperative and postoperative optimisation of patients undergoing thyroid surgery: a multicentre quality improvement project at Barts Health NHS Trust.

Hypocalcaemia following thyroid surgery can occur in up to 38% of patients. With over 7100 thyroid surgeries performed in 2018 in the UK, this is a common postoperative complication. Undertreated hypocalcaemia can result in cardiac arrhythmias and death. Preventing adverse events from hypocalcaemia requires preoperative identification and treatment of at-risk patients with vitamin D deficiency, timely recognition of postoperative hypocalcaemia and prompt appropriate treatment with calcium supplementation. This project aimed to design and implement a perioperative protocol for prevention, detection and management of post-thyroidectomy hypocalcaemia. A retrospective audit of thyroid surgeries (n=67; October 2017 to June 2018) was undertaken to establish baseline practice of (1) preoperative vitamin D levels assessment, (2) postoperative calcium checks and incidence of postoperative hypocalcaemia and (3) management of postoperative hypocalcaemia. A multidisciplinary team approach following quality improvement principles was then used to design a perioperative management protocol with all relevant stakeholders involved. After dissemination and implementation, the above measures were reassessed prospectively (n=23; April-July 2019). The percentage of patients having their preoperative vitamin D measured increased from 40.3% to 65.2%. Postoperative day-of-surgery calcium checks increased from 76.1% to 87.0%. Hypocalcaemia was detected in 26.8% of patients before and 30.43% of patients after protocol implementation. The postoperative component of the protocol was followed in 78.3% of patients. Limitations include low number of patients which precluded from analysis of the impact of the protocol on length of stay. Our protocol provides a foundation for preoperative risk stratification and prevention, early detection and subsequent management of hypocalcaemia in thyroidectomy patients. This aligns with enhanced recovery protocols. Moreover, we offer suggestions for others to build on this quality improvement project with the aim to further advance the perioperative care of thyroidectomy patients.

Toxicity of NiO nanoparticles to soil nutrient availability and herbage N uptake from poultry manure.

Recently, there is an increasing trend of using metallic nanoparticles (NPs) in agriculture due to their potential role in remediating soil pollution and improving nutrient utilization from fertilizers. However, evidence suggested that these NPs were toxic to the soil life and their associated functions, and this toxicity depended on their dose, type, and size. Here, a dose-dependent (5, 50, and 100 mg kg-1 soil) toxicity of NiO NPs on poultry manure (PM: 136 kg N ha-1) decomposition, nutrient mineralization, and herbage N uptake were studied in a standard pot experiment. The NPs doses were mixed with PM and applied in soil-filled pots where then ryegrass was sown. Results revealed that the lowest dose significantly increased microbial biomass (C and N) and respiration from PM, whereas a high dose reduced these parameters. This decrease in such parameters by the highest NPs dose resulted in 13 and 41% lower soil mineral N and plant available K from PM, respectively. Moreover, such effects resulted in 32 and 35% lower herbage shoot and root N uptakes from PM in this treatment. Both intermediate and high doses decreased herbage shoot Ni uptake from PM by 33 and 34%, respectively. However, all NPs doses did not influence soil Ni content from PM. Hence, our results indicated that high NPs dose (100 mg kg-1) was toxic to decomposition, nutrient mineralization, and herbage N uptake from PM. Therefore, such NiONPs toxicity should be considered before recommending their use in agriculture for soil remediation or optimizing nutrient use efficiency of fertilizers.

Degradation of anthropogenic pollutant and organic dyes by biosynthesized silver nano-catalyst from Cicer arietinum leaves.

The work represents the potent catalytic activity of silver nanoparticles synthesized from Cicer arietinum (chickpea) leaf extract (CAL-AgNPs). Here, silver nano-catalysts were used against the anthropogenic pollutants mainly involving nitro-amines and azo dyes. These pollutants are extremely harmful to our environment and causes severe health issues. The CAL-AgNPs have the potential to degrade harmful toxins and their by-products, thereby decreasing the pollutants from the environment. The green synthesis of nano-catalyst includes a simple, cost effective and eco-friendly method using the leaf extract from the plant. A systematic study was conducted, including synthesis, optimization and characterization of the silver particles. The AgNPs were further assessed through DLS and TEM for size and morphological evaluation. The obtained particles have shown spherical morphology with the size range of 88.8nm. Further, FTIR were performed for compositional and functional group analysis of the particles. The antibacterial efficiency was also evaluated against E. coli and P. aeruginosa. For their catalytic evaluation, CAL-AgNPs were assessed for 4-nitrophenol, methylene blue and congo red. The results obtained through catalytic evaluation suggested that the CAL-AgNPs could be helpful to surmount the environmental pollution in a very effective manner.