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The present study was undertaken to understand the dissipation behaviour/kinetics of fluoxapiprolin and its metabolites in cucumber and tomato under field conditions. A QuEChERS based extraction method followed by liquid chromatography coupled to mass spectrometry (LC-MS/MS) analysis showed that all method validation parameters were within the acceptable range as per international standards with a limit of quantitation (LOQ) of 0.01 mg kg-1 for all analytes. As significant matrix effects were observed with a few metabolites, matrix matched standards were used for the whole study. Residues of fluoxapiprolin in cucumber at standard dose were steady from 0 to 3 day after application and were below LOQ on the 5th day after application. In cucumber fruit at double dose and in tomato at both the doses the residues followed second-order kinetics and were respectively ≤ LOQ from days 7 and 14 onwards. Pre-harvest intervals (PHI) of 5 days and 14 days are proposed for cucumber and tomato fruits respectively. All the metabolites were ≤ LOQ from day 0 in all the matrices. The consumer risk, assessed as Hazard Quotient (HQ), showed that HQ was ≤1 in all the cases. The results of the present study and earlier studies on other similar fungicides suggest that the use of fluoxapiprolin in cucumber and tomato fruits may not pose health or environmental hazards provided that good agricultural practices are followed and the proposed waiting period is observed. The data from the present study can be used by regulatory bodies in establishing maximum residue limits.
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Dengue is a global epidemic causing over 100 million cases annually. The clinical symptoms range from mild fever to severe hemorrhage and shock, including some fatalities. The current paradigm is that these severe dengue cases occur mostly during secondary infections due to antibody-dependent enhancement after infection with a different dengue virus serotype. India has the highest dengue burden worldwide, but little is known about disease severity and its association with primary and secondary dengue infections. To address this issue, we examined 619 children with febrile dengue-confirmed infection from three hospitals in different regions of India. We classified primary and secondary infections based on IgM:IgG ratios using a dengue-specific enzyme-linked immunosorbent assay according to the World Health Organization guidelines. We found that primary dengue infections accounted for more than half of total clinical cases (344 of 619), severe dengue cases (112 of 202) and fatalities (5 of 7). Consistent with the classification based on binding antibody data, dengue neutralizing antibody titers were also significantly lower in primary infections compared to secondary infections (P ≤ 0.0001). Our findings question the currently widely held belief that severe dengue is associated predominantly with secondary infections and emphasizes the importance of developing vaccines or treatments to protect dengue-naive populations.
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Coinfección , Virus del Dengue , Dengue , Dengue Grave , Humanos , Niño , Dengue/epidemiología , Dengue Grave/epidemiología , Anticuerpos Antivirales , Coinfección/epidemiología , FiebreRESUMEN
The dissipation and residue status of a combination of fluopicolide and fosetyl-aluminium (fosetyl-Al) in citrus were evaluated in an experimental field. An efficient and sensitive liquid chromatography-tandem mass spectrometry, with rapid extraction, was carried out according to the SANTE guidelines. During the method validation, the recovery was within the range of 106.1-117.5, 94.4-115 and 85.4-109.5%, for fluopicolide, its metabolite 2,6-dichlorobenzamide and fosetyl-Al, respectively, with a relative standard deviation (RSD) of 0.3-10.6%. As a result, accuracy and precision at the spiking concentrations of 0.01, 0.05 and 0.10 mg/kg in citrus were within the acceptable range of 70-120% with an RSD of 20%. The amount of the deposits of fluopicolide, 2,6-dichlorobenzamide and fosetyl-Al was less than the limit of quantification (LOQ) at 0.01 mg/kg at 0 day, adhering to the application in standard [1.77 + 2.66 g of active ingredient (a.i.)/L] and double (3.54 + 5.32 g a.i./L) doses. The present study proposes that the utilisation of fluopicolide and fosetyl-Al in citrus and the soil may not pose a health or environmental hazard provided that good agricultural practices are followed.
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Citrus , Residuos de Plaguicidas , Aluminio/análisis , Espectrometría de Masas en Tándem/métodos , Citrus/química , Residuos de Plaguicidas/análisis , Cromatografía Liquida , Cromatografía Líquida de Alta PresiónRESUMEN
Background: Robotic hiatal hernia (HH) repair has been demonstrated to be feasible and safe. Recent conflicting reports have emerged on the higher incidence of perioperative complications with robotic HH repair when compared with laparoscopic repair. Materials and Methods: A retrospective review of a prospective database at an academic medical center for all robotic HH repairs performed by a high-volume foregut surgeon from 2018 to 2021 was performed. Outcome measures included operative time, estimated blood loss (EBL), length of stay (LOS), conversion rate, need for esophageal lengthening procedure, intra- and perioperative complications, and 30-day in-hospital mortality. Results: One hundred four patients were included in the analysis. Fifteen percent of patients had a type I HH, 2% had a type II, 73% had a type III, and 10% had a type IV HH. Eighty-four percent of cases were primary and 16% were revisional. Fifty-four percent of patients had mesh placed and 4.4% had an esophageal lengthening procedure. Mean EBL was 15 mL and mean operative time was 151 minutes. Median LOS was 2 days (interquartile range 1-2 days). There were zero conversions. Intraoperative complication rate was 1% and 30-day complication rate was 4%. The 30-day in-hospital mortality was zero. Conclusion: In this retrospective analysis of 114 consecutive robotic HH repairs performed, with 83% type III or IV HHs and 16% revisional hiatal cases, our results demonstrate favorable perioperative outcomes, with lower EBL, shorter LOS, lower complication rate, zero conversions, and comparable operative times compared with historical laparoscopic data.
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BACKGROUND: Health technology assessments (HTAs) of robotic assisted surgery (RAS) face several challenges in assessing the value of robotic surgical platforms. As a result of using different assessment methods, previous HTAs have reached different conclusions when evaluating RAS. While the number of available systems and surgical procedures is rapidly growing, existing frameworks for assessing MedTech provide a starting point, but specific considerations are needed for HTAs of RAS to ensure consistent results. This work aimed to discuss different approaches and produce guidance on evaluating RAS. METHODS: A consensus conference research methodology was adopted. A panel of 14 experts was assembled with international experience and representing relevant stakeholders: clinicians, health economists, HTA practitioners, policy makers, and industry. A review of previous HTAs was performed and seven key themes were extracted from the literature for consideration. Over five meetings, the panel discussed the key themes and formulated consensus statements. RESULTS: A total of ninety-eight previous HTAs were identified from twenty-five total countries. The seven key themes were evidence inclusion and exclusion, patient- and clinician-reported outcomes, the learning curve, allocation of costs, appropriate time horizons, economic analysis methods, and robotic ecosystem/wider benefits. CONCLUSIONS: Robotic surgical platforms are tools, not therapies. Their value varies according to context and should be considered across therapeutic areas and stakeholders. The principles set out in this paper should help HTA bodies at all levels to evaluate RAS. This work may serve as a case study for rapidly developing areas in MedTech that require particular consideration for HTAs.
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Procedimientos Quirúrgicos Robotizados , Humanos , Ecosistema , Consenso , Proyectos de Investigación , Curva de AprendizajeRESUMEN
Fungicides have their own unique characteristics and modes of action; a combination formulation [combination product (combi product)] of trifloxystrobin and propineb was applied to tomatoes for their dissipation kinetics and to ensure consumer safety. The combi product was applied at a 10-day interval with standard (61.25 + 1072.75 g a.i. ha-1 ) and double (122.5 + 2145.50 g a.i. ha-1 ) doses. The efficient analytical method was established using the quick, easy, cheap, effective, rugged, and safe (QuEChERS) approach followed by LC-MS. The maximum residue levels of 0.15 and 0.35 mg kg-1 of trifloxystrobin were detected in tomato fruits immediately after application at standard and double doses, respectively. The corresponding levels of propineb as carbon disulfide were 0.47 and 0.90 mg kg-1 , respectively. Considering trifloxystrobin (0.7 mg kg-1 ) codex maximum residue limit and propineb as dithiocarbamate (3.0 mg kg-1 ) European Commission maximum residue limit in tomato, a pre-harvest interval of 1 day can be proposed. The anticipated residue contributions of both fungicides were far less than the acceptable daily intake. The targeted hazard quotient and hazard index were also less than 1 for both fungicides. Furthermore, the theoretical maximum residue contribution was less than its maximum permissible intake, which indicates that the consumption of tomatoes containing the measured value of each fungicide residue could not pose any health risks.
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Fungicidas Industriales , Residuos de Plaguicidas , Solanum lycopersicum , Humanos , Fungicidas Industriales/análisis , Metacrilatos/análisis , Semivida , Residuos de Plaguicidas/análisis , Medición de RiesgoRESUMEN
Supervised field trail on dissipation of co-formulation with herbicides clodinafop-propargyl and oxyfluorfen in spring onion showed similar pattern of dissipation during two different seasons. Residues of clodinafop-propargyl reached ≤ limit of quantitation (LOQ, 0.05 mg kg-1) on 3rd day after application at both standard and double dose during both the seasons. Oxyfluorfen residues followed first-order kinetics in both the doses during first season with half-life of 0.81 to 3.14 days. The residues of clodinafop-propargyl were detected in soil at both the doses during first season. However, residues were ≤ LOQ (0.05 mg kg-1) during second season. The residues of oxyfluorfen were detected only in double dose during first season in soil. In all other cases and in onion bulb, residues were ≤ LOQ (0.05 mg kg-1) at the time of harvest. As the residues were either ≤ LOQ (0.05 mg kg-1) on 3rd day or have a half-life of 3.14 days, the co-formulation can be used safely, provided a pre harvest interval (PHI) of 3 days is followed. On the basis of maximum residue limits (MRLs) in other commodities and from the data of present study, a default MRL of 0.05 mg kg-1 is proposed for both the pesticides.
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Herbicidas , Residuos de Plaguicidas , Contaminantes del Suelo , Cebollas/química , Cinética , Herbicidas/análisis , Contaminantes del Suelo/análisis , Semivida , Suelo/química , Residuos de Plaguicidas/análisisRESUMEN
BACKGROUND: Acute appendicitis (AA) is the most common surgical emergency, with a relatively stable yearly incidence. During the first wave of the COVID-19 pandemic, as New York City (NYC) emerged as the US epicenter, hospitals saw a marked reduction in patients presenting with non-COVID-related diseases. The objective of this study was to characterize the effects of the pandemic on the incidence, presentation, and management of AA. METHODS: A retrospective analysis of patients with AA who presented to two academic medical centers during the NYC COVID peak (March 22nd-May 31st, 2020) was performed. This group was compared to a control cohort presenting during the same period in 2019. Primary outcomes included the incidence of AA, complicated disease, and management. Secondary outcomes included duration of symptoms, hospital length of stay, and complication rates. Statistical analyses were performed using Mann-Whitney U, Chi-square, and Fisher's exact tests. RESULTS: A 49.1% reduction in the incidence of AA was seen between 2019 (n = 114) and 2020 (n = 58). Median duration of symptoms doubled from 1 day in 2019 to 2 days in 2020 (P < .02). Proportionally, the incidence of complicated appendicitis rose from 19.3% to 41.4% (P < .005). 32.4% of patients with uncomplicated AA underwent non-operative management in 2020, compared to 12% in 2019 (P < .02). Hospital length of stay and complication rates were similar between years. DISCUSSION: Significantly fewer AA patients presented during the initial phase of the pandemic. Patients presented later, which may have contributed to a higher proportion of complicated disease. Surgeons were also more likely to treat uncomplicated AA nonoperatively than they were prior. Further research is needed to understand the long-term consequences of these changes.
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Apendicitis , COVID-19 , Humanos , COVID-19/epidemiología , COVID-19/complicaciones , Pandemias , Apendicitis/epidemiología , Apendicitis/cirugía , Estudios Retrospectivos , Apendicectomía , Enfermedad AgudaRESUMEN
Supervised field trial was conducted to study persistence of a pre-emergent herbicide, ipfencarbazone (25% SC) on rice crop. Single application of two different doses, 156.25 g a.i.ha-1/625 mL formulationha-1 and 312.50 g a.i.ha-1/1250 mL formulationha-1, was applied. Method was validated to analyse ipfencarbazone in rice samples (leaf/plant, grain, straw and husk) and in soil. Initial accumulation of ipfencarbazone in rice plants was 6.72 and 14.71 mg kg-1 in standard and double dose, respectively. The residues decreased linearly with r2 values of 0.92 and 0.98 in different doses and reached below limit of quantitation (LOQ) of 0.01 µg kg-1 (for rice plant/leaf) and 0.05 µg kg-1 (for rice grain, husk, straw) on 30th and 97th (harvest) day respectively after application in both the doses. An average half-life of ipfencarbazone was approximately 4 days. Less than LOQ levels at harvest and short half-life suggest that the use of ipfencarbazone is safe, provided good agricultural practices (GAP) are followed. The data can be used by regulatory authorities like Food Safety and Standards Authority of India (FSSAI) and CODEX for establishing maximum residue limits (MRLs) of ipfencarbazone.
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Oryza , Residuos de Plaguicidas , Contaminantes del Suelo , Oryza/química , Monitoreo del Ambiente/métodos , Semivida , Suelo/química , Contaminantes del Suelo/análisis , Residuos de Plaguicidas/análisisRESUMEN
BACKGROUND: Conversion rates during minimally invasive surgery are generally examined in the limited scope of a particular procedure. However, for a hospital or payor, the cumulative impact of conversions during commonly performed procedures could have a much larger negative effect than what is appreciated by individual surgeons. The aim of this study is to assess open conversion rates during minimally invasive surgery (MIS) across common procedures using laparoscopic/thoracoscopic (LAP/VATS) and robotic-assisted (RAS) approaches. STUDY DESIGN: Retrospective cohort study using the Premier Database on patients who underwent common operations (hysterectomy, lobectomy, right colectomy, benign sigmoidectomy, low anterior resection, inguinal and ventral hernia repair, and partial nephrectomy) between January 2013 and September 2015. ICD-9 and CPT codes were used to define procedures, modality, and conversion. Propensity scores were calculated using patient, hospital, and surgeon characteristics. Propensity-score matched analysis was used to compare conversions between LAP/VATS and RAS for each procedure. RESULTS: A total of 278,520 patients had MIS approaches of the ten operations. Conversion occurred in 5% of patients and was associated with a 1.77 day incremental increase in length of stay and $3441 incremental increase in cost. RAS was associated with a 58.5% lower rate of conversion to open surgery compared to LAP/VATS. CONCLUSION: At a health system or payer level, conversion to open is detrimental not just for the patient and surgeon but also puts a significant strain on hospital resources. Use of RAS was associated with less than half of the conversion rate observed for LAP/VATS.
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Laparoscopía , Procedimientos Quirúrgicos Robotizados , Colectomía/métodos , Femenino , Humanos , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Puntaje de Propensión , Estudios Retrospectivos , Procedimientos Quirúrgicos Robotizados/métodos , Cirugía Torácica Asistida por Video/métodosRESUMEN
The persistence of combination formulation of fluopyram 200 + tebuconazole 200-400 SC was evaluated across different agro-climates in India for the management of fungal diseases in two commercially important fruit crops, mango and pomegranate. The residues were extracted using quick easy cheap effective rugged and safe (QuEChERS) method and quantification was done on liquid chromatography-tandem mass spectrometry (LC-MS/MS). The fungicide degradation followed 1st-order kinetics and the half-lives were 2.9-6.4 days for mango, and 3.5-7.4 days for pomegranate for both the fungicides. On the basis of Organisation for Economic Co-operation and Development (OECD) maximum residue limit (MRL) calculation, 1.0 mg kg-1 MRL was obtained for fluopyram while for tebuconazole, it was 0.5 mg kg-1 on mango, at the pre-harvest interval (PHI) of 5 days. For pomegranate, the respective MRLs were 1.0 mg kg-1 and 0.7 mg kg-1 at PHI of 7 days. The dietary risk assessment study indicated that % acceptable daily intake (% ADI) and % acute reference dose (% ARfD) were much lower than 100; thus, the application of fluopyram and tebuconazole on mango and pomegranate is unlikely to present public health concern.
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Fungicidas Industriales , Mangifera , Residuos de Plaguicidas , Granada (Fruta) , Benzamidas , Cromatografía Liquida , Frutas/química , Fungicidas Industriales/análisis , Residuos de Plaguicidas/análisis , Piridinas , Medición de Riesgo , Espectrometría de Masas en Tándem , TriazolesRESUMEN
BACKGROUND: Elective paraesophageal hernia (PEH) repair in asymptomatic or minimally symptomatic patients ≥ 65 years of age remains controversial. The widely cited Markov Monte Carlo decision analytic model recommends watchful waiting in this group, unless the mortality rate for elective repair was to reach ≤ 0.5%; at which point, surgery would become the optimal treatment. We hypothesized that with advances in minimally invasive surgery, perioperative care, and practice specialization, that mortality threshold has been reached in the contemporary era. However, the safety net would decrease as age increases, particularly in octogenarians. METHODS: We identified 12,422 patients from the 2015-2017 ACS-NSQIP database, who underwent elective minimally invasive PEH repair, of whom 5476 (44.1%) were with age ≥ 65. Primary outcome was 30-day mortality. Secondary outcomes were length of stay (LOS), operative time, pneumonia, pulmonary embolism, unplanned intubation, sepsis, bleeding requiring transfusion, readmission, and return to OR. RESULTS: Patients age ≥ 65 had a higher 30-day mortality (0.5% vs 0.2%; p < 0.001). Subset analysis of patients age 65-80 and > 80 showed a 30-day mortality of 0.4% vs. 1.8%, respectively (p < 0.001). Independent predictors of mortality in patients ≥ 65 years were age > 80 (OR 5.23, p < 0.001) and COPD (OR 2.59, p = 0.04). Patients ≥ 65 had a slightly higher incidence of pneumonia (2% vs 1.2%; p < 0.001), unplanned intubation (0.8% vs 0.5%; p < 0.05), pulmonary embolism (0.7% vs 0.3%; p = 0.001), bleeding requiring transfusion (1% vs 0.5%; p < 0.05), and LOS (2.38 vs 1.86 days, p < 0.001) with no difference in sepsis, return to OR or readmission. CONCLUSION: This is the largest series evaluating elective PEH repair in the recent era. While morbidity and mortality do increase with age, the mortality remains below 0.5% until age 80. Our results support consideration for a paradigm shift in the management of patients < 80 years toward elective repair of PEH.
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Hernia Hiatal , Laparoscopía , Anciano , Anciano de 80 o más Años , Hernia Hiatal/complicaciones , Herniorrafia/métodos , Humanos , Laparoscopía/métodos , Morbilidad , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
BACKGROUND: Until now, there is no method available for analysis of pesticide residues in complex matrices like spices. Therefore, there is an urgent need to develop and validate a QuEChERS-based method for the estimation of 104 pesticides in cumin seed. RESULTS: Samples were spiked for 109 pesticides at concentrations of 0.1, 0.5 and 1.0 mg kg-1 . Of these 104 pesticides were recovered. At 0.1, 0.5 and 0.1 mg kg-1 , recoveries ranged from 71% to 108% when compared with matrix matched standards. Seventeen pesticides showed higher or lower recoveries than acceptable range (70-120%) when quantified using solvent standards showing significant matrix effect (ME) (≥ ±20%) even after 20× dilution. However, for the other pesticides ME was significantly eliminated on dilution. The recovery percentage improved for all pesticides on quantitation with matrix matched standards when compared with solvent standards. For pesticides with lower European Union (EU) maximum residue limits (MRLs), an experiment at lower spiking concentrations of 0.01 and 0.05 mg kg-1 with lower dilutions (8×) reveals that almost all pesticides with lower EU MRLs (0.02 and 0.05 mg kg-1 ) showed recoveries in the range 74-124% and relative standard deviation (RSD) less than 20%. CONCLUSION: Theoretical limit of quantitation (LOQ) is proposed which ranged from 0.01 to 0.18 mg kg-1 for matrix matched standards. An LOQ of 0.01 mg kg-1 was easily achieved for the pesticides with lower EU MRLs with lower dilutions (8×) with exception of fipronil for which this can be achieved without dilution provided matrix matched standards are used. The method can be extended to other spices. © 2021 Society of Chemical Industry.
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Cuminum , Residuos de Plaguicidas , Plaguicidas , Cromatografía Liquida/métodos , Residuos de Plaguicidas/análisis , Plaguicidas/análisis , Extracción en Fase Sólida/métodos , Espectrometría de Masas en Tándem/métodos , TemperaturaRESUMEN
BACKGROUND: Coronavirus SARS-CoV-2 affects multiple organs. Studies have reported mild elevations of lipase levels of unclear significance. Our study aims to determine the outcomes in patients with COVID-19 and hyperlipasemia, and whether correlation with D-dimer levels explains the effect on outcomes. METHODS: Case-control study from two large tertiary care health systems, of patients with COVID-19 disease admitted between March 1 and May 1, 2020 who had lipase levels recorded. Data analyzed to study primary outcomes of mortality, length of stay (LOS) and intensive care utilization in hyperlipasemia patients, and correlation with D-dimer and outcomes. RESULTS: 992 out of 5597 COVID-19 patients had lipase levels, of which 429 (43%) had hyperlipasemia. 152 (15%) patients had a lipase > 3x ULN, with clinical pancreatitis in 2 patients. Hyperlipasemia had a higher mortality than normal lipase patients (32% vs. 23%, OR = 1.6,95%CI = 1.2-2.1, P = 0.002). In subgroup analysis, hyperlipasemia patients had significantly worse LOS (11vs.15 days, P = 0.01), ICU admission rates (44% vs. 66%,OR = 2.5,95%CI = 1.3-5.0,P = 0.008), ICU LOS (12vs.19 days,P = 0.01), mechanical ventilation rates (34% vs. 55%,OR = 2.4,95%CI = 1.3-4.8,P = 0.01), and durations of mechanical ventilation (14 vs. 21 days, P = 0.008). Hyperlipasemia patients were more likely to have a D-dimer value in the highest two quartiles, and had increased mortality (59% vs. 15%,OR = 7.2,95%CI = 4.5-11,P < 0.001) and LOS (10vs.7 days,P < 0.001) compared to those with normal lipase and lower D-dimer levels. CONCLUSION: There is high prevalence of hyperlipasemia without clinical pancreatitis in COVID-19 disease. Hyperlipasemia was associated with higher mortality and ICU utilization, possibly explained by elevated D-dimer.
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COVID-19/complicaciones , Productos de Degradación de Fibrina-Fibrinógeno/metabolismo , Lipasa/sangre , Pancreatitis/complicaciones , SARS-CoV-2 , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Femenino , Humanos , Lipasa/metabolismo , Masculino , Persona de Mediana Edad , Pancreatitis/sangre , Pancreatitis/enzimología , Centros de Atención TerciariaRESUMEN
OBJECTIVE: The aim of this work is to formulate recommendations based on global expert consensus to guide the surgical community on the safe resumption of surgical and endoscopic activities. BACKGROUND: The COVID-19 pandemic has caused marked disruptions in the delivery of surgical care worldwide. A thoughtful, structured approach to resuming surgical services is necessary as the impact of COVID-19 becomes better controlled. The Coronavirus Global Surgical Collaborative sought to formulate, through rigorous scientific methodology, consensus-based recommendations in collaboration with a multidisciplinary group of international experts and policymakers. METHODS: Recommendations were developed following a Delphi process. Domain topics were formulated and subsequently subdivided into questions pertinent to different aspects of surgical care in the COVID-19 crisis. Forty-four experts from 15 countries across 4 continents drafted statements based on the specific questions. Anonymous Delphi voting on the statements was performed in 2 rounds, as well as in a telepresence meeting. RESULTS: One hundred statements were formulated across 10 domains. The statements addressed terminology, impact on procedural services, patient/staff safety, managing a backlog of surgeries, methods to restart and sustain surgical services, education, and research. Eighty-three of the statements were approved during the first round of Delphi voting, and 11 during the second round. A final telepresence meeting and discussion yielded acceptance of 5 other statements. CONCLUSIONS: The Delphi process resulted in 99 recommendations. These consensus statements provide expert guidance, based on scientific methodology, for the safe resumption of surgical activities during the COVID-19 pandemic.
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COVID-19/prevención & control , Procedimientos Quirúrgicos Electivos , Endoscopía , Control de Infecciones/organización & administración , COVID-19/epidemiología , COVID-19/transmisión , Consenso , Técnica Delphi , Humanos , Internacionalidad , Colaboración Intersectorial , TriajeRESUMEN
Fascial closure at 8-mm robotic port sites continues to be controversial. As the use of the robotic platform increases across multiple abdominal specialties, there are more case reports describing reoperation and small bowel resection for acute port-site hernias. A retrospective review of all robotic abdominal surgeries performed from 2012 to 2019 at NYU Langone Medical Center was conducted. Patients who had a reoperation in our facility within 30 days were identified, and medical records reviewed for indications for reoperation and findings. The study included 11,566 patients, of which 82 patients (0.71%) underwent a reoperation related to the index robotic surgery within 30 days. Fifteen of 11,566 patients (0.13%) had acute port-site hernias, and 3 of these 15 patients required small bowel resection. Eleven of 15 acute port-site hernias (73%) were at 8-mm robotic port site, 2 of which required a small bowel resection. More than a third of the patients had a hernia at an 8-mm port site where a surgical drain had been placed. Considering that each robotic case, regardless of specialty, has three ports at a minimum, the true incidence of acute postoperative robotic port-site hernia is 0.032% (11/34,698), with the incidence of concomitant small bowel resection being 0.006% (2/34,698). The incidence of acute port-site hernias from 8-mm robotic ports is exceedingly low across specialties. Our results do not support routine fascial closure at 8-mm robotic port sites due to an extremely low incidence. However, drain sites require special consideration.
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Hernia/epidemiología , Hernia/etiología , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Procedimientos Quirúrgicos Robotizados/efectos adversos , Procedimientos Quirúrgicos Robotizados/métodos , Enfermedad Aguda , Anciano , Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Femenino , Herniorrafia/métodos , Humanos , Incidencia , Intestino Delgado/cirugía , Masculino , Persona de Mediana Edad , Reoperación/estadística & datos numéricos , Estudios RetrospectivosRESUMEN
Since the resurgence of chikungunya virus (CHIKV) in India in 2005, the Indian subcontinent sublineage of the Indian Ocean lineage (IOL) has continued transmission in India and also radiation from India causing additional outbreaks in surrounding countries. This study was undertaken for an in-depth understanding of the evolutionary dynamics of the IOL, the global transmission routes in the Indian context and possible association with mutational fitness. The whole genome sequencing of Indian isolates representing CHIKV outbreaks (2014-2018) from selected States of India was carried out, followed by phylogeography analysis of the IOL using the Bayesian Markov chain Monte Carlo method and selection pressure analysis. Phylogeography analysis of IOL strains revealed indigenous evolution in India at least at three time points, with specific mutations that conferred viral fitness in the Aedes vector species. Further dispersal of the strains from India was noted to neighbouring and distant countries with multiple exportations to Sri Lanka, Bangladesh and China. The study reveals India as an endemic reservoir for CHIKV and persistent global transmissions from India. Though natural selection does not appear to play a major role in establishment of the IOL, sustainable efforts towards vector control can help address the issues.