Evaluating the Emergency Surgery Score (ESS) in Predicting Postoperative Outcomes Following Emergency Laparotomy: Insights From an Indian Tertiary Center.

AIMS AND OBJECTIVES:  To determine the predictive value of Emergency Surgery Score (ESS) with regard to mortality and morbidity rates of patients undergoing emergency laparotomy. METHOD: The ESS ranging from 0 to 29 is an extensive risk calculator based on 22 variables including important parameters like demographics, preoperative treatment, comorbidities, and laboratory values. Twenty patients who underwent emergency laparotomy were preoperatively assessed and ESS was calculated for each. After establishment of diagnosis and resuscitation, the patient was taken up for emergency laparotomy. Postoperatively, patients were monitored clinically as well as with laboratory and radiological investigations as per case needed till discharge and further followed up physically in OPD/ward or interviewed telephonically for 30 days on a weekly basis. Incidence of mortality and morbidity in terms of postoperative complications, ICU admission, reoperation and readmission among the cases occurring within 30 days of procedure were recorded. RESULTS: ESS correlated well with the outcome in the current study, 10 out of 14 patients with score less than 8 were discharged without any complications. Mean ESS was higher among non-survivors. Ability of ESS to predict postoperative mortality, morbidity and ICU stay was proven statistically with c-statistics of 0.853, 0.84, 0.879 respectively. ESS was found to be a good predictor for the development of postoperative lower respiratory tract infection (LRTI) (c-statistic=0.828), sepsis (c-statistic=0.867), disseminated intravascular coagulation (DIC) (c-statistic=0.805), acute kidney injury (AKI) (c-statistic=0.804). ESS showed poor correlation with reoperation and readmission rates. CONCLUSION: The current study underscores the critical importance of employing risk stratification through ESS for patients undergoing emergency laparotomy. By employing ESS, healthcare professionals can accurately anticipate resuscitation requirements and stabilize patients preoperatively. This proactive approach enables the identification and optimization of patients unsuitable for immediate surgery, facilitating informed decisions on targeted treatment, surgical intervention, and postoperative care pathways.

Critical weather limits for paddy rice under diverse ecosystems of India.

Rice yields are largely influenced by variability in weather. Here, we demonstrate the effect of weather variables viz., maximum and minimum temperatures, rainfall, morning and evening relative humidity, bright sunshine hours on the yield of rice cv. Swarna, grown across five rice ecologies of India through field experiments during kharif (wet) season (Jun-Sept.). Critical thresholds of weather elements were identified for achieving above average, average and below average yield for each ecology. The investigation could determine how different weather elements individually and collectively affect rice yield in different rice ecosystems of India. While a sudden increase in minimum temperature by 8-10 °C (> 30 °C) during reproductive period resulted in 40-50 per cent yield reduction at Mohanpur, a sudden decrease (< 20 °C) caused yield decline at Dapoli. The higher yields may be attributed to a significant difference in bright sunshine hours between reproductive phases of above-average and below-average yield years (ranging from 2.8 to 7.8 hours during P5 stages and 1.7 to 5.1 during P4 stages). Rice cultivar Swarna performed differently at various sowing dates in a location as well as across locations (6650 kg ha-1 at Dapoli to 1101 kg ha-1 at Samastipur). It was also found that across all locations, the above average yield could be associated with higher range of maximum temperature compared to that of below average yield. Principal component analysis explained 77 per cent of cumulative variance among the variables at first growth stage, whereas 70 per cent at second growth stage followed by 74 per cent and 66 per cent at subsequent growth stages. We found that coastal locations, in contrast to inland ones, could maximize the yield potential of the cultivar Swarna, due to the longer duration of days between panicle initiation to physiological maturity. We anticipate that the location-specific thresholds of weather factors will encourage rice production techniques that are climate resilient.

A Review on Greening and Glycoalkaloids in Potato Tubers: Potential Solutions.

Greening is an undesirable trait that develops in potatoes upon light exposure. This condition lowers market value, increases tuber waste in retail stores, and consequently influences the price of product in the long run. When potatoes are subjected to artificial light, the amyloplast converts into chloroplast. Although the development of total glycoalkaloids (TGA) is independent of light, the greening induced by exposure of potato to artificial light is an indication of probable TGA acceleration, which could be present in a low amount initially. Several research studies on optimum postharvest factors (temperature, lighting condition, relative humidity, pretreatment, storage air composition, and packaging) have been carried out to avoid greening and TGA development. This current review highlights major postharvest factors and summarizes past research regarding cause of greening and TGA development in potatoes in retail stores. Additionally, it also portrays the potential solutions that could help mitigate this problem, ultimately reducing wastage and achieving food security.

Role of Omega-3 Fatty Acid Infusion in Surgical Outcomes of Perforation Peritonitis Patients: A Randomized Controlled Trial.

Background Perforation peritonitis is associated with a high rate of morbidity and mortality in spite of advances in antibiotics and surgical techniques. The Omega-3 fatty acid is an immune-enhancing essential fatty acid that has been found to have anti-inflammatory properties, which help in quicker recovery. The present study examined the role of Omega-3 fatty acid infusion in the surgical outcome of perforation peritonitis. Methods Three hundred consecutive patients in the age group of 18-70 years operated for perforation peritonitis were included in this study. Patients in the study group received Omega-3 fatty acid emulsion postoperatively while those in the control group received a placebo. The groups were compared with respect to clinical and biochemical parameters. Results The Omega-3 fatty acid helped in reducing postoperative complications. The incidence of postoperative pyrexia (22.67% versus 82.67%), chest infection (6% versus 31.33%), and complete wound dehiscence (12% versus 34%) was significantly less in the study group compared to the control group. There was a 4.5-day difference in overall length of stay, favoring the study group who were on Omega-3 fatty acids (LOS 8.06 vs. 12.65 days). There was no mortality in the study group compared with 17 deaths (11.3%) in the control group. Conclusion Postoperative perforation peritonitis patients receiving Omega-3 fatty acids are at a lower risk of developing postoperative complications, have a shorter duration of hospital stay, and have lower morbidity and mortality.

Research advancements in optical imaging and spectroscopic techniques for nondestructive detection of mold infection and mycotoxins in cereal grains and nuts.

Cereal grains and nuts are represented as the economic backbone of many developed and developing countries. Kernels of cereal grains and nuts are prone to mold infection under high relative humidity and suitable temperature conditions in the field as well as storage conditions. Health risks caused by molds and their molecular metabolite mycotoxins are, therefore, important topics to investigate. Strict regulations have been developed by international trade regulatory bodies for the detection of mold growth and mycotoxin contamination across the food chain starting from the harvest to storage and consumption. Molds and aflatoxins are not evenly distributed over the bulk of grains, thus appropriate sampling for detection and quantification is crucial. Existing reference methods for mold and mycotoxin detection are destructive in nature as well as involve skilled labor and hazardous chemicals. Also, these methods cannot be used for inline sorting of the infected kernels. Thus, analytical methods have been extensively researched to develop the one that is more practical to be used in commercial detection and sorting processes. Among various analytical techniques, optical imaging and spectroscopic techniques are attracting growers' attention for their potential of nondestructive and rapid inline identification and quantification of molds and mycotoxins in various food products. This review summarizes the recent application of rapid and nondestructive optical imaging and spectroscopic techniques, including digital color imaging, X-ray imaging, near-infrared spectroscopy, fluorescent, multispectral, and hyperspectral imaging. Advance chemometric techniques to identify very low-level mold growth and mycotoxin contamination are also discussed. Benefits, limitations, and challenges of deploying these techniques in practice are also presented in this paper.

Phosphorene-gold nanocomposite based microfluidic aptasensor for the detection of okadaic acid.

Okadaic acid (OA) is one of the most prevalent and largely distributed bio-toxin in the world. Consumption of OA results in a series of digestive ailments such as nausea and diarrhea. This study demonstrates the preparation and functioning of an electrochemical microfluidic biochip for the detection of OA. The screen-printed carbon electrode (SPCE) was modified by phosphorene-gold nanocomposite onto which an aptamer specific to OA was immobilized. BP-Au nanocomposites were synthesized by an in-situ, one-step method without the use of a reducing agent. Potassium ferro-ferri cyanide was used as a redox pair to quantify signal strength. To improve reaction time, increase sensitivity and portability, a microfluidic platform was designed and developed. This device comprised of channels identified for specific purposes such as sample mixing and incubation. Overall, the integrated system consisted of a polydimethylsiloxane microfluidic chip housing an aptamer modified SPCE, as a single detection module for Okadaic acid. The nanomaterials and the microfluidic channels prepared were spectroscopically and electrochemically analyzed. Differential pulse voltammograms revealed a detection limit of 8 pM, while a linear range was found between 10 nM-250 nM. Selectivity studies were also performed with spiked mussel samples and other interfering species. This point-of-care device can be deployed to perform on-farm assays in fishing units.

Author Correction: The distribution and lifetime of powerful radio galaxies as a function of environment and redshift.

A correction to this article has been published and is linked from the HTML and PDF versions of this paper. The error has not been fixed in the paper.

The distribution and lifetime of powerful radio galaxies as a function of environment and redshift.

Correlations between jet power and active time for z < 0.1 high excitation and low excitation radio galaxies are explored as well as evidence in favor of a specific, non-random distribution for these objects including mid-infrared emitting radio galaxies as a function of environment and redshift. In addition, so-called weak line radio galaxies with FRII jet morphology have been identified as a class of active galaxies in the process of shutting down. This paper identifies common features between these seemingly disparate phenomena described above for the population of radio galaxies, and strings them together by way of a simple phenomenological framework that has shed light on the radio loud/radio quiet dichotomy, the jet-disk connection, and the distribution of all active galaxies as a function of redshift.

Malrotation of the Gut in Adults: An Often Forgotten Entity.

Malrotation of the gut is a common paediatric condition that usually presents in the first month of life. However, presentation in adults is rare, and as a diagnostic dilemma quite often surprises the surgeon intraoperatively. If this condition is not timely recognized, it may result in disastrous consequences, such as gangrene of the small gut. We present the case of a 21-year-old male who presented to the emergency room with recurrent episodes of colicky abdominal pain and bilious vomiting. Contrast-enhanced computerized tomography (CT) revealed malrotation of the gut. The patient was planned for Ladd's procedure. Malrotation in adults may present in an acute way due to midgut volvulus or may have a chronic indolent course with recurrent vomiting and abdominal pain. In patients with acute obstruction, this differential should be kept in mind, especially if the patient has no previous abdominal surgery or evidence of tuberculosis. Contrast-enhanced CT is the investigation of choice and reveals typical findings, like whirlpool sign, corkscrew sign, or reversed relation of superior mesenteric artery and vein. The treatment is surgical as failure to do so may result in intestinal gangrene. The procedure of choice is Ladd's procedure. Every patient, even if asymptomatic, warrants this procedure as it is impossible to predict the timing of catastrophic complications.