Accuracy of Self-Estimated BMI in the Context of Telephone Assessment Before Elective General Surgery.

Background This study aimed to determine if self-estimated body mass index (BMI) from telephone consultation was accurate and useful for surgical planning prior to elective general surgery. Methods A prospective cohort study was performed under a single surgeon at a district general hospital in the United Kingdom. Estimated BMI was collected from consecutive patients attending a pre-operative telephone consultation. Actual BMI was measured on the day of surgery and compared. Patient age and gender were also collected. Results Data were collected from 124 participants (median age 59 years, 49.2% male). A total of 33 participants under-estimated, 53 over-estimated, and 38 accurately estimated their BMIs. The median change in BMI was 0.0 (IQR -0.1, 0.3, p = 0.003). The median change in males was 0.0 (-0.1, 0.2, p = 0.479) compared to 0.1 (0.0, 0.7, p = 0.002) in females. Those with an actual BMI > 29.9 had a significantly higher median change (0.2 {0.0, 1.1}) compared to those with BMI ≤ 29.9 (0.0 {-0.2, 0.1}; p <0.001). Only two patients could have required a change in surgeon on the day of the procedure and this was not statistically significant (p = 0.500). Conclusions Self-estimated BMI, collected via telephone consultation, is a suitable method for assessing patients for surgical planning ahead of elective general surgery procedures, particularly for males. However, it is important to be aware that those with higher BMIs, particularly females, may underestimate their BMIs.

Impact of the COVID-19 pandemic on the management and outcomes of emergency surgical patients: A retrospective cohort study.

INTRODUCTION: The COVID-19 pandemic has led to drastic measures being implemented for the management of surgical patients across all health services worldwide, including the National Health Service in the United Kingdom. It is suspected that the virus has had a detrimental effect on perioperative morbidity and mortality. Therefore, the aim of this study was to assess the impact of the COVID-19 pandemic on these outcomes in emergency general surgical patients. METHODS: Emergency general surgical admissions were included in this retrospective cohort study in one of the COVID-19 hotspots in the South East of England. The primary outcome was the 30-day mortality rate. Secondary outcomes included the length of stay in hospital, complication rate and severity grade and admission rates to the ITU. RESULTS: Of 123 patients, COVID-19 was detected in 12.2%. Testing was not carried out in 26%. When comparing COVID-positive to COVID-negative patients, the mean age was 71.8 + 8.8 vs. 50.7 + 5.7, respectively, and female patients accounted for 40.0 vs. 52.6%. The 30-day mortality rate was 26.7 vs. 3.9 (OR 6.49, p = 0.02), respectively. The length of stay in hospital was 20.5 + 22.2 vs. 7.7 + 9.8 (p < 0.01), the rate of complications was 80.0 vs. 23.7 (OR 12.9, p < 0.01), and the rate of admission to the ITU was 33.3 vs. 7.9% (OR 5.83, p = 0.01). CONCLUSION: This study demonstrates the detrimental effect of COVID-19 on emergency general surgery, with significantly worsened surgical outcomes.

Congenital Peritoneal Encapsulation: A Literature Review of a Rare Pathology.

Congenital peritoneal encapsulation (CPE) is a rare, congenital entity in which an accessory peritoneal membrane surrounds the small bowel. This condition is usually asymptomatic and rarely causes intestinal obstruction. Despite the rare cause of intestinal obstruction, it has excellent post-operative recovery. There is no gold standard approach for investigating CPE; however, a computerized tomography scan of the abdomen might be helpful. Furthermore, diagnostic laparoscopy could be considered an adjunct. This report highlights the rare congenital anomaly as a cause of intestinal obstruction.

Bucket-Handle Mesenteric Tears: A Comprehensive Review of Their Presentation and Management.

Bucket-handle mesenteric tears remain a diagnostic challenge for clinicians. We aim to review the literature, including a single-surgeon series, to better understand their presentation and management. Three electronic databases (Ovid Medline, Embase, and PubMed) were searched for original research articles, describing relevant cases, from database inception to October 2021 using the following Medical Subject Heading (MeSH) terms: mesenteric avulsion, mesenteric tear, and blunt abdominal trauma. A retrospective review of cases managed under a single surgeon at our unit was also performed. Data extracted included demographics, mechanism of injury, presenting features, diagnostic imaging, surgical management, and patient outcome. In total, 19 studies were identified, including 22 patients (median age 34.5 years). The most common cause of injury was seat-belted road traffic accidents (77.3%), and patients commonly presented with abdominal pain (72.7%), tenderness (50%), positive seat-belt sign (54.5%), and haemodynamic compromise (45.5%). Computerised tomography scanning was the main imaging modality (68%), and the most common findings reported were abdominal free fluid (36.4%) and abdominal wall hernia (27.3%). The majority of patients were operated on within 24 hours of injury (68%), had a median length of stay of 14.5 days, and experienced an uncomplicated recovery (68%). There was no association between the development of complications and delayed surgical intervention >24 hours (p = 0.145). Our institution's experience was similar, with 50% of patients undergoing surgical intervention within 24 hours. The median age was 32.5 years (50% female), and the median length of stay was 11 days. A high index of suspicion, serial monitoring, including blood tests, and imaging, with a low threshold for early repeat imaging, can provide a useful guide for identifying patients with bucket-handle tears.

Presentations of the Acute Scrotum During the COVID-19 Pandemic: Experiences of a Non-urological Centre.

INTRODUCTION: Testicular torsion is a time-sensitive surgical emergency. Assessment of the acute scrotum warrants rapid surgical review and low threshold for surgical intervention.  Materials and methods: A retrospective cohort study was undertaken for a three-month period during the first wave of the 2020 COVID-19 pandemic and the corresponding period in 2019. Data were collected for all scrotal explorations undertaken at our non-urological centre during this time. RESULTS: Sixteen scrotal explorations were performed from April to June 2019, one had testicular torsion (6.25%). Forty-one explorations were performed from April to June 2020, nine had testicular torsion (21.95%). The most common diagnosis was epididymitis or epididymo-orchitis in 2019 and 2020 (27% and 37.5%, respectively). Sixty-two percent of patients presented within 12 hours in 2019 compared to only 37% during the first wave of the coronavirus disease 2019 (COVID-19) pandemic. CONCLUSION: This study found an increase in the number of patients presenting with acute scrotal pain triggering surgical intervention and the number of patients with testicular torsion. This is likely to reflect a decrease in patients able to access primary care assessment but may also be related to COVID-19. There was a marked delay in the presentation which has significant implications for testicular viability.

Rectal Foreign Bodies: Surgical Management and the Impact of Psychiatric Illness.

Background Entrapped rectal foreign bodies can be a challenge to manage and are being encountered by acute surgical teams with increasing frequency. The aims of our study were to (a) ascertain the population demographics of patients presenting with this problem in our local area of East Kent, (b) see if an association could be drawn between this presentation and proposed risk factors such as a psychiatric illness or socioeconomic deprivation, and (c) to review how foreign bodies are being removed in the East Kent Hospital University Foundation NHS Trust, United Kingdom and to highlight best practice with regards to this in line with the latest guidelines. Methodology Between 2017 and 2021, 32 cases of entrapped rectal foreign bodies were diagnosed and managed at our NHS Trust. Retrospective data taken from the theatre directory and electronic patient records were used to audit patient demographics, co-morbidities, the type of foreign body, and the extraction technique. Results The majority of patients (90%) were male (n = 29). The patients' age ranged from 15 to 95 years, with a median age of 48 years. In total, 12 (37.5%) patients had a medical history of a psychiatric illness. The most common foreign bodies removed were sex toys or vibrators (n = 8) and roll-on deodorant bottles (n = 7). Kent Area B (n = 10) and Kent Area A (n = 9) were the areas with the highest number of cases. Twenty-two (68.8%) patients underwent examination under a general anaesthetic for removal, seven (21.8%) patients had the object manually removed without sedation, and three (9.4%) required a laparotomy with or without bowel resection. Conclusions Cases of an entrapped rectal foreign body in this local region typically involved male patients between 40 and 50 years old. A high proportion of this group had a history of a psychiatric illness supporting an association between this presentation and mental health. We have proposed some explanations for this association including the anal canal nervous system interplay with the "brain-gut axis." Lower socioeconomic status and unemployment may also be risk factors for this surgical problem. A trans-anal approach for management is successful in the majority of cases; however, almost 10% of patients required emergency surgical management. We have highlighted best practice guidelines for the investigation and management of the entrapped rectal foreign body as part of our discussion.

Metabolism and dissipation kinetics of a novel protoporphyrinogen IX oxidase herbicide [oxadiargyl] in various buffered aqueous system under laboratory-simulated condition.

Present investigation was carried out using two commercial products Raft (oxadiargyl 6% EC) and Topstar (oxadiargyl 80% WP) of Oxadiargyl {5-tert-butyl-3[2,4-dichloro-5-(prop-2-ynyloxy)phenyl]-1,3,4-oxadiazol-2 (3H)-one} to investigate the persistence behavior and metabolism of the herbicide in various aqueous system under different pH condition. Half-life values revealed that alkaline hydrolysis played a dominant role in hydrolytic degradation of this compound. Q-ToF micromass study with the alkaline fractions of oxadiargyl indicated the formation of five metabolites, which was further characterized from their mass fragmentation data. The nature of metabolites formed indicated that heterocyclic oxadiazoline ring cleavage was found to be the main pathway of hydrolytic transformation of oxadiargyl.

Photolysis of oxyfluorfen in aqueous methanol.

Photolysis of oxyfluorfen, an herbicide of the nitrodiphenyl ether class, was studied in aqueous methanol under UV and sunlight. UV irradiation was carried out in a borosilicate glass photoreactor (containing 250 ppm oxyfluorfen in 50% aqueous methanol) equipped with a quartz filter and 125 watt mercury lamp (maximum output 254 nm) at 25 ± 1°C. Sunlight irradiation was conducted at 28 ± 1°C in borosilicate Erlenmeyer flasks containing 250 ppm oxyfluorfen in 50% aqueous methanol. The samples from both the irradiated conditions were withdrawn at a definite time interval and extracted to measure oxyfluorfen content by gas chromatography-flame ionization detector for rate study. The half-life values were 20 hours and 2.7 days under UV and sunlight exposure, respectively. Photolysis of oxyfluorfen yielded 13 photoproducts of which three were characterized by infrared spectrophotometer and (1)H NMR and (13)C NMR spectroscopy. The rest of the photoproducts were identified by gas chromatography-mass spectrometry (GC-MS) and thin layer chromatography (TLC). An ionization potential 70 eV was used for electron impact-mass spectrometry (EI-MS) and methane was used as reagent gas for chemical ionization-mass spectrometry (CI-MS). Two of the photoproducts were also synthesized for comparison. The main phototransformation pathways of oxyfluorfen involved nitro reduction, dechlorination, and hydrolysis as well as nucleophiles displacement reaction.

Occurrence of heavy metals in fish: a study for impact assessment in industry prone aquatic environment around Kolkata in India.

A study was conducted during November 2005-October 2006 for determining the heavy metal contamination in surface water and sediments and giving prime thrust to determine the heavy metal concentrations fish samples collected from various points of the river Ganga at different time interval. Fish samples (viz., Channa marulius and Aorichthys seengala) were analyzed for heavy metals using standard laboratory procedures by AAS method. In impact points the annual average values for Cu, Cr, Cd, Pb and Zn were 0.15, 0.04, 0.03, 0.02 and 0.29 ppm, respectively. The concentrations of heavy metals in the riverine water collected from middle point had the order Zn > Cu > Cr > Cd > Pb. The data indicated that copper was maximally accumulated in the riverine sediments whereas least annual average concentration was obtained for lead. The trend of accumulation suggested deposition was maximum for zinc and minimum for cadmium in the muscles of both fish species. Only zinc has shown some significant seasonal variation in relation to metal deposition in fish muscles (minimum in monsoon and maximum in summer). The heavy metal contamination to fish may be due to indiscriminate discharge of polluted and untreated sewage sludge to the river. The heavy metal contents in fish at some places are alarming.

Risk assessment and decontamination of Quinalphos under different culinary processes in/on cabbage.

Quinalphos 20 AF was applied at the rate of 500 and 1,000 g a.i. ha(-1) in cabbage for two consecutive seasons and the samples harvested at intervals of 0 (3 h after application), 2, 4, 6, 8, and 10 days interval after application. The calculated half-life values were 1.27-1.38 days and 1.12-1.24 days for cabbage heads and cropped soil, respectively. The calculated safe waiting period based on field dissipation study was 5.28-6.7 days, which indicated its persistence nature. Thus, to reduce the safe waiting period, efforts were made to decontaminate the Quinalphos residue from cabbage head by various household preparations (viz. washing, cooking, washing plus cooking, salt water dipping, dipping in boiled salt water, dipping in detergent solution, and dipping in boiled detergent solution). Statistical analysis of the data using Duncan's multiple range test revealed that various household processing substantially reduced the residue of Quinalphos in cabbage heads in the range of 27.72-75.01% irrespective of any dose and seasons, but none were able to satisfactorily bring down the residue below the tolerance level of 0.05 mg kg(-1).

Impact assessment and decontamination of pesticides from meat under different culinary processes.

A total of 75 animals between 1.5 and 8 years old were randomly selected for the study. Of these, 57.8% were cross-bred animals and the rest were non-descript. Moreover, 61.8% of the animals under study were brought for slaughter from local sources and the rest from farm houses. Samples collected from five districts revealed contamination with traces of organochlorine pesticides (0.01-0.22 microg g(-1)) and organophosphorus pesticides (0.111-0.098 microg g(-1)). In general, all the raw meat samples possessed dichlorodiphenyltrichloroethane at the highest level. Contamination was highest in cow meat samples and lowest in chicken samples. No particular district-wise trend was obtained for the pesticides selected for analysis. Subsequent decontamination study revealed that cooking is the best option in reducing pesticide load in raw meat samples. Cooked chicken is the safest foodstuff for consumption.

Risk assessment and chemical decontamination of an oxime carbamate insecticide (methomyl) from eggplant, Solanum melongena L.

Methomyl, S-methyl (EZ)-N-(methylcarbamoyloxy)thioacetimidate, is a systemic insecticide chosen for the management of shoot and fruit borer, Leucinodes orbonalis G. Codex Alimentarious Commission has proposed a maximum residue limit (MRL) of 0.2 mg kg( - 1) of methomyl, and there is a need to validate this value on eggplant. First + first-order model can explain the nonlinear dissipation pattern of methomyl conveniently in comparison to first-order kinetics. The preharvest intervals (PHI) of 27.3 and 35.3 days as obtained from first + first-order model for single and double doses would bring down the methomyl residue below MRL in actual practice. The respective half-lives were 6.6 and 7.8 days. On the other hand, first-order model suggests methomyl dissipated with a half-life value around 5 days and proposed PHIs of 6.57 and 8.57 days for single and double doses, which was far from reality. Hence, five different decontamination agents were chosen for the decontamination of methomyl from eggplant. Safety factors such as theoretical maximum daily intake and maximum permissible intake were used to evaluate risk assessment to human health. A 3-day waiting period for the both doses, following conventional agricultural practice and processing factor could not ensure sufficient margin of safety. Subjecting the data to a processing factor of 60% could not bring the residues below the proposed MRL by Codex. Methomyl is not found appropriate and effective for application in eggplant. Either the proposed MRL needs to be revised or good agricultural practice involving methomyl for plant protection in eggplant cultivation is questioned.

Impact assessment of various parameters polluting Ganga water in Kolkata Region: a study for quality evaluation and environmental implication.

The quality of sewage-sludge samples obtained in Kolkata region was evaluated. Both sewage water and sludge components were analyzed for a number of physico-chemical, microbiological parameters using standard laboratory procedures, some heavy metals by AAS method and pesticide contents by GC method. Some of the physical and chemical constituents of the samples are within the allowable levels while the rest are not. The samples are rich in nutrients and have suitable pH for agricultural uses. In terms of Electrical Conductivity and Sodium Adsorption Ratio, sewage water is not suitable for irrigation. Fecal and coliform bacterial population is high in all samples. Pesticide and heavy metals in some places are alarming. So sewage-sludge produced in Kolkata cannot be used for agricultural purpose without any treatment. Thus proper care, maintenance, treatment and disposal of sewage water and sludge are most vital and should be the prime thrust for the nation.

Degradation dynamics and persistence of Quinolphos and Methomyl in/on Okra (Ablemoschus esculentus) fruits and cropped soil.

Dissipation of Quinalphos (Ekalux 20 AF) and Methomyl (Lannate 12.5 L) residues were studied in/on Okra (var. Pusa Sawani) fruits and cropped soil at Baruipur, West Bengal, India. The insecticides were applied at 21 days after sowing by foliar spray at the recommended and double the recommended dose (i.e. 500 and 1,000 g a.i. ha(-1) in both the cases). Four sprays were given at 15 days interval in all the cases. The initial build-up residue on Okra fruits was to the magnitude of 3.20 and 7.50 microg g(-1) for Quinalphos, 5.61 and 8.42 microg g(-1) for Methomyl at lower and higher doses respectively. The half-lives (t(1/2)) in Okra fruit were found to be 1.25-1.43 days for Quinalphos and 0.88-0.94 days for Methomyl. The safe waiting period (T(MRL)) determined were 6.7 and 5.3 days at the lower dose of Quinalphos. The corresponding waiting period for Methomyl were 5.7 and 4.9 days. Decontamination process like washing and cooking dislodged 25.50%-81.50% residue depending on insecticides and doses, whereas 20.00%-69.60% surface residue was removed by washing alone. The residues of both insecticides in soil persisted for 6-8 days depending on dose. The half-lives in soil were found to be 1.07-1.20 days for Quinalphos and 0.97-1.25 days for Methomyl.

Impact of pesticides on soil microbiological parameters and possible bioremediation strategies.

Intensive agriculture is spectacularly successful since last couple of decades due to the inputs viz; fertilizers and pesticides along with high yielding varieties. The mandate for agriculture development was to feed and adequate nutrition supply to the expanding population by side the agriculture would be entering to into new area of commercial and export orientation. The attention of public health and proper utilization natural resources are also the main issues related with agriculture development. Concern for pesticide contamination in the environment in the current context of pesticide use has assumed great importance [1]. The fate of the pesticides in the soil environment in respect of pest control efficacy, non-target organism exposure and offsite mobility has been given due consideration [2]. Kinetics and pathways of degradation depend on abiotic and biotic factors [6], which are specific to a particular pesticide and therefore find preference. Adverse effect of pesticidal chemicals on soil microorganisms [3], may affect soil fertility [4] becomes a foreign chemicals major issue. Soil microorganisms show an early warning about soil disturbances by foreign chemicals than any other parameters.But the fate and behavior of these chemicals in soil ecosystem is very important since they are degraded by various factors and have the potential to be in the soil, water etc. So it is indispensable to monitor the persistence, degradation of pesticides in soil and is also necessary to study the effect of pesticide on the soil quality or soil health by in depth studies on soil microbial activity.The removal of metabolites or degraded products should be removed from soil and it has now a day's primary concern to the environmentalist. Toxicity or the contamination of pesticides can be reduced by the bioremediation process which involves the uses of microbes or plants. Either they degrade or use the pesticides by various co metabolic processes.

Vertical migration of some herbicides through undisturbed and homogenized soil columns.

A laboratory experiment was conducted by using three herbicides, two from dinitroaniline group and one from thiocarbamate group to know their degree of downward movement (leachability) through soil columns and their contribution in ground water contamination. Soil columns were loaded with Pendimethalin, Benthiocarb and Oryzalin at doses of 10.0, 10.0 and 7.7 kg/ha, respectively. After 30 days soil samples were analyzed from each segments (i.e. 0-6, 6-12, 12-18, 18-24 and 24-30 cm) for Benthiocarb and Pendimethalin by GLC equipped with Ni(63) electron capture detector (ECD) and for Oryzalin by HPLC coupled with UV-VIS detector. The results obtained in the present study reveal that the residues of the three herbicides under investigation were predominantly confined to the upper soil layer (0-6 cm). Comparatively, low mobility of these herbicides in soils could be due to strong adsorption of these chemical to soil colloids.

Laboratory simulated dissipation of metsulfuron methyl and chlorimuron ethyl in soils and their residual fate in rice, wheat and soybean at harvest.

Two sulfonylurea herbicides, metsulfuron methyl (Ally 20 WP) and chlorimuron ethyl (Classic 25 WP) were evaluated for their dissipation behaviour in alluvial, coastal saline and laterite soils under laboratory incubated condition at 60% water holding capacity of soils and 30 degrees C temperature was maintained. In field study herbicides were applied twice for the control of grasses, annual and perennials broad leaves weeds and sedges in rice, wheat and soybean to find out the residual fate of both the herbicides on different matrices of respective crops after harvest. Extraction and clean up methodologies for the herbicides were standardized and subsequently analyzed by HPLC. The study revealed that the half-lives of metsulfuron methyl and chlorimuron ethyl ranged from 10.75 to 13.94 d irrespective of soils and doses applied. Field trials with rice, wheat and soybean also revealed that these two herbicides could safely be recommended for application as no residues were detected in the harvest samples.

Pencycuron dissipation in soil: effect of application rate and soil conditions.

Dissipation of the fungicide pencycuron was examined under controlled laboratory conditions in clay loam soils from rice cultivated fields of alluvial soil (Typic udifluvent) and coastal saline soil (Typic endoaquept) at field rate, twice the field rate and 10 times the field rate with and without decomposed cow manure maintained at 60% of maximum water-holding capacity (WHC) and waterlogged soil condition. The half-life values depended on the initial concentrations of pencycuron. Pencycuron, in general, degraded fastest in coastal saline soil and in soil amended with decomposed cow manure at 60% of maximum WHC of soil.

HPTLC determination of vasicine and vasicinone in Adhatoda vasica.

A simple high-performance thin-layer chromatographic (HPTLC) method has been developed for the simultaneous determination of the pharmacologically important quinazoline alkaloids vasicine and vasicinone in Adhatoda vasica. The assay combines the separation and quantification of the analytes on silica gel 60 GF254 HPTLC plates with visualisation under UV and scanning at 270 and 281 nm. Using this technique, the alkaloidal content of different parts of the title plant have been determined.