Routine group and save screening prior to emergency laparoscopic surgery.

INTRODUCTION: Two group and save (G&S) samples are routinely collected from patients undergoing diagnostic laparoscopy and/or emergency appendicectomy. We aimed to identify the necessity of this practice by looking at the perioperative transfusion rates. METHODS: Data were obtained from our electronic theatre system for all patients who underwent emergency laparoscopic surgery (specifically diagnostic laparoscopy and/or laparoscopic appendicectomy) between January 2017 and December 2018. Records were reviewed for the number of G&S samples sent and perioperative transfusion rates. RESULTS: A total of 451 patients were included in the study. The numbers of procedures performed in 2017 and 2018 were 202 (44.8%) and 249 (55.2%), respectively. The total number of samples sent was 930. Only 786 (84.5%) samples were processed and the rest were rejected for various reasons. Of the 451 patients included in the study, 308 (68.3%) had two G&S samples sent, whereas 41 patients (9.1%) had only one G&S sample sent. Fifty-six (12.4%) and 20 (4.4%) patients had three and four G&S samples sent, respectively. Only two patients required transfusion perioperatively (0.4%), and the indication in both was irrelevant to the primary operation. CONCLUSIONS: These results demonstrate a near-zero transfusion rate in this patient cohort. Omitting G&S is safe and potentially saves time and resources.

Accumulation of essential (copper, iron, zinc) and non-essential (lead, cadmium) heavy metals in Caulerpa racemosa, sea water, and marine sediments of Bintan Island, Indonesia.

Background: Heavy metals are materials naturally occurring in nature and increase with a rise in human activity. Ex-mining areas and domestic waste from human settlements are sources of heavy metal contamination that enter and pollute water, which then accumulates in various organisms including the  Caulerpa racemosa community. The accumulation of heavy metals in  C. racemosa has a wide impact on the food chain in aquatic ecosystems and humans because this alga is a consumptive commodity.   Methods: Sampling of  C. racemosa was carried out at seven sites on Bintan Island, Indonesia covering the eastern (Teluk Bakau, Beralas Pasir, Malang Rapat), northern (Berakit and Pengudang), western (Sakera), and southern parts (Tg. Siambang). Sampling was carried out during different monsoons, and heavy metals in water and sediment samples were measured to determine the heavy metal concentration. Heavy metals were analyzed by a spectrophotometric method using Atomic Absorption Spectrophotometry.   Results: The results showed that heavy metal concentrations fluctuate according to changes in the wind season, which carry currents and spread pollutants into the water. The concentration of metal in the water is also from anthropogenic activities. The heavy metal content of cadmium (Cd), lead (Pb), copper (Cu), iron (Fe), and zinc (Zn) in  C. racemosa is high in locations close to settlements. Meanwhile, in seawater samples, Fe and Zn metals have the highest concentrations compared to others.  Conclusions: Ex-bauxite mines are a source of Fe and Zn metal contamination in the environment, especially at Tg. Siambang. The levels of these heavy metals in the sediment are also high, as surface particle deposits accumulate at the bottom of the sediment. In general, the levels of heavy metals Cd, Pb, Cu, Fe, and Zn increase in the northern monsoon because the dynamics of the water transport greater heavy metal pollution.

Bleaching and necrosis of staghorn coral (Acropora formosa) in laboratory assays: Immediate impact of LDPE microplastics.

The impact of low-density polyethylene (LDPE) microplastics (<100 µm; P100-A P100-B, P100-C, 100-200 µm; P200, 200-500 µm; P500) on Acropora formosa was investigated. This study investigated the bleaching and necrosis extent of A. formosa caused by LDPE contamination via laboratory assay. The staghorn coral ingested the microplastics, resulting in bleaching and necrosis that concomitantly occurred with the release of zooxanthellae. P100-A experimentation was the worst case, showing bleaching by day 2 (10.8 ±â€¯2.2%) and continued bleaching to 93.6% ±â€¯2.0 by day 14 followed by 5.9 ±â€¯2.5% necrosis. The overall results confirmed that the LDPE concentration impacts coral health. We highlighted that microplastics have been ingested and partially egested. Their presence showed either a direct or indirect impact on coral polyps via direct interaction or through photosynthesis perturbation due to microplastics that cover the coral surface.

Role of selenium in male reproduction - a review.

The role of Se and various selenoproteins in male reproductive performance is reviewed. Development of male reproductive tissue requires an optimal level of Se in testis, and a small deviation, either deficiency or excess, leads to abnormal development. Selenium is a constituent of selenoproteins including GPx1, GPx3, mGPx4, cGPx4, and GPx5 that protect against oxidative damage to spermatozoa throughout the process of sperm maturation, whereas selenoproteins, such as mGPx4 and snGPx4, serve as structural components of mature spermatozoa. Thus Se and selenoproteins ensure viability of spermatozoa as well as providing protection against reactive oxygen species. Gene knock-out studies of selenoproteins revealed that their absence during spermatogenesis results in abnormal spermatozoa, which in turn affects semen quality and fertility. Deviation from the optimal quantities of dietary Se, both above or below, may cause multiple abnormalities of spermatozoa and affect motility and fertility. Libido may also be increased by Se. Dietary Se should be in optimal quantity to maintain reproductive function in males and to avoid infertility.

The incidence and magnitude of fibrinolytic activation in trauma patients.

BACKGROUND: Trauma is a global disease, with over 2.5 million deaths annually from hemorrhage and coagulopathy. Overt hyperfibrinolysis is rare in trauma, and is associated with massive fatal injuries. Paradoxically, clinical trials suggest a much broader indication for antifibrinolytics. OBJECTIVE: To determine the incidence and magnitude of fibrinolytic activation in trauma patients and its relationship to clot lysis as measured by thromboelastometry. METHODS: A prospective cohort study of 303 consecutive trauma patients admitted between January 2007 and June 2009 was performed. Blood was drawn on arrival for thromboelastometry (TEM) and coagulation assays. Follow-up was until hospital discharge or death. TEM hyperfibrinolysis was defined as maximum clot lysis of > 15%. Fibrinolytic activation (FA) was determined according to plasmin-antiplasmin (PAP) complex and D-dimer levels. Data were collected on demographics, mechanism, severity of injury, and baseline vital signs. The primary outcome measure was 28-day mortality. The secondary outcome measures were 28-day ventilator-free days and 24-h transfusion requirement. RESULTS: Only 5% of patients had severe fibrinolysis on TEM, but 57% of patients had evidence of 'moderate' fibrinolysis, with PAP complex levels elevated to over twice normal (> 1500 µg L(-1)) without lysis on TEM. TEM detected clot lysis only when PAP complex levels were increased to 30 times normal (P < 0.001) and antiplasmin levels were < 75% of normal. Patients with FA had increased 28-day mortality as compared with those with no FA (12% vs. 1%, P < 0.001), fewer ventilator-free days, and longer hospital stay. CONCLUSIONS: FA occurs in the majority of trauma patients, and the magnitude of FA correlates with poor clinical outcome. This was not detected by conventional TEM, which is an insensitive measure of endogenous fibrinolytic activity.

Fibrinogen levels during trauma hemorrhage, response to replacement therapy, and association with patient outcomes.

BACKGROUND: Low fibrinogen levels are known to occur in trauma. However, the extent of fibrinogen depletion during trauma hemorrhage, the response to replacement therapy and association with patient outcomes remain unclear. OBJECTIVES: The study aims were to: characterize admission fibrinogen level and correlate it with factors associated with injury; describe the time course of fibrinogen depletion and response to replacement therapy; determine the correlation of fibrinogen level with rotational thromboelastography (ROTEM) parameters; evaluate the effect of fibrinogen supplementation ex vivo; and establish the association between fibrinogen level and clinical outcomes. METHODS: This was a prospective cohort study of 517 patients. Blood samples were drawn on admission and after admistration of every 4 units of packed red blood cells. Fibrinogen levels were determined with the Clauss method, and global hemostatic competence was assessed with thromboelastometry. The effect of fibrinogen supplementation was assessed in a subgroup of coagulopathic patients. RESULTS: Low admission fibrinogen level was independently associated with injury severity score (P < 0.01), shock (P < 0.001), and prehospital fluid volume (P < 0.001). Fibrinogen supplementation during transfusion maintained but did not augment fibrinogen levels. Administration of cryoprecipitate was associated with improved survival. ROTEM parameters correlated with fibrinogen level, and ex vivo fibrinogen administration reversed coagulopathic ROTEM parameters. Fibrinogen level was an independent predictor of mortality at 24 h and 28 days (P < 0.001). CONCLUSIONS: Fibrinogen level is decreased in injured patients on admission and is associated with poor outcomes. ROTEM is a rapid means of assessing hypofibrinogenemia. Earlier administration of specific fibrinogen replacement may improve outcomes, and prospective controlled trials are urgently needed.