Evaluation of Groundwater for Arsenic Contamination Using Hydrogeochemical Properties and Multivariate Statistical Methods in Saudi Arabia

The aim of this research is to evaluate arsenic distribution and associated hydrogeochemical parameters in 27 randomly selected boreholes representing aquifers in the Al-Kharj geothermal fields of Saudi Arabia. Arsenic was detected at all sites, with 92.5% of boreholes yielding concentrations above the WHO permissible limit of 10 μg/L. The maximum concentration recorded was 122 μg/L (SD = 29 μg/L skewness = 1.87). The groundwater types were mainly Ca+2-Mg+2-SO4-2-Cl− and Na+-Cl−-SO4-2, accounting for 67% of the total composition. Principal component analysis (PCA) showed that the main source of arsenic release was geothermal in nature and was linked to processes similar to those involved in the release of boron. The PCA yielded five components, which accounted for 44.1%, 17.0%, 10.1%, 08.4%, and 06.5% of the total variance. The first component had positive loadings for arsenic and boron along with other hydrogeochemical parameters, indicating the primary sources of As mobilization are derived from regional geothermal systems and weathering of minerals. The remaining principal components indicated reductive dissolution of iron oxyhydroxides as a possible mechanism. Spatial evaluation of the PCA results indicated that this secondary mechanism of arsenic mobilization may be active and correlates positively with total organic carbon. The aquifers were found to be contaminated to a high degree with organic carbon ranging from 0.57 mg/L to 21.42 mg/L and showed high concentrations of NO3- ranging from 8.05 mg/L to 248.2 mg/L

Pancreatic surgery outcomes: multicentre prospective snapshot study in 67 countries

BACKGROUND: Pancreatic surgery remains associated with high morbidity rates. Although postoperative mortality appears to have improved with specialization, the outcomes reported in the literature reflect the activity of highly specialized centres. The aim of this study was to evaluate the outcomes following pancreatic surgery worldwide. METHODS: This was an international, prospective, multicentre, cross-sectional snapshot study of consecutive patients undergoing pancreatic operations worldwide in a 3-month interval in 2021. The primary outcome was postoperative mortality within 90 days of surgery. Multivariable logistic regression was used to explore relationships with Human Development Index (HDI) and other parameters. RESULTS: A total of 4223 patients from 67 countries were analysed. A complication of any severity was detected in 68.7 per cent of patients (2901 of 4223). Major complication rates (Clavien–Dindo grade at least IIIa) were 24, 18, and 27 per cent, and mortality rates were 10, 5, and 5 per cent in low-to-middle-, high-, and very high-HDI countries respectively. The 90-day postoperative mortality rate was 5.4 per cent (229 of 4223) overall, but was significantly higher in the low-to-middle-HDI group (adjusted OR 2.88, 95 per cent c.i. 1.80 to 4.48). The overall failure-to-rescue rate was 21 per cent; however, it was 41 per cent in low-to-middle- compared with 19 per cent in very high-HDI countries. CONCLUSION: Excess mortality in low-to-middle-HDI countries could be attributable to failure to rescue of patients from severe complications. The authors call for a collaborative response from international and regional associations of pancreatic surgeons to address management related to death from postoperative complications to tackle the global disparities in the outcomes of pancreatic surgery (NCT04652271; ISRCTN95140761

Evaluation of Groundwater for Arsenic Contamination Using Hydrogeochemical Properties and Multivariate Statistical Methods in Saudi Arabia

The aim of this research is to evaluate arsenic distribution and associated hydrogeochemical parameters in 27 randomly selected boreholes representing aquifers in the Al-Kharj geothermal fields of Saudi Arabia. Arsenic was detected at all sites, with 92.5% of boreholes yielding concentrations above the WHO permissible limit of 10 μg/L. The maximum concentration recorded was 122 μg/L (SD = 29 μg/L skewness = 1.87). The groundwater types were mainly Ca+2-Mg+2-SO4-2-Cl− and Na+-Cl−-SO4-2, accounting for 67% of the total composition. Principal component analysis (PCA) showed that the main source of arsenic release was geothermal in nature and was linked to processes similar to those involved in the release of boron. The PCA yielded five components, which accounted for 44.1%, 17.0%, 10.1%, 08.4%, and 06.5% of the total variance. The first component had positive loadings for arsenic and boron along with other hydrogeochemical parameters, indicating the primary sources of As mobilization are derived from regional geothermal systems and weathering of minerals. The remaining principal components indicated reductive dissolution of iron oxyhydroxides as a possible mechanism. Spatial evaluation of the PCA results indicated that this secondary mechanism of arsenic mobilization may be active and correlates positively with total organic carbon. The aquifers were found to be contaminated to a high degree with organic carbon ranging from 0.57 mg/L to 21.42 mg/L and showed high concentrations of NO3- ranging from 8.05 mg/L to 248.2 mg/L

Evaluation of Groundwater for Arsenic Contamination Using Hydrogeochemical Properties and Multivariate Statistical Methods in Saudi Arabia

e aim of this research is to evaluate arsenic distribution and associated hydrogeochemical parameters in 27 randomly selected boreholes representing aquifers in the Al-�harj geothermal �elds of Saudi Arabia. Arsenic was detected at all sites, with 92.5% of boreholes yielding concentrations above the WHO permissible limit of 10 g/L. e maximum concentration recorded was 122 g/L (SD = 29 g/L skewness = 1.87). e groundwater types were mainly Ca +2 -Mg +2 -SO 4 −2 -Cl − and Na + -Cl − -SO 4 −2 , accounting for 67% of the total composition. Principal component analysis (PCA) showed that the main source of arsenic release was geothermal in nature and was linked to processes similar to those involved in the release of boron. e PCA yielded �ve components, which accounted for 44.1%, 17.0%, 10.1%, 08.4%, and 06.5% of the total variance. e �rst component had positive loadings for arsenic and boron along with other hydrogeochemical parameters, indicating the primary sources of As mobilization are derived from regional geothermal systems and weathering of minerals. e remaining principal components indicated reductive dissolution of iron oxyhydroxides as a possible mechanism. Spatial evaluation of the PCA results indicated that this secondary mechanism of arsenic mobilization may be active and correlates positively with total organic carbon. e aquifers were found to be contaminated to a high degree with organic carbon ranging from 0.57 mg/L to 21.42 mg/L and showed high concentrations of NO 3 − ranging from 8.05 mg/L to 248.2 mg/L

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population

Global Incidence and Risk Factors Associated With Postoperative Urinary Retention Following Elective Inguinal Hernia Repair

Importance Postoperative urinary retention (POUR) is a well-recognized complication of inguinal hernia repair (IHR). A variable incidence of POUR has previously been reported in this context, and contradictory evidence surrounds potential risk factors.Objective To ascertain the incidence of, explore risk factors for, and determine the health service outcomes of POUR following elective IHR.Design, Setting, and Participants The Retention of Urine After Inguinal Hernia Elective Repair (RETAINER I) study, an international, prospective cohort study, recruited participants between March 1 and October 31, 2021. This study was conducted across 209 centers in 32 countries in a consecutive sample of adult patients undergoing elective IHR.Exposure Open or minimally invasive IHR by any surgical technique, under local, neuraxial regional, or general anesthesia.Main Outcomes and Measures The primary outcome was the incidence of POUR following elective IHR. Secondary outcomes were perioperative risk factors, management, clinical consequences, and health service outcomes of POUR. A preoperative International Prostate Symptom Score was measured in male patients.Results In total, 4151 patients (3882 male and 269 female; median [IQR] age, 56 [43-68] years) were studied. Inguinal hernia repair was commenced via an open surgical approach in 82.2% of patients (n = 3414) and minimally invasive surgery in 17.8% (n = 737). The primary form of anesthesia was general in 40.9% of patients (n = 1696), neuraxial regional in 45.8% (n = 1902), and local in 10.7% (n = 446). Postoperative urinary retention occurred in 5.8% of male patients (n = 224), 2.97% of female patients (n = 8), and 9.5% (119 of 1252) of male patients aged 65 years or older. Risk factors for POUR after adjusted analyses included increasing age, anticholinergic medication, history of urinary retention, constipation, out-of-hours surgery, involvement of urinary bladder within the hernia, temporary intraoperative urethral catheterization, and increasing operative duration. Postoperative urinary retention was the primary reason for 27.8% of unplanned day-case surgery admissions (n = 74) and 51.8% of 30-day readmissions (n = 72).Conclusions The findings of this cohort study suggest that 1 in 17 male patients, 1 in 11 male patients aged 65 years or older, and 1 in 34 female patients may develop POUR following IHR. These findings could inform preoperative patient counseling. In addition, awareness of modifiable risk factors may help to identify patients at increased risk of POUR who may benefit from perioperative risk mitigation strategies

Pancreatic surgery outcomes: multicentre prospective snapshot study in 67 countries

Background: Pancreatic surgery remains associated with high morbidity rates. Although postoperative mortality appears to have improved with specialization, the outcomes reported in the literature reflect the activity of highly specialized centres. The aim of this study was to evaluate the outcomes following pancreatic surgery worldwide.Methods: This was an international, prospective, multicentre, cross-sectional snapshot study of consecutive patients undergoing pancreatic operations worldwide in a 3-month interval in 2021. The primary outcome was postoperative mortality within 90 days of surgery. Multivariable logistic regression was used to explore relationships with Human Development Index (HDI) and other parameters.Results: A total of 4223 patients from 67 countries were analysed. A complication of any severity was detected in 68.7 percent of patients (2901 of 4223). Major complication rates (Clavien-Dindo grade at least IIIa) were 24, 18, and 27 percent, and mortality rates were 10, 5, and 5 per cent in low-to-middle-, high-, and very high-HDI countries respectively. The 90-day postoperative mortality rate was 5.4 per cent (229 of 4223) overall, but was significantly higher in the low-to-middle-HDI group (adjusted OR 2.88, 95 per cent c.i. 1.80 to 4.48). The overall failure-to-rescue rate was 21 percent; however, it was 41 per cent in low-to-middle-compared with 19 per cent in very high-HDI countries.Conclusion: Excess mortality in low-to-middle-HDI countries could be attributable to failure to rescue of patients from severe complications. The authors call for a collaborative response from international and regional associations of pancreatic surgeons to address management related to death from postoperative complications to tackle the global disparities in the outcomes of pancreatic surgery (NCT04652271; ISRCTN95140761)