The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

Retinal pigment epithelial atrophy following indocyanine green dye-assisted surgery for serous macular detachment

To report subretinal migration of indocyanine green dye (ICG) and subsequent retinal pigment epithelial (RPE) atrophy during macular surgery for serous macular detachment. A 65-year-old woman presented with residual epiretinal membrane and serous detachment of the macula following vitreoretinal surgery for epiretinal membrane. She underwent resurgery with ICG-assisted internal limiting membrane peeling and intraocular tamponade. Intraoperatively a large area of subretinal ICG was seen with subsequent RPE mottling and atrophy of the macula in the area involved during follow-up. This case demonstrates that subretinal migration of ICG is possible and can be toxic to RPE

Low-Level Laser Therapy and Topical Medications for Treating Aphthous Ulcers:A Systematic Review

Objective: The study compares low-level laser therapy with topical medications for treating aphthous ulcers. Methods: A search of articles in this systematic review was completed in six databases. Treatment and comparative groups comprised of patients subjected to laser therapy and topical medications, respectively. Two different treatment outcomes were considered; pain and size of the lesion. Risk of bias was assessed using the Revised Cochrane risk-of-bias tool for randomized trials. Results: From 109 articles, five randomized control trials fulfilled the selection criteria. The overall sample comprised of 98 males and 232 females, with a mean age of 32.4 years. The laser therapies in each included study had different active media and varying wavelengths. Topical medication used in the comparative group were triamcinolone acetonide, amlexanox, granofurin, and solcoseryl. Findings showed that patients who reported lower pain and decreased aphthous ulcer lesions were more in the laser therapy group than in the topical medication group. Conclusion: Low-level laser therapy was better in treating aphthous ulcer lesions in comparison to topical medications, and all laser wavelengths in the included reports were seen to be effective. However, the results should be interpreted with caution, because no study demonstrated low-risk of bias in all the assessed domains

Paleoproductivity shifts since the last 130 ka off Lakshadweep, Southeastern Arabian Sea

Marine sediment deposited on the ocean floor and near coastal areas, the western coastal regions of India provide records of monsoonal shifts and productivity. To understand the paleoproductivity in the northern Indian Ocean, we analyzed carbon, hydrogen, nitrogen, sulfur, total organic carbon (TOC) and calcium carbonate (CaCO3) in a deep-sea sediment core collected using gravity corer (GC-01) off Lakshadweep, Southeastern Arabian Sea. The results were then compared with the previous data generated from the surrounding area sediment cores to understand the productivity variations since the last 130 ka. The CaCO3 content in the sediment core varies from 40.82% to 62.48% (with a mean value of 51.96%) and it is noted that these values were lower during the glacial episodes (Marine Isotope Stages-2 and 4) than the interglacial episodes (MIS-1, 3 and 5). The C/N ratio varied from 0.14 to 34.25, but was less than 9, since ∼74 ka to recent, suggesting a marine origin for the organic carbon. The C/N ratio fluctuated significantly during MIS-5, and relatively the highest C/N ratio was observed at 5e ∼127, 5d ∼110 and 5b ∼85 ka, corresponding to stadials 5b and 5d, (except 5e) indicating terrestrial OC from C3 plants. The low C/N ratios during ∼128, ∼102, ∼76 and ∼32 ka match with the interstadials especially during MIS 5 (5a, 5c and 5e), correspondingly, and are marine OC in the source. This suggests that the MIS-5 stadial was interrupted via land source signifying higher productivity owing to the strong southwest monsoon during these periods. Further, high productivity was also observed during the Last Glacial Maximum (LGM) and Holocene in the Southeastern Arabian Sea since the 130 ka.Ministry of Earth Science (MoES), Govt. of India with reference number MoES/16/07/11(i)-RDEAS and MoES/P.O.(Seismic)8(09)-Geochron/201

Low-Level Laser Therapy and Topical Medications for Treating Aphthous Ulcers: A Systematic Review

Objective: The study compares low-level laser therapy with topical medications for treating aphthous ulcers. Methods: A search of articles in this systematic review was completed in six databases. Treatment and comparative groups comprised of patients subjected to laser therapy and topical medications, respectively. Two different treatment outcomes were considered; pain and size of the lesion. Risk of bias was assessed using the Revised Cochrane risk-of-bias tool for randomized trials. Results: From 109 articles, five randomized control trials fulfilled the selection criteria. The overall sample comprised of 98 males and 232 females, with a mean age of 32.4 years. The laser therapies in each included study had different active media and varying wavelengths. Topical medication used in the comparative group were triamcinolone acetonide, amlexanox, granofurin, and solcoseryl. Findings showed that patients who reported lower pain and decreased aphthous ulcer lesions were more in the laser therapy group than in the topical medication group. Conclusion: Low-level laser therapy was better in treating aphthous ulcer lesions in comparison to topical medications, and all laser wavelengths in the included reports were seen to be effective. However, the results should be interpreted with caution, because no study demonstrated low-risk of bias in all the assessed domains