Global overview of the management of acute cholecystitis during the COVID-19 pandemic (CHOLECOVID study)

Background: This study provides a global overview of the management of patients with acute cholecystitis during the initial phase of the COVID-19 pandemic. Methods: CHOLECOVID is an international, multicentre, observational comparative study of patients admitted to hospital with acute cholecystitis during the COVID-19 pandemic. Data on management were collected for a 2-month study interval coincident with the WHO declaration of the SARS-CoV-2 pandemic and compared with an equivalent pre-pandemic time interval. Mediation analysis examined the influence of SARS-COV-2 infection on 30-day mortality. Results: This study collected data on 9783 patients with acute cholecystitis admitted to 247 hospitals across the world. The pandemic was associated with reduced availability of surgical workforce and operating facilities globally, a significant shift to worse severity of disease, and increased use of conservative management. There was a reduction (both absolute and proportionate) in the number of patients undergoing cholecystectomy from 3095 patients (56.2 per cent) pre-pandemic to 1998 patients (46.2 per cent) during the pandemic but there was no difference in 30-day all-cause mortality after cholecystectomy comparing the pre-pandemic interval with the pandemic (13 patients (0.4 per cent) pre-pandemic to 13 patients (0.6 per cent) pandemic; P = 0.355). In mediation analysis, an admission with acute cholecystitis during the pandemic was associated with a non-significant increased risk of death (OR 1.29, 95 per cent c.i. 0.93 to 1.79, P = 0.121). Conclusion: CHOLECOVID provides a unique overview of the treatment of patients with cholecystitis across the globe during the first months of the SARS-CoV-2 pandemic. The study highlights the need for system resilience in retention of elective surgical activity. Cholecystectomy was associated with a low risk of mortality and deferral of treatment results in an increase in avoidable morbidity that represents the non-COVID cost of this pandemic

PANC Study (Pancreatitis: A National Cohort Study): national cohort study examining the first 30 days from presentation of acute pancreatitis in the UK

Background Acute pancreatitis is a common, yet complex, emergency surgical presentation. Multiple guidelines exist and management can vary significantly. The aim of this first UK, multicentre, prospective cohort study was to assess the variation in management of acute pancreatitis to guide resource planning and optimize treatment. Methods All patients aged greater than or equal to 18 years presenting with acute pancreatitis, as per the Atlanta criteria, from March to April 2021 were eligible for inclusion and followed up for 30 days. Anonymized data were uploaded to a secure electronic database in line with local governance approvals. Results A total of 113 hospitals contributed data on 2580 patients, with an equal sex distribution and a mean age of 57 years. The aetiology was gallstones in 50.6 per cent, with idiopathic the next most common (22.4 per cent). In addition to the 7.6 per cent with a diagnosis of chronic pancreatitis, 20.1 per cent of patients had a previous episode of acute pancreatitis. One in 20 patients were classed as having severe pancreatitis, as per the Atlanta criteria. The overall mortality rate was 2.3 per cent at 30 days, but rose to one in three in the severe group. Predictors of death included male sex, increased age, and frailty; previous acute pancreatitis and gallstones as aetiologies were protective. Smoking status and body mass index did not affect death. Conclusion Most patients presenting with acute pancreatitis have a mild, self-limiting disease. Rates of patients with idiopathic pancreatitis are high. Recurrent attacks of pancreatitis are common, but are likely to have reduced risk of death on subsequent admissions

Median to radial nerve transfer: An 8-year experience from a lower-middle income country

Introduction: With an incidence of 2-16%, radial nerve palsy is one of the common forms of nerve injuries globally. Radial nerve palsy causes debilitating effects including loss of elbow extension, wrist drop and loss of finger extension. Reparative surgical pathways range from primary repair and neurolysis, to nerve grafting, nerve transfers, and tendon transfers. Due to ease of performance and acceptability and reproducibility of outcomes, tendon transfers are considered the gold standard of radial nerve palsy repair. However, independent finger function cannot be achieved and as such may not give truly desirable results. In lower-middle income countries, the question of nerve transfer versus tendon transfer for patients who are keen to get back to work is key. While tendon transfer recovery is faster, the functional loss is often considered devastating for fine hand function due to loss of grip secondary to lack of wrist and finger extension. In this study, we present our experience of performing median nerve transfers for radial nerve palsy in Pakistan.Methods: We performed a retrospective case-series of patients undergoing median to radial nerve transfer for radial nerve palsy over a period of 6 y, from 2012 to 2019. Patients with radial nerve palsy were diagnosed via electromyography and nerve conduction studies. The procedure involved coapting the branches of the flexor carpi radialis and flexor digitorum superficialis (long and ring finger) nerves to the posterior interosseous nerve and extensor carpi radialis brevis, respectively. Patients were assessed using the Medical Research Council scale for muscle strength of wrist, finger and thumb extension separately at 1 y time. Our results were then compared to results from similar nerve transfer studies.Results: We operated on 10 right-hand dominant patients, eight males and two females with a median age of 33 y (6-63 y). four sustained injury to the right hand and six to the left. Causes of the injuries included road traffic accident (n = 3), firearm injury (n = 4), shrapnel (n = 1), iatrogenic injury (injection in deltoid region (n = 1) and fall (n = 1). Types of fracture included mid humerus fracture, fracture of the surgical neck of the humerus, and supracondylar fracture of the humerus. Median time to surgery since injury was 4 mo (1-8 mo). Independent wrist extension was M4+ in all patients and independent finger extension was M4+ in seven and M4-in two patients. However, a patient who presented late at 8 mo had poorer finger outcomes with extension at M2-. All patients had independent movement of fingers.Conclusions: Nerve transfer is a reliable method of post traumatic nerve repair and reinnervation, particularly in lower-middle income countries, even in cases where the nerve damage is severe and extensive and up to 6 mo may have elapsed between injury and presentation. Timely median to radial nerve transfer is a highly recommended option for radial nerve palsy, with regular follow-ups and physical therapy added to ensure positive outcomes

Estimation of annual effective radon doses and risk of lung cancer in the residents of district Bhimber, Azad Kashmir, Pakistan

Results of indoor radon survey in the dwellings of district Bhimber are presented. Current study is continuation of our preceding studies aiming to setup baseline indoor radon data for the state of Azad Jammu & Kashmir, Pakistan. In this context, 60 representative houses were carefully selected and CN-85 based box type radon detectors were installed in bedrooms and living rooms of each house. The detectors were exposed to indoor radon for 90 days. After etching CN-85 detectors in 6M NaOH at 70°C for 3 hours, the observed track densities were related to the indoor radon concentration using calibration factor of 0.0092 tracks cm2/h per Bq/m3. The measured indoor radon concentration ranged from 29 ± 11 to 58 ± 8 Bq/m3, 40 ± 9 to 60 ± 7 Bq/m3, and 29 ± 12 to 66 ± 7 Bq/m3 in the regions of Bhimber, Samani, and Barnala, respectively. Excess relative risk factors were calculated using measured indoor radon concentrations, by using the risk model reported in the Biological Effects of Ionizing Radiation (BEIR VI, 1999) report. Excess relative risk was calculated for age groups of 35 and 55 years. Using local occupancy factor, average excess lung cancer risk for the population group of 35 and 55 years of age was found to be 0.42 ± 0.09 and 0.34 ± 0.08. The mean annual effective dose for Bhimber, Samani, and Barnala regions were found to be 1.05 ± 0.17 mSv, 1.09 ± 0.17 mSv, and 1.16 ± 0.17 mSv, respectively. These values are within in the safe limits recommended by the international organizations

Impact of Sporisorium scitamineum infection on the qualitative traits of commercial cultivars and advanced lines of sugarcane.

Whip smut disease of sugarcane, caused by Sporisorium scitamineum, is considered one of the main constraints in the successful cultivation of sugarcane. The pathogen infection can decrease the quantity and quality of the produce. Cultivation of resistant varieties is the most feasible strategy to combat the harms of this devastating disease. Development of varieties having disease-resistance together with improved important traits such as brix, pol, purity, CSS, and low fiber contents are desirable. Therefore, we documented the variances in quality traits of 104 sugarcane cultivars under disease pressure in split-plot design with 6 replications. The split ANOVA revealed a highly significant impact (p4.032) in brix, pol, purity, and CSS of more than 40% of the cultivars used, as compared to the uninoculated ones. On the other hand, the smut infection caused a highly significant (t>4.032) increase in fiber percentage of 41 cultivars. We found significant positive correlations between smut rating and reduction of brix, pol, purity, and CSS contents. The cultivars that were caught with greater disease severity, compromised a higher reduction of their useful contents. Similarly, a significant positive correlation was found between increased fiber percent and smut rating. Remarkably, cultivars that showed immune reactions to whip smut disease were not statistically different from uninoculated ones in brix, pol, purity, CSS, and fiber contents. Variable effects of whip smut infection to quality parameters of different cultivars depict the importance of further improvement through breeding programs

Kysy asiantuntijalta riippuvuuksista : julkinen neuvontapalsta A-klinikkasäätiön Päihdelinkissä

Päihdelinkki on A-klinikkasäätiön ylläpitämä internetpalvelu päihteistä ja riippuvuuksista. Päihdelin-kissä on tarjottu henkilökohtaista verkkoneuvontaa vuodesta 1998 lähtien. Loppuvuodesta 2008 Päihde-linkin keskustelualueelle perustettiin julkinen neuvontapalsta, asiantuntijapalsta, joka oli toiminnassa 7.10-30.11.2008. Palstalle pystyi kirjoittamaan kysymyksen, johon asiantuntijat kävivät vastaamassa noin viikon kuluessa. Kysymysten kirjoittaminen ja lukeminen ei vaatinut rekisteröitymistä, vaan ky-symykset vastauksineen olivat kaikkien palstan kävijöiden nähtävissä. Palstan vastaajina toimi kahdek-san päihdealan ammattilaista. Tämän opinnäytetyön tarkoituksena oli kuvata palstan toimintaa ja sinne tulleita kysymyksiä: mitä aihealuetta palstalle tulleet kysymykset käsittelivät, koskivatko kysymykset kysyjän omaa vai jonkun läheisen tilannetta ja mitä kysyjä kysymyksellään palstalta haki. Tämän lisäksi tarkoituksena oli myös selvittää vastaajien näkemyksiä ja kokemuksia julkisesta neuvontapalvelusta. Opinnäytetyöni on triangulaatiotutkimus. Aineistona käytin palstalle tulleita kysymyksiä sekä materiaalia, jonka keräsin lähettämällä sähköisen kyselylomakkeen palstan vastaajille. Analyysimenetelminä käytin aineistolähtöistä sisällönanalyysiä ja tilastollisia menetelmiä, kuten ristiintaulukointia. Palstalle lähetettiin yhteensä 52 kysymystä. Suurin osa kysymyksistä käsitteli alkoholinkäyttöä, mutta kysymyksiä tuli runsaasti myös huumeista ja lääkkeistä. Kysymyksistä lähes kaksi kolmannesta koski kysyjän omaa tilannetta ja eniten kysymyksillä haettiin tukea omien valintojen tekemiseen. Myös faktatietoa päihteistä ja neuvoja riippuvuusongelman ratkaisemiseksi haettiin. Koska tulokset koskevat vain yksittäistä tapausta, ei niitä voida yleistää koskemaan kaikkia julkisia neuvontapalstoja. Tarpeen olisikin tutkia, haetaanko muiltakin julkisilta neuvontapalstoilta näitä samoja asioita. Sähköiseen kyselyyn vastasi viisi palstan vastaajaa. Palstan tekninen toteutus onnistui hyvin, lukuun ottamatta kysymysten varausjärjestelmää, joka koettiin aluksi hieman sekavaksi. Vastaajien mielestä julkinen neuvontapalsta on hyvä lisäpalvelu, mutta sitä ei ole tarpeen tarjota jatkuvasti. Palstan avulla voidaan auttaa useampia kuin henkilökohtaisella neuvontapalvelulla, sillä kysymyksiä vastauksineen voi lukea myös ne, jotka eivät itse uskalla kysyä. Toisten samankaltaisen tilanteen huomaaminen voi rohkaista ottamaan itsekin yhteyttä tai hakemaan muulla tavalla apua.AddictionLink is an online service maintained by the A-Clinic Foundation, which deals with drugs and addictions. AddictionLink has offered online advice for individuals since 1998. At the end of 2008 an open advice site, an expert advice column, was created on the AddictionLink's discussion site. This expert column was in operation from 7.10.2008 until 30.11.2008. People could write questions to this site which the experts would reply within a week. Creating questions for the experts and reading the column did not require registration; all questions and answers were available for all visitors. The expert board consisted of eight trained specialists working with substance abusers. The goal of this study was to describe the function of the column and the questions it received: what did the questions that were received deal with, did the questions concern the situation of the person posing the question or someone else, and what sort of an end result people were hoping for. In addition to this, one of the main purposes was to discover what kind of ideas and experiences the respondents had on the public advice services. The study was conducted by triangular research. The material consisted of questions sent to the ad-vice column as well as material collected by sending an online questionnaire to those replying to the questions. The methods of analysis were material-based content analysis and statistical methods such as cross tabulation. In total, there were 52 questions sent to the column. Most of the questions dealt with the use of al-cohol, but there were also a great deal of questions on narcotics and prescription medicines. Two thirds of the questions were from people experiencing the problems - they were mostly concerned with getting support for making their own choices. There were also requests for factual information on narcotics and help on how to solve substance abuse problems. Because the results of the questionnaire only dealt with one particular case at a time, they could not be generalised to depict all public advice columns. In order to do generalisations it would be necessary to see if other advice columns receive similar questions. The online questionnaire was answered by five of the experts. The technical implementation was a success, with the exception of the booking system for the questions, which was considered confusing at first. The experts thought that a public advice column was a good extra service but it would not be ne-cessary to have it available all the time. More people can be helped with the column than with an indi-vidual advice service, because its questions and answers can also be read by those who dare not pose any questions of their own. Finding out that others are in a similar situation may encourage people to get in touch with experts or seek help in other ways