Effects of Arsenic and Cadmium on the Post Larvae of Giant Freshwater Prawn (Macrobrachium rosenbergii) a Preliminary Study

Arsenic (As) and Cadmium (Cd) are two of the heavy metals that gained public and nationalattention of the Sri Lankan community. Globally, As and Cd are reported as two of the mosttoxic heavy metals that cause physiological and biochemical alterations and mortality inexposed organisms. Cadmium levels in the range of 0.001 to 0.138 mg l-1 have been reportedin both ground and surface water sources of Sri Lanka. Few studies in the country havedocumented levels of arsenic in natural water bodies. Furthermore, studies assessing thepotential toxicity of these two metals to species that are of importance to Sri Lanka, arescarce. The aim of this preliminary study was to investigate the effects of environmentallyrelevant levels of As and Cd on the commercially exploited fresh water prawnMacrobrachium rosenbergii, using its post larvae, which are initially released into reservoirsin Sri Lanka. Post larvae were collected from a culture facility in Pambala, Chilaw and weremaintained in glass beakers. They were acclimatized before use for 96 hr acute toxicity trials,where they were exposed to a series of concentrations of either As (from 0.001 to 0.08 mg l-1)and Cd (from 0.001 to 0.05 mg l-1). Constant experimental conditions were maintained inboth the control and treatment, each conducted in triplicate.The results show that the heavy metals at the tested concentrations induced significantlyhigher levels of mortality (p<0.05). For instance, the lowest test level of As (0.001 mg l-1)induced a twofold higher level of mortality (50%) than the control (20 %), whilst that withthe lowest level of Cd was also similarly high (46.7 %). A strong and positive dose dependenttrend (R2 = 0.87; p<0.05) was, however, evident only for Cd. Comparing the toxicity of theheavy metals in terms of inducing mortality, Cd appears to be potentially more toxic than As.A level of 0.05 mg l-1 of Cd induced 99 % mortality in the post larvae, whilst a higher level ofAs (0.08 mg l-1) induced only around 56 % mortality. It is interesting that both heavy metalsdid not cause marked alterations in growth with no significant differences being evidentbetween the body sizes of the control and treated larvae after exposure. It should however benoted that there was a greater deviation in body sizes in treated larvae than in those of thecontrol, indicating that there may be differential sensitivity among the individual larvae. Theresults of this study are important since heavy metal pollution may threaten the incomegenerating capacity of Sri Lanka’s inland reservoir fishery.

Critical care usage after major gastrointestinal and liver surgery: a prospective, multicentre observational study

Background Patient selection for critical care admission must balance patient safety with optimal resource allocation. This study aimed to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery. Methods This prespecified secondary analysis of a multicentre, prospective, observational study included consecutive patients enrolled in the DISCOVER study from UK and Republic of Ireland undergoing major gastrointestinal and liver surgery between October and December 2014. The primary outcome was 30-day mortality. Multivariate logistic regression was used to explore associations between critical care admission (planned and unplanned) and mortality, and inter-centre variation in critical care admission after emergency laparotomy. Results Of 4529 patients included, 37.8% (n=1713) underwent planned critical care admissions from theatre. Some 3.1% (n=86/2816) admitted to ward-level care subsequently underwent unplanned critical care admission. Overall 30-day mortality was 2.9% (n=133/4519), and the risk-adjusted association between 30-day mortality and critical care admission was higher in unplanned [odds ratio (OR): 8.65, 95% confidence interval (CI): 3.51–19.97) than planned admissions (OR: 2.32, 95% CI: 1.43–3.85). Some 26.7% of patients (n=1210/4529) underwent emergency laparotomies. After adjustment, 49.3% (95% CI: 46.8–51.9%, P<0.001) were predicted to have planned critical care admissions, with 7% (n=10/145) of centres outside the 95% CI. Conclusions After risk adjustment, no 30-day survival benefit was identified for either planned or unplanned postoperative admissions to critical care within this cohort. This likely represents appropriate admission of the highest-risk patients. Planned admissions in selected, intermediate-risk patients may present a strategy to mitigate the risk of unplanned admission. Substantial inter-centre variation exists in planned critical care admissions after emergency laparotomies

Body mass index and complications following major gastrointestinal surgery: A prospective, international cohort study and meta-analysis

Aim Previous studies reported conflicting evidence on the effects of obesity on outcomes after gastrointestinal surgery. The aims of this study were to explore the relationship of obesity with major postoperative complications in an international cohort and to present a metaanalysis of all available prospective data. Methods This prospective, multicentre study included adults undergoing both elective and emergency gastrointestinal resection, reversal of stoma or formation of stoma. The primary end-point was 30-day major complications (Clavien–Dindo Grades III–V). A systematic search was undertaken for studies assessing the relationship between obesity and major complications after gastrointestinal surgery. Individual patient meta-analysis was used to analyse pooled results. Results This study included 2519 patients across 127 centres, of whom 560 (22.2%) were obese. Unadjusted major complication rates were lower in obese vs normal weight patients (13.0% vs 16.2%, respectively), but this did not reach statistical significance (P = 0.863) on multivariate analysis for patients having surgery for either malignant or benign conditions. Individual patient meta-analysis demonstrated that obese patients undergoing surgery formalignancy were at increased risk of major complications (OR 2.10, 95% CI 1.49–2.96, P < 0.001), whereas obese patients undergoing surgery for benign indications were at decreased risk (OR 0.59, 95% CI 0.46–0.75, P < 0.001) compared to normal weight patients. Conclusions In our international data, obesity was not found to be associated with major complications following gastrointestinal surgery. Meta-analysis of available prospective data made a novel finding of obesity being associated with different outcomes depending on whether patients were undergoing surgery for benign or malignant disease