The use of rapid sampling microdialysis in monitoring human bowel and anastomosis ischaemia

Intestinal ischaemia especially in the postoperative period is a complication that is dreaded by all general surgeons and poses a considerable rise in mortality and morbidity of patients, not to mention the burden it puts on the physician and on the healthcare system. Its diagnosis is always subjective relying mostly on the physicians’ awareness and clinical suspicion rather than on any quantitative method. This project explores a quantitative tool and adapts online rapid sampling microdialysis (from its use in monitoring brain tissue ischaemia) to monitor ischaemia in human bowel and bowel anastomosis. It describes its translation from the bench top model, to the pilot model, to the animal model, and finally its application in the clinical setting to monitor patients for bowel ischaemia. The online microdialysis analyzer used in monitoring brain tissue in Kings College Hospital was modified and converted for use in the setting to monitor bowel in the labs of the Bioengineering Department at Imperial College London, under collaboration with the Department of Bio Surgery and Surgical Technology. The system was designed and construction supervised by Dr. Martyn Boutelle; and work on the system to construct and optimize carried out by PhD student Emma Corcoles. The clinical collaborate of the project was supervised by Professor Ara Darzi and carried out by Mr. Samer Deeba with joint supervision by Professor George Hanna. The catheter, connections, and deployment was optimized at St. Mary’s Hospital, part of Imperial College NHS trust. This project did prove the efficacy of microdialysis in monitoring bowel ischaemia in the clinical setting, but needs further work and development in the design of the catheter and miniaturizing the analyzer to be more reliable and robust. Multicenter trials are needed to gain its wide acceptance in the clinical practice

Surgical removal of a tea spoon from the ascending colon, ten years after ingestion: a case report

INTRODUCTION: The presentation of ingested foreign bodies in the gastrointestinal system is common in the emergency setting. The majority responds to conservative management and passes spontaneously; however, giant foreign bodies pose a management difficulty. We report a peculiar case of a giant foreign body (spoon) that presented very late after ingestion and the management of this presentation. CASE PRESENTATION: A 30-year-old British white male barrister presented with abdominal pain 10 years after he swallowed a spoon that never passed spontaneously. His workup revealed the spoon lodged in his ascending colon. Laparoscopic retrieval was not feasible so a laparotomy was done for retrieval. He did well and went home with no complications. CONCLUSION: Symptomatic giant ingested foreign bodies represent a management challenge sometimes and usually necessitate surgical intervention when all conservative means fail. We review the literature on management of giant ingested foreign bodies

Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Background: Detailed, comprehensive, and timely reporting on population health by underlying causes of disability and premature death is crucial to understanding and responding to complex patterns of disease and injury burden over time and across age groups, sexes, and locations. The availability of disease burden estimates can promote evidence-based interventions that enable public health researchers, policy makers, and other professionals to implement strategies that can mitigate diseases. It can also facilitate more rigorous monitoring of progress towards national and international health targets, such as the Sustainable Development Goals. For three decades, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has filled that need. A global network of collaborators contributed to the production of GBD 2021 by providing, reviewing, and analysing all available data. GBD estimates are updated routinely with additional data and refined analytical methods. GBD 2021 presents, for the first time, estimates of health loss due to the COVID-19 pandemic. Methods: The GBD 2021 disease and injury burden analysis estimated years lived with disability (YLDs), years of life lost (YLLs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries using 100 983 data sources. Data were extracted from vital registration systems, verbal autopsies, censuses, household surveys, disease-specific registries, health service contact data, and other sources. YLDs were calculated by multiplying cause-age-sex-location-year-specific prevalence of sequelae by their respective disability weights, for each disease and injury. YLLs were calculated by multiplying cause-age-sex-location-year-specific deaths by the standard life expectancy at the age that death occurred. DALYs were calculated by summing YLDs and YLLs. HALE estimates were produced using YLDs per capita and age-specific mortality rates by location, age, sex, year, and cause. 95% uncertainty intervals (UIs) were generated for all final estimates as the 2·5th and 97·5th percentiles values of 500 draws. Uncertainty was propagated at each step of the estimation process. Counts and age-standardised rates were calculated globally, for seven super-regions, 21 regions, 204 countries and territories (including 21 countries with subnational locations), and 811 subnational locations, from 1990 to 2021. Here we report data for 2010 to 2021 to highlight trends in disease burden over the past decade and through the first 2 years of the COVID-19 pandemic. Findings: Global DALYs increased from 2·63 billion (95% UI 2·44–2·85) in 2010 to 2·88 billion (2·64–3·15) in 2021 for all causes combined. Much of this increase in the number of DALYs was due to population growth and ageing, as indicated by a decrease in global age-standardised all-cause DALY rates of 14·2% (95% UI 10·7–17·3) between 2010 and 2019. Notably, however, this decrease in rates reversed during the first 2 years of the COVID-19 pandemic, with increases in global age-standardised all-cause DALY rates since 2019 of 4·1% (1·8–6·3) in 2020 and 7·2% (4·7–10·0) in 2021. In 2021, COVID-19 was the leading cause of DALYs globally (212·0 million [198·0–234·5] DALYs), followed by ischaemic heart disease (188·3 million [176·7–198·3]), neonatal disorders (186·3 million [162·3–214·9]), and stroke (160·4 million [148·0–171·7]). However, notable health gains were seen among other leading communicable, maternal, neonatal, and nutritional (CMNN) diseases. Globally between 2010 and 2021, the age-standardised DALY rates for HIV/AIDS decreased by 47·8% (43·3–51·7) and for diarrhoeal diseases decreased by 47·0% (39·9–52·9). Non-communicable diseases contributed 1·73 billion (95% UI 1·54–1·94) DALYs in 2021, with a decrease in age-standardised DALY rates since 2010 of 6·4% (95% UI 3·5–9·5). Between 2010 and 2021, among the 25 leading Level 3 causes, age-standardised DALY rates increased most substantially for anxiety disorders (16·7% [14·0–19·8]), depressive disorders (16·4% [11·9–21·3]), and diabetes (14·0% [10·0–17·4]). Age-standardised DALY rates due to injuries decreased globally by 24·0% (20·7–27·2) between 2010 and 2021, although improvements were not uniform across locations, ages, and sexes. Globally, HALE at birth improved slightly, from 61·3 years (58·6–63·6) in 2010 to 62·2 years (59·4–64·7) in 2021. However, despite this overall increase, HALE decreased by 2·2% (1·6–2·9) between 2019 and 2021. Interpretation: Putting the COVID-19 pandemic in the context of a mutually exclusive and collectively exhaustive list of causes of health loss is crucial to understanding its impact and ensuring that health funding and policy address needs at both local and global levels through cost-effective and evidence-based interventions. A global epidemiological transition remains underway. Our findings suggest that prioritising non-communicable disease prevention and treatment policies, as well as strengthening health systems, continues to be crucially important. The progress on reducing the burden of CMNN diseases must not stall; although global trends are improving, the burden of CMNN diseases remains unacceptably high. Evidence-based interventions will help save the lives of young children and mothers and improve the overall health and economic conditions of societies across the world. Governments and multilateral organisations should prioritise pandemic preparedness planning alongside efforts to reduce the burden of diseases and injuries that will strain resources in the coming decades. Funding: Bill & Melinda Gates Foundation

Global, regional, and national progress towards Sustainable Development Goal 3.2 for neonatal and child health: all-cause and cause-specific mortality findings from the Global Burden of Disease Study 2019

Background Sustainable Development Goal 3.2 has targeted elimination of preventable child mortality, reduction of neonatal death to less than 12 per 1000 livebirths, and reduction of death of children younger than 5 years to less than 25 per 1000 livebirths, for each country by 2030. To understand current rates, recent trends, and potential trajectories of child mortality for the next decade, we present the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 findings for all-cause mortality and cause-specific mortality in children younger than 5 years of age, with multiple scenarios for child mortality in 2030 that include the consideration of potential effects of COVID-19, and a novel framework for quantifying optimal child survival. Methods We completed all-cause mortality and cause-specific mortality analyses from 204 countries and territories for detailed age groups separately, with aggregated mortality probabilities per 1000 livebirths computed for neonatal mortality rate (NMR) and under-5 mortality rate (USMR). Scenarios for 2030 represent different potential trajectories, notably including potential effects of the COVID-19 pandemic and the potential impact of improvements preferentially targeting neonatal survival. Optimal child survival metrics were developed by age, sex, and cause of death across all GBD location-years. The first metric is a global optimum and is based on the lowest observed mortality, and the second is a survival potential frontier that is based on stochastic frontier analysis of observed mortality and Healthcare Access and Quality Index. Findings Global U5MR decreased from 71.2 deaths per 1000 livebirths (95% uncertainty interval WI] 68.3-74-0) in 2000 to 37.1 (33.2-41.7) in 2019 while global NMR correspondingly declined more slowly from 28.0 deaths per 1000 live births (26.8-29-5) in 2000 to 17.9 (16.3-19-8) in 2019. In 2019,136 (67%) of 204 countries had a USMR at or below the SDG 3.2 threshold and 133 (65%) had an NMR at or below the SDG 3.2 threshold, and the reference scenario suggests that by 2030,154 (75%) of all countries could meet the U5MR targets, and 139 (68%) could meet the NMR targets. Deaths of children younger than 5 years totalled 9.65 million (95% UI 9.05-10.30) in 2000 and 5.05 million (4.27-6.02) in 2019, with the neonatal fraction of these deaths increasing from 39% (3.76 million 95% UI 3.53-4.021) in 2000 to 48% (2.42 million; 2.06-2.86) in 2019. NMR and U5MR were generally higher in males than in females, although there was no statistically significant difference at the global level. Neonatal disorders remained the leading cause of death in children younger than 5 years in 2019, followed by lower respiratory infections, diarrhoeal diseases, congenital birth defects, and malaria. The global optimum analysis suggests NMR could be reduced to as low as 0.80 (95% UI 0.71-0.86) deaths per 1000 livebirths and U5MR to 1.44 (95% UI 1-27-1.58) deaths per 1000 livebirths, and in 2019, there were as many as 1.87 million (95% UI 1-35-2.58; 37% 95% UI 32-43]) of 5.05 million more deaths of children younger than 5 years than the survival potential frontier. Interpretation Global child mortality declined by almost half between 2000 and 2019, but progress remains slower in neonates and 65 (32%) of 204 countries, mostly in sub-Saharan Africa and south Asia, are not on track to meet either SDG 3.2 target by 2030. Focused improvements in perinatal and newborn care, continued and expanded delivery of essential interventions such as vaccination and infection prevention, an enhanced focus on equity, continued focus on poverty reduction and education, and investment in strengthening health systems across the development spectrum have the potential to substantially improve USMR. Given the widespread effects of COVID-19, considerable effort will be required to maintain and accelerate progress. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd

The use of rapid sampling microdialysis in monitoring human bowel and anastomosis ischaemia

Intestinal ischaemia especially in the postoperative period is a complication that is dreaded by all general surgeons and poses a considerable rise in mortality and morbidity of patients, not to mention the burden it puts on the physician and on the healthcare system. Its diagnosis is always subjective relying mostly on the physicians’ awareness and clinical suspicion rather than on any quantitative method. This project explores a quantitative tool and adapts online rapid sampling microdialysis (from its use in monitoring brain tissue ischaemia) to monitor ischaemia in human bowel and bowel anastomosis. It describes its translation from the bench top model, to the pilot model, to the animal model, and finally its application in the clinical setting to monitor patients for bowel ischaemia. The online microdialysis analyzer used in monitoring brain tissue in Kings College Hospital was modified and converted for use in the setting to monitor bowel in the labs of the Bioengineering Department at Imperial College London, under collaboration with the Department of Bio Surgery and Surgical Technology. The system was designed and construction supervised by Dr. Martyn Boutelle; and work on the system to construct and optimize carried out by PhD student Emma Corcoles. The clinical collaborate of the project was supervised by Professor Ara Darzi and carried out by Mr. Samer Deeba with joint supervision by Professor George Hanna. The catheter, connections, and deployment was optimized at St. Mary’s Hospital, part of Imperial College NHS trust. This project did prove the efficacy of microdialysis in monitoring bowel ischaemia in the clinical setting, but needs further work and development in the design of the catheter and miniaturizing the analyzer to be more reliable and robust. Multicenter trials are needed to gain its wide acceptance in the clinical practice.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Use of online rapid sampling microdialysis electrochemical biosensor for bowel anastomosis monitoring in swine model

Bowel anastomosis ischemia carries a significant rise in morbidity and mortality after bowel surgery. Clinical measures of bowel ischemia are often non-specific and only become evident at a late stage. There is currently no method to continuously monitor, in real time, metabolic impairment at the anastomosis site. Our online rapid sampling microdialysis biosensor system has proved its efficacy in monitoring ischemia in the bowel. Selective glucose and lactate biosensors are coupled online to the microdialysis probe through a flow injection analysis (FIA) system, which performs in vivo bowel monitoring at high time resolution, typically every 30 seconds. The enzymatic reactors containing substrate oxidase (SOx) and horseradish peroxidase (IIRP) are coupled to flow cell electrodes. The system was used to monitor ischemia at the bowel anastomosis level, by monitoring in vivo changes in the metabolic substrates, like glucose and lactate in the colon of swine models. The rapid decrease in glucose and increase in lactate 5 minutes post-clamping of the artery feeding the anastomosis highlights the vulnerability of the bowel to damage with surgical stress and previous ischemic insults

Obturator hernias: A review of the laparoscopic approach

Background : Obturator hernias (OH) account for a rare presentation to the surgical unit usually associated with bowel obstruction and strangulation. The treatment of this condition is classical laparotomy with repair of the hernia and bowel resection, if deemed necessary; recently, the laparoscopic approach has been reported in literature. This review examines the existing evidence of the safety and effectiveness of the laparoscopic approach for the management of OH. Materials and Methods: We have conducted a systematic review of the cases reported in the literature between 1991 and 2009, using Medline with PubMed as the search engine, as well as Ovid, Embase, Cochrane Collaboration and Google Scholar databases to identify articles in English language reporting on laparoscopic management for the treatment of this condition. Results: A total of 17 articles reporting on 28 cases were found. We describe the pooled data for demographics, operative time, hospital stay, morbidities and method of repair. We also compare to the results of the laparoscopic repair of other types of hernias in the literature. Conclusion: This approach was found to be a safe and effective approach for the repair of OH as compared to the classical open approach; however, its adoption as the gold standard needs further multicenter trials

Bell's disk polynomials and parallel disk iteration

SIGLETIB: in RN 6361 (1986,2) / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekDEGerman