Outcomes of elective and emergency surgical repair of incisional hernia: a comparative observational study

PURPOSE

Incisional hernia (IH) is a common complication following abdominal surgery. Surgical repair of IH is associated with the alleviation of symptoms and improvement of quality of life. Operative intervention can pose a significant burden to the patient and healthcare facilities. This study aims to describe and compare outcomes of elective and emergency surgical repair of IH.

METHODS

This study is a single-centre comparative retrospective study including patients who had repair of IH. Patients were divided into Group I (Emergency) and Group II (Elective), and a comparison was conducted between them.

RESULTS

Two hundred sixty-two patients were identified with a mean age of 61.8 ± 14.2 years, of which 152 (58%) were females. The mean BMI was 31.6 ± 7.2 kg/m2. More than 58% had at least one comorbidity. 169 (64.5%) patients had an elective repair, and 93 (35.5%) had an emergency repair. Patients undergoing emergency repair were significantly older and had higher BMI, p = 0.031 and p = 0.002, respectively. The significant complication rate (Clavien-Dindo III and IV) was 9.54%. 30 and 90-day mortality rates were 2.3% (n = 6) and 2.68% (n = 7), respectively. In the emergency group, the overall complications, 30-day and 90-day mortality rates were significantly higher than in the elective group, p ≤ 0.001, 0.002 and 0.001, respectively. Overall, 42 (16.1%) developed wound complications, 25 (9.6%) experienced a recurrence, and 41 (15.71%) were readmitted within 90 days, without significant differences between the two groups.

CONCLUSION

Patients who underwent emergency repair were significantly older and had a higher BMI than the elective cases. Emergency IH repair is associated with higher complication rates and mortality than elective repair.

ADIPONECTIN LEVELS IN GRAVES' DISEASE - SYSTEMATIC REVIEW AND META-ANALYSIS

Context

Graves' disease is the most prevalent cause of hyperthyroidism worldwide. Adiponectin, the most abundant adipokine, plays a significant role in a cluster of prevalent diseases connected to metabolic disorders.

Objective

Although the association between adiponectin and Graves' disease has been studied, the existing data is inconsistent. Therefore, we conducted this systematic review and meta-analysis to evaluate the relationship between adiponectin levels and Graves' disease.

Methods

We performed a systematic electronic search on PubMed, EMBASE, Scopus and Cochrane Library using predefined keywords. We used the NHLBI quality assessment tools to assess the included studies.

Results

There were 11 studies involving 781 subjects included in our qualitative synthesis, while 6 studies were included in our quantitative synthesis. We observed significantly increased adiponectin levels in Graves' disease patients compared to controls (MD 2.983 [95% CI 0.138-5.828]) and hypothyroidism patients (MD 3.389 [95% CI 1.332-5.446]). Nevertheless, no significant MD was observed when comparing Graves' disease patients with and without Graves' ophthalmopathy (MD -27.124 [95% CI -88.893 - 34.645]).

Conclusions

Adiponectin levels were significantly higher in patients with Graves' disease compared to controls and hypothyroidism patients. However, patients with and without Graves' ophthalmopathy did not present a significant mean difference in adiponectin levels.

Differential inflammatory profile of mesenteric and omental fat in patients with colorectal cancer

Visceral obesity (mesenteric and omental adipose tissue) is a risk factor for colorectal cancer (CRC) and weight loss can reduce risk. This study examined mesenteric and omental fat activity in patients with CRC.

An environmental magnetic record of heavy metal pollution in Vembanad lagoon, southwest coast of India

Magnetic signature of the iron-bearing minerals archived in sediments is sensitive to change in environment and therefore, studied to reconstruct the signals linked with environmental processes. In the present work, we have analyzed 11 sediment cores from Vembanad lagoon, southwest coast of India, to estimate the magnetic fluctuations associated with environmental processes. Down-core variation in magnetic susceptibility and anhysteretic, isothermal and saturation isothermal remnant magnetization and S and H-ratios have been interpreted to map the degree and spatial distribution of anthropogenic pollution in and around the lagoon. Downcore variation of magnetic susceptibility of Vembanad lagoon sediments varies from 10 to 100 × 10^-8 m³/ kg. The top layers of sediment samples from river mouth regions (Periyar and Muvattupuzha rivers) show higher susceptibility values and incidentally these samples are of coarse sized. The subtle variations in SIRM/χ_lf ratios suggest that there are magnetic grain size differences in the samples. The SIRM and χ_lf relation suggests that dominant magnetic grain size in sediments. The low ARM/χ_lf ratios suggest a relatively higher ferrimagnetic contribution and coarser magnetite grain size. Rock magnetism data reveal that the coarse magnetic grain size is affecting the pollution of Vembanad lagoon. We also analyzed downcore variability of metal concentrations such as Fe, Mn, Cu, Zn, Ni and Cr, and all these metals exhibit higher concentrations in the top layers of the cores. Our study suggests that higher values of magnetic parameters and metal concentrations are due to various anthropogenic sources.

Urgency of caesarean section, grading, alarm chain and intrauterine resuscitation - a survey of Scandinavian practice

BACKGROUND

About 40,000 women have caesarean section in Scandinavia each year. Organizational factors for emergency caesarean section (CS), classification, anaesthetic practice, alarm chain, intrauterine resuscitation has all been investigated in the United Kingdom, but no information from the Scandinavian countries exists.

METHODS

Using publicly available data from the National Board of Health, obstetric anaesthetic departments were identified. The heads of the departments provided e-mail contact details of two anaesthesiologists regularly practicing obstetric anaesthesia who were then surveyed.

RESULTS

One hundred and forty-five specialists from 82 departments in Scandinavia replied to our survey. Ninety-five percent of Danish specialists reported a three-grade classification system for urgency CS. Where classification in Denmark was enumerative classification, Norwegians equally reported enumerative and verbal descriptors, whereas Swedish specialists mostly reported verbal descriptors. Local guidelines describing decision-to-delivery interval for emergency CS was reported by 100% of Danish specialists vs. 47% from Norway and 85% from Sweden. Mean benchmark decision-to-delivery interval for emergency CS was 12.7 min. General anaesthesia for emergency CS was highly favoured in Norway (95%) and Sweden (97%), compared to Denmark (49%). Twenty specialists reported existence of local guidelines for intrauterine resuscitation.

CONCLUSION

Our survey of Scandinavian specialists indicate emergency CS practise differs from United Kingdom practices in several aspects; general anaesthesia is by the majority of Scandinavian specialists reported as the default choice for emergency CS and benchmark for decision-to-delivery interval is < 20 min. Nomenclature used for classification showed considerable variance in Norway and Sweden compared to Denmark. No joint Scandinavian guidelines exist.