Evidence of Heavy Metals Distribution in Placenta in Association with Residual Levels in Some Dams’ Organs from Bodija abattoir, Oyo State, Nigeria

Heavy metals have been known to be causing serious detrimental effect on the health of livestock and human populace in general. However, little study had been carried out on the ability of heavy metal to cross placental barrier, which has already been bio-accumulated in the dam. Therefore, this study aimed at showing the evidence of placental barrier crossing by selected heavy metals. The study was carried out in Bodija abattoir, Ibadan, Oyo-state, Nigeria, located on latitude 70020N, longitude 3005E. A cross-sectional study design was adopted and lasted for 6 weeks. Samples were collected from kidney cortices, apical lobe of dam’s liver and a portion of fetal placenta. 12 sample each from liver, kidney and the placenta which were analyzed using Atomic Absorption Spectrophotometer (AAS). Results were subjected to descriptive statistics, t-test and correlation using SPSS17.0 package.From this study cadmium (Cd) and lead (Pb) residues were not found in the samples, while chromium (Cr) was found in all the samples (100% prevalence) and the total prevalence for the heavy metals in the study was 33.4%. The mean chromium (Cr) residual values in placenta, kidney and liver were 0.89±0.66mg/kg, 1.32±0.94mg/kg and 1.00±0.87 mg/kg respectively. The correlation between chromium (Cr) in the dam’s kidney and placenta was 0.3, while for the dam’s liver and placenta was 0.6.  In comparison with permissible limit, the residual level in kidney 1.32±0.94, liver 1.00±0.87 and placenta 0.89±0.66, were within the permissible limit. The study revealed that chromium (Cr) residue was a major challenge in the organs sampled. Liver of the dam had the highest level of bioaccumulation and stronger correlation in the distribution to the placenta. It is therefore recommended that attention should be paid on the disposal of chromium (Cr) residues on the grazing floor where the bulk of the residues were from. Keywords: Heavy metals, Liver, Kidney, Placenta and cattle

Timing of nasogastric tube insertion and the risk of postoperative pneumonia: an international, prospective cohort study

Aim: Aspiration is a common cause of pneumonia in patients with postoperative ileus. Insertion of a nasogastric tube (NGT) is often performed, but this can be distressing. The aim of this study was to determine whether the timing of NGT insertion after surgery (before versus after vomiting) was associated with reduced rates of pneumonia in patients undergoing elective colorectal surgery. Method: This was a preplanned secondary analysis of a multicentre, prospective cohort study. Patients undergoing elective colorectal surgery between January 2018 and April 2018 were eligible. Those receiving a NGT were divided into three groups, based on the timing of the insertion: routine NGT (inserted at the time of surgery), prophylactic NGT (inserted after surgery but before vomiting) and reactive NGT (inserted after surgery and after vomiting). The primary outcome was the development of pneumonia within 30 days of surgery, which was compared between the prophylactic and reactive NGT groups using multivariable regression analysis. Results: A total of 4715 patients were included in the analysis and 1536 (32.6%) received a NGT. These were classified as routine in 926 (60.3%), reactive in 461 (30.0%) and prophylactic in 149 (9.7%). Two hundred patients (4.2%) developed pneumonia (no NGT 2.7%; routine NGT 5.2%; reactive NGT 10.6%; prophylactic NGT 11.4%). After adjustment for confounding factors, no significant difference in pneumonia rates was detected between the prophylactic and reactive NGT groups (odds ratio 1.03, 95% CI 0.56–1.87, P = 0.932). Conclusion: In patients who required the insertion of a NGT after surgery, prophylactic insertion was not associated with fewer cases of pneumonia within 30 days of surgery compared with reactive insertion

Validation of the OAKS prognostic model for acute kidney injury after gastrointestinal surgery

Abstract Background Postoperative acute kidney injury (AKI) is a common complication of major gastrointestinal surgery with an impact on short- and long-term survival. No validated system for risk stratification exists for this patient group. This study aimed to validate externally a prognostic model for AKI after major gastrointestinal surgery in two multicentre cohort studies. Methods The Outcomes After Kidney injury in Surgery (OAKS) prognostic model was developed to predict risk of AKI in the 7 days after surgery using six routine datapoints (age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker). Validation was performed within two independent cohorts: a prospective multicentre, international study (‘IMAGINE’) of patients undergoing elective colorectal surgery (2018); and a retrospective regional cohort study (‘Tayside’) in major abdominal surgery (2011–2015). Multivariable logistic regression was used to predict risk of AKI, with multiple imputation used to account for data missing at random. Prognostic accuracy was assessed for patients at high risk (greater than 20 per cent) of postoperative AKI. Results In the validation cohorts, 12.9 per cent of patients (661 of 5106) in IMAGINE and 14.7 per cent (106 of 719 patients) in Tayside developed 7-day postoperative AKI. Using the OAKS model, 558 patients (9.6 per cent) were classified as high risk. Less than 10 per cent of patients classified as low-risk developed AKI in either cohort (negative predictive value greater than 0.9). Upon external validation, the OAKS model retained an area under the receiver operating characteristic (AUC) curve of range 0.655–0.681 (Tayside 95 per cent c.i. 0.596 to 0.714; IMAGINE 95 per cent c.i. 0.659 to 0.703), sensitivity values range 0.323–0.352 (IMAGINE 95 per cent c.i. 0.281 to 0.368; Tayside 95 per cent c.i. 0.253 to 0.461), and specificity range 0.881–0.890 (Tayside 95 per cent c.i. 0.853 to 0.905; IMAGINE 95 per cent c.i. 0.881 to 0.899). Conclusion The OAKS prognostic model can identify patients who are not at high risk of postoperative AKI after gastrointestinal surgery with high specificity. Presented to Association of Surgeons in Training (ASiT) International Conference 2018 (Edinburgh, UK), European Society of Coloproctology (ESCP) International Conference 2018 (Nice, France), SARS (Society of Academic and Research Surgery) 2020 (Virtual, UK). </jats:sec

Safety and efficacy of non-steroidal anti-inflammatory drugs to reduce ileus after colorectal surgery.

Background: Ileus is common after elective colorectal surgery, and is associated with increased adverseevents and prolonged hospital stay. The aim was to assess the role of non-steroidal anti-inflammatorydrugs (NSAIDs) for reducing ileus after surgery.Methods: A prospective multicentre cohort study was delivered by an international, student- andtrainee-led collaborative group. Adult patients undergoing elective colorectal resection between Januaryand April 2018 were included. The primary outcome was time to gastrointestinal recovery, measuredusing a composite measure of bowel function and tolerance to oral intake. The impact of NSAIDs wasexplored using Cox regression analyses, including the results of a centre-specific survey of complianceto enhanced recovery principles. Secondary safety outcomes included anastomotic leak rate and acutekidney injury.Results: A total of 4164 patients were included, with a median age of 68 (i.q.r. 57–75) years (54⋅9 percent men). Some 1153 (27⋅7 per cent) received NSAIDs on postoperative days 1–3, of whom 1061 (92⋅0per cent) received non-selective cyclo-oxygenase inhibitors. After adjustment for baseline differences, themean time to gastrointestinal recovery did not differ significantly between patients who received NSAIDsand those who did not (4⋅6 versus 4⋅8 days; hazard ratio 1⋅04, 95 per cent c.i. 0⋅96 to 1⋅12; P = 0⋅360). Therewere no significant differences in anastomotic leak rate (5⋅4 versus 4⋅6 per cent; P = 0⋅349) or acute kidneyinjury (14⋅3 versus 13⋅8 per cent; P = 0⋅666) between the groups. Significantly fewer patients receivingNSAIDs required strong opioid analgesia (35⋅3 versus 56⋅7 per cent; P &lt; 0⋅001).Conclusion: NSAIDs did not reduce the time for gastrointestinal recovery after colorectal surgery, butthey were safe and associated with reduced postoperative opioid requirement.</p

Safety and efficacy of non-steroidal anti-inflammatory drugs to reduce ileus after colorectal surgery

Abstract Background Ileus is common after elective colorectal surgery, and is associated with increased adverse events and prolonged hospital stay. The aim was to assess the role of non-steroidal anti-inflammatory drugs (NSAIDs) for reducing ileus after surgery. Methods A prospective multicentre cohort study was delivered by an international, student- and trainee-led collaborative group. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The primary outcome was time to gastrointestinal recovery, measured using a composite measure of bowel function and tolerance to oral intake. The impact of NSAIDs was explored using Cox regression analyses, including the results of a centre-specific survey of compliance to enhanced recovery principles. Secondary safety outcomes included anastomotic leak rate and acute kidney injury. Results A total of 4164 patients were included, with a median age of 68 (i.q.r. 57–75) years (54·9 per cent men). Some 1153 (27·7 per cent) received NSAIDs on postoperative days 1–3, of whom 1061 (92·0 per cent) received non-selective cyclo-oxygenase inhibitors. After adjustment for baseline differences, the mean time to gastrointestinal recovery did not differ significantly between patients who received NSAIDs and those who did not (4·6 versus 4·8 days; hazard ratio 1·04, 95 per cent c.i. 0·96 to 1·12; P = 0·360). There were no significant differences in anastomotic leak rate (5·4 versus 4·6 per cent; P = 0·349) or acute kidney injury (14·3 versus 13·8 per cent; P = 0·666) between the groups. Significantly fewer patients receiving NSAIDs required strong opioid analgesia (35·3 versus 56·7 per cent; P &amp;lt; 0·001). Conclusion NSAIDs did not reduce the time for gastrointestinal recovery after colorectal surgery, but they were safe and associated with reduced postoperative opioid requirement. </jats:sec

Safety and efficacy of non-steroidal anti-inflammatory drugs to reduce ileus after colorectal surgery

Background Ileus is common after elective colorectal surgery, and is associated with increased adverse events and prolonged hospital stay. The aim was to assess the role of non-steroidal anti-inflammatory drugs (NSAIDs) for reducing ileus after surgery. Methods A prospective multicentre cohort study was delivered by an international, student- and trainee-led collaborative group. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The primary outcome was time to gastrointestinal recovery, measured using a composite measure of bowel function and tolerance to oral intake. The impact of NSAIDs was explored using Cox regression analyses, including the results of a centre-specific survey of compliance to enhanced recovery principles. Secondary safety outcomes included anastomotic leak rate and acute kidney injury. Results A total of 4164 patients were included, with a median age of 68 (i.q.r. 57-75) years (54 center dot 9 per cent men). Some 1153 (27 center dot 7 per cent) received NSAIDs on postoperative days 1-3, of whom 1061 (92 center dot 0 per cent) received non-selective cyclo-oxygenase inhibitors. After adjustment for baseline differences, the mean time to gastrointestinal recovery did not differ significantly between patients who received NSAIDs and those who did not (4 center dot 6 versus 4 center dot 8 days; hazard ratio 1 center dot 04, 95 per cent c.i. 0 center dot 96 to 1 center dot 12; P = 0 center dot 360). There were no significant differences in anastomotic leak rate (5 center dot 4 versus 4 center dot 6 per cent; P = 0 center dot 349) or acute kidney injury (14 center dot 3 versus 13 center dot 8 per cent; P = 0 center dot 666) between the groups. Significantly fewer patients receiving NSAIDs required strong opioid analgesia (35 center dot 3 versus 56 center dot 7 per cent; P &lt; 0 center dot 001). Conclusion NSAIDs did not reduce the time for gastrointestinal recovery after colorectal surgery, but they were safe and associated with reduced postoperative opioid requirement