Small bowel obstruction secondary to primary enterolith: A rare and delayed complication of radiation enteritis.

Primary enteroliths as a result of pelvic radiotherapy are a rare cause of intestinal obstruction.

Surveillance Colonoscopy after Appendicectomy in Patients over the Age of 40: Targeted Audit of Outcomes and Variability in Practice.

Introduction: Recent evidence suggests the need to proceed with a surveillance colonoscopy in patients above the age of 40 years who undergo appendicectomy for acute appendicitis, given the higher risk of an underlying colonic tumor. After anecdotally observing a substantial variability in terms of adaptation of these recommendations by the on-call surgical teams, we performed a clinical audit regarding our relevant endoscopic follow-up compliance rates to identify areas for improvement of our practise. Materials Methods: We performed a retrospective review of the electronic records of all patients above 40 years who had appendicectomy for acute appendicitis within a 3-year period in our institution, assessing as primary outcome the actual performance of a follow-up colonoscopy and the detected endoscopic findings. Results: Our results demonstrated that more than 80% of our patients did not have an endoscopic follow-up, as suggested by the current evidence. In addition, with respect to the subspecialisation of the parent surgical team, it seems that non-colorectal teams had lower compliance regarding the arrangement of endoscopic surveillance, when compared to specialist colorectal team. Conclusions: Emergency surgical teams need to be further educated with respect to the current practise recommendations concerning the appropriate endoscopic follow-up after the performance of appendicectomy for acute appendicitis. Establishment of dedicated bundles of postoperative care, as well as clear relevant guidance from the gastrointestinal/emergency surgery societies would be of great value in this direction.

Auditing the Routine Microbiological Examination of Pus Swabs From Uncomplicated Perianal Abscesses: Clinical Necessity or Old Habit?

BACKGROUND: Obtaining pus swabs from perianal abscesses after incision and drainage for subsequent microbiological analysis is traditionally performed by general surgeons. Our aim is to assess the current practice in our institution, emphasizing on whether pus swabs were sent or not, as well as to identify any associations between the revealed microbiology and the occurrence of immediate post-operative complications and re-admission rates with fistula-in-ano up to 12 months post the emergency drainage. Finally, we aimed to identify if the any members of the surgical team reviewed at any stage post-operatively the results of the microbiological examination of the obtained pus swabs and if that resulted in changes of the patient management. METHODS: We reviewed the operative findings and perioperative antimicrobial management of all patients within our institution that required surgical treatment of perianal abscesses over a 6-week period and re-assessed them after 12 months from the performed drainage, with respect to re-admission and identification of occurred fistula-in-ano. RESULTS: A total of 24 patients met our inclusion criteria. Pus swabs were sent in 66.7% of cases and only a third of the requested microbiology reports were reviewed by a part of the surgical team. All patients were discharged prior to the release of the microbiology results with no subsequent change in the management plan. We did not find any consistent association between the microbiology results and re-admission with perianal abscess, with or without fistula-in-ano. CONCLUSIONS: We do not recommend routine use of pus swabs when draining perianal abscesses unless clinical concerns arise, including recurrent perianal sepsis, immuno-compromised status or extensive soft tissue necrosis, especially when these features are associated with systemic sepsis.

Minimal impact of COVID-19 outbreak on the postoperative morbidity and mortality following emergency general surgery procedures: results from a 3-month observational period.

Aim The outbreak of the COVID-19 pandemic has had a major impact on the delivery of elective, as well as emergency surgery on a world-wide scale. Up to date few studies have actually assessed the impact of COVID-19 on the postoperative morbidity and mortality following emergency gastrointestinal surgery. Herein, we present our relevant experience over a 3-month period of uninterrupted provision of emergency general surgery services in George Eliot Hospital NHS Trust, the United Kingdom. Methods We performed a retrospective analysis of a prospective institutional database, which included the operation types, paraclinical investigations and postoperative complications of all patients undergoing emergency general surgery operations between March - May 2020. Results The occurrence of a 5% overall respiratory complication rate postoperatively, with 3% infection rate for COVID-19 was found; no patient had unplanned return to intensive care for ventilator support and there was no mortality related to COVID-19 infection. Conclusion When indicated, emergency surgery should not be delayed in favour of expectant/conservative management in fear of COVID-19-related morbidity or mortality risks.

Understanding complex drivers of wildlife crime to design effective conservation interventions.

In conservation understanding the drivers of behavior and developing robust interventions to promote behavioral change is challenging and requires a multifaceted approach. This is particularly true for efforts to address illegal wildlife use, where pervasive-and sometimes simplistic-narratives often obscure complex realities. We used an indirect questioning approach, the unmatched count technique, to investigate the drivers and prevalence of wildlife crime in communities surrounding 2 national parks in Uganda and combined scenario interviews and a choice experiment to predict the performance of potential interventions designed to tackle these crimes. Although poverty is often assumed to be a key driver of wildlife crime, we found that better-off households and those subject to human-wildlife conflict and those that do not receive any benefits from the parks' tourism revenue sharing were more likely to be involved in certain types of wildlife crime, especially illegal hunting. The interventions predicted to have the greatest impact on reducing local participation in wildlife crime were those that directly addressed the drivers including, mitigating damage caused by wildlife and generating financial benefits for park-adjacent households. Our triangulated approach provided insights into complex and hard-to-access behaviors and highlighted the importance of going beyond single-driver narratives.

Comprensión de los Conductores Complejos de los Delitos con Vida Silvestre para Diseñar Intervenciones Efectivas de Conservación Resumen En la conservación, la comprensión de los conductores del comportamiento y el desarrollo de intervenciones sólidas para promover cambios en el comportamiento es un reto que requiere de una estrategia multifacética. Esto es particularmente cierto para los esfuerzos que se realizan para tratar el uso ilegal de la fauna, en donde las narrativas generalizadas - y en algunas ocasiones simples - comúnmente ocultan las realidades complejas. Usamos una estrategia de cuestionamiento indirecto, la técnica de conteo sin par, para investigar los conductores y la prevalencia de los delitos con fauna en las comunidades que rodean a dos parques naciones en Uganda, así como entrevistas de escenario combinado y un experimento de elección para predecir el desempeño de las intervenciones potenciales diseñadas para acabar con estos delitos. Aunque frecuentemente se asume a la pobreza como un conductor importante de los delitos con fauna, encontramos que los hogares con mayor probabilidad de estar involucrados en ciertos tipos de delitos, especialmente la cacería ilegal, son los que se encuentran en mejores condiciones, están sujetos al conflicto humano-fauna y los que no reciben beneficio alguno de las ganancias del turismo en los parques. Las intervenciones que se pronosticó tendrían el mayor impacto en la reducción de la participación local dentro del delito con fauna fueron aquellas que trataron directamente con los conductores, incluyendo la mitigación del daño causado por la fauna y la generación de beneficios económicos para los hogares circundantes al parque. Nuestra estrategia triangulada proporcionó percepciones hacia los comportamientos complejos y de difícil acceso y resaltó la importancia de ir más allá de las narrativas unifactoriales.

Awareness of Gestational Diabetes and its Risk Factors among Pregnant Women in Samoa.

Gestational diabetes mellitus (GDM) is a subtype of diabetes mellitus defined as the development, or first recognition, of glucose intolerance during pregnancy. The risk of developing type 2 diabetes mellitus (T2DM) is greater in mothers with GDM compared to the general population. Preventing the development of GDM could help lower the prevalence of T2DM and long-term morbidity in children of affected mothers. The purpose of this study was to investigate the awareness of GDM and its risk factors among pregnant women in Samoa, exploring where participants obtained information, and understanding their attitudes towards diet and physical activity. A quantitative cross-sectional study of 141 women attending Tupua Tamasese Meaole (TTM) hospital in Apia, Samoa in May 2015 was performed. Fifty-eight percent women were aware diabetes can occur for the first time during pregnancy. The greatest information source was from doctors (37%, n=44) followed by family members (22%, n=28), based on 118 respondents. Only one woman correctly identified all four risk factors for GDM. Most women recognized eating a healthy diet (79%) and regular physical activity (78%) to be appropriate lifestyle changes to help prevent GDM. These findings suggest awareness of GDM among pregnant women in Samoa is mixed, with a very small proportion having good knowledge (based on the number of risk factors identified). We conclude that increased education about GDM is necessary, both in hospital clinics and within the community. By increasing awareness of GDM, it may be possible to decrease the prevalence of T2DM in Samoa.

Breastfeeding in Samoa: A Study to Explore Women's Knowledge and the Factors which Influence Infant Feeding Practices.

A decline in breastfeeding rates in Samoa has been reported over the last century. To assess the length of time women breastfeed, their knowledge of both the advantages of and recommendations for breastfeeding, and the factors that influence their decisions to continue or discontinue breastfeeding, a questionnaire was distributed at Tupua Tamasese Meaole Hospital. One hundred and twenty-one eligible participants were included aged 18-50 years (mean age 28.2). Ninety percent of participants initiated breastfeeding, and the majority (78%) of babies were exclusively breastfed for at least the recommended 6 months. Many mothers introduced complementary (solid) foods later than World Health Organization (WHO) and United Nation's International Children's Fund (UNICEF) recommendations of 6 months. Awareness of the advantages of breastfeeding was mixed. The most widely known advantage was "the development of an emotional bond between mother and baby" (67%). Other advantages were less widely known. Only a small minority were aware that breastfeeding reduces risk of maternal diabetes and aids weight loss post partum. Doctors and healthcare workers were listed as the top factors encouraging breastfeeding. Participants' comments revealed a generally positive attitude towards breastfeeding, a very encouraging finding. Participants identified that the number of breastfeeding breaks available at work and the length of their maternity leave were factors discouraging breastfeeding. Future studies are necessary to determine if problems identified in this study are applicable on a national level. These could be important to determine measures to improve breastfeeding practices in Samoa.

The high-resolution absorption spectroscopy branch on the VUV beamline DESIRS at SOLEIL.

A VUV absorption spectroscopy facility designed for ultra-high spectral resolution is in operation as a dedicated branch on the DESIRS beamline at Synchrotron SOLEIL. This branch includes a unique VUV Fourier transform spectrometer (FTS) and a dedicated versatile gas sample chamber. The FTS instrument can cover a large UV-VUV spectral range from 4 to 30 eV, with an ultimate line width of 0.08 cm(-1) on a large spectral window, ΔE/E = 7%, over which all spectral features can be acquired in a multiplex way. The performance can be considered to be a middle ground between broadband moderate-resolution spectrometers based on gratings and ultra-high-spectral-resolution VUV tunable-laser-based techniques over very narrow spectral windows. The various available gaseous-sample-handling setups, which function over a wide range of pressures and temperatures, and the acquisition methodology are described. A selection of experimental results illustrates the performance and limitations of the FTS-based facility.