Beyond the snare: technically accessible large en bloc colonic resection in the West: an animal study

Background: Endoscopic submucosal dissection (ESD) and circumferential submucosal incision endoscopic mucosal resection (CSI‐EMR) are techniques for en bloc excision of large sessile colonic lesions. Our aims were to compare the efficacy, safety and learning curve of colonic hybrid knife (HK) ESD versus CSI‐EMR for en bloc excision of 50 mm diameter hemi‐circumferential artificial lesions in a porcine model. Patients and Methods: Two separate 50 mm diameter areas of normal recto‐sigmoid mucosa were marked out in each of ten pigs. One was excised with HK‐ESD using succinylated gelatin (SG) submucosal injection. The other was isolated with CSI with the Insulated Tip Knife 2 followed by SG submucosal injection then EMR with a large snare. Euthanasia and colectomy was performed at 72 h followed by blinded histopathology assessment. Results: En bloc excision rates were: HK‐ESD 100% versus CSI‐EMR 20% (P = 0.008). The mean number of resections per lesion was HK‐ESD 1 versus CSI‐EMR 3 (P = 0.001). The mean dimensions of the largest specimen per technique were HK‐ESD 63 × 54 mm versus CSI‐EMR 49 × 41 mm (P = 0.005). Procedure duration mean was HK‐ESD 54 min versus CSI‐EMR 22 min (P < 0.001). When procedure duration was adjusted for the size of the resected en bloc specimen, a statistically significant and accelerated learning effect was noted for HK‐ESD (r = ?0.83, P = 0.003). There were no perforations and no significant bleeding. Conclusions: HK‐ESD with SG submucosal injection is superior to CSI‐EMR for en bloc excision of 50 mm diameter lesions in a porcine model. The technique is rapidly learnt. This novel approach may lower the barrier to colonic ESD for Western endoscopists.     

Impact of COVID 19 pandemic on patients requiring renal biopsy

Introduction

The disruption of healthcare services in coronavirus disease (COVID)19 pandemic was widespread particularly due to lockdown curbs. This study was undertaken to see the effect of this pandemic on subjects requiring renal biopsy.

Materials and method

Renal biopsies performed during the COVID 19 pandemic between April 2020 and December 2020 (Group 1) were compared with those in pre-COVID period between June 2019 and February 2020 (Group 2). Indication of biopsies, syndromic diagnosis and all baseline laboratory characteristics were retrieved from the hospital records.

Results

130 and 191 patients were biopsied in groups 1 and 2, respectively. Patients in group 1 were younger compared with group 2 (32.55?±?15.60 and 36.37?±?16.96 years, respectively, p value 0.038). The mean serum creatinine value in group 1 was significantly higher than in group 2 (3.21?±?2.08 and 2.68?±?2.02 mg/dl respectively, p value: 0.023). Group 1 comprises a significantly higher percentage of rapidly progressive renal failure patients (RPRF) (39.3 vs 28, p value 0.046). A higher percentage of nephrotics was biopsied in group 2 vs group 1 (46.9 vs 30.4 respectively, p value 0.008). The treatment protocol remained similar in both the groups. Evaluation of the transplant biopsies revealed a nonsignificant higher number of rejections in group 1 (11 out of 18) as compared to group 2 (5 out of 16), p value 0.100. Combined rejection saw a lesser use of rATG in group 1.

Conclusion

COVID pandemic induced restrictive measures could have led to selective high risk patients with RPRF as presumptive diagnosis and higher creatinine values getting biopsied. Higher rejections were noticed in transplant recipients pointing towards the need of establishing a more efficient support system for managing such patients.

     

Hypoglycemia - A rare complication of carbamazepine overdose

Carbamazepine overdose usually presents with neurological manifestations such as ataxia, seizures and altered sensorium or cardiac manifestations that include tachycardia, hypotension and ventricular extra-systoles. We report a patient with carbamazepine overdose who manifested recurrent hypoglycemia on the third and fourth day following ingestion that resolved with supportive therapy.KEY WORDS: Anti-epileptic, carbamazepine, complication, hypoglycemia, overdose     

Interactions between marmatite and bornite during the oxidative dissolution process in abiotic and biotic systems

Marmatite and bornite are commonly associated together in nature, and their interactions in an acidic environment are vital for both (bio)hydrometallurgy and acid mine drainage (AMD) production. In this work, dissolution experiments (marmatite : bornite = 2 : 0, 3 : 1, 1 : 1, 1 : 3 and 0 : 2) accompanied by analytic techniques such as electrochemical methods, Raman spectroscopy and synchrotron radiation-XRD (SR-XRD) were utilized to interpret the interactions between marmatite and bornite in acidic abiotic and biotic systems. The dissolution experiments showed that marmatite can significantly accelerate the oxidative dissolution of bornite, especially in the abiotic system. On the contrary, bornite inhibited the oxidative dissolution of marmatite when the percentage of bornite was high. Electrochemical measurements proved that the galvanic interactions between marmatite and bornite were slight and should not be the main cause for the interactions. Combined with the dissolution experiments, analytic techniques and previous references, it could be speculated that marmatite accelerated bornite dissolution mainly by providing an iron source, which acted as the energy source for microorganisms and oxidants. Bornite affected the dissolution of marmatite mainly by Cu²⁺ ions dissolving from bornite. Bornite inhibited the oxidative dissolution of marmatite mainly because a high Cu²⁺ concentration could significantly hinder marmatite dissolution. In addition, the formation of elemental sulfur or jarosite was also one important cause. Bornite intensified marmatite dissolution when the percentage of bornite or the Cu²⁺ concentration was extremely low and then, a synergic dissolution process occurred.

Interactions between marmatite and bornite during the oxidative dissolution process in abiotic and biotic systems.     

Correction: Interactions between marmatite and bornite during the oxidative dissolution process in abiotic and biotic systems

Correction for ‘Interactions between marmatite and bornite during the oxidative dissolution process in abiotic and biotic systems’ by Yanjun Zhang et al., RSC Adv., 2019, 9, 26609–26618.

Hussnain Ahmed Janjua''s name was incorrectly spelled in the published article; the corrected author list is shown here.The Royal Society of Chemistry apologises for these errors and any consequent inconvenience to authors and readers.