 | | Robot-Assisted Sacro (hystero) Colpopexy with Anterior and Posterior Mesh Placement: impact on lower bowel tract function and clinical outcomes at mid-term follow-up | Robot-Assisted Sacro (hystero) Colpopexy with Anterior and Posterior Mesh Placement: impact on lower bowel tract function and clinical outcomes at mid-term follow-up
Robot-Assisted Sacro (hystero) Colpopexy with Anterior and Posterior Mesh Placement: impact on lower bowel tract function and clinical outcomes at mid-term follow-up
Overview
Robotic sacrocolpopexy (RSCP) is an established option for the treatment of apical, anterior, and proximal posterior compartment pelvic organ prolapses (POP). However, there is lack of evidence investigating how lower bowel tract symptoms (LBTS) may change after RSCP.
Data from consecutive patients treated with RSCP for stage 3 or higher POP from 2012 to 2019 at a single tertiary referral center with at least 1 year of follow-up were prospectively collected and retrospectively analysed. RSCP was performed following a standardized technique which always employed both anterior and posterior hand-shaped meshes.
Outcomes were collected at follow-up and analysed. LBTS were evaluated through the Wexner questionnaire. Overall, 114 women underwent RSCP. Eleven were excluded for missing data, whereas 12 had insufficient follow-up. Median follow-up was 42 [interquartile range (IQR), 19–62] months. Mean age was 65 ± 10 years. In our series, RSCP was mainly performed for anterior and apical/medium stage 3 POP (in 95.6% of patients). Anatomic success rate of and were treated with redo-SCP. No patient experienced clinically significant posterior vaginal wall prolapse after RSCP.
Of note, LBTS appear unaffected by posterior mesh placement, supporting its routine use to prevent posterior POP recurrence. Larger prospective studies are needed to confirm our results.
| 3 | | R485.00 |  |
| | Major Adverse Cardiovascular Events Following Partial Nephrectomy | Major Adverse Cardiovascular Events Following Partial Nephrectomy
Major Adverse Cardiovascular Events Following Partial Nephrectomy
Overview
Partial nephrectomy (PN) is associated with a non-negligible risk of postoperative cardiovascular morbidity and mortality. Identification of high-risk patients may enable optimization of perioperative management and consideration of alternative approaches. The authors aim to develop a procedure-specific cardiovascular risk index for PN patients and compare its performance to the widely used revised cardiac risk index (RCRI) and AUB-HAS2 cardiovascular risk index.
The cohort was derived from the American College of Surgeons – National Surgical Quality Improvement Program (ACS-NSQIP) database. The primary outcome was the incidence of major adverse cardiovascular events (MACE), defined as 30-day postoperative incidence of myocardial infarction stroke, or mortality. A multivariate logistic regression model was constructed; performance and calibration were evaluated using an ROC analysis and the Hosmer–Lemeshow test and compared to the RCRI and the AUB-HAS2 index.
This study proposes a novel procedure-specific cardiovascular risk index. The PN-A4CH index demonstrated good predictive ability and excellent calibration using a large national database and may enable further individualization of patient care and optimization of patient selection. | 3 | | R465.00 | |
| | Instrumental dead space and proximal working channel connector design in flexible ureteroscopy: a new concept | Instrumental dead space and proximal working channel connector design in flexible ureteroscopy: a new concept
Instrumental dead space and proximal working channel connector design in flexible ureteroscopy: a new concept
Overview
The objective of this study was to evaluate a new concept in flexible ureteroscopy: instrumental dead space (IDS). For this purpose, various proximal working channel connector designs, as well as the impact of ancillary devices occupying the working channel were evaluated in currently available flexible ureteroscopes.
IDS was defined as the volume of saline irrigation needed to inject at the proximal connector for delivery at the distal working channel tip. Because IDS is related to working channel diameter and length, proximal connector design, as well as occupation of working channel by ancillary devices, these parameters were also reviewed.
IDS appears as a new parameter that should be considered for future applications of flexible ureteroscopes. A low IDS seems desirable for several clinical applications. The main factors impacting IDS are working channel and proximal connector design, as well as ancillary devices inserted into the working channel. Future studies should clarify how reducing IDS may affect irrigation flow, intrarenal pressure, and direct in-scope suction, as well as evaluate the most desirable proximal connector design properties.
| 3 | | R460.00 | |
| | Could the vaginal wall sling still have a role after FDA’s warning? the functional outcomes at 20 years. | Could the vaginal wall sling still have a role after FDA’s warning? the functional outcomes at 20 years.
Could the vaginal wall sling still have a role after FDA’s warning? the functional outcomes at 20 years.
Overview
Aims of this study were to evaluate the functional outcomes of a vaginal wall sling technique in patients with stress urinary incontinence at 20 years after surgery and to evaluate the patient’s satisfaction after the surgical procedure.
This was a prospective single-center study on patients with stress urinary incontinence who underwent in situ vaginal sling surgery. Pre-surgery evaluation included history, pelvic examination, and urodynamic test. All patients completed Urogenital Distress Inventory–6 (UDI-6) questionnaire. They underwent checkups at 1, 3, 6, and 12 months postoperatively and then annually. The sling was created by making a rectangle (15–20 × 25 mm) on the anterior vaginal wall and it was reinforced by one roll of Marlex mesh on each side of the sling. The sutures were passed through the vagina at the suprapubic level after suprapubic incision, above the rectus fascia and tied without excessive tension.
From May 1996 to May 2002, 40 women underwent vaginal wall sling surgery for stress urinary incontinence. Last visit was performed on 20 women between March 2020 and April 2020. Median follow-up was 251.3 months (20.9 years) (range = 204.3–285.4 months). The success rate after 5 years of surgical procedure was 80%; over 5 years, the objective cure rate was 45%. Considering only the group of 13 patients with pure stress urinary incontinence, the objective cure rate decreased to 38%, in particular 7 years after surgery. Women who did not resolve their urinary incontinence needed to undergo a new treatment. At over 5 years after surgery, there was an increase in urgency (p = 0.001) and voiding symptoms (p = 0.008) and urgency urinary incontinence (UUI) (p = 0.04). Ninety-five percent were very much worse or much worse according to the Patient Global Impression of Improvement (PGI-I) scale. Conclusion: The in situ vaginal wall sling does not guarantee good long-term functional outcomes in women with stress urinary incontinence.
| 3 | | R480.00 | |
| | Cognitive function in patients undergoing cystectomy for bladder cancer – results from a prospective observational study. | Cognitive function in patients undergoing cystectomy for bladder cancer – results from a prospective observational study.
Cognitive function in patients undergoing cystectomy for bladder cancer – results from a prospective observational study.
Overview
Impaired cognitive function of bladder cancer patients plays a role in coping with the kind of urinary diversion and may impact perioperative morbidity. In this study we therefore aimed to assess the prevalence of mild cognitive impairment in patients undergoing radical cystectomy.
Secondary objectives included correlation of common cognition tests, assessment of the admitting physician, and perioperative complication rates.
Patients undergoing radical cystectomy for bladder cancer were prospectively screened by neuropsychological tests including cognition tests [DemTect (Dementia Detection test), MMSE (Mini-Mental State Examination), clock drawing test] prior to surgery. Mild cognitive impairment was observed in more than a quarter of radical cystectomy patients prior to surgery. Preoperative assessment should be supplemented by neuropsychological testing such as the DemTect as mild cognitive impairment is often underestimated and associated with significantly higher perioperative complication rates. | 3 | | R425.00 | |
| | Mixed reality applications in urology: Requirements and future potential | Mixed reality applications in urology: Requirements and future potential
Mixed reality applications in urology: Requirements and future potential
Overview Mixed reality (MR), the computer-supported augmentation of a real environment with virtual elements, becomes ever more relevant in the medical domain, especially in urology, ranging from education and training over surgeries. This study aimed to review existing MR technologies and their applications in urology. A non-systematic review of current literature was performed using the PubMed-Medline database using the medical subject headings (MeSH) term “mixed reality”, combined with one of the following terms: “virtual reality”, “augmented reality”, ‘’urology’’ and “augmented virtuality”. The relevant studies were utilized. It was found that medical students, urology residents and inexperienced urologists can gain experience thanks to MR technologies. MR applications are also used in patient education before interventions. For surgical support, the achievable accuracy is often not sufficient. The main challenges are the non-rigid nature of the genitourinary organs, intraoperative data acquisition, online and multimodal registration and calibration of devices. However, the progress made in recent years is tremendous in all respects and the gap is constantly shrinking.
Authors Gerd Reis, Mehmet Yilmaz, Jason Rambach, Alain Pagani, Rodrigo Suarez-Ibarrola, Arkadiusz Miernik, Paul Lesur, Nareg Minaskan
| 3 | | R400.00 | |
| | The psychosocial impact of surgical complications on the operating surgeon: A scoping review | The psychosocial impact of surgical complications on the operating surgeon: A scoping review
The psychosocial impact of surgical complications on the operating surgeon: A scoping review
Overview Surgical complications are common, and their management is an integral part of surgical care. The impact on the surgeon, the “second victim” is significant, particularly in terms of psychological health. The aim of this review is to describe the nature of psychosocial consequences of surgical complications on the surgeons involved. Following scoping review protocols, this study set out to identify the evidence-base for psychosocial consequences on the operating surgeon, predominantly general surgeons, following surgical complications. This review suggests that the psychosocial impact, following a complication, is variable but affects every surgeon irrespective of the level of impact on the patient. The main variables differentiating impact are severity, and outcome of the complication and seniority of the surgeon. Reported emotions and behaviours were generally negative and persist across the surgeon’s journey towards recovery. Surgeons who manage stress well exhibit largely constructive behaviours and actively work to recover. Identification of variables underpinning complications, and affected surgeons is paramount, as is the provision of services to support recovery. Efforts should be made to proactively prevent complications, via education, awareness and to formalise support processes.
Authors Manjunath Siddaiah-Subramanya, Henry To, Catherine Haigh Journal Annals of Medicine and Surgery
| 3 | | R410.00 | |
| | Eliciting Emotion and Action Increases Social Media Engagement: An Analysis of Influential Orthopaedic Surgeons | Eliciting Emotion and Action Increases Social Media Engagement: An Analysis of Influential Orthopaedic Surgeons
Eliciting Emotion and Action Increases Social Media Engagement: An Analysis of Influential Orthopaedic Surgeons
Overview The purpose of this study is to analyse the Instagram practices of current orthopaedic surgeons and the components associated with highest reach and interactions. The top 25 orthopaedic surgeon Instagram profiles using the hashtag #ortho were ranked by the number of followers. Account information regarding followers, posts, engagement percentage, average likes, average comments, average video view, average video likes, average video comments, and estimated cost per post was recorded using social media marketing tools. An analysis of each Instagram profiles’ top 10 posts, based on number of likes, was conducted. The present investigation found that the most effective strategies to generate more interactions on Instagram are those that elicit emotional responses and provoke viewer engagement by asking questions and directing actions. Additionally, it was found that promotional content was not well received by viewers
Authors Muhammad J. Abbas, B.S., LafiS. Khalil, M.D., Abdulah Haikal, B.A., Miriam E. Dash, M.S.,Gauthier Dongmo, B.S., and Kelechi R. Okoroha, M.D Journal Arthroscopy, Sports Medicine, and Rehabilitation | 3 | | R420.00 | |
| | Previous History of Knee Arthroscopy in Patients Undergoing Total Knee Arthroplasty: An Examination of the Effect of the Literature and American Academy of Orthopaedic Surgeons 2013 Arthroscopy Guidelines on Clinical Practice | Previous History of Knee Arthroscopy in Patients Undergoing Total Knee Arthroplasty: An Examination of the Effect of the Literature and American Academy of Orthopaedic Surgeons 2013 Arthroscopy Guidelines on Clinical Practice
Previous History of Knee Arthroscopy in Patients Undergoing Total Knee Arthroplasty: An Examination of the Effect of the Literature and American Academy of Orthopaedic Surgeons 2013 Arthroscopy Guidelines on Clinical Practice
Overview The purpose of this study was to compare the rate of previous knee arthroscopy in patients undergoing total knee arthroplasty (TKA) before (2005-2006) and after (2018) publication of landmark studies that examined the effectiveness of knee arthroscopy as well as the American Academy of Orthopaedic Surgeons 2013 knee arthroscopy guidelines. In this study a retrospective chart review of 214 patients who underwent a TKA between 2005 and 2006 (Group 1) and 213 patients who underwent a TKA in 2018 (Group 2) was performed. The medical records were to determine whether previous knee arthroscopy was performed. The findings suggests that the recommendations set forth by landmark clinical trials that examined the effectiveness of knee arthroscopy and the AAOS 2013 knee arthroscopy guidelines did not have a sudden impact within the geographic region, however there is significant evidence to suggest a gradual shift in treatment, where knee arthroscopy is withheld near imminent knee arthroplasty.
Authors Melissa A. Kluczynski, M.S.., Griffin Lunn, Matthew J. Phillips, M.D., andJohn M. Marzo, M.D
Journal Arthroscopy, Sports Medicine, and Rehabilitation | 3 | | R485.00 | |
| | Adoption of direct discharge of simple stable injuries amongst (orthopaedic) trauma surgeons | Adoption of direct discharge of simple stable injuries amongst (orthopaedic) trauma surgeons
Adoption of direct discharge of simple stable injuries amongst (orthopaedic) trauma surgeons
Overview The importance of routine follow-up of several relatively simple stable injuries (SSIs) is questionable. Multiple studies show that direct discharge (DD) of patients with SSIs from the Emergency Department results in patient outcomes and experiences comparable to ‘standard care’ with outpatient follow-up. The purpose of this study was to evaluate to which extent DD of SSIs has been adopted amongst trauma and orthopaedic surgeons internationally, and to assess the variation in the management of these common injuries. An online survey was sent to members of an international trauma- and orthopaedic surgery collaboration. Participants, all trauma- or orthopaedic surgeons, were presented with eleven hypothetical cases of patients with simple stable injuries in which they were asked to outline their treatment plan regarding number of follow-up appointments and radiographs, physiotherapy and when to start functional movement. Clinical agreement regarding number of appointments and when to start functional movement was not reached for any of the injuries. There was clinical agreement on number of radiographs for one injury and for four injuries regarding routine referral to a physiotherapist. Despite available evidence, DD of SSIs has not been widely adopted worldwide. Practice variation still exists even for these common injuries. This variation suggests inefficiency and consequently unnecessarily high healthcare costs. (Orthopaedic) trauma surgeons are encouraged to evaluate their cur- rent treatment protocols of SSIs.
Authors T.H. Geerdink, B.A. Uijterwijk, D.T. Meijer, I.N. Sierevelt, W.H. Mallee, R.N. van Veen, J.C. Goslings, R. Haverlag, Trauma Platform Study Collaborative Journal Injury International Journal of the Care of the Inured
| 3 | | R420.00 | |
| | Helping the Surgeon Recover: Peer-to-Peer Coaching after Bile Duct Injury | Helping the Surgeon Recover: Peer-to-Peer Coaching after Bile Duct Injury
Helping the Surgeon Recover: Peer-to-Peer Coaching after Bile Duct Injury
Overview Bile duct injury sustained during laparoscopic cholecystectomy is associated with high morbidity and mortality and can be a devastating complication for a general surgeon. This study introduces a novel, individualized surgical coaching program for surgeons who recently injured a bile duct in laparoscopic cholecystectomy. The course aims to explore the perception of coaching among these surgeons and to assess surgeons’ experiences in the coaching program. Six general surgeons who injured a bile duct at an emergency laparoscopic cholecystectomy participated in a one-on-one coaching session with a hepatopancreatobiliary surgeon. The session focused on debriefing the index case with video feedback, and discussion of strategies for safe laparoscopic cholecystectomy. Peer coaching was identified as a valuable resource in helping surgeons regain confidence and maintain well-being after a bile duct injury. Maintaining a collegial, nonjudgmental relationship is critical in establishing positive coaching experiences. An individualized surgical coaching program creates a unique opportunity for professional development and may help promote safe laparoscopic cholecystectomy.
Authors Alice ZhuShirley, DengBrittany, GreeneMelanie, TsangShiva Jayarama
Journal Journal of the American College of Surgeons
| 3 | | R425.00 | |
| | Social Media Use Among Academic Hand Surgeons | Social Media Use Among Academic Hand Surgeons
Social Media Use Among Academic Hand Surgeons
Overview Social media has become increasingly prevalent among the general population in the past decade. We examined the current prevalence of social media use among academic orthopedic-trained and plastic surgery-trained hand surgeons in the United States. All publicly available hand surgery faculty across the nation were analyzed for their public social media usage, including Instagram, Facebook, Twitter, LinkedIn, and personal websites. Comparisons of social media usage between orthopedic-trained and plastic surgery-trained hand surgeons, male and female academic hand surgeons, hand surgeons from different regions of the United States (East, West, Midwest, and South), and years of experience were analyzed. Despite the widely known use of social media among plastic and aesthetic surgeons, this study shows the use of web-based marketing strategies to be quite rare in the academic hand surgery setting. The study shows that throughout the United States, academic hand surgeons use social media at low rates. It is suggested that academic plastic surgery and orthopedic hand surgeons throughout the United States consider having a larger social media presence to expand advertising, improve patient education, and enhance networking among their practices. Social media can be a valuable tool and will likely only increase in popularity in the coming years.
Authors Nihaal Reddy BS, Tyler Evans MD, Ryan Jefferson MD, Austin J. Roebke MD, Sonu A. Jain MD Journal Journal of Hand Surgery Global Online | 3 | | R450.00 | |
| | HIV and Aids | HIV and Aids
Overview
HIV disease is caused by infection with HIV-1 or HIV-2, which are retroviruses in the Retroviridae family, Lentivirus genus. Human immunodeficiency virus (HIV) is a blood-borne virus typically transmitted via sexual intercourse, shared intravenous drug paraphernalia, and mother-to-child transmission (MTCT), which can occur during the birth process or during breastfeeding. The patient with HIV may present with signs and symptoms of any of the stages of HIV infection. No physical findings are specific to HIV infection; the physical findings are those of the presenting infection or illness. Examples of manifestations include acute seroconversion manifests as a flulike illness, consisting of fever, malaise, generalized rash, generalized lymphadenopathy is common and may be a presenting symptom. This course covers the screening, diagnosis, medication and management of Aids.
Author: Sharespike | 3 | | R425.00 | |
| | Total robotic surgery for pancreaticoduodenectomy combined with rectal cancer anterior resection | Total robotic surgery for pancreaticoduodenectomy combined with rectal cancer anterior resection
Total robotic surgery for pancreaticoduodenectomy combined with rectal cancer anterior resection
Overview
Synchronous double malignancies, including carcinoma of the ampulla of Vater and rectal carcinoma, are generally uncommon occurrences in the gastrointestinal tract. The present study reports a case of a 37-year-old man who was incidentally found to suffer from carcinoma of the ampulla of Vater and rectal carcinoma. The duodenoscopy was performed and revealed an ulcerated and bulky ampulla of Vater, the biopsy from which revealed a moderate-differentiated adenocarcinoma, A local hospital colonoscopy confirmed a tumour located in rectal 7cm from the anal margin and biopsy-confirmed poorly differentiated adenocarcinoma.
About such patient treatment, both open and laparoscopic surgery are restricted because of operation complexity, large injury, and poor cosmetic effect. surgery performed using Da Vinci robotic surgical system (DVSS). No evidence of recurrence or relapses was found in the first year after surgery. Although sporadic double malignancies are uncommon, they should be considered when evaluating cancer patients. Complex surgery performed by robotic surgery may became surgeon’s preferred treatment modality.
Acknowledgement
Authors QunGuang Jiang, TaiYuan Li, DongNing Liu and Cheng Tang,
Journal Medicine Volume 97 Issue 19
Publisher Wolters Kluwer Health, Inc
| 3 | | R389.00 | |
| | Clinical Practice Guidelines: Trauma Part 2 | Clinical Practice Guidelines: Trauma Part 2
Clinical Practice Guidelines: Trauma Part 2
Overview “Injury is an increasingly significant health problem throughout the world. Every day, 16 000 people die from injuries, and for every person who dies, several thousand more are injured, many of them with permanent sequelae. Injury accounts for 16% of the global burden of disease. The burden of death and disability from injury is especially notable in low- and middle-income countries. By far the greatest part of the total burden of injury, approximately 90%, occurs in such countries” (Mock et al., 2004).
The focus of pre-hospital trauma management remains the rapid access and extrication of patients to allow for the rapid assessment and control of bleeding, the airway and ventilation. There is a renewed focus on the importance of rapid transport as the most important factor for trauma survival remains time to access of definitive care and operative haemostasis.
Bleeding remains one of the most important contributors to traumatic death. The prevention of the trauma triad of death: hypothermia, acidosis and coagulopathy remain an important goal. Haemodilution and the role of pre-hospital fluid management has also received significant attention. Many well-developed trauma systems are moving towards restrictive fluid management regimes, specific haemodynamic targets and the introduction of pre-hospital initiation of blood product administration. The control and prevention of bleeding remains a central focus for pre-hospital providers.
Acknowledgement Journal:
Clinical Practice Guidelines (July 2018)
Publisher:
Health Professions Council of South Africa | 3 | | R410.00 | |
| | Clinical Practice Guidelines: Pain and Procedural Sedation | Clinical Practice Guidelines: Pain and Procedural Sedation
Clinical Practice Guidelines: Pain and Procedural Sedation
Overview “The management of acute traumatic pain is a crucial component of pre-hospital care and yet the assessment and administration of analgesia is highly variable, frequently suboptimal, and often determined by consensus-based protocols” (Gausche-Hill et al., 2014). Pain management is also frequently based on the assessment of need by a provider, rather than the requirements of patients. Historically only Entonox and morphine have been available for pre-hospital pain management in the local setting with the more recent introduction of ketamine. Availability of appropriate and effective treatment options, especially for non-ALS providers, remains a challenge.
Situations requiring procedural sedation and analgesia in the pre-hospital setting are common and may range from alignment of fracture to extrication and complex disentanglement during medical rescue. Until recently South African pre-hospital providers did not have agents suitable for this purpose, particularly in the setting of severe trauma and hypotension. As ketamine has been introduced into some scopes of practice providing safe and effective dissociative procedural analgesia has become a possibility. However, the use of procedural sedation and analgesia is not without risks and, at this time, no uniform practice has been suggested in the South African pre-hospital setting. Acknowledgement Journal:
Clinical Practice Guidelines (July 2018)
Publisher:
Health Professions Council of South Africa | 3 | | R410.00 | |
| | Clinical Practice Guidelines: Trauma Part 1 | Clinical Practice Guidelines: Trauma Part 1
Clinical Practice Guidelines: Trauma Part 1
Overview
“Injury is an increasingly significant health problem throughout the world. Every day, 16 000 people die from injuries, and for every person who dies, several thousand more are injured, many of them with permanent sequelae. Injury accounts for 16% of the global burden of disease. The burden of death and disability from injury is especially notable in low- and middle-income countries. By far the greatest part of the total burden of injury, approximately 90%, occurs in such countries” (Mock et al., 2004). The focus of pre-hospital trauma management remains the rapid access and extrication of patients to allow for the rapid assessment and control of bleeding, the airway and ventilation. There is a renewed focus on the importance of rapid transport as the most important factor for trauma survival remains time to access of definitive care and operative haemostasis. Bleeding remains one of the most important contributors to traumatic death. The prevention of the trauma triad of death: hypothermia, acidosis and coagulopathy remain an important goal. Haemodilution and the role of pre-hospital fluid management has also received significant attention. Many well-developed trauma systems are moving towards restrictive fluid management regimes, specific haemodynamic targets and the introduction of pre-hospital initiation of blood product administration. The control and prevention of bleeding remains a central focus for pre-hospital providers. Acknowledgement
Journal: Clinical Practice Guidelines (July 2018) Publisher: Health Professions Council of South Africa Clinical Practice Guidelines: Trauma Part 1 | 3 | | R410.00 | |
| | Viral Pneumonia Part 3 | Viral Pneumonia Part 3
Overview The reported incidence of viral pneumonia (see the image below) has increased during the past decade. In part, this apparent increase simply reflects improved diagnostic techniques, but an actual increase appears to have also occurred. Depending on the virulence of the organism, as well as the age and comorbidities of the patient, viral pneumonia can vary from a mild, self-limited illness to a life-threatening disease. This course is divided into 3 parts covering the aspects of Pneumonia leading into the much dreaded COVID 19 The influenza viruses are the most common viral cause of pneumonia. Primary influenza pneumonia manifests with persistent symptoms of cough, sore throat, headache, myalgia, and malaise for more than three to five days. Respiratory syncytial virus (RSV) is the most frequent cause of lower respiratory tract infection in infants and children and the second most common viral cause of pneumonia in adults.
Parainfluenza virus (PIV) is second in importance only to RSV as a cause of lower respiratory tract disease in children and pneumonia and bronchiolitis in infants younger than 6 months. PIV pneumonia and bronchiolitis are caused primarily by the PIV-3 strain. The signs and symptoms include fever, cough, coryza, dyspnea with rales, and wheezing.
Acknowledgements Authors:
Zab Mosenifar and Richard Brawerman | 3 | | R420.00 | |
| | Viral Pneumonia Part 2 | Viral Pneumonia Part 2
Overview The reported incidence of viral pneumonia (see the image below) has increased during the past decade. In part, this apparent increase simply reflects improved diagnostic techniques, but an actual increase appears to have also occurred. Depending on the virulence of the organism, as well as the age and comorbidities of the patient, viral pneumonia can vary from a mild, self-limited illness to a life-threatening disease. This course is divided into 3 parts covering the aspects of Pneumonia leading into the much dreaded COVID 19. The influenza viruses are the most common viral cause of pneumonia. Primary influenza pneumonia manifests with persistent symptoms of cough, sore throat, headache, myalgia, and malaise for more than three to five days. Respiratory syncytial virus (RSV) is the most frequent cause of lower respiratory tract infection in infants and children and the second most common viral cause of pneumonia in adults.
Parainfluenza virus (PIV) is second in importance only to RSV as a cause of lower respiratory tract disease in children and pneumonia and bronchiolitis in infants younger than 6 months. PIV pneumonia and bronchiolitis are caused primarily by the PIV-3 strain. The signs and symptoms include fever, cough, coryza, dyspnea with rales, and wheezing.
Acknowledgements Authors:
Zab Mosenifar and Richard BrawermanThe University of Pretoria | 3 | | R420.00 | |
| | Viral Pneumonia Part 1 | Viral Pneumonia Part 1
Overview The reported incidence of viral pneumonia (see the image below) has increased during the past decade. In part, this apparent increase simply reflects improved diagnostic techniques, but an actual increase appears to have also occurred. Depending on the virulence of the organism, as well as the age and comorbidities of the patient, viral pneumonia can vary from a mild, self-limited illness to a life-threatening disease.
This course is divided into 3 parts covering the aspects of Pneumonia leading into the much dreaded COVID 19. The influenza viruses are the most common viral cause of pneumonia. Primary influenza pneumonia manifests with persistent symptoms of cough, sore throat, headache, myalgia, and malaise for more than three to five days. Respiratory syncytial virus (RSV) is the most frequent cause of lower respiratory tract infection in infants and children and the second most common viral cause of pneumonia in adults.
Parainfluenza virus (PIV) is second in importance only to RSV as a cause of lower respiratory tract disease in children and pneumonia and bronchiolitis in infants younger than 6 months. PIV pneumonia and bronchiolitis are caused primarily by the PIV-3 strain. The signs and symptoms include fever, cough, coryza, dyspnea with rales, and wheezing.
Acknowledgements
Authors:
Zab Mosenifar and Richard Brawerman | 3 | | R420.00 | |
| | Acute Management of Stroke | Acute Management of Stroke
Acute Management of Stroke
Overview:
The goal for the acute management of patients with stroke is to stabilize the patient and to complete initial evaluation and assessment, including imaging and laboratory studies, within 60 minutes of patient arrival. Critical decisions focus on the need for intubation, blood pressure control, and determination of risk/benefit for thrombolytic intervention.
In patients with transient ischemic attacks (TIAs), failure to recognize the potential for near- term stroke, failure to perform a timely assessment for stroke risk factors, and failure to initiate primary and secondary stroke prevention exposes the patient to undue risk of stroke and exposes clinicians to potential litigation. TIAs confer a 10% risk of stroke within 30 days, and one half of the strokes occurring after a TIA, occurred within 48 hours.
Newer stroke trials have explored the benefit of using neuroimaging to select patients who are most likely to benefit from thrombolytic therapy and the potential benefits of extending the window for thrombolytic therapy beyond the guideline of 3 hours with t-PA and newer agents. CT angiography may demonstrate the location of vascular occlusion. CT perfusion studies can produce perfusion images and together with CT angiography are becoming more available and utilized in the acute evaluation of stroke patients. Advanced neuroimaging with diffusion and perfusion imaging may then serve an important role in identifying potentially salvageable tissue at risk and guiding clinical decision-making regarding therapy.
Acknowledgements:
Authors:
Edward C Jauch | 3 | | R440.00 | |
| | Protocol for the systematic review of the reporting of transoral robotic surgery | Protocol for the systematic review of the reporting of transoral robotic surgery
Protocol for the systematic review of the reporting of transoral robotic surgery
Overview
This will be a comprehensive review of transoral robotic surgery and will track its innovative evolution since first published description to present day. Inclusion of all study types will allow identification of good and poor examples of the descriptions of innovative invasive procedures. The methods described are applicable to reviews of any innovative surgical or other invasive procedure.
Transoral robotic surgery (TORS) has been adopted in some parts of the world as an innovative approach to the resection of oropharyngeal tumours. The development, details and outcomes of early-to-later phase evaluation of this technique and the quality of evidence to support its adoption into practice have hitherto not been summarised. The aim of this review is to identify and summarise the early and later phase studies of, and evidence for, TORS and to understand how early phase studies report intervention development, governance procedures and selection and reporting of outcomes to optimise methods for using the Idea, Development, Exploration, Assessment, Long-term follow-up (IDEAL) framework for surgical innovation that informs evidence based practice. The protocol has been written in line with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols checklist.
Acknowledgement
Authors Barry G Main, Natalie S Blencowe, Noah Howes, Sian Cousins, Kerry N L Avery, Alexander Gormley, Phil Radford, Daisy Elliott, Benjamin Byrne, Nicholas Wilson, Robert Hinchliffe, Jane M Blazeby,
Journal
BMJ Open
| 3 | | R420.00 | |
| | Prospective cohort study comparing quality of life and sexual health outcomes between women undergoing robotic, laparoscopic and open surgery for endometrial cancer | Prospective cohort study comparing quality of life and sexual health outcomes between women undergoing robotic, laparoscopic and open surgery for endometrial cancer
Prospective cohort study comparing quality of life and sexual health outcomes between women undergoing robotic, laparoscopic and open surgery for endometrial cancer
Overview
Endometrial cancer is the most common gynaecologic cancer in developed countries and has been increasing at a rate of over 2.5% per year in North America for the last decade [1]. Most women are diagnosed at an early stage and surgery is the primary treatment, including total hysterectomy, bilateral salpingo-oophorectomy and surgical staging, which can include pelvic and para-aortic lymph node assessment [2].
This online course aims at evaluating patient-reported outcomes (PROs) between women treated by laparoscopic, robotic and open approaches for endometrial cancer. Historically, the preferred surgical approach for treatment of endometrial cancer has been laparotomy. However, multiple randomized controlled trials (RCTs) comparing laparoscopy to laparotomy have reported decreases in postoperative complication rates and length of hospital stay in women undergoing laparoscopy [3–6]. Importantly, there appears to be no difference in disease-free and overall survival in those women treated by a minimally invasive approach [6,7]. Based on these findings, laparoscopy, and more recently robotic surgeries, have become standard surgical approaches for endometrial cancer.
It was concluded that minimally invasive approaches result in improved QOL beyond the short-term postoperative
Acknowledgement
Author Sarah E. Ferguson, Tony Panzarella, Susie Lau, Lilian T. Given, Vanessa Samouëlian, Christopher Giede, Helen Steedi, Tien Le, Ben Renkosinski, Marcus Q, Bernardini,
Journal
Gynecologic Oncology
| 3 | | R410.00 | |
| | Robotic radical hysterectomy is superior to laparoscopic radical hysterectomy and open radical hysterectomy in the treatment of cervical cancer | Robotic radical hysterectomy is superior to laparoscopic radical hysterectomy and open radical hysterectomy in the treatment of cervical cancer
Robotic radical hysterectomy is superior to laparoscopic radical hysterectomy and open radical hysterectomy in the treatment of cervical cancer
Overview
Cervical cancer (CC) continues to be a global burden for women, with higher incidence and mortality rates reported annually. Many countries have witnessed a dramatic reduction in the prevalence of CC due to widely accessed robotic radical hysterectomy (RRH). This network meta-analysis aims to compare intra-operative and postoperative outcomes in way of RRH, laparoscopic radical hysterectomy (LTH) and open radical hysterectomy (ORH) in the treatment of early-stage CC. A comprehensive search of PubMed, Cochrane Library and EMBASE databases was performed from inception to June 2016. Clinical controlled trials (CCTs) of above three hysterectomies in the treatment of early-stage CC were included in this study. Seventeen 17 CCTs were ultimately enrolled in this network meta-analysis. The network meta-analysis showed that patients treated by RRH and LRH had lower estimated blood loss compared to patients treated by ORH. the SUCRA value of three radical hysterectomies showed that patients receiving RRH illustrated better conditions on intra-operative blood loss, operation time, the number of resected lymph nodes, length of hospital stay and intra-operative and postoperative complications, while patients receiving ORH demonstrated relatively poorer conditions.
Acknowledgement
Authors Yue-Mei Jin, Shan-Shan Liu, Jun Chen, Yan-Nan Chen and Chen-Chen Ren
Journal PLoS ONE
| 3 | | R415.00 | |
| | Pregnancy following robot-assisted laparoscopic partial cystectomy and gonadotropin-releasing hormone agonist treatment within three months in an infertile woman with bladder endometriosis | Pregnancy following robot-assisted laparoscopic partial cystectomy and gonadotropin-releasing hormone agonist treatment within three months in an infertile woman with bladder endometriosis
Pregnancy following robot-assisted laparoscopic partial cystectomy and gonadotropin-releasing hormone agonist treatment within three months in an infertile woman with bladder endometriosis
Overview
Endometriosis is a benign disease defined as endometrial tissue implanting outside the uterine cavity and often causes dysmenorrhea, pelvic pain, dyspareunia and infertility. The prevalence of endometriosis has been reported in up to 50% of infertile women. This article serves to report an infertility case of deep-infiltrating bladder endometriosis conceiving following robot-assisted surgery and modified gonadotropin-releasing hormone agonist (GnRHa) treatment.
Case report: A 33-year-old infertile female presenting with dysmenorrhea was found to have a bladder mass by pelvic ultrasound. Cystoscopy revealed a protruding tumour from the posterior bladder wall, and endometriosis was highly suspected. Robot-assisted laparoscopic partial cystectomy was performed for the deep-infiltrating bladder endometriosis. With postoperative half-dose GnRHa treatment and timed intercourse, she got pregnant within 3 months.
It was concluded that robot-assisted complete resection of deep-infiltrating endometriosis and bladder repair immediately followed by GnRHa therapy and medical assistance improves reproductive outcomes efficiently in women with endometriosis-associated infertility
Acknowledgement
Author Shun-Jen Tan, Chi-Huang Chen, Shauh-Der Yeh, Yun-Ho Lin, Chii-Ruey Tzeng
Journal Taiwanese Journal of Obstetrics & Gynaecology
| 3 | | R435.00 | |
| | Technique for single axillary incision robotic assisted quadrantectomy and immediate partial breast reconstruction with robotic latissimus dorsi flap harvest for breast cancer | Technique for single axillary incision robotic assisted quadrantectomy and immediate partial breast reconstruction with robotic latissimus dorsi flap harvest for breast cancer
Technique for single axillary incision robotic assisted quadrantectomy and immediate partial breast reconstruction with robotic latissimus dorsi flap harvest for breast cancer
Overview
The clinical application of robotic surgery in breast conserving surgery or volume replacement with robotic latissimus dorsi flap harvest (RLDFH) has been rarely reported. In this study, we report the preliminary experience and clinical outcome of robotic assisted quadrantectomy (RAQ) and immediate partial breast reconstruction (IPBR) with RLDFH.
The post-operative recovery was smooth except for seroma formation over the back, which was relieved after repeated aspiration at an outpatient clinic. The patient was satisfied with the post-operative scar and aesthetic outcome. No local recurrence, distant metastasis or case mortality was found during 5 months of follow-up. RAQ and IPBR with RLDFH is a safe alternative for small-to-medium-breast-size women with breast cancer who desire breast conservation and are indicated for volume replacement with autologous latissimus dorsi flap.
Acknowledgement
Authors Hung-Wen Lai, Shou-Tung Chen, Shih-Lung Lin, Ya-Ling Lin, Hwa-Koon Wu, Shu-Hsin Pai, Dar-Ren Chen and Shou-Jen Kuo,
Journal
Medicine Baltimore
Publisher Wolters Kluwer Health, Inc.
| 3 | | R420.00 | |
| | Immunogenomic Classification of Colo-rectal Cancer and Therapeutic Implications | Immunogenomic Classification of Colo-rectal Cancer and Therapeutic Implications
Immunogenomic Classification of Colo-rectal Cancer and Therapeutic Implications
Overview
The immune system has a substantial effect on colorectal cancer (CRC) progression. Additionally, the response to immunotherapeutic and conventional treatment options (e.g., chemotherapy, radiotherapy and targeted therapies) is influenced by the immune system.
The molecular characterization of colorectal cancer (CRC) has led to the identification of favourable and unfavourable immunological attributes linked to clinical outcome. With the definition of consensus molecular subtypes (CMSs) based on transcriptomic profiles, multiple characteristics have been proposed to be responsible for the development of the tumour immune microenvironment and corresponding mechanisms of immune escape.
In this review, a detailed description of proposed immune phenotypes as well as their interaction with different therapeutic modalities will be provided. Finally, possible strategies to shift the CRC immune phenotype towards a reactive, anti-tumour orientation are proposed per CMS. The recognition of the impact of the immune system on the progression of CRC has led to the identification and detailed characterization of tumour immune phenotypes.
Acknowledgement
Author Jessica Roelands, Peter J. K. Kuppen, Louis Vermeulen, Cristina Maccalli, Julie Decock, Ena Wang, Francesco M. Marincola, Davide Bedognetti and Wouter Hendrickx
Journal International Journal of Molecular Sciences Volume 18 Issue 10
Publisher PubMed | 3 | | R460.00 | |
| | In vitro immunotherapy potency assays using real-time cell analysis | In vitro immunotherapy potency assays using real-time cell analysis
In vitro immunotherapy potency assays using real-time cell analysis
Overview
A growing understanding of the molecular interactions between immune effector cells and target tumour cells, coupled with refined gene therapy approaches, are giving rise to novel cancer immuno-therapeutics with remarkable efficacy in the clinic against both solid and liquid tumours. Therefore, there is an urgent need for functional potency assays, in vitro and in vivo, that could model the complex interaction of immune cells with tumour cells and can be used to rapidly test the efficacy of different immunotherapy approaches, whether it is small molecule, biologics, cell therapies or combinations thereof.
Herein we report the development of an xCELLigence real-time cytolytic in vitro potency assay that uses cellular impedance to continuously monitor the viability of target tumour cells while they are being subjected to different types of treatments. In summary, our results demonstrate the xCELLigence platform to be well suited for potency assays, providing quantitative assessment with high reproducibility and a greatly simplified workflow.
Acknowledgement
Author Fabio Cerignoli, Yama A. Abassi, Brandon J. Lamarche, Garret Guenther, David Santa Ana, Diana Guimet, Wen Zhang, Jing Zhang and Biao Xi
Journal PLoS ONE Volume 13 Issue 3
Publisher Cross Mark
| 3 | | R360.00 | |
| | Incidental Statin Use and the Risk of Stroke or Transient Ischemic Attack after Radiotherapy for Head and Neck Cancer | Incidental Statin Use and the Risk of Stroke or Transient Ischemic Attack after Radiotherapy for Head and Neck Cancer
Incidental Statin Use and the Risk of Stroke or Transient Ischemic Attack after Radiotherapy for Head and Neck Cancer
Overview
Interventions to reduce the risk for cerebrovascular events (CVE; stroke and transient ischemic attack [TIA]) after radiotherapy (RT) for head and neck cancer (HNCA) are needed. We aimed to test whether incidental statin use at the time of RT is associated with a lower rate of CVEs after RT for HNCA.
From an institutional database we identified all consecutive subjects treated with neck RT from 2002 to 2012 for HNCA. Data collection and event adjudication was performed by blinded teams. The primary outcome was a composite of ischemic stroke and TIA. The secondary outcome was ischemic stroke. The association between statin use and events was determined using Cox proportional hazard models after adjustment for traditional and RT-specific risk factors.
Incidental statin use at the time of RT for HNCA is associated with a lower risk of stroke or TIA.
Acknowledgement
Authors
Daniel Addison, Patrick R. Lawler, Hamed Emami, Sumbal A. Janjua, Pedro V. Staziaki, Travis R. Hallett, Orla Hennessy, Hang Lee, Bálint Szilveszter, Michael Lu, Negar Mousavi, Matthew G. Nayor, Francesca N. Delling, Javier M. Romero, Lori J. Wirth, Annie W. Chan, Udo Hoffmann, Tomas G. Neilan
Journal Journal of Stroke Publisher Cross Mark | 3 | | R420.00 | |