 | | HIV and Aids Part 2 | HIV and Aids Part 2
Overview
HIV (Human Immunodeficiency Virus) is a virus transmitted through sexual contact, shared needles, and from mother to child during childbirth or breastfeeding. It belongs to the Retroviridae family. All patients who are diagnosed with HIV should be initiated on ART as soon as possible.
HIV can also lead to complications like dementia and chronic diarrhea with weight loss (HIV wasting syndrome).
Exceptions to this include patients presenting with cryptococcal meningitis (CM) or central nervous system tuberculosis (tuberculous meningitis (TBM) or tuberculoma).
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| | HIV and Aids Part 1 | HIV and Aids Part 1
Overview
HIV (Human Immunodeficiency Virus) is a virus transmitted through sexual contact, shared needles, and from mother to child during childbirth or breastfeeding. It belongs to the Retroviridae family. Symptoms vary depending on the stage of infection and these include: - Acute stage, which resembles the flu, with fever, malaise, and a generalized rash;
- Asymptomatic stage which generally, has no symptoms.
- Lymphadenopathy, which presents with swelling of lymph nodes, which can be a primary symptom.
- AIDs, which is the advanced stage marked by severe infections or cancers.
HIV can also lead to complications like dementia and chronic diarrhea with weight loss (HIV wasting syndrome).
Sharespike Knowledge Studio | 3 | | R485.00 | |
| | Ebola Virus Infection | Ebola Virus Infection
Overview
Ebola virus is one of at least 30 known viruses capable of causing viral hemorrhagic fever syndrome. The genus Ebolavirus currently is classified into 5 separate species: Sudan ebolavirus, Zaire ebolavirus, Tai Forest (Ivory Coast) ebolavirus, Reston ebolavirus, and Bundibugyo ebolavirus. The outbreak of Ebola virus disease in West Africa from 2014 to 2016, involving Zaire ebolavirus, was the largest outbreak of Ebola virus disease in history.
As of September 17, 2019, an active outbreak of Ebola virus disease in the Democratic Republic of the Congo (DRC) had resulted in 3,034 confirmed and 111 probable cases of Ebola virus disease, including 2,103 attributable deaths. An experimental vaccine has been credited with limiting the outbreak’s scope.
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| | Oral Transmucosal Fentanyl Citrate Analgesia in Prehospital Trauma Care: an observational cohort study | Oral Transmucosal Fentanyl Citrate Analgesia in Prehospital Trauma Care: an observational cohort study
Oral Transmucosal Fentanyl Citrate Analgesia in Prehospital Trauma Care: an observational cohort study
Overview
Pain is a common prehospital symptom in trauma patients and requires timely management. Recent studies have indicated that up to 43% of trauma patients experience inadequate analgesia after prehospital treatment, suggesting the need for improvement. Evidence supports the prehospital use of oral transmucosal fentanyl citrate (OTFC) in military settings.
This observational cohort study examined the use of oral transmucosal fentanyl citrate (OTFC) for prehospital trauma care in remote and challenging environments. Conducted at three ski and bike resorts in Switzerland, the study involved 177 patients treated by trained EMS providers. Results indicated that OTFC is safe, effective, and practical for managing severe pain without the need for intravenous lines. Side effects were rare and mild.
Journal Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine Journal 31 Issue 2
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| | Predictors of post-intubation hypotension in trauma patients following prehospital emergency anaesthesia: a multi-centre observational study | Predictors of post-intubation hypotension in trauma patients following prehospital emergency anaesthesia: a multi-centre observational study
Predictors of post-intubation hypotension in trauma patients following prehospital emergency anaesthesia: a multi-centre observational study
Overview
Post-intubation hypotension (PIH) is common after prehospital emergency anaesthesia (PHEA) and is linked to increased mortality in trauma patients. A multi-centre retrospective study in the UK found that clinician judgment and provider intuition are the most reliable predictors of PIH, often influencing the administration of reduced doses of induction medications for high-risk patients.
Journal Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine Volume 31 Issue 26
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| | The value of Clinical signs in the diagnosis of Degenerative Cervical Myelopathy – A Systematic review and Meta-analysis | The value of Clinical signs in the diagnosis of Degenerative Cervical Myelopathy – A Systematic review and Meta-analysis
The value of Clinical signs in the diagnosis of Degenerative Cervical Myelopathy – A Systematic review and Meta-analysis
Overview
Degenerative cervical myelopathy (DCM) is a progressive spine condition and the most common cause of spinal cord dysfunction globally. Patients with DCM can exhibit subtle, nonspecific symptoms in their upper and lower extremities, making it challenging to diagnose this condition initially. Symptoms reported by patients include bilateral arm paresthesia, reduced manual dexterity, gait instability, and weakness. Other symptoms may include neck pain or stiffness, Lhermitte’s phenomena, and urinary or fecal urgency or incontinence. The delayed diagnosis of DCM is likely due to a combination of its subtle symptoms, incomplete neurological assessments by clinicians, and a lack of public and professional awareness. Establishing diagnostic criteria for DCM could facilitate earlier referral for definitive management. This systematic review aims to determine (i) the diagnostic accuracy of various clinical signs and (ii) the association between clinical signs and disease severity in DCM. In conclusion, the presence of clinical signs indicating spinal cord compression should prompt healthcare professionals to conduct further investigations, such as neuroimaging, to either confirm or refute a diagnosis of DCM.
Journal Global Spine Volume 14 Issue 4
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| | Multifidus Degeneration: The Key Imaging Predictor of Adjacent Segment Disease | Multifidus Degeneration: The Key Imaging Predictor of Adjacent Segment Disease
Multifidus Degeneration: The Key Imaging Predictor of Adjacent Segment Disease
Overview Adjacent segment disease (ASD), which is the degeneration of the segment next to the instrumentation, is a common long-term outcome of spinal fusion and is a primary reason for revision surgery. The incidence of radiographic ASD varies widely, with annual and 10-year revision surgery rates of 2.5% and 22.2%, respectively. The occurrence of ASD is influenced by several factors, including the definition of ASD, preexisting degeneration of adjacent discs, preoperative conditions, surgical techniques used, the number of segments fused, and the length of the follow-up period. Although not all ASDs are clinically significant, radiologically defined symptomatic ASD is a major factor for poorer patient-reported outcomes and revision surgery. These revision surgeries are more complex and riskier than the initial surgery. The objective of this course is to identify imaging predictors on pre- and perioperative imaging that are associated with a future revision surgery for ASD following lumbar fusion. It was found that multifidus fatty infiltration is a key imaging predictor for the development of ASD requiring surgical revision, while disc degeneration and spinopelvic alignment appear to have less impact.
Journal Global Spine Journal Volume 15 Issue 1
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| | The impact of an open-label design on human amniotic membranes vs. silver sulfadiazine dressings for second-degree burns: a randomized controlled clinical trial | The impact of an open-label design on human amniotic membranes vs. silver sulfadiazine dressings for second-degree burns: a randomized controlled clinical trial
The impact of an open-label design on human amniotic membranes vs. silver sulfadiazine dressings for second-degree burns: a randomized controlled clinical trial
Overview Proper medical management of burn wounds is crucial due to their significant psycho-emotional, socioeconomic impacts, and severe pain. The employment of synthetic and biological dressings enhances healing and minimizes complications associated with burn wounds. This study aims to compare the effectiveness of human amniotic membrane (hAM) dressings versus conventional silver sulfadiazine (SSDZ) ointment dressings in treating second-degree burn wounds. Burn injuries pose a major challenge for both societies and healthcare systems globally [1]. Burns represent the fourth most common type of injury worldwide, following accidents, falls, and violence [2]. Historically, burn wounds have been linked with poor prognosis. Nearly 50% of burn patients are admitted to specialized burn units, with approximately 200,000 to 300,000 individuals succumbing to fire-related burns annually around the world [3]. Burn wounds are categorized into first-degree (epidermal injury), second-degree (dermal and epidermal injury), third-degree (damage to the entire skin layer), and fourth degree (damage extending to the hypodermal layer) [4]. Second-degree burn wounds are the most prevalent and painful, representing over 50% of all burn injuries. In conclusion, despite its higher cost, hAM, as an advanced therapeutic dressing, demonstrates clear advantages over SSDZ ointment in terms of wound healing and pain management.
Journal BMC Surgery Volume 24 Issue 1 | 3 | | R485.00 | |
| | Outcome of laparoscopic feeding jejunostomy, comparison of a pure laparoscopic technique with Witzel’s tunnel to open technique: a retrospective cohort study | Outcome of laparoscopic feeding jejunostomy, comparison of a pure laparoscopic technique with Witzel’s tunnel to open technique: a retrospective cohort study
Outcome of laparoscopic feeding jejunostomy, comparison of a pure laparoscopic technique with Witzel’s tunnel to open technique: a retrospective cohort study
Overview Obstructive upper GI cancer commonly uses feeding jejunostomy as a standard procedure. Surgeons implemented laparoscopic feeding jejunostomy via minimally invasive surgery, employing a variety of techniques. This study assessed the perioperative results, safety, and costs associated with laparoscopic versus open jejunostomy surgeries. We used only Witzel’s tunnel and standard laparoscopic instruments. We collected data from all patients who underwent feeding jejunostomy between January 2016 and June 2018. We recorded pertinent data on baseline, surgical outcomes, postoperative results, complications, and costs. The study excluded patients with jejunostomy as a conversion or an addition. It was concluded that Laparoscopic jejunostomy feeding was safe, and postoperative morphine consumption was lower. Increasing operational costs did not have a significant impact on overall expenditures. Witzel’s tunnel may reduce jejunostomy site infections.
Journal BMC Surgery Volume 24 Issue 1 | 3 | | R485.00 | |
| | Postoperative outcomes after splenectomy: a 20-year single-center experience in Colombia | Postoperative outcomes after splenectomy: a 20-year single-center experience in Colombia
Postoperative outcomes after splenectomy: a 20-year single-center experience in Colombia
Overview Splenectomy indications are well documented; however, several infectious complications and potentially life-threatening conditions could arise after splenectomy. We aim to describe a 20-year single-center experience of postoperative outcomes after splenectomy and perform a subgroup analysis according to approach and surgical setting with a 30-day, 90-day, and 1-year follow-up. This study describes a 20-year single-center experience in Colombia, analysing postoperative outcomes after splenectomy with a focus on 30-day, 90-day, and 1-year follow-up periods. Splenectomy, often performed for trauma, abscesses, aneurysms, and malignant conditions, can lead to serious complications. The findings align with international data on postoperative complications and overwhelming post-splenectomy syndrome (OPSI). Further research is recommended to improve management strategies and outcomes, especially for high-risk groups.
Journal BMC Surgery Volume 24 Issue 1 | 3 | | R485.00 | |
| | Impact of early surgical complications on kidney transplant outcomes | Impact of early surgical complications on kidney transplant outcomes
Impact of early surgical complications on kidney transplant outcomes
Overview
Kidney transplantation (KT) improves clinical outcomes of patients with end stage renal disease. Little has been reported on the impact of early post-operative surgical complications (SC) on long-term clinical outcomes following KT. This article sought to determine the impact of vascular complications, urological complications, surgical site complications, and peri-graft collections within 30 days of transplantation on patient survival, graft function, and hospital readmissions. Kidney transplantation (KT) is the treatment of choice for patients with end-stage renal disease, offering improved survival and quality of life for the vast majority of patients when compared to other renal replacement therapies. Despite improving patient and graft survival rates over time, the morbidity and mortality associated with postoperative complications remain a significant clinical concern. Early postoperative surgical complications (SC) vary in severity and can be classified according to Clavien Grades. The main categories of SC associated with KT are vascular, urological, peri-graft fluid collections, and surgical site complications. It was concluded that early SC following KT are common and have a significant influence on long-term patient outcomes.
Journal BMC Surgery
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| | A Novel Approach in the Management of Tibial Plateau Fractures with Compartment Syndrome | A Novel Approach in the Management of Tibial Plateau Fractures with Compartment Syndrome
A Novel Approach in the Management of Tibial Plateau Fractures with Compartment Syndrome
Overview Compartment syndrome associated with tibial plateau fractures represents a significant challenge for orthopedic surgeons. The conventional approach involves early fasciotomy and external fixation, followed by definitive fixation at a later stage. This study prospectively examined Schatzker Type V and VI tibial plateau fractures with impending compartment syndrome, treated with single-stage double incision fasciotomy, dual internal fixation, and Vacuum-Assisted Closure (VAC). The incidence of compartment syndrome in Schatzker Type V and VI tibial plateau fractures is notably high. Managing these fractures, particularly when accompanied by impending compartment syndrome, has proven to be exceptionally challenging. Over the years, various surgical treatments have been developed, each presenting unique advantages and disadvantages. Traditionally, patients were managed through initial fasciotomy and temporary external fixation, with definitive internal fixation occurring at a subsequent stage. Current literature supports multi-staged surgical interventions, with a predominant emphasis on traditional staged procedures; however, knee stiffness remains a significant drawback of this method. Single-stage surgeries in such cases have been associated with numerous complications. Our findings suggest that early double incision fasciotomy combined with definitive dual plate internal fixation and VAC as a single-stage intervention provides excellent to good functional outcomes, with a reduction in complications for patients experiencing impending compartment syndrome.
Journal Indian J Orthop Volume 57 Issue 9
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| | Preoperative predictors of difficult early laparoscopic cholecystectomy among patients with acute calculous cholecystitis in Egypt | Preoperative predictors of difficult early laparoscopic cholecystectomy among patients with acute calculous cholecystitis in Egypt
Preoperative predictors of difficult early laparoscopic cholecystectomy among patients with acute calculous cholecystitis in Egypt
Overview Early laparoscopic cholecystectomy (ELC) for acute calculous cholecystitis (ACC) should be done by skilled surgeons to avoid complications. This study aims to identify preoperative factors predicting difficult ELC in ACC patients. Approximately 40% of patients with gallstones may experience complications like ACC, which presents primarily in 10-15% of cases. Performing ELC within 7 days of admission and 10 days of symptom onset is safer and preferred over intermediate or delayed procedures, offering shorter hospital stays, fewer re-admissions, and lower costs. However, it requires experienced surgeons in hepatobiliary and minimally invasive surgery, and advanced surgical centers with necessary support staff and equipment. The major complication of LC is iatrogenic bile duct injury due to inflamed gallbladder anatomy. Junior surgeons must assess ACC patients carefully before ELC to identify those at risk of difficult procedures, reducing postoperative complications. If risks are found, experienced biliary and laparoscopic surgeons should assist, or patients should be transferred to advanced centers. Bail-out procedures should be considered during difficult operations to prevent further damage.
Journal BMC Surgery Volume 24 Issue 1
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| | Comparison of mammography and ultrasound findings in the follow-up of patients with breast cancer treated with segmental mastectomy followed by intraoperative electron radiotherapy versus external whole breast radiotherapy | Comparison of mammography and ultrasound findings in the follow-up of patients with breast cancer treated with segmental mastectomy followed by intraoperative electron radiotherapy versus external whole breast radiotherapy
Comparison of mammography and ultrasound findings in the follow-up of patients with breast cancer treated with segmental mastectomy followed by intraoperative electron radiotherapy versus external whole breast radiotherapy
Overview This study aims to describe imaging findings in patients treated with intraoperative electron radiotherapy (IOeRT) and compare them with those detected in patients treated with external whole breast radiotherapy (WBRT). Intraoperative radiotherapy (IORT) is an adjuvant treatment option for selected cases of early-stage breast cancer. It is administered using either electron beams (IOeRT) or X-ray, and it can be used alone as primary radiotherapy or as a boost followed by WBRT. The advantages of IORT include direct visualization of the tumour bed, reduced skin doses, and patient convenience. There are limited reports on the radiological findings in patients treated with IORT. Some studies have indicated that postoperative changes in mammography and ultrasound (US) are more pronounced in patients treated with IORT compared to those treated conventionally with WBRT. Ill-defined non-mass lesions detected on US in the IORT group have not been previously defined. Radiologists should be aware of these lesions as they can be confusing, particularly in early follow-up studies. This study found that minor findings are observed more frequently in low-density breasts, while major findings are more common in high-density breasts within the IORT group. This observation has not been reported before, and further studies with larger sample sizes are necessary to confirm these results.
Journal Diagnostic and Interventional Radiology Volume 29 Issue 6
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| | Enhanced perioperative care in emergency general surgery: the WSES position paper | Enhanced perioperative care in emergency general surgery: the WSES position paper
Enhanced perioperative care in emergency general surgery: the WSES position paper
Overview Enhanced perioperative care protocols become the standard of care in elective surgery with a significant improvement in patients’ outcome. The key element of the enhanced perioperative care protocol is the multimodal and interdisciplinary approach targeted to the patient, focused on a holistic approach to reduce surgical stress and improve perioperative recovery. Enhanced perioperative care in emergency general surgery is still a debated topic with little evidence available. The present position paper illustrates the existing evidence about perioperative care in emergency surgery patients with a focus on each perioperative intervention in the preoperative, intraoperative and postoperative phase. For each item was proposed and approved a statement by the WSES collaborative group.
Journal World Journal of Emergency Surgery Citation Ceresoli et al. World Journal of Emergency Surgery (2023) 18:47 | 3 | | R485.00 | |
| | Evaluation of the advantages of robotic versus laparoscopic surgery in elderly patients with colorectal cancer | Evaluation of the advantages of robotic versus laparoscopic surgery in elderly patients with colorectal cancer
Evaluation of the advantages of robotic versus laparoscopic surgery in elderly patients with colorectal cancer
Overview The incidence of colorectal cancer increases with aging. Curative-intent surgery based on a minimally invasive concept is expected to bring survival benefits to elderly patients (aged over 80 years) with colorectal cancer who are frequently with fragile health status and advanced tumours. The study explored survival outcomes in this patient population who received robotic or laparoscopic surgery and aimed to identify an optimal surgical option for those patients. The clinical materials and follow-up data were retrieved on elderly patients with colorectal carcinoma who received robotic or laparoscopic surgery in our institution. The pathological and surgical outcomes were compared to examine the efficacy and safety of the two approaches. The DFS (disease-free survival) and OS (overall survival) results at 3 years after surgery were assessed to explore the survival benefits. It was concluded that robotic surgery was prized for elderly patients with colorectal cancer who developed anemia and/or haematological conditions.
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9942364/pdf/12877_2023_Article_3822.pdf
Journal BMC Geriatrics | 3 | | R485.00 | |
| | Long-Term Outcomes of Venous Resections in Pancreatic Ductal Adenocarcinoma Patients | Long-Term Outcomes of Venous Resections in Pancreatic Ductal Adenocarcinoma Patients
Long-Term Outcomes of Venous Resections in Pancreatic Ductal Adenocarcinoma Patients
Overview The objective was to investigate whether pancreatic resections (PR) for pancreatic ductal adenocarcinoma (PDAC) is associated with worse survival when resection of the superior mesenteric vein/portal vein (SMV/PV) is required. PR for PDAC with resection of the superior mesenteric vein/portal vein (SMV/PV, PR+V resection) may be associated with inferior overall survival (OS) compared with PR without the need for SMV/PV resection (PR–V). We hypothesized that PR+V results in lower OS compared with PR–V. Overall, 2403 patients were identified. Six hundred two underwent exploration only (EXP group), whereas 412 underwent pancreatic resection with (PR+V group) and 1389 (PR–V) without SMV/PV resection. Five-year OS for the PR+V group was lower (20% vs 30%) compared with PR–V, although multivariate Cox proportional hazards modeling could not associate PR+V status with OS (Hazard ratio 1.11, P = 0.408). When correcting for confounders, PR+V was not associated with lower OS compared with PR–V. Journal Annals of Surgery Open | 3 | | R450.00 | |
| | The role of CT in decision for acute appendicitis treatment | The role of CT in decision for acute appendicitis treatment
The role of CT in decision for acute appendicitis treatment
Overview Acute appendicitis is the most common cause of acute abdomen requiring surgery. Although the standard treatment has been surgery, it has been seen in recent years that treatment is possible with antibiotics and non-operative observation. In this study, our aim is to determine whether the computed tomography (CT) findings in patients diagnosed with acute appendicitis can be used for directing treatment. As the successful and unsuccessful medical treatment groups were compared, the only significant parameter was the severity of mural enhancement (P = .005). CT findings may be helpful in patients with uncomplicated acute appendicitis whose treatment surgeons are indecisive about. We can recommend surgical treatment in cases with appendix diameter =13 mm, intra-abdominal free fluid, appendicolith, high CT appendicitis score, and severe mural enhancement.
Journal Diagnostic Interventional Radiology
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| | Incidence rate and risk factors of surgical wound infection in general surgery patients: A cross-sectional study | Incidence rate and risk factors of surgical wound infection in general surgery patients: A cross-sectional study
Incidence rate and risk factors of surgical wound infection in general surgery patients: A cross-sectional study
Overview Hospital-acquired infections (HAIs) are considered a major challenge in health care systems. One of the main HAIs, playing an important role in increased morbidity and mortality, is surgical wound infection. Therefore, this study aimed to determine the incidence rate and risk factors of surgical wound infection in general surgery patients. This cross-sectional study was performed on 506 patients undergoing general surgery at Razi hospital in Rasht from 2019 to 2020. Bacterial isolates, antibiotic susceptibility pattern, antibiotic administration, and its type, operation duration and shift, the urgency of surgery, people involved in changing dressings, length of hospitalisation, and levels of haemoglobin, albumin, and white blood cells after surgery were assessed. The frequency of surgical wound infection and its association with patient characteristics and laboratory results were evaluated. Among these, Staphylococcus aureus was the predominant species, followed by coagulase-negative staphylococci. In addition, the most common Gram-negative isolates identified were Escherichia coli bacteria. Overall, administration of antibiotics, emergency surgery, surgery duration, and levels of white blood cells and creatinine were identified as surgical wound infection associated risk factors. Identifying important risk factors could help control or prevent surgical wound infections.
Journal Int Wound Journal. | 3 | | R485.00 | |
| | In-Hospital Mortality Following Traumatic Injury in South Africa | In-Hospital Mortality Following Traumatic Injury in South Africa
In-Hospital Mortality Following Traumatic Injury in South Africa
Overview Trauma is a leading cause of death worldwide and in South Africa. We aimed to quantify the in-hospital trauma mortality rate in Pietermaritzburg, South Africa. The in-hospital trauma mortality rate in South Africa remains unknown, and it is unclear whether deficits in hospital care are contributing to the high level of trauma-related mortality. All patients hospitalized because of trauma at the Department of Surgery at Grey’s Hospital, Pietermaritzburg Metropolitan Trauma Service, were prospectively entered in an electronic database starting in 2013 and the data were retrospectively analysed. The trauma service adheres to Advanced Trauma Life Support and the doctors have attended basic and advanced courses in trauma care. In conclusion, the in-hospital trauma mortality rate at a South African trauma center using systematic trauma care is lower than that reported from other trauma centers in the world during the past 20 years. Nevertheless, 16% of death cases were assessed as avoidable if there had been better access to intensive care, dialysis, advanced respiratory care, blood for transfusion, and improvements in surgery and medical care.
Journal Annals of Surgery Open | 3 | | R465.00 | |
| | 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.
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| | 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.
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| | 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
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| | Blood-brain barrier pathology in patients with severe mental disorders: a systematic review and meta-analysis of biomarkers in case-control studies | Blood-brain barrier pathology in patients with severe mental disorders: a systematic review and meta-analysis of biomarkers in case-control studies
Blood-brain barrier pathology in patients with severe mental disorders: a systematic review and meta-analysis of biomarkers in case-control studies
Overview Blood-brain barrier (BBB) pathology may be associated with mental disorders. The aim of this systematic review and meta-analysis is to identify, evaluate and summarize available evidence on whether potential biomarkers of BBB pathology are altered in patients with schizophrenia spectrum disorders, major depression and bipolar disorder compared to healthy controls. The findings implicate occurrence of BBB pathology in patients with schizophrenia spectrum disorders, major depression and bipolar disorder compared to healthy controls. However, definite conclusions cannot be drawn, mainly because the investigated biomarkers are indirect measures of BBB pathology.
Authors Jesper Futtrup, Rebecca Margolinsky, Michael Eriksen Benros, Torben Moos, Lisa Juul Routhe, Jørgen Rungby, Jesper Krogh
Journal Brain, Behavior, & Immunity - Health | 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 | |
| | 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 | |
| | 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 | |
| | 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 | |
| | 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 | |