SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice.
This is a ...cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure.
Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management.
There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training.
The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020.
The present study was designed to evaluate the effect of ghrelin on sex hormones, follicle stimulating hormones, luteinizing hormones, Testosterone, and prolactin in infertiled men. Abnormal ...spermatogenesis is often associated with altered serum gonadotropins and testosterone. follicle stimulating hormones, luteinizing hormones, and testosterone levels They were estimated in 50 infertiled men. Results showed statistically significant increase (p< 0.05) in the mean of ghrelin, follicle stimulating hormones, luteinizing hormones, Thyroid stimulating hormones, Prolactin, fasting blood sugar , Triglyceride, High density lipoprotein, Very low density lipoprotein, in all the studied infertiled males patients when compared with the fertiled control (n=20). In addition there was no significant differences in the levels of testosterone , Cholesterol ,and Low density Lipoprotein, between the infertiled and fertiled men.
High-grade (HG) urothelial carcinoma (UC) with variant histology has historically been managed conservatively. The presented case details a solitary lesion of muscle-invasive bladder cancer (MIBC) ...with sarcomatoid variant (SV) histology treated by partial cystectomy (PC) and adjuvant chemotherapy. A 71-year-old male with a 15-pack year smoking history presented after outside transurethral resection of bladder tumor (TURBT). Computerized tomography imaging was negative for pelvic lymphadenopathy, a 2 cm broad-based papillary tumor at the bladder dome was identified on office cystoscopy. Complete staging TURBT noted a final pathology of invasive HG UC with areas of spindle cell differentiation consistent with sarcomatous changes and no evidence of lymphovascular invasion. The patient was inclined toward bladder-preserving options. PC with a 2 cm margin and bilateral pelvic lymphadenectomy was performed. Final pathology revealed HG UC with sarcomatoid differentiation and invasion into the deep muscularis propria, consistent with pathologic T2bN0 disease, a negative margin, and no lymphovascular invasion. Subsequently, the patient pursued four doses of adjuvant doxorubicin though his treatment was complicated by hand-foot syndrome. At 21 months postoperatively, the patient developed a small (<1 cm) papillary lesion near but uninvolved with the left ureteral orifice. Blue light cystoscopy and TURBT revealed noninvasive low-grade Ta UC. To date, the patient has no evidence of HG UC recurrence; 8 years after PC. Patient maintains good bladder function and voiding every 3-4 h with a bladder capacity of around 350 ml. Surgical extirpation with PC followed by adjuvant chemotherapy may represent a durable solution for muscle invasive (pT2) UC with SV histology if tumor size and location are amenable. Due to the sparse nature of sarcomatous features within UC, large multicenter studies are required to further understand the clinical significance and optimal management options for this variant histology.
To report the incidence of the reoperation surgeries of nearly all the Rigicon Infla10® implants performed since device introduction in 1/2019. Inflatable penile prosthesis (IPP) has some of the ...highest survival from revision surgery of any medical device implanted in humans. 1 We expand on previous Rigicon Infla10® research, adding more patients and increasing follow-up duration. 2
535 patients had Rigicon Infla10® devices implanted from 1/2019 to 8/2022. 103 surgeons from 26 centers in 15 countries participated in the study. Patient Information Forms (PIF’s) were analyzed from virtually all implantations. Explantation or revision surgery for mechanical failure, infection, other medical reasons, and patient dissatisfaction were cataloged. SPSS 25.0 (IBM) was used for the statistical analysis of Kaplan Meier survival statistics.
Mean follow-up was 24.2 months 7-43 months. Mean patient age was 56 years. Reoperation was necessary for 3.5% of subjects. Revision for mechanical failure occurred in 2.24% (12/535). The rate of explant for patient dissatisfaction was 0.56% (3/535). Revision for component out of place was 0.37% (2/535) with an infection rate and unsuccessful Peyronie’s correction being 0.19% (1/535). Survival from requiring another corrective surgery at 1, 2, and 3 years was 96.4%, 95.0 %, and 94.0 % respectively. These initial survival rates compare favorably to devices currently available, which have been repeatedly enhanced to improve reliability.
In its first 2-3 years of availability, The Rigicon Infla10® IPP shows freedom from revision comparable to existing enhanced devices that have been on the market for decades.
Cardiovascular disease is the main cause of death worldwide. Magnetic resonance imaging (MRI) provides unprecedented capabilities for myocardial tissue characterization. Specifically, T1 mapping ...showed to be a valuable technique for identifying myocardial fibrosis and scar tissues without the need for contrast agent administration. Nevertheless, various factors can influence the analysis technique and affect the resulting T1 measurements. These factors include the signal calculation method (Average, Median, or pixel-wise Mapping), size and location of the analyzed region-of-interest (ROI), and signal-to-noise ratio (SNR) level of the acquired images. In this study, we evaluate the influence of these factors on T1 measurement using numerical and calibrated phantoms. The numerical phantom results showed that the percentage error for T1 estimation reached 2.3%, 3.1%, and 12.28% for the Median, Average, and Mapping methods, respectively, at SNR level of 7 dB, compared to 0% error at high SNR (44 dB) .The calibrated phantom experiments revealed high correlation (R>0.9) between the estimated and reference T1 values at high SNR levels. Based on the results in this study, the Median calculation method outperforms the Average and Mapping methods due to its lower estimation error at low SNR and higher correlation values with reference measurements. Further, large ROI's that are placed at the center of the analyzed region result in more accurate T1 estimates than smaller ROI's or those placed closer to the object boundary.
Cardiovascular disease is the main cause of death worldwide. Magnetic resonance imaging (MRI) has been considered as a noninvasive technique for characterizing myocardial tissues. Specifically, T2 ...mapping technique has been demonstrated to be an excellent tool to detect myocardial edema by estimation of the transverse relaxation time constant (T2) of myocardial tissue. However, there are several factors that could influence the analysis technique and affect the estimating T2 value. These factors include the type of exponential fitting model, which either be single exponential or exponential plus constant fitting model, the signal intensity estimation method, which either be Average, Median or Mapping method and signal-to-noise ratio (SNR) level of the T2-weighted images. In this paper, we discuss the effect of these factors on T2 estimation using a numerical phantom, T2 calibrated phantoms with different T2 values, and human subjects. The results of numerical phantom showed that the average percentage error for T2 measurement when using the single exponential fitting model reached 0.6 %, 0.4 %, and 5.9 % for the Average, Median, and Mapping methods, respectively. However, the exponential plus constant fitting model resulted in high average percentage error among the three signal intensity estimation methods (above 26 %). The experiments of calibrated phantom resulted in high correlation (R 2 > 0.99) between the estimated and reference T2 values when using the single exponential fitting model compared to low correlation (R 2 <; 0.73) when using the exponential plus constant fitting model at high SNR levels. Finally, the results of human subjects were in agreement with both numerical and calibrated phantoms. Based on the results of this paper, the single exponential fitting model with the median estimation method is the preferable analysis technique for T2 measurement as it results in a lower error for T2 measurements at low SNR levels and higher correlation values at high SNR levels compared to the other analysis techniques.
Cardiovascular disease is the main cause of death worldwide. Magnetic resonance imaging (MRI) has been considered as a noninvasive technique for characterizing myocardial tissues. Specifically, T2 ...mapping technique has been demonstrated to be an excellent tool to detect myocardial edema by estimation of the transverse relaxation time constant (T2) of myocardial tissue. However, there are several factors that could influence the analysis technique and affect the estimating T2 value. These factors include the type of exponential fitting model, which either be single exponential or exponential plus constant fitting model, the signal intensity estimation method, which either be Average, Median or Mapping method and signal-to-noise ratio (SNR) level of the T2-weighted images. In this paper, we discuss the effect of these factors on T2 estimation using a numerical phantom, T2 calibrated phantoms with different T2 values, and human subjects. The results of numerical phantom showed that the average percentage error for T2 measurement when using the single exponential fitting model reached 0.6 %, 0.4 %, and 5.9 % for the Average, Median, and Mapping methods, respectively. However, the exponential plus constant fitting model resulted in high average percentage error among the three signal intensity estimation methods (above 26 %). The experiments of calibrated phantom resulted in high correlation (R 2 > 0.99) between the estimated and reference T2 values when using the single exponential fitting model compared to low correlation (R 2 <; 0.73) when using the exponential plus constant fitting model at high SNR levels. Finally, the results of human subjects were in agreement with both numerical and calibrated phantoms. Based on the results of this paper, the single exponential fitting model with the median estimation method is the preferable analysis technique for T2 measurement as it results in a lower error for T2 measurements at low SNR levels and higher correlation values at high SNR levels compared to the other analysis techniques.
Infectious mononucleosis, also known as glandular fever or the kissing disease, is a benign lymphoproliferative disorder. It is a viral infection caused by the Epstein-Barr virus (EBV), a ubiquitous ...herpes virus that is found in all human societies and cultures. Epidemiological studies show that over 95% of adults worldwide have been infected with EBV. Most cases of symptomatic infectious mononucleosis occur between the ages of 15 and 24 years. It is transmitted through close contact with an EBV shedder, contact with infected saliva or, less commonly, through sexual contact, blood transfusions or by sharing utensils; however, transmission actually occurs less than 10% of the time. Precautions are not needed to prevent transmission because of the high percentage of seropositivity for EBV. Infectious mononucleosis is self-limiting and typically lasts for two to three weeks. Nevertheless, symptoms can last for weeks and occasionally months.Symptoms include fever, lymphadenopathy, pharyngitis, hepatosplenomegaly and fatigue. Symptom relief and rest are commonly recommended treatments. Steroids have been used for their anti-inflammatory effects, but there are no universal criteria for their use.
The objectives of the review were to determine the efficacy and safety of steroid therapy versus placebo, usual care or different drug therapies for symptom control in infectious mononucleosis.
For this 2015 update we searched the Cochrane Central Register of Controlled Trials (CENTRAL 2015, Issue 7), which includes the Cochrane Acute Respiratory Infections Group's Specialised Register; MEDLINE (January 1966 to August 2015) and EMBASE (January 1974 to August 2015). We also searched trials registries, however we did not identify any new relevant completed or ongoing trials for inclusion. We combined the MEDLINE search with the Cochrane search strategy for identifying randomised controlled trials (RCTs). We adapted the search terms when searching EMBASE.
RCTs comparing the effectiveness of steroids with placebo, usual care, or other interventions for symptom control for people with documented infectious mononucleosis.
We used the standard methodological procedures expected by Cochrane.
For this 2015 update, we did not identify any new RCTs for inclusion. The previous version of the review included seven trials with a total of 362 participants. Four trials compared the effectiveness of a steroid to placebo for short-term symptom control in glandular fever, one to aspirin, and two trials explored the effects of steroids in conjunction with an antiviral. Heterogeneity between trials prevented a combined analysis.Trials under-reported methodological design features. Three trials did not adequately describe sequence generation for randomisation. Four trials provided adequate details of allocation concealment. All trials were double-blind but four were not specific as to who was blinded. Loss to follow-up was under-reported in four trials, making it difficult to exclude attrition bias. The risk of selective reporting in the included trials was unclear.Across the trials, no benefit was found in 8/10 assessments of health improvement. Two trials found benefit of steroid therapy over placebo in reducing sore throat at 12 hours (eight-day course odds ratio (OR) 21.00, 95% confidence interval (CI) 1.94 to 227.20; one-dose OR 4.20, 95% CI 1.08 to 16.32), but the benefit was not maintained.In combination with an antiviral drug, participants in the steroid group had less pharyngeal discomfort between days two to four (OR 0.31, 95% CI 0.09 to 1.08) compared to placebo. Across the trials the effects on other common symptoms were less clear. Two trials set out to measure safety; they documented no major adverse effects. In two other trials adverse events were reported, including respiratory distress and acute onset of diabetes. However, the association of the events with the steroid is not definite.
There is insufficient evidence to the efficacy of steroids for symptom control in infectious mononucleosis. There is a lack of research on the side effects and long-term complications.
•Cerebral sinus venous thrombosis is a rare cause for a subdural hematoma and should be considered in the differential diagnosis of such cases.•Neuroradiological imaging has a valuable role in ...diagnosing and follow-up of patients.•Management of subdural hematoma secondary to venous sinus thrombosis could be challenging due to the controversy in using anticoagulation medications.
Diagnosing cerebral sinus venous thrombosis (CSVT) manifested as a spontaneous subdural hematoma (SDH) is challenging due to variability of its clinical features. The neuroradiological investigation is crucial to confirm the diagnosis. The management of SDH secondary to CVST is controversial and not well established.
We present a case of an adult man with Down’s syndrome who underwent a left-sided craniotomy and evacuation of spontaneous subdural hematoma. Post-surgery magnetic resonance venography (MRV) revealed venous sinus thrombosis in the right transverse sinus with loss of flow signal. He was started on Apixaban two weeks post-surgery. Three months later, the patient re-presented with recurrence of the SDH. His anticoagulation was discontinued, and he underwent craniotomy reopening and evacuation of the recurrent hematoma. The patient returned to his baseline following this procedure. The patient was followed up in the out-patient clinic regularly. Interval brain MRI and MRV performed at six months showed further resolution of the thrombosis of the right sigmoid sinus with restoration of the venous flow.
The management of SDH complicating CVST remains controversial due to the rarity of its presentation and the hazards associated with the use of anticoagulation.
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