Healthcare workers are at high risk of developing sleep disorders during an outbreak. This study aimed to measure severity of sleep difficulty and its correlation with duration of deal with ...suspected/confirmed cases of novel coronavirus (COVID-19) in physicians.
In this cross-sectional study, 268 physicians from different medical settings were included during the COVID-19 outbreak.
The mean age and experience of physicians were 35.06 (33–70 years) and 10.13 years. The median duration of dealing with suspected/confirmed cases of COVID-19 was 1.0 (0–30 days). The mean sleep score and stress of physicians were 8.43 of 24.0 and 4.20 of 10, respectively. More than two-thirds of the physicians were sleepless (68.3%) and majority had stress (93.7%). The study did not find a significant difference in sleep score of physicians with different specialties (P = 0.059). However, most physicians were sleepless; including anesthesia and intensive care (77.8%); general physicians (80.8%), and obstetrics and gynecology (80.0%). They were sleepless in morning (58.7%); evening (77.8%); night (100%); and multi-shift (70.9%). The physicians who dealt with suspected or confirmed cases of COVID-19 or with stress had more escalated sleep compared to those who did not deal with patients or without stress (9.39 vs. 7.17 and 8.78 vs. 2.69 P < 0.001). The sleep of physicians was escalated with increasing stress (r = 0.558; P < 0.001) and a number of days that physicians dealt with suspected/confirmed cases of COVID-19 (r = 0.210; P = 0.001), respectively.
The study confirmed that working with COVID-19 patients has a negative effect on the sleep of physicians.
•Sleep quality of physicians is poor during the COVID-19 outbreak.•Most of the physicians are sleepless during the COVID-19 outbreak.•Physicians sleep is escalated with duration of COVID-19 patient interaction.•Physicians sleep is escalated with stress during the COVID-19 outbreak.
Background: Elective laparoscopic cholecystectomy (LC) is a routine surgery performed daily in surgical settings. Objectives: In this prospective study, we aimed to explore the rate of complications ...in patients who underwent LC as a day-case surgery and discharged at an early stage (8-12 h postoperatively). In addition, the degree of symptom resolution and safety, and feasibility of the LC were examined accordingly. Materials and Methods: In this prospective study, 150 patients who underwent LC between October 2021 and October 2022 who attended surgery department of Azadi teaching hospital in Duhok were included. The general and medical characteristics of patients were obtained from their medical records. The surgical site infection was recorded through a standardized questionnaire. Results: The patients were predominately females (95, 63.3%) and had American Society of Anesthesiologists Classification I (110, 73.3%) aged between 18 and 65 years. The study found that 95% of patients were discharged within the first 8-10 h postoperatively. The rate of readmission was found among 5.3% (n = 8). The complication rate was 8% (n = 12. The surgical site infection rate was 6% (n = 6). The combined complication rate was 8% (n = 12). The complete resolution of symptoms was found among 80% of patients. Among 4% of the patients who had residual symptoms, 10% had abdominal discomfort, 4% had reflux symptoms, and 2% reported diarrhea. The satisfaction rate was 97.3%. There was a statistically significant difference between admitted and re-admitted patients regarding gall bladder perforation, conversion to open surgery and overnight hospital stay (P < 0.001). Conclusion: This study shows that the LC is a safe surgical technique because the rate of complications were low and most of them were minor and managed appropriately, we also concluded that LC is a safe day-case surgery with low readmission rate and high patients satisfaction, overall it will decrease the hospital burden and bed occupancy rate.
Fistula is an abnormal tract communicating two epithelial surfaces, uterocutaneous fistula is an extremely rare. The classical presentation is cyclical bleeding from an abnormal opening in the scar ...of previous cesarean section.
A 28 year-old was presented 6 months after cesarean section with history of severe pain and blood discharge during menstruation from the previous transverse supra-pubic scar. The patient had history of previous 2 cesarean sections. Abdominal examination revealed a localized tenderness at site of previous operation scar with 1*1 cm opening at the central part of the scar which was discharging blood during pressure over the lower abdomen. There was no urine discharge from the scar. Vaginal examination by the speculum was normal.
Endometriosis was suspected and the patient received medical treatment with little improvement. Later, surgical intervention was done, the scar was excised with an abnormal fistulous tract connecting endometrial cavity at the site of the previous scar was found. Complete excision of the tract was done and the uterus was re-sutured using a slowly-absorbable suture material. The patient had no complications with regular cycles.
Uterocutaneous fistula is rare and usually follow cesarean section, suturing the uterus with non-absorbable suture material is reported in this case to be one of the underlying causes, other causes include infection, necrosis, foreign bodies, or malignancy. The fistula tract must be defined and any associated infection controlled, complete resection of the fistulous tract and suturing the uterus with absorbable suture material is required.
•Causes of uterocutaneous fistulas are numerous like iatrogenic, endometriosis, malignancy, etc.•The classical presentation is cyclical bleeding from the scar of previous cesarean section.•A combined medical and surgical approach may be required.
•Hydatid disease rarely affect the female genital organs.•Most cases are seen in the liver and the lungs.•Surgery is the main form of treatment which can be done laparoscopically.
Hydatid disease is ...a zoonotic disease which is caused by a parasite belonging to the Echinococcus species. It may affect all part of the body mostly the liver and the lungs, involvement of the fallopian tube is a very rare.
A 30-year-female presented with acute lower abdominal pain, fever and vomiting for 2 days. The past medical history was negative and she had history of surgery for hydatid cyst of the right lobe of liver 3 years before presentation. During examination there was tenderness at the right iliac fossa with guarding. Ultrasound of the pelvic organs showed a left adnexial cyst. During surgery there was an evidence of hydatid cyst involving the left fallopian tube. Left salpingectomy was performed with excision of the cyst. The patient remained three days in the hospital with no reported complication.
Hydatid cyst is one of the differential diagnoses of any cystic lesion in patients from an endemic areas of hydatid disease. Hydatid cysts of the female pelvic organs may be diagnosed initially as ovarian cyst, ovarian tumor, or pelvic infection. Most of the cases are diagnosed during surgery which is the main treatment modality; anthelminthic medications may help to decrease the recurrence rate.
•Lymphangioma of the gastrointestinal tract is very rare, 75 % of the lesions affect the neck and 20 % affect the axillary region.•The majority of cases are asymptomatic but some cases presented with ...emergency presentations.•Complete surgical resection is the main form of therapy whenever possible.
Lymphangioma of the gastrointestinal tract is very rare, 75 % of the lesions affect the neck and 20 % affect the axillary region, the rest are seen in the mediastinum, the visceral organs, the retroperitoneum, the mesentery, or in the bones. Lymphangioma of the gastrointestinal tract comprises less than 1 %. The majority of cases are asymptomatic but some cases presented with emergency presentations.
A 31-year-old male presented to emergency department complaining of central abdominal pain for 2 days, with nausea, dyspnea but no vomiting.
The abdominal examination revealed a mildly distended abdomen, with guarding and tenderness mainly in the right lower abdominal quadrant. There were no any palpable masses or organ enlargement. The white blood cells count was elevated (14,000 c/mm).
Abdominal ultrasound showed an evidence of 10*7 cm multiloculated thick walled lesion in the right lower abdomen, suggesting the possibility of an appendicular abscess. The patient was admitted for 2 days with little clinical improvement. Therefore, a laparotomy was performed at which there were 2 yellowish cystic lesions 60 cm from the ileocecal valve that were arising from each side of the small bowel and related to its mesentery causing luminal narrowing. Resection was done with end-end anastomosis. The histopathology results revealed a diagnosis of ill lymphangioma of the ileum.
Complete surgical resection is the main form of therapy whenever possible, sometimes is impossible when there is local invasion. When complete resection is performed long term follow up is not recommended as the recurrence is very rare.
•Acute appendicitis is the commonest surgical emergency worldwide.•Surgery is usually needed which could be done by open or laparoscopic techniques.•Tumors of the appendix may cause intussusception ...of the appendix.
Intussusception of the appendix occurs when part of the appendix passes the part next to it or the whole appendix to the cecum. It is classified as primary or secondary, or can be classified to partial or complete. Most cases are secondary and partial. Patients usually presents with right lower abdominal pain and most cases are diagnosed during surgery.
A 27-year-old female presented with right iliac fossa pain and nausea for 2 days. Abdominal examination showed tenderness, guarding, and rebound tenderness at the right iliac fossa. The WBC count was 11,000 c/mm and the urinalysis was normal.
At surgery, there was intussusception of the vermiform appendix in its middle part with palpable mass attached to its wall. Appendicectomy was performed successfully. The result of the histopathology was consistent with mucinous cystadenoma of the appendix with no evidence of malignancy.
Surgery is the main form of treatment as most of the cases are diagnosed during surgery, the operation type may include appendicectomy or more extensive surgery is required such as right hemicolectomy depending on the cause. Surgery can be performed laparoscopically. Trials of colonoscopic reduction are not recommended.
Nephrolithiasis, a common urological disease, could indicate a more ominous pathology beyond the kidneys. Patients who present with renal stones must be investigated for serum calcium and ...subsequently parathyroid hormones, if indicated, as one of the clinical presentations of primary hyperparathyroidism is renal stones.
A 48-year-old married female with a past medical history significant for renal stones presented to the clinic chiefly complaining of muscle pain, joint pain, and fatigue. After thorough investigations, she was diagnosed with a case of primary hyperparathyroidism due to parathyroid adenoma and was managed surgically according to guidelines.
Hypercalcemia, serum calcium of greater than 2 standard deviations above the reference value, is commonly seen to be associated with parathyroid mass therefore, assessment of serum calcium is a necessary step toward the diagnosis of parathyroid adenoma in cases with recurrent renal stones.
Recurrent nephrolithiasis requires more thorough investigation for the possible underlying cause. Primary hyperparathyroidism due to parathyroid adenoma can present with recurrent renal stones and some vague symptoms.
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