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Showing papers in "Annals of medicine and surgery in 2016"


Journal ArticleDOI
TL;DR: The aim of this study was to thoroughly present an updated review of the TNBS-induced colitis protocols that are implemented by researchers and describe the differences among those protocols regarding types of animals and colitis induction.
Abstract: Background Despite recent advances the pathogenesis of Crohn's disease remains incompletely understood. A variety of animal models have been utilized in an effort to provide further insights and develop more therapeutic options. In order to simulate, to an extent, the pathogenesis and the clinical course of the disease, TNBS induced colitis is often used. Various approaches for inducing TNBS -colitis have been described in the literature. Methods/results In this review, we sought to present the animal model of TNBS induced colitis and outline the pathogenesis, pathophysiology, clinical course and pathological characteristics of the model. Furthermore, we describe the differences among those protocols regarding types of animals and colitis induction. Data sources The MEDLINE database was thoroughly searched using the keywords: TNBS, colitis, Crohn's disease, animal model. Two investigators independently reviewed the abstracts and appropriate articles were included in this review. Additional articles were gathered and evaluated. Conclusion The aim of this study was to thoroughly present an updated review of the TNBS-induced colitis protocols that are implemented by researchers.

218 citations


Journal ArticleDOI
TL;DR: Apart from highlighting the need for effective pain management postoperatively, this study supports the drive towards single bed bays, where steps can be taken to minimize the impact of environmental factors on sleep.
Abstract: Introduction Sleep deprivation has a potentially deleterious effect on postoperative recovery. The aim of our prospective study was to identify the factors contributing to postoperative sleep deprivation and disturbance in order to recommend improvements in postoperative care.

74 citations


Journal ArticleDOI
TL;DR: The role of lipofilling for breast reconstruction could be more significant with the application of the findings of experimental research on tissue engineering and ASCs.
Abstract: Introduction The use of autologous fat transplantation to correct volume and contour defects, scars, and asymmetry after breast cancer surgery has increased over the past 20 years. Many developments and refinements in this technique have taken place in recent years, and several studies of the safety of lipofilling in the breast have been published.

65 citations


Journal ArticleDOI
TL;DR: An algorithm, AutoTriage, which uses eight common clinical variables from the EHR to assign patient mortality risk scores, which provides an improvement in the specificity and sensitivity of patient mortality prediction over existing prediction methods.
Abstract: Background Clinical decision support systems are used to help predict patient stability and mortality in the Intensive Care Unit (ICU). Accurate patient information can assist clinicians with patient management and in allocating finite resources. However, systems currently in common use have limited predictive value in the clinical setting. The increasing availability of Electronic Health Records (EHR) provides an opportunity to use medical information for more accurate patient stability and mortality prediction in the ICU.

64 citations


Journal ArticleDOI
TL;DR: High levels of burnout are prevalent among trainee doctors in this part of the world which are comparable with international literature and efforts to improve the work environment of residents may significantly reduce levels ofBurnout.
Abstract: Introduction Recent literature has focused on burnout as a specific job related distress syndrome among physicians and residents having adverse effects on patient care. Local data on burnout is lacking.

60 citations


Journal ArticleDOI
TL;DR: A high-performance sepsis prediction algorithm, InSight, which outperforms existing methods for AUD patient populations and leads to more accurate detection and prediction of septic shock, even in cases where diagnosis may be confounded by AUD.
Abstract: Background The presence of Alcohol Use Disorder (AUD) complicates the medical conditions of patients and increases the difficulty of detecting and predicting the onset of septic shock for patients in the ICU.

51 citations


Journal ArticleDOI
TL;DR: Thromboangiitis Obliterans is a non-atherosclerotic inflammatory disease of unknown etiology, which has a strong association with tobacco.
Abstract: Thromboangiitis Obliterans is a non-atherosclerotic inflammatory disease of unknown etiology, which has a strong association with tobacco. We present current concepts on the pathophysiology and diagnosis, as well as a review in treatments.

48 citations


Journal ArticleDOI
TL;DR: My thoughts, both derived from my own reflections as well as conversations and observations of my peers, on the effectiveness, advantages, and disadvantages of a PBL curriculum are provided.
Abstract: Problem-based learning (PBL) has been a concept in existence for decades yet its implementation in medical student education is limited. Considering the nature of a physician's work, PBL is a logical step towards developing students' abilities to synthesize and integrate foundational concepts into clinical medicine. Harvard's recently redesigned Pathways curriculum has shifted almost exclusively towards PBL in its one-year preclinical curriculum. This piece provides my thoughts, both derived from my own reflections as well as conversations and observations of my peers, on the effectiveness, advantages, and disadvantages of a PBL curriculum. All in all, the feelings of my peers and I regarding PBL has been overwhelmingly positive despite potential areas of improvement and continued fine-tuning.

46 citations


Journal ArticleDOI
TL;DR: This study found delays in operating TT to represent a sizable cost, with potential efficiency savings based on TT of £347,327/theatre/year, and non-statistically significant trends were seen between length of delays and advancing patient age, ASA score and absence of either a senior clinician or an anaesthetic consultant.
Abstract: The National Health Service (NHS) is currently facing a financial crisis with a projected deficit of £2billion by the end of financial year 2015/16. As operating rooms (OR) are one of the costliest components in secondary care, improving theatre efficiency should be at the forefront of efforts to improve health service efficiency. The objectives of this study were to characterize the causes of trauma OR delays and to estimate the cost of this inefficiency. A 1-month prospective single-centre study in St. Mary's Hospital. Turnaround time (TT) was used as the surrogate parameter to measure theatre efficiency. Factors including patient age, ASA score and presence of surgical and anaesthetic consultant were evaluated to identify positive or negative associations with theatre delays. Inefficiency cost was calculated by multiplying the time wasted with staff capacity costs and opportunity costs, found to be £24.77/minute. The commonest causes for increased TT were delays in sending for patients (50%) and problems with patient transport to the OR (31%). 461 min of delay was observed in 12 days, equivalent to loss of £951.58/theatre/day. Non-statistically significant trends were seen between length of delays and advancing patient age, ASA score and absence of either a senior clinician or an anaesthetic consultant. Interestingly, the trend was not as strong for absence of an anaesthetic consultant. This study found delays in operating TT to represent a sizable cost, with potential efficiency savings based on TT of £347,327/theatre/year. Further study of a larger sample is warranted to better evaluate the identified trends.

45 citations


Journal ArticleDOI
TL;DR: 3D printing in general surgery is yet to be thoroughly exploited, and the ability to view the 3D dimensional relationship of the various hepatic and portal veins with respect to tumor deposits when planning hepatic resection is the most relevant feature of interest.
Abstract: Introduction and background Three dimensional (3D) printing has gained popularity in the medical field because of increased research in the field of haptic 3D modeling. We review the role of 3D printing with specific reference to liver directed applications.

44 citations


Journal ArticleDOI
TL;DR: The results showed that the placement modality did not affect 1-year catheter survival and percutaneous catheter placement is as safe and effective as surgical technique.
Abstract: Background Peritoneal dialysis (PD) is an effective method of renal replacement therapy for end-stage renal disease patients. The PD catheter could be inserted by surgical (open surgery/laparoscopic-assisted) or percutaneous techniques. However, the efficacy of the techniques, including catheter survival and catheter related complications, is still controversial.

Journal ArticleDOI
TL;DR: The high risk groups identified in this study need to be made aware of risk of developing varicose veins and use of compression stocking at work place added with newer procedure in management could help in betterment in their quality of life.
Abstract: Background Varicose vein is a common surgical problems in India. This study was done to assess the clinico-epidemiological profile, risk factors and management practices in varicose veins.

Journal ArticleDOI
TL;DR: There is high prevalence of burnout among the surgical residents in the authors' hospitals, and unsatisfactory training is the number one reason for development of this syndrome.
Abstract: Objective To assess the presence of burnout among surgical residents working at various public sector hospitals in Pakistan.

Journal ArticleDOI
TL;DR: This study found three miRNAs that plays a role in the development of endometrial cancer and upregulation of the miRNA was upregulated to control expression a tumor suppressor gene, PTEN to protect the cancer cell from apoptosis.
Abstract: The non-invasive diagnostic tool for early detection of endometrial cancer still limited. The etiology of this disease is believed to be associated with disharmony hormone production. One predominant factor that regulate hormone production is microRNA (miRNAs). Some studies reported that miRNAs play a significant role in the process carcinogenesis. We have identified 12 of miRNAs that potentially have a role in controlling endometrial carcinogenesis pathways. Further analysis suggested that these miRNA targeted genes that regulate the early development of endometrial cancer. These genes cluster into several functional groups involving a process of angiogenesis, apoptosis, cell cycle, cell proliferation and p53 pathways. Some of the genes are PTEN, GSK3b, and TP53, which are a tumor suppressor that control the process of growth arrest, DNA Repair, and Apoptosis. Upregulation of the miRNA may obstruct the cell ability to control the cell cycle. This study was found three miRNA that plays a role in the development of endometrial cancer. The hsa-miR-495 and hsa-miR-152 were repressed in endometrial cancer compared to normal tissue. The microRNA regulate genes that control proliferation and cell survival. Moreover, hsa-miR-181d was upregulated to control expression a tumor suppressor gene, PTEN to protect the cancer cell from apoptosis. Further investigation to validate the function of the miRNA is a warrant for developing biomarkers of endometrial carcinoma.

Journal ArticleDOI
TL;DR: This study corroborates the fact that OS is a safety procedure for LABC, offering the similar oncologic results observed in patients submitted to classic BCS.
Abstract: Background Breast conserving surgery (BCS) after neoadjuvant chemotherapy (NC) in patients with locally advanced breast cancer (LABC) is an infrequent procedure. In these patients the association with BCS and oncoplastic surgery (OS) is reported as a possible procedure in case-series, but there are limited case-control studies.

Journal ArticleDOI
TL;DR: This work reviewed the critical complications following surgery for oesophageal and gastric cancer, their prevention and reasons for failure to rescue, and proposed strategies focussing on perioperative optimization, the timely recognition and management of complications.
Abstract: 'Failure to rescue' is a significant cause of mortality in gastrointestinal surgery. Differences in mortality between high and low-volume hospitals are not associated with large difference in complication rates but to the ability of the hospital to effectively rescue patients from the complications. We reviewed the critical complications following surgery for oesophageal and gastric cancer, their prevention and reasons for failure to rescue. Strategies focussing on perioperative optimization, the timely recognition and management of complications may be essential to improving outcome in low-volume hospitals.

Journal ArticleDOI
TL;DR: Evaluating the usefulness of the ratio of serum free triiodothyronine to free thyroxine to differentiating Graves' disease from subacute thyroiditis found that it may help in differentiating the cause of thyrotoxicosis.
Abstract: Background The measurement of free thyroid hormone, instead of the total form, is more commonly used in current practice. We aimed to evaluate the usefulness of the ratio of serum free triiodothyronine (FT3, pg/mL) to free thyroxine (FT4, ng/dL) for differentiating Graves' disease from subacute thyroiditis.

Journal ArticleDOI
TL;DR: Neutrophil/lymphocyte ratio is a sign of inflammation, and it is considered that this ratio will also increase during migraine attacks, as with other inflammatory and acute processes.
Abstract: Objective As commonly seen symptoms, headaches are among the most frequently encountered health challenges in emergency rooms by healthcare professionals. Among one of the most commonly seen and primary headaches is migraine. Migraines are mostly accompanied by functional deficits.

Journal ArticleDOI
TL;DR: HA and/or PV complications specially early ones lead to significant poor outcome after LDLT, so proper dealing with the risk factors like pre LT PVT and the effective management of these complications are mandatory for improving outcome.
Abstract: Objectives Hepatic arterial (HA) and portal venous (PV) complications of recipients after living donor liver transplantation(LDLT) result in patient loss. The aim of this study was to analyze these complications.

Journal ArticleDOI
TL;DR: Nasolabial flap is an old flap for reconstructive purposes and over time different modifications have been introduced to expand its usage.
Abstract: Background The use of Nasolabial flap (NLF) to reconstruct orofacial soft tissue defects is one of the oldest methods for reconstruction in the medical literature. Despite widespread use of this invaluable flap, there are still controversies over the terms used for the description of this flap. Materials and methods A search was run in PubMed for articles in English language on nasolabial flap in oral cavity/facial reconstruction, between 1960 and 2016. Inclusion criteria was case series that focused on the anatomy, flap design, blood supply, composition, flap motion, and the reconstructed area and donor site complications. Results 560 articles were found in PubMed search for nasolabial flap (between 1960 and 2016). 84 articles with case series structure and available full text were included. The results of the search in this topic for anatomy, flap design, blood supply,NLF composition, flap motion, reconstructed area and donor site morbidity are presented. Conclusion Nasolabial flap is an old flap for reconstructive purposes. Over time different modifications have been introduced to expand its usage. Clear definition of the terms used with this flap is given.

Journal ArticleDOI
TL;DR: Placement of a transanal drainage tube in patients with colorectal anastomoses is a safe and simple technique to perform and reduces anastOMotic leakage, the severity of the complication and hospital stay.
Abstract: Background and aims The aim of this study was to investigate the clinical usefulness of the placement of a transanal drainage tube to prevent anastomotic leakage in colorectal anastomoses.

Journal ArticleDOI
TL;DR: Non-operative measures should be attempted in a select group of grade III&IV blunt pancreatic trauma in hemodynamically stable patients with a controlled leak walled off as a pseudocyst without associated organ injuries and pancreatic necrosis, NOM has a higher success rate.
Abstract: Introduction Although surgery is the preferred treatment for grade III&IV pancreatic trauma, there is a growing movement for non-operative management. in blunt pancreatic trauma. Very few studies compare operative versus non-operative management in adult patients.

Journal ArticleDOI
TL;DR: TAB is an expensive procedure with a low positive yield and patients with suspected GCA should be investigated in accordance with the above algorithm, with the exceedingly low positive TAB results found in this study.
Abstract: Background Giant cell arteritis (GCA) has the potential to cause irreversible blindness and stroke in affected patients [1–4]. Temporal artery biopsy (TAB) remains the gold standard test for GCA [6–8]. Recent literature suggests that TAB does not change management of patients with suspected GCA and that ultrasound scan (USS) may be sufficient enough alone to confirm the diagnosis [9–11,13]. The aim of this study is to therefore determine the impact of TAB on current surgical practice and emergency theatre services.

Journal ArticleDOI
TL;DR: This how to article demonstrates how trainees can make and deliver a successful academic poster.
Abstract: Academic posters are an excellent way to showcase your work at conferences and meetings. They can be used in poster presentations and serve as a summary of your project. In this how to article, we demonstrate how trainees can make and deliver a successful academic poster.

Journal ArticleDOI
TL;DR: ECPEN is safe and, especially in combination with NCJ, provides comprehensive coverage of caloric requirements during the postoperative phase, and clinical controlled trials are needed to investigate potential benefits of complete energy supplementation during the early postoperativephase after PD.
Abstract: Background Suggested guidelines for nutritional support after pancreaticoduodenectomy are still controversial. Recent evidence suggests that combining enteral nutrition (EN) with parenteral nutrition (PN) improves outcome. For ten years, patients have been treated with Early Combined Parenteral and Enteral Nutrition (ECPEN) after PD. The aim of this study was to report on rationale, safety, effectiveness and outcome associated with this method.

Journal ArticleDOI
TL;DR: Adult BH is very rare and when confronted laparoscopic treatment with mesh fixation can be performed safely, according to the literature.
Abstract: Introduction Bochdalek hernia is the most common type of congenital diaphragmatic hernia and constitutes 85% of cases. Bochdalek hernia (BH) in adults is extremely rare. We present a BH case in an adult patient and discuss the literature.

Journal ArticleDOI
TL;DR: The analysis of the confounding factors showed that they could influence the reliability of the surgical placebo effects and the validity of sham surgery should be reconsidered.
Abstract: Objective Sham surgery (placebo surgery) is an intervention that omits the step thought to be therapeutically necessary. In surgical clinical trials, sham surgery serves an analogous purpose to placebo drugs, neutralizing biases such as the placebo effect. A critical review was performed to study the statistical relevance of the clinical trials about sham surgery in the light of potential confounding factors. Materials and methods For the critical review 52 articles were included. The possible confounding factors have been studied using a structured interpretative research form designed by the authors. This form includes the following ten confounding factors: I), lack of homogeneity among inclusion/exclusion criteria. II), false double blind. III), lack of post-surgery double blind. IV), power of the study. V), sample characteristics. VI), lost patients to Follow-up. VII), gender distribution. VIII), age equilibrium. IX), lack of psychological patient evaluation. X), lack of psychiatric patient evaluation. In most of the studies, at least one confounding factor was present. Results The analysis of the confounding factors showed that they could influence the reliability of the surgical placebo effects. Conclusions The validity of sham surgery should be reconsidered.

Journal ArticleDOI
TL;DR: The case of a 47 year old diabetic man with complains of left zygomatic arch swelling of 3 months evolution is described, being this the second case of chronic mucormycosis reported in Mexico.
Abstract: Mucormycosis is a life-threatening disease, were rhinocerebral infection is most commonly seen in the clinical setting. Chronic mucormycosis is a rare presentation that exhibits a challenging diagnosis. We describe the case of a 47 year old diabetic man with complains of left zygomatic arch swelling of 3 months evolution. He had received previous antibiotic treatment without improvement. Biopsy of maxillary sinus revealed the presence of non-septated, 90° angle branched hyphae compatible with zygomicetes. The patient was treated with surgical debridement and amphotericin B until there was no evidence of fungi in the tissue by biopsy. We reviewed chronic rhino-orbito-cerebral mucormycosis from 1964–2014 and 22 cases were found, being this the second case of chronic mucormycosis reported in Mexico. A quarter of the cases were seen in immunocompetent hosts. As only 20% of the causal agent can be isolated by culture, the diagnosis is mainly made by biopsy. Besides treatment with amphotericin B, posaconazole as alternative, and control of the underlying comorbidities, surgical debridement represents the corner stone therapy. We recommend at least 36 month follow-up, due to the 13% risk of recurrence. A chronic presentation has a general survival rate of approximately 83%.

Journal ArticleDOI
TL;DR: Ultrasound (US) with color Doppler US can be helpful to the diagnosis of ovarian herniation through the canal of Nuck and hernia-related complications in female infants with palpable inguinal mass.
Abstract: Introduction Inguinal hernia with containing the ovary presenting as a palpable groin mass is an uncommon congenital condition, and it may cause complications such as strangulation, torsion, and infertility. We present a case of ovarian herniation into inguinal canal with sonographic findings.

Journal ArticleDOI
TL;DR: The existence of diabetes mellitus type 2 appears to be a significant risk factor for the development of persistent corneal oedema in diabetics and non diabetic patients that underwent cataract surgery in Xanthi General Hospital in Greece.
Abstract: Background The occurrence and severity of corneal oedema after phacoemulsification is dependent on the integrity of corneal endothelial cells. The function of these cells is affected by diabetes mellitus and consequently the behaviour of the cornea in diabetic patients is of special interest.