bluuebunny/crossref_metadata_2025_split huggingface dataset:
191 The Effect of Covid-19 on the Management of Acute Ureteric Colic in a Tertiary Hospital
Authors: Sen P , Edison E , Smith D 
Published: November 2022

Abstract

Introduction
The Covid-19 pandemic forced changes to care pathways. We have analysed the difference in provision of care to patients presenting with ureteric colic during the pandemic (PC) compared to a pre-pandemic cohort (PPC).

Method
A list was generated of all CT KUB scans requested in the emergency department. Imaging and notes were reviewed to identify acute ureteric colic presentations in September to December 2019 and 2020. Statistical significance was calculated using either the Student T-test or Chi-squared test.

Results
There were 92 patients in the PC, and 107 in the PPC.
Primary treatment was provided for more patients during the pandemic (25% vs 10%, p&lt;0.05), mainly by extracorporeal shockwave therapy (ESWL, 21% vs 7%, p&lt;0.05).
The rate of conservative management (64% vs 76%, p&gt;0.05), temporising stent (11% vs 14%, p&gt;0.05), and nephrostomy insertion (1% vs 1%, p&gt;0.05) was similar in PC and PPC.
The PC had a shorter time to intervention (17 vs 39 days, p&lt;0.05), to ESWL (4 vs 12 days, p&gt;0.05), to ureteroscopy (35 vs 45 days, p&gt;0.05), and to stone passage confirmation (44 vs 91 days, p&lt;0.05) respectively.
There was no follow up for 15% and 30% respectively (p&lt;0.05).

Conclusion
During the pandemic, a reduction in electives created capacity for urgent interventions, (21% vs 7% ESWL, 4 vs 12 waiting days). Accordingly, the stone passage confirmation time was more than halved (44 vs 91 days). In accordance with recommendations from NICE, TISU and GIRFT, this demonstrates the importance of ringfencing ESWL, particularly as we emerge from the pandemic.
213 Impact of COVID-19 Pandemic on Surgical Education and Training: A Resident Survey in a Low-Income Country
Authors: Fatima S , Arham M , Shafique MS , Waqar Bhatti H 
Published: November 2022

Abstract

Aim
The COVID-19 pandemic has adversely affected medical education and training programmes worldwide. This study aims to assess the impact of COVID-19 pandemic on surgical education and training in a low-income country.

Method
This cross-sectional study was conducted in Allied hospitals of Rawalpindi Medical University, Rawalpindi, Pakistan, from June 2021 to July 2021. A structured questionnaire designed by the researchers was distributed to all surgery departments, and surgical residents who consented to participate in this study were included. Data was analyzed using IBM SPSS v25.

Results
A total of 152 residents participated in this study, of which 53 (34.9%) were in general surgery and 99 (65.1%) in various surgical allied specialties. A large number of respondents reported a severe to complete reduction of elective surgical procedures (78, 51.3%), outpatient clinical activity (54, 35.6%) and academic sessions (86, 56.6%). A signiﬁcantly higher number of general surgery residents (52.8%) reported increase in emergency surgical procedures as compared to surgical allied specialties (35.4%) (P=0.037). Majority of the respondents believed that loss of surgical training opportunities had a negative impact on their training and job performance (127, 83.6% and 130, 85.5%, respectively) with 43 (28.3%) residents suggesting an extension in training program. 137 (90.1%) residents reported increased stress and anxiety levels with the number of surgical allied residents signiﬁcantly higher than general surgery residents (P=0.031). 125 (82.2%) respondents claimed that fear of contracting the virus affected proper patient evaluation.

Conclusions
COVID-19 pandemic has severely impacted the training and psychological wellbeing of surgical residents and drastically affected patient evaluation.
996 Impact of Extremes of BMI on Outcomes Following Lung Resection
Authors: Ahmed-Issap A , Mushtaq R , Jain S , Abah U 
Published: November 2022

Abstract

Aim
Body Mass Index (BMI) has been shown to be an independent predictor of survival following lung resection for non-small cell lung cancer. This study aimed to quantify the short-term impact of abnormal BMI on outcomes following all lung resections.

Method
Lung resections at UHNM were examined from 01/01/2012 to the 07/07/2021. Variables were extracted from a retrospective database. Patients were divided into three cohorts: low BMI (&lt;18.5), normal/high BMI (18.5–29.9) and obese BMI (&gt;30). Post-operative complications, length of stay and 30-day mortality were examined.

Results
2439 patients were identified. 2341 BMI values were available and included. 2.6% (n=60) had a low BMI, 67.7% (n=1586) had a normal/high BMI and 29.7% (n=695) had obese BMI. Post-operative complications were found to be higher in the low BMI group (43.3%) when compared to a normal/high and obese BMI group (30.8% and 23.2%, respectively). Length of stay was higher in the low BMI group (10.2 days) compared with normal/high or obese BMI group (7.5 and 6.3 day, respectively). 30-day mortality was higher in the low BMI group (8.3%) compared with the normal/high and obese BMI group (2.0% and 1.7%, respectively).

Conclusions
Low BMI is associated with significantly worse immediate post-operative outcomes and approximately a four-fold increase in mortality when compared with obese BMI. Obesity appears to incur a protective effect in mortality.
758 Unique Case of Recurrent Non-Neutropenic Typhlitis
Authors: Sahni D , Stockdale H , Leiberman D , Stevenson R 
Published: November 2022

Abstract
Tacrolimus is an important component of the immunosuppressive regime used after solid organ transplantation. It is known to predispose patients to typhlitis also known as neutropenic enterocolitis, which presents with the characteristic triad of abdominal pain, fever, and neutropenia.
A 66-year-old lady was referred with vomiting, abdominal pain, and passage of blood per ileostomy. The patient had an extensive medical history including a panproctocolectomy for Crohn's disease, cholecystectomy and a liver transplant. Her immunosuppressive regime included prednisolone, azathioprine, and tacrolimus. Based on her presentation, a presumptive diagnosis of ischemic bowel was made, and non-contrast (due to AKI) CT scan demonstrated evidence of intramural gas with marked mesenteric and portal venous gas. The decision was made to proceed to laparotomy, the findings of which included dense adhesions but with normal healthy small bowel. After several investigations, it was concluded that her symptoms were caused by typhlitis secondary to her tacrolimus therapy.
In 2020, the patient presented with similar symptoms. She was able to undergo a contrast-enhanced CT scan during this episode as she had presented early with preserved renal function. Her radiological findings were similar to the previous episode. However, owing to her known past history, she was managed conservatively.
To the authors knowledge, no similar cases have been reported so far, which makes this case unique and makes a strong motion for the clinicians to maintain a high suspicion for typhlitis inmmunocompromised patients, even in absence of classical feature of neutropenia
446 Efficacy of Early Gastrografin Use in Adhesional Small Bowel Obstruction
Authors: Hama B , Khawgali M , Elsharif M , Peter M 
Published: November 2022

Abstract

Aim
The aim of this audit was to establish the outcomes in patients who receive gastrografin versus patients who do not receive gastrografin in patients with adhesional small bowel obstruction (SBO).

Method
This was a retrospective data collection of patients admitted with “small bowel obstruction” between June and September 2021. Further patient selection criteria were applied. Data was collected using the EPR system and assimilated using Excel spreadsheet.

Results
A total of 76 patients with SBO were identified. 32 patients were diagnosed with adhesional SBO. Of these, 21/32 had previous maximally invasive surgery, 7/32 has previous minimally invasive surgery, and 4/32 had no previous surgery.
17/32 patients received gastrografin, of which 15 resolved and 2 needed surgery (1×laparoscopic adhesiolysis and 1×laparotomy). Average length of stay in patients who received gastrografin was 4.2 days.
15/32 patients did not receive gastrografin, of which 6 resolved and 9 needed surgery (7×laprascopic adhesiolysis and 2×laparotomy). Average length of stay in patients who did not receive gastrografin was 10.3 days.

Conclusions
Early use of gastrografin in stable patients with adhesional SBO appears to have good outcomes and should be considered after discussion with senior clinicans. Patients who are septic, severely tender on examination or who show signs of ischaemia should not have surgery delayed. Formal standard operating procedures (SOP) should be developed for the management of adhesional SBO.
776 Patient Outcomes Vary with Surgeons’ Experience Following Emergency Laparotomy: An Observational Study
Authors: Sultana E , Naumann DN , Williamson A , Griffiths E , Bedford M , Karandikar S 
Published: November 2022

Abstract

Aim
There is some evidence that patient outcomes for surgeons improve with years of experience. We aimed to investigate the relationship between surgeon experience and patient outcomes following an emergency laparotomy in a large sample of the UK National Emergency Laparotomy Audit (NELA) database.

Method
A 5-year retrospective observational study was undertaken using data extracted from NELA for patients who underwent emergency laparotomies at a large UK multi-site NHS Trust. The association between 30-day mortality and surgeon years of experience was investigated using logistic regression, adjusted for ASA grade, patient age and gender, Index of Multiple Deprivation (IMD) score, and time of surgery.

Results
There were 3153 patients with a median age of 66 (IQR 51–76), and 49.4% were male. Patients in the group who died within 30 days were more likely to be older, have a higher ASA score, and have an operation during the night. Increasing years of surgeon experience, patient age, and ASA were all significantly associated with increased odds ratio of death within 30-days.

Conclusions
Increasing years of surgical experience appears to be related to worse patient outcomes for an emergency laparotomy. This is likely due to surgeons taking on more complex and challenging cases as their career progresses. Further explorations of how surgeons’ activity changes over their full career are warranted.
875 Atraumatic Splenic Rupture Secondary to Ruptured Pancreatic Pseudo Cyst- a Rare Phenomenon
Authors: Okpala A , Chew M , Shaaban M 
Published: November 2022

Abstract

Introduction
Chronic pancreatitis can be complicated by the development of a pancreatic pseudocyst in 20 – 40% of cases. Splenic rupture is usually associated with blunt trauma but can be associated with non-traumatic causes like pancreatic pseudocysts associated with chronic pancreatitis.
Atraumatic splenic rupture (ASR) is rare, and a life-threatening process with a mortality of about 12%. Possible mechanisms of action of pancreatic pseudocysts causing ASR to have been described in literature, with some of them involving the action of proteolytic enzymes on the splenic vessels, parenchyma and hilum. Management of these cases involves resuscitation, and emergency splenectomy because they usually present with haemodynamic instability.

Case report
A 50-year-old woman with a background of pancreatic pseudocyst secondary to alcoholic chronic pancreatitis presented with severe left sided abdominal pain. A Computed Tomography (CT)scan confirmed the presence of splenic rupture with moderate haemoperitoneum. Emergency laparotomy revealed a ruptured and necrotic spleen adjacent to a ruptured pancreatic pseudocyst. A splenectomy was performed with abdominal packs left insitu with the view to a relook surgery 24 /48 hours later. She recovered uneventfully after HDU care.

Conclusions
ASR secondary to pancreatic pseudocyst as a complication of chronic pancreatitis is a rare phenomenon which requires a high index of suspicion for diagnosis. CT is the gold standard imaging modality for investigation in a haemodynamically stable patient. Management is surgical with adequate resuscitation and perioperative critical care.
1018 Emergency General Surgery; Physiology and Frailty Assessment with Surgical Outcome Analysis, in a Single-Centre Retrospective Cohort Study
Authors: Elamin A , Torzilli G , Ceolin M , Kurihara H , Jaly Y 
Published: November 2022

Abstract

Introduction
Emergency General Surgery (EGS) deals with the most critical of patients. It is a field that requires the precise and timely execution of life-saving interventions. For this reason, many studies have been conducted in order to find the optimal management plans.
Our research compared different scoring systems, to see which performed best in regard to Geriatric patients. Scoring systems included: APACHE II, ASA, ACS-NSQIP, MPI, and Frailty Score. The Clavien Dindo classification was utilised as a comparative tool.
Our secondary objective was to determine which variables had the greatest effect on patient outcomes. These variables included Age, Sex, BMI, Time to Surgery, Beta-blockers, ‘Open Abdomen’ treatment, Blood Transfusions, Anticoagulants, and Vasopressors.

Method
The database included 212 patients who underwent EGS in a consecutive 24-month period.

Results
All of the scoring systems proved to be statistically significant with the ACS and the ASA being most effective for predicting death and short-term complications.
Regarding variables, we performed both univariate and multivariate testing. For predicting the risk of death, ‘Open Abdomen treatment’, Blood Transfusions, and Vasopressors were statistically significant. For estimating the risk of short-term complications only Blood Transfusions and Vasopressors proved significant

Conclusions
We must take into consideration that the other systems had significant results, therefore we must contemplate if there were compounding factors. To rectify this, further studies should be conducted ensuring correct parameters are respected, for example, the APACHE II should only be used in ICU patients and within the first 24 hours of admission.
330 Gender Differences in Mortality After Stroke in Thai Patients. a National Cohort Study
Authors: Abdel-Fattah AR , Pana T , Tiamkao S , Sawanyawisuth K , Kasemsap N , Mamas M , Myint P 
Published: November 2022

Abstract

Aim
Gender differences in patients hospitalised with stroke is a major public health concern carrying important implications to service provision. There has not yet been a study specifically focussing on patients in Thailand. We aimed to assess the gender differences in mortality following ischaemic-stroke (IS) and haemorrhagic-stroke (HS) in a large Thai-cohort.

Method
All stroke admissions of patients between 2004–2015 were included from a Thai national-insurance database. The association between gender and mortality by stroke-type was assessed at one, 12 and 60-months using multivariable Cox-regression models.

Results
There were 543,763 patients included women made up 46.6% of patients with IS (n=172,800) and 41.3% of patients with HS (n=69,828). Women were older than men in both IS and HS groups (mean age:67.1, SD(13.4) vs. 64.1(12.9) and 64.2(14.3) vs. 59.1(13.9)), respectively. Women had higher prevalence of comorbidities and stroke-specific risk factors compared to men. When comparing mortality by stroke-type, mortality was higher in women post-IS at one-month (HR:1.17, 95%CI:1.15–1.20), one-year (HR:1.10, 95%CI:1.09–1.12) and five-years follow-up (HR:1.02, 95%CI:1.01–1.03). Similarly, mortality post-HS was also higher in women at all three follow-up timepoints (one-month HR:1.08, 95%CI:1.06–1.10, one-year HR:1.04, 95%CI:1.03–1.06, and five-years HR:1.09, 95% CI:1.08–1.11).

Conclusions
In Thai patients hospitalised with stroke, women have a greater burden of stroke-specific risk factors. The mortality outcome of women with stroke is consistently higher than that of men, which appears to be irrespective of stroke-type or duration following stroke, up to five-years after discharge. Whether this difference is attributable to differences in management or physiology warrants further evaluation.
599 Bullying and Harassment Awareness Amongst Junior Doctors – an Audit in Morriston Hospital Plastic Surgery Department
Authors: Hadjikyriacou E , Mistry R 
Published: November 2022

Abstract

Aim
Determine junior doctors’ awareness of bullying and harassment policy and legal requirements of the health board. If lack of knowledge/training, provide required training in the form of staff teaching. Improve workplace culture and staff safety.

Method
All junior doctors (total of 10) in the plastic surgery department were asked to fill in questionnaire about their experience of bullying and harassment in the workplace. They were asked about their personal experience of bullying and harassment, awareness of the health boards duty, reporting culture and barriers to reporting. The change implemented was staff training and information on where to access health board policies and protocols. After training, a second questionnaire was filled in to see if there was better understanding of the health board policy and the necessary steps in the event of a bullying or harassment incident.

Results
The health boards policy was easy find on the health board intranet. In the initial questionnaire: 6 out of 10 junior doctors reported experiencing bullying or harassment in the NHS, all 10 reported not being able to define bullying and harassment; and a lack awareness of NHS Wales’ bullying and harassment policy. All 10 reported that they had not reported any bullying and harassment experienced. The junior doctors were asked about barriers to reporting, all 10 identified concerns about repercussions professionally as the main barrier.

Conclusions
Training on how to identify bullying and harassment, the pathways of escalation and a change in culture over professional repercussions are vital for surgical trainees going forward in the NHS.
235 A Closed Loop Clinical Audit on the Implementation of WHO Surgical Safety Checklist at a Tertiary Hospital in India
Authors: Sinha AV , Kadam S 
Published: November 2022

Abstract

Aim
To complete an audit on the level of compliance to the WHO surgical safety checklist in surgical operating theatres at a tertiary hospital in India.

Method
A total of 40 surgical operations were observed at the operating theatres at a tertiary hospital to confirm the practice of the WHO surgical safety checklist which formed the prospective part of our study. The study was conducted for a period of 2 months starting from July to August 2021. The results were then compared with standard guidelines and analyzed. Interventions were carried out by a series of rigorous meetings and discussions with the medical and the nursing staff. Results were re-audited after 2 weeks.

Results
Of all the operations audited, 45% Sign-In and only 1% Sign-Out were performed in the first cycle. After the re-audit, a significant change was reported as the Sign-In improved to 80% and a 55% Sign-Out was conducted. The Time-Out was observed to increase from 15% to 65%.

Conclusion
Compliance is seen to be greater in major surgeries than in minor surgeries. Compliance with all items in the checklist and active participation by all medical and nursing staff is mandatory for successful implementation of the Surgical safety checklist.
610 A Case Report of Furuncular Myiasis Affecting the Glans Penis of a Young Boy Caused by the Larvae of Cordylobia Anthropophaga (The Tumbu Fly)
Authors: Jesuyajolu D 
Published: November 2022

Abstract

Introduction
Cutaneous myiasis is endemic in West Africa, and it is most commonly caused by the larvae of Cordylobia anthropophagia. In English literature, there has been no recorded case of this cutaneous myiasis affecting the glans penis. Its rarity calls for a need to consider this as a differential when looking at furuncular lesions of the glans penis. This awareness is important for practitioners who may come across this case.
We report a case of furuncular myiasis of the glans penis due to the larvae of C.anthropophaga of an 11-year-old boy living in Lagos, Nigeria.

Case presentation
We present an 11-year-old boy who presented to the surgical department with a lesion on his glans penis, initially thought to be a boil. Upon examination, the lesion contained a single larva of C.anthropophaga. It was extracted in the minor theatre with a non-toothed forceps, and the area healed well following discharge. (Pictures of extracted larvae are available upon request).

Discussion
Although endemic, furuncular myiasis of the glans penis is a very rare condition, likely related to the living circumstance of the patient. An awareness of the clinical features is important so as to prevent misdiagnoses of foruncular lesions that occur on the glans penis, especially in people with identified risk factors.
Health education and promotion of good hygiene are important in reducing the incidence of Cordylobia anthropophagia infestation.
655 Is It Time to Change Practice in Patients with Unilateral Inguinal Hernia – a Comparative Study of Laparoscopic vs Open Hernia Repair in LMIC Country
Authors: Hakeem A , Saqib S , Zafar H 
Published: November 2022

Abstract

Aim
Our aim was to assess if a return to regular activity is improved in patients undergoing one-sided inguinal hernia repair. This is critical in LMIC countries where finances are constrained, and the cost of laparoscopic repair is significantly higher than the open technique.

Method
The study was conducted at Aga Khan University Hospital, Pakistan. Patients between ages 16 to 65 planned for unilateral inguinal hernia repair were selected using non-probability consecutive sampling. Patients were selected from 1st May 2016 till 30th April 2017 and were divided into two groups. Group A included patients having laparoscopic TAP repair while Group B consisted of Liechtenstein hernia repair. All patients were followed at 1 week for resumption of regular activities, at 1 and 3 years for recurrence, the study was concluded on 30th April 2020.

Results
A total of 60 patients were enrolled in this study. Group A and B each had included 30 patients. The mean duration of return to work in group A was 5.33 ± 4.46 days and for group B it was 6.83 ± 4.58 days. There was 1 recurrence seen at 3 years in Group A.

Conclusions
Hernia recurrence is not different from the technique of repair at 1-year follow-up. Laparoscopic repair although is associated with little early return to work when compared with open technique but this difference was not statistically significant in our study. The decision of the type of repair should be balanced between surgeon expertise and patient's wishes.