Cassidymcmahon9167
Topical pharyngeal anesthesia has improved esophagogastroduodenoscopy (EGD) efficiency with smooth insertion, reducing pain and discomfort. Lidocaine spray is one of the safe and widely used methods. In practice, the patients walk, sit in a wheelchair, or lie on a trolley bed, and the lidocaine sprays are applied to those in sitting or supine positions for pre-endoscopic preparation. Although there is no current guidance technique, this study aims to compare the effects of lidocaine sprays between sitting (Group A; Gp A) and supine positions (Group B; Gp B) for patients undergoing unsedated EGD.
This study was a single-center prospective randomized controlled trial. Unsedated EGD patients were randomly allocated the lidocaine spray in sitting or lidocaine spray in the supine position.
Lidocaine spray treatments were significantly different in the gag reflex (NRS; Gp A 1.28 ± 0.67, Gp B 1 ± 0.63, p = 0.0003), ease of esophageal instrumentation (NRS; Gp A 7.68 ± 0.91, Gp B 7.95 ± 0.66, p = 0.0042), and pain score (NRS; Gp A 5.16 ± 2.08, Gp B 4.53 ± 1.93, p = 0.0059). When considering modified Mallampati classification (MMC), MMC classes III and IV were significantly different in the same direction but MMC classes I and II were not.
The technique of spraying in the supine position was associated with less gagging, less pain, and easier esophageal instrumentation, especially in patients with MMC classes III and IV.
The technique of spraying in the supine position was associated with less gagging, less pain, and easier esophageal instrumentation, especially in patients with MMC classes III and IV.
Transoral incisionless fundoplication (TIF) has been used for treating chronic gastroesophageal reflux disease (GERD) refractory to medical therapy. We aim to investigate the complications associated with TIF using a national database.
We analyzed post-marketing surveillance data from the FDA Manufacturer and User Facility Device Experience (MAUDE) database from Jan 2011 through Jan 2021.
During the study period, approximately 95 event cases reported to the FDA. Approximately 131 patient complications were identified. The number of adverse events declined from 2011 to 2016 (R
= 0.96) but increased from 2016 to 2020 (R
= 0.99). The most common adverse event was perforation (19.8%), followed by laceration 17.6%, bleeding (9.2%), and pleural effusion (9.2%). The most common patient complications were treated using endoscopic clips (12.3%), chest tube or drain insertion (12.3%), use of endoscopic retriever device (11.1%), esophageal stent (8.6%), and emergent or open surgery (11.1%).
Adverse events from TIF range from mild to severe. Further research is needed to develop approaches aimed at reducing patient risks.
Adverse events from TIF range from mild to severe. Further research is needed to develop approaches aimed at reducing patient risks.
To examine local practice for non-malignant polyps and to calculate morbidity and mortality associated with bowel resection for this indication.
This retrospective cohort study was conducted by reviewing our local gastrointestinal pathology database over a five-year period to identify colonic resections performed for benign polyps. Using search terms "polyp" and "adenoma," 272 cases were identified. Exclusion criteria included cancer diagnosis, emergency surgeries, multiple resections, and subtotal colectomies for polyposis. 106 patients were included in the study. Primary outcome was perioperative mortality. Secondary outcomes included patient morbidity, characteristics of polyps requiring surgery, and the numberof patients referred for asecond endoscopic opinion prior toproceeding with surgery.
64 male and 42 female patients with a mean age of 65.3years (± 8.6years) underwent colon resection for benign polyps. The mean polyp size was 32.7mm (± 19.5mm). 30 patients (28.6%) had polyps equal to or less tgap in endoscopic management of benign colonic polyps.
To conduct a meta-analysis to compare the short-term outcomes of transoral thyroidectomy vestibular approach (TOTVA) with non-transoral endoscopic thyroidectomy (NTET).
MEDLINE, EMBASE, science citation index expanded, and the Cochrane Central Register of Controlled Trials in the Cochrane Library from January 2007 to January 2021 were searched for relevant literature. The evaluated endpoints were intra-operative and post-operative outcomes.
Ten eligible, non-randomized comparative studies involving 1677 patients were included. Meta-analysis results revealed that TOTVA was associated with significantly longer operative time [weighted mean differences (WMD), 22.60; 95%confidence interval (CI), 7.51-37.69; P = 0.003]. No significant differences were found between TOTVA group and NTET group in terms of post-operative outcomes.
TOTVA appears to be an equally feasible and safe surgical procedure as NTET for patients with benign thyroid nodules and selected differentiated thyroid carcinomas.
TOTVA appears to be an equally feasible and safe surgical procedure as NTET for patients with benign thyroid nodules and selected differentiated thyroid carcinomas.
Magnetic sphincter augmentation (MSA) is an effective treatment for gastroesophageal reflux disease (GERD). However, the impact of obesity on MSA outcomes is unknown. The objective of this study was to evaluate the effectiveness of MSA in patients with GERD and obesity.
A retrospective cohort study was performed of consecutive patients who underwent laparoscopic MSA at three high-volume centers from 2016 to 2019. Patients were grouped into four cohorts according to the World Health Organization body mass index (BMI) classification BMI < 25 (normal weight), BMI 25-29.9 (overweight), BMI 30-34.9 (obese class I), and BMI > 35 (obese class II-III). Preoperative, operative, and postoperative data were compared between groups.
A total of 621 patients underwent laparoscopic MSA during the study period. Follow-up with endoscopy or video esophagram was available for 361 patients (58%) with a median follow-up of 15.4months. Hexamethonium Dibromide antagonist Baseline characteristics of the groups were similar except the BMI > 35 group had more females and a higher preoperative median DeMeester score. There were no significant differences in outcomes between normal weight, overweight, and obese patient groups undergoing MSA. All groups experienced significant reductions in acid suppressive medication use, low GERD-HRQL scores, low DeMeester scores, few intraoperative and postoperative complications, and low rates of hiatal hernia recurrence after MSA.
Magnetic sphincter augmentation is safe and effective in improving GERD symptoms, reducing esophageal acid exposure, and preventing hiatal hernia recurrence, irrespective of patient BMI. MSA should be considered an acceptable treatment option for obese patients with GERD.
Magnetic sphincter augmentation is safe and effective in improving GERD symptoms, reducing esophageal acid exposure, and preventing hiatal hernia recurrence, irrespective of patient BMI. MSA should be considered an acceptable treatment option for obese patients with GERD.
Robot-assisted laparoscopy is a safe surgical approach with several studies suggesting correlations between complication rates and the surgeon's technical skills. Surgical skills are usually assessed by questionnaires completed by an expert observer. With the advent of surgical robots, automated surgical performance metrics (APMs)-objective measures related to instrument movements-can be computed. The aim of this systematic review was thus to assess APMs use in robot-assisted laparoscopic procedures. link2 The primary outcome was the assessment of surgical skills by APMs and the secondary outcomes were the association between APM and surgeon parameters and the prediction of clinical outcomes.
A systematic review following the PRISMA guidelines was conducted. PubMed and Scopus electronic databases were screened with the query "robot-assisted surgery OR robotic surgery AND performance metrics" between January 2010 and January 2021. The quality of the studies was assessed by the medical education research study qu be confirmed by further studies, particularly, for non-urological procedures. Concurrent validation is also required.To manage eutrophication of reservoirs, it is important to consider the potential for unexpected releases of organic phosphorus (OP) from areas around the reservoir where the water level fluctuates. In this study, we investigated the absorption and release of OP from a riparian soil/sediment from the Miyun Reservoir under fluctuating water levels using laboratory simulations. The total organic phosphorus (TOP) content in the soils/sediments ranged from 250.76 to 298.62 mg/kg, which accounted for between 5.6 and 38.5% of the total phosphorus (TP) content. We measured three OP fractions and found that the concentration of moderately labile OP (MLOP) was the highest, followed by labile OP (LOP), and the concentration of non-labile OP (NLOP) was the lowest. As the soils and sediments dried, they adsorbed phosphorus (P). The inorganic phosphorus (IP) contents were significantly and negatively correlated with the LOP and MLOP contents, indicating exchange between IP with these two fractions when the concentrations of bioavailable phosphorus in the soil are low. During flooding, the physicochemical properties varied at the sediment-water interface, inducing the release of Fe/Al-P. Some of the LOP and MLOP in the sediments were mineralized to IP. Our results suggest that when there are external P inputs, P may be released when sediments around a reservoir are subjected to wetting and drying as water levels fluctuate, which may cause P enrichment in reservoirs, especially in areas with poor water exchange.We reflect on our experience co-teaching a medical humanities elective, "Pandemics and Plagues," which was offered to undergraduates during the Spring 2021 semester, and discuss student reactions to studying epidemic disease from multidisciplinary medical humanities perspectives while living through the world Covid-19 pandemic. The course incorporated basic microbiology and epidemiology into discussions of how epidemics from the Black Death to HIV/AIDS have been portrayed in history, literature, art, music, and journalism. Students self-assessed their learning gains and offered their insights using the SALG (Student Assessment of their Learning Gains), describing how the course enhanced their understanding of the current pandemic. In class discussions and written assignments, students paid particular attention to issues of social justice, political context, and connections between past pandemics and Covid-19. Student responses indicate enhanced understanding of the scientific and medical aspects of epidemics and also increased appreciation of the insights to be gained from the medical humanities. We discuss co-teaching the class during a real-time, twenty-four-hour-news-cycle pandemic, and the ways in which that experience underlines the value of a "critical medical humanities" approach for undergraduates.Escherichia coli ST1193 is an emerging global clone associated with fluoroquinolone resistance. A population-based study described genomics, clinical factors, susceptibility patterns, and incidence rates of ST1193 (n = 69) causing incident blood stream infections in a centralized Canadian region 2016-18. ST1193 was responsible for community-acquired upper urinary tract infections among the elderly. The incidence rate (IR) per 100,000 person-years among Calgary residents increased from 1.0 (95%confidence interval [95%CI] 0.7-1.5) in 2016, to 1.7 (95%CI 1.3-2.3) in 2018 (p = 0.05). link3 This was mainly due to the significant increase of ST1193 blood stream infections among female long-term care (LTC) residents. ST1193 IR with blaCTX-Ms was 3.18 times higher in 2018 than in 2016 (CI 95% 0.98-13.49). We identified a ST1193 isolate with only a parC S80I mutation that is different from previously published data. The population-based study identified a significant increase over a 2-year period of E. coli ST1193 blood stream infections among elderly females residing in LTC centers.
