Can we predict HoLEP surgery operating times for a given prostate volume to enhance theatre utilization?

Introduction & Objectives: Holmium laser enucleation of the prostate (HoLEP) has the strongest evidence base for bladder outlet surgery, despite its steep learning curve. Rapid enucleation rates can be achieved in established hands with day-case surgery being the norm in service delivery. We have previously shown the validity of such a model. With the post Covid surgical backlog we have developed a tool to support theatre utilization based on established surgeon specific operating room (OR) times for a given prostate volume in our unit based on almost 1100 cases. Material(s) and Method(s): Four HoLEP naive surgeons completed 1096 HoLEPs over 7.5 years using a 50 Watt (W) Holmium laser (Auriga XL, Boston Scientific Inc., Piranha morcellator, Richard Wolf). Pre and post-operative data including TRUS/MRI volume, flow rate, residual volume, international prostate symptom score, quality of life, stop-clock enucleation, morcellation and total operating room (OR) times, hospital stay, histology, haemoglobin, creatinine, sodium and catheter times were prospectively recorded. Mentorship was provided by a senior 100W HoLEP surgeon from an adjoining hospital. Result(s): The data was independently analysed by a bio-statistician (IN). Statistical regression analysis of unit and surgeon specific OR times vs prostate volume were used to produce predictive linear graphs of OR times (mins) for a given prostate volume for individual surgeons and the unit. [Figure presented] Conclusion(s): Use of surgeon-specific and unit specific OR times allows the opportunity to maximize theatre operating schedules to help tackle the post Covid surgical backlog. We encourage this process for index specialist procedures across units.Copyright © 2023 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Frustration Intolerance, Self-Efficacy and Sleep Quality in Medical Students During Pandemic of Covid-19

Introduction: A novel coronavirus disease (COVID-19) was initially reported in China in December 2019. In a few months, the virus spread rapidly across the globe, and on 30 January 2020 the World Health Organization (WHO) declared the outbreak to be a Public Health Emergency of International Concern. Objective(s): The main objective of the study is to find the frustration intolerance, self-efficacy and sleep quality in medical students during pandemic of COVID-19. Material(s) and Method(s): This cross sectional study was conducted in University of Lahore during 2021-2022. The data was collected through questionnaire. The questionnaire covered sleep conditions, stores of infection control supplies, mood and stress, usage of social media and sources of acquiring COVID-19 information, risk perception, and sociodemographic data. Result(s): The data was collected from 200 patients. About half of them were young-aged (55.0%) and married (49.1%). In terms of social media use, 57.8% spent more than 2 h per day. With regard to sleep deterioration after the COVID-19 outbreak, the weighted proportions of those who reported worsening sleep quality, worsening sleep initiation, and shortened sleep duration were 38.3%, 29.8%, and 29.1%, respectively. The weighted prevalence of current clinical insomnia was estimated at 29.9%. Practical implication: This study will help to find out the effect of COVID-19 on sleep quality, sleep initiation and duration among Pakistani population. Conclusion(s): It is concluded that COVID-19 is widely spreading in Pakistan and it effects on their sleep quality, sleep initiation, and sleep duration had worsened since the outbreak of COVID-19. This study identified high prevalence of frustration intolerance and poor sleep quality in medical students during pandemic of Covid-19.Copyright © 2023 Lahore Medical And Dental College. All rights reserved.

Are pediatric surgery fellowship websites ready for the changing paradigms in the virtual interview era?

Purpose: With the COVID-19 pandemic, in-person fellowship interviews were curtailed, leading candidates to seek information from other resources. Our main purposes were (1) to determine what information recent participants in the match needed to evaluate programs and (2) to assess which of these were available online. Methods: A focus group of ten recent graduates/applicants identified information that was important in choosing a fellowship program. In August 2020 and December 2021, websites belonging to the American Pediatric Surgical Association (APSA) and individual programs were assessed. Results: Recent applicants identified 55 pieces of information considered important to their decision making. Of 57 pediatric surgery fellowships, 98% were listed on APSA's website. Program descriptions on APSA's website listed on average 60% of program information desired by applicants. All listed fellowship director, accreditation status, faculty list, and current fellow(s). Other descriptors frequently noted were alumni (95%), graduate's board performance (83%), ECMO exposure (77%), and curriculum (70%). Information desired but less frequently available were fellow case logs (63%), trauma center designation (53%), burn center designation (40%), research opportunities (30%), candidate interview assistance (25%), and supplemental fellowships (12%). There were 7% of program descriptions that were not updated for at least a year. Conclusions: APSA and individual program websites were complimentary. Websites often lacked data that applicants sought to inform their rank list. To best adapt to the evolving virtual interview paradigm, we suggest reporting key information on a central APSA website with more nuanced information available via links to program specific websites. Supplementary Information: The online version contains supplementary material available at 10.1007/s44186-023-00104-w.

Arteriovenous Malformation of Upper Lip - a short cure for gross deformity

Aim: To evaluate the safety and success of facial artery ligation alone in arteriovenous malformation of upper lip in non-affording patients. Methodology: This prospective study was conducted at Department of Plastic surgery, on 11 consecutive patients with recurrent upper lip arteriovenous malformation who couldn’t afford angioembolization and frequent hospital visits for staged procedures. We did debulking of lesion after facial artery ligation and cosmetic lip correction. Results: Total 11 patients (9 males and 2 females) were included in this study. Majority of patients showed satisfactory results with facial artery ligation alone. One patient lost the follow up. No significant complication was noted in any patient. No recurrence was noted at 6 months and 1 year follow-up. Patient satisfaction rate remained 8.6±0.96 as per VAC. Conclusion: facial artery ligation alone provides an easy and approachable option for arteriovenous malformation where cost affordability for angioemboization and repeated hospital visits are main limitations.

Student's Satisfaction with Online Teaching during the COVID-19 Pandemic

Objective: This study was conducted to determine the level of student's satisfaction with online teaching during the COVID-19 pandemic. Methodology: The study was conducted in Sharif Medical and Dental College, Lahore from 10th June to 10th July 2020. It was a cross-sectional survey in which MBBS and BDS students were consecutively enrolled in the study. An online survey was carried out after the completion of 6 weeks of online classes through the Zoom application. A self-designed questionnaire based on a 5-point Likert scale was given to the students to grade the effectiveness of learning through e-classes and their satisfaction level on various parameters. On the Likert scale, 1 & 2 were taken as highly dissatisfied (strongly disagree, & disagree) and 4 & 5 being satisfied (strongly agree, & agree) and 3 was considered as uncertain. Percentages of the respondents in each domain of the questionnaire were calculated. Results: Out of 470 participants, only 72(15.32%) students already had an experience of e-classes. Among the study participants, 327(69.57%) were of MBBS and 143(30.43%) were of BDS. The majority of the students 291(61.91%) were not satisfied with online classes, 99(21.06%) of students were uncertain and only 80(17.02%) of the students were satisfied. Conclusion: The majority of the students 291(61.91%) were not satisfied with online classes in terms of learning environment, technological characteristics, and course management.

Influence of Covid-19 on Surgical Practice: An update is a need

Aim: To evaluate existing practice recommendations in the event of a COVID-19 pandemic and to develop future pandemic strategies. Methods: In the context of COVID-19, a review of surgical societies' and government agencies' websites, as well as current literature, was done to discover recommendations for plastic surgery operations. Our plastic surgery problems have been divided into four areas, with guidelines developed for each. Results: This pandemic demands modification in clinical practice and transformations are recommended in outpatients and perioperative settings to minimize the potential risk of disease transmission. Prioritization methods, operating room atmosphere, health care personnel safety, and preoperative patient evaluation are all covered by consensus standards for Plastic and Reconstructive Surgery. Operation theatre should be modified to minimize the disease transmission. PPE use is marked critical for all health care personals working in emergency settings. Preoperative assessment should be a critical component of management strategy. Conclusion: Since COVID-19 is predicted to resurface, doctors must weigh the risks and benefits of each operation in relation to essential patient care, COVID-19 spread reduction, and health-care worker safety. The plastic surgeon will be guided by scientific evidence-based standards that include conscious decision-making in emergency and non-urgent patients, OR changes, PPE usage, and preoperative screening tools.

The Impact of Coworker and Supervisor Support on Stress among Malaysian School Teachers during the COVID-19 Pandemic

In the current COVID-19 crisis, teaching is difficult. The demands from students, parents, the government, and school administrators may be overwhelming. Many Malaysian teachers are experiencing growing mental strain, and they are reluctant to seek help due to social stigma. This quantitative study explored the impact of coworker and supervisor support on stress among primary and secondary school teachers in Malaysia. In addition, the study examined the spill-over impact of stress on teachers’ turnover intention. A sample of 250 Malaysian school teachers completed a questionnaire. The data were analysed using correlation and regression analyses. Results re-emphasized the positive impact of coworker support on reducing teachers’ stress, but not supervisor support. Furthermore, it was found that teacher stress was linked to a higher likelihood of turnover. Therefore, it is important for school administrators and policymakers to strengthen the role of coworkers in reducing stress among Malaysian school teachers. ©Authors

The effect of COVID-19 on the air pollution in urban areas of Pakistan

Background: The impacts of lockdown on air pollution have been examined in various parts of the world. The concentration of main air pollutants has been decreased owing to a decline in anthropogenic activities like fossil fuel burning, etc. The main aim of this research was to assess the impacts of lockdown on air pollution of the main urban areas of Pakistan. Methods: The present study was conducted to assess the air quality index (AQI) of the main urban areas of Pakistan based on the pre- and post-lockdown effects and mortality rate due to coronavirus disease 2019 (COVID-19). Hotspot analysis was conducted to assess the most vulnerable spots at the country level. Results: The AQI greatly improved in all the main cities of Pakistan which ranges from 51 to 87. The pre- and post-lockdown AQI were categorized from unhealthy for sensitive groups to hazardous and moderate, respectively. There are noticeable hotspots in the vicinity of Lahore and Karachi. The level of nitrogen dioxide (NO2) dropped 45%, 49%, 20%, 35%, and 56% in Peshawar, Lahore, Multan, Karachi, Islamabad, and Rawalpindi, respectively. Conclusion: Nature healed due to lockdown, which is the only good face of the COVID-19 pandemic. The temporary lockdown greatly improved air quality which may stimulate the policymakers, researchers, and governments for the smart use of resources to minimize emissions to heal the nature. The present study also suggests the application of hotspot analysis in different contexts fur the evidence-based care services decisions during the COVID-19 pandemic.

Adapting active case-finding for TB during the COVID-19 pandemic in Yogyakarta, Indonesia.

The COVID-19 pandemic and response measures, including lockdowns and the reorientation of health services, have disrupted essential health services for other diseases, including TB, HIV and malaria. For TB, reductions in case detection due to the COVID-19 pandemic are projected to result in increased TB transmission, morbidity and mortality. Active case-finding (ACF) for TB using community-based approaches is a potential strategy to offset reductions in TB detection by obviating the need for patients to seek care at a health facility. A number of approaches can be used to conduct TB ACF safely and screen designated target populations while managing the risks of SARS-CoV-2 transmission for staff, individuals and the community. We present a framework of options for and experience of adapting TB ACF services in response to the challenges of COVID-19 in our programme in Yogyakarta, Indonesia. Key changes have included revised prioritisation of target populations focusing on household contacts, reducing case-finding throughput, implementation of additional infection control measures and precautions, and integration of COVID-19 screening among those being screened for TB. Our approach could inform other programmes seeking to adapt TB ACF services to mitigate the negative impact of COVID-19 on TB case detection.

La pandémie de COVID-19 et les mesures de riposte incluant des confinements et une réorientation des services de santé ont perturbé les services de santé essentiels destinés aux autres maladies comme la TB, le VIH et le paludisme. En ce qui concerne la TB, les réductions de la détection des cas dues à la pandémie de COVID-19 devrait entraîner une augmentation de la transmission, morbidité et mortalité de la TB. La recherche active des cas (ACF) de TB grâce à des approches communautaires est une stratégie potentielle visant à compenser pour les réductions de détection de la TB en écartant le besoin pour les patients de solliciter des soins dans un structure de santé. Plusieurs approches peuvent être utilisées pour réaliser l'ACF TB de façon sûre et de dépister des populations cibles désignées tout en gérant les risques de transmission du SARS-CoV-2 pour le personnel, les individus et la communauté. Nous présentons un cadre d'options et d'expériences d'adaptation des services TB ACF en réponse aux défis du COVID-19 dans notre programme à Yogyakarta, Indonésie. Les changements majeurs ont inclus une révision des priorités des populations cibles focalisée sur les contacts domiciliaires ; une réduction de la cadence de la recherche de cas ; la mise en œuvre de mesures supplémentaires de lutte contre l'infection et de précautions ; et l'intégration du dépistage de COVID-19 parmi ceux dépistés pour la TB. Notre approche pourrait informer d'autres programmes voulant adapter les services TB ACF afin d'atténuer l'impact négatif du COVID-19 sur la détection des cas de TB.

Anesthesiologists' occupational wellbeing and support during COVID-19 pandemic

Anesthesiologists have been at the forefront of COVID-19 pandemic and are particularly at risk of suffering both physical and emotional effects. There have been several individual and organizational strategies that can be put in place to tackle their well-being. Self-strategies that are recommended are adequate rest and sleep, consistent work breaks, help seeking behavior, emotional control and acceptance of limitations of their own competence and healthcare systems. Several online training programs are available for individual guidance. Organizations can also support their staff in different ways. It is important to recognize those who are more vulnerable physically and emotionally. Institution should implement stress reduction strategies, provide adequate PPE, should be able to communicate with their employees in a clear and honest manner and enforce infection control policies. In addition, institutions must take other physical measures where resources permit, like provision of negative pressure rooms and to provide updated and accurate information. Both personal and psychological support is needed. Several different models have been suggested for emotional support. One particularly vulnerable group that requires additional assistance are those in quarantine. Last but not least, in addition to the implementation of all these measures it is imperative to sustain these activities.

Home spirometry as a clinical endpoint in fibrotic ILD: Lessons from the injustis interim analysis

Home handheld spirometry enables repeated measurements of forced vital capacity (FVC), offering opportunities for longitudinal evaluation in interstitial lung disease (ILD). Whilst recent studies have not blinded participants to their home spirometry performance, they support feasibility in participants with idiopathic pulmonary fibrosis (IPF). However little data exists for the utility of home spirometry in non-IPF ILD. We assess correlation, agreement and non-inferiority of blinded daily home spirometry over three months relative to hospital spirometry, informing the feasibility of remote monitoring as a primary endpoint in clinical settings. We utilised interim data from the ongoing INJUSTIS study (NCT03670576). Participants with fibrotic ILD were offered a handheld spirometer linked via bluetooth to a smartphone application and asked to perform daily, blinded FVC for three months. Hospital spirometry was concurrently obtained at baseline and three months. Home FVC values were based on week averages at study timepoints. Correlation, Bland-Altman plots and equivalence tests were used to compare baseline, 3 month and delta. Sensitivity analysis was performed where test dates matched. 82 participants with ILD were included. Mean age was 69.8±8 years, 72.3% were male and mean FVC was 2.96 ±0.88L. Median adherence to daily spirometry was 79.5%, four participants had an adherence <10%. At the time of (Table presented) censorship, 35 participants had 3 month data for both home and hospital spirometry, 45 participants had date-matched values. High correlation was observed between home and hospital spirometry at baseline (r=0.86) and three-months (r=0.81), changes in 3 month DFVC were not correlated (r=-0.09). At least 90% of home spirometry values were within agreement limits of hospital values at baseline (mean difference -0.31L/min,95%CI -0.39;-0.22), three-months (-0.13L/min,95%CI -0.31;0.05) and 3 month DFVC (-0.03L/min,95%CI 0.13;0.20). Home values more frequently underestimated hospital values but non-inferiority was confirmed within 400 ml. Home spirometry in fibrotic ILD is feasible and non-inferior to hospital spirometry. This is particularly relevant in the context of the current covid-19 pandemic, where an urgent need has arisen to consider remote monitoring of lung function. Adherence to daily spirometry was high in blinded participants, but variability in home values was observed when using week-averages, supporting importance of longitudinal modelling for clinical endpoint precision.

COVID-19 complicated with arterial thrombosis resulting acute limb ischemia: a case report from Bangladesh. (Special Issue: Pandemic COVID19.)

COVID-19 (Corona virus disease 2019), which starts from Wuhan, China on December, 2019 spread rapidly to different countries of the world including Bangladesh. It affects huge impact on health care system. It's a new disease with multisystem involvement. Physicians are experiencing new presentation of different cases and rare complication including arterial thrombosis. Few data is available regarding arterial thrombosis in SARS-CoV-2 infected patients. We are currently fighting with a 60 year old lady suffering from COVID-19 pneumonia with other co-morbidities developed severe arterial occlusion of right leg despite of taking anti platelet for long time for another cause. Patient developed irreversible right lower limb ischemia not improving with continuous infusion of unfractionated heparin followed by severe pulmonary embolism. So further study and recommendations will need to evaluate the cases and treatment in COVID-19 Patients with rare presentation.