Gender Disparity in Academic Trauma Surgery: The Current State of Affairs.

INTRODUCTION: Despite the increasing number of female surgeons in general surgery programs, women are still inadequately represented in leadership positions. This study aims to investigate the magnitude of gender bias in university-based trauma surgery fellowship programs and leadership positions in the United States of America. MATERIAL AND METHODS: FRIEDA was used to identify trauma surgery programs. A thorough website review of each program obtained further information on faculty members, including their name, age, gender, and faculty rank. Trauma surgeons with an MD or DO qualification and a faculty rank of Professor, Associate Professor, or Assistant Professor were selected for inclusion in this study. SCOPUS was used to assess the H-index and the number of publications and citations of surgeons. RESULTS: The total number of programs included was 136, consisting of 715 faculty members. Less than a quarter (n = 166; 23.2%) comprised females and less than one-fifth (n = 30; 19%) of female surgeons were Professors. The difference in the research productivity of male and female trauma surgeons was statistically significant (P < .05), with the average H-index being 10 vs 7.5, respectively, amongst the top 50 surgeons of both genders. Based on a multiple regression analysis, academic rank was significantly associated (P < .05), and gender was not significantly associated (P > .05) with H-index. CONCLUSION: Gender disparity exists in the field of trauma surgery, as noted in senior faculty ranks and leadership positions. Female-inclusive state policies, appropriate mentorship, and supportive institutions can help to bridge this gap.

Efficacy of bariatric surgery in COVID-19 patients: An updated systematic review and meta-analysis.

Introduction: Obesity is linked with poor outcomes in patients with SARS-CoV-2 infection. In patients with BMI > 35 kg/m2, increased rates of hospital and subsequently ICU admissions have been noted. Bariatric surgery resulting in sustained weight loss is hypothesized to decrease the morbid outcomes associated with COVID. In this review, we update the evidence on the topic. Methods: An extensive literature search was conducted of electronic databases. Screening of the articles based on the eligibility criteria was followed by relevant data extraction. In addition to articles used in a previous meta-analysis, relevant databases were searched to filter for any new articles. Initially, two independent reviewers screened Pubmed and the Cochrane database followed by a thorough search of additional databases such as Google scholar and Medrxiv. Articles were first screened using title and abstract, followed by a full text read. Duplicates, meta-analysis, letter to the editors, and commentaries were excluded. No language restrictions were applied. Results: A total of nine articles with a population of 1,130,341 were entered into RevMan. Patients with bariatric surgery displayed significantly decreased hospitalization (OR: 0.52, 95% CI [0.45, 0.61]), were less likely to be admitted to the ICU (OR: 0.44, 95% CI [0.29, 0.67]), and had reduced overall mortality (OR: 0.42, 95% CI [0.25, 0.70]). Conclusion: Surgically induced weight loss is beneficial in reducing morbidity and mortality of COVID-19.

Association between sex and Huntington's disease: an updated review on symptomatology and prognosis of neurodegenerative disorders.

Huntington's disease is a rare autosomal dominant disorder presenting with chorea, rigidity, hypo-/akinesia, cognitive decline, and psychiatric disturbances. Numerous risk factors have been defined in the onset of this disease. However, the number of CAG repeats in the genes are the most crucial factor rendering patients susceptible to the disease. Studies have shown significant differences in onset and disease presentation among the sexes, which prompts analysis of the impact of different sexes on disease etiology and progression. This article therefore discusses the evidence-based role of sex in aspects of symptomatology, pathogenesis, biomarkers, progression, and prognosis of Huntington's disease, with a secondary review of sex-linked differences in Alzheimer's and Parkinson's disease.

Frequency and Association of Stress Levels with Modes of Commuting Among Medical Students of a Developing Country.

INTRODUCTION: This study aimed at determining the frequency and association of stress levels with modes of transportation and was likely to reveal the contributing transportation-related factors for stress in medical students. METHODS: This was a questionnaire-based, cross-sectional study that included undergraduate medical students of a public sector medical university in Karachi, Pakistan. A total of 573 students participated voluntarily, of which 300 were provided a manual questionnaire and 273 filled it online. The reliability of the questionnaire was assessed using Cronbach's alpha at 0.791. The collected data were analysed using IBM SPSS Statistics for Windows, version 21.0. RESULTS: Out of 573 participants, 99.3% (n = 298) of students filled the questionnaire manually, whereas 100% of students filled the questionnaire online. Almost two-thirds of students used university transport; more than 90% lived more than 5 km from the university and 56% had a traveling time of more than an hour. Approximately 15.4% of students reported physical trauma and some form of harassment. Sheldon Cohen's stress scale surprisingly revealed 90% of students to be within the moderate-to-high stress category. Risk factors were associated with stress levels and significant associations were observed with noise exposure (P = 0.023) and sleep quality (P = 0.001). The most common reported stressors associated with commuting included overcrowding, long travel, and air and noise pollution. Noise pollution was the main predictor of stress among commuters. CONCLUSION: Poor transportation has adverse effects on health and academic performance. Administration in their respective jurisdictions is needed to investigate this matter to make commuting a routine rather than a hassle.

Spontaneous Acalculous Gallbladder Perforation in an Adolescent Male: A Case Report and Literature Review.

Though a rare event, gallbladder perforation (GBP) can occur in children and adolescents in the absence of pre-existing cholelithiasis. Moreover, type 1 perforation is seldom found in this cohort. Vague clinical presentation and inconclusive routine investigations can often result in delayed diagnosis. Computed tomography (CT) and intraoperative diagnosis should be utilized to timely diagnose and prevent fatal outcomes. Here, we present a rare case of type 1 GBP in an otherwise healthy 15-year-old boy with no known underlying etiology. Our purpose is to emphasize that although rare, a high clinical suspicion of GBP should be kept in mind even when dealing with acute abdomen in a pediatric population for preventing associated mortality.

Prophylactic Mesh Placement for the Prevention of Incisional Hernia in High-Risk Patients After Abdominal Surgery: A Systematic Review and Meta-Analysis.

Background and objectives In high-risk populations, the efficacy of mesh placement in incisional hernia (IH) prevention after elective abdominal surgeries has been supported by many published studies. This meta-analysis aimed at providing comprehensive and updated clinical implications of prophylactic mesh placement (PMP) for the prevention of IH as compared to primary suture closure (PSC). Materials and methods PubMed, Science Direct, Cochrane, and Google Scholar were systematically searched until March 3, 2020, for studies comparing the efficacy of PMP to PSC in abdominal surgeries. The main outcome of interest was the incidence of IH at different follow-up durations. All statistical analyses were carried out using Review Manager version 5.3 (The Nordic Cochrane Centre, The Cochrane Collaboration, 2014) and Stata 11.0 (Stata Corporation LP, College Station, TX). The data were pooled using the random-effects model, and odds ratio (OR) and weighted mean differences (WMD) were calculated with the corresponding 95% confidence interval (CI). Results A total of 3,330 were identified initially and after duplicate removal and exclusion based on title and abstract, 26 studies comprising 3,000 patients, were included. The incidence of IH was significantly reduced for PMP at follow-up periods of one year (OR= 0.16 [0.05, 0.51]; p=0.002; I2=77%), two years (OR= 0.23 [0.12, 0.45]; p<0.0001; I2=68%), three years (OR= 0.30 [0.16, 0.59]; p=0.0004; I2= 52%), and five years (OR=0.15 [0.03, 0.85]; p=0.03; I2=87%). However, PMP was associated with an increased risk of seroma (OR=1.67 [1.10, 2.55]; p= 0.02; I2=19%) and chronic wound pain (OR=1.71 [1.03, 2.83]; p= 0.04; I2= 0%). No significant difference between the PMP and PSC groups was noted for postoperative hematoma (OR= 1.04 [0.43, 2.50]; p=0.92; I2=0%), surgical site infection (OR=1.09 [0.78, 1.52]; p= 0.62; I2=12%), wound dehiscence (OR=0.69 [0.30, 1.62]; p=0.40; I2= 0%), gastrointestinal complications (OR= 1.40 [0.76, 2.58]; p=0.28; I2= 0%), length of hospital stay (WMD= -0.49 [-1.45, 0.48]; p=0.32; I2=0%), and operating time (WMD=9.18 [-7.17, 25.54]; p= 0.27; I2=80%). Conclusions PMP has been effective in reducing the rate of IH in the high-risk population at all time intervals, but it is associated with an increased risk of seroma and chronic wound pain. The benefits of mesh largely outweigh the risk, and it is linked with positive outcomes in high-risk patients.

Glioblastome Multiforme: A Bibliometric Analysis.

Bibliometric analyses are widely used to gauge the scholarly impact of any scientific publication. We conducted a bibliometric analysis of the 100 most influential articles on glioblastoma multiforme (GBM). We searched Scopus using the keywords "Glioblastoma multiforme," "GBM," Glioblastoma," and "Grade IV glioma." A list of the top 100 articles was prepared. The articles were sorted according to the number of citations. A detailed analysis was carried out to identify the characteristics of the most influential studies. The 100 most cited articles in the field were published over 38 years between 1978 and 2018, with the maximum number of articles published in the 10-year period from 2001 to 2010. The total number of citations for 100 articles was 148,594 and 4.8% were self-citations. Citations ranged from 9624 to 617, with a median of 935 (interquartile range, 906). The top cited articles originated from 22 countries, with the greatest contributions from the United States. Nature made the greatest contribution to the research on GBM, with a total of 14 articles, and Cancer Cell and New England Journal of Medicine were the second biggest contributors. Fifty-seven studies focused on the pathogenesis of GBM. There were 12 authors who had ≥5 articles in the top 100 citation list. Only 31% of the articles were funded by public and private sector organizations. Our analysis highlights the characteristics of the most influential articles on GBM and provides valuable insight into the research that has been conducted in this field.

Efficacy of Positron Emission Tomography in distinguishing brain tumours from inflammation.

Positron Emission Tomography (PET) enables noninvasive evaluation of brain tumours, most commonly gliomas and metastases. However, the application of PET in distinguishing a tumour from an inflammatory lesion is still uncertain. The principle of this imaging test is based on fundamental differences in the central metabolic pathways in neoplastic and non-neoplastic tissues. 2-deoxy-2-fluoro-D-glucose (FDG) is the most widely used PET marker, whose uptake is closely related to the expression of the glucose transporter (GLUT) in malignant tumours. A limitation of FDG-PET studies is false-positive results, e.g., due to inflammation. This problem may be overcome by the use of different radiotracers targeted at different cellular sites; these include, fluoroethyl-l-tyrosine (FET), C- methionine (c- MET), 13-N ammonia, translocator receptor protein (TSPO) and ligand-11C-PK11195. All markers show variable diagnostic potential, however, more prospective trials are required to prove the efficacy.

Infective Endocarditis Associated with Atrial Septal Defect in an Intravenous Drug Abuser: A Case Report.

Atrial septal defect (ASD) is a common congenital abnormality, which accounts for 20-40% of all the adult patients with congenital heart diseases. Due to the slow velocity of shunt flow, ASD has a negligible risk for infective endocarditis (IE). However, intravenous drug abuse (IVDA) is a potential cause for IE. IE remains a diagnostic and therapeutic challenge. Our case report demonstrates the atypical presentation of IE in an ASD patient. The diagnosis was made on the basis of modified Duke criteria, and blood cultures were found out to be positive for methicillin-resistant Staphylococcus aureus (MRSA). The treatment for IE was completed in six weeks with full recovery, and the patient underwent a surgery for ASD closure. This case highlights that IE should not be overlooked in ASD patients and that a high index of suspicion, in addition to proper antibiotic therapy, is lifesaving. Also, follow-up, along with rehabilitation measures, should be taken for patients with a history of drug abuse in order to prevent the risk of reinfection.