Surgical Outcome of Pharmaco Refractory Epilepsy in the National Epilepsy Center of Sri Lanka.

BACKGROUND: The National Epilepsy Center (NEC) in Sri Lanka was established in 2017. Seizure outcome, effects on quality of life (QOL) and surgical complications among nonpediatric patients who underwent epilepsy surgery from October 2017 to February 2023 are described. METHODS: Nineteen patients (≥14 years) underwent epilepsy surgery at the NEC. We used Engel classification and Quality of Life in Epilepsy 31 (QOLIE-31) questionnaire to assess seizure outcome and QOL respectively. Surgical complications were categorized into neurological and complications related to surgery. RESULTS: Nine female and 10 male patients underwent surgery (mean age 27.5 years (range 14-44 years). The mean follow-up duration was 10.5 months (range 6-55 months). Twelve patients underwent temporal lobe resections. At 6-months follow-up, 83.3% (10/12) had favorable seizure outcomes with Engel class I/II. At 1-year follow-up 6/8 patients (75.0%) and at 2-year follow-up, 5/7 patients (71.4%) had a favorable outcome. Seven patients had extra-temporal lobe surgeries and one defaulted. Seizure freedom was observed in 6/6 at 6 months, 3/3 at 1-year, and 2/2 at 2-year follow-up. Five patients (26.3%) experienced minor post-operative surgical site infection. Two (11.1%) had persistent quadrantanopia. Meaningful improvement in QOL (change in QOLIE-31 score ≥11.8) was observed irrespective of seizure outcome or type of surgery (P < 0.001). CONCLUSIONS: Epilepsy surgery is effective in developing countries. Seizure outcomes in our patients are comparable to those worldwide. Clinically important QOL improvement was observed in our series. This is the first published data on epilepsy surgery outcomes in nonpediatric patients from Sri Lanka.

Three-Year Survival in a Cohort of Women with Breast Cancer from an Insurance Company in Cali, 2017-2020 / SUPERVIVENCIA A TRES AÑOS EN UNA COHORTE DE MUJERES CON CÁNCER DE MAMA DE UNA ASEGURADORA EN CALI 2017-2020

INTRODUCTION: Breast cancer, in particular, is a significant concern in public health due to its high mortality rate. This research focuses on understanding the factors related to the 3-year survival of women with breast cancer in Cali, contributing to addressing this health challenge. OBJECTIVE: To determine the socio-demographic, clinical, and healthcare-related factors associated with the 3-year survival of women with breast cancer affiliated with an insurance provider in Cali from 2017 to 2020. This study aims to generate scientific evidence for decision-making within the insurance provider and the region. METHODOLOGY: A study was conducted in women with breast cancer in Cali to identify factors linked to 3-year survival. Data from a cohort of women with breast cancer affiliated with an insurance provider were analyzed, applying inclusion and exclusion criteria. Socio-demographic, clinical, and healthcare-related factors were assessed. Data were collected from secondary sources and analyzed to determine variables associated with survival. Ethical and confidentiality considerations were adhered to throughout the process. RESULTS: The most significant finding of our study, based on a three-year follow-up of 140 women with breast cancer, is the alarming mortality rate of 21.4%. We emphasize the importance of diagnosing the disease at its early stages, which can make a difference in the survival and prognosis of patients. CONCLUSION: The study highlights the high vulnerability of the cohort of women with breast cancer affiliated with the insurance provider. Although a longer survival time was observed in certain groups, the mortality rate remains significant.

INTRODUCCIÓN: El cáncer de mama, en particular, es una preocupación significativa en la salud pública debido a su alta mortalidad. Esta investigación se centra en comprender los factores relacionados con la supervivencia a 3 años de mujeres con cáncer de mama en Cali, contribuyendo a abordar este desafío de salud. OBJETIVO: determinar los factores socio demográficos, clínicos y de atención en salud asociados a la supervivencia a 3 años de mujeres con cáncer de mama afiliadas a una aseguradora en Cali 2017-2020, generando evidencia científica para la toma de decisiones tanto en la aseguradora como en la región. METODOLOGIA: Se realizó un estudio en mujeres con cáncer de mama en Cali para identificar factores vinculados a la supervivencia a 3 años. Se analizaron datos de una cohorte de mujeres con cáncer de mama afiliadas a una aseguradora, aplicando criterios de inclusión y exclusión. Se evaluaron factores sociodemográficos, clínicos y de atención en salud. Los datos se recopilaron de fuentes secundarias y se analizaron para determinar las variables relacionadas con la supervivencia. Se cumplieron consideraciones éticas y de confidencialidad en el proceso. RESULTADOS: El hallazgo más significativo de nuestro estudio, basado en un seguimiento de tres años a 140 mujeres con cáncer de mama, es la alarmante tasa de mortalidad del 21.4%. Destacamos la importancia de diagnosticar la enfermedad en sus estadios iniciales, lo que puede marcar la diferencia en la supervivencia y el pronóstico de las pacientes. CONCLUSION: Estudio destaca la alta vulnerabilidad de la cohorte de mujeres con cáncer de mama afiliadas a la EAPB. Aunque se observó un mayor tiempo de supervivencia en ciertos grupos, la tasa de mortalidad sigue siendo significativa.

Quality of Life Among Residents of General Surgery Residency Training Program in Saudi Arabia: A Nationwide Study.

Introduction The General Surgery Residency Training Program is known to be one of the most challenging programs, which greatly impacts the resident's quality of life (QoL) during their training years. Undertraining residents are usually the first providers of patients' healthcare in medical facilities. They often get exposed to continuous pressure and stress, especially during long working hours. Aim This study aims to evaluate the quality of life (QoL) of general surgery residents in Saudi Arabia and investigate the personal and workplace determinants associated with the level of quality of life. Subjects and methods This cross-sectional study was conducted among general surgery residents in Saudi Arabia. A self-administered online questionnaire was distributed among the target residents. The questionnaire includes sociodemographic characteristics (e.g., gender, region of the training center, and residency level) and Work-Related Quality of Life (WRQoL) scale to measure the residents' quality of life at work. Results Of the 239 residents, 64.9% were males, and 27.2% were resident level 1. Among WRQoL components, only home-work interface (HWI) (mean score: 9.87 out of 15 points) and general well-being (GWB) (mean score: 20.6 out of 30 points) had average ratings, while control at work (CAW), job and career satisfaction (JCS), stress at work (SAW), and working conditions (WCS) were classified as good. The overall WRQoL was deemed good (mean score: 81.3 out of 115 points). Being a female and practicing residency inside central region were the factors associated with better WRQoL. No significant differences were observed between WRQoL in terms of residency level, marital status, and previous visitation to a psychiatrist or psychologist (p>0.05). Conclusion Nearly one-third of the general surgery residents perceived their WRQoL as good. Female residents practicing in the central region demonstrated better quality of life as compared to the rest of the residents. Further research is needed to establish the level of WRQoL and its effect on general surgery residents during residency training.

Is quality of life after mastectomy comparable to that after breast conservation surgery? A 5-year follow up study from Mumbai, India.

PURPOSE: Breast cancer is the commonest cancer in women worldwide. Surgery is a central part of the treatment. Modified radical mastectomy (MRM) is often replaced by breast conserving therapy (BCT) in high-income countries. MRM is still the standard choice, in low- and middle-income countries (LMICs) as radiotherapy, a mandatory component of BCT is not widely available. It is important to understand whether quality of life (QOL) after MRM is comparable to that after BCT. This has not been studied well in LMICs. We present, 5-year follow-up of QOL scores in breast cancer patients from India. METHODS: We interviewed women undergoing breast cancer surgery preoperatively, at 6 months after surgery, and at 1 year and 5 years, postoperatively. QOL scores were evaluated using FACT B questionnaire. Average QOL scores of women undergoing BCT were compared with those undergoing MRM. Total scores, domain scores and trends of scores over time were analyzed. RESULTS: We interviewed 54 women with a mean age of 53 years (SD 9 ± years). QOL scores in all the women, dipped during the treatment period, in all subscales but improved thereafter and even surpassed the baseline in physical, emotional and breast-specific domains (p < 0.05) at 5 years. At the end of 5 years, there was no statistically significant difference between the MRM and BCT groups in any of the total or domain scores. CONCLUSION: QOL scores in Indian women did not differ significantly between MRM and BCT in the long term. Both options are acceptable in the study setting.

Spinal Dural Arteriovenous Fistulas: Clinical Results and Quality of Life Assessment with Surgical Treatment as a Crucial Therapy. The Joint Experience of Two Centers.

OBJECTIVE: Dorsal intradural arteriovenous fistulas (AVFs) consist of a direct connection between a radicular feeding artery and the coronal venous plexus; this direct connection leads to arterialization of the venous plexus, venous congestion, and myelopathy. Controversy still exists regarding the best treatment modality of spinal dural AVFs. Surgical disconnection of spinal dural AVFs is a straightforward procedure with a high success rate and virtually no risk of recurrence or incomplete treatment. To identify factors associated with the clinical progression of dorsal intradural AVFs and quantify the range of surgical outcomes in terms of neurologic improvement as well as patients' perception of quality of life (QOL). METHODS: A retrospective observational study of 19 consecutive patients treated with surgery over a 10-year period was carried out. We analyzed surgical results and clinical outcomes. We also evaluated the impact of this disease and its sequelae on the patients' postoperative health-related QOL. RESULTS: The surgical procedure showed good results in terms of neurologic improvement as well as patients' perception of QOL. CONCLUSIONS: Our series confirmed that surgical obliteration of dorsal intradural AVFs is an effective and safe procedure. The results of this retrospective analysis make us believe that surgery, given its low morbidity and high success rate, represents a safe and effective first therapeutic option for these spinal vascular malformations. It could be considered to avoid unsuccessful endovascular attempts that could delay the definitive treatment of this disease. The surgical procedure showed good results in terms of neurologic improvement as well as patients' perception of QOL.

Impact on Quality of Life in Patients who came with Androgenetic Alopecia for Hair Transplantion Surgery in a Clinic.

INTRODUCTION: Androgenetic alopecia, also known as as male pattern baldness, affects up to 50% of men and 10% females worldwide. Patients with baldness seem to have a great impact on quality of life including their self-esteem, confidence, relationship as well as work. METHODS: This is a cross-sectional descriptive study on dermatology quality of life index in patients with androgenetic alopecia who came for hair transplantation surgery at Aavaran Skin Clinic Pvt Ltd, Battisputali, Kathmandu between 15th July 2017 to 15th February 2018. Ethical clearance was taken from ERB of Nepal Health Reasearch Council Reg No 113/2017. All cases enrolled for transplant surgery during the study period and meeting the inclusive criteria were included. RESULTS: A total of 120 patients participated in the study. Age of the patients ranged from 19 to 49, mean age being 31.87±6.8. Maximum number of patients was in age group 25 to 34. Mean dermatology quality of life index score was 2.79. Maximum score was 14 & minimum score was 0. Maximum effect was seen in question number 2 of self-consciousness, which had impact on 58 (48.33%) patients at some level. Minimum impact on quality of life was seen in sexual activity where only 4 (3.33%) of patients were affected. CONCLUSIONS: Androgenetic alopecia had a small effect on quality of life of our patients, but for some it had a great psychological impact not only with their personal feelings but also with the social response towards their problems.

Tratamiento quirúrgico del síndrome de apnea hipopnea obstructiva del sueño en la Clínica Rivas, Bogotá ­ Colombia / Surgical treatment of obstructive sleep apnea hypopnea syndrome in the Rivas Clinic, Bogota ­ Colombia

Introducción: El Síndrome de Apnea Hipopnea Obstructiva del Sueño es un trastorno respiratorio del sueño mayor ampliamente conocido, con importantes implicaciones para los pacientes y cuya incidencia ha venido en aumento durante los últimos años; comprende diversas manifestaciones clínicas que varían desde el ronquido hasta consecuencias cardiovasculares importantes. Objetivo: Describir la experiencia de los procedimientos quirúrgicos más utilizados para el tratamiento de pacientes con Trastornos Respiratorios del Sueño en la Clínica Rivas. Diseño: Estudio observacional descriptivo. Métodos: Revisión de 366 historias clínicas de pacientes con diagnóstico clínico y Polisomnográfico de SAHOS intervenidos quirúrgicamente debido al Trastorno Respiratorio del Sueño por rechazo de terapia de presión positiva en 3 años de observación. Resultados: Se evaluaron diferencias en medianas de los cambios del IAH, índice de Saturación de oxigeno basal y mínima, y el índice de microdespertares nocturnos tanto prequirúrgica como postquirúrgicamente. Como medida de evaluación secundaria se evaluaron las complicaciones quirúrgicas. Conclusión: En nuestra institución, como centro de referencia en apnea del sueño, la cirugía ha demostrado que disminuye de forma significativa gravedad del SAHOS y disminuye el riesgo de los pacientes con trastornos respiratorios del sueño que han rechazado el dispositivo de presión positiva.

Introduction: Obstructive Sleep Apnea Hypopnea Syndrome is a major sleep breathing disorder widely known, with important implications for patients whose incidence has been increasing in recent years; comprises various clinical manifestations ranging from snoring to major cardiovascular consequences. Objective: To describe the experience of surgical procedures commonly used for the treatment of patients with respiratory sleep disorders in Rivas Clinic. Design: Descriptive study. Methods: A review of medical records of 366 patients with clinical and polysomnographic diagnosis of OSAHS and underwent surgically due to Sleep Respiratory Disorder for rejection of positive pressure therapy in 3 years of observation was performed. Results: Differences in median changes in Apnea Hipopnea Index, baseline saturation index and minimum oxygen, and index of nocturnal arousals both preoperative and postoperatively were evaluated. As a secondary assessment of surgical complications were evaluated. Conclusion: At our institution, as a reference center on sleep apnea, surgery has been shown to decrease significantly OSAHS severity and decreases the risk of patients with respiratory sleep disorders that have rejected positive pressure device.