scholarly journals P-EGS20 Safe emergency laparoscopic cholecystectomy in the first 12 months of the Covid-19 pandemic

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Martin Michel ◽  
Helen Fifer ◽  
Emily Moran ◽  
Felix Hammett ◽  
Madara Kronberga ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Operative Time ◽  
Patient Flow ◽  
Demographic Data ◽  
Treatment Options ◽  
World Health Organisation ◽  
Time Frame ◽  
World Health ◽  
First Year ◽  
Healthcare Crisis

Abstract Background The World Health Organisation declared a global pandemic on the 11th March 2020 regarding the COVID-19 infection. This has had a dramatic impact on both acute and elective hospital services that will take a considerable time to recover from. Initial emergency intercollegiate surgical guidance released in March 2020 raised concern regarding laparoscopic surgery and advised to pursue alternative non-surgical or radiological treatment options for the safety of patients and theatre teams. The aim of this study was to assess the safety of emergency laparoscopic cholecystectomy (ELC) for patients presenting to our centre with acute gallstone pathology during the pandemic. Methods Retrospective analysis of all cholecystectomies undertaken in the department during the first year of the pandemic from 11th March 2020 to 11th March 2021. This period encapsulated two recognised peaks of the pandemic in the United Kingdom. Demographic data, elective/emergency, operative time, postop ITU admissions due to COVID and COVID related mortality was collected. Operative numbers and times were compared with historical data (HD) from the previous five years over the same time frame. Results 399 laparoscopic cholecystectomies were performed during the first year of the pandemic which was less than the previous five-year average of 570 cholecystectomies per annum (30% reduction). 247 (61.9%) were performed as an emergency on patients presenting with acute gallstone pathology compared to 35% (HD) performed acutely on average historically. Average age was 56 yrs (16-88 range). Average operative time for ELC during the pandemic was 69 minutes compared to 78 minutes HD (NS). No patients were admitted to ITU with post-operative Covid infections and there were no 30 day post-operative deaths.       Conclusions We performed more ELC’s in the first year of the pandemic compared to the previous five-year average as we were conscious of the inevitable long waiting lists, we would certainly be faced with in the coming months. The Covid-19 pandemic was a global healthcare crisis and one the NHS had never encountered before. At the time there was no high-quality evidence on the safety of laparoscopy on patients presenting acutely. This study adds to the growing body of evidence that with consistent preoperative testing, PPE and appropriate patient flow pathways that emergency laparoscopic cholecystectomies are safe to perform in the current climate.

Radiological Assessment of Giant Cell Tumour of Bone in the Sacrum: From Diagnosis to Treatment Response Evaluation

2021 ◽  
Vol 17 ◽  
Author(s):  
Kirsten Van Langevelde ◽  
Niels Van Vucht ◽  
Shinji Tsukamoto ◽  
Andreas F. Mavrogenis ◽  
Costantino Errani
Keyword(s):  
Soft Tissue ◽  
Giant Cell ◽  
Giant Cell Tumour ◽  
Imaging Modality ◽  
Treatment Options ◽  
World Health Organisation ◽  
Axial Skeleton ◽  
Cell Tumour ◽  
World Health ◽  
Response Evaluation

: Giant cell tumour of bone (GCTB) typically occurs in young adults from 20-40 years old. Although the majority of lesions are located in the epi-metaphyses of the long bones, approximately one third of tumours is located in the axial skeleton, of which only 4% in the sacrum. Sacral tumours tend to be large at the time of presentation, and they present with aggressive features such as marked cortical destruction and an associated soft tissue component. The 2020 World Health Organisation classification of Soft Tissue and Bone Tumours describes GCTB as neoplasm which is locally aggressive and rarely metastasizing. The tumour contains three different cell types: neoplastic mononuclear stromal cells, macrophages and osteoclast-like giant cells. Two tumour subtypes were defined: conventional GCTB and malignant GCTB. Only 1-4% of GCTB is malignant. In this review article, we will discuss imaging findings at the time of diagnosis to guide the musculoskeletal radiologist in reporting these tumours. In addition, imaging for response evaluation after various treatment options will be addressed, such as surgery, radiotherapy, embolization and denosumab. Specific findings will be presented per imaging modality and illustrated by cases from our tertiary sarcoma referral center. Common postoperative and post radiotherapy findings in GCTB of the sacrum on MRI will be discussed.

scholarly journals Socioeconomic influences on breastfeeding and weaning practices in a Mediterranean setting

2020 ◽  
Vol 79 (OCE2) ◽  
Author(s):  
Justine Parnis ◽  
Neville Calleja ◽  
Petra Jones
Keyword(s):  
Demographic Data ◽  
World Health Organisation ◽  
Cross Sectional Study ◽  
World Health ◽  
Complementary Foods ◽  
Cross Sectional ◽  
Professional Advice ◽  
Level Of Education ◽  
High Level ◽  
Duration Of Breastfeeding

AbstractThe World Health Organisation (2016) recommends exclusive breastfeeding up to 6 months of age and the introduction of complementary foods at around 6 months. International literature suggests that although knowledge of the guidelines is high, only a minority of parents wait until 6 months to wean and sub-optimal weaning practices are common. The aim of this study was to assess breastfeeding and weaning practices and to evaluate the effect of socio-economic determinants on such behaviours in a Mediterranean setting.A cross-sectional study design was used. One-time short interviews with 250 consenting mothers having 8 month old infants were conducted using a structured questionnaire. Mothers attending all the well baby clinics in the primary health care centres of the Maltese Islands for a period of two months were included in the study. The questionnaire included socio-economic and demographic data, details on the initiation and duration of breastfeeding, weaning practices and a short assessment of the infant's usual diet at 8 months.Mothers between 25–34 years old (26%) and mothers with a high level of education (25%) were more likely to breastfeed only during the first 8 months of life without using any other type of milk, compared to younger (6.5%) or older (21%) mothers, and to mothers with a lower level of education (16%). The level of education was also positively associated with the continuation of breastfeeding, with the mean duration of breastfeeding for higher educated mothers being 4 months compared to 2.6 months in less educated mothers. Mothers with a lower level of education and mothers who are house-wives are more likely to give their infants only ready-made foods however associations were in this case borderline significant. On the other hand, appropriateness of weaning age was not associated with any socio-economic factors.The length of breastfeeding and the introduction of complementary foods varied widely between mothers. Compliance with infant feeding guidelines was poor. The mother's age, level of education and employment status all have an impact on breastfeeding and weaning practices. The provision of professional advice and a supportive environment for mothers, together with interventions for increasing awareness may promote maternal adherence to WHO guideline.

scholarly journals O-BN09 The impact of the Covid-19 pandemic on benign upper GI surgery: The first 12 months at a single centre

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Martin Michel ◽  
Helen Fifer ◽  
Emily Moran ◽  
Felix Hammett ◽  
Clare Bonner ◽  
...  
Keyword(s):  
Waiting Times ◽  
World Health Organisation ◽  
Operative Management ◽  
Time Frame ◽  
World Health ◽  
Activity Levels ◽  
Single Centre ◽  
The Road ◽  
Upper Gi ◽  
The Impact

Abstract Background The road to recovery from the Covid-19 pandemic has started but no-one knows when it will end. 18 months on from the World Health Organisation declaring a global pandemic on the 11th March 2020 this has had a dramatic impact on both acute and elective hospital services. Whilst, quite rightly, the focus has been on prioritising cancer resections during the pandemic, many patients awaiting benign operations are facing lengthy waiting times. The aim of this study was to quantify the impact of the COVID-19 pandemic on benign upper GI surgery at a single centre compared to previous operating activity levels. Methods Retrospective analysis of computerised theatre records for the first 12 months of the pandemic (11th March 2020-11th March 2021) were compared to average historical data (HD) over the last five years (2015-2019) over the same time frame. Benign upper Gi operations included were cholecystectomy, anti-reflux/hiatus hernia repairs, cardiomyotomies and bariatric procedures. Results Conclusions The Covid-19 pandemic has dramatically affected benign upper GI surgery at our unit. Overall total operation numbers were down by 31% when compared to HD (440 vs 641). The largest deficit was in bariatrics where no bariatric surgery was performed during the first 12 months of the pandemic, which has restarted as of July 2021. There was also a 30% reduction in the number of cholecystectomies performed likely due to initial guidance recommending non-operative management at the start of the pandemic. Hiatal work numbers remained consistent. This quantitative study can direct future service delivery and help guide the post-pandemic recovery.

Infertility: Understanding investigation and treatment options

2020 ◽  
Vol 13 (7) ◽  
pp. 394-401
Author(s):  
Kirsten Lafferty ◽  
Katherine Allan ◽  
Sotirios Saravelos ◽  
Olivia Raglan
Keyword(s):  
General Population ◽  
Sexual Intercourse ◽  
Secondary Care ◽  
Maternal Age ◽  
Treatment Options ◽  
World Health Organisation ◽  
World Health ◽  
Previous Pregnancy ◽  
Obesity Epidemic ◽  
The World

The World Health Organisation has defined infertility as the inability to become pregnant after 12 months of regular unprotected vaginal sexual intercourse. Primary infertility refers to couples that have never conceived, whereas secondary infertility refers to couples that have failed to conceive despite previous pregnancy. In the general population, 80% of couples are expected to be able to conceive within a year and 90% by the end of 2 years. With the rising trend for increasing maternal age at time of first pregnancy and the obesity epidemic, the incidence of infertility is likely to increase. Couples unable to conceive will seek help and advice from their GP. Infertility is highly emotive, and patients and their partners subject to investigation and management for infertility are likely to experience anxiety. Although primarily managed in secondary care, a robust understanding of investigation and treatment options for infertility can enable GPs to educate and support patients, as well as manage expectations.

Pathogenesis, Clinical Manifestation, Diagnosis, Pathological Findings, Treatment Options, Preventive Measures and Risk Factors Of Covid-19

Coronaviruses ◽  
2020 ◽  
Vol 01 ◽  
Author(s):  
Mohammad Asif ◽  
Anshuman Patel ◽  
May Bin-Jumah ◽  
Sadaf Jamal Gilani ◽  
Iqra Rahat ◽  
...  
Keyword(s):  
Clinical Manifestation ◽  
Rna Virus ◽  
Case Reports ◽  
Treatment Options ◽  
World Health Organisation ◽  
Literature Survey ◽  
World Health ◽  
Pathological Findings ◽  
Host Cell Membrane ◽  
Clinical Phase

Background: COVID-19 an infectious disease caused by SARS-CoV-2. The disease has hit hard around the globe and is now a pandemic. As of April 01, 2020, a total of 875,560 has been registered and the figures are increasing day by day. Currently, there is no treatment or vaccine is available for curing COVID-19 and pharmaceutical companies are racing toward the common goal of achieving the cure. Methods: Scientific databases including Science direct, Pub med, Elsevier, Scopus, and Nature were explored. Data has also been accessed from case reports, newspaper reports, internet data, World Health Organisation (WHO) reports and Centre of Disease Control (CDCs) reports. US National Library of Medicine, Clinicaltrials.gov, has been accessed to get information about ongoing clinical trials. The literature survey started in the first week of February, 2020 and was completed in first week of April, 2020. Additional literature survey was done in second week of June, 2020. Results: The epicentre of COVID-19 is WuhanCity, Hubei Province, China. Coronavirus belongs to Order Nidovirale and subdivided into four groups alpha, beta , gamma and delta. Coronavirus 229E, NL63, HKU1, MERS-CoV and SARS-CoV are known to infect humans. It is an enveloped, non-segmented positive-sense RNA virus of size 30-32 kb with several structural and accessory proteins. The pathogenesis of COVID-19 involves attachment of Spike (S) protein of SARS-CoV-2 to the angiotensin-converting enzyme 2(ACE2) receptor present on the host cell membrane. Clinical manifestation of COVID-19 includes fever, cough, complicated dyspnoea, pneumonia, etc. Real-time - PCR is a sensitive test for the detection of SARS-CoV. Remdesivir, Bevacizumab, Darunavir and cobicistat, lopinavir-ritonavir, Oseltamavir, hydroxychloroquine, Sarilumab, mRNA -1273, Ad5-nCoV are some of the drugs under the clinical phase of the trial. People with Apositive blood group, comorbidities like diabetes, hypertension, chronic pulmonary obstructive disease, substance abuse disorders, immunocompromised individuals, health care workers, and older adults are at high risk of getting infected with SARS-CoV-2. Conclusion: The article give insight about the occurrence of COVID-19, classification and structure of SARS-CoV-2, pathogenesis, pathological findings, clinical manifestation, diagnosis, potential treatment options and prevention, people at risk of COVID-19.

scholarly journals Representations of dementias in the press (2001-2010)

1970 ◽  
Author(s):  
Eduardo Cintra Torres
Keyword(s):  
Public Space ◽  
Media Coverage ◽  
World Health Organisation ◽  
World Health ◽  
First Year ◽  
Negative Stereotypes ◽  
The Public ◽  
Daily Newspapers ◽  
Printed Media ◽  
The Press

In the first year of the 21st century, the World Health Organisation added itsweight toWorld Mental Health Day, with a view to stimulating interest in mentaldisorders, particularly through media coverage. This paper presents the resultsof a quantitative study on representations of types of dementia in threePortuguese daily newspapers between 2001 and 2010. The author did not wantto limit the study to the articles in the health sections and therefore looked at thewhole of the newspapers. This revealed a regular coverage of the topic in every section of the papers, especially with regard to Alzheimer’s disease, and with alarge variety of sources, protagonists and specific subjects. It also demonstratedthe existence of an inclusive attitude that is concomitant with an objective handlingof the topic. As a whole, Portuguese printed media news about dementias isfree of negative stereotypes and tends to give readers enough information andto include dementia among the themes that are both consensual in and importantto the public space.

scholarly journals The use of pharmacological protocols during the Covid-19 crisis - a déjà vu of the 2009 A/H1N1 pandemic experience

2020 ◽  
Vol 3 ◽  
Author(s):  
Wladimir Jimenez Alonso ◽  
Cynthia Schuck-Paim ◽  
Veronique Diez Vicera
Keyword(s):  
Influenza A ◽  
Treatment Options ◽  
Risk Groups ◽  
Time Frame ◽  
Conclusive Evidence ◽  
World Health ◽  
Controlled Trials ◽  
Special Importance ◽  
H1n1 Pandemic ◽  
Influenza A H1n1

Only one decade ago, the World Health Organization declared the outbreak of a novel influenza A (H1N1) virus a worldwide pandemic. Then, just as in today’s Covid-19 crisis, treatment options were the center of debate, one of which is of special importance to the current pandemic: the existence of pharmacological treatments that, although available and potentially effective, are approached with reluctance due to concerns around side effects, the development of resistance and lack of conclusive evidence of effectiveness from randomized-controlled trials. History has proven that reluctance to use antivirals during the 2009 A/H1N1 pandemic was unwise, as those countries that restricted their use to at-risk groups and to patients with advanced disease experienced higher mortality. Those same antiviral are now routinely used for seasonal influenza. We revisit this forgotten lesson as a means of weighing in on the debate over the use of new treatments with promising outcomes as observed in clinical practice, but lacking strong evidence from controlled trials, which require a time frame incompatible with that available in unfolding public health emergencies triggered by novel pathogens.

COVID-19 infection in gastrointestinal (GI) cancer patients receiving systemic anticancer treatment (SACT) during the outbreak of the pandemic: The Guy's Cancer Centre experience.

2021 ◽  
Vol 39 (3_suppl) ◽  
pp. 455-455
Author(s):  
Eirini Tsotra ◽  
Charalampos Gousis ◽  
Beth Russell ◽  
Charlotte Moss ◽  
Kieran Palmer ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Biological Treatment ◽  
Demographic Data ◽  
Stage Iv ◽  
Severe Infection ◽  
World Health Organisation ◽  
World Health ◽  
Cancer Centre ◽  
Gi Cancer ◽  
Increased Risk

455 Background: The COVID-19 pandemic has prompted difficult decisions around the use of SACT. These were based on limited early data suggesting cancer patients receiving SACT were at an increased risk of COVID-19 severe infection and death. Our study aim was to identify the COVID-19 infection and mortality rates of GI cancer patients receiving SACT. Methods: All GI patients receiving SACT at Guy’s Cancer Centre between March, and May 31, 2020 were included. Demographic data (age, ethnicity, socio-economic status (SES)) and cancer characteristics (stage, SACT type, intent and treatment-line) were collected. COVID-19 infection was confirmed by PCR and severity defined by the World Health Organisation (WHO) classification. Patients with clinical or radiological diagnosis alone were excluded. Results: Of 417 GI patients receiving SACT during the study period, 345 (82.7%) received chemotherapy (alone or combined with targeted/biological treatment), 68 (16.3%) targeted/biological treatment alone and 4 (1%) immunotherapy. 14 (3.4%) patients were diagnosed with COVID-19, 13 were on chemotherapy and 1 on targeted/biological treatment. Commonest cancers in the COVID-19 positive group were colorectal (57.1%) and hepatobiliary (21.4%), followed by oesophago-gastric (14.3%) and neuroendocrine tumours (7.1%); 57.1% had stage IV disease. 64.3% of the positive patients were male (compared to 57.3% in the COVID-19 negative population), mean age was 57.7 years (63.1 years) and 85.7% had low SES (79.7%). 8 (57.1%) patients had severe infection and there were 3 (21.4%) COVID-19 related deaths. All the patients who died from COVID-19 were male and were receiving palliative chemotherapy. Only one patient was neutropenic (grade 1) when diagnosed with COVID-19. Conclusions: The rate of COVID-19 infection in our population was relatively low (3.4 %). Of the 14 COVID-19 positive patients, 57.1% had severe infection, 21.4% died (compared to 3.7% mortality in the non-infected group) and all but one were on chemotherapy. This prospective data, from a large UK comprehensive Cancer Centre, provides some evidence that continuing SACT through the pandemic is relatively safe. The risk of COVID-19 related infection and death must be off-set against the cancer-related morbidity and mortality associated with treatment delays.

Initial Experience With a New Robotic Surgical System for Cholecystectomy

2019 ◽  
Vol 27 (2) ◽  
pp. 136-142 ◽  
Author(s):  
Ravi Aggarwal ◽  
Jasmine Winter Beatty ◽  
James Kinross ◽  
Alexander von Roon ◽  
Ara Darzi ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Operative Time ◽  
Haptic Feedback ◽  
Surgical Complication ◽  
Demographic Data ◽  
Operating Time ◽  
Surgical Techniques ◽  
Laparoscopic Group ◽  
Interquartile Range ◽  
Hospital Data

Background. Laparoscopic cholecystectomy has been the gold standard treatment for symptomatic cholelithiasis for more than 3 decades. Robotic techniques are gaining traction in surgery, and recently, the Senhance™ robotic system was introduced. The system offers advantages over other robotic systems such as improved ergonomics, haptic feedback, eye tracking, and usability of standard laparoscopic trocars and reusable instruments. The Senhance was evaluated to understand the feasibility, benefits, and drawbacks of its use in cholecystectomy. Study Design. A prospectively maintained database of the first 20 patients undergoing cholecystectomy with the Senhance was reviewed at a single hospital. Data including operative time, console time, set up time, and adverse events were collected, with clinical outcome and operative time as primary outcome measures. A cohort of 20 patients having laparoscopic cholecystectomy performed by the same surgeon was used as a comparator group. Results. The 2 groups had comparable demographic data (age, sex, and body mass index). In the Senhance group, 19 of the 20 procedures (95%) were completed robotically. The median (interquartile range) total operating, docking, and console times were 86.5 (60.5-106.5), 11.5 (9-13), and 30.8 (23.5-35) minutes, respectively. In the laparoscopic group, the median (interquartile range) operating time was 31.5 (26-41) minutes. Postoperatively, only one patient had a surgical complication, namely a wound infection treated with antibiotics. Conclusion. Our results suggest that Senhance-assisted cholecystectomy is safe, feasible, and effective, but currently has longer operative times. Further prospective and randomized trials are required to determine whether this approach can offer any other benefits over other minimally invasive surgical techniques.

scholarly journals An Intracellular Model of Hepatitis B Viral Infection: An In Silico Platform for Comparing Therapeutic Strategies

Viruses ◽  
2020 ◽  
Vol 13 (1) ◽  
pp. 11
Author(s):  
Farzad Fatehi ◽  
Richard J. Bingham ◽  
Eric C. Dykeman ◽  
Nikesh Patel ◽  
Peter G. Stockley ◽  
...  
Keyword(s):  
Hepatitis B ◽  
Treatment Options ◽  
World Health Organisation ◽  
World Health ◽  
Major Focus ◽  
Infection Dynamics ◽  
Viral Particles ◽  
B Virus ◽  
Hepatitis B Viral Infection ◽  
The Impact

Hepatitis B virus (HBV) is a major focus of antiviral research worldwide. The International Coalition to Eliminate HBV, together with the World Health Organisation (WHO), have prioritised the search for a cure, with the goal of eliminating deaths from viral hepatitis by 2030. We present here a comprehensive model of intracellular HBV infection dynamics that includes all molecular processes currently targeted by drugs and agrees well with the observed outcomes of several clinical studies. The model reveals previously unsuspected kinetic behaviour in the formation of sub-viral particles, which could lead to a better understanding of the immune responses to infection. It also enables rapid comparative assessment of the impact of different treatment options and their potential synergies as combination therapies. A comparison of available and currently developed treatment options reveals that combinations of multiple capsid assembly inhibitors perform best.

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