Acute pancreatitis: a study of urine trypsinogen-2 measurement as a screening test

Background: Usefulness of urine trypsinogen-2 as screening test for acute pancreatitis in Indian population.Methods:We prospectively compared the urinary trypsinogen-2 dipstick test and serum amylase assays in 100 consecutive patients with acute abdominal pain at the emergency department. Urine samples were obtained on admission and tested for the dipstick. The diagnosis of acute pancreatitis was made on the basis of a typical clinical picture and serum amylase at least more than threefold the upper reference limit (300 IU) and/or radiological evidence (Abdominal X ray/ultrasonography/contrast enhanced CT).Results: 1. Urine trypsinogen-2 dipstick test was having 100% sensitivity and 85.71% specificity in diagnosing acute pancreatitis in Indian population. 2. Serum amylase was having 61.36% sensitivity and 78.57% specificity in diagnosing acute pancreatitis. 3. Sensitivity and specificity of urine trypsinogen-2 dipstick test is more than that of serum amylase in diagnosing acute pancreatitis which is statistically proved to be significant (P <0.05).Conclusion:Detection of trypsinogen-2 in urine is a simple office test in diagnosing acute pancreatitis in emergency department. As the sensitivity and specificity are high, detection of urine trypsinogen-2 in urine can be used as a screening test, which will definitely help in early diagnosis and prompt treatment of acute pancreatitis.

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10&nbsp;years; 78.2% included were male with a median age of 37&nbsp;years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Acute pancreatitis: a study of urine trypsinogen-2 measurement as a screening test

Background: Usefulness of urine trypsinogen-2 as screening test for acute pancreatitis in Indian population. Methods: We prospectively compared the urinary trypsinogen-2 dipstick test and serum amylase assays in 100 consecutive patients with acute abdominal pain at the emergency department. Urine samples were obtained on admission and tested for the dipstick. The diagnosis of acute pancreatitis was made on the basis of a typical clinical picture and serum amylase at least more than threefold the upper reference limit (300 IU) and/or radiological evidence (Abdominal X ray/ultrasonography/contrast enhanced CT). Results: 1. Urine trypsinogen-2 dipstick test was having 100% sensitivity and 85.71% specificity in diagnosing acute pancreatitis in Indian population. 2. Serum amylase was having 61.36% sensitivity and 78.57% specificity in diagnosing acute pancreatitis. 3. Sensitivity and specificity of urine trypsinogen-2 dipstick test is more than that of serum amylase in diagnosing acute pancreatitis which is statistically proved to be significant (P <0.05). Conclusion: Detection of trypsinogen-2 in urine is a simple office test in diagnosing acute pancreatitis in emergency department. As the sensitivity and specificity are high, detection of urine trypsinogen-2 in urine can be used as a screening test, which will definitely help in early diagnosis and prompt treatment of acute pancreatitis. [Int J Res Med Sci 2014; 2(3.000): 897-902

Review of Intersphincteric Resections for Rectal Cancer Treatment

Colorectal cancer is the third most common cancer, second most common cancer in women, and the fourth leading cause of death in the world. Radical surgical treatment with Total Mesorectal Excision (TME) is considered the best treatment for cancer found in the lower third of the rectum and has benefits of complete tumor removal to reduce risk of recurrence and to improve survival. Advances in preoperative chemoradiation therapy have increased chances of achieving a 1 cm distal margin and allowed successful sphincter-preserving surgery by intersphincteric resection (ISR) and Coloanal Anastomosis (CAA) that allows normal defecation. MRI is particularly useful in evaluating localization of the tumor, involvement of anal sphincter (internal and external sphincters), levator ani muscles, and adjacent structures to the anus, with an accuracy of 85%, sensitivity of 87%, and specificity of 75%. Performing ISR with TME oncologic principles achieves similar results to Low Anterior Resection (LAR), but depends on the presence of sufficient Distal Rectal Margin (DRM); if a sufficient DRM cannot be achieved, then patients are offered an Abdominoperineal Resection (APR) with permanent colostomy and poor quality-of-life results.</jats:p