Fusion, 2021

https://hsrc.himmelfarb.gwu.edu/smhs_fusion/1013/thumbnail.jp

Baystate Medical Practices Annual Report - 2018

https://scholarlycommons.libraryinfo.bhs.org/bmpannual_report/1003/thumbnail.jp

Perioperative Care

Perioperative care practices worldwide are in the midst of a seeing change with the implementation of multidisciplinary processes that improve surgical outcomes through (1) better patient education, engagement, and participation; (2) enhanced pre-operative, intra-operative, and post-operative care bundles; and (3) interactive audit programs that provide feedback to the surgical team. These improved outcomes include reductions in the frequency and severity of complications and improved throughput, which ultimately reduce operative stress. Practices in theatre as well as ward are becoming more collaborative and evidence-driven.This book is best utilized by perioperative care team members engaged in quality improvement, collaborative practice, and application of innovations in surgical care

Fusion, 2020

https://hsrc.himmelfarb.gwu.edu/smhs_fusion/1012/thumbnail.jp

The Effects of COVID-19 on Cancer Care Provision: A Systematic Review

This systematic review aims to gather primary data from cancer institutions that have implemented changes to cancer service provision amid the COVID-19 outbreak to inform future intervention and health care facility response strategies. A comprehensive literature search was done on Global Health Medline and EMBASE using pertinent key words and MeSH terms relating to COVID-19 and Cancer service provision. A total of 72 articles were selected for inclusion in this systematic review. Following the narrative synthesis that was conducted of the literature, 6 core themes that encompassed common cancer service intervention adopted by institutions were identified: (1) Testing and Tracking, (2) Outreach and Communication, (3) Protection, (4) Social Distancing (5) Treatment Management, (6) Service Restructuring. Since cancer patients are a high-risk population amid the COVID-19 pandemic, these areas of targeted intervention can be used to inform necessary actions in institutions facing similar risks, based on previous learning from numerous cancer centers globally

Unilateral ischemic central retinal vein occlusion in a young healthy adult: a case report

Central retinal vein occlusion (CRVO) is an obstruction of central retinal vein due to the impingement from the fellow central retinal artery. It is the second most common retinal vascular disease after diabetic retinopathy. Risk factor of CRVO includes diabetes mellitus, hypertension, hyperlipidemia, cardiovascular disease, male gender and age above 50 years; with 90% of the cases occurred in individual aged 55 years and above. We report a rare case of left eye ischemic CRVO in a 24-year-old healthy gentleman who later on found out to have hypercholesterolemia. He presented with a sudden onset of reduced vision of his left eye. Examination revealed visual acuity (VA) of the left eye was 6/120. Fundus examination showed marked papilloedema with dilated and tortuous blood vessels and extensive flame-shaped hemorrhages with cotton wool spots in all four retinal quadrants. There was a presence of macular edema as well. The ancillary tests confirmed the diagnosis of left eye ischemic CRVO with significant macular edema. The blood investigation revealed elevated cholesterol levels. For treatment, 6 times of monthly intravitreal Ranibizumab injections were planned for the macular edema and oral Atorvastatin 40 milligrams daily was started. Following the intravitreal Ranibizumab injection, his VA has significantly improved with a reduction of macular edema. This report highlights the importance of prompt diagnosis and investigation of CRVO, especially in the younger age group. Early treatment of macular edema secondary to CRVO is able to reduce the edema thus leads to VA improvement

A disastrous complication of colonephrocutaneous fistula: brain abscess

A rare case of colonephrocutaneous fistula complicated with a brain abscess is a lifethreatening clinical condition. We report a case of a 35-year-old lady with a history of partial left nephrectomy complicated with left colonic injury who presented with persistent vomiting associated with headache and blurry vision for 5 days. Clinically, she was confused and restless with Glasgow Coma Scale (GCS) of 12/15, however her pupils were equal and reactive bilaterally. Other neurological examinations were unremarkable. Abdominal examination noted functioning ileostomy with a skin opening at left lumbar with pus discharge. Diagnosis of brain abscess was made after contrasted computed tomography (CT) scan of brain. Urgent open drainage surgery was done followed by long course of antibiotic. Contrasted CT abdomen and fistulogram revealed a left colo-psoas and left nephrocutaneous fistula, hence, she was subjected for surgery. Intraoperatively, there was a fistula tract connecting the descending colon, remaining of left kidney, and the skin. Thus, left hemicolectomy, completion of left nephrectomy, and fistulectomy was done. The long-standing infective foci can lead to septic emboli and causes formation of abscess at distant site. Its management is challenging involving both medical and surgical therapy

An experimental model of induction of osteoarthritis in New Zealand white rabbit

Introduction: Historically, animal models for osteoarthritis have been established to facilitate the study of the pathogenesis of osteoarthritis and the potential medical treatment. The anterior cruciate ligament transection (ACTL) and partial meniscal resection model in rabbits have been widely used. The aim of the study was to establish a more effective surgical approach to induce knee osteoarthritis in New Zealand White Rabbits. Materials and Methods: This descriptive study was approved by the Institutional Animal Care and Use Committee (I-ACUC) ethical committee. The surgical approach of induction of osteoarthritis was done in Advanced Orthopedics Research Laboratory, International Islamic University Malaysia. Eight rabbits underwent lateral and medial meniscectomies at bilateral foreleg knees to induce osteoarthritis. The models were examined through physical and radiographic analysis. Results: Physical exams showed that all model animal daily food and water intakes were normal. Animal model knee motion in passive range showed limitation and instability. Radiographic imaging analysis showed osteoarthritic changes in all models. Moreover, no mortality was recorded during the study. The approach requires less surgery time and easier access. The analgesia was more humane and showed faster recovery. Conclusion: These outcomes suggested an effective and feasible technique of inducing knee osteoarthritis in New Zealand White rabbit models

Chronic exposure of low-dose organic arsenic induced oxidative stress injury on the rats kidney

Introduction: Monosodium methylarsonate (MSMA) is an organic arsenical herbicide widely used in agriculture. Humans are exposed to arsenic through contaminated drinking water and anthropogenic activities. Exposure to acute and high dose of inorganic arsenic induced oxidative stress injury in the tissue. However, studies focusing on effects of chronic low dose organic arsenic exposure on oxidative genes of kidneys are limited. Therefore, the objective of this study is to determine the effects of chronic low dose organic arsenic exposure on rats’ kidneys oxidative genes at 6-month duration. Materials and Methods: Twelve male Sprague-Dawley rats, aged 2-3 months old, with average weight of 200 to 250g divided into two groups (n=6); control and treatment respectively. The control group was given daily oral gavage of distilled water and the treatment group was given daily oral gavage of MSMA at 63mg/kg body weight for 6-months duration. Kidneys were harvested for histology and gene expression analysis. Results: Histologically, on H&E & PAS staining, the control group showed normal appearance of the glomerular and tubular structures. The treatment groups showed microscopic changes of the glomerular and tubular structures such as glomerular atrophy with widening of Bowman’s space, dilated tubular lumen, loss of brush border and presence of tubular cast. Gene’s analysis showed upregulation of Glutathione reductase (GSR) and downregulation of Catalase and nitrite oxide synthase 1 (NOS1). Conclusion: Chronic exposure to low dose organic arsenic induced kidney injury through oxidative stress mechanism