Predicting surgical outcome of pediatric percutaneous nephrolithotomy

Purpose: The aim was to evaluate the outcome of pediatric percutaneous nephrolithotomy (PCNL) guided by Guy’s stone score grading system.Patients and methods: This was a prospective study of children with renal calculi more than 2 cm. They were younger than 18 years and were a candidate for PCNL at our University Hospitals from January 2013 until July 2016. All of them had a low-dose noncontrast enhanced computed tomography. The procedure was performed under general anesthesia with the patients in the prone position guided by fluoroscopy. The stone-free rate and the presence and type of complications were estimated. The demographic and clinical data, stone characteristics, radiologic anatomy as well the PCNL approach and methods of lithotripsy used were evaluated. Comparison was performed through using univariate and multivariate analyses, and factors predicting the PCNL outcome were determined.Results: A total of 110 children with kidney stones were accepted for PCNL. Overall, 95 (86.3%) of 110 children were stone free after one-stage PCNL. Grade 1 Guy’s stone score was 97.5% (40/41) (P<0.05). Mean hospital stay was 4.01 ± 2.0 days. Operative complications include bleeding in 12 (10.9%), extravasation in seven (6.4%), injury to the colon in one (0.9%), and renal pelvis perforation three (2.7%). In our study, larger Amplatz sheath, stone burden, and longer operative time are related to complications.Conclusion: Guy’s stone score correlated with both success and complications and can be used for decision making preoperatively in pediatric PCNL.Keywords: Guy’s stone score, minimally invasive, percutaneous nephrolithotomy, pediatric, urolithiasi

Relationships between the Parity and Pelvimetry of Egyptian Buffalo Cows: Prediction of Dystocia and Estimation of Age

Background: The current study aimed to determine the most strongly correlated variable of pelvimetry with the parity in our native breed Egyptian buffaloes. Methods: The study was conducted on 36 female buffaloes (nullipara, n=14, primipara n=6 and pluripara, n=16 with 2-4 births) aged between <15 months, n=15 and 65 months, n=21. The internal and external pelvic measurements were obtained using the rice pelvimeter and Freeman’s measuring tape. Results: Strong positive linear relationships were found for the distance between ischiatic tuberosities and the distance between sacral tubercles with the correlation coefficients of 0.64 and 0.62, respectively. The conjugate diameter increased progressively with the age and number of births, with a correlation coefficient of 0.96. The pelvic area had a very strong positive linear relationship with a correlation coefficient of 0.89. The linear combination of the predictor variable (conjugate diameter), to predict the number of birth was developed successfully. Conclusion: The strong relationship between the conjugate diameter and the number of births could be employed to predict the dystocia and estimate the age of female buffalo. Furthermore, these findings could be aid paleontologists in studying buffalo fossils

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 years; 78.2% included were male with a median age of 37 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

Global, regional, and national progress towards Sustainable Development Goal 3.2 for neonatal and child health: all-cause and cause-specific mortality findings from the Global Burden of Disease Study 2019

Background Sustainable Development Goal 3.2 has targeted elimination of preventable child mortality, reduction of neonatal death to less than 12 per 1000 livebirths, and reduction of death of children younger than 5 years to less than 25 per 1000 livebirths, for each country by 2030. To understand current rates, recent trends, and potential trajectories of child mortality for the next decade, we present the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 findings for all-cause mortality and cause-specific mortality in children younger than 5 years of age, with multiple scenarios for child mortality in 2030 that include the consideration of potential effects of COVID-19, and a novel framework for quantifying optimal child survival. Methods We completed all-cause mortality and cause-specific mortality analyses from 204 countries and territories for detailed age groups separately, with aggregated mortality probabilities per 1000 livebirths computed for neonatal mortality rate (NMR) and under-5 mortality rate (USMR). Scenarios for 2030 represent different potential trajectories, notably including potential effects of the COVID-19 pandemic and the potential impact of improvements preferentially targeting neonatal survival. Optimal child survival metrics were developed by age, sex, and cause of death across all GBD location-years. The first metric is a global optimum and is based on the lowest observed mortality, and the second is a survival potential frontier that is based on stochastic frontier analysis of observed mortality and Healthcare Access and Quality Index. Findings Global U5MR decreased from 71.2 deaths per 1000 livebirths (95% uncertainty interval WI] 68.3-74-0) in 2000 to 37.1 (33.2-41.7) in 2019 while global NMR correspondingly declined more slowly from 28.0 deaths per 1000 live births (26.8-29-5) in 2000 to 17.9 (16.3-19-8) in 2019. In 2019,136 (67%) of 204 countries had a USMR at or below the SDG 3.2 threshold and 133 (65%) had an NMR at or below the SDG 3.2 threshold, and the reference scenario suggests that by 2030,154 (75%) of all countries could meet the U5MR targets, and 139 (68%) could meet the NMR targets. Deaths of children younger than 5 years totalled 9.65 million (95% UI 9.05-10.30) in 2000 and 5.05 million (4.27-6.02) in 2019, with the neonatal fraction of these deaths increasing from 39% (3.76 million 95% UI 3.53-4.021) in 2000 to 48% (2.42 million; 2.06-2.86) in 2019. NMR and U5MR were generally higher in males than in females, although there was no statistically significant difference at the global level. Neonatal disorders remained the leading cause of death in children younger than 5 years in 2019, followed by lower respiratory infections, diarrhoeal diseases, congenital birth defects, and malaria. The global optimum analysis suggests NMR could be reduced to as low as 0.80 (95% UI 0.71-0.86) deaths per 1000 livebirths and U5MR to 1.44 (95% UI 1-27-1.58) deaths per 1000 livebirths, and in 2019, there were as many as 1.87 million (95% UI 1-35-2.58; 37% 95% UI 32-43]) of 5.05 million more deaths of children younger than 5 years than the survival potential frontier. Interpretation Global child mortality declined by almost half between 2000 and 2019, but progress remains slower in neonates and 65 (32%) of 204 countries, mostly in sub-Saharan Africa and south Asia, are not on track to meet either SDG 3.2 target by 2030. Focused improvements in perinatal and newborn care, continued and expanded delivery of essential interventions such as vaccination and infection prevention, an enhanced focus on equity, continued focus on poverty reduction and education, and investment in strengthening health systems across the development spectrum have the potential to substantially improve USMR. Given the widespread effects of COVID-19, considerable effort will be required to maintain and accelerate progress. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Upper Thermal Tolerances of Two Native and One Invasive Crayfish in Missouri, USA

The spread of invasive crayfish requires invaded habitats to be thermally suitable, and differences in thermal tolerances among species could provide thermal refugia for native crayfish affected by the invader. We estimated upper thermal tolerances for the invasive Faxonius hylas and native F. peruncus and F. quadruncus in Missouri, USA, using critical thermal maxima (CTmax) methodology to determine if there were ecologically exploitable differences in estimates among species and if areas within their distributional ranges exceed their thermal maximums. Estimates of CTmax did not differ among species or sexes but differed among groups acclimated to different temperatures. Additionally, crayfish size had a small, yet significant effect on CTmax estimates with smaller crayfish having lower CTmax estimates than larger crayfish. The similarity among CTmax estimates indicates that for at least upper thermal tolerance, areas thermally available to the native species will also be thermally suitable for the invader. We did not observe water temperatures in the field that exceeded CTmax estimates for any species. However, areas within the mainstem St. Francis River did have warming tolerance estimates of less than 5°C, indicating that establishment of the invader in the mainstem could be limited by water temperature

Thermal Tolerance of the Piedmont Blue Burrower Cambarus harti and Sympatric Native and Invasive Crayfish Species of the Southeastern United States

The southeast United States is the epicenter of global crayfish biodiversity, but these species are among some of the most threatened in the world. Life history and biological trait data deficiencies, particularly of burrowing crayfish species, hampers efforts for accurately assessing imperilment rates and informing conservation efforts. Rising temperatures are a threat to aquatic ectotherms and it is important to evaluate crayfish tolerances to determine if they are at or near their upper thermal limits. We conducted dynamic temperature ramps to evaluate the temperatures at which ecological death (critical thermal maximum; CTM) and physiological death (upper thermal limit; UTL) occurred for the imperiled and narrowly endemic primary burrower Cambarus harti and three common, sympatric species C. latimanus, C. striatus, and Procambarus clarkii. All species differed in CTM with C. latimanus being the most sensitive (35.0°C), C. striatus (37.0°C) and C. harti (37.8°C) having intermediate tolerance, and P. clarkii being the most tolerant (39.0°C). The UTL of all species ranged from 39.4 – 39.8°C. We found no evidence that C. harti, a rare primary burrower, will require more restrictive acute thermal guidelines for protection compared to more common sympatric secondary burrowers