Abdominal hernia mesh repair in patients with inflammatory bowel disease: A systematic review

Postoperative hernia-repair complications are frequent in patients with inflammatory bowel disease (IBD). This fact challenges surgeons’ decision about hernia mesh management in these patients. Therefore, we systematically reviewed the hernia mesh repair in IBD patients with emphasis on risk factors for postoperative complications.</p

Hepatic Abscess 6 years after ERCP

Backround : ERCP combined with the insertion of biliary endoprosthesis is considered a daily practice endoscopic intervention for the treatment of choledocholithiasis. Nevertheless, retained biliary stents for a prolonged period without follow up may cause serious complications. Case presentation : We present the case of a 62-year-old man who was hospitalized with symptoms of vomiting, abdominal pain, fatigue and fever. Clinical examination and laboratory results were indicative of an intra abdominal infection. Ultrasound and CT scans were performed, identifying a 17x11.3x7.7 cm. The cause of this lesion was a retained stent in the common bile duct which was placed 6 years ago via endoscopic retrograde cholangiopancreatography. The patient did not attend his follow up appointments after his initial ERCP. Patient’s clinical status deteriorated, and an urgent ERCP was performed replacing the retained stent, followed by ultrasound-guided pigtail stent insertion into the hepatic abscess and administration of antibiotics intravenously. Patient’s clinical condition was improved and after two months of surveillance complete resolution of the hepatic abscess was achieved. Conclusion : The insertion of biliary stents is common endoscopic technique, but close follow up is of outmost importance

Post-operative antibiotics for cutaneous abscess after incision and drainage: Variations in clinical practice

Background. Acute cutaneous abscess is a common surgical condition that mostly requires incision and drainage. Despite this, there is no standardized national or international guidance on post-operative antibiotics prescription. Traditionally, antibiotics are not indicated unless complications and/or risk factors such as immunocompromisation, diabetes or cellulitis exist. We aimed to study the local practice for post-operative antibiotics prescription for cutaneous abscesses in a UK university teaching hospital.Methods. Retrospective data collection for emergency general surgical admissions for a period of 6 months was carried out. All patients with cutaneous abscesses were included in this analysis. Scrotal, breast and limb abscesses were excluded. Patients’ demographics, co-morbidities and complications, including local (cellulitis, necrosis) and systemic (e.g sepsis), were studied. Approval for access to patient data was granted by the local clinical governance department prior to the commencement of this study. Computations were performed using IBM SPSS version 26. Chi square (X2), Pearson correlation (r), one or two samples t-test (one or two tailed) were applied.Results. A total of 148 patients were included. The mean age was 40 years (55 % males). The most common site of abscess was perianal (27.7 %), followed by pilonidal (20.3 %) and axilla (16.9 %). A total of 107 (73 %) were managed surgically with incision and drainage, and of these 92 (86 %) were managed within 24 h. Altogether, 83 (76 %) were prescribed post-operative antibiotics, while only 25 (23 %) had indications. The most used post-operative empirical antibiotics was co-amoxiclav (59 %). There was a significant relationship between ‘abscess site’ × ‘antibiotics’ [X2 (36)=54.8, P=0.023]. A total of 103 patients’ average duration of post-operative antibiotics was 7.2 (sd 2.9) days. Ten patients subject to readmission spent an average of 8.4 (sd 3.8) days on antibiotics.Conclusions. There were variations in clinical practice regarding post-operative antibiotic prescription for cutaneous abscesses. Research is required in the future in cooperation with microbiologists to develop a standardized evidence-based treatment protocol for the management of such a common surgical condition.</p

Activation pathways of cellular proliferation in breast carcinomas: relation with the clinicopathological stage of the disease

Data from laboratory and clinical studies have shown the presence of intracellular pathways such as Ras / Raf-1 / ERK1 / 2, in breast cancer. However, the interactions between these intracellular pathways and specific cellular receptors as well as the relation of these pathways with molecules associated with tumor cell proliferation are not fully understood.The main purpose of this study was to clarify the correlations that exist between cellular receptor molecules, intracellular signaling pathways and their target molecules like pElk-1 and others such as Cyclin D1 and Ki-67 that play an important role in the transition of cells from the G1 to the S phase. Further objective of this study was to investigate the relationship between these molecules with breast tumors’ pathological characteristics, their proliferative activity, their ability to metastasize and finally with patients'survival.One hundred and seventy (n = 170) of female operable breast cancer cases were studied for the expression of the ERa, ERb, PR, Her-2, receptor and the expression of intracellular molecules ERK1 / 2, pElk-1, CyclinD1 and Ki6 using immunohistochemistry 7.This study was the first to demonstrate increased expression of the phosphorylated form of the protein Elk-1 (pElk-1) in tissue samples from human breast cancer using immunohistochemistry. We fουnd a statistically significanτ relationship between the expression of estrogen receptors ERa with pElk-1 and Cyclin D1 and between pElk-1 and Cyclin D1, as well. There was also a statistically significant correlation between the expression of ERK1 / 2 and pELk-1, but we did not find any other relationship between ERK1 / 2 and the other molecules. We have also found a positive correlation between the expression of ER and PR and a negative relation of their expression with HER-2. The mean overall survival was increased among patients with positive tumors for p Elk-1 and ERK1/2 although not statistically significant.The expression of pElk-1 and Cyclin D1 in Basal cell carcinomas was reduced. We have noticed an increase of the expression of Cyclin D1 in Luminal B HER-2 negative breast carcinomas. Although not statistically significant, there was increased expression of pElk-1 in Luminal A and Luminal B HER-2 negative breast carcinomas. The median value for the pElk-1 was significantly higher compared to its expression in Basal and HER-2 tumors. It is also important to stress that H-score for pElk-1 was higher in Luminal A and Luminal B / Her-2 negative tumors compared to the Luminal B / Her-2 positive, HER-2 and Basal cell carcinomas.Our findings offer a new perspective for the role of ERK1/2 and pElk-1 in breast neoplasia suggesting a direct relation for pElk-1 molecule to tumor biology and a putative target of personalized breast cancer therapies, although its prognostic/discriminant role is not supported.Further studies of ER, PR, HER-2 expression in relation to the Raf-1 / MEK-1 / ERK1 / 2 pathway as well as to the p Elk-1, CyclinD1 and Ki-67 expression in combination with other intracellular signalling pathways and cellular receptors will provide more information regarding cellular proliferation and survival. Finally, further studies with larger number of patients and longer follow-up periods will provide more accurate information for the role of the above molecules as potential prognostic markers.Aπό πειραματικά και κλινικά δεδομένα, είναι γνωστή η ύπαρξη ενδοκυττάριων οδών αγωγής σήματος, όπως της Ras/Raf-1/ERK1/2, στα καρκινώματα του μαστού.Ωστόσο, ολοκληρωμένη συσχέτιση των οδών αυτών με την ύπαρξη συγκεκριμένων κυτταρικών υποδοχέων και κυρίως η ενδοκυττάρια δράση τους σε μόρια-στόχους σχετιζόμενων με τον πολλαπλασιασμό των νεοπλασματικών κυττάρων δεν είναι πλήρως κατανοητή. Η περαιτέρω διερεύνηση της συσχέτισης της έκφρασης μορίων-υποδοχέων, των οδών ενδοκυττάριας αγωγής του σήματος, μορίων-στόχων των παραπάνω οδών όπως η pElk-1, αλλά και πρωτεϊνών που τελικά ενεργοποιούνται και παίζουν σημαντικό ρόλο στη μετάβαση του κυττάρου από την G1 στην S φάση του κυτταρικού πολλαπλασιασμού όπως η Cyclin D1 και ο Κi-67 αποτελεί, τον κύριο σκοπό αυτής της μελέτης. Επιπλέον στόχος είναι η συσχέτιση της έκφρασης των εν λόγω μορίων με παθολογοανατομικά χαρακτηριστικά των καρκινωμάτων του μαστού, αλλά και την ικανότητα πολλαπλασιασμού, τη μεταστατική ικανότητα του νεοπλάσματος και εν τέλει με την επιβίωση των ασθενών. Στην παρούσα μελέτη εξετάστηκαν 170 ιστολογικά επιβεβαιωμένα περιστατικά καρκινώματος μαστού γυναικών, που μελετήθηκαν με τη χρήση ανοσοϊστοχημείας για την έκφραση των υποδοχέων ERa, ERb, PR, Her-2, και την έκφραση των ενδοκυττάριων μορίων ERK1/2, pElk-1, CyclinD1 και Ki67.Η παρούσα μελέτη είναι η πρώτη στην οποία καταδείχθηκε, ανοσοϊστοχημικά, η αυξημένη έκφραση της φωσφορυλιωμένης μορφής της πρωτεΐνης Elk-1 (pElk-1) σε δείγματα από καρκινώματα του μαστού του ανθρώπου. Διαπιστώθηκε ακόμα άμεση συσχέτιση μεταξύ της έκφρασης των οιστρογονικών υποδοχέων ERa και της pElk-1, των οιστρογονικών υποδοχέων ERa και της Cyclin D1, αλλά και των δύο αυτών μορίων μεταξύ τους. Παράλληλα, θετική συσχέτιση παρατηρείται και ανάμεσα στην έκφραση της ERK1/2 και της pELk-1, χωρίς όμως να επιβεβαιώνεται άλλη συσχέτιση της ERK1/2 με κάποιο από τα υπόλοιπα μόρια. Διαπιστώθηκε ακόμα, θετική συσχέτιση μεταξύ της έκφρασης των ER και PR αλλά και αντίστροφη σχέση μεταξύ της έκφρασης των δύο αυτών μορίων και του HER-2. Αν και στατιστικά μη σημαντική, η μέση τιμή της συνολικής επιβίωσης ήταν μεγαλύτερη σε ασθενείς με καρκινώματα θετικά για την p Elk-1 και την ERK 1/2. Διαπιστώθηκε ακόμα μειωμένη έκφραση των pElk-1 και Cyclin D1 στα βασικού τύπου/Basal καρκινώματα, αλλά και αυξημένη έκφραση της Cyclin D1 στα Luminal B HER-2 negative καρκινώματα του μαστού. Αν και δε διαπιστώθηκε στατιστικά σημαντική συσχέτιση της έκφρασης του pElk-1 με κάποιον από τους Luminal A και Luminal B HER-2 negative μοριακούς τύπους, η διάμεσος τιμή για την pElk-1 στα καρκινώματα αυτά, ήταν σαφώς υψηλότερη σε σχέση με αυτή στα βασικού τύπου/Basal και τα HER-2 καρκινώματα. Αξίζει, επίσης, να σημειωθεί ότι, υπολογίζοντας το H-score για την pElk-1, γίνεται εμφανές ότι τα Luminal A και Luminal Β/Her-2 αρνητικά καρκινώματα, παρουσιάζουν μεγαλύτερη θετικότητα σε σχέση με τα Luminal Β/Her-2 θετικά, HER-2 και τα βασικού τύπου/Basal καρκινώματα.Τα ευρήματά μας είναι υπέρ του ότι η έκφραση των ERK1/2 και pElk-1 στα καρκινώματα του μαστού δεν μπορεί, προς το παρόν τουλάχιστον, να χρησιμοποιηθεί ως αυτόνομος προγνωστικός δείκτης έκβασης της νόσου. Αν και η Cyclin D1 παρουσιάζει αυξημένη έκφραση στα νεοπλασματικά κύτταρα του μαστού, η έκφρασή της δεν βρέθηκε να έχει στατιστικά σημαντική συσχέτιση με δυσμενέστερη πρόγνωση ή με δυσμενή ιστολογικά χαρακτηριστικά των καρκινωμάτων του μαστού. Μελέτη των υποδοχέων ER, PR, HER-2 της οδού των Raf-1/MEK-1/ERK1/2 αλλά και των p Elk-1, CyclinD1 και Ki-67 σε συνδυασμό με άλλες ενδοκυττάριες οδούς αγωγής σήματος και κυτταρικούς υποδοχείς θα δώσει περισσότερες πληροφορίες για τον κυτταρικό πολλαπλασιασμό και την κυτταρική επιβίωση.Τέλος, περαιτέρω μελέτη των μορίων αυτών σε μεγαλύτερο αριθμό περιστατικών, με μεγαλύτερο χρόνο παρακολούθησης, θα δώσει ακριβέστερες πληροφορίες για τη χρησιμότητά τους ως πιθανών προγνωστικών δεικτών ή ως πιθανών στόχων εξατομικευμένων θεραπευτικών χειρισμών

Importance of Leadership Style towards Quality of Care Measures in Healthcare Settings: A Systematic Review

Effective leadership of healthcare professionals is critical for strengthening quality and integration of care. This study aimed to assess whether there exist an association between different leadership styles and healthcare quality measures. The search was performed in the Medline (National Library of Medicine, PubMed interface) and EMBASE databases for the time period 2004–2015. The research question that guided this review was posed as: “Is there any relationship between leadership style in healthcare settings and quality of care?” Eighteen articles were found relevant to our research question. Leadership styles were found to be strongly correlated with quality care and associated measures. Leadership was considered a core element for a well-coordinated and integrated provision of care, both from the patients and healthcare professionals

Educational strategies for teaching evidence-based practice to undergraduate health students: systematic review

Purpose The aim of this systematic review was to find best teaching strategies for teaching evidence-based practice (EBP) to undergraduate health students that have been adopted over the last years in healthcare institutions worldwide. Methods The authors carried out a systematic, comprehensive bibliographic search using Medline database for the years 2005 to March 2015 (updated in March 2016). Search terms used were chosen from the USNLM Institutes of Health list of MeSH (Medical Subject Headings) and free text key terms were used as well. Selected articles were measured based on the inclusion criteria of this study and initially compared in terms of titles or abstracts. Finally, articles relevant to the subject of this review were retrieved in full text. Critical appraisal was done to determine the effects of strategy of teaching evidence-based medicine (EBM). Results Twenty articles were included in the review. The majority of the studies sampled medical students (n=13) and only few conducted among nursing (n=2), pharmacy (n=2), physiotherapy/therapy (n=1), dentistry (n=1), or mixed disciplines (n=1) students. Studies evaluated a variety of educational interventions of varying duration, frequency and format (lectures, tutorials, workshops, conferences, journal clubs, and online sessions), or combination of these to teach EBP. We categorized interventions into single interventions covering a workshop, conference, lecture, journal club, or e-learning and multifaceted interventions where a combination of strategies had been assessed. Seven studies reported an overall increase to all EBP domains indicating a higher EBP competence and two studies focused on the searching databases skill. Conclusion Followings were deduced from above analysis: multifaceted approach may be best suited when teaching EBM to health students; the use of technology to promote EBP through mobile devices, simulation, and the web is on the rise; and the duration of the interventions varying form some hours to even months was not related to the students’ EBP competence