Periumbilical ultrasonic-guided saline infusion technique (PUGSI): A step for safer laparoscopy in high risk patients for adhesions

Objective: To validate the technique of PUGSI in high risk patients for adhesions during laparoscopy. Design: Prospective study on PUGSI to predict obliterated subumbilical adhesions. Setting: El-Shatby Maternity Hospital, Alexandria University. Patients: Sixty women with risk factors for intraabdominal adhesions. Interventions: Preoperative examination with PUGSI. Results: The prevalence of obliterated subumbilical adhesions was 26.7%. Abnormal PUGSI was detected among 18 patients, of these, 15 patients were diagnosed at the time of laparoscopy to have obliterated subumbilical adhesions (9 patients with omental and 6 patients with bowel adhesions). PUGSI had a diagnostic accuracy of 93.3%, a sensitivity of 93.8%, a specificity of 93.2%, a positive predictive value (PPV) of 83.3% and a negative predictive value (NPV) of 97.6%. Conclusion: PUGSI can accurately predict obliterated subumbilical adhesions prior to laparoscopy in patients at high risk of visceral injury. Widespread application of this technique may decrease trocar-related injuries during laparoscopic access

Prediction of endometriosis by transvaginal ultrasound in reproductive-age women with normal ovarian size

Objective: To predict endometriosis by transvaginal ultrasound (TVS) in reproductive-age women with normal ovarian size. Design: Prospective study. Setting: El-Shatby Maternity Hospital, Alexandria University. Patients: 125 Women with symptoms suggestive of endometriosis and with normal ovarian size during TVS. Interventions: Patients were subjected to high frequency ultrasound and evaluated for the presence of ultrasound signs of endometriosis (TVS-based soft markers). All patients had laparoscopy (gold standard) immediately after TVS for documentation of the presence of endometriosis. Main outcome measures: Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy of TVS and of the TVS-based soft markers in diagnosing endometriosis. Results: Endometriosis was confirmed laparoscopicaly in 68/125 patients (54.4%). The sensitivity, specificity, PPV, NPV and diagnostic accuracy of TVS in diagnosing endometriosis were 85.3%, 80.7%, 84.1%, 82.1% and 83.2%, respectively. Six TVS-based soft markers showed significant association (P < 0.05) with endometriosis (ovaries not at the same level, high left ovary, ovarian fixation to uterus, tender ultrasound, ovarian fixation to iliac vessels and non visualization of left ovary) with sensitivities of 85.3%, 80.9%, 80.9%, 66.2%, 55.9% and 55.9%, respectively. These markers could be considered as positive soft markers to predict endometriosis. The addition of these soft markers could improve the sensitivity, specificity, PPV, NPV and diagnostic accuracy to 97.3%, 98.5%, 95.7%, 89.9% and 91.2%, respectively. Conclusion: TVS appears to be a useful imaging method for the prediction of endometriosis. The inclusion of TVS-based positive soft markers either alone or in combination improves our ability to predict endometriosis

Comparing delayed cord clamping and umbilical cord milking during elective cesarean section for the neonatal outcome

Objectives: to compare between immediate cord clamping, delayed cord clamping, and umbilical cord milking and their effects on hemoglobin and bilirubin level in term infants in cesarean section. Study design: A randomized clinical trial was conducted from November 2021 to June 2022, including 162 full term pregnant women undergoing elective cesarean section at EL-Shatby Maternity University Hospital. They were randomly assigned (1:1:1 ratio) either to immediate cord clamping just after delivery (Group 1) or delayed cord clamping for 30 s (Group 2) or umbilical cord milking 10 times for 10–15 s (Group 3). The primary outcome measures included hemoglobin and hematocrit levels of the newborn at birth and the secondary outcome was bilirubin level measurement at 72 h of life. Results: one hundred sixty- two newborns were randomized into 3 groups, fifty-four cases in each, and were investigated on hemoglobin and hematocrit levels; five were lost to follow-up and one hundred fifty-seven were tested for bilirubin. Participants among groups had no significant difference regarding demographic and clinical characteristics, regarding the hemoglobin at birth it was significant higher in the umbilical cord milking group (Group 3) through all groups (14.91 ± 0.91 g/dl vs15.38 ± 0.74 g/dl vs 16.56 ± 1.03 g/dl, p value <0.001), regarding hematocrit level at birth it was significant in the umbilical cord milking group (Group 3) through all groups (44.71 ± 2.94 vs 46.48 ± 2.61 vs 49.74 ± 3.26, p value <0.001). On the other hand, bilirubin level after 72 h had no significant different through the 3 groups (8.80(IQR 4.50–17.20), vs 9.70(IQR3.50–14.70), vs 8.50(IQR 3.20–19.50), respectively p value= 0.348) Conclusion: this study showed that umbilical cord milking 10 times for 10–15 s is more effective than delayed cord clamping for 30 s in enhancing hemoglobin and hematocrit levels in newborn delivered by cesarean section with no significant difference on bilirubin level in the newborn

BJS commission on surgery and perioperative care post-COVID-19

Background: Coronavirus disease 2019 (COVID-19) was declared a pandemic by the WHO on 11 March 2020 and global surgical practice was compromised. This Commission aimed to document and reflect on the changes seen in the surgical environment during the pandemic, by reviewing colleagues experiences and published evidence. Methods: In late 2020, BJS contacted colleagues across the global surgical community and asked them to describe how severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) had affected their practice. In addition to this, the Commission undertook a literature review on the impact of COVID-19 on surgery and perioperative care. A thematic analysis was performed to identify the issues most frequently encountered by the correspondents, as well as the solutions and ideas suggested to address them. Results: BJS received communications for this Commission from leading clinicians and academics across a variety of surgical specialties in every inhabited continent. The responses from all over the world provided insights into multiple facets of surgical practice from a governmental level to individual clinical practice and training. Conclusion: The COVID-19 pandemic has uncovered a variety of problems in healthcare systems, including negative impacts on surgical practice. Global surgical multidisciplinary teams are working collaboratively to address research questions about the future of surgery in the post-COVID-19 era. The COVID-19 pandemic is severely damaging surgical training. The establishment of a multidisciplinary ethics committee should be encouraged at all surgical oncology centres. Innovative leadership and collaboration is vital in the post-COVID-19 era

BJS commission on surgery and perioperative care post-COVID-19

Coronavirus disease 2019 (COVID-19) was declared a pandemic by the WHO on 11 March 2020 and global surgical practice was compromised. This Commission aimed to document and reflect on the changes seen in the surgical environment during the pandemic, by reviewing colleagues' experiences and published evidence

Adolescent transport and unintentional injuries: a systematic analysis using the Global Burden of Disease Study 2019

Background Globally, transport and unintentional injuries persist as leading preventable causes of mortality and morbidity for adolescents. We sought to report comprehensive trends in injury-related mortality and morbidity for adolescents aged 10-24 years during the past three decades. Methods Using the Global Burden of Disease, Injuries, and Risk Factors 2019 Study, we analysed mortality and disability-adjusted life-years (DALYs) attributed to transport and unintentional injuries for adolescents in 204 countries. Burden is reported in absolute numbers and age-standardised rates per 100 000 population by sex, age group (10-14, 15-19, and 20-24 years), and sociodemographic index (SDI) with 95% uncertainty intervals (UIs). We report percentage changes in deaths and DALYs between 1990 and 2019. Findings In 2019, 369 061 deaths (of which 214337 [58%] were transport related) and 31.1 million DALYs (of which 16.2 million [52%] were transport related) among adolescents aged 10-24 years were caused by transport and unintentional injuries combined. If compared with other causes, transport and unintentional injuries combined accounted for 25% of deaths and 14% of DALYs in 2019, and showed little improvement from 1990 when such injuries accounted for 26% of adolescent deaths and 17% of adolescent DALYs. Throughout adolescence, transport and unintentional injury fatality rates increased by age group. The unintentional injury burden was higher among males than females for all injury types, except for injuries related to fire, heat, and hot substances, or to adverse effects of medical treatment. From 1990 to 2019, global mortality rates declined by 34.4% (from 17.5 to 11.5 per 100 000) for transport injuries, and by 47.7% (from 15.9 to 8.3 per 100000) for unintentional injuries. However, in low-SDI nations the absolute number of deaths increased (by 80.5% to 42 774 for transport injuries and by 39.4% to 31 961 for unintentional injuries). In the high-SDI quintile in 2010-19, the rate per 100 000 of transport injury DALYs was reduced by 16.7%, from 838 in 2010 to 699 in 2019. This was a substantially slower pace of reduction compared with the 48.5% reduction between 1990 and 2010, from 1626 per 100 000 in 1990 to 838 per 100 000 in 2010. Between 2010 and 2019, the rate of unintentional injury DALYs per 100 000 also remained largely unchanged in high-SDI countries (555 in 2010 vs 554 in 2019; 0.2% reduction). The number and rate of adolescent deaths and DALYs owing to environmental heat and cold exposure increased for the high-SDI quintile during 2010-19. Interpretation As other causes of mortality are addressed, inadequate progress in reducing transport and unintentional injury mortality as a proportion of adolescent deaths becomes apparent. The relative shift in the burden of injury from high-SDI countries to low and low-middle-SDI countries necessitates focused action, including global donor, government, and industry investment in injury prevention. The persisting burden of DALYs related to transport and unintentional injuries indicates a need to prioritise innovative measures for the primary prevention of adolescent injury