Upper lip myomucosal flap for the repair of anterior oronasal fistula

Anterior oronasal fistula after cleft palatal repair is difficult to correct and it is consider challenging to many surgeons. Many techniques were used to repair this type of fistula without guarantee for success. Upper lip myomucosal flap is an alternative technique for the repair of this type of fistula. This is a retrospective descriptive case series study which included 10 patients diagnosed with anterior oronasal fistula after cleft palatal repair. They presented to Pediatric Surgery Department at the Faculty of Medicine, Mansoura University Children Hospital from the period between November 2013 and August 2014. In this technique, we do harvesting of the flap with measurement of its length and width, then baring the edge of the fistula with trying of its closure with local flaps. After that we suture the flap to the edge of the fistula and then evaluate the success rate. This study included 10 patients with age ranging from 15 to 72 months. The size of the fistula was less than 1 cm in six patients and more than 1 cm in four patients. The flap was used as an additional layer repair in seven patients and as the only layer for the repair in three patients. This technique was found to be successful in 70% of the patients with good healing without any recurrent fistula. We concluded that the use of this technique is feasible; however, its efficacy should be tested in larger number of patients to be considered as an option for the treatment of anterior oronasal fistula.Keywords: oronasal fistula, upper lip myomucosal flap, lip fla

Characterization of abnormal sleep patterns in patients with obesity, type 2 diabetes, or combined

Introduction: Obesity and type 2 diabetes mellitus have reached epidemic proportions worldwide. Abnormal sleep has been linked to both incident and prevalent obesity and type 2 diabetes. We aimed to characterize abnormal sleep patterns [ASP’s] in patients with obesity, type 2 diabetes, or both.Subjects: The study included 92 subjects divided into four groups: Group 1, 23 obese patients (BMI > 30) with type 2 diabetes mellitus; Group 2, 23 non-obese diabetic patients; group 3, 23 obese subjects without diabetes; group 4, 23 matched healthy control subjects.Methods: Waist circumference and BMI [body mass index] estimation, fasting and post challenge plasma glucose ‘‘groups 2 & 4”, HOMAIR [Homeostatic model assessment- Insulin resistance] estimation, and finally evaluation for ASP’s using a CDC [Centers for Disease Control and prevention] validated questionnaire.Results: Post-prandial glucose and BMI significantly predicted Sleep latency and sleep hours at night respectively. Both group 1 and 3 compared to group 4 showed higher prevalence of: Insomnia [p < .01], snoring [p < .01], fragmented sleep [p < .05], excessive day time sleepiness [p < .001], and daytime dysfunction [p < .001]. Group 2 compared to group 4 showed higher prevalence of: Insomnia, snoring, fragmented sleep, and finally, daytime dysfunction [All p < .01]. Group 1 compared to groups 3 and 4 had significantly less hours of sleep at night [p < .01]. Group 1 compared to group 2 showed higher prevalence of: Insomnia, fragmented sleep, excessive day time sleepiness, and daytime dysfunction [All p < .05]. Finally, group 3 compared to group 2 showed higher prevalence of: Excessive day time sleepiness, and daytime dysfunction [p < .01].Conclusion: The combination of obesity and diabetes mellitus is associated with poor quality and quantity of sleep with resultant significant daytime dysfunction. Glycemic, and adiposity measures predicted sleep latency and hours.Keywords: Type 2 diabetes, Obesity, Abnormal sleep patterns, Insulin resistance Latency period, Impaired daily activitie

Parathormone (PTH) is strongly related to left ventricular mass index (LVMI) in hypertensives, obese, and normal control

No Abstrac

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

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Twice or thrice weekly levothyroxine provides similar rates of adherence and post-Ramadan euthyroidism compared to daily levothyroxine during Ramadan fasting

Abstract Background Having to take levothyroxine (L-T4) on a daily basis, on an empty stomach is burdensome and may impair adherence, especially during Ramadan fasting. A long half-life and autoregulation of thyroid hormone levels allows for twice or thrice weekly administration of L-T4. This study aims to establish twice or thrice weekly L-T4 dosing as a convenient and effective practice during Ramadan fasting. Methods The study included 2 groups; twice or thrice weekly (TTW) group included patients assigned to take L-T4 twice or thrice a week, and standard daily dosing (SDT) group included patients assigned to take L-T4 daily. Patients freely chose between three L-T4 regimens: before Iftar, before Suhor, or before the next fast. Thyroid status was assessed before and within 6 weeks after Ramadan. Only euthyroid patients were included. Results TTW group included 57 patients, while SDT group included 91 patients. Pre-Ramadan TSH in TTW group (1.80 ± 0.88 µIU/L) was higher compared to SDT group (1.39 ± 0.72 µIU/L) [P = 0.003]. Similar adherence rates were observed in both groups, 96.5% in TTW group versus 89% in SDT group, [P = 0.13]. similar rates of post-Ramadan euthyroidism were also found in both groups, 91.2% in TTW group versus 94.5% in SDT group, [P = 0.509]. TTW group preferred regimen 1 (64.9%) significantly more than SDT group (35.2%) [P = 0.001]. Conclusion Twice or thrice weekly levothyroxine results in similarly high rates of adherence (96.5%) and post-Ramadan euthyroidism (91.2%) compared to daily levothyroxine during Ramadan fasting

Characterization, treatment preferences, and outcomes of 390 Egyptian Graves’ disease patients: a retrospective study

Abstract Background Graves’ disease is the most common cause of thyrotoxicosis worldwide. Patient characteristics may vary according to ethnicity, iodine status, and age. Studies on characterization of Graves’ disease in Egypt are lacking. The present study aims to report the patient characteristics, as well as treatment preferences and outcomes of Graves' disease patients from Alexandria, Egypt. Methods A retrospective review of demographic, biochemical, serological, sonographic, and treatment data of Graves' disease patients attending endocrinology outpatient clinic, Alexandria faculty of medicine, Egypt. Results Three hundred ninety patients were included. Females were 75.9%, peak age was 21–40 years representing 53.1%, and family history of thyroid disease was positive in 60% of patients. Overt hyperthyroidism was present in 93.9%, TSH receptor antibodies were positive in 97.1%, and thyro-peroxidase antibodies in 74.8%. Goiter was present in 72.8%, nodularity in 18.4%, and thyroid eye disease in 17.7%. Medical treatment was used in 90% of patients, surgery in 5.4%, and radioiodine in 4.3%. For patients on medical treatment, 17.7% achieved remission, 29% relapsed, and 2.85% developed hypothyroidism. Conclusion A typical Graves’ disease patient in Egypt is a middle-aged female with a positive family history of thyroid disease. Overt hyperthyroidism was the most common presentation and goiter was a common sign at presentation. The sensitivity of TRAb’s for diagnosing Graves’ disease was excellent (97.1%). ATD’s was the commonest treatment modality with a remission rate of 17.7% and a relapse rate of 29%