Expectations versus reality in chronic venous ulceration; a quality of life assessment study

Introduction: Chronic venous ulceration is a common problem worldwide with a significant effect onQuality of Life (QoL).Objectives: Our objective was to assess Sri Lankan patients’ perspective with regard to this scenario.Methods: We involved 141 consenting patients presenting to the OPD, National Hospital with a venousulcer lasting one month or more. Data was collected using an interviewer administered questionnaire, aclinical interview and a lower limb duplex scan. Short form 36 questionnaire was used for QoLassessment.Results: The majority were elderly (median age 53 years) men (n=9[69.5%]). Fifty four (38.3%) wereunemployed at the time of the study and 28 (19.9%) directly attributed the ulcer as the cause forunemployment. Median duration of ulcer was 10[1-360] months and mean Venous Clinical SeverityScore (VCSS) was 13.85(4-24). Family history (44[31.2%]), previous limb trauma or non-venoussurgery (24[17.0%]), smoking among men (57 [58.2%]) and history of pregnancy among females(34[79.1%]) were identified as risk factors. Role limitation due to physical health (28.4[SD 42.8]) androle emotional problems (40.9 [SD 46.7]) had a mean SF 36 score below 50. Factors such as pain,duration of ulcer, older age and higher BMI significantly affected many domains of QoL (p<0.05). Sixtysix (46.8%) patients continue to have ulcers despite having had surgical treatment for varicose veins.Conclusions: Venous ulcers have a considerable impact on the quality of life in Sri Lankan patientswith venous ulcer. The need for providing preventive and rapid healing methods together with socialsupport must be emphasized

Utility of WIfI foot assessment tool in a Sri Lankan setting; an initial experience

Introduction: Potential for limb salvage and wound healing in a lower limb ulcer depends on degreeof ischemia, wound grade and superadded foot infection.Objectives: Our objective was to assess the feasibility of applying WIfI classification system to stratifypatients presenting with limb ulceration according to risk of undergoing amputation and benefit ofrevascularization.Methods: Fifty four consecutive patients with ulcerated limbs presenting over two months to theUniversity unit at the National Hospital were staged according to the Society for Vascular Surgery(SVS)Wound, Ischemia, and Foot Infection (WIfI) classification system.Results: The median age was 64 (39-93), and 42 (79%) patients were males. Diabetes (87%),hypertension (53%), ischemic heart disease (14%), cerebrovascular disease (13%), chronic renal disease(13%) were identified risk factors. Smoking was reported among 35%. Median Anterior TibialArtery(ATA), Posterior Tibial Artery(PTA), Toe pressures, Ankle Brachial Index, Pole test values ofthe affected side lower limbs were 114.5mmHg, 107.5mmHg, 41mmHg, 0.87 and 85cm respectively.Values for the contralateral limb were 140mmHg, 120mmHg, 74mmHg, 1.0 and 85cm respectively.84% of ATA and 90 % of PTA pulses were not palpable on the affected side. Grades of ischemia were;none (23.3%), mild (27.9%), moderate (18.6%), severe (30.2%), grades of infection were none (20.9%),mild (37.2%), moderate (39.5%), severe (2.3%), and wound grades were 0(0%), 1(20%.9), 2(39.5%),3(39.5%). Estimated risk of amputation were high (65.1%), moderate (11.6%), low (11.6%), very low(11.6%) and estimated benefit of revascularization were high (46.5%) moderate (23.3%), low (7.0%),very low (23.3%).Conclusions: Application of WIfI system was useful to prioritize patients with eminent limb loss forurgent intervention. Toe pressure assessment for diabetic foot ulcer stratification should become acommon practice

A cysteine protease (cathepsin Z) from disk abalone, Haliotis discus discus: Genomic characterization and transcriptional profiling during bacterial infections

Cathepsin Z (CTSZ) is lysosomal cysteine protease of the papain superfamily. It participates in the host immune defense via phagocytosis, signal transduction, cell-cell communication, proliferation, and migration of immune cells such as monocytes, macrophages, and dendritic cells. Hence, CTSZ is also acknowledged as an acute-phase protein in host immunity. In this study, we sought to identify the CTSZ homolog from disk abalone (AbCTSZ) and characterize it at the molecular, genomic, and transcriptional levels. AbCTSZ encodes a protein with 318 amino acids and a molecular mass of 36kDa. The structure of AbCTSZ reveals amino acid sequences that are characteristic of the signal sequence, pro-peptide, peptidase-C1 papain family cysteine protease domain, mini-loop, HIP motif, N-linked glycosylation sites, active sites, and conserved Cys residues. A pairwise comparison revealed that AbCTSZ shared the highest amino acid homology with its molluscan counterpart from Crassostrea gigas. A multiple alignment analysis revealed the conservation of functionally crucial elements of AbCTSZ, and a phylogenetic study further confirmed a proximal evolutionary relationship with its invertebrate counterparts. Further, an analysis of AbCTSZ genomic structure revealed seven exons separated by six introns, which differs from that of its vertebrate counterparts. Quantitative real time PCR (qPCR) detected the transcripts of AbCTSZ in early developmental stages and in eight different tissues. Higher levels of AbCTSZ transcripts were found in trochophore, gill, and hemocytes, highlighting its importance in the early development and immunity of disk abalone. In addition, we found that viable bacteria (Vibrio parahaemolyticus and Listeria monocytogenes) and bacterial lipopolysaccharides significantly modulated AbCTSZ transcription. Collectively, these lines of evidences suggest that AbCTSZ plays an indispensable role in the innate immunity of disk abalone.G. I. Godahewa, N. C. N. Perera, Sukkyoung Lee, Myoung-Jin Kim, Jehee Le

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