Minimally Invasive Approach in Surgical Management of Renal Neoplasms National Cancer Institute Experience

BACKGROUND: Minimally invasive nephrectomy is considered a technically challenging procedure requiring a long learning curve to reach acceptable warm ischemia time and perioperative complications. These minimally invasive techniques result in a shorter hospital stay and less post-operative pain. AIM: This study aims to demonstrate the National Cancer Institute experience regarding the benefits of laparoscopic and robot-assisted nephrectomy over open technique. METHODS: This is a retrospective descriptive cohort study including 62 patients with renal masses treated with nephrectomy whether partial, total or radical, 26 cases were treated by minimally invasive techniques (8 robotic and 18 laparoscopic), while 36 cases were treated by open technique. Inclusion criteria were patients between 20 and 70 years with renal neoplasm without renal vein thrombosis, with tumor stage T1 or T2 N0 M0. Exclusion criteria were patients with medical comorbidities that preclude surgical management or minimally invasive techniques and patients refusing surgery in general. RESULTS: Minimally invasive nephrectomy resulted in shorter hospital stay (mean hospital stay was 2.2 days for the minimally invasive group and 3.6 days for the open group) and less post-operative pain than open technique (p < 0.001 and = 0.002, respectively), while open technique resulted in shorter operation time (p = 0.039, mean operation time 147.8 min compared to 184.8 in the minimally invasive group). CONCLUSION: Minimally invasive nephrectomy (laparoscopic and robotic) resulted in less post-operative pain and shorter hospital stay compared to open technique despite consuming longer operation time which may be decreased by improving the learning curve of operating surgeons

Gender Differences in Presentation, Management, and In-Hospital Outcomes for Patients with AMI in a Lower-Middle Income Country: Evidence from Egypt

BACKGROUND: Many studies in high-income countries have investigated gender differences in the care and outcomes of patients hospitalized with acute myocardial infarction (AMI). However, little evidence exists on gender differences among patients with AMI in lower-middle-income countries, where the proportion deaths stemming from cardiovascular disease is projected to increase dramatically. This study examines gender differences in patients in the lower-middle-income country of Egypt to determine if female patients with AMI have a different presentation, management, or outcome compared with men. METHODS AND FINDINGS: Using registry data collected over 18 months from 5 Egyptian hospitals, we considered 1204 patients (253 females, 951 males) with a confirmed diagnosis of AMI. We examined gender differences in initial presentation, clinical management, and in-hospital outcomes using t-tests and χ(2) tests. Additionally, we explored gender differences in in-hospital death using multivariate logistic regression to adjust for age and other differences in initial presentation. We found that women were older than men, had higher BMI, and were more likely to have hypertension, diabetes mellitus, dyslipidemia, heart failure, and atrial fibrillation. Women were less likely to receive aspirin upon admission (p<0.01) or aspirin or statins at discharge (p = 0.001 and p<0.05, respectively), although the magnitude of these differences was small. While unadjusted in-hospital mortality was significantly higher for women (OR: 2.10; 95% CI: 1.54 to 2.87), this difference did not persist in the fully adjusted model (OR: 1.18; 95% CI: 0.55 to 2.55). CONCLUSIONS: We found that female patients had a different profile than men at the time of presentation. Clinical management of men and women with AMI was similar, though there are small but significant differences in some areas. These gender differences did not translate into differences in in-hospital outcome, but highlight differences in quality of care and represent important opportunities for improvement

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Mini Open Spinous Process Splitting Laminectomy in the management of Cervical Spondylotic Myelopathy

Background Data: Muscle dissection associated with posterior approach to cervical spine usually results in local pain, muscle wasting and temporarily restricted neck movement. Use of muscle sparing spinous process splitting approach for cervical laminectomy allows decompression of the spinal cord and neural foramen if needed. Meanwhile, it does not require instrumentation, fusion and it preserves cervical spine stability. Purpose: To assess the effectiveness of spinous process splitting approach for cervical laminectomy in cervical spondylotic myelopathy. Study Design: Prospective clinical case study. Patients and Methods: Patient Sample: Fifteen patients with cervical spondylotic myelopathy, eleven males and 4 females with mean age 66.4±6.6 (Range 44-71) years. All patients underwent muscle sparing spinous process splitting cervical laminectomy. Outcome Measures: Operative time and blood loss were recorded. Clinical outcome was assessed by the JOA score and VAS. MRI was done 6 months postoperative to assess decompression. Spinal stability and curvature index were assessed on plain cervical radiographs. Results: No case of wound dehiscence was recorded. There was significant improvement of JOA scores and brachialgia and neck pain VAS scores at 6 months, the mean JOA recovery rate was 56.2%. No patient had postoperative kyphosis or instability and 66.6% of patients had improved modified Ishihara cervical curvature index. No neurological deterioration was recorded in the follow-up. No patient had newly developed axial pain. MRI revealed adequate decompression of the spinal cord in all patients. Conclusion: The spinous process splitting cervical laminectomy allows good spinal cord decompression and preserves spine curvature and stability. The mini open approach and preservation of interspinous ligaments could play a role in wound dehiscence prevention. (2017ESJ133

Pregnancy outcome after multifetal reduction via early transvaginal embryo aspiration: Mansoura fertility care unit experience

Objective: To evaluate the pregnancy outcome after multifetal pregnancy reduction (MFPR) via early transvaginal embryo aspiration. Design: Prospective clinical study Material and Methods: The study included 30 patients with high-order multifetal gestations (more than 3 fetuses), Pregnancies included, before reduction: 22 quadruplet gestations (group 1) and 6 quintuplets (group 2), and 2 sextuplets (group 3). All pregnancies were reduced to twins. The primary outcome measures included procedure complications while the secondary ones were pregnancy outcomes. Results: The procedure was successfully completed in all cases. Miscarriage occurred in 2/30 patients (6.6%). Preterm delivery occurred in 20/30 cases (66.6%). The incidence of early pregnancy complications and neonatal outcomes in reduced pregnancies were similar to that of the control group. However, the cesarean section rate of reduced twin pregnancies was significantly higher (P < 0.05). Conclusion: Early transvaginal embryo aspiration is a safe, effective and simple operation. It is associated with reduced perinatal morbidity and mortality as well as minimal maternal complication

Effect of hydrophobic extension of aryl enaminones and pyrazole-linked compounds combined with sulphonamide, sulfaguanidine, or carboxylic acid functionalities on carbonic anhydrase inhibitory potency and selectivity

AbstractDesign and synthesis of three novel series of aryl enaminones (3a–f and 5a–c) and pyrazole (4a-c) linked compounds with sulphonamides, sulfaguanidine, or carboxylic acid functionalities were reported as carbonic anhydrase inhibitors (CAIs) using the “tail approach” strategy in their design to achieve the most variable amino acids in the middle/outer rims of the hCAs active site. The synthesised compounds were assessed in vitro for their inhibitory activity against the following human (h) isoforms, hCA I, II, IX, and XII using stopped-flow CO2 hydrase assay. Enaminone sulphonamide derivatives (3a–c) potently inhibited the target tumour-associated isoforms hCA IX and hCA XII (KIs 26.2–63.7 nM) and hence compounds 3a and 3c were further screened for their in vitro cytotoxic activity against MCF-7 and MDA-MB-231 cancer cell lines under normoxic and hypoxic conditions. Derivative 3c showed comparable potency against both MCF-7 and MDA-MB-231 cancer cell lines under both normoxic ((IC50 = 4.918 and 12.27 µM, respectively) and hypoxic (IC50 = 1.689 and 5.898 µM, respectively) conditions compared to the reference drug doxorubicin under normoxic (IC50 = 3.386 and 4.269 µM, respectively) and hypoxic conditions (IC50 = 1.368 and 2.62 µM, respectively). Cell cycle analysis and Annexin V-FITC and propidium iodide double staining methods were performed to reinforce the assumption that 3c may act as a cytotoxic agent through the induction of apoptosis in MCF-7 cancer cells