Primary Hepatic Leiomyosarcoma Report of a rare case with review of literature

Primary hepatic leiomyosarcoma is an extremely rare tumor with a dismal prognosis and difficulty in diagnosis. We present a 36-year-old female who presented with complaints of pain in right hypochondrium and epigastric region. Real-time ultrasonography revealed an enlarged liver with multiple hypoechoic lesions of varying sizes in both the lobes of the liver. USG guided core biopsy from the lesion showed an infiltrating malignant spindle cell neoplasm positive for smooth muscle actin and caldesmon-H confirming the diagnosis of leiomyosarcoma. It is vital to diagnose these lesions even on limited biopsies as early diagnosis can reduce hospital and operative morbidity and mortality rates in the patients

Association of Insurance Expansion With Surgical Management of Thyroid Cancer

Importance: To our knowledge, thyroid cancer incidence is increasing faster than any other cancer type and is currently the fifth most common cancer among women. While this rise is likely multifactorial, there has been scarce consideration of the effect of insurance statuses on the treatment of thyroid cancer. Objective: We evaluate the association of insurance expansion with thyroid cancer treatment using the 2006 Massachusetts health reform, which serves as a unique natural experiment. Design, Setting, and Participants: We used the Agency for Healthcare Research and Quality State Inpatient Databases to identify patients with government-subsidized or self-pay insurance or private insurance who were admitted to a hospital with thyroid cancer and underwent a thyroidectomy between 2001 and 2011 in Massachusetts (n = 8534) and 3 control states (n = 48 047). Difference-in-differences models were used to evaluate an association between the 2006 Massachusetts health care reform and thyroid cancer treatment, and participants were controlled for age, sex, comorbidities, and secular trends. Main Outcomes and Measures: Change in the thyroidectomy rate for thyroid cancer treatment was the primary outcome evaluated. Results: The Massachusetts cohort consisted of 6443 women (75.5%) and 2091 men (24.5%), of whom 6388 (79.6%) were white, 391 (4.9%) were black, 527 (6.6%) were Hispanic, 424 (5.3%) were Asian/Pacific Islander, 63 (0.8%) were Native American, and 228 (2.8%) were other. The participants from control states included 36 818 women (76.6%) and 11 229 men (23.4%), of whom 30 432 (65.5%) were white, 3818 (8.2%) were black, 6462 (13.9%) were Hispanic, 2591 (5.6%) were Asian/Pacific Islander, 211 (0.5%) were Native American, and 2947 (6.3%) were other. Before the 2006 Massachusetts insurance expansion, patients with government-subsidized or self-pay insurance had lower thyroidectomy rates for thyroid cancer in Massachusetts and the control states compared with patients with private insurance. The Massachusetts insurance expansion was associated with a 26% increased rate of undergoing a thyroidectomy (incident rate ratio, 1.26; 95% CI, 1.04-1.52; P = .02) and a 22% increased rate of neck dissection (incident rate ratio, 1.22; 95% CI, 1.07-1.37; P = .002) for treating cancer compared with control states. Conclusions and Relevance: The 2006 Massachusetts health reform, which is a model for the Affordable Care Act, was associated with a 26% increased rate of thyroidectomy for treating thyroid cancer. Our study suggests that insurance expansion may be associated with increased access to the surgical management of thyroid cancer. Further studies need to be conducted to evaluate the effect of healthcare expansion at a national level

Teaching surgical skills in a resource-limited setting: Comparing massed versus distributed practice in an ultrasound-guided breast biopsy simulator

Background: Teaching surgical skills in the simulation lab has increased markedly compared to teaching only in the operating room. Although many studies have been performed investigating the optimal teaching methodology for skills acquisition, there is no consensus on the best method. Massed and distributed practices are important methods in teaching procedural skills. Considering the limited human and logistical resources in low and middle-income settings, it is valuable to understand the optimal methodology for learning and acquiring surgical skills. Methods: Thirty-two core needle biopsy-naïve first-year residents and final year medical students rotating in general surgery were enrolled in and completed the study at University Teaching Hospital of Kigali, a tertiary, teaching and referral hospital in Kigali, Rwanda. They were assigned to a “massed” group (i.e., one time, 3-hour practice) or “distributed” group (i.e., 1-hour practice per week for 3 weeks). Trainees were taught ultrasound-guided core needle biopsy on a high-fidelity breast simulator. All participants completed pre- and post-tests and an evaluation of skill retention was performed one month after completion of the training. Analysis of performance was completed, and p-value ≤ 0.05 was considered statistically significant. Results: There was no difference between performance on the pretest (p=0.985) and the posttest (p=0.680). Both groups demonstrated improvement after implementation of the simulation training when comparing pretest and posttest results (p<0.001); there were no differences in the evaluation of skills retention after one month after the training between the two groups (p=0.273). Conclusions: The results of this study demonstrate that both groups have improved significantly their knowledge and skills. Trainees have similar retention of skills in ultrasound guided core needle biopsy on a breast simulator whether trained under a massed or distributed practice schedule. Both methods may be considered in our setting for teaching surgical skills. Keywords: surgical simulation; resource-limited setting; global surgery

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Development and standardization of Mysore Tridosha scale

The authors have developed a personality scale to assess Tridoshas i.e. Vata, Pitta, and Kapha from psychological perspective in human beings. The Tridoshas are composed of the Pancha Mahabhutas, but one or the other Dosha is dominant singularly or in combination. There can never be a state when one or the other Pancha Mahabhutas and consequently the Tridoshas are absent totally. All five are essential to sustain life. Vata Dosha is composed of Akasa and Vayu Mahabhuta. Pitta Dosha is composed of Tejas or Agni and Ap Mahabhuta. Kapha Dosha is composed of Ap and Prithvi Mahabhuta. Although Tridosha is studied, understood, and applied in Ayurveda, the present authors have tried to validate the same from the domain of psychology. Since the authors are not from the domain of Ayurveda but of Psychology, there are some constructs that are not amenable for psychological testing which have been ignored. Only those constructs that can be used by psychologists to assess the psychological aspects of the Dosha Prakriti have been used to build items for the assessment of personality. In this process, the psychometric properties of the scale are established. The scale assesses the psychological manifestation of the Tridoshas, which was the basic objective. The standardization procedure involved in the development of the Mysore Psychological Tridosha Scale is herewith delineated

Understanding personality from Ayurvedic perspective for psychological assessment: A case

The study of personality has fascinated psychologists since a long time. Personality as an area of study has grown so much that a wealth of literature is available. On the other hand, the socio-ethnic dynamics of human race in the emerging global village context provoking psychologists to develop a personality theory which can treat certain basic components of personality as invariants, so that irrespective of culture, race, and nativity could still be able to study personality which will have universal applicability and relevance, is still far away. In the above emerging backdrop, “Ayurveda” has perhaps an important role to play as it can enable providing a theoretical and empirical base of personality traits and types. These Ayurvedic concepts are applicable to all human beings irrespective of caste, color, sex or race. Therefore, it is interesting to build on the Ayurvedic knowledge which has already given us so much since time immemorial, and validate some of these issues related to personality from psychological perspective. There are already certain efforts in understanding Sattva, Rajas, and Tamas Gunas. It can be furthered so that a comprehensive personality picture can be generated, which can have implications for health, career, education and many other dimensions of life. The present paper is a theoretical attempt in developing such a personality proposition which can be validated. Thus, the present paper only builds a theoretical framework for their possible empirical validity

Development and Standardization of Mysore Triguna Scale

The authors have developed a personality tool to assess Trigunas, that is, Sattva, Rajas, and Tamas. The Trigunas are composed of the Pancha Mahabhutas, but one or the other guna is dominant singularly or in combination. There can never be a state when one or the other Pancha Mahabhutas, and consequently the Trigunas, is absent totally. One or the other guna is in dominance and is responsible for the behavior expressed by an individual. The present authors have tried to validate the same in psychology, taking into account the descriptions as delineated in Indian tradition and classical textual scriptures. In this process, the psychometric properties of the scale are established

Validation of the WHO 2016 new Gleason score of prostatic carcinoma

Context: New Gleason Score of Prostate. Aims: The aim of this study is to assign the patients with carcinoma prostate into new prognostic grade groups (PGGs) based on revised Gleason score (GS) and follow-up according to the WHO 2016. Subjects and Methods: All the biopsies/resected specimens of carcinoma prostate from January 2014 to June 2016 were reviewed, and GS was done according to the WHO 2016. Accordingly, cribriform, fused, and glomeruloid glands were assigned GS 4. Thus, two groups were identified with GS 7 (3 + 4 and 4 + 3). The patients were grouped into PGGs 1–5. The number of patients with change in the prognostic group along with follow-up was calculated. Results: There were 143 patients with carcinoma prostate, with a median age of 65 years. The initial GS was revised, and there was a decrease in GS 3 + 4 from 13.9% to 9% and increase in 4 + 3 from 19.6% to 23.8%. There was upgradation of PGG in 11 (7.69%) biopsies; with PGG from 1 to 2 in one; 2to 3 in eight; and 3to 4 in two. Follow-up at 2 years in 22 showed the poor prognoses in the patients who were upgraded to the higher prognostic group. Conclusions: A change in PGG according to the WHO 2016 criteria was assigned in 7.69% biopsies of carcinoma prostate, and it correlated with prognosis

Global cancer surgery: pragmatic solutions to improve cancer surgery outcomes worldwide

The first Lancet Oncology Commission on Global Cancer Surgery was published in 2015 and serves as a landmark paper in the field of cancer surgery. The Commission highlighted the burden of cancer and the importance of cancer surgery, while documenting the many inadequacies in the ability to deliver safe, timely, and affordable cancer surgical care. This Commission builds on the first Commission by focusing on solutions and actions to improve access to cancer surgery globally, developed by drawing upon the expertise from cancer surgery leaders across the world. We present solution frameworks in nine domains that can improve access to cancer surgery. These nine domains were refined to identify solutions specific to the six WHO regions. On the basis of these solutions, we developed eight actions to propel essential improvements in the global capacity for cancer surgery. Our initiatives are broad in scope, pragmatic, affordable, and contextually applicable, and aimed at cancer surgeons as well as leaders, administrators, elected officials, and health policy advocates. We envision that the solutions and actions contained within the Commission will address inequities and promote safe, timely, and affordable cancer surgery for every patient, regardless of their socioeconomic status or geographic location