Does emergency medicine clerkship change students' misconceptions towards this specialty? Pre- and post-clerkship perceptions

Objective: This study aims to understand students' skills based on their self-assessment and their perceptions regarding emergency medicine (EM) physicians, EM patients, and choosing EM as a future career. Methods: This study employed prospective observational design. It was conducted from 2 October to 2 November 2022 in Saudi Arabia. The study participants were senior medical students at King Faisal University. Senior students who finished a four-week EM rotation were involved as post-cases, and senior students who had not finished their EM rotation were involved as pre-cases. An online survey was administrated to all students who met out criteria. Results: A total of 161 students were included in the study; 65.2% had not yet done their EM clerkship, while 34.8% had completed their EM clerkship. Among them, 48.4% were male, and 51.6% were female. On average, post-EM clerkship students showed greater confidence in their skills of conducting an initial assessment of a patient (p=0.027), developing a management plan (p=0.007), explaining the principles of EM to others (p<0.001), presenting patient cases formally (p=0.049), interpreting electrocardiogram (p=0.006), and applying medical resuscitation (p=0.041). No significant differences were found between the average confidence in the skills and abilities of male and female students. Post-EM clerkship and male students were more likely to choose EM as a career when compared with pre-EM clerkship (p<0.001) and female students (p=0.006). Conclusion: It seems that, after completing a four-week rotation, students exhibited significant advances in knowledge, illness management, and procedural skills. It is likely that the EM clerkship significantly improved students' perceptions of the EM specialty

Echocardiographic Assessment Of Left Ventricular Systolic Function Among Patients with Chronic Kidney Disease Managed In Ebn Sena Dialysis Center In Diyala

Background: Cardiovascular diseases are prevalent in patients with chronic  kidney disease and represent the major hazard for mortality in this population . Left ventricular hypertrophy is a cardiovascular complication in patients with chronic kidney disease and end-stage renal disease. Left ventricular hypertrophy in dialysis patients has generally a bad prognostic value, because it represents a risk factor for the development of cardiac arrhythmias, ischemic heart disease, heart failure and sudden death. Objective: To study  left ventricular systolic functions by Echocardiography in patients with chronic renal failure on hemodialysis  program and their relation with some risk factors. Patients and Methods: 100 patients with end stage renal failure on dialysis were studied  by echocardiography, the patients were divided into two groups, the first group   with normal echo study , while the second group consisted of patients with left ventricular  systolic dysfunction. Risk factors  including age , sex , duration of dialysis , hypertension, DM, and hemoglobin levels were compared between the groups. Results: Left Ventricular  disorders occurred in 65% , 34% of patients showed left  ventricular  systolic dysfunction , , older age  group, longer duration of dialysis  , hypertension ,DM, and anemia were found to be significantly associated  with  left ventricular systolic dysfunction. Conclusion: Our study concluded that large numbers of end-stage renal disease patients have hypertension and diabetes as the etiology of their disease, which could be prevented by better approach in controlling blood pressure and blood sugar.         Anaemia is a major problem and as a predictor of cardiovascular risk factor for those patients. Echocardiographic Left Ventricular Study are prognostic predictors in chronic kidney disease patients, which suggest that echocardiography may play a vital role in assessing cardiac morphology and functions in those patients

Mineral Derangement and Bone Diseases in Uremic Patients on hemodialysis in Ibn-Sina Hemodialysis Center / Diyala

  Background: Chronic kidney disease is an international public health problem affecting 5–10% of the world population. As kidney function declines, there is a progressive deterioration in mineral homeostasis, with a disruption of normal serum and tissue concentrations of phosphorus and calcium, and changes in circulating levels of hormones. Objective: To determine the severity of bone and mineral disease in chronic renal failure and how efficiently controlled by drugs and hemodialysis procedure in Ibn sina dialysis center. Patients and Methods: A case control study was carried out among 75 patients with chronic kidney disease (stage5) on regular hemodialysis in Ibn Sina dialysis center. Blood was taken before dialysis session and measurements of serum calcium, phosphorus, serum alkaline phosphatase, .protein and albumin levels, Serum parathyroid hormone and VIT D3   were determined.  and another group of 25 normal peoples from surrounding area. Results: The mean parathyroid hormone level was 145.62pg/ml, with 57.33% having normal acceptable rang of parathormone level, 41% of patients having hyperparathyroidism and 1.33% having hypoparathyroidism. There was no significant correlation between serum PTH and dexa scan. Hypocalcemia was found in 52% of patients, 33% with hypercalcemia patients . There was a significant correlation found between Hypocalcemia and dexa scan results. Majority of patients had high serum phosphate levels (54.6%).and normal phosphate level in 40% while the hypophosphatemia result 5.33% and mean phosphate level is2.24 mmol/l.Total serum protein mean is 61.51 a 37.33% of them had hypoproteinemia and 62.66 %of them had normal serum protein. Also our results show 97, 33%of uremic patients have low vit D While 2.33% have normal level of serum vit D. There was a significant correlation between dexa scan and vit D level, calcium, alkaline phosphatase, female gender, smoking and body mass index. Conclusion: The current study demonstrated that we can predict the chronic kidney diseases- Metabolic bone disorder from mineral scores before potentates the diagnosis by dexa scan

Association Between Chronic Renal Failure and Thyroid Hormone

Background: The idea of the study is to follow the relation between CR.E and thyroid hormones. Material and Methods: The levels of serum urea , creatinine ,total thyroxin (TT4) , Tri-iodothyronine (TT3) , free T4 (fT4) , freeT3 (fT3) and Thyrotropin (TSH) were measured in the serum of 80 Patients with varying grades of chronic renal failure (CRF) ; and 40 healthy individuals . They were divided into 3 groups  as : Group 1 containing 40 healthy individuals as control group; Group 2 containing 40 Patients on conservative management ; and Group 3 containing 40 Patients on Regular haemodialysis therapy.     Aim: The aim of the study was to investigate the association between chronic renal failure and thyroid function.   Results: Groups 2 and 3 showed significant increased in urea and creatinine compared with control group ( P< 0.001) and significant decreased in TT4(P < 0.01) , TT3(P < 0.001) , fT4( P < 0.01) and fT3( P< 0.001) , whereas TSH values were not significantly altered .      Conclusions: Uremia is accompanied with endocrine disorders , due to impaired degradation of hormones , because of failed kidney functions and to the interference of the uremic environment with extra renal degradation or synthesis and secretion of certain hormones

PANC Study (Pancreatitis: A National Cohort Study): national cohort study examining the first 30 days from presentation of acute pancreatitis in the UK

Abstract Background Acute pancreatitis is a common, yet complex, emergency surgical presentation. Multiple guidelines exist and management can vary significantly. The aim of this first UK, multicentre, prospective cohort study was to assess the variation in management of acute pancreatitis to guide resource planning and optimize treatment. Methods All patients aged greater than or equal to 18 years presenting with acute pancreatitis, as per the Atlanta criteria, from March to April 2021 were eligible for inclusion and followed up for 30 days. Anonymized data were uploaded to a secure electronic database in line with local governance approvals. Results A total of 113 hospitals contributed data on 2580 patients, with an equal sex distribution and a mean age of 57 years. The aetiology was gallstones in 50.6 per cent, with idiopathic the next most common (22.4 per cent). In addition to the 7.6 per cent with a diagnosis of chronic pancreatitis, 20.1 per cent of patients had a previous episode of acute pancreatitis. One in 20 patients were classed as having severe pancreatitis, as per the Atlanta criteria. The overall mortality rate was 2.3 per cent at 30 days, but rose to one in three in the severe group. Predictors of death included male sex, increased age, and frailty; previous acute pancreatitis and gallstones as aetiologies were protective. Smoking status and body mass index did not affect death. Conclusion Most patients presenting with acute pancreatitis have a mild, self-limiting disease. Rates of patients with idiopathic pancreatitis are high. Recurrent attacks of pancreatitis are common, but are likely to have reduced risk of death on subsequent admissions. </jats:sec

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

Antimycobacterial Activity of <i>Rosmarinus officinalis</i> (Rosemary) Extracted by Deep Eutectic Solvents

Tuberculosis (TB) is a massive problem for public health and is the leading cause of illness and death worldwide. Rosemary (Rosmarinus officinalis) is used traditionally to treat many diseases, such as infections of the lungs including pulmonary TB. R. officinalis was collected from Al Anbar Governorate, Iraq, and was extracted with deep eutectic solvents (DESs) of many different kinds and with conventional water solvent. The antimycobacterial activities of the R. officinalis extracts were tested against multidrug-resistant (MDR) Mycobacterium tuberculosis by agar disc diffusion assay. Minimum inhibitory concentrations were measured spectrophotometrically at 570 nm. Then, a time-kill assay and cell membrane integrity analysis were conducted to investigate the effects of the most active extracts on cell growth. The in vitro cytotoxicity of the most active extracts was evaluated against Rat Embryonic Fibroblasts (REF) cell line by MTT assay. Liquid chromatography-mass spectrometry (LC-MS) was conducted to analyze the chemical components of the most active extracts. At 200 mg/mL concentration, a significant inhibition activity was seen in DES2: Tailor (DIZ = 17.33 ± 1.15 mm), followed by DES3: ChGl, DES1: LGH and DES4: ChXl. The best result was DES2: Tailor, which had a MIC of 3.12 mg/mL and an MBC of 12.5 mg/mL. The DES2 extract exhibited a high drop in the number of colonies over time, killing more than 80 colonies. The main phytochemical compounds of the R. officinalis extract were camphene, camphenilol, α-pinene, limonene, apigenin, camphor, carnosol, linalool and myrcene. R. officinalis extracts obtained by DESs have shown evident power in treating tuberculosis, and extraction by DES is a greener procedure than the methods involving conventional extraction solvents. As a result, additional research into the application of DES should be considered

Antimycobacterial Activity of Rosmarinus officinalis (Rosemary) Extracted by Deep Eutectic Solvents

Tuberculosis (TB) is a massive problem for public health and is the leading cause of illness and death worldwide. Rosemary (Rosmarinus officinalis) is used traditionally to treat many diseases, such as infections of the lungs including pulmonary TB. R. officinalis was collected from Al Anbar Governorate, Iraq, and was extracted with deep eutectic solvents (DESs) of many different kinds and with conventional water solvent. The antimycobacterial activities of the R. officinalis extracts were tested against multidrug-resistant (MDR) Mycobacterium tuberculosis by agar disc diffusion assay. Minimum inhibitory concentrations were measured spectrophotometrically at 570 nm. Then, a time-kill assay and cell membrane integrity analysis were conducted to investigate the effects of the most active extracts on cell growth. The in vitro cytotoxicity of the most active extracts was evaluated against Rat Embryonic Fibroblasts (REF) cell line by MTT assay. Liquid chromatography-mass spectrometry (LC-MS) was conducted to analyze the chemical components of the most active extracts. At 200 mg/mL concentration, a significant inhibition activity was seen in DES2: Tailor (DIZ = 17.33 &plusmn; 1.15 mm), followed by DES3: ChGl, DES1: LGH and DES4: ChXl. The best result was DES2: Tailor, which had a MIC of 3.12 mg/mL and an MBC of 12.5 mg/mL. The DES2 extract exhibited a high drop in the number of colonies over time, killing more than 80 colonies. The main phytochemical compounds of the R. officinalis extract were camphene, camphenilol, &alpha;-pinene, limonene, apigenin, camphor, carnosol, linalool and myrcene. R. officinalis extracts obtained by DESs have shown evident power in treating tuberculosis, and extraction by DES is a greener procedure than the methods involving conventional extraction solvents. As a result, additional research into the application of DES should be considered

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit