Gallstone pancreatitis vs alcohol-induced pancreatitis: does aetiology affect the extent of pancreatic necrosis?

This is the final version. Available on open access from Mattioli 1885 via the DOI in this recordBackground and aim: The impact of different aetiologies of acute pancreatitis on the development of pancreatic necrosis (PN) is unclear. This study assessed the extent and progression of pancreatic and peripan-creatic necrosis on the computed tomography (CT) scan of patients with gallstone (GP) and alcohol-induced (AIP) pancreatitis and evaluated their impact on disease severity. Methods: Patients ≥ 18-year-old with GP, AIP and PN on CT ( January 2010 – September 2018), were considered. The radiological extent of PN and clinical outcomes were analysed with a logistic regression model. Results: Eighty-one patients, 59 with GP, 22 with AIP, were included. GP had a larger extent of PN when the body and/or tail of the pancreas were involved (P = 0.009). Gallstone disease (P = 0.028) and higher American Society of Anesthetists scores (P = 0.043) were predictors of necrosis diffuse to different areas of the pancreas. Predictors of single/multiple organ failure were GP (P = 0.040), necrosis > 50% of the pancreas (P = 0.002) with a diffuse pattern (P = 0.004). Conclusions: Patients with GP had a wider extent of necrosis in the pancreatic body and/or tail. The onset of organ failure can be predicted in subjects with GP and larger amount of PN

A UK wide cohort study describing management and outcomes for infants with surgical Necrotising Enterocolitis

The Royal College of Surgeons have proposed using outcomes from necrotising enterocolitis (NEC) surgery for revalidation of neonatal surgeons. The aim of this study was therefore to calculate the number of infants in the UK/Ireland with surgical NEC and describe outcomes that could be used for national benchmarking and counselling of parents. A prospective nationwide cohort study of every infant requiring surgical intervention for NEC in the UK was conducted between 01/03/13 and 28/02/14. Primary outcome was mortality at 28-days. Secondary outcomes included discharge, post-operative complication, and TPN requirement. 236 infants were included, 43(18%) of whom died, and eight(3%) of whom were discharged prior to 28-days post decision to intervene surgically. Sixty infants who underwent laparotomy (27%) experienced a complication, and 67(35%) of those who were alive at 28 days were parenteral nutrition free. Following multi-variable modelling, presence of a non-cardiac congenital anomaly (aOR 5.17, 95% CI 1.9-14.1), abdominal wall erythema or discolouration at presentation (aOR 2.51, 95% CI 1.23-5.1), diagnosis of single intestinal perforation at laparotomy (aOR 3.1 95% CI 1.05-9.3), and necessity to perform a clip and drop procedure (aOR 30, 95% CI 3.9-237) were associated with increased 28-day mortality. These results can be used for national benchmarking and counselling of parents

Self-experimentation in the COVID Era: Is it morally justifiable? - A perspective

Supports Open AccessPublished version, accepted version (12 month embargo

Laparoscopic cholecystectomy in children: A systematic review and meta-analysis

BACKGROUND: Laparoscopic cholecystectomy (LC) has become the procedure of choice for the removal of gallbladder within the paediatric population. The aim of this study was to perform a systematic review and meta-analysis of the literature spanning the last 20 years to understand the indications for and safety of LCs in children. METHODS: A comprehensive search of the published English language literature from January 2000 to June 2020 was done on PubMed, MEDLINE, and Google Scholar. RESULTS: In total, 76,524 LC cases were identified from 114 studies. 78.9% of the patients were female and average age was 12 years old. Associated haematological disorders were identified in 16% of cases. The commonest indication for LC was cholelithiasis (68.4% in 66 studies), followed by cholecystitis (59.2% in 53 studies). Median operating time was 77 min. Median hospital stay was 2 days. The overall postoperative complication rate was 3.4% Major complications included bile duct injury (0.4%) and intra- or post-operative bleeding (0.9%). The conversion rate to open procedure was 2%. When comparing post-operative outcomes between emergency and elective admissions, three papers lent themselves to meta-analysis demonstrating no significant difference (p = 0.42). There was no statistically significant difference in postoperative complication rate between hot" and "cold" laparoscopic cholecystectomies (p = 0.6). CONCLUSION: This systematic review and meta-analysis is the largest collection of subjects on laparoscopic cholecystectomies in children. Laparoscopic cholecystectomy is a safe operation in children, with complication rates similar or comparable to the adult literature. Cholelithiasis, cholecystitis and biliary dyskinesia were the commonest indications for LC."The article is available via Open Access. Click on the 'Additional link' above to access the full-text.Published version, accepted version (12 month embargo), submitted versio

Can Preoperative Characteristics Predict the Outcomes of Laparoscopic Cholecystectomy?

Background: Intraoperative findings during laparoscopic cholecystectomy (LC) are highly unpredictable and operative difficulty varies from straightforward to very challenging procedures. Several studies described predictors of technical difficulty and graded intraoperative findings of LC; however, none specifically reported on the effect of such factors on clinical outcomes. This study aims to evaluate if preoperative characteristics of patients undergoing LC predict how likely they are to fail to be day case (DC). Methods: Data of patients who underwent LC from 2015 to 2017 were retrospectively analyzed. Subjects were divided into four groups, according to Nassar's classification of intraoperative difficulty. Differences in frequencies were evaluated with the the chi square and post hoc chi square tests or Fisher's exact test; logistic regression analysis was used to identify independent variables that were predictors of intraoperative complexity, postoperative morbidity, and length of stay. Results: A total of 1043 patient were included with male to female ratio of 1:2.5. Older age, male gender, and comorbidities were associated with higher Nassar score (P < .0001); Nassar 3 and 4 were predictors of postoperative morbidity (P < .05). The DC rate was 74.2% (Nassar 1), 75.8% (Nassar 2), 61.1% (Nassar 3), and 26.2% (Nassar 4), respectively. Age ≥60 years (P < .05), body mass index ≥35 (P < .05), and Nassar 3 and 4 (P < .05) were predictors of increased conversion from DC to inpatient (IP) stay. Conclusion: LC can be safely performed on a DC basis even when surgery is technically challenging. The need of IP stay can be predicted in comorbid old adult men with anticipated higher Nassar's score.Not heldPublished version, accepted version (12 month embargo), submitted versio

Factors affecting undergraduates' participation in medical research in Lagos

Background:&nbsp;The current situation regarding the scope and contribution of undergraduate medical research to the health space in Nigeria is still largely unreported in formal literature. This study examined the knowledge, attitudes, and the perceived barriers faced by medical students in Lagos toward research.&nbsp;Materials and Methods: A cross-sectional study design was conducted among all medical students in 200–600 levels of study at the College of Medicine, University of Lagos. With the aid of Self-administered questionnaires, we examined their knowledge of research and the analytical tools used in research, their attitudes and the perceived barriers to their participation in research.&nbsp;Results: The data were obtained from 221 medical students, of whom 52.9% had prior involvement in research and 14.0% and 6.3% had presented or published their research, respectively. The overall knowledge of medical research was low (21.3%) and reported barriers included lack of funding for research' (79.6%), “lack of research and biostatistics curriculum” (76.0%), “inadequate training in research methodology” (74.7%), “insufficient time allocation to undergraduate research” (73.3%), “lack of professional supervisors and proper mentoring” (58.8%), and “lack of equipped laboratory facilities to conduct research” (77.8%). Conclusion:&nbsp;Our results highlight the need for more mentored supervision and training to improve their knowledge of the principles and techniques of clinical research to increase involvement