Groin recurrence in patients with early vulvar cancer following superficial inguinal node dissection

AbstractObjectiveTo investigate the causes of groin recurrence in patients with vulval cancer who previously had negative nodes following superficial inguinal node dissection (SIND).Material and methodsForty-one patients with squamous cell carcinoma of the vulva (stage I or II) were operated upon. The primary treatment was wide local excision with 2cm safety margin and superficial inguinal lymphadenectomy. Six patients had ipsilateral and one patient had bilateral groin recurrence. Those patients were subjected to deep inguinal node dissection (one patient required bilateral node dissection).ResultsThe mean age at time of diagnosis was 59years (range 51–68). The median follow-up period for all patients was 63months (range 24–71) and that of the recurrent cases was 20months (range 12–38). The mean depth of invasion of the recurrent cases was 5.5mm (range 5–5.9mm) and the mean diameter of the primary tumor in recurrent cases was 3.8cm (range 3–4.5cm). All recurrent cases had a high grade of the primary tumor. The median interval to recurrence was 21months (range 12–57). The groin recurrence rate after negative SIND was 17% (7/41 patients).The mean number of nodes resected per groin was eight (range 1–17). The nodes ranged in size from 0.2 to 4.0cm.ConclusionCarcinoma of the vulva with the following criteria (size of tumor is greater than 3cm, depth of invasion greater than 5mm, and high grade tumors) is at high risk of recurrence

Anemia prevalence in women of reproductive age in low- and middle-income countries between 2000 and 2018

Anemia is a globally widespread condition in women and is associated with reduced economic productivity and increased mortality worldwide. Here we map annual 2000–2018 geospatial estimates of anemia prevalence in women of reproductive age (15–49 years) across 82 low- and middle-income countries (LMICs), stratify anemia by severity and aggregate results to policy-relevant administrative and national levels. Additionally, we provide subnational disparity analyses to provide a comprehensive overview of anemia prevalence inequalities within these countries and predict progress toward the World Health Organization’s Global Nutrition Target (WHO GNT) to reduce anemia by half by 2030. Our results demonstrate widespread moderate improvements in overall anemia prevalence but identify only three LMICs with a high probability of achieving the WHO GNT by 2030 at a national scale, and no LMIC is expected to achieve the target in all their subnational administrative units. Our maps show where large within-country disparities occur, as well as areas likely to fall short of the WHO GNT, offering precision public health tools so that adequate resource allocation and subsequent interventions can be targeted to the most vulnerable populations.Peer reviewe

Anemia prevalence in women of reproductive age in low- and middle-income countries between 2000 and 2018

Anemia is a globally widespread condition in women and is associated with reduced economic productivity and increased mortality worldwide. Here we map annual 2000–2018 geospatial estimates of anemia prevalence in women of reproductive age (15–49 years) across 82 low- and middle-income countries (LMICs), stratify anemia by severity and aggregate results to policy-relevant administrative and national levels. Additionally, we provide subnational disparity analyses to provide a comprehensive overview of anemia prevalence inequalities within these countries and predict progress toward the World Health Organization’s Global Nutrition Target (WHO GNT) to reduce anemia by half by 2030. Our results demonstrate widespread moderate improvements in overall anemia prevalence but identify only three LMICs with a high probability of achieving the WHO GNT by 2030 at a national scale, and no LMIC is expected to achieve the target in all their subnational administrative units. Our maps show where large within-country disparities occur, as well as areas likely to fall short of the WHO GNT, offering precision public health tools so that adequate resource allocation and subsequent interventions can be targeted to the most vulnerable populations

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017

A double burden of malnutrition occurs when individuals, household members or communities experience both undernutrition and overweight. Here, we show geospatial estimates of overweight and wasting prevalence among children under 5 years of age in 105 low- and middle-income countries (LMICs) from 2000 to 2017 and aggregate these to policy-relevant administrative units. Wasting decreased overall across LMICs between 2000 and 2017, from 8.4% (62.3 (55.1–70.8) million) to 6.4% (58.3 (47.6–70.7) million), but is predicted to remain above the World Health Organization’s Global Nutrition Target of <5% in over half of LMICs by 2025. Prevalence of overweight increased from 5.2% (30 (22.8–38.5) million) in 2000 to 6.0% (55.5 (44.8–67.9) million) children aged under 5 years in 2017. Areas most affected by double burden of malnutrition were located in Indonesia, Thailand, southeastern China, Botswana, Cameroon and central Nigeria. Our estimates provide a new perspective to researchers, policy makers and public health agencies in their efforts to address this global childhood syndemic

Anemia prevalence in women of reproductive age in low- and middle-income countries between 2000 and 2018

Anemia is a globally widespread condition in women and is associated with reduced economic productivity and increased mortality worldwide. Here we map annual 2000–2018 geospatial estimates of anemia prevalence in women of reproductive age (15–49 years) across 82 low- and middle-income countries (LMICs), stratify anemia by severity and aggregate results to policy-relevant administrative and national levels. Additionally, we provide subnational disparity analyses to provide a comprehensive overview of anemia prevalence inequalities within these countries and predict progress toward the World Health Organization’s Global Nutrition Target (WHO GNT) to reduce anemia by half by 2030. Our results demonstrate widespread moderate improvements in overall anemia prevalence but identify only three LMICs with a high probability of achieving the WHO GNT by 2030 at a national scale, and no LMIC is expected to achieve the target in all their subnational administrative units. Our maps show where large within-country disparities occur, as well as areas likely to fall short of the WHO GNT, offering precision public health tools so that adequate resource allocation and subsequent interventions can be targeted to the most vulnerable populations

Replacement of the Distal Radius after Resection of Primary Bone Tumors Using Nonvascularized Proximal Fibular Graft

ABSTRACT Back ground and purpose: The distal radius and its articulations clearly have a vital role in the functional ability of the hand and the wrist. The treatment of tumors of the radius, therefore, needs to achieve a satisfactory clearance of the lesions while also preserving as much wrist functions as possible. Material and methods: The study included five patients with primary and recurrent giant cell tumors and one patient with malignant fibrous histiocytoma of the distal radius. Those patients were subjected to resection of the distal radius and replacement with osteoarticular autogenous proximal fibular grafts. The mean follow up period was 21 months. Results: Bone graft healing occured at a mean of 6 months. The mean postoperative wrist flexion was 18 degrees, extension was 24 degrees, pronation was 62 degrees and supination was 46 degrees. Conclusion: Resection of tumours of the distal radius followed by replacement with nonvascularized proximal fibular graft is an effective way to manage these tumours

Synthesis, Characterization and Aqueous Properties of a Newly Prepared Lignin-based Graft Copolymer as a Drilling Mud Additiv

This study involves a free radical graft copolymerization of lignosulfonates (LS) with 2-propenamide (Am), propenoic acid (AA), and methylene-bis-acrylamide (MBAm) in the presence of hydrogen peroxide as the initiator to produce LS-g-p(AA-co-Am-co-MBAm) copolymer. The resulting copolymer was characterized by various techniques such as infrared spectroscopy (FTIR) and thermogravimetric analysis (TGA). Viscosity measurements of the copolymer solution, pH values, solid content, gravimetric conversion and mud properties were determined. The effect of various experimental conditions on the characteristics of the developed copolymer was also investigated. Moreover, the performance of the resulting LS-g-p(AA-co-Am-co-MBAm copolymer as a pH controlling agent for water-base mud was evaluated. The obtained results revealed that the newly synthesized copolymer has a remarkable pH control performance at different temperatures

Association between chemokine receptor 3T51C gene polymorphism and different clinical asthma phenotypes in Egyptian asthmatic children

Background Asthma is a heterogeneous disorder, which is affected by interaction between genes and the surrounding environment. Chemokine receptor 3 (CCR3) which is expressed over eosinophils and Th2 lymphocytes has a significant role in chemoattraction of those cells to inflammatory sites which symbolizes a key mechanism in asthma. Aim A trial to detect the association between CCR3 T51C gene polymorphism and different asthma phenotypes (allergic march phenotype, cough-predominant asthma phenotype, and wheeze-predominant asthma phenotype). Patients and methods A case–control study was conducted comprising 60 asthmatic patients and 100 healthy controls. Asthmatic children were divided into three groups of 20 patients each, group 1 allergic march phenotype (wheeze asthma phenotype with allergic rhinitis and/or atopic dermatitis), group 2 cough-predominant asthma phenotype, and group 3 wheeze-predominant asthma phenotype. The included cases and controls underwent total serum immunoglobulin E (IgE) using the enzyme-linked immunosorbent assay technique, peripheral eosinophilic percent, and PCR-restriction fragment length polymorphism for CCR3 T51C gene polymorphism. Results Asthmatic children showed significant increase in crowding index, family history of bronchial asthma, parental smoking, parental consanguinity, and total serum IgE than controls. Also, the CCR3 T51C gene polymorphism was found in Egyptian asthmatic children but no significant association concerning this polymorphism and different clinical asthma phenotypes was detected. Conclusion In conclusion, allergic march phenotype showed significant higher frequency with positive family history of asthma when compared with cough and wheezy asthma phenotypes. Also, parental consanguinity showed higher frequency in cough phenotype compared with allergic march phenotype. Furthermore, the CCR3 T51C gene polymorphism is found to be present in Egyptian asthmatic children, but there is no significant association between CCR3 T51C gene polymorphism and different asthma phenotypes. So, larger scale studies are needed. However, the TT genotype showed higher frequency in the studied phenotypes compared with CC and CT genotypes while asthmatic cases with the CC genotype showed higher total serum IgE compared with those with TT and CT genotypes