¿Afecta la estimulación del macho cabrío el rendimiento reproductivo de las cabras sincronizadas con esponjas de acetato de medroxiprogesterona (MAP)?

This investigation was executed to determine effect of buck exposure on estrus response, onset of standing estrus, ovulation rate, conception rate and pregnancy rate in goats synchronized with medroxyprogesterone acetate (MAP) sponges. Sponges were placed inside the vagina for fifteen days in buck exposed and isolated groups. Post sponge withdrawal, estrus activities were continuously observed. The interval between sponge withdrawal and the onset of standing estrus were 32.3±10 h (18-51 h) and 45.2±10.9 h (27-51h) in buck isolated and exposed group respectively (p<0.05). Ovulation and conception rates were confirmed by serum progesterone level using radioimmunoassay. Ovulation rates were 100% in both groups and conception rates were 93% and 100% in buck exposed and in isolated group respectively (p>0.05). Pregnancies were confirmed by ultrasound on day 35 post mating which were 93%, was and 69% in buck exposed and isolated group respectively (p>0.05). Based upon the evidence, it was inference that post sponge removal sudden buck exposure cause markedly earlier estrus onset while the continuous buck exposure was unable to show significantly impact on conception and pregnancy rates compare to isolated group.Esta investigación se llevó a cabo para determinar el efecto de la exposición al macho cabrío sobre la respuesta al estro, el inicio del estro permanente, la tasa de ovulación, la tasa de concepción y la tasa de preñez en cabras sincronizadas con esponjas de acetato de medroxiprogesterona (MAP). Se colocaron esponjas dentro de la vagina durante quince días en grupos aislados y expuestos a machos. Después de retirar la esponja, se observaron continuamente las actividades estrales. El intervalo entre la retirada de la esponja y el inicio del estro permanente fue de 32.3±10 h (18-51 h) y 45.2±10.9 h (27-51 h) en el grupo de machos aislados y expuestos respectivamente (p<0.05). Las tasas de ovulación y concepción se confirmaron mediante el nivel de progesterona sérica mediante radioinmunoensayo. Las tasas de ovulación fueron del 100% en ambos grupos y las tasas de concepción fueron del 93% y del 100% en los machos expuestos y en el grupo aislado, respectivamente (p>0.05). Los embarazos fueron confirmados por ultrasonido en el día 35 después del apareamiento, que fueron 93%, fue y 69% en el grupo expuesto y aislado de machos, respectivamente (p>0.05). Sobre la base de la evidencia, se infirió que la exposición repentina al macho después de la extracción de la esponja provocó un inicio del estro notablemente más temprano, mientras que la exposición continua al macho no pudo mostrar un impacto significativo en las tasas de concepción y preñez en comparación con el grupo aislado

Comparison of Post-operative mortality between early and late weekdays surgery

Objective: To compare the mortality rates between surgeries done on early weekdays (Monday to Thursday) to those conducted on late weekdays and weekends (Friday to Sunday). Methodology: This case control study was conducted at the Department of Surgery in Pakistan Institute of Medical Sciences Islamabad. Hospital record of all adult patients who had undergone surgery over a period of one year from June 2017 to May 2018 was obtained and divided according to the day of surgery into weekdays surgery group and weekend surgery group for analysis. Results: A total of 772,997 patients presented in the OPD and 441,321 patients presented in the Emergency and Accident (EAC) department in one year with a male to female ratio of 1.63. Day to day breakdown revealed that more patients presented on Mondays and Saturdays. A total of 2,832 surgeries were performed in one year, out of which 62.46% (n=1,769) were performed on weekdays and 37.54% (n=1,063) were performed on weekends. Higher risk surgeries and surgeries with more operative complexity were performed on weekends as compared to weekdays however in both groups most of the surgeries fall in Intermediate risk. More deaths were seen on weekdays as compared to weekends in General surgery wards and ICU (statistically insignificant P=0.1446) however day of surgery caused no difference in mortality on Neurosurgery and other departments. Conclusion: No significant difference was observed in mortality based on surgeries performed on early or late weekdays

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

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Pooled analysis of who surgical safety checklist use and mortality after emergency laparotomy

Background: The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods: In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results: Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89⋅6 per cent) compared with that in countries with a middle (753 of 1242, 60⋅6 per cent; odds ratio (OR) 0⋅17, 95 per cent c.i. 0⋅14 to 0⋅21, P < 0⋅001) or low (363 of 860, 42⋅2 percent; OR 0⋅08, 0⋅07 to 0⋅10, P < 0⋅001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference −9⋅4 (95 per cent c.i. −11⋅9 to −6⋅9) per cent; P < 0⋅001), but the relationship was reversed in low-HDI countries (+12⋅1 (+7⋅0 to +17⋅3) per cent; P < 0⋅001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0⋅60, 0⋅50 to 0⋅73; P < 0⋅001). The greatest absolute benefit was seen for emergency surgery in low-and middle-HDI countries. Conclusion: Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries

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

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Burnout and Ways to Reduce It among Postgraduate Residents of Neurosurgery

Objective:&nbsp;&nbsp;The objective of the study was to know the rate of burnout and to explore the potential means to reduce burnout among neurosurgery residents. Methods:&nbsp;&nbsp;This mixed-method explanatory sequential study was conducted at the Neurosurgery department of Lady Reading Hospital, Peshawar from July to September 2021. In the first phase of the study, burnout was assessed in postgraduate residents of Neurosurgery and its relationship with different demographic factors (quantitative). In the second phase focus group discussion with the residents were conducted to explore the ways to reduce burnout in residents (qualitative). Results:&nbsp;&nbsp;23 residents participated in the study. Burnout was found in 17 (73.9%) residents. The relationship between different demographic factors with burnout was not statistically significant. The results of the FGDs showed that the reasons behind burnout are; more workload, decrease interaction with the seniors, extra burden on trainees, conflicts with patient’s attendants, increased entries in the HMS system, wrong referrals from the periphery, decrease security of doctors in high-risk areas and lack of ownership by the seniors. The postgraduate residents suggested different ways to reduce burnout; including proper security of residents and all the staff, appreciation of the performance, peripheries should be developed and functional, SOPs for every part of the training should be advised, and proper training of the ancillary staff. Conclusion:&nbsp;&nbsp;The majority of the neurosurgery residents were burnout and there is no statistically significant difference between different demographic factors related to burnout. This study also provided preliminary ways to reduce burnout among neurosurgery residents

Formation of Professional Identity in Pediatric Residents Working in Military Hospitals

Background: Professionalism is one of the basic attributes of a doctor patient relationship. During development of professional identity, doctors interact with their community which provides opportunity for mutual negotiation of identity and they keep improving their abilities. The development of this professional identity is a difficult skill indoctors working in Military hospitals. Aim: To explore development of Professional Identity in doctors working in pediatrics department of military hospital. Study design: Qualitative study based on phenomenological design. Place and duration: The study was conducted in Combined Military Hospital Quetta from Jan 2022 to June 2022. Methodology: All doctors serving in uniform in paediatrics department were included.In depth interviews were taken, recorded, transcribed and anonymized. Data interpreted manually, common themes originating from interviews were analysed and results formulated. Results: Six themes were found from transcript. Participants discussed about their professional life during service in military and road to gain professional excellence. Conclusion: Military residents working in paediatrics department have dual roles of serving the nation during peace as well as war and natural disasters. Keywords: Professionalism, Professional Identity, Paediatrics, Military.</jats:p