Diverticulitis in the Under-40 Population.

BACKGROUND: As obesity and lifestyle factors become more prevalent in younger populations, we are diagnosing and treating diverticulitis in younger patients. In this study, the demographics, risk factors for the development, and treatment of acute diverticulitis were assessed focusing on patients under the age of 40. METHODS: A retrospective review of the electronic medical records of a cohort of subjects diagnosed with diverticulitis was performed. Inclusion criteria included patients aged 18-40 who were treated for acute diverticulitis with or without any complications. RESULTS: Of the 109 patients, 40 patients required surgery, and 69 patients were managed conservatively. Analysis showed that the Hinchey classification (p<0.001) was the strongest predictor of treatment modality. CONCLUSIONS: As the incidence of diverticulitis has increased in recent decades, so too has the frequency with which elective surgical procedures are performed as treatment. While these procedures are vital components in the management of diverticulitis, the majority of research comparing conservative versus surgical treatments has been done in patients over 50 years old. Although diverticulitis has been classically thought of as a disease of the elderly, it has become more prevalent in younger populations due to the rise of obesity and lifestyle modification in the under-40 population. Although the prevalence of treatment and diagnosis of acute diverticulitis in younger patients has risen, there is a paucity of data surrounding treatment protocols for diverticulitis in association with patient symptoms for patients under the age of 40 years old. Our study has found that there is a higher incidence of complications in diverticulitis in patients under the age of 40. Additionally, when considering the pattern of complication presentation in younger patients with complicated diverticulitis, surgical intervention might not be appropriate. The current treatment algorithm relates diverticulitis complications with surgical interventions. However, our data suggest that patients under the age of 40 presenting with abscesses or strictures may not need surgical intervention. This information could be particularly helpful in guiding physicians and younger patients in selecting the best choice of care and minimizing complications. Additionally, further research should help guide treatment protocol in this specific population of patients, as there is a lack of established guidelines pertaining to diverticulitis surrounding younger patients.

Vesicoureteral reflux severity is not associated with unplanned urinary catheterization or length of hospital stay after ureteroneocystostomy.

INTRODUCTION: Vesicoureteral reflux (VUR) is a common urologic condition affecting approximately 1% of all children. Surgical success often depends on the grade of VUR, as patients with grades 4 or 5 have been have a greater risk for postoperative complications. Unplanned urinary catheter placement (UCP) postoperatively and prolonged length of hospital stay (LOS) are indicative of unexpected complications. The association between VUR severity and such metrics remain unclear. OBJECTIVE: The study's objective is to determine if the severity of VUR is associated with higher rates of UCP or prolonged LOS after ureteroneocystostomy (UNC). STUDY DESIGN: The 2020 National Surgical Quality Improvement Program Pediatric database was analyzed for patients with VUR. A total of 1742 patients were initially evaluated with 1373 meeting exclusion criteria. The patients were divided into 3 groups of varying voiding cystourethrogram (VCUG) or radionuclide cystogram (RNC) severity: VCUG Grade 1 or RNC Grade 1 (Group A), VCUG Grade 2 or 3 or RNC Grade 2 (Group B), and VCUG Grade 4 or 5 or RNC Grade 3 (Group C). Basic statistical analysis was performed, and logistic regression was performed with both UCP and LOS as dependent variables. RESULTS: Among the 1373 patients, 2.9% were included in Group A, 32.5% were in Group B, and 64.6% were in Group C. Significant differences were found among the groups for mean age, gender, inpatient status, rate of congenital malformation, ureteral stents, and ASA classification. Regarding surgical treatment, differences were also found comparing mean operative time, LOS, laterality and type of procedure, urine culture results, rates of UTI, surgical site infections, postoperative returns to the emergency department, and unplanned procedures and catheterization. Multivariate analysis demonstrated no significant association between the rate of UCP and VUR severity, while postoperative UTI and unplanned procedure were both independent factors associated with UCP postoperatively. Additionally, postoperative UTI, ASA classification, mean operation time, ureteral stent placement, unplanned procedure, and UCP were independent factors found to contribute to LOS. CONCLUSION: Greater VUR severity does not appear to increase the need for catheterization or prolong hospital stay, while the development of a UTI postoperatively or having an additional unplanned procedure are associated with an increased likelihood of both. The postoperative course after UNC also appears to be influenced more so by other factors such as the operative approach and whether complications arise.

Association Between Adult-Onset Hearing Loss and Income: A Systematic Review.

INTRODUCTION: Hearing loss has been shown to be associated with both negative health outcomes and low socioeconomic position, including lower income. Despite this, a thorough review of the existing literature on this relationship has not yet been performed. OBJECTIVES: To evaluate available literature on the possible association between income and adult-onset hearing loss. DESIGN: A search was conducted in eight databases for all relevant literature using terms focused on hearing loss and income. Studies reporting the presence or absence of an association between income and hearing loss, full-text English-language access, and a predominantly adult population (≥18 years old) were eligible. The Newcastle-Ottawa Quality Assessment Scale was used to assess risk of bias. RESULTS: The initial literature search yielded 2994 references with three additional sources added through citation searching. After duplicate removal, 2355 articles underwent title and abstract screening. This yielded 161 articles eligible for full-text review resulting in 46 articles that were included in qualitative synthesis. Of the included studies, 41 of 46 articles found an association between income and adult-onset hearing loss. Due to heterogeneity among study designs, a meta-analysis was not performed. CONCLUSIONS: The available literature consistently supports an association between income and adult-onset hearing loss but is limited entirely to cross-sectional studies with the directionality remaining unknown. An aging population and the negative health outcomes associated with hearing loss, emphasize the importance of understanding and addressing the role of social determinants of health in the prevention and management of hearing loss.

A Systematic Review of Second-Line Treatments in Antiviral Resistant Strains of HSV-1, HSV-2, and VZV.

Drug-resistant variants of herpes simplex viruses (HSV) have been reported that are not effectively treated with first-line antiviral agents. The objective of this study was to evaluate available literature on the possible efficacy of second-line treatments in HSV and the use of second-line treatments in HSV strains that are resistant to first-line treatments. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a final search was conducted in six databases on November 5, 2021 for all relevant literature using terms related to antiviral resistance, herpes, and HSV. Eligible manuscripts were required to report the presence of an existing or proposed second-line treatment for HSV-1, HSV-2, or varicella zoster virus (VZV); have full-text English-language access; and potentially reduce the rate of antiviral resistance. Following screening, 137 articles were included in qualitative synthesis. Of the included studies, articles that examined the relationship between viral resistance to first-line treatments and potential second-line treatments in HSV were included. The Cochrane risk-of-bias tool for randomized trials was used to assess risk of bias. Due to the heterogeneity of study designs, a meta-analysis of the studies was not performed. The dates in which accepted studies were published spanned from 2015-2021. In terms of sample characteristics, the majority (72.26%) of studies used Vero cells. When looking at the viruses on which the interventions were tested, the majority (84.67%) used HSV-1, with (34.31%) of these studies reporting testing on resistant HSV strains. Regarding the effectiveness of the proposed interventions, 91.97% were effective as potential managements for resistant strains of HSV. Of the papers reviewed, nectin in 2.19% of the reviews had efficacy as a second-line treatments in HSV, amenamevir in 2.19%, methanol extract in 2.19%, monoclonal antibodies in 1.46%, arbidol in 1.46%, siRNA swarms in 1.46%, Cucumis melo sulfated pectin in 1.46%, and components from Olea europeae in 1.46%. In addition to this griffithsin in 1.46% was effective, Morus alba L. in 1.46%, using nucleosides in 1.46%, botryosphaeran in 1.46%, monoterpenes in 1.46%, almond skin extracts in 1.46%, bortezomib in 1.46%, flavonoid compounds in 1.46%, andessential oils were effective in 1.46%, but not effective in 0.73%. The available literature reviewed consistently supports the existence and potentiality of second-line treatments for HSV strains that are resistant to first-line treatments. Immunocompromised patients have been noted to be the population most often affected by drug-resistant variants of HSV. Subsequently, we found that HSV infections in this patient population are challenging to manage clinically effectively. The goal of this systematic review is to provide additional information to patients on the potentiality of second-line treatment in HSV strains resistant to first-line treatments, especially those who are immunocompromised. All patients, whether they are immunocompromised or not, deserve to have their infections clinically managed in a manner supported by comprehensive research. This review provides necessary information about treatment options for patients with resistant HSV infections and their providers.

Systematic review of academic robotic surgery curricula.

The use of robotic surgery has increased exponentially in the United States. Despite this uptick in popularity, no standardized training pathway exists for surgical residents or practicing surgeons trying to cross-train onto the platform. We set out to perform a systematic review of existing literature to better describe and analyze existing robotic surgical training curricula amongst academic surgery programs. A systematic electronic search of the PubMed, Cochrane, and EBSCO databases was performed for articles describing simulation in robotic surgery from January 2010 to May 2022. Medical Subject Heading (MeSH) terms and keywords used to conduct this search were "Robotic," "Surgery," "Robotic Surgery," "Training," "Curriculum," "Education," and "Residency Program." A total of 110 articles were identified for the systematic review. After screening the titles and abstracts, a total of 36 full-text original articles were included in this systematic review. Of these, 24 involved robotic surgery curricula designed to teach general robotic skills, whereas the remaining 12 were for teaching procedure specific skills. Of the 24 studies involving general robotic skills, 13 included didactics as a part of the curriculum, 23 utilized virtual reality trainers, 3 used inanimate tissue, and 1 used live animal models. Of the 12 papers reviewed regarding procedure specific curricula, seven involved urologic procedures (radical prostatectomy and nephrectomy), two involved general surgical procedures (colectomy and Roux-en-Y gastric bypass surgery), two involved obstetrics and gynecology procedures (hysterectomy with myomectomy and sacrocolpopexy, hysterectomy with pelvic lymphadenectomy) and one involved a cardiothoracic surgery procedure (robotic internal thoracic artery harvest). With the rapid implementation of robotic surgery, training programs have been tasked with the responsibility of ensuring their trainees are adequately proficient in the platform prior to graduation. However, due to the lack of uniformity between surgical training programs, when it comes to robotic surgical experience, a strong need persists for a standardized national robotics training curriculum.