Robotic assisted partial nephrectomy reduces warm ischemia time and improves renal function acutely compared to the traditional laparoscopic approach; A single surgeon twin centre study.

Herein, we compared peri-operative and post-operative outcomes between robotic-assisted and laparoscopic partial nephrectomy. Various reviews of the current literature have detailed the lack of single-surgeon studies in this domain. Our study featured a single surgeon experienced in both approaches to reduce this bias seen in other multi-centre studies. We retrospectively analysed data from two hospitals to compare patient demographics, tumour characteristics, peri-operative and post-operative outcomes of all partial nephrectomies undertaken by a single surgeon with extensive experience in both approaches. Statistical analysis was carried out using GraphPad prism software. Warm ischaemia time was significantly reduced in the robotic arm compared to the laparoscopic group. This translated into an improvement in acute renal function. Length of stay was also significantly reduced. This study highlights some benefits of robotic-assisted in comparison to laparoscopic partial nephrectomy. Further large-scale prospective studies would be valuable in confirming these findings and justifying their usage against their financial cost.

Boot camp de simulación en urología: perspectiva de los delegados no británicos / Urology simulation boot camp: A perspective from non-UK delegates

ANTECEDENTES: La simulación médica se ha convertido en una parte integral de la formación quirúrgica moderna. Pero a pesar de sus beneficios, todavía no ha sido ampliamente incorporada en la formación de los residentes. El Boot Camp de Simulación en Urología (BCSU) es un curso innovador de cinco días, dirigido a residentes que entran en el programa de formación del Reino Unido. Desde su implementación ha generado un creciente interés por parte de los residentes no británicos. OBJETIVO: Evaluar la experiencia de los residentes no británicos en el BCSU, tanto cuantitativa como cualitativamente, incluyendo un análisis de la evolución de sus habilidades. Diseño, marco y participantes: Este estudio retrospectivo de doble cohorte incluyó a 20 delegados de países no británicos y 76 residentes del Reino Unido que asistieron al BCSU en 2017 y 2018. Los residentes contestaron preguntas tipo test (PTT) antes y después del curso, cuestionarios de experiencia quirúrgica previos al curso y una encuesta sobre la utilidad de los conocimientos adquiridos, 12 meses después del curso. Medición de resultados y análisis estadístico: Las diferencias en las puntuaciones medias de las PTT entre los delegados del Reino Unido y los no británicos, antes y después del curso, fueron evaluadas con una prueba de T independiente. Cada habilidad de procedimientos de urología básica fue evaluada por un experto y calificada de acuerdo con una escala de Likert (1-5). La prueba de Kruskal-Wallis se utilizó para evaluar las diferencias en las puntuaciones entre ambos grupos en las técnicas de endourología. Se utilizó una escala de Likert (1-5) para calificar las respuestas de los participantes a la encuesta realizada 12 meses después del curso. RESULTADOS Y LIMITACIONES: Los alumnos del Reino Unido obtuvieron una puntuación significativamente más alta en las PTT previas al curso; sin embargo, tras la finalización del entrenamiento, no se observó ninguna diferencia significativa. No hubo diferencias entre los grupos en los tiempos de finalización de las e-BLUS (Habilidades básicas en técnicas por laparoscopia en urología), y ambos grupos mejoraron significativamente sus resultados. Una encuesta realizada 12 meses después del curso sobre la utilidad del entrenamiento durante el campamento y la evaluación cualitativa del curso por parte de los delegados extranjeros fue muy positiva. CONCLUSIONES: El BCSU es una experiencia valiosa de aprendizaje que conduce a una mejora de las habilidades técnicas y sociales de los residentes tanto del Reino Unido como de otros países

BACKGROUND: Medical simulation has become an integral part of modern-day surgical training. Despite its benefits, it is still not widely incorporated in the curriculum of trainees. The Urology Boot Camp (USBC) is an innovative 5-day course aimed at trainees entering the UK training scheme. Since its implementation, there's been increasing interest by non-UK trainees. OBJECTIVE: To assess the experiences of non-UK trainees in the USBC, both quantitatively and qualitatively, including skills progression analysis. Design, setting and participants: This double-group cohort retrospective study included 20 delegates from non-UK countries and 76 trainees from UK who attended the USBC in 2017 and 2018. Trainees undertook pre- and post-course MCQs, pre-course operative experience questionnaires and a 12-month post-course survey on the usefulness of the skills acquired. Outcome measurements and statistical analysis: Differences in mean MCQ scores between UK and non-UK delegates at baseline and after the course were assessed by the independent T-test. Each core urology procedural skill was evaluated by an expert and graded according to a Likert scale (1-5). The Kruskal-Wallis test was used to assess the differences in the scores between both groups on endourological techniques. A Likert scale (1-5) was used to grade the participants' answers to the post-course 12-month survey. Results and limitations: Trainees from UK scored significantly higher in the pre-course MCQ assessment, however after completion of the boot camp, no significant difference was noted. There were no differences between the groups at e-BLUS completion times, and both groups significantly improved their results. A 12-month post-course survey on the utility of training during the boot camp and qualitative evaluation of the course by overseas delegates was very positive. CONCLUSIONS: The USBC is a valuable learning experience that leads to improvement of technical and soft skills of UK and non-UK trainees alike

Urology simulation boot camp: A perspective from non-UK delegates. / Boot camp de simulación en urología: perspectiva de los delegados no británicos.

BACKGROUND: Medical simulation has become an integral part of modern-day surgical training. Despite its benefits, it is still not widely incorporated in the curriculum of trainees. The Urology Boot Camp (USBC) is an innovative 5-day course aimed at trainees entering the UK training scheme. Since its implementation, there's been increasing interest by non-UK trainees. OBJECTIVE: To assess the experiences of non-UK trainees in the USBC, both quantitatively and qualitatively, including skills progression analysis. DESIGN, SETTING AND PARTICIPANTS: This double-group cohort retrospective study included 20 delegates from non-UK countries and 76 trainees from UK who attended the USBC in 2017 and 2018. Trainees undertook pre- and post-course MCQs, pre-course operative experience questionnaires and a 12-month post-course survey on the usefulness of the skills acquired. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Differences in mean MCQ scores between UK and non-UK delegates at baseline and after the course were assessed by the independent T-test. Each core urology procedural skill was evaluated by an expert and graded according to a Likert scale (1-5). The Kruskal-Wallis test was used to assess the differences in the scores between both groups on endourological techniques. A Likert scale (1-5) was used to grade the participants' answers to the post-course 12-month survey. RESULTS AND LIMITATIONS: Trainees from UK scored significantly higher in the pre-course MCQ assessment, however after completion of the boot camp, no significant difference was noted. There were no differences between the groups at e-BLUS completion times, and both groups significantly improved their results. A 12-month post-course survey on the utility of training during the boot camp and qualitative evaluation of the course by overseas delegates was very positive. CONCLUSIONS: The USBC is a valuable learning experience that leads to improvement of technical and soft skills of UK and non-UK trainees alike.

Association between road accidents and low-grade hepatic encephalopathy among Sri Lankan drivers with cirrhosis: a prospective case control study.

BACKGROUND: Low-grade hepatic encephalopathy (LGHE) comprises minimal hepatic encephalopathy (MHE) and grade 1 hepatic encephalopathy. LGHE has no or minimal recognizable symptoms but has mild cognitive and psychomotor deficits. Studies in Western countries have demonstrated increased road accidents (RA) among patients with MHE. Our objective was to investigate the association between Sri Lankan LGHE phenotype and RA. STUDY DESIGN AND METHODS: A prospective, case-control study was conducted in the University Medical Unit, North Colombo Teaching Hospital, Ragama Sri Lanka. Patients with cirrhosis of any aetiology, without OHE, who had been driving during previous 1 month were included. A similar number of age matched, healthy control drivers were also enrolled. Both groups were subjected to five pencil-paper based psychometric tests used to detect LGHE in cirrhotics. Self-reported RA during the previous 1 month were recorded: categorized as 'major' when resulted in hospitalization of the involved, 'minor' when there were injuries, but not serious enough for hospitalization of the involved and 'other' when limited to damages to vehicle or environment without injuries. RESULTS: Among 55 drivers with cirrhosis and LGHE [males, median age 53 years (range 30-60)], 7 (12.7 %) reported RA compared to 6 (10.9 %) among 55 controls [males; median age 51 years (range 30-60)]. There were no 'major' accidents in either group. 2/55 (3.6 %) cases and 2/55 (3.6 %) controls reported 'minor' accidents. CONCLUSION: There was no increased frequency of RA among Sri Lankan drivers with LGHE compared to healthy controls. This is with the limitation of the study based only on self reported RA.

Morphological features of naevoid melanoma: results of a multicentre study of the International Dermoscopy Society.

BACKGROUND: Naevoid melanoma (NeM), a rare variant of melanoma, can be difficult to detect as its clinical and histopathological morphology can simulate a naevus. OBJECTIVES: To describe the clinical and dermoscopic features associated with NeM. METHODS: Lesions with a histopathological diagnosis of NeM were collected via an e-mail request sent to all members of the International Dermoscopy Society. All lesions were histopathologically reviewed and only lesions fulfilling a set of predefined histopathological criteria were included in the study and analysed for their clinical and dermoscopic features. RESULTS: Twenty-seven of 58 cases (47%) fulfilled the predefined histopathological criteria for NeM and were included in the study. Clinically, 16 of the 27 NeMs presented as a nodular lesion (59%), eight (30%) as plaque type and three (11%) as papular. Analysis of the global dermoscopic pattern identified three types of NeM. The first were naevus-like tumours (n = 13, 48%), typified by a papillomatous surface resembling a dermal naevus. In these lesions local dermoscopic features included irregular dots/globules (46%), multiple milia-like cysts (38%) and atypical vascular structures (46%). The second type were amelanotic tumours (n = 8, 30%), typified by an atypical vascular pattern (75%). The third type consisted of tumours displaying a multicomponent pattern (n = 4, 15%), characterized by classical local melanoma-specific criteria. Two lesions (7%) were classified as mixed-pattern tumours as they did not manifest any of the aforementioned patterns. CONCLUSIONS: While NeMs may be clinically difficult to differentiate from naevi, any papillomatous lesion displaying dermoscopically atypical vessels and/or irregular dots/globules should prompt consideration for the possible diagnosis of NeM.

Preventing caries in young children of immigrant Bangladeshi families in New York: perspectives of mothers and paediatricians.

OBJECTIVE: Childhood caries is common in South Asian immigrant families. Few children visit a dentist by 12 months, as recommended by current guidelines. The paediatric visit has important potential for linking children to preventive care. The aim of this study was to understand the barriers and facilitators to caries prevention for young children of immigrant Bangladeshi families in New York. Qualitative data were collected as a preliminary step in the development of an oral health counselling intervention for South Asian children. BASIC DESIGN: Qualitative interviews on child feeding and oral health prevention were conducted with Bangladeshi mothers. Qualitative interviews were conducted with paediatricians regarding their experiences with providing care. The data were analysed using standard qualitative approaches. SETTING: Paediatric practices serving low income Bangladeshi immigrants in New York City. PARTICIPANTS: 26 mothers of children aged 6-24 months receiving services in five paediatric settings and 15 paediatricians providing care in these settings. RESULTS: Both mothers and their paediatricians described risky feeding practices, communication problems and a lack of compliance. Oral health for young children was a low priority for some mothers. Most, however, were concerned about childhood caries but lacked skills or resources to decrease caries risk. CONCLUSIONS: Results support our plan to develop an empowerment-based counselling intervention to address caries risk in children. Paediatric dentists should be aware of the barriers to caries prevention in this group.

Carrier status of leptospirosis among cattle in Sri Lanka: a zoonotic threat to public health.

Leptospirosis is a zoonotic disease of global importance and one of the notifiable diseases in Sri Lanka. Recent studies on human leptospirosis have suggested that the cattle could be one of the important reservoirs for human infection in the country. However, there is a dearth of local information on bovine leptospirosis, including its implications for human transmission. Thus, this study attempted to determine the carrier status of pathogenic Leptospira spp in cattle in Sri Lanka. A total of 164 cattle kidney samples were collected from the meat inspection hall in Colombo city during routine inspection procedures conducted by the municipal veterinary surgeons. The DNA was extracted and subjected to nested PCR for the detection of leptospiral flaB gene. Amplicons were sequenced, and phylogenic distances were calculated. Of 164 samples, 20 (12.2%) were positive for flaB-PCR. Sequenced amplicons revealed that Leptospira species were deduced to L. borgpetersenii (10/20, 50%), L. kirschneri (7/20, 35%) and L. interrogans (3/20, 15%). The results indicate that a high proportion of the sampled cattle harbour a variety of pathogenic Leptospira spp, which can serve as important reservoirs for human disease.

Changes in elastic fibres in the small airways and alveoli in COPD.

Small airways are the major site of airflow obstruction in chronic obstructive pulmonary disease (COPD). This is attributed to loss of elastin in alveoli and fibrosis in small airways. In the present study, it was hypothesised that changes to elastic fibres in alveoli might be paralleled by a similar reduction in elastic fibres in small airways. Tissue blocks from patients who had lobectomy for bronchial carcinoma were studied. Patients were classified as COPD (forced expiratory volume in one second (FEV(1)) < 80% predicted, FEV(1)/forced vital capacity (FVC) < 0.7) or controls (FEV(1) > or = 80% pred, FEV(1)/FVC > or = 0.7). Elastic fibres were visualised using Elastic van Gieson staining and the volume fraction (v/f) of elastic fibres was determined as a percentage of tissue volume using point counting. Elastic fibre networks were also visualised by confocal microscopy. The v/f for elastic fibres in alveoli was 18.6% for COPD and 32.8% in controls. In the airways the v/f was 14.6% for COPD and 25.5% in controls. FEV(1)% predicted was correlated with v/f in both alveoli and small airways. The volume fraction of elastic fibres was reduced to a similar extent in small airways and alveoli in chronic obstructive pulmonary disease and both were correlated with the extent of airflow obstruction. Loss of elastic fibres in small airways may contribute to the development of airflow obstruction in chronic obstructive pulmonary disease.

Comparison of intracellular calcium signals evoked by heat and capsaicin in cultured rat dorsal root ganglion neurons and in a cell line expressing the rat vanilloid receptor, VR1.

The cloning of the receptor for capsaicin, vanilloid receptor 1, has shown it to be non-selective cation channel with a high calcium permeability which can be opened by noxious heat as well as capsaicin. Here we compare the calcium signals produced by native and recombinant capsaicin receptors when activated by either heat or capsaicin by imaging intracellular calcium levels ([Ca2+](i)) in rat dorsal root ganglion neurons and Chinese hamster ovary cells transfected with the rat vanilloid receptor, vanilloid receptor 1. Vanilloid receptor 1 transfected cells and a subset of dorsal root ganglion neurons responded to both capsaicin and to heating to 50 degrees C with rapid, substantial and reversible rises in [Ca2+](i). All except one of the dorsal root ganglion neurons responsive to capsaicin also showed sensitivity to heat, and most, but not all, heat-sensitive neurons also responded to capsaicin. Both capsaicin and heat responses were dependent on the presence of extracellular Ca2+. Non-transfected Chinese hamster ovary cells and non-responsive dorsal root ganglion neurons showed only small rises in [Ca2+](i) in response to heat which did not depend on the presence of external Ca2+. Responsive dorsal root ganglion neurons and vanilloid receptor 1 transfected cells showed a clear temperature threshold, above which [Ca2+](i) increased rapidly. This was estimated to be 42.6+/-0.3 degrees C for vanilloid receptor 1 transfected cells and 42.0+/-0.6 degrees C for dorsal root ganglion neurons. The competitive capsaicin antagonist capsazepine (10microM) abolished [Ca2+](i) increases stimulated by capsaicin in both dorsal root ganglion neurons and vanilloid receptor 1 transfected cells. However, responses to heat of a similar magnitude in the same cells were inhibited by only 37% by capsazepine (10microM). In vanilloid receptor 1 transfected cells, Ruthenium Red (10microM) blocked responses to both capsaicin and heat. These results demonstrate that imaging of [Ca2+](i) can identify dorsal root ganglion neurons which are responsive to both heat and capsaicin. They show that heat and capsaicin responses mediated by native and recombinant capsaicin receptors are similar with respect to the characteristics and pharmacology examined, suggesting that expression of recombinant vanilloid receptor 1 in cell lines accurately reproduces the properties of the native receptor.

An alternative to "brutacaine": a comparison of low dose intramuscular ketamine with intranasal midazolam in children before suturing.

OBJECTIVE: To compare the use of low dose intramuscular ketamine with high dose intranasal midazolam in children before suturing. METHODS: Altogether 102 children with simple wounds between 1 and 7 years old were allocated to the two study groups. RESULTS: Two children were excluded from the study because of deviation from the agreed protocol. The 50 children in the ketamine group were less likely to cry or need to be restrained during the procedure than those in the midazolam group (p < 0.01). The median oxygen saturation was 97% in both groups. There was no difference in the recovery behaviour and the range of time at which children were ready for discharge, although the median time for the latter was shorter in the midazolam group (75 v 82 minutes). Vomiting occurred in nine of the ketamine and four of the midazolam group. After discharge both groups had an unsteady gait (73% v 71%) which usually resolved within two hours. CONCLUSION: Intranasal midazolam (0.5 mg/kg) effectively sedated the children in that none could remember the suturing. However a significant number still had to be restrained (86% v 14%). Intramuscular ketamine (2.5 mg/kg) produced dissociative anaesthesia in the majority of cases and was the preferred drug of nurse, doctor, and parent.