The impact of circular stapler size on the risk of anastomotic stricture following total mesorectal excision in rectal cancer patients: A retrospective cross-sectional study.

Introduction: Colorectal cancer (CRC) surgery complications are a major issue affecting morbidity and mortality rates. Anastomotic stricture, which occurs in almost 30% of patients after surgery for rectal cancer, is one of the most serious but underreported side effects. In this study, we tried to assess the effect of stapler size on anastomotic stricture rate. Materials and Methods: At our facility, all patients underwent low anterior resections (LAR) performed using an open laparotomy technique. A contour-curved stapler and an end-to-end anastomosis (EEA) circular stapler were used in the double stapling technique (DST). All patients also underwent a protective loop ileostomy. Patients who developed stricture following leakage were excluded. Results: This study comprised a total of 173 rectal cancer patients. A 29-mm circle stapler was used to anastomose 77 patients (44.5%), while a 31-mm circular stapler was used to anastomose 96 patients (55.5%). Six individuals experienced strictures; two had a 29 mm stamper and four (4.4%) had a 31 mm one. There was no significant difference between the two groups (p:0.575). On aggregate, 8 patients experienced leakage; 3 (3.8%) of these patients received treatment with a 29 mm stapler, whereas 5 (5.2%) received treatment with a 31 mm stapler. Conclusion: this study found no statistically significant difference in the stricture rates and stapler size. The findings of this study provide credibility to the notion that in rectal cancer patients having LAR, strictures can be safely avoided by performing the anastomoses with both staplers.

Burnout in Surgical Residents of an Academic Hospital in Iran: A Cross-Sectional Study.

BACKGROUND: Academic burnout has adverse effects on residents' professional behavior as well as personal aspects of their lives and can ultimately affect their performance in the workplace. This study aimed to determine the prevalence of burnout among surgical residents in Imam Khomeini hospital and the relationship between factors such as sex, marital status, living place, specialized field, and anxiety with burnout. METHODS: We conducted a cross-sectional study in 2021. A validated version of the Maslach burnout inventory for students (MBI-SS), the Beck Anxiety Inventory, and a questionnaire on contributing factors were used. Statistical analysis for the prevalence of burnout and comparison between scores of groups were performed. RESULTS: Of 130 surgical residents who answered the survey, 26% met the criteria for burnout. There was a significantly higher prevalence of burnout among PGY1 residents. Of these residents, 85.4% and 62.3% had high scores on emotional exhaustion and cynicism, respectively. We observed an association between different surgical disciplines and anxiety with burnout. CONCLUSIONS: The prevalence of burnout among surgical residents was notable and higher than expected. There was a reliable association between anxiety and burnout. A longitudinal study on a group of students with a consideration of associated factors is suggested.

Association of fruits, vegetables, and fiber intake with COVID-19 severity and symptoms in hospitalized patients: A cross-sectional study.

Background and aims: Fruits and vegetables are rich in fiber and a good source of anti-inflammatory and immune-boosting vitamins, minerals, and antioxidants. We investigated the association between fruits, vegetables, and fiber intake and severity of COVID-19 and related symptoms in hospitalized patients. Methods: A total of 250 COVID-19 hospitalized patients aged 18 to 65 years were recruited for this cross-sectional study in Kashan, Iran, between June and September of 2021. Dietary intakes were assessed using an online validated 168-item food frequency questionnaire (FFQ). COVID-19 severity and symptoms were evaluated using the National Institutes of Health (NIH) COVID-19 Treatment Guidelines. Moreover, we examined COVID-19 symptoms, inflammatory biomarkers, and additional factors. Results: The mean age of participants was 44.2 ± 12.1 years, and 46% had severe COVID-19. Patients with higher consumption of fruits (OR: 0.28; 95% CI: 0.14-0.58, P-trend <0.001), vegetables (OR: 0.33; 95% CI: 0.16-0.69, P-trend <0.001), and dietary fiber (OR: 0.25; 95% CI: 0.12-0.53, P-trend <0.001) had lower odds of having severe COVID-19. In addition, they had shorter hospitalization and convalescence periods, lower serum C-reactive protein (CRP), and a reduced risk of developing COVID-19 symptoms such as sore throat, nausea and vomiting, dyspnea, myalgia, cough, weakness, fever, and chills. Conclusion: Higher consumption of fruits, vegetables, and fiber was inversely linked with COVID-19 severity, clinical symptoms, hospitalization and convalescence duration, and CRP concentrations. The results should be interpreted with caution in light of the limitations, and prospective cohort studies are required to further evaluate these findings.

The impact of the COVID-19 pandemic on surgical education: A survey and narrative review.

Background: Since the emergence of the COVID-19 pandemic, medical education has been a concerning issue, especially in surgical fields. Due to the postponement of many elective surgeries and even alternations in the pattern of emergent surgeries, concerns have been raised about whether residents of surgical disciplines are experienced enough after graduation or not. We aimed to describe the impact of the COVID-19 pandemic on surgical residency training in different fields. Materials and methods: We conducted a cross-sectional study with a 20-item questionnaire on residents of surgical disciplines from three different educational hospitals of Tehran University of Medical Sciences, Iran in 2020. In addition, we reviewed the current literature regarding the impact of COVID-19 pandemic on surgical education worldwide. Results: Our survey, with a response rate of 56.8% demonstrated significant reduction in the time spent in elective surgeries, surgical clinics and even in emergent surgeries for residents. Besides, it has reported that significant time has been spent in COVID 19 wards which resulted in decreased satisfaction of educational activities. Conclusions: The impacts of COVID 19 pandemic on surgical education are significant and inevitable. Thus, we must integrate novel educational methods in surgical curriculum to optimize training and minimize the adverse effects of the pandemic on surgical education.

Higher Adherence to the Mediterranean Dietary Pattern Is Inversely Associated With Severity of COVID-19 and Related Symptoms: A Cross-Sectional Study.

Background and Aims: Adherence to the Mediterranean diet (MD) has been associated with a decreased risk of developing a variety of chronic diseases that are comorbidities in COVID-19 patients. However, its association to the severity and symptoms of COVID-19 are still unknown. This study aimed to examine the association between adherence to the MD pattern and COVID-19 severity and symptoms in Iranian hospitalized patients. Methods: In this cross-sectional study, 250 COVID-19 patients aged 18 to 65 were examined. We employed a food frequency questionnaire (FFQ) to obtain data on dietary intake of participants in the year prior to their COVID-19 diagnosis. COVID-19 severity was determined using the National Institutes of Health's Coronavirus Disease 2019 report. Additionally, symptoms associated with COVID-19, inflammatory markers, and other variables were evaluated. The scoring method proposed by Trichopoulou et al. was used to assess adherence to the MD. Results: The participants' mean age was 44.1 ± 12.1 years, and 46% of them had severe COVID-19. Patients who adhered more closely to the MD had lower serum C-reactive protein levels (7.80 vs. 37.36 mg/l) and erythrocyte sedimentation rate (14.08 vs. 42.65 mm/h). Those with the highest MD score were 77% less likely to have severe COVID-19 after controlling for confounding variables. The MD score was also found to be inversely associated with COVID-19 symptoms, including dyspnea, cough, fever, chills, weakness, myalgia, nausea and vomiting, and sore throat. Conclusion: Higher adherence to the MD was associated with a decreased likelihood of COVID-19 severity and symptoms, as well as a shorter duration of hospitalization and convalescence, and inflammatory biomarkers.

A huge preperitoneal collection following acute necrotizing pancreatitis: A case report and the management approach.

Introduction and importance: Fluid collection is a critical complication of acute necrotizing pancreatitis. It is usually formed near the pancreas, but unusual collection sites have also been reported. Anterior extraperitoneal or preperitoneal collections following acute pancreatitis are rare and must be differentiated from pancreatic ascites, which is a collection of fluid in peritoneal cavity. Case presentation: A 68-year-old man with a suspected pancreatic mass presented to the emergency department, complaining of abdominal pain and gradual abdominal distention. He had experienced epigastric pain, nausea, vomiting, progressive abdominal distention, and icterus for two weeks prior to admission. An abdominopelvic CT scan revealed extensive necrotizing pancreatitis with a prominent extraperitoneal collection. The collection had extended from the retroperitoneal space to the anterior extraperitoneal or preperitoneal space and had pushed the abdominal viscera backward. We managed the patient with the "Step-up" approach, and the patient was discharged after four weeks. Clinical discussion & conclusion: Preperitoneal fluid collection can rarely occur following acute necrotizing pancreatitis. Here, we suggested two possible routes for fluid migration from the retroperitoneum to the preperitoneal space. Using minimally invasive techniques such as percutaneous drainage of peripancreatic collections could reduce morbidity and mortality in critically ill patients diagnosed with necrotizing pancreatitis.

The Association of Seasonal Variations and COVID-19 Clinical Features: A Comparative Study on the Fourth and Fifth Waves.

Purpose: The COVID-19 pandemic has overwhelmed many healthcare systems. Seasonality is a feature of several infectious diseases. Studies regarding the association of seasonal variations and COVID-19 have shown controversial results. Therefore, we aimed to compare COVID-19 characteristics and survival outcomes between the fourth and fifth waves in Iran, which corresponded to spring and summer, respectively. Methods: This is a retrospective study on the fourth and fifth COVID-19 waves in Iran. One hundred patients from the fourth and 90 patients from the fifth wave were included. Data from the baseline and demographic characteristics, clinical, radiological, and laboratory findings, and hospital outcomes were compared between the fourth and fifth COVID-19 waves in hospitalized patients in Imam Khomeini Hospital Complex, Tehran, Iran. Results: The fifth wave patients were more likely to present with gastrointestinal symptoms than the patients from the fourth wave. Moreover, patients in the fifth wave had lower arterial oxygen saturation on admission (88% vs. 90%; P = 0.026), lower levels of WBCs (neutrophils and lymphocytes) (6300.00 vs. 8000.00; P = 0.004), and higher percentages of pulmonary involvement in the chest CT scans (50% vs. 40%; P < 0.001). Furthermore, these patients had longer hospital stays than their fourth-wave counterparts (7.00 vs. 5.00; P < 0.001). Conclusions: Our study indicated that patients in the summer COVID-19 wave were more likely to present with gastrointestinal symptoms. They also experienced a more severe disease in terms of peripheral capillary oxygen saturation, percentages of pulmonary involvement in CT scans, and length of hospital stay.

Predicting Risk Score for Mechanical Ventilation in Hospitalized Adult Patients Suffering from COVID-19.

BACKGROUND: COVID-19 has become a pandemic since December 2019, causing millions of deaths worldwide. It has a wide spectrum of severity, ranging from mild infection to severe illness requiring mechanical ventilation. In the middle of a pandemic, when medical resources (including mechanical ventilators) are scarce, there should be a scoring system to provide the clinicians with the information needed for clinical decision-making and resource allocation. OBJECTIVES: This study aimed to develop a scoring system based on the data obtained on admission, to predict the need for mechanical ventilation in COVID-19 patients. METHODS: This study included COVID-19 patients admitted to Sina Hospital, Tehran University of Medical Sciences from February 20 to May 29, 2020. Patients' data on admission were retrospectively recruited from Sina Hospital COVID-19 Registry (SHCo-19R). Multivariable logistic regression and receiver operating characteristic (ROC) curve analysis were performed to identify the predictive factors for mechanical ventilation. RESULTS: A total of 681 patients were included in the study; 74 patients (10.9%) needed mechanical ventilation during hospitalization, while 607 (89.1%) did not. Multivariate logistic analysis revealed that age (OR,1.049; 95% CI:1.008-1.091), history of diabetes mellitus (OR,3.216; 95% CI:1.134-9.120), respiratory rate (OR,1.051; 95% CI:1.005-1.100), oxygen saturation (OR,0.928; 95% CI:0.872-0.989), CRP (OR,1.013; 95% CI:1.001-1.024) and bicarbonate level (OR,0.886; 95% CI:0.790-0.995) were risk factors for mechanical ventilation during hospitalization. CONCLUSIONS: A risk score has been developed based on the available data within the first hours of hospital admission to predict the need for mechanical ventilation. This risk score should be further validated to determine its applicability in other populations.