Changes in sleep architecture after burn injury: ‘Waking up’ to this unaddressed aspect of postburn rehabilitation in the developing world

BACKGROUND:

Changes in sleep architecture are common phenomena observed in post-traumatic patients; such altered sleeping patterns have negative implications on various phases of rehabilitation. Sleep is an essential process, without which one cannot function effectively and, hence, any aberrations in the quality of sleep in such patients need to be critically analyzed.

OBJECTIVE:

To probe the quality of sleep in postburn patients at one year compared with a group of adequately matched controls.

METHODS:

Quality of sleep in postburn patients at one year was measured using the Pittsburg Sleep Quality Index questionnaire and compared with a group of adequately matched controls. Data were tabulated and subjected to statistical analysis using Pearson’s χ² test.

RESULTS:

The relationship between the postburn state and sleep disturbances was found to be statistically significant. Other relevant parameters are also highlighted and discussed.

DISCUSSION:

Sleep is one of aspect of functioning that may be least taken into account by professionals during the phase of postburn rehabilitation because more obvious threats receive preferred treatment. Unless these problems are dealt with in the postburn period, rehabilitation can never be complete.

CONCLUSION:

Postburn patients experience significant changes in sleep architecture, which need to be taken into account to enable complete rehabilitation of the patient.     

Patient-perspective quality of life after laparoscopic and open hernia repair: a controlled randomized trial

Background

Laparoscopic hernia repair accounts for 10% of all hernia surgery. Potential benefits include reduction in postoperative pain, rapid recovery, lower recurrence rate, and fewer complications. The outcomes of health-related quality of life and patient perspective after hernia repair are our aim.

Methods

Consecutive patients treated for unilateral uncomplicated groin hernia were enrolled after evaluation for inclusion. Participants were randomly distributed to receive either laparoscopic transabdominal preperitoneal repair (TAPP) (group I) or Lichtenstein repair (group II). Operative and postoperative complications, operative time, hospital stay, and late complications were assessed early postoperatively, at 4?weeks, and every 6?months thereafter. Quality of life was assessed using Short Form-36 questionnaire in the first visit (after 4?weeks).

Results

One hundred and eighty-five patients of unilateral uncomplicated groin hernia were included; 88 patients (group I) were treated by TAPP, and 97 patients were treated by Lichtenstein repair (group II) with median follow-up of 17.9?months. Mean hospital stay, mean operative time, operative and postoperative complications were similar in the two groups. Quality of life showed better and significant outcomes in group I for physical function (p?≤?0.001), role physical (p?≤?0.011), bodily pain (p?≤?0.017), general health (p?≤?0.047), and total physical health (p?≤?0.008). However, mental health showed no statistical significance in its four scales, but with better outcomes in group I. Total quality outcomes showed significantly better outcomes in group I (p?≤?0.031).

Conclusions

TAPP hernia repair technique is a safe technique with low complication rate, less postoperative body pain, and better quality-of-life outcomes compared with open technique, being well accepted from the patient’s perspective for quality of life.     

Lymphangioma of the Gallbladder in Adults: Review of the Literature and a Case Report

Introduction  

Lymphangiomas of the gallbladder in adults are extremely rare with only 10 cases published worldwide to date.     

Inverted papilloma of ureter: a rare cause of hydronephrosis

A case of hydronephrosis with a rare underlying cause in a 35 years old male is described. He reported with pain in the left lumbar region with a past history of left ureterolithotomy. The ultrasound and IVU studies were suggestive of left hydronephroureter. CT Scan showed left hydronephroureter with narrowing at the lower end of left ureter. Ureterorenoscopy (URS) confirmed polypoidal lesions in the left lower ureter, completely obliterating the lumen and involving the whole circumferential wall of the lower ureter. The biopsy of the lesion revealed an inflammatory polyp. Accordingly open surgical intervention was planned. Excision of the lower third of left ureter with ureteric reimplantation was done with a Boari flap. The histopathology report of the lower third of ureter confirmed inverted papilloma of ureter. The patient made a smooth postoperative recovery.     

Simplifying four-strand flexor tendon repair using double-stranded suture: a comparative ex vivo study on tensile strength and bulking

We have compared a simple four-strand flexor tendon repair, the single cross-stitch locked repair using a double-stranded suture (dsSCL) against two other four-strand repairs: the Pennington modified Kessler with double-stranded suture (dsPMK); and the cruciate cross-stitch locked repair with single-stranded suture (Modified Sandow). Thirty fresh frozen cadaveric flexor digitorum profundus tendons were transected and repaired with one of the core repair techniques using identical suture material and reinforced with identical peripheral sutures. Bulking at the repair site and tendon-suture junctions was measured. The tendons were subjected to linear load-to-failure testing. Results showed no significant difference in ultimate tensile strength between the Modified Sandow (36.8 N) and dsSCL (32.6 N) whereas the dsPMK was significantly weaker (26.8 N). There were no significant differences in 2 mm gap force, stiffness or bulk between the three repairs. We concluded that the simpler dsSCL repair is comparable to the modified Sandow repair in tensile strength, stiffness and bulking.     

Tumor Infiltration in the Medial Resection Margin Predicts Survival After Pancreaticoduodenectomy for Pancreatic Ductal Adenocarcinoma

Background

Microscopic tumor involvement (R1) in different surgical resection margins after pancreaticoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC) has been debated.

Methods

Clinico-pathological data for 258 patients who underwent PD between 2001 and 2010 were retrieved from a prospective database. The rates of R1 resection in the circumferential resection margin (pancreatic transection, medial, posterior, and anterior surfaces) and their prognostic influence on survival were assessed.

Results

For PDAC, the R1 rate was 57.1?% (48/84) for any margin, 31.0?% (26/84) for anterior surface, 42.9?% (36/84) for posterior surface, 29.8?% (25/84) for medial margin, and 7.1?% (3/84) for pancreatic transection margin. Overall and disease-free survival for R1 resections were significantly worse than those for R0 resection (17.2 vs. 28.7?months, P?=?0.007 and 12.3 vs. 21.0?months, P?=?0.019, respectively). For individual margins, only medial positivity had a significant impact on survival (13.8 vs. 28.0?months, P?<?0.001), as opposed to involvement in the anterior (19.7 vs. 23.3?months, P?=?0.187) or posterior margin (17.5 vs. 24.2?months, P?=?0.104). Multivariate analysis demonstrated R0 medial margin was an independent prognostic factor (P?=?0.002, HR?=?0.381; 95?% CI 0.207?C0.701).

Conclusion

The medial surgical resection margin is the most important after PD for PDAC, and an R1 resection here predicts poor survival.     

Men suffer more complications from diabetes than women despite similar glycaemic control and a better cardiovascular risk profile: the ADCM study 2008

BackgroundGender differences in glycaemic control and diabetes’ complications have been well studied overseas but not locally. Gender is one of the non-modifiable factors for the diabetes patient but it is an important factor for effective personalized diabetes care. This paper examined the gender differences in glycaemic control and diabetes’ complications.MethodsThis was a registry-based observational study from May–December 2008. An online standard case record form was available for site data providers to register their diabetes patients aged 18 years old and above annually. Demographic data, diabetes duration, treatment modalities, as well as various risk factors and diabetes complications were reported. Multivariate analysis was performed.ResultsA total of 20,646 diabetes patients were included. The majority (99.2%) had been diagnosed with type 2 diabetes mellitus (T2D); 42.8% of the sample were men; 57.1% were Malay. The mean age was 58.0 years (standard deviation (SD) = 11.49) with 77.6% of the sample being 50 years old and above. Despite similar diabetes control (HbA1c < 6.5%), females suffered more microvascular complications (estimated glomerular filtration rate (eGFR) <60 mls/min: X² = 753.54, P = <0.001) while men suffered more from macrovascular complications (ischaemic heart disease (X² = 57.61, P = <0.001) and stroke (X² = 13.87, P = <0.001)). Multivariate logistic regression analyses showed that T2D men were more likely to suffer from stroke (odds ratio (OR) = 1.21, 95% confidence interval (CI) = 0.89–1.64), ischaemic heart disease (OR = 1.55, CI = 1.35–1.78) and nephropathy (OR = 1.59, CI = 1.44–1.75).ConclusionWe observed that men suffered more diabetes-related complications despite similar glycaemic control and better risk factor control. This finding requires further verification from future studies.