Introduction: The gold standard treatment for high risk upper tract urothelial cancers is radical... more Introduction: The gold standard treatment for high risk upper tract urothelial cancers is radical nephroureterectomy. Little evidence exists specifically directed for octogenarians with this disease, therefore we highlight our centre’s outcomes and compare to current literature. Methods: Demographic, operative and postoperative data were collected on all octogenarian patients who underwent minimally invasive radical nephroureterectomy between 2010 and 2018 in a single centre. Outcomes including intraoperative and postoperative complications, disease recurrence rates and survival data were analysed. A literature search was performed, with six included articles of cases series and retrospective cohort studies after screening of full manuscripts. Results: Twenty-three patients of average age 82.6 years (range 80–85) were included. Length of stay was median 10 days (range 5–53). Six patients (25%) had postoperative complications ranging from Clavien–Dindo classification 2–3. Eight patie...
Background Surgical oncology services in the UK have been impacted by the COVID-19 pandemic. Var... more Background Surgical oncology services in the UK have been impacted by the COVID-19 pandemic. Various strategies have been employed in an attempt to continue cancer resectional surgery during the pandemic. This study examined our institution’s experience and outcomes with a newly established Super Green ERAS pathway for oesophago-gastric (OG) cancer resections during the pandemic. Methods A retrospective cohort study of consecutive patients who had a resection for OG cancer performed over a 12-month period beginning from the date of the first UK National Lockdown of 23 March 2020. Barring two intervals each lasting 3 weeks, urgent elective cancer surgery continued on our mixed hot and cold site through the establishment of a Super Green ERAS pathway. Patients were confirmed COVID-19 negative within 72 hours pre-admission and retested 72-hourly post-op. 14 days self-isolation pre-admission was mandated. Patients not complying had their surgery postponed. Transhiatal oesophagect...
Background Infectious Mononucleosis (IM) is a common viral illness among adolescents and young ad... more Background Infectious Mononucleosis (IM) is a common viral illness among adolescents and young adults. While most cases are self-limiting, a small number of patient can develop life threatening complications, such as atraumatic splenic rupture (ASR). This is a rare but serious sequelae, and the commonest cause of associated mortality. While Epstein Barr Virus is commonly associated with IM, concurrent infection of cytomegalovirus (CMV) and EBV is rarely reported. Both infections are associated with splenomegaly, however this is usually mild and very rarely results in ASR. Methods We present the case of an immunocompetent nineteen year old male who underwent emergency splenectomy for ASR secondary to concurrent EBV and CMV infection. He presented to the Emergency Department with a five hour history of severe, sudden onset left upper quadrant pain preceded by coughing fit. He reported a one year history of incidental splenomegaly and recent positive monospot test in community. Comput...
Indian Journal of Community Medicine : Official Publication of Indian Association of Preventive & Social Medicine, 2021
Background: The coronavirus disease-2019 (COVID-19) pandemic is coming to the fore and has surfac... more Background: The coronavirus disease-2019 (COVID-19) pandemic is coming to the fore and has surfaced as a public health emergency of international concern. The lack of vaccines or an effective treatment has led to the global hunt for potential pharmaceuticals in adequately managing this disease. This systematic review highlights the efficacy of chloroquine and its derivative hydroxychloroquine in the treatment of COVID-19 and also explores the safety profile of these drugs. Methods: EMBASE, COCHRANE, and PubMed databases were searched for studies on the use of hydroxychloroquine or chloroquine in the treatment of COVID-19. Results: Twenty articles were selected including expert opinions, National Guidelines, three small randomized controlled trials, and one prospective study. Both hydroxychloroquine and chloroquine have shown promising results including reduction in hospital length of stay and overall mortality. Moreover, concomitant use with azithromycin seems to reduce viral load t...
AIMS Complete mesocolic excision (CME) has been proposed as a way to improve the oncological outc... more AIMS Complete mesocolic excision (CME) has been proposed as a way to improve the oncological outcomes in patients with colon cancer. To investigate whether there is rationale for adopting the technique in Scotland, our aim was to define the incidence of disease recurrence following standard right hemicolectomy and to compare this with published CME outcomes. METHODS Data was collected on consecutive patients undergoing right or extended right hemicolectomy for colonic adenocarcinoma (2012-2017) at three hospitals in Scotland (Raigmore Hospital, Aberdeen Royal Infirmary and Glasgow Royal Infirmary). Emergency or palliative surgery was excluded. Patients were followed up with CT scans and colonoscopy for a minimum of 3 years. RESULTS 689 patients (M 340, F 349) were included. 30-day mortality was 1.6%. Final pathological stage was Stage I (14%), Stage II (49.8%) and Stage III (36.1%). During follow-up, 10.5% developed loco-regional recurrence and 12.2% developed distant metastases. The 1, 3 and 5-year disease-free survival (DFS) was 94%, 84% and 82% respectively. Primary determinants of recurrence were T stage (p < 0.001), N stage (p < 0.001), apical node involvement (p < 0.001) and EMVI (p < 0.001). When compared to the literature, 30-day mortality was lower than many published series and DFS rates were similar to the largest CME study to date (4 year DFS 85.8% versus 83%). CONCLUSION The outcomes of patients undergoing right hemicolectomy in Scotland compare favourably with many published CME studies. The technique demands further evaluation before it can be recommended for adoption into routine surgical practice.
Aims Digital Rectal Examination (DRE) is an essential component of comprehensive assessment of a ... more Aims Digital Rectal Examination (DRE) is an essential component of comprehensive assessment of a surgical patients, both in acute and elective settings. Due to the intimate nature of the examination, this important examination is often not well taught. This study aims to assess the confidence and knowledge of the Foundation Year 1 (FY1) doctors in performing DRE. Methods FY1 doctors were invited for online voluntary anonymous survey via Google forms. The survey consisted of 16 questions on the indications, findings and interpretation of DRE. The purpose and aims of the study were explained in an invitation email and participants provided a declaration of consent, giving permission for their anonymous results to be used in the study. Results There were 24 responses, 79% had performed DRE (including on mannequins and simulations) less than 10 times. Two thirds of DRE were performed during the FY1 rotation and two thirds in the elective wards. Majority of respondents (83%) were moderat...
Aim Digital Rectal Examination (DRE) is an essential component of comprehensive assessment of a s... more Aim Digital Rectal Examination (DRE) is an essential component of comprehensive assessment of a surgical patient, both in acute and elective settings. Due to the intimate nature of the examination, this important examination is often not well taught. This study aims to assess the confidence and knowledge of the Foundation Year 1 (FY1) doctors in performing DRE. Method FY1 doctors were invited for online voluntary anonymous survey via Google forms. The survey consisted of 16 questions on the indications, findings, and interpretation of DRE. The purpose and aims of the study were explained in an invitation email and participants provided a declaration of consent, giving permission for their anonymous results to be used in the study. Results There were 24 responses, 79% had performed DRE (including on mannequins and simulations) less than 10 times. Two thirds of DRE were performed during the FY1 rotation and two thirds in the elective wards. Majority of respondents (83%) were moderatel...
Aim The administration of intravesical chemotherapy (IVCT) following transurethral resection of b... more Aim The administration of intravesical chemotherapy (IVCT) following transurethral resection of bladder tumour (TURBT) has been shown to decrease the risk of recurrence and is recommended as standard practice following TURBT for new & recurrent tumours. Our aim was to evaluate the adherence to this guideline in our trust and if needed, to implement changes in order to improve the patient care. Method A retrospective analysis of 25 patients was done and details regarding the time interval between administration, demographic details and disease staging was collected. NICE guidelines were later implemented, and the data was recollected for 24 patients who underwent TURBT Results The analysis showed that the mean time between the end point of TURBT and instillation of Intravesicular Mitomycin-C was 7.66 hours. Thereafter, we tried to implement the guidelines by improving communication between the Theatre staff, Nursing staff and the pharmacy. The data was collected for re-audit for 24 p...
Aim Clinical governance states that patients should have a named Consultant during their in-patie... more Aim Clinical governance states that patients should have a named Consultant during their in-patient stay. In our institution, every bed has a whiteboard above it, which mentions the name of the patient and the responsible Consultant. This should correspond with the electronic system, TrakCare. Ouraim was to audit and look into the accuracy of this practice, in order to improve the efficacy of ward-rounds and hence improve patient care and safety. Method Data was collected for general surgery and urology receiving wards over 3 consecutive days and was matched to the data available on the electronic system, TrakCare. Intervention was made in the form of verbal and written communication with the nursing staff and junior doctors. Effect of intervention was assessed 2 weeks later. Results n = 38 bed-boards were assessed. The first cycle of the audit demonstrated that 7 (18.4%) had either incorrect or no entries. The detailed analysis revealed that of these, 2 had no consultant names wher...
Aim Clinical governance states that blood results should be flagged during ward rounds to enable ... more Aim Clinical governance states that blood results should be flagged during ward rounds to enable better assessment of inpatients. As per our institutional Protocol, each patient is assigned a blood sheet which should be updated every day with outstanding bloods flagged with a circle. The aim of the audit was to evaluate the quality of blood result sheets and to discuss results in order to enhance patient care. Method Data was collected from the Urology ward at Glasgow Royal Infirmary continuously during November 2020. We reviewed the flagging of abnormal bloods and whether clear documentation of baseline eGFR was included. Intervention was carried out by series of discussion with the nursing and the medical staff along with display posters throughout the ward and staff rooms. Results Overall, first cycle assessed 65 folders and second assessed 79. We noticed that the flagging of outstanding blood results increased from 70% to 74%. Documentation of baseline eGFR raised from 32% to 44...
Introduction: The gold standard treatment for high risk upper tract urothelial cancers is radical... more Introduction: The gold standard treatment for high risk upper tract urothelial cancers is radical nephroureterectomy. Little evidence exists specifically directed for octogenarians with this disease, therefore we highlight our centre’s outcomes and compare to current literature. Methods: Demographic, operative and postoperative data were collected on all octogenarian patients who underwent minimally invasive radical nephroureterectomy between 2010 and 2018 in a single centre. Outcomes including intraoperative and postoperative complications, disease recurrence rates and survival data were analysed. A literature search was performed, with six included articles of cases series and retrospective cohort studies after screening of full manuscripts. Results: Twenty-three patients of average age 82.6 years (range 80–85) were included. Length of stay was median 10 days (range 5–53). Six patients (25%) had postoperative complications ranging from Clavien–Dindo classification 2–3. Eight patie...
Background Surgical oncology services in the UK have been impacted by the COVID-19 pandemic. Var... more Background Surgical oncology services in the UK have been impacted by the COVID-19 pandemic. Various strategies have been employed in an attempt to continue cancer resectional surgery during the pandemic. This study examined our institution’s experience and outcomes with a newly established Super Green ERAS pathway for oesophago-gastric (OG) cancer resections during the pandemic. Methods A retrospective cohort study of consecutive patients who had a resection for OG cancer performed over a 12-month period beginning from the date of the first UK National Lockdown of 23 March 2020. Barring two intervals each lasting 3 weeks, urgent elective cancer surgery continued on our mixed hot and cold site through the establishment of a Super Green ERAS pathway. Patients were confirmed COVID-19 negative within 72 hours pre-admission and retested 72-hourly post-op. 14 days self-isolation pre-admission was mandated. Patients not complying had their surgery postponed. Transhiatal oesophagect...
Background Infectious Mononucleosis (IM) is a common viral illness among adolescents and young ad... more Background Infectious Mononucleosis (IM) is a common viral illness among adolescents and young adults. While most cases are self-limiting, a small number of patient can develop life threatening complications, such as atraumatic splenic rupture (ASR). This is a rare but serious sequelae, and the commonest cause of associated mortality. While Epstein Barr Virus is commonly associated with IM, concurrent infection of cytomegalovirus (CMV) and EBV is rarely reported. Both infections are associated with splenomegaly, however this is usually mild and very rarely results in ASR. Methods We present the case of an immunocompetent nineteen year old male who underwent emergency splenectomy for ASR secondary to concurrent EBV and CMV infection. He presented to the Emergency Department with a five hour history of severe, sudden onset left upper quadrant pain preceded by coughing fit. He reported a one year history of incidental splenomegaly and recent positive monospot test in community. Comput...
Indian Journal of Community Medicine : Official Publication of Indian Association of Preventive & Social Medicine, 2021
Background: The coronavirus disease-2019 (COVID-19) pandemic is coming to the fore and has surfac... more Background: The coronavirus disease-2019 (COVID-19) pandemic is coming to the fore and has surfaced as a public health emergency of international concern. The lack of vaccines or an effective treatment has led to the global hunt for potential pharmaceuticals in adequately managing this disease. This systematic review highlights the efficacy of chloroquine and its derivative hydroxychloroquine in the treatment of COVID-19 and also explores the safety profile of these drugs. Methods: EMBASE, COCHRANE, and PubMed databases were searched for studies on the use of hydroxychloroquine or chloroquine in the treatment of COVID-19. Results: Twenty articles were selected including expert opinions, National Guidelines, three small randomized controlled trials, and one prospective study. Both hydroxychloroquine and chloroquine have shown promising results including reduction in hospital length of stay and overall mortality. Moreover, concomitant use with azithromycin seems to reduce viral load t...
AIMS Complete mesocolic excision (CME) has been proposed as a way to improve the oncological outc... more AIMS Complete mesocolic excision (CME) has been proposed as a way to improve the oncological outcomes in patients with colon cancer. To investigate whether there is rationale for adopting the technique in Scotland, our aim was to define the incidence of disease recurrence following standard right hemicolectomy and to compare this with published CME outcomes. METHODS Data was collected on consecutive patients undergoing right or extended right hemicolectomy for colonic adenocarcinoma (2012-2017) at three hospitals in Scotland (Raigmore Hospital, Aberdeen Royal Infirmary and Glasgow Royal Infirmary). Emergency or palliative surgery was excluded. Patients were followed up with CT scans and colonoscopy for a minimum of 3 years. RESULTS 689 patients (M 340, F 349) were included. 30-day mortality was 1.6%. Final pathological stage was Stage I (14%), Stage II (49.8%) and Stage III (36.1%). During follow-up, 10.5% developed loco-regional recurrence and 12.2% developed distant metastases. The 1, 3 and 5-year disease-free survival (DFS) was 94%, 84% and 82% respectively. Primary determinants of recurrence were T stage (p < 0.001), N stage (p < 0.001), apical node involvement (p < 0.001) and EMVI (p < 0.001). When compared to the literature, 30-day mortality was lower than many published series and DFS rates were similar to the largest CME study to date (4 year DFS 85.8% versus 83%). CONCLUSION The outcomes of patients undergoing right hemicolectomy in Scotland compare favourably with many published CME studies. The technique demands further evaluation before it can be recommended for adoption into routine surgical practice.
Aims Digital Rectal Examination (DRE) is an essential component of comprehensive assessment of a ... more Aims Digital Rectal Examination (DRE) is an essential component of comprehensive assessment of a surgical patients, both in acute and elective settings. Due to the intimate nature of the examination, this important examination is often not well taught. This study aims to assess the confidence and knowledge of the Foundation Year 1 (FY1) doctors in performing DRE. Methods FY1 doctors were invited for online voluntary anonymous survey via Google forms. The survey consisted of 16 questions on the indications, findings and interpretation of DRE. The purpose and aims of the study were explained in an invitation email and participants provided a declaration of consent, giving permission for their anonymous results to be used in the study. Results There were 24 responses, 79% had performed DRE (including on mannequins and simulations) less than 10 times. Two thirds of DRE were performed during the FY1 rotation and two thirds in the elective wards. Majority of respondents (83%) were moderat...
Aim Digital Rectal Examination (DRE) is an essential component of comprehensive assessment of a s... more Aim Digital Rectal Examination (DRE) is an essential component of comprehensive assessment of a surgical patient, both in acute and elective settings. Due to the intimate nature of the examination, this important examination is often not well taught. This study aims to assess the confidence and knowledge of the Foundation Year 1 (FY1) doctors in performing DRE. Method FY1 doctors were invited for online voluntary anonymous survey via Google forms. The survey consisted of 16 questions on the indications, findings, and interpretation of DRE. The purpose and aims of the study were explained in an invitation email and participants provided a declaration of consent, giving permission for their anonymous results to be used in the study. Results There were 24 responses, 79% had performed DRE (including on mannequins and simulations) less than 10 times. Two thirds of DRE were performed during the FY1 rotation and two thirds in the elective wards. Majority of respondents (83%) were moderatel...
Aim The administration of intravesical chemotherapy (IVCT) following transurethral resection of b... more Aim The administration of intravesical chemotherapy (IVCT) following transurethral resection of bladder tumour (TURBT) has been shown to decrease the risk of recurrence and is recommended as standard practice following TURBT for new & recurrent tumours. Our aim was to evaluate the adherence to this guideline in our trust and if needed, to implement changes in order to improve the patient care. Method A retrospective analysis of 25 patients was done and details regarding the time interval between administration, demographic details and disease staging was collected. NICE guidelines were later implemented, and the data was recollected for 24 patients who underwent TURBT Results The analysis showed that the mean time between the end point of TURBT and instillation of Intravesicular Mitomycin-C was 7.66 hours. Thereafter, we tried to implement the guidelines by improving communication between the Theatre staff, Nursing staff and the pharmacy. The data was collected for re-audit for 24 p...
Aim Clinical governance states that patients should have a named Consultant during their in-patie... more Aim Clinical governance states that patients should have a named Consultant during their in-patient stay. In our institution, every bed has a whiteboard above it, which mentions the name of the patient and the responsible Consultant. This should correspond with the electronic system, TrakCare. Ouraim was to audit and look into the accuracy of this practice, in order to improve the efficacy of ward-rounds and hence improve patient care and safety. Method Data was collected for general surgery and urology receiving wards over 3 consecutive days and was matched to the data available on the electronic system, TrakCare. Intervention was made in the form of verbal and written communication with the nursing staff and junior doctors. Effect of intervention was assessed 2 weeks later. Results n = 38 bed-boards were assessed. The first cycle of the audit demonstrated that 7 (18.4%) had either incorrect or no entries. The detailed analysis revealed that of these, 2 had no consultant names wher...
Aim Clinical governance states that blood results should be flagged during ward rounds to enable ... more Aim Clinical governance states that blood results should be flagged during ward rounds to enable better assessment of inpatients. As per our institutional Protocol, each patient is assigned a blood sheet which should be updated every day with outstanding bloods flagged with a circle. The aim of the audit was to evaluate the quality of blood result sheets and to discuss results in order to enhance patient care. Method Data was collected from the Urology ward at Glasgow Royal Infirmary continuously during November 2020. We reviewed the flagging of abnormal bloods and whether clear documentation of baseline eGFR was included. Intervention was carried out by series of discussion with the nursing and the medical staff along with display posters throughout the ward and staff rooms. Results Overall, first cycle assessed 65 folders and second assessed 79. We noticed that the flagging of outstanding blood results increased from 70% to 74%. Documentation of baseline eGFR raised from 32% to 44...
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Papers by Dhruv Sahni