A 76-year-old woman presented following two episodes of unexplained falls at home. Blood cultures were positive for Bacteroides fragilis and following investigations she was diagnosed with L4/L5 spondylodiscitis confirmed on spine MRI. She was initially treated with intravenous metronidazole and flucloxacillin prior to switching to ceftriaxone with good results. No primary cause of B. fragilis bacteraemia was found in this case. B. fragilis is a rare cause of spondylodiscitis.
Aim The COVID-19 pandemic has affected doctors worldwide, with 1.5 million surgeries being postponed or cancelled in England and Wales during 2020. Surgeons in competitive specialties requiring active research portfolios may have used this time to strengthen their academic work. This cross-sectional study provides insight into the academic output of Welsh plastic surgery trainees during the COVID-19 pandemic, which could be used to highlight contributing factors to benefit future training. Method A cross-sectional study was distributed to all Welsh burns and plastic surgery trainees from specialty trainee levels 3–8. Data was obtained comparing publications achieved, abstracts submitted, and projects undertaken pre-pandemic, March 1st to 31st August 2019 and mid-pandemic, March 1st to 31st August 2020. Results Of the 12 Welsh plastic surgery trainees, 75% participated in this survey, with representation from all years of training. Mid-pandemic, an average of 3 publications were achieved per trainee when compared with 1.4 pre-pandemic. 78% submitted abstracts during both periods, increasing from 1.5 to 2.44 mid-pandemic. Although the average number of projects undertaken pre- and mid-pandemic was 3.2 and 3.1 respectively, the number of trainees undertaking projects increased by 22% to 100%. Most commonly, this was attributed to an increase in capacity. Conclusions Our study demonstrated that overall, academic output increased significantly during the COVID-19 pandemic. Unsurprisingly, this sudden decrease in surgical activity led to trainees in this highly competitive specialty employing their time towards research. Further studies investigating the factors enabling trainees to increase their academic productivity would be beneficial as routine surgical activity resumes.
Aim With the reported incidence of Frey's syndrome as high as 59%, the significant morbidity experienced by patients post parotidectomy has resulted in a range of treatment options being proposed with variable outcomes. The lack of consensus has resulted in patients being offered a wide range of treatments with varying success. While fat grafting remains a treatment for contour deformity correction, there is emerging evidence to suggest its effectiveness as a treatment for Frey's syndrome, warranting further investigation. This systematic review aims to evaluate the efficacy of fat grafting as a treatment for Frey's syndrome post parotidectomy. Method A systematic review was conducted as per PRISMA guidelines, with all articles from MEDLINE, Embase, Web of Science, Ovid, Scopus, and Cochrane screened by two independent reviewers using discreet inclusion and exclusion criteria followed by in depth full-text reviews. Results 116 papers were screened with 16 meeting the inclusion criteria (13.8%) totalling 785 patients, with multiple outcome measures for assessing Frey's syndrome. Fat grafting was shown to significantly reduce the incidence of Frey's syndrome in patients having undergone both superficial and total parotidectomies, with 15 studies (93.8%) finding a significant reduction in its incidence post treatment. Conclusions With low donor site morbidity, biocompatibility, ease of use, low cost to perform and high patient satisfaction, the systematic review of the evidence supports the use of fat grafting post parotidectomy as an effective treatment for Frey's syndrome. Further research to determine the long-term outcome would inform its suitability as a first line treatment.
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