Miniaturized PCNL techniques can deliver high SFRs with a small risk of Clavien I/II complications. The size of tract seems to influence the nature of complications, with higher hematuria and renal extravasation with increasing tract size.
Day-case percutaneous nephrolithotomy procedure seems to be a safe procedure with good outcomes, and low risk of complications and readmissions. Detailed preoperative protocol and planning are paramount, with indications for inpatient admission as well as a thorough follow-up plan.
More dental practitioners should utilize diagnostic testing in order to arrive at accurate diagnoses. The availability of diagnostic tests did not completely translate to usage and none of the scenarios presented warranted pulp sensibility testing from all respondents.
Objective: The literature predicting difficulties during Laparoscopic Cholecystectomy (LC) for Acute Gallstone Pancreatitis (AGP) is mainly focused on the timing of operation. In our experience, LC for AGP is rarely difficult irrespective of the timing of operation. The aim of this study was to assess intra- operative difficulties in mild AGP patients to verify this observation.
Material and Methods: A retrospective analysis of all consecutive patients who underwent LC for mild AGP between 2014 and 2018 in a single centre was performed. Patients with known alcohol abuse, post-endoscopic retrograde cholangiopancreaticography (ERCP) induced pancreatitis, and those with chronic pancreatitis were excluded. Univariate weighted analysis was performed with 11 factors, with a linear threshold boundary defined as the mean distance between the four degrees of difficulty (DoD 1-4).
Results: Ninety-six patients (Male= 33, median age= 56; Female= 63, median age= 52) were analysed. Majority of the patients were an ASA of two (n= 50; 52%) with a median BMI of 28 (range 18-50). Five procedures were technically difficult (DoD≥ 3) and only one procedure was converted to open operation. Univariate analysis showed that duration of pancreatitis >6 days (p= 0.002) and evidence of acute cholecystitis (p< 0.05) are associated with a difficult LC (DoD≥ 3). The rest of the factors did not influence DoD.
Conclusion: Based on this result, we suggest that LC for mild AGP is rarely difficult, and this finding can be used in practice for selecting these patients for training lists.
Empowering patients through improving clarity of sun protection ratings on sunscreenSir, A recent survey by the Royal Pharmaceutical Society [1] has suggested that the majority of people cannot correctly recognize and fully understand the labelling on sun protection cream and lotion bottles with regard to the protection afforded by the contents. The survey found that only 8% of 2057 British adults understood that 'sun protection factor' (SPF) pertained to UVB protection, with 31% stating that they did not check the UVA 'star rating'.The difficulty appears to lie in the confusion between UVA and UVB protection, with many people believing that the SPF rating is the absolute measure of the quality of protection afforded by the contents of the bottle. This, however, only pertains to UVB radiation and not UVA radiation, and this lack of knowledge could result in people purchasing a product that does not fulfil their requirements.Patients being unable to understand the rating systems of sunscreen can increase the impact of sun exposure. This can potentially leave users at risk of skin damage, raising the risk of sunburn, benign sun-related lesions, or skin malignancies, which are potentially fatal. It is estimated that melanoma will become the fourth most common cancer in males and the sixth most common in females in the year 2030, affecting a predicted 5% of each gender [2].Knowledge of the quality of the sun protection provided is crucial in allowing people to make informed decisions on how to best protect themselves from harm resulting from excessive sun exposure.To this end, it is important to empower the public in their decision-making. This could easily be done through providing a clear white space on the front of all bottles, of a minimum size, that only contains the two rating scales -the SPF and the UVA protection.This is similar to the rectangle on cigarette packaging with health warnings. It would allow for the information to be readily available for the purchaser, allowing direct comparison between different products in the shop at the same time, enabling the consumer to choose the product that they feel they need and want.Increasing clarity and thus empowering people to make informed decisions is something at the very core of primary disease prevention. It is through simple yet effective measures such as improving the clarity of the labelling on sun protection products that can improve this. We as a profession should be doing our utmost to prevent disease and it is through campaigning for simple changes such as these with a coherent and unified voice that we could make big strides forward against skin cancer and other sun-related pathologies.
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