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The impact involving COVID-19 visitor policy constraints in birthing residential areas associated with colour.
For carefully selected patients with low-lying rectal cancers, ultralow anterior resection (ULAR) can be an effective alternative to abdominal perineal resection, and together with neoadjuvant radiochemotherapy can provide the opportunity for sphincter preservation. However, ULAR is not without potential postoperative complications, particularly anastomotic dehiscence which increases in likelihood after receiving radiation therapy. While surveillance imaging is not indicated three years beyond initial surgical resection, changes in chronic symptoms refractory to conservative management may warrant further investigation. In this case report, we present an interesting case of late-onset stenosis and anastomotic breakdown following neoadjuvant radiochemotherapy, ULAR, and coloanal anastomosis for a low-lying rectal adenocarcinoma. Effective patient education, reliable symptom assessment, and multidisciplinary collaboration are essential to assessing for long-term treatment-related complications and providing appropriate treatment in a timely manner. Copyright © 2020, Nguyen et al.Introduction Burnout is common among clinical specialties and has implications on the residents' well-being and mental health. Evidence suggests that optimism and burnout are correlated, but research has not focused on the applicability to medical residents. The objective of the study was to define burnout in residents and correlate it with optimism. Methods The authors conducted a correlational, prospective cross-sectional study using self-reported single item burnout (1-10) and Life Oriented Test-Revised (LOT-R) (0-24) survey instruments among residents of neurosurgery, neurology, internal medicine, family medicine and emergency medicine at a community-based hospital. Residents were asked to fill out the survey once in the 2018 academic year and once again in the 2019 academic year. Burnout and optimism scores were correlated and compared across subgroups for each year. Results There was no statistical significance found amongst any subgroups in burnout in 2018 but significance was found for both internal medicine (t = 3.74, p = 0.001) and neurosurgery (t = -3.07, p = 0.01) in 2019. Mean burnout increased from 2018 to 2019 from 4.39 to 5.1. Optimism remained constant from 2018 to 2019 (16.7 and 16.76, respectively) and there was no difference across subgroups. There was a statistically significant negative correlation between burnout and optimism in both 2018 (r = -0.364, p = 0.006) and 2019 (r = -0.39, p = .001). Conclusion Burnout and optimism are negatively correlated. Although burnout increased over time, optimism remained constant indicating the stability of this trait and implication for future interventions. Copyright © 2020, Fowler et al.Aplasia of the maxillary sinus and hypoplasia are rare conditions that can trigger symptoms such as headaches and altered speech. Most patients are asymptomatic, but given the role of these symptoms in the differential diagnoses for neoplasms and infection, such symptoms warrant investigating. We present a rare case of a young man with hypoplasia of the maxillary sinus on the left side with a large periapical cyst on the right side, diagnosed via a routine cone-beam computed tomography (CBCT). This case discusses the role of CBCT in investigating aplasia of the maxillary sinus. Copyright © 2020, Alnafisah et al.We describe a case of sebaceous carcinoma (SC) in a 75-year-old man who presented with a rapidly growing nodule on the left cheek for four weeks. A 75-year-old man presented with a crusted non-tender nodule on the left cheek that had been present for six months. The nodule showed rapid growth in the four weeks before the visit. Shave biopsy of the lesion was reported as SC. SC is a rare but aggressive type of skin cancer that can develop from any sebaceous gland in the body. learn more However, it mostly occurs in the eyelids. In this case, SC developed on the left cheek of the patient, which is an atypical presentation. Extraocular variant of SC has a greater potential to metastasize and has a lower survival rate compared to ocular variant. Early and accurate diagnosis followed by a wide excision surgery or Mohs micrographic surgery carries a favorable prognosis. Early detection of extraocular variant of SC may be difficult. It is imperative for primary care providers to order a histopathology examination to investigate a rapidly growing mass in the head and neck region where there are numerous sebaceous glands. Copyright © 2020, Kraleti et al.In this paper, we review the indications, complications, and pitfalls associated with ventriculoperitoneal (VP) shunts. As most VP shunt problems initially present to the emergency department, it is important for emergency physicians to be well-versed in managing them. In the article, the possible reasons for shunt failure are explored and summarized using an infographic. We also examine potential clinical presentations of VP shunt failure. Copyright © 2020, Ferras et al.Necrotizing soft tissue infections (NSTIs) are deadly infections that can involve all tissue layers from the epidermis to the muscle. NSTIs can be difficult to diagnose, as skin manifestations are often absent early in the course of the disease, and they can be difficult to differentiate from simple cellulitis. Definitive diagnosis and treatment occur in the operating room. We present a case of a 65-year-old female who presented with lightheadedness and presyncope, with planned admission for an exacerbation of chronic obstructive pulmonary disease. Prior to admission, however, she was found to have an NSTI. The patient went to the operating room and had an extensive debridement followed by prolonged hospital stay. This case highlights the importance of a thorough physical examination in ill-appearing patients with non-specific symptoms, possible sepsis, and any alteration in mental status. Copyright © 2020, Sarchi et al.Polycystic ovary syndrome (PCOS) commonly occurs in reproductive-age females. It elevates the hormonal levels, creates an imbalance in the metabolic system, and affects their reproductive system too. A number of studies have been conducted on PCOS, and it has been diagnosed together with several dermatological conditions. In this paper, we attempt a traditional review to study the relationship between PCOS and its cutaneous manifestations the patients are predisposed to. To uncover this association, we gathered information from English-language articles on the Pubmed database using six keywords. Materials were also collected from studies done on animal models, which helped in putting down all the data together and interlinking them with other studies. From this data collection, it is ultimately concluded that the association between PCOS and dermatological conditions is a very intricate interconnecting network comprising many factors, such as inflammation, genetics, and hormonal. This study raises some questions that are still unanswered.
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