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There is variability in intensive care unit (ICU) resources and staffing worldwide. This may reflect variation in practice and outcomes across all health systems.To improve research and quality improvement measures administrative leaders can create long-term strategies by understanding the nature of ICU practices on a global scale.The Global ICU Needs Assessment Research Group was formed on the basis of diversified skill sets. We aimed to survey sites regarding ICU type, availability of staffing, and adherence to critical care protocols. An international survey 'Global ICU Needs Assessment' was created using Google Forms, and this was distributed from February 17There were a total 121 adult/adult-pediatrics ICU responses from 34 countries in 76 cities. A majority of the ICUs were mixed medical-surgical [92 (76%)]. 108 (89%) were adult-only ICUs. Total 36 respondents (29.8%) were 31-40 years of age, with 79 (65%) male and 41 (35%) female participants. 89 were consultants (74%). A total of 71 (59%) respondents reported having a 24-h in-house intensivist. A total of 87 (72%) ICUs were reported to have either a 2:1 or ≥ 2:1 patient/nurse ratio. About 44% of the ICUs were open and 76% were mixed type (medical-surgical). Protocols followed regularly by the ICUs included sepsis care (82%), ventilator-associated pneumonia (79%); nutrition (76%), deep vein thrombosis prophylaxis (84%), stress ulcer prophylaxis (84%), and glycemic control (89%).Based on the findings of this international, multi-dimensional, needs-assessment survey, there is a need for increased recruitment and staffing in critical care facilities, along with improved patient-to-nurse ratios. Future research is warranted in this field with focus on implementing appropriate health standards, protocols and resources for optimal efficiency in critical care worldwide.

INTRODUCTION AND OBJECTIVE:Catheterisation failure in the patient with acute urinary retention (AUR) can be anxiety inducing for both patient and surgeon. In the modern era, cystoscopy has proved a...

Special access techniques during percutaneous nephrolithotomy (PCNL) are indicated for challenging stones. Various techniques have been described to inferiorly displace the kidney to facilitate optimal percutaneous access whilst minimizing thoracic complications associated with the supracostal approach. We describe our institution’s technique of using a ureteric balloon catheter to inferiorly distract and immobilize the kidney (UBC Technique) to achieve the optimal calyceal access infracostally during PCNL. This permits effective and safe access in a single puncture whilst additionally stabilizing the renal unit during respiration and reducing the skin-to-calyceal distance by mobilizing the desired calyx in line with the axis of the puncture needle. We reviewed the literature regarding alternative inferior renal displacement techniques permitting infracostal approaches. From May 2012 to October 2017 150 PCNLs were performed in our institution. Out of these, the UBC technique was used in 18 cases during both prone and supine PCNLs. In all cases, the UBC technique was used successfully to access the most desirable calyx. No complications associated with renal distraction were reported. Post operatively, 1 patient required a blood transfusion, 1 patient had a pyrexia of >38 degrees resulting in a longer admission and 1 patient developed sepsis requiring HDU admission for monitoring only. 15 out the 18 patients had complete stone clearance from their PCNL. The UBC technique provides a safe alternative to the supracostal approach in percutaneous renal surgery. It is less traumatic than alternative infracostal access techniques and has a very short learning curve.

Objectives: The objective of this study was to assess the evaluation and operative outcomes of patients attending a single urology centre with acute testicular pain (ATP) who underwent scrotal exploration. We sought to determine adherence to the Royal College of Surgeons England (RCS) commissioning guide on testicular torsion, clinical and radiological features predictive of torsion, time-dependent salvage rates and surgical technique in a contemporary cohort. Patients and Methods: A single-centre retrospective review was carried out from 2015 to 2020. All patients presenting with acute testicular pain undergoing surgical exploration were included. Results: 140 patients were identified, median age 16 years, 40 had testicular torsion (TT) (30%) where nausea (positive predictive value (PPV) 51.7%, p = 0.009) and abnormal testis lie (PPV 50%, p = 0.008) were more frequent. TT was the most common diagnosis if presenting Discussion: Surgical exploration Level of evidence: OCEBM Level 3 evidence

INTRODUCTION AND OBJECTIVE:Targeted prostate biopsy can be done using visual-estimation (cognitive) targeting or using MRI-ultrasound fusion platforms. We compared cancer detection of these two app...

INTRODUCTION AND OBJECTIVE:Castration was a common vocational requirement for the courtiers of the imperial dynasties of China, the elite households of Ottoman Constantinople and the Christian 'Whi...

Background For patients in whom laparoscopic adjustable gastric band has failed, conversion to Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy are both options for further surgical treatment. There are limited data comparing these 2 procedures. The National Bariatric Surgery Registry is a comprehensive United Kingdom–wide database of bariatric procedures, in which preoperative demographic characteristics and clinical outcomes are prospectively recorded. Objectives To compare perioperative complication rate and short-term outcomes of patients undergoing single-stage conversion of gastric band to Roux-en-Y gastric bypass or laparoscopic sleeve gastrectomy. Setting United Kingdom national bariatric surgery database. Methods From the National Bariatric Surgical Registry data set, we identified 141 patients undergoing single-stage conversion from gastric band to either gastric bypass (113) or sleeve gastrectomy (28) between 2009 and 2014, and analyzed their clinical outcomes. Results With respect to perioperative outcomes gastric bypass was associated with a higher incidence of readmission or reintervention postoperatively (16 versus 0; P = .04). There was no difference in percentage excess weight loss between sleeve gastrectomy and gastric bypass at final follow-up at 1 year (52.1% versus 57.1% respectively; P = .4). Conclusions Conversion from band to sleeve or bypass give comparable good early excess weight loss; however, conversion to sleeve is associated with a better perioperative safety profile.

INTRODUCTION AND OBJECTIVE:Although multi-parametric MRI (mpMRI) has high sensitivity and negative predictive value, the lower specificity can lead to a high prevalence of equivocal lesions which a...

A 34 year old man was referred to the emergency department by his general practitioner with a 3 day history of painful swelling of his left testicle and lethargy. He had first noticed the swelling five weeks earlier. He had also noticed an intermittent dull ache over that time but he had not sought medical attention. The patient had no urinary symptoms, history of fevers, vomiting, or weight loss. He had no clinically significant medical or family history, worked as a civil engineer, and was a non-smoker. Observations were within the expected range for all parameters except for pyrexia of 38.2°C. Examination showed an enlarged firm left testicle of approximately 5 × 4 × 4 cm with an irregular superior pole and a thickened tender spermatic cord. Examination of the right testicle and abdomen was normal. View this table: Blood test results Scrotal doppler ultrasound showed a mixed echogenic lesion measuring 4.5 × 3.4 × 3.4 cm containing a cystic component measuring approximately 2 cm and marked hyperaemia in the left testicle. Mid stream and first pass urine samples were sent for urinary and genitourinary bacteriology and the patient was admitted to the urology ward. …

Basrayatha, Muhammad Khudayyir’s innovative book, is both a personal memoir and a cityscape of Basra, Iraq. In it the author created a model city called Basrayatha, which is both based on but also serves as a mirror and critique of the actual city of Basra. This model then took on a life of its own and appeared in other works by Khudayyir. The book can be enjoyed at face value but is best understood with reference to his many critical writings. The work’s blend of influences from the visual arts, local history, and stories about the storyteller is rather special if not unique in Arabic literature.

A 26 year old man presented to the emergency department with a painful and swollen right hand. The previous night he had punched a wall. He was previously fit and well with no substantial medical history. On examination his hand was swollen and bruised, but there was no open wound. He had tenderness over the dorsum of the hand, particularly over the fifth metacarpal. There was no obvious deformity, scissoring, or malrotation of the fingers, but he was unable to make a full fist due to the pain. On extension there was an extensor lag of the little finger. Radiographs were taken (fig 1⇓) and his hand was put in a volar backslab. Fig 1 Radiographs of the patient’s right hand: anterior-posterior (left), oblique (middle), and lateral (right) ### 1. What injury has the patient sustained? #### Short answer The patient has sustained a closed fracture to the neck of the fifth metacarpal of his right hand, also known colloquially as a “boxer’s fracture.” The radiographs show a simple extra-articular fracture with approximately 50° of volar angulation. #### Discussion Fractures of the fifth metacarpal are common injuries, accounting for 10% of all hand fractures.1 The five metacarpals make up the body of each hand, articulating proximally with the trapezium, trapezoid, capitates, and hamate, respectively, and distally with the proximal phalanges. The fifth metacarpal articulates proximally with the hamate, laterally with the fourth metacarpal, and distally with the fifth proximal phalanx. Fractures of the fifth metacarpal most commonly …

A 68-year-old woman presented to the emergency department, with an abscess in the right upper anterior abdominal wall. She had a medical history of an open cholecystectomy 20 years prior, diabetes, obesity and a laparotomy for perforated sigmoid diverticular disease complicated by a large parastomal hernia. CT revealed this subcutaneous abscess to track intra-abdominally through the liver and communicate with the gallbladder fossa. The abscess was incised and drained. The wound initially drained pus, and then bile. Magnetic resonance cholangiopancreatogram (MRCP) demonstrated a remnant gallbladder containing 2 gallstones, a cholecystocutaneous fistula, portal vein thrombosis and cavernous transformation of the bile duct. The patient improved and was discharged. The patient's case history and imaging were discussed with the tertiary referral centre, in a multidisciplinary team. After an extensive and balanced discussion, the patient declined a completion cholecystectomy and continues to have occasional discharge from the fistula in her right upper quadrant.

Genetic association studies of prostate and other cancers have identified a major risk locus at chromosome 8q24, but a causal gene and a mechanism for cancer predisposition has remained elusive. The locus harbors the POU5F1B retrogene and several non-coding RNA genes, and is also proximal to the MYC oncogene. The open reading frame of the retrogene is preserved with 96% identity to that of the parent POU5F1 gene on chromosome 6, encoding the master embryonic stem cell factor Oct4. We observed that 8q24 risk alleles are significantly correlated with reduced expression of the POU5F1B retrogene in normal prostate tissue. The alleles were not correlated with the expression of MYC or other flanking genes in normal prostate tissue. Predicted deleterious POU5F1B missense germline variants were also associated with risk of prostate cancer. Thus, two independent lines of genetic evidence support a potential causal role for POU5F1B in the transformation of normal prostate tissue. A plausible hypothesis of POU5F1B function is dysregulation of Oct4; POU5F1 is transcriptionally regulated by the encoded Oct4 transcription factor. The POU5F1B retrogene on 8q24 and POU5F1 on 6p21 were significantly co-expressed. These results suggest that a pathway critical to self-renewal of embryonic stem cells may also have a role in the origin of cancer. Note: This abstract was not presented at the meeting. Citation Format: Joan Breyer, Daniel Dorset, Travis Clark, Kevin Bradley, Tiina Wahlfors, Kate McReynolds, William Maynard, Sam Chang, Michael Cookson, Joseph Smith, Johanna Schleutker, William Dupont, Jeffrey R. Smith. An expressed retrogene of master embryonic stem cell factor OCT4 alters prostate cancer susceptibility. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 5067. doi:10.1158/1538-7445.AM2014-5067