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Background: The practice of day care surgery is less embraced in many low‐middle‐income countries (LMIC), and even less for some procedures considered major such as thyroidectomy. Here we examine the safety of day care thyroidectomy at Kyabirwa Surgical Center, a stand‐alone day care surgery center in rural Eastern Uganda. Methods: This was a retrospective cohort study conducted between 2019 and 2023. All patients who had day care thyroidectomy were included. Demographics, diagnosis, investigation findings, pathology reports, and surgery outcomes were collected. Postoperative follow‐up data up to 30 days were also collected. Data were analyzed using R version 4.3.2. Results: A total of 51 patients underwent same‐day thyroidectomy, with an average age of 44.9 ± 12.1 years and 98% female. Procedures included total thyroidectomy (5, 9.8%), subtotal thyroidectomy (26, 51.0%), and lobectomy (20, 39.2%). Average size of the glands was 7.9 ± 2.21 cm. The majority 46 (90.2%) were of benign pathology. All patients were discharged by the evening of the same day. Complications encountered included hypocalcemia (1), hypertrophic scar (1), seroma (2), and transient recurrent laryngeal nerve injury (1). Overall complications rate was 9.8%. Gland size was statistically significant between patients with no complications (7.68 ± 2.06 cm) versus complications (9.90 ± 2.82, p < 0.05). Conclusion: With overall low complication rates, these findings suggest that thyroidectomy can safely be performed on a day care basis in a rural LMIC setting with suboptimal health care delivery. [ABSTRACT FROM AUTHOR]

Background: Access to minimally invasive surgery (MIS) is limited in Sub‐Saharan African countries. In 2019, the Mount Sinai Department of Surgery in New York collaborated with local Ugandans to construct the Kyabirwa Surgical Center (KSC), an independent, replicable, self‐sustaining ambulatory surgical center in Uganda. We developed a focused MIS training program using a combination of in‐person training and supervised telementoring. We present the results of our initial MIS telementoring experience. Methods: We worked jointly with Ugandan staff to construct the KSC in the rural province of Jinja. A solar‐powered backup battery system ensured continuous power availability. Underground fiber optic cables were installed to provide stable high‐speed Internet. The local Ugandan general surgeon (JOD) underwent a mini‐fellowship in MIS and then trained extensively using the Fundamentals of Laparoscopic Surgery program. After a weeklong in‐person session to train the Ugandan OR team, JOD performed laparoscopic cases with telementoring, which was conducted remotely by surgeons in New York via audiovisual feeds from the KSC OR. Results: From October 2021 to February 2024, JOD performed 61 telementored laparoscopic operations at KSC including 37 appendectomies and 24 cholecystectomies. Feedback was provided regarding patient positioning, port placement, surgical technique, instrument use, and critical steps of the operation. There were no intra‐operative complications. Postoperatively, field medical workers visited patients at home to collect follow‐up information. Two superficial wound infections (3.3%) were reported in the short‐term follow‐up. Conclusion: Telementoring can be safely implemented to assist surgeons in previously underserved areas to provide advanced laparoscopic surgical care to the local patient population. [ABSTRACT FROM AUTHOR]

Background: New York City was the epicenter of the initial surge of the COVID-19 pandemic in the United States. Tracheostomy is a critical procedure in the care of patients with COVID-19. We hypothesized that early tracheostomy would decrease the length of time on sedation, time on mechanical ventilation, intensive care unit length of stay, and mortality. Methods: A retrospective analysis of outcomes for all patients with COVID-19 who underwent tracheostomy during the first year of the COVID-19 pandemic at the Mount Sinai Hospital in New York City, New York. All adult intensive care units at the Mount Sinai Hospital, New York. Patients/subjects: 888 patients admitted to intensive care with COVID-19. Results: All patients admitted to the intensive care unit with COVID-19 (888) from 1 March 2020 to 1 March 2021 were analyzed and separated further into those intubated (544) and those requiring tracheostomy (177). Of those receiving tracheostomy, outcomes were analyzed for early (≤12 days) or late (>12 days) tracheostomy. Demographics, medical history, laboratory values, type of oxygen and ventilatory support, and clinical outcomes were recorded and analyzed. Conclusions: Early tracheostomy resulted in reduced duration of mechanical ventilation, reduced hospital length of stay, and reduced intensive care unit length of stay in patients admitted to the intensive care unit with COVID-19. There was no effect on overall mortality. [ABSTRACT FROM AUTHOR]

Introduction I. The state of the law: Divided and inconsistent 1. Ontario Court of Appeal 2. British Columbia Court of Appeal 3. Alberta Court of Appeal II. Personal liability is [...], When is a director or officer personally liable in tort to a party who is not the corporation he or she serves? In Canada, there is no clear answer. The law is marked by division both within and between appellate courts, resulting in judgments that are hard to reconcile and verge on arbitrary. This is likely attributable to the mistaken belief that there is a tension between personal liability and corporate personality, as well as the disputed relationship between common law and statutory obligations. To address these challenges, most Canadian courts have followed a threshold corporate law analysis, which seeks to categorize the allegations as either corporate or personal. When applied, this approach often results in directors and officers having immunity with respect to torts they committed in pursuit of the corporation&apos;s interests. Such immunity, however, has no basis in law. Canada&apos;s business corporations statutes do not limit the liability of directors and officers, and implicitly contemplate their exposure to tort claims. Accordingly, I propose that directors and officers ought to be personally liable when they are implicated in facts that give rise to a cause of action in tort, regardless of whether their actions may be considered authorized by, or in the interests of, the corporation. This approach is conceptually simpler and more respectful of legislative intent, while posing no serious policy concerns. This is because ordinary tort law principles are sufficiently robust to bar improper personal claims, such as those that do not implicate the director or officer, those that are inconsistent with the expectations of the parties, or those that conflict with statutory obligations or remedies. Quand un administrateur ou un dirigeant est-il personnellement responsable en responsabilite delictuelle envers une partie qui n&apos;est pas la societe pour laquelle il travaille? Au Canada, il n&apos;y a pas de reponse claire. Le droit est marque par la division au sein des cours d&apos;appel et entre elles, ce qui donne lieu a des jugements difficiles a concilier et qui frisent l&apos;arbitraire. Cette situation est probablement attribuable a la croyance erronee selon laquelle il existe une tension entre la responsabilite personnelle et la personnalite morale, ainsi qu&apos;a la relation contestee entre la common law et les obligations legales. Pour relever ces defis, la plupart des tribunaux canadiens ont suivi une analyse preliminaire du droit des societes, qui vise a classer les allegations dans la categorie des societes ou des particuliers. Lorsqu&apos;elle est appliquee, cette approche fait souvent en sorte que les administrateurs et les dirigeants jouissent de l&apos;immunite a l&apos;egard des delits civils qu&apos;ils ont commis dans la poursuite des interets de l&apos;entreprise. Cette immunite n&apos;a toutefois aucun fondement en droit. Les lois canadiennes sur les societes par actions ne limitent pas la responsabilite&apos; des administrateurs et des dirigeants et envisagent implicitement leur exposition aux poursuites en responsabilite delictuelle. Par consequent, je propose que les administrateurs et les dirigeants soient tenus personnellement responsables lorsqu&apos;ils sont impliques dans des faits qui donnent lieu a une cause d&apos;action delictuelle, peu importe si leurs actions peuvent etre considerees comme autorisees par la societe ou dans son interet. Cette approche est conceptuellement plus simple et plus respectueuse de l&apos;intention du Iegislateur, tout en ne posant pas de problemes strategiques serieux. En effet, les principes ordinaires du droit de la responsabilite&apos; civile delictuelle sont suffisamment solides pour empecher les reclamations personnelles abusives, comme celles qui n&apos;impliquent pas l&apos;administrateur ou le dirigeant, celles qui sont incompatibles avec les attentes des parties ou celles qui sont contraires aux obligations legates ou aux recours.

Introduction Canadian beer enthusiasts and originalists make unlikely fellow travellers. However, both groups eagerly awaited and were disappointed by the Supreme Court of Canada's decision in R v Comeau. (1) [...]

Objective/Introduction: Increased vascular tortuosity may be an independent marker of generalized aortic pathology. This study investigates the association between descending thoracic aortic tortuosity, aneurysm pathophysiology, and outcomes following EVAR in AAA patients. Methods: Patients who underwent elective EVAR between 2004 and 2018 were reviewed. Thoracic tortuosity index (TTI) was measured using 3D reconstruction software. Patients were dichotomized across the median TTI into high tortuosity [HT] (TTI >1.27, Figure1(a)) and low tortuosity [LT] (TTI ≤1.27, Figure 1(b)) groups. Perioperative complications, postoperative outcomes, and CT-based features of thoracic aortic wall degeneration (Figure 1(c)-(e)) were collected and analyzed. Results: 136 patients underwent treatment: 70 HT patients, including 54 males and 16 females (mean age: 77 years), and 66 LT patients, including 62 males and 4 females (mean age: 70 years) (age; P <.001). LT patients exhibited greater prevalence of hypercholesterolemia and diabetes (P =.045, P =.01). Presence of degenerative aortic wall markers was greater in HT patients (P =.045). HT patients had higher incidence of multiple aneurysms concurrently present in their aorta compared to LT (32.8% vs 11.3%; P =.002). Frequency of AAA rupture/dissection was 4.3% for HT and 1.5% for LT (P =.339). A trend was observed in all cause 30-day mortality in the HT group (P =.061). Other perioperative complications and postoperative outcomes were similar between groups. Conclusion: High TTI was associated with older age at time of EVAR, greater prevalence of degenerative markers in the descending thoracic aortic wall, and widespread aorto-iliac dilation. While not predictive of EVAR outcomes, TTI can provide valuable information regarding aneurysm pathophysiology. [ABSTRACT FROM AUTHOR]