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Context Individuals with type 2 diabetes mellitus (DM) have an increased risk of pneumonia and septic shock. Traditional glucose-lowering drugs have recently been found to be associated with a higher risk of infections. It remains unclear whether sodium-glucose cotransporter 2 inhibitors (SGLT2is), which have pleiotropic/anti-inflammatory effects, may reduce the risk of pneumonia and septic shock in DM. Methods MEDLINE, Embase, and ClinicalTrials.gov were searched from inception up to May 19, 2022, for randomized, placebo-controlled trials of SGLT2i that included patients with DM and reported outcomes of interest (pneumonia and/or septic shock). Study selection, data extraction, and quality assessment (using the Cochrane Risk of Bias Assessment Tool) were conducted by independent authors. A fixed-effects model was used to pool the relative risk (RRs) and 95% CI across trials. Results Out of 4568 citations, 26 trials with a total of 59 264 patients (1.9% developed pneumonia and 0.2% developed septic shock) were included. Compared with placebo, SGLT2is significantly reduced the risk of pneumonia (pooled RR 0.87, 95% CI 0.78-0.98) and septic shock (pooled RR 0.65, 95% CI 0.44-0.95). There was no significant heterogeneity of effect size among trials. Subgroup analyses according to the type of SGLT2i used, baseline comorbidities, glycemic control, duration of DM, and trial follow-up showed consistent results without evidence of significant treatment-by-subgroup heterogeneity (all Pheterogeneity > .10). Conclusion Among DM patients, SGLT2is reduced the risk of pneumonia and septic shock compared with placebo. Our findings should be viewed as hypothesis generating, with concepts requiring validation in future studies. more...

Endoscopic transsphenoidal surgery is challenged by restricted visualization and dexterity, and the risk of internal carotid artery (ICA) injury. This study pursued two objectives: Development of a steerable, miniature multi-tool combining visualization and suction/irrigation, and development of a simulation model for ICA injury. The multi-tool featured a two degrees of freedom notched nitinol wrist controlled by a joystick. A theoretical range of motion of 90 degrees was intended. The inner lumen of the wrist was designed for suction and irrigation, a miniature camera attached to the tip would provide visualization. During testing, slack in the actuation cables affected the tools workspace and control. A maximum force of 0.45 N was applied through the tip. The simulation model was manufactured from medical grade ABS. It featured a removable nose cartridge for a cost efficient replacement method. A peristaltic pump and a needle tip were used for ICA injury simulation. For future evaluation of the model, a 5 point Likert scale was developed. Despite successful tests, some limitations remained. The tool was affected by slack and did not include illumination. No mucosal layer was included in the simulation model and haemostasis had to be assessed manually. more...

Background:Tuberous sclerosis complex (TSC) is a rare autosomal dominant disorder characterized by benign tumor growth in multiple organs, which may cause significant negative impact on patients’ health-related quality of life (HRQoL). Since HRQoL studies in Asian TSC population are scarce, we aim to evaluate the HRQoL of our local TSC patients, who are mainly ethical Chinese, so as to provide a holistic view and information for better understanding of TSC patients in this part of the world. Methods:HUI-Ch is a validated Chinese multiple-choice questionnaire for scoring Health Utilities Index Mark 2 (HUI2) and Health Utilities Index Mark 3 (HUI3). It was used to assess HRQoL of TSC individuals in Hong Kong. Proxy-data on socio-demographics and common chronic health conditions for TSC patients were collected. Data analyses involved multiple imputation with two-sample t-test, Pearson correlation and multiple regression to predict variations in HRQoL in relation to different factors. Data was compared with existing data on HUI of other disease entities.Results:Of 27 patients in the study sample, mean HUI2 and HUI3 scores were 0.64 and 0.50 respectively (1 = perfect health, 0 = death). 81.5% and 77.8% of TSC patients belonged to the “severe” disability category on HUI2 and HUI3, which were higher than the proportion of Down syndrome patients (60.0% and 72.0%). Behavioral problems on HUI2 and attention deficit hyperactivity disorder (ADHD) on HUI3 were statistically significant predictors (both p more...

Sagittal craniosynostosis is the most common form of congenital cranial deformity. Surgical interventions are performed either open or endoscopic. Advancements in minimally invasive surgery have enabled the development of the endoscopic suturectomy technique. This is contrasted to the traditional open cranial vault reconstruction. There is a paucity of data comparing the head shape changes from both techniques. This study aims to compare the morphological outcome of endoscopic suturectomy versus total cranial vault reconstruction. Methods This is a retrospective comparative study involving 55 cases of sagittal craniosynostosis, 37 of which has open total cranial vault reconstruction and 18 had endoscopic suturectomy procedure. Preoperative and postoperative 3D photographs of both groups were analyzed and compared. The change in correction between preoperative and postoperative state was measured against a crowd-driven standard for acceptable head shape. Results Total cranial vault had higher percentage change between pre and postoperative cranial index than endoscopic suturectomy (14.7% versus 7.7%, P = 0.003). However, both techniques were able to achieve the minimum standard of 70% correction (TCV 107.5%, ES 100.4%, P = 0.02). Conclusion Total cranial vault and endoscopic suturectomy are effective in correcting scaphocephaly among children with sagittal craniosynostosis. Additionally, both techniques are able to achieve a percentage correction that exceeds the 70% benchmark established by the lay public. more...

Objective Over the last decade medical students’ interest in pursuing surgery as a career has declined. This is more apparent in high-specialized specialities such as congenital heart surgery (CHS). Early hands-on simulation has shown to have a positive impact on medical students’ interest in pursuing surgery, however, its incorporation into medical school curricula is lacking. This study aimed to evaluate the impact of incorporating medical students as surgical assistants during the Hands On Surgical Training course in CHS. Methods Local preclinical medical students were invited to participate as surgical assistants during the 5th annual Hands On Surgical Training course in CHS. Among those who responded to the invitation, students were randomly selected and allocated to assist a congenital heart surgeon. All selected students attended an assistants’ session prior to the course to familiarize themselves with assisting and to practice basic surgical skills. At the end of both courses students completed a questionnaire based on Likert 5-point scale to evaluate the courses’ usefulness. Results Fifteen medical students completed the questionnaires. All reported a beginner level of understanding of congenital heart disease. All students were highly satisfied with using 3D-printed models to help their understanding of congenital heart disease (4.80 ± 0.41) and agreed that the sessions improved their assisting skills (4.93 ± 0.26). All expressed a desire to attend similar sessions in the future and agreed that surgical simulation inclusion into medical school curricula would enhance learning (5.00 ± 0.00). Interest in pursuing a career in CHS increased from 33% (5) to 87% (13) by the end of the course. Conclusions Integration of preclinical medical students into surgical simulation increases interest in pursuing highly specialised surgical specialities such as CHS. Early exposure and the incorporation of such simulation programs into medical school curricula will likely improve surgical skill acquisition and may enable students to be better informed when selecting future career choices. more...