Explore the vast range of titles available.

Background The effect of the COVID-19 pandemic on higher education has been felt worldwide. There are many lessons to be learned about teaching and learning in the digital age. While we evaluate the full impact and prepare ourselves for the new normal, it is worth reflecting on some of the positive aspects of online teaching and learning and understanding how students, teachers and the wider faculty have been able to support each other through the challenges of the pandemic. In this article, we offer a perspective on teaching an online Global Health course to engineering students. Results The course, taught by a physician, provides a grounding in basic medical, scientific and engineering principles and is available to students of diverse engineering specialties. Students developed skills and gained confidence in active listening, sourcing and critical appraisal of information, interdisciplinary teamwork, needs assessment, problem analysis, problem-solving, effective communication, and organisation and delivery of information (in English). Students learned the importance of engineering in landmark historical public health projects, the delivery of modern health care, and the pressing need to develop engineering solutions to current global health problems. Course assessment was formative: 20% attendance and active participation in online classes, 30% problem-solving, 30% student presentations, and 20% written abstracts for two class projects: historical innovations and medicine in the future. Conclusions We show how, through conversion from a classroom to an online format, we were able to deliver a rich curriculum with sound assessment where students were able to innovate together and discover the importance of engineering in health and well-being as we all experience an unprecedented global health pandemic.

Background During the Syrian civil war, patients were initially treated on-site in Syria and later transferred to medical centers in Israel. Relevant details concerning the exact nature of injury and medical/surgical care received in Syria were unavailable to clinicians in Israel. Many of these patients required abdominal re-exploration for obvious or suspected problems related to their injury. Our aim is to present our approach to abdominal trauma patients who survived initial on-site surgery and needed subsequent abdominal re-exploration abroad, in our medical center. Methods Clinical data from all medical records were retrospectively analyzed. Each patient underwent total body computerized tomography on arrival, revealing diverse multi-organ trauma. We divided the patient population who had abdominal trauma into 4 sub-groups according to the location in which abdominal surgical intervention was performed (abdominal surgery performed only in Syria, surgery in Syria and subsequent re-laparotomy in Israel, abdominal surgery only in Israel, and management of patients without abdominal surgical intervention). We focused on missed injuries and post-operative complications in the re-laparotomy sub-group. Results By July 2018, 1331 trauma patients had been admitted to our hospital, of whom 236 had suffered abdominal trauma. Life-saving abdominal intervention was performed in 138 patients in Syria before arrival to our medical center. A total of 79 patients underwent abdominal surgery in Israel, of whom 46 (33%) required re-laparotomy. The absence of any communication between the surgical teams across the border markedly affected our medical approach. Indications for re-exploration included severe peritoneal inflammation, neglected or overlooked abdominal foreign bodies, hemodynamic instability and intestinal fistula. Mortality occurred in 37/236 patients, with severe abdominal trauma as the main cause of fatality in 10 of them (4.2%), usually following urgent re-laparotomy. Conclusions Lack of information about the circumstances of injury in an environment of catastrophe in Syria at the time and the absence of professional communication between the surgical teams across the border markedly dictated our medical approach. Our concerns were that some patients looked deceptively stable while others had potentially hidden injuries. We had no information on who had had definitive versus damage control surgery in Syria. The fact that re-operation was not performed by the same team responsible for initial abdominal intervention also posed major diagnostic challenges and warranted increased clinical suspicion and a change in our standard medical approach.

Pneumobilia is the finding of air in the biliary tree. Most cases are iatrogenic in origin, especially after sphincterotomy and after hepaticojejunostomy or choledochojejunostomy. In patients without such history, the presence of pneumobilia needs further investigation. Most patients are likely to have an enterobiliary fistula. Although patients may be asymptomatic, possible complications include gallstone ileus, Bouveret syndrome or recurrent episodes of cholangitis. We present a case of a 38-year-old man presenting with obstructive jaundice and pneumobilia in whom choledochoduodenal fistula was diagnosed at endoscopic retrograde cholangiography. A description of different types of choledochoduodenal fistulas and management recommendations are also provided.

Procedure for prolapsed haemorrhoids (PPH) is a popular treatment of haemorrhoids. PPH has the advantages of a shorter operation time, minor degree of postoperative pain, shorter hospital stay and quicker recovery but may be followed by several postoperative complications. Rectal bleeding, acute pain, chronic pain, rectovaginal fistula, complete rectal obliteration, rectal stenosis, rectal pocket, tenesmus, faecal urgency, faecal incontinence, rectal perforation, pelvic sepsis and rectal haematoma have all been reported as postoperative complications of PPH. Additionally, one rare complication of the procedure is intra-abdominal bleeding. There are a few case reports describing intra-abdominal bleeding after the procedure. We report a case of a 26-year-old man who developed severe intra-abdominal and retroperitoneal haemorrhage after PPH. The diagnosis was made on the second postoperative day by CT of the abdomen and pelvis. The patient was treated conservatively and had an uneventful recovery.

How often are we faced with a tragic diagnosis in a young patient whose life is completely changed? Often in medicine the tragedy is short-lived: the patients never stabilise, they succumb early to their injuries or complications. We present the case of a young man in whom the exact cause of a spinal cord infarct has never been confirmed. As it transpires, regardless of the sequence of events and the time elapsed between injury and the onset of paralysis, his symptoms came with no warning, were life-threatening and terrifying. He could have had no time to understand what had happened and is now faced with what must seem an eternity to come to terms with a life of quadriplegia. He gives an account of his life for the last 7 years as he has remained at home, while life for his siblings has moved on and he watches from his bed. The triumph is his adjustment to his life now, the vigilance and care of his family and the dedication of the medical staff of a local clinic in a small village in the mountains in the north of Israel.

Background Laparoscopic sleeve gastrectomy (LSG) remains under scrutiny as a stand-alone bariatric procedure. The most feared complication after LSG is staple line leak. Methods Eight bariatric centers in Israel participated in this study. A retrospective analysis was performed by querying all the LSG cases performed between June 2006 and June 2010. The data collected included patient demographics, anthropometrics, and operative and perioperative parameters. Results Among the 2,834 patients who underwent LSG, 44 (1.5 %) with gastric leaks were identified. Of these 44 patients, 30 (68 %) were women. The patients had a mean age of 41.5 years and a body mass index (BMI) of 45.4 kg/m 2 . Intraoperative leak tests and routine postoperative swallow studies were performed with 33 patients, and all but one patient (3 %) failed to detect the leaks. Leaks were diagnosed at a median of 7 days postoperatively: early (0–2 days) in nine cases (20 %), intermediately (3–14 days) in 32 cases (73 %), and late (>14 days) in three cases (7 %). For 38 patients (86 %), there was clinical suspicion, later confirmed by imaging or operative findings. Computed tomography, swallow studies, and methylene blue tests were performed for 37, 21, and 15 patients, respectively, and the results were positive, respectively, for 31 (84 %), 11 (50 %), and 9 (60 %) of these patients. Reoperation was performed for 27 of the patients (61 %). Other treatment methods included percutaneous drainage ( n  = 28, 63.6 %), endoscopic placement of stents ( n  = 11, 25 %), clips ( n  = 1, 2.3 %), and fibrin glue ( n  = 1, 2.3 %). In 33 of the patients (75 %), the leak site was found in the upper sleeve near the gastroesophageal junction. The median time to leak closure was 40 days (range, 2–270 days), and the overall leak-related mortality rate was 0.14 % (4/2,834). Conclusion Gastric leak is the most common cause of major morbidity and mortality after LSG. Routine tests to rule out leaks seem to be superfluous. Rather, selective utilization is recommended. Management options vary, depending mainly on patient disposition. An accepted algorithm for the diagnosis and treatment of gastric leak has yet to be proposed.

The importance of MCI organization and training was highlighted by the events of September 11, 2001. Training focuses on the management of physical injuries caused by a single traumatic event over a well-defined, relatively short timeframe. MCI management is integrated into surgical and trauma training, with disaster management training involving the emergency services, law enforcement, and state infrastructure agencies. The COVID-19 pandemic revealed gaps in the preparedness of nation states and global partners in disaster management. The questions that arose include ‘has training really prepared us for an actual emergency,’ ‘what changes need to be made to training to make it more effective,’ and ‘who else should training be extended to?’ This article focuses on the importance of involving multiple sectors in mass casualty training and asks whether greater involvement of non-medical agencies and the public, in operational drills might improve preparedness for global events such as the COVID-19 pandemic.

Background One anastomosis gastric bypass (OAGB) is gaining popularity worldwide due to its safety and effectiveness. OAGB is the most commonly performed metabolic bariatric surgery (MBS) in Israel. Israel is the only country where OAGB is the most prevalent MBS. Our aim is to address OAGB technical aspects using a national survey completed by members of the Israeli Society of Metabolic and Bariatric Surgery (ISMBS). Materials and Methods An online-survey composed of a 17-item–based questionnaire was sent to ISMBS members. All responses were collected and analyzed. Results A total of 47/64 (73.4%) ISMBS members participated in the survey. Most surgeons (74.5%) had > 10 years of MBS experience, and most (61.7%) performed > 100 MBS/year. The majority (78.7%) perform OAGB as their most common procedure. Most surgeons fashion a 10–15-cm pouch and use a 36-Fr bougie, (57.4% and 38.3%). Regarding bowel length measurement, 70% use visual estimation and 10.6% routinely measure total small bowel length (TSBL). The most common reasons for creating a longer biliopancreatic limb (BPL) were high body mass index (BMI) and revisional surgery (83.3% and 66%, respectively). In a primary procedure of a patient with a BMI = 40, most (76.6%) would create a 150–200-cm BPL. In patients with a BMI > 50 or revisional cases, most (70.2% and 68.0%) would create a 175–225-cm BPL. Conclusion OAGB is the most prevalent MBS performed in Israel. This survey showed common preferences and variations among ISMBS members. Further studies are needed in order to standardize and build a consensus on OAGB technique.

Background The objective of this study was to evaluate the coagulation profile by thromboelastography in morbidly obese patients who undergo bariatric surgery. Morbid obesity entails increased risk for thromboembolic events. There is no clear protocol for thromboembolic prophylaxis, regarding timing and length of treatment, in bariatric surgery. Thromboelastography provides data on a coagulation process from creation of the clot until the fibrinolysis. Methods Ninety-three morbidly obese patients were prospectively recruited within a 2-year period. Coagulation profile was measured by thromboelastography before surgery, in the immediate postoperative period, within 3 h from surgery, and in the late postoperative period, within 10–14 days after surgery. Venous thromboembolic prophylaxis was achieved by giving low molecular weight heparin (LMWH), once a day. Results Of the eligible patients, 67 underwent sleeve gastrectomy while 23 underwent Roux-en-Y gastric bypass. Normal values of coagulation factor function, clotting time, and fibrin function, as measured by R , K , and α (angle), were demonstrated in addition to higher maximal amplitude (MA) values, reflecting increased function of platelets. The average MA value before the surgery was above normal and continued rising consistently in the immediate postoperative as well as in the early postoperative period. Conclusions Morbidly obese patients have a strong tendency toward thrombosis, as demonstrated by pathologically elevated MA values. Altered coagulation profiles were demonstrated 2 weeks postoperatively; thus, prophylaxis that continued at least for 2 weeks after bariatric surgery should be considered. Since LMW heparin is not sufficient alone as thromboembolic prophylaxis, we recommend adding antiplatelet therapy. Further evaluation of appropriate thromboprophylaxis is warranted.

The effect of the COVID-19 pandemic on higher education has been felt worldwide. There are many lessons to be learned about teaching and learning in the digital age. While we evaluate the full impact and prepare ourselves for the new normal, it is worth reflecting on some of the positive aspects of online teaching and learning and understanding how students, teachers and the wider faculty have been able to support each other through the challenges of the pandemic. In this article, we offer a perspective on teaching an online Global Health course to engineering students. The course, taught by a physician, provides a grounding in basic medical, scientific and engineering principles and is available to students of diverse engineering specialties. Students developed skills and gained confidence in active listening, sourcing and critical appraisal of information, interdisciplinary teamwork, needs assessment, problem analysis, problem-solving, effective communication, and organisation and delivery of information (in English). Students learned the importance of engineering in landmark historical public health projects, the delivery of modern health care, and the pressing need to develop engineering solutions to current global health problems. Course assessment was formative: 20% attendance and active participation in online classes, 30% problem-solving, 30% student presentations, and 20% written abstracts for two class projects: historical innovations and medicine in the future. We show how, through conversion from a classroom to an online format, we were able to deliver a rich curriculum with sound assessment where students were able to innovate together and discover the importance of engineering in health and well-being as we all experience an unprecedented global health pandemic.