Background: Since the emergence of the COVID-19 pandemic, medical education has been a concerning issue, especially in surgical fields. Due to the postponement of many elective surgeries and even alternations in the pattern of emergent surgeries, concerns have been raised about whether residents of surgical disciplines are experienced enough after graduation or not. We aimed to describe the impact of the COVID-19 pandemic on surgical residency training in different fields. Materials and methods: We conducted a cross-sectional study with a 20-item questionnaire on residents of surgical disciplines from three different educational hospitals of Tehran University of Medical Sciences, Iran in 2020. In addition, we reviewed the current literature regarding the impact of COVID-19 pandemic on surgical education worldwide. Results: Our survey, with a response rate of 56.8% demonstrated significant reduction in the time spent in elective surgeries, surgical clinics and even in emergent surgeries for residents. Besides, it has reported that significant time has been spent in COVID 19 wards which resulted in decreased satisfaction of educational activities. Conclusions: The impacts of COVID 19 pandemic on surgical education are significant and inevitable. Thus, we must integrate novel educational methods in surgical curriculum to optimize training and minimize the adverse effects of the pandemic on surgical education.

Background. Rectus sheath hematoma is a rare self‐limited presentation that has become a concern in hospitalized COVID‐19 patients receiving anticoagulant therapies. Method. A retrospective multicentric study was conducted in referral hospitals affiliated with the Tehran University of Medical Science, Tehran, Iran, between June and August 2021. Patients with a confirmed diagnosis of COVID‐19 that were complicated with rectus sheath hematoma during hospitalization were included. Median (lower quartile to upper quartile) was used to report the distribution of the results. Result. This study was conducted on nine patients with confirmed COVID‐19 pneumonia, including eight females and one male. The severity of viral pneumonia was above average in eight patients. The median age and median body mass index were 65 (55.5 to 78) years and 29.38 (23.97 to 31.71) kg/m². The duration of anticoagulant therapy was 10 (6 to 14) days, and the median length of hospital stay was 20 (10 to 23.5) days. Rectus sheath hematoma occurred after a median reduction of 4 (2.7 to 6.6) units in blood hemoglobin. Although 66.7% received ICU care and all of them were under full observation in well‐equipped hospitals, the mortality rate was 55.6%. Conclusion. In summary, increased levels of inflammatory markers such as lactic acid dehydrogenase along with an abrupt decrease in blood hemoglobin in COVID‐19 patients should be considered as predisposing factors for rectus sheath hematoma, especially in patients with moderate to severe COVID‐19 pneumonia under anticoagulant therapy. This complication had been considered a self‐limited condition; however, it seems to be fatal in patients with COVID‐19 pneumonia. Further studies in larger sample sizes should be conducted to find out suitable management for this complication.

Acute mesenteric ischemia is known as a life threatening condition. Re-establishment of blood flow in this condition can lead to mesenteric ischemia reperfusion (MIR) injury which is accompanied by inflammatory response. Still, clear blueprint of inflammatory mechanism underlying MIR injury has not been provided. Interestingly, Albendazole has exhibited notable effects on inflammation and cytokine production. In this study, we aimed to evaluate outcomes of MIR injury following pretreatment with Albendazole with respect to assessment of mesenteric inflammation and ischemia threshold. Male rats were randomly divided into sham operated, vehicle treated, Albendazole 100 mg/kg and Albendazole 200 mg/kg groups. MIR injury was induced by occlusion of superior mesenteric artery for 30 min followed by 120 min of reperfusion. Samples were utilized for assessment of epithelial survival and villous height. Immunohistochemistry study revealed intestinal expression of TNF-α and HIF-1-α. Gene expression of NF-κB/TLR4/TNF-α/IL-6 was measured using RTPCR. Also protein levels of inflammatory cytokines in serum and intestine were assessed by ELISA method. Histopathological study demonstrated that pretreatment with Albendazole could ameliorate decline in villous height and epithelial survival following MIR injury. Also, systemic inflammation was suppressed after administration of Albendazole. Analysis of possible participating inflammatory pathway could demonstrate that intestinal expression of NF-κB/TLR4/TNF-α/IL-6 is significantly attenuated in treated groups. Eventually, IHC study illustrated concordant decline in mesenteric expression of HIF-1-α/TNF-α. Single dose pretreatment with Albendazole could ameliorate inflammatory response and enhance ischemia threshold following induction of MIR injury. More studies would clarify existing causality in this phenomenon.

To assess satisfaction and perspectives of adult hemodialysis (HD) patients on different vascular access (VA) types (AVF, AVG, CVC) by synthesizing quantitative studies using validated questionnaires, focusing on overall satisfaction, physical symptoms, social functioning, and complications. We systematically searched Medline, Web of Science, and Scopus for studies assessing adult HD patients' perspectives on VA using structured questionnaires. Risk of bias was assessed using the Newcastle-Ottawa Scale. Meta-analysis was performed using a random-effects model across three pairwise comparisons: AVF vs. CVC, AVF vs. AVG, and CVC vs. AVG. Of 1,253 records, 11 studies (n = 2910) met inclusion criteria. AVF patients had higher overall satisfaction compared to those with CVCs (MD: 7.06%, 95% CI: 2.98-11.14). Compared to AVG, AVF patients had higher overall satisfaction, though not statistically significant (MD: 5.12%, 95% CI: - 0.42 to 10.66; p = 0.069). Dissatisfaction with physical symptoms was significantly higher in AVF patients than in those with CVCs (MD: 8.76%, 95% CI: 4.19 to 13.34). Compared to CVC, AVF patients reported significantly lower dissatisfaction in both social functioning (MD: - 9.48%, 95% CI: - 15.98 to - 2.98) and dialysis-related complications (MD: - 10.08%, 95% CI: -12.66 to -7.50). AVFs are associated with higher overall patient satisfaction compared to other VA types. While AVF patients experience more physical discomfort, this is outweighed by significantly greater satisfaction in areas such as social functioning and dialysis-related complications. These findings emphasize the importance of considering patient-reported outcomes when evaluating VA options in HD care. Not applicable.

Background: Postoperative Nausea and Vomiting (PONV) is a multifactorial surgical complication with an unclear underlying cause. Anesthetic methods, patients' characteristics and the type of surgery are considered as factors affecting PONV. This study was designed to compare the effect of inhalational and intravenous anesthesia in abdominal surgery on the incidence and severity of PONV. Methods: A single-blinded prospective randomized clinical trial on 105 patients aged 18 - 65 years was carried out. Patients were divided in two groups of Total Intravenous Anesthesia (TIVA) and Inhalational anesthesia. The incidence and severity of PONV were examined at 0, 2, 6, 12, and 24 hours after the surgery. The use of a rescue antiemetic was also evaluated. Results: Fifty point nine percent of the patients in the inhalation group and 17.3% of the patients in the intravenous group developed PONV (p < 0.001). The incidence of vomiting was reported in 11.3% of the Inhalational group and 3.8% of the TIVA group (p = 0.15), and 24.5% of patients in the Inhalation group and 9.6% of patients in the intravenous group needed an antiemetic medication (p = 0.043). Conclusion: The incidence of postoperative nausea and vomiting and the need for administration of an antiemetic rescue drug, and the severity of nausea in patients were significantly lower in the TIVA group. (C) 2020 Published by Elsevier Editora Ltda. on behalf of Sociedade Brasileira de Anestesiologia.