OBJECTIVE: The use of robotic radical hysterectomy has greatly increased in the treatment of early stage cervical cancer. We sought to compare surgical and oncologic outcomes of women undergoing robotic radical hysterectomy compared to open radical hysterectomy. METHODS: The clinic-pathologic, treatment, and recurrence data were abstracted through an Institutional Review Board-approved protocol at 2 separate large tertiary care centers in Seattle, Swedish Medical Center and the University of Washington. Data were collected from 2001–2012. Comparisons between the robotic and open cohorts were made for complications, recurrence, progression-free survival (PFS), and overall survival (OS). RESULTS: In the study period, 109 robotic radical hysterectomies were performed. These were compared to 202 open radical hysterectomies. The groups were comparable in terms of age and body mass index (BMI). Length of stay (LOS) was considerably shorter in the robotic group (42.7 vs. 112.6 hours, p<0.001) as was estimated blood loss (EBL; 105.9 vs. 482.6 mL, p<0.001). There were more complications in the open radical hysterectomy group, 23.4% vs. 9.2% in the robotic group (p=0.002). The recurrence rate was comparable between the groups (10.1% vs. 10.4%, p=0.730). In multivariate adjusted analysis, robotic surgery was not a statistically significant predictor of PFS (p=0.230) or OS (0.85). CONCLUSION: Our study, one of the largest multi-institution cohorts of patients undergoing robotic radical hysterectomy, suggest robotic radical hysterectomy leads to comparable oncologic outcomes in the treatment of early stage cervical cancer with improved short-term surgical outcomes such as decreased LOS and EBL.
Body Mass Index ; Cohort Studies ; Disease-Free Survival ; Drug Therapy ; Female ; Humans ; Hysterectomy* ; Length of Stay ; Recurrence ; Tertiary Care Centers ; Uterine Cervical Neoplasms* ; Washington

OBJECTIVES: Areca nut is widely consumed in many parts of the world, especially in South and Southeast Asia, where cardiovascular disease (CVD) is also a huge burden. Among the forms of CVD, acute coronary syndrome (ACS) is a major cause of mortality and morbidity. Research has shown areca nut chewing to be associated with diabetes, hypertension, oropharyngeal and esophageal cancers, and CVD, but little is known about mortality and re-hospitalization secondary to ACS among areca nut users and non-users. METHODS: A prospective cohort was studied to quantify the effect of areca nut chewing on patients with newly diagnosed ACS by categorizing the study population into exposed and non-exposed groups according to baseline chewing status. Cox proportional hazards models were used to examine the associations of areca nut chewing with the risk of re-hospitalization and 30-day mortality secondary to ACS. RESULTS: Of the 384 ACS patients, 49.5% (n=190) were areca users. During 1-month of follow-up, 20.3% (n=78) deaths and 25.1% (n=96) re-hospitalizations occurred. A higher risk of re-hospitalization was found (adjusted hazard ratio [aHR], 2.05; 95% confidence interval [CI], 1.29 to 3.27; p=0.002) in areca users than in non-users. Moreover, patients with severe disease were at a significantly higher risk of 30-day mortality (aHR, 2.77; 95% CI, 1.67 to 4.59; p < 0.001) and re-hospitalization (aHR, 2.72; 95% CI, 1.73 to 4.26; p < 0.001). CONCLUSIONS: The 30-day re-hospitalization rate among ACS patients was found to be significantly higher in areca users and individuals with severe disease. These findings suggest that screening for a history of areca nut chewing may help to identify patients at a high risk for re-hospitalization due to secondary events.
Acute Coronary Syndrome* ; Areca* ; Asia, Southeastern ; Cardiovascular Diseases ; Cohort Studies ; Esophageal Neoplasms ; Follow-Up Studies ; Humans ; Hypertension ; Mass Screening ; Mastication* ; Mortality* ; Nuts* ; Pakistan* ; Proportional Hazards Models ; Prospective Studies

Aims: Coral diseases have emerged over the last several decades, causing a loss of live coral cover in the Caribbean and Indo-Pacific reefs. Hence, microbiological and disease cultural techniques are commonly used to investigate their causative microbial agents. This is the first study to identify the potential of pathogenic Vibrio spp. isolated from apparently white syndrome (WS) coral disease in Tioman Island Marine Park using biochemical and molecular techniques. Methodology and results: The Vibrio colonies were isolated from 108 samples of WS infected corals (Acropora cytherea and Montipora aequituberculata) including seawater, sediment and algae found adjacent to infected coral colonies. A total of one hundred representative Vibrio isolates were characterized and most of them (n=50) were identified as V. vulnificus, V. alginolyticus and Photobacterium damselae following biochemical analysis. The molecular analysis revealed six Vibrio spp. (V. coralliilyticus, V. hepatarius, V. brasiliensis, V. tubiashi, V. campbellii, V. ishigakensis) and one Photobacterium rosenbergii. Vibrio coralliilyticus isolated from all infected coral samples may be highly responsible for the sign of WS disease. Conclusion, significance and impact of study The findings of this study provide baseline data and information on potential coral pathogens identified in the coastal waters of Tioman Island. Etiological disease study is suggested to validate their severity and virulence factors in the future.
Vibrio--pathogenicity ; Anthozoa

Introduction: Mental health-related problems are on the rise among medical doctors, with many house officers (HOs) have quitted training prematurely owing to work and life-related factors. However, the quality of work-life (QOWL) among Malaysian HOs remains unknown. Hence, we aimed to determine the mean score of QOWL and its predictors among HOs working at two tertiary hospitals. Methods: This is a cross-sectional study conducted at two tertiary hospitals in Selangor, between May and August 2019. A stratified random sampling was employed. The Malay version of work-related quality of life scale (M-WRQLS-2) and the patient health questionnaire (M-PHQ-9) were used for data collection. Statistical analysis was performed using the SPSS version 23.0 (IBM, Chicago, IL). Results: A total of 260 (72.9%) respondents completed the questionnaires. The overall score of QOWL was 3.05 ± 0.48 (95% CI: 2.99, 3.11). Depressed HOs had a significantly lower mean score across all subscales (p < 0.005) except for the stress at work (SAW) subscale. Two predictors were inversely associated with QOWL. These were the M-PHQ-9 score [β= -0.049,95% CI: -0.06, -0.04] and being female [β=-0.129,95% CI: -0.24, -0.02]. Conclusion: HOs who worked at the two hospitals in Selangor perceived their overall QOWL as average. However, being female and having depression were found to be associated with lower QOWL. Therefore, early interventions targeting female HOs and those with depressive symptoms are warranted. Further research and strategies aiming to improve the overall quality of work-life and its dimensions for HOs during housemanship training are vital.

COVID-19/virology* ; Cities ; Environmental Monitoring ; Genome, Viral ; Humans ; Infection Control/methods* ; Pakistan ; RNA, Viral/genetics* ; SARS-CoV-2/genetics* ; Sewage/virology*