Latex Gloves Research Articles

P44 Can dermatologists help save the planet?

Abstract The National Health Service (NHS) is England’s largest contributor to public greenhouse gas emissions, accounting for 6.3% of the country’s carbon footprint (Tennison I, Roschnik S, Ashby B et al. Health care’s response to climate change: a carbon footprint assessment of the NHS in England. Lancet Planet Health 2021; 5:e84–92). Promoting sustainable practices within dermatology is often overlooked and remains an understudied area of research. Dermatologists should consider environmental sustainability when choosing their day-to-day personal protective equipment (PPE). An over-reliance on sterile PPE for minor surgical practices costs millions of pounds annually, ultimately occupying landfills and causing detrimental effects to our ecosystem. Are these sterile practices really improving clinical outcomes and reducing the prevalence of surgical site infections (SSIs)? Over the last decade, there has been an emphasis on comparing the use of sterile vs. nonsterile gloves and associated SSI rates in dermatology and Mohs micrographic surgery (MMS). MMS is often conducted with two sterile gloves and two surgical gowns. According to the sustainability guidance published by the British Society for Dermatological Surgery, surgical aprons and nonsterile gloves are preferred to surgical gowns and sterile gloves in procedures such as diagnostic biopsies, simple excision, tumour extirpation stages in MMS and outpatient reconstructive surgeries (https://bsds.org.uk/wp-content/uploads/2022/09/2022-BSDS_Sustainability_Guidance.pdf). Based on this guidance and to reduce our carbon footprint, we decided to use two plastic aprons, one pair of nonsterile and one pair of sterile gloves from August 2020 to September 2022. Of 410 MMS procedures conducted, only 1.7% resulted in a minor postoperative complication related to infection. Our data suggest no significant difference in postoperative wound infections with the use of nonsterile PPE vs. sterile PPE. Moreover, the use of nonsterile PPE has saved our department £1471.90, allowing funding to be distributed to other areas. In line with the NHS multiyear plan to become the world’s first carbon net zero national health system by 2040, we should invest in processes that facilitate sustainable alternatives to construct a fully operational eco-friendly healthcare system. By using less PPE in reconstructive surgeries, we reduce plastic waste. Despite not being able to remove PPE completely, we can make dermatology more sustainable, to help save the planet we live on.

O-090 Endocrine disruptors

Abstract Female mammals, including women, are exposed to endocrine disrupting chemicals (EDCs) on a daily basis. This is of concern because many EDCs inhibit ovarian follicle growth and steroidogenesis, processes that are critical for maintaining female fertility. Our research focuses on the effects of EDCs known as phthalates on female fertility. Phthalates are of interest because they are ubiquitous synthetic chemicals used as plasticizers and stabilizers in a myriad of consumer products, including everything from shower curtains to children’s toys to cosmetics and personal care products such as perfumes, nail polish, deodorants, and lotions. Phthalates are also used in pesticides, wood finishes, adhesives, solvents, lubricants, defoaming agents, and in medical devices including tubing, blood bags, surgical gloves, and dialysis equipment. Despite the widespread use of phthalates and ubiquitous human exposure, limited information is available about the effects of environmentally relevant phthalate mixtures on female reproduction. Thus, we tested the hypothesis that prenatal exposure to an environmentally relevant phthalate mixture affects female reproduction in the F1, F2, and F3 generations of mice. To test this hypothesis, pregnant CD-1 mice were orally dosed with vehicle control (corn oil) or a phthalate mixture (20µg/kg/day-500mg/kg/day) daily from gestational day 10 to birth. The mixture was based on urinary phthalate metabolite levels measured pregnant women in the United States, and consisted of 35% diethyl phthalate, 21% di(2-ethylhexyl) phthalate, 15% dibutyl phthalate, 15% di-isononyl phthalate, 8% diisobutyl phthalate, and 5% benzylbutyl phthalate. Adult F1 females born to these dams were used to create the F2 generation by mating them with unexposed males and F2 females were used to create the F3 generation by mating them with unexposed males. At selected times, estrous cyclicity and fertility indices were monitored and ovaries and sera were collected for analysis. Our data indicate that prenatal exposure to the phthalate mixture significantly decreases anogenital distance, testosterone levels, and litter size, but it significantly increases abnormal estrous cyclicity, uterine weight, the number of cystic ovaries, follicle-stimulating hormone levels, and luteinizing hormone levels compared to control in the F1 generation. Further, our data indicate that prenatal exposure to the phthalate mixture increases body weight, uterine weight, the number of cystic ovaries, and time to pregnancy and it decreases testosterone levels compared to control in the F2 generation. In addition, our data indicate that prenatal exposure to the phthalate mixture increases body weight, uterine weight, the number of cystic ovaries, and abnormal cyclicity and it decreases anogenital distance and the number of live pups compared to control in the F3 generation. Collectively, these data suggest that prenatal exposure to an environmentally relevant mixture of phthalates adversely affects reproductive function in a multi- and transgenerational manner in female mice. These findings have increased our understanding of the mechanisms by which EDCs cause female reproductive toxicity. This information eventually may lead to the development of novel targets for the prevention or treatment of infertility induced by EDCs.

A randomized controlled trial using surgical gloves to prevent chemotherapy-induced peripheral neuropathy by paclitaxel in breast cancer patients (AIUR trial)

BackgroundChemotherapy-induced peripheral neuropathy (CIPN) is a common adverse effect of taxane treatment and can significantly affect patient quality of life. Currently, there are no effective treatments to alleviate symptoms of CIPN; thus, starting with prevention steps in high-risk patients is considered advantageous. However, for these prevention steps to be applicable to all patients, their side effects or accompanying discomforts should be minimal, and the intervention cost-effective. Compression therapy can be considered a prevention intervention, and using surgical gloves is feasible and cost-effective (approximately $0.6 per pair). Although previous studies on compression therapy using surgical gloves have reported decreased incidence of PN, these studies were non-randomized, limited to nab-paclitaxel treatment, and involved the use of small gloves, which may have caused discomfort. Therefore, this study aimed to assess the preventive effects of compression therapy using normal-sized surgical gloves on CIPN in patients treated with paclitaxel.MethodsThis clinical trial is designed to evaluate the preventive effects of compression therapy using surgical gloves on CIPN in women with stage II–III breast cancer who received paclitaxel chemotherapy for at least 12 weeks. This multicenter, randomized-controlled, open-label study will be conducted in six academic hospitals. Patients with medication or a medical history related to neuropathy or hand disease will be excluded. The primary outcome will be the preventive effect of compression therapy using surgical gloves, measured based on changes in the neurotoxicity component of the Functional Assessment of Cancer Therapy-Taxane questionnaire. Furthermore, we will assess the National Cancer Institute’s Common Terminology Criteria for Adverse Events grade of CIPN after 6 months. Notably, the estimated sample size, based on a p-value < 0.025 and statistical power of 0.9, will consist of 104 patients (52 per group), accounting for a 10% sample loss.DiscussionThis intervention can be easily implemented in clinical practice and may serve as a preventive strategy for CIPNs with strong patient adherence. If successful, this intervention could improve the quality of life and treatment adherence in patients receiving chemotherapy that can induce PN, extending beyond paclitaxel treatment alone.Trial registrationClinicalTrials.gov, NCT05771974; Registered on March 16, 2023.

The Effect of Manipulation with Different Types of Gloves on Various Mechanical properties and Setting Time of Putty-Type Silicone Impression Materials

Aim: To evaluate the effects of handling with different type of gloves on the setting time, compressive and tensile strength of putty-type silicone impression materials. Methodology: The study was conducted at COMSATS Lahore and was approved by IRB FMH College of Medicine and Dentistry. In this in-vitro study three different type of gloves (Polythene, Latex and Vinyl) and two different brands each of addition silicone (Flexceed and Elite P&amp;P) and condensation silicone (Zetaplus and Cavex) impression materials were used. These materials were divided into four different groups (A, B, C and D). Each group was subdivided into four sub-groups based on the gloves used for manipulation. Sixty samples(n=20) of two brands each of addition (Elite P&amp;PA, Flexceed B) and condensation silicones (Zetaplus C and Cavex D) were prepared and analyzed to evaluate the setting time, compressive strength and tensile strength of addition and condensation impression materials. The samples were subdivided into groups A1, B1, C1, D1 (Control), A2, B2. C2, D2 (Polythene gloves), A3, B3, C3,D3 (Vinyl gloves) and A4, B4, C4, D4(Latex) respectively. Results: There was a significant effect(p&lt;0.5) on the setting time of Elite P &amp;P when mixed with latex gloves(A4) and Flexceed when mixed with polythene(B2) and latex gloves(B4) There was significant (p&lt;0.5) effect on the setting time of Zetaplus when mixed with vinyl(C3) and latex gloves(C4). There was significant (p&lt;0.5) effect on the setting time of Cavex when mixed with polythene(D2), vinyl(D3) and latex gloves(D4). There was a significant (p&lt;0.5) effect on the tensile strength of both brand of addition and condensation silicone when mixed with polythene, vinyl and latex gloves as compared to control group. There was significant effect on the compressive strength of both brand of addition and condensation silicone except that polythene gloves don’t affect the compressive strength of one group of addition silicon B2(Flexceed) Practical implications: Dental silicone type of impression materials are widely used to fabricate different indirect restorations. Gloves are essential to control cross infection for the safety of the dentist and the patients and cannot be avoided for manipulation of these materials. Worldwide, dentists use different types of gloves to manipulate silicone impression materials. The composition and type of gloves affect the setting time and properties of addition and condensation silicones, and ultimately, it can affect and compromise the clinical outcome too. Conclusion: Latex and polythene gloves should be avoided for the manipulation of addition and condensation silicones putty impression materials due to considerable effect on the setting time. Vinyl gloves are a better choice as all others affected the mechanical properties. Keywords: Addition silicones, Condensation silicones, tensile strength, compressive strength, setting time

Female Dermatology Residents Have Inadequate Access to Well-Fitting Surgical Gloves at Training Centers.

Female Dermatology Residents Have Inadequate Access to Well-Fitting Surgical Gloves at Training Centers.

Comparative Evaluation of Safety and Performance of Latex and Nitrile Surgical Gloves: A Post - Market Clinical Follow - Up Study

Comparative Evaluation of Safety and Performance of Latex and Nitrile Surgical Gloves: A Post - Market Clinical Follow - Up Study

A Comparison of Type IV Hypersensitivity Reaction to Synthetic Polyisoprene Gloves versus Control Gloves Using Modified Draize-95 Test in Normal Individual

Background: The emergence of epidemics in recent years, such as COVID-19 and monkeypox, has increased the need for protective gloves. Objectives: This study was performed to provide clinical evidence that no residual chemical additives are present in the powder-free, non-latex, with and without pigment, sterile and non-sterile nitrile, and polyisoprene gloves at a level that may induce type IV allergy in the unsensitized general user population. Methods and Materials: We conducted the modified Draize-95 test on the GAMMEX® Non-Latex PI, sterile powder-free synthetic polyisoprene surgical gloves (S01) and the GAMMEX® Non-Latex PI Green, sterile powder free synthetic polyisoprene surgical gloves (S02). A quasi-experimental non-equivalent study consisted of 180 healthy unsensitized adult volunteers at the Islamic University of Gaza. Participants were divided into two groups: 150 white subjects and 30 black subjects. Each group divided into two groups, each one contained approximately the same numbers of males and females. We used two sets of different test materials as 2x2 cm pieces of the glove's materials from the inner and outer surfaces mounted on an adhesive patch. For the control groups, we used Nitrile Skin Examination Powder-Free Disposable Gloves (C1) and Aegis Examination Gloves (C2). Results: None of the participants showed positive reactions to the test materials of equal or greater than 1.5 in the challenge or rechallenge phase, both on the inner and outer surfaces of the GAMMEX® Non-Latex PI, sterile powder-free synthetic polyisoprene surgical gloves (S01), and the GAMMEX® Non-Latex PI Green, sterile powder-free synthetic polyisoprene surgical gloves (S02). Only one white woman showed a reaction to the inner surface of the S02 material in the induction phase. Three participants showed skin reactions to the second control material, the Aegis Nitrile Examination Gloves (C2). Those three were a white female in the induction phase and two white males in the challenge phase. However, none of them showed any reaction later. Conclusion: The modified Draize test negative results for the GAMMEX Non-Latex PI, sterile powder-free, synthetic polyisoprene surgical gloves (white and green) support the claim that the chemical sensitization potential of these materials is low and that no residual chemical additives are present in these gloves at a level that could cause type IV hypersensitivity reactions.

Nurses Knowledge Regarding Personal Protective Equipment in Intensive Care Units at a Public Tertiary Care Public Hospital, Peshawar

PPE is designed to protect Health Care Workers (HCWs) from workplace infections and injuries and the most commonly used equipment including goggles, masks, medical gloves, and respirators. Objective: To determine nurses’ knowledge regarding PPE in intensive care units at a Public Tertiary Care Hospital, in Peshawar, Pakistan. Methods: A cross-sectional study was directed using convenient sampling. A structured questionnaire from the literature was used to collect the data. Responses of the participants as good/Average/Poor were recorded. The data were collected from the Nurses who have five or more than five years of experience in the intensive care units of Hayatabad Medical Complex, a Public sector tertiary care Hospital. Results: The mean age of the participant was evaluated which was 30.09 years with a standard deviation of 7.04 years. The professional experience of the participants was 6.78 years with a standard deviation of 5.85 years. Our study shows that 65.4% had good knowledge or an acceptable knowledge level, 30.9% had average knowledge, and 3.7% of the participants had poor knowledge. Conclusions: The study concluded that most of the participants have good knowledge of Personal Protective equipment but a significant number of participants had average knowledge and some have poor knowledge as well. Therefore, regular sessions should be given to enhance the knowledge level

Endodontic infection control practices among Pakistani general dental practitioners: A national cross-sectional questionnaire survey

ObjectiveThis study was aimed at evaluating the self-reported endodontic infection control practices of general dental practitioners in Pakistan. MethodsAn e-questionnaire was sent to 619 general dental practitioners in several WhatsApp groups. Sixteen questions associated with various infection control measures recommended by the ESE were asked, including the use of various isolation methods/rubber dams, the selection of canal irrigants and anti-bacterial solutions, and practices regarding hand hygiene and use of examination gloves. The e-questionnaire also included questions associated with demographics. Data analysis was conducted in SPSS-24. Descriptive statistics were documented as percentages and frequencies. ResultsOf 619 GDPs, 350 responded (56.5% response rate), of whom 43.7% worked in private dental practices. The majority were women (64%), had graduated after 2010 (81.1%), and were 24–34 years of age (78.9%). A total of 72.3% of GDPs used cotton rolls, and 17.4% routinely used rubber dams for endodontic isolation; 89% did not disinfect the operative field; 80% reported using different concentrations of NaOCl during root canal instrumentation; and 0.9% reported not using any irrigant during endodontic procedures. A total of 61.7% reported always using intra-canal medication during multi visit endodontic treatment, among whom 82.5% reported using Ca(OH)2. Finally, 100% of respondents reported using gloves during endodontic treatment. ConclusionThe results indicated that the GDPs tended to follow some of the endodontics quality standards recommended by the ESE, but the overall implementation of all guidelines requires improvement.

Service availability and readiness assessment of COVID-19 disease management at different tiers of health service delivery in Bangladesh

Background: The world is passing through a hard time due to the highly infectious COVID-19 pandemic. Like other countries in the world, the Bangladesh government has taken various preventive measures. As part of this, the availability and readiness of different health facilities is crucial. Objective: The study aimed to assess availability and readiness based on logistics, workforce, clinical management, and IPC. Methods: A cross-sectional quantitative study was conducted from August 20 to September 30, 2021, which comprised a health facility survey with a sample of 210. The health facilities included all three tiers of hospitals, covering 24 districts of eight divisions. All COVID-19 dedicated hospitals were included in this survey. The questionnaire consisted of a standard checklist developed by WHO, DGHS, and CDC. Results: The overall scores for ICU, HDU, and ventilation service were 76.8%, 87.5%, and 85.7%, respectively, but they were almost missing in Upazila health complex and below the average in non-dedicated hospitals. All (100%) secondary and tertiary level hospitals had a 24-hour staffed emergency unit, with dedicated hospitals outperforming non-dedicated hospitals (99.2% vs 98.7%). Above 90% of hospitals in different tiers had hand hygiene supplies and respiratory hygiene supplies for staff and patients, 98% of the primary level hospitals displayed instructions on hand and respiratory hygiene practices. On the other hand, 94.9% of secondary level hospitals had clearly identified and separated COVID-19 isolation areas from non-COVID-19 areas; 82.1% of secondary level hospitals had service providers (MOs) who used PPE; 97.4% had routine cleaning and disinfection of ambulances done according to IPC guidelines; and 64.1% had staff of laboratory, laundry, food services, and waste management teams who used appropriate PPE. Secondary level hospitals had a better availability of PPE compared to primary and tertiary level hospitals, which consisted of protective gowns (87.8%), disposable latex gloves (examination) (92.5%), goggles, protective (82.9%), face shields (72.5%), respirator masks (N95 or FFP2) (75.0%), and masks, medical/surgical (97.6%) available for all health service providers. Almost 26.2% facility have PCR testing lab and almost all (96.7%) the facilities have specimen collection system in their facility. Conclusion: The service availability and readiness regarding COVID-19 among different tiers of health facilities in Bangladesh are not adequate. We need more support for disease detection capacities through provision of technical expertise, laboratory equipment and increase capacity of the secondary and primary health care tier along with national capacity for covid-19 testing. Bangladesh Medical Res Counc Bull 2022; 48: 160-171

Recycling COVID-19 health care wastes in bitumen modification: a case of disposable medical gloves.

Disposable medical gloves (DMGs) have long been used to mitigate the risk of direct exposure to diverse microorganisms and body fluids; hence, they are a critical weapon to protect patients and healthcare staff from infectious diseases. Measures to control the spread of COVID-19 have sparked the production of an excessive number of DMGs, most of which are eventually being disposed of in landfills. Untreated DMGs in landfills do not only pose a direct risk of transmitting coronavirus and other pathological germs but also pollute air, water, and soil dramatically. As a healthier alternative, recycling discarded polymer-rich DMGs into bitumen modification is considered to be a prospective waste management strategy applicable to the asphalt pavement industry. In this study, this conjecture is tested by examining two common DMGs - latex gloves and vinyl gloves - at four different percentages (1%, 2%, 3%, and 4% by weight). The morphological characteristics of DMG-modified specimens were inspected by using a high-definition scanning electron microscope (SEM) equipped with an energy dispersive X-ray analyzer (EDX). A wide range of laboratory tests including penetration, softening point temperature, ductility, and elastic recovery were undertaken to evaluate the impact of waste gloves on the conventional engineering properties of bitumen. Moreover, viscoelastic behavior and modification processing were studied by conducting the dynamic shear rheometer (DSR) test and the Fourier transform infrared spectroscopy (FTIR) analysis. Test results have revealed the outstanding potential of recycled DMG waste for modifying neat asphalt binder. More specifically, bitumens modified with 4% latex glove and 3% vinyl glove were seen as capable of superiorly withstanding permanent deformations caused by heavy axle loads at high service temperatures. Furthermore, it has been shown that 1.2 tons of modified binder would embed approximately 4000 pairs of recycled DMGs. This study shows that DMG waste can be used as a viable modifier, which would help open a new avenue for mitigating the environmental pollution arising from the COVID-19 pandemic.

Fruit Peel Powder as Natural Antioxidant and Reinforcing Bio-Filler in Natural Rubber Latex Gloves: Cases of Mangosteen, Pomelo and Durian.

As the world is facing rapid increases in agricultural wastes that greatly affect global health, the environment, and economies, this work aims to alleviate such issues by introducing simple uses of waste fruit peel powder (FPP) derived from mangosteen (MPP), pomelo (PPP), or durian (DPP), as dual natural antioxidants and reinforcing bio-fillers in natural rubber latex (NRL) gloves. A thorough investigation was undertaken of the relevant characteristics for both FPP (morphological, functional groups, particle sizes, and thermals stability) and NRL gloves (morphological, functional groups, density, color, thermal stability, and mechanical properties-both before and after thermal/25 kGy gamma aging). The results indicated that the initial addition (2-4 parts per hundred parts of rubber by weight; phr) of FPP to NRL composites generally enhanced the strength and elongation at the break of the specimens, with the levels of the improvement varying depending on the type and content of FPPs. In addition to the reinforcing effects, the FPP also offered natural antioxidant properties, evidenced by higher values of aging coefficients for all FPP/NRL gloves under either thermal or 25 kGy gamma aging than those of pristine NRL. Furthermore, by comparing the tensile strength and elongation at break of the developed FPP/NRL gloves with the requirements for medical examination latex gloves according to ASTM D3578-05, the recommended FPP contents for actual glove production were 2-4 phr for MPP, 4 phr for PPP, and 2 phr for DPP. Consequently, based on the overall outcomes, the FPPs of interest showed promising potential for utilization as simultaneous natural antioxidants and reinforcing bio-fillers in NRL gloves, which would not only enhance the strength and ability of the gloves to resist oxidative degradation from heat and gamma irradiation but also increase their economical value as well as reducing the amounts of the investigated wastes.

Derivation and characterization of secondary zinc oxide from rubber glove manufacturing wastewater via adsorption-desorption-precipitation route

The demand for zinc oxide surged during the Covid-19 pandemic as gloves became a necessity in daily life. The washing-off of the zinc oxide used to activate crosslinking in glove latex, generates hazardous zinc-containing wastewater, which is conventionally treated by chemical precipitation using lime and caustic soda. This produces large volumes of hazardous sludge. This study aims to demonstrate removal and recovery of zinc from real wastewater via adsorption-desorption-chemical precipitation approach to produce utilizable secondary zinc oxide. A low-cost palm shell activated carbon was used to adsorb zinc from raw wastewater with 93% efficiency, straightforwardly reducing zinc concentration below 2 mg/L (discharge standard) within 45 min, at pH 7 and 60 °C. Subsequent desorption with 0.3 M HCl facilitated recovery of 63% of secondary zinc oxide from the desorption solutions via chemical precipitation and calcination path. Morphological analysis of the synthesized secondary zinc oxide confirmed high crystallinity of hexagonal wurtzite crystalline structure of typical spherical and nanorods particle shapes measuring 102 nm in size. Surface area comprised of considerable 59.02 m2/g, with pores volume and size of 0.1735 m3/g and 11.76 nm, respectively. This study demonstrated successful recovery of zinc ions from raw industrial wastewater to produce good quality secondary zinc oxide, creating opportunities for zinc recycling, reduction in consumption of chemicals and chemical sludge volume, steering way towards sustainable practices in rubber gloves manufacturing sector.

V-021 MIDLINE RESTORATION VIA EMILOS TECHNIQUE

Abstract Aim In recent years, numerous minimally invasive techniques have been developed for the repair of midline hernias associated with diastasis recti. The eMILOS technique (Endoscopic mini/less open sublay technique) allows midline repair with mesh placement in the retromuscular space through a small trans-hernial incision without entering the abdominal cavity. Material &amp; Methods We present a case of a 45 year-old male who complained of umbilical bulge and pain. On physical exam, an umbilical hernia measuring 2cm was observed, associated with 5cm diastasis recti. Midline restoration via eMILOS approach was decided. In this technique, a transhernial endoscopic approach is performed with two 5mm ports on both flanks, allowing a complete dissection of the retromuscular space. First, a sublay approach of the umbilical hernia is performed. The hernial content is reduced and the posterior sheath is closed. Then, we place a homemade device (consisting of a wound protector, a surgical glove and a port) to perform the endoscopic approach. When the retromuscular space is completely dissected, both anterior and posterior sheaths are closed with barbed sutures. A large heavy polypropylene mesh is placed and fixed with absorvable tackers and glue. Afterwards, the endoscopic step is over and the ports are taked out, the umbilical fascia is closed with a running suture and the umbilicus scar is fixed. Results The patient presented a favorable evolution, with no recurrence a year postoperatively. Conclusions The eMILOS technique is a safe and effective alternative for the treatment of diastasis recti associated with midline defects.

Simulation-Based Breast Biopsy Training Using a Low-Cost Gelatin-Based Breast Model in Rwanda.

An interdisciplinary team of healthcare providers and simulation specialists adopted and modified a protocol for the creation of a low-cost, gelatin-based breast model for teaching ultrasound-guided breast biopsy and assessed first-time user experience. An interdisciplinary team of healthcare providers and simulation specialists adopted and modified a protocol for the creation of a low-cost, gelatin-based breast model for teaching ultrasound-guided breast biopsy for approximately $4.40 USD. Components include medical-grade gelatin, Jell-O™, water, olives, and surgical gloves. The model was used to train two cohorts comprising 30 students total during their junior surgical clerkship. The learners' experience and perceptions on the first Kirkpatrick level were evaluated using pre- and post-training surveys. Response rate was 93.3% (n = 28). Only three students had previously completed an ultrasound-guided breast biopsy, and none had prior exposure to simulation-based breast biopsy training. Learners that were confident in performing biopsies under minimal supervision rose from 4 to 75% following the session. All students indicated the session increased their knowledge, and 71% agreed that the model was an anatomically accurate and appropriate substitute to a real human breast. The use of a low-cost gelatin-based breast model was able to increase student confidence and knowledge in performing ultrasound-guided breast biopsies. This innovative simulation model provides a cost-effective and more accessible means of simulation-based training especially for low- and middle-income settings.

Resected specimen extraction using a medical glove in endoscopic submucosal dissection of a large gastric submucosal tumor (with video)

Resected specimen extraction using a medical glove in endoscopic submucosal dissection of a large gastric submucosal tumor (with video)

Latex glove fragment detected in the glottic entrance during tracheal intubation

Latex glove fragment detected in the glottic entrance during tracheal intubation

The Energy a Plastic Surgeon Expends during Liposuction.

A series of cases was carried out from April 2022 to November 1, 2022, in three different plastic surgery centers. Three plastic surgeons recorded the procedures using an Apple Watch, choosing from among Apple Watch training options and free indoor walking. The surgeon then concluded the registration at the time of finishing the surgery and removed the surgical gloves and gowns. Complete data were obtained for 63 patients. The average fat obtained per 1 kcal of energy was 6.14 cm3 of fat, and 160 cal to obtain 1 cm3 of fat by liposuction. Other data that demonstrated statistically significant correlations were fat volume versus average pace (km), total fat volume versus average heart rate, fat volume versus surgical time, and fat volume versus distance. Liposuction is a surgical procedure that requires considerable effort. This study demonstrates the amount of energy required for regular liposuction. Compared with other single procedures, three times more energy is required to complete liposuction.

Self-made transvaginal ultrasound simulator: new training equipment in ultrasound evaluation of controlled ovarian stimulation and oocyte retrieval.

We sought to create and describe a self-made simulator designed and created for teaching purposes: a high-fidelity ultrasound phantom for demonstrating antral follicle count, ultrasound supervision of controlled of ovarian stimulation, and ultrasound-guided oocyte retrieval. The uterus and ovaries of the ultrasound phantom were made from beef tongue, a male condom, latex gloves, cotton suture threads, bi-distilled water, and ultrasound gel. The components were placed in a pelvis created using three-dimensional (3D) printing. The phantom was presented to and evaluated by a group of 14 physicians pursuing a postgraduate course in reproductive medicine. Two training stations were structured: one to simulate antral follicle count and controlled ovarian stimulation and the other to simulate ultrasound-guided oocyte retrieval. Future specialists were requested to complete a feedback questionnaire evaluating the self-made simulator and the two practice stations. The transvaginal ultrasound phantom was successfully created, making it possible to simulate antral follicle count, ultrasound control of ovarian hyperstimulation, and oocyte retrieval, and to capture ultrasound images. A review of the answers provided in the feedback questionnaire showed that the phantom had a good appearance and design, was realistic, helped to improve motor coordination, and could be a useful tool in the training of specialists in assisted reproduction. This phantom was designed to enable instruction and practice in the evaluation of ovarian follicles and ultrasound-guided oocyte retrieval in a supervised training environment. This self-made simulator is proposed as a training tool that could be included in the curricular structure of residency and postgraduate programs in reproductive medicine.

Guideline on the investigation and management of acute transfusion reactions.

Guideline on the investigation and management of acute transfusion reactions.