Online learning has a well-established role in medical education, and it is well accepted by students. Electronic learning (e-learning) strategy is aimed at improving the quality of medical education by providing students with equal access to quality learning resources. The main advantages of online learning are its flexibility and the capacity for learning to be self-paced. Online learning may be particularly useful for under- and post-graduate medical education. Virtual lectures can substitute conventional lectures in medical education in multiple fields. Online learning has several barriers including lack of time and poor technical skills of their providers, inadequate infrastructure, and the absence of development strategies of the universities. The current COVID-19 pandemic may represent a real challenge to medical education. Online learning techniques can be used to complete the curricula for medical schools during this crisis. This review presents a robust evidence base for e-learning in medical education. Further, it compares online and offline learning methods in medical education.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Introduction: The management of patients with upper tract urothelial carcinoma (UTUC) is challenging, with radical nephroureterectomy (RNU) being the gold standard of treatment for high-risk disease. The role of chemotherapy is unclear. The POUT trial is a multicenter UK effort that addresses whether adjuvant chemotherapy improves disease-free survival (DFS) in patients with locally advanced and/or node-positive UTUC. Methods: The POUT trial enrolled 262 patients with UTUC (pT2-T4, N0-3, and M0) between 2012 and 2017. The patients were randomized (1:1) to four cycles of adjuvant gemcitabine–cisplatine (gemcitabine–carboplatin if GFR 30–49 ml/s) or surveillance following RNU. The patients were followed with cross-sectional imaging and cystoscopy every 6 months for the first 2 years and then annually for 5 years. The primary end point was DFS, whereas recurrence-free survival (RFS), overall survival (OS), toxicity, and quality of life (QoL) were the secondary end points. Results: The intent-to-treat analysis was conducted in 262 patients (131 chemotherapy and 131 surveillance). Among the patients treated with chemotherapy, 66% were offered gem-cis, while 68% completed successfully the four planned chemotherapy cycles. Approximately 50% of the patients undergoing chemotherapy developed Grade 3 or greater adverse events. A significant improvement in DFS (hazard ratio [HR]: 0.49 [confidence interval (CI): 0.31–0.76], P = 0.001) was observed at a median follow-up of 17.3 months. Considering the secondary end points, adjuvant chemotherapy was also associated with an improvement in RFS (HR: 0.49 [CI: 0.30–0.78], P = 0.02). Following adjustment for nodal involvement, the difference was more pronounced with a HR: 0.47 (CI: 0.30–0.74), P = 0.001. A difference in the OS curves favoring the adjuvant chemotherapy arm was noticed, but the difference remained nonsignificant due to short follow-up. Conclusions: The POUT trial provides exciting and convincing Level I evidence on the benefit associated with adjuvant chemotherapy administration in patients with locally invasive or node-positive UTUC.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Introduction: The aim of this study is to evaluate treatment modalities in patients with Grade 4 renal injury. Materials and Methods: In this retrospective study, we included a total of 64 patients who were diagnosed with Grade 4 renal injury at our trauma center hospital from 2015 to 2019. Patients who underwent immediate laparotomy due to concomitant injuries or penetrating wounds were excluded from the study. Hemodynamic instability was the absolute indication for nephrectomy as well as failure to respond to conservative treatment. Results: In our study, 10 patients (15.6%) underwent immediate nephrectomy due to hemodynamic instability. In 15 out of 54 remaining patients, arterial embolization was performed. Twelve patients presented with urinoma which required intervention. In this subgroup of patients, a double J stent was inserted in four of the patients and a nephrostomy tube was placed in the remaining eight patients for perinephric space drainage. Nephrectomy was performed in four of the patients in the urinoma group. From the patients treated totally conservative, two presented with perirenal abscess, but only one underwent computed tomography-guided abscess drainage. Conclusion: Patients with Grade 4 renal injuries may be treated conservatively or in a minimally invasive way, and immediate nephrectomy should be performed only in case of hemodynamic instability.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Purpose: The study was designed to ensure the sensitivity of preoperative planning by applying radius, endophytic/exophytic, nearness to collecting system, anterior/posterior, and location to poles (RENAL) nephrometry scoring system on computed tomography films of patients having organ-confined solid and cystic renal tumors and to assess its correlation with the surgical technique by applying RENAL on the specimen intraoperative. Materials and Methods: Eighty-five patients with organ-confined solid and cystic renal masses underwent RENAL nephrometry system which was correlated with the surgical technique either radical or nephron-sparing surgery or the surgical and oncological outcome. Results: RENAL nephrometry scoring system shows high sensitivity with the type and outcome of surgery of resection of the renal tumors. Conclusion: RENAL nephrometry score system is an objective method to help in the decision of surgical approach to resect organ-confined solid and cystic renal tumors.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Over the years, a distant effort has been made to find new prognostic biomarkers in the assessment of accurate response to treatment and detection of recurrences of bladder cancer. Among them, the carbohydrate-rich glycoprotein, Carbohydrate Antigen (CA) 19-9 has shown some usefulness as it is linked with the tumour aggressiveness and the prognosis of disease. Aim of this study is to review available evidence about the role of CA 19-9 in diagnosis, staging and prognosis of bladder cancer. After careful review of the related articles, a total of 16 useful and valued studies were found on the database. These studies evaluated relation of CA 19-9 to various different aspects of bladder cancer. These aspects include use of CA 19-9 as a tool for detection of bladder cancer, its role in the assessment of the prognosis at diagnosis and also looked at the significance of the CA 19-9 in the response to treatment of bladder cancer. These studies indicate that CA19-9 sensitivity and specificity was 71.6 and 91.6 in high-grade tumour and sensitivity of 74% and 83% in Ta and T1 tumours. Serum levels of > 29 U/ml are associated with shorter survival time and carried a 2.54 higher risk of death. High levels in metastatic disease are associated with increase response to chemotherapy. Although these results are encouraging, but due to the limited evidence, there can be no strong recommendation for use of the biomarker CA 19-9 and further studies are needed to establish a useful link.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

The case concerns a geriatric male patient who was hospitalized for gastrointestinal symptoms. Polycystic horseshoe kidney was incidentally detected during imaging. The spectrum of clinical manifestations is broad extending from asymptomatic patients (e.g., the presented case) to patients with acute deterioration demanding surgical treatment. Concomitant presence of renal polycystic disease and horseshoe anomaly is likely to bring closer the age of the presentation of renal failure, due to polycystic disease, and complicates the surgical technique for nephrectomy. Due to the rarity of the anomaly, there is lack of clinical experience, so is of clinical importance to report such cases.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

We report a motorcyclist who presented with a case of empty scrotum and bilateral dislocated testes in the groin after a blunt scrotal injury. Ultrasound and computed tomography revealed viable testes. Manual reduction was performed with success under anesthesia following orchidopexy. The patient made an uneventful recovery.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]