Approach to management of penile fracture- Our Three-year experience at a Teaching Hospital

Introduction: Penile fracture is a rare surgical emergency. It usually occurs as a single rupture of the tunica albuginea in one of the two corpora cavernosa; a rupture of both masses is an uncommon finding. We conducted this study to determine the etiology, clinical presentation and to review the causes and management of penile fracture. Methods: The retrospective study was carried out on 17 patients, admitted in the department of Urosurgery from January 2017 to December 2020 with penile fracture in a tertiary care teaching hospital in Kathmandu. Patient demographic profile, etiology, clinical presentation, time interval from injury to presentation, investigation done, treatment given and intraoperative findings were analyzed. Results: The main cause of penile fractures was sexual intercourse (82.35%) followed by manual manipulation (17.65%). Crackling sound (100%) followed by penile hematoma and pain were the most common presenting symptoms among the patients. Surgical exploration and repair of injury was done in all patients. Conclusion: Most of the time diagnosis of penile fracture can be made reliably by history and physical examination. Early surgical intervention is associated with a good outcome, regardless of the timing of presentation.

Delays in Presentation Time Under the COVID-19 Epidemic in Patients With Transient Ischemic Attack and Mild Stroke: A Retrospective Study of Three Hospitals in a Japanese Prefecture

Background: Coronavirus Disease 2019 (COVID-19) has spread worldwide with collateral damage and therefore might affect the behavior of stroke patients with mild symptoms seeking medical attention.Methods: Patients with ischemic stroke who were admitted to hospitals within 7 days of onset were retrospectively registered. The clinical characteristics, including onset-to-door time (ODT), of patients with a transient ischemic attack (TIA)/mild stroke (National Institutes of Health Stroke Scale [NIHSS] score of ≤ 3 on admission) or moderate/severe stroke were compared between those admitted from April 2019 to March 2020 (pre-COVID-19 period) and from April to September 2020 (COVID-19 period). Multivariable regression analysis was performed to identify factors associated with the ODT.Results: Of 1,100 patients (732 men, median age, 73 years), 754 were admitted during the pre-COVID-19 period, and 346 were admitted during the COVID-19 period. The number and proportion of patients with TIA/minor stroke were 464 (61.5%) in the pre-COVID-19 period and 216 (62.4%) during the COVID-19 period. Among patients with TIA/mild stroke, the ODT was longer in patients admitted during the COVID-19 period compared with that of the pre-COVID-19 period (median 864 min vs. 508 min, p = 0.003). Multivariable analysis revealed the COVID-19 period of admission was associated with longer ODT (standardized partial regression coefficient 0.09, p = 0.003) after adjustment for age, sex, route of arrival, NIHSS score on admission, and the presence of hypertension, diabetes mellitus, and wake-up stroke. No significant change in the ODT was seen in patients with moderate/severe stroke.Conclusions: The COVID-19 epidemic might increase the ODT of patients with TIA/mild stroke.

Geguritan Kebo Iwa (Kajian Bentuk, Fungsi, dan Pendidikan Karakter)

<em><span lang="EN-US">The uniqueness of Balinese culture in the form of folklore (satua), should be preserved as an ancestral heritage that contains elements of education, especially in character building. One of the existing folklore is the Kebo Iwa story where its existence is starting to be forgotten. By one of the sons of Bali, the story of Kebo Iwa is presented in the form of geguritan as an educational medium with Hinduism in mind. Geguritan Kebo Iwa was formed by pupuh who were already known to the public, bound by the Padalingsa rules. The work of Mr. I Nyoman Suprapta uses the common Balinese language and the presentation time is short so that the contents and meanings are easy to understand, can provide enlightenment and foster a sense of pride, especially to the younger generation of Bali. The general purpose of research is as an effort to explore, preserve, develop, and describe conceptual values. The specific objectives are to find out the form, explain the function, and understand the value of character education in Geguritan Kebo Iwa. The concepts presented are form, function, and character education, which are guided by structuralism theory, function theory, semiotic theory and value theory. This type of research uses qualitative research. The primary data source is the Geguritan Kebo Iwa manuscript, the secondary data includes books, magazines, and other libraries that are considered relevant, as well as the results of observations, interviews, literature studies and documentation to ensure the truth of the data obtained.</span></em>

EP.TU.888Aortic dissection: Causes of delay in diagnosis and transfer, implications for patients, and how to improve

Background Aortic dissection is a common differential in patients presenting with chest pain. In Northern Ireland, there is one hospital with a cardiac surgical unit. Therefore, patients are diagnosed in district general hospitals and then transferred for intervention. Over the past number of years it has been noted that there can be delays in the diagnosis and transfer of patients with aortic dissection to the cardiac surgery service. This study aims to identify any common reasons for this and develop a way to improve. Methods Patients operated on for aortic dissection from 2014-2019 in the Royal Victoria Hospital Belfast were included. Their notes and electronic care records were analysed, looking at time of initial presentation, time of diagnosis, and time of arrival to theatre. Results 61 cases were analysed. Among those with delays in diagnosis, many were initially admitted medically or to cardiology wards for work up of their chest pain. When a medical cause was not found, scans were performed demonstrating aortic dissection. Some patients were discharged from ED after initial presentation and the diagnosis was found on re-presentation. There were delays in reports of some scans. Delay in diagnosis was a more common feature than delay in transfer. Implications Delay in diagnosis or transfer of these patients affects their prognosis. As a result of this study a pathway has been developed regarding diagnosis, initial medical management, and transfer of these patients and it is hoped this will be implemented in hospital departments in Northern Ireland in the future.

Using Video to Give More Effective and Engaging Science Talks

Science presentations at conferences are an important way that scientists share exciting research discoveries. Some presentations are informative and engaging, but unfortunately many are not. This article describes a novel method (Video Let’s Talk, VLT) for more engaging and effective science presentations, where the presenter 1. makes a video that fills half of the presentation time, 2. shows the video in lieu of a live presentation, and 3. spends the remaining time engaging with the audience. The benefits and challenges of the VLT method are described along with tips on how to do the VLT well. These insights are based on the author’s experience giving numerous VLT presentations to scientists, farmers and other groups over the past seven years. The VLT method is timely considering how the COVID pandemic has forced scientists to learn new skills in do it yourself (DIY) video making in order to participate in virtual conferences.

1203Predictors of treatment and survival in hepatocellular carcinoma patients: A Bayesian parametric survival analysis

Background Culturally and linguistically diverse communities face several challenges to receiving screening and curative treatment of hepatocellular carcinoma (HCC). We reported the predictors of receipt of treatment and survival in a cohort of patients diagnosed with HCC in Southeast Queensland. Methods Data from 1651 HCC patients (147 migrants) followed between January 1, 2007, and December 31, 2016 were analyzed using chi-square statistic to test for the association between socio-economic variables and receipt of treatment. Bayesian Weibull Accelerated Failure Time regression was used to identify predictors of time to death, and we reported time ratios. Results Receipt of surgical resection for HCC was associated with non-metropolitan residence (P=0.02), non-English language (P&lt;0.001), country of origin (P&lt;0.001), and hepatitis B virus etiology (P&lt;0.001). The median survival time after HCC diagnosis was 9.0 months (interquartile range 2.0‒24.0). The strongest predictors of survival were undifferentiated tumor at presentation (time ratio (TR)=0.30, 95% credible interval (CrI) 0.23‒0.39), age ≥70 years (TR = 0.42, 95%CrI 0.34‒0.53), living in a remote area (TR = 0.67, 95%CrI 0.55‒0.80), and presence of ≥ 1 comorbidity (TR = 0.69 95%CrI 0.54‒0.90). Conclusions Improving access to HCC surveillance and uptake of timely curative treatment for persons living in remote areas and having socioeconomic disadvantage may help patients present to clinic with early stage tumor and provide better survival. Key messages Remoteness of residence is associated with late presentation, low rate of receipt of treatment and predicts survival of patients with HCC.

Aging Does Not Enhance Social Contagion Effect

Studies on the social contagion of memory show that it is possible to create false memories from the wrong responses from other people without requiring their physical presence. The current study examined age differences between false memories via the modified social contagion paradigm. Twenty older and twenty younger adults were shown six household scenes and were exposed to the erroneous memory reports of an implied confederate who was not physically present. The presentation time of the scenes and the typicality of the contagion items were manipulated. The participants watched each scene individually and then took turns giving their recall responses with the responses belonging to a fictional participant provided by written cards. The results in a final individual recall test indicated a significant contagion effect in both groups of participants. Additionally, an effect of the typicality of the contagion items was observed, such that the more typical items produced more contagion than the less typical items. In relation to true recall, the older adults remembered significantly fewer items from the scenes than the younger ones and obtained a lower score in the word list subtest of the Weschler Memory Scale. Although the older group had an episodic memory deficit, they were not more susceptible to being affected by the wrong responses of other people than younger group.

A dynamic pink noise paradigm to assess spatial-temporal attention without biasing perceptual processing

Psychophysical paradigms measure visual attention via localized test items to which observers must react or whose features have to be discriminated. These items, however, potentially interfere with the intended measurement as they bias observers' spatial and temporal attention to their location and presentation time. Furthermore, visual sensitivity for conventional test items naturally decreases with retinal eccentricity, which prevents direct comparison of central and peripheral attention assessments. We developed a stimulus that overcomes these limitations. A brief oriented discrimination signal is seamlessly embedded into a continuously changing 1/f noise field, such that observers cannot anticipate potential test locations or times. Using our new paradigm, we demonstrate that local orientation discrimination accuracy for 1/f filtered signals is largely independent of retinal eccentricity. Moreover, we show that items present in the visual field indeed shape the distribution of visual attention, suggesting that classical studies investigating the spatiotemporal dynamics of visual attention via localized test items may have obtained a biased measure. We recommend our paradigm as an efficient method to evaluate the spatial and temporal spread of visual attention.

Most Findings Obtained With Untimed Visual Illusions Are Confounded

Visual illusions have been studied extensively, but their time course has not. Here we show, in a sample of more than 550 people, that unrestricted presentation times—as opposed to presentations lasting only a single second—weaken the Ebbinghaus illusion, strengthen lightness contrast with double increments, and do not alter lightness contrast with double decrements. When presentation time is unrestricted, these illusions are affected in the same way (decrease, increase, no change) by how long observers look at them. Our results imply that differences in illusion magnitude between individuals or groups are confounded with differences in inspection time, no matter whether stimuli are evaluated in matching, adjustment, or untimed comparison tasks. We offer an explanation for why these three illusions progress differently, and we spell out how our findings challenge theories of lightness, theories of global-local processing, and the interpretation of all research that has investigated visual illusions, or used them as tools, without considering inspection time.