Objective
To describe the impact of coronavirus disease 2019 (COVID‐19) on the management of women with ectopic pregnancy.
Design
A multicentre observational study comparing outcomes from a ...prospective cohort during the pandemic COVID‐19‐ectopic pregnancy registry (CEPR) compared with a historical pre‐pandemic cohort non‐COVID‐19‐ectopic pregnancy registry (NCEPR).
Setting
Five London university hospitals.
Population and methods
Consecutive patients diagnosed clinically and/or radiologically with ectopic pregnancy (March 2020–August 2020) were entered into the CEPR and results were compared with the NCEPR cohort (January 2019–June 2019). An adjusted analysis was performed for potentially confounding variables.
Main outcome measures
Patient demographics, management (expectant, medical and surgical), length of treatment, number of hospital visits (non‐surgical management), length of stay (surgical management) and 30‐day complications.
Results
Three hundred and forty‐one women met the inclusion criteria: 162 CEPR and 179 NCEPR. A significantly lower percentage of women underwent surgical management versus non‐surgical management in the CEPR versus NCEPR (58.6%; 95/162 versus 72.6%; 130/179; P = 0.007). Among patients managed with expectant management, the CEPR had a significantly lower mean number of hospital visits compared with NCEPR (3.0, interquartile range IQR 3, 5 versus 9.0, 5, 14; P = <0.001). Among patients managed with medical management, the CEPR had a significantly lower median number of hospital visits versus NCEPR (6.0, 5, 8 versus 9, 6, 10; P = 0.003). There was no observed difference in complication rates between cohorts.
Conclusion
Women were found to undergo significantly higher rates of non‐surgical management during the COVID‐19 first wave compared with a pre‐pandemic cohort. Women managed non‐surgically in the CPER cohort were also managed with fewer hospital attendances. This did not lead to an increase in observed complication rates.
Tweetable
A higher rate of non‐surgical management of ectopic pregnancy during the COVID‐19 pandemic did not increase complication rates.
Tweetable
A higher rate of non‐surgical management of ectopic pregnancy during the COVID‐19 pandemic did not increase complication rates.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Purpose of Study
To assess impact of COVID‐19 pandemic on mental wellbeing, workload, training progression, and fertility planning among London Obstetrics and Gynecology trainees.
Design
An anonymous ...survey comprising 41 peer‐validated questions was sent to London trainees. Anxiety and depression were screened using Generalized Anxiety Disorder Questionnaire 7 (GAD 7) and Patient Health Questionnaire‐9 (PHQ‐9).
Results
One hundred and seventy‐seven trainees completed the questionnaire, of whom 54% were aged 25–34 years, 43% were senior trainees (ST6‐7), and 51% classified themselves as Black, Asian, and Minority Asian (BAME). Although the percentage of respondents with “moderate”/“severe” GAD 7 and PHQ‐9 scores was two to three times that of UK population estimates, median GAD 7 and PHQ‐9 scores were 7 and 6 (“mild”). Sixteen percent deferred their fertility plans and 26% of ST6‐7 trainees changed their Advanced Training Skills Modules. Other issues raised ranged from lack of assistance with electronic portfolio, postponement of examinations, poor senior input for mental health, lack of debriefing for redeployed trainees and requests for deferment of annual reviews.
Conclusions
The pandemic has incurred an impact on mental health, training progression, and fertility planning of London trainees. With recommencement of nonemergency consultations and elective gynecology theater, alongside Royal College of Obstetricians and Gynecologists' Recovery Blueprint to optimize learning opportunities, there is optimism that these challenges can be overcome. Trainers and trainees need to safeguard training opportunities and consider innovative forms of future learning, while anticipating potential effects of subsequent waves.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Key contents
Reports such as Each Baby Counts and the Confidential Enquiry into Maternal Deaths and Morbidity increasingly recognise that human factors contribute to significant events such as ...hypoxic ischaemic encephalopathy and maternal deaths.
Loss of situational awareness (SA) has been implicated in at least 50% of such cases.
A clinician’s SA involves information gathering, comprehension of data in real time and developing the crucial skills to project ahead and anticipate potential errors and threats.
Good communication and shared mental models are important to maximise team SA in theatre, clinic and the labour ward.
Learning objectives
To understand the concept of SA.
To appreciate how SA can be lost and to recognise the ‘red flag’ signs for this.
To learn practical tips on how to maintain SA in day‐to‐day clinical practice.
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FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UL, UM, UPUK
Objective： To test the antioxidant, antidiabetic, anticancer and antibacterial activities along with phytochemicals of Sonneratia apetala Buch.-Ham. Methods： The antibacterial activity was determined ...by agar well diffusion method. The antioxidant activity was determined by standard assay. The antidiabetic activity was evaluated by α-glucosidase inhibition assay and in vivo anticancer property was determined against Ehrlich ascites carcinoma （EAC） cells in Swiss Albino mice. Further partial characterization of the methanol extracts was carried out by thin layer chromatography, high performance liquid chromatography, 1H nuclear magnetic resonance spectroscopy and Fourier transform-infra red spectrum spectral analysis. Results： Four solvent extracts （acetone, ethanol, methanol and aqueous） of leaf and bark possess strong antioxidant properties. In vivo anticancer activity of methanol extract leaf indicated positive activity showing 34% inhibition against EAC cells in Swiss Albino mice. All extracts exhibited a-glucosidase inhibitory activity in a dose-dependent manner indicating presence of promising antidiabetic properties. The extracts possess strong antibacterial activity against the selected pathogenic bacteria （minimal inhibitory concentration ranging from 1.25-5.00 mg/mL）. The partial characterization of the methanol extracts of leaf and bark revealed the presence of phenolics as the lead compound responsible for studied bioactivities of the plant extracts. Conclusion： Sonneratia apetala extracts have potent antibacterial, antioxidant, antidiabetic and anticancer properties which can be further exploited for its pharmaceutical applications.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Background: The treatment of chilblains remains unsatisfactory.
Nifedipine in higher doses remains the mainstay of treatment. Aims: To
compare the efficacy of diltiazem with that of nifedipine, and ...to
determine the efficacy of nifedipine in lower doses, 36 chilblains
cases were studied. Material and Methods: Group A (12 patients) was
treated with diltiazem 60 mg thrice daily, and Group B (24 patients)
with 10 mg nifedipine thrice daily till complete relief and then
maintained on a sustained release preparation of nifedipine 20 mg twice
daily. Results: Two patients in Group A showed complete relief in 7
days, and 3 patients in about 21 days, but in 7 cases there was little
or no response. In group B, 21 cases showed 80-90% relief by the
fourteenth day. Conclusions: We conclude that nifedipine remains the
drug of choice in chilblains but can be used in a smaller dosage in the
Indian population. Diltiazem is less effective in the conventional
dose, which may be optimized.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
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