The importance of non-technical skills in robot-assisted surgery in gynaecology.

Robot-assisted surgery (RAS) in gynaecology has undergone exponential growth in recent decades, with utility in treating both benign and malignant gynaecological conditions. The technological complexities and amended theatre dynamics that RAS demands mean that effective non-technical skills (NTS) are vitally important to overcome these unique challenges. However, NTS have been neglected in RAS-training programmes with focus placed instead on the exclusive acquisition of technical skills (TS). NTS include teamwork, communication, leadership, situational awareness, decision-making and stress management. Communication is the most frequently cited NTS impacted during RAS, as the physical limitations imposed by the robotic hardware make communication exchange difficult. The full immersion that RAS enables can contribute to situational awareness deficits. However, RAS can complement communication and teamwork when multidisciplinary (MDT) surgeries (such as complex endometriosis excisions) are undertaken; dual-console capabilities facilitate the involvement of specialties such as general surgery and urology. The development of NTS in RAS cannot be achieved with in-situ experience alone, and current training is poorly standardised. RAS-training programmes and curricula for gynaecology do exist, however the integration of NTS remain limited. Simulation is a viable tool to facilitate enhanced-NTS integration, yet cost implications form a barrier to its wider implementation. However, given that RAS will continue to occupy a greater proportion of the gynaecological caseload, integration of NTS within gynaecological RAS training curricula is necessary. Patients undergoing gynaecological RAS would benefit from the improved safety standards and enhanced surgical outcomes that would result.

Healthcare-seeking behaviour of marginalised older people in urban slums: a cross-sectional survey study in Khulna City, Bangladesh.

OBJECTIVES: This study aimed to measure healthcare-seeking behaviour and determine its associated factors among older people in the slums of the Khulna City Corporation (KCC) areas of Bangladesh. DESIGN: Cross-sectional survey. SETTINGS: Four slums in the KCC areas of Bangladesh. PARTICIPANTS: The participants were selected following a two-stage area probability sampling with the following specifications: they must be aged ≥60 years and must have lived in the slums of KCC for at least 5 consecutive years. OUTCOME MEASURES: A semistructured interview schedule was administered to determine participants' healthcare-seeking behaviour, with healthcare-seeking behaviour measured through a dichotomous response of 'yes' or 'no'. RESULTS: 636 participants were included in the study. Gastrointestinal problems (75.3%) and aches and pains (71.5%) were the two most common health problems among older people in the slums of KCC. Older adults in their 80s had higher adjusted odds of attaining healthcare services (adjusted OR (AOR)=2.028; 95% CI: 1.140 to 3.609; p<0.05) than other older people, while educated older people (AOR=0.664; 95% CI: 0.441 to 1.000; p<0.05) and those with greater satisfaction with domains of life (SDL index; AOR=0.860; 95% CI: 0.811 to 0.912; p<0.01) were less inclined to seek healthcare services than their counterparts. Additionally, widows/widowers (AOR=2.218; 95% CI: 1.080 to 4.556; p<0.05) and married people (AOR=2.750; 95% CI: 1.329 to 5.689; p<0.01) had higher adjusted odds of seeking healthcare services than those who were divorced/separated. CONCLUSION: Age, education, marital status and SDL index were significant predictors for the healthcare-seeking behaviour of older people in KCC slums. Effective strategies need to be implemented to reduce existing access barriers to healthcare services for older people in the slum areas of urban Bangladesh.

Prevalence and predictors of pornography exposure during the third wave of the COVID-19 pandemic: A web-based cross-sectional study on students in Bangladesh.

Background: Pornography exposure, particularly among students, in Bangladesh, has increased in the twenty-first century. However, pornography exposure during the COVID-19 pandemic, when people were compelled to "stay at home" and relied extensively on the internet for all forms of activities, including academia, socializing, and communication, has remained unexplored. The present study aimed to assess the prevalence of pornography exposure among students during the third wave of the COVID-19 pandemic and to determine the associated predictors. Methods: A web-based cross-sectional study was carried out among students with certain specifications, i.e., current students at high school/college/university with access to the internet and valid social media accounts. By administering a semi-structured e-questionnaire using Google Forms, a total of 646 valid responses were retained for this study. The data were analyzed in two phases by Pearson's Chi-square and multiple logistic regression model, using IBM SPSS Statistics, version 25. The results were expressed as an adjusted odds ratio (AOR) with a 95% confidence interval (95% CI). Results: The findings suggest that 75.9% of students were exposed to pornography during the third wave of the COVID-19 pandemic and preferred to watch the amateur/professional genre of pornography. Pornography exposure was significantly associated with age and relationship status, as students aged 22-24 years (95% CI: 1.01-2.41; p = 0.045) and over 25 years (95% CI: 1.61-10.03; p = 0.003) were more likely to watch pornography, while married students and those in relationships (95% CI: 1.24-3.49; p = 0.006) also watched pornography during the pandemic. In contrast, students who were living alone (95% CI: 0.38-0.92; p = 0.021), were living in the Khulna division (95% CI: 0.16-0.52; p < 0.001) or had a negative attitude toward pornography (95% CI: 0.94-0.99; p = 0.002) were less likely to be exposed to pornography. Conclusion: Pornography exposure was higher among students in Bangladesh during the COVID-19 pandemic, and religiosity and disapproving attitudes toward pornography negatively influenced the pornography exposure. For a better understanding of the complex dynamics of socio-demographic issues with pornography exposure among students, extensive research is required for policymakers to devise appropriate strategies and interventions to ensure healthy and safe sex life for the younger population.

Diagnosis and management of premature ovarian insufficiency.

Premature ovarian insufficiency (POI) is a complex clinical syndrome with life-changing physiological and psychological consequence in young women of reproductive age. However, the understanding of the etiology, diagnosis and optimal intervention strategies for this condition remains poorly understood. In recent years advances in epidemiologic and genetic research has improved our knowledge and awareness of POI. Further prospective randomised trials are required to improve the psychological and sexual health, fertility treatment options and long-term management of the impact on bone, cardiovascular and cognitive impact in women with POI. In this paper we aim to provide an overview on the diagnosis and management of POI, discuss the current understanding of the condition and future directions.

SARS-CoV-2 and the pandemic of COVID-19.

SARS-CoV-2 is a virus that is the cause of a serious life-threatening disease known as COVID-19. It was first noted to have occurred in Wuhan, China in November 2019 and the WHO reported the first case on December 31, 2019. The outbreak was declared a global pandemic on March 11, 2020 and by May 30, 2020, a total of 5 899 866 positive cases were registered including 364 891 deaths. SARS-CoV-2 primarily targets the lung and enters the body through ACE2 receptors. Typical symptoms of COVID-19 include fever, cough, shortness of breath and fatigue, yet some atypical symptoms like loss of smell and taste have also been described. 20% require hospital admission due to severe disease, a third of whom need intensive support. Treatment is primarily supportive, however, prognosis is dismal in those who need invasive ventilation. Trials are ongoing to discover effective vaccines and drugs to combat the disease. Preventive strategies aim at reducing the transmission of disease by contact tracing, washing of hands, use of face masks and government-led lockdown of unnecessary activities to reduce the risk of transmission.

Patterned charring along the contact points of a metallic locket due to lightning strike.

Superficial cutaneous burns following lightning strike may vary in patterns ranging from linear burns, punctate burns, feathering burns, and thermal burns. Contact with an extrinsic object in the pathway of lightning current can lead to disastrous consequences. The lucky who survive may show bizarre and interesting burn patterns to tell their story.