Geography Influences Susceptibility to SARS-CoV-2 Serological Response in Patients With Inflammatory Bowel Disease: Multinational Analysis From the ICARUS-IBD Consortium.

BACKGROUND: Beyond systematic reviews and meta-analyses, there have been no direct studies of serological response to COVID-19 in patients with inflammatory bowel disease (IBD) across continents. In particular, there has been limited data from Asia, with no data reported from India. The ICARUS-IBD (International study of COVID-19 Antibody Response Under Sustained immunosuppression in IBD) consortium assessed serological response to SARS-CoV-2 in patients with IBD in North America, Europe, and Asia. METHODS: The ICARUS-IBD study is a multicenter observational cohort study spanning sites in 7 countries. We report seroprevalence data from 2303 patients with IBD before COVID-19 vaccination between May 2020 and November 2021. SARS-CoV-2 anti-spike and anti-nucleocapsid antibodies were analyzed. RESULTS: The highest and lowest SARS-CoV-2 anti-spike seropositivity rates were found in Asia (81.2% in Chandigarh and 57.9% in Delhi, India; and 0% in Hong Kong). By multivariable analysis, country (India: odds ratio [OR], 18.01; 95% confidence interval [CI], 12.03-26.95; P < .0001; United Kingdom: OR, 2.43; 95% CI, 1.58-3.72; P < .0001; United States: OR, 2.21; 95% CI, 1.27-3.85; P = .005), male sex (OR, 1.46; 95% CI, 1.07-1.99; P = .016), and diabetes (OR, 2.37; 95% CI, 1.04-5.46; P = .039) conferred higher seropositivity rates. Biological therapies associated with lower seroprevalence (OR, 0.22; 95% CI, 0.15-0.33; P < .0001). Multiple linear regression showed associations between anti-spike and anti-nucleocapsid titers with medications (P < .0001) but not with country (P = .3841). CONCLUSIONS: While the effects of medications on anti-SARS-CoV-2 antibody titers in patients with IBD were consistent across sites, geographical location conferred the highest risk of susceptibility to serologically detectable SARS-CoV-2 infection. Over half of IBD patients in India were seropositive prior to vaccination. These insights can help to inform shielding advice, therapeutic choices, and vaccine strategies in IBD patients for COVID-19 and future viral challenges.

In this multinational study of SARS-CoV-2 seroprevalence prior to vaccination, including the first data from India, where over half of patients seroconverted, geographical location conferred the highest risk of susceptibility to serologically detectable infection.

The management of intrauterine synechiae.

PURPOSE OF REVIEW: Intrauterine adhesions are a rare but significant cause of menstrual disturbance and infertility. Most cases are caused by uterine instrumentation. It is important for clinicians to understand the cause, diagnostic tools and rationale behind treatment. RECENT FINDINGS: Hysteroscopy is the gold standard for diagnosis and treatment of intrauterine adhesions. A combination of blunt and sharp dissection or electrosurgery is used by most units. Antibiotics and postoperative administration of estrogen +/- progestogen is important in prevention of recurrence. The use of intrauterine contraceptive devices following synechiolysis is supported by some groups. Restoration of menstruation is highly successful (more than 90%), and pregnancy rates around 50-60% with live birth rates around 40-50% can be achieved. SUMMARY: Clinicians should maintain a level of suspicion of intrauterine adhesions and should investigate by hysteroscopy if necessary. Treatment should follow a protocol that incorporates sound hysteroscopic technique with antibiotic prophylaxis and postoperative hormonal therapy. Consideration should be given to the use of an intrauterine contraceptive device or Foley catheter for a short period.

In search of work/life balance: trainee perspectives on part-time obstetrics and gynaecology specialist training.

BACKGROUND: Part-time training (PTT) is accessed by approximately 10% of Australian obstetrics and gynaecology trainees, a small but increasing minority which reflects the growing demand for improved work/life balance amongst the Australian medical workforce. This survey reports the attitudes and experiences of both full-time and part-time trainees to PTT. METHODS: An email-based anonymous survey was sent to all Australian obstetrics and gynaecology trainees in April 2009, collecting demographic and training status data, data on personal experiences of PTT and/or trainees, and attitudes towards PTT. RESULTS: 105 responses were received (20% response rate). These indicated strong support (90%) from both full-time (FT) and part-time (PT) trainees for the availability of PTT. PT trainees were significantly more likely than FT trainees to be female with children. Improved morale was seen as a particular advantage of PTT; decreased continuity of care as a disadvantage. CONCLUSIONS: Although limited by poor response rate, both PT and FT Australian obstetric trainees were supportive of part-time training. Both groups recognised important advantages and disadvantages of this mode of training. Currently, part-time training is accessed primarily by female trainees with family responsibilities, with many more trainees considering part-time training than the number that access it.

Fluoroscopically guided synechiolysis for patients with Asherman's syndrome: menstrual and fertility outcomes.

OBJECTIVE: To describe a 5-year experience of fluoroscopically guided hysteroscopic synechiolysis for Asherman's syndrome. DESIGN: Retrospective, uncontrolled cohort study. SETTING: Department of Endo-Gynaecology, University of New South Wales, Royal Hospital for Women, Randwick, Sydney, New South Wales, Australia. PATIENT(S): Thirty consecutive patients with confirmed Asherman's syndrome (March 1999-March 2004). INTERVENTION(S): Women had hysteroscopy performed under general anesthetic, with the use of a spinal needle in parallel to the hysteroscope to perform synechiolysis. The progress of the procedure was determined by injecting radiographic contrast medium, and visualized with the use of an image intensifier. Individual procedures were terminated when the endometrial cavity was reconstructed, or at 60 minutes. Cyclic high-dose estrogen therapy was used to stimulate endometrial proliferation. Repeat procedures were performed monthly until the endometrial cavity was reestablished. MAIN OUTCOME MEASURE(S): Menstrual and fertility outcomes were obtained from patient records and by postal questionnaire. RESULT(S): Thirty patients were treated for Asherman's syndrome (13% AFS Grade I, 43% AFS Grade II, and 43% AFS Grade III). Prior to treatment, 60% of patients were amenorrheic. The median number of procedures per patient was 1.5 (range, 1-6), and the mean length of the procedure was 42 minutes (range, 10-70 minutes). After treatment, 96% had regular menses. Seventeen patients attempted to conceive after surgery, and 9 (53%) were successful. CONCLUSION(S): Hysteroscopic synechiolysis under image-intensifier control appears to be an effective treatment for Asherman's syndrome.

Hysteroscopic training: the butternut pumpkin model.

Operative hysteroscopy involves significant hand-eye coordination, utilizing energy sources, video imaging, and the safe control of distending media. We describe a safe, effective, inexpensive, and reproducible method of developing the skills and hand-eye coordination for diagnostic and operative hysteroscopy. In this inanimate model, advanced surgical skills can be practiced, and realistic, simulated electrosurgery including resection of the endometrium and rollerball ablation can be performed.