Prediction of early discharge after gynaecological oncology surgery within ERAS.

OBJECTIVES: Enhanced recovery after surgery programs (ERAS) have been proven to decrease the length of hospital stay without increasing readmission rates or complications. However, the patient and operative characteristics that improve the chance of a successful early hospital discharge are not well established. The aim of this study was to design a nomogram which could be used before surgery, using the characteristics of patients, to establish who could benefit from early discharge (POD ≤ 2 days). METHODS: This observational study has been prospectively conducted. All the included patients were referred for surgical treatment of gynecologic cancer. We defined two sub-groups of patients on surgical procedure characteristics: isolated procedures (hysterectomy or lymphadenectomy) and combined procedures (at least the association of two procedures). RESULTS: 230 patients were enrolled during the study protocol. 83.9% of patients were treated with a minimally invasive surgery (MIS). 159 patients (69.1%) were discharged on or before POD 2. On multivariate analysis, the surgical approach (open surgery vs. laparoscopy, OR 0.02 (95% CI [0-0.07]), p < 0.001) and the type of surgery (combined procedure versus isolated procedure, OR 0.41 (95% CI [0.18-0.91]), p = 0.028) were found to be significant predictors of increased hospital stay. A nomogram has been built for the purpose of predicting eligible patients for early post-operative discharge based on the multivariate analysis results (AUC = 0.86, 95% CI [0.81-0.92]). CONCLUSION: The use of MIS for isolated procedures in oncologic indications constitutes an independent factor of early discharge in a setting of ERAS. These promising preliminary results still require to be validated on a prospective cohort.

The Fibromyalgia Bladder Index in 100 consecutive women with fibromyalgia.

INTRODUCTION AND HYPOTHESIS: The Fibromyalgia Bladder Index (FBI) is a validated instrument to quantify bothersome bladder symptoms specifically in women with fibromyalgia syndrome (FMS). The FBI includes two sub-scales: one addressing urinary urgency and bladder pain (UP), the other addressing urinary frequency and nocturia (FN). The objectives of this study are to evaluate the FBI in a cohort of patients with FMS, to correlate it with certain characteristics in this cohort, and to compare it with controls. METHODS: We performed a case-control study of 100 women with FMS and 155 controls. Demographic data, comorbidities, and other characteristics were registered. Comparison between FBI scores of participants with and without FMS, as well as correlation of FBI scores with the characteristics of FMS patients, were undertaken using independent two-sample t test for continuous outcomes and Pearson's Chi-squared test for categorical outcomes. RESULTS: The mean UP subscale score of the FBI was significantly higher in the FMS group (10.29 ± 5.61) compared with the controls (1.65 ± 2.65; (p = 0.001). The mean FN subscale score was significantly higher in the FMS group (9.93 ± 5.37) compared with the controls (2.95 ± 3.27; p = 0.001). FMS patients diagnosed >3 years ago had a higher UP subscale score and a higher FN subscale score compared with FMS patients diagnosed <3 years ago (p = 0.020 and p = 0.024 respectively). Menopause and parity significantly increased the FBI scores. Smoking and a history of depression did not significantly affect any of the FBI subscale scores in the FMS group. CONCLUSION: Women with FMS suffer from bothersome bladder symptoms that can be readily identified and quantified.

Epinephrine-Induced Takotsubo Cardiomyopathy During Laparoscopic Myomectomy: Case Report and Review of the Literature.

Laparoscopic myomectomy, a minimally invasive procedure performed for the management of uterine leiomyomas, involves a challenging aspect: excessive local bleeding. Hemorrhage control during laparoscopic myomectomy can be achieved through the use of a wide range of vasoconstrictors, including epinephrine. Epinephrine is frequently used for the control of local bleeding during surgery; however, it has been associated with several complications. In this case report, we present a rare and unique case of stress-induced cardiomyopathy, also known as Takotsubo cardiomyopathy (TC), caused by intramyomal injection of epinephrine during laparoscopic myomectomy. TC is a transient type of cardiomyopathy associated with a reversible regional systolic and diastolic dysfunction of the left ventricle as well as various abnormal wall motions, and is often indistinguishable from myocardial infarction. TC is more prevalent in women than in men and has been linked to supraphysiological levels of plasma catecholamine. Although epinephrine is an effective vasoconstrictor used to control bleeding, it is potentially associated with adverse events that should be thoroughly investigated within the field of gynecology and its application to laparoscopic myomectomy.

Traditional Systemic Treatment Options in Advanced Low-Grade Serous Ovarian Cancer after Successful Cytoreduction: A Systematic Review and Meta-Analysis.

OBJECTIVE: We performed a systematic literature review and a subsequent meta-analysis to compare traditional treatment options, i.e., antihormonal and cytotoxic, in LGSOC. METHODS: We conducted a systematic literature review in MEDBASE and MEDLINE between September 2000 and June 2021 for women who received cytotoxic chemotherapy and/or antihormonal treatment after primary cytoreduction due to stage II-IV LGSOC and also at relapse. PFS and OS were calculated depending on the type of their adjuvant treatment. For each endpoint in the meta-analysis, pooled HR was calculated using the random effect model with the inverse variance weighted method. Only primary patients were included in the subsequent meta-analysis due to the small number of studies in the relapsed setting. RESULTS: Five eligible first-line studies were included. Systemic chemotherapy failed to provide a significant OS benefit when compared to no systemic treatment (pooled HR = 1.01, 95% CI [0.79, 1.29]) after successful cytoreduction. Moreover, systemic chemotherapy followed by antihormonal treatment also did not result to a significant PFS or OS benefit when compared to systemic chemotherapy alone (for PSF: pooled HR = 0.59, 95% CI [0.33, 1.04]; for OS: pooled HR = 0.83, 95% CI [0.50, 1.39]). There were insufficient data from studies in the recurrent setting to allow their inclusion in the meta-analysis. CONCLUSIONS: In this meta-analysis, we failed to identify a traditional cytotoxic or antihormonal systemic treatment option that was associated with a significant OS or PFS benefit when administered following successful cytoreduction for advanced LGSOC. Prospective randomized studies are urgently warranted to define optimal adjuvant options in this challenging disease.

Post orgasmic illness syndrome: what do we know till now?

BACKGROUND: Peri orgasmic dysfunctions are very rare and little information exists on their diagnosis and treatment. One of these conditions is post-orgasmic illness syndrome (POIS), manifesting by a debilitating cluster of symptoms affecting men within seconds, minutes, or hours after ejaculation. The aim of this article is to do a thorough literature review about POIS, in order to elucidate the pathophysiology, the diagnosis and the management of this rare disease. RESULTS: Updated literature review on Pubmed was done, using the following terms: "orgasm illness", "post-orgasmic" and "postorgasmic illness syndrome". The references of the 17 identified publications were also reviewed for additional 8 relevant articles that were all included in the results.POIS has 5 preliminary diagnostic criteria and criterion 1 has 7 described clusters. Pathophysiological hypotheses include: immunological phenomenon (most relevant), opioid-like withdrawal, neuroendocrine response, transient deregulation of the autonomic nervous system, hypersensitivity and disordered cytokines. Differential diagnoses include: chronic prostatitis, orgasmolepsy, benign orgasmic cephalgia, sneezing and rhinorrhea, postcoital dysphoria, post-coital asthma and rhinitis. Patients have been symptomatically treated with antihistamines, non-steroidal anti-inflammatory drugs, selective serotonin reuptake inhibitors, and benzodiazepines. A trial of hyposensitization therapy with autologous semen was successful. CONCLUSION: POIS is a rare condition that is underdiagnosed, most probably because of its unclear pathophysiology leading to a lack of treatment options. Further studies are warranted to investigate the prevalence, pathophysiology, and management of this debilitating condition.

CONTEXTE: Les dysfonctions péri-orgasmiques sont très rares et nous disposons de peu d'informations sur leurs diagnostic et traitement. L'une de ces affections est le syndrome de la maladie post-orgasmique (SMPO), qui se manifeste par un groupe de symptômes handicapants affectant les hommes durant les secondes, minutes ou heures après l'éjaculation. Le but de cet article est de faire une revue approfondie de la littérature sur le SMPO, afin d'élucider sa physiopathologie et son diagnostic pour mieux gérer cette maladie rare. RÉSULTATS: Nous avons réalisé une revue de la littérature actualisée sur Pubmed en utilisant les termes suivants: "orgasm illness", "post-orgasmic" and "postorgasmic illness syndrome". Les références des 17 publications identifiées ont également été examinées pour inclure 8 autres articles pertinents dans les résultats.Le SMPO est défini par 5 critères diagnostiques préliminaires et le critère 1 comprend 7 groupes de symptômes. Les hypothèses physiopathologiques comprennent: un phénomène immunologique (le plus pertinent), un sevrage des opioïdes endogènes, une réponse neuroendocrine, une dérégulation transitoire du système nerveux autonome, une hypersensibilité et des désordres des cytokines. Les diagnostics différentiels incluent: la prostatite chronique, l'orgasmolepsie, la céphalée orgasmique bénigne, l'éternuement et la rhinorrhée, la dysphorie post-coïtale, l'asthme post-coïtal et la rhinite. Les traitements n'ont été que symptomatiques par antihistaminiques, anti-inflammatoires non stéroïdiens, inhibiteurs sélectifs de la recapture de la sérotonine et benzodiazépines. Un essai thérapeutique de désensibilisation avec du sperme autologue a été couronné de succès. CONCLUSION: Le SMPO est une maladie rare sous-diagnostiquée, probablement à cause de sa physiopathologie peu claire, conduisant à un manque d'options thérapeutiques. Des études supplémentaires sont nécessaires pour étudier la prévalence, la physiopathologie et la prise en charge de cette maladie débilitante.

Excerpts of the 2007 Lebanese report on the prevention of child abuse and neglect [CAN] and violence against children [VAC].

The prevention of child abuse and neglect [CAN] is a sustained and long-standing teamwork. Since the regional 2005 UNSV conference in Cairo, the CRC Geneva meeting in 2006 and the UNSV remarks in 2007, Lebanon has continued to join efforts in order to control CAN and VAC. This report summarizes the realizations and pitfalls in the Lebanese experience, in terms of needs, analysis, procedures, networking, challenges and vision. These initiatives were hindered by the war on Lebanon in July 2006 and are still challenged by the current unstable socio-political situation. Despite many obstacles, the multisectoral perspective still works, in the presence of a high level of common understanding of child rights. Within the Higher Council for Childhood, the grass rooting initiative still relies on political decision, local and national human resources, regional expertise and international cooperation, seeking for a national strategy for child protection in Lebanon. Heath professionals in Lebanon have a prominent role in this framework, in terms of diagnostic skills, referral, networking, awareness and advocacy.