Perspectives on training in obstetrics and gynaecology during the COVID-19 pandemic: Thematic analysis of trainee responses from a pan-European survey.

Background: Coronavirus disease 19 (COVID-19) has affected many aspects of the lives of medical professionals. Postgraduate training has also been affected and mitigation plans are still ongoing. Objective: To understand the perspectives of trainees in obstetrics and gynaecology (ObGyn) during the pandemic. Materials and Methods: A cross-sectional exploratory survey conducted electronically from 20th of April 2020 to 1st July 2020. Main outcome measures: The original questionnaire comprised of 40 questions and a free-text option. The free-text questions covered five main domains: effect of the pandemic on training, worries about training, acquisition of skills during the pandemic, training period and extensions and responsibilities outside training during the pandemic. The responses to these questions in the survey were analysed using pragmatic thematic analysis. Results: Trainees felt there was lack of training as well as training opportunities. Some took the pandemic as an opportunity to gain new skills. Trainees were also worried about time in training and uncertainty about extensions. Lastly, many had concerns pertaining to patient care, an inability to contribute to departmental organisation, and dissatisfaction with the implemented policies. Conclusion: The difficulties in Obstetrics and gynaecology training due to the pandemic need to be mitigated. When planning for reshaping the training programmes to accommodate for the discrepancies caused, trainers need to consider the perspectives of trainees and actively involve them in the decision making, designing and executing future plans. What is new?: Efforts are currently underway to address the training time lost during the pandemic in Europe. Recognising the paramount importance of providing exceptional care for women and children across the continent, it becomes imperative to consider the valuable perspectives and insights offered by those who represent the future generation of specialists in the field.

Beneficial effects of Ankaferd Blood Stopper on caustic esophageal injuries: an experimental model.

Ankaferd Blood Stopper (ABS) is an herbal extract that enhances mucosal healing. The aim of this study was to investigate the efficacy of ABS on the healing of the esophagus and prevention of stricture development after esophageal caustic injuries in rats. The study included 50 rats. Rats were divided into five groups: group 1 (no injury, sham surgery), group 2 (injury + no ABS + study after 2 weeks of injury), group 3 (injury + ABS + study after 2 weeks of injury), group 4 (injury + no ABS + study after 4 weeks of injury), and group 5 (injury + ABS + study after 4 weeks of injury). Standard esophageal burn injury was created by applying 50% NaOH solution to distal esophagus of about 1.5 cm. To rats in the sham group, isotonic solution was given instead of NaOH. ABS (2 mL/day) was given via oral route to group 3 and 5 rats. Fourteen days (group 2 and 3) and 28 days (group 4 and 5) later, all the live rats were killed. The distal esophageal segments of all rats were removed and divided into two equal parts for biochemical and histopathological examination. Mortality rate, weight changes, inflammation, stenosis index (SI), and biochemical measurements were evaluated. The SI was found as 0.31 ± 0.03 in group 1, 0.533 ± 0.240 in group 2, 0.568 ± 0.371 in group 3, 0.523 ± 0.164 in group 4, and 0.28 ± 0.03 in group 5. The SI and inflammation in ABS-treatment group 5 was significantly lower than that in non-treatment group 4 (P= 0.005). There were no significant differences between inflammation and SI among other groups. The mortality rate was 14.2% in group 1, 37.5% in untreated group 2, 14.2% in ABS-treated group 3, 80% in untreated group 4, and 33.3% in ABS-treated group 5. The mortality rate in group 4 was significantly higher than other groups (P= 0.025). Decrease rates in mean body weights of the groups were as follows: group 1, 1%; group 2, 15%; group 3, 14%; group 4, 46%; and group 5, 15%. Biochemical tests other than albumin and creatinine were comparable among the groups. Treatment with ABS prevents inflammation, scar formation, weight loss, and mortality in esophageal caustic injuries. Additional studies to evaluate the clinical benefits of ABS in esophageal caustic injury are recommended.

Antibacterial diterpenes from the roots of Salvia blepharochlaena.

The roots of Salvia blepharochlaena have yielded two new diterpenoids, blephaein (1) and O-methylpisiferic acid methyl ester (2), together with eight known diterpenoids. The structures of the new compounds were established by spectroscopic analysis and by some chemical reactions. Potent antibacterial activity was exhibited by the known compounds horminone (9) and 7-acetylhorminone (10) against Staphylococcus aureus ATCC 6538 P, Staphylococcus epidermidis ATCC 12226, and Bacillus subtilis ATCC 6633. Horminone was also found to be active against Enterococcus faecalis ATCC 29212.

Diterpenes from Sideritis argyrea.

The known ent-kaurene diterpenes 1-9 and a new ent-labdane, ent-6beta,8alpha-dihydroxylabda-13(16),14-diene (10), were isolated from the whole plant of Sideritis argyrea. Their structures were elucidated based on one- and two-dimensional NMR techniques and HRMS.

A new antibacterial diterpene from the roots of Salvia caespitosa.

From the roots of Saliva caespitosa Montbret and Aucher ex. Bentham a new diterpene 6beta-hydroxyisopimaric acid (1) has been isolated together with four known diterpenes, one new triterpenoid, 3-acetylvergatic acid (2), as well as five known triterpenoids, two steroids and a flavone. The structures of the compounds were established by spectroscopic analyses. The isolated compounds were tested against standard bacterial strains. Only the new diterpene, 6beta-hydroxyisopimaric acid has strong activity (MIC 9 microg/ml) against S. aureus and (MIC 18 microg/ml) against S. epidermidis as well as against B. subtilis (MIC 9 microg/ml).

Triterpenoids of the roots of Lavandula stoechas ssp. stoechas.

The roots of Lavandula stoechas ssp. stoechas afforded eleven known triterpenes, two steroids and two aromatics, in addition to two new triterpenes, 18-hydroxy-27-norolean-12,14-dien-30-al-28-oic acid and 3 beta-hydroxy-1-oxo-olean-12-ene-30-al-28-oic acid. Their structures were determined by spectroscopic analyses. The chloroform extract and some isolated compounds were evaluated for their growth inhibitory activity against several mammalian cell lines.

Salvimultine, a new noricetexane diterpene from the roots of salvia multicaulis.

A new noricetexane diterpene, salvimultine, has been isolated from the polar fractions of Salvia multicaulis. Its structure was established as 1(10)-seco-2(10)-cyclo-icetexane by using 1D and 2D NMR spectral methods, including COSY, HETCOR, COLOC, and NOESY experiments as well as HRMS.

Constituents of Nepeta caesarea.

The acetone extract of Nepeta caesarea yielded four new nepetalic acid derivatives, 3'alpha-[beta-sitosteryl-3beta-oxy]dihydronepetalactone (1), 3'beta-[5alpha-stigmast-7-ene-3beta-oxy]dihydronepetalact one (2), 3'alpha-[olean-12-ene-28-oyl-3beta-oxy]dihydronepetalactone (3), and 3'alpha-[lup-20(29)-ene-28-ol-3beta-oxy]dihydronepetalactone (4). The structures were elucidated by NMR and MS techniques.

Diterpenes from the berries of Juniperus excelsa.

From the hexane extract of berries of Juniperus excelsa, one new and four known diterpenes were isolated besides a known sesquiterpene. The structures of the known diterpenes were identified as isopimaric, isocommunic, (-)ent-trans communic and sandracopimaric acids, along with the sesquiterpene 4a-hydroxycedrol and the new compound which was elucidated as 3 alpha-acetoxylabda-8(17),13(16),14-trien-19-oic acid (juniperexcelsic acid). Cytotoxic activity of the hexane extract was investigated against a panel of cell line and found highly active against LNCaP, KB-V (+VLB) and KB-V (-VLB) cell lines. Furthermore, the hexane and methanol extracts, and the new compound were found to be moderately active against Mycobacterium tuberculosis.

Terpenoids from Salvia glutinosa.

A new steroidal compound 1-oxo-7 alpha-hydroxysitosterol was isolated from the whole plant of Salvia glutinosa in addition to 11 known triterpenoids and three steroids. The structures were established by spectral data. Cytotoxic activity of the new compound and 7 alpha-hydroxysitosterol were tested against P-388 and KB systems; only marginal activity was found.

Norditerpenoids and diterpenoids from Salvia multicaulis with antituberculous activity.

From the roots of Salvia multicaulis, four new aromatic norditerpenoids, multicaulin (1), 12-demethylmulticauline (2), multiorthoquinone (3), and 12-demetylmultiorthoquinone (4), two new abietane diterpenoids, 12-methyl-5-dethydrohorminone (5) and 12-methyl-5-dehydroacetylhorminone (6), as well as a new pimarane diterpenoid, salvipimarone (7), were isolated. Also obtained in this investigation were the known compounds alpha-amyrin, hinokione, horminone, lupeol, manool, 1-oxoferruginol, 18-oxoferruginol, pisiferal, and sempervirol. The structures of compounds 1-7 were established by 1D and 2D NMR techniques and by chemical methods. The antituberculous activity of 1-7 was tested against Mycobacterium tuberculosis strain H37Rv, and all compounds were found to be significantly active, with 2 and 4-6 being the most potent substances. Six of these novel compounds were evaluated against a number of additional bacterial cultures.

An abietane diterpene and two phenolics from Salvia forskahlei.

From the roots of Salvia forskahlei a new diterpenoid, forskalinone, two new aromatic compounds, the octanol esters of cis- and trans-4-O-methyl-caffeic acid dimers, were isolated together with the known compounds stigmast-3-one, sitosterol and alpha-amyrin. The structures of the new and the known compounds were established by spectral data. The antimicrobial activity of forskalinone and the dimeric cinnamic acid esters was tested against standard bacterial strains and a yeast, namely Bacillus subtilis ATCC 6633, Staphylococcus aureus 6538P, S. epidermidis ATCC 12228, Proteus mirabilis ATCC 14153, Escherichia coli ATCC 8739, Klebsiella pneumonia ATC 4352, Pseudomonus aeruginosa ATCC 9027, Enterococcus faecalis ATCC 29212, beta-haemolytic Streptococcus and Candida albicans ATCC 10231. Forskalinone showed moderate resistance against S. epidermidis (670 micrograms ml-1) and slight activity against E. faecalis (168 micrograms ml-1). trans-4-O-Methyl-caffeic acid dimer octanol ester was inactive while the cis isomer showed a slight activity against C. albicans (156 micrograms ml-1).

Biological activities of a Turkish medicinal plant, Prangos platychlaena.

Prangos platychlaena has been used in traditional medicine in eastern Turkey. It stops bleeding and heals the scars when applied externally. When the isolated coumarins were tested against bacterial strains, only a slight activity was obtained.

Terpenoids from Salvia sclarea.

From an acetone extract of the whole plant Salvia sclarea, seven known diterpenes, sclareol, manool, salvipisone, ferruginol, microstegiol, candidissiol and 7-oxoroyleanone, and two new ones, 2,3-dehydrosalvipisone and 7-oxoferruginol-18-al, as well as two sesquiterpenes, caryophyllene oxide and spathulenol, alpha-amyrin, beta-sitosterol and the flavonoids apigenin, luteolin, 4'-methylapigenin, 6-hydroxyluteolin-6, 7,3',4'-tetramethyl ether, 6-hydroxy apigenin-7,4'-dimethyl ether were obtained. The diterpenoids and the sesquiterpenoids were tested for antimicrobial activity against standard bacterial strains and a yeast. 2,3-Dehydrosalvipisone, sclareol, manool, 7-oxoroyleanone, spathulenol and caryophyllene oxide were found to be active against Staphylococcus aureus, the first and third compound against Candida albicans and the last compound against Proteus mirabilis.

DNA as an affinity probe useful in the detection and isolation of biologically active natural products.

A simplified hplc system is described for the detection of compounds capable of binding to DNA. Compounds known to interact with DNA were found to invoke a positive response with this system, and the concentration-dependence and sensitivity were determined. When applied to 17 randomly selected plant extracts, five elicited a positive response and, of these, four were subsequently found to be cytotoxic with cultured KB or P-388 cells. As described in a companion paper, one of these extracts (derived from Albizia amara) has been further processed and found to contain a group of structurally-unique macrocyclic alkaloids that demonstrate a variety of biological activities. Therefore, this approach should prove a value in facilitating the identification of plant extracts that contain substances capable of binding to DNA and the subsequent activity-directed fractionation for the procurement of active principles. As a prescreen or monitor, these relatively uncomplicated hplc procedures can be used in laboratories not prepared to perform more complicated or costly bioassay techniques. Thus, the pool of potentially active novel chemical substances to be considered for more advanced testing could be increased.

Studies on zoapatle. VIII: Novel cytotoxic sesquiterpene lactones from Montanoa tomentosa ssp. microcephala.

Investigation of the leaves of Montanoa tomentosa Cerv. ssp. microcephala (Sch.-Bip.) Funk (Compositae) resulted in the isolation of three novel guaianolide sesquiterpenes, montacephalin (1), tomencephalin (2), and 5-hydroxytomencephalin (3), which were shown to be cytotoxic (P-388). The structures of these sesquiterpenes were elucidated through analysis of their spectroscopic characteristics, and complete proton and carbon-13 assignments were made for the new compounds. Also isolated were the known terpenes, beta-amyrin, beta-amyrin acetate, stigmasterol, stigmasterol-3 beta-D-glucoside, (-)-kaur-16-en-19-oic acid, and monoginoic acid.