Implementation of First-Trimester Screening and Prevention of Preeclampsia: A Stepped Wedge Cluster-Randomized Trial in Asia.

BACKGROUND: This trial aimed to assess the efficacy, acceptability, and safety of a first-trimester screen-and-prevent strategy for preterm preeclampsia in Asia. METHODS: Between August 1, 2019, and February 28, 2022, this multicenter stepped wedge cluster randomized trial included maternity/diagnostic units from 10 regions in Asia. The trial started with a period where all recruiting centers provided routine antenatal care without study-related intervention. At regular 6-week intervals, one cluster was randomized to transit from nonintervention phase to intervention phase. In the intervention phase, women underwent first-trimester screening for preterm preeclampsia using a Bayes theorem-based triple-test. High-risk women, with adjusted risk for preterm preeclampsia ≥1 in 100, received low-dose aspirin from <16 weeks until 36 weeks. RESULTS: Overall, 88.04% (42 897 of 48 725) of women agreed to undergo first-trimester screening for preterm preeclampsia. Among those identified as high-risk in the intervention phase, 82.39% (2919 of 3543) received aspirin prophylaxis. There was no significant difference in the incidence of preterm preeclampsia between the intervention and non-intervention phases (adjusted odds ratio [aOR], 1.59 [95% CI, 0.91-2.77]). However, among high-risk women in the intervention phase, aspirin prophylaxis was significantly associated with a 41% reduction in the incidence of preterm preeclampsia (aOR, 0.59 [95% CI, 0.37-0.92]). In addition, it correlated with 54%, 55%, and 64% reduction in the incidence of preeclampsia with delivery at <34 weeks (aOR, 0.46 [95% CI, 0.23-0.93]), spontaneous preterm birth <34 weeks (aOR, 0.45 [95% CI, 0.22-0.92]), and perinatal death (aOR, 0.34 [95% CI, 0.12-0.91]), respectively. There was no significant between-group difference in the incidence of aspirin-related severe adverse events. CONCLUSIONS: The implementation of the screen-and-prevent strategy for preterm preeclampsia is not associated with a significant reduction in the incidence of preterm preeclampsia. However, low-dose aspirin effectively reduces the incidence of preterm preeclampsia by 41% among high-risk women. The screen-and-prevent strategy for preterm preeclampsia is highly accepted by a diverse group of women from various ethnic backgrounds beyond the original population where the strategy was developed. These findings underpin the importance of the widespread implementation of the screen-and-prevent strategy for preterm preeclampsia on a global scale. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03941886.

The Asian Society of Endometriosis and Adenomyosis guidelines for managing adenomyosis.

This is the first guidelines for adenomyosis from the Asian Society of Endometriosis and Adenomyosis.

Synthesis and characterization of a photocleavable collagen-like peptide.

A 34-amino acid long collagen-like peptide rich in proline, hydroxyproline, and glycine, and with four photoreactive N-acyl-7-nitroindoline units incorporated into the peptide backbone was synthesized by on-resin fragment condensation. Its circular dichroism supports a stable triple helix structure. The built-in photochemical function enables the decomposition of the peptide into small peptide fragments by illumination with UV light of 350 nm in aqueous solution. Illumination of a thin film of the peptide, or a thin film of a photoreactive amino acid model compound containing a 5-bromo-7-nitroindoline moiety, with femtosecond laser light at 710 nm allows for the creation of well-resolved micropatterns. The cytocompatibility of the peptide was demonstrated using human mesenchymal stem cells and mouse embryonic fibroblasts. Our data show that the full-length peptide is cytocompatible as it can support cell growth and maintain cell viability. In contrast, the small peptide fragments created by photolysis are somewhat cytotoxic and therefore less cytocompatible. These data suggest that biomimetic collagen-like photoreactive peptides could potentially be used for growing cells in 2D micropatterns based on patterns generated by photolysis prior to cell growth.

Education in neuroanesthesia and neurocritical care: trends, challenges and advancements.

PURPOSE OF REVIEW: We summarize the latest evidence in neuroanesthesia and neurocritical care (NCC) training. In addition, we describe the newer advancements that clinical educators face in these subspecialties. Lastly, we highlight educational approaches that may lead to an enhanced learning experience and development of necessary skills for neurosciences trainees. RECENT FINDINGS: Current neuroanesthesia and NCC training requires acquisition of specific skills for increasing complex surgical cases, specialized neurosurgical practice and new perioperative technologies. Furthermore, there is increasing international interest for standardization and accreditation of neuroanesthesia fellowship programs. Recent evidence has demonstrated that well structured training using high-fidelity simulation improves cognitive and technical skills in acute neurological crises. SUMMARY: High-fidelity simulation in perioperative care of neurosurgical patients can be part of formal neuroanesthesia and NCC curricula, and potentially impact trainees' proficiency. A research agenda is needed to validate the assessment of most effective educational interventions in neurosciences trainees with diverse medical backgrounds. Creative combinations of cost-effective interventions including traditional teaching, specific technical skills workshops, low and high-fidelity simulation deserve to be assessed in future studies.

A Proof of Concept Study on the Comfort and Usability of a Supportive Pillow for Pregnant Patients with COVID-19 Acute Respiratory Distress Syndrome.

Background: The prone position has been seen to benefit patients experiencing acute respiratory distress syndrome. However, performing this position in pregnant patients has been difficult and raises safety concerns. Objective: The current study aimed to test the use of a supportive pillow (Prone Pillow for Pregnant Patients or 4P) to address concerns regarding pregnant patients in prone position. Methods: The study prospectively evaluated the use of the prone pillow for patient comfort and usability among healthcare workers with qualitative and quantitative measures. Results: A total of three patients were recruited alongside 16 healthcare workers assisting pregnant patients to the prone position. Overall, awake pregnant patients found the pillow to be comfortable while healthcare workers perceived the pillow to be useful in improving quality of care among awake and intubated pregnant patients. CONCLUSION: The 4P is a potentially useful and beneficial product in placing pregnant patients in the prone position during episodes of acute respiratory distress. However, due to the limited sample size, more clinical trials are needed to evaluate the impact of this innovation in improving patient and healthcare worker safety.

FIGIJ and NASPAG Advocacy Statement-Eliminating the Persistent Misconception of the "Virgin Hymen".

This advocacy statement endeavors to clarify the concept of the hymen as a symbol of "virginity". The anatomic variants of this structure precludes any correlation to prior sexual activity and the value of physical assessment of this structure is thus questioned. Moreover, physical examination of the hymen is painful, traumatic and humiliating and is a form of gender-based violence. This statement exhorts various sectors-governments, educators, the medical community and the general public-to discard the concept of the "virgin hymen", avoid its use when documenting sexual abuse, and provide progressive education to affirm female sexuality.

Clinical Diagnosis and Early Medical Management for Endometriosis: Consensus from Asian Expert Group.

This work provides consensus guidance regarding clinical diagnosis and early medical management of endometriosis within Asia. Clinicians with expertise in endometriosis critically evaluated available evidence on clinical diagnosis and early medical management and their applicability to current clinical practices. Clinical diagnosis should focus on symptom recognition, which can be presumed to be endometriosis without laparoscopic confirmation. Transvaginal sonography can be appropriate for diagnosing pelvic endometriosis in select patients. For early empiric treatment, management of women with clinical presentation suggestive of endometriosis should be individualized and consider presentation and therapeutic need. Medical treatment is recommended to reduce endometriosis-associated pelvic pain for patients with no immediate pregnancy desires. Hormonal treatment can be considered for pelvic pain with a clinical endometriosis diagnosis; progestins are a first-line management option for early medical treatment, with oral progestin-based therapies generally a better option compared with combined oral contraceptives because of their safety profile. Dienogest can be used long-term if needed and a larger evidence base supports dienogest use compared with gonadotropin-releasing hormone agonists (GnRHa) as first-line medical therapy. GnRHa may be considered for first-line therapy in some specific situations or as short-term therapy before dienogest and non-steroidal anti-inflammatory drugs as add-on therapy for endometriosis-associated pelvic pain.

Data Driven Competitive Motivation Strategies in a Longitudinal Simulation Curriculum for Trauma Team Training.

OBJECTIVE: A novel approach to trauma team simulation was used to enhance team performance in a cohort of general surgical residents. We implemented data driven debriefing using performance report cards and video footage of the simulations. We wanted to evaluate the technical and nontechnical skills developed by teams using this approach. DESIGN: All surgical residents in an academic program were divided into 5 equal "trauma teams". Throughout the academic year, each team took part in 4 standardized, high fidelity trauma simulations. Rubrics to assess technical efficiency were scored. Each team received individualized feedback in the form of report cards following each simulation. Video recordings of each simulation were analyzed by blinded raters using a validated instrument to assess nontechnical skills/Crisis Resource Management (CRM) skills. SETTING: An academic level 1 trauma hospital in Canada. RESULTS: Five teams comprising five residents participated in four simulations each. Learner feedback was universally positive and learning during simulation was rated higher than learning during didactic lecture. The effect of data driven report cards and anonymized ranking was cited by trainees as a motivating factor to improve. CRM scores improved over the course of the academic year for all teams but without reaching statistical significance. A strong positive correlation was measured between technical and CRM skills for all teams. CONCLUSIONS: Adding data driven debriefing using performance report cards that assess both technical and CRM skills to a trauma team curriculum is a feasible and acceptable way to influence trainee performance using positive competitive motivation. More data are required to confirm the early patterns of improvement uncovered in CRM scoring. A positive correlation between technical skills and CRM skills raises important questions for future research.

The effectiveness of evening primrose oil gel capsule as a cervical ripening agent during labor induction as measured by bishop score on term singleton pregnant patients / Philippine Journal of Obstetrics and Gynecology

BACKGROUND: Pre-induction of labor cervical ripening increases success of labor induction when there is unfavorable cervix. Evening primrose oil soft gel capsule contains linoleic and gamma-linolenic acid, which are precursors of prostaglandins E1 andE2.OBJECTIVE: To measure the effectiveness of evening primrose oil capsule as a cervical ripening agent by measuring the Bishop score before and 4 hours after intravaginal insertion of six capsules.METHODS: A quasi-experimental cross-sectional study was conducted from the period of May to July 2016 involving labor induction patients with a Bishop score ?4, an intact amniotic sac and a Biophysical profile score of 10/10 or 8/8.RESULTS: Thirteen patients had an average age of 27±6 years, and a mean age of gestation of 40±1 weeks. Seven patients (54%) were nulliparous, 2 (15%) were primiparous and 4 (31%) were multiparous. Seven patients (54%) had hypertension, 1 (8%) had diabetes mellitus, 5 (38%) had post-term pregnancies. A paired t-test was done to check for statistically significant changes in the Bishop score. Change in the Bishop score from baseline to 4 hours after insertion of evening primrose oil capsules was statistically significant (p=0.001). Eleven patients (85%) had improvement in the Bishop score after 4 hours, 4 (31%) of which had a clinically significant change in the Bishop score (?4). Specifically, there were statistically significant changes in the dilatation (p=0.027), effacement (p=0.006) and consistency (p=0.002). The mean birth weight of deliveries was 3192±351 grams. Nine patients (69%) underwent primary low segment cesarean section, six (46%) of which for nonreassuring fetal status, 2 (15%) for arrest in cervical dilatation, and 1 (8%) for intraamnionic infection. Four patients (31%) successfully delivered vaginally.CONCLUSION: Results showed a positive effect on the Bishop score during cervical ripening although further studies are needed to establish direct correlation.

The XY female: A rare case of Swyer syndrome with dysgerminoma

Swyer Syndrome is a pure form of gonadal dysgenesis that although rare, should not be disregarded in the differential diagnosis of patients who present with primary amenorrhea and abdominopelvic mass. The dysgenetic gonads fail to produce antimullerian hormone in an individual with Swyer Syndrome who is genetically male, resulting in feminization and absence of virilization. Phenotypically female, they usually seek consult at a later time during their teenage years due to primary amenorrhea. Our index patient consulted due to a large abdominopelvic mass and primary amenorrhea. Hormonal assay showed a hypergonadotropic hypogonadism endocrinologic milieu, and on karyotyping, showed a genetically male individual. This paper shall discuss an in-depth pre-operative, surgical and post-operative management of patients diagnosed with Swyer Syndrome.

Beckwith-Wiedemann syndrome: A case report / Philippine Journal of Obstetrics and Gynecology

Beckwith-Wiedemann Syndrome (BWS) is a rare congenital overgrowth disorder due to alterations in specific genes in chromosome 11p15. It has a variable clinical picture. Infants may exhibit a combination of the following characteristics: macroglossia, macrosomia, abdominal wall defects, ear creases or posterior helical pits, hypoglycemia, polyhydramnios and prematurity. Presented is a case of a 24-year-old gravida 3 para 2 (2002) who manifested with preterm labor and polyhydramnios. She delivered a preterm live baby girl who was diagnosed to have Beckwith-Wiedemann syndrome. The rarity of this condition, as well as the significant maternal and perinatal complications associated with it, is discussed in this paper.

Transverse vaginal septum complicated by endometriosis: a case report

Transverse vaginal septum is a rare Mullerian anomaly which is related to vertical fusion disorder. It is an uncommon anomaly that is not associated with a well-defined inheritance pattern. The vase majority of these obstructed mullerian duct abnormalities are first seen at puberty. Hematocolpos, hematometra and hematometrocolpos are some of its most common presentations. Some authors have suggested that retrograde flow through the uterus and falopian tubes could have occured earlier. It may even present before puberty. Transverse vaginal septum is infrequently associated with genitourinary tract, gastrointestinal tract, musculoskeletal, and cardiac malformations. However, it is still prudent to work up patients of the possibility of having any concomitant anomaly. The differential diagnosis of transverse vaginal septum includes imperforate hymen, Mayer-Rokitansky-Kuster-Hauser syndrome and vaginal agenesis. The complex anatomy of mullerian duct anomalies requires complete evaluation before surgical repair which would entail the use of magnetic resonance imaging, pelvic sonographic and computed tomography. In a study by Thabet, et al. in 2002, a newer modality, sonocolpography can be used to evaluate transverse vaginal septum and other allied conditions. Treatment is surgical. This presentation aims to refocus attention to the disease by reviewing the case of a 14 year old female who presented with cyclical pain and primary amenorrhea.

A cross-sectional study of patients with polycystic ovary syndrome consulting at a tertiary hospital from February - July 2004

Polycystic ovary syndrome (PCOS) is a heterogenous condition with signs and symptoms including menstrual dysfunction, weight disorders, hirsutism, diabetes mellitus, dyslipidemia and metabolic disorders. As such, diagnosis is controversial and differs between countries and communities. This study was done to identify and construct a registry of women with polycystic ovary syndrome being seen at the Out-Patient Department of Philippine General Hospital and obtain their demographic and anthropometric characteristics as well as their hormonal profile to be able to examine the best available evidence on the diagnosis and clinical management of PCOS in the Philippine setting. Results of the study showed comparable baseline characteristics and hormonal profile among Filipino women with PCOS. These data suggest that diagnostic and therapeutic modalities applied in other groups of women may be applicable and cost-effective in the Philippine setting.

Estudio epidemiológico en pacientes menores de 15 años admitidos por intoxicación medicamentosa en los hospitales oficiales de la Ciudad de Panamá, durante el período 1981-1986 / Epidemiologic study of under 15 years patients admited with medical intoxication in public hospitals of Panama City, during 1981-1986

Pretende establecer las necesidades para reglamentar, así como elaborar programas de educación dirigidos a los padres y familiares en relación al consumo y la ubicación adecuadad de los fármacos. Los resultados de esta investigación servirán para el futuro Centro de Información Medicamentosa, que la Universidad de Panamá (Facultad de Farmacia) en colaboración con otras instituciones, ofrecerán a los profesionales de la salud. Plantea como objetivo señalar la distribución de intoxicación medicamentosa en menores de 15 años en la ciudad capital, durante el período 1981-1986, según variables de tiempo, lugar y persona. Describir la incidencia de intoxicaón medicamentosa, según agente etiológico, por grupo etario, la admisión hospitalaria por intoxicación medicamentosa por sexo y por año de ocurrencia, etc. El universo estuvo constituído por 1,061 niños hospitalizados desglosados en la siguiente forma: Hospital del Niño (611) casos; Unidad de Urgencia Pediátrica y Sala de Pediatría del V§ piso del Complejo Hospilario Metropolitano de la Caja de Seguro Social (C.S.S.) (450) casos. Los medicamentos se analizaron por grupo farmacológico y no en forma global y para la elaboración de estos se adoptó la Clasificación farmacológica realizada por la Comisión del Cuadro Básico de la C.S.S. de 1981. Concluye que el 1.11 por ciento de los pacientes menores de 15 años admitidos hospitalariamente fué a causa de una intoxicación medicamentosa. Señala que (598) casos (56.4 por ciento) fueron ocasionados por intoxicación accidental, 351 casos (33.1 por ciento) por una intoxicación terapéutica y 112 (10.5 por ciento) por una intoxicación intencional. Con relación a la mortalidad hubo 14 defunciones (Letalidad de 1.3 por ciento), de las cuales 5 fueron ocasionadas por intoxicación accidental. Con referencia al sexo se observó que el (51 por ciento) de las intoxicaciones medicamentosas correspondieron al sexo femenino y (49 por ciento al masculino. Los grupos farmacológicos con mayor proporción son los Anticonvulsivos, Antieméticos, Psicosedantes Menores y los Antihistamínicos y los medicamentos con mayor frecuencia: Fenobarbital, Metoclopramida, Ciproheptadina, Sacililatos y Diazepan

Estudio epidemiológico-clínico sobre la incidencia de intoxicaciones, en pacientes menores de 15 años de edad registrados en el Hospital del Niño de la ciudad de Panamá / Clinical epidemiological study about the insidents of intoxations in pacients 15 year old under registered in the children Hospital of Panama City

Estudio de tipo retrospectivo, realizado durante los meses de abril a septiembre de 1990. En el mismo se seleccionaron los casos de intoxicaciones que se presentaron en el Hospital del Niño durante el período en mención. Una revisión cuidadosa y un registro objetivo de los casos de intoxicaciones. Los datos recopilados se describieron de acuerdo a su asociación con las variables epidemiológicas, persona, lugar y tiempo. Cabe señalar que en este estudio las intoxicaciones con insecticidas respresentaron un 1.4 por ciento del total de pacientes intoxicados, las intoxicaciones fueron causadas por insecticidas halogenadas y organofosforados