Impact of COVID-19 on gynaecological patient care: results of patient's survey with 327 patients.

PURPOSE: The pandemic SARS-CoV-2 poses new and unprecedented challenges for health care systems on a national and global level. Although the current situation has been going on for more than 1 year, there is limited data on the impact of the pandemic on general hospital and medical practice care. This survey captures the perspective of patients with gynaecological diseases of this impact. METHODS: Using a paper-based questionnaire, 327 patients were asked about medical care and their experiences during the pandemic at the University Hospital Bonn and the University Hospital Charité Berlin. The study was performed from the 1st June to 30th September 2020. RESULTS: A total of 327 patients participated in the study: 156 stated to have been tested for coronavirus, and 1 patient reported a positive test. 41.3% of the patients felt insecure about the current situation, 30.4% were concerned about the risk of infection during the hospital stay. The pandemic-specific measures in hospitals and medical practices unsettled 6.8% of patients. 18.1% of patients feared that their gynaecological disease would not be treated adequately due to the pandemic. 55.7% of patients reported that their confidence in their physicians has increased during the pandemic. CONCLUSION: The results show that patients' confidence in the healthcare system and the physicians acting significantly increased during the COVID-19 crisis. Transparent and comprehensive information policy regarding actions and restrictions within the COVID-19 crisis eases patients concerns and improves patients' confidence in their physicians, which is crucial for a successful treatment's outcome.

[New possibilities with retroflexed functional endoscopy]. / Neue Wege der Funktionsendoskopie mit Retroflexion.

BACKGROUND: Anterograde transnasal flexible endoscopy of the pharynx, larynx, and proximal trachea without sedation has been established since the 1990s. Retroflexed endoscopic functional analysis has recently been introduced. OBJECTIVES: Adding retroflexed functional endoscopy from the oral cavity up to the duodenum to anterograde diagnostics allows the precise demonstration of how different factors interact in a complex way, e. g., in case of dysphagia or pathological reflux. MATERIALS AND METHODS: A 70-cm-long high-definition endoscope without a channel system is equipped with a 200° retroflexed view, a mm-cm scale, and a roller system. The endoscope can be lengthened, stopped, or shortened during the procedure. Standard positions, viewing directions and display details ensure that findings are comparable. Mastication, food transport and digestion are observed in the unsedated patient. RESULTS: Depending on indication and symptoms, we defined a diagnostic algorithm including three specific pathways: (1) for conditions that originate in the oral cavity, larynx or pharynx, (2) for suspected reflux disease, or for neurological or neuromuscular disorders of food transport, (3) for duodenogastric, gastroesophageal and esophagopharyngeal reflux, as well for benign or malignant tumors. CONCLUSION: The advantages of functional endoscopy have an impact not only on the medical staff and patients. Its precise and participatory approach is relevant to healthcare, enlarges the diagnostic horizon, and forms a basis for interdisciplinary collaboration.

[The Dermatological University Hospital during National Socialism. A Contribution to the History of Dermatology]. / Die Universitäts-Hautklinik Greifswald im Nationalsozialismus. Ein Beitrag zur Dermatologiegeschichte.

BACKGROUND: During the period of National Socialism, many politically motivated changes occurred in Germany in all areas of medicine and consequently in the field of dermatology as well. Most of the Jewish dermatologists were removed from their positions; many of the chair reshuffles were executed for political causes. These changes caused decline of dermatology in the time of National Socialism. STUDY: This report gives an overview of the developments and changes in the Dermatological University Hospital (DUH) at Greifswald between 1933 and 1945. 3000 medical records were evaluated and archival data and literature reviewed. With these data we were able to reconstruct historical, medical and political aspects. RESULTS: We found a rapid increase in the number of patients suffering from venereal diseases during World War II and an increase in compulsory treatment as well as in forced sterilization. In six cases, the DUH was involved in the practice of compulsory sterilization. Research was performed with mustard gas in patients at the DUH.

Plasma levels of metalloproteinases-3 and -9 as markers of successful abdominal aortic aneurysm exclusion after endovascular graft treatment.

BACKGROUND: Structural alterations of aortic wall resulting from degradation of matrix proteins by matrix metalloproteinases (MMPs) characterize abdominal aortic aneurysms (AAAs). No studies have compared circulating levels of MMPs after endovascular graft (EVG) exclusion in comparison with open surgical repair (OSR) in patients affected by AAA. METHODS AND RESULTS: An abdominal angiography and CT scan were performed in all patients at the time of enrollment. A spiral CT scan was performed at 6 months to detect presence of endoleaks. MMP-3 and MMP-9 levels were measured before EVG (n=30) and OSR (n=15) treatments and at 1, 3, and 6 months of follow-up by a sandwich ELISA technique. Healthy volunteers (n=10) were used as control subjects. Immunohistochemical staining for MMP-9 and MMP-3 was performed on tissue samples from surgical cases. Both MMP-9 and MMP-3 mean basal levels were significantly higher in patients affected by AAA than in control subjects (32.3+/-20.7 ng/mL for EVG and 28+/-9.9 ng/mL for OSR versus 8.9+/-2.5 ng/mL, 2P<0.05; 18.3+/-9.7 ng/mL and 26.7+/-10.8 ng/mL versus 8.2+/-5.3 ng/mL, 2P<0.001). In the OSR group, both MMP-9 and MMP-3 mean levels decreased after surgery (28+/-9.9 ng/mL at basal versus 14.7+/-6.6 ng/mL at 6 months, 2P<0.001; 26.7+/-10.8 versus 12+/-5.3 ng/mL; 2P<0.001). In the EVG group, a statistically significant difference at 6-month follow-up in MMP-9 and MMP-3 mean plasma values was detected in patients who had endoleakage in comparison with patients without endoleakage (44.3+/-20.7 versus 14.6+/-7.0 ng/mL, 2P<0.005; 25+/-11.5 versus 10.3+/-5.4 ng/mL, 2P<0.005). CONCLUSIONS: After EVG exclusion, MMP-9 and MMP-3 levels decreased to a level similar to that of patients undergoing OSR. In addition, a lack of decrease in MMP levels after EVG exclusion may help in identifying patients who will have endoleakage and consequent aneurysm expansion caused by continuous sac pressurization during follow-up.

[Streptococcus group B and pregnancy: the therapeutic role of topical intravaginal clindamycin]. / Streptococco di gruppo B e gravidanza: ruolo terapeutico della clindamicina topica intravaginale.

OBJECTIVE: To evaluate the clinical and therapeutic efficacy of 2% clindamycin vaginal cream in pregnant women heavily colonized with group B streptococci (GBS). STUDY DESIGN: A prospective, clinical trial in which carriers of group B streptococci were randomized to receive topical intravaginal clindamycin or oral amoxicillin. PATIENTS: We randomized 105 pregnant women: 55 received 2% clindamycin vaginal cream (100 mg/day for 7 days) and 50 oral amoxicillin (2 g/day for 7 days). INTERVENTIONS: Patients were treated during pregnancy, none of them received intrapartum chemoprophylaxis. On the other hand, all the neonates, within 24 hours from delivery, were studied from the microbiological point of view, carrying out auricolar, nasal, oropharyngeal and umbilical cultures. RELIEFS: The eradication of the microorganism was evaluated by performing a vaginal culture after 6 weeks from the beginning of antibiotic therapy. RESULTS: The eradication rate of the microorganism was significantly higher in women treated with topical clindamycin compared with the group receiving oral amoxicillin (71% versus 36%; p < 0.05). The neonatal outcome was similar in the two groups in terms of gestational age at delivery and mean birthweight. None of the neonates was admitted to the neonatal intensive care unit and no cases of neonatal sepsis were recorded. CONCLUSIONS: From our experience we can conclude that, during pregnancy, a treatment with topical intravaginal clindamycin may be useful in the eradication of GBS.

[Giovanni Marinello, gallant physician of the late XVI century]. / Piacevoli ragionamenti e medicina per le donne. Giovanni Marinello, medico galante del tardo cinquecento.

The works of Giovanni Marinello on women's diseases and cosmetics offer two main benefits: on the one hand we get traditional medical notions about female physiology and pathology presented in a comprehensible way, through the use of vernacular and the unpretentious style, while on the other hand they give precious information on aspects of everyday life. Problems connected with health and illness, life appearance of the body or pain and the strategies to eliminate them occupy a big part of these practical treatise, in which we find not only prescriptions but also discoursive parts. Reflections about esthetical canons and ideals, about the relationship between nature and art or technology and the human duty to enter in competition with natural laws are some of the topics discussed. The analysis of Marinello's texts pousses on the content but also on the form to present them to a mostly feminine audience of readers.

Glutamic-oxalacetic transaminase (SGOT) and glutamic-pyruvic transaminase (SGPT) in newborns in relation to the gestational age.

The transaminase enzymatic activity (SGOT-SGPT) was measured in the first 72h. of life, within the 7th day and on the 30th day of life in two groups of new borns i.e. full-term and premature ones with a gestational age less than or equal to 37 weeks. The premature babies were divided into two sub-groups: babies with a gestational ager less than or equal to 32 and greater than 32 weeks. Our results on the SGOT and SGPT activity in healthy full-term newborns agree with literature data, but indicate a lowering of the SGOT mean values at the 30th day of life. A similar lowering occurs at the 7th day of life; in premature newborns; these have lower SGOT values during the first 72h. of life than full-term newborns. Newborns with a gestational age of less than or equal to 32 weeks have higher SGOT values than newborns with a gestational age of greater than 32 weeks. The mean values of SGPT during the first days of life are higher in full-term than in premature newborns; there are no significant differences in the sub groups with different gestational age.

Serum glutamic-oxaloacetic transaminase and glutamic-pyruvic transaminase activity in premature and full-term asphyxiated newborns.

The serum activity of SGOT and SGPT is one of the more specific parameters of liver cell injury both in adults and in the pediatric age-group. The determination of serum transaminase activity could offer a routine and rapid laboratory test for establishing the presence of hepatic cellular damage following intrauterine or perinatal asphyxia. In fact, it appears that there is a correlation between hypoxia and the increase in serum activity of transaminases in full-term and premature asphyxiated newborns. However, this increase is reversible up to the 30th day of life. The behavior of transaminase enzymatic activity in premature asphyxiated newborns compared to full-term asphyxiated newborns suggests a higher resistance of membranes to hypoxic-ischemic injuries and a lower enzymatic pool of cellular metabolism in premature newborns. Therefore, knowledge of the behavior of SGOT and SGPT activity may have important implications in the diagnosis and early treatment of perinatal asphyxia.

Simple estimate of creatinine clearance from plasma creatinine in neonates.

Thirteen newborn infants, 8 preterm and 5 term, with either mild or serious neonatal asphyxia were studied. From the first 24 hours of life to day 13, glomerular filtration rate (GFR) estimated by creatinine clearance was compared with the values obtained using Schwartz's formula: GFR (ml/min per 1.73 m2) = 0.55 x length (cm)/plasma creatinine (mg/100 ml). Both in term and preterm infants, values of formula-calculated creatinine clearance were slightly higher than values obtained by the classical method; nevertheless the data show significant correlations, respectively r = 0.867 and r = 0.795 (P less than 0.001). This formula provides an adequate estimation of neonatal creatinine clearance (a marker for GFR) directly from plasma creatinine provided that body length is taken into consideration. The necessity for urine collection and the associated problems are thus obviated. The simplicity of Schwartz's formula permits easy monitoring of renal function, especially in neonatal asphyxia in which the risk of developing renal failure is great.

Effect of lipid loading on fetal uptake of free fatty acids, glycerol, and beta-hydroxybutyrate.

The possibility of influencing the fetal uptake of free fatty acids (FFA), beta-hydroxybutyrate (beta-OH), and glycerol was demonstrated by enhancing the maternal blood level of these substances by means of 10% intralipid infusions to the mothers during delivery. The FFA uptake, which was not significant in fetuses of control mothers, became positive in fetuses born after maternal infusion with intralipid. The uptake of beta-OH and glycerol, which were positive in normal conditions, increased in fetuses from intralipid-infused mothers. These studies demonstrate that, after intralipid infusions to the mothers, the fetal FFA uptake could be correlated with the FFA concentration difference between maternal arterial, and fetal umbilical arterial blood. Since the fetal uptake of FFA subsequent to intralipid infusions is not negligible, we consider the possibility that lipid infusions to the mothers could be an approach to the treatment of the fetus with poor intrauterine growth.