Examination and counseling of gynecological cases during Corona Virus Disease 2019 (COVID-19) pandemic

HIGHLIGHTS1. Clinical gynecology examinations must adapt to pandemic situation.2. It must pay attention to universal precautions, aseptic and sterile technique to minimize infection transmission.3. In terms of reducing contact, the need for examination are divided by priority into "now", "soon", or "later".4. Gynecology examinations can be carried out with direct examinations by medical personnel wearing proper personal protective equipment if needed.5. Patient counseling can be done by remote consultation or telemedicine. ABSTRACTCOVID-19 is a recent pandemic caused by the SARS COV-2 agent with a high incidence and mortality. The disease is transmitted through respiratory droplets and direct contact. Clinically this COVID-19 patient is mainly related to the respiratory tract symptoms. The current clinical classifications are divided into suspected, probable, and confirmed cases. To reduce transmission must pay attention to universal and hierarchical precaution, aseptic standards, and sterile techniques. The types of gynecological examinations during a pandemic are the same as those in general, except that the methods, settings, and priorities are different. The examination begins with screening to assess the risk of transmission so that it can determine the place of examination. The urgency of the examination, history of TOCC, local transmission, provider, and room conditions also need to be considered. Counseling during a pandemic can be done in person or by telemedicine. Counseling is provided for general and case-specific gynecological information. Each gynecological case requires a different focus on counseling.

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Opportunistic Colorectal Cancer Screening using Colonoscopy. Comparative Results between two Historical Cohorts in Bucharest, Romania

Journal of Gastrointestinal and Liver Diseases ◽

10.15403/jgld.2014.1121.242.buch ◽

2015 ◽

Vol 24 (2) ◽

pp. 171-176 ◽

Cited By ~ 1

Author(s):

Elena Mirela Ionescu ◽

Tudor Nicolaie ◽

Serban Ion Gologan ◽

Ana Mocanu ◽

Cristina Ditescu ◽

...

Keyword(s):

Colorectal Cancer ◽

Screening Program ◽

Advanced Adenoma ◽

Detection Rates ◽

Incidence And Mortality ◽

Organized Screening Program ◽

History Of ◽

Comparative Results ◽

Asymptomatic Individuals ◽

Second Period

Background & Aims: Even though Romania has one of the highest incidence and mortality in colorectal cancer (CRC) in Europe, there is currently no organized screening program. We aimed to assess the results of our opportunistic CRC screening using colonoscopy.Methods: A single center retrospective study to include all opportunistic screening colonoscopies performed in two 18 month periods (2007-2008 and 2012-2013) was designed. All asymptomatic individuals without a personal or family history of adenoma or CRC and with complete colonoscopy performed in these two time periods were included.Results: We included 1,807 individuals, 882 in the first period, 925 in the second period. There were 389 individuals aged below 50, 1,351 between 50 and 75 and 67 older than 75 years. There were 956 women (52.9%), with a mean age of 58.5 (median 59, range 23-97). The detection rates were 12.6% for adenomas (6.1% for advanced adenoma) and 3.4% for adenocarcinoma. Adenoma incidence (4.9% in subjects under 50, 14.7% in those aged 50 to 75, and 16.4% in those older than 75, p<0.0001) and size (6.3mm in subjects younger than 50, 9.2mm in those 50 to 75 and 10.8mm in those older than 75, p=0.015) significantly increased with age. Adenoma incidence increased in the second period (14.8% vs. 10.3%, p=0.005), while adenoma size decreased in the second period (8.4mm vs. 10mm, p=0.006). There were no procedure related complications.Conclusions: The neoplasia detection rate was 16% (12.6% adenoma, 3.4% adenocarcinoma). Adenoma incidence and size increased with age in both cohorts. In the second screening period significantly more and smaller adenomas were detected.

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A new approach to the logic of discovery

Theoria Beograd ◽

10.2298/theo0701007m ◽

2007 ◽

Vol 50 (1) ◽

pp. 7-27

Author(s):

Gerald Massey

Keyword(s):

Modal Logic ◽

Scientific Discovery ◽

Traditional View ◽

New Approach ◽

Logic Of Discovery ◽

Good Fortune ◽

High Incidence ◽

History Of ◽

Deep Sense

Contending that the quest for a logic of scientific discovery was prematurely abandoned, the author lays down eight phenomena that such a logic or theory must explain: the banality of scientific discovery; the trainability of scientists; the high incidence of simultaneous discoveries; the ubiquity of relative novices; the fact of scientific genius; the barrenness of isolated workers; the incommensurability of concepts of successive theories; and the quasi-incorporation of old concepts, objects, and methods in successor theories, The author then presents a new theory or logic of discovery according to which discoveries are the termini of "tweak paths" generated when scientists "tinker" with the laws, concepts, methods, and instruments of a given theory. Tinkering and tweaking are illustrated by examples from many-valued and modal logic and from Darwinian biology. Through the history of planetary discovery, the accidental role played by luck or good fortune in some discoveries is explored, but the author emphasizes that in a deep sense serendipity is an in eliminable feature of all scientific discovery because scientists never know m advance whether their tweaks will lead to dead ends or to positive developments. The author's new theory of scientific discovery is shown to account for all eight explananda, ft also reveals science to be a more egalitarian enterprise than the traditional view of scientific discovery as ultimately inexplicable depicts it.

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Uterine serous carcinoma: key advances and novel treatment approaches

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2021-002753 ◽

2021 ◽

pp. ijgc-2021-002753

Author(s):

J Stuart Ferriss ◽

Britt K Erickson ◽

Ie-Ming Shih ◽

Amanda N Fader

Keyword(s):

Endometrial Cancer ◽

Black Women ◽

Treatment Options ◽

Molecular Genetic ◽

Serous Carcinoma ◽

Cancer Syndrome ◽

Her2 Positive ◽

Incidence And Mortality ◽

History Of ◽

Uterine Serous Carcinoma

The incidence and mortality rates from endometrial cancer continue to increase worldwide, while rates in most other cancers have either plateaued or declined considerably. Uterine serous carcinoma represents a fraction of all endometrial malignancies each year, yet this histology is responsible for nearly 40% of all endometrial cancer-related deaths. These deaths disproportionately affect black women, who have higher rates of advanced disease at diagnosis. Molecular genetic analyses reveal major alterations including TP53 mutation, PIK3CA mutation/amplification, ERBB2 amplification, CCNE1 amplification, FBXW7 mutation/deletion, PPP2R1A mutation, and somatic mutations involving homologous recombination genes. Clinical risk factors for uterine serous carcinoma include advancing age, a history of breast cancer, tamoxifen usage, and the hereditary breast–ovarian cancer syndrome. Surgery remains the cornerstone of treatment. Recent advances in our understanding of uterine serous carcinoma molecular drivers have led to development of targeted therapeutics that promise improved outcomes for patients. Overexpression or amplification of HER2 in uterine serous carcinoma carries a poor prognosis; yet this actionable target has led to the incorporation of several anti-HER2 therapies, including trastuzumab which, when added to conventional chemotherapy, is associated with improved survival for women with advanced and recurrent HER2-positive disease. The combination of pembrolizumab and lenvatinib is also a promising targeted treatment strategy for women with uterine serous carcinoma, with a recent phase II study suggesting a 50% response rate in women with recurrent disease. Several trials examining additional targeted agents are ongoing. Despite years of stalled progress, meaningful, tailored treatment options are emerging for patients with this uncommon and biologically aggressive endometrial cancer subtype.

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Renal Manifestations of Covid-19: Physiology and Pathophysiology

Journal of Clinical Medicine ◽

10.3390/jcm10061216 ◽

2021 ◽

Vol 10 (6) ◽

pp. 1216

Author(s):

Zaher Armaly ◽

Safa Kinaneh ◽

Karl Skorecki

Keyword(s):

Viral Replication ◽

Virus Disease ◽

Multiorgan Failure ◽

Critical Role ◽

Kidney Injury ◽

Small Sample ◽

Renal Physiology ◽

High Morbidity ◽

Enzymatic Production ◽

High Incidence

Corona virus disease 2019 (COVID-19) imposes a serious public health pandemic affecting the whole world, as it is spreading exponentially. Besides its high infectivity, SARS-CoV-2 causes multiple serious derangements, where the most prominent is severe acute respiratory syndrome as well as multiple organ dysfunction including heart and kidney injury. While the deleterious impact of SARS-CoV-2 on pulmonary and cardiac systems have attracted remarkable attention, the adverse effects of this virus on the renal system is still underestimated. Kidney susceptibility to SARS-CoV-2 infection is determined by the presence of angiotensin-converting enzyme 2 (ACE2) receptor which is used as port of the viral entry into targeted cells, tissue tropism, pathogenicity and subsequent viral replication. The SARS-CoV-2 cellular entry receptor, ACE2, is widely expressed in proximal epithelial cells, vascular endothelial and smooth muscle cells and podocytes, where it supports kidney integrity and function via the enzymatic production of Angiotensin 1-7 (Ang 1-7), which exerts vasodilatory, anti-inflammatory, antifibrotic and diuretic/natriuretic actions via activation of the Mas receptor axis. Loss of this activity constitutes the potential basis for the renal damage that occurs in COVID-19 patients. Indeed, several studies in a small sample of COVID-19 patients revealed relatively high incidence of acute kidney injury (AKI) among them. Although SARS-CoV-1 -induced AKI was attributed to multiorgan failure and cytokine release syndrome, as the virus was not detectable in the renal tissue of infected patients, SARS-CoV-2 antigens were detected in kidney tubules, suggesting that SARS-CoV-2 infects the human kidney directly, and eventually induces AKI characterized with high morbidity and mortality. The mechanisms underlying this phenomenon are largely unknown. However, the fact that ACE2 plays a crucial role against renal injury, the deprivation of the kidney of this advantageous enzyme, along with local viral replication, probably plays a central role. The current review focuses on the critical role of ACE2 in renal physiology, its involvement in the development of kidney injury during SARS-CoV-2 infection, renal manifestations and therapeutic options. The latter includes exogenous administration of Ang (1-7) as an appealing option, given the high incidence of AKI in this ACE2-depleted disorder, and the benefits of ACE2/Ang1-7 including vasodilation, diuresis, natriuresis, attenuation of inflammation, oxidative stress, cell proliferation, apoptosis and coagulation.

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“Old wine in a new bottle” - post COVID-19 infection, central serous chorioretinopathy and the steroids

Journal of Ophthalmic Inflammation and Infection ◽

10.1186/s12348-021-00244-4 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Srinivasan Sanjay ◽

Poornachandra B. Gowda ◽

Bhimasena Rao ◽

Deepashri Mutalik ◽

Padmamalini Mahendradas ◽

...

Keyword(s):

Virus Disease ◽

Anterior Segment ◽

Central Serous Retinopathy ◽

Oral Antibiotics ◽

Rt Pcr ◽

Case Presentation ◽

Ocular Manifestations ◽

Corrected Distance Visual Acuity ◽

History Of ◽

The Right

Abstract Introduction Corona virus disease (COVID-19) pandemic can cause myriad of ocular manifestations. We report a case of unilateral multi focal central serous retinopathy, post COVID-19 infection in an Asian Indian female. Case presentation A 42-year-old female presented to us with unilateral blurring, in the right eye (OD), 12 days after COVID-19 infection. She had fever, chills, shortness of breath and cough with tiredness and was COVID- RT PCR positive. She was administered intravenous and oral antibiotics with injection heparin/remdesivir, during her 7 day stay at the hospital. She was also on steroid inhalers. She had no systemic history of note. On ocular evaluation, her corrected distance visual acuity was 20/40 in OD and 20/20 in left eye (OS). Anterior segment was normal. Anterior vitreous was clear. Fundus examination of the OD showed central serous retinopathy (CSCR) with OS being normal. Conclusion CSCR can occur post COVID-19 due to steroid administration and physicians administering it should be aware of this and refer the patients to an ophthalmologist earlier.

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Rupture Risk of Intracranial Aneurysm and Prediction of Hemorrhagic Stroke after Liver Transplant

Brain Sciences ◽

10.3390/brainsci11040445 ◽

2021 ◽

Vol 11 (4) ◽

pp. 445

Author(s):

Hye-Mee Kwon ◽

In-Gu Jun ◽

Kyoung-Sun Kim ◽

Young-Jin Moon ◽

In Young Huh ◽

...

Keyword(s):

Risk Factors ◽

Intracranial Aneurysm ◽

Hemorrhagic Stroke ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Hazard Analysis ◽

Related Data ◽

Incidence And Mortality ◽

Before And After ◽

History Of ◽

Cirrhotic Patients

Postoperative hemorrhagic stroke (HS) is a rare yet devastating complication after liver transplantation (LT). Unruptured intracranial aneurysm (UIA) may contribute to HS; however, related data are limited. We investigated UIA prevalence and aneurysmal subarachnoid hemorrhage (SAH) and HS incidence post-LT. We identified risk factors for 1-year HS and constructed a prediction model. This study included 3544 patients who underwent LT from January 2008 to February 2019. Primary outcomes were incidence of SAH, HS, and mortality within 1-year post-LT. Propensity score matching (PSM) analysis and Cox proportional hazard analysis were performed. The prevalence of UIAs was 4.63% (n = 164; 95% confidence interval (CI), 3.95–5.39%). The 1-year SAH incidence was 0.68% (95% CI, 0.02–3.79%) in patients with UIA. SAH and HS incidence and mortality were not different between those with and without UIA before and after PSM. Cirrhosis severity, thrombocytopenia, inflammation, and history of SAH were identified as risk factors for 1-year HS. UIA presence was not a risk factor for SAH, HS, or mortality in cirrhotic patients post-LT. Given the fatal impact of HS, a simple scoring system was constructed to predict 1-year HS risk. These results enable clinical risk stratification of LT recipients with UIA and help assess perioperative HS risk before LT.

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Predictors of Incisional Hernia after Robotic Assisted Radical Prostatectomy

Advances in Urology ◽

10.1155/2015/457305 ◽

2015 ◽

Vol 2015 ◽

pp. 1-7 ◽

Cited By ~ 7

Author(s):

Avinash Chennamsetty ◽

Jason Hafron ◽

Luke Edwards ◽

Scott Pew ◽

Behdod Poushanchi ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Incisional Hernia ◽

Operative Time ◽

Patient Counseling ◽

Incisional Hernias ◽

Prostate Weight ◽

History Of ◽

Robotic Assisted Radical Prostatectomy

Introduction.To explore the long term incidence and predictors of incisional hernia in patients that had RARP.Methods.All patients who underwent RARP between 2003 and 2012 were mailed a survey reviewing hernia type, location, and repair.Results.Of 577 patients, 48 (8.3%) had a hernia at an incisional site (35 men had umbilical), diagnosed at (median) 1.2 years after RARP (mean follow-up of 5.05 years). No statistically significant differences were found in preoperative diabetes, smoking, pathological stage, age, intraoperative/postoperative complications, operative time, blood loss, BMI, and drain type between patients with and without incisional hernias. Incisional hernia patients had larger median prostate weight (45 versus 38 grams;P=0.001) and a higher proportion had prior laparoscopic cholecystectomy (12.5% (6/48) versus 4.6% (22/480);P=0.033). Overall, 4% (23/577) of patients underwent surgical repair of 24 incisional hernias, 22 umbilical and 2 other port site hernias.Conclusion.Incisional hernia is a known complication of RARP and may be associated with a larger prostate weight and history of prior laparoscopic cholecystectomy. There is concern about the underreporting of incisional hernia after RARP, as it is a complication often requiring surgical revision and is of significance for patient counseling before surgery.

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Endobronchial Foreign Body Presenting as Exacerbation of Asthma

Case Reports in Emergency Medicine ◽

10.1155/2017/6863083 ◽

2017 ◽

Vol 2017 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

James E. Tsang ◽

June Sun ◽

Gaik C. Ooi ◽

Kenneth W. Tsang

Keyword(s):

Foreign Body ◽

Respiratory Distress ◽

Foreign Bodies ◽

Main Bronchus ◽

Fiberoptic Bronchoscopy ◽

Clinical History ◽

Medical Personnel ◽

History Of ◽

Normal Chest ◽

Low Dose Computed Tomography

Airway foreign bodies are a leading cause of death among children and require urgent recognition by medical personnel. While most cases are diagnosed readily from a clinical history of acute respiratory distress, some cases remain more indolent and present later. We report the case of a 7-year-old boy who aspirated a “LEGO” toy and presented with a week history of increasing respiratory distress compatible with known asthma. Despite a normal chest X-ray, a low-dose computed tomography showed the presence of a foreign body in the left main bronchus, which was subsequently removed by fiberoptic bronchoscopy. Our case serves to reemphasize the importance of considering airway foreign bodies as a cause of respiratory distress, especially in young children.

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Purulent Otitis Media: Differences Between Populations in Different Environments

PEDIATRICS ◽

10.1542/peds.53.2.135 ◽

1974 ◽

Vol 53 (2) ◽

pp. 135-136

Author(s):

Patrick Manning ◽

Mary Ellen Avery ◽

Alan Ross

Keyword(s):

Hearing Loss ◽

Adverse Effects ◽

Language Development ◽

Otitis Media ◽

Early Life ◽

Educational Programs ◽

Previous Issue ◽

High Incidence ◽

History Of ◽

Tympanic Membranes

The paper by Kaplan and colleagues in a previous issue starts by emphasizing the unusually high incidence of otitis media among Eskimo children. Forty-one percent of their cohort of 489 Alaskan Eskimo children, followed for ten years, had perforations or scars of the tympanic membranes; significant hearing losses were present in 16% of the group. Among the 374 children with a history of otorrhea, 291 (78%) had their first attack before their second birthday. The adverse effects of hearing loss in early life on language development were underscored by the authors, who quite properly point out the need for special educational programs.

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Effect of Curcumin Coated with Polymethyl Methacrylate Nanoparticles on Lung Cancer Cells

Nanoscience and Nanotechnology Letters ◽

10.1166/nnl.2020.3205 ◽

2020 ◽

Vol 12 (8) ◽

pp. 1015-1021

Author(s):

Ximiao Ma ◽

Fangyong Fu

Keyword(s):

Lung Cancer ◽

Cell Proliferation ◽

Cancer Cells ◽

Polymethyl Methacrylate ◽

Drug Loading ◽

Lung Cancer Cells ◽

Caspase 9 ◽

Incidence And Mortality ◽

High Incidence ◽

Related Proteins

Lung cancer is a malignant tumor with an extremely high incidence and mortality rate in clinical practice and its pathogenesis remains unclear at present. Currently, the methods for treating this disease have relatively high limitations. However, with the gradual maturity and application of nanotechnology, a number of studies have pointed out that polymethyl methacrylate nanoparticles (PMMA-NPs) encapsulated with curcumin (Cur) possibly becomes a new and effective scheme for treating lung cancer. First of all, Cur-PMMA-NPs were prepared. Their sizes were determined by characterization techniques, and their effects on lung cancer cells A549 were detected by Cell proliferation experiment and flow cytometry. The expression of apoptosis-related proteins in the cells was detected by Western blotting. The results showed that polyacrylic acid (PAA)-Cur-PMMA-NPs had a particle size of (215.00±6.00) nm. The drug loading rate and the encapsulation rate of nanospheres were remarkably higher than those of free Cur (P < 0.05). After the intervention of PAA-Cur-PMMA-NPs in the cells, the cell proliferation and the Bcl-2 expression reduced, while the apoptotic rate and the expression of Bax, Caspase-3, and Caspase-9 increased (P < 0.05). Accordingly, Cur-PMMA-NPs can inhibit lung cancer cells from growth and induce their apoptosis, so they are expected to become an effective intervention measure to improve the therapeutic effect on lung cancer in the future.

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