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Objective: To evaluate fasting for 12 hours compared with expedited oral feeding in hospitalised women with hyperemesis gravidarum (HG).Design: Randomised trial.Setting: University Hospital, Malaysia: April 2016-April 2017.Population: One hundred and sixty women hospitalised for HG.Method: Women were randomised upon admission to fasting for 12 hours or expedited oral feeding. Standard HG care was instituted.Main Outcome Measure: Primary outcome was satisfaction score with overall treatment at 24 hours (0-10 Visual Numerical Rating Scale VNRS), vomiting episodes within 24 hours and nausea VNRS score at enrolment, and at 8, 16 and 24 hours.Results: Satisfaction score, median (interquartile range) 8 (5-9) versus 8 (7-9) (P = 0.08) and 24-hour vomiting episodes were 1 (0-4) versus 1 (0-5) (P = 0.24) for 12-hour fasting versus expedited feeding, respectively. Repeated measures analysis of variance of nausea scores over 24 hours showed no difference (P = 0.11) between trial arms. Participants randomised to 12-hour fasting compared with expedited feeding were less likely to prefer their feeding regimen in future hospitalisation (41% versus 65%, P = 0.001), to recommend to a friend (65% versus 84%, P = 0.01; RR 0.8, 95% CI 0.6-0.9) and to adhere to protocol (85% versus 95%, P = 0.04; RR 0.9, 95% CI 0.8-1.0). Symptoms profile, ketonuria status at 24 hours and length of hospital stay were not different.Conclusion: Advisory of 12-hour fasting compared with immediate oral feeding resulted in a non-significant difference in satisfaction score but adherence to protocol and fidelity to and recommendation of immediate oral feeding to a friend were lower. The 24-hour nausea scores and vomiting episodes were similar.Tweetable Abstract: Women hospitalised for hyperemesis gravidarum could feed as soon, as much and as often as can be tolerated compared with initial fasting. [ABSTRACT FROM AUTHOR]

Objective To assess the presence of malignancy in patients with AGUS on cervical smears. Methods A prospective descriptive study of patients with AGUS between January 2000 till August 2002. Results 77/10835 (0.7%) of cervical smears performed showed AGUS. 22/77 (28.6%) were postmenopausal. Accompanying statements with cytological diagnosis of AGUS were reactive (20), neoplastic (5) and with HGSIL (3); non specific features were noted in the remaining 49. Five main presentations were routine smear (35), menorrhagia (17), postmenopausal bleeding (8), post-coital bleeding (5) and vaginal discharge (3). Six patients were lost to follow-up. Benign disease was found in 48/71 patients (67.6%). In the remaining 23, the diagnoses were endometrial cancer (5), cervical cancer (5), ovarian cancer (2), primary peritoneal tumour (2), adenocarcinoma in situ (1), glandular atypia with a possibility of glandular intraepithelial neoplasia (1), invasive urethral adenocarcinoma (1), CIN 1 (2), focal CIN 2 (1) and CIN 3 (3). Upon review, 12/71 (16.9%) have had previous malignancy; 8 with previous nongynaecological malignancy. Six patients had persistent AGUS on repeat follow-up cervical smears. 3 patients were pregnant at the presenting cervical smear. 3 patients had AGUS diagnosed from vault smears. 2 patients succumbed (1 to advanced cervical adenoma malignum; 1 to cerebral metastases from advanced cervical cancer). Conclusion The presence of AGUS on cervical smear was associated with 22/71 (31.0%) of patients with gynaecological premalignant (8) and malignant lesions (14); Thus this cytological feature should not be ignored and needs appropriate further investigation. [ABSTRACT FROM AUTHOR]

Objective: To evaluate fasting for 12 hours compared with expedited oral feeding in hospitalised women with hyperemesis gravidarum (HG)., Design: Randomised trial., Setting: University Hospital, Malaysia: April 2016-April 2017., Population: One hundred and sixty women hospitalised for HG., Method: Women were randomised upon admission to fasting for 12 hours or expedited oral feeding. Standard HG care was instituted., Main Outcome Measure: Primary outcome was satisfaction score with overall treatment at 24 hours (0-10 Visual Numerical Rating Scale VNRS), vomiting episodes within 24 hours and nausea VNRS score at enrolment, and at 8, 16 and 24 hours., Results: Satisfaction score, median (interquartile range) 8 (5-9) versus 8 (7-9) (P = 0.08) and 24-hour vomiting episodes were 1 (0-4) versus 1 (0-5) (P = 0.24) for 12-hour fasting versus expedited feeding, respectively. Repeated measures analysis of variance of nausea scores over 24 hours showed no difference (P = 0.11) between trial arms. Participants randomised to 12-hour fasting compared with expedited feeding were less likely to prefer their feeding regimen in future hospitalisation (41% versus 65%, P = 0.001), to recommend to a friend (65% versus 84%, P = 0.01; RR 0.8, 95% CI 0.6-0.9) and to adhere to protocol (85% versus 95%, P = 0.04; RR 0.9, 95% CI 0.8-1.0). Symptoms profile, ketonuria status at 24 hours and length of hospital stay were not different., Conclusion: Advisory of 12-hour fasting compared with immediate oral feeding resulted in a non-significant difference in satisfaction score but adherence to protocol and fidelity to and recommendation of immediate oral feeding to a friend were lower. The 24-hour nausea scores and vomiting episodes were similar., Tweetable Abstract: Women hospitalised for hyperemesis gravidarum could feed as soon, as much and as often as can be tolerated compared with initial fasting., (© 2020 Royal College of Obstetricians and Gynaecologists.)

The coxsackieviruses type B3 (CVB3) are members of the genus Enterovirus of the family Picornaviridae. They are the commonest cause of chronic myocarditis and dilated cardiomyopathy. However, there is still no effective method for diagnosing CVB3 infection in humans. Here, a fast and accurate system that uses a capsid-protein-specific peptide sequence to detect CVB3 in the sera of patients with viral myocarditis was established. The peptide sequence was selected from the whole CVB3 capsid protein sequence by computationally predicting fragments with high antigenicity and low hydrophobicity. Two of eight possible peptide sequences were selected and commercially synthesized. The synthesized peptides encoded either the VP2 or VP1 capsid protein and induced immunoglobulin G antibody expression in immunized rabbits. Anti-VP2 and anti-VP1 sera detected the viral proteins extracted from CVB3-infected HeLa cells. The newly synthesized peptides successfully induced antibody production. These peptides, applied in an ELISA system, detected anti-CVB3 antibodies in virus-infected mouse serum. Moreover, an ELISA system based on the VP2 peptide detected CVB3 infection in patients with positively identified CVB3-induced fulminant myocarditis. These results indicate that these new peptides specifically interact with anti-CVB3 IgG antibodies in mouse and human sera. This ELISA system should be useful for the clinical diagnosis of enterovirus-induced myocarditis., (© 2013 The Societies and Wiley Publishing Asia Pty Ltd.)

Objective: To assess the place of laparoscopically assisted vaginal hysterectomy in the treatment of endometrial cancer., Design: A retrospective uncontrolled case series., Setting: Gynaecological Oncology Department, Queen Elizabeth Hospital, Gateshead., Population: Women with endometrial cancer referred to this centre from August 1992 to August 1997., Main Outcome Measures: Success of laparoscopically assisted vaginal hysterectomy, operative morbidity, and the length of hospital stay., Results: Laparoscopically assisted vaginal hysterectomy was successful in 35 of 40 women (88%). Five women required laparotomy. Two women sustained injury to the inferior epigastric vessels. One sustained injury to the small intestine requiring later laparotomy and three women required a blood transfusion. The mean hospital stay was 3 x 3 days (SD 1 x 5). Three women died of the disease within one year of their operation., Conclusion: Laparoscopically assisted vaginal hysterectomy is a feasible treatment for endometrial cancer. It can be performed successfully in high risk population who are medically unfit and overweight. However, a larger randomised study is required to assess the morbidity compared with the traditional open approach.