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Background: Coronavirus disease 2019 (COVID-19) pandemic had significant negative impact on sexual and reproductive health (SRH) with devastating impact on pregnant women in resource constrain humanitarian settings. This paper provides detailed account of a community midwife-led intervention in ten humanitarian settings of Afghanistan using world health organization (WHO) emergency disaster risk management (EDRM) framework.Objectives: The project is aimed at increasing access to Integrated Package of Essential SRH Services and Minimal Initial Service Package (MISP) with a specific focus on prevention of Postpartum Haemorrhage (PPH) and screening and management of preeclampsia and eclampsia.Methods: The project was implemented through 150 Community outreach midwives (COMs). Each midwife served 300 households; mentored by gynaecologists and supervisors. Midwives were trained through a digitally enabled, simulation based training and equipped with a set of off-the shelf devices and kits.Results: During COVID-19 pandemic and in absence of health care services during crisis, this intervention has played as a lifesaving intervention for the community in Afghanistan. Variable digital literacy, sociocultural barriers, reluctance in adapting to digital platforms, security and uncertainties were some of the challenges faced. Adaptation of outreach methods integrated high impactful digital technologies has been the most appropriate strategy "to reach the unreached".Conclusion: Through this model, national and global stakeholders were engaged even during the crisis in Afghanistan. It also provided vital inputs for the donors, governments, civil society organizations and other stakeholders for sustaining and advancing the delivery of quality SRH services in humanitarian settings.

Introduction: Torsion of the adnexa is a rare condition which can be potentially lethal for the women. The clinical presentation can be varied and can be seen in any age group. Understanding the clinical and pathological profile of patients suffering from adenexal torsion can guide the clinicians in diagnosing and managing the condition. Objective: To analyze the clinical and pathological profile of adnexal torsion cases in a tertiary care teaching hospital. Materials and Methods: The study was a retrospective analysis of hospital records. It included all cases of adnexal torsion that underwent laprotomy between January 2007 to December 2012 in a tertiary care teaching hospital. The study was approved by the Institute’s human Ethics Committee. Results: A total of 18 patients were included in the study. Majority (66.7%) of participants were in the reproductive age group. Abdominal pain was the most common symptom seen in 77.8% of patients. The other symptoms were abdominal distension, back ache and dysuria. Majority of the women belonged to Para 2 (44.4%) and Para 3 (27.8%). The proportion of women with one and two LSCS was 11.1% and 16.7% respectively. Tenderness (38.9%), mass (22.2%) were the common per abdomen findings. Perspeculum findings were normal in majority (88.9%) of the participants. About 39.2% of the patients presented with a mass in either fornices or pouch of Douglas on pervaginal examination. The side of lesion was only on right in 9 (50%) , only left in 7(38.9%) and both sides in 2 (11.1%) of cases. On histopathological examination, of the lesions there were mucinous cystadenoma (33.3%) serous cystadenoma (16.7%) and benign cystic teratoma (16.7%) as most common lesions. Conclusion: Adnexal torsion, though a rare clinical condition can present as an emergency most of the times. High index of suspicion is required for diagnosis, as the clinical presentation can be varied. But the diagnosis can be made certain only on the operating table, either by laparoscopy. Avoiding a delay in operating upon the patient will help prevent complications, and aid in conserving the ovary.

Peptide receptor radionuclide therapy (PRRT) is an established therapy for metastatic neuroendocrine neoplasms (NEN). The role of PRRT as a neoadjuvant treatment prior to surgery or other local therapies is uncertain. This scoping review aimed to define the landscape of evidence available detailing the utility of PRRT in the neo‐adjuvant setting, including the clinical contexts, efficacy, and levels of evidence. A comprehensive literature search of PUBMED, SCOPUS, and EMBASE through to December 2022 was performed to identify reports of PRRT use as neoadjuvant therapy prior to local therapies. Observational studies and clinical trials were included. A total of 369 records were identified by the initial search, and 17 were included in the final analysis, comprising 179 patients treated with neoadjuvant PRRT. Publications included case reports, retrospective cohort series and a phase 2 trial. Definitions of unresectable disease were variable. Radioisotopes used included 177Lu (n = 142) and 90Y (n = 36), used separately (n = 178) or in combination (n = 1). A combination of PRRT with chemotherapy was also explored (n = 2). Toxicity data was reported in 11/17 studies. Survival analysis was reported in 3/17 studies. Surgical resection following PRRT was reported for both the primary tumor (n = 71) and metastases (n = 12). Resection rates could not be calculated as not all publications reported whether resection was completed. Published literature exploring the use of PRRT in the neoadjuvant setting is mostly limited to case reports and retrospective cohort studies. From these limited data there is reported to be a role of PRRT in neoadjuvant setting in the literature. However, the low quality of evidence precludes any definite conclusion on the grade of disease, site of primary, isotope used or use of concomitant chemotherapy that can benefit from this application. Further prospective studies will require collaboration between multiple centers to gain sufficient high‐quality evidence. [ABSTRACT FROM AUTHOR]