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We report a 44-year-old woman who developed a fatal pulmonary embolus after uterine artery fibroid embolisation (UAE). Bilateral UAE was carried out through a single right-femoral artery puncture. The largest fibroid in the anterior fundal wall measured 4.5 cm, and the largest fibroid in the posterior fundal wall measured 6 cm. The appearances after UAE were satisfactory, and the procedure was apparently uneventful. No immediate complications were noted. The patient developed sudden-onset shortness of breath and went into cardiac arrest 19 h after the procedure. Postmortem autopsy confirmed that the cause of a death was a pulmonary embolism. To our knowledge this is the first reported case in the United Kingdom in which death occurred from a pulmonary embolus after UAE. [ABSTRACT FROM AUTHOR]

There is insufficient information about the migratory Eurasian teal, Anas crecca. The study provides the first anatomical description of lingual adaptations and their relationship with the species-specific feeding behavior of A. crecca collected near Egyptian Lake Nasser. Our investigation was applied with the help of gross, scanning electron microscopy (SEM), and morphometric analysis. The study focused on the feeding filtering apparatus that depends on eight lingual papillae. The spatula-shaped nail is adapted for food particle pecking, while the lingual combs, rostral border of the prominence, unique papillary crest, median groove, and papillary system aid in intra-oral transportation. The feeding apparatus is formed by the lateral and dorsal papillary systems. The lateral papillary system had conical papillae with numerous long filiform and hair-like filiform papillae to constitute the food filtration apparatus, while the dorsal papillary system had ridged-like and rod-like papillae in addition to the small papillae of the papillary crest and spinated border of the root to help in moving the food particles with water to the lateral sides of the prominence. The laryngeal region exhibited papillary (pre-glottic) and non-papillary (glottic) areas. The papillary area had two lateral papillary portions and a median smooth portion, while the non-papillary area had an ovoid laryngeal mound with a median glottic opening that was bordered by a papillary border. The papillary portion had three slightly oblique longitudinal papillary rows., (© 2024 Wiley Periodicals LLC.)

Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Unscheduled bleeding on hormone replacement therapy (HRT) can affect up to 40% of users. In parallel with the increase in HRT prescribing in the UK, there has been an associated increase in referrals to the urgent suspicion of cancer pathway for unscheduled bleeding. On behalf of the British Menopause Society (BMS) an expert review panel was established, including primary and secondary care clinicians with expertise in the management of menopause, with representatives from key related organisations, including the Royal College of Obstetricians & Gynaecologists, the British Gynaecological Cancer Society, British Society for Gynaecological Endoscopy, Royal College of General Practitioners and Faculty of Sexual and Reproductive Health, and service development partners from NHS England and GIRFT (Getting it Right First Time). For each topic, a focused literature review was completed to develop evidence led recommendations, where available, which were ratified by consensus review within the panel and by guideline groups., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The study aims to analyse the normal anatomical and radiographical features of the Manus of the southern Aswanian-adapted Arabian one-humped camel, providing crucial data for diagnosing and treating various ailments. Our study was applied to 10 cadaver forelimbs of adult male one-humped camels (4-5 years old) for an explanation of the gross anatomy of the bones of the Manus region from under the carpal bones by using traditional techniques, including the gross anatomical, radiographic and x-ray (at the dorsopalmar and lateral planes) of the preparation of Manus bones. Our results showed that the large fused (third and fourth) metacarpal bones, in which the fusion extended along the entire length of the bone except at the distal end, diverged to form separate articulations with cross-ponding digits. As described in all ruminant species, especially the camel, there were two digits, and each digit consisted of three phalanges and two proximal sesamoid bones. Our radiographic x-ray data revealed that the complete radiopaque septum that completely divided the medullary cavity into two separate parts was clear from the dorsopalmar view, while the lateral view showed the proximal sesamoid bones that were placed over each other and located palmar to the head of the large metacarpal bone. In conclusion, our study reveals the adaptations of the Arabian one-humped camel to Egyptian conditions, aiding in the early diagnosis of lameness and digit problems and enabling veterinarians and camel owners to better address these issues, thereby improving the overall health and well-being of these animals., (© 2024 Wiley‐VCH GmbH. Published by John Wiley & Sons Ltd.)

Premature ovarian insufficiency (POI) is a condition in which there is a decline in ovarian function in women who are younger than 40 years resulting in a hypo-oestrogenic state with elevated gonadotrophins and oligomenorrhoea/amenorrhoea. This leads to short term complications of menopausal symptoms and long-term effects on bone and cardiovascular health, cognition as well as the impact of reduced fertility and sexual function associated with this condition. It is managed by sex steroid replacement either with HRT or combined hormonal contraception until the age of natural menopause (51) and this can provide a beneficial role with both symptom control and minimising the long-term adverse effects associated with this condition. Women who undergo a menopause between 40 and 45 years are deemed to have an "early menopause". The limited data available for this group suggest that they also have an increased morbidity if not adequately treated with hormone therapy. As such, women who have an early menopause should be managed in a similar way to those with POI, with the recommendation that they should take HRT at least until the natural age of menopause. This is the same for induced menopause that is caused by medical or surgical treatment that impacts the ovaries. It is important to ensure early diagnosis and access to specialist care to help support and manage these patients to reduce the symptoms and risks of long-term complications. This review looks at the diagnosis, causes, short and long-term complications and management of POI, early and induced menopause., (Copyright © 2023. Published by Elsevier Ltd.)

Background: Attention deficit hyperactivity disorder is a common neurodevelopmental disorder. Accessing services for this disorder is a worldwide challenge and requires innovative interventions., Aims: We aimed to investigate the effectiveness of tele-collaborative care for attention deficit hyperactivity disorder in primary health care centres in Dubai., Methods: Six trained physicians started collaborative care clinics across Dubai. Eligible children aged 6-12 years attending primary health care centres with attention deficit hyperactivity disorder were randomly selected to receive telehealth collaborative care, or standard treatment. Baseline assessments were conducted using the Vanderbilt Behavioral Assessment Scale, the Columbia Impairment Scale, the Childhood Behavior Checklist, and the Strength and Difficulties Questionnaire. Waiting times and clinical and functional outcomes were measured in both groups and compared. Continuous variables were presented as means and standard deviations, categorical variables such as sex were presented as numbers and percentages, and continuous outcome variables were compared using the Student t-test., Results: Among the referred children (n = 112), 11 boys and 6 girls met the eligibility criteria (mean age 7.8 years). The dropout rate at 6 months in the control group was 80%, compared with 50% in the intervention group. The mean waiting time was significantly shorter in the intervention group (1.3 weeks) than the control group (7.1 weeks); P = 0.026. The mean difference in the Childhood Behavior Checklist total score over time was significantly higher in the intervention group (P = 0.042), but the mean difference in the Vanderbilt scale was not significant., Conclusion: Tele-collaborative care for children with attention deficit hyperactivity disorder within primary health care is feasible., (Copyright © Authors 2023; Licensee: World Health Organization. EMHJ is an open access journal. This paper is available under the Creative Commons Attribution Non-Commercial ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo).)

Objective: To investigate the experience of remote outpatient menopause service delivery by clinicians and patients during the COVID-19 pandemic., Methods: Two surveys explored the experiences of patients and clinicians separately. Patients attending menopause clinics in the UK were directed to an online survey which included questions on demographics and on their experience of their most recent appointment. A clinician survey was shared to members of the British Menopause Society (BMS) via email and was made available on the BMS website. It contained questions on clinic characteristics and clinicians' experience of delivering remote menopause consultations. Surveys were available for completion between 01/12/2020 and 10/02/2021., Results: Of 180 patients who completed the patient survey, 52% felt remote consultations were the same or better than face-to-face consultations, and 90% of patients felt a choice between remote and face-to-face consultations should be offered. Patients overall were satisfied with many aspects of care, though numerous problems were highlighted with appointment administration. Of 76 clinicians who completed the clinician survey, most found remote patient consultations either no different or a bit worse than face-to face consultations but found that they offered more flexibility. In some cases, significant rescheduling was necessary to accommodate for the clinical needs of the consultation., Conclusion: A 'one-size-fits-all' approach to managing the delivery of menopause care is not supported by patients or clinicians. There must be a robust process in place to avoid problems with appointment scheduling and associated communications. Lessons learned from the pandemic can help to provide holistic menopause care.

Introduction: There is increasing evidence that vitamin D has widespread tissue effects. In addition to osteoporosis, vitamin D deficiency has been associated with cardiovascular disease, diabetes, cancer, infections and neurodegenerative disease. However, the effect of vitamin D supplementation on non-skeletal outcomes requires clarification, especially in postmenopausal women., Aim: This position statement provides an evidence-based overview of the role of vitamin D in the health of postmenopausal women based on observational and interventional studies., Materials and Methods: Literature review and consensus of expert opinion., Results and Conclusions: Vitamin D status is determined by measuring serum 25-hydroxyvitamin D levels. Concentrations <20 ng/ml (<50 nmol/l) and <10 ng/ml (<25 nmol/l) are considered to constitute vitamin D deficiency and severe deficiency, respectively. Observational data suggest an association between vitamin D deficiency and adverse health outcomes in postmenopausal women, although they cannot establish causality. The evidence from randomized controlled trials concerning vitamin D supplementation is not robust, since many studies did not consider whether people were deficient at baseline. Moreover, high heterogeneity exists in terms of the population studied, vitamin D dosage, calcium co-administration and duration of intervention. Concerning skeletal health, vitamin D deficiency is associated with low bone mass and an increased risk of fractures. Vitamin D supplementation at maintenance doses of 800-2000 IU/day (20-50 μg/day), after repletion of vitamin D status with higher weekly or daily doses, may be of benefit only when co-administered with calcium (1000-1200 mg/day), especially in the elderly populations and those with severe vitamin D deficiency. Concerning cardiovascular disease, vitamin D deficiency is associated with an increased prevalence of cardiovascular risk factors, mainly metabolic syndrome, type 2 diabetes mellitus and dyslipidemia. Vitamin D deficiency, especially its severe form, is associated with an increased risk of cardiovascular events (coronary heart disease, stroke, mortality), independently of traditional risk factors. Vitamin D supplementation may have a modestly beneficial effect on lipid profile and glucose homeostasis, especially in obese individuals or those ≥60 years old and at doses of ≥2000 IU/day (≥50 μg/day). However, it has no effect on the incidence of cardiovascular events. Concerning cancer, vitamin D deficiency is associated with increased incidence of and mortality from several types of cancer, such as colorectal, lung and breast cancer. However, the data on other types of gynecological cancer are inconsistent. Vitamin D supplementation has no effect on cancer incidence, although a modest reduction in cancer-related mortality has been observed. Concerning infections, vitamin D deficiency has been associated with acute respiratory tract infections, including coronavirus disease 2019 (COVID-19). Vitamin D supplementation may decrease the risk of acute respiratory tract infections and the severity of COVID-19 (not the risk of infection). Concerning menopausal symptomatology, vitamin D deficiency may have a negative impact on some aspects, such as sleep disturbances, depression, sexual function and joint pains. However, vitamin D supplementation has no effect on these, except for vulvovaginal atrophy, at relatively high doses, i.e., 40,000-60,000 IU/week (1000-1500 IU/week) orally or 1000 IU/day (25 μg/day) as a vaginal suppository., Competing Interests: Declaration of competing interest, (Copyright © 2022 Elsevier B.V. All rights reserved.)

This care pathway from the European Menopause and Andropause Society (EMAS) provides an updated pathway for monitoring and guidance of women at midlife, focusing on those approaching the end of the reproductive life-cycle, going through the menopausal transition and beyond. The care pathway is written by professionals involved in women's health and provides a stepwise individualized approach, stratified according to needs, symptoms and reproductive stage. Furthermore, the pathway provides details on screening for chronic diseases related to menopause and ageing. Treatment options for climacteric symptoms range from menopausal hormone therapy to non-hormonal alternatives and lifestyle modifications. Therapy should be tailored to personal needs and wishes. The pathway aims to offer a holistic, balanced approach for monitoring middle-aged women, aiming to control health problems effectively and ensure healthy ageing., Competing Interests: 1. Irene Lambrinoudaki: None declared. 2.Eleni Armeni: None declared. 3. Dimitrios G. Goulis: None declared. 4. Silvia Bretz: None declared.5. Iuliana Ceausu: None declared. 6. Fatih Durmusoglu: None declared. 7. Risto Erkkola: None declared. 8. Ivan Fistonic: has received consulting fees in the past 3 years from Fotona Inc. 9. Marco Gambacciani: has received speaker and consulting fees in the past 3 years from MSD, Theramex and Bayer. 10. Marije Geukes: None declared. 11. Haitham Hamoda: None declared. 12. Caiomhe Hartley: None declared. 13. Angelica Lindén Hirschberg in the past 3 years has received grant support from ITF Research Pharma for the “Blissafe” study., (Copyright © 2022 Elsevier B.V. All rights reserved.)