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The article discusses the case of 43-year-old woman having history of a Perigee vaginal mesh five years prior referred to pelvic floor unit outpatient department. It is mentioned that Chronic pelvic pain may be side effect of use of vaginal mesh repair for primary management of pelvic organ prolapse which may sometimes be cured using removal of total vaginal mesh.

The article discusses the case of 37-year-old woman who was presented at four months following a vaginal birth after caesarean (VBAC) with ongoing pink-coloured vaginal watery discharge. CT urogram revealed 2 cm diameter vesico-uterine fistula (VUF) through to lower aspect of uterus. The treatment administered is discussed.

Objectives: Real-world data regarding rheumatoid arthritis (RA) and its association with interstitial lung disease (ILD) is still scarce. This study aimed to estimate the prevalence of RA and ILD in patients with RA (RAILD) in Spain, and to compare clinical characteristics of patients with RA with and without ILD using natural language processing (NLP) on electronic health records (EHR)., Methods: Observational case-control, retrospective and multicentre study based on the secondary use of unstructured clinical data from patients with adult RA and RAILD from nine hospitals between 2014 and 2019. NLP was used to extract unstructured clinical information from EHR and standardise it into a SNOMED-CT terminology. Prevalence of RA and RAILD were calculated, and a descriptive analysis was performed. Characteristics between patients with RAILD and RA patients without ILD (RAnonILD) were compared., Results: From a source population of 3 176 165 patients and 64 241 683 EHRs, 13 958 patients with RA were identified. Of those, 5.1% patients additionally had ILD (RAILD). The overall age-adjusted prevalence of RA and RAILD were 0.53% and 0.02%, respectively. The most common ILD subtype was usual interstitial pneumonia (29.3%). When comparing RAILD versus RAnonILD patients, RAILD patients were older and had more comorbidities, notably concerning infections (33.6% vs 16.5%, p<0.001), malignancies (15.9% vs 8.5%, p<0.001) and cardiovascular disease (25.8% vs 13.9%, p<0.001) than RAnonILD. RAILD patients also had higher inflammatory burden reflected in more pharmacological prescriptions and higher inflammatory parameters and presented a higher in-hospital mortality with a higher risk of death (HR 2.32; 95% CI 1.59 to 2.81, p<0.001)., Conclusions: We found an estimated age-adjusted prevalence of RA and RAILD by analysing real-world data through NLP. RAILD patients were more vulnerable at the time of inclusion with higher comorbidity and inflammatory burden than RAnonILD, which correlated with higher mortality., Competing Interests: Competing interests: JARI has received support for research grants or contracts from BMS. ET-A has received payment honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from BMS, and support for attending meetings from Boehringer Ingelheim, Nordic Pharma and Merck Sharp & Dohme. JF-M has received payment honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from BMS, Amgen, Lilly, Galápagos, Boehringer Ingelheim, Novartis and also support for attending meetings from Boehringer Ingelheim. LS-F has received payment honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Novartis, BMS, Lilly, support for attending meetings from Pfizer, Lilly and Novartis and also has participated on Data Safety Monitoring Board or Advisory Board for Novartis, Merck Sharp & Dohme and Sanofi. BS has received consulting fees from Boehringer Ingelheim, payment honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Roche and Boehriner Ingelheim, support for attending meetings from Boehringer Ingelheim, Roche and AstraZeneca. JLA has received consulting fees from AbbVie, Amgen, AstraZeneca, Biogen, Cellgene, Celltion, Fresenius-Kabi, Galápagos, Gebro, GSK, Merck Sharp & Dohme, Pfizer, Regeneron, UCB, payment honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from AbbVie, Antares, Biogen, GSK, Janssen, Merck Sharp & Dohme, Lilly, Nordic, Novartis, Sanofi, UCB and also support for attendings from AbbVie, Gebro, Janssen, Merck Sharp & Dohme, Nordic, Novartis and Pfizer. EB has received payment honoraria for educational events from Boehringer Ingelheim, support for attending meetings and/or travel from Boehringer Ingelheim and Janssen. DB currently works at Savana Research, has received grants or contracts from Novartis, payment honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Janssen and AbbVie, support for attending meetings from UCB, Novartis and AbbVie. DV works at BMS Company and own stocks as BMS employee. SLV works at BMS Company and own stocks as BMS employee. RACM works at BMS Company. The present manuscript was fully supported by Bristol-Myers Squibb., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Exposure to high levels of a cholinesterase inhibiting organophosphorus (OP) agent often results in seizures that progress to status epilepticus (SE). Survivors of OP-induced SE often display neuropathological consequences the days following SE. In the current study, the temporal profile of neuropathology after SE was investigated in a rat model of diisopropylfluorophosphate (DFP)-induced SE. Adult Sprague-Dawley rats were injected with DFP to induce SE for one hour. Following termination of electrographic SE with urethane (0.8 g/kg, sc), cohorts of rats were euthanized 3, 24 and 48 h later and brain tissue was processed to determine immediate early gene and inflammatory mediator expression as well as blood-brain barrier changes and neurodegeneration. After SE rats displayed a time-dependent upregulation of immediate early genes such as cFos and ΔFosB as well as pro-inflammatory mediators COX-2, IL-1β and IL-6. The profile of positive cFos staining, but not ΔFosB, coincided temporally with heightened brain activity measured by cortical electroencephalography (EEG). Neurodegeneration in limbic brain regions was absent 3 h after SE, but prominent 24 h later and continued to increase 48 h after SE. Serum albumin was detected in the cortex 3 h after SE suggesting early loss of blood brain barrier integrity. However, the blood-brain barrier appeared repaired 48 h after SE. This study demonstrates that following OP-poisoning in rats, immediate early gene expression in the brain precedes neuroinflammation followed by erosion of the blood-brain barrier and neurodegeneration. The study also demonstrates that seizure activity in brain nuclei coincides with cFos expression. Together, these studies give insight into the temporal molecular changes in the brain following organophosphate-induced status epilepticus., (Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.)

Prostaglandin-E 2 (PGE 2 ), an important mediator of inflammation, achieves its functions via four different G protein-coupled receptors (EP1, EP2, EP3, and EP4). We previously demonstrated that the EP2 receptor plays a proinflammatory and neurodegenerative role after status epilepticus (SE). We recently developed TG8-260 as a second-generation highly potent and selective EP2 antagonist. Here, we investigate whether TG8-260 is anti-inflammatory and combats neuropathology caused by pilocarpine-induced SE in rats. Adult male Sprague-Dawley rats were injected subcutaneously with pilocarpine (380-400 mg/kg) to induce SE. Following 60 min of SE, the rats were administered three doses of TG8-260 or vehicle and were allowed to recover. Neurodegeneration, neuroinflammation, gliosis, and blood-brain barrier (BBB) integrity were examined 4 days after SE. The results confirmed that pilocarpine-induced SE results in hippocampal neurodegeneration and a robust inflammatory response that persists days after SE. Furthermore, inhibition of the EP2 receptor by TG8-260 administered beginning 2 h after SE significantly reduced hippocampal neuroinflammation and gliosis but, in distinction to the earlier generation EP2 antagonist, did not mitigate neuronal injury or BBB breakdown. Thus, attenuation of neuroinflammation and gliosis is a common feature of EP2 inhibition following SE., (© 2021. The American Society for Experimental NeuroTherapeutics, Inc.)

The increasing number of cases involving the use of nerve agents as deadly weapons has spurred investigation into the molecular mechanisms underlying nerve agent-induced pathology. The highly toxic nature of nerve agents restrict their use in academic research laboratories. Less toxic organophosphorus (OP) based agents including diisopropylfluorophosphate (DFP) are used as surrogates in academic research laboratories to mimic nerve agent poisoning. However, neuropathology resulting from DFP-induced status epilepticus (SE) has not been compared directly to neuropathology observed following nerve agent poisoning in the same study. Here, the hypothesis that neuropathology measured four days after SE is the same for rats exposed to DFP and soman was tested. Adult Sprague-Dawley rats were injected with soman or DFP to induce SE. Cortical electroencephalography (EEG) was recorded prior to and during soman-induced SE. EEG power analysis of rats administered soman revealed prolonged electrographic SE similar to that of rats that endure uninterrupted SE following injection of DFP. Rats that experienced soman-induced SE displayed less hippocampal neuroinflammation and gliosis compared to rats administered DFP. Seizure-induced weight change, blood-brain barrier (BBB) leakiness and neurodegeneration in most seizure sensitive limbic brain regions were similar for rats that endured SE following soman or DFP. The amalgamated pathology score calculated by combining pathological measures (weight loss, hippocampal neuroinflammation, gliosis, BBB integrity and neurodegeneration) was similar in rats administered the OP agents. These findings support use of the rat DFP model of SE as a suitable surrogate for investigating some, but not all delayed consequences produced by nerve agents., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Introduction and Hypothesis: The objective was to determine whether levator contraction during Valsalva (i.e. levator co-activation), as visualised on four-dimensional translabial ultrasound (4D-TLUS), is associated with obstructed defecation (OD)., Methods: This was a retrospective study including patients attending a tertiary urogynecological unit. All underwent an interview, clinical examination and 4D-TLUS. Frequent straining at stool, digitation or sensation of incomplete emptying during defecation were considered symptoms of OD. Archived 4D-TLUS volumes were evaluated, blinded to all other data. Hiatal anteroposterior (AP) diameter (cm) and hiatal area (cm 2 ) were measured at rest and on maximal Valsalva. Patients with anatomical explanations for OD (rectocele, enterocele and/or rectal intussusception) were excluded. Reduction of hiatal AP diameter and hiatal area on Valsalva were tested for association with symptoms of OD., Results: Overall, 1,383 women attended the unit from May 2013 to July 2016. Seven hundred and eight were excluded because of rectocele (n = 645), enterocele (n = 116) or rectal intussusception (n = 41) and 10 owing to missing data, leaving 665. Mean age was 53 years (16-89), mean body mass index (BMI) 27.3 kg/m 2 (15.7-64.4). OD symptoms were reported by 368 (55.3%) patients. On imaging, a reduction in hiatal AP diameter on Valsalva was seen in 11.7% cases (78 out of 665) with a mean reduction of 3.5 mm (0.2-17). A mean reduction in hiatal area of 1.9cm 2 (0.03-14.8) on Valsalva was seen in 9.8% cases (65 out of 665). These sonographic measures of levator co-activation were not associated with OD symptoms or bother caused by them (p > 0.05)., Conclusions: Levator co-activation seen on TLUS is not associated with obstructed defecation.

Introduction and Hypothesis: Obstetric anal sphincter injury (OASIS) rates are reported to be higher in Asian women living in Western countries than in those living in Asia, but the reasons for the differences remain unclear. The objectives of this study were for a single examiner to prospectively compare OASIS rates in primiparous Asian women in an Asian and Western birth unit and determine potential birth factors that may influence the possible difference in OASIS incidence., Methods: This was a prospective observational study based in Hong Kong, China, and Sydney, Australia, involving primiparous women > 36 weeks gestation of Asian descent undergoing vaginal delivery. A single examiner recorded basic patient demographics, observed all the deliveries at both sites, noting birthing techniques, and then examined the women, including a rectal examination, to determine OASIS incidence., Results: Seventy births in Hong Kong and 66 in Sydney were studied. The incidence of OASIS was 34% in Sydney and 10% in Hong Kong (p = 0.001). Birthweight, epidural rate, body mass index, and instrumental delivery were higher in Sydney. Episiotomy rates were higher in Hong Kong (59.2% vs. 82.9%; p = 0.007). When comparing OASIS with no-OASIS, perineal length (OR = 0.36, 95% CI 0.17 to 0.76, p = 0.004) and birthweight (OR = 1.14, 95% CI 1.00 to 1.30, p = 0.039) were independent risk factors for OASIS., Conclusions: The incidence of OASIS in Asian women is significantly higher in a Western than in an Asian setting. In Asian women, perineal length and birthweight can affect the risk of OASIS at the time of vaginal delivery.

Midurethral slings are the mainstay of treatment for stress urinary incontinence. The role of cystourethroscopy to detect lower urinary tract injury following retropubic midurethral slings is well-established; however, its role following transobturator or single-incision sling placement remains controversial. Some advocate "routine" whereas others advocate for "selective" cystourethroscopy. This paper reviews the arguments for and against cystourethroscopy to detect lower urinary tract injury following transobturator and single-incision slings.

Aim: Vesico-uterine fistulas (VUFs) are rare in modern gynecological practice. We aim to demonstrate with a video the surgical techniques involved in laparoscopic repair of a vesico-uterine fistula (Youssef's syndrome)., Methods: A 37-year-old woman, para 2 and otherwise healthy, was referred to the Urogynaecology Unit 4 months following a vaginal birth after a previous cesarean, with ongoing pink-colored vaginal watery discharge. Cystoscopy and hysteroscopy confirmed the findings of a well-granulated fistulous tract connecting the base of the bladder and anterior uterine wall just above the level of the internal os. She underwent an uncomplicated laparoscopic repair of VUF., Results: She has remained asymptomatic with resumption of normal menses and no clinical evidence of fistula recurrence at 6-week and 6-month post-operative reviews., Conclusion: This video demonstrates the surgical techniques involved in the laparoscopic repair of a VUF, a rare case in modern gynecological practice where there are few surgical videos demonstrating techniques.

Podcasts are an emerging social media phenomenon in medicine, originating from critical care specialities and now expanding to other domains. Aided by the rapid increase in popularity of social media platforms and the advantage of accessibility, universality and portability, there has been a slow but significant expansion of podcast use in gynaecology. Current literature suggests that there is potential for digital communication to enhance dissemination of information, however there is conflicting evidence on its ability to increase users' knowledge. Emerging interest in urogynaecology presents an opportunity for the subspeciality to tailor podcasts to the needs of its users. In this review, the origins, current evidence and future trends in the use of podcasts in urogynaecology are explored.

Objective: A case review by specialist diagnostic pathologists as part of a Gynecologic Oncology Multi-disciplinary Tumor group has the potential to influence the management of patients with cancer. The primary aim of this study was to determine the frequency of diagnostic discrepancies between the initial (nonspecialist) and final pathological diagnoses in cases referred to the Gynecologic Oncology Tumor Conference (TC) in Western Australia and the impact of such revised diagnosis on clinical management. A secondary aim was to assess the evolving workload encountered by the TC during a 5-year interval., Methods: The records of the weekly TC for the 2 calendar years 2008 and 2013 were examined, and histological and cytological specimens that had been initially assessed by "outside" (nonspecialist) pathology departments, and subsequently reviewed by specialist pathologists, were assessed. The initial and final diagnoses were compared, and where the pathological findings were amended upon review, it was determined whether the change affected clinical management. Diagnostic discrepancies that resulted in a change in patient management were classified as major, whereas discrepancies that did not affect patient management were classified as minor., Results: A total of 481 outside cases were included among 2387 cases presented for histological review at the TC during the 2 years. For outside cases alone, the incidence of major diagnostic discrepancies was 3.4% in 2008, 5.5% in 2013 (no significant difference, P = 0.3787), and 4.6% for the 2 years combined. A recommendation for surgery was the most common change in clinical management as a result of major discrepancy. The minor discrepancy rate was 4.4% of outside cases for both years combined. Pathological discrepancies (major and minor) of the uterine corpus and cervix were most frequent, followed by those of the vulva and ovary. There was a 48.4% increase in total case discussions at the TC during the interval period with a significant rise in nonmalignant cases, 29.8% of the total cases in 2008 compared with 36.8% in 2013 (P = 0.0004)., Conclusions: Nonspecialist pathology departments maintained a high level of reporting accuracy during the interval period, with the major discrepancy rate not changing significantly between 2008 and 2013. Specimens from the uterine corpus and cervix in particular may prove diagnostically challenging on occasion. A pathology review of outside cases by a tertiary-based laboratory in conjunction with a TC can identify a small but clinically significant number of cases that lead to a change in clinical management. It is uncertain whether this affects patient outcomes.

The influence of the oxide support (i.e., Al2O3, Nb2O5, SiO2, and TiO2,) on the surface properties, reduction and oxidation properties, acid-base properties, and catalytic activity of supported indium oxide catalysts has been investigated by temperature-programmed reduction/oxidation, thermogravimetry coupled to differential scanning calorimetry, ammonia and sulfur dioxide adsorption calorimetry, and reduction of NOx by ethene in highly oxygen-rich atmosphere. Two series of In2O3-containing catalysts at low (approximately 3 wt %) and at theoretical geometric monolayer (from 20 to 40 wt %) In2O3 content were prepared and their properties were compared with unsupported In2O3 material. Supports able to disperse the In2O3 aggregates with high In stabilization gave rise to active catalytic systems. Among the studied oxide supports, Al2O3 and, to a lower extent, TiO2 were found to be the best supports for obtaining active de-NOx catalysts.

The efficacy and safety of loratadine and terfenadine in the treatment of 3- to 6-year-old children with seasonal allergic rhinitis were compared in a third-party-blind, randomized, parallel-group study. A total of 96 children were included in the efficacy analysis: 49 children received 5 or 10 mg of loratadine once daily, and 47 received 15 mg of terfenadine twice daily, for 14 days. The mean total score for both nasal and non-nasal symptoms was decreased significantly from baseline at days 3, 7, and 14 in both treatment groups. At endpoint, these scores had improved 73% in each group. There were no statistically significant differences between the two groups in the total symptom scores at any point during the study. Both treatments were effective in relieving individual nasal and nonnasal symptoms. Therapeutic response to treatment was good or excellent in 82% of loratadine-treated children and in 60% of terfenadine-treated children. Few adverse events were reported during the study; all were mild or moderate and were not significantly different between the two treatment groups. There were no reports of sedation or dry mouth in either group. Once-daily treatment with 5 or 10 mg of loratadine was as effective as twice-daily treatment with 15 mg of terfenadine in improving the symptoms of seasonal allergic rhinitis in children 3 to 6 years old. Both treatments were well tolerated.