Rebozo Technique Effectively Reduces Maternal Pain during Childbirth Stage 1 Active Phase

Background: Pain is the main complaint felt by mothers during childbirth. Pain management can be done with non-pharma-cological techniques, one of which is using the Rebozo technique. Objective(s): This study aimed to determine the effectiveness of the rebozo technique for active phase 1 labour pain in primipa-rous women. Method(s): The study used a quasi-experimental design with a pretest and posttest control group. An accidental sampling technique divided a sample of 30 people into control and intervention groups. The intervention group received Rebozo therapy, a therapy using a traditional cloth wrapped around the pelvis and buttocks with the mother kneeling, then shaking it slowly. The pain was measured using the Visual Analogue Scale (VAS), ranging from 0-10. Bivariate test using Wilcoxon. Result(s): The majority of respondents were aged 21-29 years (56.7%), had high school education (83.3%) and were house-wives (50%). The majority of the control group showed moderate pain (53.3%), while the intervention group showed severe (60%). The reduction in pain in the intervention group was more significant than in the control group (2.27 > 0.73). Both the control group and the intervention group showed p < 0.001. Conclusion(s): The Rebozo technique effectively reduces labour pain in the active phase of the first stage in primiparous women. This technique is easy and inexpensive, so it can be an option for non-pharmacological therapy to treat labour pain.Copyright © 2023 Japan University of Health Sciences.

Complex breathlessness in postural tachycardia syndrome and autonomic dysfunction

Breathlessness can occur in a number of autonomic conditions, often in the form of dysfunctional breathing. The exact mechanism remains uncertain, but reduced perfusion of blood pressure receptors and chemoreceptors in the carotid sinus and carotid body, leading to hyperventilation, is postulated. This is recognised to occur in vasovagal syncope and in cases of significant autonomic dysfunction. It also occurs in PoTS, a condition predominantly affecting young women and often precipitated by another illness and increasingly by coronavirus disease 2019. It is characterised by cardiovascular and respiratory symptoms when upright, is relieved by recumbency and is associated with a significant heart rate increase. Other autonomic symptoms of organ dysfunction can occur, in the gastrointestinal and genitourinary system for example. There are guidelines and therapies that can produce significant symptomatic improvements, but maintaining a high level of suspicion for the diagnosis is important, as it can easily be overlooked.Copyright © ERS 2021.

A prospective study to evaluate the efficacy and adverse effects of alpha-blockers in the management of benign prostatic hyperplasia

Conclusion: The obtained results showed that both silodosin and tamsulosin produced significant improvement in IPSS and quality of Life in BPH patients. BPH is a nonemergency medical condition, during COVID pandemic situation outpatient visit to hospitals were postponed or cancelled, even if they struggle with troublesome urinary symptoms and unavoidable impact on quality of life. [...]the need for medical management for symptomatic relief of BPH increased. Exclusion Criteria The following criteria were excluded from the study: * Prostate carcinoma. * Concomitant HIV, HBV or HCV infection. * Renal failure. * Liver disease. * Recent cataract surgery. * Psychiatry disorders.

A BLOODY MASQUERADE: A CURIOUS CASE OF HEMOPTYSIS

SESSION TITLE: Variety in Chest Infections Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: Actinomyces is a Gram-positive anaerobic and micro aerophilic filamentous bacillus that normally colonize the human mouth and digestive and urogenital tracts. They most commonly cause cervical and abdominopelvic infections and rarely pulmonary actinomycosis. CASE PRESENTATION: 67-year-old female with past medical history of recurrent DVT with IVC filter placement, non- ischemic cardiomyopathy, atrial fibrillation, 40 pack year history, recent COVID19 infection, lung nodules & COPD presented with complaint of coughing up blood associated with chest pain for the past 2 days. She had a low-grade fever with stable vitals with preliminary labs showing she was anemic and had reactive leukocytosis. She was recommended to hold oral anticoagulation and follow-up outpatient during when her symptoms worsened. On admission she was started on tranexamic acid nebulization for hemostasis and underwent CTA chest which showed no evidence for pulmonary embolism but commented on a right lower lobe perihilar 12.5 mm mass which has increased in size compared to previous scans. Patient underwent bronchoscopy which showed generalized edema of the tracheobronchial tree with bleeding from superior segment of the right lower lobe bronchus with no visualization of mass. PET scan showed hyper-metabolic lung mass with concerns for malignancy. CT guided biopsy of nodule was done and was not staining for malignant cells, acid fast bacilli with no fungal or bacterial growth. Blood cultures and Karius Digital cultures were also negative. She began expectorating blood clots despite being on treatment and cardiothoracic surgery was consulted. A partial lobectomy with lysis of adhesions of the right lower lobe was done. Specimen sent to pathology showed no evidence for malignancy but instead elicited a contained pulmonary abscess containing filamentous bacteria with parenchymal inflammation with areas of chronic hemorrhagic fibrosing pleuritis and hilar thrombi. She was diagnosed with pulmonary actinomycosis and started on IV 24,000,000 IU penicillin. She underwent a panoramic dental x-ray which was read as suboptimal dentition with multiple missing teeth and did not identify a source. Patient symptoms resolved post lobectomy and since discharged on long course of antibiotics. She continued to have no more episodes of hemoptysis. DISCUSSION: Hemoptysis as a symptom of pulmonary actinomycosis is a rather rare presentation. Actinomycosis causes cavities, nodules, and pleural effusions. It is commonly mistaken for chronic suppurative lung disease and sometimes malignancy. Isolation and identification occur only a minority of cases with a high culture failure rate due to previous antibiotic therapy, inadequate incubation time or culture conditions. CONCLUSIONS: Due to it's variable presentation pulmonary actinomyces has a large overlap with other diseases but must be considered in the differential of unexplained hemoptysis. Reference #1: Hemoptysis secondary to actinomycosis: A rare presentation. PMID: 24778485 PMCID: PMC3999682 DOI: 10.4103/0970-2113.129864 DISCLOSURES: No relevant relationships by Victoria Famuyide No relevant relationships by rukhsaar khanam

Re-audit: has diagnosis and management of UTIs in a busy DGH improved 3 years down the line?

39 Table 1Comparison of results for urine collection and diagnosis between the audit (2017) and the re-audit (2020) 39 Table 2Comparison of results for NICE compliance in terms of imaging schedule between the audit (2017) and the re-audit (2020)Conclusion- There was an eradication of urine bags after the first audit. However, we are still using urine dipsticks in <3month olds to diagnose urinary tract infections because samples for microscopy are sent non-urgently. This is an improvement from the first audit, as in most cases samples were not sent.- There is room for improvement in terms of following the imaging schedule outlined by NICE. Whereas in the first audit we were over-investigating, this re-audit showed that less investigations were ordered and in other occasions, despite requests being made, patients did not attend.- We should bear in mind that during this last year the SARS-CoV-2 pandemic has led to delays in appointments and closures of hospital services. Moreover, patients avoided attending hospital for fear to get exposed to the virus. Therefore, re-evaluation of results should be carried out once hospitals are running normally.

A UNIQUE CASE OF CANDIDA RETINITIS IN THE COVID-19 ERA

CASE: A 56-year-old male with a history of asthma was admitted to the intensive care unit (ICU) for acute hypoxic respiratory failure. He was found to have sepsis secondary to pneumococcal pneumonia superinfected by COVID19. Labs showed elevated inflammatory markers. Chest x-ray initially demonstrated left lower lobe pneumonia but throughout the COVID-19 course, worsened to persistent multifocal pneumonia. The patient was intubated and treated with enoxaparin and a ten-day course of dexamethasone as well as antibiotics due to worsening clinical status. After the COVID-19 course resolved and the patient was extubated, he developed sepsis again - this time secondary to Candidemia. Treatment with intravenous micafungin was initiated and HIV antibodies screening returned negative. The patient began to report subacute visual changes including floating spots and blurry vision in the right eye without any other acute ocular symptoms. Upon ophthalmological exam, there were multiple white retinal lesions without vitreous involvement bilaterally on the macula indicating candida retinitis. Antifungal treatment with micafungin was changed to intravenous voriconazole for greater intraocular penetration. After seven days of intravenous voriconazole, two blood cultures came back negative for Candida. At this point, the patient was medically stable and was discharged on a six- week course of oral voriconazole. IMPACT/DISCUSSION: The COVID-19 pandemic changed the landscape of medicine. Not only have healthcare systems worked hard to treat the COVID-19 infections themselves but also the long-term effects that result from an infection. As treatment guidelines have been developed and honed, steroids appear at the forefront of therapy. However, this does not come without consequences as prolonged use of corticosteroids can dampen the body's immune system. This compounds the ability of COVID-19 pneumonia to result in a severely immunocompromised state that can subsequently expose the body to opportunistic infections. Candida albicans is an organism that exists in all humans in the gastrointestinal and genitourinary systems typically without impact. In severely immunocompromised individuals such as the patient in the case, hospital courses involving ICU care can lead to hematogenous spread of Candida. The candidemia leads to sepsis and may also present with rare clinical pictures such as Candida retinitis. For this reason, candidemia should prompt thorough evaluation of patients with an echocardiogram, abdominal computer tomography, and ophthalmologic exam. CONCLUSION: This case displays the ability of COVID-19 infections to provide an opportunity for rare infectious manifestations such as Candida retinitis. As the pandemic prolongs, proper treatment regimens must be reassessed for future use as these presentations may become more common.

Electroporation: An Effective Method For In Vivo Gene Delivery

Background: Gene therapy is a promising approach for the treatment of various diseases, including cancer, hereditary disorders, and some viral infections. The development of efficient and safe gene delivery systems is essential for facilitating gene transfer to various organs and tissues in vivo. Objective: In this review, we briefly describe the principal mechanisms of gene delivery systems, particularly electroporation, and discuss the latest advancements in the application of electro-poration for in vivo gene transfer. Methods: A narrative review of all the relevant publication known to the authors was conducted. Results: In recent years, electroporation-based strategies have emerged as an auspicious and versa-tile platform for efficient and controlled delivery of various biomolecules, including nucleic acids. Applying electric pulses of enough magnitude leads to the formation of hydrophilic pores in the cell membrane and allows the entry of otherwise membrane-impermeant molecules, such as DNA. Alt-hough electroporation has been initially developed for in vitro transfection of cells, it has recently advanced to preclinical in vivo applications and finally to clinical trials. Conclusion: Electroporation has already entered the clinical practice for antitumor therapy and may be an essential part of future personalized treatments. Given the ability of electroporation to deliver multiple genes in a single event, it will also certainly be further developed both as a stand-alone delivery approach and when coupled with other technologies.

This Week in the Journal

Issue HighlightsIssue Highlights, April 07, 2022

Endometriosis Susceptibility Genes in Endometrial Stem/Progenitor Cells

To develop a much-needed cure for endometriosis, it is first necessary to understand the pathogenesis and evolution of the disease. Endometrial stem/progenitor cells have been implicated as well as multiple genetic variations, each contributing a small effect but combined may have as yet unknown biological roles. A single polygenic risk score (PRS) can be used to categorize this genetic load of the risk variants in an individual. In this project, we will assess the biological role of a high PRS in endometriosis patients versus a low PRSin normal women. Specifically, we will assess changes in gene expression in endometrial cells of eutoptic endometrium at the single cell level, functional behavior of endometrial stem/progenitor cells in organoid assays, including co-culture with stromal cells and localization of risk gene variants, and key gene signatures in relation to stem/progenitor cell locations. We have completed all required approvals, developed new tools, questionnaire, databases, assays and protocols, recruited 9 women and collected samples for all 3 aims in spite of significant challenges faced with the timing of HRPO approval and COVID-19 impacts on gynecological surgeries. As surgeries recommence following easing of 8 months COVID-19 restrictions in Melbourne, we have participants waiting for their delayed surgeries and we are ready to accelerate progress in Aims 1 and 2 in the second reporting period.

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)-Associated Urogenital Disease: A Current Update.

Severe Acute Respiratory Syndrome Coronavirus 2, which is quickly spreading around the world and causes coronavirus disease 2019, may attack the urogenital system. We thought that a summary of the current literature about urogenital disease associated with the virus would be useful for physicians treating patients with coronavirus disease 2019. PubMed was comprehensively screened for studies published from 2019 to 2020. Studies of coronavirus disease 2019 patients with kidney disease, reproductive system diseases, or urological cancer were included. Through reviewing current literature, we summarized that acute kidney injury is a risk factor for patients with coronavirus disease 2019 and is related to their survival. A diagnosis of chronic kidney disease increases the risk of infection. The therapy for kidney transplant patients should be cautious and implemented on a case-by-case basis. When the public health burden is too heavy to bear, a rational selection of treatment for patients with urological cancer is vital. The male reproductive system is at high risk of being attacked by the virus, which may cause damage to reproductive function, and the long-term effects require further study. So, the complications associated with the urogenital system should not be ignored during the course of infection treatment and more robust evidence of long-term effects on the urogenital system will be proposed as more studies are published.

Focus on Characteristics of COVID-19 with the Special Reference to the Impact of COVID-19 on the Urogenital System.

Coronavirus disease 2019 (COVID-19) is a new infectious disease that first emerged in December 2019. It has infected more than 4,890,000 people in more than 200 countries. This virus can cause progressive respiratory symptoms and severe diseases such as organ failure and death. The complete genomic sequence of SARS-CoV-2 was determined after the virus's identification, and the sequence analysis showed that SARS-CoV-2 strains are genetically similar to SARS-CoV. Angiotensin converting enzyme II is an entry receptor for SARS-CoV-2, which is highly expressed in the kidney, so some patients had symptoms of kidney damage. Here we reviewed the current progress of COVID-19 and its urogenital manifestations. In this rapidly moving field, this review was comprehensive as of May 30, 2020.

A Systematic Review on Guidelines and Recommendations for Urology Standard of Care During the COVID-19 Pandemic.

CONTEXT: The first case of the new coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV2), was identified in Wuhan, China, in late 2019. Since then, the coronavirus disease 2019 (COVID-19) outbreak was reclassified as a pandemic, and health systems around the world have faced an unprecedented challenge. OBJECTIVE: To summarize guidelines and recommendations on the urology standard of care during the COVID-19 pandemic. EVIDENCE ACQUISITION: Guidelines and recommendations published between November 2019 and April 17, 2020 were retrieved using MEDLINE, EMBASE, and CINAHL. This was supplemented by searching the web pages of international urology societies. Our inclusion criteria were guidelines, recommendations, or best practice statements by international urology organizations and reference centers about urological care in different phases of the COVID-19 pandemic. Our systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Of 366 titles identified, 15 guidelines met our criteria. EVIDENCE SYNTHESIS: Of the 15 guidelines, 14 addressed emergency situations and 12 reported on assessment of elective uro-oncology procedures. There was consensus on postponing radical prostatectomy except for high-risk prostate cancer, and delaying treatment for low-grade bladder cancer, small renal masses up to T2, and stage I seminoma. According to nine guidelines that addressed endourology, obstructed or infected kidneys should be decompressed, whereas nonobstructing stones and stent removal should be rescheduled. Five guidelines/recommendations discussed laparoscopic and robotic surgery, while the remaining recommendations focused on outpatient procedures and consultations. All recommendations represented expert opinions, with three specifically endorsed by professional societies. Only the European Association of Urology guidelines provided evidence-based levels of evidence (mostly level 3 evidence). CONCLUSIONS: To make informed decisions during the COVID-19 pandemic, there are multiple national and international guidelines and recommendations for urologists to prioritize the provision of care. Differences among the guidelines were minimal. PATIENT SUMMARY: We performed a systematic review of published recommendations on urological practice during the coronavirus disease 2019 (COVID-19) pandemic, which provide guidance on prioritizing the timing for different types of urological care.

New understanding of the damage of SARS-CoV-2 infection outside the respiratory system.

Since early December 2019, a number of pneumonia cases associated with unknown coronavirus infection were identified in Wuhan, China, and many additional cases were identified in other regions of China and in other countries within 3 months. Currently, more than 80,000 cases have been diagnosed in China, including more than 3000 deaths. The epidemic is spreading to the rest of the world, posing a grave challenge to prevention and control. On February 12, 2020, the International Committee on Taxonomy of Viruses and the World Health Organization officially named the novel coronavirus and associated pneumonia as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease 2019 (COVID-19), respectively. According to the recent research on SARS-CoV-2, the virus mainly infects the respiratory system but may cause damage to other systems. In this paper, we will systematically review the pathogenic features, transmission routes, and infection mechanisms of SARS-CoV-2, as well as any adverse effects on the digestive system, urogenital system, central nervous system, and circulatory system, in order to provide a theoretical and clinical basis for the diagnosis, classification, treatment, and prognosis assessment of SARS-CoV-2 infection.