Teaching menopause to health care professionals

The menopause is a stage in the life cycle that affects all women. Managing perimenopausal and postmenopausal health is therefore a key issue for all healthcare professionals, not just gynecologists. The curriculum should include terminology and definitions, assessment, diagnosis and evidence-based management strategies. Healthcare professionals should be aware that women have different perceptions and experiences of the menopause which may be determined by: age and type of menopause, pre-existing health conditions, disability, employment and adverse childhood events. Specialist services may be required for some. These include women with chronic disease, premature ovarian insufficiency or early menopause or pre-existing health conditions and disability, as well as transgender and gender-nonconforming people. The COVID-19 pandemic has changed the mode of delivering healthcare from face-to-face only to include virtual consultations. Teaching now needs to include both types of consultations. A holistic approach is required and teaching should be provided by an accredited expert. Rees M, Abernethy K, Bachmann G, et al. The essential menopause curriculum for healthcare professionals: A European Menopause and Andropause Society (EMAS) position statement. Maturitas. 2022;158:70-77. doi: https://doi.org/10.1016/j.maturitas.2021.12.001Copyright © 2023

Case study from Kosovo - repetitive COVID-19 infection and pregnancy

A 25-year-old woman, gravida 2, with no medical history of cardiovascular nor other chronic diseases, came to the gynaecologist and described symptoms of a flu-like disease, including very high fever. The gyneacologist prescribed her antibiotics and paracetamol to calm down the fever. At 37 week of gestation she was admitted to the provincial COVID-19 treatment center for isolation and health care in University Clinical Center of Kosovo in Gynecology/Obstetrics department. All bacteriological tests, including hemocultures and cultures of urines were negative. She received antipyretics (acetaminophen), antispasmodics trimethylphloroglucinol and antibiotics (oral azithromycin for 5 days and intravenous ceftriaxone). Despite this treatments, fever and uterine contractions persisted therefor the commission of doctors decided to deliver the baby via ceserean section. The peritoneal cavity and uterus were found to be very inflamed. Fetal appendages as well as the bladder were strewn with eruptive, vesicular lesions bleeding on contact. After few hours after the delivery her temperature (36.5 degreeC) and blood pressure (120/60 mmHg) were normal. The baby was healthy and tested negative on the COVD-19 tests performed. The patients after 2 weeks of treatment and a negative COVID-19 result she was released to go home and was counselled to eat healthy and prescribed multivitamins for her immune system and regular follow ups with the gynecologist. In a period of 8 months the patient became pregnant again and got infected with the COVID-19 again at 25 weeks pregnant. This time the symptoms were not severe and she was followed up at home. The delivery was planned with cesarean section and the baby was in healthy conditions. The patient got vaccinated with Astra Zeneca COVID-19 vaccine after the delivery. Because of their changed physiology, susceptibility to infections, and weakened mechanical and immunological processes, pregnant women are a particularly vulnerable group in any infectious disease outbreak. The requirement to protect the fetus adds to the difficulty of controlling their health. Keywords: COVID-19, pregnant women, cesarean section, Kosovo, astra-zeneca vaccineCopyright © 2023

New definition of RIME: Mucocutaneous eruptions, bullous lesions and multi-mucosal involvement

Objectives: A 14-year-old female patient presents with marked haemorrhagic, adherent crusting of the upper and lower lip and enoral vesicles and erosions. Two weeks before, she had suffered from a respiratory tract infection. She did not take antibiotics but ibuprofen. One week later, she described a swelling and crusting of the upper and lower lips. Urogenital mucosa was also erosive. There was no ocular involvement. Another week later, cocard-like single lesions with partly central blister formation developed. A flaccid blister of 15 mm in diameter was detected in the left ear helix. In total, there was a limited cutaneous involvement of <10% BSA. The girl was admitted to the paediatric clinic. Method(s): Due to mucocutaneous eruptions, bullous lesions and multimucosal involvement, we assumed a Steven-Johnson syndrome or reactive infectious mucocutaneous eruption (RIME). Intravenous rehydration and prophylactic administration of cefotaxime and aciclovir were given. She was balanced and given analgesia with novalgin. The recent increased intake of ibuprofen was discontinued. Local therapy included mometasone cream and serasept dressings. During the inpatient stay, the general condition stabilised and the skin efflorescence's showed a clear regression. Result(s): The microbiological smears for COVID-19, HSV, VZV, mycoplasma, and chlamydia were negative. Discussion(s): As adult classifications for blistering severe cutaneous adverse reactions are limited applicable in children, Ramien et al. proposed revised paediatric-focused clinical criteria 2021. They leave traditional definitions of EEM, SJS and TEN. But they distinguish erythema multiforme (EM) for classic targets with/without mucosal involvement, RIME for cases with mucosal predominance and a respiratory infection trigger, and drug-induced epidermal necrolysis (DEN) for cases caused by medications. (Ramien BJD 2021) There are no current guidelines for RIME therapy. A reasonable management approach includes symptomatic therapy, treatment of identifiable infectious triggers (if possible), consulting urologists, ophthalmologists and gynaecologists (if necessary), immunosuppression, and psychological support. (Ramien ClinExpDermatol 2021).

Teaching Effect after Changing Mode of Continuing Medical Education during the COVID-19 Pandemic

Objective To explore the teaching effect of the teaching mode changed from traditional teaching to online teaching after the outbreak of coronavirus disease 2019 (COVID-19) pandemic. Methods Relying on the Beijing Women's Health Care Technology Improvement Project, the online and offline continuing medical education was carried out, to train the obstetrician and gynecologist working in 16 maternal and child health care hospitals in 16 administrative regions of Beijing, which was planned from September 2020 to December 2025. This study retrospectively collected the assessment results of the two teaching modes from March 2021 to December 2021 (the first year of the teaching plan), and compared the teaching effects. Results Online teaching completed three sessions of 30 live online conference courses, with about 25 000 participants, including 4757 obstetricians and gynecologists from 16 maternal and child health care hospitals in Beijing. A total of 82 on-site teaching courses were held for offline teaching, and 1771 gynecologists and obstetricians from 16 maternity and child care hospitals in Beijing participated in the study. The scores of online teaching and offline teaching were 90.88+/-4.88 and 88.65+/-4.35, respectively. Conclusions Online teaching maybe has similar teaching effects as offline teaching. Compared with offline teaching, online teaching has more advantages, such as convenience, efficiency and economy, which is worthy of promotion and application in the context of the COVID-19 pandemic.Copyright © 2022, Peking Union Medical College Hospital. All rights reserved.

COVID-19 in pregnancy, childbirth and puerperium: The CRONOS registry.

Coronavirus disease 2019 (COVID-19) is an infectious disease that can lead to severe respiratory symptoms. Pregnant women have an increased risk for a severe course. Therefore, the Association of the Scientific Medical Societies in Germany (AWMF) Guidelines 015/092 "SARS-CoV-2 in pregnancy, childbirth, and the puerperium" were established to standardize care in the COVID-19 pandemic. The guideline group used data from the "COVID-19 related obstetrics and neonatal outcome study" (CRONOS) to generate evidence-based recommendations for action. CRONOS collects data from more than 130 affiliated maternity hospitals nationwide in Germany. According to the study, pregnant women positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are often asymptomatic;however, in 1 out of 25 detected infections there is a severe course requiring intensive medical treatment. Thromboembolism occurs in 1 out of 30 women hospitalized for COVID-19. An infection of the neonate of a mother infected peripartum is occasionally detected (about 1 out of 20 infants) and usually remains without consequence in the short-term outcome. Many other questions have been answered using CRONOS data. The registry is still open and recruiting and will also provide more in-depth information on different virus variants and vaccination in the future with more than 6000 cases. CRONOS is exemplary for an unprecedented cooperation of gynecologists during the pandemic.Copyright © 2022, The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.

Adnexal masses surgery in prepubertal and adolescent girls during COVID-19 pandemic

Study Objective: Global burden on healthcare system by COVID-19 patients had a significant impact on non-COVID diseases treatment.1-3 This study compares the characteristics of adnexal masses surgery in girls and adolescents during the 2020 and 2021 COVID-19 pandemic with the homologous non-COVID-19 period in 2018 and 2019. Design(s): A retrospective observational study using medical records of girls under 19 years of age with surgery of adnexal masses. Patients with neonatal cysts and patients with differences of sex development were excluded from the study. Setting(s): Mother and Child Health Care Institute of Serbia 'Dr Vukan Cupic' (Belgrade, Serbia). The study was approved by the Clinical Research Committee of the Institution. Participant(s): Patients (N=130) who had surgery for adnexal masses, of whom 49 with ovarian torsion. Interventions and Main Outcome Measure(s): Patients were diagnosed in the Institute, but also in other health institutions that referred them for final treatment to the Institute. Surgery was usually performed by gynecologists, and sometimes by pediatric surgeons as urgent abdominal operations. Open or minimally invasive approaches were used, depending on the medical indications, surgeon's experience, and the circumstances related to the organization of work in the COVID-19 period. Results and Discussion: All data of the main outcome measures are shown in Table 1. In the COVID-19 period, the time from the onset of symptoms to diagnosis is statistically significantly longer than in the non-COVID-19 period (t=2,151;p=0,034). In the COVID-19 period, there were statistically significantly fewer adnexal masses surgery than in non-COVID-19 period (chi2=8,892;p=0,003). There was also decrease in number of surgically treated patients with twisted adnexal masses, but without statistical significance. Ovarian preservations in benign adnexal processes were statistically more frequent in the non-COVID-19 period (chi2=6,575;p=0,01). There was increase in percentage of adnexectomies in the COVID-19 period. During the COVID-19 period, the number of laparoscopic procedures decreased significantly, which could be associated with the technical issues and deficit in medical staff during that period (chi2=50,915;p < 0,001). Conclusion(s): Advice on reducing non-necessary visits to the doctor given to patients during the COVID-19 pandemic led to a decrease in number of surgical procedures for adnexal masses in girls and adolescents. This also caused prolonged time to diagnosis, but did not affect the interval from the symptoms onset to operation. Reduction of number of laparoscopic procedures and ovarian preservation in benign adnexal diseases indicates a decline in the quality of health care during COVID-19 pandemic. [Formula presented]Copyright © 2023

The importance of vaginoscopy in premenarchal girls with vaginal bleeding- call for more PAG practioners

Introduction: Prepubertal vaginal bleeding outside the neonatal period is always abnormal and is very alarming to both parents and physicians. The variable etiologies of vulvovaginitis are the most common causes of vaginal bleeding during the prepubertal period. We report a series of three cases observed during covid" period of 2020-2022. Case report: two patients 8 and 9 year -old girls, were refered to pediatric secondary center due to of external vaginal bleeding. Hormonal levels were pre-pubertal and bone age was not advanced. Both girls were hospitalized and sellar X-ray and pelvic MRI were done during further course, not revealing the etiology of bleeding. Six months after the first bleeding, they were reffered to a pediatric gynecologist where foreign bodies (grass seed) were found during vaginoscopy. Third patient, a 3-year- old girl, was examined by her pediatrician because of heavy bleeding. Hormonal analysis and bone age were not suggestive of precocious puberty. Additional analyses revealed elevated alpha fetoprotein level (>5000 IJ,), which led to the diagnosis of yolk sac tumor in vagina wall, which was then confirmed by vagionoscopy and biopsy. It is important to perform vaginoscopy in premenarchal girls with repeated vaginal bleeding because in patients older than five years, a common reason for vaginal bleeding is foreign body but in younger patients, the primary goal is to exclude a malignant tumor.Copyright © 2023

Introducing the speech therapist in the Neonatology Unit: an innovative way to support breastfeeding in healthy newborns even during COVID-19 pandemic

Objective. The aim of the study was to intercept early problems and difficulties in onset and stabilization phases of breastfeeding, in a population of healthy full-term newborns - during the COVID-19 pandemic - through a Clinical Governance Project, supported by the Department of Neonatology and Pediatrics, which introduced a speech therapist, as part of the professional team acting synergistically with neonatologists, pediatricians, pediatric nurses, midwives and gynecologists. Materials and Methods. Over a period of two months (2020), n = 72 newborns, 38 males and 34 females, were recruited (mean age:1.3 days) in the Departments of Neonatology and Obstetrics and Gynecology of Castelli Hospital, ASLRM6. Lingual frenulum neonatal screening (Martinelli, 2015) was administered to all the newborns and the frenulum was classified as normal, doubtful or impaired. Breastfeeding difficulties were evaluated and speech therapist counseling was performed, to support early onset and stabilization of breastfeeding. Results. Lingual frenulum screening resulted normal in 36 (50%), doubtful in 20 (28%) and impaired in 16 (22%) of total newborns. An alteration of both lingual and upper labial frenulum was found in 16 (22%) of the newborns studied. n = 23 newborns (32%) showed alterations able to hinder breastfeeding: these cases were successfully managed by helping the mothers to change the breastfeeding position, adopting a rugby hold position. Conclusions. According to our preliminary results, speech therapist counselling, in the critical COVID-19 pandemic, allowed early detection of lingual frenulum alterations, and their impact on the onset of breastfeeding. We found that altered lingual frenulum was associated with breastfeeding difficulties: in these patients, speech therapist intervention resulted useful in managing early breastfeeding problems.

The Effect of COVID-19 on the Human Reproductive System: A Review Study

Background: Evidence reveals that COVID-19, in addition to impacting the respiratory system, affects other organs, including the male and female reproductive systems. The purpose of this study was to examine the impact of COVID-19 on the human reproductive system. Method(s): Data were collected in SID, Science Direct, PubMed, and Google Scholar databases. The Keywords including COVID- 19, reproductive system, fertility, and factors related to mesh term utilization and Boolean strategy were used. Papers from 2019 to 2022 were extracted. Finally, out of 58 searched articles, 20 articles related to the purpose of the study were reviewed. Result(s): The results were organized into two categories. The first category deals with the effect of COVID-19 on the female reproductive system including Sleep disorders following quarantine on gonadotropin release and its effect on the ovaries and menstrual cycle, preterm delivery, increased cesarean delivery, the possibility of intrauterine infection of the fetus and dysfunction of the reproductive glands. The second category concerns the effect of COVID-19 on the male reproductive system including abnormal semen quality, possible effect on gonocyte differentiation in the early stages of spermatogenesis, negative effect on spermatogenesis, testicular dysfunction, and changes in testosterone concentration by increasing serum LH, testicular inflammation, decreased sperm concentration in semen, impaired sperm motility, dysfunction of the reproductive glands, significant damage to the seminiferous tube, swelling of Sertoli cells, decreased Leydig cells, significant disorder on semen volume and impaired sperm morphology. Conclusion(s): The findings revealed that COVID-19 has an impact on various aspects of the human reproductive system. Midwives and gynecologists should alleviate couples' fears about infertility by recognizing these cases and offering suitable counseling to couples infected with COVID-19.

Intrauterine device practices amongst adolescent patients

Background: Adolescent pregnancy is a worldwide public health issue, and the intrauterine device (IUD) has been shown to be a safe and highly effective method of long-acting reversible contraception (LARC) in this group. Patient concerns regarding IUDs are common, which should be addressed during routine office visits. Recently, both Pediatric and Gynecologic societies have recommended the IUD as a first line contraceptive for adolescents given their safety and efficacy. We are hoping to understand current IUD practices amongst providers, elucidate barriers to IUD insertion, and explore whether there have been any changes in IUD insertion patterns since the advent of the COVID-19 pandemic, which has increased telehealth and reduced operating room (OR) availability. Method(s): Survey was disseminated to NASPAG (North American Society for Pediatric and Adolescent Gynecologists) members via the listserv on two separate occasions. Consent was obtained upon completion of the survey. Results from the survey are anonymous. Results were tabulated with descriptive statistics. Ethics approval was obtained (REB22-0269). Result(s): There were 55 respondents, with the majority being Pediatric and Adolescent Gynecologists (71%) from North America (93%). As per providers, adolescents most frequently seek out the IUD for contraception (45%) and menstrual management (42%). Providers felt that the most common barrier to the IUD was misconceptions/myths (67%), as well as pain with insertion (64%). Most practitioners had no change in their IUD prescribing patterns since the start of the pandemic (62%), while some performed more office insertions (11%) and some reduced their IUD practice because of less operative time (15%) and less in-person appointments. Although many physicians perform office insertions, many found that a Procedural Sedation Center facilitated wait times (38%) or felt that such a center would be helpful (33%). Cases being done in the OR were often patients with disabilities/developmental delay (95%) or anxiety (75%). Conclusion(s): Our survey demonstrated that there are still some misconceptions surrounding the IUD. Education on contraception, specifically LARCs, is pivotal in decreasing adolescent pregnancy rates, reducing barriers to IUD use, and improving the attitude of adolescents toward the IUD. Pain with insertion is another limiting factor and a Procedural Sedation Center may be helpful in managing pain expectations and increasing acceptance of the IUD. Although there was no significant change in IUD practices during COVID, a decrease in operating room availability and increase in telehealth may impede IUD prescribing, especially in patients with developmental delay or disabilities who may require insertion in the OR.Copyright © 2023

Epidemiological Situation of Syphilis and Gonorrhea in Uzbekistan during the Covid-19 Pandemic

The research describes the epidemiological situation in Uzbekistan for sexually transmitted diseases (syphilis, gonorrhea) during the Covid-19 pandemic (2019-2021).Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.

Vaccination coverage during pregnancy and factors associated with refusal

Objective. The vaccines currently recommended during pregnancy are the dTpa, the influenza vaccine, and, due to SARSCoV- 2 pandemic, the mRNA vaccine against COVID-19. The aim of this study was to evaluate vaccination coverage among pregnant women and factors associated with refusal. Materials and Methods. 307 patients who delivered at term between March and April 2022 at Careggi Hospital answered a questionnaire about vaccines during pregnancy. The primary aim was to assess vaccination coverage and factors associated with refusal. The secondary aim was to detect differences in vaccination between Italian and foreign women. Results. Overall, 74% of patients were vaccinated with dTpa, 82% against COVID-19 and only 33% against Influenza. Vaccination coverage for dTpa and COVID-19 was significantly higher among Italian than foreign patients (80% vs 51%, p < 0.001 and 86% vs 69%, p = 0.002, respectively). 89% of patients received recommendations for vaccines from the gynecologist, more frequently among Italians than foreigners (p = 0.01). The main reasons behind refusal of vaccinations were: reduced perception of the risk of disease in the case of influenza (41%), inadequate information received from the gynecologist regarding dTpa (35%), fear of side effects (63%) and of effects on the fetus (70%) from the COVID-19 vaccine. Conclusions. Adherence to the Influenza vaccine was low because of reduced perception of the disease risks. Fear of COVID-19 disease led most of the patients to receive the vaccination. The significant difference in vaccination coverage between Italians and foreigners is likely due to less information being received by foreign patients, an example of health care disparity.

Factors Associated with Anti-SARS-CoV-2 Vaccine Acceptance among Pregnant Women: Data from Outpatient Women Experiencing High-Risk Pregnancy.

Pregnant women are at higher risk of severe Coronavirus disease 2019 (COVID-19) complications than non-pregnant women. The initial exclusion of pregnant women from anti-SARS-CoV-2 vaccines clinical trials has caused a lack of conclusive data about safety and efficacy for this vulnerable population. This cross-sectional study aims to define the factors related to vaccination adherence in a sample of women experiencing high-risk pregnancies. The recruited women completed a questionnaire based on the Health Belief Model. Data were analyzed to evaluate the associations between socio-demographic variables and vaccination acceptance through descriptive, univariate and multivariate logistic analyses. Among the 233 women enrolled, 65.2% (n = 152) declared that they would accept the anti-SARS-CoV-2 vaccine. Multivariate analysis showed that vaccination acceptance was associated with a high educational level (aOR = 4.52, p = 0.001), a low perception of barriers to vaccination (aOR = 1.58, p = 0.005) and the gynecologist's advice (aOR = 3.18, p = 0.01). About a third of pregnant women are still hesitant about the anti-SARS-CoV-2 vaccine, probably because of the conflicting information received from media, friends, acquaintances and health institutions. Determining factors linked to vaccine hesitancy among pregnant women is useful for creating vaccination strategies that increase vaccination uptake.

COVID-19 and the Pakhtun pregnant women

Purpose: This exploratory study aims to explore the Pakhtun pregnant women's experiences/issues during the COVID-19 pandemic. Design/methodology/approach: This research is based on interviews. Findings: This research found that plummeting medical services pose not only serious health risks to the Pakhtun women in Khyber Pakhtunkhwa (KP) but expose them to social and cultural challenges resulting in severe mental health issues. This study also found that the policies adopted by the Government of Pakistan for tackling COVID-19 completely threw off track basic health services that both men and women require in times of health emergencies. Originality/value: This paper is 100% original research based on an exploratory study. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Evaluating Changes in the Diagnostic Setting and Treatment of Bacterial Sexually Transmitted Infections in Germany During COVID-19: A Descriptive Analysis of German Claims Data From 2018-2021

Objectives: This study compared the diagnostic setting and treatment of new cases of bacterial sexually transmitted infections (STIs) in Germany from 2018-2020. Method(s): This study utilized German claims data (AOK PLUS) from 01/01/2017-30/06/2021. We included continuously insured adult patients with an inpatient/outpatient chlamydia (ICD-10 A55/A56), gonorrhea (A54), or syphilis (A51/A53) diagnosis from 01/01/2018-31/12/2020. To account for potential re-infection, a 180-day window was used to detect new cases. Diagnostic setting was observed at index and a 6-month follow-up period was used to assess outpatient treatment with prescribed therapies. Result(s): Overall, 8,913 individuals (cases: 10,032, female: 60.3%, mean age: 32.1 years) were included. Most chlamydia (97.4%), gonorrhea (96.3%), and syphilis (96.9%) cases were diagnosed in the outpatient setting. Among STI cases recorded in the outpatient setting (96.9%), the most common diagnosing physicians were gynecologists (54.5%), general practitioners (20.8%), and urologists (11.5%). No changes in relation to diagnosing physician were observed between pre-COVID and COVID-periods. From 2018-2020, the share of syphilis and gonorrhea cases diagnosed in inpatient vs. outpatient settings varied;no difference between pre-COVID and COVID periods was detected. Despite the overall low number of inpatient chlamydia diagnoses, the proportion of new cases reported in hospitals decreased after the pandemic onset (median/range: 1.8%/1.3-2.0% vs. 2.6%/2.1-3.9% during pre-COVID). Syphilis had the lowest treatment rate at 42.2% (penicillin: 27.9%, doxycycline: 13.1%, tetracycline: 0.0%), followed by gonorrhea with 54.9% (ceftriaxone: 16.2%, azithromycin: 39.6%), and chlamydia with 60.5% (doxycycline: 41.0%, azithromycin: 22.8%, levofloxacin: 1.1%). No longitudinal changes in relation to treatment were observed. Conclusion(s): Generally, diagnosis of bacterial STIs is uncommon in the hospital. Nevertheless, the share of chlamydia cases diagnosed in the inpatient setting decreased during COVID, possibly in relation to healthcare resource capacity constraints. Further research is needed to explore potential reasons for this trend and the substantial proportion of patients without treatment. Copyright © 2022

Using QR Codes as a Form of eHealth to Promote Health Among Women in a Pandemic: Cross-sectional Study.

BACKGROUND: QR codes have played an integral role during the pandemic in many sectors, but their use has been limited in the health care sector, especially by patients. Although some authors have stated that developing specific content for women on how to cope with health problems could be an effective way to prevent problems, especially during pandemics, there is little research regarding the use of QR codes to promote health during a pandemic, and even fewer studies are focused on women. Moreover, although the importance of assessing these interventions from the users' perspective has been stated, research carried out from this point of view is still scarce. OBJECTIVE: This study aimed to assess the usefulness of using QR codes with information to promote women's health in the context of a pandemic. We also sought to design and validate a questionnaire to assess this. METHODS: A cross-sectional study was conducted among women in the gynecology waiting rooms of a reference hospital. Exploratory factorial analysis with the split-half method and Cronbach α values was performed for questionnaire validation. Univariant and bivariant analyses were performed to analyze the data obtained. RESULTS: In total, 186 women took part in the study. Exploratory factor analysis identified 2 domains: usability and applicability in medical practice. The Cronbach α value was .81. Overall, 83.7% of the answers to the first domain and 56.4% of those to the second were favorable. Women with university education or those who had used QR codes before scored better in the usability domain, while no differences were observed in the applicability scores. CONCLUSIONS: Using QR codes in the gynecology clinics' waiting rooms can help promote women's health during a pandemic, regardless of their education level or whether they have used QR codes before. The questionnaire developed herein is a helpful tool to assess this. These findings are important for clinical practice. This research can be performed in other ambits, specialties, or countries.

2022 Adult Immunization Schedule Updates

Each year, the U.S. Centers for Disease Control and Prevention (CDC) releases the adult vaccine schedule. The 2022 adult vaccine schedule has several changes which will be discussed in the following manuscript. The Advisory Committee on Immunization Practices reviews the preliminary schedules usually at their October or November meetings. The following professional societies also approve the adult schedules prior to the 2022 publications: American College of Physicians (ACP), American Academy of Family Physicians (AAFP), American College of Obstetricians and Gynecologists (ACOG), American College of Nurse-Midwives (ACNM), American Academy of Physician Assistants (AAPA) and the Society for Healthcare Epidemiology of America (SHEA). Once the final draft is approved by the CDC, it is published in the Morbidity and Mortality Weekly Report (MMWR) and released to healthcare providers and the general public with a cover page, tables, notes and—new for the 2022 schedule—an appendix with contraindications and precautions for the different approved vaccines.

Serum Antibodies SARS-CoV-2 Spike (S) Protein Receptor-Binding Domain in OBGYN Residents and Effectiveness 3 Months after COVID-19 Vaccination

BACKGROUND: The health care workers are considered as vulnerable people who had higher infecting dose of SARS-CoV-2 infection compared to other society. Among more than 500 deaths of Indonesians physicians, obstetrics and gynecologist (OBGYN) has become the most specialists who died in this pandemic. AIM: The objective of our study is to evaluate the antibodies of SARS-CoV-2 in serum OBGYN residents post-vaccination as well as the presence of infection 3 months after the vaccination. METHODS: A prospective cohort study was conducted in OBGYN residents Universitas Indonesia. Serum antibodies SARS-CoV-2 spike (S) protein receptor-binding domain (RBD) was measured using electrochemiluminescence immunoassay, 21 days after Sinovac vaccination, with basic characteristics being recorded. Within 3 months follow-up, the participants were monthly checked related to post-vaccination infection. RESULTS: The median antibodies SARS-CoV-2 for all participants were 50.72 (19.09–98.57) U/mL. There were 20 residents (24.1%) who had post-vaccination infection within 3 months and dominated by asymptomatic to mild symptoms. Body mass index (r = –0.221, p = 0.044) and sleep hours (r = –0.225, p = 0.041) were found to be inversely correlated with antibodies SARS-CoV-2 S RBD. CONCLUSION: Antibodies SARS-CoV-2 S RBD found to be correlated with BMI and sleep hours. The 3-month post-vaccine infection among OBGYN residents was almost similar to Jakarta’s positivity rate and the efficacy rate was higher than expected by National Agency of Drug and Food Control.

Characterization of remote second-opinion oncology patients and associated changes in management

Background: The utilization of virtual second opinions in oncology has increased considerably in the last decade, driven by the increased complexity of care and desire for expert opinion, improved technologies in telemedicine, and the acceleration of virtual services due to the Covid-19 pandemic. Therefore, it is important to further understand the patient populations that currently use virtual second opinion programs and to measure their effectiveness. Virtual second opinion programs provide a platform for patients to submit their medical history and questions regarding their condition to remote specialists who then render their opinions on diagnosis and management. Currently there is a paucity of research on the types of patient populations that seek second opinions and the outcomes of these rendered opinions. Here we describe the patient characteristics and changes in management associated with utilization of a virtual second opinion service at an academic medical center. Methods: In this IRB-approved retrospective review, we identified 657 cancer patients that utilized a virtual digital health platform to engage in second opinions at Stanford Healthcare. Patient demographics, cancer staging, site of origin, and prior therapeutic and surgical history were collected. Physician opinions rendered were self-classified into “major change in treatment”, “minor change in treatment”, or “no change in treatment.”. Results: The majority of patients who utilized the virtual second-opinion platform had a diagnosis late-stage cancer (with 77.2% at Stage III or IV). Breast cancer was the most common primary tumor site (24.7% of patients) followed by GI (21.9%) and GU malignancies (14.0%). Patients diagnosed with dermatological (4.4%), head and neck (3.3%), and neurological (3.2%) malignancies were least common. Physicians providing the virtual second-opinion were primarily medical oncologists (67.6%), followed by gynecologists (6.8%), urologists (5.2%), radiation oncologists (5.0%), and surgical oncologists (4.4%). Physicians self-reported that in more than half of cases reviewed (53.8%) a minor or major treatment change was recommended. Conclusions: This study showed that patients access second opinion platforms at late stage of cancer disease progression. With treatment changes recommended for more than half of the cases, virtual second opinion programs can potentially have a significant impact on cancer care. Patient satisfaction and clinical outcomes from virtual second opinion programs is an area of on-going research.