Do vaginal pessaries used to treat pelvic organ prolapse impact on sexual function? A systematic review and meta-analysis.

INTRODUCTION AND HYPOTHESIS: Pelvic organ prolapse (POP) is common and associated with sexual dysfunction. Vaginal pessaries are an effective treatment for POP, but their impact on sexual function is not well established. The aim of this systematic review and meta-analysis was to establish the impact of vaginal pessaries used for POP on female sexual function. METHODS: Systematic review of the literature following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and checklist. A comprehensive search was conducted across Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database of Systematic Reviews, EMBASE, MEDLINE, CINAHL, ClinicalTrials.gov , The WHO International Clinical Trials Registry Platform, ProQuest Dissertations & Theses, Open Grey and Scopus Citation Database. Randomised controlled trials and cohort studies that assessed sexual function in women pre- and post-pessary treatment for POP were included, assessed for risk of bias and their results synthesised. RESULTS: A total of 1,945 titles and abstracts were screened, 104 full-text articles were assessed for eligibility, 14 studies were included in the narrative analysis and 7 studies were included in the meta-analysis. The results suggest that, in sexually active women, there is no evidence of a deterioration in sexual function and some evidence of an improvement. DISCUSSION: This review offers reassurance that in sexually active women who successfully use a pessary for treatment of their prolapse, there is no deterioration in sexual function. There is some evidence of an improvement in sexual function, but given the clinical heterogeneity in the studies included, caution should be taken in generalising these findings.

Retrospective single-centre descriptive study of the characteristics, management and outcomes of adult patients with suspected sepsis in the emergency department.

BACKGROUND: Guidelines for adults presenting to the emergency department (ED) with suspected sepsis recommend protocols and bundles that promote rapid and potentially intensive treatment, but give little consideration of how patient characteristics, such as age, functional status and comorbidities, might influence management. This study aimed to describe the characteristics, management and outcomes of adults attending the ED with suspected sepsis, and specifically describe the prevalence of comorbidities, functional impairment and escalations of care. METHODS: We undertook a single-centre retrospective observational study involving medical record review of a random sample of adults admitted to an ED between February 2018 and January 2019 with suspected sepsis. Descriptive statistics were used with 95% confidence intervals (CIs) for key proportions. RESULTS: We included 509 patients (median age 74 years), of whom 49.3% met the Sepsis-3 criteria. Less than half of the patients were living at home independently (42.5%) or could walk independently (41.5%), 19.3% were care home residents and 89.2% of patients had one or more comorbidity. 22% had a pre-existing do not attempt resuscitation order. 6.5% were referred to intensive care, and 34.3% of the 13.2% who died in-hospital had an escalation plan explicitly documented. CONCLUSION: Adults with suspected sepsis have substantial functional limitations, comorbidities and treatment directives that should be considered in guidelines, especially recommendations for escalation of care.

The Buccinator Mucomuscular Flap: An In-Depth Analysis and Evaluation of Its Role in the Management of Velopharyngeal Dysfunction.

BACKGROUND: A significant proportion of patients with cleft palate experience persisting velopharyngeal dysfunction (VPD) after primary surgery. Pharyngoplasty is the most common procedure to correct inadequate velopharyngeal closure. Although it is often effective, it poses a risk for postoperative airway obstruction. The mucomuscular buccinator flap is a more recent alternative: In the largest case series to date, we outline its use and evaluate its effectiveness in managing persistent VPD. METHODS: Over 9 years, 103 buccinator flap procedures were performed by the Cambridge group to improve velar function. Clinical records were retrospectively assessed: 60 patients were analyzed by two expert speech and language therapists external to the group using the Cleft Audit Protocol for Speech-Augmented. In a subset of patients, the buccinator flap was interpolated between the limbs of a large mucosal Z-plasty. Consensus listening was undertaken, and interrater reliability was calculated for 24.17% of the cohort. The remaining samples were assessed by a single listener following calibrated consensus listening. RESULTS: There was a significant reduction in VPD (P < .001). Preoperatively, 68.5% of patients demonstrated marked VPD, falling to 24.1% postoperatively. The buccinator procedure demonstrated significant improvement for three of four individual speech parameters: hypernasality, passive cleft speech characteristics, and audible nasal emission. Overall, 13.5% of patients required further corrective speech surgery. CONCLUSIONS: The buccinator mucomuscular flap reliably and effectively improves velar function in the management of VPD and has low complication rates. We therefore recommend the use of the buccinator flap in primary surgical management of persisting VPD.

Dissociable rate-dependent effects of oral methylphenidate on impulsivity and D2/3 receptor availability in the striatum.

We have previously shown that impulsivity in rats is linked to decreased dopamine D2/3 receptor availability in the ventral striatum. In the present study, we investigated, using longitudinal positron emission tomography (PET), the effects of orally administered methylphenidate (MPH), a first-line treatment for attention deficit hyperactivity disorder, on D2/3 receptor availability in the dorsal and ventral striatum and related these changes to impulsivity. Rats were screened for impulsive behavior on a five-choice serial reaction time task. After a baseline PET scan with the D2/3 ligand [(18)F]fallypride, rats received 6 mg/kg MPH, orally, twice each day for 28 d. Rats were then reassessed for impulsivity and underwent a second [(18)F]fallypride PET scan. Before MPH treatment, we found that D2/3 receptor availability was significantly decreased in the left but not the right ventral striatum of high-impulse (HI) rats compared with low-impulse (LI) rats. MPH treatment increased impulsivity in LI rats, and modulated impulsivity and D2/3 receptor availability in the dorsal and ventral striatum of HI rats through inverse relationships with baseline levels of impulsivity and D2/3 receptor availability, respectively. However, we found no relationship between the effects of MPH on impulsivity and D2/3 receptor availability in any of the striatal subregions investigated. These findings indicate that trait-like impulsivity is associated with decreased D2/3 receptor availability in the left ventral striatum, and that stimulant drugs modulate impulsivity and striatal D2/3 receptor availability through independent mechanisms.

Glandular odontogenic cyst of the mandible: from incidental radiographic discovery to prosthetic reconstruction.

A large multilocular radiolucent lesion involving the anterior mandible was noted incidentally in a 44-year-old woman who sought routine dental treatment. An incisional biopsy revealed that this lesion represented an uncommon developmental odontogenic cyst known as a glandular odontogenic cyst. The lesion was removed surgically, followed by reconstruction with a right anterior iliac crest bone graft. This article reviews the radiographic, clinical, and histopathologic appearance of this rare odontogenic cyst, as well as the surgical management and the patient's subsequent prosthetic rehabilitation.