Re-initiation of CT colonography services during the COVID-19 pandemic: Preliminary evaluation of safety.

OBJECTIVE: The COVID-19 pandemic has led to cancellation and deferral of many cancer investigations, including CT colonography (CTC). In May 2020, BSGAR and SCoR issued guidelines outlining steps for conduct of CTC in the early recovery phase. We evaluated the implementation of these in four English hospital trusts. METHODS: Ethical permission was not required for this multicentre service evaluation. We identified patients undergoing CTC over a 2-month period from May to July 2020 at four Trusts. We recorded demographics, scan indications, colonic findings, and incidental lung base changes compatible with COVID-19. A subset of patients were contacted via telephone to document new symptoms 2 weeks following their scan. Staff were contacted to determine if any acquired COVID-19 during the period. RESULTS: 224 patients (118 male, 52.7%) were scanned during the period. In 55 patients (24.6%), CTC showed a ≥6 mm polyp. 33 of 224 (14.7%) scans showed incidental lung base changes felt unrelated to COVID-19, and only one patient had changes indeterminate for COVID-19; no classic COVID-19 pulmonary changes were found. Of 169 patients with telephone follow-up, none reported any new symptoms of COVID-19 (cough, fever, anosmia, ageusia) within 14 days of CTC. None of the 86 staff contacted developed COVID-19. CONCLUSION: We found no cases of patients or staff acquiring COVID-19 infection following CTC; and no evidence of significant asymptomatic COVID-19 patients attending for CTC appointments based on lung base changes. ADVANCES IN KNOWLEDGE: Our findings suggest that current practice is unlikely to contribute significantly to spread of SARS-nCOV2. Cancer and significant polyp detection rates were high, underlining the importance of maintaining service provision.

Renal arteriovenous malformation mimicking hydronephrosis-hidden danger.

Renal arteriovenous malformations (AVMs) are rare, with an incidence of approximately 0.04%. Diagnosis is often challenging due to mimics of AVMs. We report a case of renal AVM mimicking hydronephrosis on ultrasound and unenhanced computed tomography (CT). A 24-year-old female with background of recurrent urinary tract infections (UTIs) presented to the Accident and Emergency department with 1 day history of bilateral flank pain, dysuria, rigors and pyrexia. Urine dipstick showed microscopic haematuria and blood tests showed mild neutrophilia. Dilated right renal pelvis was seen on ultrasound. Unenhanced CT of the urinary tract demonstrated right hydronephrosis with no evidence of calculi. Subsequent Uro-radiology meeting discussion concluded that renal pelvis might be pus-filled and recommended an urgent nephrostomy. However, ultrasound Doppler scan performed at the time of the planned nephrostomy demonstrated colour flow within dilated renal pelvis suggestive of an AVM. Nephrostomy was abandoned and subsequent CT angiogram confirmed a large congenital AVM. The patient was referred for embolization.Colour flow ultrasound imaging is a simple and quick technique to diagnose AVMs. However, as in our case, when colour flow Doppler imaging was not used at the initial ultrasound, the opportunity to obtain an accurate diagnosis was missed. If the subsequently planned nephrostomy had taken place, this may have led to potentially serious outcomes. We suggest that colour flow imaging should be used prior to nephrostomy insertion to differentiate hydronephrosis from vascular abnormalities.

Systematic review of infant and young child complementary feeding practices in South Asian families: the Pakistan perspective.

OBJECTIVE: Suboptimal nutrition among children remains a problem among South Asian (SA) families. Appropriate complementary feeding (CF) practices can greatly reduce this risk. Thus, we undertook a systematic review of studies assessing CF (timing, dietary diversity, meal frequency and influencing factors) in children aged <2 years in Pakistan. DESIGN: Searches between January 2000 and June 2016 in MEDLINE, EMBASE, Global Health, Web of Science, OVID Maternity & Infant Care, CINAHL, Cochrane Library, BanglaJOL, POPLINE and WHO Global Health Library. Eligibility criteria: primary research on CF practices in SA children aged 0-2 years and/or their families. Search terms: 'children', 'feeding' and 'Asians' with their derivatives. Two researchers undertook study selection, data extraction and quality appraisal (EPPI-Centre Weight of Evidence). RESULTS: From 45 712 results, seventeen studies were included. Despite adopting the WHO Infant and Young Child Feeding guidelines, suboptimal CF was found in all studies. Nine of fifteen studies assessing timing recorded CF introduced between 6 and 9 months. Five of nine observed dietary diversity across four of seven food groups; and two of four, minimum meal frequency in over 50 % of participants. Influencing factors included lack of CF knowledge, low maternal education, socio-economic status and cultural beliefs. CONCLUSIONS: This is the first systematic review to evaluate CF practices in Pakistan. Campaigns to change health and nutrition behaviour are needed to meet the substantial unmet needs of these children.

A systematic review of complementary feeding practices in South Asian infants and young children: the Bangladesh perspective.

BACKGROUND: Sub-optimal nutrition among children remains a problem across South Asia (SA). Appropriate complementary feeding practices (CFP) can greatly reduce this risk. The primary objective of this systematic review (SR) of CF studies was to assess timing, dietary diversity, meal frequency and influencing factors in children under two in Bangladesh. METHODS: Searches included English-language research published between January 2000 and June 2016 within MEDLINE, EMBASE, Global Health, Web of Science, OVID Maternity & Infant Care, BanglaJOL, Cochrane Library, CINAHL, POPLINE and WHO Global Health Library. Eligibility criteria: primary research concerning the adequacy of complementary feeding practices in South Asian children aged 0-2 years and/or their families. We excluded interventional papers and those focusing exclusively on breast-feeding. In total 45,712 titles and abstracts were screened against inclusion criteria, 860 of which received independent full text review by two reviewers. 36 papers relevant to Bangladesh were identified. The 'EPPI-Centre Weight of Evidence Framework' was used to objectively assess each study's value in answering the review question. As per WHO Infant and Young Children Feeding Guidelines (IYCF), introduction of CF was assessed as the proportion of infants aged 6-8 months who received solid, semi-solid or soft foods. Search terms were: "children", "feeding" and "Asians" with their derivatives. Two researchers undertook study selection, data extraction and quality appraisal. RESULTS: Three cohort, 30 cross-sectional and 3 mixed methods studies were included. Despite adopting the WHO IYCF Guidelines, sub-optimal CF practices were found in many studies. Timely initiation of CF practices ranged from 24 to 83%. Achieved minimum dietary diversity ranged from 25% to 44% and minimum meal frequency from 33% to 81%. Influencing factors included maternal education, poor knowledge of CF practices and socioeconomic variables. CONCLUSIONS: This is the first systematic review to evaluate CF practices in Bangladesh. Despite adoption of the WHO IYCF guidelines, inadequate CFP remain in communities across Bangladesh. TRIAL REGISTRATION: PROSPERO Registration No: CRD42014014025.