Conundrum in primary care: should all cervical polyps be removed?

BACKGROUND: The management of asymptomatic cervical polyps has long been debated due to the scarcity of literature and guidelines regarding the need for polypectomy. While the majority of cervical polyps are diagnosed incidentally by GPs during routine cervical smears, there are no clear recommendations on referral pathways for further histological investigations. AIM: To investigate the need for polypectomy in women presenting with asymptomatic polyps. In addition, the study explores potential suggestions and guidelines for the referral of asymptomatic cervical polyps in general practice. METHOD: A retrospective study on the histological findings of extracted cervical polyps examined by the pathology department at the Countess of Chester Hospital (COCH) over 9 years (2010- 2019). RESULTS: Of the 514 patients presented with cervical polyps (74% were asymptomatic), approximately 97% of the referrals made were by GPs. Additionally, we identified 74 inappropriate referrals through the 2-week wait cancer pathway. Overall, there were no malignant samples and five (0.97%) premalignant lesions were presented. CONCLUSION: This study supported the evidence that most cervical polyps are benign. However, inappropriate referrals prompt more education on cervical pathologies. Furthermore, there is a need for robust guidelines on the management of asymptomatic cervical polyps in general practice. To lessen the financial burden of managing cervical polyps in a secondary care setting, workshops on polyp removal can be developed for GPs.

Incidence Rates of Penn Classes and Class-Specific Mortality in Acute Type A Aortic Dissection Patients: An Epidemiologic Systematic Review and Meta-Analysis.

Acute type A aortic dissection (ATAAD) is a life-threatening emergency that is associated with a high morbidity and mortality rate. One of the complications is end-organ ischemia, a known predictor of mortality. The primary aims of this meta-analysis were to summarize the findings of observational studies investigating the utility of the Penn classification system and to analyze the incidence rates and mortality patterns within each class. The electronic databases PubMed, MEDLINE, and Embase were searched through to April 2023. These were filtered by multiple reviewers to give 10 studies that met the inclusion criteria. The extracted data included patient characteristics, and primary outcomes were the incidence rates of different Penn classes, along with the corresponding mortality for each class. Out of 1,512 studies identified during the initial search, 10 studies, including 4,494 patients, met the inclusion criteria. The pooled incidence of Penn A was highest at 0.55 (95% CI 0.52, 0.58), followed by Penn B at 0.21 (95% CI 0.17, 0.25), and finally Penn C at 0.14 (95% CI 0.11, 0.17). Patients with Penn BC were found to be at the highest risk of death, as their early mortality rates were 0.36 (95% CI 0.31, 0.41). Within those populations, the subtype with the highest individual mortality was Penn C at 0.21 (95% CI 0.15, 0.27), followed by Penn B at 0.19 (95% CI 0.15, 0.23) and Penn A at 0.07 (95% CI 0.05, 0.10). Among patients presenting with ATAAD, class A was most frequently observed, followed by classes B, C, and BC. These findings indicate an incremental increase in mortality rates with the progression of Penn classification.