Evolving trends in the management of pelvic inflammatory disease (PID) during SARS-CoV-2 pandemic: A multicenter retrospective cohort study.

BACKGROUND AND AIM: Pelvic inflammatory disease (PID) is usually managed by conservative treatment, but in selected cases, especially in the presence of a tubo-ovarian abscess (TOA), surgical management is a recognized treatment option. We compared the trends in managing PID and short-term outcomes before and during the SARS-CoV-2 pandemic. METHODS: This is a retrospective study performed in three Italian gynecological centers. We included patients admitted to hospital with a diagnosis of PID. Demographic characteristics, management, time to diagnosis, and time to treatment were compared before versus during the SARS-CoV-2 pandemic. RESULTS: One hundred nineteen PID patients were screened, eighty-one before the SARS-CoV-2 pandemic, and thirty-eight after the onset. At admission, leukocytosis (median 19.73 vs. 13.99 WBC/mm3, p-value = 0.02) was significantly higher in patients who underwent surgery after the onset of the pandemic. TOA incidence was higher in patients who underwent surgery during the SARS-CoV-2 pandemic, but the difference did not reach statistically significance (p = 0.06). The proportion of patients treated with surgery dropped to 26.3% after the onset from 46% of patients before the onset of pandemic (p = 0.03). Furthermore, a higher percentage of emergency surgical procedures on day 0 of hospital admission were performed after the onset of the pandemic (50% vs. 13.1%, p = 0.01). CONCLUSIONS: In this retrospective cohort study, we found that the SARS-CoV-2 pandemic influenced the clinical presentation and management of PID in favor of conservative treatment. Patients who underwent surgery during the SARS-CoV-2 pandemic had higher inflammatory markers.

[The use of a questionnaire to test the reliability of protocols for the indication of radiologic tests in emergencies]. / Impiego di un questionario a verifica dell'affidabilità dei protocolli di indicazione agli esami radiologici nelle urgenze.

The authors developed a series of protocols for selecting patients who need emergency radiography, based on clinical criteria that maximize the yield of abnormal radiographs. In order to test safety and reliability of the protocols and to define the reasons for requesting emergency radiographs, a prospective analysis was carried out, by means of a questionnaire, on 1000 consecutive patients referred to our Accident and Emergency Department for radiography. Seven hundred and twenty-nine patients were considered as negative according to protocol criteria: none of them was found positive on X-ray examination. Of them, 639 exams were requested for medico-legal reasons and 90 for patient reassuring. Of 271 patients considered as true positive or probably positive according to the screening criteria, all the true positive cases were such also on X-ray examinations, whereas, among the probably positives, only 31 were confirmed as positive on radiological studies. Our results demonstrate the efficacy of the suggested protocols: had these referral criteria been used for the patients in our study, only 271 examinations would have been performed with no radiographic abnormalities missed. In addition, this grid included 94 cases evaluated as "probably" positive which were subsequently found negative at X-rays, which makes a further safety margin. Our analysis also shows the low therapeutic value of emergency radiographs in both nasal bone injury and post-traumatic oblique rib views. Therefore we suggest selecting patients who need X-rays based on the clinical criteria shown in our protocols: this could result in economic saving and decreased radiation exposure, with no risks of clinical underestimation of the pattern.

[Duplex and Doppler color echocardiography for the study of renovascular hypertension. Comparison with arteriography]. / Eco-duplex e color-Doppler nello studio dell'ipertensione reno-vascolare. Confronto con l'arteriografia.

Doppler US was employed to examine 46 patients with suspected renovascular hypertension (RVI) to detect stenosis/occlusion of the renal artery. In 25 cases duplex-Doppler technique was used, in 19 color-Doppler US, and 2 patients were examined with both methods. Doppler US was always performed before angiography which was considered as the reference gold standard. Using duplex-Doppler US, the diagnosis of renal artery stenosis was based on qualitative (spectral analysis of the waveform and absence of flow signal in cases of renal artery occlusion), and semiquantitative parameters (resistive index). Diagnostic accuracy of duplex US--which was compared with that of angiography--was 83%, its sensitivity was 91.6%, and specificity was 85%. With color-Doppler, two additional quantitative parameters were used (peak systolic frequency shift at the stenosis and stenosis index). In this group of patients sensitivity was 70%, specificity was 100%, and accuracy 85%. The good diagnostic yield of the method is counter-balanced by some limitations--e.g., operator dependence and long examination time (30-40 minutes, especially with duplex US). In the authors' opinion, Doppler technique can be used in the diagnosis of RVI, even though further study is necessary to exactly define diagnostic parameters, and to verify reproducibility and both inter- and intra-observer repeatibility. Technological progress may in the future reduce both difficulty and time of the examination.