Vaginal bleeding in children: A retrospective audit at a tertiary paediatric gynaecology service

Aim: The aim of this study was to describe the clinical features and investigations of vaginal bleeding in prepubertal children. Methods: We performed a retrospective case series of children under the age of 10 who presented with vaginal bleeding to our institution between 2018 and 2019. Results: There were 32 cases identified during the timeframe, with a mean age of 5.5 years (standard deviation 3.2 years, range 5.5 days to 9.6 years). Vulvovaginitis was the most common diagnosis (n = 12, 37.5%), followed by precocious puberty (n = 5, 15.6%). Uncommon but serious causes were vaginal rhabdomyosarcoma (n = 1), and sexual abuse (one patient presenting with gonorrhoea and one with a non-accidental injury). Vaginoscopy was performed in nine patients (28.1%) for various reasons, and a vaginal foreign body was identified in two patients (6.3%). All the patients who had a serious cause of bleeding (neoplasm or sexual assault) or who required specific treatment (precocious puberty, lichen sclerosus, urethral prolapse) presented with red flags on history and/or examination: recurrent episodes of vaginal bleeding, heavy bleeding, associated general symptoms (poor feeding and growth), presence of thelarche, abdominal mass, associated profuse vaginal discharge and abnormal genital examination (skin changes, urethral prolapse or protruding mass from the vagina). Conclusions: A thorough history-taking and clinical examination aiming at identifying red flags may help to discriminate between benign causes of vaginal bleeding, where no further investigations are indicated, and alternative diagnoses with a poor outcome and/or requiring specific treatment and additional investigations

Emerging strategies for the transdermal delivery of peptide and protein drugs

Transdermal delivery has been at the forefront of research addressing the development of non-invasive methods for the systemic administration of peptide and protein therapeutics generated by the biotechnology revolution. Numerous approaches have been suggested for overcoming the skin's formidable barrier function; whereas certain strategies simply act on the drug formulation or transiently increase the skin permeability, others are designed to bypass or even remove the outermost skin layer. This article reviews the technologies currently under investigation, ranging from those in their early-stage of development, such as laser-assisted delivery to others, where feasibility has already been demonstrated, such as microneedle systems, and finally more mature techniques that have already led to commercialisation (e.g., velocity-based technologies). The principles, mechanisms involved, potential applications, limitations and safety considerations are discussed for each approach, and the most advanced devices in each field are described

Inquiry-Based Chemistry Education in a High-Context Culture: a Qatari Case Study

This research took place within the context of ongoing educational reforms to promote inquiry-based science instruction and a desire to draw evidence to inform adoptions of western pedagogical practices in a high-context culture like Qatar. We report on the outcomes from Process Oriented Guided Inquiry Learning (POGIL) in a foundation chemistry course based on students’ achievement, their perceived learning gains, and their self-efficacy. The study utilized quantitative data obtained from normalized content tests and instruments to measure perceived learning gains and attitudes and experience. Qualitative data from open-ended student questionnaires were analyzed to cross-validate findings from the study. Positive effects of POGIL during fall (semester 1) and spring (semester 2) semesters were evidenced by (a) improved mean scores and medium to large effect sizes for content test results, perceived learning gains, and self-efficacy levels and (b) a positive correlation between the measures of perceived learning gains and self-efficacy. Students self-reported increased self-efficacy, interest, and better understanding of concepts using the POGIL method. Comparing fall and spring semesters, student reluctance and negative perceptions of the POGIL approach gradually diminished. Students were able to adapt easily to POGIL—a method of teaching that they had not experienced before but which was compatible with the high-context culture in which they live. In addition, this study reflects the current condition of science learning in Qatar, where the emerging outcomes of educational reforms play an important role in preparing local students to transition into higher education