Expectant Management of Miscarriage in View of NICE Guideline 154

Objective. To find out the success rate of conservative management of complete two weeks for miscarriage in view of NICE Guideline 154. Design. Prospective observational study. Setting. Early pregnancy assessment units of District General Hospital in the United Kingdom. Participants. Women of less than 14 weeks' gestation, with a diagnosis of miscarriage (missed miscarriage/anembryonic or incomplete miscarriage). Interventions. Expectant management for two weeks. Main Outcome Measure. (1) Efficacy of 2-week expectant management, that is, complete resolution of miscarriage based either on self-reporting of patient after passing products of conception at home between D0 and D14 of expectant management or confirmation on scan at D14, and (2) short-term complications needing strong analgesia, blood transfusion, and antibiotics. Results. Expectant management of miscarriage for 2 weeks from the day of diagnosis was successful in 58% (64 /111) and failed in 42% (47/111). Conclusions. Expectant management success rate is consistent with the results from the longitudinal studies and RCTs published in the past. It is a safe option as none of the patients on expectant/medical management needed strong analgesia/antibiotics or blood transfusion

Fertility Preservation for Cancer Patients: A Review

Infertility can arise as a consequence of treatment of oncological conditions. The parallel and continued improvement in both the management of oncology and fertility cases in recent times has brought to the fore-front the potential for fertility preservation in patients being treated for cancer. Oncologists must be aware of situations where their treatment will affect fertility in patients who are being treated for cancer and they must also be aware of the pathways available for procedures such as cryopreservation of gametes and/or embryos. Improved cancer care associated with increased cure rates and long term survival, coupled with advances in fertility treatment means that it is now imperative that fertility preservation is considered as part of the care offered to these patients. This can only be approached within a multidisciplinary setting. There are obvious challenges that still remain to be resolved, especially in the area of fertility preservation in prepubertal patients. These include ethical issues, such as valid consent and research in the area of tissue retrieval, cryopreservation, and transplantation

There may be a link between intrahepatic cholestasis of pregnancy and familial combined hyperlipidaemia: a case report

A 26-year-old gravida 3 para 1+1 was referred for antenatal care. In her last pregnancy she had a early spontaneous preterm delivery at 32 weeks and 2 days complicated by intra hepatic cholestasis of pregnancy. She had a strong family history of ischemic heart and combined hyperlipidaemia. In view of her past obstetric history a baseline liver function test and fasting bile acid assay was carried out. Upto 21 week her Bile acids were normal but at 22 weeks her fasting bile acid assay increased to the upper limit of normal (9 µmol/L)

Carbon Nanotubes

Carbon nanotubes (CNTs) are referred to as carbon nano-architecture allotropes, with wrapped graphene sheets forming a cylindrical structure. CNTs are either developed by metals or narrow-band semiconductors with rolling graphene sheets in various ways. Researchers have dedicated a great deal of attention to understanding the fascinating properties of CNTs over the years, and possess certain peculiar properties, such as a high degree of stiffness, a wide ratio of length to diameter, and remarkable toughness, and are employed in a number of applications. These properties can be enhanced by scheming the diameter, nature of walls, chirality, length of CNTs which is rolled up, and depending on the synthesis process. This chapter extensively covers the various properties of CNTs and how it influences to desired applications and also explains numerous methods of synthesis and processing of CNTs with advantages and some drawbacks

High Temperature Superconductors

One of the pioneers who introduced superconductivity of metal solids was Kamerlingh Onnes (1911). Researchers always struggled to make observations towards superconductivity at high temperatures for achieving goals of evaluating normal room temperature superconductors. The physical properties are based entirely on the behavior of conventional and metal superconductors as a result of high-temperature superconductors. Various synthetic approaches are employed to fabricate high-temperature superconductors, but solid-state thermochemical process which involves mixing, calcinating, and sintering is the easiest approach. Emerging novel high-temperature superconductors mainly engaged with technological applications such as power transmission, Bio-magnetism, and Tokamaks high magnetic field. Finally, in this chapter, we will discuss a brief outlook, future prospects, and finished with possible science fiction and some opportunities with high-temperature superconductors

Acute presentation of a heterotopic pregnancy following spontaneous conception: a case report

Spontaneous heterotopic pregnancy is a rare clinical condition in which intrauterine and extra uterine pregnancies occur at the same time. It can be a life threatening condition and can be easily missed with the diagnosis being overlooked. We present the case of a 40 year old patient who was treated for a heterotopic pregnancy. She had a transvaginal ultrasound because of a previous ectopic pregnancy and an intrauterine gestational sac was seen with false reassurances. The patient presented acutely with a ruptured tubal pregnancy and this was managed laparoscopically. The ectopic pregnancy was not suspected at her initial presentation. A high index of suspicion is needed in women with risk factors for an ectopic pregnancy and in low risk women who have free fluid with or without an adnexal mass with an intrauterine gestation

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Large expert-curated database for benchmarking document similarity detection in biomedical literature search

Document recommendation systems for locating relevant literature have mostly relied on methods developed a decade ago. This is largely due to the lack of a large offline gold-standard benchmark of relevant documents that cover a variety of research fields such that newly developed literature search techniques can be compared, improved and translated into practice. To overcome this bottleneck, we have established the RElevant LIterature SearcH consortium consisting of more than 1500 scientists from 84 countries, who have collectively annotated the relevance of over 180 000 PubMed-listed articles with regard to their respective seed (input) article/s. The majority of annotations were contributed by highly experienced, original authors of the seed articles. The collected data cover 76% of all unique PubMed Medical Subject Headings descriptors. No systematic biases were observed across different experience levels, research fields or time spent on annotations. More importantly, annotations of the same document pairs contributed by different scientists were highly concordant. We further show that the three representative baseline methods used to generate recommended articles for evaluation (Okapi Best Matching 25, Term Frequency-Inverse Document Frequency and PubMed Related Articles) had similar overall performances. Additionally, we found that these methods each tend to produce distinct collections of recommended articles, suggesting that a hybrid method may be required to completely capture all relevant articles. The established database server located at https://relishdb.ict.griffith.edu.au is freely available for the downloading of annotation data and the blind testing of new methods. We expect that this benchmark will be useful for stimulating the development of new powerful techniques for title and title/abstract-based search engines for relevant articles in biomedical research.Peer reviewe

Impact of climate change on human health in the coastal gulf region using data from global climate models

The study was conducted to assess long-term impacts of the anticipated changes in temperature, precipitation and humidity in the five Arabian Gulf countries over the next hundred years. The impact of the anticipated climatic changes on human health was estimated based on the Intergovernmental Panel on Climate Change (IPCC) database. Long-term simulated records for A2 and B2 scenarios were retrieved for longitude 41.25°E to 61.875°E and latitude 9.278°N to 27.833°N for Bahrain, Oman, Qatar, United Arab Emirates (UAE) and Yemen using the following three global climate models (GCMs). -- 1. Hadley Centre Global Model (U. K) -- 2. Canadian Centre for Climatic Modeling and Analysis (CCCMA) -- 3. National Centre for Atmospheric Research (NCAR) Model (USA) -- Using average of 1970 to 2000 values as baseline values, the changes in the humidity, temperature and precipitation were estimated for the period 2020 to 2050 and 2070 to 2099. The study showed inconsistency in the prediction of temperature, precipitation and humidity by the above three GCMs, probably due to lack of validation and poorly defined boundary conditions for the region. The predicted temperature increase by NCAR was conservative in 100 years as compared to the other two models. While CCCMA and NCAR predicted higher precipitation fluctuations as compared to Hadley model. The higher uncertainty and inconsistent trends in data prediction as observed by these GCMs require further investigation by validating an appropriate regional climatic model. The climatic variations play a critical role in increased morbidity and mortality due to spatial and temporal spread, timing and severity of infectious diseases. The summarized impacts of climatic changes on the human health based on the empirical approaches project significant increases in disability adjusted life years (DALY) and mortality rates. Amongst the five Gulf coastal countries Yemen and Oman are found more adversely affected with higher anticipated mortality and DALY rates than Bahrain, Qatar, and UAE