Norman Dott, Gerard Guiot, and Jules Hardy: key players in the resurrection of transsphenoidal surgery

pre-printDeveloped over a century ago, the introduction of the transsphenoidal approach to access lesions of the pituitary gland and sella turcica has transformed the field of neurosurgery, largely due to the work of Oskar Hirsch and Harvey Cushing. Furthermore, its use and modification in the early 1900s was perhaps one of Cushing's greatest legacies to skull base surgery. However, there was a period of time from 1929 to 1932 when use of the transsphenoidal approach almost became extinct. Cushing, who had worked relentlessly to improve the transsphenoidal route to the pituitary region, abandoned the approach in his pursuit to master transcranial approaches. At the time, few surgeons including Hirsch continued to do transnasal surgery with great success on a smaller scale

Peri-partum cardiomayopathy-not a rare entity, clinical profile in a rural tertiary care center in Gujarat, India

Background: Peri-partum cardiomayopathy (PPCM) in pregnancy has a potential to adversely affect both mother and fetus. Severe cases can be associated with life threatening complications unless managed promptly by multidisciplinary team. The objective was to study maternal and fetal outcome of PPCM patients.Methods: An observational cohort over 4 years (2012 to 2015) was conducted in a Rural tertiary care center. Consecutive antenatal and postpartum women with PPCM were studied for medical and obstetric complications, deliveries, fetal outcome and maternal mortality.Results: The incidence of PPCM was 0.3% and Most patients presented with typical signs and symptoms of heart failure. 55.5% were in NYHA 3 and 4 and 50% had ejection fraction below 30%. 83.3% required ICU admissions of varying length and Maternal mortality was in 1 patient (5.56%). PPCM occurred in 55.5% of ante partum against 44.4% of postpartum patients. Obstetric complications like PPH occurred in 11.1% while poor fetal outcome like preterm deliveries occurred in 50% while still births in 16.67%.Conclusions: The low incidence and rarity of PPCM presents itself with diagnostic dilemma. Obstetrician should have high index of suspicion in patients with heart failure and high risk factors. Early diagnosis and prompt treatment can only improve the outcome

Acute kidney injury requiring dialysis in obstetric patients: management and clinical outcome in case series of 30 patients in a tertiary care centre

Background: Acute Kidney Injury is a common medical problem affecting approximately 5% of all hospitalized and 30% of critically ill patients. The incidence in obstetric patients ranges from 1 in 2000 to 1 in 25000 pregnancies. In India till date, the impact of AKI on fetomaternal outcome and pertaining therapeutic interventions is only sparsely studied.Methods: It is a retrospective cross-sectional study. All obstetric patients with AKI on dialysis, admitted to Shree Krishna Hospital, a tertiary care hospital in Karamsad village in Gujarat from January 2013 to August 2015. Multivariate statistical analysis of clinical and laboratory parameters was performed using SPSS program to obtain the results.Results: The incidence of dialysis was 1.6%. HELLP syndrome and pre-eclampsia (80%) was found to be the most common etiology of AKI followed by Congestive cardiac failure (34.5%), hemorrhage and sepsis in 30% resp. All patients were admitted to ICU care. No significant difference was found between SAP II and SOFA monitoring system. Mechanical ventilation was done to support 53.3% and inotropic support was needed by 56.7% patients. According to the RIFLE criteria, majority of the patients fall under risk category followed by injury. 18% of the patients developed End Stage Renal Disease.Conclusions: In view of the multifaceted etiologies and complexity of management of AKI, a multi-disciplinary approach involving nephrologist, intensivists, obstetricians and neonatologists is extremely important

Malignant placental trophoblastic tumour a diagnostic dilemma: rare association with focal segmental glomerulonephritis and cardiomyopathy

Placental site trophoblastic tumour (PSTT) is the rarest form of Gestational trophoblastic neoplasia (GTN).It has a wide clinical spectrum of presentation and its complications have a multi organ involvment. Inspite of the advances in HCG assays and sensitive unltrasounds, its diagnosis and course in every case is a mystery. However, it is only rarely associated with glomerulonephritis. Most cases have not been biopsied and the specific nature of renal involvement is not clearly understood. Here we report a case of PSTT with glomerulonephritis and cardiomyopathy

Massive hemoperitoneum in case of large subserosal fibroid- a rare case report

Rupture of veins on the surface of uterine leiomyoma is an extremely uncommon gynaecological cause of haemoperitoneum. It is a life-threating emergency. In most cases, bleeding is a result of trauma or torsion. Here we report a case of massive intraperitoneal haemorrhage due to rupture of vessels on the surface of large sub-serous leiomyoma to stress on the fact that a differential diagnosis of rupture of surface vessels in a fibroid should be considered while dealing with a case of haemoperitoneum with pelvic masse

Research priorities to reduce the impact of COVID-19 in low- and middle-income countries.

BackgroundThe COVID-19 pandemic has caused disruptions to the functioning of societies and their health systems. Prior to the pandemic, health systems in low- and middle-income countries (LMIC) were particularly stretched and vulnerable. The International Society of Global Health (ISoGH) sought to systematically identify priorities for health research that would have the potential to reduce the impact of the COVID-19 pandemic in LMICs.MethodsThe Child Health and Nutrition Research Initiative (CHNRI) method was used to identify COVID-19-related research priorities. All ISoGH members were invited to participate. Seventy-nine experts in clinical, translational, and population research contributed 192 research questions for consideration. Fifty-two experts then scored those questions based on five pre-defined criteria that were selected for this exercise: 1) feasibility and answerability; 2) potential for burden reduction; 3) potential for a paradigm shift; 4) potential for translation and implementation; and 5) impact on equity.ResultsAmong the top 10 research priorities, research questions related to vaccination were prominent: health care system access barriers to equitable uptake of COVID-19 vaccination (ranked 1st), determinants of vaccine hesitancy (4th), development and evaluation of effective interventions to decrease vaccine hesitancy (5th), and vaccination impacts on vulnerable population/s (6th). Health care delivery questions also ranked highly, including: effective strategies to manage COVID-19 globally and in LMICs (2nd) and integrating health care for COVID-19 with other essential health services in LMICs (3rd). Additionally, the assessment of COVID-19 patients' needs in rural areas of LMICs was ranked 7th, and studying the leading socioeconomic determinants and consequences of the COVID-19 pandemic in LMICs using multi-faceted approaches was ranked 8th. The remaining questions in the top 10 were: clarifying paediatric case-fatality rates (CFR) in LMICs and identifying effective strategies for community engagement against COVID-19 in different LMIC contexts.InterpretationHealth policy and systems research to inform COVID-19 vaccine uptake and equitable access to care are urgently needed, especially for rural, vulnerable, and/or marginalised populations. This research should occur in parallel with studies that will identify approaches to minimise vaccine hesitancy and effectively integrate care for COVID-19 with other essential health services in LMICs. ISoGH calls on the funders of health research in LMICs to consider the urgency and priority of this research during the COVID-19 pandemic and support studies that could make a positive difference for the populations of LMICs

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries