Staff Publication

Comparison of cure rates in women treated with cold-coagulation versus LLETZ cervical treatment for CIN2-3 on pretreatment cervical punch biopsies: a retrospective cohort study (2017)

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Type of publication:
Journal article

Author(s):
*Papoutsis D, *Underwood M , *Parry-Smith W, *Panikkar J.

Citation:
Archives of Gynecology and Obstetrics. 2017 Apr;295(4):979-986

Abstract:
PURPOSE:
To compare the cure rates between women who were treated with cold-coagulation versus large loop excision of the transformation zone (LLETZ) for cervical intraepithelial neoplasia grade 2 (CIN2) or 3 (CIN3) on pretreatment cervical punch biopsies.
METHODS:
This was a retrospective cohort study of women having had a single cervical treatment for CIN2 or CIN3 on pretreatment cervical punch biopsies between 2010 and 2011. The cure rates were defined as the absence of any dyskaryosis (mild/moderate/severe) on cytology tests during follow-up and were determined at 6 and 12 months after treatment.
RESULTS:
We identified 411 women having had cervical treatment with 178 cases of cold-coagulation and 233 cases of LLETZ. The cure rates at 6 months following cold-coagulation and LLETZ treatment were 91.6 versus 97.1% (p = 0.02), whereas at 12 months, they were 96.5 versus 97.3% (p = 0.76). Multivariable analysis showed that after adjusting for confounding factors, there was a fourfold higher cure rate with LLETZ in comparison with cold-coagulation at 6 months after treatment (adjusted OR 4.50, 95% CI 1.20-16.83; p = 0.026), with this difference disappearing at 12 months. The lower cure rates with cold-coagulation were due to its higher rates of mild dyskaryosis cytology tests at 6 months. The rates of moderate/severe dyskaryosis cytology tests were similar between the two treatment methods at 6 and 12 months.
CONCLUSION:
We found that women with CIN2 or CIN3 on pretreatment cervical punch biopsies, after adjusting for multiple confounding factors, had higher cure rates when treated with LLETZ versus cold-coagulation at 6 months, with this difference disappearing at 12 months.

Incidence of postoperative nausea and vomiting following gynecological laparoscopy: A comparison of standard anesthetic technique and propofol infusion (2016)

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Type of publication:
Journal article

Author(s):
Bhakta P., Ghosh B.R., Singh U., Govind P.S., Gupta A., Kapoor K.S., *Jain R.K., Nag T., Mitra D., Ray M., Singh V., Mukherjee G.

Citation:
Acta Anaesthesiologica Taiwanica, March 2016(no pagination)

Abstract:
Objective: To determine the safety, efficacy, and feasibility of propofol-based anesthesia in gynecological laparoscopies in reducing incidences of postoperative nausea and vomiting compared to a standard anesthesia using thiopentone/isoflurane. Design: Randomized single-blind (for anesthesia techniques used) and double-blind (for postoperative assessment) controlled trial. Setting: Operation theater, postanesthesia recovery room, teaching hospital. Patients: Sixty ASA (American Society of Anesthesiologists) I and II female patients (aged 20-60 years) scheduled for gynecological laparoscopy were included in the study. Interventions: Patients in Group A received standard anesthesia with thiopentone for induction and maintenance with isoflurane-fentanyl, and those in Group B received propofol for induction and maintenance along with fentanyl. All patients received nitrous oxide, vecuronium, and neostigmine/glycopyrrolate. No patient received elective preemptive antiemetic, but patients did receive it after more than one episode of vomiting. Measurements: Assessment for incidence of postoperative nausea and vomiting as well as other recovery parameters were carried out over a period of 24 hours. Main Results: Six patients (20%) in Group A and seven patients (23.3%) in Group B experienced nausea. Two patients (6.66%) in Group B had vomiting versus 12 (40%) in Group A (p . <. 0.05). Overall, the incidence of emesis was 60% and 30% in Groups A and B, respectively (p . <. 0.05). All patients in Group B had significantly faster recovery compared with those in Group A. No patient had any overt cardiorespiratory complications. Conclusion: Propofol-based anesthesia was associated with significantly less postoperative vomiting and faster recovery compared to standard anesthesia in patients undergoing gynecological laparoscopy.

Link to full-text: http://www.sciencedirect.com/science/article/pii/S1875459716300145/pdfft?md5=23ae5cc15830c8a727672ad3ea135958&pid=1-s2.0-S1875459716300145-main.pdf

The SaTH risk-assessment tool for the prediction of emergency cesarean section in women having induction of labor for all indications: a large-cohort based study. (2017)

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Type of publication:
Journal article

Author(s):
*Papoutsis, Dimitrios, Antonakou, Angeliki, *Gornall, Adam, Tzavara, Chara, *Mohajer, Michelle

Citation:
Archives of Gynecology and Obstetrics, Jan 2017, vol. 295, no. 1, p. 59-66

Abstract:
To develop a risk-assessment model for the prediction of emergency cesarean section (CS) in women having induction of labor (IOL). This was an observational cohort study of women with IOL for any indication between 2007 and 2013. Women induced for stillbirths and with multiple pregnancies were excluded. The primary objective was to identify risk factors associated with CS delivery and to construct a risk-prediction tool. 6169 women were identified with mean age of 28.9 years. Primiparity involved 47.1 %, CS rate was 13.3 % and post-date pregnancies were 32.4 %. Risk factors for CS were: age >30 years, BMI >25 kg/m2, primiparity, black-ethnicity, non post-date pregnancy, meconium-stained liquor, epidural analgesia, and male fetal gender. Each factor was assigned a score and with increasing scores the CS rate increased. The CS rate was 5.4 % for a score <11, while for a score ≥11 it increased to 25.0 %. The model had a sensitivity, specificity, negative predictive value and positive predictive value of 75.8, 65.1, 93.8 and 25.0 %, respectively. We have constructed a risk-prediction tool for CS delivery in women with IOL. The risk-assessment tool for the prediction of emergency CS in induced labor has a high negative-predictive value and can provide reassurance to presumed low-risk women.

Endoscopic Ear Surgery and its impact on the operating theatre team (2016)

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Type of publication:
Conference abstract

Author(s):
Paramita Baruah and *Duncan Bowyer

Citation:
The Journal of Laryngology and Otology, Volume 130, Issue S3 (Abstracts for the 10th International Conference on Cholesteatoma). May 2016, pp. S154-S155

Link to more details or full-text: https://www.cambridge.org/core/journals/journal-of-laryngology-and-otology/article/div-classtitleendoscopic-ear-surgery-and-its-impact-on-the-operating-theatre-teamdiv/9BC11266B24CA333FE8F8C24DB660A32#

A Comparison of Operative Time Outcomes in Endoscopic and Open Tympanomastoid Surgery (2016)

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Type of publication:
Conference abstract

Author(s):
*Mohamed Rizny Sakkaff and *Duncan Bowyer

Citation:
The Journal of Laryngology and Otology, Volume 130, Issue S3 (Abstracts for the 10th International Conference on Cholesteatoma). May 2016, pp. S207-S208

Link to more details or full-text: https://www.cambridge.org/core/journals/journal-of-laryngology-and-otology/article/div-classtitlea-comparison-of-operative-time-outcomes-in-endoscopic-and-open-tympanomastoid-surgerydiv/260FA9CCDD529CE5E41661ECB229FE81

An auditon paediatric syncope: Do paediatricians identify the red flags for cardiac syncope? (2016)

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Type of publication:
Conference abstract

Author(s):
*Mikrou P.; *Kannivelu A.

Citation:
European Journal of Pediatrics; 2016; vol. 175 (no. 11); p. 1480-1481

Abstract:
Background and aims Syncope is a common presentation in Paediatrics. Although cardiac syncope is rare, identifying the red flags that could signify an underlying cardiac cause (see chart 1) is an essential skill for all Paediatricians. Methods We conducted a retrospective audit of children with presentation of syncope/presyncope in our local District General Hospital. We based our standards on the Department of Health and Arrhythmia Alliance Primary Care pathway, NICE and European Society of Cardiology guidance on Transient Loss of Consciousness in young people and adults. Results A total of 33 patients were analysed, in two different subgroups: Paediatric Assessment Unit (PAU) group (n=23) and Outpatient group (n=10). In the PAU subgroup, only 70% of patients had a 12-lead ECG (44% had a manual QTC calculated). Family history of sudden death was not documented in 48% of cases. In the outpatient subgroup a significantly higher number of investigations were performed (100% had 12-lead ECGs, 70% Holter monitors and 30% echocardiograms). There was felt to be a selection bias (clinic being run by a Paediatrician with Cardiology expertise). Conclusions A standard operating procedure pathway was formulated to guide clinicians in the Emergency Department and PAU for the management of children presenting with syncope. Key points are that all children presenting with syncope should have a 12-lead ECG and 'red flags' explored in history (e.g. family history of sudden unexplained death, exercise induced symptoms, palpitations). We hope that the pathway implementation will lead to improved patient care outcomes.

The effect of fetal gender on the delivery outcome in primigravidae women with induced labours for all indications (2016)

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Type of publication:
Journal article

Author(s):
Antonakou A.; *Papoutsis D.

Citation:
Journal of Clinical and Diagnostic Research; Dec 2016; vol. 10 (no. 12)

Abstract:
Introduction: There is increasing evidence of a gender-related phenomenon where the presence of a male fetus may have an adverse effect on the outcome of pregnancy. Aim: The aim of this study was to investigate the effect of fetal gender on the delivery outcome in primigravidae women with induced labours. Materials and Methods: This was an observational cohort study of primigravidae women who had Induction Of Labour (IOL) for all indications during a two-year period. Women with breech vaginal deliveries, stillbirths, multiple pregnancies and elective Caesarean Section (CS) were excluded. Results: Of the 936 eligible patients identified, 493(52.6%) gave birth to male neonates and 443(47.4%) to female neonates. Age, ethnicity, Body Mass Index (BMI) and smoking were similar between women that delivered male and female neonates. More than half of all women were induced for post-date pregnancies. In women who gave birth to male neonates, the CS delivery rate was higher than in those with female neonates (23.7% vs 17.8%; p=0.029). Though emergency admission rates to the neonatal Intensive Care Unit (ICU) and arterial/venous pH from umbilical cord sampling immediately after birth were similar between male and female neonates, nevertheless male neonates had lower Apgar scores of <7 at 1 minute after birth (p=0.02). Conclusions: This study has shown that, male gender fetuses have a higher CS delivery rate in primigravidae women undergoing IOL and may be more vulnerable to fetal compromise when in labour.

Link to more details or full-text: http://www.jcdr.net/articles/PDF/9104/22099_CE[Ra1]_F(GH)_PF1(PI_RK)_PFA(AK)_PF2(PAG).pdf