2017

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.

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.

Very late rupture of a post-traumatic abdominal aortic pseudoaneurysm (2017)

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Type of publication:
Journal article

Author(s):
Haneen Abed, *William Robert Ball, *Timothy Stone, *Andrew Houghton

Citation:
BMJ Case Reports 2017:published online 27 January 2017

Abstract:
Post-traumatic abdominal aortic pseudoaneurysms remain a rare yet severe complication of aortic injuries and may present many years later. Clinical presentations vary, from the traditional aneurysmal symptoms of abdominal and/or back pain with or without a pulsatile mass, to a fatal rupture. We present the case of a man aged 42 years, with a history of blunt abdominal trauma 14 years ago, presenting with symptoms of non-specific lower abdominal pain and a recent history of straining due to constipation. Clinical examination revealed umbilical bruising, in keeping with Cullen’s sign, and extensive postsacral bruising. This case highlights some of the atypical manifestations of aneurysmal rupture and the importance of early recognition and management.

Link to full-text: http://casereports.bmj.com/content/2017/bcr-2016-218356.full.pdf

Carbapenemase-producing Enterobacteriaceae in the UK: a national study (EuSCAPE-UK) on prevalence, incidence, laboratory detection methods and infection control measures (2017)

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Type of publication:
Journal article

Author(s):
Pascale Trepanier, Kim Mallard, Danièle Meunier, Rachel Pike, Derek Brown, Janet P. Ashby, Hugo Donaldson, F. Mustafa Awad-El-Kariem, Indran Balakrishnan, Marc Cubbon, Paul R. Chadwick, Michael Doughton, Rachael Doughton, Fiona Hardiman, *Graham Harvey, Carolyne Horner, John Lee, Jonathan Lewis, Anne Loughrey, Rohini Manuel, Helena Parsons, John D. Perry, Gemma Vanstone, Graham White, Nandini Shetty, John Coia, Camilla Wiuff, Katie L. Hopkins and Neil Woodford

Citation:
Journal of Antimicrobial Chemotherapy, Feb 2017, vol. 72, no. 2, p.596-603

Abstract:
OBJECTIVES:
To estimate UK prevalence and incidence of clinically significant carbapenemase-producing Enterobacteriaceae (CPE), and to determine epidemiological characteristics, laboratory methods and infection prevention and control (IPC) measures in acute care facilities.
METHODS:
A 6 month survey was undertaken in November 2013-April 2014 in 21 sentinel UK laboratories as part of the European Survey on Carbapenemase-Producing Enterobacteriaceae (EuSCAPE) project. Up to 10 consecutive, non-duplicate, clinically significant and carbapenem-non-susceptible isolates of Escherichia coli or Klebsiella pneumoniae were submitted to a reference laboratory. Participants answered a questionnaire on relevant laboratory methods and IPC measures.
RESULTS:
Of 102 isolates submitted, 89 (87%) were non-susceptible to ≥1 carbapenem, and 32 (36%) were confirmed as CPE. CPE were resistant to most antibiotics, except colistin (94% susceptible), gentamicin (63%), tigecycline (56%) and amikacin (53%). The prevalence of CPE was 0.02% (95% CI = 0.01%-0.03%). The incidence of CPE was 0.007 per 1000 patient-days (95% CI = 0.005-0.010), with north-west England the most affected region at 0.033 per 1000 patient-days (95% CI = 0.012-0.072). Recommended IPC measures were not universally followed, notably screening high-risk patients on admission (applied by 86%), using a CPE 'flag' on patients' records (70%) and alerting neighbouring hospitals when transferring affected patients (only 30%). Most sites (86%) had a laboratory protocol for CPE screening, most frequently using chromogenic agar (52%) or MacConkey/CLED agars with carbapenem discs (38%).
CONCLUSIONS:
The UK prevalence and incidence of clinically significant CPE is currently low, but these MDR bacteria affect most UK regions. Improved IPC measures, vigilance and monitoring are required.