Mr Raza’s relentless pursuit of excellence in the fields of gynecology and robotic surgery has not only transformed patient care but has also reshaped the landscape of medical research.
Background: Endometriosis is a chronic, often debilitating condition with a current significant delay from symptom onset to diagnosis with much of this in primary care. Methods: A systematic review and meta-analysis of the primary literature was conducted to investigate the accuracy of symptoms, clinical history and first-line non-invasive tests to predict pelvic endometriosis (PROSPERO: CRD42020187543). We searched Medline, Embase, Web of Science and Scopus from conception (1966; 1972; 1997; 2004 respectively) to September 2022 for primary test accuracy studies assessing non-invasive tests against reference standard diagnosis for endometriosis. Two authors independently conducted data extraction and quality assessment. Grading of evidence was performed using a novel visual pentagon model. Meta-analyses of test accuracy was estimated using bivariate random effects models. Results: The 125 included studies (250,574 participants) showed mixed quality. Studies applying non-surgical (database/self-reporting) reference standard had a greater risk of bias. In 98 studies applying surgical reference standard, summary diagnostic odds ratios for endometriosis were: dysmenorrhoea 2.56 (95% confidence interval 1.99-3.29); pelvic pain 2.56 (1.73-3.74); dyschezia 2.05 (1.36-3.10); dyspareunia 2.45 (1.71-3.52); family history of endometriosis 6.79 (4.08-11.3); nulligravidity of 2.01 (1.62-2.50); body mass index (BMI) ≥30kg/m ² 0.37 (0.19-0.68); trans-vaginal ultrasound scan (TVUSS) endometrioma 91.2 (44.0-189); TVUSS invasive endometriosis 26.1 (9.28-73.5); and cancer antigen-125 (CA-125) >35U/mL 16.0 (8.09-31.7). Sensitivity analysis excluding all high-risk studies found concordant results. Conclusions: This meta-analysis collated the performance of non-invasive tests for endometriosis across a comprehensive and geographically varied population. Study quality was mixed, however results were consistent with high-risk studies excluded. These findings will inform future prediction models for triage in primary care.
Background: Endometriosis is a chronic, often debilitating condition with a current significant delay from symptom onset to diagnosis. Objectives: To investigate the accuracy of symptoms, clinical history and non-invasive tests to predict pelvic endometriosis. Data sources: Medline, Embase, Web of Science and Scopus from conception to September 2022. Selection criteria: Primary test accuracy studies assessing selected non-invasive tests against a reference standard diagnosis for endometriosis. Data extraction and synthesis: Two authors independently conducted data extraction and study quality assessment. Grading of evidence was performed using a novel visual pentagon model. Meta-analyses of test accuracy was estimated using bivariate random effects models. Results: The 125 included studies (250,574 participants) showed mixed quality. Studies applying non-surgical (database/self-reporting) reference standard had a greater risk of bias. In 98 studies applying surgical reference standard, summary diagnostic odds ratios were: dysmenorrhoea 2.56 (95% confidence interval 1.99-3.29); pelvic pain 2.56 (1.73-3.74); dyschezia 2.05 (1.36-3.10); dyspareunia 2.45 (1.71-3.52); family history of endometriosis 6.79 (4.08-11.3); nulligravidity of 2.01 (1.62-2.50); BMI ≥30kg/m2 0.37 (0.19-0.68); TVUSS endometrioma 91.2 (44.0-189); TVUSS invasive endometriosis 26.1 (9.28-73.5); and CA-125 >35U/mL 16.0 (8.09-31.7). Sensitivity analysis excluding all high-risk studies found concordant results. Conclusions: This meta-analysis collated the performance of non-invasive tests for endometriosis across a comprehensive and geographically varied population. Study quality was mixed, however results were consistent with high-risk studies excluded. These findings will inform future prediction models for triage in primary care. Funding: This research received no specific funding. Keywords: Endometriosis; diagnosis; laparoscopy; pelvic pain; sub-fertility
Background Severe endometriosis with rectal involvement requires careful pre‐operative investigation and planning. Methodical history taking and pre‐operative discussion with the patient is key to establishing their wishes, aims, and expected outcomes of treatment options. Even with extensive prior investigation, the optimal surgical management can not always be determined until the time of laparoscopy. Setting Multidisciplinary team at the Chelsea and Westminster Hospital Endometriosis Centre, London. Surgery carried out at the Lister Hospital, Chelsea. Video We present the case of a 31 year old patient with rectovaginal endometriosis, her pre‐operative workup and laparoscopy with description of the steps and decision making leading to a laparoscopic segmental bowel resection with anastomosis. We demonstrate a systematic assessment of findings at laparoscopy, decision making prior to undertaking a segmental bowel resection, and the techniques employed in full excision of her endometriosis by a joint team of gynaecologists and colorectal surgeons. The steps involve: bilateral ureterolysis and pelvic sidewall dissection; ovarian suspension; adhesiolysis; pararectal space dissection, and segmental bowel resection with anastomosis. We describe the surgical technique and anatomical landmarks at each step by both the gynaecology and colorectal teams including post operative sigmoidoscopy and leak test. Conclusions Clear understanding of the patients’ objectives are paramount prior to any surgery for endometriosis where, even with extensive investigation, the optimal surgical management is not always certain. A systematic assessment of anatomy and pathology combined an understanding surgical technique ensures a good outcome and patient satisfaction.
Objective A pandemic afflicts the entire world. The highly contagious SARS-CoV-2 virus originated in Wuhan, China in late 2019 and rapidly spread across the entire globe. According to the World Health Organization (WHO), the novel Coronavirus (COVID-19)has infected more than two million people worldwide, causing over 160,000 deaths. Patients with COVID-19 disease present with a wide array of symptoms, ranging from mild flu-like complaints to life threatening pulmonary and cardiac complications. Older people and patients with underlying disease have an increased risk of developing severe acute respiratory syndrome (SARS) requiring mechanical ventilation. Once intubated, mortality increases exponentially. A number of pharmacologic regimens, including hydroxychloroquine-azithromycin, antiviral therapy (eg, remdesevir), and anti-IL-6 agents (e.g., toclizumab), have been highlighted by investigators over the course of the pandemic, based on the therapy’s potential to interrupt the viral life-cycle of SARS-CoV-2 or preventing cytokine storm. At present, there have been no conclusive series of reproducible randomised clinical trials demonstrating the efficacy of any one drug or therapy for COVID-19. Cases COVID-19 positive patients (n=5) at a single institution received hyperbaric oxygen therapy (HBOT) between 13 and 20 April 2020. All the patients had tachypnoea and low oxygen saturation despite receiving high FiO 2 . HBOT was added to prevent the need for mechanical ventilation. A standard dive profile of 2.0ATA for 90 minutes was employed. Patients received between one and six treatments in one of two dedicated monoplace hyperbaric chambers. Results All the patients recovered without the need for mechanical ventilation. Following HBOT, oxygen saturation increased, tachypnoea resolved and inflammatory markers fell. At the time of writing, three of the five patients have been discharged from the hospital and two remain in stable condition. Conclusion This small sample of patients exhibited dramatic improvement with HBOT. Most importantly, HBOT potentially prevented the need for mechanical ventilation. Larger studies are likely to define the role of HBOT in the treatment of this novel disease.