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Article ; Online: Laparoscopic removal of Essure device techniques, perioperative findings and evaluation of patient's satisfaction: A case series.

Antoun, Lina / Smith, Paul / Buduru, Indira / Clark, T Justin

Journal of gynecology obstetrics and human reproduction

2023 Volume 52, Issue 5, Page(s) 102567

Abstract: Objective: To evaluate perioperative outcomes and symptom resolution in women undergoing Essure removal.: Methods: Single centre cohort study at a large University Teaching Hospital in the UK. Symptoms and Quality of life (QoL) were assessed using a ... ...

Abstract	Objective: To evaluate perioperative outcomes and symptom resolution in women undergoing Essure removal. Methods: Single centre cohort study at a large University Teaching Hospital in the UK. Symptoms and Quality of life (QoL) were assessed using a standardised questionnaire administered at 6-months and up to 10-years following removal of Essure® devices. Results: 61 women underwent surgical removal of Essure® devices representing 61/1087 (5.6%) of all women undergoing this hysteroscopic form of sterilization. Patients who had Essure® removal were more likely to have a previous caesarean section [38% vs 18%; OR 0.4, 95% CI 0.2-0.6; P <0.001]. The main indication for removal was pelvic pain (49/61, 80%). Removal was achieved by laparoscopic bilateral salpingectomy/cornuectomy (44/61,71%) or hysterectomy (17/61, 28%). At surgery, perforated device was seen in 4/61 (7%) cases. 26/61 (43%) of patients had concomitant pelvic pathology; 12/26 (46%) had fibrous adhesions, 8/26 (31%) endometriosis, 4/26 (15%) adenomyosis, and 2/26 (8%) had endometriosis and adenomyosis. 10 patients underwent further procedure following removal for ongoing symptoms. 55/61 women (90%) responded to the post removal symptom questionnaire. Most respondents to the quality of life survey 42/55 (76%) reported total or some improvement. 42/53 (79%) had total or some improvement in pelvic pain, 9/13 (69%) in mental health and 10/12 (83%) in bleeding. Conclusion: Surgical removal of Essure® devices appears to improve symptoms thought to be attributable to the presence of these uterine implants in most women. However, patients should be counselled that one in five women may experience persistent or even worsening symptoms.
MeSH term(s)	Humans ; Female ; Pregnancy ; Hysteroscopy/methods ; Quality of Life ; Cohort Studies ; Adenomyosis/surgery ; Endometriosis/surgery ; Cesarean Section ; Sterilization, Tubal ; Device Removal ; Laparoscopy/methods ; Pelvic Pain/etiology ; Pelvic Pain/surgery
Language	English
Publishing date	2023-03-01
Publishing country	France
Document type	Journal Article
ISSN	2468-7847
ISSN (online)	2468-7847
DOI	10.1016/j.jogoh.2023.102567
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Severe pre-eclampsia complicated by acute fatty liver disease of pregnancy, HELLP syndrome and acute kidney injury following SARS-CoV-2 infection.

Ahmed, Irshad / Eltaweel, Nashwa / Antoun, Lina / Rehal, Anoop

BMJ case reports

2020 Volume 13, Issue 8

Abstract: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has presented many diagnostic challenges and uncertainties. Little is known about common pathologies complicating pregnancy and how their behaviour is modified by the presence of ... ...

Abstract	The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has presented many diagnostic challenges and uncertainties. Little is known about common pathologies complicating pregnancy and how their behaviour is modified by the presence of SARS-CoV-2. Pregnancy itself can alter the body's response to viral infection, which can cause more severe symptoms. We report the first case of a patient affected with sudden-onset severe pre-eclampsia complicated by acute fatty liver disease of pregnancy, HELLP (haemolysis, elevated liver enzymes and low platelet) syndrome and acute kidney injury following SARS-CoV-2 infection. Although an initial diagnostic dilemma, a multidisciplinary team approach was required to ensure a favourable outcome for both the mother and the baby. Our case report highlights the need for health professionals caring for pregnant women to be aware of the complex interplay between SARS-CoV-2 infection and hypertensive disorders of pregnancy.
MeSH term(s)	Acute Kidney Injury/blood ; Acute Kidney Injury/complications ; Acute Kidney Injury/diagnosis ; Adult ; Betacoronavirus ; COVID-19 ; Coronavirus Infections/blood ; Coronavirus Infections/complications ; Fatty Liver/blood ; Fatty Liver/complications ; Fatty Liver/diagnosis ; Female ; HELLP Syndrome/blood ; HELLP Syndrome/diagnosis ; Humans ; Kidney Function Tests ; Pandemics ; Pneumonia, Viral/blood ; Pneumonia, Viral/complications ; Pre-Eclampsia/blood ; Pre-Eclampsia/diagnosis ; Pregnancy ; Pregnancy Complications/blood ; Pregnancy Complications/diagnosis ; Pregnancy Complications, Infectious/blood ; Pregnancy Complications, Infectious/diagnosis ; SARS-CoV-2
Keywords	covid19
Language	English
Publishing date	2020-08-11
Publishing country	England
Document type	Case Reports ; Journal Article
ISSN	1757-790X
ISSN (online)	1757-790X
DOI	10.1136/bcr-2020-237521
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Telemedicine Competencies in Family Medicine Clerkships: A CERA Study.

Bajra, Rika / Lin, Steven / Theobald, Mary / Antoun, Jumana

Family medicine

2023 Volume 55, Issue 6, Page(s) 405–410

Abstract: Background: While the Association of American Medical Colleges (AAMC) designated cross-disciplinary telemedicine competencies, curricular implementation is at disparate stages across medical schools and with significant curricular gaps. We investigated ... ...

Abstract	Background: While the Association of American Medical Colleges (AAMC) designated cross-disciplinary telemedicine competencies, curricular implementation is at disparate stages across medical schools and with significant curricular gaps. We investigated factors associated with the presence of telemedicine curriculum in family medicine clerkships. Methods: Data were evaluated as part of the 2022 CERA survey of family medicine clerkship directors (CD). Participants answered questions about telemedicine curriculum in their clerkship, including whether it was required or optional, whether telemedicine competencies were assessed, the availability of faculty expertise, volume of visits, student autonomy in visits, CD's attitude about the importance of telemedicine education, and awareness of the Society of Teachers of Family Medicine's (STFM) Telemedicine Curriculum. Results: Ninety-four of 159 CDs (59.1%) responded to the survey. Over one-third of FM clerkships (38, 41.3%) did not teach telemedicine and most CDs (59, 62.8%) did not assess competencies. The presence of telemedicine curriculum was positively associated with CDs' awareness of STFM's Telemedicine Curriculum (P=.032), attitude of CDs toward importance of telemedicine teaching (P=.007), higher level of learner autonomy in telemedicine visits (P=.035), and private medical schools (P=.020). Conclusions: Almost two-thirds of clerkships (62.8%) did not assess telemedicine competencies, and fewer than one-third of CDs (28.6%) considered telemedicine education as important as other clerkship topics. CDs' attitudes were a significant determinant of whether teaching of telemedicine skills occurred. Awareness of telemedicine education resources and higher learner autonomy in telemedicine encounters may promote integration into clerkship curriculum.
MeSH term(s)	Humans ; Family Practice ; Curriculum ; Educational Status ; Faculty ; Telemedicine
Language	English
Publishing date	2023-03-13
Publishing country	United States
Document type	Journal Article
ZDB-ID	639374-3
ISSN	1938-3800 ; 0742-3225
ISSN (online)	1938-3800
ISSN	0742-3225
DOI	10.22454/FamMed.2023.242006
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Article: Severe pre-eclampsia complicated by acute fatty liver disease of pregnancy, HELLP syndrome and acute kidney injury following SARS-CoV-2 infection

Ahmed, Irshad / Eltaweel, Nashwa / Antoun, Lina / Rehal, Anoop

BMJ case reports

Abstract	The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has presented many diagnostic challenges and uncertainties. Little is known about common pathologies complicating pregnancy and how their behaviour is modified by the presence of SARS-CoV-2. Pregnancy itself can alter the body's response to viral infection, which can cause more severe symptoms. We report the first case of a patient affected with sudden-onset severe pre-eclampsia complicated by acute fatty liver disease of pregnancy, HELLP (haemolysis, elevated liver enzymes and low platelet) syndrome and acute kidney injury following SARS-CoV-2 infection. Although an initial diagnostic dilemma, a multidisciplinary team approach was required to ensure a favourable outcome for both the mother and the baby. Our case report highlights the need for health professionals caring for pregnant women to be aware of the complex interplay between SARS-CoV-2 infection and hypertensive disorders of pregnancy.
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #712861
Database	COVID19

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Article ; Online: Severe pre-eclampsia complicated by acute fatty liver disease of pregnancy, HELLP syndrome and acute kidney injury following SARS-CoV-2 infection

Ahmed, Irshad / Eltaweel, Nashwa / Antoun, Lina / Rehal, Anoop

BMJ Case Reports

2020 Volume 13, Issue 8, Page(s) e237521

Abstract	The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has presented many diagnostic challenges and uncertainties. Little is known about common pathologies complicating pregnancy and how their behaviour is modified by the presence of SARS-CoV-2. Pregnancy itself can alter the body’s response to viral infection, which can cause more severe symptoms. We report the first case of a patient affected with sudden-onset severe pre-eclampsia complicated by acute fatty liver disease of pregnancy, HELLP (haemolysis, elevated liver enzymes and low platelet) syndrome and acute kidney injury following SARS-CoV-2 infection. Although an initial diagnostic dilemma, a multidisciplinary team approach was required to ensure a favourable outcome for both the mother and the baby. Our case report highlights the need for health professionals caring for pregnant women to be aware of the complex interplay between SARS-CoV-2 infection and hypertensive disorders of pregnancy.
Keywords	covid19
Language	English
Publisher	BMJ
Publishing country	uk
Document type	Article ; Online
ISSN	1757-790X
DOI	10.1136/bcr-2020-237521
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Severe pre-eclampsia complicated by acute fatty liver disease of pregnancy, HELLP syndrome and acute kidney injury following SARS-CoV-2 infection.

Ahmed, Irshad / Eltaweel, Nashwa / Antoun, Lina / Rehal, Anoop

2020

Abstract	The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has presented many diagnostic challenges and uncertainties. Little is known about common pathologies complicating pregnancy and how their behaviour is modified by the presence of SARS-CoV-2. Pregnancy itself can alter the body's response to viral infection, which can cause more severe symptoms. We report the first case of a patient affected with sudden-onset severe pre-eclampsia complicated by acute fatty liver disease of pregnancy, HELLP (haemolysis, elevated liver enzymes and low platelet) syndrome and acute kidney injury following SARS-CoV-2 infection. Although an initial diagnostic dilemma, a multidisciplinary team approach was required to ensure a favourable outcome for both the mother and the baby. Our case report highlights the need for health professionals caring for pregnant women to be aware of the complex interplay between SARS-CoV-2 infection and hypertensive disorders of pregnancy.
Keywords	WC Communicabable diseases ; WF Respiratory system. Respiratory medicine ; WH Haemic and lymphatic systems. Haematology ; WI Digestive system. Gastroenterology ; WP Gynaecology. Women’s health ; WQ Obstetrics. Midwifery ; covid19
Subject code	610
Publishing date	2020-08-11
Publisher	BMJ Publishing Group
Publishing country	uk
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: LAparoscopic Versus Abdominal hysterectomy (LAVA): protocol of a randomised controlled trial.

Antoun, Lina / Middleton, Lee / Smith, Paul / Saridogan, Ertan / Cooper, Kevin / Brocklehurst, Peter / McKinnon, William / Bevan, Sheriden / Woolley, Rebecca / Jones, Laura / Fullard, Jayne / Morgan, Monique / Roberts, Tracy / Clark, T Justin

BMJ open

2023 Volume 13, Issue 9, Page(s) e070218

Abstract: Introduction: There is uncertainty about the advantages and disadvantages of laparoscopic hysterectomy compared with abdominal hysterectomy, particularly the relative rate of complications of the two procedures. While uptake of laparoscopic hysterectomy ...

Abstract	Introduction: There is uncertainty about the advantages and disadvantages of laparoscopic hysterectomy compared with abdominal hysterectomy, particularly the relative rate of complications of the two procedures. While uptake of laparoscopic hysterectomy has been slow, the situation is changing with greater familiarity, better training, better equipment and increased proficiency in the technique. Thus, a large, robust, multicentre randomised controlled trial (RCT) is needed to compare contemporary laparoscopic hysterectomy with abdominal hysterectomy to determine the safest and most cost-effective technique. Methods and analysis: A parallel, open, non-inferiority, multicentre, randomised controlled, expertise-based surgery trial with integrated health economic evaluation and an internal pilot with an embedded qualitative process evaluation. A within trial-based economic evaluation will explore the cost-effectiveness of laparoscopic hysterectomy compared with open abdominal hysterectomy. We will aim to recruit 3250 women requiring a hysterectomy for a benign gynaecological condition and who were suitable for either laparoscopic or open techniques. The primary outcome is major complications up to six completed weeks postsurgery and the key secondary outcome is time from surgery to resumption of usual activities using the personalised Patient-Reported Outcomes Measurement Information System Physical Function questionnaire. The principal outcome for the economic evaluation is to be cost per QALY at 12 months' postsurgery. A secondary analysis is to be undertaken to generate costs per major surgical complication avoided and costs per return to normal activities. Ethics and dissemination: The study was approved by the West Midlands-Edgbaston Research Ethics Committee, 18 February 2021 (Ethics ref: 21/WM/0019). REC approval for the protocol version 2.0 dated 2 February 2021 was issued on 18 February 2021.We will present the findings in national and international conferences. We will also aim to publish the findings in high impact peer-reviewed journals. We will disseminate the completed paper to the Department of Health, the Scientific Advisory Committees of the RCOG, the Royal College of Nurses (RCN) and the BSGE. Trial registration number: ISRCTN14566195.
MeSH term(s)	Female ; Humans ; Laparoscopy ; Hysterectomy ; Advisory Committees ; Cost-Benefit Analysis ; Ethics Committees, Research ; Randomized Controlled Trials as Topic ; Multicenter Studies as Topic
Language	English
Publishing date	2023-09-05
Publishing country	England
Document type	Clinical Trial Protocol ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2022-070218
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Maternal COVID-19 infection, clinical characteristics, pregnancy, and neonatal outcome: A prospective cohort study.

Antoun, Lina / Taweel, Nashwa El / Ahmed, Irshad / Patni, Shalini / Honest, Honest

European journal of obstetrics, gynecology, and reproductive biology

2020 Volume 252, Page(s) 559–562

Abstract: Objective: To study the effect of COVID-19 on pregnancy and neonatal outcomes.: Study design: Prospective cohort study in a large tertiary maternity unit within a university hospital with an average annual birth of over 10,000 births. We ... ...

Abstract	Objective: To study the effect of COVID-19 on pregnancy and neonatal outcomes. Study design: Prospective cohort study in a large tertiary maternity unit within a university hospital with an average annual birth of over 10,000 births. We prospectively collected and analysed data for a cohort of 23 pregnant patients including singleton and multiple pregnancies tested positive for COVID-19 between February 2020 and April 2020 inclusive to assess the effect of COVID-19 on pregnancy, and neonatal outcomes. Results: Twenty-three pregnant patients tested positive for COVID-19, delivering 20 babies including a set of twins, with four ongoing pregnancies at the time of manuscript submission. 16/23 (70 %) whom tested positive were patients from Asian (Indian sub-continent) background. The severity of the symptoms ranged from mild in 13/23 (65.2 %) of the patients, moderate in 2/23 (8.7 %), and severe in 8/23 (34.8 %). Four out of total 23 COVID-19 pregnant patients (17.4 %) developed severe adult respiratory distress syndrome complications requiring ICU support, one of whom led to maternal death 1/23 (4.3 %). 11/23 (48 %) of the patients had pre-existing co-morbidities, with morbid obesity 5/23 (21.7 %) and diabetes 4/23 (17.4 %) being the more commonly represented. Of the 23 pregnant patients 19 were in their third trimester of pregnancy and delivered; 7/19 (36.8 %) had preterm birth, 3/19 (15.8 %) developed adult respiratory distress syndrome before delivery, and 2/19 (10.5 %) had pre-eclampsia. 16/19 (84 %) of patients delivered by C-section. Out of the 20 new-borns, 18 were singletons with a set of twin. Conclusion: COVID-19 is associated with high prevalence of preterm birth, preeclampsia, and caesarean section compared to non-COVID pregnancies. COVID-19 infection was not found in the newborns and none developed severe neonatal complications.
MeSH term(s)	Adult ; Betacoronavirus ; COVID-19 ; Cesarean Section/statistics & numerical data ; Coronavirus Infections/complications ; Coronavirus Infections/virology ; Female ; Humans ; Infant, Newborn ; Pandemics ; Pneumonia, Viral/complications ; Pneumonia, Viral/virology ; Pre-Eclampsia/epidemiology ; Pre-Eclampsia/virology ; Pregnancy ; Pregnancy Complications, Infectious/virology ; Pregnancy Outcome/epidemiology ; Premature Birth/epidemiology ; Premature Birth/virology ; Prospective Studies ; SARS-CoV-2
Keywords	covid19
Language	English
Publishing date	2020-07-15
Publishing country	Ireland
Document type	Journal Article
ZDB-ID	190605-7
ISSN	1872-7654 ; 0301-2115 ; 0028-2243
ISSN (online)	1872-7654
ISSN	0301-2115 ; 0028-2243
DOI	10.1016/j.ejogrb.2020.07.008
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: LAparoscopic Versus Abdominal hysterectomy (LAVA)

Laura Jones / Peter Brocklehurst / Rebecca Woolley / Paul Smith / Lee Middleton / Tracy Roberts / Ertan Saridogan / Lina Antoun / T Justin Clark / William McKinnon / Kevin Cooper / Sheriden Bevan / Jayne Fullard / Monique Morgan

BMJ Open, Vol 13, Iss

protocol of a randomised controlled trial

2023 Volume 9

Abstract: Introduction There is uncertainty about the advantages and disadvantages of laparoscopic hysterectomy compared with abdominal hysterectomy, particularly the relative rate of complications of the two procedures. While uptake of laparoscopic hysterectomy ... ...

Abstract	Introduction There is uncertainty about the advantages and disadvantages of laparoscopic hysterectomy compared with abdominal hysterectomy, particularly the relative rate of complications of the two procedures. While uptake of laparoscopic hysterectomy has been slow, the situation is changing with greater familiarity, better training, better equipment and increased proficiency in the technique. Thus, a large, robust, multicentre randomised controlled trial (RCT) is needed to compare contemporary laparoscopic hysterectomy with abdominal hysterectomy to determine the safest and most cost-effective technique.Methods and analysis A parallel, open, non-inferiority, multicentre, randomised controlled, expertise-based surgery trial with integrated health economic evaluation and an internal pilot with an embedded qualitative process evaluation. A within trial-based economic evaluation will explore the cost-effectiveness of laparoscopic hysterectomy compared with open abdominal hysterectomy. We will aim to recruit 3250 women requiring a hysterectomy for a benign gynaecological condition and who were suitable for either laparoscopic or open techniques. The primary outcome is major complications up to six completed weeks postsurgery and the key secondary outcome is time from surgery to resumption of usual activities using the personalised Patient-Reported Outcomes Measurement Information System Physical Function questionnaire. The principal outcome for the economic evaluation is to be cost per QALY at 12 months’ postsurgery. A secondary analysis is to be undertaken to generate costs per major surgical complication avoided and costs per return to normal activities.Ethics and dissemination The study was approved by the West Midlands-Edgbaston Research Ethics Committee, 18 February 2021 (Ethics ref: 21/WM/0019). REC approval for the protocol version 2.0 dated 2 February 2021 was issued on 18 February 2021.We will present the findings in national and international conferences. We will also aim to publish the findings in high ...
Keywords	Medicine ; R
Subject code	170
Language	English
Publishing date	2023-09-01T00:00:00Z
Publisher	BMJ Publishing Group
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Maternal COVID-19 infection, clinical characteristics, pregnancy, and neonatal outcome

Antoun, Lina / Taweel, Nashwa El / Ahmed, Irshad / Patni, Shalini / Honest, Honest

European Journal of Obstetrics & Gynecology and Reproductive Biology

A prospective cohort study

2020 Volume 252, Page(s) 559–562

Keywords	Obstetrics and Gynaecology ; Reproductive Medicine ; covid19
Language	English
Publisher	Elsevier BV
Publishing country	us
Document type	Article ; Online
ZDB-ID	190605-7
ISSN	1872-7654 ; 0301-2115 ; 0028-2243
ISSN (online)	1872-7654
ISSN	0301-2115 ; 0028-2243
DOI	10.1016/j.ejogrb.2020.07.008
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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