The relationship between serum prolactin and bone mineral density (BMD) in schizophrenia is unclear. We conducted a literature review of databases from inception until December 2018 for cross-sectional, case-control, prospective and retrospective studies analyzing correlations between serum prolactin and BMD measured using dual energy X-ray absorptiometry or quantitative ultrasound at any skeletal site in people with schizophrenia. Data was summarized with a best evidence synthesis. This review identified 15 studies (1 longitudinal study, 10 cross-sectional and 4 case-control studies; 1,360 individuals with a psychotic disorder; mean age 45.1 ± 9.4 [standard deviation] years, female 742 [54.6%], mean illness duration 17.7 ± 11.3 years) assessing the relationship between serum prolactin and BMD in schizophrenia. There was a statistically significant inverse correlation between serum prolactin and BMD identified in eight of the studies (53% of all studies), suggesting mixed evidence for an association between serum prolactin and BMD. Of those studies which identified a significant inverse correlation between serum prolactin and BMD (n = 5), 152 (52.1%) of patients were treated with prolactin raising antipsychotics, compared to 197 (48.1%) of patients in those studies which did not identify a significant correlation between prolactin and BMD. Available studies cannot resolve the link between excess prolactin and reduced BMD in schizophrenia. Future studies should be longitudinal in design and combine measures of serum prolactin along with other risk factors for reduced BMD such as smoking and vitamin D and sex hormone levels in assessing the relationship between prolactin and BMD in schizophrenia.

Aims To quantify the impact Covid-19 has had on vascular surgery during the pandemic at our unit compared to previous operating activity levels at a single vascular centre. Methods Retrospective analysis of all vascular operations undertaken in the department dating from 11th March 2020 to 16th November 2020. Historical average data (HD) from the previous five years (2015-2019) over the same timeframe were then collected for comparison. Results During the Covid-19 pandemic 237 vascular operations were performed which represented a 48% operative reduction compared to average HD (454). 57 elective day-case procedures (varicose veins/temporal artery biopsies/renal access) were performed compared to a median of 259 from HD. Varicose vein surgery had an 79% reduction (37 vs 180). Renal access surgery was unaffected (15 vs 9). Major limb revascularisation procedures were reduced by 41% (36 vs 61) however this did not equate to any increase in amputation rates (79 vs 84). There was no reduction in carotid procedures performed during the pandemic (26 vs 30). There was a 60% (14 vs 35) reduction in all types of aneurysm procedures. Conclusion The Covid-19 pandemic has dramatically affected vascular surgery at our unit. In terms of arterial work the largest disparities compared to previous years was major revascularisation and aneurysm surgery. In respect to elective day case procedures, venous work has unsurprisingly been hardest hit which, once resources allow, will require significant provision to overcome the shortfall. This quantitative study can direct future service delivery and prepare for the post-pandemic recovery.

Aim To ensure guidelines are followed for cystoscopic surveillance Method Results and discussion WERE GUIDELINES FOLLOWED? Conclusion Recommendations

Aims To assess the 30-day mortality rate in patients undergoing vascular procedures in a single vascular centre during the first wave of the Covid-19 pandemic. Methods Retrospective analysis of all vascular operations undertaken at our unit from 11th March 2020 to 16th November 2020. Thirty-day mortality rate, ASA grade, 30-day Covid-19 PCR test positivity and cause of death were assessed. Mortality rate was compared to previous five-year average with a Chi- Square test. Results Within the observed period, 237 vascular operations were performed (49% operative reduction). 57 patients (24%) were operated electively through the “Green pathway” (day case) and there were no perioperative positive Covid-19 tests. 180 patients were operated through the “Amber” (elective Inpatient) or “Red” (emergency) pathway. Eight inpatients (4.4%) died within 30 days from surgery, similar to the average 30-day mortality observed in the previous years (5.9% p > 0.05). Three patients (1.42%) tested positive preoperatively but were all asymptomatic from Covid-19. One patient who died tested positive for Covid-19 but was asymptomatic from a respiratory aspect and died of cardiovascular disease. Conclusion We found no difference in 30-day post-operative mortality rate during the initial wave of Covid-19. Only 3 patients undergoing emergency operations tested positive. This study does reinforce the “Green pathway” strategy for elective patients to ensure minimising exposure to Covid-19 but we also did not witness any difference in mortality rate in the “Amber” or “Red” pathway. The impact of the second or third “wave” on current numbers will need to be studied further.