Research evaluating optimal repair techniques for the reduction of postpartum dyspareunia following obstetric laceration is severely limited. Prevailing guidelines from the American College of Obstetricians and Gynecologists (ACOG) are reliant on data from just nine clinical trials conducted from 1980 to 2012. While the literature on this topic is still limited today, this review aims to synthesize data from past and present studies to ensure that standing clinical recommendations are supported by current literature.A review was conducted per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Medical Literature Analysis and Retrieval System Online (MEDLINE), Cochrane Library, and Google Scholar were searched. Included articles (1) compared continuous with interrupted repair techniques for subjects with episiotomies and/or second-degree tears, (2) were available in full length, and (3) reported dyspareunia as an outcome variable. Excluded articles were those (1) inclusive of first-, third-, or fourthdegree tears; (2) comparing suture material rather than technique; and (3) not available in English. A metaanalysis was conducted for both acute dyspareunia (<3 months) and chronic dyspareunia (>3 months) utilizing Meta-Essentials Microsoft Excel (Microsoft Corp., Redmond, WA) workbook. Bias was evaluated via Egger regression and Begg and Mazumdar rank correlation tests.Twelve articles met inclusion and exclusion guidelines, seven for acute dyspareunia and eight for chronic dyspareunia. All publications were randomized controlled trials and were inclusive of a total of 4,081 patients. Risk ratios (RRs) and 95% confidence intervals (CIs) were calculated using a random effect model. Analysis revealed no statistically significant difference between continuous and interrupted suture groups for acute dyspareunia (RR: 0.98; 95% CI: 0.89-1.08) or chronic dyspareunia (RR: 0.96; 95% CI: 0.83-1.12). Egger regression test (p-value=0.534) and Begg and Mazumdar rank correlation test (p-value=0.570) indicated minimal publication bias. Compiled data does not indicate a preferential suture technique for the reduction of postpartum dyspareunia. These findings are congruent with the ACOG guidelines; therefore, there is no supporting evidence for ACOG's recommendation of continuous suturing to be overturned.

No abstract

With a wide variety of associated diseases, proper diagnosis and treatment of annular rashes can prove clinically challenging. It is essential to remain vigilant of atypical presentations of disease and to complete a comprehensive history, physical, and workup to ensure optimal patient care.

No abstract

Introduction: Abnormal uterine bleeding (AUB) is a common presentation in the field of gynecology. Proper diagnosis and management of this condition can be difficult and permanent treatment options, including robotic hysterectomy, may be necessary. In patients with a history of previous abdominal surgery, pelvic adhesions may present obstacles to this surgical approach. Case Report: In this case report, a 41-year-old woman desired permanent treatment for AUB. The patient underwent endometrial biopsy which revealed inexplicit squamous morules. She opted for permanent treatment via robotic hysterectomy. Her operation was complicated by the presence of dense pelvic adhesions caused by previous surgeries. Conclusion: This report aims to detail the potential difficulties in the clinical management of inconclusive biopsy results and in using a robotic approach to hysterectomy in the setting of pelvic adhesions. Authors encourage ongoing clinical investigation to determine the optimal methods for diagnosing and treating AUB.

Introduction: With a wide variety of associated diseases, proper diagnosis and treatment of annular rashes can prove clinically challenging. Case Report: A 53-year-old male presents with a painful, purpuric, annular eruption in addition to multiple risk factors for systemic diseases. An extensive in-patient work-up yielded a suspected diagnosis of IgA-vasculitis despite an atypical presentation. Conclusion: A differential diagnosis for an annular eruption may include cat scratch disease, DRESS syndrome, IgA-vasculitis, among multiple other causes. It is essential to remain vigilant of atypical presentations of disease and to complete a comprehensive history, physical, and workup to ensure optimal patient care.

Shear-wave elastography (SWE) has emerged as a novel ultrasonographic technique for the diagnosis of pediatric Hashimoto's Thyroiditis (HT). This systematic review and meta-analysis aim to summarize current evidence to determine the diagnostic value of SWE for HT. MEDLINE, a comprehensive search yielded five studies inclusive of 392 subjects. A meta-analysis comparing SWE values (kPa) between children with HT and healthy controls yielded a Cohen's d-value of 1.34 (CI 1.02-1.65), suggesting statistically significant differences in SWE values. Such evidence indicates that SWE may serve as a valuable tool in diagnosing HT in the pediatric population.

Robotic single-site hysterectomy (RSSH) has emerged as a novel surgical approach for the treatment of endometrial cancer and atypical endometrial hyperplasia (AEH). Current research regarding the benefits of RSSH compared to robotic multiport hysterectomy (RMPH) for these indications has been inconclusive. Our team sought to compare surgical outcomes between these two approaches of robotic hysterectomy via systematic review and meta-analysis to ensure optimal surgical practices. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 Checklist guided our review. MEDLINE, Clinicaltrials.gov, and Cochrane Library were searched, yielding 59 results. Articles were filtered by title and abstract and then reviewed in full for inclusion and exclusion criteria. Inclusion criteria required that (1) studies compared outcomes for RSSH and RMPH, (2) hysterectomy was indicated for endometrial cancer or hyperplasia with atypia, and (3) studies were available in English. Excluded studies (1) compared single-site and multiport laparoscopic approaches, (2) compared robotic approaches to laparoscopic or abdominal (open) techniques, and (3) employed hysterectomy for benign conditions. Publication bias was assessed using the Egger Regression Correlation analysis. Four studies complied with the selection criteria, comprising 138 patients in the RSSH group and 259 in the RMPH group. Similar outcomes were noted across all measures, including conversion rate (relative risk [RR] = 1.84 and confidence interval [CI] = 0.99-3.43), blood loss (Cohen's d = 1.05 and Z = 18.62), operating time (Cohen's d = 0.29 and Z = 4.38), and length of hospital stay (Cohen's d = 1.06 and Z = 3.86). Publication bias was deemed minimal as indicated by Egger regression values of less than 0.05. These findings suggest that either a surgical approach or AEH with the proper standard of care can provide patients with endometrial cancer.