Case reportsPatient 1 A 3.3 kg female infant was an extended breech presentation at term. She was born by lower segment caesarean section after labour had failed to progress. There was no difficulty during delivery and the infant's Apgar scores were 9 and 10 at 1 and 5 min, respectively. Examination of the infant on day 1 was normal but on day 6 her mother noticed a tender left leg. The left knee was swollen, tender and movement was limited. The baby was clinically well with a normal temperature. X-ray showed elevation of the periosteum of the distal femur and antibiotic therapy was started on a presumptive diagnosis of septic arthritis. The baby remained apyrexial. Blood cultures were sterile and white cell count and erythrocyte sedimentation rate were normal. Repeat X-rays showed callus formation at the distal end of the left femur, associated with metaphyseal fractures of the femur and upper tibia. Skeletal survey was otherwise normal. Antibiotic therapy was stopped and the baby was discharged. When reviewed 2 weeks later, the swelling and tenderness of the knee had subsided. Patient 2A female infant was born at 40 weeks gestation weighing 4.14 kg. Delivery was by elective lower segment caesarean section for flexed breech presentation in a primigravida. The baby was delivered without any difficulty and cried at birth. Apgar scores were 9 at 1 and 5 min. Routine examination on day 1 was unremarkable. On day 2, the baby was noted to have aswollen right knee but was otherwise well. The knee was warm and tender but there was full movement of the joint. Antibiotics were given and continued until blood Mill Road Maternity Hospital

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The disparity in physician practice regarding revaccination is significant and may reflect the lack of data available regarding efficacy of revaccination in this setting and/or a lack of knowledge about recommendations. Because of this, a national immunization schedule for post-BMT patients founded on evidence-based studies is required to provide optimal patient care. The lack of effective follow up and reminder systems ensuring patient completion of vaccination schedules is also an area needing improvement.

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Introduction and hypothesis This study reports the long-term anatomic and subjective outcomes following sacrocolpopexy based on mesh weight and provides device-specific data. Methods This cohort study compared ultra-lightweight (≤ 20 g/m 2 ) with lightweight mesh (≥ 25 g/m 2 ). The primary outcome was composite failure defined as at least one of ≥ stage 2 apical prolapse, anterior or posterior vaginal wall beyond hymen, complaint of bulge or retreatment. Effect measure estimates were calculated as the incidence rate ratio of composite failure comparing the use of ultra-light with lightweight mesh. Crude and adjusted incidence rate ratios (IRRs) were obtained using uni- and multivariable Poisson regression models. Results Of 358 women who met inclusion criteria, 220 (61%) agreed to attend for review; 95 (43%) had ultra-lightweight mesh and 125 (57%) had lightweight mesh including Upsylon TM . Median follow-up for ultra-light and lightweight mesh was 36 (IQR 22–42) and 63 (IQR 48–87) months, respectively ( p < 0.001). Accounting for differences in follow-up time, there was no significant difference in composite failure between ultra-light and lightweight mesh groups (IRR 1.47, 95% CI 0.83–2.52, p = 0.15). This persisted after adjustment for age, body mass index, parity, smoking and presence of advanced prolapse prior to surgery (IRR 1.52, 95% CI 0.94–2.47, p = 0.087). Mesh exposure for both groups was mostly asymptomatic, and the rate was 7% for the ultra-light group and 8% in the lightweight group. Overall, repeat surgery for recurrent apical prolapse and mesh exposure occurred in 4% and 2%, respectively. Conclusions Ultra-lightweight mesh appears to have similar incidence rate of failure compared to lightweight mesh. Upsylon TM mesh has a similar low rate of recurrent apical prolapse and mesh exposure. Supplementary Information The online version contains supplementary material available at 10.1007/s00192-022-05182-w.