Tetralogy of Fallot: Imaging of common and uncommon associations by multidetector CT

PurposeTo demonstrate the superior role of multidetector computed tomography (MDCT) in delineation of the extracardiac vascular abnormalities including the pulmonary arterial tree, major aortopulmonary collateral arteries (MAPCAs), patent ductus arteriosus (PDA), and also the detection of the common and uncommon findings in Fallot Tetralogy cases for proper pre-surgical evaluation.Material and methodsA retrospective study of all multidetector CT images acquired to evaluate suspected cases of Tetralogy of Fallot sent by their respective referring physicians between April 2009 and August 2010. A total of 23 cases were included in this study. MDCT protocol, image analysis and calculations used in the diagnosis are explained in detail.ResultsDetailed explanation of the MDCT imaging findings in the 23 cases with Tetralogy of Fallot, as well as the common and uncommon associations of the disease, namely pulmonary atresia, MAPCAs, PDAs, atrial septal defects (ASDs), right sided aortic arch, and a few less common associations.ConclusionA customized approach to MDCT imaging improves the diagnostic accuracy and reduces unneeded prolongation of the study and sedation times. A careful preoperative perceptive of the complex cardiovascular anatomy in patients with Tetralogy of Fallot aids in exposing the patient to a directed and prepared surgical approach.     

The use of Deauville criteria in follow-up assessment of response to therapy in extra-nodal Non-Hodgkin's lymphoma

Objective

Our aim was evaluate the role the PET/CT in the assessment of response to therapy in patients with Non-Hodgkin extra-nodal lymphoma: in particular, a five-point scale (Deauville criteria), which can be employed for early- and late-therapeutic response assessment.

Diagnostic accuracy of 18-F FDG-PET/CT in evaluation of malignant neuronal involvement in neurologically manifested cancer patients

Aim and objectives

The aim of this study was to assess the role of 18-F FDG-PET/CT in evaluating the peripheral malignant neuronal affection as well as perineural tumoral spread that occurs in patients with cancers.

New Tmc1 Deafness Mutations Impact Mechanotransduction in Auditory Hair Cells

Transmembrane channel-like protein isoform 1 (TMC1) is a major component of the mechano-electrical transducer (MET) channel in cochlear hair cells and is subject to numerous mutations causing deafness. We report a new dominant human deafness mutation, TMC1 p.T422K, and have characterized the homologous mouse mutant, Tmc1 p.T416K, which caused deafness and outer hair cell (OHC) loss by the fourth postnatal week. MET channels showed decreased Ca²⁺ permeability and resting open probability, but no change in single-channel conductance or expression. Three adjacent deafness mutations are TMC1 p.L416R, p.G417R, and p.M418K, the last homologous to the mouse Beethoven that exhibits similar channel effects. All substitute a positive for a neutral residue, which could produce charge screening in the channel pore or influence binding of an accessory subunit. Channel properties were compared in mice of both sexes between dominant (Tmc1 p.T416K, Tmc1 p.D569N) and recessive (Tmc1 p.W554L, Tmc1 p.D528N) mutations of residues near the putative pore of the channel. Tmc1 p.W554L and p.D569N exhibit reduced maximum current with no effect on single-channel conductance, implying a smaller number of channels transported to the stereociliary tips; this may stem from impaired TMC1 binding to LHFPL5. Tmc1 p.D528N, located in the pore''s narrowest region, uniquely caused large reductions in MET channel conductance and block by dihydrostreptomycin (DHS). For Tmc1 p.T416K and Tmc1 p.D528N, transduction loss occurred between P15 and P20. We propose two mechanisms linking channel mutations and deafness: decreased Ca²⁺ permeability, common to all mutants, and decreased resting open probability in low Ca²⁺, confined to dominant mutations.SIGNIFICANCE STATEMENT Transmembrane channel-like protein isoform 1 (TMC1) is thought to be a major component of the mechanotransducer channel in auditory hair cells, but the protein organization and channel structure are still uncertain. We made four mouse lines harboring Tmc1 point mutations that alter channel properties, causing hair cell degeneration and deafness. These include a mouse homolog of a new human deafness mutation pT416K that decreased channel Ca²⁺ permeability by introducing a positively-charged amino acid in the putative pore. All mutations are consistent with the channel structure predicted from modeling, but only one, p.D528N near the external face of the pore, substantially reduced channel conductance and Ca²⁺ permeability and virtually abolished block by dihydrostreptomycin (DHS), strongly endorsing its siting within the pore.     

Intranasal sumatriptan for acute migraine attacks: a systematic review and meta-analysis

We performed this systematic review and meta-analysis to evaluate the tolerability and efficacy of intranasal sumatriptan, a selective serotonin agonist, compared to placebo or other migraine therapeutics for the treatment of acute migraine attacks. We searched PubMed, SCOPUS, Embase, and Cochrane CENTRAL for relevant randomized controlled trials (RCTs). Data were extracted from eligible studies and pooled as risk ratios (RR), using RevMan software. We performed subgroup and meta-regression analyses for different doses and treatment endpoints. Sixteen RCTs (n = 5925 patients) matched our inclusion criteria. The overall effect-estimate showed that intranasal sumatriptan was superior to placebo in terms of pain relief (RR = 1.70, 95% CI [1.31, 2.21], p < 0.0001) and headache relief (RR = 1.58, 95% CI [1.35, 1.84], p < 0.00001) at 2 h. Although sumatriptan was superior to placebo in terms of headache relief at 30 min (RR = 1.31, 95% CI [1.08, 1.59], p = 0.005), no significant difference was found between both groups in terms of the frequency of pain-free participants at 30 min (RR = 1.18, 95% CI [0.49, 2.88], p = 0.71). Subgroup analysis and meta-regression models showed that increasing the dose of sumatriptan reduced the time needed for headache relief; however, this clinical improvement with higher doses was associated with more frequent adverse events in comparison to smaller doses. In conclusion, intranasal sumatriptan is effective for the treatment of acute migraine attacks. However, it was associated with a six-fold increase in the risk of taste disturbance, compared to the placebo. Future RCTs are recommended to provide head-to-head comparison of different administration routes and drug formulations of sumatriptan.     

Needle Pulmonary Embolism in an Intravenous Drug User: a Case Report

International Journal of Mental Health and Addiction - Pulmonary needle embolization in intravenous drug users is rarely reported in the literature. The management of these patients is...     

The success rate of pregnancy in IUI cycles following endometrial sampling. A randomized controlled study

Objective

The aim of this work was to compare the pregnancy rates during IUI cycles with or without endometrial sampling.

Study design

A prospective, randomized study.

Patients and methods

150 patients were recruited. They were classified into three groups. Each comprised 50 patients. Group 1 was considered the control group and underwent IUI with no endometrial sampling. Group 2 underwent Tao Brush endometrial sampling on day 8–9 of the uterine cycle that preceded the stimulation cycle, and finally, Group 3 underwent Tao Brush endometrial sampling on day 8–9 of the same IUI cycle

Outcome of the study

A positive pregnancy test.

Results

Pregnancy percentages were 18, 38, and 36 % for group 1, group 2, and group 3, respectively. The paired t test was used to compare each two individual group means. The results show a highly significant value for the paired t test of the control group and group 2 of the patients (p = 0.001), as well as a highly significant results (p = 0.002) for the group 3 and the control group. No significant value was present between the group 2 and 3 of patients (p = 0.322).

Conclusion

Endometrial sampling significantly increases pregnancy rates in IUI procedures when it is done in the proliferative phase of the IUI cycle, or the cycle prior to IUI, than pregnancy rates with IUI alone.     

Promoters of and barriers to cervical cancer screening in a rural setting in Tanzania

Objective

To investigate promoters and barriers for cervical cancer screening in rural Tanzania.

Methods

We interviewed 300 women of reproductive age living in Kiwangwa village, Tanzania. The odds of attending a free, 2-day screening service were compared with sociodemographic variables, lifestyle factors, and knowledge and attitudes surrounding cervical cancer using multivariable logistic regression.

Results

Compared with women who did not attend the screening service (n = 195), women who attended (n = 105) were older (OR 4.29; 95% CI, 1.61–11.48, age 40–49 years versus 20–29 years), listened regularly to the radio (OR 24.76; 95% CI, 11.49–53.33, listened to radio 1–3 times per week versus not at all), had a poorer quality of life (OR 4.91; CI, 1.96–12.32, lowest versus highest score), had faced cost barriers to obtaining health care in the preceding year (OR 2.24; 95% CI, 1.11–4.53, yes versus no), and held a more positive attitude toward cervical cancer screening (OR 4.64; 95% CI, 1.39–15.55, least versus most averse).

Conclusion

Efforts aimed at improving screening rates in rural Tanzania need to address both structural and individual-level barriers, including knowledge and awareness of cervical cancer prevention, cost barriers to care, and access to health information.     

The role of matrix metalloproteinase-2 in the culture media in embryo implantation rate in normogonadotrophic cases undergoing ICSI

ObjectiveThe aim of the study is to correlate the changes in the biochemical marker MMP-2 in the culture media with the outcome of normogonadotrophic cases undergoing ICSI.MethodologyA prospective study of infertile females was conducted in El-Shatby Maternity University Hospital between October 2011 and May 2012 utilizing a sample of 40 normogonadotrophic infertile women (22 females with unexplained infertility and 18 females with tubal factor infertility).ResultsClinical pregnancy was 57.5%; 15 out of the 22 females with unexplained infertility and 8 out of the 18 females with tubal factor infertility. There was no abortion, ectopic or chemical pregnancy. Ongoing pregnancy after 14 weeks of gestational age was 100%.Total (MMP-2) ranged between (4.1 and 21.1) and (3.5–37) ng/ml with the mean of (9.91 ± 5.48) and (13.91 ± 8.87) ng/ml for non pregnant and pregnant groups respectively. There were no statistical significant differences between the two groups regarding total MMP-2 (P = 0.055).The mean of MMP-2/embryo/h ranged between (0.05 ± 0.05) and (0.06 ± 0.08) ng/ml/embryo/h for non pregnant and pregnant groups respectively. There were no statistical significant differences between the two groups regarding MMP-2/embryo/h (P = 0.234).ConclusionsMMP-2 concentration in the culture media cannot be used as a biochemical marker for embryo selection or prediction of implantation in the normogonadotrophic cases undergoing ICSI.RecommendationsResults of the present study suggest searching for other markers in the culture media for better embryo selection and for prediction of implantation in the normogonadotrophic cases undergoing ICSI.