Associations between first-trimester uterine artery Doppler velocimetry indices and adverse perinatal outcomes in women conceiving via in vitro fertilization

Aim: To explore if first-trimester uterine artery Doppler velocimetric values might predict adverse perinatal outcomes in patients conceiving via in vitro fertilization (IVF).

Methods: We evaluated pregnancies in women who conceived via IVF (Group 1, n?=?62) and compared these subjects to a control group (spontaneous pregnancies; Group 2, n?=?53) in terms of first-trimester uterine artery Doppler velocimetric data. We explored whether these data predicted adverse perinatal outcomes (need for cesarean delivery, preterm birth, low birth weight, lower APGAR score, and need for referral to a neonatal intensive care unit [NICU]).

Results: The mean age of Group 1 patients was 29.9?±?4.7 years and that of Group 2 was 27.2?±?4.2 years. Gestational age at birth, first-minute APGAR scores, NICU referral rate, birth weight, preterm birth rate, abortion rate, delivery type, the left-side uterine arterial systole–diastole ratio (LUASD), the left-side uterine arterial resistance index (LUARI), the right-side uterine arterial systole–diastole ratio (RUASD), and the right-side uterine arterial resistance index (RUARI) differed significantly between the two groups (all p values < 0.05). In the study group, positive correlations were evident between LUASD, LUARI, RUASD, and RUARI, preterm birth rates, and NICU referral rates. Also, birth weight correlated negatively with LUASD, LUARI, RUASD, and RUARI in the study group.

Conclusions: First-trimester uterine artery Doppler velocimetric indices, including the resistance index and systole–diastole ratio, usefully predict adverse perinatal outcomes of IVF pregnancies.     

Risk factors affecting prognosis in infantile spasm

Aim: To assess risk factors that affect epilepsy prognosis and neurodevelopmental outcome and response to treatment in patients diagnosed with infantile spasm. Methods: In this study, demographics, treatment modalities, etiologies, risk factors affecting neurodevelopmental outcome and epilepsy prognosis were assessed retrospectively at the end of a minimum 24-months follow-up of 104 patients diagnosed with infantile spasm from May 2012 to October 2015. Results: Neonatal seizure during neonatal period, abnormal head circumference, young age at the time of presentation and early gestational age, symptomatic etiology, abnormal initial examination and abnormal development test at the time of diagnosis, consanguinity, the medical center where treatment was started in the second center or beyond and magnetic resonance imaging finding were found to be statistically significant for poor prognosis in terms of neurodevelopment (p < 0.05). Abnormal initial examination and abnormal development test both at the time of diagnosis and at the end of follow-up, consanguineous parents, young age at the time of presentation, symptomatic etiology, a family history of mental retardation and epilepsy were found to be statistically significant for poor prognosis in terms of epilepsy. Administration of adrenocorticotropic hormone (ACTH) for seizure control was statistically significant compared to other antiepileptic drugs (p < 0.05). Conclusion: Infantile spasm is an age-related epileptic encephalopathy, and it was observed that it is still catastrophic, and that the most important factor affecting prognosis of epilepsy is etiology, age at the time of presentation and the medical center where treatment was started in the second center or beyond.     

Coronary arteriovenous fistulas in the adults: natural history and management strategies

Objective  

To describe aspects of the natural history and pathophysiology of coronary arteriovenous fistula and to propose potential treatment strategies.     

Pigmented villonodular synovitis of a lumbar intervertebral facet joint

Background contextPigmented villonodular synovitis (PVNS) is a slowly progressive lesion of uncertain etiology that involves the synovial membrane of joints or tendon sheaths. Only rarely does PVNS affect the axial skeleton, where it arises from the vertebral articular facet joint. Its treatment and prognosis remains limited.PurposeTo describe our management in a patient with PVNS and to review previously published cases.Study designCase report.MethodsThis is a case report of a 59-year-old woman who presented left sciatica. Computed tomography (CT) imaging revealed a mixed sclerotic and lucent lesion affecting the left L4–L5 facet joint. Magnetic resonance imaging (MRI) demonstrated a diffusely infiltrative process that originated from the left inferior articular process of L4 vertebra with extension into the spinal canal. A total synovectomy with left L4 hemilaminectomy was performed. Left L5 root was decompressed with total microscopic tumor removal. Decompression of spinal canal and absence of the tumor was shown by MRI and CT scan after the operation.ResultsComplete resolution of the patient's complaints was achieved. Histopathological analysis was consistent with a diagnosis of PVNS.ConclusionsThe principle of surgical management of spinal lesions causing neurologic deficit is early surgical decompression. It is also important to totally remove the synovium, the origin of PVNS, to prevent the recurrence.     

Induction Chemotherapy and Chemoradiation Therapy for Inoperable Locally Advanced Non–Small-Cell Lung Cancer: A Single-Institution Review of Two Different Regimens

PurposeWe compared 2 different chemotherapeutic agents in combination with cisplatin as induction chemotherapy (ICT) followed by chemoradiation therapy (CHRT) in patients with inoperable locally advanced non–small-cell lung cancer (NSCLC).Patients and MethodsA total of 90 patients with inoperable locally advanced NSCLC received 3 courses of ICT consisting of gemcitabine 1200 mg/m² on day 1 and day 8 every 3 weeks and cisplatin 75 mg/m² on day 1 every 3 weeks (group 1; n = 39) or docetaxel 75 mg/m² on day 1 every 3 weeks and cisplatin 75 mg/m² on day 1 every 3 weeks (group 2; n = 51) followed by CHRT (docetaxel 30 mg/m² every week and cisplatin 20 mg/m² every week with 6600 cGy radiation therapy).ResultsAfter the ICT, the response rate for group 2 (88.2%) was significantly higher than that of the gemcitabine-cisplatin arm (64.1%; P = .017). The response assessment performed on first month after CHRT revealed statistical difference for objective response rate in group 2 when compared with group 1 (P = .04). At the median follow-up of 15.7 months (range, 5-36 months), median overall survival (OS) was 12 months in group 1 (95% CI, 9.1-14.8) and 29.9 months in group 2 (95% CI, 16-43). Median progression-free survival (PFS) was 8 months in group 1 and 15 months in group 2. There was statistically significant difference between the 2 groups regarding OS and PFS (P = .043).ConclusionOur results suggest that OS, PFS, and local control rate are significantly improved with ICT consisting of docetaxel and cisplatin when compared with gemcitabine-cisplatin in inoperable locally advanced NSCLC.     

Pulmonary Hemosiderosis in Association with Celiac Disease

A 15-year-old male had a history of increasing dyspnea on exertion, cough, sputum production, fever, weakness, hemoptysis, and diarrhea. Chest radiography demonstrated bilateral alveolar consolidation. Bronchoalveolar lavage fluid analysis revealed extensive hemosiderin-laden alveolar macrophages. On the basis of iron deficiency anemia, diarrhea, raised antigliadin and antiendomysial antibodies, widespread villous atrophy, and crypt hyperplasia on intestinal biopsy, celiac disease was diagnosed. After treatment with a gluten-free diet, all his clinical symptoms and radiographic findings improved within two weeks.     

The Change in Facial Emotion Recognition Ability in Inpatients with Treatment Resistant Schizophrenia After Electroconvulsive Therapy

People with schizophrenia have impairments in emotion recognition along with other social cognitive deficits. In the current study, we aimed to investigate the immediate benefits of ECT on facial emotion recognition ability. Thirty-two treatment resistant patients with schizophrenia who have been indicated for ECT enrolled in the study. Facial emotion stimuli were a set of 56 photographs that depicted seven basic emotions: sadness, anger, happiness, disgust, surprise, fear, and neutral faces. The average age of the participants was 33.4 ± 10.5 years. The rate of recognizing the disgusted facial expression increased significantly after ECT (p < 0.05) and no significant changes were found in the rest of the facial expressions (p > 0.05). After the ECT, the time period of responding to the fear and happy facial expressions were significantly shorter (p < 0.05). Facial emotion recognition ability is an important social cognitive skill for social harmony, proper relation and living independently. At least, the ECT sessions do not seem to affect facial emotion recognition ability negatively and seem to improve identifying disgusted facial emotion which is related with dopamine enriched regions in brain.     

Prevalence of Helicobacter pylori in symptomatic patients and detection of clarithromycin resistance using melting curve analysis

Abstract

Background:

Clarithromycin is often a component of combination therapies for Helicobacter pylori eradication; however, increases in resistance rates have decreased the success of the treatment.

Objective:

This study was designed to determine the prevalence of H pylori infection in symptomatic patients and to detect clarithromycin resistance rates using melting curve analysis.

Methods:

Patients scheduled for upper endoscopy at the Endoscopy Unit of the Department of Gastroenterology, Duzce University, Medical Faculty Hospital, Konuralp/Duzce, Turkey, were assessed for enrollment in the study. Two pairs of gastric biopsy specimens (antrum and corpus) were obtained from each study patient. Histopathologic examination, rapid urease test, culture, and polymerase chain reaction (PCR) of the specimens were used to identify H pylori infection. Clarithromycin resistance was detected using melting curve analysis.

Results:

Seventy-five patients (41 women, 34 men; mean [SD]age, 42.6 [14.5] years [range, 17–70 years]) were included in the study. Using histopathology and rapid urease test, H pylori was detected in 40 (53.3%) of the 75 specimens. H pylori was detected using PCR in 40 (53.3%) specimens and by culture in 10 (13.3%) specimens. The specificity and sensitivity of PCR and culture were interpreted by comparing them with the results of histopathologic examination and urease tests. The specificity and sensitivity of PCR were 68.6% and 72.5%, respectively, and the specificity and sensitivity of culture were 97.1% and 22.5%, respectively. Of the 40 isolates, 21 (52.5%) were susceptible to clarithromycin, 12 (30.0%) were resistant, and a mixed susceptibility pattern was detected in 7 (17.5%) specimens. H pylori isolates from 19 (79.2%) of the 24 patients who had formerly used clarithromycin showed clarithromycin resistance.

Conclusions:

The prevalence of H pylori infection was 53.3% for the symptomatic patients in this study, and 47.5% of the isolates showed clarithromycin resistance using melting curve analysis. The PCR-based system used in this study was accurate for the detection of H pylori infection as well as clarithromycin susceptibility testing directly in biopsy specimens.Key Words: Helicobacter pylori, clarithromycin resistance, melting curve analysis, PCR