Negative serology: could exclude the diagnosis of brucellosis?

Two cases of brucellar spondylodiscitis of the lumbar area were presented. Although both cases showed typical radiological changes, serological tests could not detect Brucella agglutinating antibodies. One of the patients was bacteremic and Brucella spp. was identified from blood culture. In the second patient needle biopsy was required for definite diagnosis. Although small, serologic tests have a certain rate of false negative results in brucellosis. Thus, a negative serology should not exclude the diagnosis of brucellosis, as it is demonstrated in the current cases.     

David's procedure for pulmonary artery aneurysm

Pulmonary artery aneurysm (PAA) is a rare entity with fatal complications. Its silent course contributes to large aneurysms with compression symptoms. We present a 39-year-old female idiopathic pulmonary arterial hypertension patient with a giant PAA causing severe pulmonary regurgitation (PR) and symptomatic left main coronary artery compression (LMCA). Since she had a failed LMCA stenting attempt, she underwent surgery. A valve-sparing David-like pulmonary trunk reconstruction and coronary artery bypass were performed. This case illustrates that David-like reconstruction procedure can be applied to the PAA with severe PR.     

兴趣在大学生学习中的作用与培养

在大学教学和学习中,学习兴趣是引导学生追求知识的最关键非智力因素之一,兴趣在目前的教育教学中受到越来越多的重视。本文主要论述了兴趣在大学生学习生活中的作用、个人应如何对待自身的兴趣以及作为教育工作者该如何引导和培养学生的学习兴趣,从而改善学习效果。     

In Her Own Words: Living with Urinary Incontinence in Sexual Life

Urinary incontinence (UI) is an extremely private, disturbing health issue with negative sexual effects for women. The aim of this study was to identify the feelings and experiences of women with UI effects on their sexual lives through a qualitative research method. Twelve Turkish women participated in this study. The mean age of them was 47.08 ± 6.12. Data was collected using both a demographic data form and a semi-structured interview form. Interview form was performed open-ended items which were designed to gather data on the experiences in sexual life, thoughts and perceptions of the participants about the impacts of UI on their sexual lives. Data was analysed by Colaizzi’s analysis method. The findings that attempt to describe how women with UI live their sexuality were presented under four themes such as experiences of women when the symptoms first occurred, feelings, negative effects on sexual functioning, behavior for coping with UI. Seven of the women described the feeling that the involuntary UI caused during sexual intercourse as “shameful.” The women reported that UI or the feeling of embarrassment during sexual intercourse has led to an inability to enjoy sexual intercourse by causing loss of sexual desire (five women), not having sexual intercourse (three women), and distraction (two women). There should be high degree awareness for UI and its sexual effects, not only by women but also by the healthcare staffs.     

Aphasia: an early uncommon complication of ovarian stimulation without ovarian hyperstimulation syndrome

Thromboembolic disease associated with assisted reproductive techniques is extremely rare. A 21-year-old woman with primary infertility underwent an ovulation induction cycle with luteal long protocol. Twenty-four hours following oocyte retrieval, the patient complained of difficulty in speaking. On neurological examination, mild disorientation, motor aphasia, and right-sided hypoesthesia were noted. Brain computed tomography scanning without contrast revealed left parietal lob infarct. Brain magnetic resonance imaging (MRI), MRI angiography (MRA) and perfusion MRI demonstrated an occlusion of the posterior division of the left middle cerebral artery (MCA). Physical, ultrasound examinations and laboratory test evaluation failed to reveal ovarian hyperstimulation syndrome. Except for ovarian stimulation, no additional risk factors for stroke were shown. Following anticoagulation and speech therapy, the patient recovered completely within eight months. One year after the left MCA thrombosis, she conceived spontaneously and had an uncomplicated vaginal delivery of a live male infant weighing 2900 g at 38 weeks gestation. This case supports that ovulation induction and assisted reproductive techniques may be a newly recognized cause of cerebral infarction in otherwise healthy women.     

Why and how should multiple pregnancies be prevented in assisted reproduction treatment programmes?

Although most professional societies have issued guidelines to diminish the number of embryos to be transferred during assisted reproductive techniques, the incidence of multiple pregnancies remains unacceptably high. The burden of morbidity and mortality seems to increase substantially with each fetus in a multiple gestation. As a result, there has been growing debate on the need to prevent multiple pregnancies. The infertility specialists who can solve the infertility problem are usually shielded from the complications of multiple pregnancies. If they were involved in the delivery and, more particularly in the care of multiple pregnancies (both financially and socially), their attitude would probably change. IVF centres should gradually reduce the mean number of embryos per transfer in terms of the cost:benefit ratio. A further reduction to one single embryo per transfer in good cases would be similarly acceptable. Laboratory expertise is of vital importance, especially in terms of embryo culture, embryo selection, and freezing and thawing techniques in embryo transfer programmes for reducing the number of transferred embryos.     

The inappropriate use of HbA1c testing to monitor glycemia: is there evidence in laboratory data?

RATIONALE, AIMS AND OBJECTIVES: Diabetes is a chronic illness and have relatively high prevalence. Glycemic control is fundamental to the management of diabetes. Hemoglobin A1c (HbA1c) is a commonly used laboratory test to monitor glycemia and to manage diabetes. This study aimed to assess the appropriateness of the frequency of HbA1c test order with respect to the commonly approved guidelines for monitoring glycaemia of patients. METHODS: To assess the rate of inappropriate test orders, laboratory records of HbA1c tests ordered between 2002 and 2004 were evaluated. Inappropriate orders were defined as any order for a given patient that takes place within a 29- or 89-day-period following the previous HbA1c order. The effects of various parameters, like ordering clinics, the first HbA1c level, or the on-line availability of test results on test ordering were evaluated. RESULTS: Evaluation of test intervals showed that 10.3% of all orders and 33.8% of the inpatients' orders were performed within 29 days, 35.5% of all orders and 55% of the inpatients' orders were within 89 days. CONCLUSIONS: Inappropriate laboratory utilization of HbA1c testing is very common especially in the inpatient clinics. We think that the application of the guidelines may decrease unnecessary health expenditure.