Can affinity of hemoglobin to oxygen to be a prognostic marker in critically ill COVID-19 patients?

Background

This study's objective is to determine the slope of the hemoglobin oxygen dissociation curve in critically ill patients who have COVID-19 along with blood gas measurements and how mortality might be impacted by this circumstance.

Aim

It has been reported that the hemoglobin oxygen dissociation curve is not different from healthy patients in COVID-19. However, there are insufficient data on the behavior of the curve in patients who require intensive care.

Patients and Methods

This retrospective study was conducted between 01.03.2021 and 01.07.2021 with patients who were followed up due to COVID-19 in adult intensive care unit. P50 and lactate value obtained from in vitro calculated blood gas analysis. The survival status of the patients was recorded.

Results

The mean P50 value at the admission of nonsurvivors was significantly higher than survivors. In correlation analysis, a significant positive correlation was seen between P50, mortality, and lactate level at admission. SpO₂, PaO₂/FiO₂ ratio, and length of stay in intensive care unit were significantly negatively correlated with P50 levels.

Conclusion

A right shift in the hemoglobin oxygen dissociation curve is associated with mortality. Lactate levels were also associated with a right shift. Prospective experimental studies are needed to provide a better understanding of this process.

Role of first trimester screening test in predicting the perinatal outcomes in low risk term pregnancies

Objective: This study aims to investigate the relationship between the nuchal translucency (NT) values measured in the first trimester and the well-being of the newborn. Methods: The study was planned as a retrospective cross-sectional study and was conducted between January 2018 and January 2020. A total of 2394 patients who had a combined test and delivered at our university hospital were included in the study. The demographic data of the pregnant women were recorded. NT MoM values, PAPP-A and β-hCG MoM values, birth weight, gender, need for neonatal intensive care (NICU), and Apgar scores were evaluated. Results: It was found that NT (MoM) values were similar among the SGA, AGA, and LGA groups (p=0.159). PAPP-A (MoM) values were similar in the SGA group compared to AGA and LGA infant groups (p=0.947). It was also found that β-hCG (MoM) values were similar in the AGA group compared to SGA and the LGA infant groups (p=0.694). When compared with those with NICU and non-NICU, the NT, PAPP-A, β-hCG, and birth weight values were again not found to be statistically significant (p>0.05). The NT, PAPP-A, β-hCG, and male gender factors were evaluated in the Binary Logistic Regression Analysis, in which being an SGA baby was considered as a risk. It was found that a 1 mm increase in NT values increased the risk of having an SGA baby 2.63 times at a statistically significant level (OR=2.636, p=0.009, 95% CI: 1.277–5.440). PAPP-A, β-hCG levels, and having a male gender were not related to the risk of having an SGA baby. Furthermore, NT, PAPP-A, β-hCG levels, and having a male gender were not associated with the risk of NICU hospitalization. Conclusion: In conclusion, we could not predict the birth weight with increased NT MoM values that were detected in the first trimester combined test in this study; however, we found that the risk of having an SGA fetus increases with a weak rise in NT value.

Comparison of maternal and neonatal outcomes in twin pregnancies according to delivery types: vaginal delivery or Cesarean delivery?

Objective: Our aim was to compare the maternal and neonatal outcomes of twin pregnancies, which result in vaginal delivery (VD) and Cesarean section (CS), and the factors affecting the decision of CS. Methods: Twin pregnancies between 30 and 39 weeks who gave birth in a tertiary center were included in the present study. The demographic data and maternal and neonatal outcomes of the patient groups who gave birth <32 weeks, 32–37 weeks, and >37 weeks were recorded and compared according to the type of birth. Results: A total of 1209 patients were included in the study. The 1- and 5-minute Apgar scores of the 1st and 2nd fetuses in twin pregnancies <32 weeks of gestation were higher in the CS group at a statistically significant level (p=0.007, p=0.010, p=0.001, and p=0.003, respectively). The 1- and 5-minute Apgar scores of the 2nd fetuses of the pregnant women >37 weeks of age were higher in the VD group at a statistically significant level (p=0.039 and p=0.032, respectively). The newborn intensive care unit (NICU) admission rates of 1st fetus and 2nd fetus in the groups of <32 weeks, 32–37 weeks, and >37 weeks were higher in those born by CS at a statistically significant level when compared to those born by VD (1st fetus p<0.001, p<0.001, p=0.016, respectively; 2nd fetus p<0.001, p<0.001, p=0.012, respectively). Conclusion: It must be kept in mind that twin pregnancies have high risks. However, vaginal delivery can be considered as a safe and reasonable option in appropriately selected cases and in the presence of experienced obstetricians by being careful about maternal and neonatal complications which might occur.

Comparison of cardiac morphology and function in small for gestational age fetuses and fetuses with late-onset fetal growth retardation

OBJECTIVES

To compare cardiac structural and functional findings of fetuses with fetal growth restriction (FGR) and small for gestational age (SGA).

METHODS

In this prospective cohort study, patients were classified into three groups using Delphi procedure according to fetal weight, umbilical, uterine artery Doppler and cerebroplacental ratio. Fetal cardiac ultrasonographic morphology and Doppler examination was performed to all pregnant women at 36 weeks of gestation.

RESULTS

Seventy three patients were included in the study. There were one (6.7%) patient in the control group, 2 (13.3%) in the SGA group and 12 (80%) in the FGR group who needed neonatal intensive care unit (NICU) and NICU requirement was significantly higher in FGR fetuses (p<0.001). Left spherical index was found to be lower only among FGR fetuses (p=0.046). Left ventricular wall thickness was decreased and the right/left ventricular wall ratio was increased in FGR fetuses (p=0.006, p<0.001). Tricuspid/mitral valve ratio and mitral annular plane systolic excursion value was lower in FGR fetuses (p=0.034, p=0.024 respectively). Also, myocardial performance index was remarkably higher in FGR group (p=0.002).

CONCLUSIONS

We detected cardiac morphological changes in cases of both SGA and FGR-more pronounced in the FGR cases. Findings related to morphological changes on the left side in FGR cases were considered secondary to volume increase in FGR cases as an indicator of a brain-protective effect. In the FGR group, both systolic and diastolic dysfunctions were detected in the left heart.

Fetal cardiac morphology and geometry in pregnancies with class A1 and A2 gestational diabetes mellitus

OBJECTIVE

To evaluate whether certain parameters on fetal cardiac morphology and geometry measured at 20-22 weeks of gestation differ in subsequently diagnosed gestational diabetes mellitus (GDM) pregnancies and whether these changes are associated with disease severity as indicated by class A1 and A2 GDM.

METHOD

It was designed as a retrospective study. All measurements were taken between 20 and 22 weeks of gestation. We compared fetal cardiac structural measurements of 200 uncomplicated pregnancies (control group) with those of 307 GDM patients (160 of the them were regulated with diet (GDM A1) and 147 of them received insulin treatment (GDM A2) during pregnancy). GDM were diagnosed between 24-28 weeks of gestation with 75 gram (g) oral glucose tolerance test.

RESULTS

The interventricular septum (IVS) was thicker in both in GDM A2 and GDM A1 than control (p < .001, p < .001), and there was statistically significant difference between GDM A2 and GDM A1 (p = .012). In both left and right wall thickness in GDM A1 and GDM A2 were remarkably higher than control group (p < .001, p < .001, p < .001, p < .001). The left and right spherical indices were higher in both GDM A1 and GDM A2 groups than controls (p = .021 and p = .028). Left and right area in GDM A1 and GDM A2 groups were significantly smaller than control groups (p < .001 and p = .001).

CONCLUSION

Gestational diabetes is a common obstetric morbidity, which causes fetal cardiac structural changes. Our study shows that these changes can occur during the early weeks of pregnancy.

Comparison of Depression and Anxiety Scores in Multi/Nulliparous Women who have Undergone Dilatation and Curettage

AIM

To demonstrate the duration of negative psychological effects of elective curettage on both nulliparous and multiparous women and to determine the association between parity and post-abortion depression and anxiety.

MATERIALS AND METHODS

A total of 168 women who applied to our reproductive health clinic for elective abortion were included in this prospective study. 84 nulliparous and 84 multiparous women were asked to fill out Beck Depression Inventory (BDI-II) and Beck Anxiety Inventory (BAI-II) forms by a psychiatrist at their pre-abortion consultation and at 3 months follow-up. A thorough anamnesis with demographic data of each patient was recorded at initial consultation.

RESULTS

Depression and anxiety measurements in both groups significantly decreased at the end of the 3 months follow-up. The mean depression value in nullipara group decreased from 24.2 ± 5.8 to 9.4 ± 3.3 and anxiety from 23.5 ± 3.7 to 8.8 ± 2.5. In the multipara group, the mean depression score decreased from 15.7 ± 4.0 to 7.3 ± 2.3, and anxiety from 15.9 ± 4.0 to 7.9 ± 2.3. A significant decrease in both depression and anxiety scores could be observed in both groups.

CONCLUSION

Although the severity of depression and anxiety varies between multiparous and nulliparous individuals, this study showed that both depression and anxiety scores return to normal values by the end a 3 months follow-up period.

Knowledge, attitude, and behaviors of pregnant women about COVID-19: a single-center cross-sectional study

Objective Our aim is to assess the knowledge, attitude, and behaviors of pregnant women about COVID-19. Methods This cross-sectional survey study was performed on pregnant women in their second and third trimesters between November–December 2020. The participants completed a questionnaire consisting of 5 parts. Demographic data of pregnant women, their knowledge, attitude, and risk perceptions toward COVID-19, their practices and worries about COVID-19, and what they knew about pregnancy were calculated as percentile and mean values. Results A total of 1011 participants were included in the statistical analysis. The mean age and BMI of the participants were 27.09±5.55 and 27.48±4.71 kg/m2, respectively. Mean gestational age and parity were 26.20±9.30 and 1.47±1.19, respectively. Measures taken by authorities for COVID-19 were thought to be “extremely adequate” by 21.4% of the participants and “highly adequate” by 30%. Of the participants, 47.5% trusted healthcare professionals extremely in fighting against the COVID-19 pandemic. Affection and respect for healthcare professionals during the pandemic increased in 89.1% of the participants. Of the participants, 88.5% stated that they would follow the strict quarantine requirements when necessary and 48.3% felt more vulnerable/weak as they were pregnant during the pandemic. Of the participants, 50.6% were intending to decrease their antenatal visits during the COVID-19 pandemic. Conclusion The measures taken can be applied with high awareness of COVID-19. Sufficient training, in that case, can be done through communication routes such as information and public service announcements.

Successful treatment of type III atresia ani and rectovaginal fistula in a kitten

A six-weeks-old, female kitten presented with dehydration, depression, atresia ani and a discharge of watery feces from the vulvar opening. On radiographic examination, the blind-end of the rectum was determined to be >1 cm cranial from the anal dimple, classifying it as type III atresia ani. Atresia ani combined with a rectovaginal fistula is an uncommon congenital defect of the terminal rectum and anus that can occur in kittens. After supportive medical treatment for three days, the patient was strong enough for surgical correction. The distal rectal pouch was connected to the unperforated anus and the rectovaginal fistula was closed. The kitten recovered uneventfully and was able to defecate normally at 38 weeks follow-up. In this case report, the importance of early surgical correction to avoid potential life-threatening complications from this congenital abnormality is demonstrated.

Evaluation of the effect of Birth Preparation Program on birth satisfaction with "Salmon's Item List" scale

OBJECTIVES

The aim of this study is to investigate the effects of a birth preparation program on birth satisfaction.

MATERIAL AND METHODS

This cross-sectional study was conducted with patients who applied to our hospital between January 2018 and January 2019. A total of 164 pregnant women (Study Group) who applied for the birth preparation program and completed all training in our hospital and 152 pregnant women who did not apply for the birth preparation program and who did not know about such training (Control Group) were included in the study. Demographical data and obstetric parameters of the groups were recorded. All patients were evaluated with the Visual Analog Scale and Salmon's Item List scale 48 hours after the delivery. The scores of both groups were compared.

RESULTS

There were no significant differences between the groups in terms of age, gravida, parity, gestational week of birth, the birth weight of infants, and 5th-minute APGAR scores. It was found that the Visual Analog Scale scores of the Control Group were significantly higher than in the Study Group. The Salmon's Item List scores of the Study Group were significantly higher than those of the patients in the Control Group (< 0.01).

CONCLUSIONS

The birth preparation program increases satisfaction during labor and decreases the traumas that may occur in the following births and increase comfort in the postpartum period. For this reason, such programs must be applied commonly to ensure that women can face both the birth and postpartum processes comfortably.

Predictors of the recurrence of surgically removed previous caesarean skin scars at caesarean section: A retrospective cohort study

BACKGROUND

Caesarean skin scars (CSS; hypertrophic scars and keloids) are very stressful for women and treatment strategies vary. However, there is a lack of knowledge about the outcome of surgical excision of CSS during caesarean section (CS). The study aims to determine the rate of recurrence and risk factors of recurrence for surgically removed CSS.

METHOD

This is a retrospective cohort study that used STROBE guidelines. Pfannenstiel incisions of 145 patients were evaluated. Patients were divided into two groups: recurred (group 1, n = 19) and non-recurred group (group 2, n = 126). The groups were compared.

RESULTS

The rate of recurrence of CSS was 13% in the total cohort (19/145), one of the main outcomes of the study. While emergency CS was performed for 12 patients in group 1 (63%), CS was carried out in 25 patients in group 2 (20%); this difference was significant (P = 0.001). Before surgery, white blood cell and neutrophil counts were significantly higher in group 1 (P = 0.014 and P = 0.023, respectively). There were 11 dark-skinned women (26%; Fitzpatrick type 4) in group 1 and 31 (74%) in group 2. This difference was statistically significant (P = 0.031). As the other main outcome, emergency CS could be accepted as a risk factor for recurrence in the multivariate regression analysis (P = 0.060; odds ratio = 5.07; 95% confidence interval = 0.93-17.51).

CONCLUSION

The rate of recurrence of surgically removed previous CSS at CS is promising without adjunct therapy. Emergency CS was found to be a risk factor for recurrence.

LAY SUMMARY

Background Caesarean skin scars (CSS; hypertrophic scars and keloids) are very stressful and are generally itchy and painful for women. Treatment strategies vary. However, there is a lack of knowledge about the outcome of only surgical excision of CSS scars during caesarean section (CS). The issue being explored There are few data in the literature for CSS in the lower abdomen. These scars can be removed during the second or third CS, but the results are not known exactly. How was the work conducted? In our clinic, 145 patients with CSS were given a CS and their scars were removed at the same time. While most of these scars were reported as hypertrophic by pathological examination, some were reported as keloid. At the earliest, one year after surgery, the rate of recurrence was found to be 13%. What we learned from the study Asymptomatic patients who are planning another pregnancy and do not want to receive any other radiotherapy or steroid injection therapy can wait to remove their CSS at the next CS, especially elective CS with or without adjunct therapy. Emergency CS was found to be a risk factor for the recurrence of these scars.

Vaginal axis on MRI after laparoscopic lateral mesh suspension surgery: a controlled study

INTRODUCTION AND HYPOTHESIS

Laparoscopic lateral mesh suspension (LLMS) has emerged as a practical, safe, and feasible alternative to sacrocolpopexy (SCP) for treating female genital apical prolapse. Although several prior studies have reported changes in the vaginal axis in women who have undergone SCP or sacrospinous ligament fixation (SSLF) surgery for prolapse, there is a lack of data on changes in the vaginal axis after LLMS. This study was aimed at investigating the level of anatomical correction following LLMS and comparing the vaginal axis on magnetic resonance imaging (MRI) in patients with apical genital prolapse.

METHODS

Patients who underwent LLMS and a nulliparous control group were included in this observational prospective case-control study. MRI was performed on the control group and the study group pre- and postoperatively. The angle between the pubococcygeal line and the lower vaginal segment, the angle between the levator plate and the pubococcygeal line, and the angle between the lower and upper vaginal segments were measured and compared.

RESULTS

The angles measured between the pubococcygeal line and the lower vaginal segment and between the levator plate and the pubococcygeal line were significantly lower in the preoperative than in the postoperative measurements (p < 0.001). All angles were found to be similar in the nulliparous women and in the patients following LLMS surgery. The Pelvic Organ Prolapse Symptom Score (POP-SS) score decreased significantly after the operation (p < 0.001).

CONCLUSION

The vaginal axis was found to be near-normal in patients who underwent LLMS.

The effect of vaginal disinfection on reducing post-caesarean endometritis: A prospective, randomised controlled trial

PURPOSE

We aimed to evaluate the efficacy of vaginal disinfection using 10 % povidone-iodine on rates of endometritis from post-caesarean infectious diseases before elective caesarean section (CS).

METHODS

A total of 270 pregnant women who chose to undergo elective CS were recruited for this prospective randomised controlled study. The experimental group comprised 130 patients who had preoperatively undergone vaginal disinfection with 10 % povidone-iodine for 30 s. The control group consisted of 140 patients who had not undergone any vaginal implication before CS. The primary outcome measure was the rate of postpartum endometritis for each group. Intraoperatively, all patients who had closed uterine cervical canals underwent a digital opening of the internal and external cervical canal to equalise the groups. All of the participants were checked for endometritis one week after CS at the hospital. Additionally, for the week before and after surgery, C-reactive protein (CRP) and white blood cell (WBC) values were assessed for both groups. Ethics committee approval number: 339. Statistical analysis was performed using R version 3.5.1 (R statistical Software, Institute for Statistics and Mathematics, Vienna, Austria).

RESULTS

The groups were balanced in terms of the patients' demographic characteristics. There were no significant differences between the two groups according to endometritis rates: 4.6 % in the study group versus 6.4 % in the control group (p > 0.05). The CRP and WBC values before CS were similar in both groups. In the study group, the CRPand WBC values after CS were lower, whereas they were higher in the control group after CS; these differences were significant (p = 0.01 for CRP and p = 0.001 for WBC).

CONCLUSION

Vaginal disinfection with povidone-iodine solution 10 % before elective CS does not significantly reduce post-caesarean endometritis rates; however, it does significantly reduce inflammatory markers such as CRP and WBC.

Women's knowledge and beliefs towards vaccination for influenza during pregnancy in Turkey and underlying factors of misinformation: a single-centre cross-sectional study

OBJECTIVE

The aim of the study was to evaluate the knowledge and perceptions of the pregnant women presenting to our hospital for seasonal vaccination for influenza and to determine the factors associated with it.

METHOD

In this cross-sectional study pregnant woman presenting to our hospital between October 2018 and March 2019 were evaluated. A non-validated, well-detailed questionnaire addressing the vaccination rates, participants' perceptions about the facts behind the vaccination for influenza and the factors associated with refusal of vaccination was performed. Women's knowledge level provided by their healthcare providers was also questioned.

RESULTS

A total of 250 participants were included in the study. The average age of the patients was 28.85 ± 5.42 years (range 18-43); and the average pregnancy week was 19 ± 9.75. It was determined that 98% (n = 245) of the participants did not have any vaccinations before, and 98.8% (n = 247) did not have any vaccination during their current pregnancy. 65.2% (n = 163) of the participants did not know that the vaccination for influenza was safe in pregnancy; and 64% (n = 160) did not know that the vaccination for influenza was recommended in pregnancy. The most frequent responses given by the participants to justify their refusal for the vaccination was "my doctor was against" and "it can be harmful to my baby" (25.6% and 24%, respectively). It was determined that 98.4% (n = 246) of the participants were not recommended about the vaccination for influenza by any healthcare centres; and 92.8% (n = 232) did not receive any information on vaccination for influenza.

CONCLUSION

The knowledge of the participants on vaccination for influenza was inadequate and had misconceptions. The inadequacy of healthcare employees, government institutions and the media may have played roles in this outcome. The reasons underlying the inadequacy of the healthcare providers on vaccination for influenza may be questioned.

The Effect of Neural Therapy on Long-Term Postoperative Discomforts after Bilateral Tubal Ligation

BACKGROUND

In this study, we aimed to assess the effect of neural therapy in the prevention of post-tubal syndrome, which is the combination of dysmenorrhea, bloating, dyspareunia, heavy menstrual bleeding, chronic vaginitis, and cystitis, after elective bilateral tubal ligation with modified Pomeroy technique.

MATERIAL AND METHODS

In total, 113 patients who have undergone bilateral tubal ligation with modified Pomeroy technique between January 2016 and December 2018 in our clinic have been included. Postoperatively, patients were divided into two groups. One group received neural therapy (n = 52), and the other group did not receive neural therapy (control group, n = 61). Both groups were evaluated in terms of preoperative and postoperative symptoms. One year after surgery, patients' pain levels were evaluated using visual analog scale (VAS).

RESULTS

When both groups were compared in terms of symptoms, dysmenorrhea, dyspareunia, bloating, frequency of vaginitis, and cystitis per year and pain perception using VAS, the symptoms were significantly less in the neural therapy group. However, there was no difference between the groups in terms of the amount of menstrual bleeding.

CONCLUSIONS

Patients who received neural therapy showed less pain symptoms (dysmenorrhea and dyspareunia), and their VAS scores were lower when compared to the control group. Thus, we concluded that neural therapy is effective in the treatment of post-tubal syndrome.

Comparison of hepatitis B, hepatitis C, and HIV seropositivity of Syrian and Turkish pregnant women

OBJECTIVE

In this study, we aimed to compare the seroprevalence of hepatitis B (HBV), hepatitis C (HCV), and human immunodeficieney viruse (HIV) in Syrian pregnant women and Turkish pregnant women in our hospital.

MATERIALS AND METHODS

In our study, a total of 68,169 Turkish pregnant women who received HB surface antigen (HBsAg), HB surface antibody (anti-HBs), HCV antibody (anti-HCV), anti-HIV test, and a total of 11,015 Syrian pregnant patients who received HBsAg, anti-HBs, anti-HCV and anti-HIV tests were examined retrospectively between January 2012 and January-2018 in Universty of Health Sciences Kanuni Sultan Süleyman Training and Research Hospital, Obstetrics and Gynecology Clinic.

RESULTS

In our study, the rates of HBsAg, anti-HCV, and anti-HIV seropositivity were 1.1%, 0.1%, and 0.03% in Syrian pregnant women between 2012 and 2018, respectively. In the other study group, in Turkish pregnant women, HBsAg, anti-HCV, and anti-HIV seropositivity rates for 2012 and 2018 were found as 1.8%, 0.2%, and 0.08%, respectively.

CONCLUSION

Although there were no significant differences between the HBsAg, anti-HCV, and anti-HIV results of both groups, the anti-HBs positivity was higher at a significant level in Turkish pregnant women. The reason of the significantly higher anti-HBs positivity levels in pregnant women might stem from the fact that women are vaccinated and controlled regularly due to the policies in this regard in our country.

A comparison of obstetric outcomes in adolescent pregnancies and adult pregnancies

Introduction: Adolescent pregnancies are associated with adverse maternal and fetal outcomes including preeclampsia, preterm birth, and fetal growth restriction compared to adult pregnancies. The purpose of our study is to compare the incidents of obstetric outcomes between the adolescent pregnancies and adult pregnancies.Materials and methods: This retrospective case-control study was conducted between January 2013 and January 2018 at Kanuni Sultan Suleyman Research and Training Hospital, Istanbul, Turkey. The institutions' medical records were screened for women with pregnancies after 24 weeks of gestation. Women under 19 years of age were included as the adolescent group and women between the ages of 20 and 29 were included as the control group. Obstetric outcomes were compared between the groups.Results: There were 3875 adolescent pregnancies in the case group and 3875 adult pregnancies in the control group. Even after adjusting for confounders in our adolescent pregnant cohort, the odds of intrauterine growth restriction, preterm birth and premature rupture of membranes were higher than in our adult pregnant cohort. On the other hand, we found low incidents of preeclampsia and gestational diabetes mellitus in pregnant women younger than 19 years of age.Conclusions: Adolescent pregnancies should be closely followed up as they have higher preterm birth rates as well as the risk of intrauterine growth restriction.

Evaluation of platelet-rich plasma injection activity in the treatment of abnormal uterine bleeding

OBJECTIVE

To evaluate the effectiveness of intracavitary platelet-rich plasma (PRP) therapy in patients diagnosed as having abnormal uterine bleeding (AUB).

MATERIALS AND METHODS

A total of 149 patients with AUB were included in the study. Seventy-four of these patients were included in the study group and 75 were included in the control group. All patients were evaluated using transvaginal ultrasonography. Endometrial curettage was performed to exclude underlying organic pathologies. The study group underwent intracavitary PRP therapy. Both patient groups were called for follow-up at the end of the third month. Their endometrial thickness and amount of bleeding (pictogram and pads/day) were evaluated using transvaginal ultrasonography.

RESULTS

There was no statistically significant difference between the study and control groups in terms of the decrease in the amount of bleeding. In addition, there was no statistically significant difference between the two groups in terms of the increase in endometrial thickness.

CONCLUSION

In this study, it was observed that intracavitary PRP therapy did not make a significant difference in the decrease in the amount of bleeding and in the increase in endometrial thickness between the study and control groups.

The effect of gadolinium-based contrast agents on rat testis

Previous studies have reported that repeated administrations of linear gadolinium-based contrast agents lead to their accumulation in the brain and other tissues in individuals with normal renal functions. The purpose of this prospective animal study was to investigate the effect of multiple administrations of macrocyclic ionic (gadoteric acid) and linear nonionic (gadodiamide) gadolinium-based contrast agents (GBCAs) on rat testis tissue and to compare these molecules in terms of tissue damage. Thirty-two male Sprague-Dawley rats were kept without drugs for 5 weeks after administration of 0.1 mmol mg^-1 kg^-1 (0.2 ml/kg) gadodiamide and gadoteric acid for 4 days over 5 weeks. Biochemical, histopathological and immunohistochemical changes in testis tissue were evaluated at the end of 10 weeks. When used in repeated clinical doses, gadolinium was observed to increase apoptosis in the Leydig cells of the rat testis, and to increase serum Ca⁺² levels and reduce testosterone levels (p < .05). Although the difference was not statistically significant, a greater loss of spermatozoa and immature germinal cell accumulation were observed in the seminiferous tubule lumen in the GBCA groups compared with the control and saline groups (p > .05). Both linear and macrocyclic contrast agents have toxic effects on testis tissue, irrespective of the type of drug.

Risk factors for surgical site infection after hysterectomy

INTRODUCTION

The aim of the study was to define the clinical and laboratory characteristics of patients who had surgical site infection (SSI) after hysterectomy.

METHODOLOGY

This study was a retrospective cohort study. The patient data of 840 subjects who had undergone any type of hysterectomy and reported SSI after surgery were obtained from the archives of a tertiary referral center. The different types of hysterectomy procedures performed on these patients included total abdominal hysterectomy (TAH), laparoscopic hysterectomy (LH), and vaginal hysterectomy (VH). In addition, age, body mass index (BMI), preoperative and postoperative blood parameters, gravidity, and parity were also documented.

RESULTS

TAH, LH, and VH were performed on 63.2% (n = 531), 21.6% (n = 181), and 15.2% (n = 128) of patients, respectively. Overall, SSIs were observed in 3.7% (n = 31) of all hysterectomy patients. Among them, 4.5% of TAH patients, 1.7% of LH patients, and 3.1% of VH patients had SSIs after the hysterectomy operation. Analysis of the data revealed that the patients with SSIs had significantly higher BMIs, lower preoperative hemoglobin, lower postoperative hemoglobin and hematocrit, and higher postoperative platelet counts compared to patients who did not have any SSIs.

CONCLUSIONS

High BMI, blood loss during surgery, low hematocrit levels, and resulting anemia increased the incidence of SSI after hysterectomy. Among the different types of hysterectomy, LH was found to be relatively better than TAH and VH in preventing the occurrence of SSI.

Acute effects of static stretching on isokinetic thigh strength on modern dancers

AIM

The aim of this study was to examine the acute effects of static stretching in dominant leg flexor muscle groups on concentric isokinetic leg extension and flexion peak torque (PT), peak torque % body weight (PT%BW) and total work (TW) at 60, 180 and 300 °.s-1 in stretched and non-stretched limbs of modern dancers.

METHODS

Twenty-six trained modern dancers volunteered in this study. On the first measurement, isokinetic tests were performed on dominant and non-dominant legs. On the second measurement, the dominant leg flexors were stretched using 3 unassisted and 1 assisted static stretching exercises (each 4x15 seconds; 10-second rest). After the stretching, isokinetic tests were repeated on both legs.

RESULTS

The results indicated a positive increase in strength in the stretched (PT%BW, TW) and non-stretched (PT, PT%BW, TW) limbs in flexion at 180°s-1 (P<0.05). We observed a positive increase (P<0.05) in the stretched limb (180 and 300°.s-1, TW; 300°.s-1, PT%BW) in extension whereas an acute decrease (P<0.05) was observed in both legs (60˚.s-1, PT and PT%BW).

CONCLUSION

Our findings indicated a possible positive effect of static stretching at high angular velocities on the strength production of isokinetic contraction in stretched and non-stretched muscles. However, due to its negative effect on the extensor muscle groups, we think using static stretching is required attention before maximal strength exercises.

[Dynamic left ventricular outflow tract obstruction in pulmonary embolism]

Left ventricular hypertrophy, dehydration, sepsis, vasodilatation, excessive sympathetic stimulation, pericardial tamponade and surgical treatment of the atrioventricular valve are known causes of left ventricular outflow tract (LVOT) obstruction. We report the rare case of a patient who developed dynamic LVOT obstruction as a complication of acute pulmonary embolism.

Effects of exercise training on mobilization and functional activity of blood-derived progenitor cells in patients with acute myocardial infarction

BACKGROUND

The aim of the present study was to determine whether regular exercise training (ET) is effective at promoting the mobilization of CPCs and improving their functional activity in patients with recently acquired myocardial infarction (STEMI). Regular physical training has been shown to improve myocardial perfusion and cardiovascular function. This may be related in part to a mobilization of bone marrow-derived circulating progenitor cells (CPCs) as well as an enhanced vascularisation.

METHODS

37 patients with STEMI were randomly assigned to an ET group or a non-ET group (controls). Two weeks after STEMI, three weeks after regular ET and three months after ET, BNP levels, exercise echocardiography and exercise spiroergometry were evaluated. The number of CD34+/CD45+ and CD133+/CD45+ CPCs was measured by flow cytometry analysis. The migration capacity of the CPCs was determined with a boyden chamber and the clonogenic capacity by CFU-assay.

RESULTS

In the ET-group the number and migration capacity of CPCs increased significantly after regular exercise training. The BNP level decreased significantly from 121 +/- 94 to 75 +/- 47 pg/ml (p<0.001) after the ET period, the left ventricular ejection fraction raised in parallel at peak exercise, and the cardiorespiratory condition improved as demonstrated by an increase of VO2max (from 1641 +/- 522 to 1842 +/- 724 ml/min, p<0.02). These three effects persist till three months after the ET period.

CONCLUSIONS

Regular physical activity appears to predispose the mobilization and enhanced functional activity of CPCs, a phenomenon which might lead to an improved cardiac function in patients with recently acquired acute myocardial infarction.

Bloodstream infections in a medical-surgical intensive care unit: incidence, aetiology, antimicrobial resistance patterns of Gram-positive and Gram-negative bacteria

In the present study, the incidence and antimicrobial resistance patterns of the microorganisms that caused bloodstream infections (BSIs) in a medical-surgical intensive care unit during the years 2005-2007 were determined. The mean BSI incidence density was 6.56 per 1000 patient-days. The incidence density increased linearly during the study period (from 3.57 to 9.60 per 1000 patient-days). Staphylococcus aureus was most frequently isolated (47.3%), followed by Enterococcus spp. (10.8%) and Candida spp. (10.1%). There was a high rate of resistance to several of the prescribed antimicrobials among the bacteria isolated from patients with BSIs.