The association between placenta previa and leukocyte and platelet indices — a case control study

Objectives: Despite medical advances, rising awareness, and satisfactory care facilities, placenta previa (PP) remains a challenging clinical entity due to the risk of excessive obstetric hemorrhage. Etiological concerns gave way to life-saving concerns about the prediction of maternal outcomes due to hemorrhage. Our study aimed to detect an early predictive marker of placenta previa. Material and methods: Ninety-three pregnant patients diagnosed with PP and 247 controls were recruited for this retro­spective study. Platelet and leukocyte indices were compared between the two groups. Results: The groups were similar with regard to age distribution (31.2 ± 5.1 years [mean ± SD] in the PP group and 31.7 ± 4.2 years in controls), body mass index (BMI) (27.7 ± 3.6 kg/m2 in the PP group and 27.4 ± 4.6 kg/m2 in controls), and most characteristics of the obstetric history. Total leukocyte count, neutrophil count, and neutrophil-to-lymphocyte ratio were significantly higher in the PP group. Mean platelet volume (MPV) and large platelet cell ratio (P-LCR) values were significantly lower in the PP group as compared to controls, with regard to third trimester values. However, patients who were diagnosed postnatally with placenta percreta had lower MPV and P-LCR values than other patients with PP. There were no statistically significant differences between the two groups as far as first trimester values were concerned. Conclusions: Platelet and leukocyte indices in the third trimester of pregnancy may be valuable predictors of placenta previa and placenta percreta. More comprehensive studies are needed to address this issue

Percutaneous transluminal balloon angioplasty in stenosis of native hemodialysis arteriovenous fistulas: technical success and analysis of factors affecting postprocedural fistula patency

PURPOSEWe aimed to determine the predictors of technical success and patency after percutaneous transluminal angioplasty (PTA) of de novo dysfunctional hemodialysis arteriovenous fistulas (AVF).METHODSWe performed a retrospective analysis of first time PTA in 228 patients (129 men, 99 women; mean age, 56.8±14.6 years). Anatomical (location, length, grade, and number of stenoses) and clinical variables (sex, age, prior AVF, diabetes mellitus, AVF age, side, and location) were reviewed.RESULTSA total of 330 stenoses were found in 228 patients. PTA was technically successful in 96.3% of the stenoses (n=319). Clinical success was achieved in 97.2% (n=321). Early dysfunction (within six months) was positively correlated with patient age (P < 0.001) and diabetes (P < 0.005). Older age (P < 0.001) and diabetes (P = 0.002) were associated with a lower primary patency rate. Patient age (P < 0.001), presence of diabetes (P = 0.023), length of stenosis (P = 0.003), early recurrence (P = 0.003) and presence of residual stenosis (P = 0.014) were associated with a lower secondary patency rate. CONCLUSIONPatency of dysfunctional hemodialysis fistulas can be maintained safely with continuous follow-up and repeated interventions without shortening the venous segment by surgical revision. Percutaneous approach to hemodialysis access stenosis is an alternative to the conventional surgical approach and PTA is an effective treatment method for dysfunctional AVF

Risk factors for hysterectomy among patients with placenta previa totalis

Objective: The aim of the study is to assess risk factors for hysterectomy among patients with placenta previa totalis (PPT). Methods: The medical records of all patients delivered by cesarean section (CS) for PPT were retrospectively reviewed. Eligible cases were divided into those who underwent peripartum hysterectomy (PH) and those who did not. The two groups were compared in terms of demographics, operative features and perinatal outcomes. Logistic regression analysis was used to identify risk factors associated with hysterectomy. Results: PH was performed in 43 (44.7%) patients with PPT. Referral patients were older when compared with those without hysterectomy (p: 0.029). The median values for gravidity, parity, number of live children and previous CS were statistically significantly higher in the hysterectomy group (p<0.05). Perioperative need for blood transfusion, anteriorly placed placenta and abnormal placental invasion were statistically significantly more frequent in the hysterectomy group (p<0.001). Intraoperative complication rate was higher in this group, and bladder injury was the most common complication. No significant differences were observed between the groups in terms of perinatal outcomes. In binomial logistic regression analysis; advanced maternal age (≥ 31 years), number of previous CS (≥2), preoperative need for blood transfusion, and abnormal placental invasion were found to be independent risk factors for PH in patients with PPT. Conclusion: The findings of this study suggest that placenta invasion anomaly, advanced maternal age, increased number of previous CS, and increased need for blood transfusion are important risk factors for PH in patients with PPT

Coronary artery fistula: Review of 54 cases from single center experience

Background: Demographic and clinical characteristics and angiographic findings of Turkish patients with coronary artery fistula have been investigated in this study and diagnostic tests and treatment methods used in these patients have also been evaluated in detail. Methods: We have examined the cardiac catheterization laboratory database retrospectively between March 2006 and July 2010. Among 49,567 patients, we have noted 60 patients diagnosed as coronary artery fistula. After coronary angiographic images were evaluated by two invasive cardiologists, 54 patients who had clear evidence of vessel of origin and drainage were included in the study. Results: A total of 54 (0.1%) patients with coronary artery fistula were noted. Mean age was 56.7 &#177; 10.7 years; 42 out of 54 patients had accompanying cardiac disorders. Patients&#8217; complaints were directly associated with the presence of the fistula. Chest pain was the admission symptom in all of the patients with isolated coronary artery fistula. Six patients had coexistent congenital anomalies. Myocardial infarction with ST segment elevation occurred in 11 of the patients. In contrast to the previous reports, the most common artery of origin of the fistula was left anterior descending artery (50.8%) and pulmonary artery was found to be the most frequent region of the fistula drainage by 53.7%. Conclusions: Our findings suggest that large fistulas originating from the proximal segments of coronary arteries may increase the likelihood of atherosclerosis and myocardial infarction even in asymptomatic patients with no evidence of ischemia in noninvasive tests and no dilatation of cardiac chambers, and should therefore be closed

Post-intervention Status in Patients With Refractory Myasthenia Gravis Treated With Eculizumab During REGAIN and Its Open-Label Extension

OBJECTIVE: To evaluate whether eculizumab helps patients with anti-acetylcholine receptor-positive (AChR+) refractory generalized myasthenia gravis (gMG) achieve the Myasthenia Gravis Foundation of America (MGFA) post-intervention status of minimal manifestations (MM), we assessed patients' status throughout REGAIN (Safety and Efficacy of Eculizumab in AChR+ Refractory Generalized Myasthenia Gravis) and its open-label extension. METHODS: Patients who completed the REGAIN randomized controlled trial and continued into the open-label extension were included in this tertiary endpoint analysis. Patients were assessed for the MGFA post-intervention status of improved, unchanged, worse, MM, and pharmacologic remission at defined time points during REGAIN and through week 130 of the open-label study. RESULTS: A total of 117 patients completed REGAIN and continued into the open-label study (eculizumab/eculizumab: 56; placebo/eculizumab: 61). At week 26 of REGAIN, more eculizumab-treated patients than placebo-treated patients achieved a status of improved (60.7% vs 41.7%) or MM (25.0% vs 13.3%; common OR: 2.3; 95% CI: 1.1-4.5). After 130 weeks of eculizumab treatment, 88.0% of patients achieved improved status and 57.3% of patients achieved MM status. The safety profile of eculizumab was consistent with its known profile and no new safety signals were detected. CONCLUSION: Eculizumab led to rapid and sustained achievement of MM in patients with AChR+ refractory gMG. These findings support the use of eculizumab in this previously difficult-to-treat patient population. CLINICALTRIALSGOV IDENTIFIER: REGAIN, NCT01997229; REGAIN open-label extension, NCT02301624. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that, after 26 weeks of eculizumab treatment, 25.0% of adults with AChR+ refractory gMG achieved MM, compared with 13.3% who received placebo

Minimal Symptom Expression' in Patients With Acetylcholine Receptor Antibody-Positive Refractory Generalized Myasthenia Gravis Treated With Eculizumab

The efficacy and tolerability of eculizumab were assessed in REGAIN, a 26-week, phase 3, randomized, double-blind, placebo-controlled study in anti-acetylcholine receptor antibody-positive (AChR+) refractory generalized myasthenia gravis (gMG), and its open-label extension

Preeclampsia as a cardiovascular risk factor

Preeclampsia, the leading cause of maternal and perinatal morbidity and mortality, has been recently considered not only a pregnancy disease but also a risk factor for developing diseases later in life. We aimed to assess the electrocardiographic interval between the peak and the end of the electrocardiographic T wave (Tpe), Tp-e/QT ratio and Tpe/corrected QT (QTc) ratio as candidate markers of ventricular arrhythmias in patients with history of preeclampsia. Total of 29 patients with a history of preeclampsia and 30 controls were enrolled in the present study. Cardiometabolic risk markers were compared in women with prior history of preeclampsia vs. uncomplicated term births. Fasting lipids, blood pressure (BP) and inflammatory markers measured and electrocardiogram (Tp-e interval, Tp-e/QT, and Tp-e/ QTc ratios) results evaluated at least 12 months after delivery. QT interval (371.9± 39.2 vs. 353.0±21.1; p=0.001), QTc interval (398.8±39.5 vs. 364.4±31.1; p=0.03), Tp-e interval (66.2±10.6 vs. 41.5±5.1; p [Med-Science 2018; 7(2.000): 334-7

Antenatal management of twin anemia-polycythemia sequence

Twin-twin transfusion syndrome (TTTS) and recently discovered twin anemia-polycythemia sequence (TAPS) are well-known severe complications of monochorionic pregnancies which are associated with placental anastomoses. TAPS may occur spontaneously with a prevalence of 3% to 5% in monochorionic pregnancies. It also can occur iatrogenically after laser treatment of TTTS in 2% to 13% of monochorionic pregnancies. Optimal perinatal management for TAPS has not been established yet. It has been reported that early well-timed diagnosis of the disease is very important for reducing fetal adverse events Because of the rarity, the literature is limited to the description of small series or case reports of twins affected by TAPS. Here, we describe diagnosis and management of TAPS case that was diagnosed after laser treatment of TTTS and review the literature about clinical characteristics including clinical features, prenatal characteristics, diagnosis, treatments and short-term outcomes of the TAPS. [Med-Science 2018; 7(3.000): 709-12

The role of hyponatremia in preeclampsia

Preeclampsia associated hyponatraemia is a quite rare condition that cannot be separated from preeclampsia with severe features completely. This condition may be life-threatening for mothers and fetuses and is needed a multidisciplinary management. A 31-year-old primigravida was referred to our perinatology clinic at 28 weeks 4 days due to preeclampsia. She had nephrotic proteinuria and developed hypervolemic, hypoosmolar, chronic, severe hyponatremia. The pregnant was delivered at 29 weeks of gestation because of severe preeclampsia. The baby died in 48 hours postpartum and maternal hyponatremia improved spontaneously within 72 hours. Studies major on vasopressin about hyponatremia-complicated preeclampsia that its pathogenesis and management is still unclear. Studies that note the importance of vasopressin in the pathogenesis of preeclampsia support the theories and highlight the association of vasopressin and hyponatremia. It is known that the definite treatment is delivery. Maternal outcomes are good but neonatal outcomes are variable. [Med-Science 2017; 6(3.000): 592-7