Effect of maternal dexamethasone administration on daily fetal movement count and its correlation with Doppler studies and cardiotocography

Background: Decreased fetal movements is a frequent reason for unplanned consultations through the third trimester ranging between 4% and 16% in various populations it is often a sign of fetal compromise and associated with severe outcomes such as fetal growth restriction, preterm birth and fetal death therefore it is important to question the effect of maternal dexamethasone administration for fetal well-being and its relation on decreased fetal movement which is detected by Doppler studies and cardiotocography. Methods: The current study was performed on 220 pregnant women with gestational age between 28-34 weeks who received antenatal dexamethasone at Ain Shams university hospitals.Results: Regarding fetal movements, there was significant decrease in fetal movement at the 24th hour (Day 2) after 1st and 2nd doses of dexamethasone then re-increased at 48th hour and 72nd hour but still significantly lower than baseline.Conclusions: Administration of dexamethasone had no harmful effects on the fetuses or the mothers, except for a transient decrease of fetal movements in only after 24 hours of the first dose.

Safety of Thioguanine in Pediatric Inflammatory Bowel Disease:A Multi-Center Case Series

Thioguanine (TG) has been shown as a safe alternative in adults with inflammatory bowel disease (IBD) who did not tolerate conventional thiopurines [azathioprine (AZA)/mercaptopurine]. However, data in pediatric IBD are scarce. Therefore, we aimed to assess the safety of TG as maintenance therapy. METHODS: A retrospective, multicenter cohort study of children with IBD on TG was performed in the Netherlands. TG-related adverse events (AE) were assessed and listed according to the common terminology criteria for AE. RESULTS: Thirty-six children with IBD (median age 14.5 years) on TG (median dose 15 mg/day) were included in 6 centers. Five AE occurred during follow-up [pancreatitis (grade 3), hepatotoxicity (grade 3) (n = 2), Clostridium difficile infection (grade 2), and abdominal pain (grade 2)]. All patients (n = 8) with a previously AZA-induced pancreatitis did not redevelop pancreatitis on TG. CONCLUSIONS: In pediatric IBD, TG seems a safe alternative in case of AZA-induced pancreatitis. Further research assessing long-term TG-related safety and efficacy is needed

Dyeing performance on polyester fibers and DFT investigation of newly synthesized 2-arylazo-dioxoisoindolinecyanoacetamide derivatives

A series of aryl-diazinyl-cyanoacetamide (2a–l) were prepared by coupling the appropriate diazotized arylamines with dioxoisoindoline cyanaoacetamide (1). Also, the cyclization of azo derivatives (2f, 2h, and 2j) with chloroacetonitrile to yield the pyrazole derivatives (5f, 5h, and 5j) was studied. Moreover, compound 2d reacts with malononitrile to afford compound (6e). In a similar manner compound, 2d reacts with hydroxylamine to afford the sole product tetrazine derivative 8d. All the newly synthesized compounds were fully characterized by both analytical and spectral analyses. The geometries of the azo and hydrazo tautomeric forms were optimized at the B3LYP/6-311G level of theory. The dyeing performance of the synthesized dyes on polyester fibers has been assessed. Most of the dyes showed a good affinity to polyester fibers. No details regarding the synthesis and dyeing performance of such dyes are reported before in the literature.</p

Intramuscular corticosteroid injections in seasonal allergic rhinitis: A systematic review

Objective: Seasonal allergic rhinitis (SAR) is an exaggerated immunological reaction to allergens (pollen) in the air. In a small subgroup of patients, SAR can be difficult to control with first-line therapy. Intramuscular corticosteroid injections (IMCIs) are an additional treatment in this subgroup of SAR patients. The aim of this systematic review is to investigate the efficacy and safety of IMCIs in SAR. Methods: Titles and abstracts were independently screened, followed by full-text screening based on predefined criteria. Included articles were critically appraised using the Cochrane Risk of Bias 2 (RoB 2) tool. The primary outcome is reported as the final conclusion about efficacy that was stated in the included studies. The secondary outcome is the safety of IMCIs with regard to long lasting side-effects. Results: The search yielded 2139 records, of which 10 were relevant and valid for our clinical question. Critical appraisal showed high risk of bias, which was due to unclear description of methods. Four out of four placebo-controlled, randomized controlled trials reported a significant and relevant difference in efficacy in favor of IMCIs compared with placebo. The occurrence of side-effects was not different between IMCIs and placebo or oral corticosteroids (OCs). Conclusion: The outcome of this systematic review on trials concerning intramuscular steroid injections, despite being based on individual studies claiming favorable outcome with their use, is “inconclusive.” This is because of the epidemiological high risk of bias in these studies that were mostly executed more than 30 years ago. The “inconclusive” rating allows for a description as an “optional therapy” for severe cases in guideline formation

The association between radiological spreading pattern and clinical outcomes in necrotizing external otitis

OBJECTIVES: Necrotizing external otitis (NEO) is a rare infectious disease of the skull base. The purpose of this study was to determine whether clinical outcomes of NEO can be correlated to different infectious spread patterns. METHODS: Retrospective chart review from 2010 to 2019 with NEO patients, who were divided into two cohorts: single spreading patterns (group A) or complex spreading patterns (group B) as diagnosed by CT. Clinical symptoms, diagnostic and treatment delay, course of disease, complications, and duration of antibiotic exposure were retrospectively collected from patient records. RESULTS: 41 NEO patients were included, of which 27 patients belonged to group A (66%). The disease-related mortality rate was 12.2% among the entire cohort, no differences were found between group A and B. Higher rates of N.VII (42.9% vs 14.8% P = 0.047) and N. IX palsies were found in group B compared to group A (28.6% vs 3.7%, P = 0.039). The median duration of antibiotic use was significantly different for a complex spreading pattern, clinical recovery and hospitalizations. Complications were associated with higher diagnostic delay and with a complex spread pattern. The median duration of follow-up was 12.0 (IQR 6.0–19.5) months. CONCLUSION: NEO is a severe disease, with significant mortality and morbidity (cranial nerve palsies). The radiological spread pattern may assist in predicting clinical outcome. Furthermore, complex spread patterns are associated with higher rates of clinical nerve palsies (N. VII and N.IX), complications, surgery rates and longer duration of antibiotic use. Diagnostic delay was associated with mortality, complications and facial palsies. LEVEL OF EVIDENCE: Level IV

The effect of fiber-reinforced composite versus band and loop space maintainers on oral Lactobacillus acidophilus and Streptococcus mutans levels in saliva

Background: Orthodontic bands have been shown to alter oral microbial flora that lead to convert caries-free patients to moderate or high caries risk individuals. Aim: This study aimed to evaluate the effect of conventional band and loop space maintainers versus fiber-reinforced composite (FRC) resin space maintainer on the salivary cariogenic microflora (Lactobacillus and Streptococcus mutans) in children over a period of 6 months. Materials and Methods: The study sample was divided equally into two groups: Group A: 25 patients received FRC (INFIBRA®: Reinforcing ribbon, Bioloren, Italy) space maintainer and Group B: 25 patients received band and loop space maintainers. The saliva samples were collected from the patients before the insertion of the space maintainer and at 2 weeks, 3 months, and 6 months postinsertion. Results and Conclusion: The Lactobacillus acidophilus isolated was 1.7 colony-forming unit (CFU) (×106) and 1.8 CFU (×106) in Group A and Group B, respectively, prior to the insertion of space maintainers. There was no significant increase in L. acidophilus over the follow-up of 6 months in both the groups (P > 0.05). However, the Streptococcus mutans isolated before insertion in both Group A and Group B was 2.6 CFU (×106), which over a period of 6 months showed significant increase to 3.13 CFU (×106) in Group B (P < 0.05) and no increase was seen in Group A. S. mutans level increased considerably in patients with band and loop space maintainer over the follow-up of 6 months. No significant increase in the L. acidophilus count was observed over the same period in both the groups

When right ventricular pressure meets volume: The impact of arrival time of reflected waves on right ventricle load in pulmonary arterial hypertension

Abstract: Right ventricular (RV) wall tension in pulmonary arterial hypertension (PAH) is determined not only by pressure, but also by RV volume. A larger volume at a given pressure generates more wall tension. Return of reflected waves early after the onset of contraction, when RV volume is larger, may augment RV load. We aimed to elucidate: (1) the distribution of arrival times of peak reflected waves in treatment-naïve PAH patients; (2) the relationship between time of arrival of reflected waves and RV morphology; and (3) the effect of PAH treatment on the arrival time of reflected waves. Wave separation analysis was conducted in 68 treatment-naïve PAH patients. In the treatment-naïve condition, 54% of patients had mid-systolic return of reflected waves (defined as 34–66% of systole). Despite similar pulmonary vascular resistance (PVR), patients with mid-systolic return had more pronounced RV hypertrophy compared to those with late-systolic or diastolic return (RV mass/body surface area; mid-systolic return 54.6 ± 12.6 g m–2, late-systolic return 44.4 ± 10.1 g m–2, diastolic return 42.8 ± 13.1 g m–2). Out of 68 patients, 43 patients were further examined after initial treatment. At follow-up, the stiffness of the proximal arteries, given as characteristic impedance, decreased from 0.12 to 0.08 mmHg s mL–1. Wave speed was attenuated from 13.3 to 9.1 m s–1, and the return of reflected waves was delayed from 64% to 71% of systole. In conclusion, reflected waves arrive at variable times in PAH. Early return of reflected waves was associated with more RV hypertrophy. PAH treatment not only decreased PVR, but also delayed the timing of reflected waves. Key points: Right ventricular (RV) wall tension in pulmonary arterial hypertension (PAH) is determined not only by pressure, but also by RV volume. Larger volume at a given pressure causes larger RV wall tension. Early return of reflected waves adds RV pressure in early systole, when RV volume is relatively large. Thus, early return of reflected waves may increase RV wall tension. Wave reflection can provide a description of RV load. In PAH, reflected waves arrive back at variable times. In over half of PAH patients, the RV is exposed to mid-systolic return of reflected waves. Mid-systolic return of reflected waves is related to RV hypertrophy. PAH treatment acts favourably on the RV not only by reducing resistance, but also by delaying the return of reflected waves. Arrival timing of reflected waves is an important parameter for understanding the relationship between RV load and its function in PAH

Early return of reflected waves increases right ventricular wall stress in chronic thromboembolic pulmonary hypertension

BACKGROUND: Pulmonary vascular resistance (PVR) and compliance are comparable in proximal and distal chronic thromboembolic pulmonary hypertension (CTEPH). However, proximal CTEPH is associated with inferior right ventricular (RV) adaptation. Early wave reflection in proximal CTEPH may be responsible for altered RV function. The aims of the study are 1) investigate whether reflected pressure returns sooner in proximal than in distal CTEPH, and 2) elucidate whether timing of reflected pressure is related to RV dimensions, ejection fraction (RVEF), hypertrophy and wall stress. METHODS: Right heart catheterization and cardiac MRI were performed in 17 patients with proximal and 17 patients with distal CTEPH. In addition to determination of PVR, compliance and characteristic impedance, wave separation analysis was performed to determine the magnitude and timing of the peak reflected pressure (as % of systole). Findings were related to RV dimensions and time-resolved RV wall stress. RESULTS: Proximal CTEPH was characterized by higher RV volumes, mass and wall stress, and lower RVEF. While PVR, compliance and characteristic impedance were similar, proximal CTEPH was related to an earlier return of reflected pressure than distal CTEPH (proximal 53±8% vs. distal 63±15%, P<0.05). The magnitude of the reflected pressure waves did not differ. RV volumes, RVEF, RV mass and wall stress were all related to the timing of peak reflected pressure. CONCLUSIONS: Poor RV function in patients with proximal CTEPH is related to an early return of reflected pressure wave. PVR, compliance and characteristic impedance do not explain differences in RV function between proximal and distal CTEPH