The effect of parity on longitudinal maternal hemodynamics.

BACKGROUND: Parous women have a lower risk for pregnancy complications, such as preeclampsia or delivery of small-for-gestational-age neonates. However, parous women are a heterogeneous group of patients because they contain a low-risk cohort with previously uncomplicated pregnancies and a high-risk cohort with previous pregnancies complicated by preeclampsia and/or small for gestational age. Previous studies examining the effect of parity on maternal hemodynamics, including cardiac output and peripheral vascular resistance, did not distinguish between parous women with and without a history of preeclampsia or small for gestational age and reported contradictory results. OBJECTIVE: The objective of the study was to compare maternal hemodynamics in nulliparous women and in parous women with and without previous preeclampsia and/or small for gestational age. STUDY DESIGN: This was a prospective, longitudinal study of maternal hemodynamics, assessed by a bioreactance method, measured at 11+0 to 13+6, 19+0 to 24+0, 30+0 to 34+0, and 35+0 to 37+0 weeks' gestation in 3 groups of women. Group 1 was composed of parous women without a history of preeclampsia and/or small for gestational age (n = 632), group 2 was composed of nulliparous women (n = 829), and group 3 was composed of parous women with a history of preeclampsia and/or small for gestational age (n = 113). A multilevel linear mixed-effects model was performed to compare the repeated measures of hemodynamic variables controlling for maternal characteristics, medical history, and development of preeclampsia or small for gestational age in the current pregnancy. RESULTS: In groups 1 and 2, cardiac output increased with gestational age to a peak at 32 weeks and peripheral vascular resistance showed a reversed pattern with its nadir at 32 weeks; in group 1, compared with group 2, there was better cardiac adaptation, reflected in higher cardiac output and lower peripheral vascular resistance. In group 3 there was a hyperdynamic profile of higher cardiac output and lower peripheral vascular resistance at the first trimester followed by an earlier sharp decline of cardiac output and increase of peripheral vascular resistance from midgestation. The incidence of preeclampsia and small for gestational age was highest in group 3 and lowest in group 1. CONCLUSION: There are parity-specific differences in maternal cardiac adaptation in pregnancy

A single institution experience on the correlation of Kwak Thyroid Imaging Reporting and Data System Score (Kwak TIRADS) and Malignancy of Thyroid Nodules seen in a Tertiary Hospital Setting

Objective: The purpose of this study is to determine the diagnostic accuracy of a surgeon-performed thyroid ultrasound reported using Kwak Thyroid Imaging Reporting and Data System (Kwak TIRADS) in identifying thyroid malignancy. Patients and Methods: This is a retrospective cohort study of patients who underwent preoperative thyroid ultrasound by a surgeon and subsequently underwent thyroidectomy from January 2018 – March 2020 in UP-PGH, Department of Surgery. Correlation between ultrasonographic features and Kwak TIRADS categories with malignancy were analyzed using chi square (univariate analysis) and logistic regression (multivariate analysis). Results: A total of 174 patients with thyroid nodules at least 1 cm in widest diameter were included in the study. There were 85 patients with malignant thyroid disease and 89 patients with benign nodules. Solid composition, hypoechogenicity/marked hypoechogenicity, lobulated/irregular margins, rim/microcalcifications, and shape taller than wide were significantly associated with thyroid malignancy on univariate analysis (all p-values < 0.001). However, only solid composition, hypoechogenicity/marked hypoechogenicity, and irregular/lobulated margins were significantly associated with thyroid malignancy on multivariate analysis (p-values < 0.001, 0.002 and 0.011, respectively). On the other hand, Kwak TIRADS categories 4a and above are significantly associated with thyroid malignancy (all p-values < 0.001), with the risk of malignancy increasing as the Kwak TIRADS category increases. Sensitivity, specificity, PPV and negative NPV are optimal when cutoff for further workup is set at Kwak TIRADS 4a. Conclusions: A surgeon performed thyroid ultrasonography reported using Kwak TIRADS classification can be utilized as a guide in the management of thyroid nodules. The consideration of Kwak TIRADS 4a as a cutoff level for further workup is recommended

Oral leiomyosarcoma presenting as a recurrent hard palate mass: a case report

Objective: Leiomyosarcoma (LMS), a sarcoma with smooth muscle differentiation rarely affects the oral cavity due to the paucity of smooth muscle tissues in the region. Because of the intricacy of the anatomy of the oral cavity, tumors affecting this region usually require complex surgeries. We are thus presenting this case, due to the rarity of the disease and its successful treatment by a multidisciplinary team. Case Presentation: A 30-year-old female who was previously diagnosed with a benign smooth muscle neoplasm, had a partial maxillectomy in another institution, came to us for tumor recurrence with a histopathologic report of a smooth muscle tumor of uncertain malignant potential (SmTUMP). Facial and neck CT scan, as well as facial MRI revealed a resectable disease with unremarkable metastatic workup. Results: The clinical aggressiveness of the disease prompted the multidisciplinary team to proceed with infrastructure maxillectomy with the defect covered by a surgical obturator. Final histopathologic report revealed that the tumor is LMS with good margins. Thereafter, the patient underwent adjuvant radiation therapy. At 1-year post-surgery, the patient had minimal speech deficit with good deglutition function and no recurrence. Conclusions: LMS is exceedingly rare in the head and neck region. It is also difficult to diagnose. However, it should be considered a differential diagnosis when dealing with smooth muscle tumors. Successful treatment of this disease entails high index of suspicion and involvement of a multidisciplinary team

The ProPrems trial: investigating the effects of probiotics on late onset sepsis in very preterm infants

BACKGROUND: Late onset sepsis is a frequent complication of prematurity associated with increased mortality and morbidity. The commensal bacteria of the gastrointestinal tract play a key role in the development of healthy immune responses. Healthy term infants acquire these commensal organisms rapidly after birth. However, colonisation in preterm infants is adversely affected by delivery mode, antibiotic treatment and the intensive care environment. Altered microbiota composition may lead to increased colonisation with pathogenic bacteria, poor immune development and susceptibility to sepsis in the preterm infant.Probiotics are live microorganisms, which when administered in adequate amounts confer health benefits on the host. Amongst numerous bacteriocidal and nutritional roles, they may also favourably modulate host immune responses in local and remote tissues. Meta-analyses of probiotic supplementation in preterm infants report a reduction in mortality and necrotising enterocolitis. Studies with sepsis as an outcome have reported mixed results to date.Allergic diseases are increasing in incidence in "westernised" countries. There is evidence that probiotics may reduce the incidence of these diseases by altering the intestinal microbiota to influence immune function. METHODS/DESIGN: This is a multi-centre, randomised, double blinded, placebo controlled trial investigating supplementing preterm infants born at < 32 weeks' gestation weighing < 1500 g, with a probiotic combination (Bifidobacterium infantis, Streptococcus thermophilus and Bifidobacterium lactis). A total of 1,100 subjects are being recruited in Australia and New Zealand. Infants commence the allocated intervention from soon after the start of feeds until discharge home or term corrected age. The primary outcome is the incidence of at least one episode of definite (blood culture positive) late onset sepsis before 40 weeks corrected age or discharge home. Secondary outcomes include: Necrotising enterocolitis, mortality, antibiotic usage, time to establish full enteral feeds, duration of hospital stay, growth measurements at 6 and 12 months' corrected age and evidence of atopic conditions at 12 months' corrected age. DISCUSSION: Results from previous studies on the use of probiotics to prevent diseases in preterm infants are promising. However, a large clinical trial is required to address outstanding issues regarding safety and efficacy in this vulnerable population. This study will address these important issues. TRIAL REGISTRATION: Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN012607000144415The product "ABC Dophilus Probiotic Powder for Infants®", Solgar, USA has its 3 probiotics strains registered with the Deutsche Sammlung von Mikroorganismen und Zellkulturen (DSMZ--German Collection of Microorganisms and Cell Cultures) as BB-12 15954, B-02 96579, Th-4 15957