Prediction of vaginal delivery with transperineal ultrasound in women induced with dinoprostone beyond 40 weeks of gestation

Background: Digital cervical evaluation has been used to determine the likelihood of vaginal delivery which is considered by many women to be non-tolerable. Recently, transperineal ultrasound allowing direct visualization of the fetal skull has been using for the prediction of labor route. Authors aimed to study whether measurements on transperineal ultrasound are predictive for vaginal delivery in pregnant women induced with dinoprostone at 40.0-42.0 gestational weeks.Methods: A total of 55 pregnant women at 40.0-42.0 gestational weeks were enrolled in this prospective observational study. All participated women were examined before the induction with dinoprostone to measure the head-perineum distance (HPD), the head-pubis distance and the angle of progression of fetal head (AOP).Results: The greater AOP, the shorter HPD and the head-pubis distance were associated with vaginal delivery in the nulliparous women. The HPD and the head-pubis distance were shorter, whereas the AOP was greater in the multiparous women giving birth by vaginal route.Conclusions: Transperineal ultrasound can be applied at the beginning of labor to predict whether vaginal delivery will occur or not. As shown in our study, the pregnant women with shorter HPD and wider AOP might have a high possibility to achieve vaginal delivery

N-[5-Methyl-2-(2-nitro­phen­yl)-4-oxo-1,3-thia­zolidin-3-yl]pyridine-3-carboxamide monohydrate

In the title compound, C16H14N4O4S·H2O, the benzene and pyridine rings make a dihedral angle of 85.8 (1)°. Both enanti­omers of the chiral title compound are statistically disordered over the same position in the unit cell. The methyl and carbonyl group attached to the stereogenic center (C5 of the thia­zolidine ring) were therefore refined with common site-occupation factors of 0.531 (9) and 0.469 (9), respectively, for each stereoisomer. In the crystal, inter­molecular N—H⋯O, O—H⋯O and O—H⋯N hydrogen bonds link the mol­ecules, forming a three-dimensional supra­molecular network. The crystal structure further shows π–π stacking inter­actions [centroid–centroid distance = 3.5063 (13) Å] between the pyridine rings

Different Surgical Techniques in Tubo-ovarian Abscess Management

Objectıve: Tubo-ovarian abscess is mostly a consequence of pelvic inflammatory disease. We aimed to compare success of the different surgical methods in tubo-ovarian abscess treatment. Study Design: 53 patients with Tubo-ovarian abscess that were hospitalized and operated in the Department of Obstetrics and Gynecology at Kanuni Sultan Suleyman Training and Research Hospital during one year were included. Patients who had underwent salpingectomy/salpingo-oophorectomy and only abscess drainage were compared. Results: Salpingectomy/salpingo-oophorectomy had been done in 74.5% of cases and only drainage had been applied in 25.5% of cases. Difference in mean values between 2 groups were not observed except white blood cell count. Conclusıon: Treatment of Tubo-ovarian abscess must be a combination of parenteral antibiotics and early surgical procedure to prevent poor outcomes. There is not any difference between different surgical techniques. But additionally more studies are needed to better understand which operation technique is more effective and less complicated

Clopidogrel responsiveness in chronic kidney disease patients with acute coronary syndrome

Objective: Cardiovascular diseases are the leading cause of death in patients with chronic kidney disease (CKD). There is conflicting evidence about effect of CKD on clopidogrel responsiveness. We aimed to evaluate the clopidogrel responsiveness in CKD patients with acute coronary syndrome (ACS). Methods: A total of 101 patients; 55 with moderate to severe CKD and 46 with normal renal function or mild CKD, hospitalized with ACS were included in our study. Multiplate test was used to determine clopidogrel responsiveness. Platelet aggregation results were presented as aggregation unit (AU)*min and values over 470 AU*min were accepted as clopidogrel low responders. Results: The 101 patients (mean age 64.76±8.67 years; 61 [60.4%] male) were grouped into the two study groups as follows: group 1; 55 patients with eGFR<60 ml/min/1.73 m2 and group 2; 46 patients with eGFR>60 ml/min/1.73 m2. 35 patients (34.7%) of the study population were found to have low response to clopidogrel (16 [34.8%] patients in group 1 and 18 [33.3%] patients in group 2, p=0.879) . There was no significant difference between group 1 and 2 for Multiplate test results (414.67±281.21 vs 421.56±316.19 AU*min, p=0.909). Clopidogrel low responsiveness were independently related to Multiplate test results of aspirin responsiveness (OR=1.004, CI 1.002–1.007, p=0.001) and hemoglobin (OR=0.727, CI 0.571–0.925, p=0.010). Multiplate results were also independently related to Multiplate test results of aspirin responsiveness (β=0.402, p<0.0001) and hemoglobin (β=-0.251, p=0.007). Conclusion: Platelet response to clopidogrel does not differ between patients with eGFR < 60 ml/min/1.73 m2 and eGFR>60 ml/min/1.73 m2

Neonatal transport

Bu çalışmada hastanemiz yenidoğan servisine sevk edilen yenidoğan bebeklerin gönderilme nedenleri ve nakil koşulları incelendi. Bebeklerin %59.9'u term, %40.1'i preterm idi. Nakil aracı olarak term bebeklerin %47.1'inde, pretermlerin %70.3'ünde ambulans, term bebeklerin %52.9'unda, preterm bebeklerin %29.7'sinde otomobil kullanılmıştı. Term (%29.2) ve preterm (%48.0) bebeklerde en sık sevk nedeni solunum sorunları idi. Ambulans ile nakledilen olguların %45.7'sine doktor, %54.3'üne hemşire veya diğer sağlık personeli eşlik etmekteydi. Nakil öncesi olguların %55.3'ü için hastanemize haber verilmemiş, %39'una epikriz yazılmamıştı. Olguların %77.2'si parenteral sıvı desteği sağlanmadan sevk edilmiş, transport sırasında ise olguların %48.2'sine oksijen verilememişti. Preterm bebeklerin %36.2'si küvöz içinde gönderilmişti. Olguların %25.4'ünde hipotermi, %31.2'sinde hipoglisemi ve %33.8'inde hipoksi saptandı. Term bebeklerin %3.8'i, preterm bebeklerin %9.2'si hastanemize geldikten sonraki ilk 24 saat içinde kaybedi i. Bu sonuçlar yenidoğanların nakil öncesi ve nakil sürecinde stabilizasyonunun, nakil öncesi perifer sağlık merkezleri ile yenidoğan merkezimiz arasındaki haberleşmenin, personel eğitiminin, nakil araçlarındaki donanımın yeterli düzeyde olmadığını göstermektedir.In this study the referral reasons and transport conditions of newborns referred to our neonatology unit were investigated. 59.9% of babies were term and 40.1% of babies were preterm. While 47.1% of term and 70.3% of preterm babies were transported by ambulances; 52.9% of term and 29.7% preterm babies were transported by cars. The respiratory distress syndrome was determined as the most common referral diagnosis in term (29.2%) and preterm (48%) babies. In 45.7% of the cases a doctor and in 54.3% of the cases a nurse or other medical personnel escorted the baby during transport by ambulance. Prior to transport no information had been given to our hospital for 55.3% of the cases and 39.0% of the cases had no referral letter. 77.2% of the cases was referred without parenteral fluid support and oxygen was not administred to 48.2% of the cases during transport. Only 36.2% of preterm babies was transported in an incubator. Hypothermia was found in 25.4%, hypoglycemia in 31.2% and hypoxia in 33.8% of the cases. 3.8% of term and 9.2% of preterm babies died within 24 hours after theiradmission to our hospital These results show that stabilization of the newborn before and during transport, communication between community hospital and our neonatology unit prior to transport, personnel training and equipment of the transport vehicle were not adequate

N-[2-(4-Chloro­phen­yl)-5-methyl-4-oxo-1,3-thia­zolidin-3-yl]pyridine-3-carboxamide

The title compound, C16H14ClN3O2S, crystallizes with two mol­ecules in the asymmetric unit. In the 1,3-thia­zolidine rings, the carbonyl O atoms, the S atoms, the methyl groups and the ring carbon attached to the methyl groups are disordered with occupancy ratios of 0.509 (7):0.491 (7) in one mol­ecule and 0.464 (14):0.536 (14) in the other. The crystal structure is stabilized by inter­molecular N—H⋯N, C—H⋯O hydrogen bonds and C—H⋯Cl inter­actions. In addition, there is a π–π stacking inter­action [centroid–centroid distance = 3.794 (3) Å] between the benzene and pyridine rings

Does Providing Clinical Care for Trauma Patients have a Positive Effect on Physicians’ Perspective on Child Passenger Safety?

Introduction: Motor vehicle crashes are the most common cause of the mortality in the pediatric population. Preventive strategies are the best approach to reduce mortality and morbidity due to motor vehicle crashes. Since parents mostly refer to them for guidance, doctors should have a high level of knowledge and awareness to increase the usage of car safety seats. We thought that providing care for trauma patients could have a positive effect on the physicians’ awareness and knowledge level. Based on this, we aimed to assess the awareness and knowledge of pediatricians and emergency physicians and trauma doctors. Methods: An electronic survey consisting of 23 questions was prepared. Demographic features, awareness and knowledge level of the physicians were assessed on three sections. Five suggestions in the guideline of the American Academy of Pediatrics were used to assess physicians’ knowledge level. The respondents were grouped as those providing clinical care for trauma patients and those do not. Results: The questionnaires were sent to 641 physicians and 323 who completed the questionnaire were included in the study. One hundred and fourteen (35.3%) of the respondents were providing clinical care for trauma patients. One hundred ninety (59.2%) respondents had children. Majority of the physicians had a satisfactory level of knowledge about car safety seat (CSS). The number of respondents reported having adequate self-awareness was found statistically significantly higher in the groups of doctors who have children and provide clinical care for trauma patients (p0.05). Interestingly, the knowledge level in physicians who had children was statistically significantly lower than in those with no children (p<0.01). Conclusion: Our survey revealed that physicians who provide clinical care for trauma patients think they have a high level of knowledge about CSS. Unfortunately, their knowledge level was low as other physicians in the study group

Early changes of ovarian reserve markers after laparoscopic excision of endometrioma

AMAÇ: İnaktif ve büyümekte olan folikül havuzunu işaret eden Antimüllerian hormonun (AMH), aynı zamanda menstrüel siklus boyunca serum konsantrasyonunun minimal değişimi nedeniyle günümüzde over rezerv belirteci olarak kullanımı yaygınlaşmaktadır. Biz de bu çalışma ile endometriyoma nedeniyle laparoskopik kistektomi yapılan hastalarda over rezervi belirteçlerini AMH'yı da kapsayacak şekilde kombine kullanarak rezervin nasıl değiştiğini tespit etmeyi amaçladık. Ayrıca laparoskopik kistektomi esnasında oluşan over dokusunun kaybını histopatolojik olarak inceleyerek over rezervindeki değişimi tespit etmeyi amaçladık. YÖNTEM: 18-45 yaş arası endometriyoma nedeniyle laparoskopik cerrahi geçiren 65 hasta çalışmaya dahil edildi. Preoperatif dönemde menstrüel siklusun 3. günü kanda folikül stimüle edici hormon (FSH), lüteinleyici hormon (LH), östradiol ve AMH ölçümü yapıldı ve FSH/LH oranı hesaplandıæ transvajinal veya transabdominal ultrasonografi (USG) ile her iki overdeki toplam bazal antral folikül sayısı (BAF) ve endometriyomanın boyutları bakıldı. Laparoskopi ile endometriyoma eksizyonu uygulanan bu hastalarda operasyon esnasında endometriyoma boyutları tekrar değerlendirildi ve Amerikan Reprodüktif Tıp Cemiyeti sınıflaması (Revised American Society for Reproductive Medicine Classification of Endometriosis, rAFS) skorlaması yapıldı. Postoperatif 6. haftada kontrole çağrılan hastalarda menstrüel siklusun 3. günü FSH, LH, östradiol ve AMH tekrar kanda bakıldı ve FSH/LH oranı hesaplandıæ transvajinal veya transabdominal USG ile de BAF tekrar değerlendirildi. Alınan her doku örneği histopatolojik olarak incelenmek üzere Patoloji Bölümü'ne gönderildi. Patolog kist duvarına yakın over dokusu olup olmadığını değerlendirdi ve semikantitatif bir skalayla bu dokuları 0'dan 4'e kadar derecelendirdi. (0= folikül yokluğuæ 1= sadece primordial folikülæ 2= primordial ve primer folikülleræ 3= birkaç adet sekonder folikülæ 4= normal over dokusundaki gibi primer ve sekonder foliküller). Ayrıca kesitte hesaplanan folikül sayısının FSH, FSH/LH ve AMH ile olan ilişkisi değerlendirildi. BULGULAR: Folikül stimüle edici hormonun ortalama postoperatif değeri preoperatif değerlere göre anlamlı olarak daha yüksekti (p SONUÇ: Endometriyoma ile birlikte eksize edilen normal over dokusu ve bu dokunun içerdiği folikül sayısı arttıkça AMH'nın o derece düştüğü gösterilmiştir. Dolayısıyla endometriyomanın eksizyonu esnasında over dokusuna zarar verilmesi ve buna bağlı olarak over rezervinin düşmesi kaçınılmaz bir durumdur. OBJECTIVE: Antimullerian hormone that designates inactive and growing follicular pool is being used commonly as an ovarian reserve marker at present. Its serum concentration changes minimally during menstruel cycle. In this study, we aimed to show changes of ovarian reserve by using all markers in combination that includes AMH in patients who have undergone laparoscopic cystectomy of endometrioma. At the same time, we aimed to state change in ovarian reserve with histopathologic examination of loss of ovarian tissue during laparoscopic cystectomy. METHODS: 65 patients, 18 to 45 years of age, were enrolled who have undergone laparoscopic operation for endometrioma. Preoperatively on the 3rd day of menstruation FSH, LH, estradiol and AMH were measured and FSH/LH ratio was calculatedæ also basal antral follicle (BAF) in both ovaries and dimensions of endometrioma were assessed with transvaginal or transabdominal ultrasonography. In these patients, during operation dimensions of endometrioma was assessed again and scoring was done according to revised American Society for Reproductive Medicine Classification of Endometriosis. Postoperatively on the 6th week, patients were called for controlæ hormone profile that includes FSH, LH, estradiol and AMH were measured and FSH/LH ratio was calculated and BAF were counted by transvaginal or transabdominal ultrasonography on the 3rd day of menstruation. The pathologist evaluated the presence or absence of the ovarian tissue adjacent to the cyst wall and graded the morphological characteristics of this tissue on a semiquantitative scale of 0 to 4 as previously published elsewhere (0= complete absence of folliclesæ 1= primordial follicles onlyæ 2= primordial and primary folliclesæ 3= some secondary folliclesæ 4= pattern of primary and secondary follicles as seen in the normal ovary). Also association between FSH, FSH/LH ratio, AMH and histologic analysis of excised specimens was evaluated. RESULTS: Mean level of postoperative serum FSH was higher than its preoperative level as statistically significant (p CONCLUSIONS: As follicular count increases in histopathologic examination, AMH level decreases concomitantly. So damage to ovarian tissue and decreasing of ovarian reserve is unavoidable during excision of endometriomas