Timing of diagnosis of fetal structural abnormalities after the introduction of universal cell-free DNA in the absence of first-trimester anatomical screening

Introduction: Since 2021, first-trimester anatomical screening (FTAS) is offered in the Netherlands alongside genome-wide cell-free DNA (cfDNA). Previously, only second-trimester anatomical screening (STAS) was offered. This study identifies structural abnormalities amenable to first-trimester diagnosis detected at/after STAS in the period following cfDNA implementation and preceding FTAS introduction.Methods: This retrospective cohort includes 547 fetuses referred between 2017 and 2020 because of suspected structural abnormalities before/at/after STAS. Additional prenatal investigations and postnatal follow-up were searched. Abnormalities were classified into "always", "sometimes", and "never" detectable in the first-trimester based on a previously suggested classification.Results: Of the 547 pregnancies, 13 (2.6%) received FTAS and 534 (97.6%) received a dating ultrasound and STAS. In 492/534 (92.1%) anomalies were confirmed; 66 (13.4%) belonged to the "always detectable" group in the first trimester, 303 (61.6%) to the "sometimes detectable", and 123 (25.0%) to the never detectable. Of the "always detectable" anomalies 29/66 (44%) were diagnosed during dating ultrasounds and 37 (56%) during STAS. The rate of termination of pregnancy for anomalies detected during FTAS and at/after STAS was 84.6% (n = 11/13) and 29.3% (n = 144/492) (p &lt; 0.01).Conclusion: When FTAS is not part of screening paradigms, most fetal anomalies remain undetected until the second trimester or later in pregnancy, including 56% of anomalies "always detectable" in the first trimester.</p

Psychological outcomes, knowledge and preferences of pregnant women on first-trimester screening for fetal structural abnormalities:A prospective cohort study

INTRODUCTION: The primary aim of this study is to investigate the impact of a 13-week anomaly scan on the experienced levels of maternal anxiety and well-being. Secondly, to explore women's knowledge on the possibilities and limitations of the scan and the preferred timing of screening for structural abnormalities. MATERIAL AND METHODS: In a prospective-cohort study conducted between 2013-2015, pregnant women in the North-Netherlands underwent a 13-week anomaly scan. Four online-questionnaires (Q1, Q2, Q3 and Q4) were completed before and after the 13- and the 20-week anomaly scans. In total, 1512 women consented to participate in the study and 1118 (74%) completed the questionnaires at Q1, 941 (64%) at Q2, 807 (55%) at Q3 and 535 (37%) at Q4. Psychological outcomes were measured by the state-trait inventory-scale (STAI), the patient's positive-negative affect (PANAS) and ad-hoc designed questionnaires. RESULTS: Nine-nine percent of women wished to be informed as early as possible in pregnancy about the absence/presence of structural abnormalities. In 87% of women levels of knowledge on the goals and limitations of the 13-week anomaly scan were moderate-to-high. In women with a normal 13-week scan result, anxiety levels decreased (P < .001) and well-being increased over time (P < .001). In women with false-positive results (n = 26), anxiety levels initially increased (STAI-Q1: 39.8 vs. STAI-Q2: 48.6, P = 0.025), but later decreased around the 20-week anomaly scan (STAI-Q3: 36.4 vs. STAI-Q4: 34.2, P = 0.36). CONCLUSIONS: The 13-week scan did not negatively impact the psychological well-being of pregnant women. The small number of women with screen-positive results temporarily experienced higher anxiety after the scan but, in false-positive cases, anxiety levels normalized again when the abnormality was not confirmed at follow-up scans. Finally, most pregnant women have moderate-to-high levels of knowledge and strongly prefer early screening for fetal structural abnormalities

The Treatment of Recurrent Urothelial Tumors of the Upper Urinary System and at Urostomy Site following Radical Cystectomy with Intraureteral Bacillus Calmette-Guérin and Cryotherapy

Urinary bladder carcinoma is the second most common cancer of the urinary system. The recurrence rate in the upper urinary system (UUS) for urothelial cancers is around 3% following radical cystectomy. The followup generally consists of imaging studies and urinary cytology, although there are no prospective data on the frequency, the mode, and the duration of followup. In patients carefully selected according to risk factors, kidney-sparing minimally invasive methods (ureteroscopic procedures, percutaneous approach, and local drug instillation) appear as contemporary alternatives for low-grade and low-stage primary UUS. In this paper, we present the patient who underwent radical cystectomy with urinary diversion ureterocutaneostomy, was diagnosed with widespread bilateral UUS tumors and recurrent tumor at the urostomy site at active followup, for which he was given local Bacillus Calmette-Guérin (BCG) and cryotherapy, and was followed by disease-free for 2 years thereafter

Supplementary Prognostic Variables for Pleural Mesothelioma A Report from the IASLC Staging Committee

Introduction: The staging system for malignant pleural mesothelioma is controversial. To revise this system, the International Association for the Study of Lung Cancer Staging Committee developed an international database. This report analyzes prognostic variables in a surgical population, which are supplementary to previously published CORE variables (stage, histology, sex, age, and type of procedure). Methods: Supplementary prognostic variables were studied in three scenarios: (1) all data available, that is, patient pathologically staged and other CORE variables available (2) only clinical staging available along with CORE variables, and (3) only age, sex, histology, and laboratory parameters are known. Survival was analyzed by Kaplan– Meier, prognostic factors by log rank and stepwise Cox regression modeling after elimination of nonsignificant variables. p value less than 0.05 was significant. Results: A total of 2141 patients with best tumor, node, metastasis (TNM) stages (pathologic with/without clinical staging) had nonmissing age, sex, histology, and type of surgical procedure. Three prognostic models were defined. Scenario A (all parameters): best pathologic stage, histology, sex, age, type of surgery, adjuvant treatment, white blood cell count (WBC) (≥15.5 or not), and platelets (≥400 k or not) (n = 550). Scenario B (no surgical staging): clinical stage, histology, sex, age, type of surgery, adjuvant treatment, WBC, hemoglobin (<14.6 or not), and platelets (n = 627). Scenario C (limited data): histology, sex, age, WBC, hemoglobin, and platelets (n = 906). Conclusion: Refinement of these models could define not only the appropriate patient preoperatively for best outcomes after cytoreductive surgery but also stratify surgically treated patients after clinical and pathologic staging who do or do not receive adjuvant therapy

Impact of discordance between patient's and evaluator's global assessment on treatment outcomes in 14 868 patients with spondyloarthritis

Funding: This work was supported by Novartis. Novartis had no influence on the data collection, statistical analyses, manuscript preparation or decision to submit.Peer reviewedPostprintPostprintPostprintPostprin

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Çocuklarda toplumda gelişen pnömoniler: epidemiyoloji, klinik bulgular ve tanı

Çocukluk çağında toplumda gelişen pnömoniler (TGP), 16 yaşın altındaki bireylerde “hastane ortamı dışında kazanılan etkenler” ile akciğerlerde meydana gelen enfeksiyonlar olarak tanımlanır. Bu durum etkilenen akciğerlerin (viseral plevra, alveoller ve intersitisyel doku) inflamasyonu ile sonuçlanır. Klinik olarak ise TGP, öncesinde sağlıklı bir çocukta ateş, tkipne ve öksürük gibi pnömoniye ait semptom ve bulguların varlığı ile tanımlanabilir.İÇİNDEKİLER BÖLÜM 1 GENEL BİLGİLER 1 Akın KAYA 1.1 Solunumsal Enfeksiyonların Epidemiyolojisi: Küresel ve Ulusal Veriler 3 Selma METİNTAŞ 1.2 Solunumsal Enfeksiyonlar: Tanımlar ve Sınıflandırma 19 Tevfik ÖZLÜ 1.3 Solunum Sisteminin non-immünolojik Savunma Mekanizmaları 23 Savaş ÖZSU Tevfik ÖZLÜ 1.4 Solunum Sisteminin immünolojik Savunma Mekanizmaları 27 Fatih YAKAR Cezmi AKDİŞ 1.5 Solunum Yolu Epiteli ve Mikrobiyal Aderens 37 Yılmaz BÜLBÜL BÖLÜM 2 SOLUNUMSAL PATOJENLER ve FARMAKOTERAPİ 43 İftihar KÖKSAL 2.1 Ülkemizde Solunumsal Enfeksiyonlara Neden Olan Patojenler 45 Derya ÖZTÜRK ENGİN Hakan ERDEM 2.2 Solunum Yolu Patojenlerinde Direnç 51 Mücahit YEMİŞEN Recep ÖZTÜRK 2.3 Solunumsal Enfeksiyonlarda Kullanılan Antimikrobiyaller Akciğerlerdeki Farmakokinetiği ve Farmakodinamiği 67 Büşra ERGUT SEZER Dilek ARMAN 2.4 Solunumsal Enfeksiyonlarda Antibiyotik Dışı Tedaviler 77 Fatma ÇİFTCİ Akın KAYA BÖLÜM 3 TANISAL YAKLAŞIMLAR 87 Tevfik ÖZLÜ 3.1 Solunumsal Enfeksiyonlarda Görüntüleme Bulguları 89 Recep SAVAŞ 3.2 Solunumsal Enfeksiyonlarda Örnekleme Yöntemleri 105 Ebru ÇELEBİOĞLU Ziya Toros SELÇUK 3.3 Solunumsal Örneklerin Mikrobiyolojisi 109 J. Sedef GÖÇMEN Ebru EVREN 3.4 Alt Solunum Yolu Enfeksiyonlarında Belirteçler 139 Kürşat UZUN BÖLÜM4 ERİŞKİNLERDE ÜSYE 145 Mehmet KARADAĞ 4.1 Rinit ve Soğuk Algınlığı 147 Mehmet KARADAĞ 4.2 Sinüzitler 151 Abdülcemal Ümit IŞIK 4.3 Tonsillofarenjitler 163 Süay ÖZMEN Ömer Afşın ÖZMEN 4.4 Otitis Media 177 Hatice ÇELİK 4.5 Larenjitler 195 Uğur DOKUZLAR Fikret KASAPOĞLU BÖLÜM 5 ERİŞKİNDE PNÖMONİLER 199 Tevfik ÖZLÜ 5.1 Toplumda Gelişmiş Pnömoniler 201 Tevfik ÖZLÜ Yılmaz BÜLBÜL 5.2 Sağlık Bakımı ile İlişkili Pnömoni 237 Gamze KIRKIL Yasin ABUL 5.3 Erişkinlerde Hastanede Gelişmiş Pnömoniler (Nonventile Hastalarda) 255 Emine ARGÜDER Hatice Canan HASANOĞLU Ayşegül KARALEZLİ 5.4 Ventilatörle İlişkili Pnömoni 269 Funda ÖZTUNA 5.5 Bağışıklığı Baskılanmış Erişkinlerde Gelişmiş Pnömoniler 299 Füsun ALATAŞ 5.6 Hematopoietik Kök Hücre Nakli Alıcılarında Akciğer Enfeksiyonları 315 Özlem ÖZDEMİR KUMBASAR 5.7 Solid Organ Transplantasyonu Olgularında Akciğer Enfeksiyonları 323 Şule AKÇAY 5.8 HIV Olgularında Gelişen Akciğer Enfeksiyonları 331 Nurcan İ. BAYKAM BÖLÜM 6 ÇOCUKTA SOLUNUM SİSTEMİ ENFEKSİYONLARI 339 Uğur ÖZÇELİK 6.1 Çocuklarda Kulak Burun Boğaz Enfeksiyon Hastalıkları 341 6.1.1 Kulak Enfeksiyonları 341 M. Umut AKYOL 6.1.2 Rinosinüzitler 351 Önder GÜNAYDIN 6.1.3 Adenotonsiller Enfeksiyonlar 355 Ozan ALTUNTAŞ 6.2 Boğmaca 359 Mehmet KÖSE 6.3 Akut Bronşiyolit 365 Bülent KARADAĞ 6.4 Çocuklarda Toplumda Gelişen Pnömoniler 371 6.4.1 Çocuklarda Toplumda Gelişen Pnömoniler: Epidemiyoloji, Klinik Bulgular ve Tanı 371 Ayten PAMUKÇU Emel K. ÜNSÜR 6.4.2 Çocuklarda Toplumda Gelişen Pnömoniler: Tedavi 385 Yasemin GÖKDEMİR Fazilet KARAKOÇ 6.4.3 Çocuklarda Toplumda Gelişen Pnömoniler: Korunma 393 Ali Bülent CENGİZ 6.5 Çocuklarda Hastanede Gelişen Pnömoniler 403 6.5.1 HGP: Etiyoloji, Sorunun Önemi ve Boyutu, Bulaşma Yolları ve Patogenez, Risk Faktörleri, Tanı ve Tedavi 403 Esen DEMİR Ateş KARA 6.6 Bağışıklığı Baskılanmış Çocuklarda Pnömoniler 415 6.6.1 Genel Giriş, Sınıflama, Nötropeni Tanımı, Tanı Yöntemleri, Tedavi, Tanı ve Tedavi Akış Şemaları 415 Refika ERSU Yasemin GÖKDEMİR 6.6.2 Hematopoetik Kök Hücre Transplantasyonu Yapılan Hastalarda Akciğer Sorunları 425 Deniz DOĞRU ERSÖZ 6.6.3 HIV'li Çocuk Hastalarda Akciğer Sorunları 433 Zeynep Seda UYAN 6.6.4 Solid Organ Transplantasyonu Yapılan Hastalarda Akciğer Sorunları 437 Figen GÜLEN 6.6.5 Primer İmmün Yetmezlikler ve Akciğer Bulguları 447 Deniz AYVAZ İlhan TEZCAN 6.7 Çocukluk Çağında Ampiyem 455 Ebru YALÇIN 6.8 Çocukluk Çağı Tüberkülozu 459 Emine KOCABAŞ 6.9 Tüberküloz Aşıları (BeG ve Yeni Geliştirilen Aşılar) 477 Nazan ÇOBANOĞLU 6.10 Çocuklarda Bronşektazi 485 Merih ANAR Nural KİPER 6.11 Kistik Fibrozisde Akciğer Enfeksiyonları 493 Uğur ÖZÇELİK BÖLÜM 7 PNÖMONİLER: ÖZEL DURUMLAR 505 Tevfik ÖZLÜ 7.1 Yaşlılarda Gelişen Pnömoniler 507 Figen DEVECİ 7.2 Aspirasyon Pnömonisi 533 Ebru ÇAKIR EDİS 7.3 Postoperatif Pnömoni 541 Mehmet KARADAĞ 7.4 Obstrüktif Pnömoni 547 Güntülü AK 7.5 Akciğer Apsesi 551 Hüseyin YILDIRIM 7.6 BiyolojikTerör ve Solunumsal Enfeksiyonlar 555 Selma METİNTAŞ BÖLÜM 8 PNÖMONİLERE ETYOLOJİK YAKLAŞIM 569 İftihar KÖKSAL 8.1 Akciğerin Bakteriyel Enfeksiyonları 571 Barış ERTUNÇ Gürdal YILMAZ 8.2 Akciğerin Atipik Ajanlara Bağlı Enfeksiyonları 583 Lütfiye MÜLAZIMOĞLU 8.3 Akciğerin Nadir Görülen Patojenlere Bağlı Enfeksiyonları 595 Zerrin YULUĞKURAL 8.4 İnfluenza (Grip) 605 Şaban ESEN Hasan ÇETİNKAYA 8.5 Akciğerin İnfluenza Virüs Dışı Viral Enfeksiyonları 615 Selçuk KAYA 8.6 Akciğerin Fungal Enfeksiyonları 627 Derya ÇAĞLAYAN SERİN Bilgin ARDA 8.7 Akciğerin Paraziter Enfeksiyonları 641 Oğuz KÖKTÜRK BÖLÜM 9 DİĞER SOLUNUMSAL ENFEKSİYONLARI 655 Muzaffer METİNTAŞ 9.1 Akut Trakeobronşit 657 Yılmaz BÜLBÜL 9.2 KOAH Enfeksiyöz Alevlenmeleri 663 Mehmet POLATLI 9.3 Bronşektazi 671 Hasan KAYNAR BÖLÜM 10 MİKOBAKTERİYEL ENFEKSİYONLARI 679 Mehmet KARADAĞ 10.1 Tanımlar, Sınıflandırma, Epidemiyoloji 681 Nuri KİRAZ 10.2 Tüberküloz Patogenezi ve Patoloji 693 Aslı GÖREK DİLEKTAŞLI 10.3 Postprimer Tüberküloz 701 Gaye ULUBAY Sevinç S. ULAŞLI 10.4 Erişkinde Akciğer Tüberkülozuna Klinik Yaklaşım 719 Tevfik ÖZLÜ 10.5 Dirençli Tüberküloz Tedavi ve izlemi 763 Funda COŞKUN 10.6 Tüberküloz Kontrolü 767 Ahmet URSAYAŞ 10.7 Tüberküloz Dışı Mikobakteri Enfeksiyonları 773 Ergun TOZKOPARAN Mehmet AYDOĞAN 10.8 Tüberkülozda Cerrahi Tedavi 781 Soner GÜRSOY BÖLÜM 11 PLEVRAL ENFEKSİYONLAR 797 Muzaffer METİNTAŞ 11.1 Parapnömonik Plörezi 799 Muzaffer METİNTAŞ 11.2 Plevra Tüberkülozu (Tüberküloz Plörezi) 809 Muzaffer METİNTAŞ BÖLÜM 12 SOLUNUMSAL ENFEKSİYONLARDAN KORUNMA 817 İftihar KÖKSAL 12.1 Toplumda Gelişmiş Solunumsal Enfeksiyonlardan Korunma Stratejileri 819 İftihar KÖKSAL 12.2 Hastanede Gelişmiş Pnömonilerden Korunma Stratejileri 831 Ayşegül ULU KILIÇ Emine ALP 12.3 Proflaktik Antibiyotik Tedavisi 839 Osman N. HATİPOĞL