Is routine performance of the uterine cervix canal curettage prior to the curettage of the uterine cavity justified?

Objectives: Endocervical curettage (ECC) together with the dilatation and curettage of the uterine cavity (D & C) is routinely performed in everyday clinical practice. The aim of this study is to assess the rationale of the performance of ECC prior to D & C in indications other than abnormal uterine bleeding (AUB). Material and methods: Case histories of 736 patients after ECC performed in the 1st Department of Obstetrics and Gynaecology, Medical University of Warsaw, were analyzed retrospectively, the indications for the procedure — age, menopausal status, parity, procedure operator’s experience — as well as the result of the histopathology examination were taken into account. Three groups of patients were distinguished based on the indications for the procedure. Results: In 645 (87.6%) of cases normal histopathology results were obtained. 40 (5.4%) cases were abnormal. 31 cases of uterine cervix dysplasia were disclosed (CIN 1–20; CIN 2–5; CIN 3–6), 8 cases of endometrial cancer and 1 case of cancer of the uterine cervix were disclosed. In 51 (7%) of cases tissue material for histopathology examination was not obtained. In patients where ECC and D & C were performed due to indications other than abnormal bleeding from uterine cavity, no abnormal results were revealed. In addition, in this group the highest number of non-diagnostic ECCs was reported (11.59%; p < 0.05). Conclusions: In the case of endometrial biopsy for indications other than AUB routine ECC prior to D & C need not be performed

Biological therapies in Crohn’s disease

Crohn’s disease is one of the chronic inflammatory diseases of the digestive tract. Pathophysiology of this disease involves the genetic and environmental factors, but the most important causative factor is anti-inflammatory reaction of the organism, which eventually leads to inflammatory changes, fibrosis and necrosis. Glucocorticosteroids are commonly used in therapy and may cause many negative side effects. Nowadays, new biological medicines are being tested, which are supposed to be an alternative method of treating Crohn’s disease. Infliximab, adalimumab, certolizumab pegol, natalizumab, etanerecept, vedolizumab and ustekinumab are the examples of those drugs, on which the research was already carried out. They lead to healing of the mucous membrane of the digestive tract, and thus to remission of the disease

Haloperidol and extrapyramidal symptoms: selected recent reports

Antipsychotic therapy by haloperidol is used from many decades and it still occupies a key place in the treatment ofsymptoms and prevention of recurrence of schizophrenia, mainly paranoid. It is also used in the treatment of bipolardisorder and behavioral disorders as well. It is also effective as an antiemetic and in drug-resistant hiccups. It can beused by both adults and children. The purpose of this review is to show selected articles describing methods, which mayreduce or even eliminate the risk of developing extrapyramidal syndrome, which is unavoidably accompanied by pharmacotherapywith this drug. These symptoms are a frequent cause of withdrawal of psychiatric medications by patientsand thus, they are the reasons of the therapy’s failure. This review includes interpretations of articles that present theresults of research on new methods for predicting the risk of extrapyramidal syndrome caused by haloperidol treatment.In this article we discussed predictive values of such factors as arterial blood lactate levels, creatine kinase activity, serumselenium level or early antipsychotic effect. In search of new methods of prevention of the extrapyramidal syndrome, weanalyzed the effect of caffeine, naproxen and cystamine. Evaluation of the clinical and morphological effects of chronichaloperidol administration has been based on results of patients who were suffering from paranoid schizophrenia froma minimum of 30 years. The results of experiments comparing the new form of administration of haloperidol with thepreviously known ones are also presented. The ideas presented in these works often require further clinical trials, whichmay be the reason for exploring these problems.Terapia przeciwpsychotyczna haloperidolem jest stosowana od wielu dekad i wciąż zajmuje kluczowe miejsce w leczeniu objawów i zapobieganiu nawrotom schizofrenii, głównie paranoidalnej. Jest stosowany również w terapii choroby afektywnej dwubiegunowej, jak również zaburzeń zachowania. Skuteczny też jako środek przeciwwymiotny i w opornej na leki czkawce. Dopuszcza się używanie zarówno u osób dorosłych jak i dzieci. Celem tego przeglądu jest ukazanie wybranych prac opisujących metody, które mogą w przyszłości zmniejszyć lub nawet wyeliminować ryzyko wywoływania zespołu pozapiramidowego, który nieodzownie towarzyszy farmakoterapii tym lekiem. Objawy te są częstą przyczyną odstawiania medykamentów psychiatrycznych przez pacjentów i tym samym niepowodzenia terapii. W niniejszym przeglądzie zawarte są interpretacje artykułów, które prezentują wyniki badań nad nowymi metodami przewidywania ryzyka wystąpienia zespołu pozapiramidowego wywołanego leczeniem haloperidolem. Omówiono wartości predykcyjne takich czynników jak stężenia mleczanów we krwi tętniczej, aktywność kinazy kreatynowej, poziom selenu w surowicy czy wczesny efekt przeciwpsychotyczny. W poszukiwaniu nowych sposobów prewencji zespołu pozapiramidowego przeanalizowano efekt działania kofeiny, naproksenu oraz cystaminy. Ocenie skutków klinicznych i morfologicznych przewlekłego stosowania haloperidolu zostali poddani pacjenci chorujący na schizofrenię paranoidalną od minimum 30 lat. Przedstawione zostały też wyniki doświadczeń porównujących nową formę podawania haloperidolu z dotychczas znanymi. Idee przedstawione w tych pracach nierzadko wymagają dalszych badań klinicznych, co może stać się przyczyną do zgłębiania tych problemów

Current nosological status, pathomechanism and treatment of catatonia

Catatonia, otherwise known as catatonic syndrome is a frequent neuropsychiatric syndrome characterized mainly by motor disorders. There are many somatic and psychiatric dysfunctions, and the multitude of symptoms included in it make a problem in diagnosis. Moreover, until now the mechanism of pathophysiology of catatonia has not been recognized. Among the hypotheses proposed, one may find theories concerning dysregulation of neurotransmission within the dopamineergic D2 or GABA-A-ergic receptors. For years, catatonia was closely related to schizophrenia, but with the publication of the 5th edition of the Diagnostic and Statistical Manual of Psychiatric Disorders - DSM-5, these disorders were separated, creating the hope that catatonia would be considered as a separate disease entity in the future. Pharmacotherapy involves the use of benzodiazepines in the first line, which are effective in most patients. An alternative is N-methyl-D-aspartic acid (NMDA) antagonists and atypical antipsychotic drugs, the use of which is controversial due to the high risk of neuroleptic malignant syndrome, which is a direct threat to life. In the case of catatonia resistant to benzodiazepines, electroconvulsive therapy (ECT) is effective. At the same time, in order to increase the effectiveness of treatment, electroconvulsive therapy and benzodiazepines are used in parallel, which brings satisfactory results

Sofosbuvir as a drug in recurrent HCV therapy occurring after liver transplantation

Sofosbuvir is a drug, which has been found useful in HCV (Hepatis C Virus) therapy. It replaced the previously used interferon, the applied of which has shown many side effects or lack of response to treatment. The usage of sofosbuvir with ribavirin shortens the time of treatment and minimizes the number of side effects. It is taken as a single dose of 400 mg for 12 or 24 weeks. The only place of activation of this prodrug is hepatocytes, where its active metabolite is formed (GS-461203). It should not be used together with P-glycoprotein inductors that can reduce the efficiency of its action and with amiodarone, because application of both of them together slows down the heart rate. Numerous tests have demonstrated the effectiveness of sofosbuvir in the treatment of patients who have relapsed disease after liver transplantation. A high percentage of sustained virologic response obtained in all phases of clinical trials has proven the efficacy of sofosbuvir in combination with ribavirin or another HCV drug in the therapy of hepatitis C infection

TabAttention: Learning Attention Conditionally on Tabular Data

Medical data analysis often combines both imaging and tabular data processing using machine learning algorithms. While previous studies have investigated the impact of attention mechanisms on deep learning models, few have explored integrating attention modules and tabular data. In this paper, we introduce TabAttention, a novel module that enhances the performance of Convolutional Neural Networks (CNNs) with an attention mechanism that is trained conditionally on tabular data. Specifically, we extend the Convolutional Block Attention Module to 3D by adding a Temporal Attention Module that uses multi-head self-attention to learn attention maps. Furthermore, we enhance all attention modules by integrating tabular data embeddings. Our approach is demonstrated on the fetal birth weight (FBW) estimation task, using 92 fetal abdominal ultrasound video scans and fetal biometry measurements. Our results indicate that TabAttention outperforms clinicians and existing methods that rely on tabular and/or imaging data for FBW prediction. This novel approach has the potential to improve computer-aided diagnosis in various clinical workflows where imaging and tabular data are combined. We provide a source code for integrating TabAttention in CNNs at https://github.com/SanoScience/Tab-Attention.Comment: Accepted for the 26th International Conference on Medical Image Computing and Computer Assisted Intervention (MICCAI) 202

Carbamazepine - hematologic effects of the use

Carbamazepine is an antiepileptic drug which exhibits a number of side effects, namely including a headache, abdominal pain, increased blood pressure, but also hematologic disorders. Thrombocytopenia, hypogammaglobulinemia, leukopenia, neutropenia, agranulocytosis, aplastic anemia, pure red cell aplasia, leukemia or eosinophilia with DRESS syndrome belong to the latter. There is a low incidence of carbamazepine pharmacotherapy related symptoms and their exact mechanisms of action are still unknown

Technika iniekcji naczyniowej w poporodowej ocenie kosmówkowości w trojaczej ciąży dwukosmówkowej

Ciąże trojacze występują z częstością 1 na 7000 urodzeń. W związku z tym, że każdy typ ciąży mnogiej, w tym trojaczej, koreluje z wysoką śmiertelnością i odsetkiem porodów przedwczesnych, kosmówkowość i owodniowość pozostają ważnymi czynnikami prognostycznymi determinującymi postępowanie w trakcie ciąży. Ultrasonograficzna ocena kosmówkowości w ciążach trojaczych jest bardziej złożona niż w bliźniaczych i wielu przypadkach pozostaje nieznana. Prezentujemy przypadek dwukosmówkowej ciąży trojaczej u 24- letniej pierworódki rozwiązanej drogą cięcia cesarskiego w 33 tygodniu ciąży wraz z oceną kosmówkowości na podstawie poporodowego badania łożysk z wykorzystaniem techniki iniekcji naczyniowych.The incidence of spontaneous triplet pregnancy is approximately 1 in 7000 deliveries. Due to the fact that every presentation of a triplet and higher order pregnancy is associated with high rate of morbidity and preterm delivery, chorionicity and amnionicity remain significant predictive factors which determine specific management throughout the pregnancy. Ultrasound chorionicity assessment in triplet pregnancies is more complex than in twins, and in many cases it remains unknown. We present a case report of a 24-year-old primipara in a spontaneous dichorionic triplet pregnancy, qualified for a cesarean section at 33 weeks of gestation, with subsequent placental examination with dye injections and post-delivery chorionicity assessment

Hidradenitis suppurativa – biologic therapy and other available treatment options

Hidradenitis suppurativa (HS) is a chronic recurrent inflammatory skin disease that is characterized by painful, recurrent nodules and abscesses. The overall prevalence of HS is estimated to be 11 per 100,000 individuals in the United States and 4% of the world’s population. Women are 3 times more affected than men, especially patients between 18 and 29 years of age. Similarly to acne vulgaris, HS is primarily associated with follicular occlusion, which results from a number of biological processes, including follicular epithelial hyperplasia and hyperkeratinisation. There are numerous available treatment options for cutaneous lesions in the course of HS. A combination of conservative therapy and appropriate surgical treatment conducted by an experienced surgeon ensures the best possible clinical outcomes. Presently, biologic therapy is the most effective pharmacological treatment in patients with moderate to severe course of the disease. Numerous ongoing clinical trials provide hope for greater availability of new biologic therapy methods