25 research outputs found
Perinatal outcomes of twin pregnancies affected by early twin‐twin transfusion syndrome: A systematic review and meta‐analysis
No full textIntroduction
Twin‐to‐twin transfusion syndrome (TTTS) is associated with a high risk of perinatal mortality and morbidity if not treated. However, the optimal timing and management in case of early (occurring < 18 weeks) TTTS has not been established yet.
Material and methods
This is a systematic review and meta‐analysis aiming at evaluating the outcomes of monochorionic diamniotic twin pregnancies complicated by early (ie before 18 weeks) TTTS according to different management options (expectant, laser therapy, amnioreduction or cord occlusion). The primary outcome was mortality, including single and double intrauterine, neonatal and perinatal death. Secondary outcomes were: composite morbidity, neuromorbidity, respiratory distress syndrome, admission to neonatal intensive care unit, intact survival (defined as survival free from neurological complications) and preterm birth < 32 weeks of gestation. All outcomes were reviewed according to the different management options (expectant, laser therapy, amnioreduction or cord occlusion) and reported FOR the overall population of twins, and for the donor and recipient separately. Subgroup analysis for TTTS occurring before 16 weeks of gestation was performed. Random‐effect meta‐analyses of proportions were used to analyse the data.
Results
Thirteen studies were included. Early TTTS occurred in 14.3% (95% confidence interval [CI] 11.9‐17.0) of cases. The incidence of intrauterine death was 19.0% (95% CI 2.6‐45.5) in twins managed expectantly, 32.4% (95% CI 16.5‐50.7) in those who received laser treatment and 12.5% (95% CI 4.8‐23.0) in those treated with amnioreduction. The incidence of neonatal death was 22.6% (95% CI 4.2‐49.8) in twins managed expectantly, 24.7% (95% CI 0.5‐80.3) in those who received laser and 20.2 (95% CI 5.8‐43.4) in those who had amnioreduction; it was not possible to compute the incidence of these outcomes in twins undergoing cord occlusion because of insufficient sample and lack of reporting of most of the observed outcomes. Overall, the incidence of perinatal death was 43.9% (95% CI 5.9‐87.7) in twins managed expectantly, 47.3% (95% CI 21.4‐70.0) in those treated with laser and 28.5% in those who had amnioreduction.
Conclusions
Twin pregnancies affected by early TTTS are at substantial risk of perinatal mortality and morbidity; however, the data come from very small studies with a high risk of selection bias
Perinatal outcomes of twin pregnancies complicated by late twin‐twin transfusion syndrome: A systematic review and meta‐analysis
No full textIntroduction
Untreated twin‐to‐twin transfusion syndrome (TTTS) is associated with a high risk of perinatal mortality and morbidity. Laser surgery is recommended before 26 weeks of gestation. However, the optimal management in case of late TTTS (occurring after 26 weeks of gestation) is yet to be established.
Material and methods
We conducted a systematic review and meta‐analysis to evaluate the outcomes of monochorionic‐diamniotic twin pregnancies complicated by late TTTS according to different management options (expectant, laser therapy, amnioreduction, or delivery). The primary outcome was mortality, including single and double intrauterine, neonatal, and perinatal death. Secondary outcomes were composite morbidity, neuromorbidity, respiratory distress syndrome, admission to neonatal intensive care unit, intact survival (ie, free from neurological complications), and preterm birth before <32 weeks of gestation. Outcomes were reviewed according to the management and reported for the overall population of twins and disease status (ie, donor and recipient separately). Random‐effect meta‐analyses of proportions were used to analyze the data.
Results
Nine studies including 796 twin pregnancies affected by TTTS were included. No randomized controlled trials were available for inclusion. TTTS occurred at ≥26 weeks of gestation in 8.7% (95% CI 6.9%‐10.9%; 67/769) of cases reporting TTTS at all gestations. Intrauterine death occurred in 17.7% (95% CI 4.9%‐36.2%) of pregnancies managed expectantly, 5.3% (95% CI 0.9%‐12.9%) of pregnancies treated with laser, and 0% (95% CI 0%‐9%) after amnioreduction. Neonatal death occurred in 42.5% (95% CI 17.5%‐69.7%) of pregnancies managed expectantly, in 2.8% (95% CI 0.3%‐7.7%) of cases treated with laser, and in 20.2% (95% CI 6%‐40%) after amnioreduction. Only one study (10 cases) reported data on immediate delivery after diagnosis with no perinatal deaths. Perinatal death incidence was 55.7% (95% CI 31.4%‐78.6%) in twin pregnancies managed expectantly, 5.6% (95% CI 0.5%‐15.3%) in those treated with laser, and 20.2% (95% CI 6%‐40%) in those after amnioreduction. Intact survival was reported in 44.4%, 96.4%, and 78% of fetuses managed expectantly, with laser or amnioreduction, respectively.
Conclusions
Evidence regarding perinatal mortality and morbidity in twin pregnancies complicated by late TTTS according to the different managements was of very low quality. Therefore further high‐quality research in this field is needed to elucidate the optimal management of these pregnancies
Retrospective Analysis of 90 Patients that Underwent Retrograde Intrarenal Surgery
No full textINTRODUCTION: To evaluate the results of retrograde intrarenal surgery (RIRC) performed in our clinic in cases with renal stones. METHODS: The results of 90 patients that underwent RIRC between June 2016 and January 2019 were evaluated retrospectively. The demographic data and the preoperative and postoperative clinical characteristics of the patients were examined. RESULTS: The mean age of 90 patients that underwent RIRC (41 men/49 women) was 43.35 (21-84) years, and the mean stone size was 16.22 (10-28) mm. The operation was performed under general anesthesia in 38 patients (42.22%) and spinal anesthesia in 52 (57.78%). The mean operation duration was 61.76 (30-115) min, and the mean stone fragmentation time was 48.33 (15-95) min. In 23 patients (25.55%), a double-J stent was inserted into the ureter since the kidney could not be reached due to stenosis. In 75 patients (83.33%), a double-J stent was placed at the end of the operation. The mean hospital stay was 1.08 (1-3) days. The stone-free rate was 71.12%. Of the cases with residual stones, 21 (23.32%) underwent an additional intervention and five (5.55%) were followed up without further intervention. Complications were observed in 13 patients (14.44%) and evaluated according to the modified Clavien classification. DISCUSSION AND CONCLUSION: In the presence of adequate equipment and experience, RIRC is an effective and safe procedure with high success, low complication and minimal morbidity rates in the treatment of renal stones
The Damage of Penile Doppler Ultrasonoghraphy in Diagnosis of Penile Mondor's Disease: A Report of Two Cases
No full textAbstractPenile Mondor's disease is a thrombophlebitis of the superficial dorsal vein of the penis. It is a rare clinical diagnosis and generally resolves spontaneously. A simple physical examination is sufficient for diagnosis but color Doppler ultrasonography is often carried out as a further investigation. We describe two patients who developed priapism due to penile Doppler ultrasonography which was used for diagnosis of these patients. Now, in our opinion this examination was unnecessary
The Relationship of Musician to Political Power in the Process of Modernization: The Eulogies Composed for Selim III and Mahmud II
No full textThe patronage system, which can be defined as support of an artist by a prosperous patron, has been one of the most important factors in ensuring the continuity of artistic production up to the modern market system. In the context of this relationship, artists hav e formed their artistic works through patron's pleasures and wishes in return for the support they receive. This study examines the relationship of sultans, who were major patrons of the Ottoman musical tradition, with the musicians around them through the composed eulogies (medhiye). It is limited to the reigns of Selim III and Mahmud II, who were also musicians. In spite of the prevalence in Ottoman poetry, examples of eulogies are limited in Ottoman music, with 35 composed eulogies having been found for this period. These musical works have been analyzed according to composer, mode (makam), rhythm (usul), form, and dedication. Another dimension in this study is an evaluation of these eulogies' lyrics. After focusing on each set of lyrics, the texts have been examined according to the themes set out under categories such as prayer, praise, and greeting. Thus the subjects that are significant in the eulogies have been identified
Critical appraisal and narrative review of the literature in IVF/ICSI patients with adenomyosis and endometriosis
No full textEndometriosis and adenomyosis are prevalent causes of infertility, often coexisting in a significant proportion of patients. Although endometriosis typically does not negatively impact assisted reproductive technology (ART) outcomes, the presence of coexisting adenomyosis, mainly non-severe external forms, may slightly influence IVF/ICSI success rates. However, this impact is often minimal and may result in insignificant changes in statistical analyses. Recent studies underscore the critical role of accurate diagnostic techniques, such as ultrasound or MRI, in identifying severe adenomyosis characteristics, including diffuse involvement with junctional zone participation. This precise delineation is reassuring, as it is essential for tailoring assisted reproductive technology (ART) strategies to enhance success rates and reduce the confounding effects of adenomyosis, particularly when it coexists with endometriosis. Strategic approaches, such as ultralong GnRH agonist protocols or freeze-all strategies, may provide advantages in these scenarios. However, the need for extensive research is vital to understanding the complex interactions between endometriosis, adenomyosis, and ART outcomes. This ongoing exploration is particularly important in cases where coexisting adenomyosis might not significantly influence statistical results
Cesarean delivery: A predisposing factor for autoimmune thyroid disease in iodine replete women?
No full textThe Effect Of Different 2,4-Dichlorophenoxyacetic Acid Doses On Chromosomal Structure Of Regenerants In Barley (Hordeum vulgare L.) Embryo Culture
No full textABSTRACT In this study, as a plant material, two-row barley (Hordeum vulgare L.) cultivars called 'Bülbül-89' and 'Tarm-92', which have great importance in Turkey's agricultural production, and as a synthetic auxin 2,4-dichlorophenoxyacetic acid (2,4-D) were used. This research, employed 2,4-D as an auxin for callus induction for mature barley embryos in different doses. In both cultivars, the highest values of callus induction, callus weight, regeneration capacity and culture efficiency were established when 3 mg l -1 2,4-D auxin was used. In the cytological analysis of the root tips of regenerated plantlets, at 3 mg l -1 2,4-D, no physical and numerical abnormality were observed in chromosomes, therefore the doses in question can be used confidently
Home blood pressure monitoring in the antenatal and postpartum period: A systematic review meta-analysis
No full textRecent evidence suggests that home blood pressure monitoring (HBPM) is an effective way of managing women with hypertensive disorders of pregnancy (HDP) without increasing adverse outcomes. The aim of this systematic review and meta-analysis was to investigate the safety and efficacy of HBPM during pregnancy
Cognitive, Affective Problems and Renal Cross Ectopy in a Patient with 48,XXYY/47,XYY Syndrome
No full textKlinefelter syndrome is the most common sex chromosome abnormality (SCA) in infertile patients and 47,XXY genomic configuration constitutes most of the cases. However, additional Xs and/or Y such as 48,XXYY, 48,XXXY, and 47,XYY can occur less frequently than 47,XXY. Those configurations were considered as variants of Klinefelter syndrome. In this report, we present an infertile man with tall stature and decreased testicular volume. Semen analysis and hormonal evaluation supported the diagnosis of nonobstructive azoospermia. Genetic investigation demonstrated an abnormal male karyotype with two X chromosomes and two Y chromosomes consistent with 48,XXYY(17)/47,XYY (13). Additionally, the patient expressed cognitive and affective problems which were documented by psychomotor retardation and borderline intelligence measured by an IQ value between 70 and 80. Systemic evaluation also revealed cross ectopy and malrotation of the right kidney in the patient. The couple was referred to microtesticular sperm extraction (micro-TESE)/intracytoplasmic sperm injection (ICSI) cycles and preimplantation genetic diagnosis (PGD). To the best of our knowledge, this is the first report of combination of XYY and XXYY syndromes associated with cognitive, affective dysfunction and renal malrotation
