Investigation of Effects of Gadolinium-Based Contrast Agents on Uterine Contractility Using Isolated Rat Myometrium

BACKGROUND

Despite concerns about safety, gadolinium-based contrast agents (GBCAs) are still used for abdominal and pelvic imaging during pregnancy. Researchers have mainly focused on teratogenicity, while very little is known about their possible direct effects on uterine contractility, yet free gadolinium potentially impacts contractility through interaction with calcium channels.

PURPOSE

To investigate possible effects of selected GBCAs (namely gadoteridol, gadoversetamide, gadobutrol, gadoterate meglumine, and gadoxetic acid) on the contractility of rat myometrium.

STUDY TYPE

In vitro organ bath study.

ANIMAL MODEL

Myometria were isolated from adult (10-12 weeks old) Sprague Dawley rats, both pregnant (N = 8) and nonpregnant (N = 36).

FIELD STRENGTH/SEQUENCE

NA.

ASSESSMENT

Myometrial strips were suspended in tissue bath containing physiological saline and isometric contractions were recorded. GBCAs were added to the tissue bath cumulatively, and their effects on contractility parameters (quantified by amplitude, frequency, and area under contractility curve [AUC]) were evaluated by 10-minute intervals.

STATISTICAL TESTS

Normality data, checked by Shapiro-Wilk test, were transformed by arcsine when needed. One- or two-way analysis of variance was performed, where appropriate, followed by Student-Newman-Keuls test. A P value of <0.05 was considered statistically significant.

RESULTS

All of the assayed GBCAs elicited some alterations in the myometrial contractility in a concentration-dependent manner. Gadoterate meglumine, gadoxetic acid, and gadoversetamide caused a concentration-dependent significant attenuation in AUC (oxytocin-induced, from 100% during control period to 45.1 ± 9.0% (nonpregnant) and 59.9 ± 8.5% (pregnant), for 90 μM gadoterate meglumine; respectively), and frequency of the spontaneous and oxytocin-induced contractions. Gadobutrol and gadoteridol at highest dose significantly attenuated mean AUC and frequency of oxytocin-induced contractions of nonpregnant myometrium.

DATA CONCLUSION

Results from this in vitro study indicate that GBCAs elicit modulation of myometrial contractions at clinically relevant concentrations. These effects may account, at least partially, for the known potential side effects (rare cases of miscarriages and elective abortion) of these agents.

LEVEL OF EVIDENCE

1 TECHNICAL EFFICACY: Stage 5.

Fetal cardiac Doppler changes in gestational diabetic pregnancies and its relationship with perinatal outcomes

AIM

To examine the structural and functional changes of the fetal heart in gestational diabetes mellitus (GDM) and to evaluate the power of fetal cardiac Doppler parameters in predicting adverse perinatal outcomes in this group of pregnancy.

METHODS

Within the study's scope, 36 cases in the A1 GDM group, 33 cases in the A2 GDM group, and 124 cases in the control group were evaluated. The relationship between structural and functional fetal cardiac parameters and perinatal outcomes was evaluated via fetal echocardiography.

RESULTS

Fetal left ventricular myocardial performance index (MPI) values were found to be statistically significantly higher when compared between the A1 GDM and A2 GDM groups and the control group (p = 0.000 and p = 0.000, respectively), while the E/A ratio was found to be significantly lower (p = 0.000 and p = 0.000, respectively). It was determined that the maternal blood HbA1c level showed a significant negative correlation with the fetal cardiac E/A ratio and a significant positive correlation with isovolumetric relaxation time and MPI (p = 0.000, p = 0.000, and p = 0.000, respectively). Adverse perinatal outcome rate was higher in the diabetic group (46.4%-22.6%). When the cases with GDM were examined in terms of perinatal outcomes, it was observed that there was a significant difference in HbA1c levels, E/A ratio, and MPI values between the cases in the group with adverse perinatal outcomes and the group with normal results (p = 0.001, p = 0.000, and p = 0.000, respectively).

CONCLUSIONS

The strong relationship between abnormal cardiac function and adverse perinatal outcomes suggest that cardiac Doppler may be a valuable tool for fetal monitoring and management for the GDM patient group.

Fetal US and MRI in detection of craniospinal anomalies with postnatal correlation: single-center experience

Background/aim

To reveal the contribution of magnetic resonance imaging (MRI) to ultrasound (US) in prenatal diagnosis of fetal craniospinal anomalies by retrospectively comparing the prenatal and postnatal findings.

Materials and methods

After institutional review board approval, between January 2010 and May 2020, 301 pregnant women, which had a gestational age between 19–37 weeks (mean 26.5 ± 6.1 weeks), diagnosed with cranial and spinal anomalies on fetal US and later on imaged with MRI were evaluated, and in 179 of those cases prenatal imaging findings were compared with postnatal findings.

Results

A total of 191 fetal craniospinal anomalies were detected in 179 pregnant women. MRI and US diagnosis were completely correct in 145 (75.9%) and 112 (58.6%), respectively. Diagnostic performance of MRI was significantly higher than that of the US (p < 0.05). Both prenatal MRI and US findings were concordant with postnatal diagnosis in 53% of the cases. In 28.7% cases, prenatal MRI contributed to US by either changing the wrong US diagnosis (8.9%), demonstration of additional findings (14%), or confirming the suspicious US diagnosis (5.8%).

Conclusion

Due to its high resolution and multiplanar imaging capability, fetal MRI contributes significantly to US in the correct prenatal diagnosis of craniospinal anomalies. This contribution especially is significant in neural tube defects, cortical malformations, and ischemic-hemorrhagic lesions.

Distribution of nuchal translucency thickness at 11 to 14 weeks of gestation in a normal Turkish population

Background/aim

The aim of this study was to determine fetal nuchal translucency (NT) thickness nomogram values in first trimester in a Turkish population and compare them with previously reported European and Asian nomogram data.

Material and methods

Ultrasonographic measurements of crown-rump length (CRL) and NT thicknesses were obtained from 11 to 14 weeks of gestation in a normal Turkish population. Pregnant women with singleton pregnancy and fetal CRL between 45 and 84 mm were included in the study. The mean 1st, 3rd, 5th, 50th, 90th, 95th, 97th, and 99th percentiles and fixed cut off values of ≥ 2.5 mm, ≥ 3 mm, ≥ 3.5 mm NT thicknesses for a CRL between 45 and 84 mm were determined.

Results

A total of 1605 healthy fetuses were enrolled in the study. The sonographic measurements were performed on 1541 (%94) fetuses transabdominally and on 99 cases (%4) by the transvaginal route. The mean NT thickness for CRL between 45 and 84 mm was 1.57 ± 074 mm, and the mean 95th, 97th, and 99th percentiles of these values were 2.82 mm, 3.17, and 4.75 mm, respectively. The incidence of NT thicknesses at fixed points of ≥ 2.5 mm, ≥ 3 mm, and ≥ 3.5 mm in normal fetuses were 6.7%, 4.1%, and 2.1%, respectively.

Conclusion

The present study demonstrated the nomogram data of fetal NT thickness in a Turkish population. We think that this report will be useful for further research related to NT thickness values on the prenatal diagnosis for the first trimester chromosomal abnormalities in Turkish populations.

R202Q/M694V as novel MEFV gene mutations in chronic periodontitis and familial Mediterranean fever

BACKGROUND AND OBJECTIVE

Familial Mediterranean fever (FMF) and chronic periodontitis are inflammatory diseases leading to an increase in the number of inflammasomes. To date, no published studies have reported on mutations in the Mediterranean fever (MEFV) gene in patients with chronic periodontitis, although the roles of MEFV gene mutations in FMF and FMF-associated amyloidosis (FMF-A) are well known. Therefore, the aim of this study was to evaluate the frequencies of MEFV gene mutations and serum amyloid A (SAA) and high-sensitivity C-reactive protein (hs-CRP) levels in patients with chronic periodontitis, FMF and FMF-A.

MATERIAL AND METHODS

The study population included 122 patients with FMF and 128 subjects who were systemically healthy. Clinical periodontal parameters, including the plaque index, gingival index, probing pocket depth, clinical attachment level and percentage of bleeding on probing were recorded. Blood samples were obtained from patients with FMF and systemically healthy controls, and all mutations located on exons 2 and 10 of the MEFV gene were analyzed by DNA Sanger Sequencing, which is the gold standard. SAA and high-sensitive CRP levels were also assessed.

RESULTS

Mean gingival index, percentage of bleeding on probing, probing pocket depth and clinical attachment level, and the levels of SAA and hs-CRP were higher in the FMF-A group than those in the FMF and control groups. The two most relevant mutations in patients with FMF were heterozygous M694V (46.2%), and heterozygous R202Q (32.7%). The frequencies of the homozygous M694V and R202Q mutations in the FMF-A group were 53.8% and 46.1%, respectively. The complex R202Q/M694V homozygous state led to an increased risk of chronic periodontitis (odds ratio: 3.6), and FMF-A (odds ratio: 7.6).

CONCLUSION

This is the first study to report the R202Q mutation in patients with periodontitis. Furthermore, the MEFV gene-mediated inflammatory pathway increased serum acute phase reactants, and the changes in the R202Q and M694V could play a role in inflammatory-genetic diseases, such as FMF, FMF-associated amyloidosis and chronic periodontitis.

Effects of ozone and photo-activated disinfection against Enterococcus faecalis biofilms in vitro

OBJECTIVES

The purpose of this study was to compare the antibacterial effects of gaseous ozone (O3) and photo-activated disinfection (PAD) methods against Enterococcus faecalis (E. faecalis) biofilms.

MATERIALS AND METHODS

Sixty-five human mandibular premolars with straight root canals were selected. After root canal preparation, the samples were sterilized and placed into eppendorf tubes with 1 mL brain heart infusion broth containing 1.5×10(8) colony-forming units (CFUs)/mL of E. faecalis. The contaminated samples were then divided into four groups (n=15) according to the disinfection method used: Group 1, Saline (positive control); Group 2, NaOCl (negative control); Group 3, Gaseous O3; and Group 4, PAD. Three non-contaminated teeth were used to control the infection and sterilization process. The CFUs were counted and the data were analyzed statistically.

RESULTS

There was a statistically significant difference between the experimental and control groups (P<0.05). The saline group had the highest number of remaining microorganisms. Complete sterilization was achieved in the 2.5% NaOCl group. There were no statistically differences between PAD and gaseous O3 (P>0.05).

CONCLUSION

Both PAD and gaseous O3 have a significant antibacterial effect on infected root canals. However, 2.5% NaOCl was superior in terms of its antimicrobial abilities compared with the other disinfection procedures.

Evaluating Sleep Characteristics in Intensive Care Unit and Non-Intensive Care Unit Physicians

Healthcare workers’ cognitive performances and alertness are highly vulnerable to sleep loss and circadian rhythms. The purpose of this study was to investigate the changes in sleep characteristics of intensive care unit (ICU) and non-ICU physicians. Actigraphic sleep parameters, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale and Hamilton Depression Rating Scale were evaluated for ICU and non-ICU physicians on the day before shift-work and on three consecutive days after shift-work. Total sleep time, sleep latency, wakefulness after sleep onset, total activity score, movement fragmentation index, sleep efficiency, daytime naps and total nap duration were also calculated by actigraph. In the ICU physicians, the mean Pittsburgh Sleep Quality Index score was significantly higher than the non-ICU physicians (P=0.001), however mean Epworth Sleepiness Scale scores were not found significantly different between the two groups. None of the scores for objective sleep parameters were statistically different between the groups when evaluated before and after shift-work (P >0.05). However in both ICU and non-ICU physicians, sleep latency was observed to be decreased within the three consecutive-day period after shift-work with respect to basal values (P <0.001). Total sleep time, total activity score and sleep efficiency scores prior to shift-work were significantly different from shift-work and the three consecutive-days after shift-work, in both groups. Working in the ICU does not have an impact on objective sleep characteristics of physicians in this study. Large cohort studies are required to determine long-term health concerns of shift-working physicians.

Comparison of antimicrobial effects of dexmedetomidine and etomidate-lipuro with those of propofol and midazolam

BACKGROUND AND OBJECTIVES

The aim of our study was to investigate the antimicrobial effects of dexmedetomidine and etomidate-lipuro, and to compare these effects with those of midazolam and propofol on Staphylococcus aureus, Escherichia coli, Pseudomonas aeroginosa, Acinetobacter baumannii and extended-spectrum beta-lactamase Escherichia coli ( E. coli ESBL).

METHODS

All hypnotic dilutions were exposed to micro-organisms for 0, 30, 60, 120 and 240 min at room temperature in vitro. The inoculums taken from diluted suspensions were re-inoculated on blood agar and incubated for 18-24 h at 35 degrees C after which a count of the colonies was compared.

RESULTS

Midazolam reduced the viable cells of S. aureus at 30, 60, 120 and 240 min, and also completely inhibited the growth of E. coli, P. aeroginosa, A. baumannii and E. coli ESBL. Dexmedetomidine, etomidate-lipuro and propofol, however, did not inhibit any of the micro-organisms tested.

CONCLUSION

In vitro, midazolam had an antimicrobial effect on E. coli, P. aeroginosa, A. baumannii and E. coli ESBL. Like propofol and dexmedetomidine, etomidate-lipuro had no antimicrobial effect on any of the micro-organisms tested.

Comparison of cerebral magnetic resonance and electroencephalogram findings in pre-eclamptic and eclamptic women

OBJECTIVE

To compare the cerebral magnetic resonance (MR) and electroencephalogram (EEG) findings in pre-eclamptic and eclamptic pregnant women.

METHODS

A total of 38 pregnant women with mild pre-eclampsia (n = 15), severe pre-eclampsia (n = 11) and eclampsia (n = 12) were included in this study. Cranial MR without contrast and EEG were performed in these women on admission or within 3 days of onset. Follow-up control MR or EEG evaluations were performed 4-6 weeks postpartum in women with MR or EEG abnormalities in the initial examination. To compare differences, X(2) test, Fisher exact or Mann-Whitney U-tests were used.

RESULTS

Abnormal cranial MR findings were found in one (6%) pre-eclamptic woman, in four (36%) severe pre-eclamptic women, and in 11 (92%) eclamptic women. Cranial MR findings were consistent with ischaemia in 15 (39%) patients and haemorrhage in one (3%) case. Two (5%) severe pre-eclamptic women showed cerebral infarction during the follow-up period. MR and EEG abnormalities were totally resolved in 88% of cases. The MR findings of 12 (71%) patients were located in the occipital lobes followed by the parietal lobes in six (40%) cases. Three (20%) mild pre-eclamptic women, four (36%) severe pre-eclamptic women and 10 (83%) eclamptic women had abnormal EEGs. The EEG changes were totally resolved in 13 of 14 (93%) patients after the first month. In one patient with cerebral haemorrhage, the EEG changes lasted for a duration of 6 months.

CONCLUSIONS

A correlation between EEG abnormalities and MR findings was found in this study. The combined use of MR and EEG may help to determine the prognosis for these patients, but the interictal EEG findings recorded in eclampsia were non-specific.

Is there an association between clinical symptoms and intestinal parasitic infections?

Intestinal parasitic infections are major causes of childhood diseases in rural regions. The significant causes of this problem are the insufficient resources to improve the infrastructure in these regions and inadequate health services in both the diagnosis and treatment of diseases. The aim of this study was to assess the association between intestinal parasitic infections and clinical symptoms of infected children. Cellophane tape and stool samples of 100 children, aged between 7-10 years, from two villages of Manisa city, were examined for intestinal parasites and their symptoms were recorded. Although some symptoms, such as abdominal pain, anorexia and fatigue were found to be common in infected children, no significant relationship was found between symptoms and intestinal parasitic infections.

The venous drainage of the heart in porcupines (Hystrix cristata)

The venous drainage of the heart in porcupines (Hystrix cristata) was investigated. Each of the five adult porcupines (three males, two females) was injected with a coloured latex mixture via the V. cava caudalis for the demonstration of the cardiac veins. The dissection of the specimens revealed that the venous drainage of the heart in porcupines was made by the V. cordis magna, V. distalis ventriculi sinistri, V. proximalis ventriculi sinistri, V. cordis caudalis (the left marginal vein), V. cordis media and Vv. cordis dextrae. The cardiac veins were observed in a subepicardial course on the heart except for the R. interventricularis paraconalis. The R. interventricularis paraconalis showed an intramyocardial course until the middle of the sulcus interventricularis paraconalis, and a subepicardial course after this point. The V. cordis magna and V. distalis ventriculi sinistri opened to the sinus coronarius. The V. cordis caudalis and the V. cordis media drained into the V. cava caudalis. The venous drainage of the conus arteriosus was made by the left V. coni arteriosi opening to the R. interventricularis paraconalis, and by the right V. coni arteriosi which continued to the Vv. cordis dextrae.

[Tuhfetü'l-Tib, as a pioneer periodical of the medical history]

Tuhfetü'l-Tib is a Turkish medical history periodical published regularly every two weeks in Istanbul since December 27th, 1867. Its collection comprises totally 15 issues, every one of which is consisted of 16 pages with a hard cover, printed at the Maltepe Military Hospital printing press for more than seven months. As far as we know, Tuhfetü'l-Tib's last issue was dated on July 21st, 1868. The aim of its publication was to introduce contemporary medical knowledge by translating articles from the respected academic periodicals in the West. Among the issues wer have studied, twenty chapters were about gynecology, while twenty five ones about the newborn diseases. Tuhfetü'l-Tib is the second Turkish medical review ever printed in Turkey, succeeding Vakayi-i Tibbiye (1849). It is also the first periodical in Turkey, publishing articles on gynecology and pediatrics. Having played an important role in struggle for the Turkish education at the Imperial Medical School, it was issued on the basis of the principles defended by the Ottoman Association of Medicine.

Case Report. Tinea pedis and onychomycosis in primary school children in Turkey

A cross-sectional study was performed in two primary schools with different socioeconomic status in the suburban and central areas of Manisa, Turkey, in order to determine the prevalence of tinea pedis and onychomycosis. A full dermatological examination and a questionnaire on socioeconomic conditions were performed in a group of 785 randomly selected children aged 6-14. Of 9 clinically suspected tinea pedis and 4 onychomycoses cases, KOH examination (direct microscopy) and/or mycological cultures were positive in six boys, in whom Candida glabrata and C. tropicalis grew. Older age and higher number of siblings were found to be significant factors for fungal infection.

[A study on medical periodicals published in Turkish in Arabic alphabet-II]

In this article medical periodicals published in Turkish in Arabic alphabet between the year 1849, when the first medical periodical was published, and 1928, when the Latin alphabet was accepted, are introduced. First a general history of medical periodicals is given, then each periodical is introduced with its physical characteristics and contents, such as the publisher, editor, publisher's address, office frequency and duration of the publications, press, measurements, whether it's illustrated or not, number of pages and columns and writer's names are given. Utilizing these data, each periodical is criticized. This study is published in two parts and in the end an alphabetical and chronological list of the periodicals and a list classifying the periodicals, according to their subjects, is given. A general survey of the research is made and conclusions based on the data.

The anatomy of the arterial supply of the thoracic limb of the porcupine (Hystrix cristata)

The aim of this study was to investigate the anatomy of the arterial supply and branches of the thoracic limb of the porcupine. With this aim, five (three male and two female) adult porcupines were used. The vascular tree of the thoracic limb was injected through the common carotid arteries with coloured latex. The a. thoracica externa arose from the a. axillaris at the level of the fourth rib. It divided into two branches and went to the m. cutaneus trunci and the m. pectoralis ascendens. The a. subscapularis came off the a. thoracodorsalis. Later, the a. circumflexa humeri caudalis et cranialis, the three muscular branches and the a. circumflexa scapulae arose from the a. subscapularis. The a. profunda brachii arose together with the a. bicipitalis from the same truncus. The a. collateralis ulnaris left from the a. brachialis independently. Rete carpi dorsale was formed by the a. radialis. the r. carpeus dorsalis of the a. collateralis ulnaris and the a. interossea caudalis. Arcus palmaris profundus was formed by the r. profundus of the a. interossea caudalis and the r. palmaris profundus of the a. radialis. In conclusion, despite a partial resemblance to that in the rat, the distribution of the thoracic limb arteries in the porcupine was found to be completely different from that of other mammals. These findings represent, to our knowledge, the first study on the distribution of thoracic limb arteries in the porcupine.

Evaluation of rational antibiotic use

The emergence of antibiotic resistant bacteria is a major problem throughout the world and a rational use of antibiotics is therefore very important. This study was performed to estimate the appropriateness of antimicrobial drug use in Celal Bayar University Hospital in Manisa. The data of all inpatients (n=937) between October and December 1998 were collected according to the Kunin and Jones criteria. Of the patients, 16.6% (n=156) were receiving antibiotics, and in 63.5, 23.0 and 13.5% of these, a single, two and three agents were used, respectively. The purpose of antibiotic use was for prophylaxis in 23.9%, as an empiric decision in 71.4% and for therapeutic culture-based reasons in 4.7%. The rate of rational antibiotic use was 45.7% and it was statistically higher in those patients from whom specimens had been taken for culture than in patients receiving prophylactic or empiric antibiotics. On medical wards, rational antibiotic usage was 55.1%, while it was 26.3% in surgical wards (P<0.0001). The low rate of appropriate antibiotic use in our university hospital reflects the urgent need of rationalization.