Bilateral Notches Research Articles

Serum macrophage stimulating protein α-chain and uterine artery Doppler ultrasound in the first trimester for the prediction of preeclampsia

To assess how effective macrophage stimulating protein α-chain (MSP-α) combined with uterine artery Doppler is in predicting preeclampsia in singleton pregnancies during 11–13+6 weeks of gestation. This prospective observational study included singleton pregnant women who attended antenatal care at King Chulalongkorn Memorial Hospital, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University between December 2021 and April 2023, during 11–13+6 weeks of gestation. Serum MSP-α levels were collected and uterine artery Doppler ultrasound was performed. Pregnancy outcomes were recorded, and the predictive values of these tests were determined to predict preeclampsia. A total of 365 patients, with 21 cases of preeclampsia (5.8%), were analyzed. Serum MSP-α levels were higher in pregnant women who developed preeclampsia than those who did not (899.7 ± 550.1 ng/ml vs 642.5 ± 466.1 ng/ml, p = 0.016). The mean pulsatility index of the uterine artery and the presence of diastolic notching were not significantly different between the groups. As a cut-off value for predicting preeclampsia, using serum MSP-α levels higher than 1.0 multiple of median for gestational age, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 71.4%, 50.3%, 8.1%, and 96.7%, respectively. Additionally, when abnormal serum MSP-α levels were combined with a uterine artery Doppler pulsatility index above the 95th percentile and bilateral notching as predictive values for preeclampsia, the sensitivity was 85.7%, specificity was 18.3%, PPV was 6.0%, and NPV was 95.5%. Serum MSP-α alone at 11–13+6 weeks of gestation was effective in predicting preeclampsia. However, the use of serum MSP-α in combination with uterine artery Doppler increased sensitivity but reduced specificity for the prediction of preeclampsia.

Bridging the notch: quantification of the end diastolic notch to better predict fetal growth restriction.

We aimed to evaluate several quantitative methods to describe the diastolic notch (DN) and compare their performance in the prediction of fetal growth restriction. Patients who underwent a placental scan at 16-26 weeks of gestation and delivered between Jan 2016 and Dec 2020 were included. The uterine artery pulsatility index was measured for all of the patients. In patients with a DN, it was quantified using the notch index and notch depth index. Odds ratios for small for gestational age neonates (defined as birth weight <10th and <5th percentile) were calculated. Predictive values of uterine artery pulsatility, notch, and notch depth index for fetal growth restriction were calculated. Overall, 514 patients were included, with 69 (13.4%) of them delivering a small for gestational age neonate (birth weight<10th percentile). Of these, 20 (20.9%) had a mean uterine artery pulsatility index >95th percentile, 13 (18.8%) had a unilateral notch, and 11 (15.9%) had a bilateral notch. 16 patients (23.2%) had both a high uterine artery pulsatility index (>95th percentile) and a diastolic notch. Comparison of the performance between uterine artery pulsatility, notch, and notch depth index using receiver operating characteristic curves to predict fetal growth restriction <10th percentile found area under the curve values of 0.659, 0.679, and 0.704, respectively, with overlapping confidence intervals. Quantifying the diastolic notch at 16-26 weeks of gestation did not provide any added benefit in terms of prediction of neonatal birth weight below the 10th or 5th percentile for gestational age, compared with uterine artery pulsatility index.

Serial case report: Radiological images of congenital sensorineural hearing loss patients with and without hypoplasia of the vestibulocochlear nerve

Background: Congenital Sensorineural Hearing Loss (SNHL) is a hearing loss caused by damage to the inner ear (cochlea), vestibulocochlear cranial nerve (N.VIII), or the innervation pathway from the inner ear to the brain that is acquired from birth. If hearing loss occurs from birth or before the period of speech development is not detected. Thus, this case report compares two patients with congenital sensorineural hearing loss with and without vestibulocochlear nerve hypoplasia. Case Description: The first case was a 4-year-old girl with the main complaint of not hearing and responding to calls since the age of 1.5 years. Temporal CT scan and MRI results did not show existing organ and structural abnormalities, so suspected retro-cochlear auditory neuropathy. Patients undergo the installation of a cochlear implant in the left ear with good results. Case second, a 3-year-old girl with Down Syndrome who has not been able to speak since birth. CT scan results showed left and right basal cochlea 1.5 turns and bilateral jugular notch dehiscence, while MRI results showed vestibulocochlear nerve hypoplasia, narrowing of the IAC opening width 1.5 turns cochlea. If this happens, a cochlear implant cannot be done because abnormality finding is a contraindication operation. Conclusion: CT-scan and MRI examination are necessary to evaluate the structures and organs in the outer, middle and inner ear because the presence or absence of structural abnormalities found in the patient will significantly impact further management.

Клініко-лабораторні кореляції помірного ожиріння та дисбалансу вітаміну D з предикторами прееклампсії

There is a lot of evidence regarding the validity of various biomarkers as predictors of preeclampsia. However, despite the obviousness and necessity of such studies for women with obesity, such works are not numerous and their data are contradictory. Purpose - to investigate different predictors of preeclampsia in patients with moderate obesity, depending on vitamin D status. Materials and methods. A prospective controlled clinical study was conducted in which 101 pregnant women were included: the main group, consisting of women with moderate obesity (n=75), and the control group, consisting of almost non-obese pregnant women (n=26). The level of 25(OH)D in blood serum, markers of gestational endotheliopathy, blood flow in the uterine arteries of pregnant women, and markers of prenatal screening in the first trimester were studied. STATISTICA 10 software was used for statistical data processing. Results. Among the women in the main group, 85.3% had vitamin D insufficiency or deficiency in their serum. In such women in the first trimester of pregnancy, a significant increase in cases of microalbuminuria with a level of &gt;5.0 mg albumin/mmol creatinine and a decrease in cases of endothelium-dependent vasodilatation with an index of &lt;15.0%, a significantly higher resistance index in the uterine arteries, cases of early lateral and bilateral diastolic notch, as well as a statistically significantly lower level of β-hCG were observed. Conclusions. Moderate obesity and low vitamin D status were statistically significantly associated with predictors of preeclampsia. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the author.

Unveiling Preeclampsia Prognosis: Uterine Artery Doppler Indices in Low-Risk Pregnancies.

Background Anticipating preeclampsia's onset is pivotal in mitigating adverse maternal and perinatal outcomes. This study aims to prognosticate preeclampsia within low-risk pregnancies by evaluating uterine artery Doppler indices within the 14-28 week gestation. Methodology An observational cohort comprising 360 low-risk pregnancies (14-28 weeks gestation) underwent serial uterine artery Doppler assessments at 14-20 and 20-28 weeks. Follow-up was extended to delivery to detect preeclampsia incidence. Results Among 360 participants, 56 (15.5%) developed preeclampsia. Sensitivity values for resistance index (RI), pulsatility index (PI), and bilateral notching were 17.6%, 56.25%, and 71%, respectively, during 14-20 weeks. Similarly, during 20-28 weeks, sensitivities for RI, PI, and bilateral notching were 16.6%, 36.8%, and 55.5%, respectively, with specificity exceeding 90%. Notch depth index (NDI) >0.14 emerged as a better predictor of preeclampsia between both intervals (area under the curve = 0.686 and 0.646). Conclusions Bilateral notching during 14-20 weeks and NDI >0.14 within 14-20 and 20-28 weeks indicate preeclampsia susceptibility in low-risk pregnancies. Conversely, uterine artery Doppler indices at 14-28 weeks effectively rule out preeclampsia development, exhibiting a specificity of >90%.

The noise profile and hearing impact of commercial fiberglass reinforced plastic speed boats in Port Blair, Andaman and Nicobar Islands

Background: Hearing impairment may result from tourism-related vehicle engine noise in Port Blair, Andaman, and Nicobar Islands. Aims and Objectives: Measure noise levels and test commercial fiberglass-reinforced plastic (FRP) speedboat operators for hearing loss. Materials and Methods: Hearing loss and noise impacts were checked in a total of 145 male crew members and workers exposed to commercial FRP-speedboat outboard engine noise. 18–50-year-olds with 1–20 years of experience participated. To detect hearing loss, noise-induced hearing loss (NIHL) risk indicators that could appear as a 4 kHz noise notch and the existence of high-frequency sloping hearing loss were detected using pure tone audiometry. The level of noise exposure was measured in conjunction with a questionnaire to assess an individual’s general knowledge of the effects of noise and hearing loss. Results: A 4 kHz noise notch, some high-frequency slope hearing loss, and an overall hearing loss rate of 42.1% were found in 145 participants. Out of these, 15.9% had the most common bilateral notch. Bilateral high-frequency sloping was 10.3%, Unilateral high-frequency sloping was 4.9%, and unilateral 4 kHz notch was 11.0%. According to the questionnaire, research participants are shockingly unaware of noise-induced hearing loss. The FRP Speedboat outboard engine’s measured noise level ranged from 79.7 to 89.4 dB (A). Conclusion: The FRP Speedboat crews were at risk of hearing loss, specifically NIHL with continuous noise exposure. High frequency sloping hearing loss, mild to moderate hearing loss, and a substantial 4 kHz noise notch are found in noise-exposed employees. Awareness is needed to prevent irreversible hearing loss.

Implementation of Uterine Artery Doppler Scanning: Improving the Care of Women and Babies High Risk for Fetal Growth Restriction.

While stillbirth rates have declined in many countries, these declines are less marked in the UK. Fetal growth restriction (FGR) affects about 3% to 7% of all pregnancies and is by far the single strongest risk factor for stillbirth. FGR implies a pathological restriction of the genetic growth potential and is not synonymous with small-for-gestational age (SGA). The Royal College of Obstetricians and Gynaecologists (RCOG) defines SGA as an estimated fetal weight (EFW) or abdominal circumference (AC) less than the 10th centile. The likelihood of FGR is higher in severe SGA defined as an EFW or AC less than the 3rd centile. The second version of Saving Babies' Lives Care Bundle (SBLCBv2) recommends the second trimester uterine artery Doppler (UtAD) pulsatility index (PI) screening for pregnancies at high risk of FGR. This study was aimed at determining the prevalence of FGR and assess pregnancy outcomes following the implementation of UtAD at the United Lincolnshire Hospitals NHS Trust (ULHT). One-year retrospective cohort study (1st September 2020-31st August 2021) was conducted across both ULHT hospitals in the UK (Lincoln County Hospital in Lincoln and Pilgrim Hospital in Boston). During the study period, 5197 women were booked at ULHT. Of 5197, 349 were identified as high risk for FGR. When numbers were compared for the two hospitals, FGR rate was higher in Lincoln 8.10% vs. 4.51% in Boston. In addition, an increased proportion of abnormal UtAD scans was observed in Lincoln (35.7%) vs. in Boston (22%) (P = 0.014). Of the 349 UtAD scans, 237 were normal (67.9%), 41 showed unilateral notching (11.7%), 43 bilateral notching (12.3%), and 28 raised PI (8%). Babies in the bilateral notching group exhibited the lowest birth weight (P = 0.005), born at an earlier gestation (P = 0.029), and with low Apgar scores at 1 (P = 0.007) and 5 minutes (P < 0.001). Discussion. UtAD is a useful second trimester screening tool for women identified as high risk for FGR and helps stratify the intensity of surveillance. However, the findings call into question a focus solely on the UtAD PI for improving FGR detection without taking into account bilateral notching.

Using mobile audiometry (Wulira App) to assess noise induced hearing loss among industrial workers in Kampala, Uganda: A cross-sectional study.

Occupational noise is a common cause of hearing loss in low-income countries. Unfortunately, screening for hearing loss is rarely done due to technical and logistical challenges associated with pure tone audiometry. Wulira app is a valid and potentially cost-effective alternative to pure tone audiometry in screening for occupational hearing loss. We aimed to determine the prevalence of occupational hearing loss among workers in a metal industry company in Kampala district. We recruited 354 participants conveniently from a steel and iron manufacturing industry in Kampala. All eligible participants answered a pretested and validated questionnaire and were assessed for noise induced hearing loss in a quiet office room approximately 500 meters from the heavy machinery area using the Wulira app. Descriptive statistics such as proportions were used to describe the study population while inferential statistics were used to determine associations. Of the 354 participants sampled, 333 (94.1%) were male, and the median age was 27, IQR (25-30). Regarding the risk factors of hearing loss, fourteen (3.9%) had history of smoking and more than half (65.5%) had worked in the industry for more than 2 years. The overall prevalence of hearing loss among industrial workers was 11.3% (40/354). 16.2% and 9% had mild hearing loss in the right and left ear respectively. Bilateral audiometric notch was present where fourteen (4%) of the participants had notch in their right ear while seven (2%) had notch in their left ear. Residing outside Kampala district was associated with hearing loss (OR, 95% CI, 0.213 (0.063-0.725), p = 0.013). One in 10 workers in a metal manufacturing industry in Kampala had occupational hearing loss. Industrial workers residing outside Kampala were likely to develop hearing loss. Periodic screening should be done for early detection and intervention to prevent progression of hearing loss in this population.

Zygomatico-Orbital Artery: A Reevaluation of the Temporal Blood Vessels.

The current anatomical description of the zygomatico-orbital artery (ZOA) is mainly based on cadaver head studies and does not accurately reflect the complete anatomical information of the ZOA. The purpose of this study was to reveal the anatomical characteristics of the ZOA and to provide an anatomical basis for relevant operations in the temporal area. Computed tomographic scans and autopsies were performed on 78 cadaver heads perfused with lead oxide. Mimics software was used to construct a three-dimensional image based on the bilateral intertragic notches and the right inferior orbital margin for a detailed analysis of the ZOA. The occurrence rate of ZOA in the 101 qualified hemisectioned cadaver heads was 86.14% (87 of 101). According to our observations, 46 of 87 (52.87%) originated from the superficial temporal artery above the zygomatic arch, 23 of 87 (26.44%) from the superficial temporal artery under the zygomatic arch, and 18 of 87 (20.69%) from the frontal branch of the superficial temporal artery. The ZOA communicates with the deep and superficial arches of the supraorbital artery, transverse facial artery, and ophthalmic artery. This study describes the anatomical characteristics of the ZOA. Moreover, these findings may guide skin flap transplantation and prevent associated injection complications.

Morphometric Analysis of the Supraorbital Foramen and Notch in the Population of Bosnia and Herzegovina.

The aim of this study was to learn about the morphological characteristics of the supraorbital foramen and to determine its precise position in relation to the surrounding anatomical landmarks in the adult population of Bosnia and Herzegovina. For this purpose, 60 skulls from the Bosnia and Herzegovina population of known sex (32 males and 28 females), taken from the osteological collection of the Department of Human Anatomy of the Medical Faculty in Sarajevo, were subjected to morphological and morphometric analysis. Morphometric measurements were performed using a digital vernier caliper (Mitutoyo Corporation, Japan). The study showed that most supraorbital nerves exit the orbit through the supraorbital notch (73.8%) and the rest through the foramen (26.2%). Of this number, bilateral supraorbital notches were recorded in 58.33% of cases, a bilateral supraorbital foramen in 18.34% of cases, while in 23.33% of cases a notch was recorded on one side and a foramen on the contralateral side. Morphometric measurements performed to determine the exact position of the supraorbital foramen relative to the surrounding landmarks showed different values in males and females. An accessory foramen was also observed on the examined skulls in 16.67% of cases. Detailed knowledge of anatomical variations of the supraorbital foramen is required for safe and successful administration of regional anesthesia, in order to avoid iatrogenic nerve injuries during orbitofacial region surgery.

Prediction of stillbirth low resource setting in Northern Uganda

BackgroundWomen of Afro-Caribbean and Asian origin are more at risk of stillbirths. However, there are limited tools built for risk-prediction models for stillbirth within sub-Saharan Africa. Therefore, we examined the predictors for stillbirth in low resource setting in Northern Uganda.MethodsProspective cohort study at St. Mary’s hospital Lacor in Northern Uganda. Using Yamane’s 1967 formula for calculating sample size for cohort studies using finite population size, the required sample size was 379 mothers. We doubled the number (to > 758) to cater for loss to follow up, miscarriages, and clients opting out of the study during the follow-up period. Recruited 1,285 pregnant mothers at 16–24 weeks, excluded those with lethal congenital anomalies diagnosed on ultrasound. Their history, physical findings, blood tests and uterine artery Doppler indices were taken, and the mothers were encouraged to continue with routine prenatal care until the time for delivery. While in the delivery ward, they were followed up in labour until delivery by the research team. The primary outcome was stillbirth 24 + weeks with no signs of life. Built models in RStudio. Since the data was imbalanced with low stillbirth rate, used ROSE package to over-sample stillbirths and under-sample live-births to balance the data. We cross-validated the models with the ROSE-derived data using K (10)-fold cross-validation and obtained the area under curve (AUC) with accuracy, sensitivity and specificity.ResultsThe incidence of stillbirth was 2.5%. Predictors of stillbirth were history of abortion (aOR = 3.07, 95% CI 1.11—8.05, p = 0.0243), bilateral end-diastolic notch (aOR = 3.51, 95% CI 1.13—9.92, p = 0.0209), personal history of preeclampsia (aOR = 5.18, 95% CI 0.60—30.66, p = 0.0916), and haemoglobin 9.5 – 12.1 g/dL (aOR = 0.33, 95% CI 0.11—0.93, p = 0.0375). The models’ AUC was 75.0% with 68.1% accuracy, 69.1% sensitivity and 67.1% specificity.ConclusionRisk factors for stillbirth include history of abortion and bilateral end-diastolic notch, while haemoglobin of 9.5—12.1 g/dL is protective.

Contribution of Second Trimester Sonographic Placental Morphology to Uterine Artery Doppler in the Prediction of Placenta-Mediated Pregnancy Complications.

Second-trimester uterine artery Doppler is a well-established tool for the prediction of preeclampsia and fetal growth restriction. At delivery, placentas from affected pregnancies may have gross pathologic findings. Some of these features are detectable by ultrasound, but the relative importance of placental morphologic assessment and uterine artery Doppler in mid-pregnancy is presently unclear. To characterize the association of second-trimester sonographic placental morphology markers with placenta-mediated complications and determine whether these markers are predictive of placental dysfunction independent of uterine artery Doppler. This was a retrospective cohort study of patients with a singleton pregnancy at high risk of placental complications who underwent a sonographic placental study at mid-gestation (160/7-246/7 weeks' gestation) in a single tertiary referral center between 2016-2019. The sonographic placental study included assessment of placental dimensions (length, width, and thickness), placental texture appearance, umbilical cord anatomy, and uterine artery Doppler (mean pulsatility index and early diastolic notching). Placental area and volume were calculated based on placental length, width, and thickness. Continuous placental markers were converted to multiples on medians (MoM). The primary outcome was a composite of early-onset preeclampsia and birthweight &lt; 3rd centile. A total of 429 eligible patients were identified during the study period, of whom 45 (10.5%) experienced the primary outcome. The rate of the primary outcome increased progressively with decreasing placental length, width, and area, and increased progressively with increasing mean uterine artery pulsatility index (PI). By contrast, placental thickness followed a U-shaped relationship with the primary outcome. Placental length, width, and area, mean uterine artery PI and bilateral uterine artery notching were all associated with the primary outcome. However, in the adjusted analysis, the association persisted only for placenta area (adjusted odds ratio [aOR] 0.21, 95%-confidence interval [CI] 0.06-0.73) and mean uterine artery PI (aOR 11.71, 95%-CI 3.84-35.72). The area under the ROC curve was highest for mean uterine artery PI (0.80, 95%-CI 0.71-0.89) and was significantly higher than that of placental area (0.67, 95%-CI 0.57-0.76, p = 0.44). A model that included both mean uterine artery PI and placental area did not significantly increase the area under the curve (0.82, 95%-CI 0.74-0.90, p = 0.255), and was associated with a relatively minor increase in specificity for the primary outcome compared with mean uterine artery PI alone (63% [95%-CI 58-68%] vs. 52% [95%-CI 47-57%]). Placental area is independently associated with the risk of placenta-mediated complications yet, when combined with uterine artery Doppler, did not further improve the prediction of such complications compared with uterine artery Doppler alone.

Abnormal uterine artery Doppler ultrasound during gestational 21-23 weeks associated with pre-eclampsia.

To assess whether abnormal uterine artery Doppler ultrasound during weeks 21-23 of pregnancy was associated with an increased risk of pre-eclampsia. Our retrospective cohort study analyzed uterine artery ultrasound parameters in singleton pregnant women at 21-23 weeks of pregnancy and assessed the association between abnormal ultrasound findings and the risk of pre-eclampsia. Multivariate logistic regression analysis was conducted to estimate the relative risk between uterine artery ultrasound and pre-eclampsia. Compared with normal results, unilateral pulsatile index abnormality (odds ratio [OR] 2.3, 95% confidence interval [CI] 1.71-3.10), bilateral pulsatile index anomalies (OR 6.21, 95% CI 3.53-10.95), unilateral resistance index abnormality (OR 2.36, 95% CI 1.75-3.17), bilateral resistance index anomalies (OR 2.83, 95% CI 1.27-6.32), unilateral notch (OR 3.66, 95% CI 2.03-6.62), bilateral notch (OR 5.80, 95% CI 3.30-10.20) were associated with pre-eclampsia. For every 0.1 increase in the median multiple of mean pulsatile index, the risk of pre-eclampsia increased by 13%; for every 0.1 increase in the median multiple of mean resistance index, the risk of pre-eclampsia increased by 22%. Multiples of the median for the pulsatile and resistance indices are an effective evaluation tool. Abnormal uterine artery ultrasound indices are strongly associated with the development of pre-eclampsia.

A 5G filtering antenna simultaneously featuring high selectivity and band notch

This paper presents a compact and low-profile filtering antenna featuring simultaneously bilateral high selectivity and 5G band notch functionality. The bilateral high selectivity of this quasi-Yagi antenna is achieved by using innovative ground etches instead of microstrips on the top layer. Independent U-shaped split ring on the top layer endows the filtering antenna with an additional property, namely the band notch functionality. By modifying the arm length of split ring, the notched band can completely cover 5G sub-6 GHz (3.4–3.8 GHz). Moreover, the gain of end-fire filtering antennas mostly varies around 4.5 dBi within operational band. The radiation patterns of the proposed antenna ensure a desired antenna performance at different frequencies. The results of the measurements of the S-parameter as well as the gain and the radiation pattern of filtering antenna are consistent with respective simulation results.

The association between decidual vasculopathy and abnormal uterine artery Doppler measurement.

Placental syndrome is an umbrella term encompassing the clinical phenotypes of preeclampsia and fetal growth restriction, and is associated with high maternal and neonatal morbidity. In women with placental syndrome, histologicl examination of the uteroplacental unit commonly demonstrates pathological lesions, such as decidual vasculopathy. Decidual vasculopathy are pathological changes in the spiral arteries, which are associated with adverse outcome in preeclampsia and long-term maternal cardiovascular health. The relation between placental syndrome phenotypes and placental pathology has been previously demonstrated; however, the role of uteroplacental Doppler measurements as a link between placental syndrome phenotypes and the underlying placental pathology is still unclear. We hypothesized that decidual vasculopathy is associated with abnormal uteroplacental Doppler profiles and ultrasound placental parameters, independent of clinical phenotype. We performed a retrospective analysis of data from a prospective cohort of pregnancies with placental syndrome, as well as cases without hypertensive disease or fetal growth restriction. The study group was divided into women with decidual vasculopathy on histologic analysis of placental specimen and those without the lesions. Outcome parameters included maternal and fetal Dopplers, estimated fetal weight, placental weight and thickness, placental lacunae and abnormal placental calcification. Compared with the women without the lesions (n=91), the group with decidual vasculopathy (n=25) had a higher mean uterine artery pulsatility index (1.70 vs 0.81, p<0.001) and uterine artery pulsatility index percentile (>p99 vs p67, p<0.001). Decidual vasculopathy was associated with abnormal uterine artery Doppler profile (defined as pulsatility index p>95 and/or bilateral notch) (82%) compared with women without the lesions (33%) (odds ratio [OR] 9.3, 95% CI 2.4-36.0), which remained significant after adjusting for possible confounding factors preeclampsia, tobacco use and gestational age at birth (OR 7.1, 95% CI 1.3-39.1). Decidual vasculopathy was not associated with fetal Doppler abnormalities or placental parameters and only modestly so with lower cerebroplacental ratio (p= 0.036). Histologic decidual vasculopathy is associated with abnormal uterine artery Doppler, independent of clinical phenotype during pregnancy.

The important adjacent structures for anterior ethmoidal artery in FESS: Anterior ethmoidal artery canal angle, supraorbital ethmoid cells and Keros classification

ObjectivesThis study investigated the visualization of the anterior ethmoidal artery (AEA) as notch, canal and sulcus, its relationship between supraorbital ethmoid cells (SOECs) and the Keros classification of the olfactory fossa on paranasal sinus computerized tomography (PNSCT). MethodsIn this retrospective study, the paranasal sinus computerized tomography (PNsCT) images of 204 patients (103 males and 101 females) were analyzed. AEA canal, notch and sulcus, SOECs, the distance between AEA notch and ethmoid roof, AEA canal angle and Keros classification of the olfactory fossa were evaluated. ResultsAEA notch in all patients and AEA canal (37.6 to 45.6%) and AEA sulcus (53.5 to 61.2%) were visualized. In the AEC canal and sulcus visualized patients, the Keros classification revealed higher. AEA notch and ethmoid roof distance increased in patients with higher Keros types. The presence of SOECs was significantly higher in males (41.7%) than females (19.8%) on the left side. There was a positive correlation between SOEC presence and Keros classification. In patients with SOEC, bilateral AEA canal and sulcus visualized more; and bilateral AEA notch and ethmoid roof distance increased. On the right side, the AEA canal angle of the males was significantly higher than that of the females. In patients with SOEC, the left AEA canal angle also increased. ConclusionWhen detected SOECs and higher Keros types, the AEA was detected away from the skull base, AEA notch-ethmoid roof distance increased; and the AEA canal angle increased. To avoid intracranial penetrations, PNSCT should be evaluated carefully during the preoperative period.

Loss of E-Cadherin Staining Continuity in the Trophoblastic Basal Membrane Correlates with Increased Resistance in Uterine Arteries and Proteinuria in Patients with Pregnancy-Induced Hypertension.

Pregnancy-induced hypertension (PIH), especially when complicated with pre-eclampsia (PE), could be a life-threatening complication of pregnancy. Pre-eclampsia is one of the leading causes of perinatal morbidity and mortality in women. Pre-eclampsia is mainly characterized by hypertension and kidney damage with proteinuria. Abnormal placentation and altered structure of the placental barrier are believed to participate in the pathogenesis of pregnancy-induced hypertension, leading to PE. In the current study, we aimed to analyze the immunohistochemical expression pattern of E-cadherin and p120, two markers of epithelial–mesenchymal transition, in placental samples derived from a group of 55 patients with pregnancy-induced hypertension, including pre-eclampsia and 37 healthy pregnant controls. The results were correlated with the presence of an obtained early uterine artery flow notching during diastole on Doppler ultrasound. We observed a higher frequency of discontinuous E-cadherin staining in the basement membrane of syncytiotrophoblast in patients with PIH/PE compared to controls (p < 0.001, Fisher’s exact test). Moreover, the loss of continuity of E-cadherin expression correlated with the presence of a bilateral early diastolic notch on Doppler ultrasound (p < 0.001, Fisher’s exact test) and the presence of proteinuria (p = 0.013, Fisher’s exact test). These findings suggest that E-cadherin contributes to the integrity of the placental barrier, and its loss could be an immunohistochemical marker of PE.

Audiometric notch as a sign of noise induced hearing loss (NIHL) among the rice and market flour mill workers in Tamil Nadu, South India

Objective This study aims to determine the prevalence of NIHL among rice and flour mill workers exposed to high decibel noise levels at the workplace. Methods One-hundred and seven workers exposed to noise from rice and flour mill machinery and 82 age-matched controls not exposed to noise at the workplace were recruited for the study from the south Indian state of Tamil Nadu. All the mill workers and the controls were evaluated for their hearing thresholds by pure-tone audiometry. Results The characteristic bilateral notch in 4000 Hz was detected in 25% of the mill workers, while the prevalence of the unilateral or bilateral notch was observed in 51%. The high-frequency slope (HFS) involving HL at 4000 and 8000 Hz was observed in 23.36 and 29.92% among the left and right ears of the mill workers, respectively. Years of experience and exposure to noise were strongly associated with a bilateral notch in 4000 Hz (the odds of having the notch increased with increased years of noise exposure). Self-reported HL under-represented the rates of actual HL, indicating perception of the HL was absent till audiometric evaluation revealed the loss. Conclusion Our study demonstrates exposure to high noise levels in this unorganized sector of rice and flour mill workers. Awareness education of NIHL, early detection, and the use of personal hearing protection devices can prevent HL from extending to speech frequencies.

O22 Pregnancy planning in non-criteria antiphospholipid syndrome

Case report - IntroductionAntiphospholipid Syndrome (APS) is an autoimmune condition manifested by vascular thrombosis with or without pregnancy related morbidities. APS classification criteria require detection of persistent antibodies: Anti-Cardiolipin Antibody (aCL), Anti-Beta Glycoprotein I (ab2GPI) and circulating Lupus Anticoagulant (LAC).Criteria for the diagnosis of obstetric antiphospholipid syndrome allow for optimal treatment planning in pregnancy and reduction of foetal and maternal morbidity. There are, however, several “non-criteria” features of APS, including late pre-eclampsia, which may also infer adverse obstetric outcomes.We highlight a treatment dilemma in a young female with lupus and APS with history of previous pregnancy that was complicated by pre-eclampsia.Case report - Case descriptionWe describe a case of a 26-year-old female with systemic lupus erythematosus (SLE), “triple positive” APS markers (aPL) and non-criteria APS obstetric morbidity.During her first pregnancy she presented at 22 weeks with severe and frequent migraine episodes. She had no other active clinical manifestations of SLE. There was no prior history of pregnancy and therefore no previous obstetric morbidity nor had she had any vascular thrombotic episodes. She had been commenced on low-dose aspirin (LDA) at the start of her pregnancy and was already taking hydroxychloroquine (HCQ). The dose of HCQ was increased to 400mg daily leading to improvement in the headaches. She had persistent strong ACL antibodies, positive LAC and ab2GPI antibodies. ANA was positive with hypocomplementemia and neutropenia but normal range double-stranded DNA antibodies.After discussion with a tertiary centre, it was recommended to continue HCQ and LDA. Low molecular weight heparin (LMWH) was not proposed as she did not fulfil criteria for obstetric APS. Her pregnancy was subsequently complicated by pre-eclampsia and post-partum sepsis.Two years later she sought advice to plan her second pregnancy, raising important questions as to whether the same treatment strategy should be followed or if alternative approaches should be considered, given the history of pre-eclampsia and its association with APS. Again, she did not meet the international consensus (revised Sapporo) criteria for diagnosis of obstetric APS.After further discussion with the tertiary centre, she commenced high-dose aspirin 150mg/day alone. Uterine artery dopplers were recommended and LMWH proposed if bilateral notching was noted. Dopplers were normal.Her blood pressure (BP) fluctuates between 130-145mmHg systolic. She has occasional crops of mouth ulcers but no other SLE features. Migraines continue every 2—3 weeks although severe attacks are infrequent. C4 is persistently low with normal Ds DNA and urine protein/creatinine ratio.Case report - DiscussionOur case raises questions on how pregnancy should be safely managed in patients without a prior history of APS-related pregnancy complications but who nevertheless have risk factors, in the form of APS antibody positivity and non-criteria obstetric manifestations of APS. Her previous pregnancy was treated with LDA and HCQ which had proved insufficient in avoiding the outcome of pre-eclampsia.The objective of prophylactic treatments is to prevent adverse outcomes such as miscarriage, which carry significant maternal morbidity including psychological manifestations such as depression and anxiety. In first pregnancies, mothers have no existing obstetric history, such that current treatment guidance provides few recommendations for preventative interventions, even where other risk factors are apparent. Furthermore, non-criteria manifestations of obstetric APS are now well recognised, which may further highlight potential risk for obstetric morbidity but fail to trigger interventions as they are not included within the current international criteria. These manifestations include late pre-eclampsia, placental abruption and late pregnancy loss, unexplained in vitro fertilisation failures, two unexplained miscarriages and three non-consecutive miscarriages. Low positive antibody titres and intermittent aPL are also included.Studies suggest that women with non-criteria APS may benefit from standard treatment for obstetric APS which includes LMWH in addition to aspirin, with good pregnancy outcomes.HCQ has a dose-dependent effect in preventing thrombosis through inhibition of platelet aggregation and aPL Ab-related thrombosis. However, pregnancy itself is a prothrombotic condition and in the presence of persistent triple positive aPL is a risk factor for adverse pregnancy outcomes.Further studies are needed to define the risk of non-criteria APS on pregnancy outcomes and define optimal treatment strategies.Case report - Key learning pointsObstetric APS carries significant risk for maternal foetal morbidity including miscarriage and pre-term birth.Significant maternal psychological effects are recognised even following a single miscarriage.The international consensus (revised Sapporo) criteria for diagnosis of obstetric antiphospholipid syndrome exclude certain non-criteria clinical and laboratory manifestations that may confer adverse pregnancy outcomes.First pregnancies are challenging to risk stratify in patients with identified aPL as there will be no prior pregnancy history to reference.Ultrasound doppler velocimetry is a useful non-invasive tool to diagnose poor placental perfusion, a predictor of obstetric complications, hence identifying high-risk pregnancies.Further research is required to establish the diagnostic validity, predictive value, and treatment implications of non-criteria manifestations of obstetric APS.

‘18-24 HAFTA UTERİN ARTER DOPPLER ULTRASONOGRAFİSİNDE PULSATİLİTE İNDEKSİNİN VE DİYASTOLİK ÇENTİK VARLIĞININ PREEKLAMPSİ ÖNGÖRÜSÜNDEKİ ÖNEMİ’

Aim: To determine second-trimester uterine artery pulsatility index (UA-PI) values and diastolic notch (DN) presences in primigravid, low-risk pregnant women for preeclampsia (PE) prediction.&#x0D; Matherials and Methods: We studied prospectively primigravid, pregnant women between 18 and 24 weeks of gestation who were admitted for routine prenatal care. An ultrasound examination that included measurements of the UA-PI and DN presence was performed and pregnancy outcomes were evaluated.&#x0D; Results: In total 244 primigravid pregnant women were included this study, and 15 (6,1 %) developed PE. When Preeclampsia positive (PEP) group and the preeclampsia negative (PEN) group compared, there was no difference in demographic data. PEP group mean UA-PI value was significantly higher (p&lt; 0,01) when mean time of the delivery week (p&lt; 0,01) and fetal birth weight (p&lt; 0,01) were significantly lower than PEN group.&#x0D; DN was negative (NN) in 163 (66,8 %) pregnant women, and found positive (NP) in 81 (33,2%) pregnant women. NP group had higher PE rates compared to NN group. Bilateral notch positivity increases both PE and early PE rates compared to notch negativity and unilateral notch positivity. The most sensitive and specific value of UA-PI for PE prediction was found 1,13.&#x0D; Conclusion: Uterine artery Doppler is a non-invasive and simple tool to identify high-risk pregnancies and may improve patient-specific practice. Especially pregnant women with a bilateral uterine notch accompanying with abnormal UA-PI values resulted a higher prevalence to develop these severe adverse outcomes. Closer monitoring may help to reduce both maternal and fetal morbidity and mortality in high-risk groups.