SVD Group Research Articles

A feasibility study of magnetic resonance pelvimetry in women of short stature to identify the risk of cephalo-pelvic disproportion

ObjectiveTo conduct a feasibility study to assess if MR Pelvimetry can be undertaken in short stature primigravidae, with a view to a main study to answer the question ‘can MR pelvimetry be used to predict cephalo-pelvic disproportion (CPD) in women of short stature?’. Study DesignThis was a prospective single arm feasibility study. In the first phase, patient and public involvement was undertaken to assess acceptability of the study. In the second phase, primiparous women of ≤ 160 cm in height were selected from antenatal clinics. Obstetricians and midwives were asked to inform all eligible women about the study. Patients were approached in the third trimester and written information about the study provided. If the patient agreed to participate, they were invited for consent. MR scans were performed from 36 weeks gestation. Patients and their obstetricians were not informed of the results of the MR until after delivery (in view of NICE and WHO recommendations on pelvimetry). ResultsMR scans were performed on 21/35 (60%) participants who consented. The study was conducted without adverse events and was acceptable to all participants. Data were available from 19 patients; 7 (37%) of whom had caesarean section (CS) due to CPD, 7 (37%) had assisted vaginal birth (AVB), while 5 (26%) had spontaneous vaginal births (SVD). Two patients who had an elective CS were not included in the analysis. The pelvic measurements especially anatomical conjugate (inlet), transverse diameter (mid cavity) and anteroposterior diameter at the outlet were larger in the SVD group in comparison to in-labour CS /AVB. Interobserver MR scan measurements were comparable between radiologists: intraclass correlation coefficient (ICC) range 0.68 to 0.95. ConclusionThis feasibility study suggests that conducting a full study to answer the research question ‘can MR pelvimetry predict CPD in women of short stature?’would be feasible and acceptable to patients. The recruitment, MR scan protocol, reporting, reliability of measures were all assessed and found acceptable for a trial. A trend was observed for smaller pelvic measurements in women who needed intervention compared with those who had a natural birth/SVD. With evidence from a full trial, this could have major implications for the management of short stature women, in terms of clinical practice and safety. Key messagesA large trial would be feasible and acceptable to assess whether MR pelvimetry can predict CPD in women of short stature. Despite the small number of patients, a trend was observed for smaller pelvic measurements in women who needed intervention compared to those who had spontaneous vaginal birth. Evidence from a large trial could help inform clinical practice, and provide information and choice for women at risk of CPD.

An isolated pontine infarct extending to the basal pontine surface has a higher abnormal ankle-brachial index

Patients with ischemic stroke and branch atheromatous disease (BAD) have worse neurological deficits and prognoses than those with small vessel occlusion (SVO). However, both disorders are forms of deep brain infarctions. This study aimed to investigate an MRI-based etiological classification for isolated pontine infarctions and assess differences in vascular risk factors and peripheral arterial disease among etiological subtypes. Consecutive data of patients admitted for acute ischemic stroke or transient ischemic attack between August 2016 and July 2019 were reviewed. Acute isolated pontine infarcts were classified into 3 groups: BAD, SVO, and large-artery atherosclerosis (LAA), according to basilar or vertebral artery steno-occlusion and the extent of the infarct lesion on the basal pontine surface as displayed on magnetic resonance imaging and angiography. Vascular risk factors, ankle-brachial index (ABI), and brachial-ankle pulse wave velocity were analyzed in the 3 groups. Among 64 enrolled patients, BAD was the most common cause of isolated pontine infarct. The BAD group had a higher frequency of abnormal ABI and hypertension than the SVO group. The BAD group had abnormal ABI and hyperlipidemia more frequently than the LAA group. No significant difference was found in diabetes or brachial-ankle pulse wave velocity incidence between the BAD and SVO groups. ABI and vascular risk factors in the BAD group were more similar to those in the LAA group than to those in the SVD group. This finding suggests that pontine lesions extending to the basal pontine surface have an atherosclerotic mechanism in BAD, requiring potent antiplatelet therapy for the secondary prevention of ischemic stroke.

The Effect of delivery method on optimality level and postpartum comfort in primiparous women

BackgroundDelivery is a normal event in a woman’s life and the most special experience. The delivery method affects the perinatal period as well as the level of postpartum comfort. AimsThis descriptive and cross-sectional study aims to determine the effect of delıvery method on optimality level and postpartum comfort in primiparous women MethodsThe study included 200 women. Data collection tools are the Introductory Information Form prepared by the researcher in line with the literature, the Turkish Adaptation of the Optimality Index, the Postpartum Comfort Scale. FindingsThe optimality index scores of the pregnant women with SVD obtained from PBI is 88.60 ± 5.71, the mean score obtained from OI is 84.02 ± 3.12, and the mean score of OI was determined to be 85.40 ± 2.98 for the groups who had SVD. ConclusionsIn accordance with the data, the optimality level of women has decreased due to non-evidence-based practices and invasive procedures during SVD. The total comfort score of the SVD group has also been negatively affected.

A Study on Fetomaternal Outcome of Preterm Eclampsia and its Relationship with Mode of Delivery

Introduction: Eclampsia (Greek, “shining forth”) is an acute and life-threatening complication of pregnancy, and is characterized by the appearance of tonic-clonic seizure, usually in a patient who had developed pre-eclampsia. Pre- eclampsia and eclampsia are collectively called hypertensive disorders of pregnancy and toxemia of pregnancy. This study aimed to analyze the feto-maternal outcome of preterm eclampsia and its relationship with the mode of delivery. Methods: This descriptive type of cross-sectional study was conducted at the eclampsia unit of the Department of Obstetrics and Gynecology, Dhaka Medical College Hospital, Dhaka, Bangladesh. The study was carried out from February 2012 to July 2012. A total of 92 subjects were enrolled in this study as per inclusion criteria. Result: In this study, the prevalence of eclampsia was 10.12%, and preterm eclampsia was 1.31%. The majority of the patients (48.91%) were within 20-25 years of age, and only 1.09% were >30 years of age. Most of the patients were primi gravida (78.26%). The majority of the patients (54.35%) reported within 3-5 hours. Most of the patients came at 33-34 weeks gestation, but quite a significant percentage (30%) came at 28-32 weeks of gestation. A large number of patients delivered spontaneously, a fair number of patients were induced & a few patients required LSCS. In both SVD & induced groups, the majority of the patients (62% & 66% respectively) were delivered within 7-12 hours. In the SVD group, 10% of patients were delivered within 6 hours whereas in the cesarean section group 85% of patients were delivered within 6 hours. Maximum patients (81%) had induction delivery intervals between 7-12 hours. 12 (60%) patients had LSCS done due to fetal distress, 2 (10%) due to previous H/O LSCS, 1 (5%) due to primi gravida with a twin pregnancy, and 5(25%) due to primi gravida with breech presentation. Of patients who presented at 28-32 weeks of gestation, among them 16 had SVD, 11 patients had induction of labor, and LSCS was done in only one case & which was stillborn. The majority of the babies in the SVD & induced group developed asphyxia (81% & 90% respectively) and the majority needed admission to NICU (62% & 73% respectively). PND was also high (>50%) in both groups. Of patients who presented at 33-34 weeks of gestation, 19 had SVD, 15 patients had induction of labor, and only 4 patients required LSCS. A significant number of babies in all three groups (42%, 47% & 100% respectively) were healthy. Although in SVD & induced groups a large number of babies developed asphyxia (58% & 47% respectively) and admission was required in NICU 26% in both groups. PND was few in both groups. For patients who presented at 35-36 weeks of gestation, the majority was delivered by LSCS (15) & outcomes of babies were good in this group as well as in the SVD group. Only one baby developed birth asphyxia. The maternal outcome was good in all three groups (85%, 91%, & 100% respectively). No maternal complication occurred in the cesarean section group. In SVD & induced group few maternal complications occurred such as recurrent convulsion (12% & 13% respectively), CVD (single case in both groups), pulmonary edema (1), HELLP syndrome (1), and septicemia (1). Three mothers die in SVD & induced group. Conclusion: This study concluded that early-onset eclampsia has been associated with worse perinatal outcomes. Gestational age <32 weeks who do not go into labor spontaneously may offer induction, as the cesarean section does not carry any good prognosis to the fetus but rather increases morbidity to the mother. When gestational age crosses >33 weeks, a complete evaluation of the fetal condition, mental condition, and cervix is necessary to plan for the mode of delivery.

Aged Patients With Severe Small Vessel Disease Exhibit Poor Bimanual Coordination During the Anti-Phase Horizontal Line Drawing Task.

The present study explores whether SVD affects bimanual coordination, which is easier to detect than by conventional, MRI-based methods. We tested nine severe SVD patients, eight non-severe (i.e., moderate or mild) SVD patients, eleven healthy age-matched controls, and eight young adults. They were grouped according to Fazekas scale and by age. Participants performed horizontal line drawings with both hands simultaneously on two pen tablets. The movements consisted of rhythmic patterns where participants used both hands to draw horizontal lines in anti-phase on two pen tablets. Each participant underwent a series of neuropsychiatric assessments. Results showed that SVD patients exhibited in each hand smaller horizontal movement amplitudes with variability larger compared to the healthy age-matched controls. Only movement amplitudes appeared to decrease significantly with severity of SVD. Interestingly, we found no relevant differences between the age-matched, elderly controls and the young controls. Therefore, this effect appeared indicative of SVD. The variability of the lines orthogonal to the horizontal lines of the left, non-dominant hand differed only between the severe SVD group and the other groups. Furthermore, partial correlations demonstrated that the mean horizontal movement amplitude of the left hand was positively associated with the clock drawing test score, and the inter-manual asynchrony of the horizontal movements was positively associated with the Trail Making Test-B time. These results indicated that SVD patients show poor bimanual coordination, as reflected by spatial features such as movement amplitudes and variabilities, and abnormal bimanual coordination was associated with executive dysfunction.

A Clinical, Electrocardiographic and Echocardiographic Comparison of Patients with Single Vs Multivessel Disease Presenting with Acute Coronary Syndromes

Background Prevalence of coronary artery disease is between 7-13 percent in urban and 2-7 % in rural India1. The alarm in rise in the prevalence of coronary risk factors like diabetes, hypertension, dyslipidemia, smoking, central obesity and physical inactivity2. The correlation between these risk factors and the severity of coronary atherosclerosis, assessed by angiography which may be either single or multivessel is less consistent with studies reporting conflicting results 3,4. Therefore our study aims to understand the proper correlation between risk factors and severity of coronary artery disease in an Indian population Methods This study was conducted in the department of cardiology, NIMS hospital Hyderabad which receives patients from the urban as well as rural areas of Telangana. the patients admitted in the department of cardiology, NIMS hospital Hyderabad that presented with acute coronary syndromes and diagnosed to have coronary artery disease (single vessel/multivessel disease) on coronary angiography taken for study. Sample Size is 150 Results Among the 150 subjects, males were 111(74%) and females were 39(26%). Mean age of the study population is 55.2 ± 11.4. Among SVD group 73.65% were males &26.3% were females. Among MVD group 76.2% were males & 23.7% were females. Mean age for SVD was 53±14.4 years, while mean age foe MVD was 58.6±14.5 years. For ACS mean age of presentation for females is 60.7±11.4 and for males mean age of presentation is 55.1±12.6. MVD (57.2%) were more common among smokers than SVD. In <45 years age group SVD (69.2%) were more common than MVD (30.8%). In 45- 70 years age group and >70 years age group MVD were more common than SVD with 69.6% and 66.6% respectively, which is statistically significant. MVD (60%) were more common among hypertensives than SVD. Among non-hypertensives MVD (41.8%) was less common than SVD (58.2%) MVD was common among all age groups, which is statistically signicant. Among STEMI group SVD (58.3%) was more common than MVD (41.7%). Among NSTEMI group MVD (62%) was more common than SVD (38%).Correlation between groups was statistically significant. Among SVD study group, LVEF was commonly between 30-45% & very few with LVEF <30% MVD was associated with more severe LV dysfunction as compared to SVD in acute MI. The difference in ejection fraction between the two groups was statistically significant P value=0.0002. In hospital MACE Among SVD there was 1 MI (due to stent thrombosis) who had to TVR (primary PCI) & rest were asymptomatic and discharged in normal state MVD there were in hospital deaths (due to refractory cardiogenic shock) rest were asymptomatic and were discharged in normal state. This difference between the two groups was statistically insignificant. Conclusion Multivessel disease in ACS were seen more commonly among elderly as compared to young subjects where single vessel disease were more common. Females especially elderly more commonly have multivessel disease. Mean age for multivessel disease was higher than single vessel disease. Among <45 years age group, SVD was more prevalent among smokers, obese and physically active. Multi vessel disease is more prevalent among patients with risk factors like diabetes, hypertension, dyslipidemia and physically inactive. Subjects with family history of premature CAD presented early and correlated well with prevalence of SVD.NSTEMI presented more with multi vessel disease. In echocardiographic wall motion analysis, a depressed regional segment of infarcted area with remote hyperkinesis predicted SVD where as remote area hypokinesis predicts more multivessel disease. In hospital outcomes were seen among multi vessel disease as compared to single vessel disease although not statistically significant.

Antibiotics Susceptibilities of Isolates from Eye Swabs of Babies Delivered through Spontaneous Vaginal and Caesarean Section Deliveries.

Purpose: The study aims to investigate the antibiotics susceptibilities of isolates from eye swabs of babies delivered through Spontaneous Vaginal (SVD) and non- elective Caesarean Section (CS).Materials and Methods: This was a three-month prospective cross-sectional study, with samples as eye swabs of new born babies delivered in the maternity ward of Aminu Kano Teaching Hospital. Samples were collected not more than 30 minutes after delivery from 82 neonates (50 SVD and 32 CS) and stored in the refrigerator. It was evacuated in ice pack containers in batches within 24 hours to the microbiology laboratory for culturing, characterisation and sensitivity.Results: The result showed that E. coli was isolated in 25(30.5%) of the samples, P. aeruginosa, 22(26.8%), S. aureus, 21(25.6%) and K. pneumoniae 14(17.1%). In the SVD group, E. coli was isolated in 16(32%) of samples, P. aeruginosa, 14(28%), S. aureus, 11(22%) and K. pneumonia, 9(18%). In the CS group, S. aureus was isolated in 10(31.3%) samples, E. coli, 9(28.1%), P. aeruginosa, 8(25.0%) and K. pneumonia, 5(15.6). There were 47(77%) SVD and 14(23%) CS samples that were resistant to three (3) or more antibiotics but this difference was not statistically significant (p=0.157). Babies born through SVD had higher bacterial isolates when compared with those delivered through CS, but this was also not statistically significant (p=0.787).Conclusion: The mode of delivery had non-significant association with bacterial isolates from eye swabs of new born babies. We recommend Randomized Controlled Trial to establish the risk of bacterial isolates in new born babies’ eyes.

Vitamin D levels and clinical outcomes of SARS-CoV-2 Omicron subvariant BA.2 in children: A longitudinal cohort study.

ObjectiveTo investigate the picture between vitamin D levels and clinical outcomes of SARS-CoV-2 Omicron subvariant BA.2 in children.MethodsA retrospective, longitudinal cohort study was performed. All included hospitalized cases were divided into the sufficient (sVD) and insufficient vitamin D (iVD) groups according to whether their serum 25-hydroxyvitamin D [25(OH)D] concentration was ≥30 ng/mL. Dynamic changes in clinical parameters were observed for seven time periods within 28 days after admission.ResultsSerum 25(OH)D concentrations were significantly negatively correlated with age in the included cases (r = −0.6; P < 0.001). Compared with the iVD group (n = 80), the sVD group (n = 36) had higher interleukin-6 (18.4 vs. 12.9; P = 0.003) within the first day; higher procalcitonin within the first (0.15 vs. 0.1; P = 0.03), 2–3 (0.14 vs. 0.07; P = 0.03), 4–5 (0.21 vs. 0.07; P = 0.02) days; more lymphocytes within the first (1.6 vs. 1.2; P = 0.02), 2–3 (3.7 vs. 2; P = 0.001), 4–5 (3.9 vs. 2.1; P = 0.01) and 6–7 (4.9 vs. 2.7; P = 0.02) days; notably, higher cycle threshold for N gene (30.6 vs 19.8; P = 0.03) or ORF1ab gene (31.4 vs 20.1; P = 0.03) within 2 to 3 days. Pneumonia lesions were found in eleven and six cases in the iVD and sVD groups, respectively, without significant difference on computed tomography at admission. Six out of eleven and five out of six had a repeat computed tomography after 1–2 weeks. Lesion improvement was more significant in the sVD group (P = 0.04).ConclusionsChildren with vitamin D insufficiency might have poorer clinical outcomes in Omicron subvariant BA.2 infection, especially in older pediatric patients. Further studies are needed to assess effectiveness of supplements in reducing the same.

Comparison of Salvage Autologous Hematopoietic Cell Transplantation with Outcomes Following Selinexor Combinations Among Double/Triple Refractory Myeloma Patients

Introduction: A vast majority of multiple myeloma (MM) patients requires subsequent lines of therapy following relapses. The choice of regimen following relapse is influenced by response, tolerance to prior therapies, as well as by disease and patient features. Treatment options are limited for those who develop triple-class refractory disease. In this setting, the role of a salvage autologous stem cell transplantation (sAHCT) is controversial. This unmet need has driven the development of new therapies with novel mechanisms of action. Selinexor, an oral selective inhibitor of nuclear export (SINE) compound, was recently approved by the FDA and EMA for use in heavily pretreated relapse refractory (RRMM) patients, including triple-class refractory RRMM and FDA has also approved the agent in patients with first relapse. In the absence of head-to-head studies, comparison of treatment options among triple-class treated patients is based on real world experience. Here we performed a retrospective comparison between outcomes following sAHCT versus Selinexor combinations administered among RRMMs.Patients & Methods: Between January 2015 and April 2021, 22 patients at our center underwent sAHCT for treatment of refractory relapse. A transplant was defined as salvage if the patient had already received one prior AHCT and underwent a further AHCT after evidence of disease progression not responding to second generation proteasome inhibitors (PI), İmmunomodulating agents (IMID) or antiCD38 monoclonal antibody. We compared the outcomes of these patients with 10 RRMM patients who had exhausted their treatment options and were progressing on their last line of therapy to receive Selinexor, dexamethasone in combination with either bortezomib (n=7) (XVd) or carfilzomib (n=3) (XCd) as a part of a Karyopharm Expanded Access Program (KEAP). Selinexor was administered 80-100 mg po weekly in combination. Response and disease progression were assessed according to the IMWG criteria.Results: Patients' characteristics and the outcome of treatments are shown in Table. The median age of patients was similar in both groups. Patients were heavily treated with a median of 6 prior lines of therapy (4-9) and 2 out of 10 carried high-risk cytogenetics in SVd group. Seven (31.8%) patients with high-risk cytogenetics underwent sAHCT. All patients were treated with or refractory to immunomodulators and proteasome inhibitors. Five patients responded to DCEP bridging therapy prior to sAHCT. Five patients received Selinexor after sAHCT. One patient underwent sAHCT due to progression under Selinexor treatment. In sAHCT group, 68.2% of patients relapsed within a median of 6.3 months (Figure-1). Figure-2 shows the impact of the prior lines of therapy and selinoxor on PFS.Adverse events on selinexor regimens included fatigue, nausea, thrombocytopenia which were managed with Selinexor dose adjustment and supportive care. Two patients eventually transitioned to new therapies, while 4 still remain on SVd due to continued response.Conclusion: Our results based on a small number of patients, compared with outcomes post sAHCT reflects comparable duration of response and disease control rates with Selinexor-PI regimens among selected patients. Hospitalization and prolonged infusions are not required with the selinexor regimens, and prolonged treatment is possible with advance in lines of therapy duration of response lessens with any treatment modality. Despite of a DCEP bridging therapy prior to sAHCT, Selinexor combos have achieved similar PFS even among triple class refractory MM patients. For countries where CAR-T therapies are not accessible, sAHCT and Selinexor combinations may be considered as a valid clinical option after failing CD38 monoclonal antibodies, PI and IMIDs. These data support the use of selinexor-based regimens in the treatment of relapsed MM, and given the potency of the combinations, in earlier lines of therapy including in patients who have received anti-CD38 mAbs. [Display omitted] DisclosuresKashyap: Karyopharm: Current Employment. Niblock: Karyopharm: Current Employment. Beksac: Amgen,Celgene,Janssen,Takeda,Oncopeptides,Sanofi: Consultancy, Speakers Bureau. OffLabel Disclosure:Selinexor has not been approved for myeloma patients in Turkey. It could be used as a part of Karyopharm Expanded Access program (KEAP).

Pelvic floor function and morphological abnormalities in primiparas with postpartum symptomatic stress urinary incontinence based on the type of delivery: a 1:1 matched case-control study.

The aim of this study was to assess pelvic floor muscle (PFM) morphology and function in primiparas with postpartum symptomatic SUI after different types of delivery. Retrospective analyses were carried out with individuals with postpartum symptomatic stress urinary incontinence (SUI). Among the women screened in our center from January 2018 to December 2019, participants were divided into elective cesarean section (eCS) and spontaneous vaginal delivery (sVD) groups, while being matched 1:1 on age (±5years), body mass index (BMI; ±0.5kg/m2), neonatal birth weight (±300g), gestational age (±1week), degree of pelvic organ prolapse quantification (POP-Q), International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) degree, Incontinence Impact Questionnaire short form (IIQ-7) score, and postpartum days (±10days); all participants had no sphincter defects or levator ani muscle avulsion. The bioelectrical activity of the PFM was collected using an endovaginal electrode with the Glazer protocol. For the assessment of PFM function, PFM morphometry was evaluated with 3D/4D transperineal ultrasound. A total of 78 matched pairs were recruited based on delivery mode. Regarding functional differences, both fast-twitch and slow-twitch fiber strengths in the eCS group were significantly higher than those in the sVD group, but PFMs were more hyperactive in the eCS group. Regarding morphometric differences, the retrovesical angle (RVA) and bladder neck position were not significantly different in the resting state between the two groups, nor was the RVA during the Valsalva maneuver (eCS group: 130.68 ± 17.08°, sVD group: 136.33 ± 23.93°), p >0.05. There were differences in bladder neck descent (BND; eCS group: 16.51 ± 7.55mm, sVD group: 23.92 ± 8.47mm) and urethral rotation angle (URA; eCS group: 37.53 ± 26.05°, sVD group: 59.94 ± 25.87°), all p < 0.05. BND showed a negative correlation with PFM strength, p < 0.05. URAs and RVAs showed no correlation with PFM strength, p > 0.05. Pelvic floor muscle function disorder, hyperactivity, and instability also occurred after eCS, which resulted in postpartum symptomatic SUI. The effects of sVD compared with eCS on abnormalities in the lower urinary tract were related to bladder neck and urethral hyperactivity, without an RVA increase.

Safety of Percutaneous Coronary Intervention for Chronic Total Occlusion in Patients With Multi-Vessel Disease: Sub-Analysis of the Japanese Retrograde Summit Registry

BackgroundThe success rate of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) has gradually increased thanks to the continuous development of devices and techniques. However, the impact of multi-vessel disease (MVD) on its success rate and safety is not well known. MethodsThe clinical records of 5009 patients enrolled in the Japanese Retrograde Summit Registry and who had undergone PCI for CTO at 65 centers between 2012 and 2015 were reviewed. We compared the outcome for patients with and without MVD. ResultsTwo thousand nine hundred and seventy-eight patients (59%) had MVD. Although there was no significant difference in the J-CTO score between the two groups [MVD group 1.51 ± 1.07 vs. SVD group 1.48 ± 1.07, p = 0.48], the procedural success rate of CTO-PCI in the MVD group was significantly lower than that in the SVD group (87.2% vs. 90.2%, p = 0.001). However, occurrence of procedure-related adverse events (4% vs. 5%, p = 0.11), total fluoroscopy (70 ± 45 min vs. 69 ± 50 min, p = 0.75) and procedural time (154 ± 86 min vs. 151 ± 89 min, p = 0.36), and total amount of contrast media (219 ± 102 mL vs. 222 ± 105 mL, p = 0.33) did not differ between the two groups. ConclusionsAlthough MVD had an impact on the success rate of CTO-PCI, it did not affect procedure-related adverse events.

Evaluation of Transient Ischemic Dilation (TID) Ratio in Gated SPECT Myocardial Perfusion Imaging (MPI) with Pharmacological Stress Agents

Objectives: Transient ischemic dilation (TID) refers to an apparent increase in the size of the left ventricular cavity on stress myocardial perfusion imaging compared to rest imaging. This study was performed to correlate the value of TID ratio in gated SPECT MPI in Coronary Artery Disease (CAD).&#x0D; Patients &amp; Methods: Seventy-four suspected or known CAD patients underwent MPI performed with Tc-99m sestamibi. Single day stress - rest protocol with pharmacological stress was followed, according to established practicing protocol of NINMAS. A statistical analysis was carried out by using the Statistical Package for Social Sciences version 20.0 for Windows (SPSS Inc., Chicago, Illinois, USA). Student t-test was used for continuous variables. Chi-square test used to compare categorical data. P values &lt;0.05 was considered as statistically significant.&#x0D; Results: Among 74 patients, 63(85.1%) were male and 11(14.9%) were female. The mean age found to be 53.8±10.5 years. Majority (90.5%) patients had hypertension, 45(60.8%) had diabetic mellitus and 39(52.7%) had dyslipidemia in blood lipid profile, 44(59.5%) were past smoker. The mean ejection fraction was 44.6±14.6 percent. The mean abnormal TID ratio was 1.25 ± 0.35 in patients having abnormal MPI findings and 1.03±0.21 in having normal MPI findings. The difference was statistically significant (p&lt;0.05) between two groups. It was also observed that in three cases having normal MPI had high TID ratio.Among the patients with TID ratio &gt;1.19, 24(64.9%) patients were in MVD group and 13(92.9%) were in SVD group. Whereas among the patients with TID ratio&lt;1.19, 13(35.1%) were in MVD group and 1(7.1%) were in SVD group. The difference was statistically significant (P&lt;0.05) between two groups. The mean TID ratio was 1.08±0.21 in single vessel disease and 1.24±0.26 in multiple vessel disease. The difference was also statistically significant (p&lt;0.05) between two groups.&#x0D; Conclusion: This study suggests that the TID ratios could provide incremental diagnostic information to standard myocardial perfusion analysis for the identification of severe and extensive disease in patients with suspected or known CAD.&#x0D; Bangladesh J. Nuclear Med. 21(2): 77-80, July 2018

Atherosclerosis Might Be Responsible for Branch Artery Disease: Evidence From White Matter Hyperintensity Burden in Acute Isolated Pontine Infarction.

Objective: To investigate an MRI-based etiological classification for acute isolated pontine infarcts and to assess differences in vascular risk factors, clinical characteristics and WMH burden among the etiological subtypes.Methods: All participants from SMART cohort with DWI-proven acute isolated pontine infarcts (AIPI) were included and categorized into 3 groups: large-artery-occlusive disease (LAOD), basilar artery branch disease (BAD), and small vessel disease (SVD), according to basilar artery atherosclerosis severity and lesion extent of the transverse axial plane. The vascular risk factors and 6-month functional outcome was analyzed among 3 groups.Results: Of the 1129 patients enrolled, 175 had AIPI. BAD was the most frequent subtype of AIPI (46.3%), followed by SVD (36.0%) and LAOD (17.7%). Neurological impairment on admission was more severe in the LAOD group, followed by BAD. The BAD group had greater frequencies of female sex, hypertension, diabetes mellitus compared to the SVD group (P < 0.05). NIHSS on admission were significantly higher in the BAD group as compared with the SVD group (P < 0.001), but no difference was found between BAD and LAOD group. Poor outcome (mRS≥3) was found in only 13.7% of patients at 6-month post-stroke and there was no difference among 3 groups. WMH severity was significant higher in the SVD group compared to the BAD group for the deep subcortical region; however, there was no difference for the periventricualr region. There was no significant difference in either DWMH or PVWMH severity between the BAD and LAOD groups.Conclusion: BAD is the most frequent etiology of AIPI followed by SVD and LAOD. WMH burden, vascular risk factors and clinical characteristics in BAD group were more similar to the LAOD group, rather than to the SVD group, suggesting the atherothrombotic nature of BAD.

Evaluation of serum cathepsin D concentrations in coronary artery disease

BackgroundCoronary artery disease (CAD) cannot be sufficiently explained by the presence of traditional risk factors. Cathepsin D has been proposed to serve as a surrogate marker of atherosclerosis but its alterations in CAD patients have not been studied. ObjectiveTo evaluate serum cathepsin D concentrations in relation to the presence and severity of CAD. Materials and methodsA total of 104 subjects were recruited; 71 patients with suspected CAD and 33 healthy subjects. Thirty-four patients had >50% coronary stenosis of at least one artery (CAD+); the remaining 37 patients had <50% stenosis (CAD−) based on angiography. CAD+ patients were sub-divided into three sub-groups with single (SVD; n=15), double (2VD; n=9), and triple vessel (3VD; n=10) disease. Serum soluble cathepsin D concentrations were determined using an enzyme-linked immunosorbent assay (ELISA). ResultsSerum cathepsin D concentrations were significantly higher in the CAD+ compared with healthy control (p=0.016) but not CAD− group (p=0.098). Within the CAD+ group, patients with 3VD had significantly higher serum cathepsin D concentrations compared with the SVD group (p=0.025), and also compared with the CAD− (p=0.011) and SVD (p=0.001) groups. No significant associations were found between serum cathepsin D concentrations and potential confounders including age, sex, blood pressure, smoking history and dyslipidemia. ConclusionSerum cathepsin D concentrations may be associated with the presence of CAD.

Puppy Apgar scores after vaginal delivery and caesarean section

The aim of this study was to evaluate the vital signs of newborn puppies using the modified Apgar score after spontaneous delivery and caesarean section. The survival of puppies was monitored for up to 24 hours after birth. The experiment consisted of ten deliveries of bitches with dystocia terminated by caesarean section (C-section group) and ten bitches with spontaneous vaginal delivery (SVD group). Vital signs of neonates were evaluated using a modified method of the Apgar score 5, 10 and 15 min after birth. Five evaluation criteria (colour of mucous membranes, reflex irritability, motility, heart rate and respiration) were used with puppies classified into three scoring groups: “severe distress” (0–3 points), “moderate distress” (4–6 points) and “no distress” (7–10 points). In the SVD group, 57 puppies were evaluated; 98.2% of puppies were born alive, all survived their first 24 hours of life. At the time of birth, 1.8% of puppies were dead (1/57). The Apgar scores of all foetuses were in the “no distress” category. In the C-section group (n = 37), 13.5% of puppies (5/37) were stillborn, two puppies (6.3%) died within 24 hours of delivery. The “no distress” group included 51.4% (19/37) of puppies, while 5.4% (2/37) of puppies were classified into “moderate distress” and 43.2% of puppies (16/37; P &amp;lt; 0.001 at 5 min, P &amp;lt; 0.005 at 10 min and P &amp;lt; 0.005 at 15 min after delivery) were classified into “severe distress”. These results confirm the influence of type of delivery on the Apgar score immediately after parturition and on the short-term survival rate of puppies after parturition.

Can MRI water apparent diffusion coefficient (ADC) value discriminate between idiopathic normal pressure hydrocephalus, Alzheimer's disease and subcortical vascular dementia?

Numerous similarities in MRI and clinical symptoms exist between Alzheimer's disease (AD), subcortical vascular dementia (sVD) and possible idiopathic normal pressure hydrocephalus (iHPN). The aim of this study is to explore mean apparent coefficient diffusion (ADC) difference between theses diseases in different periventricular and deep white matter areas, as compared to healthy controls. This retrospective study analyzed mean ADC values of 120 patients in normal appearing deep white matter and lenticular nuclei, frontal, caudate nuclei corpus and parietal periventricular and deep white matter areas INPH group showed significantly lower ADC than sVD group in frontal periventricular region (1567.10−6mm2/s vs 1755.10−6mm2/s; P=0.0009) and in parietal deep region (1087.10−6mm2/s vs 1271.10−6mm2/s; P=0.0052), but showed significantly higher ADC in lenticular nuclei ROI (834.10−6mm2/s vs 753.10−6mm2/s; P=0.002). The comparison between iNPH and sVD showed a cut-off value of 1676.10−6mm2/s (sensitivity 0.70, specificity 0.77) in periventricular frontal area. INPH group, in comparison with NA group, showed significantly higher ADC in all ROIs. The iNPH group also showed significantly higher ADC than AD group in all ROIs. AD group showed significantly lower ADC than sVD group in all regions, except in normal appearing lenticular nuclei and caudate nuclei corpus deep ROI. SVD group showed significantly higher ADC than NA in all ROIs, except in normal appearing lenticular nucleus ROI. Different patterns of ADC values can differentiate between AD, sVD and iNPH, even when other MRI sequences appear morphologically similar.

Interleukin 6 may be related to indoleamine 2,3-dioxygense function in M2 macrophages treated with small dense LDL particles

Macrophages are known as important immune cells involved in the improvement of atherosclerosis plaques. The M2 macrophages are beneficial because scavenging the non-functional components in vessel sub-endothelial space. In this study, we investigated the effects of small dense LDL (sdLDL) on the changes of indoleamine 2,3-dioxygense (IDO) and interleukin (IL6) in the differentiated M2 macrophages. The patients were selected from who underwent coronary artery angiography. The monocytes were isolated from the whole blood samples of healthy (<5% stenosis) and patient (>70% stenosis; SVD, 2VD and 3VD) subjects and, were differentiated into M2 macrophages. The IDO gene expression, activity and IL6 values were measured by RT-qPCR, colorimetry and ELISA techniques, respectively. In contrast with healthy group, the IDO gene expression and activity were significantly reduced in SVD and 2VD groups (P<0.05). Furthermore, they were conversely associated to secretion of IL6. In conclusion, the data suggested that inflammatory responses in M2 macrophages differentiated from monocytes of patients after treatment of sdLDL may be related to the reduced IDO function.

There is Only a Modest Increase in Neonatal Respiratory Morbidity Following Early Term Elective Cesarean in a South Indian Population.

Elective cesarean deliveries (ECD) are still performed prior to 39weeks. This study aimed to identify risk of neonatal respiratory morbidity (NRM) following ECD near term, in a South Indian population. Specifically, study aimed to measure the additional healthcare burden due to large number of ECDs performed prior to 39weeks, in this local population. We analyzed NRM among 1329 deliveries (584 ECD and 745 spontaneous vaginal delivery, SVD) in a tertiary hospital over 2years. Neonates were grouped into: A: 35+0-36+6 weeks, B: 37+0-38+6weeks, and C: ≥39weeks. NRM was compared between ECD versus SVD. Majority (433/584) of ECDs were performed between 37+0 and 38+6 weeks. Overall, 32% received steroid prophylaxis. Of 1329 newborns, 18/584 (3.82%) in ECD and 6/745 (0.8%) in SVD group developed NRM (p value of 0.004, OR 3.9, CI 1.54-9.93). Need of respiratory support among ECD was 4.28% compared to 0.53% in SVD (p<0.001, OR 8.28; CI 2.86-23.94). However, comparing neonates born by ECD between groups B Vs C; there was only a modest increase in NRM (2.07 vs 0.9%; p 0.48, OR 2.3 with CI 0.29-18.4) and in need of respiratory support (2.54 vs 0.9%; p 0.47, OR 2.84; CI 0.36-22.2). NRM following early term ECD continues to be a healthcare burden in India. Interestingly in this South Indian population, early term ECDs caused only modest increase in NRM, and this ethnic variation requires further evaluation to determine ideal time for ECD in local population.

Do female patients with predominant voiding symptoms really have objective voiding-phase dysfunction?

ObjectivesTo investigate whether female patients with predominant voiding symptom really have objective voiding phase dysfunction. MethodsFemale patients with lower urinary tract symptoms who underwent video-urodynamic study between January 2009 and December 2012 were recruited. All patients completed a 3-day frequency-volume chart. Symptom severity was evaluated using International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score (OABSS) and Urogenital Distress Inventory (UDI-6) questionnaires. The patients with IPSS-voiding subscores greater than IPSS-storage subscores and their most bother symptom are one of voiding symptom of IPSS were defined as subjective voiding dysfunction group (SVD group). The demographics, IPSS scores, OABSS scores, frequency-volume charts and urodynamic variables were compared between SVD and non-SVD groups. ResultsOf the 842 enrolled patients, 142 (16.9%) were classified into SVD group. Total IPSS and IPSS-voiding subscores of SVD group were significantly higher than those of non-SVD group. Conversely, IPSS-storage subscores, OABSS and UDI-6 scores of SVD group were significantly lower than those of non-SVD group. The prevalence of urodynamic voiding phase dysfunction was 64.7% in SVD group, which was significantly higher than those of non-SVD group (37.8%, p < 0.01). SVD group showed more prevalent bladder outlet obstruction (50.0% vs. 27.0%, p < 0.01). There were no significant differences in the prevalence of impaired detrusor contractility between SVD and non-SVD group. Detrusor overactivity was more prevalent in non-SVD group (5.6% vs. 18.6%, p < 0.01). ConclusionsEven though the female patients complain of predominant voiding symptoms, only two thirds of them were identified having urodynamic voiding phase dysfunction. On the other hand, in female patients whose predominant complaint are not voiding symptom, around one third of them were found to have urodynamic voiding phase dysfunction. This study clearly indicates that in females subjective low urinary tract symptoms are not necessarily reliable.

Association of Arterial Pressure Volume Index With the Presence of Significantly Stenosed Coronary Vessels.

BackgroundA blood pressure (BP) monitoring system (PASESA®) can be used to easily analyze the characteristics of central and peripheral arteries during the measurement of brachial BP.MethodsWe enrolled 108 consecutive patients (M/F = 86/22, age 70 ± 10 years) who underwent coronary angiography (CAG) due to suspected coronary artery disease (CAD) in whom we could measure various parameters using PASESA® in addition to brachial-ankle pulse wave velocity (baPWV). The patients were divided into two groups: patients who did not have significantly stenosed coronary vessel disease (n = 33, non-SVD group) and those who had at least one significantly stenosed coronary vessel (n = 75, SVD group). The characteristics of central and peripheral arteries (arterial velocity pulse index (AVI) and arterial pressure volume index (API), respectively) and baPWV were measured. Estimated central BP (eCBP) was calculated from the data obtained from PASESA®, and CBP was also measured simultaneously by invasive catheterization.ResultsAPI, but not AVI and baPWV, in the SVD group was significantly higher than that in the non-SVD group. Although eCBP was significantly associated with CBP, there was no difference in eCBP between the groups. There were significant associations among API, AVI and baPWV, albeit these associations were relatively weak. A multivariate logistic regression revealed that API and β-blocker were significant independent variables that were associated with the presence of significant coronary stenosis. The cut-off level of API that gave the greatest sensitivity and specificity for the presence of SVD was 24 units (sensitivity 0.636 and specificity 0.667).ConclusionIn conclusion, API, but not AVI or baPWV, is associated with the presence of significant coronary stenosis.