Predicting adverse perinatal outcomes with fetal modified myocardial performance index and epicardial fat tissue thickness in diabetes-complicated pregnancies.

OBJECTIVE: The aim of this study was to evaluate fetal modified myocardial performance index (mod-MPI) and fetal epicardial fat tissue (EFT) thickness and its association with adverse perinatal outcomes in diabetic pregnant women. PATIENTS AND METHODS: This was a prospective case-control study including 90 gestational diabetes mellitus (GDM) and 45 pregestational diabetes mellitus (PGDM) and 90 healthy pregnant women (control group). Two-dimensional gray-scale and Doppler fetal echocardiography were used to calculate the mod-MPI. EFT thickness was measured in the hypoechogenic area between the myocardium and the visceral pericardium on the right ventricle by distinguishing it from the pericardial fluid by Doppler ultrasound. RESULTS: Both mod-MPI values and EFT thickness were significantly higher in diabetic pregnant women (p<0.001; for both). No significant differences were observed in mod-MPI values and EFT thickness between pregnant women with GDM and PGDM. In addition, there was no significant difference in fetal mod-MPI values and EFT thicknesses among diabetic pregnant women based on their treatment requirements. The receiver operating characteristic (ROC) curve revealed that mod-MPI value (cut-off 0.54, 95% CI: 0.629-0.837, p<0.001, sensitivity 64.6%, specificity 61.7%) and EFT thickness (cut-off 1.85 mm, 95% CI: 0.524-0.750, p=0.014, sensitivity 65.8%, specificity 63.9%) could predict adverse neonatal outcomes in diabetic pregnant women. Multivariate regression analysis revealed that both mod-MPI (p=0.003) and EFT thickness (p=0.008) were independently associated with adverse outcomes. CONCLUSIONS: Fetal mod-MPI values and EFT thickness increase in pregnancies complicated by diabetes, and these measurements may serve as valuable predictors of adverse perinatal outcomes.

Closure of transcatheter ventricular septal defect using LifetechTM Konar-MF Occluder in children weighing less than 10 kilograms: mid-term results, a tertiary single center experience.

OBJECTIVE: Transcatheter closure of medium and large ventricular septal defects (VSDs) in young children is limited due to the use of over-sized devices that can cause hemodynamic instability and arrhythmia. In this study, we aimed to retrospectively evaluate the safety and efficacy of the device in the mid-term in children weighing less than 10 kg whose transcatheter VSD was closed only with the Konar-MFO device. PATIENTS AND METHODS: Among 70 children whose transcatheter VSD was closed between January 2018 and January 2023, 23 patients weighing less than 10 kg were included in the study. Retrospectively, the medical records of all patients were reviewed. RESULTS: The mean age of the patients was 7.3 (4.5-26) months. 17 of the patients were females, 6 of them were males, F/M: 2.83. The average weight was 6.1 (3.7-9.9) kg. The mean the pulmonary blood flow/ systemic blood flow (Qp/Qs) was 3.3 (1.7-5.5). The mean defect diameter was 7.8 mm (5.7-11) for the left ventricle (LV) side, and 5.7 mm (3-9.3) for the right ventricle (RV) side. Based on the utilized device dimensions, the measurements on the LV side were recorded as 8.6 mm (range 6-12), while those on the RV side were recorded as 6.6 mm (range 4-10). Antegrade technique was applied to 15 (65.2%) patients and retrograde technique was applied to 8 (34.8%) patients in the closure procedure. The procedure success rate was 100%. The incidence of death, device embolization, hemolysis, or infective endocarditis was zero. CONCLUSIONS: Perimembranous and muscular VSDs in children under 10 kg can be successfully closed under the management of an experienced operator with the Lifetech Konar-MFO device. This is the first study in the literature to evaluate the efficacy and safety of the device in children under 10 kg in whom only Konar-MFO VSD occluder device is used for transcatheter VSD closure.

[Determination of blood alcohol level of people who are involved in a judicial event of medical importance (case report)]. / Kisilerin olay anindaki kan alkol seviyelerinin tespit edilmesinin adli-tibbi önemi (olgu sunumu).

In some cases, determination of blood alcohol level is very important. The alcohol level at the time of an event, can affect the court decision and may lead to aggravate the penalty or on the contrary an acquittal. In this article, a criminal action, in one of Turkish High Criminal Court is examined. The case was about the death of a drunk person who had fallen down from the window of his girl friend's house which is on the third floor of an apartment. This person's parent applied to public prosecutor saying that their child did not fall down but was murdered by his girl friend. During this trial, in the victim's autopsy, no alcohol detected in blood in contrast with his girl friend's testimony. Because of this contradiction, a reasonable doubt has emerged that she was the murderer in this suspicious death. However, in the further stages of trial, the reasons of no alcohol detection in the autopsy is investigated. In the basis of this case, the importance and techniques of alcohol detection in blood is discussed with literature.