Is there an effect of thyroid autoimmunity on the outcomes of assisted reproduction?

We aimed to evaluate the role of thyroid autoantibodies (TAA) on the outcomes of intracytoplasmic sperm injection-embryo transfer (ICSI-ET). A prospective case-control study was conducted in the in vitro fertilisation (IVF) centre of Suleymaniye Maternity Training and Research Hospital, Istanbul, Turkey between July 2013 and March 2014. A total of 49 (19.52%) TAA-positive and 202 TAA-negative patients were enrolled. Demographic characteristics and laboratory parameters were recorded. All patients underwent ICSI-ET. Thirty-one TAA-positive patients (32 cycles) and 121 TAA-negative patients (126 cycles) completed the study. Mean female age, body mass index (BMI), type of infertility, duration of infertility, antral follicle count (AFC), anti-Müllerian hormone (AMH), basal follicle stimulating hormone (bFSH), luteinising hormone (bLH), and oestradiol (bE2), prolactin and thyroid hormone profiles, male age and aetiology of infertility of both groups were similar (p > 0.05). There was no significant difference between groups in terms of duration and dose of gonadotropin (Gn) therapy, day of human chorionic Gn (hCG) administration, serum E2 and progesterone levels, number of collected oocytes, ratio of fertilisation, number of available embryos, positive pregnancy test, biochemical pregnancy, clinical pregnancy, ratio of miscarriage and ongoing pregnancy (p > 0.05). In conclusion, we failed to demonstrate a significant role of TAA on the outcomes of ICSI-ET in euthyroid patients. Further studies with larger numbers of participants are required to clarify these data.

Noninvasive assessment of subclinical atherosclerosis in normotensive gravidae with gestational diabetes.

AIM: Carotid artery intima-media thickness (CIMT), hyperhomocysteinemia, microalbuminuria, and nitric oxide reflect subclinical atherosclerosis and predict the risk of future cardiovascular events. We aimed to evaluate the presence of subclinical atherosclerosis and endothelial dysfunction in normotensive patients with gestational diabetes mellitus (GDM) noninvasively. PATIENTS AND METHODS: We enrolled 41 normotensive patients with GDM and 44 healthy gravidae in the study. Serum homocysteine and nitric oxide levels, urinary albumin excretion (microalbuminuria), and CIMT were evaluated along with lipid parameters and anthropometric measurements. RESULTS: Patients with GDM had significantly higher levels of serum homocysteine, urinary albumin excretion, and increased CIMT (p < 0.001, p=0.005, and p < 0.001, respectively). Nitric oxide levels were significantly reduced in the patient group (p < 0.001). There was a significant difference between groups in terms of low-density lipoprotein (LDL) but not of high-density lipoprotein (HDL) and triglyceride levels. A significant correlation was observed between CIMT and serum LDL, HDL, homocysteine, nitric oxide levels, and urinary albumin excretion. Microalbuminuria was significantly correlated with serum homocysteine levels (p=0.03) but not with nitric oxide. CONCLUSION: Independent of elevated blood pressure, subclinical atherosclerosis and endothelial dysfunction exist in normotensive patients with GDM. Further studies with a large number of participants are required to clarify these data.

Which flap method should be preferred for the treatment of pilonidal sinus? A prospective randomized study.

BACKGROUND: Although many methods, either surgical or non-surgical, are being used for the treatment of pilonidal sinus disease (PSD), there is still no consensus as to what constitutes the most appropriate method of treatment. The aim of this study was to compare the outcomes of the Limberg flap (LF), modified Limberg flap (MLF), and Karydakis flap (KF) procedures. METHODS: A prospective, randomized study was conducted on 295 patients scheduled for surgical treatment for PSD at the General Surgery Clinic of the Konya Training and Research Hospital in January 2009-May 2010. Patients with recurrent disease, an ASA score higher than III, obesity (BMI > 35 kg/m(2)), insulin-dependent diabetes, or a drug or alcohol addiction were excluded. The procedures performed were as follows: LF (n = 96), MLF (n = 108), and KF (n = 91). RESULTS: The patients were followed up for a median of 33 months (range 24-41 months). There were more female patients in the LF group. The rate of seroma formation was higher in the KF group (19.8 %) compared to the LF and MLF groups (5.2 and 7.4 %, respectively; p = 0.027). The rate of wound dehiscence was higher in the KF group (15.4 %) compared to the LF and MLF groups (2.1 and 3.7 %, respectively; p < 0.001) as was the incidence of flap maceration (11 % in the KF vs. 1 % in the LF and 3.7 % in the MLF; p = 0.004). The incidence of PSD recurrence was also higher in the KF group (11 %) compared to the LF and MLF groups (6.3 and 1.9 % respectively; p = 0.027). In a multivariate analysis, the presence of seroma, hematoma, and wound infection were independent predictors of recurrence. CONCLUSIONS: In our study, LF and MLF procedures were associated with a lower recurrence and complication rate compared to KF. However, more randomized studies comparing different reconstruction methods after PSD excision are needed.

From dyspepsia to complicated peptic ulcer: new markers in diagnosis and prognosis.

OBJECTIVE: Peptic ulcer disease (PUD) may present with different clinical findings, ranging from mild dyspeptic complaints to mortal complications, such as gastrointestinal system perforation. The aim of this study was to investigate the potential blood parameters that can be used in the diagnosis of PUD and prediction of complications. PATIENTS AND METHODS: A total of 80 patients with dyspeptic complaints, 83 patients with PUD, and 108 patients with peptic ulcer perforation (PUP) who were treated in our hospital between January 2017 and December 2020 were included in the study. Clinical findings, laboratory data, and imaging methods were reviewed retrospectively. RESULTS: The mean age of 271 (154 men, 117 women) patients included in the study was 56.04 ± 17.98 (mean ± standard deviation) years. The neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), mean platelet volume, white blood cell, C-reactive protein, and neutrophil values were higher in patients with PUP compared to other groups (p < 0.001 for all). In the PUD group, only red blood cell distribution width was significantly higher compared to the patient group with dyspeptic complaints. In the postoperative period, NLR and PLR were significantly higher in patients who developed severe complications according to the Clavien-Dindo classification compared to patients who developed mild complications. CONCLUSIONS: This study showed that simple blood parameters can be used as diagnostic markers at different stages of PUD. NLR and PLR can be helpful in the diagnosis of PUP and red blood cell distribution width can be used to differentiate patients with peptic ulcer from dyspeptic patients. Additionally, NLR and PLR can be used to predict serious postoperative complications after PUP surgery.

Effect of chronic anal fissure components on isosorbide dinitrate treatment.

BACKGROUND: Chronic anal fissure is diagnosed in the presence of persistent symptoms: The classic triad includes a linear mucosal tear exposing the internal sphincter fibers, hypertrophied anal papilla, and a sentinel skin tag. Thus, chronic anal fissure can be divided into three components: the fissure itself; hypertrophied anal papilla; the sentinel skin tag. Not every chronic anal fissure has all three components; some have two components, and others present with only a persistent fissure. The success rate of medical treatment for chronic anal fissure is reported as 42-86 %. In this study, we intended to observe the effect of said components on healing with isosorbide dinitrate treatment. METHODS: A total of 105 patients with chronic anal fissures were admitted and were divided into three groups. Patients in group I had a single component (only the fissure with a linear mucosal tear exposing the internal sphincter fibers); group II had two components (skin tag or hypertrophied papilla in addition to the fissure); group III had all three components (fissure, skin tag, hypertrophied papilla). Isosorbide dinitrate 0.25 % was applied three times a day. RESULTS: The success rates in the study groups were 93, 74, and 64 %, respectively. The success rate was significantly higher for group I than for groups II and III. CONCLUSIONS: Chronic anal fissure components should be considered when evaluating the success rates of studies reporting the results of various medical treatments. The number of components seems to be an important factor that affects the results of isosorbide dinitrate treatment.

Tubo-ovarian abscess presenting as an ovarian tumor in a virginal adolescent: a case report.

Tubo-ovarian abscess (TOA), a serious complication of pelvic inflammatory disease, unites the fallopian tube and ovary and, is rarely observed in sexually inactive adolescent girls. A pelvic mass, supposedly originating from the ovary, was detected in a 13-year-old sexually inactive girl suffering from abdominal pain and menstrual disorder. Pelvic ultrasonography pointed out a semisolid, hyperechogenic mass of 57x73 mm in the left adnexal area. Laparotomy revealed an unilateral TOA adhering to the bowel and omentum. Abscess drainage and adhesiolysis were performed and postoperative antibiotherapy was administered. TOA should be considered in the differential diagnosis of females with abdominal pain and adnexal mass whether sexual activity is present or not.

GPR, King's Score and S-Index are superior to other non-invasive fibrosis markers in predicting the liver fibrosis in chronic Hepatitis B patients.

Background and study aims: In this study, we investigated the efficacy of nine non-invasive fibrosis markers in the assessment of the degree of fibrosis in patients with chronic Hepatitis B (CHB) in comparison with liver biopsy. Patients and methods: A total of 1454 untreated CHB patients from two different centers who underwent liver biopsy were included in the study. Laboratory results of patients were reviewed retrospectively and the pathology slides were re-evaluated in accordance with the Ishak score. Degree of fibrosis ≥ 3 was accepted as "significant fibrosis", ≥ 4 as "advanced fibrosis", and ≥ 5 as cirrhosis. The diagnostic performance of the markers Aspartate aminotransferase to Platelet Ratio Index (APRI), Fibrosis-4 score (FIB-4), Aspartate aminotransferase to Alanine aminotransferase Ratio (AAR), AAR to Platelet Ratio Index (AAPRI), Gamma-glutamyl transpeptidase to Platelet Ratio (GPR), King's Score, Fibro quotient (Fibro-Q), S Index and Platelet to Lymphocyte Ratio (PLR) were evaluated with ROC analysis. Results: In detecting significant fibrosis, APRI, GPR, King's Score and S Index had AUROC values over 0.70. For advanced fibrosis, all of the models except AAPRI; and for cirrhosis, all of the models had AUROC values over 0.70. In accordance with the chosen staging system, GPR, King's Score and S Index had high diagnostic efficacy whereas APRI, FIB-4, FibroQ and PLR had moderate diagnostic efficacy, AAR and AAPRI had low diagnostic efficacy. Conclusions: GPR, King's Score and S Index had moderate diagnostic performance in detecting significant fibrosis and advanced fibrosis, and high diagnostic performance in detecting cirrhosis.

Vessel sealing system vs. conventional knot-tying for hilar dissection during living donor hepatectomy: a prospective, randomized, double-blinded study.

OBJECTIVE: LT has become the gold standard treatment for many liver diseases, especially chronic liver disease. A commonly seen problem, even in donors who do not develop any major complications after living donor hepatectomy (LDH), is the persistent drainage of lymphatic fluid from the hepatectomy site drain, which causes extensive hospitalization and consequent loss to the workforce. To our knowledge, no study has yet been published comparing LVSS and conventional knot-tying methods for hilar dissection, which is an important stage of the LDH procedure. We aimed to prospectively compare the outcomes of these two treatment methods. PATIENTS AND METHODS: Donor candidates were divided into two groups: conventional suture tying (conventional knot tying group; n=34) and Ligasure vessel sealing system (LVSS; n=34). A simple randomization method of drawing lots was used to assign the patients to each group. The following parameters were analyzed for all patients: age, gender, BMI, duration of surgery, postoperative drainage amounts, drain removal times and complications, length of hospital stay, morbidity, and mortality. RESULTS: There were no significant differences in terms of operative times, postoperative drainage levels, hospital stay or drain removal times. CONCLUSIONS: In this study, the use of LVSS in LDH was found to be safe, although it did not offer any advantage over conventional methods. Nevertheless, it seems probable that the use of LVSS could reduce operative time and amounts of lymphatic drainage, especially in centers with minimal experience with LDH, such as new LDH centers.

Morphologic and functional vascular alterations in patients with polycystic ovary syndrome.

BACKGROUND: We aimed to investigate morphologic and functional alterations of common carotid arteries (CCA) and femoral arteries and the anteroposterior diameter of the abdominal aorta in patients with polycystic ovary syndrome (PCOS). MATERIALS AND METHODS: Fifty consecutive females with the complaint of oligoamenorrhea, infertility or hirsutismus, diagnosed with PCOS and 50 healthy females admitted to the Department of Gynecology and Obstetrics, Ergani State Hospital between January 2010 and January 2011 were included in the study. RESULTS: The mean BMI of 50 patients with PCOS was higher than control subjects (CS) (25.89 +/- 3.3 vs 22.52 +/- 2.7 kg/m2, p < 0.0001). The mean arterial blood pressure was 88.93 +/- 6.4 mmHg in the patient group and was it 85.73 +/- 7.6 mmHg in CS (p = 0.02). The mean plasma glucose level (74.04 +/- 6.7 vs 70.5 +/- 6.4 mg/dl), total cholesterol level (167.88 +/- 30.1 vs 153.38 +/- 27.8 mg/dl), low density lipoprotein level (101.28 +/- 27.0 vs 79.56 +/- 25.5 mg/dl) and triglyceride level (121.22 +/- 49.2 vs 102.54 +/- 36.6 mg/dl) were higher; also the mean high density lipoprotein level (44.56 +/- 8.1 vs 50.90 +/- 12.3 mg/dl) was lower in patients with PCOS than CS (p = 0.009, p = 0.014, p < 0.0001, p = 0.034 and p = 0.003, respectively). CCA-IMT (0.63 +/- 0.2 vs 0.52 +/- 0.1 mm), and CCA-PI (1.44 +/- 0.3 vs 1.28 +/- 0.22) were higher in patients with PCOS (p = 0.018 andp = 0.005, respectively). Femoral-IMT (0.62 +/- 0.6 vs 0.41 +/- 0.1 mm) and anteroposterior diameter of the infrarenal aorta (12.34 +/- 1.5 vs 11.4 +/- 1.0 mm) were higher in patients with PCOS (p = 0.024 and p = 0.001, respectively). CONCLUSION: The present study showed that IMT and PI of CCA, and anteroposterior diameter of the infrarenal abdominal aorta and femoral-IMT were higher in patients with PCOS. These results are probably related with increased androgens, their effects on insulin resistance and lipid profile, increased BMI and blood pressure. Detection of these functional and/or structural abnormalities are important in predicting prognosis. Larger scale prospective studies are needed to determine the effects of PCOS on the mortality and morbidity, and to clarify the relation between the duration of the disease and development of these alterations.

Hepatitis B/D-Related Hepatocellular Carcinoma. A Clinical Literature Review.

AIM: Given the current literature data, this article aims to shed light on the epidemiological and clinical effects of HBV, as well as its impact on the development of hepatocellular carcinoma (HCC). METHODS: A review of the English language literature based on a MEDLINE (PubMed) database was searched. The keywords were cirrhosis, hepatocellular carcinoma, epidemiology, hepatitis delta virus, hepatitis B virus, and co-infection. All references from retrieved papers were reviewed systematically to find additional collection of reports. RESULTS: The study has broadly confirmed the contribution of HDV viremia to liver disease and cirrhosis. However, uncertainty over the mechanism of action on HCC development remains. As the recent data has demonstrated, the HCC-HDV has a unique molecular profile which is distinct from that of HBV-HCC. CONCLUSION: Owing to the dependence of HDV on HBV, it is not clear whether HCC is a consequence of the cumulative effect of both HBV and HDV, an effect of the underlying cirrhosis, or a direct oncogenic effect of HDV. Many questions concerning the oncogenic role of HDV remain unanswered. To better understand the role of HDV in carcinogenesis, studies at the molecular level that consider genotype differences should be increased. Multicenter, high-volume, and prospective studies that compare HBV/HDV co-infected and HBV-infected individuals will be pivotal in determining the oncogenic role of HDV.

Effects of acute and subacute garlic supplement administration on serum total antioxidant capacity and lipid parameters in healthy volunteers.

Garlic has long been used for medicinal purposes. It has been shown that different forms of garlic have significant antioxidant effects. The strong flavor, odor and unwanted gastrointestinal side effects of fresh garlic has rendered the use of commercial garlic supplements as a preferable option. To investigate the effects of garlic supplementation on serum total antioxidant capacity and lipid parameters, 17 healthy volunteers were administered four standardized commercial garlic tablets every day for 30 days. Blood samples were taken at day 1 (before the first administration of tablets [control] and at 3 h after the administration of tablets), 15 and 30 days, respectively. Total antioxidant capacity (TAC), total cholesterol, low density lipoprotein cholesterol (LDL cholesterol), high density lipoprotein cholesterol (HDL cholesterol) and triglyceride (TG) were measured in sera. Serum TAC was increased significantly at 30 days compared with 15 days, 3 h and control. There was also a significant increase in serum TAC at 15 days compared with 3 h and control. Total cholesterol, LDL cholesterol, HDL cholesterol and TG were not found to be significantly different between control, 3 h, 15 and 30 days. These data suggest that garlic, used as a dietary supplementation, may be beneficial in increasing the antioxidant capacity of the body.

Parameters of oxidative stress and echocardiographic indexes in patients on dialysis therapy.

AIM: Quantity of oxidative stress (OS) is enhanced in every stage of chronic renal failure (CRF). OS and its effects on echocardiographic indexes in patients on hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) were evaluated. MATERIALS AND METHODS: Thirty-nine patients on CAPD, 32 patients on HD, and 30 healthy individuals with similar demographic features were included. Patients with diabetes mellitus and chronic inflammatory diseases were excluded. Blood samples were collected to examine hematological and biochemical parameters and levels of malonyldialdehyde (MDA), glutathione peroxidase (GSH-px), and superoxide dismutase (SOD) after a 12-hour fasting period in the middle of dialysis week. OS parameters were compared with ejection fraction (EF), interventricular septum diameter (IVSd), left ventricular posterior wall diameter (LVPWd), and left atrium diameter (LAd) determined in M-mod echocardiographic examination. RESULTS: No significant difference was observed between MDA and GSH-px levels of patients and control group; however, SOD levels of patients group were significantly lower (p<0.0001). SOD levels of patients on HD were lower than that of patients on CAPD (p=0.039). Negative correlation was detected between MDA and EF (r=-0.380, p=0.001); SOD has negative correlation with systolic blood pressure (r=-0.265, p=0.011), diastolic blood pressure (r=-0.230, p=0.028), phosphorus (r=-0.327, p=0.001), intact parathyroid hormone (iPTH) (r=-0.259, p=0.013), C-reactive protein (CRP) (r=-0.235, p=0.024), fibrinogen (r=-0.342, p=0.001), and total cholesterol (r=-0.249, p=0.017); and positive correlation with hemoglobin (r=0.414, p<0.001) and albumin (r=0.367, p<0.001). MDA was independently related with age (beta=-0.258, p=0.035), male gender (beta=-0.312, p=0.004), and EF (beta=-0.461, p<0.001). No correlation was determined between antioxidants and cardiac indexes. CONCLUSION: SOD levels decreased significantly especially in patients on HD, and it was observed that lower levels of SOD would lead to OS in patients on HD and CAPD when compared to healthy individuals; MDA levels were independently influenced from EF.

High dose calcitriol in osteopetrorickets.

Osteopetrorickets is a rare autosomal recessive disorder of osteoclast function characterized by abnormally dense bone and failure of resorption of calcified cartilage. Rickets is a paradoxical complication of osteopetrosis, resulting from the inability of the osteoclasts to maintain a normal calcium-phosphorus balance in the extracellular fluid. We report a patient with an unusual case of infantile osteopetro-rickets who was admitted with anterior fontanel bulging and was treated with haploidentical bone marrow transplantation.

Transfusion-related acute lung injury in a child with neuroblastoma during a late engraftment period of autologous stem cell transplantation.

TRALI is a rare and serious complication of blood product transfusion characterized by acute respiratory distress, non-cardiogenic pulmonary edema, hypoxia, fever, and hypotension developing during or up to six h following transfusion. The disease can be life-threatening and should be considered whenever complications occur after a transfusion in stem cell transplant recipients. Caution should be exercised as the symptoms of TRALI are similar to diseases such as pulmonary hemorrhage, pulmonary edema, and engraftment syndrome. The neutrophil engraftment generally occurs after 14 days following allogeneic stem cell transplants. The diagnosis of TRALI becomes very difficult with late engraftments. Herein, we report TRALI in a pediatric recipient whose neutrophil engraftment occurred on day 67.

Neutrophil hypersegmentation in children receiving angiotensin converting enzyme inhibitors.

Captopril and enalapril are the most commonly used angiotensin converting enzyme inhibitors in several cardiac diseases in children. On the other hand, the intrinsic renin-angiotensin system in the bone marrow might affect the growth of hematopoietic colonies and cellular production, proliferation and differentiation in physiological and pathological states. Starting with the hypothesis that inhibition of the renin-angiotensin system may have some effects on the hematopoietic system, including morphological changes within the granulocytes, we thus aimed to investigate prospectively whether the use of angiotensin converting enzyme inhibitors has any effect on the morphology, and especially segmentation, of neutrophils in peripheral blood. A total of 40 children with various heart diseases receiving either of two angiotensin converting enzyme inhibitors (captopril or enalapril) aged between 2 to 16 years were enrolled, and 40 healthy age- and sex-matched children were enrolled as controls. Complete blood count, peripheral blood smear, liver and renal function tests, and measurement of serum alkaline phosphatase, ferritin, vitamin B12 and folate levels were performed in all cases. Peripheral blood smears were viewed by two pediatric hematologists in a blinded manner. Neutrophil hypersegmentation was described as presence of five or more neutrophils with five well-separated lobes or at least one neutrophil with six or more lobes among 100 segmented neutrophils. The number of patients with neutrophil hypersegmentation in the study group was significantly higher than in the control group, and the mean lobe count in the study group was significantly higher than in the control group. Neutrophil hypersegmentation, as detected in patients using angiotensin converting enzyme inhibitors in the present study, has not been reported previously. Further studies aiming to explain the pathophysiological mechanism(s) underlying neutrophil hypersegmentation in patients receiving angiotensin converting enzyme inhibitors are needed.

Relationship between bone mineral density and biochemical markers of bone turnover in hemodialysis patients.

End-stage renal disease is closely associated with changes in bone and mineral metabolism. In recent times, osteoporosis has become important among hemodialysis (HD) patients. In this study, the investigators sought to evaluate the relationship between bone mineral density (BMD) and biochemical markers of bone turnover among HD patients. A total of 70 uremic patients on a maintenance HD program for at least 1 y were enrolled in the study. All patients were treated with conventional bicarbonated HD for 5 h through the use of low-flux hollow-fiber dialyzers. Bone densitometry was measured by dual energy x-ray absorptiometry in the lumbar spine (LS) and the femoral neck (FN). BMD was classified according to World Health Organization criteria on the basis of BMD T scores. Biochemical bone turnover markers such as calcium, phosphorus, ionized calcium, intact parathyroid hormone, alkaline phosphatase, plasma bicarbonate, blood pH, serum albumin, and hematocrit levels were measured before the HD session in the morning. Male patients (n=37; 52.9%; mean age, 46.2+/-17.0 y) were assigned to a single study group, and female patients (n=33; 47.1%; mean age, 44.0+/-13.1 y) to another. Mean duration of HD treatment was 33.7+/-28.5 mo in females and 33.0+/-26.0 mo in males. Among all patients, BMD T scores in the osteopenia/osteoporosis range were observed at the LS in 58 patients (82.8%) and at the FN in 45 patients (64.3%). According to BMD measurements in FN T score, 10% of patients (n=7) were osteoporotic, 54.3% (n=38), osteopenic, and 35.7% (n=25), normal. On the other hand, in LS T score, the results were 47.1% (n=33) osteoporotic, 35.7% (n=25), osteopenic, and 17.1% (n=12), normal. No statistically significant association was found in osteopenia/osteoporosis between sexes according to FN and LS T score (P=.542, P=.267, respectively). No significant relationship was noted between BMD and biochemical markers of bone turnover. A positive correlation was found between FN T scores of BMD and age (r=.413, P=.000). BMD T scores within the range of scores for osteopenia/osteoporosis were observed in 78.5% of patients at the LS and in 58.5% of patients at the FN. The investigators concluded that no correlation could be found between markers of bone turnover and bone mass measurements in both skeletal regions. LS T score results were worse than FN T score results. Elevated alkaline phosphastase levels combined with high intact parathyroid hormone levels are predictive of renal osteodystrophy but not of adynamic bone disease/osteoporosis.

Effects of iron deficiency versus iron deficiency anemia on brainstem auditory evoked potentials in infancy.

There has been little or no evidence of brainstem auditory evoked potentials (BAEPs) among infants with iron deficiency (ID) that is not severe enough to cause anemia. To our knowledge, the effect of ID on auditory functions and/or potentials has not been investigated previously, though it seems reasonable that it should be associated with BAEP measures intermediate between those observed in iron deficiency anemia (IDA) and in iron sufficiency, considering the role of iron in myelin formation and maintenance. We therefore aimed in this study to investigate the effect of ID on BAEPs by comparing three groups of infants with ID, IDA and iron sufficiency (control) both before and after iron treatment (in iron-deficient groups). Three groups of infants (IDA, n = 25; ID, n = 24; Control, n = 44) were compared on the basis of hematological laboratory parameters and BAEP measurements both at entry into and after (12 weeks treatment with oral iron in IDA and ID groups) the study. BAEP measurements recorded at 85 dB both at entry into and after the study were not significantly different among the groups, although a sufficient response to iron treatment was achieved in iron-deficient groups (Group I and Group II). The only positive finding determined in our study was a slight decrease in latencies obtained at the end of the study when compared to the pre-study values in all three groups of the study in accordance with the expected age-dependent developmental changes. Although no negative electrophysiological effect of ID on brainstem auditory functions was found in the present study, further longer term (late childhood or adult) studies are necessary to elucidate the relationships among anemia (maybe other than IDA), ID and auditory functions, and clinical implications of hearing loss (if any) should be questioned.

Primary angioplasty in acute myocardial infarction at hospitals with no surgery on-site (the PAMI-No SOS study) versus transfer to surgical centers for primary angioplasty.

OBJECTIVES: To investigate primary angioplasty (PA) for high-risk acute myocardial infarction (AMI) at hospitals with no cardiac surgery on-site (No SOS), we hypothesized that a nonrandomized registry of such patients treated with PA would show clinical outcomes similar to those of a group randomized to transfer for PA, and that reperfusion would occur faster. BACKGROUND: Primary angioplasty provides outcomes superior to fibrinolytic therapy in AMI, but its use in community hospitals with No SOS has been limited. METHODS: Fibrinolytic-eligible patients with high-risk AMI prospectively consented if they had one or more high-risk characteristic. Nineteen hospitals with No SOS prospectively enrolled 500 patients for PA on-site. Seventy-one similar Air Primary Angioplasty in Myocardial Infarction trial patients were randomized to transfer for PA. RESULTS: Primary angioplasty was performed in 88% of patients. Patients transferred for PA had a longer mean time to treatment (187 vs. 120 min; p < 0.0001). Thrombolysis In Myocardial Infarction (TIMI) flow grade 3 was achieved in 96% for on-site PA, 86% in the transfer group (p = 0.004). The combined primary end point of 30-day mortality, re-infarction, and disabling stroke occurred in 27 (5%) on-site PA patients and 6 (8.5%) transfer patients (p = 0.27). Unadjusted one-year mortality was improved in on-site PA patients compared with those transferred (6% vs. 13%, p = 0.043), but after adjustment for differences in baseline variables, this difference was not significant. CONCLUSIONS: On-site PA and transfer groups had similar 30-day outcomes and more rapid reperfusion for on-site PA. Primary angioplasty in high-risk AMI patients at hospitals with No SOS is safe, effective, and faster than PA after transfer to a surgical facility.