Effects of different PCOS phenotypes on placental three-dimensional power Doppler indices and placental volume during the first trimester.

INTRODUCTION: The aim of the present study was to evaluate the effects of different polycystic ovary syndrome (PCOS) phenotypes using first-trimester placental three-dimensional power Doppler indices and placental volume. METHODS: In this prospective case-control study, 170 pregnant women who met the inclusion criteria were divided into five groups according to PCOS phenotype: non-PCOS control (n = 34), PCOS phenotype A (n = 34), PCOS phenotype B (n = 34), PCOS phenotype C (n = 34), and PCOS phenotype D (n = 34). The primary outcomes determined in the present study were the differences in placental volume and placental flow index (FI), vascularization flow index (VFI), vascularization index (VI), and uterine artery pulsatility index (PI) betweenthe PCOS groups and control group. RESULTS: The mean placental volume and VI were significantly decreased in the phenotype A, B, and C groups compared to the control group and PCOS phenotype D group. The mean FI and VFI were significantly decreased in the phenotype A and B groups compared to the control group and PCOS phenotype C and D groups. The mean testosterone, dehydroepiandrostenedione, sex-hormone binding globulin, free androgen index, and insulin resistance levels were significantly increased in the phenotype A, B, and C groups compared to the control group and PCOS phenotype D group. DISCUSION: The results indicated that placental volume and placental vascular Doppler indices in the first trimester were more adversely affected in the PCOS A and B phenotypes than other PCOS phenotypes.

Case stories and Post-violence behavior of women seeking medical attention at the emergency department due to physical violence.

SUBJECT: The objective of this study is to determine the violence experienced by women who presented to the Emergency Department (ED) due to Intimate Partner Violence (IPV) and their previous experiences of violence. METHOD: The descriptive study was conducted with 96 women. The data was analyzed in SPSS 17.0 statistics package program. FINDINGS: The average age of the women is X = 35.33 ± 11.72, 35.4% of them are in the 31-40 age group, 69.6% are married, 44.8% are high school graduates, 60.4% are unemployed. It was determined that women who were IPV victims were exposed to violence by being beaten (punching, kicking etc.) at the highest rate (82.3%), and nearly half of them (47.9%) were injured in the head and neck regions. The vast majority of women (86.5%) have been subjected to violence before, only %13.5 of them stated that they experienced violence for the first time. It was found that the majority of women (69.8%) continued to live with the perpetrator after violence. Only three of the women (3.4%) attempted to initiate legal action, and the majority (76.5%) did not intend to take legal action. CONCLUSIONS: Healthcare professionals should be aware that most woman presenting to the ED with IPV has a history of violence before it, and that this will probably not be the last. Healthcare professionals should also consider the fact that the victims may be exposed to different types of violence at the same time. It is also recommended that healthcare professionals be trained on policies regarding IPV management and equipped to provide women with the right way out.

Virulence Attributes and Antifungal Susceptibility Profile of Opportunistic Fungi Isolated from Ophthalmic Infections.

Investigations of both virulence factors and antifungal susceptibility profiles are crucial for understanding the pathogenesis and prognosis of ophthalmic mycoses. In this study, we investigated the in vitro antifungal susceptibility of amphotericin B (AMB), voriconazole (VRC), and natamycin (NAT) against a set of 50 fungal isolates obtained from patients with ocular mycoses using the Clinical and Laboratory Standards Institute broth microdilution method. In addition, putative virulence factor, such as secretory phospholipases and proteinases, and biofilm formation activity were analyzed. The geometric means (GMs) of the minimum inhibitory concentrations (MICs) of the antifungals across all isolates were the following (in increasing order): VRC (0.70 µg/mL), AMB (0.81 µg/mL), and NAT (1.05 µg/mL). The highest activity against 14 Aspergillus strains was exhibited by VRC (GM MIC: 0.10 µg/mL), followed by AMB and NAT (GM MICs: 0.21 and 0.27 µg/mL), respectively. However, for 12 Fusarium spp., the GM MIC of VRC (2.66) was higher than those of NAT and AMB (GM MICs 1.3 and 0.8 µg/mL, respectively). Proteinase and phospholipase activity were observed in 30 % and 42 % of the isolates, respectively, whereas only 8 % of the isolates were able to produce biofilms. Phospholipase activity was observed in all Fusarium isolates, but not in any of the Aspergillus isolates. In contrast, biofilm-forming capability was detected in 25 % of the Fusarium isolates, but none of the Aspergillus isolates. The differences in the MICs of AMB, VRC, and NAT, biofilm-forming ability and proteinase and phospholipase activities among the isolates were not significant (p > 0.05). Overall, our study suggests no significant correlation between the antifungal susceptibility profiles and virulence attributes of ocular fungal isolates.

Infrequent Production of Xanthomegnin by Fungal Strains Recovered from Patients with Ocular Mycoses.

Mycotoxins are putative virulence factors of fungi that play an important role in the pathogenesis of fungal infections. Mycotoxin production has been used as a diagnostic marker for the early diagnosis of fungal diseases. Using high-performance liquid chromatography, we investigated whether the fungal strains recovered from eye tissue samples obtained from patients with ocular mycoses produced the mycotoxin xanthomegnin. We tested 62 well-characterized strains of fungi, including Aspergillus spp. (n = 14), Exophiala spp. (n = 9), Fusarium spp. (n = 15), and several molds (n = 24). All isolates were identified to the species level using PCR and DNA sequencing of rRNA genes. We detected xanthomegnin activity (0.02 µg/ml) in one of the three Aspergillus flavus strains. However, we were unable to detect xanthomegnin in any of the other 61 fungal strains. Our result suggests that xanthomegnin production was infrequent in fungal strains recovered from patients with ocular mycoses.

Time-Kill Kinetics and In Vitro Antifungal Susceptibility of Non-fumigatus Aspergillus Species Isolated from Patients with Ocular Mycoses.

Aspergillus species can cause ocular morbidity and blindness, and thus, appropriate antifungal therapy is needed. We investigated the in vitro activity of itraconazole, voriconazole, posaconazole, caspofungin, anidulafungin, and amphotericin B against 14 Aspergillus isolates obtained from patients with ocular mycoses, using the CLSI reference broth microdilution methodology. In addition, time-kill assays were performed, exposing each isolate separately to 1-, 4-, and 16-fold concentrations above the minimum inhibitory concentration (MIC) of each antifungal agent. A sigmoid maximum-effect (E max) model was used to fit the time-kill curve data. The drug effect was further evaluated by measuring an increase/decrease in the killing rate of the tested isolates. The MICs of amphotericin B, itraconazole, voriconazole, and posaconazole were 0.5-1.0, 1.0, 0.5-1.0, and 0.25 µg/ml for A. brasiliensis, A. niger, and A. tubingensis isolates, respectively, and 2.0-4.0, 0.5, 1.0 for A. flavus, and 0.12-0.25 µg/ml for A. nomius isolates, respectively. A. calidoustus had the highest MIC range for the azoles (4.0-16.0 µg/ml) among all isolates tested. The minimum effective concentrations of caspofungin and anidulafungin were ≤0.03-0.5 µg/ml and ≤0.03 µg/ml for all isolates, respectively. Posaconazole demonstrated maximal killing rates (E(max) = 0.63 h(-1), r(2) = 0.71) against 14 ocular Aspergillus isolates, followed by amphotericin B (E(max) = 0.39 h(-1), r(2) = 0.87), voriconazole (E(max) = 0.35 h(-1), r(2) = 0.098), and itraconazole (E(max) = 0.01 h(-1), r(2) = 0.98). Overall, the antifungal susceptibility of the non-fumigatus Aspergillus isolates tested was species and antifungal agent dependent. Analysis of the kinetic growth assays, along with consideration of the killing rates, revealed that posaconazole was the most effective antifungal against all of the isolates.

Antifungal susceptibility of ocular fungal pathogens recovered from around the world against itraconazole, voriconazole, amphotericin B, and caspofungin.

Although fungal infections of the eye are rare, they create an intractable clinical problem in ophthalmology because of the limited number of intravitreal and systemic therapeutic options. In this investigation, the in vitro efficacies of itraconazole (ITR), voriconazole (VOR), amphotericin B (AMB), and caspofungin (CAS) against 29 globally-collected ocular fungal isolates were assessed, following the standards that are outlined in the Clinical and Laboratory Standards Institute (CLSI) M38-A2 document. AMB [Geometric Mean (GM) MIC (Minimum Inhibitory Concentration): 0.49 µg/ml] was the most active drug, followed by VOR, CAS, and ITR (GM MICs: 0.52, 1.07, and 2.86 µg/ml, respectively). For the Exophiala strains (n = 8), VOR was the most active drug, followed by AMB, ITR, and CAS (GM MICS: 0.21, 0.27, and 1.09 µg/ml, respectively). ITR had no activity against Fusarium spp. (n = 9; GM MIC: 32 µg/ml), but AMB was found to be the most effective antifungal against the tested members of this genus, followed by CAS and VOR (GM MICs: 0.86, 1.59, and 2.72 µg/ml, respectively). These data should be used to design future targeted clinical efficacy trials. We also report on several fungal species that are rarely encountered in the clinical laboratory, for which little information about drug sensitivities was previously available.

A long-term follow-up study of different irrigation/aspiration techniques on formation of posterior capsule opacification.

BACKGROUND: This study was designed to determine the effect of 2 different irrigation/aspiration techniques on the formation of posterior capsule opacification (PCO) after cataract surgery in which CeeON Edge 911A (Pharmacia, Sweden) sharp-edged silicone lenses were implanted. METHODS: In this prospective study, 60 eyes from 39 patients, average age 65 (range: 46-85) years, were analyzed. Lens extraction was performed by phacoemulsification, and CeeON Edge 911A intraocular lenses were implanted. Two different irrigation/aspiration techniques were used in which the cortex of 32 eyes was removed by coaxial irrigation/aspiration (this group was designated group I) and the cortex of 28 eyes was removed by bimanual irrigation/aspiration (this group was designated group II). Secondary cataract formation and visual acuity were evaluated and compared in both groups. RESULTS: The average follow-up time was 44 (SD 11) months. In group I, secondary cataract formation causing 2 lines of decrease on visual acuity was observed in 1 eye 8 months after the operation. The secondary cataract developed in the form of cortex migration. This patient was treated with laser (Neodymium: Yttrium Aluminum Garnet [Carl Zeiss Meditech, Germany]) capsulotomy at the time of detection. Best corrected visual acuity for all eyes was 0.5 and higher; postoperative refractive error ranged between +1.0 and -2.0 diopters. INTERPRETATION: Although CeeON Edge 911A silicone lenses with sharp edge prevent formation of PCO very effectively, in 1 eye in the coaxial irrigation/aspiration group, 2 lines of decrease on visual acuity were observed due to PCO. However, we did not find any significant difference between the 2 irrigation/aspiration techniques with respect to PCO formation. In terms of complete removal of the cortical material, the bimanual irrigation/aspiration technique was found to be superior to the coaxial irrigation/aspiration technique because of the better accessibility to all areas of the capsular bag.