A postpartum arteriovenous malformation case diagnosed with late postpartum bleeding.

Postpartum hemorrhage is the most important and also preventable cause of maternal morbidity and mortality worldwide. Arteriovenous malformation (AVM) is a rare cause of postpartum hemorrhage. We present a case of arteriovenous malformation, which may be one of the rare but potentially fatal causes of postpartum hemorrhage (PPH). In the case report, on the postpartum 52nd day, the patient presented to the emergency department with a complaint of vaginal bleeding. Doppler ultrasonography revealed a lesion compatible with the vascular structure, the largest diameter of 28 * 28 mm, in the uterus. The patient was found not eligible for embolization, and a hysterectomy was then indicated. After the hysterectomy, the pathology diagnosis supported the initial clinical and radiological suspicions of AVM. Hysterectomy is the definitive treatment method of AVM and should be considered in patients who are not eligible for embolization. This case is presented to draw the attention of physicians to AVM as a possible cause of secondary PPH.

Neutrophil-to-lymphocyte ratios in pregnant women with familial mediterranean fever.

OBJECTIVE: To investigate the association between maternal serum neutrophil-to-lymphocyte ratios (NLRs) and pregnancy outcomes in women with familial mediterranean fever (FMF). BACKGROUND: FMF exists worldwide, it primarily affects Mediterranean countries METHODS: We retrospectively analysed data from 269 pregnant women, who underwent a routine prenatal follow-up and delivery in our hospital from 2016 to 2020. Clinical and demographic data, including age, gravida, parity, abortus, proteinuria in the first trimester, NLR, obstetrical complications, gestational age at delivery, birthweight were retrieved from the patients' medical records. Data from 67 pregnant women with FMF and 202 healthy pregnant women were compared. RESULTS: Patients with FMF showed higher rates of preeclampsia and primary caesarean delivery; however, there were no differences between the groups in terms of other obstetric complications or adverse neonatal outcomes. In both the FMF and control groups, NLRs in the third trimester were significantly higher than those in the first trimester. Additionally, patients in the FMF group demonstrated higher NLRs than patients in the control group in the third trimester. CONCLUSIONS: The NLRs are a haematological parameter that can be used to predict subclinical inflammation and the effects of ongoing subclinical inflammation on the pregnancy outcomes in women with FMF (Tab. 4, Ref. 39).

ARE THE FACTORS AFFECTING ADVERSE PREGNANCY OUTCOMES DIFFERENT IN OBESE GESTATIONAL DIABETES PREGNANT WOMEN RECEIVING DIET OR INSULIN TREATMENT?

CONTEXT: We aimed to examine the factors affecting adverse gestational outcome in gestational diabetes (GDM) patients, who were grouped as obese and normal- weight, having only-diet, or insulin treatments. SUBJECTS AND METHODS: The study included 373 patients, treated with diet or insulin. These patients were sub-grouped as obese and non-obese, and examined retrospectively. The variables affecting adverse gestational outcome in obese GDM patients having dietary and/ or insulin treatments were detected with multiple regression analysis. RESULTS: The weight gained during pregnancy in the GDM group having insulin treatment was more than the one in only-diet treated GDM group (p=0.004). Pre-pregnancy body mass index, the weight gained during pregnancy, hemoglobin A1C levels in the second and third trimesters, caesarian rates were higher in the insulin-treated obese patients than in the other groups (p<0.001). The odds ratio for fasting blood glucose level in insulin-treated obese GDM group was 1.081 (95% CI =1.004 - 1.163) (p=0.039); and it was 0.982 (95% CI =0.924 - 1.002) (p=0.048) for the weight gained during pregnancy, in only-diet treated obese GDM patients. CONCLUSION: The control of weight gained during pregnancy, and of fasting blood glucose levels in obese patients having GDM, is important to decrease adverse gestational outcome.

Breathing-enhanced upper extremity exercises for patients with multiple sclerosis.

OBJECTIVE: To explore the effectiveness of breathing-enhanced upper extremity exercises on the respiratory function of patients with multiple sclerosis. DESIGN: Randomized controlled study of six-week duration. SUBJECTS: Forty patients with multiple sclerosis (age 39.2 +/- 7 years; Kurtzke Expanded Disability Status Scale scores: 4.51 +/- 1.55) randomly divided into two groups. METHODS: The training group followed a six-week home training programme designed to strengthen accessory respiratory muscles. Controls performed no exercises. All subjects submitted to baseline and post-training tests of spirometry, respiratory muscle strength and 6-minute walking. They were also assessed with pulmonary dysfunction and exertion fatigue indices. RESULTS: Spirometry revealed clear improvement in forced expiratory volume in 1 second (FEV1) (+13%, P = 0.003) resulting in higher FEV1/FVC (forced vital capacity) (+8.5%, P = 0.03). Maximal inspiratory pressure (P (Imax)) increased by +7.1% but not significantly. Maximal expiratory pressure (P(Emax)) and FVC were significantly higher (by +7.1%, P = 0.0066 and +4.8%, P = 0.036 respectively) with respect to baseline measures. Pulmonary dysfunction was reduced (-9%, P = 0.002) while 6-minute walking distance was longer (+16%, P = 0.029) at equal exertion fatigue level. CONCLUSIONS: The programme improved most pulmonary performance measures and had clinical significance. Its sustained application may prevent respiratory complications frequently observed in the later stages of multiple sclerosis.

Effects of home exercises on motor performance in patients with Parkinson's disease.

OBJECTIVE: To investigate the effect of home exercises on the motor performance of patients with Parkinson's disease. DESIGN: A prospective blinded study with allocation of patients into their groups by alternate weeks. SETTING: A University Hospital neurology and physiotherapy department. SUBJECTS: Recruited from a movement disorders outpatient clinic of Cerrahpasa School of Medicine diagnosed with Parkinson's disease, classified as Hoehn and Yahr Grades I, II and III. INTERVENTIONS: Patients who fulfilled the inclusion criteria were recruited to the study. Each patient was evaluated at the end of first and second month after the baseline evaluation. Patients were divided into two groups. Those in the first and third week were put in the exercise group and second and fourth week in the control group. Patients in the exercise group (n = 15) were given a schedule of exercises to undertake at home; the others (n = 15) did not receive this instruction. MEASURES: Ten- and 20-m walking test, first pace length, pace number in 10 m, walking around a chair, Nine Hole Peg Board (NHPB) test. RESULTS: Following the home exercise programme, patients in the exercise group showed improvement in walking 10 and 20 m, time elapsed to complete walking around a chair and length of the first pace length, and in the motor performance of both hands (p < 0.001). CONCLUSIONS: A home-based rehabilitation programme for patients with Parkinson's disease helped to improve motor performance compared to patients who did not take advantage of a regular, professionally designed exercise programme.