Patient characteristics in Behçet's Syndrome and their associations with major organ involvement: a single-centre experience of 2118 cases.

Objectives: To evaluate the demographic and clinical characteristics of patients with Behçet's syndrome (BS), and to define their associations with the presence of major organ involvement (MOI).Method: Medical records of 2118 patients (964 males, 1154 females) were analysed retrospectively. MOI was defined as the presence of at least one of vascular, eye, nervous, or gastrointestinal system involvement. Univariable and multivariable binary and ordinal logistic regression analyses were applied to assess the factors that were potentially associated with MOI.Results: The mean ± sd age at diagnosis was 30.5 ± 9.4 years. Genital ulcer and joint involvement were more common in females (both p < 0.001), while MOI was more frequent in males (p < 0.001). Genital ulcer (p < 0.001) and vascular involvement (p = 0.006) were more common in patients with a younger age at diagnosis, while joint involvement was more common in older patients. A total of 1097 patients (51.8%) had at least one MOI, 322 (15.2%) at least two MOIs, and 48 (2.3%) at least three MOIs. Male gender, smoking history, and absence of genital ulcer were significantly associated with MOI in multivariable binary logistic regression. Multivariable ordinal regression analyses confirmed the association between MOI and male gender and smoking, but not the protective effect of genital ulcers. In both regression analyses, we found no significant effects of age, human leucocyte antigen-B51, skin involvement, or joint involvement on MOI.Conclusion: Male gender and positive smoking history have a significant influence on the presence of MOI in patients with BS.

Investigation of temporal illicit drugs, alcohol and tobacco trends in Istanbul city: Wastewater analysis of 14 treatment plants.

Wastewater-based drug monitoring is a complementary tool that has been used worldwide in recent years, and many cities have periodically reported monitoring results. However, this study is the first to analyze drugs in wastewater in a single city with a high population during four periods simultaneously from 14 treatment plants. The aim was to estimate the consumption of conventional illicit drugs [amphetamine (AMP), methamphetamine (METH), 3,4-methylenedioxymethamphetamine (MDMA), cannabis, cocaine, and heroin], tobacco, and alcohol in 2019 for quarterly periods in Istanbul city, which has a population of almost 20 million, to aid in implementing evidence-based measures. Additionally, the seasonal variations among the 14 wastewater treatment plants and their weekday/weekend comparison of drug use patterns and consumption per substance were examined. Solid phase extraction was followed by liquid chromatography-tandem mass spectrometry and a previously validated method was enhanced by adding new parameters (morphine, cotinine, and ethyl sulfate), and satisfactory results were obtained. In this study, alcohol, nicotine, and cannabis had the highest estimated per capita consumption with mean values of 29655.3 mL/1000 inh/day, 5507.6 mg/1000 inh/day and 3607.0 mg/1000 inh/day, respectively. These results were followed by heroin and cocaine consumption with mean values of 557.0 and 200.9 mg/1000 inh/day, respectively, whereas AMP-type stimulants had the lowest values among the targeted substances. METH and cannabis were also highly consumed drugs when compared with the results of other metropolitan cities, whereas heroin consumption was remarkably high owing to Turkey's location on a possible heroin trafficking route. Because Istanbul is the business center of the country and has the potential to attract tourists in all four seasons, meaningful seasonal consumption differences were not observed for all substances.

Antiphospholipid antibodies and non-thrombotic manifestations of systemic lupus erythematosus.

Objectives The aim of this study was to investigate the association between antiphospholipid antibodies and non-thrombotic and non-gestational manifestations of systemic lupus erythematosus. Methods Systemic lupus erythematosus patients with persistently positive antiphospholipid antibodies or lupus anticoagulant were identified and grouped as systemic lupus erythematosus with antiphospholipid syndrome (SLE-APS), systemic lupus erythematosus with positive antiphospholipid antibodies/lupus anticoagulant without antiphospholipid syndrome (SLE-aPL), and systemic lupus erythematosus with negative aPLs (SLE-No aPL). Groups were compared in terms of non-thrombotic systemic lupus erythematosus manifestations and laboratory features retrospectively. Results A total of 150 systemic lupus erythematosus patients, 26 with SLE-APS, 25 with SLE-aPL, and 99 with SLE-No aPL, were identified. Livedo reticularis, neurologic involvement, and thrombocytopenia were more common in antiphospholipid antibody positive systemic lupus erythematosus cases. Malar rash, arthritis, and pleuritis were more common in the SLE-No aPL, SLE-APS, and SLE-aPL groups, respectively. Positivity rates and titers of specific antiphospholipid antibodies did not differ between the SLE-APS and SLE-aPL groups. Conclusions Presence of antiphospholipid syndrome or persistent antiphospholipid antibodies may be related to non-thrombotic and non-gestational systemic lupus erythematosus manifestations. Patients with systemic lupus erythematosus plus antiphospholipid syndrome and persistent antiphospholipid antibodies without antiphospholipid syndrome also differ in terms of systemic lupus erythematosus manifestations.

Anti-inflammatory and anti-oxidative effects of alpha-lipoic acid in experimentally induced acute otitis media.

OBJECTIVES: To investigate the anti-inflammatory, anti-oxidative and tissue protective effects, as well as the potential therapeutic role, of alpha-lipoic acid in experimentally induced acute otitis media. METHODS: Twenty-five guinea pigs were assigned to one of five groups: a control (non-otitis) group, and otitis-induced groups treated with saline, penicillin G, alpha-lipoic acid, or alpha-lipoic acid plus penicillin G. Tissue samples were histologically analysed, and oxidative parameters in tissue samples were measured and compared between groups. RESULTS: The epithelial integrity was better preserved, and histological signs of inflammation and secretory metaplasia were decreased, in all groups compared to the saline treated otitis group. In the alpha-lipoic acid plus penicillin G treated otitis group, epithelial integrity was well preserved and histological findings of inflammation were significantly decreased compared to the saline, penicillin G and alpha-lipoic acid treated otitis groups. The most favourable oxidative parameters were observed in the control group, followed by the alpha-lipoic acid plus penicillin G treated otitis group. CONCLUSION: Alpha-lipoic acid, with its antioxidant, anti-inflammatory and tissue protective properties, may decrease the clinical sequelae and morbidity associated with acute otitis media.

The role of endothelin-1 and endothelin receptor antagonists in allergic rhinitis inflammation: ovalbumin-induced rat model.

OBJECTIVE: Desloratadine is a biologically active metabolite of loratadine which is indicated for the treatment of allergic rhinitis. Bosentan is a dual endothelin receptor antagonist used to treatment of pulmonary artery hypertension (PAH). In this study, we aimed to determine the role of endothelins in allergic rhinitis (AR) and the effects of endothelin receptor antagonists in AR rat models through comparison with desloratadine. METHODS: In total, 20 adult Sprague-Dawley rats were used in this study. An ovalbumin-induced allergic rhinitis model was formed in three study groups except for the control group. Bosentan (100 mg/kg/day) was given to the bosentan-treated group for 7 days and desloratadine (10 mg/kg/day) was administered to the antihistaminic-treated group for 7 days. Nasal symptom scorings and histopathological examinations of the nasal tissues were carried out. Serum IgE levels and ET-1 and TNF-alpha mRNA expression levels were analysed. Between group comparisons for nasal symptoms, histopathological analysis, and molecular analyses were performed with a one-way ANOVA and Duncans multiple comparison tests. Significance was accepted at p smaller than 0.05. RESULTS: Bosentan inhibited nasal symptom more significantly than desloratadine. The IgE level, ET-1 and TNF-alpha mRNA expression levels statistically increased in the allergic rhinitis group when compared to other groups. Conversely, the bosentan-treatment group showed a significant recovery from the same parameters. The deterioration in histopathological parameters reached the highest levels in the allergic rhinitis group. The histopathological findings were close to those of the control group in the bosentan and antihistaminic-treated group. CONCLUSIONS: ET-1 is one of the mediators that impact AR development and ET-1 antagonists can be useful for symptom control and for decreasing allergic inflammation in AR patients.

Factors affecting uptake of influenza vaccination among family physicians.

AIM: The aim of this study was to determine the factors that influenced the decisions of family physicians working in primary care health services to receive influenza vaccines. METHODS: This cross-sectional study was performed between June 2014 and September 2014. Physicians were reached electronically via e-mail. A self-reported questionnaire consisting of 50 items covering potential factors that may have influenced their decision to receive vaccination, including perceived risk, severity of the perceived risk, perceived benefit, perceived barriers, cues to action, attitudes, social influences and personal efficacy, was administered to the study participants. Cronbach's alpha for the questionnaire was determined to be 0.92 in the pilot study. RESULTS: The response rate was 27.5% (n=596). Regularly vaccinated physicians accounted for 27.3% of the responses. The median age was 41.84±7.80, and the median working duration of the group was 17.0±7.8years. The factors that led to increased vaccination compliance (p<0.05) included working duration, age, chronic disease history and living with a person over 65years. Nearly all major domains, i.e., perceived risk, severity of the perceived risk, perceived benefit, perceived barriers, attitudes, social influences and personal efficacy, there were differences between the compliant and noncompliant groups. Multi-regression analyses revealed that risk perception, organizational factors such as time and convenient vaccination increased vaccine compliance. However, the perceived necessity to be vaccinated annually had a negative effect on vaccination behaviour (p<0.05). CONCLUSION: Strategies aimed to increase the flu vaccination ratio among physicians that do not take different factors into account are more likely to be unsuccessful. In the planning and implementation of strategies aiming to increase the vaccination ratio among physicians, it is both necessary and important to take into account behavioural and organizational factors.

The effect of Ramadan fasting and maternal hypoalbuminaemia on neonatal anthropometric parameters and placental weight.

In Islamic religion, daytime fasting during the month called Ramadan is an annual practice. In this study, we aimed to investigate the effect of Ramadan fasting and maternal hypoalbuminaemia on neonatal growth parameters. A prospective case-control study was conducted in Diyarbakir and Istanbul, Turkey. The sample size of fasting group was 168 and that of non-fasting group was 170. Demographic characteristics, obstetrics ultrasonographic findings and laboratory parameters of the participants were recorded. Neonatal anthropometric parameters and placental weight were noted. The mean placental weight was significantly higher in the fasting group (p = 0.037). Also, in the fasting group, pregnant women with hypoalbuminaemia had significantly higher placental weight (p = 0.009). In conclusion, the mean placental weight in the fasting group was significantly higher. Also a significant correlation between placental weight and maternal serum albumin level was observed in the fasting group.

Comparison of second trimester uterine artery pulsatility index between IVF and spontaneous twin pregnancies.

PURPOSE OF INVESTIGATION: The authors aimed to determine and compare the uterine artery pulsatility index (PI) between spontaneous and IVF twins in the second trimester. MATERIALS AND METHODS: All medical records of twin pregnancies, whose fetal screening was done between May 1999 and December 2013, were evaluated retrospectively. All twin pregnancies without detected/suspicious anatomical or genetic fetal anomalies, systemic diseases, biochemical abnormalities, and familial genetic diseases were included in the data analyses. Fetuses with no information on spontaneous or IVF conception and fetuses with undetermined uterine artery impedance of second trimester were excluded from the data analyses. RESULTS: A total of 151 twin pregnancies were evaluated in the analyses. The percentages of spontaneous and IVF twins were 24.5% and 75.5%, respectively. Mean gestational age was 19.95 ± 2.25 weeks in IVF twin group and 20.10 ± 2.19 weeks in spontaneous twin group. The difference of the gestational age between groups was not statistically significant. Mean uterine artery impedance was found as 0.78 ± 0.22 in IVF twins and 0.96 ± 0.31 in spontaneous twins respectively). Mean values were significantly lower in the IVF twins (p = 0.09). CONCLUSION: The uterine artery PI in the second trimester is significantly lower in IVF twins compared to the spontaneous twins.

Uterine artery pulsatility index and diastolic notch laterality according to the placental location.

PURPOSE OF INVESTIGATION: The authors aimed to determine the effect of placental site on uterine artery pulsatility index (PI) values and tendency for laterality of uterine artery diastolic notch in singleton pregnancies. MATERIALS AND METHODS: All medical records of singleton pregnancies whose first trimester screening was done between years of 2004-2014, were evaluated retrospectively. Singleton pregnancies with detected/suspicious anatomical or genetic fetal anomalies, any systemic disease, familial genetic diseases, artificial reproduction techniques or missing data were excluded. Mean left and right uterine artery PI values and diastolic notch laterality ratios according to placental sites were determined and compared. RESULTS: A total of 2,067 singleton pregnancies were included in data analyses. Mean gestational age was 12.57 ± 0.61 weeks. Left and right uterine artery PI was 1.42 ± 0.47 and 1.48 ± 0.56, respectively. Uterine artery notch was present in 18.86%. PI measurements did not show any statistical difference according to placental locations. Uterine artery notch laterality ratios according to common placental sites are as following; in anterior location (n = 190) 67% bilateral, 21% left sided, 12% right sided; in posterior (n = 136) 66% bilateral, 18% left sided, 16% right sided. CONCLUSION: The placental site has no effect on uterine artery PI values and the laterality of uterine artery notch in singletons.

A VARIANT CASE OF 6p24 DELETION SYNDROME (OMIM #612582).

The 6p24 deletion syndrome, a contiguous gene deletion syndrome is characterized by a wide spectrum of clinical presentations. In this case report we present an antenatal case of 6p 24 deletion syndrome variant involving FOXC1 gene. First trimester fetal screening of a 34 year old pregnant female revealed ultrasonographic anomalies and chorionic villus sampling was performed to rule out any chromosomal anomaly. Cytogenetic examination resulted in normal 46,XY karyotype. In the following weeks further anomalies like cleft palate/lip, thick nuchal fold, ventral septal defect and low set ear were detected with ultrasonography. At 20 weeks of gestation, amniocentesis and whole genome array-CGH analysis revealed a 9.6 Mb interstitial deletion in the 6p25.2p24.1 region which has many genes including an important gene, FOXC1 and 119 Kb interstitial deletion at 9q22.31. The pregnancy was terminated. Postmortem morphological examination revealed turricephaly, hypertelorism, depressed nasal bridge, broad nasal tip, left sided cleft lip, low-set small ears, micrognathia, short neck, increased nuchal fold, short broad distal phalanges, broad thumbs, broad halluces and broad toes.

Fetal nuchal skin-fold thickness during the 2nd trimester of pregnancy.

A prospective study was conducted to determine the cut-off values of nuchal skin-fold thickness (NFT) with false-positive rates for each gestational week (GW) for chromosomal abnormalities during the 2nd trimester of pregnancy. A total of 2,313 women with normal singleton pregnancies were included in the study. Cases of multiple gestations, aneuploidy and major congenital malformations were excluded. The distribution of NFT between the 15th and 24th GW and the cut-off values of NFT with false-positive rates for chromosomal abnormalities were determined. A significant positive correlation was noted between NFT and GW. Statistically significant differences were observed in NFT for the each GW. The 95th percentile values of NFT between 15 and 24 weeks' gestation were 4.7, 4.77, 5.0, 5.5, 5.76, 5.9, 6.0, 6.1, 6.5 and 6.8 mm, respectively. In all fetuses, if the cut-off value of NFT was considered as 6 mm, the false-positive rate ranged from 1.8% to 37% in 15-24 weeks' gestation. Evaluation of NFT according to cut-off values determined by population-based percentiles for each GW might be a more appropriate screening method for chromosomal abnormalities than accepting NFT ≥ 6 mm for all fetuses as abnormal, regardless of gestational age.

Comparative study on effects of nebulized and oral salbutamol on a cecal ligation and puncture-induced sepsis model in rats.

AIM: The present study aimed to compare the effects of different routes of salbutamol administration (oral and nebulized) at different doses in a cecal ligation and puncture-induced (CLP-induced) sepsis model of rats. METHODS: Rats were separated into 8 groups: 1) sham, 2) sham+4 mg/kg oral salbutamol, 3) sham+6 min 2 mg/ml nebulized salbutamol, 4) CLP, 5) CLP+2 mg/kg oral salbutamol, 6) CLP+4 mg/kg oral salbutamol, 7) CLP+3 min 2 mg/ml nebulized salbutamol, 8) CLP+6 min 2 mg/ml nebulized salbutamol. Subsequently, sepsis was induced by CLP through 16 h. RESULTS: CLP-induced sepsis increased serum cytokine levels (TNF-α, IL-1ß, and IL-6), increased tissue oxidative stress (8-Isoprosraglandin F2α), decreased antioxidant parameters (SOD, GSH), and increased lung injury by inflammatory cell accumulation. CONCLUSION: This study showed for the first time that oral administration of salbutamol exerted protective effects on CLP-induced sepsis and related lung injury in rats. We conclude that despite the greater side effects of oral salbutamol, it should be considered for administration in oral form due to its systemic effectiveness during septic conditions in emergency settings.

The criterion value of fetal cerebral lateral ventricular atrium width for diagnosis of ventriculomegaly.

AIM: To determine the distribution of cerebral lateral ventricular atrium width (LVAW) as established according to gestational weeks, and calculate the criterion value of LVAW that differentiates normal fetuses from abnormal fetuses. MATERIALS AND METHODS: A total of 832 patients meeting the study's criteria were included in the control group. An additional 43 fetuses with LVAW > ten mm formed the case group. RESULTS: The criterion value ofLVAW was 9.7 mm. It did not change significantly throughout gestation. In the case group, 23 fetuses were terminated for fetal abnormalities, two fetuses died in utero, and 18 infants were born alive. Most of the abnormal development coincided with LVAW values greater than 12 mm. CONCLUSION: The authors suggest 9.7 mm as the criterion value, based on receiver operating characteristic (ROC) curve analysis. When the LVAW is between 9.8 and 12 mm without other fetal abnormalities, it may be regarded as a variation of the normal.

Fetal nasal bone length during the second trimester of pregnancy in a Turkish population.

OBJECTIVE: To determine the distribution of fetal nasal bone length (NBL) according to gestational age during the second trimester of pregnancy in a Turkish population. STUDY DESIGN: Fetal NBL and other routine biometric measurements were evaluated retrospectively in 2327 fetuses between 15 and 24 weeks of gestation. The measurements were obtained via transabdominal ultrasound. The distribution of fetal NBL between 15 and 24 weeks of gestation was established, and percentiles were calculated. Relationships between fetal NBL and other parameters were assessed using regression analysis. RESULTS: Mean (±standard deviation) fetal NBL ranged from 2.95±0.52 at 15 weeks of gestation to 6.26±0.77mm at 24 weeks of gestation. The fifth percentile for fetal NBL was 2.1mm at 15 weeks of gestation and 5.0mm at 24 weeks of gestation. A significant positive correlation was noted between fetal NBL and gestational age (NBL=gestational age×0.37-2.55; R(2)=0.59; p<0.01) and between fetal NBL and biparietal diameter (BPD) (NBL=BPD×0.11-0.33; R(2)=0.61; p<0.01). CONCLUSION: Fetal NBL is less in Turkish subjects compared with non-Turkish subjects.

Practical biometric ratios of first-trimester screening.

PURPOSE: The authors aimed to determine some practical contributive biometry ratios of the first trimester screening in order to note more accurate measurements and recognize abnormal/mistaken measurements. MATERIALS AND METHODS: All medical records of singleton pregnancies whose first-trimester screening that was performed between the years of 2004-2010, were evaluated retrospectively. Singleton pregnancies with detected/suspicious anatomical or genetic fetal anomalies, any systemic disease, and familial genetic diseases were excluded. The following ratios were calculated and compared: measurements of biparietal diameter [BPD], head circumference [HC], abdominal circumference [AC], femur length [FL], and crown rump length [CRL] of included fetuses, to each other were calculated. Mean and standard deviations of the ratios were determined for each gestational weeks of 11(0-6), 12(0-6), and 13(0-6). RESULTS: A total of 1,615 singleton pregnancies were included in the data analyses according to exclusion and inclusion criteria. Mean maternal age was 29.5 +/- 4.6 years. Mean gestational age of the fetuses was 12.6 +/- 0.6 weeks. Mean and standard deviation of the ratios were as follows; CRL/BPD: 3.0 +/- 0.2; AC/BPD: 3.0 +/- 0.2; CRL/AC: 1.0 +/- 0.1; CRL/HC: 0.8 +/- 0.1; CRL/FL: 8.8 +/- 1.6; BPD/FL: 2.9 +/- 0.6; AC/FL: 8.9 +/- 1.6; HC/FL: 11.1 +/- 2.2, and HC/AC: 1.3 +/- 0.1. Among these ratios the standard deviation was small in the ratios of CRL/BPD, AC/BPD, CRL/AC, CRL/HC, and HC/AC. The equations of these ratios were derived from linear regression analyses. The AC/BPD, and CRL/AC ratios had lower R2 values than others, indicating a rather constant ratio. CONCLUSIONS: The ratios of CRL/BPD, AC/BPD, and CRL/AC seem more practical to be used in the first-trimester fetal ultrasonography practice.

Effects of diabetes on cytokines and oxidative organ injury in a rat model of sepsis.

We aimed to investigate how Diabetes Mellitus (DM) affects myeloperoxidase activity, antioxidant status, and lipid peroxidation using biochemical approaches in heart, liver, and lung and serum cytokine analyses, such as interleukin-6 (IL-6) and tumor necrosis factor α (TNF-α) in rat with sepsis induced by a cecal ligation and puncture-induced (CLP) sepsis. The rats were divided into four groups: control group, diabetic group, sepsis group, and diabetic+sepsis group. DM was induced in the male Wistar albino rats by administration of alloxan. Polymicrobial sepsis was induced by cecal ligation and two-hole puncture. After alloxan administration, all groups of rats were allowed to recover for 1 month. CLP model was applied after 1 month recovery to group 3 and 4. IL-6 and TNF-α, were measured. Effects of antioxidant defenses on the DM and/or sepsis process, the antioxidant levels superoxide dismutase (SOD), catalase (CAT), glutathione (GSH) were evaluated in heart, lung and liver tissues. The oxidant levels, such as lipid peroxidation (LPO) and myeloperoxidase (MPO) levels were also evaluated in tissues. We demonstrated DM to augment the level of oxidant and proinflammatory cytokines in lung, liver, and heart and also to exacerbate oxidative injury as assessed by increased LPO and MPO, and decreased GSH and SOD levels in a sepsis model. DM increased levels of proinflammatory cytokines while DM also resulted in significantly increased levels of proinflammatory cytokines following CLP. DM-increased plasma proinflammatory cytokines levels correlated positively with tissue oxidant levels, such as MPO and LPO levels in a rat abdominal sepsis model, based on CLP, which resulted in the exacerbation of oxidative organs injury.

The golden ratio of nasal width to nasal bone length.

PURPOSE: To calculate the ratio of fetal nasal width over nasal bone length at 14-39 weeks' gestation in Caucasian women. METHODS: Fetal nasal bone length and nasal width at 14-39 weeks' gestation were measured in 532 normal fetuses. The mean and standard deviations of fetal nasal bone length, nasal width and their ratio to one another were calculated in normal fetuses according to the gestational age to establish normal values. RESULTS: A positive and linear correlation was detected between the nasal bone length and the gestational week, as between the nasal width and the gestational week. No linear growth pattern was found between the gestational week and the ratio of nasal width to nasal bone length, nearly equal to phi, throughout gestation. CONCLUSION: The ratio of nasal width to nasal bone length, approximately equal to phi, can be calculated at 14-38 weeks' gestation. This might be useful in evaluating fetal abnormalities.

Fetuses with single umbilical artery: analysis of 45 cases.

OBJECTIVE: The aim of this study was to analyze cases and determine the clinical significance of a prenatally detected single umbilical artery (SUA) in our population. MATERIALS AND METHODS: All second and third trimester sonographic examinations carried out between January 2004 and September 2007 in our perinatology unit were reviewed. The postnatal results of the fetuses with SUA were obtained from the medical records and the patients. RESULTS: From a total of 5,620 pregnant patients who were examined by ultrasound (US) scan between 15-36 weeks, a single umbilical artery was found in 45 cases, representing an incidence of 0.8%. Of these, 20 (45%) also presented with other malformations. There were six neonatal deaths, one fetal demise, and six terminations of pregnancy due to severe malformations in this group. Three cases with associated anomalies underwent surgery and one case required intensive care in the neonatal period. The only cytogenetic abnormality was trisomy 18 in one case. Six of 45 fetuses (13%) with single umbilical arteries had abnormal echocardiographic findings. In two of the fetuses associated anomalies (cleft palate and esophageal atresia) were detected after birth. In pregnancies without associated anomalies no aneuploidy was found and they were completely normal at birth and during the neonatal period. CONCLUSIONS: Scanning the umbilical cord is one of the essential parts of US examination. As the rate of cardiac malformations seen with single umbilical arteries is high, fetal echocardiography should be performed in suspected cases. The newborn should be reexamined immediately after birth due to the possibility of undetected anomalies.

The effect of parity on midgestational uterine artery Doppler findings in uncomplicated and low-risk pregnancies.

BACKGROUND: To establish the effect of parity on uteroplacental Doppler findings during midgestation in uncomplicated and low-risk pregnancies. METHODS: Color flow pulse Doppler imaging of uterine arteries was performed on 760 uncomplicated singleton pregnancies fulfilling the study criteria at 19-24 weeks of gestation. Pulsatility indices (PIs) and bilateral notching were compared in nulliparous and parous pregnant women during various gestational weeks. The effects of maternal age, gestational age and parity on abnormal Doppler findings were assessed. RESULTS: We found a significant difference in the prevalence of bilateral diastolic notch between nulliparous and parous women. From 19 to 24 weeks of gestation, a significant decrease in the PI values was observed (p < 0.001). The decrease in the PI values was significant in nulliparous, in contrast to parous women (p < 0.001). Parity had no effect on the mean PI, but parity was found to decrease the risk of bilateral notching (p < 0.05, R(2) = 0.031). CONCLUSION: The mean indices are similar when the first and subsequent pregnancies are compared, especially after the 21st gestational week. Notching is more prominent in the first pregnancy. Parity has an effect on PIs in earlier weeks, and this effect is more pronounced in the appearance of bilateral notches.

Arthrogryposis multiplex congenita: analysis of twelve cases.

OBJECTIVE: The term arthrogryposis multiplex congenita (AMC) refers to multiple joint contractures present at birth. AMC is not a specific disorder but is the consequence of neurological, muscular, connective tissue, and skeletal abnormalities or intrauterine crowding, which may lead to limitation of fetal joint mobility and the development of contractures. METHODS: Cases referred to our perinatology department for detailed examination were retrospectively analyzed. RESULTS: Twelve cases with AMC were detected during the antenatal period. The ultrasound features related to the "lack of movement" included limb abnormalities (multiple contractures, clenched hands, and clubbed feet), short umbilical cord, polyhydramnios, pulmonary hypoplasia, camptodactyly, and micrognathia. Five of the early detected cases (71%) were found to have increased nuchal translucency or nuchal fold. All of the cases at the third trimester resulted in neonatal death. CONCLUSION: First trimester screening may be useful for early diagnosis of AMC. Sonographic findings in late pregnancy might be helpful in predicting the prognosis. Due to the high recurrence risk, a specific screening program should be performed for the following pregnancies by examination of the fetus several times for movement and position of the limbs.