Antiphospholipid antibodies in the obstetric antiphospholipid syndrome: Detection and antibodies profile at the Maternity and Neonatal Medicine Center of Monastir, Tunisia.

PURPOSE: This study aimed to implement lupus anticoagulant (LAC) detection techniques according to the International Society on Thrombosis and Hemostasis (ISTH) recommendations, in the Biological Laboratory of the Maternity and Neonatal Medicine Center (Monastir, Tunisia) and to evaluate the profile and the prevalence of antiphospholipid antibodies (aPL) in the obstetric antiphospholipid syndrome (OAPS). METHODS: We collected two groups: a "case group" (53 women who presented one or more obstetrical criteria of APS) and a "control group." LAC was detected following the four steps recommended by ISTH 2009. Anticardiolipin (aCL) and antibeta-2-glycoprotein I (aß2GPI) antibodies testing were performed by enzyme-linked immunosorbent assay (ELISA). RESULTS: aPL were found in five patients: three patients with isolated LAC, one patient with isolated IgG aCL, and one patient with triple positivity (LAC, aCL IgM, aß2GPI IgM). Concerning LAC, 13 (24.52%) of 53 patients had a screening step with at least one positive test. The mixing step was positive in four patients and then confirmed in the confirmatory test. Thus, the prevalence of LAC in our study group is 7.54%. Surprisingly, among these positive patients, one patient had an associated combined factor V (FV) and factor VIII (FVIII) deficiency. CONCLUSION: There is no single test and no algorithm that can detect all types of LAC. It seems that the recent 2020 ISTH algorithm allows a better detection of low activity LAC than the 2009 algorithm. In our study, the most frequently identified antiphospholipid antibodies were LAC more than aCL and aß2GPI.

A Novel Ultrasound Technique Called Saline Infusion SonoPODography to Visualize and Understand the Pouch of Douglas and Posterior Compartment Contents: A Feasibility Study.

Women with infertility are often investigated with saline-infusion sonohysterography and hysterosalpingo-contrast-sonography. The high prevalence of endometriosis in this population also warrants an evaluation with transvaginal ultrasound for deep endometriosis. To minimize investigations, we prospectively evaluated the feasibility of a novel combined ultrasound technique called saline-infusion sonoPODography. In most patients, the fluid infused to assess the cavity and tubal patency spilled through patent tubes and filled the pouch of Douglas, yielding a "standoff" view of posterior compartment structures, including uterosacral ligaments, rectovaginal septum, and the pouch of Douglas. We believe this improved our ability to evaluate this space.

Intraperitoneal Bupivacaine-Meperidine Infiltration Versus Intravenous Paracetamol: A Comparison of Analgesic Efficacy in Post-Gynecologic Diagnostic Laparoscopic Pain.

BACKGROUND: Pain following laparoscopy could be due to different causes requiring effective postoperative analgesia. OBJECTIVES: In the present study, we evaluated the combined effect of intraperitoneal infiltration of bupivacaine-meperidine versus intravenous infusion of paracetamol on pain relief after diagnostic gynecologic laparoscopy. PATIENTS AND METHODS: In this prospective study, 90 female subjects with ASA class I or II scheduled for gynecologic diagnostic laparoscopy were studied in two groups; group B + M received intraperitoneal infiltration of 40 mL bupivacaine 0.25% with 50 mg of meperidine, group P received normal saline via abdominal trocar and ten minutes before the end of operation, group P received infusion of paracetamol 1000 mg in normal saline. Postoperative pain was evaluated using VAS score in PACU and 1, 2, 4, 8, 12 and 24 hours after the operation. The time to the first analgesic administration and total analgesic requirements were recorded. RESULTS: Group B + M had significantly lower pain score in the first 8 postoperative hours than group P (P < 0.05). Rescue meperidine (IM) requirement was significantly less in B + M group compared to group P. Time to first request for analgesia was different between the two groups (78 versus 60 min); however, the difference was not statistically significant. CONCLUSIONS: Intraperitoneal Infiltration of bupivacaine with meperidine following surgery provided more appropriate analgesia after gynecologic diagnostic laparoscopy than administration of IV paracetamol.

Qual é o valor da ultrassonografia 3D em ginecologia / What is the value of 3D ultrasound in gynecology

A ultrassonografia (US) 3D tem sido cada vez mais utilizada, nas diversas áreas da Ginecologia, por oferecer de forma mais objetiva e reprodutível as medidas do volume e vascularização da região de interesse, melhor avaliação da normalidade ou patologia dos órgãos estudados, reduzir o tempo de varredura e permitir o armazenamento de imagens para reavaliação posterior. Para a realização deste estudo, efetuou-se uma pesquisa no banco de dados PubMed/Medline compreendendo os estudos publicados entre os anos de 1966 a 2010. Os resultados da pesquisa mostram que, embora a US 3D tenha uma utilização crescente em ginecologia, são necessários mais estudos prospectivos de maior consistência para validar a técnica.

Three-dimensional ultrasound (US 3D) has been increasingly used in various gynecologic areas. It offers more objective and reproducible measurements of volume and vascularization in the region of interest, better evaluating the normality or pathology aspects of the organs, reducing scanning time and allowing storage of images for later review. We searched the PubMed/Medline database including in this review the studies published between the years of 1966 to 2010. The results show that although the US 3D has an increasing application in gynecology, we need more prospective studies of greater consistency to validate this technique.