Background and Objectives: Although frequent and associated with high mortality and morbidity rate, congenital heart disease (CHD) has a suboptimal prenatal detection rate, with significant variation according to the scanning protocol. The aim of this study was to evaluate the role of the 3-vessels and trachea view (3VT) in detecting CHD, with or without the use of Color Doppler, with an emphasis on major CHD. Materials and Methods: We performed a retrospective study on 1596 unselected pregnant patients presenting at 11–37 weeks of gestation for a routine anomaly scan. We selected all CHD cases, and we analyzed the performance of the 4-chamber (4C) and 3VT view in detecting CHD. Results: A total of 46 fetuses with CHD were identified, yielding a 2.86% overall incidence, and 0.87% for major CHD. Grayscale 4C detected 47.8% of all CHD, going up to 71.7% by adding grayscale 3VT, with no major CHD remaining undetected by combining grayscale 4C and 3VT. Conclusions: Grayscale 4C and 3VT views are effective in detecting major CHD, thus proving their utility even in a low resource setting.
A common problem in gynecological practice is the differential diagnosis of the ovarian masses. The clinician must apply the IOTA (International Ovarian Tumor Analysis) ADNEX (Assessment of Different Neoplasia in the Adnexa) model criteria to evaluate the risk of benign, borderline or malignant tumors. The aim of this study was to verify if the IOTA ADNEX model is a practical tool to be used before surgery and if there is a significant difference between IOTA ADNEX criteria and histological findings. A prospective single center study was performed between January 2017 and December 2019 in Obstetrics and Gynecology Hospital “Cuza-Voda”, Iasi, Romania. The study included 230 patients between 17 and 74 years old diagnosed with persistent adnexal masses. We applied the IOTA ADNEX model protocol predicting the risk of benign, borderline or malignant masses. The golden standard remains the histological diagnosis of the surgically removed mass. The patients that had been diagnosed using ultrasonography with persistent adnexal masses between 30 and 291 mm were operated on in our clinic. In our study. the majority of patients had benign ovarian tumor mass, these being 223 (96.96%) patients, from whom, according to IOTA ADNEX protocol, the correspondence was: 91.8–99.7% at risk of benign tumors, 0.3–4.5% at risk of borderline tumors and 0.3–8.2% at risk of malignant masses. Unexpected findings were obtained from the malignant group that included five patients (2.17%) with the following correspondence: 96.1–99% at risk of benign tumors, 0.6–2.4% at risk of borderline tumors and 1–3.9% at risk of malignant masses. After applying the IOTA ADNEX model criteria, the patients with a suspicion of malignant disease were correctly guided towards surgical treatment in an oncological center. In our hospital, surgical treatment was only proposed to those patients with high suspicion of benign masses.
Chorioamnionitis or intra-amniotic infection is an infection that affects the intrauterine content during pregnancy. Numerous studies have reported vaginal colonization with various types of infectious agents as a risk factor for chorioamnionitis. Although this complication occurs due to the ascending polymicrobial bacterial infection at the time of membrane breakage, it may also occur in pregnant women with intact membranes, mainly due to Ureaplasma urealyticum (U. urealyticum) and Mycoplasma hominis (M. hominis). The main aim of the present study was to identify a region-specific panel of infectious agents that can be used more accurately determine premature birth, as well as the premature rupture of membranes (PROM). Thus, a 10-year retrospective study was conducted. A total of 1,301 pregnant women with PROM and premature birth or spontaneous abortion were included in the study. It was observed that the main infectious agent varied in the five groups analyzed in total. The infectious agent distribution also varied depending on environmental parameters. Ureaplasma was found to be the most frequently detected germ amongst the infectious agents of the vaginal cultures from pregnant women enrolled in the present study, regardless of gestational age. On the whole, the findings of the present study suggest that additional studies are required, in order to confirm that diagnosis and treatment according to laboratory results of vaginal infections with U. urealyticum/M. hominis during the first trimester of pregnancy could prevent premature birth, abortion or chorioamnionitis.
Background: Despite being a very well-documented subject in the literature, there are still conflicting results regarding teenage pregnancies and their fetal outcomes. Methods: We conducted a retrospective, comparative cohort study that included 1082 mothers aged less than 18 years, compared to 41,998 mothers aged over 18 years, who delivered in our tertiary referral center between January 2015 and December 2021. To check for significant differences between the two groups, the chi-qquared or Fisher’s test for categorical variables were used. Results: We detected statistically significant higher rates of fetal malformation, premature birth, FGR and SGA fetal growth conditions, preeclampsia, condylomatosis and vaginal infection with E. coli in our cohort of teenagers. In this subpopulation of teenagers, the rate for premature birth at less than 32 weeks of gestation was 3.26-fold higher and 3.25-fold higher for condylomatosis, and these results referred to the cohort of adult patients (>18 years old) that gave birth in the same interval of time. Conclusions: Teenage pregnancies still remain a major health problem that burdens all countries worldwide regardless of their income. It needs solutions initially to prevent pregnancy in this young age segment and last but not least to improve both maternal and fetal outcomes.
The present study reported a case of a uterine leiomyoma with an unusual growth pattern featuring areas of intravascular leiomyomatosis, rarely described in the international literature available in English. It presented the case of a 44-year-old woman who, fearing the Covid-19 outbreak, postponed the recommended surgical intervention to remove a uterine leiomyoma. The two-year delay worsened the symptoms, doubled the size of the tumor, and facilitated the development of intravascular leiomyomatosis. It was possible to establish the correct diagnosis only after the histopathological examination of the excised uterine myoma, as it was not suspected prior to surgery. No other vascular tumors were identified via magnetic resonance imaging and computed tomography imaging investigations. The careful follow-up of recovering patients is essential because of the high recurrence rate of such tumors and their potential to behave aggressively, possibly even fatally. Clinicians should be aware of this rare condition and its cardiovascular implications to improve the initial and long-term management of such cases.
(1) Generating the need to impose social distancing to reduce the spread of the virus, the COVID-19 pandemic altered the ways in which the teaching process normally happens. The aim of our study was to determine the impact of online teaching on medical students during this period. (2) Our study included 2059 medical, dental and pharmacy students from the University of Medicine and Pharmacy “Grigore T. Popa”, Iasi, Romania. We used a modified metacognition questionnaire after translation into Romanian and validation. Our questionnaire included 38 items, and it was divided into four parts. Academic results and preferences regarding the on-site or online courses, information regarding practical training, self-awareness in terms of one’s feelings such as anger, boredom and anxiety and also substance use linked to online teaching, and contextualization of the relationship with colleagues, teachers, friends and family were among the most important points evaluated. A comparison was made between preclinical and clinical students. A five-item Linkert-like scale was used for rating the answers in the last three parts that evaluated the impact of the SARS-CoV-2 pandemic on the educational process. (3) Preclinical medical students, compared to preclinical dental students, obtained statistically significant improvements in their evaluation results, with fewer failed exams (p < 0.001) and with similar results being obtained by comparing dental with pharmacy students. All students obtained statistically significant improvements in their academic results during the online evaluation. A statistically significant increase in anxiety and depression with a p-value of <0.001 was registered among our students. (4) The majority found it difficult to cope with this intense period. Both teachers and students found it difficult to adjust on such short notice to the challenges posed by the new concept of online teaching and learning.
Atrial septal aneurysm (ASA) is a rarely reported fetal finding. Its definition is variable, but the diagnosis is usually made when the foramen ovale flap extends at least halfway across the left atrium. It is considered a transient, self-limiting condition, but on occasion, it can be complicated by fetal arrhythmia or left ventricular (LV) inflow obstruction—if longstanding, this can lead to left heart hypoplasia. We present two cases of ASA diagnosed at the second trimester scan, one of which was subsequently complicated by LV inflow obstruction and prenatal suspicion of hypoplastic aortic arch. This report is a good illustration of how structure follows function: a small LV preload can lead to a decreased LV output, which in turn will end up in a hypoplastic LV and outflow tract—all this is reversible after birth, due to the physiological circulatory modifications that occur in the newborn.
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