The Effects of Hyperemesis Gravidarum on the Oral Glucose Tolerance Test Values and Gestational Diabetes

This study is aimed at determination whether pregnant women who develop hyperemesis gravidarum in the first trimester have a tendency to develop gestational diabetes mellitus (GDM). It is also aimed at identification of effects of hyperemesis gravidarum and GDM on prenatal and neonatal status in case they were detected together. Hyperemesis gravidarum diagnose was based on the following signs and symptoms. To diagnose GDM, first trimester fasting blood glucose measurement and subsequent blood glucose monitoring and 75-g oral glucose tolerance test (OGTT) were performed in the second trimester. A total of 949 singleton pregnant women (95 with and 852 without hyperemesis gravidarum) who met our criteria were included in the study. In the first trimester, plasma blood glucose and positive GDM screening were found to be significantly higher in the hyperemesis gravidarum group compared to the control group (p=0.042 and p<0.001, respectively). However, actual GDM cases were similar between both groups. The positive predictive value was significantly lower in the hyperemesis gravidarum group (28.5% vs. 72.7%, p=0.003). In the second trimester, the prevalence of GDM was 6.6% in the hyperemesis gravidarum group and 7.3% in the control group, with no significant difference (p=0.218) between-groups. In this study, hyperemesis gravidarum was found to cause changes in maternal metabolism in the first trimester of pregnancy due to limited calorie intake and fasting; in the presence of hyperemesis gravidarum, it should be known that the positive predictive value of first trimester gestational diabetes screening may decrease and the diagnosis of pseudo-GDM may increase.

Therapeutic Drug Monitoring of Protein Kinase Inhibitors in Breast Cancer Patients

Protein kinase inhibitors (PKIs) represent up-to-date therapeutic approach in breast cancer treatment. Although cancer is a rapidly progressive disease, many substances, including PKIs, are usually used at fixed doses without regard to each patient’s individuality. Therapeutic drug monitoring (TDM) is a tool that allows individualization of therapy based on drug plasma levels. For TDM conduct, exposure-response relationships of drug substances are required. The pharmacokinetic data and exposure-response evidence supporting the use of TDM for 6 PKIs used in breast cancer treatment, one of the most common female tumour diseases, are discussed in this review.

Patella Fracture Identified Using Point-of-care Ultrasound

A 49-year-old female fell from standing. Her right knee extended into the air. She had acute right knee pain preventing weight-bearing. Her knee was most comfortable fully-extended. She could not flex it due to pain, nor extend it against resistance. Tenderness and a horizontal defect were noted over the anterior knee. Bedside ultrasound demonstrated a horizontally-fractured patella (confirmed on X-ray) with intact femoral and patellar tendons. She was put in a knee immobilizer and underwent surgery, with return to full function and activities. Ultrasound can identify patella fractures and help with early evaluation, management, and specialty referral, as well as ordering more-focused imaging. In one study, POCUS (point-of-care ultrasound) for patella fracture had 95% sensitivity, 63% specificity, 86% positive predictive value, and 83% negative predictive value. The dynamic nature of ultrasound allows a ruptured patella (87% sensitivity) or quadriceps tendon (100% sensitivity) to be excluded with high certainty.

Acute Appendicitis in a Diabetic Child with Salmonella Infection

Acute appendicitis is the most frequent and challenging condition requiring emergent intrabdominal surgery in children. The diagnosis of appendicitis becomes more difficult and challenging in children, especially with other medical problems. Computed tomography is the primary tool for diagnosing or excluding appendicitis in cases with atypical presentation. Salmonella infections may present as acute abdominal problems in children. We present a clinical combination that has never been previously reported, of a diabetic girl with non-typhoid Salmonella infection, diagnosed with acute appendicitis. We wonder about the causal correlation of these diseases, versus their simple coexistence.

Comparison of the Baska Mask® and Endotracheal Tube on Hemodynamic and Respiratory Parameters in Septoplasty Cases

Laryngeal mask (LM) types have been used as an airway device for an alternative to the standard endotracheal tube (ETT). One of the novel type of LM, the Baska Mask®, can be a safe alternative among the airway devices. The purpose of this study is to compare the effects of the new generation supraglottic airway device the Baska Mask® and the ETT on hemodynamic parameters (heart rate, mean arterial pressure), airway pressure and end tidal carbon dioxide (EtCO2) in patients undergoing general anesthesia. After the approval of the ethics committee, 70 patients who underwent septoplasty were included in the study. Written informed consent forms were taken from these patients. Demographic data of the patients were recorded. Hemodynamic data of patients were measured and recorded preoperative, during induction, at the time of intubation 1th, 3th and 5th minute and during extubation. Also, airway pressure and EtCO2 values of the patients were measured and recorded at the time of intubation, 1th, 3th and 5th minutes. Demographic data were similar in both groups. Mean arterial pressure, heart rate and airway pressure were lower in the group 2 (the Baska Mask® group) than in the group 1 (ETT group) and the difference was statistically significant (p<0.05). EtCO2 values were similar in both groups. No patients had tube leakage. In terms of hemodynamic and respiratory parameters the Baska Mask® is more advantageous than the ETT in short-term surgeries.

Obstructive Jaundice Secondary to Pancreatic Head Metastasis of Malignant Amelanotic Melanoma as the First Clinical Manifestation

Malignant melanoma is commonly known for its high probability of metastasizing to distant organs. Metastases to gastrointestinal tract are well documented, but resulting jaundice is only scarcely seen. We present a case of histologically verified metastasis of amelanotic melanoma to the head of pancreas infiltrating the common bile duct and consequently causing obstructive jaundice which constituted its first clinical manifestation. Multidisciplinary approach is essential in patients with malignant melanoma since early detection of the melanoma or its metastases may improve patients’ clinical outcome, especially owing to the use of targeted biological treatment without any delay.

Fatal Neutropenic Colitis and Clostridium Septicum Bacteremia in a Breast Cancer Patient

A fatal case of 67-year-old female with metastatic breast cancer on chemotherapy complicated with febrile neutropenia, colitis and sepsis due to Clostridium septicum is presented. Important clinical symptoms, laboratory and radiology findings together with therapy and outcome of neuropenic colitis are also discussed.

Testing Positive for SARS-CoV-2 in Two Countries 105 Days Apart

Recovered COVID-19 patients may test positive for SARS-CoV-2 for a long time from intermittent shedding of viral fragments. A 36-year-old man who tested positive for SARS-CoV-2 in the Czech Republic and recovered tested positive again in Bhutan, 105 days beyond his first positive test. He experienced minimal symptoms and recovered without complications. Although no virological test was conducted to rule out reinfection, the repeat positive test after initial recovery likely resulted from prolonged shedding of dead viral particles than a reinfection.

Valproate-associated Movement Disorder: A Literature Review

Valproate (VPA) was first synthesized in 1882, but it was only in the early 1960s that its anticonvulsant properties were discovered. The aim of this literature review is to evaluate the clinical epidemiological profile, pathological mechanisms, and management of VPA-associated movement disorder (MD). Relevant reports in six databases were identified and assessed by two reviewers without language restriction. A total of 138 reports containing 362 cases of subjects who developed a MD secondary to VPA were reported. The MD identified were parkinsonism (PKN) (252), myoclonus (MCL) (54), dystonia (DTN) (17), dyskinesia (DKN) (16), stutters (4), tics (3), akathisia (AKT) (1). In the not clearly defined group, 15 extrapyramidal symptoms, 3 AKT, 2 DTN, 1 rigidity, 1 unstable gait were assessed. The mean and median age was 55.8 (SD: 16.58) and 61 years (range: 4–87 years). The most common VPA-indication was epilepsy, and 51.36% were males. The mean and median time from the VPA start to the MD onset was 32.75 (SD: 30.05) and 21.15 months (range: 1 day – 20 years). The mean and median time from the VPA withdrawal until the MD recovery was 2.89 (SD: 2.79) and 3 months (1 day – 12 months). The most common management was drug withdrawal. A complete recovery was obtained in 80.61%. VPA-associated MD was extensively reported in the literature. PKN was the most well-described. Future studies need to clearly report the clinical history of the patient, considering the full investigation of other adverse events during their entire life.

Pelvic Floor Muscles Contribution in Surgical Outcome of Children with High-type Anorectal Malformations

As a consequence of high-type anorectal malformations (ARMs) pathogenesis, the pelvic floor muscles remain severely underdeveloped or hypoplastic, the rectal pouch is located at the level or above the puborectalis sling, and the bowel terminates outside the sphincter muscle complex support. For children with high-type ARMs the ultimate objective of therapy is mainly to grow up having bowel continence function that is compatible with a good quality of life, and the final prognosis depends significantly on the grade of development of pelvic floor muscles and the successful entering of the anorectum fully within the support of the external anal sphincter due to intraoperative conservation of the puborectalis sling. Pelvic magnetic resonance imaging (MRI) has recently become the preferred imaging study for prediction of functional outcomes, since it can define the anatomy and evaluate the development of the sphincteric muscles before and after surgical correction. Based on recent literature and our clinical experience, we will discuss the relevance of pelvic floor muscles MRI to the clinical outcome of children with high type ARMs.