János Szabó

HIV transmission from female to male at improperly protected sexual intercourse

There is growing evidence that human immunodeficiency virus (HIV) infection can be transmitted from female to male after only 2 sexual contacts. The authors present a case in which the wife was infected with HIV in March 1986 as a result of transfusion of blood from a homosexual. She tested positive for HIV in January 1987 and in February was notified of her positive test result. The couple had had regular unprotected sexual intercourse between April 1986 and February 1987. In February 1987 the patients husband was negative for HIV infection and condom use was initiated. By October 1987 the husband was found to be seropositive for HIV. The couple reported that the condom had torn on several occasions since protected intercourse was initiated. It cannot be determined whether HIV was transmitted before February during unprotected intercourse and the husband seroconverted after the 1st blood sampling or whether HIV was transmitted after notification of the wifes seropositive status.

Increased nuchal translucency and congenital heart defects in euploid fetuses: The Szeged experience

OBJECTIVE To determine the utility of the first-trimester fetal nuchal translucency (NT) thickness in the prediction of fetal cardiac malformations. DESIGN Retrospective study. SETTING Department of Obstetrics and Gynecology and Medical Genetics, University of Szeged. METHODS The pre- and postnatal course and outcome, and the relationship between the first-trimester fetal NT thickness and fetal congenital heart defects (CHDs) in 4309 pregnancies ended up with birth or therapeutic abortion between January 1998 and June 2000 were registered. Prenatal care included first- and second-trimester fetal sonography at weeks 10-13 and 18-20, respectively. RESULTS 4251 births and 58 first- and second-trimester therapeutic abortions due to lethal congenital malformations or chromosomal abnormalities were recorded. Altogether 209 (4.9%) congenital malformations were detected, 39 (18.7%) of which were heart defects with normal karyotype. At birth, 151 congenital malformations were diagnosed, 34 of them were known prenatally. The prevalence of CHDs was 9 per 1000 pregnancies. The measurement of fetal NT thickness was available in 35 of the 39 fetuses with heart defects: it was > or = 3 mm in 18 (51.4%) and <3 mm in 17 (48.6%). A sensitivity of 51.4% was found at a cutoff of 3mm. CONCLUSIONS An increased NT thickness in chromosomally normal fetuses was found to be highly associated with CHDs and identified in more than half of the affected cases. Furthermore, an increased NT of > or = 3 mm can be regarded a selection criterion for early second-trimester targeted fetal echocardiography and for increased fetal and neonatal surveillance.

Ring transformations of 1,3-benzothiazine derivatives II conversion of 6α-aryl-7α-chloro-2,3(2′,3′-dialkqxybenzo)-1-thiaoctems3 into 2-carbomethoxy-3-aryl-7,8-dialkoxy-4.5-dihydro-1,4-benzothiazepines

Abstract 6,7-Dialkoxy-2-aryl-4 H 1-1,3-benzothiazines (1a⇍) react with chloroacetyl chlorlde to give condensed β-lactam derivatives (2a⇍). Basic treatment of 2a⇍ in methanol led to the corresponding 1,4-banzothiazepine derivativee (3a⇍) via ring expansion. The structures of the products were determined by IR, NMR and MS studies

Four years experience of first-trimester nuchal translucency screening for fetal aneuploidies with increasing regional availability

Background. A prospective screening study was carried out at the regional genetic and perinatal center in South Hungary in order to determine the efficiency of first‐trimester nuchal translucency screening for fetal aneuploidies, following augmentation of the availability of nuchal translucency screening in the region by the inclusion of newly‐trained hospital sono‐graphers.

Cycloaddition reactions of 1,3-benzothiazines - 6. Reactions of 1,3-benzothiazine derivatives with substituted acetyl chlorides☆

Abstract 6, 7-Dimethoxy-2 H -l,3-benzothiazine derivatives ( 1 , 8 ) react with substituted acetyl chlorides to give angularly condensed β -lactams ( 3a - d , 10 , 11 ). The cis compound 11 was epimerised to the trans derivative 12 . From the interaction of 2-phenyl-6,7-dimethoxy-4 H -1,3-benzothiazine ( 7 ) and α -chloro-phenylacetyl chloride two stereoisomeric β -lactam derivatives ( 9a , b ) were isolated, whereas in the other cases studied the reactions leading to β -lactams proved to be stereospecific. Analogous reactions of 4 -methyl-6,7-dimethoxy-2 H -l,3-benzothiazine ( 5 ) furnished the enamides 6a , c , d . Structures of the new compounds and configurations of the diastereomers were elucidated by IR and NMR spectroscopy.

Leiden mutation, bed rest and infection: Simultaneous triggers for maternal deep-vein thrombosis and neonatal intracranial hemorrhage?

The possible etiologic roles of infection and bed rest are discussed in connection with a case of maternal homozygous Leiden mutation leading to prematurity, maternal deep-vein thrombosis and neonatal intracranial hemorrhage in a heterozygous premature baby. Maternal bacterial infection and bed rest may trigger deep-vein femoral thrombosis in women with a homozygous Leiden mutation on tocolytic therapy for the treatment of premature labor. The neonate carrying at least one mutated allele of factor V Leiden might be at risk for the development of intracranial hemorrhage.

New convenient synthesis of 1,4-benzothiazepines

New 1,4-benzothiazepine diastereomers 6a,b were prepared by ring expansion of the 1,3-benzothiazine derivative 1 and from 2-benzoylmethylthio-4,5-dimethoxybenzylamine hydrochloride (5) with benzaldehyde.

Synthesis of 4,5-dihydro-1,4-benzothiazepine derivatives via ring expansion

Abstract Basic treatment in methanol of a chloro-β-lactam fused with dihydrobenzothiazine led to the corresponding 1,4-benzothiazepine derivative via a new ring expansion. The structure of the product, deduced from IR and 1 H NMR data, was confirmed by X-ray measurements.

Fetomaternal Transfusion and Pregnancy Outcome after Cordocentesis

Objective: To study the extent of fetomaternal transfusion and the outcome of pregnancy after cordocentesis. Material and Methods: 268 women underwent percutaneous fetal umbilical cord blood sampling for fetal karyotyping between 15 and 26 gestations of weeks. Complete follow-up was available in 221 (82.5%) of the cases. Cordocentesis was performed under continuous real-time ultrasound guidance. The duration of the procedure and the post-procedural bleeding time was counted in seconds. Fetomaternal transfusion was calculated by using the measurements of the maternal serum levels of α-fetoprotein before and after the procedure. The data were analyzed by Student’s t and multiple regression tests. Results: The maximum and mean amounts of fetomaternal transfusion were 1.067 and 0.061 ml, respectively. Twenty percent or more α-fetoprotein elevation was in 35.4% of the cases. Positive correlation was found between bleeding time after cordocentesis and fetomaternal transfusion (r = 0.174, p < 0.0129) as well as between the duration of the procedure (r = 0.165, p < 0.0171) and the amount of fetomaternal transfusion. Comparing the cordocentesis at the placental insertion site and at the free cord loop, a smaller amount of fetomaternal transfusion was observed (p < 0.0123) in the latter. Transplacental passage was associated with a higher amount of fetomaternal transfusion (p < 0.0067). No association was found between the extent of fetomaternal transfusion and the outcome of pregnancy. The fetal loss related to the cordocentesis was 0.50%. Conclusions: The extent of fetomaternal transfusion was influenced by the subsequent four parameters: procedural time, bleeding time, puncture site and transplacental penetration. The lack of the association between the degree of fetomaternal transfusion and the outcome of pregnancy, along with the low (0.50%) post-procedural fetal loss rate, suggest that cordocentesis is clinically a safe procedure.

Cycloaddition reactions of 1.3-benzothiazines v synthesis of new tetracyclic ring systems

Abstract New tetracyclic derivatives (3a, b , 5, 8) similar to protoberberines, but containing a lactam structural element and other hetero atoms besides the bridge-head nitrogen in rings B and C, were prepared by cycloaddition of 6,7-dimethoxy-2H-1,3-benzothiazine (1a) with o -substituted aromatic carboxylic acid derivatives (2a, b , 4) and from 4- methyl-6,7-dimethoxy-2 H -1,3-benzothiazine (1b) with 3.5-dinitrobenzoyl chloride.