Melinda Vanya

Management of severe idiopathic oligohydramnios: is antepartum transabdominal amnioinfusion really a treatment option?

Objective: The aim of this study was an evaluation of the role of antepartum transabdominal amnioinfusion (APTA) in the management of severe idiopathic oligohydramnios with a view to improving the pregnancy outcome. Methods: The study comprised an analysis of 20 pregnant women with severe oligohydramnios who were treated with APTA in 2009 and 2012. The pregnancy outcomes and the complications of the procedure were analysed. Results: The mean gestational age at first treatment was 22 weeks 3 days. The preprocedure amniotic fluid index of <5 cm was restored by the treatment to 8 cm. More than a half of the pregnancies (66.7%, 8/12) treated with APTA finished with spontaneous abortion in the second trimester, mostly due to rupture of the membranes (as a consequence of retroamniotic filling with saline in four cases). The later the oligohydramnios developed, the higher the probability of a significant prolongation of the gestation. Conclusions: Although APTA is a useful procedure in the management of severe oligohydramnios, it may be followed by a relatively high rate of rupture of the membranes, particularly in the second trimester. Paradoxically, a higher volume of infused saline into the amniotic cavity is associated with a significantly lower risk of rupture.

The potential role of oxytocin and perinatal factors in the pathogenesis of autism spectrum disorders – review of the literature

Autism Spectrum Disorders (ASD) are characterized by: social and communication impairments, and by restricted repetitive behaviors. The aim of the present paper is to review abnormalities of oxytocin (OXT) and related congenital malformations in ASD. A literature search was conducted in the PubMed database up to 2016 for articles related to the pathomechanism of ASD, abnormalities of OXT and the OXT polymorphism in ASD. The pathomechanism of ASD has yet to be. The development of ASD is suggested to be related to abnormalities of the oxytocin-arginin-vasopressin system. Previous results suggest that OXT and arginine vasopressin (AVP) may play a role in the etiopathogenesis of ASD.

Pregnancy and perinatal outcomes among women with multiple sclerosis: a retrospective case-controlled study in South Hungary.

Abstract Objective: The aim of this study was to investigate the connections between multiple sclerosis (MS) and fertility, pregnancy. Methods: The case histories and pregnancy complications in a sample of 65 treatment-naive pregnant women with MS in the period 1998–2012 were compared with an age-matched case-controlled analysis. Comparisons were made between primigravidas and multigravidas subjects. Results: Our results revealed a higher rate of miscarriage (18.46%) in the first trimester in women with MS, and intrauterine death (7.69%) in the third trimester, as compared with women without MS (p < 0.001 and p = 0.035). Conclusions: These findings suggest that, the risk of miscarriages and intrauterine death may be disease-related not drug-related feature. Further studies are needed to determine to possible associated factors of miscarriages.

First report of hidradenitis suppurativa and chronic gastritis caused by antibiotic resistant Salmonella enterica Serovar Brandenburg

Introduction: Salmonella infections are one of the most common agents of food-borne diseases. Brandenburg serovar is more common in animals than in humans, and previous reports has been published on suppurative thyroiditis, peritonitis, abscess of the thigh, abscess of the endometriosic ovarian-cyst and haemorrhagic urethritis caused by Salmonella Brandenburg infection. Objective: Our aim was to demonstrate a separate case of Salmonella Enterica subsp. enterica serovar Brandenburg infection in a male presenting with symptoms of gastroenteritis with hidradentis suppurativa in a 6-month period in 2014. Case report: This article reports an unusual case of a male prison guard with good physical and psychosocial condition aged (38), who developed gastroenteritis, displaying vomitus and progressive diarrhoea of 5-day duration in June 2014, but after the antibiotic therapy, his symptoms had not ended. The local family doctor had not taken stool samples. Four months later, hidradenitis suppurativa and rosacea was detected by the prison doctor. The first examination of the stool culture and smear was positive for S. Enterica subsp. enterica serovar Brandenburg in December 2014. After several and different therapies (including dermatologists) with antibiotics, proton-pump inhibition and other agents, a final diagnosis has been revealed as the Salmonella infection. Following an oral 14-day course of ciprofloxacin treatment and B6 vitamin supplementation, the patient displayed a significant clinical improvement. Conclusion: According to our best knowledge, this is the first article to report the case of Salmonella Brandenburg-associated chronic gastroenteritis, rosacea and axillar hidradenitis suppurativa.

Monitoring of fetal heart rate via iPhone

Recording of fetal heart rate can be reassuring for the mother about the fetus’ wellbeing. Our smart phone application can detect, record and evaluate fetal heart rate at any time. This method is based on sound wave thus free from the effects of ultrasound, and can be used all day without harming the fetus. It does not require medical assistance and easy to use at home. It reduces the queue at outpatient care units, helps pregnant women to relieve stress by listening to their unborn baby’s heartbeat. It improves mother-child relationship yet sends an alarming message if further examinations are needed to prevent the consequences of hypoxia.

Acute diarrhoea caused by Salmonella enterica subsp. enterica serovar Give infections in male prisoners: a case report

Introduction: Previous studies have identified Campylobacter jejuni, Escherichia coli, and Salmonella Typhimurium as the main causative agents of foodborne diseases in Europe. Objective: Our aim was to demonstrate two separate cases of Salmonella enterica subsp. enterica serovar Give infection in male prisoners presenting with symptoms of gastroenteritis. Case: We report the cases of two male prisoners, aged 47 and 32 years, who developed gastroenteritis, displaying vomitus and progressive diarrhoea with 2-day duration. The examination of the stool culture was positive for Salmonella Give. Following intravenous sodium chloride infusion, vitamin B6 and metoclopramide treatment, and a 7-day course of ciprofloxacin treatment, the patients displayed a significant clinical improvement. Conclusion: According to our knowledge, this is the first study to report the case of Salmonella Give-associated gastroenteritis in Central Europe.

Genetic and epigenetic factors of polycystic ovary syndrome

The development of polycystic ovary syndrome and its exact pathophysiological mechanism is still unclear, but environmental and genetic factors likely play a role. Exposition to teratogenic effects during the prenatal development can lead to chronic diseases in the postnatal period. This finding confirms the common familial aggregation as well. A literature search was conducted up to January 1, 2016 for articles dealing with the genetic or epigenetic factors of polycystic ovary syndrome. This review will discuss the current understanding of the genetic basis and clinical presentation of this disease. Orv. Hetil., 2016, 157(32), 1275-1281.

Magzati és anyai betegségek kockázata 40 évesnél idősebb édesanyák esetén

A rising trend in advanced maternal age has been observed over the last few decades. Several studies have assessed the association between advanced maternal age and adverse pregnancy outcome, including miscarriage, stillbirth, pre-eclampsia, gestational hypertension, gestational diabetes mellitus, preterm birth, delivery of a small- or large-for-gestational-age neonates and elective or emergency Cesarean section. These studies reported contradictory findings. The aim of the present paper is to summarize the evidence-based information regarding advanced maternal age and pregnancy outcomes.

Perinatal Outcomes and the Risk of Autism Spectrum Disorders-Case Control Study

Introduction: Autism spectrum disorders (ASDs) are a neurodevelopmental disorders characterized by social, communication impairments and stereotyped patterns of behaviour. Recent studies to suggest that parental age and obstetric conditions are associated with an increased risk of ASD. Although not proven as independent risk factors for ASD, precise assessments of exposures and potential confounders scarcely have been investigated. Methods: The present retrospective cross-sectional study was designed to assess the effects of maternal age, medical conditions, pregnancy outcomes and prenatal exposure on the risk of ASD. A total of 43 children with ASD clinically diagnosed according to the DSM IV criteria between 2010 and 2012 were recruited. The following data were collected: clinical psychiatric data, data of cognitiv tests, obstetric history of the mother including age, medical conditions, drug use during pregnancy, ultrasonographic measurements each trimester of pregnancy and perinatal outcomes. Statistical comparisons of different parameters on the case group (n=43) and the neurologically healthy control group (n=182) were assessed. Results: The average age of the case and control group were 29.53 ± 5.1 years and 29.67 ± 8.54. Ultrasonographic parameters (NT:1.35 ± 0.42; CRL:53.64 ± 11.48; thorax: 23.38 ± 7.39; length of humerus: 13.56 ± 7.57; length of femur:13.76 ± 7.1) were in the normal range. Pre-existing hypertension and diabetes mellitus were more prevalent among the case group than among the healthy women p=0.007; p<0.001. The rate of miscarriages, per vias naturales delivery and pre-eclampsia were significantly higher among the case group than among the control group (p=0.001; p=0.023; p=0.021). There was no significant difference between the two groups from the aspects of the low birth weight, caesarean section. Conclusion: In contrast with recent publications, there were no significant differences in maternal age, low birth weight and pre-existing hypertension between the two groups. Our results are in accordance with those of previous studies from the aspect of the risk of diabetes mellitus, the elevated risk of miscarriages and caesarean section.

Lyme disease associated neuroretinitis — Case report

We describe a rare case of Lyme disease complicated by unilateral neuroretinitis in the right eye. We report a case of a 27-year-old woman with blurred vision on her right eye. Because of the suspicion of optic neuritis (multiplex sclerosis) neurological examination was ordered. Surprisingly, computer tomography of the brain revealed incomplete empty sella, which generally results not monocular, but bilateral optic nerve swelling. Opthalmological examination (ophthalmoscopy and optical coherence tomography) indicated not only monocular optic nerve, but retinal oedema next to the temporal part of the right optic disk. Visual evoked potentials (VEP) demonstrated no P100 latency delay and mild differences between the amplitudes of the responses of the left and right eye. Optical coherence tomography (OCT) demonstrated the swelling of the optic nerve head and oedematous retina at the temporal part of the disk. Suspicion of an inflammatory cause of visual disturbance blood tests was ordered. Doxycycline treatment was ordered till the result of the blood test arrived. The Western blot and ELISA test were positive for Borrelia burgdorferi sensu lato. Following one week corticosteroide and ceftriaxone treatments, the patient displayed a clinical improvement. Unilateral neuroretinitis with optic disk swelling due to neuroborreliosis is a rare complication and in many cases it is difficult to distinguish between inflammatory and ischemic lesions. Further difficulty in the diagnosis can occur when intracranial alterations such as empty sella is demonstrated by CT examination.