The maximal standardized uptake value (SUVmax) is one possible parameter that can help in distinguishing between benign and malignant thyroid PET lesions.Incidental 18F-FDG PET-CT examinations of 5,911 patients performed at two different medical centres from 2010 to 2011. If pathologically increased activity was accidentally detected in the thyroid, the SUVmax of the thyroid lesion was calculated. Patients with incidental 18F-FDG uptake in the thyroid were instructed to visit a thyroidologist, who performed further investigation including fine needle aspiration cytology (FNAC) if needed. Lesions deemed suspicious after FNAC were referred for surgery.We retrospectively evaluated 18F-FDG uptake in the thyroid was found in 3.89% — in 230 out of 5,911 patients investigated on PET-CT. Malignant thyroid lesions  were detected in 10 of 66 patients (in 15.2%). In the first medical centre the SUVmax of 36 benign lesions was 5.6 ± 2.8 compared to 15.8 ± 9.2 of 5 malignant lesions (p < 0.001). In the second centre the SUVmax of 20 benign lesions was 3.7 ± 2.2 compared to 5.1 ± 2.3 of 5 malignant lesions (p = 0.217). All 29 further investigated diffuse thyroid lesions were benign.Incidental 18F-FDG uptake in the thyroid was found in 3.89% of patients who had a PET-CT examination. Only focal thyroid uptake represented a malignant lesion in our study — in 15.2% of all focal thyroid lesions. SUVmax should only serve as one of several parameters that alert the clinician on the possibility of thyroid malignancy.Incidental  This study was conducted at two PET-CT centres (having different PET-CT scanners) in Slovenia: the Department of nuclear medicine at the University Medical Centre Ljubljana (UMC) and the Institute of Oncology Ljubljana (IO).The aims of this study were to (i) determine the incidence of thyroid lesions incidentally found on 18F-FDG PET-CT investigation between January 2010 and December 2011. Only patients  aged 18 years or more were included in this study. The 18F-FDG PET-CT investigation of patients included in the study was performed for different purposes, mainly because of oncologic indications. The study was approved by the Ethics Committee at the Ministry of Health, Republic of Slovenia (No.: 53/04/12).We retrospectively evaluated the medical records of 5,911 patients  who underwent an 18F-FDG. The acquisition on the PET-CT scanner started 60 minutes after the radiotracer administration. The PET-CT scanners used were different: at UMC a Siemens Biograph mCT and at IO a Philips Gemini 16 GXL. In all patients, the localisation and attenuation correction CT was first done, followed by the PET scan itself. The CT acquisition parameters in both centres were fairly similar. Also, the PET acquisition parameters did not differ a lot; at UMC a bed position of 2 min with 45% overlap and at IO a bed position of 2 min with 50% overlap was used. The acquired PET-CT data was processed using similar iterative reconstruction algorithms.Patients from both centres fasted for at least 6 hours, ideally having a blood glucose level less than 7 mmol/l, before receiving 370 MBq of max) for creating a final report. They had access to relevant patient history and previous examination reports. Patients with thyroid lesion incidentally found on 18F-FDG PET-CT were referred to a thyroidologist.Nuclear medicine doctors at both centres used visual and semi-quantitative data analysis . A histological report was obtained for lesions that were surgically removed. All data  were obtained only from patients treated and followed-up at UMC and IO.Thyroid investigation normally included the patient’s history, clinical examination, relevant laboratory workup, ultrasound examination and max of benign and malignant thyroid lesions were compared using Student’s t-test. Results were deemed statistically significant for p < 0.05. A receiver operating characteristic (ROC) analysis was performed to determine a SUVmax cut-off point that differentiates between suspicious and unsuspicious focal thyroid lesions.Statistical analysis was performed using IBM SPSS Statistics 22.0 and Microsoft Excel for Mac 14.1. The SUV18F-FDG PET-CT investigation mainly for cancer-related diagnostics or inflammatory/infection problems. On the other side, patients at IO underwent an 18F-FDG PET-CT investigation almost exclusively because of cancer-related diagnostics.The mean age of 2,840 patients who had a PET-CT investigation at UMC was 61.2 ± 12.9 years; the mean age of 3,071 patients at IO was 64.4 ± 12.1 years. Fifty per cent of UMC patients were males and 50% females. The percentage of males and females in the IO group was 52.5% and 47.5% respectively. Patients at UMC underwent an 18F-FDG uptake in the thyroid was found in 230 out of 5,911 investigated patients (in 3.89%). Focal thyroid uptake represented 64.3% and diffuse thyroid uptake 35.7% of detected thyroid lesions. 56.1% of all focal lesions and 81.7% of all diffuse lesions were detected in female patients. More detailed information about patients with incidentally found thyroid lesions on 18F-FDG PET-CT is presented in Incidental 18F-FDG uptake in the thyroid investigated at UMC and for 46 out of 148 patients (in 31.1%) investigated at IO. Diffuse thyroid lesions in 14/58 patients (24.1%) from UMC (SUVmax range from 3.5 to 10.3) and in 15/46 (32.6%) patients from IO (SUVmax range from 1.9 to 9.2) were all benign. Hashimoto’s thyroiditis was diagnosed in 92.9% and 73.3% respectively.Data of further treatment were found for 58 out of 82 patients (in 70.7%) with increased 18F-FDG uptake in the thyroid (SUVmax range from 2.3 to 31.9) were further investigated. Thyroid nodules were found in 30 patients (in 68.2%). Autoimmune thyroid disease was diagnosed in 29.5% – in 12 patients with Hashimoto’s thyroiditis and in one patient with Graves’ disease. One patient was diagnosed to have benign diffuse goitre. FNAC was performed in 28 of 44 patients (63.6%). Results of FNAC are presented in At UMC, 44 patients with focal max range from 1.5 to 8.7) thyroid nodules were found in 28 cases (in 90.3%). In two patients the focal lesion was caused by Hashimoto’s thyroiditis and in one by Graves’ disease. FNAC diagnostics were performed in 24 of 31 patients (77.4%)  .max cut-off point for differentiating between suspicious and unsuspicious focal thyroid lesions incidentally detected on PET-CT, calculated using ROC analysis, was 5.4 for patients investigated at UMC ; the optimal differentiating SUVmax for patients investigated at IO was 4.0 .The optimal SUV18F-FDG PET-CT malignant thyroid disease was confirmed. Detailed characteristics of all surgically removed thyroid lesions are presented in Malignant thyroid disease was found in 10 out of 18 patients (55.6%) who underwent surgery. Malignant thyroid disease was more common in males (8 cases) than in females (2 cases). Nine patients with focal thyroid lesions who were referred for surgery were lost to follow-up. Therefore in 10 out of 66 patients (15.2%) with focal thyroid lesion incidentally detected on max of malignant focal lesions  was compared to SUVmax of benign focal lesions  (p < 0.001) difference was observed between 36 benign (SUVmax from 2.3 to 13.2) and 5 malignant (SUVmax from 10 to 31.9) focal thyroid lesions incidentally detected on PET-CT in patients from UMC. No statistically significant difference (p = 0.217) was observed between 20 benign (SUVmax from 1.5 to 8.8) and 5 malignant (SUVmax from 2.7 to 7.8) focal thyroid lesions in patients from IO.SUVeatment) . A stati18F-FDG uptake in the thyroid was observed in 3.89% of 5,911 patients investigated; in 2.89% of patients investigated at UMC and in 4.82% of patients investigated at IO. This is in accordance with the present literature, where the incidence of such lesions varied from 0.2 to 8.9%, with most studies reporting a incidence between 2 and 3%.et al.Incidental Slovenia, although not an endemic goitre region, still has a significant incidence of thyroid nodules in the general population.17American Thyroid Association Guidelines Taskforce28According to the 18F-FDG on PET-CT is associated with Hashimoto’s thyroiditis.Experts agree that diffuse thyroid uptake of 18F-FDG uptake in the thyroid. In comparison to other reports, the incidence of thyroid malignancy in our study was somewhat lower.37According to the literature, the rate of focal lesions ranges from 14% to 73% of all thyroid PET lesionset al.Autoimmune thyroid disease was present in 29.5% of focal thyroid lesions from UMC patients. This finding is quite different from data published in the literature.18F-FDG uptake in the thyroid.18F-FDG uptake.According to the literature, Graves’ disease is demonstrated most commonly by diffusely increased max. The literature is quite divided on this topic, with studies claiming to being able to differentiate between benign and malignant lesionsmax of malignant lesions were on average higher than benign lesions, the overlap between both sets of lesions was considerable. For example, a Hürthle adenoma had a relatively high SUVmax of 8.9 while on the other side; a papillary thyroid carcinoma had a SUVmax of only 2.8.One of the main goals of our study was to determine whether it would be possible to differentiate between benign and malignant thyroid lesions using SUVmax is highly dependent on the type of PET-CT scanner, reconstruction algorithms and software packages used® mCT used at UMC had a better detector system and time of flight technology compared to the older Philips Gemini 16 GXL. These might be some of the factors resulting in different SUVmax readings at both centres. Therefore, the SUVmax of a thyroid lesion should only serve as one of several parameters that alert the clinician on the possibility of thyroid malignancy. The correct protocol in this situation is, as recommended by the American Thyroid Association Guidelines, to promptly investigate all focal thyroid PET lesions with additional diagnostics.38It should also be noted, that calculated SUV18F-FDG uptake in the thyroid on PET-CT was found in 3.89%. Only focal thyroid uptake represented a malignant lesion in our study – in 15.2% of all focal thyroid lesions. SUVmax should only serve as one of several parameters that alert the clinician on the possibility of thyroid malignancy and as such must be used with caution in the interpretation of PET-CT studies.Incidental


Intestinal parasites are responsible for morbidity in children worldwide, especially in low income countries. In the present study we determine the prevalence of intestinal parasites and explore its association with anemia and stunting in school-aged children.Entamoeba histolytica and Entamoeba dispar. Stunting was assessed using the z-scores of height for age and hemoglobin concentration was determined using a portable hemoglobin analyzing system.A cross-sectional study was conducted from September to October 2010 enrolling 328 children attending the primary school in Lubango, the second largest city after the capital Luanda. Stool samples were collected for parasite detection through microscopy and molecular identification of Ascaris lumbricoides (22.0%), Giardia lamblia (20.1%) and Hymenolepis nana (8.8%). Molecular detection revealed that 13.1% of the children carried E. dispar and 0.3% were infected with E. histolytica. The prevalence of stunting (mild to severe) was 41.5%. Stunting was more frequent in older children , while anemia was more frequent in younger children . The prevalence of anemia was 21.6%, and we found a significant association with infection by H. nana .The global prevalence of pathogenic intestinal parasites was 44.2%, the most common being This is one of the few published studies reporting intestinal parasites infection, nutritional status and anemia in children from Angola. Furthermore, the present work highlights the importance of regular intestinal parasites screening in children. Intestinal parasites are responsible for morbidity and mortality worldwide, especially in low-income countries and in people with other diseases , and areAscaris lumbricoides (65.8%), Trichuris trichiura (54.0%), hookworms (38.7%), Entamoeba spp. (31.2%), Giardia lamblia (19.0%), Taenia spp. (5.8%) and Hymenolepis nana (5.2%) /[Δ2]⌉, where n is the required sample size, Z  = 1.96, p is the prevalence of intestinal parasites in the population which, being unknown, was considered 0.5 and Δ (error) = 0.05. The value was corrected, as follows: n′ = n × [(N − n)/(N − 1)]. The estimated minimum size of the sample was 329 children. Data from 329 children were collected. However, due to the fact that one of them has less than 5 years, 328 children were enrolled.The study population were children aged 5 to 12 years, attending the 3 public primary schools in the community of Lucrécia, Lubango, Angola: Escola Primária N°194 with 1590 children, Escola Primária Abrigo Anjo da Guarda with 382 children and Escola 1° de Dezembro with 651 children, with a total population of 2623 children (N). Sample size was calculated using the following formula: n ≥ ⌈[Alexon-Trend, Inc.), and another portion was conserved in filter paper  for subsequent molecular analysis.The teacher gave to each child parents/guardians a sterile container and explained the procedure for the collection of a single stool sample. A portion of each fresh stool sample was stored in a Eppendorf tube with a storage and transport liquid, Protofix  with child head positioned according to the Frankfurt plane. Z-scores of height for age were calculated using the WHO AnthroPlus software. The height for age is an indicator of stunting, classified as mild (z-scores<-1 and ≥-2), moderate (z-scores<-2 and ≥-3) and severe (z-scores<-3) .HemoCue® AB, Angelhome, Sweden). Classification of anemic or non-anemic children, and subsequently in mild, moderate and severe anemia, was performed according to the reference values adjusted for the altitude [A single measurement of hemoglobin concentration in each child was conducted using a portable hemoglobin analyzing system HB 301+ . Association between two qualitative variables was explored using Chi-square test or the Fisher's Exact test whenever required.p<0.05).The multivariate regression models were applied for the dependent variables, stunting and anemia, included the independent variables for which a statistically significant association was found by binary regression . 52.8% (173/328) were less than 10 years and females represented 56.4% (185/328) of the enrolled participants.A. lumbricoides either in single or mixed infections, detected in 22.0% (72/328) of the children, followed by G. lamblia with 20.1% (66/328) and H. nana with 8.8% (29/328) (E. histolytica was detected in one sample (0.3%) while 43 of the children were carrying E. dispar DNA (13.1%). No statistically significant difference in intestinal parasite prevalence was observed either for sex or age  of the children were infected with at least one species of pathogenic intestinal parasite. Helminths were more frequent than protozoa infecting 24.1% (79/328) vs 13.4% (44/328) of the studied children. Coinfection by protozoa and helminths occurred in 6.7% (22/328) of the enrolled participants. In parallel single infections were more frequent  than coinfections . Globally, the most prevalent parasite was (29/328) . DNA of x or age .The prevalence of stunting was 41.5% (136/328) and was mostly mild. Anemia was detected in 21.6% (71/328) of children and was most frequently moderate. No cases of severe anemia were identified .H. nana, A. lumbricoides (in coinfection) and G. lamblia (in coinfection). Age and infection by H. nana  were significantly associated with anemia  in the binary analysis.Multivariate regression models to explain stunting and anemia were defined using the variables that shown to be significantly associated (p = 0.006). Stunting was more frequent in children aged 10 to 12 years when compared with younger children :1.199–2.967), adjusting for infections   .The analysis of stool samples revealed that 44.2% (145/328) of children in the study were infected with at least one type of pathogenic intestinal parasite. This prevalence is lower than the 80.0% found in the province of Bié, Angola, in a study where 791 children aged 6 to 10 years were enrolled . The difA. lumbricoides was the most prevalent soil-transmitted helminth (22.0%) while the prevalence of other helminths was very low, less than 2% (1.5% for Hookworms and 0.3% for T. trichiura). This could be related to the resistance of the eggs of A. lumbricoides to the type of soil in Lubango, a city located at 1786 meters altitude [A. lumbricoides can withstand over 2 years at temperature of 5–10°C [In our study altitude , as the f 5–10°C . For insf 5–10°C .E. histolytica worldwide remains unknown because very few studies use molecular methods, especially in Africa. The proportion of E. histolytica/E. dispar detected in the present study (1/43) highlights the importance of going beyond microscopy to identify the species of Entamoeba. In a study conducted in Gorgan city, located in northern Iran, 105 dysentery samples from children hospitalized in Taleghani hospital were collected and 25 were positive for Entamoeba complex in direct microscopic examination but PCR using positive controls indicated E. histolytica and E. dispar only in 2 and 3 samples, respectively [E. histolytica is considered pathogenic [The prevalence of ectively . As onlythogenic , these fStunting represents the chronic state of undernutrition  that oftIn the present study stunting was associated to age group, being more frequent in children aged between 10 to 12 years compared to children less than 10 years, which may be related to the fact that older children have lived most troublesome times of food shortages in Angola associated with the period of war that ended in 2002.The measurement of hemoglobin revealed that 21.6% 71/328) of children in the study had anemia. This value is slightly below the 29.7% from a screening carried out in Angola between 1998 and 1999 in 825 children less than 5 years of age . This di of childH. nana infection and previous history of abdominal pain, and H. nana and T. trichiura coinfections to acute malnutrition in children aged ˂ 5 years [H. nana was associated to anemia in the studied children, while another study found that mean value of hemoglobin (%), red blood cells and white blood cells counts and hematocrit (%) showed generalized decrease but without significant difference in H. nana patients and control denoting anemia liability [H. nana infection [The results from a survey of 2168 children aged ≤ 15 years in the Dande municipality in northern Angola suggest an association between  5 years . Our resiability . In a sunfection . Howevernfection .A limitation for this study may be related to the fact that only a single stool sample per child was analyzed and no concentration technique or Kato-Katz was applied, which may underestimate the prevalence of intestinal parasites. However, to minimize this situation each sample was observed in triplicate by two trained microscopists.H. nana and anemia was found. This results are particularly important in the context of health in Angola due to the scarcity of studies on this topic, providing information for the planning and implementation of a control program that links the fight against intestinal parasites, undernutrition and anemia.Almost half (44.2%) of studied children were infected with at least one type of pathogenic intestinal parasite. No statistically significant association between stunting and intestinal parasite infection was observed. A significant association between infection by


Geographic coordinates of the mother’s residence for each birth were linked to the nearest PM2.5 monitoring station and monthly exposure averages calculated. The association between stillbirth and increased PM2.5 levels was estimated, with adjustment for maternal age, race, education level, quantity of prenatal care, smoking, and season of conception.Geo-spatial population-based cohort study using Ohio birth records (2006-2010) and local measures of PM2.5 level in Ohio was 13.3 μg/m3 , higher than the current EPA standard of 12 μg/m3. High average PM2.5 exposure through pregnancy was not associated with a significant increase in stillbirth risk, adjOR 1.21, nor was it increased with high exposure in the 1st or 2nd trimester. However, exposure to high levels of PM2.5 in the third trimester of pregnancy was associated with 42% increased stillbirth risk, adjOR 1.42.There were 349,188 live births and 1,848 stillbirths of non-anomalous singletons (20-42 weeks) with residence ≤10 km of a monitor station in Ohio during the study period. The mean PM2.5 levels is modest, the potential impact on overall stillbirth rates could be robust as all pregnant women are potentially at risk.Exposure to high levels of fine particulate air pollution in the third trimester of pregnancy is associated with increased stillbirth risk. Although the risk increase associated with high PM The stillbirth rate  is higher in the US compared to many developed countries. ,2 The US2.5, fine particulate matter, measures <2.5 μm in aerodynamic diameter. The US Environmental Protection Agency (EPA) has air quality standards for particle pollution, and monitors local levels via stationary monitoring stations throughout the US. The US EPA National Ambient Air Quality Standard (NAAQS) for annual mean level of PM2.5 is currently 12 μg/m3., which is higher than The US EPA National Ambient Air Quality Standard (NAAQS) of 12 μg/m3.[2.5 level, IQR for the entire cohort per trimester was: 1st trimester 13.67, 3.53 μg/m3; 2nd trimester 13.30, 2.96 μg/m3; 3rd trimester 13.05, 3.17 μg/m3; pregnancy average 13.32, 2.35 μg/m3. High PM2.5 level was defined as mean + IQR for each group: 1st trimester 17.2 μg/m3; 2nd trimester 16.26 μg/m3; 3rd trimester 16.22 μg/m3; pregnancy average 15.67 μg/m3.The mean PM12 μg/m3. Mean PM22.5 levels during first trimester of pregnancy were not significantly different for stillbirths compared to the live birth group However, mean PM2.5 levels during the second trimester were slightly lower and during the third trimester were significantly higher for the stillbirth group compared to the live birth group, see 2.5 levels for the entire cohort did not significantly differ between stillbirths and live births, 13.40 ± 1.9 μg/m3 versus 13.32 ± 1.75 μg/m3, p = 0.09. We identified significant correlations between PM2.5 and exposure levels of several other airborne measures of pollutants (p<0.001) including nitrogen dioxide, sulfur dioxide, ozone, carbon monoxide and lead.The mean PM2.5 throughout the pregnancy was not associated with a significant increase in stillbirth risk, adjOR 1.21 . Likewise, the risk was not increased with exposure to high PM2.5 levels in the 1st trimester, adjOR 0.77 , or 2nd trimester adjOR 0.80 . However, exposure to high levels of PM2.5 in the third trimester of pregnancy was associated with 42% increased stillbirth risk, adjOR 1.42 , even after adjustment for important coexisting risk factors for fetal death, 2.5 levels throughout pregnancy or in the second trimester compared to live births. There was minimally decreased stillbirth odds with high 1st trimester exposure. Compared to the 10 km cut-off analysis, there was a slightly more robust effect size of stillbirth odds with high 3rd trimester PM2.5 exposure, adjusted OR 1.54 , see 2.5 exposure was modeled as a continuous variable rather than a dichotomous variable, this finding became non-significant. The relative influence of important coexisting risk factors included in the adjusted analysis of PM2.5 exposure and stillbirth risk is depicted in When analyzing the outcomes for births within 10 km of a stationary monitor, exposure to high levels of PM2.5 exposure (7.48 per 1000 minus 5.2 per 1000) was 2.2 per 1000. The attributable risk percent: (Ie-Iu)/Ie is 30%, i.e. for the exposed population, 30% of stillbirths were from high PM2.5 exposure. Assuming 10% of population was exposed to high PM2.5, the population attributable risk percentage of high PM2.5 exposure is 4% for stillbirth.The attributable risk of stillbirth related to high PM2.5, in the third trimester of pregnancy is associated with increased stillbirth risk. Despite adjustment for important coexisting risk factors for fetal death such as maternal age, race, tobacco use and lack of prenatal care, we found that pregnant women exposed to high levels of PM2.5 during the third trimester of pregnancy had a 42% increased risk of stillbirth. This is a novel finding that has not previously been reported.In this study we found that exposure to high levels of fine particulate air pollution, PM2.5 and several other airborne pollutants (p<0.001) including nitrogen dioxide, sulfur dioxide, ozone, carbon monoxide and lead. However, the differing locations of these stationary monitors across the state of Ohio and fewer numbers of monitors for most pollutants compared to PM2.5 monitors limited our capacity to accurately assess and adjust for high levels of each other pollutant in women who resided within 5 or 10 km of a stationary PM2.5 monitor. Despite this, using individual pollutant-specific stationary monitors to quantify an individual’s air pollution exposure is a commonly used and accepted quality approach of assessing the association between air pollution and birth outcomes.[One significant limitation of this study, and most studies of air pollution on heath complications, is the approach of measuring quantity of exposure through stationary monitor sites. Although these represent a good estimation of hourly, daily, or longer duration average regional air pollution levels, they do not account for variations in personal exposure levels or amount of variation of indoor air quality. This approach also does not take into consideration variations in pollutant levels throughout the geographic metric included in the analysis, which was a 10 km radius from the monitor station in this study, nor is there any adjustment for possible geographic mobility throughout the pregnancy. However, the rate of residential mobility has been estimated to be fairly low, approximately 12% during pregnancy, and the majority of those who do move stay within the same municipality. There isoutcomes.–25 Althooutcomes. Demograpoutcomes. Other vaoutcomes. however,2.5 as a continuous variable in a sensitivity analysis, differing from the significant association when modeled as a categorical variable in our primary planned analysis, may indicate that there is a threshold above which exposure levels increase risk and may not at mid-range exposure levels, and perhaps not in a linear fashion. Our contemporary study cohort (2006–2010), and large population-based sample size  of US births further improved the external validity and generalizability of our findings. Our study is the largest cohort assessing the influence of PM2.5 on stillbirth risk reported to date.Our study also has significant strengths compared to other studies on air pollution and pregnancy complications. Our cohort design and time-based approach considering cumulative daily-monthly pollutant levels and assignment to specific time periods of pregnancy by trimester enabled us to assess which time during fetal development may be the most susceptible to high levels of air pollution. In addition, we utilized data on specific location of residence of each birth in the state and were able to assign accurate regional, temporal exposure levels to each live birth and stillbirth. Furthermore, we performed sensitivity analyses by repeating our analyses to births with home residence within a closer proximity to a stationary monitor, 5 km, and demonstrated consistency of effect. The non-significant association of stillbirth risk with high exposure in the third trimester found when analyzing PM10) which can be found in dusty areas near roadways and some industries. Few studies have investigated fine particulate matter, PM2.5, which is comprised of smoke, haze, and gas emissions. These are the smallest particles in the air with the highest likelihood of being inhaled and subsequently entering the systemic circulation, ultimately causing negative health effects .[Differences in reported effects of airborne particulate matter on birth outcomes in the existing literature may be influenced by differences in populations studied.,10,12 Soth.html).2.5 influences on stillbirth. Similar to our study, prior investigators , estimated the effect of trimester-specific exposures on stillbirth risk.[2.5 exposure in the third trimester and stillbirth, adjOR 1.08 . There are several explanations for the differences in study findings. Our study was significantly larger, by more than 50%, compared to the cohort included in the study by Faiz, et al, increasing our statistical power to detect a difference. The direction of effect in Faiz’s study and our study were similar, both demonstrating a modest risk increase; however, our study demonstrated this as a significant finding with 95% confidence interval greater than the null. An additional explanation may be related to their designation of exposure quantity. In their study, stillbirth risk was measured as an interquartile range increase of PM2.5 exposure, about 4 μg/m3 increase. Our study compared the risk of stillbirth for those women within high PM2.5 exposure, >16–17 μg/m3, versus those with low exposure levels. Assuming that the highest exposure levels may have the most robust effect on adverse outcome, our choice of exposure characterization may have enhanced our power to detect a difference. A more recent study published by the same authors, Faiz et. al (2013), also found no significant association between increased PM2.5 exposure, measured per quartile increase, and stillbirth when quantified as high levels in the immediate few days prior to birth, despite similarly studying a population exposed to high mean levels of PM2.5 (mean exposure levels 14.7–15.0 μg/m3).[10) [Only two prior studies have assessed airborne PMrth risk. Despite 0 μg/m3). and courm3).[10)  and founThe mechanism by which particulate air pollution might negatively affect the fetus through maternal exposure has not been clearly elucidated. The association between particulate air pollution and poor health outcomes in adults has been more definitively established. In adult2.5 exposure in pregnancy is more difficult to postulate. These findings could be influenced by our study design, as only pregnancies progressing past 20 weeks were reliably captured as a birth in the vital statistics birth records, and included in the comparisons of stillbirth versus live birth risk. If high PM2.5 exposure in the first and early second trimester had a robust effect on some particularly vulnerable early pregnancies, resulting in miscarriage, this may have resulted in an underrepresentation of pregnancies vulnerable to PM2.5 exposure with high levels represented in the first trimester in this study. This could have biased risk estimates in those early pregnancy periods toward the null, or even appear protective. An additional hypothesis is there may be underlying pathophysiologic mechanisms by which an early inflammatory stimulus or hypercoagulable state might be protective later against pregnancy complications or other exposures that are known to lead to stillbirth.The relative decrease in stillbirth risk with high levels of exposure in the first trimester of pregnancy, when analyses were limited to birth residences within a 5 km radius of a monitor (data displayed in 2.5 in the air is modest, the potential impact on overall stillbirth rates is robust as all pregnant women are potentially at risk. This may contribute to the higher stillbirth rates in Ohio compared to other states in the US, especially in urban areas. Based on findings from this study, we estimate the attributable risk of exposure to high levels of airborne PM2.5 pollution to be 0.22%. Otherwise stated, 2.2 stillbirths per 1000 may be attributed to increased exposure to PM2.5 in Ohio in those with high PM2.5 exposure. Assuming 10% of population was exposed to high particle pollution, the population attributable risk percentage of high exposure is 4% for stillbirth. These findings may indicate that improving air quality in the US could help to address the high stillbirth rate in our country, especially as compared to many other industrialized nations. [Although the risk increase associated with exposure to high levels of PM


Aim. The present study was conducted to determine the glycaemic effects of sitagliptin in type 2 diabetes patients. Methods. Data was collected from patient medical records of a major teaching hospital in Malaysia, from 2009 to 2012. Glycated hemoglobin (HbA1c) values prior to and up to 12 months after the initiation of sitagliptin were analysed. The change in HbA1c values was accounted for based on a generalized linear model generated using the Generalized Estimating Equations (GEE) method. Results and Discussion. Of the 457 patients, 53.6% were elderly and 81.4% were overweight. The mean HbA1c (standard deviation) before initiation of sitagliptin was 8.5 (1.4)%. This dropped to 7.7 (1.4)%, 3 to 6 months after initiation of sitagliptin, with a mean difference of 0.8% : 0.7–1.0; P < 0.001). However, this value increased to 8.0 (1.7)% after 7 to 12 months on sitagliptin (P = 0.002) with a mean difference from baseline of 0.6% . Conclusion. In routine clinical practice, sitagliptin produces a significant reduction in mean HbA1c (0.8%) within the first 6 months of use which corresponds to efficacy data obtained in controlled clinical trials. However, this reduction was lesser, 7 to 12 month later.  The prevalence of diabetes is increasing worldwide. According to the World Health Organization (WHO), approximately 171 million people have diabetes globally, with 82 million in the Association of South East Asian Nations (ASEAN) region . Subsequ1c) of less than 6.5% (48 mmol/mol) but the American Diabetes Association (ADA) recommended a HbA1c  less than 7% (53 mmol/mol) [1c target despite being on multiple medications. A study in Malaysia reported that only 17.4%  of the patients achieved HbA1c less than 6.5% (48 mmol/mol) [The glycemic goal recommended by the Malaysian Clinical Practice Guidelines (CPG) is a glycated hemoglobin  is the first DPP-4 inhibitor marketed in the United States (USA) and was approved by the Food and Drug Administration of the United States  in October 2006, for the treatment of type 2 diabetes . The inh glucose –14.1c by 0.5 to 0.7% [Studies showed that sitagliptin reduced HbA to 0.7% , 13, 15. to 0.7% , 16. Sit to 0.7% , 17–19.Most of the studies on the effectiveness of DPP-4 inhibitors are controlled trials , 14, 18.A retrospective study was conducted in a major teaching hospital in Kuala Lumpur, Malaysia. All patients prescribed with sitagliptin from 2009 to 2012 were identified from the Pharmacy Information System (PIS) of the hospital and data related to the patients were extracted from the patient medical records. The study was approved by the Medical Ethics Committee of the hospital (MEC reference number 890.32) prior to initiation of the study. A pilot study was conducted to assess the feasibility and practicability of the methodology as well as to ensure that the data collection form was able to gather all the information required to meet the study objectives.Patients included were those with type 2 diabetes who were prescribed with sitagliptin by the teaching hospital within the study period. These patients must have obtained their sitagliptin supply from the hospital more than once and their medical records must be available for data extraction. Patients excluded were those who were on other DPP-4 inhibitors prior to the initiation of sitagliptin and patients prescribed with sitagliptin as first-line drug or were not started on sitagliptin by the teaching hospital under study since patients' data prior to the initiation of sitagliptin would not be available for comparison.1c readings before and 3 to 6 as well as 7 to 12 months after the initiation of sitagliptin. Insulin must not be added to or discontinued from patients medications during the 12-month period.To analyze the effectiveness of sitagliptin, patients must have HbAA list of sitagliptin transactions in the teaching hospital was retrieved from its PIS. Patients who were dispensed with sitagliptin only once were excluded from the list. Duplicated registration numbers were then deleted, leaving only the first transaction of sitagliptin for each patient. The list of remaining patients' names with registration number was submitted to the Patient Information Department of the teaching hospital to retrieve the patient medical records. The medical records were screened and relevant information was extracted and recorded in a preprepared data collection form.1c values prior to and after the initiation of sitagliptin. Patients' HbA1c values were collected at three points: at baseline prior to initiation of sitagliptin, 3 to 6 months, and subsequently 7 to 12 months after initiation of sitagliptin. Other information analyzed included demographic data of patients, medical condition(s), medication(s) and other clinical data before and after initiation of sitagliptin, reason(s) for initiating sitagliptin, and reported side effects or hypoglycaemia episodes.The primary outcome of this study was a change in HbAAll data were entered into and analyzed using the IBM SPSS Statistics for Windows, version 20 . All data were subjected to descriptive analysis which generated frequencies and percentages. For numeric data, the mean (standard deviation) and median were also obtained.1c values obtained at three points during the one-year period from the same cohort of patients were assumed to be “dependent.” Therefore, a generalized linear model was generated to account for the change in HbA1c values using the Generalized Estimating Equations (GEE) method. This model was used to assess any change in HbA1c values with time (due to the initiation of sitagliptin) while controlling for patients' baseline characteristics. The equation is as follows:Yij is the ith patient's HbA1c value measured at the jth time point and εij is the error term that cannot be explained by the model with εij ~ N.Repeated measures of HbA1c and (2) patients with no improvements in HbA1c after using sitagliptin for 7 to 12 months. The same parameters as mentioned in the equation above were analysed using the GEE to test if there is any association between these parameters and the two groups of patients.In addition, patients were divided into two groups: (1) patients with improvement in HbAA total of 904 patients were prescribed with sitagliptin at the major teaching hospital in Malaysia from 2009 to 2012. The number of patients dispensed with sitagliptin showed an increasing trend during the four-year period. However, only data from 457 patients who met the inclusion criteria was analyzed in this study .1c 6.5% (48 mmol/mol) and above) [1c target of 7% (53 mmol/mol) and above, 88.3% of the patients had uncontrolled diabetes. Most of the patients (78.4%) possessed a glucose meter at home and were able to monitor their own blood glucose level if desired.At the time when the patients were started on sitagliptin, 93.8% had uncontrolled diabetes (defined as HbA2 and above) while 48.5% were obese (defined as BMI of 27.5 kg/m2 and above) [Based on the body mass index (BMI), 81.4% of the patients were overweight (defined as BMI 23 kg/md above) . If baseAlmost all the patients initiated on sitagliptin had diabetes for more than 5 years (94.8%). Most of the patients have other comorbidities . Some paSitagliptin was prescribed to substitute patients' current antidiabetes medication in 19.2% of the cases whereas, in most cases (80.8%), sitagliptin was added to the current antidiabetes therapy. Sitagliptin was often added as an adjunct to metformin and sulphonylurea (42.3%).The most common reason for the initiation of sitagliptin was uncontrolled blood glucose even though patients were already on other antidiabetes medications (82.6%). Intolerance to the side effects of other antidiabetes medications (6.1%) such as gastrointestinal disturbances (19 cases) which were associated with the use of metformin and acarbose was also reported. Other reasons were the occurrence of hypoglycemia (5.4%), concern on possible adverse effects of rosiglitazone on the cardiovascular system (2.6%), patients' unwillingness to start insulin (1.6%), nonadherence to insulin (4 patients), difficulty in obtaining rosiglitazone (2 patients), and request by a patient who claimed that sitagliptin has better effect on his blood glucose.1c levels could be obtained for all the three points . Prior to the initiation of sitagliptin, the mean HbA1c (standard deviation (SD)) was 8.5 (1.4)% (69 mmol/mol). After the initiation of sitagliptin, the mean HbA1c value reduced significantly to 7.7 (1.4)% (61 mmol/mol) within the first 3 to 6 months (P < 0.001). Subsequently, after 7 to 12 months, the mean HbA1c value was 8.0 (1.7)% (64 mmol/mol). This is significantly higher than that of the first 3 to 6 months (P = 0.002) but still significantly lower than before the initiation of sitagliptin (P < 0.001). The changes in HbA1c before, 3 to 6 months and 7 to 12 months after initiation of sitagliptin are shown in Effectiveness of sitagliptin was analyzed based on 244 patients whose HbA1c of 0.8% : 0.7–1.0; P < 0.001) within the first 3 to 6 months after the initiation of sitagliptin and a reduction from baseline of 0.6%  after being on sitagliptin for 7 to 12 months. This model also indicates that the patient's baseline HbA1c value was the only factor which has a significant effect on the HbA1c levels of patients after the initiation of sitagliptin.In the presence of missing data among the confounders, only 157 patients could be included in the generalized linear model. Due to the nature of the study design with repeated measures, there were 87 cases (35.7%) with incomplete covariates. These incomplete data were retained in the analysis using multiple imputation approach . This me1c after 7–12 months, whereas 69 patients (28.3%) showed an increase in HbA1c and 9 patients (3.7%) had no change in HbA1c after 7–12 months. The GEE analysis showed similar results when the patients were divided into two groups, that is, those with and without improvement in HbA1c after being on sitagliptin for 7 to 12 months. Only patient's baseline HbA1c value was associated with the two groups.Amongst the 244 patients included in determining the effectiveness of sitagliptin, 166 patients (68.0%) showed an overall reduction in HbA1c below 6.5% increased from 16 patients (6.6%) at baseline to 29 patients (11.9%)  whereas the number of patients with HbA1c below 7% increased from 28 patients (11.5%) at baseline to 68 patients (27.9%) .In addition, the proportion of patients who achieved the recommended glycemic target increased by twofold 7–12 months after the patient was on sitagliptin. After sitagliptin was initiated for 7–12 months, the number of patients who achieved HbAχ2 = 7.591; P = 0.006) after the initiation of sitagliptin. Prior to the initiation of sitagliptin, the mean weight (SD) of 176 patients was 70.9 (17.2) kg. However, 12 months after the initiation of sitagliptin, the mean weight (SD) decreased to 70.4 (17.3) kg, that is, a mean decrease of 0.5 kg  but was not statistically significant.The incidence of hypoglycemia reduced significantly from 61 patients (13.3%) to 40 patients (8.8%)  duration of diabetes of patients prescribed with sitagliptin was 14.9 (7.6) years. This is similar to a study conducted in Taiwan although other studies had shown a shorter duration of 2 to 6 years , 18. Pat1c values in a majority of the patients (88.3% of the patients with HbA1c > 7%) in the present study which was reported in another similar retrospective study [Sitagliptin was added to the existing antidiabetes regimens of most patients due to uncontrolled diabetes. This is consistent with that of other studies , 24, 25.ve study . SitagliIn the present study, 6.1% of the patients were started on sitagliptin when the other antidiabetes medications caused side effects. Sitagliptin is generally well tolerated with minimal adverse effects , 24. Thi1c by 0.6%  after 7 to 12 months. Studies have shown that sitagliptin reduced HbA1c by 0.5% to 0.7% [1c reduction 3 to 6 months after initiation of sitagliptin which is 0.8%  compared to 7 to 12 months later. This indicates that sitagliptin produced the most glycemic effect during the first 6 months but this effect reduced significantly after that (P = 0.002) although still better than before the initiation of sitagliptin. This increment in HbA1c may not be seen in studies which only had two-point measurements of HbA1c (at baseline and at the end of the study). However, studies with more than two-point measurements showed similar effects with the use of sitagliptin [The Generalized Estimating Equations (GEE) model predicted that, on an average, sitagliptin resulted in a significant reduction of HbA to 0.7% , 15. Howagliptin , 27. A sagliptin .1c is higher than that of the present study [In addition, twice as many patients managed to attain glycemic control after the initiation of sitagliptin for 7 to 12 months. Other clinical studies showed similar results although they were carried out specifically to compare the efficacy of sitagliptin with placebo . One recnt study .Mafauzy reported that 26.8% of patients with diabetes in public hospitals in Malaysia conducted self-monitoring of blood glucose . On the 1c of 0.6% which is similar to that achieved by patients on sitagliptin 100 mg in other studies [1c levels. Patients' adherence to their medications could not be ascertained as no adherence assessment was carried out. Dietary habit and exercise could not be controlled, which may have affected the change in HbA1c.There are several limitations in this study. Some data were not available as only information written in the patient medical records could be extracted. The dose of sitagliptin dispensed to the patients could not be standardized and this ranged from 25 to 100 mg, with most patients being on 100 mg. However, a study carried out in Japan showed that patients on sitagliptin 50 mg also showed a reduction in HbA studies . In the 1c value, 3 to 6 months after use. However, this reduction in HbA1c was lesser 7 to 12 month later (0.6%) but still similar to that reported in clinical trials. Further investigations are required to determine if reduced adherence to sitagliptin is the reason for the increase in HbA1c with prolonged usage of sitagliptin.In conclusion, the study provides evidence that sitagliptin produces a significant reduction of 0.8% in the mean HbA


The prevalence of diabetes is increasing among the elderly. In addition to the care needed to maintain appropriate blood sugar levels, it is necessary to understand the disease. Often, this population may be more difficult to understand the risks and other factors related to the disease.Assess the degree of understanding of diabetes without appropriate control in elderly patients. Materials and methods: We performed a Cross study of diabetic patients in the Endocrinology Department of a Brazilian tertiary hospital who were treated between June and December 2014. We include patients over 60 yrs. of age, of both sexes, with HbA1c ≥ 8.5% using oral hypoglycemic agents and insulin. All patients underwent five questions related to satisfaction with the diet and treatment for diabetes. We reviewed the records of patients to assess the previous glycemic control.Forty-five patients were included. Glycated hemoglobin was 10.08±0.31 (12 months before), 10.46±0.32 (six months before) and 10.34±0.22 during the interview. When asked about the lack of clear and concrete goals in diabetes care, 40% of patients responded not have problems. Another 40% considered a serious problem. The other responded intermediate response. On “feel discouraged with the treatment,” only 28% considered a serious problem and 46.7% do not consider a problem. When asked about “diet deprivation”, 20% considered a serious problem, and 48.9% did not have concerns about it. We also ask if the patients were satisfied with their current treatment. 64.4% declared satisfied, and only 4.4% reported being dissatisfied. Other answering “more or less”. The last question was about self-understanding of diabetes. 71.1% say understanding about their illness. Only 6.7% reported not being satisfied.Despite the inappropriate glycemic control, most patients do not understand the severity and stage of disease.


Schistosoma haematobium strains and the severity of the disease.Over 650 million people globally are at risk of schistosomiasis infection, while more than 200 million people are infected of which the higher disease rates occur in children. Eighty three students between 6-20 years (mean 12.45 ± 3.2) from Quran School for boys in Radwan village, Gezira state were recruited to investigate for the relationship between the genetic diversity of Schistosoma haematobium infection was detected by filtration of urine. Ultrasonography was done on each study subject, while PCR technique was used for genotyping via random amplified polymorphic DNA (RAPD) with A01, A02, A12, Y20 and A13 primers. A01 primer gave three different genotypes .S. haematobium egg positive by urine filtration. On assessment of the upper and lower urinary tract by ultrasound technique, 61.4% (51/83) were positiveand73.3% (60/83) samples were PCR positive. No significant difference was found when comparing the three different genotypes with severity of the disease.About 54.2% (45/83) were S.haemtobium and the severity of the disease. Examination of more samples from different areas to identify any possible differences between the parasites genes and disease severity was recommended.This study concludes that no association was found between the different genotypes of The online version of this article (doi:10.1186/1471-2334-14-469) contains supplementary material, which is available to authorized users. Schistosoma is approximately 270 Mbp [S. mansoni genome has a GC content of 34% [S. haematobium in the Planorbidae intermediate host [Schistosoma mansoni infection in naturally infected rodent species revealed even more genetic diversity per infection with as many as 28 specific genotypes per rat [The genome of  270 Mbp , which it of 34% . Numerouate host , 6. RAPDS. haematobium, it is feasible to sample a population of parasites conveniently and arrive at estimates of the frequency of various alleles using RAPD–PCR. The method of schistosome sampling, through single genetic drift, and through limited numbers of infected snails, snail mortality, does play a role, increasing the numbers of snails for haematobium [Although few specific primers for polymorphic regions exist, RAPD-polymerase chain reaction (PCR) technology has made it possible to conduct population-based studies of schistosomes with little prior sequence information . RAPD prmatobium . Knowingmatobium . RAPD prmatobium , 15. As matobium , 16.S.haematobium in Sudan in several irrigation schemes have been constructed e.g. Gezira, Rahad Agriculture Scheme, Ginaid, AL Gerba, Kenana and other sugar cane schemes [S. haematobium within its definitive host, humans. Understanding the genetic structuring of populations at each stage of the life cycle is essential to account for the creation of diversity and its maintenance in natural populations of parasites [S.haematobium and pathology of the disease in school children in Gezira State, Sudan.Distribution of  schemes , also fo schemes . Little arasites . Geneticarasites . The aimThis study was conducted in Roudwan village, located in the south west of Wadmedeni city. This village is a part of Gezira irrigation scheme and surrounded by canals from the south and east. There is only one small health center and no school as most of the children study in Khalwa (Quranic schools). No safe water source is available, and the main source of water is from canals.Quranic School  was selected for this study and the students came from different regions of Gezira state and other states of Sudan such as . They stay up to 15 years to study the Quran. All the students were at risk of infection of schistosomiasis due to the daily exposure to the infection by swimming and daily activities in canal water. Eighty three students aged 6-17 years old were recruited from Hilt Radowan .S.haematobium eggs were detected and egg count recorded as number of egg/10 ml. The remaining urine was centrifuged and the deposit kept at -80°C as preparation for DNA extraction. The students were weighted and all positives for S. haematobium infections were treated with Praziquantel.Urine sample were collected from each students and 10 ml examined by filtration method . S.haemaS.haematobium divided according to the size of bladder wall thickening irregularity, calcification, nodularity, dilatation and ureter thickness, nodularity, dilatation, calcification and kidney dilatation, and echogencity. Classification of severity was done by ultrasonographicas normal or abnormal finding in upper and lower urinary tract.Ultrasonographic examination was done by expert radiologist on each student. Transabdominal ultrasonographic examination of the urinary tract was performed by Aloka (5100) with a 3.5 MHz convex probe and Shimadzu with convex probe 2-5 and 5-10 MHz on all the study subjects after adequate filling of the bladder. Urinary tract and kidneys were examined according to WHO standards . The blaS. haematobium DNA using Random Amplified PCR Reaction (RAPD) test the amplification conditions were based on the original method described by Williams et al (1990). In this study five primers were used for genotyping of S. haematobium strain , primers were selected according to Shiff et al (2000). Amplification reaction was carried out in a final volume of 25 μl and the PCR product determined on 4% polyacrylamide by electrophoresis.DNA extraction was done for all collected samples using QIAamp DNA Mini kit (Germany). Genotyping of Ethical clearance was obtained from National Cancer Institute Research Ethical committee NCI-REC University of Gezira. Prior to conducting the study, aims and all information about the study was explained to community during meetings. Written consent was obtained from the local leaders. All infected subjects were treated immediately after diagnosis.Data was analyzed using SPSS version 16 statistical package. Descriptive, correlation and chi square analysis done in this study.S.haematobium by filtration. The stratification of the age range showed that the high positive frequency was 18% (15) in the age range (9-11 years), as in Figure All of the study subjects were males; the mean age was 12.45 ± 3.2 with age range between 6 - 20 years. The majority of age groups were between 9-11years, 36.1% (30) followed by 12-14years 26.5% (22) as shown in Figure The intensity of infection was classified as egg count <100 eggs recorded as low level infection and between 101-199 eggs as moderate and >200 eggs as high intensity of infection . Forty tEighty three of the Khalwas’ students were diagnosed by ultrasound. The diagnosis included upper urinary tract (Kidneys and ureters) and lower urinary tract (urinary bladder). About 85% 51) of study subjects had pathological changes. Those with abnormalities were 85.9% 49); abnormal wall thickness 56.8% (29) multiple nodularities and 3.9% (2) one polyp as shown in Figure 9; abnorm of studyPCR was done for all urine samples using RAPD test 72.3% (60) study subjects had a PCR product for A01 primer, while no product was detected for the other primers . A01 primer showed three different genotypes mentioned as genotype  in polyacrylamide gel using 100 bp DNA marker polymorphic band in marker 700, 800, 900, 1100 bp Figure .Figure 5S.haematobium, genotype A01 (genotype1) recorded;33.3% (16) study subjects were mild, 20.8% (10) had moderate severity and 20.8% (10) had severe feature of the disease. Genotype A01-2 was recorded 44.4% (4) moderate and 22.3% (2) were severe. There is no significant correlation between Severity of S.haematobium and the genotypes Pearson Chi-Square = 24, P- Value = 0.004 (Table 72.3% (60) were positive by PCR; 80% (48) were genotyped A01- genotype 1, 15% (9) were genotype A01-genotype2 and 5% (3) were genotype A03-3. Correlation between severity and genotype of S.haematobium, genotype A01 (type1) recorded; 25.6% (10) normal and 38.4% (15) mild, 18% (7) had moderate infection severity and 18% (7) had severe clinical feature. Genotype A01-2 had 50% (2) normal and 25% (1) were severe, while 25% (1) were moderate. There is no significant correlation between Severity of S.haematobium and the genotypes Pearson Chi-Square = 4, p = 0.6,  were genotype A01- 1, 9% (4) were genotype A02-2 and 5% (2) were genotype A03-3. Correlation between infection severity and genotype of 9 were geS. haematobium, genotype A01 (type1) recorded;11.1% (1) normal and 22.3% (2) mild, 33.3% (3) had moderate infection severity and 33.3% (3) had severe clinical feature. Genotype A01-2 had 60% (3) moderate and 20% (1) had severe infection, while 20% (1) were normal. There is no significant correlation between infection severity of S.haematobium and the genotypes Pearson Chi-Square = 6, p = 0.3  abnormal wall thickness 56.8%(29) multiple nodularity and 3.9% (2) one polyps and 1.9% (1) wall bladder calcifications. When compared to a similar study from Mali  more irrAnother study conducted in southern Nigeria identified about 6.7% and 1.7% of the patients had the right pelvis and left pelvis of their kidney moderately dilated, respectively ; in contS.haematobium in urine to be more sensitive than filtration technique. A study performed in Ghana using PCR methods for diagnosis reported sensitivity 100% and specificity at 89% [S.haematobium is more sensitive than filtration; this was indicated by 15 study subject in this study found negative by filtration while they were positive by PCR. But the study from northern Senegal showed significant correlation with microscopic egg counts both for S. mansoni in stool and S. haematobium in urine. They found that Schistosoma detection rate of PCR (84.1%) was similar to that of microscopy performed on duplicate stool samples (79.5%) [Schistosomiasis diagnosis by PCR results recorded 72.3% (60) while schistosomiasis diagnosis by filtration methodsrevealed 54.2% (45), this may be due to presence of a small number of eggs that are difficult to diagnose by the microscope. Many studies confirmed the sensitivity of PCR to detect egg of y at 89% , in cont (79.5%) , that maS. haematobium generated by primers G17 and A02, using miracidial isolate from a particular host. Differences in alleles were recorded among the 37 variable bands. In this study, only three variable bands were recorded, and polymorphic region was between 700 and 1100 bp. The small number of variation alleles in this study refer to the samples collection from children infected with schistosomiasis which transmitted to them from the same study area, while [Schistosoma, this can increase the chances of finding more different polymorphic.In this study PCR was done by Using RAPD test 72.3% (60) study subjects had a PCR product for A01 primer, A01 primer showed different three genotypes  80% (48) were genotype A01-1 while 9/60 (15%) genotype A01 - 2 and 5% (3) genotype A01-3, in polyacrylamide gel. Study done by  RAPD fraa, while  study saRAPD primers have been used in several studies to examine the genetic diversity among populations of schistosomes in snails . StudiesS.haematobium and genetic differences may lead to some strains being innately more immunogenic or fecund than others, these differences may play important role in severity features. There are few studies that found the relation between severity and genetic diversity [S. haematobium and clinical outcome. They found that parasite heterogeneity did not differ; allelic frequencies at eight loci differed significantly between the mild and severe groups. Parasite isolates were analyzed further using a modified cluster analysis that segregated the population into 13 clusters of associated genotypes. Three clusters were significantly over-represented in children with severe lesions. Although preliminary parasite genetic associations may be important in clinical outcome , is the most prevalent strain in study area. Difference in genotypes of S.haematobium may play a major role in severity features. However, molecular characterization of strain is needed to identify the type of strain in the area which may facilitate prevention and treatment. More samples from different parts of the state will be collected for future molecular study of the strains.Molecular characterization on


Bronchial asthma is a common and important cause of morbidity in adults. The World Health Organization (WHO) estimates that, the number of people suffering from asthma will exceed 100 million by 2025. Two recent national studies reported the burden of ‘self-reported’ and ‘diagnosed’ bronchial asthma to be 1.8% and 2.5% respectively in adult Indians. The diagnosis of Chronic Obstructive Pulmonary Disease (COPD) and bronchial asthma in developing countries are mostly empirical, and not dependent on ventilatory function evidence.The study aims to measure the burden of reduced predicted forced expiratory volume in one second (FEV1), doctor diagnosed asthma, comparative relation of the two and to assess the role of smoking habits and body mass index (BMI) on both: reduced fev1and doctor diagnosed asthma.2] and classified according the WHO. The study was approved by the Institutional Ethics Committee of Barrackpore Population Health Research Foundation, India.The cross sectional study was conducted among 3575 adult individuals. Subjects were recruited from longitudinal study of urban population cohort in Barrackpore, West Bengal. 'Asthma' was defined as a positive response to the question ‘Has been a doctor ever told you that you have asthma?’. Pulmonary function test was performed by trained and supervised spirometry technicians using computer based electronic spirometers. The predicted level of FEV1 was derived from Global Initiative for Asthma (GINA) guideline. The BMI was calculated by weight and height [weight (kg)/height (m)Overall 3.02%  of the population reported doctor diagnosed asthma, 3.02% male and 3.02% female. Reduced FEV1 (<80% of predicted) was reported in 11.94% (427) in the total study population, 15.45% (210) male and 9.79% (217) female. 319 (8.92%) of participants with FEV1<80% and 39 (1.37%) were FEV1<60% (not previously diagnosed).39.22% of males and 0.22% of females were current smokers. Significant association was seen in the reduced FEV1 (<80% of predicted) in respect of never, former and current smoking (p<0.05) while asthma was not significantly associated with reduced FEV1 (p=0.25).9.51% were found to be obese 4.49% (61 of 1359) male and 12.60% (279 of 2216) female. BMI was significantly associated with reduced FEV1 (p<0.05) but not with doctor diagnosed asthma.The prevalence of reduced FEV1 (<80% predicted) was high compared with doctor diagnosed asthma among the urban adults in the study area. Undetermined and undiagnosed asthma and or chronic obstructive pulmonary disease is an unrecognized significant non-communicable disease burden in this urban Indian community.


Retrospective studies can complement information derived from double-blinded randomized trials. There are multiple retrospective studies reporting good efficacy and tolerability of the anti-epileptic drug levetiracetam (LEV) in human patients with epilepsy; however, reports of LEV's tolerability and efficacy in dogs with epilepsy remain limited. The purpose of this retrospective study was to describe the use of LEV in a canine epilepsy clinic and determine the long-term efficacy and tolerability of LEV in veterinary clinical practice. The electronic database of a UK based referral hospital was searched for LEV usage in dogs with seizures. Information and data necessary for the evaluation were obtained from a combination of electronic and written hospital records, the referring veterinary surgeons’ records and telephone interviews with dog owners. Only dogs that were reportedly diagnosed with idiopathic epilepsy were included in the study.Fifty-two dogs were included in this retrospective study. Two treatment protocols were recognised; 29 dogs were treated continuously with LEV and 23 dogs received interval or pulse treatment for cluster seizures. LEV treatment resulted in 69% of dogs having a 50% or greater reduction of seizure frequency whilst 15% of all the dogs were completely free from seizures. Seizure frequency reduced significantly in the whole population. No dog was reported to experience life-threatening side effects. Mild side effects were experienced by 46% of dogs and a significantly higher number of these dogs were in the pulse treatment group. The most common side-effects reported were sedation and ataxia.LEV appears to be effective and well tolerated for reduction of seizures. Double-blinded, randomized controlled clinical trials to establish efficacy and safety of novel AEDs are of pivotal importance, but are not without limitations due to their often strict dosing and entry requirements, reducing their applicability to the wider population, e.g. geriatric patients or those with multiple co-occurring conditions. In studies of epilepsy treatment in humans post-marketing studies assessing the clinical use of a drug deemed an important tool, with the most valuable data on efficacy and safety thought to be obtained from prospective and retrospective studies that are monocentric, and gather information on long-term anti-epileptic drug therapy in a single centre only ,2. MultiSome of the new AEDs in humans, such as gabapentin, pregabalin, zonisamide and levetiracetam have been trialled in dogs with poorly controlled seizures with variable success -15. LEV,Despite its potential, reports of LEVs tolerability and efficacy in epileptic dogs remain limited. Two recent clinical studies of acute seizures showed that LEV had good seizure suppressing activity in the dog. Dogs receiving LEV 24 h prior to undergoing surgical attenuation of extrahepatic congenital shunts had a significantly decreased risk of postoperative seizures . In anot(i)Describe the way LEV is used to treat epilepsy in a canine epilepsy clinic in a small animal referral hospital.(ii)Evaluate the long-term efficacy and tolerability of LEV in these dogs.The aim of this retrospective study was to:The study was approved by the Animal Care and Ethics committee of the Royal Veterinary College (RVC 2012/P129). The hospital’s electronic records were searched for the terms ‘levetiracetam’, ‘dog’ and ‘epilepsy’ or ‘seizure’ between February 2006 and February 2012. Information and data necessary for the evaluation were obtained from a combination of electronic and written hospital records, the referring veterinary surgeons records and telephone interview with the dog’s owner. Only dogs which were reported in the records to be diagnosed with idiopathic epilepsy  and were administered LEV for ≥3 months were included in the study.Seizures were classified according to the former guidelines of the International League Against Epilepsy, modified for veterinary patients ,27. ClusP < 0.05 being considered statistically significant.Data is presented as median with range and interquartile ranges (IQR). Differences between variables of the two treatment protocols were tested with a Fisher’s exact test for categorical variables and the Mann–Whitney U-test for continuous variables. Within groups, comparisons were performed by McNemar test for categorical data and the Friedman test, followed by the Dunn multiple comparison test for continuous data. Univariate analyses for non-parametric data were used to investigate associations between AED-use prior to LEV and other clinical variables on treatment success (either a >50% reduction in seizure frequency or seizure freedom) using Chi-squared and Mann–Whitney U test for categorical and continuous variables, respectively. All tests were used two-sided with (i)How was levetiracetam used to treat epilepsy in a canine epilepsy clinic?The search of the RVC’s electronic database revealed 128 dogs with epilepsy for which LEV was either recommended or prescribed. Sixty-four dogs fulfilled the inclusion criteria of which six owners did not give consent to participate in the study and from a further six dogs follow-up data could not be gathered, leaving a study population of 52 dogs in total.n = 7), Border collie (n = 5), crossbreed (n = 6), German shepherd (n = 4), Labrador retriever (n = 3), Staffordshire bull terrier (n = 3), Yorkshire terrier (n = 2), Weimeraner (n = 2), German shorthaired pointer (n = 2), Doberman pinscher (n = 2), Cocker spaniel (n = 2), Boxer (n = 2), Bichon Frise (n = 2), Hungarian Viszla, Beagle, Airedale terrier, Jack Russell terrier, Rottweiler, English springer spaniel, Welsh springer spaniel, Cavalier King Charles spaniel, Curly coated retriever and Irish setter (n = 1 each).Breeds represented in the study were Golden retriever .LEV was prescribed for all dogs to improve seizure control apart from one case for which it was prescribed to shorten the post-ictal phase and in five cases it was used as a result of side-effects attributable to KBr and/or PB use .The LEV dose for the maintenance group was 19.5 mg/kg three times daily , for the pulse treatment group the initial dose was approximately three times the 8 hourly maintenance dose of 22.2 mg/kg .P > 0.05).All the dogs in the pulse treatment group experienced cluster seizures and cluster seizures were reported in 83% (95% CI 67.7-98.4%) of the dogs in the maintenance treatment group (P = 0.04). Twenty-four per cent (95% CI 6.6-41.5%) of dogs in the maintenance and 22% (95% CI 3.4-40.6%) in the pulse treatment group had a status epilepticus prior to LEV treatment Long-term efficacy and tolerability of LEV in epileptic dogsNinety per cent of dogs received treatment with an AED prior to LEV Table , with 89P > 0.05).LEV treatment resulted in 69% (95% CI 56.4-81.6%) of dogs having a 50% or greater reduction of seizure frequency with 15% (95% CI 5.3-24.7%) of dogs being free from seizures with a follow up time of 1.2 (0.3-6.4 years) and of 1.4 years (0.3-6.4 years) respectively. There was no significant difference in the number of responders between the maintenance and the pulse treatment group  vs. 74% (95% CI 54.3-93.7%); free of seizures, 7% (95% CI 0–17.4%) vs. 26% (95% CI 6.3-45.7); P > 0.05).Forty-two per cent (95% CI 28.6-55.4%) of dogs had a ≥50% reduction of seizure days frequency with a follow up time of 1.3 years (0.3-6.4 years). There was also no significant difference between the two groups in respect of the number of dogs that had a reduction of seizure days frequency  vs. 52% (95% CI 29.5-74.5%); free of seizures, 7% (95% 0–17.4%) vs. 26% (95% CI 6.3-45.7%); The seizure frequency  and the seizure days frequency (maintenance group) increased prior to LEV treatment compared to before any treatment Figure . LEV redP = 0.02), which was also significant in the pulse treatment group (from 39% (95% CI 17.1-60.9%) to 100%; P = 0.02) but not in the maintenance treatment group (from 59% (95% CI 38.9-79.1%) to 83% (95% CI 67.7-98.4%); P > 0.05). The number of dogs experiencing cluster seizures decreased on LEV treatment from 90% (95% CI 81.9-98.2%) to 27% (95% CI 14.9-39.1%) (P = 0.0001). The dog owners reported that their dog’s seizure severity ; pulse treatment group, 43% (95% CI 20.7-65.3%)) and duration ; pulse treatment group, 30% (95% CI 9.4-50.6%) improved during LEV treatment.The percentage of dogs having cluster seizures increased prior to LEV treatment from 50% (95% CI 36.4-63.6%) to 90% (95% CI 81.9-98.2%) (n = 3) or gabapentin (n = 2) was added after 168 days . One dog did not respond to LEV in the pulse treatment group and topiramate was added after 92 days.Five dogs in the LEV maintenance group did not respond adequately to LEV and zonisamide (P = 0.03). The following side effects were reported to be increased after initiation of LEV treatment; LEV maintenance treatment group: ataxia , polyphagia , sedation , polydipsia , vomiting  and diarrhoea ; LEV pulse treatment group: Ataxia , sedation , polyphagia , polydipsia , aggression  and restlessness .Life-threatening side effects during the follow-up period was not reported in any of the LEV treated dogs. Forty-six per cent (95% CI 32.5-59.6%) of the dogs in the study experienced side effect during LEV treatment. More dogs in the LEV pulse treatment group were reported to have side effects than in the maintenance treatment group (65% (95% CI 43.6-86.5%) vs. 34% (95% CI 14.6-53.4%), Mortality was not significantly different between the maintenance (52% (95% CI 31.6-72.4%)) and the pulse treatment groups (35% (95% CI 15.5-54.5%)) in the proportion of dogs having been euthanized at follow-up. Seventy-four per cent (95% CI 53.7-94.3%) of these dogs were euthanized because the owners perceived the seizure control not to be sufficient.No associations were found between AED-use prior to LEV and treatment success (either a >50% reduction in seizure frequency or seizure freedom), including length of previous epilepsy treatment, time on PB or KBr prior to LEV. There was no difference in seizure frequency or seizure days frequency, or presence of cluster seizures between dogs that achieved a >50% seizure frequency reduction or remission, indicating that pharmacoresponse to LEV is not dependent on seizure type.The results of this retrospective study provide further evidence that LEV is a well tolerated, seizure-suppressing drug in dogs with epilepsy when used as a maintenance or pulse therapy. Spontaneous and drug-induced epilepsy remission rates in human medicine are around 63% , which iNinety per cent of the dogs had cluster seizures prior to LEV treatment. In a recent epidemiological study, 38% of dogs with epilepsy had cluster seizures , howeverThe introduction of the pulse treatment protocol was developed after our former study showed that some dogs develop a tolerance to LEV when used chronically . In humaPulse treatment was associated with more side effects post LEV administration than seen in the maintenance group. This could be secondary to the threefold initial LEV dose (60 mg/kg). Another explanation could be that the owners were not able to discriminate between the side effects caused by LEV and the changes seen as a result of seizures. However, overall the drug was well tolerated. No serious life-threatening side effects were reported. The most common side effects associated with LEV in this study were sedation and ataxia which were around three times more common in the pulse treatment group compared to the maintenance treatment group. This is similar to previous clinical and toxicity studies ,14,23,38In a former study, eight dog owners documented that their dogs became more lively and interactive on LEV treatment . In the A main predictor for drug-resistance is a high seizure frequency prior to treatment ,30,42,43There is no doubt that double-blinded, randomized controlled clinical trials are of pivotal importance to establish efficacy and safety of novel AEDs, however, in recent years studies assessing the use of AEDs in practice are increasingly accepted to provide additional useful data in human medicine. The clinical study population is heterogeneous and as the groups are not as standardized as in a prospective blinded trial, which is a significant limitation when drug efficacy is evaluated. However, it is interesting that despite studying a heterogeneous population, potentially useful data was gathered which showed that LEV has a good tolerability and is potentially efficacious in treating epilepsy in the dog. Based on the current study LEV pulse treatment protocol should be considered as an alternative for LEV maintenance therapy. Future studies are needed to confirm this finding.


Analysis of hemorrhagic fever with renal syndrome cases in Zibo City, China, during 2006–2014 showed that it occurred year-round. Peaks in spring and fall/winter were caused by Hantaan and Seoul viruses, respectively. Rodent hosts were the striped field mouse for Hantaan virus and the brown rat and house mouse for Seoul virus. Hemorrhagic fever with renal syndrome (HFRS) is caused by hantavirus and transmitted primary by rodents .Zibo City is a prefecture-level city located at 36°47′N 118°3′E . The cit2 test for statistical analysis. The research protocol was approved by the human bioethics committee of the Zibo Center for Disease Control and Prevention, and all participants provided written informed consent. HFRS cases were confirmed by detection of hantavirus IgM in patients’ serum with an ELISA kit .We obtained data for HFRS patients from the Zibo Center for Disease Control and Prevention and analyzed these data with Excel 2007  and SPSS 16.0 software  and χDuring 2006–2014, a total of 782 HFRS cases were reported in Zibo City; 9 (1.2%) persons died. The incidence rate of HFRS varied from 0.74 to 3.65 per 100,000 persons annually  . HFRS paHFRS cases peaked twice each year. The spring peak occurred during March–May, and the fall/winter peak occurred during October–December . Serum s2 = 74.40, p<0.0001).The incidence for the fall/winter peak was higher than that for the spring peak for the entire city , 2. Howe2 = 38.01, p<0.0001).The seasonal distribution of HFRS also varied in different years , 2. In 2Ages of the 782 HFRS patients ranged from 7 to 85 years (median 46 years). Most (73.8%) patients were 30–65 years of age, and more than half (51.4%) were 40–50 years of age. Most (68.4%) patients were farmers, and most  lived in the countryside. The male:female ratio was 2.2:1.Of the 9 persons who died, 4 died in October, 3 died in November, and 1 each died in August and September. Five decedents were male. Decedent ages ranged from 33 to 60 years; 3 were 30–49 years of age, and 6 were 50–59 years of age. HFRS was diagnosed 3–8 days (average 5.3 days) after illness onset. The patients died 4–8 days (average 5.9 days) after illness onset.Rattus norvegicus) was the predominant rodent species and had the highest infection rate . The house mouse (Mus musculus) was next in both population and infection rate . Other residential rodents were all negative for hantavirus, including 16 Chinese hamsters (Cricetulus griseus) and 1 striped field mouse (Apodemus agrarius). Among field rodents, the striped field mouse was the most common species and had the highest hantavirus infection rate . Other field rodent species were all negative to hantavirus, including 27 brown rats, 18 buff-breasted rats (R. flavipectus), and 3 house mice. Infection rates for the striped field mouse, brown rat, and house mouse did not differ significantly . The hantavirus antigen–positive rodents were further tested by reverse transcription PCR amplification of hantavirus M segment (http://blast.ncbi.nlm.nih.gov/Blast.cgi) indicated that 13 sequences belonged to SEOV and 6 belonged to HTNV. SEOV-positive rodents were all brown rats from residential areas, and HTNV-positive rodents were all striped field mice from field areas. The reverse transcription PCR–positive rate was 3.3% (13/393) for SEOV in brown rats from residential areas and 10.2% (6/59) for HTNV from field areas.During 2006–2014, we trapped 559 rodents with 21,384 snap-traps in residential area (inside and outside farmhouse) and in fields. The rodents’ lungs were tested for hantavirus antigen with monoclonal antibody  by direct immunofluorescence assay (HFRS consistently occurred in Zibo City and peaked twice: in the spring and fall/winter. The spring peak was caused mainly by SEOV and the fall/winter peak mainly by HTNV. The major animal host of HTNV was the striped field mouse, and the major animal hosts of SEOV were the residential brown rat and house mouse. The house mouse is not considered the animal host of HTNV or SEOV, but this study and recent studies (


This study evaluated the characteristics and results of patients who sufferfrom recurrent implantation failure (RIF).In this cross sectional study, a total of 2183 cases who wereevaluated retrospectively at the Istanbul University Cerrahpasa Medical Faculty, Department of Obstetrics and Gyneacology, IVF unit between 2000-2007. According to the datagathered, we included 1822 cases in this study. We compared 185 patients with RIF to 1637women without RIF.Pregnancy was achieved by 589 couples out of 1822 (32%). The implantation ratewas 10%, which declined to 5.8% after the fourth attempt. In the RIF group, patients’ meanage was higher and there were more overweight women, the duration of fertility was longer,day 3 follicle stimulation hormone (FSH) levels and the total gonadotropin dose administered were higher, mean level of Estradiol (E2) on the human chorionic gonadotropin (hCG)day was lower, and the mean level of progesterone on the hCG day was elevated comparedto the non-RIF group. Although the comparison of MII oocyte number was not significant,the mean number of fertilized oocytes was found to be significant in favor of the non-RIFgroup. The endometrial thicknesses were found to be similar for both groups. Comparisonof sperm motility and morphology were statistically significant in favor of the RIF group.In our study, we have found that the group with RIF were comprised ofpatients with poor prognosis who were older, overweight, had a longer infertility duration, a higher FSH level, and needed more gonadotropin doses in controlled ovarianhyperstimulation (COH). Sperm motility and morphology were better in the RIF groupcompared to the non-RIF group, and multiple pregnancy rates were lower in RIF patients. Resulransfers -6. Curreransfers -6. InTuIn recent years, great advances have beenachieved in the treatment of infertile couples.However despite these advances, there are stillsome infertile couples who suffer from RIF.Probable underlying etiologies for RIF are aneuploidyof embryos, uterine cavity abnormalities,diminished endometrial response, and insufficienciesin transfer techniques . ThesefOur aim was to investigate the characteristicsof our patients who suffer from RIF and to discussthe management protocols in view of theliterature.In this cross sectional study, patients who underwentIVF/ICSI cycles at İstanbul UniversityCerrahpasa School of Medicine, Departmentof Obstetrics and Gynecology, IVF Unit fromJanuary 2000-January 2007 were retrospectivelyreviewed to locate those patients diagnosedwith RIF. A total of 1822 cases out of 2183were included in the study. Of these, 185 RIFpatients were compared to 1637 patients whodid not have RIF. Patients with cycle cancellationand no oocyte during oocyte pick up ormen without sperm at TESE were all excludedfrom the study. The inclusion criteria was: agelimit of 42 years, basal follicle stimulation hormone(FSH) (day 3) level of <20 mIU/mL, and normalgynecological ultrasound and cervical smear.All patients were given a written informed consent.The local Institutional Ethics Committeeapproved the study.st day the of previous cycle (long protocol)or the first day of the cycle (short protocol). Leuprolideacetate was reduced to 0.5 mg/day andgonadotropin 150-450 IU were initiated on the third day of menstruationaccording to age, body mass index (BMI), basalFSH value, and prior ovulation induction trials.All patients received the GnRH agonist leuprolideacetate  beginning onthe 21Controlled ovarian hyperstimulation (COH) wasmonitored by transvaginal sonography, and thegonadotropin dose was adjusted according to folliclesize and number. When three or more folliclesreached >18 mm, we administered 10000 IU ofhuman chorionic gonadotropin  for ovulationinduction.Oocyte aspiration was performed transvaginally,35-36 hours after administration of thehCG injection. During the oocyte pick-up procedure,sedative anesthetics or local anesthesiawas used. Sequential medium was used forembryo culture and transfer. Embryos were selectedfor transfer by pronuclei scoring, cleavagerate, fragmentation, and blastomere equivalencescoring. Assisted hatching was applied toembryos which had thick zona pellucida layers.Quality of embryos and age of the patients werethe main factors in determining the number ofembryos to be transferred. Hard manipulations,bleeding from cervix during the transfer procedure,or the use of a tenaculum were considered"difficult transfer".The luteal phase was supported by progesteroneadministered vaginally three times daily or 100mg progesterone IM injections daily . In appropriatecases, embryos were followed until the blastocystphase and transfer was performed at thattime. Clinical pregnancy was defined as the detectionof a gestational sac on the ultrasound.Implantation rate was defined as the number ofgestational sacs over the number of embryostransferred. Pregnancy rate was defined as thenumber of pregnancies with visible fetal heartactivity on ultrasound examination over thenumber of transferred embryos.Results were expressed as mean ± SD, frequency,and percentages. Analyses were performedby Unistat 5.1 software. Categorical characteristics of patients were compared withthe chi square test. Independent Samples t-testand Mann Whitney U tests were used for comparisonof numeric variables. P<0.05 was consideredstatistically significant.In our study, 589 couples achieved pregnancyout of 1822 (32%). Implantation rates wereas follows: 10% ; 9.6%; 11% ; 5.8% ; 2% , and 6% for >5 attempts (n=75).Success rates diminished significantly after thethird attempt.According to age, implantation and pregnancyrates were 10% and 29.5% under 35 years; implantationrate was 7% and pregnancy rate was25.7% between 35-39 years while implantationrate was 2% and pregnancy rate was 12.8%over 40 years.Subjects had the following diagnoses: tuboperitonealfactor 314), male factor (1320),polycystic ovary syndrome , unexplainedinfertility (50), hypogonadotropichypogonadism , male fa.The group characteristics and results havebeen given in table 2. Non-RIF patients constitutegroup I, which included 1637 cases. GroupII comprised 185 cases of RIF. The mean agewas 32.48 ± 5.24 years in group I and 35.93 ±4.76 years in group II (p<0.0001). Mean durationof infertility was 8.25 ± 5.05 years in groupI and 11.04 ± 5.30 years in group II (p<0.0001).The mean weight of subjects in group I was65.92 ± 10.85 kg and 69.85 ± 11.52 kg in groupII (p<0.003). Mean values for waist circumferenceswere 82.88 ± 10.89 cm in group I and88.12 ± 12.89 cm in group II (p<0.016).Day 3 FSH values were 7.45 ± 3.86 IU/mlin group I and 8.95 ± 6.55 IU/ml in group II(p<0.0001). The total number of 75 IU gonadotropinampules administered was 29.85 ± 13.93 ingroup I and 37.93 ± 15.30 in group II (p<0.0001).Total gonadotropin dose was 2392.45 ± 1209.49IU in group I and 2989 ± 1262.37 IU in group II(p<0.0001).Estradiol (E2) values on hCG day were 2001.95± 1617.75 pg/ml in the first group and 1621.47 ±1184.36 pg/ml in the second group (p<0.003). Themean value of serum progesterone level on thehCG day was 0.96 ± 0.63 ng/ml in group I and3.37 ± 1.48 ng/ml in group II (p<0.001).The mean number of MII oocytes were 4.1 ± 3.5in group I and 3.9 ± 3.9 in group II; there was nostatistical significance between groups. The meanendometrial thicknesses were 10.27 ± 2.45 mm ingroup I and 11.33 ± 1.28 mm in group II, whichwas not statistically significant.The mean number of fertilized oocytes were 4.78± 3.05 in the non-RIF group and 4.13 ± 2.95 in theRIF group (p<0.006). The number of transferredembryos was 3.49 ± 1.4 in the non-RIF and 3.27 ±1.65 in the RIF group (p<0.045).Blastocyst transfers were done in 18 patientsin group I and 7 patients in group II. The meannumber of transferred blastocysts were 2 ± 1.32 ingroup I and 3.14 ± 0.69 in group II (p<0.043). Assistedhatching was applied to 19 patients in groupI and 8 patients in group II.According to Kruger’s criteria, the sperm parametermorphology was 3.81 ± 2.27 % (group II)vs. 3 ± 2.19 % (group I) and motility was 72.32± 20.15% (group II) vs. 66 ± 23.36% (group I)(p<0.001).The values were found to be significantlybetter in the RİF group.The groups were also compared for singletonand multiple pregnancies. In the first group,rates for singleton pregnancies were 13.5%,twin were 5.4%, and triple were 1.9%, whilethey were 8.5% (single), 3.5% (twin), and 0.5%(triple) in the second group. Multiple pregnancyrates were lower in the RIF group compared tothe non-RIF group.Embryo transfer was classified into easy and difficulttransfers. In group I the transfer was easy in91.6% of cases, and in group II it was easy in92.9% of cases. The transfer technique was notsignificant between the groups. Ultrasonographywas used in 52.3% of the transfers in group I and44% of the transfers in group II; there was nosignificant difference.Recurrent IVF failure continues to be an importantproblem and a distressing condition for couples.Despite recent advances in medical technology, implantationrates still remain low. Our implantationrate was reported as 10% for the first attempt anddiminished significantly after the third attempt. Asnoted in the literature, implantation and pregnancyrates decrease after the fourth attempt .In our study, we found that the RIF group consistedof women with poor prognoses. In contrast,sperm morphology and motility were better in thatgroup. Severe male factor was treated successfullyin the first attempts, as they were probably marriedto normal fertile women.Women in the RIF group had advanced meanage, higher day 3 FSH levels, longer infertilitydurations, and a higher mean weight whencompared to non-RIF women. These differenceswere all statistically significant and can be definedas poor prognoses factors for women whounderwent IVF.It has long been known that with increasing agethere is a decline in natural fecundity and pregnanacyrates. Along with the decrease in folliclenumber, the oocyte quality also diminishes .In recent decades, numerous reports regardingthe outcome of ART treatment have confirmed thatthe probability of a live birth decreases distinctly after the age of 35 years .Walsh et al. stated that couples with RIF hadpoor prognosis and the pregnancy rates decreasedfurther over the age of 35 .In our study the mean age of the RIF group was35.93 years, which was older than the non-RIFgroup. Maheshwari et al. have concluded thatolder women were more likely to have a diagnosisof unexplained infertility compared withthose who were younger. They also reported thatthe duration of infertility was more widespreadin older women, which was compatible with ourfindings .Both increasing age and basal FSH were significantlyassociated with reduced numbers of oocytescollected, oocytes fertilized, and embryostransferred. Markers of ovarian reserve, day 3FSH, inhibin B and E2, anti-müllerian hormon(AMH), antral follicle count (AFC) are particularlypredictive and useful in guiding the choiceof the optimal protocol for ART. However, notests have been absolutely predictive of a successfuloutcome. Today there is no technologythat can predict the IVF outcome or estimate theRIF group .In our study we found a statistically significantdifference for weight between the two groups infavor of the non-RIF group. The published dataregarding the effect of body mass index (BMI)on IVF cycles is varied. Some studies highlighteda state of gonadotropin resistance in obesewomen, which lead to higher gonadotropin requirementfor COH . Many stIn our study the numbers of metaphase IIoocytes obtained were similar in both groups, butin the RIF group we used a higher amount of gonadotropinand a lower mean level of E2 on hCGday was calculated.Kably Ambe et al. have shown that E2 levelson hCG day is not an influential factor on pregnancyrates, especially in older patients . IncontIn our study the serum progesterone level onthe hCG day was higher in the RIF group dueto early luteinization. Early luteinization incidencevaries, ranging between 5% and 30% inIVF patients. It may adversely affect the clinicaloutcome and could be related to diminishedovarian reserve. It is not necessarily a LH-dependent event and is observed mostly in womenof advanced age .Concurrent to our study, Ozturk Turhan etal. have reported that in the group whose progesteronelevels were higher than 1.5 ng/mlon the hCG day, mature oocytes, fertilization,and cleavage rates were significantly lower(p<0.05) .Early luteinization leads to more post-matureoocytes at oocyte pick-up and higher progesteronelevels disturb endometrial maturation andintegrity. Furthermore, fewer oocytes are fertilizedand go under cleavage. As a result, theprogesterone level has been shown to be higherin the RIF group and the mean number of transferredoocytes was lower compared to the non-RIF group.Sperm count and motility were better in theRIF group, which lead us to conclude that ourRIF patients constituted abundant, poor responderwomen and accordingly we needed toobtain better quality oocytes and prevent prematureluteinization.We measured endometrial thickness onthe hCG day and did not find any difference.Richter et al. stated that thicker endometriumincreased clinical pregnancy, continuing pregnancyand live birth rates independent fromage and embryo quality . In anotIn our study, more embryos were transferredin patients without RIF. They also had a greaternumber of embryos available for transfer,which was statistically significant (p<0.024). InIVF procedures, the embryo number to be transferredis increased when the patient has adverseprognostic factors such as higher age, poorembryo quality, and RIF. Fewer embryos aretransferred in couples with secondary infertilitythat already have healthy children. Although itis the usual practice to transfer three embryosin Turkey, in couples who obviously have abetter prognosis single embryo transfer is thetreatment of choice. Frequently up to three embryoscould be transferred in the presence ofadvanced maternal age and/or poor embryoquality. However, even in the presence of anobviously positive prognosis, more than half ofthe physicians prefer to transfer three embryos,and the percentage of doctors choosing singleembryo transfer has remained below 15% .The guidelines published in 2006 emphasizedthat embryo transfers yielded more successfuloutcomes if they were performed at the blastocyststage in IVF cycles in order to reduce and preventmultiple pregnancies. It has been determined essentialto transfer one or two embryos for thoseunder 35 years old, a maximum of three embryosfor those between 35-37, three embryos between38-39, and four embryos for those over 39 yearsof age . In TurkIn order to increase implantation rate, moreblastocysts were formed and transferred in theRIF group. Transferring the embryos in blastocyststage resulted in higher implantation andlive birth rates in the RIF group , 29. MarThe practice of assisted hatching was more frequentin the non-RIF group. Sallam et al. concludedthat assisted hatching increased the rates of ongoingpregnancy, implantation and pregnany .CochranAs recommended in the literature, in our unitblastocyst transfer is preferred in appropriate patients,assisted hatching is used for thick zona pellucidas,embryo quality is evaluated by embryoscoring systems, and embryos of the highest qualityare transferred, in order to have a better implantationand pregnancy rate.In the literature, ulitrasound-guided embryotransfer was associated with increased rates ofclinical, ongoing, and live pregnancy rates comparedwith the transfers made without ultrasonographyguidance . In our In our study we found that the group with RIFwas composed of poor prognosis patients whowere older, overweight, had a longer infertility duration,an elevated FSH level, and needed to usemore gonadotropins in COH.Sperm motility and morphology were better inthe RIF group compared to the non-RIF group andmultiple pregnancy rates were lower in RIF patients.In such patients, the RIF probability mustbe taken into account and an appropriate treatmentmust be made individually.