ABSTRACT
Background: Intraabdominal adhesions are associated with an increase in complications during cesarean section because of recurrent cesarean sections. This is why the possibility of predicting adhesions is important. In this study, the diagnostic value of depressed scar, severe striae gravidarum, and negative sliding sign, and their combinations were evaluated for predicting intraabdominal adhesions of cesarean candidates. Methods: This prospective descriptive study was performed during 2019-2020 on 123 pregnant women referred to Ayatollah Taleghani university hospital with a gestational age of ≥36 weeks 0 days who were candidates for cesarean section because of a previous cesarean section. In each patient, the presence of a depressed scar, a severe striae gravidarum, the absence of a sliding sign, and the presence and severity of adhesions during the operation were examined. Sensitivity and specificity, and positive and negative predictive values of each of the 3 indicators and their combinations were calculated. Results: The frequency distribution of severe adhesion in these individuals was 16.27%. The highest sensitivity was related to depressed scar and negative sliding sign (65%). The highest specificity was related to the negative sliding sign and its combinations (97%-99%). The highest positive predictive value was related to negative sign sliding and its combinations (81%-92%). The negative predictive values of depressed scar, negative sliding sign, and severe striae gravidarum, and even their combinations were almost the same and approximately between 89% and 93%. Conclusion: To predict the presence of adhesions in a cesarean candidate because of a previous cesarean section, you should first examine the striae gravidarum and scar. In the absence of a depressed scar and severe striae gravidarum, there is a 90% chance of no adhesions. According to this study, if both signs are present, it is recommended to check the sliding sign to obtain a more accurate estimate.
ABSTRACT
PURPOSE: Multi-drug-resistant tuberculosis (MDR-TB) is simultaneously resistant to isoniazid and rifampin. Of course, this germ may also be resistant to other anti-tuberculosis drugs. Patients with extensively drug-resistant tuberculosis (XDR-TB) are also resistant to all types of fluoroquinolone and at least one of the three injectable medications: amikacin, clarithromycin, or kanamycin, in addition to isoniazid and rifampin. Therefore, the main objective of the current study was to evaluate and compare the computed tomography (CT) scan findings of MDR-TB and XDR-TB patients. MATERIAL AND METHODS: In this comparative descriptive cross-sectional study 45 consecutive TB patients who referred to Masih Daneshvari Hospital, Tehran, Iran from 2013 to 2019 were enrolled. TB was diagnosed based on sputum smear and sensitive molecular and microbial tests. Patients were divided into two groups (MDR-TB and XDR-TB) based on two types of drug resistance. CT scan findings were compared for cavitary, parenchymal, and non-parenchymal disorders. The early diagnostic values of these factors were also calculated. RESULTS: Findings related to cavitary lesions including the pattern, number, size of the largest cavity, maximum thickness of the cavity, lung involvement, number of lobes involved, and the air-fluid levels in the two patient groups were similar (p > 0.05). Parenchymal findings of the lung also included fewer and more nodules of 10 mm in the MDR-TB and XDR-TB groups, respectively. Tree-in-bud, ground-glass-opacity, bronchiectasis, cicatricial emphysema, and lobar atelectasis were similar in the two patient groups (p > 0.05). Findings outside the parenchymal lung, including mediastinal lymphadenopathy and pericardial effusion, showed no statistically significant difference between the MDR-TB and XDR-TB groups (p > 0.05). Parenchymal calcification was more common in the XDR group than in the MDR group (64.7% and 28.6%, respectively) with a significant difference (p = 0.01). CONCLUSIONS: CT scan findings in patients with XDR-TB are similar to those of patients with MDR-TB for cavitary, parenchymal, and non-parenchymal lung characteristics. However, patients with XDR-TB tend to have more parenchymal calcification and left-sided plural effusion. CT characteristics overlap between XDR-TB and those with MDR-TB. It can be concluded that CT scan features are not sensitive to the diagnosis.
