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Background: Phenytoin is the most commonly reported aromatic Anti-Epileptic Drug (AED) to cause Cutaneous Adverse Drug Reactions (CADRs). Cutaneous adverse drug reactions may be immune or non-immune mediated. It has been observed that predisposition is multifactorial and that gene mutations alone cannot be the cause. Objectives: In this study, we investigated the patient, disease, and drug-related risk factors associated with phenytoin-induced cutaneous adverse drug reactions in South Indian epileptic patients. Methods: This study was conducted as a single-center prospective case-control study over a period of 13 months. The Fisher’s exact test and multivariate binary logistic regression analysis were used to test the association of single and multiple variables, respectively. Results: This study comprised 26 patients with phenytoin-induced cutaneous adverse drug reactions (PHT-CARDs) and 32 phenytoin-tolerant controls with a mean age of 40.60±18.15 and 36.21±14.71 years, respectively. Among 26 phenytoin-induced cutaneous adverse drug reactions, 76.92% cases were mild-moderate reactions and 23.07% were severe. The onset latency period of these reactions ranged from 7-42 days. The multivariate analysis showed that multiple AEDs (OR =18.62, 95% CI 4.28-80.87, p=< .001) and comorbidities (OR= 5.98, 95% CI 1.33-26.78, p=.01) are risk factors for PHT-CADRs. PHT-SCARs were shown to be associated with previous allergy history (OR= 31, % CI 2.40-398.8, p=.008). Conclusion: The risk factors found to be associated with CARDs in South Indian Epileptic patients are multiple AEDs, comorbidities, and past allergic history. Therefore, physicians and other associated health care professionals should closely monitor the patients when phenytoin is employed.

Objectives/hypothesis Radiation-associated sarcomas of the head and neck (RASHN) are known but rare sequelae after radiation for squamous cell carcinoma. The purpose of this study was to characterize RASHN, estimate the risk of RASHN in head and neck squamous cell patients after therapeutic radiation, and compare their survival to that of patients with de novo sarcomas of the head and neck (dnSHN). Study design Retrospective database analysis. Methods RASHN and dnSHN cases were collected from the Surveillance, Epidemiology, and End Results Database to identify risk factors and calculate incidence and latency. Survival was compared between RASHN and dnSHN. Results The risk of RASHN was 20.0 per 100,000 person-years. The average latency period was 124.2 months (range 38-329). The cumulative incidence of RASHN at 20 years was 0.13%. Oral cavity and oropharynx primaries demonstrate increased risk. Five-year overall survival of RASHN was 22.4% compared to 64.5% for dnSHN. Conclusions RASHN are confirmed to be rare. RASHN have poor overall survival and worse survival compared to dnSHN. The impact of intensity-modulated radiation therapy protocols on this risk is unknown. Modifiable risk factors of smoking and alcohol consumption continue to dwarf radiation therapy as risk factors of second primary head and neck cancers. Level of evidence 3 Laryngoscope, 2021.

Background Drug reaction with eosinophilia and systemic symptoms (DRESS) is a cutaneous and systemic drug allergy disorder. Patients exist on a severity spectrum, with some experiencing a mild form of the disorder that fails to meet the Registry of Severe Cutaneous Adverse Reactions (SCAR) to Drugs diagnostic criteria for DRESS. Objective We sought to determine whether there were any cutaneous or dermatopathologic features that discriminate between the mild form of DRESS (DRESS minor) and the severe phenotype (DRESS major). Methods Hospitalized patients from a single center with a diagnosis of DRESS were prospectively recruited over a 7-year period. Clinical and dermatopathologic features were analyzed to discriminate between DRESS minor and DRESS major. Results Forty-five patients were included, of whom 19 had a Registry of Severe Cutaneous Adverse Reactions (SCAR) to Drugs score of ≤3 (DRESS minor) and 26 had a score of ≥4 (DRESS major). The mean latency period (P = .001), fever >38.5 °C (P = .001), and a reaction lasting >15 days (P = .010) discriminated DRESS major from DRESS minor. Facial edema was the sole discerning cutaneous feature (P = .025). Discriminating histopathologic features included basal squamatization (P = .005), dermal red blood cell extravasation (P = .009), and interface inflammation (P = .005). Conclusion We propose a new classification system—DRESS minor—to distinguish the milder illness from the severe form, DRESS major. Facial edema and certain histopathologic features can help discriminate between major and minor versions.

Low grade fibromyxoid sarcoma (LGFMS) is an uncommon variant of fibrosarcoma with high risk of local recurrence, immense metastatic potential and frequently protracted period between tumour presentation and metastasis. This unusual malignancy rarely affects the region of the head and neck which makes cases of laryngeal LGFMS extremely infrequent. To date, LGFMS of the larynx has been scatteredly mentioned in the literature. Neither incidence nor causes and risk factors for laryngeal LGFMS have been clarified so far. To the authors’ knowledge, this is the first case report that discusses the clinical course, imaging diagnosis, histopathological evaluation and surgical approach to radiation-induced laryngeal LGFMS. We present a case of a 70-year-old man who developed a LGFMS after previous radiotherapy (RT) for squamous cell carcinoma (SCC) of the larynx. The latency period between the time of radiation exposure and the diagnosis of LGFMS was twenty-seven months. After re-confirming the diagnosis with second biopsy and extensive imaging evaluation the patient was subjected to an open partial resection of the larynx. Owing to the rarity of the tumour, there is no established protocol with follow-up recommendations. This case highlights the importance of considering the RT history of the patient in order to monitor radiotherapy-related complications, including the occurrence of LGFMS.

Study design Longitudinal study. Objectives To describe the severity of spinal cord injury/disease (SCI/D), type and management of neurogenic lower urinary tract dysfunction, tumor characteristics, and bladder cancer latency period in SCI/D patients. Setting Spinal cord injury centers in Germany, Austria, and Switzerland. Methods Data of SCI/D patients diagnosed with bladder cancer were collected between Jan 2012-Dec 2019 in the course of annual surveys in the neuro-urological departments of all 28 centers. Demographic and paralysis-specific data, data on the type and management of neurogenic lower urinary tract dysfunction, and histopathological tumor characteristics were collected. Results Regarding histopathological tumor characteristics, no significant differences were found in 135 individuals with SCI/D when stratified for bladder management without chronic catheterization, SCI/D severity, and ASIA classification. The mean latency period between the onset of SCI/D and the diagnosis of bladder cancer was significantly longer in patients with catheter-free emptying methods compared to patients with intermittent catheterization, and in patients with LMNL (Lower Motor Neuron Lesion) compared to patients with UMNL (Upper Motor Neuron Lesion). Conclusions Urinary bladder carcinomas are late events in the long-term course of SCI/D. Follow-up and approaches to screening must therefore be intensified with increasing duration of long-term SCI.

In France, in 2017, the foster care system is taking care of more than 177 000 children, adolescent or young adults (DREES, 2019). They suffer from a complex symptomatology which has consequences on every aspect of their development. A better understanding of the psychological impact of past, present and future separations could improve their support. This doctoral research aims to study the representations of separation in children in foster care during their latency stage. Our methodology is based on the Grounded Theory (Glaser & Strauss, 1967), a qualitative approach, but also on projective medias such as the drawing and the Tales Test (Royer, 1978). We also study the transference and counter-transference mechanisms during these meetings. We have met 14 children aged 7 to 11, each one of them 3 times. In these interviews, we have found 5 categories linked to this topic: the powerlessness of the child, a failing environment, a split temporality, the irrepresentability of affects and the internal world, discontinuities in the link to others and to the self. The drawings and the Tales Test showed difficulties in representation and mentalization, but also violence and death-linked mechanisms about the concept of separation. These children undergo a real self-transformation which force them to live in a parallel life from others. We have to help them by rethinking this topic at several levels: therapeutic, educative and institutional.; En 2017, en France, plus de 177 000 enfants, adolescents et jeunes adultes sont accueillis dans des institutions ou des familles d’accueil (DREES, 2019) suite à une mesure de placement. Ils rencontrent de nombreuses difficultés qui ont des répercussions sur de multiples pans de leur développement. Une meilleure compréhension des enjeux sur le plan psychique des séparations passées, présentes et futures permettrait ainsi d’améliorer leur prise en charge. Cette recherche doctorale vise donc à étudier les représentations de la séparation chez des enfants d’âge de latence placés en protection de l’enfance. Notre méthodologie est basée sur la Grounded Theory (Glaser & Strauss, 1967), une approche qualitative, mais également sur l’utilisation d’outils projectifs (le dessin, le test des contes de Royer, 1978) et sur l’analyse des mouvements transféro-contre-transférentiels. Nous avons ainsi rencontré à trois reprises 14 enfants de 7 à 11 ans. À partir de ces entretiens, nous avons dégagé cinq catégories qui illustrent les mouvements psychiques en lien avec cette question : l’impuissance de l’enfant placé, un environnement défaillant, une temporalité clivée, l’irreprésentabilité des affects et du monde interne, les discontinuités dans le lien à l’autre et à soi. Le dessin et le test des contes ont montré les difficultés de représentation et de mentalisation de ces enfants et l’émergence de mouvements violents et mortifères à l’évocation de cette notion de séparation. Ces enfants vivent une véritable transformation identitaire les condamnant à vivre une vie en parallèle de celles des autres. Il est donc primordial de mettre en place une authentique réflexion et prise en compte de cette question, à la fois au niveau thérapeutique, éducatif et institutionnel.

Objective Preterm prelabour rupture of membranes occurs in over one third of pregnant women with a cervical cerclage in situ. In the setting of preterm prelabour rupture of membranes, clinicians are faced with the difficult decision of the optimal timing for removing the cerclage. We compared the maternal and neonatal outcomes following immediate removal or retention of the cervical cerclage. Study design Women were retrospectively identified from St Thomas’s Hospital Preterm Surveillance clinic database. Asymptomatic women with preterm prelabour rupture of membranes were identified and separated into those that had the cerclage removed and those that had the cerclage retained within 24 h of presentation. Women who were symptomatic at presentation and who delivered within 24 h of presentation were excluded from the analysis. Maternal outcomes measured were latency between preterm prelabour rupture of membranes and delivery, gestation at delivery and maternal chorioamnionitis and infection markers. Neonatal outcomes including birthweight and Apgar scores were also measured. Results 43 women with cerclage retained for over 24 h following preterm prelabour rupture of membranes were compared to 25 women in whom the cerclage was removed. The latency between preterm prelabour rupture of membranes and delivery was on average 70.4 h longer in women who had their cerclage retained compared to the removed group (p = 0.009). Rates of chorioamnionitis, maternal blood results, neonatal birthweight and Apgar scores did not differ significantly between the two groups, however a trend towards higher rates of chorioamnionitis (60 % vs 45 %) were seen in the retained group. Conclusion Cervical cerclage retention in women following preterm prelabour rupture of membranes was associated with a longer latency period to delivery and was not significantly associated with any adverse obstetric, maternal or neonatal outcomes. Therefore, in women at risk of spontaneous preterm birth, cerclage retention may be beneficial, however these women and their babies should be monitored closely for any signs of infection. Further prospective randomised controlled studies assessing these outcomes as well as longer-term outcomes in these women and their children are needed.

The use of combination drug therapy instead of monotherapy is a new positive and promising approach in the treatment of cancer. Oxidal® and Pyrucet® are food supplements containing Methylene blue (USP), Caffeine (USP), Salicylic acid (USP) and Ethyl Acetoacetate and Ethyl Pyruvate respectively. The therapeutic significance of each of these compounds (their derivatives) is well established, but no data are available on their combined action in in vivo experimental tumor models. The aim of the present study was to investigate the in vivo protective effect of mono- and combined experimental therapy with dietary supplements Oxidal® and Pyrucet® in the Graffi myeloid tumor model in hamsters. For this purpose, the two drugs were administered alone or in combination in two treatment regimens - prophylactic (before) and therapeutic (simultaneously) with the transplantation of Graffi tumor cells. The protective effect was determined by the biometric parameters of tumor growth (transplantability, tumor size, mortality, mean survival time, survival rate) recorded during the experiment. The results showed a favorable effect of both drugs, administered alone or in combination, before and simultaneously with the transplantation of tumor cells on the appearance and development of Graffi tumor in hamsters. About 2-fold lower transplantability, prolongation of the latency period by 7 days, inhibition of tumor growth till 30thday of experiments, reduced mortality and increased individual and overall survival time between 7 to 10 days were observed in the Graffi tumor-bearing hamsters with experimental therapy compared to control-Graffi tumor-bearing hamsters, without therapy. The obtained data revealed that Oxidal® and Pyrucet® could be a promising candidate for the treatment of tumor diseases.

BACKGROUND Prior studies have confirmed the ability of posterior cranial vault distraction osteogenesis (PVDO) to expand the intracranial volume in patients with craniosynostosis. To date, there is scant literature on the optimal distraction protocol for PVDO. The authors sought to review the literature and define a common protocol for posterior cranial vault distraction. METHODS The authors performed a systematic review for published PVDO protocols. The data collected from these studies included age at the time of PVDO, number of distraction devices placed, time for latency, rate and rhythm of distraction, distraction length, time for consolidation, and surgical outcomes. RESULTS A total of 286 patients were identified within 24 studies from 2011 to 2019. The mean age of patients identified was 25.34 months. After application of distractors, latency period ranged between 1 and 7 days, with most patients undergoing 5 to 7 days of latency. Once distraction was begun, the majority of patients (77.4%) underwent 1 mm of distraction daily. Total lengths of distraction ranged between 13 and 35 mm, with the largest cohort of patients undergoing 26 to 30 mm of total distraction. A total of 60 complications were reported for a total of 212 patients, yielding an overall complication rate of 28.3%. CONCLUSIONS Although there is variability in reported PVDO protocols, the majority are similar to distraction osteogenesis protocols described for long bone sites. Increased patient age correlates with selection of a greater latency period and total distraction length, while frequency of complications is also increased.

Objective Prophylactic or emergency type cervical cerclage procedures are being used for treatment of cervical insufficiency. The aim was to review and compare the outcomes of these cerclage types and identify factors affecting outcomes. Material and methods Retrospective review of seventy-five patients in whom transvaginal cervical cerclage procedures were performed over a seven-year period in a tertiary referral center. Results Twenty seven of 75 (36%) patients were in the emergency cerclage group and 48 (64%) of them were in the prophylactic group. Mean body mass index (BMI), hospitalization time and gestational week at cerclage were significantly higher, whereas latency period was significantly shorter for the emergency group. Mean gestational ages at delivery were 35.6±4.5 and 33.6±5.9 weeks in the prophylactic and emergency groups, respectively (p=0.117). Delivery rates under 34th gestational week were 20.8% and 37.0% in the prophylactic and emergency groups, respectively (p=0.175). Birthweight, and delivery ≥34th gestational week was higher in the prophylactic group, whereas complication rate was higher in the emergency group, but these differences were not significant. High BMI was associated with more deliveries before 34-week in the prophylactic group. Pre-cerclage cervical length was shorter in patients who delivered before 34 gestational weeks at delivery. Conclusion Prophylactic and emergency cerclage procedures have comparable results regarding gestational week at delivery. High BMI and low pre-cerclage cervical length may have adverse effects on success of cerclage procedures.

Basal cell carcinoma (BCC) has been linked mostly to ultraviolet radiation exposure, but ionizing radiation has also been implicated in the genesis of a subset of BCCs occurring after radiotherapy. We present a 93-year-old woman with 4 BCCs of the scalp after radiotherapy for tinea capitis, diagnosed after a latency period of over 80 years. The largest lesion was located on the right temporal region and corresponded to a BCC of mixed type, with nodular, infiltrative, and micronodular components. We performed genomic study with array comparative genomic hybridization in samples from each BCC, which revealed more imbalances in the largest lesion than in the remaining ones, correlating with its higher histological complexity. Furthermore, this was the only lesion presenting loss at 2p22.3, where is mapped the BIRC6 gene associated with regulation of apoptosis, and loss at 16q24.3, where is mapped FANCA gene, responsible for DNA repair and maintenance of chromosome stability. Despite these differences, there were aberrations shared by all tumor samples, suggesting a common genetic signature. Our report describes, to the best of our knowledge, the longest latency period between exposure to radiotherapy and the diagnosis of BCC. The genomic study showed imbalances common to all tumor samples but also differences that could explain their heterogeneity in terms of histological subtype and biological potential. In addition, these differences could also be a consequence of different times in the evolution of the lesions at the moment of presentation, thus having a diverse combination of accumulated genomic imbalances.

A recent meta-analysis of five case–control studies and one cohort study reported that exposure to glyphosate was associated with increased risk of non-Hodgkin’s lymphoma (NHL). The meta-analysis was based on estimates of risk from the included studies at the highest reported exposure level obtained from analyses with the longest lag period. The extent to which the summary estimate depends upon the exposure definitions and assumed latency period is uncertain. We carried out sensitivity analyses to determine how the definition of exposure and the choice of latency period affect the summary estimate from meta-analyses of the 6 studies included in the recent meta-analysis. We also conducted a meta-analysis of ever-exposure to glyphosate incorporating the most updated results from the case–control studies. The summary estimates of risk varied considerably depending on both the assumptions about exposure level and latency. Using the highest reported exposure levels, evidence of an association between glyphosate and NHL was strongest when estimates from analyses in the cohort study with a 20-year lag [RR = 1.41 (95% CI 1.13–1.76)] and a 15-year lag [RR = 1.25 (95% CI 1.01–1.25)] were included. In our meta-analysis of ever-exposure with no lag period, the summary relative risk with updated estimates was 1.05 (95% CI 0.87–1.28). The results of meta-analyses of glyphosate exposure and NHL risk depend on assumptions made about both exposure level and latency period. Our results for ever-exposure are consistent with those of two recent meta-analyses conducted using somewhat different study inclusion criteria.

This study was carried out to evaluate the antitumor activity of Metformin (Met) and its impending utility to potentiate the chemotherapeutic action of doxorubicin on 2-amino-1-methyl-6-phenylimidazo[4,5b]pyridine (PhIP)-induced rat mammary carcinogenesis. Female Sprague -Dawley (SD) rats were divided into seven groups (n = 15 each). Mammary carcinogenesis was induced by the administration of PhIP at a dose of 75 mg/kg by gavage. Met treatment was 2 mg/ml in drinking water for 26 weeks started after the last PhIP dose. Doxorubicin (Dox) treatment started after one month of the last PhIP dose with a dose of 4 mg/kg, i.v. once per week for 4 weeks. Compared to the PhIP group, the latency period of tumors in the PhIP+Dox, PhIP+Met, and PhIP+Dox+Met groups were significantly increased and tumors' incidences and multiplicities were significantly reduced. By immunohistochemistry, carcinomas from the combination treatment groups showed a significant decrease in the labeling indexes (LI%) of cellular proliferation and CD44 compared to the PhIP group while LI% for ERα was significantly decreased in all combination treatment groups compared to the PhIP-administered group. Moreover, the quantitative mRNA expression of ERα was significantly decreased in mammary tumors from PhIP + Dox+Met combined group more than the PhIP + Dox group. However, mRNA expression of EGF was found significantly lower in all combination treatment groups compared to the PhIP group. These findings suggest that Metformin potentiate the antitumor efficacy of doxorubicin and had beneficial effects on PhIP-induced mammary carcinogenesis through the prevention of cellular proliferation and mRNA expression of ERα and EGF.

This study was conducted to investigate the effect of different doses injection of human chorionic gonadotropin (HCG) hormone on stripping response and reproductive performance of African catfish (Clarias gariepinus). African catfish spawners were intramuscularly injected with different doses of HCG (500, 1500, 3000, 6000 IU/kg female); males were injected at half the female dose. The results showed that fish group injected by 6000 IU/ kg female had the highest ovaries weight and gonadsomatic index, but, recorded the lowest value from ovulated egg diameter. The lower latency period was recorded with 6000 IU/ kg female (12 h). While, the highest latency period were in 500, 1500 IU/ kg (28 h) and 3000 IU/ kg (22 h). The number of fertilized eggs/ female and fertilization rate (%) were significantly different (P£0.05) among the experimental treatments, with the highest number of fertilized eggs/ female and fertilization rate were observed with 6000 IU/ kg female (60848 fertilized eggs/ female with 84.45%) and the lowest number of fertilized eggs/ female and fertilization rate were presented with 500 IU/ kg female (3372 fertilized eggs/ female with 10.15%). The number of larvae/ female and hatching rate showed significant differences (P£0.05) among different level of HCG hormone with the highest number of larvae and hatching rate with 6000 IU/ kg female (49657 larvae/ female with 81.45%) followed by those 3000 IU/ kg female (43177 larvae/ female with 73.65%), 1500 IU/ kg female (12099 larvae/ female with 57.9 %), while the incubation eggs of group injected with 500 IU/ kg female don’t show any hatching larvae. It was observed, HCG hormone has successfully and accelerate induced spawning in African catfish (Clarias gariepinus)and increased in reproductive performance with the increase in HCG dosage.

Little is known about the physiology of latent Mycobacterium tuberculosis infection. We studied the mutational rates of 24 index tuberculosis (TB) cases and their latently infected household contacts who developed active TB up to 5.25 years later, as an indication of bacterial physiological state and possible generation times during latent TB infection in humans. Here we report that the rate of new mutations in the M. tuberculosis genome decline dramatically after two years of latent infection (two-sided p, Here, Colangeli et al. use a human household contact cohort to measure the rate of mutation and evolution of Mycobacterium tuberculosis strains and find that long term latency is characterized by reduced mutation rates compared to latency in the first year, coinciding with clinical risk of developing active TB.

Objectives: To investigate association of amniotic fluid index (AFI) with perinatal fetal and maternal outcomes in pregnancies complicated by preterm premature rupture of membranes (PPROM) Material and methods: A total of 70 singleton pregnancies complicated by PPROM at 23–33 weeks’ gestation were enrolled in this prospective observational study. Data on maternal clinical and obstetric characteristics [maternal age, gravidity, parity, PPROM time, and AFI (cm), latency period, treatments, type of delivery, length of hospital stay (LOS, day)], fetal characteristics (gestational age at delivery, birth weight (g), gender) and maternal and fetal complications were recorded and compared in AFI < 5 cm (n = 27) and AFI ≥ 5 cm (n = 21) groups. Results: Overall AFI was ≤ 5 cm in 27 (56.3%) patients and > 5 cm in 21 (43.7%) patients. No significant difference was noted in maternal clinical and obstetric characteristics, gestational age at delivery and gender of the newborn as well as in maternal and fetal complications rates with respect to AFI groups. AFI was correlated positively with latency period (r = 0.399, p = 0.018) and negatively with postpartum LOS (r = –0.314, p = 0.030). Conclusions: In conclusion, our findings seems to indicate increased likelihood of shorter latency to delivery and longer postpartum LOS with decrease in AFI after PPROM between 23–33 weeks’ gestation, whereas no impact of AFI on mode of delivery and fetal or maternal complications.

The present study was conducted to ascertain the effects of using farmed and wild Clarias gariepinus (CG) pituitary hormones on the fecundity, percentage hatchability, and survival rates after induced propagation, explicitly indicating the induction with high-quality seeds. Twelve gravid female and twelve matured male CG from farmed and wild sources (weight range of 711–841 g) were used for the study. The samples were put into four treatments, namely, F♀ × F♂ (farmed-female induced with farmed-male), F♀ × W♂ (farmed-female induced with wild-male), W♀ × F♂ (wild-female induced with farmed-male), and W♀ × W♂ (wild-female induced with wild-male). Females under each treatment were injected with 2-ml pituitary gland solution and stripped eggs fertilized with their respective male milt. Mean weight (28.6 ± 1.14–41.12 ± 1.87 g) and the total number (9266 ± 120.74–13,252 ± 240.92 eggs) of stripped eggs after 14-h latency period for treatment F♀ × F♂ was significantly higher (P

OBJECTIVE Trigeminal neuralgia (TN) is a chronic pain condition that is difficult to control with conservative management. Furthermore, disabling medication-related side effects are common. This study examined how stereotactic radiosurgery (SRS) affects pain outcomes and medication dependence based on the latency period between diagnosis and radiosurgery. METHODS The authors conducted a retrospective analysis of patients with type I TN at 12 Gamma Knife treatment centers. SRS was the primary surgical intervention in all patients. Patient demographics, disease characteristics, treatment plans, medication histories, and outcomes were reviewed. RESULTS Overall, 404 patients were included. The mean patient age at SRS was 70 years, and 60% of the population was female. The most common indication for SRS was pain refractory to medications (81%). The median maximum radiation dose was 80 Gy (range 50–95 Gy), and the mean follow-up duration was 32 months. The mean number of medications between baseline (pre-SRS) and the last follow-up decreased from 1.98 to 0.90 (p < 0.0001), respectively, and this significant reduction was observed across all medication categories. Patients who received SRS within 4 years of their initial diagnosis achieved significantly faster pain relief than those who underwent treatment after 4 years (median 21 vs 30 days, p = 0.041). The 90-day pain relief rate for those who received SRS ≤ 4 years after their diagnosis was 83.8% compared with 73.7% in patients who received SRS > 4 years after their diagnosis. The maximum radiation dose was the strongest predictor of a durable pain response (OR 1.091, p = 0.003). Early intervention (OR 1.785, p = 0.007) and higher maximum radiation dose (OR 1.150, p < 0.0001) were also significant predictors of being pain free (a Barrow Neurological Institute pain intensity score of I–IIIA) at the last follow-up visit. New sensory symptoms of any kind were seen in 98 patients (24.3%) after SRS. Higher maximum radiation dose trended toward predicting new sensory deficits but was nonsignificant (p = 0.075). CONCLUSIONS TN patients managed with SRS within 4 years of diagnosis experienced a shorter interval to pain relief with low risk. SRS also yielded significant decreases in adjunct medication utilization. Radiosurgery should be considered earlier in the course of treatment for TN.

To compare pregnancy outcomes in women with pPROM and a cervical cerclage in whom the cerclage was removed within 24 h and those in whom the cerclage was retained in situ. A two-center retrospective cohort study of women with a singleton gestation with pPROM at 48 h (87.2% vs. 65.2%, p = 0.03; aOR 3.9, 95% CI 3.1–4.9) or > 7 days (29.8% vs. 8.7%, p = 0.04; aOR 7.0, 95% CI 2.5–19.6) compared with women in whom cerclage was removed. Furthermore, chorioamnionitis rate was lower in the cerclage retention group compared to cerclage removal group (aOR 0.7, 95% CI 0.5–1.0). There were no differences between the groups in early neonatal sepsis, severe brain injury, or composite neonatal outcome. In women with pPROM and cervical cerclage, retention of cerclage may be associated with a longer latency period, and a lower chorioamnionitis rate, without an associated increase in the risk of neonatal infectious morbidity. Presentation information: The abstract of this study was presented as a poster at the 38th SMFM (Society of Maternal and Fetal Medicine) annual meeting, February 2018, Dallas, Texas, USA.

We report a 55-yr-old woman who presented with bilateral ovarian masses, 11 yr after hysterectomy for superficially invasive stage IA1 cervical adenocarcinoma of usual (human papillomavirus-associated) type. The bilateral ovarian tumors were composed of glands lined by malignant mucinous epithelium and these tumors were metastases from her previous cervical adenocarcinoma, based on morphology, immunophenotype, and positive in situ hybridization for human papillomavirus. In addition, there was extensive involvement of the mucosa of the left fallopian tube by malignant mucinous epithelium. The patient is alive and well 2 yr after the ovarian recurrence. The phenomenon of minimally invasive cervical adenocarcinoma metastasizing to the ovary has been described previously; the extrauterine disease is typically limited to the ovaries and associated with a relatively favorable prognosis. The presence of fallopian tube involvement by cervical adenocarcinoma has rarely been reported, and suggests transtubal spread of tumor. Unique to this case is the >11 yr interval between diagnosis of the cervical and ovarian disease, with previously described cases showing up to a 7 yr latency period. This case demonstrates that spread of cervical adenocarcinoma to the ovaries, via the fallopian tube lumen, can occur after a very long latent period and this possibility must be considered when examining adnexal mass(es) in women who have previously had a hysterectomy for cervical adenocarcinoma.

Background The aim of this study was to integrate the available data published on radiation-induced sarcoma of the oral cavity into an analysis of its clinical features, treatment modalities and prognostic factors. Methods An electronic search was undertaken in September 2019. The eligibility criteria included publications that had enough clinical and histological information to confirm the diagnosis. Results Forty-two publications with 122 radiation-induced sarcoma of the oral cavities (RISOCs) were included. The mean latency period was 114 months and mean radiation total dose was 62.5 Gy. The tumors were more prevalent in males between 50 and 60 years old and the mandible was the most affected site. Osteosarcoma was the most prevalent histological type and patients were mostly treated with radical surgery. Conclusions RISOC showed a poor survival rate of 15.1% in 5-year follow-up. Gender and histological type were independently associated with survival.

The author discusses some aspects of the impact of our changing society on the latency phase, while presenting a clinical case. At this age, children need a reliable environment, protecting them fr...

Graphical abstract, Highlights • DBP intoxicated F3 progeny scored low in sensorimotor-indices than F1 and F2. • A higher behavioural discrepancy in F3 progeny and subjects committed more errors. • Correlates between hormonal milieu and behavioural indices signify vulnerability of developing animals. • Deceptive cholinergic functionary was apparent in experimental rats. • Marked neuronal degeneration in CA1 and CA3 and severe hyperplasia in the dentate gyrus region were evident., Di-n-butyl phthalate (DBP) cause significant deficits in cognition and memory, however the neuroanatomical basis for impairments remain poorly understood. This study evaluates neurobehavioral changes in rats for three successive generations between non-siblings by administering DBP at 500mg/kg bw dose through oral gavage from gestation day-6 to 21 and lactation (3-weeks). Weaning period evaluations and developmental deficits assessed showed variations specific to generation and the toxic potential of DBP was confounded by behavioral deficits that include changes in sensorimotor development reflex response, poor performance, low memory retention and greater latency period. The cytoarchitectural alterations witnessed in hippocampus include condensed nuclei, vacuole formation and remarkable degeneration, shrinkage of pyramidal neurons in CA1 and CA3 regions; disorganized hilar cells and hyperplasia in dentate gyrus. Comparatively, the enlisted changes were high in subsequent generations than preceding and correlates assessed between cognitive impairment(s) and endocrine function confirm a link indicating vulnerability of immature animals as target to disrupt neural and endocrine functions.

Objective: Preterm premature rupture of membranes (PPROM), associated with prematurity, is an important obstetric complication that may cause neonatal mortality and morbidity. The optimal delivery ...

Glomerulonephritis, secondary to bacterial, or, more rarely, viral or parasitic infections, is called infection-associated. The epidemiology of infection-associated glomerulonephritis has changed in recent decades. For a long time, the classic form has been acute poststreptococcal glomerulonephritis (APGN), but in developed countries its incidence has declined sharply. However, there is an increase in staphylococcal associated glomerulonephritis (SAGN). The clinical manifestations of APGN and SAGN are different: APGN typically presents with a glomerulonephritis after an infectious latency period (post-infectious), while SAGN typically shows an immune complex glomerulonephritis concomitant with infection (para-infectious). SAGN often presents with an occult infections in older patients with multiple comorbidities.

This study sought to compare the latency from membrane rupture to delivery and subsequent neonatal outcomes in twin gestations complicated by preterm premature rupture of membranes (PPROM) of the presenting versus non-presenting sac.This was a retrospective study of twin pregnancies over a 7-year period diagnosed with PPROM between 12 and 37 weeks gestation with a latency period to delivery of24 hours. The ruptured sac was identified by ultrasound scan. The study compared the latency period from PPROM to delivery and subsequent neonatal morbidity and mortality resulting from rupture of the presenting versus non-presenting sac. Obstetric and neonatal outcomes were evaluated using a matched-cohort subset analysis (Canadian Task Force Classification II-2).During the study period, 77 twin pregnancies diagnosed with PPROM satisfied the inclusion criteria. The mean latency periods from PPROM to delivery were 10.1 days (n = 7) when the presenting sac ruptured and 41.3 days (n = 10) when the non-presenting sac ruptured (P 0.05). Neonatal death was higher with PPROM of the presenting than the non-presenting sac (21.4% vs. 0%, respectively; P = 0.05). Neonates were more likely to be affected by retinopathy of prematurity (57% vs. 19%; P 0.05) but less likely to have persistent pulmonary hypertension of the newborn (0% vs. 25%; P 0.05) when the rupture occurred in the presenting sac. The rates of other neonatal adverse outcomes were similar between the two groups.In twin gestations there is a longer latency from PPROM to delivery and fewer neonatal complications when rupture occurs in the non-presenting rather than the presenting sac.

Introduction. After exposure to radiation, an increase in the long-term of cerebrovascular pathology is noted in exposed individuals. Cognitive impairments have a growing importance in the pattern of cerebrovascular diseases which significantly deteriorates social and medical forecast of a patient.The objective of the research is to study cognitive evoked potentials in exposed persons with chronic cerebral ischemia (CCI).Materials and methods. Two groups of patients were examined: the main group consisted of 69 persons exposed to radiation as a result of the “Mayak” PA activity, the comparison group included 110 unexposed residents of the Techa riverside settlements who were diagnosed with chronic cerebral ischemia. The following methods were used in the study: clinical, evaluation method of cognitive evoked potentials (EP), and statistical methods.Results. In the course of clinical examination, it was revealed that the number of people with organic cognitive impairment and syndrome of cognitive decline is statistically significantly higher in the group of the exposed persons with CCI (p < 0.001, p = 0.003, respectfully). It was stated that the studied groups were statistically significantly different in N1 peak latency (ð = 0.030), N2 – P3 inter-peak latency (p = 0.003), N2 – N3 inter-peak latency (p = 0.011).Conclusion. According to the results of clinical examination and study of cognitive EP, cognitive impairments are more expressed in the group of the exposed persons with CCI which is manifested in an increase in the number of patients with syndrome of cognitive decline and organic cognitive impairment in this group; in the change of a latency period of a number of components that characterize both the perception process and the very process of recognition and decision-making.

Background: Preterm prelabor rupture of membranes (PPROM) is a major cause of Pretem Birth (PTB), Pretem Birth (PTB) is the most significant cause of perinatal morbidity and mortality worldwide. Cervical length (CL), posterior uterocervical angle (PUCA) and anterior uterocervical angle (AUCA) have been postulated in several studies to have an important role in prediction of PTB. Up to our knowledge, this is the first study that combines the three cervical parameters in prediction of latency period in women with PPROM. Aim of the Work: To assess the accuracy of cervical length, posterior uterocervical angle and anterior uterocervical angle in prediction of latency period in women with Preterm prelabor rupture of membranes. Subjects and Methods: A Prospective cohort study on 205 women with PPROM was held at Ain Shams University Maternity Hospital, a transvaginal ultrasound was performed to measure cervical length, posterior uterocervical angle, anterior uterocervical angle. Results: A total of 205 pregnant women with PPROM were included in this study, the latency grade was within 2 days in 57 (27.8%) of cases while was after 2 days in 148 (72.2%) of cases. As regards cervical length cut-off value 25.0 mm, sensitivity was 78.9%, specificity was 65.5%, posterior uterocervical angle cut-off value 108.0°, sensitivity was 93.0%, specificity was 60.1%, and anterior uterocervical angle cut-off value 106.0°, sensitivity was 93.0%, specificity was 71.6%. Conclusion: The combination of cervical length (CL), posterior uterocervical angle (PUCA) and anterior uterocervical angle (AUCA) measurements greatly predicts the latency period in women with PPROM, and Anterior uterocervical angle (AUCA) ≥ 106.0° had the highest diagnostic value in predicting latency period within two days.

At the beginning of a COVID-19 infection, there is a period of time known as the exposed or latency period, before an infected person is capable of transmitting the infection to another person. We develop two differential equations models to account for this period. The first is a model that incorporates infected persons in the exposed class, before transmission is possible. The second is a model that incorporates a time delay in infected persons, before transmission is possible. We apply both models to the COVID-19 epidemic in China. We estimate the epidemiological parameters in the models, such as the transmission rate and the basic reproductive number, using data of reported cases. We thus evaluate the role of the exposed or latency period in the dynamics of a COVID-19 epidemic.

Disease development in plants is strongly dependent on weather conditions, with temperature playing a particularly significant role by influencing latency period duration. Using two models describi...

To describe the perinatal outcomes of twin pregnancies with preterm premature rupture of membranes (PPROM) before 34 weeks’ gestation and identify factors associated with discharge without severe or moderate-severe neonatal morbidity. This study was conducted as a retrospective analysis of twin pregnancies with PPROM occurring at 24 0/7 to 33 6/7 weeks’ gestation. Perinatal outcomes were assessed by gestational age (GA) at PPROM and compared between PPROM and non PPROM twins. Factors associated with discharge without severe or moderate-severe neonatal morbidity were identified using logistic regression analysis. Of the 180 pregnancies (360 foetuses), only 17 (9.4%) women remained pregnant 7 days after PPROM. There were 10 (2.8%) cases of prenatal or neonatal death; 303 (84.2%) and 177 (49.2%) neonates were discharged without severe or moderate-severe morbidity, respectively. As GA at PPROM increased, the adverse obstetric and neonatal outcomes decreased, especially after 32 weeks. There was no significant difference in general neonatal outcomes between PPROM and non PPROM twins. The GA at PPROM and latency period were both significantly associated with discharge without severe or moderate-severe neonatal morbidity. Pregnancy complications and 5-min Apgar score

This study evaluated the time trends in mobile phone subscriber number by mobile network generation (G) and brain cancer incidence by type in Korea. We obtained data from the Information Technology Statistics of Korea (1984-2017) and Korea Central Cancer Registry (1999-2017). The average annual percent change was estimated using Joinpoint regression analysis. We evaluated 29,721 brain cancer cases with an age-standardized incidence rate (ASR) of 2.89/100,000 persons. The glioma and glioblastoma annual ASR significantly increased in 2.6% and 3.9% of males and 3.0% and 3.8% of females, respectively. The ASR for frontal lobe involvement was the highest. The ASR of gliomas of unspecified grade annually increased by 7.8%; those for unspecified topology and histology decreased. The incidence of glioma, glioblastoma, frontal, temporal, and high-grade glioma increased among those aged ≥60 years. No association was observed between the mobile phone subscriber number and brain cancer incidence in Korea. Furthermore, long-term research is warranted because of the latency period of brain cancer. © 2021 Bioelectromagnetics Society.

Importance Owing to improved survival among US patients with prostate cancer (PC), patients tend to live long enough after a PC diagnosis for non–cancer-related comorbidities to be associated with their overall survival. Although studies have investigated causes of death among patients with localized PC, data are lacking regarding causes of death among patients with metastatic PC. Objective To assess causes of death among US patients with metastatic PC from 2000 to 2016. Design, Setting, and Participants This retrospective cohort study used data from the Surveillance, Epidemiology, and End Results Program database to analyze a sample of 26 168 US men who received a diagnosis of metastatic PC from January 1, 2000, to December 31, 2016. Data were analyzed from February 2 to July 28, 2020. Exposure Diagnosis of metastatic PC. Main Outcomes and Measures Standardized mortality ratios (SMRs) for different causes of death were calculated by dividing the observed number of deaths from each cause of death by the expected number of deaths in the age-matched US male population for the same period, adjusting for age and race/ethnicity. Results Of 26 168 patients with metastatic PC included in the analysis, 48.9% were aged 50 to 70 years (mean age at diagnosis, 70.83 years); 74.5% were White individuals, and 72.7% received a diagnosis of stage M1b metastatic PC. A total of 16 732 patients (63.9%) died during the follow-up period. The mean age at death was 74.13 years. Most deaths (59.0%) occurred within the latency period of 2 years after diagnosis of metastatic PC, whereas 31.6% occurred 2 to 5 years after diagnosis and 9.4% occurred more than 5 years after diagnosis. Of the total deaths, 13 011 (77.8%) were from PC, 924 (5.5%) were from other cancers, and 2797 (16.7%) were from noncancer causes. During all latency periods, the most common noncancer causes of death were cardiovascular diseases (SMR, 1.34; 95% CI, 1.26-1.42), chronic obstructive pulmonary disease (SMR, 1.19; 95% CI, 1.03-1.36), and cerebrovascular diseases (SMR, 1.31; 95% CI, 1.13-1.50). Conclusions and Relevance In this cohort study, deaths from noncancer causes, including cardiovascular disease, constituted a substantial number of deaths among men with metastatic PC. Therapy and follow-up should be tailored to the needs of each patient with metastatic PC, and counseling regarding future health risks should be provided.

Background: Patient-derived xenograft (PDX) models have been a focus of attention because they closely resemble the tumor features of patients and retain the molecular and histological features of diseases. They are promising tools for translational research. In the current systematic review, we identify publications on PDX models of cervical cancer (CC-PDX) with descriptions of main methodological characteristics and outcomes to identify the most suitable method for CC-PDX. Methods: We searched on PubMed to identify articles reporting CC-PDX. Briefly, the main inclusion criterion for papers was description of PDX created with fragments obtained from human cervical cancer specimens, and the exclusion criterion was the creation of xenograft with established cell lines. Results: After the search process, 10 studies were found and included in the systematic review. Among 98 donor patients, 61 CC-PDX were established, and the overall success rate was 62.2%. The success rate in each article ranged from 0% to 75% and was higher when using severe immunodeficient mice such as severe combined immunodeficient (SCID), nonobese diabetic (NOD) SCID, and NOD SCID gamma (NSG) mice than nude mice. Subrenal capsule implantation led to a higher engraftment rate than orthotopic and subcutaneous implantation. Fragments with a size of 1–3 mm3 were suitable for CC-PDX. No relationship was found between the engraftment rate and characteristics of the tumor and donor patient, including histology, staging, and metastasis. The latency period varied from 10 days to 12 months. Most studies showed a strong similarity in pathological and immunohistochemical features between the original tumor and the PDX model. Conclusion: Severe immunodeficient mice and subrenal capsule implantation led to a higher engraftment rate; however, orthotopic and subcutaneous implantation were alternatives. When using nude mice, subrenal implantation may be better. Fragments with a size of 1–3 mm3 were suitable for CC-PDX. Few reports have been published about CC-PDX; the results were not confirmed because of the small sample size.

Objective Pituitary carcinoma is a rare tumor, defined as a tumor of adenohypophyseal cells with systemic or craniospinal metastasis. We present a case of a growth hormone (GH)-secreting pituitary carcinoma with a review of literature to better characterize this disease. Design Case report and literature review of 25 cases of GH-secreting pituitary carcinomas Results The age of diagnosis of GH-secreting carcinomas ranged 24–69 years old with a mean age of 44.4 with 52% of cases present in females. Mean latency period between diagnosis of acromegaly and transition to pituitary carcinoma was 11.4 years with mean survival being 3.4 years. Conclusion Growth hormone (GH)-secreting pituitary carcinomas are rare and hard to distinguish from aggressive pituitary adenomas. From review of literature, treatment options include debulking surgery, radiotherapy, or chemotherapy with dismal outcomes. There are no diagnostic markers or features which can predict metastatic progression of these tumors. Future studies with genomic landscapes and relevant tumor markers are needed to identify pituitary tumors most likely to metastasize.

Epilepsy is one of the most frequent neurological disorders characterized by an enduring predisposition to generate epileptic seizures. Oxidative stress is believed to directly participate in the pathways of neurodegenerations leading to epilepsy. Approximately, one-third of the epileptic patients who suffer from seizures do not receive effective medical treatment. Sodium valproate (SVP) is a commonly used antiepileptic drug (AED); however, it has toxic effects. Lutein (L), a carotenoid, has potent antioxidant and anti-inflammatory properties. The aim of this study was to determine the neuroprotective effect of sodium valproate (SVP) and lutein (L) in a rat model of pilocarpine- (PLC-) induced epilepsy. To achieve this aim, fifty rats were randomly divided into five groups. Group I: control, group II: received PLC (400 mg/kg intraperitoneally), group III: received PLC + SVP (500 mg/kg orally), group IV: received PLC + SVP + L (100 mg/kg orally), and group V: received (PLC + L). Racine Scale (RC) and latency period to onset seizure were calculated. After eight weeks, the hippocampus rotarod performance and histological investigations were performed. Oxidative stress was investigated in hippocampal homogenates. Results revealed that SVP and L, given alone or in combination, reduced the RC significantly, a significant delay in latency to PLC-kindling onset, and improved rotarod performance of rats compared with the PLC group. Moreover, L was associated with a reduction of oxidative stress in hippocampal homogenate, a significant decrease in serum tumor necrosis factor-alpha (TNF-α) level, and inhibition of cerebral injury and displayed antiepileptic properties in the PLC-induced epileptic rat model. Data obtained from the current research elucidated the prominent neuroprotective, antioxidant, and anti-inflammatory activities of lutein in this model. In conclusion, lutein cotreatment with AEDs is likely to be a promising strategy to improve treatment efficacy in patients suffering from epilepsy.

Background: Parkinson's disease was described for the first time by James Parkinson in 1817 in the trial "Shaking Palsy," and thus there is also evidence of this disease in the Indian medical system 4500 years ago, for the diagnosis and its management with Mucuna pruriens.Years later, it was subsequently determined to contain levodopa. Two types of manifestations of Parkinson's disease are currently known, such as motor and non-motor, the first being the one that usually leads to diagnosis. Success in this will depend on the skill of the primary care physician, the ability to recognize the first symptoms by the patient, and the health systems in the management of care for the timely referral. This work shows the comprehensive management of a patient who arrives at Primary Care services, presenting vague and specific symptoms. These symptoms were treated with medications or remedies in order to calm the condition temporarily. It is convenient to call the specific symptoms such as headache, nausea, pain, dizziness, tiredness and weakness, poor motivation, sadness, easy crying, and sleep disturbances; A large percentage go to their health centers for presenting motor alterations, many times identified by their relatives or by themselves and despite being recognized as something abnormal, many of them come when the tremor intervenes with the activities of daily life. At this point, the management of the disease would begin, making clear the importance of education for the population to attend abnormal situations on time and not in late stages, significantly improving the quality of life or the prognosis of the disease Parkinson's, as is the case that occurred in our institution; A 64-year-old female patient who presents with tremor in the fifth finger of the right hand, she mentions that it is more intense when there are apparently stress situations, hyposmia and sleep disturbances, going to different health centers where they were controlled the discomfort with essential medications, many of these not requiring a prescription, temporarily decreasing in intensity; This being the beginning of multi-causality for proper management from considering the first contact doctor as a resource manager with the use of diagnostic skills to recognize characteristic signs in early stages of the disease and the ability to maintain continuity with the patients and their families as a model of family system. Studies were determined that non-motor manifestations could appear months or years before they manifest as motor symptoms to give comprehensive management to patients from their first contact with the health centers closest to them. The diagnostic presumption and its referral to the neurology and timely treatment service, until evaluating the functionality and efficacy of health policies, avoiding the delay in pharmacological treatment and access to specific neuroimaging studies at any stage of the disease. Objective: The objective of this report is to present a clinical case of a patient diagnosed with Parkinson's disease, from its management in the first contact medical services to have comprehensive management by a neurologist, thus in this way the period of latency to start treatment. Methods: We present a clinical case of a 64-year-old patient who came to consultation due to a tremor in the fifth finger of the right hand.A review of her medical history is performed, and management by different specialties is identified, for mood disorders, insomnia, essential tremor in addition to allergic rhinitis, already with drug treatment with slight or no improvement. The patient underwent a neurological examination and imaging and laboratory studies. She was referred to the neurology service as soon as possible. Result: After the interrogation and physical examination, the patient was referred to the Neurology service to confirm the presumption of diagnosis as a movement disorder under study. This process is often called the "latency period" of the diagnosis. The present work is shown as a decisive factor in giving a verdict on this problem. It is known that this level of resolution takes into account the pillars of first contact medicine as health resource managers. In this way, pharmacological treatment was started with a decrease in tremor as a motor symptom and an increase in quality and amount of sleep, increased mood, and affect as non-motor symptoms. Conclusion: The patient is under established medical and pharmacological control, and the long diagnostic latency period could be evidenced, as it usually happens in many movement disorders or their early stages, in this case, Parkinson's disease. Likewise, the family doctor is an instrument that allows the resolution of more than 90% of health problems in general, and the proper management of the remaining percentage is multifactorial, as well as medical skill and experience, the capacity of the patient or the family members. in recognizing early-stage motor disorders and health systems that often make a referral to other medical specialties difficult.

Background and Objectives: Pre-term premature rupture of membranes (PPROM) responds for one third of preterm births, and it is associated with other complications that increase the risk of maternal or fetal poor outcome. To reduce uncertainty and provide accurate information to patients, the analysis of the large series is of great importance. In order to learn about the evolution over the time of the obstetric and perinatal outcomes in cases of PPROM at, or before, 28 weeks (very early PPROM) managed with an expectant/conservative protocol, we have designed the present study.&nbsp, Materials and Methods: We retrospectively studied all cases of very early PPROM attended in Malaga University Regional Hospital from 2000 to 2020. Results: Among 119888 deliveries assisted, 592 cases of PPROM occurred in pregnancies at or before 28 weeks (0.49% of all deliveries, 3.9% of all preterm births and 12.9% of all cases of PPROM). The mean duration of the latency period between PPROM and delivery was 13.5 days (range 0 to 88 days), enlarging over the years. The mean gestational age at delivery was 27 weeks (SD 2.9, range 17–34). The proportion of cesarean deliveries was 52.5%. The overall perinatal mortality rate was 26.5%, decreasing over the period with a significant correlation Pearson’s coefficient −0.128 (p &lt, 0.05). Conclusions: In the period 2000–2020, there was an improvement in the outcomes of very early PPROM cases and perinatal mortality showed a clear trend to decrease.