SELEKTIVNI FETICID – NAUČENE LEKCIJE I BUDUĆI IZAZOV

The paper reviews cases of fetal reduction done for high order multi-fetal pregnancies, over a course of four years (2004 – 2008) at Hamad Medical Corporation, in Doha, Qatar. The aim is to find out the success of the procedure, its outcome, any related complications to both the mother or the fetuses and wheather or not it has any relation to the method of the procedure or the gestational age at which it was done. Material. There were seven cases done out of which five were successful. The other two cases declined to have another trial of reduction. Our results have shown that fetal reduction is a successful procedure with minimal affection of the fetus and the mother. It also decreases the rate of high order multiple gestation complications and prolongs the pregnancy to near maturity. Conclusion. Based on the results of the study the procedure should be offered to all high order gestations.Članak prikazuje slučajeve fetalnih redukcija u mnogoplodovih trudnoća, učinjene u četverogodišnjem razdoblju (2004–2008) u Hamad Medical Corporation, Doha, Qatar. Cilj rada je prikazati uspjeh postupka, njegov ishod, komplikacije nastale u majke i fetusa, te povezanost postupka s načinom zahvata i ovisnost o dobi trudnoće, u kojoj je zahvat rađen. Materijal. Ukupno je feticid učinjen u sedam trudnoća. Postupak je u pet bio uspješan; daljnje dvije trudnice su odustale od ponovljenog zahvata. Rezultati. Fetalna redukcija je uspješan postupak, koji neznatno šteti fetusu ili majci. Postupkom se smanjuju mnogoplodne trudnoće te produljuje trudnoća do njene zrelosti za porod. Zaključak. Na temelju rezultata studije, postupak bi trebalo ponuditi svim trudnicama s mnogoplodnim trudnoćama

RAK CERVIKSA U TRUDNOĆI: PRIKAZ BOLESNICE

The case of 29 years old pregnant III-para at 38 weeks of gestational age is presented. The patient was admitted complaining of vague abdominal pain. By speculum examination the large cervix with reddish ulcerative cervical canal was established and punch biopsy performed. The pathohistological diagnosis was well differentiated squamous cell carcinoma. No local metastases or lymph node or other signs of cancer spreading were present (stage 1a). The CS was done, born vital newborn of 2 kg weight, proceeded to total abdominal hysterectomy with bilateral salpingoophorectomy. The pathohistological finding was: Stromal invasion of 3 mm in depth and 6 mm in lateral spread (FIGO stage 1a1). Postoperative period was uneventfull, the patient was reffered to Institute of Nuclear Medicine for further management, where she received only 2 cycles of radiation and chemotherapy and thereafter stopped the treatement. Two years later the patient presented very ill and passed because of uremia.Prikazana je bolesnica dobi 29 godina, III-para, s oko 38 tjedana trudnoće. Primljena je zbog nejasnih boli u donjem trbuhu. Pregledom u spekulima nađen je krupni cerviks s ulceracijom u cervikalnom kanalu. Pod anestezijom je učinjena biopsija cerviksa i dobivena patohistološka dijagnoza: dobro diferencirani karcinom pločastih stanica. Nije bilo lokalnih metastaza, širenja u limfne čvorove ili drugih znakova širenja raka (stupanj 1a). Učinjen je carski rez i nastav¬ljena totalna histerektomija s obostranom salpingooforektomijom. Patohistološki nalaz je bio: stomalna invazija 3 mm u dubinu i postranična zahvaćenost 6 mm (FIGO stupanj 1a1). Postoperativni je tijek bio uredan, bolesnica je upućena u Zavod za nuklearnu medicinu radi zračenja i kemoterapije. Primila je samo dva ciklusa terapije i tada napustila liječenje. Nakon dvije godine pacijentica se pojavila vrlo bolesna, umrla je od uremije

Assessment of Variation in Clinical Presentation of Visceral Leishmaniasis Among Patients Attending the Tropical Diseases Teaching Hospital in Sudan

Background: Visceral leishmaniasis (also known as Kala-azar) is a systemic parasitic infection with many clinical presentations. The present study assesses the variation in presentations among patients who attended the Tropical Diseases Teaching Hospital (TDTH) in Khartoum, Sudan. Methods: This analytical cross-sectional, hospital-based study was conducted at the TDTH between November 2019 and September 2020. Medical records of patients who presented at the TDTH were reviewed using a structured data extraction checklist. The Chi-square test was used to determine the associations between sociodemographic and clinical presentations of patients. P-value < 0.05 was considered as statistically significant. Results: Out of 195 patients, 79.5% were male and 48.2% were <31 years old. Fever was the main clinical presentation (90.2%) while 53.3% presented with weight loss and 72.3% and 39% presented, respectively, with splenomegaly and hepatomegaly. HIV was detected in 4.6% of the patients. RK39 was the main diagnostic test. We found a significant association between the abdominal distention and the age of the patients (P < 0.05) – age groups 11–20 and 41–50 years were more likely to present with abdominal distention than other age groups. Conclusion: There is no exact clinical presentation or routine laboratory findings that are pathognomonic for visceral leishmaniasis; therefore, it should be considered in the differential diagnosis of any patient with fever, weight loss, and abdominal distention, and among patients with HIV

EPIDEMIC OF RIFT VALLEY FEVER IN SUDAN, GEZIRA, 2007; GEZIRA EXPERIENCE

In the last 3 months of 2007, an acute episode of an ill-defined severe febrile illness presented to Medani hospital isolation words, with severe hemorrhagic manifestations. This initially did not harbor any attention as other possibilities were thought of like severe malaria , septicaemia but by the end of the same week the number of patients increased dramatically and the suspicion was put and the whole case was addressed officially in an epidemical paradigm. This study was conducted in Wad Medani Teaching Hospital. From the beginning of 41st week of the year 2007, the Gezira state in Sudan was tremendously affected by an epidemic of Rift valley fever as declared by the WHO authorities (11).all the districts of the estate were involved with a total number of patients was around 392. During the period of epidemic of RVF, (week 41.2007 - up to the 1st week of January 2008) total number of patients admitted were about 392 and total number of patients died were 158 patients .The main presenting symptoms were fever, epistaxsis, haematemesis and vaginal bleeding, and the main complication was acute renal failure and death

Preface

Obesity defined as BMI ≥30 kg/m2 is now considered one of the most important contributors to the rising morbidity and mortality world-wide from non-communicable diseases and by implication cost of healthcare. The WHO estimated that in 2016, there were about 1.9 billion people living with overweight of which 560 million were obese. Further characterisation of the data showed that 40% and 13% of women aged 18 years were living with overweight and obesity respectively. The rates have been rising and more so in the low- and middle-income countries and the World Obesity Federation estimates that if current trends continue, there will be over 1 billion people living with obesity by 2030. A comprehensive study from 2005 to 2014 of obesity rates in pregnancy in 184 countries, estimated that in 2014 there were 38.9 million overweight and 14.6 million obese pregnant women world-wide. The rise in obesity rates were disproportionately higher in low- and middle-income countries