Fetomaternal hemorrhage - case report

Maternal fetal leakage (FMH) is a well-known cause of fetal anemia. We define it as the transition of the fetal erythrocytes into the maternal circulation. Its severity is determined by measuring the level of fetal hemoglobin in the mother's blood using the Kleinhauer-Betke test or the cytometric method (FCM). The paper presents a case of a newborn with massive maternal-fetal leakage. The maternal blood Kleinhauer test result was greater than 5% of the fetal blood cells, and the initial neonatal hemoglobin level was 3.5 g / dl. Correct treatment of fetal anemia is presented. The additional studies performed allowed for the exclusion of other causes as a result of the extremely severe condition of the newborn after delivery. Early diagnosis of fetal-maternal leak and its treatment through execution

Parents' knowledge of neonatal transitory conditions and their expectations of the midwife

Introduction The neonatal period is the period of the child's adaptation to life outside the mother's body. The child has to adapt to the changes taking place in its body. After delivery, the new-born baby is assessed according to the Apgar scale. Objective of the study The objective of the study was to assess the parents' knowledge of the transitory conditions of neonates and to identify their expectations towards medical personnel. Material and methods 248 women participated in the study. Inhabitants of large cities accounted for 64.5% of the respondents and 16.2% of the respondents were inhabitants of rural areas. Women aged over 35 accounted for 46.8% of patients, 19.3% were patients between the ages of 26 and 30. Patients between the ages of 30 and 35 also accounted for 19.3%. Patients under 25 years of age accounted for 14.6%. The Bioethics Committee approved the project. Statistical analysis was performed with the use of the Statistica computer program. Results 81% of women displayed knowledge about the duration of the neonatal period. 62% of the respondents knew the effect of vitamin K in preventing the occurrence of haemorrhagic disease in the neonate. Half of the women prefer to feed on demand. A big problem among women in childbed is the lack of access to a psychologist. Conclusions Parents cannot recognize transitory conditions in a neonate. Antenatal education of future mothers influences their pro-health behaviour. Parents source their knowledge from their family, friends, guides and books.Introduction The neonatal period is the period of the child's adaptation to life outside the mother's body. The child has to adapt to the changes taking place in its body. After delivery, the new-born baby is assessed according to the Apgar scale. Objective of the study The objective of the study was to assess the parents' knowledge of the transitory conditions of neonates and to identify their expectations towards medical personnel. Material and methods 248 women participated in the study. Inhabitants of large cities accounted for 64.5% of the respondents and 16.2% of the respondents were inhabitants of rural areas. Women aged over 35 accounted for 46.8% of patients, 19.3% were patients between the ages of 26 and 30. Patients between the ages of 30 and 35 also accounted for 19.3%. Patients under 25 years of age  accounted for 14.6%.          The Bioethics Committee approved the project.      Statistical analysis was performed with the use of the Statistica computer program. Results 81% of women displayed knowledge about the duration of the neonatal period. 62% of the respondents knew the effect of vitamin K in preventing the occurrence of haemorrhagic disease in the neonate. Half of the women prefer to feed on demand. A big problem among women in childbed is the lack of access to a psychologist. Conclusions Parents cannot recognize transitory conditions in a neonate. Antenatal education of future mothers influences their pro-health behaviour. Parents source their knowledge from their family, friends, guides and books

Can We Predict the Insulin Therapy Need and Early Postpartum Prediabetes in Patients with Gestational Diabetes Mellitus?

Objective: The authors aimed to identify risk factors for insulin therapy need and for the development of postpartum prediabetes in women with gestational diabetes mellitus (GDM). Materials and methods: This was a prospective observational single-center study including pregnant women with GDM. Women with overt diabetes were excluded. Risk factors for insulin use and prediabetes were identified using logistic regression. Univariable analyses were performed to select factors for multivariable analysis. Stepwise logistic regression was used to create multivariable models. Results: Among 135 women with GDM, 63 (46.7%) required insulin therapy. Multivariable analysis demonstrated that family history of diabetes, abnormal pre-pregnancy body mass index ( > 25 kg/m2), the performance of 75 g oral glucose tolerance test (OGTT) before 24 Hbd, fasting plasma glucose (FPG) at pregnancy diagnosis constitute predictive factors for further insulin therapy need. Thirteen women (9.6%) developed prediabetes shortly (6–12 weeks postpartum) after gestation. In multivariable analysis family history of diabetes, rapid weight gain, 1 h plasma glucose (PG) in OGTT, 2 h PG in OGTT and glycated hemoglobin (HbA1c) concentration were identified as independent risk factors for prediabetes postpartum. Conclusions: Many easily-available parameters individually and combined in prediction models can be useful in assessing the risk of insulin therapy need and early postpartum prediabetes in women with GDM. Evaluation of the risk of above complications at GDM diagnosis is possible using metabolic parameters and family history of diabetes

Knowledge on the guideline-recommended use of antiplatelet and anticoagulant therapy during dental extractions : a contemporary survey among Polish dentists

Background: The number of dental patients requiring periodic or lifelong antiplatelet or anticoagulanttherapy is constantly growing. Aims: We aimed to determine the level of knowledge on antiplatelet and anticoagulant therapy among Polish dentists. Methods: self‑designed online questionnaire was distributed among dentists to evaluate their knowledge on the use of antiplatelet and anticoagulant drugs in clinical dental practice. Results: The study included 352 dentists. Patients requiring vitamin K antagonists were referred for a cardiac consultation by 64.52%, 57.29%, and 58.55% of dentists with < 5, 5–15, and > 15 years of experience,respectively (P = 0.003). A similar trend was observed for non–vitamin K antagonist oral anticoagulants among nonsurgical dentists. However, an equal percentage of surgical dentists (39.7%) performedextraction with and without consultation, and they were more likely to perform extraction withoutconsultation than nonsurgical dentists (39.7% vs 27.8%; P = 0.01). Most surgical and nonsurgical dentistspreferred to consult a cardiologist about dual antiplatelet therapy before an invasive procedure (56.9%and 73.81%, respectively; P = 0.03). Extractions in patients on aspirin were accepted by 75.81%, 70.83%, and 49.34% of dentists with < 5, 5–15, and > 15 years of experience, respectively (P = 0.004), and by 79.31%of surgical and 57.14% of nonsurgical dentists (P = 0.003). Conclusions: Knowledge on antiplatelet and anticoagulant therapy in patients undergoing dental procedures is unsatisfactory among Polish dentists. Both therapies were discontinued before extractionsmore frequently than recommended in the guidelines, while extractions in patients on aspirin were common

Giant cell arteritis: Diagnostic difficulties

Giant cell arteritis (GCA) is the most common form of vasculitis present in adults. Its symptoms result from ischemia of the areas supplied by the arteries or the severity of the inflammatory reaction: headache, jaw and limb claudication, visual disturbances, blindness, stroke, polymyalgia, and fever. Because of the variety of symptoms, the disease is often overlooked in diagnostics, possibly leading to permanent ischemic complications. The current classification criteria and the gold standard for diagnostics – temporal artery biopsy – apply to the cranial form of the disease. European Alliance of Associations for Rheumatology guidelines have systematized diagnostics, based mainly on simple and reproducible ultrasound examination (ultrasonography). Despite the widespread availability of this imaging method, GCA is still diagnosed too late, and therefore the authors analyzed the possible diagnostic difficulties, based on a group of 21 patients

Does the operator's sex matter? An analysis based on the national interventional cardiology registry

Background: A small number of female cardiologists work in the field of interventional cardiology. Such disparity is observed in most European countries. Aims: We present the first national report on the practice patterns and outcomes regarding percutaneous coronary interventions (PCIs) performed by female operators (FOs) in Poland. Methods: Data were collected from the National Registry of Invasive Cardiology Procedures (Ogólnopolski Rejestr Procedur Kardiologii Inwazyjnej [ORPKI]) between January 2014 and December 2017. Results: A total of 31 FOs (4.1%) performed 12 935 PCIs (2.8%). The median (interquartile range [IQR]) number of PCIs performed by FOs per year was 75 (43–154), whereas that by male operators was 139 (67–216; P < 0.01). Patients handled by FOs were characterized by a lower prevalence of cardiovascular risk factors and previous coronary artery interventions. Acute coronary syndrome was the main indication for treatment (74.66%). Compared with male operators, FOs handled significantly more patients with single‑vessel disease (87.02% vs 84.72%; P < 0.001). They used smaller contrast doses during PCIs (median [IQR], 170.36 [77.54] cm3 vs 173.48 [77.54] cm3; P < 0.001) yet higher doses of radiation exposure (median [IQR], 843 [472–1409] mGy vs 815 [458–1390] mGy; P = 0.01). There was no difference in clinical outcomes (a composite of all‑cause death, bleeding at the puncture site, or coronary artery perforation) associated with the operator’s sex. Conclusions: Women represent a minority of operators in interventional cardiology and are responsible for a low percentage of PCIs. Nonetheless, the practice patterns and outcomes of PCIs performed by FOs are similar to those of male operators

Clinical outcomes in patients with acute myocardial infarction treated with primary percutaneous coronary intervention stratified according to duration of pain-to-balloon time and type of myocardial infarction

Background: Based on the clinical outcomes of patients with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI), treated with primary percutaneous coronary intervention (pPCI), this study intended to assess mortality and major adverse cardiac and cerebrovascular event (MACCE) rates according to duration of pain-to-balloon (PTB) time and type of MI.   Methods: This is a retrospective cohort study based on the prospectively collected ORPKI registry which covers PCIs performed in Poland chosen between January 2014 and December 2017. Under assessment were 1,994 STEMI and 923 NSTEMI patients. Study endpoints included mortality and MACCE rates (in-hospital, 30-day, 12- and 36-month). Predictors of all-cause mortality in the overall group, STEMI and NSTEMI were assessed by multivariable analysis. Results: Kaplan-Meier survival curve analysis did not reveal significant differences between the STEMI and NSTEMI group for all-cause mortality or MACCE at the 36-month follow-up. While in the long PTB time group, MACCE rate was significantly greater in STEMI patients when compared to NSTEMI (p = 0.004). Among STEMI patients, the short, medium and long PTB time groups differed significantly in the rate of all-cause mortality (p = 0.006) and MACCE (p = 0.04) at 1,095 days of follow-up, which were the greatest in the long PTB time group. Conclusions: Before considering the length of PTB time, there were no statistically significant differences in mortality or MACCE frequency between the STEMI and NSTEMI group at 36-month follow-up. Longer PTB times are related to significantly greater mortality at the 36-month follow-up in the STEMI, but not in the NSTEMI group

Diabetes mellitus is still a strong predictor of periprocedural outcomes of primary percutaneous coronary interventions in patients presenting with ST-segment elevation myocardial infarction (from the ORPKI Polish National Registry)

The impact of diabetes mellitus (DM) on outcomes of patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) was confirmed by several studies. However, it is unclear whether this effect is still present in large groups of unselected patients undergoing up-to-date treatment. Thus, we sought to assess the impact of DM on periprocedural outcomes of primary PCI in STEMI using data from the Polish National Registry of PCI. Data on 150,782 STEMI patients undergoing primary PCI were collected. Of them, 26,360 (17.5%) patients had DM. Patients with DM were higher-risk individuals who experienced longer reperfusion delays and were less likely to have closed infarct-related artery at baseline (TIMI 0 + 1 flow: 73.2% vs. 72.0%; p < 0.0001) and achieve optimal reperfusion after PCI (TIMI 3 flow: 91.8% vs. 88.5%; p < 0.0001). The periprocedural mortality (1.1% vs. 1.9%; p < 0.0001) was higher in patients with DM and DM was identified as an independent predictor of periprocedural death. In conclusion, despite continuous progress in STEMI treatment, DM remains a strong predictor of periprocedural mortality. However, this detrimental effect of DM may be partially explained by the overall higher risk profile of diabetic patients