First Midwives in the Town of Bjelovar, Croatia 1756-1856

Prve izučene (aprobirane) primalje dolaze u novoosnovani Bjelovar, jako vojno središte Vojne krajine početkom druge polovice XVIII. stoljeća zajedno s vojnim liječnicima, kirurzima i ljekarnicima, a većina njih je germanskoga podrijetla. U do sada neistraženom arhivskom materijalu za razdoblje 1756.-1856. pronađeni su podaci o 23 izučene primalje, od kojih je 14 bilo pukovnijskih i 9 gradskih primalja. Visok perinatalni pomor djece i majki i kriminalni pobačaji karakteristike su toga razdoblja. Uz model domicilnoga primaljstva: skrb za trudnice, rodilje, babinjače, novorođenčad i dojenčad, primalje u teškim porodima obavljaju krštenje iz nužde ugroženoj novorođenčadi ili su pak krsne kume zdravoj dojenčadi. Premda je u samom gradu Bjelovaru ustrojeno stručno primaljstvo, u okolici grada i dalje se porodi obavljaju bez stručne pomoći. Za razliku od većine tadašnjih gradova kontinentalne Hrvatske, pa i Dalmacije, u Bjelovaru postoji kontinuirano izučeno primaljstvo i zaštita materinstva od polovice XVIII. stoljeća.The first trained (certified) midwives came to the newly founded town of Bjelovar, a strong military centre of Vojna Krajina (Croatian province bordering Ottoman Empire), at the beginning of the 1750s, along with army physicians, surgeons, and pharmacists. Most were of German origin. The archival material investigated for the period 1756-1856 speaks of 23 certified midwives, of whom 14 were regimental and nine municipal. This period was characterised by high neonatal and maternal mortality rates and criminal abortions. Within the scope of the domiciliary midwifery model that included care for pregnant women, parturient women, neonates, and infants, midwives used to act as godmothers to newborns at risk, in periculo, or to healthy newborns. Although Bjelovar had professional midwifery service, the practice of unassisted childbirths continued in the town surroundings. Unlike other inland and coastal (Dalmatian) towns of the time, Bjelovar has had a continuous tradition of training midwives and maternal health care since the 1750s

Coliform pyosalpinx as a rare complication of appendicectomy: a case report and review of the literature on best practice

<p>Abstract</p> <p>Introduction</p> <p>Coliform pyosalpinx is a rare entity. We report a case that occurred three months after appendicectomy for gangrenous appendicitis. There follows a literature review on best practice for the treatment of pyosalpinx.</p> <p>Case presentation</p> <p>A seventeen year old girl presented with an acute abdomen three months after an appendicectomy for gangrenous appendicitis. Intraoperative findings were bilateral pyosalpinx treated by aspiration, saline and Betadine irrigation and intravenous antibiotics.</p> <p>Conclusion</p> <p>Microbiological analysis of the pus revealed <it>Escherichia coli </it>and anaerobes. Chlamydia and Candida were not isolated. This is the first known reported case of Coliform Pyosalpinx following appendicectomy. The best treatment does not necessarily involve salpingectomy especially in women of reproductive age where fertility may become compromised.</p

Breech presentation at term and associated obstetric risks factors-a nationwide population based cohort study

Purpose The aim of this study was to estimate whether breech presentation at term was associated with known individual obstetric risk factors for adverse fetal outcome. Methods This was a retrospective, nationwide Finnish population-based cohort study. Obstetric risks in all breech and vertex singleton deliveries at term were compared between the years 2005 and 2014. A multivariable logistic regression model was used to determine significant risk factors. Results The breech presentation rate at term for singleton pregnancies was 2.4%. The stillbirth rate in term breech presentation was significantly higher compared to cephalic presentation (0.2 vs 0.1%). The odds ratios (95% CIs) for fetal growth restriction, oligohydramnios, gestational diabetes, a history of cesarean section and congenital fetal abnormalities were 1.19 CI (1.07-1.32), 1.42 CI (1.27-1.57), 1.06 CI (1.00-1.13), 2.13 (1.98-2.29) and 2.01 CI (1.92-2.11). Conclusions The study showed that breech presentation at term on its own was significantly associated with antenatal stillbirth and a number of individual obstetric risk factors for adverse perinatal outcomes. The risk factors included oligohydramnios, fetal growth restriction, gestational diabetes, history of caesarean section and congenital anomalies.Peer reviewe

Prevalencija infekcije Neisseriom gonorrhoeae ili Chlamydiom trachomatis kod akutnoga mukopurulentnog cervicitisa

The aim of this study was to determine the incidence of N. gonorrhoae (NG) and/or C. trachomatis (CT) in acute mucopurulent cervicitis (MPC). The study included 617 non-pregnant women with MPC, who had not been receiving any antimicrobial treatment. The average age of patients was 22.2 years. There were no statistically significant differences according to place of residence, education, and marital status. Samples for laboratory analysis were collected using a routine procedure; NG was identified using the cytochrome oxidase test and Gram staining. CT was isolated on McCoy cell culture and stained with Lugol solution. NG was isolated in three women (0.8 %) and CT in 58 women (9.4 %). Fifty-six of the CT-positive patients were nullipara and only two were unipara. All NG-positive patients were also nullipara. The mean number of sexual partners was 2.2 in all study subjects, 2.4 in CT-positive subjects, and 2.9 in NG-positive subjects. Vaginal discharge purity according to Schröder was significantly deteriorated in CT-positive patients (p=0.011). When asked about the use of contraceptives, as many as 32.7 % patients answered that they did not use any protection, 39 % women used the rhythm method and coitus interruptus, 20 % were taking oral contraceptives, 6.1 % used mechanical devices, and 1.9 % used chemical protection. Previous acute and chronic pelvic infl ammatory diseases correlated with MPC (p<0.01). Our statistical analysis suggests that chlamydial infection significantly reduces the purity of vaginal discharge, which is more pronounced in nulliparae. Pap smear was not specific enough to demonstrate chlamydial infection. In view of the MPC findings, the prevalence of CT and NG infection is low.Cilj istraživanja jest utvrditi koincidenciju N. gonorrhoae (NG) i/ili C. trachomatis (CT) u akutnim mukopurulentnim cervicitisima (MPC). Istraživanje je provedeno na populaciji 617 žena izvan trudnoće koje prethodno nisu uzimale antimikrobnu terapiju. NG i CT su izolirane iz obrisaka vrata maternice primjenom standardnih metoda. NG je transportirana na selektivnoj hranjivoj podlozi i identificirana citokrom-oksidaznim testom bojenjem po Gramu. CT je izolirana McCoyevom staničnom kulturom nakon bojenja Lugolovom otopinom. NG je izolirana u tri ispitanice (0,8 %), a CT u 58 ispitanica (9,4 %). Srednja dob bolesnica iznosila je 22,2 godine. Školovanje i bračno stanje nisu statistički značajno utjecali na rezultate istraživanja. Među bolesnicama s izoliranom CT prevladavaju nulipare, a u slučaju NG sve su pozitivne bolesnice također bile nulipare. Srednja vrijednost broja partnera za čitavu populaciju iznosi 2,2. Bolesnice s potvrđenom CT imale su prosječno 2,4, a one s potvrđenom NG 2,9 partnera. Vrijednost određivanja stupnja čistoće rodničkog iscjetka po Schroderu značajno je povišena u CT-pozitivnih bolesnica (p=0.011). Utvrđeno je da 32.7 % ispitanica uopće nije koristilo kontracepciju, dok je većina (39 %) rabila ritmičke metode i prekinuti snošaj. Preostale ispitanice uzimale su oralne kontraceptive (20 %), mehaničku zaštitu (6,1 %) ili lokalne kemijske kontraceptive (1,9 %). Također je dokazano da prethodna akutna i kronična zdjelična upalna bolest korelira s MPC-om (p<0.01). Zaključeno je da klamidijska infekcija statistički značajno korelira sa stupnjem čistoće rodničkog iscjetka, posebice u nulipara. Papanicolaouov razmaz nije specifičan u određivanju klamidijske infekcije. Rezultati istraživanja pokazuju da je učestalost klamidijske i gonokokne infekcije ipak relativno niska u odnosu na nalaz MPC-a

Physiotherapeutic interventions in multiple sclerosis across Europe: Regions and other factors that matter.

BACKGROUND: A wide variety of interventions exists in physical therapy (PT), but knowledge about their use across different geographical regions is limited. This study investigated the use of PT interventions in people with multiple sclerosis (MS) across Europe. It aimed to determine whether regions differ in applying interventions, and explore whether factors other than regions play a role in their use. METHODS: In an online cross-sectional survey, 212 respondents from 115 European workplaces providing PT services to people with MS representing 26 countries (four European regions) participated. Cluster analysis, Pearson Chi-squared test and a Poisson regression model were used to analyze the data. RESULTS: Thirteen of 45 listed PT interventions were used by more than 75% of centers, while nine interventions were used by less than 25%. For 12 interventions, regions differed markedly in their use. Cluster analysis of centers identified four clusters similar in their intervention use. Cluster assignment did not fully align with regions. While center region was important, center size, number and gender of physical therapists working in the center, and time since qualification also played a role. Cluster analysis exploring the use of the interventions provided the basis for a categorization of PT interventions in line with their primary focus: 1. Physical activity (fitness/endurance/resistance) training; 2. Neuroproprioceptive "facilitation/inhibition"; 3. Motor/skill acquisition (individualized therapy led); 4. Technology based interventions. CONCLUSIONS: To our knowledge this is the first study that has explored this topic in MS. The results broaden our understanding of the different PT interventions used in MS, as well as the context of their use

Qualitatively and quantitatively similar effects of active and passive maternal tobacco smoke exposure on in utero mutagenesis at the HPRT locus

BACKGROUND: Induced mutagenesis in utero is likely to have life-long repercussions for the exposed fetus, affecting survival, birth weight and susceptibility to both childhood and adult-onset diseases, such as cancer. In the general population, such exposures are likely to be a consequence of the lifestyle choices of the parents, with exposure to tobacco smoke one of the most pervasive and easily documented. Previous studies attempting to establish a direct link between active smoking and levels of somatic mutation have largely discounted the effects of passive or secondary exposure, and have produced contradictory results. METHODS: Data from three studies of possible smoking effects on in utero mutagenesis at the HPRT locus were compiled and reanalyzed, alone and in combination. Where possible, passive exposure to environmental tobacco smoke was considered as a separate category of exposure, rather than being included in the non-smoking controls. Molecular spectra from these studies were reanalyzed after adjustment for reported mutation frequencies from the individual studies and the entire data set. RESULTS: A series of related studies on mutation at the X-linked HPRT locus in human newborn cord blood samples has led to the novel conclusion that only passive maternal exposure to tobacco mutagens has a significant effect on the developing baby. We performed a pooled analysis of the complete data from these studies, at the levels of both induced mutation frequency and the resulting mutational spectrum. CONCLUSION: Our analysis reveals a more commonsensical, yet no less cautionary result: both active maternal smoking and secondary maternal exposure produce quantitatively and qualitatively indistinguishable increases in fetal HPRT mutation. Further, it appears that this effect is not perceptibly ameliorated if the mother adjusts her behavior (i.e. stops smoking) when pregnancy is confirmed, although this conclusion may also be affected by continued passive exposure