A review of randomized trials comparisons of epidural with parenteral forms of pain relief during labour and its impact on operative and cesarean delivery rate

Objectives: The aim of this review was to summarise the available literature on different modalities of labour pain relief (epidural vs. parenteral) and to assess their impact on the rate of caesarean section deliveries and instrumental deliveries, and on the need to support the uterine contractile function. Material and methods: The PubMed, Web of Science and Cochrane databases were reviewed to identify articles describing the effect of labour pain relief on the course of labour. This review includes 16 studies with 7150 patients. Results: The analysis of the obtained data revealed that epidural analgesia (EA) or combined epidural and spinal anaesthesia (CESA) provided significantly better labour pain relief when compared with parenteral opioids. Conduction anaesthesia was not associated with an increase in the caesarean section delivery rate. Some authors concluded that conduction anaesthesia was associated with the need for assisted delivery. Conclusions: Epidural analgesia is a well-recognised method of labour pain relief. It is associated with the parturient’s higher satisfaction when compared to parenteral opioids. EA does not directly increase the caesarean section delivery rate, yet it can lead to instrumental deliveries (vacuum-assisted, obstetrics forceps) and a need to pharmacologically support the uterine contractile function. Further studies are required to evaluate the effect of EA on the course of labour, and methods of minimising its adverse effects

Identification of transport parameters of chlorides in different soils on the basis of column studies

Knowledge of transport patterns of chemicals in groundwater is essential for environmental assessment of their potential impact. In the present study, the mobility of a chloride tracer injected into three different soils was investigated, using column experiments. The column tests were performed under steady-state conditions to determine parameters of chloride migration through soils. Based on breakthrough curves, pore-water velocity, dispersion coefficient and dispersivity constant were calculated for each soil sample using CXTFIT/STANMOD software. Pore-water velocity was in the range of 0.31 cm/min for fine sand, to 0.35 cm/min for silty sand and to 0.40 cm/min for vari-grained sand. The highest values of dispersion coefficient and dispersivity constant were observed for silty sand (0.55 cm2 /min and 1.55 cm, respectively), while the lowest value was found for fine sand (0.059 cm2 /min and 0.19 cm, respectively). Column experiments for chlorides (conservative tracer) are a preliminary stage for further research which will be undertaken to investigate migration parameters of selected neonicotinoids (reactive tracers) through different soils

Metals Ions Removal by Polymer Membranes of Different Porosity

The effect of the amount of pore generating agent (polyvinylpyrrolidone) added to standard polymer membranes containing 18 wt.% of polyethersulfone on the physicochemical properties of the membranes and their capacity for removal of iron and copper ions from the liquid phase was studied. The membranes were obtained by the phase inversion method. The results have shown that the modification of polymer membranes by the use of different amounts of the pore forming agent in their syntheses leads to significant changes in porosity and has beneficial effect on equilibrium water content. The membranes studied were found to show different acid-base surface character, but for all membranes studied, a significant dominance of oxygen groups of acidic character was evidenced. The most effective were the membranes of the lowest content of polyvinylpyrrolidone, while the lowest values of resistance showed the membranes of the highest content of PVP, and so the ones of the greatest porosity

Metals Ions Removal by Polymer Membranes of Different Porosity

The effect of the amount of pore generating agent (polyvinylpyrrolidone) added to standard polymer membranes containing 18 wt.% of polyethersulfone on the physicochemical properties of the membranes and their capacity for removal of iron and copper ions from the liquid phase was studied. The membranes were obtained by the phase inversion method. The results have shown that the modification of polymer membranes by the use of different amounts of the pore forming agent in their syntheses leads to significant changes in porosity and has beneficial effect on equilibrium water content. The membranes studied were found to show different acid-base surface character, but for all membranes studied, a significant dominance of oxygen groups of acidic character was evidenced. The most effective were the membranes of the lowest content of polyvinylpyrrolidone, while the lowest values of resistance showed the membranes of the highest content of PVP, and so the ones of the greatest porosity

Paediatric Cushing’s disease — a literature review of epidemiology, pathogenesis, clinical symptoms, and diagnostics

Cushing’s disease (CD) is characterised by excess production of adrenocorticotropic hormone (ACTH) by a pituitary corticotroph adenoma, which results in hypercortisolaemia. CD is extremely rare in the paediatric population, and few paediatric endocrinology centres have experience in diagnosing and treating this disease. The clinical presentation of hypercortisolaemia is variable, so proper and rapid diagnosis of CD is often challenging. The molecular pathogenesis of CD was largely unknown until recently. The latest research has revealed somatic mutations in the USP8 gene as the most common pathogenic molecular variants of this disease. Herein, we describe the current state of knowledge of paediatric CD epidemiology, molecular pathogenesis, clinical symptoms, and diagnostics

Predictive factors for the recurrence of Cushing’s disease after surgical treatment in childhood

Introduction: Cushing’s disease (CD) is a rare cause of hypercortisolaemia caused by excessive adrenocorticotropic hormone (ACTH) excretion by a pituitary adenoma. Data on the predictive factors for the recurrence of the disease are limited in comparison with those for the adult population. The identification of the predictive factors for CD recurrence in patients after surgical treatment in childhood was the aim of the presented study. Material and methods: A retrospective analysis of 26 CD patients, mean age at the time of diagnosis 13.46 years, treated at the Children’s Memorial Health Institute (CMHI) in the years 1994–2018. Two time points were set at which the follow-up (FU) of patients was finished. The first time point (shorter FU, 24 patients) was set when the patients completed their treatment at the CMHI. The second time point (longer FU, 26 patients) was determined on the basis on the time when adult patients (previous CMHI patients) completed the author’s questionnaire. In the case of the other patients (current CMHI paediatric patients and patients who did not respond to the questionnaire), the latest FU in this second time point was made during the last visit to the CMHI. The predictors of disease recurrence were evaluated by the construction of a logistic regression model and receiver operating characteristics. Results: The average FU after transsphenoidal pituitary surgery (TSS) of 26 patients was 10.23 years (0.67–24.50). Recurrence of CD occurred in four out of 26 patients (15.4%) after an average time of 3.6 years (0.92–8.08) following definitive treatment. The results of the statistical analysis of potential predictive factors for CD recurrence were not conclusive, with no variables confirmed above the statistical significance threshold of p < 0.05. As regards the longer FU, two potential predictors: mean cortisol level at night (p = 0.10) and max. ACTH level after ovine corticotropin-releasing hormone (oCRH) test (p = 0.10), were the closest to meeting the assumed threshold of statistical significance. Conclusion: Recurrence of CD may be diagnosed even a long time after its effective treatment. It is possible that cortisol levels at night and ACTH values in oCRH test before TSS may be helpful to predict which patients may experience a recurrence after successful initial treatment. However, further studies on a larger sample are needed to confirm this hypothesis

Czy nadszedł czas na zmiany w badanich przesiewowych w kierunku nosicielstwa GBS?

Group B Streptococcus (GBS) infections remain an important cause of perinatal complications, despite advanced preventive measures. The most common clinical symptoms of early-onset disease, diagnosed in neonates up to 7 days of life, are sepsis and pneumonia. Late-onset disease is diagnosed in children between 7 and 89 days of life and presents also in forms of other infections. As a result of collaborative efforts of clinicians, researchers and many organizations, various recommendations for intrapartum prevention of perinatal GBS disease have been issued so far. Revised 2002 CDC guidelines for the prevention of early-onset GBS disease recommended universal culture-based screening of all pregnant women at 35–37 weeks of gestation to optimize the identification of those who should receive intrapartum antibiotic prophylaxis (IAP). They were customized by the Polish Gynecological Society and applied in Poland as well. As a result of preventive efforts worldwide, global incidence of GBS infections has declined dramatically over the past 15 years. About 10-30% of pregnant women are colonized with Group B Streptococcus. According to the literature, GBS culture at 35 to 37 weeks of gestation has about 95% negative predictive value for the absence of colonization at the time of labor. However, studies reporting early-onset GBS disease in newborns found that about 60 to 80% of all cases occurred in neonates with negative maternal screening during pregnancy. If the only available screening test is vagino-rectal swab during pregnancy, about 7.5% of women with GBS colonization during labor are not administered IAP. It seems optimal to perform routine screening not during pregnancy, but directly before the delivery – preferably at the time of regular uterine contractions or the rupture of membranes. As the screening test should be widely accessible and rapid, the usual microbiological culture is not a suitable option.Recently, new biochemical and genetic methods have become available. Polymerase chain reaction (PCR) and optical immunoassay are candidates for rapid patient intrapartum GBS testing to determine whether women in labor are colonized with GBS. PCR tests have the sensitivity of over 90% with the specificity of 99%, which is about 13% higher than microbiological culture. According to the literature, IAP does not reduce the overall neonatal mortality, mortality due to GBS infection, or due to other bacterial infections. The incidence of early-onset GBS infection was reduced with IAP in comparison to no intrapartum prophylaxis, but there was no difference in late-onset GBS disease occurrence. Besides GBS, IAP may influence maternal and neonatal infections caused by other pathogens. Moreover, it can also induce GBS and no-GBS pathogen resistance to antibiotics. It therefore seems necessary to replace the current type of GBS screening with GBS DNA PCR intrapartal test – a rapid, highly sensitive and specific method of carrier identification – in order to optimize IAP and, eventually, to decrease the rate of early onset GBS disease in neonates.Paciorkowce grupy B (GBS), najczęściej Streptococcus agalactiae, są patogenami odpowiedzialnymi za około 0,34-0,37 zakażeń noworodków na 1000 żywych urodzeń. Wczesne zakażenia (0 – 7 doba życia) to najczęściej posocznica, zapalenie płuc lub opon mózgowo-rdzeniowych, natomiast późne (7 – 89 doba) to posocznica, zapalenie opon mózgowo-rdzeniowych, zapalenia układu oddechowego, pokarmowego, stawów i tkanki łącznej. Nosicielstwo GBS stwierdza się u około 10-30% ciężarnych. Około 60 – 80% zakażeń GBS noworodków dotyczy matek, u których wynik skriningu ciążowego był negatywny. Według rekomendacji Polskiego Towarzystwa Ginekologicznego każdej ciężarnej pomiędzy 35 a 37 tygodniem ciąży należy pobrać wymaz z przedsionka pochwy i odbytu w celu identyfikacji nosicielstwa GBS. Tak prowadzony skrining ciążowy charakteryzuje się jednak wysokimi odsetkami wyników fałszywie pozytywnych i negatywnych, ponieważ status kolonizacji ciężarnej zmienia się w czasie. W przypadku wykrycia kolonizacji oraz kilku wyjątkowych sytuacjach, wyszczególnionych w rekomendacjach, obowiązkowa jest śródporodowa profilaktyka antybiotykowa. Zastosowanie profilaktyki nie zredukowało jednak ogólnej śmiertelności noworodków, ani śmiertelności związanej z zakażeniami GBS, bądź innymi niż GBS. Szerokie stosowanie antybiotyków indukuje oporność GBS (10-20% inwazyjnych szczepów GBS jest oporne na klindamycynę, 25-30% na erytromycynę), jak i innych patogenów. Być może zmiana prowadzonego skriningu na śródporodowe wykrywanie DNA GBS metodą reakcji łańcuchowej polimerazy (PCR) - metodę szybszą, charakteryzującą się wyższą czułością i mniejszym odsetkiem wyników fałszywie negatywnych - pozwoliłaby na optymalizację profilaktyki zakażeń, a docelowo zmniejszenie odsetka wczesnych zakażeń GBS u noworodków

Reclassification to another sport using FC Berlin as an example

Education through sport is widely discussed in world literature. Sport theorists emphasize the importance of the long-term process of training a player for many years as a hierarchically complex system-structured task. Nevertheless, practical actions which are taken often differ from theoretical recommendations. In many countries due to cultural, technological or financial conditions, various systems of solutions are used.         On the basis of direct observation in one of the German teams, the article attempts to discuss the benefits of retraining young athletes for another sport. These actions are taken systematically. In addition, reference was made to the dangers arising from the use of commercialized sports activities for children and youth in Poland.           Bearing in mind both theoretical justifications and practical actions taken in the German team, one can observe the positive impact of correctly diagnosing the predisposition of children starting football training and retraining for other sports activities. In addition, based on the author's experience in training work in Germany, no negative impact on the functioning of sports training or education of such action through sport was observed

Antimicrobial properties of silver nanoparticles against biofilm formation by Pseudomonas aeruginosa on archaeological textiles

The aims of this work were to: (i) microscopically analyse the pre- and post-Columbian archaeological textiles using Scanning Electron Microscopy with Energy Dispersive X-Ray Analysis (SEM-EDX); (ii) microbiologically analyse the archaeological textiles (from the Southern Andean Area, La Plata Museum); (iii) determine the ability of Pseudomonas sp. isolates from archaeological textiles to biofilm formation by SEM; (iv) assess the anti-biofilm properties of AgNPs protecting cotton against Pseudomonas sp. Results showed the presence of bacteria with proteolytic and lipolytic activities on archaeological textiles, including Clostridium sp. and Pseudomonas aeruginosa. Two nucleotide sequences of 16S ribosomal RNA gene of P. aeruginosa strains were deposited in GeneBank NCBI database with accession numbers: KP842564 (strain 1) and KP842565 (strain 2). Those strains exhibited different morphological and growth characteristics: strain 1 with ability to form biofilms on archaeological textiles was rod-shaped, produced bluish-green pigment, and smaller than strain 2; and strain 2 was pleomorphic and produced brown pigment. The use of silver nanoparticles (90 ppm, φ 10–80 nm) allowed to protecting textiles against P. aeruginosa growth by 63%–97%, depending on the strain and exposition time.Instituto de Investigaciones Fisicoquímicas Teóricas y Aplicada