Usporedba kriterija Svjetske zdravstvene organizacije i studije "HAPO" u dijagnostici gestacijskoga dijabetesa [Comparison between World Health Organization criteria and HAPO study criteria in the diagnosis of gestational diabetes mellitus]

Gestational diabetes mellitus is the most common metabolic disorder in pregnancy. Pregnancies with gestational diabetes have worse outcomes compared to pregnancies with normal glucose tolerance. The objectives of the study were to determine the incidence of GDM according to the IADPSG criteria, to compare the outcomes of pregnancies with GDM based on the WHO (1999) and IADPSG diagnostic criteria and to determine the degree of insulin resistance in a group of pregnant women with GDM according to the IADPSG criteria and their newborns. PATIENTS AND METHODS: The study is divided into retrospective and prospective part. A retrospective part included 2 405 pregnant women who delivered in the Department of Obstetrics and Gynecology Clinical Hospital Centre Zagreb in the period from 2009 to 2010. Based on the results of the oGTT pregnant women were divided into four groups: the first group of pregnant women with gestational diabetes according to the WHO criteria; the second group of pregnant women with normal glucose tolerance according to the WHO criteria, but according to the IADPSG criteria with gestational diabetes; the third group of pregnant women with overlapping results and the fourth group of pregnant women with normal glucose tolerance according to the both criteria. A prospective part of the study analyzed 120 pregnant women divided according to the results of oGTT in the two groups. The first group included 60 pregnant women with GDM according to the IADPSG criteria (fasting plasma glucose 5,1 - 6,9 mmol/L) and the second group included 60 pregnant women with normal glucose tolerance. We analyzed demographic data of pregnant women and their newborns, primary outcomes (LGA, macrosomia, cesarean section) and secondary outcomes (hypertensive disordes, preterm delivery, SGA). Prospectively we analyzed concentration of plasma glucose and C-peptide in maternal and umbilical blood samples. RESULTS: We found significantly higher prevalence of GDM according to the IADPSG criteria compared to the WHO criteria (6.2% vs. 21.7%; Χ² = 361; p < 0.001). Pregnant women with hyperglycemic disorders in pregnancy had worse pregnancy outcomes compared to pregnant women with normal glucose tolerance. The overall proportion of overweight and obese pregnant women was the highest in the group of untreated pregnant women with GDM according to the IADPSG criteria (44%) (group 2). In this group we found significantly higer rate of fetal macrosomia (23,2%) and LGA (25,1%). The rate of caesarean section was significantly higher in comparison to healthy controls (20.0% vs. 13.8%, p < 0,001). Prospectively, in a group of pregnant women with GDM according to the IADPSG criteria, who were treated, we found higher rate of macrosomia, LGA and cesarean section. The differencies were statistically significant (p = 0,043). The newborns of diabetic pregnant women had higher insulin resistance compared to the newborns of pregnant women with normal glucose tolerance (p < 0,001). Increased body mass index is associated with adverse pregnancy outcomes. The rate of chronic hypertension (3%), gestational hypertension (18,8%), cesarean section (31%), fetal macrosomia (24,4%) and LGA (28%) was significantly higher in obese pregnant women compared tonpregnant women with normal body weight (p < 0,001). The rate of preterm delivery (6,5%) and SGA (10,9%) was higher in underweight pregnant women. CONCLUSION: IADPSG diagnostic criteria for GDM reveals more women with hyperglycemic disorders in pregnancy. A group of pregnant women who were normoglycemic according to the WHO criteria, but according to the IADPSG were diagnosed GDM, had adverse pregnancy outcomes. Lower values of glycemia, than those defined for diabetes in pregnancy, are associated with adverse pregnancy outcomes. Hyperglycemic disorders in pregnancy are closely related to obesity. Obese women should be educated and treated well before the pregnancy to reduce the risk of adverse pregnancy outcomes. The important focus should be on the prevention of obesity

Urinary Incontinence in Women and Guidelines for Treatment

Poremećaji mokrenja znatno umanjuju kvalitetu života žene i važan su javnozdravstveni problem koji utječe na fizičko i psihičko zdravlje žena. Naime, poznato je da čak 25 – 30% žena u starijoj životnoj dobi obolijeva od statičke inkontinencije mokraće (SIU). Velika epidemiološka studija u SAD-u pokazala je da umjerenu do tešku urinarnu inkontinenciju ima 7% žena u dobi od 20 do 39 godina, 17% u dobi od 40 do 59 godina, 23% u dobi od 60 do 79 godina i 32% žena starijih od 80 godina. SIU nastaje zbog prirođenih ili stečenih oštećenja statike organa u maloj zdjelici s gubitkom anatomske potpore vezikouretralnom segmentu. Za postavljanje dijagnoze prolapsa organa male zdjelice i urinarne inkontinencije važni su detaljna anamneza, ginekološki pregled, klinički testovi, cistometrija, cistoskopija i urodinamski testovi. Liječenje urinarne inkontinencije može biti kirurško i konzervativno. Uspjeh liječenja ovisi o dobroj dijagnostici i dobro odabranom načinu liječenja (kirurškom ili konzervativnom). Suvremenim dijagnostičkim i terapijskim postupcima postiže se optimalan učinak liječenja i osigurava kvalitetan život pacijentica.Urinary incontinence significantly reduces quality of life, and it is an important public health problem with a great impact on physical and mental health. It is known that nearly 25-30% of elderly women develop stress urinary incontinence. Large epidemiological studies in the United States of America show that moderate to severe urinary incontinence is present in 7% of women aged 20-39, 17% aged 40-59, 23% aged 60-79 and 32% aged 80 years and more. Stress urinary incontinence results from inherited or acquired pelvic organ support impairment, with loss of anatomic support to vesicourethral segment. The diagnosis of pelvic organ prolapse and urinary incontinence is based on anamnesis, gynaecologic examination, clinical testing, cystometry, cystoscopy and urodynamic testing. The treatment of urinary incontinence can be surgical or conservative. Treatment success depends on a diagnostic procedure and a properly chosen therapy method (operative or conservative). The use of contemporary diagnostic and therapy procedures yields optimal therapeutic effects and helps maintain a patient’s quality of life

Rad Centra za dobrovoljno savjetovanje i testiranje na HIV u Dubrovačko-neretvanskoj županiji

U kolovozu 2003.g. u Hrvatskoj je započela realizacija Projekta pod nazivom « U n a p r e đ e n j e   b o r b e   p r o t i v   H I V / A I D S - a   u   H r v a t s k o j », koji provodi Ministarstvo zdravstva i socijalne skrbi RH, uz financijsku potporu Globalnog Fonda za borbu protiv HIV/AIDS-a, tuberkuloze i malarije. Projekt se sastoji od preventivnih programa i obuhvaća pet područja djelovanja – zdravstveni odgoj, poboljšanje dostupnosti savjetovanja i testiranja, pružanje socijalne i psihološke podrške osobama pod povećanim rizikom za HIV infekciju, osiguranje kontinuiranog liječenja, te unapređenje epidemiološkog praćenja HIV/AIDS-a. Hrvatski zavod za javno zdravstvo nositelj je programa HIV-2   - “Poboljšanje dostupnosti službe za dobrovoljno savjetovanje i testiranjeâ€, te programa HIV-5 – “Poboljšanje praćenja HIV infekcije u Hrvatskojâ€, a navedeni programi se provode u suradnji za županijskim zavodima za javno zdravstvo

Sex or Surgery – Erectile Dysfunction after Radical Treatment of Localized Prostate Cancer

The maintenance of satisfactory quality of life is major concern in majority of patients who elect treatment for localized prostate cancer. We conducted a cross-sectional study to determine sexual function after radical prostatectomy (RP) and external beam radiotherapy (EBRT). Study population consisted of series of 57 patients with early-stage adenocarcinoma of the prostate, treated in our institution in the period from January 2003 till December 2003. Thirty three patients underwent radical retropubical prostatectomy and 24 patients were treated by primary radical radiotherapy. Patients have been given the full international index of erectile function (IIEF) questionnaire two to four and six months after the treatment. Post treatment sexual function in patients treated by EBRT is significantly better than in patients treated by RP (48,5% vs. 21.57%, p<0,0001). Subgroup analysis reveals that satisfaction with erectile function, maintaining of sexual intercourse and possibility of ejaculation is better in patients treated by EBRT than in patients treated by RP (44.67% vs. 11.57%, p <0,0001) as well as general satisfaction with quality of sexual life (48.5% in EBRT group vs. 21.57% in RP group, p <0,0001). On the other hand, sexual desire remains the same in both groups of patients (63.75% in EBRT group vs. 60.61% in RP group, p = 0.71). Six months after surgical or radiotherapy treatment erectile function is almost as twice as worse in patients treated by surgery than in patients treated by radiotherapy

Fetal Macrosomia in Pregnant Women with Gestational Diabetes

The aim of the study was to determine the frequency of fetal macrosomia in newborns from mothers with gestational diabetes mellitus (GDM) and healthy mothers, as well as determining the influence of fetal growth on pregnancy termination, on complications in pregnancy, during delivery and puerperium and on neonatal complications. In the study were included 351 pregnant women with GDM, as well as control group of 1502 healthy pregnant women. Newborns of mothers with GDM had significantly higher birth weight and length, ponderal index >2.85 was more frequent, they were macrosomic and hypertrophic (disproportional and proportional), had smaller Apgar score and more frequent neonatal complications (p<0.05). Fetal macrosomia and fetal hypertrophy alone or, particularly, connected with disproportional fetal growth, but disproportional hypotrophy as well, had significantly influence on greater frequency of delivery and puerperal complications, delivery completion with Cesarean section and neonatal complications in pregnant women with GDM

Fetal Macrosomia in Pregnant Women with Gestational Diabetes

The aim of the study was to determine the frequency of fetal macrosomia in newborns from mothers with gestational diabetes mellitus (GDM) and healthy mothers, as well as determining the influence of fetal growth on pregnancy termination, on complications in pregnancy, during delivery and puerperium and on neonatal complications. In the study were included 351 pregnant women with GDM, as well as control group of 1502 healthy pregnant women. Newborns of mothers with GDM had significantly higher birth weight and length, ponderal index >2.85 was more frequent, they were macrosomic and hypertrophic (disproportional and proportional), had smaller Apgar score and more frequent neonatal complications (p<0.05). Fetal macrosomia and fetal hypertrophy alone or, particularly, connected with disproportional fetal growth, but disproportional hypotrophy as well, had significantly influence on greater frequency of delivery and puerperal complications, delivery completion with Cesarean section and neonatal complications in pregnant women with GDM

Risk Factor Analysis and Diagnoses of Coronary Heart Disease in Patients with Hypercholesterolemia from Croatian Zagorje County

Our aim is to determine if there exists a difference in risk factors and diagnosis between patients being treated on internal medicine ward for coronary heart disease who have higher levels of cholesterol in their blood and other patients, without proved higher levels of cholesterol, hospitalized for coronary heart disease. We followed patients hospitalized in General Hospital Zabok for coronary heart disease for the period between 2004–2006y. On admission patients were diagnosed with coronary heart disease based on laboratory markers specific for the disease (CK, troponin, LDH,CRP), ECG and history taking. We analyzed two groups of patients for diagnosis and risk factors on discharge from the hospital: one group with proven hypercholesterolemia, the other with coronary heart disease without hypercholesterolemia. For the duration of the study there were no significant alternations concerning risk factors for coronary heart disease, and hypertension was the most prevalent of these factors in both groups. Values of HDL, as an indirect indicator of coronary heart disease, were lower in both groups for the duration of the study. In group of patients with hypercholesterolemia myocardial infarction with a ST segment elevation, as a discharge diagnosis, was a more prevalent complication of the disease, while for the group of patients without hypercholesterolemia stable angina pectoris was more prevalent and this is explained as atheroma plaque stabilization when there are normal values of blood cholesterol

Expression of Matrix Metalloproteinase-1 in Uterosacral Ligaments Tissue of Women with Genital Prolapse

Collagen metabolism is altered in the pelvic organ tissues of women with genital prolapse. The aim of this study was to compare collagen metabolism by measuring matrix metalloproteinase – 1 (MMP – 1) expression in uterosacral ligament tissues of postmenopausal women with and without genital prolapse. Uterosacral ligament tissues were obtained at the time of abdominal or vaginal surgery from twenty-four patients with pelvic organ prolapse (POP) and 21 women who underwent gynecologic surgery for benign indications. The tissue samples were analyzed by immunohistochemistry. There were no differences in age, BMI and parity between two groups. The patients with genital prolapse demonstrated significantly higher occurences of MMP – 1 expression compared to controls. These findings indicate that increased MMP – 1 expression in uterosacral ligaments is associated with genital prolapse. Our data are consistent with the theory that increased collagen breakdown may play an important role in the onset and development of pelvic organ prolapse (POP)

Comparison between World Health Organization criteria and HAPO study criteria in the diagnosis of gestational diabetes mellitus

Gestacijski dijabetes melitus najčešći je metabolički poremećaj u trudnoći. Trudnoće komplicirane gestacijskim dijabetesom imaju lošije ishode u odnosu na trudnoće s normalnom tolerancijom glukoze. Žene koje su bolovale od GDM-a i njihova djeca imaju kasnije u životu povišeni rizik razvoja dijabetesa melitusa, arterijske hipertenzije, dislipidemije, pretilosti i metaboličkog sindroma. Ciljevi studije bili su odrediti pojavnost GDM-a prema IADPSG kriterijima, usporediti ishode trudnoća opterećenih s GDM-om s obzirom na WHO (1999.) i IADPSG dijagnostičke kriterije te odrediti stupanj inzulinske rezistencije u skupini trudnica s GDM-om prema IADPSG kriterijima i njihovoj novorođenčadi. ISPITANICE I METODE: Istraživanje je podijeljeno u retrospektivni i prospektivni dio te je provedeno u Klinici za ženske bolesti i porode KBC-a Zagreb. U retrospektivnom dijelu obuhvaćeno je 2 405 trudnica koje su rodile u razdoblju od 2009. do 2010. godine. Na temelju rezultata oGTT-a trudnice su podijeljene u 4 skupine: prva skupina trudnica s GDM-om po WHO kriterijima; druga skupina trudnica s normalnom tolerancijom glukoze prema WHO kriterijima, a koje su prema IADPSG kriterijima imale GDM; treća skupina trudnica s GDM-om po WHO i IADPSG kriterijima (preklapajuća skupina) i četvrta skupina trudnica s normalnom tolerancijom glukoze prema oba kriterija. Prospektivni dio istraživanja proveden je tijekom 2011. godine na uzorku od 120 trudnica. Prva skupina od 60 trudnica s koncentracijom glukoze natašte 5,1 - 6,9 mmol/L (GDM) i druga skupina od 60 trudnica s normalnom tolerancijom glukoze. Analizirani su opći podaci trudnica i novorođenčadi te primarni ishodi trudnoća (fetalna makrosomija i hipertrofija, trudnoće dovršene carskim rezom) i sekundarni ishodi trudnoća (hipertenzivni poremećaji u trudnoći, fetalna hipotrofija i prijevremeni porod). U prospektivnom dijelu analizirane su koncentracije glukoze i C-peptida iz krvi majke i umbilikalne krvi te je određena inzulinska rezistencija. REZULTATI: Utvrdili smo statistički značajno veću pojavnost GDM-a prema IADPSG kriterijima u odnosu na WHO kriterije (6,2% vs. 21,7%; Χ² = 361; p < 0,001). Trudnice s hiperglikemijskim poremećajem u trudnoći imale su lošije ishode trudnoća u odnosu na trudnice s normalnom tolerancijom glukoze. Zabilježene su statistički značajne razlike u demografskim podacima trudnica po ispitivanim skupinama. Ukupni udio prekomjerno teških i pretilih trudnica bio je najviši u skupini trudnica koje su imale GDM po IADPSG kriterijima (44%) (skupina 2). Navedene trudnice imale su statistički značajno višu stopu fetalne makrosomije (23,2%), hipertrofične djece (25,1%), rađale su u prosjeku najtežu djecu, najvišeg ponderalnog indeksa. Stopa carskih rezova je u navedenoj skupini trudnica bila statistički značajno viša u odnosu na trudnice s normalnom tolerancijom glukoze (20,0% vs. 13,8%, p < 0,001). Trudnice s GDM-om iz prospektivnog dijela istraživanja, a koje su liječene dijabetičkom dijetom, češće su rađale makrosomnu i hipertrofičnu djecu, trudnoće su češće dovršavane carskim rezom. Razlike su u odnosu na skupinu trudnica s normalnom tolerancijom glukoze bile statistički značajne (p = 0,043). Inzulinska rezistencija novorođenčadi majki s gestacijskim dijabetesom značajno je bila viša u odnosu na novorođenčad majki s normalnom tolerancijom glukoze (p < 0,001). Porastom indeksa tjelesne mase raste stopa nepovoljnih ishoda trudnoća. Udio kronične hipertenzije (3%), gestacijske hipertenzije (18,8%), carskog reza (31%), fetalne makrosomije (24,4%) i fetalne hipertrofije (28%) bio je najviši u pretilih trudnica u odnosu na trudnice normalne tjelesne težine (p < 0,001). Udio hipotrofične djece (10,9%) i prijevremenog poroda (6,5%) bio je najviši u pothranjenih trudnica. Nađena je statistički značajna pozitivna korelacija između tjelesne težine trudnica na početku trudnoće i novorođenačke težine. ZAKLJUČAK: Zbog snižene granične vrijednosti koncentracije glukoze natašte, IADPSG kriterijima otkrivamo veći broj trudnica s hiperglikemijskim poremećajem u trudnoći. U trudnica koje po WHO kriterijima imaju normalnu toleranciju glukoze, a po IADPSG kriterijima imaju GDM, zabilježeni su lošiji ishodi trudnoća. Niže vrijednosti glikemije, od one definirane za dijabetes u trudnoći, povezane su s nepovoljnim ishodima trudnoća. Hiperglikemijski poremećaji u trudnoći usko su vezani uz problem pretilosti. Pretile žene bi trebalo educirati i liječiti znatno prije trudnoće i na taj način umanjiti rizik nepovoljnih ishoda trudnoća. Važan naglasak trebao bi biti na mjerama prevencije pretilosti.Gestational diabetes mellitus is the most common metabolic disorder in pregnancy. Pregnancies with gestational diabetes have worse outcomes compared to pregnancies with normal glucose tolerance. The objectives of the study were to determine the incidence of GDM according to the IADPSG criteria, to compare the outcomes of pregnancies with GDM based on the WHO (1999) and IADPSG diagnostic criteria and to determine the degree of insulin resistance in a group of pregnant women with GDM according to the IADPSG criteria and their newborns. PATIENTS AND METHODS: The study is divided into retrospective and prospective part. A retrospective part included 2 405 pregnant women who delivered in the Department of Obstetrics and Gynecology Clinical Hospital Centre Zagreb in the period from 2009 to 2010. Based on the results of the oGTT pregnant women were divided into four groups: the first group of pregnant women with gestational diabetes according to the WHO criteria; the second group of pregnant women with normal glucose tolerance according to the WHO criteria, but according to the IADPSG criteria with gestational diabetes; the third group of pregnant women with overlapping results and the fourth group of pregnant women with normal glucose tolerance according to the both criteria. A prospective part of the study analyzed 120 pregnant women divided according to the results of oGTT in the two groups. The first group included 60 pregnant women with GDM according to the IADPSG criteria (fasting plasma glucose 5,1 - 6,9 mmol/L) and the second group included 60 pregnant women with normal glucose tolerance. We analyzed demographic data of pregnant women and their newborns, primary outcomes (LGA, macrosomia, cesarean section) and secondary outcomes (hypertensive disordes, preterm delivery, SGA). Prospectively we analyzed concentration of plasma glucose and C-peptide in maternal and umbilical blood samples. RESULTS: We found significantly higher prevalence of GDM according to the IADPSG criteria compared to the WHO criteria (6.2% vs. 21.7%; Χ² = 361; p < 0.001). Pregnant women with hyperglycemic disorders in pregnancy had worse pregnancy outcomes compared to pregnant women with normal glucose tolerance. The overall proportion of overweight and obese pregnant women was the highest in the group of untreated pregnant women with GDM according to the IADPSG criteria (44%) (group 2). In this group we found significantly higer rate of fetal macrosomia (23,2%) and LGA (25,1%). The rate of caesarean section was significantly higher in comparison to healthy controls (20.0% vs. 13.8%, p < 0,001). Prospectively, in a group of pregnant women with GDM according to the IADPSG criteria, who were treated, we found higher rate of macrosomia, LGA and cesarean section. The differencies were statistically significant (p = 0,043). The newborns of diabetic pregnant women had higher insulin resistance compared to the newborns of pregnant women with normal glucose tolerance (p < 0,001). Increased body mass index is associated with adverse pregnancy outcomes. The rate of chronic hypertension (3%), gestational hypertension (18,8%), cesarean section (31%), fetal macrosomia (24,4%) and LGA (28%) was significantly higher in obese pregnant women compared tonpregnant women with normal body weight (p < 0,001). The rate of preterm delivery (6,5%) and SGA (10,9%) was higher in underweight pregnant women. CONCLUSION: IADPSG diagnostic criteria for GDM reveals more women with hyperglycemic disorders in pregnancy. A group of pregnant women who were normoglycemic according to the WHO criteria, but according to the IADPSG were diagnosed GDM, had adverse pregnancy outcomes. Lower values of glycemia, than those defined for diabetes in pregnancy, are associated with adverse pregnancy outcomes. Hyperglycemic disorders in pregnancy are closely related to obesity. Obese women should be educated and treated well before the pregnancy to reduce the risk of adverse pregnancy outcomes. The important focus should be on the prevention of obesity