The Role of Oral Glucose Intolerance Test in Reducing Pregnancy Complications

The influence of glucose monitoring during pregnancy on newborn body weight, and complications during pregnancy and labor was assessed. We performed a retrospective analysis of macrosomal children, fetal growth, caesarean sections, malformations, still-births and the number of oral glucose tolerance test (OGTT) carried out in a five-year period. The proportion of women participating in OGTT tests increased from 20% to 40% (p<0.05) between 2000 and 2004. Gestation diabetes mellitus (GDM) proportions among pregnant women seen at the Department of Obstetrics and Gynecology at Slavonski Brod General Hospital, Croatia increased from 1% to 6.7% (p<0.05) during the observed period. Proportion of births identified as macrosomal decreased from 13.3% to 12.2% (p<0.05). Additionally, infant mortality and stillbirths along with other fetal and maternal complications declined during the same period. These results suggest that regular measurements of glucose tolerance during pregnancy may prevent preterm birth, decrease the proportion of macrosomal newborns, lower mortality and decrease fetal and maternal complication incidence during pregnancy and delivery

COVID-19 and children

Novi koronavirus, nazvan virus teškog respiratornog sindroma (engl. Severe Acute Respiratory Syndrome Coronavirus-2, SARS-CoV-2), identificiran je u prosincu 2019. godine. U sljedećim mjesecima, zahvaljujući obilježjima brzog i lakog prijenosa infekcije među ljudima, SARS-CoV-2 doveo je do pandemije s više od 2.000.000 oboljelih i više od 100.000 smrti. Bolest uzrokovana virusom SARS-CoV-2 nazvana je koronavirusna bolest 2019 (engl. Coronavirus disease 2019, COVID-19), a obilježena je općim simptomima infekcije koji su praćeni upalnim promjenama donjih dišnih putova. U manjeg broja inficiranih, ponajprije osoba starije životne dobi s komorbiditetima, bolest napreduje ka akutnom respiratornom distresu, višestrukom zatajenju organa i letalnom ishodu. Epidemiološka izvješća prikazuju mali postotak djece među oboljelim osobama (≤5%). Djeca imaju laboratorijske dokaze infekcije virusom ili blaže do umjereno teške kliničke slike, s nešto blažim radiološki potvrđenim upalnim promjenama u plućima nego odrasli i rijetkim letalnim ishodima. Uočeno je kako su jednako osjetljiva na infekciju kao i odrasle osobe, ali nije do kraja razjašnjeno zašto ostaju asimptomatski odnosno imaju blage do umjereno teške oblike COVID-19. Uzroci se traže u međudjelovanju između domaćinovih imunoloških snaga i patogenetskih mehanizama virusa. Dječja dob je obilježena virusnim infekcijama i cijepljenjem koji pružaju križnu imunost odnosno reaktivnost prema drugim patogenima, povećanim brojem limfocita te povećanom ekspresijom angiotenzin konvertirajućeg enzima 2 (engl. angiotensin converting enzyme 2, ACE2). Smatra se kako bi navedena obilježja dječje dobi mogla pružiti zaštitu od težih i letalnih oblika COVID-19. I u novorođenačkoj dobi postoji mogućnost infekcije i razvoja različitih oblika bolesti. Detaljnim analizama amnionske tekućine, krvi iz pupkovine i majčinog mlijeka za sada nije dokazan vertikalni prijenos infekcije s majke na dijete. Novorođenčad i dojenčad, posebice s komorbiditetima, zbog imunološke nezrelosti i nedostatka križne imunosti ugroženija su razvojem koronavirusne bolesti. U tijeku trajanja pandemije neophodno je strogo provoditi protektivne mjere protiv širenja infekcije, tražiti prve znakove bolesti kako bi se što ranije započelo primjereno liječenje.The new coronavirus, called the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was identified in December 2019. In the following months SARS-CoV-2 has led to a pandemic with over 2,000,000 confirmed cases and 100,000 deaths. The disease caused by SARS-CoV-2, called the coronavirus disease 2019 (COVID-19), is characterized by general symptoms of infection, which are accompanied with inflammatory changes in the lower respiratory tract. In a small number of infected people, most notably the elderly with comorbidities, the disease progresses to acute respiratory distress and multiple organ failure with lethal outcome. Epidemiological reports, however, show a small percentage of children among the sick: up to 5%. Children tend to have laboratory evidence of virus infection or mild to moderately severe clinical presentations, with slightly milder radiological changes in the lungs than adults, and with rare lethal outcomes.. It has been observed that children are as susceptible to infection as adults, but it is not fully understood why they remain asymptomatic, or have mild forms of COVID-19. The causes for that are sought in the interaction between the host immune forces and the pathogenic mechanisms of the virus. Childhood is characterized by viral infections and vaccinations that provide cross-immunity and reactivity to other pathogens, increased lymphocyte counts and increased expression of angiotensin converting enzyme 2 (ACE2). It is considered that the characteristics mentioned above could provide protection against the more severe forms of COVID-19. When it comes to the newborns, analyses of amniotic fluid, cord blood and breast milk have not yet demonstrated the vertical transmission of infection from mother to child. While the pandemic lasts, it is necessary to implement strict protective measures against the spreading of the disease, and to look for the first signs of the disease in order to start the appropriate treatment as soon as possible

Effects of Raloxifene on Changes in Bone Density

Raloxifene hydrochloride therapy effectiveness in bone mineral density (BMD) changes compared to calcium and vitamin D3 therapy over a 2-year period. Case-control study: a group of 254 women was prescribed raloxifene (raloxifene hydrochloride) together with calcium and vitamin D3 while other group of 254 women used calcium and vitamin D3 therapy. BMD was measured at the hip, spine and forearm at the beginning and at the end of the 2-year period. Treatment with raloxifene resulted in a 3.7% increase in BMD at the spine in 98% of examinees. A 1.2% BMD increase was shown in 75% of examinees at the hip. A 1.2% decrease in BMD at forearm shown in 93% of examinees using raloxifene. The calcium and vitamin D3 therapy led to an increase in BMD in 58% examinees at the spine, in 56% at the hip and in 38% at the forearm, which was significantly lower than in women using raloxifene. Among women using calcium and vitamin D alone an average BMD decrease of 1.2% was registered on 42% of examinees at the spine, 2.6% decrease on 46% of examinees at the hip and 4.2% decrease on 35% of examinees at the forearm. Treatment with raloxifene resulted in a significant increase in BMD at the spine with odds ratio (OR 5.85, p<0.05) compared with calcium and vitamin D3 alone. There was no statistically proven increase in BMD at either the hip (OR 0.015) or forearm (OR 0.122)

Glycemic Control in Diabetes Type 2 Patients in Foster Families of Brod-Posavina County During the COVID-19 Pandemic

COVID-19 pandemic has changed everyday life and medical supervision of chronically ill patients. Epidemiological measures, social distancing, and limited access to medical care impair glycemic control in patients with diabetes. Also, type 2 diabetes is a risk factor for more severe form of coronavirus disease. A large proportion of diabetic patients are placed in foster families who also adapt to the new situation. The purpose of this study was to examine the manner and frequency of glycemic control in patients with type 2 diabetes who are placed in foster families in the region of Brod- Posavina County. We established contact with patients suffering from type 2 diabetes situated in foster families and their caregivers. Measurement of glycemia was performed several times a day with regular notes and the data were supplemented by an insight into the medical documentation of patients in the hospital information system. The study included 33 patients with type 2 diabetes. The relationship between HbA1C with fasting and postprandial glycemia was linear. There were no statistically significant differences in HbA1C regulation by type of therapy. There was a significant difference in the number of complications according to the level of HbA1C (Hi square test = 25.982, p <.001). The number of complications generally increased as HbA1C regulation was poorer. During current COVID-19 pandemic, care for patients with type 2 diabetes is significantly limited. Improved medical care for patients can be achieved by establishing cooperation and daily communication between caregivers, family physicians and, if necessary, diabetologists, especially through the use of online platforms and telephone communication, all with the aim of early detection of diabetes complications and adequate treatment of patients in current conditions

Recommendations for People with Osteoporosis and General Practitioners During COVID-19 Pandemic

The paper presents the guidelines made by the Multidisciplinary Team for Osteoporosis for patients in the General Hospital “Dr.Josip Benčević”, Slavonski Brod and general practitioners in the Brod-Posavina County in order to inform them properly about the COVID-19 pandemic and the recommendations of the National Civil Protection Committee, as well as to help them reduce their fear and to improve their cooperation with their general practitioners. A system of recording new fractures in the county was maintained since the onset of the epidemic. The recommendations for patients with osteoporosis include their lifestyle, medical treatment and balanced nutrition, following the advices of the International Osteoporosis Foundation, the Croatian Osteoporosis Society and the British Royal Osteoporosis Society. Living with osteoporosis demands balanced nutrition, regular exercise and taking prescribed medications. As in the present conditions of COVID-19 epidemic outdoor physical activities are temporarily limited it is necessary to ensure the availability of calcium-rich food and vitamin D supplies. As medical treatment of osteoporosis does not increase risk of COVID-19 infection it is recommended for patients to continue their prescribed therapy in consultation with their general practitioner

Uloga inhibitora renin-angiotenzin-aldosteronskog sustava u patogenezi koronavirusne bolesti (COVID-19)

Koronavirusna bolest (COVID-19) zarazna je bolest koju uzrokuje novi koronavirus odnosno virus teškoga respiratornog sindroma (engl. Severe acute respiratory syndrome coronavirus 2 – SARS-CoV-2). U većeg broja zaraženih bolest obilježavaju opći simptomi infekcije koji su praćeni upalnim promjenama donjih dišnih putova. U osoba starije dobi s komorbiditetima, osobito s kardiovaskularnim bolestima, koronavirusna bolest češće napreduje prema akutnomu respiratornom distresu, akutnoj ozljedi miokarda, višestrukom zatajenju organa i mogućemu smrtnom ishodu. Bolest se prvi put pojavila u prosincu 2019. u kineskom gradu Vuhanu i do danas je poprimila razmjere pandemije, s više od 70 milijuna oboljelih i 1,6 milijuna umrlih. Koronavirus SARS-CoV-2 inficira stanice domaćina preko receptora enzima koji konvertira angiotenzin tipa 2 (engl. Angiotensin converting enzyme 2 – ACE2) i važna je komponenta renin-angiotenzin-aldosteronskog sustava (engl. Renin-angiotensin-aldosterone system – RAAS). Kao membranski protein, ACE2 je prisutan u plućima, srcu, bubrezima i crijevima. Patologija koronavirusne bolesti pokazuje povezanost s raspodjelom ACE2 po tkivima. RAAS je presudan u homeostazi kardiovaskularnog sustava. Inhibitori RAAS-a (inhibitori enzima koji konvertira angiotenzin, blokatori receptora angiotenzina II tipa 1) primjenjuju se u liječenju kardiovaskularnih bolesti, hipertenzije i šećerne bolesti. Iz pretkliničkih radova poznato je da inhibitori RAAS-a mogu povećati ekspresiju ACE2. U vrijeme pandemije koronavirusne bolesti javila se zabrinutost o sigurnosti njihove primjene. Razmatra se kako povećana ekspresija ACE2 može utjecati na tijek te bolesti: povećanjem infektivnosti koronavirusa (SARS-CoV-2) ili zaštitnim, organoprotektivnim učincima koji vode do smanjene smrtnosti. Znanstvenici su postulirali potencijalno štetne učinke inhibitora RAAS-a u patogenezi koronavirusne bolesti (COVID-19), kao i njihove moguće korisne učinke, međutim, rezultate eksperimentalnih i pretkliničkih radova ne možemo potpuno primijeniti na ljudsku fiziologiju. Stručna društva preporučila su nastavak primjene inhibitora RASS-a za vrijedeće kardiovaskularne indikacije. Potrebna su klinička ispitivanja o sigurnosti i učinkovitosti rekombinantnoga humanog ACE2 i drugih inhibitora RAAS-a u koronavirusnoj bolesti. Dotad inhibitore RAAS-a treba i dalje primjenjivati u liječenju stabilnih pacijenata bez obzira na rizik ili koronavirusnu bolest

MIDWIVES IN BROD NA SAVI (CROATIA) IN 19th CENTURY

Razvoj populacijske politike i zdravstvene legislative kao posljedica državne potrebe za većim brojem mladih, zdravih, radno i vojno aktivnih stanovnika, rezultirao je školovanjem svih zdravstvenih radnika pa i primalja, zakonskim reguliranjem njihovog rada, povećanjem njihovog broja, te usavršavanjem primaljske struke. Razvojem ove struke su se postepeno poboljšavali uvjeti rađanja žena , nadzor trudnoća i porođaja, a na taj način se utjecalo na natalitet i mortalitete populacije kao i na prirodni prirast. Na primjeru Broda na Savi vidi se da je to bio dugotrajan i ne kontrolirani razvoj primaljske struke, na ovim prostorima, na koji su utjecale loše socioekonomske prilike ,loše klimatske prilike, te prisutnost granice i posljedično velikih migracija stanovništva. Važno je uočiti da tada udareni temelji populacijskoj politici, a uz nju i promatranoj primaljskoj struci su omogućili razvoj istih u nadolazećim periodu.The development of population policy and health legislation as a result of government, the need for more young, healthy, working and military active population, resulted in the education of all health workers including midwives, legal regulation of their work, increasing their number and training of midwifery profession. With the development of this profession conditions of women giving birth, pregnancy and birth control were gradually improved, and thus influenced the birth rate and mortality of the population and the natural growth. On the example of the town of Brod na Savi one can see that it was time-consuming and controlled development of the midwifery profession in the region, which have affected the poor socio-economic conditions, poor climatic conditions, and the presence of the border and the consequent large-scale migration of the population. It is important to note that the foundations for population policies and the observed midwifery profession enabled the development of the same in the coming period

Znanja i stavovi vinkovačkih srednjoškolaca o darivanju i presađivanju organa

Transplantacijska medicina omogućila je spašavanje i produljenje života mnogim ljudima. No, zamijeniti bolestan ili oštećeni organ zdravim moguće je samo zahvaljujući darivateljima organa. Pozitivan stav javnosti može doprinijeti povećanju svijesti o važnosti darivanja organa. Ciljevi rada su istražiti informiranost vinkovačkih srednjoškolaca o darivanju i presađivanju organa, postoje li razlike u stavovima s obzirom na spol i postoji li više senzibiliziranosti za darivanje organa kod učenika zdravstvene škole u odnosu na ostale. Uzorak ispitanika obuhvatio je 142 učenika završnih razreda Poljoprivredno šumarske i Zdravstvene i veterinarske škole iz Vinkovaca. U istraživanju je korišten anonimni upitnik s 20 pitanja o znanju i stavovima o darivanju i presađivanju organa, s osvrtom na osnovne sociodemografske podatke. Dobiveni rezultati nisu pokazali da postoje značajnije razlike u znanju i stavovima među ispitanicima niti po školi koju pohađaju niti po spolu. Većina smatra da s tematikom nije dovoljno upoznata, a najviše informacija dobivaju iz medija. Organe bi nakon smrti darivalo 49% učenika, a vjerojatno i dio onih 44% koji o tome još nisu razmišljali. Spašavanje života druge osobe bio bi glavni razlog za odluku o darivanju vlastitih organa nakon smrti. Najvažniji razlog da ne daruju organ bio bi strah da se zdravstveni djelatnici ne bi maksimalno potrudili pomoći im ako bi znali da su na listi darivatelja organa. Dodatne edukacije, informiranje cjelokupne javnosti, uklanjanje predrasuda, promicanje pozitivnog stava u svezi darivanja organa i potpisivanje donorske kartice uvelike bi moglo povećati broj potencijalnih darivatelja.

Znanja i stavovi vinkovačkih srednjoškolaca o darivanju i presađivanju organa

Transplantacijska medicina omogućila je spašavanje i produljenje života mnogim ljudima. No, zamijeniti bolestan ili oštećeni organ zdravim moguće je samo zahvaljujući darivateljima organa. Pozitivan stav javnosti može doprinijeti povećanju svijesti o važnosti darivanja organa. Ciljevi rada su istražiti informiranost vinkovačkih srednjoškolaca o darivanju i presađivanju organa, postoje li razlike u stavovima s obzirom na spol i postoji li više senzibiliziranosti za darivanje organa kod učenika zdravstvene škole u odnosu na ostale. Uzorak ispitanika obuhvatio je 142 učenika završnih razreda Poljoprivredno šumarske i Zdravstvene i veterinarske škole iz Vinkovaca. U istraživanju je korišten anonimni upitnik s 20 pitanja o znanju i stavovima o darivanju i presađivanju organa, s osvrtom na osnovne sociodemografske podatke. Dobiveni rezultati nisu pokazali da postoje značajnije razlike u znanju i stavovima među ispitanicima niti po školi koju pohađaju niti po spolu. Većina smatra da s tematikom nije dovoljno upoznata, a najviše informacija dobivaju iz medija. Organe bi nakon smrti darivalo 49% učenika, a vjerojatno i dio onih 44% koji o tome još nisu razmišljali. Spašavanje života druge osobe bio bi glavni razlog za odluku o darivanju vlastitih organa nakon smrti. Najvažniji razlog da ne daruju organ bio bi strah da se zdravstveni djelatnici ne bi maksimalno potrudili pomoći im ako bi znali da su na listi darivatelja organa. Dodatne edukacije, informiranje cjelokupne javnosti, uklanjanje predrasuda, promicanje pozitivnog stava u svezi darivanja organa i potpisivanje donorske kartice uvelike bi moglo povećati broj potencijalnih darivatelja.