Complicated extubation in a patient with an obstructing tracheobronchial thrombus

Endotracheal intubation is an effective and rapid technique used as a standard practice for airway management. Airway injury or complications could be a significant cause of morbidity and mortality for patients. Tracheobronchial obstruction secondary to thrombus formation are life threatening complications of traumatic intubations. We present a case of complicated extubation resulting in cardiac arrest in a patient with an obstructing tracheobronchial thrombus. The patient, an 83-year-old female, with atrial fibrillation presented for neck pain. During CT imaging, she developed ventricular fibrillation cardiac arrest. Return of spontaneous circulation (ROSC) was achieved after three cycles of compressions and defibrillation and the patient was intubated. After stabilization of the patient and passing of spontaneous breathing trials, the patient was extubated. The patient rapidly developed hypoxic respiratory failure and progressed to pulseless electrical activity. ROSC was achieved again after 3 rounds of compressions. The following days, after passing her SBT yet again, extubation was attempted. She had an audible stridor and visible respiratory distress. Bedside Yankauer suction of the oropharynx resulted in retrieval of a large 6x2cm thrombus. Immediate resolution of stridor and improved oxygenation occurred. Tracheobronchial clots are a cause of cardiac arrest and potentially fatal cause of endotracheal intubation. Physicians and respiratory therapists must be aware of optimizing pre-extubation conditions in the setting of TB obstruction as it can lead to arrest and death

Uterine fibroids - clinical presentation and complications

Fibroids are the most common benign tumors of the genital organs in women of childbearing age. In some women, fibroids can be present for years without any symptoms and then are discovered accidentally during a gynecological examination. In others, they can cause significant morbidity and necessitate the need for multiple surgical procedures. The scope of this clinical review is to provide information about the clinical data as well as the complications of uterine fibroids and their clinical presentation. The most common symptoms that may occur in women with uterine fibroids include: bleeding (menometrorrhagia, metrorrhagia or intermenstrual bleeding), pain, symptoms of compression of adjacent structures, changed appearance of the abdomen and infertility. Complications of uterine fibroids include: venous thromboembolism, torsion of pedunculated fibroids, acute urinary retention and renal insufficiency, vaginal and intraabdominal bleeding, mesenteric vein thrombosis and gangrene of the intestine. Complications of uterine fibroids fibroids are rare and though they may cause significant morbidity, and rarely, mortality, which indicates the need for further research in this area. Accurate diagnosis is an essential prerequisite for the evaluation of therapeutic options, especially recently, when medical and numerous non-invasive treatment options have become available

Endometrial polyps in infertility patients: The first study of their clinical characteristics

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Primena gravitacionog stola u doradi semenske lucerke

Processing alfalfa seed from natural sources with admixture, grains of other species and various impurities are removed and clear grain of the basic culture is obtained. Grain of the basic culture is prepared for sowing machine and quality planting, germination and sprouting. Alfalfa seed loses during the processing depend on quantity and type of weed and other impurities of organic and inorganic origin present in the naturalized seed. In this paper is given the analyses of the efficiency during natural alfalfa seed processing of two different purities (B1, B2), processed on the same equipment that involves gravity table Oliver - 240. As the relevant parameters that define the effects of alfalfa seed were: clear grain (%), weed and other cultures seed (%), inert matter (%), quantity of processed seed (kg), time of seed processing (h), active (kWh) and reactive (kVArh) current consumption, processing output (%), and seed loses (%).Procesom dorade semenske lucerke iz naturalnog semena sa primesama uklanjaju se sva zrna stranih primesa i razne nečistoće i izdvaja čisto zrno osnovne kulture koje se priprema u što povoljnije stanje za sejalicu i kvalitetnu setvu, klijanje i nicanje. Gubici semena lucerke u procesu dorade zavise od vrste i količine korova i ostalih nečistoća, organskog i neorganskog porekla prisutnih u naturalnom semenu. U radu je data analiza efikasnosti pri doradi naturalnog semena lucerke dve različite čistoće (B1, B2) dorađene na istom sistemu mašina za doradu u okviru koga je korišćen gravitacioni sto Oliver - 240. Kao relevantni parametri koji definišu efekte dorade semena lucerke bili su: čisto seme (%), seme korova i seme drugih kultura (%), inertne materije (%), količina dorađenog semena (kg), vreme dorade semena (h), utrošak aktivne električne energije (kWh) i reaktivne električne energije (kVArh), randman dorade (%) i gubici semena (%)

Rola nacięcia krocza w profilaktyce uszkodzeń podczas porodów pochwowych – wyniki z dwóch ośrodków europejskich

Objectives: There is an ongoing debate regarding the routine versus restrictive use of episiotomy. The study aim was to investigate if episiotomy during vaginal deliveries can reduce both, the number and severity of genital lacerations. Material and methods: The study included all women who gave vaginal birth at AOU. “G. Martino” Messina (n=382) and the Clinic for Ob/Gyn Clinical Center of Serbia, Belgrade (n=4221) during 2011. Lacerations during birth were recorded and divided according to location and severity. Women with lacerations were subdivided into two groups: with or without medio-lateral episiotomy. We assessed potential risk factors for laceration: maternal age, parity, use of labor stimulants and epidural analgesia, participation in antenatal classes, fetal presentation, neonatal birth weight, and duration of the second stage of labor. Results: Older women had higher grade perineum or combined lacerations. Children with higher birth weight in occipito-posterior presentation caused higher grade lacerations. Performance of episiotomy was connected with fewer perineum and labial lacerations. There were no differences in laceration grade between patients with and without episiotomy. Assessed parameters proved to be good discriminating factors between lacerations sites. According to logistic regression, laceration site was the most important risk factor for laceration grade. Combined lacerations had the highest grade. Conclusions: Episiotomy can significantly reduce the number of genital lacerations, but it does not influence laceration grade. Advanced maternal age, higher parity, occipito-posterior presentation and fetal macrosomia can cause lacerations during vaginal birth. Therefore, we suggest analysis of maternal and fetal factors to prevent widespread genital lacerations.Cel: Trwa debata w prawie właściwego stosowania nacięcia krocza: regularne kontra ograniczone. Celem badania była ocena czy nacięcie krocza podczas porodu pochwowego może zredukować zarówno liczbę jak i ciężkość uszkodzeń krocza. Materiał i metoda: Do badania włączono wszystkie kobiety, które w 2011 roku urodziły drogą pochwową w ośrodku w AOU „G.Martino” Messina (n=382) i w Klinice Położniczo-Ginekologicznej w Serbii, w Belgradzie (n=4221). Uszkodzenia krocza podczas porodu zostały podzielone względem lokalizacji i ciężkości. Kobiety z uszkodzeniami podzielono na dwie podgrupy: z nacięciem i bez nacięcia pośrodkowo-bocznego krocza. Oceniono możliwe czynniki ryzyka uszkodzeń krocza: wiek matki, rodność, użycie stymulacji porodu, znieczulenie zewnątrzoponowe, uczestnictwo w szkole rodzenia, położenie płodu, masa urodzeniowa noworodka, czas trwania drugiej fazy porodu. Wyniki: Starsze kobiety miały wyższy stopień uszkodzenia krocza i bardziej złożone pęknięcia. Urodzenie dziecka z większą masą urodzeniową w ułożeniu potylicowym-tylnym powodowało wyższy stopień pęknięć krocza. Nacięcie krocza wiązało się z mniejszą ilością pęknięć krocza i warg sromowych. Nie zanotowano różnic w stopniu uszkodzenia krocza pomiędzy pacjentkami z i bez nacięcia krocza. Oceniane czynniki są przydatne w różnicowaniu miejsca uszkodzenia. Na podstawie regresji logistycznej, miejsce pęknięcia było najważniejszym czynnikiem ryzyka stopnia uszkodzenia krocza. Złożone uszkodzenia miały najwyższy stopień. Wnioski: Nacięcie krocza istotnie zmniejszało liczbę uszkodzeń krocza, lecz nie wpływało na ich stopień. Zaawansowany wiek matki, wyższa rodność, ułożenie potylicowe-tylne i makrosomia płodu mogą powodować pęknięcia krocza w trakcie porodu. Sugerujemy analizę matczynych i płodowych czynników ryzyka celem zapobiegania szerokim uszkodzeniom krocza w trakcie porodu

Histopathological diagnoses of adnexal masses: which parameters are relevant in preoperative assessment?

Objective: The aim of the study was to assess which clinical, laboratory and ultrasound characteristics of adnexal masses might predict the histopathological nature of the disease. Materials and Methods: The study involved all women treated at the Clinic of Gynecology and Obstetrics Clinical Centre of Serbia for adnexal tumors between July 1, 2010 and December 31, 2011. On admission, detailed anamnestic and laboratory data were obtained, expert ultrasound scan performed and RMI was calculated for all patients. Data were related to histopathological findings and statistically analyzed. Results: The study included 540 women out of which 85 had malignant (seven diagnoses), 435 benign (seven diagnoses) and 20 borderline tumors. All types of malignant and borderline tumors were more frequent in postmenopausal women (p=0.000). Only papillary adenocarcinoma significantly more often produced early metastases (p=0.000). Ascites is a common finding in Krukenberg tumors, granulose cell tumors and papillary adenocarcinomas. There were significant differences between tumor diagnoses regarding the levels of Ca 125 and CEA, erythrocyte sedimentation rate (ESR) and risk of malignancy index (RMI) (p0.05). Conclusions: In the light of our results, patient age, menopausal status, blood levels of Ca 125, CEA and ESR, as well as calculated RMI, can predict the nature of adnexal masses. Unfortunately, none of the examined parameters can accurately determine the exact histopathological diagnosis of the adnexal tumor

Утицај чистоће натуралног семена lуцерке на рандман дораде

To improve seed quality, harvested seed must be transported to processing facility. Harvested, naturalized alfalfa seed contains many different particles such as weed seed, seed of other raised plants ant inert matter. In the processing of small grained legumes, output is in direct dependence with percent of weed species and of quality of other particles in naturalized seed. High percent of purity of naturalized alfalfa seed is not always a guarantee for high processing output. It primary depends on species of present weed in naturalized seed. High purity seed with low percent of weed leads to high output. Weed usually makes processing more difficult and costly. In this study, was analyzed the effect of quantity of particles on utilization of alfalfa seed and two different kind of seed purity, that were processed on the same system of machine.У процесу дораде семена ситнозрних легуминоза висина рандмана семена директно зависи од заступљености коровских врста и осталих примеса у натуралном семену. Висок степен чистоће натуралног семена луцерке није увек гаранција и високог рандмана дораде, чак и при малом садржају корова, већ он првенствено зависи од врсте присутних корова у натуралном семену. Већи садржај штетних корова у натуралном семену луцерке са високом чистоћом смањује укупну количину дорађеног семена, отежава и поскупљује дораду. У раду је дата анализа утицаја садржаја примеса у натуралном семену луцерке, на искоришћење семена, односно добијену количину семена, при чему се дорада две различите чистоће семена обављала на истом систему машина за дораду

QUALITY-OF-LIFE ASSESSMENT OFWOMEN UNDERGOING IN VITRO FERTILIZATION IN KAZAKHSTAN

Infertility is a problem that affects millions of couples worldwide and has a significant impact on their quality of life. The recently introduced “Fertility Quality of Life Questionnaire (FertiQoL)” quickly became a gold standard for evaluation of the quality of life of patients suffering from infertility. The aim of this study was to determine the quality of life of Kazakhstani women coping with infertility problems by FertiQoL and assess the validity of the questionnaire. This cross-sectional study involved women of reproductive age undergoing an in vitro fertilization (IVF) cycle at a large IVF center in Kazakhstan in the period from 1 September 2020 to 31 September 2021. A total of 453 women out of 500 agreed to participate in the study, and the response rate was 90.6%. The overall Core FertiQoL was 56.95 14.05, and the Treatment FertiQoL was 66.18 11.13 points. Respondents with secondary infertility had statistically significantly higher Emotional (p < 0.001), Mind–body (p = 0.03), Social (p < 0.001), Environment (p = 0.02), and Treatment (p < 0.001) domains of FertiQoL than women with primary infertility. Respondents with a low income had the lowest levels of Total FertiQoL (56.72 11.65). The longer duration of infertility of women undergoing IVF treatment presented the worse scale of Treatment and Total FertiQoL. Cronbach’s alpha revealed good internal reliability for all FertiQoL subscales on the Kazakhstan women’s questionnaire and averaged 0.8, which is an indicator of a high degree of reliability. The Total FertiQoL of Kazakhstan women undergoing IVF treatment was 59.6 11.5, which is considerably lower than European countries. We identified statistically significant differences across medical and demographic groups. As this questionnaire had validity in Kazakhstan survey it possibly be used for both medical counseling and future investigation in our country

Unveiling the Role of the Work Environment in the Quality of Life of Menopausal Physicians and Nurses

Background: There is a lack of scientific evidence regarding the specific challenges faced by menopausal medical professionals in different work settings. This study aims to investigate the relationship between work environment and the menopausal quality of life (QoL) in physicians and nurses. Methods: This survey was conducted using the Menopausal Quality of Life Questionnaire (MENQOL) with a sample of 35 menopausal physicians and 95 nurses employed in health facilities in Astana and Kyzylorda cities, Kazakhstan. Results: Physicians reported a higher frequency of menopausal symptoms compared to nurses. The difference was statistically significant (p &lt; 0.05) for symptoms such as decreased productivity (60.00% vs. 38.20%), flatulence or gas pains (71.43% vs. 48.39%), weight gain (79.41% vs. 61.80%), changes in skin appearance (79.59% vs. 50.00%), and changes in sexual desire (58.82% vs. 33.70%). Physicians with managerial duties had a significantly higher occurrence of vasomotor symptoms compared to non-managerial physicians (mean 3.35 ± 2.14 vs. 1.69 ± 0.89) and also had a higher mean psychological score (mean 3.26 ± 1.28 vs. 2.29 ± 1.19). Conclusions: These findings reflect differences between the menopause effects related to work environment for doctors and nurses, and shed light on the specific challenges faced by them during menopause. In addition, it is important to consider socio-demographic and workplace-related factors in investigating their impact on the QoL

Reproductive and Obstetric Outcomes after UAE, HIFU, and TFA of Uterine Fibroids: Systematic Review and Meta-Analysis

Novel treatment options for uterine fibroids, such as uterine artery embolization (UAE), ultrasound-guided and magnetic resonance-guided high-intensity focused ultrasound (USgHIFU and MRgHIFU), and transcervical radiofrequency ablation (TFA) methods, are widely used in clinical practice. This systematic review and meta-analysis (CRD42022297312) aims to assess and compare reproductive and obstetric outcomes in women who underwent these minimally invasive approaches for uterine fibroids. The search was performed in PubMed, Google Scholar, ScienceDirect, Cochrane Library, Scopus, Web of Science and Embase. Risk of bias was assessed using the Newcastle-Ottawa Scale (NOS) and Cochrane guidelines. The articles were selected to meet the following eligibility criteria: (1) research article, (2) human subject research, and (3) the study of pregnancy outcomes after the treatment of uterine fibroids by either one of three methods-UAE, HIFU, and TFA. The analysis of 25 eligible original articles shows a similar rate of live births for UAE, USgHIFU, MRgHIFU, and TFA (70.8%, 73.5%, 70%, and 75%, respectively). The number of pregnancies varied considerably among these studies, as well as the mean age of pregnant women. However, the results of pregnancy outcomes for TFA are insufficient to draw firm conclusions, since only 24 women became pregnant in these studies, resulting in three live births. The miscarriage rate was highest in the UAE group (19.2%). USgHIFU was associated with a higher rate of placental abnormalities compared to UAE (2.8% vs. 1.6%). The pooled estimate of pregnancies was 17.31% to 44.52% after UAE, 18.69% to 78.53% after HIFU, and 2.09% to 7.63% after TFA. The available evidence confirmed that these minimally invasive uterine-sparing treatment options for uterine fibroids are a good approach for patients wishing to preserve their fertility, with comparable reproductive and obstetric outcomes among the different techniques