“Bladder Effect†- An Urodynamic Parameter to Distinguish Subtypes of Urinary Incontinence in Women

BACKGROUND: Urinary incontinence (UI) is defined by the International Continence Society (ICS) as the involuntary loss of urine that represents a hygienic or social problem to the individual. The aetiology is multifactorial. The diagnosis of UI is important because it can result in the application of appropriate therapy. Urodynamics is a golden standard, without which every UI diagnosis is insufficient.AIM: The goal of this study was, based on urodynamic results, to prove the existence of evident differences between the subtypes of UI.METHODS: Eighty patients with UI were evaluated (50 with urinary stress incontinence-USI and 30 with detrusor instability-DI) according to a standard evaluation protocol. Exclusion criteria were: mixed UI and diseases that simulated UI. All patients were 36-65 years of age (mean 56). The following parameters were measured: maximal and average flow, maximal and average voiding pressure. These parameters were compared between both groups, to determine the diagnostic significance of the parameter “Bladder Effect†(BE). It is a product of the urine flow and the pressure during voiding.RESULTS: The results showed a significant difference with a high confidence interval. Mean BEmax was 577 units in the patient group with USI, and 1014 in the DI group. Similarly, BEav was 313 units in the USI group, and 499 units in the DI group, with a significant difference and a high interval of confidence.CONCLUSION: In conclusion, the results of the study suggested that BE could be a useful diagnostic parameter to distinguish between USI and DI

Аnal Incontinence after Vaginal Delivery, Risk Factors and Quality of Life in Patients in North Macedonia

The aim of this study is to determine the impact of individual obstetric risk factors on occurrences of anal incontinence in patients after vaginal delivery, and its impact on quality of life.  We designed the study as a cross-sectional, and developed the research at the University Clinic for Obstetrics and Gynecology, University of "Ss. Cyril and Methodius" in Skopje, Macedonia, over a period of one year. In this study, we engaged patients in their reproductive age, who had undergone at least one vaginal delivery (spontaneous or assisted vaginal delivery). The degree of incontinence was determined using St. Mark's Anal Incontinence Score (SMIS). We used a specific questionnaire related to anal incontinence to assess quality of life Fecal Incontinence Quality of Life Scale (FIQLS) Four hundred and seventy (470) patients were included in the study, 30% of which (141 patients) had St. Mark’s scores ≥8. The following factors were found to influence the St. Mark’s score: number of vaginal deliveries, delivery mode, fetal macrosomia, use of episiotomy and the existence of perineal lacerations Results of this study show consistency with data published so far on the influence of obstetric risk factors on occurrences of anal incontinence in patients after vaginal delivery. Changes in anal continence are expressed in increased St. Mark’s score. Our study showed that the following factors had statistically significant impact on the score value: multi-parity, delivery mode, use of episiotomy, fetal macrosomia and perineal injury (grades 3 and 4)

Acute Inflammatory Changes of the Placenta in Patients with Preterm Delivery Syndrome

Preterm delivery is one of the most serious challenges of contemporary perinatology. Considering the multi factorial etiology of this issue, contemporary scientific approach addresses this topic as a Preterm Delivery Syndrome. If we exclude the congenital anomalies of the female reproductive system and iatrogenic causes, we can pinpoint infections, as one of the most important etiological factor for preterm delivery. The aim of the study is to determine the frequency of the histopathological changes of the placenta in patients with preterm delivery, to determine their stage and grade, according to the classification proposed by the Amniotic Fluid Infection Nosology Committee of the Perinatal Section of the Society of Pediatric Pathology (AFINCPSPP).  Finally, to define the correlation between those changes and the gestational age, as well as the correlation between the degree of the histopathological changes and the time passed from the preterm premature rupture of the fetal membrane and the delivery. This cohort prospective study includes 30 patients delivered at the University clinic for Ob/Gyn in Skopje. We’ve selected the patients according to the previously determined inclusion and exclusion criteria: gestational age between 24+0-34+0 weeks of gestation (w.g), premature preterm rupture of the fetal membranes (pPROM), presence of uterine contractions, cervical dilatation of ≥ 2 cm determined by vaginal examination or shortening of the cervical length by > 50% determined by vaginal ultrasound.For the evaluation of the histopathological changes of the placenta, 6 samples were provided from four (4) zones of the placentas of the delivered women: chorionic plate, umbilical cord, border between amnion and chorion, and fetal membranes. Statistical analysis was performed on IBM SPSS Statistics software package, version 23.0. Probability of p≤0.05 was considered statistically significant. Differences between descriptive variables were determined using Chi square and Fisher exact tests. For determination of correlation between variables, we used Kendall tau correlation coefficient. Of all the patients included in the study, 14 (46,7%) were at gestational age of 32+0-34+0 w.g, 7 (23,3%) were at gestational age of 28+0-31+6 w.g, and 9 (30 %) were at gestational age of 24+0-27+6 w.g. PPROM was registered in 14 (46,7%) of the patients, out of which almost half, 42,8 % were delivered in less than 24 hours after the rupture of the membranes. In 42,8% of the patients delivered between 32+0-34+0 w.g, histopathological analysis of the placenta did not detected presence of inflammatory response. On the other side, in patients delivered between 24+0-27+6 w.g,histological chorioamnionitis was present in all cases. Even more, in as high as 66,7% of these cases, inflammatory changes of the placenta were categorized as Stage 3, which is highest or most advanced stage of inflammatory response. Results of our study are consistent with previously published data. They confirm the inversely proportional relationship between gestational age at the time of delivery, and the stage and grade of histopathological changes of the placenta, defined as acute chorioamnionitis. Additional evaluation of the data showed that, there is no correlation between the degree of the inflammatory response, and the time passed from the pPROM and delivery, expressed in hours

Survival of Advanced Stage High-Grade Serous Ovarian Cancer Patients in the Republic of Macedonia

AIM: The primary objective of the study was to evaluate the overall survival of women with advanced stage (Stage IIIA-IV) high-grade serous ovarian cancer in MacedoniaMATERIALS AND METHODS: The study was a cross-sectional medical record review of patients diagnosed with advanced stage HGSC. Patients were deemed eligible for inclusion if they were diagnosed with an advanced stage (Stage IIIA-IV) HGSC of the ovary, fallopian tube or peritoneum between 2009 and 2015.  The data were analyzed in a descriptive fashion and summary statistics were provided, as appropriate. Survival was calculated using the Kaplan-Meier method.RESULTS: A total of 81 eligible patients were identified and included in the study. The average overall survival in the studied cohort was 46.59 months (95%CI = 39.11-54.06). Patients that were optimally debulked and patients that had a platinum-free interval larger than 12 months had significantly longer survival in the current series (p < 0.001).CONCLUSION: the average overall survival of advanced stage HGSC patients in the studied series was 46.59 months (95%CI = 39.11-54.06). Patients aged 65 years or younger tended to live approximately ten months longer than patients older than 65 years, but this difference was not statistically significant. There was no difference in HGSC survival in the groups of patients with grade 2 and grade 3 disease. However, optimal surgical debulking and platinum sensitivity were associated with significantly better overall survival

Preoperative detection of sentinel lymph node in patients with endometrial cancer — comparison of planar lymphoscintigraphy, spect and SPECT/CT

Background: Sentinel lymph node (SLN) mapping allows minimal invasive assessment of lymph node status in patients with early-stage endometrial cancer (EC). Intraoperative detection of SLNs is based on the results obtained from preoperative nuclear medical images. The purpose of this study was to compare the data obtained from planar lymphoscintigraphy (PL), single-photon emission computed tomography (SPECT), and SPECT with computed tomography (SPECT/CT) for preoperative SLN detection in patients with EC. Material and methods: A total of 44 images in 22 patients with early-stage EC (22 PL, 9 SPECT and 13 SPECT/CT) were analyzed. The scans were performed in the period 2018–2020 at the Institute of Pathophysiology and Nuclear Medicine in Skopje. Thirteen patients underwent PL and SPECT/CT and nine patients underwent PL and SPECT after cervical injection of 4 mCi 99mTc-SENTI-SCINT on the day of surgery. Descriptive statistics, Wilcoxon Matched Pairs Test, and Spearman rank R coefficient were used for data analyses. Results: Twenty-two patients with mean age of 61.1 ± 7.5 and body mass index (BMI) 34.62 ± 6.4 kg/m2 were included in the study. In four patients (18.2%) SLN was not detected on PL. Detection rate on SPECT and SPECT/CT was 100%. The average number of detected SLN was 1.4 ± 1.05, 2.2 ± 1.1 и 2.15 ± 1.1 on PL, SPECT and SPECT/CT respectively. We found a statistically significant difference in the number of detected SLNs on PL vs SPECT/CT (p = 0.0077). The most common SLN location on SPECT/CT was the right internal iliac followed by the left common iliac region. Conclusions: The results of the presented study indicate a higher diagnostic value of SPECT/CT in terms of SLN detection and exact anatomic localization as compared to planar lymphoscintigraphy (PL)

Interleukin 6 and fetal fibronectin as a predictors of preterm delivery in symptomatic patients

Preterm delivery is the leading cause of neonatal mortality and morbidity. The rate of preterm births has been estimated to be about 15 million, which accounts for 11.1% of all live births worldwide. The purpose of this study was to evaluate the cervico-vaginal (CVF) cytokine IL-6 and fetal fibronectin (fFN) status as predictors of preterm delivery in patients with symptoms of preterm labor. Patients with symptoms suggestive of preterm labor were recruited from September 2013 to March 2014. Vaginal swabs were taken for fetal fibronectin test (fFN) and CVF IL-6. Antibiotics, steroids and tocolytics were administered, where appropriate. The outcome was measured by the occurrence of preterm delivery within 14 days from the day of hospital admission. Cut-off value of 1305 pg/mL for the concentration of IL-6 in the CVF was the best predictor of preterm delivery, with the sensitivity of 69.4% and specificity of 68.2%. Patients with positive fFN test had the OR of 6.429 (95%CI 1.991-20.758) to deliver prematurely. The multivariate analysis of combined fFN and CVF IL-6 tests resulted in risk of 86.7% to deliver prematurely, if both tests were positive. The combination of both tests performed better than the individual tests and decreased the false positive rate, which in turn reduced the chances for inappropriate patient treatment, bringing down the costs