Prevalence of epilepsy in Podgorica, Montenegro

The purpose of this study was to assess for the first time the prevalence of epilepsy in the capital of Montenegro and to describe the clinical and epidemiological profile of the disorder. A door-to-door screening was performed on population of 6 randomly selected areas of Podgorica (capital of Montenegro) using validated screening questionnaire. In phase 1, the screening by questionnaire of 4007 individuals identified 307 suspected cases of epilepsy. Four of them dropped out of further investigation just before entering the phase 2. In phase 2, the remaining 303 suspected cases were first examined by general practioner and then by an epileptologist, on two follow-up visits. The confirmation of epilepsy was based on clinical examination. Electroencephalogram (EEG), computed tomography (CT) and/or magnetic resonance imaging (MRI) were also used. 29 persons were diagnosed with epilepsy. An overall prevalence of 7.2 cases per 1000 inhabitants was calculated (CI 95% 5.0–10.0). Majority of them had been previously diagnosed (86.20%), 27 had active epilepsy and over a half of them were on polymedication (65.51%). Referring to the 27 patients with active epilepsy, the predominant seizure type was partial (all types) in 14 (48.27%) and undetermined in 2 (6.89%). Cause of epilepsy was determined in 10 patients. EEG abnormalities were found in almost all patients (89.65%). CT anomaly was determined in 9 whereas only 1 patient had an abnormal MRI finding. The estimated prevalence of epilepsy indicated higher rates compared to neighboring counties and the rest of the Europe, but limitations of the study (high rejection rate and stigma) should be taken into consideration

KUMULATIVNA STOPA TRUDNOĆA OSTVARENA NAKON PRIJENOSA ZAMETAKA U SVJEŽEM CIKLUSU I PRVOM NAREDNOM CIKLUSU S ODMRZNUTIM ZAMETCIMA: JE LI VRIJEME ZA PROMJENU PRAKSE?

The aim: was to clarify parameters that contribute to successful pregnancy outcomes from one oocyte retrieval cycle with the least procedure steps. Methods: This retrospective study included 42 stimulated IVF cycles with fresh embryo transfers (fresh ET) and the subsequent 42 frozen embryo transfer cycles (FET) performed between January 2012 and December 2015. Results: The observed clinical pregnancy rate of 21.4% in stimulated cycles with fresh embryo transfers was significantly lower compared with the pregnancy rate of 52.4% in cycles with thawed embryo transfers (p=0.015) indicating impaired endometrium quality in stimulated IVF cycles. Most of the patients (78.6%) failed to achieve pregnancy after fresh ET, but more than half of them (57.6%) succeeded to achieve pregnancy after FET. The cumulative pregnancy rate after fresh ET and the first subsequent FET was 73.8% per initiated cycle. Conclusion: The results suggest that not only the presence of supernumerary good-quality blastocysts but also a receptive endometrium is needed for a successful IVF outcome. Our findings suggest that ovarian stimulation protocol had an impact on the pregnancy rate in the fresh cycle and that a better chance of conceiving was after FET. Thus, IVF outcomes can be improved with a better embryo transfer strategy.Cilj rada je razjasniti parametre koji pridonose uspješnom ostvarivanju trudnoće iz jednog započetog postupka prikupljanja jajnih stanica uz najmanji broj postupaka koji slijede. Metode: U retrospektivnu studiju uključeno je 42 stimulirana IVF ciklusa s prijenosom svježih zametaka (“svježi ET”) i 42 ciklusa prijenosa kriopohranjenih zametaka (“FET”) učinjenih između siječnja 2012. i prosinca 2015. Rezultati: Zabilježena je značajno niža stopa kliničkih trudnoća (p=0,015) nakon prijenosa svježih zametaka u stimuliranim ciklusima (21,4 %) u usporedbi sa stopom trudnoća nakon prijenosa odmrznutih zametaka (52,4 %) što ukazuje na smanjenu kvalitetu/receptivnost endometrija u stimuliranim IVF ciklusima. Ukupna, kumulativna stopa trudnoća nakon “svježeg ET” i FET postupka iznosila je 73,8 % po započetom ciklusu. Zaključak: Rezultati ukazuju da je osim kvalitetnih blastocisti za uspješnost IVF postupka nužan i receptivni endometrij. Uočen je utjecaj protokola stimulacije jajnika u svježem ciklusu na stopu trudnoća i veća uspješnost začeća nakon FET postupka. Stoga bi se uspješnost IVF postupka mogla poboljšati boljom strategijom prijenosa zametak

WHAT DO WE KNOW ABOUT THE GENETIC BACKGROUND OF PRIMARY CILIARY DYSKINESIA (PCD) AND THE REPRODUCTIVE APPROACH?

Introduction: Primary ciliary dyskinesia (PCD; MIM 244400) is a heterogeneous autosomal recessive genetic disorder associated with infertility due to impaired sperm motility in men. We describe two such cases and give a literature review on the genetic background and reproductive outcome. Materials and methods: Two primary infertile couples were referred to our clinic. Native semen, analyzed according to the WHO manual (2010), showed that male partners have completely immotile sperm with a negative pentoxifylline test. Sample vitality was compared according to different semen preparation methods (gradient density and washing method only). Genetic testing was done by Whole Exome next-generation Sequencing (WES) analysis. For the IVF/ICSI procedure, semen was prepared using the gradient density method, and prior to the ICSI procedure itself, a hypo-osmotic swelling test (HOST) was done. Results: Semen analysis showed oligoasthenozoospermia in Patient 1 and oligoasthenoteratozoospermia in Patient 2. Blood draw for hormones and karyotype showed no irregularities in either case. Patient 1 was previously diagnosed with PCD, while Patient 2 was not. Parallel vitality testing did not show any differences between the two semen preparation methods in either of the two cases. Genetic testing in Patient 2 showed a pathogenic apparently homozygous CCDC40:c.2440C>T variant in exon 14 of the CCDC40 gene (MIM 613799). Fertilization rate after HOST/ICSI in both patients was 100%, and the final outcome for both patients was the birth of a healthy child. Conclusion: Although PCD has diverse etiology, assisted reproduction techniques such as HOST give these couples a good chance for parenthood. Advances in testing and strict adherence to advised procedures are to be credited for such outcome improvement. Additionally, our recommendation for PCD patients and patients with immotile sperm is to do genetic testing and counselling prior to the IVF/ICSI procedure

WHAT DO WE KNOW ABOUT THE GENETIC BACKGROUND OF PRIMARY CILIARY DYSKINESIA (PCD) AND THE REPRODUCTIVE APPROACH?

Introduction: Primary ciliary dyskinesia (PCD; MIM 244400) is a heterogeneous autosomal recessive genetic disorder associated with infertility due to impaired sperm motility in men. We describe two such cases and give a literature review on the genetic background and reproductive outcome. Materials and methods: Two primary infertile couples were referred to our clinic. Native semen, analyzed according to the WHO manual (2010), showed that male partners have completely immotile sperm with a negative pentoxifylline test. Sample vitality was compared according to different semen preparation methods (gradient density and washing method only). Genetic testing was done by Whole Exome next-generation Sequencing (WES) analysis. For the IVF/ICSI procedure, semen was prepared using the gradient density method, and prior to the ICSI procedure itself, a hypo-osmotic swelling test (HOST) was done. Results: Semen analysis showed oligoasthenozoospermia in Patient 1 and oligoasthenoteratozoospermia in Patient 2. Blood draw for hormones and karyotype showed no irregularities in either case. Patient 1 was previously diagnosed with PCD, while Patient 2 was not. Parallel vitality testing did not show any differences between the two semen preparation methods in either of the two cases. Genetic testing in Patient 2 showed a pathogenic apparently homozygous CCDC40:c.2440C>T variant in exon 14 of the CCDC40 gene (MIM 613799). Fertilization rate after HOST/ICSI in both patients was 100%, and the final outcome for both patients was the birth of a healthy child. Conclusion: Although PCD has diverse etiology, assisted reproduction techniques such as HOST give these couples a good chance for parenthood. Advances in testing and strict adherence to advised procedures are to be credited for such outcome improvement. Additionally, our recommendation for PCD patients and patients with immotile sperm is to do genetic testing and counselling prior to the IVF/ICSI procedure

CROATIAN SOCIETY OF CLINICAL EMBRYOLOGISTS – GUIDELINES ON THE EPIDEMIOLOGICAL FRAMEWORK FOR THE IMPLEMENTATION OF MEDICALLY ASSISTED REPRODUCTION (MAR) PROCEDURES DURING THE COVID-19 PANDEMIC REGARDING THE SAFETY OF PATIENTS AND MEDICAL HEALTH WORKERS

Due to the high virulence of the SARS-CoV-2 virus, the infection rate in the community has led to a state of pandemic, leading to the introduction of new emergency measures all over the world. With the aim of controlling and preventing the SARS-CoV-2 viral epidemic, the health institutions performing medically assisted reproduction (MAR) suspended any new MAR treatments in order to reduce the burden on the health care system and implement current social distancing recommendations. Considering the favorable epidemiological situation in Croatia, our perspective is that it is time to conceive, plan and bring forth guidelines for restarting work in MAR centres, taking into account the selection of patients and organization of good laboratory and clinical practices with emphasis on the safety of patients and health workers. In regard to epidemiological knowledge, it is important to establish the reorganization of work in MAR centres including epidemiological measures of reducing unnecessary stays in closed spaces, the usage of protective gear by patients and health workers and disinfection of the working spaces and equipment

Modification of conservative treatment of heterotopic cervical pregnancy by Foley catheter balloon fixation with cerclage sutures at the level of the external cervical os: a case report

<p>Abstract</p> <p>Introduction</p> <p>Conservative treatment of a heterotopic cervical pregnancy was performed with a modification of the fixation of a Foley catheter at the level of the external cervical os, followed by the ligature of the descending cervical branches of the uterine arteries and systemic methotrexate application.</p> <p>Case presentation</p> <p>A 34-year-old Caucasian woman was diagnosed with double gestation after 6 weeks of <it>in vitro </it>fertilization treatment. A gynecological examination and color Doppler ultrasound scan revealed intra-uterine and cervical gestational sacs both containing live fetuses. A Foley catheter balloon was inserted into the cervical canal, inflated and fixed by a cerclage suture at the level of the external cervical os, followed by ligation of the descending cervical branches of the uterine arteries. Systemic methotrexate was applied. Three days after removal of the Foley catheter, an evacuation of the intra-uterine gestational sac was performed. Hemorrhage from the implantation site was controlled immediately and a pregnancy termination was successfully performed. The procedure was uneventful and our patient was discharged with a preserved uterus.</p> <p>Conclusions</p> <p>Conservative treatment of cervical pregnancy using a Foley catheter balloon is more efficacious if the Foley catheter balloon is attached in the correct position with a cerclage suture at the level of the external os, followed by ligation of the descending cervical branches of the uterine arteries, thereby exerting maximal pressure on the bleeding vessels.</p

Epilepsy awareness, knowledge and attitudes among secondary school teachers in Montenegro

Introduction/Objective. Epilepsy is associated with numerous misconceptions due to its dramatic manifestation and poor knowledge among the public. The aim of this study was to assess epilepsy awareness, knowledge and attitudes among secondary school teachers. Methods. We conducted a cross-sectional survey by sending a simple self-administered questionnaire to all secondary schools in Podgorica, Montenegro. The questionnaire contained 16 questions regarding epilepsy awareness, knowledge and attitudes, first aid attitudes, as well as demographic and teaching experience data. Results. We analyzed 219 questionnaires. Almost all teachers had heard or read about epilepsy, 57.5% of whom knew someone with epilepsy; 21% had a pupil with epilepsy in their class; more than 50% had witnessed a seizure, with 25% of them linking epilepsy to a central nervous disturbance. Over 60% of teachers chose convulsions/shaking to be a major feature of an epileptic attack. Forty percent of teachers thought epilepsy could be cured. Almost 80% thought people with epilepsy should get married and have children, but only one third would marry a person with epilepsy. Over 13% would object to their child playing with another child with epilepsy, and more than 50% would object if their child married a person with epilepsy. About 35% of teachers suggested putting something in a person’s mouth during attack to prevent tongue injury and asphyxiation. Conclusion. Awareness and understanding of epilepsy among teachers were satisfactory, but the results also revealed negative attitudes. Teachers need further education about epilepsy to increase seizure recognition and first aid management, reduce stigma, and intensify acceptance of people with epilepsy

Prevalence of epilepsy in Podgorica, Montenegro

The purpose of this study was to assess for the first time the prevalence of epilepsy in the capital of Montenegro and to describe the clinical and epidemiological profile of the disorder. A door-to-door screening was performed on population of 6 randomly selected areas of Podgorica (capital of Montenegro) using validated screening questionnaire. In phase 1, the screening by questionnaire of 4007 individuals identified 307 suspected cases of epilepsy. Four of them dropped out of further investigation just before entering the phase 2. In phase 2, the remaining 303 suspected cases were first examined by general practioner and then by an epileptologist, on two follow-up visits. The confirmation of epilepsy was based on clinical examination. Electroencephalogram (EEG), computed tomography (CT) and/or magnetic resonance imaging (MRI) were also used. 29 persons were diagnosed with epilepsy. An overall prevalence of 7.2 cases per 1000 inhabitants was calculated (CI 95% 5.0–10.0). Majority of them had been previously diagnosed (86.20%), 27 had active epilepsy and over a half of them were on polymedication (65.51%). Referring to the 27 patients with active epilepsy, the predominant seizure type was partial (all types) in 14 (48.27%) and undetermined in 2 (6.89%). Cause of epilepsy was determined in 10 patients. EEG abnormalities were found in almost all patients (89.65%). CT anomaly was determined in 9 whereas only 1 patient had an abnormal MRI finding. The estimated prevalence of epilepsy indicated higher rates compared to neighboring counties and the rest of the Europe, but limitations of the study (high rejection rate and stigma) should be taken into consideration