Stališče ZPMS o preventivnem zdravljenju nosečnic s povečanim tveganjem za preeklampsijo z nizkoodmernim aspirinom

Preeklampsija je pomemben vzrok maternalne in neonatalne umrljivosti in obolevnosti po vsem svetu. Opredeljena je kot pojav povečanega arterijskega tlaka po 20. tednu nosečnosti s pridruženo proteinurijo in/ali disfunkcijo materinih organov ali zastojem plodove rasti. Medtem ko je smrt mater zaradi preeklampsije v razvitih državah manj pogosta, pa je obolevnost velika in pomembno prispeva k pogostosti sprejemov na oddelke za intenzivno nego in terapijo. Preeklampsija je vzrok za približno 15–20 % vseh prezgodnjih porodov, kar povečuje neonatalno umrljivost in dolgoročno obolevnost novorojenčkov. Aspirin v majhnem odmerku ima preventivni učinek na pojav preeklampsije le v primeru, če se začne jemati pred 16. tednom nosečnosti. Da bi odkrili, pri katerih nosečnicah je tveganje za preeklampsijo povečano, potrebujemo učinkovito presejanje, ki bo organizacijsko, cenovno in po učinkovitosti najprimernejše za izvajanje na primarni ravni

Hydrogeological characterization of karst springs of the white (Proteus anguinus anguinus) and black olm (Proteus anguinus parkelj) habitat in Bela krajina (SE Slovenia)

The springs west of Črnomelj, in SE Slovenia, are the habitat of the black (Proteus anguinus parkelj) and the white olm (Proteus anguinus anguinus). Some of these springs are also the only known habitat in the world of endemic species of black olm. A steady decline in olm populations has been observed in this area over the past decades. Owing to the rapid runoff and groundwater flow high-resolution monitoring is essential in providing better insight into the hydrogeological characterization of the catchment area of springs. Specific factors and critical parameters of water behind said olm degradation have not yet been defined. Because the olm’s environment is largely aquatic, one potential critical parameter could be the higher water temperatures (>12 °C) or higher nitrate concentration (>9.2 mg/l). The six-month observation of the springs (July – December 2021) point to water temperature as a potential critical parameter since the water temperature of the springs exceeded 12 °C in months July and August. Nitrate concentrations could also be a second critical parameter in the degradation of the olm’s habitat. Maximum nitrate concentrations above 9.2 mg/l throughout much of the observation period (except for Dobličica spring). Due to less agricultural activity in December in the spring catchment area and a higher dilution rate due to reduced evapotranspiration and increased effective precipitation during this time of the year, the nitrate concentrations are decreased. The results of the measured parameters of groundwater could show the hydrogeological connection between the Otovski and Pački breg springs and between Šotor, Jamnice and Dobličica. The Obršec spring has an independent catchment area. A detailed estimation of the springs catchment area is possible due to a detailed geologic map. It is necessary to determine the origin of the nitrate (nitrate isotope analysis), to quantify the threshold values of the critical parameters, to define precisely all the causes of the olm deterioration, and to make proposals for appropriate measures to limit or even stop the decline of the olm population

Slovensko strokovno stališče za zdravljenje s pripravki železa v nosečnosti

Slabokrvnost je najbolj pogost simptom v nosečnosti. Zaradi razvoja zarodka in hitre rasti ploda se močno povečajo potrebe organizma po železu in vitaminih. Zato je slabokrvnost zaradi pomanjkanja železa daleč najbolj razširjena oblika slabokrvnosti v nosečnosti. Anemija v nosečnosti je opredeljena z ravnijo hemoglobina (Hb), ki je manjša od 110 g/L. V normalni nosečnosti se sestava krvi pomembno spremeni. Povečanje celokupnega volumna krvi in hemostatske spremembe so fiziološke spremembe, ki omogočajo, da porodnica brez posledic prenese normalno izgubo krvi med porodom. Plazemski volumen se v nosečnosti poveča za 50 %, masa eritrocitov pa za 18 – 25 %, odvisno od razpoložljivega železa. Te spremembe povzročijo razredčitev koncentracije hemoglobna, kar poznamo kot fiziološko slabokrvnost v nosečnosti. Fiziološka slabokrvnost doseže vrh v 32. tednu nosečnosti. Zaradi fizioloških sprememb odkrijemo s presejalnimi testi v nosečnosti mnogo slabokrvnosti, ki bi sicer ostale neodkrite. Povečane ali spremenjene prehranske in presnovne zahteve v nosečnosti povzročijo, da je slabokrvnost zaradi pomanjkanja železa (sideropenična anemija) bolj pogosta. Prva nepravilnost v biokemičnih izvidih, ki kaže na pomanjkanje železa v nosečnosti, je zmanjšana koncentracija feritina (na pomanjkanje železa lahko sklepamo že, ko je vrednost feritina manjša od 20–30 g/L). Feritin je stabilen in zadovoljivo zrcali zaloge železa, za razliko od vrednosti serumskega železa. Zato učinkovito dodajanje železovih pripravkov in s tem preprečevanje sideropeničnih anemij lahko pričnemo že zelo zgodaj. Tako na zelo enostaven način učinkovito preprečimo nastanek zapletov v nosečnosti, ob porodu in v poporodnem obdobju. Slabokrvnost v nosečnosti je povezana s višjo pogostnostjo za prezgodnji porod, nizko porodno težo, z nujnostjo uporabe transfuzije ob in po porodu ter s poporodno depresijo

Discutindo a educação ambiental no cotidiano escolar: desenvolvimento de projetos na escola formação inicial e continuada de professores

A presente pesquisa buscou discutir como a Educação Ambiental (EA) vem sendo trabalhada, no Ensino Fundamental e como os docentes desta escola compreendem e vem inserindo a EA no cotidiano escolar., em uma escola estadual do município de Tangará da Serra/MT, Brasil. Para tanto, realizou-se entrevistas com os professores que fazem parte de um projeto interdisciplinar de EA na escola pesquisada. Verificou-se que o projeto da escola não vem conseguindo alcançar os objetivos propostos por: desconhecimento do mesmo, pelos professores; formação deficiente dos professores, não entendimento da EA como processo de ensino-aprendizagem, falta de recursos didáticos, planejamento inadequado das atividades. A partir dessa constatação, procurou-se debater a impossibilidade de tratar do tema fora do trabalho interdisciplinar, bem como, e principalmente, a importância de um estudo mais aprofundado de EA, vinculando teoria e prática, tanto na formação docente, como em projetos escolares, a fim de fugir do tradicional vínculo “EA e ecologia, lixo e horta”.Facultad de Humanidades y Ciencias de la Educació

Peripheral arterial tonometry and angiogenic biomarkers in preeclampsia

Objective: To evaluate changes in vascular function and serum biomarkers in women with and without preeclampsia (PE) to create a model for the easier and more precise diagnosis of PE in the future. Methods: Endothelial function and arterial stiffness were evaluated using peripheral arterial tonometry and concentrations of placental growth factor (PlGF), soluble fms like tyrosine kinase 1 (sFlt-1) and soluble endoglin (sEng) were determined by immunoassay. Results: Arterial stiffness deteriorates and endothelial function is better in women with PE compared with a healthy pregnancy. Women who developed PE had a decreased PlGF and PlGF/(sFlt-1+ sEng) ratio and an increased sEng, and sFlt-1/PlGF ratio. Conclusion: Peripheral arterial analysis did provide additional information beyond serum biomarkers in the diagnosis of PE

Effects of maternal abdominal decompression on umbilical artery and fetal middle cerebral artery blood flow

Introduction: Maternal abdominal decompression during pregnancy could be used in an attempt to improve utero-placental blood flow. We utilized Doppler ultrasonography to investigate the effects of this procedure on blood flow in the umbilical artery and fetal middle cerebral artery. Methods: Women (n = 23) with singleton pregnancies attending antenatal abdominal decompression were enrolled in the study. Doppler velocity waveforms were obtained from umbilical artery and fetal middle cerebral artery before and after a 30-minute decompression session. Resistance indices were compared using the Student's t - test (p < 0.05 significant). Results: 23 healthy pregnant women were included at an average gestational age of 36+1 weeks. The mean resistance index before decompression in the umbilical artery was 0.58 (s = 0.10) and after decompression 0.54 (s = 0.07, p = 0.06). In the middle cerebral artery the values were 0.72 (s = 0.11) and 0.77 (s = 0.08), respectively (p = 0.01). Discussion and conclusion: Significantly increased resistance index in the middle cerebral artery implies a higher fetal brain oxygenation after decompression. This is further corroborated by the trend towards a decrease in umbilical artery resistance index. The effects of decompression could be beneficial in pregnancies complicated by IUGR or hypertensive disorders of pregnancy

Zero-fluoroscopy catheter ablation of focal atrial tachycardia in a pregnant woman with tachycardia induced cardiomyopathy

Introduction: Occurrence of tachycardias increase during pregnancy in line with the increased propensity to ectopic activity. Case presentation: We present a case of a 30-year-old woman in the 18th week of pregnancy with atrial tachycardia and tachycardia-induced cardiomyopathy that was successfully treated with zero fluoroscopy catheter ablation. Discussion: The described method is safe and efficient and could be used in the future when drug refractory tachycardias occur during pregnancy

Correlation between uterine artery Doppler and the sFlt-1/PlGF ratio in different phenotypes of placental dysfunction

Objective: To explore correlations between the sFlt-1/PlGF ratio and uterine arteries (UtA) Doppler indexes in placental dysfunction-related disorders (PDD). Methods: We prospectively included women with a singleton pregnancy with preeclampsia (PE) only (n = 22), preeclampsia with fetal growth restriction (FGR) (n = 32), FGR only (n = 12), or normal pregnancy (n = 29). Results: In PDDs, significantly positive correlations between the sFlt-1/PlGF ratio and the mean UtA pulsatility (mPI-UtA), as well as the resistance index (mRI-UtA) were found (p = 0.015, p = 0.019, respectively), but not in normal pregnancies. PDD with signs of impaired placentation, evidenced by the increased sFlt-1/PlGF ratio and mPI-UtA, was found in 50.0%, and, by the increased sFlt-1/PlGF ratio and mRI-UtA, in 65.2%. PDD without signs of impaired placentation, evidenced by the increased sFlt-1/PlGF ratio but normal mPI-UtA, was found in 24.2%, and, by the increased sFlt-1/PlGF ratio but normal mRI-UtA, in 7.6%. A substantial proportion of women with signs of impaired placentation were diagnosed with FGR with or without PE. Conclusion: In PDD, the sFlt-1/PlGF ratio and UtA Doppler indexes increase proportionally. Correlations between the sFlt-1/PlGF ratio and UtA Doppler indexes might help to distinguish between PDDs with and without impaired placentation. However, further studies are needed to explore the correlations in different phenotypes of PDD

Pro- and Anti-Angiogenic Markers as Clinical Tools for Suspected Preeclampsia with and without FGR near Delivery—A Secondary Analysis

Objective—the objective of this study was to assess the accuracy of placental growth factor (PlGF), soluble Fms-like Tyrosine Kinase 1 (sFlt-1), and endoglin (sEng) in the diagnosis of suspected preeclampsia (PE) with and without fetal growth restriction (FGR) near delivery. Methods—this is a secondary analysis of a dataset of 125 pregnant women presenting at the high risk pregnancy clinic with suspected PE, FGR or PE + FGR in the University Medical Center of Slovenia. The dataset included 31 PE cases, 16 FGR cases, 42 PE + FGR cases, 15 cases who developed with unrelated complications before 37 weeks (wks) (PTD), and 21 unaffected controls who delivered a healthy baby at term. We also analyzed a sub-group of women who delivered early (&lt;34 wks) including 10 PE, 12 FGR, 28 PE + FGR, and six PTD. Clinical management adhered to hospital guidelines. Marker levels were extracted from the dataset and were used to develop Receiver Operating Characteristic (ROC) curves and to calculate the area under the curve (AUC), the detection rates (DRs), and the false positive rates (FPRs). Previously published marker cutoffs for yes/no admission to hospital wards were extracted from the literature. Negative and positive predictive values (NPVs and PPVs) were evaluated for their value in determining whether hospital admission was required. Non-parametric tests were applied for statistical analysis; p &lt; 0.05 was considered significant. Results—near delivery, all the pro-and anti-angiogenic markers provided diagnostic (ROC = 1.00) accuracy for the early (&lt;34 wks) group of FGR. Diagnostic or near diagnostic (ROC = 0.95) accuracy was achieved by all marker for early PE + FGR but lower accuracy was achieved for early PE. For all cases, all markers, especially PlGF reached diagnostic or near diagnostic accuracy for FGR and PE + FGR. At this accuracy level, they can contribute to the clinical management of FGR, and PE + FGR. All the markers were less accurate for all PE cases. The use of published cutoffs was adequate for clinical management of FGR, whether early or for all cases, using an NPV &gt; 90%. For PE + FGR, the PPV value approached 100%, especially for early cases, and can thus be implemented in clinical management. Neither NPV nor PPV were high enough for managing all cases of PE. There was no added value in measuring the PlGF/(sFlt-1 + sEng) ratio. Conclusion—This is the first study on a Slovenian population. It shows that near-delivery angiogenic biomarkers tests may be useful for confirming the diseases in cases where there is a diagnostic doubt. However, the clinical use of the biomarkers needs to be weighed against resources available and degree of certainty of the diagnosis made with and without them for managing suspected FGR and PE + FGR requiring delivery &lt;34 wks, where they are very accurate, and furthermore in the management of all cases of FGR and FGR+PE. The markers were less accurate for the clinical diagnosis of PE