35 research outputs found
Ishod trudnoÄe uz gestacijski dijabetes u usporedbi s indeksom tjelesne mase
Gestational diabetes involves disorder of glucose metabolism first diagnosed in pregnancy. Obese women undoubtedly have more often complications in reproductive age, such as fertility difficulties, spontaneous and recurrent miscarriages, premature births, and various obstetric and surgical complications related to the course of pregnancy, delivery and puerperium. Children of obese pregnant women are more likely to develop obesity in childhood and adulthood. We analyzed the outcome of 51 pregnancies in obese pregnant women and 50 pregnant women with normal body mass index. All women in both groups were diagnosed with gestational diabetes by the IADPSG criteria. We analyzed gestational age at delivery and mode of delivery, gestational weight gain, presence of concomitant diagnosis of gestational or chronic hypertension, difference in birth weight, and prevalence of hypertrophic newborns. There was no significant difference in gestational age at pregnancy termination and in the mode of delivery. There was a significant difference in gestational weight gain, number of pregnant women with hypertension, neonatal birth weight and number of hypertrophic children. Based on the data presented, we conclude that obesity is an unfavorable factor for pregnancy outcome. It also influences birth weight and fetal hypertrophy, as well as gestational weight gain.Gestacijski dijabetes podrazumijeva poremeÄaj metabolizma glukoze koji se prvi puta dijagnosticira u trudnoÄi, a njegova incidencija je u porastu. Pretile žene nedvojbeno imaju ÄeÅ”Äe probleme i komplikacije u reproduktivnim godinama, Å”to podrazumijeva teÅ”koÄe pri zanoÅ”enju, spontane i habitualne pobaÄaje, prijevremene poroÄaje i razliÄite opstetriÄke i kirurÅ”ke komplikacije vezane za tijek trudnoÄe, poroÄaja i babinja. Djeca iz takvih trudnoÄa ÄeÅ”Äe razvijaju pretilost u djetinjstvu kao i u odrasloj dobi. S obzirom na navedeno analizirali smo ishod trudnoÄa u 51 pretile trudnice i 50 trudnica s urednim indeksom
tjelesne mase, pri Äemu su sve trudnice (u objema skupinama) imale dijagnozu gestacijskog dijabetesa prema kriterijima IADPSG. Analizirali smo gestacijsku dob, naÄin dovrÅ”enja trudnoÄe, prirast na težini trudnica, prisutnost istodobnih dijagnoza gestacijske ili kroniÄne hipertenzije, razliku u težini novoroÄenÄadi te uÄestalost hipertrofiÄne novoroÄenÄadi. Rezultati su pokazali da ne postoji statistiÄki znaÄajna razlika u gestacijskoj dobi kad je zavrÅ”ena trudnoÄa niti u naÄinu
dovrÅ”enja poroÄaja. UtvrÄena je statistiÄki znaÄajna razlika u dobivenim kilogramima tijekom trudnoÄe, broju trudnica s hipertenzijom,
poroÄajnoj masi novoroÄenÄadi i broju hipertrofiÄne djece. U zakljuÄku, pretilost u trudnoÄi s gestacijskim dijabetesom je nepovoljan Äimbenik za ishod trudnoÄe, poroÄajnu masu i prekomjeran rast novoroÄenÄadi, kao i za prirast tjelesne mase trudnice tijekom trudnoÄe
Perinatalne znaÄajke infekcije virusom SARS-CoV-2 u trudnoÄi: moguÄ razlog za zabrinutost
Ever since the beginning of COVID-19 pandemic, uncertainty regarding clinical
presentation and differences among various subpopulations exist. With more than 209,870,000
confirmed cases and more than 4,400,000 deaths worldwide, we are facing the new era of health crisis
which will undoubtedly impair global health, economic and social circumstances. In the past year,
numerous genetic mutations which code SARS-CoV-2 proteins led to the occurrence of new viral
strains, with higher transmission rates. Apart from the implementation of vaccination, the effect of
SARS-CoV-2 on pregnancy outcome and maternal fetal transmission remains an important concern.
Although neonates diagnosed with COVID-19 were mostly asymptomatic or presented with mild
disease, the effect on early pregnancy is yet to be evident. While positive finding of SARS-CoV-2
RNA in some samples such as amniotic fluid, placental tissue, cord blood and breast milk exists, additional
research should confirm its association with transplacental transmission.Od poÄetka pandemije COVID-19 do danas tijek bolesti meÄu razliÄitim subpopulacijama ljudi nije do kraja poznat.
Diljem svijeta potvrÄeno je viÅ”e od 209.870.000 oboljelih, ali i viÅ”e od 4.400.000 smrtnih sluÄajeva. Nalazimo se u vremenu
globalne krize, suoÄeni s njezinim posljedicama na zdravlje ljudi, ekonomiju i druÅ”tvo. Protekle godine su brojne genske
mutacije koje dovode do strukturnih promjena proteina SARS-CoV-2 dovele do pojave novih sojeva virusa s veÄom transmisijom.
Bez obzira na uvoÄenje cijepljenja uÄinak SARS-CoV-2 na ishod trudnoÄe i prijenos virusa s majke na dijete i
dalje su važan predmet interesa. Zasad je poznato da je novoroÄenÄad s COVID-19 najÄeÅ”Äe asimptomatska ili s blagom
kliniÄkom slikom, a utjecaj infekcije na ranu trudnoÄu bit Äe tek vidljiv. Iako je RNK SARS-CoV-2 potvrÄena u uzorcima
plodove vode, posteljiÄnog tkiva, krvi pupkovine i u majÄinu mlijeku potrebna su dodatna istraživanja koja Äe potvrditi njezinu
povezanost s transplacentnim prijenosom
UtjeÄu li novi dijagnostiÄki kriteriji za gestacijski dijabetes na ishod trudnoÄa?
The incidence of pregnancy related diabetes has been steadily increasing during the past decade. The aim of this retrospective study was to evaluate the type and prevalence of gestational diabetes complications after implementing new diagnostic criteria for gestational diabetes. The incidence of gestational diabetes, maternal age, mode of delivery and birth weight were analyzed. Study patients were divided into three groups. The first group consisted of patients who gave birth during 2005, the second group during 2011 and the third group during 2012. In 2005, the World Health Organization criteria were used on diagnosing gestational diabetes, whereas in 2011 and 2012 the criteria issued by the International Association of Diabetes and Pregnancy Study Groups were considered. Th ere was no statistically significant difference among the groups according to maternal age, birth weight (p=0.203) and mode of delivery (p=0.883). Cesarean section was performed in about 30% of deliveries in all groups combined. There was no significant difference in the number of neonatal hypertrophy (p=0.348), although the distribution of hypertrophy showed a tendency towards higher values in 2005. Th e incidence of gestational diabetes was 2.2% in 2005, 6.6% in 2011 and 12% in 2012. In conclusion, difference in the incidence of pregnancy related diabetes appeared to have resulted
directly from using different diagnostic criteria. The new criteria contributed to a relatively higher incidence of gestational diabetes but also achieved better gestational glycemic control and consequently better fetal growth regulation.Incidencija gestacijskog dijabetesa je u stalnom porastu u proteklom desetljeÄu. Cilj ove retrospektivne studije bio je utvrditi komplikacije gestacijskog dijabetesa i ishode trudnoÄa nakon promjene kriterija za dijagnozu gestacijskog dijebetesa. Analizirana je incidencija dijabetesa u trudnoÄi, dob majki, naÄin dovrÅ”enja poroÄaja i težina novoroÄenÄadi. Ispitanice su bile podijeljene u tri skupine. U prvoj skupini su bile žene koje su rodile u 2005. godini, u drugoj skupini one koje su rodile 2011. godine, a u treÄoj skupini one koje su rodile 2012. godine. Za dijagnozu gestacijskog dijabetesa 2005. godine koriÅ”teni su kriteriji Svjetske zdravstvene organizacije, a 2011. i 2012. godine kriteriji IADPSG (International Association of Diabetes and Pregnancy Study Groups). U ispitivanim skupinama nije naÄena statistiÄki znaÄajna razlika s obzirom na dob rodilja. Nije bilo statistiÄki znaÄajne razlike u prosjeÄnoj težini novoroÄenÄadi (p=0,203) meÄu ispitivanim skupinama. TakoÄer nije naÄena
statistiÄki znaÄajna razlika niti u naÄinu dovrÅ”enja poroÄaja (p=0,883). U ispitivanom uzorku carskim rezom rodilo je oko 30% trudnica. Nije bilo statistiÄki znaÄajne razlike u pojavnosti fetalne hipertrofije (p=0,348), ali je 2005. godine roÄeno viÅ”e djece u skupinama s veÄom poroÄajnom masom. Godine 2005. incidencija gestacijskog dijabetesa bila je 2,2%, 2011. godine 6,6%, a 2012. godine 12%. Razlika u incidenciji gestacijskog dijabetesa posljedica je primjene razliÄitih dijagnostiÄkih kriterija. Novi kriteriji su doprinijeli porastu incidencije gestacijskog dijabetesa, ali i boljoj regulaciji glikemije te posljediÄno boljoj regulaciji fetalnoga rasta
Secular Changes in Growth and Obesity in Perinatal Population
The survey was conducted during the last 25 years and included 2414 healthy women who delivered in Ā»Sestre
milosrdniceĀ« University Hospital Center in Zagreb, Croatia and their newborns. The aim was to establish the secular
trend of some anthropological factors through two generations. Anthropological features such as pre-pregnancy weight,
body mass index before pregnancy, height, age, place of residence, educational level, parity and the newborn weight were
registered. The study was randomized. The mothers from the city of Zagreb and the surrounding villages, rural areas
are examined. The women age was different and also different levels of education and socioeconomic status. The study
included women who had not given birth yet, who had delivered once, twice, and three or more times. Maternal height in
25 years increased by 3.1cm. and increases with education. The pre-pregnancy weight increased 2.8 kg and increases
with age, parity and rural life. The body mass index (BMI) which the women had before pregnancy was calculated, and
according to its value the participants were divided in three groups: with normal weight, overweight and fat. Among the
studied periods BMI does not differ significantly, but does differ significantly with respect to the ordinal number of
births, parity, age and living environment. Higher BMI was associated with deliveries to heavier children
Dijastaza simfize u blizanaÄkoj trudnoÄi
Pubic symphysis diastasis is a rare pregnancy complication whose exact incidence is still not known, but it is estimated to be in the range of 1:300 to 1:30,000 pregnancies. It is defined as a distance between the two pubic bones or an interpubic gap greater than 10 mm with typical presentation. Typical symptoms of diastasis symphysis are pain in the symphyseal region that radiates to the lower back and thighs, waddling gait, painful movement, reduced mobility, and, rarely, urinary retention. In this case report we present a case of antepartum pubic symphysis diastasis diagnosed by palpation during a pelvic exam in a multiparous woman with a twin pregnancy. The patient had an uneventful previous antenatal period; at a routine follow-up she reported symphyseal pain over a longer period with exacerbatio in the previous three weeks, in addition to difficulty walking and staying in an upright position. On manual palpation a 10-mm interpubic gap was found and the patient was hospitalized. In view of the twin pregnancy and pubic
symphysis diastasis it was decided that a cesarean section was the appropriate mode of delivery. A postoperative pelvic X-ray showed an interpubic gap of 14 mm. With regard to the simplicity and reliability of manual palpation in cases of suspected pubic symphysis diastasis, implementing palpation of the pubis in regular obstetrical practice would enable early recognition, immediate treatment, and a better outcome in the long term. Also, as there are no evidence-based guidelines considering antepartum pubic symphysis diastasis and each case is approached individually, a comprehensive investigation of this condition is needed in order to achieve standardization of practice.Dijastaza simfize rijetka je komplikacija trudnoÄe Äija toÄna incidencija joÅ” nije poznata, a procijenjena incidencija kreÄe se u rasponu od 1 : 300 do 1 : 30.000 trudnoÄa. Definira se kao udaljenost izmeÄu dvije pubiÄne kosti odnosno kao interpubiÄni razmak veÄi od 10 mm s tipiÄnom kliniÄkom slikom. TipiÄni simptomi dijastaze simfize jesu bol u podruÄju simfize koja se Å”iri u donji dio leÄa i bedro, gegavi hod, bolno kretanje, smanjena pokretljivost i, rijetko, urinarna retencija. U ovom radu prikazujemo bolesnicu s antepartalnom dijastazom simfize, koja je dijagnosticirana manualnom palpacijom za vrijeme redovitoga ginekoloÅ”kog pregleda. ViÅ”erotkinja s blizanaÄkom trudnoÄom, koja dotad nije imala kompliciran tijek trudnoÄe, pri redovitom je pregledu navela da dulje osjeÄa bol u podruÄju simfize, uz pogorÅ”anje tegoba u posljednja 3 tjedna te otežano hodanje i stajanje. Manualnom palpacijom otkriven je interpubiÄni razmak od 10 mm te je trudnica hospitalizirana. S obzirom na blizanaÄku trudnoÄu i dijastazu simfize, odluÄeno
je da trudnoÄa bude dovrÅ”ena elektivnim carskim rezom. Postoperativni rendgenogram (RDG) zdjelice pokazao je interpubiÄni razmak od 14 mm. Manualna palpacija jednostavna je i pouzdana metoda pa bi njezino uvoÄenje u svakodnevnu opstetriÄku praksu omoguÄilo rano otkrivanje dijastaze simfize, brži poÄetak terapije i dugoroÄno bolji ishod. TakoÄer, buduÄi da ne postoje znanstveno dokazane smjernice o zbrinjavanju antepartalne dijastaze simfize, nego se svakoj bolesnici pristupa individualizirano, potrebno je sveobuhvatno istraživanje ove patologije koje bi dovelo
do standardiziranja prakse
THE IMPORTANCE OF ANTENATAL ULTRASOUND SCREENING FOR CONGENITAL OSTEOCHONDRODYSPLASIA ā TWO CASE REPORTS
Osteohondrodisplazije velika su skupina rijetkih genskih bolesti karakterizirana poremeÄajem rasta i razvoja hrskavice i kosti. Äesto su povezane s malformacijama drugih organskih sustava. Mogu se podijeliti na letalne i neletalne skeletne displazije. TanatoforiÄna displazija jedna je od najÄeÅ”Äih letalnih skeletnih displazija s uÄestaloÅ”Äu pojavljivanja od 0,69 na 10.000 poroÄaja, dok je heterozigotna ahondrodisplazija meÄu najÄeÅ”Äim neletalnim displazijama s
uÄestaloÅ”Äu od 0,15 na 10.000 poroÄaja. Prikazat Äemo dva novoroÄenÄeta s osteohondrodisplazijom. Prvi je prikaz
letalne osteohondrodisplazije kod novoroÄenÄeta 41-godiÅ”nje viÅ”erotkinje koja je u 33. tjednu nekontrolirane trudnoÄe doÅ”la u naÅ”u Kliniku zbog zapoÄetog poroÄaja. Drugi je prikaz neletalne osteohondrodisplazije u novoroÄenÄeta
31-godiÅ”nje viÅ”erotkinje kod kojeg se od 30. tjedna trudnoÄe prate kraÄe kosti udova.Osteochondrodysplasias comprise a large, genetically heterogeneous group of disorders characterized by abnormalities
of cartilage and bone growth. They are often associated with abnormalities in other organ systems. They are
classified as lethal or non-lethal skeletal dysplasias. Thanatophoric dysplasia is the most common form of lethal skeletal
dysplasia with an incidence of 0.69 per 10.000 births. Heterozygous achondroplasia is the most common non-lethal dysplasia with an incidence of 0.15 per 10.000 births. We will present two cases of skeletal dysplasia. The first case is the case of lethal osteochondrodysplasia in the fetus of a 41-year-old multiparous woman, who came to our hospital in active preterm labor, in the 33th week of uncontrolled pregnancy. The second case is the case of non-lethal osteochondrodysplasia in the fetus of a 31-year-old multiparous woman. The fetal short femur length was detected in the 30th week of pregnancy
Influence of Tabacco Use on Periodontal Health in PTSD Patients
Brojne epidemioloÅ”ke i kliniÄke studije utvrdile su puÅ”enje duhana Äimbenikom rizika za progresiju parodontne bolesti. TakoÄer je pronaÄena pozitivna korelacija izme Äu nižega socioekonomskog statusa i težine parodontne bolesti.Željeli smo istražiti utjecaj puÅ”enja na kliniÄki parodontni status i subgingivni mikrobni profil u pacijenata s PTSP-om i pacijenata s progresivnom parodontnom bolesti. Istraživanje je ukljuÄilo 130 ispitanika podijeljenih u 3 skupine. Prva je skupina bila 50 osoba kojima je postavljena dijagnoza PTSP-a, i aktivno su sudjelovali u Domovinskom ratu. Druga se skupina sastojala od 50 pacijenata s uznapredovalim parodontitisom, a kontrolnu skupinu tvorilo je 30 parodontno zdravih osoba. Osobe iz tih skupina nisu bile izravno izložene ratnom stresu. KliniÄki pregled parodonta ukljuÄivao je mjerenje indeksa plaka (PI), indeksa krvareÄeg sulkusa (SBI) dubine sondiranja (PD) i kliniÄki gubitak priÄvrstka (CAL). Parodontni patogeni Actinobacillus actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg) i Eikenella corrodens (Ec) identificirani su s pomoÄu metode lanÄane reakcije polimeraze (PCR). PuÅ”aÄki i druÅ”tvenoekonomski status, mjeren stupnjem naobrazbe takoÄe su odreÄeni. Ispitanici s PTSP-om su u usporedbi s drugim dvjema skupinama imali najveÄi postotak puÅ”aÄa. U skupini s PTSP-om 78% ispitanika bili su puÅ”aÄi, a samo je 33% kontrolnih ispitanika puÅ”ilo. U skupini s PTSP-om 34% je puÅ”ilo manje od 20 cigareta na dan, a 30% je puÅ”ilo viÅ”e od 40 cigareta na dan. Ovo razlikuje PTSP skupinu od druge dvije. Rezultati pokazuju da su, gledajuÄi sve skupine zajedno, puÅ”aÄi imali viÅ”e parodontnih upala i destrukcija nego nepuÅ”aÄi, premda su samo PI i SBI vrijednosti bile statistiÄki znatne. Odnos jakosti parodontne upale i destrukcije u puÅ”aÄa i nepuÅ”aÄa je isti, i kada se promatra svaka skupina zasebno. Nisu pronaÄene statistiÄki znatne razlike izmeÄu prevalencije bakterija Aa, Pg i Ec imeÄu puÅ”aÄa i nepuÅ”aÄa. Skupina s PTSP-om imala je najniži stupanj Å”kolovanja. Navika puÅ”enja i niži druÅ”tvenoekonomski status Äimbenici su koji utjeÄu na zdravlje parodonta i pridonose parodontnoj upali u oboljelih od PTSP-a.Numerous epidemiological and clinical studies have identified tobacco smoking as a risk factor for periodontal disease progression. Positive correlation between lower socioeconimic status and periodontal disease severity has also been found. We wanted to study the influence of smoking on clinical periodontal status and the subgingival microbial profile in post-traumatic stress disorder (PTSD) patients and patients with progressive periodontal disease. The investigation included 130 subjects divided in to three groups. The first group comprised 50 persons diagnosed with PTSD, who has actively participated in the Croatian liberation war. The second group were 50 patients treated for advanced periodontitis, and the control group were 30 periodontally healthy subjects. Subjects from the latter two groups were not directly subjected to war-related stress. Clinical periodontal examination included recording of plaque index (PI), sulcus bleeding index (SBI), probing depth (PD) and clinical attachment loss (CAL). Periodontal pathogens Actinobacillus actinomycetemcomitans (Aa),Porphyromonas gingivalis (Pg) and Eikenella corrodens (Ec) were identified using poymerase chain reaction (PCR) method. Smoking and socioeconomic status, evaluated by the level od education, were also assessed. The group of subjects with PTSD, compared to the other groups, had most cigarette smokers. In the PTSD group, 78% were smokers, wile only 33% of control subjects smoked. In the PTSD group, 34% smoked less than 20 cigarettes per day, and 30% smoked more than 40 cigarettes per day. In this respect PTSD group differs greatly from the other group. The results show that, of all participiants, smokers had more periodontal inflammation and destruction than non-smokers, although only PI and SBI values were significantly higher. This relationship is similar for each of the studied groups. No statistically significant difference was observed between bacterial prevalence of Aa, Pg and Ec between smokers and nonsmokers. PTSD group had the lowest education level. Smoking habits and lower socioeconimic status are contributing factors influencing the periodontal status of PTSD patients