The value of Pap test in women with endometrial cancer

Introduction: Endometrial cancer is the second most common gynecological tumor. There is still no recommended screening method for endometrial cancer. The application of transvaginal sonography, hysteroscopy and Pap test may prove useful in screening for this disease. Atypical glandular cells represent an important finding in Pap tests and they are related to histopathological verification of the endometrium. The aim of the study was to determine the usefulness of the Pap test in assessing the cervical infiltration, as well as to determine the significance of hormonal status and histopathological type of tumor in a pathological Pap test in patients with endometrial cancer.Methods: The study was retrospective. The analysis included the data obtained from 62 operated patients diagnosed with enometrial cancer, medical history (menopausal status), histopathological findings after surgery (type and stage of the disease) and a preoperative Pap smear. The chi squared and Fisher’s test were used.Results: The difference in the prevalence of pathological Pap test in premenopausal and postmenopausal group of patients was not statistically significant. The difference in the prevalence of pathological Pap test in the group of endometrioid and non-endometrioid tumours of the uterine corpus had statistical significance. The difference in the prevalence of pathological Pap test compared to the present stage (I and II) was not statistically significant.Conclusion: Pap smear does not correlate with menopausal status in women with endometrial carcinoma. Abnormal Pap test is more commonly found in cases of non-endometroid tumours. Pap smears cannot beused to assess cervical involvement

The impact of somatic symptoms on depressive and anxiety symptoms among university students in central Serbia

Background/Aim. Depression and anxiety problems are a major public health concern due to their high prevalence rates, difficult treatment, and often chronic course. This study examined the impact of somatic symptoms on depressive and anxiety symptoms among university students in Serbia. Methods. A cross-sectional study was performed among 1,940 students using a questionnaire specially designed for this study which included presence of Somatic and Non-specific Mental Symptoms (SNMS), Beck Depression Inventory and Beck Anxiety Inventory. The presence of somatic and associated non-specific mental symptoms over the last six months served as the basis for creating a new variable called SNMS score. Results. Receiver operating characteristic (ROC) curve showed that the SNMS score might be a very good marker for the distinction of students with or without depressive symptoms (area = 0.754, p < 0.05). The threshold value was 8.50 (sensitivity 67.6%, specificity 69.4%). Binary logistic regression showed that Odds ratio was 1.052 [95% confidence interval (CI) 1.045–1.059], which means that an increase in the value of the SNMS score by 1 increases the risk of depressive symptoms by 5.2%. ROC curve showed that the SNMS score might be an excellent marker for the distinction of students with or without anxiety symptoms (area = 0.800, p < 0.05). Limit value (cut-off) was 7.50 (sensitivity 74.2%, specificity 71.6%). Binary logistic regression showed that odds ratio was 1.056 (95% CI 1.049–1.064), which means that increasing the value of SNMS score by 1 increases the risk of anxiety symptoms by 5.6%. Conclusion. The SNMS score might be a state marker for the screening and distinction of students with depressive symptoms, and excellent state marker for screening and making distinction between students with anxiety symptoms and the students who do not have these symptoms

VAGINAL DELIVERY OF GIANT FETUS – SHOULDER DYSTOCIA

Shoulder dystocia (SD) is defined as unpredictable and urgent obstetric complication that happens when the pelvis of a mother is spread sufficiently to deliver fetal head, but insufficiently to deliver fetal shoulders. It is associated with high percentage of maternal and fetal morbidity. Fetal lethality from hypoxia ranges from 2-16%.We observed the case of vaginal delivery in a multiparous woman in the 39th gestational week. Head delivery was performed by using vacuum extraction. Because of the shoulder dystocia, we applied McRoberts’ maneuver with Resnik’s suprapubic pressure and performed one more episiotomy. Since these maneuvers did not give the expected result, we did the aspiration of the upper respiratory paths of the fetus, after which we performed Hibbard’s cord with simultaneous Kristeler’s maneuver. It led to releasing the shoulders and fetal delivery. On delivery, male fetus was 6000 g/60 cm, estimated with Apgar 1. The urgent reanimation was undertaken. After few hours, the baby was transferred to Pediatric Surgical Clinic for further treatment of present pneumotorax and humerus fracture. After many days, the baby being in normal state, was referred to physical rehabilitation treatment. Today, the baby is without sequelae.SD is one of the most difficult, hardly predictable perilous obstetric complications with high percentage of maternal morbidity and fetal morbidity and mortality. It requires caution, training and skills of obstetric-neonatal team. Liberalization of the use of Caesarian section in managing SD decreases the appearance of injuries in both mother and child. However, regardless of very rapid development of perinatology and the use of modern diagnostic-therapeutic protocols, some questions from classical, practical obstetrics remain unanswered

The value of Pap test in women with endometrial cancer

Introduction: Endometrial cancer is the second most common gynecological tumor. There is still no recommended screening method for endometrial cancer. The application of transvaginal sonography, hysteroscopy and Pap test may prove useful in screening for this disease. Atypical glandular cells represent an important finding in Pap tests and they are related to histopathological verification of the endometrium. The aim of the study was to determine the usefulness of the Pap test in assessing the cervical infiltration, as well as to determine the significance of hormonal status and histopathological type of tumor in a pathological Pap test in patients with endometrial cancer. Methods: The study was retrospective. The analysis included the data obtained from 62 operated patients diagnosed with enometrial cancer, medical history (menopausal status), histopathological findings after surgery (type and stage of the disease) and a preoperative Pap smear. The chi squared and Fisher’s test were used. Results: The difference in the prevalence of pathological Pap test in premenopausal and postmenopausal group of patients was not statistically significant. The difference in the prevalence of pathological Pap test in the group of endometrioid and non-endometrioid tumours of the uterine corpus had statistical significance. The difference in the prevalence of pathological Pap test compared to the present stage (I and II) was not statistically significant. Conclusion: Pap smear does not correlate with menopausal status in women with endometrial carcinoma. Abnormal Pap test is more commonly found in cases of non-endometroid tumours. Pap smears cannot be used to assess cervical involvement

Opportunities for emotional intelligence in the context of nursing

Introduction: Emotional intelligence is the ability to recognize and control one´s own emotions as well as emotions of other people. There are two orientations in studying emotional intelligence. They differ in whether they relate abilities and personal characteristic features or not. Emotional intelligence usage is currently being understood as a fundamental requirement of nursing in care provision to patients.Methods: In a research conducted with a group of nursing students (n = 86), we were examining emotional intelligence as an ability and as a feature. We used SIT-EMO (Situational Test of Emotional Understanding) scales in order to fi nd out emotional intelligence as an ability, and SEIS (Schutte Emotional Intelligence Scale), measuring emotional intelligence as a feature. In the context of nursing, we were finding out emotional self-effi cacy in relation to geriatric patients (ESE-GP). TEIQue-SF (Trait Emotional Intelligence Questionnaire – short form) method was used to set up our own questionnaire.Results: We were fi nding out the extent of emotional intelligence and we were analyzing it from the viewpoint of its grasping as a feature, ability and emotional self-effi cacy in relation to geriatric patients. We found out lower levels in social awareness, emotional management and stress management dimensions of the nursing students.Conclusion: Emotional intelligence as an ability of the nursing students can be enhanced through psychological and social trainings. Emotional intelligence has an impact on social and communication skills, which are a precondition of effective nursing care

Surgical treatment of symptomatic patellofemoral malalignment: Do we need an ideal patellofemoral congruency to solve the symptoms?

Background/Aim. The aim of this prospective nonrandomized study was to test functional results of different surgical strategies in the operative treatment of symptomatic patellofemoral malalignment. Our hypothesis was that immediate extensive surgery does not have serious advantage comparing to “step by step” procedure, regarding the main symptoms and functional end result. We wanted to check whether obtaining ideal surgical patellofemoral congruency is an essential prerequisite for subsidence of the major symptoms of patellofemoral malalignment. Methods. The study included 35 patients with patellofemoral malalignment who had persistant major symptoms: patellar pain and slipping, 3 months after nonoperative treatment. Divided into three groups, they all underwent the realignment surgery, but in different extent and sequence: immediate extensive surgery, step by step surgery, and only proximal realignment. Their overall functional scores as well as major symptoms were assessed at the beginning, after the surgery, and during the 3-years follow-up period and then, compared at the end. Results. There was no significant difference in the functional results among the groups, neither at the beginning (p = 0.1318) nor at the end of the study (p = 0.3996), but the results at the beginning compared to those at the end of the study showed a statistically significant difference in all three groups (p1 = 0.005062; p2 = 0.011719; p3 = 0.000352). The same result was in regard to the major symptoms. Conclusion. The study confirmed that insisting on immediate extensive surgery in order to achieve precise and complete congruency of the patellofemoral joint, did not prove its advantage over the less invasive, individual surgical approach concerning functional scores and major symptoms

Unruptured retroperitoneal pregnancy implanted in the left broad ligament: A case report

Introduction. Retroperitoneal ectopic pregnancy is extremely rare, but potentially fatal condition due to possible massive hemorrhage, representing a great challenge to clinicians. Case report. We presented early retroperitoneal pregnancy in a patient with previous caesarean section, diagnosed at the sixth gestational week, located in the left broad ligament, primary treated by laparoscopy, which had to be converted to laparotomy due to massive intraoperative bleeding from the implantation site. Conclusion. High index of suspicion, combined with carefully interpreted clinical and ultrasound findings are crucial for the timely diagnosis of retroperitoneal pregnancy, before the occurrence of severe bleeding. The rising, even plateau of serum β-human chorionic gonadotropin (β-HCG) levels without identification of uterine or ectopic (tubal) pregnancy should cause suspicion on ectopic pregnancy in unusual location

The influence of respiratory pattern on heart rate variability analysis in heart failure

Introduction. Autonomic dysfunction is present early in the course of heart failure, and has a direct role on deterioration of cardiac function and prognosis. Heart rate variability (HRV) estimates sympathovagal control of heart frequency. The influence of respiratory pattern on HRV is clinically important. Breathing disorders are common in heart failure and highly affect HRV and autonomic evaluation. It was previously shown that slow and deep breathing increased parasympathetic tone, but effects of this respiratory pattern on HRV were not evaluated. Objective. The aim of the study was to estimate effects of slow and deep breathing (SDB) on HRV in heart failure patients. Method. In 55 patients with heart failure (78% male, mean age 57.18±10.8 yrs, mean EF=34.12±10.01%) and 14 healthy controls (57.1% male, mean age 53.1±8.2 yrs), short term HRV spectral analysis was performed (Cardiovit AT 60, Schiller). VLF, LF, HF and LF/HF were determined during spontaneous and deep and slow breathing at 0.1 Hz (SDB). Results. LF, HF and LF/HF significantly increased during SDB compared with spontaneous breathing both in controls (LF 50.71±61.55 vs. 551.14±698.01 ms2, p&lt;0.001; HF 31.42±29.98 vs.188.78±142.74 ms2, p&lt;0.001 and LF/HF 1.46±0.61 vs. 4.21±3.23, p=0.025) and heart failure patients (LF 27.37±36.04 vs. 94.50±96.13 ms2, p&lt;0.001; HF 12.13±19.75 vs. 41.58±64.02 ms2, p&lt;0.001 and LF/HF 3.77±3.79 vs. 6.38±5.98, p=0.031). Increments of LF and HF induced by SDB were significantly lower in patients than healthy controls. Heart failure patients had lower HRV compared to healthy controls both during spontaneous breathing and SDB. During spontaneous breathing, only HF was significantly lower between healthy controls and patients (p=0.002). During SDB VLF (p=0.022), LF (p&lt;0.001) and HF (p&lt;0.001) were significantly lower in heart failure patients compared to controls. Conclusion. These data suggest that SDB increases HRV both in healthy and heart failure patients; the highest increment is in LF range. Differences in spectral profile of HRV between healthy controls and heart failure patients become more profound during SDB. Controlled respiration during HRV analysis might increase sensitivity and reliability in detection of autonomic dysfunction in heart failure patients.

The role of two-dimensional echocardiography in diagnostics of coarctation of the aorta in newborns

Introduction. Diagnosis of neonatal coarctation of the aorta (CoA) still presents a challenge in routine practice because of absence of reliable morphologic and functional parameters for early detection of this congenital heart defect in newborns. Objective. The aim of this study is to identify easy obtainable two-dimensional echocardiographic parameters for detection of the CoA in newborns. Methods. Echocardiographic evaluation was performed in 30 newborns with CoA and 20 healthy neonates (control group). Measurements of the proximal transverse arch (PTA), distal transverse arch (DTA), isthmus, distance between the left common carotid artery (LCCA) at the origin of the left subclavian artery (LSA), were obtained by two-dimensional echocardiography. Aortic arch hypoplasia was defined using Mouleart, Karl and Mee criteria, and Z-value. Index 1 was calculated as a ratio of DTA and distance between origins LCCA-LSA, Index 2 was calculated as a ratio of the ascending aorta and the distance between LCCA-LSA origins, and Index 3 was calculated as a ratio of PTA and distance between LCCA-LSA origins. Results. Index 1 was significantly lower in patients with CoA in comparison with control group (0.50 vs. 1.39; p≤0.01). A cutoff point at 0.39, for Index 1, showed a sensitivity of 92% and specificity of 99% for the diagnosis of neonatal CoA, while cut off points at 0.69 and 0.44, for Index 2 and Index 3, showed the highest sensitivity and specificity for the diagnosis of CoA in newborns. Conclusion. By using these echo indexes, two-dimensional echocardiographic aortic arch measurement becomes a simple, reliable noninvasive method for the evaluation of aortic coarctation in newborns and may lead to earlier diagnosis and subsequent surgical correction

Smrt u opusu Vladana Desnice i europskoj kulturi: poetički povijesni i filozofski aspekti:

Zbornik Smrt u opusu Vladana Desnice i europskoj kulturi: poetički, povijesni i lozofski aspekti najvećim dijelom čine prilozi nastali na temelju izlaganja na međunarodnom znanstvenom&nbsp;skupu Desničini sureti 2017., održanom u Zagrebu od 15. do 17. rujna.&nbsp; Skup&nbsp;kojim je obilježena i pedeseta obljetnica piščeve smrti imao je, nakon 2012. godine, najveći&nbsp;broj prijavljenih sudionika, a od četrdeset osam najavljenih izlaganja, održano je četrdeset.&nbsp;Iako su bili spriječeni održati svoja izlaganja, neki su prijavljeni ipak napisali članke te su oni&nbsp;uvršteni u ovaj zbornik. Osim tekstova sudionika Desničinih susreta 2017., zbornik sadrži i&nbsp;dva rada autora čiji su predmeti istraživačkog interesa bliski temi skupa te su na molbu urednika,&nbsp;a i potaknuti pozitivnim odjecima skupa, odlučili napisati svoje priloge. &nbsp;(...) Iako zborničke cjeline nisu vizualno odvojene, članci u zborniku mogu se grupirati&nbsp;u tri skupine. Prvu, najbrojniju, čine prilozi u kojima se autori bave motivima smrti u&nbsp;djelima Vladana Desnice, bilo da se radi o opusu u cjelini, određenoj književnoj vrsti (npr.&nbsp;pripovijetkama) ili pojedinom književnom djelu (najčešće romanima Proljeća Ivana Galeba&nbsp;i Zimsko ljetovanje te nedovršenom romanu Pronalazak Athanatka). Slijede potom prilozi u&nbsp;kojima se tematizira motiv smrti u radovima drugih književnika (npr. arapskih pjesnika,&nbsp;Miroslava Krleže, Dragiše Vasića, Miroslava Antića, Dževada Karahasana i Juana Rulfa) i filozofa (Martina Heideggera, Karla Jaspersa i Stjepana Zimmermanna), a završava historiografskom&nbsp;cjelinom, tekstovima koji pokrivaju teme u rasponu od antike do sredine dvadesetog&nbsp;stoljeća. Urednici – nakon neizbježnih višekratnih čitanja svakog priloga – odlučili&nbsp;su napraviti vlastiti izbor naglasaka u svakom uvrštenom prilogu, nastojeći slijediti logiku&nbsp;„velikih tema“ koje integriraju ovaj zbornik.Zbornik Smrt u opusu Vladana Desnice i europskoj kulturi: poetički, povijesni i lozofski aspekti najvećim dijelom čine prilozi nastali na temelju izlaganja na međunarodnom znanstvenom&nbsp;skupu Desničini sureti 2017., održanom u Zagrebu od 15. do 17. rujna.&nbsp; Skup&nbsp;kojim je obilježena i pedeseta obljetnica piščeve smrti imao je, nakon 2012. godine, najveći&nbsp;broj prijavljenih sudionika, a od četrdeset osam najavljenih izlaganja, održano je četrdeset.&nbsp;Iako su bili spriječeni održati svoja izlaganja, neki su prijavljeni ipak napisali članke te su oni&nbsp;uvršteni u ovaj zbornik. Osim tekstova sudionika Desničinih susreta 2017., zbornik sadrži i&nbsp;dva rada autora čiji su predmeti istraživačkog interesa bliski temi skupa te su na molbu urednika,&nbsp;a i potaknuti pozitivnim odjecima skupa, odlučili napisati svoje priloge. &nbsp;(...) Iako zborničke cjeline nisu vizualno odvojene, članci u zborniku mogu se grupirati&nbsp;u tri skupine. Prvu, najbrojniju, čine prilozi u kojima se autori bave motivima smrti u&nbsp;djelima Vladana Desnice, bilo da se radi o opusu u cjelini, određenoj književnoj vrsti (npr.&nbsp;pripovijetkama) ili pojedinom književnom djelu (najčešće romanima Proljeća Ivana Galeba&nbsp;i Zimsko ljetovanje te nedovršenom romanu Pronalazak Athanatka). Slijede potom prilozi u&nbsp;kojima se tematizira motiv smrti u radovima drugih književnika (npr. arapskih pjesnika,&nbsp;Miroslava Krleže, Dragiše Vasića, Miroslava Antića, Dževada Karahasana i Juana Rulfa) i filozofa (Martina Heideggera, Karla Jaspersa i Stjepana Zimmermanna), a završava historiografskom&nbsp;cjelinom, tekstovima koji pokrivaju teme u rasponu od antike do sredine dvadesetog&nbsp;stoljeća. Urednici – nakon neizbježnih višekratnih čitanja svakog priloga – odlučili&nbsp;su napraviti vlastiti izbor naglasaka u svakom uvrštenom prilogu, nastojeći slijediti logiku&nbsp;„velikih tema“ koje integriraju ovaj zbornik