Serbia - public sector accounting review : report on the enhancement of public sector financial reporting

The government’s public financial management (PFM) Reform Program 2016-2020 foresees the gradual transition of public sector financial reporting from a cash basis to an accrual basis of accounting and the application of International Public Sector Accounting Standards (IPSAS). This will significantly improve the quality of financial information and should enable better informed decision-making, more efficient use of public funds and resources and improved fiscal performance. This Report on the Enhancement of Public Sector Financial Reporting is one output of the Serbia Public Sector Accounting Reform Technical Assistance project funded by the Swiss State Secretariat for Economic Affairs (SECO) through the Strengthening Accountability and Fiduciary Environment (SAFE) Trust Fund under the Public Sector Accounting and Reporting Program (PULSAR) which provides support for the development and implementation of public sector accounting standards. This report supports the development of a plan towards that goal by assessing the institutional framework for public sector accounting as well as the gap between Serbian public sector generally accepted accounting principles (PS GAAP) and IPSAS

Epidemiology, prevention and management of early postpartum hemorrhage — a systematic review

Early Postpartum Hemorrhage (EPH) is one of the leading causes of postpartum mortality. It is defined as blood loss of atleast 500 mL after vaginal or 1000 mL following cesarean delivery within 24 hours postpartum. The following paper includesliterature review aimed to estimate the incidence and predictors of early postpartum hemorrhage (EPH). Available preventionand treatment methods were also assessed. The inclusion criteria for the study were met by 52 studies.The exact frequency of EPH in different populations varies from 1.2% to 12.5%. Maternal, pregnancy-associated, laborcorrelatedand sociodemographic risk factors seem to be important predictors of EPH. In these cases appropriate prophylaxisshould be considered. However, EPH may occur without previous risk factors. The main reason for EPH is uterine atonywhich contributes to up to 80% of cases of postpartum hemorrhage (PPH). Other common reasons for PPH include genitaltract injuries, placenta accreta or coagulopathies. Interestingly, the majority of uterotonics seem to have a similar effect.However, carbetocin seems to be the most effective in certain situations.Appropriate diagnosis of EPH is the most important issue. The treatment should be causative. The first-line treatment shouldinclude uterotonics. Surgical interventions, if required, should be performed without delay, although preoperative uterinetamponade should be considered due to its high effectiveness.Medical staff training in medical simulation centers is an important factor that improves the outcomes of EPH treatment.It provides adaptation to hospital protocols, team work improvement, self-confidence building, more accurate blood lossevaluation and reduced perception of stress. The implementation of systematic trainings provides better outcomes in the future

The Impact of Endometriosis on the Quality of Life and the Incidence of Depression—A Cohort Study

The objective was to evaluate the quality of life and the incidence of depression among women suffering from endometriosis. Afterwards, the dependency between pelvic pain, its severity and stages of endometriosis were analyzed. The study protocol included women of reproductive ages with confirmed endometriosis. The stage of disease was conferred according to the ASRM (American Society of Reproductive Medicine) classification. Women fulfilled two questionnaires: “WERF EPHect Clinical Questionnaire” and self-prepared survey about fertility disorders. The study group comprised of 246 respondents. A total of 77.2% of women were symptomatic. The most common complaints were chronic pelvic pain (CPP, 71.1%), dysmenorrhea (69.0%) and dyspareunia (45.2%). Intensity of pain was independent from the stage of endometriosis. The incidence of infertility and the time to conceive increased with the stage of disease (stage 1—52.8%, 3.4 years; stage 2—66.7%, 4.1 years; stage 3—61.3%, 3.7 years; stage 4—96%, 6.1years; p = 0.02 and 0.03, respectively). The prevalence of depression was positively correlated with the beginning of dyspareunia (14.5 vs. 19.6 years old., p = 0.002). CPP (OR(odds ratio) = 3.8, 95% CI 1.2–12.8, p = 0.04) and painful defecation (OR = 7.7, 95% CI 1.4–42.3, p = 0.01) increased the risk of depression. Symptoms related to endometriosis and severity of pain correlate with the prevalence of depression. Stage of endometriosis is significantly related to the prevalence of infertility

Should the patients with endometriosis be treated as a risk group of pregnancy complications? Single center experience and literature review and literature review

Objectives: Multidirectional influence of endometriosis on fertility impairments is well known. Altered implantation and placentation among affected patients raised concerns regarding possible negative influence on the course of pregnancy. The primary objective of the study was to assess the course of gestation and the incidence of pregnancy complications among women with endometriosis. It also aimed to determine whether the method of conception might impact the primary results. Material and methods: A single-center cohort study included 64 women with confirmed endometriosis and 296 healthy controls. Data concerning treatment of endometriosis related infertility, course of pregnancy and perinatal outcomes were evaluated. Results: Patients with endometriosis were older than controls (33.6 +/- 4.2 y vs 31.8 +/- 4.6, p = 0.01) and more often gave birth for the first time (87.5% vs 43.9%, p = 0.001). The age at the time of first delivery was significantly higher within the study group (33.1 y +/- 4.1 vs 29.9 +/- 4.6, p < 0.001). In the study, 81.2% of patients with endometriosis had the diagnosis of infertility. Patients suffering from endometriosis were significantly more prone to spontaneous placental abruption during pregnancy and delivery (4.7 vs 0.3%, odds ratio = 14.5). Several complications occurred more often in endometriotic patients (gestational diabetes mellitus, small-for-gestational-age and anemia); however, without statistical significance. The risk of pregnancy complications was independent from stage of endometriosis and way of conception. The incidences of adverse neonatal outcomes (preterm delivery, low Apgar score, lower birth weight) were similar in both groups. Conclusions: Endometriosis may adversely affect perinatal outcomes, especially due to increased risk of placenta abruption and operative delivery. Stage of endometriosis and method of conception does not enhance these complications

The efficacy of paritaprevir/ritonavir/ombitasvir+dasabuvir and ledipasvir/sofosbuvir is comparable in patients who failed interferon-based treatment with first generation protease inhibitors - a multicenter cohort study

Abstract Background According to the EASL and AASLD guidelines, the recommended treatment for patients who failed to achieve a sustained virologic response (SVR) on prior interferon-based triple therapy with protease inhibitors (PI), is a combination of sofosbuvir and NS5A inhibitors. Polish national recommendations also allow the use of paritaprevir/ritonavir/ombitasvir+dasasbuvir±ribavirin (PrODR) in this group of patients. The aim of the study was to evaluate the efficacy and safety of PrODR vs. ledipasvir/sofosbuvir±RBV (LSR) in PI-experienced patients in real-life setting. Methods Our analysis included patients registered in the nationwide, investigators initiated, multicentre EpiTer-2 database. Among 4530 patients registered, 335 with genotype 1 (93% 1b) were previously treated with IFN-based regimens with PIs: 127 with boceprevir (BOC), 208 with telaprevir (TVR). Patients with advanced fibrosis (F3/F4) were significantly predominant (BOC 28.4%/61.4%, TVR 18.8%/64.4%, respectively). Subjects were assigned to IFN-free retreatment as follows: BOC - 64 (50.4%) PrODR and 63 (49.6%) LSR; TVR- 103 (49.5%) PrODR and 105 (50.5%) LSR. Results SVR rates were comparable for particular groups: BOC → PrODR- 100%; BOC → LSR - 98%; TVR → PrODR - 97%; TVR → LSR - 96% (intent-to treat analysis-ITT) and BOC → PrODR→100%; BOC → LSR - 99%; TVR → PrODR - 99%; TVR → LSR - 98% (modified intent-to treat analysis-mITT). Both treatment regimens had a favourable safety profile. Adverse events (AEs) were generally mild or moderate in severity. Three deaths were reported. The treatment was stopped due to AEs in five patients (three treated with PrODR and two with LSR). Conclusion Efficacy and safety of treatment with PrODR and LSR is comparable in BOC or TVR-experienced patients