Influence of Seasonal Variations on In-Vitro Fertilization Success

This study was designed to investigate the influence of seasonal variations on the number of retrieved ova, fertilization rate, embryo quality rates and pregnancy rate in IVF cycles. Prospective cohort study was conducted on a total number of 2140 cycles in infertile patients undergoing their first IVF cycle between 2000 and 2007 in IVF policlinic. c2-test, Pearson’s correlation coefficient and one-way analysis of variance were used for statistical analyses. Overall fertilization rate was 77.96% and pregnancy rate 29.15±2.72% per cycle. Seasonal prevalence of pregnancy rate was highest during fall 33.8±4.5% and lowest during summer 23.4±6.2%, but these differences did not reach statistical significance. The study did not show any statistically significant differences in the number of retrieved oocyte, fertilization, and embryo quality according to season. Therefore seasonal changes should not be taken into account in everyday IVF practice

Development of education in northwestern Croatia from 1874 to 1910: quantitative indicators

U radu se raspravlja o ulozi vlasti Kraljevine Hrvatske i Slavonije, kao samoupravne jedinice u okviru Austro-Ugarske Monarhije, u stvaranju javnog, općeg i obveznog sustava pučkoga školstva. Na temelju analize različitih statističkih podataka, nastoji se preko odabranih pokazatelja postaviti osnovne teze o tome jesu li pokrenute obrazovne i školske reforme bile u praksi uspješne ili neuspješne. Dodatni zadatak rada jest iscrpnije, putem statističkih podataka, pružiti pokazatelje strukture obrazovanja i školstva na području sjeverozapadne Hrvatske. Iako je naglasak na pučkome školstvu, u radu se prikazuju osnovni podaci i za ostale školske i obrazovne razine srednjega obrazovanja, kako bismo mogli dobiti što potpuniju sliku obrazovanja kao jednoga od najvažnijih područja u oblikovanju moderne države.The paper discusses the role of the government of the Kingdom of Croatia and Slavonia as a self-governing unit within the Austro-Hungarian Monarchy within creation of a public, general and compulsory system of public education. Based on the analysis of various statistical data, an attempt is made through selected indicators to establish basic theses about whether the initiated educational and school reforms were successful or unsuccessful in practice. An additional task of the paper is to provide more detailed indicators of the structure of education and schooling in the area of north-western Croatia by means of analysing statistical data. Although the emphasis is on public education, the paper presents basic data for other school and educational levels of secondary education as well, so that we can get the most complete picture of education as one of the most important areas in shaping a modern state

Development of education in northwestern Croatia from 1874 to 1910: quantitative indicators

U radu se raspravlja o ulozi vlasti Kraljevine Hrvatske i Slavonije, kao samoupravne jedinice u okviru Austro-Ugarske Monarhije, u stvaranju javnog, općeg i obveznog sustava pučkoga školstva. Na temelju analize različitih statističkih podataka, nastoji se preko odabranih pokazatelja postaviti osnovne teze o tome jesu li pokrenute obrazovne i školske reforme bile u praksi uspješne ili neuspješne. Dodatni zadatak rada jest iscrpnije, putem statističkih podataka, pružiti pokazatelje strukture obrazovanja i školstva na području sjeverozapadne Hrvatske. Iako je naglasak na pučkome školstvu, u radu se prikazuju osnovni podaci i za ostale školske i obrazovne razine srednjega obrazovanja, kako bismo mogli dobiti što potpuniju sliku obrazovanja kao jednoga od najvažnijih područja u oblikovanju moderne države.The paper discusses the role of the government of the Kingdom of Croatia and Slavonia as a self-governing unit within the Austro-Hungarian Monarchy within creation of a public, general and compulsory system of public education. Based on the analysis of various statistical data, an attempt is made through selected indicators to establish basic theses about whether the initiated educational and school reforms were successful or unsuccessful in practice. An additional task of the paper is to provide more detailed indicators of the structure of education and schooling in the area of north-western Croatia by means of analysing statistical data. Although the emphasis is on public education, the paper presents basic data for other school and educational levels of secondary education as well, so that we can get the most complete picture of education as one of the most important areas in shaping a modern state

Progesteronska potpora žutom tijelu u stimuliranim ciklusima izvantjelesne oplodnje

Objectives: To compare efficacy (on-going pregnancy rate and early abortion rate), satisfaction and tolerability of different route of progesterone supplementation i.e. oral dydrogesterone, vaginal progesterone gel, micronized vaginal capsules and combined therapy of oral micronized progesterone capsules plus vaginal progesterone gel used in luteal support of stimulated cycles. Study design: Meta-analysis of three own prospective clinical studies. Study population consisted of a total of 1508 infertile women undergoing IVF/ICSI treatment in University Hospital Center ‘‘Sisters of Mercy’’ and IVF Polyclinic, Zagreb, Croatia. Luteal support was provided as: a) Crinone 8% vaginal progesterone gel (1x90 mg) administered daily, or Utrogestan vaginal capsules (2x100 mg) administered three times daily; b) Comibined therapy of Crinone 8% vaginal gel, 1x90 mg daily dose and Utrogestan oral capsules 3x100 mg, or Crinone 8% vaginal gel, 1x90 mg daily; c) Crinone 8% vaginal progesterone gel (1x90 mg) administered daily, or oral dydrogesterone Duphaston (2x10 mg) administered two times daily. Progesterone was administered from the day of oocyte retrieval (day 0) to menses or, in a case of pregnancy, until week 10. Results: The primary outcome aims were on-going pregnancy rate and early abortion rate. The on-going pregnancy rates were comparable between different routes of progesterone supplementation in luteal support i.e. in the case of combined oral-vaginal route 39.5% vrs. Crinone 8% vaginal gel 33.5%; Crinone 8% vaginal gel vrs. Utrogestan vaginal capsules 30.9%; oral progesterone tablets (Duphaston) 30.5% vrs Crinone vaginal progesterone gel 32.9% per ET (RR 0.93-1.18; p= 0.78). Early abortion rate was almost equal between different routes of progesterone supplementation with the exception of comparison between combined progesterone therapy 6.4% and vaginal progesterone gel 15.6%, which presented lower abortion rate with the use of combined progesterone therapy (RR 0.41; 95%CI 0.22-0.79; p <0.01). Early abortion rate in other comparison arms was as following: Crinone 8% vaginal gel 10.8% vrs. Utrogestan vaginal capsules 14.7%; Crinone 8% vaginal gel 6.8% vrs. Duphaston oral progesterone tablets 10.1% that give a meta-analysis RR 0.59; 95%CI 0.43-0.82 and p=0.44. Overall tolerability showed similar rates but vaginal bleeding was significantly more present with the use of Crinone 8% vaginal gel when compared with the combined therapy (RR 0.21; 95%CI 0.07-0.61; p<0.01) and oral progesterone tablets. Interference with coitus and local adverse side effects such as perineal irritation (RR 0.06; 95%CI 0.01-0.47; p<0.01) and vaginal discharge (RR 0.08; 95%CI 0.02-0.32; p<0.001) occurred significantly more with the use of vaginal progesterone (capsules and vaginal gel) than with the use of oral dydrogesterone. Satisfaction assessment showed significantly more absolutely satisfied patients with the used of oral progesterone tablets (Duphaston) in comparison with vaginal progesterone gel. Almost the same result was noticed with the use of vaginal gel vrs vaginal capsules. Overall the patients were significantly more satisfied with the use of vaginal progesterone gel, combined oral-vaginal progesterone therapy and oral vaginal tablets then with the use of vaginal progesterone capsules. Users of oral progesterone tablets showed significantly more absolute satisfaction and significantly less absolute dissatisfaction when compared with all other routes of progesterone supplementation. Conclusions: All routes of progesterone supplementation in luteal phase support of induced cycles showed almost equall efficacy considering rate of on-going pregnancy and early abortion rate. Oral tablets of dydrogesterone are effective drug, well tolerated with less adverse side effects such as perineal irritation and vaginal discharge and more overall satisfaction among patients when compared with combined therapy and vaginal route of progesterone use and can be considered for routine luteal support

Ethnic Identities of Population of Croatian Lands in the 1st Half of the 19th Cen tury According to Austrian Encyclopedias

Centralni istraživački zadatak rada je analiza etničkih identiteta koje autori austrijskih enciklopedijskih i leksikonskih članaka pridaju stanovnicima hrvatskih zemalja u prvoj polovici 19. stoljeća, te komparacija podataka koje oni donose s istovrsnim podatcima drugih onovremenih autora iz Habsburške Monarhije. Budući da su autori, leksikografi, etničke identitete tumačili u skladu s vlastitim spoznajama, govori se o konstrukcijama identiteta. U svojim analizama oslanjali su se na izvore koji su im bili dostupni, poput tiska, putopisa i statističkih edicija iz Monarhije. Etnički identiteti se tijekom vremena izgrađuju i razvijaju i kao individualna i kao kolektivna pojava.The aim of this article is to analyze ethnic identities which authors in Austrian encyclopedias and lexicons assign to population of Croatian lands in the first half of the 19th century, and compare them with datas which other autors from that period use in their books. The lack of official datas is the reason why authors interpret these ethnic groups according to their own knowledge. In another words, they construct identities. On the other hand, those identifications prove the state of self – identification which inhibitants have of themselves

Heterotopična troplodna trudnoća komplicirana sindromom hiperstimulacije jajnika nakon in vitro fertilizacije

Heterotopic pregnancy is a rare event that occurs in less than 1% of pregnancies following in vitro fertilization and embryo transfer, especially when complicated with ovarian hyperstimulation syndrome. We report a case of a 31-year-old woman in the 6th gestational week of pregnancy achieved after in vitro fertilization, who was complaining of acute lower abdominal pain and distension, breathing difficulties and vaginal spotting. Transvaginal ultrasound examination and laboratory tests confirmed the ovarian hyperstimulation syndrome in the presence of two viable gestational sacs. The patient’s condition worsened five days later with sudden onset of sharp abdominal pain, nausea and vomiting, along with impaired laboratory test values. Laparoscopy was attempted, but enlarged ovaries and adhesions prevented further procedure, which was then converted to mini-laparotomy. Operative removal of the right tubal pregnancy resulted in uncomplicated course of the intrauterine twin pregnancy and delivery of two healthy neonates by cesarean section at 37 weeks of gestation. Clinicians need to be aware of this rare complication where ovarian hyperstimulation syndrome coexists with heterotopic pregnancy after in vitro fertilization and embryo transfer procedure. Enlarged ovaries may mask accurate ultrasound diagnosis, but timely surgical intervention can prevent fatal consequences and result in normal course and outcome of intrauterine pregnancy.Heterotopična trudnoća je rijetka i događa se u manje od 1% trudnoća nakon postupka izvantjelesne oplodnje i prijenosa zametaka, pogotovo kada je komplicirana sindromom hiperstimulacije jajnika. Prikazujemo slučaj 31-godišnje žene u 6. tjednu trudnoće postignute nakon izvantjelesne oplodnje, koja se žalila na akutnu bol u donjem desnom abdomenu, napetost, poteškoće s disanjem i vaginalnu sukrvicu. Transvaginalni ultrazvučni pregled i laboratorijski testovi su potvrdili ovarijsku hiperstimulaciju u prisutnosti dvije vijabilne gestacijske vrećice. Pacijentici se zdravstveno stanje pogoršalo pet dana kasnije s iznenadnom pojavom oštre boli, mučnine i povraćanja, zajedno s pogoršanim vrijednostima laboratorijskih testova. Pokušalo se učiniti laparoskopiju, ali su povećani ovariji i priraslice spriječili nastavak operacije te je ista konvertirana u mini-laparotomiju. Operacijsko odstranjenje desne tubarne trudnoće rezultiralo je nekompliciranim tijekom unutarmaternične blizanačke trudnoće i porodom dva zdrava novorođenčeta putem carskog reza u 37. tjednu gestacije. Kliničari moraju biti svjesni moguće rijetke komplikacije u kojoj sindrom hiperstimulacije postoji uz heterotopičnu trudnoću nakon postupka izvantjelesne oplodnje i transfera embrija. Povećani jajnici mogu omesti točnu ultrazvučnu dijagnozu, ali na vrijeme izvedena kirurška intervencija može spriječiti fatalne posljedice i rezultirati normalnim tijekom i ishodom intrauterine trudnoće

Snodgrass’ Urethroplasty in Hypospadias Surgery in Clinical Hospital Mostar – Preliminary Report

Amongst the various methods of reconstructing the hypospadic urethra such as the MAGPI, Mathieu’s and Preputial island flap urethroplasty method and the Snodgrass method, the latter is being used more frequently nowadays in patients with the urethral meatus located in the proximity of the penis. In the Pediatric ward at Mostar Clinical Hospital, we have recently adopted the Snodgrass method when reconstructing the hypospadic urethra. We herewith present our research regarding the successful results in adopting the aforementioned method. Success was evaluated according to the frequency of post-operative complications, as well as the patients’ satisfaction with the functional and the cosmetic result of the urethra reconstruction. The conclusions relating to our research result in an addition basis from which to evaluate whether the Snodgrass method should receive privileged preference in future operative treatment of the hypospadias over others methods, as can be seen from our research

Liječenje izvanmaternične trudnoće metotreksatom

The aim of the present study was to analyze retrospectively the safety and success rates of single- and two-dose methotrexate (MTX) protocols for the treatment of hemodynamically stable cases of ectopic pregnancy at University Department of Gynecology and Obstetrics, Zagreb University Hospital Center, during a five-year period. The study evaluated MTX treatment efficacy in 35 women with ectopic pregnancies in relation to the initial levels of human chorionic gonadotropin (hCG) and progesterone. Successful treatment was recorded in 32/35 women, 24/25 on single dose MTX and 8/10 on double dose MTX, whereas 3/35 patients underwent laparoscopy. The mean initial hCG level in all 35 patients on day 0 was 657.54±592.4 IU/L; 572.99±488.10 IU/L in those successfully treated with MTX and 1560.30±890.70 IU/L in those requiring additional laparoscopy (p<0.005). The mean initial hCG level was 393.10±305.9 IU/L in patients successfully treated with a single dose of MTX and 973.5±722.40 IU/L in those with an additional dose of MTX (p<0.002). The mean initial progesterone level was 16.36±10.70 nmol/L in 35 MTX-treated ectopic pregnancy patients, 13.64±8.89 nmol/L in those with treatment success and 28.45±11.32 nmol/L in cases of treatment failure (p<0.05). The mean level of progesterone on day 0 was 12.74±8.30 nmol/L in patients successfully treated with a single dose of MTX and 26.10±18.80 nmol/L in patients treated with double-dose MTX (p<0.006). It is concluded that pretreatment values of hCG and progesterone are inversely related to medicamentous treatment success in selected cases of hemodynamically stable patients, thus they may be used as an important predictor in the management of ectopic pregnancy treated with MTX.Cilj ove studije bio je retrospektivno analizirati uspješnost i pouzdanost liječenja metotreksatom (MTX) kroz protokole pojedinačne i dvostruke doze u slučajevima hemodinamski stabilnih izvanmaterničnih trudnoća u Klinici za ženske bolesti i porode, KBC Zagreb tijekom petogodišnjeg razdoblja. U radu se procjenjivala učinkovitost liječenja 35 izvanmaterničnih trudnoća pomoću MTX u odnosu na početne razine humanog korionskog gonadotropina (hCG) i progesterona. Uspješno liječenje zabilježeno je kod 32/35 žena, od kojih 24/25 uz pojedinačnu dozu, a 8/10 uz dvostruku dozu MTX, dok su 3/35 bolesnica podvrgnute laparoskopiji. Prosječna početna razina hCG nultoga dana u svih 35 bolesnica bila je 657,54±592,4 IU/L, 572,99±488,10 IU/L kod bolesnica izliječenih pomoću MTX i 1560,30±890,70 IU/L kod žena u kojih je bilo potrebno dodatno načiniti laparoskopiju (p<0,005). U bolesnica uspješno liječenih pomoću MTX prosječna početna razina hCG bila je 393,10±305,9 IU/L kod žena s pojedinačnom dozom i 973,5±722,40 IU/L kod žena s dvostrukom dozom lijeka (p<0,002). Prosječna početna razina progesterona u svih 35 žena liječenih pomoću MTX bila je 16,36±10,07 nmol/L, 13,64±8,89 nmol/L kod izliječenih žena i 28,45±11,32 nmol/L u slučajevima izostanka uspješnosti (p<0,05). Kod bolesnica izliječenih jednom dozom MTX prosječna početna razina progesterona bila je 12,74±8,30 nmol/L, a kod onih s dvije doze lijeka 26,10±18,80 nmol/L (p<0,006). Može se zaključiti da su početne vrijednosti hCG i progesterona bile obrnuto proporcionalne s uspješnošću medikamentnog liječenja u odabranoj skupini hemodinamski stabilnih bolesnica i da su važni prediktori u liječenju izvanmaternične trudnoće pomoću MTX

Self-Reported Confidence, Attitudes and Skills in Practical Procedures among Medical Students: Questionnaire Study

The aim of our study was to investigate the influence of gender, loss of academic year(s), confidence and attitudes of students on the clinical experience gained by undergraduate education. The survey was conducted during 2004 and 2005 in a sample of 182 students of the 5th and the 6th year at J.J.Strossmayer University School of Medicine in Osijek. The participants were grouped and matched according to their gender, regular studying, the number of time(s) student has performed certain practical medical procedure and the self-confidence arisen by performing one. Furthermore, participants were grouped and compared due to their own assessment of their own practical and theoreticalmedical knowledge, courses which provide them the least and oppositely – the most practical medical knowledge and their attitude toward current medical faculty curriculum on clinical courses as well as the possibilities of improving them. Fisher’s exact test and c 2-test were used to estimate statistical differences between the groups and the parameters in research, while coefficient of contingency was introduced with the aim of defining their correlation. The results showed statistically significant differences between male students who performed more practical medical procedures than female (p<0.001), nonrepeaters performed medical procedures more often than repeaters (p<0.001, C=0.658) while repeaters thought higher of their theoretical knowledge than non-repeaters (p<0.005). Data analysis showed statistically significant correlation between clinical experience and the level of confidence (C=0.944). This study confirmed influence of male gender, regular studying, better opinion about one’s own practical skills and higher confidence in one’s own work on greater number of clinical skills performed during undergraduate education

The Advantages of End-to-Side Arteriovenous Anastomosis over the Other Two Types of Arteriovenous Anastomosis in Dialysis Patients

The functional duration of vascular access in dialysis patients depends on the emergence of threatening complications. Discussions are constantly being held in an attempt to discover their causality and decrease their emergence. In 260 patients undergoing haemodialysis, we have studied the potential existence of a cause-and-effect relation between the emergence of complications in the vascular access and the applied type of arteriovenous (av.) anastomosis in the arteriovenous (AV) fistula. We have observed the incidence of all complications, both that of the thrombosis incidence as well as the primary and secondary fistula patency (survival). The complications – The examinees with the end-to-end anastomosis showed the incidence of 8.08%, 6.15% of the patients with the end-to-side anastomosis and 7.31% of the patients with the side-to-side anastomosis. The differences regarding incidences are statistically significant ( 2-test = 29.25; P=0.0001). Thrombosis – it has been found that thrombosis was the most frequent complication developing in 30.00 % patients with the end-to-end av. anastomosis, in 2.31% patients with end-to-side av. anastomosis and in 5.56% patients with side-to-side av. anastomosis. The difference between the highest and the lowest assessment is 27.69%, and it is statistically relevant ( 2-test = 33.920; P=0.0001). The »primary patency« (primary survival): within a 6-month interval following the establishment of vascular access, the first complications arose in 62.50% of patients with end-to-end av. anastomosis, 10.76% in those with end-to-side av. anastomosis and 18.88% in those with side-to-side av. anastomosis. The difference between the highest and the lowest assessment is 51.74%, which is statistically significant ( 2-test = 49.009; P=0.0001). The secondary patency: 24 months subsequent to the establishment of vascular access, the AV-fistula was still functional in 52.50% of the patients with end-to-end av. anastomosis, 89.23% in those with end-to-side av. anastomosis and 81.11% in those with side-to-side av. anastomosis. The difference between the highest and the lowest assessment is 36.73%, which is also statistically significant ( 2-test = 26.579; P=0.0001). According to our research, the end- -to-side type of av. anastomosis in vascular access provides better results both in relation to the duration as well as the maintenance of the functionality of the Av-fistula and in the lower incidence of the complications than the other types, and hence it shows a definite advantage