A study of the pulmonary complications of preterm infants after prenatal corticosteroids prophylaxis in a major Bulgarian hospital

Abstract: An increasingly common problem in obstetrics and neonatology is premature birth. This problem is the cause of many health complications in premature neonates and is leading to neonatal mortality. These complications affect the whole body of premature babies, the respiratory system has the largest percentage due to lack of the period for intrauterine maturation of the lung. A retrospective study was carried out at the Clinic of Obstetrics and Gynecology, University Hospital St. Georgi, Plovdiv, Bulgaria for the period 2015-2016. 167 preterm infants have been studied. They were divided into two main groups: a working group of 89 preterm infants with prenatal corticosteroid prophylaxis and a control group of 78 preterm infants without prenatal prophylaxis. Data on clinical outcomes, health status, background complications of prenatal corticosteroid prophylaxis have been analyzed. The summary, however, of the results that is: the 3.6% difference has been found between newborn children with RDS and those with all other disabilities; this shows that in preterm infants the priority is to damage the respiratory system. Over 60% of the prematurity develop respiratory distress syndrome. The presence of respiratory complications is dew to the earlier gestational week of birth and the older age of the mother and is somewhat limited by the prenatal administration of corticosteroids.peer-reviewe

Medico-legal and obstetric challenges of recent demographic increases in Malta

The southern Mediterranean island of Malta, strategically located between North Africa and Europe and a full member of the European Union, offers an excellent European standard obstetric service. Yet, this obstetric service, like all other medical disciplines, is undergoing a severe evolutionary challenge imposed by rapid demographic shifts. It also finds itself without significant and relevant medico-legal legislation which is likely to lead to serious acute needs at the interface between the rapidly changing nature and number of foreigners residing in Malta and their medical needs, especially in the obstetric sector.The article looks at several factors, which argue for the immediate need of implementation of such legislation. One aspect of crucial importance is the demographic fact of rapidly changing profile of the patients making use of the Maltese Obstetric Service (MOS). This is the result of an influx of both EU nationals as well as irregular migrants, mostly of sub-Saharan origin. Both provide their own form of challenges to the MOS. In both, albeit more likely in the case of EU nationals, these challenges may easily find expression and resolution in eventual medico-legal action.

A primary echinococcosis of the extrahepatic bile ducts: case report

Introducere. Echinococoza continuă sa fie endemică în Bulgaria. Cea mai frecventă formă este cea hepatică. Prezentare de caz. Noi raportăm un caz rar de echinococoză primară a căilor biliare extrahepatice la o pacientă de 70 de ani, cu anamnestic de febră înaltă, icter, greaţă, vomă și durere în etajul superior al abdomenului, pe parcursul a 10 zile. A fost descoperit un chist hidatic complicat, de dimensiuni mari, în lobul stâng al ficatului, fără comunicare cu arborele biliar. S-a efectuat explorarea căilor biliare, capitonarea chistului hepatic, colecistectomie și coledoco-duodenostomie. Nu a fost înregistrată nicio complicaţie. Discuţii. Echinococoza primară a căilor extrahepatice este foarte rară. Cazul nostru este al doilea, descris în Bulgaria. Tratamentul patologiei depinde de stadiu, localizare, dimensiune și de complicaţiile chistului. Concluzii. Tratamentul chirurgical și terapia postoperatorie cu albendazol rămân a fi cele mai bune opţiuni terapeutice.Introduction. Echinococcosis is still endemic in Bulgaria. The most common site of the hydatid cysts is the liver. Case presentation. We report on a rare case of a primary echinococcosis of the extrahepatic bile ducts in a 70 years old female patient with history of high fever, jaundice, nausea, vomiting and pain in the upper abdomen lasting for 10 days. We found a big complicated hydatid cyst in the left liver lobe without communication with the bile tree. Exploration of the bile ducts, capitonnage of the liver cyst, cholecystectomy and choledocho-duodenostomy were performed. We didn’t have any complications. Discussion. A primary echinococcosis of the extrahepatic bile ducts is very rare. Our case was the second of the kind described in Bulgaria. The treatment of the disease depends on the stage, the localization, the size and the complications of the cysts. Conclusions. Surgical treatment and postoperative therapy with albendazole remain the best treatment options

Independent predictors of preeclampsia and their impact on the complication in Bulgarian study group of pregnant women

Introduction: One of the major obstetrical complications, affecting 2%–8% of all pregnancies, is preeclampsia. To predict the onset of preeclampsia, several methods have recently been put forth. The Fetal Medicine Foundation has developed combined screening that can identify the vast majority of women who will develop preeclampsia using a combination of maternal factors, obstetrical history, biochemical, and biophysical factors. Aim: The objective of the present study was to identify and analyze which classical risk factors may be independent predictors of preeclampsia, and assess their impact on this complication. In order to assess the high risk of preeclampsia, we also suggest further predictors that may optimize the risk constellation. Materials and methods: The study included 1511 pregnant women who were examined during their routine checkups in a two-phase retrospective study that took place from January 30, 2018, to August 31, 2020, in the Outpatient Department of the University Hospital in Plovdiv. All primary data were obtained from their archived medical records. Information about the maternal factors, the patients’ medical and obstetric histories, and status was obtained during the first phase of the study (11th gestation week + 0 days – 13th gestation week + 6 days). The second phase was conducted as a telephone interview (up to six months after the birth of the child): we collected data on the mode of birth, weight of the newborn, PE occurrence, at which gestation week the PE onset occurred, presence of gestational hypertension (GH) and diabetes, intrauterine growth retardation (IUGR), whether patients took aspirin and in what dosage, other complications, etc. The patients were divided into two groups: a high-risk group (with a risk for PE higher than 1:150), and a low-risk group, with or without onset of IUGR, GH, diabetes, etc. Results: The mean age of the analyzed 1511 pregnant women was 29.91±5.32 years (range 18 – 46 years). Of these, 38 (2.9%) women developed preeclampsia, and 5.9% had gestational hypertension. The classification of participants by risk of developing preeclampsia showed that 591 (39.1%) of the examined patients were reported as high-risk. All patients at risk higher than 1:150 were classified as high-risk, and it was recommended that they should take aspirin 150 mg every night from 12th to 36th week of gestation. 80.6% of the high-risk group took the medication regularly. Comparing the beta coefficients for the parameters we studied (beta coefficient indicates the predictors’ impact on PE), we established that the risk factors that are the most significant and apparently independent in predicting preeclampsia were (in ascending order): 1. Weight of newborn, β=0.157; 2. Mean arterial blood pressure (MAP), β=0.150; 3. IUGR, β=0.120; 4. Pregnancy associated plasma protein-A (PAPP-A), β=0.112; 5. Cervix length, β=0.095 Conclusions: In the analysis of the four multiple regression models, adequately describing the role (and independence) of the PE predictors – common to all pregnant women; in cases of early midterm and term PE: placental growth factor (PlGF), PAPP-A, MAP, mean Ut PI, cervical length, newborn weight, and IUGR. As common for all cases with PE, and depending on whether the PE onset was ≤32, ≤4, or ≤36 week of gestation, the following conclusions can be made: independent predictors of PE in all studied pregnant women were (indicators are ranked according to their degree of impact on the occurrence of PE): 1. MAP; 2. Intrauterine growth retardation (newborn weight is an indirect indicator of probable IUGR); 3. Pregnancy-associated protein-A; 4. Cervix length (with the corresponding standardized coefficients being β=0.150; β=0.120; β=0.112; β=0.095, respectively)

Histological Alterations in Common Carp (Cyprinus carpio Linnaeus, 1758) Gills as Potential Biomarkers for Fungicide Contamination

ABSTRACTThe present study aimed to investigate the histological alterations in common carp gills caused by a fosetyl-Al and fenamidone based fungicide tested in laboratory conditions at 30, 38 and 50 mg/L concentration. In general, all the tested concentrations activated compensatory-adaptive mechanisms, which caused pathological changes in the fish gills. Results showed different histological alterations in the gill structure, which included lamellar lifting, edema, proliferation of the glandular cells and epithelium, covering the gill filament, fusion and degenerative alterations. Blood circulatory system showed vasodilatation of the secondary lamellae and aneurysms. Overall, there was enhancement of the gill histological changes, which was dose-dependent, i.e., proportional to the increasing fungicide concentrations. Thus, based on the results, it was concluded that the histological alterations in common carp gills could be applied as possible biomarkers in risk assessment and monitoring programs for pesticide contamination of aquatic ecosystems

High-sensitivity CRP levels in women with gestational hypertension, preeclampsia and in normotensive pregnant women and its correlations

Introduction: Gestational hypertension is a less investigated hypertensive disorder of pregnancy than preeclampsia, but evidence exists of an unfavourable cardiovascular profile for women after such a pregnancy.Aim: To determine serum high-sensitivity C-reactive protein (hs-CRP) levels in women with preeclampsia, gestational hypertension, and in normotensive pregnancy in order to assess the cardiovascular implications and to examine its correlations with some characteristics of women.Materials and methods: Thirty-six women with gestational hypertension, thirty-seven with preeclampsia, and fifty maternal and gestational age-matched controls were included in a single-center prospective clinical-epidemiological study. Serum hs-CRP levels were determined using ELISA method.Results: Significantly higher hs-CRP levels were found in the gestational hypertension group than in the controls (p=0.043), but not in the preeclampsia group (p=0.445). The levels between the two pathological groups did not differ significantly (p=0.247). Odds ratio for hs-CRP levels higher than the provided cut-off was 3.31 (95% CI 1.32–8.29) for the presence of gestational hypertension. In the normotensive pregnant women, the hs-CRP levels had a positive correlation with BSA, pre-pregnancy and current BMI, but such correlations were absent in the hypertensive groups. There were no correlations with the maternal or gestational age, current weight gain in any of the groups or with the highest detected blood pressure in the pathological groups. These levels did not differ according to gravidity, smoking status and smoking during pregnancy.Conclusions: Elevation of hs-CRP was more pronounced in women with gestational hypertension than in women with preeclampsia, which could indicate a different pathophysiological mechanism and a higher cardiovascular risk for those women

Mermaid syndrome associated with VACTERL-H syndrome

Mermaid syndrome or sirenomelia is an extremely rare congenital malformation with an incidence between 1.5 and 4.2 per 1,000,000 pregnancies. Association of mermaid syndrome with VACTERL-H syndrome is extremely rare, with only two cases reported so far in the literature. We present a new case of type I sirenomelia associated with VACTERL-H syndrome and review the relevant literature. A 15-year-old female patient was admitted to the Department of Pathological Pregnancy at St George University Hospital, Plovdiv with progredient abortion during her first pregnancy. She had low socioeconomic status, negative history of concomitant diseases and addictions. The patient avoided prophylactic intake of folic acid during her pregnancy. Prenatal ultrasound found a malformative fetus. Consequently, magnetic resonance imaging was performed which established the presence of hydrocephalus and defects in the lower part of the spine. These pathological findings indicated interruption of pregnancy at 20 weeks of gestation. The fetopathological examination found sirenomelia type I associated with myelomeningocele, hydrocephalus, anal imperforation, single umbilical artery, bilateral renal and ureteric agenesis, bladder agenesis, tracheo-esophageal fistula, agenesis of external genitals, monkey fold of the left palm of the hand, also known as VACTERL-H syndrome.Our case demonstrates that mermaid syndrome and VACTERL-H syndrome represent different manifestations of a single pathological process that results in disorders of the blastogenesis at different stages during embryonic development.&nbsp

High-sensitivity CRP levels in women with gestational hypertension, preeclampsia and in normotensive pregnant women and its correlations

Introduction: Gestational hypertension is a less investigated hypertensive disorder of pregnancy than preeclampsia, but evidence exists of an unfavourable cardiovascular profile for women after such a pregnancy.Aim: To determine serum high-sensitivity C-reactive protein (hs-CRP) levels in women with preeclampsia, gestational hypertension, and in normotensive pregnancy in order to assess the cardiovascular implications and to examine its correlations with some characteristics of women.Materials and methods: Thirty-six women with gestational hypertension, thirty-seven with preeclampsia, and fifty maternal and gestational age-matched controls were included in a single-center prospective clinical-epidemiological study. Serum hs-CRP levels were determined using ELISA method.Results: Significantly higher hs-CRP levels were found in the gestational hypertension group than in the controls (p=0.043), but not in the preeclampsia group (p=0.445). The levels between the two pathological groups did not differ significantly (p=0.247). Odds ratio for hs-CRP levels higher than the provided cut-off was 3.31 (95% CI 1.32–8.29) for the presence of gestational hypertension. In the normotensive pregnant women, the hs-CRP levels had a positive correlation with BSA, pre-pregnancy and current BMI, but such correlations were absent in the hypertensive groups. There were no correlations with the maternal or gestational age, current weight gain in any of the groups or with the highest detected blood pressure in the pathological groups. These levels did not differ according to gravidity, smoking status and smoking during pregnancy.Conclusions: Elevation of hs-CRP was more pronounced in women with gestational hypertension than in women with preeclampsia, which could indicate a different pathophysiological mechanism and a higher cardiovascular risk for those women

Hypertension in pregnancy as an early sex-specific risk factor for cardiovascular diseases: evidence and awareness

Despite being a physiological condition, human pregnancy is known to cause numerous complications that can endanger the life of the mother and the fetus alike. While the majority of complications are mostly limited within the peripartum period, more and more information is available about persistently higher short- and long-term cardiovascular risk after a pregnancy complicated by a hypertensive disorder. There is evidence that women after gestational hypertension or preeclampsia are more likely to develop arterial hypertension, coronary atherosclerosis, myocardial infarction, stroke, peripheral artery disease, and even diabetes mellitus and venous thromboembolism years after the target pregnancy. This has urged some authors to view hypertensive disorders of pregnancy as a “stress test” for the maternal organism that unmasks latent endothelial dysfunction. An explanation is sought in the presence of common risk factors and underlying pathological pathways with cardiovascular diseases, although a certain etiological mechanism for the development of hypertensive disorders in pregnancy has not been established yet. More attention is needed towards the follow-up of women after a hypertensive pregnancy as it could be an opportunity for early prevention of cardiovascular diseases

Incidence of Atrial Fibrillation in Postmenopausal Women with Endometrial Cancer

Endometrial cancer (EC) has been associated with an increased risk of cardiovascular disease, including atrial fibrillation (AF). We performed a prospective, case-controlled analysis among 310 Bulgarian women with new-onset, histologically confirmed EC, free of AF at the baseline survey, and women with normal (senile) endometrium/endometrial hyperplasia as a control group (n = 205). The risk of AF as well as relationship of adiponectin (APN) and high sensitivity C-reactive protein (hs-CRP) levels with AF in women with EC were calculated by Cox proportional hazards models. During the mean follow-up of 2.5 ± 0.5 years, new-onset AF had occurred in 11.7% of women with EC vs. 5.8% in the control group (p < 0.01). The risk of AF was highest in the first 6 months after new-onset EC, with an incidence rate ratio (IRR) of 1.19 (95% CI 1.10–1.29; p = 0.01). Women with EC, who were obese (body mass index (BMI) > 30 kg/m2) and younger (age < 60) were found to be more likely to develop AF (HR 1.95; 95% CI 1.18–3.32; p = 0.05). APN levels were not significantly associated with new-onset AF (95% CI 0.87–1.21; p = 0.063). However, the secondary analysis showed evidence of APN–AF association when adjusted for BMI (2.05; 95% CI 1.04–4.04; p = 0.037). We conclude that EC was significantly associated with the incidence of AF