4,675 research outputs found
Proportion of preterm birth caused by bacterial infections in perinatal mortality and morbidity at Gynecology and Obstetrics Clinic, Clinical Hospital Sveti Duh for the 2016-2020 period
No full textPrijevremeni porod je svaki porod koji se dogodi prije navršenih 37 tjedana gestacije. Godišnje se oko 15 milijuna djece rodi prijevremeno, dok u Hrvatskoj taj broj iznosi oko 2500 novorođenčadi, tj. oko 6 % živorođenih. Jedan od važnih uzroka prijevremenog poroda su infekcije, posebno bakterijske, koje svojstvenom patogenezom uzrokuju prijevremeno prsnuće vodenjaka prije termina ili intraamnijsku infekciju. Prijevremeni porod predstavlja velik javnozdravstveni problem - uzrok je oko 75 % perinatalne smrtnosti i oko dvije trećine neonatalnog morbiditeta. Prijevremeno rođena djeca imaju povećan rizik za različite komplikacije netom nakon rođenja uzrokovane nedovoljnom razvijenošću višestrukih organskih sustava. Također, povećan je rizik i za dugoročne posljedice u vidu neurorazvojnih poremećaja. Cilj ovog retrospektivnog istraživanja provedenog na Klinici za ginekologiju i porodništvo Kliničke bolnice „Sveti Duh“ u razdoblju od 1. siječnja 2016. g. do 31. prosinca 2020. g. bio je detektirati najznačajnije bakterijske uzročnike povezane s prijevremenim porodom te ustanoviti utjecaj na ishod trudnoće, odnosno perinatalni mortalitet i morbiditet. U tom periodu bilo je 13 922 poroda, od kojih je 953 (6,85 %) bilo prijevremenih, a u njih 123 (12,91 %) mikrobiološki je izoliran bakterijski uzročnik u produktima začeća, cerviksu ili kavumu maternice. Najčešće izolirani uzročnici bili su Escherichia coli (16,67 %), Staphilococcus koagulaza neg. (16,67 %), te Enterococcus faecalis (15,48 %). Isti uzročnici gotovo u potpunosti odgovaraju onima detektiranim u (rano) neonatalno umrle novorođenčadi - Escherichia coli (53,05 %), Staphilococcus koagulaza neg. (23,08 %), te Enterococcus faecalis (38,46 %), kao i perinatalno oboljele novorođenčadi. Najčešća oboljenja povezana s infekcijom bila su respiratorni distres sindrom (42,86 %), intrakranijalno krvarenje (20,88 %), konatalna pneumonija (10,99 %), sepsa (9,89 %), prematurna retinopatija (7, 69 %), konjunktivitis (6,59 %) te nekrotizirajući enterokolitis (1,10 %).Premature birth is any birth that occurs before 37 weeks of gestation. Annually, about 15 million children are born prematurely, while in Croatia that number is about 2,500 newborns, i.e., about 6% of live births. One of the important causes of premature birth are infections, especially bacterial ones, which, due to their specific pathogenesis, cause preterm premature rupture of membranes or intra-amniotic infection. Premature birth is a major public health problem - it is the cause of about 75% of perinatal mortality and about two thirds of neonatal morbidity. Premature children have an increased risk for various short-term complications due to immaturity of multiple organ systems. Also, there is an increased risk for long-term consequences in the form of neurodevelopmental disorders. The aim of this retrospective study conducted at the Gynecology and Obstetrics Clinic, Clinical Hospital "Sveti Duh" in the period from January 1, 2016, to December 31, 2020, was to detect the most significant bacterial pathogens associated with premature birth and to determine the impact on pregnancy outcome, namely perinatal mortality and morbidity. In that period, there were 13,922 births, of which 953 (6.85%) were premature, and in 123 (12.91%) the bacterial pathogen was microbiologically isolated in the products of conception, cervix, or uterine cavity. The most frequently isolated bacteria were Escherichia coli (16.67%), Staphilococcus coagulase neg. (16.67 %), and Enterococcus faecalis (15.48 %). The same pathogens almost completely correspond to those detected in newborns who died in the early neonatal period - Escherichia coli (53.05%), Staphilococcus coagulase neg. (23.08 %), and Enterococcus faecalis (38.46 %), as well as perinatally ill newborns. The most common diseases associated with infection were respiratory distress syndrome (42.86%), intracranial hemorrhage (20.88%), conatal pneumonia (10.99%), sepsis (9.89%), premature retinopathy (7.69%), conjunctivitis (6.59%) and necrotizing enterocolitis (1.10%)
Microbiological causes of septic abortion and preterm birth at the Clinical Hospital "Sveti Duh" in the period from 2016-2020
No full textSeptički pobačaj je značajan zdravstveni problem s kratkotrajnim, ali i dugotrajnim komplikacijama koje u velikoj mjeri utječu na daljnju kvalitetu života trudnice. Prijevremeni porod glavni je uzrok neonatalne smrtnosti i morbiditeta u cijelom svijetu. Bakterijska infekcija i naknadni upalni odgovor prepoznati su kao važan uzrok prijevremenog poroda. Pretpostavlja se da u većini slučajeva mikroorganizmi invadiraju maternicu putem cervikalnog kanala, koloniziraju plodove ovoje i posteljicu te uzrokuju korioamnionitis, a u pojedinim slučajevima inficiraju i fetus.
Cilj ovog rada bio je ustanoviti najčešće mikrobiološke uzročnike spontanih septičkih pobačaja i ranih prijevremenih porođaja u Kliničkoj bolnici „Sveti Duh“ u periodu od 1. siječnja 2016. do 31. prosinca 2020. godine. U istraživanje su bile uključene pacijentice sa dijagnosticiranim spontanim septičkim pobačajem i ranim prijevremenim porodom kojima je mikrobiološki obrađena posteljica, plodovi ovoji, plodna voda i pupkovina. Sveukupno je iz navedenih uzoraka izolirano 44 vrste mikrobioloških uzročnika. Najčešće izolirani uzročnici pri spontanom septičkom pobačaju su Enterococcus faecalis (54%) Escherichia coli (43%) BHS-B (32%) Klebsiella pneumoniae (16%) i Candida albicans (10%). Međutim najčešće izolirani uzročnici u ranim prijevremenim porodima su Escherichia coli (60%), Enterococcus faecalis (44%), BHS-B (31%), Ureaplasma urealyticum (20%) i Klebsiella pneumoniae (18%).Septic abortion is an important and serious health problem with short-term and long-term complications that affect the further quality of life of pregnant women. Preterm birth is a serious health and social problem, also a major cause of neonatal death and morbidity worldwide. Bacterial infection and subsequent inflammatory response have been identified as an important cause of preterm birth.
The aim of this study was to identify the most common microbiological causes of spontaneous septic abortions and extreme and very preterm birth at the Clinical hospital "Sveti Duh" in the period from January 1, 2016 to December 31, 2020. The study included patients diagnosed with spontaneous septic abortion and extreme and very preterm birth who underwent microbiological analysis of the placenta, fetal membranes, amniotic fluid and umbilical cord. A total of 44 species of microbiological agents were isolated from these samples. The most commonly isolated pathogens in spontaneous septic abortion were Enterococcus faecalis (54%) Escherichia coli (43%) BHS-B (32%) Klebsiella pneumoniae (16%) and Candida albicans (10%). However, the most commonly isolated pathogens in early preterm birth were Escherichia coli (60%), Enterococcus faecalis (44%), BHS-B (31%), Ureaplasma urealyticum (20%), and Klebsiella pneumoniae (18%)
Life and work of academician Vladimir Bayer
No full textAkademik Vladimir Bayer, učenik gimnazije u Osijeku, redoviti profesor na katedri Kazneni postupak Pravnog fakulteta Sveučilišta u Zagrebu i redoviti član JAZU-a, od 1986. jedan je od najistaknutijih i najcjenjenijih hrvatskih pravnika. Autor je brojnih zanstvenih i stručih radova iz procesnog i materijalnog kaznenog prava, povijesti kaznenog prava, penologije i pravne nastave. Znatan dio njegova znanstvenog djela ugrađen je u zakonske propise. Zastupa ideje pravnopolitički liberalno usmjerene teorije kaznenog prava i suglasno tome zalaže se za postavljanje preciznih i čvrstih granica represivnih ovlasti državnih tijela. Zajedno s profesorom Bogdanom Zlatarićem utemeljitelj je uglednog Poslijediplomskog studija iz kaznenopravnih znanosti Pravnog fakulteta Sveučilišta u Zagrebu.The academician Vladimir Bayer, who attended secondary-school in Osijek and has been professor at the Chair of Criminal Procedural Law at the Faculty of Law in Zagreb, University of Zagreb has also been a regular member of JAZU since 1986. He is one of the most significant and highly regarded Croatian jurists, the author of a number of scientific, expert papers in the field of procedural and material criminal law, history of criminal law, penology and law teaching. His scientific work makes a considerable integral part of legal regulations. He stands for the criminal law theory of legal-political liberal orientation and accordingly for setting precise and firm boundaries to repressive powers of the authorities. He established together with professor Bogdan Zlatarić the renowned postgraduate studies in criminal law science at the Faculty of Law in Zagreb
Names of Vladimir the Great in Liturgical Texts and the Perception of his Sainthood in the 14th and 17th Centuries
No full textThe article examines attributive and agentive names of the grand prince of Kiev, Vladimir Svyatoslavich as they appear in liturgical texts of the 14th and 17th centuries, that either circulated independently or were employed at church services especially dedicated to the saint. Presuming that the first laudatory songs glorifying Vladimir date back to the 12th century, the author observes the steady increase of the number of such attributive and agentive names in liturgical texts and marks the period from the 14th through the 17th centuries as a peak of textual activity surrounding Vladimir. As the tables included in the article indicate, the increase in number was accompanied by the corresponding increase in semantic and imagery complexity. The names, employed in broader contextual meanings, became associated with various semantic fields and, above all, began to express abstract ideas related to the ideal vision of the personality of the saint and its historical, metaphysical, and spiritual dimensions
Treatment of Ureaplasma urealyticum in pregnancy
No full textUreaplasma spp. je mikroorganizam koji se pronalazi kao normalna mikrobiota u cervikovaginalnim uzorcima čak 40-80% žena te kod većine žena ne predstavlja problem u trudnoći. Međutim, također je i najčešće izolirani mikroorganizam u intrauterinim infekcijama te se smatraju faktorom rizika za prijevremeni porod, prijevremeno pucanje plodovih ovoja, korioamnionitis, endometritis te BPD, IUGR, NEC, IVH, diseminiranu infekciju kod novorođenčeta. Točni uvjeti u kojima Ureaplasma spp. postaje opasna za ishod trudnoće nisu jasni. Predloženi su mehanizmi direktnog učinka, putem faktora virulencije (ureaza, IgA proteaza, fosfolipaza A i C), te mehanizmi posredovani imunološkim odgovorom majke i/ili fetusa. Potonji su vrlo varijabilni za što se primarno smatraju odgovornima varijacije u mba genu.
Metode probira nisu određene službenim smjernicama. Dosadašnja istraživanja stavljaju naglasak na molekularne metode (PCR) zbog veće osjetljivosti i specifičnosti. Preporuča se uzorak amnijske tekućine ukoliko je dostupan. Cervikovaginalnom brisu ne pridaje se jednako značenje te je, ukoliko se uzima, potrebna je kvantifikacija bakterija u uzorku. Također, sve više se stavlja naglasak na dodatne parametre kako bi se bolje definirao rizik koji pozitivan nalaz Ureaplasma spp. predstavlja te odredila potreba za liječenjem. Među predloženim dodatnim parametrima su BV, VC i neki upalni medijatori- IL-6 i MMP-8 koji se mogu određivati i u amnijskoj tekućini i u cervikalnoj sluzi.
Ureaplasma spp. ima opsežnu rezistenciju na antibiotike te znatan potencijal za razvoj daljnje rezistencije. Od antimikrobne terapije preporučaju se makrolidi. Unutar te skupine prednost se daje azitromicinu i klaritromicinu, te novijem solitromicinu. Put primjene terapije i doza, koji sa sigurnošću dovode do eradikacije, nisu još određeni. Također, istražuje se mogućnost korištenja lijekova s protuupalnim djelovanjem.Ureaplasma spp. is a microorganism found as normal microbiota in cervicovaginal samples of 40-80% of women and, for most of them, it does not represent a problem during pregnancy. However, it is also the most commonly isolated microorganism in intrauterine infections and is considered a risk factor for premature birth, premature membrane rupture, chorioamnionitis, endometritis, also BPD, IUGR, NEC, IVH and disseminated infection in newborns. The exact conditions in which Ureaplasma spp. becomes a risk for pregnancy outcome are unclear. Proposed mechanisms of action are direct, through virulence factors (urease, IgA protease, phospholipase A and C), and indirect, through immune response of mother and/or foetus. The latter shows a lot of variation, for which the mba gene is considered to be the primary reason.
There are no official guidelines for screening. The research emphasises the importance of using molecular methods (PCR) due to their higher sensitivity and specificity. The sample of amniotic fluid is recommended, if available. A cervicovaginal sample is not considered to be of equal significance. If it is done, the quantification of bacteria is necessary. Also, the research emphasises the need for additional parameters to better distinguish the risk of a positive finding of Ureaplasma spp. and to determine the need for treatment. BV, VC and inflammatory mediators such as IL-6 and MMP-8 are the most commonly suggested additional parameters which can be measured in amniotic fluid and in cervical fluid.
Ureaplasma spp. has both extensive resistance to antibiotics and significant potential to develop further resistance. Macrolides are a recommended antimicrobial therapy. Within that group the preferred option is azithromycin or clarithromycin, or a newer one, solithromycin. Route of administration and the dosage, which would lead to successful eradication, have not yet been determined. The new research is focusing on the usage of anti-inflammatory therapy
Unintentional trauma and complications during Cesarean section
No full textCarski rez je kirurški zahvat ekstrakcije djeteta kroz rez napravljen na trbušnoj stijenci (laparotomija) i maternici (uterotomija) majke te je jedan od najčešćih kirurških zahvata u ginekologiji. Incidencija carskog reza je u porastu te se sve češće izvodi, što iz opravdanih medicinskih razloga, što na zahtjev pacijentice. Prema istraživanjima Svjetske zdravstvene organizacije (WHO), incidencija poroda carskim rezom do 2030. godine će biti 29% , što čini gotov jednu trećinu svih poroda. Carski rez spašava život majke i djeteta u opravdanim situacijama, kao što su fetalna distocija, kefalopelvina disproporcija, poremećaj placentacije i sijela posteljice te produljeni porod. Iako su se znanja, tehnike i način izvođenja carskog reza od samih početaka pa do danas značajno promijenili, a morbiditet i mortalitet su se nemjerljivo smanjili, treba imati na umu da je i carski rez velika operacija koja sa sobom nosi i moguće komplikacije i za majku i za fetus. Bitno je naglasiti da je kvaliteta izvođenja carskog reza uz regionalnu anesteziju dovela do povećanog broja ponavljanog carskog reza koji sa sobom nosi najveće rizike i komplikacije. Maternalne komplikacije su češće i uključuju širok spektar; od krvarenja, ozljeda mokraćnog i probavnog sustava, infekcija, plućnih embolija pa do kasnih komplikacija kao što su fistule i endometrioze u ožiljku carskog reza. Posljedice za novorođenče najčešće nastaju tijekom ekstrakcije ili tijekom zarezivanja maternice te uključuju laceracije, ozljede dugih kostiju (humerus i femur), ozljede brahijalnog pleksusa i u nekim najtežim slučajevima ozljede kralježnične moždine sa posljedičnom smrti.Cesarean section is a surgical procedure involving the extraction of a child through an incision made in the abdominal wall (laparotomy) and the uterus (hysterotomy) of the mother, and it is one of the most common surgical procedures in gynecology. The incidence of cesarean sections is on the rise and is being performed increasingly often, both for justified medical reasons and at the patient's request. According to research by the World Health Organization (WHO), the incidence of cesarean deliveries will reach 29% by 2030, which will constitute nearly one-third of all deliveries. A cesarean section saves the lives of the mother and child in justified situations, such as fetal dystocia, cephalopelvic disproportion, placental disorders, and prolonged labor. Although the knowledge, techniques, and methods of performing cesarean sections have significantly changed since their inception, and morbidity and mortality rates have been dramatically reduced, it is essential to remember that a cesarean section is a major surgery that carries potential complications for both the mother and the fetus. It is important to note that the quality of performing cesarean sections with regional anesthesia has led to an increased number of repeat cesarean sections, which carry the highest risks and complications. Maternal complications are more frequent and include a wide range; from hemorrhage, injuries to the urinary and digestive systems, infections, and pulmonary embolisms, to late complications such as fistulas and endometriosis in the cesarean section scar. Neonatal consequences often arise during extraction or during uterine incision and include lacerations, injuries to long bones (humerus and femur), brachial plexus injuries, and in some severe cases, spinal cord injuries with consequent death
Proportion of preterm birth caused by bacterial infections in perinatal mortality and morbidity at Gynecology and Obstetrics Clinic, Clinical Hospital Sveti Duh for the 2016-2020 period
No full textPrijevremeni porod je svaki porod koji se dogodi prije navršenih 37 tjedana gestacije. Godišnje se oko 15 milijuna djece rodi prijevremeno, dok u Hrvatskoj taj broj iznosi oko 2500 novorođenčadi, tj. oko 6 % živorođenih. Jedan od važnih uzroka prijevremenog poroda su infekcije, posebno bakterijske, koje svojstvenom patogenezom uzrokuju prijevremeno prsnuće vodenjaka prije termina ili intraamnijsku infekciju. Prijevremeni porod predstavlja velik javnozdravstveni problem - uzrok je oko 75 % perinatalne smrtnosti i oko dvije trećine neonatalnog morbiditeta. Prijevremeno rođena djeca imaju povećan rizik za različite komplikacije netom nakon rođenja uzrokovane nedovoljnom razvijenošću višestrukih organskih sustava. Također, povećan je rizik i za dugoročne posljedice u vidu neurorazvojnih poremećaja. Cilj ovog retrospektivnog istraživanja provedenog na Klinici za ginekologiju i porodništvo Kliničke bolnice „Sveti Duh“ u razdoblju od 1. siječnja 2016. g. do 31. prosinca 2020. g. bio je detektirati najznačajnije bakterijske uzročnike povezane s prijevremenim porodom te ustanoviti utjecaj na ishod trudnoće, odnosno perinatalni mortalitet i morbiditet. U tom periodu bilo je 13 922 poroda, od kojih je 953 (6,85 %) bilo prijevremenih, a u njih 123 (12,91 %) mikrobiološki je izoliran bakterijski uzročnik u produktima začeća, cerviksu ili kavumu maternice. Najčešće izolirani uzročnici bili su Escherichia coli (16,67 %), Staphilococcus koagulaza neg. (16,67 %), te Enterococcus faecalis (15,48 %). Isti uzročnici gotovo u potpunosti odgovaraju onima detektiranim u (rano) neonatalno umrle novorođenčadi - Escherichia coli (53,05 %), Staphilococcus koagulaza neg. (23,08 %), te Enterococcus faecalis (38,46 %), kao i perinatalno oboljele novorođenčadi. Najčešća oboljenja povezana s infekcijom bila su respiratorni distres sindrom (42,86 %), intrakranijalno krvarenje (20,88 %), konatalna pneumonija (10,99 %), sepsa (9,89 %), prematurna retinopatija (7, 69 %), konjunktivitis (6,59 %) te nekrotizirajući enterokolitis (1,10 %).Premature birth is any birth that occurs before 37 weeks of gestation. Annually, about 15 million children are born prematurely, while in Croatia that number is about 2,500 newborns, i.e., about 6% of live births. One of the important causes of premature birth are infections, especially bacterial ones, which, due to their specific pathogenesis, cause preterm premature rupture of membranes or intra-amniotic infection. Premature birth is a major public health problem - it is the cause of about 75% of perinatal mortality and about two thirds of neonatal morbidity. Premature children have an increased risk for various short-term complications due to immaturity of multiple organ systems. Also, there is an increased risk for long-term consequences in the form of neurodevelopmental disorders. The aim of this retrospective study conducted at the Gynecology and Obstetrics Clinic, Clinical Hospital "Sveti Duh" in the period from January 1, 2016, to December 31, 2020, was to detect the most significant bacterial pathogens associated with premature birth and to determine the impact on pregnancy outcome, namely perinatal mortality and morbidity. In that period, there were 13,922 births, of which 953 (6.85%) were premature, and in 123 (12.91%) the bacterial pathogen was microbiologically isolated in the products of conception, cervix, or uterine cavity. The most frequently isolated bacteria were Escherichia coli (16.67%), Staphilococcus coagulase neg. (16.67 %), and Enterococcus faecalis (15.48 %). The same pathogens almost completely correspond to those detected in newborns who died in the early neonatal period - Escherichia coli (53.05%), Staphilococcus coagulase neg. (23.08 %), and Enterococcus faecalis (38.46 %), as well as perinatally ill newborns. The most common diseases associated with infection were respiratory distress syndrome (42.86%), intracranial hemorrhage (20.88%), conatal pneumonia (10.99%), sepsis (9.89%), premature retinopathy (7.69%), conjunctivitis (6.59%) and necrotizing enterocolitis (1.10%)
Palpitations during pregnancy
No full textPalpitacije tijekom trudnoće odnose se na osjećaj nepravilnog ili ubrzanog rada srca koji trudnica može doživjeti tijekom trudnoće. Obično se opisuju kao osjetljivost, lupanje ili titranje srca u prsima ili vratu. Lupanje srca tijekom trudnoće je uobičajeno i obično bezopasno. Tijekom trudnoće u tijelu se događaju mnoge fiziološke promjene, uključujući povećanje volumena krvi, ubrzanje otkucaja srca i promjene u hormonskoj ravnoteži. Ove promjene mogu utjecati na srčani ritam i dovesti do lupanja srca. Hormoni poput estrogena i progesterona koji se dramatično mijenjaju tijekom trudnoće mogu utjecati na srčani ritam i uzrokovati palpitacije. Tijekom trudnoće, cirkulacija se povećava kako bi se zadovoljile potrebe rastućeg fetusa. Ovo povećanje volumena krvi može uzrokovati promjene u srčanom ritmu i dovesti do lupanja srca. Trudnoća može biti emocionalno stresno razdoblje zbog promjena u tijelu, hormonalnih promjena i drugih čimbenika. Emocionalni stres također može utjecati na srčani ritam i izazvati lupanje srca. Rastući fetus i maternica mogu stvoriti dodatni pritisak na srce, što može utjecati na srčani ritam i dovesti do lupanja srca. Ako trudnica već ima zdravstvenih problema poput anemije, tjeskobe, hipertireoze ili bolesti srca, to može povećati rizik od lupanja srca tijekom trudnoće. Lupanje srca tijekom trudnoće obično nije opasno i nestaje nakon poroda. Međutim, ako trudnica osjeti teške simptome kao što su jaka bol u prsima, vrtoglavica, gubitak svijesti ili otežano disanje, treba odmah potražiti liječničku pomoć. Svrha pisanja o palpitacijama tijekom trudnoće je pružiti informacije o uzrocima, simptomima i liječenju ovog stanja. Cilj je pomoći trudnicama da razumiju uobičajene uzroke palpitacija tijekom trudnoće i uvjeriti ih da su većinu vremena palpitacije bezopasne i nisu razlog za brigu. Trudnice koje osjete palpitacije trebale bi razgovarati sa svojim liječnikom kako bi utvrdile uzrokuju li neki zdravstveni problemi u pozadini te simptome i kako bi razvile plan za praćenje i upravljanje stanjem ako je potrebno.Palpitations during pregnancy refer to the feeling of an irregular or accelerated heartbeat that a pregnant woman may experience during pregnancy. They are usually described as tenderness, palpitations or fluttering of the heart in the chest or neck. Palpitations during pregnancy are common and usually harmless. During pregnancy, many physiological changes occur in the body, including an increase in blood volume, an increased heart rate, and changes in hormonal balance. These changes can affect the heart rhythm and lead to palpitations. Hormones such as estrogen and progesterone that change dramatically during pregnancy can affect the heart rhythm and cause palpitations. During pregnancy, circulation increases to meet the needs of the growing fetus. This increase in blood volume can cause changes in heart rhythm and lead to palpitations. Pregnancy can be an emotionally stressful time due to changes in the body, hormonal changes, and other factors. Emotional stress can also affect the heart rhythm and cause palpitations. The growing fetus and uterus can put extra pressure on the heart, which can affect the heart rhythm and lead to palpitations. If a pregnant woman already has health problems such as anemia, anxiety, hyperthyroidism, or heart disease, this can increase the risk of heart palpitations during pregnancy. Heart palpitations during pregnancy are usually not dangerous and disappear after delivery. However, if a pregnant woman experiences severe symptoms such as severe chest pain, dizziness, loss of consciousness or difficulty breathing, she should seek medical help immediately. The purpose of writing about palpitations during pregnancy is to provide information about the causes, symptoms, and treatment of this condition. The goal is to help pregnant women understand the common causes of palpitations during pregnancy and to reassure them that most of the time palpitations are harmless and nothing to worry about. Pregnant women who experience palpitations should talk to their doctor to determine if any underlying health problems are causing these symptoms and to develop a plan to monitor and manage the condition if necessary
Ivan IV and Vladimir Staritsky: Political Struggle or Competition in Piety?
No full textIntroduction. The author researched and prepared for publication four acts of 1547–1566 issued by Ivan IV and the appanage prince Vladimir Andreevich on the villages of the Trinity-Sergius Monastery in Vereysky and Dmitrov counties. The diplomas are studied in the context of the corpus of act and narrative sources, containing the plot of the relationship of the appanage prince with his suzerain. Methods and materials. The task of this article is to clarify the real participation of Prince Vladimir in the political and administrative life of the country for three years from 1566 to 1569 and is solved by a comprehensive analysis of narrative texts and the act material in which the real prerogatives of the appanage prince are documented. Analysis. An indicator of Vladimir Staritsky’s administrative and political activity is the intensity and nature of the charters issued and preserved by him, and their correlation with the acts of Ivan IV, to which the key part of the article is devoted. Results. It has been established that in addition to the acts drawn up in the office of the appanage prince relatively independently, acts have been preserved in the compilation of which protographs were used. When creating the acts in 1566, the offices of the tsar and the appanage prince used the letters of 1547 and 1548, the form of which was reproduced without significant changes. It is hypothesized that the acts of Prince Vladimir Andreevich and Ivan IV indicate a kind of competition in piety between the autocratic monarch and the prince of the blood
Treatment of Ureaplasma urealyticum in pregnancy
No full textUreaplasma spp. je mikroorganizam koji se pronalazi kao normalna mikrobiota u cervikovaginalnim uzorcima čak 40-80% žena te kod većine žena ne predstavlja problem u trudnoći. Međutim, također je i najčešće izolirani mikroorganizam u intrauterinim infekcijama te se smatraju faktorom rizika za prijevremeni porod, prijevremeno pucanje plodovih ovoja, korioamnionitis, endometritis te BPD, IUGR, NEC, IVH, diseminiranu infekciju kod novorođenčeta. Točni uvjeti u kojima Ureaplasma spp. postaje opasna za ishod trudnoće nisu jasni. Predloženi su mehanizmi direktnog učinka, putem faktora virulencije (ureaza, IgA proteaza, fosfolipaza A i C), te mehanizmi posredovani imunološkim odgovorom majke i/ili fetusa. Potonji su vrlo varijabilni za što se primarno smatraju odgovornima varijacije u mba genu.
Metode probira nisu određene službenim smjernicama. Dosadašnja istraživanja stavljaju naglasak na molekularne metode (PCR) zbog veće osjetljivosti i specifičnosti. Preporuča se uzorak amnijske tekućine ukoliko je dostupan. Cervikovaginalnom brisu ne pridaje se jednako značenje te je, ukoliko se uzima, potrebna je kvantifikacija bakterija u uzorku. Također, sve više se stavlja naglasak na dodatne parametre kako bi se bolje definirao rizik koji pozitivan nalaz Ureaplasma spp. predstavlja te odredila potreba za liječenjem. Među predloženim dodatnim parametrima su BV, VC i neki upalni medijatori- IL-6 i MMP-8 koji se mogu određivati i u amnijskoj tekućini i u cervikalnoj sluzi.
Ureaplasma spp. ima opsežnu rezistenciju na antibiotike te znatan potencijal za razvoj daljnje rezistencije. Od antimikrobne terapije preporučaju se makrolidi. Unutar te skupine prednost se daje azitromicinu i klaritromicinu, te novijem solitromicinu. Put primjene terapije i doza, koji sa sigurnošću dovode do eradikacije, nisu još određeni. Također, istražuje se mogućnost korištenja lijekova s protuupalnim djelovanjem.Ureaplasma spp. is a microorganism found as normal microbiota in cervicovaginal samples of 40-80% of women and, for most of them, it does not represent a problem during pregnancy. However, it is also the most commonly isolated microorganism in intrauterine infections and is considered a risk factor for premature birth, premature membrane rupture, chorioamnionitis, endometritis, also BPD, IUGR, NEC, IVH and disseminated infection in newborns. The exact conditions in which Ureaplasma spp. becomes a risk for pregnancy outcome are unclear. Proposed mechanisms of action are direct, through virulence factors (urease, IgA protease, phospholipase A and C), and indirect, through immune response of mother and/or foetus. The latter shows a lot of variation, for which the mba gene is considered to be the primary reason.
There are no official guidelines for screening. The research emphasises the importance of using molecular methods (PCR) due to their higher sensitivity and specificity. The sample of amniotic fluid is recommended, if available. A cervicovaginal sample is not considered to be of equal significance. If it is done, the quantification of bacteria is necessary. Also, the research emphasises the need for additional parameters to better distinguish the risk of a positive finding of Ureaplasma spp. and to determine the need for treatment. BV, VC and inflammatory mediators such as IL-6 and MMP-8 are the most commonly suggested additional parameters which can be measured in amniotic fluid and in cervical fluid.
Ureaplasma spp. has both extensive resistance to antibiotics and significant potential to develop further resistance. Macrolides are a recommended antimicrobial therapy. Within that group the preferred option is azithromycin or clarithromycin, or a newer one, solithromycin. Route of administration and the dosage, which would lead to successful eradication, have not yet been determined. The new research is focusing on the usage of anti-inflammatory therapy
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