While clear cell renal cell carcinoma (ccRCC) is curable, advanced metastatic (mRCC) remains a clinical challenge. We analyzed clinical, pathohistological, and molecular data (Receptor Interacting ...Protein 5-RIP5 and Vestigial Like Family Member 4-VGLL4 expression) of 55 mRCC patients treated with first-line treatment with sunitinib. The trend of linear increase in the protein expression of RIP5 was observed with the progression of tumor grade. Overall, 80% of RIP5-positive cells were in the control kidneys and high-grade mRCC. On the contrary, RIP5 displayed low expression in grade 2 mRCC (5.63%). The trend of linear decrease in the expression of VGLL4 was observed with the progression of tumor grade. The highest protein expression of VGLL4 was observed in grade 2 (87.82%) in comparison to grade 3 and 4 and control. High expression of RIP5 mRNA was associated with longer first-line overall survival and longer progression-free survival in mRCC. In addition, a high VGLL4 mRNA expression showed better overall survival in patients with ccRCC. In conclusion, high mRNA expression of RIP5 and VGLL4 are important markers of better survival rates in mRCC patients.
Homocysteine is known to be associated with adverse vascular and metabolic effects, as well as pregnancy complications. Its serum levels are influenced by the function of the enzyme ...methylenetetrahydrofolate reductase (MTHFR) and the dietary intake of folic acid, vitamin B12, and methionine. In this cross-sectional study, we investigated the association of genetic polymorphisms of the MTHFR gene with vitamin status in pregnant women during mandatory folic acid supplementation. The study included 102 pregnant women between 24 and 28 weeks of gestation who were attending regular outpatient examinations at the maternity clinic. Homocysteine, folic acid, vitamin B12 levels, and MTHFR gene polymorphisms (C677T and A1298C) were analyzed. Significant associations were found between vitamin B12 and folic acid levels with homocysteine (P < 0.001), with lower serum levels of these vitamins being associated with higher homocysteine levels. Surprisingly, there was no significant association between MTHFR genetic polymorphisms and serum homocysteine levels, likely attributed to the supplementation of folic acid and vitamin B12 in vitamin supplements for pregnant women, which counteracts the effect of the mutation. Remarkably, a high prevalence of MTHFR gene mutations was found, with the C677T polymorphism present in 56.9% and the A1298C polymorphism in 87.2% of pregnant women. These findings emphasize the importance of adequate folic acid and vitamin B12 intake during pregnancy to regulate homocysteine levels. Although the MTHFR gene mutations were highly prevalent, their influence on homocysteine levels in this population appears to be mitigated by vitamin supplementation. Further research is warranted to explore the impact of these mutations on other aspects of pregnancy outcomes. The trial is registrated at Clinicaltrail.gov (NCT04952324).
Aim
To evaluate satisfaction of mothers who gave birth at term with received hospital care and to find areas for improvement at a tertiary hospital.
Methods
A cross-sectional study at the Department ...of Obstetrics & Gynaecology at the University Clinical Hospital Mostar was
conducted by an anonymous survey using a questionnaire designed exclusively for this study. A total of 100 mothers were included in the study.
Results
Satisfaction with midwives’ communication and their approach to the women during their stay in the delivery room
was rated significantly higher (4.7±0.6) when compared to obstetricians-gynaecologists (4.5±0.8) (p=0.02). Midwives were rated better in providing breastfeeding information (4.5±0.8) than for the speed of arrival after a call bell (average grade 4.2±1.0). Respondents were least satisfied with the hygiene (toilet, shower and rooms) and the quality of food (average grades 3.8±1.1 and 3.9±1.0, respectively). Mothers with previous experience in childbirth at the same hospital rated current stay with a similar level of satisfaction.
Conclusion
Good communication skills of medical and non-medical staff are a recommended step to maintain mothers′ childbirth
satisfaction, while improvement in quality of nutrition and hygiene should be mandatory.
Background: Placenta accreta spectrum (PAS) is a clinical term used to describe the abnormal trophoblast invasion into the myometrium of the uterine wall and may enter into the serosa or even into ...adjacent organs. It is associated with severe obstetric haemorrhage and often requires emergency hysterectomy, which is one of the foremost causes of maternal morbidity and mortality. The vast of these conditions are seen in women with a history of previous caesarean section and placenta previa. Cases: In this study we present two cases of a rare type of PAS, placenta percreta, in women with a history of previous caesarean section (CS). Both instances were diagnosed prenatally, using the method of ultrasound and magnetic resonance imaging. They were scheduled for deliveries by CS, and both were hysterectomized. These diagnoses were confirmed in histopathological findings. Conclusion: Considering sparse published data and absence of well conducted studies, optimal management is still undefined. Caesarean hysterectomy is still the gold standard treatment for placenta accreta spectrum proposed by many societies as an absolute and final treatment.
BACKGROUND:Congenital cytomegalovirus infection (cCMV) is a leading cause of sensorineural hearing loss (SNHL) and neurodevelopmental disabilities in developed countries. Although high cCMV rates ...have been reported in populations with high seroprevalence, the cCMV prevalence in low/middle-income countries in Europe has not been defined.
OBJECTIVE:To determine cytomegalovirus (CMV) seroprevalence and the cCMV prevalence in Bosnia and Herzegovina.
METHODS:Between March 2010 and February 2019, 5222 sera samples from patients seen at the University Clinical Hospital Mostar were tested for CMV IgG. The cord blood samples collected from 2091 infants between July 2011 and January 2013 were analyzed for CMV IgG and CMV DNA. The cCMV prevalence was determined by testing saliva swabs from 1293 infants between November 2015 and October 2016.
RESULTS:The overall CMV IgG prevalence was 81.4% (95% confidence interval0.8–0.82). Significantly higher prevalence was observed among females (84.9%) than in males (77.0%), and the rate increased from 50.8% in the 1 to 5 years group to 97.7% in the group > 65 years old. Most cord blood samples (2091/1925, 92.1%) were CMV IgG positive, and 2 (0.1%) were CMV DNA positive. Of the 1293 saliva swabs, 8 (0.62%; 95% confidence interval0.3–1.2) were CMV positive. All 8 infected infants had asymptomatic cCMV, and none had SNHL at 18 months of age.
CONCLUSIONS:In a highly CMV seropositive population, the prevalence of cCMV was lower compared with that reported from other low/middle-income countries populations. None of the infected infants had symptomatic infection or SNHL at 18 months.
Pregnancy is a unique experience accompanied by significant physiological, biochemical, and psychological changes that may affect a woman's mental health status. With the development of a holistic ...approach, midwives have become continuous support during pregnancy and childbirth. Childbirth education is an intervention that affects delivery outcomes and the experience of childbirth. Music therapy has been proven to be a safe and effective non - pharmacological method to gain in pregnancy and puerperium. The study aimed to prove the impact of educating pregnant women and listening to classical music on the experience of childbirth pains and the occurrence of psychological symptoms during puerperium.
A prospective randomized controlled trial (n=198) was conducted. The experimental group of pregnant women was educated during pregnancy and listened to classical music the rest of the pregnancy, while the control group received the usual care. The VAS scale was used to assess pain, and the 90 - point scale was used to assess the incidence of psychological symptoms.
The difference in pain assessment between the experimental and control groups was significant (p<0.001). The experimental group rated their childbirth pain as moderate (M=5.98), while the control group experienced severe pain (M=8.42). A significant difference in the incidence of psychological symptoms between groups was found in the dimensions of interpersonal sensitivity, hostility, phobic anxiety, and paranoid ideations (p=0.042; p=0.014; p=0.013; p=0.008).
This study demonstrated the impact of midwifery education and listening to classical music on the perception of childbirth pain and mental health in the puerperium. The experimental group rated childbirth pain significantly lower compared to the control group and had significantly fewer psychological symptoms 6 weeks after delivery.
Highlights • We analyzed the maternal serum concentration of progesterone-induced blocking factor. • The study was conducted on a sample of 78 women. • The onset of labor could be predicted on the ...basis of PIBF serum concentrations. • Pregnancy termination can be predicted by lower PIBF values.
Urine neutrophil gelatinase-associated lipocalin (uNGAL) is a biochemical marker significant for early prediction of acute kidney injury in adults. However, it has not been examined sufficiently ...among the infant population, particularly newborns in terms of reference values. The aim of our study was to determine the concentration of uNGAL in healthy term newborns and to determine if there was a difference in uNGAL concentration according to gender, postnatal age and birth weight.
Our study involved 81 healthy term newborns birth (≥ 37 weeks, Apgar score ≥ 8 in the first minute after birth, CRP < 5 mg/L). Urine NGAL was measured using chemiluminescent microparticle immunoassay (CMIA) within 72 hours after birth, on Architect plus ci8200 analyser (Abbott, Chicago, USA). Data were analysed using Statistica software.
The median concentration of uNGAL in the whole study group of healthy term newborns was 27.1 ng/mL (16.5-56.0 ng/mL) (newborn girls, 27.1 ng/mL (15.8-47.9 ng/mL); newborn boys, 27.9 ng/mL (16.5-61.0 ng/mL), P = 0.941). Median uNGAL concentration according to postnatal age expressed in days was 28.2 ng/mL (11.7-57.2 ng/mL) 1
day, 28.9 ng/mL (16.5-64.2 ng/mL) 2
day and 23.9 ng/mL (20.2-46.6) 3
day, P = 0.863. Regarding birth weight for newborns < 3500 g, median concentration was 25.0 ng/mL (16.5-45.4 ng/mL) and for weight ≥ 3500 g 30.6 ng/mL (16.5-64.2 ng/mL), P = 0.455.
There were no significant difference in uNGAL concentration in relation to gender, postnatal age and birth weight.
Aim
To examine whether there are differences in the experience in giving informed consent of patients whose surgery was elective compared to emergency surgery in the same department.
Methods
A ...prospective cross-sectional study was conducted in the Department of Gynaecology and Obstetrics of University Clinical Hospital Mostar during a 6-month period. The sample of respondents consisted of two groups of patients, 145 with elective surgery and 90 patients with emergency surgery. The study was conducted using an anonymous questionnaire.
Results
Patients in both examined groups were equally satisfied with the procedure of informed consent. Most patients signed the informed consent at the request of a nurse, 195 (83%). During the process of consenting, almost all patients, regardless of whether they had elective or emergency surgery, claimed that they understood the form, which had to be signed, it was important to them, 230 (97.9%), except the patients who had elective surgery, 130 (90.3%), regularly stated that having an opportunity to ask questions was important to them. Respondents with emergency surgery more frequently agreed to sign whatever was in the form, 42 (46.7%).
Conclusion
Patients who had a planned surgery and patients who had an urgent surgery, mostly declare contentment with the use of informed consent although they did not have the same experience about informed consent.
Background:
Painful and damaged nipples are frequently associated with breastfeeding cessation in the early postpartum period. The results of researchers’ studies utilizing different treatments have ...been inconclusive.
Research Aim:
To compare the intensity of nipple pain and the healing of damaged nipples during the first 10 days postpartum using either lanolin or human milk treatments.
Methods:
This single-blind randomized controlled trial included participants (N = 206) who were primiparous with painful and damaged nipples. Participants were recruited from the tertiary teaching hospital within the first 72 hr after delivery and randomized to the intervention group with lanolin (n = 103) and a human milk control group (n = 103). Data were collected in the maternity ward, 3 and 7 days after randomization. The primary outcome was nipple pain intensity and quality measured 3 and 7 days after randomization by the McGill Pain Questionnaire – short form. The nipple damage self-assessment questionnaire was used for the assessment of nipple healing. Breastfeeding self-efficacy, breastfeeding duration, and exclusivity were assessed as secondary outcomes.
Results:
Participants in both groups reported a statistically nonsignificant reduction in pain (quality and intensity of pain) as well as improved nipple healing 7 days after randomization. Participants in the lanolin group exclusively breastfed their infants 3 days after randomization—significantly more often than participants in the control group (p = .026). The study did not reveal any statistically significant differences for other secondary outcomes.
Conclusion:
Both lanolin and human milk are equally effective in treating painful and damaged nipples.
Registered with Clinicaltrials.gov (NCT04153513)
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