Diagnosis and Treatment of Lower Limb Arteries True Aneurysms

Abstract:Lower extremities artery true aneurysm is a rare but significant vascular problem. It is usually found in the popliteal artery, seldom femoral artery. Most important symptoms related with this vascular condition are mainly due to peripheral embolization and untreated may lead to a severe limb ischemia. Usually it is very easy to diagnose such an aneurysm, as we can simply palpate a pulsing knob. Aneurysms can be treated conservatively or surgically. Generally surgical procedure is regarded as a safe and effective method of treatment. Despite rapid development of endovascular techniques open surgery still remains a gold standard of treatment. However, there is still lack of data to confirm the advantages of open or endovascular approach. Read full text »

Antenatal Corticosteroid Therapy in Management of Preterm Labor Caused by Preterm Premature Rupture of Membranes – Risks and Benefits

Abstract:Preterm labor is a common complication of pregnancy, in one third of the cases it is caused by preterm premature rupture of membranes (PPROM). Since the crucial article by Liggins and Howie published in 1972, antenatal corticosteroid therapy has played a prominent role in the management of preterm labor. Nowadays plenty of studies have shown the effectiveness of the therapy in reducing neonatal mortality and morbidity. However, there is some ambiguity about the therapy in certain cases, including PPROM. The immunosuppressive activity of steroids is widely known. Even though the corticosteroids generally used in the management of preterm labor (betamethasone, dexamethasone) show very weak immunosuppressive activity, there is still some doubt -regarding the possible increase in risk of neonatal and maternal infection. Other questions concern the effectiveness of the therapy in this group of patients, as well as current recommendation of main obstetricians’ societies and safety of use of repeated doses. The aim of this article is to highlight the latest knowledge in this area. Read full text »

Acute Renal Failure in the Course of Hellp Syndrome

Abstract:HELLP syndrome is a severe pregnancy complication with high mortality among mothers and children. Incidence of HELLP syndrome according to literature is about 1% of all pregnancies. HELLP syndrome is associated with preeclampsia in one- quarter of patients. Current researches on HELLP syndrome address etiology, treatment and prediction of the syndrome. Currently there are no useful predictors and established treatment is the delivery. This study presents the case of HELLP syndrome in 37 year-old patient at 28th week in her first successful pregnancy after in-vitro fertilization technique. Read full text »

Hysterectomy in the 33rd Week of Pregnancy Due to Placenta Praevia – A Severe Obstetric Complication Despite Correct Diagnosis

Abstract:Placenta praevia is one of the leading causes of maternal morbidity and mortality. The incidence of placenta praevia is from 0.1 to 1.0% of all births. Postpartum haemorrhage (PPH) is the most common cause of maternal death and is responsible for one-quarter of maternal deaths globally, approximately for 140,000 deaths annually. Obstetric haemorrhage can occur at any stage of pregnancy. In early pregnancy the major causes of bleeding are ectopic pregnancy, incomplete abortion and trauma. In the second half of pregnancy and during labour the most common causes of bleeding are placenta praevia, placental abruption and uterine rupture, including scar dehiscence after previous operations. The causes of postpartum bleeding are uterine atony, haemorrhage from the space of incorrectly nested placenta, infections, bleeding disorders, injuries and damage to the birth canal. Haemorrhage in the second half of pregnancy relates to 4% of pregnant women and they are most often related to abnormalities of the placenta. More than half of the cases are due to placenta praevia (22%) and improper localization of the placenta (31%). The study presents the case of postpartum haemorrhage and hysterectomy performed in a 30-year-old woman at 33rd week of pregnancy with placenta praevia. Read full text »

Infective endocarditis caused by dental problems correlated with bicuspid aortic valve

Abstract:The aim of the study was to emphasize the importance of prophylaxis of infective endocarditis. Also, the influence of heart failure and bacterial etiology on the treatment was analyzed. This study presents a case report of a patient who was suffering from IE. He was treated in the Cardiology Ward at the Medical University of Lublin. 47-year-old man has resected his tooth in a dental surgery. After a few days at home, he presented non-specific symptoms like fever and chest pain. Bicuspid aortic valve was diagnosed at the Cardiology Ward. Furthermore, vegetation on aortic valve was recorded in echocardiography. That is why IE diagnosis was made. After the therapy with Vancomycin, vegetation on aortic valve was still present. Regurgitation in 3rd state was developed by the patient. New valve was implanted. A few days after operation the patient had subfebrile state. He was treated with Vancomycin and Clindamycin. Currently, he is receiving ciprofloxacin as prophylaxis of IE. Heart failure is a risk factor of IE. These patients should get antibiotic prophylaxis before dental surgery. Patients with heart defect can develop more severe type and treatment in these cases is more difficult. Everyone should undergo non-specific prophylaxis of infective endocarditis. Read full text »

How stress and anti-stress remedies influence bone health

Abstract:Various factors affect the increased risk of skeletal system disorders in the modern society. Chronic stress can be regarded as one of the causes of greatest importance. Epidemiological studies conducted by the World Health Organization (WHO) indicate that the level of stress in the society is constantly increasing. This phenomenon is particularly apparent in developed countries. Bone tissue loss affects not only the elderly, but also people of younger age. Studies have shown reduced bone mineral content (BMC) and bone mineral density (BMD) in people exposed to chronic stress and suffering from depression. These facts can be explained through the mechanism of action of glucocorticoids (GCs) on the bone. It reduces the content of inorganic substances in the bone, thereby weakening its strength. Additionally, important factors causing BMC and BMD to decrease include usage of drugs such as antidepressants, as well as addictions such as smoking. Metyrapone, an inhibitior of cortisol synthesis, has been found to increase serum BMC and osteocalcin (OC) levels and to promote bone formation. Moreover, Alzheimer’s disease (AD) patients using rivastigmine arebe at lower risk of developing hip fracture. Read full text »

Understanding tokophobia phenomenon as a key to proper management

Abstract: Tokophobia also known as fear of childbirth (FOC) becomes a frequent psychiatric indication to Caesarean section which makes it a rising problem of current obstetrics. Patients with FOC may suffer from additional psychiatric conditions such as depression. Women with higher risk of developing tokophobia are those with immense levels of fear of pain, young, with low educational level, poor socio-economic status, low self-esteem and lack of proper knowledge concerning peripartum period. History of unfortunate events during previous deliveries or illness of the older child are also associated with more frequent occurrence of FOC. Adequate management of FOC focuses on implementing psychotherapy. Symptoms of FOC can be decreased by means of qualified and trustworthy medical staff during labor or support from a closely related person. Secondary tokophobia can be prevented by minimalisation of negative experience during the first birth. If tokophobia is the symptom of depression, the underlying illness should be treated. Tokophobic patients are more prone to experience higher levels of pain during labor, which makes peripartum pain management harder for clinicians. FOC is one of the main reasons for performing caesarean delivery on maternal request (CDMR), which may lead to post-operative complications. Research shows that FOC is related to anxiety concerned with lower self-esteem due to changes occurring in women’s body during pregnancy and delivery. Learning and understanding the reasons behind tokophobia might lead to reducing the number of patients suffering from this condition and in consequence minimalizing the number of performed CDMR. Read full text »

Microcephaly associated with Zika virus infection – prevention, diagnosis and treatment

Background: Zika virus (ZIKV) is a mosquito-borne flavivirus, first identified in Uganda in 1947 in monkeys by researchers monitoring yellow fever. Later virus was identified in humans in 1952 in Uganda and the United Republic of Tanzania. Outbreaks of ZIKV disease have been recorded in Africa, the Americas, Asia and the Pacific. From the 1960s to 1980s, human infections were found across Africa and Asia, typically accompanied by mild illness. The first large outbreak of disease caused by Zika infection was reported from the Island of Yap (Federated States of Micronesia) in 2007. The next epidemic of ZIKV infection was reported in 2015 in South and Central America and the Caribbean. Read full text »

FINDRISC scale as a common tool to assess the risk of diabetes type 2

Background: The aim of the study was to evaluate the risk of developing type 2 diabetes among middle-aged and elderly with the use of FINDRISC scale. Material and methods: The study involved 200 people. Those participating in the study were given the form representing the scale of developing diabetes risk, based on FINDRISC scale and classified into one of five groups of risk of developing type 2 diabetes within 10 years. Results: 47% of examined patients are of a moderate, high or very high risk of developing diabetes type 2. There was no significant difference between men and women. The correlation between age and the risk of developing diabetes type 2 appeared insignificant. The correlation between BMI and the risk as well as waist circumference and the risk appeared to be high, positive. Conclusions: FINDRISC scale is a simple tool to rank the risk of developing diabetes in the general popula- tion, among the overweight or obese patients having positive family history of developing diabetes. Read full text »

The Prevalence Of Mycoplasma In Pregnant Women’s Genital Tracts Delivering In TERTIARY Hospital

Background: The aim of this study was to evaluate the prevalence of Mycoplasma hominis and Ureaplasma urealyticum among pregnant women and an attempt to identify risk factors for maternal infection and assessment of the impact of infection on perinatal outcomes. Material and methods: Patients included into the analysis were divided into 2 groups. The first group consisted of 97 (78.9%) women who had not isolated the strains of Mycoplasma, and the second group of 26 (21.1%) women who had isolated a strain of Mycoplasma. Results: Women who had isolated strains of Mycoplasma were significantly younger (p=0.0031), less frequently completed higher education (p=0.0163), less frequently were married (p=0.0061). Women who were not classified with Mycoplasma were more frequently multiparas (p=0.012) and were more likely to have previous caesarean birth (p=0.022). The groups did not differ significantly in terms of gestational age at birth, the incidence of premature rupture of membranes, intrauterine infection, the percentage of women who gave birth vaginally, the birth weight of newborns and the condition of the newborns after delivery. The neonatal respiratory support type nCPAP was more frequently applied to the babies born to mothers who had isolated Mycoplasma. Conclusions: Based on the survey results and data from the world literature, it can be concluded that women with pre-term labour and PROM should be tested for Mycoplasma colonization and the newborn should be observed primarily in terms of complications caused by respiratory tract. Colonization with Mycoplasma in term pregnancy does not impact significantly maternal and neonatal outcome. Read full text »