The association of factor V G1961A (factor V Leiden), prothrombin G20210A, MTHFR C677T and PAI-1 4G/5G polymorphisms with recurrent pregnancy loss in Bosnian women.

Aim To investigate association of factor V Leiden, prothrombin G20210A, MTHFR C677T and PAI-1 4G/5G polymorphisms with recurrent pregnancy loss in Bosnian women. Methods A total of 60 women with two or more consecutive miscarriages before 20 weeks of gestation with the same partners and without history of known causes or recurrent pregnancy loss were included. A control group included 80 healthy women who had one or more successful pregnancies without history of any complication which could be associated with miscarriages. Genotyping of factor V Leiden, prothrombin G20210A, MTHFR C677T and PAI-1 4G/5G polymorphisms were performed by polymerase chain reaction/restriction fragments length polymorphism method (PCR/RFLP). Results Both factor V Leiden and MTHFR C677T polymorphisms were significantly associated with recurrent pregnancy loss (RPL) in Bosnian women while prothrombin G20210A and PAI-1 4G/5G polymorphisms did not show strongly significant association. Conclusion The presence of thrombophilic polymorphisms may predispose women to recurrent pregnancy loss. Future investigation should be addressed in order to find when carriers of those mutations, polymorphisms should be treated with anticoagulant therapy.

Age at natural menopause in refugee and domicile women who lived in Tuzla Canton in Bosnia and Herzegovina during and after the war.

OBJECTIVE: This study aims to estimate age at onset of natural menopause in domicile and refugee women who lived in Tuzla Canton in Bosnia and Herzegovina during the war (1992-1995) and in the postwar period until the interview. METHODS: A cross-sectional study was conducted on a sample of 331 postmenopausal women-264 (80%) domicile women and 67 (20%) refugee women-between June 2009 and February 2011. RESULTS: The study encompassed 331 women with a mean age of 57.0 years (range, 39-75 y). The overall mean age at menopause was 49.1 years. The mean age at menopause was higher in domicile women (49.3 y) than in refugee women (48.0 y; unpaired t test, P = 0.023). After adjustment for age at menarche, education, marital status, living place, body mass index, number of abortions, use of contraceptives, and current smoking, only refugee status and parity remained as significant independent predictors of age at menopause (score test, P = 0.025). Refugee women had an increased probability of earlier onset of menopause compared with nonrefugee women (adjusted hazard ratio, 1.33; 95% CI, 1.02-1.75; P = 0.039), whereas there was a decreased probability of experiencing menopause with increasing number of births (adjusted hazard ratio, 0.92; 95% CI, 0.84-0.996; P = 0.04). CONCLUSIONS: The age at onset of menopause in refugee women is lower than that in domicile women, indicating that war, independently of other factors, could influence the age when menopause occurs. On average, women who lived in Bosnia and Herzegovina during the war and postwar period entered menopause earlier than did women from Europe.

Parity and menarche as risk factors of time of menopause occurrence.

INTRODUCTION: Menopause is the last physiological menstruation and represents a crucial moment in the life of every woman. OBJECTIVE OF THE STUDY: Determine the effect of parity and menarche as risk factors in the time of menopause occurrence. PATIENTS AND METHODS: This study included 460 women in natural menopause. Each patient has undergone an interview based on the questionnaire, following the verbal consent of the patient who was previously explained nature of the research. Statistical analysis of data was carried out by the usual statistical methods of descriptive statistics, using regression models and "hazard ratio" for the period of life compared to the individual parameters. RESULTS: The average age of menopause occurrence in women who gave birth, was somewhat higher (48.6), in comparison to women who did not give birth (47.8), but the difference was not statistically important (t=-1.07, p=0.287). In the study group there was no correlation between the age of menarche occurrence and the age of menopause occurrence. CONCLUSION: There is no correlation between the age of menarche occurrence, parity and age of the menopause.

The association between lipid profile and bone density in postmenopausal women.

AIM: The aim of this research was to examine the correlation between lipid profile and bone density in postmenopausal and premenopausal women. MATERIAL AND METHODS: This research covered 53 subjects who were in postmenopause and 30 subjects who had regular menstruation, older than 45. RESULTS AND DISCUSSION: The postmenopausal subjects have lower bone density of the lumbar spine, if triglyceride levels were higher (p = 0.030) and VLDL is higher (p = 0.032). In subjects with regular menstruation, the density of the neck of the femur was greater if the cholesterol values were higher (p = 0.002) and the density of the lumbar spine was greater where the levels of triglycerides (p = 0.002) and of ApoB (p = 0.026) were higher. In subjects in postmenopause there was a correlation between the density of the lumbar spine (p = 0.04) and the density of the neck of the femur (p = 0.008) with the length of menopause. The effect of lipid profile on bone density differs in women with regular menstruation and in postmenopausal women. The triglyceride levels in postmenopausal women contribute to a reduction in bone density, whilst the effect on bone density in women with regular menstruation is reversed, which indicates that the lipid profile is not an isolated factor affecting bone density, but that other factors, such as oestrogen levels and the length of post-menopause, have a significant effect on bone density.

How to make assisted reproductive technologies (ART) affordable in Bosnia and Herzegovina: experience after the first 105 cycles.

OBJECTIVE: Evaluation of the results after the first 105 cycles in private IVF centres in Bosnia and Herzegovina. STUDY DESIGN: Retrospective analysis of one hundred and five infertile couples who underwent IVF procedures. RESULTS: The mean age of women who underwent IVF/ ICSI was 34.1 +/- 5.1. The male factor was the cause of infertility in 50 (47.6%), tubal factor in 24 (22.2%), idiopathic infertility in 14 (13.3%), advanced age in 14 (13.3%) and PCOS in 4 (3.8%) infertile couples. The average number of retrieved oocyte was 7.84 +/- 5.30. In 96.2% cycles ICSI was performed and in 3.8% IVF/ICSI. The average number of transferred embryos per cycle was 2.49 +/- 0.9. The pregnancy rate per aspiration was 26.7%. The clinical pregnancy rate per transfer was 26.3%. The percentage of live births per transfer to date was 13.1% and 7 of them are still pregnant. In the entire group of pregnant women 40% had twin pregnancies, 1 of them had an ectopic pregnancy (1.01%) and 4 (4.04%) had spontaneous abortions. CONCLUSIONS: The pregnancy and delivery rates are not satisfactory. The twin pregnancy rate is higher than is acceptable. Low-cost hormonal stimulation, natural cycles and freezing of embryos could be a possible way to make IVF affordable to a larger number of infertile couples.

[Fetal echocardiography in the 15th week of gestation]. / Fetalna ehokardiografija u XV nedjelji trudnoce.

A fast development of the ultrasound technology has enabled a very high resolution of images thus opening a possibility for better quality of images of all fetal structures including fetal heart. Transabdominal ultrasound examination of heart is commonly conducted after the 10th week when it is possible to get a quality image of all relevant heart structures using 3-5MHz probes. Having in mind that fetal heart is mostly formed by the end of the 14th week, an idea of a vaginal ultrasound examination in the 15th week using 5-9MHz probes has been a logical one. In that period the length of the fetus ranges from 9 to 10 centimeters, which is a basis for an assumption that a quality examination of the fatal heart may be conducted using the vaginal probe. This paper is showing all standard cross-sections of fetal heart (4 chambers, outflow tracts, cross-section of three great vessels and longitudinal view of aortic and ductal arches) obtained by vaginal examination in the 15th week and abdominal examination in the 20th and 22nd week. The transvaginal examination of fetal heart is possible in the 15th week and it is recommended to be done in all pregnant women with problematic personal and reproductive anamnesis and those with positive ultrasonographic markers for chromosomal defects.

Progesterone-induced blocking factor and cytokine profile in women with threatened pre-term delivery.

PROBLEM: The objective of this study was to compare serum concentrations of progesterone-induced blocking factor (PIBF), anti-inflammatory (IL-10),and pro-inflammatory (IL-6, TNFa, and IFNc) cytokines of women with threatened pre-term delivery, with those of women with normal pregnancy and to evaluate the impact of PIBF on the outcome of pregnancy. METHOD OF STUDY: A prospective study was conducted on a sample of 30 women with threatened pre-term delivery (study group) and 20 healthy pregnant women (control group) between the 24th and 37th gestational weeks. Serum PIBF, anti-inflammatory (IL-10), and pro-inflammatory (IL-6, TNFa, and IFNc) cytokine concentrations were measured by enzyme-linked immunosorbent assay (ELISA). RESULTS: Thirteen of 30 patients (43.3%) with symptoms of threatened pre-term delivery, and one of 20 patients (5%) in the control group delivered before the 37th week of gestation. Mean PIBF concentrations in serum samples of patients with threatened pre-term delivery were significantly lower than in those of healthy pregnant women (171.12 +/-162.06 ng/mL versus 272.85 +/- 114.87 ng/mL; P < 0.05).Women with symptoms of threatened pre-term delivery had significantly lower serum levels of IL-10, and higher levels of IL-6 as well as IFNc compared with healthy controls. CONCLUSION: Our results indicate that measuring PIBF and cytokine concentrations in serum during pregnancy is feasible and may be important for understanding immunological causes of pre-term delivery.

Correlation between hormonal and lipid status in women in menopause.

It is widely accepted that menopause leads to changes in hormonal status, metabolism and lipid profile. The aim of this study was to analyze the influence of menopause on the concentrations of lipids, lipoproteins and, the influence of estradiol, progesterone, FSH, LH on lipid profile in menopausal women as well. The menopausal women had higher but non-significant (p>0,05) concentrations of total cholesterol, VLDL, LDL, and triglycerides than women with regular menstruation. The concentration of HDL was significantly lower in menopausal women than in women with regular menstruation (p<0,05). Also, the concentration of apolipoprotein B was significantly higher in menopausal women (p<0,05), but the concentrations of apolipoprotein and lipoprotein (a) were lower but without significance (p>0,05). Estrogen concentration has significant negative correlation with VLDL and triglycerides (p<0,05) and significant positive correlation with HDL (p<0,05) in menopausal women. Progesterone concentration has shown no correlation with concentrations of lipids and lipoproteins in menopause. We can conclude that menopause leads to changes in lipid profile by reducing HDL, and elevating apolipoprotein B levels, thus increasing the risk for cardiovascular disease. These changes were caused by reduction of estrogen concentrations in menopause.

Insulin-like growth factor-binding protein-1 (IGFBP-1) in cervical secretions as a predictor of preterm delivery.

OBJECTIVE: The objective of this study was to investigate the level of insulin-like growth factor-binding protein-1 (IGFBP-1) in cervical secretions and Bishop score as predictors of preterm delivery in asymptomatic pregnant women. METHODS: This was a prospective study at the Clinic for Gynecology and Obstetrics at the University Clinical Center in Tuzla, on a sample of 80 healthy pregnant women at between 24 and 34 gestational weeks. After interview every woman underwent IGFBP-1 concentration measurement by the 'Actim Partus' test. The Bishop score was determined by the author (A.L) during vaginal examination. Rates among groups were compared using arithmetic mean and standard deviation, Student's t-test, Mann-Witney U-test, and Spearman-Rank correlation test. Statistical importance was determined at the variation levels of 5% and 1%. RESULTS: Eight (10.00%) women in the study group had a positive Actim Partus test and six (7.50%) of them had a preterm delivery. The positive predictive value was 44.44% and negative predictive value was 98.59%. The specificity of the Bishop score in the study group was 83.78% and the sensitivity was 50.00%. The positive predictive value of the Bishop score in this group was 20.00% and the negative predictive value was 95.36%. There was no correlation between the Bishop score and Actim Partus test (p = 0.15). CONCLUSIONS: If the concentration of IGFBP-1 is <10 microg/L (negative Actim Partus test) in asymptomatic pregnant women, the risk of preterm delivery is low. The Actim Partus test could be used as a screening test for preterm delivery in asymptomatic pregnant women.

[Adolescents and knowledge of sexually transmitted diseases in Tuzla Canton]. / Adolescenti i poznavanje spolno prenosivih bolesti u Tuzlanskom kantonu.

INTRODUCTION: Sexually transmitted diseases today are the most spread infectious diseases. Their incidence is constantly increasing. Usually they affect the population age 15 to 19. OBJECTIVE: To examine and determine parameters related to sexual behavior (sexarcha, duration of sexual activity, number of sexual partners), knowledge of adolescents of Tuzla Canton about sexually transmitted diseases and how do they get informed about it. MATERIAL AND METHODS: In period June to September 2003 we conduct a survey with 2995 high school boys and girls age 14 to 19 in Tuzla Canton. The survey contained questions about sexarcha, knowledge on sexually transmitted diseases, usage and knowledge on methods of contraception. RESULTS: Sexually active high school youth was 395 (13,18 %). Of that number 306 (10.22%) were boys and 89 (2.9 %) were girls (p<0.001). Average age of sexarcha for girls was 16.5+0.97 and for boys 15.7+1.2. Earliest average age of sexarcha for girls was in the municipality of Sapna (15.25+0.5) and for the boys in the municipality of Teocak (15 +1.1). In undeveloped municipalities sexual activity of adolescents of both sexes is significantly higher then in developed ones (p<0.5). High school boys and girls of Tuzla Canton showed insufficient knowledge of sexually transmitted diseases. Good knowledge showed only 87 (5 %) of girls and 25 (2 %) of boys. Girls showed statistically significant better knowledge on sexually transmitted diseases than boys p<0.001). Only 208 (19 %) boys and 539 (29 %) girls talks with parents about sexually transmitted diseases and contraception. CONCLUSION: Work on education of youth, especially in undeveloped municipalities in insufficient, as well as knowledge on sexually transmitted diseases and methods of contraception.

Secondary amenorrhea and lipid profile.

The aim of this study was to evaluate the lipid profile in women with amenorrhea in reproductive age and to investigate possible impact of type of amenorrhea on lipid profile by comparing lipid profile in normogonadotropic and hypergonadotropic women with amenorrhea. This cross-sectional study included 23 amenorrheic and 12 eumenorrheic women under 40 years old. Each woman underwent the measurement of body mass index, serum levels of FSH, LH, estradiol, progesterone, total cholesterol, HDL, VLDL, LDL, and triglycerides. According to FSH levels women with amenorrhea were divided in two groups: hypergonadotropic (FSH>25 IU/L) (n=9) and normogonadotropic (FSH>25 IU/L) (n=14). There were no differences in BMI, estradiol, progesterone, cholesterol, HDL, LDL, VLDL and triglycerides between amenorrheic and eumenorrheic women. Women with normogonadotropic amenorrhea had higher plasma concentrations of triglycerides (P=0.027) and VLDL (P=0.262) and lower levels of HDL (P=0.014) than women with hypergonadotropic amenorrhea. In hypergonadotropic women with amenorrhea was found positive correlation between progesterone and HDL (P=0.043). The normogonadotropic women with amenorrhea had higher levels of VLDL and triglycerides and lower levels of HDL than hypergonadotropic women with amenorrhea. These results suggest that the type of amenorrhea is important factor which may modify lipid profile in women with amenorrhea. The changes in lipid profile in normogonadotropic women with amenorrhea could be a risk for cardiovascular diseases.

[Induced abortion: pro and con]. / Namjerni prekid trudnoce: za i protiv.

Induced abortion like a method of birth control is the most unpopular method but it is a choice of great deal women especially in our environment. In connection with very loud demands for sharpened the low of pregnancy interrupting, many authors analyse methods, complications and risk groups of women, its acceptability like a method of family planning. At the end they give conclusion with some concrete suggestions and the aim to reduce the number of induced abortions.