Comparative Efficacy of High-Dose Dexamethasone Versus Methylprednisolone in Coronavirus Disease 2019 (COVID-19)-Associated Acute Respiratory Distress Syndrome.

OBJECTIVE: This retrospective (matched paired) clinical trial aimed to compare the efficacy of dexamethasone vs. methylprednisolone at equipotent (high) doses in patients with coronavirus disease 2019 (COVID-19)-associated acute respiratory distress syndrome (ARDS). METHODS: A total of 347 patients with moderate and severe COVID-19-associated ARDS were administered either a high (equipotent) dose of dexamethasone (32 mg) or methylprednisolone (180 mg) for a duration of up to 10 days. All participants received the standard of care for critically ill COVID-19 patients. RESULTS: The primary outcomes included length of stay in the ICU, ICU mortality, and discharge from the hospital. Based on the obtained results, a tendency towards more favorable clinical outcomes concerning the length of stay in the ICU (in the group of patients treated with non-invasive mechanical ventilation (NIV), p<0.05), ICU mortality, and discharge from the hospital (in the group of patients who were intubated, p<0.05) in patients receiving the high dose of dexamethasone compared to those receiving methylprednisolone was observed. CONCLUSION: It appears that severe cases of COVID-19, especially intubated ones, treated with high doses of dexamethasone have a more favorable clinical outcome than the use of equipotent doses of methylprednisolone. However, larger multicenter studies are needed to validate our observations.

Neonatal Outcomes in Labor After Intravenous Remifentanil Analgesia vs. Epidural Analgesia: A Retrospective Observational Study.

Background Some evidence indicates that maternal analgesia during labor may have adverse effects on neonates due to exposure to specific drugs or the potential effects of analgesia on the course of labor. We assessed the clinical outcome of term neonates born to mothers who received epidural analgesia (E) or systemic analgesia with remifentanil (R) during labor. Methods Data was collected retrospectively over one year. We have evaluated the medical records of 247 full-term neonates; 208 were born to mothers who received E and 39 to mothers who received R. Data on Apgar scores and neonatal complications (perinatal asphyxia, respiratory distress, infection, hyperbilirubinemia, and birth injuries), and average hospital stay were collected. Mann-Whitney U test, chi-square test, and logistic regression analysis were used where appropriate. Results The values of the mean Apgar scores between E and R at 1 and 5 minutes were similar (8.83 vs. 8.97, p = 0.252; 9.81 vs. 9.87, p = 0.762, respectively). The average length of neonatal hospitalization did not differ between groups (4.19 vs. 4; p = 0.557). The percentages of neonates with any complication were similar between groups (28.3% vs. 32.5%, p = 0.598). Neonates born by cesarean delivery (CD) had significantly worse outcomes than those born vaginally (p = 0.008, OR 2.8, 95% CI [1.30, 6.17]). Conclusion We did not find a statistically significant difference in mean Apgar scores and neonatal complications between neonates who received epidural vs. remifentanil analgesia. An increased rate of complications in neonates born via CD was found. Future studies should have a larger sample size and be powered to detect associations in these findings.

Hemodynamics of arterial and venous circulation in the intrauterine fetal evaluation.

INTRODUCTION: The purpose of each antenatal control focuses on the detection and prevention of hypoxic-ischemic injury and fetal death (1)) using modern biophysical tests and Doppler parameters. GOAL: This study examines the correlation of changes in arterial compared to venous hemodynamics of the fetus and is determined by the most sensitive and most specific Doppler parameter in the assessment of intrauterine fetal status. MATERIAL AND METHODS: The study was conducted as prospective and included 119 pregnant women. All subjects underwent NST (nonstres test), and Doppler measurements of blood flow in the umbilical artery (Aum), fetal aorta (Ao) and the central cerebral artery (MCA). In case of borderline and pathological arterial flow was measured through the ductus venozus (DV) and umbilical vein (VU). At birth to the child was determined umbilical artery blood pH and Apgar score (AS) in the first minute. Based on the clinical condition of the newborn and outcome was calculated perinatal morbidity and mortality. RESULTS: In all cases with a pathological arterial flow, which is verified during measurement also the pathological venous flow and confirmed fetal acidemia at birth and low Apgar scores? In this group, the two neonates died in the first week. CONCLUSION: There is a justification for the analysis of venous flow in the event borderline and pathologic findings in fetal arterial system. It has been proven that the cerebroumbilical (C/U) index is most effective parameter in predicting changes in the venous system and this the most sensitive Doppler parameter in predicting fetal acidosis and the most specific Doppler flow through the central cerebral artery.

Importance of the cytoplasmic super-oxide dismutase in the normal tissue of the endometrium and the endometrium carcinoma.

OBJECTIVES: The objective of the study is comparing pathohistological picture and test results of the activity of the enzymes of the anti-oxidative protection -cytoplasmic super-oxide dismutase (CuZnSOD) from the blood and endometrium in the promotion of the progression or regression of the hyperplasia and endometrium carcinoma. MATERIALS AND METHODS: The study has been carried out on 70 patients. We have analysed:The age patients, the supersonic test - transvaginal probe, pathohistological diagnosis (PHD) analysis of the curet of the patient-we have gathered the tissue of the normal and the pathologicaly changed endometrium from the exploratory curretage, determining the CuZnSOD in the blood and in the tissue of the normal and pathological endometrium of the uterus. The Group A has been made out of 30 of them who did not have the irregular bleeding from the uterus, and 40 of them represented the Group B with the irregular bleeding, who also had PHD confirmed hyperplasia or malign changes of the endometrium. We have tested if there has been the pathalogical changes in the small pelvis (the ovary tumor, myoma etc.) in both groups. RESULTS: Dominant age in the Group B is 41 - 50 (55%), in Group A, age difference is not that apparent (p > 0.05). The results of the arithmetic mean of the CuZnSOD in the blood (19.90%) and (29.05%) in the endometrium which is lower than the Group A (blood-29.95%, endometrium-32.56%). Lower values CuZnSOD in the blood (18.9%) and endometrium (30.09%) we have in the experimental group patients who have had bleeding as well as those beside bleeding had some other gynecological - patological proces (myoma, cyst on the ovary etc.) CONCLUSIONS: According to the facts we can see the significance of the activity of the enzymes of the anti-oxidative system in the diagnostic of the hyperplasia and endometrium carcinoma as well as the possibility of their application in the clinical practice.

Surgery of condyloma acuminatum permagnum and permagnum recurrence after two years.

The authors in their paper show the case with the female patient D.S. 51 years old, which was surgically treated for genital condyloma in 1981, 1986, 1999, 2006 and 2008. Under registration number 3119/2006 was received at Gynecology and Obstetrics Clinic in Banja Luka with the diagnosis of condyloma acuminatum permagnum. Patient suffered from a huge tumorous, cauliflower formation, which was located on the mons pubis, and down to the anus, laterally to the right of the gluteal region to the left thigh. Patient was operated-Vulvectomia simplex cum extirpatio tumoris reg glutealis l dex. We obtained pathohistological findings (no. 4876 / 06) which read: condyloma acuminatum permagnum. After two years patient was rehospitalized at Gynecology and Obstetrics Clinic in Banja Luka, (registration number 1311/08) with almost identical findings in the same region under the diagnosis of condyloma acuminatum permagnum recidivans, St. post. vulvectomiam simplex et extitpationem tumoris glutealis reg l dex. All preoperative findings - laboratory analysis, X-ray of the lung and heart and ultrasound of the small pelvis were within the reference values. In this paper we describe the location of the tumor and how it is resolved - Extirpatio tumoris reg glutealis l. dex. et perianalis.Pathohistological findings confirmed previous diagnosis. In this paper we highlight our experiences regarding the operations of an unusually large tumors of genital condyloma and recurrent genital condyloma that were almost of the same size. Our experience could be useful to work on the education about sexually transmitted diseases, in order to improve the prevention of the viral diseases (vaccination), the treatment of these illnesses and to disseminate the warning that the regular check-ups with gynecologist are necessary.