MIFEPRISTON IN OBSTETRICS - WHY NOT?

Cervical ripening is a critical component of normal parturition. There are substantial variations in labour induction (IOL) techniques around the world. Mifepristone causes the termination of unwanted pregnancies, but there is a lack of consensus on its use for labour induction. The purpose of our study was to compare the combination of Mifepristone and Misoprostol with the combination of a Foley balloon and Misoprostol for labour induction. The study included 175 pregnant women, with gestational age 37-42 weeks. In the study group - 88 pregnant aged 21-35 (28.56±3.23), a combination of Mifepristone-Misoprostol was used. A combination of Foley catheter and Misoprostol was used in the control group - 87 pregnant aged 21-35 (29.48±3.03). The outcomes were assessed. In the study group the rate of vaginal delivery was higher and the frequency of cesarean section was lower compared to the control group (75 vs. 72, and 13 vs. 15, respectively); The total duration of labour was shorter in the study group (p<0,05); There was no difference between groups in the incidences of neonatal morbidity on the first and the fifth minute of life (p>0,05); The pain level was significantly low in the study group compared to the control group (5±0,75 vs. 8±0,96) and no cervical laceration was revealed in the study group. The Mifepristone - Misoprostol combination has advantages over the Foley balloon - Misoprostol combination for induction of labour regarding reduction in pain intensity, duration of labour, and cervical laceration.

Successful treatment of Rhizopus arrhizus rhino-orbital-cerebral mucormycosis with isavuconazole salvage therapy following extensive debridement.

A 61-year old lady with poorly-controlled type 2 diabetes mellitus was diagnosed with rhino-orbital-cerebral mucormycosis following presentation with sinusitis, ophthalmoplegia, proptosis and facial numbness. She was treated successfully with aggressive surgical intervention including orbital exenteration, accompanied by anti-fungal therapy with liposomal amphotericin B and posaconazole, followed by isavuconazole as salvage therapy. We discuss the challenges around optimising antifungal therapy of this lethal infection in the context of hepatic and renal toxicity.

Highly crystalline mesoporous SSZ-13 zeolite obtained via controlled post-synthetic treatment.

The generation of mesoporosity in SSZ-13 zeolite by means of desilication via post alkaline treatment normally results in severe damage to the microporous framework hence giving an undesirable decline in catalytic performance. Herein, we propose a post-synthetic desilication treatment that is controllable with an aim to preserve the high crystallinity of SSZ-13 zeolite during the formation of mesopores. The extent of desilication in alkaline media is controlled by deliberately leaving the organics within SSZ-13 frameworks as they can effectively hinder the attack of hydroxyl ions on siloxane bonds. The resulting SSZ-13 exhibits substantial development of mesoporosity with preserved high crystallinity and microporosity that can then be used to relieve the mass transport issues and lead to an increased activity of LDPE pyrolysis.

PATHOLOGICAL ADHERENCE OF PLACENTA - CASE REPORTS.

Major obstetric hemorrhage is the leading cause of maternal morbidity and mortality. In rare cases, life-threatening hemorrhage in pregnant women may result from abnormal adherence of placenta. Three grades of abnormal placental attachment are defined according to the depth of invasion: placenta accreta, placenta increta, and placenta percreta. An important risk factor for placenta abnormal adherence of placenta is placenta previa in the presence of a uterine scar. The increased prevalence of cesarean section, uterine surgery, and increasing parturient age and parity have led to an increased incidence of abnormal placentation, from one in 2,500 a quarter century ago, to one in 533 deliveries currently. Placenta percreta significantly increases risk for both maternal and fetal morbidity and mortality. Placental invasion of the bladder carries a maternal morbidity of 9.5% and perinatal mortality of 24%. Prevention of the maternal death in the condition when the patients have uterine scarring or a history of other invasive procedures may be improved by the adequate preoperative diagnostics of these conditions. When it involves the urinary bladder, a multidisciplinary approach utilizing a team of physicians and surgeons representing urology, radiology, and obstetrics-gynecology is the key to successful management.

[Benchmarking study of effectiveness of simultaneous and isolated surgeries].

Benchmarking study was conducted on effectiveness of simultaneous and isolated surgeries in practice of obstetrics and gynecology. In terms of the work, data were analyzed on the isolated and simultaneous surgeries with the patients with combined gynecological and surgical pathologies, requiring operative treatment. Man group included 254 patients with combined abnormalities, who underwent simultaneous surgeries; control group included 122 patients who underwent surgical treatment for combined diseases consecutively in two stages, in different times. Periodicity of complications in early and late post-surgical periods was evaluated, as well as risk ratio (RR) and attributable risk (AR). Simultaneous surgery is safe method of treatment of combined gynecological and surgical abnormalities. Notwithstanding extension of duration of pre-surgical examinations and post- surgical hospital stay, simultaneous operations are considered to be opportunity for being cured from several combined abnormalities within one hospitalization and anesthesia, creating positive moral and psychological background for the patients and making additional argument in favor of their conducting.

[Gynecology operations combined with hernioplasty].

Hernioplasty is one of the most widespread planned simultaneous operations in practice of obstetrics and gynecology. Rising trend of such interventions has been steadily increasing in these latter days. We have conducted 64 gynecology operations combined with hernioplasty. 5 operations were conducted in an expedited manner; 59 interventions were planned. Age of our patients ranged from 24 to 57. Duration of the surgical interventions was 129 minutes as average; duration of hospital stay days - 4±2 days, which didn't extend terms of stay at the stationary of the patients with separately conducted operations. Expressed pain syndrome was assessed with the amount of the used analgesics. Tension free hernioplasty by using reticulated polypropylene implants, on simultaneous operations, including hernioplasty combined with the gynecological components, gives good functional results and esthetic effect, excluding possibility of serious complications in the postoperative period.

Distribution of HLA DQA.1 alleles in New Zealand Caucasian, Maori and Pacific Islander populations. Comparison with other population studies.

Allele and genotype frequencies for the HLA DQA.1 locus were determined for 127 unrelated Caucasians, 177 unrelated Maori and 98 unrelated Pacific Islanders from the New Zealand population. DNA from blood cells was analysed by polymerase chain reaction amplification of DNA followed by hybridization to allele specific oligonucleotide probes in a reverse dot-blot test. Allele frequencies at the HLA DQA.1 locus for New Zealand Caucasians, Maori and Pacific Islanders were compared with published data for other populations. The distribution of HLA DQA.1 genotype frequencies did not deviate from Hardy Weinberg expectations for the Caucasian and Maori populations. The power of discrimination was 0.93 for Caucasians and 0.86 for Maori. The total Pacific Islander population tested was analysed as was data obtained from Western Polynesians contained within that larger group. Both the total Pacific Islander group analysed, and the Western Polynesians contained within that larger group, failed Hardy Weinberg expectations for the distribution of HLA DQA.1 genotypes. This significant deviation was due to excess homozygotes. The power of discrimination for the total Pacific Islander group and for Western Polynesians was 0.86 and 0.85 respectively. Comparison of Caucasian population studies from New Zealand, the United Kingdom, South Australia, Norway, the United States and Sweden showed these populations have similar HLA DQA.1 allele frequency distributions. Maori and Pacific Islanders have HLA DQA.1 allele frequency distributions that are more similar to each other than any of the other populations studied.