SARS-CoV-2 in Pregnancy-A Retrospective Analysis of Selected Maternal and Fetal Laboratory Parameters.

Pregnant women and their neonates belong to the group of individuals with elevated risk for COVID-19 infection. Data on the course of the disease and how it affects the pregnancy and neonatal wellbeing remain conflicting. The aim of the study was to evaluate the effect of SARS CoV-2 infection on the mode of delivery, neonatal condition and selected maternal and fetal laboratory parameters. This was a single-center retrospective case-control study. This dataset was generated using electronic medical records collected by medical personnel. Two groups of patients, hospitalized between April, 2020 and February, 2021, were included in the study: study group (304)-pregnant women with SARS-CoV-2 and control group (N = 329)-healthy pregnant women or parturients. Mothers with a severe course of COVID-19 had higher activated partial thromboplastin-APTT (p = 0.02), C-Reactive Protein-CRP (p = 0.00) and procalcitonin (p = 0.032) levels as compared to pregnant women with mild or moderate course of the disease. Neonates born to SARS-CoV-2-infected mothers presented with worse condition at 1 and 5 minutes of life (p = 0.000 and 0.00, respectively) and lower Arterial Blood Gas-ABG pH scores (p = 0.016). Elective cesarean section is the most common mode of delivery for SARS-CoV2-infected mothers. Emergency cesarean sections are performed at earlier gestational age as compared to vaginal delivery and elective cesarean section. Lower Apgar scores were observed in neonates born to SARS-CoV-2-infected mothers who required oxygen therapy and whose procalcitonin levels were elevated. There is a relationship between more severe course of COVID-19 and APTT, as well as CRP and procalcitonin levels.

Determinants favoring weight regain after weight-loss therapy among postmenopausal women.

Little is known about the factors affecting body weight-loss maintenance among postmenopausal women. We thus performed an analysis to identify some sociodemographic, physiological, and behavioral predictors of weight regain in a targeted subpopulation of women who had lost weight 1 year earlier. We also measured how eating behaviors and habits as well as physical activity pattern differ among successful and unsuccessful weight-loss maintainers over the trial. Sixty-four postmenopausal women were followed up for a year after dieting, and the successful and unsuccessful maintainers were identified. The regainers had regained an average of 4.9 kg of their lost body weight, while the maintainers had regained only 1.5 kg. Regainers had fewer years of education and lower initial body weight loss than maintainers. They also showed poor dietary adherence during dieting, and had unhealthy patterns of eating involving the avoidance of breakfast and a lower intake of nuts, seeds, and pulses, and a higher intake of sweets, biscuits, cakes, and pastries over time (excluding the dieting period). All the significant sociodemographic, physiological and behavioral variables differentiating regainers and maintainers before and after dieting were then examined as independent variables in a logistic regression model. The model showed that less weight reduction during dieting, higher disinhibition scores after dieting, and avoidance of breakfast before dieting were significant predictors of body weight regain in postmenopausal women. From a practical point of view, early identification of postmenopausal women who are at risk of regaining lost weight can allow health professionals to create behavioral and dietary supports to help prevent this. A regular schedule of follow-ups over at least the first year should be considered for them-including psychological and dietary intervention, if necessary. Since this sample study included only postmenopausal women, our findings are not generalizable to other populations.

Outcome dependent growth curves for singleton pregnancies based on birth weight of babies for Polish population.

OBJECTIVES: To create outcome dependent fetal growth curves and birth weight standards that can be analyzed for use in clinic specifically for Western European populations. MATERIAL AND METHODS: We conducted a retrospective study on fetal growth and birth weight trends from live birth singleton pregnancies between 2005 and 2018 at one of the largest tertiary gynecologic-obstetric hospitals in Poland. The inclusion criteria were at least 22 weeks of gestation at birth regardless of delivery mode (vaginal or C-section), no congenital anomalies diagnosed before and after delivery and an Apgar score of at least 7 in the first minute. The final sample had a total of 39,413 cases (18,562 girls and 20,851 boys). We presented 7 (for all fetuses in the 5th, 10th, 25th, 50th, 75th, 90th and 95th percentiles) and 6 (for boys and girls each at 10th, 50th and 90th percentiles) fetal growth curves between 25 and 40 weeks of gestation. Birth weight trends were obtained and analyzed from all babies in the 5th, 10th, 25th, 50th, 75th and 95th percentiles born between 22 to 42 weeks of gestation with also separate trends for boys and girls. RESULTS: The largest differences in fetal growth curves were observed in the 10th and 50th percentiles between 22 and 34 weeks of gestation. A decreasing fetal weight gain pattern was observed between 27 and 30 weeks and after 38 weeks of gestation, the decrease was more drastic in female. A significant increase from 2009 to 2017 was observed in the weight of 50th percentile babies born at or after 35 weeks. We found significant discrepancies between our results and the most used European fetal growth curves particularly in the 10th and 90th percentile weights at 30 weeks. CONCLUSIONS: Separate scales for boys and girls were implied and given the overall difference form commonly used references. We believe there is significant value in using these unique patterns found in fetal growth curves and birth weights of ethnically homogenous population (such as Poland) at everyday clinical practice for more opportunities of safe obstetric care and higher chances of delivering a healthy child.

The clinical usefulness of biochemical (free ß-hCg, PaPP-a) and ultrasound (nuchal translucency) parameters in prenatal screening of trisomy 21 in the first trimester of pregnancy.

OBJECTIVES: The aim of the study was to analyze the correlation of multiples of the normal median of PAPP-A, free ß-hCG levels and nuchal translucency values in prenatal, first trimester screening of trisomy 21 in pregnant women. MATERIAL AND METHODS: 251 pregnant women underwent antenatal screening at 11-13+6 weeks of pregnancy which was composed of the measurement of free ß-human chorionic gonadotropin (ß-hCG) and pregnancy-associated plasma protein (PAPP-A) levels in the maternal serum and an ultrasound assessment of nuchal translucency (NT). The pregnant women with a high risk of trisomy 21 (≥ 1:300) were given amniocentesis to verify fetal defects. There were 217 cases of normal fetal karyotype and 34 cases of trisomy 21. PAPP-A, ß-hCGMoM and NT values were analyzed for the predefined ranges. RESULTS: 85% cases of trisomy 21 had elevated free ß-hCGMoM (> 1.5) and only 53% of these had a PAPP-AMoM result below 0.5 (p < 0.05). Analysis of NT in selected ranges of ß-hCG (> 1.5) and PAPP-AMoM (< 0.05), which are typical for Down Syndrome values, showed that not all fetuses with Down Syndrome presented with an increased NT. Respectively 44.15% and 26.5% of fetuses presented with increased NT. Characteristic for trisomy 21, a correlation with all 1st trimester screening tests' parameters occurred in only 23.5% of cases. In 53% of cases the results were atypical. CONCLUSIONS: The PAPP-A and ß-hCG values in the selected MoM ranges did not shown a correlation to the NT measurement, therefore they are independent factors in the diagnosis of trisomy 21. Simultaneous biochemical and ultrasound testing is an indispensable condition for prenatal diagnosis of trisomy 21 in the 1st trimester of pregnancy.

The Role of Matrix Gla Protein (MGP) Expression in Paclitaxel and Topotecan Resistant Ovarian Cancer Cell Lines.

The major cause of ovarian cancer treatment failure in cancer patients is inherent or acquired during treatment drug resistance of cancer. Matrix Gla protein (MGP) is a secreted, non-collagenous extracellular matrix protein involved in inhibition of tissue calcification. Recently, MGP expression was related to cellular differentiation and tumor progression. A detailed MGP expression analysis in sensitive (A2780) and resistant to paclitaxel (PAC) (A2780PR) and topotecan (TOP) (A2780TR) ovarian cancer cell lines and their corresponding media was performed. MGP mRNA level (real time PCR analysis) and protein expression in cell lysates and cell culture medium (Western blot analysis) and protein expression in cancer cells (immunofluorescence analysis) and cancer patient lesions (immunohistochemistry) were determined in this study. We observed increased expression of MGP in PAC and TOP resistant cell lines at both mRNA and protein level. MGP protein was also detected in the corresponding culture media. Finally, we detected expression of MGP protein in ovarian cancer lesions from different histological type of cancer. MGP is an important factor that might contribute to cancer resistance mechanism by augmenting the interaction of cells with ECM components leading to increased resistance of ovarian cancer cells to paclitaxel and topotecan. Expression found in ovarian cancer tissue suggests its possible role in ovarian cancer pathogenesis.

Maternal health-related behaviours during pregnancy: a critical public health issue.

AIM: The aim of the study was to investigate the health-related behaviours of pregnant women. Maternal health-related habits, use of psychoactive medicines, diet, prevention of neural tube defects, oral cavity hygiene, chronic diseases and physical activity were analysed in a group of pregnant women attending antenatal classes. METHODS: Hundred pregnant women recruited from various antenatal classes in Poznan, Poland, were investigated using a questionnaire based on the Pregnancy Risk Assessment Monitoring System. RESULTS: The results showed that 29% of pregnancies were unplanned. In women with higher education, 62% reported that they were taking folic acid supplements during pregnancy, in contrast with 35% women with a lower level of education (p = .012). The study showed that 24% of women were exposed to second-hand smoke during pregnancy, and this was more common among younger study participants (p = .038). Nine percentage of women admitted drinking alcohol during pregnancy. Pre-pregnancy alcohol consumption was more frequent among women with higher education (p = .011). Only 46.7% of women informed their dentist about their pregnancy, and these were more often older participants (p = .023). CONCLUSION: The study found low maternal awareness regarding health-related behaviours, which presents a serious challenge to public health care in Poland. Pregnant women and those who wish to conceive need to be educated effectively about preventive measures in order to maintain optimal maternal and reproductive health, as well as normal fetal development.

Costs of the use of carbetocin in the prevention of uterine atony following delivery of the infant by Caesarean section - retrospective multicenter study.

OBJECTIVES: The aim of this study was to compare the costs of using carbetocin in the prevention of uterine atony following delivery of the infant by Cesarean section (C-section) under epidural or spinal anesthesia with standard methods of prevention (SMP). MATERIAL AND METHODS: This retrospective multicenter study was based on data from three medical centers. A questionnaire was developed to gather patient records on consumption and costs of resources related to C-section, prevention of uterine atony and postpartum hemorrhage (PPH) treatment. Six subpopulations were considered, depending on patient characteristics. The analysis covered two perspectives: that of the hospital and of the public payer. RESULTS: The subpopulations were homogenous, which was a premise for pooling the data. The use of carbetocin in the prevention of uterine atony following Cesarean section generates savings for hospital in comparison with SMP (oxytocin) in 5 of 6 subpopulations. The biggest savings were observed amongst patients who experienced severe PPH and reached 2.6-6.2 thousand PLN per patient. Costs of services related to C-section borne by the hospitals were higher than the refund received from a public payer. The greatest underestimation reached 12.1 thousand PLN per patient. Nevertheless, loss generated by this underfunding was lower in carbetocin versus oxytocin group. CONCLUSIONS: The use of carbetocin instead of SMP gives hospitals an opportunity to make savings as well as to reduce losses resulting from the underfunding of the services provided by the National Health Fund.

Misoprostol Vaginal Insert in Labor Induction: A Cost-Consequences Model for 5 European Countries-An Economic Evaluation Supported with Literature Review and Retrospective Data Collection.

INTRODUCTION: The present study aimed to assess the costs and consequences of using an innovative medical technology, misoprostol vaginal insert (MVI), for the induction of labor (IOL), in place of alternative technologies used as a standard of care. METHODS: This was a retrospective study on cost and resource utilization connected with economic model development. Target population were women with an unfavorable cervix, from 36 weeks of gestation, for whom IOL is clinically indicated. Data on costs and resources was gathered via a dedicated questionnaire, delivered to clinical experts in five EU countries. The five countries participating in the project and providing completed questionnaires were Austria, Poland, Romania, Russia and Slovakia. A targeted literature review in Medline and Cochrane was conducted to identify randomized clinical trials meeting inclusion criteria and to obtain relative effectiveness data on MVI and the alternative technologies. A hospital perspective was considered as most relevant for the study. The economic model was developed to connect data on clinical effectiveness and safety from randomized clinical trials with real life data from local clinical practice. RESULTS: The use of MVI in most scenarios was related to a reduced consumption of hospital staff time and reduced length of patients' stay in hospital wards, leading to lower total costs with MVI when compared to local comparators. CONCLUSIONS: IOL with the use of MVI generated savings from a hospital perspective in most countries and scenarios, in comparison to alternative technologies. FUNDING: Sponsorship, article processing charges, and the open access charge for this study were funded by Ferring Pharmaceuticals Poland.

An Association between Single Nucleotide Polymorphisms of Lys751Gln ERCC2 Gene and Ovarian Cancer in Polish Women.

Aim. The aim of this study was to evaluate the role of the Lys751Gln (rs13181) ERCC2 gene polymorphism in clinical parameters and the risk for development of ovarian cancer. Material and Methods. The study consisted of 430 patients with ovarian cancer (mean age: 53.2 ± 10.11) and 430 healthy subjects (mean age: 50.31 ± 18.21). Analysis of the gene polymorphisms was performed using the PCR-based restriction fragment length polymorphism (PCR-RFLP). The odds ratios (ORs) and 95% confidence intervals (CIs) for each genotype and allele were calculated. Results. The results obtained indicate that the genotype Gln/Gln is associated with an increased risk of ovarian cancer (OR 5.01; 95% CI 3.37-7.43; p < 0.0001). Association of Lys751Gln polymorphism with histological grading showed increased ERCC2 Gln/Gln (OR = 6.96; 95% CI 3.41-14.21; p < 0.0001) genotype in grading 1 as well as Gln allele overrepresentation (OR = 4.98; 95% CI 3.37-7.40; p < 0.0001) in G1 ovarian patients. Finally, with clinical FIGO staging under evaluation, an increase in ERCC2 Gln/Gln homozygote frequencies in staging I and Gln allele frequencies in SI were observed. Conclusion. On the basis of these results, we conclude that ERCC2 gene polymorphism Lys751Gln may be associated with an increased risk of ovarian carcinoma.

Single nucleotide polymorphisms (SNPs) of hOGG1 and XRCC1 DNA repair genes and the risk of ovarian cancer in Polish women.

The aim of this study was to determine single nucleotide polymorphisms in hOGG1 (Ser326Cys (rs13181)) and XRCC1 (Arg194Trp (rs1799782)) genes, respectively, and to identify the correlation between them and the overall risk, grading and staging of ovarian cancer in Polish women. Our study comprised 720 patients diagnosed with ovarian cancer and 720 healthy controls. The genotype analysis of hOGG1 and XRCC1 polymorphisms was performed using polymerase chain reaction (PCR)-based restriction fragment length polymorphism (PCR-RFLP). Odds ratios (OR) and 95 % confidence intervals (CI) for each genotype and allele were calculated. Results revealed an association between hOGG1 Ser326Cys polymorphism and the incidence of ovarian cancer. Variant Cys allele of hOGG1 increased the overall cancer risk (OR 2.89; 95 % CI 2.47-3.38; p < .0001). Moreover, ovarian cancer grading remained in a relationship with both analysed polymorphisms; G1 tumours presented increased frequencies of hOGG1 Cys/Cys homozygotes (OR 18.33; 95 % CI 9.38-35.81; p < .0001) and XRCC1 Trp/Trp homozygotes (OR 20.50; 95 % CI 10.17-41.32; p < .0001). Furthermore, G1 ovarian cancers displayed an overrepresentation of Cys and Trp allele. In conclusion, hOGG1 Ser326Cys and XRCC1 Arg194Trp polymorphisms may be regarded as risk factors of ovarian cancer.

Practical aspects of change management at the Obstetrics and Gynecology Clinic at the University Hospital of Medical Sciences in Poznan, Poland.

INTRODUCTION AND OBJECTIVES: Recent changes to the Polish healthcare system have forced healthcare managers and administrators to implement modern instruments for strategic and operations management. The main aim of the study was to analyze the effect of managerial decisions in the area of human resources, resulting from the adopted restructuring program, on the economic situation of the OGCH, PUMS. MATERIAL AND METHODS: The research material comprised of secondary sources on finance, accounting and human resources data: financial statements, analysis of costs incurred by individual hospital departments, reports on the implementation of NHF contracts for providing health services and on hospital workforce at the time of the study, as well as the results of patient satisfaction survey at the OGCH, PUMS. RESULTS: After implementation of the restructuring program all clinics apart from one - Surgical Gynecology Clinic - reached better beds occupancy rates in 2012 as compared to 2009, as well as significantly improved profit/per hospital bed. Over the course of three years, since the launch of the hospital restructuring program, a significant (20%) increase in the revenues from selling healthcare services and a simultaneous decrease (2%) of the operating cost was observed. CONCLUSIONS: Inclusion of department heads into the decision making processes of managerial accounting seems to be necessary to improve the overall financial condition of a hospital. However, it requires a more flexible hospital structure, what can be achieved by implementing a divisional organizational structure, which grants individual organizational units a certain autonomy in the process of making medical-financial decisions.