Correlation between cervical infection and preterm labor.

Aim To investigate a correlation between cervical canal infection and imminent preterm labor and to identify most frequent pathogens. Methods A prospective study was conducted in obstetrics/gynecology departments of Health Center and the University Clinical Center Tuzla, and General Hospital Tesanj (Bosnia and Herzegovina, B&H) between October 2013 and May 2014. An examined group included 50 healthy pregnant women with singleton pregnancy of the gestation age between the 28th and 37th week, with cervical changes that are related to imminent preterm labor. Changes were detected by ultrasound biometry of cervix and modified Bishop score. A control group included 30 healthy pregnant women with singleton pregnancy of the gestation age between the 28th and 37th week of pregnancy without signs of imminent preterm labor. Cervical mucus was microbiologically analyzed for identification of pathogens. Results The infection in cervical canal was proven in 35 (70%) examinees and four (13%) patients from the control group (p=0.015). In seven (20%) cases each Ureaplasma and Mycoplasma were detected followed by E. coli in five (14%) cases (p=0.001). Conclusion Cervical canal infection is associated with changes on cervix and premature rupture of fetal membranes, i.e. preterm labor and imminent preterm labor. Screening for infection before pregnancy should be the main task of family doctors as well as gynecologists.

IGFBP-1 marker of cervical ripening and predictor of preterm birth.

Aim To establish a correlation between positive values of IGFBP-1(>10 mg/L, Actim Partus Test, APT) and premature cervical ripening in imminent preterm labor. Methods A prospective study was conducted in primary health care centers in Tuzla, Gynecology and Obstetrics Clinic of the University Clinical Centre in Tuzla and General Hospital Tesanj. The study included 50 women (singleton pregnancy, 28-37 week) with imminent preterm labor diagnosed by cervical biometry and modified Bishop score) (examinees) and 30 healthy pregnant women (control group). The presence of IGFBP-1 was tested in cervical secretion several times in weeks 28-37 until a positive test was shown. Results IGFBP-1 was positive in 43 (86%) examinees and in six (20%) patients from the control group (p=0.001). In 31 (62%) examinees APT was positive in weeks 28-30, and in nine (18%) in weeks 31- 33, while three (6%) examinees had positive test in 34-37 week; in the control group, three (10%) were tested positive in weeks 31-33 and three (10%) in weeks 34-37. At first testing (28-30 weeks) APT was statistically significantly more frequently positive in the examined group (p<0.05). Later, tests did not find statistically significant difference in the frequency of positivity between the control and examined group (p=0.08). Conclusion Elevated values of IGFBP -1 in cervical secretion were highly correlated with preterm labor. Screening for IGFBP could help in preventing preterm labor and its complications.

Estimate of cervical cancer incidence and mortality rate in Bosnia and Herzegovina.

The exact incidence and mortality rate in Bosnia and Herzegovina are unknown as there are no National Cancer Register. The available data are mostly based on the estimation from neighboring countries. Therefore, the aim of this study was to present the preliminary but more accurate estimates of cervical cancer incidence and mortality rates in Bosnia and Herzegovina. The data on cervical cancer cases in Bosnia and Herzegovina were collected from different sources and varies depending on the size of the city or region. To calculate the crude rates for the period from 2000 to 2008, we used the Bosnian and Herzegovinian population census for 1991. Thus, the crude incidence rate in Sarajevo region is more equable (app. 30.4/100,000 women-year), while in Tuzla Canton it varied from 18.5 in 2005 to 4.8/100,000 in 2000. In Tuzla Canton, in the period 1993-2006, 27.1% of all women with cervical cancer were younger than 30. However, the exact crude incidence in Bosnia and Herzegovina could be even higher. Data from Tuzla Canton showed slight increase in mortality rate in the last 5years (4.9/100,000), with the peak in 2007 (7.0/100,000). The presented data reflects the situation throughout Bosnia and Herzegovina and underline the necessity of the implementation of cervical cancer register and organized screening program.

Ovarian cancer in the Federation of Bosnia and Herzegovina during the 1996 - 2010 period.

AIM: To investigate the ovarian cancer incidence for the period 1996-2010 in the Federation Bosnia and Herzegovina (FBandH) emphasizing that there is no official cancer database for that period. METHODS: This retrospective study analyzed ovarian cancer incidence in the period 1996-2000 and an estimation of incidence for the period 2000-2010 based on this data, as well as on 2007 -2010 incidence according to the Federal Public Health Institute. RESULTS: The incidence of ovarian cancer in the period 1996-2000 was 3.68-6.38/100.000. The estimate of incidence for the period 2000-2010 resulted with the rate of 14.6 at the end of the analyzed period. According to the Federal Public Health Institute, incidence for the period 2007-2010 was 11.4-12.4/100.000. CONCLUSION: According to different sources incidence of ovarian cancer in the Federation BH varies from 11.4-12.4/100.000, which is lower than the incidence for Southern Europe and neighboring countries. Incidence published by the International Agency for Research on Cancer (2008) for BH (both entities) was 10.1/100.000. An increasing trend of incidence is evident too. However, in FBiH a cancer database does not exist, while the system of cancer registration does not function or operate without proper coordination. A further main task for health authorities is to establish a functional system of cancer registration and a database, which would enable a follow-up and work on prevention and early detection of ovarian cancer.

Human papillomavirus genotype distribution in invasive cervical cancer in Bosnia and Herzegovina.

PURPOSE: Countries of the former Yugoslavia bear some of the highest cervical cancer burden in Europe. In Bosnia and Herzegovina (B&H), data on human papillomavirus (HPV) genotype distribution among cervical cancer cases is scarce. This baseline information is critical in order to evaluate the impact of prophylactic HPV vaccines. This study aims to provide specific information for B&H. METHODS: The final analysis comprised 283 cases of invasive cervical cancer identified at the Polyclinic for Laboratory Diagnostic, University Clinical Center Tuzla in B&H between 1984 and 2004. HPV was detected through amplification of HPV DNA using SPF-10 broad spectrum primers followed by deoxyribonucleic acid enzyme inmunoassay and genotyping by reverse line probe assay (LiPA(25), version 1). RESULTS: Most cases (92.2%) were histologically classified as squamous cell carcinoma (SCC). A total of 268 cases (94.7%) were positive for HPV. Infections were mainly present as single (95.5%) and HPV16 and 18 accounted for 77.8% of the positive cases. The next most common HPV types were HPV45 (4.4%), HPV33 (3.1%), HPV51 (2.3%) and HPV31 (2.2%). The mean age of cases infected with the seven most common types worldwide (HPV16/18/45/31/33/52/58) was 51.1 (SD=11.6), six years younger than the one for cases infected with other types (56.3, SD=12.9). CONCLUSIONS: Available HPV vaccines could potentially prevent 77.8% of Bosnian cervical cancer cases (i.e. those associated with HPV16/18). If the reported magnitude of the cross-protection of licensed vaccines for non-vaccine HPV types is long lasting, an additional 6 to 10% of cases could be prevented.

[Early detection of ovarian cancer in FB&H--role of family medicine]. / Rana detekcija raka jajnika u FBiH--uloga porodicne medicine.

PURPOSE: Detection of ovarian malignancy in early stage is one of the main problems of modern medicine. In FB&H problem is even larger due to fact that official demographic data are insufficient while National Cancer Registry and National strategy for early detection of ovarian malignancy are not established yet. Overlook of ovarian malignancy in Federation B&H considers comprehensive and precise analysis of populations' characteristics with highlights of risk factors such as: age, parity, hereditary factors, menstrual cycle characteristics, environmental factors. WORK METHOD: Retrospective multi-centric study. Disease histories of 272 patients with ovarian cancer within the Federation B&H were analyzed. Usual statistic methods were performed (T- test, chi2 -Test, Fisher exact test) using statistical programme Arcus Quick Stat. WORK RESULTS: 1) Disease was diagnosed most often in stage III and IV (60%); 2) Epithelial cancer was diagnosed in 88.6% cases; 3) most frequently in age of 55 to 70; 4) Out of 272 patients null-parity was seen in 16.9% while 19.8% had just one pregnancy; 5) Approximately 1.8% patients had close relatives with cancer of breast, ovary or colon; 6) Menstrual cycle duration shorter than 21day was found in 26,5% cases. DISCUSSION: Ovarian cancer is severe disease which is detected mostly in advanced stages and has poor prognosis. Most often disease is detected in perimenopause. Epithelial carcinoma is most often histological type. There are some proven risk factors: age, parity, genetic predisposition. Seeking for those that belong to risk group should be main task in National strategy. Family doctors who are supposed to cover whole population with their activity should be involved in process of identification of risk groups bearing in mind their role in Health System Reform. CONCLUSION: Ovarian cancer known as "Silent Killer" due to lack of symptoms and insufficiency of diagnostics methods for early detection. There are some particular problems existing in B&H caused by the lack of National strategy for ovarian cancer early detection. We recommend to medical health officials several activities that should be performed to improve prognosis for patient with such deadly disease: 1. To establish of Cancer registry; 2. To form available official and precise demographic database; 3. To involve family doctors in process of risk group identification; 4. To identify medical centres for early diagnostic, treatment and follow up; 5. To establish algorithms for: diagnostic, treatment and follow up.