Natural Cyanobacteria Removers Obtained from Bio-Waste Date-Palm Leaf Stalks and Black Alder Cone-Like Flowers.

The impact of urbanization and modern agricultural practice has led to accelerated eutrophication of aquatic ecosystems, which has resulted in the massive development of cyanobacteria. Very often, in response to various environmental influences, cyanobacteria produce potentially carcinogenic cyanotoxins. Long-term human exposure to cyanotoxins, through drinking water as well as recreational water (i.e., rivers or lakes), can cause serious health consequences. In order to overcome this problem, this paper presents the synthesis of completely new activated carbons and their potential application in contaminated water treatment. The synthesis and characterization of new active carbon materials obtained from waste biomass, date-palm leaf stalks (P_AC) and black alder cone-like flowers (A_AC) of reliable physical and chemical characteristics were presented in this article. The commercial activated carbon (C_AC) was also examined for the purpose of comparisons with the obtained materials. The detailed characterization of materials was carried out by X-ray diffraction (XRD), Fourier-transform infrared spectroscopy (FTIR), low-temperature N2 physisorption, and Field emission scanning electron microscopy (FESEM). Preliminary analyzes of the adsorption capacities of all activated carbon materials were conducted on water samples from Aleksandrovac Lake (Southern part of Serbia), as a eutrophic lake, in order to remove Cyanobacteria from water. The results after 24 h showed removal efficiencies for P_AC, A_AC, and C_AC of 99.99%, 99.99% and 89.79%, respectively.

Flexible GnRH antagonist protocol vs. long GnRH agonist protocol in patients with polycystic ovary syndrome treated for IVF: comparison of clinical outcome and embryo quality.

OBJECTIVES: Polycystic ovary syndrome (PCOS) is a common endocrine disorder, primarily affecting women of the reproductive age. The aim of the study was to assess the clinical efficacy and embryo quality in flexible gonadotropin-releasing hormone (GnRH) antagonist protocol in comparison to the long GnRH agonist protocol in PCOS women undergoing in vitro fertilization (IVF). MATERIAL AND METHODS: This prospective, randomized study was conducted at the Department of Gynecology and Obstetrics, Clinical Center Nis, Serbia, between 2013 and 2014. The treatment included either a flexible GnRH antagonist protocol (n = 45, antagonist group) or a long GnRH agonist protocol (n = 45, agonist group). RESULTS: The length of the stimulation, total amount of gonadotropins used, as well as the average number of the aspirated and mature oocytes were higher in the agonists group. The endometrial thickness was also greater in the agonists group. A higher number of Class I and Class IV embryos were obtained after the agonist treatment and higher number of Class II and Class III embryos were obtained after the antagonist treatment. Pregnancy, implantation, and miscarriage rates were comparable between the groups. CONCLUSIONS: The GnRH antagonist protocol in PCOS patients has a pregnancy rate comparable to that of the GnRH agonist protocol. Since this protocol has a lower rate of complications and is more convenient for patients, we believe that the GnRH antagonist protocol should be used as the first-line treatment for PCOS patients in an IVF program.

Number of decidual natural killer cells & macrophages in pre-eclampsia.

BACKGROUND & OBJECTIVES: The process of human placentation is complex and still not well understood. This study was aimed to examine the relationship between clinical features of pre-eclampsia and degree of trophoblastic invasion after its immunohistochemical visualization in the context of possible alterations in the number of natural killer (NK) cells and macrophages in the decidua. METHODS: This prospective study included a study group comprising 30 pregnant women with pre-eclampsia delivered by caesarean section and a control group comprising 20 healthy pregnant women also delivered by caesarean section. Samples of placental bed obtained during caesarean section were analyzed after immunohistochemical labelling CD56 + NK cells, CD68 + macrophages and cytokeratin 7 trophoblastic cells. RESULTS: In pre-eclampsia, there was a significantly lower number of CD56 + NK cells in the decidua (P<0.001) and a higher number of CD68 + macrophages (P<0.001) compared to control group. In the subgroup of pre-eclampsia with intrauterine growth retardation (IUGR), a significantly greater number of NK cells (P<0.05) was recorded, as well as an increased number of macrophages, but not significantly compared to pre-eclampsia without IUGR. There was no significant difference in the distribution of these cells in the decidua in relation to the severity of pre-eclampsia. CD56 + NK cells were significantly less (P<0.05) and macrophages were more (P<0.05) in the group with poor trophoblastic invasion. INTERPRETATION & CONCLUSIONS: Alterations in the number of immune cells in relation to the degree of trophoblastic invasion indicated their role in aetiopathogenesis of pre-eclampsia, while the direct association between their number and severity of pre-eclampsia was not confirmed.

Metastatic malignant melanoma of the uterus diagnosed by colposcopy.

Introduction: Primary and metastatic malignant melanomas represent a rare diagnosis with a small number of described cases. The aggressive nature of the tumor, non-specific symptoms, difficult diagnosis, and no official protocol about the treatment result in poor disease prognosis. Case Outline: The authors presented a 41-year-old multigravida patient. She had an operation of malignant melanoma in the occipital area of the head. She went to her gynecologist because of increased pale pink vaginal secretion. Gynecological examination didn't show any significant abnormalities apart from a slightly enlarged uterus. Papanicolaou test and vaginal secretion examination were normal. Colposcopically, a significant dark brown hyperpigmented area around 1 cm in size was observed on the posterior lip of the cervix, near the orifice and cervical canal, suspicious of melanoma, which was proven on targeted biopsy of the hyperpigmented change on the cervix, and by magnetic resonance imaging of the lesser pelvis. Classic hysterectomy with adnexectomy and regional pelvic lymphadenectomy were performed. Conclusion: This case report pointed out the significance of applying colposcopy in diagnosing suspected metastatic melanoma of the uterine cervix, along with other diagnostic methods and anamnestic data.

ALTERNATIVES OF MENOPAUSAL HORMONE THERAPY.

INTRODUCTION: It has been generally accepted that the benefits of menopausal hormone therapy outweigh the risks. but there are still some concerns about the administration of menopausal hormone therapy, which has introduced alternative treatments. Pharmacological Alternatives. Central alpha-2 agonist clonidine is only marginally more effective than placebo, and significantly less effective than estrogen. Antiepileptic drug gabapentin reduces hot flashes; however, it is less effective than estrogen. Selective serotonin reuptake inhibitors (paroxetine and fluoxetine) and selective noradrenaline reuptake inhibitors (venlafaxine) reduce vasomotor symptoms and improve depression, anxiety and sleep. Results of studies about dehydroepiandrosterone effects on menopausal symptoms are inconsistent and additional investigations are needed. Non-Pharmacological Alternatives. Stellatum ganglion blockade is a successful treatment for reducing vasomotor symptoms in patients with contraindications for menopausal hormone therapy. Efficacy of acupuncture, homeopathy and reflexology Should be proved by adequate studies. Phytoestrogens could reduce vasomotortymptoms but to a lesser extent than conventional menopausal hormone therapy. However, they have not been proved yet to pro-ide cardiovascular protection and prevention of osteoporosis. nor they could be recommended instead of traditional menopausal hor-one therapy. There is a concern about their undesirable effects. Adequate diet, unchanging body weight Nwthin ideal values and adequate physical activities have beneficial long-term effects, first of all onlpreservation of bone density Alternatives for Atrophic Changes of Vaginal Epithelium. Menopausal symptoms resulting from vaginal atrophy could be resolved by use of hydrophilic prep- arations, lubricants and topical lidocaine creamn r 4% lidocaine water solution for dyspareunia. CONCLUSION: If there are contrain-ications to menopausal hormone therapy or patients are unwilling to take hormone therapy, alternative treatments, which canlalso solve menopausal symptoms, should be considered.

MENOPAUSAL HORMONE THERAPY BENEFITS AND DIFFERENT FORMS.

INTRODUCTION: Declining of ovarian hormone production can seriously disturb the quality of woman's life, with physical and emotional consequences and to potentiate the development of additional health risks such as cardiovascular diseases and osteoporosis which are already present in women of older age. Benefits of Menopausal Hormone Therapy. Menopausal hormone therapy ameliorates the quality of life by resolving the atrophic symptoms and vasomotor problems, protecting from the osteoporosis, maintaining the skin and connective tissue turgor, as well as by improving libido, mood and depression during the menopausal transition. Forms of Menopausal Hormone Therapy. There are several possibilities to treat menopausal problems: estrogen, combination of estrogen and progestogen, androgens, selective estrogen receptor modulators, tissue selective estrogen complex, tibolon and alternatives. Initiating, Monitoring and Discontinuing Menopausal Hormone Therapy. Menopausal hormone therapy should be started when the problems due to menopausal symptoms appear. It is important to have on mind that the effects of hormones depend on age and actual condition of the woman's organism. The goal is effective treatment at the lowest dose and during the shortest interval needed for symptom control. The therapy must be reevaluated every year and potential risks must be discussed as well. CONCLUSION: Menopausal hormone therapy ameliorates the quality of woman's life in perimenopause. Type, doses and duration of the menopausal hormone therapy should be individualized.

INFLUENCE OF BODY MASS INDEX ON IN VITRO FERTILIZATION OUTCOME IN WOMEN WITH POLYCYSTIC OVARY SYNDROME.

INTRODUCTION: The purpose of this study was to investigate the influence of the body mass index on the outcome of in vitro fertilization in patients with polycystic ovary syndrome. MATERIAL AND METHODS: The study sample consisted of 123 patients with polycystic ovary syndrome who completed their in vitro fertilization treatment at the Department of Gynecology and Obstetrics, Clinical Center Nis. Republic of Serbia, and they were retrospectively analyzed. The patients were divided by body mass index into two groups for the comparison of the findings. One group (normal weight) consi- sted ofwomenwithbodymass index ≤25 kg/in² (mean22.O8±1.90), and the other group (overweight) included women with body mass index>25 kg/in² (mean 27.65±1.47). The patients underwent either the standard long gonadotrophin-releasing hormone agonist protocol or flexible multidose gonadotrophin-releasing hormone antagonist protocol. RESULTS: The normal-weight patients had a higher number of mature oncytes, significantly higher fertilization rate (p

The structure of immunocompetent decidual cells in recurrent missed abortions.

Background/Aim: Recurrent or habitual missed abortions (RMA) are defined as three or more consecutive abortions. In the first trimester of pregnancy habitual missed abortions occur in about 1% of population. The aim of this immunohistochemical study of decidua in RMA of unknown etiology was to identify subpopulations of decidual lymphocytes in recurrent miscarriages and compare the distribution of immunocompetent cells in artificial abortions and RMA. Methods. The study included 30 women with at least 2 consecutive miscarriages in the first trimester of pregnancy. Curettements of the third missed abortion were immunohistochemically analyzed. The control group consisted of 20 women without loaded reproductive anamnesis, with the abortion for social reasons. Criteria for exclusion from the study were diagnosed uterine anomalies, positive screening for thrombophilia and women who suffered from diabetes mellitus and disorders in the function of the thyroid gland. Immunophenotyping was performed by immuno-alkaline phosphatase (APAAP) using monoclonal antibodies: CD 30, CD 45 RO, CD 56 and CD 57, CD 68. Methods: The number of missed abortions (1,223) was on the average 9.7% of all deliveriies during the test period. Among them RMA were registered in 52 (4.2%) patients and in 30 (57%) the exact etiology of abortions was not determined. RMA was most common in the 25-34 years of age group. The largest number of RMA showed the ultrasound characteristics of missed abortion in 60% of cases and was in nulliparous patients (76.7%). The number of NK CD56 positive cells did not differ significantly between the types of abortion. In the decidual tissue, a number of NK CD57 positive cells was significantly higher in missed abortions compared to artificial interruptions (p < 0.01). In artificial termination of pregnancy there was an absolute predominance of CD45RO lymphocyte subpopulations, whereas in the RMA group there was slightly greater predominance of CD30 positive cells. The completed analysis showed a significantly higher number of CD68 positive macrophages in a decidual tissue of RMA pregnancy (p < 0.01). Results: The number and phenotypic structure of NK cells are significantly different in normal pregnancy decidua and in RMA. The NK cell dominance is present in the RMA group, in favor of CD56+ and CD 57 of subpopulations with increased CD30 of T lymphocyte subpopulations. Macrophages are more numerous in the decidua of pregnancies ended in abortion, so the cause to RMA of unknown etiology in a number of cases could be disregulation of immunocompetent cells.

EARLY PRIMARY ABDOMINAL PREGNANCY IMPLANTED IN THE VESICOUTERINE POUCH - A CASE REPORT.

INTRODUCTION: An abdominal pregnancy is a rare form of ectopic pregnancy and potentially life-threatening condition. It is difficult to make an early diagnosis of abdominal pregnancy. CASE REPORT: We present a case of early primary abdominal pregnancy, diagnosed at 6th gestational week, located in thevesicouterine pouch and treated laparoscopically. Despite the rapidly decreasing serum ß-human chorionic gonadotropin levels, the presence of the intraperitoneal blood allowed neither expectant management nor medical treatment, although the patient was hemodinamically stable at that moment. The absence of significant bleeding during the surgery and histopathological finding of placental villi with necrosis confirmed that, in this case, the abdominal pregnancy was already the subject of spontaneous involution. CONCLUSION: High index of suspicion and carefully interpreted clinical and ultrasound findings are crucial for timely diagnosis of early abdominal pregnancy before the occurrence of massive and potentially fatal intraperitoneal bleeding.

In vitro fertilization outcome in women with endometriosis & previous ovarian surgery.

BACKGROUND & OBJECTIVES: Women with endometriosis often need in vitro fertilization (IVF) to concieve. There are conflicting data on the results of IVF in patients with endometriosis. This study was undertaken to elucidate the influence of endometriosis on IVF outcome to give the best counselling for infertile patient with this problem. METHODS: The outcome measures in 78 patients with surgically confirmed endometriosis were compared with 157 patients with tubal factor infertility, all of whom have undergone IVF. The groups were matched for age and follicle stimulating hormone (FSH) levels. Outcome measures included number of follicles, number of oocytes, peak oestradiol (E2) concentrations and mean number of ampoules of gonadotropins. Cumulative pregnancy, miscarriage and live birth rates were calculated in both the groups. RESULTS: Higher cancelation rates, higher total gonadotropin requirements, lower peak E2 levels and lower oocyte yield were found in women with endometriosis and previous surgery compared with those with tubal factor infertility. However, no differences were found in fertilization, implantation, pregnancy, miscarriage, multiple births and delivery rates between the endometriosis and tubal factor infertility groups. INTERPRETATION & CONCLUSIONS: The present findings showed that women with endometriosis and previous surgery responded less well to gonadotropins during ovarian stimulation and hence the cost of treatment to achieve pregnancy was higher in this group compared with those with tubal factor infertility. However, the outcome of IVF treatment in patients with endometriosis was as good as in women with tubal factor infertility.

Stages of endometriosis: does it affect in vitro fertilization outcome.

OBJECTIVE: Women with endometriosis often need in vitro fertilization (IVF) to conceive. There are conflicting data on the results of IVF in patients with endometriosis. The present study was undertaken to investigate whether or not the stage of endometriosis affects the IVF outcome in order to give the best patient counseling MATERIALS AND METHODS: We compared IVF outcome measures between 40 patients with surgically confirmed minimal and mild endometriosis (American Society for Reproductive Medicine Stage I/II) and 38 patients with moderate and severe endometriosis (Stage III/IV). Each group was also compared with a control group of 157 patients with tubal factor infertility. Outcome measures included number of follicles, number of oocytes, mean number of ampoules of gonadotropins, cumulative pregnancy, and live birth rates RESULTS: Higher cancelation rates, higher total gonadotropin requirements, and lower oocyte yield were found in women with endometriosis Stage III and IV compared with both the Stage I/II and control groups. The fertilization rate was higher in Stage III/IV endometriosis compared to Stage I/II. Clinical pregnancy and live birth rates were comparable between patients with endometriosis Stage I/II and control group, whereas they were significantly lower in patients with endometriosis Stage III/IV compared to other two groups. CONCLUSION: The American Society for Reproductive Medicine classification of endometriosis is useful in predicting IVF outcome. Advanced endometriosis means a worse prognosis for IVF treatment compared to milder stages or tubal factor infertility. The decreased fertilization rate in Stage I/II endometriosis might be a cause of subfertility in these women, as a result of a hostile environment caused by the disease.

Postpartum HELLP syndrome--the case of lost battle.

Unexpected rapid maternal death after delivery due to HELLP syndrome is rarely encountered and may become the subject of forensic expertise. Unexpectedness, suddenness, and fulminant course of this syndrome as well as absence of classical signs of pre-eclampsia can confuse physicians and lead to diagnostic delay. A definitive post-mortem diagnosis of HELLP syndrome in questionable cases of maternal death should be based on accepted laboratory criteria and characteristic histopathological alterations. We present a case of acute postpartum HELLP syndrome complicated by disseminated intravascular coagulation and acute renal failure which caused rapid maternal death only 20 hours after a caesarean section following an uncomplicated pregnancy.

[Results of in vitro fertilization cycles at the Clinic for Gynecology and Obstetrics, Clinical Center of Nis].

INTRODUCTION: Infertility affects 15-17% of reproductive age couples in our country. In vitro fertilization brought revolution in treatment of this problem, bringing hope to many couples around the world for more than 3 decades. The aim of this paper was to present results and experiences of implementation of this method of treatment at the Clinic of Gynecology and Obstetrics in Nis. MATERIAL AND METHODS: The study included the first 402 women who had undergone in vitro fertilization program at the Clinical Center of Nis. The data were statistically analyzed by basic descriptive methods. The main outcome measures were demographic features, cause of infertility, duration of stimulation, average gonadothropine consumption, number of oocytes per aspiration and embryos transferred, mode of conception as well as clinical pregnancy and aspiration rate. RESULTS: The two main factors were the male infertility and tubal factor inferitily, being 51.61% and 48.39%, respectively The classical method of in vitro fertilization constituted 72.40% of all cycles, while intra cytoplasmic sperm injection method was used in 27.60% of all cycles. The average number of embryos transferred was 2.75. The cycle cancellation rate was 15.05%. The clinical pregnancy rate per ermbryo transfer was 35.44%; while the live birth rate per embryo transfer was 26.53%. DISCUSSION AND CONCLUSION: Our success rates are comparable with those in other European countries, where for in vitro fertilization the clinical pregnancy rates per aspiration and per transfer were 29.0 and 32.4%, respectively in the observed period. For intra cytoplasmic sperm injection, the corresponding rates were 29.9 and 33.0%. The main difference from the European average was the average number of transferred embryos and lower percentage rate of intra cytoplasmic sperm injection as a method of conception. Results

[Characteristics of endometrial carcinoma in obese women].

INTRODUCTION: In most developed countries, endometrial cancer appears as most frequent invasive neoplasm of genital tract. Obesity is one of most important risk factors. Aim of study was to establish characteristics endometrial cancer in obese women. MATERIAL AND METHODS: The study included 50 surgically treated women with endometrial cancer. According body mass index they were divided into two groups--group A (30 obese women), group B (20 non-obese women). RESULTS AND DISCUSSION: Non-obese women with endometrial cancer are statistically significantly older than obese. Menopausal status, parity are not statistically significant. The obese group most frequently includes endometrioid type of tumor, while non-obese group most frequently includes non-endometrioid types of endometrial cancer. Over 50% thick myometrial invasion is statistically more frequent in non-obese group than in obese group. In obese group, less than 50% thick myometrial invasion, is statistically significant in comparison to nonobese group. High-differentiated endometrial cancer (G1) is statistically significantly more present in obese women than non-obese. Low-differentiated endometrial cancer is statistically more frequent in non-obese women than in obese. Most frequent in both groups is NG2. According to FIGO stage I, disease is statistically significantly more frequent in obese group than in non-obese. In non-obese group, total number of diseased in higher stages (II and III) is statistically significantly higher than in stage I. CONCLUSION: Endometrial cancer present in obese women is mostly endometroid type I, with slow myometrial invasion, with histological grade I, nuclear grade II in FIGO stage I of disease. In non-obese women, non-endometrioid cancer-- type II is more frequent, with faster myometrial invasion, histological grade II and III, nuclear grade II, in FIGO stage II of disease.

Insulin resistance and C-reactive protein in preeclampsia.

Preeclampsia is referred to as the "disease of the theories" because of the multiple hypotheses proposed to explain is occurrence. Despite considerable research, the causes of preeclampsia remain unclear. Preeclampsia is likely to be multifactorial in origin, and recent research has focused on endothelial dysfunction as a central abnormality in preeclampsia. Insulin resistance and inflammation may contribute to the onset of preeclampsia. They could also be correlated. The aim of the study was to evaluate the presence and relationship between insulin resistance and its markers and C-reactive protein as a marker of inflammation. During their third trimester, 17 preeclamptic women and 20 normotensive controls underwent oral glucose tolerance test, basic biochemical analyses and SHBG. Preeclamptic women were more insulin resistant (p=0,004), and they had higher triglycerides levels (p=0,006), uric acid (p=0,002). However, the study groups did not differ in C-reactive protein (CRP), sex hormone-binding globulin (SHBG), high and low-density lipoproteins (HDL-cholesterol and LDL-cholesterol). In multiple regression analysis only SHBG (p=0,014) and triglycerides (p=0,003) were associated with insulin sensitivity independently of the body mass index (BMI), weight gain, HDL and LDL, and CRP. Preeclampsia is a state of increased insulin resistance, and CRP as the marker of inflammation was not increased in our research, and not associated with established preeclampsia.

Evaluation of absolute volume of human fetal kidney's cortex and medulla during gestation.

BACKGROUND: Human fetal kidney is quite different from the mature kidney, both macroscopically and hystologically. Lobulated surface of the human fetal kidney reflects its inner organisation. AIM: To determine the fetal kidneys' volume according to the gestational age, to establish periods of their maximal and minimal growth and to compare these values for various gestational ages. METHODS: Forty five human fetal kidneys aged from IV to X lunar months were analyzed. Kidneys were divided into nine groups according to their gestational age. The volumes of cortex and medulla were determined using stereological methods. The results were statistically analyzed and the periods of significant growth of these structures were marked. RESULTS: Fetal kidney's cortex and medulla grew continually with a very high coefficient of linear correlation with crown-rump length. The cortex/medulla ratio was minimal in the first half of V lunar month, when medulla grew most rapidly and it was maximal immediately before birth, when cortex achieved its maximum. CONCLUSION: This study was an effort to provide some parameters which would help in the future investigations of the development of human fetal kidney.

[Laparoscopic ovarian biopsy and infertility]. / Laparoskopska biopsija ovarijuma i infertilitet.

In the most developed countries, laparoscopic diagnostics and surgical procedures in the chosen cases still play a very important role and represent the acceptable alternative to the extrauterine fertilization. On the basis of histopathological verification of ovary biopsy cuts taken during the laparoscopy, the optimum conditions are fulfilled for determination of the ovary potentiality enabling the selection of patients for the further proper treatment. 113 patients that, due to the marriage infertility, were examined and treated at the Department of Sterility and infertility of the Obstetrics and Gynecology Clinic, Clinical Center of Nis, with the average age of 31.39 +/- 6.10 and with the average marriage infertility period lasting from 4.11 +/- 2.99 had undergone the surgical laparoscopy. The most frequently used interventions that were performed, disregarding the adnexial findings, were salipongovariolyses in 73 cases (64.60%), then fimbrioplastic in 60 cases (53.10%). Ovary biopsy and histopathological analysis of the cuts taken were performed in 110 patients (89.39%). We got 105 histopathological findings. The most common histopathological findings showed the existence of the primordial folicules in 39.60% of women, with the prevalence in younger ones. (In patients younger than 20--66.67%, while in patients over 40--25%). We found out that the prevailing number of women had the histological findings that spoke on behalf of the potential ovaries in case the infertility lasted shorter. The ovary tissue cuts taken by biopsy that were histopathologically analyzed, showed the significantly higher pregnancy and delivery rate in findings with the primordial folicules present (67.5% of the pregnancy rate 57.5% of the intrauterine pregnancy rate and 47.5% of the delivery rate).