Mirjana Varjacic

Population aging and migration – history and UN forecasts in the EU-28 and its east and south near neighborhood – one century perspective 1950–2050

BackgroundThere is a gap in knowledge on long term pace of population aging acceleration and related net-migration rate changes in WHO European Region and its adjacent MENA countries. We decided to compare European Union (EU-28) region with the EU Near Neighborhood Policy Region East and EU Near Neighborhood Policy Region South in terms of these two essential features of third demographic transition. One century long perspective dating back to both historical data and towards reliable future forecasts was observed.MethodsUnited Nation’s Department of Economic and Social Affairs estimates on indicators of population aging and migration were observed. Time horizon adopted was 1950–2050. Targeted 44 countries belong to either one of three regions named by EU diplomacy as: European Union or EU-28, EU Near Neighborhood Policy Region East (ENP East) and EU Near Neighborhood Policy Region South (ENP South).ResultsEuropean Union region currently experiences most advanced stage of demographic aging. The latter one is the ENP East region dominated by Slavic nations whose fertility decline continues since the USSR Era back in late 1980s. ENP South region dominated by Arab League nations remains rather young compared to their northern counterparts. However, as the Third Demographic Transition is inevitably coming to these societies they remain the spring of youth and positive net emigration rate. Probably the most prominent change will be the extreme fall of total fertility rate (children per woman) in ENP South countries (dominantly Arab League) from 6.72 back in 1950 to medium-scenario forecasted 2.10 in 2050. In the same time net number of migrants in the EU28 (both sexes combined) will grow from − 91,000 in 1950 to + 394,000 in 2050.ConclusionsLong term migration from Eastern Europe westwards and from MENA region northwards is historically present for many decades dating back deep into the Cold War Era. Contemporary large-scale migrations outsourcing from Arab League nations towards rich European Protestant North is probably the peak of an iceberg in long migration routes history. However, in the decades to come acceleration of aging is likely to question sustainability of such movements of people.

Monitoring of drug-associated electrolyte disturbances in a hospital.

The aim of our study was to find drug‐associated changes in serum levels of major electrolytes using clinical‐event monitoring method.

Estradiol decreases blood pressure in association with redox regulation in preeclampsia

ABSTRACT In this study, we tested a hypothesis that a short-term estradiol therapy may reduce blood pressure in preeclampsia by modulating plasma oxidative stress. The intramuscular injections of 10 mg 17-beta-estradiol were prescribed to preeclamptic pregnant women during the 3-day therapy before a labor induction. The analyses of mean arterial pressure (MAP), serum estradiol concentrations, plasma superoxide anion (O2.), hydrogen peroxide (H2O2), nitrites (NO2−), and peroxynitrite (ONOO−) were conducted before and during the therapy. We found that the plasma concentrations of oxidative stress markers, such as O2– and H2O2, are higher in preeclampsia and positively correlated with the MAP value. Moreover, it was shown that the plasma concentration of NO2– as an indicator of NO levels is higher in preeclampsia. A short-term intramuscular application of estradiol decreases the MAP value and the plasma concentration of O.–, H2O2, NO2−, and ONOO– in preeclampsia. A positive correlation between the decrease of MAP values and the decrease of plasma concentrations of O2–, H2O2, and ONOO– was found in preeclampsia during a short-term estradiol therapy. We conclude that the short-term estradiol therapy decreases the MAP value in preeclampsia by modulating the plasma oxidative stress. We speculate that the estradiol metabolism in preeclampsia is an important mechanism that contributes to vascular dysfunction.

Characteristics of Pregnancy, Delivery and The Postpartum Period in Pregnant Women Diagnosed with Gestational Diabetes Mellitus

Abstract Gestational diabetes mellitus refers to both transient diabetes that arises during pregnancy and is restored postpartum as well as forms of the disease that arise for the first time during pregnancy and persistently exhibit insulin-dependence (type 1) after childbirth. The basis for the development of gestational diabetes is the existence of insulin resistance. Our target population was pregnant women between 20 and 46 years of age who were diagnosed with gestational diabetes (after the 24th week of pregnancy) and who were treated at the Department of Pathology of Pregnancy, Clinical Centre Kragujevac. During the research period, data were collected from 95 pregnant women with diagnosed gestational diabetes. In 3 women, the pregnancy ended in intrauterine foetal demise, and the study was continued with 92 subjects. This is a cross-sectional, retrospective and observational study. The average age of the examinees in our sample is 31.6 years. A total of 77.89% of the examinees achieved normoglycaemia exclusively via a hygienic dietary regimen. However, 27.2% of the subjects exhibited comorbidities in addition to gestational diabetes, which further complicated the pregnancy. A total of 70.7% examinees delivered between the 37th and 40th week of gestation. Vaginal delivery was dominant, with episiotomy in almost half the cases. The average body weight of newborns from pregnancies complicated by gestational diabetes was 3587.07 grams, which is very close to the macrosomia limit of 4000 grams. The timely detection of gestational diabetes and an adequate treatment of pregnant women can prevent the occurrence of foetal macrosomia as the primary complication of these pregnancies. Pregnancy complicated by gestational diabetes is not necessarily an indication for a Caesarean section.

Unnecessary Hysterectomy due to Menorrhagia and Disorders of Hemostasis: An Example of Overuse and Excessive Demand for Medical Services

Excessive menstrual bleeding—menorrhagia is a common gynecologic disorder affecting women of reproductive age. Subjectively, menorrhagia is defined as a complaint of heavy cyclical menstrual bleeding occurring over several consecutive cycles (Rönnerdag and Odlind, 1999). Objectively, it can be defined as heavy menstrual bleeding lasting for more than 7 days or resulting in the loss of more than 80 mL per menstrual cycle (ACOG Committee on Practice Bulletins—Gynecology, American College of Obstetricians and Gynecologists, 2001). An objective evaluation of the existence of menorrhagia is not simple. Alkaline hematin technique is completely objective measure (extracting hemoglobin from sanitary wear to assess blood loss), but it is impractical out of controlled research settings. Widely used alternative is the pictorial blood loss assessment chart (PBAC) and this is semiobjective method takes into account the number and the degree of staining of items of sanitary wear used. PBAC is easier to perform than the alkaline hematin technique, yet yields more objective results than self-reporting (Warner et al., 2004). Data from literature suggested that approximately 10% of reproductive-aged women had objective evidence of menorrhagia, but studies based on self-reported information suggested that approximately 30% of women of reproductive age were afflicted with heavy menstrual bleeding (Dilley et al., 2002; Shapley et al., 2004). According to our research, out of 115 women who self-report these excessive menstrual bleeding only 55% had actually verified menorrhagia by PBAC (Djukic et al., 2013). Menorrhagia can happen due to anatomic (uterine fibroids, endometrial polyps, endometrial hyperplasia, and pregnancy), endocrinologic (thyroid and adrenal gland dysfunction, pituitary tumors, anovulatory cycles, polycystic ovarial syndrome, obesity, and vasculature imbalance), iatrogenic (steroid hormones, chemotherapy agents, medications) and organic (organ dysfunction infection, bleeding disorders) abnormality (Vilos et al., 2001; Albers et al., 2004).

Correlation Between Cervical Cytology and Histopathological Cervical Biopsy Findings According to the Bethesda System / Stepen Korelacije Cervikalne Citologije Po Bethesda Klasifikaciji Sa Patohistološkim Nalazima Cervikalne Biopsije

ABSTRACT The Pap test (Pap smear) is a morphological cytodiagnostic test that reveals premorbid and early stages of cervical cancer through the use of cervicovaginal cytology. The present study was conducted at the Department of Gynecology and Obstetrics, Clinical Center Kragujevac, from January 01, 2013, to December 1, 2013, with patients who were part of the national screening program and who used a secondary cytological examination (Pap test) performed using a conventional method. The patients were grouped according to the results of a Pap smear and histopathological findings. The classification of cytological smears was performed in accordance with the Bethesda system. The hypotheses established in this study were statistically tested. The greatest number of cytological findings was NILM. However, the most frequent abnormal cytological findings in terms of percentage were ASC-US. After secondary cervical findings of 8.1% of the total number of women, biopsies were performed. In 68.57% of the biopsies performed, CIN was present in all of them, with the most frequent ones being LSIL (50.6%), HSIL (10.4%) and CA Invasiva (0.5%). This study, using the X2 test, confirmed that cervical cytology and biopsy results are dependent features (sig. = 0.036), between which there is a medium association (Cramer’s V = 0.176). In the ASC-US cytological findings, small percentages of CIN1 and CIN2 were detected. Cervical cytology in this study presented high sensitivity, specificity, positive and negative predictive value. As a relatively inexpensive, painless and easily approachable method, cervical cytology fully substantiates its implementation in diagnostic procedures as well as in organized screening programs. SAŽETAK Papa test je morfološki citodijagnostički test kojim se pomoću analize cervikovagnalne citologije otkrivaju predstadijumi i rani stadijumi karcinoma grlića materice. Studija je sprovedena na Klinici za ginekologiju i akušerstvo, KC Kragujevac u periodu od 01. 01. 2013. god. do 01. 12. 2013. god. na pacijentkinjama kojima je u okviru Nacionalnog skrining programa odrađen sekundarni citološki pregled (PAP test) konvencionalnom metodom. Pacijentkinje su grupisane prema rezultatima PAP testa i patohistološkim rezultatima. Klasifikacija citoloških briseva je vršena prema Bethesda klasifikaciji. Statističkim testovima su testirane hipoteze postavljene u ovoj studiji. Najveći broj citoloških nalaza bio je NILM. Procentualno najzastupljeniji abnormalni citološki nalazi su bili ASCUS. Nakon sekundarnog cervikalnog nalaza kod 8,1% od ukupnog broja žena je odrađena biopsija. U 68,57% urađenih biopsija je bio prisutan CIN od kojih je najzastupljeniji bio nalaz LSIL (50,6%), zatim HSIL (10,4%), i CA INVASIVA (0,5%). Ovom studijom, uz primenu Xi2 testa, potvrđeno je da su cervikalna citologija i rezultati biopsije zavisna obeležja (Sig.=0,036), između kojih postoji veza srednje jačine (Cramer’s V=0,176). U citološkom nalazu ASCUS detektovano je mali procenat CIN1 i CIN2. Cervikalna citologija u ovoj studiji pokazuje visoku senzitivnost, specifičnost, pozitivnu i negativnu prediktivnu vrednost. Kao relativno jeftina, bezbolna i lako dostupna metoda u potpunosti potvrđuje svoju primenu, kako u dijagnostičkim procedurama, tako i u organizovanim skrining programima.

The incidence of Down syndrome in newborns at the Department of Obstetrics and Gynecology of the Clinical center Kragujevac during the period 2007-2012

Objective. The main objective of this study was to determine the incidence of Down syndrome in newborn infants diagnosed prenatally and in newborn children in Kragujevac. Methods. This retrospective study included groups of 1208 pregnant women and 10,712 mothers aged 14-55 years, who came to the Gynecology and Obstetrics Clinic, Clinical Center Kragujevac during the period 2007-2012. Cells of amniotic fluid, taken during amniocentesis between 16 and 18 weeks of pregnancy, were cultured for 12 days and, after cytogenetic processing, stained and analyzed with light microscopy. Data were analyzed and presented descriptively. Results. During the four year period, between January 2007 and December 2011, 8 cases of Down syndrome were diagnosed by amniocentesis of 1208 amnions, which resulted in incidence of 1 in 151 amnions. Also, there were 15 cases of liveborn children with Down syndrome in 10822 liveborn babies, which made an incidence of 1 in 721 liveborns. The total of 1070 pregnancies were with mothers older than 35 years at the time of labor and 5 of 15 liveborn babies with Down syndrome were from mothers belonging to this group. Also, 9464 pregnancies were with mothers aged 18-35 years and in this group there were the last 10 cases of Down syndrome. There were 8 fetuses with Down syndrome, all diagnosed with trisomy 21, and all 8 aborted by choice of the Ethical committee of the Clinical Center Kragujevac. Conclusion. The decision of not having prenatal diagnostics for pregnancies, some by late amniocentesis, some by the decision of the family, resulted in Down syndrome liveborns.