Testing the Institute of Medicine (IOM) recommendations on maternal reproductive health and associated neonatal characteristics in a transitional, Mediterranean population

BACKGROUND

High pre-pregnancy body mass index (BMI) and excessive gestational weight gain (GWG) are significant risk factors for maternal and neonatal health.

AIM

To assess pre-pregnancy BMI and GWG during pregnancy and their association with different maternal and neonatal characteristics in the transitional Mediterranean population from the Eastern Adriatic islands.

SUBJECTS AND METHODS

262 mother-child dyads from the CRoatian Islands' Birth Cohort Study (CRIBS) were included in the study. Chi-square test, ANOVA and regression analysis were used to test the association between selected characteristics.

RESULTS

22% of women entered pregnancy with overweight/obesity and 46.6% had excessive GWG. Pre-pregnancy overweight and obesity were significantly associated with elevated triglycerides uric acid levels, and decreased HDL cholesterol in pregnancy. Excessive GWG was associated with elevated fibrinogen and lipoprotein A levels. Women with high pre-pregnancy BMI and GWG values were more likely to give birth to babies that were large for gestational age (LGA), additionally confirmed in the multiple logistic regression model.

CONCLUSION

High maternal pre-pregnancy BMI and excessive GWG were both significantly associated with deviated biochemical parameters and neonatal size. More careful monitoring of maternal nutritional status can lead to better pre- and perinatal maternal health care.

Stress, locus of control, hope and depression as determinants of quality of life of pregnant women: Croatian Islands' Birth Cohort Study (CRIBS)

The aims were to investigate determinants of the quality of life (QoL) of pregnant women. Total of 302 healthy women 18 to 28 weeks of gestation participated in prospective study. WHOQOL-bref, Multidimensional Health Locus of Control scales, Edinburgh Postnatal Depression Scale, and the perceived stress appraisals were administered. Various patterns of predictors for four domains of QoL were identified, for psychological (42% variance explained), social relationship (29%), environmental (29%) and physical health (25%). Depression and hope, together with the extent to which one's health is influenced by powerful other or chance should be targeted in health promotion strategies during pregnancy.

Human papillomavirus-related diseases of the female lower genital tract: oncogenic aspects and molecular interaction

The causal role of human papillomavirus (HPV) in all cancers of the uterine cervix has been firmly established biologically and epidemiologically. Most cancers of both the vulva and the vagina are also induced by HPV. Papillomaviruses are perfectly adapted to their natural host tissue, the differentiating epithelial cell of skin or mucosae, and exploit the cellular machinery for their own purposes. The infectious cycle is initiated once the infectious particles reach the basal layer of the epithelium, where they bind to and enter the cells. The critical molecules in the process of virus replication are the viral proteins E6 and E7, which interact with a number of cellular proteins. In experimental system these interactions have been shown to induce proliferation and eventually immortalization and malignant transformation of cells. Binding of E7 to pRb activates the E2F transcription factor, which then triggers the expression of proteins necessary for DNA replication. Unscheduled S-phase would normally lead to apoptosis by the action of p53. However, in HPV-infected cells, this process is counteracted by the viral E6 protein, which targets p53 for proteolytic degradation. Besides blocking p53 function in regulation of apoptosis, high-risk HPV proteins interact with both extrinsic and intrinsic apoptotic pathways. As an aberration of virus infection, constant activity of the viral proteins E6 and E7 leads to increasing genomic instability, accumulation of oncogene mutations, further loss of cell-growth control and ultimately cancer. The immune system uses innate and adaptive immunity to recognize and combat foreign agents that invade the body, but these methods are sometimes ineffective against human papillomavirus. HPV has several mechanisms for avoiding the immune system. Furthermore, HPV infections disrupt cytokine expression with the E6 and E7 oncoproteins, particularly targeting the expression of interferon genes. Approximately 10% of individuals develop a persistent infection, and it is this cohort who is at risk of cancer progression, with the development of high-grade precursor lesions and eventually invasive carcinoma.

Prevalence of depressive symptoms among college students and the influence of sport activity

The present study asses the prevalence of depressive symptoms among college students in Split, Croatia, and positive influence of sport activity on decreasing the depression symptoms. Authors screened all 664 college students of the first year of study. All of them were over the 18 years and the mean age was 19.4 +/- 1.2 years. There were 466 females (70.2%) and 178 (26.8%) males. They answered The Beck Depression Inventory (BDI) and questionnaire about their sport activity (no sport activity, recreational and active in sports). For the purpose of the analysis depressive symptoms were defined as a score of > 11. Chi-square and Mann-Whitney test were used for data analysis. 9.4% of the students had significant depression symptoms (score > 11). No one student had score > 26 (symptoms of major depression). Statistically significant lower score on BDI have students who are active in sports (score median = 3) compared to group of recreational (score median = 4) and in correlation to group who are not active in sports (score median = 5) (Kruskal-Wallis: p < 0.001). In the group of active in sports (N = 254) there are only 5.5% with depressions symptoms, while in the group of non active in sports (N = 60) are 18 depressive (chi2-test: p = 0,005). Females are statistically more depressed than males (chi2-test: p = 0.01). In the female group 49 (10.5%) are depressed, and in the male group are 9 (5%). Compared to gender in separate analysis we did not find correlation of decreasing depression symptoms and sport activity among males (chi2-test: p = 0.47), while in females we find that sport activity has significant effect (chi2-test: p = 0.026). Our results shoved moderate values of depression symptoms among college population in Split, Croatia. More females than males experienced depressive symptoms. While sport activity did not have significant influence on the depression in male population, it has significant influence in reducing the depression symptoms among females.

[The loss of visual field after proliferative diabetic retinopathy treatment with two different techniques of panretinal photocoagulation]

Diabetic retinopathy (DR) is the most common cause of blindness in the active population of industrialized countries. Panretinal argon laser photocoagulation (PRP) is used in the treatment of proliferative diabetic retinopathy. Despite its usefulness, the mentioned treatment has some side effects such as permanent visual field damage. The treatment was performed with two PRP techniques, peripheral panretinal photocoagulation (PPRP) and central panretinal photocoagulation (CPRP). Peripheral visual fields defects were assesed with Vaughans method. The aim of the study was to determine the extent of visual field defects entailed by the two different PRP techniques.

RESULTS

Visual field loss in percentage was greater in the group treated with PPRP (mean 9.09 +/- 6.36%) than in group treated with CPRP (mean 4.9 +/- 4.5%) (p = 0.000037). The initial functional DR severity and presence of risk factors that influence DR severity were similar in the two treatment groups. Different results were mostly attributable to the PRP techniques employed, being significantlly less favorable with PPRP.

[Haemolytic disease of the newborn--from a mother with anti-Kell, anti-E and anti-Vel anti-erythrocyte alloantibodies]

A grave form of HDN (haemolytic disease of the new-born) is described in female twins, caused by Kell, E and Vel isoimmunisation. The weakly vital and anaemic new-born babies were hospitalised with signs of respiratory distress on the first day of their life after the delivery by Caesarean section in the 38 (th) week of pregnancy in the General Hospital Dubrovnik. Already during the first hours of their life jaundice developed with a high bilirubin level for their age. The direct Coombs' test on the twins and the indirect Coombs' test on the mother were positive. Immuno-haematological analysis proved the presence of anti-Kell, anti-E and the very rare anti-Vel antibodies in the mother's serum and in the plasma of both twins. We had no possibility to obtain appropriate blood for the indicated exsanguine transfusion because cross-probes with the accessible blood samples were positive. Up to the fourteenth day of life the anaemia deepened and was aggravated in one twin, the Kell positive one (phenotype CcDEe,Kk) in relation to the other, the Kell negative (phenotype CcDEe,kk) twin. The recovery of the female twins started on the 15 (th) day of life, after the transfusion of blood (phenotype: 0,ccddee, Vel negative, Kel negative), received from the bank of rare blood groups in London. This is the first described case of haemolytic disease of the new-born caused by antibodies on the antigen Kell, E and Vel. The low frequency of immunisation with rare antigens such as Kell, E and Vel, does not exclude the possibility of the occurrence of grave forms of haemolytic disease. All pregnant women with a positive indirect Coombs' test should be further immuno-haematologically tested in order to identify the antibodies type so that the treatment of the new-borns could be commenced in time.

[Perinatal outcome of multiple pregnancies in maternity wards in Knin and Livno in 1990-2002]

The aim of this study was to examine perinatal outcome of twin pregnancies in maternity wards in Livno and Knin. The perinatal outcome in these two maternity wards was examined retrospectively during the period 1990-2002. The incidence of twin births, the month with the highest incidence of twin births, the age and parity of the women with twins and their gestational age were examined. Also, we compared the perinatal outcome of twins with singletons, distribution according to sex, lie and presentation at birth. During 13 years 10,856 newborns were delivered, and 127 (1.2%) of them were twins. The incidence of twins in maternity wards in Knin and Livno during the war and after the war was not significantly different (p = 0.89). The month with the highest incidence of twin births was May (14.8%). The avarage age of women with twins was 28.9 +/- 9.7. Twins were born mostly by multiparas (2-4 deliveries). 94 (74%) twins were born on term and 33 (26%) twins before term. 74 newborns (7% per hundred) from singletons and 11 (43% per hundred) from twins died during perinatal period. Twins were delivered by cesarean section (27%) three times more often than singletons (8%). Hypertension in twin pregnancies (7%) was twice as frequent as in singletons (4%). 132 (51.6%) male and 122 (48.4%) female newborns were born. The distribution according to sex was: 58 pairs "male-females", 37 "male-male" and 32 pairs "female-female". The distribution according to presentation at birth was: 49% "cephalic-cephalic", 29% "cephalic-breech", 12% "cephalic-transverse", 5% "breech-breech" and all other combinations got 5%. In conclusion, our results during the war and after the war were not different from other centers and studies thanks to good antenatal care and selection of twin pregnancies for transportation on time to the center with higher level of health care.

[Cyclocryocoagulation in treatment of neovascular glaucoma]

Neovascular glaucoma (NVG) is a pathological condition of the eye with fast deterioration, accompanied with eyeball pain and loosing sight. The aim of the study was to examine the efficacy of cryotherapy in the treatment of NVG which is resistant to medical and surgical therapy, concerning intraocular pressure (IOT) and eyeball pain immediately after the treatment and 6 months after. In the Department of Ophthalmology, Split University Scool of Medicine, during three years 70 patients with NVG, which were resistant to medical and surgical treatment, were included in the prospective study. There were 50 males and 21 women, average age 74 +/- 6.94 (45-87). The patients were treated with transconjuctival cyclocryocoagulation, machine ERBOKRYIO AE-ERBE was used. The average value of IOT was: at admission 44.8 mmHg, 7 days after the treatment 30.7 mmHg with the tendency of falling down 30 and 90 days later, to finally 19.9 mmHg 180 days after the treatment. The IOT was significantly lower after the treatment. At admission, the average value of eyeball pain intensity was high (4.2), 7 days after the treatment it was 2.1 with the tendency of falling down to finally 1.1 180 days after the treatment. The eyeball pain intensity was significantly lower after the treatment. Cyclocryocoagulation is a method of choice in the treatment of NVG resistant to medical and surgical treatment. Cyclocryocoagulation, as a treatment of noncontrolled progressive NVG, does not have any effect on the improvement of sight in these patient.

A study of replacement of timolol-pilocarpine with latanoprost in pseudoexfoliation glaucoma

The aim of the study was to evaluate the efficacy of replacing current dual local therapy (timolol and pilocarpine) with latanoprost 0.005% in 71 pseudoexfoliation glaucoma patients with controlled intraocular pressure (IOP). 39 patients switched to latanoprost 0.005%) and 32 patients continued timolol-pilocarpine therapy. Mean diurnal (IOP) was measured at baseline, after 0.5, 1, 3 and 6 months of treatment. After 6 months 38 patients with latanoprost and 30 patients with timolol-pilocarpine had completed the study. At baseline the mean diurnal IOP was 20.4 +/- 2.0 mmHg for patients in latanoprost treatment group and 21.4 +/- 2.1 mmHg for patients in timolol-pilocarpine group. At the end of the study, after 6 months of treatment, the mean diurnal IOP values were 16.6 +/- 2.4 and 17.9 +/- 2.0 mmHg respectively. IOP was statistically significantly reduced from baseline (p < 0.001). The mean diurnal IOP change from baseline was -3.3 +/- 0.5 mmHg (mean +/- SEM, ANCOVA) for the patients treated with latanoprost and -3.2 +/- 0.4 mmHg for the patients treated with timolol + pilocarpine. This difference in IOP reduction between groups was not statistically significant (z = 0.69; p = 0.49). This study showed that combination therapy (timolol plus pilocarpine) in pseudoexfoliation glaucoma can effectively be replaced by latanoprost monotherapy.

Lispro insulin and metformin versus other combination in the diabetes mellitus type 2 management after secondary oral antidiabetic drug failure

The purpose of the study was to find out differences between treatments of diabetes type 2 after secondary oral antidiabetic drug failure. Three different methods of treatment were compared: lispro insulin in combination with metformin, glimepiride and metformin combination or two daily doses of biphasic insulin 30/70 together with bed-time NPH insulin. The study included 87 patients with diabetes mellitus type 2 randomly distributed into 3 different treatment groups. Fasting and postprandial glucose were analyzed by enzymatic colorimetric method and HbA1c was measured by ion exchange chromatography. HbA1c significantly decreased in all three study groups. The decrease was mostly expressed among patients treated with lispro and metformin. When focused on postprandial glucose control, antihyperglycemic metformin and insulin lispro therapy has greater impact on the overall metabolic control (decrease in level of HbA1c) in comparison with the above mentioned more traditional approaches.

[Perinatal care in Livno immediately after the war from 1995 to 1999]

The paragraphs of statistics for maternity hospital of county hospital in Livno for period 1995-1999, year are presented and describe perinatal, fetal and early neonatal mortality, newborns to birth-weight, the frequency of caesarean section, eclampsia, vacuum extraction, antenatal care and equipment maternity hospital and morbidity of the infants. Perinatal mortality in 1995 was 5.6@1000, but for 4 years 6.9@1000. Early neonatal mortality was appearing till 1996 year only with one death of newborn (1.1@1000). Fetal mortality was increased to 12.3@1000 in 1997; but the years before was 6.2@1000. According to the weight of newborns, 3.5% were no more than 2.500 g, but 93.5% were between 2.500-3.000 g, while newborns over 4.000 g where 3.0 percent. Watching and closely looking statistics for years in the classified groups does not fortify the major differences, except 1995 when was 1.7% newborns less than 2.500 g, but over 4.000 g 7.9%, that is under average and explaining to the minimum numbers of birth that year, and orienting refugees and exilied pregnant women to the centres with stronger obstetric and neonatal care Eclampsy were 9 and it was 2.2@1000. The number of antenatal visits of pregnant women increase during all these years, so that total number of visits was 20.905, that means 5.2 was the middle number of visits. There are much more without 2.0% or less than 3 visits 5.0%; with 9 or more 29.0%; the average number ultrasound examination is 3.4, and total 13.748, 37.0 percent of pregnant women is with 3 examples and 10.0% with 4 or over it, but 7.0% without ultrasonographc. It is obviously, that the number of the pregnant women without ultrasound examination is falling, so in 1995 there was 14.0% but 2.0% in 1999. Very important is increase those with 3 examination according to 1995 when there was 27.0%, but 47.0% in 1999. The usage of caesarean section is 7.7% but the major increase was in 1998 and it was 9.4% and 1999 is 10.1%. Vacuum extraction was used in 67 (1.7%) of newborns but in 1995 was 3.2%, the obstetric activity does three gynecologists. For perinatal mortality is important to say, that, during the war time, about 6.9@1000 in maternity hospital Livno was ranged into the group with low perinatal mortality. According to, the number of vacuum extraction belongs to the number of maternity hospital with vacuum extractions below 2.0%. Maternity hospital has two incubator after 1997 year and cardiotocographic intrapartal monitoring was used in about 55-65% of all deliveries.

The effect of delivery on regression of abnormal cervical cytologic findings

The purpose of this study was to determine whether abnormal antepartum cervical cytologic findings result in differing postpartum regression rates. Between 1993 and 2000, 107 pregnant women with antepartum abnormal cervical cytologic findings were identified. Papanicolaou smear data were separated into three groups by use of the CIN classification system. Postpartum regression rates of antepartum Papanicolaou smears were analyzed six months after delivery. Normalization of Papanicolaou smears in the postpartum period were observed in 50 of 107 women (46.7%). Regression of cervical cytologic findings was noted in 61 of 107 women (57%). Respectively, persistence of Papanicolaou smear was noted in 43 of 107 patients (40%). Only 3 of 107 (3%) antepartum findings progressed after delivery. Desquamation of the cervical epithelium or enhancement of a localized reparative immunologic response after vaginal delivery could play an important role in the spontaneous regression of cervical dysplasia in the postpartum period.

Circulating platelet aggregates and progression of visual field loss in glaucoma

The aim of the study was to assess a relationship between circulating platelet aggregates (CPA) and progression of visual field loss in primary open-angle glaucoma patients. CPA was determined in 27 patients with open-angle glaucoma with nonprogressive visual field loss and 15 patients with open-angle glaucoma and progression of visual field loss. Intraocular pressure (IOP) under topical therapy was < 18 mmHg in all patients. CPA in glaucoma patients with progression of visual field loss was not significantly higher than those without visual field progression (p = 0.59). In conclusion, our study shows that increased platelet aggregability is not solely responsible for progression of visual field loss in glaucoma patients, and indicates the role of IOP in the pathogenesis of visual field loss.

Influence of war circumstances on tumor morphological characteristics in patients with breast cancer

The influence of war circumstances on tumor morphological characteristics in patients with breast cancer has not been studied up to now. The aim of this study is to investigate if war circumstances have influenced breast cancer incidence. The study covered both the patients in which during a period of observation a breast cancer was diagnosed as well as those who died of the same disease in the same period. Three sources of data were used: 1) The archives of the Oncology and Radiotherapy Center of the University Hospital "Split" (UHS): hospital data of 768 patients were reviewed. The war sample consisted of 380 patients aged 59.4+/-12.1 (31 to 86) (including 5 males), whereas the pre-war sample was made up of 388 patients aged 58.4+/-12.7 (19 to 88) (including 3 males); 2) Register of death of the Pathology Department of UHS with 162 analyzed persons whose death was caused by breast cancer in the six-year period between 1988 and 1993. The list of 162 dead patients included 79 people who died from breast cancer diagnosed in that period (1988-1993) and another 83 people that had been diagnosed before that period; 3) The biopsy register of the Pathology Department of UHS with 851 breast biopsies performed between 1988 and 1993. Breast cancer is predominantly a female illness (99.1%). The war circumstances influenced the of T, N and M rate. The rate of N2, N3, Ml were conspicuously higher in the war period. There were significantly more malignant histological diagnoses found in new patients and also significantly more patients died due to breast cancer. Stress and other war circumstances undoubtedly have a negative impact on the numerous markers of breast cancer which we have proved in this study.

Perinatal outcome of pregnancies in women aged 40 and over

Perinatal outcome of pregnancies at forty and over was analyzed starting from the diagnosis of pregnancy to seven days following delivery. Retrospectively, pre-gestational health and reproduction status were dealt with, as well as the course of pregnancy, deliveries, and newborn children (study group). The control group was composed of pregnant women aged 20 to 29, who were identical to study group in terms of parity. Statistical data processing was done by means of chi2-test, and contingency 2 x 2 tables. The difference was significant if p < 0.05. Out of 2,099 diagnosed wanted pregnancies at forty and over, 415 (19.8%) had a miscarriage, in 33 (1.6%) an artificial abortion was performed after determining the fetus karyotype and 1,651 (78.2%) of pregnant women delivered. In 66.2% of pregnancies the fetus karyotype was determined and in 33 (2.5%) fetuses chromosomal abnormalities were found Incidence of deliveries at 40 and over is 1.38%, which is a 35.6-percent increase in the last ten years. Nullipara and pluripara had an increase, and multipara had a decrease. Pre-gestational health and reproduction status in study group is lower than in control group. Complications during pregnancy: threatened abortion, EPH gestosis, placenta praevia, gestational diabetes, late fetal death are more frequent than in control group (p < 0.05). In intrapartal terms, more frequent were induction of delivery, meconium-stained amniotic fluid, fetal distress, operative vaginal deliveries, and Cesarean section (p < 0.05). In neonatal outcome there are more premature infant, there are more VLBW, LBW, SGA, newborn with low Apgar index values, and the total perinatal death is greater than in the control group (p < 0.05). In perinatal terms, (from the diagnosis to the seventh day following delivery) 1,617 children survived (77.0%), meaning that perinatal loss was 482 (23.0%). Authors conclude that pregnancy at 40 and over is a high-risk pregnancy. There is a high risk of pre-gestational and gestational complications, and perinatal loss is high. Therefore, those pregnancies are not desirable from the medical point of view.

Socio-demographic characteristics of postmenopausal estrogen users

The purpose of the paper was to describe general health, socio-economic and demographic characteristics of postmenopausal estrogen users in comparison to nonusers. During years 1994-2000, 717 postmenopausal estrogen users and 235 postmenopausal nonusers were gynecological examined, interweaved with a questionnaire including information on their health, socio-economic and demographic status and compared. Women who had prescription on a hormone replacement minimally 6 months before interview were deemed to be current users, but the controls had not use hormone replacement ever. Hormone replacement users were statistically significant more often smokers, they had better physical activity and better general health than nonusers. Women with surgical menopause were more often hormone replacement users than nonusers. Women with better socio-economic status, higher education and urban population were more likely to use hormone replacement. Single, divorced and widowed women were more likely, but married women were less likely to use hormone replacement. However, more healthy profiles among hormone replacement users may inflate the apparent benefit of treatment. The gynaecologists play a major role in hormone replacement therapy decision-making because of a substantial public health impact.

Acute angle-closed glaucoma and meteorological factors in Split, Croatia

This study is a retrospective analysis of medical findings of patients treated at the Department of Ophthalmology, Clinical Hospital Split, Croatia in the period of 1995-1999. Seventy-three cases of acute closed-angle glaucoma were analyzed and compared in relation to the meteorological factors--hours of sunshine, air temperature and atmospheric pressure. No significant statistical correlation was found between the development of acute closed-angle glaucoma and air temperature, atmospheric pressure and mean sunshine hours in all months, except in November (z = 2.1; p = 0.03). The mean daily sunshine hours on the day of the acute closed-angle glaucoma onset were found to be lower than the mean monthly sunshine hours. An increased incidence of acute closed-angle glaucoma was found in the the winter months (chi 2 = 14.4; p < 0.01). Seasonal variations of the incidence of acute closed-angle glaucoma in Split cannot be directly attributed to the meteorological factors, although the correlation between acute glaucoma and sunshine seems to have a slightly inverse ratio.

Hypertensive retinopathy and pre-eclampsia

The aim of the study was to determine the relationship between hypertensive retinopathy and the severity of pre-eclampsia. Forty women with pre-eclampsia, mean age 29.1 (+/- 7.4; range, 19-44) years, were retrospectively analyzed. They were treated at the Department of Obstetrics and Gynecology of the Clinical Hospital Split, from January 1997 to December 1999. The mean age of gestation was 36.0 +/- 2.8 weeks (range, 28-39). Pre-eclampsia was classified according to Goecke. Based on the ophthalmoscopic fundus examinations the patients were divided into four groups, according to Keith-Wagner classification system of grading retinal changes. Of 40 analyzed women, 18 (45%) had ophthalmologically verified hypertensive retinopathy. Ten of them were classified as grade I, six as grade II and two as grade III. Twenty-two patients had mild pre-eclampsia, ten patients had moderate pre-eclampsia, and eight patients had severe pre-eclampsia. A statistically significant correlation (t-test) was found between the degree of hypertensive retinopathy and patient age, Apgar score, trophism, Goecke's index, proteinuria, systolic and diastolic pressure (P < 0.001) and edema (P = 0.01). The degree of hypertensive retinopathy was directly proportional with the severity of pre-eclampsia and significant correlation was found between them (r = 0.338, p = 0.033). These findings showed that the degree of hypertensive retinopathy in women with pre-eclampsia is a valid and reliable prognostic factor in determining the severity of the pre-eclampsia. Therefore, it can be concluded that the examination of the fundus is a valuable and necessary diagnostic procedure in pregnant women with pre-eclampsia.

A cure from the small cell neuroendocrine carcinoma of the uterine cervix following conventional surgery

The small cell neuroendocrine carcinoma of the uterine cervix is a rare, but very aggressive neoplasm. Previous reports suggested that it had dismall prognosis if treated with conventional surgery and radiotherapy, even in early stage disease. We present the case of neuroendocrine cervical carcinoma that was cured from the disease following conventional surgery only.

[Development of obstetrics at Knin Hospital after liberation in 1995]

The objective of this study is to present the development of obstetrics in the Knin General Hospital after military action "Storm" and consecutive liberation in 1995. Delivery register was used as the source of data in the period from liberation, i.e. from August 1995 to December 31, 1998. The number of medical visits during pregnancy, number and methods of deliveries and perinatal outcome are presented. Along with the improved organization of the Obstetrics and Gynecology Department of the Knin General Hospital the number of visits during pregnancy increased from average 2.4 (0-4) in 1995 to 6.7 (2-13) in 1998. With return of the population, the number of deliveries increased from 18 in 1995 to 275 in 1998. Also, the number of Cesarean sections increased from 1 (5.6%) in 1995 to 18 (6.5%) in 1998, but the frequency is the same. Perinatal mortality was low, only one child died from twin pregnancy, as a fetal death because of cord prolapse. The results of the Department of Obstetrics and Gynecology from the Knin General Hospital are comparable with other modern centers which were not under war occupation, thanks to the great effort of the Ministry of Health and help of medical staff from Zagreb, Sisak, Sibenik, Bjelovar, Cakovec and the Knin General Hospital.

Oral lichen planus and HLA DR

Oral lichen planus (OLP) is a chronic inflammatory mucocutaneous disease, predominantly seen in middle-aged female patients. Histopathologically, OLP includes parakeratosis with T-lymphocyte subepithelial infiltration. In etiology of OLP, chronically liver and biliary diseases, stress-induced hypertension, inheritance and most commonly carbohydrate metabolism disorders including diabetes mellitus are mentioned. Considering the autoimmune nature of the illness and the role of the HLA DR 3/4 antigens in development of diabetes mellitus we hypothesized that the same antigens could play role in the development of OLP. We examined 50 unrelated Croatian patients (5 males) from Institute of Oral Pathology, Faculty of Dental Medicine, Zagreb, with clinical and histopathological diagnosis of OLP. They were all tested for HLA DR and compared with 1089 Croatian controls that underwent the tissue standardization in fathership cases. OLP patients had blood sugar level controlled, and those with HLA DR 3/4 and those with blood sugar level higher then 5.6 mmol/l additionally underwent standard oral glucose tolerance test. Carbohydrate metabolism disorder was found in 13 OLP patients (26%) while 10 of them (20%) had diabetes mellitus type I. This finding is 400 times more frequent than is appearance of diabetes in healthy controls (0.05%) in Croatia.

Physiological anthropology and the Internet

The Internet is the greatest computer network with many services like Web, FTP, Gopher, E-mail Discussion Groups, and Usenet Discussion Groups, that provides a rapid and the cheapest exchange of information. The benefits to anthropologists of using the Internet are growing rapidly, as the Internet becomes easier to use and ever more anthropological resources become available on line. Physiological anthropology is concerned with the evolution and biological features of human population and it's sources on the Internet are growing continuously. However, in that enormous number of data, is not easy to find a needed information. Currently, number of indexed physiological anthropology related sites on Web only is 233990 (October 98). This paper provides informations about Internet and needed hardware and software for using it. It also describes and lists the most important physiological anthropology addresses, together with physiological anthropology-related journals on the Internet, as well as the ways of searching them.

Oral lichen planus and HLA A

Oral lichen planus (OLP) is autoimmune disease that appears on the oral mucosa only, or in combination with skin lesions. The occurrence of squamous cell carcinoma in areas of lichen erosions makes it necessary to follow up patients suffering from chronic lesions. Prevalence in general population varies from 0.9% to 1.2% and varies in different ethnic groups. It is known that cell-mediated immune mechanisms and genetic factors underline OLP pathogenesis. We tested 50 OLP unrelated patients (5 males) for HLA A and compared them to 1089 healthy controls. OLP patients had 3 times less frequently HLA A w19 and 5 times less frequently HLA A28, compared with controls. Erosive OLP type had 4 times less frequently HLA A11 and 2 times less frequently HLA A26 than plaque form. In conclusion, HLA A w19 and A28 appeared associated with OLP in particular, while HLA A11 and A26 with erosive types of OLP.

Oral lichen planus and HLA B

Oral lichen planus (OLP) is mucocutaneous autoimmune disease of still unknown etiology. Among all etiological factors, OLP can be associated with carbohydrate disorders. As it is known that some HLA B and DR 3/4 antigens are cross-linked, we have determined the frequencies of HLA B antigens in group of 50 Croatian patients (5 males) with OLP and compared them with the 1089 healthy controls. Alterations in the frequencies of several HLA B antigens were noted, in particular, the frequencies of HLA B 15 were 4 times higher, and HLA B18 were 4 times lower compared with controls. The OLP patients with carbohydrate metabolism disorders had more frequently HLA B16, B2 and B40 and the patients with OLP without disturbed carbohydrate metabolism had more frequently HLA B5, B7 and BX. HLA B15 and B18 are closely connected with DR 3/4 antigens in diabetes mellitus, so these particular antigens may predispose a person to a lichen planus.