[Antenatal corticosteroids in respiratory distress syndrome prevention: efficacy in relation to treatment--delivery interval]

Antenatal corticosteroids given to women, who are 24 to 34 weeks pregnant and may deliver within the next 24 hours to 7 days, are associated with significant reduction in rates of respiratory distress syndrome, intraventricular hemorrhage and mortality of pre-term babies. The aim of this study is assessment of antenatal corticosteroid effectiveness in reduction of RDS incidence in optimal delivery-treatment interval, in comparison to babies delivered before and after the optimal treatment interval has elapsed. This investigation included 80 pre-term babies between 26 and 34 gestational weeks whose mothers received corticosteroids before delivery. Control group consisted of 92 children of the same gestational age, whose mothers did not received corticosteroids antenatally. Babies of diabetic mothers, babies with IUGR and babies with congenital abnormalities were excluded. RDS was significantly less frequent in babies antenatally treated by corticosteroids (x2 31,473 p < 0.0001 coefficient contingency 0.366) then in babies whose mothers did not received corticosteroids before delivery. The majority of babies, 54.67% (p < 0.01) were born in optimal interval, 24 hours to 7 days from the beginning of the treatment, 32.0% (24/75) children were born within 24 hours and 13.3% (10/75) were born more then 7 days after the start of treatment. Comparing the incidence of RDS between groups of children born in optimal treatment-delivery interval (1 -7 days) and in the group of children born within 24 hours or after 7 days from the beginning of the treatment, no significant difference was found. The effect was clinically comparable, which suggests the possibility of reduction treatment-delivery interval in acute clinical conditions.

The effects of antenatal corticosteroid treatment on IVH-PVh of premature infants

Intraventricular-periventricular hemorrhage (IVH-PVH) is the most frequent type of intracranial hemorrhage in premature infants and the major cause of neurodevelopmental disabilities in children too. The objective of this work is to evaluate the effects of prenatal corticosteroid treatment on the incidence of IVH-PVH in premature infants. The study enrolled 163 prematures of 26-34 weeks' gestation. They have been divided into two groups: the experimental group (80/163), who have been treated with corticosteroids prenatally and control group (83/163), who have not received such treatment. There is statistically significant difference in IVH-PVH incidence between the experimental group (18/80) and control group (32/83) (chi2 =5,616, p<0,05). There is no statistically significant difference in Apgar score after 5 minutes between the experimental group and control group of IVH-PVH prematures, t= 0,121. There is no statistically significant difference in mean gestation age between the experimental group (30,74 weeks) and control group (29,97 weeks) of IVH-PVH prematures, t= 1,299. There is no statistically significant difference in mean birth weight between the experimental group (1479,44 grams) and control group (1379,37 grams) of IVH-PVH prematures, t= 0,913. Antenatal corticosteroid treatment of premature infants reduced the incidence of IVH-PVH significantly. There is no statistically significant difference in Apgar score after 5 minutes, mean gestation age and mean birth weight between the experimental and control group of IVH PVH prematures.

[Disability caused by essential hypertension complications in Sarajevo Canton in the period 1998-1999]

The aim of this study was to assess working ability of persons suffering from some of essential hypertension (EH) complications in Canton Sarajevo in the period of two years (01.01.1998-31.12.1999). Recorded complications included: congestive heart failure (CHF), heart attack (HA), angina pectoris (AP) and cerebrovascular disease (CVD). The study included 606 persons with EH with clinically verified complications, out of whom there were 416 males of average age of 53.4 (+/- 14.7) years, and 190 females of average age of 50.3 (+/- 12.8) years. There were 377 (62.2%) persons assessed with complete loss of working capability, 126 (20.8%) with limited working capability and only 103 (16.9%) were found without disability in regard to the tasks required in their job description. It was confirmed that EH complications have significant impact to disability among insurants in their most productive working age. CHF is the leading cause of complete loss of working capability, particularly in the group of labour workers with low qualification structure, followed by CVD, HA and AP. Disability-loss and limited working capability was dependant on sex, age, type of complication, qualification structure and the type of occupation. The results of this study indicate urgent need for establishing a more efficient concept of primary prevention as well as better and comprehensive treatment of the EH in order to reduce morbidity and disability among the working age population.

Protective effect of neonatal BCG vaccines against tuberculous meningitis

Neonatal BCG vaccination reduces the risk of tuberculosis and provides protection higher than 80% against the development of meningeal and miliary tuberculosis in newborns. Tuberculosis meningitis remains a major problem and also an important cause of death in some countries. In countries with high and moderate incidence of tuberculosis, prevention from the most severe complications of tuberculosis can be achieved only with a high coverage of the universal BCG neonatal immunization, being higher than 98% in the cohort of newborns. The decrease in BCG immunization coverage within immunization program during the year 2003 in Bosnia and Herzegovina influenced the increase in tuberculous meningitis. During 2002, when coverage with BCG vaccination in cohort of newborns was 90%, the incidence rate of tuberculous meningitis was 19. 04%oo. With the 68% decrease in BCG immunization coverage in the cohort of newborns in Bosnia and Herzegovina during the year 2003, the incidence of tuberculous meningitis raised to 33 33%oo. It has been proven that the 22% decrease of the neonatal BCG immunization coverage in the cohort of newborns /vaccination program of children/ caused 175 times higher number of the tuberculous meningitis cases. Newborns affected by the tuberculous meningitis were not BCG vaccinated. BCG vaccine provided effective protection against tuberculous meningitis, as well against the death of newborns caused by tuberculosis.

[Trial of labor after previous cesarean section]

Elective repeat cesarean section continues to remain the standard to care at GYK and OBST. Department in Sarajevo. This paper is a study of 216 patients with previous cesarean section who requested and were allowed a trial of labor. One hundred fifty-six (72%) achieved successful vaginal delivery with no maternal or fetal mortality or significant morbidity. Review of the USA literature indicates similar results in other independent studies. Continued accumulation of cases showing the efficacy of post-cesarean section trial of labor should encourage a reassessment of the continuing practice of elective repeat cesarean section.

[Perinatal mortality at the Gynecology-Obstetrical Clinic of the Clinical Center in Sarajevo in 2001]

Work results of the gynecology-obstetrics clinic Sarajevo maternity ward have been shown. Number of deliveries reached 3289, which iz significantly less then in the year 200. Prematurity reached 6.6%. Cesarian Sections were carried out in 19.3% cases and this represents a remarkable increase in comparison with the previous year 2000, when it reached 16.8%. Perinatal mortality iz 11.1@1000. Perinatal mortality shows a decrease in comparison with the period before the war. Late fetal mortality has not been significantly changed. Neonatal mortality shows an apparent decrease. Total perinatal mortality of mature newborns iz 6.9@1000 and has a constant tendency to decrease, reaching 10.5@1000 in 1991. Clinical presentation of deceased newborns predominantly presents with respiratory distress syndrome.