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INTRODUCTION: In vitro fertilization (IVF) singletons have a worse perinatal outcome than spontaneously conceived singletons, especially in terms of preterm birth and its complications. MATERIAL AND METHODS: An observational retrospective case control study was carried out. The study population consisted of 644 women in singleton pregnancies (336 IVF/intracytoplasmic sperm injection (ICSI); 308 controls) who delivered > 22 weeks of gestation at the 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Poland, between 2004 and 2014. Controls were initially matched by age and parity and drawn from the group of deliveries following each IVF delivery. Collected data included maternal characteristics, incidence of pregnancy complications, time and mode of delivery, and neonatal outcome at delivery. RESULTS: The two study groups were initially matched for age and parity and were also similar with regard to BMI and gestational weight gain. The IVF treatment increased the odds of having vaginal bleeding in the first trimester (OR = 1.68; 95% CI: 1.0-2.86), placenta previa (OR = 5.15; 95% CI: 1.1-33.9), preterm delivery (OR = 2.06; 95% CI: 1.16-3.68), newborn's low birth weight (OR = 2.27; 95% CI: 1.19-4.36) and elective cesarean section (OR = 2.39; 95% CI: 1.7-3.4). CONCLUSIONS: The IVF singleton pregnancies have an increased risk of adverse perinatal outcome, among which prematurity remains the greatest problem. Therefore, they should be managed as high risk not only due to psychological reasons.
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This study seeks to define factors affecting the development of adverse reactions to intensive therapy of toxoplasmic retinochoroiditis with antifolate agents (pyrimethamine/sulfadoxine) and antibiotics followed by secondary antifolate prophylaxis. The study was of retrospective and observational nature. Medical files were reviewed of 551 patients suffering from ocular toxoplasmosis during 1994-2013. All patients were treated with the same protocol: 3-week intensive pyrimethamine/sulfadoxine plus antibiotic/steroid therapy. Three hundred and fourteen out of the 551 patients qualified for the subsequent 6-month long secondary antifolate prophylaxis. The type and occurrence rate of adverse reactions were taken into account. The probability of an adverse reaction during the intensive therapy phase was 33.4%. Hypertransaminasemia was the most common event observed in 24.6% of the patients, but it assumed a severe character in just 0.9%, with male gender and age over 25 years being the predisposing factors. Less common adverse effects included thrombocytopenia (8.3%), hypersensitivity skin reactions (3.0%), and abdominal pain (1.4%). The adverse effects of secondary antifolate prophylaxis, most commonly hypersensitivity skin reactions and hypertransaminasemia, followed by thrombocytopenia and abdominal pain, were observed in 4.9% of the patients. Ten of them (2.7%) had to discontinue the treatment while eight others continued with pyrimethamine alone without further adverse effects, which suggests that discontinuation of the sulfonamide decreased the propensity for adverse reactions. The treatment strategy in these patients differed from previous reports in that it used lower doses of pyrimethamine/sulfonamide, with no folinic acid supplementation. Nonetheless, the rate and severity of adverse events were no greater than those noticed with traditional regimens, with higher antifolate doses and folinic acid supplementation. We conclude that the dose and drug-mitigated treatment strategy we employed deserves consideration as a promising alternative to traditional treatments for ocular toxoplasmosis.
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Anti-Infecciosos/efeitos adversos , Antagonistas do Ácido Fólico/efeitos adversos , Toxoplasmose Ocular/tratamento farmacológico , Anti-Infecciosos/uso terapêutico , Feminino , Antagonistas do Ácido Fólico/uso terapêutico , Humanos , Masculino , Pirimetamina/efeitos adversos , Pirimetamina/uso terapêutico , Estudos Retrospectivos , Sulfadoxina/efeitos adversos , Sulfadoxina/uso terapêuticoRESUMO
PURPOSE: To assess the impact of intensive antifolate treatment, followed by secondary antifolate prophylaxis (A-SP) on the recurrence rate of toxoplasmic retinochoroiditis (TRC). To investigate whether there are any other factors potentially predisposing for recurrence. MATERIAL AND METHODS: A total of 637 medical records of TRC patients, who had been treated in the years 1994-2013 were reviewed. All patients were treated with pyrimethamine /sulfadoxine one 25mg/500mg tablet daily (P/S 25/500mg) for 21 days with a double loading dose for the first two days. From Day 2 the patients also received prednisone at a starting dose of 40mg and spiramycine 3 million IU three times daily, given for 10 days followed by azithromycin 500mg once daily for another 6 days. The analysis of the recurrence rate involved 352 patients who had completed 6-month secondary prophylaxis (P/S one 25 mg/500mg tablet twice a week). RESULTS: When secondary antifolate prophylaxis (A-SP) was instituted immediately after the treatment for TRC, the probability of 3-year recurrence-free survival after the first course of A-SP was 90.9%. A recurrence was most likely approximately 3.5 years after the first treatment. A univariate Cox regression model demonstrated that a risk for recurrence was 2.82 times higher (p = 0.02) in patients with retinal scars. In the multivariate analysis, the risk for recurrence was 2.41 higher (p = 0.06). In patients with haemorrhagic lesions the risk for recurrence was lower, aRR = 0.17 (approaching borderline statistical significance p = 0.08). CONCLUSIONS: With the institution of A-SP of immediately after the intensive treatment for TRC, i.e. when a reactivation was most likely, there was no recurrence during A-SP. Following A-SP the recurrence rates were low and recurrence-free periods tended to be longer. The treatment regimen employed had a beneficial effect on the recurrence interval as it reduced and delayed the highest probability of recurrence.
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Antagonistas do Ácido Fólico/uso terapêutico , Pirimetamina/uso terapêutico , Sulfadoxina/uso terapêutico , Toxoplasmose Ocular/tratamento farmacológico , Toxoplasmose Ocular/prevenção & controle , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anti-Inflamatórios/uso terapêutico , Coccidiostáticos/administração & dosagem , Coccidiostáticos/uso terapêutico , Esquema de Medicação , Quimioterapia Combinada , Feminino , Antagonistas do Ácido Fólico/administração & dosagem , Humanos , Masculino , Prontuários Médicos , Pessoa de Meia-Idade , Prednisona/administração & dosagem , Prednisona/uso terapêutico , Pirimetamina/administração & dosagem , Recidiva , Prevenção Secundária/métodos , Espiramicina/administração & dosagem , Espiramicina/uso terapêutico , Sulfadoxina/administração & dosagem , Toxoplasmose Ocular/etiologia , Toxoplasmose Ocular/parasitologia , Resultado do Tratamento , Adulto JovemRESUMO
OBJECTIVE: A retrospective analysis of the course of labour in patients after one caesarean section (CS) and of factors influencing successful attempt of vaginal birth after caesarean (VBAC). DESIGN: A group of 296 patients after one CS was divided into: group G1 (206 patients) - elective CS, group G2 (90) - VBAC attempt, and G2 to: G2a (35) - VBAC and G2b (55) - CS after an unsuccessful VB attempt. A comparative analysis between the groups and logistic regression analysis of factors influencing a successful VBAC was made. RESULTS: There were no differences regarding age, BMI, weight gain during pregnancy or gestational age between groups G1 and G2, as well as G2a and G2b. G2a patients had more often already given VB previously (28.6% vs 10.9%; p=0.03). The most frequent indication for a repeat elective CS was the lack of informed consent for VBAC (29.13% of all indications). The mean neonatal birthweight was highest in G1 (3 410 g), and in G2b higher than in G2a (3 275 g vs 3 098 g; p=0.009). There were no differences in newborns' general condition between the group. There were no cases of uterine rupture and 4 cases of uterine scar dehiscence in G1 and 1 in G2. Of all the analysed factors only spontaneous delivery onset (OR 7.78) and previous vaginal birth after the caesarean (OR 1.99) or before the caesarean (OR 2.03) had significant influence on successful VBAC trial. CONCLUSION: The right classification of patients is a significant factor having effect on the success of a VB attempt after CS.
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Cesárea/normas , Tomada de Decisões , Procedimentos Cirúrgicos Eletivos/normas , Nascimento Vaginal Após Cesárea/normas , Adulto , Cesárea/efeitos adversos , Cesárea/estatística & dados numéricos , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Feminino , Humanos , Complicações do Trabalho de Parto/epidemiologia , Gravidez , Resultado da Gravidez/epidemiologia , Estudos Retrospectivos , Nascimento Vaginal Após Cesárea/efeitos adversos , Nascimento Vaginal Após Cesárea/estatística & dados numéricosRESUMO
We report the case of rickettsial eschar-associated spotted fever, most probable due to Rickettsia raoultii, an emerging pathogen, which was previously described in patients with tick-borne lymphadenopathy (TIBOLA), also called Dermacentor-borne necrosis erythema and lymphadenopathy (DEBONEL). The pathogenicity of R. raoultii is not well established. The survey of ticks from Poland (Ixodes ricinus and Dermacentor reticulatus) revealed that R. raoultii occur in all regions of Poland and predominate over other rickettsiae of spotted fever group--R. slovaca and R. helvetica. A 17-year-old otherwise healthy girl was admitted to Department of Zoonotic and Tropical Diseases because of fever, eschar and rash. Multiple disseminated small lesions were present on the skin of her head, trunk and limbs, also palms and soles, and mucosa of her lips. The majority of them had necrotic center slightly elevated with redness around, single ones had vesicular appearance. The lymph nodes on the right side of her neck were enlarged. Laboratory investigations revealed: leukopenia (with 22% of bands in differential), thromocytopenia, slightly elevated C-Reactive Protein, as well as procalcytonin. The quick improvement was observed with a treatment with ceftriaxone and doxycycline. Two weeks after the onset of disease, IgG serum antibodies titer of 128 reacting with R. rickettsii antigen only was detected. IFA tests with six SFG rickettsial species demonstrated the strongest reaction with R. raoultii group antigens in a titer of 64. The case we report, resembling boutonneuse fever, with leukopenia, thrombocytopenia and septic parameters indicates possible higher virulence of R. raoultii than it was previously observed.
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Mordeduras e Picadas/microbiologia , Dermacentor/microbiologia , Infecções por Rickettsia/microbiologia , Rickettsia/isolamento & purificação , Doenças Transmitidas por Carrapatos/microbiologia , Adolescente , Animais , Antibacterianos/uso terapêutico , Anticorpos Antibacterianos/imunologia , Feminino , Humanos , Infecções por Rickettsia/diagnóstico , Infecções por Rickettsia/tratamento farmacológico , Doenças Transmitidas por Carrapatos/diagnóstico , Doenças Transmitidas por Carrapatos/tratamento farmacológico , Tiques , Resultado do TratamentoRESUMO
Dengue virus is distributed in tropical and subtropical regions and transmitted by mosquitoes of the genus Aedes. In September 2010 two cases of indigenous dengue fever were diagnosed in metropolitan France for the first time and next DENV infection was diagnosed in a German traveler returning from a trip to Croatia. The Aedes albopictus mosquitoes were found in several European countries (for example in greenhouses in Netherlands). The indigenous DENV infections in Europe are rare diseases, probably acquired after bites of infected mosquitoes imported by airplanes from endemic areas. Nonspecific symptoms including: fever (up to 39 degrees C), chills, arthralagia, headache, myalgia and abnormalities in laboratory tests such as: thrombocytopaenia, leukopaenia and liver tests cause problems with differential diagnosis ofhematologic and hepatologic syndromes. The most serious complications are associated with dengue shock syndrome with mortality rate of 50%.
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Aedes/virologia , Vírus da Dengue/isolamento & purificação , Dengue Grave/epidemiologia , Dengue Grave/virologia , Viagem , Animais , Europa (Continente) , Promoção da Saúde/métodos , Humanos , Insetos Vetores/virologia , Dengue Grave/diagnóstico , Dengue Grave/prevenção & controle , Dengue Grave/transmissão , Clima TropicalRESUMO
The article presents the clinical course of Dengue in 22 patients hospitalized in the Ward of Tropical Diseases and Zoonoses in Warsaw in 2002-2011. Dengue belong to hemorrhagic fevers.The virus which causes dengue (DENV) belonging to the Flaviviridae family of RNA viruses. It is transmitted by arthropods (mosquitoes Aedes). Among the hospitalized patients most aged 20-30 years (10 people), there were more women than men. There were two foreigners from Asia and Central America. The majority of patients visited regions of South East Asia (Thailand, Laos, Vietnam) then India, Brazil and Mexico. Most of hospitalized people had light and average course. Symptoms of the disease usually occurred shortly after returning from the visited region and were not specific (flulike). In of one of the patients the course was very heavy. The average hospital stay was 9 days, the longest, in one person was 27 days. All patients were treated symptomatically, one person received a platelet transfusion twice without complications. Two people were treated with steroid drugs. All patients were discharged without serious consequences for health and life.
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Anticorpos Antivirais/sangue , Vírus da Dengue/isolamento & purificação , Dengue/diagnóstico , Dengue/terapia , Viagem , Clima Tropical , Adulto , Sudeste Asiático , Brasil , Dengue/epidemiologia , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Índia , Masculino , México , Pessoa de Meia-Idade , Admissão do Paciente/estatística & dados numéricos , Polônia/epidemiologia , Estudos Retrospectivos , Resultado do TratamentoRESUMO
UNLABELLED: The aim of this paper was the evaluation of clinical characteristics, demographics and therapeutic response for oseltamivir, among patients with swine flu confirmed, hospitalized in the Hospital For Infectious Diseases in Warsaw, Poland. MATERIAL: We have observed infection A/H1N1 occurrence in 109 patients (Female-64, Male-45, aged 17-71 y), hospitalized between August and December 2009. The influenza specific test PCR (TaqMan A/H1N1) were used to pandemic flu confirmation. RESULTS: Out of 109 analyzed patients, 67% were young, before 40 y. old. The largest infected group were patients between 20 and 29 years. Among multiple acute symptoms we observed high temperature, cough, myalgia and neurological manifestations, very frequent. In 42 patients (38%) the interstitial pneumonia were observed. Eight patients developed severe respiratory insufficiencies -ARDS (7%) and one died. We observed also 10 infections A/H1N1 influenza during pregnancy, with good oseltamivir tolerance and without recent perinathal complications. CONCLUSIONS: Among 109 individuals with swine flu influenza, 67% have not complicated clinical manifestation and they recovered during 3-4 days. Eight patients developed ARDS and one of them died. Test PCR for influenza A/H1N1 was the basis in diagnostics procedures of the new pandemic influenza confirmation. Oseltamivir safety and tolerability were verified in patients with new variant infection A/H1N1.
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Vírus da Influenza A Subtipo H1N1/isolamento & purificação , Influenza Humana/diagnóstico , Influenza Humana/tratamento farmacológico , Pacientes Internados/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Idoso , Antivirais/uso terapêutico , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Influenza Humana/complicações , Influenza Humana/epidemiologia , Masculino , Pessoa de Meia-Idade , Oseltamivir/uso terapêutico , Pneumonia Viral/epidemiologia , Pneumonia Viral/etiologia , Polônia/epidemiologia , Síndrome do Desconforto Respiratório/epidemiologia , Síndrome do Desconforto Respiratório/etiologia , Insuficiência Respiratória/epidemiologia , Insuficiência Respiratória/etiologia , Índice de Gravidade de Doença , Resultado do Tratamento , Adulto JovemRESUMO
UNLABELLED: Many cases of swine flu is mild or even asymptomatic. The recent cases have been much more severe, and many patients have presented pneumonia, respiratory failure and acute respiratory distress syndrome (ARDS). Illness-related fatalities have been recorded among individuals hospitalized in The Hospital For Infectious Diseases in Warsaw, Poland. There were 109 patients (age: 17-71y), with A/H1N1 infection confirmed by PCR. In this article have shown cases of H1N1 influenza - related complications. We observed bacterial superinfections associated with swine flu, ARDS and shock syndrome, secondary bacterial pneumonia and neurological complications. Severe hypoxemia, multilobar pneumonia, and dramatic signs and symptoms progression, were reported in 8 individuals. All patients required admission to intensive care unit and the mechanical ventilation. One patient died due to ARDS and encephalitis. Many people have experienced risk factors, e.g.: asthma, sarcoidosis, or chronic bronchitis and other pulmonary illness. One patient after renal transplant with immunosuppressive therapy recovered, as well as two patients with chronic lymphatic leucaemia in remission. Two woman with clinically-relevant obesity have developed rapid progression of respiratory insufficiency and were still on mechanical ventilation. Influenza A/H1N1 were observed in 10 pregnant women, without co-morbidities. Three of them developed interstitial pneumonia. Consequently pregnant women with confirmed pandemic A/H1N1 infection received treatment with oseltamivir. IN CONCLUSION: Among 109 hospitalized individuals with A/H1N1 infection, eight (7%) developed severe pulmonary complications, and one of this patient died. The risk factors of progression to acute respiratory distress syndrome (ARDS) have all of this group patients.
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Influenza Humana/epidemiologia , Pacientes Internados/estatística & dados numéricos , Insuficiência Respiratória/epidemiologia , Índice de Gravidade de Doença , População Urbana/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Idoso , Comorbidade , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Vírus da Influenza A Subtipo H1N1/isolamento & purificação , Influenza Humana/diagnóstico , Influenza Humana/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/epidemiologia , Polônia/epidemiologia , Gravidez , Complicações na Gravidez/epidemiologia , Síndrome do Desconforto Respiratório/epidemiologia , Sarcoidose/epidemiologia , Resultado do Tratamento , Adulto JovemRESUMO
A 44-year-old female was admitted because of tender, enlarged inguinal lymph nodes with a history of tick bite five weeks earlier. In the place of a tick bite on the skin a small ulcer was present. The primary symptoms before admission suggested typical diseases related to tick bite such as Lyme borreliosis and tick-borne encephalitis, what corresponded with positive IgM ELISA test for Lyme borreliosis. The course of disease however clarified the diagnosis of tularaemia, which is a relatively rare disease in Poland (6 cases per 40 million population are reported annually). The ultimate diagnosis was confirmed by serological tests.
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We present three cases of typhoid fever imported to Poland from India in the beginning of the year 2006 treated in our Zoonosis and Tropical Medicine Department. Two of them, with mild course of the disease, were vaccinated with Typhim Vi vaccine, the third didn't obtain any, and had very heavy, almost classical course of the disease. All of them behaved in India in improper way, probably also because were convinced they were protected by the vaccine. We emphasize that proper prophylaxis against typhoid fever for travelers should consist of vaccination with two vaccines, oral Ty 21a and parenteral Typhim Vi and it doesn't release travelers from avoiding risky behavior.