Characteristics and Outcomes of Critically Ill Pregnant/Postpartum Women with COVID-19 Pneumonia in Western Balkans, The Republic of Srpska Report.

Background and Objectives: Coronavirus disease 2019 (COVID-19) is a novel infectious disease that has spread worldwide. As of 5 March 2020, the COVID-19 pandemic has resulted in approximately 111,767 cases and 6338 deaths in the Republic of Srpska and 375,554 cases and 15,718 deaths in Bosnia and Herzegovina. Our objective in the present study was to determine the characteristics and outcomes of critically ill pregnant/postpartum women with COVID-19 in the Republic of Srpska. Materials and Methods: The retrospective observational study of prospectively collected data included all critically ill pregnant/postpartum women with COVID-19 in a university-affiliated hospital between 1 April 2020 and 1 April 2022. Infection was confirmed by real-time reverse transcriptase polymerase chain reaction (RT-PCR) from nasopharyngeal swab specimens and respiratory secretions. Patients' demographics, clinical and laboratory data, pharmacotherapy, and neonatal outcomes were analysed. Results: Out of the 153 registered pregnant women with COVID-19 treated at the gynaecology department of the University Clinical Centre of the Republic of Srpska, 19 (12.41%) critically ill pregnant/postpartum women (median age of 36 (IQR, 29-38) years) were admitted to the medical intensive care unit (MICU). The mortality rate was 21.05% (four patients) during the study period. Of all patients (19), 14 gave birth (73.68%), and 4 (21.05%) were treated with veno-venous extracorporeal membrane oxygenation (vvECMO). Conclusions: Fourteen infants were born prematurely and none of them died during hospitalisation. A high mortality rate was detected among the critically ill pregnant/postpartum patients treated with mechanical ventilation and vvECMO in the MICU. The preterm birth rate was high in patients who required a higher level of life support (vvECMO and ventilatory support).

Standardized extract of wild apple fruit in alkyl-polyglucoside-based cosmetic cream - estimation of stability, safety, antioxidant activity and efficiency.

OBJECTIVE: The aim of this study was in vitro and in vivo characterization of cosmetic cream with 6% of wild apple fruit water extract, containing 3.5% of alpha-hydroxyacids-AHAs and polyphenolic compounds, stabilized by biodegradable alkyl-polyglucoside emulsifiers. METHODS: In vitro characterization of cream included organoleptic and physico-chemical (pH values and electrical conductivity) analysis, antioxidant activity-AA estimation (using DPPH test) during 180 days of storage at 22±2°C and determination of cosmetic active substances content-AHAs (using HPLC analysis). In vivo estimation of skin irritation potential after creams application under occlusion during 24h was investigated employing the biophysical methods on 12 healthy volunteers; hydration efficiency, transepidermal water loss-TEWL, skin pH, erythema-EI and melanin index-MI on 10 healthy volunteers after 28 days of cream application and bleaching efficiency on 10 healthy volunteers after 7 days of cream application after artificially induced skin hyperpigmentation. RESULTS: Investigated cosmetic cream was pale beige color, odorless, semi-solid consistency and homogeneous, with pH values of 6.53±0.14, electrical conductivity above 50 µS/cm and AA of 24.96%RSC after preparation and these characteristics were stable during investigated period. In vivo measurements revealed absence of skin irritation after cream application under occlusion, which was part of it's safety profile. Increase of skin hydration after 14 days of cream application was 17.28±12.23 and after 28 days 21.19±7.59. In addition, in performed experiment TEWL and skin pH values during cream application remained unchanged. Cream application after artificial hyperpigmentation induced decrease of MI (∆MI after 7 days was -45.30±18.55) CONCLUSION: Formulated cosmetic cream with 6% of standardized wild apple fruit water extract and stabilized by biodegradable alkyl-polyglucoside emulsifiers demonstrated good stability, acceptable level of in vitro antioxidant activity, absence of skin irritation after cream application under occlusion and positive effects of cream on human skin after application (hydrating and bleaching effects). All mentioned properties make the cream suitable for possible usage as cosmetic product for preventing the skin damages caused by oxidative stress, for moisturizing the dry skin and bleaching of skin hyperpigmentation. This article is protected by copyright. All rights reserved.

Neonatal Outcomes in Labor After Intravenous Remifentanil Analgesia vs. Epidural Analgesia: A Retrospective Observational Study.

Background Some evidence indicates that maternal analgesia during labor may have adverse effects on neonates due to exposure to specific drugs or the potential effects of analgesia on the course of labor. We assessed the clinical outcome of term neonates born to mothers who received epidural analgesia (E) or systemic analgesia with remifentanil (R) during labor. Methods Data was collected retrospectively over one year. We have evaluated the medical records of 247 full-term neonates; 208 were born to mothers who received E and 39 to mothers who received R. Data on Apgar scores and neonatal complications (perinatal asphyxia, respiratory distress, infection, hyperbilirubinemia, and birth injuries), and average hospital stay were collected. Mann-Whitney U test, chi-square test, and logistic regression analysis were used where appropriate. Results The values of the mean Apgar scores between E and R at 1 and 5 minutes were similar (8.83 vs. 8.97, p = 0.252; 9.81 vs. 9.87, p = 0.762, respectively). The average length of neonatal hospitalization did not differ between groups (4.19 vs. 4; p = 0.557). The percentages of neonates with any complication were similar between groups (28.3% vs. 32.5%, p = 0.598). Neonates born by cesarean delivery (CD) had significantly worse outcomes than those born vaginally (p = 0.008, OR 2.8, 95% CI [1.30, 6.17]). Conclusion We did not find a statistically significant difference in mean Apgar scores and neonatal complications between neonates who received epidural vs. remifentanil analgesia. An increased rate of complications in neonates born via CD was found. Future studies should have a larger sample size and be powered to detect associations in these findings.

Comparative Effects of Target-Controlled Infusion of Propofol Versus Spinal and Thiopental-Sevoflurane Anesthesia on Lipid Peroxidation in Elective Cesarean Section: A Prospective, Open-Label Study.

BACKGROUND: During pregnancy, physiological changes can increase oxidative stress (OS) in both mothers and fetuses. The use of anesthesia for cesarean sections (CSs) could exacerbate this stress due to its impact on the ischemia-reperfusion effect. Our study aimed to explore the effects of target-controlled infusion of propofol on OS during CSs, and to compare these effects with those of spinal and thiopental-sevoflurane anesthesia. METHODS: The study included ninety parturients undergoing elective CS, allocated into three groups: Group S (spinal) (n = 30), Group P (propofol) (n = 30), and Group TS (thiopental-sevoflurane) (n = 30). Venous blood samples were taken from mothers at three time points, before, during, and after surgery, and one sample was taken from the umbilical vein after delivery. Blood samples were analyzed with the thiobarbituric acid reactive substances (TBARS) assay and blood gas analysis. A statistical comparison between groups was obtained by one-way analysis of variance (ANOVA) and the Wilcoxon test where appropriate. RESULTS: Levels of TBARS after the induction of anesthesia were lower in all groups compared to values preoperatively. In Group P, TBARS levels started to decrease in the first five minutes after the induction (1.90 ± 0.47; P < 0.001) and had significantly lower values compared to Group S (2.22 ± 0.21) and Group TS (2.40 ± 0.20). Two hours after surgery, TBARS values were the lowest in Group P (1.76 ± 0.15, P<0.001), compared to Group S (2.18 ± 0.24) and Group TS (2.41 ± 0.21). TBARS value in umbilical venous blood was significantly lower in Group P (1.56 ± 0.16, P < 0.001) compared to Group S (2.18 ± 0.17) and Group TS (2.09 ± 0.09). Umbilical cord venous blood gas values (pH, PCO2, HCO3, lactates, and base excess (BE)) were not different between the groups, except for PO2, which was significantly lower in Group S (20.5 ± 5.0; P < 0.001) compared to Group P (36.5 ± 19.2) and Group TS (33.5 ± 10.1). CONCLUSION: Target-controlled infusion of propofol anesthesia could be advantageous for parturients with compromised oxidative status, especially those undergoing emergency CSs when general anesthesia is required.

Standardized wild apple fruit extract as a bioactive agent in dermocosmetic products for efficacy skin hydration-In vitro and in vivo evaluation.

BACKGROUND: Wild apple fruit is rich source of bioactive substances, which can be potentially used for a production of dermocosmetic products. AIM: The aim of study was in vitro and in vivo investigation of standardized wild apple fruit extracts (obtained by purified water and maceration-EM, percolation-EP, Soxhlet extraction-ES and ultrasonic extraction-EU) and dermocosmetic creams of o/w type containing 6%, 12%, and 15% of extract EU, as extract with the best content of polyphenolic compounds (CE6, CE12, and CE15, respectively), in order to determine the optimal concentration of the extract, which manifests the best effect on the biophysical characteristics of the skin after application. METHODS: Content of polyphenolic substances-PP was investigated using HPLC analysis, while in vitro biological activity was examined on L929 fibroblasts using MTT viability test. In vivo efficacy included screening and comparison of skin hydration potential, transepidermal water loss-TEWL, and skin pH after 28 days of creams application on healthy volunteers' skin. RESULTS: Content of identified PP was the highest in the extract EU (2001.57 ± 0.87 mg PP/100 g EU) and satisfactory in cream CE6 (53.83 ± 0.23 mg PP/100 g CE6). Procyanidin B2 was the most common PP. Biological activity analysis showed that extract EU could be considered as non-cytotoxic for fibroblasts in examined concentrations. In vivo investigation revealed an increase of skin hydration (after 28 days ΔEC was 21.19 ± 7.59, 26.71 ± 7.94, and 29.60 ± 10.95 for CE6, CE12, and CE15, respectively), with unchanged TEWL and skin pH values. CONCLUSION: Obtained results indicate that wild apple fruit extract represents a valuable source of bioactive substances, with good hydration effects of creams on human skin (effect of creams increased proportionally to the increase of concentration of incorporated extract), so it might be considered as a great potential for application in dermocosmetic industry.

Blunt trauma of bone structures of the chest--computed tomography vs multidetector computed tomography.

BACKGROUND/AIM: Computerized tomography (CT), especially multidetector CT (MDCT), has had a revolutionary impact in diagnostic in traumatized patients. The aim of the study was to identify and compare the frequency of injuries to bone structures of the thorax displayed with 5-mm-thick axial CT slices and thin-slice (MDCT) examination with the use of 3D reconstructions, primarily multiplanar reformations (MPR). METHODS: This prospective study included 61 patients with blunt trauma submitted to CT scan of the thorax as initial assessment. The two experienced radiologists inde pendently and separately described the findings for 5-mm-thick axial CT slices (5 mm CT) as in monoslice CT examination; MPR and other 3D reconstructions along with thin-slice axial sections which were available in modern MDCT technologies. After describing thin-slice examination in case of disagreement in the findings, the examiners redescribed thin-slice examination together which was ultimately considered as a real, true finding. RESULTS: No statistically significant difference in interobserver evaluation of 5 mm CT examination was recorded (p > 0.05). Evaluation of fractures of sternum with 5 mm CT and MDCT showed a statistically significant difference (p < 0.05) in favor of better display of injury by MDCT examination. CONCLUSION: MDCT is a powerful diagnostic tool that can describe higher number of bone fractures of the chest in traumatized patients compared to 5 mm CT, especially in the region of sternum for which a statistical significance was obtained using MPR. Moreover, the importance of MDCT is also set by easier and more accurate determination of the level of bone injury.

[Co-induction in ambulatory anesthesia]. / Koindukcija u ambulantnoj anesteziji.

BACKGROUND: Co-induction in anesthesia is very useful: synergistic effects of two inductional drugs may lower the dose regimen and the incidence of adverse effects. The aim of this study was to investigate and compare two anesthesiological techniques for short-lasting gynecological procedures in outpatient anesthesia. A total of 80 patients scheduled for surgical termination of pregnancy were randomly assigned into two equal groups--control and co-induction group. METOHDS: The first group of patients received atropine 0.5 mg i.v., alfentanil 0.5 mg i.v. and propofol as a fractionated i.v. bolus until the loss of eyelash reflex. The second group received atropin 0.5 mg, alfentanil 0.5 mg, midazolam 3 mg and propofol in the same manner as the first group. Anesthesia was maintained with propofol increments. Cardiovascular parameters, parameters of post anesthesia recovery and the adverse effects were registered. RESULTS: In patients receiving midazolam inductional dose of propofol was significantly lower, whereas cardiovascular parameters were not significantly different. The recovery after anesthesia was slightly longer after co-induction, but it was not of great clinical significance. The reduction of the adverse effects was found in the co-induction group. CONCLUSION: The results of the study showed that co-induction of midazolam-propofol in comparison with propofol alone for outpatient anesthesia had the following advantages: the reduction of propofol dose, better quality of anesthesia and the reduction of the adverse effects. Recovery was faster in the group that didn't receive midazolam, but it was not of great clinical significance. The conclusion is that co-induction with the combination midazolam-propofol has the advantage in outpatient procedures.

[Successful resuscitation of a patient with prolonged tocolytic therapy and an emergency cesarean section]. / Uspesna reanimacija bolesnice na produzenoj tokolitickoj terapiji kod koje je uraden hitan carski rez.

Ritodrine is the only medicament approved by FDA in the USA as well as in our country for prevention of the threatening preterm labor. Its adverse effects upon the respiratory and cardiovascular systems, including pulmonary oedema and myocardial ischemia, occur more frequently during the intravenous therapy than during the oral maintenance therapy. The aim of this report was to present a patient with cardiovascular adverse effects of ritodrine, who had her pregnancy terminated by an urgent cesarean section under general anesthesia. In the course of operation, the patient had two cardiac arrest (total of 70 min). Resuscitation was performed by direct and indirect heart massage. The patient's condition was stabilized during the next six hours. The patient was transferred to the coronary unit, where the treatment was continued for 30-days period, after which the patient was released home as completely recovered.