Choice of contraception at 6-8 weeks postpartum in south-eastern Hungary.

OBJECTIVES: The aims of the study were to describe the sociodemographic determinants, breastfeeding- and sexual life-related predictive factors of contraceptive use at 6-8 weeks postpartum. METHODS: A prospective, web-based questionnaire survey was carried out by distributing an access code to women immediately after delivery at the Department of Obstetrics and Gynaecology, the University of Szeged, Szeged, Hungary, between 1 September 2013 and 1 May 2015. RESULTS: In total, 1875 women were invited to participate in the study, 632 of whom refused or were excluded and 644 were not sexually active. The remaining sexually active women (n = 599) completed the questionnaire. At 6-8 weeks postpartum, 22.5% were using an effective contraceptive method and 40.2% were relying on lactational amenorrhoea (LAM). We found a significant direct association between the educational level of a woman's partner and her use of an effective contraceptive method (p < .001) (adjusted odds ratio [AOR]: 1.9) or LAM (AOR: 1.49). Use of an effective contraceptive method before pregnancy increased the likelihood of using the same method after delivery (AOR: 3.16) and decreased the likelihood of LAM use at weeks 6-8 (AOR: 0.31). The AOR for effective contraceptive use was 2.23 times higher in women who had sexual intercourse once or more a week compared with those who had sexual intercourse less frequently. CONCLUSIONS: Concerted efforts to promote the use of long-acting reversible contraception (LARC) are required, particularly among women who would like future childbearing. Further research is needed on the factors contributing to the low uptake of LARC in this population.

[Forensic aspects of sexul assault].

No abstcarct available.

[Diagnosis and treatment of stroke during pregnancy]. / A stroke diagnózisa és kezelése terhesség alatt.

Stroke, the sudden onset of brain dysfunction from a vascular cause, is one of the most common causes of long-term disability. Although rare during childbearing years, stroke is even more devastating when it occurs in a young woman trying to start a family. Pregnancy and the postpartum period are associated with an increased risk of ischemic stroke and intracerebral hemorrhage, although the incidence estimates have varied. There are several causes of stroke that are in fact unique to pregnancy and the postpartum period, such as preeklampszia and eklampszia, amniotic fluid embolus, postpartum angiopathy and postpartum cardiomyopathy. The purpose of this article is to summarize existing data regarding incidence, risk factors and potential etiologies, as well as treatment strategies for stroke in pregnancy.

[Preconceptional and perinatal challenges of pregnancy in women with epilepsy]. / Epilepsziával szövodött terhesség preconceptionalis és perinatalis kihívásai.

Reproductive-aged women with epilepsy may present a number of specific issues to be managed in daily clinical practice. The impact of epileptic seizures and antiepileptic therapy on pregnancy outcome and the risk of teratogenicity should be minimized, which require careful attention and cooperation between obstetric gynecologyst and neurologist. The aim of the present paper is to review the impact of epilepsy attack on fetus and the pathomechanism and teratogenic effect of antiepileptic drugs.

[Knowledge of university students in Szeged, Hungary about reliable contraceptive methods and sexually transmitted diseases]. / Szegedi egyetemi hallgatók ismeretei a megbízható fogamzásgátlásról és a szexuális úton terjedo betegségekrol.

INTRODUCTION: Promiscuity and lack of use of reliable contraceptive methods increase the probability of sexually transmitted diseases and the risk of unwanted pregnancies, which are quite common among university students. AIM: The aim of the study was to assess the knowledge of university students about reliable contraceptive methods and sexually transmitted diseases, and to assess the effectiveness of the sexual health education in secondary schools, with specific focus on the education held by peers. METHOD: An anonymous, self-administered questionnaire survey was carried out in a randomized sample of students at the University of Szeged (n = 472, 298 women and 174 men, average age 21 years) between 2009 and 2011. RESULTS: 62.1% of the respondents declared that reproductive health education lessons in high schools held by peers were reliable and authentic source of information, 12.3% considered as a less reliable source, and 25.6% defined the school health education as irrelevant source. Among those, who considered the health education held by peers as a reliable source, there were significantly more females (69.3% vs. 46.6%, p = 0.001), significantly fewer lived in cities (83.6% vs. 94.8%, p = 0.025), and significantly more responders knew that Candida infection can be transmitted through sexual intercourse (79.5% versus 63.9%, p = 0.02) as compared to those who did not consider health education held by peers as a reliable source. The majority of respondents obtained knowledge about sexual issues from the mass media. CONCLUSIONS: Young people who considered health educating programs reliable were significantly better informed about Candida disease.

[Genetic and epigenetic factors of polycystic ovary syndrome]. / Genetikai és epigenetikai faktorok polycystás ovarium szindróma esetén.

The development of polycystic ovary syndrome and its exact pathophysiological mechanism is still unclear, but environmental and genetic factors likely play a role. Exposition to teratogenic effects during the prenatal development can lead to chronic diseases in the postnatal period. This finding confirms the common familial aggregation as well. A literature search was conducted up to January 1, 2016 for articles dealing with the genetic or epigenetic factors of polycystic ovary syndrome. This review will discuss the current understanding of the genetic basis and clinical presentation of this disease. Orv. Hetil., 2016, 157(32), 1275-1281.

[Low rate of oropharyngeal human papillomavirus infection among women with cervical lesion. Preliminary results from the South-Eastern Hungarian population]. / Oropharyngealis humán papillomavírus ritka elofordulása cervicalis laesióval rendelkezo nokben. Elozetes eredmények dél-magyarországi vizsgálat alapján.

INTRODUCTION: Although the natural history of cervical and oral human papillomavirus infection has been intensively investigated in the past years, the ability of this virus to infect oral and genital mucosae in the same individual and its potential to co-infect both cervical and oral mucosa are still unclear. AIM: The aim of the authors was to assess the presence of oropharyngeal human papillomavirus infection in women with cervical lesions in the South-Eastern Hungarian population. METHOD: The total of 103 women have been included in the study between March 1, 2013 and January 1, 2015. Brushing was used to collect cells from the oropharyngeal mucosa. Human papillomavirus DNA was detected using polymerase chain reaction, and Amplicor line blot test was used for genotyping. RESULTS: Oropharyngeal human papillomavirus infection was detected in 2 cases (3%). The detected genotypes were 31, 40/61 and 73 in the oropharyngeal region. CONCLUSIONS: The results indicate that in women with cervical lesions oropharyngeal human papillomavirus infection rarely occurs.

NMDA-receptor associated encephalitis in a woman with mature cystic ovarian teratoma.

Introduction - N-methyl-D-aspartate receptor (NMDA-R) antibody-associated encephalitis has been reported in the international neurological literature to be associated with mature or immature ovarian teratomas (OTs). However, few cases of encephalitis were diagnosed in Hungary. In 2011 Hollody et al. described the first case of anti-NMDA receptor associated encephalitis in Hungary. Objective - Our aim was to present a case of NMDA-R antibody-mediated encephalitis in a woman with OT thereby providing information facilitating diagnosis of OT in women, who present with symptoms of encephalitis. Case - We report the case of a 25 year-old women, who developed NMDA-R -antibody associated autoimmune encephalitis and who displayed confusion, disorientation, a behavioural disturbance with agitation and features of paranoia and at least one reported generalized tonic clonic seizure and orofacial dyskinesia. Magnetic resonance imaging revealed a functional ovarian cyst measuring 3.3 cm, which was removed surgically and demonstrated histologically to be a mature cystic OT. The serum was positive for antibodies to NMDA receptors. Following intravenous immunoglobulin treatment, oophorectomy and a 5-day course of plasma exchange, followed by corticosteroid and azathioprine immunosuppressive therapy, the patient displayed a significant clinical improvement. Conclusion - Cystic teratomas are common benign ovarian lesions in women of reproductive age. Although the association of OTs and NMDA-R antibody-associated encephalitis has been described in the international neurological literature, this relationship needs to be considered from on the interdisciplinary aspect by the health care providers.

[Outcomes of childbearing and pregnancy in women with multiple sclerosis--a literature review]. / Gyermekvállalás és szüléskimenetel sclerosis multiplexben a nemzetközi irodalom tükrében.

In the last few years more studies indicated that although sclerosis multiplex frequently manifests in young adulthood, it should not be considered as contraindication for pregnancy in women affected with the disease. In fact, despite controversial literature data, pregnancy appears to be a protective factor to the disease without a harmful effect on the fetus. However, the use of immunomodulatory therapy during pregnancy needs a careful evaluation process and experts of this field may contribute to family happiness of the affected mother.

[Risk of maternal and fetal disease among women older than 40 years]. / Magzati és anyai betegségek kockázata 40 évesnél idosebb édesanyák esetén.

A rising trend in advanced maternal age has been observed over the last few decades. Several studies have assessed the association between advanced maternal age and adverse pregnancy outcome, including miscarriage, stillbirth, pre-eclampsia, gestational hypertension, gestational diabetes mellitus, preterm birth, delivery of a small- or large-for-gestational-age neonates and elective or emergency Cesarean section. These studies reported contradictory findings. The aim of the present paper is to summarize the evidence-based information regarding advanced maternal age and pregnancy outcomes.

[Clinical aspects of congenital maxillofacial deformities]. / A veleszületett maxillofacialis deformitások klinikai aspektusai.

The cleft lip and palate deformity is one of the most common type of congenital abnormalities. The aim of this paper is to summarise the literature knowledge about cleft lip and/or palate. The authors review and discuss international literature data on the prevention, genetic and environmental predisposing factors, anatomical and embryological features, as well as pre- and post-natal diagnosis and treatment of these deformities. The aetiology is multifactorial, driven by both genetic and environmental factors which lead to multifaceted phenotypes and clinical features of these malformations. The lack of the multidisciplinary knowledge about prenatal diagnosis, prevention, genetic aspects and treatment strategy could result in serious diagnostic errors, hence clinical teamwork is critically important to solve the problems of this pathology. Only the professional teamwork and multidisciplinary cooperation can guarantee the optimal level of health care and better quality of life for these patients and their families.

[Differential diagnostic and therapeutic aspects of Q-fever in a male prisoner. Case report]. / A Q-láz differenciáldiagnosztikai és terápiás aspektusai egy 46 éves fogva tartott férfi esete kapcsán.

The authors describe the case of a 46-year-old man, who developed atypical pneumonia caused by Coxiella burnetii. Chest X-ray revealed interstitial pneumonia. Western blot and ELISA test were positive for Coxiella burnetii antibody. After treatment with doxycyclin and amoxicillin supplemented with vitamin B6 for 10 days, the patient displayed a clinical improvement. The authors conclude that in cases with atypical pneumonia, Coxiella burnetii antibody as well as other bacterial or viral antibodies should be determined.

EFFECTS OF MATERNAL EPILEPSY AND ANTIEPILEPTIC THERAPY IN WOMEN DURING PREGNANCY.

OBJECTIVE: The aim of this study was to analyse the effects of epilepsy and antiepileptic drug (AED) treatment on pregnancy and the perinatal outcome, retrospectively. METHODS: We examined the obstetric and fetal outcomes among women with epilepsy (WWE), who were followed-up at the Department of Neurology, and who delivered at the Department of Obstetrics and Gynaecology (n=91) between 31th December 2000 and 31th March 2014. Statistical comparisons of different obstetric and fetal parameters on a sample of 91 WWE and 182 non-WWE were assessed by the chi-square-test, the independent sample t-test. RESULTS: The rate of major congenital malformations (MCMS) among the newborns of all AEDs exposed mothers was 7.69%. There were three peaks of seizures: during the third trimester, during delivery and in the puerperium. The prevalence of miscarriages, post-term birth and the rate of caesarean section were significantly higher among the WWE than among the non-WWE (p=0.001; p<0.001; p=0.02). Parameters of neonates (birth weight, birth length, head-, and chest circumference) were significantly different between the WWE group and the non-WWE group (p=0.003, p<0.001, p<0.001, p<0.001) CONCLUSIONS: In contrast with recent publications, there were significant differences in the parameters of neonates between the two groups. Our results are in accordance with those of previous studies from the aspect of AED-related MCM, the elevated risk of miscarriages and pre-existing hypertension.

[The possibility of prenatal diagnosis of autism spectrum disorder]. / Az autizmusspektrum-zavarok prenatális diagnózisának lehetoségei.

Autism spectrum disorder (ASD) is an idiopathic multifactorial disease. Chromosomal abnormalities could be found only in a few percent (0.3-0.6) of cases. The estimated prevalence is 0.6 in Europe and the prevalence of the disease has been increased in last few decades. ASD have an impact on the quality of life of the patient and his family. The early diagnosis of ASD is most important. There are limited data regarding the measure of biparietal diameter (BPD) of the fetus in the first trimester of pregnancy. These data suggested the BPD is an important screening marker for ASD, but the complex prenatal screening is unresolved. There is a need for further investigations of the genetic background of ASD and to identify potentially first trimester ultrasound markers for ASD.

[News methods for second trimester screening of Down syndrome: statistical analysis of the use of nasal bone length and prenasal thickness]. / Új módszerek a Down-szindróma második trimeszterbeli ultrahangszurésére: az orrcsonthosszúság és a praenasalis lágyrész-vastagság mérésének statisztikai elemzése.

INTRODUCTION: Sonographic measurements of nasal bone length and prenasal soft tissue thickness are ultrasonographic methods for prenatal screening of Down syndrome. AIM: The aim of the authors was to create a local normogram for nasal bone length and prenasal soft tissue thickness measurements and to test the performance of different statistical methods. METHOD: Euploid (N = 1500) and trisomy 21 foetuses (N = 10) studied between April 2008 and December 2013 were included. Nasal bone length and prenasal thickness measurements were performed at the Medisono Fetal and Maternal Health Research Centre, Szeged, and cytogenetic tests were performed at the Department of Medical Genetics, University of Szeged, Hungary. Normograms were created with different number of patients (N = 100, 300, 500, 750. 1000 and 1500) and using 3 different statistical methods (linear regression, square-based regression, and box-plot analysis). RESULTS: The results indicated that at least 1000 measurements are strongly recommended for the normograms. The increase of patient number improved the efficacy of the normograms in each of the 3 statistical methods used for analysis. In general practice box-plots provides a better performance over the other screening methods. However, advanced level screening requires local linear normograms for the best screening results. CONCLUSION: The use of box-plots is recommended for the use in the daily practice but regression-based normograms are necessary for advanced prenatal screening.

The potential role of oxytocin and perinatal factors in the pathogenesis of autism spectrum disorders - review of the literature.

Autism Spectrum Disorders (ASD) are characterized by: social and communication impairments, and by restricted repetitive behaviors. The aim of the present paper is to review abnormalities of oxytocin (OXT) and related congenital malformations in ASD. A literature search was conducted in the PubMed database up to 2016 for articles related to the pathomechanism of ASD, abnormalities of OXT and the OXT polymorphism in ASD. The pathomechanism of ASD has yet to be. The development of ASD is suggested to be related to abnormalities of the oxytocin-arginin-vasopressin system. Previous results suggest that OXT and arginine vasopressin (AVP) may play a role in the etiopathogenesis of ASD.

Knowledge and opinion of pharmacists on emergency contraceptive pills in Hungary.

Background Emergency contraceptive pills (ECPs) are used to prevent unintended pregnancy. There is a worldwide intention to improve access to ECPs; therefore, identifying potential barriers to introducing over-the counter (OTC) access is of utmost importance. As pharmacists are the key personnel to convey accurate drug information, their knowledge and attitude on ECPs is important. Objective We aimed to conduct a nationwide study to assess pharmacists' knowledge on ECPs and to survey their opinion on sales category change of ECPs (i.e. to introduce OTC access in pharmacies). Setting Registered pharmacists in Hungary. Method A prospective cross-sectional study was conducted with an anonymous, web-based questionnaire. Univariate analysis (Mann-Whitney U test and Fischer's exact test) was used to identify factors associated with supportive opinion toward OTC provision. Main outcome measure Knowledge level of pharmacists, proportion of pharmacists with supportive opinion on OTC access. Results 357 out of 2019 pharmacists completed the questionnaire, yielding a 17.7% response rate. Almost 30% of pharmacists (N = 99) agreed that ECPs should have an OTC availability in Hungary. More than 40% of pharmacists (N = 145) considered ECPs as contraceptives. On average, 55.18% (standard deviation: ±12.40%) of the answers were correct, showing moderate knowledge of the pharmacists. Age and rating ECPs as contraceptives were significantly associated with supportive opinion toward OTC provision (p < 0.001). The effect of knowledge on the pharmacist's opinion was significant in young pharmacists (p = 0.02). Conclusion Pharmacists' knowledge and opinion on ECPs should be improved, especially that of the young ones. Currently the attitude of pharmacists does not favor sales category changes of ECPs in Hungary.

Lyme disease associated neuroretinitis - Case report.

We describe a rare case of Lyme disease complicated by unilateral neuroretinitis in the right eye. We report a case of a 27-year-old woman with blurred vision on her right eye. Because of the suspicion of optic neuritis (multiplex sclerosis) neurological examination was ordered. Surprisingly, computer tomography of the brain revealed incomplete empty sella, which generally results not monocular, but bilateral optic nerve swelling. Opthalmological examination (ophthalmoscopy and optical coherence tomography) indicated not only monocular optic nerve, but retinal oedema next to the temporal part of the right optic disk. Visual evoked potentials (VEP) demonstrated no P100 latency delay and mild differences between the amplitudes of the responses of the left and right eye. Optical coherence tomography (OCT) demonstrated the swelling of the optic nerve head and oedematous retina at the temporal part of the disk. Suspicion of an inflammatory cause of visual disturbance blood tests was ordered. Doxycycline treatment was ordered till the result of the blood test arrived. The Western blot and ELISA test were positive for Borrelia burgdorferi sensu lato. Following one week corticosteroide and ceftriaxone treatments, the patient displayed a clinical improvement. Unilateral neuroretinitis with optic disk swelling due to neuroborreliosis is a rare complication and in many cases it is difficult to distinguish between inflammatory and ischemic lesions. Further difficulty in the diagnosis can occur when intracranial alterations such as empty sella is demonstrated by CT examination.

Pregnancy and perinatal outcomes among women with multiple sclerosis: a retrospective case-controlled study in South Hungary.

OBJECTIVE: The aim of this study was to investigate the connections between multiple sclerosis (MS) and fertility, pregnancy. METHODS: The case histories and pregnancy complications in a sample of 65 treatment-naive pregnant women with MS in the period 1998-2012 were compared with an age-matched case-controlled analysis. Comparisons were made between primigravidas and multigravidas subjects. RESULTS: Our results revealed a higher rate of miscarriage (18.46%) in the first trimester in women with MS, and intrauterine death (7.69%) in the third trimester, as compared with women without MS (p < 0.001 and p = 0.035). CONCLUSIONS: These findings suggest that, the risk of miscarriages and intrauterine death may be disease-related not drug-related feature. Further studies are needed to determine to possible associated factors of miscarriages.

Management of severe idiopathic oligohydramnios: is antepartum transabdominal amnioinfusion really a treatment option?

OBJECTIVE: The aim of this study was an evaluation of the role of antepartum transabdominal amnioinfusion (APTA) in the management of severe idiopathic oligohydramnios with a view to improving the pregnancy outcome. METHODS: The study comprised an analysis of 20 pregnant women with severe oligohydramnios who were treated with APTA in 2009 and 2012. The pregnancy outcomes and the complications of the procedure were analysed. RESULTS: The mean gestational age at first treatment was 22 weeks 3 days. The preprocedure amniotic fluid index of <5 cm was restored by the treatment to 8 cm. More than a half of the pregnancies (66.7%, 8/12) treated with APTA finished with spontaneous abortion in the second trimester, mostly due to rupture of the membranes (as a consequence of retroamniotic filling with saline in four cases). The later the oligohydramnios developed, the higher the probability of a significant prolongation of the gestation. CONCLUSIONS: Although APTA is a useful procedure in the management of severe oligohydramnios, it may be followed by a relatively high rate of rupture of the membranes, particularly in the second trimester. Paradoxically, a higher volume of infused saline into the amniotic cavity is associated with a significantly lower risk of rupture.