Peripartum hysterectomy: A 9-year population-based study in Slovakia.

OBJECTIVE: To assess the incidence of peripartum hysterectomy (PH) in Slovakia. Additionally, we wanted to describe reasons for the procedure, associated clinical circumstances, and complications. METHODS: This was a descriptive, population-based study among women who underwent PH in Slovakia between January 2012 and December 2020. Peripartum hysterectomy was defined as surgical removal of the uterus from the peripartum period up to 42 days postpartum. Data were obtained retrospectively from the standardized questionnaires that are completed in Slovakia for any case of PH. The background population consisted of all other women who delivered during the study period. RESULTS: Of the 436 136 births, there were 397 cases of PH, giving an incidence of 0.91 per 1000 births. It was higher with advanced maternal age, multiparity, multiple pregnancies, and cesarean deliveries. The main reasons for the procedure were placental pathologies and uterine atony in 52.9% and 33.0%, respectively. A total of 150 (37.8%) women required admission to an intensive care unit. The mortality rate was 1.5%. CONCLUSION: The incidence of PH is relatively high in Slovakia when compared with other European countries, highlighting the need to improve prenatal diagnosis of morbidly adherent placenta and the management of peripartum hemorrhage.

Morbidly adherent placenta as a cause of peripartum hysterectomy in the Slovak Republic in the years 2012-2020.

OBJECTIVE: The main aim of this study was to analyze the cases of peripartum hysterectomy associated with morbidly adherent placenta in the Slovak Republic. MATERIALS AND METHODS: Cases of morbidly adherent placenta managed by peripartum hysterectomy in the Slovak Republic between January 2012 and December 2020 were retrospectively analyzed. Data were obtained from the standardized anonymous questionnaires. RESULTS: The incidence of morbidly adherent placenta was 0.39 per 1,000 births. A total of 151 (89.9%) women with morbidly adherent placenta were managed by peripartum hysterectomy (38.0% of all peripartum hysterectomies). Placenta accreta, increta and percreta were present in 56.3%, 28.5% and 15.2%, respectively. Placenta previa was present in 60 (39.7%) cases. Up to 112 (74.2%) cases of morbidly adherent placenta were diagnosed at the time of delivery. Hysterectomy was preceded by unsuccessful uterus-saving procedure in 23 (15.2%) of cases. The median of estimated blood loss was 1,500 mL. A packed red blood cells transfusion was used in 138 (91.4%), fresh frozen plasma in 118 (78.2%), fibrinogen concentrate in 39 (25.8%) and tranexamic acid in 25 (16.6%) women. A total of 58 (38.4%) women required admission to an intensive care unit. The mortality rate was 1.3%. CONCLUSION: In recent years, there was an increase in the incidence of morbidly adherent placenta, peripartum hysterectomy in the Slovak Republic, along with an increase in caesarean section rates, too. Case analysis highlights the need to improve the prenatal diagnosis and management of morbidly adherent placenta.

Severe maternal morbidity requiring intensive care units admission in the Slovak Republic - a 9-year population based study.

OBJECTIVE: Analysis of life-threatening maternal morbidities, the condition of which required subsequent treatment in Intensive Care Units (ICU) in the Slovak Republic in the years 2012-2020. METHODOLOGY: Retrospective analysis of 655 identified cases of mothers admitted to the intensive care units out of 436,136 births. The reasons for the transport were divided into nine categories: peripartum bleeding, hypertensive diseases, thromboembolism, cardiovascular diseases, sepsis/severe infections, metabolic diseases, complications of anaesthesiology, gastroenterological problems and others. RESULTS: The total incidence of admission to the intensive care units in the observed period was 1.5 per 1,000 births, but for mothers of Roma nationality it was 8.8 per 1,000 births. The average age of mothers was 30.7 years, while 29.7% were over 35 years old. Overweight and obesity was present by 70.4% of mothers. The most common reason for transport to the ICU (49.3%) was severe postpartum hemorrhage. The second most common cause (26.0%) was hypertensive diseases (preeclampsia, eclampsia and HELLP syndrome). The third most common cause (4.9%) was sepsis and severe maternal infections. The mortality rate of mothers admitted to the ICU was 2.3% and infant mortality of these mothers was 8.7%. CONCLUSION: The incidence of admission of mothers to the ICU in the monitored years was 1.5 per 1,000 births, which in international comparison ranks Slovakia among countries with a lower incidence.

Comparative Analysis of Methods for Somatic Cell Counting in Cow's Milk and Relationship between Somatic Cell Count and Occurrence of Intramammary Bacteria.

The aim of this study was to compare three on-farm commercial methods for the indirect detection of subclinical mastitis in dairy cows: the California mastitis test (CMT), the Porta side somatic cell count milk test (Porta SCC), and the DeLaval cell counter (DCC), with the Fossomatic cell count (FSCC), and to evaluate the relationship between the determined somatic cell count SCC and the occurrence of intramammary pathogens in the milk of dairy cows. A total of 284 sensory unchanged mixed milk samples, collected during the milking on a dairy farm, were analyzed in this study for somatic cell counts by the mentioned on-farm tests. Quarter milk samples (n = 583) from all the selected cows were cultured. The agreement, sensitivity, and specificity of the three indirect commercial diagnostic tests (the CMT, the Porta SCC, and the DeLaval cell counter) were calculated, and the FSCC was used as the gold standard. The results were analyzed statistically using the Pearson correlation test and the paired t-test. The CMT matched with the FSCC in 83.1% of the samples, with the Porta SCC in 80.6%, and with the DCC in 80.3% of the samples. The sensitivity and specificity reached 81.0% and 92.9% for the CMT, 79.4% and 90.7% for the Porta SCC, and 75.8% and 97.5% for the DCC, respectively. The correlation between the FSCC and the Porta SCC was 0.86 (p < 0.0001), and between the FSCC and the DCC, it was 0.92 (p < 0.0001). The differences between them were insignificant. Bacteria were detected in 130 (22.3%) quarter milk samples. The most prevalent bacteria were Enterococcus spp. (36.2%), followed by E. coli (20%), coagulase-negative staphylococci (13.1%), A. viridans (9.2%), Streptococcus spp. (9.2%), Proteus spp. (6.2%), and S. intermedius (3.9%). Contagious isolates (S. aureus) were detected in 3 quarter milk samples (2.3%). The agreement between the individual tests and the microbiological culture was as follows: 69.2% for the CMT; 73.7% for the Porta SCC; 71.6% for the DCC; and 76.5% for the FSCC. Higher SCCs were detected in the milk samples contaminated with bacteria than in the healthy milk (p < 0.001). No significance was found between the presence of individual species of intramammary pathogens and the different levels of SCCs. Based on the results, bacteria are the predominant cause of subclinical mastitis. The increased SCC of some milk samples with no presence of bacteria meant that the increase could have been caused by numerous other agents (viruses, fungi, or algae) or factors for mastitis in the dairy industry.

Biofilm-Producing Ability of Staphylococcus aureus Obtained from Surfaces and Milk of Mastitic Cows.

This study was conducted to evaluate the incidence of mastitis in 153 dairy cows and to evaluate the kinetics of adhesion of isolates obtained from surfaces and milk in comparison with the reference strain (RS), CCM 4223. The surfaces of the floor, teat cup, and cow restraints were aseptically swabbed in three replicates (n = 27). Of the total number of infected cows (n = 43), 11 samples were found to be positive for Staphylococcus aureus, 12 samples tested positive for non-aureus staphylococci, 6 samples tested positive for Streptococcus spp., and 11 samples tested positive for other bacteria (Escherichia coli, Pseudomonas spp.) or a mixed infection. The most represented pathogen in milk (11/43) and on surfaces (14/27) was S. aureus. The kinetics of adhesion of the reference strain and isolates of S. aureus on stainless steel surfaces were determined after 3, 6, 9, 12, 24, and 48 h, and 3, 6, 9, 12, and 15 days of incubation. All strains reached counts higher than 5 Log10 CFU/cm2 needed for biofilm formation, except RS (4.40 Log10 CFU/cm2). The isolates of S. aureus revealed a higher capability to form biofilm in comparison with RS during the first 3 h (p < 0.001). Thus, there is a significant difference between the occurrence of S. aureus on monitored surfaces-floor, teat cup, and cow restraints-and the frequency with which mastitis is caused by S. aureus (p < 0.05). This finding raises the possibility that if various surfaces are contaminated by S. aureus, it can result in the formation of biofilm, which is a significant virulence factor.

Effectiveness of sanitation regime in a milking parlour to control microbial contamination of teats and surfaces teat cups'.

INTRODUCTION AND OBJECTIVE: The major sources of bacterial contamination of raw milk are post-harvest manipulation; therefore the disinfection of teat and teat cups which decrease the bacterial load has a positive impact on minimizing new infection rates. The aim of the study was determination of the incidence of pathogens on investigated surfaces, evaluation of the effectiveness of sanitation regime in the reduction of surface microbial load, and determination of the effectiveness of mechanical cleaning of teats in a milking parlour for dairy cows. MATERIAL AND METHODS: Samples from surfaces were taken by microbiological swabs using a sterile cotton swab from area of 5×2 cm2. Sanitation regime was evaluated based on the effectiveness of active substances - lactic acid and sodium hypochlorite. RESULTS: From a total of 105 swab, 44 samples were found positive for Staphylococcus aureus, 16 samples for E. coli, 15 samples for Micrococcus spp., 8 samples for Staphylococcus xylosus, 9 samples for Staphylococcus cohni urealyticum, 1 sample for Enterococcus faecalis. Among isolates, S. aureus was the predominat species from teats - 19/45, teat cups, 15/45 and from wiping cloths 10/15. Sanitation regime was confirmed by a decrease in the number of coliform bacteria (CB) determined on teat and teat cups from 2.33-0.95 Log10 CFU/cm2 (p<0.001) and 0.90-0.62 Log10 CFU/cm2 (p<0.001), respectively, and in the number of total bacteria count (TBC) determined on teat and teat cups from 4.36-0.99 Log10CFU/cm2 (p<0.001), and 1.85-0.77 Log10 CFU/cm2 (p<0.001), respectively. Incidence of CB (2.53 Log10 CFU/cm2) and TBC (3.83 Log10 CFU/cm2) on wiping cloths after mechanical cleaning of udders stress the importance of this step. CONCLUSIONS: Results show that disinfectant with lactic acid as the main active ingredient is suitable for bacterial reduction. Post-milking disinfection of teat and teat cups reduces bacterial contamination and proves to be most effective against environmental bacteria.

Caesarean section, vaginal instrumental delivery and perineal morbidity in the Slovak Republic in the years 2007-2018.

OBJECTIVE: Analysis of caesarean section, vaginal instrumental deliveries and severe perineal morbidity in the Slovak Republic in the years 2007-2018. METHODS: The analysis of prospectively collected caesarean section and vaginal instrumental delivery data in the years 2007-2018, and episiotomies and severe perineal morbidity data in the years 2008-2018 from obstetrics hospitals in the Slovak Republic. RESULTS: Caesarean section rate progressively increased from 24.1% in 2007 up to 30.8% in 2013 and decreased to 29.6% in 2018. Vacuum-extraction frequency was 1.3% in 2007 and increased up to 2.0% till 2018. Forceps frequency decreased since 2008-2018 from 0.56% to 0.43%. In the years 2008-2018, frequency of perineal tears of the 3rd and 4th degree increased from 0.4% to 0.8%. Frequency of episiotomies decreased in the years 2008-2018 from 74.7% to 47.7%. CONCLUSION: The highest caesarean section rate in the Slovak Republic - 30.8% occurred in 2013, but slowly decreased in the following years. The frequency of vacuum extraction increased and forceps decreased. Frequency of episiotomies had decreased and severe perineal tears held an increasing trend.

Severe maternal morbidity in the Slovak Republic in the years 2012-2018.

OBJECTIVE: Analysis of maternal morbidity in the Slovak Republic in the years 2012-2018. METHODS: The analysis of selected maternal morbidity data prospectively collected in the years 2012-2018 from all obstetric units in the Slovak Republic. RESULTS: In the years 2012-2018, incidence of severe peripartum bleeding was 2.17, peripartum hysterectomy was 0.89, maternal admission to intensive care units was 1.59, eclampsia was 0.21, HELLP syndrome was 0.73, abnormally invasive placentation was 0.37, uterine rupture was 0.68, severe sepsis in pregnancy and puerperium was 0.18 and nonfatal amniotic fluid embolism was 0.027 per 1,000 births. CONCLUSION: Incidence of total severe acute maternal morbidity in the Slovak Republic was 6.84 per 1,000 births. In Slovak local conditions, there is still room for reduction of severe acute maternal morbidity.

Dairy Cows' Udder Pathogens and Occurrence of Virulence Factors in Staphylococci.

This study investigated 960 Slovak and Czech spotted cattle from four different conventional (non-organic) dairy herds located in Eastern Slovakia and Czechia during early lactation (14-100 days after calving). Dairy cows were examined clinically; milk from fore-stripping of each udder quarter was subjected to sensory examination and assessed by the California mastitis test (CMT), and laboratory analyses of bacterial pathogens in milk, including virulence factors, were conducted. Positive CMT scores (1-3) for one or more quarters were detected in 271 (28.2%) of the examined animals. Out of 230 infected milk samples, representing 24.0% of all dairy cows, staphylococci (59.1% of positive findings) were the most commonly isolated organisms, followed by E. coli (11.3%), streptococci Str. uberis (9.1%) and Str. agalactiae (3.4%), and enterococci (6.1%). From 136 isolates of S. aureus (38 isolates) and non-aureus staphylococci (NAS; 98 isolates), virulence factors and their resistance to 14 antimicrobials were detected using the disk diffusion method, with PCR detection of the methicillin resistance gene, mecA. An increased incidence of clinical and chronic forms of mastitis has been reported in mastitic cows in which staphylococci, especially S. aureus and NAS (S. chromogenes, S. warneri, and S. xylosus), have been detected and compared to other isolated udder pathogens. From those species, S. aureus and isolates of NAS mentioned above showed multiple virulence factors that are more likely to hydrolyze DNA, hemolysis, produce gelatinase and biofilm, and have multi-drug resistance as compared to other less virulent staphylococci. Generally, the isolated staphylococci showed 77.2% resistance to one or more antimicrobials, in particular to aminoglycosides, ß-lactams, macrolides, or cephalosporins. Isolates that showed the ability to form a biofilm were more resistant to more than one antimicrobial than isolates without biofilm production. Multi-drug resistance to three or more antimicrobial classes was recorded in 16 isolates (11.7%), and the presence of the mecA gene was also confirmed in two isolates of S. aureus and two species of NAS.

Effect of Ornithine Transcarbamylase (OTC) Deficiency on Pregnancy and Puerperium.

Ornithine transcarbamylase (OTC) deficiency is the most common inherited metabolic disorder in urea cycles with an incidence of 1:14,000 live births. Pregnancy, childbirth and the postpartum period are considered challenging for women with this hereditary metabolic disorder, with a risk of hyperammonemia, especially in the first week after delivery. In our article, we discuss severe hepatic failure, a pregnancy complication in an OTC deficient patient that has not previously been published. Firstly, our aim is to highlight the need for a strict adherence to the recommendation of the gradual increase of protein intake during pregnancy and the importance of multidisciplinary monitoring of pregnant patients with OTC deficiency. Secondly, we refer to critical postpartum hyperammonemia in patients with this hereditary metabolic disorder.

Antimicrobial Resistance of Enterococcus sp. Isolated from Sheep and Goat Cheeses.

This study aimed to calculate the proportion of antibiotic resistance profiles of Enterococcus faecium, E. faecalis, and E. durans isolated from traditional sheep and goat cheeses obtained from a selected border area of Slovakia with Hungary (region Slanské vrchy). A total of 110 Enterococcus sp. were isolated from cheese samples, of which 52 strains (E. faecium (12), E. faecalis (28), E. durans (12)) were represented. After isolation and identification by polymerase chain reaction and matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry, the enterococci (E. faecium, E. faecalis, and E. durans) were submitted to susceptibility tests against nine antimicrobial agents. In general, strains of E. faecalis were more resistant than E. durans and E. faecium. A high percentage of resistance was noted in E. faecalis to rifampicin (100%), vancomycin (85.7%), teicoplanin (71.4%), erythromycin (71.4%), minocycline (57.1%), nitrofurantoin (57.1%), ciprofloxacin (14.3%), and levofloxacin (14.3%). E. durans showed resistance to rifampicin (100%), teicoplanin (100%), vancomycin (66.7%), erythromycin (66.7%), nitrofurantoin (66.7%), and minocycline (33.3%), and E. faecium showed resistance to vancomycin, teicoplanin, and erythromycin (100%). Multidrug-resistant strains were confirmed in 80% of the 52 strains in this study. Continuous identification of Enterococcus sp. and monitoring of their incidence and emerging antibiotic resistance is important in order to prevent a potential risk to public health caused by the contamination of milk and other dairy products, such as cheeses, made on farm level.

Risk of exposure to acrylamide.

OBJECTIVES: Acrylamide is a toxic compound that can be found it both occupational and non-occupational environments. This study focuses on its sources and health effects of its exposure. METHODS: Adverse effects of acrylamide, especially carcinogenic, genotoxic, and teratogenic were reported in many studies conducted on animals. Neurotoxicity was reported in workers exposed to acrylamide in the occupational environment. Another important source of populations' exposure to acrylamide is their nutrition. RESULTS: This study focuses on humans' exposure to acrylamide from various sources and its harmful effects on their health. CONCLUSIONS: Dietary intake of acrylamide, as well as occupational exposure, cigarette smoking, cosmetics usage and other environmental sources could have a significant effect on human health.

Concentrations of selected toxic elements in ewe living near an environmentally loaded area of eastern part of Slovakia.

INTRODUCTION AND OBJECTIVE: Research focused on the monitoring of selected heavy metals in ewes' blood. Concentrations of selected toxic elements, lead, cadmium and zinc, in ewes living near an environmentally-loaded area, concerned 15 ewes (aged 3-4 years) in good physical condition, during the spring of 2014 and 2015 in the eastern part of Slovakia. The aim of the research was to determine the concentration of selected heavy metals and state the correlations of selected heavy metals in ewes' blood. MATERIAL AND METHODS: Within the period of 2 years, 15 ewe were evaluated. Ewes' blood samples were collected twice during the spring season from a farm located in area Spis, eastern Slovakia, and then analysed for heavy metal contents. In the area under investigation, contamination with heavy metals was assumed as a result of intensive agricultural development and former mining activities. The level of selected heavy metals in the experimental group of animal blood was determined using an optical spectrophotometry. RESULTS: Statistical analyses were carried out using the Statistica programme. The significant differences between means were calculated by the statistical method of the non-parametric Mann-Whitney´s U test. The statistical test experimental group of ewes in 2014 and 2015 confirmed the presence of selected heavy metals in ewes. The measured values of Cd (P=0.0003), Pb (P=0.0200) and Zn (P=0.0018) showed significant differences when comparing the years 2014 and 2015. CONCLUSIONS: The obtained and analysed blood samples confirmed the presence of selected heavy metals in ewes from area of Spis in eastern Slovakia, which belongs the sub-region or is among the localities environmentally burdened. The conclusions are centred on the population's interest and concern for the environment, as well as on the preoccupation with factors that affect the satisfaction of basic needs, the local agricultural development and former mining activities.