Clinical Manifestation and Obstetric Outcomes in Pregnant Women with SARS-CoV-2 Infection at Delivery: A Retrospective Cohort Analysis.

This retrospective cohort study aimed to analyze the clinical manifestations, complications, and maternal-fetal outcomes in patients affected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during delivery. The cohort included 61 pregnant women positive for SARS-CoV-2 infection at the time of delivery. Patients were divided into two groups: symptomatic and asymptomatic. We found a significantly higher rate of leukocytosis (p < 0.00078) and lymphopenia (p < 0.0024) in symptomatic women compared with asymptomatic ones. Other laboratory parameters, such as CRP (p = 0.002), AST (p = 0.007), LDH (p = 0.0142), ferritin (p = 0.0036), and D-dimer (p = 0.00124), were also significantly more often increased in the group of symptomatic pregnant women. Overall, symptomatic pregnant women with SARS-CoV-2 infection at the delivery show more often altered laboratory parameters compared with asymptomatic ones; nevertheless, they have a slightly higher but non-significant rate of preterm delivery, cesarean section, as well as lower neonatal birth weight and Apgar score, compared with asymptomatic women.

Progression Low Squamous Intraepithelial Lesion and Human Papillomavirus Infections.

INTRODUCTION: Infection with human papillomavirus is the main cause of cervical carcinoma. In Bosnia and Herzegovina (BIH) 556 cases of cervical carcinoma are diagnosed annually, and 141 women die from it. AIM: To determine the most common HPV type found in ASCUS and LSIL and progression, regression and persistence of lesions. METHODS: In a retrospective study, 11 051 PAP tests, performed in several private gynecological practices located in Tuzla Canton from January 2016 to December 2019, were analyzed. In processing of data , X2 - statistical method was used. RESULTS: 11051 PAP test were inspected. Normal findings were found in 90.48% (N-10002) and pathological findings in 9.49% (N- 049). ASCUS was present in 4.9% (N-544), LSIL in 3.04% (N-337), HSIL in 0.74% (N-84), ASC-H in 0.27% (N-30) and AGC in 0.49% (N-55) of cases. The most common is HPV 16, found in 50.5% (N-44) of ASCUS and LSIL. Monoinfection with HPV 16 was found in 40.9% (N-18) ASCUS (N-3) and LSIL (N-15), and a combination of HPV 16 with other types like HPV 18, 31, 33, 39 in 59% (N-26). Progression of ASCUS lesion in HSIL 1.6% (N-2), and LSIL 9.6% (N-12). Progression of LSIL to HSIL was found in 9.0% (N-10). HSIL progresses significantly more frequent from LSIL (p<0.05) than from ASCUS changes. Lesions that progress into higher grade HSIL are HPV 16 positive. Progression into HSIL is not found in patients with low-risk HPV 6 and 11 infection. CONCLUSION: Women infected with HPV 16 have more a frequent progression of a lesion into higher grade HSIL. They should be intensively monitored because of the increased risk for development of cervical carcinoma.

Cytological, Colposcopic and Pathohistological Correlation of HSIL and ASC H Findings.

INTRODUCTION: Cervical cancer can be successfully prevented by timely detection of changes that precede it such as atypical (ASC-H) and high grade squamous lesions (HSIL). AIM: To investigate the correlation between Pap smear and colposcopy in the detection of premalignant and malignant cervical lesions based on a pathohistological finding. METHODS: In a retrospective study 118 patients with HSIL and ASC-H findings were examined. A Pap smear, colposcopic examination and cervical canal biopsy were performed. The study was conducted at the Gynecological Center "Dr Mahira Jahic" Tuzla and the Clinical Center Tuzla, Department of Gynecology and Obstetrics. RESULTS: 1049 abnormal Pap tests were analyzed, ASCUS in 51,8% (N-544), LSIL 32,1% (N-337), HSIL 7,7% (N-81) and ASC-H 3,5% (N-37), AGC 4,8% (N-51). The mean age of the subjects with the abnormal Pap test was 46.33 ± 3.2. The age of patients with ASCUS lesion was 38,6 , LSIL 41,0, ASC-H was 47,3 , HSIL (CIN II and CIN III) 45,8 , while patients with CIS were 51,2 years. Pathological histology HSIL confirmed a high grade lesion in 67,7% (CIN II, CIN III and CIS) (N-55), in 32% (N-26) a lower grade CIN I in 18,5% and chronic cervicitis in 13,5% (N-11). In ASC-H lesion pathohistological HSIL was found in 13,5% (N-5), CIN I 13,5% (N-5) and chronic cervicitis 48,6 % (N-18). Abnormal colposcopic imaging with HSIL lesion was found in 72,9% (N-69), in 8,6% (N-7) was unsatisfactory and in 18,5% (N-15) the colposcopic finding was normal. In ASC-H lesions, abnormal colposcopic imaging was found in 40,5% (N-15), unsatisfactory findings in 10,8% (N-4), and normal findings in 48,6% (N-18). CONCLUSION: Colposcopy has proven to be better method than cytology with an accuracy of 72,9% in high-grade lesion such as HSIL and ASC-H.

Difference Between Cryotherapy and Follow Up Low Grade Squamous Lesion of Cervix Uteri.

INTRODUCTION: Cervical cancer can be successfully prevented by effective treatment. AIM: Analyse of success of cryotherapy in LSIL and ASCUS. MATERIALS ET METHODS: In retrospective study between January 2016 to March 2017, 3244 PAP test were analysed. 257 patients who had been diagnosed with LSIL and ASCUS from PAP smear were divided in two groups: women who had HPV positive, colposcopic positive and cytologic finding of LSIL or ASCUS treathed with cryotherapy and women with LSIL, ASCUS and negative colposcopy. χ2 test was used for statistical analysis of data. RESULTS: Analysis of 3244 PAP smears showed negative for intraepithelial lesion or malignancy (NILM) in 90,10% (N-2923), and abnormal in 9,8% (N-321) of women. ASCUS was found in 4,8% (N-156) and ASC-H in 0,2% (N-6), LSIL in 3,1% (N-101), HSIL in 0,64% (N-21). The average age of patients with ASCUS lesion was 41 ± 12 years. After cryotherapy, HSIL had progression in 1,5% (N-1), persistence in 6,3% (N-4) and regression in 91,7% (N-58). Progression occured in 10,5% (N-4) of HSIL, persistence in 52,6% (N-20) and regression in 36,7% (N-14) in 38 women with LSIL lesion after repeated PAP test. Progression occured in 8% (N-10) of LSIL and 4% HSIL (N-5), persistence in 58% (N-72) and regression in 29,8% (N-37) in 124 women with ASCUS lesion after treatment and repeated PAP test. Difference in progression lesions in HSIL between women with cryotherapy (1,5%) and follow-up (10,5%) after LSIL is not significant, but progression to CIN II occured after cryotherapy. CIN III or cervical cancer was not found. CONCLUSION: Cryotherapy prevents progression of LSIL in HSIL and in cervical cancer. Because of that cryotherapy is successful method in prevention of cervical cancer.

Behavioral Sexual Characteristics of Female Students in Bosnia and Herzegovina.

INTRODUCTION: Characteristics of sexual behaviour of female students, which will affect fertility in adulthood, represent one of the critical parameters of reproductive health. AIM: The aim of this study was assess characteristics of sexual behavior of female students in Bosnia and Herzegovina. MATERIALS AND METHODS: In a prospective study on a representative sample of 2,872 regular girls aged 19-24 years, an anonymous survey on the reproductive health of female students in Bosnia and Herzegovina from 2007 to 2009 was conducted. RESULTS: Of the total number (N = 2872) of surveyed female students, 49.44% were sexually active. Average sexarcha age was 18.14±1.83 years, and there was statistically significant earlier sexarcha in female students in Banja Luka vs. female students of the University of Sarajevo (p<0.001), as well as in female students in Mostar vs. female students of the University of Tuzla (p<0.001). Sexually active female students in 74,4 % cases had intercourses with only one partner, and 7,7 % of them had intercourses with three or more partners. Regarding the use of contraceptive methods, 69.4% female students were using contraception at first intercourse and 66.7% of them at last intercourse. 3.5% of sexually active students (N=50) had intentional abortion. Almost half (46.9%) of surveyed female students had regular pelvic exams; nearly two-third of those (63.4%) had gynecological exams in private institutions, and 36.6% of them in public health facilitie. Only one-third (35.8%) sexually active female students in BiH stated that Pap test was performed. CONCLUSION: Sexual behaviour of female students in BiH is less risky than in the immediate environment, but health care quality is poor.

Association between aerobic vaginitis, bacterial vaginosis and squamous intraepithelial lesion of low grade.

GOAL: To determine frequency of HPV infection, aerobic vaginitis and bacterial vaginosis in respondents with squamous intraepithelial lesion of lower grade comparing to respondents with normal PAP test results. MATERIAL AND METHODS: Prospective research of 100 respondents has been conducted at University-Clinic Center Tuzla and Gynecology and Obstetrics Department at Primary Health Care Center Tuzla in period from May 2011 untill January 2012. Examination program included: anamnesis, clinical gynecological examination, HPV typization, microbiological examination of vaginal and cervical smear and PAP test. RESULTS: High risk HPV group has been found more frequently among the respondents with LG SIL 46% (23) than in those with normal PAP result 14% (7) p < 0.05. Aerobic vaginitis has been found in the respondents with LG SIL in 28% (14) and there is statistically significant difference of this vaginitis comparing to the respondents with normal PAP result (p < 0.05). Bacterial vaginosis has been found in 12% (6) of the respondents with LG SIL and in 4% (2) of those with normal PAP result which is not statistically significant. In women with LG SIL and aerobic vaginitis in 9 cases E. coli has been isolated, in 4 E. faecalis and in 1 Staphylococcus aureus, while in women with normal PAP test results 3 cases of E.coli have been isolated. Examining changes in pH value of vaginal environment, higher measured values have been found in the respondents with LG SIL- 5.26 while in the respondents with normal PAP test result was 4.94 (p < 0.05). There is also statistically significant increase in the number of leukocytes in the respondents with LG SIL in relation to those with normal result. CONCLUSION: In women with LG SIL aerobic vaginitis is very common but is not an indicator of HPV infection. An adequate treatment of aerobic vaginitis would decrease the frequency of LG SIL and number of precancerous lesions which may

Heterotopic pregnancy in natural conception -- our initial experience: case report.

Heterotopic pregnancy refers to the presence of simultaneous pregnancies at two different implantation sites. Heterotopic pregnancy is rare, estimated to occur in 1 per 30,000 pregnancies. We report a case of a 27-year-old woman presented to the emergency department with the diagnosis of ruptured ectopic pregnancy. Careful ultrasound assessment indicated the diagnosis of heterotopic pregnancy. Right salpingectomy with removal of the hemoperitoneum and suction curettage were performed. Our operative diagnosis of heterotopic pregnancy was confirmed by histopathology. Heterotopic pregnancy can occur in the absence of any predisposing risk factors, and the detection of intrauterine pregnancy does not exclude the possibility of the simultaneous existence of ectopic pregnancy. Transvaginal ultrasound and assessment of the whole pelvis, even in the presence of intrauterine pregnancy, can be an important aid in the diagnosis of heterotopic pregnancy.

[Adolescents and knowledge of sexually transmitted diseases in Tuzla Canton]. / Adolescenti i poznavanje spolno prenosivih bolesti u Tuzlanskom kantonu.

INTRODUCTION: Sexually transmitted diseases today are the most spread infectious diseases. Their incidence is constantly increasing. Usually they affect the population age 15 to 19. OBJECTIVE: To examine and determine parameters related to sexual behavior (sexarcha, duration of sexual activity, number of sexual partners), knowledge of adolescents of Tuzla Canton about sexually transmitted diseases and how do they get informed about it. MATERIAL AND METHODS: In period June to September 2003 we conduct a survey with 2995 high school boys and girls age 14 to 19 in Tuzla Canton. The survey contained questions about sexarcha, knowledge on sexually transmitted diseases, usage and knowledge on methods of contraception. RESULTS: Sexually active high school youth was 395 (13,18 %). Of that number 306 (10.22%) were boys and 89 (2.9 %) were girls (p<0.001). Average age of sexarcha for girls was 16.5+0.97 and for boys 15.7+1.2. Earliest average age of sexarcha for girls was in the municipality of Sapna (15.25+0.5) and for the boys in the municipality of Teocak (15 +1.1). In undeveloped municipalities sexual activity of adolescents of both sexes is significantly higher then in developed ones (p<0.5). High school boys and girls of Tuzla Canton showed insufficient knowledge of sexually transmitted diseases. Good knowledge showed only 87 (5 %) of girls and 25 (2 %) of boys. Girls showed statistically significant better knowledge on sexually transmitted diseases than boys p<0.001). Only 208 (19 %) boys and 539 (29 %) girls talks with parents about sexually transmitted diseases and contraception. CONCLUSION: Work on education of youth, especially in undeveloped municipalities in insufficient, as well as knowledge on sexually transmitted diseases and methods of contraception.