Screening for diabetes and prediabetes: the newest communication opportunities

Type 2 diabetes mellitus (DM-2) and prediabetes are serious diseases that can lead to early disability and death. DM-2 can remain undiagnosed for many years; therefore, screening is one of the main assistants of a doctor in establishing a diagnosis, allowing to start treatment as early as possible.Research objective: early identification of patients with prediabetes and DM-2 using an online questionnaire.Materials and methods. The study was carried out online using the Google Forms platform, where a questionnaire was created based on Appendix 3 “Form of risk assessment of diabetes mellitus-2” of the Unified clinical protocol of primary and secondary (specialized) medical care “Type 2 diabetes mellitus”, approved by order of the Ministry of Health of Ukraine No. 1118 dated 12.21.2012, as well as additional questions on nutrition and physical activity. As of June 2021, the study involved 209 patients (151 women and 58 men) who did not have a documented diagnosis of DM-2 or prediabetes.Results. Most of the respondents (89 people) were overweight. 51 respondents had grade I obesity, 31 respondents had grade II, and 7 patients had a body mass index > 40 kg/m2, which corresponds to grade III obesity. Only 49 respondents had a healthy weight, which corresponds to a body mass index 18.5–24.9 kg/m2. 29 (19.21%) women had a history of childbirth with a child weighing more than 4 kg. The diagnosis of polycystic ovary disease (a risk factor for the DM-2) was in 34 (22.52%) women. Upon receipt of laboratory tests, we established a diagnosis of prediabetes in 28 (13.40%) patients, and a diagnosis of DM-2 in 17 (8.13%) people.Conclusions. It is necessary to search for new opportunities in communicating with patients during the COVID-19 pandemic, one of which is online questionnaires based on regulatory documents.

Risk factors of uterine contraction after ureteroscopy in pregnant women with renal colic

Background Ureteroscopy is widely applied in pregnant women with renal colic, but such patients are easy to experience uterine contraction after surgery. There are many factors which may affect uterine contraction, this study aims to explore the risk factors of uterine contraction triggered by ureteroscopy in pregnant women with renal colic. Methods One hundred and one pregnant women were retrospectively analyzed, the patients were hospitalized because of severe renal colic. All patients received ureteroscopy during which double J catheters were inserted into ureters for drainage. Patients received other medical treatments individually according to their condition and uterine contractions were detected by EHG within 12 h after operation. Patients were classified as group A (uterine contraction) and group B (no uterine contraction) according to the presence or absence of continuously regular uterine contraction. Clinical characteristics were collected for further analysis, including history of childbirth, anesthesia method, application of phloroglucinol or not, operation time, Oxygen inhalation or not, pain relief or not after surgery, systemic inflammatory response syndrome (SIRS) occurred or not. A binary logistic regression analysis model was established to explore whether such clinical characteristics were relevant to uterine contraction after ureteroscopy. Results Continuously regular uterine contraction presented in 46 pregnant women within 12 h after ureteroscopy, making the incidence of uterine contraction as high as 45.54%. The presence of uterine contraction was related to the following factors(P < 0.05): history of childbirth (primipara versus multipara)(OR 6.593, 95% CI 2.231–19.490), operation time (each quarter additional) (OR 2.385, 95% CI 1.342–4.238), application of phloroglucinol (yes versus not) (OR 6.959, 95% CI 1.416–34.194), pain relief after surgery(yes versus not)(OR 6.707, 95% CI 1.978–22.738), SIRS occurred after surgery (yes versus not) (OR 0.099, 95% CI 0.014–0.713). Conclusion Continuously regular uterine contraction is easy to occur within 12 h after ureteroscopy in pregnant women. SIRS occurred after surgery is a risk factor for uterine contraction; on the contrary, no history of childbirth, shorter operation time, application of phloroglucinol, pain relief after surgery are protective factors.

Anal and urinary incontinence in nulliparous women – Prevalence and associated risk factors

Objective To establish the prevalence and risk factors of urinary and anal incontinence in nulliparous women. Study design Thirty-one catholic convents were sent a validated questionnaire to determine the prevalence and severity of urinary incontinence, and a similarly structured questionnaire to assess anal incontinence. Multivariable regression models were used to determine independent risk factors associated with the likelihood of urinary incontinence or anal incontinence. Main outcome measures Urine/faecal/flatal incontinence and symptom severity. Results Of 202 nuns, 167 (83%) returned the questionnaire. Twenty-two women were excluded due to history of childbirth. Of 145 nulliparous women, 56.2% reported urinary incontinence and 53.8% reported anal incontinence. Women aged 66–76 years had significantly increased odds of experiencing urinary incontinence in comparison to women aged 40–65 years: OR: 2.35 (95% CI: 1.02–5.45) ( p = 0.04). The risk of urinary incontinence was increased in women with a body mass index ≥ 30 in comparison to those with a body mass index < 19: OR: 6.25 (95% CI: 1.03–38.08) ( p = 0.04). With regards to anal incontinence, although none of the differences with age and body mass index groups reached statistical significance, there was a trend towards women in higher body mass index groups having an increased prevalence of anal incontinence. Current/previous hormonal replacement therapy was also associated with significantly increased odds of experiencing urinary incontinence: OR: 2.53 (95% CI: 1.01–6.36), ( p = 0.04). However, when adjusting for age and body mass index, there was no significant association with urinary incontinence. Conclusions This study highlights that while childbirth is an important risk factor, urinary incontinence and anal incontinence also occur in over 50% of nulliparous women. Additional studies are required to identify other risk factors that may be associated with incontinence in this population.

Morphofunctional characteristics of cutaneous connective tissue scars in women with past history of childbirth after cesarian delivery

The inevitable outcome of skin injuries caused by a variety of external factors is the formation of a connective tissue scar. A scar can deform when exposed to stretching, pressure or repeat surgeries and undergo structural changes leading to its dehiscence. Scar dehiscence is a common problem seen in women with a past history of cesarean delivery. There have been comprehensive studies of uterine scars formed after the C-section, but the morphology of cutaneous C-section scars has not yet been investigated. The aim of this study was to look into the morphology of connective tissue scars in multiparas with a past history of cesarean delivery. Specimens of cutaneous scars were collected from 30 women after the C-section. Within one age group, fiber thickness was directly proportional to the number of previous deliveries. Comparison of different age groups with the same number of previous deliveries revealed the thinning of collagen fibers and the increased density of type III collagen fibers. The most pronounced changes were observed in women with a history of 3 or more deliveries. We hypothesize that a connective tissue scar undergoes structural transformation, becomes thinner, and its fibers dissociate due to repeated skin stretching, which might indirectly suggest the dehiscence of the postoperative scar.

Examination of clinical factors affecting intrauterine microbiota

Purpose: Following reports of an increase in implantation and pregnancy continuation rates by a higher percentage of Lactobacillus in the intrauterine microbiota, it has received attention in infertility treatment. This study aimed to examine Japanese women for intrauterine microbiota. Methods: The clinical background factors in women that influence the abundance of Lactobacillus in the bacterial microbiota were examined. We included 147 patients (31 and 116 in the follicular and luteal phase, respectively), from June 2018 to June 2020, who underwent their first intrauterine microbiota test and had not used antibiotics for at least four weeks before the test. In the luteal phase, we compared the background factors of women in cases with 90% or more and less than 90% of Lactobacillus. Differences in the intrauterine microbiota were examined during the follicular and luteal phases. Results: The proportion of Lactobacillus tended to be low among women aged 36 years and older with a history of childbirth (p=0.0631). Some bacteria were only detected during the follicular and luteal phases, and the bacterial microbiota may change during the menstrual cycle. Conclusion: Bacterial microbiota in the uterus may differ between the follicular and luteal phases. Furthermore, it was shown that the rate of Lactobacillus may be lower in women (older than 36 years) who have delivered, indicating that intrauterine microbiological testing may be considered for these women in clinical practice.

Kehamilan Pasca Tindakan Manchester Fothergill

Pregnancy after a manchester fothergill action is rare, occurring 1-10,000 post-action. post- manchester fothergill pregnancy can cause premature labor, spontaneous abortion, fetal death, maternal urinary complaints, and sepsis. Case of a 34-year-old female patient, G3P1A1L1 37-38 weeks of term parturient latent phase of first stage + once previous cesarean section + history of manchester fothergill. Previous history of childbirth the patient gave birth through cesarean section and term, the birth weight of children 3200 gr. The second pregnancy the patient suffered a miscarriage at 13-14 weeks gestation and found cervical elongation, then the patient was performed cervical reconstruction with the manchester fothergill procedure after the patient received his normal menstrual cycle. after 2 years later the patient came pregnant with a gestational age of 9 months with complaints of low back pain in the placenta. The conclusion of this case of pregnancy after the manchester fothergill action is a rare condition. pelvic organ prolapse and cervical elongation in pregnancy are conditions to be aware of, therefore early diagnosis is very important for smooth pregnancy. individual approach depends on gestational age, the severity of the prolapse is a matter that must be considered for the choice of delivery. prevention of complications can determine the success of a pregnancy. it must also be concluded that prolapse is not a disease of the elderly. Keywords: cervical elongation, Manchester Fothergill

Introduction

On December 8, 2009, Brazilian supermodel Giselle Bundchen and Patriots quarterback Tom Brady welcomed their son Rein into the world. Unlike the majority of babies born in the United States, Rein’s first view was not of a hospital delivery room, but of his parents’ Beacon Hill penthouse overlooking the Charles River in Boston. Bundchen joined a number of celebrities—Demi Moore, Meryl Streep, Juliane Moore, Jennifer Connelly, and Cindy Crawford, to name a few—who have opted for a home birth and generated flashy headlines about the birthing practice. The idea that home birth could be sexy, splashy, or even desirable shocked many Americans, who have little knowledge of the history of midwifery or home birth. This introduction provides a brief overview of the history of childbirth in the United States in order to explain the recent home birth trend.