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Abstract: BACKGROUND: Classic bladder exstrophy (CBE) is a rare congenital condition affecting multiple organs, primarily the urinary and musculoskeletal systems. Management involves multiple reconstructive surgical procedures and aims to maintain renal function, achieve urinary continence, and support normal reproductive health. Pregnancies in women with CBE can be complicated by recurrent urinary tract infections, pelvic prolapse, and a higher risk of preterm birth. CASE REPORT: We report the case of a 33-year-old woman with a history of CBE, admitted at 32 weeks of pregnancy with fever and symptoms of a urinary tract infection. Her medical history included multiple surgeries, including formation of neovesica from the cecum with appendicovesicostomy to the abdominal wall. The pregnancy was complicated by recurrent urinary tract infections, anemia, gestational diabetes, and stage IV uterine prolapse. A multidisciplinary team managed her care, with imaging revealing altered abdominal anatomy and breech fetal presentation. At 37 weeks, due to concerns about fetal growth restriction, breech position, and potential prolapse exacerbation, an elective cesarean delivery with median relaparotomy and vertical uterine fundal incision was performed to avoid emergency intervention. Both the delivery and postpartum recovery were uneventful despite the complexity of the case. CONCLUSIONS: Managing pregnancy in patients with CBE requires close, multidisciplinary collaboration to address potential complications. Detailed delivery planning and vigilant monitoring are crucial to ensure maternal and fetal safety.
Keywords: bladder exstrophy, cesarean section, congenital abnormalities, fetal growth retardation, urinary tract infections
Published in DiRROS: 03.12.2025; Views: 17; Downloads: 13
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Abstract: Background: In Slovenia, patients with suspected tick-borne encephalitis (TBE) were historically referred to infectious diseases (ID), but during the COVID-19 pandemic, there were increased referrals to neurology. This study compared the clinical management of TBE patients between ID specialists and neurologists and assessed patients’ outcomes. Methods: We retrospectively reviewed the clinical, laboratory, and imaging data of 318 adult patients with TBE managed by ID (n = 256; 80.5%) and neurology (n = 62; 19.5%) at a tertiary centre in Slovenia between March 2020 and September 2022 to explore variations in diagnostic and therapeutic approaches by specialty and to assess the severity and outcome of acute illness. Results: Patients referred to ID or neurology did not differ regarding their basic demographic and epidemiologic characteristics or basic laboratory parameters. However, patients referred to neurology more often presented with severe illness, including impaired consciousness and/or focal neurological signs (72.6% vs. 55.5%; p < 0.001). ID specialists used head imaging before lumbar puncture (6.6% vs. 64.5%; p < 0.001), performed microbiological tests other than for TBE (16.0% vs. 51.6%; p < 0.001), and empirically prescribed antimicrobials less often than neurology (5.1% vs. 22.6%; p < 0.001). When adjusting for age, sex, comorbidities, vaccination status, and the severity of acute illness, clinical outcomes were similar between the two groups of patients, but those with more severe acute illness had higher odds for incomplete recovery. Conclusions: Differences in clinical presentation between ID and neurology referrals could only partially explain the narrower diagnostic and therapeutic approach used by ID, which, given the study design, was not associated with adverse outcomes. Additionally, in patients with clinical characteristics suggestive of TBE in endemic areas, tremor in the absence of other focal neurological signs or impaired consciousness may not necessitate head imaging before lumbar puncture. Future prospective studies could help to optimise the management of this clinical syndrome.
Keywords: tick-borne encephalitis, clinical management, neuroimaging, outcomes, lumbar puncture
Published in DiRROS: 02.12.2025; Views: 77; Downloads: 31
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Abstract: Introduction: The classification of antiphospholipid syndrome (APS) comprises clinical criteria (vascular thrombosis or obstetric complications throughout life) and laboratory criteria (antiphospholipid antibodies (aPLs) positivity, confirmed at least twice at 12-week interval). Methods: In 100 patients admitted to the hospital with COVID-19 pneumonia, thrombosis and pregnancy complications were recorded during the hospital stay and in personal medical history. They were tested for nine types of aPLs at four time points (admission, deterioration, discharge, and 3-month follow-up): anticardiolipin (aCL), anti-β2-glycoproteinI (anti-β2GPI), and antiphosphatidylserine/prothrombin (aPS/PT) isotypes IgM/IgG/IgA. Results: During hospitalization, aPLs were detected at least once in 51% of patients. All 7% of deceased patients tested negative for aPLs upon admission, and only one patient became aCL IgG positive as his condition worsened. In 83.3% of patients, intrahospital thrombosis was not related to aPLs. One patient with pulmonary artery and cerebral artery thrombosis was given an APS diagnosis (triple aPLs positivity on admission, double on follow-up). Personal anamnesis (PA) for thromboembolism was verified in 10 patients, all of whom tested negative for aPLs at admission; however, transition to aPLs positivity at discharge (as the disease subsided) was seen in 60% of patients: three of six with arterial thrombosis (at follow-up, two did not appear, and one was negativized) and three of four with deep vein thrombosis (one was confirmed at follow-up and diagnosed with APS, one was negativized, and one did not appear). At admission, the majority of the aPLs were of the aCL IgG class (58.8%). Unexpectedly, as the COVID-19 disease decreased, anti-β2GPI IgG antibodies (linked with thromboses) became newly positive at discharge (14.9%), as confirmed at follow-up (20.8%). Conclusion: The incidence of APS in our cohort was 2.0%, whereas in the general population, it ranges from 0.001% to 0.002%. The incidence might have increased even more if the four aPLs-positive patients with intrahospital thrombosis/history of thrombosis had attended follow-up. Recommendation: All patients with severe COVID-19 or post-COVID syndrome should be evaluated for current/previous thrombosis and tested for aPLs at least twice: at admission to the hospital and at discharge, then retested 3 months later in positive cases in order to be given the appropriate therapy.
Keywords: COVID-19, SARS-CoV2, anti-phosphatidylserine-prothrombin (aPS/PT) antibodies, anti-β2-glycoprotein I (anti-β2GPI) antibodies, anticardiolipin (aCL) antibodies, antiphospholipid antibodies (aPLs), antiphospholipid syndrome, immunology, post-COVID syndrome, vascular thrombosis
Published in DiRROS: 01.12.2025; Views: 85; Downloads: 43
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Abstract: Ongoing shifts in climate and land use have altered interactions between trees and insect herbivores, changing biotic disturbance regimes. However, as these changes are complex and vary across host species, insect taxa, and feeding guilds, they remain poorly understood. We compiled annual records of forest insect disturbance from 15 countries in temperate and boreal Europe, spanning the period from 2000 to 2022. The dataset comprises 1361 time series characterizing the dynamics of 50 herbivorous insects. We used this dataset to test whether insect disturbance has systematically changed during the 23-year period across host trees and feeding guilds, whether it varies along latitudinal and climatic gradients, and whether synchrony exists among species in the same guild or among species sharing the same host. Since 2000, borer disturbance was predominantly concentrated on gymnosperms, while defoliators impacted gymnosperms and angiosperms more evenly. While 85.8% of gymnosperm disturbance was inflicted by a single species, Ips typographus, the majority of disturbances to angiosperms were caused by six different species. Borer impact on gymnosperms has increased in the 21st century, while defoliator impact has decreased across both clades. In contrast to diverging temporal trends, disturbance was consistently greater in warmer and drier conditions across feeding guilds and host types. We identified significant synchrony in insect disturbance within host types and feeding guilds but not between these groups, suggesting shared drivers within guilds and host types. Increasing insect disturbance to gymnosperms may catalyze adaptive transformations in Europe's forests, promoting a shift from historical conifer-dominated management to broadleaved trees, which are less affected by insect herbivores. Our findings reveal a diversity of trends in insect herbivory, underscoring the need to strengthen monitoring and research in order to better understand underlying mechanisms and identify emerging threats that may not be apparent in currently available data.
Keywords: climate change, ecosystem adaptation, forest disturbance, forest insect herbivores, host tree types, insect feeding guilds
Published in DiRROS: 26.11.2025; Views: 68; Downloads: 32
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Published in DiRROS: 24.11.2025; Views: 131; Downloads: 60
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