Ulevičius, Jonas

Aim: To review existing scientific literature and assess the effect of vitamin D supplementation on pregnancy course and neonatal outcomes.
Objectives:

1. To investigate how vitamin D supplementation affects the course of pregnancy.
2. To investigate how vitamin D supplementation affects neonatal and early childhood outcomes.
3. To analyze existing literature concerning the safety and appropriate dosage of vitamin D supplementation during pregnancy. Methodology: The articles used for this literature review were collected from the “PubMed” database by searching specific keywords. The initial search yielded a total of 132 articles, which were narrowed down to 22 articles that were the most relevant to the topic. This paper is based on but not limited to the search results. Results: based on the included studies, we found that Vitamin D supplementation during pregnancy effectively reduces postpartum depression, preterm delivery, preeclampsia, and gestational diabetes mellitus incidence, especially in vitamin D-deficient women. In addition it was found to increase the likelihood of spontaneous vaginal delivery. Maternal supplementation is effective in enhancing early postnatal linear growth in the first year of life. In addition, it has a protective effect on the development of infantile atopic eczema, however, the results were inconclusive regarding childhood asthma and recurrent wheezing development. Vitamin D supplementation effectively increases maternal and neonatal concentrations of 25(OH)D and is generally safe during pregnancy. Conclusions: vitamin D supplementation during pregnancy might have a positive effect on the pregnancy course and neonate, however, further research is required to acquire more reliable results that can be generalized to the entire pregnant population. Practical recommendations: further in-depth research is required to obtain more precise data on the short-term and long-term effects of vitamin D supplementation and its safety.

Polycystic ovary syndrome (PCOS) is one of the leading causes of infertility in women; and even upon successful conception, women with PCOS often suffer with adverse effects during the gestation period. The aim of the thesis is to understand and further investigate the correlation between PCOS and its impact on pregnancy. The objectives of the thesis include investigating how PCOS affect the course of pregnancy (i.e. the prevalence of gestational diabetes and pregnancy-induced hypertension in a PCOS-diagnosed woman, and the rate of caesarian deliveries in said pregnancies), exploring the correlation between PCOS and the incidence of preterm labour, and analysing the adverse effects of PCOS on neonatal birth weight. This literature review includes results from searches conducted on MEDLINE (PubMed), Google Scholar, and ScienceDirect Publication. The articles and studies were selected for inclusion in this thesis based on their relevance to the topic. The titles and abstracts associated with these searches were reviewed for references to the topic, and if found relevant, full texts of those articles were retrieved, and 85% of them were chosen within an 11-years range (i.e. 2012-2023). The definition of PCOS referenced in this thesis is based on the Rotterdam Criteria due to the inclusion of polycystic ovaries’ appearance in the ultrasound as one of its major criteria. Gestational diabetes mellitus (GDM) causes complications in up to 40-50% of PCOS pregnancies; the risk of GDM is around three times greater in women with PCOS. Women with PCOS are at an increased risk of being diagnosed with hypertensives diseases during their course of pregnancies, with its occurrence in up to 8% of said pregnancies; it includes pregnancy-induced hypertension (PIH) and in severe cases, preeclampsia (PE). Due to the complications that come with PCOS in pregnant women along their course of pregnancy – which includes an increased risk for neonatal complications as well – the rate of caesarian section (CS) requirement increases as well, being more common in women with PCOS (64.7%) than those without PCOS (39.2%). Preterm birth is a significant cause of child morbidity and mortality worldwide, with preterm delivery posing 6-15% of complications in PCOS-related pregnancies. The adverse effects of the mother’s PCOS symptoms on the neonate’s well-being – the neonatal birth weight, in this case – is an under-researched current subject of controversy with contradicting results. But, the common ground stands that the weight of the neonate is often affected, with either the neonates being large-for-gestational-age (LGA) or small-for-gestational-age (SGA). Upon in-depth analysis of several studies on the subject, the hypothesis formulated correlated with those in existence, with a strong effect played by the pathophysiology of PCOS on the increased prevalence of gestational diabetes, pregnancy-induced hypertension (in particular, preeclampsia), and caesarian section deliveries along the course of pregnancy. In addition to that, PCOS also has an adverse effect on preterm deliveries, and neonatal weight (with more frequency of births of large-for-gestational-age and small-for-gestational-age neonates – albeit inconsistency amongst several studies regarding the statistics on which is more prevalent than the other). The conclusion derived was that rather than PCOS and its symptoms alone – which play a small but possibly significant role – the pathophysiology of PCOS plays a significant role throughout the course of pregnancy, by increasing the prevalence of gestational diabetes, pregnancy-induced hypertension (particularly preeclampsia), and caesarian section deliveries. However, despite the clinical presentation, PCOS alone has a negative impact on the rate of premature births and newborn birth weight.

Eglė Vaičiulytė. „Gydytojų ir gydytojų rezidentų profesionalumas ir požiūris į profesionalumą“. Darbo tikslas. Įvertinti ir palyginti gydytojų ir gydytojų rezidentų profesionalumą bei požiūrį į profesionalumą. Darbo uždaviniai: 1. Sukurti ir validuoti gydytojų ir gydytojų rezidentų profesionalumo vertinimo anketą. 2. Įvertinti gydytojų ir gydytojų rezidentų požiūrį į profesionalumą bei profesionalumo principų ir įsipareigojimų laikymąsi kasdienėje praktikoje. 3. Palyginti gydytojų ir gydytojų rezidentų požiūrį į profesionalumą bei profesionalumo principų ir įsipareigojimų laikymąsi kasdienėje praktikoje. 4. Pateikti rekomendacijas profesionaliam elgesiui gerinti, remiantis tyrimo bei literatūros analize. Tyrimo metodika. Tyrimui atlikti naudota originali validuota anketa, apskaičiuotas Cronbacho alfa koeficientas α=0,9. Tiriamosios imties kintamieji buvo suskirstyti į grupes (gydytojai ir gydytojai rezidentai). Gydytojų anketą sudarė 6 sociodemografiniai klausimai, 47 klausimai profesionalumui bei 26 klausimai požiūriui į profesionalumą vertinti. Gydytojų rezidentų anketą sudarė 5 sociodemografiniai klausimai, 38 klausimai profesionalumui bei 26 klausimai požiūriui į profesionalumą vertinti. Kintamųjų tarpusavio sąsajos ir skirtumai vertinti naudojant Spirmeno koreliacijos koeficientą (rS), Mann-Whitney kriterijų, Kruskal-Wallis kriterijų, Kolmogorov-Smirnov kriterijus. Hipotezėms patikrinti buvo pasirinktas 0,05 reikšmingumo lygmuo. Statistinė duomenų analizė atlikta naudojantis Microsoft Excel 2016 ir IBM SPSS Statistics 27.0 programomis. Tyrimo dalyviai. LSMUL KK Akušerijos ir ginekologijos klinikos, Ausų, nosies ir gerklės ligų klinikos ir Gastroenterologijos klinikos gydytojai ir gydytojai rezidentai. Rezultatai. Analizuoti 75 gydytojų ir 52 gydytojų rezidentų duomenys. Atsako dažnis – atitinkamai 76,0% ir 76,8%. Geriausiai gydytojai vertino teiginį, jog vienodai tiria ir gydo pacientus, nepaisant jų amžiaus 4,8 (SN 0,4), blogiausiai – dalyvavimą oficialiose iniciatyvose siekiant gerinti sveikatos priežiūros paslaugų kokybę (2,27 (SN 1,49)). Geriausiai gydytojai rezidentai vertino teiginį, jog vienodai tiria ir gydo pacientus, nepaisant jų negalios (4,85 (SN 0,36)), blogiausiai – atsakingų asmenų arba institucijų informavimą apie itin nekompetentingus kolegas (2,12 (SN 0,81)). Daugiausiai gydytojų ir gydytojų rezidentų pritarė teiginiui, kad gydytojas turėtų nuolat tobulinti savo profesines žinias ir įgūdžius, nepaisant privalomų kvalifikacijos kėlimo valandų (atitinkamai 4,93 (SN 0,25); 5,0 (SN 0,0)). Mažiausiai pritarimo gydytojų vertinimu sulaukė teiginys „Gydytojas visuomenei turėtų atskleisti iškilusius interesų konfliktus tarp sveikatos priežiūros ir su sveikatos priežiūra susijusių sektorių“ (3,68 (SN 1,0)). Mažiausiai gydytojų rezidentų sutiko su teiginiu „Paciento su sveikata susiję interesai turėtų būti iškeliami aukščiau kitų gydytojo interesų“ (3,77 (SN 1,06)). Išvados. Abiejų tiriamųjų grupių rezultatai, jas lyginant tarpusavyje, neturėjo statistiškai reikšmingo skirtumo. Siekiant užtikrinti sąlygas, palankias gydytojų profesionalumui pasireikšti, yra būtina užtikrinti tinkamą fizinę, socialinę ir organizacinę gydytojų darbo aplinką bei sudaryti tinkamas sąlygas profesionalumo įgūdžių ir vertybių ugdymui.

This is a literature review about the impact of hormonal contraceptives on women with migraine. It contains information about the impact of hormonal contraceptives on the different types of migraine and headache. Also in this review we compare the impact on migraine between the uses of combined hormonal contraceptives and progestin only contraceptive.