Integration of the e-Learning into the medical university curricula.

OBJECTIVES: The aim of this contribution was to present the e-Learning introduction in the Slovak Medical University (SMU) with a focus on the implementation phase of the two blended courses - Healthcare Quality and Healthcare Professionals' Ethics. BACKGROUND: The introduction of the e-Learning was realized during the period 2008-2009 in the partnership of SMU and IBM Company, following strictly the project management approach. METHODS: The development of the e-module beta-versions was evaluated by the modules' authors using a structured interview. In a consequent pilot testing, the blended courses were evaluated by 23 students of the bachelor program in Rescue health care, and by 61 public health students at the master level program, respectively, using the standardized questionnaires. RESULTS: The tangible results included the documented SMU strategy for the e-Learning integration, six e-Learning modules and evaluation results. The authors' evaluation showed high scores for the experience in collaboration with IBM, as well as for the experience with the LMS environment. The students' evaluation showed a high acceptance of the e-Learning by both part-time and full-time students. The access to Internet was not recognized as a serious barrier. CONCLUSION: The first experience with the integration of the e-Learning into the curricula of the Slovak Medical University showed the advantage of the systematic approach. The experience with developing the strategy in an interdisciplinary/ intercultural team, the knowledge about specific characteristics of distance learning by the involved SMU staff, and the know-how and skills represented the important benefits. It was demonstrated that the blended learning is recommended as optimal for the education in medical environment (Tab. 4, Fig. 1, Ref. 22).

Comparison of long-term care in European developed countries to possible implementation in Slovakia.

Long-term care within the public services system does not exist in Slovakia. Long-term care is a relatively closed system of health care and social care services. Initially, long-term care policies were formulated as a response to ageing of the population, which brought about growing needs of elderly people for social care and health care, and was associated with relatively rapid increases of necessary costs. All industrial countries are facing similar problems when it comes to the integration of long-term care. In developed countries, current long-term care focuses on all age groups in need of assistance and support from others due to the limitations caused by their state of health (Ref. 34). Full Text (Free, PDF) www.bmj.sk.

[Doppler hemodynamic study in evaluation of liver metastases].

The color Doppler spectral analyses can be usefully in description of the liver circulation as one from non-invasive methods. Using color Doppler B mod ultrasound (Toshiba Core Vision) with duplex ultrasound we founded difference in liver circulation between patients with colon cancer and liver metastasis in comparison with those without metastases. We suggested this non invasive method for early detection of occult liver metastasis presence.

Long-term care as an urgent challenge.

Long-term care is a relatively closed system of health care and social care services and assistance that has developed as a response to the needs of those who due to disability, chronic health conditions, trauma or disease limiting their self-care capabilities and independence, are in need of assistance and support of third persons for a prolonged period of time. Long-term care within the public services system does not exist in Slovakia (Ref. 12).

Identification of factors contributing to degradation in autothermal thermophilic sludge digestion.

A laboratory scale ATAD reactor (6 days SRT, 24 h feed cycle) was operated at quasi steady-state conditions with real waste activated sludge feed. Hydrolysis tests of waste activated sludge demonstrated that 10% of feed suspended matter is hydrolysed practically instantaneously and 20-30% of all fed suspended matter is dissolved after 60 minutes in tap water and in cell free reactor liqueur equally. Respirometric, VSS and COD concentration data served as basis for calibration of a simple VSS based kinetic model. The calibrated model provided good fit to two separate sets of measured data. This model was used to evaluate different operation strategies. Modification of cycle length does not affect overall VSS emoval rate, while shorter cycle length or continuous operation helps avoid oxygen limited conditions. Further advantages of shorter feed cycles (reduced cooling effect, greater realizable load) support choosing continuous operation of the ATAD system if the main goal is VSS reduction. While reactor cascades increase efficiency, this advantage diminishes with increasing load. At high load rates increased construction costs are not justified by the expected improvement in efficiency.

Langerhans cells and immature dendritic cells as model systems for screening of skin sensitizers.

Langerhans cells are the most potent antigen-presenting cells in the skin and play a critical role in the induction of contact allergy. Research on the phenotypical and functional changes of LCs occurring after application of skin sensitizers indicated their use as an in vitro model for the screening of chemicals. In the present investigations, LCs from human skin explants served as the test system. The application of this cell system has been aggravated by the difficulty in isolating sufficient numbers of live LCs from skin. This disadvantage was overcome by the culture of immature dendritic cells from peripheral mononuclear blood cells. These cells can serve as a replacement for LCs as they bind haptens and show phenotypical and functional changes similar to LCs. The sensitizers NiSO(4), dinitrochlorobenzene, 2,4,6-trinitrobenzene sulfonic acid, alpha-hexylcinnamaldehyde and eugenol were applied. Both the expression of surface markers and the induction of intracellular interleukin-1 beta (IL-1 beta) were analyzed. No clear-cut results could be established for intracellular cytokine production, only NiSO(4) induced a remarkable number of IL-1 beta-positive cells. However, all skin sensitizers caused an up-regulation of the co-stimulatory molecule CD86, of intercellular adhesion molecule CD54 and of the HLA-DR antigen. The irritant sodium dodecyl sulfate (SDS) and the vehicle dimethyl sulfoxide (DMSO) had no effect.

The expression of surface markers on dendritic cells as indicators for the sensitizing potential of chemicals.

Novel approaches to testing of skin sensitizing chemicals have made use of immature dendritic cells (DCs) cultured from different hematopoietic progenitors. These cells resemble Langerhans cells (LCs), which are the most potent antigen presenting cells in the skin. Former research has focused on the phenotypic and functional changes of LCs after application of skin sensitizers. But it has proven difficult to isolate sufficient numbers of LCs from skin. This disadvantage is overcome by cultures of immature DCs providing high numbers of reactive cells. The aim of the present investigation was to test the response of DC cultures established from different blood donors to known sensitizers, an irritant and a vehicle. The sensitizers NiSO(4), dinitrochlorobenzene (DNCB), 2,4,6 trinitrobenzene sulfonic acid (TNBS), alpha-hexylcinnamaldehyde (Cinn) and eugenol (Eu) induced the up-regulation of the co-stimulatory molecule CD86, of intercellular adhesion molecule CD54 and of the HLA-DR antigen. The irritant sodium dodecyl sulfate (SDS) and the vehicle dimethyl sulfoxide (DMSO) had no effect. A high rate of responders within blood donors was found for NiSO(4), TNBS, Cinn and Eu, while DNCB was less effective. The augmentation of surface marker expression in dendritic cells obtained from peripheral human blood seems to be a promising readout in prescreening for strong and moderate sensitizers. This test could thus help to reduce animal numbers for in vivo testing.

5-fluorouracil extravasation following port failure.

A case is presented of cytotoxic extravasation as a result of an implantable venous port being perforated by a standard Huber needle. A patient receiving 5-fluorouracil via a dual reservoir port, implanted within the left chest wall, presented with hemoserous discharge from the right needle entry site. The left chest wall was warm to touch, erythematous, and swollen. Subcutaneous infiltration was suspected, and the infusion was ceased. A venogram was performed demonstrating significant extravasation around the left reservoir only. On port removal, inspection showed the Huber needle had penetrated the base plate on the left side. It is recommended that this complication be added as a possible sequelae of central venous port use.

Immunological investigations in a group of workers exposed to various levels of polycyclic aromatic hydrocarbons.

To evaluate a possible immunotoxic effect of chronic exposure to polycyclic aromatic hydrocarbons (PAHs), several immune parameters were investigated in two groups of coke-oven workers. Exposure levels were different for both groups, one group being employed in a new coking facility of sophisticated technical standard, and the other in a facility with rather high emission of PAH-containing dust, built during the late 1960s. Immunomodulating effects of exposure were found on three levels of immunity: a reduced mitogenic response of T cells to phytohaemagglutinin observed by a reduced rate of DNA synthesis and a retardation in the expression of interleukin 2 receptor; an impairment of B cell activity, observed by a reduced proliferation of B cells and a low synthesis of immunoglobulin M after Staphylococcus aureus stimulation; a reduced oxidative burst in monocytes after challenge with E. coli. The differences in numbers of lymphocytic subpopulations in peripheral blood and in immunoglobulin levels of serum were statistically insignificant. The data of the present investigations point to significant, albeit slight, changes in immune function by PAH exposure. But these changes could not yet be related to health impacts of the exposure.

Investigations on immune parameters in welders.

The aim of the present investigation was to study the effects of welding fumes on the human immune system. Thirty male subjects who had regularly welded and 16 control persons without occupational exposure were examined. Cellular immunity was evaluated by phenotyping of peripheral leucocytes, measurement of mitogenic T cell response and T cell stimulation in a heterologous mixed lymphocyte reaction. Non-specific immune reactions were quantified by oxidative burst of granulocytes and monocytes and the cytotoxicity of lymphokine-activated killer (LAK) cells. Serum immunoglobulin levels and immunoglobulin production by stimulated B cells served to demonstrate humoral immune reactions. Welding fumes retarded the kinetics of DNA synthesis after phytohaemagglutinin stimulation of T cells and reduced the cytotoxic activity of LAK cells. No effects on lymphocytic subpopulations, mixed lymphocyte reaction, the phagocytosis of leucocytes or the production of immunoglobulins were observed. Several welders reported on recurrent respiratory infections or bronchitis, a few on allergic skin reactions and one worker was affected by asthmatic symptoms. With the exception of a reduced activity of LAK cells, these effects could not be related to any impairment of immune reactions as they were measured by the immunotoxicity tests applied.

Occupational exposure and its effect on some immune parameters.

Some immunological parameters were investigated in a group of workers exposed to external radiation (1.4 to 9.8 mSv) and inhalation of tritium (comm. eff. dose equiv. 1.2 to 2.8 mSv). The present investigations indicate the differential radiosensitivity of lymphocytic subsets: CD8 positive suppressor T cells were found to be the most sensitive subpopulation in the peripheral blood of radiation exposed workers. CD4/CD8 ratios were increased mainly due to an increase in absolute numbers of CD4 positive helper T cells indicating a selective cell renewal after irradiation. Results obtained after phytohaemugglutinin stimulation of lymphocytes showed individual variation, though there seems to be a trend towards an inverse correlation between absolute T cell numbers in peripheral blood and the number of S phases observed after stimulation, low T cell numbers leading to a high rate of stimulation. The calculation of the committed effective dose equivalents show that radiation protection against internal tritium contamination in power plants should not be neglected.

[Genetic and immunologic studies after space flight]. / Genetische und immunologische Untersuchungen nach einem Raumflug.

The effect of spaceflight on lymphocytes of the peripheral blood was investigated in the Austrian cosmonaut flying the Austro-Soviet mission Austromir. Blood was sampled before and after flight, and the following parameters studied: quantities of lymphocytic subsets (T cells, helper cells, suppressor cells, B cells and natural killer cells); mitogenic stimulation of lymphocytes--DNA (= deoxyribonucleic acid) synthesis and expression of Interleukin-2-receptor; structural modification of DNA, unscheduled DNA synthesis and sister chromatid exchanges. Besides reducing the number of natural killer cells, spaceflight caused on impairment of lymphocyte activity and a slight modification of DNA structure. 4 weeks after flight, control values were reestablished, indicating efficient repair mechanisms.

[Monitoring the effects of oxyphilline Spofa in the umbilical-placental circulation]. / Sledovanie úcinku oxyphyllinu Spofa na umbiliko-placentárnu cirkuláciu.

Vasodilatation treatment is an inevitable part of comprehensive therapy of intrauterine growth retardation of the foetus. The authors present the results of investigations of the effect of Oxyphylline on the umbilical and placental circulation of pregnant women with confirmed disorders of the flow parameters. Oxyphylline Spofa, 3 x 100 mg orally, is the drug of choice in treatment of foetal hypotrophy with a marked effect on the umbilical and placental circulation.

T-lymphocyte subsets in occupationally exposed persons.

The percentage of CD2+, CD4+, CD8+ and HNK-1+ cells in peripheral blood was investigated in persons occupationally exposed to very low doses of ionizing radiation. Investigations were carried out by monoclonal antibodies and flow cytometry. While significant effects of age and smoking habits on the relative number of CD8 cells and CD4/CD8 ratios could be established, no influence of the very low radiation exposure on the profile of lymphocytic T cells in blood was found, except a very slight effect on the relative number of CD2+ cells.

Sister chromatid exchanges (SCEs) in lymphocytes of persons working at Shlobin (USSR), 150 km north of Chernobyl.

Workers at a building plot in Shlobin (USSR), 150 km north of Chernobyl, were examined for the occurrence of spontaneous and mitomycin C induced SCEs in peripheral lymphocytes. Personnel being present during and after the Chernobyl accident exhibited a decreased number of inducible SCEs compared with test-persons starting work at Shlobin by 1st of June, 1986. Since effective dose equivalents were rather low (about 2 m Sv till the end of August 1986), induced SCEs proved to be a very sensitive test for the demonstration of low dose exposure.

[Functional reserve of umbilico-placental circulation]. / Vysetrenie funkcnej rezervy umbiliko-placentárnej cirkulácie.

The authors present the results of the action of 10% magnesium sulphate on the umbilico-placental circulation. They found that intravenous administration of magnesium sulphate reduces the vascular resistance in the umbilico-placental circulation and improves its parameters when a functional disorder is involved. The maximum effect was recorded during the 10th minute following administration. In case of absolute reduction of the placental circulation or in case of an obstruction in the umbilical artery the above parameters did not improve. Magnesium sulphate administration may serve as a loading test of the functional reserve of the umbilico-placental circulation.

Vascular density in carcinoma of the uterine cervix and its predictive value for radiotherapy.

The vascular density (VD) in stage-III tumors of the uterine cervix was determined by morphometric analysis of histologic, Masson-trichrome stained sections prepared from biopsies. In a retrospective study, VD was found to be related to results of radiotherapy, larger VD being associated with prolonged survival, in agreement with similar observations made earlier with stage-IB and -IIA tumors of the cervix. In a complementary study the variation of VD within tumors was investigated in relation to the variation between tumors using surgically removed cervical carcinomas in stage IB. Statistically significant F-ratios were calculated, suggesting a more or less individual pattern of vascularization of the tumors despite a considerable intra-tumoral heterogeneity of the vasculature. It is concluded that VD may reflect oxygenation of neoplastic tissue, and may have a predictive value in regard to the response of tumors to irradiation.

Prognostic significance of vascular density and a malignancy grading in radiation treated uterine cervix carcinoma.

In a retrospective study of 95 patients with squamous cell carcinoma of the uterine cervix (Stage IB, IIA, III) treated by radiation only, pretreatment biopsy material was used for assessment of the prognostic value of histopathological multifactorial malignancy grading and a morphometric estimation of vascular density in stroma. By comparison of the two systems, vascular density has been proved superior to malignancy grading with respect to prognostic value.