The freshwater molluscs of Serbia: Annotated checklist with remarks on distribution and protection status.

We present a checklist of 86 valid freshwater mollusc species of Serbia (65 gastropods and 21 bivalves) belonging to 19 families (15 gastropods and four bivalves). The list is based on our latest research and includes data from published sources and personal communications. The most diverse family among gastropods is Planorbidae (16 species), while Sphaeriidae are most diverse within the bivalves (10 species). Ten species are local endemics (all of them gastropods), while eight are introduced species (three gastropods and five bivalves). The Danube River and its smaller tributaries harbour the most diverse gastropod community, with a total of 61 species (41 gastropods and 20 bivalves). The snail Theodoxus transversalis (Pfeiffer, 1828) and the bivalve Unio crassus Philipson, 1788 are listed as EN (endangered) on the global (IUCN) level, while the snail Plagigeyeria gladilini Kuer, 1937 and the bivalves Pseudanodonta complanata (Rossmssler, 1835) and Sphaerium rivicola (Lamarck, 1818) are considered as VU (vulnerable) species. Of those IUCN taxa, only U. crassus is listed as protected on the national level (along with 12 mostly local endemic gastropod species). In comparison with the previous checklist of gastropods by Karaman Karaman (2007), a total of seven species are added here: Belgrandiella serbica Gler 2008, Bythinella istoka Gler Pei 2014, B. nonveilleri Gler 2008, B. pesterica Gler 2008, Acroloxus lacustris (Linnaeus, 1758), Melanoides tuberculata (O.F. Mller, 1774) and Armiger crista (Linnaeus, 1758). In view of global and regional trends in taxonomy, ecology and invasive biology, an even richer diversity of the Serbian freshwater malocofauna can be expected.

Intermittent pneumatic compression after varicose vein surgery.

OBJECTIVE: Intermittent pneumatic compression (IPC) is an established treatment option to remove tissue fluid from patients with lymphedema and chronic venous disease. The effects of IPC applied directly after varicose vein surgery performed with high volumes of tumescent local anesthesia have not been investigated. The aim of the present study was to evaluate the use of postoperative IPC concerning its effects on the leg volume and patient comfort after surgery. METHODS: We performed an investigator-initiated, single-center, open-label randomized controlled trial. A total of 186 patients indicated for saphenofemoral junction ligation and great saphenous vein or anterior accessory saphenous vein stripping or great saphenous vein redo surgery were randomly assigned 1:1 to the intervention or control group. The patients in the intervention group were treated with IPC at 40 mm Hg for 45 minutes directly after surgery. The outcome measures were the leg volume changes calculated using an optical three-dimensional scanning system (primary objective), quality of life (QoL; Freiburg Life Quality Assessment for chronic venous disease, short form), pain, and extent of ecchymosis with follow-up examinations on days 1 and 7 after surgery. RESULTS: The patients in both groups had comparable mean leg volume reductions from baseline to day 1 (IPC group, 58.8 mL; control group, 37.4 mL; P = .967) and to day 7 (63.1 mL and 57.0 mL, respectively; P = .546). We also did not observe significant differences between the two groups in QoL and pain. The patients in the IPC group had developed larger areas of ecchymosis compared with the control group (16% vs 13.3% of leg surface, respectively; P = .046), with a tendency toward an increase in pain at 7 days after surgery compared with no IPC application. CONCLUSIONS: The present randomized controlled trial was designed to evaluate the decongestive effects of a single postoperative session of IPC and its effect on QoL, pain, and ecchymosis in patients who had undergone varicose vein surgery under tumescent local anesthesia. Because no evidence for a benefit from IPC could be found in the present study and increased ecchymosis was found, its standard use after varicose vein surgery cannot be recommended.

Reliability of a simple novel field test for the measurement of plantar flexor muscle strength / Confiabilidade de um novo teste de campo simples para medir a força dos músculos flexores plantares / Confiabilidad de un nuevo test de campo simple para medir la fuerza de los músculos flexores plantares

ABSTRACT Introduction When a person is in a standing position, the plantar flexor muscles are involved in most static and dynamic body movements. Objectives The aim of this study was to investigate the trial to trial and factorial reliability of measuring the contractile characteristics of PF muscles using a simple novel field test. Methods The sample consisted of 452 healthy subjects, 120 male and 332 female. The research was conducted by means of the trial to trial testing method, using isometric dynamometry performed in field conditions. ANOVA was used to estimate the differences among the trials, Cronbach's alpha and interclass correlation to estimate the correlations among the trials, and principal component analysis to evaluate the contribution of each trial to overall variability. Results The main findings of this study are that trials differed significantly (p<0.000) for maximal force (Fmax) and maximal rate of force development (RFDmax), indicating that the three procedural trials were necessary. The trials were highly correlated (Fmax, RFDmax, r>0.9), proving that measuring was reliable, and the factorial analysis separated the second and third trials, the second trial accounting for most of the total variability. Conclusions The simple novel field test for the measurement of plantar flexor contractile characteristics recommended by this study proved to be as highly reliable as laboratory testing, but was easy to perform in conditions outside of scientific or diagnostic institutions, which greatly facilitates the work of scientists, coaches and professionals. Level of Evidence II; Diagnostic Studies - Investigating a diagnostics test.

RESUMO Introdução Quando uma pessoa está em pé, os músculos flexores plantares são envolvidos na maioria dos movimentos corporais estáticos e dinâmicos. Objetivos O objetivo deste estudo foi investigar a confiabilidade teste-reteste e fatorial da mensuração das características contráteis dos músculos plantares, usando um novo teste de campo simples. Métodos A amostra consistiu em 452 indivíduos saudáveis, 120 homens e 332 mulheres. O estudo foi realizado pelo método de teste-reteste, com dinamometria isométrica conduzida em condições de campo. Empregou-se a ANOVA para estimar a diferença entre os testes o alfa de Cronbach e a correlação interclasse para estimar a correlação entre os testes e análise de componentes principais , para avaliar a contribuição de cada teste para a variabilidade global. Resultados Os principais achados deste estudo são que os testes diferiram significativamente (p < 0,000) para a força máxima (Fmáx) e a taxa máxima de desenvolvimento de força (TDFmáx), indicando que os três testes de procedimento foram necessários. Os testes foram altamente correlacionados (Fmáx, TDFmáx, r > 0,9), provando que a medição era confiável, e a análise fatorial separou o segundo e o terceiro testes, sendo que o segundo teste apresentou a maior parte da variabilidade total. Conclusões O novo teste de campo simples para medição das características contráteis dos flexores plantares recomendado por este estudo provou ser tão confiável quanto os testes de laboratório e, ao mesmo tempo, mais fácil de realizar fora das instituições científicas ou de diagnóstico, o que facilita muito o trabalho de cientistas, treinadores e profissionais. Nível de Evidência II; Estudos Diagnósticos - Investigação de um exame para diagnóstico.

RESUMEN Introducción Cuando una persona está de pie, los músculos flexores plantares son involucrados en la mayoría de los movimientos corporales estáticos y dinámicos. Objetivos El objetivo de este estudio fue investigar la confiabilidad test-retest y factorial de la medición de las características contráctiles de los músculos plantares, usando un nuevo test de campo simple. Métodos La muestra consistió en 452 individuos saludables, 120 hombres y 332 mujeres. El estudio fue realizado a través del método de test-retest, con dinamometría isométrica conducida en condiciones de campo. Se empleó ANOVA para estimar la diferencia entre los tests, alpha de Crombach y la correlación interclase para estimar la correlación entre los tests y el análisis de componentes principales, para evaluar la contribución de cada test para la variabilidad global. Resultados Los principales hallazgos de este estudio son que los tests difirieron significativamente (p<0,000) para la fuerza máxima (Fmáx) y la tasa máxima de desarrollo de fuerza (TDFmáx) indicando que los tres tests de procedimiento fueron necesarios. Los tests fueron altamente correlacionados (Fmáx, TDFmáx, r>0,9) probando que la medición era confiable, y el análisis factorial separó el segundo y tercer test, siendo que el segundo test presentó la mayor parte de variabilidad total. Conclusiones El nuevo test de campo simple para medición de las características contráctiles de los flexores plantares recomendado por este estudio probó ser tan confiable como los tests de laboratorio y, al mismo tiempo, más fácil de realizar fuera de las instituciones científicas o de diagnóstico, lo que facilita mucho el trabajo de científicos, entrenadores y profesionales. Nivel de evidencia II; Estudios diagnósticos - Investigación de un examen para diagnóstico.

Tinea capitis et barbae caused by Trichophyton tonsurans: A retrospective cohort study of an infection chain after shavings in barber shops.

BACKGROUND: Tinea capitis is a highly contagious infectious disease caused by dermatophytes. In Central Europe, it is mainly caused by zoophilic dermatophytes, as, for example Microsporum (M) canis or Trichophyton (T) mentagrophytes and increasingly by anthropophilic fungi. T tonsurans was commonly related to the Tinea gladiatorum, where transmission occurred between infected persons or via contaminated floors. OBJECTIVE: Reporting the transmission of this highly contagious dermatophyte for the first time via beard shaving and hairdressing in barber shops in Germany. PATIENTS AND METHODS: 18 young male patients developed tinea capitis and/or barbae shortly after shavings of the beard and/or hair in a barber shop. Native, cultural and molecular diagnostics as well as tissue biopsies and resistance tests were performed of skin and hair samples. RESULTS: In all samples, T tonsurans could be identified. The medical history and the clinical picture suggest a transmission through contaminated hairdressing tools. The patients were treated with terbinafine or itraconazole in combination with or exclusively with topical antimycotics. CONCLUSION: The transmission and a resulting increase in the incidence of infections with T tonsurans may be due to shavings with direct skin contact of insufficiently disinfected hairdressing tools. This path of infection has already been observed in Africa and is now being described for the first time in Germany. Knowledge of the pathogen and its transmission ways are essential to interrupt the chain of infection.

Assessment of gait in patients with fibromyalgia during motor and cognitive dual task walking: a cross-sectional study

Abstract Background: The aim of the study was to assess gait pattern of patients diagnosed with fibromyalgia (FM) while performing demanding motor and/or cognitive dual tasks while walking. Further, idea was to explore possible correlations of dual task gait pattern alterations to patients' functional status and presence or absence of clinical symptoms associated with FM. Methods: Twenty-four female FM patients and 24 healthy female subjects performed a basic walking task, a dual motor, a dual mental (cognitive) and a combined, dual motor and cognitive task simultaneously. Quantitative spatial (stride length) and temporal (cycle time, swing time and double support time) gait parameters were measured using GAITRite walkway system and their variability was assessed. Patients underwent clinical examination including assessment of functional status, pain and fatigue level, psychiatric and cognitive manifestations. Results: The motor, cognitive and combined dual tasks affect gait performance in FM patients. Difference in tasks between FM and healthy subjects was found as double support time prolongation. Comparison of tasks showing that cycle time in FM was longer than controls and stride length was shorter in patients for all conditions, while no changes were found in any of the gait parameters variability. Further, mental/cognitive dual tasks had a larger effect than motor tasks. Correlations were also found between depression and functional status of the patients and the gait parameters. Conclusion: Gait is affected in FM patients while dual task walking. No changes in stride-to-stride variability point that patients preserve stability in complex walking situations. Analysis of gait may provide additional information for the FM identification based on presence of clinical features and cognitive status. Correlation of dual task gait alterations with occurrence of clinical symptoms and influence of cognitive changes on gait pattern could additionally define FM subgroups.

Angiotensin 2 type 1 receptor blockade different affects postishemic kidney injury in normotensive and hypertensive rats

Many studies demonstrated that angiotensin 2 type 1 receptor (AT1R) blockade accelerates renal recovery in post-ischaemic kidney but there are many controversies related to its net effect on kidney structure and function. During the past years, our research group was trying to define the pathophysiological significance of the renin-angiotensin system on post-ischemic acute renal failure (ARF) development in normotensive Wistar as well as hypertensive rats (SHR). This review mostly summarizes our experience in that field. Our previous studies in normotensive rats revealed that AT1R blockade, except slightly renal vascular resistance improvement, had no other obvious beneficial effects, and therefore implies angiotensin 2 (Ang-2) overexpression as non-dominant on kidney reperfusion injuries development. Similarly it was observed in Wistar rats with induced mild (L-NAME, 3 mg/kg b.w.) nitric oxide (NO) deficiency. Expectably, in strong induced (L-NAME, 10 mg/kg b.w.) NO deficiency associated with ARF, massive tubular injuries indicate harmful effects of AT1R blockade, implying strongly disturbed glomerular filtration and suggesting special precaution related to AT1R blockers usage. Opposite to previous, by our opinion, AT1R antagonism promises new advance in treatment of essentially hypertensive subjects who develop ARF. Increased glomerular filtration, diminished oxidative stress, and most importantly improved tubular structure in postishemic SHR treated with AT1R blocker losartan, implicate Ang-2 over production as potently agent in the kidney ischemic injury, partly trough generation of reactive oxygen species. These data contribute understanding the pathogenesis of this devastating illness in hypertensive surroundings (AU)

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Administering the Sarcoidosis Health Questionnaire to sarcoidosis patients in Serbia / Aplicação do Sarcoidosis Health Questionnaire em pacientes com sarcoidose na Sérvia

Objective: The aim of this study was to use a Serbian-language version of the disease-specific, self-report Sarcoidosis Health Questionnaire (SHQ), which was designed and originally validated in the United States, to assess health status in sarcoidosis patients in Serbia, as well as validating the instrument for use in the country. Methods: This was a cross-sectional study of 346 patients with biopsy-confirmed sarcoidosis. To evaluate the health status of the patients, we used the SHQ, which was translated into Serbian for the purposes of this study. We compared SHQ scores by patient gender and age, as well as by disease duration and treatment. Lower SHQ scores indicate poorer health status. Results: The SHQ scores demonstrated differences in health status among subgroups of the sarcoidosis patients evaluated. Health status was found to be significantly poorer among female patients and older patients, as well as among those with chronic sarcoidosis or extrapulmonary manifestations of the disease. Monotherapy with methotrexate was found to be associated with better health status than was monotherapy with prednisone or combination therapy with prednisone and methotrexate. Conclusions: The SHQ is a reliable, disease-specific, self-report instrument. Although originally designed for use in the United States, the SHQ could be a useful tool for the assessment of health status in various non-English-speaking populations of sarcoidosis patients.

Objetivo: O objetivo deste estudo foi utilizar uma versão no idioma sérvio do Sarcoidosis Health Questionnaire (SHQ), um questionário de autorrelato doença-específico, concebido e originalmente validado nos EUA, para verificar o estado de saúde de pacientes com sarcoidose na Sérvia, além de validar o instrumento para uso no país. Métodos: Estudo transversal com 346 pacientes com sarcoidose confirmada por biópsia. Para avaliar o estado de saúde dos pacientes, utilizamos o SHQ, o qual foi traduzido para o sérvio para os propósitos deste estudo. Comparamos os escores do SHQ por gênero, idade, duração da doença e tratamento. Escores do SHQ mais baixos indicam pior estado de saúde. Resultados: Os escores do SHQ demonstraram diferenças no estado de saúde entre os subgrupos de pacientes avaliados. O estado de saúde foi significativamente pior entre as mulheres e pacientes mais velhos, assim como entre aqueles com sarcoidose crônica ou com manifestações extrapulmonares da doença. A monoterapia com metotrexato associou-se com melhor estado de saúde do que a monoterapia com prednisona ou a terapia combinada com prednisona e metotrexato. Conclusões: O SHQ é um instrumento de autorrelato doença-específico confiável. Embora originalmente concebido para uso nos EUA, o SHQ pode ser uma ferramenta útil na avaliação do estado de saúde de populações de pacientes com sarcoidose em vários países de língua não inglesa.

Compliance with guidelines and predictors of mortality in hemodialysis. Learning from Serbia patients / Cumplimiento de las guías y factores predictivos de la mortalidad en la hemodiálisis. Enseñanzas de la experiencia en pacientes de Serbia

Objectives: The aims of the study were to determine the percentage of patients on regular hemodialysis (HD) in Serbia failing to meet KDOQI guidelines targets and find out factors associated with the risk of time to death and the association between guidelines adherence and patient outcome. Methods: A cohort of 2153 patients on regular HD in 24 centers (55.7% of overall HD population) in Serbia were followed from January 2010 to December 2012. The percentage of patients failing to meet KDOQI guidelines targets of dialysis dose (Kt/V>1.2), hemoglobin (>110g/L), serum phosphorus (1.1–1.8mmol/L), calcium (2.1–2.4mmol/L) and iPTH (150–300pg/mL) was determined. Cox proportional hazards analysis was used to select variables significantly associated with the risk of time to death. Results: The patients were on regular HD for 5.3±5.3 years, dialyzed 11.8±1.9h/week. Kt/V<1.2 had 42.4% of patients, hemoglobin <110g/L had 66.1%, s-phosphorus <1.1mmol/L had 21.7% and >1.8mmol/L 28.6%, s-calcium <2.1mmol/L had 11.7% and >2.4mmol/L 25.3%, iPTH <150pg/mL had 40% and >300pg/mL 39.7% of patients. Using Cox model (adjustment for patient age, gender, duration of HD treatment) age, duration of HD treatment, hemoglobin, iPTH and diabetic nephropathy were selected as significant independent predictors of time to death. When targets of five examined parameters were included in Cox model, target for KtV, hemoglobin and iPTH were found to be significant independent predictors of time to death. Conclusion: Substantial proportion of patients examined failed to meet KDOQI guidelines targets. The relative risk of time to death was associated with being outside the targets for Kt/V, hemoglobin and iPTH (AU)

Objetivos: Los objetivos del estudio fueron determinar el porcentaje de pacientes en tratamiento de hemodiálisis (HD) regular de Serbia en los que no se alcanzaron los objetivos de la guía KDOQI y determinar los factores asociados al riesgo de tiempo hasta la muerte, así como la asociación entre el cumplimiento de la guía y los resultados clínicos. Métodos: Se llevó a cabo un seguimiento de una cohorte de 2153 pacientes en HD regular de 24 centros de Serbia (un 55,7% de la población total en HD) entre enero de 2010 y diciembre de 2012. Se determinó el porcentaje de pacientes que no alcanzaron los objetivos establecidos en la guía KDOQI respecto a dosis de diálisis (Kt/V>1,2), hemoglobina (>110 g/L), fósforo en suero (1,1-1,8 mmol/L), calcio (2,1-2,4 mmol/L) e iPTH (150-300 pg/mL). Se utilizó un modelo de riesgos proporcionales de Cox para identificar las variables con una asociación significativa con el riesgo de tiempo hasta la muerte. Resultados: Los pacientes habían estado en HD regular durante un periodo de 5,3±5,3 años, con un tiempo de diálisis de 11,8±1,9 horas/semana. Se observaron valores de Kt/V <1,2 en el 42,4% de los pacientes, hemoglobina <110 g/L en el 66,1%, fósforo en suero <1,1 mmol/L en el 21,7% y >1,8 mmol/L en el 28,6%, calcio en suero <2,1 mmol/l en el 11,7% y >2,4 mmol/L en el 25,3%, iPTH <150 pg/mL en el 40% y >300 pg/mL en el 39,7%. Con el empleo de un modelo de Cox (con ajuste respecto a edad del paciente, sexo y duración del tratamiento de HD) se seleccionaron las variables de edad, duración del tratamiento de HD, hemoglobina, iPTH y nefropatía diabética como factores predictivos independientes significativos del tiempo hasta la muerte. Al introducir los objetivos de los cinco parámetros examinados en un modelo de Cox, se observó que los objetivos de KtV, hemoglobina e iPTH eran factores predictivos independientes para el tiempo hasta la muerte. Conclusión: Una parte sustancial de los pacientes examinados no alcanzaron los objetivos establecidos en la guía KDOQI. El riesgo relativo del tiempo hasta la muerte se asoció al hecho de no estar en el objetivo de Kt/V, hemoglobina e iPTH (AU)

Syndromes of collateral-reported psychopathology for ages 18-59 in 18 Societies / Síndromes psicopatológicos informados por personas allegadas a adultos de 18 a 59 años de edad en 18 países

The purpose was to advance research and clinical methodology for assessing psychopathology by testing the international generalizability of an 8-syndrome model derived from collateral ratings of adult behavioral, emotional, social, and thought problems. Collateral informants rated 8,582 18-59-year-old residents of 18 societies on the Adult Behavior Checklist (ABCL). Confirmatory factor analyses tested the fit of the 8-syndrome model to ratings from each society. The primary model fit index (Root Mean Square Error of Approximation) showed good model fit for all societies, while secondary indices (Tucker Lewis Index, Comparative Fit Index) showed acceptable to good fit for 17 societies. Factor loadings were robust across societies and items. Of the 5,007 estimated parameters, 4 (0.08%) were outside the admissible parameter space, but 95% confidence intervals included the admissible space, indicating that the 4 deviant parameters could be due to sampling fluctuations. The findings are consistent with previous evidence for the generalizability of the 8-syndrome model in self-ratings from 29 societies, and support the 8-syndrome model for operationalizing phenotypes of adult psychopathology from multi-informant ratings in diverse societies (AU)

El propósito fue avanzar en la metodología clínica y de investigación de la evaluación psicopatológica mediante el examen de la generalización internacional de un modelo de 8 síndromes derivados de evaluaciones de personas allegadas a adultos, en sus problemas emocionales, sociales y de pensamiento. Informantes allegados a los adultos calificaron a 8.582 residentes de 18 países entre 18 y 59 años de edad con el Adult Behavior Checklist (ABCL). Un análisis factorial confirmatorio examinó el ajuste del modelo de 8 síndromes a las puntuaciones provenientes de cada país. El índice primario de ajuste del modelo (RMSEA) mostró un buen ajuste del modelo para todas las sociedades, mientras que índices secundarios (TLI, CFI) mostraron un ajuste de aceptable a bueno para 17 países. Las cargas factoriales fueron robustas a través de los países e ítems. Los hallazgos son consistentes con evidencia previa existente para la generalización del modelo de 8 síndromes en autoinformes de 29 sociedades. Además, los resultados respaldan el modelo de 8 síndromes para operacionalizar fenotipos de psicopatología del adulto provenientes de evaluaciones de múltiples informantes en diversas sociedades (AU)

Clinical manifestations of primary syphilis in homosexual men

At the beginning of a new millennium, syphilis incidence has been increasing worldwide, occurring primarily among men who have sex with men (MSM). The clinical features of primary syphilis among MSM is described, a case-note review of the primary syphilis (PS) patients who attended the Institute of Skin and Venereal Diseases. The diagnosis was assessed based upon the clinical features and positive syphilis serology tests. Among 25 patients with early syphilis referred during 2010, PS was diagnosed in a total of 13 cases. In all patients, unprotected oral sex was the only possible route of transmission, and two out of 13 patients had HIV co-infection. Overall, 77% of men presented with atypical penile manifestation. The VDRL test was positive with low titers. The numerous atypical clinical presentations of PS emphasize the importance of continuing education of non-experienced physicians, especially in countries with lower reported incidence of syphilis.

The preoperative assessment of patients with valvular heart disease as a comorbidity.

In patients with valvular heart disease planned for any type of surgery preoperative evaluation and preparation are especially important for a successfull outcome of the surgery. Preoperative preparation and intraoperative treatment of patients with valvular heart disease are different de-Spending on the type of valvular disease: aortic stenosis, aortic regurgitation, mitral stenosis, mitral regurgitation or mitral valve prolapse. In this paper we have outlined the criteria for evaluating the severity of valvular disease, given that the risk in surgery is proportional to the degree of valvular disease. Also, given that the risk in surgery is also directly proportional to the type and extent of non cardiac surgery, it will be presented recommendations for intraoperative monitoring, with the purpose of evaluating patient's hemodynamic state, as well as recommendations for perioperative treatment of hypotension, tachycardia, and other hemodynamic disturbances. In the paper we will separately discuss bacterial endocarditis profilaxys which can occur after the surgery of patients with valvular disease. Since the patients with valvular disease, and especially the ones with implanted prosthetic valve or heart arrhythmia, are usually on oral anticoagulation therapy, it will be given recommendations for treatment of patients on oral anticoagulation therapy as part of preoperative preparations.