Health care access of thyroid disease patients in Serbia during the COVID-19 pandemic.

PURPOSE: The aim of this study was to assess the impact of repurposing health care facilities in response to COVID-19 on the access of patients with thyroid disease to health care. METHODS: This study consisted of a web-based survey. The survey was anonymous and consisted of forty questions. RESULTS: This survey included 206 respondents. 91.3% of the respondents had health insurance through the Republic Fund of Health Insurance, 9.7% had private or both health insurances, and 3.4% did not have any health insurance. A significant proportion of respondents (60.4%) had to switch from public to private health care to reach a physician and 73.8% had to switch from public to private laboratories. For the 91.9%, this was perceived as a financial burden. Before the pandemic, 83.1% of respondents reported regular follow-up by physicians, which decreased to 44.9% during the pandemic (p < 0.01). 76.3% of the respondents regarded that their thyroid disease was managed optimally before the pandemic, while this figure declined to only 48% during the pandemic (p < 0.01). CONCLUSIONS: The COVID-19 pandemic disrupted the medical care of thyroid patients in Serbia. For the patients treated in the public health care system, access to general practice was hindered, while access to specialist care was disrupted. It led to a switch from public to private health care, which was perceived as a financial burden for almost all the respondents. However, private health care proved to be an important safety net when the public system was overwhelmed.

Association of polymorphisms in TNF-α, IL-1ß, GSTM and GSTT genes with apical periodontitis: is there a link with herpesviral infection?

AIM: To investigate the possible association between TNFα (-308 G/A) and IL-1ß (-511 C/T) single nucleotide polymorphisms (SNPs) and GSTT and GSTM deletion polymorphisms and risk of apical periodontitis (AP) development, and determine the association of different genotypes with the presence of herpesviral infection in AP. METHODOLOGY: The study included 120 periapical lesions and 200 control samples. Gene polymorphism analysis was performed using either polymerase chain reaction (PCR) or PCR/ restriction fragment length polymorphism (RFLP). Relative gene expression of TNF-α and IL-1ß was analysed using reverse transcriptase - real-time PCR. The presence of Epstein-Barr virus (EBV) and human cytomegalovirus (HCMV) was assessed by nested PCR. Chi-square and Fisher's exact tests and logistic regression analyses were done for polymorphisms, whilst Mann-Whitney U-test was performed for the expression analysis. The expected frequency of variants was analysed by the Hardy-Weinberg equilibrium test. RESULTS: TNF-α (-308 G/A) SNP increased AP susceptibility for heterozygous (odds ratio (OR) = 1.72, 95% confidence interval (CI) = 1.06-2.80, P = 0.027) and homozygous (OR = 8.55, 95% CI = 1.77-41.36, P < 0.001) carriers of the variant A allele. On the other hand, IL-1ß (-511 C/T) polymorphism exerted a protective effect both in heterozygotes (OR = 0.540, 95% CI = 0.332-0.880, P = 0.013) and homozygotes (OR = 0.114, 95% CI = 0.026-0.501, P < 0.001). In addition, GSTM1 and GSTT1 null genotypes separately, as well as concomitantly, were associated with an increased risk for AP development (P < 0.001). The null GSTT1 genotype increased approximately twice the risk of Epstein-Barr infection (EBV) in AP (OR = 2.17, 95% CI = 1-4.71, P = 0.048), whilst TNF-α SNP decreased it, both in heterozygotes (OR = 0.20, 95% CI = 0.08-0.48, P < 0.001) and AA homozygotes (OR = 0.07, 95% CI = 0.01-0.37, P = 0.001). CONCLUSIONS: GSTM and GSTT deletion polymorphisms, as well as TNFα (-308 G/A) SNP, are associated with increased risk, whereas IL-1ß (-511 C/T) polymorphism decreases the risk of AP development. GSTT and TNFα polymorphisms also appear to modulate the risk of EBV infection in Serbian patients with AP.

Estimation of the hepatitis E assay-dependent seroprevalence among Croatian blood donors.

BACKGROUND: Seroprevalence of hepatitis E virus (HEV) in blood donors presenting to the Croatian Institute of Transfusion Medicine was assessed with 4 available tests (3 ELISA tests and 1 immunoblot (IB) test). MATERIALS AND METHODS: In October and November 2014, a total of 1,036 serum samples of blood donors were collected for the study. Samples were primarily tested for total HEV antibodies by Dia.Pro HEV Ab test (a). All reactive samples were tested by ELISA tests: Dia.Pro HEV IgG (b) and IgM (c), Mikrogen recomWell HEV IgG_old (d) and IgM_old (e), recomWell HEV IgG_new (f) and IgM_new (g), and IB Mikrogen recomLine HEV IgG (h) and IgM (i). HEV IgM reactive samples also positive by the IB were further tested for HEV RNA. RESULTS: There were 21.5% of samples reactive for total HEV antibodies (a). Seroprevalence of HEV IgG according to the b, d, f and h tests was 20.2%, 9.6%, 18.1% and 17.8%, respectively. Seroprevalence of HEV IgM according to the c, e, g and i tests was 4.4%, 1.5%, 2.0% and 1.7%, respectively. Out of 46 HEV IgM (Dia.Pro HEV IgM) positive samples, 18 (39.1%) were also positive by IB. HEV RNA was not detected in any of those samples. There was a significant association between age and HEV seroprevalence (P<0.001). CONCLUSION: Different HEV antibody detection assays showed a high HEV IgG seroprevalence in Croatian blood donors. Among HEV IgG and HEV IgM positive samples HEV RNA was not detected.

Identifying sagittal otoliths of Mediterranean Sea gobies: variability among phylogenetic lineages.

In this study, we describe and analyse the morphology of the sagitta, the largest otolith, of 25 species of Gobiidae inhabiting the Adriatic and north-western Mediterranean seas. Our goal was to test the usefulness and efficiency of sagittal otoliths for species identification. Our analysis of otolith contours was based on mathematical descriptors called wavelets, which are related to multi-scale decompositions of contours. Two methods of classification were used: an iterative system based on 10 wavelets that searches the Anàlisi de Formes d'Otòlits (AFORO) database and a discriminant method based only on the fifth wavelet. With the exception of paedomorphic species, the results showed that otolith anatomy and morphometry can be used as diagnostic characters distinguishing the three Mediterranean phylogenetic goby lineages (Pomatoschistus or sand-goby lineage, Aphia lineage and Gobius lineage). The main anatomical differences were related to overall shape (square to rhomboid), the development and shape of the postero-dorsal and antero-ventral lobes and the degree of convexity of dorsal and ventral margins. Iterative classifications and discriminant analysis of otolith contour provided very similar results. In both cases, more than 70% of specimens were correctly classified to species and more than 80% to genus. Iterations in the larger AFORO database (including 216 families of teleosts) attained a 100% correct classification at the family level.

Real-time chest-wall-motion tracking by a single optical fibre grating: a prospective method for ventilator triggering.

OBJECTIVE: The ventilators involved in non-invasive mechanical ventilation commonly provide ventilator support via a facemask. The interface of the mask with a patient promotes air leaks that cause errors in the feedback information provided by a pneumatic sensor and hence patient-ventilator asynchrony with multiple negative consequences. Our objective is to test the possibility of using chest-wall motion measured by an optical fibre-grating sensor as a more accurate non-invasive ventilator triggering mechanism. APPROACH: The basic premise of our approach is that the measurement accuracy can be improved by using a triggering signal that precedes pneumatic triggering in the neuro-ventilatory coupling sequence. We propose a technique that uses the measurement of chest-wall curvature by a long-period fibre-grating sensor. The sensor was applied externally to the rib-cage and interrogated in the lateral (edge) filtering scheme. The study was performed on 34 healthy volunteers. Statistical data analysis of the time lag between the fibre-grating sensor and the reference pneumotachograph was preceded by the removal of the unwanted heartbeat signal by wavelet transform processing. MAIN RESULTS: The results show a consistent fibre-grating signal advance with respect to the standard pneumatic signal by (230 ± 100) ms in both the inspiratory and expiratory phases. We further show that heart activity removal yields a tremendous improvement in sensor accuracy by reducing it from 60 ml to 0.3 ml. SIGNIFICANCE: The results indicate that the proposed measurement technique may lead to a more reliable triggering decision. Its imperviousness to air leaks, non-invasiveness, low-cost and ease of implementation offer good prospects for applications in both clinical and homecare ventilation.

Levels of oxidative stress biomarkers and bone resorption regulators in apical periodontitis lesions infected by Epstein-Barr virus.

AIM: To investigate whether apical periodontitis lesions infected by Epstein-Barr virus (EBV) exhibit higher levels of oxidative stress biomarkers [8-hydroxydeoxyguanosine (8-OHdG) and oxidized glutathione (GSSG)] and bone resorption regulators [receptor activator of nuclear factor (NF-κB) ligand (RANKL) and osteoprotegerin (OPG)] compared to EBV-negative periapical lesions and healthy pulp tissues. METHODOLOGY: The experimental group consisted of 30 EBV-positive and 30 EBV-negative periapical lesions collected in conjunction with apicoectomy. The pulp tissues of 20 impacted third molars were used as healthy controls. The qualitative and quantitative analysis of EBV was performed by nested and real-time polymerase chain reaction (PCR), respectively. The levels of RANKL and OPG were analysed by reverse transcriptase real-time PCR. The levels of 8-OHdG and GSSG were determined by enzyme-linked immunosorbent assay (ELISA). Mann-Whitney U-test and Spearman's correlation were used for statistical analysis. RESULTS: The levels of RANKL, OPG, 8-OHdG and GSSG were significantly higher in apical periodontitis lesions compared to healthy pulp controls (P = 0.001, P < 0.001, P < 0.001 and P < 0.05, respectively). RANKL and OPG mRNA expression was significantly higher in EBV-positive compared to EBV-negative periapical lesions (P < 0.05). There was no significant correlation between EBV copy numbers and levels of RANKL, OPG, 8OH-dG and GSSG in apical periodontitis. CONCLUSION: Levels of bone resorption regulators and oxidative stress biomarkers were increased in apical periodontitis compared to healthy pulp tissues. EBV-positive periapical lesions exhibited higher levels of RANKL and OPG compared to EBV-negative periapical lesions. EBV may contribute to progression of apical periodontitis via enhanced production of bone resorption regulators.

Nitrate-assisted photocatalytic efficiency of defective Eu-doped Pr(OH)3 nanostructures.

Pr(OH)3 one-dimensional nanostructures are a less studied member of lanthanide hydroxide nanostructures, which recently demonstrated an excellent adsorption capacity for organic pollutant removal from wastewater. In this study, Pr1-xEux(OH)3 (x = 0, 0.01, 0.03, and 0.05) defective nanostructures were synthesized by a facile and scalable microwave-assisted hydrothermal method using KOH as an alkaline metal precursor. The phase and surface composition, morphology, vibrational, electronic and optical properties of the as-prepared samples were characterized by X-ray diffraction (XRD), X-ray photoelectron spectroscopy (XPS), inductively coupled plasma optical emission spectrometry (ICP-OES), transmission electron microscopy (TEM), field emission scanning electron microscopy (FE-SEM), Raman, infrared (IR), photoluminescence (PL), and diffuse reflectance spectroscopy (DRS). It was deduced that the incorporation of Eu3+ ions promoted the formation of oxygen vacancies in the already defective Pr(OH)3, subsequently changing the Pr(OH)3 nanorod morphology. The presence of KNO3 phase was registered in the Eu-doped samples. The oxygen-deficient Eu-doped Pr(OH)3 nanostructures displayed an improved photocatalytic activity in the removal of reactive orange (RO16) dye under UV-vis light irradiation. An enhanced photocatalytic activity of the Eu-doped Pr(OH)3 nanostructures was caused by the synergetic effect of oxygen vacancies and Eu3+ (NO3-) ions present on the Pr(OH)3 surface, the charge separation efficiency and the formation of the reactive radicals. In addition, the 3% Eu-doped sample exhibited very good adsorptive properties due to different morphology and higher electrostatic attraction with the anionic dye. Pr1-xEux(OH)3 nanostructures with the possibility of tuning their adsorption/photocatalytic properties present a great potential for wastewater treatment.

Should we abandon regional anesthesia in open inguinal hernia repair in adults?

Inguinal hernia repair is a common worldwide surgical procedure usually done in the outpatient setting. The purpose of this systematic review is to make an evidence-based meta-analysis to determine the possible benefits of regional (neuraxial block) anesthesia compared to general anesthesia in open inguinal hernia repair in adults. Cochrane Library, Medline, EMBASE, CINAHL, SCI-EXPANDED, SCOPUS as well as trial registries, conference proceedings and reference lists were searched. Only randomized controlled trials (RCT) that compare neuraxial block (spinal or/and epidural) anesthesia (NABA) and general anesthesia (GA) were included. Main outcome measures were postoperative complications, urinary retention and postoperative pain. Seven RCTs were included in this review. A total of 308 patients were analyzed with 154 patients in each group. Overall complications were evenly distributed in NABA and in GA group [OR 1.17, 95 % CI (0.52-2.66)]. Urinary retention was statistically less frequent in GA group compared to NABA group [OR 0.25, 95 % CI (0.08-0.74)]. Movement-associated pain score 24 h after surgery was significantly lower in NABA group [SMD 5.59, 95 % CI (3.69-7.50)]. Time of first analgesia application was shorter in GA group [SMD 8.99, 95 % CI 6.10-11.89]. Compared to GA, NABA appears to be a more adequate technique in terms of postoperative pain control. However, when GA is applied, patients seem to have less voiding problems.

Rib-cage-movement measurements as a potential new trigger signal in non-invasive mechanical ventilation.

Non-invasive ventilation performed through an oronasal mask is a standard in clinical and homecare mechanical ventilation. Besides all its advantages, inevitable leaks through the mask cause errors in the feedback information provided by the airflow sensor and, hence, patient-ventilator asynchrony with multiple negative consequences. Here we investigate a new way to provide a trigger to the ventilator. The method is based on the measurement of rib cage movement at the onset of inspiration and during breathing by fibre-optic sensors. In a series of simultaneous measurements by a long-period fibre grating sensor and pneumotachograph we provide the statistical evidence of the 200 ms lag of the pneumo with respect the fibre-optic signal. The lag is registered consistently across three independent delay metrics. Further, we discuss exceptions from this trend and identify the needed improvements to the proposed fibre-sensing scheme.

Serum interleukin-17 & nitric oxide levels in patients with primary Sjögren's syndrome.

BACKGROUND & OBJECTIVES: The interleukin (IL)-17 producing T-helper cells have been linked to pathogenesis of autoimmunity and mostly investigated in rheumatoid arthritis (RA). In this study we tested the IL-17 levels, as well as the levels of nitric oxide (NO) as possible IL-17-induced product, in patients with primary Sjögren's syndrome (pSS), an intricate and complex chronic autoimmune disorder of exocrine glands. METHODS: Serum IL-17 levels and nitrite concentrations determined in patients with pSS (n=30) were compared with the values obtained in patients with RA (n=10) and healthy controls (n=15). The values obtained for IL-17 in pSS patients were also associated with the patients' clinical characteristics, particularly the rheumatoid factor (RF) and total antinuclear antibodies (tANA) levels. RESULTS: Serum concentrations of IL-17 were significantly (P<0.01) higher in patients with pSS (12.9 ± 28.0 pg/ml) as compared to those obtained in healthy individuals (0.2 ± 0.6 pg/ml), but not as high as the values obtained for the patients with RA (34.5 ± 56.2 pg/ml). The mean IL-17 levels were significantly (P<0.05) higher in the pSS patients positive for rheumatoid factor (20.3 ± 33.3 pg/ml) than in RF-negatives (0.3 ± 0.6 pg/ml). Mean serum concentrations of IL-17 were also higher in antinuclear antibody (ANA)-positive samples (19.8 ± 33.5 pg/ml) in comparison to ANA-negative sera (1.1 ± 3.1 pg/ml) (P<0.05). The NO levels also showed elevated values in both pSS and RA patients, as compared to the healthy controls, since mean nitrite levels in patients with pSS and RA were 38.2 ± 29.2 µM and 41.7 ± 21.1 µM, respectively, while those in healthy controls were significantly lower, at 19.2 ± 10.5 µM. INTERPRETATION & CONCLUSIONS: The findings of this study showed that there was increased IL-17 and NO production in patients with primary SS, especially if they had associated elevated rheumatoid factor and antinuclear antibody values.

Occurrence of four-spined Gasterosteus aculeatus in an isolated Croatian river population.

An isolated population of the three-spined stickleback Gasterosteus aculeatus in Croatia was found to have a high incidence of specimens either having a fourth dorsal spine or showing remnants of a fourth spine. Juvenile individuals showed a 9.4% incidence of a fourth spine. The population was examined for asymmetry of the skeletal defensive complex in order to determine whether the additional spine could be the result of developmental instability, a response to predation or environmental conditions.

Metal contents in tench otoliths: relationships to the aquatic environment.

A monitoring of the quality of waters was attempted determining metal accumulation in target organs as otoliths of freshwater fish. Tenchs of age ranging between 2 and 10 years were sampled in three different canals receiving wastewater from industrial, agricultural and urban activities. Metal contents were determined in both lapilli and asterisci otoliths, using inductively coupled plasma-atomic emission spectroscopy (ICP-AES). Analytical data are reported for minor metals and for some trace metals. Al, Fe and Zn have contents depending on the environment where the fish has lived, while Na, K, Ca and Sr contents are insensitive to the different aquatic habitat. Considering the two types of otolith separately, lapilli display a different affinity for trace metals (Al, Fe and Zn), while in asterisci this affinity is matched only for zinc. The high affinity of zinc for both types of otoliths suggests using this metal for discriminating the fresh waters by checking its accumulation in otoliths, as well as correlating this accumulation with age of the fish: a negative power curve equation is proposed. Since highest concentrations are found in individuals of 2-3 yr., it is advisable to use this fish for such environmental studies.

An overview on anticancer activities of the Viscum album extract Isorel.

The activity principle of the mistletoe (Viscum album L.) phytotherapeutics could be considered as combined cytotoxic and "biological response modifying" activities (increasing host defense against cancer) that result from the activities of the plant lectins and the other biologically relevant substances. We found before that the aqueous extract Isorel, produced by Novipharm GmbH (Pörtschach, Austria) from the entire plant (planta tota) of fresh mistletoe under standardized conditions with bioassay validated batch consistency, can be valuable in experimental adjuvant cancer therapy increasing efficiency of cyclophosphamide chemotherapy. In current study we found that Isorel increases the reactivity of the tumor-bearing mice lymphocytes to the mitogens (ConA and LPS) in vitro, thus indicating its immune stimulating effects for the cancer-immunosuppressed lymphocytes. Moreover, Isorel inhibited the incorporation of 3H-labelled amino acids (protein synthesis) in various malignant cell lines. For the growth inhibition mostly higher MW components were responsible, although even less than 500 Da components were also active. We further analyzed the effects of drug application in vicinity of tumor (murine mammary carcinoma) and compared it with systemic effects. The animals carried mammary carcinoma in both hind limbs and were also injected with tumor cells i.v. to develop artificial lung metastases. Isorel was applied only at the right side (in the limb distal from the tumor) and caused persistent and almost complete inhibition of the tumor growth for 2/7 animals. Anticancer effects were less pronounced on the contralateral side tumors, although tumor growth rate was transiently reduced for some mice. Histology revealed that Isorel treatment, both at the side of tumor and systemically, increased the incidence of apoptosis and necrosis in the tumors, while reduction of mitosis was noticed only for the tumors in vicinity of the tumor exposed to Isorel. Finally, animals treated with Isorel had, on the average, three times less lung metastases than the controls. Thus, we conclude that both local and systemic effects of the application of Isorel could be of benefit for the tumor-bearing organism resulting in immunomodulation combined with tumor growth inhibition and reduction of metastases. According to the in vitro results, antitumorous effects could be the result not only of the mistletoe lectins and the other high MW factors, but also of the very low MW (< 500 Da) substances that deserve further analyses.

Vascular endothelial growth factor (VEGF) in astrocytic gliomas--a prognostic factor?

Survival in astrocytic gliomas is closely related to WHO tumor grade. Within one tumor grade, especially in grade II and III tumors, the clinical course is variable and can hardly be predicted by histological criteria. Neovascularization is a neuropathological hallmark in high grade gliomas and angiogenic factors may play an important role in malignant tumor progression. Therefore, 162 primary astrocytic gliomas (57 astrocytomas WHO grade II, 27 astrocytomas WHO grade III and 78 glioblastomas WHO grade IV) were investigated immunohistochemically for expression of vascular endothelial growth factor (VEGF), which is considered to represent the main angiogenic factor in astrocytic gliomas. Clinical data known to influence prognosis were documented. VEGF expression was found in 21 of 57 astrocytomas WHO grade II (36.8%), in 18 of 27 astrocytomas WHO grade III (66.7%) and in 50 of 78 glioblastomas (64.1%). A strong correlation between VEGF expression and survival was found within the whole study group, however, within one tumor grade no such correlation was obvious. In a multifactorial analysis VEGF expression was not found to be an independent prognostic factor in astrocytic gliomas.

[Care of injured and ill patients in combat areas in the former Yugoslavia 1991-1992]. / Neka iskustva u zbrinjavanju povredenih i obolelih u oruzanim sukobima na teritoriji prethodne Jugoslavije u toku 1991/1992. godine.

Large number of military and civilian physicians took part in war on the territory of former Yugoslavia during 1991/1992, managing the medical service or in medical units of Yugoslav Peoples' Army and civilian health institutions. Their vast war experiences were presented in their reports and numerous papers published in proceedings of congresses and meetings, held in the period from 1992 till today. This is an attempt to systematize those experiences and to draw out some conclusions significant for the further development of doctrinaire approach to the organization and functioning of the medical service of the Army of Yugoslavia at war.

[Risk factors and ischemic heart disease in officers of the Yugoslav Army: cross-sectional study and recommendations for prevention]. / Faktori rizika i ishemijska bolest srca u staresina JNA: presek stanja i preporuke za prevenciju.

The cross-sectional study comprised 8095 officers of the Y.P.A. from the limited territory, and relationship between cardiovascular risk factors and prevalence of ischemic heart disease (IHD) has been analysed. The high and statistically significant positive relationship of serum cholesterol, blood pressure, relative body weight, glycemia and previous cigarette smoking and IHD prevalence was found. Besides, a relatively high distribution of the mentioned risk factors was found among officers without IHD. The results of the study suggest the necessity of application of the strategy of mass prevention of risk factors aiming at primary prevention of IHD among officers of the Y.P.A.

Preventive medical protection in the Armed Forces of Yugoslavia during military conflicts.

Some experiences in preventive medical protection in the Armed Forces of the Yugoslav People's Army (Y.P.A.) in the blockade and combat operations in 1991 are presented. In garrisons which were in the total blockade the basic life-needs were threatened and in the same time personnel was exposed to combat operations of enemy forces. Owing to alterness and discipline of the whole staff the basic hygienic measures of health protection were maintained. In units which were engaged in combat operations the hygienic prophylactic measures were conducted based on our doctrinal principles in preventive medical protection. The decrease in the incidence of infectious diseases and lack of epidemics point to the successfully applied protection. The health service provided protection both of people and refugees and also a significant help was extended to the units of the Armed Forces.