Long-term compliance of patients with osteoporosis treatment and its effect to fracture occurrence.

OBJECTIVES: The objective of this study was to evaluate the effect of long-term treatment of patients with osteoporosis being actively managed by medical staff and following the therapeutic methods and principles of treatment of osteoporosis. METHODS: The medical records of patients which were examined in an osteological outpatient office first time in the year 2009 were reviewed. The results of densitometry examinations were compared with the results from the year 2019. Patients regularly absolved densitometry, properly and regularly took prescribed medicaments for either anti-osteoporotic treatment or for supplementation of vitamin D and calcium. The cohort consisted of 100 patients. Next, we split the group into 3 categories - less than 65 years of age, 65-75 years of age and lastly over 75 years of age. By default, we assessed and compared the T-scores (deviation from the average value of bone density of 30 years old healthy person) in the area of the proximal femur and in the area of the lumbar spine. The bone mineral density (BMD) values in g/cm2 and their relation to corresponding T-score from set area were also reviewed. RESULTS: Based on the results of densitometry, osteoporosis was diagnosed in 41 patients, manifest osteoporosis in 14 and osteopenia in 36, nine patients had their bone density value within the normal range. The average T-score values of "total hip" were -1.42, "neck" -2.08, BMD values of "total hip" were 0.802 g/cm2, "L1-L4" -2.05, "L total" -1.45, and BMD of "L total" was 0.886 g/cm2. In the time of the last examination, the T-score (disregarding the type of treatment) raised from the initial value by 40.16% in the area of lumbar spine, by 56.69% in the area of "total hip", and by 40.16% in the area of "neck". While sorting the cohort based on age, we detected a similar effect of active management of treatment in each of the 3 categories. CONCLUSION: Cooperation of the patients during the treatment of a chronic disease requiring long-term usage of medicaments is often problematic and it is necessary to devote adequate attention to it. The solution to improve the treatment can be active management of the patient by the medical facility or by the medical staff.

West Nile virus - a new infection in the Slovak Republic?

OBJECTIVE: The aim of the study was to evaluate the seroprevalence of West Nile virus (WNV) among the variable population of Eastern Slovakia. METHODS: A serologic survey was conducted using 464 serum samples. The basic demographic, epidemiologic and clinical information was obtained for each serum sample at the time of specimen collection. The presence of antibodies against WNV was investigated using a commercial enzyme-linked immunosorbent assay (ELISA). All the ELISA positive samples were further analysed by a neutralization test with WNV and Usutu virus. RESULTS: Three serum samples (0.65%) from the participants (N = 464) were considered positive for antibodies to WNV. A 29-year-old female was repeatedly exposed to mosquito bites working as a shepherdess and participating in many outdoor activities. Two other females (61 and 76 years old) were treated at the Department of Neurology due to monoparesis of the upper extremity, vertigo; both had a significant epidemiological history with frequent tick and mosquito bites and stay in an endemic region. CONCLUSIONS: Although there was no evidence of WNV infection in the Slovak Republic, the epidemiological situation in the neighbouring countries warrants vigilance and appropriate measures, including the introduction of specific diagnostic tools into clinical practice. The constant monitoring of birds and mosquitoes also seems necessary.

Seroprevalence of Lyme disease in Eastern Slovakia.

OBJECTIVE: Lyme disease (LD) is chronic, multi-system zoonosis transmitted by ticks, and LD aetiological agents are spirochetes of the Borrelia burgdorferi sensu lato complex. The aim of the cross-sectional study was to analyze the LD incidence on the basis of the presence of specific antibodies in the serum of patients in Eastern Slovakia, and to compare the results of serological ELISA and immunoblot assays. METHODS: Venous blood with questionnaires was obtained by field sampling of respondents from Eastern Slovakia. Overall, we examined 537 human sera by the ELISA and for confirmation we tested all positive IgG antibodies against the Borrelia immunoblot assay. RESULTS: Our results confirmed the high serum prevalence of anti-Borrelia antibodies (17.9% for IgG), while the immunoblot seropositive test was confirmed in 69.8% of responders from ELISA IgG positive sera. Positive antibodies of the IgM class were found in 7.6% of the population under study. Most commonly found were antibodies against VlsE (80.2%), p41 (66.7%), p18 (56.3%), p100 (41.7%), p58 (31.3%), and p39 (30.2%). CONCLUSION: It should be noted that detection of antibodies against B. burgdorferi s.l. is only an indirect evidence of the presence of this bacterium in the development of clinical signs of LD in humans. Laboratory LD tests should be performed in accordance with valid standards, positive and uncertain results must be confirmed by the Western Blot/Immunoblot assay.

Serostatus and risk factors of tick-borne encephalitis.

OBJECTIVE: The aim of this seroepidemiological study was to determine the current prevalence of antibodies against tick-borne encephalitis virus (TBEV) in the representative group of Slovak population with included potential risk factors for TBEV. METHODS: Representative group consisted of 428 persons (also with possible exposure to risk factors for tick bite or raw milk consumption). Serum samples were screened by commercial enzyme-linked immunosorbent assay (ELISA). The persons involved in the study completed questionnaires with general demographic, epidemiological and clinical data. During the analysis, we used linear regression to interpret the influence between selected variables. RESULTS: We detected 1.2% prevalence of positive IgG and 1.6% prevalence of positive IgM antibodies in all tested groups. Our results also confirmed that the following risk factors such as tourism, hunting, fishing, and consumption of raw milk are significantly associated with the prevalence of specific antibodies against TBEV. CONCLUSION: The results of seroprevalence obtained by this study confirm the possibility of infection with TBEV among respondents exposed to possible contact with ticks.

Comparison of intravenous and intra-articular tranexamic acid in reducing blood loss in primary total knee replacement.

OBJECTIVES: This study aims to compare the efficacy and safety of intra-articular tranexamic acid (TA) versus intravenous (IV) TA in the reduction of perioperative blood loss and the degree of early postoperative complications associated with primary unilateral cemented total knee replacement. PATIENTS AND METHODS: This prospective randomized study included 90 patients (36 males, 54 females; mean age 68.7 years; range 47 to 82 years) with knee osteoarthritis undergoing a unilateral cemented total knee replacement. Patients were randomized into three groups: group 1 received TA intravenously (dose 10 mg/kg) 20 minutes preoperatively and three hours after first dose, group 2 received TA (dose 3 g) locally (intra-articular) into surgical site, and group 3 did not receive TA. We measured perioperative blood loss, volume of drained blood in 24 hours postoperatively, overall blood loss, decrease in hemoglobin and hematocrit levels, and amount of blood transfusion. RESULTS: There were no differences between the groups in terms of patient preoperative demographics. Local or IV administration of TA significantly reduced the number of blood transfusions and blood losses in drainage. Intravenous application of TA was associated with statistically significantly higher hemoglobin and hematocrit levels and lower overall postoperative blood losses. No serious complications were observed in any of the groups. CONCLUSION: Intra-articular TA was equally effective as IV regimen in reducing the number of blood transfusions. However, IV administration of TA was associated with overall lower blood loss. Our results showed that IV administration of TA during total knee replacement is superior compared to intra-articular administration of TA.

Preliminary clinical experience with the preparation and therapeutic use of autologous osteoblasts and chondrocytes.

Particular results of autologous osteoblasts preparation from patient's bone marrow and autologous chondrocytes from cartilage, both for therapeutic application are given. Osteoblastic cells were cultivated from fresh bone marrow in the presence of dexamethasone in alpha MEM medium containing 10% of patient's and 10% of fetal bovine sera and other necessary additives without any cytokine stimuli. Alkaline phosphatase cell surface activity was used as a marker for quick osteoblastic phenotype confirmation. Autologous chondrocytes were enzymatically separated from fresh knee cartilage. Pieces of cartilage, 2 mm(3) in volume, were sufficient for live cellular graft preparation. Viability of chondrocytes obtained by this approach was more than 90%. In both cases, in osteoblasts as well as in chondrocytes, the amount of cells obtained during the 4 week culture, was sufficient for clinical use.