Haemodynamic assessment in simulated operative positions before knee arthroplasty can be useful in deep vein thrombosis prediction.

PURPOSE: During knee arthroplasty, the leg is placed in several forced positions, which are mainly uncomfortable for all tissue structures in the region, including the vascular structures. Veins have a weaker quality of the wall structure than arteries, so during the forced position morphological and haemodynamic consequences are expected mainly in the venous system. Conditions of safe aseptic environment for the arthroplasty are in collision with routine intra-operative analysis of local haemodynamics in real time. This is the reason why we have no insight into the haemodynamic and morphological changes at the time in which the initiation of deep vein thrombosis (DVT) occurs. For this reason we created the hypothesis that the monitoring of the occurrence and detection of potential DVT risks can be achieved pre-operatively using echosonograms in simulated operative positions, and then compare them with the cases of postoperative DVT. METHODS: This research was conducted as a prospective, analytical, minimally manipulative and observational clinical study in the period January 2011 to October 2013. In the preoperative period we made ultrasound and colour-Doppler examinations of deep veins in simulated operative position (full extension 0°, semiflexion 30-60°, flexion 90° and maximal flexion 90°+). The target vein was the posterior tibial vein in the distal third of calf. During the operation we took a note of anaesthesia duration and forced positions duration. After the operation we were looking for ultrasound signs of DVT in a follow-up period of six weeks. The sample was made from 91 patients selected for knee arthroplasty: 56 women and 35 men patients of average age 67.46 years. The oldest patient was 81, and the youngest 48. Average body mass index was 26.98 (±2.20) kg/m(2). After initial ultrasound, the sample was divided into two groups according to vein flow velocity. Patients who had a flow velocity lower than 10 cm/s in any of the forced positions were in the investigated group (N-b, n = 38), and patients who had more favourable haemodynamics in forced positions were in the control group (N-a, n = 53). Patients underwent arthroplasty without tourniquet, and the operative, postoperative and anaesthesiological protocol was the same for all the patients. RESULTS: Friedman's test results point out significant differences of posterior tibial vein flow velocity in four simulated positions (0°, 30-60°, 90°, 90°+). Overview of the median value of the posterior tibial vein flow velocity points out reduction of the posterior tibial vein flow velocity in the third and fourth simulated positions. Average range values were lowest in simulated position 90°+. Relative risk for the DVT occurrence was 21.6% higher in the group of patients with flow velocity lower than 10 cm/s with statistical significance. The incidence of DVT was higher in women (22.85%) than in men (14.28%). There was one (1.09%) case of pulmonary embolism (PE) presented as segmental PE. CONCLUSIONS: We believe that preoperative ultrasound analysis performed during the simulation of operative positions is a useful pre-operative test that can identify patients at risk of developing postoperative DVT. We would recommend that during surgery procedure to minimise forced position of knee flexion.

TrichoScan findings in patients with effluvium capillorum.

Effluvium capillorum is a form of nonscarring alopecia characterized by diffuse hair shedding. This condition occurs when the normal balance of hairs in growth and rest phases is disrupted. Trichoscan is a computerized program used for digital measurement of hair growth and hair loss. This study was performed to describe the TrichoScan as a method, which combines standard epiluminiscence microscopy with automatic digital image analysis for the measurement of human hair. The study included 30 patients with effluvium capillorum (16 women and 14 men). A control group consisted of 30 generally healthy patients (14 women and 16 men). For the measurement of hair density and anagen/telogen ratio, a commercially available software (TrichoScan) was used. The results of digital image analysis from the patients showed a highly increased proportion of telogen hair roots. The authors' results indicate that TrichoScan represents a very useful tool in the evaluation of hair loss.

Vitiligo and autoimmunity.

BACKGROUND: Vitiligo is an acquired skin disorder characterized by depigmented maculae resulting from a reduction of the number and function of melanocytes. The etiopathogenesis of the disease is still unclear, but there is evidence that autoimmunity may be involved. OBJECTIVE: The aim of this study was to determine the prevalence and significance of antinuclear (ANA) and thyroid peroxidase (anti-TPO) antibodies in patients with vitiligo and control group. METHODS: In a prospective case-control study, we compared the frequency of antibodies (ANA and anti-TPO) in 40 patients with vitiligo and in 40 healthy volunteers. RESULTS: ANA were positive in 7 (17%) patients, which was insignificantly higher than control group, 2 (5%). Anti-TPO were positive in 11 (27%) patients. In control group, only two subjects (5%) had positive anti-TPO. Compared with the control group, the frequency anti-TPO were significantly higher in those with vitiligo (p < 0.05). CONCLUSION: Our findings show a significant association between vitiligo and thyroid autoimmunity, and that tests to detect anti-TPO are useful markers in patients with vitiligo. In contrary, ANA seems to have limited diagnostic relevance in routine clinical practice. Additional studies of a wider sample are warranted to confirm these findings and allow a detailed analysis.

Effects of fixed combination of lisinopril plus hydrochlorothiazide on regression of left ventricular hypertrophy in patients with essential hypertension: an opened, multi-centre, prospective clinical trial.

The aim of this trial was to examine the effects of antihypertensive fixed combination of lisinopril plus hydrochlorothiazide (Lopril H, Bosnalijek dd, Bosnia and Herzegovina) on regression of left ventricular hypertrophy in patients with essential arterial hypertension. We included 297 patients in our trial, aged 54.65+/-9.6 years, with treated or untreated hypertension and with high risk of cardiac events, in an opened trial of therapy based on lisinopril plus hydrochlorothiazide. Patients from five European countries were followed up for a period of 12 weeks. Duration of treatment was 12 weeks. We adjusted daily doses of lisinopril plus hydrochlorothiazide after every clinical examination and recorded adverse effects of drugs. In the beginning and after 12 weeks of treatment, 277 patients (93.2%) underwent 2-dimensional echocardiography and there were 186 patients evaluated for efficacy of treatment on left ventricular hypertrophy (LVH). We recorded a regression of index mass LVH (168.56 vs 161.51 g/m2, P<0.0001), and regression was something more in women vs men. We recorded average reduction of left ventricular mass index for patients with LVH (N=186) by 7.05 g/m2 (4.18%) in all patients, by 6.73 g/m2 (3.93%) in men and 7.27 g/m2 (4,37%) in women. The proportion of patients who attained a regression of left ventricular mass tended to be greater in men (54.55% vs 53.21%). This research has proved regression of LVH in more than 53% patients after using fixed combination of lisinopril plus hydrochlorothiazide.

Fixed combination lisinopril plus hydro-chlorothiazide in the treatment of essential arterial hypertension: an opened, multi-centre, prospective clinical trial.

The aim of this trial was to examine the efficacy and safety of antihypertensive fixed combination lisinopril plus hydrochlorothiazide (Lopril H, Bosnalijek dd) in the treatment of essential arterial hypertension. In our trial we included 297 patients, aged 54.65+/-9.6 years, with treated or untreated hypertension and with high risk of cardiac events, in an opened trial of therapy based on lisinopril plus hydrochlorothiazide. Upon the examination by physicians, patients were divided into three groups in accordance with European Society of Cardiology guidelines for the management of arterial hypertension. Patients from five European countries were followed up for a period of 12 weeks. Duration of treatment was 12 weeks. We adjusted daily doses of lisinopril plus hydrochlorothiazide after every clinical examination and recorded adverse effects of drugs. After 12 weeks of treatment, 288 patients (96%) were evaluated for efficacy, tolerability and safety. In almost 81.5% patients with mild, moderate and severe hypertension, we recorded a reduction in blood pressure to approximately normal values SBP and DBP (140/90 mmHg). Drug-related side-effects occurred in 11 patients (3.66%). The most commonly reported adverse effects associated with lisinopril plus hydrochlorothiazide were cough (5) and dry mouth (5). This research has proved good efficacy of fixed combination lisinopril plus hydrochlorothiazide with more than 97% patients. Based on subjective estimation by patients: this drug improved quality of life in all cases.

Open Clinical Trial on Using Nifuroxazide Compared to Probiotics in Treating Acute Diarrhoeas in Adults.

BACKGROUND: Nifuroxazide is well known and often used anti-diarrhoeal medicine which has been pushed back from routine practice in recent years and often replaced with probiotics. Even probiotics are accepted and placed in some therapeutic guidelines for diarrhoea treatment, there are no enough evidence for its effectiveness and no comparative efficacy data with nifuroxazide in treatment of acute diarrhea. PATIENTS AND METHODS: In open, prospective observational study, the efficacy and safety of nifuroxazide were compared with a probiotic containing lactic acid bacteria in the treatment of acute diarrhoea. A total number of 169 adult patients were included in this study, who administered nifuroxazide in the dose of 200 mg/4 times a day, while they took preparation containing lactic acid bacteria (1,2 x 107 live lyophilised lactic-acid bacteria) three times a day for three days. RESULTS: Mean time to last unformed stool (TLUS) in a group which was treated with nifuroxazide was two days, while it took five days for the stool normalisation in the group using probiotic (p=0.0001). CONCLUSIONS: Orally administered nifuroxazide has demonstrated better efficiency as compared to probiotic in treating acute diarrhoea, and both medicines have shown the same safety and tolerance in this study.

Oral acute toxicity of polyenylphosphatidylcholine (PPC) in rats.

Endogen phospholipids play a major role in determining the structure and nature of cell membranes. A deficiency of phospholipids in cellular membranes makes it almost impossible for the cell membrane to perform its function as a selective barrier between what passes in and out of the cell. Polyenylphosphatidylcholine chemical structure corresponds to that of endogen phospholipids, but it possesses functional superiority because of its content of unsaturated fatty acids. Polyenylphosphatidylcholine integrates in the cell membrane and organelle systems while becoming their constitutive elements. A healthy cell membrane leads to healthy cells and then healthy tissue and then to healthy organs or body systems and finally, healthy bodies and minds. For a long time, polyenylphosphatidylcholine in combination with vitamins has been used in the treatment of numerous health problems such as liver diseases, dyslipoproteinaemias and different intoxications with consequent liver failure. The main aim of toxicology studies is evaluation of the toxic potential and risks of human exposition to the substance. According to the Organization for Economic Cooperation and Development (OECD) acute oral toxicity refers to those adverse effects occurring following oral administration of a single dose of a substance or multiple doses given within 24 hours. LD50 (median lethal dose), oral, is a statistically derived single dose of a substance that can be expected to cause death in 50 per cent of animals when administered by the oral route. Our acute toxicity study was performed on albino Wistar rats. Animals were randomised in three experimental and one control group, each of 5 males and 5 females. Study was based on the administration of a single oral dose of the test substance (polyenylphosphatidylcholine) to each experimental animal. There were three dose-levels of the test substance: 300, 500 and 1000 mg/kg. Test substance administration day was the first day of the observation period that lasted 14 days. Control animals were given milk vehicle. At the end of the study, no statistically significant differences between experimental and control animals were observed concerning the recorded parameters: body weight, respiratory rate, tremor, faeces and phonation quality, indicating the absence of the test substance acute toxicity.

Food and water consumption in assessment of acute oral toxicity of HEPALIP FORTE in rats.

Body weight variations during toxicological testing can be one of the indicators of the test substance toxic effects. Data on food and water consumption are true indicators of the rate of growth of experimental animals (Stevens & Gallo, 1989). Daily recording of the food and water consumption was done during the acute toxicity testing of HEPALIP FORTE. The study was performed on Wistar rats. The active component of HEPALIP FORTE is EPL substance--essential phospholipids, a natural substance present in every living cell. Essential phospholipids in combination with vitamins have been used in the treatment of liver diseases, dyslipoproteinaemias and intoxications accompanied with liver failure. Statistical analysis of the body weight variations was performed separately, for males and females. The analysis failed to show any significant difference between the groups. There was a significant difference in water consumption between the male group 2M and female groups 3F and 2F in comparison with control groups. Statistical analysis of the variations of food consumption showed a significant difference in all male groups in comparison with control groups, and only in the 3F female group in comparison with a control group. Considering the absence of lethality and the lack of significant influence of the test substance on animal body weights, we concluded that the test substance was not acutely toxic in rats, if applied orally, in single doses of 300 mg/kg, 500 mg/kg and 1000 mg/kg. Significant differences found in food and water consumption suggest a need of their during the future chronic toxicity testing.

Oral acute toxicity of HEPALIP FORTE in rats.

The main active component of preparation HEPALIP FORTE is EPL--essential phospholipids. Their chemical structure corresponds to that of endogen phospholipids, but they have functional superiority because of the content of unsaturated fatty acids. Essential phospholipids in combination with the vitamins have been used in the treatment of liver diseases, dyslipoproteinaemias and intoxications with consequent liver failure. Acute toxicity study on HEPALIP FORTE was performed on Wistar rats. The main aim of toxicology studies for the drug registration process is evaluation of the toxic potential and risks of human exposition to the substance (Gelbke et al., 1999). Acute toxicity is an orientation point of the test substance toxicity and represents a starting test for the toxicological evaluation. Study included one oral dose of the substance, applied with oesophageal intubations. There were three dose-levels: 300, 500 and 1000 mg/kg. No lethality was recorded and statistical analysis of body weight variations failed to show any significant difference between the groups. Reversible tremor was more frequently recorded in females and was not present in control animals. After the planed sacrifice, no changes related to the test substance were recorded. We noticed a statistically significant difference in the liver weights between males of 3M and 2M groups in comparison to the control. Similar (not significant) tendency was noticed in females. Significant differences in organ weights might be suggestive of a toxic effect that experimental animal managed to recover from in partial manner. The histopathological analysis detected no changes in the structure and morphology of liver parenchyma.

Outpatient antihypertensive drug utilization in Canton Sarajevo during five years period (2004-2008) and adherence to treatment guidelines assessment.

Hypertension is chronic disease with high prevalence, which can successfully be treated with antihypertensive drugs. Previous researches have shown that existing hypertension treatment guidelines are not fully implemented in practice. We have analysed antihypertensive drug utilization in Canton Sarajevo during five-year period (2004-2008). Research findings are discussed in relation to expected drug utilization according to Canton Sarajevo treatment guidelines. Objective of this research is to examine prescription patterns of antihypertensive drugs in primary health care in Canton Sarajevo during five-year period. Based on study findings we did an estimation of adherence to local treatment guidelines, which are similar to those published globally. Drug utilization data were collected from the largest pharmacy (retail) chain, representing more than 80% of pharmacies in Canton Sarajevo. Following drug groups have been analyzed: diuretics, beta-blockers, calcium-channel-blockers, ACE-Inhibitors (plain and combinations), Angiotensin-II-antagonists and alpha-blockers. Drug utilization is expressed in number of defined daily dose (DDDs), defined daily dose per thousand inhabitants per day (DDD/TID), drug utilization 90% (DU90%) and value in euros. ACE-Inhibitors are most prescribed drug class; combination of ACE-Inhibitors and diuretics account 46% of total antihypertensive budget spending. ACEIs are followed by calcium-channel-blockers. Diuretics utilization is decreasing from 2006 and being replaced with beta-blockers. Diuretics, recommended as first line therapy, are ranked as third in total antihypertensive drug utilization. It is necessary to introduce follow-up and enforce adherence to developed treatment guideline. Drug utilization studies can be used as tool for assessment of treatment guidelines adherence in primary health care.

Association between Vitiligo and Thyroid Autoimmunity.

Background. Vitiligo is a common skin disorder characterized by macular depigmentation of the skin. The etiopathogenesis of the disease is still unclear, but there is evidence that autoimmunity and endocrine disfunction may be involved. Objective. The aim of this study was to determine whether vitiligo is statistically associated with thyroid autoimmunity. Method. In a prospective case-control study, we compared the frequency of thyroid autoantibodies (thyroglobulin antibody, anti-Tg and thyroid peroxidase antibody, and anti-TPO) in 33 patients with vitiligo and in 33 healthy volunteers. Thyroid autoantibodies and thyroid hormones (thyroxine (T4), triiodothyronine (T3), and thyroid stimulating hormone (TSH) were measured in all subjects. Results. Thyroid functional abnormalities were found in 6 (18.18%) patients. Anti-Tg and anti-TPO were positive in 9 (27.27%) and 8 (24.24%) patients, respectively. In control group, only one subject (3.03%) had abnormalities in thyroid hormonal status, and two subjects had positive thyroid autoantibodies. Compared with the control group, the frequency of both anti-Tg and anti-TPO was significantly higher in those with vitiligo (P < .05). Conclusion. This study shows a significant association between vitiligo and thyroid autoimmunity, and that tests to detect thyroid autoantibodies are relevant in patients with vitiligo.

TrichoScan as a method to determine hair root pattern in patients with scalp psoriasis.

Scalp involvement is a prominent and often the initial presentation in patients with psoriasis. Hair growth may be impaired with a hair loss and an increased telogen/anagen ratio. The aim of this study was to investigate the hair density and anagen/telogen ratio in psoriatic patients, using epiluminescence microscopy combined with digital image analysis (TrichoScan). Thirty psoriatic patients with scalp involvement and the same number of clinically healthy individuals were included in the study. For the measurement of hair density, anagen/telogen ratio and number of terminal and vellus hairs, a commercially available software TrichoScan was used. Hair density measurements did not show significant difference between patients and controls (P=0.05). The anagen ratio was significantly lower and telogen ratio significantly higher in psoriasis patients than in controls (P<0.01 both). There was no correlation between hair parameters and patient age or duration of disease. Study results support the evidence that scalp psoriasis is associated with an increased telogen/anagen ratio.

The importance of using peritoneal equlibration test for the peritoneal transport type characterization in continuous ambulatory peritoneal dialysis patients.

The aim of this study was to analyze the importance of the peritoneal equilibration test (PET) in evaluation of the peritoneal membrane transport status in patients treated with continuous ambulatory peritoneal dialysis (CAPD). The study included 30 adult continuous ambulatory peritoneal dialysis (CAPD) patients, 16 male and 14 female, mean age 61 +/- 16.5 years with a prescription of four exchanges of 2 litres (L) per day, who underwent peritoneal equilibration test (PET). Eleven of patients were diabetics. A modified PET was performed during a 4 hours dwell using 4.25% glucose dialysis solution. The dialysate/ plasma ratio of creatinine (D/P) at the end of the procedure, and the dialysate 240 min/ initial dialysate ratio of glucose (D/Do) were calculated and used as parameter of solute transport. With the test, categorization of patients was possible into high (H), high-average (HA), low average (LA), and low (L) transporters. In multivariate analysis age, gender, time on dialysis, comorbid diseases, diabetes mellitus (DM), serum albumin, were considered as independent factors influencing the PET. Among 30 patients 5 (16.7%) were classified as H transporters, 6 (20%) as HA, and 19 (63.3%) as LA. There were no patients in low category. Creatinine D/P at 4 hours was not different DM and non-DM patients. There were significant differences in gender, comorbid disease, serum albumin, D4/Do glucose and volume drained in 4 hours. The high transporter group had higher proportion of man (p<0.05), higher proportion of patients with comorbid diseases, lower serum albumin concentration (p<0.001), lower D4/Do glucose (p<0.001), and lower drained volume (p<0.001). The PET was en easy, inexpensive, reliable test to assess peritoneal transport type and it also provided information about peritoneal clearance of solutes and ultrafiltration. Peritoneal transport type classification was recognized not only as aid for prescription, but also as a prognostic index.

Acute renal insufficiency and toxic hepatitis following scorpions sting.

Scorpion sting is a huge medical problem in countries of South America, Arabian Peninsula and Africa. In countries of Mediterranean region, where Bosnia and Herzegovina belongs, this problem is sporadic. Following the sting of very poisonous red scorpions, death may occur inside of 48 hours by reason of cardiac arrest and acute renal insufficiency (ARI). In our work we represent a case of 54-years old man. In his case, ARI and toxic hepatitis developed inside of 24 hours after the scorpion sting. Applied conservative therapy was not sufficient enough to solve ARI, so patient needed haemodialysis. With intensive conservative therapy and haemodialysis applied every other day, ARI and toxic hepatitis were solved within 25 days. After that, patient was released from hospital for ambulant treatment.

[Classification of drugs using the ATC system (Anatomic, Therapeutic, Chemical Classification) and the latest changes]. / Klasificiranje lijekova po ATC sistemu i najnovije izmjene.

World Health Organization (WHO) established ATC system of drug classification. All drugs are grouped in five levels (anatomical main group, therapeutic subgroup, pharmacological subgroup, chemical subgroup and chemical substance). Alterations in ATC classification are made only by experts in WHO centre in Oslo, Norway. Changes are made in assigned new international generic names (INN), in ATC levels likes in changes of Defined Daily Doses (DDD) once a year. Changes are made following current scientific articles and international pharmacopeas, as well as the guideline.