Vojnosanitetski pregled

Acute intracranial hemorrhage in 76 COVID-19 patients during the first and second pandemic waves

2024-10-31T09:06:40+01:00

Background/Aim. There is limited data on the frequency of intracranial hemorrhage (ICrH) in the first wave [beta variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)] and second wave (delta variant of SARS-CoV-2) coronavirus disease 2019 (COVID-19) pandemic. The aim of this study was to analyze the appearance of ICrH in COVID-19 patients (CP). Methods. Among 505 CP treated at the Special Hospital for Cerebrovascular Diseases “Sveti Sava” intermittently during the 2020–2021 period, ICrH was diagnosed in 76 (15.1%) patients. The available information from the medical records regarding clinical, demographic, as well as radiological data (multislice computed tomography examination of the endocranium) was collected and analyzed. Results. In the first wave, out of 308 CP, 63 (20.5%) were diagnosed with ICrH. In the second wave, out of 197 CP, ICrH was diagnosed in 13 (6.6%) patients, which was a statistically significant difference (p < 0.002). There was no statistically significant difference for the presence of hypertension (p = 0.271), diabetes mellitus (p = 0.558), and chronic obstructive pulmonary disease (p = 0.794) among CP with ICrH comparing the two waves of the pandemic. However, a statistically significant difference was proven in the frequency of patients with atrial fibrillation and anticoagulant drug therapy (p = 0.021 each). There was no statistically significant difference in the frequency of patients with fever (p = 0.637), fatigue (p = 0.587), hemiparesis (p = 0.831), respiratory symptoms (p = 0.289), and loss of consciousness (p = 0.247). D-dimer values in the second pandemic wave were statistically significantly lower (p = 0.003). The combination of ischemic stroke and ICrH was six times more common in the second wave (p = 0.003). However, cerebral parenchymal hemorrhage was two times less frequent (p = 0.001) in the second wave but with statistically higher frequencies of multifocal (23.1%) and diffuse type (36.4%) of ICrH (p = 0.007). Combined hemorrhages, as well as subarachnoid and subdural subtypes, were more common in the second wave (23.1% each). Fatal outcomes occurred in 38.1% of patients in the first wave compared to 69.2% in the second wave (p = 0.039). Conclusion. In the first pandemic wave of COVID-19, ICrH in CP was significantly more frequent and D-dimer was singled out in laboratory analyses, the values of which were statistically significantly higher in comparison with second wave. In the second wave of COVID-19, parenchymal ICrH was less frequent and multifocal and diffuse ICrH were more common in CP with ICrH. The mortality rate was very high in the second wave.

Clinical and laboratory status in Parkinson’s disease patients with and without polyneuropathy

2024-10-31T09:06:41+01:00

Background/Aim. The etiology of polyneuropathy (PNP) in patients with Parkinson’s disease (PD) is unclear, and there is a possible association between levodopa therapy, hyperhomocysteinemia, and PNP development due to methylation processes involving vitamin B12 and folic acid. The aim of this study was to analyze the difference in clinical presentation and disease severity between PD patients with and without PNP and to evaluate blood levels of vitamin B12, homocysteine, and folic acid in these patients. Methods. This cross-sectional study included 200 consecutive patients diagnosed with PD, divided into two groups: those with PNP and those without PNP. Diagnosis of PNP was confirmed by electromyoneurography. The first group consisted of 50 patients with PD with confirmed PNP, and the second 50 patients with PD without PNP. All patients were receiving levodopa therapy. Laboratory tests analyzed vitamin B12, folic acid, and homocysteine levels. Results. Patients with PNP were older when PNP was diagnosed (71 vs. 66 years, p < 0.0001), without differences in duration of levodopa therapy (p = 0.359) or daily dose (p = 0.442), and with significant motor impairment according to Unified Parkinson’s Disease Rating Scale III (p = 0.017). No difference was found between groups for vitamin B12 (p = 1.0), folic acid (p = 0.124), and homocysteine (p = 0.313) serum levels. Conclusion. PD patients with PNP have a more pronounced motor deficit, while differences in vitamin B12, homocysteine, and folic acid values compared to the group without PNP were not registered.

The effect of vitamin D serum levels on the values of C-reactive protein and fecal calprotectin in patients with ulcerative colitis in clinical remission

2024-10-31T09:06:41+01:00

Background/Aim. Vitamin D plays a critical role in digestive calcium absorption and, thanks to its immunomodulatory properties, affects intestinal barrier integrity, gut microbiota, and immune system functionality. The aim of the study was to examine 25-hydroxyvitamin D [25(OH)D] levels in patients with ulcerative colitis (UC) in clinical remission, as well as its effects on the values of fecal calprotectin (FC) and C-reactive protein (CRP). Methods. The research, conducted as a cross-sectional study, included 62 patients with UC in clinical remission. Serum levels of 25(OH)D and CRP were determined from venous blood specimens, while FC levels were assessed from stool samples. Endoscopic activity was evaluated through colonoscopy and was expressed by the Mayo Endoscopic Score (MES). Results. Out of the 62 participants with UC in clinical remission, 38 (61.3%) were males, and 24 (38.7%) were females. The average 25(OH)D level in those patients was 49.87 ± 23.5 nmol/L. Among the patients with UC, six (9.7%) participants had sufficient vitamin D levels (> 75 nmol/L), whereas insufficiency (< 50 nmol/L) and deficiency (50–75 nmol/L) were established in 32 (51.6%) and 24 (38.7%) participants, respectively. In the analyzed sample, 25(OH)D serum levels did not significantly correlate either with FC (r = 0.077, p = 0.551), CRP (r = –0.111, p = 0.392), or MES (r = 0.02, p = 0.787). Conclusion. In our investigation, the 25(OH)D serum level did not significantly influence the values of the MES nor the biomarkers of inflammation – FC and CRP.

Diagnostic and therapeutic efficacy of urinary bladder hydrodistension in patients with bladder pain syndrome

2024-10-31T09:06:42+01:00

Background/Aim. Interstitial cystitis (IC)/bladder pain syndrome (BPS) is a condition with recurring discomfort or pain in the urinary bladder and the surrounding pelvic region without an identifiable disease. The aim of this study was to assess hydrodistension as a diagnostic and treatment procedure in patients with BPS. Methods. This prospective study included 45 patients who underwent cystoscopy with hydrodistension. The mean values for 24-hr voiding frequency, maximal voided urine volume, average voided urine volume, and minimal voided urine volume originated from the frequency volume chart. The values were compared between the time before hydrodistension and one, three, and six months after that. Results. By comparing the initial data and data in all three follow-up periods (after 1, 3, and 6 months), the statistical significance (p < 0.046) was found, and that: for 24-hr voiding frequency, it was 19.64 ± 3.56, 9.42 ± 1.71, 9.58 ± 1.45, and 12.2 ± 2.79, respectively; then, for the minimal voided urine volume (p < 0.03), it was 59.11 ± 23.72 mL, 114.89 ± 4.09 mL, 112.44 ± 100.86 mL, and 89.00 ± 29.45 mL, respectively; for an average voided volume (p < 0.04), it was 105.33 ± 18.29 mL, 186.89 ± 23.14 mL, 186.44 ± 21.44 mL, and 155.78 ± 30.78 mL, respectively. There was no significant statistical difference (p < 0.1) regarding the maximal voided urine volume between initial and follow-up interval data: 196.89 ± 43.68 mL, 312.89 ± 54.59 mL, 316.00 ± 49.47 mL, 266.67 ± 53.17 mL, respectively. Conclusion. Our results demonstrate that hydrodistension is a reliable diagnostic and therapeutic procedure.

Strengthening pharmacy practice: development and validation of the Resilience Scale

2024-10-31T09:06:43+01:00

Background/Aim. Despite the demanding nature of their roles in community pharmacies and their critical importance to patient safety, healthcare professionals, including pharmacists, are often not covered by the Resilience Scale. Therefore, the aim of the study was to develop and validate a resilience scale specifically tailored for pharmacists working in community pharmacies. Methods. The study involved the development and validation of a scale aimed at assessing psychological resilience among community pharmacists. The domains and items of the scale were considered from the aspect of reviewing the available literature. Content validation by subject matter experts and subsequent computation of the content validity index ensured the scale’s content validity. Face validity assessment ensured alignment with the intended construct. The final scale was distributed to a sample of 504 community pharmacists, after which the scale was analyzed using statistical methods such as factor analysis, multiple regression, and reliability analysis. Additionally, test-retest reliability analysis was performed on 80 community pharmacists. Results. During the brainstorming sessions and focus groups, 95 items were generated within five domains – Confidence, Agility, Coping with stress, Interpersonal relations, and Developmental thinking. Following expert review and rigorous content and face validity analyses, 30 items with Content Validity Index and Face Validity Index values surpassing 0.80 were retained. The scale exhibited strong internal consistency, with Cronbach’s alpha exceeding 0.9. Factor analysis confirmed the five-factor structure, with each component displaying high factor loadings and significant variable loadings on only one component. Conclusion. The Resilience Scale emerged as a promising tool for assessing community pharmacists’ resilience, demonstrating robust psychometric properties. The study contributed validity evidence concerning content and internal structure, thereby enhancing the scale’s credibility in evaluating resilience domains within the pharmacy profession.

The influence of autoclave sterilization on the cyclic fatigue of M-wire rotary endodontic instruments

2024-10-31T09:06:43+01:00

Background/Aim. The most important moment in modern endodontics is the inclusion of rotating instruments made of nickel-titanium alloy in daily clinical work, which have supplanted stainless steel instruments due to their superior properties. The aim of this study was to investigate the influence of autoclave sterilization on cyclic fatigue (CF) in two types of rotating instruments produced by M-wire technology with different types of rotation. Methods. This research included two types of M-wire rotary instruments – 48 ProTaper Next^® instruments with full rotation and 48 WaveOne^® Gold instruments with reciprocating rotation. Each of the two groups of instruments was divided into four additional groups of 12 instruments depending on the number of cycles of sterilization in the autoclave. The instruments were tested in an artificial canal with a 2 and 5 mm radius of curvature. Results. Statistically significantly higher resistance to CF was observed with WaveOne^® Gold compared to ProTaper Next^® (p < 0.001) instruments, both in the non-sterilized group and after their exposure to the first, third, and fifth cycle of sterilization. The third and fifth cycle of sterilization significantly reduced resistance to CF in the WaveOne^® Gold (p < 0.001) group. There was no statistically significant difference in CF resistance between sterilized and non-sterilized instruments of the ProTaper Next^® group. Conclusion. Sterilization in an autoclave for instruments based on M-wire technology did not increase resistance to CF.

Acrometastasis as a first sign of lung cancer

2024-10-31T09:06:44+01:00

Introduction. Bone metastases occurring distally to the elbow or knee joint are called acrometastases. Acrometastases make up only 0.1% of all bone metastases, but only 0.007% to 0.3% occur in the bones of the foot or hand. In 10% of patients, bone metastases occur as the first sign of a previously undiagnosed primary tumor. Case report. A 64-year-old male reported to the hospital due to painful swelling and redness of the fifth finger of the dominant hand. Osteolysis of the proximal phalanx of the fifth finger was diagnosed radiographically. A working diagnosis of osteomyelitis and phlegmon of the proximal phalanx was made. After incisional drainage, a tumor mass was observed intraoperatively. Amputation of the finger was performed at the level of the metacarpophalangeal joint. Pathohistological analysis revealed squamous cell carcinoma metastasis. After a computed tomography scan and bronchoscopy with biopsy, a diagnosis of squamous cell carcinoma of the bronchus was made. The patient was given chemotherapy. During the application of the second cycle, there was a fatal outcome. Conclusion. Pathohistological verification and determination of the location of the primary tumor are important when acrometastasis is found because starting novel immunotherapy and targeted therapy in a timely manner could change the median survival of these patients.

The evolution of periodontology in the 19th and 20th century

2024-10-31T09:06:45+01:00