Blank spaces in the management of venous thromboembolism prophylaxis at surgical departments and the impact of a clinical pharmacist.

INTRODUCTION: A venous thromboembolism (VTE) prophylaxis policy should be in place at all hospitals. While professional societies provide general guidance, they do not take into account the full range of procedures in this area. The aim of this study was to fill these “blank spaces” and design a VTE prophylaxis system which would reflect the wide range of surgical procedures. METHODS: We conducted an extensive literature review. Surgeons were subsequently asked to help score procedures according to VTE and bleeding risk while taking into consideration procedure type and duration, surgical techniques, etc. Results: Clinical pharmacists proposed a standardized VTE prophylaxis protocol. For some surgical fields the Caprini risk assessment model (RAM) was adapted. A unique VTE prophylaxis system was created for surgical fields where Caprini RAM has not been validated. We proposed dosage adjustments for obese patients and for patients with renal impairment. A dedicated software application was developed. CONCLUSION: The implementation of the VTE prophylaxis system resulted in a uniform and more rational prescription of pharmacological and mechanical prophylaxis as well as in financial savings. The development of the app increased compliance with the system and, in combination with real-time auditing, significantly improved safe drug administration practices at Military University Hospital Prague. The system is unique in continental Europe and contains wide range of surgical procedures and matching VTE prophylaxis, which has never before been published in this scope. It demonstrates the contribution of clinical pharmacists to the improvement of hospital care quality.

The impact of multicomponent programmes on balance and fall reduction in adults with intellectual disabilities: a randomised trial.

BACKGROUND: One challenge a modern society faces is this: providing those vulnerable and ageing groups of adults who have intellectual disabilities with appropriate support for improving static and dynamic balance. Balance is a crucial component of physical fitness and, consequently, of fall reduction and prevention. The aim of the present randomised controlled trial was to evaluate the efficacy, after 16 weeks, that three different Special Olympics physical activity programmes had on balance and on fall reduction in adults with intellectual disabilities. METHOD: A convenience sample of 150 persons with mild and moderate intellectual disabilities was recruited from the accessible Special Olympics Slovenia population of physically inactive adults with intellectual disabilities. The sample was randomised to the experimental group 1 (multicomponent balance-specific exercise programme group with additional workshops on such social gerontology topics as active and healthy ageing; N = 50), the experimental group 2 (multicomponent wellness programme group; N = 50) and a control group (regular Special Olympics athletic training; N = 50). RESULTS: Significant differences were found between groups in the balance scores throughout the study period and in the ability to decrease fall frequency. CONCLUSIONS: Balance assessment is a high predictor of frequency of falls, and among adults with intellectual disabilities, it significantly correlates with exercise. The results indicate that a multicomponent balance-specific exercise programme with a significant sociogerontological component on active ageing could be a useful intervention for intellectually disabled adults who have poor balance and who experience frequent falls.

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.

First Report of Entomopathogenic Nematode Steinernema Feltiae (Rhabditida: Steinernematidae) from Croatia.

A survey of entomopathogenic nematodes was conducted in Croatia between 2016 and 2017. The steinernematids were recovered in two out of 100 soil samples from agricultural land characterized as loamy soils with acidic reaction. Molecular and morphological identification was used to distinguish the nematodes. The isolates were identified as two different strains conspecific with Steinernema feltiae. The variations in morphometrical characteristics of infective juveniles (IJs) and males were observed among Croatian strains and with the original description. The analysis of ITS region revealed the greatest similarity of Croatian strains with Slovenian B30 and English A2 strains, which together comprised a monophyletic group in evolutionary analysis. This is the first record of steinernematids, namely S. feltiae in Croatia.

A new species of Gobius (Perciformes: Gobiidae) from the Mediterranean Sea and the redescription of Gobius bucchichi.

A new species of the gobiid genus Gobius (Gobiidae, Perciformes), Gobius incognitus sp. nov. is described from the Mediterranean Sea, and its most morphologically similar species Gobius bucchichi is redescribed. The new species is distinguished from its congeners by: scales in lateral series 51-59; predorsal scales 25-35; opercle scaled in adults with 10-16 scales present; pectoral fin with ray count 18-20 and free tips on upper rays well developed and on the first ray longer than two thirds of the entire ray length; pelvic disc complete and with well-developed anterior membrane without lateral lobes; anterior oculoscapular canal with pore α at rear of orbit; oculoscapular row x(1) not extending forwards to pore ß; suborbital row d discontinuous with large gap below suborbital rows 3 and 4; eye diameter 1·08-1·32 in snout length; by pigment rows on cheek and pigmentation on pectoral-fin base.

[SURGICAL TREATMENT OF THYROID GLAND IN ELDERLY PATIENTS: OUR EXPERIENCES].

The share of elderly persons in the population is growing rapidly and continuously. Requirements for their surgical treatment are increasing and so is the number of published papers on the safety and success of some surgical procedures performed in these patients. The present study included 183 patients aged ≥65 out of 897 patients surgically treated for thyroid gland diseases. They were divided into two groups (group 1 aged 65-69 and group 2 aged ≥70) in order to determine between-group differences in the indications, surgical strategy, final histopathologic analysis, preoperative physical status, number of comorbid diseases and postoperative complications. Analysis of the results justified our decision to divide our patients into two groups of younger and older ones. In group 1, the indications for surgery were mostly benign changes (93.2%), whereas malignant, verified and suspected disease was considerably more frequent in group 2 (21.8%), with a significantly higher percentage of compressive syndrome. Significant between-group differences were recorded in the preoperative physical status (group 2: ASA III and IV, 73.8% and 5%, respectively), number of thyroidectomies performed (group 1, 56.2% vs. group 2, 77.3%) and secondary hemithyroidectomy. A difference was also found in the number of surgical and non surgical complications. The absence of a higher percentage of permanent complications, hypocalcemia and recurrent laryngeal nerve paralysis, in total and by groups, confirmed that surgical treatment of thyroid gland diseases can be considered safe and successful in older age groups, regardless of the between-group differences observed.

Genetic approach identifies distinct asthma pathways in overweight vs normal weight children.

The pathogenesis of asthma in the context of excess body weight may be distinct from asthma that develops in normal weight children. The study's objective was to explore the biology of asthma in the context of obesity and normal weight status using genetic methodologies. Associations between asthma and SNPs in 49 genes were assessed, as well as, interactions between SNPs and overweight status in child participants of the Greater Cincinnati Pediatric Clinic Repository. Asthma was significantly associated with weight (OR = 1.38; P = 0.037). The number of genes and the magnitude of their associations with asthma were notably greater when considering overweight children alone vs normal weight and overweight children together. When considering weight, distinct sets of asthma-associated genes were observed, many times with opposing effects. We demonstrated that the underlying heterogeneity of asthma is likely due in part to distinct pathogenetic pathways that depend on preceding/comorbid overweight and/or allergy. It is therefore important to consider both obesity and asthma when conducting studies of asthma.

Detection of human papillomavirus in the oral cavities of persons with Fanconi anemia.

OBJECTIVE: We conducted a cross-sectional study to describe the prevalence and correlates of type-specific human papillomavirus (HPV) DNA in the oral cavities of persons with Fanconi anemia. MATERIALS AND METHODS: Oral swabs were collected from 67 participants with Fanconi anemia and tested for 27 HPV genotypes using polymerase chain reaction-based methods. RESULTS: Participants were a mean of 18.6 (standard deviation, 10.0) years of age (range 4-47 years). The prevalence of oral HPV infection was 7.5%, and the prevalence of high-risk HPV infection was 6.0%. HPV type 16 was not detected in any samples. Prevalence was higher in adults than in children (13.3% vs 2.7% in those ≥18 vs <18 years of age). Among adults, prevalence was higher in males than in females (25.0% vs 9.1%, respectively). CONCLUSIONS: Prevalence of oral HPV infection in persons with Fanconi anemia was comparable to estimates from other studies in the general population. However, in contrast to previous studies, we did not identify HPV type 16 (the type found in most HPV-related head and neck cancers) in any participants.

Modelling of diffraction grating based optical filters for fluorescence detection of biomolecules.

The detection of biomolecules based on fluorescence measurements is a powerful diagnostic tool for the acquisition of genetic, proteomic and cellular information. One key performance limiting factor remains the integrated optical filter, which is designed to reject strong excitation light while transmitting weak emission (fluorescent) light to the photodetector. Conventional filters have several disadvantages. For instance absorbing filters, like those made from amorphous silicon carbide, exhibit low rejection ratios, especially in the case of small Stokes' shift fluorophores (e.g. green fluorescent protein GFP with λ exc = 480 nm and λ em = 510 nm), whereas interference filters comprising many layers require complex fabrication. This paper describes an alternative solution based on dielectric diffraction gratings. These filters are not only highly efficient but require a smaller number of manufacturing steps. Using FEM-based optical modelling as a design optimization tool, three filtering concepts are explored: (i) a diffraction grating fabricated on the surface of an absorbing filter, (ii) a diffraction grating embedded in a host material with a low refractive index, and (iii) a combination of an embedded grating and an absorbing filter. Both concepts involving an embedded grating show high rejection ratios (over 100,000) for the case of GFP, but also high sensitivity to manufacturing errors and variations in the incident angle of the excitation light. Despite this, simulations show that a 60 times improvement in the rejection ratio relative to a conventional flat absorbing filter can be obtained using an optimized embedded diffraction grating fabricated on top of an absorbing filter.

Spatial heterogeneity in the Mediterranean Biodiversity Hotspot affects barcoding accuracy of its freshwater fishes.

Incomplete knowledge of biodiversity remains a stumbling block for conservation planning and even occurs within globally important Biodiversity Hotspots (BH). Although technical advances have boosted the power of molecular biodiversity assessments, the link between DNA sequences and species and the analytics to discriminate entities remain crucial. Here, we present an analysis of the first DNA barcode library for the freshwater fish fauna of the Mediterranean BH (526 spp.), with virtually complete species coverage (498 spp., 98% extant species). In order to build an identification system supporting conservation, we compared species determination by taxonomists to multiple clustering analyses of DNA barcodes for 3165 specimens. The congruence of barcode clusters with morphological determination was strongly dependent on the method of cluster delineation, but was highest with the general mixed Yule-coalescent (GMYC) model-based approach (83% of all species recovered as GMYC entity). Overall, genetic morphological discontinuities suggest the existence of up to 64 previously unrecognized candidate species. We found reduced identification accuracy when using the entire DNA-barcode database, compared with analyses on databases for individual river catchments. This scale effect has important implications for barcoding assessments and suggests that fairly simple identification pipelines provide sufficient resolution in local applications. We calculated Evolutionarily Distinct and Globally Endangered scores in order to identify candidate species for conservation priority and argue that the evolutionary content of barcode data can be used to detect priority species for future IUCN assessments. We show that large-scale barcoding inventories of complex biotas are feasible and contribute directly to the evaluation of conservation priorities.

Dentition of eight species of Mediterranean Sea Gobiidae: do dentition characters of gobies reflect phylogenetic relationships?

Oral and pharyngeal dentition was analysed in eight Mediterranean species of five different genera using scanning electron microscopy (SEM). Number, position, shape and size of teeth in the jaws and the pharyngeal tooth plates were used as a basis for comparison among taxa. Three different groups could be established based on the dental morphology among the species investigated and homoplasy due to feeding ecology cannot be considered the reason for similarity among them. The established groups are suggested to reflect phylogenetic relationships and correspond with the scarce published data on the topic.

Radiation exposure to the population of Europe following the Chernobyl accident.

On the occasion of the 20th anniversary of the Chernobyl accident an attempt has been made to evaluate the impact of the Chernobyl accident on the global burden of human cancer in Europe. This required the estimation of radiation doses in each of the 40 European countries. Dose estimation was based on the analysis and compilation of data either published in the scientific literature or provided by local experts. Considerable variability has been observed in exposure levels among the European populations. The average individual doses to the thyroid from the intake of (131)I for children aged 1 y were found to vary from approximately 0.01 mGy in Portugal up to 750 mGy in Gomel Oblast (Belarus). Thyroid doses to adults were consistently lower than the doses received by young children. The average individual effective doses from external exposure and ingestion of long-lived radiocaesium accrued in the period 1986-2005 varied from approximately 0 in Portugal to approximately 10 mSv in Gomel Oblast (Belarus) and Bryansk Oblast (Russia). The uncertainties in the dose estimates were subjectively estimated on the basis of the availability and reliability of the radiation data that were used for dose reconstruction in each country.

Prediction of maintenance of sinus rhythm after electrical cardioversion of atrial fibrillation by non-deterministic modelling.

AIMS: Atrial fibrillation (AF) is the most common rhythm disorder. Because of the high recurrence rate of AF after cardioversion and because of potential side effects of electrical cardioversion, it is clinically important to predict persistence of sinus rhythm after electrical cardioversion before it is attempted. The aim of our study was the development of a mathematical model by "genetic" programming (GP), a non-deterministic modelling technique, which would predict maintenance of sinus rhythm after electrical cardioversion of persistent AF. PATIENTS AND METHODS: Ninety-seven patients with persistent AF lasting more than 48h, undergoing the first attempt at transthoracic cardioversion were included in this prospective study. Persistence of AF before the cardioversion attempt, amiodarone treatment, left atrial dimension, mean, standard deviation and approximate entropy of ECG R-R intervals were collected. The data of 53 patients were randomly selected from the database and used for GP modelling; the other 44 data sets were used for model testing. RESULTS: In 23 patients sinus rhythm persisted at 3 months. In the other 21 patients sinus rhythm was not achieved or its duration was less than 3 months. The model developed by GP failed to predict maintenance of sinus rhythm at 3 months in one patient and in six patients falsely predicted maintenance of sinus rhythm. Positive and negative likelihood ratios of the model for testing data were 4.32 and 0.05, respectively. Using this model 15 of 21 (71.4%) cardioversions not resulting in sinus rhythm at 3 months would have been avoided, whereas 22 of 23 (95.6%) cardioversions resulting in sinus rhythm at 3 months would have been administered. CONCLUSION: This model developed by GP, including clinical data, ECG data from the time-domain and nonlinear dynamics can predict maintenance of sinus rhythm. Further research is needed to explore its utility in the present or an expanded form.

Predicting defibrillation success by 'genetic' programming in patients with out-of-hospital cardiac arrest.

BACKGROUND: In some patients with ventricular fibrillation (VF) there may be a better chance of successful defibrillation after a period of chest compression and ventilation before the defibrillation attempt. It is therefore important to know whether a defibrillation attempt will be successful. The predictive power of a model developed by 'genetic' programming (GP) to predict defibrillation success was studied. METHODS AND RESULTS: 203 defibrillations were administered in 47 patients with out-of-hospital cardiac arrest due to a cardiac cause. Maximal amplitude, a total energy of power spectral density, and the Hurst exponent of the VF electrocardiogram (ECG) signal were included in the model developed by GP. Positive and negative likelihood ratios of the model for testing data were 35.5 and 0.00, respectively. Using a model developed by GP on the complete database, 120 of the 124 unsuccessful defibrillations would have been avoided, whereas all of the 79 successful defibrillations would have been administered. CONCLUSION: The VF ECG contains information predictive of defibrillation success. The model developed by GP, including data from the time-domain, frequency-domain and nonlinear dynamics, could reduce the incidence of unsuccessful defibrillations.

Indirect traumatic optic neuropathy--two case report.

The aim of the study was to evaluate the treatment of indirect traumatic optic neuropathy (ITON). ITON is defined as traumatic loss of vision that occurs without external or initial ophthalmoscopic evidence of injury to the eye or its nerve. The optimal management of ITON remains controversial. History, clinical findings and treatment of two cases of ITON with high-dose corticosteroids are described. Improvement of visual acuity after treatment with high-dose corticosteroids was achieved in both cases. The treatment is evaluated in comparison to endorsed treatment modalities found in literature. We concluded that was clinically reasonable to decide to treat or not to treat the indirect optic neuropathy on an individual patient basis.

Reconstruction of total lower lip, labial commissure and palatomaxillary defect with composite island cheek flap.

Functional and cosmetic restoration of total lower lip, labial commissure, and palatomaxillary defects can be achieved by using multiform flaps. The possibility of reconstruction of these areas with composite island cheek flap is presented. The flap was used in three patients who were surgically treated between 1993 and 1998. In one female patient, total lower lip and chin defect was restored with a small contralateral platysma muscle cutaneous flap. The functional and cosmetic result was achieved with composite island cheek flap. In the other two cases, reconstruction was performed without another flap. Composite island cheek flap is supplied with bloody by the facial artery and vein, and contains mucous membrane, muscle and skin of the cheek. In two cases, the flap was formed by the anterior part of the buccal muscle, and in the case with the reconstruction of labial commissure, the greater and lesser zygomatic muscles with levator muscle of the angle of mouth were used. By freeing the blood vessels from the surrounding structures, isolation and transsection of minor vessel branches allowed straightening of the tortuous main vessels. With this technique, excellent functional and satisfactory cosmetic results were achieved in a single act, with minimal morbidity for labial commissure, and total lower lip or palatomaxillary defect reconstruction.

[Metastasis of cutaneous squamous cell carcinoma of the face into the parotid area]]. / Metastaza planocelularnog karcinoma koze lica u podrucje parotidne regije.

Presence of planocellular skin carcinoma always implies the possibility of disease spreading into regional lymph nodes. The average occurrence of metastasis of this face carcinoma is about 5% (from 0.5% to 19.5%). This paper presents seven patients with lymphogenic metastasis of planocellular carcinoma of face skin into parotid region. All patients were treated surgically, and in three patients with extracapsular spreading of metastasis radiation therapy was applied. The choice of the extent of surgery was made on the basis of clinical status. In three patients with small solitary metastases superficial parotidectomy was performed as the only treatment method, and during the three-year follow up the disease did not recur. in other four patients radical procedure with total parotidectomy and elective neck dissection was done due to greater number and size of parotid gland lymph nodes. During the second year of treatment of these patients, disease dissemination and lethal outcome were recorded. The importance of surgical treatment of the primary tumor is emphasized, as well as obligatory pathohistologic examination of the tissue (determination of the depth of invasion, edges), and frequent follow-up of patients at risk with the aim of early detection of recurrence and occult metastases.

The prevalence of oral mucosal lesions in a population in Ljubljana, Slovenia.

The purpose of the present study was to evaluate the prevalence of oral mucosal lesions and conditions in a population in Ljubljana, capital of Slovenia. A total 1609 subjects represented the study population in the survey about the periodontal treatment needs in a population in Ljubljana, conducted from 1983 to 1987. Ten years later the same 1609 subjects were invited to the second examination. Altogether, 555 (34.5%) of the invited subjects in the age range 25-75 years came for an interview and clinical examination at the Department of Oral Medicine and Periodontology of the Dental Clinic in Ljubljana. Oral mucosal lesions and conditions were evaluated according to the WHO Guide to Epidemiology and Diagnosis of Oral Mucosal Diseases and Conditions. The results showed the presence of one or more mucosal lesions in 61.6% of the population. Fordyce's condition was observed the most frequently (49.7%) followed by: fissured tongue (21.1%), varices (16.2%), history of herpes labialis (16.0%), history of recurrent aphthae (9.7%), denture stomatitis (4.3%), leukoplakia (3.1%), cheek biting (2.7%), lichen planus (2.3%), frictional keratosis (2.2%), geographic tongue (2.2%), geographic and fissured tongue together (1.1%), mucocele (0.9%), smoker's palate (0.5%) and angular chelitis (0.4%). In the population examined, no oral malignancies were observed. Mucosal lesions like whitish lesions, denture related lesions, fissured tongue, varices and mucocele were more prevalent with increasing age. Tobacco-related lesions (leukoplakia and smoker's palate together) were significantly more prevalent among men than among women (P<0.05), while lichen planus, denture stomatitis and herpes labialis occurred more frequently in the female population.

[Clinical success of treatment of chronic otitis media using topical and peroral administration of ofloxacin]. / Klinicka uspjesnost lijecenja kronicne upale srednjeg uha lokalnom i peroralnom primjenom ofloksacina.

The paper presents results of the treatment of 32 patients (35 ears) with chronic otitis media and long lasting purulent otorrhea with local and oral ofloxacin. The patients were divided in two groups. Group A included 17 patients (49%), with previous middle ear surgery. Group B comprised 15 patients (18 ears, 51%) treated with local and systemic antimicrobial drugs. Ofloxacin was administered after taking the swab sample, and the duration of treatment was the same in all patients. The most frequently isolated microorganisms were P. aeruginosa (50%), S. aureus (17.7%) and Proteus sp. (14.7%). Upon the completion of treatment which lasted two weeks, 76% of patients in group A had no otorrhea, and in group B 95% of patients were free of otorrhea. At follow-up three months after the treatment, the success rate of ofloxacin therapy remained the same in group A. In group B in four cases there was recurrence of otorrhea, so the success rate in this group decreased to 72%. Ofloxacin treatment gave good result in reduction of otorrhea, regardless of the earlier treatment of chronic otitis media.

[Thyroglossal duct cysts]. / Cista duktusa tireoglosusa.

Fifty-one patients operated for thyroglossal duct cyst at the Ear, Nose and Throat Department of the Zadar General Hospital in the period from 1981 to 1996 were retrospectively analyzed. Thyroglossal duct cyst occurs most commonly in childhood, but it can also appear in adults, even in the elderly persons. The cyst is always localized at the medial neck line, most often beside the lingual bone. The first symptom of the disease in the majority of patients was a painless tumor on the neck. Less frequently, the first symptoms were difficulties in swallowing and signs of infection: pain, redness and swelling on the neck. In majority of patients the diagnosis was established by inspection and palpation, and confirmed by puncture and cytologic examination. In two patients, in whom the site of the cyst was behind the lingual bone, the diagnosis was established by ultrasound. For the diagnosis of thyroglossal duct cyst, physical examination with cytologic evaluation and ultrasound are generally sufficient. Only exceptionally, gamma scintigraphy of the thyroid gland and CT of the neck should be done. After comparing the results of several surgical methods, the author recommends that in addition to the removal of the cyst, the trunk of the lingual bone should be removed as well, to minimize the likelihood of a recurrence.