Ability of S100B to predict post-concussion syndrome in paediatric patients who present to the emergency department with mild traumatic brain injury.

INTRODUCTION: Among children who sustain mild traumatic brain injury (mTBI), 10-30% develop a cluster of cognitive, physical, and emotional symptoms commonly referred to as post-concussion syndrome (PCS). Symptoms typically resolve within 7-10 days, but a minority of patients report symptoms that persist for months or even years. The aim of our study was to identify a neurobiochemical marker after mTBI that can predict the presence of post-concussion syndrome three months after head injury in paediatric patients. MATERIALS AND METHODS: Children between 7 and 16 years of age who had head trauma and no other complaints were included. Three months after the initial visit, participants or parents/guardians were interviewed in person about the children's PCS symptoms using the Rivermead Post-Concussion Symptoms Questionnaire (RPQ). RESULTS: The mean value of S100B protein in serum in 38 patients without signs of PCS was 0.266 µg L-1, with a 95% confidence interval (CI) of 0.221 - 0.310 µg L-1. Among the 22 patients with signs of PCS, the mean value of S100B protein in serum was 0.845 µg L-1, with a 95% CI of 0.745-0.945 µg L-1. Patients with signs of PCS had higher S100B protein levels than those without signs of PCS (p < 0.0001). CONCLUSIONS: Our prospective study showed that S100B protein is a useful neurobiomarker for detecting paediatric patients at risk for post-concussion syndrome. We found that the biomarker S100B correlated with the severity of traumatic brain injury (number of lesions on CT) and the presence of post-concussion syndrome.

Prevalence of Coxitis and its Correlation with Inflammatory Activity in Rheumatoid Arthritis.

BACKGROUND: Rheumatoid arthritis (RA) is an autoimmune inflammatory disease characterised by intra-articular and extra-articular manifestations but very rarely with coxitis. AIM: This study aimed to investigate the prevalence of coxitis, clinical changes, and its correlation with the parameters of inflammatory activity. METHODS: A cohort of 951 patients diagnosed with ACR/EULAR (American College of Rheumatology/European League against Rheumatism) 2010 criteria was enrolled in this prospective, observational and analytic research study. The CBC (Complete Blood Count), ESR (Erythrocyte sedimentation rate), CRP(C - reactive protein), Anti CCP (Antibodies to cyclic citrullinated peptides), X-ray examination of palms and pelvis, and the activity of the disease as measured by DAS - 28 (28 - joint disease activity score) were carried out in all subjects. Independent samples t-test was used to compare the group's characteristics, whereas Pearson correlation test was used to analyse the correlation between study variables. RESULTS: Of the total number of the subjects, 730 (76.8 %) were females, whereas 221 (23.2%) were males. The average age was 51.3, y/o while the most of them were between 40 - 49 y/o (32.6%). The prevalence of coxitis was 14.2%, mostly found in males (19.46%). The echosonografic prevalence of changes was 21.45%, while the radiological changes were 16.3%; in both cases, the changes were more expressed in males. The analysis showed that inflammatory parameters were significantly higher in patients with coxitis. CONCLUSION: Coxitis has high economic cost because it ends up with a mandatory need for a total hip joint prosthesis. Thus the results of this study can serve to plan and initiate early preventive measures.

Musculoskeletal Health of 40-65 Year Old Males and Females in Kosova and the Impact of N05B, A02B (PPI, H2RA), H02AB and Lifestyle Factors on It.

BACKGROUND: This observational, cross-sectional study investigates the impact of medication usage, physical activity (PA) and nutritional status on musculoskeletal health (MSH) in males and females aged 40-65 in the population of a post conflict, developing country. METHODS: Bone Mineral Density (BMD), T-score and Z-score at distal forearm regions (measured by DEXA scan), together with isometric hand grip strength (dynamometer) were evaluated in a total of 162 subjects (53 Males, average age 55.15±7.12 and 109 Females, 54.27±5.1). Additionally, bio-anthropometric assessments, medication usage, PA level and nutritional status were assessed. RESULTS: Significant differences (p<0.05) were found in total subjects Body Mass Index (BMI), PA, BMD, T-score and Hand grip between genders. 42% of total participants met the diagnostic criteria of, out of which 6.8% with T-score below -2, while no cases of Osteoporosis was recorded. N05B Anxiolytics and A02B Drugs for peptic ulcer and gastro-oesophageal reflux disease medication groups consumption turned to have no significant differences (p>0.05) in BMD, T-score, and hand grip in total population, except for A02B where p<0.05 were found in Hand grip, as well as between female consumers and no consumers in all variables. Meanwhile, in total subjects consuming H02AB Glucocorticoids p<0.05 were observed in BMD and T-score, but not on hand grip. CONCLUSIONS: This study shows a low risk for MSH problems amongst the studied population in Kosova, while the consumption of H02AB medication group in both genders and A02B in females only for extended periods might effect MSH, therefore appropriate benefit/risk assessment should be made before prescribing these medications, notwithstanding age, gender, PA or nutritional status.

Physiological cost index and comfort walking speed in two level lower limb amputees having no vascular disease.

BACKGROUND: The Physiological Cost Index (PCI) was introduced by MacGregor to estimate the energy cost in walking of healthy people, also it has been reported for persons with lower limb amputation, walking with prosthesis. OBJECTIVE: To assess energy cost and walking speed in two level lower limb amputation: transfemoral and transtibial amputation and to determine if the age and prosthetic walking supported with walking aids have impact on energy cost and walking speed. METHODS: A prospective cross sectional study was performed in two level lower limb amputees with no vascular disease who were rehabilitated at the Department of Prosthetics and Orthotics at the University Clinical Center of Kosovo. The Physiological Cost Index (PCI) was assessed by five minutes of continuous indoor walking at Comfort Walking Speed (CWS). RESULTS: Eighty three lower limb amputees were recruited. It is shown relevant impact of level of amputation in PCI (t=6.8, p<0.001) and CWS (T=487, p<0.001). The great influence of using crutches during prosthetic walking in PCI (ANOVA F= 39.5 P < 0.001) and CWS (ANOVA F=32.01, P <0.001) has been shown by One Way ANOVA test. The correlation coefficient (R) showed a significant correlation of age with PCI and CWS in both groups of amputation. CONCLUSIONS: Walking with transfemoral prosthesis or using walking aids during prosthetic ambulation is matched with higher cost of energy and slower walking speed. Advanced age was shown with high impact on PCI and CWS in both groups of amputees.

Energy expenditure and walking speed in lower limb amputees: a cross sectional study.

BACKGROUND: Energy expenditure and walking speed are generally recommended for use as measures of status and outcome for walking. The objective of this study was to measure the physiological cost index (PCI) and comfort walking speed (CWS) at three levels of lower limb amputation: transfemoral, transtibial and Syme level, and the relationship of these physiological variables to prosthetic ambulation supported with walking aids and stump length. MATERIAL AND METHODS: This study was a prospective cross-sectional study.Eighty-nine individuals with lower limb amputation for reasons other than peripheral vascular disease (PVD) were recruited among patients at the Department of Prosthetics and Orthotics in University Clinical Center of Kosovo. PCI was assessed by five minutes of continuous indoor walking at CWS. RESULTS: Significant differences were found in PCI (F=29.87, P < 0.001) and CWS (F=19.33, P < 0.001) among the three amputation groups. Prosthetic ambulation supported with crutches showed an important impact on PCI (F=35.1, P < 0.001) and CWS (F=28.42, P < 0.001). Stump length was associated with significantly increased PCI (r=0.53, P = 0.02) and reduced CWS (r=0.58, P = 0.004) in transfemoral amputees. CONCLUSIONS: 1. A higher level of amputation is associated with less energy-efficient walking and with lower walking speed. 2. Prosthetic ambulation supported with crutches has significant impact on increasing of energy expenditure and decreasing walking speed. 3. Stump length is shown to have a major impact on PCI and CWS in transfemoral amputees.

Analysis of potential oral cleft risk factors in the Kosovo population.

The aim of this study was to analyze the association of potential risk factors such as positive family cleft history, smoking, use of drugs during pregnancy, and parental age with oral clefts in offspring within the Kosovo population. We conducted a population-based case-control study of live births in Kosovo from 1996 to 2005. Using a logistic regression model, 244 oral cleft cases were compared with 488 controls. We have excluded all syndromic clefts. Heredity increases the risk of clefts in newborns [odds ratio (OR) = 8.25, 95% confidence interval (CI) 3.12-23.52]. Clefts were also associated with smoking (OR = 1.87, 95% CI 0.75-4.08), use of drugs during pregnancy (OR = 2.25, 95% CI 0.82-5.12), increasing maternal age (OR = 1.83, 95% CI 1.42-2.49), and increasing paternal age (OR = 1.3, 95% CI 1.2- 1.4). We found heredity to be the most important factor for cleft occurrence in Kosovar newborns. Another significant potential risk factor for occurrence of clefts is the parental age. We found the use of drugs and smoking during pregnancy to be less significant.

Demographic features of patients with rheumatoid arthritis in kosovo.

INTRODUCTION: Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory illness characterized by polyarthritis of small and large joints which in the course of time may progress to disability. MATERIAL AND METHODS: In our prospective study were included 951 patients (females 730, and males 221 respectively) with an average age 51.3 year old, diagnosed with RA in accordance with ACR-EULAR/2010 criteria. The purpose of the paper is to investigate gender, age, group age by gender, level of education, residing place, nationality, religion, social condition, marital status, and vocation in our patients. Statistical processing has been carried out with program SPSS 20.0, SigmaStat 2.03, SigmaPlot 2000, MedCalc and Excel 2010. Most present group age was 40 - 49 year old with difference in distribution based on gender. RESULTS: The largest number of them had completed secondary education, most of them originated from rural areas, were farmers by vocation and housewives. The database created by this survey can serve for building the RA patients' national registry. This registry can serve for further researches and planning the management of RA as a systemic rheumatic disease that has an immense social, economic and health impact. Largest portion of RA patients were farmers and housewives respectively (38% and 32.2% respectively). Vocations such as: retail sellers, workers in administration, education, factory, maintenance, and artisan workers had similar incidence in both genders that ranged from 9.7% to 6.2%, whereas these vocations among males ranged from 11.3% to 2.7%.

Rehabilitation outcome following war-related transtibial amputation in Kosovo.

BACKGROUND: Previous literature has suggested that age, level of amputation, residual limb length, comorbidities, mental disorders, and cause of amputation can affect the ability to successfully ambulate with prosthesis. OBJECTIVES: The objective of this study was to analyze the predictors that affect the rehabilitation outcome of war-related transtibial amputees and the relationship of these factors with ambulation ability after prosthetic fitting. STUDY DESIGN: Retrospective observational study. METHODS: We reviewed the records of 69 war-related transtibial amputees. The rehabilitation outcome was analyzed according to the grade of rehabilitation summarized in three grades. Multiple logistic regression analysis was used to determine the odds of achieving the first rehabilitation grade. RESULTS: The majority of patients with transtibial amputations achieved the first grade of rehabilitation (59.4%). The factors that significantly influenced the achievement of the first grade of rehabilitation were age and absence of posttraumatic stress disorder. For every 1-year increase in patient age, the odds of achieving first grade of rehabilitation decreased by a factor of 0.9. Patients without posttraumatic stress disorder had 12.9 greater odds of achieving the first rehabilitation grade compared to patients with posttraumatic stress disorder. CONCLUSION: Achievement of the first grade of rehabilitation among war-related transtibial amputees is dependent on patient age and the absence of posttraumatic stress disorder. CLINICAL RELEVANCE: Understanding the factors that may affect the rehabilitation outcome of war-related amputees could lead to a more specific organization of the rehabilitation, especially in a country that has recently been involved in war. This is the first study to focus on determinants of prosthetic rehabilitation in these patients.

Development strategies for herbal products reducing the influence of natural variance in dry mass on tableting properties and tablet characteristics.

One "Quality by Design" approach is the focus on the variability of the properties of the active substance. This is crucially important for active substances that are obtained from natural resources such as herbal plant material and extracts. In this paper, we present various strategies for the development of herbal products especially taking into account the natural batch-to-batch variability (mainly of the dry mass) of tablets that contain a fixed amount of tincture. The following steps in the development have been evaluated for the outcome of the physico-chemical properties of the resulting tablets and intermediates: concentration of the tincture extracted from Echinacea fresh plant, loading of the concentrate onto an inert carrier, the respective wet granulation and drying step, including milling, and the adjuvant excipients for the tablet compression step. The responses that were investigated are the mean particle size of the dried and milled granulates, compaction properties and disintegration time of the tablets. Increased particle size showed a significant increase of the disintegration time and a decrease of the compaction properties. In addition, our results showed that the particle size has a great dependency on the ratio of liquid to carrier during the wet granulation process. Thus, the variability of the respective parameters tested was influenced by the performed strategies, which is how the tincture correlated to its dry mass and the relation of the amount of carrier used. In order to optimize these parameters, a strategy considering the above-mentioned points has to be chosen.

Rehabilitation of patients with war-related lower limb amputations.

AIM: To investigate the influence of factors: the amputation type and the time lag between last surgery and prosthetic rehabilitation, on the rehabilitation duration and outcome, in patients with war-related lower limb amputations. METHODS AND SUBJECTS: We reviewed the records of 101 war-related lower limb amputees who had inpatient rehabilitation at the National Ortho-Prosthetic Centre (NOPC) of Kosovo in Pristina, from July 1999 to June 2001, a retrospective observational study. Assessment of rehabilitation outcome-ambulation grade with prosthesis, is made on a 3-point scale. RESULTS: The amputation type was shown as an important predictor for the rehabilitation duration and outcome. The analysis by comparative groups has confirmed the amputation type to be of biggest importance. Earlier prosthetic rehabilitation, was shown as a factor of influence on the rehabilitation duration in all cases (r=0.22, P=0.027). This predictor was not relevant for the rehabilitation outcome. The most frequent type of prosthesis manufactured for the amputees, was the patellar tendon bearing below-knee prosthesis with suspension band (36.9%). CONCLUSION: Amputation of the limb should be performed as low as possible. If there are possibilities for prosthetic rehabilitation, any delays must be avoided, particularly in war-related lower limb amputees.

Comparison of the growth-inhibitory effect of Hypericum perforatum L. extracts, differing in the concentration of phloroglucinols and flavonoids, on leukaemia cells.

In this study we compared, simultaneously, the growth-inhibitory effect of Hypericum perforatum L. extracts, containing various amounts of hyperforin (A 3.25%; B 2.21%; C 0.21% w/w) and flavonoids (A and B 5.3%; C 10% w/w), but closely same amounts of naphthodiantrones (0.3%) on two leukaemic cell lines K562 and U937 in the WST-1 assay. The GI50 (concentration of extracts which caused 50% of cell growth inhibition) for H. perforatum extracts analysed and characterized by HPLC for their biologically active constituents was 248.3-621.3 microg mL(-1) in K562 and 378.2-911.7 microg mL(-1) in U937 cells. The corresponding values of the three main groups were 1.6-3.9 microM naphthodianthrones, 1.0-40.7 microM phloroglucinols and 30.5-68.5 microM flavonoids. The results of this study supported the hypothesis that, apart from hyperforin and flavonoids, other components of the extract could be involved in its growth-inhibitory effect that it exerts without light activation.