Clinical significance of possible HLA biomarkers in axial spondyloarthritis beyond HLA-B27 positivity.

The aim of this study is to compare four forms of axial spondyloarthritis (axSpA): non-radiographic axial spondyloarthritis (nr-axSpA), ankylosing spondylitis (AS), non-radiographic axial psoriatic arthritis (nr-axPsA) and radiographic axial psoriatic arthritis (r-axPsA). In a cross-sectional retrospective study, gender difference, human leukocyte antigen (HLA) typing, laboratory C-reactive protein (CRP) and erythrocyte sedimentation (SE) values, and radiographic and magnetic resonance scans were analyzed. One hundred and thirty-seven patients were included in the study: 45 AS, 51 nr-axSpA, 32 r-axPsA and 9 nr-axPsA; 74 women and 63 men. Most of the gender, laboratory and radiological findings confirmed the results of previously conducted studies about each group of the investigated axSpA. The key findings of our study are the newly detected findings of HLA typing beyond HLA-27 positivity: HLA-DR16 in AS, HLA-DR11 in nr-axSpA, HLA-B13, HLA-B57, HLA-Cw12 and HLA-DR7 in r-axPsA, and HLA-B18 in nr-axPsA. Our study also confirmed some of the results of previously conducted studies on predominant genes of HLA typing in axSpA: HLA-B27 in AS, HLA-B39 and HLA-Cw6 in r-axPsA, and HLA-Cw7 in nr-axPsA. Important conclusions about the nr-axPsA group cannot be drawn because of the very small number of subjects included in this group of axSpA. Our results suggest that the newly detected HLA typing findings beyond HLA-B27 positivity could be possible biomarkers of early detection of axSpA, but further studies on larger samples are needed.

Development of simple descriptions of the ICF Generic-30 Set in different languages: laying the foundation for an ICF-based clinical tool for Europe.

BACKGROUND: Functioning is considered a third indicator of health and a key outcome in rehabilitation. A universal practical tool for collecting functioning information is essential. This tool would be ideally based on the International Classification of Functioning, Disability and Health. AIM: To report the results of the development of country/language-specific versions of an ICF-based clinical tool in six European countries. DESIGN: Consensus process. SETTING: Expert conferences. POPULATION: Multi-professional group of rehabilitation professionals in six European countries. METHODS: 1) Developed an initial proposal by translating the published English-language version of the simple descriptions into the targeted language; 2) conducted a multi-stage consensus conference to finalize the descriptions; 3) employed a three-stage multi-professional expert panel translation back to English. The consensus conference model was modified for geographically large countries. RESULTS: Croatian, Flemish/Dutch, Greek, Polish, and Turkish versions were produced. CONCLUSIONS: The creation of the country/language-specific simple descriptions is a significant part of the "system-wide implementation of the ICF" initiative that will pave the way for the implementation of the ICF in national health systems. CLINICAL REHABILITATION IMPACT: The practical ICF-based clinical tool with country/language specific versions for standardized reporting of functioning will serve as a means of integrating functioning information in national health systems and additionally for monitoring the effects of rehabilitation interventions.

NUTRITIONAL RISK SCREENING IN GASTROENTEROLOGICAL PATIENTS AT THE RIJEKA UNIVERSITY HOSPITAL CENTRE.

Malnutrition is usually related to some diseases such as inflammatory bowel disease, chronic pancreatitis, chronic liver disease and malignant tumors. It is characterized by weight loss, protein deficiency, and deficit of specific nutrients. The aim was to estimate the prevalence of nutritional risk among 160 gastrointestinal patients by use of the Nutritional Risk Screening (NRS-2002) score at hospital admission and discharge. The patients stayed in the hospital between 5 and 15 days or longer. Results showed that 40% of patients at admission and 36.2% at discharge were malnourished. There were 53.1% of patients with recognized malnutrition at admission that received nutritional support, whereas at discharge 34.4% of patients at risk were not dietary supported. Malnourished patients were significantly older, had lower body mass index, longer hospital stay and higher rate of malignant diseases than properly nourished patients. Regular screening for malnutrition should be conveyed in hospitals as to provide appropriate dietary support for all patients at risk.

Determination of physiotherapy ultrasound beam quality parameters from images derived using thermochromic material.

The evaluation of the performance of nine physiotherapy ultrasound transducers used clinically was performed in the hospital environment using an acoustically absorbing thermocromic tile developed at the National Physical Laboratory (UK). The method consists of exposing an acoustic absorber tile, part of which contains a thermochromic pigment, to the ultrasonic beam, thereby forming an image of the intensity profile of the transducer. Images acquired using thermochromic materials were postprocessed in order to estimate effective radiating area (ERA) and beam nonuniformity ratio (BNR) for ultrasound transducers operating within the frequency range from 1.0 to 3.3 MHz, and nominal applied intensities in the range of 1-2W/cm2. Results of our measurements have shown that thermocromic tile can be used for quality control of ultrasound transducers in the hospital environment. Experimental results show that proposed method can be used to distinguish highly non - uniform ultrasound beams with high value of BNR. Influence of exposure duration on obtained ERA and BNR values was also analysed. Our results show that values for ERA increase with insonation time, while BNR values decrease. In order to compare our results with theory we have estimated temperature rise in thermochromic material experimentally and compare it with theoretical prediction.

Rasch validation and comparison of Slovenian, Croatian, and Italian versions of the Mini-BESTest in patients with subacute stroke.

We aimed to verify by Rasch analysis whether the Mini-BESTest, a balance measure, confirms its main psychometric properties in patients with subacute stroke undergoing rehabilitation in three different countries (Slovenia, Croatia, and Italy), and to examine the stability of item hierarchy and difficulty across the three national versions through a differential item functioning analysis. We investigated 159 patients with subacute stroke consecutively admitted to three rehabilitation facilities after screening for an intensive, tailored rehabilitation program. Balance function was tested within 36 h from admission and after ∼25 days. As no differential item functioning was found between admission and discharge data or among countries, all data were pooled. Rasch criteria for the functioning of rating scale categories were fulfilled. In terms of internal construct validity, all items except item #14 (Cognitive Get Up & Go; infit value=1.42) showed an acceptable fit to the Rasch model. The patient ability-item difficulty matching was very good. Reliability indices were high. The Principal Component Analysis of standardized residuals confirmed the unidimensionality of the test. On the basis of the item calibration, raw scores of the Mini-BESTest were transformed into linear estimates of dynamic balance and six statistically detectable levels of balance ability were defined. Good psychometric features of the Mini-BESTest were confirmed. The three different national versions showed stability in item hierarchy, indicating equivalence of their cross-cultural adaptations. Problems with item #14 in these patients warrant further study.

[EVALUATION OF PAIN AND LOCAL PHARMACOLOGICAL PAIN TREATMENT IN RHEUMATOLOGY].

The objective of this review is to present outcome measurement tools for chronic musculoskeletal pain in rheumatology patients and to provide an overview of local pharmacological pain treatment. Reliable and valid assessment of pain is fundamental for both clinical trials and effective pain management. The complex nature of pain makes objective measurement impossible. Evaluation of chronic musculoskeletal pain and its impact on physical, emotional, and social functions requires multidimensional qualitative tools and health-related quality of life instruments. The main recommendation concerning outcome measurements of pain is that they should include an evaluation of pain, fatigue, disturbed sleep, physical functioning, emotional functioning, and patient global ratings of satisfaction and quality of life. Despite the growing field of new instruments and publications related to measuring the various aspects of chronic pain, there is still little agreement on the topic among researchers and clinical experts and no unified approach has been adopted. There is still considerable need for the development of a core set of measurement tools and response criteria regarding chronic pain management. It is well known that pain in articular joints and soft tissues of the musculoskeletal system represents the most common symptom presenting to rheumatologists. Therefore, local pharmacological pain tretment has an important role in rheumatology treatment algorithms. Topical administration, as well as injection administration in joints and soft tissue trigger points, can be done under the control of musculoskeletal ultrasound. The most frequently prescribed drugs include NSARs and corticosteroids, with their effectiveness being well-proven in evidence-based practice.