Normal Values of Tissue-Muscle Perfusion Indexes of Lower Limbs Obtained with a Scintigraphic Method.

Introduction Muscle perfusion is a physiologic process that can undergo quantitative assessment and thus define the range of normal values of perfusion indexes and perfusion reserve. The investigation of the microcirculation has a crucial role in determining the muscle perfusion. Materials and method The study included 30 examinees, 24-74 years of age, without a history of confirmed peripheral artery disease and all had normal findings on Doppler ultrasonography and pedo-brachial index of lower extremity (PBI). 99mTc-MIBI tissue muscle perfusion scintigraphy of lower limbs evaluates tissue perfusion in resting condition "rest study" and after workload "stress study", through quantitative parameters: Inter-extremity index (for both studies), left thigh/right thigh (LT/RT) left calf/right calf (LC/RC) and perfusion reserve (PR) for both thighs and calves. Results In our investigated group we assessed the normal values of quantitative parameters of perfusion indexes. Indexes ranged for LT/RT in rest study 0.91-1.05, in stress study 0.92-1.04. LC/RC in rest 0.93-1.07 and in stress study 0.93-1.09. The examinees older than 50 years had insignificantly lower perfusion reserve of these parameters compared with those younger than 50, LC (p=0.98), and RC (p=0.6). Conclusion This non-invasive scintigraphic method allows in individuals without peripheral artery disease to determine the range of normal values of muscle perfusion at rest and stress condition and to clinically implement them in evaluation of patients with peripheral artery disease for differentiating patients with normal from those with impaired lower limbs circulation.

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.

The Effect of Combined Therapy ICS/LABA and ICS/LABA plus Montelukast in Patients with Uncontrolled Severe Persistent Asthma Based on the Serum IL-13 and FEV1.

BACKGROUND: IL-13 is one of many cytokines responsible for the chronic inflammation of asthma. AIM: The aim of this study was to determine the effect of combined therapy ICS/LABA and ICS/LABA plus Montelukast in patients with uncontrolled severe persistent asthma by analyzing of serum IL-13 and FEV1 before the treatment and after 6 months of therapy. MATERIAL AND METHODS: In study we included two groups. First group with 27 patients were treated with ICS/LABA. Second group with 29 patients were treated with ICS/LABA plus Montelukast. In each of them were measured serum IL-13 levels by the ELISA method and FEV1 before and after 6 months of treatment. Results were statistically analyzed according to the Wilcoxon Pairs Test and T-test. RESULTS: The obtained results in both groups showed that the serum IL-13 before the start of therapy were much higher and after 6 months of treatment significantly reduces their value, which in the second group were more expressed. The difference in the average value of FEV1 in both groups before and after therapy was statistically significant. CONCLUSION: Treatment with ICS/LABA plus Montelukast proved superior compared to therapy of ICS/LABA in patients with uncontrolled severe persistent asthma and allows achievement of well controlled of asthma with subjective clinical improvement.

Stress Causing Factors Among Teachers in Elementary Schools and Their Relationship with Demographic and Job Characteristics.

BACKGROUND: Once high levels of work-related stress among teachers were confirmed many studies concentrated on identifying and investigating key stress factors among school teachers. Unfortunately there are very few researches made on stress causing factors among teachers in Republic of Macedonia. AIM: To determine the most frequent stress causing factors among teachers in elementary schools and to investigate their relationship with demographic and job characteristics. METHODOLOGY: We performed a descriptive-analytical model of a cross-sectional study which involved 300 teachers employed in nine elementary schools. Evaluation of examined subjects included completion of a specially designed questionnaire. RESULTS: Among six categories of factors that generate work related stress (job demands, control, relationships, role, changes and support) control and support had the highest mean scores. Within the control category the highest levels of perceived teacher's work-related stress were caused by the following factors - changes in terms and conditions without consultation and given responsibility without the authority to take decisions. 141 out of the interviewed teachers (47%) have mentioned changes in terms and conditions without consultation as very stressful, while another 50 (16.67%) have reported it as stressful. 123 out of interviewed teachers (41%) have stated given responsibility without the authority to take decisions as very stressful, with another 105 (35%) have reported it as stressful. In the category support the highest levels of perceived teacher's work-related stress were caused by stress factors - lack of funds/resources to do the job and limited or no access to training. Out of 300 interviewed teachers, 179 (59.67%) have reported lack of funds/resources to do the job as very stressful, while another 50 (16.67%) as stressful. There is no significant relationship between the stress factor limited or no access to training and demographic and job characteristics. CONCLUSION: Our findings confirm that within the control category, the highest levels of perceived teacher's work-related stress were caused by changes in terms and conditions without consultation and given responsibility without the authority to take decisions, while in the category support, the same was true for stress factors lack of funds/resources to do the job and limited or no access to training. We have also concluded that the lower-grade school teachers, female teachers, teachers for whom this is the first job and teachers with university education perceive more often the lack of authority to take decisions as a very stressful factor than the upper-grade school teachers, male teachers, teachers previously employed in another workplace, and those with high education. The lower-grade school teachers, older teachers and teachers with university education perceive more often changes in education as a very stressful factor than the upper grade school teachers, younger teachers and those with high education.

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.

Chlamydia pneumoniae and helicobacter pylori serology - importance in patients with coronary heart disease.

BACKGROUND: Chronic infections in CHD are due to one or both of the organisms Chlamydia pneumoniae and Helicobacter pylori. AIM: To examine the association between serum markers of Chlamydia pneumoniae and Helicobacter pylori infection and markers of myocardial damage. in patients with acute coronary syndrome (ACS), with chronic coronary artery disease (CAD) and in-control group. MATERIAL AND METHODS: Sera were taken from a total of 153 subjects. Subjects were divided in three groups: 64 patients with ACS; 53 patients with CAD and a group of 35 conditionally healthy individuals. Analysis of patients' sera for IgG antibodies to H. pylori and markers for myocardial damage was done on the Immulite system. The presence of specific IgG and IgA antibodies to C. pneumoniae was determined with MIF, Sero FIA (Savyon Diagnostics, Israel). Statistical analysis of data was done using the statistical program SPSS (Statistical Package for Social Sciences), version 13. RESULTS AND DISCUSSION: There was a high significant difference in troponin levels between the three groups of subjects (p=0.0000). Levels of creatine kinase isoenzyme (CK-MB) were highest in the ACS group (500.0 ng/mL). There was a statistically significant difference between CG subjects and ACS patients due to more frequent detection of antichlamydial IgA antibodies in patients with acute coronary syndrome. Positive serum immune response for Helicobacter pylori was 17 (53.1%) and 29 (80.6%), respectively. CONCLUSION: Increased IgA antibody titers for C. Pneumoniae, increased CRP values as well as classic markers of myocardial damage are risk factors for coronary events.

An epidemiologic study of some characteristics of lung cancer.

OBJECTIVE: The principal aim of this study was to determine lung cancer distribution according to some epidemiologic and demographic variables in patients diagnosed to have this disease. METHODS: The study included 1731 patients diagnosed to have lung cancer between January 1, 1990 and December 31, 1999. Data were gathered from the patients' history of disease and from the bronchoscopy Record book. Establishment of significance in analyzed differences between some statistical series was done using Pearson's chi2 test and Kolmogoroff-Smirnoff test (K-S test) for one and two samples. RESULTS: The majority of male patients (out of a total of 1523 males) were in the age range of 60 to 64 years (21.7%). The age range of 65 to 69 was predominant in the female patients (16.3%). The distribution by sex and age showed significant differences (K-S; p < 0.05). 81.4% of the male patients and 39% of the female patients were smokers. This characteristic was significantly associated with the patients' sex (chi2 = 258.12; DF = 1; p < 0.01). Bronchoscopic localization of the pathological process was not significantly correlated with the habit of cigarette smoking (Kruskal-Wallis chi2 = 1.36; DF = 2; p > 0.05). Pathohistological diagnosis and smoking were significantly correlated (chi2 = 49.37; DF = 2; p < 0.01). CONCLUSIONS: In the study period, the men fell ill seven times as frequently as the women. The pathological process was most commonly localized in the right and left upper lobes. The predominant histologic type in men was squamous cell carcinoma (SQC), and in women--adenocarcinoma (ADC). Smokers were the greatest number in the patients with SQC and small cell carcinoma. ADC was most common in nonsmokers.