A comparison of the incidence of early postoperative infections between patients using synthetic mesh and those undergoing traditional pelvic reconstructive surgical procedures.

New mesh-related complications such as erosion, etc., can result from abnormal postoperative healing due to surgical site infection. The aim of our study was to compare systemic inflammatory responses and the incidence of early infectious complications after reconstructive surgery using synthetic mesh and after traditional vaginal wall repair. In this prospective observational study 99 women with symptomatic pelvic organ prolapse were included; 55 women underwent traditional repair and 44 repair using mesh. After the procedure infectious complications were monitored. The patients who underwent reconstructive surgery using mesh material were more likely to have febrile morbidity in the postoperative period than the patients who had been treated with traditional repair (p=0.031); there was a higher incidence of combination febrile morbidity with elevated C-reactive protein (CRP) > 50 mg/l; p=0.046, and a higher incidence of CRP increase over 30 mg/l; p=0.005. Reconstructive procedures using synthetic mesh are accompanied by a higher incidence of early post-operative infectious complications.

[Comparison of short term results of TVT-O and TVT-S in the surgical treatment of stress urinary incontinence]. / Porovnání krátkodobých výsledku TVT-O a TVTS v operacní lécbe stresové inkontinence moci.

OBJECTIVE OF THE STUDY: To compare short term results of tension free vaginal tape - obturator (TVT-O) and the tension free vaginal tape Seccure in the treatment of urodynamic stress urinary incontinence (USI). DESIGN: Randomize trial. SETTINGS: Department of Gynecology and Obstetrics, First Medical Faculty, Charles University; General Teaching Hospital, Prague. MATERIAL AND METHODS: This single-centre randomized three-arm trial compared the objective and subjective efficacy and early failure rate of the TVT-O and TVT-S H and U approach by objective criteria (cough test) and subjective criteria using the International Consultation on Incontinence Questionnaire-Short form (ICIQ-UI SF). The objective efficacy rate was defined as the number of patients with a negative cough stress test. Subjective cure was defined by no stress leakage of urine after surgery based on evaluation of ICIQ - UI SH (when patients ticked "Never" / "Urine does not leak" in answer to Question 6: When does urine leak?). RESULTS: 197 women with proved SUI were randomized into three groups - TVT-O (68), TVT-S H (64) and TVT-S U (65). Each patient allocated to a treatment group received the planned surgery. There were no differences in each group in pre-operative characteristics. Three months after surgery were analyzed 65 women in TVT-O group, 61 in TVT-S H and 60 in TVT-S U. 95.4% subjects in the TVT-O group, 82% in the TVT-S H group and 76.7% in the TVT-S U group had stress test negative (p=0.006). 90.8% subjects in the TVT-O group, 82% in the TVT-S H group and 78.3% in the TVT-S U group were subjectively continent (NS). CONCLUSIONS: Our study demonstrated a significantly lower objective cure rate in the single incision TVT S group compared to the TVT-O group three months after surgery.

The new features of the ExaMe evaluation system and reliability of its fixed tests.

OBJECTIVES: The ExaMe system for the evaluation of targeted knowledge has been in development since 1998. The new features of the ExaMe system are introduced in this paper. Especially, the new three-layer architecture is described. Besides the system itself, the properties of fixed tests in the ExaMe system are studied. In special detail, the reliability of the fixed tests is discussed. The theory background is explained and some limitations of the reliability are pointed out. METHODS FOR ESTIMATION OF THE RELIABILITY: Three characteristics used for estimation of reliability of educational tests are discussed: Cronbach's alpha, standardized item alpha and split half coefficient. The relation between these characteristics and reliability and between characteristics themselves is investigated. In more detail, the properties of Cronbach's alpha, the characteristics mostly used for the estimation of reliability, are discussed. A confidence interval is introduced for the characteristics. RESULTS AND CONCLUSIONS: Since 2000, the serviceability of the ExaMe evaluation system as the supporting evaluation tool has been repeatedly shown at the courses of Ph.D. studies in biomedical informatics at Charles University in Prague. The ExaMe system also opens new possibilities for self-evaluation and distance learning, especially when connected with electronic books on the Internet. The estimation of reliability of tests contains some limitations. Keeping them in mind, we can still get some information about the quality of certain educational tests. Therefore, the estimation of reliability of the fixed tests is implemented in the ExaMe system.

Decrease of psychomotor performance in subjects with latent 'asymptomatic' toxoplasmosis.

Toxoplasma gondii is known to induce specific behavioural changes in its intermediate hosts. This is usually considered to be an evolutionary adaptation aimed to increase the probability of transmission of the parasite into its definitive host, the cat, by predation. In rodents an increase of reaction time as well as many other specific behavioural patterns have been observed. Here we report the results of our double blind study showing the significantly longer reaction times of 60 subjects with latent toxoplasmosis in comparison with those of 56 controls. Moreover, the existence of a positive correlation between length of infection and mean reaction time suggested that slow and cumulative effects of latent toxoplasmosis rather than a one-step (and possibly transient) effect of acute toxoplasmosis disease are responsible for the decrease of psychomotor performance of infected subjects. To our knowledge, this is the first study confirming the existence of such parasite-induced changes in human behaviour that could be considered in evolutionary history of the human species as adaptive from the point of view of parasite transmission.

Evaluation of knowledge using ExaMe program on the Internet.

In the paper we describe the function of the ExaMe program that serves for evaluation of students' knowledge using Internet. Evaluation is based on the knowledge base of a given course. Two types of evaluation tests are described. The fixed test is appropriate for examination of students by the teacher in computer classroom connected to Internet. By this test the evaluation is done in the limited time period and all students are tested with the same evaluation test. The automatic test is appropriate for self-evaluation and self-study by students on remote places. The student can ask the ExaMe program for the test of different difficulty levels and state the number of questions required. Finally thee first experience with the ExaMe program in practice is given.

Evaluation of medical knowledge using electronic textbooks and ExaMe program on Internet.

In the paper we describe the function of the ExaMe program that serves for evaluation of students knowledge using Internet. Evaluation is based on the knowledge base of a given course. Two types of evaluation tests are described. The fixed test is appropriate for examination of students by the teacher in computer classroom connected to Internet. By this test the evaluation is done in the limited time period and all students are tested with the same evaluation test. The automatic test is appropriate for self-evaluation and self-study by students on remote places. The student can ask the ExaMe program for the test of different difficulty levels and state the number of questions required. Finally the first experience with the ExaMe program in practice is given. The application of the ExaMe program is shown in connection with IT EDUCTRA electronic products and electronic textbook on biomedical statistics.

Heteroxenous coccidia increase the predation risk of parasitized rodents.

We have investigated the influence of heteroxenous coccidia (Apicomplexa: Eimeriorina) on the predation risk of intermediate hosts. Voles infected with Frenkelia spp. were found more frequently in buzzards' (Buteo buteo) prey than among snap-trapped rodents. To eliminate the possibility of traps selecting for uninfected rodents, a laboratory experiment was performed. Mice experimentally infected with Sarcocystis dispersa seemed to be more likely caught by the final host, the long-eared owl (Asio otus); this result was confirmed by a mathematical model. Field data confirmed the adaptive value of parasite-induced changes. The increase of predation is directed towards the specific final host only or is non-specific. In the populations studied the probability of predation of parasitized individuals by the specific predator was increased.

Decision support and data analysis tools for risk assessment in primary preventive study of atherosclerosis.

In the paper we show results of two programs applied for data analysis and decision support in primary preventive study of atherosclerosis. First program E.T. (Epidemiology Tools) can be used for analysis of data from retrospective (case-control) studies, prospective (cohort) studies and for standardization. Second program called CORE (COnstitution and REduction) supports the process of selection of features that are relevant for given decision making task. Program CORE is using information theory approach. Both these programs were applied to analysis of data about 1417 middle age men collected in the longitudinal study on atherosclerosis in urban population. Apart from these two new programs we have analyzed data also by the STATISTICA software.

Quantitative analysis of drug handling by the kidney using a physiological model of renal drug clearance.

Published data on the renal clearance of creatinine, p-aminohippuric acid (PAH) and kanamycin in relation to glomerular filtration rate (GFR) in patients with various renal diseases were analysed by a physiological model of renal clearance. Fitting of the data by the general linear equation representing the model proposed by Levy [10] resulted in insignificant intercepts with the ordinate, indicating the unsuitability of the model for the detection of tubular secretory activity. Use of this model also did not lead to significant improvement in goodness of fit compared to simple proportionality of renal clearance and GFR. On the other hand, parameter estimates of the physiological model obtained from the data by nonlinear regression analysis revealed statistically significant tubular secretion both of PAH and creatinine. The much lower tubular secretory activity estimated from the kanamycin data did not reach statistical significance. For compounds exhibiting statistically significant tubular secretion, use of the physiologically based relationship between renal clearance and GFR significantly improved the goodness of fit to the data as compared to simple proportionality of both variables. It is concluded that analysis of the relationship between renal clearance of drugs and GFR using the physiological model of renal clearance can contribute to our knowledge of drug handling by the kidney, and may facilitate drug classification according to total extraction by this organ.

Computer-based evaluation of antibiotic therapy predictions.

Planning antibiotic treatment according to the given data on patients and results of microbiological examinations are important decision-making goals for physicians. One approach using a computer in medical education to improve the teaching process in this respect is described in this paper. On the basis of data about real patients and the optimal antibiotic treatment validated by the antibiotic center of the Faculty Hospital II, we can evaluate the student's abilities to predict correct antibiotic treatment. The general program written for this task and the method of evaluating the student's predictive skills are described.

Age correlation of alpha-2-macroglobulin levels in healthy subjects.

Groups of 336 female and 310 male subjects from the age of 11 years to 94 and 86 years respectively were examined by radial immunodiffusion for their alpha-2-macroglobulin ( A 2M ) levels. Both groups were subjected to regression analysis, using a third degree polynomial, and the equations of the curves giving the best fit for the observed distribution of the values in relation to age were computed. The implications of the results for biology and medicine are discussed.