Structural damage of the hand in hand osteoarthritis: impact on function, pain, and satisfaction.

BACKGROUND: As hand osteoarthritis (HOA) is a highly prevalent disease, the purpose of the present study was to examine the relationship between structural damage of the hand in HOA patients and assess its impact on their hand function, pain, and satisfaction. METHODS: This prospective cross-sectional study included 60 postmenopausal women aged 60-70 years, all of whom underwent structural damage assessments using the Kellgren-Lawrence scale and the Altman Atlas, as well as completed the Michigan Hand Outcomes Questionnaire (MHQ) to assess their hand function, pain, and satisfaction. To examine the influence of HOA grade on these outcomes, patients were segregated into three groups (grade II-IV), and their average MHQ subscale scores were compared. RESULTS: The three groups differed in terms of scores achieved on all MHQ subscales: overall hand function-right hand (H =35.42, p <0.001), overall hand function-left hand (H =29.94, p <0.001), activities of daily living-right hand (H =39.88, p <0.001), activities of daily living-left hand (H =33.82, p <0.001), activities of daily living-both hands (H =30.93, p <0.001), activities of daily living-total (H =37.81, p <0.001), work performance (H =32.33, p <0.001), pain-right hand (H =27.94, p <0.001), pain-left hand (H =24.63, p <0.001), appearance-right hand (H =26.28, p <0.001), appearance-left hand (H =23.82, p <0.001), satisfaction-right hand (H =22.40, p =0.001), and satisfaction-left hand (H =26.71, p <0.001). CONCLUSION: The study findings reveal that respondents with more severe structural damage experienced more significant pain, reported greater functional and work-related limitations, and were more dissatisfied with the function and appearance of their hands. HIPPOKRATIA 2022, 26 (1):7-12.

Sex differences of human corpus callosum revealed by polar coordinate system: magnetic resonance imaging study.

BACKGROUND: Evaluation of morphological and size changes related to various pathological conditions of the corpus callosum (CC) requires the data about sex dimorphism of the CC. The purpose of our study is to define potential morphological sex differences of the CC by the use of polar coordinate system as a system of measurements. MATERIALS AND METHODS: After division of the CC into three equal segments by the use of polar coordinate system, we investigated the length of the hemisphere (A-A'), the CC size as its midsagittal section area (CCA), the size of its segments (C1, C2, C3), thickness of the thinnest part of the CC (TCC) and the angular coordinate (a angle) of dorsal point of the TCC in a sample of 30 human brains magnetic resonance images (15 males and 15 females, age 20-50 years). RESULTS: We found significantly larger CCA, C3 segment and the TCC in males. Statistically significant correlation in both, males and females, was found between parameters of the CCA and of all of its segments (C1, C2, C3), the C1 and C2, the C2 and C3 segments, as well as like as between the C2 and TCC. Sex differences were also in findings of significant correlation between the C1 and C3 segments, between CCA and TCC, and of significant negative correlation between the a angle and A-A' only in females. CONCLUSIONS: We concluded that the use of polar coordinate system appropriately reflects the anatomical and encephalometric characteristics of human CC.

Biphasic insulin aspart 30: better glycemic control than with premixed human insulin 30 in obese patients with Type 2 diabetes.

AIM: This 3-month study compared the effect on overall glycemic control of adding biphasic insulin aspart 30 (BIAsp30) and premixed human insulin 30/70 (BHI30) to metformin (met) in insulin-naïve, obese patients (30 males/20 females) with Type 2 diabetes (T2DM). MATERIAL/SUBJECTS: At baseline, patients had a mean age of 58.7 yr, glycated hemoglobin (HbA1c) 9.5%, and body mass index 34+/-2 kg/m2. Patients received either twice-daily BIAsp30 (no.=20) or twice-daily BHI30 (no.=30), and continued to receive maximal doses (2000 mg) of met for the duration of the study, but sulphonylurea oral antidiabetic drugs were discontinued. Primary efficacy endpoint was the change in HbA1c in both groups at study end. Safety endpoints included hypoglycemic episodes and weight gain. RESULTS: Both groups reduced HbA1c by end of trial: BIAsp30 + met by 2.5% [2.16-2.86%; 95% confidence interval (CI)]; BHI30 + met by 1.18% (0.98- 1.39%; 95% CI), giving a significantly better HbA1c reduction with BIAsp30 + met (1.33%; p<0.05). Post-prandial plasma glucose decreased in both groups, by 6.38 mmol/l in patients treated with BIAsp30 + met, and by 4.34 mmol/l in those treated with BHI30 + met (p<0.05). Fasting plasma glucose also decreased in both groups, with a slightly larger decrease seen in BIAsp30 patients than in BHI30 patients (7.36 mmol/l at end of study vs 7.82 mmol/l; p=ns). Subjects treated with BIAsp30 gained less weight than those receiving BHI30 (0.3+/-0.1 kg vs 1.2+/-0.4 kg). There was no significant difference in the frequency or number of hypoglycemic episodes between groups. CONCLUSIONS: Adding BIAsp30 to met in obese patients with T2DM results in better glycemic control and less weight gain than adding BHI30.

[The lipodystrophy syndrome and protease inhibitor therapy in HIV infection]. / Lipodistroficki sindrom i terapija inhibitorima proteaza kod HIV infekcije.

The accumulation of adipose tissue in the dorsocervical region is a typical finding in patients with intensive glycocorticoid function. This finding was described in numerous HIV infected patients. Combined antiretroviral therapy that included a protease inhibitor implied the suggestion that dorsocervical fat pad could be a consequence of protease inhibitor therapy. This is a case report of a patient who developed a similar changes a year after the beginning of protease inhibitor therapy.

[Successful treatment of echinococcal kidney disease with a combination of albendazole administration and percutaneous drainage]. / Uspesno lecenje ehinokokne bolesti bubrega kombinovanom primenom albendazola i perkutane drenaze.

Primary echinococcosis of the kidney, with no involvement of other organs is very rare manifestation of hydatid disease in humans. Until few years ago surgical treatment was the only therapeutical choice in patients suffering from this disease. This is a case report of a patient with large hydatid cyst of the left kidney. The patient was successfully treated with albendazole and percutaneous drainage of the cyst.

[Rhino-orbital zygomycosis]. / Rino-orbitalna zigomikoza.

Zygomycosis is rare but highly invasive fungal infection, with high mortality rate. A 67 years old diabetic man was presented with rhino-ocular form of the disease. Fungal elements invaded the skin and subutaneous facial tissue, with involvement of the nose, paranasal sinuses and orbit. The portal of entry of fungus was through paranasal sinuses, after the tooth extraction. Various clinical manifestations were presented: headache, facial swelling, tenderness over the involved sinuses, unilateral orbital cellulitis with proptosis, facial and orbital pain, black nasal discharge, decreased visual acuity, blindness. Patient was treated surgically and by liposomal amphotericin B. He underwent maxillectomy, ethmoidectomy and sphenoidectomy and orbital exenteration because of the dissemination of the disease into the orbit. The specific diagnosis of the infection was established upon the microscopic demonstration of casual agent in the debridement tissue. Early diagnosis was important in this highly fatal disease. Aggressive surgical debridement, therapy with amphotericin B and correction of underlying metabolic acidosis must be performed. The successful medical therapy in this patient suggests that lipid formulation of amphotericin B should be given, because this antifungal agent performed the best control of the infection with the minimal adverse effects.

[A severe form of falciparum malaria associated with staphylococcal endocarditis]. / Teska forma faliciparum malarije udruzene sa stafilokoknim endokarditisom.

A case is presented of a patient, aged 56 years, with severe form of imported malaria caused by Plasmodia falciparum. Hyperparasitemia of erythrocytes > 30% was registered, and during the course of the disease CNS dysfunction, severe anemia, acute renal failure, disseminated intravenous coagulation with manifest hemorrhagic syndrome, icterus, enterocolitis, pneumonia and staphylococcal endocarditis were developed Due to hyperparasitemia and numerous complications, antimalarial drugs such as quinidine (1,200 mg/day) and artemether (160 mg/day) were administered parenterally. Infected erythrocytes were exchanged with 2.5 litres of healthy erythrocytes suspension. Hemodialysis was also performed as well as nine-week antistaphylococcal therapy. During the treatment preparation of deplasmated blood, concentrated thrombocytes, fresh frozen plasma, cryoprecipitates, human albumins and immunoglobulins were applied, along with the correction of electrolytic dysbalance, administration of diuretic, cardiotonic, antiarrhythmic, anxiolytic, antipsychotic and antidepressive drugs. Two months after the admission the patient was released from the Clinic in good condition, with normal clinical-laboratory findings.

Effect of four-week metformin treatment on plasma and erythrocyte antioxidative defense enzymes in newly diagnosed obese patients with type 2 diabetes.

The principal metabolic effect of metformin-an oral antihyperglycaemic agent-is the improvement in the sensitivity of peripheral tissues and liver to insulin. This study examined the effect of metformin monotherapy on antioxidative defence system activity in erythrocytes and plasma in diabetic patients. We studied the effect of metformin treatment on the activities of Cu, Zn-superoxide dismutase (EC 1. 15. 1. 1.), catalase (EC 1. 11. 1. 6.) and glutathione peroxidase (EC 1. 11. 1. 9.) in relation to lipid peroxidation products and reduced glutathione level in plasma and erythrocytes. In this study we also examined erythrocytes' susceptibility to H2O2-induced oxidative stress during metformin therapy. Although metformin monotherapy ameliorated the imbalance between free radical-induced increase in lipid peroxidation (by reducing the MDA level in both erythrocytes and plasma) and decreased plasma and cellular antioxidant defences (by increasing the erythrocyte activities of Cu, Zn, SOD, catalase and GSH level) and decreased erythrocyte susceptibility to oxidative stress, it had negligible effect to scavenge Fe ion-induced free radical generation in a phospholipid-liposome system.

[Crimean-Congo hemorrhagic fever]. / Krimska-kongo hemoragijska grozinica.

Crimean-Congo hemorrhagic fever was for the first time recognized in Yugoslavia in 1971. In this paper were presented clinical and laboratory findings of a patient infected with Crimean-Congo hemorrhagic fever in Kosovo in 1999. The disease was manifested with fever, headache, vomiting, myalgia, abdominal pain, pharyngitis, conjuctival injection, diarrhoea, hypotension, gingival bleeding, skin hemorrhages, hematuria, hepatomegaly, splenomegaly, jaundice, thrombocytopenia, prolonged prothrombin and partial thromboplastin time, high serum fibrinogen degradation product, leukocytosis, mild anemia, elevated levels of bilirubin and serum aminotransferases. Diagnosis was set clinically, epidemiologically and supported by serological tests. Supportive management of hypotension, multi-organ failure, coagulation disturbances the patient was of the utmost in the treatment together with the isolation and prophylactic measures.

[Significance of determination of certain clinical and laboratory parameters in the evaluation of severity and outcome in sepsis]. / Znacaj odredjivanja pojedinih klinicko-laboratorijskih parametara u proceni tezine i ishoda sepse.

Sepsis and its complications are severe clinical syndrome that is caused by systemic inflammatory response of the host to infection. Despite the use of common and numerous new therapeutic protocols, mortality from this severe disease is still very high. In the study are presented 155 patients (111 males, 44 females) of average age 49.6 years with mean septic score 12.9 (2-40). Mortality in our patients was 20.6%, septic shock developed in 31.6%, ARF in 20.0%, DIC in 12.9%, and MODS in 25.8% of patients. Positive correlation existed between initial sepsis score and mortality. Older age and the presence of primary diseases (34.2% of patients) were associated with significantly higher septic score and were good prognostic factor for the poor outcome of sepsis. Between mean arterial pressure in the first 24 h after the admission and mortality existed negative correlation (p < 0.05). Positive hemocultures were found in 69.7%, and bacterial infection in 78.7% of patients. GP bacteremia was found in 55.6% of patients and GN in 45.4% of all positive hemocultures. Confirmed bacteremia and bacteremia caused by GPB were associated with the higher mortality rate compared to the patients with negative hemocultures and GN bacteremia (p < 0.05). Concentrations of fibrinogen and urea in the blood at the admission in the patients with sepsis were very good prognostic factors of the disease outcome, and leukopenia, leukocytosis and neutropenia were associated with the increased mortality. Negative correlation existed between fibrinogen concentration and mortality (p < 0.001), while positive correlation (p < 0.001) existed between urea concentration and mortality. In the absence of more efficacious therapeutic protocols, fast recognition of the sepsis, evaluation of its severity, knowledge of the risk factors for its poor outcome and aggressive use of antibiotic and existing supportive therapy can significantly decrease high mortality of this too severe clinical syndrome.

[Personal experience in the diagnosis and treatment of hepatic echinococcosis]. / Nasa iskustva u dijagnostici i lecenju ehinokokoze jetre.

Human echinococcosis is endemic disease that occurs in some regions of Yugoslavia. It is caused by tapeworm Echinococcus granulosus, whose larva can develop cysts in liver and other organs. In the study were presented 119 patients with hepatic echinococcosis, 57 (47.9%) females of average age 41.4 years (9-80) and 62 (52.1%) males of average age 35.5 years (6.72). Primary echinococcosis was present in 75 (63%), and recurrent in 44 (37%) patients. Right lobe of liver was affected in 83 (69.7%), left in 17 (14.3%) and both lobes in 19 (16%) of cases. The complications of hepatic echinococcosis such as cyst infection, cholestasis, cyst rupture in biliary tract and liver fibrosis were observed in 20 (16.8%) patients. Indirect immunofluorescence antibody test was positive in 91 out of 119 (68.1%) patients, and hemagglutination inhibition test was positive in 56 out of 77 (72.7%) patients. Surgically were treated 57 (47.9%) patients, and 41 of them received antihelminithic drugs pre and/or postoperatively. Disease recurrence was observed in 4 (7%) patients. Percutaneous puncture and drainage of echinococcus cyst with simultaneous albendazole administration was performed in 12 (10%) patients. In three of them liver abscess was developed during drainage, and for that reason, two patients had to be surgically treated. Ten (83.3%) patients were completely cured. Medicamentous therapy as the only treatment was used in 31 (26.1%) patients, 9 patients received mebendazole, 19 received albendazole and 3 patients received praziquantel. The success was achieved in 10 (32.3%) patients. Out of the total number, 19 (16%) patients were not treated at all. Surgical removal of the cyst takes a leading place in the treatment of hepatic echinococcosis. However, in well-selected cases and in the patients with high surgical risk, antihelminithic therapy and percutaneous drainage of echinococcus cyst are of more significance.

[Tonsillo-pharyngeal form of tularemia]. / Tonzilofaringealni oblik tularemije.

Clinical, laboratory and serologic features of tonsillopharyngeal form of tularemia in 14 patients were analyzed in the study. The disease was ignored under the diagnosis of typical tonsillopharyngitis followed by cervical lymphadenopathy. Routine laboratory analyses results were non-specific and didn't reveal the disease etiology, while microagglutination test (MAT) of F. tularensis in the second week of disease was positive in 86% of patients. Skin tularin test was positive in all the tested patients during the first week of the disease. The best results in the treatment were achieved by administration of streptomycin and doxycycline. Well timed therapy prevented the lymph nodes colliquation, disease recurrence and infection generalization. The authors point out the significance of this clinical form of tularemia in the differential diagnosis of tonsillopharyngitis and cervical lymphodenopathy.

[Clinico-laboratory characteristics and treatment of patients with trichinosis]. / Klinicko-laboratorijske karakteristike i lecenje bolesnika sa trihinelozom.

The severity of clinical features of trichinosis and cardiac involvement incidence were examined in the study. The values of eosinophiles, serum enzymes and serologic response to T. spiralis were determined in relation to the disease severity. Twenty-nine patients, of mean age from 24 to 29 years treated in the Clinic in the period from January to April 1995 were presented-7 with severe form of trichinosis, 10 with moderately severe and 12 with light. The fever was noticed in 93.1% of patients, gastrointestinal disorders in 65.5%, myalgias in 96.6%, facial edema in 79.3%, cardiac disorders in 31% and rash in 20.7%. Positive IIF test result was found in 100% of patients with severe clinical features, and only in 58.3% of patients with light clinical features. The patients were treated with mebendazole in the dose of 25 mg/kg BM a day during 14 days. It was concluded that severe trichinosis forms were frequently followed by myocardial damage, that severe forms responded faster and better serologically to trichinella and those patients should be treated with high mebendazole doses.

[Viral hepatitis C. Personal experience with diagnostic, monitoring and epidemiologic studies]. / Virusni hepatitis C. Nasa iskustva u dijagnostici, pracenju i epidemioloskim ispitivanjima.

In the period from 1991 to 1993, 18 patients with the acute viral hepatitis type C were treated and followed up--13 men and 5 women, the average age of 42 years. The group of 6 patients (4 men and two women) with the "old" proven liver cirrhosis, whose etiology was unknown for 20 years, was analyzed. The investigations showed that the acute viral hepatitis type C usually began with the mild subjective disorders. The half of the patients did not have either jaundice or hepatomegaly, only half of them recover, and the first cases of cirrhosis could have been expected almost as early as a year after the beginning of illness. The developed liver cirrhoses remained compensated for years. About 58% of patients got infected parenterally, and the rest of them could have gotten infected in other manner. ELISA test showed great reliability in proving the antibodies against the viral hepatitis type C in the confirming the diagnosis of illness.

[Clinical manifestations of infectious erythema in adults]. / Klinicko ispoljavanje infektivnog eritema kod odraslih.

The infectious erythema is usually childhood disease associated with rash and caused by parvovirus B19. At the beginning of 1993., at the Clinic for infectious and tropical diseases of the Military Medical Academy 36 patients were treated for this disease, the average age 21 years. The prodromal phase of illness lasted approximately 2.9 days, the elevated temperature 5.2 days, and 17 patients had temperature above 39 degrees C. The rash was usually maculo-papullous and lasted about 6 days. Four patients had the recurrence of rash. The polyarthralgia appeared for short in six patients and in one patient lasted longer than 4 months. The mild anemia during infectious erythema was observed in 18 patients. IgM antiparvo B19 antibodies were proven in serum in 91.7%, and IgG antibodies in 58.3% of patients.