TEST - ZV

Observational study of adult patients with uncontrolled asthma in pneumology outpatients clinics in Slovenia

Stanislav Kajba — Mon, 28 Oct 2019 11:40:24 +0000

Background: Almost 50 % of patients in clinical practice still have poor control of their asthma despite treatment according to the GINA (Global Initiative for Asthma) criteria. The most common causes of uncontrolled asthma are: poor inhaler technique, poor medication adherence, incorrect diagnosis, comorbidities (rhinosinusitis, GERD (Gastroesophageal Reflux Disease), obesity, depression, obstructive sleep apnea) and ongoing exposure to specific triggers (allergens, drugs and smoking).
Methods: Observational study was conducted on 323 adult patients with uncontrolled asthma in 14 outpatient pulmonology practices in Slovenia in the period from December 2017 to April 2018. Data about common causes of uncontrolled asthma and exacerbations in the last year were entered in electronic case report forms at the investigator`s site.
Results: The most common factors associated with uncontrolled asthma were comorbidities in 70 % (obesity 33 %, rhinosinusitis 28 %, GERD 22 %), specific triggers in 56 % (ongoing exposure to allergens 39 %, drugs 35 %, smoking 10 %) and poor medication adherence in 53 %. Thirty percent of patients had one or more severe exacerbations in the last year. Patient’s non-understanding of the role of asthma medications (95 % IZ: [1.4; 4.8]; p = 0.019) and the lack of self-management plan (95 % IZ: [1.3; 4.3]; p = 0.042) were the most important factors in the logistic regression model for severe exacerbations. 23 % of included patients had severe asthma according to the GINA criteria.
Conclusion: Obesity, specific triggers and poor medication adherence are the most important factors for uncontrolled asthma in the adult patient sample with uncontrolled asthma in pneumology outpatient clinics in Slovenia. Severe exacerbations are still present in these patients. Therefore, better education and providing all asthma patients with written self-management plan would be warranted in the future.

Feeding and Swallowing Disorders in Children with Clefts in Orofacial Region

Nika Jelenc, Andreja Eberlinc, Irena Hočevar Boltežar — Mon, 28 Oct 2019 00:00:00 +0000

Background: Orofacial clefts are the most common congenital craniofacial malformations. Children with orofacial clefts do not only have problems with speech, but also with feeding and swallowing. Alternative methods of feeding need to be introduced in severe cases. Until now there has not been conducted a single study regarding feeding and swallowing problems in children with orofacial clefts in Slovenia.
Methods: The aim of the study was to determine the prevalence and the type of feeding and swallowing problems in children with orofacial clefts, aged between five months and six years. An anonymous questionnaire for parents was created, containing questions about the type of the child’s orofacial cleft, child’s possible feeding, swallowing and speech problems, and special feeding gadgets. The questionnaire was initially tested in a pilot study during routine medical follow-up visits. Afterwards, it was sent to 93 parents of children with clefs, born in a period of three consecutive years. A descriptive statistics was used to present the prevalence of feeding and swallowing problems in children with orofacial clefts. The factors correlated with feeding problems were analysed.
Results: Almost three-quarters of children had problems with feeding immediately after birth; problems with feeding later decreased, but they were still present in one quarter of all cases until the completed surgical treatment. Most difficulties occurred due to nasal regurgitation, excessive air intake while bottle feeding, and prolonged feeding time. Children with cleft palate with or without cleft lip had significantly more feeding problems in comparison to children with cleft lip only. Most parents used special feeding bottles and were generally satisfied with their use. More than a half of the parents believed that they had received too little information about feeding before and immediately after the child’s birth.
Conclusion: Despite the well-organized multidisciplinary care of children with orofacial clefts in Slovenia, parents still miss the professional counselling about feeding their children. Therefore, an additional education of nurses working in maternity hospitals will be necessary in the future. Considering the high prices of special feeding gadgets for children with orofacial clefts, covering of their costs by the health insurance would be welcome.

Human breast cancer cell lines

Thu, 24 Oct 2019 09:31:57 +0000

Breast cancer is the second most common cancer worldwide and ranked first in incidence in women living either in developed or developing countries. It is ranked as the fifth common causes of cancer death. Annually, there are 1310 new cases of breast cancer in Slovenia.There are many types of breast cancer, which we can differentiate based histopathology (primary, secondary, invasive, non-invasive) and molecular i.e. intrinsic properties. Breast cancer cell lines play a significant role in breast cancer research and analysis of different subtypes. The first breast cancer cell line was established in 1958 and named BT-20 (1958, Lasfargues in Ozzello). In recent years the number of cell lines has drastically increased, however the most commonly used breast cancer cell lines are still MCF7, T47D and MDAMB231. The MCF7 and T47D cell lines are luminal A type (ER+/PR+/HER2-), whereas MDAMB231 is triple negative (ER-/PR-/HER2-). There are many inconsistencies in nomenclature and culturing of cell lines. Also, questionable is the consistency and repeatability of research in different laboratoriesorconditions,wherecelllinescoulddevelopdifferenttraits(e.g.dedifferentiation, change of phenotype, mutations). There are examples of different categorization into unique subtypes of the same cell lines in literature, based on different molecular and morphological descriptions. Due all of this, the authors believe that there is a need for a literature review of the currently available information. The authors focused on breast cancer cell lines, their nomenclature, differentiation, culturing andusefulness.

Acute traumatic spinal cord injury

Marko Jug — Mon, 28 Oct 2019 13:05:38 +0000

Traumatic spinal cord injury (tSCI) is a devastating event with huge impact on modern society. Despite recent advancements in different therapeutic strategies in preclinical models the transition of these approaches into the clinical setting remains elusive. However, recent studies showed that urgent spinal cord decompression and adequate spinal cord perfusion have a positive effect on neurologic recovery. Additional treatment strategies that try to address the complexity of tSCI are under clinical investigation and follow a superior understanding of pathophysiologic processes involved in tSCI. Therefore, in this review we present a comprehensive understanding of pathophysiologic processes involved in tSCI with emerging and evolving concepts of modern treatment.

Estimated antimicrobial susceptibility of oral beta-lactam antibiotics and their suitability for empirical treatment of uncomplicated urinary tract infections in Slovenia

Kristina Nadrah, Iztok Štrumbelj, Bojana Beović — Mon, 28 Oct 2019 13:20:25 +0000

Background: Uncomplicated urinary tract infections are among the most common infections in young healthy women. When treating such infections we use narrow-spectrum antibiotics with activity against the most common pathogens. The treatment of such infections is usually empirical, therefore in our study we estimated the susceptibility of the most common isolates to oral betalactam antibiotics to determine whether they are an acceptable alternative in case of contraindications to first-line agents.
Methods: We used a theoretical distribution of the frequency of urinary tract pathogens and antimicrobial susceptibilities from clinical urinary cultures in women to calculate an estimate of overall susceptibility of the pathogens using a mathematical model.
Results: The estimated susceptibility to ampicillin was low (50 %), but much higher for cephalosporins of 1st to 3rd generation (88 % – 90 %).
Conclusion: The mathematical model for susceptibility estimation represents an interesting tool for predicting clinical efficacy of antibiotics, based on local antibiotic susceptibility and frequency of pathogens. Our results show that among betalactam antibiotics, 1st generation cephalosporins are suitable for the treatment of uncomplicated cystitis.

Transjugular approach for zero-fluoroscopy catheter ablation of the right anterolateral accessory pathway

Tine Prolič Kalinšek, David Žižek, Matevž Jan — Mon, 28 Oct 2019 13:38:46 +0000

We present a case of successful zero-fluoroscopy catheter ablation (CA) of the right anterolateral accessory (AP) pathway via a transjugular approach in an 18-year-old patient with a congenital agenesis of inferior vena cava (IVC). Three-dimensional (3D) electroanatomic mapping (EAM) system and intracardiac echocardiography (ICE) were used to navigate the catheters in the heart.

Wrong blood in tube: an occasional lapse or a significant healthcare hazzard

Urška Dolinar, Irena Bricl — Mon, 28 Oct 2019 13:32:10 +0000

Background: Mistakes, while taking, labelling and sending blood samples, are important near miss mistakes in transfusion medicine. These mistakes can potentially lead to a wrong blood transfusion with a fatal outcome and can reflect poorly on the quality of Slovenian healthcare. Because these mistakes are preventable, it is important to identify their causes and to examine possible solutions to prevent potentially fatal complications.
Methods: One of the best quality indicators to identify misidentified samples is quantifying the wrong blood in the tube (WBIT) of all samples sent for blood type and cross-matching. We examined all cases of WBIT recorded at the Blood Transfusion Centre of Slovenia to identify the causes of mistakes and find solutions to this problem.
Results: In the last five years, the number of WBIT ranged between 0.04 and 0.2 promile. In particular, there were nine cases discovered in 2012, two in 2013, six in 2014, five in 2015, eight in 2016 and seven cases in 2017.
Conclusion: The article establishes the percent of WBIT sent to our transfusion centre over the last several years. We have also identified the causes for WBIT along with solutions for resolving this problems within our system. According to the results, we can conclude that in our Blood Transfusion Centre we have low levels of mislabelled/misidentified blood samples and therefore a low risk of mismatched transfusions with a fatal outcome.

Recommendations for fetal movement monitornig and assesment

Vid Janša, Gabrijela Bržan Šimenc, Tanja Premru Sršen — Mon, 28 Oct 2019 13:32:49 +0000

Reduced fetal movements or change in pattern of fetal movements may be associated with poor perinatal outcome. In case of reduced fetal movements inadequate response of physician -gynecologist and obstetrician is a factor that contributes to stillbirth. All pregnant women should be given information about the normal fetal movement. We recommend uniform informing about fetal movements monitoring, a uniform method of monitoring fetal movements (modified "count to ten" method) and using a uniform table/chart for recording fetal movements. In case of maternal perception of less than ten movements within 2 hours, women should contact their maternity unit. Appointment is also necessary in case of changes in the pattern of fetal movements or sudden significant prolongation of time to count 10 moves that persist over several days. The history and clinical examination help us find high risk pregnancies. At every appointment we should monitor blood pressure and test urine for proteinuria. Clinical assessment of women with reduced fetal movements should include assessment of fetal size with the aim of detecting fetuses small for gestational age. CTG is needed to exclude fetal compromise if the pregnancy is over 28 weeks of gestation. Ultrasound scan assessment should be done if there are any additional risk factors for stillbirth, in case of pathological CTG and if the perception of reduced fetal movements persists despite a normal CTG.