The Influence of Wound Closure Techniques after Surgical Decompression in Patients with Carpal Tunnel Syndrome on Sleep Disturbance and Life Quality: A Prospective Comparison of Surgical Techniques

BACKGROUND

The compression of the median nerve within the carpal tunnel is the cause of carpal tunnel syndrome (CTS). Surgical decompression is successful in improving sleep and quality of life, but the effect of tissue adhesives as a material for wound closure has not been investigated. The objective of the study was to evaluate sleep disorders and health-related life quality by comparing two methods for wound closure after carpal surgery in participants who were randomized to receive tissue adhesives or transcutaneous sutures.

METHODS

The subjects, aged 61.56 ± 12.03 years, were randomized to receive either tissue adhesives (n = 50) or suture-based wound closure (n = 50) using the Glubran Tiss 2® skin adhesive after subcutaneous running sutures. The outcomes were assessed during the 12-month postoperative follow-up. The Pittsburgh Sleep Quality Index (PQSI) and Insomnia Severity Scale (ISI) were used for the sleep disturbance assessment, and for the health-related quality of life assessment, the total SF-36 (36-Item Short Form Survey) was used.

RESULTS

The PQSI, ISI, and SF-36 were not statistically different between groups during the follow-up, except in the ISI score two weeks after surgery (9.40 ± 1.18 in the tissue adhesive group vs. 9.96 ± 1.09 in the suture-based group, p = 0.008). The PQSI, ISI, and SF-36 scores for all the subjects and groups were persistently improved at all the follow-up intervals after surgery. The total SF-36 score increased 12 months after surgery (49.84 ± 5.85 vs. 82.46 ± 5.68, p < 0.001).

CONCLUSIONS

Cyanoacrylate-based adhesion material can be used for wound closure after open CTS decompression as a standard transcutaneous suture, and both techniques equally lead to improved sleep and life quality. The possible advantages of tissue adhesives include a faster reduction in the ISI.

Should I Supplement Vitamin D in a Patient With Sepsis?

Sepsis is a potentially fatal organ failure produced by the host's immune response to infection. It is critical to identify risk factors associated with a poor prognosis in septic patients in order to develop new therapy options. Vitamin D deficiency (25-hydroxyvitamin cholecalciferol < 20 ng/mL) is common in critical and septic patients. Serum vitamin D concentrations are associated with an increased incidence of mortality in critically ill adult patients. In critically ill patients, vitamin D supplementation (a very high vitamin D 3 or cholecalciferol loading dosage as a single bolus dose ranging from 400,000 to 540,000 IU) is feasible and safe. Some of the trials and their post-hoc analyses evaluating vitamin D supplementation in severely sick individuals, including septic patients, suggested possible benefits in mortality (reduced 28-day mortality in the range of 8.1%-17.5%), and other outcomes (reduction in hospital length in the range from 9 to 18 days, and decrease in duration of mechanical ventilation in the range from 5 to 10 days). Despite the fact that many studies support the provision of vitamin D to septic patients, there are still many studies that contradict this opinion, and there is still debate about the recommendation to use vitamin D in sepsis. A pragmatic clinical approach in severe sepsis could be supplementation of vitamin D if serum levels are diminished (< 30 ng/mL). It appears that a single ultrahigh dose of vitamin D 3 (cholecalciferol) could be administered to the septic patient via an enteral tube, followed by daily or monthly maintenance doses. Parenteral administration might be reserved for a subgroup of septic patients with gastrointestinal, hepatic, or renal dysfunction. Future clinical trials designed exclusively for septic patients are required to assess the potential advantages of vitamin D. Possible impacts of selective activators of vitamin D receptors, such as paricalcitol, should be elucidated in sepsis. This emphasizes the requirement for more study and confirmation of any potential beneficial effects of vitamin D in sepsis.

The Influence of the Tissue Adhesive Material as a Surgical Wound-Closure Technique Following Carpal Tunnel Decompression on Neurological and Functional Outcomes: A Single-Center Randomized Controlled Trial

Background Carpal tunnel syndrome (CTS) is caused by compression of the median nerve in the carpal tunnel. The effect of tissue adhesives as a material for wound closure following CTS decompression has been insufficiently investigated. This study aimed to evaluate outcomes by comparing two modalities of wound closure following carpal surgery in patients randomly assigned to either tissue adhesives or sutures. Methodology This randomized, prospective study was conducted in April 2022 at the University Hospital of Split in Croatia. Patients aged 61.56 ± 12.03 years were randomized to either tissue adhesive Glubran Tiss 2®-based (n = 50) or suture-based (n = 50) wound-closure techniques. The following outcomes were assessed before surgery and six months postoperatively: hand strength, electroneurographic characteristics of the median nerve, and the Boston Carpal Tunnel Questionnaire. Results Significant differences between glue-based and suture-based wound-closure techniques were found in the six-month postoperative hand grip strength (25.06 ± 6.69 vs. 21.41 ± 5.62 kg; p = 0.002), postoperative sensory amplitude (10.08 ± 5.50 vs. 7.54 ± 5.41 mV; p = 0.012), and postoperative sensory velocity (42.22 ± 11.04 vs. 35.23 ± 16.40 m/s; p = 0.008). In the glue-based group, significantly more patients achieved a postoperative sensory velocity greater than 45 m/s (47.9% vs. 22.0%; p= 0.006), postoperative distal sensory latency less than 3.5 ms (89.6% vs. 84.0%; p = 0.304), and postoperative motor latency of less than 4.2 ms (60.42% vs. 38.00%; p = 0.022). Conclusions This trial demonstrated that cyanoacrylate-based adhesion material for wound closure after open CTS decompression compared with sutures showed a significant six-month postoperative increment in hand grip strength and median nerve sensory conduction.

Association between COVID-19 Infection or Vaccination Outcomes and Methylenetetrahydrofolate Reductase Gene Polymorphism: A Systematic Review of the Literature

BACKGROUND

Thrombosis is a detrimental sequala of COVID-19 infection; thus, prophylactic anti-coagulant therapy has been deemed mandatory in treatment unless serious contraindications are present. Susceptibility to thromboembolic events in COVID-19, or following COVID-19 vaccination, is likely attributable to an interplay of factors, including a patient's baseline clinical status and comorbidities, alongside genetic risk factors. In Europe, 8-20% of the population are homozygous for the MTHFR (methylene tetrahydrofolate reductase) variant, which compromises folate metabolism and elevates homocysteine levels. While heightened homocysteine levels are considered a risk factor for thromboembolic events, the precise clinical significance remains a contentious issue. However, recent research suggests elevated homocysteine levels may predict the course and severity of COVID-19 infection. Given the lack of reliable biomarkers predictive of COVID-19 thrombotic risk existing in practice, and the accessibility of MTHFR screening, we established two main outcomes for this study: (1) to determine the association between hereditary MTHFR mutations and COVID-19 severity and thromboembolic events and (2) to determine the link between MTHFR variants and adverse thrombotic events following COVID-19 vaccination.

METHODS

The review was conducted in accordance with PRISMA guidelines. Medline, Scopus, and Web of Science databases were searched from pandemic inception (11 March 2020) to 30 October 2023. Eligibility criteria were applied, and data extraction performed.

RESULTS

From 63 citations identified, a total of 14 articles met the full inclusion criteria (8 of which were cross-sectional or observational studies, and 6 were case studies or reports). Among the eight observational and cross-sectional studies evaluating the relationship between MTHFR variants (C667T; A1298C) and thromboembolic events in COVID-19 infection, four studies established a connection (n = 2200), while the remaining four studies failed to demonstrate any significant association (n = 38).

CONCLUSIONS

This systematic review demonstrated a possible association between the MTHFR gene variants and COVID-19 severity, thromboembolic events, and adverse events following vaccination. However, the paucity of robust data precluded any firm conclusions being drawn. Further prospective trials are required to determine the connection between the MTHFR gene variant and COVID-19 infection and vaccination outcomes.

Atypical HUS with multiple complement system mutations triggered by synthetic psychoactive drug abuse: a case report

Atypical hemolytic uremic syndrome is a rare disorder with an estimated annual incidence of about two cases per million in the adult population. It is caused by the overactivation of the alternative pathway of the complement system. The disease can be triggered by many factors, including pregnancy, viral diseases, and sepsis; approximately 30% of atypical hemolytic uremic syndrome cases are caused by unknown processes. We present a case of a patient with C3-complement system mutations and aHUS triggered by the use of a new synthetic psychoactive drug.

Clinical and demographic features with outcome predictors of adult patients with acute intoxication admitted to a medical intensive care unit in the Mediterranean part of Croatia

Background

The objective of the study was to assess the demographics, clinical parameters, and outcome of acute intoxications among adult patients admitted to a medical intensive care unit in southern Croatia.

Materials and Methods

An observational retrospective study was conducted over a 1-year period. The subjects were patients admitted to the intensive care unit for acute poisoning.

Results

In all, 81 subjects (32.1% females) aged 43.16 ± 14.77 years were admitted to the intensive care unit because of poisoning (14.97% of the total annual intensive care unit admissions). Psychiatric disorders were previously established in 76.5% participants, and 69.1% of all acute intoxications were classified as suicidal. Non-suicidal subjects differed from suicidal subjects in age (37.36 ± 9.71 vs. 45.75 ± 15.93 years; P = 0.009), in pCO2 (6.38 ± 1.78 vs. 5.50 ± 1.26 kPa; P = 0.020), in length-of-stay in intensive care unit (median 1.00, interquartile range 1.00 vs. median 2.00, interquartile range 2.00 days; P = 0.022), and in length-of-stay in hospital (median 2.00, interquartile range 2.00 vs. median 10.50, interquartile range 15.25 days; P < 0.001). Three (3.7%) patients died. Pharmaceutical psychoactive drug intoxications were the most common poisoning cases; of these, diazepam was the most frequent (16.8%), followed by ethanol (9.0%) and alprazolam (7.8%). Benzodiazepines/hypnotics were the most common group (28.7%), followed by antipsychotics (13.2%). Intoxications with more than 1 poison accounted for the largest number of cases (67.9%). The number of toxins was significantly correlated with length-of-stay in the hospital (rho = -0.265; P = 0.008), systolic blood pressure (rho = -0.318; P = 0.002), and diastolic blood pressure (rho = -0.262; P = 0.009). The electrocardiogram was considered abnormal in 50.62% of the cases.

Conclusion

Acute intoxicants were most commonly caused by psychiatric pharmaceutical drugs. Multidrug exposure was a typical pattern of acute intoxication.

A Comparison of Tissue Adhesive Material and Suture as Wound-Closure Techniques following Carpal Tunnel Decompression: A Single-Center Randomized Control Trial

BACKGROUND

Carpal tunnel syndrome (CTS) is the most common peripheral neuropathy caused by compression of the median nerve in the carpal tunnel. The presented study aimed to evaluate clinical outcomes by comparing two techniques of wound closure following carpal tunnel surgery in subjects randomized to the application of tissue adhesive or sutures.

METHODS

From April 2022 to December 2022, a single-center randomized prospective trial was conducted at the University Hospital of Split in Croatia. The study participants consisted of 100 patients (70 females) aged 61.56 ± 12.03 years, randomly assigned to suture-based wound closure (n = 50) or tissue adhesive-based wound closure (n = 50) with two-component skin adhesive Glubran Tiss 2^®. The outcomes were assessed postoperatively during the follow-up period at intervals of 2, 6, and 12 weeks. A scar assessment was performed using the POSAS (Patient and Observer Scar Assessment Scale) and cosmetic VAS (Visual Analog Scale). The VNRS (Verbal Number Rating Scale) was used to assess pain.

RESULTS

There were significant differences between glue-based wound closure and suture-based wound closure at 2-week and 6-week intervals after the surgery on the POSAS and cosmetic-VAS scales (better aesthetic effect with glue-based wound closure technique where noticed), with less postoperative pain at the same intervals. With the 12-week interval, differences in outcomes were insignificant.

CONCLUSIONS

This trial demonstrated that cyanoacrylate-based adhesion mixtures might be possibly superior in the short term in terms of cosmetic appearance and discomfort compared to conventional skin suturing techniques for the closing of surgical wounds following open CTS decompression, but there was no difference between both procedures in the long term.

Emergency Air Transport of Patients with Acute Chest Pain in the Adriatic Islands of Croatia: A Four-Year Analysis

BACKGROUND

An efficient first-aid system usually supports ground services with a helicopter emergency medical service (HEMS). An HEMS is important for patients with acute chest pain on remote islands. The current study sought to identify the characteristics of HEMS in acute chest pain cases on the Croatian Adriatic islands over a four-year period.

METHODS

We conducted a four-year observational study to investigate HEMS from Adriatic islands. The study population consisted of all patients with acute coronary syndrome or pulmonary embolisms who were urgently transferred by HEMS to the University Hospital in Split 1 June 2018-1 June 2022.

RESULTS

During the observation period, 222 adult patients (67 females, or 30.2%) were urgently transferred. The mean age was 71.81 ± 13.42 years. The most common diagnosis was ST-elevated myocardial infarction (113, 50.9%). Most of the HEMS cases were from Hvar (91, 41.0%). The mean call-to-flight time was 19.10 ± 10.94 min, and the total time from call to hospital was 68.50 ± 22.29 min. The total time from call to hospital was significantly correlated with call-to-flight time (r = 0.761, P < 0.001). Of the 222 participants, 5 (2.25%) were transported for more than 120 min, and 35 (15.8%) were transported for more than 90 min.

CONCLUSION

This study provided a detailed insight into HEMS in the area of the Croatian Adriatic islands. The average time from the call to the helicopter taking off was 19.10 min. An increase in dispatching time has a significant impact on the prolongation of the total time for the hospital admission. Shortening the response time is critical to reducing hospital arrival time.

Serum Catestatin Level as a Stratification Assessment Tool in Non-Critical COVID-19 Patients

Introduction: Catestatin (CST) is a peptide with immunomodulatory, anti-inflammatory, and anti-microbial activities. There are only a few studies that have investigated plasma CST levels in COVID-19 patients (mostly in ICU patients). In our work, the aim was to demonstrate serum CST levels and their correlation with clinical outcomes in a group of severe COVID-19 patients admitted to the non-ICU department. Methods: The subjects were 32 patients (25 females, 7 males) admitted to the non-ICU unit for COVID-19 patients. Results: CST levels in our cohort were higher (8.91 ± 7.00) than previously reported CST levels in control subjects. We found a significant positive correlation between serum CST levels and C-reactive protein (r = 0.423, p = 0.008), D-dimers (r = 0.395, p = 0.013), hsTNT (high-sensitivity troponin T) (r = 0.603, p < 0.001), proBNP (N-terminal pro-brain natriuretic peptide) (r = 0.569, p < 0.001), and hospitalization days (r = 0.388, p = 0.014). There was a difference between groups of participants with SOFA <3 (n = 18) and SOFA >=3 (n = 14) in catestatin serum levels (7.25 ± 3.66 vs. 11.05 ± 9.52 ng/mL), but the difference was statistically insignificant (p = 0.065). Conclusion: We considered plasma CST level at hospital admission as a possible tool for early risk assessment in non-critical COVID-19 patients. This study is an attempt to clarify the complex pathophysiological mechanisms present in the development of severe forms of SARS-CoV2 infection.

Effects of covid-19 on cognitive functioning

We were interested in whether the covid-19 pandemic affects cognitive functioning in addition to emotional responses. To this end, we applied four questions related to everyday activities that inevitably involve fluid cognitive abilities, e.g., problems concentrating, remembering, and switching between different mental activities. Respondents self-assessed their cognitive abilities during the covid-19 pandemic compared to the period before the pandemic on a 7-point scale (1 - much easier than before, .. 4 - the same as earlier, .. and 7 - much harder than before). The results showed that, on average, respondents estimated slightly more cognitive problems during the covid-19 pandemic period than before the pandemic (4.21, where 4 means that the respondent does not notice changes). Nearly three-quarters of the respondents(72%) did not report changes in cognitive abilities. In comparison, 7% reported improved cognitive abilities, and as many as 21% of respondents self-assessed that their cognitive abilities deteriorated during the covid-19 pandemic. There were no differences between men and women in terms of self-assessment of cognitive abilities. More significant problems with their cognitive abilities during covid-19 pandemic reported younger as compared to older respondents, students as compared to other employment groups, less educated as compared to more educated, those living alone as compared to those living in the family, those whose financial situation had deteriorated, and, as expected, those with chronic illnesses, and those who also reported depressive and mental health symptoms. The results of the survey indicate the interdependence between different demographic factors, mood and mental health problems, and self-assessed changes in cognition. Therefore, interventions to mitigate the covid-19 pandemic should include peoples' emotional response and their cognitive problems.

Early initiation of enteral nutrition improves outcomes in burn disease

BACKGROUND

Burned patients have increased level of mortality, possibly due to late introduction of enteral feeding. The aim of this study was to compare the benefits and safety of very early enteral nutrition introduction compared to the normal diet among burns patients in an intensive care unit.

PARTICIPANTS AND METHODS

Participants consisted of 101 patients, aged 20-76 years (mean age 48 years), 49 men and 52 women, with burns that covered more than 20% of the body. The intervention group consisted of 52 subjects fed via introduced nasojejunal probe that started within four hours after admission to the hospital. The control group consisted of fifty patients fed in standard manner per os (three standard hospital meals) immediately after the first wound dressing.

RESULTS

The average decline BMI in control group was 2.27±0.56 kg/m2, while the average reduction in BMI in the intervention group was 1.77±0.38 kg/m2 (p<0.001). The largest drop of albumin concentration in the control group was 28.5%, whereas in the intervention group was 23.8%. (p<0.001). The greatest decrease of transferrin concentration in the control group was 31.1%, while the average reduction in the intervention group was 18.3%. (p<0.001). C-reactive protein values were statistically higher in control group (p<0.001). Intervention group had lower rate of complications and infection rates.

CONCLUSION

Enteral nutrition in burned patients should begin within few hours of burn onset. Such approach leads to better outcomes, reduces complications, and improves nutritional profile.

Spleen rupture associated with septic emboli and endocarditis in a hemodialysis patient

We present an uremic patient on chronic hemodialysis with splenic septic emboli associated with active infective endocarditis and anaerobic bacteremia complicated by ruptured spleen. A 62-year-old female patient was admitted because of fever and pain in the left upper abdomen and swelling and hematoma around the left brachiocephalic arteriovenous fistula. Transthoracic echocardiography revealed mobile hyperechoic mass (vegetation) on the anterior mitral valve. Abdominal ultrasound scan showed multiple hypoechoic lesions of the enlarged spleen, described as possible necroses or abscesses, and computed tomography showed low-density inhomogeneous lesions in the enlarged spleen with large perisplenic hematoma, with spleen rupture. Blood culture revealed anaerobic Gram-negative bacilli ( Bacteroides spp.), ampicillin resistant. This is the first report of splenic rupture associated with anaerobic bacteremia and splenic septic emboli in a uremic patient on chronic hemodialysis. Splenic septic emboli with abscess/infarction in hemodialysis patients are a rare disorder but could be a consequence of dialysis access site infection and might predispose to splenic rupture. Ultrasound scan of abdomen is fast, inexpensive and easy to perform. As mortality is high, early surgical intervention on vascular access is mandatory.

The influence of selective vitamin D receptor activator paricalcitol on cardiovascular system and cardiorenal protection

The ubiquitous distribution of vitamin D receptors in the human body is responsible for the pleiotropic effects of vitamin D-receptor activation. We discuss the possible beneficial effects of a selective activator of vitamin D receptor, paricalcitol, on the cardiovascular system in chronic heart failure patients and chronic kidney patients, in light of new trials. Paricalcitol should provide additional clinical benefits over the standard treatment for chronic kidney and heart failure, especially in cases of cardiorenal syndrome.

The Influence of Decreased Low-Molecular-Weight Heparin Nadroparin Dose on Diastolic Blood Pressure in Patients on Hemodialysis

The aim of present study was to assess the impact of decreasing single bolus dose of nadroparin on blood pressure in patients on hemodialysis (HD). Forty HD patients were included in this study. The bolus dose of nadroparin was decreased twice by 25%; this lower dose was maintained for last 4 weeks, during which the dose was adjusted. There were no significant differences between the first and the last predialysis: systolic blood pressure ([pre-SBP]; 131.05 ± 25.58 vs 125.92 ± 25.49 mm Hg; P = .133), diastolic blood pressure ([pre-DBP]; 73.82 ± 11.82 vs 72.89 ± 9.13 mm Hg; P = .653), and pulse pressure ([pre-PP]; 57.24 ± 20.39 vs 53.03 ± 21.20 mm Hg; P = .121). We found correlation between delta nadroparin and pre-DBP in the last HD (rho = 0.310; P = .031) but not between delta nadroparin and pre-SBP and pre-PP values. This is the first report of influence of nadroparin dose lowering on pre-DBP in HD patients.

Gastric carcinoma presenting as pericardial tamponade during pregnancy

We describe a rare presentation of acute cardiac tamponade in a patient with gastric cancer in pregnancy. A 32-year-old woman developed dyspnea and tachycardia during the 28(th) week of her pregnancy. These symptoms were interpreted initially by the patient as a condition related to the normal state of pregnancy; however, her symptoms persisted over the next two weeks, and she was hospitalized for evaluation. The diagnostic work-up revealed metastatic gastric carcinoma to the pericardium associated with pericardial tamponade. Large pericardial and pleural effusions were the primary causes of her shortness of breath. Gastric cancer is very rare in pregnancy, and therefore may be not be suspected by physicians. Diagnosis may be further delayed because of overlapping symptoms occurring during normal pregnancy (nausea, vomiting, and shortness of breath). All these factors may contribute to a very high mortality of this malignancy during pregnancy.

A long-lasting topical deltamethrin treatment to protect dogs against visceral leishmaniasis

To develop long-lasting, topical pour-on insecticides for dogs to control zoonotic visceral leishmaniasis, two deltamethrin-based formulations (emulsifiable concentrate [EC] and suspension concentrate [SC]) were tested for their efficacy against the phlebotomine sandfly Lutzomyia longipalpis Lutz & Neiva (Diptera: Psychodidae), vector of Leishmania infantum Nicolle (Kinetoplastida: Trypanosomatidae). The entomological outcomes tested were anti-feeding effect (proportion of female sandflies unfed), lethal effect (24-h female sandfly mortality) and these two effects combined, and the insecticide persistence time at 50% (residual activity, RA50) and 80% (RA80) efficacy. On initial application, the proportions of female flies that demonstrated anti-feeding activity or were killed were similar for both formulations, at 0.93 (95% confidence interval [CI] 0.856-0.977) vs. 0.81 (95% CI 0.763-0.858) (anti-feeding) and 0.86 (95% CI 0.787-0.920) vs. 0.76 (95% CI 0.698-0.817) (24-h mortality) for EC and SC, respectively. The RA(50) rates for anti-feeding and mortality caused by the EC formulation were 4.7 months (95% CI 4.18-5.84) and 2.5 months (95% CI 2.25-2.90), respectively, compared with 1.1 months (95% CI 0.96-1.15) and 0.6 months (95% CI 0.50-0.61), respectively, for the SC formulation. The RA(50) for the combined anti-feeding and mortality effects of EC was 5.2 months (95% CI 4.73-5.96), compared with only 0.9 months (95% CI 0.85-1.00) for the SC formulation. The four- to six-fold superior residual activity of the EC formulation was attributed to the addition of a solvent-soluble resin in the formulation which improved fur adhesion and acted as a reservoir for the slow release of the active ingredient. These results identify the potential of such a low-cost formulation to reduce the inter-intervention interval to 5-6 months, similar to that recommended for deltamethrin-impregnated dog collars or for re-impregnation of conventional bednets, both of which are currently used to combat Leishmania transmission. Finally, a novel bioassay was developed in which sandflies were exposed to fur from treated dogs, revealing no detectable tolerance (24-h mortality) in wild-caught sandflies to the insecticide formulations up to 8 months after the initiation of communitywide application of the insecticides to dogs.

Ultrafiltration Volume Is Associated with Changes in Blood Pressure in Chronically Hemodialyzed Patients

INTRODUCTION

Volume overload is a main factor in development of hypertension in hemodialysis patients. In order to demonstrate impact of ultrafiltration volume on blood pressure during 15-months period in a group of patients undergoing chronic hemodialysis therapy, we conducted this study. We hypothesized that ultrafiltration volume different affects the pre/postdialysis systolic pressure, diastolic pressure, mean arterial pressure (MAP), and pulse pressure (PP) values.

SUBJECTS AND METHODS

Study subjects were 23 anuric chronically hemodialyzed patients. The overall study time was 15 months, and 136 single hemodialysis treatments were analyzed.

RESULTS

Ultrafiltration was negatively correlated with predialysis systolic blood pressure (r = -0.169, p = 0.025), postdialysis systolic blood pressure (r = -0.292, p < 0.001), postdialysis MAP (r = -0.186, p = 0.015), predialysis PP (r = -0.290, p < 0.001), and postdialysis PP (r = -0.370, p < 0.001). Ultrafiltration/dry body mass (UF/W) ratio was negatively correlated with predialysis PP (r = -0.222, p = 0.005), postdialysis PP (r = -0.340, p < 0.001), and postdialysis systolic blood pressure (r = -0.243, p = 0.002). We found significant difference in postdialysis PP between dialyses with UF/W ratio < or = 0.05 an dialyses with UF/W ratio > 0.05 (63.49 +/- 20.76 vs. 56.27 +/- 16.33 mmHg, p = 0.033).

CONCLUSION

The ultrafiltration volume strongly affects postdialysis PP values. Evaluation of elevated blood pressure treatment in patients undergoing chronic hemodialysis therapy must be considered in respect of postdialysis PP values, not just depending on pre/postdialysis systolic and diastolic pressur or MAP values.

Influence of haemodialysis on early markers of atherosclerosis

INTRODUCTION

End-stage renal disease (ESRD) patients treated by haemodialysis (HD) have impaired endothelium-dependent vasodilatation and increased intima-media thickness (IMT) of the carotid artery The aim of the study was to analyse the relationships between parameters of chronic HD treatment and non-invasive assessments of preclinical atherosclerosis (endothelial dysfunction and carotid IMT) in ESRD patients on HD.

METHODS

Fifty-two (19 females, 33 males) adult patients on chronic maintenance (4.65 +/- 3.29 years) HD aged 59.88 +/- 15.49 years were investigated. Ultrasonographic studies were performed with a 7.5 MHz high-resolution probe. The common carotid artery IMT was measured. Brachial artery diameter was analysed to the rest. In order to assess flow-mediated dilatation (FMD), hyperaemia was induced by a pneumatic cuff, and an analysis of the diameter was performed 1, 2, 3 and 4 min after cuff deflation.

RESULTS

Significant differences were found in the average carotid IMT value between subjects with delivered dialysis dose (Kt/V) > or =1.2 and <1.2 (0.89 +/- 0.21 vs 1.04 +/- 0.11, P = 0.0045). A correlation between Kt/V and IMT (r = 0.366, P = 0.004) was demonstrated. FMD values of the brachial artery did not correlate with Kt/V. A correlation between low molecular weight heparin per kg of body mass and maximal percent of FMD was demonstrated (r = -0.242, P = 0.049). The maximal percent of brachial FMD was correlated with absolute difference between pre- and postdialysis pulse pressure values (r = -0.265, P = 0.033). In a partial correlation with haemoglobin as control, a variable significant correlation between total erythropoietin dose and maximal carotid IMT (r = -0.262, P = 0.036) was found. In a multiple linear regression model, Kt/V was independently correlated with carotid IMT values (beta = -0.227, P = 0.0335).

CONCLUSION

This study has demonstrated the association between HD procedure and early atherosclerosis markers. HD treatment has to be considered as potential modifying factor in atherosclerosis development.

Two Spent Dialysate Samples are Sufficient for Hemodialysis Efficacy Assessment

Introduction

The measure of dialysis efficacy is expressed as Kt/V value (calculated from predialysis and postdialysis blood urea concentration). The aim of this study was to assess the possibility of direct calculation of Kt/V value from two spent dialysate samples by using the regular blood-based Kt/V calculation formula with dialysate samples used as surrogates for blood samples, and to detect the most appropriate couple of dialysate samples for Kt/V estimation.

Patients and Methods

Fifty-two single hemodialysis treatments in 34 anuric patients on chronic bicarbonate low-flux hemodialysis were observed. Kt/V values according to Daugirdas formula from two blood samples and from two dialysate samples were calculated.

Results

Kt/V values calculated according to Daugirdas 2nd generation formula from blood samples (Kt/Vsp Daugirdas) were in significant correlation with all Kt/V values obtained from two spent dialysate samples. The highest correlation coefficient (r = 0.74, p & 0.001) and the least standard error of mean of the differences were found between Kt/Vsp Daugirdas and value obtained with substitution of urea concentration from dialysate samples taken 60 minutes after dialysis start and at the end of the dialysis into Daugirdas 2nd generation formula (Kt/VDCD(60)-CD(e)), which can be expressed as a equation of linear regression y = 0.47 + 0.86x. The highest correlation coefficient (r = 0.74, p & 0.001) was found between Kt/Vsp Daugirdas values equilibrated according to Daugirdas rate formula, and Kt/VDCD(60)-CD(e) value, which can also be expressed as an equation of linear regression y = 0.43 + 0.73x.

Conclusion

The results of this study clearly show the sufficiency of only two spent dialysate samples for direct estimation of the Kt/V values, with no blood sample required.

HIV infection and risk behaviour of commercial sex workers and intravenous drug users in Slovakia

INTRODUCTION

Aim of the study was to determine risk behaviour and HIV prevalence among commercial sex workers (CSWs) and intravenous drug users (IDUs) in streets of Bratislava and B. Bystrica, SR.

METHODS

HIV antibodies were tested from saliva using ELISA test. Anonymous questionnaire was completed.

RESULTS

121 persons (61 men and 60 women) were involved in the sociological study. Mean age of the participants was 21.9 years. 185.1% of subjects were from Bratislava. 108 participants were tested for the presence of HIV-antibodies, one was confirmed HIV-positive (0.82%). In the past 47.9% of participants and 22.3% of their partners were tested for the presence of HIV-antibodies. 10.8% of subjects proclaimed that they suffered from other sexually transmitted infection (STI) in the past HIV testing of participants significantly correlated with the testing for other STI (p<0.002) as well as with HBV/HCV (p<0.001). 58 participants were using tattooing (47.9%). 46.3% of all participants never used condoms with partners. 31.4% of respondents proclaimed disruption of condom during sexual intercourse. Significant correlation was found between testing of participants for other STI and usage of condoms with their partners (p<0.013). Women used condoms more often by sexual contacts with partners than men used condoms (p<0.094). They were also significantly more tested for other STI in the past (p<0.021) and they suffered from other STI more often than men (p<0.033). 26.5% of person--only women--were involved in commercial sex work. 93.5% of them were taking drugs as well, 21.8% suffered for other STI in the past They were working in sex business on average for 26 months. The average number of their clients per week was 12.3. CSWs used condoms more often with clients than with partners. 98.2% of all participants were taking drugs, 93% of them intravenously. 24.6% of IDUs always used new or their own needles and syringes, while 69.4% shared equipments with the other users. IDUs drug users used condoms significantly less often with their partners than did CSWs (p<0.006). CSWs were significantly more often tested for other STI (p<0.001) and they also more often suffered for other STI than IDUs (p<0.045).

CONCLUSION

More effort should be done to decrease risk behaviour revealed in the groups of CSWs and drug users.

Seasonal variations of clinical and biochemical parameters in chronic haemodialysis

INTRODUCTION

Seasonal variations in clinical and laboratory variables occur commonly among chronic haemodialysis patients. In order to demonstrate seasonal differences, we prospectively compared biochemical and clinical parameters in a group of chronically haemodialysed patients living in South Croatia, a region with a Mediterranean climate.

MATERIALS AND METHODS

Data were processed on 135 single dialysis treatments involving a group of 34 anuric chronic haemodialysis (HD) patients. Outcomes were measured at 3-month intervals, in March, June, September and December.

RESULTS

The seasonal differences were found in phosphorus (P = 0.001), creatinine before HD (P <0.001), creatinine after HD (P = 0.005), alkaline phosphatase (P = 0.012), alanine aminotransferase (P = 0.042), urea before HD (P = 0.039), albumins (P <0.001), total cholesterol (P <0.001), low-density lipoprotein (LDL) cholesterol (P <0.001), high-density lipoprotein (HDL) cholesterol (P <0.001), glucose (P = 0.033), and ultrafiltration per HD (P = 0.037). When the data were grouped into cold (March and December) and mild (June and September) months, we found differences in phosphorus (1.48 +/- 0.47 versus 1.72 +/- 0.51, P = 0.005), alkaline phosphatase (119.46 +/- 69.03 versus 169.78 +/- 107.98, P = 0.002), urea before HD (27.13 +/- 5.35 versus 24.40 +/- 5.99, P = 0.006), albumins (37.92 +/- 5.17 versus 40.58 +/- 5.69, P = 0.006), total cholesterol (4.93 +/- 0.93 versus 5.30 +/- 0.93, P = 0.023), LDL cholesterol (2.85 +/- 1.04 versus 3.23 +/- 0.87, P = 0.046), glucose (4.62 +/- 1.15 versus 5.57 +/- 1.46, P = 0.004), and ultrafiltration per HD (3.57 +/- 1.18 versus 2.97 +/- 1.20, P = 0.004).

CONCLUSION

In Mediterranean climates, seasonal differences in predialysis urea concentration and ultrafiltration rate per dialysis could be attributed to different food and water intake. The seasonal differences in blood concentration of phosphorus, alkaline phosphatase, total cholesterol, LDL cholesterol, and glucose might be the results of neurohormonal influences. This climate has no impact on haemoglobin and blood pressure levels.

Seasonal Variations of Chronic Hemodialysis Dose in South Croatia

INTRODUCTION

The dialysis parameters are used for prescribing the dose of dialysis therapy. Delivered dialysis dose could be calculated from predialysis and postdialysis blood urea concentrations. Seasonal variations in some clinical and laboratory variables occur among chronic hemodialysis patients. Seasonal variations in chronic hemodialysis dose have not been investigated. We prospectively compared hemodialysis adequacy parameters in order to demonstrate its seasonal differences.

SUBJECTS AND METHODS

Data were processed on 201 single dialysis treatments involving a group of 51 anuric chronic hemodialysis patients. The study period was 12 months. Four measurements per subject were obtained (in January, April, July, and October).

RESULTS

We could not demonstrate seasonal variability in prescribed and delivered hemodialysis dose, in "delta" values (absolute differences between prescribed and delivered dialysis doses for the same hemodialysis treatment), or in ultrafiltration per hemodialysis. Seasonal differences were found in blood urea concentrations before and after hemodialysis (p = 0.001, p = 0.010). When the data were grouped into two groups: cold (January and October) and mild (April and July) months; we could not demonstrate significant differences in dialysis adequacy parameters, but there were differences in blood urea concentration before hemodialysis (26.06 +/- 14.73 vs. 24.35 +/- 4.50, p = 0.004), blood urea concentration alter hemodialysis (10.24 +/- 2.96 vs. 9.43 +/- 2.60, p = 0.019), and ultrafiltration per hemodialysis (3.36 +/- 1.13 vs. 3.10 +/- 1.11, p = 0.046).

CONCLUSION

Based of the results of this investigation conducted on chronically hemodialyzed patients in the mild Mediterranean climate in South Croatia, Europe; we have concluded that clinicians should not pay attention to season when they prescribe hemodialysis dose or analyze delivered hemodialysis dose.

Mean arterial pressure and pulse pressure are associated with different clinical parameters in chronic haemodialysis patients

The mean arterial pressure (MAP) usually serves as an expression of blood pressure in patients on chronic haemodialysis (PCHD), instead of using solely systolic or diastolic pressure. Pulse pressure (PP) has been recognized as an important correlate of mortality in PCHD. We conducted this study in order to demonstrate clinical and biochemical determinants and variability of predialysis and postdialysis MAP and PP values. A total of 136 single haemodialysis (HD) treatments in 23 subjects (PCHD, 11 male and 12 female patients) were processed during 15 months. MAP before HD was in negative correlation with haemoglobin (P<0.001) and body mass index (BMI) (P<0.001), and in positive correlation with weekly erythropoietin dosage (P=0.017). MAP after HD was in negative correlation with haemoglobin (P<0.001), ultrafiltration per HD (P=0.015), and BMI (P=0.001), and in positive correlation with weekly erythropoietin dosage (P=0.003). PP before HD was in negative correlation with parathyroid hormone (PTH) level (P=0.020), haemoglobin (P<0.001), ultrafiltration per HD (P=0.001), and years on the chronic HD treatment (P=0.001), and in positive correlation with weekly erythropoietin dosage (P<0.001) and age (P<0.001). PP after HD was in significant negative correlation with PTH (P=0.015), haemoglobin (P=0.005), ultrafiltration per HD (P<0.001), BMI (P=0.003), and in positive correlation with weekly erythropoietin dosage (P<0.001) and age (P=0.004). Multiple regression analyses unveiled the strongest and negative correlations between MAP before HD and BMI (beta=-0.37, P=0.01); MAP after HD and haemoglobin (beta=-0.36, P=0.01); PP after HD and ultrafiltration/body weight ratio (beta=-0.41, P<0.001). The strongest and positive correlation was found between PP before HD and erythropoietin dosage per week (beta=0.51, P&<0.001). In conclusion, our findings support the assumption that PP and MAP are associated with different clinical parameters. PP values have advantages as the method of blood pressure expression.

Metabolic acidosis of chronically hemodialyzed patients

Metabolic acidosis is a condition that is commonly encountered in both chronic renal failure and in end-stage renal disease. Metabolic acidosis is associated with many adverse effects: negative nitrogen balance, increased protein decomposition, anorexia, fatigue, bone lesions, impaired function of the cardiovascular system, impaired function of the gastrointestinal system, hormonal disturbances, insulin resistance, hyperkalemia, altered gluconeogenesis and triglyceride metabolism, increased progression of chronic renal failure, and growth retardation in children. Even 'minor' degrees of metabolic acidosis are deleterious. Metabolic acidosis of end-stage renal patients could be successfully corrected with bicarbonate hemodialysis and with peroral bicarbonate-containing phosphate binders, i.e. calcium carbonate. Bicarbonate powder compared with bicarbonate solutions has some advantages and enables a stabile composition of electrolytes. 'High' dialysate bicarbonate (40- 42 mmol/l) is a safe, well-tolerated and useful tool for better correction of the metabolic acidosis and must become a standard of hemodialysis treatment. Measured postdialysis blood bicarbonate concentration should be obtained at least every month and correction of metabolic acidosis by maintaining serum bicarbonate >or=22 mmol/l should be a goal of the management of patients undergoing chronic hemodialysis.

Efficient haemodialysis improves the response to hepatitis B virus vaccination

BACKGROUND

As patients on chronic haemodialysis (PCHD) elicit a weaker response to vaccination with recombinant hepatitis B virus surface antigen (HBsAg), we conducted this study to see how dialysis efficacy affects response to hepatitis B virus (HBV) vaccination.

METHODS

Study subjects consisted of 30 PCHD. All subjects were vaccinated with 4 x 40 microg HBsAg i.m. at 0, 1, 2, and 6 months. If a subject had an HBsAg antibody (HBsAb) level <10 IU/l after vaccination, he or she received a booster dose. Subjects were divided into groups according to the level of HBsAb: non-responders (<10 IU/l), weak responders (10-100 IU/l), and good responders (>100 IU/l).

RESULTS

The group of responders had a significantly more efficient dialysis (Kt/V) than the group of non-responders (p = 0.027). This difference was not observed between groups of non-responders and weak responders. The group of good responders had a significantly better Kt/V than the group of non-responders (p = 0.012). Good responders had a significantly better Kt/V than weak responders (p = 0.019). Kt/V values showed a significantly positive correlation with the HBsAb level (r = 0.47; p = 0.006).

CONCLUSIONS

The HBV vaccination reaction was weaker in PCHD with inefficient dialysis. Efficient haemodialysis significantly improves the response to vaccination with recombinant HBsAg.

Health status of Romanies (Gypsies) in the Slovak Republic and in the neighbouring countries

Romanies belong to Indo-European race. The ethnography and anthropology locate their original home to Central Northern India. The highest concentration of Romanies in Europe is in the Balkan and Carpathian regions and they are the second most numerous minority in the Slovak Republic. The inner structure of Romanies shows clear marks former ancestry creation, which they brought from India. Their natural increase of population is 21-33 per mile, but their reproductive health is worse than in majority of Slovak population. Among Romany children there is generally a higher prevalence of infectious diseases, injuries, poisoning and burns caused by environmental hazards, to which they are often exposed. Total premature mortality in the Romanies are probably three times higher than in the total Slovak population. The main causality of a bad health status consists in long-term bad economical situation, low educational level and incorrect lifestyle of the Romany minority. Western authors and politicians claim that at the beginning of 21st Century it is not conceivable for European governments to ignore health needs of a great number of their citizens. The aim of this review is to react to this notice with an analysis of present situation and with presentation of data of our epidemiological investigation on health status, nutrition and lifestyle of Romanies. (Fig. 4, Ref. 35.)

Oxidative modification of low-density lipoproteins and the outcome of renal allografts at 1 1/2 years

BACKGROUND

Previous studies reported a significant association between hyperlipidemia of the recipient and chronic allograft nephropathy (CAN). However, the nature and the pathogenic mechanism of circulating lipid abnormalities in CAN remain unclear.

METHODS

In a prospective study of 50 consecutive adult recipients of a cadaveric renal allograft, we investigated the impact of lipid abnormalities on the outcome of the graft at 1 1/2 years. Besides morphometric analysis of implantation and protocol biopsies, clinical and biochemical variables were studied at three-month intervals. Plasma concentrations of oxidized low-density lipoprotein (OxLDL) were determined by means of enzyme-linked immunosorbent assay. Immunohistochemical staining for OxLDL and macrophages was performed on paired renal biopsies. Study end points were the fractional interstitial volume and the 24-hour creatinine clearance at 11/2 years.

RESULTS

High-density lipoprotein (HDL) cholesterol of the recipient < or =47 mg/dL was a risk factor for the functional (RR = 1.56; 95% CI, 0.978 to 2.497) and the morphological (RR = 2.75; 95% CI, 1.075 to 7.037) outcome of the graft, mainly in patients without acute rejection (RR = 2.03; 95% CI, 1.13 to 3.65, and RR = 4.67; 95% CI, 1.172 to 18.582, respectively). Interstitial accumulation of OxLDL was inversely associated with HDL cholesterol (R = -0.476, P = 0.019), and was associated with a higher density of tubulointerstitial macrophages (R = 0.656, P = 0.001) and a higher fractional interstitial volume at 11/2 years (P = 0.049).

CONCLUSION

Decreased HDL cholesterol levels of the recipient adversely affect the outcome of renal allografts through the accumulation of OxLDL in the renal interstitium of the graft. Interstitial accumulation of OxLDL was associated with the presence of macrophages and the development of interstitial fibrosis.